Soft Tissue Rheumatism

Diagnosis of Heel Pain

Heel pain is a common presenting symptom in ambulatory clinics. There are many causes, but a mechanical etiology is most common. Location of pain can be a guide to the proper diagnosis. The most common diagnosis is plantar fasciitis, a condition that leads to medial plantar heel pain, especially wit…|By Priscilla Tu|Jeffrey R. Bytomski

Soft tissue rheumatic conditions (rheumatism) probably account for most causes of “joint pain” than actual arthritis.

Patellar Tendinopathy

Sports Health. 2015 Sep;7(5):415-20. doi: 10.1177/1941738114568775. Epub 2015 Jan 23.|By Schwartz A , et al.

Knee pain is often not due to knee osteoarthritis. The pain may be due to bursitis, inflamed fat pads & plica, ligamentous & iliotibial strain, and this: patellar tendinopathy. I’ve got this, and I no longer run marathons.

So what are eccentric exercises? That’s the phase of muscular contraction while the muscle is lengthening (while concentric contraction occurs when the muscle contracts and shortens). Where patellar tendinosis is concerned, an example of eccentric exercise is to do sitting leg lifts, focusing on slow controlled release as the quadriceps are lengthened.

Here’s an ultrasound shot of my right patella tendon in long axis. Note the hypoechoeic area. I’m seriously considering injecting PRP into this lesion. 

Eugene Lim's photo.

Platelet-Rich Plasma in Arthroscopic Rotator Cuff Repair: A Meta-analysis of Randomised Controlled Trials

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Moving on to the shoulder, rotator cuff tears, tendinosis, impingement & bursitis are the main bane. Referred pain from the neck is also not uncommon.

Platelet-Rich Plasma Treatment With Physical Therapy in Chronic Partial Supraspinatus Tears

Despite the insufficient evidence, due to potential contribution to the improvement, platelet-rich plasma (PRP) is emerging as a promising method.The aim of this study was to assess the effectiveness of PRP injection in partial supraspinatus tears by …

In this study comparing PRP with physical therapy in partial rotator cuff tears, the various outcomes (pain, range of motion, function) at 12 months were similar.

Lateral Epicondylitis Treatment & Management

The most common overuse syndrome is related to excessive wrist extension and commonly referred to as “tennis elbow,” but it is actually more common in non-tennis players. It is also commonly referred to as lateral epicondylitis, but this is usually a misnomer because, in general, microscopic evaluat…

Elbow pain is overwhelmingly Tennis Elbow, and there is no “best” treatment. The popular toss-up is between needle fenestration (dry, saline/destrose, steroid, PRP) and ESWT.  Entrapment of the posterior interosseous nerve (PIN) at the arcade of Frohse can mimic the pain, albeit more vague and diffuse.  Hydrodissection may help in this case.