Tendon pain can limit movement, affect your performance, and stop you from doing the things you love. At Bromley Sports Injury Clinic, we specialise in diagnosing and treating tendinopathies and tenosynovitis using advanced musculoskeletal ultrasound and elastography to guide personalised rehabilitation — removing the guesswork and accelerating your recovery.

 

What Is a Tendon?

Tendons connect muscles to bones and help generate movement. They’re tough, flexible, and load-bearing — but they can become irritated or injured through overuse, poor biomechanics, or ageing.

Surrounding some tendons is a protective sheath called a synovial sheath. When this sheath becomes inflamed, it’s known as tenosynovitis.

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What Are Tendinopathy and Tenosynovitis?

Tendinopathy

A broad term for pain or dysfunction in a tendon. It includes:

• Tendinitis – short-term inflammation of the tendon

• Tendinosis – chronic, degenerative change without inflammation

• Calcific Tendinopathy – calcium deposits within the tendon, often seen in the shoulder

• Degenerative Tendinopathy – long-standing damage with disorganised tissue and reduced tendon strength

Tenosynovitis

Inflammation of the fluid-filled sheath (synovium) that surrounds a tendon, commonly affecting the hands, wrist, feet, or ankles. It causes:

• Pain with movement

• Swelling or thickening along the tendon

• Sometimes a creaking or grating sensation (crepitus)

• Stiffness and pain in the morning or after rest

 

Common Conditions We Diagnose and Treat

• Achilles tendinopathy

• Rotator cuff tendinopathy (supraspinatus)

• Tennis elbow / Golfer’s elbow

• Patellar tendinopathy (jumper’s knee)

• Biceps tendinopathy

• Gluteal tendinopathy

• Calcific shoulder tendinopathy

• De Quervain’s tenosynovitis (thumb/wrist)

• Extensor and flexor tenosynovitis (wrist/hand)

• Posterior tibial or peroneal tenosynovitis (ankle)

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The Tendinopathy Continuum (Cook & Purdam Model)

Understanding where your tendon sits along this path helps us treat it effectively and with diagnostic ultrasound we have a better understanding where you a likely to be along this continuum. 

1. Reactive Tendinopathy

• Early, short-term overload

• Tendon thickening and pain

• Reversible with load management and early treatment

2. Tendon Disrepair

• Structural breakdown begins

• Disorganised tissue, nerve and vessel growth

• Detectable via ultrasound and elastography

3. Degenerative Tendinopathy

• Common in long-standing tendon pain

• Irreversible in some cases, but manageable

• Ultrasound shows hypoechoic areas, thickening, or partial tears

 

How Ultrasound & Elastography Improve Diagnosis

Our high-resolution ultrasound scans provide a clear image of your tendon and surrounding structures. We can identify:

• Tendon thickness and fibre alignment

• Inflammation or swelling

• Calcium deposits (calcific tendinopathy)

• Fluid in the tendon sheath (tenosynovitis)

• Bursal inflammation or small tears

• Neovascularisation (new blood vessels)

 

Elastography: Measuring Tendon Stiffness

Elastography helps us assess the stiffness and elasticity of your tendon in real-time. This allows us to:

• Identify areas of degeneration or scarring

• Track tendon healing and treatment effectiveness

• Adjust your rehabilitation based on actual tissue condition

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Blood Tests & Tendon Health – Identifying Underlying Risk Factors

Emerging evidence suggests that metabolic health can influence tendon integrity. At Bromley Sports Injury Clinic, we offer blood testing to screen for systemic risk factors that may contribute to chronic tendon injury or poor healing. One such factor is hyperlipidaemia — elevated blood lipid levels (including cholesterol and triglycerides). Research shows a link between high cholesterol and increased risk of tendinopathy, particularly in the Achilles, rotator cuff, and patellar tendons. By identifying metabolic contributors such as dyslipidaemia, diabetes, or vitamin D deficiency, we can build a more targeted rehabilitation plan and work in conjunction with your GP or specialist.

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Personalised Treatment Plans

After diagnosis, we’ll develop a tailored plan based on your condition and stage of injury. This may include:

• Load management and rehabilitation planning

• Isometric and eccentric loading exercises

• Ultrasound-guided injection therapy (e.g., Ostenil)

• Shockwave therapy (if applicable)

• Dry needling or aspiration for calcific tendinopathy

• Manual therapy and tendon mobility work

• Cross-referral for splinting or bracing (e.g., thumb tenosynovitis)

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FAQs – Tendinopathy & Tenosynovitis

Q: Can you see tenosynovitis on a scan?
Yes. Ultrasound is ideal for visualising inflammation, thickening, or fluid in the tendon sheath — confirming tenosynovitis in areas like the wrist or ankle.

Q: Do all tendon pains need a scan?
If your pain has persisted for more than a few weeks or hasn’t responded to rehab, a scan is strongly recommended.

Q: What is calcific tendinopathy?
This occurs when calcium builds up inside the tendon, often in the shoulder. It causes intense pain and stiffness, and is clearly visible on ultrasound.

Q: Can tendons fully heal?
Tendons respond well to graded loading, but degenerative changes may not fully reverse. Treatment focuses on strengthening what’s healthy and offloading what’s damaged.

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Ready to take the next step?

Book an appointment today and start your journey toward feeling better — your body will thank you.

​​Not quite sure yet?

No problem. Get in touch and we’ll be happy to talk things through with you. Whether you have a question about your symptoms, our services, or what to expect, we’re here to help, just pop us a message.