Mitos, verdades, dudas y confusiones sobre las ondas de choque y su rol en la enfermedad musculoesquelética / Myths, truths, doubts and confusions about shockwave. Therapy and its role in musculoskeletal pathology

El advenimiento de la litotricia renal en la década de los 80 tuvo un efecto disruptivo en el tratamiento de los cálculos renales. El descubrimiento de los efectos biológicos de las ondas de choque expandió rápidamente el uso de este método terapéutico al campo de la Ortopedia y Traumatología. Si bien, en los últimos años, ha tenido un amplio desarrollo, persisten muchas confusiones y dudas en el ambiente de nuestra especialidad, sobre todo entre los profesionales que no están directamente involucrados en el tema. El objetivo de esta presentación es hacer un análisis de los puntos de controversia y las dudas más frecuentes, basado en la bibliografía científica. Nivel de Evidencia: V

The advent of renal lithotripsy in the 1980s had a disruptive effect on the treatment of kidney stones. The discovery of the biological effects of shock waves quickly expanded the use of this therapeutic method to the field of Orthopedics and Traumatology. Although the topic has advanced significantly in recent years, there are still many questions and confusions in our specialty's environment, particularly among professionals who are not directly involved in the field. The objective of this presentation is to provide a scientific analysis of the points of controversy and the most frequent doubts. Level of Evidence: V

Genetic Polymorphisms in COL1A2 gene and the Risk of Tendinopathy: Case-Control Study / Polimorfismos genéticos no gene COL1A2 eo risco de tendinopatia: Estudo de caso-controle

Abstract Objective To evaluate the influence of polymorphisms on genes encoding type I collagen and the genetic susceptibility of tendinopathy. Methodology Case-control study involving 242 Brazilian athletes from different sports modalities (55 cases of tendinopathy and 187 controls). The polymorphisms COLIAI (rs1107946) and COLIA2 (rs412777, rs42524, and rs2621215) were analyzed by theTaqMansystem. Odds ratio(OR)withtheir 95% confidence intervals (CIs) were calculated using a nonconditional logistic regression model. Results The mean age was 24.0 ± 5.6 years old and 65.3% were men. Of the 55 cases of tendinopathy, 25.4% had > 1 affected tendon, the most frequent being patellar (56.3%), rotator cuff (30.9%) and elbow or hand flexors (30.9%). Age and amount of time of sports practice were associated with a higher chance of presenting tendinopathy (5 and 8 times, respectively). The frequency of variant alleles in control and case patients, respectively, was: COLIAI rs1107946 24.0 and 29.6%; COLIA2 rs412777 36.1 and 27.8%; rs42524 17.5 and 25.9%; and rs2621215 21.3 and 27.8%. After adjusting for confounding factors (age and years of sports practice), COLIA2 rs42524and rs2621215 polymorphisms were associated with increased risk of tendinopathy (OR = 5.5; 95% CI = 1.2-24.6 and OR = 3.9; IC95% = 1.1-13.5, respectively). The haplotype COLIA2 CGT was associated with low risk for disease development (OR = 0.5; 95%CI = 0.3-0.9). Conclusion Age (≥ 25 years old), time of sports practice (≥ 6years) and polymorphisms in the COLIA2 gene increased the risk of developing tendinopathy.

Resumo Objetivo Avaliar a influência de polimorfismos nos genes que codificam o colágeno tipo I e a suscetibilidade genética da tendinopatia. Metodologia Estudo caso-controle envolvendo 242 atletas brasileiros de diferentes modalidades esportivas (55 casos de tendinopatia e 187 controles). Os polimorfismos COL1A1 (rs1107946) e COL1A2 (rs412777, rs42524 e rs2621215) foram analisados pelo sistema TaqMan. As razões de chance (OR) com seus intervalos de confiança (IC) de 95% foram calculadas usando um modelo de regressão logística não-condicional. Resultados A média de idade foi de 24,0 ± 5,6 anos e 65,3% eram homens. Dos 55 casos de tendinopatia, 25,4% apresentaram mais de um tendão acometido, sendo os maisfrequentesopatelar(56,3%),omanguitorotador(30,9%)eodocotoveloou flexores das mãos (30,9%). A idade e o tempo de prática esportiva foram associados a uma maior chance de apresentar tendinopatia (5 e 8 vezes, respectivamente). A frequência dos alelos variantes nos controles e casos, respectivamente, foi: COL1A1 rs1107946 24,0 e 29,6%; COL1A2 rs412777 36,1 e 27,8%; rs42524 17,5 e 25,9%; e rs2621215 21,3 e 27,8%. Após ajuste pelos fatores de confundimento (idade e anos de práticas esportiva), os polimorfismos COL1A2 rs42524 e rs2621215 foram associados a um risco aumentado de tendinopatia (OR = 5,5; IC95% = 1,2-24,6 e OR = 3,9; IC95% = 1,1-13,5, respectivamente). O haplótipo COL1A2 CGT foi associado a um baixo risco para desenvolvimento da doença (OR = 0,5; IC95% = 0,3-0,9). Conclusão Aidade (> 25 anos), o tempo de prática esportiva (> 6 anos) e polimorfismos no gene COL1A2 aumentaram o risco de desenvolvimento da tendino-patia.

