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Sample records for achilles tendinopathy patients

  1. Achilles tendinopathy

    Wetke, E; Johannsen, F; Langberg, Henning

    2015-01-01

    In published efficacy studies on Achilles tendinopathy (AT) exercise alone results in improvement in 60-90% of the cases. However, this high success rate cannot be expected in usual clinical practice. We prospectively investigated the effectiveness of a treatment regimen consisting of home-based ...

  2. Ultrasound guided electrocoagulation in patients with chronic non-insertional Achilles tendinopathy

    Boesen, M Ilum; Torp-Pedersen, S; Koenig, M Juhl;

    2006-01-01

    High resolution colour Doppler ultrasound shows intratendinous Doppler activity in patients with chronic Achilles tendinopathy. Treatment of this neovascularisation with sclerosing therapy seems to relieve the pain. However, the procedure often has to be repeated.......High resolution colour Doppler ultrasound shows intratendinous Doppler activity in patients with chronic Achilles tendinopathy. Treatment of this neovascularisation with sclerosing therapy seems to relieve the pain. However, the procedure often has to be repeated....

  3. Eccentric overload training in patients with a chronic Achilles tendinopathy: a systematic review.

    Kingma, J.J.; Knikker, R. de; Wittink, H.M.; Takken, T.

    2007-01-01

    Background: Eccentric overload training seems to be a promising conservative intervention in patients with chronic Achilles tendinopathy. The efficacy of eccentric overload training on the outcome measures of pain and physical functioning are not exactly clear. Study design: Systematic review of the

  4. Low recurrence rate after mini surgery outside the tendon combined with short rehabilitation in patients with midportion Achilles tendinopathy

    Alfredson, Håkan

    2016-01-01

    Background There is a general opinion that a structured and specific rehabilitation is needed after treatment of midportion Achilles tendinopathy to minimize recurrence of the condition. There is sparse knowledge about the recurrence rates in large patient materials after specific treatments for midportion Achilles tendinopathy. Aim This study aimed to investigate the recurrence rates in a large number of patients with chronic painful midportion Achilles tendinopathy that had been surgically treated with the ultrasound (US) and Doppler (DP)-guided mini-surgical scraping technique. Postoperatively, a relatively simple rehabilitation protocol, including a range of movement exercises and gradually increased walking and biking before allowing free activity, was used. Materials and methods From a database, information about the recurrence rates after US + DP-guided mini-surgical scraping, performed by a single surgeon on 519 tendons with US + DP-verified chronic painful midportion Achilles tendinopathy, was obtained. Results Recurrence of painful midportion Achilles tendinopathy was found in 26 of 519 (5%) operated tendons, 13 from women and 13 from men. In 13 tendons, a close by located plantaris tendon was extirpated during the reoperation. Conclusion In this large material on patients treated with US + DP-guided mini-surgical scraping for midportion Achilles tendinopathy, there were few recurrences, although only a simple and nonspecific rehabilitation protocol was used. PMID:27274323

  5. The microvascular volume of the achilles tendon is increased in patients with tendinopathy at rest and after a 1-hour treadmill run

    Pingel, Jessica; Harrison, Adrian; Simonsen, Lene;

    2013-01-01

    BACKGROUND:Achilles tendinopathy (AT) is initiated asymptomatically and is therefore often discovered at a very late stage. PURPOSE:To elucidate whether the microvascular volume (MV) of the Achilles tendon is elevated in patients with AT compared with healthy controls during pre-exercise rest...... tendinopathy. CLINICAL RELEVANCE:This study underlines that tendon flexibility is altered in patients with AT and that CEU is a promising tool to establish the early diagnosis of this condition....

  6. Clinical improvement after 6 weeks of eccentric exercise in patients with mid-portion Achilles tendinopathy - a randomized trial with 1-year follow-up.

    Roos, Ewa; Engström, Mikael; Lagerquist, Annika; Söderberg, Bengt

    2004-01-01

    Achilles tendinopathy is common and treatment with eccentric exercises seems promising. We designed a prospective randomized clinical trial to test the hypothesis that eccentric calf muscle exercises reduce pain and improve function in patients with Achilles tendinopathy. Forty-four patients were recruited from primary care (mean age: 45 years; 23 women; 65% active in sports) and randomized to three treatment groups for 12 weeks: eccentric exercises, a night splint or a combination of both tr...

  7. Magnetic Resonance Imaging in Chronic Achilles Tendinopathy

    Shalabi, A. [Karolinska Institutet, Stockholm (Sweden). Center for Surgical Sciences Divisions of Radiology and Orthopedics

    2004-09-01

    The main objective of this thesis was to evaluate and monitor the morphological response following treatment interventions in patients with chronic Achilles tendinopathy by using different MRI techniques. For this purpose, we investigated different types of sequences, including gadolinium contrast medium-enhanced T1-WI images (CME T1-WI), and developed a precise method to measure tendon volume and mean intratendinous signal of the Achilles tendon. Study I aimed at evaluating 15 patients with chronic, painful Achilles tendinosis, before and 2 years after surgical treatment. There was marked regression of the intratendinous signal postoperatively. The most sensitive sequence for depicting an intratendinous lesion in this study was CME T1-WI images. They showed a regression of the intratendinous signal abnormality from 13/15 patients preoperatively to 4/15 postoperatively. The clinical outcome was excellent in eight, good in five, fair in one and poor in one patient. In study II, the early contrast agent enhancement in the dynamically enhanced MRI signal (DEMRI) was correlated with the histopathologic findings in 15 patients with chronic Achilles tendinopathy. Early contrast enhancement (within the first 72 s) was seen in DEMRI in the symptomatic Achilles tendons, with a significant difference compared to the asymptomatic contralateral tendons. Increased severity of tendon changes, including fiber structure abnormality, increased vascularity, rounding of nuclei, and increased amount of glycosaminoglycans, correlated to CME. In study III, we developed a computerized 3-D seed-growing MRI technique to measure tendon volume and mean intratendinous signal. This technique showed an excellent inter- and intra-observer reliability. The technique was also used to follow up prospectively the tendon adaptation and healing described in studies IV-VI. In study IV, using serial MRI during a period of 1 year, we evaluated the biological effect of tendon repair following iatrogenic

  8. Magnetic Resonance Imaging in Chronic Achilles Tendinopathy

    The main objective of this thesis was to evaluate and monitor the morphological response following treatment interventions in patients with chronic Achilles tendinopathy by using different MRI techniques. For this purpose, we investigated different types of sequences, including gadolinium contrast medium-enhanced T1-WI images (CME T1-WI), and developed a precise method to measure tendon volume and mean intratendinous signal of the Achilles tendon. Study I aimed at evaluating 15 patients with chronic, painful Achilles tendinosis, before and 2 years after surgical treatment. There was marked regression of the intratendinous signal postoperatively. The most sensitive sequence for depicting an intratendinous lesion in this study was CME T1-WI images. They showed a regression of the intratendinous signal abnormality from 13/15 patients preoperatively to 4/15 postoperatively. The clinical outcome was excellent in eight, good in five, fair in one and poor in one patient. In study II, the early contrast agent enhancement in the dynamically enhanced MRI signal (DEMRI) was correlated with the histopathologic findings in 15 patients with chronic Achilles tendinopathy. Early contrast enhancement (within the first 72 s) was seen in DEMRI in the symptomatic Achilles tendons, with a significant difference compared to the asymptomatic contralateral tendons. Increased severity of tendon changes, including fiber structure abnormality, increased vascularity, rounding of nuclei, and increased amount of glycosaminoglycans, correlated to CME. In study III, we developed a computerized 3-D seed-growing MRI technique to measure tendon volume and mean intratendinous signal. This technique showed an excellent inter- and intra-observer reliability. The technique was also used to follow up prospectively the tendon adaptation and healing described in studies IV-VI. In study IV, using serial MRI during a period of 1 year, we evaluated the biological effect of tendon repair following iatrogenic

  9. Cross-cultural adaptation and validation of the VISA-A questionnaire for German-speaking Achilles tendinopathy patients

    Nauck Tanja

    2009-10-01

    Full Text Available Abstract Background Achilles tendinopathy is the predominant overuse injury in runners. To further investigate this overload injury in transverse and longitudinal studies a valid, responsive and reliable outcome measure is demanded. Most questionnaires have been developed for English-speaking populations. This is also true for the VISA-A score, so far representing the only valid, reliable, and disease specific questionnaire for Achilles tendinopathy. To internationally compare research results, to perform multinational studies or to exclude bias originating from subpopulations speaking different languages within one country an equivalent instrument is demanded in different languages. The aim of this study was therefore to cross-cultural adapt and validate the VISA-A questionnaire for German-speaking Achilles tendinopathy patients. Methods According to the "guidelines for the process of cross-cultural adaptation of self-report measures" the VISA-A score was cross-culturally adapted into German (VISA-A-G using six steps: Translation, synthesis, back translation, expert committee review, pretesting (n = 77, and appraisal of the adaptation process by an advisory committee determining the adequacy of the cross-cultural adaptation. The resulting VISA-A-G was then subjected to an analysis of reliability, validity, and internal consistency in 30 Achilles tendinopathy patients and 79 asymptomatic people. Concurrent validity was tested against a generic tendon grading system (Percy and Conochie and against a classification system for the effect of pain on athletic performance (Curwin and Stanish. Results The "advisory committee" determined the VISA-A-G questionnaire as been translated "acceptable". The VISA-A-G questionnaire showed moderate to excellent test-retest reliability (ICC = 0.60 to 0.97. Concurrent validity showed good coherence when correlated with the grading system of Curwin and Stanish (rho = -0.95 and for the Percy and Conochie grade of

  10. Achilles tendinopathy in amateur runners: role of adiposity (Tendinopathies and obesity)

    Abate, Michele; Oliva, Francesco; Schiavone, Cosima; Salini, Vincenzo

    2012-01-01

    Obesity is an important risk factor for Achilles tendinopathy, and running is usually carried out to reduce excess body weight. Aim of this study was to evaluate the prevalence of Achilles tendinopathy in young over-weight amateur runners.

  11. Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy

    Beyer, Rikke; Kongsgaard, Mads; Hougs Kjær, Birgitte;

    2015-01-01

    BACKGROUND: Previous studies have shown that eccentric training has a positive effect on Achilles tendinopathy, but few randomized controlled trials have compared it with other loading-based treatment regimens. PURPOSE: To evaluate the effectiveness of eccentric training (ECC) and heavy slow...... resistance training (HSR) among patients with midportion Achilles tendinopathy. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 58 patients with chronic (>3 months) midportion Achilles tendinopathy were randomized to ECC or HSR for 12 weeks. Function and symptoms...... tendinopathy and that the latter tends to be associated with greater patient satisfaction after 12 weeks but not after 52 weeks....

  12. Midportion Achilles Tendinopathy : Incidence, Imaging and Treatment

    S. de Jonge (Suzan)

    2015-01-01

    markdownabstractAbstract The aim of this thesis was to elucidate the effect of different treatment options in midportion Achilles tendinopathy, with optimizing current diagnostic methods. For this purpose we conducted two randomised controlled trials, a case control study, a cadaveric study, and a

  13. Shock wave therapy for Achilles tendinopathy

    Wilson, Michelle; Stacy, Jason

    2010-01-01

    Achilles tendinopathy has been reported as the most common overuse injury in sports medicine clinics (Clement et al. Am J Sports Med 12: 179–184, 1984). Standard treatment regimens include activity modification, heel lifts, arch supports, stretching exercises, nonsteroidal anti-inflammatories, and eccentric loading. There is a lack of consensus regarding treatment. Even so, most athletes will respond to this regimen. However, conservative management will prove to be inadequate for a subset of...

  14. Local biochemical and morphological differences in human Achilles tendinopathy

    J, Pingel; Fredberg, Ulrich; K, Qvortrup;

    2012-01-01

    The incidence of Achilles tendinopathy is high and underlying etiology as well as biochemical and morphological pathology associated with the disease is largely unknown. The aim of the present study was to describe biochemical and morphological differences in chronic Achilles tendinopathy. The...

  15. A treatment algorithm for managing Achilles tendinopathy: new treatment options

    Alfredson, Håkan; Cook, J.

    2007-01-01

    Achilles tendinopathy affects athletes, recreational exercisers and even inactive people. The pathology is not inflammatory; it is a failed healing response. The source of pain in tendinopathy could be related to the neurovascular ingrowth seen in the tendon's response to injury. The treatment of Achilles tendinopathy is primarily conservative with an array of effective treatment options now available to the primary care practitioner. If conservative treatment is not successful, then surgery ...

  16. Inflammatory and Metabolic Alterations of Kager's Fat Pad in Chronic Achilles Tendinopathy

    Pingel, Jessica; Petersen, M Christine H; Fredberg, Ulrich;

    2015-01-01

    BACKGROUND: Achilles tendinopathy is a painful inflammatory condition characterized by swelling, stiffness and reduced function of the Achilles tendon. Kager's fat pad is an adipose tissue located in the area anterior to the Achilles tendon. Observations reveal a close physical interplay between...... Kager's fat pad and its surrounding structures during movement of the ankle, suggesting that Kager's fat pad may stabilize and protect the mechanical function of the ankle joint. AIM: The aim of this study was to characterize whether Achilles tendinopathy was accompanied by changes in expression of...... inflammatory markers and metabolic enzymes in Kager's fat pad. METHODS: A biopsy was taken from Kager's fat pad from 31 patients with chronic Achilles tendinopathy and from 13 healthy individuals. Gene expression was measured by reverse transcription-quantitative PCR. Focus was on genes related to inflammation...

  17. Eccentric exercise in treatment of Achilles tendinopathy

    Nørregaard, J; Larsen, C C; Bieler, T;

    2007-01-01

    Prognosis and treatment of Achilles tendon pain (achillodynia) has been insufficiently studied. The purpose of the present study was to examine the long-term effect of eccentric exercises compared with stretching exercises on patients with achillodynia....

  18. A Comparison of Two Different High-Volume Image-Guided Injection Procedures for Patients With Chronic Noninsertional Achilles Tendinopathy: A Pragmatic Retrospective Cohort Study.

    Wheeler, Patrick C; Mahadevan, Dev; Bhatt, Raj; Bhatia, Maneesh

    2016-01-01

    We undertook a comparison evaluation of outcomes after 2 different high-volume image-guided injection (HVIGI) procedures performed under direct ultrasound guidance in patients with chronic noninsertional Achilles tendinopathy. In group A, the HVIGI involved high-volume (10 mL of 1% lidocaine combined with 40 mL of saline) and no dry needling. In group B, the HVIGI involved a smaller volume (10 mL of 1% lidocaine combined with 20 mL of saline) and dry needling of the Achilles tendon. A total of 34 patients were identified from the clinical records, with a mean overall age of 50.6 (range 26 to 83) years and an overall mean follow-up duration of 277 (range 49 to 596) days. The change between the preinjection and postinjection Victorian Institute of Sports Assessment-Achilles scores of 33.4 ± 22.5 points in group A and 6.94 ± 22.2 points in group B, was statistically significant (p = .002). In group A, 3 patients (16.7%) required surgical treatment compared with 6 patients (37.5%) in group B requiring surgical treatment (p = .180). Our results indicated that a higher volume without dry needling compared with a lower volume with dry needling resulted in greater improvement in noninsertional Achilles tendinopathy. However, confounding factors mean it is not possible to categorically state that this difference was solely due to different injection techniques. PMID:27286927

  19. A 5-year follow-up study of Alfredson's heel-drop exercise programme in chronic midportion Achilles tendinopathy

    2011-01-01

    Background Eccentric exercises have the most evidence in conservative treatment of midportion Achilles tendinopathy. Although short-term studies show significant improvement, little is known of the long-term (>3 years) results. Aim To evaluate the 5-year outcome of patients with chronic midportion Achilles tendinopathy treated with the classical Alfredson's heel-drop exercise programme. Study design Part of a 5-year follow-up of a previously conducted randomised controlled trial. Methods 58 p...

  20. A 5-year follow-up study of Alfredson's heel-drop exercise programme in chronic midportion Achilles tendinopathy

    Plas, J.F.A.N.; Jonge, Suzan; Vos, Robert-Jan; Van der Heide, H.J.L.; Verhaar, Jan; Weir, Adam; Tol, Johannes

    2012-01-01

    textabstractBackground: Eccentric exercises have the most evidence in conservative treatment of midportion Achilles tendinopathy. Although short-term studies show significant improvement, little is known of the long-term (>3 years) results. Aim: To evaluate the 5-year outcome of patients with chronic midportion Achilles tendinopathy treated with the classical Alfredson's heel-drop exercise programme. Study design: Part of a 5-year follow-up of a previously conducted randomised controlled tria...

  1. CHELT therapy in the treatment of chronic insertional Achilles tendinopathy.

    Notarnicola, Angela; Maccagnano, Giuseppe; Tafuri, Silvio; Forcignanò, Maria Immacolata; Panella, Antonio; Moretti, Biagio

    2014-05-01

    The application of laser therapy on soft tissue is used for pain relief, anti-inflammation action and biostimulation. The efficiency of High Energy Laser Therapy has not yet been studied on Achilles tendinopathy. The aim of the study is to evaluate the effectiveness of a flow of Cold air and High Energy Laser Therapy (CHELT) versus Extracorporeal Shock Waves Therapy (ESWT) in the treatment of Achilles tendinopathy. In this prospective, clinical trial, 60 subjects affected by insertional Achilles tendinopathy were enrolled and randomized to CHELT (30 subjects) or to ESWT (30 subjects). In CHELT group the patients received ten daily sessions of 1,200 J and 12 W of laser therapy (wavelength of 1,084, 810 and 980 nm) added to a flow of cold air at -30 °C. In the ESWT group, the patients received three sessions at 3- to 4-day intervals of 1,600 impulses with an energy flux density (EFD) of 0.05-0.07 mJ/mm(2). Both groups of participants performed stretching and eccentric exercises over a 2-month period. The visual analogue scale (VAS), the Ankle-Hindfoot Scale, and the Roles and Maudsley Score were measured before treatment (T0), and at end of the treatment session (T1) and 2 (T2) and 6 months (T3) after treatment during the follow-up examinations. In both groups, we found a statistically significant improvement of the VAS at T1, T2 and T3 (p < 0.01). The difference between the two groups was statistically significant in favour of the CHELT group (p < 0.001). At 2 months, the CHELT group was statistically better for Ankle-Hindfoot Scale and the Roles and Maudsley Score (p < 0.05) and at 6 months only for the Roles and Maudsley Score (p < 0.001). High Energy Laser Therapy gave quicker and better pain relief. It also gave the patient a full functional recovery and greater satisfaction. PMID:24352875

  2. Laser Therapy in the Treatment of Achilles Tendinopathy: A Randomised Controlled Trial

    Tumilty, Steve; Munn, Joanne; Haxby Abbott, J.; Mcdonough, Suzanne; Hurley, Deirdre A.; Basford, Jeffrey R.; David Baxter, G.

    2010-05-01

    Background: Low Level Laser Therapy (LLLT) has emerged as a possible treatment modality for tendinopathies. Human studies have investigated LLLT for Achilles Tendinopathy and the effectiveness remains contentious. Purpose: To assess the clinical effectiveness of Low-Level Laser Therapy (LLLT) in the management of Achilles Tendinopathy. Method: Forty patients were randomised into an active laser or placebo group; all patients, therapists and investigator were blinded to allocation. All patients were given an eccentric exercise program and irradiated 3 times per week for 4 weeks with either an active or placebo laser at 6 standardized points over the affected tendons. Irradiation parameters in the active laser group were: 810 nm, 100 mW, applied to 6 points on the tendon for 30 seconds giving a dose of 3 J per point and 18 J per session; power density 100 mW/cm2. Outcome measures were the VISA-A questionnaire and a visual analogue scale of pain. Patients were measured before treatment, at 4 and 12 weeks. ANCOVA was used to analyze data, using the effects of baseline measurements as a covariate. Results: Within groups, there were significant improvements (p0.05). Conclusion: This use of the above parameters demonstrated no added benefit of LLLT over that of eccentric exercise in the treatment of Achilles Tendinopathy.

  3. Longitudinal microvascularity in achilles tendinopathy (power doppler ultrasound, magnetic resonance imaging time-intensity curves and the Victorian Institute of Sport Assessment-Achilles questionnaire): a pilot study

    To evaluate the imaging of the natural history of Achilles tendinopathy microvascularisation in comparison with symptoms, using a validated disease-specific questionnaire [the Victorian Institute of Sport Assessment-Achilles (VISA-A)]. A longitudinal prospective pilot study of nine patients with post-contrast magnetic resonance imaging (MRI), time-intensity curve (TIC) enhancement, ultrasound (US) and power Doppler (PD) evaluation of tendinopathy of the mid-Achilles tendon undergoing conservative management (eccentric exercise) over 1 year. There were five men and four women [mean age 47 (range 30-62) years]. Six asymptomatic tendons with normal US and MRI appearance showed less enhancement than the tibial metaphysis did and showed a flat, constant, but very low rate of enhancement in the bone and Achilles tendon (9-73 arbitrary TIC units). These normal Achilles tendons on imaging showed a constant size throughout the year (mean 4.9 mm). At baseline the TIC enhancement in those with tendinopathy ranged from 90 arbitrary units to 509 arbitrary units. Over time, 11 abnormal Achilles tendons, whose symptoms settled, were associated with a reduction in MRI enhancement mirrored by a reduction in the number of vessels on power Doppler (8.0 to 2.7), with an improvement in morphology and a reduction in tendon size (mean 15-10.6 mm). One tendon did not change its abnormal imaging features, despite improving symptoms. Two patients developed contralateral symptoms and tendinopathy, and one had more abnormal vascularity on power Doppler and higher MRI TIC peaks in the asymptomatic side. In patient with conservatively managed tendinopathy of the mid-Achilles tendon over 1 year there was a reduction of MRI enhancement and number of vessels on power Doppler, followed by morphological improvements and a reduction in size. Vessels per se related to the abnormal morphology and size of the tendon rather than symptoms. Symptoms improve before the Achilles size reduces and the

  4. Longitudinal microvascularity in achilles tendinopathy (power doppler ultrasound, magnetic resonance imaging time-intensity curves and the Victorian Institute of Sport Assessment-Achilles questionnaire): a pilot study

    Richards, Paula J. [University Hospital of North Staffordshire NHS Trust (UHNS), Stoke on Trent, Staffordshire (United Kingdom); Keele University, Keele, Staffordshire (United Kingdom); North Staffs. Royal Infirmary, X-ray Department, Stoke on Trent, Staffordshire (United Kingdom); McCall, Iain W. [Keele University, Keele, Staffordshire (United Kingdom); North Staffordshire NHS Trust, Stoke on Trent, Staffordshire (United Kingdom); Day, Christopher [University Hospital of North Staffordshire NHS Trust (UHNS), Stoke on Trent, Staffordshire (United Kingdom); Belcher, John [Cardiff University, Department of Primary Care and Public Health, North Wales Clinical School, Cardiff (United Kingdom); Maffulli, Nicola [Keele University, Keele, Staffordshire (United Kingdom)

    2010-06-15

    To evaluate the imaging of the natural history of Achilles tendinopathy microvascularisation in comparison with symptoms, using a validated disease-specific questionnaire [the Victorian Institute of Sport Assessment-Achilles (VISA-A)]. A longitudinal prospective pilot study of nine patients with post-contrast magnetic resonance imaging (MRI), time-intensity curve (TIC) enhancement, ultrasound (US) and power Doppler (PD) evaluation of tendinopathy of the mid-Achilles tendon undergoing conservative management (eccentric exercise) over 1 year. There were five men and four women [mean age 47 (range 30-62) years]. Six asymptomatic tendons with normal US and MRI appearance showed less enhancement than the tibial metaphysis did and showed a flat, constant, but very low rate of enhancement in the bone and Achilles tendon (9-73 arbitrary TIC units). These normal Achilles tendons on imaging showed a constant size throughout the year (mean 4.9 mm). At baseline the TIC enhancement in those with tendinopathy ranged from 90 arbitrary units to 509 arbitrary units. Over time, 11 abnormal Achilles tendons, whose symptoms settled, were associated with a reduction in MRI enhancement mirrored by a reduction in the number of vessels on power Doppler (8.0 to 2.7), with an improvement in morphology and a reduction in tendon size (mean 15-10.6 mm). One tendon did not change its abnormal imaging features, despite improving symptoms. Two patients developed contralateral symptoms and tendinopathy, and one had more abnormal vascularity on power Doppler and higher MRI TIC peaks in the asymptomatic side. In patient with conservatively managed tendinopathy of the mid-Achilles tendon over 1 year there was a reduction of MRI enhancement and number of vessels on power Doppler, followed by morphological improvements and a reduction in size. Vessels per se related to the abnormal morphology and size of the tendon rather than symptoms. Symptoms improve before the Achilles size reduces and the

  5. Achilles tendon rupture following surgical management for tendinopathy: a case report

    Maffulli Nicola; Carmont Michael R

    2007-01-01

    Abstract Background Achilles tendinopathy is understood to be a failed healing response. Operative management is utilised following the failure of non-operative methods. Case Presentation We present a case of Achilles tendon rupture, sustained whilst isometrically loading the Achilles tendon during an eccentric loading exercise programme. Conclusion: Bilateral surgical exploration and debridement had previously been performed after conservative management of bilateral Achilles tendinopathy ha...

  6. Achilles and Patellar Tendinopathy Loading Programmes

    Malliaras, Peter; Barton, Christian J; Reeves, Neil D;

    2013-01-01

    performance was associated with Achilles but not patellar tendon clinical outcomes. The mechanisms associated with clinical benefit may vary between loading interventions and tendons. CONCLUSION: There is little clinical or mechanistic evidence for isolating the eccentric component, although it should be made...

  7. The victorian institute of sports assessment - achilles questionnaire (visa-a) - a reliable tool for measuring achilles tendinopathy

    Iversen, Jonas Vestergård; Bartels, Else Marie; Langberg, Henning

    2012-01-01

    Achilles tendinopathy (AT) is a common pathology and the aetiology is unknown. For valid and reliable assessment The Victorian Institute of Sports Assessment has designed a self-administered Achilles questionnaire, the VISA-A. The aim of the present study was to evaluate VISA-A as an outcome...

  8. The victorian institute of sports assessment - achilles questionnaire (visa-a) - a reliable tool for measuring achilles tendinopathy

    Iversen, Jonas Vestergård; Bartels, Else Marie; Langberg, Henning

    2012-01-01

    Achilles tendinopathy (AT) is a common pathology and the aetiology is unknown. For valid and reliable assessment The Victorian Institute of Sports Assessment has designed a self-administered Achilles questionnaire, the VISA-A. The aim of the present study was to evaluate VISA-A as an outcome meas...

  9. Magnetic Resonance Signal, Rather Than Tendon Volume, Correlates to Pain and Functional Impairment in Chronic Achilles Tendinopathy

    Gaerdin, A.; Bruno, J.; Movin, T.; Kristoffersen-Wiberg, M.; Shalabi, A. [Karolinska Univ. Hospital, Stockholm (Sweden). Depts. of Radiology and Orthopedics

    2006-09-15

    Purpose: To depict abnormal tendon matrix composition using magnetic resonance imaging (MRI) in chronic Achilles tendinopathy, and correlate intratendinous signal alterations to pain and functional impairment. Material and Methods: MRI of the Achilles tendon was performed on 25 patients with chronic Achilles tendinopathy (median age 50, range 37-71 years). All patients suffered from pain in the mid-portion of the Achilles tendon. Intratendinous signal was calculated from five different sagittal sequences, using a computerized 3D seed-growing technique. Pain and functional impairment were evaluated using a questionnaire completed by patients. Results: Severity of pain and functional impairment correlated to increased mean intratendinous signal in the painful tendon in all MR sequences (P 0.05). Difference in mean intratendinous signal between symptomatic and contralateral asymptomatic tendons was highly significant in all sequences (P <0.05) except on T2-weighted images (P = 0.6). Conclusion: Severity of pain and disability correlated to increased MR signal rather than to tendon volume in patients with unilateral mid-portion chronic Achilles tendinopathy.

  10. Current evidence of extracorporeal shock wave therapy in chronic Achilles tendinopathy.

    Gerdesmeyer, Ludger; Mittermayr, Rainer; Fuerst, Martin; Al Muderis, Munjed; Thiele, Richard; Saxena, Amol; Gollwitzer, Hans

    2015-12-01

    Chronic Achilles tendinopathy has been described as the most common overuse injury in sports medicine. Several treatment modalities such as activity modification, heel lifts, arch supports, stretching exercises, nonsteroidal anti-inflammatories, and eccentric loading are known as standard treatment mostly without proven evidence. After failed conservative therapy, invasive treatment may be considered. Extracorporeal shock wave therapy (ESWT) has been successfully used in soft-tissue pathologies like lateral epicondylitis, plantar fasciitis, tendinopathy of the shoulder and also in bone and skin disorders. Conclusive evidence recommending ESWT as a treatment for Achilles tendinopathy is still lacking. In plantar fasciitis as well as in calcific shoulder tendinopathy shock wave therapy is recently the best evaluated treatment option. This article analysis the evidence based literature of ESWT in chronic Achilles tendinopathy. Recently published data have shown the efficacy of focused and radial extracorporeal shock wave therapy. PMID:26327530

  11. Inflammatory and metabolic alterations of Kager's fat pad in chronic achilles tendinopathy

    Jessica Pingel; M Christine H Petersen; Ulrich Fredberg; Søren G Kjær; Bjørn Quistorff; Henning Langberg; Hansen, Jacob B.

    2015-01-01

    BACKGROUND: Achilles tendinopathy is a painful inflammatory condition characterized by swelling, stiffness and reduced function of the Achilles tendon. Kager's fat pad is an adipose tissue located in the area anterior to the Achilles tendon. Observations reveal a close physical interplay between Kager's fat pad and its surrounding structures during movement of the ankle, suggesting that Kager's fat pad may stabilize and protect the mechanical function of the ankle joint.AIM: The aim of this s...

  12. Danish VISA-A questionnaire with validation and reliability testing for Danish-speaking Achilles tendinopathy patients

    Iversen, J V; Bartels, E M; Jørgensen, J. -E.;

    2016-01-01

    structure were performed on 71 patients. VISA-A-DK showed good reliability for patients (r = 0.80 ICC = 0.79) and healthy individuals (r = 0.98 ICC = 0.97). Internal consistency was 0.73 (Cronbach's alpha). The mean VISA-A-DK score in AT patients was 51 [47-55]. This was significantly lower than healthy...

  13. Imaging Findings in Two Cases of Fluoroquinolone-Induced Achilles Tendinopathy

    Sterne, Gregory M.; Richardson, Michael L.; Warren, Bill H.

    2015-01-01

    Tendonitis and tendon rupture are rare but recognized complications of fluoroquinolone therapy. Most reports of this problem have appeared in the rheumatology and pharmacology literature, and this topic has received little attention in the radiologic literature. We report two cases of fluoroquinolone-induced tendinopathy and describe their magnetic resonance (MR) and sonographic findings. Although Achilles tendinopathy is generally the result of repetitive injury, it is useful to keep other c...

  14. A pilot study on biomarkers for tendinopathy: lower levels of serum TNF-α and other cytokines in females but not males with Achilles tendinopathy

    Jamie E Gaida; Alfredson, Håkan; Forsgren, Sture; Cook, Jill L

    2016-01-01

    Background Achilles tendinopathy is a painful musculoskeletal condition that is common among athletes, and which limits training capacity and competitive performance. The lack of biomarkers for tendinopathy limits research into risk factors and also the evaluation of new treatments. Cytokines and growth factors involved in regulating the response of tendon cells to mechanical load have potential as biomarkers for tendinopathy. Methods This case–control study compared serum concentration of cy...

