Role of Magnetic Resonance Imaging in rotator cuff pathologies

Background: Stability to the shoulder joint which has great range of motility, is provided by the rotator cuff, the coraco-acromial arch and the glenoid labrum along with the capsule and glenohumeral ligaments. The common disorders involving the rotator cuff tendons include impingement, tendinopathies and tears. Magnetic Resonance Imaging (MRI) has good spatial resolution for identifying tendon edema and tears in the rotator cuff. Aim and objectives: To describe the MRI characteristics of rotator cuff pathologies. To describe the rotator cuff pathologies in terms of age, gender, symptomatology and predisposing factors among the study population. Materials and methods: The study was performed in the Department of Radiodiagnosis, NRI General Hospital, Chinakakani, Guntur from September 2015 to August 2017 and comprises of 100 patients with suspected rotator cuff pathologies who were referred for MRI shoulder. Results: The age distribution of patients with rotator cuff abnormalities was in the range of 21 and 74 years. The most commonly affected was supraspinatus tendon followed by subscapularis and infraspinatus tendons. Among the rotator cuff abnormalities the frequently encountered finding was tendinosis followed by partial tears. Conclusion: Magnetic Resonance Imaging is very useful in depicting rotator cuff disease in patients with painful, weak or stiff shoulder for prompt and accurate diagnosis.

Tendinitis of the temporalis muscle: differential diagnosis and treatment: a case report / Tendinitis del músculo temporal: diagnóstico diferencial y tratamiento: informe de caso

Abstract: introduction: The temporalis muscle plays an essential role in mastication and is actively involved in the mandibular closing movement. It is covered by a fibroelastic fascia that forms its tendon. Tendinitis is a degenerative and inflammatory process, which originates in the tendon-bone junction. Signs and symptoms such as swelling, pain, tenderness on palpation, limitation of movement and mouth opening are frequently associated with other temporomandibular disorders and not with tendinitis as a causal factor. Objective: To describe a clinical case identifying the diagnostic process and management of tendinitis of the temporalis muscle. Case report: A 30-year old male patient who sought treatment after continuous squeezing pain in the zygomatic and bilateral temporal regions with increased pain during mouth opening and mandibular function. The patient referred pain in the insertion region of the tendon of the temporalis muscle. Pain was removed after using anesthesia, consequently confirming the diagnosis of tendinitis of the temporalis muscle. Primary management measures were performed and then peritendinous corticosteroids were administered. The patient did not refer spontaneous or functional pain during check-up. Conclusion: Tendinitis of the temporalis muscle is a common condition, although frequently underdiagnosed. A good differential diagnosis must be performed to avoid confusion with other common conditions such as odontogenic pain, sinusitis, arthralgia, myofascial pain and migraine. Management depends on the type of tendinitis. It usually occurs in conjunction with other types of TMD or facial pain, so it is important to know the different clinical characteristics of pathologies with similar manifestations.

Resumen: introducción: El músculo temporal es fundamental en la masticación, participa activamente en los movimientos de cierre mandibular. Está recubierto por una fascia fibroelástica que conforma su tendón. La tendinitis es un proceso degenerativo e inflamatorio, que se origina en la unión tendón-hueso. Con frecuencia, signos y síntomas como inflamación, dolor a la palpación, limitación del movimiento y apertura, son asociados a otros trastornos temporomandibulares no considerando la tendinitis como un factor causal. Objetivo: Describir un caso clínico identificando el proceso diagnóstico y el manejo de una tendinitis del músculo temporal. Descripción del caso: Paciente sexo masculino de 30 años, acude por dolor opresivo continuo en la región cigomática y temporal bilateral con aumento del dolor en apertura y función mandibular. A la palpación presenta dolor en la zona de inserción del tendón del músculo temporal, el cual se elimina al anestesiar confirmando el diagnóstico de tendinitis del músculo temporal. Se realizan medidas primarias de manejo y luego se infiltra corticoides peritendineos. Al control el paciente no presenta dolor espontáneo ni en función. Conclusión: La tendinitis del músculo temporal es una patología frecuente, aunque subdiagnosticada. Debe realizarse el correcto diagnóstico diferencial con patologías frecuentes como dolor odontogénico, sinusitis, artralgia, dolor miofascial y migraña. El manejo dependerá del tipo de tendinitis. Habitualmente se presenta en conjunto con otros o dolores faciales, por lo que es importante conocer las distintas características clínicas de patologías con presentaciones similares.

