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Introduction: Surgery for the management of individuals with long head of the biceps tendon (LHBT) tendinopathy is common. Little is known about physical therapy (PT) utilization prior to surgery. The purpose of this review was to investigate the use of PT prior to biceps tenodesis and tenotomy surgeries by assessing the number of visits and the types of interventions. A secondary objective was to report on themes of PT interventions. Methods: A retrospective observational cohort study design was used to analyze medical records and report on patient visits, procedure codes based on active or passive interventions, and themes of interventions utilized by PT. Results: Patient records (n=308) were screened for eligibility, n=62 (20.1%) patients attended PT prior to surgery. The median number of PT visits was four (IQR=3.5), and 39/62 (63%) patients had four or more visits to PT. Active interventions were used in 54.5% (533/978) of the codes billed; passive interventions were used in 45.5% (445/978) of the codes. There was high utilization of therapeutic exercise [93.4% (498/533) of active procedure codes] including muscle performance/resistance, functional activity, motor control and stretching. Manual therapy [84.3% (375/445) of passive procedure codes] included soft tissue mobilization, non-thrust manipulation (glenohumeral joint and cervical spine) and thrust manipulation (thoracic spine). Conclusions: PT was not commonly utilized prior to undergoing biceps tenodesis and tenotomy surgery. Further research is needed to understand the reasons for low utilization. Level of Evidence: 3b [ABSTRACT FROM AUTHOR]

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BACKGROUND: Increasing studies have found that estrogen has a certain correlation with tendinopathy, but for a long time, there are few experiments and summaries of estrogen in tendinopathy, which makes it difficult for specialists and scholars in related fields to fully understand the research status. OBJECTIVE: To summarize the current clinical or preclinical original research, so as to summarize the role of estrogen in tendinosis, and make a certain prospect for the evaluation and management of estrogen in tendinosis in the future. METHODS: Relevant literature in PubMed, Web of Science, CNKI, WanFang, and VIP databases were searched by computer. Search time was from January 2008 to September 2023. The search terms were “oestrogen, estrogen, estrogen receptor, tendinopathy, tendonopathy, sinew, tendon, tendons, myotenositis” in English and “estrogen, estrogen receptor, tendinosis, tendon, tendinitis” in Chinese. According to the selection criteria, the search results were screened and excluded, and finally 60 documents were included for review and analysis. RESULTS AND CONCLUSION: In vivo studies have shown that estrogen can promote tendon anabolism. In vitro experiments have also proved that various estrogens can promote the proliferation of tendon cells and reduce inflammation and apoptosis, but most of the experiments are limited to animal models. Estrogen receptor β acts more in tendon injury and repair processes, but estrogen receptor α has not been found to have a major impact on tendon injury. The expression of estrogen receptor β can repair the tendon by affecting the formation of fat, the deposition of type I collagen and reducing the apoptosis of tendon cells, while its over-expression may promote inflammation and angiogenesis, thus promoting the inflammatory process and playing a role in tendon injury. Animal studies have shown that estrogen deficiency may reduce the synthesis efficiency of collagen in the tendon, decrease the elasticity of tendon, inhibit the synthesis and metabolism of the tendon, which is not conducive to the repair of tendon injury, while normal level of estrogen may stimulate the synthesis of type I collagen in tendon and promote the proliferation and metabolism of tendon cells. At present, the molecular mechanism of estrogen in tendon injury has not been fully explained. More experiments focus on tendon collagen synthesis, cell proliferation and apoptosis. Only a few documents have studied the molecular mechanisms of estrogen receptor β deficiency regulating interferon regulatory factor 5-chemokine ligand 3 axis, E2 regulating estrogen receptor α and PI-3K-Akt signaling pathways, and high levels of estradiol reducing the level of free-circulating insulin-like growth factor. Various estrogens, including endogenous estrogens and phytoestrogens, are beneficial to the repair of tendinopathy at normal levels, and estrogen receptor β mainly affects the formation of fat, the deposition of type I collagen and the reduction of apoptosis of tendon cells through, which lays a foundation for the future treatment of tendinopathy with different subtypes of estrogens in vivo and the influence of estrogen membrane receptors on tendinopathy. [ABSTRACT FROM AUTHOR]

The lack of representative in vitro models recapitulating human tendon (patho)physiology is among the major factors hindering consistent progress in the knowledge‐based development of adequate therapies for tendinopathy.Here, an organotypic 3D tendon‐on‐chip model is designed that allows studying the spatiotemporal dynamics of its cellular and molecular mechanisms.Combining the synergistic effects of a bioactive hydrogel matrix with the biophysical cues of magnetic microfibers directly aligned on the microfluidic chip, it is possible to recreate the anisotropic architecture, cell patterns, and phenotype of tendon intrinsic (core) compartment. When incorporated with vascular‐like vessels emulating the interface between its intrinsic‐extrinsic compartments, crosstalk with endothelial cells are found to drive stromal tenocytes toward a reparative profile. This platform is further used to study adaptive immune cell responses at the onset of tissue inflammation, focusing on interactions between tendon compartment tenocytes and circulating T cells.The proinflammatory signature resulting from this intra/inter‐cellular communication induces the recruitment of T cells into the inflamed core compartment and confirms the involvement of this cellular crosstalk in positive feedback loops leading to the amplification of tendon inflammation.Overall, the developed 3D tendon‐on‐chip provides a powerful new tool enabling mechanistic studies on the pathogenesis of tendinopathy as well as for assessing new therapies. [ABSTRACT FROM AUTHOR]

Background Posttraumatic stress disorder (PTSD) has been extensively studied in patients who have experienced natural disasters or military conflict, but there remains a substantial gap in knowledge about the prevalence of PTSD after civilian orthopaedic trauma, especially as related to firearms. Gun violence is endemic in the United States, especially in urban centers, and the mental impact is often minimized during the treatment of physical injuries. Questions/purposes (1) Do patients who experience gunshot wound (GSW) trauma have higher PTSD screening scores compared with patients with blunt or other trauma (for example, motor vehicle and motorcycle accidents or stab wounds) and those with elective conditions (for example, arthritis, tendinitis, or nerve compression)? (2) Are PTSD scores correlated with pain scores in patients with GSW trauma, those with non-GSW trauma, and patients with elective orthopaedic symptoms? Methods We performed a retrospective study of adults older than 18 years of age presenting to an orthopaedic clinic over an 8-month period between August 2021 and May 2022. All patients presenting to the clinic were approached for inclusion (2034 patients), and 630 new or postoperative patients answered study surveys as part of routine care. Patients were divided into three cohorts based on the orthopaedic condition with which they presented, whether gunshot trauma, blunt trauma, or elective orthopaedic symptoms. Overall, the results from 415 patients were analyzed, including 212 patients with elective orthopaedic symptoms, 157 patients with non-GSW trauma, and 46 patients with GSW trauma. Clinical data including demographic information were collected at the time of appointment and abstracted along with results from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, short screening questionnaire, which uses a 7-item scale scored from 0 to 7 (with higher scores representing worse symptoms), and fromthe numeric rating scale for pain (range 0 to 10). Both questionnaires were routinely administered by medical assistants at patient intake. The proportions of patients completing PTSD scoring were 45% (95) in the elective group, 74% (116) in the group with non-GSWtrauma, and 85% (39) in the group with GSWtrauma (p = 0.01). We compared the PTSD scores across the three groups and then dichotomized the scores as a negative versus positive screening result at a value of$4withfurther comparative analysis. The correlation between pain and PTSD scores was also evaluated. Results Patients with GSW trauma had higher mean 6 SD PTSD scores compared with those who had non-GSW trauma (4.87 6 4.05 versus 1.75 6 2.72, mean difference 3.21 [95% CI 1.99 to 4.26]; p < 0.001) and those who presented with elective conditions (4.87 6 4.05 versus 0.49 6 1.04, mean difference 4.38 [95%CI 3.50 to 5.26]; p < 0.001). When dichotomized for positive or negative PTSD screening results, patients withGSWtrauma had a higher risk of having PTSD (64% [25 of 39]) compared with patients with non-GSW trauma (27% [31 of 116], relative risk 2.40 [95% CI 1.64 to 3.51]; p < 0.001) and compared with patients with elective conditions (4%[4 of 95], relative risk 15.22 [95%CI 5.67 to 40.87]; p < 0.001). Pain scores were correlated with PTSD scores only for patients with non-GSW trauma (r = 0.37; p < 0.0001). No correlation with pain scores was present for patients withGSW(r = 0.24; p = 0.16) or patients with elective conditions (r = -0.04; p = 0.75). Conclusion In an orthopaedic clinic population, the prevalence of positive screening for PTSD was highest in the population sustaining gunshot trauma as compared with blunt or other trauma and elective orthopaedic conditions. Interestingly, pain scores correlated with PTSD screening only in the patients with non-GSW trauma. These differences suggest a substantial difference in the populations at risk of PTSD after trauma. Overall, the psychological impacts of gun trauma are poorly understood. The next step would be to prospectively study the differences and timelines of PTSD screening in patients with GSW trauma in comparison with patients with blunt or other trauma to better define the treatment needs in this population. Level of Evidence Level III, prognostic study. [ABSTRACT FROM AUTHOR]

Background: Adult tendon tissue has limited and slow regenerative capacity. Sambucus nigra plant possesses antioxidant and anti‐inflammatory attributes. Objectives: This study aimed to evaluate the effect of hydroalcoholic extract of this plant's fruit on superficial digital flexor tendon repair in rabbits (SDFT). Methods: Twenty‐five male New Zealand white rabbits weighing 1.5–2 kg were selected, quarantined and randomly divided into four groups of six. By performing a partial left posterior limb tenotomy, differentiating the SDFT and creating multiple scrapes were performed. During 3 consecutive days post‐surgery, the positive control group was injected with 0.5 mg/kg dexamethasone, whereas the treatment groups received extract doses of 200 and 400 mg/kg, respectively. The negative control group did not receive any medication. Evaluation of sonographic and histopathological parameters was conducted on days 0, 7 and 28 post‐surgeries. Findings were analysed and compared using SPSS22. Results: Both treatment groups showed significant differences in echogenicity, and collagen fibre alignment compared to the control and positive control groups, in sonographic evaluation. Histopathological examination revealed fewer inflammatory cells and increased collagen fibre formation in the treatment groups compared to the other two groups. No significant difference in angiogenesis was observed among the groups on days 7 and 28 (p value <0.05). Conclusions: The results indicate that the S. nigra fruit extract, by stimulating collagen synthesis and reducing inflammation, effectively accelerates the healing process of injured tendons. [ABSTRACT FROM AUTHOR]

Rotator cuff tears (RCT) are the most common cause of shoulder pain among adults. "Rotator cuff" refers to the four muscles that cover the shoulder joint: supraspinatus, infraspinatus, subscapularis, and teres minor. These muscles help maintain the rotational movement and stability of the shoulder joint. RCT is a condition in which one or more of these four muscles become ruptured or damaged, causing pain in the arms and shoulders. RCT results from degenerative changes caused by chronic inflammation of the tendons and consequent tendon tissue defects. This phenomenon occurs because of the exhaustion of endogenous tendon stem cells. Tendon regeneration requires rejuvenation of these endogenous tendon stem/progenitor cells (TSPCs) prior to their growth phase. TSPCs exhibit clonogenicity, multipotency, and self-renewal properties; they express classical stem cell markers and genes associated with the tendon lineage. However, specific markers for TSPC are yet to be identified. In this review, we introduce novel TSPC markers and discuss various strategies for TSPC reprogramming. With further research, TSPC reprogramming technology could be adapted to treat age-related degenerative diseases, providing a new strategy for regenerative medicine. [ABSTRACT FROM AUTHOR]

The prevalence of asymptomatic shoulder pathology has been shown to be high on both ultrasound and magnetic resonance imaging (MRI). The most common shoulder pathologies identified in asymptomatic, non‐athlete individuals include rotator cuff pathology, acromioclavicular (AC) joint pathology, labral tears, subacromial bursitis, and calcific tendinitis. The data in the current literature suggest that asymptomatic rotator cuff tears are diagnosed on ultrasound and MRI at high rates, suggesting that rotator cuff tears may be considered an age‐related, normal, degenerative change. However, there are data to suggest that the presence of an asymptomatic rotator cuff tear on imaging may predispose a patient to shoulder pain in the future, although the data remain inconclusive. AC joint arthritic changes are also common in older individuals on advanced imaging. Recent studies have reported that labral tears are common in asymptomatic shoulders, although at less frequent rates than in athletes, but more research is required on this topic. In addition, the presence of subacromial bursitis on imaging has not been found to accurately differentiate between symptomatic and asymptomatic shoulders. Finally, calcific tendinitis has been diagnosed asymptomatically, with most individuals remaining asymptomatic. Individuals who did develop pain developed severe pain, although the risk factors for developing symptomatic calcific tendinitis are unclear. In summary, given the high prevalence of shoulder pathology diagnosed on imaging, it is important to not over diagnose or complete an unnecessary workup for an asymptomatic person who is otherwise healthy. [ABSTRACT FROM AUTHOR]

Background: Achilles tendinopathy is a common condition without a reproducible and timely treatment modality. Platelet-rich plasma (PRP) injection has been proposed as an enticing treatment option, but there is no consensus regarding its effectiveness. Purpose: To pool the available data and evaluate the evidence of the effect of PRP injections on Achilles tendinopathy. Study Design: Systematic review; Level of evidence, 1. Methods: This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. CINAHL via EBSCOhost, Cochrane Library, and PubMed databases were searched for randomized controlled trials comparing PRP injection with nonoperative treatment, with the Victorian Institute of Sport Assessment–Achilles (VISA-A) questionnaire score or maximal Achilles tendon (AT) thickness on ultrasound as outcome measures. Risk-of-bias assessment was performed of the included studies, and meta-analyses compared differences in outcome measures between PRP injection and control at the short-term (3-month), intermediate-term (6-month), and long-term (12-month) follow-ups. Results: Of 409 publications, 6 publications (N = 422 patients with chronic midportion Achilles tendinopathy) were identified from the literature search. Risk-of-bias assessment revealed 2 studies were low risk, 1 was of some concern, and 3 were high risk of bias. Meta-analysis revealed no significant differences between PRP injection and control at any time point for both VISA-A score (short term: P =.29; intermediate term: P =.42; long term: P =.57) and maximal AT thickness (short term: P =.60; intermediate term: P =.20; long term: P =.55). Conclusion: Our review demonstrated that although recent trends have shown an increasing popularity of PRP injection, no solid evidence has been established. The heterogenicity of the tendinopathy pathology and the PRP injection content and methodology should be controlled by better-designed clinical trials. Further research is needed before it should be recommended as a standard treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: Parsonage-Turner syndrome (PTS) is a rare brachial neuritis of sudden onset resulting in constant, severe shoulder girdle pain followed by weakness and sensory deficits. The complex presentation often results in delayed diagnosis or misdiagnosis. This case report provides insight into a comprehensive approach to diagnosing PTS. CASE PRESENTATION: A 50-year-old man began experiencing severe left shoulder pain 48 hours before seeking medical treatment. OUTCOME AND FOLLOW-UP: The lack of conclusive findings during the physical therapy evaluation prompted a magnetic resonance imaging that revealed PTS. The patient reported full resolution of symptoms within 12 months. DISCUSSION: Severe pain, neurological weakness, and sensory changes led to the initial suspicion of a rotator cuff tear and brachial plexus injury, and a magnetic resonance imaging was recommended. This case study adds to the body of evidence emphasizing the importance of differential diagnosis in patients with neuromusculoskeletal involvement. JOSPT Cases 2024;4(4):1-4. Epub 18 September 2024. doi:10.2519/josptcases.2024.0038 [ABSTRACT FROM AUTHOR]

Introduction: Biceps tendinosis, a milder form on the spectrum of biceps tendinopathy, is unusual at the distal insertion site. Patients with distal biceps tendinosis may experience pain and dysfunction which could inhibit their activities of daily living. Diagnosis of distal biceps tendinosis may be facilitated with ultrasonography (US), whose accuracy is increasingly recognised, while providing many benefits over other modalities, like magnetic resonance imaging (MRI). Case report: We report two cases of distal biceps tendinosis diagnosed by US with clinical details, imaging findings and patient management. Two patients present with elbow pain after nontraumatic activities. US revealed a thickened distal biceps tendon with mild heterogeneous hypoechogenicity without fibre disruption or retraction in both cases and evidence of hyperemia on Doppler with surrounding bursal fluid in case 2. Discussion: Tendinosis has variable aetiologies, but US commonly cannot differentiate among these; therefore, patient's clinical history is the major component in determining the underlying cause. Chronic progression of tendon pathology leads to partial and full thickness tears. Tendinosis has a characteristic US appearance. US has many benefits and clinicians may use this modality to assess possible pathological structures with ease, convenience and efficiency compared with using MRI. Conclusion: Distal biceps tendinosis may present with clinical symptoms of pain and decreased activities of daily living, and may progress to more severe forms of tendinopathy. Early diagnosis is beneficial for the treatment outcomes of this condition. US can visualise distal biceps tendinosis with reliability, providing an alternative diagnostic technique with many benefits compared with MRI. [ABSTRACT FROM AUTHOR]

