Difference In Tendon Thickness Research Articles

Normative ultrasound values for Achilles tendon thickness in the general population and patients with Achilles tendinopathy: A large international cross-sectional study.

The objective of the study was to obtain adjusted ultrasonographic reference values of the Achilles tendon thickness (maximum anterior-posterior distance) in adults without (previous) Achilles tendinopathy (AT) and to compare these reference values with AT patients. Six hundred participants were consecutively included, comprising 500 asymptomatic individuals and 100 patients with clinically diagnosed chronic AT. The maximum tendon thickness was assessed using Ultrasound Tissue Characterization. A multiple quantile regression model was developed, incorporating covariates (personal characteristics) that were found to have a significant impact on the maximum anterior-posterior distance of the Achilles tendon. A 95% reference interval (RI) was derived (50th, 2.5th-97.5th percentile). In asymptomatic participants median (95% RI) tendon thickness was 4.9 (3.8-6.9) mm for the midportion region and 3.7 (2.8-4.8) mm for the insertional region. Age, height, body mass index, and sex had a significant correlation with maximum tendon thickness. Median tendon thickness for the midportion region was calculated with the normative equation -2.1 + AGE × 0.021 + HEIGHT × 0.032+ BMI × 0.028 + SEX × 0.05. For the insertional region, the normative equation was -0.34 + AGE × 0.010+ HEIGHT × 0.018 + BMI × 0.022 + SEX × -0.05. In the equations, SEX is defined as 0 for males and 1 for females. Mean (95% CI) difference in tendon thickness compared to AT patients was 2.7 mm (2.3-3.2, p < 0.001) for the midportion and 1.4 mm (1.1-1.7, p < 0.001) for the insertional region. Compared to the asymptomatic population 73/100 (73%) AT patients exhibited increased tendon thickening, with values exceeding the 95% RI. This study presents novel reference values for the thickness of midportion and insertional region of the Achilles tendon, which were adjusted for personal characteristics. Our novel web-based openly accessible calculator for determining normative Achilles tendon thickness (www.achillestendontool.com) will be a useful resource in the diagnostic process. Trial registration number: This trial is registered in the Netherlands Trial Register (NL9010).

Measuring Average Supraspinatus Tendon Thickness on Musculoskeletal Ultrasound: Variation in Young Adults

Background: The human shoulder is one of the most mobile joints of the body but it has less stability as compared to the hip joint which is also a ball and socket joint. Aim: To measure average supraspinatus tendon thickness in young adults, and compare the tendon thickness between genders by using musculoskeletal ultrasound. Study design: Cross sectional study. Methodology: A total of 128 healthy young adults were screened for shoulder pathology using Apley scratch test, Empty Can and Full Can test. The measurements were taken in Modified Crass Short Axis View of Supraspinatus Tendon at 5mm, 10mm and 15mm from Bicep Long Head Tendon and Modified Crass Long Axis View of Supraspinatus Tendon at 5mm, 7mm and 10mm from the highest point of humerus. Data was evaluated by using SPSS version 23. All qualitative data was presented in frequency form and quantitative data was in the form of mean ± SD. Results: There was a significant difference in tendon thickness between males and females. In the long axis view males had thicker tendon as compared to females at 5mm and 7mm in the right side whereas in the left side there was difference at 5mm, 7mm and 10mm from the highest point on the humerus. Within gender comparison showed significant difference in tendon thickness measured in short axis as significant tendon thickness difference measured at 5mm, 7mm and 10mm from highest point of humerus. Conclusion: It was concluded that supraspinatus tendon thickness differed significantly in young males and females. Keywords: Musculoskeletal Ultrasound, Supraspinatus Tendon Thickness, Young Adults, Body Mass Index and Rotator Cuff.