Sonographic Evaluation of Subscapularis Tendon Tears with Surgical Correlation.

Aims: The purpose of this study was to evaluate the ability of ultrasound in detecting subscapularis tendon pathology with operative correlation. Methodology: A retrospective study was conducted on 86 patients who had shoulder ultrasound prior to surgical repair from January 2006 to August 2008. All sonographic examinations and surgical reports were reviewed. Sonographic evaluation of subscapularis tendon, including normal, tendinosis, partial thickness tear, full thickness tear, and complete tear were correlated to operative reports. Results: Of the 86 patients, 19 patients had surgically proven abnormal subscapularis tendons. There was 100% ultrasound concordance in tendinosis (n = 1), 100 % ultrasound concordance in partial thickness tears (n =3), 88 % ultrasound concordance in full thickness tears (n = 8), 57 % ultrasound concordance in complete tears (n = 7). Overall, there was 79% ultrasound concordance in diagnosing subscapularis tendon pathology when surgery is used as a gold standard. Conclusion: Ultrasound is useful in the evaluation of the subscapularis tendon. The sonographic findings of tendinosis and partial thickness tears correlate best with surgery. However, ultrasound may underestimate complete tears.

Musculoskeletal Disorders of the Upper Extremities Due to Extensive Usage of Hand Held Devices

OBJECTIVE: The use of hand held devices (HHD) such as mobile phones, game controls, tablets, portable media players and personal digital assistants have increased dramatically in past decade. While sending a text message or using the controls of the HHD the users need to use their thumb and other palm muscles extensively. The objective of this study was to describe the risk factors and clinical features of the musculoskeletal disorders (MSDs) arising due to usage of hand held devices and to evaluate the effectiveness of a sequenced rehabilitation protocol. METHODS: A retrospective report analysis of 70 subjects, who were diagnosed to have a MSD affecting the upper extremities, was conducted. Medical charts from a tertiary level rehabilitation centre from 2005-2013 were analysed. All the subjects reported pain in their upper extremities following extensive usage of HHD and were examined and diagnosed to have a MSD by an orthopaedic and rehabilitation physician. After the assessment and diagnosis, all the patients underwent rehabilitation using a sequenced protocol. RESULTS: All the subjects reported pain in the thumb and forearm with associated burning, numbness and tingling around the thenar aspect of the hand, and stiffness of wrist and hand. 43 subjects had symptoms on the right side; 9 on left and 18 had bilateral symptoms. Correlation was found between hand dominance and MSD. 33 subjects complained of onset of symptoms following extensive text messaging. All the subjects were diagnosed to have tendinosis of Extensor Pollicis Longus and Myofascial Pain Syndrome affecting the 1st interossei, thenar group of muscles and Extensor Digitorum Communis. 23 of the subjects were senior executives, among these 7 were CEO's of major multinational companies in India. All the subjects recovered completely following the rehabilitation. CONCLUSIONS: The study concluded that mobile phones and gadgets that promoted the predominant usage of thumb or only one finger while texting or using the controls were associated with a higher prevalence of MSDs. Treatment using a sequenced rehabilitation protocol was found to be effective.

