Perilesional photobiomodulation therapy and physical rehabilitation in post-operative recovery of dogs surgically treated for thoracolumbar disk extrusion.

BACKGROUND: Recent studies have reported contrasting results of the effects of laser therapy on post-operative intervertebral disk herniation, with a lack of evidence-based advantages of this modality within a rehabilitation protocol. The aim of this study was to report the clinical effects of photobiomodulation therapy within a post-operative rehabilitation protocol in dogs submitted to surgery for thoracolumbar disk extrusion. Twenty-four dogs were included in the study (12 dogs treated with laser therapy and rehabilitation protocol and 12 dogs treated with same rehabilitation protocol but without laser therapy). RESULTS: All dogs treated with laser therapy showed improved neurological status (Modified Frankel Score more than 3 within 30 days of physiotherapy starting) if deep nociception on admission was maintained (P = 0.04). However, Kaplan-Meier analysis did not show any statistical difference in time to regain ambulatory ability, although there was a tendency for a shorter mean time of 14.2 ± 8.55 days in the laser group versus 24 ± 18.49 days in the no laser group. CONCLUSIONS: The use of laser therapy in the post-operative rehabilitation of dogs affected by intervertebral disc extrusion and submitted to surgery for spinal decompression could help improve their neurological status.

Ultrasonographic assessment of normal jugular veins in Standardbred horses.

BACKGROUND: Ultrasonography (US) is the recommended imaging technique to evaluate jugular veins. This prospective randomized clinical study was designed to collect a series of B-mode US measurements of manually distended jugular veins in healthy Italian Standardbreds and to find possible correlations between ultrasound measurements and animal morphometric characteristics. Forty-two horses, eight males and 34 females (range 3-22 years; bodyweight 494.4 ± 41.7 kg), were included in the study. The diameters and wall thicknesses of both jugular veins were measured at three different sites of the neck. The differences in ultrasound measurements based on scans, age, gender, side, and site of the neck were evaluated by ANOVA or by the Kruskal-Wallis test. The effects of the morphometric measures on each ultrasound parameter were evaluated by MANOVA (P < 0.05). RESULTS: The ultrasound measurements did not differ significantly between the three different sites or between genders; hence, they were pooled together in the results. On the transverse scan, the mean dorsoventral and lateromedial diameters were 1.58 ± 0.23 and 2.20 ± 0.25 cm, respectively; the mean superficial and deep wall thicknesses (SWT and DWT) were 0.07 ± 0.01 and 0.08 ± 0.01 cm, respectively. On the longitudinal scan, the mean dorsoventral diameter was 1.59 ± 0.26 cm, and the SWT and DWT were both 0.08 ± 0.01 cm. Neck length, from the caudal edge of the mandible to the thoracic inlet, was related to the dorsoventral diameter in both longitudinal and transverse scan and to the SWT and DWT in transverse scan, whereas height at the withers (measured with tape) and estimated weight were related to the wall thickness. Dividing the subjects into groups by age in years ("young" 3-7, "mature" 8-14, "old" > 14), differences were found for the lateromedial diameter in the transverse scan and the SWT on the longitudinal scan. The main limitation of this study was that only one operator performed the measurements. CONCLUSION: The US measurements of the jugular veins and their relationship with morphometric measures reported in this manuscript might be considered as guidelines both for early diagnosis and monitoring jugular vein abnormalities in healthy Italian Standardbred horses.

Deep Vegetal Foreign Bodies in Cats: A Retrospective Study of 10 Cases.

The aim of this study was to describe the anatomic locations and treatments available for deeply located vegetal foreign bodies in cats. Ten cases of migrating vegetal foreign bodies (vFBs) requiring surgical removal are reported. The diagnoses of vFBs in the thoracic cavity (4/10), retroperitoneal space (2/10), and paratracheal region (1/10) were obtained by ultrasound examination; however, in the perineum or penile urethra (2/10) and peritoneum (1/10), the vFBs were found during surgery. Intraoperative ultrasound guidance helped remove vFBs from the retroperitoneal space and paratracheal tissues. Clinical signs resolved in 8 out of 10 cases, 1 out of 10 cases had recurrent draining fistula, and 1 out of 10 was euthanized for ethical reasons. The intrathoracic was the most common location in the present study, followed by retroperitoneal space and urethra/perineum. Ultrasound guidance was essential for the diagnosis and/or treatment of vFBs located in the thoracic, retroperitoneal, and cervical regions.

