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.

Xantoma del tendón de aquiles bilateral: debut de xantomatosis cerebrotendinosa / Bilateral achilles tendon xanthoma: cerebrotendinous xanthomatosis debut

OBJETIVO Presentación de un inusual caso de xantomatosis cerebrotendinosa en un paciente de edad cuya primera manifestación fueron xantomas bilaterales del tendón de Aquiles. MATERIAL Y MÉTODOS Mujer de 62 años, que presenta tumoraciones, que presenta tumoraciones sólidas y polilobuladas, en la cara posterior de ambos tendones de Aquiles de 8 años de evolución. El diagnóstico se realizó mediante el hallazgo de hiperlipidemia y estudio genético. Se realió la exóresis quirúrgica parcial de las tumoraciones. RESULTADOS A los 5 años de la cirugía del pie izquierdo y 4 años del pie derecho la paciente estaba asintomática. Presentaba una fuerza para la flexión plantar bilateral de 5/5, pudiendo caminar y subir escaleras sin molestias. Presentaba una escala AOFAS de 85 y 90 puntos en el pie izquierdo y derecho, respectivamente. No hubo recidivas. DISCUSIÓN Los xantomas son depósitos de colesterol en el tejido conectivo de la piel, tendones o fascia, como resultado de una hiperlipoproteinemia. La importancia del caso radica en su sospecha diagnóstica, ya que la xantomatosis cerebrotendinosa suele manifestarse en pacientes de menos de 30 años de edad y en los que se ha recomendado la resección radical de las tumoraciones, e incluso del tendón, debido a las frecuentes recidivas. CONCLUSIÓN En pacientes de mayor edad con lesiones que infiltran el tendón, se puede optar por un tratamiento menos agresivo con un buen resultado clínico.

OBJETIVE Presentation of an unusual case of cerebrotendinous xanthomatosis in an elderly patient whose first manifestation was bilateral Achilles tendon xanthomas. MATERIAL AND METHODS 62-year-old woman presenting solid and polylobed tumors on the posterior aspect of both Achilles tendons for eight years. The diagnosis was made by means of hyperlipidemia and a genetic study. Surgical partial excision of the tumors was performed. RESULTS Five years after surgery on the left foot and four years after the right foot, the patient was asymptomatic. Bilateral plantar flexion force was 5/5, The patient was able to walk and climb stairs without discomfort. AOFAS score was 85 and 90 on the left and right feet, respectively. There were no recurrences. DISCUSSION Xanthomatosis is a genetic alteration with deposits of cholesterol in connective tissue of the skin, tendons or fascia, because of hyperlipoproteinemia. The importance of the present case lies in its diagnostic suspicion, since cerebrotendinous xanthomatosis manifests usually in patients under 30 years of age and in whom radical resection of tumors, and even of the tendon, has been recommended due to frequent recurrences . CONCLUSION In older patients with tumors that infiltrate the tendon, a less aggressive treatment can be chosen with a good clinical result.

Alterações ultrassonográficas do ligamento patelar em jogadores de futebol assintomáticos / Echogenicity changes of patellar ligament in asymptomatic soccer players

Introdução: O ligamento patelar é a estrutura do joelho que liga a patela à tíbia. As lesões desta estrutura fazem parte de um grupo maior de doenças que causam o que os ortopedistas denominam como "dor anterior do joelho". Devido a isso, as lesões do ligamento patelar por trauma repetitivo receberam o nome genérico de "joelho do saltador". O objetivo geral do estudo foi avaliar o ligamento patelar de jogadores profissionais de futebol, assintomáticos, através da ultrassonografia. Métodos: A amostra foi de 52 jogadores profissionais de futebol que passaram pelo exame de ultrassonografia. Resultados: No total, 52 jogadores foram incluídos no estudo com idade média de 23 anos (DP±4,95), com um tempo de prática médio no esporte de 9,35 anos (DP±3,71). A média de tempo de prática esportiva dos jogadores que não tiveram lesão foi de 10,14 anos (DP±3,71), enquanto a média dos jogadores que tiveram lesão foi de 5 anos (DP±0,76). Dos jogadores que tiveram lesão, a maioria, 24,1%, era de defensores, enquanto apenas 4,3% eram atacantes. Conclusões: O tempo médio de treinamento nos jogadores que tiveram lesão foi menor do que naqueles que não tiveram nenhuma anomalia encontrada. Os defensores tiveram mais lesões que os atacantes (AU)

