Ultrasound findings in lateral elbow tendinopathy: A retrospective analysis of radiological tendon features

Background: Lateral elbow tendinopathy (LET) is prevalent in the upper extremity, with various therapeutic options. Understanding the types and the relations between the radiological tendon features would help to develop more specific treatments. This study reviewed ultrasound exams of LET to investigate the types of degenerative findings and the relationships between them in one of the most prominent sports medicine clinics in Latin America. Methods: A retrospective study was performed. We evaluated 4335 ultrasonographic exams with LET from 2017 and 2018. Five principal degenerative ultrasound criteria with subtypes were selected: hypoechogenicity, neovascularity, calcification, enthesopathy, and intrasubstance tear. A multiple linear regression model was conducted to explore the association between the findings, sex, and age. Results: Overall, 4324 ultrasound exams were analyzed; 2607 (60.29%) were males. Multiple degenerative tendon findings were found in adults (≥18 years) with LET. Hypoechogenicity (67.77%) and neovascularity (37.8%) were the most frequent. The mean length of a tendon tear in both sexes was 4.44 (± 2.81) millimeters. Mild hypoechogenicity (P < .001), and depth intrasubstance tear (P < .01) were statistically significant between them. Severe hypoechogenicity was associated with an increase in all tendon tear dimensions for length 1.37 ([95% Confidence interval (CI), 0.57, 2.17]; P < .001), for width 1.10 ([95% CI, 0.33, 1.87]; P < .01) and for depth 1.64 ([95% CI, 0.40, 2.88]; P < .01). Additional findings associated with an increase in the length dimension were 0.42 associated with focal neovascularity ([95% CI, 0.19, 0.65]; P < .001), and 0.71 associated with multiple neovascularity ([95% CI, 0.27, 1.15]; P < .01). Conclusions: Hypoechogenicity and neovascularity findings presented a positive association with the size of tendon tear in patients with LET. This study reaffirms the increased predominance of tendon tear during the 4th to 6th decades of life.

Role of magnetic resonance imaging on fingers in diagnosis of post-traumatic tendon and ligament injuries

Background Magnetic resonance (MR) imaging is a powerful method for evaluating acute and chronic lesions of the stabilizing articular elements (volar plate and collateral ligaments) of the fingers and thumbs, the condition of tendons, the presence of a tear, the number of affected tendons, the extent of tendon retraction, and the presence of associated lesions. This study was done to clarify the value of magnetic resonance imaging (MRI) in assessment of trauma-related injuries of the tendons and ligaments of the fingers and subsequently positively affect the surgical decisions in such cases. Results This study included 42 patients (33 males and 9 females) with a mean age of 35 years. All of them had history of trauma. Male affection was 78.5%, while females constituted only 21.5%, striking right-sided-hand affection (92.9%). The most affected finger was the thumb. The most common affected sites were extending from the metacarpophalangeal (MCP) till the proximal interphalangeal (PIP). The tendons were affected in 42.9%; meanwhile, ligamentous affection represented 57.2%. The flexor tendon tear represented by 28.6%%, while extensor tendon tear occurred in 14.3%. The study also showed that partial thickness tear is represented by 66.7%, while complete thickness tear occurred in about 33.3%. Bone marrow edema and post-traumatic tenosynovitis occurred in about 14% of cases. Conclusions Magnetic resonance imaging is an essential technique to obtain a correct pre-surgical diagnosis. It is of utmost importance to possess an in-depth knowledge of finger radiological anatomy in detail, as well as the appearance of the different pathologic entities on MRI. It provides a great assessment of the tendons and ligaments tear by whether partial or complete, any associated marrow edema or bony fragment avulsion and the extent of retraction in cases of complete tear.

