Effectiveness analysis of "tail compression fixation+suture bridge" technology under shoulder arthroscopy for treating primary tear in medial enthesis of rotator cuff / 中国修复重建外科杂志

OBJECTIVE@#To investigate the feasibility and effectiveness of "tail compression fixation+suture bridge" technology under shoulder arthroscopy for treating primary tear in medial enthesis of rotator cuff.@*METHODS@#The clinical data of 11 patients with primary tear in medial enthesis of rotator cuff who met the selection criteria between October 2020 and October 2022 were retrospectively analyzed, including 3 males and 8 females, aged 39-79 years, with an average of 61.0 years. Rotator cuff injury was caused by traumatic fall in 8 cases, and the time from injury to admission was 1-4 months, with an average of 2.0 months; the remaining 3 cases had no obvious inducement. The active range of motion of the affected shoulder was limited, with an active forward flexion range of motion of (64.1±10.9)°, abduction of (78.1±6.4)°, internal rotation of (48.2±6.6)°, and external rotation of (41.8±10.5)°; 5 cases had shoulder stiffness. The preoperative visual analogue scale (VAS) score was 7.8±0.8 and the American Society of Shoulder and Elbow Surgeons (ASES) score was 23.9±6.4. The patients were treated with "tail compression fixation+suture bridge" technology under shoulder arthroscopy, and the pain and functional recovery were evaluated by VAS score, ASES score, and active range of motion of shoulder joint at last follow-up; MRI was performed after operation, and the integrity of rotator cuff was evaluated by Sugaya classification system.@*RESULTS@#All the 11 patients were followed up 2-22 months, with an average of 13.5 months. All incisions healed by first intention, and there was no complication such as infection, rotator cuff re-tear, and anchor falling off. At last follow-up, the VAS score was 0.8±0.7 and the ASES score was 93.5±4.2, which significantly improved when compared with those before operation ( P<0.05). All 11 patients had no significant swelling in the shoulders, and the active range of motion was (165.1±8.8)° in flexion, (75.3±8.4)° in abduction, (56.6±5.5)° in internal rotation, and (51.8±4.0)° in external rotation, which significantly improved when compared with those before operation ( P<0.05). Shoulder MRI showed adequate tendon thickness and good continuity in 9 cases, including 4 cases with partial high signal area; and 2 cases with inadequate tendon thickness but high continuity and partial high signal area. According to Sugaya classification system, there were 4 cases of type 1 (36.4%), 5 cases of type 2 (45.5%), and 2 cases of type 3 (18.1%).@*CONCLUSION@#For the patients with primary tear in medial enthesis of rotator cuff, the "tail compression fixation+suture bridge" technology under shoulder arthroscopy is simple and effective.

Enfermedad de Scheuermann lumbar atípica en rara asociación con artritis idiopática juvenil / Atypical lumbar Scheuermann disease and juvenile idiopathic arthritis: a rarely association

El dolor lumbar en los adolescentes es causa frecuente de motivo de consulta en reumatología y obedece a diferentes causas. Se presenta un caso clínico de un adolescente de 14 años de edad, de procedencia rural que acudió a consulta refiriendo dolor y aumento de volumen de ambas rodillas de 3 meses de evolución, acompañado de dolor lumbar desde hacía más de 2 años y que había requerido tratamiento con antinflamatorios no esteroideos y reposo, sin otros síntomas sistémicos acompañantes. Al examen físico se encontró artritis de rodillas, aumento de la cifosis fisiológica en la columna dorsal y puntos sacroilíacos positivos. En los exámenes complementarios fue significativa la presencia del HLA-B27, sinovitis en bolsa subcuadricipital bilateral detectada mediante ultrasonido de rodillas, así como hallazgos en las radiografías a nivel de los cuerpos de las vértebras lumbares característicos de la enfermedad de Scheuermann, y esclerosis de ambas sacroilíacas, características de artritis idiopática juvenil. Se concluyó que el paciente padecía de dos afecciones que por mecanismos diferentes causan dolor lumbar(AU)

Low back pain in adolescents is a frequent reason for consultation in rheumatology and is due to different causes. A clinical case of a 14-year-old adolescent from rural origin who comes to the clinic reporting pain and volume increase in both knees of three months of evolution accompanied by low back pain of more than two years of evolution that had required treatment is presented. with non-steroidal anti-inflammatory drugs and rest, without other accompanying systemic symptoms, physical examination revealed knee arthritis, increased physiological kyphosis in the thoracic spine and positive sacroiliac points. In the complementary tests, the presence of HLA-B27, synovitis in the bilateral sub quadriceps bursa on ultrasound of the knees, findings in the radiographs at the level of the bodies of the lumbar vertebrae characteristic of Scheuermann's disease, and sclerosis of both sacroiliacs' characteristic of juvenile idiopathic arthritis, it is concluded that the patient suffers from two conditions, which by different mechanisms cause low back pain(AU)

