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Rev. Assoc. Méd. Rio Gd. do Sul ; 65(3): 01022105, Jul-Set 2021.
Article in Portuguese | LILACS | ID: biblio-1370032


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

Humans , Magnetic Resonance Imaging , Rotator Cuff , Tendinopathy
Rev. venez. cir. ortop. traumatol ; 53(1): 20-26, jun. 2021. ilus
Article in Spanish | LILACS, LIVECS | ID: biblio-1252895


Cuando fracasa el tratamiento conservador en el Estadio I de Disfunción del Tendón Tibial posterior (DTTP), se debe indicar sinovectomía y debridamiento del tendón. En este estudio evaluamos la evolución con 8 años mínimo de seguimiento, de los pacientes con esta patología tratados vía tenoscópica. Este es un estudio retrospectivo de pacientes operados entre el año 2008 y el año 2011. En ese período de tiempo se intervinieron 11 pacientes con esta patología. Sólo 9 de los 11 pacientes operados pudieron ser evaluados. 7 pacientes mejoraron su sintomatología según el VAS y no progresaron a estadio II. En 3 pacientes se evidenció lesión tendinosa durante la tendoscopía y ameritaron reparación a cielo abierto. La sinovectomía tendoscópica del TTP es un procedimiento quirúrgico efectivo para tratar a los pacientes con DTTP Estadio I, rebeldes a tratamiento conservador(AU)

When conservative treatment fails for Stage I Posterior Tibial tendon dysfunction (PTTD), synovectomy and tendon debridement is indicated. In this study we evaluate tendoscopic treatment results for this pathology with a minimum of 8 years follow up. This is a retrospective study of patients after tendoscopic surgery performed between 2008 and 2011. 9 of the 11 patients were available for evaluation. 7 improved their symptoms according to VAS scale, and did not progress to stage II. In 3 patients tendon tear was visualized during tendoscopy and needed open repair. PTT tendoscopy is an effective surgical treatment to treat Stage I PTTD, failing to conservative treatment(AU)

Humans , Male , Female , Adult , Middle Aged , Flatfoot , Magnetic Resonance Spectroscopy , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Posterior Tibial Tendon Dysfunction/pathology , Tendinopathy , Synovectomy , Ultrasonics , Cryotherapy , Diagnostic Techniques and Procedures , Debridement
Clinics ; 76: e2803, 2021. tab, graf
Article in English | LILACS | ID: biblio-1278922


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.

Humans , Male , Female , Adult , Middle Aged , Achilles Tendon , Tendinopathy , Biomechanical Phenomena , Cross-Sectional Studies , Muscle, Skeletal , Torque , Muscle Strength , Ankle , Ankle Joint
Article in Chinese | WPRIM | ID: wpr-888334


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.

Adult , Arthroscopy , Female , Follow-Up Studies , Hip/surgery , Hip Joint/surgery , Humans , Male , Middle Aged , Retrospective Studies , Tendinopathy/surgery , Treatment Outcome
Article in Spanish | LILACS, BINACIS | ID: biblio-1353916


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

Adult , Middle Aged , Shoulder/anatomy & histology , Chronic Disease , Tendinopathy , Tenodesis
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1142107


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.

Humans , Male , Middle Aged , Cervical Atlas/pathology , Axis, Cervical Vertebra/pathology , Calcinosis/diagnostic imaging , Tendinopathy/drug therapy , Tendinopathy/diagnostic imaging , Neck Muscles/pathology , Deglutition Disorders/etiology , Neck Pain/etiology , Diagnosis, Differential , Analgesics/therapeutic use
Rev. bras. ortop ; 55(6): 657-664, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1156185


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.

Pain , Achilles Tendon , Sports , Surgical Procedures, Operative , Aging , Acute Disease , Incidence , Costs and Cost Analysis , Delivery of Health Care , Tendinopathy
Rev. bras. ortop ; 55(4): 470-475, Jul.-Aug. 2020. tab, graf
Article in English | LILACS | ID: biblio-1138040


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.

Humans , Male , Female , Adult , Middle Aged , Tendon Injuries , Case-Control Studies , Probability , Surveys and Questionnaires , Risk Factors , Rotator Cuff , Trust , Tendinopathy , Control , Gender Identity , Genetics , Medical History Taking
Rev. bras. ortop ; 55(3): 329-338, May-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1138020


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.

