Tendinitis / Tendinopathy — বাংলা Clinical Notes
Clinical note: “Tendinitis” মানে tendon-এর inflammation বোঝালেও বাস্তবে অনেক chronic case-এ মূল pathology হয় tendinopathy/tendinosis—অর্থাৎ tendon-এর degenerative failed-healing process, pure inflammation নয়। তাই chronic pain-এ শুধু painkiller নয়, load management + tendon-loading physiotherapy সবচেয়ে গুরুত্বপূর্ণ।
1. Definition — সংজ্ঞা
Tendinitis হলো tendon-এর ব্যথা, tenderness, swelling এবং movement/load দিলে pain হওয়া—সাধারণত overuse, repetitive strain বা acute injury-এর কারণে হয়।
Tendinopathy হলো umbrella term—যেখানে tendon pain, swelling, impaired performance থাকে; chronic case-এ tendon degeneration বেশি থাকে।
Common sites:
- Shoulder — rotator cuff tendinopathy
- Elbow — lateral epicondylitis / tennis elbow
- Wrist/thumb — De Quervain tenosynovitis
- Knee — patellar tendinopathy / jumper’s knee
- Heel — Achilles tendinopathy
2. Causes — কারণগুলো
A. Mechanical / overuse causes
- Repeated movement: একই motion বারবার করা—typing, lifting, running, jumping, throwing।
- Sudden excessive load: হঠাৎ বেশি exercise/weight training শুরু করা।
- Poor technique: ভুল posture, wrong running gait, improper lifting technique।
- Inadequate recovery: tendon load নেওয়ার পর rest না পাওয়া।
- Occupation-related strain: carpenter, tailor, computer user, athlete, manual worker।
B. Patient-related risk factors
- Age > 35–40 years: collagen elasticity কমে যায়।
- Obesity: lower limb tendon-এ load বেশি পড়ে।
- Diabetes mellitus: tendon collagen glycation হয়, healing কমে।
- Rheumatoid arthritis / gout / CKD: inflammatory/metabolic tendon involvement হতে পারে।
- Reduced flexibility or muscle weakness: tendon-এর উপর stress বাড়ে।
C. Drug-related causes
- Fluoroquinolone antibiotics যেমন ciprofloxacin, levofloxacin—Achilles tendon pain/rupture risk বাড়াতে পারে।
- Systemic corticosteroid use tendon weakening করতে পারে, especially repeated/local intratendinous steroid injection হলে rupture risk বাড়ে। Corticosteroid injection কখনও tendon substance-এর ভেতরে দেওয়া উচিত নয়।
3. Symptoms — উপসর্গগুলো
- Localized pain: নির্দিষ্ট tendon-এর জায়গায় ব্যথা; যেমন Achilles হলে heel-এর পেছনে, tennis elbow হলে elbow-এর outer side।
- Pain on activity/load: কাজ করলে ব্যথা বাড়ে, rest নিলে কমে।
- Morning stiffness: সকালে বা দীর্ঘ rest-এর পরে stiffness।
- Tenderness: tendon চাপ দিলে ব্যথা।
- Swelling/thickening: tendon মোটা বা ফোলা লাগতে পারে।
- Crepitus: movement করলে ঘর্ষণ/কচকচ শব্দ বা অনুভূতি—paratendonitis/tenosynovitis-এ বেশি।
- Weakness: pain inhibition বা disuse atrophy-এর কারণে grip/heel raise/shoulder abduction weak লাগে।
- Function limitation: হাঁটা, দৌড়ানো, সিঁড়ি ওঠা, হাত দিয়ে কাজ, lifting—সব সীমিত হতে পারে।
Red flag: sudden “pop”, acute severe pain, inability to bear weight, gap in tendon, positive Thompson test → tendon rupture suspect; urgent orthopedic referral.
