The ultrasonography (US) is an important modality in evaluating shoulder disease. It is accurate in diagnosing the various shoulder diseases including tendinosis, calcific tendinitis, and subacromial bursitis as well as rotator cuff tears. This article presents a pictorial review of US anatomy of the shoulder, the technical aspects of shoulder US, major types of shoulder pathology, and interventional procedure under US guidance.
Bursitis ; Pathology ; Rotator Cuff* ; Shoulder ; Tendinopathy ; Tendons ; Ultrasonography*

Calcifying tendinopathy is a tendon disorder with calcium deposits in the mid-substance presented with chronic activity-related pain, tenderness, local edema and various degrees of incapacitation. Most of current treatments are neither effective nor evidence-based because its underlying pathogenesis is poorly understood and treatment is usually symptomatic. Understanding the pathogenesis of calcifying tendinopathy is essential for its effective evidence-based management. One of the key histopathological features of calcifying tendinopathy is the presence of chondrocyte phenotype which surrounds the calcific deposits, suggesting that the formation of calcific deposits was cell-mediated. Although the origin of cells participating in the formation of chondrocyte phenotype and ossification is still unknown, many evidences have suggested that erroneous tendon cell differentiation is involved in the process. Recent studies have shown the presence of stem cells with self-renewal and multi-differentiation potential in human, horse, mouse and rat tendon tissues. We hypothesized that the erroneous differentiation of tendon-derived stem cells (TDSCs) to chondrocytes or osteoblasts leads to chondrometaplasia and ossification and hence weaker tendon, failed healing and pain, in calcifying tendinopathy. We present a hypothetical model on the pathogenesis and evidences to support this hypothesis. Understanding the key role of TDSCs in the pathogenesis of calcifying tendinopathy and the mechanisms contributing to their erroneous differentiation would provide new opportunities for the management of calcifying tendinopathy. The re-direction of the differentiation of resident TDSCs to tenogenic or supplementation of MSCs programmed for tenogenic differentiation may be enticing targets for the management of calcifying tendinopathy in the future.
Animals ; Cell Differentiation ; physiology ; Humans ; Mice ; Rats ; Stem Cells ; pathology ; Tendinopathy ; etiology ; pathology ; Tendons ; pathology

There is no sport in which the knee does not play an integral role. Blazina described the clinical aspects and treatment of the “jumper's knee”. A jumper's knee is a tendinitis of the patella or less frequently quadriceps tendon at the inferior or superior pole of the patella, respectively. It is typically encountered in athletes who are involved in some type of repetitive activity such as jumping, climbing, kicking, or running. the pathology is still ill understood and further date on the etiology and treatment are scarce. Fourty seven cases of patella tendinitis were analyzed in clinical aspects. Results of the study are as follows: l. Of the 47 cases, male were 9 or 19.1%, female were 38 or 80.9%. 2. Complained pain on proximal pole of patella were 11 or 23.4%, both pole were 9 or 19.1%, distal pole were 27 or 57.4%. 3.0f 47 cases, 22 cases or 46.8% were Grade I, 20 cases or 42.5% were Grade II, 4 cases or 8.5% were Grade III, 1 case or 2.1% was Grade IV. 4. 1 case, Grade IV, was confirmed fracture on distal pole of patella by radiologic examination. 5. The Grade I & II patients had subsided an improved by a few days rest, Quadriceps and Hamstrings setting exercise, Ice massage and medication.
Athletes ; Female ; Humans ; Ice ; Knee ; Male ; Massage ; Patella ; Pathology ; Running ; Sports ; Tendinopathy ; Tendons

This case report describes the intralesional application of autologous conditioned plasma (ACP) in seven horses as treatment of severe tendinitis of the superficial digital flexor tendon, deep digital flexor tendon, or desmitis of the inferior check ligament. Follow-up data of the horses revealed a positive outcome in 10 to 13 months post injury. All horses treated with ACP were either performing in their previous work-load or were back in full training. Further studies with long-term follow-up will have to be performed to support these clinical intermediate-term observations.
Animals ; Blood Component Transfusion/*veterinary ; Female ; Horses/*injuries ; Ligaments/*injuries/pathology ; Male ; *Platelet-Rich Plasma ; Tendinopathy/pathology/therapy/*veterinary

