• 대한족부족관절학회지
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• 제25권2호
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• pp.66-71
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• 2021

Achilles tendinopathy has seen good results with conservative management. However, the management of Achilles tendinopathy lacks evidence-based support, and tendinopathy patients are at risk of long-term morbidity with unpredictable clinical outcomes. Data suggests that 29% of tendinopathy patients required surgical intervention during the follow-up period. Chronic pain after damage to the Achilles tendon is a result of incomplete recovery of fibrous tissue. Recently, many procedures, including various injection treatments, have been tried without understanding proper preservation techniques and procedures for faster tendon recovery, especially for patients who want to quickly return to their daily lives. This article is an extensive literature review on nonoperative management of Achilles tendinopathy.

• 대한족부족관절학회지
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• 제25권2호
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• pp.95-99
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• 2021

The surgical treatment of Achilles tendinopathy can be considered after the failure of conservative treatment, and the surgical methods may be divided into two groups; treatments for insertional and non-insertional tendinopathy. In the case of insertional tendinopathy, debridement including tendon and calcification of the diseased lesion, reattachment of the tendon, and calcaneal ostectomy of the Haglund lesion are the primary treatments. If reattachment is not possible, reconstruction should be performed by other methods such as tendon transfer. As a result of surgery for insertional tendinopathy, there is an improvement in the pain and function after surgery, but there are some patients whose pain does not completely disappear. Some residual pain may persist; therefore, the overall success rate of the surgery can be expected to be 80% to 90%. For the patients of non-insertional tendinopathy, conservative treatment through eccentric exercise is the primary treatment, and most of them have reported good results. In case of failure after various conservative treatments, debridement of the diseased lesion and repair of the remaining tendon would be the primary surgical treatments. If the remaining tendon is not sufficient, reconstruction such as tendon transfer should be considered.

• 대한족부족관절학회지
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• 제25권2호
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• pp.61-65
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• 2021

It is widely acknowledged that Achilles tendinopathy and resultant degeneration of the Achilles tendon could be either due to vigorous physical exertion or due to inflammation of the tendon associated with systemic disease. The overuse injuries are generally multifactorial in origin and are caused by repetitive strain of the affected tendon till the tendon can no longer endure the tensile stress. Various alignment and biomechanical faults are claimed to play a causative role. Only 2% of patients complaining of Achilles tendon pain are caused by systemic disease. However, to ensure the right approach to treatment, it is necessary to rule out inflammatory tendinitis caused by systemic diseases such as rheumatoid arthritis, gout, and seronegative spondyloarthrosis.

• Clinics in Shoulder and Elbow
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• 제22권2호
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• pp.79-86
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• 2019

Background: Increased oxidative stress and inflammation play a critical role in the etiopathogenesis of chronic tendinopathy. Melatonin is an endogenous molecule that exhibits antioxidant and anti-inflammatory activity. The aim of this study was to evaluate the biochemical and histopathological effects of exogenous melatonin administrations in supraspinatus overuse tendinopathy. Methods: Fifty rats were divided into the following four groups: cage activity, melatonin treatment, corticosteriod therapy, and control. Melatonin (10 mg/kg, intraperitoneal; twice a day) and triamcinolone (0.3 mg/kg, subacromial; weekly) were administered to the treatment groups after the overuse period. Biochemical and histopathological evaluations were performed on serum samples and biopsies obtained from rats. Plasma inducible nitric oxide synthase (iNOS), vascular endothelial growth factor (VEGF), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels were evaluated biochemically. Results: The TAS, TOS, OSI, iNOS, and VEGF values were significantly lower than the pre-treatment levels in rats receiving exogenous melatonin treatment (3 or 6 weeks) (p<0.05). TOS, iNOS, VEGF, and OSI values after 3 weeks of triamcinolone administration, and TOS, VEGF, and OSI levels after 6 weeks of triamcinolone application, were significantly lower than the pre-treatment levels (p<0.05). Conclusions: Exogenous melatonin application in overuse tendinopathy reduces oxidative stress and inflammation. Melatonin might be an alternative potential molecule to corticosteroids in the treatment of chronic tendinopathy.