Introduction: The patellar ligament is the structure of the knee that connects the patella to the tibia. Lesions of this structure belong to a larger group of diseases that cause what orthopedists refer to as "knee anterior pain". Because of this, the patellar ligament injuries due to repetitive trauma received the generic name of "jumper's knee". The overall objective of the study was to evaluate the patellar ligament of asymptomatic professional soccer players through ultrasound. Methods: The sample consisted of 52 professional soccer players who underwent an ultrasound examination. Results: In total, 52 players were included in the study with an average age of 23 years (SD ± 4.95), with an average practice time of 9.35 years in the sport (SD ± 3.71). The average time of sports practice of players who had no injury was 10.14 years (SD ± 3.71), while the average in those who had injury was 5 years (SD ± 0.76). Of the players who had injury, most (24.1%) were defenders while only 4.3% were forwards. Conclusions: The average training time in players who had injury was smaller than in those who had no abnormality. Defenders had more injuries than forwards did (AU)

Serial superficial digital flexor tendon biopsies for diagnosing and monitoring collagenase-induced tendonitis in horses / Biópsias seriadas do tendão flexor digital superficial para o diagnóstico e monitoração da tendinite induzida por colagenase em equinos

The purpose of this investigation was to demonstrate the feasibility of a biopsy technique by performing serial evaluations of tissue samples of the forelimb superficial digital flexor tendon (SDFT) in healthy horses and in horses subjected to superficial digital flexor tendonitis induction. Eight adult horses were evaluated in two different phases (P), control (P1) and tendonitis-induced (P2). At P1, the horses were subjected to five SDFT biopsies of the left forelimb, with 24 hours (h) of interval. Clinical and ultrasonographic (US) examinations were performed immediately before the tendonitis induction, 24 and 48 h after the procedure. The biopsied tendon tissues were analyzed through histology. P2 evaluations were carried out three months later, when the same horses were subjected to tendonitis induction by injection of bacterial collagenase into the right forelimb SDFT. P2 clinical and US evaluations, and SDFT biopsies were performed before, and after injury induction at the following time intervals: after 24, 48, 72 and 96 h, and after 15, 30, 60, 90, 120 and 150 days. The biopsy technique has proven to be easy and quick to perform and yielded good tendon samples for histological evaluation. At P1 the horses did not show signs of localised inflammation, pain or lameness, neither SDFT US alterations after biopsies, showing that the biopsy procedure per se did not risk tendon integrity. Therefore, this procedure is feasible for routine tendon histological evaluations. The P2 findings demonstrate a relation between the US and histology evaluations concerning induced tendonitis evolution. However, the clinical signs of tendonitis poorly reflected the microscopic tissue condition, indicating that clinical presentation is not a reliable parameter for monitoring injury development. The presented method of biopsying SDFT tissue in horses enables the serial collection of material for histological analysis causing no clinical signs and tendon damage seen by US images. Therefore, this technique allows tendonitis to be monitored and can be considered an excellent tool in protocols for evaluating SDFT injury.

Objetivou-se demonstrar a viabilidade de uma técnica de biópsia na realização de avaliações sequenciais de amostras de tecido do tendão flexor digital superficial (TFDS) do membro torácico, em equinos hígidos e em equinos submetidos à indução de tendinite do TFDS. Oito equinos adultos foram avaliados em duas fases (F) diferentes, controle (F1) e apresentando tendinite induzida (F2). Na F1, os equinos foram submetidos a cinco biópsias do TFDS do membro torácico esquerdo, com 24 horas (h) de intervalo entre as mesmas. Avaliações clínicas e ultrassonográficas (US) foram realizadas imediatamente antes e, 24 e 48 h após cada procedimento. O tecido tendíneo coletado por biópsia foi analisado histologicamente. A F2 ocorreu três meses depois, quando os mesmos equinos foram submetidos à indução de tendinite do TFDS do membro torácico direito por injeção intratendínea de colagenase. Na P2, Avaliações clínicas e US foram realizadas antes da indução da tendinite e após a mesma nos seguintes momentos: 24, 48, 72 e 96 h depois e, 15, 30, 60, 90, 120 e 150 dias depois. A técnica de biópsia se demonstrou ser de fácil e rápida realização, fornecendo fragmentos de tecido tendíneo adequados para a realização de histologia. Na F1, os equinos não demonstraram sinais de inflamação local, dor ou claudicação, bem como não apresentaram alterações na avaliação US do TFDS após as biópsias, demonstrando que o dano físico ao tendão provocado pela biópsia não compromete sua integridade. Assim, o procedimento pode ser utilizado rotineiramente para avaliações histológicas do tecido tendíneo. Na F2, observou-se uma relação entre os achados US e histológicos no que se refere à evolução da tendinite induzida. Entretanto, observou-se que os sinais clínicos da tendinite não acompanham a condição microscópica do tecido, o que indica que a apresentação clínica não pode ser utilizada como parâmetro para a monitoração da evolução da enfermidade. A técnica de biópsia apresentada para colheita de tecido do TFDS em equinos, permite a obtenção de tecido para avaliação histológica seriada sem provocar sinais clínicos e alterações ultrassonográficas que indiquem dano tecidual. Assim, a técnica permite a monitoração da tendinite e pode ser considerada uma excelente ferramenta na avaliação de injúrias do TFDS.

