What are Peritendinous Injections?
Peritendinous injections involve the administration of medication, such as corticosteroids, platelet-rich plasma, or other biologics, around a tendon rather than directly into it, while minimizing the risk of tendon rupture associated with intratendinous injections. These are typically used to reduce inflammation, relieve pain, and promote healing in conditions where the tendon sheath or surrounding tissues are irritated, such as tendinitis or tenosynovitis.
What are the Indications for Peritendinous Injections?
Peritendinous injections are typically used to treat tendon-related conditions, such as:
- Lateral or medial epicondylitis (tennis/golfer’s elbow)
- Achilles tendinopathy
- Rotator cuff tendinopathy
- De Quervain’s tenosynovitis
- Trigger finger
- Patellar tendinopathy
What Does the Procedure for Peritendinous Injections Involve?
The procedure for peritendinous injections is typically performed in an outpatient setting and involves the following steps:
- The patient is positioned comfortably to allow optimal access to the affected tendon. The target area is exposed and supported.
- The injection site is cleaned thoroughly with an antiseptic solution to reduce the risk of infection.
- The clinician palpates the tendon or uses ultrasound guidance to accurately locate the peritendinous space (the area around the tendon, not within it).
- A fine needle is carefully inserted beside the tendon, avoiding direct penetration of the tendon fibers. Ultrasound guidance helps ensure precision and safety.
- The chosen medication—commonly a corticosteroid, platelet-rich plasma (PRP), anesthetic, or a combination—is slowly injected into the peritendinous space. The volume and type depend on the condition being treated.
- After administering the medicine, the needle is withdrawn, and the site may be bandaged.
What Does Post-Procedure Care for Peritendinous Injections Involve?
After a peritendinous injection, patients are typically advised to rest the affected area for 24 to 48 hours to allow the medication to take effect and to minimize irritation. Applying ice to the injection site can help reduce any mild soreness or swelling. Strenuous activity or heavy use of the treated tendon should be avoided for a few days, followed by a gradual return to normal activity as tolerated. Depending on the condition, physical therapy may be recommended to support tendon healing and prevent recurrence. Patients should monitor for any signs of infection, such as redness, increased pain, or fever, and report these to their healthcare provider promptly.
What are the Risks and Complications of Peritendinous Injections?
Risks and complications of peritendinous injections are generally rare but may include pain or bruising at the injection site, infection, allergic reaction to the injected substance, temporary flare-up of symptoms, and skin or fat atrophy with corticosteroid use. There is also a minimal risk of tendon weakening if the medication inadvertently enters the tendon.
What are the Benefits of Peritendinous Injections?
Benefits of peritendinous injections include reduced pain and inflammation, improved tendon function, faster recovery, and minimal risk of tendon rupture compared to intratendinous injections. They are also minimally invasive, quick to perform, and often help avoid or delay the need for surgery.