Humans , Male , Female , Middle Aged , Aged , Pain , Arthroscopy , Rupture , Tendon Injuries , Wounds and Injuries , Rotator Cuff , Elbow , Tendinopathy , Rotator Cuff Injuries
Rev. chil. radiol ; 26(2): 52-61, jun. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1126194


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.

Humans , Calcinosis/etiology , Calcinosis/diagnostic imaging , Rotator Cuff/diagnostic imaging , Tendinopathy/etiology , Tendinopathy/diagnostic imaging , Ultrasonics , Calcinosis/classification , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Tendinopathy/classification
Int. j. morphol ; 38(1): 186-192, Feb. 2020. graf
Article in English | LILACS | ID: biblio-1056419


As a result of their intense physical activity, racehorses suffer high tendon stress which may result in various pathologies. One of these is tendonitis in the tendon of the superficial digital flexor muscle (TSDFM). Conventional treatment with rest, has not shown to be very effective, and regenerative medicine through the application mesenchymal stem cells appears to be a promising therapy. The objective of this work was to assess the effect of the application of autologous MSC on reduction of the scar length in recurrent TSDFM tendinitis in Holsteiner horses, using image analysis. This study included two groups of five animals each: A control group that received conventional treatment (CG) and an experimental group which was also treated with intralesional injections of MSC (EG). Scar evolution was assessed by echographic analysis, with measurements taken of the scar length over a four month period; the length at month zero, was taken as the initial value of 100 %. During the first month, the mean scar length diminished to 81.14 % (EG) and 95.85 % (CG); after the second month, lengths were 64.4 % (EG) and 92.3 % (CG); following the third month lengths were 51.92 % (EG) and 87.42 % (CG); finally at the end of the fourth month the lengths recorded were 26.7 % (EG) and 83.92 % (CG). These results show that treatment with autologous MSC helps TSDFM scar length was significantly reduced, as compared to conventional treatment.

Reducción de la cicatriz de tendinitis recidivante mediante células Madre mesenquimales autólogas derivadas de tejido adiposo de la base de la cola en equinos Holsteiner (Equus ferus caballus). En equinos deportistas, la actividad física intensa ocasiona gran estrés en los tendones, pudiendo ocasionar diversas patologías como la tendinitis del tendón del músculo flexor digital superficial (TMFDS). El tratamiento convencional con reposo es poco eficaz, siendo la medicina regenerativa a través de la aplicación de células madres mesenquimáticas (MSC) una promisoria terapia. El objetivo de este trabajo, fue evaluar el efecto de la aplicación de MSC autólogas, sobre la reducción de la longitud de la cicatriz en tendinopatías recidivantes del TMFDS en equinos Holsteiner, a través del análisis de imagen. Este estudio conto con dos grupos de cinco animales cada uno, el grupo control mantuvo el tratamiento convencional (GC) y el grupo experimental fue tratado adicionalmente con inyección interlesional de MSC (GE). El análisis ecográfico permitió evaluar la evolución de la cicatriz, a través de la medición de su longitud durante los cuatros meses, tomando la longitud del mes cero como la medición inicial del 100 %. Durante el primer mes, la longitud de la cicatriz se redujo a un 81,14 % (GE) y 95,85 % (GC), al segundo mes la longitud fue de un 64,4 % (GE) y de 92,3 % (GC), al tercer mes, la longitud fue de 51,92 (GE) y un 87,42 (GC), finalmente al cuarto mes la longitud fue de 26,7 % (GE) y del 83,92 % (GC). Estos resultados muestran que el tratamiento con MSC autólogas favorece a la disminución de la longitud de la cicatriz del TMFDS de forma significativa respecto al tratamiento convencional.

Animals , Wound Healing , Adipose Tissue , Tendinopathy/therapy , Mesenchymal Stem Cells , Recurrence , Disease Models, Animal , Tendinopathy/complications , Horses
s.l; RedARETS; feb. 2020.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-1095215


TECNOLOGÍA EVALUADA: Inyección peritendinosa de ácido hialurônico. GUIAS DE PRÁCTICA CLÍNICA: No se encontraron guias de práctica clínica que evalúen la recomendación incluida en la pregunta de investigación. BUSQUEDA BIBLIOGRÁFICA: Terminología: Medical Subject Headings (MeSH). Estrategia en Medline. Estrategia epistemonikos. Estrategia Cochrane library. RESULTADOS: Desenlace: Reducción del dolor 3 a 6 semanas. Desenlace: mejoría funcional a las 6 semanas. I2 mayor al 90%. Diferencias en intervenciones y pacientes. Evaluado para lesiones tendinosas sin ruptura en general del manguito de los rotadores. Ausencia de estudios pequeños con resultados negativos. Estudios registrados en clinical trials. gov no publicados.

