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There is limited high level research supporting the use of dry needling for mechanical shoulder pain. Dry needling is often used as an adjunct or primary treatment for musculoskeletal pain to address impairments related to muscle pain, range of motion (ROM), and strength deficits. This case study describes a 68-year-old female referred from her Physician to physical therapy (PT) with diagnosis of shoulder impingement syndrome. She underwent 12 sessions of traditional PT including manual therapy and therapeutic exercises with moderate pain reductions, improved ROM, and optimal functional outcomes using the Quick DASH. However, when progress was stalled, Dry needling (DN) was included in the plan of care. Dry needling was then performed as primary treatment to the anterior muscles of the shoulder (pectoralis major, pectoralis minor near the musculotendinous junction), and the latissimus, subscapularis and anterior deltoid) for two treatments resulting in significant improvements with ROM, reduced pain and improved functional outcomes which continued at 6-months with follow-up with patient. [ABSTRACT FROM AUTHOR]

Targeted resistance training stimulates hamstring muscle hypertrophy, but its effect on tendon‐aponeurosis geometry is unknown. This study examined changes in hamstring muscle, free tendon, and aponeurosis geometry following a 10 week Nordic or hip extension exercise intervention. Thirty recreationally active males were randomly allocated (n = 10 per group) to a Nordic, hip extension, or control group. Magnetic resonance imaging of both thighs was acquired pre‐ and post‐intervention. Changes in free tendon and aponeurosis volume for each hamstring muscle, biceps femoris long head (BFlh) aponeurosis interface area and muscle volume‐to‐interface area ratio were compared between groups. Regional changes in muscle CSA were examined via statistical parametric mapping. The change in semimembranosus free tendon volume was greater for the Nordic than control group (mean difference = 0.06 cm3, 95% CI = 0.02–0.11 cm3). No significant between‐group differences existed for other hamstring free tendons or aponeuroses. There were no between‐group differences in change in BFlh interface area. Change in BFlh muscle volume‐to‐interface area ratio was greater in the hip extension than Nordic (mean difference = 0.10, 95% CI = 0.007–0.19, p = 0.03) and control (mean difference = 0.12, 95% CI = 0.03–0.22, p = 0.009) groups. Change in muscle CSA following training was greatest in the mid‐portion of semitendinosus for both intervention groups, and the mid‐portion of BFlh for the hip extension group. There was limited evidence for tendon‐aponeurosis hypertrophy after 10 weeks of training with the Nordic or hip extension exercises. For the BFlh, neither intervention altered the interface area although hip extension training stimulated an increase in the muscle volume‐to‐interface area ratio, which may have implications for localized tissue strains. Alternative muscle‐tendon loading strategies appear necessary to stimulate hamstring tendon adaptations. [ABSTRACT FROM AUTHOR]

