RESUMO
Minimally invasive approaches for the Achilles tendon have emerged as viable alternatives for acute Achilles ruptures, with several potential benefits in comparison to the open approach. Occasionally, proper purchase in the proximal tendon stump is not achieved due to severe degenerative disease of the tendon. In this article, we present a technique in which a small accessory incision is used during percutaneous Achilles repair in order to pass the sutures in a more proximal and healthy area of the tendon. This technique is useful for situations in which adequate tendon grasp is not obtained, avoiding the need of conversion to an open approach.Level of Evidence: Level V: Expert opinion.
Assuntos
Tendão do Calcâneo , Traumatismos dos Tendões , Humanos , Tendão do Calcâneo/cirurgia , Traumatismos dos Tendões/cirurgia , Técnicas de Sutura , Ruptura/cirurgia , Suturas , Resultado do TratamentoRESUMO
Introducción: Por más de 20 años la litotricia extracorpórea se ha aplicado con éxito en el mundo. Objetivo: Evaluar la efectividad de la terapia por ondas de choque en el tratamiento a pacientes que presentan lesiones en los tendones y ligamentos del sistema osteomioarticular. Métodos: Se realizó un estudio descriptivo, de corte transversal, con 107 pacientes diagnosticados con lesiones en los tendones y ligamentos del sistema osteomioarticular, los cuales fueron tratados con el equipo Well Wave (ondas de choque extracorpóreas) en el Complejo Científico Ortopédico Internacional Frank País, en el período comprendido entre marzo de 2019 y abril de 2020. Se realizó el análisis de las variables edad, sexo, dolor y discapacidad. Se obtuvieron frecuencias absolutas y relativas, y con ellas se confeccionaron las tablas que resumen la información estadística de la investigación. Resultados: Predominó el sexo femenino (71,9 por ciento), de 51 - 60 años (28 por ciento). El 40,2 por ciento de los pacientes fueron atendidos por presentar una tendinitis del supraespinoso. Todos los pacientes presentaban dolor antes de la aplicación de la terapia. Luego del tratamiento el 78,5 por ciento de los enfermos dejaron de sentirlo y el 71 por ciento presentó ausencia de discapacidad según escala de DASH. Según los criterios de evaluación de la respuesta al tratamiento los resultados fueron satisfactorios en el 56 por ciento de los pacientes. Conclusiones: La terapia con las ondas de choque posibilitó una rápida recuperación de los pacientes atendidos y su incorporación a las actividades diarias(AU)
ABSTRACT Introduction: Over more than 20 years, extracorporeal lithotripsy has been successfully used worldwide. Objective: To evaluate the effectiveness of shock wave therapy in the treatment of patients with injuries to the tendons and ligaments of the osteomioarticular system. Methods: A descriptive, cross-sectional study was carried out with 107 patients diagnosed with injuries to the tendons and ligaments of the osteomioarticular system. These subjects were treated with the Well Wave equipment (extracorporeal shock waves) at Frank País International Orthopedic Scientific Center, from March 2019 to April 2020. The variables age, sex, pain and disability were analyzed. Absolute and relative frequencies were obtained, and the results of statistical information of the investigation was shown in summarizing tables. Results: The female sex prevailed (71.9percent), 51 - 60 years old (28 percent). 40.2 percent of the patients were treated for supraspinatus tendinitis. All patients had pain before the use of therapy. After treatment, 78.5 percent of the patients stopped feeling pain and 71 percent showed no disability according to DASH scale. According to the treatment response evaluation criteria, the results were satisfactory in 56percent of the patients. Conclusions: This therapy enabled rapid recovery of the patients treated and their integration into daily activities(AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Traumatismos dos Tendões , Tendões , Resultado do Tratamento , Tratamento por Ondas de Choque Extracorpóreas/métodos , Ligamentos/lesões , Sistema Musculoesquelético , Epidemiologia Descritiva , Estudos TransversaisRESUMO
Background: Soft tissue injuries are common in sport horses, especially those involving tendons, with few current reportsin the literature on the diagnosis of extensor injuries, especially with regard to ultrasound characteristics, being essential forthe diagnosis of these injuries. The objective of the study is to characterize the clinical signs and the alterations of images,especially ultrasound, in the diagnosis of these lesions of the dorsal radiocarpal region, through case reports of horses seenat the Medical Clinic of Large Animals of the Federal University of Campina Grande (MCLA/UFCG), Patos, PB, Brazil.Cases: The study includes five vaquejada competitions horses, of which two were active and the others were awayfrom the sport before the onset of the problem, with injuries to the extensor tendons in the radiocarpal region. Two of theanimals had involvement of the common digital extensor muscle tendon (CDEMT), with acute and chronic tenosynovitis,and three with involvement of the extensor carpi radialis muscle tendon (ECRMT), presenting acute tendonitis, septictenosynovitis and rupture, all of traumatic etiology, except for one whose cause has not been determined. On physical examination, the affected tendon was noticeable in three cases, and two had other injuries associated with the tendons. Bonealteration in the radiographic examination was observed in two cases, however, one of them related to another disease inthe radiocarpal palmar region. Ultrasound images, performed in all cases, showed different characteristics and degrees ofthe involvement of the tendon and its sheath.Discussion: The scarcity of current reports of extensor tendon injuries in horses can...(AU)
Assuntos
Animais , Cavalos/lesões , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/veterinária , Tendões , Tenossinovite/veterinária , Tendinopatia/veterinária , Ultrassonografia/veterináriaRESUMO
Background: Soft tissue injuries are common in sport horses, especially those involving tendons, with few current reportsin the literature on the diagnosis of extensor injuries, especially with regard to ultrasound characteristics, being essential forthe diagnosis of these injuries. The objective of the study is to characterize the clinical signs and the alterations of images,especially ultrasound, in the diagnosis of these lesions of the dorsal radiocarpal region, through case reports of horses seenat the Medical Clinic of Large Animals of the Federal University of Campina Grande (MCLA/UFCG), Patos, PB, Brazil.Cases: The study includes five vaquejada competitions horses, of which two were active and the others were awayfrom the sport before the onset of the problem, with injuries to the extensor tendons in the radiocarpal region. Two of theanimals had involvement of the common digital extensor muscle tendon (CDEMT), with acute and chronic tenosynovitis,and three with involvement of the extensor carpi radialis muscle tendon (ECRMT), presenting acute tendonitis, septictenosynovitis and rupture, all of traumatic etiology, except for one whose cause has not been determined. On physical examination, the affected tendon was noticeable in three cases, and two had other injuries associated with the tendons. Bonealteration in the radiographic examination was observed in two cases, however, one of them related to another disease inthe radiocarpal palmar region. Ultrasound images, performed in all cases, showed different characteristics and degrees ofthe involvement of the tendon and its sheath.Discussion: The scarcity of current reports of extensor tendon injuries in horses can...
