Emerging treatments

Pulsed ultrasound therapy for calcific rotator cuff tendinopathy

One randomized, double-blind trial that evaluated ultrasound therapy for calcific tendinopathy of the shoulder in 54 patients found that ultrasound helped diminish calcifications, and improved pain and quality of life, in the short term.[120][Figure caption and citation for the preceding image starts]: MRI demonstrating calcific tendinopathy involving the distal central supraspinatusFrom the personal collection of James Wang, PhD [Citation ends].com.bmj.content.model.Caption@a0bd19a

Autologous whole blood injection

In this procedure, blood is taken from the patient and reinjected around the affected tendon to supply growth factors that initiate healing. One systematic review concluded that autologous whole blood injections provide significant pain relief to patients with epicondylitis at 8 to 24 weeks.[121] However, the authors note that this conclusion is limited by the risk of bias. One network meta-analysis concluded that autologous blood injection is preferable to corticosteroid injection in patients with lateral epicondylitis.[122]

Cell-based therapies

Stem cell therapy for tendinopathy is poorly defined in clinical practice, but most commonly includes bone marrow aspirate concentration or adipose-derived stromal vascular fraction. At present, there is insufficient evidence to support cell-based therapies, including stem cell therapies, for tendinopathies.[123][124] Further research is required to define the safety and efficacy of cell-based therapies as a treatment for tendinopathy.

Sclerosing therapy

Studied for Achilles and patellar tendinopathy.[19][125][126][127] Involves ultrasound and color Doppler-guided polidocanol injections. Hypothesized to decrease pain by decreasing the amount of neovascularization in the overused tendon. One randomized controlled trial of 20 patients compared the effects of a sclerosing injection (polidocanol) with a non-sclerosing injection (lidocaine plus epinephrine). The sclerosing group showed improvement in pain at 3 months.[18][127] However, the clinical significance of neovascularization as a cause of pain remains contentious, and there is insufficient robust evidence to support the use of sclerosing injections in the treatment of painful tendinopathy with concomitant neovascularity. Further clinical, imaging, and laboratory studies investigating the relationship between neovascularity, tendon pain, and its management are required.[128]

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