Gastric inflammatory pseudotumour secondary to Actinomyces hordeovulneris infection in a cat.

BACKGROUND: The authors report the first case of feline gastric actinomycosis associated with infection by Actinomyces hordeovulneris. CASE PRESENTATION: A 4-year-old, neutered male, semi-feral European cat, with a 1 year history of chronic vomiting, was referred to the clinic. Abdominal ultrasound examination identified a hypoechoic focal transmural thickening with loss of normal wall layering and hyperechoic speckles at the gastric body. Initial gastroscopic examination showed a tumour-like gastric mass with an ulcerated depression at the level of the greater curvature. Histologic examination of endoscopic biopsy specimens was consistent with a severe lymphoplasmacytic gastritis. After 2 months, due to persistence of abdominal discomfort, surgical exploration and intraoperative sampling of gross abnormalities was recommended. Full thickness gastric wall biopsies, and fine needle aspiration of the gastric thickening and gastric lymph node, were performed. Histopathological examination identified a transmural pyogranulomatous gastritis. Aspirate samples of the gastric wall cultured positive, with colony morphology, biochemical testing and PCR of the 16 s rRNA gene compatible with Actinomyces hordeovulneris. After 4 months of treatment with cefovecin (8 mg/kg subcutaneously every 14 days), the vomiting completely resolved, as well as the ultrasonographic gastric alteration. CONCLUSION: This case report of feline gastric actinomycosis, caused by Actinomyces hordeovulneris, suggests that gastric bacterial infection should be considered in cases of focal gastric wall thickening associated with chronic vomiting in the cat, which may otherwise closely resemble neoplastic disease. Once a diagnosis of actinomycosis was obtained, a correct treatment with antibiotic therapy can resolve it.

Observational Study on Cardiac Activity in Rescue Dogs with Holter and Electrocardiogram Methodologies during a Simulated Search Activity.

The aim of this study was to observe electric cardiac activity in real working conditions, with the application of Holter and the electrocardiogram in search and rescue dogs. Thirty-one handlers of search and rescue dogs voluntarily participated in this study. Nine dogs were selected to wear the Holter, and twenty-three were submitted to electrocardiographic recordings (one dog, excluded by Holter examination, was then included in the ECG group). Our results showed few cardiac rhythm alterations, such as escape beats, premature ventricular beat, and depression and elevation of the ST segment, particularly during the working phase in the Holter group and during recovery time immediately after activity in the electrocardiographic group. Detected alterations in real working conditions may provide more information than routine checks, and Holter monitoring can be more functional. However, not all dogs tolerate wearing the Holter harness, and more time is thus needed to apply the equipment. In addition, the results are not immediate, and the absence of water is essential because it would damage the equipment.

Controlled, blinded force platform analysis of the effect of intraarticular injection of autologous adipose-derived mesenchymal stem cells associated to PRGF-Endoret in osteoarthritic dogs.

BACKGROUND: Adipose-derived mesenchymal stem cell (ADMSC) therapy in regenerative medicine is a rapidly growing area of research and is currently also being used to treat osteoarthritis (OA). Force platform analysis has been consistently used to verify the efficacy of different therapeutic strategies for the treatment of OA in dogs, but never with AD-MSC.The aim of this study was to use a force platform to measure the efficacy of intraarticular ADMSC administration for limb function improvement in dogs with severe OA. RESULTS: Eight lame dogs with severe hip OA and a control group of 5 sound dogs were used for this study. Results were statistically analyzed to detect a significant increase in peak vertical force (PVF) and vertical impulse (VI) in treated dogs. Mean values of PVF and VI were significantly improved after treatment of the OA groups, reaching 53.02% and 14.84% of body weight, respectively, at day 180, compared with only 43.56% and 12.16% at day 0. CONCLUSION: This study objectively demonstrated that intraarticular ADMSC therapy resulted in reduced lameness due to OA.

Internet-Based Survey on Physical Activity and Incidence of Injury in Active Working Dogs.

