Sclerosing therapy and eccentric training in flexor carpi radialis tendinopathy in a tennis player.
BACKGROUND
Tendinopathy of the flexor carpi ulnaris tendon is a rare entity. Recent research revealed the role of a neurovascular ingrowth at the point of pain in various tendinopathic locations, such as at the Achilles and patellar tendon, in plantar fasciitis as well as in supraspinatus and tennis elbow tendinopathy. However, beyond the elbow no such neovascularisation has been reported to date.


METHODS
We present a 35-year old tennis player suffering tremendous pain (visual analogue scale (VAS) rating of 9/10) at the flexor carpi ulnaris tendon with adjacent calcification in close proximity to the pisiform bone. The patient was assessed with power Doppler and laser Doppler quantification of neovascularisation at the point of pain.


RESULTS
Power Doppler and laser Doppler quantification of neovascularisation at the point of pain identified higher capillary blood flow at three points over the painful vs the non-painful tendon (146/240/232rU vs 93/74/70rU at the non-affected side). Sclerosing therapy using polidocanol under power and laser Doppler guidance was initiated, with immediate decrease of capillary blood flow by 25% with resolution of the neovascularisation in power Doppler. Immediately following sclerosing, the patient's reported pain level on the VAS was reduced from 9/10 to 4/10. Following a short period of rest, eccentric training of the forearm muscle was initiated over 12 weeks with functional complete recovery and complete resolution of wrist pain.


CONCLUSIONS
Sclerosing therapy using polidocanol under power- and laser-Doppler guidance can decrease capillary blood flow by 25% with resolution of the neovascularisation. Subsequent eccentric training of the forearm muscle over 12 weeks can result in complete resolution of wrist pain.
Knobloch
Karsten
K
Plastic, Hand and Reconstructive Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625 Hanover, Germany. kknobi@yahoo.com
Spies
Marcus
M
Busch
Kay H
KH
Vogt
Peter M
PM
D000328:Adult; D005081:Exercise Therapy / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D010147:Pain Measurement; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000628:therapy*; D013715:Tennis / Q000293:injuries*; D016896:Treatment Outcome; D014463:Ultrasonography; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000628:therapy*
D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols