Achilles Tendinopathy Toolkit: Section F - Medical and Surgical Interventions: Difference between revisions
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= 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 | 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_Toolkit:_Summary_of_Interventions|Achilles Tendinopathy: Summary of the Evidence for Physical Therapy Interventions]]”). | ||
== Pharmacological Approaches == | == Pharmacological Approaches == | ||
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| '''Cons:''' | | '''Cons:''' | ||
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*Precautions and contraindications that accompany specific medications. | *Precautions and contraindications that accompany specific medications. | ||
*Inhibition of inflammation may delay soft tissue repair by impairing fibroblastic proliferation. | *Inhibition of inflammation may delay soft tissue repair by impairing fibroblastic proliferation. | ||
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| colspan="2" | '''Evidence''' | | colspan="2" | '''Evidence''' | ||
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Weak evidence for a modest effect in acute stage in Achilles tendinopathy. | 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. | Recommendation for a short course of NSAIDs for acute symptoms within 14 days. | ||
No difference between oral or topical application. | No difference between oral or topical application. | ||
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Developed by Michael Yates, PT. BC Physiotherapy Tendinopathy Task Force. April 2012. | Developed by Michael Yates, PT. BC Physiotherapy Tendinopathy Task Force. April 2012. | ||
= References = | = References = | ||
<references /> | <references /> | ||
Revision as of 10:52, 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: |
| |
| 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 |
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 |
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Glycerol Trinitrate (GTN)[edit | edit source]
| Method | ||
| Proposed Mechanism | ||
| Benefit: Pros/Cons |
Pros: | |
| Cons: | ||
| Evidence | ||
|
Take Home Message |
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Injection Therapies[edit | edit source]
| Method | ||
| Proposed Mechanism | ||
| Benefit: Pros/Cons |
Pros: | |
| Cons: | ||
| Evidence | ||
|
Take Home Message |
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Polidocanol[edit | edit source]
| Method | ||
| Proposed Mechanism | ||
| Benefit: Pros/Cons |
Pros: | |
| Cons: | ||
| Evidence | ||
|
Take Home Message |
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Prolotherapy[edit | edit source]
| Method | ||
| Proposed Mechanism | ||
| Benefit: Pros/Cons |
Pros: | |
| Cons: | ||
| Evidence | ||
|
Take Home Message |
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Platelet Rich Plasma (PRP) and Autologous whole blood[edit | edit source]
| Method | ||
| Proposed Mechanism | ||
| Benefit: Pros/Cons |
Pros: | |
| Cons: | ||
| Evidence | ||
|
Take Home Message |
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High volume injection (HVI) or Hydrostatic dissection[edit | edit source]
| Method | ||
| Proposed Mechanism | ||
| Benefit: Pros/Cons |
Pros: | |
| Cons: | ||
| Evidence | ||
|
Take Home Message |
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Dry Needling[edit | edit source]
| Method | ||
| Proposed Mechanism | ||
| Benefit: Pros/Cons |
Pros: | |
| Cons: | ||
| Evidence | ||
|
Take Home Message |
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Dry Needline using a Hypordermic Needle ("tendon fenestration")[edit | edit source]
| Method | ||
| Proposed Mechanism | ||
| Benefit: Pros/Cons |
Pros: | |
| Cons: | ||
| Evidence | ||
|
Take Home Message |
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Surgical Approaches[edit | edit source]
Percutaneous tenetomy[edit | edit source]
| Method | ||
| Proposed Mechanism | ||
| Benefit: Pros/Cons |
Pros: | |
| Cons: | ||
| Evidence | ||
|
Take Home Message |
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Surgical debridement[edit | edit source]
| Method | ||
| Proposed Mechanism | ||
| Benefit: Pros/Cons |
Pros: | |
| Cons: | ||
| Evidence | ||
|
Take Home Message |
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Minimally invasive stripping[edit | edit source]
| Method | ||
| Proposed Mechanism | ||
| Benefit: Pros/Cons |
Pros: | |
| Cons: | ||
| Evidence | ||
|
Take Home Message |
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Developed by Michael Yates, PT. BC Physiotherapy Tendinopathy Task Force. April 2012.
References[edit | edit source]
- ↑ McLauchlan , G, Handoll, H. Interventions for treating acute and chronic Achilles tendinitis. Cochrane Collaboration of Systemic Reviews. 2009;2:1‐36.
