Deciphering the Pathogenesis of Tendinopathy: A Three-stages Process
Our understanding of the pathogenesis of "tendinopathy" is based on fragmented evidences like pieces of a jigsaw puzzle. We propose a "failed healing theory" to knit these fragments together, which can explain previous observations. We also propose that albeit "overuse injury" and other insidious "micro trauma" may well be primary triggers of the process, "tendinopathy" is not an "overuse injury" per se. The typical clinical, histological and biochemical presentation relates to a localized chronic pain condition which may lead to tendon rupture, the latter attributed to mechanical weakness. Characterization of pathological "tendinotic" tissues revealed coexistence of collagenolytic injuries and an active healing process, focal hypervascularity and tissue metaplasia. These observations suggest a failed healing process as response to a triggering injury. The pathogenesis of tendinopathy can be described as a three stage process: injury, failed healing and clinical presentation. It is likely that some of these "initial injuries" heal well and we speculate that predisposing intrinsic or extrinsic factors may be involved. The injury stage involves a progressive collagenolytic tendon injury. The failed healing stage mainly refers to prolonged activation and failed resolution of the normal healing process. Finally, the matrix disturbances, increased focal vascularity and abnormal cytokine profiles contribute to the clinical presentations of chronic tendon pain or rupture. With this integrative pathogenesis theory, we can relate the known manifestations of tendinopathy and point to the "missing links". This model may guide future research on tendinopathy, until we could ultimately decipher the complete pathogenesis process and provide better treatments.
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Muscle Roles: What is an Agonist, Antagonist, Stabilizer, Fixator or Neutralizer Muscle?
Perhaps the biggest misunderstanding about how skeletal muscles function to produce the body's movements concerns their particular role. Most people think that a muscle performs ONE particular and very defined role and that they always perform this role. This is not how it works. Muscles must work together to produce different bodily movements and a particular muscle's role may change depending on the movement.
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Torn Rotator Cuff
By Asheesh Bedi, M.D.
In an adult population, rotator cuff tears are the most common cause of debilitating shoulder pain and disability, with approximately 300,000 rotator cuff surgeries performed annually in the United States. The diagnosis and management of rotator cuff disease places a significant financial burden on the U.S. economy, amounting to an annual cost of 3 billion dollars.
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Computer work and Musculoskeletal Disorders of the Neck and Upper Extremity
Musculoskeletal complaints in the neck and upper extremity and computer work are common in modern society and both show an increasing trend. Several previous reviews have indicated a possible causal relationship between computer work and musculoskeletal complaints in the neck and arm [1-9]. The epidemiological studies concerning computer use and musculoskeletal health are mainly based on subjective measures of upper extremity musculoskeletal symptoms. This may give important knowledge with regard to preventing these ailments. However, when evaluating a possible causal relationship between computer work and musculoskeletal disorders, such as when handling insurance claims, it is necessary with a more objective measure of a sustained effect on the musculoskeletal system and this is the basis for the present review. In Norway this topic has a special interest at present (2010), as the government investigates the possibility to include specific musculoskeletal disorders on the list of occupational diseases that may receive compensation.
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The Shoulder Complex: Demystifying the Shoulder with Eric Beard
The shoulder joint itself is known as the glenohumeral joint. It is a multi-axial ball and socket enarthrodial joint. This joint is the articulation between the glenoid fossa of the scapula and the head of the humerus. This is the area that most people think of as the shoulder joint. The humerus is, however, one bone of the shoulder.
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