OBJECTIVE: The study objectives were (i) to explore the agreement between the Outcome Measures in Rheumatology (OMERACT) ultrasound lesions of enthesitis and physical examination in assessing enthesitis in patients with spondyloarthritis (SpA) and (ii) to investigate the prevalence and clinical relevance of subclinical enthesitis in this population. METHODS: Twenty rheumatology centers participated in this cross-sectional study. Patients with SpA, including axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), underwent both ultrasound scan and physical examination of large lower limb entheses. The OMERACT ultrasound lesions of enthesitis were considered, along with a recently proposed definition for "active enthesitis" by our group. Subclinical enthesitis was defined as the presence of "active enthesitis" in ≥1 enthesis in patients with SpA without clinical enthesitis (ie, number of positive entheses on physical examination and Leeds Enthesitis Index score = 0). RESULTS: A total of 4,130 entheses in 413 patients with SpA (224 with axSpA and 189 with PsA) were evaluated through ultrasound and physical examination. Agreement between ultrasound and physical examination ranged from moderate (ie, enthesophytes) to almost perfect (ie, power Doppler and "active enthesitis"). Patellar tendon entheses demonstrated the highest agreement, whereas Achilles tendon insertion showed the lowest. Among 158 (38.3%) of 413 patients with SpA with clinical enthesitis, 108 (68.4%) exhibited no "active enthesitis" on ultrasound. Conversely, of those 255 without clinical enthesitis, 39 (15.3%) showed subclinical enthesitis. Subclinical enthesitis was strongly associated with local structural damage. However, no differences were observed regarding the demographic and clinical profiles of patients with SpA with and without subclinical enthesitis. CONCLUSION: Our study underscores the need for a comprehensive tool integrating ultrasound and physical examination for assessing enthesitis in patients with SpA.
- MeSH
- Achillova šlacha diagnostické zobrazování MeSH
- axiální spondyloartritida diagnostické zobrazování MeSH
- dospělí MeSH
- entezopatie * diagnostické zobrazování MeSH
- fyzikální vyšetření * MeSH
- lidé středního věku MeSH
- lidé MeSH
- průřezové studie MeSH
- psoriatická artritida diagnostické zobrazování komplikace MeSH
- spondylartritida * diagnostické zobrazování komplikace MeSH
- ultrasonografie * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Trigger finger (TF), also known as stenosing flexor tenosynovitis, is a common pathology of the fingers causing functional deficit of the hand. In recent years, new therapeutic approaches such as extracorporeal shock wave therapy (ESWT) and ultrasound-guided (USG) procedures have joined the most traditional conservative treatments as the adaptation of daily activities involving the affected hand and the orthosis. Likewise, the ultrasound (US) examination of the affected finger using modern high-frequency probes has progressively become part of the comprehensive assessment of patients with TF coupled with the medical history, the physical examination, and the functional scales. In this sense, considering the technological advances in both diagnostic and therapeutic fields, the non-surgical strategies have progressively grown defining a rehabilitation panel more complex than in the past. The present manuscript aims to provide an updated practical guide for clinicians and surgeons reviewing the state-of-art of both the assessment and the treatments of patients with TF to plan tailored rehabilitation management taking advantage of the matching of traditional and novel techniques.
- MeSH
- intervenční ultrasonografie metody MeSH
- léčba mimotělní rázovou vlnou metody MeSH
- lidé MeSH
- lupavý prst * diagnóza rehabilitace MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
AIM: To propose a standardized, high-resolution ultrasound (US) protocol to assess the patellar tendon-Hoffa fat pad interface (PTHFPI) in patients with (proximal) patellar tendinopathy (PPT). METHODS: Using a high-frequency transducer and a high-level machine, we matched the cadaveric and histological microarchitecture of the PTHFPI with multiple sonographic patterns of patients with PPT. Likewise, high-sensitive color/power Doppler assessments were also performed to evaluate the microcirculation of the soft tissues beneath the patellar tendon. RESULTS: Modern US equipment allows for detailed assessment of the potential pain generators located inside the PTHFPI in patients with PPT. They include anterosuperior portion of the Hoffa body and the loose connective tissue of the deep paratenon with its microvascular plexus. CONCLUSIONS: In patients with PPT, accurate sonographic assessment of the PTHFPI can be performed using adequate technological equipment. Accordingly, tailored ultrasound-guided interventions can also be planned if/when clinically indicated.
