Tendonitis Treatment & Management

  • Author: Mark Steele, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Dec 29, 2010
 

Emergency Department Care

The goal of treatment is to reduce pain and to return to activity.

Treatments of tendinopathy are listed below.

  • 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.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in relieving tendinopathy pain. However, because the vast majority of tendinopathies are not inflammatory, whether NSAIDs are more effective than other analgesics is unclear.
  • 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.[5]
  • Peritendinous lidocaine/corticosteroid injection
    • Consider this injection for patients with tendonitis in whom conservative therapy with rest, immobilization, and anti-inflammatory agents has failed.
    • 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. Response to injection therapy may vary with the anatomic site of tendinopathy.[6]
    • Never inject into the Achilles tendon 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.
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Consultations

An ED consultation is rarely necessary for tendonitis.

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Contributor Information and Disclosures
Author

Mark Steele, MD  Associate Dean for Truman Medical Center Programs, Professor, Department of Emergency Medicine, University of Missouri-Kansas City

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

Disclosure: Nothing to disclose.

Coauthor(s)

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, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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

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, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Gino A Farina, MD, FACEP, FAAEM  Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; 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, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

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

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

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

  4. [Best Evidence] 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. Mar 2007;35(3):427-36. [Medline].

  5. 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). Apr 2008;47(4):467-71. [Medline].

  6. 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. Nov 20 2010;376(9754):1751-67. [Medline].

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

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

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

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

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

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

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

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

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

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

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

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

  19. 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].

 
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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.
 
 
 
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