Comparison of efficacy of platelet-rich plasma and extracorporeal shock wave for the treatment of chronic insertional Achilles tendinopathy / 中国骨伤

OBJECTIVE@#To compare clinical efficacy of platelet-rich plasma (PRP) and extracorporeal shock wave in treating chronic insertional Achilles tendinopathy.@*METHODS@#From February 2019 to August 2021, 42 patients with chronic insertional Achilles tendinopathy were selected and divided into PRP group(20 patients, 28 feet) and shock wave group (22 patients, 29 feet). In PRP group, there were 12 males and 8 females, aged 47.00(28.00, 50.75) years old, and the courses of disease ranged 7.00(6.00, 7.00) months;PRP injection was performed in the Achilles tendon stop area of the affected side. In shock wave group, there were 16 males and 6 females, aged 42.00(35.75, 47.25) years old;and the courses of disease was 7.00(6.00, 8.00) months;shock wave was performed in Achilles tendon stop area of the affected side and triceps surae area. Visual analogue scale (VAS) and Victorian Institute of Sport Assessment-Achilles (VISA-A) were applied to evaluate clnical effect before treatment, 1, 3 and 6 months after treatment, and satisfaction of patients was investigated.@*RESULTS@#VAS and VISA-A score in both groups were significantly improved at 1, 3 and 6 months after treatment than before treatment (P<0.05), VAS and VISA-A score in PRP group at 6 months after treatment were significantly higher than those at 1 and 3 months after treatment, and VAS and VISA-A score in shock wave group were lower than those at 1 and 3 months after treatment (P<0.05). There was no significant difference in VAS and VISA-A score between two groups before treatment, 1 and 3 months after treatment(P>0.05), while VAS and VISA-A score in PRP group were better than those in shock wave group at 6 months after treatment(P<0.05), and the satisfaction survey in PRP group was better than that in shock wave group(P<0.05).@*CONCLUSION@#PRP injection has a good clinical effect on chronic insertional Achilles tendinopathy with high patient satisfaction, and medium-and long-term effect of PRP injection for the treatment of chronic insertional Achilles tendinopathy is better than that of extracorporeal divergent shock wave.

Human hair follicle-derived mesenchymal stem cells promote tendon repair in a rabbit Achilles tendinopathy model / 中华医学杂志(英文版)

BACKGROUND@#Hair follicles are easily accessible and contain stem cells with different developmental origins, including mesenchymal stem cells (MSCs), that consequently reveal the potential of human hair follicle (hHF)-derived MSCs in repair and regeneration. However, the role of hHF-MSCs in Achilles tendinopathy (AT) remains unclear. The present study investigated the effects of hHF-MSCs on Achilles tendon repair in rabbits.@*METHODS@#First, we extracted and characterized hHF-MSCs. Then, a rabbit tendinopathy model was constructed to analyze the ability of hHF-MSCs to promote repair in vivo . Anatomical observation and pathological and biomechanical analyses were performed to determine the effect of hHF-MSCs on AT, and quantitative real-time polymerase chain reaction, enzyme-linked immunosorbent assay, and immunohistochemical staining were performed to explore the molecular mechanisms through which hHF-MSCs affects AT. Furthermore, statistical analyses were performed using independent sample t test, one-way analysis of variance (ANOVA), and one-way repeated measures multivariate ANOVA as appropriate.@*RESULTS@#Flow cytometry, a trilineage-induced differentiation test, confirmed that hHF-derived stem cells were derived from MSCs. The effect of hHF-MSCs on AT revealed that the Achilles tendon was anatomically healthy, as well as the maximum load carried by the Achilles tendon and hydroxyproline proteomic levels were increased. Moreover, collagen I and III were upregulated in rabbit AT treated with hHF-MSCs (compared with AT group; P  < 0.05). Analysis of the molecular mechanisms revealed that hHF-MSCs promoted collagen fiber regeneration, possibly through Tenascin-C (TNC) upregulation and matrix metalloproteinase (MMP)-9 downregulation.@*CONCLUSIONS@#hHF-MSCs can be a treatment modality to promote AT repair in rabbits by upregulating collagen I and III. Further analysis revealed that treatment of AT using hHF-MSCs promoted the regeneration of collagen fiber, possibly because of upregulation of TNC and downregulation of MMP-9, thus suggesting that hHF-MSCs are more promising for AT.

Tendinitis cálcica atraumática de tendón extensor común del dedo medio: un caso infrecuente de dolor metacarpofalángico / Atraumatic calcium tendonitis of common extensor tendon of the middle finger: a rare case of metacarpophalangeal pain

Calcific tendinitis is a pathology characterized by the deposits of periarticular hydroxyapatite. Its pathophysiology is not completely known. It is clinically characterized by important inflammatory changes with incapacitating pain. It most commonly affects the shoulder joint and it rarely affects the hand and wrist. Given the unusual nature of this localization, we present the clinical case of a woman who developed calcific tendinitis of the third metacarpophalangeal muscle. We present the clinical evolution of the case, the treatments carried out, and a review of the literature related to this unusual localization of calcific tendinitis.

