Pain Relief after Extracorporeal Shock Wave Therapy for Patellar Tendinopathy: An Ultrasound Evaluation of Morphology and Blood Flow

We aimed to investigate the changes caused by focused extracorporeal shock wave pain therapy (f-ESWT) in patients with patellar tendinopathy by means of ultrasound imaging. We included 18 knees from 11 college athletes with patellar tendinopathy. We assessed the tendon thickness and blood flow of the patellar tendon using ultrasound imaging, rest pain using NRS and tenderness using a pressure pain gauge. We recorded four measurements: immediately before f-ESWT (PRE①) and after f-ESWT (POST①) and two weeks after the first irradiation before f-ESWT (PRE②) and after f-ESWT (POST②). Only the resting pain in both the first and second irradiations showed a significant difference immediately before and after the treatment. In terms of pain changes after two weeks later, we observed significant differences in the resting pain between PRE① and PRE② and also in the resting pain, tenderness and blood flow area between PRE① and POST②. No significant difference was seen in the tendon thickness. We concluded that pain in the patellar tendon at rest decreased before and after irradiation, suggesting that f-ESWT may have influenced the nociceptive structures and had an analgesic effect.

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Examination of Intrarenal Blood Flow by Doppler Ultrasound Before and After Extracorporeal Shock Wave Lithotripsy for Urolithiasis

Scandinavian Journal of Urology and Nephrology ◽

10.3109/00365599709070297 ◽

1997 ◽

Vol 31 (1) ◽

pp. 27-30 ◽

Cited By ~ 5

Author(s):

Mats Johansson ◽

Viggo Sörensen ◽

Olof Jonsson ◽

Silas Pettersson ◽

Reinhard Volkmann

Keyword(s):

Shock Wave ◽

Blood Flow ◽

Doppler Ultrasound ◽

Extracorporeal Shock Wave Lithotripsy ◽

Shock Wave Lithotripsy ◽

Extracorporeal Shock Wave ◽

Before And After ◽

Intrarenal Blood Flow

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Plain Radiography, Renography, and 99mTc-DMSA Renal Scintigraphy Before and After Extracorporeal Shock Wave Lithotripsy for Urolithiasis

Acta Radiologica ◽

10.3109/02841859209173215 ◽

1992 ◽

Vol 33 (6) ◽

pp. 569-572 ◽

Cited By ~ 1

Author(s):

O. Munck ◽

I. Gerquari ◽

J. T. Møller ◽

L. I. Jensen ◽

H. S. Thomsen

Keyword(s):

Shock Wave ◽

Extracorporeal Shock Wave Lithotripsy ◽

Shock Wave Lithotripsy ◽

Plain Radiography ◽

Renal Scintigraphy ◽

Extracorporeal Shock Wave ◽

Before And After

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Extracorporeal shock wave therapy for isokinetic muscle strength around the knee joint in athletes with patellar tendinopathy

The Journal of Sports Medicine and Physical Fitness ◽

10.23736/s0022-4707.18.09023-0 ◽

2019 ◽

Vol 59 (5) ◽

Author(s):

Liang Cheng ◽

Shuwan Chang ◽

Li Qian ◽

Yayi Wang ◽

Ming Yang

Keyword(s):

Shock Wave ◽

Muscle Strength ◽

Knee Joint ◽

Extracorporeal Shock Wave Therapy ◽

Patellar Tendinopathy ◽

Shock Wave Therapy ◽

Extracorporeal Shock Wave ◽

Isokinetic Muscle Strength

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Morpho-textural changes of the patellar tendon in professional volleyball players: a six month longitudinal study

Revista Fisioterapia Invasiva ◽

10.1055/s-0039-3402505 ◽

2019 ◽

Vol 02 (02) ◽

pp. 126-126

Author(s):

de Groot Ferrando A.

