Tendinitis
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Tendinitis


Signs and Symptoms
What Causes It?
What to Expect at Your Provider's Office
Treatment Options
Following Up
Special Considerations
Supporting Research
  

Tendinitis happens when a tendon -- which attaches muscle to bone -- gets inflamed. You feel pain and tenderness right outside a joint. It often happens as a result of repetitive movements.

Acute or sudden tendinitis may become chronic or long-lasting if it is not treated. People get tendinitis most often in the shoulder (rotator cuff tendinitis), elbow (tennis elbow or golfer's elbow), wrist and thumb (de Quervain's disease), knee (jumper's knee), ankle (Achilles tendinitis), and hip.

Calcific tendinitis, which happens when calcium deposits build up in a joint, often happens in people who have a chronic disease, such as diabetes.

Most times, you can treat tendinitis with rest and physical therapy.

Signs and Symptoms

  • Swelling
  • Tenderness
  • Pain that gets worse when you move the affected limb
  • Warmth and redness
  • A crackling sound, called crepitus

What Causes It?

Tendinitis can happen because of:

  • Overuse, undertraining, or poor technique in sports
  • Repetitive movement in some jobs, such as typing
  • Falling
  • Lifting or carrying heavy objects
  • Extreme or repeated injury

People who are overweight have a higher risk of tendinitis because of the increased pressure on tendons, ligaments, and bones. People with some inflammatory conditions, such as Reiter syndrome or ankylosing spondylitis; autoimmune disorders, such as type 1 diabetes; and some infections may also get tendinitis.

What to Expect at Your Provider's Office

Your health care provider will give you a physical examination and may take x-rays and other diagnostic tests.

Treatment Options

Your health care provider may prescribe pain relievers or steroid injections. Treatment also may include ice, rest, or keeping the area still, such as with a sling. Massage, strengthening exercises, or physical therapy may help. Some studies show that high energy shock wave therapy improves symptoms and pain associated with tendinitis. If you have severe tendinitis that is not healing from other treatments, you may need surgery.

Drug Therapies

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) -- such as ibuprofen (Advil, Motrin) and naxproxen (Aleve), reduce pain and inflammation. There are also prescription NSAIDs. NSAIDs may increase the risk of stomach bleeding.
  • Lidocaine or corticosteroid injections into the tendon -- cannot be used for weight-bearing tendons because of risk of rupture.
  • Colchicine -- for calcific tendinitis, when calcium builds up in the joint.

Complementary and Alternative Therapies

  • Ice, especially right after the injury
  • Rest
  • Massage
  • Immobilizing the affected limb (slings, splints)
  • Flexibility and strengthening exercises after the inflammation goes down
  • Physical therapy, such as range-of-motion exercises
  • Ultrasonography -- high-frequency sound used to heat an area and increase circulation
  • Transcutaneous electrical nerve stimulation (TENS) -- electricity used to help relieve pain

Nutrition and Supplements

  • Bromelain, 250 mg twice a day. This enzyme that comes from pineapples reduces inflammation. Bromelain may increase the risk of bleeding, so people who take anticoagulants (blood thinners) such as warfarin (Coumadin), clopidogrel (Plavix), and aspirin should not take bromelain without first talking to their doctor. People with stomach ulcers should avoid bromelain. If taken with antibiotics, bromelain may increase the levels of antibiotic in the body, which could be dangerous. Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger.
  • Vitamin C (250 - 500 mg two times a day) to aid in healing, increase immune function, and reduce inflammation. Vitamin C supplements may interact with other medications, including chemotherapy drugs, estrogen, warfarin (Coumadin), and others.
  • Calcium (1,500 mg a day) and magnesium (750 mg a day) to aid healing of connective tissues and muscles
  • Vitamin A (15,000 IU a day) for immune function and healing. Do not use if you are, or may become, pregnant. Vitamin A interacts with a number of medications, including some that are available over-the-counter. Some of these interactions can be dangerous. Ask your doctor before taking vitamin A.
  • Vitamin E (400 - 800 mg a day) and essential fatty acids, such as fish oil or evening primrose oil (1,000 - 1,500 IU one to three times a day) to reduce inflammation. Vitamin E may interact with a number of medications. Vitamin E, fish oil, and evening primrose oil may increase the risk of bleeding. If you take blood-thinners, ask your doctor before taking any of these supplements.

Herbs

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your provider to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Tell your doctor if you are pregnant or nursing, before using any herbal products.

  • Turmeric (Curcuma longa) -- for pain and inflammation. Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger. Turmeric may increase the risk of bleeding, so people who take anticoagulants (blood thinners), such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin should not take turmeric without first talking to their doctor.
  • Willow bark (Salix alba) -- to relieve pain. Willow acts similar to aspirin. Do not take white willow if you are also taking aspirin or blood-thinning medications. Do not take willow bark products if you are allergic to aspirin or salicylates. Willow should not be given to children under the age of 18.
  • Licorice (Glycyrrhiza glabra) -- to reduce inflammation. Do not take licorice if you have high blood pressure, edema, or heart failure; hormone-sensitive cancers such as breast, prostate, ovarian, or uterine cancer; diabetes; kidney disease; liver disease; or if you are taking corticosteroids prescribed by your doctor. Licorice interacts with a number of medications, so to be safe ask your doctor before taking licorice if you take any other medications.

The following herbs may also help with inflammation, although they have not been tested for tendinitis.

