Tendinosis - Fisiokinesiterapia.biz


Tendinosis - Fisiokinesiterapia.biz


What is the primary investigation ?35ys old jogger with achillodynia,All previous tests were negative

Rupture of plantar fascia30ys female: after pilgrimage from Leon to Santiago de Compostella

Stress fracture resulting fromexcessive joggingAssociated with TOS 2:peroneal tendovaginitisLow bone density

vascular malformationen

Foreign body22ys male jogger with lateralknee pain:DDx: Runner‘s knee (ITBFsyndromefluid

Soccer playersM de Jonge, Radiologe, 2002

FibromatosisSoccer player: rigid mass in hamstrings:DDx: myositis ossificansdiscriminate a hamstring tendon avulsion frommusculotendinous strain and helps identify whichpatients necessitate surgical management.Koulouris G, ConnellD, Skel Radiol


Patella partita vs. Patellar fracture

Superolateral patellar defectL. Johanna, 13 J., female:

Stressfracture C 221-ys female dancer with upper cervical syndrome

Traumatic contusion of myelon57ys female, fall from horse, tretraplegic

Runner‘s knee

Christian Dopplerborn 1803 in Salzburgprofessor of physics in Prague andViennadied 1853 in Venice“The best research results are yieldedif not only the investigator is satisfiedabout his work but if also a significantbenefit for humanity is created."Ch. Doppler

EU-referral criteriahttp://europa.eu.int/comm/environment/radprot/118/118.htmcontinuous discussion needed to keep them livingsports overuse and trauma should be mentioned...

IMAGING IN SPORTS MEDICINE – AN UPDATEIndicationSpecified referral – specified diagnosisInvestigationInterpretationDiagnosisTrends towards‣ High resolution‣ 3D display‣ documentation offunction‣ computer-assistedtreatment planning‣ open role of NIRF

Referral: (sports related) overuse syndromeFootPlantaris tendonruptureAchilles:TendinosisTibialis-anterior-TendovaginitisTibialis posterior-TendinosisDancer‘s heel(Snowboarder‘s foot)Haglund‘s heelSesamoiditisJogger‘s footPeroneal-split-syndromePlantar fasciitisBursitisMorton-Neuroma

High resolution US vs. MRITendinosis:MRT > US in zwei FällenUlreich N, Huber W et al., 2002

US‣ Panoramic (extended view) imaging‣ Tissue harmonic imagingSofka CM, Adler RS. Sonographic evaluationof shoulder arthroplasty. AJR 03‣ US contrast mediawith small bubble size and low mechanicalindex‣ US-guided pain management

Musculoskeletal USRuptured Achillestendon5 – 12 MHzOhberg L, Alfredson H.US guided sclerosing ofneovessels in tendinosis.ESSR 03Zanetti M et al.Achilles Tendons: Clinical Relevanceof Neovascularization Diagnosed withPower Doppler USRadiology 2003Power-Doppler US

Kinematic „motion“ MRITo document malalignment21-ys beachvolleybal lplayer withfemoropatellar pain syndromeK. Friedrich, doctorial thesis 2002Wiener Med Wochenschr 2002, Suppl.

16-row MD-CTfrom 3D-Reformation to3 D Volume renderingHill-Sachs-lesionImage interpretation based on 3D

IMAGING IN SPORTS MEDICINE – AN UPDATEIndicationInvestigationInterpretationSpecified referral – specified diagnosisThe higher the resolution the betterPatterns of overuse and injuryDiagnosis

Tendon overuse syndrome (TOS)Rosenberg Z et al., Radiology 1988‣ 1 - Painful functional impairment‣ 2 - Inflammation of peritendineal tissue:tendovaginitis, bursitis, peritendinitis‣ 3 - Degenerative tendon disease:3 forms: tendinosis (former „tendinitis“)fibroostosis, juvenile apophysitiscompression syndrome (impingement)‣ 4 – Rupture:direct force (rare) or indirect force on tendinosis (common)Kainberger et al., Wien Med Wochenschr, 2001

TOS 3: Tendinosis (grade 3)Achillodynia

NODULAR TENDINITISOriginating frominternal peritendineaVan Holsbeeck, 1992

TOS 3: Tendinosis, spur, hyperpronationAchillodynia

Tendon rupture:due to microtrauma and/or microinfarctionTension of tendon with elongation:< 4 % : fully reversibel4 – 8 % : disruption of cross-link structuresRepair phase with high vulnerabilityi. e. destruction and reparation dysbalanced> 8 % : frank ruptureO’Brien M. Clin Sports Med 1992; 11:505–520, Towers et al, 2003Tendon tissue of mice in a hamster mill:Sedentary behavior: normalContinuous activity: slight abnormalitiesDyscontinuous activity: focal necrosis Wernig, 1992

Tibialis posterior tendon and flatfoot deformity and heel valgusCollapse of longitudinal archTraction injury ofposterior tibial nerveTarsal tunnel syndromeTpt is part of „coxa pedis“ functional unitAssociated findings: Malalignment of talus (plantar flexion)Insufficiency of Spring-Ligament, Sinus tarsi syndrome

The risk of tendon rupture‣ THE CRITICAL ZONEAnatomic site specifically prone to trauma,vascular necrosis,or both‣ THE VULNERABLE PHASEtime during high dysbalance between destructive and reparative forces:active form due to sports: apophysitis: adolescentstendinosis: 40 ys males (athletes earlier)passive form due to muscle insufficiency: middle-aged womenUS Doppler seems to be promising in differentiating stages of dysbalance[Richards et al. Clin Radiol 2001, Ulreich and Kainberger, 2004 in press].

TOS: the radiologist‘s roleto asess severity of disease and potential risk of ruptureIntrinsic factorsVariantsdiseasesExtrinsic factorsMalalignment:femoral anteversion,varus, valgus.foot deformitieslocal variants:hypomochlia,accessory musclesmuscular imbalanceage, gender,weight, heightTendinosis (TOS)systemic diseaserheumatism,steroidsfluoroquinolonepsychosomaticreactionsTraining errors, dopingclothingimproper shoesenvironmenthard/soft soilmodif. after Kannus et al., Radiologe 2002 Oct

Golfer‘s arm

Radiological concepts‣ Tendinosis: a pre-stage of ruptureNehrer S, Breitenseher M, Brodner W,Kainberger F, Fellinger EJ, Engel A, Imhof F.Arch Orthop Trauma Surg. 1997;116‣ hyaline cartilage is part of osteochondral unitImhof H, Breitenseher M, Kainberger F,Trattnig S. Degenerative joint disease:cartilage or vascular disease? SkeletalRadiol. 1997‣ Osteonecrosis: etiology multifactorialEngel, Scand J Orthop1992‣ Menisceal rupture is often degenerativeMink, Deutsch et al., Radiology 1987

IMAGING IN SPORTS MEDICINE – AN UPDATEIndicationInvestigationInterpretationDiagnosisSpecified referral – specified diagnosisThe higher the resolution the betterPatterns of overuse and injuryOlympic onsite service

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