title: Ultrasonography as a prognostic and objective parameter in Achilles tendinopathy: a prospective observational study.
abstract: OBJECTIVE
  To study prospectively whether structural changes determined by ultrasound scanning (US) can be used as prognostic markers for outcome in patients with symptomatic Achilles tendinopathy (AT) and to investigate whether there exists an association between US findings and pain measured by visual analog scale (VAS) and a general assessment score (GA).
  
  
  METHODS
  92 consecutive patients with AT symptoms were recruited from two outpatient clinics in rheumatology. The patients underwent a conservative treatment protocol consisting of reduced activities, controlled rehabilitation including eccentric exercises of the calf muscles and if needed supplemented with corticosteroid injections. The patients were examined clinically and by US (tendon thickness, hyper- and hypoechogenicity, calcification, bursitis, calcaneusspure, tenosynovitis, gray scale and color Doppler focusing on increased flow intra- or peritendinous). The clinical and US examination were performed at entry, 1, 2, 3 and at 6 month.
  
  
  RESULTS
  42 women and 50 men were included (mean age of 47 years). They had symptoms for more than 13 months and a symptomatic Achilles tendon mean thickness of 7.4±2.3mm. Heterogeneity at the initial examination was found to be a prognostic marker for the clinical outcome. Tendon thickness, hypoechogenicity and increased flow at any time point were significantly correlated to pain at function, palpatory pain and morning pain at the same time points. A reduction in tendon thickness was statistically associated with a decrease in palpatory pain.
  
  
  CONCLUSIONS
  Heterogeneity is a prognostic marker in AT. Tendon thickness, hypoechogenicity and increased Doppler activity can be used as objective outcome parameters for the treatment effect of AT.
authors.affiliation: Department of Rheumatology, Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk, Denmark. Electronic address: mbakkegaard@hotmail.com.
authors.forename: Mads
authors.initials: M
authors.lastname: Bakkegaard
authors.affiliation: Private Department of Rheumatology, Furesø-reumatologerne, Farum and ISMC, Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Bispebjerg Bakke 23, 2. Tværvej, Indgang 8, 1. sal, 2400 København NV, Denmark. Electronic address: f.e.johannsen@dadlnet.dk.
authors.forename: Finn E
authors.initials: FE
authors.lastname: Johannsen
authors.affiliation: Danish Institute for Local and Regional Government Research, Købmagergade 22, 1150 København K, Denmark. Electronic address: beho@kora.dk.
authors.forename: Betina
authors.initials: B
authors.lastname: Højgaard
authors.affiliation: Institute of Social Medicine, Department of Public Health and Centre for Healthy Ageing, Faculty of Heath Sciences, University of Copenhagen, Øster Farimagsgade 5, bygn. 24, postboks 2099, 1014 København, Denmark. Electronic address: henninglangberg@gmail.com.
authors.forename: Henning
authors.initials: H
authors.lastname: Langberg
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging* / Q000473:pathology; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D010147:Pain Measurement; D011379:Prognosis; D011446:Prospective Studies; D052256:Tendinopathy / Q000000981:diagnostic imaging* / Q000473:pathology; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Achilles tendinopathy; Cause of pain; Prognostic markers; Ultrasonography