Hip Tendinopathies: An Update of Concepts and Approaches / Tendinopatias do quadril: Uma atualização de conceitos e abordagens

Abstract The present update was based on new scientific evidence of major hip-related tendinopathies. Themes were addressed that involve the principles of the onset of tendinopathies through, mainly, the principle of capacity versus demand and the biomechanical aspects involved in its onset, its main characteristics, and clinical presentations. Associated with this, treatment-related updates were presented, with exercise therapy being the focus of conservative treatment and surgical approaches necessary for the control or resolution of these cases.

Resumo A presente atualização foi embasada nas novas evidências científicas das principais tendinopatias relacionadas ao quadril. Foram abordadas temáticas que envolvem os princípios do aparecimento das tendinopatias através, principalmente, do princípio da capacidade versus demanda e os aspectos biomecânicos envolvidos no seu aparecimento, suas principais características e apresentações clínicas. Associadas a isso, foram expostas as atualizações voltadas ao tratamento, coma terapia por exercício sendo o foco do tratamento conservador e as abordagens cirúrgicas necessárias para o controle ou resolução desses casos.

Efectos de los antiinflamatorios no esteroideos en las tendinopatías / Effects of Non-Steroidal Anti-Inflammatory Drugs in Tendinopathies

Introducción: Los antiinflamatorios no esteroideos son comúnmente usados para el tratamiento de las tendinopatías, pero la evidencia sobre este tratamiento es escasa. Objetivo: Realizar una revisión sistemática acerca de los efectos de los en las tendinopatías. Métodos: Se desarrolló una búsqueda bibliográfica en PubMed, WOS, PEDro, Medline, Cinahl y SPORTDiscus. Se incluyeron un total de 13 ensayos clínicos con una calidad metodológica media de 7,15/10 en la escala PEDro. Conclusiones: En la mayoría de los artículos se observó una mejoría corto plazo en el dolor y la funcionalidad con el uso de AINEs. Los ensayos clínicos incluidos no analizaron la presencia de inflamación en esta patología. Se necesitan más estudios que determinen la función de la inflamación en la tendinopatía que justifique el uso de los antiinflamatorios no esteroideos(AU)

Introduction: Non-steroidal anti-inflammatory drugs are commonly used for the treatment of tendinopathies, but the evidence on this treatment is scarce. Objective: To carry out a systematic review about the effects of non-steroidal anti-inflammatory drugs in tendinopathies. Methods: A bibliographic search was carried out in PubMed, WOS, PEDro, Medline, Cinahl and SPORTDiscus. A total of 13 clinical trials with a mean methodological quality of 7.15/10 on the PEDro scale were included. Conclusions: In most of the articles, a short-term improvement in pain and functionality was observed with the use of non-steroidal anti-inflammatory drugs. The clinical trials included did not analyze the presence of inflammation in this pathology. More studies are needed to determine the role of inflammation in tendinopathy that justifies the use of nonsteroidal anti-inflammatory drugs(AU)

Identificación de riesgos ergonómicos en personal administrativo que realizó teletrabajo / Identificación of ergonomic risks un administrative personnel that performed teleworking

INTRODUCCIÓN. El riesgo ergonómico es la situación adversa que surge de una inadecuada interacción entre el trabajador y su puesto de trabajo. Su identificación es el punto de partida para la corrección y prevención de daños a la salud. OBJETIVO. Describir los riesgos ergonómicos del personal administrativo que realizó teletrabajo. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo, retrospectivo, con una población de 66 empleados y una muestra de 25 encuestas a personal administrativo de una empresa importadora de la ciudad de Quito, que realizó teletrabajo desde marzo de 2020. Criterios de inclusión: mayores de 18 años de ambos sexos; que realizaron teletrabajo al menos 60 días. Para el análisis de datos se utilizó el programa Microsoft Excel 2013. RESULTADOS. Se observaron y registraron riesgos ergonómicos en la conformación del puesto de trabajo por mobiliario inadecuado; 20% (5; 25) del personal tuvo una silla ergonómica; 48% (12; 25) un computador tipo PC; 72% (18; 25) utilizó mouse. Se identificó disconfort en zonas corporales, resaltó lumbar 48% (12; 25), codo o antebrazo derecho 36% (9; 25) y cervical 28% (7; 25). CONCLUSIÓN. Se pudo identificar riesgos ergonómicos a los que estuvo expuesto el personal administrativo que realizó teletrabajo.

