Ultrasound guided Injection with needle visualization to the Rotator Cuff
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Normal appearing Achilles Tendon
The chronic painful tendon or tendinopathy is well known to be difficult to treat, and the source of pain has not been scientifically clarified. The condition has for many years been treated as an inflammatory condition, secondary to overuse of the tendon. Even the terminology used, tendinitis, implies involvement of inflammation. This has not been based on scientific knowledge, on the contrary, histological examination of tendon tissue specimens has repeatedly shown the absence of inflammatory cell-infiltrates. Still, cortico-steroid injections, and tons of anti-inflammatory tablets, have been used in the treatment, often with very poor clinical response. Fortunately, during recent years, researchers have started to question this treatment, and studied the background to pain in the chronic painful tendon. Based on the absence of inflammatory cell-infiltrates in biopsies, the terminology has recently been changed to tendinopathy ( pain and impaired function of the affected tendon) and tendinosis (where ultrasound, MRI, or biopsies, show specific changes in the affected tendon) . This idea of Tendinopathy has resulted in a paradigm shift in how we think about Tendonitis and Bursitis. These chronic changes in Tendinopathy are better thought of as a degenerative process, in which case an anti-inflammatory treatment strategy doesn't make sense. Rather a regenerative treatment approach to stimulate the body to repair this degenerative tissue in Tendinopathy seems much more logical. This is where precise ultrasound guided injection of either PRP or Platelet Rich Plasma Injection has been shown to be helpful.
Chronic Tendinopathy most frequently treated areas are: