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Reflecting a compound whose biological effects span multiple molecular targets and pathways rather than operating through a single defined receptor, Established and proposed mechanisms include upregulation of growth hormone receptor expression in tendon and other connective tissue, promotion of angiogenesis through nitric oxide-dependent and VEGF-mediated pathways, modulation of the dopaminergic and serotonergic neurotransmitter systems in the central nervous system, interaction with the NO-synthase and prostaglandin systems to produce cytoprotective effects in gastrointestinal epithelium, activation of the FAK-paxillin pathway to promote cell survival and migration, and anti-inflammatory effects through modulation of inflammatory cytokine production

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Examination with ultrasound separates it from other causes