Assuntos
Animais , Cavalos/lesões , Tendões , Tenossinovite/veterinária , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/veterinária , Tendinopatia/veterinária , Ultrassonografia/veterináriaRESUMO
Calcific insertional Achilles tendinopathy (CIAT) is a relatively common musculoskeletal entity that results in significant pain and disability, as well as posterior muscle group weakness. There is a lack of evidence criteria to support the timing of operative intervention, choice of procedures, or whether equinus requires treatment. The purpose of this study was to retrospectively review 45 patients (48 feet) who have undergone surgical management of CIAT with concomitant posterior muscle group weakness with the single heel rise testing. All patients underwent debridement and repair of the Achilles tendon with reattachment of the Achilles tendon to the calcaneus, ostectomy of the calcaneus, and flexor hallucis longus tendon transfer. Those patients with equinus also underwent gastrocnemius recession. The focus includes patient-reported satisfaction, time to return to normal shoe gear, and the incidence of revision surgery. The overall average of time to weightbearing was 4.3 weeks. After surgery, 73.3% (nâ¯=â¯33) of the 45 patients responded to the following question: "Would you have this surgery done again?" Of these patients, 93.9% (nâ¯=â¯31) responded "Yes" and 6.1% (nâ¯=â¯2) responded "Unsure." Of the same 33 patients, 84.8% (nâ¯=â¯28) responded that they were "Very Satisfied" with the procedure and 15.2% (nâ¯=â¯5) responded that they were "Satisfied." Twelve patients (26.7%) did not respond to either question. One of the 12 patients (8.3%) who did not respond had bilateral procedures. None of the patients experienced tendon rupture, deep vein thrombosis, or the need for revision surgery. Four patients (8%) experienced a superficial infection, whereas 1 patient (2%) had development of a deep infection. No correlations were found when looking at the relationship between body mass index and return to weightbearing/normal shoe gear with Spearman analysis.
Assuntos
Tendão do Calcâneo/cirurgia , Calcinose/cirurgia , Imageamento por Ressonância Magnética/métodos , Satisfação do Paciente , Tendinopatia/cirurgia , Transferência Tendinosa/métodos , Tendão do Calcâneo/diagnóstico por imagem , Tendão do Calcâneo/fisiopatologia , Adulto , Idoso , Calcâneo/cirurgia , Calcinose/diagnóstico por imagem , Calcinose/fisiopatologia , Estudos de Coortes , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Osteotomia/métodos , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Fatores de Risco , Tendinopatia/diagnóstico por imagem , Tendinopatia/fisiopatologia , Resistência à Tração , Resultado do TratamentoRESUMO
Introdução: Exercícios com cargas vêm se mostrando eficiente na promoção de saúde e ocupando cada vez mais espaço no cenário de prática esportiva atual, porém merecem atenção em relação a ocorrência de lesões, em especial as tendinites. Objetivo: Avaliar a prevalência de tendinites em praticantes de musculação, divididos em três grupos, verificando os fatores de associação. Métodos: Estudo transversal, descritivo e analítico, de caráter quantitativo. A amostra foi composta por 208 alunos com idade a partir de 18 anos. Foi utilizado um questionário próprio composto de dados sociodemográficos e relacionados à presença ou não de tendinites, que foi confirmada através do diagnóstico médico. Os dados foram tabulados e analisados no SPSS 15.0, sendo geradas as frequências relativas e absolutas de interesse para pesquisa. As associações entre a tendinite, o tipo de treinamento e os fatores associados foram analisadas a partir do teste do qui-quadrado ou Exato de Fischer. Resultados: A prevalência de tendinite foi de 17,8% foi associada ao treino de hipertrofia, ser do sexo masculino, usar anabolizantes, suplementos e medicamentos, além de não treinar sem supervisão. Conclusão: A tendinite apresenta-se como uma lesão frequente em praticantes de musculação. Existem alguns fatores que contribuem para ocorrência dessa lesão, servindo de alerta aos profissionais de saúde a fim de minimizar essa lesão. [AU]
Introduction: Exercises with loads have been shown to be efficient in promoting health and occupying more and more space in the current sport practice scenario, but deserve attention in relation to the occurrence of injuries, especially tendinitis. Objective: To evaluate the prevalence of tendonitis in bodybuilders, divided into three groups, verifying the factors that are associated with this affection. Methods: Cross-sectional, descriptive and analytical study of a quantitative nature. The sample consisted of 208 students aged 18 years and over. A self-administered questionnaire composed of sociodemographic data and related to the presence or absence of tendinitis was used, which was confirmed through medical diagnosis. The data were tabulated and analyzed in SPSS 15.0, generating the relative and absolute frequencies of interest for research. The associations between tendonitis, type of training and associated factors were analyzed from the chi-square test or Fischer's exact test. Results: The prevalence of tendonitis was 17.8% and was associated with hypertrophy training, being male, using anabolic steroids, supplements and medications, besides not being accompanied. Conclusion: Tendonitis is a frequent injury in bodybuilders. There are some factors that contribute to the occurrence of this lesion, serving as an alert for health professionals in order to minimize this involvement. [AU]
Assuntos
Exercício Físico , Treinamento Resistido , TendinopatiaRESUMO
La fascitis plantar es un síndrome degenerativo que se produce como resultado de traumas repetidos en el origen de ésta, en el calcáneo. Suele presentarse en atletas y corredores, aunque también aparece en la población general, afectando aproximadamente a un 10% en ambos casos. Aunque su etiología no es del todo clara, es probable que la causa no sea única y haya diversos factores que contribuyan a su aparición. Estos son tales como el aumento de peso, el exceso de ejercicio físico o el calzado inadecuado, entre otros. La fascitis plantar se caracteriza por dolor en la región inferior del talón, en la planta del pie, que es especialmente intenso en los primeros momentos de la mañana al andar o después de un período de inactividad física o tras una bipedestación prolongada. A lo largo del día el dolor va disminuyendo, pero volverá si se lleva a cabo la actividad de levantamiento de peso. El tiempo de recuperación o resolución de esta patología es prolongado y existen varios métodos que pueden ayudar en su tratamiento, todos ellos diríamos que convencionales. Esta revisión plantea el tratamiento de la fascitis plantar a través del entrenamiento funcional de esquí, dadas las características biomecánicas que comporta este deporte.
