Lower Limb Tendinopathy Tissue Changes Assessed through Ultrasound: A Narrative Review.

Tendinopathy is a common disease that affects athletes, causing pain and dysfunction to the afflicted tendon. A clinical diagnose is usually combined with imaging and, among all the existing techniques, ultrasound is widely adopted. The aim of this review is to sum up the existing evidence on ultrasound as an imaging tool and guide for treatments in lower limbs tendinopathy. Using three different databases-PubMed, MEDLINE and CENTRAL-a literature search has been performed in May 2020 combining MeSH terms and free terms with Boolean operators. Authors independently selected studies, conducted quality assessment, and extracted results. Ultrasound imaging has a good reliability in the differentiation between healthy and abnormal tendon tissue, while there are difficulties in the identification of tendinopathy stages. The main parameters considered by ultrasound imaging are tendon thickness, hypoechogenicity of tendon structure and neovascularization of the tendon bound tissue. Ultrasound-guide is also used in many tendinopathy treatments and the available studies gave encouraging results, even if further studies are needed in this field.

Percutaneous Electrical Nerve Stimulation (PENS) for Infrapatellar Saphenous Neuralgia Management in a Patient with Myasthenia gravis (MG).

Myasthenia gravis is a neuromuscular transmission disorder characterized by weakness of the cranial and skeletal muscles, however, neuropathies are extremely rare. In this case report we present a case of a 61-year-old man diagnosed Myasthenia gravis who came to our attention due to a 1 week of acute deep pain [NPRS 8/10] in the anterior and medial right knee which occurred during walking [NPRS 8/10] or stair climbing [NPRS 9/10]. A complete medical record and clinical examination based on physical exploration and ultrasound assessment confirmed a infrapatellar saphenous neuralgia. Therapeutic interventions included Percutaneous nerve electrical stimulation combined with pain neuroscience education, neural mobilization of the saphenous nerve and quadriceps resistance exercises. After 4 weeks, pain intensity [NRPS = 1/10], knee functionality [OKS = 41/48] and lower limb functionality [LLFI = 80%] were notably improved, nevertheless, fatigue [RPE = 2/10] was similar than baseline. At 2 months of follow-up, the effect on intensity of pain NRPS [0/10] and functionality OKS [40/48] and LLFI [82%] was maintained, however, no significant clinical changes were detected on perceived fatigue RPE Scale [2/10]. Despite the important methodological limitations of this study, our case report highlights the efficacy of percutaneous electrical nerve stimulation combined with physical agents modalities for pain and functionality of infrapatellar saphenous neuralgia in the context of Myasthenia gravis.

Reliability of Sonography Measures of the Lumbar Multifidus and Transversus Abdominis during Static and Dynamic Activities in Subjects with Non-Specific Chronic Low Back Pain.

PURPOSE: The purpose of this study was to investigate the test-retest reliability of ultrasound (US) thickness measurements and the muscle contraction ratio (CR) of lumbar multifidus (LM) and transversus abdominis (TA) muscles in participants with and without nonspecific chronic low back pain (NCLBP). METHODS: A total of 62 participants (37 with NCLBP, 25 without NCLBP) with participated in the study. The within-day and between-day reliability of US thickness measurements and CR in a lying (supine for TA and prone for LM) and sitting positions for both muscles (sitting on a gym ball with both feet on the ground or lifting one foot off the floor) were assessed. Reliability analysis was performed with intraclass correlations (ICCs) for these two static and dynamic positions. RESULTS: Test-retest reliability was calculated to be good to high for the static position (ICC = 0.72-0.95) and the dynamic position (ICC = 0.74-0.94) sonographic measurements in both group of TA measurement. Test-retest reliability of LM measurements was good to high for the static position (ICC = 0.82-0.95) and the dynamic position (ICC = 0.85-0.97) sonographic measurements in both groups. CONCLUSIONS: US imaging is a highly reliable method for the assessment of TA and LM thickness muscles in the dynamic position in participants with and without NCLBP. The CR measures may be adequately reliable in assessing the function of the TA and LM muscles in participants with NCLBP and healthy ones.

A new ultrasound-guided percutaneous electrolysis and exercise treatment in patellar tendinopathy: three case reports.

Purpose: To present preliminary clinical results of the effects of a new treatment with percutaneous electrolysis directed to peripheral tendon and therapeutic resistance exercise, with or without the presence of degenerative zone. Methods: 3 patients with patellar tendinopathy aged 37-45 years with diagnostic of patellar tendinopathy with pain since 5-8 weeks were treated with a novel, less invasive electrolysis technique. Pain severity was measured by Numerical Pain Rating Scale (NPRS). Lower limb functionality was measured by a Victorian Institute of Sport Assessment questionnaire (VISA-P). A clinical interview and ultrasonography assesment were performed before study protocol were carried out. Each participants received 4 to 7 sessions of percutaneous electrolysis (350 µA, 80 s) leaving at least one week between sessions during a total of 8 weeks. During this time, subjects also were undergone a therapeutic exercise protocol of lower limbs resistance training. Results: Pain severity decreased after 3 weeks treatment (p = 0.01) and was practically abolished after 4-7 sessions at 8 weeks (p = 0.2). The lower limb functionality (VISA-P) increased after 3 weeks treatment and the major difference was found at 8 weeks post-intervention (p = 0.001). Thickness of the patellar tendon decreased after 8 weeks treatment (p = 0.01). Conclusions: The present work provides the first evidence that percutaneous electrolysis with a least invasive physiotherapy treatment targeted to peripheral tendon in combination with therapeutic resistance exercise diminished pain, improved funcitonality and showed a tendency to decreased thickness in subjects with patelallar tendinopathy.