Search Results (171)

This study aimed to describe the anatomical composition of the Achilles tendon in dromedary camels and to characterize the clinical, radiographic, and ultrasonographic features of tendon laceration and rupture. Six pelvic limbs from an adult healthy Mejhem camel were dissected following fixation in 10% formaldehyde. Additionally, 19 camels with confirmed Achilles tendon injuries were evaluated clinically and by imaging. Anatomically, the tendon is a composite structure formed by the semitendinosus, gastrocnemius (medial and lateral heads), and superficial digital flexor muscles, arranged in superficial and deep layers and inserting at the tuber calcanei. Clinically, affected camels showed acute hindlimb lameness, reduced weight-bearing, and swelling near the calcaneus. Wadeh camels were more frequently affected than other breeds (p < 0.05–0.001). Age > 2 years (OR = 14.06; p < 0.001) and male sex (OR = 28.4; p < 0.001) were significant risk factors, with blunt trauma as the main cause (p < 0.001). Ruptures were more common than lacerations (OR = 28.4; p < 0.001). Radiography revealed soft tissue swelling and occasional calcaneal avulsion fractures, while ultrasonography showed tendon enlargement, fiber disruption, and hypoechoic gaps. These findings highlight the diagnostic value of combined imaging for accurate evaluation and management. Full article

Background: Among the superficial flexor muscles of the upper limb, the Palmaris longus muscle is the most susceptible to anatomical variation. The most common anatomical variant is complete bilateral absence, followed by unilateral absence. Although considerable study has been conducted on the frequency of Palmaris longus muscle absences in Africa, much of it has been conducted at the national level. The pooled prevalence of Palmaris longus absence in Africa has not been established. Objectives: To assess the absence of Palmaris longus muscle and its clinical significance in Africa cadaveric and clinical studies: systematic review and meta-analysis. Methods: We thoroughly examined Google Scholar, PubMed/med line, Science Direct, Hinari, African online journals, Web of Sciences, Central, Embase, Scopus, Cochrane, and institutional repositories. The studies’ quality were assessed using the Newcastle–Ottawa Scale. The pooled prevalence of Palmaris longus muscle absences was estimated using a random-effects meta-analysis model. Data analysis was conducted using STATA 17; heterogeneity, funnel plots, and meta-regression were examined. Sensitivity analyses, publication bias, and subgroup analysis by study time code, location code, and sample size code were also carried out. Result: A total of 23 studies were included in the meta-analysis. The pooled prevalence of Palmaris longus absence in Africa was 14.0% (95% CI: 10.0–18.0). However, there was significant variation in reported prevalence rates, as seen by the significant heterogeneity found across studies (I² = 99.13%). The results were not significantly changed by sensitivity analysis. Conclusions and recommendation: This study found that the Palmaris longus muscle is absent in 14% of African populations. Comparison with international studies revealed both similarities and differences, influenced by methodology and genetic factors. Clinicians should consider this prevalence when advising patients requiring tendon grafts. Further long-term studies using imaging techniques (MRI; ultrasound) are recommended to improve understanding in African populations and globally. Full article

Flexor hallucis longus (FHL) tendon injuries, although rare, severely affect foot stability and mobility, particularly in individuals engaging in repetitive push-off actions. This case study examines a 27-year-old male who underwent surgical repair for FHL tendon rupture, followed by a structured, multi-modal rehabilitation program integrating advanced therapeutic techniques. The 12-week program was divided into three distinct phases to ensure a structured and progressive recovery process. The Early Phase (Weeks 1–4) focused on pain and edema control through interventions such as massage, electrotherapy, kinesiotaping, and the use of peritendinous ultrasonography to monitor recovery progress. The Intermediate Phase (Weeks 5–8) aimed to enhance strength and flexibility by incorporating Proprioceptive Neuromuscular Facilitation (PNF), weight-bearing exercises, dynamic stretching, and the progressive integration of Graston massage techniques. Finally, the Advanced Phase (Weeks 9–12) prioritized functional recovery, utilizing balance training, load transfer exercises, agility drills, and Theragun applications to prepare the individual for a return to optimal physical performance. Significant improvements were observed, including pain reduction (VAS score reduced by X%), increased dorsiflexion flexibility (from X° to X°), and enhanced muscle strength (e.g., tibialis anterior strength increased by X%). Functional assessments, such as the Y Balance Test, revealed improved endurance and mobility. This case study highlights the benefits of integrating innovative techniques like Graston massage and Theragun within a structured, evidence-based rehabilitation program to optimize recovery post-FHL tendon surgery. Full article

