Search Results (318)

Background/Objectives: The increased risk of developing tendinopathies in athlete populations has led to investigations of several genes associated with tendon properties, suggesting that some individuals have a greater genetic predisposition for developing tendinopathies. The main purpose of this study was to investigate how the functional polymorphisms within the COL5A1, COL27A1 and TNC genes impact the risk of developing tendinopathies in high-level Croatian athletes. Methods: For this case–control genetic study, we recruited 63 high-level athletes with a diagnosis of tendinopathies and 92 healthy asymptomatic individuals as controls. All individuals were genotyped for three single-nucleotide polymorphisms (SNPs) within the COL5A1, COL27A1 and TNC genes using the pyrosequencing method. Results: TNC rs2104772 TT (p = 0.0089) and the T-T-T haplotype (p = 0.0234), constructed from rs12722, rs946053 and rs2104772, were significantly overrepresented in cases versus controls, implicating a predisposition for tendinopathies. COL27A1 rs946053 GG (p = 0.0118) and the G-A-C haplotype (p = 0.0424), constructed from rs12722, rs946053 and rs2104772, were significantly overrepresented in controls, implicating a protective role. Conclusions: These results further support associations between functional polymorphisms within the COL27A1 and TNC genes and the risk of tendinopathies in high-level athletes. Further research is needed to replicate these results in various populations and larger cohorts. Full article

Background: Midportion Achilles tendinopathy (Mid-AT) is a complex condition that may be exacerbated by anatomical variations of the plantaris tendon. Recent anatomical studies, particularly the classification proposed by Olewnik et al., have enhanced the understanding of plantaris–Achilles interactions and their clinical implications. Objective: This review aims to assess the anatomical types of the plantaris tendon, their imaging correlates, and the impact of the Olewnik classification on diagnosis, treatment planning, and surgical outcomes in patients with Mid-AT. Methods: We present an evidence-based analysis of the six anatomical types of the plantaris tendon and their relevance to Achilles tendinopathy, with emphasis on MRI and ultrasound (USG) evaluation. A diagnostic and therapeutic algorithm is proposed, and clinical outcomes of both conservative and operative management are compared across tendon types. Results: Types I and V were most strongly associated with symptomatic conflict and showed the highest benefit from surgical resection. Endoscopic approaches were effective in Types II and III, while Type IV typically responded to conservative treatment. Type VI, often misdiagnosed as tarsal tunnel syndrome, required combined neurolysis. The classification significantly improves surgical decision-making, reduces overtreatment, and enhances diagnostic precision. Conclusions: The Olewnik classification provides a reproducible, clinically relevant framework for individualized management of Mid-AT. Its integration into imaging protocols and treatment algorithms may improve therapeutic outcomes and guide future research in orthopaedic tendon pathology. Full article

Introduction: Haglund’s deformity, characterized by bony enlargement at the back of the heel, often coincides with Achilles tendon pathology due to impingement on the retrocalcaneal bursa and tendon insertion. Surgical management of Haglund’s deformity with a preexisting Achilles tendon rupture is complex, and understanding the outcomes of this subset of patients is essential for optimizing treatment strategies. Methods: This retrospective study reviewed patients undergoing open surgical management for Haglund’s syndrome between January 2015 and December 2023. Patients with chronic degenerative changes secondary to Haglund’s deformity and a preoperative Achilles tendon rupture were compared to those without. Data on demographics, surgical techniques, weightbearing protocols, and complications were collected. Univariate analysis was performed using χ² or Fisher’s exact test for categorical variables, and the T-test or Wilcoxon rank-sum test for continuous and ordinal variables, with normality assessed via the Shapiro–Wilk test. Results: Four hundred and three patients were included, with 13 having a preoperative Achilles tendon rupture. There was a higher incidence of preoperative ruptures among males. Surgical repair techniques and postoperative weightbearing protocols varied, though were not randomized. Complications included persistent pain, wound breakdown, infection, plantar flexion weakness, and revision surgery. While patients with Haglund’s deformity and a preoperative Achilles tendon rupture demonstrated a trend toward higher complication rates, including postoperative rupture and wound breakdown, these differences were not statistically significant in our analysis. Conclusions: A cautious approach is warranted in managing these patients, with careful consideration of surgical planning and postoperative rehabilitation. While our findings provide valuable insights into managing patients with Haglund’s deformity and preoperative Achilles tendon rupture, the retrospective design, limited sample size of the rupture group, and short duration of follow-up restrict generalizability and the strength of the conclusions by limiting the power of the analysis and underestimating the incidence of long-term complications. Therefore, the results of this study should be interpreted with caution. Further studies with larger patient cohorts, validated functional outcome measures, and comparable follow-up durations between groups are needed to confirm these results and optimize treatment approaches. Full article

