ACHILLES TENDINITIS - US-GUIDED INTRATENDINOUS STEROID INJECTION

Background: When there is indication for treatment of Achilles tendonitis (AT) with steroid injection the general recommendations are that the injection should be administered peritendinously Intratendinous injections are not recommended for fear of rupture.On US AT is seen as a thickening of the tendon. On color Doppler multiple vessels are seen in the pathologic area and not in the normal part of the tendon. With spectral Doppler there is diastolic flow indicating diminished vascular resistance. The US findings indicate inflammation inside the tendonObjectives: To evaluate the effect of steroid injections into the area of inflammation, i.e. intratendinously.Methods: US was performed with an Acuson Sequoia equipped with a 15 MHZ linear array transducer. The tendon and peritendinous tissues were evaluated with color Doppler. A longitudinal image with maximum flow on color Doppler was obtained to calculate the percentage of colored pixels. A spectral Doppler analysis was made on 3 random intratendinous arteries and as a measure of peripheral resistance the resistive index (RI) was calculated.Injection: 1 ml Depomedrol 40 mg mixed with 0.5 ml Lidocaine was injected from the side guided by transverse US. The patient was instructed to rest the leg for one day and to refrain from any strenuous activity for 2 weeks.Results: Five tendons in 5 patients (4 men, 1 woman – aged 35 – 74) were treated. Only 1 of the patients was an elite athlete. In all patients previous treatment with rest, NSAID or peritendinous injections had failed. Initially all patients had marked hyperaemia on color Doppler. RI ranged from 0.58 to 0.77. In all patients all symptoms disappeared, color Doppler signals decreased to near zero and RI rose to 1.00 (normal value). One patient relapsed after 2 months. He continued the provoking activity. No ruptures were encountered.Conclusion: The results indicate that intratendinous steroid injection into AT seems a safe and highly efficient therapy. For the effect to become lasting, however, the patient must remove the provoking factor. Color Doppler identifies the injection site. Color and spectral Doppler are correlated to disease activity.Citation: , volume , supplement , year 2003, page Session: Diagnostics and imaging procedures