Tendinitis treatment

Drug Acetic acid Principal Indication(s) Calcific tendinitis Treatment Rationale Acetate is believed to increase solubility of calcium deposits in tendons and other soft tissues Iontophoresis 2°/o-5°/o aqueous solution from negative pole Phonophoresis... 

Commercially available electrotransport systems are bulky and limited to acute appHcations (96). One example, the Drionic system used for the treatment of hyperhidrosis (excessive perspiration), is presoaked in water for 30 min before each 20- to 30-min treatment. Another system, the Phoresor, approved for the deHvery of Hdocaine [137-58-6] for local anesthesia, and of dexamethasone [50-02-2] for treatment of local inflammation such as bursitis or tendinitis, is powered by a 9 V replaceable battery and features a disposable, fiHable dmg electrode. 

The sahcylates are useful in the treatment of minor musculoskeletal disorders such as bursitis, synovitis, tendinitis, myositis, and myalgia. They may also be used to relieve fever and headache. They can be used in the treatment of inflammatory disease, such as acute rheumatic fever, rheumatoid arthritis, osteoarthritis, and certain rheumatoid variants, such as ankylosing spondylitis, Reiter s syndrome, and psoriatic arthritis. However, other NS AIDS are usually favored for the treatment of these chronic conditions because of their lower incidence of GI side effects. Aspirin is used in the treatment and prophylaxis of myocardial infarction and ischemic stroke. 

It is indicated in the treatment of a variety of painful inflammatory conditions, including osteoarthritis, oncology, postopera-tively, trauma, sports injuries, ear, nose and throat disorders, dental surgery, bursitis/ tendinitis, thrombophlebitis, upper airways inflammation and gynaecological disorders. Nimesulide has shown to be well tolerated even by aspirin sensitive asthmatic patients. 

Fluoroquinolones may damage growing cartilage and cause an arthropathy. Thus, these drugs are not routinely recommended for patients under 18 years of age. However, the arthropathy is reversible, and there is a growing consensus that fluoroquinolones may be used in children in some cases (eg, for treatment of pseudomonal infections in patients with cystic fibrosis). Tendinitis, a rare complication that has been reported in adults, is potentially more serious because of the risk of tendon rupture. Risk factors for tendonitis include advanced age, renal insufficiency, and concurrent... 

Auclair, J., Georges, M., Grapton, X., Gryp, L., D Hooghe, M., Meiser, R. G., Noto, R., Schmidtmayer, B. A double-blind controlled multicenter study of percutaneous niflumic acid gel and placebo in the treatment ofachilles heel tendinitis, Curr. Ther. Res. 1989, 46, 782-788. 

Physical therapists may encounter the use of local anesthetics in several patient situations because of their various clinical applications. For example, therapists may be directly involved in the topical or transdermal administration of local anesthetics. As discussed earlier, repeated topical application of local anesthetics may help produce long-term improvements in motor function in patients with skeletal muscle hypertonicity, so therapists may want to consider incorporating topical anesthetics into the treatment of certain patients with CNS dysfunction. Therapists may also administer local anesthetics transdermally, using the techniques of iontophoresis and phonophoresis. Agents such as lido-caine can be administered through this method for the treatment of acute inflammation in bursitis, tendinitis, and so on. 

Brief History. R.D. is a 35-year-old man who developed pain in his right shoulder after spending the weekend chopping firewood. He was examined by a physical therapist and evaluated as having supraspinatus tendinitis. Apparently, this tendinitis recurred intermittently, usually after extensive use of the right shoulder. During past episodes, the tendinitis was resistant to treatment and usually took several months to resolve. 

Berginer, VJM., Salen, G., Shefer, S. Long-term treatment of cerebro-tendinous xanthomatosis with chenodeoxycholic acid. New EngJ. X Med. 1984 311 1649-1652... 

Buerklin EM, Ballard IM. A double blind comparison of fentiazac and phenylbutazone in the treatment of acute tendinitis and bursitis. Curr Med Res Opin 1979 6(Suppl 2) 90. 

In 42 spontaneous reports of fluoroquinolone-associated tendon disorders, 32 patients had tendinitis, 24 bilaterally, and 10 had a tendon rupture most affected the Achilles tendon (89). The median age was 68 years and there was a male predominance. In 16 cases ofloxacin was implicated, in 13 ciprofloxacin, in eight norfloxacin, and in five pefloxacin. The delay between the start of treatment and the appearance of the first symptoms was 1-510 (median 6) days. Most patients recovered within 2 months after withdrawal, but 26% had not yet recovered at follow-up. 