- MeSH
- kolenní kloub diagnostické zobrazování MeSH
- lidé středního věku MeSH
- lidé MeSH
- ligamentum patellae * diagnostické zobrazování MeSH
- mrtvola MeSH
- senioři MeSH
- tendinopatie * diagnostické zobrazování patologie MeSH
- tuková tkáň * diagnostické zobrazování MeSH
- ultrasonografie metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY: In this study, we aimed to evaluate acromiohumeral distance (AHD) and supraspinatus tendon (ST) thickness measurements and their relationship with pain and function in ST pathologies. MATERIAL AND METHODS: The study included 111 patients and 25 healthy controls (HC). Patients were divided into 3 groups according to their diagnosis: non-tear tendinopathy (NTT), partial thickness tear (PTT), and full thickness tear (FTT). The AHD and ST thickness of the participants were measured with ultrasound. The pain and functional status of the patients were evaluated with the Numeric Rating Scale (NRS), The QuickDASH shortened version of the DASH Outcome Measure - Disabilities of the Arm Shoulder and Hand (QDASH), and Simple Shoulder Test (SST). RESULTS: The AHD value was significantly higher in the NTT group (p=0.000). The AHD value was significantly lower in the FTT group (p=0.000). ST thickness value was significantly lower in the PTT group compared to the NTT group (p=0.000). There was a positive correlation between ST thickness and BMI (r=0.553,p<0.01). There was a negative correlation between ST thickness and SST and a positive correlation between ST thickness (r=-0.223,p<0.05) and QDASH (r=0.276,p<0.05). CONCLUSIONS: We found that AHD and SST thicknesses significantly differed in the NTT, PTT, FTT, and HC groups. This difference may be important for diagnosis. In addition, the effect of obesity on ST thickness and the relationship between ST thickness and functional scores may be considered. Weight control may be effective at this point. KEY WORDS: acromiohumeral distance, supraspinatus tendon thickness, ultrasound.
- MeSH
- akromion diagnostické zobrazování MeSH
- bolest ramene etiologie diagnostické zobrazování patofyziologie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- měření bolesti metody MeSH
- poranění rotátorové manžety * diagnostické zobrazování patofyziologie MeSH
- rotátorová manžeta * diagnostické zobrazování patofyziologie MeSH
- studie případů a kontrol MeSH
- tendinopatie diagnostické zobrazování patofyziologie MeSH
- ultrasonografie * metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Insertional Achilles tendinopathy is an umbrella medical term referring to pain and swelling on the posterior aspect of the calcaneus. High-resolution ultrasound imaging is commonly used in daily practice to assess the pathological changes of the Achilles tendon, cortical bone of the calcaneus, and soft tissues located inside the retrocalcaneal space to optimize the management of relevant patients. To the best of our knowledge, a standardized ultrasound protocol to evaluate the retrocalcaneal bursal complex is lacking in the pertinent literature. In this sense, our step-by-step sonographic approach is intended to be an easy and ready-to-use guide for sonographers/physicians in daily practice to assess this anatomical complex in patients with Achilles tendinopathy. Needless to say, the peculiar histological features of this V-shaped synovial/fibrocartilaginous bursa surrounding the posteroinferior wedge of the Kager's fat pad and the retrocalcaneal space make the examination challenging.
- MeSH
- Achillova šlacha * diagnostické zobrazování MeSH
- bursa synovialis * diagnostické zobrazování MeSH
- lidé MeSH
- patní kost * diagnostické zobrazování MeSH
- tendinopatie * diagnostické zobrazování MeSH
- ultrasonografie metody normy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- směrnice pro lékařskou praxi MeSH
OBJECTIVES: The main objective was to generate a GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis and to test its reliability. To this end, we assessed the validity, feasibility and applicability of ultrasound assessment of finger entheses to incorporate them into the scoring system. METHODS: The study consisted of a stepwise process. First, in cadaveric specimens, we identified enthesis sites of the fingers by ultrasound and gross anatomy, and then verified presence of entheseal tissue in histological samples. We then selected the entheses to be incorporated into a dactylitis scoring system through a Delphi consensus process among international experts. Next, we established and defined the ultrasound components of dactylitis and their scoring systems using Delphi methodology. Finally, we tested the interobserver and intraobserver reliability of the consensus- based scoring systemin patients with psoriatic dactylitis. RESULTS: 32 entheses were identified in cadaveric fingers. The presence of entheseal tissues was confirmed in all cadaveric samples. Of these, following the consensus process, 12 entheses were selected for inclusion in GLOUDAS. Ultrasound components of GLOUDAS agreed on through the Delphi process were synovitis, tenosynovitis, enthesitis, subcutaneous tissue inflammation and periextensor tendon inflammation. The scoring system for each component was also agreed on. Interobserver reliability was fair to good (κ 0.39-0.71) and intraobserver reliability good to excellent (κ 0.80-0.88) for dactylitis components. Interobserver and intraobserver agreement for the total B-mode and Doppler mode scores (sum of the scores of the individual abnormalities) were excellent (interobserver intraclass correlation coefficient (ICC) 0.98 for B-mode and 0.99 for Doppler mode; intraobserver ICC 0.98 for both modes). CONCLUSIONS: We have produced a consensus-driven ultrasound dactylitis scoring system that has shown acceptable interobserver reliability and excellent intraobserver reliability. Through anatomical knowledge, small entheses of the fingers were identified and histologically validated.
