Overuse Injury Medication

  • Author: Scott R Laker, MD; Chief Editor: Consuelo T Lorenzo, MD   more...
 
Updated: Nov 29, 2011
 

Medication Summary

Injection of involved structures with combinations of corticosteroids and local anesthetics frequently is quite helpful in persons with overuse injury. Pain relief enables more effective participation in therapy, and it may help to limit the likelihood that the patient will develop a chronic pain syndrome. In most cases, injections should be performed after less invasive measures fail. Rarely, immediate relief of pain may be necessary to allow participation in an athletic or performing arts event, and this can be achieved through injection therapy. Techniques for the injection of specific structures are described in more specific articles in the eMedicine Journal (eg, see the related eMedicine topic Corticosteroid Injections of Joints and Soft Tissues).

Nonsteroidal anti-inflammatory drugs (NSAIDs) are mainstays in the treatment of overuse injuries. However, considerable evidence has been revealed that true inflammation is rarely a component of these disorders, especially tendinopathies. Consequently, the use of simple analgesics has become more prevalent in the treatment of such disorders.

Muscle relaxants, opiates, corticosteroids, tricyclic antidepressants, and sleep medications have a role in the tailored treatment of individuals with overuse injury.

See also the following related eMedicine topic:

Chronic Pain Syndrome

Next

Corticosteroids

Class Summary

Have anti-inflammatory properties and cause profound and varied metabolic effects. Used for pain relief and reduction of inflammation.

View full drug information

Cortisone (Cortone)

 

Reduces inflammation. Decreases inflammation by suppressing migration of PMN leukocytes and reversing increased capillary permeability.

Previous
Next

Nonsteroidal anti-inflammatory drugs

Class Summary

Most commonly used for relief of mild to moderate pain. Effects in treatment of pain tend to be patient-specific.

View full drug information

Diclofenac (Voltaren, Cataflam)

 

Used to reduce inflammation; inhibits prostaglandin synthesis by decreasing activity of COX enzyme, which, in turn, decreases formation of prostaglandin precursors.

Previous
Next

Muscle relaxants

Class Summary

Thought to work centrally by suppressing conduction in the vestibular cerebellar pathways. May have an inhibitory effect on the parasympathetic nervous system.

View full drug information

Cyclobenzaprine (Flexeril)

 

Acts centrally and reduces motor activity of tonic somatic origins, influencing alpha and gamma motor neurons. Structurally related to TCAs. Skeletal muscle relaxants have modest, short-term benefit as adjunctive therapy for nociceptive pain associated with muscle strains and, used intermittently, for diffuse and certain regional chronic pain syndromes. Long-term improvement over placebo has not been established. Often produces a "hangover" effect, which can be minimized by taking the nighttime dose 2-3 h before going to sleep.

Previous
Next

Narcotic analgesics

Class Summary

Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and enables physical therapy regimens. Many analgesics have sedating properties, which are beneficial for patients who have sustained injuries.

View full drug information

Hydrocodone and acetaminophen (Vicodin, Vicodin ES, Lorcet-HD, Norcet, Lortab)

 

Drug combination indicated for moderate to severe pain.

Previous
Next

Tricyclic antidepressants

Class Summary

Used in the treatment of overuse injury, not for their antidepressant effects but as adjunct pain medications. Act synergistically with narcotic analgesics and appear to alter brainstem pain processing. Their sedating effects also may be used advantageously if the patient's sleep is disrupted.

View full drug information

Amitriptyline (Elavil)

 

Analgesic for certain chronic and neuropathic pain.

Previous
Next

Anxiolytic agents

Class Summary

Sleep-inducing medications are used in overuse injury when the patient's sleep is disrupted because of discomfort from the injury.

View full drug information

Zolpidem (Ambien)

 

Structurally dissimilar to benzodiazepine but similar in activity, with exception of having reduced effects on skeletal muscle and seizure threshold.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Scott R Laker, MD  Staff Physician, Department of Rehabilitation, University of Colorado Health Sciences Center

Scott R Laker, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Coauthor(s)

William J Sullivan, MD  Associate Professor, Pain Medicine Fellowship Site Director, Director of Medical Student Education, Department of Physical Medicine and Rehabilitation, University of Colorado at Denver Health Sciences Center

William J Sullivan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, International Spine Intervention Society, and North American Spine Society

Disclosure: Nothing to disclose.

