Most cases of tendinitis and tenosynovitis clear up with adequate rest, application of warm or cold compresses, and use of nonsteroidal anti-inflammatory medications (NSAIDs; e.g., ibuprofen, naproxen). For some people, corticosteroid (e.g., triamcinolone, methylprednisolone) injections with or without an anesthetic (e.g., lidocaine) are used to help with inflammation and pain. A splint or cast may be needed to hold the joint in place and rest the irritated tendon, but not for long because it can cause contractures, muscle wasting, and adhesions.
Physiotherapy techniques such as ultrasound or interferential current can be useful to reduce pain and swelling. There is some evidence that certain chiropractor treatments, such as manual and manipulative therapy, can be used to help with shoulder disorders, such as rotator cuff injuries.
Surgery is rarely used for tendinitis, but it's sometimes necessary in cases of separated shoulder or ruptured tendons. Seriously torn shoulder cuffs often have to be sutured back in place in a procedure called rotator cuff repair.
Tenosynovectomy relieves inflammation over the long-term by drawing synovium out of the tendon sheaths. Synovium is a membrane that lines the sheaths that secretes synovial fluid. Normally, this fluid lubricates the joint, but too much of it can cause the sheath to swell.
Ruptured tendons in the hand may not be repairable, but a number of surgical procedures try using other tendons to perform double duty. Sometimes, the surgeon switches tendon attachment points (tendon transfer), giving the most important tasks to the healthiest tendons. If the tendon has been cut or cleanly torn, it may be repaired by primary tendon repair.
Hand tendon repair and tendon transfer are unlikely to restore full freedom of movement when symptoms are longstanding. These procedures are used only for cases of severe injury, often involving multiple tendons. Surgery is rarely used for people with rheumatoid arthritis or lupus, as the disease process will continue, undoing the surgeon's work. The answer to these problems is to treat the underlying disease.
Most cases of irreversibly damaged tendons occur in people who keep exercising the joint after the initial strain. Many forms of tendinitis are less painful after a few minutes of exercise. If exercise is continued day after day, the inflammation will progress, and the tendon will start to deteriorate. It's then replaced by weaker fibrous tissue that may cause pain every time the joint and muscle is used. The correct way to deal with a tendon injury is to stop exercising and consult with your doctor as soon as possible.
*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®). The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For information on a given medication, check our Drug Information database. For more information on brand names, speak with your doctor or pharmacist.
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