What are the treatments for tendonitis?

There are several effective non-surgical approaches to the treatment and relief of tendonitis, depending on the severity of the condition. Here is a summary of recommended methods : 

• Activity modifications and relative rest: It is crucial to limit or modify the activities responsible for the mechanical overload of the tendon. This approach reduces the stress on the painful tissue and avoids aggravating the injury. Rest is the first-line treatment and is also used as a control in some studies⁽¹⁾. 
• Orthosis: The brace exerts a relieving action on the musculotendinous structures, thus promoting functional rest. Its effectiveness depends on the anatomical location of the injury and the type of brace. It should be used in combination with physical therapy⁽¹⁾.
• Physical therapy and exercises: Eccentric loading exercises (a return of contraction to the elongation phase) have been shown to be effective in promoting tendon healing. The mechanism of action is based on stressing the tendon, thereby stimulating its structural remodelling and repair. However, it is essential that these exercises are performed under the supervision of a physiotherapist⁽¹⁾. 
• Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs can be used to reduce pain (analgesic effect) and inflammation (anti-inflammatory effect). NSAIDs may relieve symptoms and improve quality of life for a short period, but their effectiveness decreases with the duration of treatment and they do not alter the tendon healing process in the long term⁽¹⁾. 
• Injection of corticosteroids: This method mainly has an anti-inflammatory effect. In terms of their mechanism of action, their efficacy is equivalent to that of NSAIDs in the short-term treatment of chronic tendonitis. Studies show that corticosteroid injections are particularly effective in restoring short-term function and relieving pain in patients with calcific shoulder tendonitis^{(1, 2)}. 
• Therapeutic ultrasound: This method uses high-frequency sound waves to target specific areas of the body. This focused energy triggers cellular changes, accelerating the synthesis of growth factors and collagen, and promoting tissue repair by modulating the inflammatory process⁽¹⁾. 
• Platelet-rich plasma (PRP) injections: Platelets produce growth factors that promote tissue repair and regeneration. In addition, a meta-analysis demonstrated additional benefits when leukocyte-rich PRP was combined with ultrasound therapy⁽¹⁾. 
• Surgery: Surgical treatment of tendonitis is generally effective, particularly in patients who have not responded to conservative treatment. It offers significant improvements in pain and function, although it carries a higher risk of complications than non-surgical options. Minimally invasive techniques can mitigate some of these risks, offering a balance between efficacy and safety⁽³⁾. 

In conclusion, a combination of activity modification, specific exercises, anti-inflammatory medication, and in some cases, innovative therapies such as ultrasound or platelet-rich plasma injections, can effectively treat tendonitis.