A survey with 100 multiple choice and open-ended questions was proposed by free access to working dogs' handlers. One hundred and nine respondents were recorded and their dates processed. The most represented breeds were: Belgian Malinois, Labrador, Border Collie and German Shepherds. Of these, 71.6% were intact dogs and 28.4% were spayed or neutered, with a median age range of 3-4 years. Furthermore, 55.5% had undergone early radiographic examinations for hip or elbow dysplasia diagnosis. The dogs performed the following activities: search and rescue on surface (59%), search and rescue on rubble (37%), Internationale Gebrauchshund Pruefung (IGP) (9%), man trailing (5%), sled dog (5%), search on avalanche (4%), dog towing (3%), canine shows (3%), hunting (2%), water rescue (1%), pet therapy (1%), wildlife conservation dog (1%), Mondioring (1%). Only 36.4% of respondents submitted their dogs to a specific sports medical examination and 55.5% to an orthopaedic examination. An injury incidence of 45.5% was recorded, generally related to mild musculoskeletal trauma. A limited number of handlers routinely performed warm-up and/or cool-down activities. A positive assessment emerged of the need for many respondents to attend and request education courses and updates on the proper health management of their dogs.

Ocular and Superficial Body Thermographic Findings in Sled Dogs before and after Competition.

Competitions involving sled dogs are rapidly growing and body temperature assessment could represent a prompt and non-invasive method of screening for potential pathological conditions during or after activity. The aim of this clinical study was to evaluate if thermography is able to monitor the pre- and post-competition ocular and superficial body temperature variations during a sled dog competition. It subsequently compared the data relating to the ocular temperatures in different race types: mid-distance (30 km) and sprint (≤16 km). Results showed a statistically significant increase in post-competition ocular temperature of both eyes, regardless of the length of the race. The relative increase in the temperatures of the other body surfaces was lower than the expected values, probably due to the influence of environmental and subjective factors such as the type of coat of the Siberian Husky or subcutaneous fat. Infrared thermography has therefore proved to be useful method in sled dog competition conditions for screening superficial temperature variations, as the investigation is normally conducted in an external environment and often in demanding work conditions.

Effects of exercise on urinary biochemical parameters and proteins in a group of well-trained military working dogs.

Exercise-induced proteinuria has been widely investigated in humans, also in relation to intensity and duration of activity. Instead, there are only limited publications regarding urinary biochemical parameters and urinary proteins before and after physical activity in dogs. This paper aimed to investigate the effects of exercise on urinary biochemistry and proteins in military dogs. Twenty-four dogs were enrolled in this study. All the dogs were clinically sound, and they were examined before and after activity. Pulse rates (PR) and respiratory rate (RR) were monitored. Urine was sampled before and after a training session of search activity. Standard urinalysis was carried out, urine total proteins and creatinine were measured and the urinary protein:creatinine ratio was calculated; finally, the urinary proteins were separated using sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). Clinical examination before and after activity did not reveal any pathological finding. After activity, the PR was slightly increased, while the RR was notably increased (p < 0.05). Total proteins, albumin, and their ratio with creatinine were significantly higher after exercise when considering all the dogs included or only the females while, when considering only the males no significant difference was detected. The clinical relevance of this study was related to the possibility of using urine as a non-invasive sample for monitoring health status after training activity and exercise in dogs. An increase in microalbuminuria after search activity, measured using SDS-PAGE could be considered an early biomarker of renal function during training sessions.

Overview of the Current Literature on the Most Common Neurological Diseases in Dogs with a Particular Focus on Rehabilitation.

Intervertebral disc herniation, degenerative myelopathy, fibrocartilaginous embolism and polyradiculoneuritis often affect dogs; and physiotherapy may improve the patient's quality of life and/or reduce recovery times. The aim of this review was to evaluate the current scientific outcomes on these four neurological diseases and on their physiotherapy approaches. From the analysis of the published articles, it emerged that intervertebral disc herniation can be treated, with different rates of success, through a conservative or a surgical approach followed by physiotherapy. The literature is generally oriented toward the efficacy of the rehabilitation approach in this specific canine disease, often proposing intensive post-surgery physiotherapy for the most severe conditions with the absence of deep pain perception. When degenerative myelopathy, fibrocartilaginous embolism or polyradiculoneuritis occur, the existing literature supports the use of a physiotherapeutic approach: allowing a delay in the onset and worsening of the clinical signs in degenerative myelopathy, physical improvement, and, sometimes, complete remission during fibrocartilaginous embolism or acute idiopathic polyradiculoneuritis. However, papers on rehabilitation in dogs affected by polyradiculoneuritis are currently limited to single clinical cases and further blinded, controlled, prospective studies are still advisable for all four neurological diseases.

