Painful Tendinopathy Research Articles

Do Anxiety, Depression, Fear of Movement and Fear of Achilles Rupture Correlate with Achilles Tendinopathy Pain, Symptoms or Physical Function?

Objectives: To determine if psychological factors, such as anxiety, depression, fear of movement and fear of rupture are associated with increased tendon-related disability, quantified by the Tendinopathy Severity Assessment-Achilles (TENDINS-A). Design: Cross-sectional. Setting: Online Qualtrics survey. Participants: Sixty-eight participants (54% female) with Achilles tendinopathy and a mean (standard deviation) age of 40.1 (12.6) years. Main Outcome Measures: The TENDINS-A (including subscales of pain; symptoms such as stiffness; physical function), Patient Health Questionnaire-9, General Anxiety Disorder-7, Tampa Scale for Kinesiophobia and fear of tendon rupture. Associations were evaluated using generalised linear models (adjusting for age and sex), with significance accepted when p < 0.05. Results: Anxiety symptoms were positively associated with Achilles pain (p = 0.035), symptoms (p = 0.045) and physical function (p = 0.019). Depressive symptoms were negatively associated with symptoms (p = 0.045) but not pain (p = 0.078) or physical function (p = 0.429). Fear of movement was not associated with pain (p = 0.479), symptoms (p = 0.915) or physical function (p = 0.064). Fear of rupture was associated with pain (p = 0.042), but not symptoms (p = 0.797) or physical function (p = 0.509). Conclusions: Our research demonstrated anxiety symptoms and fear of rupture, not fear of movement or depressive symptoms, are positively associated with the severity of tendon-related disability. Therefore, clinicians should include an assessment anxiety symptoms and fear of rupture in their practice.

Methodological Variation Among Studies Evaluating Pain Processing in Tendinopathy: A Scoping Review.

Background/Objectives: Tendinopathy is a condition associated with pain and limited function. While upper and lower extremity tendinopathies may have different functional implications, there have been a number of reports supporting different patterns of dysfunction in pain processing and inhibition. The purpose of this scoping review was to examine the methods across studies examining pain processing in patients with upper and lower extremity tendinopathy. Methods: Five electronic databases (PubMed, Scopus, CINAHL, the Cochrane Library, and SPORTDiscus) and gray literature sources were searched from inception through 15 April 2024, using appropriate keywords and relevant synonyms. Results: In total, 3219 titles were retrieved from the searches, with 43 studies retained for final inclusion. Of the 43 studies, 22 were specific to upper extremity tendinopathies, 19 were specific to lower extremity tendinopathies, and 2 studies included mixed samples. Physical testing to detect nervous system sensitization was most commonly performed using pressure pain thresholds. Although infrequent, questionnaire instruments were used mostly to include the central sensitization inventory. Substantial variation was noted across studies in mode of testing and instruments used, while patient demographics and inclusion criteria were not clearly reported in many instances. Thirty-one studies (72%) reported nervous system sensitization or dysfunction in tendinopathy, while 13 (28%) did not. Conclusions: While the difference between pain processing in tendinopathy is likely multifactorial, the results of this review identified substantial variability in methodology used and reporting in tendon pain research. As inconsistency in evidence can limit clinical guidance, efforts to standardize tendinopathy pain research appear warranted.