Plantar fasciitis is a degenerative syndrome that occurs because of repeated traumas in the fascia origin on the calcaneus. It usually occurs in athletes and runners, although it also appears in the general population, affecting approximately 10% in both cases. Although its etiology is not entirely clear, it is likely, not due to a unique cause since there are several factors that contribute to its appearance. These are: weight gain, excessive physical exercise or inadequate footwear, etc. Plantar fasciitis is characterized by pain in the lower region of the heel, in the sole of the foot, which is especially intense in the first moments of the morning when walking, after a period of physical inactivity or after prolonged standing. Throughout the day the pain diminishes, but will return if weight-lifting activity is carried out. The recovery time or resolution of this pathology is prolonged and there are several conservative methods that may help in the treatment of plantar fasciitis. Therefore, in this review we propose the treatment of plantar fasciitis through functional ski training, given the biomechanical characteristics of this sport.
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Introducción. La tendinitis es una condición inflamatoria y degenerativa que se caracteriza por dolor en las intersecciones tendinosas de los huesos. La muñeca es uno de los sitios más comunes de tendinitis. La causa principal de tendinitis es la combinación de carga mecánica, uso intenso, movimientos repetitivos, fuerza y posición de la muñeca. Objetivos: Describir los factores asociados a tendinitis de muñeca producida en pacientes con diagnóstico clínico de tendinitis de muñeca. Métodos: Estudio descriptivo observacional, los participantes fueron 33 personas mayores de 18 años de edad con diagnóstico clínico de tendinitis de muñeca en consulta externa de cirugía de la mano. Resultados: Sí existe una relación importante entre los pacientes con diagnóstico clínico y sus condiciones laborales; mayormente la realización de movimientos manuales repetitivos, utilización de máquina de escribir o computadora y el uso de equipo que implique la fuerza entre los dedos pulgar e índice. Conclusión: Las condiciones laborales que impliquen el uso constante y crónico de la muñeca sí están relacionadas con el desarrollo de tendinitis de muñeca. Palabras clave: Tendinitis de muñeca, condiciones laborales, factores asociados.
Background. Tendinitis is an inflammatory and degenerative condition characterized by pain in tendon bone intersections. The wrist is one of the most common sites of tendinitis. The principal cause of tendinitis is the combination of mechanical load, heavy use, repetitive motion, wrist position and force. Objectives: To describe factors associated with wrist tendinitis produced in patients with clinical diagnosis of wrist tendinitis. Methods. Observational descriptive study, the participants were 33 subjects over 18 years old with a clinical diagnosis of wrist tendinitis all from the outpatient clinic of hand surgery. Results: There is a significant relationship between patients with clinical diagnosis and working conditions; mostly performing repetitive hand movements, using typewriter or computer and use of equipment involving force between thumb and forefinger. Conclusion: working conditions involving the use of constant and chronic wrist if it is related to the development of wrist tendinitis. Key words: Wrist tendonitis, working conditions, associated factors
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This study assessed the overall and specific prevalence of the main rheumatic regional pain syndromes (RRPS) in four Latin-American indigenous groups. A Community Oriented Program for Control of Rheumatic Diseases (COPCORD) methodology-based census study was performed in 4240 adults (participation rate: 78.88 %) in four indigenous groups: Chontal (Oaxaca, Mexico, n = 124), Mixteco (Oaxaca, Mexico; n = 937), Maya-Yucateco (Yucatán, Mexico; n = 1523), and Qom (Rosario, Argentina; n = 1656). Subjects with musculoskeletal pain were identified using a cross-cultural, validated COPCORD questionnaire administered by bilingual personnel, and reviewed by general practitioners or rheumatologists using standardized case definitions for the 12 most frequent RRPS. The overall prevalence of RRPS was confirmed in 239 cases (5.64 %, 95 % CI: 4.98-6.37). The prevalence in each group was Chontal n = 19 (15.32 %, 95 % CI: 10.03-22.69); Maya-Yucateco n = 165 (10.83 %, 95 % CI: 9.37-12.49); Qom n = 48 (2.90 %, 95 % CI: 2.19-3.82); and Mixteco n = 7 (0.75 %, 95 % CI: 0.36-1.53). In the whole sample, the syndrome-specific prevalence was rotator cuff tendinopathy: 1.98 % (95 % CI: 1.60-2.45); lateral epicondylalgia: 0.83 % (95 % CI: 0.59-1.15); medial epicondylalgia: 0.73 % (95 % CI: 0.52-1.04); biceps tendinopathy: 0.71 % (95 % CI: 0.50-1.01); anserine syndrome: 0.64 % (95 % CI: 0.44-0.92); inferior heel pain: 0.61 % (95 % CI: 0.42-0.90); trochanteric syndrome: 0.49 % (95 % CI: 0.25-0.64); de Quervain's tendinopathy: 0.45 % (95 % CI: 0.29-0.70); trigger finger: 0.42 % (95 % CI: 0.27-0.67); carpal tunnel syndrome: 0.28 % (95 % CI: 0.16-0.49); Achilles tendinopathy (insertional): 0.12 % (95 % CI: 0.05-0.28); and Achilles tendinopathy (non-insertional): 0.07 % (95 % CI: 0.02-0.21). Leaving aside the comparison between Maya-Yucateco and Chontal groups (p = 0.18), we found significant differences (p < 0.001) in overall RRPS prevalence between the remaining pairs of indigenous groups. Syndrome-specific prevalences were also different between groups. Our findings support the hypothesis that overall RRPS prevalence and syndrome-specific prevalences are modulated by population-specific factors.