INTRODUCTION. Ergonomic risk is the adverse situation that arises from an inappropriate interaction between the worker and his job. Their identification is the starting point for the correction and prevention of damage to health. OBJECTIVE. To describe the ergonomic risks of administrative personnel who performed telework. MATERIALS AND METHODS. Observational, descriptive, retrospective study, with a population of 66 employees and a sample of 25 surveys to administrative staff of an importing company in the city of Quito, who performed telework since March 2020. Inclusion criteria: over 18 years of age of both sexes; who teleworked for at least 60 days. For data analysis, the Microsoft Excel 2013 program was used. RESULTS. Ergonomic risks were observed and recorded in the conformation of the workplace due to inadequate furniture; 20% (5; 25) of the staff had an ergonomic chair; 48% (12; 25) a PC type computer; 72% (18; 25) used a mouse. Discomfort was identified in body areas, 48% of the lumbar (12; 25), the right elbow or forearm 36% (9; 25) and the cervical 28% (7; 25). CONCLUSION. It was possible to identify ergonomic risks to which the administrative personnel who performed teleworking were exposed.

Platelet-rich plasma vs corticosteroid for treatment of rotator cuff tendinopathy:a Meta-analysis / 中国骨伤

OBJECTIVE@#To explore clinical effects regrarding functional recovery, pain relief, and range of motion of shoulder of platelet-rich plasma (PRP) injection and corticosteroid(CS) injection in treating rotator cuff tendinopathy.@*METHODS@#Randomized controlled trials (RCT) of PRP injection and CS injection in Cochrane Library, EMBASE(Excerpta Medica Database), PebMed, China knowledge Network(CNKI) and Wanfang database were searched from building database to April 20, 2022. According to inclusion and exclusion criteria, literature screening, data extraction and quality evaluation were carried out between two independent researchers, and extracted data were statistically analyzed by Review Manager 5.4.1 software. Short-term (3-6 weeks), medium-term (8-12 weeks) and long-term (≥24 weeks) visual analogue score (VAS), American Shoulder and Elbow Surgeons (ASES) score, Xi'an Western Ontario Rotator Cuff Index (WORC) and shoulder range of motion (ROM) were compared between two groups.@*RESULTS@#Totally 7 RCT were included with 379 patients, 188 patients in PRP group and 191 patients in CS group. Meta analysis results showed there were no significant difference in VAS, ASES and WORC between short-term group and medium-term group(P>0.05). During long-term follow-up, there were significant differences in ASES score[MD=7.1, 95%CI(2.06, 12.14), P=0.006] and VAS [MD=-1.55, 95%CI(-2.65, 0.55), P=0.002]. There was no significant difference in shoulder ROM between two groups(P>0.05).@*CONCLUSION@#For patients with shoulder cuff tendon disease, there are no significant difference in pain relief and functional recovery during short and medium-term follow-up period. However, RPR injection showed advantages over corticosteroid injection in terms of functional recovery and pain relief during long-term follow-up. There is no significant difference in shoulder range of motion between two groups during the whole follow-up period.

Miositis del subescapular. Una evolución infrecuente en la tendinopatía calcificada. Estudio de un caso / Subscapularis myositis: An uncommon complication in calcific tendinopathy. A case study

RESUMEN La tendinopatía calcificada del hombro se caracteriza por el depósito de cristales de hidroxiapatita en uno o varios tendones del hombro. Dentro de los procesos que ocurren en esta entidad está la fase de reabsorción, en la que los depósitos podrían migrar hacia estructuras adyacentes. Una muy rara complicación es la migración hacia la unión miotendinosa del tendón correspondiente, la cual provoca una importante reacción inflamatoria muscular que puede objetivarse en pruebas complementarias específicas. Presentamos un caso clínico de una tendinopatía calcificante del subescapular, con pos terior migración hacia la unión miotendinosa causando una miositis del mismo.

ABSTRACT Calcific tendinopathy of the shoulder is characterised by the deposit of hydroxy apatite crys tals in one or more tendons of the shoulder. Within the processes that occur within this disorder, there is the resorption phase, in which the deposits could migrate towards adjacent structures. A very rare complication is the migration towards the myotendinous junction of the corresponding tendon, which causes a significant muscular inflammatory reaction that can be seen in specific complementary tests. A clinical case is presented of a subscapular calcific tendinopathy, with subsequent migra tion to the myotendinous junction, causing myositis of the same.

Prevalência de lesões de manguito rotador em laudos de ressonância magnética de ombro em uma clínica ortopédica do sul de Santa Catarina / Prevalence of rotator cuff injuries in shoulder magnetic resonance imaging reports in an orthopedic clinic in southern Santa Catarina