Effectiveness of high-intensity laser therapy on pain in tendinopathy

Introduction: High-intensity laser therapies (HILT) have gained significant attention in therapeutic pain treat-ment. The aim of this systematic review was to determine the effectiveness of HILT therapies in the management of different types of tendinopathy-related pain, and the long-term benefits associated with treatment process.Methodology: A systematic literature review of prospective randomized controlled trials from electronic data-bases: Google Scholar, Pub Med, Embase, Science Direct, and ProQuest, using relevant key words, was per-formed. Randomized trials that included HILT, patients with tendinopathy, pain management, and at least one single clinically pertinent attribute were selected. Standard PRISMA protocols were followed when completing the assessment.Results: The physical, demographic, and theoretical insights from various studies suggest that HILT is a highly promising approach for managing pain in patients with tendinopathy. The most common body parts for treating tendinopathy using this method were the shoulder, elbow, ankle, and knee. Various attributes and parameters, such as Hand function evaluated by Quick Disabilities of Arm, Shoulder and Hand Questionnaire (QDASH) and Hand-grip Strength; pain assessed by the visual analogue score (VAS) during rest or activity, 36-item short-form health survey (SF-36) for physical and mental health, and the shoulder pain and Disability Index (SPADI) for shoulder and elbow assessment, were frequently significant across studies.Conclusion: HILT could be recommended as a treatment of choice for reducing pain and improving function in patients with tendinopathy, with potential benefits when combined with other physical therapy treatments. Further studies are needed to clarify optimal treatment protocols and long- term outcomes.

Ultrasound- and Doppler-Guided WALANT Arthroscopic Surgery for Patellar Tendinopathy with Partial Rupture in Elite Athletes-A 2-Year Follow-Up of a Prospective Case Series.

Background and Objectives: Patellar tendinopathy is difficult to treat, and when combined with partial rupture, there are additional challenges. The aim of this study was to evaluate the subjective outcome and return-to-sport status after ultrasound (US)- and colour doppler (CD)-guided wide awake local anaesthetic no tourniquet (WALANT) arthroscopic shaving in elite athletes. Material and Methods: Thirty Swedish and international elite athletes (27 males) with a long duration (>1 year) of persistent painful patellar tendinopathy in 35 patellar tendons, not responding to non-surgical treatment, were included. All patients were treated with the same protocol of arthroscopic shaving, including bone removal and debridement of partial rupture, followed by at least 3 months of structured rehabilitation. The VISA-P score and a study-specific questionnaire evaluating physical activity level and subjective satisfaction with the treatment were used for evaluation. Results: At the 2-year follow-up (mean 23, range 8-38 months), 25/30 patients (29/35 tendons) were satisfied with the treatment result and had returned to their pre-injury sport. The mean VISA-P score increased from 37 (range 7-69) before surgery to 80 (range 44-100) after surgery (p < 0.05). There was one drop-out (one tendon). There were no complications. Conclusions: US- and CD-guided WALANT arthroscopic shaving for persistent painful patellar tendinopathy, including bone removal and debridement of partial rupture, followed by structured rehabilitation showed good clinical results in the majority of the elite-level athletes.

Transcatheter arterial tendinopathy embolization as a treatment for painful and refractory tendinopathy: a systematic review and meta-analysis.

Transcatheter arterial embolization (TAE) is a novel minimally invasive therapy for painful tendinopathy in patients with pain refractory to conservative management. The purpose of this study was to evaluate evidence on the efficacy of TAE for tendinopathy related pain. Using Embase, PubMed, and Web of Science, a systematic review and meta-analysis was performed to identify studies evaluating TAE for painful tendinopathy. The primary outcome measure was change in pain scale score at 6months. A Ratio of Means (ROM) was used to compare the effect size post treatment as compared to baseline. The Visual Analog Scale (VAS) was used as the metric for comparison. After screening titles, abstracts, and the full text, 5 studies met inclusion criteria. A total of 97 tendinopathy embolization procedures performed in 74 patients were included. Patients who underwent TAE demonstrated declines in VAS ROM at 1day 0.53 [95% CI 0.31,0.88], 1week (0.51 [95% CI 0.32,0.79]), 1month (0.45 [95% CI 0.29, 0.71]), 3-4months (0.33 [95% CI 0.22,0.48]), and 6months following embolization (0.18[95% CI 0.13,0.26]), respectively. TAE provides substantial short-term reductions in pain scores for patients suffering with refractory tendinopathy related pain of the rotator cuff, elbow extensor and flexor, Achilles, and patellar tendons.

Where is Your Pain? Achilles Tendinopathy Pain Location on Loading Is Different to Palpation, Imaging and Recall Location.

