What are the recommended first-line treatments for patients with acute tendonitis in the upper limb?

Recommended first-line treatments for acute tendonitis in the upper limb include:

• Rest in the acute phase to reduce pain and inflammation, followed by gradual resumption of activity within pain limits to avoid future disability and improve function.
• Modification of activities that exacerbate symptoms, such as avoiding overhead movements or repetitive arm use.
• Use of analgesia starting with paracetamol for pain relief; if ineffective, consider oral NSAIDs (e.g., ibuprofen) for short-term use (up to 2 weeks), taking into account contraindications and risks.
• Topical NSAIDs (such as ibuprofen gel) may be considered, especially for conditions like tennis elbow, with caution regarding application and fire risk.
• Consider orthoses (e.g., forearm straps or braces) to offload tendons and reduce stress, particularly in lateral elbow tendonitis (tennis elbow).
• Referral for physiotherapy including stretching, strengthening exercises, and manual therapy to restore function and reduce symptoms.

Corticosteroid injections are generally not recommended as routine first-line treatment due to short-term benefits but poorer long-term outcomes and higher relapse rates; they may be considered in shared decision-making if severe pain persists.

These recommendations apply to common upper limb tendonitis presentations such as tennis elbow and rotator cuff tendonitis.

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