Treatment of Peritendinitis Crepitans: Heparin or Prednisone?

In Sweden, my treatment would have been IV Heparin. But a single dose prednisone also worked.

My trusted SUV, now with 266,000 miles on it, needed a new transfer case so I couldn’t trailer my monthly hay purchase last weekend as I usually do. Instead I rented a U-Haul with an incredibly awkward driving position. Afterward, the front of my right lower leg started hurting and Saturday morning, almost a week later there was the characteristic crunching feeling of peritendinitis crepitans whenever I dorsiflexed my ankle.

In a sudden blast from the past I remembered how we used to treat it in Sweden: A little heparin IV push. I’ve been gone long enough that I don’t know if they even do that now but I certainly have never heard of it in this country.

I demonstrated my clinical findings to Autumn, my Medical Assistant, and to a colleague, and told them about the heparin. Obviously, we don’t stock any in my clinic, and, besides, it wouldn’t look good if I injected myself with anything intravenously in this day and age. (I have previously quoted the famous 1800’s Parisian Swedish physician and writer Axel Munthe, who shamelessly reported shooting up some “Morphia” after a hard day at the office).

So I did he next best thing I could think of, 20 mg prednisone (the wonder drug I wrote about the other day). Saturday 7 pm, resting after a somewhat crazy Walk-in day and a nice dinner, the crunching is gone and the pain much less severe.

So now I have time to do some research. The first page or two on my Google search had articles from 1957-1961, all or most from Scandinavia.

I did find one guideline from 2017 that recommends low molecular weight heparin:

http://www.ebm-guidelines.com/ebmg/ltk.free?p_artikkeli=ebm00430

But, in my case, the prednisone seems to be working. And my old Mercedes is fixed, running like new again, so my next hay trip will be more comfortable.

1 Response to “Treatment of Peritendinitis Crepitans: Heparin or Prednisone?”



  1. 1 read the article Trackback on June 12, 2019 at 11:08 pm

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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