There is a phenomenon in which the tendon appears to increase the length after rotator cuff repair. However, it is unclear in which cases tendon lengthening occurs and how the degree of lengthening affects the surgical outcome. This study aimed to evaluate preoperative and postoperative musculotendinous junction (MTJ) and tendon length on magnetic resonance imaging and assess the postoperative tendon lengthening and its impact on postoperative outcomes. We reviewed 109 patients with good repair integrity after arthroscopic rotator cuff repair. Patients whose supraspinatus tendons were simply pulled out laterally without any additional procedures were included. They underwent serial magnetic resonance imaging before surgery and at 3, 6, and 24 months after surgery. The location of the MTJ in relation to the line of the glenoid fossa and the supraspinatus tendon length were measured. Clinical evaluation was conducted 2 years after surgery, including the range of shoulder motion, shoulder strength index (affected/unaffected strength), Constant score, University of California, Los Angeles score, and pain numeric rating scale. The characteristics of the preoperative tendon, change in tendon length over time, amount of the lateral shift of MTJ location and tendon length, and impact of tendon lengthening on postoperative clinical outcomes were analyzed. The preoperative tendon retraction significantly correlated with the MTJ location (r = −0.75; P <.0001) and preoperative tendon length (r = −0.46; P <.0001). The tendon length at 3, 6, and 24 months after surgery was significantly longer than those before surgery (26.7 ± 5.8 mm, 27.9 ± 6.6 mm, 28.5 ± 5.6 mm, and 21.5 ± 5.1 mm, respectively). From before surgery to 24 months after surgery, the MTJ location moved 8.4 ± 8.6 mm laterally and the tendon length increased 7.0 ± 6.1 mm. A significant and weak negative correlation was found between tendon lengthening and the abduction strength index (r = −0.22; P =.03); however, no significant correlation with pain, range of shoulder motion, external rotation strength index, Constant score, and University of California, Los Angeles score was found. Multiple linear regression analysis also showed that tendon lengthening was only associated with the abduction strength index (standardized coefficient = −0.20, P =.03). Tendon lengthening and lateral shift of MTJ location were observed after arthroscopic rotator cuff repair, and they correlated with preoperative tendon retraction. Although the amount of tendon lengthening had negative weak correlation with abduction strength index, it did not affect other postoperative outcomes. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the efficacy of bone marrow stimulation (BMS) on the repair integrity of the rotator cuff insertion treated with arthroscopic knotless suture bridge (K-SB) rotator cuff repair. We hypothesized that BMS during K-SB repair can improve the healing of the rotator cuff insertion. Sixty patients who underwent arthroscopic K-SB repair of full-thickness rotator cuff tears were randomly allocated to 2 treatment groups. Patients in the BMS group underwent K-SB repair augmented with BMS at the footprint. Patients in the control group underwent K-SB repair without BMS. Cuff integrity and retear patterns were evaluated by postoperative magnetic resonance imaging. The clinical outcomes included the Japanese Orthopaedic Association score, University of California at Los Angeles score, Constant–Murley score, and Simple Shoulder Test. Clinical and radiological evaluations were completed in 60 patients at 6 months postoperatively, in 58 patients at 1 year postoperatively, and in 50 patients at 2 years postoperatively. Both treatment groups showed significant improvements in the clinical outcome from baseline to the 2-year follow-up, but no significant differences were found between the 2 groups. At 6 months postoperatively, the retear rate at the tendon insertion was 0.0% (0 of 30) in the BMS group and 3.3% (1 of 30) in the control group (P =.313). The retear rate at the musculotendinous junction was 26.7% (8 of 30) in the BMS group and 13.3% (4 of 30) in the control group (P =.197). All retears in the BMS group occurred at the musculotendinous junction, and the tendon insertion was preserved. There was no significant difference in the overall retear rate or retear patterns between the 2 treatment groups during the study period. No significant differences were detected in the structural integrity or retear patterns regardless of the use of BMS. The efficacy of BMS for arthroscopic K-SB rotator cuff repair was not proven in this randomized controlled trial. [ABSTRACT FROM AUTHOR]

The transfer of the posterior tibial tendon through the interosseous membrane is potentially an effective treatment to correct the deformity of the foot and ankle. Our study aimed to evaluate the anatomical feasibility of anterior transfer of the posterior tibial tendon through the interosseous membrane route using the musculotendinous junction (MTJ). Eighteen adult cadavers were used. The width and thickness of the tibial posterior MTJ, width of the interosseous membrane at the corresponding level, and the window size of the interosseous membrane were measured. Additionally, the distance between the distal end of the MTJ and the tip of the medial malleolus were recorded. The mean length of the posterior tibial tendon was 83.60 mm, the mean distance of the posterior tibial MTJ to medial malleolus tip was 45.48 mm and the mean length of MTJ was 31.74 mm. The mean width of distal end of MTJ was 7.76 mm, thickness of distal end of MTJ was 4.07 mm and the mean width of the interosseous membrane at the distal end of MTJ was 4.76 mm. We found the mean width of the proximal end of MTJ was 20.68 mm, the mean thickness of proximal end of MTJ was 5.52 mm, and mean width of interosseous membrane at the proximal end of MTJ was 8.76 mm. Our study has demonstrated that a 31 mm length incision made at approximately 45 mm from the proximal end of the medial malleolus can safely reach the MTJ. We recommend an opening length of the interosseous membrane of at least 20 mm. [ABSTRACT FROM AUTHOR]

Introduction: the objective of this anatomical investigation was to record the morphology of peroneus longus (PL), brevis (PB) and tertius (PT) muscles in human cadaveric specimens. Material and Methods: this study utilized 40 cadaveric formalin fixed lower limb specimens. The leg region was meticulously dissected to expose the muscle belly and their tendons to study the morphology. They were traced till their insertion in the foot. The morphometric data were recorded by using the digital Vernier caliper. Results: PL tendon was inserting to the first metatarsal and medial cuneiform bones in 32 specimens (80%), to the shaft of first metatarsal in 3 cases (7.5%) and in 5 specimens, tendon got inserted into the second metatarsal (12.5%). Thirty PB specimens (75%) had tubular morphology at the insertion and 10 specimens (25%) showed a fan or triangular shaped flattened insertion into the fifth metatarsal. The PT was observed in all of our specimens (100%). It presented a single tendon at the site of insertion in 28 specimens (70%), presented a flattered broad insertion (band like) in 7 specimens (17.5%). This morphology shared a slip to the PB and in 5 specimens (12.5%), the muscle got inserted into the fourth metatarsal and gave fibrous expansion to the extensor digitorum longus. Conclusion: we believe that the morphological data of the peroneal muscles presented in this study are beneficial to the plastic and reconstructive surgeries, ankle and foot surgeries during the muscle flap and correction procedures of the lower extremity. [ABSTRACT FROM AUTHOR]

