Sclerosing polidocanol injections of small vessels to treat the chronic painful tendon.
The chronic painful tendon (tendinopathy, tendinosis) is generally considered difficult to treat, not seldom causing long-term disability and sometimes ending the sports or work carreér. Most common sites for tendinopathy are the Achilles-, patellar-, extensor carpi radialis brevis (ERCB)-, and supraspinatus tendons. The origin of pain has for many years been unknown, but recently, by using ultrasound (US) + colour Doppler (CD), immunohistochemical analyses of tendon biopsies, and diagnostic injections of local anaestesia, we found a close relationship between areas with vasculo-neural ingrowth and tendon pain. Sensory nerves (Substance-P-SP and Calcitonin Gene Related Peptide-CGRP) were found inside and outside the vascular wall. In following clinical studies we have demonstrated good short-and mid-term clinical results using treatment with US+CD-guided sclerosing polidocanol injections, targeting the area with neovessels outside the tendon. Two-year follow ups have showed remaining good clinical results, and sonographically signs of remodelling with a significantly thinner tendon with a more normal structure. Whether the effects of polidocanol are mediated through destruction of neovessels, activity on nerves or a combination, is under evaluation.
Alfredson
H
H
Sports Medicine Unit, University of Umeå, 901 87 Umeå, Sweden. hakan.alfredson@idrott.umu.se
Lorentzon
R
R
D006801:Humans; D009389:Neovascularization, Pathologic / Q000188:drug therapy*; D010146:Pain / Q000188:drug therapy*; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D013710:Tendons / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000187:drug effects*; D018615:Ultrasonography, Doppler, Color
D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols