Column: Opathy, osis and itis, oh my


Commentary by Dr. Joseph Hui


Chronic tendon pain is the most common problem I see in my office. Unfortunately, it is almost always misdiagnosed. In most cases, the problem actually is a tendinopathy or tendinosis, not a tendinitis.

In healthy tendons, the fibers appear like a bundle of dry noodles. When tendons sustain micro tears, our bodies attempt to heal themselves by weaving in new fibers. These fibers might not run correctly, which causes the tendon to become more of a twisted mop-like structure. This makes the tendon more structurally unsound and causes increased pain. To compensate, the tendon often thickens, and a lump can form over time.

A diagnostic ultrasound usually shows there is little inflammation, so the designation of an “itis,” which indicates inflammation, is inappropriate. As a result, anti-inflammatories like ibuprofen or Aleve do little to alleviate the pain. Injections of corticosteroids, a powerful anti-inflammatory, can be harmful when injected directly into the tendon because it can cause the tendon to wear out quicker and even rupture. I perform these steroid injections sparingly and always guide the injection using ultrasound in order to inject near the tendon, rather than directly into it to avoid these complications. Even then, steroids only provide temporary relief.

Eccentric strengthening, which involves strengthening the tendon as it lengthens, and cross-friction massage, a type of deep tissue massage technique, through physical therapy are recommended treatment options. Our goal is to revert the tissue from a mop back into a noodle. When these treatments fail, platelet-rich plasma injections, covered in a previous Current issue, can be performed. An alternative treatment, which uses a vibrating needle to break up the diseased mop-like tissue and remove it via a small incision, also has proven to treat the issue.

It’s important to talk to a health care professional when experiencing any sort of chronic pain. By properly diagnosing and treating these chronic problems, you will save time and pain when it comes to those nagging injuries.

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