Humans , Tendinopathy/drug therapy , Hyaluronic Acid/therapeutic use , Technology Assessment, Biomedical , Cost-Benefit Analysis
Rev. bras. ortop ; 55(1): 95-99, Jan.-Feb. 2020. tab
Article in English | LILACS | ID: biblio-1092669


Abstract Objective To assess how shoulder specialists have used infiltration in their daily practice. Methods A survey study in which shoulder and elbow specialists answered a questionnaire on the use of infiltration in painful shoulders. Results Most of the doctors (45.9%) have > 10 years of experience in the area and have carried out up to 10 infiltrations in the last 12 months. The main indications for glenohumeral and subacromial infiltration are glenohumeral arthrosis and rotator cuff tendinopathy, respectively. The most used portals are the posterior (52.2%) for glenohumeral infiltration and the lateral (57.5%) for subacromial infiltration. The majority of the doctors (752%) infiltrate in an outpatient setting without imaging methods, and the most commonly used drug is the combination of corticoid and anesthetic. The main contraindication cited is the presence of diabetes, and the most common complication is pain after infiltration. Conclusion Subacromial infiltrations are indicated especially for the treatment of rotator cuff tendinopathies and bursitis, performed by the lateral portal, in an outpatient setting, with low index of long-term complications. Glenohumeral infiltrations are indicated especially for glenohumeral arthrosis, with a combination of a corticoid and anesthetic, performed mostly in an outpatient setting.

Resumo Objetivo Avaliar como especialistas de ombro têm utilizado a infiltração na sua prática diária. Métodos Estudo tipo survey interseccional em tempo único, no qual especialistas em ombro e cotovelo responderam a um questionário sobre o uso de infiltrações no ombro doloroso. Resultados A maior parte (45,9%) dos entrevistados possui experiência > 10 anos na área e realizaram até 10 infiltrações nos últimos 12 meses. As principais indicações para infiltração glenoumeral e subacromial são artrose glenoumeral e tendinopatia do manguito rotador, respectivamente. Os portais mais utilizados são o posterior (52,2%) para infiltração glenoumeral e o lateral (57,5%) na subacromial. A maioria (75,2%) dos entrevistados realiza a infiltração ambulatorialmente sem auxílio de métodos de imagem, e a droga mais utilizada é a combinação de corticoide e anestésico. A principal contraindicação citada é a presença de diabetes, e a complicação mais comum é a dor após a infiltração. Conclusão Infiltrações subacromiais são indicadas especialmente para tratamento de tendinopatias do manguito e bursites, realizadas pelo portal lateral, em ambiente ambulatorial, com baixo índice de complicações em longo prazo. As infiltrações glenoumerais são indicadas especialmente para artrose glenoumeral, com combinação de corticoide e anestésico, realizadas, em sua maioria, ambulatorialmente.

Humans , Male , Female , Osteoarthritis , Outpatients , Pain , Shoulder , Bursitis , Surveys and Questionnaires , Tendinopathy , Anesthesia, Local
Rev. chil. ortop. traumatol ; 61(3): 112-115, 2020. ilus
Article in Spanish | LILACS | ID: biblio-1177827


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.

Humans , Female , Middle Aged , Achilles Tendon , Xanthomatosis/surgery , Xanthomatosis/diagnosis , Xanthomatosis, Cerebrotendinous/complications , Tendinopathy/surgery , Tendinopathy/diagnosis , Magnetic Resonance Imaging , Xanthomatosis/etiology , Xanthomatosis/diagnostic imaging , Tendinopathy/etiology , Tendinopathy/diagnostic imaging , Hyperlipidemias
Pesqui. vet. bras ; 39(12): 942-948, Dec. 2019. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1056931