  15. Central tendon splitting combined with SutureBridge double-row technique as a surgical treatment for insertional Achilles tendinopathy

    LIN Yuan; WANG Zhi-wei; ZHANG Bo; PAN Jiang; QU Tie-bing; HAI Yong

    2013-01-01

    Background Surgical treatment of insertional Achilles tendinopathy should be considered when a variety of conservative measures fail.To achieve a satisfactory outcome,thorough debridement of the Achilles tendon is critical,besides excision of the bursitis and the calcaneal exostosis.Central tendon-splitting provides straightforward access to the calcified or degenerative tissue within the Achilles tendon.For Achilles tendon reconstruction if detachment is present,several surgical techniques have been reported.Controversy surrounds the technique can provide maximum security for reattachment of the Achilles tendon.The SutureBridge double-row construct,initially used in rotator cuff repair,is probably a good choice.Methods Ten consecutive patients with insertional Achilles tendinopathy underwent tendon reattachment using the SutureBridge technique through a central tendon-splitting approach.We retrospectively evaluated the surgical outcomes,which included pre-and postoperative visual analog scale (VAS),postoperative Maryland Foot Score (MFS),postoperative range of motion of the affected ankle,and related complications.Follow-up was performed in the outpatient department.Results One patient was lost to follow-up.Nine patients (two male and seven female; 12 feet) were reviewed with a minimum follow-up of six months (range 6-30 months).The postoperative VAS pain scores were markedly lower than the preoperative scores.Postoperative MFS was 92.1±8.0 (range 74-100).No intra-or postoperative complications were found,except for one case of delayed healing incision.At last follow-up,all affected ankles achieved their normal range of motion,and patients were able to resume daily activities without any assistive device.Conclusions Although a randomized control trial with a larger sample may be necessary to compare the central tendonsplitting combined with the SutureBridge technique with other techniques,our results confirmed that it was a promising alternative for treatment of

  16. Platelet-rich plasma: evidence for the treatment of patellar and Achilles tendinopathy--a systematic review.

    Di Matteo, B; Filardo, G; Kon, E; Marcacci, M

    2015-04-01

    Platelet-rich plasma (PRP) has been introduced in the clinical practice to treat a growing number of different musculoskeletal pathologies. It is currently applied in the treatment of Achilles and patellar tendinopathies, which are common sport-related injuries very challenging to manage. Aim of the present paper was to review systematically the available clinical evidence concerning the application of PRP in the treatment of patellar and Achilles tendinopathy. A systematic review of the literature was performed according to the following inclusion criteria for relevant articles: (1) clinical reports of any level of evidence, (2) written in the English language, (3) with no time limitation and (4) on the use of PRP to treat conservatively Achilles and patellar tendinopathy. Twenty-two studies were included and analyzed. Two studies on patellar tendinopathy were randomized controlled trials (RCTs), whereas just one RCT was published on Achilles tendon. All the papers concerning patellar tendon reported positive outcome for PRP, which proved to be superior to other traditional approaches such as shock-wave therapy and dry needling. In the case of Achilles tendon, despite the encouraging findings reported by case series, the only RCT available showed no significant clinical difference between PRP and saline solution. The main finding of this study was the paucity of high-level literature regarding the application of PRP in the management of patellar and Achilles tendinopathy. However, the clinical data currently available, although not univocal, suggest considering PRP as a therapeutic option for recalcitrant patellar and Achilles tendinopathies. PMID:25323041

  17. Imaging in chronic achilles tendinopathy: a comparison of ultrasonography, magnetic resonance imaging and surgical findings in 27 histologically verified cases

    Aastroem, M. [Department of Orthopaedics, Malmoe University Hospital (Sweden); Gentz, C.F. [Department of Radiology, Malmoe University Hospital (Sweden); Nilsson, P. [Department of Radiology, Malmoe University Hospital (Sweden); Rausing, A. [Department of Pathology, Malmoe University Hospital (Sweden); Sjoeberg, S. [Department of Radiology, Malmoe University Hospital (Sweden); Westlin, N. [Department of Orthopaedics, Malmoe University Hospital (Sweden)

    1996-10-01

    Objective. To compare information gained by ultrasonography and magnetic resonance imaging (MRI) in chronic achilles tendinopathy with regard to the nature and severity of the lesion. Design. Imaging of both achilles tendons with ultrasonography and MRI was performed prior to unilateral surgery. Operative findings and histological biopsies together served as a reference. Patients. Twenty-seven patients (22 men, 5 women; mean age 44 years; 21 athletes) suffering from chronic achilles tendinopathy participated in the study. Eighteen patients had unilateral and 9 had bilateral symptoms. Results and conclusions. Surgical findings included 4 partial ruptures, 21 degenerative lesions and 2 macroscopically normal cases. Microscopy revealed tendinosis (degeneration) in all tendon biopsies, including cases with a partial rupture, but only slight changes in the paratendinous tissues (paratenon). Ultrasonography was positive in 21 of 26 and MRI in 26 of 27 cases. Severe intratendinous abnormalities and a sagittal tendon diameter >10 mm suggested a partial rupture. In tendons with a false negative result histopathological changes were mild and a tendency towards a better clinical outcome was noted in the sonographic cases. Assessment of the paratenon was unreliable with both methods. Ultrasonography and MRI give similar information and may have their greatest potential as prognostic instruments. (orig.). With 2 figs., 1 tab.

  18. One-year follow-up of a randomised controlled trial on added splinting to eccentric exercises in chronic midportion Achilles tendinopathy

    Jonge, Suzan; de Vos, Robert-Jan; van Schie, Hans; Verhaar, Jan; Weir, Adam; Tol, Johannes

    2008-01-01

    textabstractOBJECTIVE: The study examined whether the addition of a night splint to eccentric exercises is beneficial for functional outcome in chronic mid-portion Achilles tendinopathy. DESIGN: One-year follow-up of a randomised controlled single blinded clinical trial. SETTING: Sports medicine department in a general hospital. PATIENTS: 58 patients (70 tendons) were included. INTERVENTIONS: All patients completed a 12-week heavy load eccentric training programme. One group received a night ...

  19. Lower limb biomechanics during running in individuals with achilles tendinopathy: a systematic review

    Munteanu Shannon E

    2011-05-01

    Full Text Available Abstract Background Abnormal lower limb biomechanics is speculated to be a risk factor for Achilles tendinopathy. This study systematically reviewed the existing literature to identify, critique and summarise lower limb biomechanical factors associated with Achilles tendinopathy. Methods We searched electronic bibliographic databases (Medline, EMBASE, Current contents, CINAHL and SPORTDiscus in November 2010. All prospective cohort and case-control studies that evaluated biomechanical factors (temporospatial parameters, lower limb kinematics, dynamic plantar pressures, kinetics [ground reaction forces and joint moments] and muscle activity associated with mid-portion Achilles tendinopathy were included. Quality of included studies was evaluated using the Quality Index. The magnitude of differences (effect sizes between cases and controls was calculated using Cohen's d (with 95% CIs. Results Nine studies were identified; two were prospective and the remaining seven case-control study designs. The quality of 9 identified studies was varied, with Quality Index scores ranging from 4 to 15 out of 17. All studies analysed running biomechanics. Cases displayed increased eversion range of motion of the rearfoot (d = 0.92 and 0.67 in two studies, reduced maximum lower leg abduction (d = -1.16, reduced ankle joint dorsiflexion velocity (d = -0.62 and reduced knee flexion during gait (d = -0.90. Cases also demonstrated a number of differences in dynamic plantar pressures (primarily the distribution of the centre of force, ground reaction forces (large effects for timing variables and also showed reduced peak tibial external rotation moment (d = -1.29. Cases also displayed differences in the timing and amplitude of a number of lower limb muscles but many differences were equivocal. Conclusions There are differences in lower limb biomechanics between those with and without Achilles tendinopathy that may have implications for the prevention and management of

  20. Changes of Gait Parameters and Lower Limb Dynamics in Recreational Runners with Achilles Tendinopathy

    SungJoong Kim, JaeHo Yu

    2015-06-01

    Full Text Available This study aimed to clarify the mechanical gait changes caused by achilles tendinopathy by comparing gait parameters and changes in hip, knee, and ankle moments between an experimental group (EG and a control group (CG. Twenty runners with achilles tendinopathy were included in the EG (male/female: 10/10, age: 27.00 ± 4.63, and 20 CG (male/female: 10/10, age: 27.25 ± 4.33 participants were recruited. Subjects walked a 13-m distance at their normal walking speed 5 times to obtain motion analysis and joint moment data. Gait parameter analysis showed significant differences in double-limb support (EG: 22.65 ± 4.26%, CG: 20.37 ± 4.46%, step length (EG: 0.58 ± 0.0 7m, CG: 0.64 ± 0.08 m, step width (EG: 0.16 ± 0.04 m, CG: 0.14 ± 0.05 m, stride time (EG: 1.09 ± 0.10 second, CG: 1.05 ± 0.08 second, and walking speed (EG: 1.09±0.18 m·s-1, CG: 1.23 ± 0.17 m·s-1 between the 2 groups (p < 0.05. Significant differences were found in hip joint moment for initial contact, mid-stance, terminal stance, and pre-swing phases; knee joint moment for initial contact and pre-swing phases; and ankle joint moment for pre-swing and terminal swing phases (p < 0.05. Gait parameters and hip, knee, and ankle moments were altered in runners with achilles tendinopathy. Thus, clinical features of gait changes should be understood for optimal treatment of achilles tendinopathy; further research is required in this field.

  1. Physical therapies for Achilles tendinopathy: systematic review and meta-analysis

    Sussmilch-Leitch Samuel P; Collins Natalie J; Bialocerkowski Andrea E; Warden Stuart J; Crossley Kay M

    2012-01-01

    Abstract Background Achilles tendinopathy (AT) is a common condition, causing considerable morbidity in athletes and non-athletes alike. Conservative or physical therapies are accepted as first-line management of AT; however, despite a growing volume of research, there remains a lack of high quality studies evaluating their efficacy. Previous systematic reviews provide preliminary evidence for non-surgical interventions for AT, but lack key quality components as outlined in the Preferred Repo...

  2. Ultrasonography as a prognostic and objective parameter in Achilles tendinopathy: A prospective observational study

    Bakkegaard, Mads, E-mail: mbakkegaard@hotmail.com [Department of Rheumatology, Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk (Denmark); Johannsen, Finn E., E-mail: f.e.johannsen@dadlnet.dk [Private Department of Rheumatology, Furesø-reumatologerne, Farum and ISMC, Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Bispebjerg Bakke 23, 2. Tværvej, Indgang 8, 1. sal, 2400 København NV (Denmark); Højgaard, Betina, E-mail: beho@kora.dk [Danish Institute for Local and Regional Government Research, Købmagergade 22, 1150 København K (Denmark); Langberg, Henning, E-mail: henninglangberg@gmail.com [Institute of Social Medicine, Department of Public Health and Centre for Healthy Ageing, Faculty of Heath Sciences, University of Copenhagen, Øster Farimagsgade 5, bygn. 24, postboks 2099, 1014 København (Denmark)

    2015-03-15

    Objectives: To study prospectively whether structural changes determined by ultrasound scanning (US) can be used as prognostic markers for outcome in patients with symptomatic Achilles tendinopathy (AT) and to investigate whether there exists an association between US findings and pain measured by visual analog scale (VAS) and a general assessment score (GA). Methods: 92 consecutive patients with AT symptoms were recruited from two outpatient clinics in rheumatology. The patients underwent a conservative treatment protocol consisting of reduced activities, controlled rehabilitation including eccentric exercises of the calf muscles and if needed supplemented with corticosteroid injections. The patients were examined clinically and by US (tendon thickness, hyper- and hypoechogenicity, calcification, bursitis, calcaneusspure, tenosynovitis, gray scale and color Doppler focusing on increased flow intra- or peritendinous). The clinical and US examination were performed at entry, 1, 2, 3 and at 6 month. Results: 42 women and 50 men were included (mean age of 47 years). They had symptoms for more than 13 months and a symptomatic Achilles tendon mean thickness of 7.4 ± 2.3 mm. Heterogeneity at the initial examination was found to be a prognostic marker for the clinical outcome. Tendon thickness, hypoechogenicity and increased flow at any time point were significantly correlated to pain at function, palpatory pain and morning pain at the same time points. A reduction in tendon thickness was statistically associated with a decrease in palpatory pain. Conclusion: Heterogeneity is a prognostic marker in AT. Tendon thickness, hypoechogenicity and increased Doppler activity can be used as objective outcome parameters for the treatment effect of AT.

  3. Ultrasonography as a prognostic and objective parameter in Achilles tendinopathy: A prospective observational study

    Objectives: To study prospectively whether structural changes determined by ultrasound scanning (US) can be used as prognostic markers for outcome in patients with symptomatic Achilles tendinopathy (AT) and to investigate whether there exists an association between US findings and pain measured by visual analog scale (VAS) and a general assessment score (GA). Methods: 92 consecutive patients with AT symptoms were recruited from two outpatient clinics in rheumatology. The patients underwent a conservative treatment protocol consisting of reduced activities, controlled rehabilitation including eccentric exercises of the calf muscles and if needed supplemented with corticosteroid injections. The patients were examined clinically and by US (tendon thickness, hyper- and hypoechogenicity, calcification, bursitis, calcaneusspure, tenosynovitis, gray scale and color Doppler focusing on increased flow intra- or peritendinous). The clinical and US examination were performed at entry, 1, 2, 3 and at 6 month. Results: 42 women and 50 men were included (mean age of 47 years). They had symptoms for more than 13 months and a symptomatic Achilles tendon mean thickness of 7.4 ± 2.3 mm. Heterogeneity at the initial examination was found to be a prognostic marker for the clinical outcome. Tendon thickness, hypoechogenicity and increased flow at any time point were significantly correlated to pain at function, palpatory pain and morning pain at the same time points. A reduction in tendon thickness was statistically associated with a decrease in palpatory pain. Conclusion: Heterogeneity is a prognostic marker in AT. Tendon thickness, hypoechogenicity and increased Doppler activity can be used as objective outcome parameters for the treatment effect of AT

  4. Successful Management of Tendinopathy With Injections of the MMP-inhibitor Aprotinin

    Orchard, John; Massey, Andrew; Brown, Richard; Cardon-Dunbar, Adéline; Hofmann, Jamie

    2008-01-01

    Aprotinin is a broad spectrum proteinase inhibitor (including matrix metalloproteinase [MMP] inhibitor) used for treating patellar and Achilles tendinopathies. One previous randomized control trial demonstrated aprotinin injections superior to both corticosteroid and saline injections in patellar tendinopathy (Level II), whereas results reported for aprotinin treatment in Achilles tendinopathy have been mixed. We performed a case review and followup questionnaire for 430 consecutive patients ...

  5. Efficacy of customised foot orthoses in the treatment of Achilles tendinopathy: study protocol for a randomised trial

    Menz Hylton B

    2009-10-01

    Full Text Available Abstract Background Achilles tendinopathy is a common condition that can cause marked pain and disability. Numerous non-surgical treatments have been proposed for the treatment of this condition, but many of these treatments have a poor or non-existent evidence base. The exception to this is eccentric calf muscle exercises, which have become a standard non-surgical intervention for Achilles tendinopathy. Foot orthoses have also been advocated as a treatment for Achilles tendinopathy, but the long-term efficacy of foot orthoses for this condition is unknown. This manuscript describes the design of a randomised trial to evaluate the efficacy of customised foot orthoses to reduce pain and improve function in people with Achilles tendinopathy. Methods One hundred and forty community-dwelling men and women aged 18 to 55 years with Achilles tendinopathy (who satisfy inclusion and exclusion criteria will be recruited. Participants will be randomised, using a computer-generated random number sequence, to either a control group (sham foot orthoses made from compressible ethylene vinyl acetate foam or an experimental group (customised foot orthoses made from semi-rigid polypropylene. Both groups will be prescribed a calf muscle eccentric exercise program, however, the primary difference between the groups will be that the experimental group receive customised foot orthoses, while the control group receive sham foot orthoses. The participants will be instructed to perform eccentric exercises 2 times per day, 7 days per week, for 12 weeks. The primary outcome measure will be the total score of the Victorian Institute of Sport Assessment - Achilles (VISA-A questionnaire. The secondary outcome measures will be participant perception of treatment effect, comfort of the foot orthoses, use of co-interventions, frequency and severity of adverse events, level of physical activity and health-related quality of life (assessed using the Short-Form-36 questionnaire

  6. Progressive high-load strength training compared with general low-load exercises in patients with rotator cuff tendinopathy

    Ingwersen, Kim Gordon; Christensen, Robin; Sørensen, Lilli;

    2015-01-01

    tendinopathy. Exercise is often considered the primary treatment option for rotator cuff tendinopathy, but there is no consensus on which exercise strategy is the most effective. As eccentric and high-load strength training have been shown to have a positive effect on patella and Achilles tendinopathy, the aim...... rotator cuff tendinopathy will be recruited from three outpatient shoulder departments in Denmark, and randomised to either 12 weeks of progressive high-load strength training or to general low-load exercises. Patients will receive six individually guided exercise sessions with a physiotherapist and...... of this trial is to compare the efficacy of progressive high-load exercises with traditional low-load exercises in patients with rotator cuff tendinopathy. Methods/Design: The current study is a randomised, participant- and assessor-blinded, controlled multicentre trial. A total of 260 patients with...

  7. Ultrasonography as a prognostic and objective parameter in Achilles tendinopathy:

    Bakkegaard, Mads; Johannsen, Finn E; Højgaard, Betina;

    2015-01-01

    eccentric exercises of the calf muscles and if needed supplemented with corticosteroid injections. The patients were examined clinically and by US (tendon thickness, hyper- and hypoechogenicity, calcification, bursitis, calcaneusspure, tenosynovitis, gray scale and color Doppler focusing on increased flow...

  8. No inflammatory gene-expression response to acute exercise in human Achilles tendinopathy

    Pingel, Jessica; Fredberg, Ulrich; Mikkelsen, Lone Ramer;

    2013-01-01

    Although histology data favour the view of a degenerative nature of tendinopathy, indirect support for inflammatory reactions to loading in affected tendons exists. The purpose of the present study was to elucidate whether inflammatory signalling responses after acute mechanical loading were more...... pronounced in tendinopathic versus healthy regions of human tendon and if treatment with non-steroidal anti-inflammatory medications (NSAID's) reduces this response. Twenty-seven tendinopathy patients (>6 months) were randomly assigned to a placebo (n = 14) or NSAID (Ibumetin NYCOMED GmbH Plant Oranienburg...

  9. Effects of 12-wk eccentric calf muscle training on muscle-tendon glucose uptake and SEMG in patients with chronic Achilles tendon pain

    Masood, Tahir; Kalliokoski, Kari; Magnusson, S Peter;

    2014-01-01

    Achilles tendon GU. A longitudinal study design with control (n = 10) and patient (n = 10) groups was used. Surface electromyography (SEMG) from four ankle plantar flexors and GU from the same muscles and the Achilles tendon were measured during submaximal intermittent isometric plantar flexion task. The...... within- or between-group differences. Eccentric rehabilitation was effective in decreasing subjective severity of Achilles tendinopathy. It also resulted in redistribution of relative electrical activity, but not metabolic activity, within the triceps surae muscle....

  10. Physical therapies for Achilles tendinopathy: systematic review and meta-analysis

    Sussmilch-Leitch Samuel P

    2012-07-01

    Full Text Available Abstract Background Achilles tendinopathy (AT is a common condition, causing considerable morbidity in athletes and non-athletes alike. Conservative or physical therapies are accepted as first-line management of AT; however, despite a growing volume of research, there remains a lack of high quality studies evaluating their efficacy. Previous systematic reviews provide preliminary evidence for non-surgical interventions for AT, but lack key quality components as outlined in the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA Statement. The aim of this study was to conduct a systematic review and meta-analysis (where possible of the evidence for physical therapies for AT management. Methods A comprehensive strategy was used to search 11 electronic databases from inception to September 2011. Search terms included Achilles, tendinopathy, pain, physical therapies, electrotherapy and exercise (English language full-text publications, human studies. Reference lists of eligible papers were hand-searched. Randomised controlled trials (RCTs were included if they evaluated at least one non-pharmacological, non-surgical intervention for AT using at least one outcome of pain and/or function. Two independent reviewers screened 2852 search results, identifying 23 suitable studies, and assessed methodological quality and risk of bias using a modified PEDro scale. Effect size calculation and meta-analyses were based on fixed and random effects models respectively. Results Methodological quality ranged from 2 to 12 (/14. Four studies were excluded due to high risk of bias, leaving 19 studies, the majority of which evaluated midportion AT. Effect sizes from individual RCTs support the use of eccentric exercise. Meta-analyses identified significant effects favouring the addition of laser therapy to eccentric exercise at 12 weeks (pain VAS: standardised mean difference −0.59, 95% confidence interval −1.11 to −0.07, as well as no

  11. MRI of the Achilles tendon: A comprehensive review of the anatomy, biomechanics, and imaging of overuse tendinopathies

    The Achilles tendon is the largest tendon in the body; it plays an important role in the biomechanics of the lower extremity. It can withstand great forces, especially during sporting exercises and pivoting. The pathologies related to the Achilles tendon are diverse and many carry undesirable consequences. We retrospectively analyzed the images of patients who underwent examinations of the ankle/foot region to review the anatomy of the Achilles tendon and its surroundings and to search for pathologies consistent with overuse injuries. The anatomy of the tendon is described from origin to insertion. The imaging characteristics of the Achilles tendon including pitfalls are reviewed. We also describe the Achilles overuse injuries: paratenonitis, tendinosis, tendon tear, atypical tear, tendon re-tear, retrocalcaneal bursitis, retro-Achilles bursitis, Haglund's deformity, and tendon calcification. We present other entities like tendon ossification and failed transplanted Achilles tendon, with emphasis on MRI

  12. MRI of the Achilles tendon: A comprehensive review of the anatomy, biomechanics, and imaging of overuse tendinopathies

    Pierre-Jerome, Claude; Moncayo, Valeria; Terk, Michael R. (Dept. of Radiology, Emory Univ. Orthopedics and Spine Center, Atlanta, GA (United States)), e-mail: cpierr3@emory.edu

    2010-05-15

    The Achilles tendon is the largest tendon in the body; it plays an important role in the biomechanics of the lower extremity. It can withstand great forces, especially during sporting exercises and pivoting. The pathologies related to the Achilles tendon are diverse and many carry undesirable consequences. We retrospectively analyzed the images of patients who underwent examinations of the ankle/foot region to review the anatomy of the Achilles tendon and its surroundings and to search for pathologies consistent with overuse injuries. The anatomy of the tendon is described from origin to insertion. The imaging characteristics of the Achilles tendon including pitfalls are reviewed. We also describe the Achilles overuse injuries: paratenonitis, tendinosis, tendon tear, atypical tear, tendon re-tear, retrocalcaneal bursitis, retro-Achilles bursitis, Haglund's deformity, and tendon calcification. We present other entities like tendon ossification and failed transplanted Achilles tendon, with emphasis on MRI

  13. Oedema and fatty degeneration of the soleus and gastrocnemius muscles on MR images in patients with achilles tendon abnormalities

    Hoffmann, Adrienne [University Hospital Balgrist Zuerich, Radiology Department, Zuerich (Switzerland); Hirslanden Klinik Aarau, Radiology Department, Aarau (Switzerland); Mamisch, Nadja; Buck, Florian M.; Pfirrmann, Christian W.A.; Zanetti, Marco [University Hospital Balgrist Zuerich, Radiology Department, Zuerich (Switzerland); Espinosa, Norman [University Hospital Balgrist Zuerich, Orthopedic Surgery Department, Zuerich (Switzerland)

    2011-09-15

    The purpose of this study was to evaluate the frequency of oedema and fatty degeneration of the soleus and gastrocnemius muscles in patients with Achilles tendon abnormalities. Forty-five consecutive patients (mean 51 years; range 14-84 years) with achillodynia were examined with magnetic resonance (MR) images of the calf. The frequency of oedema and fatty degeneration in the soleus and gastrocnemius muscles was determined in patients with normal tendons, tendinopathy and in patients with a partial tear or a complete tear of the Achilles tendon. Oedema was encountered in 35% (7/20) of the patients with tendinopathy (n = 20; range 13-81 years), and in 47% (9/19) of the patients with partial tears or complete tears (n = 19; 28-78 years). Fatty degeneration was encountered in 10% (2/20) of the patients with tendinopathy, and in 32% (6/19) of the patients with tears. The prevalence of fatty degeneration was significantly more common in patients with a partial or complete tear compared with the patients with a normal Achilles tendon (p = 0.032 and p = 0.021, respectively). Oedema and fatty degeneration of the soleus and gastrocnemius muscles are common in patients with Achilles tendon abnormalities. (orig.)

  14. Patellar and Achilles tendinopathy : sclerosing injections and ultrasound guided arthroscopic shaving

    Willberg, Lotta

    2013-01-01

    Chronic painful tendinopathy is a common cause for elite- and recreational athletes to stop or decrease the level of their sports activity. Recent research on innervation patterns, histopathology and possible pain mechanisms in tendons has led to an increased knowledge about the chronic painful tendon. Ultrasound (US) and colourDoppler (CD) examination showing localized high blood flow, inside and outside regions with structural tendon abnormalities, has been shown to be of importance for ten...

  15. Autologous leukocyte-reduced platelet-rich plasma therapy for Achilles tendinopathy induced by collagenase in a rabbit model

    González, Juan C.; López, Catalina; Álvarez, María E.; Pérez, Jorge E.; Carmona, Jorge U.

    2016-01-01

    Leukocyte-reduced platelet-rich plasma (LR-PRP) is a therapy for tendinopathy of the Achilles tendon (TAT); however, there is scarce information regarding LR-PRP effects in rabbit models of TAT. We compared, at 4 and 12 weeks (w), the LR-PRP and placebo (PBS) effects on ultrasonography, histology and relative gene expression of collagen types I (COL1A1) and III (COL3A1) and vascular endothelial growth factor (VEGF) in 24 rabbits with TAT induced by collagenase. The rabbits (treated with both treatments) were euthanatised after either 4 or 12 w. A healthy group (HG (n = 6)) was included. At 4 and 12 w, the LR-PRP group had a no statistically different histology score to the HG. At w 4, the COL1A1 expression was significantly higher in the LR-PRP group when compared to HG, and the expression of COL3A1from both LR-PRP and PBS-treated tendons was significantly higher when compared to the HG. At w 12, the expression of COL3A1 remained significantly higher in the PBS group in comparison to the LR-PRP group and the HG. At w 4, the LR-PRP group presented a significantly higher expression of VEGF when compared to the PBS group and the HG. In conclusion, LR-PRP treatment showed regenerative properties in rabbits with TAT. PMID:26781753

  16. Clinical commentary of the evolution of the treatment for chronic painful mid-portion Achilles tendinopathy

    Håkan Alfredson

    2015-10-01

    Full Text Available ABSTRACTThe chronic painful Achilles tendon mid-portion was for many years, and still is in many countries, treated with intratendinous revision surgery. However, by coincidence, painful eccentric calf muscle training was tried, and it showed very good clinical results. This finding was unexpected and led to research into the pain mechanisms involved in this condition. Today we know that there are very few nerves inside, but multiple nerves outside, the ventral side of the chronic painful Achilles tendon mid-portion. These research findings have resulted in new treatment methods targeting the regions with nerves outside the tendon, methods that allow for a rapid rehabilitation and fast return to sports.

  17. Infiltration of Autologous Growth Factors in Chronic Tendinopathies

    Antonio Crescibene

    2015-01-01

    Full Text Available Achilles tendinopathy and patellar tendinopathy are among the most frequent diagnoses in sports medicine. Therapeutic treatment of the disease is difficult, particularly in chronic cases. In literature, several studies suggest the employment of Platelet-Rich Plasma as a therapeutic alternative in tendinopathies. The choice of employing this method is based on the activity of growth factors contained in platelets which activate, amplify, and optimize the healing process. We selected 14 patients affected by Achilles tendinopathy and 7 patients affected by patellar tendinopathy, with a two-year final follow-up. These patients underwent a cycle of three tendinous infiltrations, after clinical and instrumental evaluation carried out by means of specific questionnaires and repeated ultrasound scans. Ultrasound scans of 18 patients showed signs of reduction in insertional irregularities. The result is confirmed by complete functional recovery of the patients, with painful symptomatology disappearing. The patients showed a clear pain reduction, along with an enhanced VISA score after the 24-month follow-up, equal to 84.2 points on a scale of 0 to 100. In conclusion, the present study provides evidence to suggest that PRP infiltration is a valid option to patients with chronic tendinopathy who did not benefit from other treatments.

  18. Arthroscopic treatment of chronic painful Achilles tendinopathy%关节镜治疗慢性疼痛性跟腱炎初步临床效果报告

    杨渝平; Hajo Thermann; 敖英芳

    2011-01-01

    Objective To decrease the postoperative complication rate of traditional open surgical treatment of chronic painful Achilles tendinopathy, we created and applied a kind of special arthroscopic technique in curing a series of patients diagnosed with it. Methods 8 consecutive patients (7 men and 1 woman, mean age 52 years) were included in this study and treated by arthroscopic debridement of the ventral neovascularized area, the peritendineum and the Achilles tendon. The visual analogue scale was used to assess the severity of Achilles tendon pain during tendon loading activity pre and postoperatively. Results All the patients were followed-up at 6 months after the surgeries. Every one of them felt immediate postoperative pain relief. And there were no postoperative complications. The median visual analogue score ( VAS) increased from 40 (10-60) (preoperatively) to 97. 5 (85-100) (follow-up at the sixth month ). In terms of Achilles tendon function, the median VAS are 22.5 (0-30) and 90 (80-95) respectively. Conclusion Treatment with arthroscopic technique of chronic painful Achilles tendinopathy can obviously reduce the incidence rate of postoperative complication. The short-term clinical results were satisfactory.%目的 探讨关节镜微创治疗慢性疼痛性跟腱炎的临床效果以及其在降低手术并发症发生率方面的作用.方法 8例(男7例,女1例,平均年龄52岁)经过常规保守治疗无效的慢性疼痛性跟腱炎患者,在德国海德堡ATOS医院接受关节镜下的清理手术.主要清理内容包括跟腱腹侧的神经血管区、腱围以及跟腱本身三个病变部分.术后6个月时进行随访,应用VAS主观疼痛评分表分别对术前和术后随访时患者的跟腱区疼痛程度进行评分.结果 所有患者在手术结束、麻醉作用消退后即感觉疼痛较术前有明显的缓解,而且未发生任何手术并发症.跟腱疼痛的VAS评分的均值从术前的40(10~60)分升至97.5(85~100)分.跟

  19. Magnetic resonance imaging of the Achilles tendon using ultrashort TE (UTE) pulse sequences

    Robson, M.D.; Benjamin, M.; Gishen, P.; Bydder, G.M. E-mail: gbydder@ucsd.edu

    2004-08-01

    AIM: To assess the potential value of imaging the Achilles tendon with ultrashort echo time (UTE) pulse sequences. MATERIALS AND METHODS: Four normal controls and four patients with chronic Achilles tendinopathy were examined in the sagittal and transverse planes. Three of the patients were examined before and after intravenous gadodiamide. RESULTS: The fascicular pattern was clearly demonstrated within the tendon and detail of the three distinct fibrocartilaginous components of an 'enthesis organ' was well seen. T2* measurements showed two short T2* components. Increase in long T2 components with reduction in short T2 components was seen in tendinopathy. Contrast enhancement was much more extensive than with conventional sequences in two cases of tendinopathy but in a third case, there was a region of reduced enhancement. CONCLUSION: UTE pulse sequences provide anatomical detail not apparent with conventional sequences, demonstrate differences in T2* and show patterns of both increased and decreased enhancement in tendinopathy.

  20. Motor responses to experimental Achilles tendon pain

    Henriksen, Marius; Aaboe, Jens; Graven-Nielsen, Thomas;

    2011-01-01

    Background Achilles tendinopathies are characterised by pain and reduced function, and heavy-load exercises have been shown to be effective in the treatment of painful chronic Achilles tendinopathies. However, basic information is needed on how the biomechanics and neuromuscular control of the...

  1. In vivo biological response to extracorporeal shockwave therapy in human tendinopathy

    Waugh, C. M.; Morrissey, D.; Jones, E.;

    2015-01-01

    Extracorporeal shock wave therapy (ESWT) is a non-invasive treatment for chronic tendinopathies, however little is known about the in-vivo biological mechanisms of ESWT. Using microdialysis, we examined the real-time biological response of healthy and pathological tendons to ESWT. A single session...... of ESWT was administered to the mid-portion of the Achilles tendon in thirteen healthy individuals (aged 25.7 ± 7.0 years) and patellar or Achilles tendon of six patients with tendinopathies (aged 39.0 ± 14.9 years). Dialysate samples from the surrounding peri-tendon were collected before and...... in tendinopathy by promoting the inflammatory and catabolic processes that are associated with removing damaged matrix constituents. The non-response of some individuals may help to explain why ESWT does not improve symptoms in all patients and provides a potential focus for future research....