Background: Anatomy of flexor hallucis longus (FHL) is essential for the achievement of tendon transfer and several procedures performed in the foot and ankle. The aim of this study was to evaluate the anatomical knowledge of FHL including the type and location of musculotendinous junction (MTJ), tendinous interconnections (TIC) morphology, its location related to Master Knot of Henry (MKH), and the pattern of TIC distribution.Materials and Methods: One hundred and sixty-six legs from 52 embalmed and 31 soft cadavers were assessed. The medial (MB) and lateral (LB) bellies of FHL were identified and traced until the end of the most distal muscle fibre to determine the medial and lateral MTJs. MTJ was classified into four types based on the existence and length of MB and LB: type 1, long LB and shorter MB; type 2, equal length of both bellies; type 3, only LB and no MB; type 4, long MB and shorter LB. Low lying muscle belly was defined as muscle extending beyond the zero point (the point of intersection between distal osseous part of tibia and FHL tendon). The distance between MTJ and zero point was measured. TIC was classified into seven types based on the direction and number of slip: type I, one slip from FHL to flexor digitorum longus (FDL); type II, crossed connection: type III, one slip from FDL to FHL; type IV, no connection; type V, two slip from FHL to FDL; type VI, two slip from FHL to FDL and one slip from FDL to FHL; type VII, two slips from FDL to FHL and one slip from FHL to FDL. The distance between the TIC and MKH was measured. TIC distribution was defined into four types based on slip distribution to lesser toes: type a, distributed to second toe; type b, distributed to second and third toes; type c, distributed to second to fourth toes, and type d, distributed to second to fifth toes.Results: Type 1 and type 3 of MTJ morphology were found in 87.3% and 12.7%, respectively. Low lying LB was detected in 66.13% of cases with a mean distance of 13.10 ± 4.51 mm. All MBs ended proximal to the zero point with a mean distance of -21.99 ± 13.21 mm. Three types of TIC (I, II, V) were identified. The highest frequency was type I (82.93%). In addition, a new type of TIC was depicted in 8.53% of cases. Part of the FHL tendon in this type fused with FDL tendon and the rest extended directly to the first toe. TIC could be located either proximal, distal or at the MKH. The highest prevalence was distal to MKH in 51.67% of cases with a mean distance of 11.23 ± 5.13 mm and 8.73 ± 4.2 mm in low lying and non-low-lying groups, respectively. Four types of slip distribution to lesser toes were defined, mostly in type b. No statistically significant differences were detected among all parameters including genders, sides, and groups.Conclusions: Knowledge of this investigation might enhance the clinical efficacy of tendon harvesting and transfer in foot and ankle surgery. [ABSTRACT FROM AUTHOR]

Abstract Background Calf muscle strain and Achilles tendon injuries are common in many sports. For the treatment of muscular and tendinous injuries, one of the newer approaches in sports medicine is capacitive-resistive electric transfer therapy. Our objective was to analyze this in vitro, using invasive temperature measurements in cadaveric specimens. Methods A cross-sectional study designed with five fresh frozen cadavers (10 legs) were included in this study. Four interventions (capacitive and resistive modes; low- and high-power) was performed for 5 min each by a diathermy “T-Plus” device. Achilles tendon, musculotendinous junction and superficial temperatures were recorded at 1-min intervals and 5 min after treatment. Results With the low-power capacitive protocol, at 5 min, there was a 25.21% increase in superficial temperature, a 17.50% increase in Achilles tendon temperature and an 11.27% increase in musculotendinous junction temperature, with a current flow of 0.039 A ± 0.02. With the low-power resistive protocol, there was a 1.14% increase in superficial temperature, a 28.13% increase in Achilles tendon temperature and an 11.67% increase in musculotendinous junction temperature at 5 min, with a current flow of 0.063 A ± 0.02. With the high-power capacitive protocol there was an 88.52% increase in superficial temperature, a 53.35% increase in Achilles tendon temperature and a 39.30% increase in musculotendinous junction temperature at 5 min, with a current flow of 0.095 A ± 0.03. With the high-power resistive protocol, there was a 21.34% increase in superficial temperature, a 109.70% increase in Achilles tendon temperature and an 81.49% increase in musculotendinous junction temperature at 5 min, with a current flow of 0.120 A ± 0.03. Conclusion The low-power protocols resulted in only a very slight thermal effect at the Achilles tendon and musculotendinous junction, but current flow was observed. The high-power protocols resulted in a greater temperature increase at the Achilles tendon and musculotendinous junction and a greater current flow than the low-power protocols. The high-power resistive protocol gave the greatest increase in Achilles tendon and musculotendinous junction temperature. Capacitive treatments (low- and high-power) achieved a greater increase in superficial temperature.

