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

Treatment Plan

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

Prescription

• Nonsteroidal anti-inflammatory drugs—such as indocin 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)

Over the Counter

• Nonsteroidal anti-inflammatory drugs—such as ibuprofen reduce pain and inflammation; various side effects

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 (500 to 1 000 mg three 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 15 000 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.

• Bioflavonoids (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 tumeric (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 aspirinlike 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 virgineana 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 12X to 30C 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 lift 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.

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.

Supporting Research

Balch JF Balch PA. Prescription for Nutritional Healing. 2nd ed. Garden City Park NY: Avery Publishing; 1997:174–175.

Duke JA. The Green Pharmacy. Emmaus Pa: Rodale Press; 1997:106–109.

Kelly WN Harris Jr ED Ruddy S Sledge CB. Textbook of Rheumatology. 5th ed. Philadelphia Pa:WB Saunders Company; 1997:372–373 386 422–429 462–463 486 558–559 598–599 603–606 642.

Koopman WJ. Arthritis and Allied Conditions: A Textbook of Rheumatology. 13th ed. Baltimore Md:Williams & Wilkins; 1997:44 1769–1771 1795 1894–1896.

Millar AP. Sports Injuries and Their Management. Sydney Australia: Maclennan & Petty; 1994:10–14 84–85 101–103 111–112 118–119 8830–8831.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany Calif: Hahnemann Clinic Publishing; 1993:72–74 298.

Murray MT Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin Calif: Prima Publishing; 1998:805–809.

Noble J. Textbook of General Medicine and Primary Care. Boston Mass: Little Brown; 1987:228–229 288–290 293–296.

Vinger PF Hoener EF eds. Sports Injuries: The Unthwarted Epidemic. Boston Mass: John Wright; 1982:227 255.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.