  2. The Achilles heel of adults and children

    J.I. Wiegerinck

    2014-01-01

    This thesis focuses on the imaging and treatment of the Achilles heel of adults and children. The figurative and literal Achilles heel consists of a number of pathologies: ankle impingement, Achilles tendinopathy, retrocalcaneal bursitis and calcaneal apophysitis. Research as well as diagnosis and t

  3. Ossification of the Achilles tendon: imaging abnormalities in 12 patients

    Yu, J.S. [Dept. of Radiology, Veterans Administration Medical Center, San Diego, CA (United States); Witte, D. [Dept. of Radiology, Veterans Administration Medical Center, San Diego, CA (United States); Resnick, D. [Dept. of Radiology, Veterans Administration Medical Center, San Diego, CA (United States); Pogue, W. [Dept. of Radiology, AMI Valley Medical Center, El Cajon, CA (United States)

    1994-02-01

    Ossification of the Achilles tendon is a rare clinical entity that is characterized by the presence of an ossific mass contained within the fibrocartilaginous substance of the tendon. Because the radiographic features of this condition have not been documented entirely and the magnetic resonance (MR) imaging findings have not been determined, a review of 16 affected tendons in 12 patients was performed in an attempt to characterize the imaging abnormalities associated with this process. MR imaging was performed in three Achilles tendons which demonstrated thickening of the tendons at the level of the ossifications and a lack of intratendinous signal abnormalities compatible with acute tendinitis. Signal intensity similar to that of bone marrow was present in the ossifications. (orig.)

  4. Ossification of the Achilles tendon: imaging abnormalities in 12 patients

    Ossification of the Achilles tendon is a rare clinical entity that is characterized by the presence of an ossific mass contained within the fibrocartilaginous substance of the tendon. Because the radiographic features of this condition have not been documented entirely and the magnetic resonance (MR) imaging findings have not been determined, a review of 16 affected tendons in 12 patients was performed in an attempt to characterize the imaging abnormalities associated with this process. MR imaging was performed in three Achilles tendons which demonstrated thickening of the tendons at the level of the ossifications and a lack of intratendinous signal abnormalities compatible with acute tendinitis. Signal intensity similar to that of bone marrow was present in the ossifications. (orig.)

  5. Is proprioception diminished in patients with patellar tendinopathy?

    Groot, H E; van der Worp, H; Nijenbanning, L; Diercks, R L; Zwerver, J; van den Akker-Scheek, I

    2016-01-01

    PURPOSE: Patellar tendinopathy is a highly prevalent overuse injury, and most treatments are only effective to some extent. This persistence of complaints could be linked to changed proprioception. One study showed diminished proprioception in athletes with lateral epicondylitis. Aim of this study w

  6. Is proprioception diminished in patients with patellar tendinopathy?

    Groot, H. E.; van der Worp, H.; Nijenbanning, L.; Diercks, R. L.; Zwerver, J.; van den Akker-Scheek, I.

    2016-01-01

    Purpose: Patellar tendinopathy is a highly prevalent overuse injury, and most treatments are only effective to some extent. This persistence of complaints could be linked to changed proprioception. One study showed diminished proprioception in athletes with lateral epicondylitis. Aim of this study w

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

    Kijowski, Richard; Smet, Arthur de [University of Wisconsin Hospital, Department of Radiology, Madison, WI (United States); Mukharjee, Rajat [University of Wisconsin Hospital, Department of Radiology, Madison, WI (United States); University of Wisconsin Hospital, Department of Statistics, Madison, WI (United States)

    2007-02-15

    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

  8. 缪刺对大鼠跟腱病恢复的实验研究%Experimental Study on the Effect of Healthy Side Acupuncture for Rat's Achilles Tendinopathy

    王泉巅; 赵勇

    2014-01-01

    Objective:To observe the effect of electro-acupuncture on Achilles tendinopathy by stimulating some related points of rat's healthy lower limb and to provide information for healthy side acupuncture treatment of achilles tendinopathy.Methods:Six male SD (2months old) rats were at random drown out from thirty-six rats as blank contrast group (K group).The models of rat's achilles tendinopathy were set up by 1% collagenase injection into the left achilles tendons of the other thirty rats.The model rats were divided into controlled group (Y group),healthy side acupuncture group (M group).Group Y was divided into three subgroups (Y0,Y1,Y2group) and group M were respectively divided into two groups (M1,M2group).After three weeks of setting up the model,M1and M2group were treated respectively by electro-acupuncturing the healthy limbs points Yanglingquan,Zusanli,Chengshan,Taixi,once a day.Each time lasted 15minutes.A treating process was 10days.After resting two days,the second treating process started.Group K and Y had no treatment.Group K and group Y0were executed after three weeks of setting up the model.Groups Y1,Mland Y2,M2were executed at the end of the first and second treating process.For all achilles tendons specimen,histological and immunohistochemical observation were obtained.The number of the fibroblasts was counted and statistically analysis by Microsoft excel.The effect of transforming growth factor betar1was obtained and compared with the histological observation to study the recovery of achilles tendinopathy.Results:(①)After the fist treating process,the fibroblast counts of the group M1were significantly higher than the group Y1and showed significantly difference between the group M1and Y1.After the second treating process,the fibroblast counts of the group M2were significantly lower than the group Y2and showed significantly difference between the groups M2and Y2.②)TGF-β1was not detected in the group K,TGF-β1expressed in the group Y and

  9. Elbow Tendinopathy (Tennis and Golf Elbow) (Beyond the Basics)

    ... Use ©2016 UpToDate, Inc. Patient information: Elbow tendinopathy (tennis and golf elbow) (Beyond the Basics) Author Neeru ... elbow tendinitis is available by subscription. (See "Epicondylitis (tennis and golf elbow)" .) WHAT IS ELBOW TENDINOPATHY? — Tendinopathy ( ...

  10. 体外冲击波治疗跟腱腱病的临床疗效研究%The treatment with extracorporeal shock waves for Achilles tendinopathy

    黄合琴; 杨柳; 段小军; 陈光兴; 郭林; 何锐

    2015-01-01

    目的:探讨体外冲击波治疗跟腱腱病的方法及近期疗效。方法以2012年12月1日至2013年12月1日,该院关节外科门诊诊治的跟腱腱病患者为研究对象。患者主要症状是行走时后踝区域疼痛,休息时可缓解,治疗前常规行踝关节X片正侧位和M RI检查,明确诊断和排除其他引起疼痛的病因。冲击波治疗,2000脉冲/次,1次/周,共4次。治疗期间避免跑跳剧烈运动,治疗当晚口服1次止痛药。采用VAS评分,患者在治疗前、治疗4次后和治疗3个月时,这3个时间点进行VAS评分和踝‐后足AOFAS评分。记录治疗并发症,随访并进行统计学分析VAS和AOFAS评分。结果32例跟腱肌腱病患者全部均获得随访,其中跟腱止点性腱病22例,非止点性腱病10例。8例双侧病变,24例为单侧病变。5例患者在治疗后出现局部红斑,休息后缓解,1例患者在4次治疗后局部疼痛缓解,但在治疗5个月后下楼时摔伤致跟腱断裂;患者在治疗前、治疗4次后和治疗3个月时,这3个时间点进行VAS评分分别为(8.2±1.5)分、(2.1±0.8)分、(1.3±0.6)分(前两组数据 P<0.01,后两组数据 P>0.05),AOFAS评分分别为(72.2±5.1)分、(86.3±5.2)分、(91.3±3.5)分(3组数据间 P<0.01)。结论在治疗跟腱腱病时,采用体外冲击波治疗后能够改善局部症状,患者满意程度高,该技术具有创伤小、疗效可靠的优势,使部分患者免去或者推迟手术治疗。%Objective The purpose of this study is to investigate extracorporeal shock waves therapy on Achilles tendopathy and evaluate its short‐term effectiveness .Methods The subjects were out‐patients with Achilles tendopathy who came to center for Joint Surgery ,Southwest Hospital ,from Dec .1st 2012 to Dec .1st 2013 .The main symptom of these patients showed pain at the hock site ,while the pain

  11. Effects of Calf Muscle Eccentric Training and Rehabilitation on Athletes with Chronic Achilles Tendinopathy%肌肉离心训练结合康复治疗跟腱炎的临床观察

    杜锋; 张志杰; 朱毅; 刘春龙; 李凝

    2012-01-01

    Objective To investigate the effect of calf muscle eccentric training(CMET) and rehabilitation on athletes with chronic Achilles tendinopathy. Methods 21 athletes with chronic Achillas tendinopathy were randomly divided into CWET groap (n = 12) and control group( n = 9), The CMET group received both routine rehabilitation and CMET treatment for ihree months, meanwhile, the control group only received routine rehabilitation treatment too. Their pain intensity was assessed using Visual A-nalogy Scale(VAS) during walking, up and down stairs, jumping. Results There was a significant improvement both in the CMET group and the control group after treatment P <0.05),but the CMET group improved more( P <0. 05). Conclusion CMET can improve the efficacy of the routine rehabilitation an athletes with chronic Achilles%目的 观察小腿三头肌离心训练结合常规康复疗法改善运动员慢性跟腱炎的临床效果.方法 将21例患慢性跟腱炎运动员随机分为小腿三头肌离心训练(Calf Muscle Eccentric Training,CMET)组(12例)和对照组(9例),CMET组采用常规康复疗法结合CMET进行康复治疗,对照组应用常规康复疗法.疗程总计3个月,分别在治疗始末次步行,上下楼梯,跳越过程中间时间点应用视觉疼痛量表(Visual Analogy Scale,VAS)进行评估,比较两组治疗前后VAS.结果 康复前后跟腱疼痛的变化CMET组和对照组组内比较差异均有统计学意义(P<D.05);康复治疗后跟腱疼痛CMET组与对照组组间比较差异有统计学意义(P<0.05).结论 单独应用综合康复疗法可有效改善跟腱疼痛,但CMET结合常规综合康复疗法的疗效更好.

  12. Study of Platelet Rich Plasma Injections in Patients of Tendinopathy in South Gujarat Population

    Manish Patel

    2016-06-01

    Full Text Available Introduction: Tendinopathy is a major medical problem associated with sports and physical activity in active people over 25 years of age. We study about the effect of PRP in the patients of chronic Tendinopathy. Methods: The patients of chronic tendinopathy come to OPD at government medical college, surat who failed medical treatment for last 3 months. After getting informed consent platelet rich plasma is prepared from patients own blood. After giving platelet rich plasma injection, patient is advised to take rest for 3 weeks with analgesics. Physiotherapy is started after 3 weeks of injection as this is causing pain for first 3 weeks. Patients are advised to join their duty after 3 weeks of injection. All the patients were followed up in OPD at 3 weeks, 6 weeks, 3 months and 6 months. At every follow up, range of motion, visual analogue scale and functional activity score recorded. Results: The follow up shows that most of the patients do not get relief within 3 weeks after injection. Follow up shows that 16 patients out of 50 got relief within 6 weeks after injection. Result shows that 46 patients out of 50 get relief within 6 months after injection. That means 94% of patients are having relief within 6 months of injection. Conclusion: The findings of this study shows that platelet rich plasma injection under ultrasound guidance at the tendon is effective mode of treatment for patients and takes time but result in gradual decrease in symptoms. [Natl J Med Res 2016; 6(2.000: 191-195

  13. Research Progress of Integrated Traditional Chinese and Western Medicine in Treating Achilles Tendinopathy%跟腱病中西医治疗研究进展

    韩涛; 张成亮

    2012-01-01

    At home and abroad, the treatment of achilles tendon disease is in a deep study in recent years, according to experiences in the treatment of this disease, from etiology and pathogenesis, Chinese and Western medicine treatment of achilles tendon disease in recent years was detailed analyzed and systematic summarized.The researches on this disease have certain significance for the best treatment options.%目前国内外对跟腱病的诊疗有很深的研究,文章根据近几年对本病的治疗经验,从病因病机详细分析,中西医治疗跟腱病方案进行综述,系统总结了近几年本病的研究进展,对本病的最佳治疗方案选择有一定的意义.

  14. Plantarflexor muscle function in healthy and chronic Achilles tendon pain subjects evaluated by the use of EMG and PET imaging

    Masood, Tahir; Kalliokoski, Kari; Bojsen-Møller, Jens;

    2014-01-01

    BACKGROUND: Achilles tendon pathologies may alter the coordinative strategies of synergistic calf muscles. We hypothesized that both surface electromyography and positron emission tomography would reveal differences between symptomatic and asymptomatic legs in Achilles tendinopathy patients and...... between healthy controls. METHODS: Eleven subjects with unilateral chronic Achilles tendon pain (28 years) and eleven matched controls (28 years) were studied for triceps surae and flexor hallucis longus muscle activity in response to repetitive isometric plantarflexion tasks performed at 30% of maximal...... electromyography showed greater relative amplitude in the symptomatic leg, the results based on muscle glucose uptake suggested relatively similar behavior of both legs in the patient group. Higher glucose uptake in the symptomatic Achilles tendon suggests a higher metabolic demand....

  15. Functional rehabilitation of patients with acute Achilles tendon rupture

    Mark-Christensen, Troels; Troelsen, Anders; Kallemose, Thomas;

    2014-01-01

    PURPOSE: The optimal treatment for acute Achilles tendon rupture (ATR) is continuously debated. Recent studies have proposed that the choice of either operative or non-operative treatment may not be as important as rehabilitation, suggesting that functional rehabilitation should be preferred over...

  16. Biceps Tendinitis or Tendinopathy (Beyond the Basics)

    ... 2016 UpToDate, Inc. Patient information: Biceps tendinitis or tendinopathy (Beyond the Basics) Authors Stephen M Simons, MD, ... to pain and impaired function. This is called tendinopathy. Some people call this condition biceps tendinitis, although ...

  17. Low level laser therapy reduces inflammation in activated Achilles tendinitis

    Bjordal, Jan M.; Iversen, Vegard; Lopes-Martins, Rodrigo Alvaro B.

    2006-02-01

    Objective: Low level laser therapy (LLLT) has been forwarded as therapy for osteoarthritis and tendinopathy. Results in animal and cell studies suggest that LLLT may act through a biological mechanism of inflammatory modulation. The current study was designed to investigate if LLLT has an anti-inflammatory effect on activated tendinitis of the Achilles tendon. Methods: Seven patients with bilateral Achilles tendonitis (14 tendons) who had aggravated symptoms by pain-inducing activity immediately prior to the study. LLLT (1.8 Joules for each of three points along the Achilles tendon with 904nm infrared laser) and placebo LLLT were administered to either Achilles tendons in a random order to which patients and therapist were blinded. Inflammation was examined by 1) mini-invasive microdialysis for measuring the concentration of inflammatory marker PGE II in the peritendinous tissue, 2) ultrasound with Doppler measurement of peri- and intratendinous blood flow, 3) pressure pain algometry and 4) single hop test. Results: PGE 2- levels were significantly reduced at 75, 90 and 105 minutes after active LLLT compared both to pre-treatment levels (p=0.026) and to placebo LLLT (p=0.009). Changes in pressure pain threshold (PPT) were significantly different (P=0.012) between groups. PPT increased by a mean value of 0.19 kg/cm2 [95%CI:0.04 to 0.34] after treatment in the active LLLT group, while pressure pain threshold was reduced by -0.20 kg/cm2 [95%CI:-0.45 to 0.05] after placebo LLLT. Conclusion: LLLT can be used to reduce inflammatory musculskeletal pain as it reduces inflammation and increases pressure pain threshold levels in activity-induced pain episodes of Achilles tendinopathy.

  18. The Achilles tendon total rupture score: a study of responsiveness, internal consistency and convergent validity on patients with acute Achilles tendon ruptures

    Kearney Rebecca S

    2012-02-01

    Full Text Available Abstract Background The Achilles tendon Total Rupture Score was developed by a research group in 2007 in response to the need for a patient reported outcome measure for this patient population. Beyond this original development paper, no further validation studies have been published. Consequently the purpose of this study was to evaluate internal consistency, convergent validity and responsiveness of this newly developed patient reported outcome measure within patients who have sustained an isolated acute Achilles tendon rupture. Methods Sixty-four eligible patients with an acute rupture of their Achilles tendon completed the Achilles tendon Total Rupture Score alongside two further patient reported outcome measures (Disability Rating Index and EQ 5D. These were completed at baseline, six weeks, three months, six months and nine months post injury. The Achilles tendon Total Rupture Score was evaluated for internal consistency, using Cronbach's alpha, convergent validity, through correlation analysis and responsiveness, by analysing floor and ceiling effects and calculating its relative efficiency in comparison to the Disability Rating Index and EQ 5D scores. Results The Achilles tendon Total Rupture Score demonstrated high internal consistency (Cronbachs alpha > 0.8 and correlated significantly (p Conclusions A universally accepted outcome measure is imperative to allow comparisons to be made across practice. This is the first study to evaluate aspects of validity of this newly developed outcome measure, outside of the developing centre. The ATRS demonstrated high internal consistency and responsiveness, with limited convergent validity. This research provides further support for the use of this outcome measure, however further research is required to advocate its universal use in patients with acute Achilles tendon ruptures. Such areas include inter-rater reliability and research to determine the minimally clinically important difference

  19. An exercise-based physical therapy program for patients with patellar tendinopathy after platelet-rich plasma injection

    van Ark, Mathijs; van den Akker-Scheek, Inge; Meijer, L.T.B.; Zwerver, Hans

    2013-01-01

    Objectives: To describe a post platelet-rich plasma (PRP) injection, exercise-based physical therapy program, investigate feasibility and report the first results of patellar tendinopathy patients treated with PRP injection combined with the physical therapy program. Study Design: Case-series. Setti

  20. Stereological quantification of immune-competent cells in baseline biopsy specimens from achilles tendons

    Kragsnaes, Maja Skov; Fredberg, Ulrich; Stribolt, Katrine;

    2014-01-01

    BACKGROUND: Limited data exist on the presence and function of immune-competent cells in chronic tendinopathic tendons and their potential role in inflammation and tissue healing as well as in predicting long-term outcome. PURPOSE: To quantify subtypes of immune-competent cells in biopsy specimens....... METHODS: Fifty patients with nonruptured chronic Achilles tendinopathy and 15 healthy participants were included. At time of inclusion, an ultrasound examination was performed immediately before an ultrasound-guided Achilles tendon biopsy specimen was obtained. Tissue samples were evaluated......(+)) using a stereological technique. A follow-up examination was conducted more than 4 years (range, 4-9 years) after the biopsy procedure to evaluate the long-term presence of Achilles tendon symptoms. RESULTS: Macrophages, T lymphocytes, mast cells, and natural killer cells were observed in the majority...

  1. The prevalence of neovascularity in patients clinically diagnosed with rotator cuff tendinopathy

    Raza Syed A

    2009-12-01

    Full Text Available Abstract Background Shoulder dysfunction is common and pathology of the rotator cuff tendons and subacromial bursa are considered to be a major cause of pain and morbidity. Although many hypotheses exist there is no definitive understanding as to the origin of the pain arising from these structures. Research investigations from other tendons have placed intra-tendinous neovascularity as a potential mechanism of pain production. The prevalence of neovascularity in patients with a clinical diagnosis of rotator cuff tendinopathy is unknown. As such the primary aim of this pilot study was to investigate if neovascularity could be identified and to determine the prevalence of neovascularity in the rotator cuff tendons and subacromial bursa in subjects with unilateral shoulder pain clinically assessed to be rotator cuff tendinopathy. The secondary aims were to investigate the association between the presence of neovascularity and pain, duration of symptoms, and, neovascularity and shoulder function. Methods Patients with a clinical diagnosis of unilateral rotator cuff tendinopathy referred for a routine diagnostic ultrasound (US scan in a major London teaching hospital formed the study population. At referral patients were provided with an information document. On the day of the scan (on average, at least one week later the patients agreeing to participate were taken through the consent process and underwent an additional clinical examination prior to undergoing a bilateral grey scale and colour Doppler US examination (symptomatic and asymptomatic shoulder using a Philips HDI 5000 Sono CT US machine. The ultrasound scans were performed by one of two radiologists who recorded their findings and the final assessment was made by a third radiologist blinded both to the clinical examination and the ultrasound examination. The findings of the radiologists who performed the scans and the blinded radiologist were compared and any disagreements were resolved

  2. Ultrasound-guided sclerosing treatment in patients with patellar tendinopathy (jumper's knee): 44 month follow-up

    Hoksrud, Aasne Fenne; Bahr, Roald

    2011-01-01

    Background: A randomized controlled study has shown good clinical results after treatment with sclerosing injections into the area with neovessels in patients with patellar tendinopathy, but no study has investigated medium- or long-term outcomes. Purpose: This study investigates the effect of sclerosing treatment 44 months (range, 42-47 months) after start of treatment. Study Design: Case series; Level of evidence, 4. Methods: Patients with a diagnosis of jumper’s knee and neo...

  3. Evidence for an Environmental and Inherited Predisposition Contributing to the Risk for Global Tendinopathies or Compression Neuropathies in Patients With Rotator Cuff Tears

    Tashjian, Robert Z.; Farnham, James M.; Granger, Erin K.; Teerlink, Craig C.; Cannon-Albright, Lisa A.

    2016-01-01

    Background: Rotator cuff tearing has been found to be clinically associated with other tendinopathies and compression neuropathies; a significant excess of these phenotypes has been seen in patients with rotator cuff tears. It is unclear if the association is secondary to environmental or genetic influences. Purpose: To examine population-based data for comorbid association of rotator cuff tearing and tendinopathies and compression neuropathies and to determine whether the association extends to relatives of patients with rotator cuff tears, which could suggest a genetic contribution. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The Utah Population Database (UPDB) contains health and genealogical data on over 2 million Utah residents. Current Procedural Terminology, Fourth Revision, codes (CPT 4) and International Classification of Diseases, Ninth Revision, codes (ICD-9) entered in patient records were used to identify patients with rotator cuff tearing and with comorbid tendinopathies and compression neuropathies. We tested the hypothesis of excess familial clustering of these other phenotypes with rotator cuff tearing using a well-established method (estimation of relative risks) in the overall study group of rotator cuff patients (N = 1889). Results: Significantly elevated risk for elbow, hand/wrist, foot/ankle, knee, and hip tendinopathies, as well as for all tendinopathies and compression neuropathies, was observed in rotator cuff tear cases themselves (P tendinopathies (P = 3.1e–3) was also observed in second-degree relatives, and a significant excess of compression neuropathies (P = .03) was observed in third-degree relatives. Conclusion: The current study shows strong evidence of familial clustering of rotator cuff tearing with other tendinopathies and with compression neuropathy. Observed increased risks in spouses and first-degree relatives supports shared environmental risk factors for rotator cuff tearing, most tendinopathies

  4. Ciprofloxacin-Induced Tendinopathy of the Gluteal Tendons

    Shimatsu, Kaumakaokalani; Subramaniam, Somasundaram; Sim, Helen; Aronowitz, Paul

    2014-01-01

    Fluoroquinolone-induced tendinopathy most commonly affects the Achilles tendon; however, involvement of several other tendons has been described. This is a case report of ciprofloxacin-induced tendinopathy of the gluteal tendons with MRI findings. An obese 25-year-old woman with no significant past medical history was diagnosed with acute pyelonephritis and was treated with intravenous ciprofloxacin. Shortly after her first dose of ciprofloxacin, she developed severe left hip pain and decreas...

  5. Fluoroquinolone-induced bilateral rupture of the Achilles tendon: clinical and sonographic findings

    P. Busilacchi

    2011-09-01

    Full Text Available The fluoroquinolones are antibiotics widely used in the clinical practice. The concomitant use of corticosteroids and fluoroquinolones in elderly patients is recognised as a risk factor for developing clinically relevant tendon lesions. Fluoroquinolone-induced tendinopathy is underreported in the literature. Clinical case. A 67-year-old man, came to our observation complaining of 5 days history of bilateral heel pain. The patient had a medical history of sarcoidosis and was treated with a daily dose of 5 mg of prednisone. He was initially given oral levofloxacin (500 mg/die for 10 days, because of an acute respiratory infection. Two days before the end of the antibiotic therapy, he developed bilateral heel pain. He denied any history of trauma. Physical examination revealed swelling and marked tenderness with mild palpation of the Achilles tendons at the calcaneal insertion. The ultrasound evaluation of the Achilles tendons revealed the following main abnormalities: diffuse thickening, loss of the “fibrillar” echotexture, blurred margins, and bilateral partial tendon tears. Discussion. Bilateral Achilles tendon pain and rupture has been described as a rare adverse effect of fluoroquinolone treatment. Most of the fluoroquinolone-induced tendinopathies of the Achilles tendon are due to ciprofloxacin. To the best of our knowledge, this is the first description of bilateral Achilles tendon rupture due to levofloxacin. The risk/benefit ratio of the fluoroquinolones should be carefully considered and these drugs should be prescribed cautiously in elderly patients treated with corticosteroids. This case can be regarded as a representative example of the potential clinical efficacy of sonography in daily rheumatological practise.

  6. Patellar tendon: From tendinopathy to rupture

    Federica Rosso

    2015-10-01

    Full Text Available Patellar tendinopathy is very common in patients complaining of anterior knee pain. Its aetiology is still unclear, but neovascularisation seems to play a role. Different treatments have been proposed overtime, from rehabilitation to platelet-rich-plasma injections, but there is no agreement on the best treatment protocol. The final stage of patellar tendinopathy is patellar tendon rupture. In these cases surgical treatment is often required. The aim of this literature review is to focus on the aetiology, diagnosis, and treatment of both patellar tendinopathy and rupture. We report the conservative treatments proposed for patellar tendinopathy and the surgical techniques described for its rupture.

  7. Uphill running improves rat Achilles tendon tissue mechanical properties and alters gene expression without inducing pathological changes

    Heinemeier, K M; Skovgaard, D; Bayer, M L;

    2012-01-01

    Overuse Achilles tendinopathy is a common and challenging problem in sports medicine. Little is known about the etiology of this disorder, and the development of a good animal model for overuse tendinopathy is essential for advancing insight into the disease mechanisms. Our aim was to test a...... tendinopathy, as the rats were able to adapt to 12 wk of uphill running without any signs of tendinopathy. Improved mechanical properties were observed, as well as changes in gene-expression that were distinctly different from what is seen in tendinopathy and in response to short-term tendon loading....

  8. Biomechanical characteristics of the eccentric Achilles tendon exercise

    Henriksen, Marius; Aaboe, Jens; Bliddal, Henning;

    2009-01-01

    although the tendon loads are similar, the tendon is vibrated at higher frequencies during the eccentric phase than during the concentric phases. This study provides data that may explain the mechanisms behind the effectiveness of eccentric exercises used in the treatment of Achilles tendinopathies....

  9. Different distributions of operative diagnoses for Achilles tendon overuse injuries in Italian and Finnish athletes

    Johansson, Kristian; Lempainen, Lasse; Sarimo, Janne; Laitala-Leinonen, Tiina; Orava, Sakari

    2016-01-01

    Summary Background the origin of chronic Achilles tendinopathy (AT) is currently unclear and epidemiological factors, such as ethnicity, may be associated. Methods intraoperative findings from the treatment of 865 Finnish and 156 Italian athletic patients with chronic Achilles tendon related pain were evaluated, retrospectively. The mean age was 34 years (range, 18 to 65 years) in the Finnish and 29 years (range, 17–63 years) in the Italian patients. In total, 786 patients were males and 226 females of which 84 and 87% Finnish, respectively. Data were collected, retrospectively from patient records. The differences in the frequencies of operative findings were assessed for statistical significance. Results retrocalcaneal bursitis, partial tear and chronic paratenonitis were the most prevalent findings in patients with chronic AT undergoing surgery. Tendinosis and chronic paratenonitis were significantly (p=0.011) more common in Finnish athletes. Italian patients exhibited significantly (ptendinopathy (heel spurs) and prominent posterosuperior calcaneal corners (Haglund’s heel). Conclusion ethnicity appears to be associated with specific characteristics of overuse-related Achilles tendon pathology. This is an issue that should be considered in the planning of genetic research on AT. PMID:27331038

  10. Achilles tendinitis

    Tendinitis of the heel ... foot. Rarely, it is caused by an injury. Tendinitis due to overuse is most common in younger ... occur in walkers, runners, or other athletes. Achilles tendinitis may be more likely to occur if: There ...

  11. Patient guided Piezo-electric Extracorporeal Shockwave Therapy as treatment for chronic severe patellar tendinopathy : A pilot study

    Zwerver, J.; Dekker, F.; Pepping, G.J.

    2010-01-01

    Background and purpose: Patellar tendinopathy is a common overuse injury for which no evidence-based treatment guidelines exist. Extracorporeal Shock Wave Therapy (ESWT) seems to be an effective treatment for patellar tendinopathy but the most beneficial treatment strategies still need to be ascerta

  12. Demonstration of Achilles tendon on CT

    Ligaments and tendons, including the Achilles tendon, show the highest density among normal soft tissue structures in the body. Traumatic and degenerative changes of the Achilles tendon are often associated with marked thickening and reduction in density associated with increased opacity of the space in front of the Achilles tendon. These changes are easily demonstrated by CT, whereas conventional radiological techniques only show non-specific changes. Twenty-five patients were examined, including nine with pain, seven following rupture of the Achilles tendon and nine post-operative controls; it was found that CT can add information important for the diagnosis and treatment planning of abnormalities of the Achilles tendon. (orig.)

  13. The long-term clinical and MRI results following eccentric calf muscle training in chronic Achilles tendinosis

    Gaerdin, Anna; Shalabi, Adel [Karolinska University Hospital/Huddinge, Departments of Radiology, Karolinska Institutet, Clintec, Stockholm (Sweden); Movin, Tomas [Karolinska University Hospital/Huddinge, Karolinska Institutet, Departments of Orthopedics, Stockholm (Sweden); Svensson, Leif [Karolinska Institutet, Karolinska University Hospital/Huddinge, Departments of Medical Physics, Stockholm (Sweden)

    2010-05-15

    To evaluate the long-term results following eccentric calf-muscle training in patients with chronic Achilles tendinopathy. A total of 24 patients with chronic Achilles tendinopathy were included in a study evaluating MRI findings and clinical symptoms before and after 3 months of daily eccentric calf-muscle strength training. Median duration of symptoms was 18 months (range 6-120). Four of the patients did not perform the prescribed treatment for different reasons and were followed for 14 months. The resulting 20 treated patients completed 4.2-year (range 29-58 months) follow up. Tendon volume was evaluated by using 3D seed growing technique and signal abnormalities were visually semi-quantitatively graded. Level of pain and performance was categorized using a questionnaire completed by the patient. In the symptomatic treated patients, median intensity level of pain decreased from moderate/severe at time of inclusion to mild at follow up (p < 0.05). Median level of performance increased from severe impairment at time of inclusion to normal at follow up (p < 0.05). 12 out of 20 patients had raised intratendinous signal at time of inclusion compared to 2 out of 20 patients at follow up (p < 0.001). Mean tendon-volume measured 6.7 cm{sup 3} (SD 2.0) at time of inclusion and 6.4 cm{sup 3} (SD 2.0) at follow up (p = 0.18). The four symptomatic non-treated tendons did not improve regarding pain, performance, intratendinous signal or tendon volume. We found decreased pain, improved performance and decreased intratendinous signal both compared to index examination and immediately after the 3 months training regimen in a 4.2-year clinical and MRI follow up, in a group of patients treated with heavy loaded eccentric calf-muscle training for chronic Achilles tendinopathy. The improvements were greater at 4.2-year follow up, despite no further active treatment, than immediately after the treatment. This may indicate a good long-term prognosis for Achilles tendinosis patients

  14. The effect of dry needling and treadmill running on inducing pathological changes in rat Achilles tendon.

    Kim, Bom Soo; Joo, Young Chae; Choi, Byung Hyune; Kim, Kil Hwan; Kang, Joon Soon; Park, So Ra

    2015-11-01

    Achilles tendinopathy is a common degenerative condition without a definitive treatment. An adequate chronic animal model of Achilles tendinopathy has not yet been developed. The purpose of this study was to evaluate the individual and combined effects of dry needling and treadmill running on the Achilles tendon of rats. Percutaneous dry needling, designed to physically replicate microrupture of collagen fibers in overloaded tendons, was performed on the right Achilles tendon of 80 Sprague-Dawley rats. The rats were randomly divided into two groups: a treadmill group, which included rats that underwent daily uphill treadmill running (n = 40), and a cage group, which included rats that could move freely within their cages (n = 40). At the end of weeks 1 and 4, 20 rats from each group were sacrificed, and bilateral Achilles tendons were collected. The harvested tendons were subjected to mechanical testing and histological analysis. Dry needling induced histological and mechanical changes in the Achilles tendons at week 1, and the changes persisted at week 4. The needled Achilles tendons of the treadmill group tended to show more severe histological and mechanical changes than those of the cage group, although these differences were not statistically significant. Dry needling combined with free cage activity or treadmill running produced tendinopathy-like changes in rat Achilles tendons up to 4 weeks after injury. Dry needling is an easy procedure with a short induction period and a high success rate, suggesting it may have relevance in the design of an Achilles tendinopathy model. PMID:26076317

  15. Fluoroquinolone-associated tendinopathy: a case report

    Ng Wan-Fai; Naughton Michael

    2007-01-01

    Abstract Fluoroquinolone-associated tendinopathy is well described. This adverse effect however does not appear to be widely known among medical practitioners. We hereby described a case of ciprofloxacin-associated tendinopathy for which the adverse drug reaction was not suspected initially and the patient was inappropriately reassured and incorrectly advised to complete the antibiotic course. Given the frequent use of fluoroquinolones in clinical practice and the potential for severe disabil...

