Tendinosis , meaning or sometimes called chronic tendinitis , chronic tendinopathy, or chronic tendon injury, is damage to the tendon at the cellular level (the "osis" suffix implies a pathology of chronic degeneration without inflammation). It is thought to be caused by microtears on the connective tissue inside and around the tendon, which causes increased tendon repair cells. This can lead to reduced tensile strength, thereby increasing the likelihood of a tendon rupture. Tendinosis is often misdiagnosed as tendinitis due to limited understanding of tendinopathies by the medical community. The classic characteristics of "tendinosis" include degenerative changes in collagen matrices, hypercellularity, hypervascularity, and lack of inflammatory cells that have challenged the original "tendinitis" erroneousness.
Video Tendinosis
Cause
Tendinosis of the general elbow tendon ("tennis elbow"), such as the Rotator Cuff, is a common cause of pain in the elbow or shoulder.
The common opinion is that tendinosis is due to tendons being overused, and healing tendons fail. In addition, the extensor muscle carpi radialis brevis plays a key role.
Maps Tendinosis
Pathophysiology
Histologic findings include granulation tissue, microrupture, degenerative changes, and no traditional inflammation. As a result, "lateral elbow tendinopathy or tendinosis" is used instead of "lateral epicondylitis".
Tennis elbow tissue examination showed noninflammatory tissue, so the term "angiofibroblastic tendinosis" was used.
Cultures of the tendinopathic tendon contain increased production of collagen type III.
The longitudinal sonogram of the lateral elbow exhibits thickening and heterogeneity of general extensor tendons consistent with tendinosis, since ultrasound reveals calcification, intracubstique tears, and marked lateral epicondyle occlusion. Although the term "epicondylitis" is often used to describe this disorder, most histopathological findings from the study do not show acute evidence, or chronic inflammatory processes. Histologic studies have shown that this condition is a result of tendon degeneration, which causes normal tissue to be replaced by irregular collagen settings. Therefore, this disorder is more accurately referred to as "tendinosis" or "tendinopathy" rather than "tendinitis."
Doppler color ultrasound reveals structural tendon changes, with vascularization and hypo-echoic areas corresponding to the extensor pain area.
Human-induced non-ruptured probinopathy is associated with increased collagen III: I protein ratio, shift of large-diameter collagen fibrils, buckling of collagen fesikel on the tendon extracellular matrix, and bending of the cell's tenocytes and their nuclei.
Diagnosis
Symptoms can vary from pain or pain and stiffness to the local area of ​​the tendon, or burning that surrounds the entire joint around the affected tendon. With this condition, the pain is usually worse during and after the activity, and the tendons and joint regions may become stiff the next day as swelling that affects tendon movement. Many patients report stressful situations in their lives in correlation with the onset of pain, which may contribute to the symptoms.
Swelling in the area of ​​micro-damage or partial tear can be detected visually or by touch.
Medical description
Ultrasound imaging can be used to evaluate tissue strains, as well as other mechanical properties.
Ultrasound-based techniques are becoming more popular because of their affordable price, safety, and speed. Ultrasound can be used for imaging networks, and sound waves can also provide information about the mechanical state of the network.
Increased water content and unorganized collagen matrices in tendon lesions can be detected by ultrasonography or magnetic resonance imaging.
Treatment
Wounded tendons are very slow to cure. Partial tears heal with the production of irregular-type III collagen that is weaker than the normal tendon. Recurring injuries in the damaged areas of the tendon often occur.
Rehabilitation, rest, and gradual return to the activity in which tendinosis is experienced are common therapies. There is evidence to suggest that tendinosis is not a disorder of inflammation; anti-inflammatory drugs are not an effective treatment; and inflammation is not the cause of this type of tendon dysfunction. There are various treatment options but more research is needed to determine its effectiveness. Initial recovery is usually within 2 to 3 months, and full recovery is usually within 3 to 6 months. About 80% of patients will recover fully within 12 months. If conservative therapy does not work, then surgery can be an option. This operation consists of abnormal tissue excision. The time it takes to recover from surgery is about 4 to 6 months. Studies with a torn-up tendon rat model suggest that delaying exercise until after the initial inflammatory phase of repair may promote faster remodeling.
Research
The eccentric use and therapy of extracorporeal shock waves is currently being investigated as a possible treatment for tendinosis. One study found two modalities were equally effective in treating tendon tendon Achilles and were more effective than the 'wait and see' approach. Other treatments for ongoing research include vitamin E, vitamin B6, nitric oxide, Rich Plasma Platelets (PRP), and stem cell injections.
Vitamin C
One study found an increase in Achilles tendon healing in rats equipped with high doses of vitamin C, which is needed for collagen synthesis.
Vitamin E
Vitamin E has been found to increase the activity of fibroblasts, which leads to increased collagen fibrils and synthesis, which seem to accelerate regeneration and increase the tendon regenerative capacity.
Nitric oxide
Nitric oxide (NO) also seems to play a role in healing the tendon and inhibition of its synthesis damaging the healing of the tendon. The use of a nitric oxide delivery system (glyceryl trinitrate patch) applied over the maximum softness area was tested in three clinical trials for the treatment of tendinopathy and was found to significantly reduce pain and increase range of motion and strength.