Background: Biceps tenodesis is a common treatment for proximal long head of biceps (LHB) tendon pathology. To maintain biceps strength and contour and minimize cramping, restoration of muscle-length tension and appropriate positioning of the tenodesis is key. Little is known about the biceps musculotendinous junction (MTJ) anatomy, especially in relation to the overlying pectoralis major tendon (PMT), which is a commonly used landmark for tenodesis positioning. Purpose: To characterize the in vivo topographic anatomy of the LHB tendon, in particular the MTJ relative to the PMT, using a novel axial proton-density magnetic resonance imaging (MRI) sequence. Study Design: Descriptive laboratory study. Methods: In total, 45 patients having a shoulder MRI for symptoms unrelated to their biceps tendon or rotator cuff were prospectively recruited. There were 33 men and 12 women, with a mean age of 37 ± 13 years (range, 18-59 years). All patients underwent routine shoulder MRI scans with an additional axial proton density sequence examining the LHB tendon and its MTJ. Three independent observers reviewed each MRI scan, and measurements were obtained for (1) MTJ length, (2) the distance between the proximal MTJ and the superior border of the PMT (MTJ-S), (3) the distance between the distal MTJ to the inferior border of the PMT, and (4) the width of the PMT. Results: The average position of the MTJ-S was 5.9 ± 10.8 mm distal to the superior border of the PMT. The mean MTJ length was 32.5 ± 8.3 mm and the width of the PMT was 28.0 ± 7.3 mm. We found no significant correlation between patient age, height, sex, or body mass index and any of the biceps measurements. We observed wide variability of the MTJ-S position and identified 3 distinct types of biceps MTJ: type 1, MTJ-S above the PMT; type 2, MTJ-S between 0 and 10 mm below the superior border of the PMT; and type 3, MTJ-S >10 mm distal to the superior PMT. Conclusion: In this study, the in vivo anatomy of the LHB tendon is characterized relative to the PMT using a novel MRI sequence. The results demonstrate wide variability in the position of the MTJ relative to the PMT, which can be classified into 3 distinct subtypes or zones relative to the superior border of the PMT. Understanding this potentially allows for accurate and anatomic placement of the biceps tendon for tenodesis. Clinical Relevance: To our knowledge, this is the first study to radiologically analyze the in vivo topographic anatomy of the LHB tendon and its MTJ. The results of this study provide more detailed understanding of the variability of the biceps MTJ, thus allowing for more accurate placement of the biceps tendon during tenodesis. [ABSTRACT FROM AUTHOR]

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Introduction: Pelvic apophyseal avulsion fractures are uncommon injuries that frequently affect adolescents while participating in sports. This occurs because the enthesis cannot withstand the tractional force applied because the apophysis has not yet fully fused. Due to its complex muscular structure, being the origin of several muscles that cross two lower extremity joints, the pelvis has an increased risk for such injuries. The diagnosis of pelvic avulsion injuries depends heavily on imaging. The best way to detect soft-tissue changes, including tendon or muscle strain, bone marrow edema, hematomas, and soft tissue avulsion injuries, is with an magnetic resonance imaging . It is also the best at showing tendon retraction and can help the clinician spot patients who might benefit from surgical treatment., Case Report: We report six cases of adolescents professional footballers that suffered avulsion injuries while playing football. The patients had painfully restricted hip range of motion and were unable to bear weight. Some of them on physical examination felt pain at the palpation of the injured area. Magnetic resonance revealed apophysis growth plate avulsion with or without displaced bone fragments that were treated conservatively with an excellent clinical and radiological outcome., Conclusion: For an accurate diagnosis of pelvic avulsion injuries and clinical management, it is important that everyone caring for this patient population is aware of the common injury mechanisms, radiographic findings, and available treatments., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

ABSTRACT: The aim of this paper was to describe the clinical and sonographic findings of partial tear at the musculotendinous junction of the proximal long digital extensor tendon during the acute phase and one year after initial presentation. The dog presented with acute, moderate weight-bearing lameness of the right hind limb. During an orthopedic examination of the stifle, the dog expressed pain on extension and flexion of the right knee. Under general anesthesia, no instability was evident. Radiographic images suggested the presence of joint effusion in the right stifle. Ultrasonography revealed that the long digital extensor tendon was hyperechoic, surrounded by an anechoic effusion, and the muscle fibers were disorganized and interspersed with anechoic fluid. Clinical outcome was considered good after conservative treatment. The dog was re-evaluated approximately one year after treatment and did not present with any clinical signs.

