tendinopathy injections

Quick Review: What are Tendinopathy Injections?

Tendinopathy refers to painful changes in tendons or their attachment points. Injections are placed peritendinously (around the tendon) or in nearby structures such as tendon sheath or inflamed gliding tissues. The aim is to reduce pain in order to enable a structured training program. The tendon's self-healing process is not "injected", but rather temporary relief of the pain can make active therapy easier.

What is tendinopathy?

Tendinopathies often arise from excessive or incorrect strain. They are less an acute inflammation than a painful adjustment disorder with changes in collagen structure and pain processing. Pure “tendinitis” (acute inflammation) is less common. The treatment is therefore primarily aimed at load control and targeted strength training.

• Typical complaints: stress-dependent pain at the base of the tendon or along the tendon
• Morning start-up pain, stiffness
• Pain provocation when subjected to tension or pressure
• Common locations: Achilles tendon, patellar tendon, epicondyles (tennis/golfer's elbow), gluteal trochanter tendons, rotator cuff, plantar fascia

When do injections make sense – and when not?

Injections are an option if conservative therapy according to guidelines does not work sufficiently over several weeks or if pain blocks the development of training. They are not a replacement for active therapy, but an option to make it possible. Particular caution is required for certain tendons.

• Useful for: persistent pain despite 6-12 weeks of structured training to enable an increase in load
• Useful in cases of: severe irritation of tendon sheaths or gliding tissues
• Caution/Restraint: Achilles tendon and patellar tendon – cortisone is used peritendinally very cautiously here; Intratendinous steroid administration is avoided
• Not suitable as primary therapy or “quick fix” without an accompanying rehabilitation plan

Common areas and special features

Depending on the affected tendon, procedures and precautions vary. Ultrasound-assisted placement increases precision and safety.

• Achilles tendon: primarily training and load management; Peritendinous steroid only very reserved; PRP evidence mixed
• Patellar tendon (jumper's knee): focus on eccentric/heavy-slow resistance training; Reluctant to give injections; Avoid intratendinous steroid
• Epicondylopathy (tennis/golfer's elbow): Injections can reduce pain in the short term; PRP partly shows medium-term effects; Recurrences possible
• Gluteal tendinopathy (trochanteric pain): peritendinous infiltration or bursa infiltration may help, combined with hip abductor training
• Rotator cuff: depending on the findings, subacromial infiltration (not intratendinous) to reduce pain and enable training
• Plantar fascia: strictly speaking, fascia, not a muscle-tendon complex; Injections possible, but with caution and preferably combined with a stretching/strengthening program

Process and active ingredients

The selection of the procedure depends on the location, symptoms, comorbidities and your goals. We discuss the options transparently, including benefits, risks and evidence.

• Corticosteroid plus local anesthetic: can reduce pain in the short to medium term, especially in peritendinous irritation or bursitis; Intratendinous steroid administration is avoided
• Local anesthetic alone: ​​short-term pain relief for functional diagnostics or for targeted inflammation of the surrounding area
• Autologous conditioned plasma (ACP/PRP): the patient's own blood plasma with platelets; The study situation is heterogeneous - depending on the location, some positive, some neutral effects; always combined with structured training
• High-volume injection (high-volume): saline with/without local anesthetic to dissolve adhesions around the tendon; Evidence limited, individual decision
• Sclerosing procedures: are rarely used and only according to strict indications
• Ultrasound-controlled technology: supports millimeter-precise placement outside the tendon and avoids sensitive structures

Often 1-2 injections with sufficient intervals are sufficient. Multiple series without clear benefit are avoided. The combination with an adaptive training plan is key.

Process in our practice

We plan infiltrations in a structured and patient-specific manner. The process is transparent and includes information, sterile implementation and follow-up care.

Benefits and evidence

The effectiveness of injections depends heavily on location, technique and concomitant therapy. Corticosteroids can reduce pain in the short term, but the recurrence rate is increased depending on the tendon. The results for PRP are mixed: some studies show advantages over placebo or steroids for epicondylopathy and plantar fasciopathy, while results for Achilles tendon or patellar tendon problems are inconsistent. Overall, the greatest effect occurs in combination with a structured, progressive training program.

Risks, side effects and contraindications

Injections are usually well tolerated. However, there are risks that we address openly. A safe technique (e.g. ultrasound) and the correct indication are crucial.

• Local reactions: temporary increase in pain, bruising, swelling
• Skin changes after steroid: depigmentation, skin or fatty tissue atropia
• Tendon Risk: Steroid can weaken tendon tissue; intratendinous steroid administration is avoided; Peritendinous only when strictly indicated
• Infection: very rare, minimized by sterile technique
• Systemic effects of steroid: temporary increase in blood sugar, flushing, sleep disorders
• Contraindications: local/systemic infection, unexplained pain, recent tendon rupture, uncontrolled diabetes, relevant coagulation disorder; Clarify blood thinners individually

Preparation and aftercare

Good preparation and a clear plan after the injection increase the chances of success. We will coordinate this with you and your physiotherapy.

• Preparation: list of medications, relevant previous findings, information about blood thinners and metabolic diseases
• On the day of the injection: comfortable clothing; If necessary, no intensive exercise after the injection
• Stress build-up: 24-48 hours of relative rest, then gradual, symptom-oriented increase according to plan
• Training: Focus on eccentric/heavy-slow resistance protocols; Technology and load adaptation
• PRP-specific: avoid NSAIDs during treatment if possible (individual coordination)
• Warning signs: rapidly increasing pain, fever, redness - please seek medical advice

Conservative alternatives and supplements

The cornerstone of tendinopathy therapy is conservative. Injections are a supplement – ​​never a replacement – ​​to a structured program.

• Education, load management and gradual training build-up
• Eccentric or heavy-slow resistance training adapted to pain scale
• Physiotherapy: technique training, tendon and surrounding muscle chains
• Aids: Tapes, bandages, insoles depending on the location
• Shock wave therapy (ESWT): an option for certain locations, evidence moderate
• Pain management: short-term NSAIDs or topical preparations – consider individually

Your orthopedic contact point in Hamburg

We treat tendinopathies conservatively and offer injections in a targeted manner - with information, sonographic guidance and clear follow-up care. Location: Dorotheenstraße 48, 22301 Hamburg. You can easily get appointments online via Doctolib or by email.