Tendonitis: How to get rid of the agony of shoulder tendonitis!

The shoulder is a complex joint consisting of three bones (the scapula, the humerus, and the clavicle) and held together by an arrangement of ligaments, tendons, muscles, and bursae.  Shoulder pain is a common complaint.  It’s important to separate shoulder pain from referred pain coming from the neck.  Most primary shoulder pain is due to degeneration occurring in the rotator cuff or biceps tendons.  The term tendonitis is incorrect since there is very little inflammation.  The problem is tendon degeneration. Accurate diagnosis is important.  Examination with history, physical, and imaging procedures can establish the correct diagnosis. Treatment involves the use of rest, ice, physical therapy, stretching and strengthening exercises.  More aggressive measures include steroid injection, needle tenotomy with  platelet rich plasma,  and Tenex.

Coming up next…A new test that might be useful if you own a Ferrari…

PET useful for detecting early disease

Published in Arthritis Care and Research, an article indicated that positron emission tomography or PET scanning is a useful tool for monitoring disease activity.  The study analyzed data from 18 studies encompassing 276 patients with inflammatory joint disease.  Results showed PET was highly sensitive and correlated well with clinical assessments.

Comment: Good luck getting insurance companies to pay for this one!

Tennis elbow.

Tennis elbow, also known as lateral epicondylitis, is a common form of painful tendon disorder involving the outside part of the elbow. Interestingly, very few people who suffer from tennis elbow actually play tennis.

Risk factors for tennis elbow include aging, repetitive motion, excessive load on the arm, and trauma.

The diagnosis is made by history, physical examination, and imaging procedures such as magnetic resonance imaging and diagnostic ultrasound.

The treatment for this disorder consists of physical therapy, stretching and strengthening exercises, nonsteroidal anti-inflammatory drugs, a tennis elbow band, and avoidance of those activities that brought the disorder on in the first place.

Extracorporeal shock wave therapy has shown some promise. The treatment of choice today is platelet rich plasma, and ultra concentrate of blood, that contains a large number of platelets. Platelets are cells that are packed with growth and healing factors. Platelet rich plasma is administered using ultrasound guidance. A more recent treatment is Tenex. This is the device that uses at an oscillating needle along with irrigation and suction to vacuum out debris. This also uses ultrasound guidance. At our institution. We use a combination of 10 ask and platelet rich plasma with excellent results. I want to stress that cortisone should not be used for tennis elbow. While it may provide short-term relief, it causes long-term tendon degeneration.


Jumpers knee.

Jumpers the, also known as patellar tendinopathy, is a common injury affecting athletes who do a lot of running and jumping. It is considered a repetitive stress injury and affects people who play basketball, volleyball, soccer, and who engage in high jumping.

Risk factors include overtraining and training on hard surfaces.

Symptoms include pain at the passion of the patellar tendon into the telephone. The diagnosis is made by history, physical examination, and imaging studies such as MRI and ultrasound.

Often there is an area of cartilage irregularity where the patellar tendon inserts into the tell.

Treatment includes modification of activity, ice, joint motion, stretching, strengthening, a patellofemoral race, and occasionally arch supports. Knee immobilization is contraindicated.

More aggressive treatment includes sport specific physical therapy, electric shock wave therapy, and more recently the use of platelet rich plasma and Tenex. Corticosteroids should never be used because they weaken tendon and cartilage.

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