Muscle and Tendon Injuries (eBook)

Gian Luigi Canata, MD, has been Director of the Center of Sports Traumatology and Arthroscopic Surgery at Koelliker Hospital, Turin, Italy since 1995. He has been a member of the Medical Commission of the Italian Track and Field Federation (FIDAL) and Director of Medical Services and a member of the Board of Directors of the Centro Universitario Sportivo  of Torino (CUS Torino) for more than 35 years. His previous academic positions include Professor of Sports Medicine at SUISM (Scuola Universitaria in Scienze Motorie) (2001–2012) and Professor of Kinesiology at ISEF (Istituto Superiore di Educazione Fisica) (1989–2001). Dr. Canata has been a member of ISAKOS since 1995 and has served on various ISAKOS committees. He is also President of the SIGASCOT Sports Committee and Vice-President of EFOST. He has authored almost 120 articles, many of them in peer-reviewed journals and is co-editor, with C. Niek Van Dijk, of the 2015 Springer book Cartilage Lesions of the Ankle.Pieter d’Hooghe is Associate Chief of Surgery (Research) at the Department of Orthopaedic Surgery, Aspetar Hospital, Qatar. As an orthopaedic surgeon, he specializes in arthroscopic surgery of the ankle and foot, knee, and hip. He holds a Master in Sports Medicine and Tropical Medicine and has an MBA on Leadership and Sports Management. He was previously Director of the FIFA F-MARC Flemish Surgical Center of Excellence, where he treated many national and international athletes. Prior to working in Aspetar, Dr. d’Hooghe spent 17 years as team physician/surgeon of FC Club Bruges in Belgium (Champions League, Europa League, 7 national titles, 4 national cups, 3 national supercups). As Chairman of the ISAKOS Leg, Ankle, and Foot Committee he heads an international group of experts in the field, and as FIFA F-MARC Board Member and Instructor he is also involved in research, injury prevention, delivering lectures worldwide, publishing peer-reviewed articles, books and book chapters and assisting in PCMA projects.Kenneth J. Hunt, MD, is Associate Professor and Chief, Foot and Ankle Surgery in the Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA. He was previously Assistant Professor in the Department of Orthopaedic Surgery at Stanford University and Director of the Stanford/Palo Alto Foot & Ankle Fellowship. Dr. Hunt is Deputy Chair of the ISAKOS Leg, Ankle, and Foot Committee. He also chairs the Orthopaedic Foot and Ankle Research Network (OFAR) and is a member of the Board of Directors of the Northern California Orthopaedic Society. Dr. Hunt is a Diplomate of the American Board of Orthopaedic Surgeons. He is an Associate Editor of Physical Medicine & Rehabilitation and a reviewer for various leading journals, including the American Journal of Sports Medicine and the Journal of Bone and Joint Surgery.

Foreword 5
Preface 6
Acknowledgements 7
Contents 3
1: Functional Morphology of Muscles and Tendons 11
1.1 Muscle 11
1.1.1 Anatomy of Skeletal Muscle Tissue 12
1.1.2 Classification of Skeletal Muscles 14
1.1.3 Number of Points of Origin 15
1.1.4 Mode of Action 15
