Tendinopathy assessment and injection (Tendinopathy assessment and corticosteroid injection)
An assessment of a painful tendon, and where appropriate an injection (often a steroid) to ease pain, usually alongside an exercise programme rather than instead of it.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Most tendon problems are best managed with a graded exercise programme; an injection is an add-on, not a replacement.
- A steroid injection can ease pain in the short term, but the benefit often fades over weeks to months.
- Only a limited number of injections should be given to the same tendon, and they are avoided or used with caution in some tendons such as the Achilles.
- A short, temporary flare of pain after the injection is common, and there are specific risks to discuss.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
A clear diagnosis of which tendon is affected and what is driving it
An injection alone is not a substitute for a graded exercise programme, which is the main treatment.
You may have a flare of pain and some bruising. Rest the tendon relatively, avoid heavy loading, and use simple pain relief if needed.
A clear graded exercise plan as the central treatment, with physiotherapy where needed.
You may have a flare of pain and some bruising. Rest the tendon relatively, avoid heavy loading, and use simple...
Any flare usually settles and the steroid may begin to ease pain. You can gradually return to your usual gentle...
If the injection has helped, this is the time to make the most of reduced pain by progressing your graded exercise...
Any pain relief from the injection may start to fade. The exercise programme is what carries the longer-term...
What is tendinopathy assessment and injection?
Tendinopathy is pain and reduced function in a tendon — the strong cord that joins muscle to bone — usually from overuse or load rather than simple inflammation. Common sites include the elbow (tennis or golfer's elbow), shoulder, hip (gluteal tendons), knee and Achilles tendon.
The assessment works out which tendon is affected, how severe it is, and what is driving it. It usually includes a history, an examination, and sometimes an ultrasound scan. The most important treatment for most tendon problems is a graded exercise programme that gradually loads the tendon, along with activity changes; this is what helps the tendon recover over time.
A corticosteroid injection is one option that can reduce pain in the shorter term, which sometimes helps people get going with rehabilitation. It is not a cure and does not replace exercise. The benefit often fades over weeks to months, only a limited number of injections should be given to one tendon, and there are specific risks, including a temporary flare of pain afterwards.
This guide explains the assessment, when an injection may or may not help, what it involves, and what good aftercare looks like.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Clinical assessment
A history and examination to identify which tendon is affected, how severe it is, and what is loading it, plus a check for other causes of the pain.
Ultrasound scan (where used)
A scan can confirm the tendon involved and its condition, and can be used to guide an injection accurately. Not everyone needs a scan.
Exercise and load management (core treatment)
A graded programme that progressively loads the tendon, with advice on modifying activity. This is the main treatment and the part most likely to give lasting benefit.
Corticosteroid injection
An injection of steroid, sometimes with local anaesthetic, around the tendon to reduce pain in the shorter term. Used selectively, often to help someone engage with...
Preparing for your procedure
- Note how long the tendon has hurt, what makes it worse, and how it affects your activity, work or sport.
- List previous treatments, including any past injections to the same area and how they worked.
- Tell the clinician about diabetes, as steroid injections can raise blood sugar for a few days.
- Mention blood-thinning medicines, bleeding problems and any allergies before an injection.
- Tell them if you might be pregnant or are breastfeeding, so options can be discussed.
- Arrange to rest the tendon relatively for a short time after an injection, and avoid heavy loading that day.
- Expect the plan to centre on exercise, with an injection considered only if it is likely to help you.
What happens
At the assessment, the clinician takes a history and examines the affected area to confirm which tendon is involved and rule out other causes. An ultrasound scan may be used to look at the tendon and, if an injection is planned, to guide it.
If you and the clinician decide an injection is appropriate, the skin is cleaned and a small needle is used to place steroid (sometimes with local anaesthetic) around the tendon. It takes only a few minutes. You may feel pressure or brief discomfort, and there can be a flare of pain over the next day or two.
Assessment and injection are usually carried out by a rheumatologist, sports and musculoskeletal physician, or a suitably trained clinician. Most importantly, you should leave with a graded exercise plan, because that is what helps the tendon recover, whether or not you have an injection.
Is this procedure right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- An injection alone is not a substitute for a graded exercise programme, which is the main treatment.
- Steroid injection is generally avoided, or used only with great caution, in certain tendons such as the Achilles because of rupture risk.
- An injection is not appropriate if there is infection at the site or signs of an alternative diagnosis.
- Repeated injections to the same tendon are not appropriate because they may weaken it.
Delay or rearrange if…
- Delay an injection if there is any infection at or near the site.
- Blood-thinning medicine or a bleeding tendency may need managing before an injection.
- Poorly controlled diabetes may warrant caution because steroids raise blood sugar.