Background and Clinical Significance: Post-traumatic finger stiffness is frequently attributed to soft tissue adhesions; however, mechanical obstruction from occult osseous structures remains a rare but critical differential diagnosis in adults. Case Presentation: This report describes a 56-year-old female presenting with severe, refractory stiffness of the little finger eight months after a proximal phalanx fracture. Despite extensive conservative therapy, active and passive flexion at the proximal and distal interphalangeal joints remained locked in extension. While conventional radiographs demonstrated bony union, musculoskeletal ultrasonography (MSUS) revealed an occult protruding malunited fragment incarcerating the flexor tendons. Dynamic MSUS provided real-time evidence of mechanical impingement by demonstrating proximal muscle contraction without distal tendon excursion. Intraoperatively, initial soft tissue tenolysis failed to restore motion; further exploration guided by MSUS evidence successfully identified a sharp bone spike. Subsequent ostectomy resulted in immediate restoration of functional range of motion. This case underscores the limitations of static imaging in evaluating the dynamic gliding mechanism and highlights the valuable role of MSUS in identifying mechanical functional obstructions. Conclusions: Early sonographic evaluation should be considered for refractory post-traumatic stiffness to prevent prolonged, ineffective conservative care and to guide definitive surgical management. Full article

Background: Percutaneous needle fasciotomy has been practiced for many years as a therapeutic alternative to open fasciectomy in Dupuytren’s disease. In addition to collagenase injection, it has established itself as a minimally invasive procedure in everyday clinical practice. This study analyzes the treatment results of 1146 patients. Methods: Patients at a center for needle fasciotomy were surveyed retrospectively by means of a questionnaire. In addition to previous illnesses and the localization and number of affected fingers, the frequency of recurrences, the need for renewed treatment, and satisfaction with the surgical result were also surveyed. Results: Between 1994 and 2012, 1146 patients with 1803 finger rays were treated and their data analyzed on the basis of records. In addition, a questionnaire survey on patient satisfaction was conducted and 174 questionnaires were analyzed. Overall, 83% of the patients were male and 16% female. In 50% of cases the right side was treated, in 45% of cases the left side (5% unknown), while 46% of the finger rays treated were on the little finger and ring finger. In all but one case, an improvement in the contracture was achieved. Complications included skin tears (264 cases), increased swelling (five cases), hypesthesia (one case), flexor tendon rupture (four cases) and a mid-limb base fracture (one case). The mean operation time was 26.9 min, the duration of pain was 2.7 days, and patient satisfaction on a scale of 1–10 was 7.2. Overall, 77% of patients stated that there had been a further deterioration or recurrence within one year of treatment, and 35% of these patients stated that further treatment was necessary. Conclusions: Needle fasciotomy is a safe and effective method with a low complication rate, but targeted and stringent follow-up treatment is necessary, as is information about possible recurrences or further deterioration of the result. Full article

Background/Objectives: Progressive collapsing foot deformity (PCFD) is driven by multiplanar peritalar instability. This study evaluated the clinical and radiographic outcomes of a standardized four-component reconstruction protocol designed to facilitate immediate postoperative weight-bearing in Stage 1a/1b PCFD. Methods: This single-center retrospective study included 20 patients treated between 2015 and 2023 with medializing calcaneal osteotomy, spring ligament repair, flexor digitorum longus (FDL) tendon transfer with internal brace augmentation, and subtalar arthroereisis. Clinical (VAS, AOFAS) and radiographic parameters (anteroposterior and lateral Meary angles, calcaneal pitch, and talonavicular coverage angle) were assessed longitudinally, with subgroup analysis comparing implant removal versus retention. Results: The protocol yielded significant overall improvements. Mean VAS decreased by 4.37 points (p < 0.001), and final AOFAS reached 84.7 ± 7.6 at the final follow-up. Although subtalar arthroereisis was removed in 45% of patients due to symptomatic irritation, subgroup analysis revealed no significant loss of radiographic correction (p > 0.05). Notably, a significant interaction effect was observed for VAS scores (p = 0.002) and AOFAS scores (p = 0.041), with the removal group demonstrating a pronounced functional recovery trajectory following explantation. No major complications occurred. Conclusions: A standardized four-in-one reconstruction provides reliable multiplanar correction in Stage 1a/1b PCFD. The maintenance of structural alignment despite a high implant removal rate supports the role of arthroereisis as a temporary but valuable adjunct for early mobilization. This strategy offers a reproducible framework for joint-preserving PCFD management. Full article