Assuntos
Indígenas Centro-Americanos , Indígenas Sul-Americanos , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etnologia , Doenças Reumáticas/etnologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Censos , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Doenças Reumáticas/classificação , Inquéritos e Questionários , Adulto JovemRESUMO
Abstract Objective: The present study was aimed at investigating bone involvement secondary to rotator cuff calcific tendonitis at ultrasonography. Materials and Methods: Retrospective study of a case series. The authors reviewed shoulder ultrasonography reports of 141 patients diagnosed with rotator cuff calcific tendonitis, collected from the computer-based data records of their institution over a four-year period. Imaging findings were retrospectively and consensually analyzed by two experienced musculoskeletal radiologists looking for bone involvement associated with calcific tendonitis. Only the cases confirmed by computed tomography were considered for descriptive analysis. Results: Sonographic findings of calcific tendinopathy with bone involvement were observed in 7/141 (~ 5%) patients (mean age, 50.9 years; age range, 42-58 years; 42% female). Cortical bone erosion adjacent to tendon calcification was the most common finding, observed in 7/7 cases. Signs of intraosseous migration were found in 3/7 cases, and subcortical cysts in 2/7 cases. The findings were confirmed by computed tomography. Calcifications associated with bone abnormalities showed no acoustic shadowing at ultrasonography, favoring the hypothesis of resorption phase of the disease. Conclusion: Preliminary results of the present study suggest that ultrasonography can identify bone abnormalities secondary to rotator cuff calcific tendinopathy, particularly the presence of cortical bone erosion.
Resumo Objetivo: Investigar o envolvimento ósseo secundário a tendinopatia calcificada do manguito rotador por meio da ultrassonografia. Materiais e Métodos: Estudo retrospectivo de uma série de casos. Foi realizada busca dos relatórios de ultrassonografia do ombro no sistema informatizado da instituição, no período de quatro anos. Cento e quarenta e um pacientes foram diagnosticados com tendinopatia calcificada do manguito rotador. Os achados de imagem foram analisados retrospectivamente em consenso por dois radiologistas musculoesqueléticos experientes. Os casos sem confirmação pela tomografia computadorizada foram excluídos da análise descritiva. Resultados: Foram identificados sinais de tendinopatia calcificada com envolvimento ósseo pela ultrassonografia em 7/141 (~ 5%) dos pacientes (idade: 50,9 anos; faixa etária: 42-58 anos; 42% do sexo feminino). Erosão do osso cortical adjacente à calcificação tendínea foi o achado mais comum, observado em 7/7 casos. Foram identificados sinais de migração intraóssea em 3/7 casos e cistos subcorticais adjacentes à calcificação tendínea em 2/7 casos. Os achados foram confirmados pela tomografia computadorizada. Nenhuma calcificação associada com anormalidades ósseas mostrou sombra acústica, favorecendo a fase reabsortiva da doença. Conclusão: Nossos resultados preliminares sugerem que a ultrassonografia é capaz de identificar anormalidades ósseas secundárias a tendinopatia calcificada do manguito rotador, especialmente a presença de erosões da cortical óssea.
RESUMO
OBJECTIVE: The present study was aimed at investigating bone involvement secondary to rotator cuff calcific tendonitis at ultrasonography. MATERIALS AND METHODS: Retrospective study of a case series. The authors reviewed shoulder ultrasonography reports of 141 patients diagnosed with rotator cuff calcific tendonitis, collected from the computer-based data records of their institution over a four-year period. Imaging findings were retrospectively and consensually analyzed by two experienced musculoskeletal radiologists looking for bone involvement associated with calcific tendonitis. Only the cases confirmed by computed tomography were considered for descriptive analysis. RESULTS: Sonographic findings of calcific tendinopathy with bone involvement were observed in 7/141 (~ 5%) patients (mean age, 50.9 years; age range, 42-58 years; 42% female). Cortical bone erosion adjacent to tendon calcification was the most common finding, observed in 7/7 cases. Signs of intraosseous migration were found in 3/7 cases, and subcortical cysts in 2/7 cases. The findings were confirmed by computed tomography. Calcifications associated with bone abnormalities showed no acoustic shadowing at ultrasonography, favoring the hypothesis of resorption phase of the disease. CONCLUSION: Preliminary results of the present study suggest that ultrasonography can identify bone abnormalities secondary to rotator cuff calcific tendinopathy, particularly the presence of cortical bone erosion.
OBJETIVO: Investigar o envolvimento ósseo secundário a tendinopatia calcificada do manguito rotador por meio da ultrassonografia. MATERIAIS E MÉTODOS: Estudo retrospectivo de uma série de casos. Foi realizada busca dos relatórios de ultrassonografia do ombro no sistema informatizado da instituição, no período de quatro anos. Cento e quarenta e um pacientes foram diagnosticados com tendinopatia calcificada do manguito rotador. Os achados de imagem foram analisados retrospectivamente em consenso por dois radiologistas musculoesqueléticos experientes. Os casos sem confirmação pela tomografia computadorizada foram excluídos da análise descritiva. RESULTADOS: Foram identificados sinais de tendinopatia calcificada com envolvimento ósseo pela ultrassonografia em 7/141 (~ 5%) dos pacientes (idade: 50,9 anos; faixa etária: 42-58 anos; 42% do sexo feminino). Erosão do osso cortical adjacente à calcificação tendínea foi o achado mais comum, observado em 7/7 casos. Foram identificados sinais de migração intraóssea em 3/7 casos e cistos subcorticais adjacentes à calcificação tendínea em 2/7 casos. Os achados foram confirmados pela tomografia computadorizada. Nenhuma calcificação associada com anormalidades ósseas mostrou sombra acústica, favorecendo a fase reabsortiva da doença. CONCLUSÃO: Nossos resultados preliminares sugerem que a ultrassonografia é capaz de identificar anormalidades ósseas secundárias a tendinopatia calcificada do manguito rotador, especialmente a presença de erosões da cortical óssea.
