Universiẗat, Diss., 2004--München.

No description available.

Midportion Achilles tendinopathy (tendinosis) is a troublesome painful condition, often characterised by pain, local swelling, tenderness and functional disability. Despite extensive research, the pathogenesis is poorly understood and treatment remains challenging. Features related to the peritendinous connective tissue can be of importance. Recently it has been suggested that the plantaris tendon might be involved in this condition. Furthermore, it has been hypothesised that tendon pain and the tendinosis-related tissue changes in tendinopathy might be mediated by signalling substances such as glutamate and acetylcholine. A clinical observation, not scientifically evaluated, has been that unilateral treatment for bilateral Achilles tendinosis can lead to an effect on the contralateral side.      The aim of this work was to examine the morphology and innervation patterns in the plantaris tendon and the peritendinous connective tissue in between the Achillles and plantaris tendons in midportion Achilles tendinopathy, and to evaluate if plantaris tendon removal has an effect on Achilles tendon structure. Another aim was to determine if unilateral treatment for Achilles tendinopathy targeting the peritendinous connective tissue can result in bilateral recovery. Furthermore the presence of non-neuronal cholinergic and glutamate systems was examined.      Sections of plantaris tendons with adjacent peritendinous connective tissue from patients with midportion Achilles tendinopathy were stained for morphology (H&E), and innervation patterns were evaluated using antibodies against general nerve marker (PGP9.5), sensory (CGRP) and sympathetic (TH) nerve fibres and Schwann cells (S-100β). Furthermore immunostainings against non-neuronal aceylcholine (ChAT) and glutamate signalling components (glutamate, VGluT2, NMDAR1) were performed. Plantaris tendon cells were cultured and also stained for glutamate signalling components, and were stimulated with glutamate and glutamate receptor agonist NMDA. Furthermore, Ultrasound Tissue Characterisation (UTC) was used to monitor the integrity of the Achilles tendon collagen structure after plantaris tendon removal.      Plantaris tendons exhibited tendinosis-like tissue patterns such as hypercellularity, collagen disorganisation and large numbers of blood vessels. The peritendinous connective tissue between the plantaris and Achilles tendons contained large numbers of fibroblasts and blood vessels and to some extent macrophages and mast cells. A marked innervation was found in the peritendinous connective tissue and there were also nerve fibres in the loose connective tissue spaces within the tendon tissue proper. Most nerve fibres were identified as sensory fibres. Some nerve fascicles in the peritendinous connective tissue showed absence of axons but homogenous reactions for Schwann cell marker. Tenocytes and cells in the peritendinous connective tissue expressed ChAT, glutamate, VGluT2 and NMDAR1. Tendon cells in vitro expressed VGluT2, NMDAR1 and glutamate. UTC showed significant improvement of Achilles tendon integrity 6 months after surgical plantaris tendon removal and scraping procedure. Eleven out of thirteen patients reported of a bilateral recovery after unilateral surgical treatment.      The results of this work show that plantaris tendons exhibit tendinosis-like tissue changes, internal innervation and features that suggest occurrence of glutamate and acetylcholine production and signalling. Plantaris removal improves Achilles tendon structure suggesting possible compressive/shearing interference between the Achilles and plantaris tendons in tendinopathy. The peritendinous connective tissue shows marked innervation, which thus might transmit pain when being compressed. The partial absence of axons indicates a possible nerve degeneration. On the whole, the study gives new evidence favouring that the plantaris tendon and the peritendinous connective tissue might be of importance for pain and the tendinopathy process in midportion Achilles tendinopathy.