Aims. To investigate the relationship between ultrasound (US)-detected parenchymal abnormalities in the major salivary glands (MSG), joint and tendon inflammation, and systemic disease activity in patients with primary Sjögren’s syndrome (pSS). Patients and methods. This cross-sectional, multicenter study enrolled 60 patients with pSS and 20 healthy controls (HCs). Systemic disease activity was evaluated using the EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI), while symptom burden was assessed with the EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI). MSG evaluation included bilateral gray-scale (GS) and power Doppler (PDUS) assessment of the parotid and submandibular glands using a semi-quantitative 0–3 scoring system. Musculoskeletal ultrasound (MSUS) assessment comprised bilateral examination of the wrists, second to fifth metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, the fourth extensor wrist compartment, and the flexor tendons of the second to fifth fingers for GS and PD-detected synovitis and tenosynovitis, also scored semi-quantitatively. Recorded outcomes included GS and PD synovitis scores, total synovitis score, tenosynovitis score, GS and PD glandular scores, and total glandular score. Results. Synovitis was most frequently detected in the wrists, followed by the second PIP joint. Subclinical synovitis—defined as a GSUS synovitis score > 0 in a joint without clinical swelling—was detected in 66.7% (n = 28) of patients with pSS. No significant correlations were found between joint US scores and salivary gland US scores. ESSPRI showed moderate positive correlations with both the GS synovitis score (p = 0.002) and the total synovitis score (p = 0.003), as well as significant positive correlations with all salivary gland US scores: GS (p < 0.001), PD (p = 0.002), and total glandular score (p < 0.001). ESSDAI demonstrated only a weak positive correlation with the GS salivary gland score (p = 0.030). Conclusions. In patients with pSS, the extent of US-detected MSG parenchymal abnormalities does not reflect systemic disease activity and does not correlate with US-detected joint synovitis. In contrast, patient-reported symptom burden is associated with both joint inflammation and MSG parenchymal changes on US. Larger studies are needed to further define the role of salivary gland and joint US in evaluating disease activity in pSS. Full article

Multimodal high-resolution ultrasound, including B-mode, Power Doppler, MicroVessel Doppler, spectral Doppler, and strain elastography, was used to assess concomitant dactylitis and hidradenitis suppurativa (HS) in a 46-year-old woman with severe hidradenitis suppurativa (IHS4 = 28), who was diagnosed 1.5 years ago and has been using adalimumab. Axillary ultrasound demonstrated abscess cavities and draining fistulous tracts with marked structural distortion, increased vascular signal on advanced Doppler modalities, and heterogeneous stiffness patterns on elastography, consistent with active deep inflammatory involvement. Simultaneously, evaluation of the third right finger revealed flexor tendon sheath thickening, soft-tissue edema, Doppler-positive inflammatory activity, and altered biomechanical properties compatible with dactylitis. High-resolution ultrasound has been increasingly recognized as a valuable tool for evaluating inflammatory and structural changes in cutaneous diseases, including HS. These multimodal findings illustrate how structural, vascular, and biomechanical ultrasound parameters may provide complementary information for characterizing inflammatory tissue remodeling in HS associated with dactylitis. As this report describes a single patient, these elastographic observations should be considered exploratory and hypothesis-generating rather than evidence of clinical validation. Full article

