Medscape is available in 5 Language Editions – Choose your Edition here.


Tendonitis Treatment & Management

  • Author: Mark Steele, MD; Chief Editor: Herbert S Diamond, MD  more...
Updated: Oct 01, 2014

Approach Considerations

The goal of treatment is to reduce pain and to return to activity. Nonpharmacologic treatments of tendinopathy are as follows:

  • Rest or decrease activity level. No clear recommendations are available for the duration of rest; however, patients should restrict activities that cause pain.
  • Ice is recommended for the first 24-48 hours.
  • Splinting and/or immobilization; sling for rotator cuff tendonitis
  • Strengthening and stretching exercises can be performed once the pain has subsided. Eccentric strength training can be effective in treating tendinopathies.

Low-intensity pulsed ultrasound was shown to be no more effective than placebo in the treatment of patellar tendinopathy.[9] Transcutaneous electrical nerve stimulation (TENS) provided no benefit over primary care management in a randomized trial in 241 adults with tennis elbow.[10]

Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in relieving tendinopathy pain, and may be administered topically or orally. However, because the vast majority of tendinopathies are not inflammatory, whether NSAIDs are more effective than other analgesics is unclear.

Corticosteroid injection may be considered for patients with tendonitis in whom conservative therapy with rest, immobilization, and anti-inflammatory agents has failed.The corticosteroid (eg, triamcinolone) is typically combined with a local anesthetic (eg, lidocaine) to provide prompt analgesia; in addition, pain relief confirms the diagnosis and accurate placement of the corticosteroid.

The efficacy of locally injected steroids is debated. A systematic review concluded that steroid injections provide short-term pain relief but may not have long-term efficacy.[11] Response to injection therapy may vary with the anatomic site of tendinopathy.

A randomized, controlled trial in 165 patients with unilateral lateral epicondylalgia of longer than 6 weeks' duration found that although results at 4 weeks favored corticosteroid injection, at 1 year the rate of much improvement or complete recovery was lower with corticosteroid injection than with placebo injection (83% vs 96%, respectively; relative risk [RR], 0.86; P = 0.01)). One-year recurrence was also higher with corticosteroid versus placebo (54% vs 12%; RR, 0.23; P < 0.001).[12]

Never use injections for Achilles tendonitis, because cases of Achilles tendon rupture have been reported following a single injection of corticosteroid. Avoid repetitive corticosteroid injections in any site, as well as injection directly into a tendon, because of the risk of tendon rupture.

In patients with calcific tendonitis of the shoulder, a systematic review concluded that ultrasound (US)-guided needling and lavage has a high success rate and low complication rate.[13] In a randomized controlled study in 48 patients with calcific tendonitis of the rotator cuff that compared the combination of barbotage and US-guided corticosteroid injection in the subacromial bursa with subacromial bursa injection alone, both treatment groups demonstrated improvement at 1-year follow-up, but clinical and radiographic results were significantly better in the barbotage group.[14] After US-guided treatment, recovery may be enhanced by use of a rehabilitation protocol that focuses on mobility, strength, and function.[15]

Surgical therapy

Patients with symptoms resistant to conservative therapy may benefit from arthroscopic or open surgical treatment for tendon decompression and tenodesis. A Japanese study in 23 patients with chronic lateral epicondylitis who underwent arthroscopic surgery found that the procedure provided significant improvement in pain and functional recovery up to 3 months after surgery. However, the visual analog scale (VAS) for pain and satisfaction criteria during activity did not fall below 10 points until 6 months postoperatively.[16]

Platelet-rich therapies

Platelet-rich therapies represent an experimental approach to treatment of tendinopathies and other musculoskeletal soft tissue injuries. In this technique, a quantity of the patient's blood is centrifuged and the active, platelet-rich fraction is extracted and applied to the injured tissue (eg, by injection). In theory, the growth factors produced by platelets should enhance tissue healing. Although platelet-rich therapies are gaining wider use, a Cochrane review concluded that at present there is insufficient evidence to support the clinical use of platelet-rich therapies.[17]

Contributor Information and Disclosures

Mark Steele, MD Professor, Department of Emergency Medicine, Chief Medical Officer, Truman Medical Center, University of Missouri-Kansas City School of Medicine

Mark Steele, MD is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.


Jeffrey G Norvell, MD Clinical Assistant Professor of Emergency Medicine, University of Kansas School of Medicine

Jeffrey G Norvell, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Gino A Farina, MD, FACEP, FAAEM Professor of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine at Hofstra University; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Richard S Krause, MD Senior Clinical Faculty/Clinical Assistant Professor, Department of Emergency Medicine, University of Buffalo State University of New York School of Medicine and Biomedical Sciences

Richard S Krause, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

  1. Taylor SA, Hannafin JA. Evaluation and management of elbow tendinopathy. Sports Health. 2012 Sep. 4(5):384-93. [Medline]. [Full Text].

  2. Mann KJ, Edwards S, Drinkwater EJ, Bird SP. A lower limb assessment tool for athletes at risk of developing patellar tendinopathy. Med Sci Sports Exerc. 2012 Oct 10. [Medline].

  3. Khaund R, Flynn SH. Iliotibial band syndrome: a common source of knee pain. Am Fam Physician. 2005 Apr 15. 71(8):1545-50. [Medline].

  4. Ackermann PW, Renström P. Tendinopathy in sport. Sports Health. 2012 May. 4(3):193-201. [Medline]. [Full Text].

  5. Gold L, Igra H. Levofloxacin-induced tendon rupture: a case report and review of the literature. J Am Board Fam Pract. 2003 Sep-Oct. 16(5):458-60. [Medline].

