Treatment Of Tendinitis Research Articles

Systematic Review of Platelet-Rich Plasma in Medical and Surgical Specialties: Quality, Evaluation, Evidence, and Enforcement.

Background: Platelet-rich plasma (PRP) is widely used in various medical and surgical specialties for its regenerative properties, including aesthetics (facial rejuvenation, hair restoration, and skin tightening) and orthopedics (treatment of tendinitis and osteoarthritis). However, the inconsistent literature on PRP's efficacy and safety leads to critical knowledge gaps. This systematic review evaluates quality control measures in PRP preparation and application and explores the regulatory environment governing its clinical use. Methods: Following PRISMA guidelines, a comprehensive search was conducted across multiple databases, including PubMed, EMBASE, and Web of Science, for studies published from January 2020 to April 2024. The review included randomized controlled trials (RCTs) involving human participants undergoing PRP treatment for aesthetic or regenerative purposes. Key parameters such as the PRP preparation methods, platelet concentration, and quality control measures were analyzed. The study protocol was registered with PROSPERO (ID: CRD42024557669). Results: Out of 75 RCTs involving 5726 patients, the review identified significant variability in PRP preparation methods and application techniques, including differences in centrifugation protocols and platelet concentration levels. A new evidence-based scoring system, the William-Eqram Scoring System for PRP Quality Reporting (WESS-PQR), was proposed to address these inconsistencies. Correlation analysis revealed a strong positive correlation (r = 0.79) between proper temperature control during preparation and PRP efficacy. Initial platelet count assessment showed a moderate positive correlation (r = 0.57) with efficacy. Conclusions: Standardized PRP preparation protocols and robust regulatory frameworks are urgently needed to ensure the safety and efficacy of PRP treatments. The proposed WESS-PQR scoring system can serve as a valuable tool for clinicians and researchers, promoting consistency and reliability in PRP applications.

Open-label clinical study to compare the effect of Agnikarma, as a stand-alone treatment, versus, in association with Snayugatavata treatment protocol, in tennis elbow

Abstract Background: Tennis elbow, the painful condition of extensor tendons of the humerus caused by repetitive stress, has no reliable treatment apart from symptomatic support. Ayurvedic practitioners widely use Agnikarma (therapeutic/thermal cauterization) and Snayugatavata Chikitsa (tendinitis treatment protocol) as treatment modalities for it. Agnikarma or Daha is indicated in extremely painful conditions of tendons. Snayugatavata Chikitsa includes Snehana (oleation), Upanaha (medicated bandage), and Daha (thermal cauterization). Aim: To evaluate the efficacy of “Agnikarma” alone and along with Sneha and Upanaha as a part of Snayugatavata Chikitsa’ in tennis elbow treatment and to compare their relative effectiveness. Materials and methods: The study was an open-label, double-armed, prospectively designed, comparative clinical study with 60 patients with tennis elbow randomly allocated into two groups. Group I received Snayugatavata treatment protocol for 8 days, where Kottamchukkadi oleation and medicated bandage were administered for 7 consecutive days and a single sitting of Agnikarma was done on the 8th day. Group II received Agnikarma with Panchadhatu Shalaka (a five-metal alloyed thermal cautery instrument) alone in two sittings on the 1st and 8th days. Assessment was carried out on the 8th, 15th, 30th, and 90th days for five parameters, namely pain, tenderness, inability to do specific tasks, Cozen’s test, and Mill’s maneuver. Results: Both groups showed significant results in all five assessed parameters with P < 0.0001. On comparative analysis between the groups, Agnikarma alone was proved more effective than Snayugatavata Chikitsa with P < 0.0001 for all the parameters for 3 months. Conclusion: Agnikarma, as a stand-alone treatment, can be chosen to offer a simple, cost-effective, safe, and short-term treatment to cure the tennis elbow.

