Sclerosing Polidocanol Injections of Small Vessels to Treat the Chronic Painful Tendon

Author(s): H. Alfredson, R. Lorentzon.

Journal Name: Cardiovascular & Hematological Agents in Medicinal Chemistry
(Formerly Current Medicinal Chemistry - Cardiovascular & Hematological Agents)

Volume 5 , Issue 2 , 2007

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Abstract:

The chronic painful tendon (tendinopathy, tendinosis) is generally considered difficult to treat, not seldom causing long-term disability and sometimes ending the sports or work carreer. Most common sites for tendinopathy are the Achilles-, patellar-, extensor carpi radialis brevis (ERCB)-, and supraspinatus tendons. The origin of pain has for many years been unknown, but recently, by using ultrasound (US) + colour Doppler (CD), immunohistochemical analyses of tendon biopsies, and diagnostic injections of local anaestesia, we found a close relationship between areas with vasculoneural ingrowth and tendon pain. Sensory nerves (Substance-P-SP and Calcitonin Gene Related Peptide-CGRP) were found inside and outside the vascular wall. In following clinical studies we have demonstrated good short-and mid-term clinical results using treatment with US+CD-guided sclerosing polidocanol injections, targeting the area with neovessels outside the tendon. Two-year follow ups have showed remaining good clinical results, and sonographically signs of remodelling with a significantly thinner tendon with a more normal structure. Whether the effects of polidocanol are mediated through destruction of neovessels, activity on nerves or a combination, is under evaluation.

Keywords: Chronic tendon pain, neovessels, nerves, ultrasonography, Doppler, polidocanol

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Article Details

VOLUME: 5
ISSUE: 2
Year: 2007
Page: [97 - 100]
Pages: 4
DOI: 10.2174/187152507780363232
Price: $58

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