About This Condition
Uncover the cause
Work with a knowledgeable health professional to find out what is causing your tendinitis and apply effective treatments
Discover proteolytic enzymes
Take a few tablets of bromelain or similar enzymes every day to reduce the severity of symptoms and speed healing
Make an appointment with an acupuncturist
See a qualified practitioner for a series of treatments that may reduce pain and increase function
About This Condition
Tendinitis is a condition where a tendon or the connective tissue that surrounds the tendon becomes inflamed.
This is often due to overuse (e.g., repetitive work activities), acute injury, or excessive exercise. People who are at higher risk of developing tendinitis include athletes, manual laborers, and computer keyboard users. Occasionally, tendinitis may be due to diseases that affect the whole body, such as rheumatoid arthritis or gout.
The most common sites of tendinitis are the shoulder, elbow, forearm, thumb, hip, hamstring muscles (in the back of the upper leg), and Achilles tendon (behind the ankle).1
People with tendinitis may have symptoms, which appear after injury or overuse, including swelling, redness, tenderness, and sharp pain in the affected area, which is worsened with movement or pressure.
Healthy Lifestyle Tips
Many people suffer from tendinitis as a result of their work environment. Studies have shown that tendinitis of the wrist, hands, and fingers are often caused by repetitive work and physical stress.2 , 3 , 4 Physical changes to the work environment, such as setting up the work station so that the body is in a balanced, untwisted position, minimizing the need to use excessive force, avoiding overuse of any one joint, changing positions frequently, and allowing for rest periods, have all been shown to diminish symptoms of lower arm tendinitis.5 One study of computer workers with arm and wrist tendinitis found that using an ergonomic keyboard versus a standard keyboard reduced the severity of pain and improved hand function after six months of use.6
Acupuncture may be helpful for treating tendinitis. A controlled trial compared acupuncture to sham (fake) acupuncture in people with shoulder tendinitis and found that acupuncture treatment produced significantly higher scores on a combined measurement of pain, ability to perform daily activities, ability to move shoulder without pain, and strength.7 This study also reported that the beneficial effects of acupuncture continued for at least three months following treatment. Another controlled study found traditional "deep" acupuncture more effective than superficial acupuncture for tennis elbow immediately after a series of ten treatments, but at 3 to 12 months' follow up, both treatment groups had improved similarly.8 A third controlled study found no benefit from ten treatments of laser acupuncture for tennis elbow.9
Certain treatments used by physicians and other healthcare practitioners have been shown to be effective for tendinitis. In a controlled trial, patients with tendinitis of the shoulder received 24 treatments over six weeks of either ultrasound or a sham treatment.10 Ultrasound resulted in considerable improvement in pain level and overall quality of life, but many of the patients had their original symptoms return after nine months. The use of ultrasound for tennis elbow has not been validated, according to a systematic review of controlled studies.11 One controlled trial compared the effects of ultrasound alone to ultrasound plus a topical steroid medication (a process known as phonophoresis, where ultrasound is used to drive a substance into the skin).12 Both of these treatments were given three times per week for three weeks and both produced similar reductions in pain and tenderness.
Preliminary studies have suggested that daily use of TENS (transcutaneous electrical nerve stimulation) for one to two weeks reduces or eliminates pain in patients with tendinitis.13 , 14 Controlled studies are needed to confirm these findings.
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Apply a 10% gel twice per day under medical supervision
Dimethyl sulfoxide is anti-inflammatory and may be applied topically to reduce pain and swelling.
DMSO , or dimethyl sulfoxide, has a long history as a topical anti-inflammatory agent. One double-blind trial used a 10% DMSO gel topically on patients with tendinitis of the elbow and shoulder and found that it significantly reduced pain and inflammation in each joint. Other preliminary and double-blind trials found DMSO to be effective in treating tendinitis, but one double-blind trial found no difference between the effects of a 70% DMSO solution and a 5% DMSO placebo solution. Certain precautions must be taken when applying DMSO, and it should only be used under the guidance of a qualified healthcare professional.
2,000 to 9,000 mcu per day
Bromelain is anti-inflammatory and may help heal minor injuries and relieve pain.
Several tablets per day of proteolytic enzymes
Supplementing with digestive enzymes may reduce the severity of symptoms and speed healing.
Alternative healthcare practitioners frequently recommend proteolytic enzymes for various minor injuries. Research demonstrates that these enzymes are well absorbed when taken by mouth, and preliminary and double-blind trials have shown their effectiveness for reducing pain and swelling associated with various injuries and for speeding up the healing process. Unfortunately, many of these studies did not specifically identify the patients' injury, so it is unclear whether the positive results included improvements in tendinitis.
1. Berkow PK, Fletcher AJ, Beers MH (eds). The Merck Manual of diagnosis and therapy, 16th Ed. Rahway, NJ: Merck Research Laboratories, 1992;1367-8.
2. Latko WA. Armstrong TJ, Franzblau A, et al. Cross-sectional study of the relationship between repetitive work and the prevalence of upper limb musculoskeletal disorders. Am J Ind Med 1999;36:248-59.
3. Piligian G, Herbert R, Hearns M, et al. Evaluation and management of chronic work-related musculoskeletal disorders of the distal upper extremity. Am J Ind Med 2000;37:75-93.
4. Stock SR. Workplace ergonomic factors and the development of musculoskeletal disorders of the neck and upper limbs: a meta-analysis. Am J Ind Med 1991;19:87-107.
5. Piligian G, Herbert R, Hearns M, et al. Evaluation and management of chronic work-related musculoskeletal disorders of the distal upper extremity. Am J Ind Med 2000;37:75-93.
6. Tittiranonda P, Rempel D, Armstrong T, Burastero S. Effect of four computer keyboards in computer users with upper extremity musculoskeletal disorders. Am J Ind Med 1999;35:647-61.
7. Kleinhenz J, Streitberger K, Windeler J, et al. Randomised clinical trial comparing the effects of acupuncture and a newly designed placebo needle in rotator cuff tendinitis. Pain 1999;83:235-41.
8. Haker E, Lundeberg T. Acupuncture treatment in epicondylalgia: a comparative study of two acupuncture techniques. Clin J Pain 1990;6:221-6.
9. Haker E, Lundeberg T. Laser treatment applied to acupuncture points in lateral humeral epicondylalgia. A double-blind study. Pain 1990;43:243-7.
10. Ebenbichler GR, Erdogmus CB, Resch KL, et al. Ultrasound therapy for calcific tendonitis of the shoulder. N Engl J Med 1999;340:1533-8.
11. van der Windt DA, van der Heijden GJ, van den Berg SG, et al. Ultrasound therapy for musculoskeletal disorders: a systematic review. Pain 1999;81:257-71.
12. Klaiman MD, Shrader JA, Danoff JV, et al. Phonophoresis versus ultrasound in the treatment of common musculoskeletal conditions. Med Sci Sports Exerc 1998;30:1349-55.
13. Kaada B. Treatment of peritendinitis calcarea of the shoulder by transcutaneous nerve stimulation. Acupunct Electrother Res 1984;9:115-25.
14. Saveriano G, Lionetti P, Maiolo F, Battisti E. Our experience in the use of a new objective pain measuring system in rheumarthropatic subjects treated with transcutaneous electroanalgesia and ultrasound. Minerva Med 1986;77:745-52 [in Italian].
Last Review: 06-08-2015
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The information presented by Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2018.
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