4. Clinical Diagnosis — clinically কীভাবে diagnosis করবেন
Diagnosis অধিকাংশ ক্ষেত্রে history + focused examination দিয়ে হয়; imaging mainly atypical, severe, trauma, rupture suspicion, or refractory case-এ দরকার।
Core clinical points
- Pain onset: sudden নাকি gradual?
- Load relation: কোন movement/load-এ pain বাড়ে?
- Local tenderness: tendon insertion/midportion কোথায়?
- Pain on resisted movement: affected tendon contract করলে pain হয়।
- Stretch pain: tendon stretch করলে pain বাড়ে।
- Compare both sides: swelling, ROM, strength, function।
Site-specific clinical tests
| Tendon/site | Specific clinical test | Positive finding |
| Achilles | Palpation 2–6 cm above insertion, single-leg heel raise, painful arc sign; rupture suspect হলে Thompson test | Localized pain/swelling, heel raise pain/weakness; Thompson positive হলে rupture |
| Patellar tendon | Single-leg decline squat test | Inferior pole of patella pain; patellar tendinopathy-তে useful |
| Lateral epicondylitis | Cozen test, Mill test, Maudsley test | Resisted wrist/finger extension-এ lateral elbow pain |
| Rotator cuff | Painful arc, Hawkins-Kennedy, Neer, resisted external rotation/Jobe | Shoulder abduction/overhead activity pain |
| De Quervain | Finkelstein/Eichhoff test | Radial wrist/thumb pain |
5. Investigations — specific approach
Usually not needed initially
- Typical overuse tendinitis/tendinopathy-তে initial diagnosis clinical।
Imaging
- X-ray: fracture, calcific tendinopathy, bony spur, arthritis, enthesophyte suspect হলে।
- Ultrasound + Doppler: tendon thickening, hypoechoic area, tear, tenosynovitis, neovascularity; dynamic assessment; guided injection-এ useful।
- MRI: partial tear, full-thickness tear, deep tendon lesion, failed conservative therapy, pre-surgical planning, unclear diagnosis।
- Diagnostic ultrasound/MRI Achilles location uncertain হলে করা যায়।
Labs — only if systemic disease/infection suspected
- CBC, ESR, CRP — infection/inflammatory arthritis suspect।
- Serum uric acid — gout suspect।
- HbA1c/FBS — diabetes risk।
- RF, anti-CCP — rheumatoid arthritis suspect।
- Renal function/LFT — NSAID safety assessment before pharmacotherapy।
6. Differential Diagnosis
- Muscle strain or tear
- Ligament sprain
- Bursitis
- Osteoarthritis / inflammatory arthritis
- Fracture / stress fracture
- Nerve entrapment — carpal tunnel, radial tunnel, cervical radiculopathy
- Gout / pseudogout
- Septic arthritis / infectious tenosynovitis
- Tendon rupture
7. Complications — রোগের জটিলতা
- Chronic pain: ব্যথা মাসের পর মাস থাকতে পারে।
- Reduced function: হাঁটা, grip, lifting, overhead কাজ কমে যায়।
- Tendon degeneration: tendon-এর collagen disorganized হয়ে weak হতে পারে।
- Partial tear: untreated overload চললে tendon fibre ছিঁড়ে যেতে পারে।
- Complete rupture: Achilles/rotator cuff/patellar tendon-এ rare but serious complication।
- Muscle wasting: pain-এর কারণে limb কম use করলে muscle atrophy হয়।
- Recurrence: cause ঠিক না করলে repeated flare হয়।
- Steroid-related complication: repeated বা intratendinous steroid injection দিলে skin atrophy, depigmentation, tendon weakening/rupture হতে পারে।
8. Treatment Management — Guideline-based
A. Non-pharmacological management — মূল চিকিৎসা
1) Relative rest, complete bed rest নয়