Caracterización ultrasonográfica del daño articular en rodilla para evaluación de las espondiloartropatías / Ultrasonographic characterization of knee joint damage for evaluation of spondyloarthropathies

Introducción: Las espondiloartropatías son enfermedades caracterizadas por la inflamación del esqueleto axial, de las articulaciones periféricas y de las inversiones tendinosas. Muchas de las alteraciones en pacientes asintomáticos con sinovitis y entesitis subclínica han sido reveladas mediante ultrasonido, técnica adecuada para evaluar este padecimiento. Objetivo: Evaluar las características ecográficas sobre el daño en la articulación de la rodilla en pacientes con diagnóstico de espondiloartropatías y su relación con la exploración clínico-analítica. Métodos: Se realizó un estudio descriptivo, transversal en pacientes con diagnóstico de EspA atendidos en el Hospital Clínico Quirúrgico Hermanos Ameijeiras en los servicios de Reumatología e Imagenología en el período entre enero de 2018 y agosto de 2020. Se estudiaron 53 pacientes con espondiloartropatías; 26 mujeres y 27 hombres; se examinaron 106 rodillas. Resultados: Predominaron pacientes con espondilitis anquilosante; 73,6 por ciento de los pacientes estudiados. De toda la muestra, el 43,4 por ciento tuvo actividad inflamatoria en la rodilla derecha y 37,7 por ciento fue bilateral. El 58,5 por ciento tuvo derrame articular; el 84 por ciento fue transparente. El 61,3 por ciento de los casos estudiados mostró engrosamiento sinovial y el 81,5 por ciento fue avascular. En la membrana vascularizada predominó el vaso recto, (12 por ciento). El 23,6 por ciento de la muestra tuvo quiste poplíteo. Conclusiones: El ultrasonido de alta resolución en la espondiloartropatía de la rodilla resultó una técnica útil para detectar engrosamiento de la membrana sinovial, derrame y el aumento de la vascularización. También se demostró que no existió relación entre los reactantes de fase aguda y la actividad inflamatoria, así como con la actividad Doppler en las espondiloartropatías en la rodilla en esta serie(AU)

Introduction: Spondyloarthropathies are diseases characterized by inflammation of the axial skeleton, peripheral joints and tendon inversions. Many of the alterations in asymptomatic patients with synovitis and subclinical enthesitis have been revealed by ultrasound, an adequate technique to evaluate this condition. Objective: To evaluate the ultrasound characteristics of knee joint damage in patients diagnosed with spondyloarthropathies and their relationship with clinical-analytical examination. Methods: An observational, descriptive and cross-sectional study was carried out in 53 patients with spondyloarthropathies; 26 women and 27 men; 106 knees were examined. Results: Patients with ankylosing spondylitis predominated; 73.6 percent of the patients studied. Out of the entire sample, 43.4 percent had inflammatory activity in the right knee and 37.7 percent was bilateral. 58.5 percent had joint effusion; 84 percent were transparent. 61.3 percent of the cases studied showed synovial thickening and 81.5 percent was avascular. In the vascularized membrane, the vasa recto predominated (12 percent). 23.6 percent of the sample had a popliteal cyst. Conclusions: High resolution ultrasound in knee spondyloarthropathy was a useful technique to detect thickening of the synovial membrane, effusion and increased vascularization. It was also shown that there was no relationship between acute phase reactants and inflammatory activity, as well as Doppler activity in knee spondyloarthropathies in this series(AU)

Development of fibrocartilage layers in Achilles tendon enthesis in rabbits / Journal of Rural Medicine