  16. Patellar tendon: From tendinopathy to rupture

    Federica Rosso; Davide Edoardo Bonasia; Umberto Cottino; Federico Dettoni; Matteo Bruzzone; Roberto Rossi

    2015-01-01

    Patellar tendinopathy is very common in patients complaining of anterior knee pain. Its aetiology is still unclear, but neovascularisation seems to play a role. Different treatments have been proposed overtime, from rehabilitation to platelet-rich-plasma injections, but there is no agreement on the best treatment protocol. The final stage of patellar tendinopathy is patellar tendon rupture. In these cases surgical treatment is often required. The aim of this literature review is to focus on t...

  17. Severe shoulder tendinopathy associated with levofloxacin

    Walter de Araujo Eyer-Silva

    2012-08-01

    Full Text Available Fluoroquinolone (FQ-associated tendinopathy and myopathy are uncommon but well recognized complications of the use of this class of antibacterial agents. The case of a 63-year-old previously asymptomatic female patient who developed severe left shoulder tendinopathy after surreptitiously doubling the prescribed dose of levofloxacin for the treatment of community-acquired pneumonia is reported here. Surgical stabilization with suture anchors and subacromial decompression were needed.

  18. Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management.

    Goom, Thomas S H; Malliaras, Peter; Reiman, Michael P; Purdam, Craig R

    2016-06-01

    Synopsis Proximal hamstring tendinopathy (PHT) typically manifests as deep buttock pain at the hamstring common origin. Both athletic and nonathletic populations are affected by PHT. Pain and dysfunction are often long-standing and limit sporting and daily functions. There is limited evidence regarding diagnosis, assessment, and management; for example, there are no randomized controlled trials investigating rehabilitation of PHT. Some of the principles of management established in, for example, Achilles and patellar tendinopathy would appear to apply to PHT but are not as well documented. This narrative review and commentary will highlight clinical aspects of assessment and management of PHT, drawing on the available evidence and current principles of managing painful tendinopathy. The management outline presented aims to guide clinicians as well as future research. J Orthop Sports Phys Ther 2016;46(6):483-493. Epub 15 Apr 2016. doi:10.2519/jospt.2016.5986. PMID:27084841

  19. Magnetization transfer in human achilles tendon assessed by a 3D ultrashort echo time sequence. Quantitative examinations in healthy volunteers at 3T

    Syha, R.; Grosse, U.; Springer, F. [Tuebingen Univ. (Germany). Diagnostic and Interventional Radiology; Tuebingen Univ. (Germany). Section on Experimental Radiology; Martirosian, P.; Schick, F. [Tuebingen Univ. (Germany). Section on Experimental Radiology; Ketelsen, D.; Claussen, C.D. [Tuebingen Univ. (Germany). Diagnostic and Interventional Radiology

    2011-11-15

    Magnetization transfer contrast (MTC) imaging provides insight into interactions between free and bounded water. Newly developed ultrashort echo time (UTE) sequences implemented on whole-body magnetic resonance (MR) scanners allow MTC imaging in tissues with extremely fast signal decay such as tendons. The aim of this study was to develop a technique for the quantification of the MT effect in healthy Achilles tendons in-vivo at 3 Tesla. 16 normal tendons of volunteers with no history of tendinopathy were examined using a 3D-UTE sequence with a rectangular on-resonant excitation pulse and a Fermi-shaped off-resonant MT preparation pulse. The frequency of the MT pulse was varied from 1 to 5 kHz. MT effects were calculated in terms of the MT ratio (MTR) between measurements without and with MT preparation. Direct saturation effects of MT preparation on the signal intensity were evaluated using numerical simulation of Bloch equations. One patient with tendinopathy was examined to exemplarily show changes of MTR under pathologic conditions. Calculation of MTR data was feasible in all examined tendons and showed a decrease from 0.53 {+-} 0.05 to 0.25 {+-} 0.03 (1 kHz to 5 kHz) for healthy volunteers. Evaluation of variation with gender and dominance of ankle revealed no significant differences (p > 0.05). In contrast, the patient with confirmed tendinopathy showed MTR values between 0.36 (1 kHz) and 0.19 (5 kHz). MT effects in human Achilles tendons can be reliably assessed in-vivo using a 3D UTE sequence at 3 T. All healthy tendons showed similar MTR values (coefficient of variation 10.0 {+-} 1.2 %). The examined patient showed a clearly different MT effect revealing a changed microstructure in the case of tendinopathy. (orig.)

  20. Platelet-rich plasma (PRP) increases healing process of rats' Achilles tendons

    Kaux, Jean-François; Drion, Pierre; Pascon, Frédéric; Libertiaux, Vincent; Le Goff, Caroline; Gothot, André; CESCOTTO, Serge; Defraigne, Jean-Olivier; Rickert, Markus; Crielaard, Jean-Michel

    2010-01-01

    Introduction Some tendinopathies (epicondylitis, jumper’s knee or Achilles tendinopathy) are frequently considered as rebel to “classic” treatments such as rest, orthotics, NSAIs, electrotherapy, physiotherapy, corticosteroid infiltrations, extracorporeal shock waves… Recently, several studies, essentially in vitro, demonstrated the positive effects of platelets on the healing process of different tissues: bones, muscles and tendons. Objectives The aim of our experiment was to ascert...

  1. Regulation of gene expression in human tendinopathy

    Archambault Joanne M

    2011-05-01

    Full Text Available Abstract Background Chronic tendon injuries, also known as tendinopathies, are common among professional and recreational athletes. These injuries result in a significant amount of morbidity and health care expenditure, yet little is known about the molecular mechanisms leading to tendinopathy. Methods We have used histological evaluation and molecular profiling to determine gene expression changes in 23 human patients undergoing surgical procedures for the treatment of chronic tendinopathy. Results Diseased tendons exhibit altered extracellular matrix, fiber disorientation, increased cellular content and vasculature, and the absence of inflammatory cells. Global gene expression profiling identified 983 transcripts with significantly different expression patterns in the diseased tendons. Global pathway analysis further suggested altered expression of extracellular matrix proteins and the lack of an appreciable inflammatory response. Conclusions Identification of the pathways and genes that are differentially regulated in tendinopathy samples will contribute to our understanding of the disease and the development of novel therapeutics.

  2. The roentgenographic findings of achilles tendon rupture

    To evaluate the diagnostic value of a lateral view of the ankles in Achilles tendon rupture. We performed a retrospective analysis of the roentgenographic findings of 15 patients with surgically proven Achilles tendon rupture. Four groups of 15 patients(normal, ankle sprain, medial lateral malleolar fracture, and calcaneal fracture) were analysed as reference groups. Plain radiographs were reviewed with regard to Kager's triangle, Arner's sign, Toygar's angle, ill defined radiolucent shadow through the Achilles tendon, sharpness of the anterior margin of Achilles tendon, and meniscoid smooth margin of the posterior skin surface of the ankle. Kager's triangle was deformed and disappeared after rupture of the Achilles tendon in nine patients(60%) with operative verification of the rupture, six patients(40%) had a positive Arner's sign, while none had a diminished Toygars angle. In 13 patients(87%) with a ruptured Achilles tendon, the thickness of this was nonuniform compared with the reference group. The anterior margin of the Achilles tendon became serrated and indistinct in 14 patients(93%) in whom this was ruptured. An abnormal ill defined radiolucent shadow through the Achilles tendon was noted in nine patient(60%), and nonparallelism between the anterior margin of the Achilles tendon and posterior skin surface of the ankle was detected in 11 patients(73%). The posterior skin surface of the ankle had a nodular surface margin in 13 patients(87%). A deformed Kager's triangle and Achilles tendon, and an abnormal ill defined radiolucent shadow through the Achilles tendon in a lateral view of the ankles are important findings for the diagnesis of in diagnosing achilles tendon rupture

  3. The roentgenographic findings of achilles tendon rupture

    Seouk, Kang Hyo; Keun, Rho Yong [Shilla General Hospital, Seoul (Korea, Republic of)

    1999-03-01

    To evaluate the diagnostic value of a lateral view of the ankles in Achilles tendon rupture. We performed a retrospective analysis of the roentgenographic findings of 15 patients with surgically proven Achilles tendon rupture. Four groups of 15 patients(normal, ankle sprain, medial lateral malleolar fracture, and calcaneal fracture) were analysed as reference groups. Plain radiographs were reviewed with regard to Kager's triangle, Arner's sign, Toygar's angle, ill defined radiolucent shadow through the Achilles tendon, sharpness of the anterior margin of Achilles tendon, and meniscoid smooth margin of the posterior skin surface of the ankle. Kager's triangle was deformed and disappeared after rupture of the Achilles tendon in nine patients(60%) with operative verification of the rupture, six patients(40%) had a positive Arner's sign, while none had a diminished Toygars angle. In 13 patients(87%) with a ruptured Achilles tendon, the thickness of this was nonuniform compared with the reference group. The anterior margin of the Achilles tendon became serrated and indistinct in 14 patients(93%) in whom this was ruptured. An abnormal ill defined radiolucent shadow through the Achilles tendon was noted in nine patient(60%), and nonparallelism between the anterior margin of the Achilles tendon and posterior skin surface of the ankle was detected in 11 patients(73%). The posterior skin surface of the ankle had a nodular surface margin in 13 patients(87%). A deformed Kager's triangle and Achilles tendon, and an abnormal ill defined radiolucent shadow through the Achilles tendon in a lateral view of the ankles are important findings for the diagnesis of in diagnosing achilles tendon rupture.

  4. Strain mapping in the Achilles tendon - A systematic review.

    Bogaerts, Stijn; Desmet, Hannelore; Slagmolen, Pieter; Peers, Koen

    2016-06-14

    Achilles tendinopathy remains one of the most prevalent overuse injuries in elite as well as recreational athletes. Regardless of the fact that the aetiology of tendinopathy has not been fully understood, therapeutic mechanical loading programs have emerged as being the treatment of choice. In this light, mechanical properties of the tendon and their response to changes in loading or unloading have been the subject of many previous investigations. One of these properties often investigated is strain, a measure of relative deformation. By means of a systematic review, an overview was given of research in this field, with a primary objective to list the methods used and secondary aim to synthesize data on strain mapping in the Achilles tendon. Following the guidelines of the PRISMA statement, 47 articles were found appropriate for qualitative assessment. Achilles tendon strain has been investigated across a variety of contexts, including the response to exercise, walking, unloading, ageing, hormonal changes and weight. Only three studies investigated the effect of the presence of tendinopathy on strain. Ultrasound was the most often used imaging modality to measure or estimate strain. Further methodological parameters, e.g. the location of measurement, differed greatly between all different studies. Nearly all studies considered global strain. Some studies investigated the transverse strain response of the Achilles tendon. Recently, however, the role of local - intratendinous - strain distribution has been found to be of critical importance and further studies should focus on imaging modalities to investigate these local changes. PMID:27113537

  5. Achilles Tendinitis

    ... to adjust to the new distance • Tight calf muscles—Having tight calf muscles and suddenly starting an aggressive exercise program ... is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles place increased stress on the Achilles tendon, ...

  6. Current Opinions on Tendinopathy

    Jean-François Kaux; Bénédicte Forthomme; Caroline Le Goff; Jean-Michel Crielaard; Jean-Louis Croisier

    2011-01-01

    Tendinopathy is characterized by pain in the tendon and impaired performance sometimes associated with swelling of the tendon. Its diagnosis is usually clinical but ultrasonography and magnetic resonance imaging can refine the diagnosis. Tendinopathy is highly prevalent and is one of the most frequently self reported musculoskeletal diseases in physical workers and sports people. Nevertheless, it is very difficult to carry out general epidemiologic studies on tendinopathy because of the varyi...

  7. Collagen fibril size and crimp morphology in ruptured and intact Achilles tendons

    Magnusson, S P; Qvortrup, K; Larsen, Jytte Overgaard;

    2002-01-01

    The present study examined the hypothesis that collagen fibril diameter and crimp angle in ruptured human Achilles tendons differed from that of intact ones. Tissue samples were obtained from the central core (distal core) and the posterior periphery (distal superficial) at the rupture site, and ...... Achilles tendon rupture site. Moreover, the lack of symptoms prior to the rupture suggests that clinical tendinopathy is not an etiological factor in complete tendon ruptures....

  8. MRI of normal achilles tendon

    Rollandi, G.A. [Institute of Radiology, Univ. of Genoa (Italy); Bertolotto, M. [Institute of Radiology, Univ. of Genoa (Italy); Perrone, R. [Institute of Radiology, Univ. of Genoa (Italy); Garlaschi, G. [Institute of Radiology, Univ. of Genoa (Italy); Derchi, L.E. [Institute of Radiology, Univ. of Genoa (Italy)

    1995-12-01

    To investigate the normal internal structure of tendons 11 volunteers without clinical evidence of tendinopathy were examined using conventional spin-echo T1-, T2- and proton-density weighted sequences. The Achilles tendon was chosen because of its high frequency of injury in athletic activity, large size, superficial position and because it is oriented nearly parallel to the static magnetic field, therefore minimizing the ``magic angle phenomenon``. The tendons exhibited areas of slighly increased signal in four T1-weighted and in all but one proton-density-weighted scans. No intratendinous signal was detected in T2-weighted images. The possible origin of these findings is discussed. We conclude that the knowledge of these normal signals may be useful to avoid incorrectly diagnosing as pathological. (orig.). With 2 figs.

  9. MRI of normal achilles tendon

    To investigate the normal internal structure of tendons 11 volunteers without clinical evidence of tendinopathy were examined using conventional spin-echo T1-, T2- and proton-density weighted sequences. The Achilles tendon was chosen because of its high frequency of injury in athletic activity, large size, superficial position and because it is oriented nearly parallel to the static magnetic field, therefore minimizing the ''magic angle phenomenon''. The tendons exhibited areas of slighly increased signal in four T1-weighted and in all but one proton-density-weighted scans. No intratendinous signal was detected in T2-weighted images. The possible origin of these findings is discussed. We conclude that the knowledge of these normal signals may be useful to avoid incorrectly diagnosing as pathological. (orig.). With 2 figs

  10. Ultrasound-guided retro-calcaneal bursa corticosteroid injection for refractory Achilles tendinitis in patients with seronegative spondyloarthropathy: efficacy and follow-up study.

    Srivastava, Puja; Aggarwal, Amita

    2016-06-01

    Ultrasound (US)-guided corticosteroid injection has been shown to be safe and effective for varied causes of plantar fasciitis; however, its use for Achilles tendinitis is controversial. We studied the efficacy and changes in US findings at Achilles enthesitis after corticosteroid injection in patients with spondyloarthropathy (SpA). Patients with SpA with symptomatic Achilles enthesitis, refractory to 6 weeks of full-dose NSAIDs, were offered US-guided local corticosteroid injection. Injected entheses were examined by US (both B mode and power Doppler) at baseline and 6 weeks after injection. Standard OMERACT definitions were used to define enthesitis. Achilles tendon thickness >5.29 mm, 2 cm proximal to insertion in long axis, was considered thickened. Twenty-seven symptomatic Achilles tendons (in 18 patients) were injected with 20 mg methylprednisolone under US guidance baseline, and 6-week follow-up US features were compared. All patients reported improvement in pain (VAS) in the affected tendon after injection (p < 0.0001). Simultaneously, improvement in local inflammatory changes were noted, in the form of significant reduction in tendon thickness (p < 0.0001), vascularity (p < 0.0001), peritendinous oedema (p = 0.001), bursitis and bursal vascularity (p < 0.001 and < 0.0001, respectively). There was no change in bone erosions and enthesophyte. None of the patients had tendon rupture or other injection-related complications at 6 weeks of follow-up. US-guided local corticosteroid injection is an effective and safe modality for refractory Achilles enthesitis in patients with SpA and leads to reversion of acute changes at entheseal site. PMID:26894910

  11. 跟腱Haglund病的手术治疗%Surgical Treatment of Haglund's Syndrome of the Achilles Tendon

    焦晨; 郭秦炜; 陶昊; 陈临新; 谢兴; 杨渝平; 胡跃林

    2013-01-01

    目的:研究跟腱Haglund病的手术治疗效果.方法:21例跟腱Haglund病患者保守治疗无效后采用切开或关节镜手术治疗.术前测量Fowler-Phillip角和斜平行线,术前术后分别进行VAS评分、Tegner评分和VISA-A评分.结果:术后平均随访(47.5±16.7)个月(23 ~72个月),与术前相比,VAS评分显著降低,Tegner评分和VISA-A评分显著提高,优良率95.2%.结论:跟腱Haglund病手术治疗可获得良好的临床效果,但需根据跟腱的病变情况确定采取关节镜或切开手术.%Objective To study the surgical effect of Haglund's syndrome of the Achilles tendon. Methods Twenty-one cases underwent open or arthroscopic surgical treatment. The Fowler-Phillip angle and parallel pitch line were measured preoperatively. The visual analog scale (VAS),Tegner score and VISA-A score for Achilles tendinopathy were assessed preoperatively and postoperatively. Patients were followed up for average (47.5±16.7) months (23~72 months). Results VAS,Tegner score and VISA-A score improved significantly. 95.2% of patients presented excellent or good results. Conclusion Surgical treatment for Haglund's syndrome can reach satisfactory result. It depends on the Achilles tendinopathy to choose arthroscopic or open surgery.

  12. Achilles tendon: US diagnosis of pathologic conditions. Work in progress

    Blei, C.L.; Nirschl, R.P.; Grant, E.G.

    1986-06-01

    Twenty-three patients were prospectively examined with ultra-sound (US) for acute or recurrent Achilles tendon symptoms. Three types of pathologic conditions of the Achilles tendon were found: tendinitis/tenosynovitis, acute tendon trauma, and postoperative changes. US appears to enable differentiation of these conditions and to contribute to the diagnosis of a broad range of Achilles tendon disorders.

  13. Achilles tendon: US diagnosis of pathologic conditions. Work in progress

    Twenty-three patients were prospectively examined with ultra-sound (US) for acute or recurrent Achilles tendon symptoms. Three types of pathologic conditions of the Achilles tendon were found: tendinitis/tenosynovitis, acute tendon trauma, and postoperative changes. US appears to enable differentiation of these conditions and to contribute to the diagnosis of a broad range of Achilles tendon disorders

  14. The influence of physical activity during youth on structural and functional properties of the Achilles tendon

    Lenskjold, A; Kongsgaard, M; Larsen, J O;

    2015-01-01

    Achilles tendinopathy is a highly prevalent sports injury. Animal studies show a growth response in tendons in response to loading in the immature phase but not after puberty maturation. The aim of this investigation was to examine the structural and material properties in long distance runners who...

  15. In vivo biological response to extracorporeal shockwave therapy in human tendinopathy

    CM Waugh

    2015-05-01

    Full Text Available Extracorporeal shock wave therapy (ESWT is a non-invasive treatment for chronic tendinopathies, however little is known about the in-vivo biological mechanisms of ESWT. Using microdialysis, we examined the real-time biological response of healthy and pathological tendons to ESWT. A single session of ESWT was administered to the mid-portion of the Achilles tendon in thirteen healthy individuals (aged 25.7 ± 7.0 years and patellar or Achilles tendon of six patients with tendinopathies (aged 39.0 ± 14.9 years. Dialysate samples from the surrounding peri-tendon were collected before and immediately after ESWT. Interleukins (IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-17A, vascular endothelial growth factor and interferon-γ were quantified using a cytometric bead array while gelatinase activity (MMP-2 and -9 was examined using zymography. There were no statistical differences between the biological tissue response to ESWT in healthy and pathological tendons. IL-1β, IL-2, IL-6 and IL-8 were the cytokines predominantly detected in the tendon dialysate. IL-1β and IL-2 did not change significantly with ESWT. IL-6 and IL-8 concentrations were elevated immediately after ESWT and remained significantly elevated for four hours post-ESWT (p < 0.001. Pro-forms of MMP-2 and -9 also increased after ESWT (p < 0.003, whereas there were no significant changes in active MMP forms. In addition, the biological response to ESWT treatment could be differentiated between possible responders and non-responders based on a minimum 5-fold increase in any inflammatory marker or MMP from pre- to post-ESWT. Our findings provide novel evidence of the biological mechanisms underpinning ESWT in humans in vivo. They suggest that the mechanical stimulus provided by ESWT might aid tendon remodelling in tendinopathy by promoting the inflammatory and catabolic processes that are associated with removing damaged matrix constituents. The non-response of some individuals may

  16. The pathogenesis of tendinopathy

    Magnusson, S Peter; Langberg, Henning; Kjær, Michael

    2010-01-01

    , such as tendinopathy, which is characterized by pain during activity, localized tenderness upon palpation, swelling and impaired performance. Tendon histological changes include reduced numbers and rounding of fibroblasts, increased content of proteoglycans, glycosaminoglycans and water...... injury mechanisms, thus implying that one or more 'weak links' are present in the structure. Understanding how tendon tissue adapts to mechanical loading will help to unravel the pathogenesis of tendinopathy....

  17. The Dose That Works: Low Level Laser Treatment of Tendinopathy

    Tumilty, Steve; Munn, Joanne; McDonough, Suzanne; Hurley, Deirdre A.; Basford, Jeffrey R.; David Baxter, G.

    2010-05-01

    Background: Low Level Laser Therapy (LLLT) is used in the treatment of tendon injuries. However, the clinical effectiveness of this modality remains controversial with limited agreement on the most efficacious dosage and parameter choices. Purpose: To assess the clinical effectiveness of LLLT in the treatment of tendinopathy and the validity of current dosage recommendations for treatment. Method: Medical databases were searched from inception to 1st August 2008. Controlled clinical trials evaluating LLLT as a primary intervention for any tendinopathy were included in the review. Methodological quality was classified using the PEDro scale. Appropriateness of treatment parameters were assessed using established guidelines. Results: Twenty five trials met the inclusion criteria. There was conflicting findings from multiple trials: 12 showed positive effects and 13 were inconclusive or showed no effect. Dosages used in the 12 positive studies support the existence of an effective dosage window that closely resembled current guidelines. Where pooling of data was possible, LLLT showed a positive effect size; in high quality studies of lateral epicondylitis, participants' grip strength was 9.59 Kg higher than the control group; for participants with Achilles tendinopathy, the effect was 13.6 mm less pain on a 100 mm visual analogue scale. Conclusion: This study found conflicting evidence as to the effectiveness of LLLT in the treatment of tendinopathy. However, an effective dosage window emerged showing benefit in the treatment of tendinopathy. Strong evidence exists from the 12 positive studies that positive outcomes are associated with the use of current dosage recommendations for the treatment of tendinopathy.

  18. The Dose That Works: Low Level Laser Treatment of Tendinopathy

    Background: Low Level Laser Therapy (LLLT) is used in the treatment of tendon injuries. However, the clinical effectiveness of this modality remains controversial with limited agreement on the most efficacious dosage and parameter choices. Purpose: To assess the clinical effectiveness of LLLT in the treatment of tendinopathy and the validity of current dosage recommendations for treatment. Method: Medical databases were searched from inception to 1st August 2008. Controlled clinical trials evaluating LLLT as a primary intervention for any tendinopathy were included in the review. Methodological quality was classified using the PEDro scale. Appropriateness of treatment parameters were assessed using established guidelines. Results: Twenty five trials met the inclusion criteria. There was conflicting findings from multiple trials: 12 showed positive effects and 13 were inconclusive or showed no effect. Dosages used in the 12 positive studies support the existence of an effective dosage window that closely resembled current guidelines. Where pooling of data was possible, LLLT showed a positive effect size; in high quality studies of lateral epicondylitis, participants' grip strength was 9.59 Kg higher than the control group; for participants with Achilles tendinopathy, the effect was 13.6 mm less pain on a 100 mm visual analogue scale. Conclusion: This study found conflicting evidence as to the effectiveness of LLLT in the treatment of tendinopathy. However, an effective dosage window emerged showing benefit in the treatment of tendinopathy. Strong evidence exists from the 12 positive studies that positive outcomes are associated with the use of current dosage recommendations for the treatment of tendinopathy.

  19. Further proof of the existence of a non-neuronal cholinergic system in the human Achilles tendon: Presence of the AChRα7 receptor in tendon cells and cells in the peritendinous tissue.

    Forsgren, Sture; Alfredson, Håkan; Andersson, Gustav

    2015-11-01

    Human tendon cells have the capacity for acetylcholine (ACh) production. It is not known if the tendon cells also have the potential for ACh breakdown, nor if they show expression of the nicotinic acetylcholine receptor AChRα7 (α7nAChR). Therefore, tendon tissue specimens from patients with midportion Achilles tendinopathy/tendinosis and from normal midportion Achilles tendons were examined. Reaction for the degradative enzyme acetylcholinesterase (AChE) was found in some tenocytes in only a few tendinopathy tendons, and was never found in those of control tendons. Tenocytes displayed more regularly α7nAChR immunoreactivity. However, there was a marked heterogeneity in the degree of this reaction within and between the specimens. α7nAChR immunoreactivity was especially pronounced for tenocytes showing an oval/widened appearance. There was a tendency that the magnitude of α7nAChR immunoreactivity was higher in tendinopathy tendons as compared to control tendons. A stronger α7nAChR immunoreactivity than seen for tenocytes was observed for the cells in the peritendinous tissue. It is likely that the α7nAChR may be an important part of an auto-and paracrine loop of non-neuronal ACh that is released from the tendon cells. The effects may be related to proliferative and blood vessel regulatory functions as well as features related to collagen deposition. ACh can furthermore be of importance in leading to anti-inflammatory effects in the peritendinous tissue, a tissue nowadays considered to be of great relevance for the tendinopathy process. Overall, the findings show that tendon tissue, a tissue known to be devoid of cholinergic innervation, is a tissue in which there is a marked non-neuronal cholinergic system. PMID:25981114

  20. Percutaneous Achilles Tendon Lengthening

    ... require a more complex lengthening surgery. ​ Extent of ankle mobility before Achilles lengthening surgery . General Details of Procedure ... with strength and range of motion. ​ Extent of ankle mobility after Achilles lengthening surgery . Potential Complications There are ...

  1. Achilles tendon healing

    This paper reports on symptomatic Achilles tendon abnormalities (rupture, tendinitis) evaluated with MR imaging during the healing phase after either surgical or conservative treatment. A total of 21 patients were studied. Fifteen of 21 underwent surgery (13 tendon ruptures) and six were managed conservatively (one rupture). MR studies were obtained before treatment in 11, at 3 months in eight, at 6 months in seven, and at 12 months in 12. The 1.5-T spin-echo and gradient-echo images were correlated with clinical results, planter reflex response times, and calf force measurements. Sequential T2 times were obtained from representative levels in the tendons

  2. Minimally Invasive Approach to Achilles Tendon Pathology.

    Hegewald, Kenneth W; Doyle, Matthew D; Todd, Nicholas W; Rush, Shannon M

    2016-01-01

    Many surgical procedures have been described for Achilles tendon pathology; however, no overwhelming consensus has been reached for surgical treatment. Open repair using a central or paramedian incision allows excellent visualization for end-to-end anastomosis in the case of a complete rupture and detachment and reattachment for insertional pathologies. Postoperative wound dehiscence and infection in the Achilles tendon have considerable deleterious effects on overall functional recovery and outcome and sometimes require plastic surgery techniques to achieve coverage. With the aim of avoiding such complications, foot and ankle surgeons have studied less invasive techniques for repair. We describe a percutaneous approach to Achilles tendinopathy using a modification of the Bunnell suture weave technique combined with the use of interference screws. No direct end-to-end repair of the tendon is performed, rather, the proximal stump is brought in direct proximity of the distal stump, preventing overlengthening and proximal stump retraction. This technique also reduces the suture creep often seen with end-to-end tendon repair by providing a direct, rigid suture to bone interface. We have used the new technique to minimize dissection and exposure while restoring function and accelerating recovery postoperatively. PMID:26385574

  3. Distal posterior tibial artery perforator flaps for the management of calcaneal and Achilles tendon injuries in diabetic and non-diabetic patients

    Ioannis A. Ignatiadis

    2011-08-01

    Full Text Available Management of Achilles tendon and heel area defects is a common challenge for the reconstructive surgeon due to the lack of soft tissue availability in that region. In this article, we present our experience in covering these defects by using the distal perforator propeller flaps based on the posterior tibial artery. Perforator flaps are based on cutaneous, small diameter vessels that originate from a main pedicle and perforate the fascia or muscle to reach the skin. Their development has followed the understanding of the blood supply from a source artery to the skin. Six patients (five males and one female underwent reconstruction by using the posterior tibial artery distal perforator flap for covering defects in the distal Achilles tendon region in patients with and without diabetes mellitus. Postoperative complications included a hypertrophic scar formation in one patient, partial marginal flap necrosis in another patient, and a wound infection in a third patient. All wounds were eventually healed by the last postoperative visit. In conclusion, perforator flaps based on the distal posterior tibial artery may be a reliable option for the coverage of small to moderate size defects of the Achilles tendon and heel area regions.

  4. Cross-cultural Adaptation and Validation of the Victorian Institute of Sport Assessment-Patella Questionnaire for French-Speaking Patients With Patellar Tendinopathy.

    Kaux, Jean-François; Delvaux, François; Oppong-Kyei, Julian; Beaudart, Charlotte; Buckinx, Fanny; Croisier, Jean-Louis; Forthomme, Bénédicte; Crielaard, Jean-Michel; Bruyère, Olivier

    2016-05-01

    Study Design Clinical measurement study. Background The Victorian Institute of Sport Assessment-Patella (VISA-P), originally developed in English, assesses the severity of patellar tendinopathy symptoms. To date, no French version of the questionnaire exists. Objectives The aim of our study was to translate the VISA-P into French and verify its psychometric properties. Methods The translation and cultural adaptation were performed according to international recommendations in 6 steps: initial translation, translation merging, back translation to the original language, use of an expert committee to reach a prefinal version, test of the prefinal version, and expert committee appraisal of a final version. Afterward, the psychometric properties of the final French version (VISA-PF) were assessed in 92 subjects, divided into 3 groups: pathological subjects (n = 28), asymptomatic subjects (n = 22), and sports-risk subjects (n = 42). Results All members of the expert committee agreed with the final version. On a scale ranging from 0 to 100, with 100 representing an asymptomatic subject, the average ± SD scores on the VISA-PF were 53 ± 17 for the pathological group, 99 ± 2 for the healthy group, and 86 ± 14 for the sports-risk group. The test-retest reliability of the VISA-PF was excellent, with good internal consistency. Correlations between the VISA-PF and divergent validity of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were low, and the correlation coefficient values measured between the VISA-PF scores and converged items of the SF-36 were higher. Conclusion The VISA-PF is understandable, valid, and suitable for French-speaking patients with patellar tendinopathy. J Orthop Sports Phys Ther 2016;46(5):384-390. Epub 21 Mar 2016. doi:10.2519/jospt.2016.5937. PMID:26999409

  5. Tendinopatia patelar Patellar tendinopathy

    Moisés Cohen

    2008-08-01

    results in small lesions that may, when chronic, lead to tendinosis specially in the lower pole of the patella. Pain in the anterior region of the knee is the first symptom reported by the patient with this disease. The beginning is insidious and gradual, mainly after physical activity, but with the progression of the disease, pain may be frequent during or already in the beginning of the activity. The diagnosis of patellar tendinopathy is eminently clinical, characterized by pain when palpating the lower pole of the patella and adjacent areas. In more advanced cases, a palpable nodule and associated edema may be visualized. Supplemental exams, such as X-ray, ultrasound, and MRI help in the diagnosis. Ultrasound and MRI are the best indications, as they may define the exact location of the lesion, its extension, and also identify whether or not degenerating changes are present, MRI providing the best resolution. Initial tendinopathy treatment is clinical, with relative rest, correction of etiologic factors, cryotherapies and physiotherapy. The use of pain killers and anti-inflammatory drugs is controverted. For those cases that do not respond to clinical treatment, surgical is an option, and the literature brings several techniques with varying rates of good results.

