New Treatment Option for Tendon Injury Mediated Shoulder Pain, Tennis Elbow

New Treatment Option for Tendon Injury Mediated Shoulder Pain, Tennis Elbow

The shoulder has an enormous range of motion, and that mobility is used repeatedly in daily life, to say nothing of sports. Yet to achieve free motion, the shoulder has to sacrifice stability and strength. Instead of being a snug joint held together by strong ligaments, the shoulder has to depend on muscles and tendons for much of its stability and strength as well as its mobility.


A tendon is a flexible band of fibrous tissue that connects muscles to bones. Tendonitis/ tendinitis is inflammation of a tendon. Tendons transmit the pull of the muscle to the bone to cause movement. They are found throughout the body, including the hands, wrists, elbows, shoulders, hips, knees, ankles, and feet. Bursitis and tendonitis are both common conditions that involve inflammation of the soft tissue around muscles and bones, most often in the shoulder, elbow, wrist, hip, knee, or ankle.

The classic tennis elbow is caused by repeated forceful contractions of wrist muscles located on the outer forearm. The stress, created at a common muscle origin, causes microscopic tears leading to inflammation. The elbow is the second most commonly injured area in golfers. The two most common problems are medial epicondylitis (also known as golfer’s or thrower’s elbow) and lateral epicondylitis (more commonly known as tennis elbow).

People at risk for tennis elbow are those in occupations that require strenuous or repetitive forearm movement. Such jobs include mechanics or carpentry. Sport activities that require individuals to twist the hand, wrist, and forearm, such as tennis, throwing a ball, bowling, golfing, and skiing, can cause tennis elbow. Often what is critically overlooked, however, is the imbalance that can develop between the front of the shoulder and the back.

Chronic tendinosis is a common overuse injury which can be very painful and debilitating and can affect many tendons throughout the body. This condition- tendinitis- is perhaps the most common of all shoulder problems. It rarely requires treatment in young people; as we enter middle age, however, the cumulative effects of years of tendinitis can result in much more serious ailments. What’s worse, each episode of tendinitis weakens the muscles further. Ultimately, this cumulative damage can lead to larger tears in the muscles and tendons. This is why conservative treatment of tendinitis at an early stage, along with education about the way the shoulder works and proper exercise, is crucial to preventing further (and more serious) injury.

Tendon repair refers to the surgical repair of damaged or torn tendons, which are cord-like structures made of strong fibrous connective tissue that connect muscles to bones. The shoulder, elbow, knee, and ankle joints are the most commonly affected by tendon injuries.

A large array of techniques from new approaches to physical therapy and rehabilitation to stretch and strengthen tendons and muscles by new, less-invasive treatments that stimulate your body to heal the problematic tendon that can help you keep swinging your racquet or clubs without pain.The initial treatment for a tendinopathy usually entails warming up the muscle/tendon before exercise, resting it, applying ice and wrapping it shortly afterward, and taking pain relievers. You also may do gentle stretching exercises to prevent stiffness.

This idea of creating a healing trauma is behind newer treatments such as noninvasive shockwave therapy and autologous blood injections. In shockwave therapy, the doctor uses high-energy ultrasound waves to hammer problem areas and stimulate healing. The treatment, although somewhat painful and therefore not for everyone, is relatively safe, carries few adverse effects and can be effective for many tendinopathies.

Chiropractor Dr. Lynn Kelly has identified the number one cause of arthritis as being joints that aren't moving properly because of misalignments of the bones that form them. Chiropractic adjustments are painless for most patients. Tiny pockets of gas are relieved from the joints when your vertebrae are adjusted, making a "popping" noise. Dozens of research studies have recognized the safety and helpfulness of chiropractic care. Chiropractors are also taught to identify when damage is outside of their scope of practice and will refer patients to the proper medical specialist if needed.

A randomized controlled trial examined 60 patients with shoulder tendonitis and the effect of Transcutaneous electrical nerve stimulation (TENS) and shock-wave therapy on pain. This study showed shock-wave therapy to be more effective than TENS for this condition. Another randomized trial evaluated burst TENS in Achilles tendon injuries. TENS appeared to be beneficial after suture of the Achilles tendon. Further research is needed to confirm these results.

Patients with chronic tendinosis of the Achilles tendon can experience a reduction in pain when injected with a small amount of a dextrose solution, according to a recent study conducted by researchers at St. Paul's Hospital in Vancouver, BC.

A study in the November 2006 issue of the British Journal of Sports Medicine found that the blood injections relieved pain in patients with medial epicondylitis ("golfer's elbow"). Side effects include soreness and a minimal risk of infection.

Patients with chronic tendinosis of the Achilles tendon can experience a reduction in pain when injected with a small amount of a dextrose solution, according to a recent study (Nov.2007) conducted by researchers at St. Paul's Hospital in Vancouver, BC. They performed this treatment using a small needle under ultrasound guidance so that the abnormal areas could be accurately targeted.

Another same like new study found a effective new minimally invasive procedure is a quick, inexpensive way to treat tendonitis in the shoulder, Italian researchers report.

The researchers used ultrasound-guided percutaneous (through the skin) therapy to treat the shoulders of more than 2,000 people (average age 42) with calcific tendonitis, characterized by the formation of small calcium deposits within the tendons of the rotator cuff. These deposits can cause pain and restrict mobility.

Ultrasound-guided percutaneous therapy is a 10-minute procedure in which a radiologist, guided by ultrasound, injects a saline solution into the rotator cuff to wash the area and break up the calcium. A second needle is then used to remove the calcium residue. Patient recovery time is about an hour.

In 71.7 percent of patients, the calcification was fully removed in one treatment, resulting in improved mobility and pain reduction. In 23.6 percent of patients, a second treatment was required because of the presence of more than one calcification. In 3.8 percent of patients, the calcification had moved or dissolved before treatment. In 0.9 percent of patients, there was no easing of symptoms, due to the presence of a tendon tear.

The findings were to be presented at the annual meeting of the Radiological Society of North America in Chicago.

"This is a quick, successful and inexpensive therapy for tendon calcifications. It provides significant and long-lasting reduction of symptoms," Dr. Luca M. Sconfienza, of the department of radiology at A.O. Ospedale Santa Corona in Pietre Ligure, and the department of experimental medicine at the University of Genova, said in a prepared statement.

While only a few institutions currently offer this therapy, it could be performed in any hospital or clinic that has ultrasound equipment with a superficial probe, Sconfienza said.

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