RESUMO Introdução: As lesões de manguito rotador são uma das principais causas de incapacitação da prática de exercícios físicos e de ausência no trabalho. A população acometida por essa patologia apresenta diferentes perfis. Exames de imagem são recursos de elevada relevância no diagnóstico dessas lesões, sendo a ressonância magnética extensamente utilizada como ferramenta diagnóstica, por ser capaz de detectar com eficiência características morfológicas da ruptura do tendão. Este estudo teve como objetivo estimar a prevalência e as características das lesões de manguito rotador em exames de ressonância magnética de ombro realizados em uma clínica ortopédica. Métodos: Foi realizado um estudo observacional com delineamento transversal, que analisou 292 laudos de ressonância magnética de ombro de pacientes com idade entre 18 e 65 anos, realizados entre julho de 2016 e junho de 2017. O nível de significância estabelecido foi de 5% (p < 0,05). Resultados. Observou-se prevalência de 91,1% de lesões de manguito rotador nos laudos analisados, sendo o supraespinhal acometido em 89,7% destes. A média de idade dos pacientes com lesão de manguito rotador foi superior à dos pacientes sem lesão. Alterações degenerativas acromioclaviculares, presença de líquido na bursa e tendinopatia da cabe- ça longa do bíceps apresentaram correlação com as lesões de manguito. Conclusão: Concluiu-se que as lesões do manguito rotador apresentaram alta prevalência, em especial as do músculo supraespinhal. Envelhecimento e achados associados nos laudos de imagem tiveram correlação com o surgimento dos diferentes tipos de lesão do manguito. PALAVRA-CHAVE: Manguito rotador, tendinopatia, imagem por ressonância magnética

ABSTRACT Introduction: Rotator cuff injuries are one of the main causes of disability from physical exercise and absence from work. The population affected by this pathology has different profiles. Imaging scans are highly relevant resources in the diagnosis of these injuries, and magnetic resonance is extensively used as a diagnostic tool, as it is capable of efficiently detecting morphological characteristics of tendon rupture. This study aimed to estimate the prevalence and characteristics of rotator cuff injuries in MRI scans of the shoulder performed in an orthopedic clinic. Methods: An observational, cross-sectional study was carried out, which analyzed 292 shoulder MRI reports of patients aged between 18 and 65 years, carried out between July 2016 and June 2017. The level of significance established was 5% (p < 0.05). Results. There was a prevalence of 91.1% of rotator cuff injuries in the analyzed reports, with the supraspinatus being affected in 89.7% of these. The mean age of patients with rotator cuff injuries was higher than that of patients without injuries. Acromioclavicular degenerative changes, presence of fluid in the bursa, and tendinopathy of the long head of the biceps correlated with cuff injuries. Conclusion: It was concluded that rotator cuff injuries had a high prevalence, especially those of the supraspinatus muscle. Aging and associated findings in the imaging reports were correlated with the appearance of different types of cuff injuries. KEYWORDS: Rotator cuff, tendinopathy, magnetic resonance imaging

Histología del bíceps en pacientes con tendinopatía crónica tratados con tenodesis subpectoral / Histology of the biceps in patients with chronic tendinitis treated with subpectoral tenodesis

Introducción: El objetivo de este estudio fue evaluar los cambios morfológicos en la zona intrarticular y extrarticular de la porción larga del bíceps de pacientes sometidos a una tenodesis subpectoral.materiales y métodos: Se incluyeron 9 pacientes con diag-nóstico de tendinopatía del bíceps, a quienes se les realizó una tenodesis subpectoral de la porción larga del bíceps. La porción eliminada del tendón del bíceps se colocó en formalina al 10% y se dividió en 2 segmentos. Quedaron definidas la zona proximal, desde la inserción supraglenoidea hasta el borde proximal del pectoral mayor y la zona distal correspondiente a la inserción del pectoral mayor. Los segmentos se tiñeron con hematoxilina y eosina, y se evaluaron histológicamente utilizando el puntaje de Bo-nar.Resultados: Macroscópicamente todos los tendones estaban engrosados en la región proximal. En la evaluación histológica, entre las variables más relevantes evaluadas por el puntaje de Bonar, el puntaje de morfología celular en la zona proximal fue significativamente más alto que en la zona distal (p <0,0001).Conclusiones: Nuestros hallazgos mostraron niveles más altos de patología dentro del bíceps proximal, lo que respalda la eliminación de dicho segmento cuando se realiza un procedimiento para la tendinopatía crónica del bíceps, lo cual se puede lograr con una tenodesis subpectoral. Nivel de Evidencia: IV

Introduction: The objective of the present study was to evaluate the morphological changes in the intra- and extra-articular area of the long head of the biceps in patients who had undergone subpectoral tenodesis. methods: We included 9 patients with a diagnosis of biceps tendinitis, who underwent subpectoral tenodesis of the long head of the biceps. The removed portion of the biceps tendon was placed in 10% formalin and divided into 2 segments. The proximal area extended from the supraglenoid insertion to the proximal edge of the pectoralis major and the distal area corresponded to the insertion of the pectoralis major. The segments were histologically evaluated using the Bonar score. Results: Macroscopically, all the tendons were found to be thickened in the proximal region. In the histological evaluation, among the most relevant variables evaluated by the Bonar score, the cell morphology score in the proximal area was significantly higher than in the distal area (p <0.0001). Conclusion: Our findings showed higher levels of pathology within the proximal biceps, supporting the elimination of this segment for chronic biceps tendinopathy, which can be accomplished through subpectoral tenodesis. Level of Evidence: IV