Lesiones tendinosas en medicina del deporte: ciencias básicas aplicadas al tratamiento actual / Tendinopathy in sports medicine: the basic sciences and current management

Las lesiones del tendón, denominadas “Tendinosis” son muy frecuentes en la práctica de deportistas de alto rendimiento y recreacionales. Están dentro de las patologías de sobreuso que representan cerca del 60 por ciento de las lesiones deportivas y se relacionan con una sobrecarga cíclica repetidas. Los tendones más afectados del organismo son el rotuliano, aquiliano y manguito rotador. Estudios demuestran que la condición de tendinosis aumenta significativamente su incidencia en relación a la edad; sexo masculino y obesidad. El incremento de la vascularización y terminaciones nerviosas, asociado a un aumento en la producción local de neurotransmisores explicaría la presencia de dolor crónico en las tendinosis. Tendinosis implica una pérdida progresiva de la capacidad de respuesta del tendón para una adecuada regeneración o cicatrización cuando es sometido a una carga cíclica de gran volumen en forma reiterada. La carga cíclica alta repetida induce 1- Estrés oxidativo y apoptosis. 2- Genes cartílago sustituto. Histológicamente esta falla en la respuesta reparativa se refleja en descontrolada proliferación de Tenocitos, disrupción de fibras colágenas, alteraciones en la matriz extracelular, incremento en el fenómeno de apoptosis y cambios en la homeostasis de las Metalo-proteinasas. Se inicia la destrucción de la matriz, aumenta la vascularización y terminaciones nerviosas y el tendón presenta dolor y mecánicamente respuestas a la carga inferiores a un tendón sano. Existe una gran cantidad de opciones de tratamientos pero el objetivo de este artículo es presentar aquellas opciones que nuestro equipo de trabajo aplica, basada en las ciencias básicas y últimos hallazgos con evidencia científica 1- Ejercicios excéntricos asociados a aplicación de ondas de choque radiales han demostrado alto grado de éxito 2- Uso de sustancias esclerosante (polidocanol) y concentrado...

Tendinopathies account for a substantial proportion of overuse injuries associated with sports1 and are a common cause of disability. Most major tendons, such as the Achilles, patellar, rotator cuff, and forearm extensor tendons (among others), are vulnerable to overuse, which induces pathological changes in the tendon. Tendinopathy has an increased incidence with age and the male gender and with obesity. Excessive long-distance running, intensity, and hill work are risk factors for acute. Tendinopathy is a failed healing response of the tendon. The aim of this review is to identify recent advances in the understanding of tendinopathy, particularly from a cell and molecular biology perspective. There has been much new information and there are many gaps in our understanding of the pathogenesis of tendinopathy. The current hypothesisis that tendinopathy is induced when tendon cells experience a large volume of repetitive load. High doses of cyclical strain induce genes for two major pathways ) oxidative stress- apoptosis; and cartilage like genes. The tendon cells become rounded and apoptotic and produce a matrix that contains less Type I collagen and is more cartilaginous and ‘immature’’ in nature. The therapeutic options with clinical evidence are 1- Combining eccentric training and shock wave therapy produces higher success rates compared with eccentric loading alone or shock wave therapy alone. 2- The use of injectable substances such as platelet-richplasma, autologuos blood, polidocanol, corticosteroids, and aprotinin in and around tendons is popular, but there isminimal clinical evidence to support their use: 3- The aim of operative treatment is 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...

Fundamentos anatómicos de la epicondilitis lateral / Fondements anatomiques de l'épicondylite latérale / Anatomical basic principles of the lateral epicondylitis

Introducción: el término tendinitis ha sido usado con frecuencia para referirse a la enfermedad alrededor del epicóndilo, sin embargo, tendinosis sería más apropiado porque el proceso patológico es degenerativo con presencia de fibroblastos e hiperplasia vascular. El tratamiento en general es conservador, menos de 10 por ciento requiere cirugía. Objetivo: describir la anatomía de los músculos en el epicóndilo lateral con el enfoque sobre el extensor carpi radialis brevis (ECRB) y el ligamento colateral lateral. Métodos: se disecaron 20 codos de cadáveres frescos. Se identificó el origen del ECRB y del ligamento colateral lateral; se hicieron mediciones entre ellos y respecto al epicóndilo. Resultados: el origen tendinoso del ECRB se encontró en todos los casos profundo al extensor digitorum comunis. En 19 codos se identificó el tendón del ECRB como una estructura separada, que se originaba anterior al epicóndilo en promedio de 6 mm y con un ancho de 7,93 mm. En todos los codos se observó que el origen del ligamento colateral lateral era distal al origen del ECRB. Conclusión: se observaron dos patrones de distribución proximal del ECRB. En 60 por ciento discurría profundo al extensor digitorum comunis y en 40 por ciento superficial, en el mismo plano que el extensor carpi radialis longus y el extensor digitorum comunis. El ligamento colateral lateral se encontraba en la parte media del cóndilo en 40 por ciento de su diámetro, dato útil en la técnica artroscópica, porque al realizar la fasciotomía profunda del extensor carpi radialis brevis, existe riesgo de seccionar el ligamento debido a la inmediata vecindad entre este y el ligamento(AU)

