As mentioned in a previous article, tendon disorders are ubiquitous among Baby Boomers. Together with bursitis, ligament injuries, and muscle disorders, problems in these areas are termed "soft tissue arthritis."
Tendon disorders arise as a result of repetitive activity, exertion, exposure to vibration, mechanical stress, and prolonged static posture.
Tendon problems occur through a sequence of events including an initial injury, followed by degeneration of tendon fibers. Inflammation is rarely seen in chronic tendon injury. As a result the term "tendonitis" is a misnomer. The proper term is "tendinosis." To heal, tendons go through three stages: inflammation, repair, and remodeling.
Multiple factors in the blood, termed growth factors, initiate tendon healing.
When a patient is first evaluated, they must undergo a careful history and physical examination. Imaging studies such as diagnostic ultrasound and magnetic resonance imaging can help confirm the clinical impression.
In the early phases of mild injury, stretching can help accelerate healing. At one week, stretching has been shown to promote collagen synthesis by fibroblasts. Stretching also increases strength and diameter of injured tendon and improves repair and remodeling. Prolonged immobilization has a negative effect on healing. For mild tendonitis early on, a simple program includes rest, avoidance of the activity that provoked the tendonitis, ice, splinting, physical therapy, and stretches. Non-steroidal anti-inflammatory drugs and corticosteroid injections may be useful.
Newer approaches to treating tendinopathy include: hydrodissection, prolotherapy, needle tenotomy, and platelet-rich plasma.
Hydrodissection is used where peritendindonitis is present. This is where the tendon sheath is swollen but the tendon itself is intact. An example is trigger finger. Using ultrasound guidance, a large volume of fluid is injected into the tendon sheath between the sheath and the tendon. This acts as an "angioplasty" for the tendon sheath.
Prolotherapy is a procedure where injection of proliferant solution into the damaged tendon is performed. This causes inflammation and leads to tissue repair.
Needle tenotomy comes from the theory that acute inflammation leads to healing. Here, multiple punctures ("peppering") of diseased tendon causes acute inflammation with subsequent repair.
Platelet-rich plasma (PRP) is the treatment of choice for tendon injuries. PRP contains multiple growth factors that stimulate tissue repair. It is used in conjunction with tenotomy and must be given with ultrasound guidance.
Autologous stem cells, a patient's own stem cells, are reserved for severe disease and partial tendon tears not responsive to PRP. The procedure must be administered with ultrasound guidance.