Treatment of Medial Epicondylar Tendinopathy in Athletes

Mishra, Allan; Pirolo, Joseph M.; Gosens, Taco

doi:10.1097/jsa.0000000000000031

Cited by 9 publications

(3 citation statements)

References 29 publications

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“…The exact incidence of elbow tendinopathy is unknown, but it is estimated to affect 1-3% of adults each year in the lateral elbow 8 and 0.1-0.75% in the medial elbow 9 . It has been reported that the pathogenesis of the medial pathology parallels that of the lateral pathology, with similar patterns of angiofibroblastic degeneration 10 .…”

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confidence: 99%

Influence of genetic factors in elbow tendon pathology: a case-control study

Alakhdar

Cook

Benítez-Martínez

et al. 2020

Sci Rep

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Elbow tendinopathy is a common pathology of the upper extremity that impacts both athletes and workers. Some research has examined the genetic component as a risk factor for tendinopathy, mainly in the lower limbs. A case-control study was designed to test for a relationship between certain collagen gene single nucleotide polymorphisms (SNPs) and elbow tendon pathology. A sample of 137 young adult athletes whose sports participation involves loading of the upper limb were examined for the presence of structural abnormalities indicative of pathology in the tendons of the lateral and medial elbow using ultrasound imaging and genotyped for the following SNPs: COL5A1 rs12722, COL11A1 rs3753841, COL11A1 rs1676486, and COL11A2 rs1799907. Anthropometric measurements and data on participants' elbow pain and dysfunction were collected using the Disabilities of the Arm, Shoulder and Hand and the Mayo Clinic Performance Index for the Elbow questionnaires. Results showed that participants in the structural abnormality group had significantly higher scores in pain and dysfunction. A significant relationship between COL11A1 rs3753841 genotype and elbow tendon pathology was found (p = 0.024), with the CT variant associated with increased risk of pathology.Tendinopathy is a common condition that affects a large portion of the population, making up 30% of all musculoskeletal injuries 1 and being the most prevalent tendon disorder 2 . It is generally defined as an overuse injury resulting in tendon degeneration after a failed early inflammatory healing response 3 , leading to collagen disorientation and disorganization in the absence of classic inflammatory changes, accompanied by pain and dysfunction 4,5 . Tendon homeostasis relies on a dynamic remodeling process influenced by tendon loading and cytokines, among other things. Evidence support the expression and functional involment of pro-inflammatory cytokines such as interleukin-1ß in tissues surrounding mechanically injured tendon 6 . Tendon inflammation and tendinopathy are possible manifestations of a disturbance of this homeostasis. The role of inflammation in tendon healing or failure to heal is complex and not fully understood, but it is known that an initial inflammatory response is required to begin the healing process. On the other hand, cytokines appear to be capable of inducing a failed healing response in several diseases of connective tissue (cartilage, bone, synovial joint) possibly by altering the expression of matrix metalloproteinases 7 . Probably the tendon is no exception, although there are no conclusive data at present on the role of these cytokines in the tendinopathy development 6,7 .The exact incidence of elbow tendinopathy is unknown, but it is estimated to affect 1-3% of adults each year in the lateral elbow 8 and 0.1-0.75% in the medial elbow 9 . It has been reported that the pathogenesis of the medial pathology parallels that of the lateral pathology, with similar patterns of angiofibroblastic degeneration 10 . In athletes, individuals who practice s...

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confidence: 99%

Influence of genetic factors in elbow tendon pathology: a case-control study

Alakhdar

Cook

Benítez-Martínez

et al. 2020

Sci Rep

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“…Achilles tendinopathy and patellar tendinopathy are common in runners [5][6][7], jumpers [8,9]. Shoulder tendinopathies are common in swimmers [10] and throwers [11]. Early rehabilitation is important; if not done properly, it may lead to deterioration of performance in athletes sometimes it may even rupture of tendons.…”

