[Achillodynia is not just a sports injury]. / Achillodynia er ikke kun en idraetsskade.

INTRODUCTION: A descriptive study of patients referred to two rheumatology clinics. MATERIAL AND METHODS: Over a period of eight months, all patients with Achilles tendon pain (AT) were registered. All patients were clinically investigated and an ultrasound scan (US) was performed. RESULTS: A total of 113 patients were included (3.65% of all patients) with 132 AT. In all, 85 patients were sports active and the AT could be explained by overuse. A total of 28 patients had no relevant overuse and their ATs were considered to be degenerative. US changes were found in 112 tendons, but no pathologic changes were found in 20 symptomatic tendons. Conversely, we found US changes in 21 asymptomatic tendons. In our study, US helped to identify a misdiagnosed tendon rupture. In five patients, erosions were found, possibly as an initial sign of arthritis. US diagnosed 9% with bursitis, 35% with peritendinitis, 39% with neovascularisation within the tendon and 53% with increased thickness of the tendon. In most cases, the thickening was found 4-6 cm above the insertion, often in the vicinity of the soleus muscle-tendon junction. CONCLUSION: AT is a common complaint in rheumatology clinics. US alone cannot diagnose AT, but it serves as a supplement to clinical investigation. US can assist in achieving more precise diagnoses. Future studies must elucidate if the various diagnoses are associated with different prognoses and treatments.

Ultrasound therapy in musculoskeletal disorders: a meta-analysis.

We have reviewed 293 papers published since 1950 to assess the evidence of effect of ultrasound in the treatment of musculoskeletal disorders. Twenty-two clinical papers describing trials comparing ultrasound treatment with sham-ultrasound treated, non-ultrasound treatment and untreated groups were found. These papers were evaluated with respect to a list of criteria which should be met in this type of trial. They were generally found lacking with respect to description of drop-outs, randomisation methods, ultrasound apparatus, sham-ultrasound apparatus, control of apparatus, mode of delivery, size of sound-head, treated area and follow-up time. In 16 of these trials, ultrasound treatments were compared with sham-ultrasound and in 13 cases data were presented in a way that made pooling possible. Two standardized effect sizes (dd/r and dd/s) were applied to the results to enable evaluation of the effect of ultrasound treatment on pain. None of the methods (dd/r = 0.64%, confidence limits -6.7 to 7.5%; and dd/s = 0.24, confidence limits -0.01 to 0.49) gave evidence that pain relief could be achieved by ultrasound treatment. Hence we found no reason to analyze the other papers where ultrasound treatment was compared with another treatment or an untreated control group. We found a significant influence of degree of blinding using the d/s for the analysis (t test, P = 0.009), while when the d/r was used, only a trend was found (P = 0.10). An analysis of the effect of proper randomisation on the result was not possible because of inadequate description of the methods used. We conclude that the use of ultrasound in treatment of musculoskeletal disorders is based on empirical experience, but is lacking firm evidence from well-designed controlled studies. One question remaining is whether ultrasound treatment can augment an effect of exercise therapy with respect to musculoskeletal disorders.

The effect of low-level laser therapy on musculoskeletal pain: a meta-analysis.

A meta-analysis was undertaken of low-level laser therapy (LLLT) on musculoskeletal pain. A literature search revealed 23 LLLT trials and of these 17 were controlled trials. Ten were double blind and 7 were insufficiently blinded. Within the studies identified pain was assessed by visual analogue scale or by "some other indices of pain". Nine double-blind trials and 4 controlled trials presented results in a form which allowed pooling of data. In the double-blind trials, the mean difference in pain between LLLT and placebo was 0.3% (S.E.(d) 4.6%, confidence limits -10.3-10.9%). In the insufficiently blinded trials the mean difference in pain was 9.5% (S.E.(d) 4.5%, confidence limits -2.9-21.8%). We conclude that LLLT has no effect on pain in musculoskeletal syndromes.