Polidocanol Injection

Use:   Treatment for chronic tendinosis with associated neovascularity.

BACKGROUND:

Polidocanol (aethoxysclerol) is a medication which was developed originally as a local anaesthetic in 1961. It was noted to have the additional and far more effective property of being a sclerosant.

It was originally used in the treatment of venous disease. It was first used in the treatment of tendon pathology in 2002. (Ohberg L, Alfredson H. Ultrasound guided sclerosis of neovessels in painful chronic Achilles tendinosis: pilot study of a new treatment. Br J Sports Med. 2002; 36:173-175)

WHY INJECT POLIDOCANOL?

In areas of chronic tendinosis often new vessels develop (neovascularity). Reason for this is not known. This neovascularity does not appear to necessarily help in the healing process.

It has been postulated that these vessels, and likely accompanying nerves, are associated with the pain seen in chronic tendinosis.

Studies have shown that up to 80% of patients with chronic painful tendinosis have this neovasculartization.Also those with neovascularization are associated with more discomfort that those without this vascularity.

It has been found that ablating the neovascularity settles the pain, associated with the tendinosis.

Ablating/destroying the neovascularity does not in itself help heal the tendon, but makes the region pain free, and is usually done in conjunction with strengthening exercises and physiotherapy.

The injection in addition does not weaken the tendon, but may in fact help heal the tendon due to associated sclerosis.

HOW IS THE PROCEDURE PERFORMED ?

If you have not had a prior ultrasound an expert musculo-skeletal Sonographer or Dr Berman (specialist musculo-skeletal radiologist) will usually first scan the area of concern.

The skin is cleaned with an antiseptic agent. Under ultrasound control the area of concern will be injected directly with Polidocanol. Occasionally an initial injection of local anaesthetic into the skin will be performed first.

Also please remember to always bring with you any prior imaging that you may have had as this would possibly assist Dr Berman in determining the best treatment option in your case, or use the prior imaging as a source of comparison to assess for interval improvement after any particular therapy.

RISKS ANDS SIDE EFFECTS

The procedure is usually well tolerated and adverse reactions are rare.

  1. After injection discomfort.
    Common. May last a few days and rarely up to a week. Painkillers
    such as Paracetamol or ibuprofen if necessary.
  2. Redness of the skin:
    This is usually of nuisance value only. May last a few days.
  3. Infection:
    This is rare!Signs/symptoms include: Pain (increasing after 2-3 days at injection site),       redness, swelling, temperature and feeling of being unwell.
    Please consult your doctor as soon as possible.
  4. Other: These are uncommon or rare;
    Allergy to Polidocanol or the anaesthetic, band aid or antiseptic solution.

IS THE PROCEDURE PAINFUL?

The degree of discomfort varies depending on:

  • Area to be injected.
  • Degree of inflammation in the area.
  • Number of injections needed.
  • Previous experiences (good or bad). Fear of needles.

Overall the procedure is well tolerated and usually produces only minimal discomfort. There can be a slight increase in pain in the area injected for a day or two afterwards. Occasionally up to a week. I strongly recommend the use of ice-packs to be used 3-4 times a day for the first 2 days after treatment; beginning immediately afterwards. This is extremely successful in limiting the degree of discomfort produced by this therapy.

This is usually mild and helped with the use of analgesia (such as Ibuprofen and Paracetamol) and cold packs.

HOW EFFECTIVE IS THIS PROCEDURE?

The response to treatment is variable.

The degree of response to treatment depends on several factors; including:

  • Body part injected.
  • Other associated abnormalities, e.g. partial tear of the tendon.

Overall about 70% of patients get improvement. This improvement can be quite dramatic in many cases.

POST PROCEDURE

Following this procedure, please be advised of the following recommendations:

  • For one week after this treatment please refrain from any significant activity involving the treated area.
    From a practical point of view, activities of daily living are permissible.
  • Some discomfort may occur following the procedure, usually for the first 48 -72 hours. This will usually gradually then settle down. If required pain killers such as paracetamol or anti-inflammatories can be helpful. Intermittent icing may also be of benefit.
  • After 7-10 days you are advised to commence a program of rehabilitation under the supervision of a physiotherapist, concentrating on stretching and eccentric exercises.

Usually your rehabilitation program gradually increases over the following 3-6 weeks. The exact program and its intensity will depend on the body part treated, your tolerance and progress through the rehabilitation and your particular physiotherapists methods.

  • If progress is good and you are achieving designated goals, no further injection therapy is required.
  • If pain has decreased but plateaued at a level that is still troubling you or if there has been no benefit then a repeat injection may be required. We would suggest a repeat Ultrasound to assess the area prior to any further treatment being undertaken.
  • If a second injection is performed, and this together with continued rehabilitation fails to achieve the desired clinical outcome, then a different injection therapy, such as autologous blood, platelet rich protein or orthokine may be of value.

If required we would discuss the above at the appropriate time.

Please remember that a referral is required as Dr Berman is a specialist.

FOLLOW UP

After the injection a report would be sent to your referring general practitioner or specialist as well as you your treating physiotherapist.

If you do not have a physiotherapist, we would be happy to suggest someone in or close to your area.

The radiologist conducting the injection will send your referring doctor a report.

To download a Patient Information Brochure please click on the link below:

Independent Sports Imaging – Patient Fact Sheet on Polidocanol injections

 

Polidocanol right

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Credentials

Dr Berman is a dual specialist – Musculoskeletal Radiologist and Vein Specialist (Phlebologist)
Please click on Specialist Vein Care to see dedicated website.