Tendinitis del flexor digital superficial en la cara palmar del metacarpo / Tendinopathy of the superficial digital flexor of the palmar metacarpus

Características de la tendinitis en equinos deportivos, procedimientos y protocolos para obtener una imagen, técnica ecográfica, e interpretación ecográfica para esta patología.

Avaliação da altura patelar em atletas com tendinopatia crônica do aparelho extensor do joelho / Evaluation of the patellar height in athletes with diagnosed with chronic tendinopathy of the knee extensor mechanism

OBJETIVO: Avaliar radiograficamente a altura patelar de atletas com diagnóstico de tendinopatia crônica do aparelho extensor do joelho (TCAE). MÉTODOS: Na amostra foram avaliados radiograficamente 65 pacientes (110 joelhos) com idade entre 15 e 40 anos e de diferentes modalidades esportivas com e sem diagnóstico de tendinopatia crônica do aparelho extensor do joelho (jumper's knee). Os atletas foram divididos em dois grupos: aqueles com diagnóstico de TCAE (grupo 1: 38 atletas - 56 joelhos) e um grupo que denominamos de controle (grupo 2: 27 atletas - 54 joelhos). RESULTADOS: No grupo 1 tivemos 18 atletas que apresentavam a doença bilateralmente na ocasião dos exames. Para a medida da altura patelar utilizamos os índices radiográficos de Insall e Salvati e Blackburne e Peel. CONCLUSÃO: A presença de patela alta no grupo de atletas com tendinopatia crônica do aparelho extensor do joelho foi significante maior do que a observada no grupo controle.

OBJECTIVES: To carry out a radiographic evaluation of patellar height in athletes diagnosed with chronic tendinopathy of the knee extensor mechanism; METHODS: Radiographic assessments were carried out on 65 patients (110 knees) aged between 15 and 40 years, who practiced different kinds of sports, some with of chronic tendinopathy of the knee extensor mechanism (jumper's knee) and others without. The athletes were divided into two groups: those with diagnosed "jumper's knee" (group 1:38 athletes - 56 knees) and a control group (group 2:27 athletes - 54 knees). In group 1, 18 of the athletes presented the condition in both knees on examination. The height of the patella was measured using the Insall-Salvati and Blackburne-Peel x-ray methods. CONCLUSION: The presence of a high patella in the group of athletes with chronic tendinopathy of the knee extensor mechanism was significantly higher than in the control group.

Tendinopatia dos fibulares: [revisão] / Fibular tendinopathy: [review]

JUSTIFICATIVA E OBJETIVOS: Ressaltar as características do acometimento dos tendões fibulares e o seu tratamento. O objetivo deste estudo foi analisar as diferenças referentes à nomenclatura do acometimento dos tendões, a etiologia, incidência, sintomatologia e o tratamento da tendinopatia dos fibulares. CONTEÚDO: Foram consultados os bancos de dados da Pubmed, CAPS e Google acadêmico, bem como revistas científicas com as seguintes palavras-chaves: tendinose, tendinopatia, tendinite e tenossinovite dos músculos fibulares. Além disso, livros também foram verificados. Foram revisadas 33 referências bibliográficas e foi encontrado que a tendinopatia está ligada a um processo degenerativo, a etiologia é de caráter multifatorial, sua maior incidência é em esportes como basquete, balé e atletismo. Nos achados clínicos, encontra-se fraqueza muscular e nem sempre há dor. CONCLUSÃO: Quando há prevalência de processo degenerativo a nomenclatura mais correta a ser utilizada é tendinopatia, ocorrendo com maior frequência em esportes e não sendo obrigatória a presença de dor. Apesar de o tratamento ser pouco descrito, os exercícios excêntricos parecem trazer os melhores resultados, porém, há a necessidade de outros estudos que abordem o tema.