Scott Strum, MD  Director of Traumatic Brain Injury Service, Assistant Professor, Department of Physical Medicine and Rehabilitation, Loma Linda University Medical Center

Scott Strum, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation and Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Specialty Editor Board

Teresa L Massagli, MD  Professor of Rehabilitation Medicine and Pediatrics, University of Washington School of Medicine

Teresa L Massagli, MD is a member of the following medical societies: American Academy of Pediatrics, American Academy of Physical Medicine and Rehabilitation, and Association of Academic Physiatrists

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

Patrick M Foye, MD  Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

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

  1. Flick J, Devkota A, Tsuzaki M, et al. Cyclic loading alters biomechanical properties and secretion of PGE2 and NO from tendon explants. Clin Biomech (Bristol, Avon). Jan 2006;21(1):99-106. [Medline].

  2. Arnoczky SP, Lavagnino M, Egerbacher M. The mechanobiological aetiopathogenesis of tendinopathy: is it the over-stimulation or the under-stimulation of tendon cells?. Int J Exp Pathol. Aug 2007;88(4):217-26. [Medline].

  3. Archambault JM, Jelinsky SA, Lake SP, et al. Rat supraspinatus tendon expresses cartilage markers with overuse. J Orthop Res. May 2007;25(5):617-24. [Medline].

  4. Devkota AC, Tsuzaki M, Almekinders LC, et al. Distributing a fixed amount of cyclic loading to tendon explants over longer periods induces greater cellular and mechanical responses. J Orthop Res. Aug 2007;25(8):1078-86. [Medline].

  5. Le P, Solomonow M, Zhou BH, et al. Cyclic load magnitude is a risk factor for a cumulative lower back disorder. J Occup Environ Med. Apr 2007;49(4):375-87. [Medline].

  6. Moore A, Wells R. Effect of cycle time and duty cycle on psychophysically determined acceptable levels in a highly repetitive task. Ergonomics. Jun 10 2005;48(7):859-73.

  7. Nakama LH, King KB, Abrahamsson S, et al. Effect of repetition rate on the formation of microtears in tendon in an in vivo cyclical loading model. J Orthop Res. Sep 2007;25(9):1176-84. [Medline].

  8. Bongers PM, Kremer AM, ter Laak J. Are psychosocial factors, risk factors for symptoms and signs of the shoulder, elbow, or hand/wrist?: A review of the epidemiological literature. Am J Ind Med. May 2002;41(5):315-42. [Medline].

  9. Melhorn JM. Cumulative trauma disorders and repetitive strain injuries. The future. Clin Orthop. Jun 1998;(351):107-26. [Medline].

  10. Hart DA, Archambault JM, Kydd A, et al. Gender and neurogenic variables in tendon biology and repetitive motion disorders. Clin Orthop. Jun 1998;(351):44-56. [Medline].

  11. Pritchard MH, Pugh N, Wright I, et al. A vascular basis for repetitive strain injury. Rheumatology (Oxford). Jul 1999;38(7):636-9. [Medline].

  12. Battery L, Maffulli N. Inflammation in overuse tendon injuries. Sports Med Arthrosc. Sep 2011;19(3):213-7. [Medline].

  13. Siewe J, Rudat J, Röllinghoff M, Schlegel UJ, Eysel P, Michael JW. Injuries and overuse syndromes in powerlifting. Int J Sports Med. Sep 2011;32(9):703-11. [Medline].

  14. IJmker S, Huysmans MA, Blatter BM, et al. Should office workers spend fewer hours at their computer? A systematic review of the literature. Occup Environ Med. Apr 2007;64(4):211-22. [Medline].

  15. Palmer KT. Carpal tunnel syndrome: the role of occupational factors. Best Pract Res Clin Rheumatol. Feb 2011;25(1):15-29. [Medline]. [Full Text].

  16. Andersen JH, Harhoff M, Grimstrup S, et al. Computer mouse use predicts acute pain but not prolonged or chronic pain in the neck and shoulder. Occup Environ Med. Feb 2008;65(2):126-31. [Medline].