OBJECTIVE: To describe and compare pain maps reported during Achilles tendon loading exercises with recall pain location, in people with pain on palpation in their Achilles tendon and tendon pathology on imaging. DESIGN: Cross-sectional analysis of baseline RCT. METHOD: Participants were recruited from a larger Achilles tendinopathy clinical trial. Inclusion criteria were at least 2-month self-reported history of Achilles tendinopathy, midtendon palpation pain, and pathology on ultrasound tissue characterization. Participants were asked to identify their Achilles tendon pain location on a pain map with 8 prespecified locations while at rest prior to loading (recall pain), and subsequently during tendon loading exercises (loading pain). Participants could select multiple locations or select "other" if the locations did not represent their pain. RESULTS: Ninety-three participants were included (93% of participants from a clinical trial). The locations of pain on loading were diverse; all 8 pain locations (and an "other" option) were represented within this sample. Twenty-five percent of participants did not report pain with loading (n = 23 of 93). Of the 70 participants with loading pain, recall pain location differed to loading pain location in 40% (n = 28 of 70) of the participants. CONCLUSION: Palpation pain location, recall pain location, or location of pathology on imaging were not valid proxies for load-related pain in the Achilles tendon. How different pain locations respond to treatment is unknown. Some pathologies (eg, plantaris) have clear pain locations (eg, medial tendon), and assessing pain location may assist differential diagnosis. J Orthop Sports Phys Ther 2024;54(1):1-9. Epub 7 December 2023. doi:10.2519/jospt.2023.12131.

Efficacy of Externally Paced Training on Pain in Tendinopathy: A Systematic Review and Meta Analysis.

Tendinopathy is acommon condition with treatmentsfocused on local tissue adaptations. Externally paced loading programs are designed to cue (visually, auditorily, or temporally) a person as to when to perform an exercise repetition during a set of repetitions. Externally paced loading programs propose central and peripheral changes with tendinopathy but conclusions regarding their efficacy on pain outcomes remain limited. Our review seeks to explore the efficacy of externally paced loading as a method to reduce self-reported pain in tendinopathic conditions.An electronic database search was conducted of PubMed, SPORTDiscus, Scopus, and CINAHL databases. A total of 2,104 studies were identified after a preliminary search; four reviewers narrowed the selection to seven articles based on inclusion and exclusion criteria. Articles selected for review(patellar = three, Achilles = two, rotator cuff = one, and lateral elbow tendinopathy = one) were randomized control trials assessing the externally paced loading programs' efficacy on tendon pain compared to the control; allwere included in the meta-analysis. This review identified no superiority in externally paced loading compared to alternative treatment. There were potential population differences between non-athletic and athletic populations as identified with subgroup analyses. Current activity levels, region of tendinopathy, and chronicity of symptoms may explain the variability of findings. There is little clinically significant evidence to support the use of externally paced loading programs for reducing tendon pain over standard clinical care based on a low level of certainty which is based on the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) of articles included in the review. Clinicians should interpret outcomes between athletic and non-athletic participants with caution as further high-quality studies are required to confirm specific clinical outcomes in these populations.

Irreversible Electroporation Improves Tendon Healing in a Rat Model of Collagenase-Induced Achilles Tendinopathy

Background: Treatment of painful chronic tendinopathy is challenging, and there is an urgent need to develop new regenerative methods. Irreversible electroporation (IRE) can lead to localized cell ablation by electrical pulses and induce new cell and tissue growth. Previously, the authors’ group reported that electroporation-ablated tendons fully regenerated. Purpose: To assess the efficiency of IRE in improving tendon healing using a collagenase-induced Achilles tendinopathy rat model. Study Design: Controlled laboratory study. Methods: After screening for the IRE ablation parameters, a collagenase-induced Achilles tendinopathy rat model was used to assess the efficacy of IRE in improving tendon healing via biomechanical, behavioral, histological, and immunofluorescence assessments. Results: The experiments showed that the parameter of 875 V/cm 180 pulses could ablate most tenocytes, and apoptosis was the main type of death in vitro. In vivo, IRE promoted the healing process of chronic tendinopathy in the Achilles tendon of rats, based on biomechanical, behavioral, and histological assessments. Finally, immunofluorescence results revealed that IRE improved blood supply in the early stages of tendon repair and could potentially reduce neuropathic pain. Conclusion: IRE enhanced tendon tissue healing in a rat model of collagenase-induced Achilles tendinopathy. Clinical Relevance: IRE may as a potential alternative treatment for tendinopathy in clinical usage.

