What is the treatment for tendinitis?

Treatment for Tendinitis

The most effective treatment for tendinitis includes relative rest, ice therapy, NSAIDs, and eccentric strengthening exercises for 3-6 months before considering more invasive interventions. 1, 2

First-Line Conservative Management

• Relative rest is essential to prevent further damage while maintaining some activity to prevent muscle atrophy and deconditioning 3, 1
• Ice therapy should be applied through a wet towel for 10-minute periods to provide short-term pain relief, reduce swelling, and blunt inflammatory response 1, 2
• NSAIDs (oral or topical) effectively relieve acute pain, with topical formulations preferred due to reduced risk of gastrointestinal side effects 1, 2
  • For naproxen, the recommended dose for tendonitis is 500 mg initially, followed by 500 mg every 12 hours or 250 mg every 6-8 hours as required 4
  • The initial total daily dose should not exceed 1250 mg, with subsequent daily doses not exceeding 1000 mg 4
• Eccentric strengthening exercises stimulate collagen production and guide normal alignment of newly formed collagen fibers 1, 2
• Stretching exercises are generally helpful for tendon rehabilitation 1, 2

Second-Line Treatments

• Braces or tennis elbow bands can help reinforce, unload, and protect tendons during activity, though evidence for their effectiveness is limited 1, 2
• Corticosteroid injections may provide better acute pain relief than NSAIDs but do not alter long-term outcomes 1, 2
  • Caution: Direct injection into the tendon substance should be avoided as it may inhibit healing, reduce tensile strength, and potentially predispose to rupture 1, 5
• Therapeutic ultrasonography may decrease pain and increase collagen synthesis, though evidence for consistent benefit is weak 1, 2
• Extracorporeal Shock Wave Therapy (ESWT) appears safe and effective but requires further research 1, 2
• Sclerotherapy and nitric oxide patches show promising results but need larger trials to confirm their effectiveness 6

Surgical Management

• Surgery should be considered only if conservative measures fail after 3-6 months of well-managed treatment 3, 1
• Surgical techniques typically include excision of abnormal tendon tissue and longitudinal tenotomies to release areas of scarring and fibrosis 1

Important Considerations

• Most patients with overuse tendinopathies (approximately 80%) fully recover within 3-6 months with appropriate conservative treatment 3, 1
• The term "tendinopathy" is now preferred over "tendinitis" as recent research suggests little or no inflammation is present in these conditions 6, 7
• Despite the lack of histologic evidence of inflammation, NSAIDs and corticosteroids can still be beneficial for pain control and facilitating rehabilitation exercises 7
• Technique modification for athletes and manual laborers is important to minimize repetitive stresses placed on tendons 1, 2
• Different tendinopathies may require specific approaches:
  • For lateral epicondylitis (tennis elbow), which is 7-10 times more common than medial epicondylitis, focus on activities requiring repetitive wrist extension 1
  • For De Quervain tenosynovitis, treatment focuses on the first dorsal compartment containing abductor pollicis longus and extensor pollicis brevis tendons 5
  • For trigger finger, corticosteroid injections have strong supporting evidence 5, 8

Emerging Treatments

• Preliminary work with growth factors and stem cells is promising but requires further study 6
• Platelet-rich plasma injections have varying levels of evidence for certain tendinopathies 7
• Topical nitroglycerin is an additional nonsurgical treatment option with some supporting evidence 7