Chronic Tendonitis: Treatment Options and Expert Advice for Knee Pain

Chronic tendinitis

Hello Doctor, I have been suffering from patellar valgus since mid-last year, which made it nearly impossible for me to walk during severe episodes.
After nearly a year of treatment, my condition has gradually improved.
However, during the rehabilitation process, due to muscle tightness, I improperly stretched my muscles at the beginning of this year, injuring the inner and outer sides of my knees.
After using topical ointments and medications prescribed by my doctor, the pain subsided.
By the end of April, while my physical therapist instructed me to stretch my quadriceps with bent knees, I re-injured the inner and outer sides of both knees, and it has not healed since.
Initially, the rehabilitation physician diagnosed it as an injury to the medial collateral ligament.
Despite taking medications, using topical treatments, undergoing rehabilitation, manual therapy, and six injections of dextrose, there has been no improvement.
Recently, I was referred to an orthopedic specialist who diagnosed me with chronic tendinitis, specifically at the insertion point.
I have received three steroid injections at a total of six sites, but the results have been limited.
Additionally, the pain on the inner side of both knees has gradually spread from the original site to the inner and posterior aspects of my thighs and calves, causing inflammation and pain after walking for less than half an hour, making it nearly impossible to walk.
Recently, I researched information on insertion point tendinitis online, and some sources suggested that extracorporeal shockwave therapy could be beneficial.
I asked my orthopedic doctor about it, and he recommended that I continue with the steroid injections and consider shockwave therapy after the acute phase has passed, as it would be more effective.
However, yesterday I sought a second opinion from another orthopedic doctor, who believes I can proceed with shockwave therapy immediately.
I would like to ask you, Dr.
Hong, whether you would recommend that I continue with the steroid injections and wait to do shockwave therapy later, or if I should follow the latter doctor's advice and proceed with it now? Thank you for your assistance.

selina, 20~29 year old female. Ask Date: 2016/09/08

Dr. Hong Ximing reply Orthopedics

Patellar valgus can lead to joint wear and pain, where rehabilitation and medication injections serve only as adjunctive treatments.
Once the cartilage layer is completely worn away, pain relief can only occur after bone spurs develop in the worn area.
In addition to stretching the quadriceps, injections of hyaluronic acid joint fluid or PRP (platelet-rich plasma) can be considered to prevent the early onset of osteoarthritis.

Reply Date: 2016/09/08

More Info

Chronic tendonitis, particularly in the knee, can be a challenging condition to manage, especially when it significantly impacts daily activities and mobility. Your experience with patellar malalignment and subsequent injuries during rehabilitation highlights the complexities involved in treating such conditions.
Firstly, it’s essential to understand that chronic tendonitis is characterized by inflammation and degeneration of the tendon, often due to repetitive stress or overuse. In your case, the pain radiating from the inner knee to the inner and posterior aspects of the leg suggests that the condition may be affecting not just the tendon but also the surrounding structures, including ligaments and muscles.

The treatment options for chronic tendonitis typically include a combination of conservative measures and, when necessary, more invasive procedures. Here are some commonly recommended approaches:
1. Physical Therapy: Continuing physical therapy is crucial. A skilled physical therapist can tailor a rehabilitation program that focuses on strengthening the muscles around the knee, improving flexibility, and correcting any biomechanical issues that may contribute to your pain. It’s important to communicate with your therapist about your pain levels and any discomfort during exercises to avoid exacerbating your condition.

2. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce inflammation and pain. However, since you are already on medications, it’s essential to consult your physician about the best options for you.

3. Corticosteroid Injections: As you mentioned, corticosteroid injections can provide temporary relief by reducing inflammation. However, they should be used judiciously, as repeated injections can weaken the tendon over time. It’s not uncommon for patients to require multiple injections, but the effectiveness can vary.

4. Platelet-Rich Plasma (PRP) Therapy: This is an emerging treatment option where a concentration of platelets is injected into the affected area to promote healing. Some studies suggest that PRP can be effective for chronic tendon injuries, although results can vary.

5. Shockwave Therapy: Extracorporeal shockwave therapy (ESWT) has gained popularity as a non-invasive treatment for chronic tendonitis. It involves sending acoustic waves to the affected area to promote healing and reduce pain. Your orthopedic surgeon's suggestion to wait until the acute phase has passed before starting shockwave therapy is generally sound, as it may be more effective once inflammation has subsided.

6. Surgery: In cases where conservative treatments fail, surgical options may be considered. This could involve repairing or removing degenerated tissue from the tendon.

Regarding your specific situation, the decision to continue with corticosteroid injections or to proceed with shockwave therapy should be made in consultation with your orthopedic surgeon. If the pain is still acute and you are experiencing significant discomfort, it may be prudent to follow the advice of your current orthopedic physician and continue with the corticosteroid injections until the inflammation decreases. Once you are in a more stable condition, shockwave therapy could be introduced as a complementary treatment.

In conclusion, managing chronic tendonitis requires a multifaceted approach. It’s essential to work closely with your healthcare team, including orthopedic specialists and physical therapists, to develop a personalized treatment plan that addresses your specific needs and circumstances. Regular follow-ups and open communication about your symptoms will help in adjusting the treatment plan as necessary. Remember to listen to your body and avoid activities that exacerbate your pain, as this can lead to further complications.

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