Military Working Dogs Operating in Afghanistan Theater: Comparison between Pre- and Post-Mission Blood Analyses to Monitor Physical Fitness and Training.

The intergovernmental organization known as the United Nations (UN) was born "to maintain international peace and security" through different operations and tasks, including "mine action" and "explosive detection". Explosives are the most frequent cause of injuries in military personnel and an enormous danger for civilians. The role of explosive detection dogs (EDDs) and mine detection dogs has gained great consideration over time, leading to their intense use in military operations. Literature regarding working injuries reported by EDDs during missions is limited. The aim of the present study is to investigate the hematological changes that occurred between pre- and post-mission blood analyses in military working dogs deployed to Afghanistan in order to evaluate signs of health problems or physical adjustments. Examining the clinical records, only three dogs reported a medical issue, one with gastric dilatation-volvulus (GDV), and two with lameness episodes. Lack of health issues occurring during the missions was reflected by the absence of significant differences between pre- and post-mission blood analyses. Blood results were also examined by dividing the EDDs into groups considering age at departure, sex, breed and mission length. A few categories demonstrated significant changes in some parameters; however, the mean values were always included in the ranges of normality, indicating that their physical fitness and training were adequate for the required tasks.

Cranial Cruciate Ligament Rupture in Dogs: Review on Biomechanics, Etiopathogenetic Factors and Rehabilitation.

Cranial cruciate ligament (CrCL) rupture is one of the most common orthopaedic conditions in veterinary medicine. CrCL plays a fundamental role in the stability and biomechanics of the femoral-tibio-patellar joint, and its incorrect functionality severely impacts on the quality of life of patients. In dogs, the structural weakening of this joint due to the progressive degeneration of the ligament is the most accredited etiopathogenetic hypothesis in relation to the dog signalment (breed, sex and age) and the stifle joint conformation. In humans, this injury is often traumatic and generally occurs during sporting activities. CrCL rupture can be managed conservatively or surgically, and decisions regarding treatment are due to numerous factors: the patient's age and health, the degree of stifle instability, and cost. Physiotherapy protocols play an important role in rehabilitation, with similar goals in humans and dogs: pain management, physiological articular range of motion recovery, periarticular and core muscle strengthening, and proprioceptive deficit correction. Physiotherapy, even if often neglected in veterinary medicine, is mandatory for the recovery of the correct functionality of the injured limb and for the return to normal daily and sporting activities.

Observational Study on Lameness Recovery in 10 Dogs Affected by Iliopsoas Injury and Submitted to a Physiotherapeutic Approach.

This preliminary study has investigated the outcome of physiotherapy in 10 dogs affected by a primary lesion of the iliopsoas muscle and the potential effects of sex, age, and breed on recovery. Ten dogs with primary injury of the iliopsoas muscle were retrospectively included in this study. Dogs were submitted to a rehabilitation program, characterized by a multimodal approach, including physical therapies and modalities. After recovery, patients were submitted to a further support period of rehabilitation to promote muscle strengthening and limit injury recurrence during their return to normal functional and sports activity. Border collies were highly represented. The recovery of lameness occurred after a mean of 22.6 ± 14.7 (median 18) days with a median number of five sessions. None of the examined variables affected the recovery time, except for the border collie breed, which showed a significantly faster recovery time; however, there was no difference between the breeds with regard to the number of sessions. Multimodal rehabilitation therapy may promote lameness recovery of mild-to-moderate iliopsoas lesions within 3 weeks. This preliminary study reports a clinical approach and recovery of primary iliopsoas lesions, findings that can provide clinicians with useful prognostic information for dogs involved in sports activities.

Clinical Evaluation of Creatine Kinase and Aspartate Aminotransferase for Monitoring Muscle Effort in Working Dogs in Different Simulated Fieldworks.

