School of Health and Rehabilitation Sciences: Physiotherapy, University of Queensland, St Lucia, Brisbane, Australia.
Transcare Transdisciplinary Pain Management Center, Groningen, The Netherlands.
Br J Sports Med. 2018 Mar;52(5):284-291. doi: 10.1136/bjsports-2016-097163. Epub 2017 Jul 11.
Case-control design.
Tendinopathy is characterised by pain on tendon loading. In persistent cases of upper limb tendinopathy, it is frequently associated with central nervous system sensitisation, whereas less commonly linked in the case of persistent lower limb tendinopathies.
Compare somatosensory and psychological profiles of participants with persistent patellar (PT) and Achilles tendinopathies (AT) with pain-free controls.
A comprehensive battery of Quantitative Sensory Testing (QST) was assessed at standardised sites of the affected tendon and remotely (lateral elbow) by a blinded assessor. Participants completed the Victorian Institute of Sports Assessment, a health-related quality of life questionnaire, the Hospital Anxiety and Depression Scale and the Active Australia Questionnaire. Independent t-test and analysis of covariance (sex-adjusted and age-adjusted) were performed to compare groups.
Participants with PT and AT did not exhibit differences from controls for the QST at the remote site, but there were differences at the affected tendon site. Compared with controls, participants with PT displayed significantly lower pressure pain threshold locally at the tendon (p=0.012) and fewer single limb decline squats before pain onset, whereas participants with AT only displayed fewer single heel raises before pain onset, but this pain was of a higher intensity.
PT and AT appear to be predominantly local not widespread pain states related to loading of tendons without significant features of central sensitisation.
Level 4.
病例对照设计。
肌腱病的特征是在肌腱负重时出现疼痛。在上肢肌腱病的持续病例中,它常与中枢神经系统敏化有关,而在持续下肢肌腱病的情况下则较少见。
比较髌腱(PT)和跟腱(AT)持续疼痛患者与无疼痛对照组的躯体感觉和心理特征。
由盲法评估者在受影响的肌腱的标准部位和远程部位(外侧肘部)进行全面的定量感觉测试(QST)评估。参与者完成了维多利亚运动评估、与健康相关的生活质量问卷、医院焦虑和抑郁量表以及积极澳大利亚问卷。进行独立 t 检验和协方差分析(性别调整和年龄调整)以比较组间差异。
与对照组相比,PT 和 AT 患者在远程部位的 QST 上没有差异,但在受影响的肌腱部位存在差异。与对照组相比,PT 患者在肌腱局部的压力疼痛阈值明显较低(p=0.012),在疼痛发作前单腿下蹲次数减少,而 AT 患者仅在疼痛发作前单腿提踵次数减少,但疼痛强度更高。
PT 和 AT 似乎主要是局部而不是广泛的与肌腱负重相关的疼痛状态,没有明显的中枢敏化特征。
4 级。