Tendon
Tendon Injuries & Tendinopathy
Chronic and acute tendon conditions treated with PRP, extracorporeal shockwave therapy, and percutaneous needle tenotomy — evidence-based approaches to restore function and relieve pain.
Understanding tendinopathy
Tendinopathy refers to chronic tendon pain and dysfunction caused by failed healing and disorganized collagen within the tendon. Unlike acute tendonitis (inflammation), tendinopathy reflects a degenerative process where the tendon's internal structure breaks down over time, often from repetitive use or overload.
These conditions are notoriously difficult to resolve with rest alone because the underlying problem is structural, not inflammatory. That is why we use treatments that target the root cause — stimulating a new healing response, breaking down disorganized tissue, and promoting healthy collagen remodeling.
All of our tendon injections are performed under ultrasound guidance to ensure precise needle placement directly at the site of pathology.
Diagnostic imaging
Musculoskeletal ultrasound is our primary tool for evaluating tendon conditions. It allows us to visualize tendon thickening, tears, neovascularization, and calcification in real time. Ultrasound also guides our needle during procedures for maximal precision. MRI may be ordered for complex cases or when surgical consultation is being considered.
Common tendon conditions we treat
- Achilles tendinopathy
- Tennis elbow (lateral epicondylitis)
- Golfer's elbow (medial epicondylitis)
- Patellar tendinopathy (jumper's knee)
- Gluteal tendinopathy
- Plantar fasciitis
- Rotator cuff tendinopathy
- De Quervain's tenosynovitis
- Proximal hamstring tendinopathy
- Posterior tibial tendinopathy
Treatment options
PRP injection (Platelet-Rich Plasma)
PRP harnesses your body's own healing factors by concentrating platelets from your blood and injecting them directly into the damaged tendon. These platelets release growth factors that stimulate tissue repair, reduce pain, and promote healthy collagen formation.
At Halcyon Health, we use a manual two-spin centrifugation technique to produce high-dose PRP, which current research indicates is critical for clinical efficacy. The injection is performed under ultrasound guidance to ensure the PRP is delivered precisely to the area of tendon pathology.
Multiple randomized controlled trials have demonstrated the superiority of PRP over placebo and corticosteroid injections for chronic tendinopathies, particularly lateral epicondylitis and patellar tendinopathy.
Extracorporeal Shockwave Therapy (ESWT)
ESWT uses focused acoustic waves to stimulate a healing response in chronically damaged tendons. The mechanical energy promotes neovascularization (new blood vessel growth), breaks down calcifications, and triggers the release of growth factors — essentially "restarting" the healing process in tissue that has stalled.
ESWT is non-invasive and performed in-office over a series of sessions. It is supported by strong evidence for plantar fasciitis, calcific tendinopathy of the shoulder, and lateral epicondylitis, with systematic reviews showing significant improvement in pain and function compared to placebo.
Percutaneous Needle Tenotomy
Also known as tendon fenestration or dry needling of the tendon, this procedure involves repeatedly passing a needle through the area of tendon degeneration under ultrasound guidance. The controlled micro-trauma stimulates a fresh inflammatory healing response, breaks down disorganized scar tissue, and promotes new collagen formation.
Percutaneous needle tenotomy can be performed alone or in combination with PRP injection. Studies have shown significant improvements in pain scores and functional outcomes for chronic tendinopathies that have failed conservative management, with success rates ranging from 75 to 90 percent.
What to expect
Your appointment begins with a clinical evaluation and diagnostic ultrasound to assess the tendon. Based on the findings, we will discuss which treatment approach is best suited to your condition and goals.
PRP and tenotomy procedures typically take 30 to 45 minutes including preparation. ESWT sessions are shorter, typically 15 to 20 minutes per session. Most patients require minimal downtime, though we will provide a specific rehabilitation protocol tailored to your condition and treatment.
Improvement from PRP and tenotomy is gradual and typically peaks at 8 to 12 weeks. ESWT effects often begin to manifest after 2 to 3 sessions. We schedule follow-up visits to monitor progress with repeat ultrasound imaging.
References
- Mishra AK, Skrepnik NV, Edwards SG, et al. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial. Am J Sports Med. 2014;42(2):463-471. doi:10.1177/0363546513494359
- Dragoo JL, Wasterlain AS, Braun HJ, Nead KT. Platelet-rich plasma as a treatment for patellar tendinopathy: a double-blind, randomized controlled trial. Am J Sports Med. 2014;42(3):610-618. doi:10.1177/0363546513518416
- Defined L, Rompe JD, Gerdesmeyer L, et al. Extracorporeal shockwave therapy for the treatment of chronic calcifying tendonitis of the rotator cuff: a randomized controlled trial. JAMA. 2003;290(19):2573-2580.
- Gerdesmeyer L, Frey C, Vester J, et al. Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis. Am J Sports Med. 2008;36(11):2100-2109. doi:10.1177/0363546508324176
- Housner JA, Jacobson JA, Misko R. Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis. J Ultrasound Med. 2009;28(9):1187-1192. doi:10.7863/jum.2009.28.9.1187
- Chiavaras MM, Jacobson JA, Carlos R, et al. IMpact of Platelet Rich plasma OVer needle tenotomy (IMPROVE): a randomized controlled trial. Am J Sports Med. 2023;51(5):1182-1192.
- Defined L, Maffulli N, Longo UG, Denaro V. Platelet-rich plasma therapy for tendinopathies: an updated meta-analysis of randomized controlled trials. Br J Sports Med. 2019;53(5):308-315.