2nd appt t/s
Tendon pain is currently very topical in sports medicine. The problem is the physician or interventional radiologist or orthopaedist now have several dilemmas to contend with. Several years ago we had conservative care (which largely consisted of some sort of partial or full immobilisation with lengthy rehabilitation) or surgical with lengthy rehabilitation. Now we have two new dimensions that of injectable substrate and one of image guidance. Sports medicine has certainly become for more complex and controversial than it was even five years ago. The substrates I am talking about are numerous.
Some attempt at deciding which injection for which problem has been made however the evidence for any of these types of treatment is certainly weak at best.
One thing is sure injections in sport and exercise medicine especially at the highest level are not going to disappear any time soon. At benchmark54 we capture all types of treatment an athlete receives and not only that how the treatment was carried out so in the area of injections in sports medicine we record what was injected ( hard coded) for which diagnosis (Osics10) we also code how the injection was performed eg with ultrasound guidance or using anatomical landmarks. Over time we will be able to query the database and evaluate the actual impact of injections for tendon pain for example in terms of time loss.
Weather or not it makes a difference if anything is injected by which route and exactly what is injected will be the topic of many debates over the coming years for now her is a case of my own in a 54 year old male fell walker who has had pain in the achilles tendon on and off for 30 years. For the past 12 months he had been unable to walk uphill without pain and had significant morning stiffness.
This is a transcript of my consultations
30 September 13 Problem: Achilles tendinitis (N2174) R sided VAS 7 – 9 / 10 stiffness every day and pain 33 years history ! Failed Physiotherapy 8 sessions – no change
Achilles initial visit Ultrasound t/s
L/S Ultrasound 1st visit
We discussed options, patient and myself decided on injectable option.
After consent US Guided procedure R Achilles tendon
Lidocaine to skin aspiration of the intrasubstance torn area 1 ml blood aspirated. Dry needling done also Prolotherapy with 25% dextrose 1 ml. Placed in walking boot to be removed when driving or sleeping to be work walking. Also advised chondroitin 1200mg / day Vit C 1 g per day I will see in 5 weeks for second dry needling procedure
14.10.13
I reviewed Mr X today he is definitely better by about 60 – 70 % VAS 4/10
2nd appt t/s
2nd appt l/s
The tendon no longer has the large defect internally and appears to be healing.I have dry needled the tendon today and will see him in 10 weeks Boot can be worn for next 2 weeks every day then alternate days. Continue supplements
23.12.13
I saw Mr Xtoday he is back walking and working now no longer using the boot minimal symptoms. VAS 1/10 US Scan no evidence of tear complete healing achieved this tendon is still thickened however. Neovascular grade 1
3rd appt t/s
3rd appt l/s
3rd visit doppler
Patient very pleased with outcome able to unrestricted walking minimal am stiffness for 1 minute after sitting down after walking Discharged PRN