Horses performing tasks is a common scene in urban centers, evidenced by the significant number of animals pulling carts along the streets (cart horses). Despite the rising concern of the population for animal welfare, as well as the creation of laws that prohibit traction activity in several Brazilian municipalities, these attitudes must be based on the impact of such activity on equine health. Locomotor system disorders are commonly observed in animals of this species, and become even more frequent when they are submitted to unhealthy working conditions. In this context, we conducted a survey on locomotor system disorders in 11 active draft horses. To this end, we performed lameness assessments and radiographic and ultrasound examinations. Information on management regarding the horses' hooves, type of harness used, and type of work performed was also obtained through the application of questionnaires to the owners. The collected data showed that, although most of the animals in the study presented critical orthopedic conditions, they were not treated and the horses did not rest for adequate time. We observed that the disorders, which are often chronic, may be directly associated with incorrect management of the animals. We emphasize the importance to disseminate information that values the welfare of traction animals in order to tackle mistreatment.(AU)

Cavalos desempenhando tarefas para o homem é ainda uma cena marcante nos centros urbanos, evidenciada pela grande quantidade de animais que tracionam carroças pelas ruas (carroceiros). Apesar da crescente preocupação da população com o bem estar animal, assim como a criação de leis que proíbem a atividade de tração em diversos municípios brasileiros, é imprescindível que estas atitudes estejam embasadas no impacto de tal atividade sobre a saúde dos equinos. Nesta espécie, afecções do aparelho locomotor são comuns, tornando-se ainda mais frequentes quando os animais são submetidos a condições insalubres de trabalho. Por conseguinte, este estudo promoveu um levantamento das afecções que acometem o aparelho locomotor de 11 equinos de tração em atividade, por meio de exames de claudicação, radiográficos e ultrassonográficos. Informações sobre manejo realizado pelos proprietários quanto aos cascos de seus animais, tipos de arreios utilizados e tipo de trabalho ao qual eram submetidos foram obtidas através de questionários. Verificou-se ao relacionar dados coletados, que a maioria dos animais do estudo apresentava afecções ortopédicas importantes, e que, entretanto, não eram tratados ou mantidos em repouso por tempo adequado. Observou-se que as afecções encontradas, muitas vezes crônicas, podem ter relação direta com o manejo incorreto dos animais, e ressalta-se a importância da disseminação de informações que prezem pelo bem estar do animal de carroça, a fim de combater maus tratos nesta categoria animal.(AU)

Animals , Animal Welfare , Physical Exertion , Horses/injuries , Motor Activity , Tendinopathy/veterinary , Fractures, Bone/veterinary , Intermittent Claudication/veterinary , Joint Diseases/veterinary
ABCS health sci ; 44(3): 167-171, 20 dez 2019. tab
Article in English, Portuguese | LILACS | ID: biblio-1047667


INTRODUÇÃO: A Tendinopatia do Manguito Rotador (TMR) acarreta dor e prejuízo na função do ombro, porém não se sabe se ambas na mesma proporção. OBJETIVO: Verificar se a intensidade dolorosa se correlaciona com a função do membro superior em sujeitos com TMR. MÉTODOS: Estudo observacional transversal, com 60 indivíduos com TMR. Utilizou-se a Escala Visual Analógica (EVA) para avaliar a dor e o questionário Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) para função do ombro. Para análise dos dados foi realizada estatística descritiva (médias e desvio-padrão, apresentação numérica e percentual) e aplicada a correlação de Spearman utilizando nível de significância de 5%. RESULTADOS: A dor média pela EVA foi de 5,02 (moderada). Verificou-se limitação leve (pontuação média de 34,43) nas 30 questões do questionário DASH. Em relação aos módulos opcionais, no módulo destinado a atletas/músicos, não houve limitação dos sujeitos que praticavam este (média de pontuação de 11,82). No módulo referente ao trabalho houve limitação leve (média de pontuação de 35,38). Houve correlação baixa entre dor e a função do ombro (rs=0,2949; p=0,0222). CONCLUSÃO: Embora os sujeitos com TMR apresentassem dor moderada, a correlação foi fraca entre dor e função do ombro.

INTRODUCTION: Rotator Cuff Tendinopathy (RMR) causes pain and impairment in shoulder function, but it is not known if both in the same proportion. OBJECTIVE: Verify whether pain intensity correlates with upper limb function in subjects with RMR. METHODS: Cross-sectional observational study of 60 individuals with RMR. The Visual Analogue Scale (VAS) was used to assess pain and the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) for shoulder function. For data analysis, descriptive statistics (means and standard deviation, numerical and percentage presentation) were performed and Spearman correlation was applied using a significance level of 5%. RESULTS: The average pain by VAS was 5.02 (moderate). Mild limitation (mean score 34.43) was found in the 30 questions of the DASH questionnaire. Regarding the optional modules, in the module intended for athletes/musicians, there was no limitation of the subjects who practiced this (average score of 11.82). In the work module there was a slight limitation (average score 35.38). There was a low correlation between pain and shoulder function (rs=0.2949; p=0.0222). CONCLUSION: Although subjects with RMR had moderate pain, the correlation was weak between pain and shoulder function.

