Tendon rupture atrophy

Tendon rupture atrophy - These are probably minimized by careful attention to technique, i.e. withdraw the needle a little if an unusual amount of resistance is encountered and use a peppering technique at the enthesis with the smallest effective dose and volume of steroid7'1 . The whole issue of steroid-associated tendon rupture is controversial disputed8 0 , anecdotal- in humans - is not well supported in the literature although it is widely accepted that the repeated injection of steroids into load-bearing tendons carries the risk of tendon rupture8 1.

The current climate of opinion among consultants in locomotor specialties is equivocal about steroid injection around the Achilles tendon. If this is being contemplated it is advisable to image the tendon first (by MRI or ultrasound) to confirm that it is a peritendinitis with no tendinopathy (degenerative change with or without tears in the body of the tendon). Low-dose peritendinous steroid injections appear to be safe1 6 1 . The patient should rest from provocative activity for 6-8 weeks7 5 (consider putting the keen athlete into a walking cast), and return to it gradually after a graduated programme of stretching and strengthening. In rabbits, local injections of corticosteroid, both within the tendon substance and into the retrocalcaneal bursa, adversely affect the biomechanical properties of Achilles tendons. Additionally, tendons from rabbits that have received bilateral injections of corticosteroid demonstrate significantly worse biomechanical properties than tendons from those that have received unilateral injections of corticosteroid. Bilateral injections of corticosteroids should be avoided because they might impart a systemic effect in conjunction with the local effect, further weakening the tendon1 4 3 . Surgery for chronic Achilles tendinopathy has a complication rate of around 10% and should not be assumed to be a trouble-free treatment option1 6 8 .