Transdermal carbon monoxide delivery

Overuse injuries or acute trauma in joints often lead to painful tendinopathy, and pharmacological treatment effects are limited. The site of the disease is hard to reach with drugs, both systemically and through the skin. Therapeutic gases may close this gap, as they permeate easier through tissues than conventional small molecules. We present a patch device releasing the anti-inflammatory gas carbon monoxide (CO) through the skin to the subcutaneous tendons and tissues. CO is chemically generated upon device activation and its design maximizes CO exposure to the underlying skin and protects the patient from all side and degradation products. The patch delivered CO successfully through the intact skin, granting lasting, subcutaneous CO exposure for up to 16h. Furthermore, the released CO induced the proliferation of fibroblasts and the polarization of monocytes into anti-inflammatory M2 macrophages. In conclusion, the CO-releasing device might open an entirely new treatment option against tendinopathies in case of a positive outcome of future in vivo studies.

The Effects of Increasing Trunk Flexion During Stair Ascent on the Rate and Magnitude of Achilles Tendon Force in Asymptomatic Females

Research indicates that increasing trunk flexion may optimize patellofemoral joint loading. However, this postural change could cause an excessive Achilles tendon force (ATF) and injury risk during movement. This study aimed to examine the effects of increasing trunk flexion during stair ascent on ATF, ankle biomechanics, and vertical ground reaction force in females. Twenty asymptomatic females (age: 23.4 [2.5] y; height: 1.6 [0.8] m; mass: 63.0 [12.2]kg) ascended stairs using their self-selected and flexed trunk postures. Compared with the self-selected trunk condition, decreases were observed for peak ATF (mean differences [MD] = 0.14N/kg; 95% confidence interval [CI], 0.06 to 0.23; Cohen d = -1.2; P = .003), average rate of ATF development (MD = 0.25N/kg/s; 95% CI, 0.07 to 0.43; Cohen d = -0.9; P = .010), ankle plantar flexion moment (MD = 0.08N·m/kg; 95% CI, 0.03 to 0.13; Cohen d = -1.1; P = .005), and vertical ground reaction force (MD = 38.6N/kg; 95% CI, 20.3 to 56.90; Cohen d = -1.8; P < .001). Increasing trunk flexion did not increase ATF. Instead, this postural change was associated with a decreased ATF rate and magnitude and may benefit individuals with painful Achilles tendinopathy.

The association between daily pain, physical activity, and biomechanical measures measured by wearable technology in people with Achilles tendinopathy

Background: Physical activity modification, paired with progressive exercise, is part of recommended care for Achilles tendinopathy. Pain during activities that load the tendon such as walking or calf raises are commonly used as a guide to progress exercises and physical activities. However, pain in tendinopathy is complex and is influenced by biological, psychological, and social factors, which may lead to different coping strategies in response to pain, load mismanagement, and poor treatment outcomes.

Effectiveness of combined extracorporeal shock-wave therapy and hyaluronic acid injections for patients with shoulder pain due to rotator cuff tendinopathy: a person-centered approach with a focus on gender differences to treatment response

