Tendinitis

Tendinitis is the painful inflammation of a tendon and its ligaments, which attach it to the bone. It often results from the stress of repetitive movements. Acute tendinitis may become chronic if it is not treated. The areas most commonly affected by tendinitis are the shoulder (rotator cuff tendinitis or impingement syndrome), elbow (tennis elbow or golfer's elbow), wrist and thumb (de Quervain's disease), knee (jumper's knee), and ankle (Achilles tendinitis). Calcific tendinitis, which occurs when calcium deposits build up in a joint, often appears in people with a chronic disease, such as diabetes.

Signs and Symptoms

• Minor edema (swelling)
• Tenderness in affected limb
• Pain that worsens when you move the affected limb
• Warmth and redness
• Crepitus (crackling)

What Causes It?

Although the exact cause of tendinitis is unknown, it can result from overuse, undertraining, or poor technique in sports, repetitive movement in certain occupations, falling, lifting or carrying heavy objects, and extreme or repeated trauma. It may also be seen with certain inflammatory conditions (for example, Reiter's syndrome, ankylosing spondylitis), autoimmune disorders (for example, diabetes mellitus), and some infections.

What to Expect at Your Provider's Office

Your health care provider will give you a thorough physical examination. X rays may be taken and other diagnostic tests may be performed.

Treatment Options

Your provider may prescribe pain relievers or steroid injections. Treatment also may include ice, rest, or temporary immobilization. Massage, strengthening exercises, or physical therapy help improve tendon use. Ultrasound and use of electricity help to control pain. Surgery is used only for severe tendinitis that is not healing from other treatments.

Drug Therapies

• Nonsteroidal anti-inflammatory drugs (NSAIDs)—such as indocin (by prescription) and ibuprofen (over the counter), reduce pain and inflammation; various side effects
• 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 after the initial injury
• Rest
• Massage
• Temporary immobilization of the affected limb (slings, splints)
• Flexibility and strengthening exercises after acute phase has passed
• Physical therapy (such as range-of-motion exercises)
• Ultrasonography (phonophoresis)—high-frequency sound to heat an area and increase the blood supply
• Transcutaneous electrical nerve stimulation (TENS)—electricity used to control pain

Nutrition

• Vitamin C (250 to 500 mg two times a day) to aid in healing, increase immune function, and reduce inflammation
• 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
• Vitamin E (400 to 800 mg a day) to reduce inflammation
• Bromelain (250 to 750 mg three times a day between meals) to reduce swelling
• Essential fatty acids (1,000 to 1,500 IU one to three times a day): anti-inflammatory

Herbs
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

• Flavonoids (500 to 1,000 mg three times a day) to reduce inflammation and maintain healthy collagen (protein found in connective tissue, skin, cartilage, and other tissue)
• Curcumin (Curcuma longa), yellow pigment of turmeric, (200 to 400 mg three times a day between meals) to reduce inflammation
• Willow (Salix alba) bark tea (2 to 3 tsps. in 1 cup of boiling water three times a day) for pain relief. (Caution: if you are allergic to aspirin, do not take willow bar or other aspirin-like herbs.)
• Licorice (Glycyrrhiza glabra) (3 cups tea a day) to reduce inflammation. (Do not use if you have high blood pressure.)
• Comfrey (Symphytum officinale) (1 tsp. in 1 cup boiling water four times a day) to aid healing and for pain relief

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 injuries, always start with Arnica.

Internally, the dose is usually 3 to 5 pellets of a 12X to 30C remedy every one to four 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

Physical Medicine

• Orthotics or heel lifts and shoe correction (Achilles tendinitis)
• Elbow strap and small (2 lb.) weights (tennis elbow)
• Contrast hydrotherapy. Alternate hot and cold applications. After the first 24 to 48 hours, soak affected part for three minutes in hot water, then 30 seconds in cold water.

Acupuncture
In 1997, the National Institutes of Health reported that acupuncture may be an effective therapy for tennis elbow. In addition, two studies examining the effect of acupuncture on this and other types of tendinitis have found that acupuncture provides better pain relief than placebo.

Acupuncturists report that patients with tendinitis frequently exhibit 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/or moxibustion may also be directly applied to painful areas and related sore points.

Chiropractic
Although no well-designed studies have examined the effectiveness of chiropractic treatment for 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. Joint manipulation may also be performed on individuals with diminished joint mobility.

Following Up

Tendinitis often has three stages: Stage 1 is characterized by a dull ache following activity, which improves with rest; stage 2, by pain with minor movements (for example, dressing); and stage 3, by constant pain.

Special Considerations

Recurrences are common, particularly for athletes and people whose work requires repetitive motions.

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