BACKGROUND AND OBJETIVES: To describe the characteristics of the involvement of the peroneal tendons and their treatment. The aim of this study was to analyze the differences regarding the nomenclature of the affected tendon, the etiology, incidence, symptoms and treatment of peroneal tendinopathy. CONTENTS: Web pages for search (PubMed, Google scholar and CAPS) and journals were consulted with the following keywords: tendinosis; tendinopathy, tendinitis and tenosynovitis of the peroneal muscles. In addition, books were also checked. We reviewed 33 references and found that tendinopathy is related to a degenerative process, the etiology is multifactorial, and its highest incidence is in sports like basketball, ballet and athletics. In clinical findings, there is muscle weakness and there is not always pain. CONCLUSION: When there is prevalence of the degenerative process more accurate nomenclature to be used is tendinopathy, occurring more frequently in sports and not being required the presence of pain. Although the treatment is not well described, eccentric exercises seem to bring the best results, however, there is a need for further studies that will address this issue.

A síndrome anserina: [revisão] / Anserine syndrome: [review]

Dor no joelho é uma condição comum na clínica diária e a patologia anserina, também conhecida como pata de ganso, tem sido considerada uma das principais causas. O diagnóstico tem sido realizado de maneira eminentemente clínica, o que tem gerado equívocos. Os pacientes queixam-se tipicamente de dor na parte medial do joelho, com sensibilidade na porção ínferomedial. Estudos de imagem têm sido realizados para esclarecer se tais pacientes possuem bursite, tendinite ou ambos os distúrbios na região conhecida como pata de ganso. Entretanto, o defeito estrutural responsável pelos sintomas permanece desconhecido, motivo pelo qual preferimos intitular como "Síndrome Anserina". O diabetes mellitus é um fator predisponente bem reconhecido. O sobrepeso e a osteoartrite de joelho parecem ser fatores adicionais de risco, contudo, seus papéis na gênese da moléstia ainda não são bem entendidos. O tratamento atual inclui anti-inflamatório, fisioterapia e infiltração de corticoide, com evolução muito variável, que oscila entre 10 dias e 36 meses. A falta de conhecimento sobre a etiofisiopatologia e dados epidemiológicos exige futuros estudos para esse frequente e intrigante distúrbio.

Knee pain is a common complaint in clinical practice, and pes anserinus tendino-bursitis syndrome (PATB) has been frequently diagnosed based only on clinical features that may cause equivocal interpretations. Patients complain of characteristic spontaneous medial knee pain with tenderness in the inferomedial aspect of the joint. Studies with different imaging modalities have been undertaken during the last years to identify whether these patients suffer from bursitis, tendinitis, or both. Nevertheless, little is known regarding the structural defect responsible for this disturbance. Due to these problems and some controversies, we suggest the term "anserine syndrome" for this condition. Diabetes Mellitus is a known predisposing factor for this syndrome. Overweight and osteoarthritis seem to represent additional risk factors; however, their role in the pathophysiology of the disease is not yet understood. Treatment includes non-steroidal anti-inflammatory drugs, physiotherapy, and injections of corticosteroid, with highly variable responses, from 10 days to 36 months to achieve recovery. The lack of knowledge about its epidemiological, etiological, and pathophysiological aspects requires future studies for this common and intriguing disorder.

Reliability of MRI Findings of Peroneal Tendinopathy in Patients with Lateral Chronic Ankle Instability

BACKGROUND: Patients with chronic lateral ankle instability also have peroneal tendinopathy often. However, preoperative MRIs of these patients are vague in many cases. Our study was performed to see the reliability of MRI findings of peroneal tendinopathy in patients with chronic lateral ankle instability. METHODS: MRI images for 82 patients who had chronic lateral ankle instability, and had received surgical treatment between March 2006 and November 2009 were compared with impressions from operating rooms. The mean age of patients was 36.4 years (range, 15 to 64 years), 82 ankles were studied, and patients with rheumatoid diseases were excluded from the study. RESULTS: Of the 82 cases, 26 were true positives, 38 true negatives, 13 false positives and 5 false negatives. Of 39 cases of peroneal tendinopathy diagnosed from MRI, 14 had peroneal tendon partial tears, 15 tenosynovitis, 3 dislocations, 17 low-lying muscle bellies, and 6 peroneus quartus muscles. Of 31 cases of peroneal tendinopathy observed in surgery 11 had peroneal tendon partial tears, 4 tenosynovitis, 5 dislocations, 12 low-lying muscle belliess, and 1 peroneus quartus muscle. Sensitivity and specificity of peroneal tendinopathy were 83.9% and 74.5%, respectively. Positive predictive value was 66.7%. Negative predictive value was 88.4%. Accuracy rate was 78.0%. CONCLUSIONS: MRI is a useful diagnostic tool for detecting peroneal tendinopathy in patients with chronic lateral ankle instability. However, MRI is vague in many cases. Therefore, a thorough delicate physical examination and careful observation is needed.

