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  • Flodgren, Gerd M, et al. (författare)
  • Glutamate and prostaglandin E2 in the trapezius muscle of female subjects with chronic muscle pain and controls determined by microdialysis.
  • 2005
  • Ingår i: European Journal of Pain. - 1090-3801. ; 9:5, s. 511-515
  • Tidskriftsartikel (refereegranskat)abstract
    • Much is still unknown concerning the mechanisms underlying the development of chronic muscle pain. The presence and magnitude of inflammatory substances and neurotransmitters in chronic painful conditions is not clear. The aims of the present study were to determine, with the use of microdialysis, the interstitial concentrations and the equilibration times for PGE(2) and glutamate in the trapezius muscles of nine female subjects with chronic muscle pain, and nine pain-free age-matched controls. A microdialysis probe was implanted in the upper part of the trapezius muscle and perfused with Ringer-acetate solution at a flow rate of 0.3 muL/min. Samples were obtained every 30 min, during a 4-h rest period. At equilibration, the mean concentrations (+/-SE) of PGE(2) were 0.71 (+/-0.11) ng/mL for the pain-group and 0.97 (+/-0.35) ng/mL for the controls. For glutamate the mean concentrations for the pain-group were 66.3 (+/-13.3) mumol/L and 60.6 (+/-22.9) mumol/L for the controls. For the pain group and the control group, respectively, equilibration for PGE(2) was reached at 180 and 150 min, and for glutamate at 150 and 120 min. The present study showed no differences between groups in the concentrations of PGE(2) and glutamate in the trapezius muscle. Further, it revealed that when using the slow-flow method, a period of at least 2.0-2.5 h is needed, after probe insertion, to reach steady state for glutamate and PGE(2).
  • Sunding, Kerstin, et al. (författare)
  • Sclerosing injections and ultrasound-guided arthroscopicshaving for patellar tendinopathy : good clinical results and decreased tendon thickness after surgery-a medium-term follow-up study
  • 2015
  • Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - 0942-2056. ; 23:8, s. 2259-2268
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: Treatment of patellar tendinopathy/jumper's knee with ultrasound-guided sclerosing injections or ultrasound-guided arthroscopic shaving has shown good clinical short-term results. Former studies indicate that the tendon thickness and structure stays unaffected after successful treatment. The aim of this study was to evaluate the sonographic findings and clinical outcome 3-5 years after treatment of patellar tendinopathy with ultrasound-guided sclerosing injections or arthroscopic shaving.METHODS: Fifty-seven patellar tendons (43 patients) with chronic patellar tendinopathy were evaluated, with ultrasound, colour Doppler (CD) and visual analogue scale (VAS) for pain and satisfaction with treatment, 3-5 years after treatment. Functional status was evaluated with a single question-"Back in full loading activity?" yes or no.RESULTS: At endpoint (mean 46 months), there was a significant decrease in anteroposterior thickness of the proximal patellar tendon in patients treated with ultrasound-guided arthroscopic shaving but not after sclerosing injections. Tendon structure had improved, and CD local blood flow had diminished significantly in both groups. There were good clinical results with a significant decrease in VAS for pain after sclerosing injections (VAS 64 ± 18 → 17 ± 23) with 74 % satisfied patients and also after arthroscopic shaving (VAS 77 ± 16 → 13 ± 23) with 80 % satisfied patients. There were no significant differences in VAS between groups. A significant correlation between low local blood flow and high patient satisfaction was found.CONCLUSIONS: Tendon thickness decreased over time after ultrasound-guided arthroscopic shaving, and tendon structure and local blood flow decreased after both treatments. There were good, and similar, clinical results with both methods. LEVEL OF EVIDENCE: III.
  • Fahlström, Martin, et al. (författare)
  • Shoulder pain -- a common problem in world-class badminton players.
  • 2006
  • Ingår i: Scandinavian journal of medicine & science in sports. - 0905-7188. ; 16:3, s. 168-73
  • Tidskriftsartikel (refereegranskat)abstract
    • Badminton is a sport that requires a lot of over-shoulder motion, with the shoulder in abduction/external rotation. This questionnaire study on 188 international top-level badminton players during the World Mixed Team Championships showed that previous or present shoulder pain on the dominant side was reported by 52% of the players. Previous shoulder pain was reported by 37% of the players and on-going shoulder pain by 20% of the players. There were no significant differences in the prevalence of shoulder pain between men and women. The majority of the shoulder pain had started gradually. The pain was usually associated with shoulder activity, and stiffness was a common, associated symptom. Furthermore, the shoulder pain was associated with consequences such as sleeping disturbances, changes in training and competition habits, and it also affected activities of daily living. The majority of the players had sought medical advice and had been given different kinds of treatment. The study showed that shoulder pain is a common and significant problem in world-class badminton players, and the consequences are most likely of importance for their training and playing capacity.
