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‘Constant attention by a good nurse may be just as important as a major operation by a surgeon’ goes the famous yet rarely used quote from the early 20th century and is something we should pause and consider for our tendon patients. We argue that there is often a ‘silo’ approach in the management of tendinopathy based on the practitioner who first encounters the tendinopathy patient. Surgeons tend to ignore loading regimes, physiotherapists can be dismissive of surgery even when the patient is not making progress and we contend that many sports doctors use ‘novel’ treatment modalities which have a little evidence base.
This divergent approach to management in daily practice among specialties merely highlights how difficult the decision-making process in tendinopathy is for the treating healthcare professional. In many practitioners’ minds, surgery has always been the last resort of failed responders to various non-medical management. While expert opinions, guidelines and systematic reviews have attempted to guide clinicians on when surgery may be an appropriate next treatment step, there is little evidence comparing surgical versus non-surgical treatments.1
What does the literature …
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