Objective: The details regarding the development of fibrocartilage layers in Achilles tendon (AT) enthesis are unknown. Therefore, we evaluated the development of fibrocartilage layers in AT enthesis using a rabbit model.Materials and Methods: Forty-eight male Japanese white rabbits were used in this study. Six of them were euthanized at different stages (day 1, and 1, 2, 4, 6, 8, 12, and 24 weeks of age). The proliferation, apoptosis, Sox9-positivity rates, and chondrocyte number were evaluated. Additionally, safranin O-stained glycosaminoglycan (GAG) areas, width of AT enthesis, and calcaneus length were assessed. All parameters were compared to those at 24 weeks of age.Results: The level of chondrocyte apoptosis was high from 1 to 8 weeks of age, and high expression level of Sox9 was maintained from day 1 to 6 weeks of age, which decreased gradually. Safranin O-stained GAG areas increased up to 12 weeks, calcaneus length increased up to 6 weeks, and the width of AT enthesis increased up to 1 week of age.Conclusion: The changes in chondrocyte and extracellular matrix were completed by 8 and 12 weeks of age, respectively. The development of fibrocartilage layers in AT enthesis was completed by 12 weeks of age. Our results contribute to the administration of appropriate treatments based on age and aid in the development of novel methods for regenerating AT enthesis.

Línea espiral del fémur / Spiral line of the femur

La Linea aspera localizada en el margen posterior de la diáfisis del fémur, es considerada una referencia topográfica, imagenológica y antropológica. Hacia la epífisis proximal, esta línea se divide en varias líneas divergentes. De ellas, la rama lateral da inserción al músculo glúteo máximo (Tuberositas glutea), mientras que la rama media da inserción al músculo pectíneo (Linea pectinea). Ambas estructuras se encuentran en Terminologia Anatomica (TA), sin embargo, la rama medial conocida como línea espiral, donde se origina el musculo vasto medial (VM), no se encuentra en TA. Se realizó una revisión de la literatura del área morfológica con el objetivo de recopilar, analizar y verificar el uso del término línea espiral en nóminas, terminologías, textos de anatomía y publicaciones científicas. Se revisaron la Nomina Anatomica de Basilea, Paris Nomina Anatomica y Terminologia anatomica FCAT (2001) y FIPAT (2011). También fueron seleccionados 45 libros y 20 artículos en idiomas inglés y español, con el fin de analizar textos, tablas e imágenes del fémur y/o VM. Se confeccionaron tablas para resumir la información obtenida. Su término no es mencionado en nóminas ni terminologías, sin embargo en la columna de inglés de TA, se utiliza como sinónimo de Linea pectinea. En algunos textos anatómicos y artículos científicos se observa que el término línea espiral se utiliza en relación a la descripción del fémur y/o al origen del VM. El uso del término en textos de anatomía y publicaciones científicas, con fines descriptivos, antropológicos y clínicos, sumado al hecho que dentro de los principios de TA el latín es el idioma oficial y se debe considerar un único nombre por término, con el fin de evitar confusiones, fundamentan la necesidad de incorporar a TA, el término línea espiral (Linea spiralis).

The Linea aspera located on the posterior margin of the femur diaphysis is considered a tomographic, imaging and anthropological reference. To the proximal epiphysis, this line is divided in several divergent lines. Of these, the lateral branch gives insertion to the gluteus maximus muscle (Tuberositas glutea), while the middle branch gives insertion to the pectineal muscle (pectinea line). Both structures are found in Terminologia Anatomica (TA), however the medial branch known as the Spiral Line, where the vastus medial muscle (VM) originates, is not found in TA. We aimed to collect, analyze and verify the level of use of the term Spiral line in terminologies, anatomy texts and scientific publications. Nomina Anatomica from Basilea (BNA), Paris Nomina Anatomica (PNA) y Terminologia anatomica FCAT (2001) and FIPAT (2011) were reviewed. In addition, 45 books and 20 articles in English and Spanish were also selected, in order to analyze text, tables and images of the femur and/or VM. Tables were made to summarize the information obtained. The term is not mentioned in payrolls or terminologies, however in the English column of TA, this term is used as a synonym for Linea pectinea. In some anatomical texts and scientific articles it is observed that the term spiral line is used in relation to the description of the femur and / or the origin of the vast medial. The use of the term in anatomy texts and scientific publications, for descriptive, anthropological and clinical purposes, added to the fact that within the principles of Anatomical Terminology Latin is the official language and should be considered a single name per term, in order to avoid confusion, they base the need to incorporate the term spiral line (Linea spiralis) into TA.