The clinical profiles of muscle biomarkers (Creatine Kinase-CK-and Aspartate Aminotransferase-AST) performed during training may help in determining the fitness level of dogs and their potentiality to perform specific activities. This study investigated the potential variations of physiological parameters and muscular biomarkers in trained search and rescue dogs during search activity in two different areas. The aim was to verify the absence of any muscular enzymes after 20 min of search activity. The variations of physiological parameters (pulse rate; respiratory rate; rectal body temperature) and skeletal muscular biomarkers (CK and AST) were evaluated before and after search activity. Twenty-three trained dogs met the inclusion criteria and were divided into two groups. One group experienced search activity in a well-known area, while the second one in a similar, but unknown, area. The results for physiological parameters and skeletal muscular biomarkers values showed no significant differences between the two groups (p > 0.05), confirming that an effective conditioning protects against enzymatic alteration during a 20 min duration of submaximal activity.

Superficial Heating Evaluation by Thermographic Imaging before and after Tecar Therapy in Six Dogs Submitted to a Rehabilitation Protocol: A Pilot Study.

Thermography is a non-invasive diagnostic method commonly used to monitor changes of the body surface temperature potentially induced by different conditions such as fever, inflammation, trauma, or changes of tissue perfusion. Capacitive-resistive diathermy therapy (such as energy transfer capacitive and resistive-Tecar) is commonly used in rehabilitation due to its diathemic effect secondary to blood circulation increase that could accelerate the healing process. The aim of this study was to monitor by thermal camera the diathermic effects induced by Tecar on the surface of the region of application. The investigation was conducted on six dogs referred for Tecar therapy to treat muscle contractures (three dogs) or osteoarthritis (three dogs). Eleven anatomical treated regions were recorded. Thermographic images and relative measurements were obtained by each region immediately before (T0), at conclusion (T1), and sixty seconds after the Tecar application (T2). Data were recorded and statistically analyzed. A comparison of temperature differences (maximum, minimum and mean values) between T0 and T1, T0 and T2, and T1 and T2 was performed by ANOVA test with Bonferroni post hoc (p ≤ 0.05). Statistically significant differences were detected for mean temperature between T0 (32.42 ± 1.57 °C) and T1 (33.36 ± 1.17 °C) (p = 0.040) and between T1 and T2 (32.83 ± 1.31 °C) (p = 0.031). Furthermore, there was no significant difference between the mean temperature at T0 and T2, demonstrating that superficial diathermic effect exhausted within 60 s.

Effect of intravenous tiludronate disodium administration on the radiographic progression of osteoarthritis of the fetlock joint in Standardbred racehorses.

OBJECTIVE: To compare the effects of tiludronate disodium and 3 other medical treatments on clinical and radiographic findings and biomarkers of disease progression in horses with osteoarthritis of the fetlock joint. ANIMALS: 100 Standardbred racehorses with spontaneous traumatic injury of the fetlock joint. PROCEDURES: Horses were retrospectively grouped by whether they received tiludronate IV or triamcinolone acetonide and hyaluronan, polysulfated glycosaminoglycan, or interleukin-1 receptor antagonist protein intra-articularly. Data were collected on clinical, radiographic, and ultrasonographic findings and results for serum and synovial samples obtained before and 6 months after treatment. Lameness score, joint flexion test response, radiographic score, serum concentrations of tumor necrosis factor-α and carboxy-terminal telopeptides of collagen types I and II (CTX-I and II, respectively), and synovial fluid concentrations of interleukin-1ß, prostaglandin E2, and CTX-II were compared among treatments. RESULTS: All treatments resulted in a significant improvement in lameness score and joint flexion test response at 6 months. In horses that received triamcinolone acetonide and hyaluronan, synovial fluid interleukin-1ß, prostaglandin E2, and CTX-II concentrations decreased after treatment, suggesting this treatment inhibited progression of hyaline cartilage degeneration and inflammatory processes. Horses that received tiludronate were the only group that had a decrease in radiographic score and serum CTX-I concentration after treatment, supporting the effect of tiludronate on bone metabolism. Tiludronate treatment was also followed by increases in serum and synovial fluid concentrations of CTX-II, a marker of cartilage damage. CONCLUSIONS AND CLINICAL RELEVANCE: Tiludronate appeared to inhibit the radiographic progression of osteoarthritis in high-motion joints of racehorses at 6 months after treatment by inhibiting subchondral bone remodeling. Whether this effect was associated with a worsening of progressive cartilage damage remains to be ascertained.

Kinematic characteristics of myositis ossificans of the semimembranosus muscle in a dog.