Keyword(s):

Patellar Tendon ◽

Effect Size ◽

Repeated Measures ◽

Structural Changes ◽

Patellar Tendinopathy ◽

Average Effect ◽

Average Effect Size ◽

Significant Difference ◽

Volleyball Players ◽

Textural Changes

Abstract Introduction Tendinopathy is a term used to describe a clinical presentation of pain and dysfunction, which, at times, is accompanied by pathologic structural changes in the tendon matrix. Jumper's knee has been studied for some time, however the etiology is still unknown. The deep fibers of the proximal region are the most affected area in tendinopathies affecting the patellar tendon. Ultrasound (US) scanning may have the greatest sensitivity for confirming clinically diagnosed patellar tendinopathy compared with other imaging techniques such as magnetic resonance. Some studies have found that a minimum of six months is required to observe significant structural changes, although other studies reveal that structural changes can be visible in a shorter period of time. Thus, sonography has been used to evaluate quantitative variables such as thickness, echogenicity, texture measures and the internal tendon matrix. Objective The purpose of this study was to evaluate the sonographic behavior of morpho-textural changes of the patellar tendon in professional male volleyball players over a one year season. Material and Methods This is an observational, longitudinal and analytical study. A sample of 66 patellar tendons from 33 volleyball players of the Spanish super league was recruited, with an average of: 28 years, 86kg and 192cm. An ultrasound scan was performed using the Sonosite Titan ultrasound system, L38, 5–10 MHz, with a cross section of 5mm from the lower pole of the patella. Two depths were analyzed: a.39mm: echogenicity, echogenicity variation, circularity, width and thickness. b.24mm: entropy and contrast. Statistical analysis and analysis of variance (ANOVA) was performed for repeated measures and, in addition, the effect size was calculated with Cohen's d. The confidence interval was 95%. SPSS Statistics software was used. Results For textural variables: contrast increased significantly with an average effect size, and entropy showed no significant difference. Circularity was significantly lower. Width was shown to be significantly greater, with an average effect size, while thickness was reduced significantly. Regarding echogenicity, no significant changes were detected and variation in echogenicity did not show significant changes. Conclusions Imaging analysis could be a potential tool to detect changes in the pattern of patellar tendons. Some morpho-textural changes were found in male volleyball players: the textural contrast variable increases significantly throughout the annual season, meaning that the tendon becomes slightly flatter and loses circularity in its transverse section. The entropy and echogenic parameters obtained from the gray-scale histogram did not reveal any significant changes.

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Efficacy of Percutaneous Nephrolithotomy in the Treatment of Renal Calculi of 10 to 20 MM Size: A Comparison With Extracorporeal Shock Wave Lithotripsy

Bangladesh Journal of Urology ◽

10.3329/bju.v21i2.49881 ◽

2020 ◽

Vol 21 (2) ◽

pp. 98-104

Author(s):

Muhammad Mahmud Alam ◽

Mohammad Rezaul Karim ◽

Mohammad Ohiduzzaman Khan ◽

Mohammad Mukhlesur Rahman ◽

Mahfuja Asma ◽

...

Keyword(s):

