TEN-YEAR FOLLOW-UP OF PRELIMINARY BICEPS BRACHIAL MUSCLE CONTRACTION IN THE REHABILITATION AND PROPHYLAXIS OF RECURRENT SHOULDER PAIN DUE TO TENDON DEGENERATION

Introduction:- One of the overlooked facilitating factors of recurrent shoulder pain due to tendon degeneration is the periarticular muscle latency (M1, M2, and M3). It leads to a lack of muscle protection against the external loads on the shoulder during the initiation of every shoulder movement. This creates multiple repetitive micro-traumas, gradually accumulating to tendon degeneration. The only way to overtake the periarticular muscle latency and its consequences is the preliminary biceps brachial muscle contraction. Aim:- To study the effect of the preliminary biceps brachial muscle contraction on the short-term rehabilitation and the long-term prophylaxis of recurrent shoulder pain due to tendon degeneration. Material and Methods:- For 10 years were followed 44 outpatients (age 50.1 ± 14.8 years) with recurrent shoulder pain due to tendon degeneration. They were randomized into two groups – standard (n=22) and maneuver (n=22). Both groups received prophylactic recommendations and were treated for two weeks with exercise, interferential current, and laser. The maneuver group received an additional recommendation to perform preliminary biceps brachial muscle contraction before every movement of the shoulder during the daily activities. Pain intensity, shoulder mobility, periarticular muscle strength, number of recurrences, number of rehabilitation courses, and success rate of the maneuver were followed-up for two weeks and ten consecutive years. For the statistical analysis, ANOVA with Bonferronis tests and Pearsons correlation with regression tests were used. Results:- The pain decreased significantly after the first day in the maneuver group (P<0.05), and after the fifth day in the standard group (P<0.05). All results improved significantly after two weeks (P<0.05) and after one year (P<0.05) in both groups. The maneuver group showed superior results versus the standard group after two weeks (P<0.05) and after 10 consecutive years (P<0.05). With increasing the maneuver success rate, the short-term treatment effect and the long-term prophylactic effect increased in the maneuver group (P<0.05). There were no dropouts, side effects, or complications. Conclusion:- The preliminary biceps muscle contraction is appropriate an important additional recommendation in short-term treatment and long-term prophylaxis of recurrent shoulder pain due to tendon degeneration. It is simple, quick, effective, and without side effects or complications. It requires no allocation of space, time, or resources. This maneuver protects the shoulder before the initial external forces, avoiding the repetitive micro-traumas during the muscle latency, which is otherwise inevitable in daily activities. Another protecting factor is the increased muscle strength and co-contraction of all periarticular muscles, as a result of this bracing maneuver, leading to lesser pain with higher shoulder stability and mobility.

The expression of substance P and calcitonin gene-related peptide is associated with the severity of tendon degeneration in lateral epicondylitis

Background In this study, we investigated whether substance P (SP) or calcitonin gene-related peptide (CGRP) expression is associated with tendon degeneration in patients with lateral epicondylitis. Methods Twenty-nine patients who underwent surgical treatment for lateral epicondylitis were enrolled in the final analyses. Extensor carpi radialis brevis tendon origins were harvested for histological analysis. Results SP and CGRP immunostaining were negative in healthy tendons but positive in degenerative tendons; moreover, their immunoreactivity increased with degeneration severity. Univariate analysis indicated that variables such as the preoperative visual analog scale (VAS) score or SP or CGRP expression levels were significantly associated with the Movin score. However, multivariate analysis revealed that only higher SP and/or CGRP signals were associated with higher Movin scores. Elevations in SP or CGRP expression were also linked with significantly severe preoperative VAS scores. Conclusion We demonstrated that tendon degeneration severity is associated with increased SP and CGRP expression in the biopsy samples of lateral epicondylitis.

Therapeutic Efficacy of Intratendinous Delivery of Dexamethasone Using Porous Microspheres for Amelioration of Inflammation and Tendon Degeneration on Achilles Tendinitis in Rats

Achilles tendinitis caused by overuse, aging, or gradual wear induces pain, swelling, and stiffness of Achilles tendon and leads to tendon rupture. This study was performed to investigate the suppression of inflammation responses in interleukin-1β- (IL-1β-) stimulated tenocytes in vitro and the suppression of the progression of Achilles tendinitis-induced rat models in vivo using dexamethasone-containing porous microspheres (DEX/PMSs) for a sustained intratendinous DEX delivery. DEX from DEX/PMSs showed the sustained release of DEX. Treatment of IL-1β-stimulated tenocytes with DEX/PMSs suppressed the mRNA levels for COX-2, IL-1β, IL-6, and TNF-α. The intratendinous injection of DEX/PMSs into Achilles tendinitis rats both decreased the mRNA levels for these cytokines and increased mRNA levels for anti-inflammatory cytokines IL-4 and IL-10 in tendon tissues. Furthermore, DEX/PMSs effectively prevented tendon degeneration by enhancing the collagen content and biomechanical properties. Our findings suggest that DEX/PMSs show great potential as a sustained intratendinous delivery system for ameliorating inflammation responses as well as tendon degeneration in Achilles tendinitis.