- Pregnancy or breastfeeding should be discussed so options can be weighed.
- If a different or more serious cause of the pain is suspected, assess that first.
Alternatives to discuss
- A graded exercise and load-management programme as the core treatment.
- Activity or technique changes to reduce overload.
- Simple pain relief and relative rest rather than injection.
- Other options such as shockwave therapy or, occasionally, surgery for persistent problems.
- Choosing not to inject, given that benefit is often short-term.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- A clear diagnosis of which tendon is affected and what is driving it
- A graded exercise plan, the treatment most likely to give lasting improvement
- An injection can reduce pain in the short term for some people
- Short-term pain relief may help you engage with rehabilitation
- Identifying when a different problem or treatment is more appropriate
Risks & complications
- A flare of pain in the hours to days after an injection before any benefit is felt
- Benefit from an injection that fades over weeks to months
- Temporary bruising, soreness or a small mark at the injection site
- A short-term rise in blood sugar after a steroid injection, especially with diabetes
- Thinning or a dimple of the skin, or a lightening of skin colour, at the injection site
- Loss of fatty tissue under the skin at the site
- Little or no benefit from the injection
- Needing to rely on exercise alone because injections are limited in number
- Infection at the injection site
- Weakening or rupture of the tendon, a particular concern with repeated injections and with certain tendons such as the Achilles
- An allergic reaction to the injection
Steroid injections can help pain in the short term but do not heal the tendon, and repeated injections into the same tendon may weaken it, so the number is deliberately limited. Some tendons, such as the Achilles, are generally avoided or injected only with great caution. Ask your clinician how an injection fits with your exercise plan, how many injections are safe for your tendon, and what to do if pain flares.
Published figures to discuss
How well an injection works, and how long it lasts, varies a lot by tendon, severity and whether exercise is followed. Reported figures differ between studies and sites, so this guide describes benefit and risk cautiously. The well-supported pattern is meaningful short-term pain relief for many people that tends to wane over a few months, with serious complications such as rupture being uncommon but important, particularly with repeated injections.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Short-term pain relief that fades over months (gluteal tendinopathy example) | In a trial setting, around three-quarters improved at about one month after a single injection, falling to roughly half by around four months and at longer follow-up | Illustrates that benefit is often short-lived and varies by tendon; figures are not a guarantee for any individual. | Guide sourcesClinical context |
| Tendon weakening or rupture after steroid injection | Rare, but risk is higher with repeated injections and injections into or very close to tendon substance | Achilles and patellar tendon injections need particular caution; image guidance does not remove biological risk. | Adverse effects of extra-articular corticosteroid injections: a systematic review (BMC Musculoskeletal Disorders)bmcmusculoskeletdisord.biomedcentral.comSource-linked context |
| Temporary blood-sugar rise after steroid injection | Common in people with diabetes for 1 to 5 days | People with diabetes should be warned to monitor glucose and know who to contact if readings rise significantly. | Guide sourcesClinical context |
| Recurrence if load management is not addressed | Common | Injection may settle pain, but rehabilitation and graded loading are what reduce repeated flares. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is little physical recovery from the assessment. After an injection, this means resting the tendon relatively for a short time, expecting a possible flare, and continuing your exercise plan as the main treatment.
- A short-lived flare of pain in the first day or two after an injection
- Mild bruising or a small mark at the injection site
- Pain relief that builds over a few days, if the injection helps
- Benefit that may fade over weeks to months, so exercise continues
Aftercare
- Rest the affected tendon relatively for a short time after an injection and avoid heavy loading that day.
- Continue your graded exercise programme, which is the main treatment.
- Use simple pain relief for a post-injection flare if needed and as advised.
- Watch the injection site for spreading redness, heat or swelling that could signal infection.
- If you have diabetes, monitor your blood sugar for a few days after a steroid injection.
- Do not push for repeated injections; discuss the safe limit and alternatives with your clinician.
- Keep follow-up so your progress and exercise plan can be reviewed.
- Graded exercise plan understood and started
- Plan for resting the tendon relatively after an injection
- Simple pain relief available for a possible flare
- Blood-sugar monitoring planned if you have diabetes
- Clear advice on signs of infection
- Agreed limit on number of injections and the next review
- Named contact for the clinic saved
Scars and how they heal
An injection leaves a needle puncture rather than any cut. There may be a small mark, bruising or tenderness for a few days. Occasionally a steroid injection just under the skin causes a small dimple, thinning, or lightening of skin colour at the site, which can take time to settle and is usually minor. There are no surgical wounds with an injection.
