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Cotswold Diagnostic Clinic Specialist Local Mobile Musculoskeletal Radiology Service with Sports Clinic Diagnosis & Treatment of Orthopaedic, Spinal, Rheumatological & Sports Conditions
Educational Updates

Reporting Musculoskeletal Ultrasound
Article for Rad Magazine December 2018
Rad review of ultrasound - link to article

A complete guide to MRI scans from a radiologist

Article for Doctify published on 22 July 2018

Link to article

A complete guide to ultrasound scans from a radiologist
Article for Doctify published on 22 July 2018

Talk on High Volume Injections for treatment of (click here to access talk):

Frozen Shoulder (Capsulitis)

Achilles tendinosis

Patellar tendinosis

Rotator cuff tendinosis

Gluteus medius tendinosis (trochanteric bursitis)

Update on Tendons from the International Skeletal Society (Paris 2016)

Tendons are dense bundles of fibroconnective tissue which transmit tension, and are predominantly made up of collagen.

Tendons are very strong - they have the tensile strength of bone and half the tensile strength of steel.  Moderate activity can increase bundle size and tensile strength.

However, too much mechanical strain can lead to increased expression of fat, cartilage and bone genes, and increased destruction of the tendon (mucoid degeneration).  This can also happen in underused tendons subject to bouts of activity.

Tendons fail only if they are degenerate, like an old rubber band.  In two thirds of people this is not likely to be symptomatic. 
Normal tendons don’t fail except for in a laceration.

Tendon turnover time is 50-100 day, which is why it can take at least 2-3 months for tendon injuries to heal, assuming that are you doing the right type of rehabilitation exercises and not overusing the tendon.

Necrosis of the tendon is rare, and is only seen post steroid injections.  Steroid injections also increase risk of rupture of tendons, which is why they aren’t usually used for weight bearing tendons, particularly the Achilles tendon.  Instead we use high volume injections for the Achilles tendon, (and patellar tendon), which is thought to break up the excessive blood supply to the tendon contributing to symptoms.

Tendons originate deep in the muscle.  Injuries to the central musculotendinous junction take longer to heal.

Ultrasound and MRI don’t see early changes and can’t predict post operative changes.  New types of imaging are being researched to improve detection (e.g. shear wave elastography, contrast ultrasound, ultrashort TE MRI).

Treatment is done best in a multidisciplinary team setting, i.e. with a sports physician, surgeon, radiologist, physiotherapist, rehabilitation practitioner.  80% patients recover with rehabilitation and exercises alone. 

Treatment options include:
Load reduction/relative rest - eccentric stretching
DON’T IMMOBILISE - destroys tendon
Biomechanical correction
Massage, cryotherapy, drugs, extracorporeal shock wave therapy
Injections - high volume, plasma related protein (PRP), glycosoaminoglycans (GAG), sclerosant, dry needling (stimulates fibroblasts), Ostenil Tendon
Surgery - strip medial plantaris tendon
Plantaris stripping procedure can also be done via ultrasound guidance.
Email: enquiries@cotswolddiagnosticclinic.co.uk

Registered address for correspondence: 80 Chesterton Lane, Cirencester, Gloucestershire GL7 1YD
Ultrasound Scan Clinics in Cirencester at Active Therapy Clinic and Dyer St Chiropractic
Locations covered: Gloucestershire and the Cotswolds, Wiltshire, Oxfordshire, Gloucester, Cheltenham, Swindon, Witney and Oxford