Neovascularisation is associated with pain in Achilles tendinopathy (AT). The anatomical relationship between ultrasound (US)-defined indicators of tendinopathy and clinically determined pain sites has not been investigated. The objective of this study was to measure the spatial correlation between the sites of maximum palpated tenderness, site of patient-indicated pain, maximum US-determined neovascularisation and maximum antero-posterior tendon thickness in patients with chronic recalcitrant AT (CRAT). A custom-designed measuring apparatus and clinical examination were used to measure the sites of maximum tenderness and subjectively defined pain on 29 tendons from patients diagnosed with mid-tendon CRAT. All tendons had been previously non-responsive to eccentric loading. Maximal neovascularisation and tendon thickness were measured by US scanning in conjunction with the measuring device. A significant association exists between clinically determined pain and neovascularisation, patient reported pain, maximal tendon thickness, maximal thickness and maximal neovascularisation.
Sites of subjectively defined pain, clinically palpated tenderness, tendon thickness and neovascularisation are anatomically associated. Palpation can be reliably used as a clinical guide when planning interventions in patients with CRAT.
Kiran Divani, Otto Chan, Nat Padhiar, Richard Twycross-Lewis, Nicola Maffulli, Tom Crisp and Dylan Morrissey.Â Site of maximum neovascularisation correlates with the site of pain in recalcitrant mid-tendon Achilles tendinopathy. Manual Therapy, 28 April 2010, online article ahead of print