ABSTRACT - Tendinopathy is a broad term encompassing painful conditions occurring in and around tendons in response to overuse. Recent basic science research suggests little or no inflammation is present in these conditions. Thus, traditional treatment modalities aimed at controlling inflammation such as corticosteroid injections and nonsteroidal antiinflammatory medications (NSAIDS) may not be the most effective options. We performed a systematic review of the literature to determine the best treatment options for tendinopathy. We evaluated the effectiveness of NSAIDS, corticosteroid injections, exercise-based physical therapy, physical therapy modalities, shock wave therapy, sclerotherapy, nitric oxide patches, surgery, growth factors, and stem cell treatment. NSAIDS and corticosteroids appear to provide pain relief in the short term, but their effectiveness in the long term has not been demonstrated. We identified inconsistent results with shock wave therapy and physical therapy modalities such as ultrasound, iontophoresis and low-level laser therapy. Current data support the use of eccentric strengthening protocols, sclerotherapy, and nitric oxide patches, but larger, multicenter trials are needed to confirm the early results with these treatments. Preliminary work with growth factors and stem cells is promising, but further study is required in these fields. Surgery remains the last option due to the morbidity and inconsistent outcomes. The ideal treatment for tendinopathy remains unclear.

OPINION: Dr. Brian McEnaney: This study speaks to the premise that if inflammation is not the cause of tendinopathy than why do clinicians continue to use anti-inflammatory interventions. The researchers wanted to put some data to this premise and see if anti-inflammatory interventions were, indeed, ineffective. They found that aside from strengthening exercises and nitric oxide patches the other medical and physical therapy protocols (cortisone injections, NSAIDS, iontophoresis, sclerotherapy, ultra-sound, shock-wave, laser) while possibly providing short term relief they showed little long term effectiveness in the treatment of tendinopathy. This is yet another study of this 20 year debate of whether overuse tendon pathologies are an "itis" - inflammation, "osis" - degeneration or "opathy" - we don't know. However, in my opinion, the research is in. The debate is over. The histological and pathological findings are clear....there are no inflammatory markers found in this condition. The evidence clearly shows that clinicians need to heed the yelling and screaming of medical researchers for the past 20 years and stop icing, injecting cortisone and prescribing NSAIDS. Enough already with these tried and ineffective protocols.