Myths and Facts of In-Office Regenerative Procedures for Tendinopathy

Abstract

Tendinopathy carries a large burden of musculoskeletal disorders seen in both athletes and aging population. Treatment is often challenging, and progression to chronic tendinopathy is common. Physical therapy, nonsteroidal anti-inflammatory drugs, and corticosteroid injections have been the mainstay of treatment but are not optimal given that most tendon disorders seem to involve degenerative changes in addition to inflammation. The field of regenerative medicine has taken the forefront, and various treatments have been developed and explored including prolotherapy, platelet rich plasma, stem cells, and percutaneous ultrasonic tenotomy. However, high-quality research with standardized protocols and consistent controls for proper evaluation of treatment efficacy is currently needed. This will make it possible to provide recommendations on appropriate treatment options for tendinopathy.

Figures

Figure 1:

Sonographically guided CET prolotherapy injection with CET (arrow) and radial collateral ligament (asterisk) seen in anatomic long axis view with the needle (open arrow) guided in an in-plane, distal to proximal technique. The radius is distal, to the right and the humerus is proximal, to the left.

Figure 2:

Sonographically guided prolotherapy injection for rotator cuff tendinopathy with long axis view of subacromial bursa (asterisk) and supraspinatus tendon (closed arrow). Acromion is located medially, to the left. A. Needle (open arrow) is directed in plane, lateral to medial, into the sub-deltoid sub-acromial bursa. B. Needle is directed in plane, lateral to medial, into the tendinopathic supraspinatus tendon (closed arrow).

Figure 2:

Sonographically guided prolotherapy injection for rotator cuff tendinopathy with long axis view of subacromial bursa (asterisk) and supraspinatus tendon (closed arrow). Acromion is located medially, to the left. A. Needle (open arrow) is directed in plane, lateral to medial, into the sub-deltoid sub-acromial bursa. B. Needle is directed in plane, lateral to medial, into the tendinopathic supraspinatus tendon (closed arrow).

Figure 3:

Sonographically guided PRP injection for Achilles tendinopathy with transducer in anatomic short axis view utilizing an in plane, lateral to medial, injection technique. Achilles tendon (asterisk), needle (open arrow).