Biomechanical evaluation in runners with Achilles tendinopathy

OBJECTIVES: To evaluate the clinical characteristics, ground reaction force (GRF), and function of the plantar muscles and dorsiflexors of the ankle in runners with and without Achilles tendinopathy (AT) and in non-runners. METHODS: Seventy-two participants (42 men, 30 women; mean age: 37.3±9.9 years) were enrolled in this cross-sectional study and divided into three groups: AT group (ATG, n=24), healthy runners' group (HRG, n=24), and non-runners' group (NRG, n=24). Both ankles were evaluated in each group. The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale was used for clinical and functional evaluation. GRF was evaluated using force plates and muscle strength was evaluated using an isokinetic dynamometer. RESULTS: The AOFAS scores were lower in the ATG. The strike impulse was higher in the ATG than in the HRG and NRG. However, GRF was similar among the groups. The ATG exhibited lower total work at 120°/s speed than the HRG. The peak torque in concentric dorsiflexion was lower in the NRG than in the ATG and HRG. The peak torque and total work in concentric plantar flexion were lower in the NRG than in the ATG. The peak torque and total work in eccentric plantar flexion were lower in the NRG than in the ATG and HRG. CONCLUSION: Runners with AT showed higher strike impulse, lower muscle strength of the plantar flexors, and higher clinical and functional damage.

Arthroscopic treatment for the calcific tendinitis at soft tissues around hip / 中国骨伤

OBJECTIVE@#To explore the feasibility and clinical effects of arthroscopic treatment for the calcific tendinitis at soft tissues around hip.@*METHODS@#A total of 16 patients diagnosed as the calcific tendinitis at soft tissues around hip from May 2013 to July 2018 were retrospectively analyzed. All the 16 patients received arthroscopic procedures. There were 10 males and 6 females with an average age of 35 to 63 (44.50±6.67) years old and 9 left hips, 6 right hips were involved. The course of disease were 1 to 8(3.18±1.97) days. Clinical effects were evaluated with visual analogue scale(VAS), modified Harris hip scores (HHS), nonarthritic hip score (NAHS) and imaging examinations before operation, 1 day after operation and the final follow-up.@*RESULTS@#All 16 patients successfully finished the arthroscopic procedures in 0.5 to 1.2 (0.75±0.21) hours. Primary healing of incision were obtained without any complications of infection, wound hematocele and neurovascular injury. All 16 patients received an average postoperative follow-up of 6 to 12 (9.6±2.3) months. Before operation, the VAS were 7.88±0.72, modified HHS were 29.25±3.23, NAHS were 27.42±3.08. The 1st day postoperative VAS were 2.19±0.66, modified HHS were 82.56± 5.64, NAHS were 82.11±2.94, all the difference were statistically significant between before and 1 day after operation (@*CONCLUSION@#Arthroscopic treatment for the calcific tendinitis at soft tissues around hip is effective.It has advantages of minimal invasive, rapid pain relief, rapid hip joint function recovery and definite clinical effects.

Tendinitis calcificante del musculo largo del cuello: presentación de un caso clínico / Calcific tendinitis of the longus colli muscle: a case report / Tendinite calcificante do músculo longo do pescoço: apresentação de um caso clínico

La tendinitis calcificante del músculo largo del cuello es una patología subdiagnsoticada, de baja frecuencia, autolimitada. Se presenta clínicamente como una de las causas de odinofagia en la consulta médica. Se produce debido al depósito de cristales de hidroxiapatita en espacio retrofaríngeo, desencadenándose una respuesta inflamatoria local. En la TMLC el principal diagnóstico diferencial es el absceso retrofaríngeo, ya que puede presentarse clínicamente con odinofagia, disfagia , disminución de la movilidad del cuello y cervicalgia. En nuestro trabajo se analiza un caso clínico sobre dicha patología, en un hombre de 45 años; realizando un análisis de la sintomatología, diagnóstico y tratamiento de esta entidad.

Calcific tendinitis of the long neck muscle is an underdiagnosed, low frequency, self-limited pathology. It is clinically presented as one of the causes of odynophagia in the medical consultation. It occurs due to the deposit of hydroxyapatite crystals in the retropharyngeal space, triggering a local inflammatory response. On This patholgy, the main differential diagnosis is retropharyngeal abscess, since it can present clinically with odynophagia, dysphagia, decreased mobility of the neck, and neck pain. In our work, a clinical case of this pathology is analyzed, in a 45-year-old man; performing an analysis of the symptoms, diagnosis and treatment of this entity.

A tendinite calcificante do músculo longo do pescoço é uma patologia subdiagnsoticada, de baixa frequência, autolimitada. Apresenta-se clinicamente como uma das causas de odinofagia na consulta médica. Ocorre devido ao depósito de cristais de hidroxiapatita em espaço retrofaríngeo, desencadeando-se uma resposta inflamatória local. Na TMLC o principal diagnóstico diferencial é o abscesso retrofaríngeo, já que pode apresentar-se clinicamente com odinofagia, disfagia , diminuição da mobilidade do pescoço e cervicalgia. Em nosso trabalho analisa-se um caso clínico sobre essa patologia, em um homem de 45 anos; realizando uma análise da sintomatologia, diagnóstico e tratamento desta entidade.

