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Musculoskeletal imaging and therapeutic options in soft tissue disorders
Published in David Silver, Silver's Joint and Soft Tissue Injection, 2018
The terminology for tendon disorders has been confused in the past. Tendinopathy is a clinical description referring to both acute and chronic conditions.Tendinosis is a misnomer, as inflammatory cells are rarely seen histologically. The term refers to a non-inflammatory state with histological evidence of collagen disorganisation and necrosis.
Tendinopathy
Published in Kohlstadt Ingrid, Cintron Kenneth, Metabolic Therapies in Orthopedics, Second Edition, 2018
Patients with tendinopathy and tendinitis will both present with the following symptoms: pain in the area of a tendon that is worse with use, palpation pressure and muscle testing. There may be visible tendon thickening in Achilles tendinopathy. In advanced cases, there may be muscle atrophy, but this is unusual. Both conditions are usually worse with eccentric loads. Patients with tendinopathy usually have had pain in a tendon that has gone on for more than 6–8 weeks. The tenderness in the tendon can become quite easily provoked with little pressure or use. The tendon area becomes sensitized and demonstrates low threshold characteristics in regard to pressure and pain with use. There is also a possibility of the development of secondary hyperalgesia, in which the receptive field for pain processing in the cord expands and the patient perceives a wider area of pain that is larger than the tendon itself. Patients with tendinopathy may have had strain injuries of the muscle or tendon that did not heal. Tendinopathy pain is usually not constant but is usually intermittent but easily set off or aggravated. Patients may also have pain, spasm or trigger points in the muscle belly of the tendon. Muscle testing of the muscle with the tendinopathy can show poor recruitment or breakaway weakness.
Effectiveness of topical glyceryl trinitrate in treatment of tendinopathy – systematic review and meta-analysis
Published in Disability and Rehabilitation, 2022
Mikhail Saltychev, Jouni Johansson, Viljami Kemppi, Juhani Juhola
The MEDLINE defines tendinopathy as a “clinical syndrome describing overuse tendon injuries characterized by a combination of pain, diffuse or localized swelling, and impaired performance.” The syndrome is very common and affects different tendons. Pain is often the first clinical symptom causing motion restriction, disability, absence from work, and increased use of healthcare services [1,2]. The most common sites are shoulder rotator cuff, Achilles tendon, humeral lateral epicondyle, and patellar area. In addition to physiotherapy and operative methods, a diverse spectrum of topical agents has been used to treat this condition such as cortisone injections, shockwave therapy, platelet-rich plasma injections, topically applied nonsteroidal anti-inflammatory drugs, and many others [1,3,4].
Treating tendinopathies – are we searching for a needle in a haystack, when we should include the whole haystack?
Published in European Journal of Physiotherapy, 2021
There is quite convincing correlational data between a strength deficit and the presence of tendinopathy, as demonstrated by several studies [14–16]. Further, there is evidence that low strength could predict the onset of Achilles tendinopathy [17], and a recent systematic review shows that there is limited evidence for calf muscle strength deficit as a risk factor for Achilles tendinopathy [18]. Thus, most treatments for tendinopathy are strength-based exercise [19–21]. However, full symptomatic recovery does not have to equal a full-strength recovery after surgery for Achilles tendinopathy [22]. Similarly, in other areas, it has been shown that an increase in physical capacity (strength, mobility) does not need to change to get a better outcome regarding pain [23,24]. Thus, it is problematic to attribute the clinical effects on any specific effects of the exercises (i.e. changes in strength, among others).
An evaluation of reports of ciprofloxacin, levofloxacin, and moxifloxacin-association neuropsychiatric toxicities, long-term disability, and aortic aneurysms/dissections disseminated by the Food and Drug Administration and the European Medicines Agency
Published in Expert Opinion on Drug Safety, 2019
Andrew C Bennett, Charles L Bennett, Bartlett J Witherspoon, Kevin B Knopf
FDA reviewers at the 2015 Advisory Committee meeting focused on six FQ-associated advents: acute kidney injury, anaphylaxis, tendinopathy, peripheral neuropathy, retinal detachment, and cardiac arrhythmias (the FDA reported that their review identified 722 articles in PubMed from 1996 to 2015) [15]. Publications that were not epidemiologic studies had no safety data, or only assessed pediatric populations were not reviewed. The result was 25 publications, all observational epidemiologic studies and one poster of FDA/Department of Defense Work. Eleven studies and the poster focused on tendinopathy. A consistently elevated risk of tendinopathy was observed, using healthcare claims or prescription event monitoring data. For arrhythmias, one study used infection-related diagnoses in the past year and focused on all-cause mortality [13]. Chou et al used diagnoses associated with the index prescription and focused on cardiovascular deaths [14]. For every 100,000 prescriptions or patients who received FQs, 12 to 57 patients experienced cardiac arrhythmias [13,14]. Underlying cardiovascular disease greatly increased serious arrhythmia risks. Peripheral neuropathy was evaluated based on the review of two studies, including one FAERS analysis. Compared to controls, cases were 30% more likely to have used any FQ in the past year and 80% more likely to have an active FQ prescription.