- MeSH
- delfská metoda MeSH
- dospělí MeSH
- entezopatie diagnostické zobrazování MeSH
- kloub prstu ruky * diagnostické zobrazování patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mrtvola MeSH
- odchylka pozorovatele MeSH
- prsty ruky diagnostické zobrazování patologie MeSH
- psoriatická artritida * diagnostické zobrazování MeSH
- reprodukovatelnost výsledků MeSH
- senioři MeSH
- studie proveditelnosti MeSH
- stupeň závažnosti nemoci * MeSH
- synovitida diagnostické zobrazování patologie MeSH
- tenosynovitida diagnostické zobrazování MeSH
- ultrasonografie * metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- validační studie MeSH
Souhrn: Tendinopatie Achillovy šlachy (AŠ) je běžně používaný termín pro popis klinických projevů bolesti a dysfunkce AŠ spojené se zátěží. Jednou z doporučovaných a často používaných metod v léčbě těchto poruch je terapie fokusovanou rázovou vlnou (ESWT – extracorporeal shock wave therapy). Cílem této studie bylo hodnotit změny ve struktuře patologicky změněné AŠ s využitím ultrasonografie a v klinických projevech po léčbě nízkoenergetickou ESWT v krátkodobém horizontu sledování. Do studie bylo zapojeno celkem 18 pacientů s tendinopatií AŠ, náhodně rozdělených do dvou skupin v poměru 1: 1. Pacienti ve skupině A byli léčeni ESWT. Ve skupině B bylo použito tzv. placebo-ESWT. Jednalo se celkem o pět aplikací s týdenním rozestupem. Hodnoceny byly následující parametry: plocha průřezu šlachy (CSA – tendon cross-sectional area), průměr šlachy (TD – tendon diameter), maximální bolest na numerické škále bolesti (NRS – numeric rating scale) a VISA-A (Victorian Institute of Sports Assessment – Achilles) dotazník. V 8. týdnu od první aplikace ESWT došlo pouze ke statisticky významnému zlepšení parametru NRS (p < 0,05) v meziskupinovém porovnání mezi intervenční skupinou A a kontrolní skupinou B. Kromě toho se ve skupině A statisticky významně snížil parametr NRS průměrně o 4 body (p < 0,001), TD o 0,3 mm (p < 0,05) a zvýšilo se skóre VISA-A o 20,6 bodu (p < 0,001). Ve skupině B nebyl shledán statisticky významný rozdíl (p > 0,05) v žádném měřeném parametru. Parametr CSA se významně nezměnil ani v jedné skupině. Z dosažených výsledků lze konstatovat, že ESWT má v krátkodobém horizontu významný vliv na snížení bolesti ve srovnání s placebem. Kromě toho bylo ve skupině ESWT a nikoli v kontrolní skupině pozorováno významné zlepšení celkového subjektivního vnímání poruchy pacienty. ESWT však neměla výrazný vliv na plochu průřezu šlachy a měla jen minimální vliv na průměr šlachy. Nicméně vzhledem ke krátkodobému sledování nemůžeme potvrdit ani vyvrátit, zda ESWT dlouhodobě ovlivňuje morfologii šlachy. Současně tyto výsledky podporují výběr parametrů pro léčbu rázovou vlnou dle guidelines publikovaných Mezinárodní společností pro léčbu rázovou vlnou. Je třeba zmínit, že nižší počet zařazených pacientů mohl ovlivnit statistickou významnost.
