Tendinitis and Its Most Common Drug List

Ever heard of tennis elbow or swimmer’s shoulder or jumper’s knee? Well, these are nothing but tendinitis (also known as tendonitis).

A tendon is a tough band of tissues that connects muscle to bone. Tendons serve to move the bone and enable us to perform our daily activities. Any inflammation and irritation of tendons can cause pain, tenderness and restricted movement of the joint(s).

The most common cause of this inflammatory condition is a repetitive action, particularly while playing sports. Thus, it is more common in athletes, who have a faulty technique. Improper sitting posture, walking habit or a strenuous exercise also increase our chances of developing tendinitis. A sudden injury to the tendons can also cause tendinitis. Diseases like diabetes and arthritis also predispose a person to tendinitis. Tendinitis is frequently seen in elderly as, the flexibility of tendons decreases with age, making the tendons more prone to injury.

Although it can be a dreadful condition to deal with, it can be easily managed through some at-home measures and medications. If left untreated, it can lead to a ruptured (torn) tendon, necessitating invasive treatment modalities.

Symptoms

Tendinitis can affect any tendon of the body, but it most commonly involves shoulder, elbow, wrist, knee and heel. The inflammation of the tendon may present as following symptoms.

• Pain usually felt as a dull ache, which aggravates on moving the affected joint
• A grating or crackling sensation on movement of joint
• Tenderness of affected area on touching
• Presence of a lump along the tendon
• A tightness in the joint, making it difficult to move
• Sometimes, a swelling accompanied with redness, may also be seen in the affected joint

Treatment

Tendinitis usually resolves on its own with adequate rest, application of an ice-pack and a compression bandage. However, if the condition does not improve with these measures or the tendon has ruptured due to a sudden injury, medical help must be sought.

The goal of treatment is to relieve pain and reduce the inflammation. Over-the-counter painkillers may be consumed as oral preparations or topically applied to relieve the pain and inflammation. However, severe tendinitis not responding to painkillers may need corticosteroid injections to counteract the pain and swelling. Topical rubefacients are another group of drugs which can effectively relieve the symptoms of tendinitis.

A doctor may also recommend a physical therapy involving a range-of-motion exercises to strengthen the tendons and muscles. However, when these non-invasive methods prove ineffective, surgical intervention may be needed.

Another recently discovered treatment modality of tendinitis involves injecting Platelet-rich plasma (PRP) in the affected joint. However, more research is needed to know the safety and efficacy of this therapy.

Various drugs used in the treatment of tendinitis are described below.

1. Non-steroidal Anti-inflammatory Drugs (NSAIDs)

This group of drugs is directed at inhibiting the release of a chemical, known as prostaglandins. Prostaglandins are responsible for causing inflammation and pain in the body. These are produced in the body by numerous enzymes, one of which is known as Cyclo-oxygenase (COX) enzyme, which exists in two forms, COX-1 and COX-2.
NSAIDs inhibit COX enzyme and block the release of prostaglandins, thus relieving pain and swelling in tendinitis.

Available as: Oral preparations and Topical preparations

I. Ibuprofen
US-FDA Status: Approved for tendinitis
Availability: Over-the-counter
Generic name: ibuprofen
Brand name: Motrin IB tablet
Side-effects: Belching, abdominal pain, bloating, cloudy urine, diarrhea, decreased urination
Indicated in pregnancy: Usually contraindicated, especially in third trimester
Alcohol content: Absent

II. Indomethacin
US-FDA Status: Approved for tendinitis
Availability: Prescription
Generic name: indomethacin
Brand name: Tivorbex capsule
Side-effects: Diarrhea, sour stomach, belching, indigestion, heartburn, nausea, vomiting
Indicated in pregnancy: Usually contraindicated, especially in third trimester
Alcohol content: Absent

III. Naproxen
US-FDA Status: Approved for tendinitis
Availability: Over-the-counter
Generic name: naproxen sodium
Brand name: Aleve tablet
Side-effects: Bruising, indigestion, difficulty breathing, belching, itchy skin, headache
Indicated in pregnancy: Usually contraindicated, especially in third trimester
Alcohol content: Absent

IV. Sulindac
US-FDA Status: Approved for tendinitis
Availability: Prescription
Generic name: sulindac
Brand name: Sulindac tablet
Side-effects: Stomach pain, sour stomach, belching, headache, constipation, heartburn
Indicated in pregnancy: Usually contraindicated, especially in third trimester
Alcohol content: Absent

V. Ketoprofen
US-FDA Status: Approved for tendinitis
Availability: Over-the-counter
Generic name: ketoprofen
Brand name: Ketoprofen capsule
Side-effects: Abdominal pain, headache, bloody urine, decreased amount or frequency of urination, increased thirst, appetite loss
Indicated in pregnancy: Usually contraindicated, especially in third trimester
Alcohol content: Absent

VI. Diclofenac

Diclofenac Oral
US-FDA Status: Approved for tendinitis
Availability: Prescription
Generic name: diclofenac
Brand name: Zorvolex capsule
Side-effects: Belching, abdominal pain, cloudy urine, constipation, dizziness, diarrhea
Indicated in pregnancy: Usually contraindicated, especially in third trimester
Alcohol content: Absent

Diclofenac topical
US-FDA Status: Approved for tendinitis
Availability: Prescription
Generic name: diclofenac sodium (topical)
Brand name: Voltaren gel (topical)
Side-effects: Skin rash, burning sensation, fever, body ache, headache
Indicated in pregnancy: Usually contraindicated, especially in third trimester
Alcohol content: Contains traces of alcohol

NSAIDs are also used to treat other inflammatory conditions, such as osteoarthritis, gouty arthritis, rheumatoid arthritis and ankylosing spondylitis.