Objective: The objective of the case report is to analyze the clinical manifestations and imaging features of gouty long head of biceps tendinitis, and to summarize the methods and effects of shoulder arthroscopic surgery. Clinical presentation and intervention: The clinical data of a 39-year-old Han Chinese female with gouty long head of the biceps tendinitis was retrospectively analyzed, and the clinical manifestations, imaging features, and diagnosis and treatment were analyzed. The patient presented with pain and limited movement of right shoulder joint. Computed tomography showed irregular high-density shadows above the glenoid and adjacent to the coracoid process of the right shoulder. Magnetic resonance imaging revealed superior labrum anterior and posterior injury with edema in the upper recess and axillary sac. After arthroscopic surgery, the "tofu residue" tissue of the long head of the biceps was removed, and the postoperative pathological examination proved that it was gout stone. Conclusion: Gouty long head of the biceps tendinitis is a rare disease. Arthroscopic surgery can probe the structural lesions of shoulder cavity in all aspects, improve the surgical accuracy, and reduce the trauma. [ABSTRACT FROM AUTHOR]

Background: Tendinopathy refers to conditions characterized by collagen degeneration within tendon tissue, accompanied by the proliferation of capillaries and arteries, resulting in reduced mechanical function, pain, and swelling. While inflammation in tendinopathy can play a role in preventing infection, uncontrolled inflammation can hinder tissue regeneration and lead to fibrosis and impaired movement. Objectives: The inability to regulate inflammation poses a significant limitation in tendinopathy treatment. Therefore, an ideal treatment strategy should involve modulation of the inflammatory process while promoting tissue regeneration. Methods: The current review article was prepared by searching PubMed, Scopus, Web of Science, and Google Scholar databases. Several treatment approaches based on biomaterials have been developed. Results: This review examines various treatment methods utilizing small molecules, biological compounds, herbal medicine‐inspired approaches, immunotherapy, gene therapy, cell‐based therapy, tissue engineering, nanotechnology, and phototherapy. Conclusion: These treatments work through mechanisms of action involving signaling pathways such as transforming growth factor‐beta (TGF‐β), mitogen‐activated protein kinases (MAPKs), and nuclear factor kappa‐light‐chain‐enhancer of activated B cells (NF‐κB), all of which contribute to the repair of injured tendons. [ABSTRACT FROM AUTHOR]

Knowledge of how to treat chronic tendinopathy has advanced in recent years, but the treatment of early tendinopathy is not well understood. The main purpose of this prospective observational study was to investigate if changes occur in clinical and imaging outcomes over 12 weeks in elite athletes with recent debut of tendinopathy. Sixty‐five elite adult athletes (24 ± 5 years) with early Achilles or patellar tendinopathy (symptoms < 3 months) were examined at baseline and after 12 weeks. Patients were divided into groups based on the duration of symptoms at the time of inclusion: (T1): 0–1 month, (T2): 1–2 months, or (T3): 2–3 months. Pain‐guided activity modification was the only intervention. We assessed the following clinical outcomes: Questionnaires (Victorian Institute of Sports Assessment (VISA)) and pain scores (0–10 numeric rating scale, NRS), structural outcomes from ultrasonography: Thickness, echogenicity, and Doppler flow, and from magnetic resonance imaging: Cross‐sectional area (CSA), thickness and length. Tendinopathic Achilles and patellar tendons displayed no significant differences on imaging tendon structural outcomes between T1 (n = 19), T2 (n = 23), and T3 (n = 20) at baseline or after 12 weeks, with one exception: Patellar tendons in T1 were thicker than T2 and T3 at baseline. Although athletes improved clinically on VISA and most NRS scores after 12 weeks, affected tendons with greater thickness, CSA and Doppler flow than contralateral tendons at baseline remained unchanged after 12 weeks. In conclusion, these data suggest that early tendinopathy in elite athletes can improve clinically after 12 weeks while morphology remains unchanged. [ABSTRACT FROM AUTHOR]

with acquired spinal cord injuries. The findings suggest that preoperative counseling should address realistic expectations and potential challenges specific to each patient population. [Extracted from the article]

Background: Poor balance ability may contribute to shoulder pathology in patients with existing shoulder pathologies or vice versa. The relationship between kinesiophobia and chronic shoulder pain intensity has been researched, although the conclusions are conflicting. To our knowledge, no study in the literature explores the association between kinesiophobia and balance in patients with shoulder pain. Objective: To investigate the relationship between kinesiophobia, upper extremity functions, and balance abilities in patients with shoulder pain. Design: Cross‐sectional observational study. Setting: Physical medicine and rehabilitation hospital. Interventions: Not applicable. Participants: A total of 44 patients with shoulder pain were included in the study. Main Outcome Measures: The pain severity was assessed using a visual analog scale (VAS). The Tampa Scale for Kinesiophobia (TSK), Berg Balance Scale (BBS), and Shoulder Pain and Disability Index (SPADI) were used to assess the patients. Ultrasound was used to diagnose underlying shoulder joint problems. Static and dynamic postural control was evaluated. Results: The most common pathologies detected by ultrasound were supraspinatus tendinitis/rupture (77.3%), cortical irregularity (68.2%), and bursitis (63.6%). TSK score did not correlate with age, body mass index, symptom duration, or VAS score in rest (all p >.05), but it was associated with scores on the BBS (r = −0.437, p =.003), SPADI‐pain (r = 0.474, p =.001), SPADI‐disability (r = 0.355, p =.018), SPADI‐total (r = 0.405, p =.006), and VAS in activity (r = 0.331, p =.028). According to multiple linear regression analysis, BBS score, SPADI‐total score, and anterior–posterior sway length were significant predictors of TSK (r = 0.645, r2 = 0.416). Conclusions: According to the findings of this study, the main risk factors for high levels of kinesiophobia are poor balance, severe pain, and disability. In addition to mechanical causes of shoulder pain, diagnosing and intervening on underlying balance issues and psychosocial causes of shoulder pain will improve treatment success. [ABSTRACT FROM AUTHOR]

Periarticular calcifications are a common condition for rheumatologists. They are characterized by deposition of carbonated apatite in tendons or connective tissues around joints. It most commonly affects patients between 30 and 60, and the main location is the shoulder (rotator cuff tendons), followed by the hip. Although the disease is frequent, factors associated with the appearance of the deposits or their spontaneous resorption remain unclear. In this review, we will summarize the available data about mechanisms underlying the constitution of the deposits and their resorption and describe the various affected sites and the associated symptoms. In the last part, we will discuss current treatment options. [ABSTRACT FROM AUTHOR]