Equívocos diagnósticos envolvendo as tendinites: impacto médico, social, jurídico e econômico: [revisão] / Diagnostic mistakes involving tendonitis: medical, social, legal, and economic impact: [review]

Evidências sobre o impacto clínico, social e econômico provenientes de equívocos diagnósticos são analisadas à luz das tendinites e outras moléstias dolorosas crônicas. O objetivo desta revisão é alertar sobre uma possível hipervalorização diagnóstica das tendinites, em especial aquelas supostamente múltiplas ou refratárias, com base em evidências. É apresentada uma revisão da literatura sobre as condições dolorosas crônicas, tais como a síndrome da fibromialgia, no contexto dos diagnósticos equivocados de tendinites, bem como revisão sobre falsa-positividade e parâmetros diagnósticos da ultrassonografia (US) neste cenário. Foram encontradas evidências de equívocos terapêuticos em 41 por cento e equívocos diagnósticos entre 70 e 85 por cento, com despreparo comprovado em até 93,7 por cento dos médicos, tudo envolvendo tais doenças. As vastas repercussões dessa epidemia de equívocos são comentadas.

Evidence of the clinical, social, and economic impact of mistaken diagnoses of tendonitis and other chronic painful disorders are analyzed. The objective of this review is to call attention to the possible diagnostic hyper valuation of tendonitis, especially those supposedly multiple or refractory, based on evidence. A review of the literature on chronic painful disorders, such as fibromyalgia, in the context of mistaken diagnosis of tendonitis, as well a review of false positive and ultrasonographic (US) scan diagnostic parameters, is presented. Evidence of therapeutic mistakes were found in 41 percent and diagnostic mistakes in 70 to 85 percent of the cases, with proven unpreparedness regarding those disorders in up to 93.7 percent of the physicians. The diverse repercussions of this epidemic of mistakes are discussed.

Aplicación de farmacopuntura en afecciones dolorosas del hombro / Application pharmacopuncture in painful affections of the shoulder

Se realizó un estudio experimental, tipo ensayo clínico controlado, en el período comprendido entre enero del 2007 hasta enero del 2008, con el fin de comparar la respuesta al tratamiento con farmacopuntura en el hombro doloroso con respecto al bloqueo del nervio supraescapular y proponer un algoritmo de tratamiento. La muestra quedó constituida por 60 pacientes, los cuales fueron aleatorizados y divididos en dos grupos, a uno se le realizó bloqueo del nervio supraescapular con betametasona y lidocaína al 2 por ciento en dosis habituales y al otro grupo se les aplicó farmacopuntura con pequeñas dosis de betametasona diluida con agua para inyección. El tratamiento fue aplicado dos veces por semana y hasta seis sesiones como máximo. Se evaluaron semanalmente por un equipo de trabajo teniendo en cuenta el criterio del paciente según la escala visual análoga, según criterio médico basado en el examen clínico, explorándose el dolor, la limitación de la movilidad articular y el balance funcional . Se observó una evolución satisfactoria más rápida en los pacientes tratados con farmacopuntura. El tratamiento con farmacopuntura en el hombro doloroso es de alta eficacia frente al bloqueo del nervio supraescapular.

We carried out an experimental, longitudinal and prospective study, at the Provincial Centre for the Development of Natural and Traditional Medicine Dr Mario E Dihigo, during the period from January 2007 to January 2008, with the objective of treating the increased incidence of patients with painful affections of the shoulder, requiring in many cases the usage of long, risk treatments, with results not always satisfactory. The sample was formed by 60 patients who were randomized and divided in two groups. A blockade of the supraescapular nerve with betamethasone and lidocain 2 per cent in habitual doses was applied to one group; the second one received pharmacopuncture with low doses of betamethasone diluted in water for injection. The treatment was applied 2 times a week and up to the maximum of 6 sessions. They were evaluated weakly for a working group, taking into account the patient's criteria according to the visual analogous scale, according to the medical criteria based on the clinical examination looking for pain, joint mobility limitation and functional balance. Among the studied patients there was a predominance of the female sex beginning from the third and fourth decades of life. Tendinitis of the rotator cuff was the most frequent diagnosis. There was a faster satisfactory recovery in patients treated with pharmacopuncture. Pharmacopuncture therapy in painful shoulder is of higher efficacy than the blockade of the supraescapular nerve.