  17. Banks KP, Ly JQ, Beall DP, et al. Overuse injuries of the upper extremity in the competitive athlete: magnetic resonance imaging findings associated with repetitive trauma. Curr Probl Diagn Radiol. Jul-Aug 2005;34(4):127-42.

  18. Cartwright MS, White DL, Demar S, Wiesler ER, Sarlikiotis T, Chloros GD, et al. Median nerve changes following steroid injection for carpal tunnel syndrome. Muscle Nerve. Jul 2011;44(1):25-9. [Medline].

  19. Meltzer KR, Standley PR. Modeled repetitive motion strain and indirect osteopathic manipulative techniques in regulation of human fibroblast proliferation and interleukin secretion. J Am Osteopath Assoc. Dec 2007;107(12):527-36. [Medline]. [Full Text].

  20. Hölmich P, Nyvold P, Larsen K. Continued significant effect of physical training as treatment for overuse injury: 8- to 12-year outcome of a randomized clinical trial. Am J Sports Med. Nov 2011;39(11):2447-51. [Medline].

  21. Brenner JS,. Overuse injuries, overtraining, and burnout in child and adolescent athletes. Pediatrics. Jun 2007;119(6):1242-5. [Medline].

  22. Hreljac A. Etiology, prevention, and early intervention of overuse injuries in runners: a biomechanical perspective. Phys Med Rehabil Clin N Am. Aug 2005;16(3):651-67, vi.

  23. Landorf KB. Foot orthoses can reduce lower limb overuse injury rate. J Physiother. 2011;57(3):193. [Medline].

  24. Ireland DC. Australian repetition strain injury phenomenon. Clin Orthop. Jun 1998;(351):63-73. [Medline].

  25. MacEachen E. The demise of repetitive strain injury in sceptical governing rationalities of workplace managers. Sociol Health Illn. May 2005;27(4):490-514.

  26. Szeto GP, Straker LM, O'Sullivan PB. A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work--2: neck and shoulder kinematics. Man Ther. Nov 2005;10(4):281-91.

  27. Szeto GP, Straker LM, O'Sullivan PB. A comparison of symptomatic and asymptomatic office workers performing monotonous keyboard work--1: neck and shoulder muscle recruitment patterns. Man Ther. Nov 2005;10(4):270-80.

  28. Allan DA. Structure and physiology of joints and their relationship to repetitive strain injuries. Clin Orthop. Jun 1998;(351):32-8. [Medline].

  29. Armstrong AJ, McMahon BT, West SL, et al. Workplace discrimination and cumulative trauma disorders: the national EEOC ADA research project. Work. 2005;25(1):49-56.

  30. Barr AE, Barbe MF, Clark BD. Work-related musculoskeletal disorders of the hand and wrist: epidemiology, pathophysiology, and sensorimotor changes. J Orthop Sports Phys Ther. Oct 2004;34(10):610-27. [Medline].

  31. Bernard BP, ed. Musculoskeletal Disorders and Workplace Factors. Cincinnati, Ohio: National Institute for Occupational Safety and Health; July 1997. [Full Text].

  32. Bonde JP, Mikkelsen S, Andersen JH, et al. Understanding work related musculoskeletal pain: does repetitive work cause stress symptoms?. Occup Environ Med. Jan 2005;62(1):41-8. [Medline].

  33. Bozentka DJ. Cubital tunnel syndrome pathophysiology. Clin Orthop. Jun 1998;(351):90-4. [Medline].

  34. Cailliet R. Foot and Ankle Pain. 3rd ed. Philadelphia, Pa: FA Davis; 1997.

  35. Cailliet R. Knee Pain and Disability. 3rd ed. Philadelphia, Pa: FA Davis; 1992.

  36. Cailliet R. Neck and Arm Pain. 3rd ed. Philadelphia, Pa: FA Davis; 1991.

  37. Cohen RB, Williams GR Jr. Impingement syndrome and rotator cuff disease as repetitive motion disorders. Clin Orthop. Jun 1998;(351):95-101. [Medline].

  38. Costa CR, Morrison WB, Carrino JA. MRI features of intersection syndrome of the forearm. AJR Am J Roentgenol. Nov 2003;181(5):1245-9. [Medline]. [Full Text].

  39. Geraci MC, Brown W. Evidence-based treatment of hip and pelvic injuries in runners. Phys Med Rehabil Clin N Am. Aug 2005;16(3):711-47.