1.1.5 Classification of Skeletal Muscle Fibres 16
1.1.6 Motor Units and Their Recruitment 18
1.1.7 Vascularisation and Innervation 18
1.1.8 Muscle Plasticity 19
1.2 Tendons 19
1.2.1 Tendon Structure 19
1.2.2 Biochemical Composition of the Tendon 20
1.2.2.1 Collagen 21
1.2.2.2 Elastin 21
1.2.2.3 Proteoglycans 21
1.2.3 Tendon Cells 22
1.2.4 Tendon Crimps 22
1.2.5 Vascularisation 23
1.2.6 Innervation 23
References 23
2: Tendon Biomechanics 25
2.1 Introduction 25
2.2 Composition and Structure 25
2.3 Mechanics 26
2.4 Mechanical Testing Methods 29
2.5 Experimental Factors Influencing Tendon Mechanics 30
2.6 Biological Factors Influencing Tendon Mechanics 31
References 32
3: Pathophysiology of Tendinopathy 33
3.1 Structure and Histology 33
3.2 Tenocytes 34
3.3 Extracellular Matrix 34
3.3.1 Ground Substance 35
3.4 Blood and Nerve Supply 35
3.5 Structural Regions in Tendons 36
3.6 Response to Load 36
3.7 Function and Mechanics of Tendons 37
3.8 Summary 37
3.9 Structural Changes in Tendon Pathology 37
3.10 Pathoaetiology 38
3.10.1 Continuum Model of Tendinopathy 38
3.11 Pain in Tendinopathy 39
3.12 Regional Changes in Tendinopathy 40
3.13 Epidemiology of Tendinopathy 40
3.14 Intrinsic Risk Factors 41
3.14.1 Genetics 42
3.14.2 Sex 42
3.14.3 Age 42
3.14.4 Medications 43
3.14.5 General Health 43
3.14.6 Flexibility and Joint Stiffness 44
3.14.7 Strength 44
3.15 Extrinsic Risk Factors 45
3.15.1 Load 45
References 45
4: Tendon Healing 55
4.1 Introduction 55
4.2 Tendon Homeostasis 55
4.2.1 Mechanism of Tendon Injury 56
4.2.1.1 Stages of Tendon Healing 56
4.2.1.2 Growth Factors 57
4.2.1.3 Tendon Healing of Intrasynovial and Extrasynovial Tendon 57
4.3 Rehabilitation 58
References 59
5: Muscle-Tendon Junction Injury 61
5.1 Introduction 61
5.2 Structure 61
5.3 Function 63
5.4 Injury 64
5.5 Recovery 66
5.6 Clinical Implications 67
References 69
6: MRI of Muscle and Tendon Pathology 71
6.1 Introduction 71
6.2 Standard MRI 72
6.2.1 Contrast-Enhanced MRI 72
6.2.2 Magnetic Resonance Angiography 72
6.2.3 Fusion Technology 73
6.2.4 Diffusion MRI 74
6.2.5 MR Elastography 74
6.2.6 Upright MRI 74
6.2.7 Dynamic MRI 75
6.3 Muscles 75
6.3.1 Trauma-Related Conditions 75
6.3.1.1 Minor Traumas 75
6.3.1.2 Major Traumas 76
6.3.2 Myofascial Disinsertion 77
6.3.3 Myotendinous Avulsion 77
6.3.4 Lesions Due to Compression Injury 77
6.3.5 Post-traumatic Degenerative Conditions 78
6.3.5.1 Post-traumatic Fibrosis 78
6.3.5.2 Metaplastic Ossification 79
6.3.5.3 Rhabdomyolysis 79
6.3.6 Compartmental Syndromes 79
6.3.6.1 Muscle Hernias 80
6.3.6.2 Neuromuscular Conditions 80
6.3.7 Neoplastic Disease 80
6.4 Tendons 80
6.4.1 Peritendinitis 81
6.4.2 Degenerative Tendinopathy 82
6.4.3 Partial Tears 82
6.4.4 Complete Tears 82
6.4.5 Tenosynovitis 82
6.4.6 Tenorrhaphy 83
Suggested Reading 83
7: Ultrasound of Muscle and Tendon Pathology 84
7.1 Introduction 84
7.2 B-Mode Ultrasound 84
7.3 Ultrasound Fusion 85
7.4 Elastography 85
7.5 Muscles 86
7.5.1 Trauma-Related Conditions 86
7.5.1.1 Minor Traumas 86
7.5.1.2 Major Traumas 86
7.5.2 Complete Ruptures 88
7.5.3 Myotendinous Disinsertion 89