2-Octyl Cyanoacrylate Adjuvant Use in Calcaneal Tendon Repair: Comparative Experimental Study in Rabbits

Category: Basic Sciences/Biologics; Ankle; Sports Introduction/Purpose: The best alternative for treating calcaneal tendon rupture is still controversial. The treatment can be conservative or surgical; the latter is better indicated in high-performance athletes. The pursue of faster recovery, reductions in skin complications and re-ruptures have brought about improvements to the tendon repair technique and to early assisted rehabilitation programs. Our goal was to check whether or not the adjuvant use of 2-octyl cyanoacrylate provides additional mechanical resistance to the calcaneal tenorraphy, when compared to suture alone, using the same tenorraphy technique. Methods: We used 45 three-month-old New Zealand rabbits, distributed into three groups of 15 animals each. The rabbits underwent two surgical procedures at a 30-day interval. In the first procedure, we performed the complete calcaneal tendon section on the right side, and then we repaired it using three different techniques: suture alone in group 1, suture with 2-octyl cyanoacrylate in group 2, and 2-octyl cyanoacrylate alone in group 3. After 30 days, we slaughtered the rabbits, and resected their right-side calcaneal tendon, and sent the specimen for pathology analysis. Then, we performed a cross section of the left calcaneal tendon, and used the same three repair techniques. After 15 minutes, we subjected the repaired tendons to the linear traction mechanical strength test. Results: The results from the linear strength test showed that suture with glue outperformed suture alone (p = 0.0427), and glue alone (p &lt;0.0001). There was no rupture pattern difference between the groups, whether due to suture rupture or slipping. The pathology results were evaluated according to inflammation, repair process and tendon thickness. The report mentioned a high- intensity mixed inflammatory pattern (acute and chronic), outstanding neovascularization, tissue necrosis and abscess in most of the cases that used cyanoacrylate. However, there were no local or systemic clinical signs of an infectious process, or difference in tendon thickness between the three groups. Conclusion: 2-octyl cyanoacrylate added immediate mechanical strength to the calcaneal tendon repair in the rabbits, without increasing local complications, despite pathological changes (focal necrosis, microabscesses and granulomatous reaction) in up to 30 days after the repair.

Preliminary Study on Grading Diagnosis of Early Knee Osteoarthritis by Shear Wave Elastography.

Knee osteoarthritis (KOA) is the most common chronic bone joint disease. The WHO points out that KOA has become the fourth most disabling disease in the world, and the main clinical treatment is prevention. At present, the clinical diagnosis of knee osteoarthritis with deformation is mainly made by X-ray and two-dimensional ultrasound, and the preventive treatment effect is not good. Shear wave elastography (SWE) has been widely used in clinical practice for its advantages of noninvasive, simple, rapid, and high accuracy in soft tissue hardness. This study investigates the feasibility of using SWE in the grading diagnosis of KOA and the detection of early skeletal muscle injury. 60 patients were enrolled with unilateral KOA who met the inclusion criteria. Routine scanning and SWE exploration were carried out and compared between the affected and healthy knee joints. The measurements included morphology, damage degree of cartilage, joint effusion, joint synovial thickness, the degree of meniscus convexity, and shear wave speed (SWS) in the tendon attachment area of the quadriceps femoris superior patella, and tendon thickness and SWS between and within groups. The affected was scored according to the ultrasonic characteristics. The correlation between them was analyzed to evaluate the feasibility of SWE in grading the diagnosis of KOA. 57 cases had knee cavity effusion (57/60, 95.0%), 58 cases had knee cartilage injury (58/60, 96.6%), and 35 cases had a lateral process of the medial meniscus (35/60, 53.3%); 30 cases had synovial hyperplasia (30/60, 50%), 21 cases had osteophyte formation (21/60, 35%), and no one had a popliteal cyst. There was no significant difference in tendon thickness between and within groups (p > 0.05), but a significant difference in SWS (p < 0.01); the SWS of the quadriceps femoris tendon is negatively correlated with ultrasound score (r = 0.955, p < 0.01). There is a strong negative correlation between SWS and the degree of KOA. It can be used in the grading diagnosis of KOA to help find more early strain points.