Background: Nonoperative management of injuries to the distal musculotendinous T junction of the biceps femoris is associated with variable periods of rehabilitation and high risk of recurrence. To our knowledge, the efficacy of operative treatment in patients with these acute injuries has not been previously reported. Hypothesis: Surgical repair of injuries to the distal musculotendinous T junction of the biceps femoris would enable return to preinjury level of sport with low risk of recurrence. Study Design: Case series; Level of evidence, 4. Methods: This prospective single-surgeon study included 34 professional athletes (mean age, 26.4 ± 3.1 years; 31 male [91.2%]; 3 female [8.8%]; body mass index, 25 ± 2.0 kg/m2) undergoing primary surgical repair of acute injuries to the distal musculotendinous T junction of the biceps femoris. All study patients underwent a standardized postoperative rehabilitation program. Predefined study outcomes relating to time for return to sporting activity, patient satisfaction, range of motion, hamstring muscle strength, passive range of motion, functional progress, and complications were recorded at regular intervals after surgery. Mean follow-up time was 28.4 months (range, 24.0-36.3 months) from date of surgery. Results: All study patients returned to their preinjury level of sporting activity. Mean time from surgical repair to full sporting activity was 11.7 ± 3.6 weeks. No patients had recurrence of the primary injury. At 1-year follow-up, 18 patients (52.9%) were very satisfied and 16 patients (47.1%) were satisfied with the outcomes of their surgery. At 3 months after surgery, patients had improved mean passive straight leg raise (69.7° ± 11.7° vs 24.1° ± 7.4°; P <.001); increased mean isometric hamstring muscle strength at 0° (93.1% ± 5.4% vs 63.1% ± 7.7%; P <.001), 45° (76.8% ± 9.7% vs 24.8% ± 8.3%; P <.001), and 90° (96.4% ± 3.9% vs 85.6% ± 5.9%; P <.001); higher mean lower extremity functional scores (64.5 ± 4.5 vs 27.2 ± 5.4; P <.001); and improved mean Marx Activity Rating Scale scores (10.7 ± 2.7 vs 2.2 ± 2.1; P <.001) compared with preoperative values. High patient satisfaction and functional outcome scores were maintained at 1 and 2 years after surgery. Conclusion: Surgical repair of acute injuries to the distal musculotendinous T junction of the biceps femoris is associated with high patient satisfaction, increased muscle strength, improved functional outcome scores, and high return to preinjury level of sporting activity with low risk of recurrence at short-term follow-up. [ABSTRACT FROM AUTHOR]

The aim of this paper was to describe the clinical and sonographic findings of partial tear at the musculotendinous junction of the proximal long digital extensor tendon during the acute phase and one year after initial presentation. The dog presented with acute, moderate weight-bearing lameness of the right hind limb. During an orthopedic examination of the stifle, the dog expressed pain on extension and flexion of the right knee. Under general anesthesia, no instability was evident. Radiographic images suggested the presence of joint effusion in the right stifle. Ultrasonography revealed that the long digital extensor tendon was hyperechoic, surrounded by an anechoic effusion, and the muscle fibers were disorganized and interspersed with anechoic fluid. Clinical outcome was considered good after conservative treatment. The dog was re-evaluated approximately one year after treatment and did not present with any clinical signs. [ABSTRACT FROM AUTHOR]

Background: Calf muscle strain and Achilles tendon injuries are common in many sports. For the treatment of muscular and tendinous injuries, one of the newer approaches in sports medicine is capacitive-resistive electric transfer therapy. Our objective was to analyze this in vitro, using invasive temperature measurements in cadaveric specimens.Methods: A cross-sectional study designed with five fresh frozen cadavers (10 legs) were included in this study. Four interventions (capacitive and resistive modes; low- and high-power) was performed for 5 min each by a diathermy "T-Plus" device. Achilles tendon, musculotendinous junction and superficial temperatures were recorded at 1-min intervals and 5 min after treatment.Results: With the low-power capacitive protocol, at 5 min, there was a 25.21% increase in superficial temperature, a 17.50% increase in Achilles tendon temperature and an 11.27% increase in musculotendinous junction temperature, with a current flow of 0.039 A ± 0.02. With the low-power resistive protocol, there was a 1.14% increase in superficial temperature, a 28.13% increase in Achilles tendon temperature and an 11.67% increase in musculotendinous junction temperature at 5 min, with a current flow of 0.063 A ± 0.02. With the high-power capacitive protocol there was an 88.52% increase in superficial temperature, a 53.35% increase in Achilles tendon temperature and a 39.30% increase in musculotendinous junction temperature at 5 min, with a current flow of 0.095 A ± 0.03. With the high-power resistive protocol, there was a 21.34% increase in superficial temperature, a 109.70% increase in Achilles tendon temperature and an 81.49% increase in musculotendinous junction temperature at 5 min, with a current flow of 0.120 A ± 0.03.Conclusion: The low-power protocols resulted in only a very slight thermal effect at the Achilles tendon and musculotendinous junction, but current flow was observed. The high-power protocols resulted in a greater temperature increase at the Achilles tendon and musculotendinous junction and a greater current flow than the low-power protocols. The high-power resistive protocol gave the greatest increase in Achilles tendon and musculotendinous junction temperature. Capacitive treatments (low- and high-power) achieved a greater increase in superficial temperature. [ABSTRACT FROM AUTHOR]