7.5.4 Myofascial Disinsertion 89
7.5.5 Myotendinous Avulsion 89
7.6 Post-traumatic Degenerative Conditions 90
7.6.1 Fibrosis 90
7.6.2 Metaplastic Ossification 90
7.6.3 Rhabdomyolysis 90
7.6.4 Compartmental Syndrome 90
7.7 Muscle Hernias 91
7.7.1 Accessory Muscles 91
7.7.2 Neuromuscular Conditions 91
7.7.3 Neoplastic Disease 91
7.8 Tendons 91
7.8.1 Peritendinitis 92
7.8.2 Insertional Tendinopathy (Enthesopathy) 92
7.8.3 Partial Tears 93
7.8.4 Complete Tears 93
7.8.5 Tenorrhaphy 93
7.8.6 Tenosynovitis 94
Suggested Reading 94
8: The Dynamic Magnetic Resonance Imaging 96
Suggested Reading 102
9: Classification of Muscle Lesions 103
9.1 Introduction 103
9.2 Epidemiology 104
9.3 Anatomy and Mechanism of Injury 104
9.3.1 Direct Trauma 105
9.3.2 Indirect Trauma 105
9.4 Classifications 106
9.4.1 Classic Classification System 107
9.4.2 New Classification System Proposed 107
9.5 Imaging 108
9.6 Imaging Features 108
References 109
10: Prevention of Musculotendinous Pathologies 111
10.1 Introduction 111
10.2 General Principles of Injury Prevention 112
10.2.1 Around the Hip 113
10.2.2 Hamstrings 113
10.2.3 Quadriceps 113
10.2.3.1 Quadriceps Tendon 113
10.2.3.2 Rectus Femoris 113
10.2.4 Patellar Tendon 113
10.2.5 Calf 114
10.2.6 Achilles Tendon 114
10.3 Iatrogenic Causes 115
10.4 Specific Preventative Measures 115
10.4.1 Physical Agents 115
References 116
11: Why the Tendon Tears and Doesn’t Like to Heal 118
11.1 Introduction 118
11.2 Intrinsic or Extrinsic Factors Leading to Tendon Tears 119
11.2.1 Intrinsic Factors 119
11.2.1.1 Anatomical Factors 119
11.2.1.2 Aging 119
11.2.1.3 Pathologies 119
11.2.2 Extrinsic Factors 120
11.2.2.1 Trauma and Overload Injuries 120
11.2.2.2 Drugs, Alcohol, and Smoking 120
11.3 Factors Affecting Tendon Healing 121
11.3.1 Biomechanical Factors 121
11.3.1.1 Immobilization 121
11.3.1.2 Passive Motion 122
11.3.1.3 Early Loading 122
11.3.2 Nonsteroidal Anti-­inflammatory Drugs (NSAIDs) 122
References 122
12: Growth Factor Therapy for Tendon Regeneration 125
12.1 Introduction: Epidemiology of the Tendon Injuries 125
12.1.1 Anatomy and Histology 126
12.1.2 Biomechanics of the Tendon 126
12.1.3 Aetiology 127
12.1.4 Injury Classification (Fig. 12.3) 127
12.1.5 Diagnosis 127
12.1.6 Treatment 128
12.2 Biologic Therapy: Growth Factors 128
12.2.1 What Are Growth Factors? 128
12.2.2 Mode of Action 128
12.2.3 Growth Factors 129
12.3 PRP as a Medication 130
12.3.1 Are All PRP the Same? 130
12.3.2 PRP in Tendon 130
12.4 Effects of PRP in Tendon Healing 131
12.4.1 Ultrastructural Effect 131
12.4.2 Biomechanical Effects 132
12.5 Augmentation in Surgery 132
12.6 Physiotherapy 133
12.7 Take-Home Message 134
References 134
13: Biomaterials for Tendon Regeneration 136
13.1 Introduction 137
13.2 Tendon 137
13.2.1 Structure 138
13.2.1.1 Extracellular Matrix (ECM) 138
13.2.1.2 Cells 139
13.2.1.3 Tendon Blood Supply 139
13.2.2 Tendon–Bone interface (TBi) 139
13.3 Injury, Healing, and Repair 140
13.4 Scaffolds and Biomaterials 141
13.4.1 Basic Considerations and Scaffold Design 142
13.4.2 Synthetic Scaffolds 142
13.4.3 Natural Scaffolds 143
13.4.4 Composite Scaffolds 144