Differences in Achilles tendon stiffness in people with gout: a pilot study

BackgroundGout has been associated with weaker foot/leg muscles and altered gait patterns. There is also evidence of on-going foot pain and an increased risk of tendinopathy, with the Achilles and patella tendons most frequently affected in gout. Additionally, the inflammation associated with gout may change tissue elasticity. Ultrasound imaging utilising shear wave elastography (SWE) offers a non-invasive method of quantifying changes in tendon stiffness. SWE findings have not previously been reported in individuals with gout. We sought to determine differences in Achilles tendon stiffness in people with gout compared to controls (non-gout).MethodsA cross sectional study comparing 24 people with gout and 26 age/sex-matched controls. Clinical and demographic data were collated, and US imaging used to determine tendon thickness, presence of gouty tophi and/or aggregates and levels of angiogenesis. Ten shear wave elastography (SWE) measures were taken along the centre of a longitudinal section of the mid-portion of each Achilles tendon. Prior to data collection, intra-observer error was good (>0.69). Data were summarised using descriptive statistics and a repeated measures ANCOVA was used to compare SWE measures between the two groups for the left and right foot separately after accounting for Body Mass Index (BMI).ResultsA small proportion of those with gout presented with intra-tendon aggregates and/or intra-tendon tophi in one or both tendons. There was no statistically significant difference in tendon thickness between groups. Neo-vascularity was present in a third of gout participants. SWE findings demonstrated significantly reduced tendon stiffness in those with gout compared to controls: right Achilles mdiff =1.04 m/s (95% CI (0.38 to 1.7) p = 0.003 and left Achilles mdiff = 0.7 m/s (95% CI 0.09 to 1.32) p = 0.025. No relationship between the presence of tophi and SWE values were detected.ConclusionSubjects with chronic gout show significantly reduced Achilles tendon stiffness compared to non-gout controls. From a clinical standpoint, our findings were similar to SWE measurements in subjects with Achilles tendinopathy and who did not have gout.

Virtual touch IQ elastography in evaluation of Achilles tendon in patients with chronic renal failure

To evaluate the sonoelastographic changes in the Achilles tendon in patients with chronic renal failure (CRF) using virtual touch imaging quantification (VTIQ) elastography. Twenty-six patients undergoing three hemodialysis sessions per week and 26 subjects admitted to our institution between January 2016 and April 2016 were included in this prospective study. The characteristics and body mass index of the patients were noted. Ultrasonography was performed parallel to the long axis of the bilateral Achilles tendons during relaxation of the legs using the Siemens Acuson S3000™ ultrasound device (Siemens HealthCare, Erlangen, Germany). Tendon thickness was reviewed, and tissue stiffness was quantitatively assessed using VTIQ elastography. Independent samples t test and Mann-Whitney U test were used for statistical analyses. The median values of shear wave velocities of the Achilles tendon in patients with CRF were 7.19m/s (4.23-9.77m/s) on the right and 6.98m/s (4.00-9.82m/s) on the left, while they were 5.11m/s (4.09-8.82m/s) on the right and 5.36m/s (4.05-8.80m/s) on the left in controls. The stiffness of the Achilles tendons in patients with CRF was found to be higher than that in controls (right: P < 0.001, left: P = 0.004). There was no statistically significant difference in tendon thickness between the CRF and control groups (P > 0.05). The thickness and stiffness of tendon can be effectively evaluated with sonoelastography. The thickness of the Achilles tendon did not significantly differ between the patients with CRF and healthy subjects. However, the stiffness of the Achilles tendon measured with VTIQ elastography was demonstrated to be increased in the patients with CRF.

Is Platelet-rich Plasma Injection Effective for Chronic Achilles Tendinopathy? A Meta-analysis.