We report a rare case of a partial thickness tear of the supraspinatus at the musculotendinous junction in a softball catcher. Preoperative magnetic resonance images of the shoulder showed high signal intensity areas at the musculotendinous junction, along with discontinuity of the articular side of the supraspinatus. Arthroscopic examination revealed articular-side partial tear at the musculotendinous junction. The patient was able to return to playing softball 20 weeks after arthroscopic side-to-side repair. [ABSTRACT FROM AUTHOR]

Objectives: Muscle injury often occurs in sports activity. To avoid reinjury, it is important to determine the appropriate period until return to play after injury. The purpose of this study was to evaluate characteristics of the healing process for gastrocnemius muscle injury by B‐mode imaging, power Doppler (PD) imaging, and shear wave elastography (SWE). Methods: Twenty patients with acute calf musculotendinous injury were enrolled. Scar thickness on B‐mode imaging, new vessels according to PD grades, and SWE values in the muscle, musculotendinous junction, and tendon of the medial head of gastrocnemius were measured at 4, 8, and 12 weeks after injury. Results: Scar thickness was significantly larger at 8 and 12 weeks compared with 4 weeks (P < .01 for both). Power Doppler grades at 4 and 8 weeks were significantly higher compared with 12 weeks (P < .01 for both). Shear wave elastographic values in the muscle on the injury side were significantly higher at 8 and 12 weeks compared with 4 weeks (P < .01 for both), whereas those in the musculotendinous junction on the injury side were significantly higher at 12 weeks compared with 4 and 8 weeks (P < .01; P =.01, respectively). Conclusions: B‐mode imaging, PD imaging, and SWE can measure the healing process after musculotendinous injury of the gastrocnemius medial head. [ABSTRACT FROM AUTHOR]

Background: Functional impairment of the muscle-tendon unit is one of the most remarkable effects of aging. The function of the peroneus longus muscle is to stabilise the foot and ankle joint. A deterioration of the structural and mechanical properties of this muscle can potentially lead to foot problems in older adults. This study aimed to investigate the effects of age on structural, histological, and mechanical features in peroneus longus muscle samples taken from embalmed cadavers of two different age groups; young adult (30-60 years) and old adult (over 60 years).Materials and Methods: The mechanical property was analysed through the results of cross-sectional area, tensile, tensile stress, and modulus of elasticity. The arran- gement of the collagen in the perimysium and tendon was examined by scanning electron microscopy. Fatty infiltration within the musculotendinous junction was evaluated by Masson' trichrome stained muscle sections.Results: This study thus provides evidence that there are indeed age-induced mechanical property changes in the peroneus longus muscle, which include reductions in the tensile force, tensile stress, and modulus of elasticity, and is related to the malformation of collagen fibrils and the massive fat accumulation in the musculotendinous junction.Conclusions: These alterations may further result in a reduction of muscle strength and quality in an older person. [ABSTRACT FROM AUTHOR]

Gastrocnemius medialis (GM) architecture and ankle angle were compared between flexibility trained (n = 10) and not trained (n = 6) female athletes, aged 8−10 years. Ankle angle, fascicle length, pennation angle and muscle thickness were measured at the mid-belly and the distal part of GM, at rest and at the end of one min of static stretching. Flexibility trained (FT) and not trained athletes (FNT) had similar fascicle length at the medial (4.19 ± 0.37 vs. 4.24 ± 0.54 cm, respectively, p = 0.841) and the distal part of GM (4.25 ± 0.35 vs. 4.18 ± 0.65 cm, respectively, p = 0.780), similar pennation angles, and muscle thickness (p > 0.216), and larger ankle angle at rest (120.9 ± 4.2 vs. 110.9 ± 5.8°, respectively, p = 0.001). During stretching, FT displayed greater fascicle elongation compared to FNT at the medial (+1.67 ± 0.37 vs. +1.28 ± 0.22 cm, respectively, p = 0.048) and the distal part (+1.84 ± 0.67 vs. +0.97 ± 0.97 cm, respectively, p = 0.013), larger change in joint angle and muscle tendon junction displacement (MTJ) (p < 0.001). Muscle thickness was similar in both groups (p > 0.053). Ankle dorsiflexion angle significantly correlated with fascicle elongation at the distal part of GM (r = −0.638, p < 0.01) and MTJ displacement (r = −0.610, p < 0.05). Collectively, FT had greater fascicle elongation at the medial and distal part of GM and greater MTJ displacement during stretching than FNT of similar age.

