Also indexed as: Tendonitis
Tendinitis tenderness can slow you down and cramp your lifestyle.
What can you do to calm the inflammation and ease the pain? According to research or other
evidence, the following self-care steps may be helpful:
- 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 several tablets of bromelain or similar enzymes every day to
reduce the severity of symptoms and speed healing
- Get to know DMSO
- Under the guidance of a qualified healthcare professional, apply
this topical anti-inflammatory agent (10% dimethyl sulfoxide gel) twice a day to reduce pain
and swelling
- Make an appointment with an acupuncturist
- See a qualified practitioner for a series of treatments that may
reduce pain and increase function
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full tendinitis article for more
in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and
lifestyle changes that may be helpful.
About tendinitis
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
Product ratings for
tendinitis
What are the symptoms?
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.
Medical options
Over-the-counter pain medications, such as
aspirin (Genuine Bayer®, Ecotrin®, Bufferin®), acetaminophen (Tylenol®), naproxen (Aleve®),
and ibuprofen (Motrin IB®, Advil®),
are routinely recommended to relieve minor pain and reduce inflammation. Topical methyl
salicylate (Icy Hot®, Bengay®), trolamine salicylate (Aspercreme®), and
combination counterirritant products (Maximum Strength Flexall 454®) may be beneficial to
relieve pain.
Prescription strength nonsteroidal
anti-inflammatory drugs (NSAIDs), such as
celecoxib (Celebrex®), ibuprofen (Motrin®), naproxen (Anaprox®, Naprosyn®), meloxicam (Mobic®), and indomethacin (Indocin®), may be necessary to
treat inflammation and pain. Acetaminophen combined with codeine (Tylenol® with Codeine) or hydrocodone (Vicodin®, Lortab®, Norco®)
may be used to treat moderate pain.
Treatment may include local injections of
steroids such as dexamethasone (Decadron-LA®), methylprednisolone
(Depo-Medrol®), and hydrocortisone (Solu-Cortef®), or anesthetics such as lidocaine
(Xylocaine®), as well as immobilization and controlled physical therapy.
Lifestyle changes that may be helpful
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
Vitamins that may be helpful
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.7 Other
preliminary8 9 and double-blind10 11 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.12
Certain precautions must be taken when applying DMSO, and it should only be used under the
guidance of a qualified healthcare professional.
Alternative healthcare practitioners frequently recommend proteolytic enzymes for various minor injuries.
Research demonstrates that these enzymes are well absorbed when taken by mouth,13
14 and preliminary15 16 17 18 and
double-blind19 20 21 22 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.
Bromelain, a proteolytic enzyme, is an
anti-inflammatory agent and for this reason is helpful in healing minor injuries, particularly
sprains and strains, muscle injuries, and the
pain, swelling, and tenderness that accompany
sports injuries.23 24 25
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Holistic approaches that may be helpful
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.26 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.27 A
third controlled study found no benefit from ten treatments of laser acupuncture for tennis
elbow.28
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.29
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.30 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).31 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.32 33 Controlled studies are needed to confirm these
findings.
References: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. Kneer W, Kuhnau S, Bias P, et al. Dimethylsulfoxide (DMSO) gel in
treatment of acute tendopathies. A multicenter, placebo-controlled, randomized study.
Fortschritte Med 1994;112:142–6 [in German].
8. Lockie LM, Norcross BM. A clinical study on the effects of dimethyl
sulfoxide in 103 patients with acute and chronic musculoskeletal injuries and inflammations.
Ann N Y Acad Sci 1967;141:599–602.
9. Steinberg A. The employment of dimethyl sulfoxide as an
antiinflammatory agent and steroid-transporter in diversified clinical diseases. Ann N Y
Acad Sci 1967;141:532–50.
10. Brown JH, Wood DC, Jacob SW. Current status of dimethyl sulfoxide
(DMSO). A double blind evaluation of its therapeutic value in acute strains, sprains, bursitis
and tendonitis. Bull Soc Int Chir 1972;31:561–6.
11. Brown JH. A double blind study-DMSO for acute injuries and
inflammations compared to accepted standard therapy. Curr Ther Res Clin Exp
1971;13:536–40.
12. Percy EC, Carson JD. The use of DMSO in tennis elbow and rotator cuff
tendonitis: a double-blind study. Med Sci Sports Exerc 1981;13:215–9.
13. Miller JM. The absorption of proteolytic enzymes from the
gastrointestinal tract. Clin Med 1968;75:35–42 [review].
14. Castell JV, Friedrich G, Kuhn CS, et al. Intestinal absorption of
undegraded proteins in men: presence of bromelain in plasma after oral intake. Am J
Physiol 1997;273:G139–46.
15. Cirelli MG. Five years’ experience with bromelains in therapy
of edema and inflammation in postoperative tissue reaction, skin infections and trauma.
Clin Med 1967;74:55–9.
16. Trickett P. Proteolytic enzymes in treatment of athletic injuries.
Appl Ther 1964;6:647–52.
17. Sweeny FJ. Treatment of athletic injuries with an oral proteolytic
enzyme. Med Times 1963:91:765.
18. Boyne PS, Medhurst H. Oral anti-inflammatory enzyme therapy in
injuries in professional footballers. Practitioner 1967;198:543–6.
19. Deitrick RE. Oral proteolytic enzymes in the treatment of athletic
injuries: A double-blind study. Pennsylvania Med J 1965;Oct:35–7.
20. Holt HT. Carica papaya as ancillary therapy for athletic injuries.
Curr Ther Res 1969;11:621–4.
21. Rathgeber WF. The use of proteolytic enzymes (Chymoral) in sporting
injuries. S Afr Med J 1971;45:181–3.
22. Buck JE, Phillips N. Trial of Chymoral in professional footballers.
Br J Clin Pract 1970;24:375–7.
23. Seligman B. Bromelain: an anti-inflammatory agent. Angiology
1962;13:508–10.
24. Cirelli MG. Treatment of inflammation and edema with bromelain.
Delaware Med J 1962;34:159–67.
25. Masson M. Bromelain in the treatment of blunt injuries to the
musculoskeletal system. A case observation study by an orthopedic surgeon in private practice.
Fortschr Med 1995;113:303–6.
26. 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.
27. Haker E, Lundeberg T. Acupuncture treatment in epicondylalgia: a
comparative study of two acupuncture techniques. Clin J Pain 1990;6:221–6.
28. Haker E, Lundeberg T. Laser treatment applied to acupuncture points
in lateral humeral epicondylalgia. A double-blind study. Pain
1990;43:243–7.
29. Ebenbichler GR, Erdogmus CB, Resch KL, et al. Ultrasound therapy for
calcific tendonitis of the shoulder. N Engl J Med 1999;340:1533–8.
30. 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.
31. 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.
32. Kaada B. Treatment of peritendinitis calcarea of the shoulder by
transcutaneous nerve stimulation. Acupunct Electrother Res 1984;9:115–25.
33. 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].