title: High volume image guided injections in chronic Achilles tendinopathy.
abstract: OBJECTIVE
  To determine the effectiveness of high volume image guided injections (HVIGI) for chronic Achilles tendinopathy.
  
  
  METHODS
  We included in the study 30 consecutive patients (mean age 37.2 years, range 24 - 58 years) with Achilles tendinopathy for a mean of 35.8 months (range 2 - 276 months) who had failed to improve after a three-month programme of eccentric loading of the gastro-soleus complex. Patients were injected with 10 ml of 0.5% Bupivacaine Hydrochloride, 25 mg Hydrocortisone acetate, and up to 40 ml of injectable normal saline. A study-specific questionnaire and the Victorian Institute of Sport Assessment - Achilles tendon (VISA-A) were retrospectively administered to assess short- and long-term pain and functional improvement.
  
  
  RESULTS
  Some 21 patients (70%) responded. Patients reported significant short-term improvement at 4 weeks of both pain (mean change 50 mm, [SD 28, p < 0.0001], from a mean of 76 mm [SD 18.2], to a mean of 25 mm [SD 23.3]), and function scores (mean change 51 mm, [SD 31.2, p < 0.0001], from a mean of 78 mm [SD 20.8], to a mean of 27 mm [SD 28.4]). Patients also reported significant long-term improvement in symptoms using the VISA-A questionnaire (mean change 31.2 points, [SD = 28, p < 0.0001], from a mean of 44.8 points [SD 17.7], to a mean of 76.2 points [SD 24.6]) at a mean of 30.3 weeks from the injection.
  
  
  CONCLUSIONS
  HVIGI significantly reduces pain and improves function in patients with resistant Achilles tendinopathy in the short- and long-term.
authors.affiliation: Department of Imaging, The London Independent Hospital, London, UK.
authors.forename: Otto
authors.initials: O
authors.lastname: Chan
authors.forename: Dominic
authors.initials: D
authors.lastname: O'Dowd
authors.forename: Nat
authors.initials: N
authors.lastname: Padhiar
authors.forename: Dylan
authors.initials: D
authors.lastname: Morrissey
authors.forename: John
authors.initials: J
authors.lastname: King
authors.forename: Rosy
authors.initials: R
authors.lastname: Jalan
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
authors.forename: Tom
authors.initials: T
authors.lastname: Crisp
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000503:physiopathology*; D000328:Adult; D000779:Anesthetics, Local / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D007267:Injections; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D055070:Resistance Training; D012720:Severity of Illness Index; D052256:Tendinopathy / Q000503:physiopathology / Q000628:therapy*; D018084:Ultrasonography, Interventional; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; C021650:hydrocortisone acetate; D006854:Hydrocortisone; D002045:Bupivacaine