Treating the cause of pain
Chronic tendon and soft tissue injuries – tennis elbow, golfer’s elbow and Achilles tendonopathy – are being treated in appropriate candidates at UCLA by sports medicine and radiology specialists using an ultrasound-guided needle debridement procedure. Many of these injuries are the result of overuse, which can lead to disruption of the normal tendon structure, producing both pain and weakness. These often stubborn problems can be difficult to treat.
In many cases of chronic tendon pain, tendonitis may not be the correct diagnosis. Histological examination of tendons typically shows no signs of inflammation, but rather degenerative tissue. While non-steroidal anti-inflammatory drugs (NSAIDs) and cortisone-like injections into the area may be helpful in relieving pain, they do not address the underlying tendonopathy. In many cases, these treatments are not successful in enabling patients to resume sports or other activities.
Specialists at UCLA’s Sports Medicine Tendon Treatment Program are using an ultrasound-guided percutaneous therapy technique to treat degenerative tendon tissue. “The technique precisely targets the injured portion of the tendon using visualization with ultrasound,” says Dr. John DiFiori, chief of the Division of Sports Medicine in the UCLA Department of Family Practice and a team physician at UCLA. Ultrasound-guided percutaneous therapy, which has been used at UCLA for nearly two years with excellent results, differs from traditional surgical treatments that require an incision and more invasive debridement procedure.
Visualization with dynamic examination
This new procedure, performed with local anesthesia on an outpatient basis, usually takes only 15 to 20 minutes. A small-gauge needle is advanced under ultrasound guidance to the injured portion of the tendon or muscle. The tip of the needle is used to debride scar tissue, calcification or small tears that can impede healing.
The physician is able to clearly visualize the tendon and have the patient participate in the dynamic examination of the injured areas. This interactive exam is unique, and assists in specifically identifying the anatomic location of the injury. By directly observing the tendon when the symptoms are provoked, the physician can precisely direct treatment to the injured area. In addition, the use of real-time ultrasound allows direct comparison to the opposite extremity to confirm suspicious findings.
The risk of complications is low. Post-procedure discomfort is generally minimal, with local soreness typically treated with ice and oral pain relievers, if necessary. Depending on the location of the injury, a splint or brace may be applied after the procedure and a specific rehabilitation program prescribed.
Candidates for referral
Patients who have not responded to at least three months of conservative treatment (relative rest, splinting or bracing if appropriate) including a comprehensive program of rehabilitation should be considered for referral for this procedure. Problems that can be treated with this technique include:
- Achilles tendonopathy
- Lateral epicondylitis (tennis elbow)
- Medial epicondylitis (golfer’s elbow)
- Calcific tendonopathy
- Chronic muscle strains/tears
- Patellar tendonopathy (jumper’s knee)
- Plantar fasciitis
Team members
John DiFiori, M.D.
Associate Professor and Chief
Division of Sports Medicine/Department of Family Medicine
Kambiz Motamedi, M.D.
Assistant Clinical Professor
Musculoskeletal Radiology Section/Department of Radiology
Patient referral
Contact Lillian Embray
(310) 319-3333 phone
310-319-3372 fax
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