Chronic Achilles tendinopathy is common in the general population, and platelet-rich plasma (PRP) is seeing increased use to treat this problem. However, studies disagree as to whether PRP confers a beneficial effect for chronic Achilles tendinopathy, and no one to our knowledge has pooled the available randomized trials in a formal meta-analysis to try to reconcile those differences. In the setting of a systematic review and meta-analysis of randomized controlled trials (RCTs), we asked: Does PRP plus eccentric strength training result in (1) greater improvements in Victorian Institute of Sports Assessment-Achilles (VISA-A) scores; (2) differences in tendon thickness; or (3) differences in color Doppler activity compared with placebo (saline) injections plus eccentric strength training in patients with chronic Achilles tendinopathy? A search of peer-reviewed articles was conducted to identify all RCTs using PRP injection with eccentric training for chronic Achilles tendinopathy in the electronic databases of PubMed, Web of Science (SCI-E/SSCI/A&HCI), and EMBASE from January 1981 to August 2017. Results were limited to human RCTs and published in all languages. Two reviewers assessed study quality using the Cochrane Collaboration risk-of-bias tool. All the included studies had low risk of bias. The primary endpoint was improvement in the VISA-A score, which ranges from 0 to 100 points, with higher scores representing increased activity and less pain; we considered the minimum clinically important difference on the VISA-A to be 12 points. Secondary outcomes were tendon thickness change (with a thicker tendon representing more severe disease), color Doppler activity (with more activity representing a poorer result), and other functional measures (such as pain and return to sports activity). Four RCTs involving 170 participants were eligible and included 85 participants treated with PRP injection and eccentric training and 85 treated with saline injection and eccentric training. The patients in both PRP and placebo (saline) groups seemed comparable at baseline. We assessed for publication bias using a funnel plot and saw no evidence of publication bias. Based on previous studies, we had 80% power to detect a 12-point difference on the VISA-A score with the available sample size in each group. With the numbers available, there was no difference between the PRP and saline groups regarding the primary outcome (VISA-A score: mean difference [MD], 5.3; 95% confidence interval [CI], -0.7 to 11.3; p = 0.085). Likewise, we found no difference between the PRP and saline groups in terms of our secondary outcomes of tendon thickness change (MD, 0.2 mm; 95% CI, 0.6-1.0 mm; p = 0.663) and color Doppler activity (MD, 0.1; 95% CI, -0.7 to 0.4; p = 0.695). PRP injection with eccentric training did not improve VISA-A scores, reduce tendon thickness, or reduce color Doppler activity in patients with chronic Achilles tendinopathy compared with saline injection. Larger randomized trials are needed to confirm these results, but until or unless a clear benefit has been demonstrated in favor of the new treatment, we cannot recommend it for general use. Level I, therapeutic study.

COMPARISON OF FUNCTIONAL ACTIVITIES ON STRUCTURAL CHANGES OF THE INFERIOR PATELLAR POLE.

It is well known that eccentric and concentric exercise produce varied amounts of stress on the connective tissues. Diagnostic ultrasound has been used to measure these structural changes by observing fascicle length, angle, and thickness; however, there is a lack of evidence comparing the structural changes as it relates to eccentric, concentric, and stretching protocols. The purpose of this study was to compare the acute effects of static stretching, eccentric, concentric, and a combination of eccentric/concentric exercises on structural changes of the muscle tendon unit at the inferior patellar pole utilizing the diagnostic ultrasound. A repeated measures 2 × 4 within factorial study design with repeated measures on both factors was used to determine the differences in patellar tendon thickness within and between groups. Forty-seven healthy subjects were screened for any lower extremity deficits or orthopaedic pathology. Forty-four (N=44) subjects completed all four protocols; the attrition was due to injuries to the lower extremity, occurring unrelated to the study. A baseline measurement of the anterior inferior patellar tendon was performed with the diagnostic ultrasound prior to each participant completing one of the four interventions per week over a four-week period. Interventions completed by each participant included static stretching, concentric, eccentric, and combined concentric and eccentric exercises. Immediately following each intervention, a post-intervention inferior patellar tendon measurement was recorded using the diagnostic ultrasound. Significant differences in anterior to posterior tendon thickness of the inferior patellar tendon were observed between pre (4.983 ± 0.041mm) and post (5.198 ± 0.055mm) measurements (p<0.0005) for the main effect of time. However, no differences in tendon thickness were noted comparing each intervention to one another (p=0.351). Differences in tendon thickness were noted acutely for pre- to post measurements across all interventions. Further research is needed to determine if differences in tendon thickness exist with a longer duration of exercise over time and with different types of intervention.

Achilles and patellar tendinopathy display opposite changes in elastic properties: A shear wave elastography study.

