Ask Dr. Scofield: Which Tendon Treatment Is Right for Me?
Dr. Scofield explains the factors he considers when making decisions about which tendon treatment to use.
Thank your tendons for your ability to move. These tough fibrous connective tissues attach muscle to bone in our arms, legs, hands, feet, head, and torso. We take them for granted—until an injury brings them painfully to our attention. When tendons are damaged, identifying the best tendon treatment requires the expertise of an orthopedic specialist.
One treatment doesn’t fit all tendon injuries
Tendon injuries vary, ranging from specific tears and focused scar tissue to diffuse tendon disease. Not surprisingly, the range of tendon treatment options is as diverse as the injuries themselves. Because it takes experience and expertise to match a specific injury to the best treatment option, we asked sports medicine physician Dr. Kirk Scofield to discuss some of the factors he weighs when evaluating tendon treatment options.
Emerging technologies have expanded treatment options
“Historically, we thought inflammation caused tendon pain,” says Dr. Scofield. “Now we understand that scar tissue in the tendon is at the root of chronic tendon pain. As new treatments like Tenex ultrasonic technology and platelet-rich plasma (PRP) regenerative therapies emerged to remove painful scar tissue or promote healing, treatment options expanded. But we still have to decide which therapy to use.”
One factor that makes treatment choice difficult: Tenex and PRP treatments have not been directly compared in research studies. “These therapies are fairly new,” explains Dr. Scofield. “We don’t have the data to tell us whether specific tendon injuries respond better to Tenex versus PRP. However, there are still a number of considerations that guide us in evaluating patient options.”
Patient age and preference affect tendon treatment choice
“As we age, our platelet production slows,” says Dr. Scofield. “Of course platelet production varies from one individual to another. But age is a consideration. In addition, patient preference plays a role in treatment selection. Some patients are more comfortable with the idea of one therapy over another.”
Comparative treatment costs influence patient decisions
Cost is another factor when considering which tendon treatment to choose. PRP therapies are generally not covered by insurance. “For most patients, PRP is an out-of-pocket cost,” explains Dr. Scofield. “You can use a health savings account to pay for PRP treatments. But as a general rule, insurance companies don’t cover them. The one exception is a work-related tendon injury, because workers’ compensation insurance will usually pay for PRP.”
The location of the injured tendon is a consideration
The joint involved in the injury and the type of tendon also play roles in treatment decisions. “I tend not to do PRP injections for shoulder injuries because damaged tendons are more difficult to access in the shoulder joint,” explains Dr. Scofield. “However, PRP works well for tendons in a knee or ankle joint. The damage in these long-sheathed tendons tends to be diffuse, which makes PRP treatment preferable to Tenex.”
The nature of the injury influences the selection of tendon treatment
“When making treatment decisions, it’s important to know whether the injury is localized or diffuse,” says Dr. Scofield. “I also want to know if there is tearing involved. Consequently, I usually do an ultrasound evaluation of the tendon to check for tearing and evaluate the disease. Is the tendon disease localized in one little spot or is it diffused throughout the tendon?”
PRP treatment is preferred for torn cartilage and diffuse tendon injury
“PRP promotes healing,” explains Dr. Scofield. “If the tendon is torn or if the injury is diffuse, I’ll consider PRP to support healing. I don’t like to treat diffused tendon damage with Tenex because it is a very directed therapy. It works by breaking up and removing tendon scar tissue. When the injury is localized and focused, breaking up the scar tissue with Tenex treatment works well. But I hesitate to use Tenex for diffuse damage in a long-sheathed tendon like the Achilles tendon. My worry is that widespread abrasive Tenex treatment over the entire tendon might further weaken it.”
However, Dr. Scofield points out that Tenex does work well to treat Achilles tendinitis at the insertion point of the tendon at the heel bone. “Injuries at the insertion point of the tendon are focused; that’s a good fit for Tenex,” he says. “But Tenex is not the best choice to treat the midportion of the Achilles tendon. These are two very different injuries.”
Calcium in the tendon often responds better to Tenex
“Sometimes,” explains Dr. Scofield, “calcium infiltrates the tendon, causing calcific tendinopathy. This is an injury we may see in the shoulder joint. Tenex can be an effective therapy to flush calcium out of the rotator cuff. In fact, it’s probably the best treatment for calcific shoulder tendinopathy.
But Dr. Scofield notes an exception to this guideline. “If calcium infiltrates weight-bearing tendons like the Achilles tendon or the patellar tendon, I’ll think twice about using Tenex,” he says. “Under pressure, calcium gets extremely hard, like a pebble. These more solid calcifications don’t respond as successfully to Tenex therapy.”
Recovery time is another consideration
“The recovery with Tenex can be a little slower than with PRP,” says Dr. Scofield. “That’s because Tenex disrupts the tendon by breaking up and flushing out the diseased tissues. For this reason, we are going to protect the tendon for three to five days following Tenex treatment. If the treated tendon is weight-bearing, we’ll protect it in a fracture boot. If the rotator cuff is treated, I’ll give patients a sling for about five days. That’s enough time to protect the tendon during initial healing, without risking a stiff shoulder. In addition, you’ll reduce your activities for about two weeks. It’s OK to perform the activities of daily living, but not more than that. Depending on the patient’s objectives, the recuperation period can be a factor in treatment choice.
Summit Orthopedics offers comprehensive sports medicine expertise
From Olympians to pro athletes to kids in youth sports and those that just want to be more active—Summit Orthopedics delivers expert care by fellowship-trained sports medicine physicians. If you are recently injured or concerned about ongoing pain, Summit Orthopedics sports medicine specialists have the expertise to evaluate your discomfort and develop a plan to quickly and safely help you get back to being active.
Start your journey to stronger, healthier athletic condition. Find your sports medicine expert, and request an appointment online. Or call us at (651) 968–5201 to schedule a sports medicine consultation.
Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MN, Vadnais Heights, MN, and Woodbury, MN, as well as several additional community clinics.
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