T2* mapping and subregion analysis of the tibialis posterior tendon using 3 Tesla magnetic resonance imaging

Objective: Early detection of tibialis posterior tendon changes and appropriate intervention is necessary to prevent disease progression to flat-foot deformity and foot/ankle dysfunction, and the need for operative treatment. Currently, differentiating between early-stage tibialis posterior tendon deficiency patients who will benefit from conservative vs more aggressive treatment is challenging. The objective of this work was to establish a quantitative MRI T2* mapping method and subregion baseline values in the tibialis posterior tendon in asymptomatic ankles for future clinical application in detecting tendon degeneration. Methods: 26 asymptomatic volunteers underwent T2* mapping. The tendon was divided axially into seven subregions. Summary statistics for T2* within each subregion were calculated and compared using Tukey post-hoc pairwise comparisons. Results: Results are reported for 24 subjects. The mean tibialis posterior tendon T2* was 7 ± 1 ms. Subregion values ranged from 6 ± 1 to 9 ± 2 ms with significant between-region differences in T2*. Inter- and intrarater absolute agreement intraclass correlation coefficient (ICC) values were all "excellent" (0.75 < ICC=1.00) except for regions 5 through 7, which had "fair to good" interrater and/or and intrarater ICC values (0.4 < ICC=0.75). Conclusion: A tibialis posterior tendon T2* mapping protocol, subregion division method, and baseline T2* values for clinically relevant regions were established. Significant differences in T2* were observed along the tendon length. Advances in knowledge: This work demonstrates that regional variation exists and should be considered for future T2*-based research on posterior tibias tendon degeneration and when using T2* mapping to evaluate for potential tibialis posterior tendon degeneration.

Advanced Glycation End-Products Suppress Mitochondrial Function and Proliferative Capacity of Achilles Tendon-Derived Fibroblasts

Debilitating cases of tendon pain and degeneration affect the majority of diabetic individuals. The high rate of tendon degeneration persists even when glucose levels are well controlled, suggesting that other mechanisms may drive tendon degeneration in diabetic patients. The purpose of this study was to investigate the impact of advanced glycation end-products on tendon fibroblasts to further our mechanistic understanding of the development and progression of diabetic tendinopathy. We proposed that advanced glycation end-products would induce limitations to mitochondrial function and proliferative capacity in tendon-derived fibroblasts, restricting their ability to maintain biosynthesis of tendon extracellular matrix. Using an in-vitro cell culture system, rat Achilles tendon fibroblasts were treated with glycolaldehyde-derived advanced glycation end-products (0, 50, 100, and 200μg/ml) for 48 hours in normal glucose (5.5mM) and high glucose (25mM) conditions. We demonstrate that tendon fibroblasts treated with advanced glycation end-products display reduced ATP production, electron transport efficiency, and proliferative capacity. These impairments were coupled with alterations in mitochondrial DNA content and expression of genes associated with extracellular matrix remodeling, mitochondrial energy metabolism, and apoptosis. Our findings suggest that advanced glycation end-products disrupt tendon fibroblast homeostasis and may be involved in the development and progression of diabetic tendinopathy.

Correlation of the Expression of IGF-1, TGF-β1 and BMP12 with Tendon Degeneration Caused by Overused Tendon of the Long Head of Biceps Brachii

Objective: To assess the association of the expression of insulin-like growth factor-1 (IGF-1), transforming growth factor beta-1 (TGF-β1) and bone morphogenetic protein-12 (BMP-12) with tendon degeneration in rats caused by overuse of biceps brachii long head tendon. Methods: Sixteen Sprague-Dawley (SD) rats were randomly divided into normal group (n = 8) and overuse group (n = 8). Rats were fed routinely in normal group and were treated by small animal treadmills for continuous 6 weeks of exercise at 1 h/day in overuse group followed by analysis of histological morphology of the tendon of the long head of biceps brachii by Hematoxylin-eosin (HE) staining, the expression levels of IGF-1, TGF-β1 and BMP-12 by Western blotting. Correlation analysis was used to analyze the correlation of the protein expression with the pathological score. Results: HE staining showed normal morphology of biceps brachii long head tendon in normal group (with dense structure, uniform arrangement and no fiber damage) and abnormal morphology in overuse group (with disordered structure, uneven arrangement and some of breakage fibers). The pathological score in overuse group was significantly higher than that in normal group (p < 0.05). Compared with those in normal group, the protein levels of IGF-1, TGF-β1 and BMP-12 were significantly elevated in overuse group (p < 0.05). Conclusion: The expression of IGF-1, TGF-β1 and BMP-12 in overused tendon of the long head of the biceps brachii are elevated, and positively correlated with tendon degeneration.