Tendinopathy Injections

What are tendinopathy injections?

Tendinopathy injections are a type of non-surgical treatment for some tendon conditions. There are different types of injections including:

Cortisone injections

What is cortisone?

Cortisone is a corticosteroid medication. Corticosteroids are used to treat many conditions, particularly inflammatory conditions.

Although cortisone injections are often called ‘steroid’ injections, these are not the same as anabolic steroids such as testosterone.

Why have a cortisone injection?

A cortisone injection may relieve inflammation and pain in your tendon.

Where is the injection given?

The injection is usually given around the tendon. Injections directly into the tendon can be done but are associated with further damage to the tendon.

What happens during a cortisone injection?

The procedure is done in your doctor’s office and only takes a few minutes to do, although you might be asked to stay for a short while afterwards for observation.

The injection is usually done with you sitting or lying down (depending on which joint is being injected). Your doctor may apply a topical anaesthetic and may also apply some ultrasound gel, if the injection is being guided by ultrasound.

Through a disinfected site, your doctor will inject a small volume of cortisone into/around the affected tendon. There may be local anaesthetic mixed with the cortisone, but you might still feel a slight pinching or burning sensation.

How long does the effect from the injection last?

The effect from a cortisone injection may last somewhere between 6 weeks and 6 months.

Are there any complications?

Possible complications include:

  • an allergic reaction (to the local anaesthetic more than the cortisone)
  • pain and swelling
  • infection
  • skin lightening in people with darker skin
  • elevated blood sugar in people with diabetes

Cortisone injections into tendons may cause damage to the tendon.

Platelet Rich Plasma Injections

What is platelet rich plasma?

Platelet rich plasma (PRP) is made from a sample of your own blood. Your blood is made up of plasma (the ‘water’ part that contains proteins and nutrients) and cells (red cells, white cells and platelets).

PRP is blood with the red cells and white cells removed, but with a higher concentration of platelets than normal blood. Platelets are activated during the healing process to release growth factors that can further influence healing.

Although PRP has been in use for 30 years, it is considered novel therapy.

How is PRP made?

PRP is made from a sample of your blood. Different doctors have different ways to prepare it. Generally, a small amount of your blood is collected into a tube and that tube is then spun in a high-speed centrifuge. Spinning separates the blood into layers (red cells at the bottom, white cells and platelets in the middle and plasma at the top). The platelet layer at the top of the cells is removed, together with some plasma, to create platelet rich plasma ready for use.

Why have a PRP injection?

A PRP injection may help damaged tissue heal. Experts are not yet sure how it works, but some theories are that PRP:

  • inhibits inflammation
  • increases production of lubricating joint fluid
  • stimulates new cartilage growth
  • alters pain receptors

PRP injections do not work for everyone. Our specialists at Orthopaedic Clinics Gold Coast will discuss whether you are a good candidate for PRP injections.If you decide to have PRP injections, you will be advised about what medications you need to avoid (eg anti-inflammatories and blood thinners) before and after treatment.

Where is the injection given?

The injection is given around the affected tendon. It may be given in conjunction with a procedure called a needle tenotomy, where a needle is used to make small cuts in the tendon. These are done under local anaesthetic and with the help of an ultrasound. The cuts stimulate bleeding, bringing fresh healing factors to the area. They may also allow the PRP to work better.

What happens during a PRP injection?

The procedure starts with taking a blood sample. It takes 45–90 minutes to prepare the PRP injection from the sample.

Once the PRP is ready, the injection site is cleaned. Your doctor may apply some ultrasound gel, if the injection is being guided by ultrasound. Then a small volume of PRP is injected around your tendon. As above, the procedure may be done with needle tenotomy.

A bandage is applied and you can then go home, but you should try to rest the joint for a couple of days.

How long does the effect last?

There is no standard duration of effect. It can take a while to work, with maximum benefit being felt 6–12 weeks after the injection.

Are there any complications?

The PRP stimulates a response from your body, so it’s common for there to be some pain and swelling for a few days to a few weeks. For some people, the pain can be severe.

The main complication is that the PRP injection may not work for you.