Can Chronic Tendinopathy Be Turned Into an Acute Condition?

Laird Harrison

Disclosures

March 31, 2015

In This Article

Other New Therapies in Development

The parade of alternatives to anti-inflammatory therapies doesn't stop there. Investigators have tried zapping tendons with electricity (iontophoresis) or lasers, injecting them with irritants (prolotherapy) or botulinum toxin, or destroying damaged tissues with an ultrasonically vibrating needle—all with unproven success.[6]

To make the field even more confusing, some researchers think inflammation may be causing at least part of the problem after all. A recent article in the British Journal of Sports Medicine cited evidence of specific inflammatory factors in tendinopathy, such as macrophages and T and B lymphocytes. It called for research into treatments that might block specific inflammatory compounds, such as tumor necrosis factor alpha.[7]

With so many options on the table, it can be hard to know where to start. "We're so advanced in other areas," Dr Rocco Monto says. "In joint replacement and fracture care, we're very elegant. In tennis elbow, we don't know what to do."

In the absence of overwhelming evidence for one of the new therapies, Dr Rocco Monto sends his patients to physical therapy. "After 8 weeks of physical therapy, I do an MRI to see if there's a tear," he says. "I objectively score the patients to find out whether their symptoms are more than a nuisance." If the tendon is torn, he surgically repairs it. If not, he tries platelet-rich plasma.

He can't show you randomized controlled trials to prove his approach is better than everyone else's. But most patients, he says, end up satisfied.

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