Anti-inflammatory management for tendon injuries - friends or foes?

Abstract

Acute and chronic tendon injuries are very common among athletes and in sedentary population. Most physicians prescribe anti-inflammatory managements to relieve the worst symptoms of swelling and pain, including non-steroidal anti-inflammatory drugs, corticosteroids and physical therapies. However, experimental research shows that pro-inflammatory mediators such as prostaglandins may play important regulatory roles in tendon healing. Noticeably nearly all cases of chronic tendon injuries we treat as specialists have received non-steroidal anti-inflammatory drugs by their physician, suggesting that there might be a potential interaction in some of these cases turning a mild inflammatory tendon injury into chronic tendinopathy in predisposed individuals. We are aware of the fact that non-steroidal anti-inflammatory drugs and corticosteroids may well have a positive effect on the pain control in the clinical situation whilst negatively affect the structural healing. It follows that a comprehensive evaluation of anti-inflammatory management for tendon injuries is needed and any such data would have profound clinical and health economic importance.

Figure 1

Overuse or excessive mechanical stimulation to tendons can lead to elevation of metalloproteinases (MMPs) which mediate collagen degradation and hence degenerative tendon injuries. Healing responses are activated but failed to repair the degenerative injuries, resulting in tendinopathy. It is possible that anti-inflammatory management may affect the development of degenerative injuries as well as the pathological processes of failed healing in tendinopathy.