Combination of Local Anesthetics and Corticosteroids as Pain Management in Supraspinatus Tendinitis: A Case Report

Introduction: This study aimed to report the treatment of tendinitis in combination with local anesthetics and corticosteroids.
 Case presentation: A man, 34 years old, came to the hospital with complaints of pain in the right shoulder. This pain is felt especially when moving the right shoulder, and the patient also cannot raise his right hand. Pain when moving the right arm appeared after falling off a motorbike about 1 month ago. The intensity of pain has been getting higher for the last 14 days, especially when going to bed, so the patient complains of difficulty sleeping. The patient has been treated at the public health center for a month and has received pain relievers. Physical examination showed vital signs within normal limits and pain intensity of 8/10 based on the visual analogue scale. Examination of the extremity shows the abduction of pain starting at 60°-70° on activity and no pain on passive movement. In the special tests, the Neer test is positive, the Hawkin test is positive, and the Empty Can test is positive. The patient was diagnosed with supraspinatus tendinitis. The treatment for this patient is supraspinatus tendon injection. The anesthetic agent used was 2% lidocaine combined with 20 mg triamcinolone corticosteroids. This procedure is performed under ultrasound guidance for precise injection sites. Evaluation after the action found no side effects. After 1 month of action, the patient felt that the pain was greatly reduced (1/10) and the joint movement was not limited.
 Conclusion: The use of a combination of triamcinolone and lidocaine is beneficial in reducing pain in cases of supraspinatus tendinitis.

Physiological and Neurophysiological Effects of Sports Massage on the Athletes’ Performance: A Review Study

Background and Aims: Massage therapy is widely used by athletes for various reasons such as recovery from fatigue, preventing injury, and relaxation. It is believed that massage improves the performance of the athletes by increasing their blood flow, removing lactic acid, and stimulating the nervous system. This review study aims to investigate the physiological and neurophysiological effects of sports massage on the athletes’ performance, to find out whether the clinical beliefs of sports physiotherapists about the effects of sports massage on sports injuries are supported by scientific evidence or not. Methods: In this review study, a search was conducted in Google Scholar PubMed, and ScienceDirect databases on studies published in English from 1975 to 2020 using the keywords: Sports massage, sports injuries, physiological mechanisms, neurophysiological mechanisms, and performance of athletes. Fifty articles about the effects of sports massage were assessed for eligibility. Finally, 14 clinical trial studies and one case report study were included in the review. Results: Few studies have been conducted on the effect of sports massage on the athletes’ performance. The existing studies are heterogeneous, i.e., they have examined the effect of massage on different factors and reported contradictory results. It seems that the effects of sports massage on the athletes’ performance are more due to its psychological effects rather than its clinical effects. The effects of sports massage on athletes’ performance have not yet been supported by scientific evidence. Conclusion: Many scholars consider that the effects of sports massage are due to increasing blood flow, but there is insufficient scientific evidence. In treatment of tendonitis and muscle strains, there is insufficient evidence that sports massage can reduce pain and accelerate healing. It seems the therapeutic effects of sport massage are more psychological and less physiological.

Clinical Outcomes of Long Head Biceps Tendinitis Treatment by a Semitenodesis Technique.

Introduction Long head biceps (LHB) tendon pathology results in anterior shoulder pain, affecting activities requiring overhead movement and forward flexion. Current surgical options for those in whom conservative management failedinclude tenotomy and tenodesis, and both have considerable success rates and various complications. Herein, we present a novel technique using tenotomy with autotenodesis of the LHB. Methods Patients with isolated LHB tendinopathy and for whom the six-month conservative treatment failed were included in our study. Our semitenodesis technique was performed from May 2015 to May 2021. All patients underwent postoperative rehabilitation and were followed in the clinic to document the visual analog scale (VAS) score, constant functional score, supination and flexion power, and postoperative satisfaction score. We used IBM SPSS Statistics for Windowsversion 20.0(IBM Corp., Armonk, NY) to analyze our data. Results The study included 26 patients with a mean age of 50 ± 4.3 years and a male predominance. Following our technique, the postoperative VAS score improved significantly from 8.8 to 3 within three months and decreased to 0.4 during the final follow-up. The shoulder average constant score improved significantly from 45 ± 4 to 79 ± 5, in addition to a high postoperative mean satisfaction score. Only one patient had a Popeye sign deformity, making an incidence percentage of 3.8% with our technique. Conclusions We conducted this study to assess the outcomes of our novel technique using tenotomy with autotenodesis of the LHB compared to traditional techniques such as tenotomy and tenodesis. Our novel technique showed an improvement in pain score superior to patients who underwent tenodesis and tenotomy three months postoperatively. Furthermore, our technique yielded lower postoperative complications than traditional techniques. Our patients also scored a high mean of postoperative satisfaction. Therefore, our technique is a promising treatment option, proving its superiority over tenotomy and tenodesis in treating isolated LHB tendonitis.

