Refractory Tendonitis

[Abid Husain]

Hello Everyone,

I have a MMA fighter who has refractory elbow tendonitis.  I have been able to eliminate the pain and inflammation at rest but he continues to get exacerbations with use and with increasing training load.  I’ve used cycles of BPC SQ TID and TB4 with good effect in the beginning but it seems to have plateaued.  Has anyone used KPV SQ or topical for tendonitis?  Any other  thoughts?

Thanks

Abid

[Jamie Costello]

Hi Abid, I typically use 2.5mg TB4 tiw for up to 4 weeks. Was this the dose you used? I think you can use up to 10mg a week. I have always had luck with this protocol. Lmk, Jamie

[Abid Husain]

I didnt go that high with TB4.  I was using the standard 500mcg QD.  I will do up the dose for the coming cycle.

Thanks for the input.

[Mitchell Fleisher, M.D., D.Ht., D.A.B.F.M.]

Hi Abid,

KPV cream (2mg/ml) 2 clicks BID applied to the tendon may be helpful; it often takes a week or more to take effect.  You can also try PPS 0.25 ml SQ a few centimeters proximal to the inflamed tendon BIW for a few weeks.  The PPS alone trends to burn, so I add 0.25 ml of 2% procaine to the mixture, and it is much better tolerated.

Other helpful interventions for tendonitis are MSM 3-5,000 mg BID/TID, Multi Collagen Protein Powder 2 scoops BID, QB-Zyme Pro 3-4 capsules TID/QID (PGL, 800-527-9512, #7876), and Ruta graveolens 30C HPUS 5 pellets qday for 10-14 days.

Best, Mitch

[Bonnie Friehling]

Hi, Mitch,

Do you have experience using KPV sq injections for arthritis/joint pain/ joint inflammation?

Thanks.

Bonnie

[Mitchell Fleisher, M.D., D.Ht., D.A.B.F.M.]

Yes, Bonnie.  I’ve learned from experience not to inject it into a joint.  It can be painful for the patient, esp. when the ropivacaine wears off.  I prefer to use the 2mg/ml cream topically over the joint BID, and/or inject 0.25 ml of KPV plus 0.25 ml of PPS with 1.0 ml of procaine 2% SQ a few centimeters proximal to the affected joint once or twice a week as a trial.

Best, Mitch

[Abid Husain]

The topical KPV seems like a nice add-on option to try to manage without specific guided injections.

Thanks

[Kristelle Reyes]

Hi @drhusaininterlinkedmd-com,

Here’s a video reply from Dr. Seeds’ SSRP Office Hours 3/16/21 at 40:13, please watch below:

 

Thank you! 🙂

[Kristelle Reyes]

Claim your CME here: https://earnc.me/eEh3iH

[sjzman@gmail.com]

Any updates on this?

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