Symptomatic Tendinopathy Research Articles

Are asymptomatic ultrasound abnormalities in the achilles tendon of elite soccer players risk factors for symptoms one year later? a longitudinal cohort study

BackgroundAchilles tendinopathy is common and can bring a sports career to a premature end. Identifying players at an increased risk of this debilitating condition could lead to better prevention.ObjectivesThe primary...

US-Guided Therapy of Calcific Tendinopathy: Clinical and Radiological Outcome Assessment in Shoulder and Non-Shoulder Tendons

To analyze the effectiveness and complication rate of ultrasound (US)-guided perforation and lavage using a two-needle technique with 16 - 18 G needles in the treatment of patients with calcific tendinopathy in the shoulder, elbow, hip, and knee by radiological and clinical follow-up. A retrospective chart review was performed and 40 patients (13 male, 27 female; mean age, 53.5 years; range 24 -74 years) were identified as having received US-guided perforation and lavage due to symptomatic calcific tendinopathy of the rotator cuff tendons, triceps, extensor and flexor tendons at the elbow, rectus femoris tendon and patellar tendons. The radiographic outcome was assessed by comparison of the size and quality of the calcification before and 6 weeks after the procedure. On US images, the quality of the acoustic shadow was assessed, together with other alterations of the tendon and surrounding tissue. Patients were interviewed by telephone to assess the clinical outcome regarding pre-treatment and post-treatment pain and tendon function. 34 shoulder tendons and 6 non-shoulder tendons were identified. The mean calcium reduction was 39.9 mm(2) (range, 0 - 215; p < 0.001), while 80 % of patient showed a resolution of more than 60 % resulting in good clinical improvement. A very low complication rate was found (1 partial tear). The US-guided perforation and lavage technique is an effective and safe treatment for rotator cuff calcifications as well as for other body tendons. Although the two-needle technique and large needles were used in this study, a very low complication rate was detected.

Bilateral simultaneous complete quadriceps rupture following chronic symptomatic tendinopathy: a case report

IntroductionQuadriceps rupture is a disabling injury mostly seen in men over 40 years of age. Bilateral quadriceps rupture is a rare injury that is often secondary to predisposing medical conditions. Ultrasound is a cheap and reliable tool for diagnosis but is operator dependent. Thus, magnetic resonance imaging is the preferred method of investigation despite its cost and availability. Prompt diagnosis and early surgical repair are needed for an optimal end result.Case presentationWe report the case of a healthy 54-year-old Caucasian male farmer who presented with bilateral simultaneous complete quadriceps rupture, which was managed surgically and he was followed up for three years. He was previously under our care for enthesopathy of the quadriceps on both sides. We believe that chronic enthesopathy of the superior pole of patella made his quadriceps susceptible to complete rupture on eccentric loading.ConclusionOnly a few cases of bilateral simultaneous complete quadriceps rupture in patients with symptomatic enthesopathy have been previously reported. We stress the importance of warning patients of the risk of developing complete tendon rupture when they present with an enthesopathy around the knee.

Effects of Low-Level Laser Therapy and Eccentric Exercises in the Treatment of Recreational Athletes with Chronic Achilles Tendinopathy

Background Eccentric exercises (EEs) are recommended for the treatment of Achilles tendinopathy, but the clinical effect from EE has a slow onset. Hypothesis The addition of low-level laser therapy (LLLT) to EE may cause more rapid clinical improvement. Study Design Randomized controlled trial; Level of evidence, 1. Methods A total of 52 recreational athletes with chronic Achilles tendinopathy symptoms were randomized to groups receiving either EE + LLLT or EE + placebo LLLT over 8 weeks in a blinded manner. Low-level laser therapy (Λ = 820 nm) was administered in 12 sessions by irradiating 6 points along the Achilles tendon with a power density of 60 mW/cm2 and a total dose of 5.4 J per session. Results The results of the intention-to-treat analysis for the primary outcome, pain intensity during physical activity on the 100-mm visual analog scale, were significantly lower in the LLLT group than in the placebo LLLT group, with 53.6 mm versus 71.5 mm (P = .0003) at 4 weeks, 37.3 mm versus 62.8 mm (P = .0002) at 8 weeks, and 33.0 mm versus 53.0 mm (P = .007) at 12 weeks after randomization. Secondary outcomes of morning stiffness, active dorsiflexion, palpation tenderness, and crepitation showed the same pattern in favor of the LLLT group. Conclusion Low-level laser therapy, with the parameters used in this study, accelerates clinical recovery from chronic Achilles tendinopathy when added to an EE regimen. For the LLLT group, the results at 4 weeks were similar to the placebo LLLT group results after 12 weeks.