Modulation of Inflammation by Plant-Derived Nutraceuticals in Tendinitis

Tendinitis (tendinopathy) is a pro-inflammatory and painful tendon disease commonly linked with mechanical overuse and associated injuries, drug abuse, and lifestyle factors (including poor diet and physical inactivity) that causes significant healthcare expenditures due to its high incidence. Nuclear factor kappa B (NF-κB) is one of the major pro-inflammatory transcription factors, along with other inflammation signaling pathways, triggered by a variety of stimuli, including cytokines, endotoxins, physical and chemical stressors, hypoxia, and other pro-inflammatory factors. Their activation is known to regulate the expression of a multitude of genes involved in inflammation, degradation, and cell death. The pathogenesis of tendinitis is still poorly understood, whereas efficient and sustainable treatment is missing. Targeting drug suppression of the key inflammatory regulators represents an effective strategy for tendinitis therapy, but requires a comprehensive understanding of their principles of action. Conventional monotherapies are often ineffective and associated with severe side effects in patients. Therefore, agents that modulate multiple cellular targets represent therapeutic treatment potential. Plant-derived nutraceuticals have been shown to act as multi-targeting agents against tendinitis via various anti-oxidant and anti-inflammatory mechanisms, whereat they were able to specifically modulate numerous signaling pathways, including NF-κB, p38/MAPK, JNK/STAT3, and PI3K/Akt, thus down-regulating inflammatory processes. This review discusses the utility of herbal nutraceuticals that have demonstrated safety and tolerability as anti-inflammatory agents for the prevention and treatment of tendinitis through the suppression of catabolic signaling pathways. Limitations associated with the use of nutraceuticals are also described.

Calebin A, a Compound of Turmeric, Down-Regulates Inflammation in Tenocytes by NF-κB/Scleraxis Signaling.

Calebin A (CA) is one of the active constituents of turmeric and has anti-inflammatory and antioxidant effects. Excessive inflammation and cell apoptosis are the main causes of tendinitis and tendinopathies. However, the role of CA in tendinitis is still unclear and needs to be studied in detail. Tenocytes in monolayer or 3D-alginate cultures in the multicellular tendinitis microenvironment (fibroblast cells) with T-lymphocytes (TN-ME) or with TNF-α or TNF-β, were kept without treatment or treated with CA to study their range of actions in inflammation. We determined that CA blocked TNF-β-, similar to TNF-α-induced adhesiveness of T-lymphocytes to tenocytes. Moreover, immunofluorescence and immunoblotting showed that CA, similar to BMS-345541 (specific IKK-inhibitor), suppressed T-lymphocytes, or the TNF-α- or TNF-β-induced down-regulation of Collagen I, Tenomodulin, tenocyte-specific transcription factor (Scleraxis) and the up-regulation of NF-κB phosphorylation; thus, its translocation to the nucleus as well as various NF-κB-regulated proteins was implicated in inflammatory and degradative processes. Furthermore, CA significantly suppressed T-lymphocyte-induced signaling, similar to TNF-β-induced signaling, and NF-κB activation by inhibiting the phosphorylation and degradation of IκBα (an NF-κB inhibitor) and IκB-kinase activity. Finally, inflammatory TN-ME induced the functional linkage between NF-κB and Scleraxis, proposing that a synergistic interaction between the two transcription factors is required for the initiation of tendinitis, whereas CA strongly attenuated this linkage and subsequent inflammation. For the first time, we suggest that CA modulates TN-ME-promoted inflammation in tenocytes, at least in part, via NF-κB/Scleraxis signaling. Thus, CA seems to be a potential bioactive compound for the prevention and treatment of tendinitis.

Histological tissue healing following high-power laser treatment in a model of suspensory ligament branch injury.

