title: Site of maximum neovascularisation correlates with the site of pain in recalcitrant mid-tendon Achilles tendinopathy.
abstract: 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.
authors.affiliation: Centre for Sports and Exercise Medicine, Mile End Hospital, London E14DG, United Kingdom.
authors.forename: Kiran
authors.initials: K
authors.lastname: Divani
authors.forename: Otto
authors.initials: O
authors.lastname: Chan
authors.forename: Nat
authors.initials: N
authors.lastname: Padhiar
authors.forename: Richard
authors.initials: R
authors.lastname: Twycross-Lewis
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
authors.forename: Tom
authors.initials: T
authors.lastname: Crisp
authors.forename: Dylan
authors.initials: D
authors.lastname: Morrissey
mesh_terms: 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