Tendon and Ligament injuries

Seventeen patients with 28 flexor tendon injuries were examined after tendon repair. The current most frequently used evaluation systems, including grip and pinch strength, were compared with functional outcome as assessed by a questionnaire, evaluating Disabilities of Arm, Shoulder and Hand (DASH). Good correlation was found between Total Active Motion (TAM) and the Original Strickland test (kappa = 0.85), however with reduced categories. Only limited correlation was found between the DASH-score and TAM (r = -0.33) as well as between the DASH-score and pinch strength (r = -0.35). We suggest reporting the average Range of Motion (ROM) of the complete finger as a percentage of the contralateral finger, instead of reporting the classified result, and to include assessment of pinch strength. It would be very useful to have an accurate functional outcome assessment, but DASH proves to be insufficiently sensitive.

Mid-portion Achilles tendinopathy is a common injury in sporting populations. There is conflicting evidence about the best approach to conservative management. This report focuses on the rehabilitation of an Achilles tendinopathy utilising osteopathic manual therapy (OMT) and a structured exercise program in a semi-professional volleyballer. The patient presented with a 4-month history of right mid-portion Achilles tendon pain that begun after a lateral inversion sprain of the right ankle. The primary complaint was pain impacting the patients vertical jump performance. The patient complained of pain that was greatest in the morning and at the beginning of a training session prior to warming up. The inventory therapy was a combination of OMT and rehabilitation. The manual therapy was complemented with a rehabilitation program. Outcomes were assessed with the Victorian Institute of Sport Assessment- Achilles (VISA-A), visual analogue scales (VAS), painful arc, London Hospital Test, soleus lunge test and maximum vertical jump. This case presented many challenging management options including a resolving right ankle lateral inversion sprain, a past history of contralateral Achilles tendinopathy and a high training load. The case demonstrated the importance of patien-tcentred practice. It was integral that the patient’s role as a semi-professional athlete on the volleyball court was analyzed closely in order to replicate different facets of his game, so that the rehabilitation program could support a return to performance at the highest level. Once the initial deficits in mobility and strength were addressed, the rehabilitation program focus moved to injury prevention.

Skeletal ligaments are well characterized as mechanical stabilizers of diarthrodial joints. New evidence now suggests that the normal regulation of ligament and joint function may occur through a neural and microvascular ''axis,'' where the physiology of normal ligaments is influenced by heterogeneous cellular, neural, and micro-vasculature elements. Within ligament tissue, complex networks of cellular processes linked by gap junctions allow the direct cell-to-cell transfer of signaling molecules, whereas sensory innervation and neurovascular reflexes contribute to motor control and affect ligament mechanical properties. The application of new imaging technologies may assist in determining the functional implications of an integrated neural and microvascular axis. Aging and gender related differences in ligament function are also discussed.