An episode of tendonitis may last for only a few days, but it can be more persistent and last for several weeks or months.
There are several different treatment options, although what's best for you may depend on which tendon you have injured.
Self-care
You can treat tendonitis yourself using the self-care techniques below.
Rest the tendon
Stop doing the activity that caused tendonitis, such as sport or typing, or at least reduce the amount you do. This will help prevent any further inflammation (swelling) or damage.
It's important to rest the affected area. This will allow the inflammation to settle. Some form of support, such as a bandage, splint or brace, may help as this will reduce movement.
How long you need to rest may depend on which tendon is affected and how severely it is damaged. For example, if you have golfer's elbow, which causes pain in the middle of your elbow, you may need to rest your elbow for at least six weeks.
Ice packs
You can ease the pain and swelling by applying an ice pack to the affected area. Do not put ice directly on your skin as this may cause a cold burn. Wrap it in a towel or put a towel over the injured area before applying the ice pack. If you do not have an ice pack, wrap ice cubes or a bag of frozen vegetables in a towel and use this.
Hold the ice pack on the affected area for around 15-20 minutes several times a day. You can also use an ice pack after exercise to try and prevent symptoms occurring.
Painkillers
Tendonitis can be treated with mild non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. These are effective at providing short-term pain relief and are available as a medicine that you swallow or as a gel that you apply directly to the affected area.
These should not be used for long periods and are not recommended for people with asthma, or kidney or liver disease.
Other painkillers, such as paracetamol, will also help ease the pain. If your pain is more severe, a stronger painkiller, such as codeine, can be prescribed.
Therapies and injections
Physiotherapy
Physiotherapy, often referred to as physio, uses physical methods such as massage and manipulation to promote healing and wellbeing. There are many different physiotherapy techniques, such as:
- special exercises to stretch and strengthen the tendon and surrounding muscles
- massaging the affected area
- using high-frequency sound waves (ultrasound)
- using narrow beams of light (lasers)
Physiotherapy can be used to relieve pain and may result in more long-term improvement than corticosteroid injections.
Corticosteroid injections
Corticosteroids are medicines that contain steroids, a type of hormone, and can be used to reduce inflammation. If there is swelling and evidence of inflammation, corticosteroids can be injected around the affected tendon or into the tendon sheath.
Possible side effects of corticosteroid injections include:
- thinning of the skin
- lightening of the skin
Although corticosteroid injections can relieve pain, they do not have a long-term effect and it is common for the pain to return. You can have another injection, but you will need to wait at least six weeks. You cannot have more than three injections into the same area in a year as this can increase the risk of the tendon rupturing (splitting).
Local anaesthetic injections
Local anaesthetic is used during minor surgical procedures to numb a body part. In some types of tendonitis, local anaesthetic can be injected into the affected area as well as corticosteroids.
Extracorporeal shock wave therapy
Extracorporeal shock wave therapy (ESWT) is a treatment option for tendonitis that has not responded to other treatments. ESWT involves passing shock waves through your skin to the affected area. This may be carried out over one or more sessions and local anaesthetic may be used to numb the area first.
ESWT may relieve the pain caused by tennis elbow or Achilles tendonitis, but it is not clear if ESWT is better than some other treatment options. If you are considering this treatment, you may be asked to take part in a clinical trail (a type of medical research) to look at how effective the treatment is over time. There are also possible risks, such as:
- the tendon rupturing – in one study, this happened to 2 out of 49 people who had ESWT for Achilles tendonitis
- temporary redness or swelling
- pain during the treatment
- feeling sick
The National Institute for Health and Clinical Excellence (NICE) has produced guidelines on the use of:
Surgery
In some types of tendonitis, surgery may be a possible treatment. However, as most cases of tendonitis improve with time, it is not usually necessary. You may want to try other treatments for up to a year before considering surgery.
Tennis elbow
Several different surgical techniques have been used for tennis elbow, such as:
- removing a damaged part of muscle from the elbow
- removing part of a ligament in your elbow – ligaments are tough bands of tissue that link two bones together at a joint
- damaging a nerve in your elbow so you no longer feel pain there
The benefits of surgery for tennis elbow have not yet been proven. It may improve your symptoms, but this could be because your condition was getting better anyway, or may be due to the placebo effect. This is when you feel better after having a "dummy" treatment, rather than a "real" treatment.
After surgery, you should be able to start playing sport again within four to six months.
Calcific tendonitis
If calcium deposits have formed in the tendon in your shoulder, you can have surgery to remove these. This can be done using a technique called Arthroscopy. An arthroscopy is a form of keyhole surgery that is used to look inside a joint and repair any damage that has occurred. Only a very small cut is made in your body.
Biceps tendonitis
Biceps tendonitis affects the tendon that attaches the muscle on the front of your upper arm (bicep) to your shoulder. You can have surgery to reattach the end of the tendon to the bone in your upper arm (humerus). This may be considered if you are in severe pain or if you have torn the tendon.