Achilles Tendon Lesions - Part 1: Tendinopathies / Lesões do Aquiles - Parte 1: Tendinopatias

Abstract Calcaneal tendon injuries are extremely common in the general population and in orthopedics routine care. Its increasing incidence, which is motivated by an aging population, improved access to the health care system, increased prescription of continuous-use medication, erratic participation in sports and other factors, has had a direct impact on society. Consolidated treatment options for tendinopathies lack quality scientific support for many modalities. New therapies have emerged to enhance nonsurgical approach outcomes and to reduce the number of patients requiring surgery. Although these operative procedures provide good pain relief and functional outcomes, they are costly and may lead to complications.

Resumo As afecções que acometem o tendão calcâneo são extremamente comuns na população geral e no cotidiano da atenção ortopédica. Sua crescente incidência, motivada pelo envelhecimento da população, pela melhora no acesso à saúde, pelo aumento na utilização de drogas de uso contínuo, pela errática participação esportiva e outros fatores, tem causado impacto direto na sociedade. As tendinopatias, ainda que hoje respaldadas por tratamentos consolidados, carecem de suporte científico de qualidade para muitas das suas recomendações. Novas terapêuticas têm surgido com o objetivo de potencializar o resultado da abordagem não-operatória e diminuir a quantidade de pacientes que necessitam de uma cirurgia. Esses procedimentos operatórios apresentam uma boa resposta álgica e funcional dos pacientes, no entanto não são livres de complicações e dos altos custos que os cercam.

Family Predisposition for Rotator Cuff Tear and Other Tendinopathies - A Case-Control Study / Predisposição familiar para rotura do manguito rotador e outras tendinopatias - Um estudo de caso-controle

Abstract Objective To evaluate the prevalence of family history of rotator cuff tear and the presence of tendinopathy in other joints in patients with rotator cuff tears and to compare them with paired controls. To estimate the odds ratio for rotator cuff tear for these two risk factors. Methods We performed a case-control study comparing patients submitted to treatment for rotator cuff tear with asymptomatic controls. All cases and controls were evaluated by imaging exams and matched by age (±2 years) and gender. We conducted an interview using a standardized questionnaire, and collected data on various risk factors. Results We evaluated 144 patients, 72 per group. Patients with rotator cuff tears reported a higher number of consanguineous relatives who underwent treatment for the same disease and tendon injuries in other joints compared to the controls (p= 0.005 and p= 0.045 respectively). Individuals with a family history of treatment for rotator cuff tear or with tendinopathies in other joints were more likely to present a rotator cuff tear, with odds ratios of 3.3 (95% confidence interval [95%CI] = 1.4-7.7) and 2.7 (95%CI = 1.1-6.9) respectively. Conclusions Patients with rotator cuff tear have a higher prevalence of family members with the same disease and tendinopathies or tendon injuries in other joints. The presence of consanguineous relatives with treatment for rotator cuff and tendinopathies in other joints are risk factors for the presence of rotator cuff tears.

Resumo Objetivo Avaliar as prevalências de antecedente familiar de rotura do manguito e de tendinopatia em outras articulações em pacientes com rotura do manguito rotador e compará-las com controles pareados. Estimar a razão de chances de uma rotura do manguito rotador para estes dois fatores de risco. Métodos Realizamos um estudo de caso-controle comparando pacientes submetidos ao tratamento para rotura do manguito rotador com controles assintomáticos. Todos os casos e controles foram avaliados por exames de imagem e pareados por idade (±2 anos) e sexo. Realizamos uma entrevista utilizando um questionário padronizado, e coletamos dados referentes a vários fatores de risco. Resultados Avaliamos 144 pacientes, 72 por grupo. Os pacientes com rotura do manguito rotador relataram, em maior número, a presença de familiares consanguíneos que realizaram tratamento para a mesma doença e de lesões tendíneas em outras articulações em relação aos indivíduos controles (p= 0,005 e p= 0,045, respectivamente). Indivíduos com antecedente familiar de tratamento para rotura do manguito rotador ou com tendinopatias em outras articulações tiveram maior probabilidade de apresentar rotura do manguito rotador, com razões de chances de 3,3 (intervalo de confiança de 95% [IC95%] = 1,4-7,7) e 2,7 (IC95% = 1,1-6,9), respectivamente. Conclusões Os pacientes com rotura do manguito rotador têm maior prevalência de familiares com a mesma doença e de tendinopatias ou lesões tendíneas em outras articulações. A presença de familiares consanguíneos com tratamento para rotura do manguito rotador e tendinopatias em outras articulações são fatores de risco para presença de roturas do manguito rotador.

