Tendonitis - treated as tendinopathy, not as inflammation.

Prices vary by hospital, by the consultant, by tendon site and by whether imaging, shockwave and injection are combined. The NHS route - GP referral, community musculoskeletal physiotherapy, long waits for consultant review and imaging - remains free but slow.

• Achilles tendinopathy (mid-portion or insertional)

  Morning stiffness, pain 2–6cm above the heel or at the bone. The commonest lower-limb tendinopathy in runners and midlife active adults.

• Patellar tendinopathy (jumper’s knee)

  Pain at the lower pole of the kneecap in jumping and change-of-direction sports - volleyball, basketball, football.

• Rotator cuff tendinopathy

  Shoulder pain reaching overhead, sleeping on the affected side, weakness on abduction. Overlaps with subacromial pain syndrome.

• Tennis elbow (lateral epicondylalgia)

  Pain on the outside of the elbow, gripping, lifting a kettle, shaking hands. Racket sport is a minority of cases - most are keyboard and manual work.

• Golfer’s elbow (medial epicondylalgia)

  Pain on the inside of the elbow with gripping and wrist flexion - golfers, throwers, climbers and manual workers.

• De Quervain’s tenosynovitis

  Pain at the thumb side of the wrist, worse lifting a baby or a mug. Common postpartum and in repetitive thumb use.

• Gluteal tendinopathy

  Pain over the outside of the hip, worse lying on that side and climbing stairs. Common in midlife women and often mis-labelled as bursitis.

• Red flag: sudden pop or unable to bear weight

  A sudden pop, bruising, a visible gap or an inability to bear weight or push up on tiptoes may be a full tendon rupture - same-day imaging and surgical opinion, not a routine appointment.

• Steroid injection is short-term relief, not a cure

  A steroid injection can quiet the pain for weeks. Trials in lateral elbow and Achilles show worse long-term outcomes than doing nothing or doing rehab alone. We use them sparingly and honestly.

• Steroids near load-bearing tendons can rupture them

  Corticosteroid injected into or around the Achilles or patellar tendon carries a real rupture risk. Where used, it is ultrasound-guided, kept away from the tendon substance, and load is reduced afterwards.

• PRP evidence is genuinely mixed

  PRP helps some patients with refractory lateral elbow or patellar tendinopathy. Trials in mid-portion Achilles are largely negative. We are honest about which sites the evidence supports.

• Shockwave is uncomfortable, and needs adequate dose

  Shockwave sessions are uncomfortable but tolerable. Under-dosed courses are the commonest reason shockwave "does not work" - the settings and session count matter.

• Rehab only works if you actually do it

  Loading programmes take 12 weeks minimum, done 3–4 times a week. Adherence is the single biggest predictor of outcome - bigger than any injection, shockwave or scan.

• Symptoms can recur when you stop loading

  Tendons need continued load to stay healthy. A maintenance programme after discharge - one or two sessions a week - is how you keep the pain from coming back.

• The diagnosis may be something else entirely

  Partial or full tears, referred pain from the neck or spine, and stress reactions in nearby bone all mimic tendinopathy. Imaging and a proper examination sort them out.

• Systemic causes must not be missed

  Widespread tendon pain, especially with morning stiffness across multiple joints, can be inflammatory arthritis - psoriatic, spondyloarthritis, rheumatoid. A rheumatology opinion is worth having.

• Red flags after a suspected acute injury

  A sudden pop, sharp pain, bruising, a visible gap or an inability to bear weight or push up on tiptoes needs same-day imaging and a surgical opinion - not a physiotherapy appointment next week.