How to perform local soft-tissue glucocorticoid injections?

Inflammation of periarticular soft-tissue structures such as tendons, tendon sheaths, entheses, bursae, ligaments and fasciae is the hallmark of many inflammatory rheumatic diseases, but inflammation or rather irritation of these structures also occurs in the absence of an underlying rheumatic disease. In both these primary and secondary soft-tissue lesions, local glucocorticoid injection often is beneficial, although evidence in the literature is limited. This chapter reviews local injection therapy for these lesions and for nerve compression syndromes.     

Calcific Tendonitis : A Model

Calcific tendonitis is a common clinical condition associated with high rates of tendon rupture, prolonged symptoms, and poor response to therapy. Little is known about the pathogenesis of calcifications in tendons and consequently few effective therapies are available. We hypothesized that tendon calcification, like pathologic calcification in other sites, was generated by extracellular organelles known as matrix vesicles and that isolated matrix vesicles would constitute the basis for a useful model of this process. Tendon matrix vesicles were isolated from adult porcine patellar tendons using enzymatic digestion and differential centrifugation. Vesicle morphology was examined with electron microscopy. Levels of calcium, phosphate, pyrophosphate, ATP, and mineralization-associated enzymes were measured and compared with articular cartilage vesicles from porcine articular cartilage. Vesicles were embedded in agarose gels with or without type I collagen or dermatan sulfate and incubated in calcifying salt solution trace labeled with ⁴⁵calcium. ⁴⁵Calcium in the vesicle fraction was measured after 5–7 days. The type of mineral formed was determined by micro-x-ray diffraction. Matrix vesicles isolated from adult porcine tendon were similar morphologically to those obtained from articular cartilage. They contained mineralization-related enzymes and formed hydroxyapatite mineral in vitro. Mineralization was suppressed by levamisole and modulated by extracellular matrix components. Matrix vesicles isolated from tendons mineralize in vitro. This model may aid in the study of the pathogenesis of calcific tendonitis as well as serve as a means to identify effective therapies for this common disorder.     

Pain and musculoskeletal pain syndromes in adolescents

The presence of musculoskeletal pain was evaluated in adolescents. Pain was reported by 40% of respondents, benign joint hypermobility syndrome by 10%, myofascial syndrome by 5%, tendonitis by 2%, and fibromialgia by 1%. Logistical regression analysis indicated that sex and age were predictive of pain.     

超声引导下治疗肌腱炎的临床应用进展

目前对于肌腱炎尚无特效治疗方法。超声引导或定位下治疗肌腱炎是非手术治疗领域的重要新技术,本文对超声引导或定位治疗肌腱炎的研究概况进行综述。     

肩袖炎症性病变的超声诊断价值

目的探讨超声对肩袖炎症性病变的定位和定性诊断价值。方法高频超声检测162例患有肩痛和不同程度的肩关节活动障碍的患肩，对声像图进行分型研究。结果超声将162例患肩的声像图分为肱二头肌长头肌腱腱鞘炎（39例）、肱二头肌长头肌腱炎（33例）、冈上肌腱炎症（51例）、钙化性肌腱炎（19例）和肩关节周围滑囊炎（20例）六种类型，各型超声分别分为几个亚型。结论高频超声可以提供某些肩袖软组织病变的定位和定性诊断，对于临床针对性的治疗具有重要的价值。