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confidence: 99%

Physiotherapy Management in Common Tendon Injuries: Review of Reviews

Ateef

2018

International Journal of Physiotherapy

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Background: Numerous systematic reviews have been published on tendinopathies that deals with specific therapies on a specific location. Clinical therapists find it difficult to synthesize these results into their practice as evidence is conflicting between the sites of tendinopathy. The objective of this systematic review is to see the effectiveness of physiotherapy interventions (both active-exercise and passive-physical agents) in the management of tendinopathies.Methods: Articles were selected from Web of Science (WoS) by entering keywords in mid-December 2017. Articles published in the English language, between 2000 and 2017 were selected. The author selected 14 reviews from 31 possible reviews for this article and all, but one was indexed in PubMed too. Seven, 1, 3 and 3 were the number of articles that were carried treatment, physiotherapy, exercise and physical agents in their titles. Shoulder, hip or knee, ankle locations were dealt in 6, 4 and four articles respectively.Results: Current evidence-based literature shows that exercise especially eccentric one is the definite physiotherapy treatment option for treating lower limb and some upper limb tendinopathies. However, reviews show that other forms of exercises particularly stabilization as a promising option in upper limb conditions. Physical agents (Ultra Sound [US], Transcutaneous electrical nerve stimulation [TENS] are showing conflicting results hence not recommended at this point. The LASER can be used in Shoulder tendinopathies. Conclusion:The traditional concept of eccentric training in tendinopathies is challenged by recent reviews which show stabilization and other types of exercises also improving pain and function in tendinopathies. Well-designed large RCT trials are required to see the effectiveness of physical agents, different types of exercise training on tendinopathies.

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“…The primary function of tendons is to transfer mechanical loads from muscle to bone, which can easily lead to tendinopathy (1). Tendinopathy commonly affects adult athletes and aged population; it occurs in the rotator cuff (2), Achilles, patellar tendons (3), and medial epicondyle (4). Bi firstly identified tendon stem/progenitor cells (TSPCs) in 2007 (5).…”

Section: Introductionmentioning

confidence: 99%

mTOR REGULATES THE PROLIFERATION AND DIFFERENTIATION OF TENDON STEM CELLS: AN IN VITRO STUDY

Gao¹,

Tang²,

Zhou³

et al. 2017

J Aging Res & Lifestyle

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Objectives: The mechanistic target of rapamycin (mTOR) controls cell growth and proliferation via translation regulation in eukaryotes. The present study investigated the effects of mTOR on the proliferation and differentiation of tendon stem cells (TSCs). Methods: The proliferation and differentiation ability of TSCs was tested in response to antagonist (MHY1485), and a depressor of mTOR (Rapamycin and KU0063794). CCK test was performed to test cell proliferation; quantitative real-time PCR (RT-PCR) and Western blot test were performed to evaluate the differentiation of TSCs. Results: Blocking of mTOR1 inhibited the proliferation of TSCs and blocking of mTOR2 enhanced the proliferation of TSCs; however, the effects of mTOR1 surpassed the effects of mTOR2. Blocking of mTOR1 or activation of mTOR2 induced the expression of TNC, and blocking of mTOR2 inhibited the expression of TNC. Blocking of mTOR1 by rapamycin decreased the expression of ap2. Both blocking of mTOR1 or mTOR2 had little effects on the expression of Runx2 and Sox9; however, activation of mTOR2 induced the expression of Runx2 and Sox9. Moreover, the Western blot test showed that blocking of mTOR1 by Rapamycin or the blocking of both mTOR1 and mTOR2 by KU-0062794 enhanced the expression of TNC; in addition, blocking of mTOR1 by Rapamycin enhanced the expression of c-EBPα and Sox9. However, activation of mTOR1 and mTOR2 by MHY1485 increased the expression of Runx2. Conclusions: mTOR played important roles in the proliferation and differentiation of TSCs. Furthermore, mTOR1 and mTOR2 played different roles on the proliferation and differentiation of TSCs. Blocking mTOR1 inhibited the proliferation of TSCs and played a dominant function.Blocking of mTOR1 enhanced the expression of tenocyte related genes; however, blocking of mTOR2 inhibited the expression of TNC. Blocking of mTOR1 by rapamycin decreased the expression of ap2 and activation of mTOR2 induced the expression of Runx2.

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Treatment of Medial Epicondylar Tendinopathy in Athletes

Cited by 9 publications

References 29 publications

Influence of genetic factors in elbow tendon pathology: a case-control study

Influence of genetic factors in elbow tendon pathology: a case-control study

Physiotherapy Management in Common Tendon Injuries: Review of Reviews

mTOR REGULATES THE PROLIFERATION AND DIFFERENTIATION OF TENDON STEM CELLS: AN IN VITRO STUDY

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