From the Guidelines
Topical diclofenac is typically available in concentrations of 1% to 3% for treating tendinitis, with the 1% gel or solution being the most commonly prescribed. The choice of concentration depends on the severity of the condition and the patient's response to treatment. For tendinitis treatment, apply a thin layer of the medication to the affected area 3-4 times daily, gently massaging it into the skin until absorbed 1. Treatment duration usually ranges from 1-2 weeks, though some cases may require up to 4 weeks of consistent application.
Key Points to Consider
- Topical diclofenac works by reducing inflammation locally while minimizing systemic absorption compared to oral NSAIDs, resulting in fewer gastrointestinal side effects 1.
- The medication penetrates the skin to reach the inflamed tendon tissue, inhibiting prostaglandin synthesis and reducing pain and swelling.
- Some patients may experience mild skin irritation, redness, or itching at the application site, but these side effects are generally less severe than those associated with oral NSAID use.
- According to a study published in the Annals of Internal Medicine, topical NSAIDs, including diclofenac, have been shown to reduce pain and improve physical function in patients with musculoskeletal injuries 1.
- Another study published in the American Family Physician found that topical NSAIDs can be an effective treatment option for tendinopathy, with the added benefit of reducing the risk of gastrointestinal hemorrhage associated with systemic NSAIDs 1.
From the Research
Topical Diclofenac for Tendinitis
- The effectiveness of topical diclofenac for tendinitis is supported by a systematic review of 44 studies (11,165 participants) which found that topical diclofenac is effective for acute pain, such as sprains, with minimal adverse events 2.
- For acute pain, the number needed to treat (NNT) for different formulations of topical diclofenac were as follows: diclofenac plaster, 4.7 (95% CI 3.7-6.5); diclofenac plaster with heparin, 7.4 (95% CI 4.6-19); and diclofenac Emulgel, 1.8 (95% CI 1.5-2.1) 2.
- For chronic pain, a clinical success rate of ∼60% (NNT 9.5 [95% CI 7-14.7]) was achieved with a variety of formulations of topical diclofenac 2.
- Local adverse events (∼14%) were similar for both diclofenac and placebo in chronic pain studies 2.
- The percentage of participants who achieved clinical success with topical diclofenac for tendinitis is around 60% for chronic pain, but the exact percentage for tendinitis specifically is not reported in the available studies 2.
Comparison with Other Treatments
- Platelet-rich plasma (PRP) injections have been compared to corticosteroid injections for partial supraspinatus tears, and PRP showed superior benefits over corticosteroid at 6-month follow-up 3.
- However, the studies provided do not directly compare topical diclofenac to PRP or other treatments for tendinitis, so it is not possible to determine the relative effectiveness of these treatments 4, 5, 3, 6.
Post-Procedure Protocols
- Post-PRP protocols, such as weight-bearing restrictions, orthosis use, and rehabilitation protocols, may affect the outcomes attributed to PRP itself, but there is substantial heterogeneity in these protocols and no studies directly compare them 6.
- The studies provided do not report on post-procedure protocols for topical diclofenac, so it is not possible to determine the optimal protocol for this treatment 2.