smjournalСпортивная медицина: наука и практикаSports medicine: research and practice2223-25242587-9014NEICON10.47529/2223-2524.2022.3.6smjournal-432Research ArticleСПОРТИВНАЯ ТРАВМАТОЛОГИЯSPORTS TRAUMATOLOGYОценка применения ударно-волновой терапии в комплексном лечении спортсменов с латеральным эпикондилитомShock wave therapy evaluation in the complex treatment of athletes with lateral epicondylitishttps://orcid.org/0000-0002-3361-4522ИвановМ. В.IvanovM. V.

Иванов Марк Владимирович, ассистент кафедры восстановительной медицины, спортивной медицины, курортологии и физиотерапии медико-биологического университета инноваций и непрерывного образования

123098, Москва, ул. Маршала Новикова, 23

Mark V. Ivanov, assistant professor of the Department of Rehabilitation Medicine, Sports Medicine, Balneology and Physiotherapy of Biomedical University of Innovation and Continuing Education

23, Marshala Novikova str., Moscow, 123098

dr.markivanov@gmail.comhttps://orcid.org/0000-0002-9241-7238СамойловА. С.SamoylovA. S.

Самойлов Александр Сергеевич, д.м.н., профессор, член-корреспондент РАН, генеральный директор

123098, Москва, ул. Маршала Новикова, 23

Alexander S. Samoylov, M.D., D.Sc. (Medicine), Professor, Corresponding Member of the RAS, general director

23, Marshala Novikova str., Moscow, 123098

fmbc@fmba.ruhttps://orcid.org/0000-0002-8733-2504ЖестянкинН. Р.ZhestyankinN. R.

Жестянкин Никита Романович, студент

127473, Москва, ул. Делегатская, 20, стр. 1

Nikita R. Zhestyankin, student

20, bld. 1, Delegatskaya str., Moscow, 127473

nikita221100@mail.ruФГБУ «Государственный научный центр РФ — Федеральный медицинский биофизический центр имени А.И. Бурназяна» Федерального медико-биологического агентстваРоссияRussian State Research Center — Burnasyan Federal Medical Biophysical Center of Federal Medical Biological AgencyRussian FederationФГБОУ ВО «Московский государственный медико-стоматологический университет имени А.И. Евдокимова» Минздрава РоссииРоссия“A.I. Yevdokimov Moscow State University of Medicine and Dentistry”Russian Federation202220122022123513Copyright © Иванов М.В., Самойлов А.С., Жестянкин Н.Р., 20232023Иванов М.В., Самойлов А.С., Жестянкин Н.Р.Ivanov M.V., Samoylov A.S., Zhestyankin N.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.smjournal.ru/jour/article/view/432Цель исследования

Цель исследования: в сравнительном аспекте оценить эффективность ударно-волновой терапии в комплексном лечении спортсменов с латеральным эпикондилитом по сравнению со стандартными методами лечения.

Материалы и методы

Материалы и методы: на амбулаторном лечении в период с 2019 по 2022 г. находились 168 спортсменов с диагнозом «M77. 1 Латеральный эпикондилит», из них 78 женщин (46,4 %) и 90 мужчин (53,6 %) в возрасте от 20 до 45 лет. Средний возраст пациентов составил 31,48 ± 6,72 года. Средняя длительность заболевания составила 33,68 ± 28,17 дня. Для решения поставленных цели и задач было проведено проспективное рандомизированное контролируемое клиническое исследование. В работе использовали клиническое обследование пациентов, исследование кистевой динамометрии пораженной руки, оценку уровня боли и качества жизни по шкалам QuickDash и Patient-Rated Tennis Elbow Evaluation (PRTEE), статистические методы исследования, а также применение стандартного лечения латерального эпикондилита и радиальной ударно-волновой терапии с оценкой эффективности через месяц после лечения.

Результаты

Результаты: ударно-волновая терапия в комплексном лечении спортсменов с латеральным эпикондилитом по сравнению со стандартными методами лечения позволяет повысить качество жизни и уменьшить боль через три недели от начала лечения и имеет более выраженный эффект в отсроченной перспективе (p < 0,05); позволяет снизить интенсивность сигнала от костной ткани (трабекулярный отек) по результатам магнитно-резонансной томографии.

