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The Use of Ultrasound-Guided Injections for Tendinopathies

Abstract

Purpose of Review

The purpose of the study was to review the efficacy and safety of common ultrasound-guided injections for tendinopathy conditions. Corticosteroid injections have historically been the most common injection used for tendinopathy; however, there are an increasing number of injections including platelet-rich plasma, hyaluronan, polidocanol, botulinum toxin, and high volume saline injections.

Recent Findings

There is growing evidence that while corticosteroid injections for tendinopathies usually have short-term efficacy, they may result in medium-term harm, particularly for tennis elbow (lateral epicondylitis). Corticosteroid injections appear to have more clinical utility for tenosynovitis conditions. There is insufficient evidence regarding other injection options to make a broad recommendation in favour, although individual trials for certain tendons illustrate benefits for some of the non-corticosteroid options.

Summary

When considering the use of ultrasound-guided corticosteroid injections for tendinopathies, the risk of possible medium-term harm must be weighed up against any short-term efficacy. Other injection-based therapies may be appropriate in certain clinical situations; however, the evidence and clinical circumstances must be considered for the particular tendon and patient. Load-based rehabilitation remains the cornerstone of tendinopathy management.

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References

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Correspondence to John W. Orchard.

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John W. Orchard, Richard Saw, and Lorenzo Masci each declare no potential conflicts of interest.

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None of the images illustrated in this study were obtained from live patients where consent would have been required (either cadaver models or self-images of the authors were used for all Figures).

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This article is part of the Topical collection on Sports Imaging.

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Orchard, J.W., Saw, R. & Masci, L. The Use of Ultrasound-Guided Injections for Tendinopathies. Curr Radiol Rep 6, 38 (2018). https://doi.org/10.1007/s40134-018-0296-2

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Keywords

  • Tendinopathy
  • Tenosynovitis
  • Ultrasound-guided
  • Injection
  • Corticosteroid
  • Platelet-rich-plasma