Tendinopathy

What it means

A tendon is the rope-like tissue that anchors a muscle to a bone. When a tendon is repeatedly loaded beyond what it can recover from — through sport, work, or daily overuse — the fibres inside it start to lose their tidy parallel arrangement. The tendon thickens, takes on more water, and may develop small areas of disrupted tissue. Older names like "tendinitis" (which implies inflammation) and "tendinosis" (which implies wear) have largely been replaced by this single umbrella term, because the picture is usually a mix of both.

Why it appears on a CT or MRI report

MRI and ultrasound show tendinopathy as a thickened tendon with brighter signal inside than normal. Reports usually name the specific tendon — rotator cuff (shoulder), common extensor (elbow), patellar (knee), Achilles (ankle), gluteal (hip) — and grade it as mild, moderate, or severe. They may mention small partial tears, fluid around the tendon, or small calcium deposits within it. CT shows the bigger structural changes but is less sensitive for early tendon problems than MRI.

What it usually means

The picture on imaging is very common and doesn't always match how a person feels. Studies of pain-free athletes and older adults regularly find tendon changes on scans of people who have no symptoms at all — the Achilles, rotator cuff, and patellar tendons are particularly prone to this. When tendinopathy does cause pain, it typically builds gradually, hurts more after activity than during it, and feels stiff at first thing in the morning. The good news is that tendons respond well to careful, progressive loading — that's why physical therapy with graded strength work is the first-line treatment for most cases, often more effective than rest alone. Rest, anti-inflammatories, or steroid injections can ease pain in the short term but don't rebuild the tendon. Severity on the scan doesn't reliably predict how long recovery will take or how much pain there is.

When to follow up

Most cases improve with a structured rehab programme — usually progressive loading exercises tailored to the affected tendon — and a temporary reduction in the activities that aggravate it. See a doctor or physiotherapist if pain is limiting daily life, has lasted more than a few weeks, or is getting worse despite rest. Seek prompt care for sudden severe pain, a popping sensation followed by weakness, a visible gap or bulge in the muscle, or inability to use the limb normally — these can suggest a full tendon rupture rather than gradual wear.

A plain-language way to picture it

Picture a thick climbing rope. New, it's tightly woven, every fibre running clean and parallel. After years of bearing loads, some fibres start to fray, the weave loosens in places, and the rope thickens a little where it has been working hardest. The rope still holds, but it needs careful conditioning to stay strong. Tendons respond the same way — to gradual, deliberate load, not to being put away in a drawer.