- Pain-provoking activity 2–6 সপ্তাহ modify করবেন।
- Complete immobilization long-term করলে stiffness/atrophy হতে পারে।
2) Ice / cryotherapy
- Acute flare হলে 10–15 মিনিট, দিনে 2–4 বার।
- Skin burn এড়াতে towel wrap ব্যবহার।
3) Physiotherapy — cornerstone
- Chronic tendinopathy-তে eccentric loading / heavy slow resistance সবচেয়ে গুরুত্বপূর্ণ।
- Achilles tendinopathy-তে tendon-loading exercise first-line; load patient tolerance অনুযায়ী বাড়ানো হয়।
- Exercise pain-free বা tolerable pain range-এ হবে; pain progressively worse হলে load কমাতে হবে।
4) Brace / support
- Tennis elbow: counterforce brace।
- Patellar tendinopathy: patellar strap।
- Achilles: heel raise/orthotics if biomechanical issue।
5) Injection / procedure
- Steroid injection short-term pain relief দিতে পারে, কিন্তু chronic tendinopathy-তে long-term outcome ভালো নাও হতে পারে; tendon-এর ভেতরে injection দেওয়া যাবে না।
- Ultrasound-guided peritendinous/bursal injection specialist দ্বারা।
- ESWT/PRP refractory case-এ consider করা যায়; evidence site-specific।
6) Surgery
- Usually 3–6 মাস proper conservative treatment fail করলে orthopedic/sports medicine referral। AAFP review অনুযায়ী conservative management fail করলে surgery consideration reasonable।
9. Pharmacological Drugs — Bangladesh prescription-oriented list
Adult dosing only. একসাথে একাধিক oral NSAID দেবেন না। CKD, uncontrolled HTN, IHD, peptic ulcer/GI bleed, anticoagulant use, pregnancy, asthma with NSAID sensitivity থাকলে NSAID avoid/modify করতে হবে।
1) Paracetamol
- Generic name: Paracetamol / Acetaminophen
- Therapeutic category: Analgesic, antipyretic
- Pharmacological class: Para-aminophenol derivative; central analgesic
- কেন use হয়: mild pain relief; NSAID contraindication থাকলে safer analgesic option।
- Adult dose: 500 mg–1 g orally every 6–8 hours PRN; max 3–4 g/day, liver disease/alcohol use হলে lower max।
- Duration: 3–7 days PRN; chronic daily use avoid unless supervised।
- Side effects: nausea, rash rare; overdose → hepatotoxicity।
- Interactions: alcohol, warfarin long-term high dose, enzyme-inducing drugs।
- Bangladesh available brands: Napa 500 mg, Napa Rapid 500 mg, Fevac 500 mg, Neopara 500 mg; suspension 120 mg/5 ml forms also available. MedEx lists multiple paracetamol brands and strengths including 500 mg tablets and 120 mg/5 ml suspension.
- Drug therapeutic class: Non-opioid analgesic/antipyretic.
2) Topical Diclofenac gel
- Generic name: Diclofenac sodium topical
- Therapeutic category: Local analgesic/anti-inflammatory
- Pharmacological class: NSAID; COX inhibitor
- কেন use হয়: superficial tendon pain—tennis elbow, De Quervain, patellar/Achilles superficial pain—কম systemic side effect সহ pain relief।
- Dose: Diclofenac gel 1% — affected area-তে 2–4 g, দিনে 3–4 বার; rub lightly। MedEx diclofenac gel instructions এ 2–4 g 3–4 times daily উল্লেখ করে।
- Duration: 7–14 days; response না হলে reassess।
- Side effects: local burning, rash, dermatitis; broken skin-এ দেবেন না।
- Interactions: systemic absorption কম, কিন্তু oral NSAID/anticoagulant use থাকলে caution।
- Bangladesh available brands: DicloGel 1% w/w, Diclomol 1% w/w, Emov 1% w/w, Erdon gel 1% w/w, Voligel 1% w/w, Voligel Max 2% w/w, Volifen 1% w/w.
- Drug therapeutic class: Topical NSAID.
