What Tendonitis Really Is
Biopsy studies of chronic painful tendons consistently reveal degenerative tissue changes — disorganized collagen architecture, increased Type III collagen production, failed neovascularization, and fibroblast dysfunction — rather than the inflammatory cell infiltrates the term "tendonitis" implies. The more accurate clinical term is tendinopathy.
This matters for treatment. Anti-inflammatory approaches target a process not meaningfully present in chronic tendon pain — which is why cortisone provides temporary relief while failing to improve tissue quality, and why recurrence rates of conventionally managed tendon pain are so high. Effective treatment must stimulate biological repair of degenerated tissue.