Tendonopathies

PURPOSE: The proximal part of the long head of the biceps muscle has become a recognized cause of significant shoulder pain. Tenodesis of the long head of the biceps has been advocated as a treatment for pain resulting from biceps tendonopathy, biceps instability, and biceps tendon tears. All of these pathologies may be encountered during rotator cuff, SLAP or Bankart surgery, or in isolation. Several techniques have been described for this tenodesis, including various arthroscopic and subpectoral methods...

INTRODUCTION: Total shoulder replacement (TSR) is a reliable treatment for glenohumeral osteoarthritis. In addition to proper component orientation, successful arthroplasty requires accurate restoration of soft tissues forces around the joint to maximize function. We hypothesized that pathological changes within the rotator cuff on preoperative magnetic resonance imaging (MRI) adversely affect the functional outcome following TSR. MATERIALS AND METHODS: A retrospective analysis of case notes and MRI of patients undergoing TSR for primary glenohumeral osteoarthritis over a 4-year period was performed...

This study was undertaken to determine whether the incidence of lower limb overuse injuries (LLOIs) sustained during Royal Marine training could be reduced by issuing the recruits with shock-absorbing insoles (SAIs) to wear in their military boots. This was a retrospective longitudinal trial conducted in two phases. Injury data from 1,416 recruits issued with standard Saran insoles and 1,338 recruits issued with SAI were compared. The recruits in the two groups were of similar height, body mass, and aerobic fitness and followed the same training course...

Tendinopathy is a general term that describes any painful condition that occurs in or around a tendon. Historically, treatments have been directed at inflammation, but an improved understanding of the pathophysiology of tendinopathy has led to redirecting the treatment toward methods that address the underlying pathophysiology. Anti-inflammatory treatments such as NSAIDs and corticosteroid injections are still in common use. Novel treatments such as topical nitrates and platelet rich plasma injections aim to address the biological changes seen in tendinopathy, but evidence of clinical benefit is scant...

OBJECTIVE: Conventional imaging modalities can diagnose the source of foot pain in most cases, but have limitations in some horses, which can be overcome by using magnetic resonance imaging (MRI). However, there are no reports of the MRI appearance and prevalence of foot lesions of a large series of horses with chronic foot lameness. METHODS: In the present study, 79 horses with unilateral or bilateral forelimb lameness because of chronic foot pain underwent standing low-field MRI to make a definitive diagnosis...

It was hypothesised that there is increased blood vessel frequency and proteoglycan staining intensity within the distal aspect of the deep digital flexor tendon (DDFT) in horses with chronic foot pain. Samples of the DDFT from three standardised sites from 10 age-matched mature horses, with chronic foot pain (Group L) or with no history of forelimb lameness (Group N), were collected for this study. A histological analysis of haematoxylin and eosin-stained sections focussed on the frequency and location of blood vessels, while safranin 0 fast green staining was used for semi-quantitative assessment of matrix proteoglycan...

INTRODUCTION: In order to ensure we provided an appropriate patient focused service we undertook a prospective audit of referrals to our surgical foot and ankle department in a large District General Hospital/Treatment centre. METHODOLOGY: An audit was conducted over a 12 month period to establish the initial referral patterns to a dedicated foot and ankle service. This was undertaken by completion of a dedicated audit form, with departmentally agreed terms and domains following the International coding of diseases (ICD) system...

Simultaneous bilateral patellar tendon rupture occurs rarely and is even rarer in patients without systemic disease or predisposing conditions. We present a case of bilateral, midsubstance patellar tendon ruptures along with a partial anterior cruciate ligament tear from a fall from a standing height in an otherwise healthy adult without any predisposing conditions. Most patients that sustain a tendon rupture have risk factors for tendonopathy including chronic renal disease, systemic lupus erythematosus, rheumatoid arthritis, or exposure to medications (such as corticosteroids or fluoroquinolones)...

OBJECTIVE: Detail the progress of an adolescent soccer player with right-sided chronic medial foot pain due to striking an opponent's leg while kicking the ball. The patient underwent diagnostic ultrasound and a conservative treatment plan. CLINICAL FEATURES: The most important features were hindfoot varus, forefoot abduction, flatfoot deformity, and inability to single leg heel raise due to pain. Conventional treatment was aimed at decreasing hypertonicity and improving function of the posterior tibialis muscle and tendon...

Plantar fasciopathy is a common cause of heel pain. This article covers the imaging anatomy of the hindfoot, the imaging findings on ultrasound and magnetic resonance imaging (MRI) of plantar fasciopathy, plantar fibromas, trauma, Achilles tendonopathy, neural compression, stress fractures of the os calcis and other heel pad lesions. Thickening of the plantar fascia insertion more than 5 mm either on ultrasound or MRI is suggestive of plantar fasciopathy. Ultrasound is superior to MRI for diagnosis of plantar fibroma as small low signal lesions on MRI are similar to the normal plantar fascia signal...