To compare tendon elastic and structural properties of healthy individuals with those with Achilles or patellar tendinopathy. Sixty-seven participants (22 Achilles tendinopathy, 17 patellar tendinopathy, and 28 healthy controls) were recruited between March 2015 and March 2016. Shear wave velocity (SWV), an index of tissue elastic modulus, and tendon thickness were measured bilaterally at mid-tendon and insertional regions of Achilles and patellar tendons by an examiner blinded to group. Analysis of covariance, adjusted for age, body mass index, and sex was used to compare differences in tendon thickness and SWV between the two tendinopathy groups (relative to controls) and regions. Tendon thickness was included as a covariate for analysis of SWV. Compared to controls, participants with Achilles tendinopathy had lower SWV at the distal insertion (Mean difference MD; 95% CI: -1.56; -2.49 to -0.62m/s; P<.001) and greater thickness at the mid-tendon (MD 0.19; 0.05-0.33cm; P=.007). Compared to controls, participants with patellar tendinopathy had higher SWV at both regions (MD 1.25; 0.40-2.10m/s; P=.005) and greater thickness proximally (MD 0.17; 0.06-0.29cm; P=.003). Compared to controls, participants with Achilles and patellar tendinopathy displayed lower Achilles tendon elastic modulus and higher patellar tendon elastic modulus, respectively. More research is needed to explore whether maturation, aging, or chronic load underlie these findings and whether current management programs for Achilles and patellar tendinopathy need to be tailored to the tendon.

Ultrasonographic Characteristics of the Common Extensor Tendon of the Elbow in Asymptomatic Individuals: Thickness, Color Doppler Activity, and Bony Spurs.

Background:Ultrasonography (US) of the common extensor tendon (CET) of the elbow is often part of the assessment of patients with lateral epicondylitis. This US assessment is currently based on general tendinopathy references and not well-defined US entities.Purpose:To describe CET thickness, color Doppler activity, and bony spurs on US in asymptomatic volunteers and to investigate the influence of sex, age, height, body mass index (BMI), weight, and elbow dominance on the measurements.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Tendon thickness, color Doppler activity, and bony spurs of the CET were measured sonographically in 264 adults (50% women) aged 20 to 96 years. Two different tendon-thickness measuring techniques were applied, labeled the “plateau measure” and the “1-cm measure.” Color Doppler activity was based on a 0 to 4 rating scale (negative, grades 0 and 1; positive, grades 2-4). A bony spur was defined as a bony outgrowth (≥0.3 mm) arising at the insertional site of the CET.Results:With both tendon-thickness measuring techniques, the CET in the dominant elbow was thicker than that in the nondominant elbow, and male tendons were thicker than female tendons (all P ≤ .03). In regression analysis, tendon thickness correlated with weight, color Doppler activity, and arm dominance for both measuring techniques in multiple regression analysis. In addition, the plateau measure correlated with height and the presence of bony spurs. No correlations were observed regarding BMI, sex, or age. Positive color Doppler activity was found in 9% of examined elbows, with no difference between the sexes regarding dominant versus nondominant elbows (all P ≥.20). Bony spurs were found to increase with age, from 23% for people in their 20s to 74% in people older than 70 years. Bony spurs were more common in the dominant elbow (P ≤ .01). Women had a higher prevalence of bony spurs than men, but only in the dominant elbow (P = .03).Conclusion:This study presents the US characteristics and normal values of the CET. In 264 asymptomatic participants, the CET was found to be thicker in men and in the dominant elbow. No difference in tendon thickness could be demonstrated with regard to different age groups. Color Doppler activity was found to be positive in nearly 1 of 10 asymptomatic subjects. Bony spurs were a common finding; they increased in prevalence with every decade in age and were considered part of the aging process. Normal variations in CET morphologic characteristics should therefore be considered when implementing US in trials and clinical practice.

Sonographic Evaluation of Supraspinatus Cross-sectional Area in Collegiate Baseball Players