  • Kristoffersen, Mads, et al. (författare)
  • Neovascularisation in chronic tendon injuries detected with colour Doppler ultrasound in horse and man: : implications for research and treatment
  • 2005
  • Ingår i: Knee Surg Sports Traumatol Arthrosc. - 0942-2056. ; 13:6, s. 505-508
  • Tidskriftsartikel (refereegranskat)abstract
    • Recent research on chronic painful Achilles tendons in humans using ultrasonography and immunohistochemistry, has demonstrated an association between neurovascular ingrowth and tendon pain. In horses, chronic debilitating tendon conditions are well-known to be very difficult to treat, and the background to impaired function and pain is not scientifically clarified. In a collaborative research project between the Sports Medicine Unit in Umea and Stromsholm Equine Hospital, grey-scale ultrasonography (US) and colour Doppler (CD) examination were performed in ten horses with chronic tendon injuries (> 3 months) and a control group of six healthy and asymptomatic horses. In all symptomatic tendons, but not in any of the tendons in the control group, neovessels were seen in the area with structural tendon changes. The neovessels found in the horse tendons looked similar to what has recently been presented in human Achilles tendons. These findings motivate evaluation of the same treatment, a sclerosing injection that was demonstrated recently to give promising results in the treatment of chronic Achilles tendon injuries (tendinosis) in humans
  • Öhberg, Lars, et al. (författare)
  • Eccentric training in patients with chronic Achilles tendinosis–normalized tendon structure and decreased thickness at follow-up
  • 2004
  • Ingår i: British Journal of Sports Medicine. - London : BMJ Publishing Group Ltd. - 0306-3674. ; 38:1, s. 8-11
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To prospectively investigate tendon thickness and tendon structure by ultrasonography in patients treated with eccentric calf muscle training for painful chronic Achilles tendinosis located at the 2 6 cm level in the tendon.Methods: The patients were examined with grey scale ultrasonography before and 3.8 years ( mean) after the 12 week eccentric training regimen. At follow up, a questionnaire assessed present activity level and satisfaction with treatment.Results: Twenty six tendons in twenty five patients ( 19 men and six women) with a mean age of 50 years were followed for a mean of 3.8 years ( range 1.6 - 7.75). All patients had a long duration of painful symptoms ( mean 17.1 months) from chronic Achilles tendinosis before treatment. At follow up, 22 of 25 patients were satisfied with treatment and active in Achilles tendon loading activities at the desired level. Ultrasonography showed that tendon thickness ( at the widest part) had decreased significantly (p< 0.005) after treatment (7.6 (2.3) v 8.8 ( 3) mm; mean (SD)). In untreated normal tendons, there was no significant difference in thickness after treatment (5.3 (1.3) mm before and 5.9 (0.8) mm after). All tendons with tendinosis had structural abnormalities (hypoechoic areas and irregular structure) before the start of treatment. After treatment, the structure was normal in 19 of the 26 tendons. Six of the seven patients with remaining structural abnormalities experienced pain in the tendon during loading.Conclusions: Ultrasonographic follow up of patients with mid-portion painful chronic Achilles tendinosis treated with eccentric calf muscle training showed a localised decrease in tendon thickness and a normalised tendon structure in most patients. Remaining structural tendon abnormalities seemed to be associated with residual pain in the tendon.
  • Abat, F, et al. (författare)
  • Current trends in tendinopathy consensus of the ESSKA basic science committee. Part II
  • 2018
  • Ingår i: Journal of experimental orthopaedics. - Springer. - 2197-1153. ; 5:38
  • Tidskriftsartikel (refereegranskat)abstract
    • The treatment of painful chronic tendinopathy is challenging. Multiple non-invasive and tendon-invasive methods are used. When traditional non-invasive treatments fail, the injections of platelet-rich plasma autologous blood or cortisone have become increasingly favored. However, there is little scientific evidence from human studies supporting injection treatment. As the last resort, intra- or peritendinous open or endoscopic surgery are employed even though these also show varying results. This ESSKA basic science committee current concepts review follows the first part on the biology, biomechanics and anatomy of tendinopathies, to provide a comprehensive overview of the latest treatment options for tendinopathy as reported in the literature.
  • Alfredson, Håkan (författare)
  • Achilles and patellar tendon operations performed in local anestesia
  • 2018
  • Ingår i: American journal of Anesthesiology and Pain medicine. - New York : ONOMY. - 2640-5377. ; 1:1, s. 001-002
  • Tidskriftsartikel (refereegranskat)abstract
    • From 20 years of research on innervation patterns and pain mechanisms in chronic painful Achilles and patellar tendinopathy, we have learned that the nerves are located outside the affected tendon. With this background we use local anestetics in combination with Adrenaline when these patients are surgical treated. We have now more than 15 years of experience in treating Achilles tendinopathy, and 10 years of experience in treating patellar tendinopaty, in local anesthesia alone. I will present the scientific background and practi-cal techniques to use local anesthesia for treatment of chronic painful Achilles and patellar tendinopathy.