BackgroundRotator cuff (RC) tendinopathy is a common shoulder pain condition. Extracorporeal shockwave therapy (ESWT) and hyaluronic acid peritendinous injection are viable treatment options for RC tendinopathy.The aim of this study is to evaluate the response in two different therapeutic rehabilitative approaches, the combined treatment ESWT plus hyaluronic acid injections (E + Hy) compared to ESWT alone (ESWT-al), in a cohort of patients with RC tendinopathy according to gender differences.MethodsThis is a retrospective longitudinal cohort study of patients with painful RC tendinopathy. Patients that had received a clinical evaluation, a shoulder ultra sound examination, as well as the Shoulder Pain and Disability Index (SPADI) questionnaire, and the Numerical Rating Scale (NRS) for pain at baseline, 1-month (T1) and 2-month follow-ups (T2) were included.ResultsMedical records of 53 patients were analyzed. In the comparison between baseline to T1 and similarly from baseline to T2, a statistically significant reduction has been reported in the NRS (p < 0.001) and in the SPADI (p < 0.001) in the entire study group. At T1, patients in the E + Hy compared to ESWT-al group, showed a slight but statistically significant reductions in both NRS and SPADI score, while these changes were more evident at T2 (p < 0.001). Interestingly, a gender dimorphism in NRS and in SPADI was found, with female patients that apparently responded better to the combined E + Hy compared to ESWT-al approach.ConclusionThis retrospective cohort study suggests that the combination of ESWT plus HyA injections seems to be more effective than ESWT alone in RC tendinopathy in both genders. Moreover, in ESWT alone treatment, male patients reported better outcomes compared to females. However, further randomized controlled trials should be structured to confirm and enforce these conclusions.

Photobiomodulation effects on Achilles tendon pain: a systematic review and meta-analysis of randomized clinical trials

BACKGROUND: Achilles tendon pain is present in tendons’ non-rupture injuries usually exacerbated by mechanical loading (i.e., overuse injury).Photobiomodulation is a light therapy that may reduce pain in tendinopathy. AIM: This systematic review and meta-analysis of randomized clinical trials tested the acute and chronic effects of photobiomodulation on Achilles tendon pain. METHOD: Randomized clinical trials were included comparing photobiomodulation with a control group in patients with Achilles tendon pain.The search included MEDLINE (Pubmed), SCOPUS, EMBASE, Physiotherapy Evidence Database (PEDro), Cochrane Central Register of Controlled Trials (Cochrane CENTRAL), LILACS, and Science Direct databases, and manual search until November 2021.The bias’s risk was assessed by the Cochrane Collaboration bias risk assessment tool and PEDro scale, while the level of evidence strength by the GRADE. Quantitative analysis through meta-analyzes was performed. The protocol was registered (PROSPERO-CRD42018091509). RESULTS: The search yielded 3.239 papers in the seven databases. Five studies were included after screening, eliminating duplicates, and applying eligibility criteria, and three were included in the meta-analysis. The meta-analysis (n=79) showed no photobiomodulation acute and chronic effects compared with control group on Achilles tendon pain (p= 0.45, SMD: 0.28). In the qualitative analysis, three studies showed a high risk, and two studies a low risk of bias in all characteristics. GRADE analysis showed very low- to low-quality evidence of the studies. CONCLUSION: There is no photobiomodulation effect in Achilles tendon pain. Due to the very low and low strength of evidence, new studies with better methodological quality should be conducted to improve the level of evidence.

Role of platelets rich plasma in tendinopathy

Background: Medication and steroid injection therapy only help to reduce the pain, but exercise is effective as a treatment for regaining function in addition to reduction of pain in tendinopathy. Tendinopathy is a major medical problem. It can be defined as a syndrome of tendon pain, localized tenderness, and swelling that impairs performance. In chronic tendinopathy thee is an increasing degree of degeneration with little or no inflammation present. The application of PRP has been documented in many fields. First promoted by M. Ferrari in 1987 as an autologous transfusion component after an open heart operation to avoid homologous blood product transfusion, there are now over 5200 entries in the NCBI for PRP ranging in fields from orthopaedics, sports medicine, dentistry, otolaryngology, neurosurgery, ophthalmology, urology, wound healing, cosmetic, cardiothoracic and maxillofacial surgery. Materials and Methods: Our prospective study conducted in the Department of Orthopaedics, Maharaja Agrasen Medical College, Agroha, Haryana, India. Patients with chronic tendinopathy like supraspinatus tendinopathy, patellar tendinopathy, tendo A chilles tendinopathy, planter fasciitis, medial epicondylar tendinopathy, lateral epicondylar tendinopathy came to our hospital included in the study after obtaining their informed consent.