Key Clinical Message: The differential diagnoses of popliteal ganglion cysts include Baker's cysts, popliteal artery aneurysms, popliteal tendinitis, popliteal lymphadenopathy, lipomas, and synovial sarcoma. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of tendon rupture and tendinopathies (TRT) has not been determined in a large population of patients with atherosclerotic cardiovascular disease (ASCVD). We investigated TRT prevalence among patients with ASCVD and in the general population, using data from the Symphony Health Integrated Dataverse, a large US medical and pharmacy claims database. Methods: This retrospective, observational study included patients aged ≥ 19 years from the claims database during the identification period (January 2019 to December 2020) and 12 months of continuous enrollment. The primary outcome was evidence of TRT in the 12 months following the index date (first ASCVD diagnosis in the ASCVD cohort; first claim in the claims database in the overall population). Diagnostic codes (ICD-10 and/or CPT) were used to define ASCVD and TRT diagnosis. Results: The ASCVD cohort and overall population included 5,589,273 and 61,715,843 patients, respectively. In the ASCVD cohort, use of medications with a potential or known association with TRT was identified in 67.9% (statins), 17.7% (corticosteroids), and 16.7% (fluoroquinolones) of patients. Bempedoic acid use was reported in 1556 (< 0.1%) patients. TRT prevalence during 12-month follow-up was 3.4% (ASCVD cohort) and 1.9% (overall population). Among patients with ASCVD, 83.5% experienced TRT in only one region of the body. Factors most associated with TRT in the ASCVD cohort were increasing age, most notably in those aged 45–‍64 years (odds ratio [OR] 2.19; 95% confidence interval [CI] 2.07–2.32), obesity (OR 1.51; 95% CI 1.50–1.53), and rheumatoid arthritis (OR 1.47; 95% CI 1.45–1.79). Use of statins or bempedoic acid was not associated with increased TRT risk. Conclusion: Patients with ASCVD may have greater risk of TRT than the general population, which may be driven by an increased prevalence of comorbidities and use of medications with a potential or known association with TRT. Plain Language Summary: Patients with atherosclerosis, the main cause of heart attacks, strokes, and peripheral vascular disease, typically require several drugs to control the disease. Some of the drugs used to treat atherosclerosis have been linked to a higher occurrence of tendon tears (or ruptures) or swelling/inflammation of the tendons (tendinopathies). However, there may be other factors present in these patients that increase the risk of tendon injuries that are not related to these drugs. This study used the medical records of over 5.5 million patients with atherosclerosis and over 63 million patients reflecting the general population in the United States to determine the prevalence of tendon injury. Additionally, the researchers looked at other factors that might be related to a higher risk of tendon injury in each group. Over a 12-month period, tendon injuries occurred in 3.4% of patients with atherosclerosis and 1.8% of patients in the general population. In patients with atherosclerosis, factors such as being obese, older (45–64 years), or having rheumatoid arthritis were also linked to an increased risk of tendon injuries. There was no association seen between statin or bempedoic acid use and tendon injuries. These results may help healthcare providers to determine the underlying risk of tendon injuries and guide treatment of this patient population. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of intra-articular steroid injection with ultrasound-guided supra-scapular nerve block in the management of frozen shoulder in terms of shoulder pain and disability index score and range of motion. Method: This randomized controlled trial was conducted in orthopedic department, PIMS, Islamabad from 1st January, 2020 to 30th June, 2020. A total of 72 patients were randomly equally (n=36 each) allocated to Group-A (intra-articular steroid injection) and Group-B (supra-scapular nerve block). Adults above 18 years of both genders having diffuse shoulder pain were included. Cases of shoulder pain localized because of bicipital tendinitis, rotator cuff tear, pain due to acute trauma and those with osteoarthritis were excluded. Data was analyzed in SPSS version 22.0. Results: Patients average age was 60.1 ± 6.29 in IASI and 58.0 ± 5.83 years in SSNB group and there were 19 (52.8%) males in IASI group compared to 15 (41.7%) in SSNB. At three weeks mean pain was significantly less in SSNB (57.1 ± 9.53 vs 49.4 ± 9.02) compared to IASI group (p-value, <0.001). The mean disability index was significantly low in SSNB (51.5 ± 5.10 vs 63.9 ± 5.14) versus IASI group (p-value, <0.001). At one week, three weeks and six weeks, mean external rotation was better in SSNB than IASI group (p-value, <0.001). The mean abduction was also better in SSNB group. Conclusion: Ultrasound guided supra-scapular nerve block is better than intra-articular steroid injection in managing frozen shoulder. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the small joints of the hands and feet, characterized by pain, inflammation, and joint damage. In this context, magnetic resonance imaging (MRI) is useful to identify and monitor joint/tendon inflammation and the evolution of joint damage, playing a key role in treatment response evaluation, in addition to clinical measurements. Various methods to quantify joint inflammation and damage with MRI in RA have been developed, such as RA-MRI Score (RAMRIS), Early RA-MRI Score (ERAMRS), and Simplified RA-MRI Score (SAMIS). RAMRIS, introduced in 2002, offers an objective means to assess inflammation and damage via MRI in RA trials, encompassing findings such as synovitis, bone erosion, and edema/osteitis. Recently, an updated RAMRIS version was developed, which also includes the evaluation of joint space narrowing and tenosynovitis. The RAMRIS-5, which is a condensed RAMSIS version focusing on five hand joints only, has been proven to be a valuable resource for the semi-quantitative evaluation of RA joint damage, both in early and established disease. This narrative literature review will provide an overview of the MRI scoring systems that have been developed for the assessment of joint inflammation and structural damage in RA patients. [ABSTRACT FROM AUTHOR]

Systemic sclerosis (SSc) is a multi-organ, systemic connective tissue disease, which affects the lungs, heart, gastrointestinal tract, kidneys, skin, and musculoskeletal system. Musculoskeletal involvement is observed in 40-90% of patients with SSc. During the disease, any structure of the musculoskeletal system, such as bones, joints, tendon sheaths, tendons, and muscles, may be affected. The most common symptoms include joint pain, arthritis, tendinitis leading to tendon rupture, acro-osteolysis, calcinosis, myalgia, and myositis. Osteo-articular complications and changes in the soft tissues of the hand lead to finger contracture, which causes deterioration of the patients' quality of life and disability. To sum up, a more detailed understanding of the aetiology leading to progressive changes in the musculoskeletal system may contribute to the introduction of new therapeutic options, and thus improve the quality of life and reduce disability in patients with SSc. [ABSTRACT FROM AUTHOR]

An 18 months old Hannoverian mare was presented with an approximately 8-week old, non-healing focal wound in the left mid metatarsal region and severe left hind limb lameness at a walk (grade 4/5). Ultrasonography revealed a sinus tract between the skin and the superficial digital flexor tendon (SDFT) and a diffuse chronic tendonitis of the SDFT. Surgical en bloc resection of the sinus tract and the affected SDFT tissue was performed, and two collagen sponges (size 5 cm × 5 cm×0.5 cm) consisting of 70 mg equine tendon collagen impregnated with 50 mg gentamicin sulfate (GENTA-COLLresorb®, Resorba Medical GmbH, Nürnberg, Germany) were implanted into the wound prior to closure in 3 layers. A half limb cast was applied for 14 days followed by 4 days of a splint bandage. The wound healed by primary intention and the horse was discharged 4 weeks post operatively. Follow up examinations 6 and 24 month after discharge revealed excellent wound healing and soundness. Seven and 14 years after surgery the horse was still successfully used as pleasure riding horse as intended. [ABSTRACT FROM AUTHOR]

Iliopsoas tendonitis, typically caused by impingement with the acetabular cup, occurs in up to 18% of patients after total hip arthroplasty (THA) and up to 30% of patients after hip resurfacing arthroplasty (HRA). We have developed a simulation for detecting iliopsoas impingement and validated it in a previous study of THA patients. However, due to the difference in incidence between HRA and THA, this study had two aims. First, to validate the simulation in a cohort of HRA patients and, second, to comparethe results of the HRA and THA patients to understand any differences in their etiology. We conducted a retrospective search in an experienced surgeon's database for HRA patients with iliopsoas tendonitisand control patients without iliopsoas tendonitis, resulting in two cohorts of 12 patients. Using CT scans, 3D models of the each patient's prosthetic and bony anatomy were generated, landmarked, and simulated. Regarding validation of the simulation for HRA patients, impingement significantly predicted the probability of iliopsoas tendonitis in logistic regression models and the simulation had a sensitivity of 83%, specificity of 100%, and an AUC ROC curve of 0.95. Unexpectedly, the HRA cohort exhibited less impingement than the THA cohort. Our novel simulation has now been demonstrated to detect iliopsoas impingement and differentiate between the symptomatic and asymptomatic cohorts in investigations of THA and HRA patients. This tool has the potential to be used preoperatively, to guide decisions about optimal cup placement, and postoperatively, to assist in the diagnosis of iliopsoas tendonitis. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the distribution of intra- and extraarticular MRI findings in children and adolescents with clinically suspected intraarticular cause of hip pain in order to assess the need for additional intraarticular contrast administration. Material and methods: Database was searched over a period of 34 months retrospectively for consecutive hip MR arthrography in young patients (8–17 years) with suspected intraarticular cause of hip or groin pain. Exclusion criteria were prior hip surgery, follow-up examination due to known intraarticular pathology, incomplete examination, qualitatively non-diagnostic examinations, and missing informed consent. Reports of fellowship-trained MSK radiologists were searched for intraarticular versus extraarticular findings explaining hip or groin pain. Results: Seventy patients (68% female; median age: 14.5 years; range:10.8–16.9 years) were analyzed. No reason for pain was found in 30 (42.9%) hips, extraarticular reasons in 20 (28.6%) cases, intraarticular in 14 (20.0%), and both (intra- and extraarticular) in 6 (8.6%) hips. Most common extraarticular reasons were apophysitis (14.3%), other bony stress reactions (12.9%), intramuscular edema (7%), tendinitis (5.7%), and trochanteric bursitis (4.3%). Labral pathology was the most common intraarticular finding (overall:34.3%; partial tear:15.7%, complete tear:15.7%), most frequent at the anterosuperior position (81.8%). Cartilage defects (1.4%), intraarticular neoplasia (1.4%), and tear of the femoral head ligament (2.8%) were rarely found. Synovitis and loose bodies were not observed. Cam-(37.1%) and pincer-configurations (47.1%) were common while hip dysplasia was rare (5.7%). Conclusion: MRI in children and adolescents with hip pain should be done primarily without intraarticular contrast administration since most cases show an extraarticular pain reason or no diagnosis detectable with MRI. [ABSTRACT FROM AUTHOR]

