When tendinitis has been present for several months or more, it progresses to become chronic tendinitis or tendinosis. Tendinosis includes degenerative changes in the collagenous matrix of a tendon that weakens and increases its likelihood of a tendon rupture. Regenerative medicine treatments using ultrasound guidance for targeted platelet-rich plasma (PRP) injections aim to resolve chronic tendinitis by promoting natural healing and decreasing the likelihood of a catastrophic tendon rupture.
Tendinitis and Tendinosis Overview
Tendinitis refers to inflammation of a tendon, usually of less than several months duration. Symptoms of tendinitis can vary from a burning sensation around the inflamed tendon to aching pains and joint stiffness. Sometimes swelling along the tendon occurs with associated warmth and redness. If tendinitis symptoms become chronic and persist for several months or more, then the tendinitis condition progresses to chronic tendinitis or tendinosis.
Chronic tendinitis (tendinosis) of the Achilles tendon, rotator cuff of the shoulder, lateral epicondyle of the elbow (Tennis Elbow), medial epicondyle of the elbow (Golfer’s Elbow), and patellar tendon of the knee are common causes of “tendon inflammatory pain” in adults. PRP treatments promote natural healing of an injured, partially torn, or degenerative tendon. PRP treatments are options for promoting natural healing of chronic tendinitis (tendinosis). The choice of which bio-cellular agents to use depends on the extent of tendon and surrounding tissue injury contributing to the patient’s symptoms. Often times, PRP treatments alone are performed as the initial treatment for chronic tendinitis. For severe tendinosis or partial tendon tears, a more complex bio-cellular treatment approach using a combination of PRP and others may be considered.
Platelet-rich plasma (PRP) therapy is a recommended bio-cellular treatment to promote natural healing and to prevent progression of tendon degeneration that could lead to tendon rupture. In the case of a severe tendon rupture or complete tendon tear, surgical repair may be necessary to reattach the torn tendon. In the case of a partial tendon tear or rupture, PRP and others, or a combination of the two, may be considered to promote repair and regeneneration.
Regenerative medicine specialists at MRM advise their patients with chronic tendinitis (tendinosis) to avoid corticosteroid injections for at least three months prior to having a PRP treatment. This is done to optimize treatment success. Local wound healing is significantly impaired in the presence of injected corticosteroids. Similarly, over-the-counter medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin should be avoided for at least 10 days prior to any PRP treatment, then for several weeks to months thereafter while healing and regeneration occur. Both NSAIDs and aspirin impair platelet function as well as suppress elements of local wound healing.