(1) Achilles tendon rupture is one of the most severe lower-limb injuries, frequently occurring during movements involving maximal dorsiflexion with the knee at near-full extension. Preventive strategies are crucial, particularly for athletes engaged in high-risk sports such as basketball. (2) In this work, we examined the effect of a novel Achilles brace on Achilles tendon loading during concentric and eccentric mechanisms associated with tendon rupture. (3) Twenty-eight young basketball players performed tests under two conditions: with the adaptive brace and without it (control). Participants were divided into two groups (n = 14 in both). The first group assessed concentric Achilles loading by performing three plantar-flexor strength tests in three different joint configurations: maximal dorsiflexion with the knee flexed (FKF); injury mechanism position—full plantar flexion with the knee extended (FKE); and neutral ankle position with the knee extended (NKE). The number of maximal heel-raise repetitions performed before onset of fatigue was recorded. The second group assessed eccentric tendon loading by performing single-leg forced maximal-velocity dorsiflexion with the knee extended. In all tests, the time between maximal plantar flexion and maximal dorsiflexion, as well as the ankle range of motion, was analyzed using 2D video. Paired t-tests were used to compare braced and control conditions. In all tests, the ankle range of motion (ROM) did not differ significantly between brace and control conditions. Wearing the brace significantly improved plantar-flexor muscle strength only in the FKE test (31 ± 1.3 repetitions with brace vs. 21 ± 1.3 in control, p < 0.05). No significant differences were found for the FKF (27 ± 1.3 vs. 25 ± 1.3) or NKE (25 ± 1.3 vs. 24 ± 1.3) positions. During drop eccentric loading, wearing the brace resulted in a significantly slower transition time from plantar flexion to dorsiflexion (460 ± 60 ms with brace vs. 320 ± 30 ms in control, p < 0.001). (4) In brief, the novel Achilles brace was found to significantly reduces Achilles tendon load during both concentric and eccentric activities, but only in high-risk joint positions. These findings suggest that the brace provides mechanical protection, and may reduce the risk of Achilles tendon rupture, in athletes exposed to high tendon stress. Full article

Lesions of the tendons and manica flexoria (MF) within the digital flexor tendon sheath (DFTS) are a common cause for lameness in horses. This prospective study compared and quantified the agreement and disagreement of positive contrast computed tomographic tenography (CTT), positive contrast radiographic tenography (RXT), ultrasonography (US) and tenoscopy for diagnosing naturally occurring lesions within the DFTS, without application of a gold standard. Lesions affecting the deep (DDFT) and/or superficial digital flexor tendon (SDFT), and/or the MF and/or constriction of the palmar/plantar annular ligament (PAL) were evaluated in eighteen horses with distention of the DFTS. For DDFT lesions, comparing CTT with tenoscopy, US, and the combined results of US and RXT (US+RXT) attained the highest agreements, with 83% matching results (κ: 0.65). For SDFT lesions, CTT and tenoscopy showed the highest agreement with 94% matching results (κ: 0.89), followed by tenoscopy with US+RXT (78%; κ: 0.56). The highest agreement for MF-tear detection was found comparing CTT with tenoscopy (83%; κ: 0.67), followed by CTT with RXT (78%; κ: 0.56). None of the modalities agreed on positive diagnoses of PAL constriction. CTT achieved the highest agreement with tenoscopy and US for the diagnosis of lesions within the DDFT and is, therefore, considered the most useful modality for preoperative evaluation. Full article

Background: Chronic Achilles tendon ruptures present a major surgical challenge due to tendon retraction, degeneration, and large defects. Autologous hamstring tendon grafts have emerged as a reliable reconstructive option, yet their biomechanical consequences remain poorly understood. This study investigated whether Achilles tendon reconstruction with semitendinosus and gracilis autografts alters the plantar flexor moment arm and whether such changes affect muscle strength. Methods: A cohort of 25 patients (mean age: 44.5 years) underwent minimally invasive endoscopic reconstruction using hamstring autografts. This secondary salvage procedure was performed in patients with neglected ruptures or failed primary treatment. Five patients were excluded from the original intervention group due to inadequate radiographic quality. Radiographic measurements of the Achilles tendon moment arm and isometric plantar flexor strength assessments were performed at 12 and 24 months postoperatively. Statistical analyses included paired t-tests, Wilcoxon signed-rank tests, and correlation analyses. Results: Results showed a significant shortening of the Achilles tendon moment arm after reconstruction compared with the preoperative imaging length (mean reduction: 6.6 mm; p < 0.0001). Despite this, plantar flexor strength in the operated limb improved significantly over time at 12 and 24 months (+388.6 N at 24 months; p = 0.0067) and did not correlate with the degree of moment arm shortening (p > 0.3). By 24 months, the operated limb demonstrated comparable or greater strength than the contralateral side, with nearly half of the patients achieving substantial clinically meaningful improvements. Conclusions: In conclusion, Achilles tendon reconstruction with hamstring autografts leads to consistent moment arm shortening, yet this does not impair long-term restoration of plantar flexor strength. A progressive rehabilitation program extending up to two years appears essential to optimize recovery and compensate for biomechanical alterations. Full article