13.5 Tissue Engineering Strategies 144
13.5.1 Tenocytes 144
13.5.2 Dermal Fibroblasts 144
13.5.3 Mesenchymal Stromal Cells 145
13.5.4 Tendon-Derived Stem Cells (TDSCs) 145
13.5.5 Nanoparticles 145
13.6 Conclusion and Future Trends 145
References 146
14: New Strategies for Muscular Repair and Regeneration 149
14.1 Introduction 149
14.2 Physiopathology and Muscle Healing Process 150
14.2.1 Degeneration and Necrosis 150
14.2.2 Inflammation and Cellular Response 150
14.2.3 Regeneration and Repair 150
14.2.4 Remodeling and Fibrosis 150
14.3 Treatment 151
14.4 New Strategies for Muscular Repair and Regeneration 153
14.4.1 Growth Factors 153
14.4.2 Stem Cells 155
14.4.3 Anti-fibrotic Agents 156
14.4.4 Scaffolds 156
References 157
15: Conservative Treatments for Tendinopathy 161
15.1 Exercises Therapy 161
15.1.1 Introduction: The Importance of Loading Program in Tendinopathy 161
15.1.2 Not All Tendons Are Created Equal 162
15.1.3 Pain and Psychological Variables 164
15.1.4 To a Comprehensive Model of Tendinopathy 165
15.1.5 Rehabilitation Program 167
15.1.5.1 Phase 1: Reduce Pain (The Load Management) 167
15.1.5.2 Phase 2: Recover Flexibility (Look at Distant Sites) 168
15.1.5.3 Phase 3: Recover Strength (The Muscle–Tendon Specific Function) 169
15.1.5.4 Phase 4: Recover Coordination (The Kinetic Chain Function) 169
15.1.5.5 Phase 5: Return to Sport (Sport-Specific Exercises) 171
15.2 Nonsteroidal Anti-­inflammatory Drugs 172
15.3 Physical Therapy Modalities 172
15.4 Corticosteroid 173
15.5 Glyceryl Trinitrate Patches 174
References 174
16: Use of Nutraceuticals for Tendinopathies 179
16.1 Introduction 179
16.2 Basic Science 180
16.2.1 Glucosamine and Condroitin Sulfate 180
16.2.2 Vitamin C 180
16.2.3 Hydrolyzed Type 1 Collagen 180
16.2.4 L-Arginine Alfa-Ketoglutarate 180
16.2.5 Curcumin 181
16.2.6 Boswellic Acid 181
16.2.7 Methylsulfonylmethane (MSM) 181
16.2.8 Bromelain 181
16.3 Clinical Evidence 182
16.4 Take-Home Message 183
References 183
17: Surgical Treatment of Acute and Chronic Muscle Injuries 185
17.1 Introduction 185
17.2 Definition and Classification of the Muscle Injuries 186
17.3 Surgical Treatment Options: The Decision-Making Approach for the Most Frequent Muscle Injuries 187
17.3.1 Acute Muscle Insertional Injuries 187
17.3.2 Acute Muscle Belly Injuries 189
17.3.3 Chronic Muscles Injuries 191
References 193
18: Rotator Cuff Tendinopathy 196
18.1 Anatomy and Function 197
18.2 Extrinsic Causes 197
18.3 Intrinsic Causes 199
18.4 Diagnosis 199
18.5 Diagnostic Imaging 201
18.6 Treatment 203
18.7 Summary 204
References 204
19: Anterosuperior Rotator Cuff Ruptures 207
19.1 Introduction 207
19.2 Relevant Anatomy and Pathology 208
19.3 Clinic and Imaging 209
19.4 Treatment 211
References 215
20: Long Head of the Biceps Tendinopathy 217
20.1 Anatomy 217
20.2 Pathology 218
20.3 History and Physical Exam 218
20.4 Diagnosis 220
20.5 Treatment 220
20.6 Discussion 222
References 222
21: Medial and Lateral Epicondylitis 224
21.1 Epitrochleitis 224
21.1.1 Physical Examination 225
21.1.2 Treatment 226
21.1.3 Surgical Technique 226