BACKGROUND: Hair follicles are easily accessible and contain stem cells with different developmental origins, including mesenchymal stem cells (MSCs), that consequently reveal the potential of human hair follicle (hHF)-derived MSCs in repair and regeneration. However, the role of hHF-MSCs in Achilles tendinopathy (AT) remains unclear. The present study investigated the effects of hHF-MSCs on Achilles tendon repair in rabbits. METHODS: First, we extracted and characterized hHF-MSCs. Then, a rabbit tendinopathy model was constructed to analyze the ability of hHF-MSCs to promote repair in vivo . Anatomical observation and pathological and biomechanical analyses were performed to determine the effect of hHF-MSCs on AT, and quantitative real-time polymerase chain reaction, enzyme-linked immunosorbent assay, and immunohistochemical staining were performed to explore the molecular mechanisms through which hHF-MSCs affects AT. Furthermore, statistical analyses were performed using independent sample t test, one-way analysis of variance (ANOVA), and one-way repeated measures multivariate ANOVA as appropriate. RESULTS: Flow cytometry, a trilineage-induced differentiation test, confirmed that hHF-derived stem cells were derived from MSCs. The effect of hHF-MSCs on AT revealed that the Achilles tendon was anatomically healthy, as well as the maximum load carried by the Achilles tendon and hydroxyproline proteomic levels were increased. Moreover, collagen I and III were upregulated in rabbit AT treated with hHF-MSCs (compared with AT group; P  < 0.05). Analysis of the molecular mechanisms revealed that hHF-MSCs promoted collagen fiber regeneration, possibly through Tenascin-C (TNC) upregulation and matrix metalloproteinase (MMP)-9 downregulation. CONCLUSIONS hHF-MSCs can be a treatment modality to promote AT repair in rabbits by upregulating collagen I and III. Further analysis revealed that treatment of AT using hHF-MSCs promoted the regeneration of collagen fiber, possibly because of upregulation of TNC and downregulation of MMP-9, thus suggesting that hHF-MSCs are more promising for AT.
Animals ; Humans ; Rabbits ; Hair Follicle ; Achilles Tendon/pathology* ; Tendinopathy/pathology* ; Proteomics ; Collagen Type I ; Mesenchymal Stem Cells

OBJECTIVETo examine whether acupuncture treatment would improve outcome in chronic Achilles tendinopathy.

METHODSA randomized, controlled trial at two centers of 64 randomized patients aged 18 to 70 years with chronic Achilles tendinopathy was conducted from July 2007 to April 2010, with follow-up until October, 2010. These patients were randomly allocated into an acupuncture treatment group (acupuncture group) and an eccentric exercises group (control group). The validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire was completed at baseline and 8, 16, and 24 weeks. The pain at rest and after activity was accessed at baseline and 8 weeks with Visual Analogue Scale (VAS).

RESULTSAfter randomization into the acupuncture group or control group, one patient was loss of follow-up. The mean VISA-A score improved signifificantly after 8 weeks in the acupuncture group to 67.1 points [95% confifidence interval (CI), 64.1-70.2] and in the control group to 48.5 points (95% CI, 45.5-51.6) with an additional 18.6 points increase in acupuncture treatment patients (P=0.0000). Acupuncture treatment resulted in a significant increase from baseline in VISA-A of 25.8 after 16 weeks and 28.4 after 24 weeks. Whereas, in the control group the increase from baseline in VISA-A were 10.0 and 16.6 after 16 and 24 weeks, respectively (P=0.0000). The VAS diminished by 2.0 cm after activity, and by 1.5 cm at rest after 8 weeks in the control group. In the acupuncture group, the pain scores diminished significantly more than in the control group, with pain reduction of 3.7 cm after activity (P=0.0000) and 3.2 cm at rest (P =0.0000).

CONCLUSIONAcupuncture intervention could improve pain and activity in patients with chronic Achilles tendinopathy compared with eccentric exercises.