High-power laser therapy gained popularity recently as a regenerative treatment for tendinitis and desmitis in the horse. However, studies evaluating the effects of laser therapy on tissue repair at the histological level in large mammals are lacking. To evaluate the effects of high-power laser therapy on suspensory desmitis healing, using a model of suspensory ligament branch injury. In vivo experiments. Standardised lesions were surgically induced in all four lateral suspensory branches of 12 healthy Warmblood horses. Laser therapy (class 4, 15W) was applied daily on two of four induced lesions for four consecutive weeks. Horses were randomly assigned to either short-term study (horses were sacrificed after 4weeks) or long-term study (6months). Suspensory ligament samples were scored after staining with haematoxylin-eosin and immunostaining for collagen 1- collagen 3- and factor VIII. In the short-term study, significantly better (lower) scores for variation in density (17% above cut-off score in treated lesions vs. 31% above cut-off score in controls, P=.03), shape of nuclei (54% vs 92%, P=.02), fibre alignment (32% vs 75%, P=.003) and fibre structure (38% vs 71%, P=.02) were found in laser-treated lesions when compared to controls. Collagen 3 expression was significantly higher (32% vs 19%, P=.006) in control lesions. In both short- and long-term studies combined, parameters lesion size (44% vs 56%, P=.02) and shape of nuclei (53% vs 84%, P=.05) scored significantly better in treated lesions. Long-term, significantly better (lower) scores were found in the laser-treated group for lesion size (15% vs 45%, P=.008) and a higher percentage above cut-off score for density of the nuclei (27% vs 9%, P=.02), compared to controls. The model of suspensory branch injury is not an exact representation of clinical overstrain lesions. These results suggest that high-power laser therapy enables better lesion healing than conservative treatment.

Efficacy of Shock Waves Combined with Adjuvant Therapy with Tendon Supplement in the Treatment of Plantar Fasciitis: A Prospective Randomized Study

Physical treatment with focused shock waves is effective in the treatment of tendonitis in 60-90% of cases. Plantar fasciitis is attributable to the group of tendon pathologies for its degenerative-inflammatory anatomopathological characteristics. Food supplements could facilitate the healing of tendinopathies when combined with shock wave therapy. We designed a single-blind, randomized prospective study (level of evidence IB). Forty-four patients with plantar fasciitis were recruited and randomized to group A (18 patients) and group B (26 patients), where they were treated with focused shock waves alone and the combination of focused shock waves and tendon supplement, respectively. Statistically significant improvement in pain remission (primary endpoint) and functional recovery (secondary endpoint) occurred in both groups at three time points of the monitoring (Months 0, 3, and 6). The time-group interaction analysis confirmed the best efficacy of the combination treatment with shockwave and supplement (group B). The results of this study demonstrate a positive therapeutic effect of the combination of focused shock wave therapy and a complex tendon supplement in the treatment of plantar fasciitis.

Superficial digital flexor tendinitis treatment using high-intensity laser therapy and therapeutic ultrasound in polo ponies

High-intensity laser therapy (HILT) is an alternative technique that should provide better results than therapeutic ultrasound in the treatment of tendinitis. However, there has not yet been a study to support this hypothesis in horses, especially in polo ponies. This study aims to follow up the outcomes of high-intensity laser therapy and therapeutic ultrasound in tendinitis polo ponies in Thailand. Twelve limbs with tendinitis from 10 ponies were included in the study after lameness examination; the limbs were confirmed to have tendinitis via ultrasonography. The ponies were randomized to high-intensity laser therapy and therapeutic ultrasound group. Recordings of the severity of the cross-sectional area (CSA), echogenicity score, fiber alignment score (FAS), lameness examination and pain responsive were performed on day 0, day 8, day 30 and day 60. The samples were randomized to six limbs in each treatment group. The results show that there was no significantly change in the CSA within treatment groups (HILT: p = 0.2; therapeutic ultrasound p > 0.9) and between the treatment group (p > 0.9), echogenicity score or FAS within and between the treatment group in 60 days of study. None of the ponies in this study experienced skin reactions from the treatment. In conclusion, both high-intensity laser therapy and therapeutic ultrasound are safe to use in the tendinitis of polo ponies and have the ability to decrease inflammation. However, a rehabilitation program is still the most important part that should be controlled along with the treatment.

