What is the best treatment for severe tendonitis in the hands?

Treatment for Severe Hand Tendonitis

Start with relative rest, topical or oral NSAIDs, ice therapy (10 minutes through a wet towel), and eccentric strengthening exercises for 3-6 months before considering any invasive treatments. 1, 2

First-Line Conservative Treatment (3-6 Months)

Activity Modification

• Continue activities that don't worsen your pain, but avoid complete immobilization to prevent muscle wasting and deconditioning 1
• Reduce repetitive hand movements that aggravate symptoms while maintaining some tendon loading to stimulate collagen production 1, 3

Pain Control Strategies

• Topical NSAIDs are preferable to oral NSAIDs because they eliminate the risk of gastrointestinal bleeding while providing equivalent pain relief 1, 2
• Oral NSAIDs (like naproxen 500mg twice daily) provide short-term pain relief but don't improve long-term outcomes 4, 5
• Apply ice through a wet towel for 10-minute periods to reduce pain and swelling in the acute phase 1, 2

Exercise Rehabilitation (The Most Important Component)

• Eccentric strengthening exercises are the cornerstone of treatment and can actually reverse degenerative tendon changes 2, 6, 5
• These exercises involve controlled lengthening of the muscle-tendon unit under load 1
• Stretching exercises are widely accepted and should be incorporated 1, 2
• Exercises should be performed relatively pain-free 7

Supportive Measures

• Hand/wrist braces can help unload and protect tendons during activities, though evidence for their effectiveness is limited 1, 2

Important Caveats About Common Treatments

What NOT to Do

• Avoid corticosteroid injections in hand tendons - they may provide short-term pain relief but don't alter long-term outcomes and can inhibit healing, reduce tendon strength, and predispose to rupture 1, 2, 3
• If injections are considered despite these risks, never inject directly into the tendon substance itself - only peritendinous injections should be attempted 1, 6, 3
• Don't expect NSAIDs to "heal" the tendon - they only provide temporary pain relief 8, 5

Second-Line Options (If Conservative Treatment Fails)

If pain persists after 3-6 months of well-managed conservative treatment, consider:

• Extracorporeal shock wave therapy (ESWT) - appears safe and effective but costly 2, 6, 3
• Therapeutic ultrasound - may decrease pain and increase collagen synthesis, though evidence is weak 1, 2

Surgical Referral

• Surgery is warranted only if pain persists despite 3-6 months of appropriate conservative treatment 2, 6, 3
• Surgical techniques involve excision of abnormal tendon tissue and release of scarred areas 2, 6

Expected Outcomes

Approximately 80% of patients with overuse tendinopathies recover completely within 3-6 months with appropriate conservative treatment 2, 6, 3

Key Clinical Pitfall

The traditional view that tendonitis involves ongoing inflammation is incorrect - most chronic tendon problems show degenerative changes without significant inflammation 8, 9. This is why anti-inflammatory treatments (NSAIDs, corticosteroids) provide only temporary symptom relief without addressing the underlying tendon pathology. The focus should be on eccentric exercise rehabilitation, not anti-inflammatory medications. 5, 7