Steroid injections are commonly used to treat rotator cuff tendinopathy, but controlled studies have demonstrated modest benefit, particularly in the long term. 34 Steroid injections should be reserved for patients who have discomfort that would limit them from engaging in rehabilitative exercises. Injections into the gluteal muscle versus guided injections into the subacromial bursa have demonstrated similar levels of pain relief. 35 Surgical options are available for patients with persistent symptoms, or for patients in whom function cannot be maintained.
The procedure is usually performed under ultrasound control by a radiologist. The injection of blood contains small cells called platelets, which contain platelet derived growth factor. This substance is thought to promote tendon healing. A variation on the technique is Platelet Rich Plasma(PRP), which is where the whole blood removed from the patient is spun in a centrifuge, separating the cells of the blood. As such a higher concentration of platelets is delivered into the tissue for healing. As yet, there has been no study to demonstrate that a PRP injection is superior to ABI, with both techniques demonstrating improvement in 70-80% of patients.
The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.