One study found that arginine supplementation, which may increase NO signaling, was able to increase the rate of tendon healing
Soft network driver
Augmented Soft Tissue Mobilization (ASTM) is a form of manual therapy that has been shown in studies in mice to accelerate healing of tendons by increasing fibroblast activity. One case study showed ASTM resulted in a full recovery in the case of an athlete suffering from ankle pain and chronic fibrosis, following failed surgery and conventional physical therapy.
Eccentric loading
A promising line of therapy involves an eccentric loading exercise involving elongation of muscle contraction.
Blow brace
The use of an inflatable brace (AirHeel) proved to be as effective as eccentric loading in the treatment of chronic Achilles tendinopathy. Both modalities result in significant reductions in pain scores, but their combination is no more effective than treatment alone.
Shock shock therapy
Shock shock therapy (SWT) may be effective in treating calcific tendinosis in humans and mice. In the subject of rats, SWT increased levels of healing hormones and proteins that led to increased cell proliferation and tissue regeneration in the tendon. Other studies found no evidence that SWT is useful in treating chronic pain in the Achilles tendon.
Biotechnological tendons
The future of non-surgical treatment for possible tendinosis is biotechnology. Ligament reconstruction is possible using mesenchymal stem cells and silk scaffolds. This same stem cell is able to repair damaged animal tendon repairs. Autocous tenocyte implantation is currently being tested for tendinosis. There is a large, double-blind, placebo-controlled, placebo-controlled trial conducted in the Netherlands to test the safety and efficacy of tenocyte therapy. The outcome of the trial is expected in April 2013.
Autologous tenocyte injection
A study investigated autologous tenocyte injection for the treatment of severe and chronic lateral epicondylitis. Needle biopsy is used on the patellar tendon, and the extracted tendon cell is expanded by in vitro cultures. The autologous tenocytes are sorted and purified by real-time polymerase chain reaction, and amplified by flow cytometry. Tenocytes are then injected into the injured tendinopathy site, which is the origin of the extensor carpi radialis brevis tendon, under ultrasound guidance. Following the treatment of autologous tenocyte injections, patients with chronic lateral epicondylitis demonstrate improved clinical function and structural improvement in general extensor tendon origin.
Nonbulbar dermal membrane
RepliCel has planned clinical trials Phase 1/2 Achilles tendinosis using fibroblasts isolated from nonbulbal dermal sheathing cells from hair follicles, and recruited in Q1 2015. Treatment of the tendon will be tested on about 28 subjects. Nonbulbar dermal membrane cells are used because they produce more type I collagen than fibroblasts derived from adipose tissue. Collagen type I is the main collagen in the tendon. Nonbulbar dermal cell cells will be replicated, and then reintroduced into the injured tendon with ultrasound. After the injection, subjects will be assessed for pain, safety, and function, as well as changes in interstitial tears, tendon thickness, echotexture, and neovascularity.
Injection of microRNA
The scientists found that the mir-29a, a microRNA, through its interaction with protein, interleukin 33, played a key role in regulating collagen production in tendon disease. Loss of miR29a from human tendons results in increased production of type-3 collagen, which is a key feature of tendon disease. The replacement of miR-29a in damaged tendon cells in the laboratory restores the production of collagen to pre-injury levels. The experiment will place an injection of microRNAs - small molecules that help regulate gene expression - into the tendon to reduce the production of collagen type 3 and switch to type-1.
Mesenchymal stem cells are allogenic
In November 2013, researchers at Seoul National University Hospital will be looking to recruit participants into clinical trials to evaluate the efficacy of mesenchymal stem cells originating from allogenic stem cells (ALLO-ASC) for the treatment of lateral epicondylitis tendon where the duration of symptoms more than six months. Mesenchymal stem cells derived from adipose will be administered to patients with lateral epicondylitis (tennis elbow) with ultrasound injection.
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Researchers have tried to analyze tissue strains and mechanical properties using elastography, which is an acoustic imaging technique that measures the strain distribution in tissues resulting from tissue stress or compression. Strains are inversely proportional to stiffness, so under the amount of stress given, the tissue that displays fewer strains is considered more rigid than the tissues that show more pressure. Elastography is an indirect method of estimating tissue stiffness.
One limitation of elastography is that it is inherently linear when ultrasonic wave velocity and material properties do not change during strain measurements. This is a problem in soft tissues such as tendons, because they are not linear in stiffness, and can experience major deformation in activity. Elastography measures tension, and to better describe mechanical behavior, more data, such as stiffness or stress will be needed.
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The acoustoelastic theory is based on the principle that the acoustic properties of a material are altered as a loaded and deformed material. Properties can be measured as changes in amplitude and wave velocity.
Using ultrasound A-mode, the researchers have obtained an acoustic link between the reflected wave amplitude, and stiffness that depends on strain and stress on the defective material.
