The innervation of tendons and aponeuroses

Stilwell, Donald L.

doi:10.1002/aja.1001000302

Cited by 88 publications

(22 citation statements)

References 23 publications

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“…The Achilles tendon is innervated by nerves from the surrounding muscles and by small fasciculi from cutaneous nerves, particularly the sural nerve (Stilwell, 1957). As it is a very large tendon, the Achilles tendon has a relatively small number of nerve fibers and nerve endings compared with the smaller tendons involved in fine movements (Józsa and Kannus, 1997).…”

Section: Innervationmentioning

confidence: 99%

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

Neeter

Thomeé

Silbernagel

et al. 2003

Scandinavian Med Sci Sports

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The purpose of this double‐blind study was to evaluate the effects of iontophoresis with dexamethazone to iontophoresis with saline solution on patients who had acute (less than 3 months) pain from the Achilles tendon, in terms of range of motion, muscular endurance, pain and symptoms. Twenty‐five patients (15 men and 10 women), aged between 18 and 76 years (mean = 38), were evaluated before and after 2 weeks of treatment with iontophoresis, as well as after 6 weeks, 3 and 6 months and 1 year. Two groups were treated for 2 weeks with iontophoresis for each treatment. Three ml of dexamethazone were used for the experiment group (n = 14) and 3 ml of saline solution for the control group (n = 11). Both groups then followed the same rehabilitation programme for 10 weeks. Good reliability was found for the toe‐raise and range of motion tests. Poor reliability was, however, found for the pain on palpation test, which was therefore excluded. No difference was found between or within groups for the toe‐raise test. Several significant improvements were seen in the experiment group but not in the control group, in the range of motion test, pain during and after physical activity, pain during walking and walking up and down stairs, morning stiffness and tendon swelling. Even though the small sample size limits the possibilities to draw definite conclusions, we conclude from the present study, using a double‐blind, randomised approach and a 1‐year follow‐up period, that positive effects from using iontophoresis with dexamethazone were found in the treatment of patients with acute Achilles tendon pain.

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Section: Innervationmentioning

confidence: 99%

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

Neeter

Thomeé

Silbernagel

et al. 2003

Scandinavian Med Sci Sports

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“…The Achilles tendon is innervated by nerves of the attaching muscles and by small fascicels from cutaneous nerves, in particular the sural nerve (Stilwell, 1957).…”

Section: Nerve Supplymentioning

confidence: 99%

Magnetic resonance imaging in chronic achilles tendinopathy

Shalabi

2004

Acta Radiol

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The main objective of this thesis was to evaluate and monitor the morphological response following treatment interventions in patients with chronic Achilles tendinopathy by using different MRI-techniques. For this purpose, we investigated different types of sequences, including gadolinium contrast medium enhanced T1-WI images (CME T1-WI) and developed a precise method to measure tendon volume and mean intratendinous signal of the Achilles tendon. Study I aimed at evaluating 15 patients with chronic painful Achilles tendinosis, before -and two years after -surgical treatment. There was marked regression of the intratendinous signal postoperatively. The most sensitive sequence for depicting an intratendinous lesion in this study was CME T1-WI images. They showed a regression of the intratendinous signal abnormality from 13/15 patients preoperatively to 4/15 postoperatively. The clinical outcome was excellent in 8, good in 5, fair in 1 and poor in 1 patient. In study II, the early contrast agent enhancement in the dynamically enhanced MRI signal (DEMRI) was correlated to the histopathological findings in 15 patients with chronic Achilles tendinopathy. Early contrast enhancement (within the first 72 seconds) was seen in DEMRI in the symptomatic Achilles tendons with a significant difference compared to the asymptomatic contralateral tendons. Increased severity of tendon changes, including fiber structure abnormality, increased vascularity, rounding of nuclei and increased amount of glycosaminoglycans, correlated to CME. In study III, we developed a computerized 3-D seed growing MRI-technique to measure tendon volume and mean intratendinous signal. This technique showed an excellent inter-and intra-observer reliability. The technique was also used to prospectively follow up the tendon adaptation and healing described in studies IV-VI. In study IV, using serial MRI during a period of one year we evaluated the biological effect of tendon repair following iatrogenic tendon injury by five transversal ultrasound-guided core-biopsies employing a needle technique in chronic Achilles tendinopathy. Alterations found during healing, such as tendon volume and intratendinous reactive changes could be monitored by MR imaging, and subsided as noted in the seven and twelve months follow-up. In study V, we evaluated the effect of treatment with three months daily-performed heavy loaded calf muscle strength training program in 25 patients who had been suffering from chronic painful Achilles tendinopathy. The tendon volume decreased with 14%, and the mean intratendinous signal with 23%. The clinical outcome was improved. In study VI, we revealed tendon adaptation immediately following calf muscle strength training. An MRI examination within 30 minutes of the performed exercises resulted in increased total tendon volume (12%) and mean intratendinous signal (31%).In conclusion, MRI-techniques can be used as an adjunct to clinical evaluation by monitoring morphological effects following different treatment interventions, thereby ...

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“…He also reports, in accordance with Swett [1972. 1974], that 'end organs of Golgi' [Stilwell. 1957b] receive afferents only from intramuscular nerves.…”

Section: Discussionmentioning

confidence: 99%

“…1957b). Muscle spindles and 'end organs of Golgi" or *Ruffini endings' [Stilwell, 1957b] as well as free and Paciniform endings are terminations of intramuscular nerve trunks [Stilwell, 1957a. b].…”

Section: Discussionmentioning

confidence: 99%

Functional Topography and Ultrastructure of Periarticular Mechanoreceptors in the Lateral Elbow Region of the Rat

Strasmann

Wal

Halata

et al. 1990

Cells Tissues Organs

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The distribution and ultrastructure of sensory nerve endings were investigated in the deep lateral elbow region of the rat. Three zones of distribution of mechanoreceptors were distinguished each in relation to the functional architecture of the connective and muscular tissue in that area: (1) a zone with muscle spindles, Golgi tendon organs, free nerve endings and single small lamellated corpuscles (‘muscle-tendon spectrum’), situated in the middle third of the supinator muscle and its superficial aponeurosis; (2) a zone with small lamellated corpuscles and free nerve endings situated pericapsularly to the humeroradial joint capsule (‘shearing spectrum’): this moderately dense, irregular connective tissue is covered by the proximal continuation of the supinator’s aponeurosis, and muscle fibers insert from beneath this aponeurosis, which displays, as a part of the joint capsule, a strong collagenous tissue plate; (3) a zone with only free nerve endings within the tendon-like, most proximal part of the supinator’s aponeurosis, inserting into the periosteal layer of the lateral humeral epicondyle (‘endotenonial spectrum’): it is part of the joint capsule. The ultra-structure of these sensory endings is described and the distribution pattern of the mechanoreceptors observed is discussed in relation to the classification into ‘muscle receptors’ and ‘joint receptors’.

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The innervation of tendons and aponeuroses

Cited by 88 publications

References 23 publications

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

Magnetic resonance imaging in chronic achilles tendinopathy

Functional Topography and Ultrastructure of Periarticular Mechanoreceptors in the Lateral Elbow Region of the Rat

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