21.2 Lateral Epicondylitis 227
21.2.1 Physical Examination 227
21.2.2 Treatment 227
21.2.3 Surgical Technique 228
References 229
22: Disorders of the Distal Biceps Tendon 231
22.1 Background 231
22.2 Anatomy 232
22.3 Clinical Assessment 232
22.3.1 History 232
22.3.2 Physical Examination 232
22.3.3 Imaging 234
22.4 Classification 235
22.5 Indication for Endoscopy 235
22.6 Surgical Techniques 235
22.6.1 Two-Incision Technique 235
22.6.2 Single Anterior Incision: Endobutton Technique 235
22.6.3 Endoscopic-Assisted Repair 236
22.6.4 Chronic Biceps Tendon Rupture 239
22.7 Outcomes 239
22.8 Complications 239
References 240
23: Hand and Wrist Tendinopathies 241
23.1 Acute Conditions 241
23.1.1 Flexor Digitorum Profundus (FDP) Tendon Avulsion 241
23.1.1.1 Management 242
23.1.2 Mallet Finger 243
23.1.2.1 Management 244
23.1.3 Extensor Tendon Subluxation 245
23.1.3.1 Management 246
23.2 Chronic Conditions 248
23.2.1 Extensor Carpi Ulnaris (ECU) Subluxation 248
23.2.1.1 Management 248
23.2.2 de Quervain’s Disease 248
23.2.2.1 Management 249
23.2.3 Trigger Finger 250
23.2.3.1 Management 250
23.2.4 Flexor Tendon Adhesions 250
23.2.4.1 Management 250
23.3 The Future 251
References 251
24: Hip Tendinopathies 254
24.1 Introduction 254
24.2 Tendinopathies of the Medial Area 255
24.3 Tendinopathies of the Anterior Area 256
24.3.1 Iliopsoas 256
24.3.2 Rectus Femoris 258
24.4 Tendinopathies of the Lateral Area 260
24.5 Tendinopathies of the Posterior Area 263
24.5.1 Hamstrings 263
24.5.2 Piriformis 266
References 268
25: The Groin Pain Syndrome 272
25.1 Introduction 272
25.2 The Different Causes of GPS 273
25.3 The Most Frequent Causes of GPS in Athletes 275
25.4 The Different Types of GPS 275
25.5 The Particular Case of LSGPS 275
25.6 The Complication of Inguinal Hernia Surgical Repair 277
25.7 The Association Between Inguinal Hernia and Adductor Tendinopathy 278
25.8 The Problematic of Double (Hernia and Cam-FAI) Surgical Intervention 278
References 279
26: Indications for Surgical Treatment in Hamstring Tears 282
26.1 Introduction 282
26.2 Terminology 282
26.3 Absolute Indications for Surgery 283
26.4 Relative Indications for Surgery 284
26.5 Chronic Injuries 285
References 286
27: Patellar Tendon Rupture 287
27.1 Introduction 287
27.2 Biomechanics and Physiopathology 287
27.3 Clinical Presentation 288
27.4 Imaging Diagnosis 288
27.5 Treatment of PT Lesions 290
References 291
28: Pathogenesis and Treatment of Patellar Tendinopathy 293
28.1 Concept of Tendinopathy 293
28.2 Staging and Treatment 294
28.3 Pathomechanism of Patellar Tendinopathy 295
28.4 Treatment of Patellar Tendinopathy 296
28.4.1 Eccentric Exercise 296
28.4.2 Heavy Slow Resistance Training 297
28.4.3 Sclerosing Agents 297
28.4.4 Extracorporeal Shockwave Therapy 297
28.4.5 Surgical Treatment 297
28.4.6 Other Treatments 298
28.5 Our Treatment Regimen 299
28.6 Summary 300
References 300
29: Surgical Treatment of Patellar Tendinopathy 303
29.1 Introduction 303
29.2 Open Surgical Techniques 305
29.3 Arthroscopic Techniques for Patellar Tendinopathy 306
29.4 Postoperative Management and Rehabilitation Program 308
