Tendonitis or Tendon Tear? How Ultrasound Can Tell the Difference

🕒 Read Time: 6–7 minutes

(Because guessing isn’t a treatment plan)

You’ve got pain in your shoulder. Or maybe your elbow. Or that stubborn Achilles that acts up every time you so much as look at a set of stairs.
You’ve probably heard two words thrown around: tendonitis and tendon tear. They sound kind of similar. They definitely feel kind of similar. But they’re not the same thing—and treating one like the other can lead to a whole lot of wasted time (and sore body parts).

So, how do you actually tell the difference? That’s where musculoskeletal ultrasound swoops in like a friendly, gel-wielding superhero.

Let’s break it all down—so you can stop guessing and start healing.

First: What’s the Difference Between Tendonitis and a Tendon Tear?

🧨 Tendonitis (a.k.a. Tendinopathy or Tendinosis)
Tendonitis is inflammation or irritation of a tendon, often caused by overuse. The pain tends to creep in gradually and gets worse with movement. It might feel achy, sore, or stiff—especially in the morning or after activity.

Think:
• Repetitive strain injuries
• Desk work + poor posture = sore shoulders
• Too much running too soon = angry Achilles

Over time, tendonitis can evolve into tendinosis, which is more about degeneration than inflammation—but the symptoms often overlap.

✂️ Tendon Tear
A tear is more like a structural injury—a partial or full break in the tendon fibers. It might happen suddenly (like lifting something heavy or a sports injury), or gradually in a weakened tendon. Pain is often sharper, and movement can feel difficult, weak, or just “off.”

There are two types:
• Partial tear• : Some of the tendon is damaged, but not all the way through
‍Full-thickness tear: The tendon is completely torn or detached

And yep, some tears can actually feel less painful than tendonitis—which makes things even more confusing.

Symptoms: Spot the Clues

Let’s play detective for a second. Here are some rough symptom patterns:

But remember: these are clues, not a diagnosis. Sometimes tendonitis mimics a tear. Sometimes a tear hides behind mild symptoms. That’s why imaging is so important.

How Can Ultrasound Help?

Enter musculoskeletal ultrasound—the MVP of tendon imaging.

Ultrasound uses high-frequency sound waves to create real-time images of your tendons, muscles, and soft tissues. It’s safe (no radiation), quick, and often available right in your physio or MSK clinic.

Here’s what ultrasound can do:

✅ See the Structure of the Tendon
Ultrasound shows the actual fibres of the tendon. If there’s a tear, we can literally see the gap or disruption in the tissue. If it’s tendonitis, we’ll likely see thickening, swelling, or disorganised fibres—but no actual break.

🎯 Tendonitis looks different than a tear - and ultrasound can tell the difference in minutes.

✅ Assess Movement in Real Time
We can scan the tendon while you move—which helps us spot tears that only show up under tension or see how inflamed tissue behaves during function.It’s not just a picture; it’s a live-action view of your injury.

✅ Guide Treatment Decisions
Knowing whether you’ve got tendonitis or a tear changes everything:Tendonitis may respond best to load management, exercise, shockwave, or dry needling.Tears may require rest, rehab, or in some cases, injections or surgery—depending on the size and location.

🎯 A good scan = the right plan.

✅ Track Progress Over Time
Ultrasound is also great for monitoring healing. Not sure if that rehab plan is working? A follow-up scan can show if your tendon is improving structurally—not just symptomatically.

Common Spots for Tendon Troubles

Here’s where we see tendonitis and tears most often:
‍• Shoulder (Rotator cuff): Supraspinatus tendon is the usual suspect
• Elbow: Tennis elbow (lateral) or golfer’s elbow (medial)
• Wrist: De Quervain’s tenosynovitis
• Hip: Gluteus medius/minimus tendons
• Knee: Patellar tendon
• Ankle: Achilles tendon or peroneal tendonsIf you’ve got pain in one of these spots, ultrasound is a smart first step.

What Happens During the Scan?

The process is simple, non-invasive, and (let’s be honest) kinda cool:
1. You lie down or sit comfortably.
2. A small amount of gel is applied to the skin over the painful area.
3. The clinician glides a handheld scanner (transducer) over the area.
4. The image appears instantly on screen—and you get a guided tour of your tendon’s current situation.

It usually takes 10–20 minutes, and you'll often get the results immediately. No waiting. No referrals. No wondering.

What Happens After the Scan?

This is where things get exciting: treatment can start right away.

Whether it’s tendonitis, a tear, or something else entirely, your clinician can:
• Confirm the diagnosis
• Tailor your rehab or exercise plan
• Recommend further treatment like shockwave, injection, or referral (if needed)
• Give you peace of mind that you’re finally on the right track

🎯 Knowledge is power—and when it comes to tendon pain, it’s also the fastest way to recovery.

Final Thoughts: Know Your Tendon, Know Your Treatment

If your tendon pain has you stuck in a cycle of stretching, guessing, Googling, and crossing your fingers—it’s time for clarity.

‍Ultrasound takes the mystery out of tendon injuries.

No more wondering if it’s just irritation or a legit tear. No more wasting time on treatments that aren’t right for what’s actually going on.

A simple, safe scan could be the most important step you take toward getting back to moving, training, lifting, or just living without that annoying ache.

‍Tendon pain that won’t quit?
Let’s scan it, diagnose it, and build the right plan.
Book your musculoskeletal ultrasound today—because your body deserves better than guesswork.