Achilles tendinopathy (TP) is characterized as the third most common disease of the musculoskeletal system, and occurs in three phases. There is currently no evidence of effective treatment for this medical condition. In this study, the modulatory effects of the minimally invasive technique intratissue percutaneous electrolysis (EPI) and combinations of EPI with four nutritional factors included in the diet, hydroxytyrosol (HT), maslinic acid (MA), glycine, and aspartate (AA), on hepatic intermediary metabolism was examined in Wistar rats with induced tendinopathy at various stages of TP. Results obtained showed that induced tendinopathy produced alterations in the liver intermediary metabolisms of the rats. Regarding carbohydrate metabolism, a reduction in the activity of pro-inflammatory enzymes in the later stages of TP was observed following treatment with EPI alone. Among the combined treatments using nutritional factors with EPI, HT+EPI and AA+EPI had the greatest effect on reducing inflammation in the late stages of TP. In terms of lipid metabolism, the HT+EPI and AA+EPI groups showed a decrease in lipogenesis. In protein metabolism, the HT+EPI group more effectively reduced the inflammatory effects of induced TP. Treatment with EPI combined with nutritional factors might help regulate intermediary metabolism in TP disease and reduce the inflammation process. [ABSTRACT FROM AUTHOR]

Background: Platelet-rich plasma (PRP) helps in the treatment of various insertion tendinitis, and the recurrence rate will be low. In this study, we used intralesional injections of autologous PRP for the treatment of insertion tendinitis. Aims and Objectives: Assessment of pain relief following PRP treatment for insertion tendinitis and ascertaining the efficacy of PRP as a treatment option for insertion tendinitis. Materials and Methods: The study was done at Maharani Laxmi Bai Medical College, Jhansi, between January 2021 and June 2022, including 100 patients were applied for the treatment of PRP. We assessed patients before treatment and at three follow-up time points: 2, 4, and 6 months after the end of treatment. During each evaluation, three parameters were noted: Victorian Institute of Sports AssessmentAchilles (VISA-A) score, the Visual Analog Scale, and patient satisfaction according to the roles and Maudsley score. Results: This was a prospective trial by study design conducted on 100 patients, which included 44 patients with plantar fasciitis and 56 patients with tennis elbow. The response to PRP injection in patients with plantar fasciitis was assessed by the VISA-A score. The pre-injection VISA-A score of patients with plantar fasciitis was 56.82 (mean with SD of 18.015), which improved to 65.45 in the 2nd month (mean with SD −18.857), 4th month with 69.77 (mean with SD–19.823), and at 6 months 71.82 (mean with SD–20.829). Statistical analysis with an analysis of variance test gave a P=0.001. In our study, the patients had gradual sequential improvement in VISA-A score throughout the follow-up, with maximum improvement from the pre-injection score were observed in 2 months (65.45 with SD 18.85). Conclusion: Autologous PRP injection is a safe and useful modality of treatment in the treatment of insertion tendinitis. [ABSTRACT FROM AUTHOR]

Objectives: Accurate and sizeable footprint restoration, a secure tendon-suture interface, and high ultimate failure load (UFL) are keys to a successful distal biceps tendon repair (DBTR) that no current repair technique uniformly achieves. Inlay repair methods demonstrate satisfactory UFLs, but do not accurately restore the native footprint size or location. The smaller tunnels in onlay repairs help improve footprint location accuracy and bone preservation, but footprint area maximization has not been reported or studied, and concerns persist about their UFL and overall security. Tendon-suture interface remains a universal potential weak spot, as all current techniques rely on Krakow or whipstitch constructs. We developed a new onlay DBTR technique with novel reinforced tendon suturing, knotless anchors, and suture interlinkage, to specifically target the above concerns. The purposes of this study were: (1) to biomechanically characterize the new technique; (2) to evaluate the native and post-repair footprints for restoration size and accuracy; (3) to compare the tendon-suture interface integrity of the reinforced looping suture versus the standard whipstitch constructs; and (4) to establish the biomechanical benchmark for our new technique, with a comprehensive literature search for DBTR biomechanical studies and their highest reported UFLs. Methods: Twenty elbows from 10 donors were separated into in two matched, side-randomized groups, and their sharply excised distal biceps tendons were prepared with (1) whipstitch or (2) tape-reinforced looping suture. All elbows then underwent onlay DBTR, with two intramedullary 2.6 mm knotless all-suture anchors placed in the distal and proximal native footprint, and the repair sutures shuttled through the suture-tendon construct, over distal tendon tissue, and through the opposing anchor, creating a suture-bridge construct with broad tendon-bone compression upon maximal tensioning (Fig.1). Native and post-repair tendon footprints areas (mm2) and locations were digitized with a 3D coordinate-measuring machine (CMM), and native/post-repair location overlap (%) determined to quantify restoration accuracy. The repairs then underwent progressive cyclic loading (50/75/100N, 100 cycles/load). Bone-tendon gap, suture construct and total construct lengths were measured pre- and post-cycling. Repairs were then loaded to failure, and the UFLs and modes of failure recorded. Paired t-test and Fisher's exact test were performed to compare continuous-variable and categorical results, respectively. We collaborated with a university library research consultation service to conduct a comprehensive multi-database search and review (PubMed, Embase, Scopus, Web of Science) of all peer-reviewed cadaveric DBTR biomechanical studies with reported UFL values over the past 20 years (October 2003 – September 2023), and documented the highest mean UFL achieved in each identified study, to define the historical and current biomechanical benchmark of our novel construct. Results: Mean UFL was 516±102 N in repairs with reinforced looping suture, and 471±134 N with whipstitch (N.S.). Nine (90%) whipstitch repair specimens failed at the tendon-suture interface, typically with sutures pulling through and splitting the tendons longitudinally, compared to three (30%) suture-tendon failures in the reinforced looping stitch repair group, typically at the proximal tendon-suture junction (P =.02) (Fig.2). Mean native footprint area was 146±26 mm2, and mean post-repair footprint area was 91±7.4 mm2, with 89% of the post-repair footprint located within the native footprint (Fig.3). Compared to whipstitch repairs, reinforced looping suture repairs demonstrated 50% lower mean bone-tendon gap formation (0.8±0.1 mm vs 1.6±0.7 mm), 78% lower mean suture construct elongation (0.9±0.4 mm vs 4.0±1.8 mm), and 46% lower mean total construct elongation (3.0±0.5 mm vs 5.6±2.3 mm) after cyclic loading; the differences did not reach statistical significance. Our comprehensive literature search identified 27 peer-reviewed cadaveric biomechanical studies published between October 2003 and September 2023, describing a variety of onlay and inlay DBTR techniques. Compared to the range of mean UFL values reported in the 27 studies over the past 20 years (range 162-537 N, mean 308 N), our novel DBTR construct demonstrated the second-highest mean UFL (Fig.4). Conclusions: The use of knotless anchors in our construct, novel for DBTR, helped create a large and accurate footprint through a suture-bridge effect, without sacrificing satisfactory UFL. The reinforced looping suture, also novel, improved tendon-suture interface integrity, addressing a weak spot common to all current DBTR techniques. While a direct in-vitro comparison with all the reported methods was outside the scope of our study, the UFL range from all 27 identified DBTR biomechanical studies in the past 20 years provided an important biomechanical context, and suggests that our novel construct can achieve a satisfactory and likely high level of UFL. In summary, our novel DBTR technique demonstrated uniformly favorable performances in mean UFL, footprint restoration accuracy, and tendon-suture security, all the essential features we targeted, and may represent an advantageous new DBTR option. [ABSTRACT FROM AUTHOR]