Tendinopatia patelar / Patellar tendinopathy

A tendinopatia do tendão patelar é uma patologia que acomete frequentemente atletas que exigem força de impacto repetitivo ou de saltos frequentes. A sobrecarga excessiva no tendão pode provocar alterações na matriz extracelular que cronicamente poderá levar a um quadro de tendinose. Ocorre principalmente na região do polo inferior da patela. Seu início é insidioso e gradual, principalmente após uma atividade física, mas com a progressão da doença pode tornar-se frequente durante ou mesmo no início da atividade. O diagnóstico de tendinopatia do tendão patelar é eminentemente clínico, caracterizado por dor a palpação no polo inferior da patela e adjacências. Exames complementares auxiliam no diagnóstico. O USG e a RM são os mais indicados, pois podem definir o local exato da lesão, sua extensão, como também identificar a presença ou não de alterações degenerativas. O tratamento inicial desta tendinopatia é clínico, com repouso relativo, correção dos fatores etiológicos, além de crioterapia e medidas fisioterápicas. Já nos casos não responsivos ao tratamento clínico, o tratamento cirúrgico é uma opção, em que várias técnicas são descritas, com a literatura expondo índices variados de bons resultados.

Prevalence of pain on palpation of the inferior pole of the patella among patients with complaints of knee pain

CONTEXT AND OBJECTIVE: Patellar tendinopathy is a common condition in sports. It may occur at any location of the patellar tendon, but the most commonly affected area is the inferior pole of the patella. Among various diagnostic tests, the one most used is palpation of the inferior pole of the patella. The aim of this study was to investigate the prevalence of pain complaints among individuals with pathological knee conditions and to evaluate palpation of the inferior pole of the patella as a diagnostic test for patellar tendinopathy. METHODS: Palpation of the patellar tendon was performed on 318 individuals who presented with knee-related complaints. Palpation was performed with the individual in the supine position and the knee extended. The age, gender, physical activity and labor activity of each individual were recorded at the time the symptoms appeared; the diagnosis was also recorded. RESULTS: Of the total number of individuals evaluated, 124 (39 percent) felt pain on palpation of the inferior pole of the patella. Of these, only 40 (32.3 percent) received a diagnosis of patellar tendinopathy. We did not observe any difference with respect to gender and age distribution. When evaluating daily physical activity levels, however, we observed that individuals with pain on palpation of the inferior pole of the patella experienced more intense physical activity. CONCLUSIONS: Palpation of the inferior pole of the patella is a diagnostic procedure with high sensitivity and moderate specificity for diagnosing patellar tendinopathy, especially among individuals who perform activities with high functional demands.

Tendinopatia patelar / Patellar tendinopathy

A tendinopatia do patelar ou jumper's knee (joelho do saltador) é uma afecção que acomete freqüentemente atletas praticantes de atividades de salto ou aquelas que exigem força de impacto repetitivo. Histologicamente, a sobrecarga excessiva no tendão pode provocar alterações na matriz extracelular, resultando em pequenas lesões que, cronicamente, poderão levar a um quadro de tendinose, principalmente na região do pólo inferior da patela. A dor na região anterior do joelho é o primeiro sintoma relatado pelo paciente portador dessa afecção. Seu início é insidioso e gradual, principalmente após atividade física, mas, com a progressão da doença, pode tornar-se freqüente durante ou já no início da atividade. O diagnóstico de tendinopatia do patelar é eminentemente clínico, caracterizado por dor à palpação no pólo inferior da patela e adjacências e, nos casos mais avançados, nódulo palpável e edema associado podem ser visualizados. Exames complementares, como radiografia, ultra-sonografia (US) e ressonância magnética (RM) auxiliam no diagnóstico. O US e a RM são os mais indicados, pois podem definir o local exato da lesão, sua extensão, como também identificar a presença ou não de alterações degenerativas, sendo a RM o que fornece melhor resolução. O tratamento inicial da tendinopatia é clínico, com repouso relativo, correção dos fatores etiológicos, além de crioterapia e medidas fisioterápicas. A utilização da medicação analgésica e antiinflamatória é controversa. Nos casos que não respondem ao tratamento clínico, o cirúrgico é opção, e várias técnicas são descritas, a literatura demonstrando índices variados de bons resultados.

