Ligament and Tendon Injection

Many chronic pain conditions are caused by injury to the connective tissues. Connective tissues containing collagen are often elastic but may tear, and generally have a poor blood supply limiting their ability to heal after injury. Ligaments are made of collagen tissue and connect bone to bone. They help to stabilize the joint that is where one bone moves with respect to the next. Tendons are also collagen-based and they connect muscle to bone. They tend to stretch or tear at their interfaces, either where the red muscle tissue fibers splice into the tendon, or at the bone-tendon interface. Tendons and ligaments do not heal as rapidly or as completely as do muscles, blood vessels, and other body tissues. The limited and often insufficient healing is a source of pain, weakness, muscle inhibition, and even sensory disturbances including numbness.

Finding the pain generator is often a confusing and lengthy process. Ligament and tendon injury often will not show up on most diagnostic studies. Diagnostic tests, such as MRI, CT, X-Ray, bone scan, electromyography, and other such studies often either leave the diagnosis in question , or leave the doctor and patient to conclude that there is nothing really wrong with the patient. Many patients are left to feel as if the pain is "in their heads."

A thorough understanding of myofascial pain, ligament injury, and tendon injury can help to shorten the time it takes to arrive at a diagnosis and treatment plan for these conditions. A physician skilled in these concepts will carefully examine and put mild pressure at each of the ligaments and tendons around the site of the pain, and usually can arrive at the diagnosis in minutes. The "jump signs" that are found are then typically treated with injection of local anesthetic to try to confirm or deny whether the tender sites in question are the source of the patient's pain.

A complete block of pain can be diagnostic (prove the source of the pain) and therapeutic (help to resolve the pain). Sometimes anesthetic solutions are combined with dilute corticosteroid solutions in case there is also an inflammatory component to the patient's pain. In such a case, simple injections are often curative. If the patient's pain resolves for a limited duration (days or weeks), but then returns to baseline, then regenerative injection techniques (prolotherapy) are the most likely tool that will resolve the patient's pain. A monthly treatment program using standard prolotherapy or platelet-rich plasma will usually resolve the problem in 3-6 treatments.