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Search Results for : Tendinopathy
Merck Online Lab
Diagnosis Therapy Rehabilitation Imaging Clinical Laboratory
Variation and clinical significance of extensor pollicis brevis: a study in South Indian cadavers.
Author(s): Nayak, SR; Hussein, M; Krishnamurthy, A; Mansur, DI; Prabhu, LV; D'Souza, P; Potu, BK; Chettiar, GK
Journal: Chang Gung Med J 2010 Mar 11; Vol. 32, Issue 6; Page(s) 600-4
[Medline ID - 20035638]

BACKGROUND: de Quervain's disease is a condition in which there is pain in the radial styloid process caused by stenosing tenosynovitis of the abductor pollicis longus (APL) or/and extensor pollicis brevis (EPB) tendons in the first extensor compartment of the wrist. In this study we studied variations in the tendons of the EPB in the first extensor compartment and its site of insertion. METHODS: One hundred fifty six upper limbs from adult cadavers of south Indian origin were dissected to observe the number of EPB tendons and the presence of an osseo-fibrous septum in the first extensor compartment of the wrist. RESULTS: The EPB had a single tendon in 133 limbs, double tendons in 17 limbs and triple tendons in only 6 limbs. The EPB was present in all of the upper limbs in our study. In 34.6% of cases, the tendons of the EPB were separated from the tendons of APL by an osseo-fibrous septum in the first extensor compartment. CONCLUSION: Variation in the number of EPB tendons and site of insertion should be taken into consideration by clinicians and surgeons when performing surgical decompression of the first extensor compartment of the wrist in de Quervain's syndrome. Surgical failure may occur due to overlooking variations in EPB tendons or septation of the first extensor compartment.

Synergistic effects of dexamethasone and quinolones on human-derived tendon cells.
Author(s): Sendzik, J; Shakibaei, M; Sch; äfer-Korting, M; Lode, H; Stahlmann, R
Journal: Int J Antimicrob Agents 2010 May 6; Vol. 35, Issue 4; Page(s) 366-74
[Medline ID - 20034766]

Quinolones and glucocorticoids are frequently used drugs that may cause tendinopathy as a rare adverse effect. We exposed human tenocyte cultures to the steroid dexamethasone alone or in combination with either ciprofloxacin or levofloxacin at concentrations of 3mg/L and 10mg/L. At concentrations corresponding to peak levels in plasma and tissues during therapy (ca. 3-10mg/L), ciprofloxacin caused a significant decrease in collagen type I and the beta(1)-integrin receptor. In contrast, no corresponding effect was induced by 3mg/L levofloxacin. With both quinolones at 3mg/L and 10mg/L, the amount of matrix metalloproteinase-1 (MMP-1) and MMP-13 was increased. In addition, 3mg/L ciprofloxacin and 10mg/L levofloxacin activated caspase-3. Apoptotic changes were confirmed by electron microscopy. Incubation of human tenocytes with dexamethasone decreased the main matrix protein collagen type I, the transmembrane beta(1)-integrin receptor and the cytoskeleton protein vinculin, but only at the high concentrations tested (0.1 microM or 10 microM). Concentrations of 0.1 microM and 10 microM dexamethasone increased the amount of MMPs and activated caspase-3 as an indicator of apoptosis. Combined exposure to quinolones and dexamethasone led to more pronounced effects in tenocyte cultures at most of the analysed endpoints. The clinical observations of an increased risk of quinolone-induced tendinopathy by glucocorticoids are supported by these in vitro data.

Sonographic Identification of the intracompartmental septum in de Quervain's disease.
Author(s): Kwon, BC; Choi, SJ; Koh, SH; Shin, DJ; Baek, GH
Journal: Clin Orthop Relat Res 2011 Aug 1; Vol. 468, Issue 8; Page(s) 2129-34
[Medline ID - 20033358]

BACKGROUND: The intracompartmental septum in the first extensor compartment in patients with de Quervain's disease has been associated with disease development and prognosis. However, with the exception of surgical exploration, there is no way of detecting the septum. QUESTIONS/PURPOSES: We evaluated the accuracy of sonography for identifying the intracompartmental septum in the first extensor compartment in patients with de Quervain's disease using surgical findings as the reference standard. PATIENTS AND METHODS: We performed surgical release of the first extensor compartment in 43 wrists of 40 patients who were unresponsive to nonoperative treatment. In each case, a sonographic evaluation was performed before surgery by a radiologist and the sonographic and surgical findings were compared. RESULTS: Sonography identified the intracompartmental septum in 19 of the 19 septum-present wrists and absence of the septum in 23 of the 24 septum-absent wrists. The sensitivity of sonography was 100% (95% confidence interval, 80%-100%), its specificity 96% (95% confidence interval, 78%-100%), accuracy 98% (95% confidence interval, 87%-100%), positive predictive value 95% (95% confidence interval, 74%-100%), and negative predictive value 100% (95% confidence interval, 83%-100%). Sonography also identified septum-like structures in 15 of 37 (41%) asymptomatic contralateral wrists. CONCLUSIONS: Sonography is useful for detecting the intracompartmental septum in the first extensor compartment in patients with de Quervain's disease. LEVEL OF EVIDENCE: Level I, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