3) Ibuprofen
- Generic name: Ibuprofen
- Therapeutic category: Analgesic, anti-inflammatory
- Pharmacological class: Non-selective NSAID; COX-1/COX-2 inhibitor
- কেন use হয়: acute inflammatory pain, swelling, painful movement কমাতে short course।
- Adult dose: 200–400 mg orally every 6–8 hours after food; OTC-type max 1200 mg/day; physician-supervised rheumatic dosing higher হতে পারে। MedEx adult mild–moderate pain dose 200–400 mg single dose or 3–4 times daily with 6-hour interval and max 1200 mg/day উল্লেখ করে।
- Duration: 3–5 days; usually 7 days-এর বেশি without review নয়।
- Side effects: dyspepsia, gastritis, ulcer/GI bleed, renal impairment, fluid retention, BP rise, bronchospasm in NSAID-sensitive asthma।
- Interactions: anticoagulant/antiplatelet, SSRI/SNRI, ACEi/ARB + diuretic, lithium, methotrexate, steroids, other NSAIDs।
- Bangladesh available brands: Profen 400 mg, Inflam 400 mg, Neurofen 400 mg, Rapofen 400 mg, G-Ibuprofen 400 mg, Iburex 200/400 mg; Profen suspension 100 mg/5 ml.
- Drug therapeutic class: NSAID.
4) Naproxen / Naproxen sodium
- Generic name: Naproxen / Naproxen sodium
- Therapeutic category: Analgesic, anti-inflammatory
- Pharmacological class: Non-selective NSAID; COX inhibitor
- কেন use হয়: tendon pain with inflammation; longer duration NSAID option, especially musculoskeletal pain।
- Adult dose: Naproxen 250–500 mg orally twice daily after food; lowest effective dose।
- Duration: 5–10 days; chronic use হলে renal/GI/CV risk assess।
- Side effects: gastritis, GI bleed, renal impairment, edema, BP rise, dizziness।
- Interactions: warfarin/DOAC, aspirin/clopidogrel, ACEi/ARB/diuretics, lithium, methotrexate, steroids, other NSAIDs।
- Bangladesh available brands: Naproxen 500 mg, Napro-A 500 mg, Naprosyn 250/500 mg, Naprox 250/500 mg, Naxin 250/500 mg, Naspro 250/500 mg, Nuprafen 250/500 mg; Naproxen + Esomeprazole 500 mg+20 mg combinations also available.
- Drug therapeutic class: NSAID.
5) Aceclofenac
- Generic name: Aceclofenac
- Therapeutic category: Analgesic, anti-inflammatory
- Pharmacological class: NSAID; COX inhibitor
- কেন use হয়: musculoskeletal pain, trauma-related soft tissue pain, inflammatory pain কমাতে।
- Adult dose: 100 mg orally twice daily after food; SR 200 mg once daily. MedEx adult dose হিসেবে film-coated tablet 100 mg twice daily এবং ER 200 mg daily উল্লেখ করে।
- Duration: 3–7 days; review ছাড়া prolonged use নয়।
- Side effects: dyspepsia, abdominal pain, nausea, ulcer/GI bleed, renal impairment, dizziness, edema।
- Interactions: lithium/digoxin level বাড়তে পারে, diuretics effect কমতে পারে, anticoagulant effect বাড়তে পারে, methotrexate level বাড়তে পারে—MedEx এ এসব monitoring interaction উল্লেখ আছে।
- Bangladesh available brands: Flexi 100 mg, Flexi SR 200 mg, Reservix 100 mg/SR 200 mg, Avenac 100 mg, Ceclofen 100 mg, Movex 100 mg/SR 200 mg, Preservin 100 mg/SR 200 mg, Paino 100 mg, Painkil 100 mg/SR 200 mg, Zerodol 100 mg.
- Drug therapeutic class: MedEx therapeutic class—Drugs for Osteoarthritis, Rheumatoid Arthritis drugs, NSAIDs.
