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The chronic painful Achilles tendon: sonographic findings and new methods for treatment
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology. Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Sports Medicine.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of the present thesis was to evaluate sonographic methods for investigation of the chronic painful Achilles tendon.

In a prospective study on patients with chronic painful mid-portion Achilles tendinosis, grey-scale ultrasound (US) showed a decreased tendon thickness and a “normalized” structure in the majority of patients successfully treated with eccentric calf-muscle training. By combining US with colour Doppler examination (CDV), a neovascularisation was shown in the region with structural tendon changes in all painful tendons, but not in any of the pain-free normal tendons. In a small pilot study, the sclerosing agent Polidocanol was injected towards the neovessels under US and CDV guidance. The majority of the patients became painfree and had no remaining neovessels, while the patients with remaining pain had remaining neovessels. The combined findings from US, immuno-histochemical analyses of biopsies, and diagnostic injections, showed that the patients were temporarily pain-free after US and CDV guided injections of local anaesthesia towards the region with neovessels, and biopsies from the region with tendon changes and neovascularisation showed nerve structures in close relation to blood vessels. The presence of neovessels was shown also in patients with chronic pain in the Achilles tendon insertion, and it was found that treatment with sclerosing injections cured the pain in the majority of patients. A good result of treatment was associated with no remaining neovessels.

In a prospective study on patients with chronic mid-portion Achilles tendinosis treated with eccentric training, CDV after treatment showed no remaining neovessels in the majority of the pain-free patients. In the patients with remaining tendon pain there were remaining neovessels. In conclusion, the findings in this thesis indicate that neovessels and accompanying nerves might be the source of chronic Achilles tendon pain. Sclerosing injections towards the neovessels, and eccentric training, seem to have a potential to cure the pain.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2003. , 68 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 860
Keyword [en]
Radiation sciences
Keyword [sv]
Strålningsvetenskap
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
URN: urn:nbn:se:umu:diva-140ISBN: 91-7305-536-0 (print)OAI: oai:DiVA.org:umu-140DiVA: diva2:140899
Public defence
2003-11-14, Umeå, 09:00 (English)
Opponent
Available from: 2003-11-05 Created: 2003-11-05 Last updated: 2012-04-03Bibliographically approved
List of papers
1. Eccentric training in patients with chronic Achilles tendinosis–normalized tendon structure and decreased thickness at follow-up
Open this publication in new window or tab >>Eccentric training in patients with chronic Achilles tendinosis–normalized tendon structure and decreased thickness at follow-up
2004 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 38, no 1, 8-11 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To prospectively investigate tendon thickness and tendon structure by ultrasonography in patients treated with eccentric calf muscle training for painful chronic Achilles tendinosis located at the 2 6 cm level in the tendon.

Methods: The patients were examined with grey scale ultrasonography before and 3.8 years ( mean) after the 12 week eccentric training regimen. At follow up, a questionnaire assessed present activity level and satisfaction with treatment.

Results: Twenty six tendons in twenty five patients ( 19 men and six women) with a mean age of 50 years were followed for a mean of 3.8 years ( range 1.6 - 7.75). All patients had a long duration of painful symptoms ( mean 17.1 months) from chronic Achilles tendinosis before treatment. At follow up, 22 of 25 patients were satisfied with treatment and active in Achilles tendon loading activities at the desired level. Ultrasonography showed that tendon thickness ( at the widest part) had decreased significantly (p< 0.005) after treatment (7.6 (2.3) v 8.8 ( 3) mm; mean (SD)). In untreated normal tendons, there was no significant difference in thickness after treatment (5.3 (1.3) mm before and 5.9 (0.8) mm after). All tendons with tendinosis had structural abnormalities (hypoechoic areas and irregular structure) before the start of treatment. After treatment, the structure was normal in 19 of the 26 tendons. Six of the seven patients with remaining structural abnormalities experienced pain in the tendon during loading.

Conclusions: Ultrasonographic follow up of patients with mid-portion painful chronic Achilles tendinosis treated with eccentric calf muscle training showed a localised decrease in tendon thickness and a normalised tendon structure in most patients. Remaining structural tendon abnormalities seemed to be associated with residual pain in the tendon.

Place, publisher, year, edition, pages
London: BMJ Publishing Group Ltd, 2004
Keyword
patellar tendinosis, magnetic resonance, surgical findings, ultrasonography, diagnosis, pathology, injuries
National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:umu:diva-2661 (URN)10.1136/bjsm.2001.000284 (DOI)000188539400005 ()
Available from: 2003-11-05 Created: 2003-11-05 Last updated: 2017-01-30Bibliographically approved
2. Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons
Open this publication in new window or tab >>Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons
2001 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, Vol. 9, no 4, 233-238 p.Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-2662 (URN)
Available from: 2003-11-05 Created: 2003-11-05 Last updated: 2010-08-12Bibliographically approved
3. Ultrasound guided sclerosis of neovessels in painful Achilles tendinosis: pilot study of a new treatment
Open this publication in new window or tab >>Ultrasound guided sclerosis of neovessels in painful Achilles tendinosis: pilot study of a new treatment
2002 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, Vol. 36, no 3, 173-175 p.Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-2663 (URN)
Available from: 2003-11-05 Created: 2003-11-05 Last updated: 2010-08-12Bibliographically approved
4. Sclerosing therapy in chronic Achilles tendon insertional pain: results of a pilot study
Open this publication in new window or tab >>Sclerosing therapy in chronic Achilles tendon insertional pain: results of a pilot study
2003 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, Vol. 11, no 5, 339-343 p.Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-2664 (URN)
Available from: 2003-11-05 Created: 2003-11-05 Last updated: 2010-08-12Bibliographically approved
5. Effects on neovascularisation behind the good results with eccentric training in chronic mid-portion Achilles tendinosis?
Open this publication in new window or tab >>Effects on neovascularisation behind the good results with eccentric training in chronic mid-portion Achilles tendinosis?
2004 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 12, no 5, 465-470 p.Article in journal (Refereed) Published
Keyword
Achilles, tendinosis, eccentric training, ultrasonography
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-15649 (URN)10.1007/s00167-004-0494-8 (DOI)15060761 (PubMedID)
Available from: 2007-10-18 Created: 2007-10-18 Last updated: 2010-08-12Bibliographically approved
6. Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis?: An investigation using US and colour Doppler, immunohistochemistry, and diagnostic injections
Open this publication in new window or tab >>Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis?: An investigation using US and colour Doppler, immunohistochemistry, and diagnostic injections
2003 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, Vol. 11, no 5, 334-338 p.Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-2666 (URN)
Available from: 2003-11-05 Created: 2003-11-05 Last updated: 2010-08-12Bibliographically approved

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