Protocol: Tendinitis and Related Overuse Syndromes
This describes the various treatment procedures the physical therapist may select, as indicated by patient evaluation, re-evaluation, treatment responses.
Note: This protocol describes management approaches to tendinitis and related overuse disorders in a general manner. Diagnosis-specific protocols are available upon request, addressing specific overuse problems: lateral or medical epicondylitis, deQuervain’s, rotator cuff tendinitis, Achilles’ tendinitis, etc.
1. Initial patient education on problem, treatment, self-care.
2. Protective splinting and rest as indicated, if acute, with preventive ROM.
3. Remedial ROM, gentle stretching, lowest-grade joint mobilization.
4. Thermal modalities, used in concert with restorative procedures.
5. Electric stimulation for acute pain and inflammation control: iontophoresis, TNS, microcurrent, LLLT, etc.
6. MD referral for medication intervention as indicated
7. Employer consultation for work duties modification
1. Evolve exercise sequence from remedial range of motion exercises, to stretching, to strengthening, to restoring balanced muscle function and tonicity, to stability, to work reconditioning (emphasizing home exercises).
2. Soft tissue and articular manual therapy:
Joint mobilization, myofascial release, strain-counterstrain, etc.
Transverse friction massage for scar remodeling.
3. Electric Stimulation and other modalities to assist is pain control, reduced spasm and inflammation; used in concert with restorative procedures.
4. Address proximal contributory dysfunctions from neck, shoulder girdle, thoracic outlet.
5. Advanced patient education; risk factor education.
6. Ergonomic job evaluation and modification; job coaching.
7. Return-to-work plan; restricted duty recommendations; employer education.
8. Reconditioning exercise plan; home and gym.
9. Specific splinting to protect affected structures vulnerable to re-injury or resistive to recovery, as indicated per evaluation, treatment responses, work demands.
10. Occupational Therapist or Certified Hand Therapist referrals, as indicated.
Establish self-care skills and participation to minimize dependence on providers
Safe, early return to work; reduction of disability
Reduce pain, inflammation, spasm
Restore affected tissue structure, function, scar remodeling, extensibility
Restore strength, flexibility, mobility, stability
Correct contributory stresses from proximal structures