  • Alfredson, Håkan, et al. (författare)
  • Achilles tendinosis and calf muscle strength : the effect of short-term immobilization after surgical treatment
  • 1998
  • Ingår i: American Journal of Sports Medicine. - 0363-5465. ; 26:2, s. 166-71
  • Tidskriftsartikel (refereegranskat)abstract
    • We prospectively studied calf muscle strength in 7 men and 4 women (mean age, 40.9 +/- 10.1 years) who had surgical treatment for chronic Achilles tendinosis. Surgery was followed by immobilization in a weightbearing below-the-knee plaster cast for 2 weeks followed by a stepwise increasing strength training program. Strength measurements (peak torque and total work) were done preoperatively (Week 0) and at 16, 26, and 52 weeks postoperatively. We measured isokinetic concentric plantar flexion strength at 90 and 225 deg/sec and eccentric flexion strength at 90 deg/sec on both the injured and noninjured sides. Preoperatively, concentric and eccentric strength were significantly lower on the injured side at 90 and 225 deg/sec. Postoperatively, concentric peak torque on the injured side decreased significantly between Weeks 0 and 16 and increased significantly between Weeks 26 and 52 at 90 deg/sec but was significantly lower than that on the noninjured side at all periods and at both velocities. The eccentric strength was significantly lower on the injured side at Week 26 but increased significantly until at Week 52 no significant differences between the sides could be demonstrated. It seems, therefore, that the recovery in concentric and eccentric calf muscle strength after surgery for Achilles tendinosis is slow. We saw no obvious advantages in recovery of muscle strength with a short immobilization time (2 weeks) versus a longer (6 weeks) period used in a previous study.
  • Alfredson, Håkan, et al. (författare)
  • Aerobic workout and bone mass in females
  • 1997
  • Ingår i: Scandinavian Journal of Medicine and Science in Sports. - Wiley. - 0905-7188. ; 7:6, s. 336-341
  • Tidskriftsartikel (refereegranskat)abstract
    • This cross-sectional study aimed to investigate bone mass in females participating in aerobic workout. Twenty-three females (age 24.1 +/- 2.7 years), participating in aerobic workout for about 3 hours/week, were compared with 23 age-, weight- and height-matched non-active females. Areal bone mineral density (BMD) was measured in total body, head, whole dominant humerus, lumbar spine, right femoral neck, Ward's triangle, trochanter femoris, in specific sites in right femur diaphysis, distal femur, proximal tibia and tibial diaphysis, and bone mineral content (BMC) was measured in the whole dominant arm and right leg, using dual energy X-ray absorptiometry. The aerobic workout group had significantly (P < 0.05-0.01) higher BMD in total body (3.7%), lumbar spine (7.8%), femoral neck (11.6%), Ward's triangle (11.7%), trochanter femoris (9.6%), proximal tibia (6.8%) and tibia diaphysis (5.9%) compared to the non-active controls. There were no differences between the groups concerning BMD of the whole dominant humerus, femoral diaphysis, distal femur and BMC and lean mass of the whole dominant arm and right leg. Leaness of the whole dominant arm and leg was correlated to BMC of the whole dominant arm and right leg in both groups. In young females, aerobic workout containing alternating high and low impact movements for the lower body is associated with a higher bone mass in clinically important sites like the lumbar spine and hip, but muscle strengthening exercises like push-ups and soft-glove boxing are not associated with a higher bone mass in the dominant humerus. It appears that there is a skeletal adaptation to the loads of the activity.
  • Alfredson, Håkan, et al. (författare)
  • Autologous periosteum transplantation for the treatment of full thickness patellar cartilage defects.
  • 2001
  • Ingår i: Ortopedia, traumatologia, rehabilitacja. - 1509-3492. ; 3:2, s. 216-223
  • Tidskriftsartikel (refereegranskat)abstract
    • Full-thickness patellar cartilage defects are often, but not always, associated with disabling anterior knee-pain and inability to take part in regular daily activities. There is no treatment of choice for this condition. It is well known that the cells in the cambium layer of the periosteum are pluripotent and can differentiate into hyaline (or hyaline-like) cartilage, especially if in a joint environment and under the influence of continous passive motion. In a few clinical studies autologous periosteum transplants alone have been used in the treatment of full thickness patellar cartilage defects. The results are varying. At our clinic, autologous periosteum transplantation alone, followed by continous passive motion (CPM) in the immediate postoperative period and non-weight bearing loading for 3 months, has shown promising clinical results. The best clinical results have been achieved on traumatic (fracture, contusion, dislocation) cartilage defects, where 83% of patients have been clinically graded as excellent or good at follow-up (> 2 years postoperatively). For non-traumatic patellar cartilage defects (chondromalacia NUD) the results are poor, with only 35% of patients being graded as excellent or good. Therefore, we believe that no-traumatic patellar cartilage defects (chondromalacia NUD) are less suitable for treatment with autologous periosteum transplants, and are at our clinic not any longer included for this type of treatment.
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