Tendinitis is the painful inflammation of a tendon and its ligaments, which
attach it to the bone. It often results from the stress of repetitive movements.
Acute tendinitis may become chronic if it is not treated. The areas most
commonly affected by tendinitis are the shoulder (rotator cuff tendinitis or
impingement syndrome), elbow (tennis elbow or golfer's elbow), wrist and thumb
(de Quervain's disease), knee (jumper's knee), and ankle (Achilles tendinitis).
Calcific tendinitis, which occurs when calcium deposits build up in a joint,
often appears in people with a chronic disease, such as diabetes.
Signs and Symptoms
Minor edema (swelling)
Tenderness in affected limb
Pain that worsens when you move the affected limb
Warmth and redness
What Causes It?
Although the exact cause of tendinitis is unknown, it can result from
overuse, undertraining, or poor technique in sports, repetitive movement in
certain occupations, falling, lifting or carrying heavy objects, and extreme or
repeated trauma. It may also be seen with certain inflammatory conditions (for
example, Reiter's syndrome, ankylosing spondylitis), autoimmune disorders (for
example, diabetes mellitus), and some infections.
What to Expect at Your Provider's Office
Your health care provider will give you a thorough physical examination. X
rays may be taken and other diagnostic tests may be
Your provider may prescribe pain relievers or steroid injections. Treatment
also may include ice, rest, or temporary immobilization. Massage, strengthening
exercises, or physical therapy help improve tendon use. Ultrasound and use of
electricity help to control pain. Surgery is used only for severe tendinitis
that is not healing from other treatments.
Nonsteroidal anti-inflammatory drugs
(NSAIDs)—such as indocin (by prescription) and
ibuprofen (over the counter), reduce pain and inflammation; various side
Lidocaine or corticosteroid injections into the
tendon—cannot be used for weight-bearing tendons
because of risk of rupture
Colchicine—for calcific tendinitis (when
calcium builds up in the joint)
Complementary and Alternative
Ice, especially after the initial injury
Temporary immobilization of the affected limb (slings,
Flexibility and strengthening exercises after acute phase has
Physical therapy (such as range-of-motion exercises)
(phonophoresis)—high-frequency sound to heat an area
and increase the blood supply
Transcutaneous electrical nerve stimulation
(TENS)—electricity used to control
Vitamin C (250 to 500 mg two times a day) to aid in healing, increase
immune function, and reduce inflammation
Calcium (1,500 mg a day) and magnesium (750 mg a day) to aid healing
of connective tissues and muscles
Vitamin A (15,000 IU a day) for immune function and
Vitamin E (400 to 800 mg a day) to reduce inflammation
Bromelain (250 to 750 mg three times a day between meals) to reduce
Essential fatty acids (1,000 to 1,500 IU one to three times a day):
Herbs may be used as dried extracts (capsules, powders, teas), glycerites
(glycerine extracts), or tinctures (alcohol extracts). Unless otherwise
indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep
covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots.
Drink 2 to 4 cups per day.
Flavonoids (500 to 1,000 mg three times a day) to reduce inflammation
and maintain healthy collagen (protein found in connective tissue, skin,
cartilage, and other tissue)
Curcumin (Curcuma longa), yellow pigment of turmeric, (200 to
400 mg three times a day between meals) to reduce inflammation
Willow (Salix alba) bark tea (2 to 3 tsps. in 1 cup of boiling
water three times a day) for pain relief. (Caution: if you are allergic to
aspirin, do not take willow bar or other aspirin-like herbs.)
Licorice (Glycyrrhiza glabra) (3 cups tea a day) to reduce
inflammation. (Do not use if you have high blood pressure.)
Comfrey (Symphytum officinale) (1 tsp. in 1 cup boiling water
four times a day) to aid healing and for pain
Homeopathic remedies for tendinitis include creams or gels. Arnica
cream by itself or in combination with Calendula officinalis, Hamamelis
virginiana, Aconitum napellus, and Belladonna, applied three to six
times a day, speeds healing and decreases discomfort. For acute injuries, always
start with Arnica.
Internally, the dose is usually 3 to 5 pellets of a 12X to 30C remedy every
one to four hours until the symptoms get better.
Bryonia for pains that are worse with the slightest motion or
when jarred. The pain feels worse with cold and better with heat.
Phytolacca for tendinitis where the pain is focused at the
insertion of the tendons and feels worse with heat
Rhus toxicodendron for tendinitis that is worse in the
Rhododendron for tendinitis that gets worse with barometric
Orthotics or heel lifts and shoe correction (Achilles
Elbow strap and small (2 lb.) weights (tennis elbow)
Contrast hydrotherapy. Alternate hot and cold applications. After the
first 24 to 48 hours, soak affected part for three minutes in hot water, then 30
seconds in cold water.