• Clinics in Shoulder and Elbow
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• 제26권3호
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• pp.260-266
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• 2023

Background: Knowledge of the base rate of signal changes consistent with distal biceps tendinopathy on magnetic resonance imaging (MRI) has the potential to influence strategies for diagnosis and treatment of people that present with elbow pain. The aim of this study is to measure the prevalence of distal biceps tendon signal changes on MRIs of the elbow by indication for imaging. Methods: MRI data for 1,306 elbows were retrospectively reviewed for mention of signal change in distal biceps tendon. The reports were sorted by indication. Results: Signal changes consistent with distal biceps tendinopathy were noted in 197 of 1,306 (15%) patients, including 34% of patients with biceps pain, 14% of patients with unspecified pain, and 8% of patients with a specific non-biceps indication. Distal biceps tendon changes noted on radiology reports were associated with older age, male sex, and radiologists with musculoskeletal fellowship training. Conclusions: The finding that distal biceps MRI signal changes consistent with tendinopathy are common even in asymptomatic elbows reduces the probability that symptoms correlate with pathology on imaging. The accumulation of signal changes with age, also independent of symptoms, suggests that tendon pathology persists after symptoms resolve, that some degree of distal biceps tendinopathy is common in a human lifetime, and that tendinopathy may often be accommodated without seeking care. Level of evidence: IV.

• Physical Therapy Rehabilitation Science
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• 제13권3호
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• pp.294-303
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• 2024

Objective: The objective of this study is to evaluate the effects of radial shock wave therapy (RSWT) targeting multiple myofascial trigger points (MTrPs) along myofascial chains on shoulder pain, function, range of motion, and muscle strength in patients with bicipital tendinopathy. While traditional treatments primarily focus on a single MTrP, this study aims to achieve better clinical improvement by simultaneously treating multiple MTrPs along the myofascial chains. Design: A randomized controlled trial. Methods: Twenty-eight patients with bicipital tendinopathy were randomly assigned to either an experimental group (n=14) or a control group (n=14). The experimental group received RSWT targeting multiple MTrPs along myofascial chains, while the control group received RSWT focused on a single MTrP in the biceps brachii. Both groups underwent three treatment sessions over a nine-day period, with one session every three days. Outcomes, including shoulder pain, function, range of motion, and muscle strength, were measured before and after treatment to assess therapeutic effects. Results: Both groups showed significant improvements in shoulder pain, function, range of motion, and muscle strength (p<0.05). However, the experimental group demonstrated significantly greater improvements in all outcome measures compared to the control group (p<0.05). Conclusions: RSWT targeting multiple MTrPs along myofascial chains showed significantly greater effects in relieving shoulder pain, improving function, enhancing range of motion, and strengthening muscles in patients with bicipital tendinopathy compared to treatment targeting a single MTrP. Therefore, this study proposes that a comprehensive treatment strategy considering the entire myofascial pathway may be more effective in the rehabilitation of patients with bicipital tendinopathy.

• Clinics in Shoulder and Elbow
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• 제8권2호
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• pp.81-87
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• 2005

Epicondylitis, as a tendinopathy characterized by fibroblast and microvascular hyperplasia, is a common musculoskeletal problem especially related with repetitive hand and wrist motion. It has a prevalence of between 0.2% and 5% in general population depending on the amount of exposure to manual labor jobs. Although it is known that the pathological lesions lie in the flexor or extensor common tendons, there could be collateral ligament lesions and/or reactive synovitis accompanied, which may make a case unresponsive to the treatment aimed only at the tendinopathy. Epicondylitis is easy to diagnose with typical pain, tenderness, and positive provocation tests. However, many conditions can mimic epicondylitis that further imaging or electrodiagnostic studies should be undertaken to exclude other possible problems. Ultrasonography provides information about the existence and extent of tendinopathy with relatively high specificity. Magnetic resonance imaging is often required to rule out other problems and confirm the diagnosis of the cases intractable to long term treatment. Many options of treatment are available for epicondylitis while numerous conflicting evidences have been noted, debating one treatment method is better than the others. Since it was reported that over 80% of epicondylitis improved within a year no matter what was done as treatment, it is a challenge to make accurate diagnosis and combine effective therapeutic regimens for the 20% of intractable cases.