BACKGROUND AND PURPOSE: Extracorporeal shock waves (ESWs) are used to good effect in the treatment of soft tissue injuries, but the underlying mechanisms are still unknown. We therefore determined the effects of ESWs on normal fibroblasts in vitro, in order to assess treatment-induced cell response. METHODS: A normal human fibroblast cell line (NHDF-12519) was treated with ESWs generated by a piezoelectric device (Piezoson 100; Richard Wolfe) using different protocols of impulses (300, 1,000, or 2,000 shots) and energy (0...

We compared contrast-enhanced computed tomography (CT) and high field magnetic resonance (MR) imaging in a horse with deep digital flexor tendonopathy. Lesions in the distal extremity were documented grossly and histopathologically. In contrast-enhanced CT, the deep digital flexor tendon lesions were markedly contrast enhancing with evidence of angiogenesis in the core and dorsal border lesions. The lesion morphology was clearly delineated on MR imaging, but without contrast media angiogenesis cannot be identified...

Extra-articular crystalline deposition secondary to gout, and less commonly, pseudogout is a well known phenomenon. Despite this well-documented entity of extra-articular deposition, there have been few reports of infiltration of the flexor tendon sheath of the hand. Here, we present a case series of this unique occurrence, including surgical techniques, pathology, and the clinical outcomes of 5 patients. We encountered 2 cases of calcium pyrophosphate and 3 cases of uric acid deposition into the flexor tendon sheath masquerading as common tendonopathies...

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To determine if runners with a history of Achilles tendonopathy (AT) demonstrate a difference in transverse-plane motion and moments at the distal tibia and knee compared to runners without a history of AT. BACKGROUND: One of the more prevalent overuse running injuries is AT. It has been hypothesized that prolonged pronation causes contradictory rotational forces acting on the AT. Conflicting joint motions may also accentuate the rotation of the tendon...

OBJECTIVE: This study investigated the association between accessory soleus muscle and abnormalities of the Achilles tendon. MATERIALS AND METHODS: The authors reviewed 15 consecutive cases with a diagnosis of accessory soleus muscle from a computerized database of ankle magnetic resonance (MR) examinations reported between January 1998 and January 2007. On review, two cases were eliminated because of an incorrect initial diagnosis: One patient had a low lying soleus attachment to the Achilles tendon, while the other had a prominent flexor hallucis longus tendon partially obliterating Kager's fat...

No abstract text is available yet for this article.

Chronic Achilles tendinosis can be a challenging problem to the foot and ankle surgeon. Multiple surgical treatment options have been described for this condition including transfer of the Flexor Hallucis Longus (FHL) tendon for an incompetent Achilles tendon. Our technique describes FHL tendon transfer into the calcaneus to replace or supplement the Achilles tendon using a single posterior incision, a "short harvest" and interference screw fixation.

REASON FOR PERFORMING STUDY: Conditioning by early training may influence the composition of certain musculoskeletal tissues, but very few data exist on its effect during growth on tendon structure and function. OBJECTIVES: To investigate whether conditioning exercise in young foals would lead to any ultrasonographically detectable damage to the superficial digital flexor tendon or an increase in cross-sectional area (CSA). METHODS: Thirty-three Thoroughbred foals reared at pasture were allocated to 2 groups: control (PASTEX) allowed exercise freely at pasture; and CONDEX, also at pasture, began conditioning exercise from mean age 21 days over 1030 m on a purpose-built oval grass track, for 5 days/week until mean age 18 months...

PURPOSE: It has been shown that eccentric training can be effective in the rehabilitation of patients with Achilles tendonopathy. The mechanism behind these results is not clear. However, there is evidence that tendons are able to respond to repeated forces by altering their structure and composition, and, thus, their mechanical properties change. In this regard, the objective of the present study was to investigate whether eccentric training affects the mechanical properties of the plantar flexor's muscle-tendon tissue properties...

BACKGROUND: This study presents the surgical technique of fractional lengthening of extensor carpi radialis brevis, extensor digitorum communis and the superficial head of supinator, for chronic lateral epicondylitis. The anatomical basis for this surgical approach is reviewed. The results of surgical treatment in a consecutive series of patients with severe chronic lateral epicondylitis are reviewed. METHODS: Twenty-one elbows in 17 subjects underwent surgery. All elbows had severe resistant symptoms, unresponsive to a minimum 6 months (mean 14 months) of a non-operative treatment protocol...