Objectives: Rotator Cuff Repair (RCR) is frequently associated with treatment of the long head of the biceps brachii tendon. This is because the biceps tendon is a common pain generator of the shoulder, and it is commonly diseased concurrently with the rotator cuff. Biceps tendinopathy is commonly treated with tenodesis (open or arthroscopic) or tenotomy. Previous studies have shown no differences in complication rates and patient-reported outcomes (PROs) at 2-year follow-up between arthroscopic tenodesis or open tenodesis. Other literature has shown open biceps tenodesis (OBT) to have similar costs and operative time compared to arthroscopic biceps tenodesis (ABT); however, time-driven activity-based costing was not used. The purpose of this study was to evaluate for differences in day of surgery (DOS) costs at one-year for OBT, ABT, and biceps tenotomy in the context of RCR. We hypothesized that cost would be similar between OBT and ABT and would be less for tenotomy. The primary outcome was DOS cost as measured by time-driven activity-based costing. Secondary aims included assessing PROs with the Single Assessment Numeric Evaluation (SANE) score, and the American Shoulder and Elbow Surgeons (ASES) score, as well as operative time, symptomatic retear rate, and reoperation rate at one year. Methods: A prospectively collected PRO database was retrospectively reviewed for patients who underwent surgical treatment of their biceps tendon in the setting of primary RCR between 2018 and 2022. Inclusion criteria consisted of patients who underwent supraspinatus or supraspinatus and infraspinatus tendon repair, as well as biceps tenodesis (arthroscopic or open) or tenotomy and had full PRO data at preoperative baseline and at one-year follow up. Patients were excluded if they were missing PRO data, missing cost and implant data, had a prior history of shoulder surgery, underwent revision rotator cuff repair, or had their subscapularis, teres minor, or isolated infraspinatus tendon repaired. A total of 266 patients met criteria. PROs collected included SANE and ASES scores at baseline and one-year follow-up. Patient demographics, injury and surgical characteristics, operative time, retear and reoperation rates, and day of surgery cost were evaluated. Time-driven activity-based costing was used to determine DOS costs. Statistical analyses conducted included descriptive statistics, Fisher exact tests, and analysis of variance. Results: Of the 266 patients that met criteria, approximately half were female (n = 131, 49.3%). Mean patient age at time of surgery was 60.4 years old and mean body mass index was 30.15. Chronic tears were present in 55.6% of patients. 113 patients underwent OBT, 75 underwent ABT, and 78 underwent biceps tenotomy. The average values for ASES and SANE scores at baseline versus 1-year follow-up were 46.9 versus 84.3 and 40.2 versus 84.0, respectively. The age of patients who underwent tenotomy (64.2 years old) was significantly older than the ABT (58.7 years old) and OBT (58.8 years old) groups (p < 0.001). Additionally, more women underwent biceps tenotomy versus tenodesis compared to men (37.4% of women vs. 21.5% of men). Mean operative time was significantly different between the groups with tenotomy being the fastest (ABT 128.0 minutes, OBT 139.9 minutes, tenotomy 121.6 minutes, p < 0.001). DOS costs as well as biceps tendon fixation costs were highest for OBT compared to ABT and biceps tenotomy (DOS $3,963.64 vs. $3,426.67 vs. $3,095.34, p < 0.001, respectively; Biceps fixation $505.25 vs. $237.94 vs. $5.15, p < 0.001, respectively). Additionally, overall implant costs (including RCR) were highest for OBT, despite the number of anchors used not differing between the groups (p = 0.132). There was no difference in the number of tendons repaired by bicep treatment type (p = 0.203). Changes in 1-year ASES and SANE scores were not different between the group (p = 0.221 and p = 0.159, respectively). There were also no differences between groups in rotator cuff symptomatic retears or reoperations (p = 0.731 and p = 0.391, respectively). Conclusions: This study found DOS costs were lowest for biceps tenotomy and highest for OBT with a difference of more than $850. Operative time from shortest for biceps tenotomy, while OBT was associated with an 18 minute longer operative time. Despite the differences in cost and operative time, there were no differences in PROs, symptomatic rotator cuff retear rates, or reoperation rates at one-year follow-up. These results may indicate that all three treatment types can provide patients with similar outcomes; however, lower operative times and costs can be provided by tenotomy or ABT compared to OBT. Surgeons can use these results to help guide technique selection when treating patients with biceps pathology. [ABSTRACT FROM AUTHOR]

Primary glenohumeral osteoarthritis is a multifactorial condition with a complex cause that affects patients across different age groups, impairing physiologic and psychologic well-being, and substantially reducing patient quality of life and overall productivity. To effectively manage this condition, healthcare providers need to be well informed about treatment guidelines, as well as the available therapeutic options and the evidence supporting their use. Nonsurgical interventions should be regarded as the primary treatment option, particularly for patients in the initial phases of this condition. No conclusive guidelines exist for treating young and active patients, and the literature lacks high-quality data to evaluate the efficacy, safety, and long-term consequences of several interventions, regardless of patient characteristics and expectations. [ABSTRACT FROM AUTHOR]

Introduction: Fluoroquinolones are a class of broad-spectrum antibiotics widely used to treat various bacterial infections. Despite their effectiveness, increasing evidence links fluoroquinolones to tendinopathy and tendon rupture, with cases occurring shortly after initiation or even months post-therapy. This review provides a comprehensive overview of the impact of fluoroquinolones on tendon health - highlighting the underlying pathomechanisms, clinical manifestations, and epidemiology of fluoroquinolone-associated tendinopathy. Purpose of the work: The purpose of this study is to review the effects of fluoroquinolones on tendon health in the general population. Special attention is given to the athletes, who are particularly vulnerable to tendon injuries. Materials and methods: A comprehensive analysis of research articles available on PubMed, Google Scholar, Web of Science, Embase, and Scopus was conducted using search terms related to: "fluoroquinolones," "tendinopathy," "tendon rupture," "athletes" and "connective tissue damage." Results: Fluoroquinolones are linked to an increased risk of tendinopathy and tendon rupture, particularly among those with certain risk factors, including athletes. Understanding the mechanisms by which fluoroquinolones affect tendon tissue and recognizing early signs of tendon damage can help mitigate these risks. Prevention strategies, including cautious prescribing fluoroquinolones and targeted rehabilitation programmes, may reduce the adverse effects of fluoroquinolone usage, particularly in high-risk groups like athletes.

Tendinitis, characterized by the inflammation of tendons, poses significant challenges in both diagnosis and treatment due to its multifaceted etiology and complex pathophysiology. This study aimed to dissect the molecular mechanisms underlying tendinitis, with a particular focus on inflammasomerelated genes and their interactions with the immune system. Through comprehensive gene expression analysis and bioinformatics approaches, we identified distinct expression profiles of inflammasome genes, such as NLRP6, NLRP1, and MEFV, which showed significant correlations with immune checkpoint molecules, indicating a pivotal role in the inflammatory cascade of tendinitis. Additionally, MYD88 and CD36 were found to be closely associated with HLA family molecules, underscoring their involvement in immune response modulation. Contrary to expectations, chemokines exhibited minimal correlation with inflammasome genes, suggesting an unconventional inflammatory pathway in tendinitis. Transcription factors like SP110 and CREB5 emerged as key regulators of inflammasome genes, providing insight into the transcriptional control mechanisms in tendinitis. Furthermore, potential therapeutic targets were identified through the DGidb database, highlighting drugs that could modulate the activity of inflammasome genes, offering new avenues for targeted tendinitis therapy. Our findings elucidate the complex molecular landscape of tendinitis, emphasizing the significant role of inflammasomes and immune interactions, and pave the way for the development of novel diagnostic and therapeutic strategies. [ABSTRACT FROM AUTHOR]

Inflammation is a serious symptom of tendon rupture, that leads to peritendinous adhesion and damages the recovery of motor function. Although it is commonly treated using medical therapy, side effects occur in the cardiovascular and genitourinary systems. Electrical stimulation (ES) is a novel alternative to neural modulation. However, its inflammatory inhibitory effect around the tendon has rarely been investigated. Here, an ultraflexible cuff electrode with a thickness of only 3.3 µm is constructed to conformally wrap around the sympathetic chain ganglia for both stimulation and recording. The superior pliancy of the electrode causes less damage to the surrounding tissues and enhances the efficiency of stimulation and recording. ES reduces inflammation‐related factors of IL‐6 and IL‐1β by 51.6% and 19.8%, respectively, and increases the sympathetic nerve neurotransmitter of norepinephrine (NE) by almost an order of magnitude in the ruptured tendon. Sympathetic recordings have also demonstrated that more neural activity is evoked after ES. To the best of the knowledge, this study is the first to verify that the ES of the sympathetic nerve can inhibit inflammation around the tendon, bringing new inspiration for the tendon rupture treatment. [ABSTRACT FROM AUTHOR]

