Achilles Tendinopathy Toolkit: Section F - Medical and Surgical Interventions: Difference between revisions

m (Created page with " APPENDIX D Achilles Tendinopathy: Medical and Surgical Interventions")
 
mNo edit summary
Line 1: Line 1:
 APPENDIX D Achilles Tendinopathy: Medical and Surgical Interventions
= Achilles Tendinopathy: Medical and Surgical Interventions  =
 
The purpose of this document is to summarize common medical and surgical interventions which may be considered for the management of Achilles tendinopathy – particularly if it is not responding adequately to more strongly supported conservative management strategies (see “Achilles Tendinopathy: Summary of the Evidence for Physical Therapy Interventions”).
 
== Pharmacological Approaches  ==
 
=== NSAIDS<ref>McLauchlan , G, Handoll, H. Interventions for treating acute and chronic Achilles tendinitis. Cochrane Collaboration of Systemic Reviews. 2009;2:1‐36.</ref>  ===
 
{| width="700" border="1" cellpadding="1" cellspacing="1"
|-
| colspan="2" | '''Method'''
| Short term benefit in the acute stage of tendinopathy to minimise inflammatory process.
|-
| colspan="2" | '''Proposed Mechanism'''
| Interrupts the chemical pathway of inflammation.
|-
| rowspan="2" | '''Benefit: Pros/Cons'''<br>
| '''Pros:'''
| Inexpensive, easily accessible.
|-
| '''Cons:'''
|
*Precautions and contraindications&nbsp;that accompany&nbsp;specific medications.
*Inhibition of inflammation may&nbsp;delay soft tissue repair by&nbsp;impairing fibroblastic&nbsp;proliferation.
 
|-
| colspan="2" | '''Evidence'''
|
Weak evidence for a modest effect in acute stage in Achilles tendinopathy.
 
Recommendation for a short course of NSAIDs for acute symptoms within 14 days.
 
No difference between oral or topical application.
 
|-
| colspan="2" |
'''Take Home Message '''''<br>''''''Implications for Physiotherapy'''
 
| PTs are involved in the treatment of tendon pain at all stages of<br>recovery. General knowledge of commonly used NSAIDS is important for treatment planning.
|}
 
=== Corticosteroid (injection)  ===
 
{| width="700" border="1" cellpadding="1" cellspacing="1"
|-
| colspan="2" | '''Method'''
|
|-
| colspan="2" | '''Proposed Mechanism'''
|
|-
| rowspan="2" | '''Benefit: Pros/Cons'''<br>
| '''Pros:'''
|
|-
| '''Cons:'''
|
|-
| colspan="2" | '''Evidence'''
|
|-
| colspan="2" |
'''Take Home Message '''''<br>''''''Implications for Physiotherapy'''
 
|
|}
 
=== Glycerol Trinitrate (GTN)  ===
 
{| width="700" border="1" cellpadding="1" cellspacing="1"
|-
| colspan="2" | '''Method'''
|
|-
| colspan="2" | '''Proposed Mechanism'''
|
|-
| rowspan="2" | '''Benefit: Pros/Cons'''<br>
| '''Pros:'''
|
|-
| '''Cons:'''
|
|-
| colspan="2" | '''Evidence'''
|
|-
| colspan="2" |
'''Take Home Message '''''<br>''''''Implications for Physiotherapy'''
 
|
|}
 
== Injection Therapies  ==
 
{| width="700" border="1" cellpadding="1" cellspacing="1"
|-
| colspan="2" | '''Method'''
|
|-
| colspan="2" | '''Proposed Mechanism'''
|
|-
| rowspan="2" | '''Benefit: Pros/Cons'''<br>
| '''Pros:'''
|
|-
| '''Cons:'''
|
|-
| colspan="2" | '''Evidence'''
|
|-
| colspan="2" |
'''Take Home Message '''''<br>''''''Implications for Physiotherapy'''
 
|
|}
 
=== Polidocanol  ===
 
{| width="700" border="1" cellpadding="1" cellspacing="1"
|-
| colspan="2" | '''Method'''
|
|-
| colspan="2" | '''Proposed Mechanism'''
|
|-
| rowspan="2" | '''Benefit: Pros/Cons'''<br>
| '''Pros:'''
|
|-
| '''Cons:'''
|
|-
| colspan="2" | '''Evidence'''
|
|-
| colspan="2" |
'''Take Home Message '''''<br>''''''Implications for Physiotherapy'''
 
