Tendinopathy andchronic pain
Tendinopathy is a chronic degenerative tendon condition that fails to heal and affects daily function, participation in physical activity, and quality of life. Tendinopathy is generally thought to occur when the tendon is chronically overloaded and does not have time to heal appropriately.
The typical course of care involves months of conversative treatment, but this often fails to relieve symptoms and return the patient to pain-free function.
Tendinopathy is one of the most common causes of pain in the world.
While any tendon is susceptible to chronic injury or pain, the most commonly affected tendon and tissue areas include:
- The patellar tendon (jumper’s knee)
- The plantar fascia (plantar fasciitis)
- The Achilles tendon (Achilles tendinopathy)
- The tendons originating at the medial and lateral epicondyles of the elbow (golfer’s elbow and tennis elbow, respectively)
Tendinopathy has a fundamentally different composition than healthy tendon. The tendon is unable to engage with the healing cycle properly, leading to degeneration of the tendon and an inability to recover.
Treatment options for tendinopathy are not without challenges.
Injections of platelet-rich plasma and other orthobiologic agents
Utilized to promote or facilitate healing of the tendon.
High-quality evidence is lacking, and the cost is expensive and may not be covered by insurance.
Extracorporeal shockwave therapy
Delivers low-energy shockwaves directly to the damaged tendon to increase blood flow and encourage appropriate healing.
This procedure is not approved for all types of tendinopathy and has mixed results in the literature.
Open surgery and debridement
Debrides damaged tissue and repairs the tendon, if needed.
Failure rates are high for surgical procedures of this nature.
Percutaneous tenotomy is a cost-effective, time-saving, and lower-risk treatment option.
Tenotomy utilizes fragmentation and debridement under ultrasound guidance to disrupt the damaged tendon and restart the healing process. This procedure typically results in a more organized tendon structure that leads to a reduction in symptoms and is less-invasive than open surgery.