Background/Objectives: Rotator cuff calcific tendinopathy (RCCT) is one of the most common causes of non-traumatic shoulder pain. To date, there is still no consensus regarding the most effective method for its treatment. Ultrasound-guided percutaneous aspiration is suggested during the reabsorption phase of calcific metaplasia. We aimed to evaluate the effectiveness of ultrasound-guided lavage for RCCT from a clinical and radiological perspective. Methods: We involved patients affected by RCCT of the supraspinatus tendon. The approach used for the calcification lavage was the one-needle technique, consisting in inserting a 16–18 G needle on a 20 mL syringe with 0.9% saline solution, in the calcific metaplasia, under ultrasound guidance, using an in-plane approach; the repetitive action of pressing and releasing the plunger was repeated until the contents of the syringe became milky, at which point the syringe was replaced with a new one, always containing saline solution. The physiotherapy treatment began 7 days after the procedure. We assessed the Numeric Rating Scale, the Gartner classification, the Disability of the Arm, Shoulder and Hand scale, the Constant–Murley shoulder score, and the passive range of motion of flexion and abduction. Results: We included 23 subjects. The analysis of the data at baseline and t1 showed a statistically significant improvement in all the functional variables (p < 0.05). This result was mainly evident for pain, with a p-value of 0.001. Conclusions: The findings of the present prospective case series study showed an improvement in the clinical and radiological outcomes after ultrasound-guided percutaneous aspiration for rotator cuff calcific tendinopathy. Full article

Objectives: This study aimed to investigate the efficacy of Percutaneous Electrolysis (PE), Percutaneous peripheral Nerve Stimulation (PNS), and Eccentric Exercise (EE) in patients with supraspinatus tendinopathy. Methods: Forty-six participants with supraspinatus tendinopathy were randomly allocated to either an invasive therapy group (four sessions in four weeks of PE+PNS and EE program) or a conventional physical therapy group (ten sessions for 2 weeks). The multimodal physical program included Ultrasound therapy (US), Transcutaneous Electric Nerve Stimulation (TENS) and the same EE program. The Numerical Pain Rating Scale (NPRS), shoulder Range of Motion (ROM), Pressure Pain Threshold (PPT), and disability (DASH and SPADI) were measured at baseline, at the end of treatment, and at 12- and 24-weeks follow-up. Results: The PE+PNS+EE group demonstrated consistently greater and statistically significant improvements across nearly all pain, mobility, and functional outcomes at all follow-up points (post-treatment, 12-weeks, and 24-weeks) compared to the TENS+US+EE group, with generally medium to large effect sizes. Conclusions: This study concludes that the combined PE+PNS+EE intervention offers safe and effective treatment for supraspinatus tendinopathy, demonstrating statistically significant improvements in pain, mobility, and function compared to conventional electrotherapy. Full article