Effectiveness of ultrasound-guided corticosteroid injection for the treatment of gluteus medius tendinopathy.
Author(s): Labrosse, JM; Cardinal, E; Leduc, BE; Duranceau, J; R; émillard, J; Bureau, NJ; Belblidia, A; Brassard, P
Journal: AJR Am J Roentgenol 2010 Jan 27; Vol. 194, Issue 1; Page(s) 202-6
[Medline ID - 20028924]

OBJECTIVE: The objective of our study was to evaluate the effectiveness of ultrasound-guided corticosteroid injection for the treatment of gluteus medius tendinopathy. SUBJECTS AND METHODS: We prospectively evaluated 54 consecutive patients (48 women, six men; mean age, 54.7 years; mean body mass index, 26 kg/m2) with a clinical diagnosis of gluteus medius tendinopathy. Pain assessment using a 10-cm visual analog scale (VAS) was obtained as part of the initial clinical evaluation of all patients. A hip ultrasound study was performed followed by a gluteus medius peritendinous ultrasound-guided injection of 30 mg of triamcinolone combined with 3 mL of bupivacaine 0.5% using an anterior oblique coronal plane. One month after treatment, participants were reassessed clinically, and they were asked to quantify their pain using the VAS pain score and their satisfaction with the outcome of the injection using a 4-point rating scale (very satisfied, somewhat satisfied, somewhat dissatisfied, or very dissatisfied). Statistical analysis included a paired Student's t test (comparison of pain levels before and after treatment, p=0.05) and a multivariate analysis of covariance. RESULTS: There was a 55% average reduction of pain level before versus after treatment (mean VAS pain score, 6.4 vs 2.9 cm, respectively; p < 0.001). One month after treatment, 72% of the patients showed a clinically significant improvement in pain level, which was defined as a reduction in the VAS pain score of > or=30%. Seventy percent of patients were satisfied with the results of the intervention. No correlation was shown between treatment outcome and any of the clinical variables or ultrasound findings. CONCLUSION: Our study shows that a peritendinous ultrasound-guided corticosteroid injection may be an effective treatment of gluteus medius tendinopathy.

The prevalence of neovascularity in patients clinically diagnosed with rotator cuff tendinopathy.
Author(s): Lewis, JS; Raza, SA; Pilcher, J; Heron, C; Poloniecki, JD
Journal: BMC Musculoskelet Disord 2010 Mar 24; Vol. 10; Page(s) 163
[Medline ID - 20025761]

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 by consensus. RESULTS: Twenty-six patients agreed to participate and formed the study population. Of these, 6 subjects were not included in the final assessment following the pre-scan clinical investigation. This is because one subject had complete cessation of symptoms between the time of the referral and entry into the trial. Another five had developed bilateral shoulder pain during the same period. The mean age of the 20 subjects forming the study population was 50.2 (range 32-69) years (SD = 10.9) and the mean duration of symptoms was 22.6 (range .75 to 132) months (SD = 40.1). Of the 20 subjects included in the formal analysis, 13 subjects (65%) demonstrated neovascularity in the symptomatic shoulder and 5 subjects (25%) demonstrated neovascularity in the asymptomatic shoulder. The subject withdrawn due to complete cessation of symptoms was not found to have neovascularity in either shoulder and of the 5 withdrawn due to bilateral symptoms; two subjects were found to have signs of bilateral neovascularity, one subject demonstrated neovascularity in one shoulder and two subjects in neither shoulder. CONCLUSIONS: This study demonstrated that neovascularity does occur in subjects with a clinical diagnosis of rotator cuff tendinopathy and to a lesser extent in asymptomatic shoulders. In addition, the findings of this investigation did not identify an association between the presence of neovascularity; and pain, duration of symptoms or shoulder function. Future research is required to determine the relevance of these findings.

Midportion Achilles tendinopathy--a cardiovascular disease?
Author(s): Knobloch, K; Kraemer, R; Vogt, PM
Journal: Med Sci Sports Exerc 2010 Mar 6; Vol. 42, Issue 1; Page(s) 213-4; author reply 216
[Medline ID - 19461549]

ABSTRACT NOT AVAILABLE

Multiple extensor tendon ruptures caused by tophaceous gout.
Author(s): Iwamoto, T; Toki, H; Ikari, K; Yamanaka, H; Momohara, S
Journal: Mod Rheumatol 2010 Jul 24; Vol. 20, Issue 2; Page(s) 210-2
[Medline ID - 20013296]

A 54-year-old woman presented with painless subcutaneous masses on her right hand and spontaneous loss of extension of her ring finger. Surgical exploration of the wrist showed hypertrophic white-colored crystal deposits that both surrounded and invaded into the extensor tendons (intratendinous invasion). Histopathologic examination of the specimen demonstrated findings consistent with gouty tophi. We conclude that tophaceous gout needs to be included in the differential diagnosis of chronic extensor tenosynovitis of the hand.