Заключение

Заключение: обоснована целесообразность применения ударно-волновой терапии в комплексном лечении спортсменов с латеральным эпикондилитом, что дает возможность рекомендовать его использование в практическом здравоохранении.

Objective

Objective: to evaluate the effectiveness of shock wave therapy in the complex treatment of athletes with lateral epicondylitis in comparison with standard methods of treatment.

Materials and methods

Materials and methods: On outpatient treatment in the period from 2019 to 2022. There were 168 athletes diagnosed with Lateral epicondylitis, including 78 women (46.4 %) and 90 men (53.6 %) aged 20 to 45 years. The mean age of the patients was 31.48 ± 6.72 years. The average duration of the disease was 33.68 ± 28.17 days. To achieve the set goals and objectives, a prospective randomized controlled clinical trial was conducted. We used a clinical examination of patients, a study of carpal dynamometry of the affected arm, an assessment of the level of pain and quality of life using the QuickDash and Patient-Rated Tennis Elbow Evaluation (PRTEE) scales, statistical research methods, as well as the use of standard treatment for lateral epicondylitis and radial shock wave therapy with an assessment of effectiveness one month after treatment.

Results

Results: shock wave therapy in the complex treatment of athletes with lateral epicondylitis, compared with standard methods of treatment, improved the quality of life and reduced pain three weeks after the start of treatment and has a more pronounced effect in the long term (p < 0.05); allowed to reduce the intensity of the signal from the bone tissue (trabecular edema) according to the results of magnetic resonance imaging.

Conclusion

Conclusion: the expediency of using shock wave therapy in the complex treatment of athletes with lateral epicondylitis is substantiated, which makes it possible to recommend its use in practical healthcare.