Ultrasound-guided percutaneous irrigation of calcific tendinopathy outside the rotator cuff: short-term evaluation.

While ultrasound-guided percutaneous irrigation for painful calcific tendinopathy (US-PICT) is the treatment of choice for the rotator cuff, there is a lack of knowledge regarding the treatment of this condition with atypical location. The purpose of our study is to assess if US-PICT can be applied safely and successfully in atypical sites, outside of the rotator cuff. We retrospectively reviewed the US-PICT performed outside the rotator cuff, in the last 5years in a single institution. A total of 16 patients have been included in this study. We collected the values of the numerical rating scale (NRS) for pain pre- and post-procedure (7days and 3-month follow-up). Moreover, we assessed the imaging studies available pre- and post-procedure (ultrasound and plain radiography) to assess complications. In all the 16 patients (10F, 6M; mean age 50.2; range 24-65-year-old), no complications have been observed during and after the procedures. The mean pain NRS before treatment was 8.7 (range 10-6) and dropped to 1.1 (6-0) after 1week as well after 3months 1.1 (6-0). The NRS pain reduction from baseline resulted to be statistically significant after 7days and 3months (p < 0.001). Our results suggest the safety and efficacy of this procedure, underlining the great potential of US-PICT applied even in different atypical locations.

Small extracellular vesicles from iPSC-derived mesenchymal stem cells ameliorate tendinopathy pain by inhibiting mast cell activation.

Aim: This study aimed to explore the effect of small extracellular vesicles from induced pluripotent stem cell-derived mesenchymal stem cells (iMSC-sEVs) on acute pain and investigate the underlying mechanisms. Materials & methods: The pathology of tendons was accessed by hematoxylin and eosin staining, immunohistochemical and immunofluorescent staining. The pain degree was measured by pain-related behaviors. In vitro, we performed β-hexosaminidase release assay, RT-qPCR, toluidine blue staining, ELISA and RNA sequencing. Results: iMSC-sEVs effectively alleviated acute pain in tendinopathy as well as inhibiting activated mast cell infiltration and interactions with nerve fibers in vivo. In vitro, iMSC-sEVs reduced the degranulation of mast cells and the expression of proinflammatory cytokines and genes involved in the HIF-1 signaling pathway. Conclusion: This study demonstrated that iMSC-sEVs relieved tendinopathy-related pain through inhibiting mast cell activation via the HIF-1 signaling pathway.

The Therapeutic Effect of iMSC-Derived Small Extracellular Vesicles on Tendinopathy Related Pain Through Alleviating Inflammation: An in vivo and in vitro Study.

BackgroundTendinopathy is a common cause of tendon pain. However, there is a lack of effective therapies for managing tendinopathy pain, despite the pain being the most common complaint of patients. This study aimed to evaluate the therapeutic effect of small extracellular vesicles released from induced pluripotent stem cell-derived mesenchymal stem cells (iMSC-sEVs) on tendinopathy pain and explore the underlying mechanisms.MethodsRat tendinopathy model was established and underwent the injection of iMSC-sEVs to the quadriceps tendon one week after modeling. Pain-related behaviors were measured for the following four weeks. Tendon histology was assessed four weeks after the injection. To further investigate the potential mechanism, tenocytes were stimulated with IL-1β to mimic tendinopathy in vitro. The effect of iMSC-sEVs on tenocyte proliferation and the expression of proinflammatory cytokines were measured by CCK-8, RT-qPCR, and ELISA. RNA-seq was further performed to systematically analyze the related global changes and underlying mechanisms.ResultsLocal injection of iMSC-sEVs was effective in alleviating pain in the tendinopathy rats compared with the vehicle group. Tendon histology showed ameliorated tendinopathy characteristics. Upon iMSC-sEVs treatment, significantly increased tenocyte proliferation and less expression of proinflammatory cytokines were observed. Transcriptome analysis revealed that iMSC-sEVs treatment upregulated the expression of genes involved in cell proliferation and downregulated the expression of genes involved in inflammation and collagen degeneration.ConclusionCollectively, this study demonstrated iMSC-sEVs protect tenocytes from inflammatory stimulation and promote cell proliferation as well as collagen synthesis, thereby relieving pain derived from tendinopathy. As a cell-free regenerative treatment, iMSC-sEVs might be a promising therapeutic candidate for tendinopathy.