As the tendon tension increases, the intensity of the reflected ultrasonic echo increases. Increased intensity produces a brighter B-mode ultrasound image.
Acoustoelastography is an ultrasound technique that connects changes in the amplitude of ultrasonic waves to the mechanical properties of the tendon.
This is an ultrasound-based model that can be used to evaluate the function of the tendon. Gradual deformation of the tendon may produce a cynical loop, in which a change in the intensity of the echo can be observed. By analyzing the intensity of echo changes with Acoustoelastography, one can deduce the stiffness gradient, which is the rate of change in normal stiffness as a function of strain.
The EchoSoft ultrasound software from the Wisconsin Alumni Research Foundation and Echometrix applies acoustoelasticity theory to measure musculoskeletal tissues (tendons and ligaments). The software examines previously unused information found by ultrasound waves to measure rates of musculoskeletal injury, or patient progress in the healing process.
Ultrasonic Perkutaneous Tenotomy
Percutaneous ultrasonic ultrasound provides advanced pain relief and functional improvement for tennis elbow at ten-year follow-up.
Other animals
The bent tendon is a horseman's term for tendinitis (tendinitis) and tendinosis (degeneration), most commonly seen in a shallow digital flexor tendon on the horse's forelegs.
Diagnosis
When the superficial digital flexor tendon of the horse is damaged, there is a tendon thickening, giving it a bent appearance when the foot is seen from the side.
Medical imaging
A study tested the repetition and feasibility of using acoustoelastography for measurement of in vivo gradient stiffness in the superficial digital flexor tendon (SDFTs) of clinically normal horses. The results show that acoustoelastography is a repeatable and feasible technique for measuring superficial digital flexor tendon rigidity in clinically normal horses, and acoustoelastography has the potential to be used to compare the state of sick and healthy tendons.
A report describes the use of acoustoelastography to monitor the mechanical healing of the Achilles tendon laceration in dogs after stitch repair. Seroustoelastography serial tendon examination showed that mechanical properties increased during the recovery period. At 29 weeks, the mechanical properties of the improved tendon resemble the normal contralateral Achilles mechanism.
A study shows that acoustoelastography is a repeatable and feasible method for measuring stiffness gradients in the superficial digital equine flexor tendon.
The acoustoelastic strain gauge is an ultrasound-based tissue evaluation technique that is associated with changes in the intensity of the echoes observed during stretching or relaxation tendons with the mechanical properties of the tissues. This method reduces the stiffness gradient (the normalized rate of stiffness change as a function of tissue strain) by evaluating the ultrasound dynamic images captured from the tissue as it gradually changes shape. The Acoustoelastic strain gauge has been shown to accurately model the stiffness and tension in the in vitro tendon. To determine the repetition and feasibility of ASG measurements in vivo canine tendon function, a stiffness gradient for a dog's gastrocnemius tendon is noted. The findings suggest that acoustoelastic strain gauges are a recurrent technique and feasible to measure stiffness gradients in the canine tendon.
Pathophysiology
The Achilles tendon in mice was studied by acoustoelastography ultrasound. After tendon injury, and during healing of the tendon, vascularization changes and cellular activity are essential for granular tissue formation in the tendon gap, and subsequent development of neo-tendinous tissue that replaces the damaged native tissue. The normal and intact tendon consists mainly of type I collagen, and collagen type III increases after injury. Other studies have noted the relationship between collagen fibers and tendon echogenicity during Achilles tendon healing.
This report further indicates that the decrease in type I procancers (and increased collagen type III and periostin) correlates with reduced strength, echo intensity, and normal stiffness. This suggests that the normalized stiffness of tissue is linearly correlated with procollagen I, while the intensity of echo is seen nonlinearly correlated with type I procollagen. Furthermore, an increase in M1 macrophages, blood vessels, and reproducing cells that occur within two weeks after injury is associated with granulation tissue formation. The primary stress, echo intensity, and normalized rigidity are the lowest during this time. The results confirmed that stress reduction and stiffness normalization as measured by ultrasonic and mechanical methods correlated well with the biological aspects of tendon healing.
Treatment
Mesenchymal stem cells, derived from horse or bone marrow bone, are currently used for tendon repair in horses. Confusion_between_tendonitis_and_tendinosis [54] "> Confusion between tendonitis and tendinosis
Tendonitis is a very common, but misleading term. By definition, the suffix "-itis" means "inflammation". Inflammation is the body's local response to tissue damage involving red blood cells, white blood cells, blood proteins by dilation of blood vessels around the site of injury. Tendons are relatively avascular. Corticosteroids are drugs that reduce inflammation. Corticosteroids can be useful to relieve chronic tendinopathic pain, improve function, and reduce swelling in the short term. However, there is a greater risk of long-term recurrence. They are usually injected along with a small amount of numbing medication called lidocaine. Research shows that tendons are weaker following corticosteroid injections. Tendinitis is still a very common diagnosis, although studies increasingly document that what is considered tendinitis is usually tendinosis.
See also
- Repetitive strain injury
- Ehlers-Danlos syndrome
References
External links
- tendinosis.org
Source of the article : Wikipedia
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