ABSTRACT Background: On behalf of the Orthopedic clinic, Västerås, a study has been conducted with focus on comparing the results after conservative and surgical treatment due to complete achillestendon rupture. Aim: To compare results when testing the active and passive range of motion, calf muscle endurance, estimation of pain related to the achillestendon and self-efficacy to be physically active for individuals who have undergone conservative or surgical treatment after complete achillestendon rupture. Method: 14 individuals afflicted by complete achillestendon rupture in 2010 were recruited as a purposive sample. Examination were conducted of: Ankle range of motion with a goniometer, calf muscle endurance through a toe-raise test, estimation of pain intensity related to the achillestendon by VAS and self-efficacy to be physically active through “Exercise self-efficacy scale”. P-value and the median were calculated. Result: The results of ankle range of motion and calf muscle endurance were based on the difference between the injured and the healthy side. When testing active plantarflexion the conservative group had a median of 4 ̊ and the surgical group had a median of 10 ̊. At the toe-raise test the conservative group had a median of 11 toe-raises and the surgical group a median of 7. Through estimation of “Exercise self-efficacy scale” the conservative group had a median of 115 point and the surgical group a median of 94. When testing active dorsiflexion, passive plantarflexion, passive dorsiflexion and estimation of pain related to the achillestendon the median value were 0 for both groups. Conclusion: There was no statistical significance between the groups.   Key words: Achilles tendon, operative, rupture, self efficacy, treatment outcome. / SAMMANFATTNING Bakgrund: På uppdrag av Ortoped kliniken Västerås, har en studie genomförts med fokus på att jämföra resultat efter konservativ respektive operativ behandling i samband med total hälseneruptur. Syfte: Att jämföra resultaten vid test av aktiv och passiv fotledsrörlighet, vadmuskeluthållighet, skattning av smärta relaterat till hälsenan samt self-efficacy för att vara fysiskt aktiv för individer som genomgått konservativ respektive operativ behandling efter total hälseneruptur. Metod: 14 individer som drabbats av total hälseneruptur under 2010 rekryterades enligt ett ändamålsenligt urval. Undersökningar gjordes av fotledsrörlighet med hjälp av goniometer, vadmuskeluthållighet via ett tåhävningstest, skattning av smärtintensitet relaterat till hälsenan via VAS och self-efficacy för att vara fysiskt aktiv via ”Exercise self-efficacy scale”. P-värde och median beräknades. Resultat: Resultaten för fotledsrörligheten och vadmuskeluthålligheten baserade sig på skillnaden mellan frisk och skadad sida. Vid test av aktiv plantarflexion hade den konservativa gruppen en median på 4° och den operativa gruppen en median på 10°. Vid tåhävningstestet hade den konservativa gruppen en median på 11 stycken tåhävningar och den operativa gruppen en median på 7. Vid skattning via ”Exercise self-efficacy scale” hade den konservativa gruppen en median på 115 poäng och den operativa gruppen en median på 94. Vid test av aktiv dorsalflexion, passiv plantarflexion, passiv dorsalflexion samt vid skattning av smärta blev medianvärdet 0 för båda grupperna. Slutsats: Det förelåg ingen statistisk signifikant skillnad mellan grupperna.   Nyckelord: Behandlingsresultat, egen förmåga, hälsena, operationer, ruptur.

Published also as Thesis (Ph. D.)--Columbia University. / Bibliography: p. 89-91.

Diss. (sammanfattning) Göteborg : Univ. , 2006. / Härtill 5 uppsatser.

Thesis (D.PT.)--Sage Colleges, 2010. / "May 2010." "A Capstone project for PTY 768 presented to the faculty of The Department of Physical Therapy Sage Graduate School in partial fulfillment of the requirements for the degree of Doctor of Physical Therapy." Includes bibliographical references.

