tendon thickness
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Author(s):  
Brooke A. Christensen ◽  
David C. Lin ◽  
M. Janneke Schwaner ◽  
Craig P. McGowan

Small bipedal hoppers, including kangaroo rats, are thought to not benefit from substantial elastic energy storage and return during hopping. However, recent species-specific material properties research suggests that, despite relative thickness, the ankle extensor tendons of these small hoppers are considerably more compliant than had been assumed. With faster locomotor speeds demanding higher forces, a lower tendon stiffness suggests greater tendon deformation and thus a greater potential for elastic energy storage and return with increasing speed. Using the elastic modulus values specific to kangaroo rat tendons, we sought to determine how much elastic energy is stored and returned during hopping across a range of speeds. In vivo techniques were used to record tendon force in the ankle extensors during steady-speed hopping. Our data support the hypothesis that the ankle extensor tendons of kangaroo rats store and return elastic energy in relation to hopping speed, storing more at faster speeds. Despite storing comparatively less elastic energy than larger hoppers, this relationship between speed and energy storage offer novel evidence of a functionally similar energy storage mechanism, operating irrespective of body size or tendon thickness, across the distal muscle-tendon units of both small and large bipedal hoppers.


2021 ◽  
Vol 67 (4) ◽  
pp. 490-501
Author(s):  
Tuğba Şahbaz ◽  
Cansın Medin Ceylan ◽  
Başak Çiğdem Karacay ◽  
Merve Damla Korkmaz ◽  
Demirhan Dıracoğlu

Objectives: In this study, we aimed to investigate the effectiveness or comparative therapeutic superiority of exercise, extracorporeal shock wave therapy (ESWT), and platelet-rich plasma (PRP) on pain, grip strength and functional activities in chronic lateral epicondylitis (LE). Patients and methods: Between January 2016 and February 2017, a total of 74 patients (14 males, 60 females; mean age; 49.7±7.6 years, range, 26 to 60 years) with chronic LE were included in this prospective, randomized-controlled study. All patients received stretching and eccentric strengthening exercises for three months. The patients were divided into three groups. The first group (Exercises group, n=24) was given home exercises. The second group (ESWT+Exercises group, n=25) received one session of ESWT added once a week for three weeks. The third group (PRP+Exercises group, n=25) received one session of PRP in addition to the exercise program. All patients were evaluated for pain by Visual Analog Scale (VAS), for functionality by Disabilities of Arm, Shoulder and Hand (DASH) questionnaire and Patient-Rated Tennis Elbow Evaluation (PRTEE), handgrip strength by a dynamometer, and extensor tendon thickness by ultrasonography (USG) at baseline and at one, two, three, and six months. Results: A significant improvement was found in the VAS, DASH, PRTEE, handgrip strength values at six months compared to between in all groups (p<0.001). Extensor tendon thickness as assessed by USG indicated no significant difference (p>0.05). Regarding the VAS activity levels, there was a significant difference in the PRP+Exercises group compared to the Exercises group at six months of follow-up (p<0.001). The decrease in the DASH scores during six-month follow-up was significantly higher in the PRP+Exercises group compared to the Exercises group (p=0.004). For the PRTEE scores at six months, the PRP+Exercises group showed a statistically significant improvement than both Exercises (p<0.001) and ESWT+Exercises (p=0.007) groups. Conclusion: In the treatment of chronic LE, PRP combined with exercise seems to be superior to exercise or ESWT in terms of pain and functionality in chronic LE patients.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Donald J. Hunter ◽  
Darren A. Rivett ◽  
Sharmaine McKiernan ◽  
Suzanne J. Snodgrass

Abstract Background Shoulder impingement syndrome (SIS) is the most common form of shoulder pain. Conservative and surgical treatments for SIS are often not effective. One such surgical intervention is subacromial decompression, aimed at widening the subacromial space (SAS). A better understanding of the changes in the SAS may help explain the relative ineffectiveness of current interventions. Objective: To measure the acromiohumeral distance (AHD) and supraspinatus tendon thickness (STT) in people with SIS using a case control study. Methods The AHD and STT of 39 participants with SIS ≥3 months and 39 age, gender and dominant arm matched controls were measured using ultrasound imaging. Between-group differences for AHD and STT were compared using t-tests. A linear regression was used to determine if there was a relationship between AHD and STT measures, with group as a covariate. Results Compared to controls (mean age 55.7 years, SD 10.6), individuals with SIS (mean age 57.1 years, SD 11.1) had a significantly larger AHD (mean difference 2.14 mm, 95% CI 1.21, 3.07, p < 0.001) and STT (mean difference 1.25 mm, 95% CI 0.60, 1.90, p < 0.001). The linear regression model indicated an association between AHD and STT (β = 0.59, 95% CI 0.29, 0.89, p < 0.01, R2 = 0.35, n = 78), suggesting that as STT increases in size, so does the AHD. Conclusion Individuals with SIS had a larger AHD and greater STT than controls. These results suggest the SAS is already wider in people with SIS and that the symptoms associated with SIS may be more related to an increased STT than a smaller SAS.


