Ultrasound Guided Tendon Injections | London Clinics

The first option is for insertional tendinopathy, meaning the tendon pain is located where the tendon inserts into the bone, such as pain in the back of the heel where the Achilles tendon attaches. In these cases, we can provide an injection under local anaesthetic to cause mild trauma and stimulate a healing response. Some cases respond better to an irritant solution, such as glucose, which disrupts the cells and triggers a more robust inflammatory pre-healing response. In previous decades, these techniques have been known as prolotherapy or proliferative therapy and may be preferable to corticosteroid injections, which can weaken the tendon insertion over the longer term. 

The second option is for mid-portion tendinopathy, where pain is located in the central body of the tendon, such as in the Achilles tendon itself. Here, an injection technique known as a high-volume injection may be used. Chronic tendinopathies often show small abnormal blood vessels growing into the tendon (a process called angiogenesis), which research suggests may contribute to pain. A high-volume injection with local anaesthetic, saline, and a small dose of corticosteroid can compress these vessels and eliminate them, often reducing pain significantly.