Effectiveness of kinesio taping in bicipital tendinitis treatment: A randomized controlled trial

Effectiveness of kinesio taping in bicipital tendinitis treatment: A randomized controlled trial

Comparison of Radial Extracorporeal Shock Wave Therapy and Traditional Physiotherapy in Rotator Cuff Calcific Tendinitis Treatment.

This study aims to investigate the efficacy of radial extracorporeal shock wave therapy (rESWT) in relieving pain and improving range of motion (ROM) and functionality besides conventional physiotherapy methods in the treatment of chronic rotator cuff calcific tendinitis (RCCT). We studied 80 patients (35 males, 45 females; mean age 53.3±9.6 years; range, 40 to 70 years) with chronic RCCT. Patients were randomly divided into two groups: rESWT group (n=40) treated with conventional physiotherapy and rESWT, and control group (n=40) treated only with a conventional physiotherapy program. The traditional physiotherapy program included ultrasound, transcutaneous electrical nerve stimulation, shoulder joint ROM and stretching exercises, and ice applications. All patients received a total of 20 treatments, five days a week for four weeks. rESWT was applied once a week for four weeks in total. Before and after treatment, all patients were evaluated for age, height, weight, Body Mass Index (BMI), pain intensity with a Visual Analog Scale, shoulder ROM, and functional disability status with the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH). Mean BMI value of the participants was 26.1±3.0 kg/m2. Although all parameters of the patients in both groups improved significantly, patients in the rESWT group had a statistically significant improvement in pain, ROM and QuickDash scores (p<0.001, p<0.001, and p<0.001, respectively). We assume that rESWT is an effective and noninvasive method of reducing pain and increasing ROM and functional status without the need for surgery.

Rotator cuff tendon calcific tendinitis treatment algorithm for primary care musculoskeletal physicians.

Purpose:Calcific tendinitis of the shoulder is a common pathology encountered by primary care sports medicine physicians and orthopedic surgeons. Understanding the patient demographics responsible for calcific tendinitis outcomes from various treatment modalities may lead to greater understanding of appropriate management.Methods:This was a retrospective study on patients who were diagnosed with calcific tendinitis by imaging (radiographs, MRIs) at our institution from 2014 to 2016. The data collection included patient demographics, clinical signs and symptoms management. Treatment outcomes were assessed by whether symptoms resolved and the number and type of treatment.Results:A total of 250 medical records were reviewed out of which 237 were involved in the data analysis. There were 95 male and 141 female patients with a mean age of 54.9 ± 11.5 years. In all, 120 patients complained of right shoulder pain and 117 of left shoulder pain. Smokers had a higher VAS Pain at Rest and Activity of 6.1 ± 3.5 and 8.2 ± 2.4, respectively, with non-smokers scoring a lower VAS Pain Rest score of 4.2 ± 3.1 and 7.9 ± 2.0 (P = 0.18). The VAS Pain Rest score after follow-up from corticosteroid injection, ultrasound-guided injection with needling, and surgery were 3.9 ± 3.0, 3.5 ± 3.0, and 0.7 ± 1.4, respectively.Conclusion:An algorithm constructed from our results recommends initial management with a subacromial corticosteroid injection with physical therapy followed by ultrasound-guided injection with needling and PT if the initial treatment fails. Surgical management is considered when the patient is recalcitrant to the first two forms of non-operative treatment.

Ketoprofen Loaded in Natural Rubber Latex Transdermal Patch for Tendinitis Treatment