Patellar tendinopathy, or jumper's knee, is often seen in athletes that practice jumping modalities, or modalities that require repetitive impact strength. Histologically, the excessive load on the tendon may cause changes in the extracellular matrix and results in small lesions that may, when chronic, lead to tendinosis specially in the lower pole of the patella. Pain in the anterior region of the knee is the first symptom reported by the patient with this disease. The beginning is insidious and gradual, mainly after physical activity, but with the progression of the disease, pain may be frequent during or already in the beginning of the activity. The diagnosis of patellar tendinopathy is eminently clinical, characterized by pain when palpating the lower pole of the patella and adjacent areas. In more advanced cases, a palpable nodule and associated edema may be visualized. Supplemental exams, such as X-ray, ultrasound, and MRI help in the diagnosis. Ultrasound and MRI are the best indications, as they may define the exact location of the lesion, its extension, and also identify whether or not degenerating changes are present, MRI providing the best resolution. Initial tendinopathy treatment is clinical, with relative rest, correction of etiologic factors, cryotherapies and physiotherapy. The use of pain killers and anti-inflammatory drugs is controverted. For those cases that do not respond to clinical treatment, surgical is an option, and the literature brings several techniques with varying rates of good results.

Comparison of the effect of low-power laser with therapeutic ultrasound on the treatment of rotator cuff tendonitis

Shoulder pain is the third most prevalent cause of musculoskeletal disorder after low back and cervical pains. Most of the shoulder symptoms are attributed to the rotator cuff. The objective of this study was to compare the effects of low-power laser therapy with ultrasound therapy on the patients with rotator cuff tendonitis. This clinical trial was performed in Zahedan university of medical sciences in 2006. Thirty patients with rotator cuff tendonitis were randomly assigned to either a low-power laser therapy group [15 patients] or an ultrasound therapy group [15 patients]. Strength [kg] of shoulder abduction, and internal and external rotation were measured before and after intervention using hand-held dynamometer and goniometer respectively. The pain was evaluated using the visual analogue scale. In the laser group, a low-level Ga-As laser was applied with a 100 mw point probe [average power], wave length of 905 nm, pulse duration of 200ns, 6j/cm[2] dosage, 5 KHz frequency, and lasting 3 minutes. The ultrasound treatment was applied with a power of 1 W/cm2, a frequency of 1 MHz, pulse mode of 1:4, and lasting 10 minutes on each occasion. The treatment was carried out 3 times weekly for 10 days. The data were analyzed using independent sample t-test and paired t-test. The pain in the laser group was significantly decreased from 6.06 +/- 1.6 to 5 +/- 1.3 in abduction, from 5.3 +/- 1.5 to 4.7 +/- in internal rotation, and from 5.06 +/- 1.4 to 4.3 +/- 1.44 in external rotation [p<0.05]. On the other hand, the pain in the ultrasound therapy group was decreased from 6.3 +/- 1.06 to 6.2 +/- 1.01 in abduction, from 6.07 +/- 0.9 to 5.9 +/- 0.84 in internal rotation, and from 5.87 +/- 0.92 to 5.8 +/- 0.96 in external rotation [p>0.05]. A significant improvement after treatment was observed in the laser group in measures of shoulder abductor, internal rotator and external rotator muscles strength compared to those of the ultrasound therapy group [p<0.05]. The pain level was also significantly decreased after the treatment in the laser group compared to the ultrasound therapy group in each of the three movements [p<0.05]. In rotator cuff tendonitis, the results support the effectiveness of Gallium-arsenide low power laser therapy in order to decrease pain, and subsequently the occurrence of muscle strength. A period of low power laser therapy is more efficient than ultrasound therapy

Tratamiento quirurgico de la tendinitis rotuliana en atletas de alto rendimiento / Surgical treatment of patellar tendonitis in high performance athletes

Introducción: El número de deportistas de alto rendimiento está en constante aumento, así como las exigencias a las que son sometidos. Algunos autores han llamado rodilla del saltador (jumper’s knee) a la tendinitis rotuliana. El objetivo de este trabajo fue evaluar el resultado del tratamiento quirúrgico en atletas de alto rendimiento con tendinitis de grado II o III de Blazina. Materiales y métodos: Incluimos en este estudio a 19 pacientes, todos atletas profesionales, operados entre 1995 y 2005, con edades comprendidas entre 20 y 31 años. Se describe la técnica quirúrgica utilizada y el tratamiento posquirúrgico. Se evaluaron los resultados de acuerdo con el retorno de los atletas a su nivel de competencia. Resultados: Se presentan 19 pacientes operados, con excelentes y buenos resultados en 16 de ellos. Dos pacientes tuvieron resultado regular y uno, malo. Las lesiones asociadas no influyeron en el resultado final. El retorno a la competencia varió entre 4 y 6 meses. Conclusiones: Se indicó cirugía a los atletas con tendinitis de grado II apremiados por su calendario deportivo y en aquellos con grado III cuando fracasó el tratamiento conservador. El tratamiento quirúrgico de la tendinitis rotuliana en los atletas de alto rendimiento, grado II o III, presenta excelentes y buenos resultados en la mayoría de los casos.

