Can Chronic Tendinopathy Be Turned Into an Acute Condition?

Laird Harrison

Disclosures

March 31, 2015

In This Article

New Hope for Tendinopathy Sufferers

As director of athletic training education at the University of Delaware, Thomas Kaminski, PhD, knows plenty about rehabilitating athletic injuries.

So he was particularly frustrated that he couldn't cure his own persistent case of lateral epicondylitis. Finally he turned to a treatment until recently on the margins of medicine: A family practice doctor with a specialty in sports medicine jabbed his elbow with a large needle, opening holes in the tendon.

The treatment, percutaneous needle tenotomy (PNT), is one of several therapies gaining attention as the general understanding of chronic tendinopathy shifts. "PNT was a last resort in my situation, and it brought about some lasting relief," says Dr Kaminski.

Such treatments as PNT, extracorporeal shockwave therapy, and platelet-rich plasma therapy attempt to kick-start healing in damaged tissue. Small clinical trials have provided some support for the procedures, and many physicians are regularly performing one or more of them. But none has yet sealed its case as the standard of care.

Questions About the Role of Inflammation

That's in part because experts are still debating the causes of chronic tendinopathy. Before the 1990s, a view took root that inflammation causes the pain. Chronic tendon pain became known as 'tendinitis,' and laypersons soon adopted that term. Treatment with anti-inflammatory medication became widespread.

But later, researchers couldn't find evidence of inflammation. They noted that anti-inflammatory treatments, such as cortisone injections, only provided short-term pain relief at best. "It is time for medical educators to accept the irrefutable evidence that the term tendonitis must be abandoned to highlight a new perspective on tendon disorders," read a 2002 editorial in the British Medical Journal(BMJ).[1]

According to this view, anti-inflammatory treatments might actually interfere with healing. "Certainly the use of cortisone treatments is not going to be condoned much longer," says Raymond Rocco Monto, MD, head of orthopedics at Nantucket Cottage Hospital in Nantucket, Massachusetts, and a spokesperson for the American Academy of Orthopaedic Surgeons.

If inflammation isn't the problem, what is? The BMJ editorialists and others cited evidence of separated collagen, thinning of the tendon, and tissue disruption. They developed the theory that overuse causes cumulative damage to joints and scarring, and that the blood supply in these joints is insufficient for healing.

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