6) Oral Diclofenac
- Generic name: Diclofenac sodium / diclofenac potassium
- Therapeutic category: Analgesic, anti-inflammatory
- Pharmacological class: NSAID; COX inhibitor
- কেন use হয়: acute painful flare, soft tissue inflammation, tendon-area pain।
- Adult dose: Diclofenac sodium 50 mg orally 2–3 times daily after food; SR 100 mg once daily; use shortest possible duration।
- Duration: 3–5 days preferred; high CV/GI/renal risk হলে avoid।
- Side effects: gastritis, ulcer/GI bleed, renal injury, edema, BP rise, liver enzyme elevation, CV risk।
- Interactions: anticoagulant, antiplatelet, SSRI, steroids, ACEi/ARB/diuretics, lithium, methotrexate, other NSAIDs।
- Bangladesh available brands: Diclofen 50 mg/SR 100 mg/gel 1%, Diclofix 50 mg, Fengel 50 mg/SR 100 mg/gel, Erdon TR 100 mg/gel, Voligel 1%/2%, Volifen gel 1%.
- Drug therapeutic class: NSAID.
7) Etoricoxib
- Generic name: Etoricoxib
- Therapeutic category: Analgesic, anti-inflammatory
- Pharmacological class: Selective COX-2 inhibitor NSAID
- কেন use হয়: NSAID দরকার কিন্তু GI intolerance relatively বেশি হলে COX-2 option হিসেবে; তবে CV/HTN risk থাকলে caution।
- Adult dose: 60–90 mg once daily for musculoskeletal inflammatory pain; acute severe pain/gout-type dosing 120 mg short course only under physician decision। MedEx etoricoxib page OA/RA/AS/pain-inflammatory indications ও 30/90/120 mg dosing contexts উল্লেখ করে।
- Duration: 3–7 days; uncontrolled hypertension/IHD/stroke risk থাকলে avoid or specialist decision।
- Side effects: dyspepsia, edema, hypertension, renal impairment, headache; CV thrombotic risk concern।
- Interactions: warfarin/DOAC, ACEi/ARB/diuretics, lithium, methotrexate, rifampicin, other NSAIDs।
- Bangladesh available brands: Etorix 60/90/120 mg, Etoshine 60/90/120 mg, Oricox 30/60/90/120 mg, Recox 60/90/120 mg, Tory 60 mg, Rito 60/90/120 mg, Ribox 60/90/120 mg, Setorib 60/90/120 mg, Etorica 60/90/120 mg.
- Drug therapeutic class: COX-2 selective NSAID.
8) PPI gastroprotection — NSAID দিলে risk patient-এ
- Generic name: Pantoprazole / Esomeprazole / Omeprazole
- Therapeutic category: Anti-ulcerant
- Pharmacological class: Proton pump inhibitor
- কেন use হয়: NSAID-induced gastritis/ulcer risk কমাতে—age >60, ulcer history, steroid/anticoagulant/antiplatelet use, high-dose NSAID হলে।
- Adult dose: Pantoprazole 20–40 mg once daily before breakfast; Esomeprazole 20 mg once daily; Omeprazole 20 mg once daily।
- Duration: NSAID যতদিন, সাধারণত 5–14 days; long-term use indication ছাড়া নয়।
- Side effects: headache, diarrhea/constipation, abdominal discomfort; long-term হলে hypomagnesemia, B12 deficiency, fracture/C. difficile risk।
- Interactions: clopidogrel interaction বেশি concern omeprazole/esomeprazole; warfarin, high-dose methotrexate, antifungals absorption issue।
- Bangladesh available brands:
- Pantoprazole: Pantonix 20/40 mg, Pantobex 20/40 mg, Pantodac 20/40 mg, Pantogut 20/40 mg, Pantolok 20/40 mg, Panzer 20/40 mg, Protocid 20/40 mg.