Tendinopathy has been reported with levofloxacin. Four cases of Achilles tendinitis have been reported in patients taking levofloxacin (29). Two were on chronic dialysis, one was a kidney transplant recipient, and one had chronic vasculitis. In all four cases, tendinitis had an acute onset with bilateral involvement and was incapacitating. In three cases the onset was early during levofloxacin treatment and in one case it began 10 days after the end of treatment. AH the patients recovered completely after 3-8 weeks. 

Naproxen (200 mg every 8 to 12 hours with a full glass of liquid) is indicated for the relief of mild to moderate pain, treatment of primary dysmenorrhea, rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, tendinitis, bursitis, and acute gout. Naproxen (Naprosyn) is used in juvenile arthritis. Naproxen, a nonsteroidal antiinflammatory agent, has analgesic and antipyretic actions. It should be used cautiously in patients with a history of angioedema or of... 

Propionic acid derivatives are approved for use in the symptomatic treatment of rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and acute gouty arthritis they also are used as analgesics, for acute tendinitis and bursitis, and for primary dysmenorrhea. 

In noninflammatory degenerative joint diseases (e.g., osteoarthritis) or in a variety of regional pain syndromes (e.g., tendinitis or bursitis), glucocorticoids may be administered by local injection for the treatment of episodic disease flares. Intra-articular injections should be performed with intervals of at least 3 months to minimize painless joint destruction, a potential side effect of this treatment. 

Naproxen is indicated for the treatment of rheumatoid arthritis, osteoarthritis, juvenile arthritis, ankylosing spondylitis, tendinitis, bursitis, acute gout, and primary dysmenorrhea and for the relief of mild to moderate pain. 

It has a wide range of action in the human body, having been found effective in the treatment of cataracts, heart disease, migraines, stroke, amenorrhea, angina, athlete s foot, bursitis, chronic fatigue, colds and flu, coughs, depression, dizziness, fever, infertility, erection problems, kidney stones, Raynaud s disease, sciatica, tendinitis, and viral infections. 

Magnetic therapy is considered an effective non-invasive, no-side-effects treatment that can speed recovery from a variety of conditions ranging from tendinitis and back pain to migraine headaches and a neuromuscular condition known as fibromyalgia. Application of one or more small, powerful magnets to the area of an injury will relieve pain and accelerate healing. Figure 4.15 is a bottom per-... 

Cacchio A, De Blasis E, Desiati P, Spacca G, Santilli V, De Paulis F. Effectiveness of treatment of calcific tendinitis of the shoulder by disodium EDTA. Arthritis Rheum 2009 61(1) 84-91. 

Some general considerations merit attention. First, only painful calcifications must be treated finding calcification within a rotator cuff tendon does not automatically mean that shoulder pain is related to it. A typical mistake is to treat calcifying tendinitis in patients with shoulder pain derived from other causes, including cervical spine disease. Remember that most calcifications are asymptomatic. Second, the best results are achieved on large calcifications. Treatment of clusters of smaller calcifications is almost invariably unsuccessful. Third, the goal of the procedure is to disrupt the calcification and to remove some but not all calcific material (Fig. 18.14f). Too many needle insertions to remove as much as possible of the calcification should be avoided to prevent tendon tears. Once ruptured, calcification almost invariably evolves toward resorption, and shoulder pain and disability improve in most cases (Fig. 18.16). 

Fig. 18.14a-f. US-guided treatment of calcifying tendinitis aspiration irrigation technique. Schematic drawings illustrate the standard sequence of a two-needle procedure, a Under real-time US observation, lidocaine is injected within the subacromial bursa (asterisk) by the first 18 gauge needle. The needle path should point toward the rotator cuff (rc) calcification (star) to be treated, b The same needle is advanced (black arrows) until its tip penetrates the calcification, c A second 20 gauge needle is inserted (black arrows) within the calcification. With this needle, multiple passages within the calcification and rotational movements are performed, d Injection (open arrows) of saline and lidocaine by the second needle and aspiration by the first needle is then performed in an effort to remove as much calcified material as possible, e When a substantial amount of calcium has been washed out, steroids are injected (open arrow) into the subacromial bursa to treat inflammation secondary to diffusion of calcium into the bursa. Then the needles are withdrawn (black arrows), e At the end of the procedure, residual calcific deposits remain within the tendon... 

Fig. 18.16a-c. US-guided treatment of calcifying tendinitis radiographic results. Series of anteroposterior standard radiographs of the shoulder obtained a before, b soon after the procedure and c 2 months later in a patient with a painful calcification (arrow) in the supraspinatus tendon. Although partial removal of the calcification is observed initially, most of the calcification then dissolves with time. (Courtesy of Dr. Giovanni Serafini, Pietra Ligure, Italy)... 

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