References 309
30: Periarticular Tendinopathies of the Knee 312
30.1 Tendonitis of the Quadriceps Tendon 312
30.1.1 Anatomy 312
30.1.2 Pathogenesis: Clinical Presentation 313
30.1.3 Treatment 313
30.1.4 Tendon Rupture 313
30.2 Iliotibial Band (ITB) Syndrome 314
30.2.1 The Iliotibial Band Anatomy 314
30.2.2 Pathogenesis and Clinical Presentation 315
30.2.3 Treatment 316
30.3 Tendinopathy of the Popliteal 316
30.3.1 Anatomy 316
30.3.2 Popliteus Tendinitis 316
30.3.3 Popliteus Subluxation 317
30.3.4 Popliteus Tendon Rupture 317
30.4 Semimembranosus Tendinitis 318
30.4.1 Anatomy 318
30.4.2 Pathogenesis: Clinical Presentation 318
30.4.3 Treatment 318
30.5 Tendinitis of the Goose Foot 319
30.5.1 Anatomy 319
30.5.2 Pathogenesis: Clinical Presentation 319
30.5.3 Treatment 319
References 320
31: Pitfalls and Risks of Tendon Harvest About the Knee 321
31.1 Introduction: The Basics of Tendon Harvest 321
31.2 Complications Specific to BTB Autografts 321
31.2.1 Tibial Plateau Fracture 322
31.2.2 Patellar Fracture 322
31.2.3 Patellar Tendon Ruptures 322
31.2.4 Patellar Tendinitis 323
31.2.5 Secondary Complications 323
31.3 Complications Specific to Hamstring Autografts 324
31.3.1 Incomplete Tendon Harvest 324
31.3.2 MCL Injury 324
31.3.3 Secondary Complications 324
31.4 Surgical Tips to Minimize the Risk of Pitfalls 324
31.5 Nonoperatively Managing Effects of Major Complications 325
References 325
32: Triceps Surae Injuries 326
32.1 Introduction 326
32.2 Definition of the Injury 327
32.2.1 Anatomy of the Calf 327
32.2.1.1 Gastrocnemius 327
32.2.1.2 Soleus 327
32.2.1.3 Plantaris 328
32.2.2 Injury Mechanism and Epidemiology 328
32.2.2.1 Gastrocnemius 329
32.2.2.2 Distal Gastrocnemius Injury (“Tennis Leg”) 329
32.2.2.3 Proximal Gastrocnemius Injuries 330
32.2.2.4 Injuries of the Lateral Head of the Gastrocnemius 330
32.2.2.5 Soleus and Plantaris Injuries 330
32.3 Clinical Signs and Symptoms 330
32.3.1 Physical Examination 331
32.3.2 Clinical and Imaging Classification 331
32.4 Imaging 333
32.4.1 Modalities for Imaging of Musculotendinous Injuries 333
32.4.1.1 MRI 333
32.4.1.2 MRI Features in Musculotendinous Strains and Tears 333
32.4.1.3 Echotomography 334
32.4.1.4 Ultrasonographic Features of Musculotendinous Strains and Tears 335
32.4.1.5 US in Soleus Muscle Injuries 335
32.4.1.6 US in Plantaris Muscle Injuries 335
32.5 Treatment 336
32.6 Return to Play in Sports 336
32.6.1 Gastrocnemius 336
32.6.2 Soleus 336
References 337
33: Achilles Tendinopathy 339
33.1 Introduction 339
33.2 Terminology 339
33.3 Functional Anatomy 340
33.4 Etiology 340
33.5 Epidemiology 341
33.6 Clinical and Diagnostic Features 341
33.7 Conservative Treatment 343
33.7.1 Eccentric Exercises 344
33.7.2 Extracorporeal Shockwave Therapy (ESWT) 344
33.7.3 Continued Tendon Loading or Physical Activity 344
33.8 Surgical Procedures 344
33.8.1 Non-insertional Achilles Tendinopathy 344
33.8.2 Insertional Achilles Tendinopathy 345
References 347
34: Tibialis Posterior and Anterior Tendons 349
34.1 Introduction 350
34.2 Posterior Tibial Tendon Pathology 351
34.2.1 Clinical Anatomy 351