Introduction: the term tendinitis has been used frequently for the disease around the epicondyle; however, tendinosis would be more appropriate because of the pathologic process is degenerative with presence of fibroblasts and vascular hyperplasia. Treatment in general is conservative, less of 10 percent require surgery. Objective: to describe the anatomy of muscles in the lateral epicondyle with the focus on the extensor carpi radialis brevis (ECRB) and the lateral collateral ligament. Methods: twenty elbows were dissected from fresh cadavers. The origin of ECRB and of the lateral collateral ligament was identified; measurements between them werw made and regarding the epicondyle. Results: the tendinous origin of ECRB was present in all the cases located deep into the extensor digitorum comunis. In 19 elbows the tendon of the ECRB was identified as a separate structure, originated anterior to epicondyle in 6 mm as average and 7.93 mm in width. In all elbows it was noted that the origin of the lateral collateral ligament was distal to origin of ECRB. Conclusions: there were two patterns of proximal distribution of ECRB. In the 60 percent passed deep to extensor digitorum comunis and in the 40 percent it was superficial in the same plane that the extensor carpi radialis longus and the extensor digitorum comunis. The lateral collateral ligament was located in the middle area of condyle in the 40 percent of its diameter, it is a useful datum for arthroscopy technique because of performing the deep fasciotomy of extensor carpi radialis brevis, there is the risk of to section the ligament due to the immediate proximity between it and the ligament(AU)

Introduction: le terme tendinite a été fréquemment utilisé pour définir la maladie affectant la région épicondylienne. Cependant, le terme tendinopathie serait le plus approprié, parce que le processus pathologique est dégénératif avec la présence de fibroblastes et hyperplasie vasculaire. Le traitement est généralement conservateur, moins de 10 percent des patients ont besoin d'une chirurgie. Objectifs: décrire l'anatomie des muscles de l'épicondyle latéral, en mettant l'accent sur l'extensor carpi radialis brevis (ECRB) et le ligament collatéral latéral. Méthodes: vingt coudes de cadavres frais ont été disséqués; l'origine de l'ECRB et celle du ligament collatéral ont été identifiées. Résultats: dans tous les cas, on a trouvé que l'origine tendineuse de l'ECRB était profonde par rapport à l'extensor digitorum comunis. Le tendon de l'ECRB a été identifié dans 19 cas, avec une structure séparée, d'origine antérieure par rapport à l'épicondyle de 6 mm, et d'un épaisseur de 7.93 mm. Dans tous les cas, on a également trouvé que l'origine du ligament collatéral était distale par rapport à l'origine de l'ECRB. Conclusions: on a remarqué qu'il y avait deux schémas de distribution proximale de l'ECRB. Soixante pour cent étaient profonds par rapport à l'extensor digitorum comunis, et quarante pour cent étaient superficiels au même plan que l'extensor carpi radialis longus et l'extensor digitorum comunis. Le ligament collatéral latéral se trouvait au milieu du condyle dans 40 percent de son diamètre, donnée utile pour la technique arthroscopique, parce que quand une fasciotomie profonde de l'extensor carpi radialis brevis est réalisée, il y a risque de sectionner le ligament dû à leur proximité(AU)