Site of maximum neovascularisation correlates with the site of pain in recalcitrant mid-tendon Achilles tendinopathy.
BACKGROUND
Neovascularisation is associated with pain in Achilles tendinopathy (AT). The anatomical relationship between ultrasound (US)-defined indicators of tendinopathy and clinically determined pain sites has not been investigated.


OBJECTIVE
To measure the spatial correlation between the sites of maximum palpated tenderness, site of patient-indicated pain, maximum US-determined neovascularisation and maximum antero-posterior tendon thickness in patients with chronic recalcitrant AT (CRAT).


METHODS
A custom-designed measuring apparatus and clinical examination were used to measure the sites of maximum tenderness and subjectively defined pain on 29 tendons from patients diagnosed with mid-tendon CRAT. All tendons had been previously non-responsive to eccentric loading. Maximal neovascularisation and tendon thickness were measured by US scanning in conjunction with the measuring device.


RESULTS
A significant association exists between clinically determined pain and neovascularisation (r = 0.85, p < 0.001), patient reported pain (r = 0.91, p < 0.001), maximal tendon thickness (r = 0.91, p < 0.001), maximal thickness and maximal neovascularisation (r = 0.86, p < 0.001).


CONCLUSIONS
Sites of subjectively defined pain, clinically palpated tenderness, tendon thickness and neovascularisation are anatomically associated. Palpation can be reliably used as a clinical guide when planning interventions in patients with CRAT.
Divani
Kiran
K
Centre for Sports and Exercise Medicine, Mile End Hospital, London E14DG, United Kingdom.
Chan
Otto
O
Padhiar
Nat
N
Twycross-Lewis
Richard
R
Maffulli
Nicola
N
Crisp
Tom
T
Morrissey
Dylan
D
D000125:Achilles Tendon / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000293:injuries; D000328:Adult; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging*; D010147:Pain Measurement; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D052256:Tendinopathy / Q000000981:diagnostic imaging*; D014463:Ultrasonography