A 6-year-old Doberman pinscher dog was presented with myositis ossificans of the semimembranosus muscle. Linear, temporal, and angular kinematic patterns were recorded and compared with those of sound dogs of the same breed. The results indicate that the specific gait compensations occurring with this disease may aid in the diagnosis of myositis ossificans of the caudal thigh muscles.

Changes in Pulse Rate, Respiratory Rate and Rectal Temperature in Working Dogs before and after Three Different Field Trials.

Physiological changes (pulse rate, respiratory rate and rectal temperature) induced by exercise are usually studied as physical fitness indices. The aim of this study was to investigate how these physiological parameters could be modified in a group of trained working dogs during three different field trials (rubble, search on field, obedience), in order to assess which parameter would be more useful to detect the dog response to exercise. Nine dogs were included in this study. The animals were monitored at rest, immediately before and after the working session. Pulse rate values increased significantly in all the phases compared to rest status. Respiratory rate values increased significantly after the competition, while rectal temperature was significantly increased only after search on rubbles and obedience activities. Reference values for specific competitions need to be stablished in order to promptly identify poor performance or exercise intolerance.

Pre- and post-surgical evaluation of plasma lactate concentration in 45 dogs with gastric dilatation-volvulus: A preliminary study.

This preliminary study was designed to contribute to the evaluation of reliability of plasma lactate concentration (PLC) and its clearance as predictive and prognostic factors of gastric necrosis and clinical outcome of dogs affected by gastric dilatation-volvulus (GDV). Main aims of the study were: 1) to evaluate the prognostic reliability of PLC at presentation (T0) in dogs with GDV, 2) to compare the obtained data and considerations with the veterinary literature, and 3) to introduce the possible validity of PLC values at 24 (T24) and 48 (T48) hours after surgery as a predictive factor. Dogs with GDV were retrospectively evaluated. PLC at T0, T24 and T48 were recorded and correlated to the presence or absence of macroscopic necrosis of the stomach and to outcome. Forty-five dogs met the inclusion criteria. Significant differences were not detected in the mean values between the initial PLC in dogs with and without necrosis of the gastric wall, as well as between surviving and non-surviving dogs; these values were not associated with higher risk of gastric necrosis or death. At T24 and T48 no significant differences were recorded between necrosis and non-necrosis, and surviving and non-surviving categories. A median plasma lactate concentration clearance from arrival to T24 ≥ 50% was identified in both groups (with and without necrosis), and this parameter failed in identifying dogs that survived to discharge. In conclusion, the results presented here failed to detect PLC at T0 and its clearance at T24 as prognostic factors in this population of dogs with GDV.

Shoulder Lameness in Dogs: Preliminary Investigation on Ultrasonography, Signalment and Hemato-Biochemical Findings Correlation.

Forelimb lameness in medium and large breed dogs is frequently caused by traumatic or degenerative injuries of the shoulder. Patient history, physical examination, x-rays, blood, and chemical work are routinely used to achieve diagnosis, and may be associated with ultrasonography or magnetic resonance imaging. Ultrasonography is increasingly popular in small animal practice due to its low cost, ease of repetition, and the fact that it is non-invasive and can be performed in conscious patients. It is also widely accepted that muscular stress or injuries can induce detectable variations in blood and chemical work. The aim of this preliminary study is to search for correlation between measurements of selected hematobiochemical parameters and ultrasound diagnosis in dogs affected by shoulder injuries. A retrospective study was conducted on orthopedic clinical records of dogs presented to our Veterinary Teaching Hospital for lameness caused by shoulder problems over a period of 5 years. Dogs with both hematobiochemical and ultrasound examinations were selected. Patients were classified into 5 groups according to ultrasound diagnosis: (1) mild/moderate tendinopathy, (2) severe tendinopathy, (3) articular damage, (4) chronic myopathy, and (5) neoplastic injury. Statistical analysis was performed to detect possible correlations between group and hematobiochemical parameters. Forty-four dogs met the inclusion criteria and forty-nine shoulders were diagnosed as injured. Significant differences were found between the age, sex, body weight, neutrophil count, and AST levels. In particular, statistically significant increases were found for neutrophil count and AST concentration in case of ultrasonographically diagnosed severe tendinopathy, articular damage, and neoplastic pathology. Further and wider studies are suggested to determine whether these biomarkers can become a useful diagnostic aid.