Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon

Abstract

Tendinopathy is a broad term encompassing painful conditions occurring in and around tendons in response to overuse. Recent basic science research suggests little or no inflammation is present in these conditions. Thus, traditional treatment modalities aimed at controlling inflammation such as corticosteroid injections and nonsteroidal antiinflammatory medications (NSAIDS) may not be the most effective options. We performed a systematic review of the literature to determine the best treatment options for tendinopathy. We evaluated the effectiveness of NSAIDS, corticosteroid injections, exercise-based physical therapy, physical therapy modalities, shock wave therapy, sclerotherapy, nitric oxide patches, surgery, growth factors, and stem cell treatment. NSAIDS and corticosteroids appear to provide pain relief in the short term, but their effectiveness in the long term has not been demonstrated. We identified inconsistent results with shock wave therapy and physical therapy modalities such as ultrasound, iontophoresis and low-level laser therapy. Current data support the use of eccentric strengthening protocols, sclerotherapy, and nitric oxide patches, but larger, multicenter trials are needed to confirm the early results with these treatments. Preliminary work with growth factors and stem cells is promising, but further study is required in these fields. Surgery remains the last option due to the morbidity and inconsistent outcomes. The ideal treatment for tendinopathy remains unclear.

Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis

“…The reasons for wide use of corticosteroid injections for rotator cuff tendinopathy may include training or habit, to satisfy the patient's desire to intervene, for remuneration, and other factors, but it is not clear that corticosteroid injections outperform placebo injections. The effectiveness of corticosteroid injections for pain relief in patients with rotator cuff tendinosis is debated despite numerous prospective randomized trials and several systematic reviews [5,15,24,25,27,36,50]. The first four systematic reviews regarding this topic did not conduct a meta-analysis [5,24,32,50].…”

“…The effectiveness of corticosteroid injections for pain relief in patients with rotator cuff tendinosis is debated despite numerous prospective randomized trials and several systematic reviews [5,15,24,25,27,36,50]. The first four systematic reviews regarding this topic did not conduct a meta-analysis [5,24,32,50]. The results of two meta-analyses [15,24] reached different conclusions.…”

Nonoperative Management of Common Shoulder Conditions

“…Other studies have shown that steroids are more efficacious than NSAIDs and their higher doses provide more pain relief [18]. Similar discrepancies have been demonstrated with regard to length of efficacy; some studies show that corticosteroid injections can relieve shoulder pain caused by tendinitis for up to six weeks, with no benefit beyond six months, while others demonstrate that subacromial space injections can be effective for up to nine months [6,18]. Injections that do not provide relief do not warrant a second attempt, as it is not likely to help [33].…”

Enthesopathy – a personal perspective on its manifestations, implications and treatment

“…The pathology and treatment approach to tendinopathy has recently been well discussed 16 – 18 . The cornerstone of therapy is to remove any biomechanical predispositions and treat with physiotherapy.…”