{"id":5979,"date":"2014-09-10T06:13:28","date_gmt":"2014-09-10T05:13:28","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bjsm\/?p=5979"},"modified":"2014-09-10T21:18:47","modified_gmt":"2014-09-10T20:18:47","slug":"top-10-clinical-pearls-from-tendons2014-ists-beginning-the-long-walk-to-tendon-freedom","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bjsm\/2014\/09\/10\/top-10-clinical-pearls-from-tendons2014-ists-beginning-the-long-walk-to-tendon-freedom\/","title":{"rendered":"Top 10 Clinical Pearls from #Tendons2014 \/ ISTS: Beginning the Long Walk to (tendon) Freedom"},"content":{"rendered":"

By Paul Dijkstra @DrPaulDijkstra & Jill Cook @ProfJillCook<\/h4>\n
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Micrograph of tendon insertion ‘tide line’.<\/figcaption><\/figure>\n

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Before we delve into evidence based medicine as it relates to tendons, here are the\u00a0top 10 short (clinical) pearls from the 3rd<\/sup> International Scientific Tendinopathy Symposium (ISTS) or #Tendons2014:<\/strong><\/span><\/p>\n

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  1. Tendinopathy is still not clearly defined<\/li>\n
  2. Do not treat all tendons with the same recipe \u2013 what works for the upper limb tendons might not be good for lower limb weight bearing tendons<\/li>\n
  3. Pain is complex \u2013 consider central sensitization; psychosocial factors contributing<\/li>\n
  4. Do not rely on (expensive) special investigations \u2013 they are often not helpful in diagnosis or follow up<\/li>\n
  5. UTC \u2013 (the imaging tool Ultrasound Tissue Characterization<\/a>) too early to use in private practice or isolation; research setting \/ big team perhaps OK<\/li>\n
  6. No good evidence for injections into or around tendons yet<\/li>\n
  7. Inflammation poorly defined and not part of the (clinical) equation \u2013 no evidence to suggest otherwise<\/li>\n
  8. Load, Load, Load \u2013 adjust; sensibly progress; role of isometrics<\/li>\n
  9. Each patient is an individual \u2013 own special genetic make-up. Treat them as individuals, do not fall into the trap of \u2018individual genetic profiling\u2019 and reject the direct to consumer genetic \u2018profiling\u2019 for whatever tendon reason!<\/li>\n
  10. We\u2019re giving the early steps on a long and complex road to understand tendons better!<\/li>\n<\/ol>\n

    We don\u2019t have an agreed, consensus definition for tendinopathy<\/em><\/strong>;<\/span> we\u2019re all thinking about tendons and tendon injuries from a biased personal framework, including our interpretation of \u2018evidence\u2019.<\/p>\n

    A question of concern for all clinicians is how effective (and efficient) our approach is to a specific, individual patient with a certain clinical problem. With the best of intentions, we can still do harm. An evidence-based approach helps minimise the potential for harm.<\/p>\n

    Time for a quick recap on EBM \u2013 because folks are overlooking elements. The term \u2018evidence-based medicine\u2019 (EBM) was coined by the David Sackett and colleagues at McMaster University in Ontario, Canada in the early 1990s. EBM gained significant ground worldwide since the inception in 1993 of the Cochrane Collaboration, a non-profit body which systematically organizes research information. The central role of the Cochrane Collaboration has been \u2018to liberate the results of unpublished clinical trials from their neglect, with the aim of pulling together separate strands of research into a coherent, useful and reliable guide to best outcomes\u2019. (1) <\/em><\/p>\n

    4 pillars of the evidence-based medicine\u00a0approach in the tendon context<\/strong><\/p>\n

    In its broadest form, EBM integrates the best research evidence with clinical expertise and patient values to achieve the best possible patient management.<\/p>\n

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    1. The best research evidence<\/strong> (systematic reviews of randomized clinical trials as the top level of evidence). It is important that we all agree on the fact that \u2018the plural of anecdote is NOT evidence\u2019.<\/em><\/li>\n
    2. Patient expectation<\/strong>, values, concerns:\n