In 1997, the National Institutes of Health reported that acupuncture may be
an effective therapy for tennis elbow. In addition, two studies examining the
effect of acupuncture on this and other types of tendinitis have found that
acupuncture provides better pain relief than placebo.
Acupuncturists report that patients with tendinitis frequently exhibit a
primary deficiency in the liver meridian, with a relative excess in the
gallbladder meridian. In addition to needling treatment on the liver meridian
and the supporting kidney meridian, treatments using moxibustion (a technique in
which the herb mugwort is burned over specific acupuncture points) may also be
included. Needling and/or moxibustion may also be directly applied to painful
areas and related sore points.
Although no well-designed studies have examined the effectiveness of
chiropractic treatment for tendinitis, chiropractors commonly treat this
condition with ultrasound, electrical muscle stimulation, manual trigger point
therapy (applying firm pressure by hand on a trigger point for several seconds
and then stretching the muscle afterwards), and massage. Joint manipulation may
also be performed on individuals with diminished joint
Tendinitis often has three stages: Stage 1 is characterized by a dull ache
following activity, which improves with rest; stage 2, by pain with minor
movements (for example, dressing); and stage 3, by constant
Recurrences are common, particularly for athletes and people whose work
requires repetitive motions.
Balch JF, Balch PA. Prescription for Nutritional Healing. 2nd ed.
Garden City Park, NY: Avery Publishing; 197:174-175.
Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C
based on antioxidant and health effects in humans. Am J Clin Nutr.
Duke JA. The Green Pharmacy. Emmaus, Pa: Rodale Press;
JAMA Patient Page. How much vitamin C do you need? JAMA.
Gimblett PA, Saville J, Ebrall P. A conservative management protocol for
calcific tendonitis of the shoulder. J Manipulative Physiol Ther.
Jensen R, Gothesen O, Liseth K, Baerheim A. Acupuncture treatment of
patellofemoral pain syndrome. J Altern Complement Med.
Johnston CS. Recommendations for vitamin C intake. JAMA.
Kelly WN, Harris ED Jr, Ruddy S, Sledge CB. Textbook of Rheumatology.
5th ed. Philadelphia, Pa: WB Saunders Co; 1997:372-373, 386, 422-429,
462-463, 486, 558-559, 598-599, 603-606, 642.
Kleinhenz J, Streitberger K, Windeler J, Gubbacher A, Mavridis G, Martin E.
Randomised clinical trial comparing the effects of acupuncture and a newly
designed placebo needle in rotator cuff tendinitis. Pain.
Koopman WJ. Arthritis and Allied Conditions: A Textbook of Rheumatology.
13th ed. Baltimore, Md:Williams & Wilkins; 1997:44, 1769-1771, 1795,
Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and
recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.
Millar AP. Sports Injuries and Their Management. Sydney, Australia:
Maclennan & Petty; 1994:10-14, 84-85, 101-103, 111-112, 118-119,
Molsberger A, Hille E. The analgesic effect of acupuncture in chronic tennis
elbow pain. Br J Rheumatol. 1994;33:1162-1165.
Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms.
Albany, Calif: Hahnemann Clinic Publishing; 1993:72-74, 298.
Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed.
Rocklin, Calif: Prima Publishing; 1998:805-809.
NIH Consensus Statement: Acupuncture. National Institutes of Health, Office
of the Director. 1997;15(5):1-34. Accessed at
on September 24, 2001.
Noble J. Textbook of General Medicine and Primary Care. Boston, Mass:
Little, Brown; 1987:228-229, 288-290, 293-296.
Vinger PF, Hoener EF, eds. Sports Injuries: The Unthwarted Epidemic.
Boston, Mass: John Wright; 1982:227, 255.
Review Date: August 1999
Reviewed By: Participants in the review process include: Gary Guebert, DC, DACBR,
(Chiropractic section October 2001) Login Chiropractic College, Maryland
Heights, MO; Peter Hinderberger, MD, PhD, Ruscombe Mansion Community Health
Center, Baltimore, MD; Joseph Lamb, MD, The Integrative Medicine Works,
Alexandria, VA; Joseph Trainor, DC, (Chiropractic section October 2001)
Integrative Therapeutics, Inc., Natick, MA; Marcellus Walker, MD, LAc,
(Acupuncture section October 2001) St. Vincent's Catholic Medical Center, New
York, NY; Terry Yochum, DC, Rocky Mountain Chiropractic Center, Arvada, CO; Ira
Zunin, MD, MPH, MBA, (Acupuncture section October 2001) President and Chairman,
Hawaii State Consortium for Integrative Medicine, Honolulu,
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