латеральный эпикондилиттендиниттравма сухожилияlateral epicondylitistendinitistendon injuryReferencesIkonen J., Lähdeoja T., Ardern C.L., Buchbinder R., Reito A., Karjalainen T. Persistent Tennis Elbow Symptoms Have Little Prognostic Value: A Systematic Review and Meta-analysis. Clin. Orthop. Relat. Res. 2022;480(4):647–660. https://doi.org/10.1097/corr.0000000000002058Ikonen J., Lähdeoja T., Ardern C.L., Buchbinder R., Reito A., Karjalainen T. Persistent Tennis Elbow Symptoms Have Little Prognostic Value: A Systematic Review and Meta-analysis. Clin. Orthop. Relat. Res. 2022;480(4):647–660. https://doi.org/10.1097/corr.0000000000002058Elzaki M., Kelly M., Foghlú C.N., Lenehan B., O’Farrell D. Tennis elbow: what is the score on Internet-based information? Ir. J. Med Sci. 2022;191(1):497–498. https://doi.org/10.1007/s11845-021-02559-6Elzaki M., Kelly M., Foghlú C.N., Lenehan B., O’Farrell D. Tennis elbow: what is the score on Internet-based information? Ir. J. Med Sci. 2022;191(1):497–498. https://doi.org/10.1007/s11845-021-02559-6Dragoo J.L., Meadows M.C. The use of biologics for the elbow: a critical analysis review. J. Shoulder Elbow Surg. 2019;28(11):2053–2060. https://doi.org/10.1016/j.jse.2019.07.024Dragoo J.L., Meadows M.C. The use of biologics for the elbow: a critical analysis review. J. Shoulder Elbow Surg. 2019;28(11):2053–2060. https://doi.org/10.1016/j.jse.2019.07.024Day J.M., Lucado A.M., Dale R.B., Merriman H., Marker C.D., Uhl T.L. The Effect of Scapular Muscle Strengthening on Functional Recovery in Patients With Lateral Elbow Tendinopathy: A Pilot Randomized Controlled Trial. J. Sport Rehabil. 2021;30(5):744–753. https://doi.org/10.1123/jsr.2020-0203Day J.M., Lucado A.M., Dale R.B., Merriman H., Marker C.D., Uhl T.L. The Effect of Scapular Muscle Strengthening on Functional Recovery in Patients With Lateral Elbow Tendinopathy: A Pilot Randomized Controlled Trial. J. Sport Rehabil. 2021;30(5):744–753. https://doi.org/10.1123/jsr.2020-0203Runge F. Zur genese und behandlung des schreibekramfes. Berlin Klin Wochenschr. 1873;10:245–248 (In German).Runge F. Zur genese und behandlung des schreibekramfes. Berlin Klin Wochenschr. 1873;10:245–248 (In German).Castillo-Lozano R., Casuso-Holgado M.J. Incidence of musculoskeletal sport injuries in a sample of male and female recreational paddle-tennis players. J. Sports Med. Phys. Fitness. 2016;57(6):816–821. https://doi.org/10.23736/s0022-4707.16.06240-xCastillo-Lozano R., Casuso-Holgado M.J. Incidence of musculoskeletal sport injuries in a sample of male and female recreational paddle-tennis players. J. Sports Med. Phys. Fitness. 2016;57(6):816–821. https://doi.org/10.23736/s0022-4707.16.06240-xBhandari R., Sinha R., Kayastha N., Joshi A. Calcific Tendinitis in the Elbow Presented as Acute Tennis Elbow. J. Nepal Health Res. Counc. 2020;17(4):553–555. https://doi.org/10.33314/jnhrc.v17i4.2104Bhandari R., Sinha R., Kayastha N., Joshi A. Calcific Tendinitis in the Elbow Presented as Acute Tennis Elbow. J. Nepal Health Res. Counc. 2020;17(4):553–555. https://doi.org/10.33314/jnhrc.v17i4.2104Shiri R., Viikari-Juntura E., Varonen H., Heliovaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am. J. Epidemiol. 2006;164(11):1065–1074. https://doi.org/10.1093/aje/kwj325Shiri R., Viikari-Juntura E., Varonen H., Heliovaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am. J. Epidemiol. 2006;164(11):1065–1074. https://doi.org/10.1093/aje/kwj325Yi R., Bratchenko W.W., Tan V. Deep Friction Massage Versus Steroid Injection in the Treatment of Lateral Epicondylitis. Hand. 2018;13(1):56–59. https://doi.org/10.1177/1558944717692088Yi R., Bratchenko W.W., Tan V. Deep Friction Massage Versus Steroid Injection in the Treatment of Lateral Epicondylitis. Hand. 2018;13(1):56–59. https://doi.org/10.1177/1558944717692088Tarpada S.P., Morris M.T., Lian J., Rashidi S. Current advances in the treatment of medial and lateral epicondylitis. J. Orthop. 