Shock Wave ◽

Percutaneous Nephrolithotomy ◽

Extracorporeal Shock Wave Lithotripsy ◽

Shock Wave Lithotripsy ◽

Renal Stones ◽

Renal Calculi ◽

Post Procedure ◽

Extracorporeal Shock Wave ◽

Significant Difference

Background: Stones in the urinary tract is a common medical problem in the general population. At present, the great expansion in minimally invasive techniques has led to the decrease in open surgery. Extracorporeal shock wave lithotripsy (ESWL) has been introduced as an alternative approach which disintegrates stones in the kidney and upper urinary tract through the use of shock waves. Nevertheless, as there are limitations with the success rate in ESWL, other minimally invasive modalities for kidney stones such as percutaneous nephrolithotomy (PCNL) is also widely applied. There is a trend of using ESWL for treatment of renal stones smaller than 1 cm and PCNL in those with stones greater than 2 cm. Nevertheless, no consensus regarding treatment of renal stones between 1 to 2 cm stones. The objective of this prospective study was to compare the results of ESWL and PCNL for treatment of 1 to 2 cm renal stones. Method : This is a quasi experimental study. This study was conducted to compare the efficacy and safety of percutaneous nephrolithotomy (PCNL) and extracorporeal shock wave lithotripsy (ESWL) in treating 10 to 20 mm sized renal stone among the Bangladeshi population. This prospective study conducted between the periods of September, 2011 to August, 2012 in the department of urology, Bangabandhu Sheikh Mujib medical university (BSMMU) Hospital. All the patients attending the urology outpatient clinic with 10 to 20mm renal calculi were the study population. A total of 70 subjects were enrolled for this study and they were equally divided into two groups so that each group had 35 subjects. The one group received PCNL whereas the other group received ESWL. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-15). Results: There is no statistically significant difference in regarding age, sex, stone side(lt. or rt.), the distribution of stone (upper, middle and lower calyx) and size between the groups (p>0.05). At 3 month follow up among the patients in ESWL group stone cleared and not cleared were 25(71.4%) and 10(28.6%) respectively and at 3 month follow up among the patients in PCNL group stone cleared and not cleared were 33(94.3%) and 2(5.7%)respectively. There is statistically significant difference in stone clearance rate at 3 month follow up between the groups (p<0.05). All patients in ESWL group developed post procedure haematuria 35(100.0%). Other post procedure complications among the ESWL group pain, fever and steinstrasse were 12(34.3%), 07(20.0%) and 03(08.6%) respectively. Common post procedure complications among the patients of PCNL group pain, haematuria and fever were 11(31.4%), 33(94.3%) and 13(37.1%) respectively. Other post procedure complications in PCNL group were vomiting (8.6%), urinary leakage (5.7%), wound infection (11.4%) and urinary cutaneous fistula (5.7%). There was no statistically significant difference post procedure pain, haematuria and fever between the groups (p>0.05), but statistically significant difference observed in steinstrasse and wound infection between the groups (p<0.05). Mean±SD of hospital stay among the patients of ESWL group and PCNL group was 1.37±0.65 and 4.34±1.43 days respectively. There is statistically significant difference in hospital stay between the groups (p<0.05). Conclusion: Though some specific complications which can be treated conservatively are more in PCNL group it may be concluded that the treatment with PCNL is better option than ESWL among the patients having renal calculi 10 to 20 mm. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.98-104

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Contrast-Enhanced Ultrasound Evaluation of Mifepristone for Treatment of Low-Risk Cesarean Scar Pregnancy

Contrast Media & Molecular Imaging ◽

10.1155/2020/3725353 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Xi Xiong ◽

Chun-yan Gao ◽

De-mei Ying ◽

Ping Yan ◽

Zhi-jia Zhang ◽

...

Keyword(s):

Effective Treatment ◽

Low Risk ◽

Contrast Enhanced Ultrasound ◽

Intrauterine Pregnancy ◽

Cesarean Scar Pregnancy ◽

Cesarean Scar ◽

Ultrasound Evaluation ◽

Contrast Enhanced ◽

Significant Difference ◽

Before And After

Purpose. The effect of mifepristone for treatment of low-risk cesarean scar pregnancy (CSP) was monitored by contrast-enhanced ultrasound (CEUS). Methods. Data were collected from 23 CSP patients with a 10-point risk score <5 (low-risk CSP) and from 23 intrauterine pregnancy (IUP) patients with a scar from a previous cesarean delivery. All patients were prescribed 75 mg mifepristone daily for 2 days and underwent transvaginal CEUS before and after administration of mifepristone. On the third day, uterine curettage was performed after transvaginal CEUS. Arrival time (AT), peak intensity (PI), and area under the curve (AUC) around the gestational sac were monitored by CEUS before and after application of mifepristone, and the rate of effective treatment was compared between the two patient groups. Results. No patients experienced side effects from either the CEUS procedure or the mifepristone treatment. Changes in AT, PI, and AUC index from before vs. after mifepristone treatment did not differ significantly between the two groups (all p values >0.05). There was also no significant difference in the rate of effective treatment between the two groups (95.65% in the CSP group vs. 100% in the IUP group; p > 0.05 ). Conclusions. Based on monitoring by CEUS, the effect of mifepristone in low-risk CSP was comparable to that in IUP.

