Ultrasound-guided injection treatments for tendinopathy: an update

The choice of treatment for chronic tendinopathy and related peritendinous conditions has become challenging as multiple options are available. When conservative treatments fail, injections of platelet-rich plasma (PRP), corticosteroids, and hyaluronic acid have become important in the management of these conditions. Other interventions, such as dry-needling, percutaneous tenotomy, percutaneous release, and hydrodissection, may also be used. Ultrasound guidance allows real-time visualization of the needle relative to its target and adjacent neurovascular structures. This is particularly advantageous for deep or small-caliber tendons, for procedures requiring precise intratendinous or peritendinous needle placement (e.g., PRP injection, hydrodissection), and for percutaneous release, where a blind approach carries a materially higher risk of neurovascular or tendon injury. This review summarizes the mechanism of action, technique, evidence, and indications for the injection treatments currently used for tendinopathy, and outlines the general principles of ultrasound-guided injection technique.