Comparison of shoulder Magnetic Resonance Imaging findings between patients with stage 4 chronic kidney disease and hemodialysis patients with healthy controls

Platelet-rich plasma in the pathologic processes of tendinopathy: a review of basic science studies

Tendinopathy is a medical condition that includes a spectrum of inflammatory and degenerative tendon changes caused by traumatic or overuse injuries. The pathological mechanism of tendinopathy has not been well defined, and no ideal treatment is currently available. Platelet-rich plasma (PRP) is an autologous whole blood derivative containing a variety of cytokines and other protein components. Various basic studies have found that PRP has the therapeutic potential to promote cell proliferation and differentiation, regulate angiogenesis, increase extracellular matrix synthesis, and modulate inflammation in degenerative tendons. Therefore, PRP has been widely used as a promising therapeutic agent for tendinopathy. However, controversies exist over the optimal treatment regimen and efficacy of PRP for tendinopathy. This review focuses on the specific molecular and cellular mechanisms by which PRP manipulates tendon healing to better understand how PRP affects tendinopathy and explore the reason for the differences in clinical trial outcomes. This article has also pointed out the future direction of basic research and clinical application of PRP in the treatment of tendinopathy, which will play a guiding role in the design of PRP treatment protocols for tendinopathy.

Tendon Disorders in Chronic Liver Disease: A Retrospective Cohort Study in Taiwan

To investigate the relationship between chronic liver disease and tendon disorder, a retrospective cohort study was conducted using the Kaohsiung Veterans General Hospital database. Patients >18 years with newly diagnosed liver disease and with at least a two-year follow-up in the hospital were included. An equal number of 20,479 cases were enrolled in both the liver-disease and non-liver-disease groups using a propensity score matching method. Disease was defined using ICD-9 or ICD-10 codes. The primary outcome was the development of tendon disorder. Demographic characteristics, comorbidities, use of tendon-toxic drugs, and status of HBV/HCV infection were included for analysis. The results showed 348 (1.7%) and 219 (1.1%) individuals developed tendon disorder in the chronic liver disease group and non-liver-disease group. Concomitant use of glucocorticoids and statins may have further raised the risk of tendon disorder in the liver disease group. The co-existence of HBV/HCV infection did not increase the risk of tendon disorder in the patients with liver disease. Considering these findings, physicians should be more aware of tendon issues in advance, and a prophylactic strategy should be adopted in patients with chronic liver disease.

Ultrasound Versus Magnetic Resonance Imaging in the Evaluation of Shoulder Pain in End Stage Renal Disease Patients on Chronic Hemodialysis

BACKGROUND

Musculoskeletal pain is common in hemodialysis (HD) patients and may be related to articular or periarticular amyloid deposition. The shoulder is one of the most common afflicted joints, but not all causes of shoulder pain are detectable on radiography, and magnetic resonance imaging (MRI) is not always available. The aim of this study was to evaluate the validity of musculoskeletal ultrasound (MSUS) to properly detect shoulder disorders in HD patients by identifying US abnormalities in the shoulder and comparing them to those identified on MRI, with MRI serving as the gold standard test.

METHODS

This cross-sectional observational study was conducted on 28 HD patients (16 males and 12 females, mean age 46.89) with either unilateral or bilateral shoulder pain. Demographic data and clinical characteristics were recruited. All patients were subjected to clinical assessment, MSUS and MRI of both shoulders.

RESULTS

US abnormalities were prevalent in almost all patients. Supraspinatus tendinopathy was the most common abnormality in symptomatic shoulders (92.1%), followed by subacromial-subdeltoid (SASD) bursitis (65.8%), humoral erosions (57.9%), and acromioclavicular joint (ACJ) osteoarthritis (52.6%). MSUS shows high sensitivity and specificity when compared to MRI in all the studied shoulder pathologies except glenohumeral joint (GHJ) effusion (sensitivity, 33.3%) and infraspinatus tendinopathy (sensitivity, 58.3%). The percentage of agreement between MSUS and MRI in detecting biceps tenosynovitis was 82.14% (kappa, 0.64), subscapularis tendinopathy 83.93% (kappa, 0.654), supraspinatus tendinopathy 91.07% (kappa, 0.617), infraspinatus tendinopathy 82.14% (kappa, 0.470), SASD bursitis 80.36% (kappa, 0.569), humeral head erosions 82.14% (kappa, 0.635), GHJ effusion 82.14% (kappa, 0.352), and ACJ osteoarthritis 76.79% (kappa, 0.539).

CONCLUSIONS

Shoulder problems are common in HD patients, even in people who do not have obvious shoulder complaints. MSUS is a valuable imaging technique that assists in the diagnosis of HD patients who report shoulder pain.

Ultrasonographic evaluation of shoulder tendons in patients with Hashimoto's disease

OBJECTIVES

To investigate the thickness of the shoulder tendons and the measurement of acromiohumeral distance (AHD) in patients with Hashimoto's disease (HD).

MATERIAL AND METHODS

Twenty-eight patients with subclinical hypothyroid HD, 40 patients with euthyroid HD, and 51 healthy subjects were included. The thicknesses of biceps brachii, subscapularis, supraspinatus, infraspinatus tendons at both shoulders were evaluated with ultrasonography. Serum levels of thyroid stimulated hormone (TSH), free tri-iodothyronine, free thyroxine (FT4), anti-thyroid peroxidase (TPO) and anti-thyroglobulin (anti-TG) antibodies levels were measured.

RESULTS

Height, weight, body mass index (BMI), free T3 and free T4 levels were similar between the three groups (P = .839, P = .205, P = .374, P = .430 and P = .497, respectively). Biceps brachii, supraspinatus and infraspinatus tendon thicknesses in dominant arm and biceps brachii, subscapularis and infraspinatus tendon thicknesses in non-dominant arm were significantly increased in euthyroid HD compared to healthy controls (P = .003, P = .030, P < .001; P = .035, P = .042, P < .001, respectively). Biceps brachii tendon thickness in dominant arm and subscapularis and supraspinatus tendon thicknesses in non-dominant arms were significantly increased in subclinical hypothyroid HD compared to healthy controls (P = .025; P = .046, P = .017, respectively). However there was no such difference between euthyroid HD and subclinical hypothyroid HD groups (P < .05). There was low correlation between biceps brachii tendon thickness and free T4 level in non-dominant shoulder in patients with HD (r = .272 P = .030). For the rest of the tendons, there was no correlation between TSH, anti-TPO, anti-TG levels and tendon thicknesses in patients with HD.

CONCLUSIONS

This study suggests that thyroid autoimmunity in HD may lead to an increase in thickness of shoulder tendons.