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Double-Blind Trial Comparing Epidural Lignocaine with Epidural Fentanyl for Anaesthesia during Extracorporeal Shock Wave Lithotripsy

Anaesthesia and Intensive Care ◽

10.1177/0310057x8901700104 ◽

1989 ◽

Vol 17 (1) ◽

pp. 9-15 ◽

Cited By ~ 3

Author(s):

B. S. Silbert ◽

R. Kluger ◽

A. C. Meads ◽

K. Stasytis

Keyword(s):

Shock Wave ◽

Extracorporeal Shock Wave Lithotripsy ◽

Shock Wave Lithotripsy ◽

Epidural Fentanyl ◽

Double Blind Trial ◽

Double Blind ◽

Blind Trial ◽

Extracorporeal Shock Wave ◽

Significant Difference ◽

Fentanyl Group

A randomised double-blind trial was undertaken to compare epidural lignocaine 1.5% with adrenaline to epidural fentanyl (100μg in saline 10 ml) in forty unpremedicated patients undergoing extracorporeal shock wave lithotripsy without ancillary procedures. Midazolam only was used for sedation. There was no significant difference in intraoperative pain scores with several patients in each group complaining of pain. Decreases in blood pressure occurred in both groups but were more pronounced in the lignocaine groups (36% vs 25 % maximum decrease from control, P = 0.004). Heart rate was increased in the lignocaine group compared with control and to the fentanyl group, but there was no difference in respiratory rates within or between groups. Pruritis was more common in the fentanyl group and leg heaviness in the lignocaine group, but neither was troublesome. There was no difference in urological outcome at one month. Both techniques were satisfactory for the majority of patients, but the fentanyl group had a shorter preparation time and less cardiovascular changes.

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Rethinking Patellar Tendinopathy and Partial Patellar Tendon Tears: A Novel Classification System

The American Journal of Sports Medicine ◽

10.1177/0363546519894333 ◽

2020 ◽

Vol 48 (2) ◽

pp. 359-369 ◽

Cited By ~ 1

Author(s):

Mikhail Golman ◽

Margaret L. Wright ◽

Tony T. Wong ◽

T. Sean Lynch ◽

Christopher S. Ahmad ◽

...

Keyword(s):

Logistic Regression ◽

Patellar Tendon ◽

Classification System ◽

Treatment Guidelines ◽

Patellar Tendinopathy ◽

Partial Tear ◽

Partial Thickness ◽

Tendon Thickness ◽

Tendon Tears ◽

The Relationship

Background: Patellar tendinopathy is an overuse injury of the patellar tendon frequently affecting athletes involved in jumping sports. The tendinopathy may progress to partial patellar tendon tears (PPTTs). Current classifications of patellar tendinopathy are based on symptoms and do not provide satisfactory evidence-based treatment guidelines. Purpose: To define the relationship between PPTT characteristics and treatment guidelines, as well as to develop a magnetic resonance imaging (MRI)–based classification system for partial patellar tendon injuries. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: MRI characteristics and clinical treatment outcomes were retrospectively reviewed for 85 patients with patellar tendinopathy, as well as 86 physically active control participants who underwent MRI of the knee for other conditions. A total of 56 patients had a PPTT and underwent further evaluation for tear size and location. The relationship between tear characteristics and clinical outcome was defined with use of statistical comparisons and univariate and logistic regression models. Results: Of the 85 patients, 56 had partial-thickness patellar tendon tears. Of these tears, 91% involved the posterior and posteromedial regions of the proximal tendon. On axial MRI views, patients with a partial tear had a mean tendon thickness of 10 mm, as compared with 6.2 mm for those without ( P < .001). Eleven patients underwent surgery for their partial-thickness tear. All of these patients had a tear >50% of tendon thickness (median thickness of tear, 10.3 mm) on axial views. Logistic regression showed that tendon thickness >8.8 mm correlated with the presence of a partial tear, while tendon thickness >11.45 mm and tear thickness >55.7% predicted surgical management. Conclusion: Partial-thickness tears are located posterior or posteromedially in the proximal patellar tendon. The most sensitive predictor for detecting the presence of a partial tear was patellar tendon thickness, in which thickness >8.8 mm was strongly correlated with a tear of the tendon. Tracking thickness changes on axial MRI may predict the effectiveness of nonoperative therapy: athletes with patellar tendon thickness >11.5 mm and/or >50% tear thickness on axial MRI were less likely to improve with nonoperative treatment. A novel proposed classification system for partial tears, the Popkin-Golman classification, can be used to guide treatment decisions for these patients.

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