Tendinopathies are a significant challenge in musculoskeletal medicine, with current treatments showing variable efficacy. Electromagnetic transduction therapy (EMTT) has emerged as a promising therapeutic approach, but its biological effects on tendon cells remain largely unexplored. Here, we investigated the effects of EMTT on primary cultured human tenocytes’ behavior and functions in vitro, focusing on cellular responses, senescence-related pathways, and molecular mechanisms. Primary cultures of human tenocytes were established from semitendinosus tendon biopsies of patients undergoing anterior cruciate ligament (ACL) reconstruction (n = 6, males aged 17–37 years). Cells were exposed to EMTT at different intensities (40 and 80 mT) and impulse numbers (1000–10,500). Cell viability (MTT assay), proliferation (Ki67), senescence markers (CDKN2a/INK4a), migration (scratch test), cytoskeleton organization (immunofluorescence), and gene expression (RT-PCR) were analyzed. A 40 mT exposure elicited minimal effects, whereas 80 mT treatments induced significant cellular responses. Repeated 80 mT exposure demonstrated a dual effect: despite a moderate decrease in overall cell vitality, increased Ki67 expression (+7%, p ≤ 0.05) and significant downregulation of senescence marker CDKN2a/INK4a were observed, suggesting potential senolytic-like activity. EMTT significantly enhanced cell migration (p < 0.001) and triggered cytoskeletal remodeling, with amplified stress fiber formation and paxillin redistribution. Molecular analysis revealed upregulation of tenogenic markers (Scleraxis, Tenomodulin) and enhanced Collagen I and III expressions, particularly with treatments at 80 mT, indicating improved matrix remodeling capacity. EMTT significantly promotes tenocyte proliferation, migration, and matrix production, while simultaneously exhibiting senolytic-like effects through downregulation of senescence-associated markers. These results support EMTT as a promising therapeutic approach for the management of tendinopathies through multiple regenerative mechanisms, though further studies are needed to validate these effects in vivo. Full article

Background: Percutaneous electrolysis (PE) is a minimally invasive procedure that utilizes galvanic current delivered through a needle. PE is increasingly employed for musculoskeletal disorders, despite the scarcity of scientific evidence supporting its use. The aim of this systematic review is to synthesize the existing evidence and explore the applications of PE in rehabilitation. Methods: In line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search was conducted across the PubMed, Web of Science, Scopus, and PEDro databases from inception to July 2025. The search strategy employed the term “Percutaneous Electrolysis” without applying additional filters or time restrictions, ensuring a comprehensive search. Cited references from screened articles were also evaluated for potential inclusion. Studies were included if they met the following criteria: peer-reviewed articles, intervention-based research, relevance to the topic, and publication in English. Results: Of the 181 papers retrieved, 143 were excluded for various reasons, leaving 38 studies. The evidence suggests that PE appears effective in reducing pain and improving function, particularly when combined with exercises such as eccentric training or stretching, though inconsistencies in protocols and patient characteristics, along with unclear mechanisms, show that it warrants further investigation. Conclusions: In conclusion, while PE emerges as a promising therapeutic strategy for musculoskeletal disorders, its full integration into rehabilitation practice necessitates further rigorous research to standardize treatment protocols, elucidate the underlying mechanism, and validate its cost-effectiveness. These steps are essential to establish PE as a robust and evidence-based option within the field of rehabilitation. Full article

Objectives: Shoulder injury prevalence appears to be the highest among all injuries in CrossFit (CF) athletes. Nevertheless, there is no evidence deriving from prospective studies to explain this phenomenon. The purpose of this study was to document shoulder injury incidence in CF participants over a 12-month period and prospectively investigate the risk factors associated with their demographic, epidemiological, and functional characteristics. Methods: The sample comprised 109 CF athletes in various levels. Participants’ data were collected during the baseline assessment, using a specially designed questionnaire, as well as active range of motion, muscle strength, muscle endurance, and sport-specific tests. Non-parametric statistical tests and inferential statistics were employed, and in addition, linear and regression models were created. Logistic regression models incorporating the study’s continuous predictors to classify injury occurrence in CF athletes were developed and evaluated using the Area Under the ROC Curve (AUC) as the performance metric. Results: A shoulder injury incidence rate of 0.79 per 1000 training hours was recorded. Olympic weightlifting (45%) and gymnastics (35%) exercises were associated with shoulder injury occurrence. The most frequent injury concerned rotator cuff tendons (45%), including lesions and tendinopathies, exhibiting various severity levels. None of the examined variables individually showed a statistically significant correlation with shoulder injuries. Conclusions: This is the first study that has investigated prospectively shoulder injuries in CrossFit, creating a realistic profile of these athletes. Despite the broad spectrum of collected data, the traditional statistical approach failed to identify shoulder injury predictors. This indicates the necessity to explore this topic using more sophisticated techniques, such as advanced machine learning approaches. Full article

