Tendonopathies
Low Dose Radiotherapy can decrease pain and improve function for tendinopathies (plantar fasciitis and tennis elbow) and also for Osteoarthritis pain and stiffness (hands, feet, knees, elbows and shoulders). In the 0.3 to 0.7 Gy dose per fraction range radiation therapy acts as a local antiinflammatory immunomodulator. Most reports describe 7 out of 10 patients gaining significant benefit, usually with no side effects noted. The low dose correlates with a less than 1/1000 late skin cancer risk when treating extremities. The dose is roughly 1/200 of a full cancer treatment course. German centers report an extensive experience with this approach and now select centers in the US are adopting it. National society recommendation reviews including the UK Royal College of Radiologist recommend this treatment for selected patients with OA and tendonopathy. Benefit may be transient (a few months) but may extend out to years. More than one course may be required for optimal effect. We do not yet have results from ongoing large prospective randomized trials but US centers doing this off-trial report encouraging results. Laboratory, animal and an ongoing prospective human trial indicate that the effect is due to modulation of pro-inflammatory vascular adhesion and permeability, macrophage and fibroblast action, and cytokine signaling. The synovial capsule appears to be an important part of the response structure.
There may be a favorable response for some patients with Rheumatoid arthritis and Erosive arthritis but data is limited so far.
We favor limiting this treatment to non-spine sites and patients over 40 years of age. The optimal patient has tried conservative measures for 3 to 6 months but still has pain and stiffness. Steroid injections and Nonsteroidal Anti-inflammatories like Ibuprofen and Naproxen Sodium should be held shortly before, during and for a week after the low dose radiation course.
Treatment is delivered in 6 quick visits given every other day. Treatment may be repeated after a few months if needed for more response.
This treatment is covered by most insurance.