34.2.2 Etiology and Pathogenesis 352
34.2.3 Clinical Presentation and Imaging 352
34.2.4 Principles for Treatment 356
34.3 Technique for Posterior Tibial Tendoscopy (van Dijk et al. 1997) 358
34.4 Operative Treatment Guidelines 358
34.5 Anterior Tibial Tendon Pathology 360
34.5.1 Anterior Tibial Tendon (ATT) Clinical Anatomy 360
34.5.2 Etiology and Clinical Presentations 360
34.5.3 Principles for Treatment 361
34.6 Injection Therapy in Tendinopathies 362
References 364
35: Peroneal Tendons 367
35.1 Introduction 367
35.2 Anatomy and Function 368
35.3 Peroneal Tendon Pathologies 368
35.3.1 Tendinitis, Tenosynovitis, Tendinosis and Stenosis 369
35.3.2 Tears and Ruptures 369
35.3.3 Subluxation and Dislocation of the Tendons 369
35.4 Patient History and Clinical Examination 370
35.5 Diagnostics 370
35.6 Treatment 371
35.7 Rehabilitation 372
References 373
36: Insertional Plantar Fasciitis 375
36.1 Introduction 375
36.2 Anatomy and Function 375
36.3 Mechanism of Disorder 376
36.4 Risk Factor 376
36.5 Diagnosis 376
36.6 Conservative Treatment 378
36.6.1 Nonsteroidal Anti-­Inflammatory Drugs (NSAIDs) 378
36.6.2 Stretching 378
36.6.3 Low Dye Taping 378
36.6.4 Orthotic Devices 378
36.6.5 Extracorporeal Shockwave Therapy (ESWT) 378
36.7 Injection Therapy 379
36.8 Surgical Treatment 379
36.9 Open Plantar Fasciotomy 379
36.10 Endoscopic Plantar Fasciotomy 380
36.11 Echo-Guided Plantar Fasciotomy 380
36.12 Gastrocnemius Resection 381
36.13 Radiofrequency Microtenotomy 381
36.14 Percutaneous Cryosurgery 381
References 382
37: Posterior Impingement in the Ankle: “Can There Also Be a Muscular or Tendinous Entity?” 384
37.1 Terminology 384
37.2 Introduction 385
37.3 Functional Anatomy 385
37.4 Etiology 386
37.5 Clinical and Diagnostic Features 387
37.6 Accessory Muscles that Can Impinge on the Surrounding Musculotendinous Structures Around the Posterior Ankle 387
37.7 Surgical Procedure 389
References 392
38: Compartment Syndromes 393
38.1 Compartment Syndrome of the Upper Limbs 394
38.2 Compartment Syndrome of the Lower Limbs 396
38.3 Chronic Exertional Compartment Syndrome 398
References 401
39: Gold-Induced Autologous Cytokine Treatment in Achilles Tendinopathy 403
39.1 Introduction 403
39.2 GOLDIC® Procedure 404
39.3 Biological Effects of GOLDIC® Procedure on the Cellular Level 404
39.4 Protein Analyses of GOLDIC®-Treated Human Serum 405
39.5 First Clinical Results After GOLDIC® Treatment 405
39.5.1 Clinical Studies in Horses 405
39.5.2 Clinical Studies in Humans 406
39.5.2.1 Material and Methods 406
39.5.2.2 Statistical Analysis 406
39.5.2.3 Results 406
39.6 Discussion 408
References 410
40: Shock Wave Therapy for Tendinopathies 412
40.1 Brief History 413
40.2 General Characteristics of Shock Waves (SW) 414
40.3 Radial or Pressure Waves (Radial Pulse Therapy or RPT) 416
40.4 SW Mechanisms of Action: Biocellular Action and Responses 417
40.5 ESWT for Tendinopathies? 418
40.6 ESWT for Tendinopathies: Basic Science 419
40.7 Brief Overview of ESWT in Tendinopathies 420
40.8 Comparison of ESWT with Some Other Therapies 422
40.9 SW and Sports Activities 423
References 425
Index 431