• Physical Therapy Rehabilitation Science
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• 제11권2호
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• pp.269-278
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• 2022

Objective: The aim of this study was to evaluate the effects on pain and function of patients with rotator cuff tendinopathy when applying trigger point of infraspinatus and teres minor to myofascial trigger point release (MFR) plus mobility exercise and MFR. Design: A randomized controlled trial. Methods: The total participants were 30patients and were separated to MFR plus mobility exercise group(n=15) and MFR group (n=15) according to the randomized treatment method. The MFR was performed at two infraspinatus tampon points and one teres minor tampon point for twice a week for 4 weeks and the treatment time was 6 minutes 20 seconds in each position. The MFR group also carried out the myofascial trigger point release in the same way as the MFR plus mobility exercise group. Results: The MFR plus mobility exercise group significantly reduced objective and subjective pain (p<0.05). The range of motion of the shoulder joint flexion and external rotation, Quick-Disability of the Arm, shoulder and Hand, and Shoulder Pain and Disability Index were significantly improved in the group to which MFR plus mobility exercise was applied (p<0.05). Conclusions: These results confirmed that MRF plus mobility exercise is more effective in relieving shoulder pain and improving function in rotator cuff tendinopathy.

• 대한족부족관절학회지
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• 제27권3호
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• pp.103-107
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• 2023

Quinolone antibiotics are frequently prescribed for suspected respiratory or urinary tract infections because of their effectiveness and generally perceived safety profile. On the other hand, some studies have raised concerns regarding the potential association between quinolone use and Achilles tendinopathy or tendon rupture. There is a lack of reports on the link between quinolone use and multiple tendon and tendon attachment site pain in the foot and ankle joints; hence, this study examined this issue further. This paper presents a case report of a patient with persistent Achilles tendinopathy and multiple tendon and tendon attachment site pain in the foot who did not respond adequately to conservative treatments. In particular, the discontinuation of quinolone use resulted in favorable clinical outcomes. This report offers valuable insights into the potential risks associated with quinolone antibiotics and highlights the importance of vigilance when managing patients with tendon-related complaints. A comprehensive review of the relevant literature is also presented to contextualize these findings.

• Clinics in Shoulder and Elbow
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• 제21권4호
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• pp.213-219
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• 2018

Background: The study of conservative and surgical treatment of distal biceps tendinopathy and associated biceps tendon partial rupture. Methods: Twenty-one cases with distal biceps tendonitis and partial ruptures were studied who visited Pohang Semyeong Christianity Hospital from June 2010 to August 2017. The mean age was 57.1 years (39-69 years), 14 males and 7 females. The mean duration of symptom at the time of first visit was 4.9 months (0.2-14 months). Ultrasonography and magnetic resonance imaging were performed for patients with severe symptoms. According to the severity of the symptoms, splint immobilization, oral nonsteroidal anti-inflammatory drugs, and ultrasound-guided steroid injection were performed. Surgical treatment was performed if the patient did not respond to conservative treatment for 3 to 6 months or longer. Results: There were 9 cases of partial rupture of the distal biceps tendon associated with distal biceps tendinopathy on imaging studies. Conservative treatment showed symptomatic improvement in 16 of 21 cases. In 4 cases with a relatively mild symptom, anti-inflammatory analgesics and intermittent splinting showed good result. In 12 cases, symptoms improved after ultrasonography-guided steroid injection. Surgical treatment was performed on 5 cases that did not respond to conservative treatment. Conclusions: Conservative treatment of distal biceps tendinopathy may promise good results. However, in case of partial tear of the distal biceps tendon and refractory to conservative treatment, surgical treatment may be needed.