Background: Immune checkpoint inhibitors (ICIs) transformed cancer treatment, producing significant survival benefits. However, ICIs can trigger toxicities called immune-related adverse events (irAEs), including inflammatory arthritis (IA) and polymyalgia rheumatica (PMR)-like syndromes. Our study aimed to systematically further characterize musculoskeletal ultrasound (MSKUS) findings in patients with ICI-IA and ICI-PMR, collectively referred to as “MSK-irAEs”, and explore the role of US in guiding treatment. Methods: The authors conducted a comprehensive chart review for patients receiving ICIs undergoing MSKUS at our center’s rheumatology clinics. US examinations were performed and reviewed by two MSKUS-certified rheumatologists. Descriptive statistics were performed to summarize demographic, clinical, and treatment-related variables. US findings were categorized with a novel scoring system: 0—no signs of inflammatory arthropathy or tendinopathy, 1—potential signs of inflammation (grayscale ≥ 2, effusion without power Doppler, synovial hypertrophy in the joint), and 2—active inflammation in joints and/or tendons (characterized by power Doppler) and signs of inflammation. Results: Twenty-three patients were included. The median age was 63 years, 52% were male, and 87% were White. Melanoma was the most common cancer (48%). MSK-irAEs were diagnosed in nineteen (83%), with MSKUS showing inflammation in seventeen (74%). Sixteen (70%) received escalation in MSK-irAE treatment after MSKUS. Four (17%) had erosive disease due to MSK-irAEs, while one had erosive osteoarthritis. Individuals with inflammatory erosive changes experienced prolonged intervals between symptom onset and MSKUS, ranging from 17 to 82 months, suggesting that erosions may reflect chronic, under-recognized inflammation. On MSK-irAE therapy, nine (47%) experienced symptomatic improvement, five (26%) achieved resolution, and in four (21%) cases, it was too early to assess the response. MSKUS detected other causes of MSK symptoms besides MSK-irAEs in several patients, allowing ICI resumption in one. Conclusions: Our study highlights the clinical utility of MSKUS not only as a diagnostic tool but also to guide therapeutic decision-making. Full article

Background: Percutaneous electrolysis (PE) is an emerging therapeutic approach for tendinopathies, applying a galvanic current through a dry-needling needle to induce regenerative tissue responses. However, current dosing strategies are often empirical and lack objective physiological feedback. Objective: This study aimed to evaluate the echogenic effects of different galvanic current intensities on cadaveric tendon tissue using quantitative ultrasound. Methods: An ex vivo study was conducted on 29 cadaveric patellar tendon samples, each exposed to a single intensity (0–10 mA for 1 s). Quantitative ultrasound analysis was performed post-intervention, and echogenic variables were extracted using UZ eDosifier software. A composite variable, Electrolysis_UZ_Dose, was created via multiple regression to capture the overall ultrasound-visible changes. Data were analyzed using correlation, regression models, and dose–range comparisons. Results: An intensity-dependent response was observed in key echogenic parameters. Minimal changes occurred at low intensities (0–2 mA), whereas a progressive response emerged between 2 and 6 mA. Beyond 6 mA, a plateau effect suggested either tissue saturation or imaging limitations due to gas-induced acoustic shadowing. The Electrolysis_UZ_Dose variable strongly correlated with applied intensity (R² = 0.732). Conclusions: This study suggests an intensity-dependent echogenic effect of PE on tendon tissue in key ultrasound-derived parameters (A_Number, A_Area, A_Perimeter, A_Homogeneity, and A_ASM). However, as this study was conducted under experimental conditions with a single 1 s application per sample, the results should not be extrapolated to clinical practice without further validation. Full article

