Treatment of tendinopathy: is there a role for autologous whole blood and platelet rich plasma injection?

BACKGROUND: Chronic tendinopathies are a common source of disability and can be recalcitrant to conservative measures, which once exhausted may necessitate operative intervention. Blood and platelets, in particular, are a rich source of factors necessary for tissue healing. Autologous blood injections (ABI) are thought to promote tendon healing, but have been explored clinically in only a few limited studies. However, recently they have attracted media attention in relation to the world of professional athletes and sports-related injuries. METHOD: We review the evidence base for this technique using the available literature on PubMed. CONCLUSION: Refractory chronic tendinopathy may be responsive to ABIs, but the data available to date are limited by quality and size of study, as well as length of follow up, and are currently insufficient to recommend this modality for routine clinical use.

The internervous safe zone for incision of the capsule of the hip. A cadaver study.

In order to determine the potential for an internervous safe zone, 20 hips from human cadavers were dissected to map out the precise pattern of innervation of the hip capsule. The results were illustrated in the form of a clock face. The reference point for measurement was the inferior acetabular notch, representing six o'clock. Capsular branches from between five and seven nerves contributed to each hip joint, and were found to innervate the capsule in a relatively constant pattern. An internervous safe zone was identified anterosuperiorly in an arc of 45 degrees between the positions of one o'clock and half past two. Our study shows that there is an internervous zone that could be safely used in a capsule-retaining anterior, anterolateral or lateral approach to the hip, or during portal placement in hip arthroscopy.

Broken bones and fractures - an audit of patients' perceptions.

INTRODUCTION: 'Have I got a fracture or a break doctor?' remains a commonly posed question in fracture clinics, suggesting that patients frequently feel a 'fracture' and a 'break' are two separate entities. This apparent misconception amongst fracture clinic patients may result in confusion and occasionally anger that doctors appear to have inconsistent views on the severity of their injury. Compliance and outcome of patient care can also be affected by poor communication. PATIENTS AND METHODS: Our questionnaire-based study was conducted in two stages. The initial objective was to establish whether this misconception surrounding the words 'fracture' and 'break' is commonly held amongst our out-patient trauma patients. The second stage of the audit was to determine whether a patient information leaflet on fractures/broken bones could help reduce this misconception. RESULTS: The preliminary audit involving 50 new patients attending our fracture clinic showed that 84% thought there was a difference between a 'fracture' and a 'break', with 68% believing a 'break' to be worse than a 'fracture'. Following the introduction of an information leaflet, a re-audit of 61 new patients took place. This time 67% felt there was a difference between a 'fracture' and a 'break', with 65% believing a 'break' to be worse than a 'fracture'. Only 21% had read the supplied information leaflet, and 69% of those still believed there was a difference between a 'fracture' and a 'break'. CONCLUSIONS: The majority of patients believed that there was a difference between a 'fracture' and a 'break'. Access to information leaflets did not appear to alter this misconception. Verbal communication and explanation may be more beneficial and practical than visual aids and leaflets in overcoming this problem.

Incidence of SLAP lesions in a military population.

OBJECTIVES: SLAP (superior labrum anterior and posterior) lesions are a recognised cause of shoulder pain and instability. They can occur following a direct blow, biceps traction and compression injuries, and are commonly seen in overhead athletes. Military personnel are physically active and often subjected to trauma. We assessed the incidence of SLAP lesions within a military population presenting with shoulder symptoms. METHODS: A retrospective review, of all shoulder arthroscopies performed by a single surgeon between June 2003 and December 2004 at a district general hospital serving both a military and civilian population, was undertaken. The presentation and incidence of SLAP lesions were recorded for both military and civilian patients. RESULTS: One hundred and seventy eight arthroscopies were performed on 70 (39.3%) military and 108 (60.7%) civilian patients. The average age was 42.3 (range 17-75), 50 females and 128 males were included. Indications for arthroscopy included pain (75.3%), instability (15.7%), pain and instability (7.9%), or "other symptoms" (1.1%). 39 SLAP lesions (22%) were found and grouped according to the Snyder classification--20.5% type 1, 69.3% type 2, 5.1% type 3, 5.1% type 4. Patients with a history of trauma or symptoms of instability were more likely to have a SLAP lesion (p<0.0001). The incidence of SLAP lesions in the military patients was 38.6% compared to 11.1% in civilian patients (p<0.0001). After allowing for the increased incidence of trauma and instability in the military, SLAP lesions were still more common in the military patients (p<0.001). CONCLUSIONS: There is a higher than average incidence of SLAP lesions in military patients compared to civilian patients. They tend to present with a history of trauma, as well as symptoms of pain and instability. Given the high incidence in military personnel, this diagnosis should be considered in military patients presenting with shoulder symptoms, and there should be a low threshold for shoulder arthroscopy.

Region-specific immediate-early gene expression following the administration of corticotropin-releasing hormone in virgin and lactating rats.

Central administration of corticotropin-releasing hormone (CRH) induces immediate-early gene (IEG) expression (c-fos and NGFI-B) in forebrain structures in a pattern similar to that observed following restraint stress. Lactating rats display modified neuroendocrine and behavioural responses to stress which have been hypothesized to be at least partially mediated through changes within the circuitry converging on the PVN, including CRH activated pathways. Quantitative measures of regional expression of c-fos and NGFI-B mRNA representative of two classical intracellular pathways, were used to define modification of the circuitry involved in the altered response to central CRH in the lactating female. Compared to saline controls, virgin female rats injected with 5 micrograms CRH i.c.v. displayed significantly increased immediate-early gene expression in the hypothalamic paraventricular nucleus (PVN), arcuate nucleus, lateral septum, bed nucleus of the stria terminalis, central, medial and cortical nuclei of the amygdala, and all subfields of the hippocampal formation. In lactating rats treated with CRH there was a significant increase in c-fos gene expression in the CeA and in the hippocampal subfields CA1, CA4 and dentate gyrus but not in the other areas examined. The i.c.v. administration of CRH significantly increased NGFI-B expression in the PVN, arcuate nucleus, medial amygdala and all hippocampal subfields of virgin rats. Lactating rats treated with CRH failed to show a significant increase in NGFI-B expression in the PVN, median eminence, arcuate nucleus, medial amygdala, CA2 and CA3 subfields of the hippocampus. These results further suggest that changes in specific neural circuits might at least partially underlie the modified responses to CRH and perhaps to stress in the lactating female.