Repair of Lafosse I subscapularis injury adds no additional value in anterosuperior rotator cuff injury

Background The study aimed to explore the additional value of repair of Lafosse I subscapularis injury compared with debridement in anterosuperior rotator cuff injury. Methods The prospective study was conducted on a total of 41 patients with supraspinatus tendon tear combined with Lafosse I subscapularis injury. Eighteen patients were divided into the repair group and 23 patients were divided into the non-repair group. The two groups were compared for intraoperative parameters, pain score, range of motion of the shoulder joint, shoulder joint function and quality of life (QoL) at pre-operation, 3 and 6 months postoperatively and the final follow-up visit. Results The width of supraspinatus tendon tear did not exceed 3 cm and did not retract beyond the glenoid in among patients. There was no statistical difference of preoperative data between two groups, including age, course of disease, positive Jobe test, positive Bear-hug test, positive Lift-off test, Patte stage, longitudinal tear and pain severity (P > 0.05). Compared to preoperative levels, the severity of pain, ASES scores and EQ-5D-3L scores were significantly lower at 3 and 6 months postoperatively and the final position (P < 0.05). However, there was no statistical difference in pain severity, ASES scores and EQ-5D-3L scores between repair group and non-repair group (P > 0.05). Similarly, compared to preoperative levels, the range of motion of shoulder joint was significantly improved after operation, including internal rotation, external rotation, forward flexion and elevation (P < 0.05). However, there was no statistical difference in range of motion of shoulder joint between repair group and non-repair group (P > 0.05). Conclusion Operative treatment can effectively lessen severity of pain in the patients, improve shoulder joint function, increase the range of motion of the shoulder joint and enhance the QoL in treating anterosuperior rotator cuff injury. However, repair of subscapularis brings no benefit compared to debridement in treating supraspinatus tendon tear combined with Lafosse I subscapularis injury.

Ultrasonography and MR Arthrogram in detection of shoulder joint disorders

Purpose To know the role of Ultrasonography and MR Arthrogram in detection of shoulder joint disorders Methods and material Thirty patients with suspected shoulder joint disorders underwent US,MRI ,MR arthrography shoulder. Results All cases with ALAPSA, Bankert, reverse bankert, hillsachs, perthes and SLAP are diagnosed accurately by MR arthrography with sensitivity of (100%) in GLAD ,Supraspinatus tendenopathy ,Supraspinatus tendon tear and IGHL injury sensitivity was decreased to 75%,in cases of paraglenid cysts arthrography did not diagnose any of them as there are no communication between the cyst and the joint Conclusion MR arthrography shoulder has a golden rule in diagnosis ,classification of cases of shoulder dislocation ,SLAP injuries and rotator cuff impingement

The Potential Role of Human Derived Amniotic Membrane Graft in The Repair of Induced Tendon Tear in Adult Male Albino Rat: Histological Study

Introduction Achilles tendon tears cause severe impairment in patient mobility and productivity, causing significant reduction in the quality of life. Many complications are associated with the tendon healing process such as peritendinous adhesions and excessive fibrotic scars. Unsatisfactory results appeared with the existing medical and surgical treatments to regain full tendon structure and function. Amniotic membrane is avascular, and characterized by low immunogenicity, anti-inflammatory, antiscarring properties. These criteria render it as a natural biological substitute and a novel therapeutic alternative for tendon tears. Aim: The aim of the work was to study the effect of human amniotic membrane graft application on the repair of induced Achilles tendon tear. Material and methods Fresh human amniotic membrane (AM) grafts were prepared from harvested human full-term caesarian sections-delivered placentas. Thirty adult male albino rats were divided into 3 equal groups (n = 10); group I (control group), group II (tendon tear group) and group III (AM treated group). After anesthesia, a full thickness transverse incision was induced in the rat right Achilles tendons of group II and III. Human derived amniotic membrane graft measuring 1 cm2 was applied circumferentially on the tendon tear in group III. Rats were sacrificed after 28 days. Results After the tendon tear, the untreated group (II) showed gradual accumulation of fat cells replacing the collagen bundles in focal areas. Areas of mononuclear cellular infiltration were demonstrated. The AM-treated group showed many thick parallel regularly arranged collagen fibers with a significant increase in the collagen fibers area percentage. It also showed apparent increase in tenoblasts with regular organization and apparent decrease of mononuclear inflammatory cells. Conclusion This study demonstrated the potential therapeutic role of the application of human amniotic membrane grafts in the repair of Achilles tendon tears, suggesting a future alternative therapy for patients suffering from Achilles tendon tears.