- Esomeprazole: EZ-20 20 mg, Exor 40 mg, Gaspro 40 mg.
- Omeprazole: Losectil 20/40 mg, Losek 20/40 mg, O-20 20 mg, OM 20/40 mg, Omepra 20/40 mg.
- Drug therapeutic class: PPI / anti-ulcerant.
9) Local corticosteroid injection — selected cases only
- Generic name: Triamcinolone acetonide / Methylprednisolone acetate
- Therapeutic category: Local anti-inflammatory injection
- Pharmacological class: Glucocorticoid corticosteroid
- কেন use হয়: severe pain limiting physiotherapy, tenosynovitis/bursitis component, De Quervain, subacromial bursitis, selected lateral epicondylitis short-term relief। Chronic degenerative tendon pain-এ routine/repeated steroid preferred নয়।
- Dose: Site-dependent; commonly 10–40 mg peritendinous/bursal/intra-sheath with/without local anesthetic; never intratendinous. Ultrasound guidance preferable।
- Duration/effect: pain relief often days to weeks; rehab must continue after short rest।
- Side effects: post-injection flare, skin atrophy, depigmentation, infection, hyperglycemia, tendon rupture risk। RACGP notes steroid may reduce pain 6–8 weeks but long-term outcome neutral/negative; tendon substance-এ injection avoided due to rupture risk.
- Interactions/cautions: diabetes—temporary hyperglycemia; anticoagulant use—bleeding risk; local infection—contraindicated।
- Bangladesh available brands:
- Triamcinolone acetonide injection 40 mg/ml: Cenolon, Alfacort, Cynocort, Emicort, Intracort, Trecilon, Triacin, Trialon, Triamon.
- Methylprednisolone acetate injection 40 mg/ml or 80 mg/2 ml: Depo-Medrol 80 mg/2 ml, Depo-pred 40 mg/ml, Depomed 40 mg/ml and 80 mg/2 ml.
- Drug therapeutic class: Corticosteroid anti-inflammatory injection.
10. Bangladesh doctors commonly prescribe — practical list
বাংলাদেশে tendinitis/tendinopathy prescription-এ সাধারণত নিচের pattern দেখা যায়:
- Paracetamol 500 mg
- Mild pain, fever নেই কিন্তু pain control দরকার হলে।
- NSAID contraindication থাকলে safer first analgesic।
- Topical diclofenac gel 1%
- Local superficial tendon pain-এ।
- Oral NSAID risk কমাতে।
- Oral NSAID — only one:
- Ibuprofen 400 mg বা Naproxen 500 mg বা Aceclofenac 100 mg বা Diclofenac 50 mg বা Etoricoxib 60/90 mg
- Pain + inflammation + movement limitation থাকলে short course।
- একসাথে দুই NSAID দেওয়া উচিত নয়।
- PPI — Pantoprazole/Esomeprazole/Omeprazole
- NSAID দিলে gastric protection দরকার হলে।
- Local steroid injection — Triamcinolone/Methylprednisolone
- Severe/refractory pain, tenosynovitis/bursitis component, physiotherapy শুরু করতে pain barrier থাকলে।
- Specialist/orthopedic/sports medicine/PM&R physician দ্বারা, preferably ultrasound-guided।
- Physiotherapy prescription
- Eccentric loading, stretching, strengthening, posture/ergonomic correction—এটাই long-term definitive management।
11. Prevention — কীভাবে prevent করবেন
- Exercise বা workload gradually increase করবেন; হঠাৎ intensity বাড়াবেন না।
- Proper warm-up ও cool-down করবেন।
- Same movement দীর্ঘ সময় করলে micro-break নেবেন।
- Workstation ergonomics ঠিক করবেন—keyboard, mouse, chair height।
- Running/jumping sports-এ proper shoes, surface, technique maintain করবেন।
- Muscle strengthening ও flexibility maintain করবেন।
- Previous tendinopathy থাকলে maintenance exercise চালিয়ে যাবেন।
- Diabetes, obesity, gout, RA control করবেন।