Tratamiento de afecciones músculo-esqueléticas con ondas de choque extracorpóreas / Extracorporeal shock wave therapy for musculoskeletal disorders

Extracorporeal shock waves are pressure waves used to treat certain musculoskeletal conditions. Focused wavetherapy, the same that is used in lithotripsy, but actingthrough a different mechanism, is used to treat pseudoarthritis and delayed consolidation, avascular necrosis of large joints, osteochondritis dissecans, calcific tendonitis and enthesopathies. We study its use in myocardial infarction. Results are positive, and this constitutes a non invasive alternative to surgery. It must be applied with anesthesia or analgesics and presents the same risks as lithotripsy. Radial wave therapy has shown good results in pathologies that do not respond well to conventional treatments, such as calcific tendonitis of the shoulder, frozen shoulder, plantar fasciitis (with or without calcaneal spurs), epicondilitis, trocanterous bursitis, patellar tendonitis,Achilles tendonitis, Morton’s neuroma, trigger points; and less favorable results in medial epicondylitis, andmore recently in diabetic foot. This therapy constitutes a non invasive alternative to surgery, practically riskfree. It is ambulatory and requires neither anesthesianor significant analgesics. It does not require sick leave. Shock waves act through the so called biological effect, producing analgesia and inducing osteogenesis, repairing tendons and other soft tissue damage, as well as reabsorbing calcium deposits. Results using shock waves are comparable to surgery, without the risks of complications associated to the later, with lower costs and less days of physical invalidity.

A ultra-sonografia na avaliação da síndrome do ombro doloroso: análise de uma série de casos / The ultrasonography in the assessment of painful shoulder syndrome: analysis of cases serie

Com objetivo de estudar os possíveis achados ultra-sonográficos na Síndrome do Ombro Doloroso (SOD), foram avaliados 77 pacientes com diagnóstico clínico de ombro doloroso encaminhados para investigação através da ultra-sonografia (USG). Além dos achados de exame, procurou-se identificar variáveis clínicas e epidemiológicas, as quais, pudessem estar associadas à presença de alterações patológicas. Dos 77 pacientes incluídos no estudo foram encontradas alterações no exame de USG de 47(61%), destes 38 (80%) apresentaram algum tipô de lesão no manguito rotador (MR), classificadas de tendinose ou tendinopatia, ruptura parcial e ruptura completa. Dentre os outros nove (20%) pacientes, cinco (11%) apresentaram bursite e quatro (9%) derrame articular como diagnósticos isolados. Dentre as variáveis clínicas e epidemiológicas avaliadas, a idade acima de 51 anos e limitação funcional articular estiveram associadas a presença de alterações no exame ultra-sonográfico destes pacientes. A lesão do MR além de ter sido a alteração mais freqüente, esteve associada ao diagnóstico ultra-sonográfico de derrame articular e a necessidade de uso de drogas antiinflamatórias. Concluiu-se que a USG é um importante método de avaliação de pacientes com SOD e que fatores como idade, limitação funcional articular apresentam associação com a presença de lesão do manguito rotador.

MR Imaging Findings of Painful Type II Accessory Navicular Bone: Correlation with Surgical and Pathologic Studies

OBJECTIVE: To evaluate the MR imaging findings of painful type II accessory navicular bone and to correlate these with the surgical and pathologic findings. MATERIALS AND METHODS: The MR images of 17 patients with medial foot pain and surgically proven type II accessory navicular abnormalities were reviewed. The changes of signal intensity in the accessory navicular, synchondrosis and adjacent soft tissue, the presence of synchondrosis widening, and posterior tibial tendon (PTT) pathology on the T1-weighted and fat-suppressed T2-weighted images were analyzed. The MR imaging findings were compared with the surgical and pathologic findings. RESULTS: The fat-suppressed T2-weighted images showed high signal intensity in the accessory navicular bones and synchondroses in all patients, and in the soft tissue in 11 (64.7%) of the 17 patients, as well as synchondrosis widening in 3 (17.6%) of the 17 patients. The MR images showed tendon pathology in 12 (75%) of the 16 patients with PTT dysfunction at surgery. The pathologic findings of 16 surgical specimens included areas of osteonecrosis with granulomatous inflammation, fibrosis and destruction of the cartilage cap. CONCLUSION: The MR imaging findings of painful type II accessory navicular bone are a persistent edema pattern in the accessory navicular bone and within the synchondrosis, indicating osteonecrosis, inflammation and destruction of the cartilage cap. Posterior tibial tendon dysfunction was clinically evident in most patients.