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La tendinitis del tibial posterior se presenta comúnmente en pacientes con actividades deportivas. Se puede originar ya sea por exceso de uso o una sobrecarga brusca sobre el tendón. Esta tendinitis también se puede presentar en pacientes con enfermedades inflamatorias sistémicas, y se clasifica como el estadio I en la disfunción del tendón tibial posterior. El tratamiento inicial, con el que se han presentado buenos resultados, se basa en la inmovilización y rehabilitación. En los casos que no presentan mejoría del cuadro clínico o la tendinitis se asocia a una ruptura parcial del tendón, existen técnicas abiertas para realizar tenosinovectomías y revisiones del tendón para mejorar la sintomatología dolorosa. Con el advenimiento de las técnicas miniinvasivas se pueden realizar revisiones amplias del tendón con una mínima agresión o combinarlas con técnicas tradicionales si se asocian con roturas parciales. En este artículo se describe el caso clínico de un paciente femenino de 35 años con patología y dolor crónico a nivel de tibial posterior, la cual fue manejada mediante tenoscopía del tibial posterior y su evolución postquirúrgica a 24 meses. El tratamiento endoscópico y/o tenoscópico es una técnica simple y reproducible. En esta paciente encontramos excelentes resultados funcionales y cosméticos. Es necesario aumentar nuestra casuística sobre este método de tratamiento...
Posterior tibial tendinitis occurs commonly in patients involved in sports activities. It may result from either excessive use or sudden overload of the tendon. This tendinitis may also occur in patients with systemic inflammatory conditions and is classified as posterior tibial tendon dysfunction stage I. Initial treatment, which has produced good results, is based on immobilization and rehabilitation. In cases without clinical improvement or in which tendinitis is associated with partial tendon rupture, open techniques may be used to perform tenosynovectomy and tendon revisions to improve painful symptoms. With the advent of minimally invasive techniques broad tendon revisions may be done that cause minimal damage or they may be combined with traditional techniques in cases of partial rupture. This paper describes the clinical case of a 35 year-old female patient with posterior tibial pathology and chronic pain. She underwent posterior tibial tenoscopy and was followed-up postoperatively for 24 months. Endoscopic and/or tenoscopic treatment is a simple and reproducible technique. We obtained excellent functional and cosmetic results in this patient. We need larger case series of patients subjected to this treatment...
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Adulto , Feminino , Humanos , Endoscopia , Tendinopatia/cirurgia , TíbiaRESUMO
REASONS FOR PERFORMING STUDY: Mesenchymal stem cells (MSCs) have been used to treat equine tendonitis with promising results; however, little is known about the potential migration of these cells. OBJECTIVES: To assess the possible migration of MSCs from an implantation site in the superficial digital flexor tendon (SDFT) to a lesion in the SDFT of the contralateral limb. STUDY DESIGN: In vivo experimental study. METHODS: Adipose-derived MSCs were isolated from 4 healthy horses. Lesions were induced in the SDFTs of both forelimbs, followed by intralesional implantation of autologous adipose-derived MSCs labelled with nanocrystals into one of the limbs. Flow cytometry of the peripheral blood mononuclear cells and fluorescence microscopy of biopsies of the SDFT lesions were used to search for the labelled cells. RESULTS: Labelled cells were detected among the peripheral blood mononuclear cells in all animals, but labelled cells were present only in the SDFTs that were treated with the intralesional implants. CONCLUSION: Nanocrystals were a valuable in vivo marker of MSCs to be used for tendonitis treatment. Although migration of MSCs to the bloodstream was observed, it was not possible to identify the labelled cells in the untreated tendons.
Assuntos
Movimento Celular/fisiologia , Doenças dos Cavalos/terapia , Transplante de Células-Tronco Mesenquimais/veterinária , Células-Tronco Mesenquimais/fisiologia , Tendinopatia/veterinária , Tecido Adiposo/citologia , Animais , Células Cultivadas , Feminino , Cavalos , Masculino , Células-Tronco Mesenquimais/citologia , Tendinopatia/terapiaRESUMO
Três equinos adultos atletas, dois na prática de pólo e um trotador, apresentaram tendinite crônica recidivante do flexor digital superficial confirmado por exames físicos e ultrassonográficos, com acometimento das regiões 1A a 2A. Na fase inicial foram tratados com anti-inflamatórios sistêmicos, crioterapia e outros procedimentos conservativos. Apresentando a recidiva e cronicidade do processo, estes foram submetidos à desmotomia do ligamento acessório do TFDS. Quatro dias após a cirurgia iniciou-se o exercício controlado, crioterapia e pomadas antiflogísticas. Após 120 dias os animais foram reavaliados e considerados aptos a exercício inicial em treinamento para esporte. Vinte e quatro meses após a reintrodução ao exercício os três animais desempenhavam atividades esportivas, demonstrando a possibilidade terapêutica da tendinite crônica pela desmotomia acessória do flexor digital superficial.
Three adult equine athletes, two Thoroughbreds in practice of polo and a Standardbred had recurrence of superficial digital flexor tendonitis confirmed by physical examination and ultrasound with involvement of the regions IA to 2A. In the initial phase were treated with anti-inflammatory systemic, cryotherapy and other conservative therapeutics procedures. By presenting the recurrence and chronicity of the process, these were submitted to superior check desmotomy. Four days after the surgery was started the controlled exercises, cryotherapy and heparinoid ointment. After 120 days the animals were reevaluated and deemed suitable subjected to initial exercise in training for sport. Twenty-four months after reintroduction to exercise the three animals performing sports activities, demonstrating the therapeutic potential of chronic tendonitis by superior check desmotomy.