Calcific tendinopathy is characterized by the deposition of calcium hydroxyapatite crystals in various tendons of the body. Terms like calcium tendinitis, tendinosis, and tendinopathy are used interchangeably. Calcific tendinopathy is a common and well-documented ailment in the literature. Although common, the natural history, aetiology, and progression of calcific tendinitis are poorly understood. The treatment options include conservative and interventional measures. However, these measures cannot be applied as a blanket and are often tailored depending on the stage/phase of the disease. Out of the recognized stages of the disease, the resorptive stage causes the utmost symptoms when the calcium is rather soft and unstable. During this stage, the calcium may migrate beyond expected resorption and get deposited in the adjacent tissues contiguous with the calcium focus. The common destinations include bursal migration, intraosseous migration, muscular migration, and other less common migration sites. Such atypical presentations can lead to dilemmas in the diagnosis, prolongation of the diagnostic pathway, unwarranted apprehension, and treatment delay. Radiologists' role in this situation is to correctly recognize the imaging findings of atypical presentations of calcific tendinopathy and prevent unnecessary diagnostic and interventional studies. In this review article, we describe the pathogenic pathway and natural history of calcific tendinopathy from a radiologist's perspective and discuss different migratory patterns of calcium in calcific tendinopathy not only around the shoulder but also in other areas of the body on different imaging modalities. We also show a few examples of mimics and pitfalls on imaging. Finally, we discuss the appropriate management option of this condition. [ABSTRACT FROM AUTHOR]

Background Fluoroquinolones (FQs) are widely used in the management of several bacterial infections including urinary tract infections (UTIs), upper respiratory tract infections (URTIs), lower respiratory tract infections (LRTIs), skin and soft tissue, gastrointestinal tract infections (GITIs), and many other infections. Objective This review article focuses on some serious side effects notified by United States Food and Drug Administration (US FDA) in different warning statements. Methods The literature was searched, in databases such as Medline/PubMed/PMC, Google Scholar, Science Direct, Ebsco, Scopus, Web of science, Embase, and reference lists to identify publications relevant to the serious side effects associated with the use of FQs. Results Several epidemiological studies and meta-analyses have documented the occurrence of serious side effects of FQs including tendinopathy, peripheral neuropathy, aortic aneurysm/dissection, hypoglycemia, QT prolongation, retinal detachment, and worsening of myasthenia gravis. Conclusion The clinicians should be aware of serious side effects of FQs. The US FDA and European Medicines Agency recommend against the use of FQs as first-line therapies to treat infections such as acute sinusitis, acute bronchitis, and uncomplicated UTIs, as the risks outweigh the benefits. The risk of incidence of serious side effects of FQs is higher among patients with advanced age, renal insufficiency, and certain concomitant medications. To avoid occurrence of any serious side effects of FQs, the clinicians should prefer non-FQ antibacterial drugs to manage uncomplicated UTIs, respiratory tract infections, and other infections for which alternatives available. [ABSTRACT FROM AUTHOR]

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Background: Pathologies of the long head of the biceps (LHB) tendon are a common cause of anterior shoulder pain. While the influence of the anatomical morphology of the intertubercular groove (ITG) on the development of LHB tendon instability has been investigated with ambiguous results, the relationship of the LHB to ITG anatomy has not yet been considered in this context. The objective of this study was to reliably extract the tendon-to-groove ratio from MRI scans of symptomatic patients and examine its potential influence on the occurrence of certain causes for LHB-associated symptoms. Methods: In this retrospective study, preoperative MRI scans of 35 patients (mean age of 46 ± 14 years) presenting with anterior shoulder pain and clinical indications of LHB tendinopathy were analyzed in transversal planes. Long and short diameters of the LHB tendon and ITG were measured, cross-sectional areas of the LHB tendon and ITG were calculated from these measurements, and the ratio of cross-sectional areas (LHB/ITG) was introduced. All measurements were repeated independently by three investigators and inter-rater reliability was assessed using intraclass correlation coefficient (ICC). Thereafter, tendon-to-groove ratios were compared in patients with and without intraoperative signs of LHB tendon instability. Results: All patients exhibited intraoperative signs of LHB tendinitis, with additional findings including pulley lesions and SLAP lesions. Analysis revealed variations in the dimensions of the LHB tendon and ITG cross sections, with the tendon-to-groove ratio decreasing from 37% at the pulley to 31% at the deepest point of the sulcus. Very good inter-rater reliability was observed for all measurements. The tendon-to-groove ratio did not significantly differ (p > 0.05) in patients with or without pulley lesions or SLAP lesions. Conclusions: Our study introduced the novel parameter of the tendon-to-groove ratio of cross-sectional areas as a reproducible parameter for the description of local anatomy in the field of targeted diagnosis of LHB tendon disorders. While our findings do not yet support the predictive value of the tendon-to-groove ratio, they underscore the importance of further research with larger cohorts and control groups to validate these observations. [ABSTRACT FROM AUTHOR]

Comparing the midterm clinical outcome of surgical treatment versus ultrasound guided needle aspiration of the calcific deposits (NACD) treatment for conservative therapy resistant calcifying tendinitis (CT) of the shoulder. The hypothesis is that both surgical treatment and NACD treatment led to a comparable good clinical outcome. A comparative cohort study was performed (n = 76). The allocation to surgical group (n = 35) or NACD group (n = 41) was the result of a shared decision-making strategy. Primary outcome was decrease in VAS for pain (pVAS). Secondary outcomes were EQ-5D index, DASH score, ASES, VAS for satisfaction, recommendation of treatment, adverse events, cross-over between groups, additional treatments, and symptomatology after care as usual. At midterm follow-up (5.5 years, SD 0.5 years) decrease in pVAS did not differ (p = 0.20) between two groups (60.6 mm, SD 23.3 mm vs 53.4 mm, SD 24.2 mm). Secondary clinical outcomes were also comparable. In 68.3% surgical treatment was avoided. At final follow-up none of the outcome scores differed significantly between the crossed-over patients (n = 13, 31.7%) and the initial surgical group. At midterm follow-up surgical and NACD treatment result in comparable clinical outcomes. In 68.3% a surgical treatment could be avoided. In 31.7% the patient eventually needed a surgical treatment after failed NACD treatment. After midterm follow-up these patients showed comparable good clinical outcomes. In our opinion, both NACD and surgical treatment could be considered as a next step treatment option for conservative therapy resistant CT of the shoulder. Though, one should be aware that after a midterm follow-up a high number of patients cross-over to surgical treatment after a NACD treatment. [ABSTRACT FROM AUTHOR]

To determine the relationships between (1) Achilles tendon pain and loading symmetry, and (2) number of running bouts and symptom severity, during two weeks of outdoor running in individuals with Achilles tendinopathy. Prospective, observational study. Biomechanics laboratory and outdoors. Seventeen runners with Achilles tendinopathy in the return-to-sport phase of rehabilitation. Symptom severity was recorded with the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire. Running bouts and Achilles tendon pain during runs were recorded with daily training logs. Ground contact time was collected during runs with wearable sensors. Linear mixed modeling determined if the relationship between Achilles tendon pain and ground contact time symmetry during running was moderated by consecutive run days. Multiple regression determined the relationship between number of running bouts and change in VISA-A scores over two weeks, adjusted for run distance. Greater ground contact time on the contralateral leg corresponded to increased ipsilateral tendon pain for each consecutive run day (b = −0.028, p < 0.001). Number of running bouts was not associated with 2-week changes in VISA-A scores (p = 0.672). Pain during running is associated with injured leg off-loading patterns, and this relationship strengthened with greater number of consecutive run days. Number of running bouts was not related to short-term symptom severity. • Achilles tendon pain during running was related to off-loading of the injured leg. • Consecutive run days strengthened the pain and asymmetric loading relationship. • Number of running bouts was not related to increased short-term symptom severity. • Wearable devices can capture loading asymmetry in those with Achilles tendinopathy. [ABSTRACT FROM AUTHOR]

Simple Summary: In the current era, sport horses face the challenge of increasingly rigorous workouts, overtaking, and, at times, certain physiological thresholds, leaving them susceptible to injury. This shift underscores the significance of prioritizing the exercise preparation quality and post-care to proactively mitigate the risk of injuries. Despite these measures, injuries may still occur, thus requiring a nuanced understanding of the most effective therapeutic approaches for various types of lesions. In the dynamic field of equine sports medicine, keeping abreast of the expansive therapeutic options proves challenging, especially when aiming to address injuries comprehensively, restore organ function, and sustain the horse's athletic life. The present endeavor seeks to elucidate the array of available therapies, encompassing both conservative and regenerative methods, for the effective management of musculoskeletal injuries in sport horses. Musculoskeletal injuries such as equine osteoarthritis, osteoarticular defects, tendonitis/desmitis, and muscular disorders are prevalent among sport horses, with a fair prognosis for returning to exercise or previous performance levels. The field of equine medicine has witnessed rapid and fruitful development, resulting in a diverse range of therapeutic options for musculoskeletal problems. Staying abreast of these advancements can be challenging, prompting the need for a comprehensive review of commonly used and recent treatments. The aim is to compile current therapeutic options for managing these injuries, spanning from simple to complex physiotherapy techniques, conservative treatments including steroidal and non-steroidal anti-inflammatory drugs, hyaluronic acid, polysulfated glycosaminoglycans, pentosan polysulfate, and polyacrylamides, to promising regenerative therapies such as hemoderivatives and stem cell-based therapies. Each therapeutic modality is scrutinized for its benefits, limitations, and potential synergistic actions to facilitate their most effective application for the intended healing/regeneration of the injured tissue/organ and subsequent patient recovery. While stem cell-based therapies have emerged as particularly promising for equine musculoskeletal injuries, a multidisciplinary approach is underscored throughout the discussion, emphasizing the importance of considering various therapeutic modalities in tandem. [ABSTRACT FROM AUTHOR]