2018;15(1):107–110. https://doi.org/10.1016/j.jor.2018.01.040Tarpada S.P., Morris M.T., Lian J., Rashidi S. Current advances in the treatment of medial and lateral epicondylitis. J. Orthop. 2018;15(1):107–110. https://doi.org/10.1016/j.jor.2018.01.040Ahmed A.F., Rayyan R., Zikria B.A., Salameh M. Lateral epicondylitis of the elbow: an up-to-date review of management. Eur. J. Orthop. Surg. Traumatol. 2022 Jan. 15. https://doi.org/10.1007/s00590-021-03181-z.Ahmed A.F., Rayyan R., Zikria B.A., Salameh M. Lateral epicondylitis of the elbow: an up-to-date review of management. Eur. J. Orthop. Surg. Traumatol. 2022 Jan. 15. https://doi.org/10.1007/s00590-021-03181-z.Graf D.N., Fritz B., Bouaicha S., Sutter R. Elbow Instability. Semin. Musculoskelet. Radiol. 2021;25(4):574–579. https://doi.org/10.1055/s-0041-1735467Graf D.N., Fritz B., Bouaicha S., Sutter R. Elbow Instability. Semin. Musculoskelet. Radiol. 2021;25(4):574–579. https://doi.org/10.1055/s-0041-1735467Houck D.A., Kraeutler M.J., Thornton L.B., McCarty E.C., Bravman J.T. Treatment of Lateral Epicondylitis With Autologous Blood, Platelet-Rich Plasma, or Corticosteroid Injections: A Systematic Review of Overlapping Meta-analyses. Orthop. J. Sports Med. 2019;7(3):2325967119831052. https://doi.org/10.1177/2325967119831052Houck D.A., Kraeutler M.J., Thornton L.B., McCarty E.C., Bravman J.T. Treatment of Lateral Epicondylitis With Autologous Blood, Platelet-Rich Plasma, or Corticosteroid Injections: A Systematic Review of Overlapping Meta-analyses. Orthop. J. Sports Med. 2019;7(3):2325967119831052. https://doi.org/10.1177/2325967119831052Dedes V., Tzirogiannis K., Polikandrioti M., Dede A.M., Mitseas A., Panoutsopoulos G.I. Comparison of radial extracorporeal shockwave therapy with ultrasound therapy in patients with lateral epicondylitis. J. Med. Ultrason. 2020;47(2):319–325. https://doi.org/10.1007/s10396-019-01002-9Dedes V., Tzirogiannis K., Polikandrioti M., Dede A.M., Mitseas A., Panoutsopoulos G.I. Comparison of radial extracorporeal shockwave therapy with ultrasound therapy in patients with lateral epicondylitis. J. Med. Ultrason. 2020;47(2):319–325. https://doi.org/10.1007/s10396-019-01002-9Descatha A., Albo F., Leclerc A., Carton M., Godeau D., Roquelaure Y., et al. Lateral epicondylitis and physical exposure at work? A review of prospective studies and meta-analysis. Arthritis Care Res. 2016;68(11):1681–1687. https://doi.org/10.1002/acr.22874Descatha A., Albo F., Leclerc A., Carton M., Godeau D., Roquelaure Y., et al. Lateral epicondylitis and physical exposure at work? A review of prospective studies and meta-analysis. Arthritis Care Res. 2016;68(11):1681–1687. https://doi.org/10.1002/acr.22874Clarke A.W., Ahmad M., Curtis M., Connell D.A. Lateral elbow tendinopathy: Correlation of ultrasound findings with pain and functional disability. Am. J. Sports Med. 2010;38(6):1209–1214. https://doi.org/10.1177/0363546509359066Clarke A.W., Ahmad M., Curtis M., Connell D.A. Lateral elbow tendinopathy: Correlation of ultrasound findings with pain and functional disability. Am. J. Sports Med. 2010;38(6):1209–1214. https://doi.org/10.1177/0363546509359066Challoumas D., Kirwan P.D., Borysov D., Clifford C., McLean M., Millar N.L. Topical glyceryl trinitrate for the treatment of tendinopathies: A systematic review. Br. J. Sports Med. 2019;53(4):251–262. https://doi.org/10.1136/bjsports-2018-099552Challoumas D., Kirwan P.D., Borysov D., Clifford C., McLean M., Millar N.L. Topical glyceryl trinitrate for the treatment of tendinopathies: A systematic review. Br. J. Sports Med. 2019;53(4):251–262. https://doi.org/10.1136/bjsports-2018-099552Özmen T., Koparal S.S., Karataş Ö., Eser F., Özkurt B., Gafuroğlu T.Ü. Comparison of the clinical and sonographic effects of ultrasound therapy, extracorporeal shock wave therapy, and Kinesio taping in lateral epicondylitis. Turkish journal of medical sciences. 