Tendinopatía cálcica: etiopatogenia y evaluación por imágenes / Calcific tendinitis: aetiopathogenesis and imaging evaluation

Resumen: La tendinopatía cálcica es causada por el depósito patológico de cristales de hidroxiapatita de calcio en los tendones y es una causa común de dolor en las articulaciones. Afecta más frecuentemente al hombro y la cadera, con hallazgos característicos en imágenes; sin embargo, cualquier tendón puede estar involucrado. Ocasionalmente, la tendinopatía cálcica puede simular patología agresiva, como infección o neoplasia, especialmente en RM. Fisiotpatológicamente, las calcificaciones provendrían de una diferenciación anormal de las células madre del tendón, que comienzan a producir calcio, aunque todavía no es del todo claro. Los radiólogos deben estar familiarizados con los hallazgos de las imágenes para distinguir la tendinopatía cálcica de procesos más agresivos. La aspiración y lavado guiado bajo ecografía es una técnica útil realizada por el radiólogo para el tratamiento de casos sintomáticos. La familiaridad con estos procedimientos y su apariencia en imágenes es un aspecto importante en el manejo de esta enfermedad. El propósito de esta revisión es analizar la etiopatogenia de la tendinopatía cálcica, la evaluación con imágenes en los sitios de presentación más comunes y también en los menos frecuentes, así como el papel que desempeña la ecografía en el tratamiento de la patología.

Abstract: Calcific tendinitis is caused by abnormal deposition of calcium hydroxyapatite crystals in tendons and is a common cause of joint pain. The disease typically affects the shoulder and hip, with characteristic imaging findings; however, any tendon can be involved. Occasionally, calcific tendinitis can mimic aggressive disorders, such as infection and neoplasm, especially on MRI. Apparently, the calcifications come from an abnormal differentiation of the tendon stem cells, which begin to produce calcium. Radiologists should be familiar with the imaging findings to distinguish calcific tendinitis from more aggressive processes. Image-guided percutaneous needle aspiration is a useful technique performed by the radiologist for the treatment of symptomatic cases. Being familiar with these processes and their imaging appearance is an important aspect in the management of this common disease. The purpose of this review is to analyze the pathogenesis of calcium tendinopathy, the evaluation of images in both the most common and less frequent presentation sites, as well as the role played by ultrasound in the treatment of pathology.

Supraspinatus Muscle Tendon Lesion and Its Relationship with Long Head of the Biceps Lesion / Lesão do tendão do músculo supraespinal e sua relação com a lesão do tendão da cabeça longa do bíceps

Abstract Objective To identify the clinical, radiological, and arthroscopic correlation of long head of the biceps tendon injuries and their influence on pain when associated with rotator cuff injuries. Methods Between April and December 2013, 50 patients were evaluated, including 38 (76%) women and 12 (24%) men, with a mean age of 65.1 years old. The patients were operated by the Shoulder and Elbow Group, Discipline of Sports Medicine, Orthopedics and Traumatology Department, Universidade Federal de São Paulo. The subjects underwent repair of the rotator cuff lesion with clinical, radiological and/or arthroscopic evidence of involvement of the long head of the biceps tendon. Results An association between pain at palpation of the intertubercular groove of the humerus and high-grade partial lesions (partial rupture of the tendon affecting more than 50% of its structure) was observed at the arthroscopy (p = 0.003). There was also an association between the high-grade lesion of the long head of the biceps and injury to the supraspinatus muscle tendon (p < 0.05). For each centimeter of the supraspinatus muscle tendon injury, the patient presented a 1.7 higher probability of having a high-grade lesion at the long head of the biceps. Conclusion Pain at the anterior shoulder region during palpation of the intertubercular groove of the humerus may be related to high-grade lesions to the long head of the biceps. Rotator cuff injury and its size are risk factors for high-grade injuries to the long head of the biceps tendon.

Resumo Objetivo Identificar a correlação clínica, radiológica, e artroscópica das lesões do tendão da cabeça longa do bíceps e sua influência na dor do paciente quando associada às lesões do manguito rotador. Métodos Entre abril e dezembro de 2013, foram avaliados 50 pacientes, sendo 38 (76%) do sexo feminino e 12 (24%) do sexo masculino, com idade média de 65,1 anos. Os pacientes foram operados pelo Grupo de Ombro e Cotovelo da Disciplina de Medicina Esportiva do Departamento de Ortopedia e Traumatologia da Universidade Federal de São Paulo. Os indivíduos foram submetidos a reparo da lesão do manguito rotador com evidência clínica, radiológica e/ou artroscópica de acometimento do tendão da cabeça longa do bíceps. Resultados Observou-se associação entre dor à palpação do sulco intertubercular do úmero com lesão parcial de alto grau (ruptura parcial acometendo mais de 50% do tendão) na artroscopia (p = 0,003). Encontramos ainda uma associação entre a lesão de alto grau da cabeça longa do bíceps e a lesão do tendão do músculo supraespinal (p < 0,05), sendo que, para cada centímetro de lesão do tendão do músculo supraespinal, o paciente apresenta probabilidade 1,7 maior de ter uma lesão de alto grau da cabeça longa do bíceps. Conclusão A dor na região anterior do ombro à palpação do sulco intertubercular do úmero pode estar relacionada às lesões de alto grau da cabeça longa do bíceps. A lesão do manguito rotador e o seu tamanho são fatores de risco para lesão de alto grau do tendão da cabeça longa do bíceps.