Sclerosing therapy and eccentric training in flexor carpi radialis tendinopathy in a tennis player

Karsten Knobloch ^1*, Marcus Spies ¹, Kay H Busch ¹ and Peter M Vogt ¹

¹ Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Germany, Germany

^* To whom correspondence should be addressed. E-mail: kknobi{at}yahoo.com.

Accepted 30 April 2007

Abstract

Tendinopathy of the flexor carpi ulnaris tendon is a rare entity. Recent research revealed the role of a neurovascular ingrowth at the point of pain in various tendinopathic locations, such as at the Achilles and patellar tendon, in plantar fasciitis as well as in supraspinatus and tennis elbow tendinopathy. However, beyond the elbow no such neovascularisation has been reported yet. We present a 35-year old tennis player suffering tremendous pain (VAS 9/10) at the flexor carpi ulnaris tendon with adjacent calcification in close proximity to the pisiform bone. Power-Doppler and Laser-Doppler quantification of neovascularisation at the point of pain identified higher capillary blood flow at three points over the painful vs. the non-painful tendon (146/240/232rU vs. 93/74/70rU at the non-affected side). Sclerosing therapy using polidocanol under Power-& Laser-Doppler guidance was initiated with immediate decrease of capillary blood flow by 25% with resolution of the neovascularisation in Power-Doppler. Immediately following sclerosing, pain level was reduced from 9/10 to 4/10. Following a short period of rest, eccentric training of the forearm muscle was initiated over 12 weeks with functional complete recovery and complete resolution of wrist pain.

Key Words: microcirculation, sclerosing, tendinopathy, tendon, wrist

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