Magnetic resonance imaging findings in patients with peroneal tendinopathy and peroneal tenosynovitis

To compare the magnetic resonance (MR) imaging findings of a group of patients with clinically diagnosed peroneal tendonopathy and peroneal tenosynovitis with the MR imaging findings of a control group of patients with no clinical evidence of peroneal tendon disorder. The MR examinations of 24 patients with symptomatic peroneal tendinopathy or peroneal tenosynovitis and 70 patients with no clinical evidence of peroneal tendon disorder were retrospectively reviewed to determine the presence or absence of four MR imaging findings: 1) predominantly or uniform intermediate signal intensity within the peroneal tendons on one or more axial proton density-weighted images, 2) predominantly or uniform intermediate signal intensity within the peroneal tendons on three consecutive axial proton density-weighted images, 3) intermediate T2 signal intensity within the peroneal tendons, and 4) circumferential fluid within the common peroneal tendon sheath greater than 3 mm in maximal width. The sensitivity and specificity of these MR imaging findings for determining the presence or absence or symptomatic peroneal tendinopathy or peroneal tenosynovitis were calculated. The sensitivity of MR imaging findings 1, 2, 3, and 4 for determining the presence of peroneal tendinopathy or peroneal tenosynovitis were 92%, 92%, 50%, and 17% respectively. The specificity of MR imaging findings 1, 2, 3, and 4 for determining the absence of peroneal tendinopathy or peroneal tenosynovitis were 57%, 79%, 93%, and 100% respectively. The presence of predominantly or uniform intermediate signal intensity within the peroneal tendons on three consecutive axial proton density-weighted images is a highly sensitive and moderately specific indicator of symptomatic peroneal tendinopathy. The presence of intermediate T2 signal within the peroneal tendons, and the presence of circumferential fluid within the peroneal tendon sheath greater than 3 mm in maximal width, are highly specific indicators of peroneal tendinopathy and peroneal tenosynovitis respectively.

Clinical diagnosis of Achilles tendinopathy with tendinosis.

To evaluate sensitivity, specificity, reproducibility, and predictive value of palpation of the painful arc sign and of the Royal London Hospital test in 10 patients with Achilles tendinopathy and in 14 asymptomatic subjects. Test-retest study. University teaching hospital. Ten male athletes on the waiting list for exploration of one of their Achilles tendons for tendinopathy of the main body of the tendon attended a special clinic. Each was invited to bring at least one athlete of the same sex in the same discipline aged within 2 years of themselves with no history and no symptoms of Achilles tendinopathy. A total of 14 controls were thus recruited. Pain and tenderness following performance of palpation, the painful arc sign, and the Royal London Hospital test. There were no statistically significant differences at the 5% level among the effects of investigator or between morning and afternoon measurements for any of the three measurement methods. There was no evidence of a difference of the three assessment methods (p > 0.05). When the three methods were combined, the overall sensitivity was 0.586 (confidence interval [CI], 0.469-0.741), and the overall specificity was 0.833 (CI, 0.758-0.889). In patients with tendinopathy of the Achilles tendon with a tender area of intratendinous swelling that moves with the tendon and whose tenderness significantly decreases or disappears when the tendon is put under tension, a clinical diagnosis of tendinopathy can be formulated, with a high positive predictive chance that the tendon will show ultrasonographic and histologic features of tendinopathy.

Letters to the editor

<h3>Abstract</h3> Achilles tendinopathy affects many running athletes and often leads to chronic pain and functional deficits. While changes in tendon structure have been linked with tendinopathy, the effects of distance running on tendon structure is not well understood. Therefore, the purpose of this study was to characterize structural differences in the Achilles tendons in healthy young adults and competitive distance runners using quantitative ultrasound analyses. We hypothesized that competitive distance runners with no clinical signs or symptoms of tendinopathy would have quantitative signs of tendon damage, characterized by decreased collagen alignment and echogenicity, in addition to previous reports of thicker tendons. Longitudinal ultrasound images of the right Achilles tendon mid-substance were acquired in competitive distance runners and recreationally-active adults. Collagen organization, mean echogenicity, and tendon thickness were quantified using image processing techniques. Clinical assessments confirmed that runners had no signs or symptoms of tendinopathy and controls were only included if they had no history of Achilles tendon pain or injuries. Runner tendons were 40% less organized, 48% thicker, and 41% less echogenic compared to the control tendons (p &lt; 0.001). Young adults engaged in competitive distance-running have structurally different tendons than recreationally-active young adults. While these structural differences have been associated with tendon damage, the lack of clinical symptoms of tendinopathy may suggest that these detected differences may either be precursors of tendinopathy development or protective adaptations to cyclic tendon loading experienced during running.

Comparative Studies of Platelet-Rich Plasma (PRP) and Prolotherapy for Proximal Biceps Tendinitis

PURPOSE: This research sought to study Platelet-Rich Plasma therapy (PRP) and prolotherapy for shoulder pain and dysfunction related to symptomatic biceps tendinopathy, and to judge effective results.MATERIALS AND METHODS: We selected 100 cases that had significant inflammatory effusion of the biceps tendon (that was shown on MRI), and was refractory to conservative treatment. The cases were followed up for more than one year and were divided into 2 groups. The 1st group received PRP therapy; the 2nd group received prolotherapy under sonographic guidance. We evaluated results for visual analog score (VAS), (Korean Shoulder Society Score (KSS), UCLA Score, Constant Shoulder Score (CSS) for 12 months.RESULTS: There was no significant difference between the 2 groups in the first month after the procedure. However, in the third, sixth, and twelfth months after the procedure, the 1st group showed significant improved results for VAS, KSS, UCLA, and CSS scores compared to the 2nd group (p&lt;0.05).CONCLUSION: Among nonsurgical treatments, both PRP and prolotherapy could be effective against biceps tendinopathy. But, PRP treatment is considered as more reliable method than prolotherapy for maintaining effective results.