Background: Adhesive capsulitis (AC) of the glenohumeral joint is a recognized cause of pain associated with both active and passive restricted ranges of movement. AC can be subdivided into primary and secondary forms. Trauma, surgery, immobilization, and diabetes mellitus are the leading well-recognized causes of secondary AC. Calcific tendinitis/tendinitis (CT) of the rotator cuff is considered a possible trigger for AC, as reported in a few previous articles. However, there are no original investigations that assess the frequency and characteristics of this association. The aim of our research was to evaluate the presence of AC in a cohort of patients with a known CT condition of the rotator cuff by an ultrasound (US) examination. Materials and methods: We prospectively enrolled all the patients admitted at our single institution (October 2022–June 2023) for the preoperative US evaluation of a known CT condition. In these patients, we searched for parameters related to secondary AC. An axillary pouch (AP) thickness equal to or greater than 4 mm (or greater than 60% of the contralateral AP) was considered diagnostic of AC. Moreover, rotator interval (RI) thickness and the presence of effusion within the long-head biceps tendon (LHBT) sheath was also assessed in all patients. Results: A total of 78 patients (54F, 24M—mean age = 50.0 and range = 31–71 y.o.) were enrolled in the study. In 26 of those patients (26/78—33.3%), US signs of AC were detected. Notably, the mean AP thickness in patients with AC and CT was 3.96 ± 1.37 mm (Group 1) and 2.08 ± 0.40 mm in patients with CT only (Group 2). RI thickness was significantly greater in patients with superimposed AC: 2.54 ± 0.38 mm in Group 1 and 1.81 ± 0.41 mm in Group 2 (p < 0.00001). Moreover, effusion within the LHBT was significantly more frequently detected in patients with AC: 84.61% in Group 1 versus 15.79% in Group 2—p < 0.00001. Conclusion: US signs of AC are found in one-third of patients with CT of the rotator cuff, demonstrating that AC represents a frequent complication that should be routinely evaluated during US investigation to provide more personalized treatment strategies. [ABSTRACT FROM AUTHOR]

Although most cases of Achilles tendinitis are caused by some form of biomechanical stress, other factors may play a role in its etiology. Fluoroquinolone use is a wellknown contributing factor to Achilles tendon pathology. This report describes a case of fluoroquinolone-induced Achilles tendinitis in a 77-year-old woman. Eight weeks after she presented to our office, the patient reported significant improvements after a course of care that included low level laser therapy (LLLT), activity modification and graduated exercises. Management can include many of the treatment tools used for biomechanically induced tendinopathy, with particular consideration given to delaying more advanced weightbearing rehabilitative exercise due to the increased risk of rupture. [ABSTRACT FROM AUTHOR]

The gold-standard surgical management for superior labral anterior to posterior (SLAP) lesions is unclear. This meta-analysis compares the outcomes of different surgical SLAP lesion management techniques including labral repair, long head of biceps (LHB) tenodesis and LHB tenotomy with consideration to clinical scores, return to sports, re-operation, range-of-motion and patient satisfaction. PRISMA guidelines were adhered. Web of Science, PubMed, Cochrane Central, Science direct and EMBASE were searched using relevant keywords. Eligible studies were screened, data extracted and synthesised using Review Manager (Version 5.4.1). Bayesian network meta-analysis (NMA) was conducted. Randomised control and clinical trials regarding SLAP lesion management in patients over 18 years old were included. Studies were excluded if patients had concomitant massive tears of the rotator cuff, Bankart lesions or instability of the shoulder. Patient satisfaction with LHB tenodesis was superior to superior labral repair. No difference was demonstrated with respect to ASES score, pain VAS score, return to sports and pre-injury activities, reoperation rate or range-of-motion. LHB tenodesis and LHB tenotomy show no difference in ASES score or post operative deformity in management of SLAP lesions. High-quality, standardised randomised control studies between the different surgical techniques is warranted. • Patient satisfaction was superior following LHB tenodesis in comparison to repair of the labrum. • Significant heterogeneity present in patient demographics, presence of concurrent rotator cuff injury and measured outcomes. [ABSTRACT FROM AUTHOR]

Background: Patients with persistent symptomatic iliopsoas tendonitis following total hip arthroplasty may benefit from iliopsoas fractional lengthening. We present an arthroscopic approach utilizing an air bursogram that provides safe and predictable access to the iliopsoas tendon for efficient tendon lengthening without violating the capsule or unintentional instrumentation of the nearby medial neurovascular bundle. Indications: Arthroscopic iliopsoas fractional lengthening is indicated for patients with clinical evidence of symptomatic iliopsoas tendonitis following total hip arthroplasty and have no radiographic evidence of frank acetabular malpositioning. A diagnosis of iliopsoas tendinitis amenable to surgical management can be established with substantial but nondurable relief following image-guided anesthetic injection to the iliopsoas bursa. Technique Description: Under fluoroscopic guidance, an air bursogram is employed in the anatomic plane of the iliopsoas tendon to accurately identify its course. This allows for hip portal placement with precise subsequent instrumentation. This technique is preferred in the setting of postarthroplasty anatomy because it avoids capsular violation and the challenge of working in an altered anatomic space with a nearby, medially based neurovascular bundle. Results: Arthroscopic and endoscopic approaches to iliopsoas release have been shown to provide excellent functional and patient-reported outcomes in >85% of patients, and several studies have shown that an arthroscopic approach not only provides a less invasive technique but also results in comparable or improved clinical outcomes with lower revision rates compared to open release or acetabular cup revision. Our technique for arthroscopic iliopsoas fractional lengthening using the air bursogram is both safe and reproducible and offers distinct advantages, including maintenance of an intact capsule, visual confirmation of the correct anatomic structure to be released, and percutaneous access with standard arthroscopic access cannulas without the need for hip distraction. Conclusions: Arthroscopic fractional iliopsoas lengthening is a minimally invasive and successful treatment option for patients with persistent groin pain after total hip arthroplasty, especially without substantial acetabular component malpositioning. This technique includes using an air bursogram to safely identify and navigate to the iliopsoas tendon without violating the hip capsule, thereby reducing the risk of inadvertent instrumentation of adjacent critical neurovascular structures. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. [ABSTRACT FROM AUTHOR]

Purpose: To assess the feasibility, operative time, clinical outcomes, possible complications, and failure rates of all-through arthroscopic biceps tenodesis using press-fit bony plug technique. Methods: This prospective case series study involved 30 skeletally mature patients with long head of biceps pathology (tendinitis after failure of conservative treatment, subluxation, dislocation, or tendon tears). All patients were followed up for 24 months at least. Results: Twenty-nine patients regained full shoulder and elbow range of motion; one case suffered from reflex sympathetic dystrophy. There was a significant improvement in the constant, ASES, and VAS scores when comparing the pre-operative and post-operative values. The average biceps strength was 96% compared to the opposite healthy side. No cases were complicated by neuro-vascular deficits or failure of the tenodesis. Conclusion: Press-fit biceps tenodesis is safe and accessible with low economic demands. We recommend this technique to be used more often when addressing patients with long head of biceps pathologies. Registration data: Registration number: N-1562023. Registration date: June 2022 "Retrospectively registered". [ABSTRACT FROM AUTHOR]

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Calcific tendinitis is classically a painful condition that most commonly affects the rotator cuff, but may infrequently involve other tendons. We discuss a 57-year-old man who presented to the emergency department with a 4-day history of right hip pain, described as the "worst pain in (his) life." The pain was first noticed at night and had progressively worsened. History, physical examination, and initial laboratory workup indicated an inflammatory vs. infectious process. Continued investigations with imaging techniques revealed the source of pain as calcific tendinitis involving the gluteus maximus tendon. Symptoms of musculoskeletal pain in the emergency department are ubiquitous. In the proper clinical context, the diagnosis of calcific tendinitis, although uncommon, should be considered once emergent conditions are ruled out. Proper imaging techniques will facilitate accurate diagnosis, expedited pain management, and proper outpatient follow-up. [ABSTRACT FROM AUTHOR]