  6. Wise BL, Peloquin C, Choi H, Lane NE, Zhang Y. Impact of Age, Sex, Obesity, and Steroid Use on Quinolone-associated Tendon Disorders. Am J Med. 2012 Sep 28. [Medline].

  7. Harrell RM. Fluoroquinolone-induced tendinopathy: what do we know?. South Med J. 1999 Jun. 92(6):622-5. [Medline].

  8. Warden SJ, Kiss ZS, Malara FA, Ooi AB, Cook JL, Crossley KM. Comparative accuracy of magnetic resonance imaging and ultrasonography in confirming clinically diagnosed patellar tendinopathy. Am J Sports Med. 2007 Mar. 35(3):427-36. [Medline].

  9. Warden SJ, Metcalf BR, Kiss ZS, Cook JL, Purdam CR, Bennell KL, et al. Low-intensity pulsed ultrasound for chronic patellar tendinopathy: a randomized, double-blind, placebo-controlled trial. Rheumatology (Oxford). 2008 Apr. 47(4):467-71. [Medline].

  10. Chesterton LS, Lewis AM, Sim J, Mallen CD, Mason EE, Hay EM, et al. Transcutaneous electrical nerve stimulation as adjunct to primary care management for tennis elbow: pragmatic randomised controlled trial (TATE trial). BMJ. 2013 Sep 2. 347:f5160. [Medline]. [Full Text].

  11. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010 Nov 20. 376(9754):1751-67. [Medline].

  12. Coombes BK, Bisset L, Brooks P, Khan A, Vicenzino B. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA. 2013 Feb 6. 309(5):461-9. [Medline]. [Full Text].

  13. Gatt DL, Charalambous CP. Ultrasound-Guided Barbotage for Calcific Tendonitis of the Shoulder: A Systematic Review including 908 Patients. Arthroscopy. 2014 Sep. 30(9):1166-1172. [Medline].

  14. de Witte PB, Selten JW, Navas A, Nagels J, Visser CP, Nelissen RG, et al. Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids. Am J Sports Med. 2013 Jul. 41(7):1665-73. [Medline].

  15. Abate M, Schiavone C, Salini V. Usefulness of Rehabilitation in Patients with Rotator Cuff Calcific Tendinopathy after Ultrasound-Guided Percutaneous Treatment. Med Princ Pract. 2014 Sep 6. [Medline].

  16. Oki G, Iba K, Sasaki K, Yamashita T, Wada T. Time to functional recovery after arthroscopic surgery for tennis elbow. J Shoulder Elbow Surg. 2014 Oct. 23(10):1527-31. [Medline].

  17. Moraes VY, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC. Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev. 2013 Dec 23. 12:CD010071. [Medline].

  18. Adler RS, Finzel KC. The complementary roles of MR imaging and ultrasound of tendons. Radiol Clin North Am. 2005 Jul. 43(4):771-807, ix. [Medline].

  19. Biundo JJ Jr, Mipro RC Jr, Fahey P. Sports-related and other soft-tissue injuries, tendinitis, bursitis, and occupation-related syndromes. Curr Opin Rheumatol. 1997 Mar. 9(2):151-4. [Medline].

  20. Biundo JJ, Irwin RW, Umpierre E. Sports and other soft tissue injuries, tendinitis, bursitis, and occupation-related syndromes. Curr Opin Rheumatol. 2001 Mar. 13(2):146-9. [Medline].

  21. Crawford JO, Laiou E. Conservative treatment of work-related upper limb disorders: a review. Occup Med (Lond). 2007 Jan. 57(1):4-17. [Medline].

  22. Garrick JG, Webb DR. Sports Injuries: Diagnosis and Management. Philadelphia, Pa: WB Saunders; 1990.

  23. Hales TR, Bernard BP. Epidemiology of work-related musculoskeletal disorders. Orthop Clin North Am. 1996 Oct. 27(4):679-709. [Medline].

  24. McLoughlin RF, Raber EL, Vellet AD, et al. Patellar tendinitis: MR imaging features, with suggested pathogenesis and proposed classification. Radiology. 1995 Dec. 197(3):843-8. [Medline].

  25. Sharma P, Maffulli N. Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am. 2005. 87-A:187-202. [Medline].

  26. Sorosky B, Press J, Plastaras C, Rittenberg J. The practical management of Achilles tendinopathy. Clin J Sport Med. 2004 Jan. 14(1):40-4. [Medline].

  27. Tytherleigh-Strong G, Hirahara A, Miniaci A. Rotator cuff disease. Curr Opin Rheumatol. 2001 Mar. 13(2):135-45. [Medline].

  28. van Tulder M, Malmivaara A, Koes B. Repetitive strain injury. Lancet. 2007 May 26. 369(9575):1815-22. [Medline].

  29. Wang JH, Iosifidis MI, Fu FH. Biomechanical basis for tendinopathy. Clin Orthop Relat Res. 2006 Feb. 443:320-32. [Medline].

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

Hawkins test. The examiner forward flexes the arms to 90° and then forcibly internally rotates the shoulder. This movement pushes the supraspinatus tendon against the anterior surface of the coracoacromial ligament and coracoid process. Pain indicates a positive test result for supraspinatus tendonitis.
Speed test.
Yergason test.
The proximal patellar tendon is most commonly affected in jumper's knee.
Iliotibial band at the lateral femoral condyle, with the posterior fibers denoted.
The Ober test.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.