Introduction: The Neurovascular Bundle (NVB) in the dorsum of the foot is likely to get injured during midfoot surgeries. Finding an anatomical landmark to identify this NVB is essential to prevent iatrogenic injury. Aim: To identify an anatomical landmark to locate the Dorsalis Pedis Artery (DPA) and Deep Peroneal Nerve (DPN) in the dorsum of foot. Materials and Methods: The relationship of this NVB to Extensor Hallucis Brevis Musculotendinous (EHBMT) junction was noted in dorsum of seventy feet. Correlation between the foot length and EHBMT junction length was determined. Result: In 30 feet (42.85%), the DPN was medial to DPA and in 40 (57.14%), it was lateral to DPA. In two feet, the medial branch of DPN pierced the EHB proximal to the musculotendinous junction and in the remaining feet it passed behind EHBMT junction. There was a positive correlation between the foot length and the EHBMT junction length. Conclusion: The EHBMT junction can be used as a reliable landmark to identify the DPN during the mid-foot surgical approaches.

Gastrocnemius recession is a practical and effective procedure to address gastrocnemius equinus. It has been shown that an equinus deformity can lead to the development of plantar fasciitis, osteoarthritis, and foot ulcerations. The 2 approaches to gastrocnemius recession are open and endoscopic. Both are viable options; however, both also have associated complications. We compared and evaluated the postoperative complications associated with these procedures. The electronic database of our orthopedics division at the University of Florida College of Medicine, Jacksonville, was retrospectively searched to identify all cases of gastrocnemius recession (Current Procedural Terminology [CPT] code 27687), and unlisted arthroscopy (CPT code 29999) from February 2006 to February 2016. The difference in the outcome variable, the incidence of postoperative complications, was assessed using Fisher's exact test. A total of 39 patients (41 procedures) were in the open gastrocnemius recession group and 35 (39 procedures) were in the endoscopic gastrocnemius recession group. The median follow-up time was shorter in the open gastrocnemius recession group than in the endoscopic gastrocnemius recession group (9 versus 12 months; p  < .001). Postoperative complications developed after 12 of the 80 procedures (15%), with a greater incidence after open than endoscopic procedures (26.8% versus 2.6%; p  = .003). The complications associated with the open technique included 1 case of scar pain (2.4%), 5 of dehiscence (12.2%), 1 of infection (2.4%), 2 of calf abscess (4.9%), and 2 cases of nerve injury (4.9%). A single complication occurred with the endoscopic technique—1 case of dehiscence (2.6%). To the best of our knowledge, ours is the first study to compare the postoperative complications between these 2 techniques. We found the incidence of postoperative complications was significantly lower in the endoscopic group, emphasizing the benefit of using the endoscopic approach. These findings could prove invaluable when addressing gastrocnemius equinus in those with a greater risk of postoperative complications. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tendons show morphological and vascular adaptations to mechanical loadings. OBJECTIVE: To measure and compare the features of regional microcirculation within the supraspinatus tendon, and to investigate the correlations between those features and shoulder strength in overhead athletes. METHODS: Seventeen badminton athletes were recruited. DCE-MRI was conducted on the tendons in each athlete’s dominant arm, including measures for the volume transfer constant (Ktrans), reverse reflux rate constant (Kep) and the extravascular extracellular space volume (Ve). Isokinetic tests were used to measure the acceleration time and the relative fatigue ratio of the shoulder external rotation of the arm. RESULTS: The DCE-MRI measures for the anterior, posterior, and entirety of the tendon showed regional differences and correlations between the Kep values for the whole supraspinatus tendon and the acceleration time (r = —0.663, p = 0.005) and between the Vp value of the whole tendon and the relative fatigue ratio (r = —0.605, p = 0.01). CONCLUSION: There are differences in the microcirculatory features of the anterior and posterior portions of the supraspinatus tendon. In addition, microcirculation at the supraspinatus tendon and shoulder external rotation explosive strength and fatigue are correlated. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to evaluate the position of the subscapular nerves relative to surgical landmarks during exposure and to analyze the pattern of innervation of the subscapularis to avoid injury during anterior shoulder surgery.Methods: 20 embalmed human cadaveric shoulder specimens were used in the study. The muscular insertions of the subscapular nerves were marked and their closest branches to the musculotendinous junction and the coracoid process were measured in horizontal and vertical distances. In addition, the innervation pattern of each specimen was documented.Results: 14/20 specimens showed an innervation of the subscapularis with an upper, middle and lower subscapular nerve branch. Even though the nerve branches were in average more than 2 cm medial to the musculotendinous junction, minimal distances of 1.1-1.3 cm were found. The mean vertical distance as measured from the medial base of the coracoid to the nerve innervation point into the muscle was 0.7 cm for the upper nerve branch, 2.2 cm for the middle nerve branch and 4.4 cm for the lower nerve branch.Conclusions: The subscapularis has a variable nerve supply, which increases the risk of muscle denervation during open shoulder surgery. Dissection or release should be avoided at the anterior aspect of the subscapularis muscle more than 1 cm medial to the musculotendinous junction. In approaches with a horizontal incision of the subscapularis, splitting should be performed at a vertical distance of 3.2-3.6 cm to the coracoid base to avoid iatrogenic subscapular nerve injuries. [ABSTRACT FROM AUTHOR]