To establish the normal thickness of the supraspinatus tendon in collegiate baseball players with the use of ultrasound and to determine whether there are any significant differences between the dominant and nondominant supraspinatus thickness. A cross-sectional observational study. An outpatient clinical setting. Twelve healthy, asymptomatic collegiate pitchers between the ages of 19 and 22 years. Sonographic evaluation of 12 asymptomatic pitchers (9 right-hand dominant and 3 left-hand dominant) between the ages of 19 and 22 years was performed in a transverse plane (short axis) and longitudinal view (long axis) of their right and left shoulders. Maximum thickness was measured in both the long- and short-axis views. On the long-axis view, measurement was taken at the point where there was maximal height observed at the footprint insertion. Mixed-model analysis of variance was used to test for differences in tendon thickness across factors. Post hoc contrasts were performed with a Tukey adjustment for the P values. The mean ± SD values, side-to-side difference, and difference between dominant and nondominant values were calculated and statistically analyzed for differences. An ultrasound examination showed a significant 3-way interaction (P = .038) for view by side of hand dominance. Post hoc contrasts revealed that supraspinatus tendon thickness for right-handed pitchers in the long-axis view on the right side showed a mean value of 8.0 ± 0.32 mm versus the long-axis view on the left side of 6.5 ± 0.34 mm (P = .006) and the short-axis view on the right of 7.4 ± 0.40 mm versus the short-axis view on the left of 6.1 ± 0.26 mm (P = .036). Supraspinatus tendon thickness for left-handed pitchers in the long-axis view on the left side showed a mean value of 7.5 ± 0.59 mm versus the long-axis view on the right side of 5.9 ± 0.56 mm (P = .137) and the short-axis view on the left of 6.5 ± 0.45 mm versus the short-axis view on the right of 6.5 ± 0.68 mm (P = .999). A database of normal values for supraspinatus tendon thickness in collegiate baseball pitchers has been developed. The results are consistent with expectations when the dominant side is compared with the nondominant side for right-handed pitchers with increased tendon thickness noted on the dominant side. There was no side-to-side difference found in left-hand dominant pitchers.

Reliability and Responsiveness of Musculoskeletal Ultrasound in Subjects with and without Spinal Cord Injury

Rehabilitation after spinal cord injury (SCI) aims to preserve the integrity of the paralyzed musculoskeletal system. The suitability of ultrasound (US) for delineating training-related muscle/tendon adaptations after SCI is unknown. The purpose of this study was to quantify within- and between-operator reliability for US and to determine its responsiveness to post-training muscle/tendon adaptations in SCI subjects. Two novice operators and one experienced operator obtained sonographic images of the vastus lateralis, patellar tendon, soleus, and Achilles tendon from seven SCI subjects and 16 controls. For control subjects, within-operator concordance (ICC [3,1]) ranged from 0.58 to 0.95 for novice operators and exceeded 0.86 for the experienced operator. Between-operator concordance (ICC [2,1]) ranged from 0.62 to 0.74. Ultrasound detected muscle hypertrophy ( p < 0.05) following electrical stimulation training in subjects with SCI (responsiveness) but did not detect differences in tendon thickness. These error estimates support the utility of US in future post-SCI training studies. (E-mail: richard-shields@uiowa.edu)

Increased palpation tenderness and muscle strength deficit in the prediction of tendon hypertrophy in symptomatic unilateral shoulder tendinopathy: an ultrasonographic study

Objective In asymptomatic, normal tendons, the difference in tendon thickness between sides is less than 15%. In this study, three tests were used to examine differences between symptomatic and asymptomatic shoulders. Design Cross-sectional study. The three tests were performed in sequence. The observer was blinded in the maximal pain-free isometric force test. Setting Outpatient physiotherapy clinic at Bergen University College, Norway. Participants Sixty-four patients with an exclusive, tentative diagnosis of unilateral shoulder tendinopathy. Main outcome measures Differences in maximal pain-free isometric force, tendon pain pressure and tendon thickness measured by ultrasonography. Results This paper follows the STARD recommendations for papers on diagnostic accuracy. When cut-off values for within-subject side differences were selected at ≥0.8 mm for tendon thickness (TT diff), ≥10 N for maximal pain-free isometric force (PFF diff) and ≥0.6 kg for tendon pain pressure (PPT diff), positive tests were found in 92% of patients. All three tests were sensitive for the detection of within-subject side differences with the selected cut-off values (TT diff, n = 60/64; PPT diff, n = 59/64; PFF diff, n = 57/64; P > 0.35). There were strong agreements between the three tests: TT diff and PFF diff, 0.89; TT diff and PPT diff, 0.83; and PFF diff and PPT diff, 0.84. When both clinical tests were positive (PFF diff and PPT diff), the positive predictive value was excellent (94%) for finding increased tendon thickness in the symptomatic side on ultrasonography. Conclusions Within the limitations of this partially blinded study, patients with unilateral shoulder tendinopathy exhibited significant differences between sides in all three tests. The combination of the two clinical tests seems to be valid for the detection of unilateral shoulder tendinopathy if other diagnoses have been excluded.

