An accurate diagnosis is the first step to effective treatment. This is especially true in the world of musculoskeletal medicine. As providers, we rely on signs, symptoms and various other tests to make decisions. While certain conditions are relatively easy to identify, such as a wrist fracture after falling on an outstretched hand, others can be a bit trickier to diagnose.

Among these are tendon problems, particularly the non-traumatic, overuse variety. While this form of tendon pain can go by various names, including tendonitis and tendinosis, I will use the umbrella term tendinopathy in this article. Tendons connect muscle to bone, subjecting them to high forces, and may become symptomatic when the loads applied to them are higher than they can handle.

Classically, tendinopathies are diagnosed when someone has pain in the area of a tendon, especially if their pain is increased when the affected muscle/tendon is either stretched or contracted. While these are features of most tendinopathies, they aren’t specific to tendons. The ability to differentiate tendon problems from other conditions is crucial, however, as the treatment for tendinopathies is fairly unique.

There are five characteristics found in nearly all tendinopathies, which allow us to rule in/rule out a tendon pain diagnosis more effectively.

•The pain is very localized. Pain is nearly always confined to a relatively small area in tendinopathies. It is so small that you can usually cover up the area with a half dollar. In some instances, for example acute tendinopathies, the pain may radiate to a broader area. More often than not, however, the pain will be localized when a tendon is the culprit.

•Pain provocation is very consistent.Tendinopathies become symptomatic when movements or activities exceed the load-bearing capacity of the tendon, and will consistently hurt each time the individual performs them. It would be uncommon to hear someone with a tendinopathy say that sometimes an activity hurts and other times it doesn’t.

•There is no pain at rest.Since tendinopathies generally only become symptomatic when loaded beyond their capacity, they rarely hurt at rest. One exception would be if the tendon was recently overloaded, in which case the individual may experience an ache later that night.

•The pain gets worse when more load is applied to the tendon. Since tendons are sensitive to load, it makes sense that the more load applied to them, the more symptomatic they become. For example, if someone with an elbow tendinopathy was sensitive to the motion of a biceps curl, curling 30 pounds should create more pain than 10 pounds.

•There is no passive motion loss at the affected joint. Limited motion is uncommon in true tendon problems. While tendinopathies might render certain movements painful if performed actively, another person should be able to passively move that same joint without restriction.

There are certainly exceptions to these rules, and a couple were mentioned earlier. These, however, are uncommon. Most true tendinopathies display all five features, allowing us to be much more precise in our diagnosis and subsequent intervention.

Dr. Jordan Duncan is from Kitsap County and writes a monthly online health column for Kitsap News Group. He is the owner of Silverdale Sport & Spine.