Achilles Tendon ; pathology ; Acupuncture ; Chronic Disease ; Female ; Humans ; Male ; Middle Aged ; Tendinopathy ; therapy ; Treatment Outcome ; Visual Analog Scale

OBJECTIVES: To design and validate a computer application for the diagnosis of shoulder locomotor system pathology. METHODS: The first phase involved the construction of the application using the Delphi method. In the second phase, the application was validated with a sample of 250 patients with shoulder pathology. Validity was measured for each diagnostic group using sensitivity, specificity, and positive and negative likelihood ratio (LR(+) and LR(−)). The correct classification ratio (CCR) for each patient and the factors related to worse classification were calculated using multivariate binary logistic regression (odds ratio, 95% confidence interval). RESULTS: The mean time to complete the application was 15 ± 7 minutes. The validity values were the following: LR(+) 7.8 and LR(−) 0.1 for cervical radiculopathy, LR(+) 4.1 and LR(−) 0.4 for glenohumeral arthrosis, LR(+) 15.5 and LR(−) 0.2 for glenohumeral instability, LR(+) 17.2 and LR(−) 0.2 for massive rotator cuff tear, LR(+) 6.2 and LR(−) 0.2 for capsular syndrome, LR(+) 4.0 and LR(−) 0.3 for subacromial impingement/rotator cuff tendinopathy, and LR(+) 2.5 and LR(−) 0.6 for acromioclavicular arthropathy. A total of 70% of the patients had a CCR greater than 85%. Factors that negatively affected accuracy were massive rotator cuff tear, acromioclavicular arthropathy, age over 55 years, and high pain intensity (p < 0.05). CONCLUSIONS: The developed application achieved an acceptable validity for most pathologies. Because the tool had a limited capacity to identify the full clinical picture in the same patient, improvements and new studies applied to other groups of patients are required.
Classification ; Diagnosis ; Humans ; Logistic Models ; Medical Informatics Applications ; Methods ; Pathology ; Radiculopathy ; Rotator Cuff ; Self-Examination ; Sensitivity and Specificity ; Shoulder ; Tears ; Tendinopathy

BACKGROUNDConventional ultrasonography or magnetic resonance (MR) imaging is commonly performed to obtain information about the severity of the disease, location of the injury, and differential diagnosis. The aim of this research was to investigate the diagnostic confidence of sonoelastography as an adjunct to greyscale ultrasonography in lateral elbow tendinopathy.

METHODSA single experienced physiatrist performed greyscale ultrasonography and sonoelastography in 28 patients (9 men, 19 women; mean age, 48.5 years; age range, 36-67 years) with unilateral symptoms of lateral elbow tendinopathy; the asymptomatic elbows were used as controls. Greyscale images were described as normal, tendinosis, partial-thickness tear, and full-thickness tear. Sonoelastographic images of the common extensor tendon were analyzed qualitatively (scoring of the elastic spectrum) and quantitatively (based on a color histogram).

RESULTSBoth the imaging methods had high sensitivity, specificity, and accuracy for diagnosing lateral elbow tendinopathy. Considering the clinical diagnosis of lateral elbow tendinopathy, sonoelastography showed significantly higher diagnostic accuracy (96.4%) than ultrasonography (89.5%, P < 0.01). Quantitative analysis showed objective interpretation of the sonoelastographic images that revealed greater intensity of green and blue pixels in symptomatic elbows (P < 0.01).

CONCLUSIONSonoelastography increases diagnostic confidence in tennis elbow pathology over greyscale ultrasonography alone and may be an additional powerful diagnostic tool in cases of lateral elbow tendinopathy with inconclusive greyscale ultrasonographic findings.

Adult ; Aged ; Elasticity Imaging Techniques ; methods ; Elbow ; pathology ; Female ; Humans ; Male ; Middle Aged ; Tendinopathy ; diagnosis ; diagnostic imaging ; Tendons ; pathology ; Tennis Elbow ; diagnosis ; diagnostic imaging

OBJECTIVETo study the effect of close needling in the treatment of calcifying tendonitis.

