Introduction:

Tendinitis is the painful inflammation of a tendon and its ligaments, which attach the tendon to bone. It often results from the stress of repetitive movements. Acute or sudden tendinitis may become chronic or long-lasting if it is not treated. People get tendinitis most often in 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 happens 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 gets worse when you move the affected limb
• Warmth and redness
• Crepitus (crackling)

What Causes It?:

Tendinitis can happen because of:

• Overuse, undertraining, or poor technique in sports
• Repetitive movement in some jobs (such as typing)
• Falling
• Lifting or carrying heavy objects
• Extreme or repeated injury

People who are overweight have a higher risk of tendinitis because of the increased pressure on tendons, ligaments, and bones. Tendinitis may also accompany some inflammatory conditions (such as Reiter syndrome or ankylosing spondylitis), autoimmune disorders (such as type 1 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 keeping the area still (such as with a sling). Massage, strengthening exercises, or physical therapy may help. Some studies show that high energy shock wave therapy 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 ibuprofen (Advil, Motrin) and naxproxen (Aleve), reduce pain and inflammation. NSAIDs may increase the risk of stomach bleeding.
• 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 right after the injury
• Rest
• Massage
• Temporary immobilization of the affected limb (slings, splints)
• Flexibility and strengthening exercises after the inflammation goes down
• 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 help relieve pain

Nutrition and Supplements

• Bromelain, 250 mg twice a day. This enzyme that comes from pineapples reduces inflammation. Bromelain may increase the risk of bleeding, so people who take anticoagulants (blood thinners) should not take bromelain without first talking to their doctor. People with peptic ulcers should avoid bromelain. Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger.
• 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. Vitamin E, fish oil, and evening primrose oil may increase the risk of bleeding. If you take blood-thinning medication, ask your doctor before taking any of these supplements.

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.

Tell your doctor if your are pregnant or nursing -- before using any herbal products.

• Turmeric (Curcuma longa) standardized extract, 300 mg three times a day, for pain and inflammation. Turmeric is sometimes combined with bromelain, because it makes the effects of bromelain stronger. Turmeric may increase the risk of bleeding, so people who take anticoagulants (blood thinners) should not take turmeric without first talking to their doctor.
• Willow bark (Salix alba) standardized extract, 500 mg up to three times daily, to relieve pain. Willow acts similar to aspirin. Do not take white willow if you are also taking aspirin or blood-thinning medications. Do not take willow bark products if you are allergic to aspirin or salicylates before taking white willow. Willow should not be given to children under the age of 18.
• 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) standardized extract, 30 mg three times a day, has been used traditionally for pain relief. Do not take cat' s claw if you take medicine for high blood pressure or blood-thinning medications.
• Devil's claw (Harpagophytum procumbens) standardized extract, 100 - 200 mg one to two times daily. Devil' s claw has been used traditionally to relieve pain. Devil' s claw may increase the risk of bleeding and interact with diabetes medications, so tell your doctor before taking it if you also take blood-thinning medication or if you have diabetes.
• Boswellia (Boswellia serrata), 300 - 400 mg three times per day. Boswellia may increase the risk of bleeding, so tell your doctor before taking it if you also take blood-thinning medication.

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 (sudden) injuries, always start with Arnica.

Orally, 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 looking at the effect of acupuncture on this and other types of tendinitis found that acupuncture provides better pain relief than placebo.

Acupuncturists report that people 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 may 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. People with stiff joints may also receive joint manipulation.

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.