2. Corticosteroid Injections

Corticosteroids are drugs that mimic the action of a hormone, cortisol which is naturally produced by our adrenal glands. There are two types of corticosteroids i.e., mineralocorticoids and glucocorticoids. In tendinitis, glucocorticoids hold significance. When consumed in doses exceeding the body’s usual limit, glucocorticoids produce an anti-inflammatory effect by inhibiting the release of prostaglandins. However, unlike NSAIDs, they inhibit phospholipase A2 enzyme, which is also needed for the production and release of prostaglandins.

Other than anti-inflammatory action, glucocorticoids also have an immunosuppressant action. Hence, it may have some major side-effects.

Therefore, injections of corticosteroids are reserved for patients not responding to NSAIDs. Also, corticosteroids are not indicated in chronic tendinitis as regular use of this drug can weaken the tendon and can cause tendon rupture.

Available as: Injectable preparations

I. Triamcinolone acetonide
US-FDA Status: Approved for tendinitis
Availability: Prescription
Generic name: triamcinolone acetonide
Brand name: Kenalog-40
Side-effects: Aggression, agitation, blurred vision, anxiety, dizziness, decreased amount of urine
Indicated in pregnancy: Only if benefit outweighs fetal risk
Alcohol content: Contains traces of alcohol

II. Dexamethasone
US-FDA Status: Approved for tendinitis
Availability: Prescription
Generic name: dexamethasone sodium phosphate
Brand name: Dexamethasone Sodium Phosphate
Side-effects: Aggression, agitation, blurred vision, anxiety, dizziness, decreased amount of urine
Indicated in pregnancy: Only if absolutely indicated
Alcohol content: Absent

III. Methylprednisolone
US-FDA Status: Approved for tendinitis
Availability: Prescription
Generic name: methylprednisolone sodium succinate
Brand name: Sol-U-Medrol
Side-effects: Aggression, agitation, blurred vision, anxiety, dizziness, decreased amount of urine
Indicated in pregnancy: Only if absolutely indicated
Alcohol content: Contains traces of alcohol

Injectable corticosteroids are also used in the treatment of other disorders, such as lupus, arthritis, ulcerative colitis, psoriasis and some breathing disorders.

3. Topical Rubefacients

As per a research paper, published in The Cochrane Database of Systemic Reviews, topical rubefacients can effectively relieve acute and chronic musculoskeletal pain. These are usually applied topically on the affected joint and act by dilating the capillaries and increasing the blood circulation. By doing so, these cause a “counter-irritation” and cause reddening of the skin, giving a warm feeling to the skin. In contrast to topical NSAIDS, rubefacients do not inhibit any enzyme on penetration of the skin. Rather, they cause local irritation of the sensory nerve endings, which supply the underlying muscle and joint.

Therefore, by causing irritation of the skin and the local nerve endings, it relieves pain and inflammation in tendinitis.^[1]

Available as: Topical preparations

I. Salicylates
It is chemically similar to aspirin and NSAIDs, but differs in the acting mechanism (already mentioned above).

US-FDA Status: Approved for tendinitis
Availability: Over-the-counter
Generic name: methyl salicylate/ menthol
Brand name: Salonpas patch
Side-effects: Redness, skin irritation, hives, rashes, itching, peeling skin
Indicated in pregnancy: Only if benefit outweighs fetal risk
Alcohol content: Absent

II. Trolamine
US-FDA Status: Approved for tendinitis
Availability: Over-the-counter
Generic name: trolamine
Brand name: Mobisyl cream
Side-effects: Redness, skin irritation, hives, rashes, itching, peeling skin
Indicated in pregnancy: Only if benefit outweighs fetal risk
Alcohol content: Contains traces of alcohol

III. Capsaicin
US-FDA Status: Approved for tendinitis
Availability: Over-the-counter/ Prescription
Generic name: capsaicin
Brand name: Capzasin HP cream
Side-effects: Dryness, itching, burning, soreness, swelling, redness
Indicated in pregnancy: Only if benefit outweighs fetal risk
Alcohol content: Contains traces of alcohol

OTC

There are several over-the-counter medications available to relieve the swelling and pain seen in tendinitis. The availability of these drugs in different countries have been described in the table below.

It must be remembered that a doctor’s consultation is of utmost importance. Self-medication is not recommended.