- Fluoroquinolone use করলে tendon pain শুরু হলে activity stop করে clinician-কে জানাবেন।
- Pain ignore করে repeated loading করলে chronic tendinopathy/tear risk বাড়ে।
Overview / Summary
Tendinitis হলো tendon pain syndrome, কিন্তু chronic case-এ “tendinopathy” term বেশি accurate, কারণ pathology অনেক সময় degenerative failed healing। Diagnosis সাধারণত clinical—localized tendon pain, tenderness, pain with resisted movement, load-related symptoms। Investigation only atypical/refractory/rupture suspect হলে। Treatment-এর core হলো relative rest + load modification + eccentric/heavy slow resistance physiotherapy; drugs mainly pain control ও rehab facilitation-এর জন্য। NSAID short course, topical NSAID, paracetamol, selected PPI, এবং selected cases-এ local steroid injection ব্যবহার করা হয়।
Actionable Plan / Steps
- Confirm site — Achilles, patellar, elbow, shoulder, wrist/thumb—কোন tendon affected।
- Rule out red flag — sudden pop, inability to move/bear weight, fever, marked redness, neuro deficit, rupture sign।
- Start conservative care — relative rest, ice, topical diclofenac, paracetamol ± one NSAID short course if safe।
- Physiotherapy — 4–6 সপ্তাহ tendon-specific eccentric/loading program।
- Review at 2–4 weeks — pain/function improve হচ্ছে কি না।
- Imaging — persistent symptoms, severe swelling, traumatic onset, tear suspect হলে ultrasound/MRI।
- Referral — rupture suspect, failed 6–12 weeks rehab, recurrent tendinopathy, athlete/high-demand worker, injection/procedure needed হলে orthopedic/sports medicine/PM&R।
Reference List — Textbook + Guideline + DOI
Textbooks
- Brukner & Khan’s Clinical Sports Medicine, 5th ed. Tendinopathy chapters.
- DeLee, Drez & Miller’s Orthopaedic Sports Medicine, latest ed. Tendon injuries/tendinopathy sections.
- Harrison’s Principles of Internal Medicine, 21st ed. Musculoskeletal pain and soft-tissue rheumatism overview.
- Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 14th ed. NSAIDs and glucocorticoids chapters.
- Katzung & Trevor’s Basic & Clinical Pharmacology, 16th ed. NSAIDs, acetaminophen, corticosteroids.
Guidelines / Reviews
- Chimenti RL, et al. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024. JOSPT. 2024. DOI: 10.2519/jospt.2024.0302.
- de Vos RJ, et al. Dutch multidisciplinary guideline on Achilles tendinopathy. Br J Sports Med. 2021;55:1125–1134. DOI: 10.1136/bjsports-2020-103867.
- Kane SF, Olewinski LH, Tamminga KS. Management of Chronic Tendon Injuries. Am Fam Physician. 2019;100(3):147–157.
- RACGP. Tendon injuries—practice tips for GPs. Aust Fam Physician. 2013.
Peer-reviewed DOI
- Khan KM, Cook JL, Kannus P, Maffulli N, Bonar SF. Histopathology of common tendinopathies: update and implications for clinical management. Sports Med. 1999;27:393–408. DOI: 10.2165/00007256-199927060-00004.
- Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43:409–416. DOI: 10.1136/bjsm.2008.051193.
- Cook JL, Rio E, Purdam CR, Docking SI. Revisiting the continuum model of tendon pathology. Br J Sports Med. 2016;50:1187–1191. DOI: 10.1136/bjsports-2015-095422.
- Kongsgaard M, et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports. 2009. DOI: 10.1111/j.1600-0838.2009.00949.x.
Md.Rafiqul Islam Lipu,Date:-15-06-2026 Tuesday,Time:-03-33-12 Pm