Background/Objectives: Tendon injuries are a common cause of emergency department presentation and impose a substantial socioeconomic burden. Despite advances in surgical techniques, rupture rates after primary repair remain at 3.1–11.7%. Contemporary repairs typically combine at least four core strands with epitenon sutures to achieve sufficient tensile strength while limiting bulk. Increasing the number of core strands improves strength but may impair gliding and healing. Looped core sutures increase the effective strand number without additional knots or passes, potentially allowing omission of the epitenon suture and thus limiting repair complexity and bulk. The objective was to determine whether six- or eight-strand looped core suture techniques provide sufficient tensile strength to allow omission of an epitenon suture without excessive repair bulk, compared with a conventional four-strand Adelaide repair. Methods: One hundred and twenty human flexor digitorum profundus tendons were harvested from fresh-frozen anatomical specimens and allocated to six groups: Adelaide (four-strand) ± epitenon suture, six-strand ± epitenon suture, and eight-strand ± epitenon suture. Repairs were performed in zone II. The cross-sectional area (CSA) was measured before and after repair to quantify bulkiness. Tendons were tested to failure using axial tensile loading, and the failure mode was recorded. Results: The Adelaide with epitenon suture, six-strand with epitenon suture, and eight-strand with epitenon suture demonstrated significantly higher load to failure than the Adelaide without epitenon suture. The eight-strand without epitenon suture achieved a load to failure comparable to the Adelaide with epitenon suture, while also resulting in a smaller increase in CSA. The Adelaide with epitenon suture showed the greatest increase in CSA, while the six-strand without epitenon suture showed the smallest increase in CSA. Suture breakage was the predominant failure mode. Conclusions: An eight-strand looped core suture without epitenon suture provides comparable tensile strength to the conventional Adelaide repair with epitenon suture while minimizing repair bulk. The six-strand with epitenon suture demonstrated similar tensile strength to higher-strand techniques and may represent a mechanically adequate alternative with less tissue manipulation. These findings support a more individualized approach to flexor tendon repair, in which the choice of repair construct can be tailored to biomechanical demands and clinical context rather than applying a single uniform technique. Full article

The iliopsoas muscle (IPM) is a flexor of the hip joint in dogs that is vulnerable to injury. Intraobserver and interobserver reliability of musculoskeletal ultrasound when evaluating the tendon of insertion of the IPM was studied. The IPM tendons of insertion of a randomly selected cohort were screened by one investigator and recorded. Musculoskeletal ultrasound recordings were separated into two groups of 20 dogs with presumptively normal IPM tendons of insertion and 32 dogs with one or two presumptively abnormal IPM tendons. Recordings were anonymized. The 104 tendons from these 52 dogs were independently reviewed twice by three observers. Abnormalities were detected in 6 of 40 presumptively normal IPM tendons (15%) and 59 of 64 presumptively abnormal IPM tendons (92%). Intraobserver repeatability of measurements of tendon dimensions was good (range, 0.24 to 0.76 mm), intraobserver reliability was good or excellent (range, 0.812 to 0.917), and intraobserver consistency was good (all coefficients of variation <20%). All measurements had poor interobserver consistency (intraclass correlation coefficients <0.500). Measurements of the tendon of insertion of the IPM have acceptable intraobserver repeatability, consistency, and reliability but have poor interobserver consistency, suggesting that efforts should be made to standardize the interpretation methods when using diagnostic ultrasound to evaluate problems affecting the tendon of insertion of the IPM in dogs. Full article