Tendinopathy is a common condition that affects the tendons, often resulting in pain, stiffness, and reduced function. It is usually caused by overuse, repetitive strain, or injury to a tendon. Common areas affected by tendinopathy include the Achilles tendon and shoulder rotator cuff.
Many patients prefer non-surgical options when managing tendinopathy. These treatments can provide effective pain relief, reduce inflammation, and promote healing while avoiding the risks and downtime associated with surgery.
What is Tendinopathy?
Tendinopathy refers to the degeneration of a tendon. It can occur as a result of repetitive overuse, sudden injury, or age-related wear and tear. Tendons are tough bands of tissue that connect muscles to bones, and they play an essential role in movement and stability. When tendons are subjected to repeated stress, small tears can form, causing pain and impaired function. The process of tendon repair typically starts with inflammation but does not always lead to full healing, which can result in tendinopathy.
Common areas affected by tendinopathy include the Achilles tendon, rotator cuff, patellar and quadriceps tendons, elbow tendons (Tennis and Golfer's elbow) and finger tendons (Trigger finger). Symptoms typically include localised pain, tenderness, swelling, and difficulty with movement. Tendinopathy can be a significant barrier to performing daily activities, making effective treatment essential.
Conventional Treatments for Tendinopathy
Management of tendinopathy often begins with rest, physical therapy, and the use of non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation. Corticosteroid injections are sometimes used to reduce inflammation and provide short-term pain relief, but their long-term effectiveness can be limited, and repeated use may lead to further tendon damage.
While these approaches can be effective for many patients, they may not address the underlying pathology in tendinopathy, and the relief they provide is often temporary. In some cases, surgical intervention may be considered, but it comes with the risk of complications and a prolonged recovery period.
Hyaluronic Acid Injection in Tendinopathy
Hyaluronic Acid (HA) is a naturally occurring substance found in the human body, particularly in the joints and connective tissues. It plays a crucial role in maintaining joint lubrication and cushioning, which helps protect the cartilage and promote smooth joint movement. HA has been used for many years in the treatment of osteoarthritis and has proven potential benefits in treating tendinopathy. This treatment involves injecting HA directly into the affected tendon sheath or surrounding area to improve tendon gliding, reduce scarring and promote healing. Conditions such as Achilles tendinopathy and trigger finger have shown promising responses to this treatment.
The mechanism of action of HA includes its ability to enhance lubrication, reduce inflammation, and support the regeneration of damaged tendon tissue. Recent studies have shown that hyaluronic acid injections can be an effective treatment for tendinopathy, providing pain relief and improving function with minimal side effects. (see links below)
The benefits of hyaluronic acid injections include their minimally invasive nature, their ability to provide pain relief, and their role in reducing the need for long-term use of pain medications. Compared to other treatments, hyaluronic acid offers a unique combination of lubrication and anti-inflammatory effects that can help restore tendon health and function, in addition to their excellent safety profile when compared with steroid injections or surgery.
Comparing HA to Other Treatments
HA injections are just one of several non-surgical options available for treating tendinopathy. Corticosteroid injections are commonly used to provide short-term pain relief by reducing inflammation. However, repeated use of corticosteroids can weaken tendons over time and may lead to further injury.
Platelet-rich plasma (PRP) is another treatment option that involves injecting a patient’s own plasma (containing platelets and growth factors) into the affected area in the tendon to promote healing. PRP is known for its powerful healing properties, as it releases growth factors that stimulate tissue repair and regeneration. However, it may require multiple treatments to achieve optimal results, and the cost can be a consideration for some patients.
Procedure: What to Expect
HA injections are typically administered in a clinical setting by an experienced doctor. Before the procedure, the area is cleaned and sterilised, and a local anaesthetic is applied to reduce discomfort. During the injection, HA is carefully injected into the affected tendon or surrounding area under ultrasound guidance to ensure an accurate injection. The procedure is typically performed in a clinic or procedure room.
After the injection, patients may experience mild swelling or discomfort at the injection site, but these side effects are generally short-lived. Recovery times vary depending on the severity of the tendinopathy and the patient’s overall health, but many patients can resume normal activities within a few days.
Is HA Right for You?
HA injections may be an appropriate treatment for individuals with tendinopathy who have not responded well to other non-surgical treatments, such as physical therapy or NSAIDs. It is particularly useful for those seeking a minimally invasive option that can provide lasting pain relief without the risks associated with corticosteroids or surgery.
If you're considering hyaluronic acid injections for tendinopathy, consulting with an orthopaedic specialist is essential to determine if this treatment suits your specific condition. Accurate diagnosis and patient selection are key determinants of good outcomes, and factors such as the severity of the tendinopathy, your activity level, and overall health will play a role in ensuring the best course of treatment.
Conclusion
HA injections offer an effective and safe non-surgical treatment for tendinopathy, providing pain relief, improved function, and reduced reliance on long-term pain medications. This minimally invasive option is particularly valuable for patients seeking an alternative to corticosteroids or surgery.
For personalised care, you may book an appointment at ACTIVATE Musculoskeletal Clinic, where Dr Alnaib can guide you through your treatment options. It is important to consider a comprehensive treatment plan that includes physical therapy and other supportive measures to achieve the best possible outcome.
About the Author: Dr. Mustafa Alnaib MBChB, MRCS, MSc, FEBOT is an orthopaedic surgeon, musculoskeletal doctor and Clinic Director at ACTIVATE Musculoskeletal Clinic in Kent.
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