by Lee Wai Chi, Edwin. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1993. / Includes bibliographical references (leaves 115-125). / Acknowledgments --- p.I / List of figures --- p.II / List of tables --- p.III / List of graphs --- p.III / Abstract --- p.VIII / Chapter I.CHAPTER ONE --- Introduction --- p.1 / Chapter 1.1 --- Electromagnetic / Magnetic field in biological interventions --- p.1 / Chapter 1.2 --- Objective of the study --- p.4 / Chapter 1.3 --- Hypothesis of the study --- p.5 / Chapter II.CHAPTER TWO --- Literature Review --- p.6 / Chapter 2.1 --- Inflammation / Chapter 2.1.1 --- Models of studying tendon injuries --- p.6 / Chapter 2.1.2 --- Methods of measuring inflammation --- p.7 / Chapter 2.1.3 --- Treatments of soft tissue inflammation --- p.9 / Chapter 2.2 --- Aspects of electromagnetic and magnetic fields / Chapter 2.2.1 --- Applications of electromagnetic / magnetic fields in soft tissue inflammation --- p.12 / Chapter 2.2.2 --- Physiological effects of electromagnetic/magnetic fields / Chapter 2.2.2.1 --- Experiments on inflammation --- p.16 / Chapter 2.2.2.2 --- Experiments on soft tissue / tendon injuries --- p.16 / Chapter 2.2.2.3 --- Experiments on blood circulation --- p.18 / Chapter 2.2.3 --- Experiments with different parameter settings of PEMF / PMF in soft tissue inflammation --- p.19 / Chapter 2.2.4 --- Proposed mechanisms of electromagnetic/magnetic fields --- p.22 / Chapter III.CHAPTER THREE --- Methods and Materials --- p.23 / Chapter 3.1 --- Animal models --- p.23 / Chapter 3.2 --- Apparatus --- p.24 / Chapter 3.3 --- Treatment Regimen --- p.27 / Chapter 3.4 --- Assessments --- p.29 / Chapter IV.CHAPTER FOUR --- Histological Assessment --- p.30 / Chapter 4.1 --- Introduction --- p.30 / Chapter 4.2 --- Methods --- p.31 / Chapter 4.3 --- Results --- p.31 / Chapter 4.4 --- Discussions --- p.45 / Chapter V.CHAPTER FIVE --- Morphometrical analysis on tissue sections with immunochemical staining --- p.51 / Chapter 5.1 --- Introduction / Chapter 5.1.1 --- Different approaches in identification of macrophages --- p.51 / Chapter 5.1.2 --- Avidin-biotin enzyme complex assay --- p.52 / Chapter 5.2 --- Methods --- p.54 / Chapter 5.2.1 --- ABC method --- p.54 / Chapter 5.2.2 --- Morphometric analysis of tissue sections --- p.55 / Chapter 5.2.3 --- Statistical method --- p.56 / Chapter 5.3 --- Results / Chapter 5.3.1 --- Immunochemical results --- p.56 / Chapter 5.3.2 --- Morphometric results --- p.60 / Chapter 5.4 --- Discussions --- p.64 / Chapter VI.CHAPTER SIX --- Biochemical Assessments --- p.67 / Chapter 6.1 --- Water content / Chapter 6.1.1 --- Introduction --- p.67 / Chapter 6.1.2 --- Methods --- p.68 / Chapter 6.1.2.1 --- Water content measurement --- p.68 / Chapter 6.1.2.2 --- Statistical method --- p.69 / Chapter 6.1.3 --- Results --- p.72 / Chapter 6.1.4 --- Discussions --- p.77 / Chapter 6.2 --- Total collagen content / Chapter 6.2.1 --- Introduction --- p.81 / Chapter 6.2.1.1 --- Hydroxyproline as an indicator for collagen content assay --- p.81 / Chapter 6.2.2 --- Methods / Chapter 6.2.2.1 --- Hydrolysis method --- p.82 / Chapter 6.2.2.2 --- Standard-curve preparation --- p.83 / Chapter 6.2.2.3 --- Statstical method --- p.84 / Chapter 6.2.3 --- Results --- p.84 / Chapter 6.2.4 --- Discussions --- p.89 / Chapter VII.CHAPTER SEVEN --- Discussion --- p.92 / Chapter VIII.CHAPTER EIGHT --- Summary and Conclusions --- p.103 / Appendix A : Histological reagents preparations --- p.106 / Appendix B : Staining procedures for standard H & E --- p.107 / Appendix C : Immunochemical staining reagents preparations --- p.108 / Appendix D : Staining procedure for StreptABComplex / HRP --- p.110 / AppendixE : Biochemical reagents and preparations --- p.111 / Appendix F : Hydrolysis method for the tendon --- p.112 / Appendix G : Standard-curve of hydroxyproline --- p.113 / Appendix H : Determination of optimal hours for collagen hydrolysis --- p.114 / REFERENCES --- p.115

Achilles tendinopathy is a prevalent, highly debilitating condition. It is believed to result from repetitive overuse, which creates micro-damage tendon, and initiates a catabolic cell response. The aetiology of tendinopathy remains poorly understood, therefore appropriate treatment remains unclear. Current data support the use of shock wave therapy and eccentric exercise as some of the more effective treatment options for tendinopathy. Studies have shown that these treatments generate perturbations within tendon at a frequency of approximately 8-12Hz. Consequently, it is hypothesised that 10Hz loading initiates increased anabolic tenocyte behaviour promoting tendon repair. The primary aim of this thesis is to investigate the effects of 10Hz perturbations on tenocyte metabolism, comparing tenocyte gene expression in response to a 10Hz and 1Hz loading profile. A variety of in vitro models for mechanically stimulating cells were explored, comparing tissue explants with isolated cells on a 2D or within a 3D collagen gel. The mechanical environment of each model was investigated, in addition to cell viability and gene stabilisation following strain, as needed for future cell studies. 3D collagen gels arose as the most suitable model. Human tenocytes from healthy semitendinosus and tendinopathic Achilles tendons were seeded into 3D collagen gels and subjected to cyclic strain at 10Hz and 1Hz to establish cell response. Tenocyte gene expression was characterised using qRT-PCR. Healthy tenocytes showed increased expression of all analysed genes in response to loading. Furthermore, the increase was significantly larger in the 10Hz loading group. Tendinopathic tenocytes showed a more varied response, possibly indicative of an early healing response. Nevertheless, the response to 10Hz loading was consistently greater than seen with 1Hz loading. Analysis of the signalling pathways involved suggested that the IL1 signalling pathway may be involved in the strain response reported. This study has demonstrated for the first time that loading at a frequency of 10Hz may enhance metabolic response in healthy tenocytes.

