Abstract
Chronic painful tendinosis is a recalcitrant disease. Recent research using grey-scale ultrasound + colour Doppler complemented with immunohistochemical analyses of tendon tissue biopsies confirmed the presence of neovessels juxtapositioned to nerves in chronic painful Achilles and patellar tendinosis. There are relatively few nerves inside the tendon, but there are multiple nerves outside especially on the deep side of the tendon. These nerve fascicles contain sympathetic and sensory fibers. Ultrasound and Doppler-guided injections of polidocanol, targeting the region of neovascularisation (and nerves) outside the tendon, afford scientifically proven good clinical short- and mid-term effects in patients with chronic Achilles and patellar tendinosis. Remodeling of successfully treated Achilles tendons has been demonstrated.