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      Treatment of periscapular tendinopathy with radiofrequency coblation: A case report

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          Abstract

          Overuse injuries of the tendon – ‘tendinopathy’ – account for 30%–50% of all sporting injuries and a high proportion of orthopaedic referrals from primary care physicians. Tendinopathies often have a multifactorial aetiology and injury can be due to a combination of both acute and chronic trauma which contributes to loss of tissue integrity and eventual rupture. Our incomplete understanding of the mechanisms surrounding tendon pathophysiology continues to cause difficulties in treatments beyond loading regimes which can be unsuccessful in up to 30% of cases. We describe an uncommon case of tendinopathy affecting the periscapular muscle/tendon unit in a 35-year-old female with persistent pain around the inferior posterior pole of her right scapula. Magnetic resonance imaging findings confirmed oedema of the muscles around the inferior scapular margin in keeping with enthesopathy/tendinopathy and she was treated with radiofrequency coblation to the area. This case highlights radiofrequency ablation as a surgical option should non-operative treatments fail in the rare diagnosis of periscapular tendinopathy.

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          Inflammatory mechanisms in tendinopathy – towards translation

          Neal Millar, George A. C. Murrell, Iain McInnes (2017)
          Tendinopathy is a multifactorial spectrum of tendon disorders that affects different anatomical sites and is characterized by activity-related tendon pain. These disorders are common, account for a high proportion (∼30%) of referrals to musculoskeletal practitioners and confer a large socioeconomic burden of disease. Our incomplete
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            Blood supply of the Achilles tendon.

            G Sefton, Chulbul M I Ahmed, M Lagopoulos … (1998)
            The Achilles tendon is one of the most common sites of injury and rupture as a result of overuse. Evidence suggests that the pathogenesis of rupture could involve the pattern of its blood supply. With use of angiographic and histological techniques, the blood supply of the Achilles tendon was investigated in 12 human cadaveric specimens. Angiography confirmed Mayer's 1916 finding that the blood supply to the tendon is from three areas: the musculotendinous and osseotendinous junctions and the paratenon, with the posterior tibial artery providing the major contribution. However, qualitative and quantitative histological analyses in this study showed that the Achilles tendon has a poor blood supply throughout its length, as determined by the small number of blood vessels per cross-sectional area, which do not in general vary significantly along its length. In light of these findings, it is suggested that poor vascularity may prevent adequate tissue repair following trauma, leading to further weakening of the tendon.
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              Surgical treatment compared with eccentric training for patellar tendinopathy (Jumper's Knee). A randomized, controlled trial.

              Lars Engebretsen, Bjørn Fossan, Sverre Løken … (2006)
              Although the surgical treatment of patellar tendinopathy (jumper's knee) is a common procedure, there have been no randomized, controlled trials comparing this treatment with forms of nonoperative treatment. The purpose of the present study was to compare the outcome of open patellar tenotomy with that of eccentric strength training in patients with patellar tendinopathy. Thirty-five patients (forty knees) who had been referred for the treatment of grade-IIIB patellar tendinopathy were randomized to surgical treatment (twenty knees) or eccentric strength training (twenty knees). The eccentric training group performed squats on a 25 degrees decline board as a home exercise program (with three sets of fifteen repetitions being performed twice daily) for a twelve-week intervention period. In the surgical treatment group, the abnormal tissue was removed by means of a wedge-shaped full-thickness excision, followed by a structured rehabilitation program with gradual progression to eccentric training. The primary outcome measure was the VISA (Victorian Institute of Sport Assessment) score (possible range, 0 to 100), which was calculated on the basis of answers to a symptom-based questionnaire that was developed specifically for patellar tendinopathy. The patients were evaluated after three, six, and twelve months of follow-up. There was no difference between the groups with regard to the VISA score during the twelve-month follow-up period, but both groups had improvement (p < 0.001). The mean combined VISA score for the two groups increased from 30 (95% confidence interval, 25 to 35) before the start of treatment to 49 (95% confidence interval, 42 to 55) at three months, 58 (95% confidence interval, 51 to 65) at six months, and 70 (95% confidence interval, 62 to 78) at twelve months. In the surgical treatment group, five knees had no symptoms, twelve had improvement but were still symptomatic, two were unchanged, and one was worse after twelve months (p = 0.49 compared with the eccentric training group). In the eccentric training group, five knees did not respond to treatment and underwent secondary surgery after three to six months. Of the remaining fifteen knees in the eccentric training group, seven had no symptoms and eight had improvement but were still symptomatic after twelve months. No advantage was demonstrated for surgical treatment compared with eccentric strength training. Eccentric training should be tried for twelve weeks before open tenotomy is considered for the treatment of patellar tendinopathy.
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                Author and article information

                Journal
                Journal ID (nlm-ta): SAGE Open Med Case Rep
                Journal ID (iso-abbrev): SAGE Open Med Case Rep
                Journal ID (publisher-id): SCO
                Journal ID (hwp): spsco
                Title: SAGE Open Medical Case Reports
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Electronic): 2050-313X
                Publication date (Electronic): 9 July 2020
                Publication date Collection: 2020
                Volume: 8
                Electronic Location Identifier: 2050313X20930612
                Affiliations
                [1-2050313X20930612]Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
                Author notes
                [*]Neal L Millar, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, 120 University Avenue, Glasgow G12 8TA, UK. Email: neal.millar@ 123456glasgow.ac.uk
                Author information
                https://orcid.org/0000-0003-4601-1621
                https://orcid.org/0000-0001-9251-9907
                Article
                Publisher ID: 10.1177_2050313X20930612
                DOI: 10.1177/2050313X20930612
                PMC ID: 7350035
                SO-VID: 7de56693-930e-4508-a8a8-35ded20720bc
                Copyright © © The Author(s) 2020
                License:

                This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 7 November 2018
                Date accepted : 9 May 2020
                Funding
                Funded by: medical research council, FundRef https://doi.org/10.13039/501100000265;
                Categories
                Subject: Case Report
                Custom metadata
                cover-date January-December 2020
                typesetter ts1

                Keywords: tendinopathy,tendon,therapy,coblation,inflammation
                Data availability:
                Keywords: tendinopathy, tendon, therapy, coblation, inflammation

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