Tendon Injury (Tendinopathy)

Treatment Overview

Initial treatment for a tendon injury (tendinopathy) generally includes rest and pain relievers. Acetaminophen can reduce pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce both the pain and inflammation you might have from a tendon injury. The goals of this early treatment are to:

• Reduce pain and inflammation of the tendon.
• Restore normal motion and strength.

If you are still having pain, stiffness, and weakness after initial treatment, your health professional may recommend some type of physical therapy. In addition, you may need to make long-term changes in the type of activities you do or how you do them to prevent your tendinopathy from returning. The goals of ongoing treatment are to:

• Reduce pain.
• Avoid further degeneration or tearing of the tendon.
• Encourage regeneration of the damaged tendon.

Treatment for tendinopathies

Take the following steps to treat tendinopathies:

• Rest the affected area, and avoid any activity that may cause pain. Get enough sleep. To maintain your overall health and fitness, continue exercising but only in ways that do not stress the affected area. Do not resume an aggravating activity as soon as the pain stops. Tendons require weeks of additional rest to heal. You may need to make long-term changes in the types of activities you do or how you do them.
• Apply ice or cold packs as soon as you notice pain and tenderness in your muscles or near a joint. Apply ice 10 to 15 minutes at a time, as often as twice an hour, for 72 hours. Continue applying ice (15 to 20 minutes at a time, 3 times a day) as long as it relieves pain. Although heating pads may feel good, ice will relieve pain and inflammation.
• Take pain relievers if needed. Use acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, or aspirin, as directed for pain relief. (Do not give aspirin to anyone younger than age 20 because of the risk of Reye syndrome, a central nervous system complication in children.) NSAIDs also reduce any inflammation you might have in or around the tendon (tendinitis). Do not rely on medicine to relieve pain in order to continue overusing a joint.
• Do range-of-motion exercises each day. Gently move your joint through its full range of motion, even during the time that you are resting the joint area. This will prevent stiffness in your joint. As the pain goes away, continue range-of-motion exercises and add other exercises to strengthen the muscles around your joint.
• Gradually resume your activity at a lower intensity than you maintained before your symptoms began. Warm up before and stretch after the activity. You can also try making some changes. For example, if exercise has caused your tendinopathy, try alternating with another activity. If using a tool is the problem, try alternating hands or changing your grip. Increase your activity slowly, and stop if it hurts. After the activity, apply ice to prevent pain and swelling.
• Avoid tobacco smoke. Tendon injuries heal more slowly in smokers than in nonsmokers. Smoking delays wound and tissue healing.

If these steps do not help to relieve pain, other treatment may be considered. Your health professional may:

• Prescribe physical therapy.
• Use a corticosteroid injection to relieve pain and swelling. But corticosteroid treatments usually are not repeated because of the potential for tendon damage.
• Prescribe a brace, splint, sling, or crutches for a brief period to allow tendons to rest and heal.
• Recommend a cast to rest and heal a badly damaged tendon. Casting or surgery is typically used to treat a ruptured tendon.

Medical researchers continue to study new ways to treat tendon injuries. In separate small clinical trials, nitric oxide and glyceryl trinitrate, applied topically (to the skin), showed promise at relieving pain caused by tendon injury.^{2, 3} In another study, the pain caused by calcific tendinitis (calcium built up in the tendons) was relieved by directing ultrasonic, or shock, waves at the injured tendon (shock wave therapy).⁴

Open or arthroscopic surgery is sometimes used to treat calcific tendinitis that has not responded to nonsurgical treatment and is causing pain.¹

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Author:	Shannon Erstad, MBA/MPH	Last Updated: December 17, 2008
Medical Review:	Adam Husney, MD - Family Medicine William M. Green, MD - Emergency Medicine Nicola Maffulli, MD, PhD - Orthopedics
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