Ketoprofen is an analgesic with potent anti-inflammatory activity against acute inflammation, subacute inflammation, for the acute and long-term treatment of various inflammatory pathologies, as rheumatoid arthritis and colonic adenocarcinoma. In order to minimize the incidence of systemic events related to ketoprofen, the transdermal drug delivery system development has been most important. The advantages of using natural rubber latex membranes include not only the reduction of adverse systemic events, but also the suitability of the low cost of the material together with its physicochemical properties such as flexibility, mechanical stability, surface porosity and water vapor permeability, and besides being a biocompatible material also presents biological activity to stimulate the angiogenesis, being able to be used in tissue repair. This study demonstrated that ketoprofen was successfully incorporated into natural latex membranes for drug delivery. FTIR indicated that the drug did not interact chemically with the membrane. Moreover, the natural latex membranes released 60% of the ketoprofen incorporated in 50 h. SEM images indicated that a portion of the drug was present on the membrane surface, being this portion responsible for the burst release. The tensile tests showed that the addition of the drug into the natural latex membrane did not influence on the polymer mechanical behavior. In addition, drug-natural latex membranes presented no red blood cell damaging effects. Our data shows that the ketoprofen loaded natural latex membranes is a promising system for sustained drug delivery which can be used to minimize the adverse side effects of high dose systemic drug delivery.

Adipose tissue as mesenchymal stem cells source in equine tendinitis treatment

Tendinitis is an important high-relapse-rate disease, which compromises equine performance and may result in early athletic life end to affected animals. Many therapies have been set to treat equine tendinitis; however, just few result in improved relapse rates, quality of extracellular matrix (ECM) and increased biomechanical resistance of the treated tissue. Due to advances in the regenerative medicine, promising results were initially obtained through the implantation of mesenchymal stem cells (MSC) derived from the bone marrow in the equine tendon injury. Since then, many studies have been using MSCs from different sources for therapeutic means in equine. The adipose tissue has appeared as feasible MSC source. There are promising results involving equine tendinitis therapy using mesenchymal stem cells from adipose tissue (AdMSCs).

CORR Insights®: Does the use of ultrasound affect contamination of musculoskeletal injections sites?

This CORR Insights® is a commentary on the article “Does the Use of Ultrasound Affect Contamination of Musculoskeletal Injections Sites? by Sherman and colleagues available at: DOI: 10.1007/s11999-014-3903-4. The author certifies that he, or any member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR ® or the Association of Bone and Joint Surgeons®. This CORR Insights® comment refers to the article available at DOI: 10.1007/s11999-014-3903-4.

THU0339 Management of Achilles Tendinopathy in Reactive VS Degenerative Stage: A Prospective, Randomized, Controlled Trial Evaluating the Efficacy of A Dietary Supplement Associated to Eccentric Training or Passive Stretching

BackgroundTendinopathy is an overuse tendon injury that results in pain, decreased exercise tolerance and a reduction in function, being a major problem in sports and occupational medicine. A new pathology...

THU0338 A Randomized, Placebo-Controlled Study to Evaluate Efficacy and Safety of A Dietary Supplement Containing Mucopolysaccharides, Collagen Type I and Vitamin C for Management of Different Tendinopathies

BackgroundOveruse tendon injury (tendinopathy) occurs in loaded tendons of the upper and lower limb and results in pain, decreased exercise tolerance of the tendon and a reduction in function. Characteristic...

Calcified shoulder's supra-spinatus tendinitis treatment by mesotherapy by calcium chelating agent

Calcified shoulder's supra-spinatus tendinitis treatment by mesotherapy by calcium chelating agent

Biomechanical and biochemical protective effect of low-level laser therapy for Achilles tendinitis

For three decades, low level laser therapy (LLLT) has been used for treatment of tendinitis as well as other musculoskeletal diseases. Nevertheless, the biological mechanisms involved remain not completely understood. In this work, the effects of LLLT and of the widely used nonsteroidal anti-inflammatory drug, diclofenac, have been compared in the case of collagenase-induced Achilles tendinitis. Wistar rats were treated with diclofenac or laser therapy. The tensile behavior of tendons was characterized through successive loading–unloading sequences. The method considered 11 characteristic parameters to describe the mechanical behavior. It was shown that during the acute inflammatory process of the tendon, the mechanical properties were significantly correlated to the high levels of MMP-3, MMP-9 and MMP-13 expression presented in a previous paper (Marcos, R.L., et al., 2012). The treatment by non-steroidal anti-inflammatory drugs such as diclofenac sodium produces a low protective effect and can affect the short-term biochemical and biomechanical properties. On the contrary, it is shown that LLLT exhibits the best results in terms of MMPs reduction and mechanical properties recovery. Thus, LLLT looks to be a promising and consistent treatment for tendinopathies.