What treatment is there for tendinopathy or tenosynovitis?
The best treatment for tendinopathy or tenosynovitis is uncertain. However, one or more of the following treatments may be used:
- Rest. It is important to rest, or at least reduce the use of the affected area, to allow the condition to settle. Sometimes a splint, firm bandage or brace is put on a wrist if this is the area affected. This forces your hand and wrist to stay in the same position for a time to allow rest of the affected tendon.
- Ice packs over the affected area may ease swelling and pain. A simple ice pack can be made by wrapping a pack of frozen peas in a tea towel. Apply it to the affected area for 10 minutes twice a day to reduce pain.
- Anti-inflammatory painkillers are often prescribed (for example, ibuprofen). These ease pain and reduce inflammation. However, as discussed above, inflammation may not be the main problem in tendinopathy and tenosynovitis. They will, however, provide pain relief. Some anti-inflammatory painkillers also come as creams or gels which you can rub over the painful area. These tend to produce fewer side-effects than those taken by mouth. There are various brands which you can buy, or obtain on prescription. Ask your doctor or pharmacist for advice.
- Other painkillers. Other painkillers such as paracetamol, with or without codeine added, may be helpful.
- Physiotherapy is recommended if the condition is not settling with the above measures. A physiotherapist will give you a programme of exercises to gradually make the muscles of the affected tendon stronger. This will involve doing exercises that increase the load that the muscle can bear. These exercises are called eccentric loading exercises. They may be a bit painful but this does not mean they are harmful.
- A steroid injection into the affected area may be given if the above measures do not work. Steroid injections may be helpful in easing pain in the short term but they don't treat the underlying problem and pain tends to come back in many people.
- Surgical release of a tendon is a rarely needed option.
- Antibiotic medicines are needed in the rare situation where infection is the cause.
What about other treatments also being used to treat tendinopathy and tenosynovitis?
- Shock-wave therapy. This uses high-energy sound waves to treat the condition. A special device allows the shock waves to be passed through your skin to the affected area. A local anaesthetic may also be given, as sometimes the shock waves can be painful. One or more treatment sessions may be needed. The procedure appears to be safe but it is not clear yet exactly how well it works; more research is needed.
- Autologous blood injection. Blood is taken from you and then injected into the area around the damaged tendons. It is thought that the blood helps to heal the tendons. A local anaesthetic is often given as a pain relief during the procedure. Several treatment sessions may be needed. This procedure is generally only considered if all other treatments have failed. Again, it is not clear yet whether this treatment works; more research is needed.
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- Extracorporeal shockwave therapy for refractory tennis elbow; NICE Interventional Procedure Guidance, August 2009
- Autologous blood injection for tendinopathy; NICE Interventional Procedure Guidance, January 2013
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