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
- Crepitus (crackling)
|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.
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|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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