Determining normal ultrasound values of the supra- and infraspinatus muscles

Sonographic investigations concerning thickness of tendons (in longitudinal sections) and muscles (in resting position and isometric contraction) were performed on 60 volunteers without shoulder complaints. Increase in muscle thickness within isometric contraction did not depend on thickness in resting position. There was no side difference in tendon thickness. Since the observed values (median 4-5 mm) were far below measurements cited in the greater part of literature, we tried to verify our data by sonographic and anatomic examination of shoulders of corpses. We conclude that, by standardising, thickness measurement of tendons and muscles might become more important in diagnosis of shoulder complaints.

Chronic Achilles Tendinopathy

Background Previous studies have shown that eccentric training has a positive effect on chronic Achilles tendinopathy. A new strategy for the treatment of chronic Achilles tendinopathy is the AirHeel brace. Hypothesis AirHeel brace treatment improves the clinical outcome of patients with chronic Achilles tendinopathy. The combination of the AirHeel brace and an eccentric training program has a synergistic effect. Study Design Randomized controlled clinical trial; Level of evidence, 1. Methods One hundred patients were randomly assigned to 1 of 3 treatment groups: (1) eccentric training, (2) AirHeel brace, and (3) combination of eccentric training and AirHeel brace. Patients were evaluated at 6, 12, and 54 weeks after the beginning of the treatment protocol with ultrasonography, visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, and Short Form-36 (SF-36). Results The VAS score for pain, AOFAS score, and SF-36 improved significantly in all 3 groups at all 3 follow-up examinations. At the 3 time points (6 weeks, 12 weeks, and 54 weeks) of follow-up, there was no significant difference between all 3 treatment groups. In all 3 groups, there was no significant difference in tendon thickness after treatment. Conclusions The AirHeel brace is as effective as eccentric training in the treatment of chronic Achilles tendinopathy. There is no synergistic effect when both treatment strategies are combined. Clinical Relevance The AirHeel brace is an alternative treatment option for chronic Achilles tendinopathy.

Ultrasonography in Evaluation of Achilles and Patella Tendon Thickness

Despite the general acknowledgement that measurement of tendon thickness by ultrasonography (US) is an integral part of clinical examination of tendons in both symptomatic and asymptomatic athletes, there is no consensus on where and how the tendons should be measured. This study aims to evaluate the Achilles and patellar tendons by ultrasonography with the intention of establishing a consensus for measuring the thickness of Achilles and patellar tendons in future studies. This study includes three sub-studies, evaluating: 1. Achilles and patellar tendon thickness in relation to the distance from the attachment at the calcaneus or patella, 2. longitudinal versus transversal US scan for measurement of the tendon thickness by examining the tendons in both longitudinal and transversal scan planes twice by the same observer, and 3. differences in tendon thickness using three different US measurement methods, when measuring both the sagittal AP thickness and the "true" thickness (measured perpendicular to the greatest width) twice by the same observer. A total of 209 tendons were included. Normal Achilles tendons have the same thickness in the distal 5 cm-long section. Patellar tendons are more cone-shaped proximally. There is no significant difference between the longitudinal and transversal scan except when applied on abnormal patellar tendons. The tendon thickness and coefficient of variation is smaller when measuring the true thickness compared to the AP thickness. The true tendon thickness is less than the AP thickness, because the AP-thickness is dependent upon the rotation of the tendon. Moreover, the true thickness is a more precise measurement. In future measurements, the true thickness of tendons could be measured in either transversal or longitudinal scan. When measuring abnormal patellar tendons, however, it is necessary to apply a longitudinal scan as this is the only method allowing the examiner to record the distance from the point where the thickness is measured to the bony attachment. The measurement can thereby be repeated at exactly the same point during subsequent controls.