How to know whether an inflammation is present in a tendinopathy?
I wonder how to know whether an inflammation is present in a tendinopathy. In other words, how to distinguish a tendinosis from a tendonitis. physical-therapy.advanceweb.com/Features/Articles/Tendinitis-or-Tendinosis.aspx says:
Therapists should be using a sort of process of elimination when it comes to figuring out whether their patient has degeneration or inflammation, advised Bishop. Since the patellar tendon is so close to the skin, PTs should be looking for obvious, visible symptoms of tendonitis to rule out tendinosis.
"What you should see with tendonitis patients are the hallmark signs of inflammation, like swelling, redness, or palpable amounts of fluid in or around the tendon," said Bishop. And if you don't see these signs, the pain the patient is experiencing is most likely caused by the degenerative condition rather than the inflammatory. "In the absence of those symptoms, the likelihood is that people don't have tendonitis -- but they have tendinosis, and this condition must be managed in a different way
I wonder whether they are other ways to detect an inflammation. I am mostly interested in epicondyles of the humerus.
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You can use an ultrasound probe with power doppler to look at blood flow to see if there is increased blood flow present that would be compatible with an inflammatory process.
And, neovascularization demonstrated by power Doppler may be present in more painful lesions
pubs.rsna.org/doi/full/10.1148/radiol.2272012069 but currently it's not possible to distinguish between tendinitis and tendinosis as the distinction may not exist. Cell activation studies suggests inflammation occurs in what was thought to be microscopically non inflammatory tendon lesions. m.bjsm.bmj.com/content/early/2013/03/08/bjsports-2012-091957.full
References:
Wakefield, Richard J., Andrew K. Brown, Philip J. O'Connor, and Paul Emery. "Power Doppler sonography: improving disease activity assessment in inflammatory musculoskeletal disease." Arthritis & Rheumatism 48, no. 2 (2003): 285-288.
Traditional gray-scale US has been successfully
used for some time for the detection of joint and soft
tissue inflammation (1–15). More recently, additional
US techniques, including Doppler, have been introduced,
offering the potential for improving the accuracy
of a US assessment. Doppler US is a technique for
making noninvasive measurements of blood flow and
was developed from the principles first described by
Austrian physicist Christian Doppler in 1842 (16). He
was the first to observe the effect of motion on sound
when he detected a change in the frequency of a sound
wave as a result of movement of either its source or
receiver.
[...] US has a number of advantages over other imaging
techniques. It is safe, noninvasive, and emits no
ionizing radiation. The equipment can be situated in the
rheumatology outpatient clinic, improving patient access
and enabling rapid, “real-time” dynamic examinations of
multiple joints in multiple planes at one sitting. In
addition, both the capital and running costs of US are
significantly lower than those of other imaging modalities, such as magnetic resonance imaging (MRI) and
computed tomography (CT).
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