Use: Treatment for chronic tendinosis with associated neovascularity.
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)
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.
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.
The procedure is usually well tolerated and adverse reactions are rare.
The degree of discomfort varies depending on:
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.
The response to treatment is variable.
The degree of response to treatment depends on several factors; including:
Overall about 70% of patients get improvement. This improvement can be quite dramatic in many cases.
Following this procedure, please be advised of the following recommendations:
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 required we would discuss the above at the appropriate time.
Please remember that a referral is required as Dr Berman is a specialist.
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.
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