⚠ Get urgent help if…
- Spreading redness, heat, swelling or pus at the injection site, especially with fever (possible infection — seek urgent help)
- Sudden severe pain, a snap or popping sensation, or inability to use the tendon (possible rupture — seek urgent help)
- A hot, swollen, very painful joint with fever
- Severe or rapidly worsening pain that is not settling
- Signs of an allergic reaction such as rash, swelling or breathing difficulty (call 999)
- Very high blood sugar symptoms if you have diabetes
- Numbness, weakness or pins and needles spreading from the area
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result from the assessment is a clear diagnosis and an effective, graded exercise plan that improves the tendon over time. Where an injection is used, a good short-term result is reduced pain that helps you get going with rehabilitation.
It is important to be realistic: a steroid injection can ease pain for some people in the short term, but the benefit often wanes over weeks to months, and it does not heal the tendon. Lasting improvement usually comes from the exercise programme, not the injection.
Pain relief from a steroid injection is typically short-lived, often most noticeable in the first weeks and fading over a few months, and tendon pain can return if the underlying load is not addressed. The improvement gained through a graded exercise programme tends to be more durable, which is why the injection is positioned as an aid to rehabilitation rather than a stand-alone fix.
Related tests, treatments or support
An injection is most often combined with a graded exercise programme and activity changes, which do the long-term work. Depending on the tendon, other options such as physiotherapy, shockwave therapy or, occasionally, surgery may be considered if symptoms persist, and these would be discussed separately.
Follow-up & long-term care
Follow-up checks how your pain and function are progressing and reviews your exercise plan. If an injection was given, it also reviews whether it helped and confirms the safe limit on any further injections. Persistent or worsening symptoms may prompt a scan, a change of plan, or onward referral.
- Ongoing graded exercise and sensible load management
- Activity or technique changes to reduce overload
- Limiting the number of injections to the same tendon
- Review if symptoms persist or recur
- Considering other treatments if the tendon does not improve
Repeat, follow-on and what comes next
- The benefit of an injection often fades, and the tendon may need ongoing exercise rather than repeat injections.
- Only a limited number of injections should be given to the same tendon.
- If symptoms persist, a scan, a change of plan or onward referral may be needed.
- A small number of people need other treatments such as shockwave therapy or surgery.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear graded exercise plan as the central treatment, with physiotherapy where needed.
- Written advice on the post-injection flare and signs of infection or rupture.
- An agreed limit on injections and a sensible review interval.
- Blood-sugar advice for people with diabetes.
- A named contact and findings shared with the GP.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Length and seniority of the assessing clinician's appointment
- Whether an ultrasound scan is used for diagnosis or to guide the injection
- Whether an injection is given and the type used
- Whether the injection is guided by ultrasound or by landmarks
- Access to physiotherapy and the number of sessions
- Follow-up reviews and any repeat assessment
- Which clinician will assess and inject, and their experience
- Whether an ultrasound scan is included and whether the injection is guided
- What the injection itself and any local anaesthetic cover
- Whether a graded exercise programme or physiotherapy is included
- The agreed limit on number of injections and the follow-up plan
- How findings will be shared with your NHS GP
- What happens if the injection does not help or a complication occurs
On the NHS? Tendinopathy assessment and corticosteroid injections are available on the NHS, often through your GP, physiotherapy or a musculoskeletal service; private care may be used for faster access or ultrasound-guided injection.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Being led to expect a cure rather than short-term pain relief.
- Not being told that exercise is the main treatment and that injection benefit fades.
- No discussion of the limit on injections or the rupture risk for certain tendons.
- No warning about a post-injection flare or what to do about it.
- Diabetes or blood-sugar effects not discussed.
Marketing red flags
- Promoting injections as a pain-free, no-risk quick fix for tendon pain.
- Offering repeated injections to the same tendon without limit.
- Skipping the exercise programme in favour of injection alone.
- Claiming an injection heals or cures the tendon.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Which tendon is affected, and how is it best managed?
- Is an injection likely to help me, and how does it fit with my exercise plan?
- How many injections are safe for this tendon, and what are the specific risks here?
- Should the injection be guided by ultrasound?
- What should I do if I get a flare of pain afterwards?
- What are the alternatives if the tendon does not improve?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my procedure, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this procedure not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Will a steroid injection cure my tendon problem?
Will the injection hurt?
How many injections can I have?
Do I need an ultrasound scan?
Can I have this on the NHS?
When can I get back to sport or activity?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Tendonitis NICE CKS — Tennis elbow (lateral epicondylitis) Versus Arthritis — Steroid injections Adverse effects of extra-articular corticosteroid injections: a systematic review (BMC Musculoskeletal Disorders) Local and systemic side effects of corticosteroid injections (AJR, 2024)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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