  6. Minimally invasive surgery for Achilles tendon pathologies

    Nicola Maffulli

    2010-07-01

    Full Text Available Nicola Maffulli1, Umile Giuseppe Longo2, Filippo Spiezia2, Vincenzo Denaro21Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, London, England; 2Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University, Rome, ItalyAbstract: Minimally invasive trauma and orthopedic surgery is increasingly common, though technically demanding. Its use for pathologies of the Achilles tendon (AT hold the promise to allow faster recovery times, shorter hospital stays, and improved functional outcomes when compared to traditional open procedures, which can lead to difficulty with wound healing because of the tenuous blood supply and increased chance of wound breakdown and infection. We present the recent advances in the field of minimally invasive AT surgery for tendinopathy, acute ruptures, chronic tears, and chronic avulsions of the AT. In our hands, minimally invasive surgery has provided similar results to those obtained with open surgery, with decreased perioperative morbidity, decreased duration of hospital stay, and reduced costs. So far, the studies on minimally invasive orthopedic techniques are of moderate scientific quality with short follow-up periods. Multicenter studies with longer follow-up are needed to justify the long-term advantages of these techniques over traditional ones.Keywords: tendinopathy, rupture, percutanous repair, less invasive

  7. Injection treatments for patellar tendinopathy

    van Ark, Mathijs; Zwerver, Johannes; van den Akker-Scheek, Inge

    2011-01-01

    Objective Injection treatments are increasingly used as treatment for patellar tendinopathy. The aim of this systematic review is to describe the different injection treatments, their rationales and the effectiveness of treating patellar tendinopathy. Methods A computerised search of the Medline, Em

  8. Platelet Rich Plasma for Treating Chronic Tendinopathy

    Kaux, Jean-François

    2016-01-01

    Tendinopathy is a major problem in medicine and sports traumatology. It is due, inter alia, to mechanical overload. It remains a challenge for the medical world to the extent that its frequent resistance to conventional treatments never promises the patient a favourable response following therapeutic management. The development of platelet-rich plasma (PRP) is a new hope when therapeutic treatments such as NSAIDs, corticosteroid injections, eccentric rehabilitation, shock waves, etc. have sho...

  9. Obesity as a Risk Factor for Tendinopathy: A Systematic Review

    Francesco Franceschi

    2014-01-01

    Full Text Available Purpose. In the last few years, evidence has emerged to support the possible association between increased BMI and susceptibility to some musculoskeletal diseases. We systematically review the literature to clarify whether obesity is a risk factor for the onset of tendinopathy. Methods. We searched PubMed, Cochrane Central, and Embase Biomedical databases using the keywords “obesity,” “overweight,” and “body mass index” linked in different combinations with the terms “tendinopathy,” “tendinitis,” “tendinosis,” “rotator cuff,” “epicondylitis,” “wrist,” “patellar,” “quadriceps,” “Achilles,” “Plantar Fascia,” and “tendon.” Results. Fifteen studies were included. No level I study on this subject was available, and the results provided are ambiguous. However, all the 5 level II studies report the association between obesity measured in terms of BMI and tendon conditions, with OR ranging between 1.9 (95% CI: 1.1–2.2 and 5.6 (1.9–16.6. Conclusions. The best evidence available to date indicates that obesity is a risk factor for tendinopathy. Nevertheless, further studies should be performed to establish the real strength of the association for each type of tendinopathy, especially because the design of the published studies does not allow identifying a precise cause-effect relationship and the specific role of obesity independently of other metabolic conditions.

  10. Reconstruction of neglected traumatic Achilles tendon rupture in a young girl

    Tudisco, C; Bisicchia, S.

    2012-01-01

    Posttraumatic neglected Achilles tendon ruptures in a young patient have not been described in the literature to our knowledge; indeed, neglected ruptures of the Achilles tendon have only rarely been described in adults. We present the case of a 7 year old girl with posttraumatic neglected rupture of the Achilles tendon that was operated on 8 weeks after the trauma.

  11. 自体富含血小板血浆痛点注射治疗慢性跟腱炎15例分析%Platelet-rich plasma trigger point injection treatment for chronic achilles insertion tendonitis

    邹国友; 贾伟涛; 郑闽前; 徐小卒; 曹正春; 殷俊; 吴亚

    2013-01-01

    Retrospective analysis was performed for the clinical data of 15 chronic insertion achilles tendinitis patients undergoing platelet-rich plasma (PRP) trigger point injection.The scores of Validated Victorian Institute of Sports Assessment-Achilles (VAS-A) and foot function index (FFI) improved greatly versus pre-treatment (all P < 0.05).Tendon insertion structure inflammation decreased significantly on magnetic resonance imaging.At the last follow-up,all patients recovered normal gait and daily activity.The trigger point injection of PRP is efficacious for chronic insertion achilles tendinopathy.%回顾分析15例慢性跟腱炎采用自体富含血小板血浆(PRP)痛点注射治疗患者的临床资料.每例患者3~5个痛点共注射2 ml PRP[血小板浓度为(1643±180)×109/L],治疗后维多利亚医学院跟腱评分和足功能指数(FFI)与治疗前相比差异有统计学意义(均P<0.05);MRI显示跟腱炎周围的软组织炎症明显改善;患者恢复了正常步态和日常活动能力.

  12. Achilles tendon Total Rupture Score at 3 months can predict patients' ability to return to sport 1 year after injury

    Hansen, Maria Swennergren; Christensen, Marianne; Budolfsen, Thomas;

    2016-01-01

    PURPOSE: To investigate how the Achilles tendon Total Rupture Score (ATRS) at 3 months and 1 year after injury is associated with a patient's ability to return to work and sports as well as to investigate whether sex and age influence ATRS after 3 months and 1 year. METHOD: This is a retrospective...... study analysing the data from the Danish Achilles tendon Database. A total of 366 patients were included. Logistic regression was conducted to describe the effect of ATRS on return to work and sports. The effect of age and sex on ATRS was analysed by linear regression. RESULTS: Three months after injury...... patients had a significantly increased chance of return to sport after 1 year with an increased ATRS (OR 1.06, p = 0.001) but a non-significant effect on return to work. After 1 year, patients had a significantly increased probability of having returned to sport (OR 1.11, p < 0.001) and also having...

  13. Mesh Achilles tendon lengthening--a new method to treat equinus deformity in patients with spastic cerebral palsy: surgical technique and early results.

    Lin, Cheng-Li; Lin, Chii-Jeng; Huang, Ming-Tung; Su, Wei-Ren; Wu, Tung-Tai

    2013-01-01

    Equinus of the ankle is a common deformity in spastic cerebral palsy. Many methods have been developed to lengthen the Achilles tendon to correct the deformity. A new mesh Achilles tendon lengthening (ATL) procedure that might decrease immobilization and promote recovery was performed in 36 tendons with equinus deformity (22 patients, average age=6.2). The results were compared with those of two other methods: the Vulpius group and the Z-lengthening group. The corrected dorsiflexion angle of the ankle at a subsequent 2-year follow-up of the mesh ATL and Vulpius groups matched (25.5±3.0 and 27.1±3.5°, respectively), whereas that of the Z-lengthening group was higher (33.9±3.8°). Nevertheless, statistics of the timing of each patient's readiness to begin rehabilitation and walking as well as gaining better stability for running and one-legged hopping indicated that the mesh ATL group recovered significantly quicker than the Vulpius and Z-lengthening groups. The mesh ATL procedure achieves a successful correction of the equinus deformity in spastic cerebral palsy comparable with that of the Vulpius procedure, with the advantage of preserving the gastrocnemius without a complete section. This confers greater antigravity stability and quicker recovery in patients. PMID:23192252

  14. One-year follow-up of platelet-rich plasma infiltration to treat chronic proximal patellar tendinopathies

    Kaux, Jean-François; Bruyère, Olivier; Croisier, Jean-Louis; Forthomme, Bénédicte; Le Goff, Caroline; Crielaard, Jean-Michel

    2015-01-01

    Introduction: Infiltration of Platelet-Rich Plasma (PRP) may be considered as a recent therapeutic option for chronic tendinopathies. The aim of this study is to evaluate the clinical status and the return to sports activities in patients with chronic upper patellar tendinopathies. Material and methods : Twenty subjects with chronic upper patellar tendinopathy benefited from 1 infiltration of PRP. The follow-up (up to 1 year) was assessed by means of a Visual Anologue Scale (VAS), t...

  15. Critical review on the socio-economic impact of tendinopathy

    Chelsea Hopkins

    2016-04-01

    Full Text Available There are currently no studies that determine the total burden that tendinopathy places on patients and society. A systematic search was conducted to understand the impact of tendinopathy. It demonstrated that the current prevalence is underestimated, particularly in active populations, such as athletes and workers. Search results demonstrate that due to the high prevalence, impact on patients' daily lives and the economic impact due to work-loss, treatments are significantly higher than currently observed. A well-accepted definition by medical professionals and the public will improve documentation and increase awareness, in order to better tackle the disease burden.

  16. BET 2: Do fluoroquinolones increase the incidence of tendinopathy?

    Baombe, Janos P; Ford, Rebecca

    2016-07-01

    A shortcut review of the literature was carried out to establish whether the use of fluoroquinolones was associated with an increased risk of tendinopathy in adult patients. 10 trials were found to be directly relevant to the three-part question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that there is an association between the use of fluoroquinolones and a broad range of tendinopathies. PMID:27330182

  17. Creating an Animal Model of Tendinopathy by Inducing Chondrogenic Differentiation with Kartogenin.

    Ting Yuan

    Full Text Available Previous animal studies have shown that long term rat treadmill running induces over-use tendinopathy, which manifests as proteoglycan accumulation and chondrocytes-like cells within the affected tendons. Creating this animal model of tendinopathy by long term treadmill running is however time-consuming, costly and may vary among animals. In this study, we used a new approach to develop an animal model of tendinopathy using kartogenin (KGN, a bio-compound that can stimulate endogenous stem/progenitor cells to differentiate into chondrocytes. KGN-beads were fabricated and implanted into rat Achilles tendons. Five weeks after implantation, chondrocytes and proteoglycan accumulation were found at the KGN implanted site. Vascularity as well as disorganization in collagen fibers were also present in the same site along with increased expression of the chondrocyte specific marker, collagen type II (Col. II. In vitro studies confirmed that KGN was released continuously from KGN-alginate in vivo beads and induced chondrogenic differentiation of tendon stem/progenitor cells (TSCs suggesting that chondrogenesis after KGN-bead implantation into the rat tendons is likely due to the aberrant differentiation of TSCs into chondrocytes. Taken together, our results showed that KGN-alginate beads can be used to create a rat model of tendinopathy, which, at least in part, reproduces the features of over-use tendinopathy model created by long term treadmill running. This model is mechanistic (stem cell differentiation, highly reproducible and precise in creating localized tendinopathic lesions. It is expected that this model will be useful to evaluate the effects of various topical treatments such as NSAIDs and platelet-rich plasma (PRP for the treatment of tendinopathy.

  18. Creating an Animal Model of Tendinopathy by Inducing Chondrogenic Differentiation with Kartogenin.

    Yuan, Ting; Zhang, Jianying; Zhao, Guangyi; Zhou, Yiqin; Zhang, Chang-Qing; Wang, James H-C

    2016-01-01

    Previous animal studies have shown that long term rat treadmill running induces over-use tendinopathy, which manifests as proteoglycan accumulation and chondrocytes-like cells within the affected tendons. Creating this animal model of tendinopathy by long term treadmill running is however time-consuming, costly and may vary among animals. In this study, we used a new approach to develop an animal model of tendinopathy using kartogenin (KGN), a bio-compound that can stimulate endogenous stem/progenitor cells to differentiate into chondrocytes. KGN-beads were fabricated and implanted into rat Achilles tendons. Five weeks after implantation, chondrocytes and proteoglycan accumulation were found at the KGN implanted site. Vascularity as well as disorganization in collagen fibers were also present in the same site along with increased expression of the chondrocyte specific marker, collagen type II (Col. II). In vitro studies confirmed that KGN was released continuously from KGN-alginate in vivo beads and induced chondrogenic differentiation of tendon stem/progenitor cells (TSCs) suggesting that chondrogenesis after KGN-bead implantation into the rat tendons is likely due to the aberrant differentiation of TSCs into chondrocytes. Taken together, our results showed that KGN-alginate beads can be used to create a rat model of tendinopathy, which, at least in part, reproduces the features of over-use tendinopathy model created by long term treadmill running. This model is mechanistic (stem cell differentiation), highly reproducible and precise in creating localized tendinopathic lesions. It is expected that this model will be useful to evaluate the effects of various topical treatments such as NSAIDs and platelet-rich plasma (PRP) for the treatment of tendinopathy. PMID:26848746

  19. Acetabular anteversion is associated with gluteal tendinopathy at MRI

    Moulton, Kyle M. [University of Saskatchewan, Department of Medical Imaging, Saskatoon, SK (Canada); Royal University Hospital, Department of Medical Imaging, Saskatoon, SK (Canada); Aly, Abdel-Rahman [University of Saskatchewan, Department of Physical Medicine and Rehabilitation, Saskatoon, SK (Canada); Rajasekaran, Sathish [Health Pointe - Pain, Spine and Sport Medicine, Edmonton, AB (Canada); Shepel, Michael; Obaid, Haron [University of Saskatchewan, Department of Medical Imaging, Saskatoon, SK (Canada)

    2015-01-15

    Gluteal tendinopathy and greater trochanteric pain syndrome (GTPS) remain incompletely understood despite their pervasiveness in clinical practice. To date, no study has analyzed the morphometric characteristics of the hip on magnetic resonance imaging (MRI) that may predispose to gluteal tendinopathy. This study aimed to evaluate whether acetabular anteversion (AA), femoral neck anteversion (FNA), and femoral neck-shaft angle (FNSA) are associated with MRI features of gluteal tendinopathy. A total of 203 MRI examinations of the hip met our inclusion and exclusion criteria. A single blinded investigator measured AA, FNA, and FNSA according to validated MRI techniques. Two blinded subspecialty-trained musculoskeletal radiologists then independently evaluated the presence of gluteal tendinosis, trochanteric bursitis, and subgluteal bursitis. Statistical analysis was performed using a one-way analysis of variance (ANOVA; post-hoc Tukey's range test). At MRI, 57 patients had gluteal tendinosis with or without bursitis, 26 had isolated trochanteric bursitis, and 11 had isolated subgluteal bursitis. AA was significantly (p = 0.01) increased in patients with MRI evidence of gluteal tendinosis with or without bursitis [mean: 18.4 , 95 % confidence interval (CI): 17.2 -19.6 ] compared with normal controls (mean: 15.7 , 95 % CI: 14.7 -16.8 ). Similarly, AA was significantly (p = 0.04) increased in patients with isolated trochanteric bursitis (mean: 18.8 , 95 % CI: 16.2 -21.6 ). No association was found between FNA or FNSA and the presence of gluteal tendinopathy. Interobserver agreement for the presence and categorization of gluteal tendinopathy was very good (kappa = 0.859, 95 % CI: 0.815-0.903). Our MRI study suggests that there is an association between increased AA and gluteal tendinopathy, which supports a growing body of evidence implicating abnormal biomechanics in the development of this condition. (orig.)

  20. Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in Its Management.

    Grimaldi, Alison; Fearon, Angela

    2015-11-01

    Synopsis Gluteal tendinopathy is now believed to be the primary local source of lateral hip pain, or greater trochanteric pain syndrome, previously referred to as trochanteric bursitis. This condition is prevalent, particularly among postmenopausal women, and has a considerable negative influence on quality of life. Improved prognosis and outcomes in the future for those with gluteal tendinopathy will be underpinned by advances in diagnostic testing, a clearer understanding of risk factors and comorbidities, and evidence-based management programs. High-quality studies that meet these requirements are still lacking. This clinical commentary provides direction to assist the clinician with assessment and management of the patient with gluteal tendinopathy, based on currently limited available evidence on this condition and the wider tendon literature and on the combined clinical experience of the authors. J Orthop Sports Phys Ther 2015;45(11):910-922. Epub 17 Sep 2015. doi:10.2519/jospt.2015.5829. PMID:26381486

  1. Achilles tendon of wistar rats treated with laser therapy and eccentric exercise

    Maria Verônica de Souza

    2015-10-01

    Full Text Available ABSTRACTIntroduction:Both laser therapy and eccentric exercises are used in tendon injuries. However, the association of these physiotherapeutic modalities is yet little investigated.Objective:To evaluate the effect of low-level laser therapy associated to eccentric exercise (downhill walking on Achilles tendinopathy of Wistar rats.Method:Eighteen Achilles tendon from 15 adult male Wistar rats were used. Tendons were distributed in six groups (laser, eccentric exercise, laser and eccentric exercise, rest, contralateral tendon, and healthy tendon. Unilateral tendinopathy was surgically induced by transversal compression followed by scarification of tendon fibers. The treatments laser therapy (904 nm, 3J/cm² and/or eccentric exercise (downhill walking; 12 m/min; 50 min/day; 15o inclination treadmill began 24 hours after surgery and remained for 20 days. Clinical and biomechanical analyzes were conducted. Achilles tendon was macroscopically evaluated and the transversal diameter measured. Euthanasia was performed 21 days after lesion induction. Tendons of both limbs were collected and frozen at -20°C until biomechanical analysis, on which the characteristic of maximum load (N, stress at ultimate (MPa and maximum extension (mm were analyzed.Results:Swelling was observed within 72 hours postoperative. No fibrous adhesions were observed nor increase in transversal diameter of tendons. Animals with the exercised tendons, but not treated with laser therapy, presented lower (p=0.0000 locomotor capacity. No difference occurred be-tween groups for the biomechanical characteristics maximum load (p=0.4379, stress at ultimate (p=0.4605 and maximum extension (p=0.3820 evaluated, even considering healthy and contralateral tendons.Conclusion:The concomitant use of low-level laser and the eccentric exercise of downhill walking, starting 24 hours after surgically induced tendinopathy, do not result in a tendon with the same biomechanical resistance or elasticity

  2. Tendinitis: the achilles heel of quinolones!

    Shortt, P; Wilson, R.; Erskine, I

    2006-01-01

    We present a case series of two patients who presented to the emergency department with spontaneous bilateral Achilles tendon rupture associated with the use of ciprofloxacin. Tendinitis and tendon rupture are now well recognised but rare complications of treatment with quinolone antimicrobials. The emergency department is an important setting for both surveillance and detection of adverse events associated with drug treatment.

  3. STRENGTH EXERCISES COMBINED WITH DRY NEEDLING WITH ELECTRICAL STIMULATION IMPROVE PAIN AND FUNCTION IN PATIENTS WITH CHRONIC ROTATOR CUFF TENDINOPATHY: A RETROSPECTIVE CASE SERIES

    2016-01-01

    ABSTRACT Background and Purpose Rotator cuff tendinopathy (RTCT) is regularly treated by the physical therapist. Multiple etiologies for RTCT exist, leading an individual to seek treatment from their provider of choice. Strengthening exercises (SE) have been reported to be effective in the treatment of RTCT, but there is limited evidence on the effectiveness of dry needing (DN) for this condition. The purpose of this retrospective case series was to investigate DN to various non-trigger point-based anatomical locations coupled with strengthening exercises (SE) as a treatment strategy to decrease pain and increase function in healthy patients with chronic RTC pathology. Case Descriptions Eight patients with RTCT were treated 1-2 times per week for up to eight weeks, and no more than sixteen total treatment sessions of SE and DN. Outcomes were tested at baseline and upon completion of therapy. A long-term outcome measure follow up averaging 8.75 months (range 3 to 20 months) was also performed. The outcome measures included the Visual Analog Scale (VAS) and the Quick Dash (QD). Outcomes Clinically meaningful improvements in disability and pain in the short term and upon long-term follow up were demonstrated for each patient. The mean VAS was broken down into best (VASB), current (VASC), and worst (VASW) rated pain levels and the mean was calculated for the eight patients. The mean VASB improved from 22.5 mm at the initial assessment to 2.36 mm upon completion of the intervention duration. The mean VASC improved from 28.36 mm to 5.0 mm, and the mean VASW improved from 68.88 mm to 13.25 mm. At the long-term follow up (average 8.75 months), The mean VASB, VASC, and VASW scores were 0.36 mm, 4.88 mm, and 17.88 mm respectively. The QDmean for the eight patients improved from 43.09 at baseline to 16.04 at the completion of treatment. At long-term follow-up, the QDmean was 6.59. Conclusion Clinically meaningful improvements in pain and disability were

  4. Platelet-Rich Fibrin Promotes an Accelerated Healing of Achilles Tendon When Compared to Platelet-Rich Plasma in Rat

    Dietrich, Franciele; L. Duré, Gustavo; P. Klein, Caroline; F. Bampi, Vinícius; V. Padoin, Alexandre; D. Silva, Vinícius; Braga-Silva, Jefferson

    2015-01-01

    BACKGROUND Autologous platelet concentrate has been used to improve the function and regeneration of injured tissues. Tendinopathies are common in clinical practice, although long-term treatment is required. On the basis of lead time, we compared the effect of using platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in repairing rat Achilles tendon. METHODS The effectiveness of using PRP and PRF was evaluated after 14 and 28 postoperative days by histological analysis. The quantificati...

  5. Spectrum of Ultrasound Pathologies of Achilles Tendon, Plantar Aponeurosis and Flexor Digiti Brevis Tendon Heel Entheses in Patients with Clinically Suspected Enthesitis

    Enthesitis is considered a characteristic presentation of the second most common group of rheumatoid disorders, i.e. spondyloarthropathies (SpAs), particularly peripheral spondyloarthropathies. At the initial stages, enthesitis may be the only symptom of SpA, particularly in patients lacking the HLA-B27 receptor. In light of diagnostic difficulties with detecting enthesitis in clinical examinations and laboratory investigations, many studies point out the high specificity of imaging studies, and particularly ultrasonography. A total of 20% Achilles tendon entheses, 45% plantar aponeurosis entheses and 89.5% of flexor digiti brevis tendon entheses were unremarkable. In the remaining cases, the presentation of pathological lesions was not specific to enthesitis and might more likely correspond to degeneration or microinjuries of the entheses, beside the most obvious cases of achillobursitis or Kager’s fat pad inflammation. The studies demonstrated that ultrasound scans rarely confirm the clinical diagnosis of enthesitis

  6. Ossification of the bilateral Achilles tendon: a rare entity

    Ossification of the Achilles tendon is a rare clinical entity comprising of one or more segments of variable sized ossified masses in the fibrocartilaginous substance of the tendon. The etiology of ossification of the Achilles tendon is multifactorial with recurrent trauma and surgery comprising major predisposing factors, with others being metabolic, systemic, and infectious diseases. The possibility of a genetic predisposition towards this entity has also been raised, but has not yet been proven. We present a rare case of ossification of the bilateral Achilles tendons without any history of trauma or surgery in a 48-year-old female patient

  7. Gene expression analysis in calcific tendinopathy of the rotator cuff

    F Oliva

    2011-06-01

    Full Text Available We evaluated the expression of several genes involved in tissue remodelling and bone development in patients with calcific tendinopathy of the rotator cuff. Biopsies from calcified and non-calcified areas were obtained from 10 patients (8 women and 2 men; average age: 55 years; range: 40-68 with calcific tendinopathy of the rotator cuff. To evaluate the expression of selected genes, RNA extraction, cDNA synthesis and quantitative polymerase chain reaction (PCR were performed. A significantly increased expression of tissue transglutaminase (tTG2 and its substrate, osteopontin, was detected in the calcific areas compared to the levels observed in the normal tissue from the same subject with calcific tendinopathy, whereas a modest increase was observed for catepsin K. There was also a significant decrease in mRNA expression of Bone Morphogenetic Protein (BMP4 and BMP6 in the calcific area. BMP-2, collagen V and vascular endothelial growth factor (VEGF did not show significant differences. Collagen X and matrix metalloproteinase (MMP-9 were not detectable. A variation in expression of these genes could be characteristic of this form tendinopathy, since an increased level of these genes has not been detected in other forms of tendon lesions.

  8. Photoacoustic microscopy of collagenase-induced Achilles tendinitis in a mouse model

    Wang, Po-Hsun; Chen, Wen-Shiang; Li, Meng-Lin

    2010-02-01

    Assessments of vascularity are important when assessing inflammation changes in tendon injuries since Achilles tendinitis is often accompanied with neovascularization or hypervascularity. In this study, we have investigated the feasibility of photoacoustic imaging in noninvasive monitoring of morphological and vascular changes in Achilles tendon injuries. Collagenase-induced Achilles tendinitis model of mice was adopted here. During collagenase-induced tendinitis, a 25-MHz photoacoustic microscopy (PAM) was used to image micro-vascular changes in Achilles tendons longitudinally up to 23 days. The positions of vessels imaged by PAM were identified by co-registration of PAM Bmode images with 25-MHz ultrasound (USM) ones. Morphological changes in Achilles tendons due to inflammation and edema were revealed by the PAM and USM images. Proliferation of new blood vessels within the tendons was also observed. Observed micro-vascular changes during tendinitis were similar to the findings in the literatures. This study demonstrates that photoacoustic imaging, owning required sensitivity and penetration, has the potential for high sensitive diagnosis and assessment of treatment performance in tendinopathy.

  9. Validity and Reliability of the Achilles Tendon Total Rupture Score

    Ganestam, Ann; Barfod, Kristoffer; Klit, Jakob;

    2013-01-01

    The best treatment of acute Achilles tendon rupture remains debated. Patient-reported outcome measures have become cornerstones in treatment evaluations. The Achilles tendon total rupture score (ATRS) has been developed for this purpose but requires additional validation. The purpose of the present...... study was to validate a Danish translation of the ATRS. The ATRS was translated into Danish according to internationally adopted standards. Of 142 patients, 90 with previous rupture of the Achilles tendon participated in the validity study and 52 in the reliability study. The ATRS showed moderately...... strong correlations with the physical subscores of the Medical Outcomes Study 36-item Short-Form Health Survey (r = .70 to .75; p <.0001) and Victorian Institute of Sports Assessment-Achilles questionnaire (r = .71; p <.0001). Test-retest of the ATRS showed no significant difference in the mean (2.41; p...

  10. Effects of Low-Level Laser Therapy and Eccentric Exercises in the Treatment of Patellar Tendinopathy

    Xiao-Guang Liu; Lin Cheng; Ji-Mei Song

    2014-01-01

    The study aims to investigate if low-level laser therapy (LLLT) combined with eccentric exercises could more effectively treat patellar tendinopathy than LLLT alone and eccentric exercises alone. Twenty-one patients with patellar tendinopathy were randomized to three groups: laser alone, exercise alone, or laser plus exercise, with seven in each group. Laser irradiations were administered at the inferior pole of the patella and the two acupoints of Extra 36 (Xiyan) with the intensity of 1592 ...

  11. Platelet-rich plasma to treat patellar tendinopathies: a 1 year follow-up.

    Kaux, Jean-François; Croisier, Jean-Louis; Bruyère, Olivier; Forthomme, Bénédicte; Le Goff, Caroline; Gothot, André; DELCOUR, Sandra; Crielaard, Jean-Michel

    2014-01-01

    Background: Jumper’s knee is a frequent chronic overuse syndrome of the upper part of the patellar tendon. Platelets contain lots of growth factors which could enhance the healing process of tendons. Infiltration of Platelet Rich Plasma (PRP) may be considered as a recent therapeutic option for chronic tendinopathies. The aim of the current study is to evaluate the clinical status and the return to sports activities in patients with chronic upper patellar tendinopathies up to 1 year after 1 ...

  12. Colour doppler ultrasonography and sclerosing therapy in diagnosis and treatment of tendinopathy in horses-a research model for human medicine

    Boesen, Morten Ilum; Nanni, Simone; Langberg, Henning;

    2007-01-01

    diagnosed chronic tendinopathy and to test if experience from human studies could be extrapolated to horses. Special interest was focused on the treatment with sclerosing therapy and whether we could obtain the same successful peroperative findings as in humans. Four horses with clinically diagnosed...... intratendinous neovascularisation in the affected limb but not in the contralateral limb. The CD findings had the same appearance as seen in human Achilles tendons with chronic tendinopathy. In all cases the intratendinous neovascularisation was successfully "shut down" peroperatively. The horses showed no signs...... of discomfort or worsening of symptoms during the short follow-up period after the procedure. The results indicate that the promising results from human medicine might be transferred to treatment of horses with chronic tendinopathy. In the future it will hopefully be possible to use the model from...

  13. IL-17A mediates inflammatory and tissue remodelling events in early human tendinopathy.

    Millar, Neal L; Akbar, Moeed; Campbell, Abigail L; Reilly, James H; Kerr, Shauna C; McLean, Michael; Frleta-Gilchrist, Marina; Fazzi, Umberto G; Leach, William J; Rooney, Brian P; Crowe, Lindsay A N; Murrell, George A C; McInnes, Iain B

    2016-01-01

    Increasingly, inflammatory mediators are considered crucial to the onset and perpetuation of tendinopathy. We sought evidence of interleukin 17A (IL-17A) expression in early human tendinopathy and thereafter, explored mechanisms whereby IL-17A mediated inflammation and tissue remodeling in human tenocytes. Torn supraspinatus tendon (established pathology) and matched intact subscapularis tendon (representing 'early pathology') along with control biopsies were collected from patients undergoing shoulder surgery. Markers of inflammation and IL-17A were quantified by RT-PCR and immunohistochemistry. Human tendon cells were derived from hamstring tendon obtained during ACL reconstruction. In vitro effects of IL-17A upon tenocytes were measured using RT-PCR, multiplex cytokine assays, apoptotic proteomic profiling, immunohistochemistry and annexin V FACS staining. Increased expression of IL-17A was detected in 'early tendinopathy' compared to both matched samples and non-matched control samples (p tendinopathy processes thus providing novel therapeutic approaches in the management of tendon disorders. PMID:27263531

  14. The pathogenesis of tendinopathy. A molecular perspective

    Riley, GP

    2003-01-01

    There are many publications that discuss the aetiology, diagnosis and treatment of the various forms of tendinopathy, but few are based on conclusive scientific evidence. The pathogenesis of tendinopathy is difficult to study because tendon biopsies are rarely obtained before a tendon has ruptured. There are interesting comparisons with animal tendinopathy, particularly in the equine athlete, although many animal models do not accurately reflect the human condition—the tendon lesions usually ...

  15. Advanced Ultrasound-Guided Interventions for Tendinopathy.

    Peck, Evan; Jelsing, Elena; Onishi, Kentaro

    2016-08-01

    Tendinopathy is increasingly recognized as an important cause of musculoskeletal pain and disability. Tendinopathy is thought to be principally a degenerative process, rather than inflammatory as was traditionally believed. Consequently, traditional tendinopathy treatments focused solely on decreasing inflammation have often been ineffective or even harmful. The advancement of ultrasonography as for guidance of outpatient musculoskeletal procedures has facilitated the development of novel percutaneous procedures for the treatment of tendinopathy, mostly by using mechanical intervention to stimulate regeneration. Several of these techniques, including percutaneous needle tenotomy, percutaneous ultrasonic tenotomy, high-volume injection, and percutaneous needle scraping, are reviewed in this article. PMID:27468675

  16. Validity and reliability of the Dutch translation of the VISA-P questionnaire for patellar tendinopathy

    van den Akker-Scheek Inge

    2009-08-01

    Full Text Available Abstract Background The VISA-P questionnaire evaluates severity of symptoms, knee function and ability to play sports in athletes with patellar tendinopathy. This English-language self-administered brief patient outcome score was developed in Australia to monitor rehabilitation and to evaluate outcome of clinical studies. Aim of this study was to translate the questionnaire into Dutch and to study the reliability and validity of the Dutch version of the VISA-P. Methods The questionnaire was translated into Dutch according to internationally recommended guidelines. Test-retest reliability was determined in 99 students with a time interval of 2.5 weeks. To determine discriminative validity of the Dutch VISA-P, 18 healthy students, 15 competitive volleyball players (at-risk population, 14 patients with patellar tendinopathy, 6 patients who had surgery for patellar tendinopathy, 17 patients with knee injuries other than patellar tendinopathy, and 9 patients with symptoms unrelated to their knees completed the Dutch VISA-P. Results The Dutch VISA-P questionnaire showed satisfactory test-retest reliability (ICC = 0.74. The mean (± SD VISA-P scores were 95 (± 9 for the healthy students, 89 (± 11 for the volleyball players, 58 (± 19 for patients with patellar tendinopathy, and 56 (± 21 for athletes who had surgery for patellar tendinopathy. Patients with other knee injuries or symptoms unrelated to the knee scored 62 (± 24 and 77 (± 24. Conclusion The translated Dutch version of the VISA-P questionnaire is equivalent to its original version, has satisfactory test-retest reliability and is a valid score to evaluate symptoms, knee function and ability to play sports of Dutch athletes with patellar tendinopathy.

