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I have read contradictory statements regarding whether nonsteroidal anti-inflammatory drugs (NSAIDs) decrease or increase swelling during the acute phase of a tendon injury.

E.g., http://emedicine.medscape.com/article/97217-treatment:

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) is somewhat controversial. [1, 17] Some physicians argue that the anti-inflammatory effects of NSAIDs are helpful in decreasing swelling, thereby increasing the speed of an individual's recovery. [14, 18, 19] Other authors believe that NSAID use during the acute injury phase may increase swelling by increasing the potential for bleeding via platelet inhibition. [17]

(all the cited reference are at least 13-year-old)

Do nonsteroidal anti-inflammatory drugs (NSAIDs) decrease or increase swelling during the acute phase of a tendon injury?

I am mostly interested in epicondylitis (epicondylopathy).

  • 1 Plancher KD, Halbrecht J, Lourie GM. Medial and lateral epicondylitis in the athlete. Clin Sports Med. 1996 Apr. 15(2):283-305. [Medline].
  • 14 Baskurt F, Ozcan A, Algun C. Comparison of effects of phonophoresis and iontophoresis of naproxen in the treatment of lateral epicondylitis. Clin Rehabil. 2003 Feb. 17(1):96-100. [Medline].
  • 17 Stanley KL, Weaver JE. Pharmacologic management of pain and inflammation in athletes. Clin Sports Med. 1998 Apr. 17(2):375-92. [Medline].
  • 18 Burnham R, Gregg R, Healy P, Steadward R. The effectiveness of topical diclofenac for lateral epicondylitis. Clin J Sport Med. 1998 Apr. 8(2):78-81. [Medline].
  • 19 Labelle H, Guibert R. Efficacy of diclofenac in lateral epicondylitis of the elbow also treated with immobilization. The University of Montreal Orthopaedic Research Group. Arch Fam Med. 1997 May-Jun. 6(3):257-62. [Medline].
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A big difference here is due to the structures involved. Mature tendons are composed of cartilage and contain a very poor blood supply. They rely on localized synovial fluid for tissue perfusion and nutrition as opposed to simply a connecting blood vessel.

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Epicondylitis (lateral or medial) is a chronic from of inflammation caused over time by repetitive micro-trauma (wear and tear) to the tendon, nerve and vessel in the related area.

NSAIDS would help with any inflammation and pain resulting from this.

Also in looking at that medscape article. It seems some involved are not realizing your tendon not only very minimally bleeds (if at all), it does not produce sufficient platelet rich plasma that is capable of healing these micro-traumas. This is why injections of exactly that - platelet-rich plasma (PRP) is used as a treatment to heal the damaged tissue.

This would be a debate in more vascularized tissues (where the injury is generally some type of acute trauma and bodies own healing process is required).

See Here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505250/

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