By K M Khan, assistant professor.
Department of Family Practice, University of British Columbia, Vancouver, Canada V6T 1Z3

Tendonitis such as that of the Achilles, lateral elbow, and rotator cuff tendons is a common presentation to family practitioners and various medical specialists.

Most currently practicing general practitioners were taught, and many still believe, that patients who present with overuse tendonitis have a largely inflammatory condition and will benefit from anti-inflammatory medication.

Unfortunately this dogma is deeply entrenched.

Ten of 11 readily available sports medicine texts specifically recommend non-steroidal anti-inflammatory drugs for treating painful conditions like Achilles and patellar tendonitis despite the lack of a biological rationale or clinical evidence for this approach.

Instead of adhering to the myths above, physicians should acknowledge that painful overuse tendon conditions have a non-inflammatory cause.

A critical review of the role of various anti-inflammatory medications in soft tissue conditions found limited evidence of short term pain relief and no evidence of their effectiveness in providing even medium term clinical resolution of clearly diagnosed tendon disorders.

Laboratory studies have not shown a therapeutic role for these medications. Steroid injections provide mixed results in relieving the pain of tendon problems.

If general practitioners, orthopedic surgeons, and other members of the healthcare professions treating tendon disorders made a quantum shift from previous flawed teaching about overuse tendonitis and adopted these data there would be immediate ramifications.

Some pockets of the sports medicine, orthopedics, and rheumatology specialties have adopted this paradigm, 2-4 10 but it must no longer remain within that cabal. It is time for medical educators to accept the irrefutable evidence that the term tendonitis must be abandoned to highlight a new perspective on tendon disorders. Adopting the tendinopathy paradigm is essential if general practitioners are to practice evidence based medicine.

British Medical Journal March 16, 2002; 324: 626-627