Interview with Dr. Mahmud Ibrahim, MD
Q1. In primary care, tendinitis is a very common condition. What would you say causes the tendinitis most often: overuse injuries/poor biomechanics in sports/idiopathic? Any suggestions how to prevent it?
Tendinitis occurs for multiple reasons. One is direct trauma, for example, someone gets hit with a baseball or something. Second is doing too much too soon, for example, someone tries to climb 10,000 stairs one day. The third, and the most common reason, is poor biomechanics. This is especially true for tendons of the shoulders and hips. If someone has neck or back pain, they tend to overcompensate by overusing their shoulders and hips. This can lead to inflammation of those tendons.
The best way to prevent tendinitis is to maintain proper posture and stretch before physical activity. If you develop pain during an activity, you should stop that activity.
Q2. For most cases of tendinitis, would you say they can be managed conservatively? What do you recommend as first line therapy?
Yes, most cases of tendinitis can be treated conservatively. First line treatment includes physical therapy, chiropractic care, acupuncture, and anti-inflammatories. If that doesn’t help, then a corticosteroid injection may be necessary to help reduce inflammation. An alternative is platelet rich plasma (PRP). PRP works by tricking your body into thinking this is a new injury and brings in all those healing factors that are floating around in your blood and concentrating them into the area of injury. This allows the tendons to actually heal, rather than just reduce the inflammation. Finally, another option is a minimally invasive procedure called a percutaneous tenotomy. This procedure is a same day procedure done at a surgery center, usually under local anesthesia, with faster recovery time than traditional surgery. This works by using a special probe through a tiny incision which breaks up inflamed scar tissue, while leaving healthy tissue alone. This also encourages healing factors to come into the area to help the tendon to heal. Recovery time is usually within 6 weeks and patients are back to doing the things they previously enjoyed. This procedure can also be combined with PRP for even better results.
Q3. What red flags should raise concern that something else is going on?
Something to keep an eye out for is severe pain that is not getting better, muscle wasting, numbness/tingling in the extremity. If you’re at all concerned, bring it to the attention of your physician.
Q4. When should a patient consider doing a therapy such as tenotomy?
A percutaneous tenotomy is indicated for patients with chronic tendinitis who have failed PT and/or injections and are looking for alternatives to traditional surgery.
Q5. What exactly is tenotomy?
A tenotomy basically involves poking small holes in the inflamed tendon, which brings growth factors into the area to help the tendon to heal.
Q6. Is tenotomy ever used as first line therapy?
No, although this is a minimally invasive procedure, it is still a procedure. First line should always be PT and oral medications. If the tendinitis keeps coming back despite good relief with previous therapy, then it can be an option.
Q7. What should a patient expect to feel during the procedure?
Some patients chose to be sedated for the procedure, which is not necessary. The area is anesthetized with local anesthetic, so patients should only feel some pressure. If it is uncomfortable at any point, we can always numb it some more.
Q8. Which specialties perform this procedure?
Typically sports medicine physicians, orthopedic surgeons, and physiatrists.
Q9. What do you particularly like about this procedure?
It’s a very effective procedure with very quick recovery time. Patients are typically back to activity within 4 weeks and fully recovered by 6-8 weeks. I’ve had amazing results with it in patients who have been to other doctors and had other treatments which did not provide any relief.
Q10. What are potential risks?
Anytime someone makes a hole in the skin, there is always risk of infection or bleeding. This is usually minimal. In addition, this procedure is usually done under ultrasound guidance so we know that the probe is in the area of inflammation. In addition, there is a very small risk of rupturing the tendon, however, this can be avoided by having the patient where a splint for a week or two following the procedure to allow the tendon to heal.
Q11. Is this procedure covered by insurance?
Yes, most insurances cover this procedure.
Q12. Why do you think many people are not aware of this procedure?
It’s a fairly new procedure that not too many physicians are performing.
Q13. What additional information would you like patients to know?
Tendinitis can happen for any number of reasons. There are a lot of treatment options out there, so I would encourage patients to speak to their health care providers about all the different treatment options.
Dr. Mahmud Ibrahim, MD is a Physical Medicine & Rehabilition (PM&R) and Sports Medicine Specialist in East Brunswick, NJ. For more information on Dr. Ibrahim, please read his bio. If you would like to schedule an appointment, you can contact him by email at mibrahim@pssmwellness.com or call his office at (732) 955-9139 for assistance.
Copyright secured by Digiprove © 2019 Linda Girgis, MD, FAAFP
Linda,
Some sound advice. So many of us deal with the problem.
I sit with a chronic one in my forearm. The percutaneous tenotomy seems like an option I should explore.
Thanks for having Dr. Ibrahim!