METHODSSeventeen patients with calcifying tendonitis who had received close needling treatment were followed-up for 9.3 months on average. An 18-gauge or 16-gauge needle was used during needling. X-ray examination was given 4, 6, 8 and every 4 weeks after needling. SST (simple shoulder test) questionnaire, ASES (American Shoulder & Elbow Surgeon) score, constant-Murley score and UCLA score were adopted for evaluation before and after treatment.

RESULTSCalcium deposition disappeared within 4 - 20 weeks mean 9.4 weeks in 15 of the 17 patients after needling for 1 - 3 times. Average ASES score before treatment was 47.7 (34 - 59), forward elevation was 90 degrees (70 degrees - 100 degrees ), external rotation was 15 degrees (0 degrees - 30 degrees ), and internal rotation was L3-4 (L1-buttock). Average constant-Murley score before treatment was 44.6 (34 - 54), UCLA score was 11.6 (8 - 15), and numbers of questions for "yes" in SST questionnaire was 3.4 (2 - 5). After needling the average ASES score was 87.1 (72 - 91), forward elevation was 143.5 degrees (120 degrees - 160 degrees ), external rotation was 40 degrees (30 degrees - 50 degrees ), internal rotation was T(8)-T(9), constant-Murley score was 87.8 (64 - 94), UCLA score was 29.5 (19 - 33), and numbers of questions for "yes" in SST questionnaire was 9.1 (6 - 12). Significant difference was found between before and after needling (ASES: P < 0.01, forward elevation, external rotation and internal rotation: P < 0.01, constant-Murley: P < 0.01, UCLA: P < 0.01, SST: P < 0.01).

CONCLUSIONSClose needling is an effective method for the treatment of calcifying tendonitis. Symptoms and disability are greatly relieved non-surgically in most of patients. Care should be taken in differential diagnosis of degenerative calcification in chronic rotator cuff disease.

Adult ; Aged ; Calcinosis ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Nerve Block ; methods ; Rotator Cuff ; innervation ; Tendinopathy ; pathology ; surgery ; Treatment Outcome

The purpose of this study was to determine shoulder pain and shoulder ultrasonographic findings in poliomyelitis Wheelchair Basketball (WB) players. Three physicians performed physical examinations and interviewed WB players about their shoulder pain by using Wheelchair User's Shoulder Pain Index (WUSPI), Performance-Corrected WUSPI (PC-WUSPI), and Shoulder Pain and Disability Index (SPADI). One physician performed shoulder ultrasonography on WB players. All confirmed their International Wheelchair Basketball Federation (IWBF) classifications through Korean Wheelchair Basketball Federation (KWBF). Seventeen men and 6 women players were enrolled in the study, with 46 shoulders evaluated. Nine players had unilateral lower extremity weakness and 14 players were bilateral weakness. Six players used wheelchair for daily living, and 17 players used wheelchair only when playing WB. They were 44.35+/-5.42 years old on average. They had played WB for 11.09+/-9.49 years and trained 8.69+/-3.83 hours a week. PC-WUSPI was significantly correlated with age (p=0.014). There were no significant differences between time spent playing WB, training time for WB, types of poliomyelitis involvement, their use of wheelchair, and WUSPI, PC-WUSPI and SPADI. Tendon tear prevalence was significantly different with training time for WB (p=0.021). Most common abnormal shoulder ultrasonographic findings were subscapularis and supraspinatus tendinopathy. Tendinopathy and tendon tear prevalence did not differ significantly with age, time spent playing WB, types of poliomyelitis, and the use of wheelchair. High prevalence of shoulder pain and rotator cuff pathology were found by physical and ultrasonographic examination in the poliomyelitis wheelchair basketball players. Rotator cuff injury prevention program are needed for prevent shoulder pain and rotator cuff pathology.
Basketball* ; Classification ; Female ; Humans ; Lower Extremity ; Male ; Pathology ; Physical Examination ; Poliomyelitis* ; Prevalence ; Rotator Cuff ; Shoulder Pain ; Shoulder* ; Tendinopathy ; Tendons ; Ultrasonography* ; Wheelchairs*