Author(s):  
Busra Yurumez Korkmaz ◽  
Mujde Akturk ◽  
Murat Ucar ◽  
Alev Eroglu Altınova ◽  
Mehmet Ali Can ◽  
...  

Abstract Aim To investigate the alterations in the plantar fascia (PF), intrinsic muscles, and tendons in the feet of patients at high risk for developing diabetic foot. Methods The healthy feet of 22 patients with type 2 diabetes, who had developed diabetic foot ulcers on a single foot without any pathology on the contralateral extremity, and those of 22 healthy volunteers were evaluated by magnetic resonance imaging. The volume of the Achilles tendon (AT), the surface area of the PF, the thickness of AT, flexor hallucis longus, flexor digitorum longus, tibialis posterior, and peroneus longus tendons, irregularity in the PF, and edema of intrinsic foot muscles were examined. Results Nineteen patients (86%) had irregularity in the PF, whereas none of the healthy controls had any (p<0.001). Intrinsic muscle edema was more common in the group with diabetes (p=0.006). The volume of AT and the surface area of PF were decreased in patients with peripheral arterial disease (PAD) (p<0.05). Patients with diabetes mellitus but without PAD had a larger surface area of PF than that of controls (p<0.05). There were no differences in the volume of AT, the surface area of the PF, and other tendon thickness between the groups. Conclusion Irregularity in the PF and muscle edema may indicate a high risk for the diabetic foot. The presence of PAD may lead to regression in the structure of AT and PF.


2021 ◽  
Author(s):  
Mahmut ÇAY ◽  
Sinan BAKIRCI ◽  
Ali KARAHAN ◽  
Hakan YILMAZ ◽  
Deniz ŞENOL

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hanaa Ahmed Hany Abd Eldayem Ahmed El-Naggar ◽  
Mona Mansour Mohammed Hasab El-Naby ◽  
Naglaa Youssef Mohammed Assaf ◽  
Mohja Ahmed Abd El-Fattah Elbadawy

Abstract Background Lateral elbow pain (LEP) or lateral epicondylitis (LE) is a common problem affecting both males and females. Multiple therapeutic modalities are used with different outcomes. Objective The current study aimed at description of the effectiveness of a newly introduced modality, Perineural Injection (PNI) therapy in comparison to the already used therapeutic ultrasound (TUS) as a conventional modality in the treatment of resistant LEP (LE). Patients and methods This is a longitudinal interventional study. Thirty patients of both sexes aged between 21 to 62 years old who had LE were randomly allocated into two groups (15 each). In PNI group, 5% buffered dextrose was injected subcutaneously around the lateral epicondyle once weekly for 8 weeks. In TUS group, continuous US was used 3 sessions per week for 4 weeks. Tenderness grading scale, visual analogue scale (VAS), Patient- Rated Tennis Elbow Evaluation Questionnaire (PRTEE) score, and ultrasonographic evaluation were used before and 12 weeks after treatment. Results In both groups, there was a high significant clinical improvement at 12th week after treatment. However, the improvement was better in the PNI group than the TUS group. By US evaluation at 12th week after treatment, there was a significant decrease in hypoechoic areas and disturbed fibrillar pattern in PNI group compared to before therapy (p &lt; 0.001 and = 0.025) respectively. But in TUS group, there was decrease in hypoechoic areas and tendon thickness compared to before treatment (p = 0.02 and 0.026) respectively. Conclusion Both PNI and TUS therapies for LE gave clinical improvement for pain, functional limitations and some ultrasonographic findings (as echogenity, fibrillar pattern and tendon thickness). However, PNI therapy gave better outcome as compared to TUS.


2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0026
Author(s):  
Thomas Kremen ◽  
Michael Arnold ◽  
Myra Trivellas ◽  
Ignacio Garcia-Mansilla