  40. Hadler NM. Coping with arm pain in the workplace. Clin Orthop. Jun 1998;(351):57-62. [Medline].

  41. Hoppenfeld S. Physical Examination of the Spine and Extremities. New York, NY: Appleton-Century-Crofts; 1976.

  42. Kaufman KR, Brodine SK, Shaffer RA, et al. The effect of foot structure and range of motion on musculoskeletal overuse injuries. Am J Sports Med. Sep-Oct 1999;27(5):585-93. [Medline].

  43. Lassen CF, Mikkelsen S, Kryger AI, et al. Elbow and wrist/hand symptoms among 6,943 computer operators: a 1-year follow-up study (the NUDATA study). Am J Ind Med. Nov 2004;46(5):521-33.

  44. Lassen CF, Mikkelsen S, Kryger AI, et al. Risk factors for persistent elbow, forearm and hand pain among computer workers. Scand J Work Environ Health. Apr 2005;31(2):122-31. [Medline].

  45. Lazzarini KM, Troiano RN, Smith RC. Can running cause the appearance of marrow edema on MR images of the foot and ankle?. Radiology. Feb 1997;202(2):540-2. [Medline]. [Full Text].

  46. Maganaris CN, Narici MV, Reeves ND. In vivo human tendon mechanical properties: effect of resistance training in old age. J Musculoskelet Neuronal Interact. Jun 2004;4(2):204-8. [Medline].

  47. Morton JP, Atkinson G, MacLaren DP, et al. Reliability of maximal muscle force and voluntary activation as markers of exercise-induced muscle damage. Eur J Appl Physiol. Aug 2005;94(5-6):541-8.

  48. Novak CB. Upper extremity work-related musculoskeletal disorders: a treatment perspective. J Orthop Sports Phys Ther. Oct 2004;34(10):628-37. [Medline].

  49. Novak CB, Mackinnon SE. Nerve injury in repetitive motion disorders. Clin Orthop. Jun 1998;(351):10-20. [Medline].

  50. Plastaras CT, Rittenberg JD, Rittenberg KE, et al. Comprehensive functional evaluation of the injured runner. Phys Med Rehabil Clin N Am. Aug 2005;16(3):623-49.

  51. Rooks MD, Johnston RB 3rd, Ensor CD, et al. Injury patterns in recreational rock climbers. Am J Sports Med. Nov-Dec 1995;23(6):683-5. [Medline].

  52. Safran MR, Fu FH. Uncommon causes of knee pain in the athlete. Orthop Clin North Am. Jul 1995;26(3):547-59. [Medline].

  53. Scheer SJ, Mital A. Ergonomics. Arch Phys Med Rehabil. Mar 1997;78(3 Suppl):S36-45. [Medline].

  54. Shah SN, Miller BS, Kuhn JE. Chronic exertional compartment syndrome. Am J Orthop. Jul 2004;33(7):335-41. [Medline].

  55. Sheon RP. Repetitive strain injury. 1. An overview of the problem and the patients. The Goff Group. Postgrad Med. Oct 1997;102(4):53-6, 62, 68. [Medline].

  56. Sjogaard G, Sogaard K. Muscle injury in repetitive motion disorders. Clin Orthop. Jun 1998;(351):21-31. [Medline].

  57. Szabo RM. Carpal tunnel syndrome as a repetitive motion disorder. Clin Orthop. Jun 1998;(351):78-89. [Medline].

  58. Toledo SD, Nadler SF, Norris RN, et al. Sports and performing arts medicine. 5. Issues relating to musicians. Arch Phys Med Rehabil. Mar 2004;85(3 Suppl 1):S72-4.

  59. Viikari-Juntura E. Risk factors for upper limb disorders. Implications for prevention and treatment. Clin Orthop. Jun 1998;(351):39-43. [Medline].

  60. Werner RA, Franzblau A, Gell N, et al. A longitudinal study of industrial and clerical workers: predictors of upper extremity tendonitis. J Occup Rehabil. Mar 2005;15(1):37-46. [Medline].

  61. Wilson JJ, Best TM. Common overuse tendon problems: a review and recommendations for treatment. Am Fam Physician. Sep 1 2005;72(5):811-8. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.