Tendinopathy: Debate on concepts and pathogenesis / 中国组织工程研究

BACKGROUND: Tendinopathy is a hotspot in the fields of sports medicine and rehabilitation, but there have been many controversies about the concept, mechanism and pathological stages of tendinopathy for a long. OBJECTIVE: To systematically review and summarize the related concepts of tendinopathy, the role of inflammation in the occurrence of tendinopathy and the pathological mechanism of tendinopathy. METHODS: CNKI, VIP, CBM, WanFang, PubMed and Embase databases were searched. From the aspects of tendinopathy, enthesis, inflammation and pathological mechanism, some related research results since 1990 were retrieved and summarized. RESULTS AND CONCLUSION: The results show that the debate on the concept of tendinopathy is based on the understanding of its pathological mechanism, and the understanding of the pathological mechanism of tendinopathy will continue to be improved with the emergence of more high-quality researches. The research on the relationship between tendinopathy and inflammation, the relationship between tendinopathy and load patterns, and the mechanical characteristics of enthesis will be a future focus.

Basic science related to tendinopathy: Microbiomechanics and stress shielding / 中国组织工程研究

BACKGROUND: Tendon is a special connective tissue that can transmit the force generated by the muscle to the bone through the enthesis. The occurrence of tendinopathy is closely related to the mechanical characteristics of tendon and enthesis and its micro-structure, but the specific mechanism still remains controversial OBJECTIVE: To summarize the micro-structure of tendon and en thesis, the biomechanical characteristics of tendon, the healing and repair of tendon injuries, and the biomechanical factors related to chronic tendinopathy. METHODS: CNKI, VIP, CBM, WanFang, PubMed and Embase databases were searched. The articles concerning micro-structure of tendon and enthesis, relationship between tendinopathy/enthesis and stress, and biomechanical mechanisms of tendinopathy/enthesis were selected. RESULTS AND CONCLUSION: The biomechanical properties of tendon and enthesis are closely related to their microstructures. The biomechanical properties of tendon are reduced due to the damage of their microstructures in the process of repair. The occurrence and development of chronic tendinopathy are related to the microstructures and biomechanical characteristics of enthesis. Compression load and stress shielding of enthesis may play a key role, but further high-quality studies on the specific mechanism are still required.

Ultrasound assessment of enthesis thickness in psoriasis and psoriatic arthritis: A cross-sectional study

Background: The inflammatory involvement of the enthesis in the course of psoriasis is accompanied by structural abnormalities detectable by ultrasound. The most common of these abnormalities is the thickening of the tendon at the insertion site. Aims: The aim of the present study was to compare the thickness of entheses of patients with psoriatic arthritis, only skin psoriasis, and healthy controls. Methods: A cross-sectional study was conducted in a cohort of patients affected with either only skin psoriasis or psoriatic arthritis as well as in a control group. Eight entheses sites were scanned by ultrasound bilaterally. The following entheseal characteristics were collected and recorded in a predefined database: entheseal thickness, bone erosions, enthesis calcifications (enthesophytes), presence of blood flow, and presence of bursitis. All the detected entheseal changes were scored, and the data was statistically analyzed. Results: The major differences in enthesis thickness between only skin psoriasis and psoriatic arthritis patients were found at the following sites: (i) olecranon tuberosity, (ii) superior pole of the patella, and (iii) medial epicondyle of femur. The thickness of the medial collateral ligament at the site of the femoral origin was increased in psoriatic arthritis, but not in both only skin psoriasis and healthy controls. The score obtained by adding the thickness of all the 8 examined entheses for each patient showed significant differences among the three groups (psoriatic arthritis: 81.3; only skin psoriasis 74.4; Controls: 67.6; P < 0.0001). Interestingly, we found that in psoriatic arthritis patients, the highest enthesis thickening was seen in entheses affected by bone erosions. Limitations: The small sample of patients studied is a limiting factor in this study. Conclusions: Our data demonstrated that the ultrasound measurement of the enthesis thickness enables a distinction between patients with psoriatic arthritis from those with only skin psoriasis. It is a useful method to improve diagnostic accuracy, especially in patients without clear clinical signs of enthesitis.

Prolotherapy / 대한정형외과학회잡지

Prolotherapy is defined as “the rehabilitation of an incompetent structure such as ligament or tendon by induced proliferation of new cells” in the dictionary. It may include any treatment promoting the proliferation of new cells such as stem cell therapy. Traditionally, prolotherapy has been thought of as a method of strengthening a lax ligament by injecting various types of sclerosing or proliferant solutions which have commonly included hypertonic dextrose. And this therapy should involve the process of injecting solutions at the enthesis, where tendons and ligaments attach to the bone, to cause an inflammatory reaction. This inflammation initiates the regeneration and repair processes of the injured tissue in and around the joint to promote tissue proliferation and growth. Therefore, the method of prolotherapy includes the injection of small volumes of an irritant solution at painful ligament and tendon insertion sites over several treatment sessions. Because prolotherapy is a treatment modality that may provide a solution to a patient who complains of enthesopathic pain symptoms, it may be beneficial prior to long-term medication treatment or surgical intervention. Despite controversies over prolotherapy, its usage appears to be increasing gradually. This article discusses the current state of knowledge on prolotherapy and informs it to the physicians who manage the musculoskeletal pains.

