When Tendon Pain Won't Go Away: Non-Surgical Options That May Help

Tendon pain, or tendinopathy, can be frustrating — especially when rest, physical therapy, changes in activity, anti-inflammatory medicine or injections haven’t brought adequate relief.

When should you consider seeing a specialist? Are there non-surgical options for relief?

If you have pain that’s persisted for more than three months, it may be time to see a specialist, says Raul Rosario-Concepcion, M.D., a physical medicine and rehabilitation physician at Baptist Health Miami Neuroscience Institute.

“This is especially important if you’ve already tried physical therapy, changed or limited activities, taken anti-inflammatory medicines or had an injection, but still have pain that keeps you from work, exercise or daily activities,” Dr. Rosario-Concepcion says.

He first uses musculoskeletal ultrasound, an imaging test that shows muscles, tendons and nearby tissues in real time. This helps confirm what’s actually causing the pain and whether a nonsurgical procedure may be a good fit.

Treatment is then matched to the severity and location of the tendon problem. The different types of non-surgical treatment include Focused Extracorporeal Shockwave Therapy (F-ESWT) and Ultrasound-Guided Tenotomy.

“We offer a structured nonsurgical pathway for people who have ongoing tendon pain but may not yet need, or may want to delay, surgery,” says Dr. Rosario-Concepcion. “The goal is to choose the least invasive treatment that is likely to help.”

Focused Extracorporeal Shockwave Therapy (F-ESWT)

Focused Extracorporeal Shockwave Therapy (F-ESWT) is a noninvasive, regenerative-focused therapy that uses sound waves to help stimulate healing in painful tendon tissue resulting from aging, prior injury, chronic irritation, or reduced blood supply.

“Typically, this is the first interventional step after conservative care has failed,” Dr. Rosario-

Concepcion says.

F-ESWT may be used for several common tendon and fascia problems, he points out. These include plantar fasciitis, Achilles tendon pain, tennis elbow, golfer’s elbow, jumper’s knee, hamstring tendon pain, hip tendon pain and certain shoulder tendon problems with calcium buildup.

Treatment is done in the office, according to Dr. Rosario-Concepcion. Each visit usually takes

about 15 to 20 minutes, and F-ESWT require three to five visits, usually about one week apart.

“No anesthesia is needed,” he says. “Most people can return to work the same day, and there

are usually no major activity restrictions after treatment.

Ultrasound-Guided Tenotomy

Ultrasound-guided tenotomy is a minimally invasive, ultrasound-guided percutaneous procedure for more damaged tendon tissue.

Ultrasound lets the doctor see the tendon and surrounding tissues during the evaluation and, when needed, during a procedure. This can help identify tendon damage, partial tears, inflammation in nearby fluid-filled areas or nerve-related problems that may be contributing to pain.

“This treatment is reserved for patients who have not responded to F-ESWT or who present with more advanced tendinosis,” notes Dr. Rosario-Concepcion.

During this procedure, the physician uses ultrasound to guide a small instrument to the painful tendon area. The instrument uses ultrasonic energy to remove damaged tissue while helping protect nearby healthy tissue. The procedure is done with local anesthesia, which numbs the area.

“Compared with open surgery, this approach may mean less disruption to surrounding tissue, less soreness afterward and less time away from work,” Dr. Rosario-Concepcion says. “Many people return to desk work in two to three days and light activity in one to two weeks.”

Return to sports or more demanding activity depends on the tendon being treated and the person’s rehabilitation plan, he adds.

Surgical Referral

A nonsurgical plan for long-lasting tendon pain may help relieve pain, improve function and support a safer return to daily activities, says Dr. Rosario-Concepcion. But when both F-ESWT and ultrasound-guided tenotomy fail to achieve the desired outcome, surgery is always an option.

“When minimally invasive options have been exhausted or anatomic findings warrant it from the outset, we will coordinate surgical referrals for the patient,” he says. “But patients with tendinopathy should always start with the least invasive approach.”

Click here for more information about the services and specialists available at Baptist Health Miami Neuroscience Institute.