Chronic Tendon Pain Services at UPMC in South Central Pa.

Tendon Pain and Treatment

Tendons are the tough fibers that connect your muscle to your bones. Through aging, overuse or injury, these tendons can get small tears and scarring that make movement very painful. This condition is most common in the elbow, shoulder, knee, hip, and Achilles heel tendons. You may know this as tennis elbow or chronic runner’s knee.

Tendinosis starts when you perform an activity over and over again, causing you pain for three months or more. Repetitive motions, no matter how ordinary, can cause you injury. You may feel burning, cutting, or stabbing, and the pain is interfering with your everyday activities.

Unfortunately, not every patient responds to conservative, non-invasive treatment for chronic tendon pain. In the past, the only option available to these patients was an invasive surgery with a long, debilitating recovery.

But today, patients have a minimally invasive treatment called percutaneous ultrasound tenotomy (PUT) that uses high-frequency sound waves—or ultrasound—to remove damaged and scarred tissue that causes the tendon pain. And this treatment allows patients to continue their normal lives with few restrictions.

Common Causes of Tendinosis

Chronic tendon pain is caused by small tears in the tendon which form scar tissue and is usually caused by an overuse of the tendon. It can also be caused by physical trauma, such as a fall or sports injury.

Hobbies or professions that require putting repeated stress on the tendons can cause tendinosis. Athletes and manual laborers, for example, are more prone to this disorder.

Tendon problems are more common in older adults because the joints become less flexible as a person ages. People with joint conditions such as arthritis may also be more prone to tendinosis.

Symptoms of Tendinosis

Chronic tendon pain is caused by small tears in the tendon which form scar tissue. This scar tissue causes much of the pain that we feel. This includes:

• Pain, stiffness, and loss of strength in the affected area
• Sharp pain when the tendon is used
• Pain and stiffness during the night or in the morning
• Tenderness or swelling in the affected area
• A crunchy sound or feeling when using the tendon

Treatment for Chronic Tendon Pain

Tendons usually take a long time to heal, so the treatments for tendinosis aim to speed up the body's natural healing processes.

In most cases, patients can treat a tendon injury at home by following these steps:

• Resting the painful area
• Applying ice or cold packs for 10 to 15 minutes at a time, as often as two times an hour, for the first 72 hours
• Taking over-the-counter pain relievers such as acetaminophen or NSAIDs (e.g., ibuprofen or naproxen)
• Doing gentle range-of-motion exercises and stretching to prevent stiffness

If these steps don’t help, physical therapy may be needed. If the injury is severe or long-lasting, your doctor may have you use a splint, brace, or cast to hold the tendon still.

While these steps are generally effective, it may take weeks or months for your tendon injury to heal.

If these treatments don’t help, the only option used to be an invasive surgical procedure to scrape out the scar tissue on the tendon. In addition to involving more complicated surgery, this requires a long, debilitating recovery and lost work time.

A new option: percutaneous ultrasound Ttenotomy (PUT)

Tenex's Health PUT offers patients an alternative. It is a minimally invasive procedure done in one sitting - usually taking less than 20 minutes total - and the patient goes home with few restrictions in what they can do.

Ultrasound has been used for a long time as an imaging tool. What’s new is that PUT uses ultrasound as an energy source to cut and remove scar tissue on the tendon -- without harming healthy tendon tissue.

Patients may feel uncomfortable for a day or two, but they are encouraged to get moving again. Full recovery can be as early as six weeks.

Tendon repair

During the procedure, the physician uses musculoskeletal ultrasound guidance for this procedure to ensure that the abnormal region of the tendon is accurately targeted. Then a needle is repeatedly passed into the damaged tendon tissue which precisely breaks down and extracts the damaged tissue that causes tendon pain. When the damaged tissue is removed and there is increased blood flow, the body stimulates a healing response.

Patient benefits include:

• Effective pain relief and rapid recovery
  • Clinically proven to remove tendon pain for 90 percent of patients
  • Average recovery of 6 to 8 weeks to return to normal activities
• Safe, minimally invasive
  • Performed generally with local anesthetic
  • No stitches, requires only a small, adhesive bandage
• Easy, short procedure time
  • Short procedure tie with minimal downtown
  • No additional post-procedure treatment needed
• Covered by most insurance

Are you a candidate?

• Do you suffer from tendon pain in the shoulder, elbow, knee, Achilles, or plantar fascia?
• Have you tried and failed a recommended conservative treatment plan (RICE, PT) for at least three months and still have pain?
• Do you still feel pain despite receiving cortisone shots?
• Can you easily identify location and source of your pain?

Our UPMC in South Central Pa. board-certified sports medicine physicians perform this treatment at UPMC Lititz and UPMC Pinnacle Procedure Center. For more information, you can contact us at 717-791-2620.

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