Altered endogenous pain modulation and mechanical pressure hyperalgesia at the unaffected side Achilles tendon insertion in men

Introduction: Achilles tendinopathy pain mechanism investigations have included mixed midportion and insertional cohorts. Given clinical differences exist between these conditions, pain mechanisms may vary and warrant separate investigation. Assessing the unaffected side in people with unilateral insertional Achilles tendinopathy (IAT) can identify if nociplastic mechanisms contribute to pain experienced, as upregulated local injury nociception would not be expected to affect the response. Our primary aim was to determine if men with unilateral IAT have altered endogenous modulation of mechanical pressure pain at the unaffected side following painful cold-water immersion, and secondarily to determine if mechanical pressure hyperalgesia was present at the unaffected side.

Efficacy of Hyaluronic Acid Injections versus Steroid Injections on Painful Tendinopathies

Background: Tendinopathies are manifested by pain, swelling, and limited mobility functions.Corticosteroid injections have been a mainstay in the treatment of tendinopathy, and are widely used despite the controversy regarding their usefulness and safety.The peri-tendinous administration of hyaluronic acid (HA) has shown promising results in the management of tendinopathy. Objectives: The aim of the current study was to evaluate the efficacy of peri-tendinous injections of hyaluronic acid versus steroid injections on pain reduction in patients with painful tendinopathies. Patients and methods: A prospective study, including a total of 90 patients with tendinopathy who were recruited from the Rheumatology and Rehabilitation Outpatient Clinic at Sohag University Hospital. Demographic data including age, disease duration, and tendon affected were evaluated. Patients were divided into three groups, each group contained 30 patients. First group received peritendinous steroid injection, second group received peritendinous hyaluronic acid injection, and the third group received both peritendinous hyaluronic acid and steroid injections. Groups were compared using in visual analogue scale, tenderness and range of motion after one week, one month and after 3 months from injection. Results: Best improvement was seen in the group of combined hyaluronic acid and steroid; followed by the group of steroid injection alone, which showed early response better than hyaluronic acid alone. Conclusion: Local injection for tendinopathies by combined hyaluronic acid and steroid gives significantly better and more long standing effect compared to either hyaluronic acid or steroid alone. On the other hand, monotherapy showed non-significant difference between steroid and hyaluronic acid.

Left/right discrimination is not impaired in people with unilateral chronic Achilles tendinopathy

Impaired left/right discrimination of an affected body part has been observed in various chronic pain states. This study aimed to examine whether people with unilateral chronic Achilles tendinopathy also present with impaired left/right discrimination. Cross-sectional study. Nineteen runners with persistent unilateral Achilles tendinopathy and 19 matched healthy volunteers performed a left/right discrimination task in a laboratory setting. Participants were shown pictures of feet, hands and Shepard-Metzler figures and were asked to decide as accurately and as fast as possible whether the body part belonged to the left or right side of the body, or whether the Shepard-Metzler figures were rotated or mirrored. Performance was evaluated in terms of accuracy and response time. Data were analysed with mixed-design ANOVAs. The decline in left/right discrimination ability at group level, if present, between affected and unaffected side, or compared to healthy participants, was negligible for both accuracy (<1.5%) and response time (<50ms). There was no significant effect of side (affected versus unaffected side) or group (people with Achilles tendinopathy versus healthy) for accuracy (p>0.36) or response time (p>0.69). People with Achilles tendinopathy recognised the affected side as accurately and as fast as the non-affected side and their performance was comparable to healthy participants. The absence of impaired left/right discrimination despite the chronicity of the condition may be attributable to the typical intermittent nature of Achilles tendinopathy pain and/or maintained sports activity.