Humans , Male , Female , Adult , Middle Aged , Rotator Cuff/pathology , Shoulder Pain , Tendinopathy , Rotator Cuff Injuries , Shoulder Injuries , Activities of Daily Living
Rev. otorrinolaringol. cir. cabeza cuello ; 79(4): 433-436, dic. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1058719


RESUMEN La tendinitis calcificante prevertebral es una patología benigna y poco frecuente, con una incidencia anual de 0,5 casos por cada 100.000 habitantes. Se presenta un caso de una paciente de 52 años que consultó por cervicalgia, odinofagia y disfonía de 5 días de evolución. Tras una exploración otorrinolaringológica completa se sospechó ocupación del espacio retrofaríngeo, confirmada con pruebas de imagen. Ante estos hallazgos y con la sospecha de absceso retrofaríngeo, se decidió ingreso hospitalario para tratamiento intravenoso. Por discordancia entre la clínica, la TC y los hallazgos analíticos, se solicitó RM cervical, cuya imagen hizo sospechar una tendinitis aguda calcificante del longísimo del cuello. En este trabajo se ha realizado una revisión de la sintomatología, el diagnóstico y el tratamiento de esta entidad. Consideramos importante sospecharla dentro del diagnóstico diferencial de la ocupación del espacio retrofaríngeo para evitar realizar procedimientos innecesarios.

ABSTRACT Prevertebral calcific tendinitis is a benign and infrequent pathology, with an annual incidence of 0.5 cases per 100,000 habitants. We report the case of a 52-year-old woman that presented with a 5-day history of cervicalgia, odynophagia and dysphonia. Otolaryngological examination and radiological images showed occupation of the retropharyngeal space. The patient was admitted to the hospital for intravenous treatment. A cervical MRI was requested, suggesting an acute calcific tendinitis of the longus colli muscles. The authors provide a discussion of the clinical findings, diagnosis and treatment of this condition. We consider it to be an important differential diagnosis of a retropharyngeal space occupation, in order to avoid unnecessary procedures.

Humans , Female , Middle Aged , Retropharyngeal Abscess , Tendinopathy/diagnostic imaging , Neck Muscles/pathology , Tendinopathy/etiology
Pesqui. vet. bras ; 39(11): 858-862, Nov. 2019. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1056915


The objectives of this study were to demonstrate the lesions that affect athlete bulls and to correlate the disorders with weight, age, affected limb and region of the limb. The present study was accomplished using radiographic images of athletic rodeo bulls collected from the medical and surgical records of the large animal service at the veterinary hospital. Radiographic images were evaluated for 136 bulls that were taken care of at the Veterinary Hospital, ranging in age from 4 to 13 years, with an average weight of 800kg and proven prior physical activity through participation in rodeos. The chi-square or Fisher's exact test was used to assess the association between the studied variables. It was observed that 71.6% of the bulls studied and suffering from lameness had radiographic lesions, predominantly in experienced animals. Enthesopathy in starter and experienced bulls, septic arthritis in starter bulls, and fractures and degenerative joint disease in experienced bulls were the most frequent radiographic lesions diagnosed. The region of limb where the majority of radiographic changes occurred was the digits. Risk factors and occurrence of diseases of the locomotor system in athletic bulls are similar to those in sport equines.(AU)

O objetivo desse trabalho foi demostrar quais lesões acometem touros atletas, correlacionando as desordens com peso, idade, membro e região afetada. O presente estudo foi realizado utilizando radiografias de touros atletas de rodeio, após levantamento dos prontuários clínicos e cirúrgicos do serviço de grandes animais de um hospital veterinário. Foram avaliadas radiografias de 136 touros que haviam sido atendidos em tal hospital, com idade variando de quatro a 13 anos, com média de peso de 800kg e realizavam participação em rodeios. Para avaliar a associação entre as variáveis estudadas foi utilizado o teste exato de Fischer e o Qui-quadrado. Observou-se que 71,6% dos touros estudados que claudicavam, apresentavam lesões radiográficas, predominantemente em animais mais experientes. A entesiopatia em todos os animais, artrite séptica nos touros iniciantes, fraturas e doença articular degenerativa nos touros mais experientes, foram as alterações radiográficas mais frequentes. As regiões com maior ocorrência de lesões radiográficas foram os dígitos. Os fatores de risco para ocorrência de doenças no sistema locomotor de touros atletas são diversos, similares aos que ocorrem nos equinos atletas.(AU)