Tres caballos adultos, dos en la práctica del polo y un trotador, com recurrencia de tendinitis del flexor digital superficial confirmado mediante el examen físico y ultrasonido, con participación de las regiones 1A a 2A. En la fase inicial fueron tratados con anti-inflamatorio sistémico, la crioterapia y otros procedimientos conservativos. Mediante la presentación de la recurrencia y cronicidad del proceso, se sometieron a desmotomía del ligamento accesório del tendon flexor digital superficial. Cuatro días después de la cirugía fue iniciado el ejercicio controlado, la crioterapia y abrillantadores antiflogisticas. Después de 120 días los animales fueron reevaluados y considerados adecuados para el ejercicio inicial en la formación para el deporte. Veinticuatro meses después de reintroducción del ejercicio los tres caballos ejecutan práctica deportiva, lo que demuestra el potencial terapéutico de tendinitis crónica por desmotomía del ligamento accesório del tendon flexor digital superficial.
Assuntos
Animais , Tendinopatia/veterinária , Cavalos/lesões , Ligamentos Articulares/cirurgia , Ligamentos Articulares/lesõesRESUMO
The purpose of this investigation was to demonstrate the feasibility of a biopsy technique by performing serial evaluations of tissue samples of the forelimb superficial digital flexor tendon (SDFT) in healthy horses and in horses subjected to superficial digital flexor tendonitis induction. Eight adult horses were evaluated in two different phases (P), control (P1) and tendonitis-induced (P2). At P1, the horses were subjected to five SDFT biopsies of the left forelimb, with 24 hours (h) of interval. Clinical and ultrasonographic (US) examinations were performed immediately before the tendonitis induction, 24 and 48 h after the procedure. The biopsied tendon tissues were analyzed through histology. P2 evaluations were carried out three months later, when the same horses were subjected to tendonitis induction by injection of bacterial collagenase into the right forelimb SDFT. P2 clinical and US evaluations, and SDFT biopsies were performed before, and after injury induction at the following time intervals: after 24, 48, 72 and 96 h, and after 15, 30, 60, 90, 120 and 150 days. The biopsy technique has proven to be easy and quick to perform and yielded good tendon samples for histological evaluation. At P1 the horses did not show signs of localised inflammation, pain or lameness, neither SDFT US alterations after biopsies, showing that the biopsy procedure per se did not risk tendon integrity. Therefore, this procedure is feasible for routine tendon histological evaluations. The P2 findings demonstrate a relation between the US and histology evaluations concerning induced tendonitis evolution. However, the clinical signs of tendonitis poorly reflected the microscopic tissue condition, indicating that clinical presentation is not a reliable parameter for monitoring injury development. The presented method of biopsying SDFT tissue in horses enables the serial collection of material for histological analysis causing no clinical signs and tendon damage seen by US images. Therefore, this technique allows tendonitis to be monitored and can be considered an excellent tool in protocols for evaluating SDFT injury.(AU)
Objetivou-se demonstrar a viabilidade de uma técnica de biópsia na realização de avaliações sequenciais de amostras de tecido do tendão flexor digital superficial (TFDS) do membro torácico, em equinos hígidos e em equinos submetidos à indução de tendinite do TFDS. Oito equinos adultos foram avaliados em duas fases (F) diferentes, controle (F1) e apresentando tendinite induzida (F2). Na F1, os equinos foram submetidos a cinco biópsias do TFDS do membro torácico esquerdo, com 24 horas (h) de intervalo entre as mesmas. Avaliações clínicas e ultrassonográficas (US) foram realizadas imediatamente antes e, 24 e 48 h após cada procedimento. O tecido tendíneo coletado por biópsia foi analisado histologicamente. A F2 ocorreu três meses depois, quando os mesmos equinos foram submetidos à indução de tendinite do TFDS do membro torácico direito por injeção intratendínea de colagenase. Na P2, Avaliações clínicas e US foram realizadas antes da indução da tendinite e após a mesma nos seguintes momentos: 24, 48, 72 e 96 h depois e, 15, 30, 60, 90, 120 e 150 dias depois. A técnica de biópsia se demonstrou ser de fácil e rápida realização, fornecendo fragmentos de tecido tendíneo adequados para a realização de histologia. Na F1, os equinos não demonstraram sinais de inflamação local, dor ou claudicação, bem como não apresentaram alterações na avaliação US do TFDS após as biópsias, demonstrando que o dano físico ao tendão provocado pela biópsia não compromete sua integridade. Assim, o procedimento pode ser utilizado rotineiramente para avaliações histológicas do tecido tendíneo. Na F2, observou-se uma relação entre os achados US e histológicos no que se refere à evolução da tendinite induzida. Entretanto, observou-se que os sinais clínicos da tendinite não acompanham a condição microscópica do tecido, o que indica que a apresentação clínica não pode ser utilizada como parâmetro para a monitoração da evolução da enfermidade. A técnica de biópsia apresentada para colheita de tecido do TFDS em equinos, permite a obtenção de tecido para avaliação histológica seriada sem provocar sinais clínicos e alterações ultrassonográficas que indiquem dano tecidual. Assim, a técnica permite a monitoração da tendinite e pode ser considerada uma excelente ferramenta na avaliação de injúrias do TFDS.(AU)
Assuntos
Animais , Biópsia/veterinária , Tendinopatia/diagnóstico , Tendinopatia/veterinária , CavalosRESUMO
The purpose of this investigation was to demonstrate the feasibility of a biopsy technique by performing serial evaluations of tissue samples of the forelimb superficial digital flexor tendon (SDFT) in healthy horses and in horses subjected to superficial digital flexor tendonitis induction. Eight adult horses were evaluated in two different phases (P), control (P1) and tendonitis-induced (P2). At P1, the horses were subjected to five SDFT biopsies of the left forelimb, with 24 hours (h) of interval. Clinical and ultrasonographic (US) examinations were performed immediately before the tendonitis induction, 24 and 48 h after the procedure. The biopsied tendon tissues were analyzed through histology. P2 evaluations were carried out three months later, when the same horses were subjected to tendonitis induction by injection of bacterial collagenase into the right forelimb SDFT. P2 clinical and US evaluations, and SDFT biopsies were performed before, and after injury induction at the following time intervals: after 24, 48, 72 and 96 h, and after 15, 30, 60, 90, 120 and 150 days. The biopsy technique has proven to be easy and quick to perform and yielded good tendon samples for histological evaluation. At P1 the horses did not show signs of localised inflammation, pain or lameness, neither SDFT US alterations after biopsies, showing that the biopsy procedure per se did not risk tendon integrity. Therefore, this procedure is feasible for routine tendon histological evaluations. The P2 findings demonstrate a relation between the US and histology evaluations concerning induced tendonitis evolution. However, the clinical signs of tendonitis poorly reflected the microscopic tissue condition, indicating that clinical presentation is not a reliable parameter for monitoring injury development. The presented method of biopsying SDFT tissue in horses enables the serial collection of material for histological analysis causing no clinical signs and tendon damage seen by US images. Therefore, this technique allows tendonitis to be monitored and can be considered an excellent tool in protocols for evaluating SDFT injury.