  17. Patellar tendinopathy: etiology and treatment

    van der Worp, Hendrik

    2012-01-01

    Bestaande behandeling jumper’s knee niet effectief Zo’n tienduizend Nederlanders hebben last van een jumper’s knee (patella tendinopathie). Deze blessure komt vooral voor bij basketbal, volleybal en andere sporten waarin veel gesprongen wordt. De blessure heeft vaak langdurige gevolgen en is moeilijk te behandelen. Het onderzoek van Henk van der Worp verschaft nader inzicht in de oorzaken van de aandoening en levert suggesties ter verbetering van de behandeling. Van der Worp stelt vast dat he...

  18. Experimental diabetes induces structural, inflammatory and vascular changes of Achilles tendons.

    Rodrigo R de Oliveira

    Full Text Available This study aims to demonstrate how the state of chronic hyperglycemia from experimental Diabetes Mellitus can influence the homeostatic imbalance of tendons and, consequently, lead to the characteristics of tendinopathy. Twenty animals were randomly divided into two experimental groups: control group, consisting of healthy rats and diabetic group constituted by rats induced to Diabetes Mellitus I. After twenty-four days of the induction of Diabetes type I, the Achilles tendon were removed for morphological evaluation, cellularity, number and cross-sectional area of blood vessel, immunohistochemistry for Collagen type I, VEGF and NF-κB nuclear localization sequence (NLS and nitrate and nitrite level. The Achilles tendon thickness (µm/100g of diabetic animals was significantly increased and, similarly, an increase was observed in the density of fibrocytes and mast cells in the tendons of the diabetic group. The average number of blood vessels per field, in peritendinous tissue, was statistically higher in the diabetic group 3.39 (2.98 vessels/field when compared to the control group 0.89 (1.68 vessels/field p = 0.001 and in the intratendinous region, it was observed that blood vessels were extremely rare in the control group 0.035 (0.18 vessels/field and were often present in the tendons of the diabetic group 0.89 (0.99 vessels/field. The immunohistochemistry analysis identified higher density of type 1 collagen and increased expression of VEGF as well as increased immunostaining for NFκB p50 NLS in the nucleus in Achilles tendon of the diabetic group when compared to the control group. Higher levels of nitrite/nitrate were observed in the experimental group induced to diabetes. We conclude that experimental DM induces notable structural, inflammatory and vascular changes in the Achilles tendon which are compatible with the process of chronic tendinopathy.

  19. Fluoroquinolone-Associated Tendinopathy: Does Levofloxacin Pose the Greatest Risk?

    Bidell, Monique R; Lodise, Thomas P

    2016-06-01

    Fluoroquinolone antibiotics recently have gained increased national attention due to safety concerns. A well-described and serious adverse event associated with receipt of fluoroquinolones is tendinitis and tendon rupture. These tendon injuries can result in long-term sequelae, including chronic pain and mobility restrictions, and may warrant surgery. Due to the severity of these adverse events, a black box warning is included in the product labeling of all fluoroquinolones. In light of the mounting concerns surrounding fluoroquinolone-associated toxicities, the purpose of this clinical review is to provide a comprehensive summary of the risk of tendinopathy associated with levofloxacin, one of the most widely prescribed antibiotics in the United States, across in vitro, animal, and clinical studies, relative to other antibiotics. As part of this review, clinical presentation and onset, proposed mechanisms, patient-specific risk factors, and management of fluoroquinolone-induced tendon injury are summarized. Data were obtained from a comprehensive PubMed literature search and a review of U.S. Food and Drug Administration documents. Although tendinopathy is considered a fluoroquinolone class-wide toxicity, data from in vitro studies, animal studies, patient-level analyses, and large national and international surveillance reports suggest that levofloxacin, as well as its parent compound ofloxacin, possess higher propensities to cause tendon damage relative to other fluoroquinolones. Risk with ofloxacin and levofloxacin appears to be exposure dependent, with higher doses and longer durations being most commonly associated with tendinopathy. Other well-described patient risk factors for fluoroquinolone-associated tendinopathy include older age (older than 60 yrs), receipt of concomitant corticosteroid therapy, presence of renal dysfunction, and history of solid organ transplantation. Given widespread use of levofloxacin across patient care settings, knowledge of both

  20. EVIDENCE–SUPPORTED REHABILITATION OF PATELLAR TENDINOPATHY

    Rutland, Marsha; O'Connell, Dennis; Brismée, Jean-Michel; Sizer, Phil; Apte, Gail; O'Connell, Janelle

    2010-01-01

    Chronic tendinopathy is a common musculoskeletal disorder that frequently affects athletes who train and compete at all levels. This Clinical Commentary presents a review of the etiology, incidence, and contributory factors related specifically to patellar tendinopathy. Examination and differential diagnosis considerations are provided, and an evidence-based, staged rehabilitation program is described.

  1. Preventive interventions for tendinopathy : A systematic review

    Peters, Janne A; Zwerver, Johannes; Diercks, Ronald L; Elferink-Gemser, Marije T; van den Akker-Scheek, Inge

    2015-01-01

    OBJECTIVES: Tendinopathy, the most prevalent tendon disorder which is considered as the clinical diagnosis of pain and dysfunction, is common in sports and its prevalence is ever-increasing. Despite the lack of clarity about risk factors, various preventive interventions for tendinopathy have been i

  2. Factors Associated with Operative Treatment of De Quervain Tendinopathy

    Amir Reza Kachooei

    2015-07-01

    Full Text Available Background:  Geographic and doctor-to-doctor variations in care are a focus of quality and safety efforts in medicine. This study addresses factors associated with variation in the rate of operative treatment of de Quervain tendinopathy.   Methods: We used a database including all patient encounters at 2 large medical centers, to study the experience of 10 hand surgeons and 1 physiatrist working in a hand surgery office in the treatment of 2,513 patients with de Quervain tendinopathy over a 12-year period. Survival analysis using the Kaplan-Meier method was used to compare surgery rates and time to surgery. Cox multivariable regression analysis was applied to identify factors associated with operative treatment. Results:  One hundred ninety nine (7.9% patients had surgery. The odds of operative treatment were 1.7 times greater after corticosteroid injection and varied more than 10-fold among providers. There was substantial variation in the overall rate of surgery by provider. Corticosteroid injection delayed surgery slightly, but was associated with a higher rate of surgery.  Conclusion:  Providers have substantial influence on treatment of de Quervain tendinopathy. The use of decision aids and other methods that help involve the patient in decision-making merit investigation as interventions to help reduce doctor-to-doctor variation.

  3. Achilles tendon rupture; assessment of nonoperative treatment

    Barfod, Kristoffer Weisskirchner

    2014-01-01

    -related quality of life in the weight-bearing group (p=0.009). Compared to the unaffected limb, the affected limb had decreased stiffness (77%, p < 0.001) and strength (93%, p = 0.009) of the plantar flexor muscle-tendon complex. Study IV showed excellent intra-rater reliability (ICC 0.96, SEM 3.7 mm and MDC 10...... be clarified, particularly the role of weight-bearing during early rehabilitation. Also, there is a need for a clinically applicable and accurate measurement to detect patients in risk of developing Achilles tendon elongation. PURPOSE: The aim of this PhD thesis was to evaluate non...... trial (RCT). In study III, the effect of immediate weight-bearing on the biomechanical properties of the plantar flexor muscle-tendon complex was investigated in an RCT. In study IV, validity, reliability and agreement of a novel ultrasound measurement of Achilles tendon length and elongation was tested...

  4. Tendinopathies Around the Elbow Part 2: Medial Elbow, Distal Biceps and Triceps Tendinopathies

    Donaldson, Oliver; Vannet, Nicola; Gosens, Taco; Kulkarni, Rohit

    2013-01-01

    In the second part of this review article the management of medial elbow tendinopathy, distal biceps and distal triceps tendinopathy will be discussed. There is a scarcity of publications concerning any of these tendinopathies. This review will summarise the current best available evidence in their management. Medial elbow tendinopathy, also known as Golfer's elbow, is up to 6 times less common than lateral elbow tendinopathy. The tendinopathy occurs in the insertion of pronator teres and flexor carpi radialis. Diagnosis is usually apparent through a detailed history and examination but care must be made to exclude other conditions affecting the ulnar nerve or less commonly the ulnar collateral ligament complex. If doubt exists then MRI/US and electrophysiology can be used. Treatment follows a similar pattern to that of lateral elbow tendinopathy. Acute management is with activity modification and topical NSAIDs. Injection therapy and surgical excision are utilised for recalcitrant cases. Distal biceps and triceps tendinopathies are very rare and there is limited evidence published. Sequelae of tendinopathy include tendon rupture and so it is vital to manage these tendinopathies appropriately in order to minimise this significant complication. Their management and that of partial tears will be considered.

  5. Power Doppler ultrasonography of painful Achilles tendons and entheses in patients with and without spondyloarthropathy-a comparison with clinical examination and contrast-enhanced MRI

    Wiell, Charlotte; Szkudlarek, Marcin; Hasselquist, Maria;

    2013-01-01

    /or enthesis due to sports-related causes and 10 CTRLs were examined at the Achilles tendons and entheses with US, MRI and clinical assessment. Intratendinous changes, entheseal changes, bursitis and peritendonitis were assessed. An US interobserver substudy was performed in nine persons. US findings showed...

  6. Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management.

    Grimaldi, Alison; Mellor, Rebecca; Hodges, Paul; Bennell, Kim; Wajswelner, Henry; Vicenzino, Bill

    2015-08-01

    Tendinopathy of the gluteus medius and gluteus minimus tendons is now recognized as a primary local source of lateral hip pain. The condition mostly occurs in mid-life both in athletes and in subjects who do not regularly exercise. Females are afflicted more than males. This condition interferes with sleep (side lying) and common weight-bearing tasks, which makes it a debilitating musculoskeletal condition with a significant impact. Mechanical loading drives the biological processes within a tendon and determines its structural form and load-bearing capacity. The combination of excessive compression and high tensile loads within tendons are thought to be most damaging. The available evidence suggests that joint position (particularly excessive hip adduction), together with muscle and bone elements, are key factors in gluteal tendinopathy. These factors provide a basis for a clinical reasoning process in the assessment and management of a patient presenting with localized lateral hip pain from gluteal tendinopathy. Currently, there is a lack of consensus as to which clinical examination tests provide best diagnostic utility. On the basis of the few diagnostic utility studies and the current understanding of the pathomechanics of gluteal tendinopathy, we propose that a battery of clinical tests utilizing a combination of provocative compressive and tensile loads is currently best practice in its assessment. Management of this condition commonly involves corticosteroid injection, exercise or shock wave therapy, with surgery reserved for recalcitrant cases. There is a dearth of evidence for any treatments, so the approach we recommend involves managing the load on the tendons through exercise and education on the underlying pathomechanics. PMID:25969366

  7. Achilles tendon and sports

    Because of the rising popularity of recreational sports activities achillodynia is an often associated symptom with running, soccer and athletics. Therefore radiologist are frequently asked to image this tendon. The origin of the damage of the Achilles tendon is explained by numerous hypothesis, mainly a decreased perfusion and a mechanical irritation that lead to degeneration of the tendon. High-resolution technics such as sonography and magnetic resonance imaging show alterations in the structure of the tendon which can be graduated and classified. Manifestations like tendinosis, achillobursitis, rupture and Haglunds disease can summarized as the tendon overuse syndrom. A rupture of a tendon is mostly the result of a degeneration of the collagenfibres. The task of the radiologist is to acquire the intrinsic factors for a potential rupture. (orig.)

  8. [Achilles tendon rupture].

    Thermann, H; Hüfner, T; Tscherne, H

    2000-03-01

    The treatment of acute of Achilles tendon rupture experienced a dynamic development in the last ten years. Decisive for this development was the application of MRI and above all the ultrasonography in the diagnostics of the pathological changes and injuries of tendons. The question of rupture morphology as well as different courses of healing could be now evaluated objectively. These advances led consequently to new modalities in treatment concepts and rehabilitation protocols. The decisive input for improvements of the outcome results and particularly the shortening of the rehabilitation period came with introduction of the early functional treatment in contrast to immobilizing plaster treatment. In a prospective randomized study (1987-1989) at the Trauma Dept. of the Hannover Medical School could show no statistical differences comparing functional non-operative with functional operative therapy with a special therapy boot (Variostabil/Adidas). The crucial criteria for therapy selection results from the sonographically measured position of the tendon stumps in plantar flexion (20 degrees). With complete adaptation of the tendons' ends surgical treatment does not achieve better results than non-operative functional treatment in term of tendon healing and functional outcome. Regarding the current therapeutic standards each method has is advantages and disadvantages. Both, the operative and non-operative functional treatment enable a stable tendon healing with a low risk of re-rupture (1-2%). Meanwhile there is consensus for early functional after-treatment of the operated Achilles' tendons. There seems to be a trend towards non-operative functional treatment in cases of adequate sonographical findings, or to minimal invasive surgical techniques. PMID:10798233

  9. Classification and arthroscopic surgery of chronic achilles tendinitis%慢性跟腱炎的分型与关节镜微创治疗

    刘玉杰; 朱娟利; 王晓; 王志刚; 陈旭; 李众利; 蔡谞; 齐玮; 李春宝; 魏民

    2010-01-01

    目的 观察慢性跟腱炎的分型与局部麻醉下关节镜微创治疗的效果.方法 2003年3月至2009年3月,采用局部麻醉下关节镜微创治疗慢性跟腱炎22例,男16例,女6例,年龄17~53岁,平均33.5岁.运动损伤16例,病因不明6例.术前根据X线片、MRI检查、CT扫描和临床特点,将其分为:增生肥大型(10例)、钙化结节型(5例)和纤维撕裂型(7例).分别采用局麻关节镜下等离子刀消融、刨削清理术治疗.结果 术后随访22例,平均随访14个月(9~54个月),采用制定的评定标准和VAS评分进行疗效评价,优:12例,良8例,可2例.无血管神经损伤、感染和跟腱断裂等并发症.结论 跟腱炎分型有助于临床诊断和治疗方案制定;局麻关节镜下微创治疗慢性跟腱炎方法可行,操作简便,疗效显著.%Objective To investigate the clinical classification of chronic achilles tendinitis and analyze the surgical technique and efficacy of arthroscopic surgery. Methods Twenty-two patients ( 16 males, 6 females) with chronic achilles tendinitis were recruited. The average age was 33.5 years old ( range: 17-53). Sixteen cases were caused by sport injury while 6 cases had no definite etiological factor.The Achilles tendinopathy was divided into three types according to clinical characteristics and the results of X ray, CT scan and MRI examination of ankle: Type 1, hypertrophy (n = 10); Type 2, calcified tubercle (n = 5 ); Type 3, fiber tear (n = 7 ). All cases were treated with endoscopic debridement of ventral neovascularized area, poritendineum and Achilles tendon by shaver and radiofrequency (RF) probe.Resuits The patients were followed-up for a mean of 14 months (range: 9-15). Evaluated by our criteria and visual analogue scale, the post-operative efficacy was excellent in 12 cases, good in 8 and fair in 2. No postoperative complications, such as neurovascular injury, infection and rupture of Achilles tendon, was recorded. Conclusion This scheme of

  10. Eccentric training in the treatment of tendinopathy

    Jonsson, Per

    2009-01-01

    Chronic painful tendinopathies are common, not only in sports and recreationally active people, but also among people with a sedentary lifestyle. Both the lower and upper limbs are affected. There is lack of knowledge about the etiology and pathogenesis to tendinopathy, and many different treatments options have been presented. Unfortunately, most treatments have not been tested in scientific studies. Conservative (non-surgical) treatment has since long shown unsatisfactory results and surgic...

  11. Diagnostic confidence of sonoelastography as adjunct to greyscale ultrasonography in lateral elbow tendinopathy

    Park Giyoung; Kwon Dongrak; Park Junghyun

    2014-01-01

    Background Conventional ultrasonography or magnetic resonance (MR) imaging is commonly performed to obtain information about the severity of the disease,location of the injury,and differential diagnosis.The aim of this research was to investigate the diagnostic confidence of sonoelastography as an adjunct to greyscale ultrasonography in lateral elbow tendinopathy.Methods A single experienced physiatrist performed greyscale ultrasonography and sonoelastography in 28 patients (9 men,19 women; mean age,48.5 years; age range,36-67 years) with unilateral symptoms of lateral elbow tendinopathy; the asymptomatic elbows were used as controls.Greyscale images were described as normal,tendinosis,partialthickness tear,and full-thickness tear.Sonoelastographic images of the common extensor tendon were analyzed qualitatively (scoring of the elastic spectrum) and quantitatively (based on a color histogram).Results Both the imaging methods had high sensitivity,specificity,and accuracy for diagnosing lateral elbow tendinopathy.Considering the clinical diagnosis of lateral elbow tendinopathy,sonoelastography showed significantly higher diagnostic accuracy (96.4%) than ultrasonography (89.5%,P <0.01).Quantitative analysis showed objective interpretation of the sonoelastographic images that revealed greater intensity of green and blue pixels in symptomatic elbows (P <0.01).Conclusion Sonoelastography increases diagnostic confidence in tennis elbow pathology over greyscale ultrasonography alone and may be an additional powerful diagnostic tool in cases of lateral elbow tendinopathy with inconclusive greyscale ultrasonographic findings.

  12. Spontaneous bilateral patellar tendon rupture: case report and review of fluoroquinolone-induced tendinopathy.

    Rosa, Bárbara; Campos, Pedro; Barros, André; Karmali, Samir; Gonçalves, Ricardo

    2016-07-01

    The present case emphasizes the importance of adhering to strict indications when prescribing fluoroquinolones. Although rare, drug-induced tendinopathy is not confined to fluoroquinolones. The patient's and physician's awareness should be increased to reduce fluoroquinolones-associated morbidity, particularly in patients with previously described risk factors. PMID:27386128

  13. Spontaneous bilateral patellar tendon rupture: case report and review of fluoroquinolone‐induced tendinopathy

    Rosa, Bárbara; Campos, Pedro; Barros, André; Karmali, Samir; Gonçalves, Ricardo

    2016-01-01

    Key Clinical Message The present case emphasizes the importance of adhering to strict indications when prescribing fluoroquinolones. Although rare, drug‐induced tendinopathy is not confined to fluoroquinolones. The patient's and physician's awareness should be increased to reduce fluoroquinolones‐associated morbidity, particularly in patients with previously described risk factors.

  14. New options in the management of tendinopathy

    Nicola Maffulli

    2010-03-01

    Full Text Available Nicola Maffulli1, Umile Giuseppe Longo2, Mattia Loppini2, Filippo Spiezia2, Vincenzo Denaro21Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, England; 2Department of Orthopedic and Trauma Surgery, Campus Biomedico University, Rome, ItalyAbstract: Tendon injuries can be acute or chronic, and caused by intrinsic or extrinsic factors, either alone or in combination. Tendinopathies are a common cause of disability in occupational medicine and account for a substantial proportion of overuse injuries in sports. Tendinopathy is essentially a failed healing response, with haphazard proliferation of tenocytes, abnormalities in tenocytes, with disruption of collagen fibres and subsequent increase in noncollagenous matrix. The scientific evidence base for managing tendinopathies is limited. What may appear clinically as an “acute tendinopathy” is actually a well advanced failure of a chronic healing response in which there is neither histologic nor biochemical evidence of inflammation. In this review we report the new options for the management of tendinopathy, including eccentric exercises, extracorporeal shockwave therapy, injections (intratendinous injections of corticosteroids, aprotinin, polidocanol platelet-rich plasma, autologous blood injection, high-volume injections and surgery. Open surgery aims to excise fibrotic adhesions, remove areas of failed healing and make multiple longitudinal incisions in the tendon to detect intratendinous lesions, and to restore vascularity and possibly stimulate the remaining viable cells to initiate cell matrix response and healing. New surgical techniques aim to disrupt the abnormal neoinnervation to interfere with the pain sensation caused by tendinopathy. These procedures are intrinsically different from the classical ones in present use, because they do not attempt to address directly the pathologic

  15. The Achilles tendon resting angle as an indirect measure of Achilles tendon length following rupture, repair, and rehabilitation

    Michael R. Carmont

    2015-04-01

    Conclusion: The ATRA increases following injury, is reduced by surgery, and then increases again during initial rehabilitation. The angle also correlates with patient-reported symptoms early in the rehabilitation phase and with heel-rise height after 1 year. The ATRA might be considered a simple and effective means to evaluate Achilles tendon function 1 year after the rupture.

  16. IL-21 Receptor Expression in Human Tendinopathy

    Abigail L. Campbell

    2014-01-01

    Full Text Available The pathogenetic mechanisms underlying tendinopathy remain unclear, with much debate as to whether inflammation or degradation has the prominent role. Increasing evidence points toward an early inflammatory infiltrate and associated inflammatory cytokine production in human and animal models of tendon disease. The IL-21/IL-21R axis is a proinflammatory cytokine complex that has been associated with chronic inflammatory diseases including rheumatoid arthritis and inflammatory bowel disease. This project aimed to investigate the role and expression of the cytokine/receptor pair IL-21/IL-21R in human tendinopathy. We found significantly elevated expression of IL-21 receptor message and protein in human tendon samples but found no convincing evidence of the presence of IL-21 at message or protein level. The level of expression of IL-21R message/protein in human tenocytes was significantly upregulated by proinflammatory cytokines (TNFα/IL-1β in vitro. These findings demonstrate that IL-21R is present in early human tendinopathy mainly expressed by tenocytes and macrophages. Despite a lack of IL-21 expression, these data again suggest that early tendinopathy has an inflammatory/cytokine phenotype, which may provide novel translational targets in the treatment of tendinopathy.

  17. Supraspinatus and biceps brachii tendinopathy in dogs

    Calcifying tendinopathy was seen on radiographic views of the scapulohumeral joint in 12 of 183 (7 per cent) dogs reviewed retrospectively. Calcifying tendinopathy was identified only in large breed dogs, five being labradors. All the affected dogs, except one, were presented for unilateral thoracic limb lameness, which was typically of a chronic and intermittent pattern. Pain on manipulation of the scapulohumeral joint in the lame leg was present in eight of 12 dogs (67 per cent). Calcification of the supraspinatus tendon was seen in eight dogs and calcification of the biceps brachii tendon was seen in the other four dogs. Radiographic changes indicative of biceps brachii tendon avulsion were found in conjunction with calcification of the contralateral biceps brachii tendon in two dogs. Filling defects, indicative of bicipital tenosynovitis, were also seen in positive contrast arthrograms of two dogs with biceps brachii calcification. Of the eight dogs for which radiographic views of both scapulohumeral joints were available, six dogs had bilateral radiographic signs of calcifying tendinopathy. Overall, radiographic signs of calcifying tendinopathy were seen in 18 scapulohumeral joints, but lameness was apparent in only nine limbs, suggesting the lesion may at times be asymptomatic. Further prospective investigation of calcifying tendinopathy is needed to determine why lameness does not always appear to be associated with the presence of the lesion

  18. Case Study of Oriental Medicine Treatment with acupotomy Therapy of the Achilles Tendinitis

    Jang Eun-ha; Lim Na-ra; Na Won-min; Kim Sung-chul

    2008-01-01

    Purpose : In order to estimate clinical effects of Oriental Medicine Treatment with acupotomy therapy of Achilles Tendinitis Methods : From 4th August, 2008 to 14th August, 2008, 1 female patient diagnosed as Chronic Achilles Tendinitis (clinical diagnosed) was treated with general oriental medicine therapy(acupuncture, moxibustion, cupping, physical therapy, herbal medication) and acupotomy. Results : The patient's chief complaints- Lt. heel pain and stiffness, dorsi-flexion limitation...

  19. Validity and reliability of the Dutch translation of the VISA-P questionnaire for patellar tendinopathy

    Zwerver, Johannes; Kramer, Tamara; van den Akker-Scheek, Inge

    2009-01-01

    Background: The VISA-P questionnaire evaluates severity of symptoms, knee function and ability to play sports in athletes with patellar tendinopathy. This English-language self-administered brief patient outcome score was developed in Australia to monitor rehabilitation and to evaluate outcome of cl

  20. Ultrasound assessment for grading structural tendon changes in supraspinatus tendinopathy: an inter-rater reliability study

    Ingwersen, Kim Gordon; Hjarbæk, John; Eshøj, Henrik;

    2016-01-01

    Aim To evaluate the inter-rater reliability of measuring structural changes in the tendon of patients, clinically diagnosed with supraspinatus tendinopathy (cases) and healthy participants (controls), on ultrasound (US) images captured by standardised procedures. Methods A total of 40 participants...

  1. Case Study of Oriental Medicine Treatment with acupotomy Therapy of the Achilles Tendinitis

    Jang Eun-ha

    2008-12-01

    Full Text Available Purpose : In order to estimate clinical effects of Oriental Medicine Treatment with acupotomy therapy of Achilles Tendinitis Methods : From 4th August, 2008 to 14th August, 2008, 1 female patient diagnosed as Chronic Achilles Tendinitis (clinical diagnosed was treated with general oriental medicine therapy(acupuncture, moxibustion, cupping, physical therapy, herbal medication and acupotomy. Results : The patient's chief complaints- Lt. heel pain and stiffness, dorsi-flexion limitation, nodules in the achilles tendon- were notably improved. Conclusions : This study demonstrates that oriental medical treatment with acuputomy therapy has significant effect in improving symptoms of achilles tendinitis. as though we had not wide experience in this treatment, more research is needed.

  2. Active Achilles tendon kinesitherapy accelerates Achilles tendon repair by promoting neurite regeneration☆

    Jielile, Jiasharete; Aibai, Minawa; Sabirhazi, Gulnur; Shawutali, Nuerai; Tangkejie, Wulanbai; Badelhan, Aynaz; Nuerduola, Yeermike; Satewalede, Turde; Buranbai, Darehan; Hunapia, Beicen; Jialihasi, Ayidaer; Bai, Jingping; Kizaibek, Murat

    2012-01-01

    Active Achilles tendon kinesitherapy facilitates the functional recovery of a ruptured Achilles tendon. However, protein expression during the healing process remains a controversial issue. New Zealand rabbits, aged 14 weeks, underwent tenotomy followed immediately by Achilles tendon microsurgery to repair the Achilles tendon rupture. The tendon was then immobilized or subjected to postoperative early motion treatment (kinesitherapy). Mass spectrography results showed that after 14 days of mo...

  3. Case report: can sacroiliac joint dysfunction cause chronic Achilles tendinitis?

    Voorn, R

    1998-06-01

    This case study discusses the possible relationship between chronic Achilles tendinitis and sacroiliac joint dysfunction. The patient presented is an active pole jumper, competing at both the national and international levels. He suffered from chronic Achilles tendinitis during the 1994-95 season, and conservative treatment applied locally was not successful. The athlete discarded the possibility of operative debridement of the tendon. Instead, an evaluation of the kinetic chain of the lower extremity and pelvic-lumbar area was performed, and the athlete was diagnosed with sacroiliac joint dysfunction and Achilles tendinitis. Evaluation findings, treatment program, and treatment outcome are also presented. The literature regarding sacroiliac joint mechanics and biomechanics of the foot-knee-hip and pelvic area is discussed and used to support the author's thesis that sacroiliac joint dysfunction, in this case a backward rotation of the right ilium, may have changed the kinematic chain of the lower extremity and caused a tendinitis in the Achilles tendon of the affected leg. Sacroiliac joint function and dysfunction, the reliability of sacroiliac joint mobility tests, and the validity of treatment programs are still considered controversial, and more research is needed to understand these mechanisms. PMID:9617730

  4. Human Achilles tendon glycation and function in diabetes.

    Couppé, Christian; Svensson, Rene Brüggebusch; Kongsgaard, Mads; Kovanen, Vuokko; Grosset, Jean-Francois; Snorgaard, Ole; Bencke, Jesper; Larsen, Jytte Overgaard; Bandholm, Thomas; Christensen, Tomas Møller; Boesen, Anders; Helmark, Ida Carøe; Aagaard, Per; Kjaer, Michael; Magnusson, Stig Peter

    2016-01-15

    Diabetic patients have an increased risk of foot ulcers, and glycation of collagen may increase tissue stiffness. We hypothesized that the level of glycemic control (glycation) may affect Achilles tendon stiffness, which can influence gait pattern. We therefore investigated the relationship between collagen glycation, Achilles tendon stiffness parameters, and plantar pressure in poorly (n = 22) and well (n = 22) controlled diabetic patients, including healthy age-matched (45-70 yr) controls (n = 11). There were no differences in any of the outcome parameters (collagen cross-linking or tendon stiffness) between patients with well-controlled and poorly controlled diabetes. The overall effect of diabetes was explored by collapsing the diabetes groups (DB) compared with the controls. Skin collagen cross-linking lysylpyridinoline, hydroxylysylpyridinoline (136%, 80%, P ratio (33%, P gait. The difference in foot pressure distribution may contribute to the development of foot ulcers in diabetic patients. PMID:26542519

  5. Therapeutic Roles of Tendon Stem/Progenitor Cells in Tendinopathy

    Zhang, Xin; Lin, Yu-cheng; Rui, Yun-feng; Xu, Hong-liang; Chen, Hui; Wang, Chen; Teng, Gao-jun

    2016-01-01

    Tendinopathy is a tendon disorder characterized by activity-related pain, local edema, focal tenderness to palpation, and decreased strength in the affected area. Tendinopathy is prevalent in both athletes and the general population, highlighting the need to elucidate the pathogenesis of this disorder. Current treatments of tendinopathy are both conservative and symptomatic. The discovery of tendon stem/progenitor cells (TSPCs) and erroneous differentiation of TSPCs have provided new insights into the pathogenesis of tendinopathy. In this review, we firstly present the histopathological characteristics of tendinopathy and explore the cellular and molecular cues in the pathogenesis of tendinopathy. Current evidence of the depletion of the stem cell pool and altered TSPCs fate in the pathogenesis of tendinopathy has been presented. The potential regulatory factors for either tenogenic or nontenogenic differentiation of TSPCs are also summarized. The regulation of endogenous TSPCs or supplementation with exogenous TSPCs as therapeutic targets for the treatment of tendinopathy is proposed. Therefore, inhibiting the erroneous differentiation of TSPCs and regulating the differentiation of TSPCs into tendon cells might be important areas of future research and could provide new clinical treatments for tendinopathy. The current evidence suggests that TSPCs are promising therapeutic targets for the management of tendinopathy. PMID:27195010

  6. [Is the use of STABHA™ for supplementation of damaged extracellular matrix of soft tissues in the musculoskeletal system an effective treatment of acute injuries and tendinopathies?].