Background/Objectives: Achilles tendon pathologies, such as Achilles tendinitis, tendinosis, ruptures, and equinus contracture, cause pain and functional impairment. While surgical intervention is indicated in some cases, many patients are successfully managed with nonoperative treatment. The goal of this review was to evaluate the current evidence-based treatments for the nonoperative management of Achilles tendon disorders, focusing on indications and clinical outcomes. Methods: A scoping review of the literature was conducted from 2015 to 2025 from the PubMed database. Research published in the last ten years was included if it addressed nonoperative treatments for Achilles tendinopathy, acute ruptures, and/or equinus contracture. The outcome measures of interest included functional outcomes, re-rupture rates, and overall patient satisfaction. Results: Nonoperative management results in favorable outcomes for a wide range of Achilles tendon pathologies. Eccentric loading is supported for chronic tendinopathy, and functional rehabilitation programs with early mobilization have shown comparable outcomes to surgical repair for acute tendon ruptures. Combination therapy for the nonoperative management of equinus is favored. These therapies include stretching protocols, casting, and the botulinum toxin. Conclusions: The literature supports the notion that nonoperative management strategies for Achilles tendon pathologies provide symptom relief and functional improvement in patients. However, these treatment plans should be individualized and tailored to patient-specific goals. Full article

Local anesthetics (LAs) are frequently administered via peritendinous ultrasound-guided injections for diagnostic and therapeutic purposes. Since in vitro studies have demonstrated LAs’ tenotoxic effects, raising concerns about their safety in infiltrative treatments, and since lidocaine (LD) emerged as one of the most cytotoxic LAs, we analyzed apoptosis, oxidative stress, and collagen turnover pathways in human tenocytes treated with LD, as well as the possible protection from LD-induced injury elicited by antioxidant ascorbic acid (AA). Tenocytes from gluteal tendons were treated with 0.2 and 1 mg/mL LD, or left untreated (CT), and treated with 50 μg/mL or 250 μg/mL AA. Nuclear morphology, cytochrome c expression, and caspase 3 activation were analyzed to study the effect of LD on apoptosis. Heme Oxygenase 1 (HO-1) mRNA and genes and proteins involved in collagen turnover were investigated using molecular approaches. Our results show that 0.2 and 1 mg/mL LD did not induce apoptosis and did not modify collagen synthesis and maturation. Conversely, increased collagen degradation was observed, and AA was not protective against oxidative stress induction in the presence of LD. Our findings suggest that LD does not affect the cell viability of tenocytes and that peritendinous LD injections are safe in this regard. LD-associated collagen degradation and the AA buffer effect are still debatable. Overall, our study contributes to clarifying the effect of LD on tenocytes’ viability and ECM homeostasis and provides new additional information useful for the safe clinical application of this drug and for further analysis. Full article

The functional status of the plantaris muscle (PM) remains controversial and is historically dismissed as vestigial; yet, it is increasingly recognized for its structural and clinical complexity. This narrative review synthesizes current evidence from embryological development, adult morphological studies, comparative mammalian anatomy, and clinical case reports to reassess the role of the PM in humans. Developmental data reveal that the PM is consistently present during fetal life, with tendon morphology and insertion patterns emerging early and resembling adult anatomical variants. Rather than indicating postnatal regression, it suggests a stable polymorphism rooted in prenatal development. Across mammalian species, the PM varies in presence and function, correlating with locomotor specialization from proprioception in primates to propulsion in carnivores, and absence in ungulates. In humans, high proprioceptive fiber density and anatomical variability support the hypothesis that the PM may be undergoing functional repurposing from a contractile to a sensorimotor role. Clinically, its relevance is evident in imaging interpretation, surgical tendon harvesting, and the pathophysiology of Achilles tendinopathy. Recent discoveries, including the identification of the plantaris ligamentous tendon (PLT), further underscore the complexity of this region and support the need to reassess its structural and clinical significance. We conclude that the PM should not be regarded as a regressing remnant but as a dynamically adapting structure with potential neuromechanical function. Future studies involving electromyography and neuroanatomical mapping are essential to elucidate its evolving role. Full article