Objetivou-se demonstrar a viabilidade de uma técnica de biópsia na realização de avaliações sequenciais de amostras de tecido do tendão flexor digital superficial (TFDS) do membro torácico, em equinos hígidos e em equinos submetidos à indução de tendinite do TFDS. Oito equinos adultos foram avaliados em duas fases (F) diferentes, controle (F1) e apresentando tendinite induzida (F2). Na F1, os equinos foram submetidos a cinco biópsias do TFDS do membro torácico esquerdo, com 24 horas (h) de intervalo entre as mesmas. Avaliações clínicas e ultrassonográficas (US) foram realizadas imediatamente antes e, 24 e 48 h após cada procedimento. O tecido tendíneo coletado por biópsia foi analisado histologicamente. A F2 ocorreu três meses depois, quando os mesmos equinos foram submetidos à indução de tendinite do TFDS do membro torácico direito por injeção intratendínea de colagenase. Na P2, Avaliações clínicas e US foram realizadas antes da indução da tendinite e após a mesma nos seguintes momentos: 24, 48, 72 e 96 h depois e, 15, 30, 60, 90, 120 e 150 dias depois. A técnica de biópsia se demonstrou ser de fácil e rápida realização, fornecendo fragmentos de tecido tendíneo adequados para a realização de histologia. Na F1, os equinos não demonstraram sinais de inflamação local, dor ou claudicação, bem como não apresentaram alterações na avaliação US do TFDS após as biópsias, demonstrando que o dano físico ao tendão provocado pela biópsia não compromete sua integridade. Assim, o procedimento pode ser utilizado rotineiramente para avaliações histológicas do tecido tendíneo. Na F2, observou-se uma relação entre os achados US e histológicos no que se refere à evolução da tendinite induzida. Entretanto, observou-se que os sinais clínicos da tendinite não acompanham a condição microscópica do tecido, o que indica que a apresentação clínica não pode ser utilizada como parâmetro para a monitoração da evolução da enfermidade. A técnica de biópsia apresentada para colheita de tecido do TFDS em equinos, permite a obtenção de tecido para avaliação histológica seriada sem provocar sinais clínicos e alterações ultrassonográficas que indiquem dano tecidual. Assim, a técnica permite a monitoração da tendinite e pode ser considerada uma excelente ferramenta na avaliação de injúrias do TFDS.
Assuntos
Animais , Biópsia/veterinária , Cavalos , Tendinopatia/diagnóstico , Tendinopatia/veterináriaRESUMO
Evidências sobre o impacto clínico, social e econômico provenientes de equívocos diagnósticos são analisadas à luz das tendinites e outras moléstias dolorosas crônicas. O objetivo desta revisão é alertar sobre uma possível hipervalorização diagnóstica das tendinites, em especial aquelas supostamente múltiplas ou refratárias, com base em evidências. É apresentada uma revisão da literatura sobre as condições dolorosas crônicas, tais como a síndrome da fibromialgia, no contexto dos diagnósticos equivocados de tendinites, bem como revisão sobre falsa-positividade e parâmetros diagnósticos da ultrassonografia (US) neste cenário. Foram encontradas evidências de equívocos terapêuticos em 41 por cento e equívocos diagnósticos entre 70 e 85 por cento, com despreparo comprovado em até 93,7 por cento dos médicos, tudo envolvendo tais doenças. As vastas repercussões dessa epidemia de equívocos são comentadas.
Evidence of the clinical, social, and economic impact of mistaken diagnoses of tendonitis and other chronic painful disorders are analyzed. The objective of this review is to call attention to the possible diagnostic hyper valuation of tendonitis, especially those supposedly multiple or refractory, based on evidence. A review of the literature on chronic painful disorders, such as fibromyalgia, in the context of mistaken diagnosis of tendonitis, as well a review of false positive and ultrasonographic (US) scan diagnostic parameters, is presented. Evidence of therapeutic mistakes were found in 41 percent and diagnostic mistakes in 70 to 85 percent of the cases, with proven unpreparedness regarding those disorders in up to 93.7 percent of the physicians. The diverse repercussions of this epidemic of mistakes are discussed.