Expression of carbonic anhydrase IX in human fetal joints, ligaments and tendons: a potential marker of mechanical stress in fetal development? / 대한해부학회지

Carbonic anhydrase type IX (CA9) is known to express in the fetal joint cartilage to maintain pH against hypoxia. Using paraffin-embedded histology of 10 human fetuses at 10-16 weeks of gestation with an aid of immunohistochemistry of the intermediate filaments, matrix components (collagen types I and II, aggrecan, versican, fibronectin, tenascin, and hyaluronan) and CA9, we observed all joints and most of the entheses in the body. At any stages examined, CA9-poisitive cells were seen in the intervertebral disk and all joint cartilages including those of the facet joint of the vertebral column, but the accumulation area was reduced in the larger specimens. Glial fibrillary acidic protein (GFAP), one of the intermediate filaments, expressed in a part of the CA9-positive cartilages. Developing elastic cartilages were positive both of CA9 and GFAP. Notably, parts of the tendon or ligament facing to the joint, such as the joint surface of the annular ligament of the radius, were also positive for CA9. A distribution of each matrix components examined was not same as CA9. The bone-tendon and bone-ligament interface expressed CA9, but the duration at a site was limited to 3-4 weeks because the positive site was changed between stages. Thus, in the fetal entheses, CA9 expression displayed highly stage-dependent and site-dependent manners. CA9 in the fetal entheses seemed to play an additional role, but it was most likely to be useful as an excellent marker of mechanical stress at the start of enthesis development.

Dense distribution of macrophages in flexor aspects of the hand and foot of mid-term human fetuses / 대한해부학회지

In the developing human musculoskeletal system, cell death with macrophage accumulation occurs in the thigh muscle and interdigital area. To comprehensively clarify the distribution of macrophages, we immunohistochemically examined 16 pairs of upper and lower extremities without the hip joint (left and right sides) obtained from 8 human fetuses at approximately 10-15 weeks of gestation. Rather than in muscles, CD68-positive macrophages were densely distributed in loose connective tissues of the flexor aspects of the extremities, especially in the wrist, hand and foot. In contrast, no or fewer macrophages were evident in the shoulder and the extensor aspects of the extremities. The macrophages were not concentrated at the enthesis of the tendon and ligament, but tended to be arranged along other connective tissue fibers. Deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling revealed apoptosis in the hand lumbricalis muscles, but not in the area of macrophage accumulation. Likewise, podoplanin-positive lymphatic vessels were not localized to areas of macrophage accumulation. Re-organization of the connective tissue along and around the flexor tendons of the hand and foot, such as development of the bursa or tendon sheath at 10-15 weeks, might require the phagocytotic function of macrophages, although details of the mechanism remain unknown.

Remodelación ósea en espondiloartritis / Bone remodeling in spondyloarthritis

Las espondiloartropatías (EAS) corresponden a un grupo de patologías inflamatorias crónicas caracterizadas por proliferación ósea que progresivamente conduce a anquilosis y discapacidad funcional. Las alteraciones radiológicas observadas en dichos pacientes revelan cambios erosivos y sobrecrecimiento de estructuras óseas conocidas como sindesmofitos. Teniendo en cuenta la entesis como órgano primario de la enfermedad, varios procesos tienen lugar en este sitio anatómico: inflamación, destrucción ósea y finalmente nueva formación ósea. El proceso inflamatorio tiene como resultado un exceso de formación ósea, y el impacto neto depende de la localización, tipo celular, citoquinas y factores presentes en el micro ambiente local. Varias moléculas que actúan ya sea como moduladores inmunológicos o reguladores de la homeostasis del hueso, han sido implicadas en la mediación del imbalance entre reabsorción y formación que finalmente resulta en degeneración a nivel de la zona de entesis y/o articular. Modelos animales sugieren que la anquilosis articular que puede llegar a producirse puede ser independiente del Factor de Necrosis Tumoral Alfa; por lo tanto, el proceso de neoformación tisular puede ser considerado un blanco terapéutico adicional. La vía de señalización Wnt, considerada el principal regulador de osteoblastogénesis (Familia de glicoproteína Wnt), teniendo en cuenta su papel en cuanto a regulación del imbalance entre formación y resorción ósea, ha constituido un nuevo campo de investigación de gran interés durante los últimos años.

