Jefferson Researchers Find That Ultrasound Helps In Treating Tennis Elbow And Other Tendon Problems

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Source: Jefferson University

Date:

12/5/2002

Jefferson Researchers Find That Ultrasound Helps In Treating Tennis Elbow

And Other Tendon Problems

Minimally-invasive ultrasound-guided needle therapy may help treat a wide

variety of sports injuries, said Jefferson radiologist Researchers at

Jefferson University Hospital have found that they can successfully treat

chronic tendon problems such as " tennis elbow, " " jumper's knee " and Achilles

tendon, with the help of diagnostic ultrasound, as an alternative to

surgery.

The ultrasound is used to better visualize abnormal tendons, identify areas

of the tendon containing scar tissue and determine if the scar tissue is

infiltrated with calcification, explained radiologist Lev N. Nazarian, M.D.,

professor of Radiology, Jefferson Medical College of Jefferson

University, Philadelphia, one of the investigators. Then needle therapy is

applied to treat the problem.

The study is co-authored by McShane, M.D., clinical assistant professor

of Family Medicine, Jefferson, and sports medicine specialist at the Rothman

Institute at Jefferson, who performs the procedure with Dr. Nazarian.

Many of the 400 patients who participated in the trial were able to resume

athletic and other activities after 12 weeks, Dr. Nazarian said. " These are

small abnormalities that a surgeon wouldn't touch, but can still cause

considerable symptoms, " the Jefferson radiologist said. " It's the kind of

problem that falls between the cracks, so to speak, when it come to

treatment. This procedure provides effective treatment to patients who may

not have been able to get relief before, with minimal disruption to a

patient's life. "

The study's findings will be presented at the 88th Scientific Assembly and

Annual Meeting of the Radiological Society of North America (RSNA) on Wed.,

Dec. 4, in Chicago. The study is also authored by Jefferson Family

Medicine/Sports Medicine specialist Marc I. Harwood, M.D., of the Rothman

Institute at Jefferson.

Athletes and non-athletes alike are prone to chronic tendon problems that

can be caused by a wide variety of activities and can range in severity from

mildly annoying to completely debilitating.

" Tendons are sinewy, somewhat elastic connective tissue that attach muscle

to bones, " Dr. Nazarian said. " They are vulnerable to wear and tear,

particularly as we get older. Over time, tendons become weaker than normal

and become subject to tiny breaks and tears in their fibers. When the tendon

is overused, strained, or injured, some of the tendon tissue is replaced

with scar tissue instead of normal elastic tendon tissue.

" Scar tissue is not elastic, " he said. " It is thick and dense and it occurs

right at the location where the tendon attaches to the bone. So when the

muscle contracts, the normal tendon that is remaining pulls on this now

dense, non-elastic tissue that then pulls against the bone. And that

interface causes pain. "

Treatments to date for chronic tendon problems have been imperfect in that

they either do not fully remedy the problem-- or they entail major

orthopaedic surgery and long recovery periods, said Dr. Nazarian.

The ultrasound-guided hypodermic needle procedure can be used to treat a

variety of problems including:

* Easing inflammation by injecting corticosteroid at the site

* Smoothing out bone adjacent to the tendon

* Eliminate calcifications rubbing against the tendon

" Roughing up " tissue around small tears in the tendon to promote healing

" Once we see the abnormality on the ultrasound, we can make a diagnosis

right away and tell exactly what is wrong. Additionally, we can treat the

problem immediately, " said Dr. Nazarian said. Traditionally, physicians have

used magnetic resonance imaging (MRI) to assess problem areas. But the

researchers found that ultrasonography provides a more accurate look.

" In fact, in many ways, ultrasonography is preferable to MRI. It's quicker,

less expensive, and better tolerated by patients, " Dr. Nazarian said.

" Furthermore, because the ultrasound examination is performed in so-called

'real-time,' any abnormalities can be directly correlated with the physical

examination. "

The study found that approximately 65 percent of the participants (151

males, 155 females, ages 13-82) reported improvement. They suffered from

various tendon, muscle and ligament injuries, including tennis elbow,

golfer's elbow, jumper's knee, hamstring and rotator cuff injuries and

Achilles tendon problems. They had not responded to more conservative

therapies such as medication, bracing, physical therapy or rest, and had

been living with symptoms from three months to 15 years.

To treat the identified problem, local anesthesia is administered. Then,

with the guidance of ultrasound, a needle is inserted down to the areas that

contain scar tissue. The needle tip breaks up scar tissue and any

calcifications.

Depending on the exact problem being treated, the procedure is often

completed with an injection of cortisone-like medication into the area. " The

procedure encourages blood vessels to enter the area and enables the body to

dissolve the scar tissue and lay down new, healthier tissue. After the

procedure, stretching and physical therapy encourage this tissue to become

more elastic and lengthened, enabling the tendon to function more normally, "

the Jefferson radiologist said.

This minimally-invasive procedure takes between five and 15 minutes, and

patients are awake and comfortable, watching the procedure. After the

procedure, patients may be outfitted with a splint or brace.