    Tomaszewski, Wiesław

    2015-01-01

    Viscosupplementation, or the intra articular administration of hyaluronic acid in order to stabilise synovial fluid chemistry and improve its functional quality, is now a popular therapeutic method whose efficacy, based on numerous published studies, makes it not only a form of symptomatic treatment, but also, to a considerable extent, a cause-oriented treatment. However, a possibly controversial aspect of this therapy is the use of “intra articular hyaluronate” in the treatment of post-traumatic or inflammatory soft-tissue lesions in in the musculoskeletal system. Inappropriate administration of this dosage form to the area of the injured soft tissue (Achilles tendon, periarticular tendon of tarsal joint or knee, tennis elbow, tendinopathy within the rotator cuff, etc.) may not only lead to a failure to achieve the desired therapeutic effect but can even increase the severity of the symptoms, including a rupture of the frayed tendon. The role and importance of hyaluronate in the process of natural regeneration of damaged soft tissue has been demonstrated unequivocally and beyond any doubt. Subsequent research aimed to produce forms of hyaluronic acid that would be characterised by a greater influence and support of the regeneration processes in musculoskeletal soft tissue after an acute or chronic injury, as well as to develop the technology to produce a formulation which would be biocompatible, efficient and adapted to the treatment of ligament and tendon injuries. Following administration, such formulation would also need to be identified by the body as a naturally produced hyaluronate, which plays an essential role in the repair of damaged tissue, beginning with the bleeding phase and involving in all phases of the healing process, as has been demonstrated in numerous scientific studies. The development of a technology for producing hyaluronic acid known as STABHA™ (Soft Tissue Adapted Biocompatible Hyaluronic Acid) in 2008 proved to be a significant

  7. Patellar tendinopathy : physical therapy and injection treatments

    van Ark, Mathijs

    2015-01-01

    Patellar tendinopathy, commonly known as jumper’s knee, is an overuse injury of the patellar tendon. It is a frequent injury, particularly in jumping athletes such as volleyball and basketball players. Jumper’s knee is often a long-lasting injury and can have a major impact on sports and even work p

  8. ESWT for tendinopathy : technology and clinical implications

    van der Worp, Henk; van den Akker-Scheek, Inge; van Schie, Hans; Zwerver, Johannes

    2013-01-01

    The general consensus that tendinopathy, at least in the chronic stage, is mainly a degenerative condition and inflammation plays a minor role has led to a shift from treatments that target inflammation towards treatment options that promote regeneration. One of these treatments is extracorporeal sh

  9. Astym treatment vs. eccentric exercise for lateral elbow tendinopathy: a randomized controlled clinical trial

    Thomas L. Sevier

    2015-05-01

    Full Text Available Introduction. Patients with chronic lateral elbow (LE tendinopathy, commonly known as tennis elbow, often experience prolonged symptoms and frequent relapses. Astym treatment, evidenced in animal studies to promote the healing and regeneration of soft tissues, is hypothesized to improve outcomes in LE tendinopathy patients. This study had two objectives: (1 to compare the efficacy of Astym treatment to an evidence-based eccentric exercise program (EE for patients with chronic LE tendinopathy, and (2 to quantify outcomes of subjects non-responsive to EE who were subsequently treated with Astym treatment. Study Design. Prospective, two group, parallel, randomized controlled trial completed at a large orthopedic center in Indiana. Inclusion criteria: age range of 18–65 years old, with clinical indications of LE tendinopathy greater than 12 weeks, with no recent corticosteriod injection or disease altering comorbidities. Methods. Subjects with chronic LE tendinopathy (107 subjects with 113 affected elbows were randomly assigned using computer-generated random number tables to 4 weeks of Astym treatment (57 elbows or EE treatment (56 elbows. Data collected at baseline, 4, 8, 12 weeks, 6 and 12 months. Primary outcome measure: DASH; secondary outcome measures: pain with activity, maximum grip strength and function. The treating physicians and the rater were blinded; subjects and treating clinicians could not be blinded due to the nature of the treatments. Results. Resolution response rates were 78.3% for the Astym group and 40.9% for the EE group. Astym subjects showed greater gains in DASH scores (p = 0.047 and in maximum grip strength (p = 0.008 than EE subjects. Astym therapy also resolved 20/21 (95.7% of the EE non-responders, who showed improvements in DASH scores (p < 0.005, pain with activity (p = 0.002, and function (p = 0.004 following Astym treatment. Gains continued at 6 and 12 months. No adverse effects were reported. Conclusion. This

  10. Magnetic resonance imaging of Achilles tendon xanthomas in familial hypercholesterolemia

    The demonstration of tendon xanthomas is helpful in diagnosing heterozygous familial hypercholesterolemia. We investigated the possibility the lipid element with magnetic resonance (MR) imaging in seven patients with familial hypercholesterolemia and six controls. Although the mean relative signal intensities measured on long TR/TE spin echo sequences of the tendon were significantly higher in patients than in controls, the lack of such elevation does not rule out the presence of such lesions. MR imaging and US provide equal information on the anatomy of the Achilles tendon; as an abnormally increased signal intensity within the xanthoma on MRI was found in only a minority of our patients, the value of MRI in the demonstration of Achilles tendon xanthomas is limited when using conventional T1 and T2 spin echo sequences. (orig./DG)

  11. Active Achilles tendon kinesitherapy accelerates Achilles tendon repair by promoting neurite regeneration

    Jiasharete Jielile; Beicen Hunapia; Ayidaer Jialihasi; Jingping Bai; Murat Kizaibek; Minawa Aibai; Gulnur Sabirhazi; Nuerai Shawutali; Wulanbai Tangkejie; Aynaz Badelhan; Yeermike Nuerduola; Turde Satewalede; Darehan Buranbai

    2012-01-01

    Active Achilles tendon kinesitherapy facilitates the functional recovery of a ruptured Achilles tendon. However, protein expression during the healing process remains a controversial issue. New Zealand rabbits, aged 14 weeks, underwent tenotomy followed immediately by Achilles tendon microsurgery to repair the Achilles tendon rupture. The tendon was then immobilized or subjected to postoperative early motion treatment (kinesitherapy). Mass spectrography results showed that after 14 days of motion treatment, 18 protein spots were differentially expressed, among which, 12 were up-regulated, consisting of gelsolin isoform b and neurite growth-related protein collapsing response mediator protein 2. Western blot analysis showed that gelsolin isoform b was up-regulated at days 7–21 of motion treatment. These findings suggest that active Achilles tendon kinesitherapy promotes the neurite regeneration of a ruptured Achilles tendon and gelsolin isoform b can be used as a biomarker for Achilles tendon healing after kinesitherapy.

  12. Therapeutic Roles of Tendon Stem/Progenitor Cells in Tendinopathy

    Xin Zhang; Yu-cheng Lin; Yun-feng Rui; Hong-liang Xu; Hui Chen; Chen Wang,; Gao-jun Teng

    2016-01-01

    Tendinopathy is a tendon disorder characterized by activity-related pain, local edema, focal tenderness to palpation, and decreased strength in the affected area. Tendinopathy is prevalent in both athletes and the general population, highlighting the need to elucidate the pathogenesis of this disorder. Current treatments of tendinopathy are both conservative and symptomatic. The discovery of tendon stem/progenitor cells (TSPCs) and erroneous differentiation of TSPCs have provided new insights...

  13. Achilles tendinopathy: new insights in cause of pain, diagnosis and management

    Dijk, van, W.; Kerkhoffs, G.M.M.J.; Sterkenburg, van, M.N.

    2012-01-01

    Maayke van Sterkenburg deed onderzoek naar chronische achillespeesklachten. Deze klachten komen wereldwijd veel voor; vaak bij sporters, maar soms ook bij niet-sporters. Globaal kunnen de verschillende klachten worden onderverdeeld in klachten van het middengedeelte van de pees en klachten bij de aanhechting aan het hielbeen. Er zijn veel therapeutische mogelijkheden, de meeste met matige uitkomst. Bij klachten in het middengedeelte van de pees wordt vaak als een van de laatste opties de dege...

  14. Comparison of structural anisotropic soft tissue models for simulating Achilles tendon tensile behaviour.

    Khayyeri, Hanifeh; Longo, Giacomo; Gustafsson, Anna; Isaksson, Hanna

    2016-08-01

    The incidence of tendon injury (tendinopathy) has increased over the past decades due to greater participation in sports and recreational activities. But little is known about the aetiology of tendon injuries because of our limited knowledge in the complex structure-function relationship in tendons. Computer models can capture the biomechanical behaviour of tendons and its structural components, which is essential for understanding the underlying mechanisms of tendon injuries. This study compares three structural constitutive material models for the Achilles tendon and discusses their application on different biomechanical simulations. The models have been previously used to describe cardiovascular tissue and articular cartilage, and one model is novel to this study. All three constitutive models captured the tensile behaviour of rat Achilles tendon (root mean square errors between models and experimental data are 0.50-0.64). They further showed that collagen fibres are the main load-bearing component and that the non-collagenous matrix plays a minor role in tension. By introducing anisotropic behaviour also in the non-fibrillar matrix, the new biphasic structural model was also able to capture fluid exudation during tension and high values of Poisson׳s ratio that is reported in tendon experiments. PMID:27108350

  15. Une infiltration de plasma riche en plaquettes (PRP) pour traiter les tendinopathies rotuliennes supérieures chroniques

    Kaux, Jean-François; Croisier, Jean-Louis; Bruyère, Olivier; Rodriguez de la Cruz, Carlos; Simoni, Paolo; ALVAREZ MIEZENTSEVA, Victoria; Le Goff, Caroline; Crielaard, Jean-Michel

    2013-01-01

    Objectif: Le jumper’s knee est un syndrome chronique de surutilisation de la partie supérieure de la rotule. Les plaquettes contiennent de nombreux facteurs de croissance qui peuvent initier le processus de cicatrisation des tendons. Une infiltration de plasma riche en plaquettes (PRP) pourrait constituer une nouvelle thérapeutique pour ces tendinopathies chroniques. Matériel et méthodes: Vingt patients présentant une tendinopathie rotulienne supérieure chronique ont été inclus dans l’étud...

  16. IL-21 Receptor Expression in Human Tendinopathy

    Abigail L. Campbell; Smith, Nicola C.; Reilly, James H.; Kerr, Shauna C.; Leach, William J.; Umberto G. Fazzi; Rooney, Brian P.; George A. C. Murrell; Neal L. Millar

    2014-01-01

    The pathogenetic mechanisms underlying tendinopathy remain unclear, with much debate as to whether inflammation or degradation has the prominent role. Increasing evidence points toward an early inflammatory infiltrate and associated inflammatory cytokine production in human and animal models of tendon disease. The IL-21/IL-21R axis is a proinflammatory cytokine complex that has been associated with chronic inflammatory diseases including rheumatoid arthritis and inflammatory bowel disease. Th...

  17. Animal models for the study of tendinopathy

    Warden, S. J.

    2006-01-01

    Tendinopathy is a common and significant clinical problem characterised by activity‐related pain, focal tendon tenderness and intratendinous imaging changes. Recent histopathological studies have indicated the underlying pathology to be one of tendinosis (degeneration) as opposed to tendinitis (inflammation). Relatively little is known about tendinosis and its pathogenesis. Contributing to this is an absence of validated animal models of the pathology. Animal models of tendinosis represent po...

  18. Effects of tendon viscoelasticity in Achilles tendinosis on explosive performance and clinical severity in athletes.

    Wang, H-K; Lin, K-H; Su, S-C; Shih, T T-F; Huang, Y-C

    2012-12-01

    The aim was to compare viscoelastic properties of Achilles tendons between legs in elite athletes with unilateral tendinosis, and to investigate relationships between the properties and explosive performance and clinical severity. Seventeen male athletes (mean ± standard deviation age, 27.3 ± 2.0 years) who had unilateral, chronic middle-portion tendinopathy of the Achilles tendon were assessed by the Victorian Institute of Sport Assessment questionnaire, measurements of tendon viscoelastic properties, voluntary electromechanical delay (EMD), normalized rate of force development (RFD), and one-leg hopping distance. Compared with the non-injured leg, the tendinopathic leg showed reduced tendon stiffness (-19.2%. P mechanical hysteresis (+21.2%, P = 0.004), lower elastic energy storage and release (-14.2%, P = 0.002 and -19.1%, P < 0.001), lower normalized RFD at one-fourth (-16.3%, P = 0.02), 2/4 (-17.3%, P = 0.006), and three-fourths maximal voluntary contraction (-13.7%, P = 0.02), longer soleus and medial gastrocnemius voluntary EMD (+26.9%, P = 0.009 and +24.0%, P = 0.004), and shorter hopping distances (-34.1%, P < 0.001). Tendon stiffness was correlated with normalized RFD, voluntary EMD in the medial gastrocnemius, and hopping distances (r ranged from -0.35 to 0.64, P < 0.05). Hysteresis was correlated to the soleus voluntary EMD and hopping distances (r = 0.42 and -0.39, P < 0.05). We concluded that altered tendon viscoelastic properties in Achilles tendinosis affect explosive performance in athletes. PMID:22830527

  19. Using the Literature to Understand Achilles' Fate.

    Rakic, Vesna S

    2016-05-01

    According to Greek mythology, Achilles was fatally wounded in his heel, bled out, and died. Several unproven hypotheses mention poisoning, infection, allergy, hemophilia, thyrotoxic storm (ie, pain and stress), and suicide. The author, a plastic surgeon who often treats chronic wounds, proposes an additional scenario: Although not mortally wounded, Achilles was considered dead, because in his time a wounded hero was as good as a dead hero, so he lived out the remainder of his life as former hero with a chronic wound far away from everyone. To determine whether his injury was enough to cause fatal bleeding and quick death or if other factors might have been in play, a search of the literature was conducted to enhance what is known about Achilles, basically through the tale related in The Iliad and the clinical impact of an Achilles' injury. Search terms utilized included bleeding tibialis posterior artery (3 manuscripts were found) and chronic wound, Achilles tendon (631 manuscripts were located). Although science may not be able to explain how and why Achilles died, the literature supported the conjecture that Achilles probably had a chronic wound with skin and paratenon defect, de- vitalized tendon tissue, bleeding, granulation, and repeated infections. It is interesting to consider the state of his injury and his mind in the making of this legend. PMID:27192720

  20. Human Achilles tendon glycation and function in diabetes

    Couppe, Christian; Svensson, Rene Brüggebusch; Kongsgaard, Mads;

    2016-01-01

    Diabetic patients have an increased risk of foot ulcers, and glycation of collagen may increase tissue stiffness. We hypothesized that the level of glycemic control (glycation) may affect Achilles tendon stiffness, which can influence gait pattern. We therefore investigated the relationship between...... tissue cross-linking were greater in diabetic patients compared to controls. The higher foot pressure indicates that material stiffness of tendon and other tissue (e.g skin and joint capsule) may influence on foot gait. The difference in foot pressure distribution may contribute to the development of...... foot ulcers in diabetic patients....

  1. Patellar tendinopathy: physical therapy and injection treatments

    van Ark, Mathijs

    2015-01-01

    Patellar tendinopathy, commonly known as jumper’s knee, is an overuse injury of the patellar tendon. It is a frequent injury, particularly in jumping athletes such as volleyball and basketball players. Jumper’s knee is often a long-lasting injury and can have a major impact on sports and even work participation. The development of jumper’s knee and the best treatment for it are still unclear. The general aim of this thesis was to investigate the development and management of patellar tendinop...

  2. In vivo quantification of the shear modulus of the human Achilles tendon during passive loading using shear wave dispersion analysis

    Helfenstein-Didier, C.; Andrade, R. J.; Brum, J.; Hug, F.; Tanter, M.; Nordez, A.; Gennisson, J.-L.

    2016-03-01

    The shear wave velocity dispersion was analyzed in the Achilles tendon (AT) during passive dorsiflexion using a phase velocity method in order to obtain the tendon shear modulus (C 55). Based on this analysis, the aims of the present study were (i) to assess the reproducibility of the shear modulus for different ankle angles, (ii) to assess the effect of the probe locations, and (iii) to compare results with elasticity values obtained with the supersonic shear imaging (SSI) technique. The AT shear modulus (C 55) consistently increased with the ankle dorsiflexion (N  =  10, p  clinical relevance of the shear wave dispersion analysis, for instance in the case of tendinopathy or tendon tear.

  3. EMG monitoring during functional non-surgical therapy of Achilles tendon rupture.

    Hüfner, Tobias; Wohifarth, Kai; Fink, Matthias; Thermann, H; Rollnik, Jens D

    2002-07-01

    After surgical therapy of Achilles tendon rupture, neuromuscular changes may persist, even one year after surgery. We were interested whether these changes are also evident following a non-surgical functional therapy (Variostabil therapy boot/Adidas). Twenty-one patients with complete Achilles tendon rupture were enrolled in the study (mean age 38.5 years, range 24 to 60; 18 men, three women) and followed-up clinically and with surface EMG of the gastrocnemius muscles after four, eight, 12 weeks, and one year after rupture. EMG differences between the affected and non-affected side could only be observed at baseline and after four weeks following Achilles tendon rupture. The results from our study show that EMG changes are not found following non-surgical functional therapy. PMID:12146771

  4. The effect of foot position on Power Doppler Ultrasound grading of Achilles enthesitis.

    Zappia, Marcello; Cuomo, Giovanna; Martino, Maria Teresa; Reginelli, Alfonso; Brunese, Luca

    2016-06-01

    The aim of this study was to determine whether foot position could modify power Doppler grading in evaluation of the Achilles enthesis. Eighteen patients with clinical Achilles enthesitis were studied with power Doppler ultrasound (PDUS) in five different positions of the foot: active and passive dorsiflexion, neutral position, active and passive plantar flexion. The Doppler signal was graded in any position and compared with the others. The Doppler signal was higher with the foot in plantar flexion and decreased gradually, sometimes till to disappear, while increasing dorsiflexion. The Doppler signal was always less during the active keeping of the position of the joint, than during the passive. The PDUS examination of the Achilles enthesis should be performed also with the foot in passive plantar flexion, in order not to underestimate the degree of vascularization. PMID:27002715

  5. Recurrence of Diabetic Pedal Ulcerations Following Tendo-Achilles Lengthening

    Richard D. Weiner

    2011-05-01

    Full Text Available Foot and ankle surgeons are frequently challenged by the devastating systemic consequences of diabetes mellitus manifested through neuropathy, integumentary and joint breakdown, delayed healing, decreased ability to fight infection, and fragile tendon/ligaments. Diabetic neuropathic pedal ulcerations lead to amputations at an alarming rate and also carry a high mortality rate. This article will discuss causes of diabetic pedal ulcerations that persist or recur after tendo-Achilles lengthening and will highlight areas that need to be addressed by the practitioner such as infection, vascular and nutritional status, glucose control, off-loading, biomechanics, and patient compliance.

  6. The pathogenesis of tendinopathy: balancing the response to loading

    Magnusson, S Peter; Jørgensen, Henning Langberg; Kjaer, Michael

    2010-01-01

    , such as tendinopathy, which is characterized by pain during activity, localized tenderness upon palpation, swelling and impaired performance. Tendon histological changes include reduced numbers and rounding of fibroblasts, increased content of proteoglycans, glycosaminoglycans and water...... injury mechanisms, thus implying that one or more 'weak links' are present in the structure. Understanding how tendon tissue adapts to mechanical loading will help to unravel the pathogenesis of tendinopathy....

  7. Platelet-rich plasma (PRP) to treat upper patellar tendinopathies

    Kaux, Jean-François; Croisier, Jean-Louis; Simoni, Paolo; ALVAREZ MIEZENTSEVA, Victoria; Brabant, Gautier; Lapraille, Stuart; Lonneux, Vincent; Noël, David; Rodriguez de la Cruz, Carlos; Collette, Julien; Le Goff, Caroline; Gothot, André; Crielaard, Jean-Michel

    2013-01-01

    Introduction: Tendinopathies, especially upper patellar tendinopathy also known as jumper’s knee, often remain rebel to conservative treatments. Several experimental studies have shown the healing properties of platelet and their growth factors. These factors have the potentiality to improve healing of different tissues: bones, muscles, tendons... Researches have specifically demonstrated the platelets action as mediator and/or enhancer of tissue healing. On the other hand, such treatment has...

  8. Epidemiology of Patellar Tendinopathy in Elite Male Soccer Players

    Hägglund, Martin; Zwerver, Johannes; Ekstrand, Jan

    2011-01-01

    Background: Patellar tendinopathy is common among athletes in jumping sports and in sports with prolonged repetitive stress of the knee extensor apparatus. The epidemiology in soccer is not well described. less thanbrgreater than less thanbrgreater thanPurpose: This study was undertaken to investigate and describe the epidemiology of patellar tendinopathy in elite male soccer players and evaluate potential risk factors. less thanbrgreater than less thanbrgreater thanStudy Design: Cohort study...

  9. Automated volumetric assessment of the Achilles tendon (AVAT) using a 3D T2 weighted SPACE sequence at 3 T in healthy and pathologic cases

    Purpose: Achilles tendinopathy has been reported to be frequently associated with increasing volume of the tendon. This work aims at reliable and accurate volumetric quantification of the Achilles tendon using a newly developed contour detection algorithm applied on high resolution MRI data sets recorded at 3 T. Materials and methods: A total of 26 healthy tendons and 4 degenerated tendons were examined for this study. Automated identification (AI) of tendon boundaries was performed in transverse slices with isotropic resolution (0.8 mm) gained with a T2-weighted SPACE sequence at 3 T. For AI a snake algorithm was applied and compared to manual tracing (MT). Results: AI was feasible in all examined tendons without further correction. AI of both tendons was performed in each participant within 2 min (2 × 37 slices) compared to MT lasting 20 min. MT and AI showed excellent agreement and correlation (R2 = 0.99, p 3 vs. 0.5 cm3) and coefficient of variation (1% vs. 2%). Discussion: Compared to MT the AI allows assessment of tendon volumes in highly resolved MRI data in a more accurate and reliable time-saving way. Therefore automated volume detection is seen as a helpful clinical tool for evaluation of small volumetric changes of the Achilles tendon.

  10. Fibril morphology and tendon mechanical properties in patellar tendinopathy: effects of heavy slow resistance training

    Kongsgaard, Mads; Qvortrup, Klaus; Larsen, Jytte;

    2010-01-01

    BACKGROUND: Patellar tendinopathy is characterized by pathologic abnormalities. Heavy slow resistance training (HSR) is effective in the management of patellar tendinopathy, but the underlying functional mechanisms remain elusive. PURPOSE: To investigate fibril morphology and mechanical properties...

  11. Patellar tendinopathy - recent developments toward treatment.

    Christian, Robert A; Rossy, William H; Sherman, Orrin H

    2014-01-01

    Patellar tendinopathy (PT) is a clinical and chronic overuse condition of unknown pathogenesis and etiology marked by anterior knee pain typically manifested at the inferior pole of the patella. PT has been referred to as "jumper's knee" since it is particularly common among populations of jumping athletes, such as basketball and volleyball players. Due to its common refractory response to conservative treatment, a variety of new treatments have emerged recently that include dry-needling, sclerosing injections, platelet-rich plasma therapy, arthroscopic surgical procedures, surgical resection of the inferior patellar pole, extracorporeal shock wave treatment, and hyperthermia thermotherapy. Since PT has an unknown pathogenesis and etiology, PT treatment is more a result of physician experience than evidence-based science. This review will summarize the current literature on this topic, identify current research efforts aimed to understand the pathological changes in abnormal tendons, provide exposure to the emerging treatment techniques, and provide suggested direction for future research. PMID:25429390

  12. Long-term effect of Prolotherapy on symptomatic rotator cuff tendinopathy

    Suad Trebinjac

    2015-12-01

    Full Text Available Introduction: The objective of this study was to assess a long-term clinical effect of Prolotherapy on chronic symptomatic rotator cuff tendinopathy.Methods: We conducted a retrospective, uncontrolled study in the outpatient setting with 12 months follow-up. Adults diagnosed clinically and radiologically with rotator cuff tendinopathy that has been persisting for a minimum of six months were included. Patients received 15% extra-articular and 25% intra-articular hyperosmolar dextrose injections, repeated at weeks 5, 9, 13, 17 and 21. Primary outcome measure was validated Shoulder Pain and Disability Index (SPADI. Secondary outcome measure was validated visual pain analogue scale (VAS 0-10. The third outcome measures were patient’s satisfaction with Prolotherapy and adverse reactions after injections.Results: Twenty-one patients, 14 male and 7 female were treated with 6 sessions of hyperosmolar dextrose Prolotherapy repeated every 4 weeks. Average SPADI before starting the treatment was 73.995 ± 13.6, while 12 months after completed treatment was 20.84 ± 26.03 (P< 0.0001. Average VAS score before starting the treatment was 8.14 ± 1.2, while 12 months after completed treatment was 2.29 ± 2.8 (P<0.0001. Out of 21 patients, 18 (85.71% would recommend Prolotherapy to other people with the similar condition, and no one participant reported any side effect that was not resolved within one week after the treatment.Conclusion: Hyperosmolar dextrose Prolotherapy may result in significant reduction of pain and disability index in adult patients with chronic rotator cuff tendinopathy, without eliciting long-lasting side effects. Results of this pilot study need to be validated in prospective controlled randomized trials.

  13. Capacity for sliding between tendon fascicles decreases with ageing in injury prone equine tendons: a possible mechanism for age-related tendinopathy?

    CT Thorpe

    2013-01-01

    Full Text Available Age-related tendinopathy is common in both humans and horses; the initiation and progression of which is similar between species. The majority of tendon injuries occur to high-strain energy storing tendons, such as the human Achilles tendon and equine superficial digital flexor (SDFT. By contrast, the low-strain positional human anterior tibialis tendon and equine common digital extensor (CDET are rarely injured. It has previously been established that greater extension occurs at the fascicular interface in the SDFT than in the CDET; this may facilitate the large strains experienced during locomotion in the SDFT without damage occurring to the fascicles. This study investigated the alterations in whole tendon, fascicle and interfascicular mechanical properties in the SDFT and CDET with increasing age. It was hypothesised that the amount of sliding at the fascicular interface in the SDFT would decrease with increasing horse age, whereas the properties of the interface in the CDET would remain unchanged with ageing. Data support the hypothesis; there were no alterations in the mechanical properties of the whole SDFT or its constituent fascicles with increasing age. However, there was significantly less sliding at the fascicular interface at physiological loads in samples from aged tendons. There was no relationship between fascicle sliding and age in the CDET. The increase in stiffness of the interfascicular matrix in aged SDFT may result in the fascicles being loaded at an earlier point in the stress strain curve, increasing the risk of damage. This may predispose aged tendons to tendinopathy.

  14. Arthroscopic excision of giant cell tumor of the tendon sheath in the knee mimicking patellar tendinopathy: A case report

    GAO, KAI; CHEN, JIWU; CHEN, SHIYI; LI, YUNXIA

    2016-01-01

    Giant cell tumor of the tendon sheath (GCTTS) predominantly occurs in the tendon sheaths of the hand, but rarely in those of the knee. The current study reports the case of a 36-year-old male patient presenting with anterior knee pain. The patient was ultimately diagnosed with GCTTS in the knee mimicking patellar tendinopathy. To the best of our knowledge, this is the first case of its kind. Magnetic resonance imaging revealed a well-defined oval intra-articular lesion located at the proximal segment of the infrapatellar fat pad. The lesion was completely excised under arthroscopy and pathological examination confirmed the diagnosis of GCTTS. There was no evidence of recurrence at the 2-year follow-up examination. The findings of the present study suggest that, despite its rarity, GCTTS should be considered in the differential diagnosis of patellar tendinopathy. PMID:27123148

  15. Deciphering the pathogenesis of tendinopathy: a three-stages process

    Fu Sai-Chuen

    2010-12-01

    Full Text Available Abstract Our understanding of the pathogenesis of "tendinopathy" is based on fragmented evidences like pieces of a jigsaw puzzle. We propose a "failed healing theory" to knit these fragments together, which can explain previous observations. We also propose that albeit "overuse injury" and other insidious "micro trauma" may well be primary triggers of the process, "tendinopathy" is not an "overuse injury" per se. The typical clinical, histological and biochemical presentation relates to a localized chronic pain condition which may lead to tendon rupture, the latter attributed to mechanical weakness. Characterization of pathological "tendinotic" tissues revealed coexistence of collagenolytic injuries and an active healing process, focal hypervascularity and tissue metaplasia. These observations suggest a failed healing process as response to a triggering injury. The pathogenesis of tendinopathy can be described as a three stage process: injury, failed healing and clinical presentation. It is likely that some of these "initial injuries" heal well and we speculate that predisposing intrinsic or extrinsic factors may be involved. The injury stage involves a progressive collagenolytic tendon injury. The failed healing stage mainly refers to prolonged activation and failed resolution of the normal healing process. Finally, the matrix disturbances, increased focal vascularity and abnormal cytokine profiles contribute to the clinical presentations of chronic tendon pain or rupture. With this integrative pathogenesis theory, we can relate the known manifestations of tendinopathy and point to the "missing links". This model may guide future research on tendinopathy, until we could ultimately decipher the complete pathogenesis process and provide better treatments.

  16. Percutaneous, Minimally Invasive Repair of Traumatic and Simultaneous Rupture of Both Achilles Tendons: A Case Report.

    Zietek, Pawel; Karaczun, Maciej; Kruk, Bartosz; Szczypior, Karina

    2016-01-01

    Achilles injury is a common musculoskeletal disorder. Bilateral rupture of the Achilles tendon, however, is much less common and usually occurs spontaneously. Complete, traumatic, and bilateral ruptures are rare and typically require long periods of immobilization before the patient can return to full weightbearing. A 52-year-old male was hospitalized for bilateral traumatic rupture to both Achilles tendons. No risk factors for tendon rupture were found. Blood samples revealed no peripheral blood pathologic features. Both tendons were repaired with percutaneous, minimally invasive surgery using the Achillon(®) tendon suture system. Rehabilitation was begun 4 weeks later. An ankle-foot orthosis was prescribed to provide ankle support with an adjustable range of movement, and active plantar flexion was set at 0° to 30°. The patient remained non-weightbearing with the ankle-foot orthosis device and performed active range-of-motion exercises. At 8 weeks after surgery, we recommended that he begin walking with partial weightbearing using a foot-tibial orthosis with the range of motion set to 45° plantar flexion and 15° dorsiflexion. At 10 weeks postoperatively, he was encouraged to return to full weightbearing on both feet. Beginning rehabilitation as soon as possible after minimally invasive surgery, compared with 6 weeks of immobilization after surgery, provided a rapid resumption to full weightbearing. We emphasize the clinical importance of a safe, simple treatment program that can be followed for a patient with damage to the Achilles tendons. To our knowledge, ours is the first report of minimally invasive repair of bilateral simultaneous traumatic rupture of the Achilles tendon. PMID:26002678

  17. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy

    Kongsgaard, M.; Kovanen, V.; Aagaard, P.;

    2009-01-01

    A randomized-controlled single-blind trial was conducted to investigate the clinical, structural and functional effects of peritendinous corticosteroid injections (CORT), eccentric decline squat training (ECC) and heavy slow resistance training (HSR) in patellar tendinopathy. Thirty-nine male...... patients were randomized to CORT, ECC or HSR for 12 weeks. We assessed function and symptoms (VISA-p questionnaire), tendon pain during activity (VAS), treatment satisfaction, tendon swelling, tendon vascularization, tendon mechanical properties and collagen crosslink properties. Assessments were made at 0...

  18. Efficacy of betamethasone valerate medicated plaster on painful chronic elbow tendinopathy: a double-blind, randomized, placebo-controlled trial

    Frizziero, Antonio; Causero, Araldo; Bernasconi, Stefano; Papalia, Rocco; Longo, Mario; Sessa, Vincenzo; Sadile, Francesco; Greco, Pasquale; Tarantino, Umberto; Masiero, Stefano; Rovati, Stefano; Frangione, Valeria

    2016-01-01

    Summary Objective to investigate the efficacy and safety of a medicated plaster containing betamethasone valerate (BMV) 2.25 mg in patients with chronic elbow tendinopathy. Methods randomized, double-blind, placebo-controlled study with assignment 2:2:1:1 to BMV medicated plaster applied daily for 12 hours, daily for 24 hours or matched placebo. 62 patients aged ≥18 years with chronic lateral elbow tendinopathy were randomized. The primary efficacy variable was pain reduction (VAS) at day 28. Secondary objectives included summed pain intensity differences (SPID), overall treatment efficacy and tolerability. Results mean reduction in VAS pain score at day 28 was greater in both BMV medicated plaster groups, −39.35±27.69 mm for BMV12-h and −36.91±32.50 mm for BMV24-h, than with placebo, −20.20±27.32 mm. Considering the adjusted mean decreases, there was a statistically significant difference between BMV12-h and placebo (p=0.0110). Global pain relief (SPID) and overall treatment efficacy were significantly better with BMV. BMV and placebo plasters had similar local tolerability and there were few treatment-related adverse events. Conclusions BMV plaster was significantly more effective than placebo at reducing pain in patients with chronic elbow tendinopathies. The BMV plaster was safe and well tolerated. PMID:27331041

  19. Effects of long-term immobilization and recovery on human triceps surae and collagen turnover in the Achilles tendon in patients with healing ankle fracture

    Christensen, Britt; Dyrberg, Eva; Aagaard, Per;

    2008-01-01

    The aim of the present study was to analyze how human tendon connective tissue responds to an approximately 7-wk period of immobilization and a remobilization period of a similar length, in patients with unilateral ankle fracture, which is currently unknown. Calf muscle cross-sectional area (CSA...... calf muscle CSA and strength was found in relation to 7 wk of immobilization. Immobilization increased both collagen synthesis and degradation in tendon near tissue. However, it cannot be excluded that the facture of the ankle in close proximity could have affected these data. Remobilization increased...... muscle size and strength and tendon synthesis and degradation decreased to baseline levels. These dynamic changes in tendon connective tissue turnover were not associated with macroscopic changes in tendon size....