Evidence supporting the use of physical modalities in the treatment of upper extremity musculoskeletal conditions.
Author(s): Valen, PA; Foxworth, J
Journal: Curr Opin Rheumatol 2010 Apr 20; Vol. 22, Issue 2; Page(s) 194-204
[Medline ID - 20010297]

PURPOSE OF REVIEW: To evaluate recent trials and reviews of physical modalities and conservative treatments for selected upper extremity musculoskeletal conditions for evidence supporting their use. RECENT FINDINGS: Recent evidence suggests that many localized tendinopathies are related more to degenerative than inflammatory processes. With this realization, there is increased emphasis on finding new modalities to treat tendinopathies and other localized musculoskeletal conditions that rely on other than anti-inflammatory mechanisms. Although there is good evidence to support the short-term benefits of corticosteroid injections, convincing evidence in support of other conservative treatments and modalities is generally lacking. Extracorpal shock wave therapy may have significant clinical benefit for calcific tendinitis; however, it requires intravenous sedation in most cases and does not appear to be effective in lateral epicondylitis. The most consistent positive treatment effects for rotator cuff tendinitis were achieved by ultrasound-guided subacromial corticosteroid injection as well as manual therapy in conjunction with therapeutic exercise. SUMMARY: Although there is evidence supporting the use of several different physical modalities and conservative treatments for upper extremity musculoskeletal conditions, there is a strong need for larger, higher quality randomized controlled trials. Although most studies are able to demonstrate short-term benefits, there is a lack of high-quality data demonstrating that these conservative treatments have long-term benefits, particularly, with regard to functional outcomes.

Electrical impedance spectroscopy and diagnosis of tendinitis.
Author(s): Yoon, K; Lee, KW; Kim, SB; Han, TR; Jung, DK; Roh, MS; Lee, JH
Journal: Physiol Meas 2010 Feb 25; Vol. 31, Issue 2; Page(s) 171-82
[Medline ID - 20009187]

There have been a number of studies that investigate the usefulness of bioelectric signals in diagnoses and treatment in the medical field. Tendinitis is a musculoskeletal disorder with a very high rate of occurrence. This study attempts to examine whether electrical impedance spectroscopy (EIS) can detect pathological changes in a tendon and find the exact location of the lesion. Experimental tendinitis was induced by injecting collagenase into one side of the patellar tendons in rabbits, while the other side was used as the control. After measuring the impedance in the tendinitis and intact t endon tissue, the dissipation factor was computed. The real component of impedance and the dissipation factor turned out to be lower in tendinitis than in intact tissues. Moreover, the tendinitis dissipation factor spectrum showed a clear difference from that of the intact tendon, indicating its usefulness as a tool for detecting the location of the lesion. Pathologic findings from the tissues that were obtained after measuring the impedance confirmed the presence of characteristics of tendinitis. In conclusion, EIS is a useful method for diagnosing tendinitis and detecting the lesion location in invasive treatment.

Kinematic analysis of runners with achilles mid-portion tendinopathy.
Author(s): Ryan, M; Grau, S; Krauss, I; Maiwald, C; Taunton, J; Horstmann, T
Journal: Foot Ankle Int 2010 Mar 5; Vol. 30, Issue 12; Page(s) 1190-5
[Medline ID - 20003878]

BACKGROUND: Despite anecdotal evidence linking overpronation to the onset of Achilles tendinopathy (AT), there is little conclusive evidence of a particular movement pattern of the lower extremity associated with this injury. Therefore, the objective of the present study was to observe differences in the kinematic profiles of healthy runners (CON) and runners with mid-portion Achilles tendinopathy (ATG). MATERIALS AND METHODS: In this cross-sectional analysis, 48 male height and weight matched subjects were invited to participate: 27 with mid-portion Achilles tendon pain and 21 asymptomatic controls. Subje cts underwent lower extremity clinical examination, then ran barefoot for 10-trials at a self-selected pace. A 3D motion capture system analysed tri-plane kinematic data for the lower extremity. RESULTS: The ATG displayed significantly greater sub-talar joint eversion displacement during mid-stance of the running gait (13 +/- 3 degrees vs. 11 +/- 3 degrees; p = 0.04). Trends were observed such that the ATG showed lower peak dorsiflexion velocity (300 +/- 39 degrees/s vs. 330 +/- 59 degrees/s; p = 0.08) and greater overall frontal plane ankle joint range of motion (45 degrees +/- 7 vs. 41 degrees +/- 7; p = 0.09). CONCLUSION: We found an increase in eversion displacement of the sub-talar joint in runners with Achilles mid-portion tendinopathy. Based on the findings from this study, there is evidence that devices used to control sub-talar eversion may be warranted in patients with Achilles mid-portion tendinopathy who demonstrate over-pronation during mid-stance of the running gait.
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