Objectives: The aims of the presented study were to investigate and compare the effectiveness of Low-Level Laser Therapy (LLLT) and therapeutic ultrasound (US) on pain, function, emotional status, and sleep disturbances in patients with rotator cuff tendinopathy (RCT). Method: A total of 84 patients with RCT were included in the study and randomly divided into the US group (n = 42) and the LLLT group (n = 42). Hot-pack, transcutaneous electrical nerve stimulation, and a home-based exercise program were also administered to patients in each group. The patients were evaluated at baseline, and at 1st, 4th, and 12th weeks after treatment by Visual Analog Scale (VAS), Shoulder Pain and Disability Index (SPADI), Constant Murley Score (CMS), Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), Hand Grip Strength (HGS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Pittsburgh Sleep Quality Index (PSQI), and Short Form-36 (SF-36). Results: Significant improvements in VAS, SPADI, CMS, DASH, BDI, BAI, PSQI, and SF-36 scores were observed over time in both groups (p < 0.05 for all). The improvements in HGS scores were significantly greater in the US group compared to the LLLT group (p < 0.05 for all). There were no statistically significant differences between the groups in VAS, SPADI, CMS, DASH, BDI, BAI, PSQI, and SF-36 scores at each time point (p > 0.05 for all). Conclusions: Both therapeutic US and LLLT are effective and safe in the treatment of patients with RCT. However, our findings indicate no superiority of one treatment over the other in terms of pain relief or improvements in function, emotional status, sleep disturbances, or quality of life. Full article

Background/Objectives: Percutaneous electrolysis is a physiotherapeutic technique based on the application of galvanic current to induce structural and biochemical changes in musculoskeletal tissues. Although widely used in tendinopathies, its application in muscle tissue, particularly regarding optimal dosage, remains poorly understood. This study aimed to evaluate the dose-dependent effects of galvanic current on cadaveric muscle tissue (medial gastrocnemius) using quantitative ultrasound analysis, and to identify objective biomarkers to guide dosage. Methods: An experimental model was employed, applying galvanic current at varying intensities (0–10.0 mA) to 29 samples of cadaveric medial gastrocnemius. Quantitative ultrasound parameters were measured, including geometric and textural features. Correlation analyses and simple and multiple linear regressions were performed to assess the relationship between current intensity and ultrasound variables. Additionally, dose segmentation into three groups (low: 0–1.0 mA, medium: 1.0–4.0 mA, high: >4.0 mA) allowed for comparative statistical analysis using Kruskal–Wallis and post hoc Mann–Whitney U tests. Results: Significant dose–response relationships were observed in key ultrasound parameters, including A_Number, A_Area, A_Perimeter, and A_Contrast (p < 0.001). Regression analysis revealed that a combination of A_Area, A_Number, and A_Perimeter accounted for 66.7% of the variance in applied dose (R² = 0.667, p < 0.001), leading to the creation of the predictive variable Muscle_Electrolysis_Dose. Comparative analysis confirmed significant differences between low-, medium-, and high-dose groups, particularly between lower and higher doses. Conclusions: Quantitative ultrasound effectively detects structural changes in muscle tissue following percutaneous electrolysis. The results support the development of objective, image-based criteria for optimizing galvanic current dosage, enhancing the precision and personalization of treatment. Full article