What is tendinopathy?
Tendinopathy is a tendon injury that causes pain. A tendon connects muscle to bone. The tendon may have an abnormal structure or may not function properly. Tendon-related pain may result from a disorder of a tendon or multiple tendons.
What causes tendinopathy?
Tendon disorders are common. About 30 to 50% of sports injuries involve tendinopathy. Tendinopathy may be caused by multiple factors, including:
- Overloading the tendon without proper recovery
- Repetitive microtrauma. This is ongoing stress on the tendon that can cause injury
- Inflammation (redness and swelling)
- Aging
How is tendinopathy treated?
In most cases, tendinopathy improves with standard treatments such as modifying activities, using a brace, stretching, and exercise. For example, most people who develop tennis elbow find their condition improves in about 3 months of trying these approaches.
Most patients can work with a physical therapist or occupational therapist for effective treatment. A therapist can guide you on how to use a brace and review proper exercise and stretching techniques you can do at home. They also may use manual therapies to help reduce pain and improve healing.
As a general rule, anti-inflammatory drugs typically don’t work well for tendinopathy. Steroid injections may help, but only temporarily. Steroid injections can reduce inflammation and pain temporarily. They also don’t address the underlying problem with the tendon.
Are there advanced treatment options for tendinopathy?
When tendinopathy does not improve with standard treatment, Mass General Brigham Sports Medicine offers these advanced treatment options:
During this noninvasive treatment, a machine produces shockwaves that deliver impulses through the skin to the area of pain. These impulses are intended to increase blood flow and promote new tendon cell growth. Patients often have to pay for this procedure as it’s not usually covered by health insurance.
This treatment involves placing a patch containing a vasodilator (a drug that causes blood vessels to relax) on the skin over the area of pain. Blood vessel expansion can increase blood flow to the treated area. This treatment has been shown to reduce pain, increase function and increase tendon strength in some patients. Side effects include headache and low blood pressure.
PRP is a concentrated source of platelets taken from a patient’s blood. The blood is placed in a centrifuge, a machine that spins and separates the blood into various components. The doctor injects the platelet rich component into the area of injury. This injection can release growth factors which may stimulate healing and promote repair in tissues.
A doctor passes a standard needle through the abnormal tendon multiple times. The needle tenotomy is meant to trigger tendon healing and remodeling. Studies have shown it can increase the formation of new blood vessels.
This is a minimally invasive technique in which a doctor uses an FDA-cleared needle device that releases ultrasonic energy. This energy helps to remove abnormal tissue from the injured tendon. The idea of this procedure is to produce inflammation, break up scar tissue and increase blood flow to painful tendons. PUT has been FDA-cleared since 2012 and more than 65,000 procedures nationwide have been completed since its approval. Multiple clinical trials show that PUT is a safe and effective treatment that can be done in an outpatient setting under local anesthesia.
PUT can be appropriate for treating most areas of tendon disorders including, but not limited to:
- Elbow: Lateral epicondylitis (tennis elbow) and medial epicondylosis (golfer’s elbow)
- Shoulder: Rotator cuff disorders, including calcific tendinopathy and biceps tendinopathy
- Hip: Gluteal tendinopathy (commonly diagnosed as hip bursitis or tendinitis)
- Knee: Patellar tendinopathy (jumper’s knee)
- Ankle: Achilles tendinopathy
- Foot: Plantar fasciitis