|
|}
 
=== Prolotherapy  ===
 
{| width="700" border="1" cellpadding="1" cellspacing="1"
|-
| colspan="2" | '''Method'''
|
|-
| colspan="2" | '''Proposed Mechanism'''
|
|-
| rowspan="2" | '''Benefit: Pros/Cons'''<br>
| '''Pros:'''
|
|-
| '''Cons:'''
|
|-
| colspan="2" | '''Evidence'''
|
|-
| colspan="2" |
'''Take Home Message '''''<br>''''''Implications for Physiotherapy'''
 
|
|}
 
=== Platelet Rich Plasma (PRP) and Autologous whole blood  ===
 
{| width="700" border="1" cellpadding="1" cellspacing="1"
|-
| colspan="2" | '''Method'''
|
|-
| colspan="2" | '''Proposed Mechanism'''
|
|-
| rowspan="2" | '''Benefit: Pros/Cons'''<br>
| '''Pros:'''
|
|-
| '''Cons:'''
|
|-
| colspan="2" | '''Evidence'''
|
|-
| colspan="2" |
'''Take Home Message '''''<br>''''''Implications for Physiotherapy'''
 
|
|}
 
=== High volume injection (HVI) or Hydrostatic dissection  ===
 
{| width="700" border="1" cellpadding="1" cellspacing="1"
|-
| colspan="2" | '''Method'''
|
|-
| colspan="2" | '''Proposed Mechanism'''
|
|-
| rowspan="2" | '''Benefit: Pros/Cons'''<br>
| '''Pros:'''
|
|-
| '''Cons:'''
|
|-
| colspan="2" | '''Evidence'''
|
|-
| colspan="2" |
'''Take Home Message '''''<br>''''''Implications for Physiotherapy'''
 
|
|}
 
== Dry Needling  ==
 
{| width="700" border="1" cellpadding="1" cellspacing="1"
|-
| colspan="2" | '''Method'''
|
|-
| colspan="2" | '''Proposed Mechanism'''
|
|-
| rowspan="2" | '''Benefit: Pros/Cons'''<br>
| '''Pros:'''
|
|-
| '''Cons:'''
|
|-
| colspan="2" | '''Evidence'''
|
|-
| colspan="2" |
'''Take Home Message '''''<br>''''''Implications for Physiotherapy'''
 
|
|}
 
=== Dry Needline using a Hypordermic Needle ("tendon fenestration")  ===
 
{| width="700" border="1" cellpadding="1" cellspacing="1"
|-
| colspan="2" | '''Method'''
|
|-
| colspan="2" | '''Proposed Mechanism'''
|
|-
| rowspan="2" | '''Benefit: Pros/Cons'''<br>
| '''Pros:'''
|
|-
| '''Cons:'''
|
|-
| colspan="2" | '''Evidence'''
|
|-
| colspan="2" |
'''Take Home Message '''''<br>''''''Implications for Physiotherapy'''
 
|
|}
 
== Surgical Approaches  ==
 
=== Percutaneous tenetomy  ===
 
{| width="700" border="1" cellpadding="1" cellspacing="1"
|-
| colspan="2" | '''Method'''
|
|-
| colspan="2" | '''Proposed Mechanism'''
|
|-
| rowspan="2" | '''Benefit: Pros/Cons'''<br>
| '''Pros:'''
|
|-
| '''Cons:'''
|
|-
| colspan="2" | '''Evidence'''
|
|-
| colspan="2" |
'''Take Home Message '''''<br>''''''Implications for Physiotherapy'''
 
|
|}
 
=== Surgical debridement  ===
 
{| width="700" border="1" cellpadding="1" cellspacing="1"
|-
| colspan="2" | '''Method'''
|
|-
| colspan="2" | '''Proposed Mechanism'''
|
|-
| rowspan="2" | '''Benefit: Pros/Cons'''<br>
| '''Pros:'''
|
|-
| '''Cons:'''
|
|-
| colspan="2" | '''Evidence'''
|
|-
| colspan="2" |
'''Take Home Message '''''<br>''''''Implications for Physiotherapy'''
 
|
|}
 
=== Minimally invasive stripping  ===
 
{| width="700" border="1" cellpadding="1" cellspacing="1"
|-
| colspan="2" | '''Method'''
|
|-
| colspan="2" | '''Proposed Mechanism'''
|
|-
| rowspan="2" | '''Benefit: Pros/Cons'''<br>
| '''Pros:'''
|
|-
| '''Cons:'''
|
|-
| colspan="2" | '''Evidence'''
|
|-
| colspan="2" |
'''Take Home Message '''''<br>''''''Implications for Physiotherapy'''
 
|
|}
 
Developed by Michael Yates, PT. BC Physiotherapy Tendinopathy Task Force. April 2012.
 
