Malcolm Read Scholarship Winner 2009 – Dr Richard Seah

Dr Richard Seah MSc MAcadMed MRCGP MFSEM(UK&I) DSEM(GB&I) DCH

Abstract

Introduction

Tendons are inelastic fibrous tissues which connect muscle to bone. During activities such as jumping and running, tendons can suffer repeated microscopic tears. With age and persistent use, the ability to heal these microscopic tears becomes extremely limited and degeneration of the tendon escalates, causing severe pain, swelling and disability. Histologically, the diseased tendon shows evidence of degeneration and abnormal tissue architecture (tendinosis), with increasing collagen disarray and neovascularisation. Ultrasound imaging is the current ‘gold standard’ for diagnosis for these conditions. In the heel, this condition is referred to clinically as ‘achilles tendinopathy’ (AT) and within the knee, ‘patellar tendinopathy’ (PT). The current ‘gold standard’ treatment for these conditions at present is ‘eccentric loading’ physiotherapy (EP). This treatment modality is, however, far from perfect.

Aims & Objectives

I wish to consider whether the use of 2 promising and novel ultrasound-guided injection therapies (High volume image guided injections and Platelet-rich plasma injections) in addition to EP can significantly improve upon existing results. To this end, I propose a pilot study considering the following:

References

  1. A literature review of the evidence for the use of these novel injections in AT and PT.
  2. A feasibility study to consider what is required to set up and power a randomised control trial looking at these 2 novel injections in addition to eccentric physiotherapy in treating AT and PT.
  3. Once formal permission has been obtained from the Research Ethical Committee (REC) to proceed, to consider the preliminary results generated by direct comparison of the 2 treatments in addition to eccentric physiotherapy in treating recalcitrant AT and PT.

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