Assuntos
Humanos , Doença Crônica , Transtornos Traumáticos Cumulativos , Erros de Diagnóstico , Fibromialgia , Revisão , Tendinopatia , Tendinopatia/diagnóstico , UltrassonografiaRESUMO
Neste estudo, lesões tendíneas foram induzidas experimentalmente em eqüinos por meio da administração de diferentes doses de colagenase. Foram usados 12 eqüinos adultos, clinicamente sadios e distribuídos aleatoriamente em dois grupos que receberam diferentes doses de colagenase. O grupo 1 (G1) recebeu 1,25mg e o grupo 2 (G2) recebeu 2,5mg de colagenase. Com a agulha posicionada no centro dos tendões flexores digitais superficiais dos membros torácicos, as diferentes doses de colagenase foram aplicadas conforme o grupo experimental. O acompanhamento das lesões tendíneas baseou-se em exames físicos e ultra-sonográficos, realizados a cada sete dias até o período de 28 dias pós-indução. Nas imagens ultra-sonográficas, foram avaliados os parâmetros ecogenicidade, percentual de área lesada, grau de redução e severidade das lesões do tendão flexor digital superficial. O parâmetro mais fiel em resposta às diferentes doses de colagenase administradas foi o percentual de área lesada no interior do tendão. O G2 apresentou uma melhor resposta ultra-sonográfica da tendinite do flexor digital superficial para a realização de estudos experimentais.
In this study, tendinous injuries were induced experimentally in horses, through the administration of different doses of collagenase. Twelve horses, clinically healthy, were distributed into two groups that received different doses of collagenase. Group 1 (G1) received 1.25mg and Group 2 (G2) received 2.5mg of collagenase. With the needle positioned at the center of the superficial digital flexor tendon in the equine forelimbs, different doses of collagenase were applied in agreement the experimental group. The monitoring of colagenase-induced tendonitis was based on physical and ultrasonographic exams, carried out every seven days until the period of 28 days post-induction. In the images of ultrasound were evaluated the echogenicity, the percentage of injured area, degree of reduction and severity of injuries of colagenase-induced tendonitis. The most accurate parameter in response to different doses of collagenase administered was the percentage of area injured in the interior of the tendon. The G2 presented one better ultrasonographic reply of the tendonitis of the superficial digital flexor for the accomplishment of experimental studies.
Assuntos
Animais , Masculino , Feminino , Colagenases/efeitos adversos , Tendinopatia/induzido quimicamente , Tendinopatia , Tendinopatia/veterinária , CavalosRESUMO
In this study, tendinous injuries were induced experimentally in horses, through the administration of different doses of collagenase. Twelve horses, clinically healthy, were distributed into two groups that received different doses of collagenase. Group 1 (G1) received 1.25mg and Group 2 (G2) received 2.5mg of collagenase. With the needle positioned at the center of the superficial digital flexor tendon in the equine forelimbs, different doses of collagenase were applied in agreement the experimental group. The monitoring of colagenase-induced tendonitis was based on physical and ultrasonographic exams, carried out every seven days until the period of 28 days post-induction. In the images of ultrasound were evaluated the echogenicity, the percentage of injured area, degree of reduction and severity of injuries of colagenase-induced tendonitis. The most accurate parameter in response to different doses of collagenase administered was the percentage of area injured in the interior of the tendon. The G2 presented one better ultrasonographic reply of the tendonitis of the superficial digital flexor for the accomplishment of experimental studies.
Neste estudo, lesões tendíneas foram induzidas experimentalmente em eqüinos por meio da administração de diferentes doses de colagenase. Foram usados 12 eqüinos adultos, clinicamente sadios e distribuídos aleatoriamente em dois grupos que receberam diferentes doses de colagenase. O grupo 1 (G1) recebeu 1,25mg e o grupo 2 (G2) recebeu 2,5mg de colagenase. Com a agulha posicionada no centro dos tendões flexores digitais superficiais dos membros torácicos, as diferentes doses de colagenase foram aplicadas conforme o grupo experimental. O acompanhamento das lesões tendíneas baseou-se em exames físicos e ultra-sonográficos, realizados a cada sete dias até o período de 28 dias pós-indução. Nas imagens ultra-sonográficas, foram avaliados os parâmetros ecogenicidade, percentual de área lesada, grau de redução e severidade das lesões do tendão flexor digital superficial. O parâmetro mais fiel em resposta às diferentes doses de colagenase administradas foi o percentual de área lesada no interior do tendão. O G2 apresentou uma melhor resposta ultra-sonográfica da tendinite do flexor digital superficial para a realização de estudos experimentais.
RESUMO
In this study, tendinous injuries were induced experimentally in horses, through the administration of different doses of collagenase. Twelve horses, clinically healthy, were distributed into two groups that received different doses of collagenase. Group 1 (G1) received 1.25mg and Group 2 (G2) received 2.5mg of collagenase. With the needle positioned at the center of the superficial digital flexor tendon in the equine forelimbs, different doses of collagenase were applied in agreement the experimental group. The monitoring of colagenase-induced tendonitis was based on physical and ultrasonographic exams, carried out every seven days until the period of 28 days post-induction. In the images of ultrasound were evaluated the echogenicity, the percentage of injured area, degree of reduction and severity of injuries of colagenase-induced tendonitis. The most accurate parameter in response to different doses of collagenase administered was the percentage of area injured in the interior of the tendon. The G2 presented one better ultrasonographic reply of the tendonitis of the superficial digital flexor for the accomplishment of experimental studies.
Neste estudo, lesões tendíneas foram induzidas experimentalmente em eqüinos por meio da administração de diferentes doses de colagenase. Foram usados 12 eqüinos adultos, clinicamente sadios e distribuídos aleatoriamente em dois grupos que receberam diferentes doses de colagenase. O grupo 1 (G1) recebeu 1,25mg e o grupo 2 (G2) recebeu 2,5mg de colagenase. Com a agulha posicionada no centro dos tendões flexores digitais superficiais dos membros torácicos, as diferentes doses de colagenase foram aplicadas conforme o grupo experimental. O acompanhamento das lesões tendíneas baseou-se em exames físicos e ultra-sonográficos, realizados a cada sete dias até o período de 28 dias pós-indução. Nas imagens ultra-sonográficas, foram avaliados os parâmetros ecogenicidade, percentual de área lesada, grau de redução e severidade das lesões do tendão flexor digital superficial. O parâmetro mais fiel em resposta às diferentes doses de colagenase administradas foi o percentual de área lesada no interior do tendão. O G2 apresentou uma melhor resposta ultra-sonográfica da tendinite do flexor digital superficial para a realização de estudos experimentais.