= References  =
 
<references />

Revision as of 10:50, 31 July 2012

Achilles Tendinopathy: Medical and Surgical Interventions[edit | edit source]

The purpose of this document is to summarize common medical and surgical interventions which may be considered for the management of Achilles tendinopathy – particularly if it is not responding adequately to more strongly supported conservative management strategies (see “Achilles Tendinopathy: Summary of the Evidence for Physical Therapy Interventions”).

Pharmacological Approaches[edit | edit source]

NSAIDS[1][edit | edit source]

Method Short term benefit in the acute stage of tendinopathy to minimise inflammatory process.
Proposed Mechanism Interrupts the chemical pathway of inflammation.
Benefit: Pros/Cons
 Pros: Inexpensive, easily accessible.
Cons:
  • Precautions and contraindications that accompany specific medications.
  • Inhibition of inflammation may delay soft tissue repair by impairing fibroblastic proliferation.
Evidence

Weak evidence for a modest effect in acute stage in Achilles tendinopathy.

Recommendation for a short course of NSAIDs for acute symptoms within 14 days.

No difference between oral or topical application.

Take Home Message
'Implications for Physiotherapy

PTs are involved in the treatment of tendon pain at all stages of
recovery. General knowledge of commonly used NSAIDS is important for treatment planning.

Corticosteroid (injection)[edit | edit source]

Method
Proposed Mechanism
Benefit: Pros/Cons
 Pros:
Cons:
Evidence

Take Home Message
'Implications for Physiotherapy

Glycerol Trinitrate (GTN)[edit | edit source]

Method
Proposed Mechanism
Benefit: Pros/Cons
 Pros:
Cons:
Evidence

Take Home Message
'Implications for Physiotherapy

Injection Therapies[edit | edit source]

Method
Proposed Mechanism
Benefit: Pros/Cons
 Pros:
Cons:
Evidence

Take Home Message
'Implications for Physiotherapy

Polidocanol[edit | edit source]

Method
Proposed Mechanism
Benefit: Pros/Cons
 Pros:
Cons:
Evidence

Take Home Message
'Implications for Physiotherapy

Prolotherapy[edit | edit source]

Method
Proposed Mechanism
Benefit: Pros/Cons
 Pros:
Cons:
Evidence

Take Home Message
'Implications for Physiotherapy

Platelet Rich Plasma (PRP) and Autologous whole blood[edit | edit source]

Method
Proposed Mechanism
Benefit: Pros/Cons
 Pros:
Cons:
Evidence

Take Home Message
'Implications for Physiotherapy

High volume injection (HVI) or Hydrostatic dissection[edit | edit source]

Method
Proposed Mechanism
Benefit: Pros/Cons
 Pros:
Cons:
Evidence

Take Home Message
'Implications for Physiotherapy

Dry Needling[edit | edit source]

Method
Proposed Mechanism
Benefit: Pros/Cons
 Pros:
Cons:
Evidence

Take Home Message
'Implications for Physiotherapy

Dry Needline using a Hypordermic Needle ("tendon fenestration")[edit | edit source]

Method
Proposed Mechanism
Benefit: Pros/Cons
 Pros:
Cons:
Evidence

Take Home Message
'Implications for Physiotherapy

Surgical Approaches[edit | edit source]

Percutaneous tenetomy[edit | edit source]

Method
Proposed Mechanism
Benefit: Pros/Cons
 Pros:
Cons:
Evidence

Take Home Message
'Implications for Physiotherapy

Surgical debridement[edit | edit source]

Method
Proposed Mechanism
Benefit: Pros/Cons
 Pros:
Cons:
Evidence

Take Home Message
'Implications for Physiotherapy

Minimally invasive stripping[edit | edit source]

Method
Proposed Mechanism
Benefit: Pros/Cons
 Pros:
Cons:
Evidence

Take Home Message
'Implications for Physiotherapy

Developed by Michael Yates, PT. BC Physiotherapy Tendinopathy Task Force. April 2012.

References[edit | edit source]

  1. ↑ McLauchlan , G, Handoll, H. Interventions for treating acute and chronic Achilles tendinitis. Cochrane Collaboration of Systemic Reviews. 2009;2:1‐36.
Retrieved from "https://www.physio-pedia.com/index.php?title=Achilles_Tendinopathy_Toolkit:_Section_F_-_Medical_and_Surgical_Interventions&oldid=58907"