Spondyloarthritis are a group of chronic inflammatory diseases characterized by progressive new bone formation leading to ankylosis and functional disability. The radiographic changes in these patients may show erosive changes and overgrowth of bony structures called syndesmophytes. Given the enthesis as the primary organ of the disease, several processes take place: inflammation, bone destruction and finally new bone formation. The inflammatory process results in excess of bone formation and the impact depends on the location, cell type, cytokines and factors in the local microenvironment. Several molecules that act either as immune modulators or regulators of bone homeostasis have been implicated in mediating the imbalance between resorption and formation that ultimately results in joint degeneration. Animal models suggest that joint ankylosis may be independent of TNF alfa; therefore the process of new tissue formation can be an additional therapeutic target. The Wnt signaling pathway, considered the primary regulator of osteoblastogenesis and its role in terms of regulating the imbalance between bone formation and resorption, is a new research field of great interest in recent years.

Rol actual de la ecografía en la evaluación de la artritis psoriática / The current role of the ultrasound in the assessment of psoriatic arthritis

La artritis psoriática es una enfermedad inflamatoria crónica y heterogénea que afecta articulaciones, tendones, entesis, piel y uñas. Indudablemente, a lo largo de los últimos años la ecografía se ha ido perfilando como un método de imágenes imprescindible en la práctica cotidiana reumatológica, no sólo por su bajo costo y su mayor sensibilidad respecto al examen físico, sino por la capacidad de detectar compromiso subclínico y permitir el monitoreo de la evolución de la enfermedad. El incesante crecimiento tecnológico orientado al diseño de equipos dotados de sondas de alta frecuencia y módulos power Doppler altamente sensibles permite actualmente apreciar alteraciones morfo-estructurales con una resolución inferior al décimo de milímetro, y detectar el mínimo flujo sanguíneo presente en los microvasos de los tejidos superficiales. No obstante estas ventajas, aún son pocos los estudios que demuestran la utilidad de la ecografía en la artritis psoriática. El objetivo principal de esta revisión es demostrar el potencial actual de la ecografía en el estudio de pacientes con artritis psoriática mediante la ilustración de alteraciones a nivel de articulaciones, tendones, entesis, piel y uñas.

Psoriatic arthritis (PsA) is a chronic and heterogeneous inflammatory disease that involves joints, tendons, enthesis, skin and nails. Without doubt, ultrasound has become a rapidly evolving technique that is gaining more and more importance among rheumatologists. The continuous technological advances in the field of ultrasound has allowed the development of equipment provided with high and variable frequency probes and very sensitive power Doppler, which permit both the detailed study (with resolution power of 0.1 mm) of morphostructural changes and the sensitive detection of blood flow, even in small vessels of superficial tissues. To date most of the studies have been aimed at investigating its capacity in the assessment of joints, tendons and entheses in psoriatic arthritis patients. Less attention has been paid to demonstrate the potential of ultrasound in the evaluation of skin and nails.The aim of this study is to show the main high frequency greyscale and power Doppler ultrasound findings in patients with psoriatic arthritis at joint, tendon, enthesis, skin and nail level.

ENTHESIS PAIN PREVENTION IN JUNIOR HIGH SCHOOL SOCCER PLAYERS / 体力科学

The purpose of this study was to examine factors related to the occurrence of enthesis pain by long-term longitudinal investigation and measurement in junior high school soccer players, while intervening for its prevention. The subjects were 107 male junior high school soccer club members. The presence or absence of enthesis pain, the height growth velocity, muscle tightness, and alignment were longitudinally investigated, and stretching was instructed periodically. The time of enthesis pain occurrence was consistent with phase II of the height growth velocity curve in many cases. On comparison between before and after the appearance/disappearance of enthesis pain, no association was noted between the muscle tightness and occurrence of enthesis pain. But, on comparison of changes with time in muscle tightness, the tightness of the right quadriceps significantly increased, being useful for the prediction of enthesis pain. A significant increase in the Q-angle was also noted when enthesis pain appeared. Furthermore, the tightness of the bilateral iliopsoas, hamstrings, hip adductors, and gastrocnemius had significantly improved on the final measurement, showing that instruction in stretching was effective. This study showed the necessity of the long-term longitudinal evaluation of muscle tightness, suggesting that there is a possibility of intervention for prevention, as well as physical therapy for sporting injuries in the growth period.