Animals , Male , Cattle , Osteoarthritis/veterinary , Cattle/injuries , Arthritis, Infectious/veterinary , Tendinopathy/veterinary , Fractures, Bone/veterinary , Radiography/veterinary
Rev. bras. ortop ; 54(5): 540-548, Sept.-Oct. 2019. tab
Article in English | LILACS | ID: biblio-1057927


Abstract Objective The present study determined the pattern of presentation and severity of patellar tendinopathy (PT) and its relationship with selected biomechanical variables in elite athletes. Methods The study involved 98 elite Nigerian basketball and volleyball players aged between 18 and 35 years. Clinical tests and ultrasound imaging were used to divide the participants into symptomatic and asymptomatic groups. Standard procedures were used to assess the quadriceps angle (Q-angle), tibial torsion, ankle dorsiflexion, hamstring flexibility, and foot posture. The Victorian Institute of Sport Assessment Questionnaire, Patellar Tendon (VISA-P) was used to assess the severity of the symptoms. The statistical analysis was performed using analysis of variance (ANOVA), and a post hoc analysis and Pearson correlation with significance level set at p < 0.05 were also performed. Results Significantly lower sit-and-reach scores (p = 0.01), increased foot posture index score (p = 0.01) and reduced ankle dorsiflexion range (p = 0.03) were found in participants of both sexes with symptomatic PT. Higher Q-angles (p = 0.02) in males and tibial torsion angles (p = 0.001) in females were also found in the symptomatic PT groups. Symptom severity was significantly higher in the group with clinical symptoms only (p = 0.042), and it was significantly correlated with hamstring flexibility in both males (r = -0.618) and females (r = -0.664). Conclusion Reduced hamstring flexibility, increased foot pronation and reduced ankle dorsiflexion range were significant in participants with symptomatic PT.

Resumo Objetivo Este estudo determinou o padrão de apresentação e gravidade da tendinopatia patelar (TP) e sua relação com variáveis biomecânicas selecionadas em atletas de elite. Métodos O estudo envolveu 98 jogadores de elite nigerianos de basquetebol e voleibol com idades entre 18 e 35 anos. Testes clínicos e ultrassonografia foram usados para separar os participantes em grupos sintomáticos e assintomáticos. Procedimentos padrão foram utilizados para avaliar o ângulo do quadríceps (ângulo Q), a torção da tíbia, a dorsiflexão do tornozelo, a flexibilidade dos isquiotibiais, e a postura do pé. Usou-se o questionário Victorian Institute of Sport Assessment Questionnaire, Patellar Tendon (VISA-P) para avaliar a gravidade dos sintomas nos grupos sintomáticos. A análise estatística foi realizada por meio de análise de variância (ANOVA, na sigla em inglês), análise post hoc, e correlação de Pearson, com nível de significância estabelecido em p < 0,05. Resultados Pontuações significativamente menores de sentar e alcançar (p = 0,01), aumento da pontuação do índice de postura do pé (p = 0,01), e redução da amplitude de dorsiflexão do tornozelo (p = 0,03) foram encontrados em participantes de ambos os sexos com TP sintomática. Ângulos Q (p = 0,02) maiores nos homens e ângulos de torção tibial maiores (p = 0,001) nas mulheres também foram encontrados nos grupos de TP sintomática. A gravidade dos sintomas foi significativamente maior no grupo que tinha apenas sintomas clínicos (p = 0,042), e estava significativamente correlacionada com a flexibilidade dos isquiotibiais tanto nos homens (r = -0,618) quanto nas mulheres (r = -0,664). Conclusão A redução da flexibilidade dos isquiotibiais, o aumento da pronação do pé, e a redução da amplitude de dorsiflexão do tornozelo foram significativos em participantes com TP sintomática.

Humans , Male , Female , Adult , Patella , Athletic Injuries , Sports , Tibia , Biomechanical Phenomena , Basketball , Surveys and Questionnaires , Lower Extremity , Tendinopathy , Volleyball