0:00

What would be the best advice when describing the images

0:03

used to evaluate patients

0:05

after biological treatment of tendinopathies?

0:08

Mainly partial ruptures.

0:10

Taking into account

0:12

that many times no major changes are seen on the images.

0:16

What are the findings that make you think of improvement?

0:20

That's a very challenging question to answer,

0:23

and I, I don't know that I can answer it.

0:26

Um, I think the best answer to it is how the,

0:30

how the patient feels

0:32

because, you know, you're introducing blood

0:35

and, uh, spin down platelet rich plasma, uh,

0:38

sometimes you're taking as much as 90 ccs

0:41

and spinning it down and putting, putting it into, say,

0:45

a tenderness object.

0:46

Um, so I would say to you this, if you've had a focal defect

0:52

and now you're at least 90 days out

0:54

and that focal defect has filled in, that suggests

0:58

that things are going well.

1:00

But I, but I'd much prefer that, uh, you, you use

1:05

how the patient is doing rather than the

1:07

imaging, uh, in a vacuum. Okay.

1:11

The question here, uh, can you please show us

1:14

with a practical example?

1:16

I can't, 'cause I don't know if cases here, how

1:18

to evaluate ERUs fibrosis.

1:20

I don't know if you have a case or you wanna show that.

1:24

I just would make a couple points about it

1:26

before, maybe you have some images on that,

1:29

but, um, ERUs fibrosis is a strand of tissue

1:33

as we see it on mr.

1:34

But if you know, it's anatomy, it doesn't stop there.

1:38

It has medial and lateral limbs that go down

1:40

and attach to the surface of the ulnar.

1:44

And I, I learned that a number of years ago,

1:47

and since then I've been trying to find those limbs

1:49

and I have never been able to do so.

1:51

So for me, the lacerda fibrosis, I try

1:56

to find the val linear strand of tissue that blends

2:00

with the surface of the pronator flexor group.

2:03

And with injury, I look for the,

2:07

the most helpful finding is the edema usually superficial

2:10

and deep, but sometimes you can see actually disruption

2:14

of the fibers itself.

2:15

But I've never seen a case where I could follow

2:19

the injury down to where it attaches to the oma.

2:22

Yeah, I'm not sure this one will do it

2:24

because this is a, this is a very abnormal one.

2:28

Um, there's extensive interstitial signal in the,

2:31

in the erti and the erti is a, you know,

2:34

it's a fibroelastic membrane.

2:36

So here you're at the myotendinous junction

2:39

with, with the tendon.

2:40

And then as you leave the muscle and things flatten out.

2:44

Now this one doesn't flatten out

2:46

because it is involved, it's actually infiltrated

2:49

by this tissue that has involved the operative site.

2:53

So what I might do tomorrow for those of you that are here,

2:56

is maybe give you a quick snippet.

2:58

I'll find a normal one

3:00

and show you, show you the anatomy of a normal one.

3:03

And I, I will remember to do that

3:05

'cause I know they'll remind me.

3:06

Good.

3:08

Any other questions?

3:13

Okay. How do you describe a distal triceps injury

3:17

that involves a tendon portion, long

3:20

and lateral, the common tendon,

3:22

but not the medial muscular portion?

3:24

That's, do you consider them as complete ruptures?

3:26

It is the most it is, is it?

3:29

Yes, it is the most frequently observed pattern.

3:32

And in fact, I only showed you,

3:34

or I showed you a couple of cases,

3:36

but typically the muscular attachment

3:40

of the medial head is intact.

3:42

I do have a few cases where that was not the case.

3:45

Uh, I have examples of the central

3:49

or common tendon combined with injury to the medial tendon,

3:53

uh, as being involved together.

3:55

Uh, now complete

3:57

and incomplete tears is very, uh, interesting.

4:01

Remember when I talked about the rotator cuff,

4:03

I did not talk about complete tears

4:06

or, uh, incomplete tears of the rotator cuff.

4:09

I used the terminology full thickness or full width.

4:14

Uh, i, with the triceps and with the biceps.

4:17

I will often use the terms complete or incomplete.

4:21

So as you described this as a distal triceps injury

4:25

that involves a certain portion.

4:28

I might say that this is a complete tear of the tendon

4:31

of the long and lateral, uh, heads of the triceps muscle,

4:35

but it is not involving the tendon

4:38

or muscular attachment of the medial head.

4:40

But I wouldn't say that it's a complete tear

4:43

of the entire tendonous apparatus.

4:46

So that's how I would describe it.

4:48

And I, I handle it the exact same way.

4:50

And I will, uh, specifically tell them that the

4:53

muscular head, which rarely tears the medial head,

4:56

which rarely tears, it's got a very, very short tendon

4:58

by the way, is intact.

5:00

I'll add add that into the descriptor that you just gave.

5:04

Right. And is it incorrect

5:06

that the common extensive tendon is not really tendonous?

5:10

As far as I know, in younger people it is purely tenderness.

5:14

But as you go around the human body, as we get older

5:17

in some tendons, as they attach to bone, you get fibro,

5:20

cartilaginous, uh, changes.

5:23

So I think it would depend upon the age of the person

5:25

that you're talking about.