Summary: Achilles tendinopathy (AT) is a commonly used term to describe the clinical manifestations of pain and dysfunction of the Achilles tendon associated with loading. One of the recommended and often used methods in the treatment of these disorders is focused shockwave therapy (ESWT – extracorporeal shock wave therapy). The aim of this study was to observe changes in the structure of the Achilles tendon using ultrasonography and in clinical manifestations after the treatment with low-energy ESWT in a short-term follow-up period. A total of 18 patients with AT were involved in the study, randomly divided into two groups in a ratio of 1: 1. Patients in group A were treated with ESWT. In group B, placebo- -ESWT was used. A total of five applications were done with a weekly interval. The following parameters were evaluated – tendon cross-sectional area (CSA), tendon diameter (TD), maximum pain rating (NRS) and VISA-A (Victorian Institute of Sports Assessment – Achilles) questionnaire. In the 8th week after the first application of ESWT, no statistical significance in the reduction of CSA was observed. Compared with the control group, there was only a statistically significant reduction in NRS (P < 0.05). In addition, there was a significant decrease in NRS by an average of 4 points (P < 0.001), TD by 0.3 mm (P < 0.05), and VISA-A score increased by 20.3 points (P < 0.001) in group A. In group B, no statistically significant difference (P > 0.05) was found in any measured parameter. From the results achieved, it can be concluded that ESWT has a significant effect on pain reduction in the short-term compared to placebo. In addition, a significant improvement in patients‘ overall subjective perception of the disorder was observed in the ESWT group and not in the control group. However, ESWT had no significant effect on tendon CSA and only a minimal effect on TD. Nevertheless, given the short-term follow-up, we cannot confirm or deny whether ESWT affects tendon macromorphology in the long term. At the same time, these results support the selection of parameters for shockwave treatment according to the guidelines published by The International Society for Medical Shockwave Treatment. It should be mentioned that the lower number of included patients may affect the statistical significance.
- Klíčová slova
- ChondroGrid,
- MeSH
- injekce intraartikulární metody MeSH
- klinická studie jako téma MeSH
- kolagen * aplikace a dávkování farmakologie terapeutické užití MeSH
- lidé MeSH
- rotátorová manžeta * patofyziologie MeSH
- tendinopatie * etiologie farmakoterapie patologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Itálie MeSH
OBJECTIVES: To assess, in spondyloarthritis (SpA), the discriminative value of the Outcome Measures in Rheumatology (OMERACT) ultrasound lesions of enthesitis and their associations with clinical features in this population. METHODS: In this multicentre study involving 20 rheumatology centres, clinical and ultrasound examinations of the lower limb large entheses were performed in 413 patients with SpA (axial SpA and psoriatic arthritis) and 282 disease controls (osteoarthritis and fibromyalgia). 'Active enthesitis' was defined as (1) power Doppler (PD) at the enthesis grade ≥1 plus entheseal thickening and/or hypoechoic areas, or (2) PD grade >1 (independent of the presence of entheseal thickening and/or hypoechoic areas). RESULTS: In the univariate analysis, all OMERACT lesions except enthesophytes/calcifications showed a significant association with SpA. PD (OR=8.77, 95% CI 4.40 to 19.20, p<0.001) and bone erosions (OR=4.75, 95% CI 2.43 to 10.10, p<0.001) retained this association in the multivariate analysis. Among the lower limb entheses, only the Achilles tendon was significantly associated with SpA (OR=1.93, 95% CI 1.30 to 2.88, p<0.001) in the multivariate analyses. Active enthesitis showed a significant association with SpA (OR=9.20, 95% CI 4.21 to 23.20, p<0.001), and unlike the individual OMERACT ultrasound lesions it was consistently associated with most clinical measures of SpA disease activity and severity in the regression analyses. CONCLUSIONS: This large multicentre study assessed the value of different ultrasound findings of enthesitis in SpA, identifying the most discriminative ultrasound lesions and entheseal sites for SpA. Ultrasound could differentiate between SpA-related enthesitis and other forms of entheseal pathology (ie, mechanical enthesitis), thus improving the assessment of entheseal involvement in SpA.
- MeSH
- Achillova šlacha diagnostické zobrazování patologie MeSH
- dospělí MeSH
- entezopatie * diagnostické zobrazování MeSH
- lidé středního věku MeSH
- lidé MeSH
- psoriatická artritida diagnostické zobrazování komplikace MeSH
- spondylartritida * diagnostické zobrazování komplikace MeSH
- studie případů a kontrol MeSH
- stupeň závažnosti nemoci MeSH
- ultrasonografie dopplerovská * metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- MeSH
- analgetika terapeutické užití MeSH
- dospělí MeSH
- komplexní regionální syndromy bolesti * diagnóza farmakoterapie patologie MeSH
- lidé MeSH
- mladiství MeSH
- opožděná diagnóza MeSH
- poranění kotníku diagnostické zobrazování komplikace terapie MeSH
- poranění lokte diagnostické zobrazování komplikace terapie MeSH
- tenisový loket chirurgie terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