Sammanfattning Syfte och frågeställningar: Syftet med denna studie var att a) undersöka om motionärer med Achilles tendinopati (AT) i mittportionen har nedsatt dorsalflexion i första metatarso-  falangealleden (MTP 1-leden) på affekterad sida jämfört med frisk b) undersöka om det finns sidoskillnader i naviculare position samt c) undersöka vilken metod - goniometermätning (GM) eller visuell estimation (VE) - som är att föredra vid mätning av dorsalflexionen i MTP 1-leden. Frågeställningarna var följande: Hur förhåller det sig med skillnaden för dorsalflexion i MTP 1-leden då affekterad sida jämförs med frisk hos motionärer med AT? Hur förhåller det sig med sidoskillnaden för fotvalvets höjd ? Hur förhåller det sig med sidoskillnaden för den vertikala rörligheten i mellanfoten? Hur förhåller det sig med mätvärdet för dorsalflexion i MTP 1-leden då affekterad sida jämförs med frisk vid användandet av respektive mätmetod (GM och VE)? Hur förhåller det sig med den samtidiga validiteten mellan VE och GM vid mätning av dorsalflexionen i MTP 1-leden? Metod: 28 patienter med unilateral AT (medelålder 39 år, symtomtid median 12 veckor), rekryterades konsekutivt. Patienterna diagnosticerades kliniskt, nedre extremitet screenades för rörelseinskränkningar i sagittalplanet, naviculares höjd (NH) mättes i två positioner och naviculare drop (ND) beräknades. MTP 1-leden fotograferades tre gånger i standardiserad mätposition och dorsalflexionen mättes med GM på fotografierna som randomiserats. Fotografierna med det högsta mätvärdet för respektive fots dorsalflexion i MTP 1-leden användes randomiserat för VE som utfördes med protokoll för standardisering. Resultat: Motionärer med AT uppvisade signifikant lägre medelvärde (p=0,015) för dorsalflexionen i MTP 1-leden på affekterad sida jämfört med frisk. Ingen signifikant sidoskillnad på medelvärdena för fotvalvets höjd (NH) eller på medelvärdena för vertikal rörlighet i mellanfoten (ND) förelåg. GM uppvisade signifikant högre medelvärde (p=0,0009) för dorsalflexion i MTP 1-leden jämfört med VE. Oavsett mätmetod (GM och VE), visade resultatet även ett signifikant (p= 0,047) högre medelvärde för dorsalflexionen i MTP 1-leden på frisk sida jämfört med affekterad. Pearson korrelation test visade r= 0,90 på frisk respektive r=0,86 på affekterad sida då metoderna VE och GM undersöktes för samvarians. Konklusion: Motionärer med unilateral AT har nedsatt dorsalflexion i MTP 1-leden på den affekterade sidan jämfört med friska. Inga sidoskillnader verkar finnas beträffande naviculare position. GM är att föredra framför VE vid klinisk mätning av dorsalflexion i MTP 1-leden, eftersom rörligheten underestimerades vid VE. / Abstract   Aim: The aim of this study was to a) investigate if recreational athletes diagnosed with midportion Achilles tendinopathy (AT) have restricted dorsiflexion in the 1st metatarsophalangeal (MTP) joint on affected side, compared to non-affected, b) investigate whether there are side side differences in naviculare position and also c) investigate which method - goniometric measurement (GM) or visual estimation (VE) - is preferable in measurement for dorsiflexion in the 1st MTP joint. The questions were: Is there a difference for dorsiflexion in the 1st MTP joint when comparing the affected side with the unaffected? Is there a side difference for the height of the medial longitudinal arch? Is there a side difference for the size of midtarsal vertical movement? Are there differences between the values of dorsiflexion in the 1st MTP joint using the respective method (GM and VE) when comparing the affected side to the unaffected? Does the method VE exhibit concurrent validity with the method GM in measuring dorsiflexion for the 1st MTP joint? Method: 28 patients with unilateral AT (mean age 39 years, weeks of symptoms median =12) were consecutively recruted. The patients were diagnosed clinically, the lower extremity was screened for restrictions in the sagittal plane, naviculare height (NH) was measured in two positions and navicular drop (ND) was calculated. The 1st MTP joint was photographed three times in a standardized position, and the dorsiflexion was measured by GM in the photos, which were randomized. The highest value measured for dorsiflexion in the 1st MTP joint for each foot was used for VE, and a protocol was used to standardize. Results: There was a significantly restricted dorsiflexion (p=0.015) in the 1st MTP joint on the affected side for recreational athletes with AT. There was no significance between the height of the longitudinal arch (NH) or the size of midtarsal vertical movement (ND) when comparing the affected side to the unaffected. Using GM there was a significantly higher mean (p= 0.0009) for dorsiflexion in the 1st MTP joint compared to VE. The mean was also significantly higher for dorsiflexion in the 1st MTP joint, using GM as well as VE, on the unaffected side, compared to the affected. When the methods VE and GM were examined for covariance, Pearson's correlation test showed r = 0.90 to the unaffected side and r = 0.86 to the affected side. Conclusions: Recreational athletes with unilateral AT have a restriction of dorsiflexion in the 1st MTP joint on the affected side compared to the unaffected. There were no side differences found between naviculare position. GM is to be chosen over VE for clinical measurements of dorsiflexion in the 1st MTP joint, since VE underestimated the range of motion.