Background. Significant and/or complete rupture in the musculotendinous junction (MTJ) is a challenging lesion to treat because of the lack of reliable suture methods. Skeletal muscle-derived multipotent stem cell (Sk-MSC) sheet-pellets, which are able to reconstitute peripheral nerve and muscular/vascular tissues with robust connective tissue networks, have been applied as a “bio-bond”. Methods. Sk-MSC sheet-pellets, derived from GFP transgenic-mice after 7 days of expansion culture, were detached with EDTA to maintain cell–cell connections. A completely ruptured MTJ model was prepared in the right tibialis anterior (TA) of the recipient mice, and was covered with sheet-pellets. The left side was preserved as a contralateral control. The control group received the same amount of the cell-free medium. The sheet-pellet transplantation (SP) group was further divided into two groups; as the short term (4–8 weeks) and long term (14–18 weeks) recovery group. At each time point after transplantation, tetanic tension output was measured through the electrical stimulation of the sciatic nerve. The behavior of engrafted GFP+ tissues and cells was analyzed by fluorescence immunohistochemistry. Results. The SP short term recovery group showed average 64% recovery of muscle mass, and 36% recovery of tetanic tension output relative to the contralateral side. Then, the SP long term recovery group showed increased recovery of average muscle mass (77%) and tetanic tension output (49%). However, the control group showed no recovery of continuity between muscle and tendon, and demonstrated increased muscle atrophy, with coalescence to the tibia during 4–8 weeks after operation. Histological evidence also supported the above functional recovery of SP group. Engrafted Sk-MSCs primarily formed the connective tissues and muscle fibers, including nerve-vascular networks, and bridged the ruptured tendon–muscle fiber units, with differentiation into skeletal muscle cells, Schwann cells, vascular smooth muscle, and endothelial cells. Discussion. This bridging capacity between tendon and muscle fibers of the Sk-MSC sheet-pellet, as a “bio-bond,” represents a possible treatment for various MTJ ruptures following surgery.

Objectives The purpose of this study was to examine the effect of long-term self-massage at the musculotendinous junction on hamstring extensibility, stiffness, stretch tolerance, and structural indices. Design Single-blind, randomized, controlled trial. Setting Laboratory. Participants Thirty-seven healthy men. Intervention The right or left leg of each participant was randomly assigned to the massage group, and the other leg was assigned to the control group. The participants conducted self-massage at the musculotendinous junction for 3 min daily, five times per week, for 12 weeks. Main outcome measures Hamstring extensibility, stiffness, stretch tolerance, and structural indices were measured by a blinded examiner prior to the massage intervention and after 6 and 12 weeks of intervention. Results The maximum hip flexion angle (HFA) and the maximum passive pressure after 6 and 12 weeks of intervention in the massage group were significantly higher than prior to intervention. The visual analog scale (for pain perception) at maximum HFA, the stiffness of the hamstring, and the structural indices did not differ in either group over the 12 week period. Conclusions Our results suggest that long-term self-massage at the musculotendinous junction increases hamstring extensibility by improving stretch tolerance. However, this intervention does not change hamstring stiffness. Clinical trial registration number University Hospital Medical Information Network registration number UMIN000011233 . [ABSTRACT FROM AUTHOR]

Introduction: The Neurovascular Bundle (NVB) in the dorsum of the foot is likely to get injured during midfoot surgeries. Finding an anatomical landmark to identify this NVB is essential to prevent iatrogenic injury. Aim: To identify an anatomical landmark to locate the Dorsalis Pedis Artery (DPA) and Deep Peroneal Nerve (DPN) in the dorsum of foot. Materials and Methods: The relationship of this NVB to Extensor Hallucis Brevis Musculotendinous (EHBMT) junction was noted in dorsum of seventy feet. Correlation between the foot length and EHBMT junction length was determined. Result: In 30 feet (42.85%), the DPN was medial to DPA and in 40 (57.14%), it was lateral to DPA. In two feet, the medial branch of DPN pierced the EHB proximal to the musculotendinous junction and in the remaining feet it passed behind EHBMT junction. There was a positive correlation between the foot length and the EHBMT junction length. Conclusion: The EHBMT junction can be used as a reliable landmark to identify the DPN during the mid-foot surgical approaches. [ABSTRACT FROM AUTHOR]