  20. Diagnosing Achilles tendon injuries in the emergency department.

    Gibbons, Lynda

    2013-09-01

    Achilles tendon (AT) injury is an overuse injury often seen in professional and recreational athletes. It tends to affect men, particularly those in their thirties and forties, more than women, and is typically seen in people who are intermittently active. To ensure AT ruptures are identified and treated effectively, early intervention in emergency departments (EDs) is crucial. This article discusses how advanced nurse practitioners can use their comprehensive problem-solving, clinical decision-making and clinical judgement skills to manage patients who present with suspected AT injury. It also describes the anatomy of tendon rupture, the aetiology and mechanism of injuries, and the importance of assessment and diagnostic tools, therapeutic techniques and management strategies. Finally, it considers the psychological effect this injury can have on patients, while in the ED and after discharge. A case study is included as an example of ED management.

  1. Achilles tendon rupture; assessment of nonoperative treatment

    Barfod, Kristoffer Weisskirchner

    2014-01-01

    -related quality of life in the weight-bearing group (p=0.009). Compared to the unaffected limb, the affected limb had decreased stiffness (77%, p < 0.001) and strength (93%, p = 0.009) of the plantar flexor muscle-tendon complex. Study IV showed excellent intra-rater reliability (ICC 0.96, SEM 3.7 mm and MDC 10...... trial (RCT). In study III, the effect of immediate weight-bearing on the biomechanical properties of the plantar flexor muscle-tendon complex was investigated in an RCT. In study IV, validity, reliability and agreement of a novel ultrasound measurement of Achilles tendon length and elongation was tested...... Sweden. Immediate weight-bearing was found to be safe and recommendable in non-operative treatment of acute Achilles tendon rupture. The novel ultrasound measurement showed excellent reliability and acceptable validity and agreement....

  2. The TOPGAME-study: effectiveness of extracorporeal shockwave therapy in jumping athletes with patellar tendinopathy. Design of a randomised controlled trial

    Diercks Ron L

    2010-02-01

    Full Text Available Abstract Background Patellar tendinopathy is a major problem for many athletes, especially those involved in jumping activities. Despite its frequency and negative impact on athletic careers, no evidence-based guidelines for management of this overuse injury exist. Since functional outcomes of conservative and surgical treatments remain suboptimal, new diagnostic and therapeutic strategies have to be developed and evaluated. Extracorporeal shockwave therapy (ESWT appears to be a promising treatment in patients with chronic patellar tendinopathy. ESWT is most often applied after the known conservative treatments have failed. However, its effectiveness as primary therapy has not been studied in athletes who keep playing sports despite having patellar tendon pain. The aim of this study is to determine the effectiveness of ESWT in athletes with patellar tendinopathy who are still in training and competition. Methods/design The TOPGAME-study (Tendinopathy of Patella Groningen Amsterdam Maastricht ESWT is a multicentre two-armed randomised controlled trial with blinded participants and outcome assessors, in which the effectiveness of patient-guided focussed ESWT treatment (compared to placebo ESWT on pain reduction and recovery of function in athletes with patellar tendinopathy will be investigated. Participants are volleyball, handball and basketball players with symptoms of patellar tendinopathy for a minimum of 3 to a maximum duration of 12 months who are still able to train and compete. The intervention group receives three patient-guided focussed medium-energy density ESWT treatments without local anaesthesia at a weekly interval in the first half of the competition. The control group receives placebo treatment. The follow-up measurements take place 1, 12 and 22 weeks after the final ESWT or placebo treatment, when athletes are still in competition. Primary outcome measure is the VISA-P (Victorian Institute of Sport Assessment - patella score

  3. Optical properties of human tendons characterized by PSOCT and their relation to tendinopathy: a clinical study

    Bagnaninchi, P. O.; Churmakov, D.; Bonesi, M.; Yang, Y.; Phelan, C.; Maffulli, N.; Meglinski, I.; El Haj, A.

    2008-02-01

    Polarisation-sensitive optical coherence tomography (PSOCT) is a non destructive technique with great potential for tendinopathy diagnosis. Functional optical assessment can be used in operating theatres to delineate in depth the margin of the non-healthy area, and limit the amount of tissue to be removed. A clinical study of 21 patients has been undertaken to correlate the optical properties of tendons to their clinical conditions. Tendons were scanned ex vivo with a fibre based time domain PSOCT. The beam from a superluminescent diode with a bandwidth of 52nm is sent through a polarizer and a polarizer modulator, and split into a sample and reference arm. After passing through polarization beam splitter, the interferences fringes are detected with two balanced detectors, for horizontal and vertical polarization. Scattering, birefringence and in depth stokes vectors are extracted from the measurements. Direct microstructural variation and changes in scattering properties are correlated with different tendinopathy and presence of scar tissue, which is cross-validated by histology. Lack of tissue organization, detected as the disappearance of the bands of birefringence, is representative of tendon degeneration. Special attention is paid to the difference between crimp patterns of different patient's tendons. As in polarization microscopy, the crimp pattern appears as extinction bands, and is particularly important as its alteration is generally symptomatic and could be used as an early diagnosis. Its optical origin is investigated by varying polarization and scanning conditions.

  4. Epidemiology of Patellar Tendinopathy in Elite Male Soccer Players

    Hägglund, Martin; Zwerver, Johannes; Ekstrand, Jan

    2011-01-01

    Background: Patellar tendinopathy is common among athletes in jumping sports and in sports with prolonged repetitive stress of the knee extensor apparatus. The epidemiology in soccer is not well described. Purpose: This study was undertaken to investigate and describe the epidemiology of patellar te

  5. Eccentric or Concentric Exercises for the Treatment of Tendinopathies?

    Couppé, Christian; Svensson, René B; Silbernagel, Karin Grävare;

    2015-01-01

    Tendinopathy is a very common disorder in both recreational and elite athletes. Many individuals have recurrent symptoms that lead to chronic conditions and termination of sports activity. Exercise has become a popular and somewhat efficacious treatment regime, and in particular isolated eccentri...

  6. Relationship between landing strategy and patellar tendinopathy in volleyball

    Bisseling, Rob W.; Hof, At L.; Bredeweg, Steef W.; Zwerver, Johannes; Mulder, Theo

    2007-01-01

    Objective: The aetiology of patellar tendinopathy ( jumper's knee) remains unclear. To see whether landing strategy might be a risk factor for the development of this injury, this study examined whether landing dynamics from drop jumps differed among healthy volleyball players ( CON) and volleyball

  7. Nonoperative dynamic treatment of acute achilles tendon rupture

    Barfod, Kristoffer Weisskirchner; Bencke, Jesper; Bloch Lauridsen, Hanne;

    2014-01-01

    BACKGROUND: Dynamic rehabilitation has been suggested to be an important part of nonoperative treatment of acute Achilles tendon rupture that results in functional outcome and rerupture rates comparable with those of operative treatment. However, the optimal role of weight-bearing during early...... Rupture Score (ATRS) after one year. Secondary outcomes included heel-rise work, health-related quality of life, and the rerupture rate. Outcome assessors were blinded to the intervention. RESULTS: Thirty patients were randomized to each group; twenty-nine in the weight-bearing group and twenty-seven in...... months, the total heel-rise work performed by the injured limb relative to that by the uninjured limb was 53% in the weight-bearing group and 58% in the control group (p = 0.37). There were three reruptures in the weight-bearing group and two in the control group (p = 1.0). CONCLUSIONS: The ATRS and heel...

  8. Finite Element Analysis of the Achilles Tendon While Running

    Anițaș Răzvan

    2013-02-01

    Full Text Available Introduction: The Achilles tendon is the most frequent recipient of traumatic injuries. The aim of this study is to identify and describe the varying load at ankle level and especially at the Achilles tendon’s insertion on the calcaneus.

  9. Use of fluroquinolone and risk of Achilles tendon rupture

    Sode, Jacob; Obel, Niels; Hallas, Jesper;

    2007-01-01

    OBJECTIVE: Several case-control studies have reported that the use of fluoroquinolone increases the risk of rupture of the Achilles tendon. Our aim was to estimate this risk by means of a population-based cohort approach. SETTING: Data on Achilles tendon ruptures and fluoroquinolone use were...... retrieved from three population-based databases that include information on residents of Funen County (population: 470,000) in primary and secondary care during the period 1991-1999. A study cohort of all 28,262 first-time users of fluoroquinolone and all incident cases of Achilles tendon ruptures were...... identified. MAIN OUTCOME MEASURES: The incidence rate of Achilles tendon ruptures among users and non-users of fluoroquinolones and the standardised incidence rate ratio associating fluoroquinolon use with Achilles tendon rupture were the main outcome measures. RESULTS: Between 1991 and 2002 the incidence of...

  10. Development in treatment of midportion Achilles tendinopathy%跟腱中部腱病治疗进展

    王军; 马昕; 王旭

    2009-01-01

    跟腱中部腱病是常见的运动性损伤,以保守治疗为主.离心性训炼作为具有里程碑意义的治疗手段,得到绝大多数文献的肯定,最为经济有效.在跟腱疼痛急性期,有必要采取休息和冷冻疗法.冲击波治疗效果尚未得到肯定,目前研究提示可能有一定积极作用.激素或硬化剂局部注射可有效缓解疼痛症状,但局部注射激素是否有不良作用还需进一步研究.非类固醇类抗炎药的有效性尚未得到证明,可能会影响跟腱愈合.保守治疗缓解症状无效时可选择手术治疗,目标是切除变性的纤维组织,改善肌腱血供,促进创口愈合.目前开放手术约有80%成功率,并发症发生率约为10%.内镜手术具有微创、住院时间短、并发症发生率低等优点.

  11. Creating an Animal Model of Tendinopathy by Inducing Chondrogenic Differentiation with Kartogenin

    Ting Yuan; Jianying Zhang; Guangyi Zhao; Yiqin Zhou; Chang-Qing Zhang; James H-C Wang

    2016-01-01

    Previous animal studies have shown that long term rat treadmill running induces over-use tendinopathy, which manifests as proteoglycan accumulation and chondrocytes-like cells within the affected tendons. Creating this animal model of tendinopathy by long term treadmill running is however time-consuming, costly and may vary among animals. In this study, we used a new approach to develop an animal model of tendinopathy using kartogenin (KGN), a bio-compound that can stimulate endogenous stem/p...

  12. Practice Patterns in the Care of Acute Achilles Tendon Ruptures

    Sheth, Ujash; Wasserstein, David; Moineddin, Rahim; Jenkinson, Richard; Kreder, Hans; Jaglal, Susan

    2016-01-01

    Objectives: Over the last decade, there has been a growing body of level I evidence supporting non-operative management (focused on early range of motion and weight bearing) of acute Achilles tendon ruptures. Despite this emerging evidence, there have been very few studies evaluating its uptake. Our primary objective was to determine whether the findings from a landmark trial assessing the optimal management strategy for acute Achilles tendon ruptures influenced the practice patterns of orthopaedic surgeons in Ontario, Canada over a 12-year time period. As a second objective we examined whether patient and provider predictors of surgical repair utilization differed before and after dissemination of the landmark trial results. Methods: Using provincial health administrative databases, we identified Ontario residents ≥ 18 years of age with an acute Achilles tendon rupture from April 2002 to March 2014. The proportion of surgically repaired ruptures was calculated for each calendar quarter and year. A time series analysis using an interventional autoregressive integrated moving average (ARIMA) model was used to determine whether changes in the proportion of surgically repaired ruptures were chronologically related to the dissemination of results from a landmark trial by Willits et al. (first quarter, 2009). Spline regression was then used to independently identify critical time-points of change in the surgical repair rate to confirm our findings. A multivariate logistic regression model was used to assess for differences in patient (baseline demographics) and provider (hospital type) predictors of surgical repair utilization before and after the landmark trial. Results: In 2002, ˜19% of acute Achilles tendon ruptures in Ontario were surgically repaired, however, by 2014 only 6.5% were treated operatively. A statistically significant decrease in the rate of surgical repair (p < 0.001) was observed after the results from a landmark trial were presented at a major

  13. Nonoperative biological treatment approach for partial Achilles tendon lesion.

    Filardo, Giuseppe; Presti, Mirco Lo; Kon, Elizaveta; Marcacci, Maurilio

    2010-02-01

    Tendon injuries, especially those of the Achilles tendon, are major concerns in sports medicine. The clinical presentation can be acute or chronic and the pathologic findings can range from peritendonitis to full-thickness tendon rupture. Nonsurgical treatment is not always successful; in particular, significant partial ruptures seem to respond poorly to conservative measures and do not improve with time. Surgery is most often considered the favored treatment option for this kind of lesion to obtain pain relief and full functionality with long-standing effects.This article describes a case of a partial tear of the Achilles tendon in a 34-year-old competitive athlete where surgical treatment was avoided in favor of a new biological approach. We applied autologous platelet growth factors through multiple platelet-rich plasma injections; approximately 6.5 billion platelets were injected into the lesion 3 times, 7 days apart. The treatment with platelet-rich plasma and a progressive rehabilitation program allowed the patient to play for 20 minutes in a basketball game 64 days after the trauma and in a full game 75 days after the trauma. To date, 18 months later, he has participated regularly in all the season's games and received no further treatment for his tendon.The fast tissue repair, confirmed by magnetic resonance and ultrasound imaging, allowed a swift return to full functionality and competitive sports activity, suggesting a possible role of platelet growth factors in promoting rapid tendon healing with high-quality tissue. This biological approach may represent a less-invasive therapeutic option even in cases where severe tendon lesions are candidates for surgical treatment. PMID:20192152

  14. Cuboid oedema due to peroneus longus tendinopathy: a report of four cases

    O' Donnell, Paul; Saifuddin, Asif [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, Stanmore, Middlesex (United Kingdom)

    2005-07-01

    To highlight focal bone abnormality in the cuboid due to tendinopathy of the adjacent peroneus longus. A retrospective review was carried out of the relevant clinical and imaging features. Two male and two female patients were studied, mean age 51.5 years (range 32 - 67 years), referred with foot pain and imaging showing an abnormal cuboid thought to represent either tumour or infection. A long history of foot pain was usual with a maximum of 8 years. Radiographs were normal in two cases and showed erosion in two, one of which exhibited periosteal new bone formation affecting the cuboid. Bone scintigraphy was undertaken in two patients, both of whom showed increased uptake of isotope. MRI, performed in all patients, showed oedema in the cuboid adjacent to the peroneus longus tendon. The tendon and/or paratendinous tissues were abnormal in all cases, but no tendon discontinuity was identified. One patient possessed an os peroneum. Unequivocal evidence of bone erosion was seen using MRI in three patients, but with greater clarity in two cases using CT. Additional findings of tenosynovitis of tibialis posterior, oedema in the adjacent medial malleolus and synovitis of multiple joints in the foot were seen in one patient. Imaging diagnosis was made in all cases avoiding bone biopsy, but surgical exploration of the peroneal tendons was performed in two cases and biopsy of ankle synovium in one. Oedema with erosion of the cuboid bone, simulating a bone lesion (cuboid ''pseudotumour''), may be caused by adjacent tendinopathy of peroneus longus. It is vital to be aware of this entity to avoid unnecessary biopsy of the cuboid. (orig.)

  15. Heated lidocaine/tetracaine patch for treatment of patellar tendinopathy pain

    Gammaitoni AR

    2013-07-01

    Full Text Available Arnold R Gammaitoni,1 Henry T Goitz,2 Stephanie Marsh,2 Thomas B Marriott,3 Bradley S Galer1 1Pain Group, Nuvo Research US, West Chester, PA, USA; 2Sports Medicine, Detroit Medical Center, Warren, MI, USA; 3Pain Group, Nuvo Research US, Salt Lake City, UT, USA Introduction: The pain of patellar tendinopathy (PT may be mediated by neuronal glutamate and sodium channels. Lidocaine and tetracaine block both of these channels. This study tested the self-heated lidocaine-tetracaine patch (HLT patch in patients with PT confirmed by physical examination to determine if the HLT patch might relieve pain and improve function. Methods: Thirteen patients with PT pain of ≥14 days' duration and baseline average pain scores ≥4 (on a 0–10 scale enrolled in and completed this prospective, single-center pilot study. Patients applied one HLT patch to the affected knee twice daily for 2–4 hours for a total of 14 days. Change in average pain intensity and interference (Victorian Institute of Sport Assessment [VISA] scores from baseline to day 14 were assessed. No statistical inference testing was performed. Results: Average pain scores declined from 5.5 ± 1.3 (mean ± standard deviation at baseline to 3.8 ± 2.5 on day 14. Similarly, VISA scores improved from 45.2 ± 14.4 at baseline to 54.3 ± 24.5 on day 14. A clinically important reduction in pain score (≥30% was demonstrated by 54% of patients. Conclusion: The results of this pilot study suggest that topical treatment that targets neuronal sodium and glutamate channels may be useful in the treatment of PT. Keywords: patellar tendinopathy, patellar tendinosis, heated lidocaine/tetracaine patch, topical analgesic patch, knee pain

  16. Heat Shock Proteins in Tendinopathy: Novel Molecular Regulators

    Neal L. Millar

    2012-01-01

    Full Text Available Tendon disorders—tendinopathies—are the primary reason for musculoskeletal consultation in primary care and account for up to 30% of rheumatological consultations. Whilst the molecular pathophysiology of tendinopathy remains difficult to interpret the disease process involving repetitive stress, and cellular load provides important mechanistic insight into the area of heat shock proteins which spans many disease processes in the autoimmune community. Heat shock proteins, also called damage-associated molecular patterns (DAMPs, are rapidly released following nonprogrammed cell death, are key effectors of the innate immune system, and critically restore homeostasis by promoting the reconstruction of the effected tissue. Our investigations have highlighted a key role for HSPs in tendion disease which may ultimately affect tissue rescue mechanisms in tendon pathology. This paper aims to provide an overview of the biology of heat shock proteins in soft tissue and how these mediators may be important regulators of inflammatory mediators and matrix regulation in tendinopathy.

  17. Clinical Applications of Platelet-Rich Plasma in Patellar Tendinopathy

    D. U. Jeong

    2014-01-01

    Full Text Available Platelet-rich plasma (PRP, a blood derivative with high concentrations of platelets, has been found to have high levels of autologous growth factors (GFs, such as transforming growth factor-β (TGF-β, platelet-derived growth factor (PDGF, fibroblastic growth factor (FGF, vascular endothelial growth factor (VEGF, and epidermal growth factor (EGF. These GFs and other biological active proteins of PRP can promote tissue healing through the regulation of fibrosis and angiogenesis. Moreover, PRP is considered to be safe due to its autologous nature and long-term usage without any reported major complications. Therefore, PRP therapy could be an option in treating overused tendon damage such as chronic tendinopathy. Here, we present a systematic review highlighting the clinical effectiveness of PRP injection therapy in patellar tendinopathy, which is a major cause of athletes to retire from their respective careers.

  18. Clinical applications of platelet-rich plasma in patellar tendinopathy.

    Jeong, D U; Lee, C-R; Lee, J H; Pak, J; Kang, L-W; Jeong, B C; Lee, S H

    2014-01-01

    Platelet-rich plasma (PRP), a blood derivative with high concentrations of platelets, has been found to have high levels of autologous growth factors (GFs), such as transforming growth factor-β (TGF-β), platelet-derived growth factor (PDGF), fibroblastic growth factor (FGF), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF). These GFs and other biological active proteins of PRP can promote tissue healing through the regulation of fibrosis and angiogenesis. Moreover, PRP is considered to be safe due to its autologous nature and long-term usage without any reported major complications. Therefore, PRP therapy could be an option in treating overused tendon damage such as chronic tendinopathy. Here, we present a systematic review highlighting the clinical effectiveness of PRP injection therapy in patellar tendinopathy, which is a major cause of athletes to retire from their respective careers. PMID:25136568

  19. Heat Shock Proteins in Tendinopathy: Novel Molecular Regulators

    Neal L. Millar; George A. C. Murrell

    2012-01-01

    Tendon disorders—tendinopathies—are the primary reason for musculoskeletal consultation in primary care and account for up to 30% of rheumatological consultations. Whilst the molecular pathophysiology of tendinopathy remains difficult to interpret the disease process involving repetitive stress, and cellular load provides important mechanistic insight into the area of heat shock proteins which spans many disease processes in the autoimmune community. Heat shock proteins, also called damage-as...

  20. Risk Factors for Lower Extremity Tendinopathies in Military Personnel

    Owens, Brett D.; Wolf, Jennifer Moriatis; Seelig, Amber D.; Jacobson, Isabel G.; Boyko, Edward J.; Smith, Besa; Ryan, Margaret A. K.; Gackstetter, Gary D; Smith, Tyler C; ,

    2013-01-01

    Background: Overuse injuries have a significant impact on United States military service members, but research to date has been limited in its ability to assess occupational and behavioral risk factors. Hypothesis/Purpose: To prospectively identify risk factors for the development of lower extremity tendinopathy and plantar fasciitis in United States military personnel. Study Design: Descriptive epidemiology study. Methods: Baseline data from the Millennium Cohort Study, a long-term observati...

  1. Biomechanical properties of Achilles tendon repair augmented with a bioadhesive-coated scaffold

    Brodie, Michael; Vollenweider, Laura; Murphy, John L; Xu Fangmin; Lyman, Arinne; Lew, William D; Lee, Bruce P, E-mail: b-lee@nerites.com [Nerites Corporation, 505 S. Rosa Road, Suite 123, Madison, WI 53719 (United States)

    2011-02-15

    The Achilles tendon is the most frequently ruptured tendon. Both acute and chronic (neglected) tendon ruptures can dramatically affect a patient's quality of life, and require a prolonged period of recovery before return to pre-injury activity levels. This paper describes the use of an adhesive-coated biologic scaffold to augment primary suture repair of transected Achilles tendons. The adhesive portion consisted of a synthetic mimic of mussel adhesive proteins that can adhere to various surfaces in a wet environment, including biologic tissues. When combined with biologic scaffolds such as bovine pericardium or porcine dermal tissues, these adhesive constructs demonstrated lap shear adhesive strengths significantly greater than that of fibrin glue, while reaching up to 60% of the strength of a cyanoacrylate-based adhesive. These adhesive constructs were wrapped around transected cadaveric porcine Achilles tendons repaired with a combination of parallel and three-loop suture patterns. Tensile mechanical testing of the augmented repairs exhibited significantly higher stiffness (22-34%), failure load (24-44%), and energy to failure (27-63%) when compared to control tendons with suture repair alone. Potential clinical implications of this novel adhesive biomaterial are discussed.

  2. Differences in tendon properties in elite badminton players with or without patellar tendinopathy

    Couppé, C; Kongsgaard, M; Aagaard, P;

    2012-01-01

    The aim of this study was to examine the structural and mechanical properties of the patellar tendon in elite male badminton players with and without patellar tendinopathy. Seven players with unilateral patellar tendinopathy (PT group) on the lead extremity (used for forward lunge) and nine players...

  3. In vivo quantification of the shear modulus of the human Achilles tendon during passive loading using shear wave dispersion analysis

    Helfenstein-Didier, C.; Andrade, R. J.; Brum, J.; Hug, F.; Tanter, M.; Nordez, A.; Gennisson, J.-L.

    2016-03-01

    The shear wave velocity dispersion was analyzed in the Achilles tendon (AT) during passive dorsiflexion using a phase velocity method in order to obtain the tendon shear modulus (C 55). Based on this analysis, the aims of the present study were (i) to assess the reproducibility of the shear modulus for different ankle angles, (ii) to assess the effect of the probe locations, and (iii) to compare results with elasticity values obtained with the supersonic shear imaging (SSI) technique. The AT shear modulus (C 55) consistently increased with the ankle dorsiflexion (N  =  10, p  SSI was always lower than C55 and the difference increased with the ankle dorsiflexion. However, shear modulus values provided by both methods were highly correlated (R  =  0.84), indicating that the conventional shear wave elastography technique (SSI technique) can be used to compare tendon mechanical properties across populations. Future studies should determine the clinical relevance of the shear wave dispersion analysis, for instance in the case of tendinopathy or tendon tear.

  4. Acute Calcific Bursitis After Ultrasound-Guided Percutaneous Barbotage of Rotator Cuff Calcific Tendinopathy: A Case Report.

    Kang, Bo-Sung; Lee, Seung Hak; Cho, Yung; Chung, Sun Gun

    2016-08-01

    Ultrasound-guided percutaneous barbotage is an effective treatment for rotator cuff calcific tendinopathy, providing rapid and substantial pain relief. We present the case of a 49-year-old woman with aggravated pain early after ultrasound-guided barbotage of a large calcific deposit in the supraspinatus tendon. Subsequent examination revealed a thick calcification spreading along the subacromial-subdeltoid bursa space, suggesting acute calcific bursitis complicated by barbotage. Additional barbotage alleviated her pain completely. Therefore, a high index of suspicion for acute calcific bursitis is required in patients with unresolved or aggravated pain after barbotage. Repeated barbotage could be effective for this condition. PMID:26902864

  5. The Transformation of Achilles in The Iliad: A Reading from the Views of Sibling Narratives and Nonlinear Growth.

    Lament, Claudia

    2014-01-01

    I wish to showcase the importance of plasticity of narrative in fantasy formations, as exemplified in Achilles' psychological trajectory in The Iliad. Applying conceptual formulations concerning the psychoanalytic developmental process to Achilles' growth piques my reflections about the sibling experience and its unique position in the mental life of children and adolescents. With developmental advance and the capacity for measured fluidity of self and other structures, the original sibling experience--whether it be tilted toward aggressiveness or toward loving concern or a place in between--may acquire new meanings. By locating it within this contextual framework, Achilles' story line can be seen as a metaphorical description of the continuous and discontinuous patterns in growth. This poses intriguing questions: What contexts are useful in pondering Achilles' psychological shifts? Might the domain of disposition prove useful? Is birth order another? Is his gradual empathic concern for the enemy a demonstration of an elasticity of imaginative capacity that reassembles murderous potential? Child and adult analysts alike may find a rich trove in Homer's masterpiece for contemplating potential sources within their patients that spur forward movement. PMID:26173338

  6. Tendinopathy of the long head of the biceps tendon: histopathologic analysis of the extra-articular biceps tendon and tenosynovium

    Streit JJ

    2015-03-01

    Full Text Available Jonathan J Streit,1 Yousef Shishani,1 Mark Rodgers,2 Reuben Gobezie1 1The Cleveland Shoulder Institute, 2Department of Pathology, University Hospitals of Cleveland, Cleveland, OH, USA Background: Bicipital tendinitis is a common cause of anterior shoulder pain, but there is no evidence that acute inflammation of the extra-articular long head of the biceps (LHB tendon is the root cause of this condition. We evaluated the histologic findings of the extra-articular portion of the LHB tendon and synovial sheath in order to compare those findings to known histologic changes seen in other tendinopathies. Methods: Twenty-six consecutive patients (mean age 45.4±13.7 years underwent an open subpectoral biceps tenodesis for anterior shoulder pain localized to the bicipital groove. Excised tendons were sent for histologic analysis. Specimens were graded using a semiquantitative scoring system to evaluate tenocyte morphology, the presence of ground substance, collagen bundle characteristics, and vascular changes. Results: Chronic inflammation was noted in only two of 26 specimens, and no specimen demonstrated acute inflammation. Tenocyte enlargement and proliferation, characterized by increased roundness and size of the cell and nucleus with proteoglycan matrix expansion and myxoid degenerative changes, was found in all 26 specimens. Abundant ground substance, collagen bundle changes, and increased vascularization were visualized in all samples. Conclusion: Anterior shoulder pain attributed to the biceps tendon does not appear to be due to an inflammatory process in most cases. The histologic findings of the extra-articular portion of the LHB tendon and synovial sheath are similar to the pathologic findings in de Quervain tenosynovitis at the wrist, and may be due to a chronic degenerative process similar to this and other tendinopathies of the body. Keywords: biceps tendinitis, biceps tendinopathy, tenosynovium, anterior shoulder pain, long head biceps

  7. Nutraceutical supplement in the management of tendinopathies: a systematic review

    Fusini, Federico; Bisicchia, Salvatore; Bottegoni, Carlo; Gigante, Antonio; Zanchini, Fabio; Busilacchi, Alberto

    2016-01-01

    Summary Background nutraceuticals are common support therapy for management of tendinopathies. Even if they are widely diffused, our knowledge is still poor. The aim of this systematic review is to analyze the most commonly used nutraceuticals and their effects on tendons. Methods glucosamine and chondroitin sulphate, vitamin C, hydrolazed type 1 collagen, arginine alpha-keto-glutarate, bromelain, curcumin, boswellic acid, and methil-sulfonil-methane were considered. During the last week of Dicember 2015 a comprehensive research of main databases for each substance was made in relation with tendinopathy. Repeated articles, articles not in English nor in Italian, not common nutraceuticals, and articles not related with tendons or tenocytes were excluded. Clinical article quality was assessed independently by two reviewers using the modified Coleman methodology score. Results preclinical and clinical data from 46 articles from all databases were analyzed. All these nutraceuticals demonstrated several effects on normal and pathological tendons. Preclinical and clinical studies showed a possible role on collagen synthesis, inflammation, mechanical properties, and maturation of collagen bundles, antioxidant effect, edema, and analgesia. The majority clinical studies had some methodological limitations with an average Modified Coleman Methodology Score of 51.3 points and SD of 20.5 points. In particular, there were very low values in power, error, outcome assessment, and clinical effect. Conclusion preclinical results are very encouraging, however they are not fully confirmed by clinical studies. There are few clinical papers on the use of nutraceuticals in tendon disorders, and their methodological quality is poor. Furthermore, in most of the studies more than one supplement was administered at the same time. This may bias the results, and the effect of each single component cannot be determined. Furthermore, the interactions between nutraceuticals and drugs, or other

  8. Patellar tendinopathy: Causes, consequences and the use of orthoses

    de Vries, Astrid Johanna

    2016-01-01

    Patellar tendinopathy (PT), also known as jumper’s knee, is a painful overuse injury of the patellar tendon. This injury is common in jumping athletes. There are numerous treatment options currently available for PT, yet none of them guarantee full recovery. As a result, many athletes have long-lasting symptoms, even after ending their athletic career. The scope of this thesis was to gain more insight into the causes and consequences of PT, and to study the effectiveness of commonly used orth...

  9. The effects of laser treatment in tendinopathy: a systematic review

    Nogueira, Adelmário Cavalcanti; Júnior, Manoel de Jesus Moura

    2015-01-01

    Tendons have as main function transmit forces from the muscle to the bones. Tendinopathy is an inflammatory process that occurs in and around the tendon, when these are affected by some injury. Low level laser therapy consists in a local application of a monochromatic, coherent and short wavelength light. Its use began in 60's and since then several benefits for tendon injuries have been reported. The objective of this study is to collect the most recent studies about the use of laser on the ...

  10. Single-Stage Reconstruction of Achilles Tendon and Overlying Tissue With the Extended Temporoparietal Fasciagaleal Flap-23-Year Follow-Up and the Review of the Literature.

    Dobke, Marek; Suliman, Ahmed; Mackert, Gina A; Herrera, Fernando A; Singer, Robert; Nelson, Jeffrey

    2016-05-01

    In the absence of an established "gold standard" for complex Achilles tendon and regional soft tissue defect reconstruction, many techniques have been advocated. Two cases describing a novel technique of successful repair with the review of literature are presented. The underlying problem consisted of Achilles tendon necrosis with local inflammation in the first case and tendon contracture with foot malposition due to a burn injury in the other. Each patient, upon debridement, had a 6-cm Achilles tendon defect with associated overlying soft tissue deficits reconstructed with an extended temporoparietal fasciagaleal flap and a split thickness skin graft. Both cases highlight the successful functional and aesthetic quality as well as the durability of concurrent vascularized tendon and soft tissue replacement and coverage in 2 distinct clinical scenarios. PMID:27070674