Objectives: Hamstring tendon autograft (HTA) is the most common graft source used worldwide for anterior cruciate ligament reconstruction (ACLR). The graft is comprised of a patient’s own semitendinosus tendon (ST) and gracilis tendon (GT), typically double stranded. Recent literature suggests that HTAs below 8mm in diameter are associated with higher failure rates and poorer outcome scores. Currently, surgeons do not have a reliable, user-friendly tool to estimate HTA diameter pre-operatively. The inability to do so leads to potentially harvesting an insufficient graft. There is a growing body of evidence that suggests a correlation between preoperative MRI measurements and the intraoperative measured HTA diameter. This could be used to identify patients at risk of having small HTA diameter, however, it is unknown if these patients also are at risk of smaller caliber alternative autograft tendon sources (i.e., quadriceps tendon and patellar tendon). Our hypotheses were: i) Intra-operative HTA diameter is strongly correlated with pre-operative MRI measurements of ST cross-sectional area (STCSA), GT cross-sectional area (GTCSA), and the sum of the ST and GT cross-sectional area (STGTCSA); and ii) patients with HTA diameters less than 8mm will also have smaller caliber patellar tendon and quadriceps tendon measurements on pre-operative MRI. Methods: After appropriate IRB approval was obtained, patients undergoing ACLR with HTA between the period of 01/01/2013 to 05/31/2020 were retrospectively reviewed. Inclusion criteria included the following: MRI proven ACL tear, 3-Telsa MRI available for review, surgery performed within our institution using standard quadrupled hamstring technique, intra-operative HTA diameter recorded in the operative report, and age greater than 12 years old. The MRI measurements were performed by two physicians: one orthopedic sports medicine research fellow and one orthopedic surgery resident. Each physician was blinded to the intraoperative HTA diameter. CSA of the ST and GT was measured on axial MRI sequences using the axial slice that included the widest (medial-lateral (M-L) width) portion of the distal femur. This image was magnified 4 times and CSAs of the GT and ST were measured using the elliptical region of interest tool (Figure 1). In addition, the patellar tendon length (PTL), patellar tendon thickness (PTT), patellar tendon medial-lateral width (PTW), and quadriceps tendon thickness (QT) were measured. PTL was measured at the sagittal slice showing the most distal pole of the patella and tibial tubercle. PTT was also measured on this MRI slice at the tendon’s mid-point. PTW was measured in the sagittal view and cross referenced to an axial view as previously described. A point at the center of the tendon width (M-L width) was defined, and the width was then measured from this point to the medial and lateral borders separately in order to accommodate the tendon contour. The sum of the widths was regarded as the total tendon width. QT was measured in the anterior-posterior plane on a sagittal slice located 25mm proximal to the superior pole of the patella and measured at the mid-point of the tendon (M-L plane) orthogonal to the quadriceps tendon fibers. All measurements were taken using the universal viewer image analysis software. Pearson r values were calculated for MRI measurements from both readers and the average of their measurements against intra-operative HTA diameter. Receiver operator curves (ROC) were used to calculate sensitivity and specificity values for each MRI measurement. The measurement that best correlated with HTA diameter (e.g., GTCSA) was then compared to PTL, PTT, PTW, and QT among the patients with HTA less than 8mm. Intra-class correlation coefficients (ICC) were calculated for inter-rater reliability between reader 1 and reader 2 for all MRI measurements. Results: Fifty-two patients (53 knees, 26 female and 26 male) met inclusion criteria, with a mean age of 23 years old. The mean intraoperative HTA diameter was 7.98mm, with 18 grafts (34%) measuring less than 8mm. Pearson r values for all MRI measurements and ICC values are shown in in table 1. HTA diameter was significantly correlated to all averaged MRI measurements with the exception of PTW and QT. The strongest correlation was seen with GTCSA (r=0.72, p<.01). By entering a patient’s GTCSA measurement as “x” into the line of best fit (y = 41.83x + 5.0846), the estimated HTA diameter “y” can be extrapolated (Figure 2). Using our dataset, we determined that a GTCSA cut off value of 0.0625mm can be used to identify patients who will have a HTA diameter of 8mm or greater with a sensitivity of 0.91. For our cohort of 53 knees, GTCSA significantly correlated with PTL (r=0.352, p<.01), QT (r=0.334, p<.05), and STCSA (r=0.531, p<.01). [AMT(S2] Of the 18 patients with HTA diameter less than 8mm, GTCSA showed a significant correlation with PTL (r=0.34, p<.05) and QT (r=0.33, p<.05) (Figure 3). No significant correlation was observed between GTCSA and ST, PTT, or QT. Conclusions: Pre-operative MRI measurements of STCSA and STGTCSA did not correlate with intra-operative HTA in our cohort. However, pre-operative MRI measurement of GTCSA did show a strong correlation with intra-operative HTA diameter in our cohort of patients. Among patients with HTA diameters less than 8mm, GTCSA on pre-operative MRI showed a significant correlation with PTL and PTW. GTCSA can help to estimate whether or not a patient will have a HTA greater than 8mm and may provide insight regarding alternative autograft characteristics. The methods described in this study are reproducible between observers at different levels of their orthopedic training. By knowing how likely a patient is to have a sufficient HTA, surgeons can better educate patients regarding the risks and benefits pre-operatively as well as plan for alternative graft sources as needed.


2021 ◽  
Vol 11 (18) ◽  
pp. 8748
Author(s):  
Toshihiro Maemichi ◽  
Toshiharu Tsutsui ◽  
Takumi Okunuki ◽  
Takuma Hoshiba ◽  
Tsukasa Kumai

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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