Achilles Tendon Injuries and Tendonitis Medication

Author: Anthony J Saglimbeni, MD; Chief Editor: Consuelo T Lorenzo, MD more...

Updated: Jan 18, 2012

What would you like to print?

Medication Summary
Analgesics
Opioid analgesics
Nonsteroidal anti-inflammatory drugs
Cyclo-oxygenase II inhibitors
Show All

Medication Summary

Two major categories of drugs used in Achilles tendon rupture and Achilles tendonitis are analgesics, both opioid and nonopioid, and nonsteroidal anti-inflammatory agents (NSAIDs). Consider side effects and patient profiles when choosing medications. Acetaminophen can result in liver damage. Opioids can result in gastrointestinal distress, constipation, and sedation and have addictive potential. NSAIDs can result in gastrointestinal upset, gastrointestinal bleeding, renal damage, and impaired coagulation. New generation of COX-2 inhibiting NSAIDs may have fewer side effects. Currently, the only available COX-2 drug is celecoxib.

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort and have sedating properties, which are beneficial for patients who have sustained trauma or have sustained injuries.

View full drug information

Acetaminophen (Tylenol, Feverall, Aspirin Free Anacin)

DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, with upper GI disease, or who are taking oral anticoagulants.

Class Summary

Control of moderate to severe pain.

View full drug information

Hydrocodone and acetaminophen (Vicodin, Lorcet, Lortab)

Drug combination indicated for moderate to severe pain.

Class Summary

Have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclo-oxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.

View full drug information

Naproxen (Naprosyn, Aleve, Naprelan, Anaprox)

For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing activity of cyclo-oxygenase, which results in a decrease of prostaglandin synthesis.

Class Summary

Control of pain and inflammation, especially in cases of contraindication to conventional anti-inflammatories. Although increased cost can be a negative factor, the incidence of costly and potentially fatal GI bleeds is clearly less with COX-II inhibitors than with traditional NSAIDs. Ongoing analysis of cost avoidance of GI bleeds will further define the populations that will find COX-II inhibitors the most beneficial.

View full drug information

Celecoxib (Celebrex)

Inhibits primarily COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited thus GI toxicity may be decreased. Seek lowest dose of celecoxib for each patient.

Proceed to Follow-up

Contributor Information and Disclosures

Author

Anthony J Saglimbeni, MD President, South Bay Sports and Preventive Medicine Associates; Private Practice; Team Internist, San Francisco Giants; Team Internist, West Valley College; Team Physician, Bellarmine College Prep; Team Physician, Presentation High School; Team Physician, Santa Clara University; Consultant, University of San Francisco, Academy of Art University, Skyline College, Foothill College, De Anza College

Anthony J Saglimbeni, MD, is a member of the following medical societies: California Medical Association and Santa Clara County Medical Association

Disclosure: South Bay Sports and Preventive Medicine Associates, Inc Ownership interest Other

Coauthor(s)

Christian J Fulmer, DO Private Practice in Sports and Family Medicine; Team Physician, Valley Christian High School

Christian J Fulmer, DO is a member of the following medical societies: American Academy of Family Physicians, American Academy of Osteopathy, American Medical Society for Sports Medicine, and American Osteopathic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists

Disclosure: Allergan Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

Kelly L Allen, MD Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

References

de Jonge S, van den Berg C, de Vos RJ, van der Heide HJ, Weir A, Verhaar JA, et al. Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med. Oct 2011;45(13):1026-8. [Medline].
Juras V, Zbyn S, Pressl C, Domayer SE, Hofstaetter JG, Mayerhoefer ME, et al. Sodium MR Imaging of Achilles Tendinopathy at 7 T: Preliminary Results. Radiology. Jan 2012;262(1):199-205. [Medline].
Miners AL, Bougie TL. Chronic Achilles tendinopathy: a case study of treatment incorporating active and passive tissue warm-up, Graston Technique, ART, eccentric exercise, and cryotherapy. J Can Chiropr Assoc. Dec 2011;55(4):269-79. [Medline]. [Full Text].
Chan AP, Chan YY, Fong DT, Wong PY, Lam HY, Lo CK, et al. Clinical and biomechanical outcome of minimal invasive and open repair of the Achilles tendon. Sports Med Arthrosc Rehabil Ther Technol. Dec 20 2011;3(1):32. [Medline].
Nilsson-Helander K, Silbernagel KG, Thomeé R, Faxén E, Olsson N, Eriksson BI, et al. Acute achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med. Nov 2010;38(11):2186-93. [Medline].
Grigg NL, Stevenson NJ, Wearing SC, et al. Incidental walking activity is sufficient to induce time-dependent conditioning of the Achilles tendon. Gait Posture. Oct 5 2009;[Medline].
Henriksen M, Aaboe J, Bliddal H, et al. Biomechanical characteristics of the eccentric Achilles tendon exercise. J Biomech. Sep 21 2009;[Medline].
Gardin A, Movin T, Svensson L, et al. The long-term clinical and MRI results following eccentric calf muscle training in chronic Achilles tendinosis. Skeletal Radiol. Sep 23 2009;[Medline].
Wegrzyn J, Luciani JF, Philippot R, et al. Chronic Achilles tendon rupture reconstruction using a modified flexor hallucis longus transfer. Int Orthop. Aug 21 2009;[Medline].
Silbernagel KG, Nilsson-Helander K, Thomee R, et al. A new measurement of heel-rise endurance with the ability to detect functional deficits in patients with Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc. Aug 19 2009;[Medline].
Hawkins D, Lum C, Gaydos D, et al. Dynamic creep and pre-conditioning of the Achilles tendon in-vivo. J Biomech. Sep 15 2009;[Medline].
Adler RS, Finzel KC. The Complementary Roles of MR Imaging and Ultrasound of Tendons. Radiol Clin North Am. Jul 2005;43(4):771-807. [Medline].
Alvarez-Nemegyei J, Canoso JJ. Heel pain: diagnosis and treatment, step by step. Cleve Clin J Med. May 2006;73(5):465-71.
Brown DE. Ankle and leg injuries. In: Mellion MB, Walsh M, Shelton GL, eds. The Team Physician's Handbook, 3rd ed. Philadelphia, Pa: Hanley & Belfus; 2002:. 518-9.
Canale T. Rupture of muscles and tendons. In: Campbell's Operative Orthopaedics. Vol 10. St. Louis, Mo: Mosby; 2003:. 2458-2468.
Furia JP. High-energy extracorporeal shock wave therapy as a treatment for insertional Achilles tendinopathy. Am J Sports Med. May 2006;34(5):733-40.
Humble RN, Nugent LL. Achilles' tendonitis. An overview and reconditioning model. Clin Podiatr Med Surg. Apr 2001;18(2):233-54. [Medline].
Johnson MD. Physiology of musculoskeletal growth. In: Essentials of Sports Medicine. Vol 1. St. Louis, Mo: Mosby; 1997:. 534-8.
Kingma JJ, de Knikker R, Wittink HW. Eccentric overload training in patients with a chronic Achilles tendinopathy: a systematic review. Br J Sports Med. Oct 11 2006.
Maffulli N, Testa V, Capasso G. Surgery for chronic Achilles tendinopathy yields worse results in nonathletic patients. Clin J Sport Med. Mar 2006;16(2):123-8.
Nunley JA, Ruskin G, Horst F. Long-term clinical outcomes following the central incision technique for insertional Achilles tendinopathy. Foot Ankle Int. Sep 2011;32(9):850-5. [Medline].
Pedowitz RA, Saglimbeni AJ. The leg. In: Safran MR, McKeag DB, Van Camp SP, eds. Manual of Sports Medicine. Vol 1. Philadelphia, Pa: Lippincott-Raven; 1998:. 460-6.
Taunton J, Smith C, Magee DJ. Leg, foot and ankle injuries. In: Athletic Injuries and Rehabilitation. Vol 1. Philadelphia, Pa: WB Saunders; 1996:. 736-9.
Tomczak RL. Surgery of the Achilles' tendon. Clin Podiatr Med Surg. Apr 2001;18(2):255-71, vi. [Medline].
Ufberg J, Harrigan RA, Cruz T, Perron AD. Orthopedic pitfalls in the ED: Achilles tendon rupture. Am J Emerg Med. Nov 2004;22(7):596-600.