High-Volume Injection

A high-volume injection delivers a large volume of fluid, usually around 40 to 50 ml in total, into the plane between a tendon and the fat pad lying against it. The aim is to separate that plane and disrupt the new blood vessels and nerve fibres that grow into a chronically painful tendon.

It is usually called high-volume image-guided injection (HVIGI). The main targets are the Achilles tendon, between the tendon and Kager's fat pad, and the patellar tendon, between the tendon and Hoffa's fat pad. Most of the evidence is in mid-portion Achilles tendinopathy.

In sport and exercise medicine (SEM) it is an adjunct for persistent tendinopathy in a patient who has already completed a proper loading programme. This page covers the rationale, the technique and what the trials show.