5 inch standard needle is guided under real-time ultrasound guidance to the insertion of the calcaneal tendon and specifically underneath/anterior to any identified enthesophyte and in very close proximity to calcification.
Ultrasound evaluation in the clinic showed a prominent enthesophyte along with insertional mixed echogenicity of the Achilles tendon.
Ultrasound evaluation showed a prominent enthesophyte in proximity to the insertion of the Achilles tendon.
As the enthesophyte grew, the already weaker tendon insertion deep to the enthesophyte was subjected to a less nourishing environment and began terminal breakdown.
The difference in these cases is that the patients had pain primarily with push off at the area of the enthesophyte and that care was taken to only and specifically inject the small area of tissue between the enthesophyte and the calcaneus.
Ultrasound guidance should be the technique of choice for prolotherapy injection for this condition as it provides the highest likelihood that the injectable fluid is placed in deep to the enthesophyte or calcified area.
Caption: FIGURE 2: Long axis view ultrasound evaluation in a male with long-time chronic symptoms shows enthesophyte irregularity of the cortex of the calcaneus as well as intratendinous calcification at the Achilles tendon insertion.
Factors for rotator cuff pathology like diminished vascularity in the cuff tissue and the extrinsic factors like impingement secondary to spurs, enthesophytes, downsloping acromion, type II and III of acromion increases with age.
13) Variation in acromion configuration and slope with presence of enthesophytes drastically affects the space available for supraspinatus tendon, especially during abduction and rotational movements.
The presence of enthesophytes with supraspinatus pathology were found in some patients using ultrasound, which showed sensitivity, specificity and accuracy of 35%, 100% and 74% respectively compared to MRI and significant p value difference of .