  • Cat's claw (Uncaria tomentosa) has been used traditionally for pain relief. Do not take cat's claw if you take medicine for high blood pressure or blood-thinning medications. Cat's claw may stimulate the immune system, and might interact with any drugs taken to suppress the immune system. Cat's claw may also lower blood pressure, so if you take medication for high blood pressure you run the risk of your blood pressure dropping too low.
  • Devil's claw (Harpagophytum procumbens) has been used traditionally to relieve pain. Devil's claw may increase the risk of bleeding, especially if you also take blood thinners such as warfarin (Coumadin). It can interact with diabetes medications and other drugs. Talk to your doctor before taking it.
  • Boswellia (Boswellia serrata). Boswellia may increase the risk of bleeding, so tell your doctor before taking it if you also take blood-thinning medication.

Homeopathy

Homeopathic remedies for tendinitis include creams or gels. Arnica cream by itself or in combination with Calendula officinalis, Hamamelis virginiana, Aconitum napellus, and Belladonna, applied three to six times a day, speeds healing and decreases discomfort. For acute (sudden) injuries, always start with Arnica.

Orally, the dose is usually 3 - 5 pellets of a 12X to 30C remedy every 1 - 4 hours until the symptoms get better.

  • Bryonia -- for pains that are worse with the slightest motion or when jarred. The pain feels worse with cold and better with heat.
  • Phytolacca -- for tendinitis where the pain is focused at the insertion of the tendons and feels worse with heat.
  • Rhus toxicodendron -- for tendinitis that is worse in the morning.
  • Rhododendron -- for tendinitis that gets worse with barometric changes.

Many naturally oriented doctors use injectable homeopathic medications, including Traumeel, which has shown promise in reducing inflammation in some studies.

Physical Medicine

  • Orthotics or heel lifts and shoe correction, for Achilles tendinitis.
  • Elbow strap and small (2 lb.) weights, for tennis elbow.
  • Contrast hydrotherapy, or alternating hot and cold applications. After the first 24 - 48 hours, soak affected part for 3 minutes in hot water, then 30 seconds in cold water.
  • Castor oil pack: Apply oil to a clean, soft cloth, cover in plastic wrap, and apply to the affected area. Place a heat source over the pack, and let sit for 30 - 60 minutes.

Acupuncture

The National Institutes of Health has reported that acupuncture may help treat tennis elbow. In addition, two studies looking at the effect of acupuncture on this and other types of tendinitis found that acupuncture provides better pain relief than placebo.

Acupuncturists say that people with tendinitis frequently have a primary deficiency in the liver meridian, with a relative excess in the gallbladder meridian. In addition to needling treatment on the liver meridian and the supporting kidney meridian, treatments using moxibustion, a technique in which the herb mugwort is burned over specific acupuncture points may also be included. Needling and moxibustion may also be directly applied to painful areas and related sore points.

A technique known as balance method acupuncture may be effective in treating many musculoskeletal problems, including tendinitis.

Chiropractic

Although no well-designed studies have looked at chiropractic for treating tendinitis, chiropractors commonly treat this condition with ultrasound, electrical muscle stimulation, manual trigger point therapy (applying firm pressure by hand on a trigger point for several seconds and then stretching the muscle afterwards), and massage. People with stiff joints may also receive joint manipulation.

Following Up

Tendinitis often has three stages:

  • Stage 1: a dull ache following activity, which improves with rest.
  • Stage 2: pain with minor movements (such as dressing).
  • Stage 3: constant pain

Special Considerations

Tendintitis often comes back, particularly for athletes and people whose work requires repetitive motions.

Supporting Research

Albert JD, Meadeb J, Guggenbuhl P, Marin F, Benkalfate T, Thomazeau H, Chales G. High-energy extracorporeal shock-wave therapy for cacifying tendinitis of the rotator cuff: a randomized trial. J Bone Joint Surg Br. 2007;89(3):335-41.

Cacchio A, Paoloni M, Barile A, Don R, de Paulis F, Calvisi V, Ranavolo A, Frascarelli M, Santilli V, Spacca G. Effectiveness of radial shock-wave therapy for calcific tendinitis of the shoulder: single-blind, randomized clinical study. Phys Ther. 2006;86(5):672-82.

Fray C, Zamora J. The effects of obesity on orthopaedic foot and ankle pathology. Foot Ankle Int. 2007;28(9):996-9.

Fredberg U, Stengaard-Pedersen K. Chronic tendinopathy tissue pathology, pain mechanisms, and etiology with a special focus on inflammation. Scand J Med Sci Sports. 2008;18(1):3-15.

Gelineck J, Salomonsen M, Hviid C. Retropharyngeal tendinitis: radiographic and magnetic resonance imaging findings. Acta Radiol. 2006;47(8):806-9.

Gobel H, Heinze A, Ingwersen M, et al. Effects of Harpagophytum procumbens LI 174 (devil's claw) on sensory, motor und vascular muscle reagibility in the treatment of unspecific back pain. Schmerz. 2001;15:10-18.

Harvie P, Pollard TC, Carr AJ. Calcific tendinitis: natural history and association with endocrine disorders. J Shoulder Elbow Surg. 2007;16(2):169-73.

Kimmatkar N, Thawani V, Hingorani L, et al. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee -- a randomized double blind, placebo controlled trial. Phytomedicine. 2003;10:3-7.

Lathia AT, Jung SM, Chen LX. Efficacy of acupuncture as a treatment for chronic shoulder pain. J Altern Complement Med. 2009 Jun;15(6):613-8.

Rahman MH, Khan SZ, Ramiz MS. Effect of therapeutic ultrasound on calcific supraspinatus tendinitis. Mymensingh Med J. 2007;16(1):33-5.

Rees JD, Maffulli N, Cook J. Management of tendinopathy. Am J Sports Med. 2009 Sep;37(9):1855-67.

Zubler C, Mengiardi B, Schmid MR, Holder J, Jost B, Pfirrmann CW. MR arthrography in calcific tendinitis of the shoulder: diagnostic performance and pitfalls. Eur Radiol. 2007;17(6)1603-10.


Review Date: 4/10/2012
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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