Follow us on

Tendon pain (PTTD?)

    • Tendon and ligaments are fibrous connective tissue that are prone to acute and repetitive work and sport injuries. Tendon injuries, or tendinopathy are common, especially in relation to sports and occupation. Initially, tendons can be injured or overused and go through a short inflammatory stage. If pain persists, it may be a sign that the tendon has been damaged and the tendon has entered a chronic degenerative phase.

    • Symptoms of tendon pain may include dull achy or sharp shooting pain that worsens with activity, decreased rain of motion or difficulty moving the affected area, swelling or tenderness of the injured area.

    • Diagnosis is based on detailed history, physical examination, and imaging. Certain physical tests may be utilized to reproduce symptoms and measure range of motion at time of exam. The majority of tendons and ligaments are superficial and can be assessed with musculoskeletal ultrasound.

    • X-ray imaging may be utilized to determine involvement of bone or calcific deposits within the tendon. Magnetic resonance imaging (MRI) can also confirm the presence of injury to the tendon.

    • Conservative Management
      • Initial treatment of tendon pain consists of rest, ice, NSAIDs, and physical therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for pain relief and physical therapy may be utilized to improve strength and restore function of the injured area.

      • In chronic cases, conservative and even surgical management of tendinopathy is not always successful. New treatment modalities have been developed including shockwave therapy (ESWT), which has strong evidence for the effectiveness of ESWT for chronic tendinopathy (Chung et al, 2002).

    • Shockwave Therapy
      • Shockwave therapy may be used as an adjunctive therapy for chronic tendon pain. Shockwave therapy initiates the body’s natural healing process, stimulating tissue regeneration by increasing regional blood flow and through direct effects on the cells to reduce pain and increase function (Khan & Scott, 2009; Vetrano et al, 2011).

    • Platelet Rich Plasma (PRP) Injections
      • PRP concentrates a patient’s blood to increase various growth factors. When injected into the injured tendon it stimulates the natural healing response of the tendons.

    • Prolotherapy Injection
      • Prolotherapy is an injection therapy that involves stimulating a healing response through the use of an irritating solution that mimics the natural healing process of the body by initiating a local inflammatory cascade, which triggers the release of growth factors and a healing response in the injured tendon.

    • Stem Cell Injection
      • Stem cell injections use your own cells to stimulate the growth of healthy tissue to improve pain and function.

    • Ultrasound Guided Needle Tenotomy (TENEX)
      • Tenex is a minimally invasive procedure that can help eliminate chronic tendon pain by precisely targeting and removing damaged tendon tissue stimulating the healing process.

    • Surgical Intervention
      • Depending on the severity and location of the injury, surgery may be recommended to repair or reconstruct the injured tendon.

Chung B, Wiley JP. Extracorporeal shockwave therapy—a review. Sports Med. 2002;32:851–865.

Khan KM, Scott A. Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. Br J Sports Med. 2009;43:247–252.

Vetrano M, d’Alessandro F, Torrisi MR, Ferretti A, Vulpiani MC, Visco V. Extracorporeal shock wave therapy promotes cell proliferation and collagen synthesis of primary cultured human tenocytes. Knee Surg Sports Traumatol Arthrosc. 2011;19:2159–2168.