What are the treatment options for a patient with arm pain due to overuse without any injury?

Patient Education for Arm Pain from Overuse

For arm pain from overuse without injury, educate patients that this represents a degenerative tendon condition called "tendinopathy" requiring activity modification, relative rest, and a structured rehabilitation program—not acute inflammation requiring complete immobilization. 1

Understanding the Condition

Correct terminology matters for patient understanding:

• This is "tendinopathy" or "tendinosus," not "tendonitis"—the condition involves degenerative tendon changes from repetitive microtrauma, not active inflammation 1
• The pain develops gradually from repetitive stress causing collagen breakdown and reduced blood supply to the tendon 1
• Approximately 80% of patients fully recover within 3-6 months with proper conservative management 1

What to Expect with Symptoms

Typical symptom patterns patients should recognize:

• Pain that starts during activity and may initially improve after "warming up" 1
• Gradually increasing pain intensity and duration over time if activity continues unchanged 1
• Well-localized tenderness when pressing on the affected tendon 1
• Pain reproduced by specific movements that load the tendon 1

Most Common Arm Locations

The rotator cuff (shoulder) and elbow epicondyles (tennis/golfer's elbow) are the most frequent sites for arm overuse tendinopathy 1

For elbow tendinopathy specifically, lateral epicondylosis ("tennis elbow") is 7-10 times more common than medial epicondylosis and affects the dominant arm 75% of the time, typically occurring after age 40 2

Activity Modification Strategy

The RICE protocol is crucial within the first 72 hours of symptom onset and can shorten recovery by 50-70%: 3

• Rest: Relative rest, not complete immobilization—reduce repetitive loading while maintaining some activity to prevent muscle atrophy 4
• Ice: Apply during acute symptom flares
• Compression: Use as needed for swelling control
• Elevation: When applicable

Technique modification is essential:

• Identify and eliminate the specific repetitive movements causing tendon stress 2
• For work-related overuse, address non-ergonomic tools, furniture, or equipment 5
• Modify activity duration and intensity during rehabilitation 3

Treatment Approach

Conservative management follows this sequence:

1. Initial phase (first 2-4 weeks):

   • Relative rest from aggravating activities 4
   • NSAIDs (like ibuprofen) provide short-term pain relief but do not alter the underlying degenerative process 4, 6
   • Patients should be alert for NSAID side effects including GI discomfort, ulcers, and bleeding 6

2. Rehabilitation phase (weeks 4-12):

   • Eccentric strengthening exercises are the cornerstone of treatment—these reduce symptoms, increase strength, and promote tendon healing 4
   • Stretching exercises of affected muscles and antagonistic muscle groups 3
   • Gradual return to activity as pain allows 3

3. Supportive measures:

   • Orthotics or bracing to offload the affected tendon during healing 4
   • Deep transverse friction massage may reduce pain 2

What to Avoid

Critical warnings for patients:

• Avoid corticosteroid injections directly into tendons—while they may provide short-term relief in acute phases, they do not improve long-term outcomes and can inhibit healing and reduce tendon strength 2, 4
• Do not expect NSAIDs alone to fix the problem—they only provide temporary symptom relief 4
• Do not resume full activity too quickly—rehabilitation requires 3-6 months for most patients 1

When to Seek Further Evaluation

Red flags requiring medical reassessment:

• Symptoms persisting beyond 3-6 months despite proper conservative management may warrant surgical evaluation 2, 4
• Development of significant weakness, muscle atrophy, or loss of motion 1
• Inability to perform basic daily activities despite treatment 3

Prevention After Recovery

To prevent recurrence:

• Continue strengthening exercises for rotator cuff, scapular stabilizers, and core musculature even after symptoms resolve 2
• Maintain proper technique during repetitive activities 2
• Ensure ergonomic workplace setup and tools 5
• Gradually increase activity intensity rather than sudden increases in repetitive movements 7