Introduction:

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 are the shoulder (rotator cuff tendinitis), elbow (tennis elbow or golfer's elbow), wrist and thumb (de Quervain's disease), knee (jumper's knee), ankle (Achilles tendinitis), and hip. Calcific tendinitis, which occurs when calcium deposits build up in a joint, often occurs in people who have a chronic disease, such as diabetes.

Signs and Symptoms:

• Swelling
• Tenderness
• Pain that worsens when you move the affected limb
• Warmth and redness
• Crepitus (crackling)

What Causes It?:

Tendinitis can result from overuse, undertraining, or poor technique in sports, repetitive movement in certain occupations (such as typing), falling, lifting or carrying heavy objects, and extreme or repeated trauma. Obese individuals have a higher risk of tendinitis because of the increased weight on skeletal structures. Tendinitis may also be seen with certain inflammatory conditions (such as Reiter syndrome or ankylosing spondylitis), autoimmune disorders (such as diabetes), and some infections.

What to Expect at Your Provider's Office:

Your health care provider will give you a thorough physical examination and may take x-rays and other diagnostic tests.

Treatment Options:

Your health care 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 control pain. Several studies show that high energy shock wave therapy significantly improves symptoms and pain associated with tendinitis. In cases of severe tendinitis that is not healing from other treatments, surgery may be necessary.

Drug Therapies

• Nonsteroidal anti-inflammatory drugs (NSAIDs) -- such as indocin (by prescription) and ibuprofen (over the counter), reduce pain and inflammation. NSAIDs have 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 the acute phase has passed
• Physical therapy (such as range-of-motion exercises)
• Ultrasonography (phonophoresis) -- high-frequency sound used to heat an area and increase the blood supply
• Transcutaneous electrical nerve stimulation (TENS) -- electricity used to control pain

Nutrition and Supplements

• Vitamin C (250 - 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 - 800 mg a day) and essential fatty acids, such as fish oil or evening primrose oil (1,000 - 1,500 IU one to three times a day) to reduce inflammation

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your provider to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Bromelain (250 - 750 mg three times a day between meals), an enzyme derived from pineapple, to reduce swelling and inflammation.
• Curcumin (Curcuma longa), yellow pigment of turmeric, (200 - 400 mg three times a day between meals) to reduce inflammation.
• White willow (Salix alba) bark contains salicin, which acts similar to aspirin in reducing inflammation and pain. Make a tea with 1 - 2 g of bark boiled in a cup of water. Strain and cool. Or use 2 - 3 tsps. powder in 1 cup of boiling water. Drink three times a day. Do not use if you are allergic to aspirin or take blood-thinning medication.
• Licorice (Glycyrrhiza glabra) (3 cups of tea a day) to reduce inflammation. Do not use if you have high blood pressure or heart failure.

The following herbs may also help with inflammation, although they have not been tested for tendinitis.

• Cat's claw (Uncaria tomentosa), one 20 mg capsule per day.
• Devil's claw (Harpagophytum procumbens), 750 mg three times per day. Do not use if you take blood-thinning medication.
• Boswellia (Boswellia serrata), 300 - 400 mg three times per day.

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 - 5 pellets of a 12X to 30C remedy every 1 - 4 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.

Many naturally oriented doctors use injectable homeopathic medications, including Traumeel, which has shown promise in reducing inflammation in some studies.

Physical Medicine

• Orthotics or heel lifts and shoe correction (Achilles tendinitis).
• Elbow strap and small (2 lb.) weights (tennis elbow).
• Contrast hydrotherapy, or alternating hot and cold applications. After the first 24 - 48 hours, soak affected part for 3 minutes in hot water, then 30 seconds in cold water.
• Castor oil pack: Apply oil to a clean, soft cloth, cover in plastic wrap, and apply to the affected area. Place a heat source over the pack, and let sit for 30 - 60 minutes.

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 moxibustion may also be directly applied to painful areas and related sore points.

A technique known as balance method acupuncture can be effective in treating many musculoskeletal problems, including tendinitis.

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: a dull ache following activity, which improves with rest.
• Stage 2: pain with minor movements (such as dressing).
• Stage 3: constant pain

Special Considerations:

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