2021;51(1):76–83. https://doi.org/10.3906/sag-2001-79Özmen T., Koparal S.S., Karataş Ö., Eser F., Özkurt B., Gafuroğlu T.Ü. Comparison of the clinical and sonographic effects of ultrasound therapy, extracorporeal shock wave therapy, and Kinesio taping in lateral epicondylitis. Turkish journal of medical sciences. 2021;51(1):76–83. https://doi.org/10.3906/sag-2001-79Yan C., Xiong Y., Chen L., Endo Y., Hu L., Liu M., et al. A comparative study of the efficacy of ultrasonics and extracorporeal shock wave in the treatment of tennis elbow: a meta-analysis of randomized controlled trials. J. Orthop. Surg. Res. 2019;14(1):248. https://doi.org/10.1186/s13018-019-1290-yYan C., Xiong Y., Chen L., Endo Y., Hu L., Liu M., et al. A comparative study of the efficacy of ultrasonics and extracorporeal shock wave in the treatment of tennis elbow: a meta-analysis of randomized controlled trials. J. Orthop. Surg. Res. 2019;14(1):248. https://doi.org/10.1186/s13018-019-1290-yWalton M.J., Mackie K., Fallon M., Butler R., Breidahl W., Zheng M.H., Wang A. The reliability and validity of magnetic resonance imaging in the assessment of chronic lateral epicondylitis. J. Hand. Surg. Am. 2011;36(3):475–479. https://doi.org/10.1016/j.jhsa.2010.11.040Walton M.J., Mackie K., Fallon M., Butler R., Breidahl W., Zheng M.H., Wang A. The reliability and validity of magnetic resonance imaging in the assessment of chronic lateral epicondylitis. J. Hand. Surg. Am. 2011;36(3):475–479. https://doi.org/10.1016/j.jhsa.2010.11.040Patel H., Lala S., Helfner B., Wong T.T. Tennis overuse injuries in the upper extremity. Skeletal Radiol. 2021;50(4):629–644. https://doi.org/10.1007/s00256-020-03634-2Patel H., Lala S., Helfner B., Wong T.T. Tennis overuse injuries in the upper extremity. Skeletal Radiol. 2021;50(4):629–644. https://doi.org/10.1007/s00256-020-03634-2Thomas L., Kremers H.M., Bryan A.J., Ransom J.E., Smith J., Morrey B.F. The Epidemiology and Health Care Burden of Tennis Elbow. A Population-Based Study. Am. J. Sports Med. 2015; 43(5):1066–1071. https://doi.org/10.1177/0363546514568087Thomas L., Kremers H.M., Bryan A.J., Ransom J.E., Smith J., Morrey B.F. The Epidemiology and Health Care Burden of Tennis Elbow. A Population-Based Study. Am. J. Sports Med. 2015; 43(5):1066–1071. https://doi.org/10.1177/0363546514568087Sayegh E.T., Strauch R.J. Does nonsurgical treatment improve longitudinal outcomes of lateral epicondylitis over no treatment? A meta-analysis. Clin. Orthop. Relat. Res. 2015;473(3):1093–1107. https://doi.org/10.1007/s11999-014-4022-ySayegh E.T., Strauch R.J. Does nonsurgical treatment improve longitudinal outcomes of lateral epicondylitis over no treatment? A meta-analysis. Clin. Orthop. Relat. Res. 2015;473(3):1093–1107. https://doi.org/10.1007/s11999-014-4022-yMezian K., Novotný T., Chomiak J., Hrazdira L. Sonografické vyšetření lokte [Scanning Technique in Elbow Ultrasonography]. Acta Chir. Orthop. Traumatol. Cech. 2021;88(4 Suppl):15–20.Mezian K., Novotný T., Chomiak J., Hrazdira L. Sonografické vyšetření lokte [Scanning Technique in Elbow Ultrasonography]. Acta Chir. Orthop. Traumatol. Cech. 2021;88(4 Suppl):15–20.Tarpada S.P., Morris M.T., Lian J., Rashidi S. Current advances in the treatment of medial and lateral epicondylitis. J. Orthop. 2018;15(1):107–110. https://doi.org/10.1016/j.jor.2018.01.040Tarpada S.P., Morris M.T., Lian J., Rashidi S. Current advances in the treatment of medial and lateral epicondylitis. J. Orthop. 2018;15(1):107–110. https://doi.org/10.1016/j.jor.2018.01.040Struijs P.A., Kerkhoffs G.M., Assendelft W.J., Van Dijk C.N. Conservative treatment of lateral epicondylitis: Brace versus physical therapy or a combination of both — A randomized clinical trial. Am. J. Sports Med. 2004;32(2):462–469. https://doi.org/10.1177/0095399703258714Struijs P.A., Kerkhoffs G.M., Assendelft W.J., Van Dijk C.N. Conservative treatment of lateral epicondylitis: Brace versus physical therapy or a combination of both — A randomized clinical trial. Am. J. Sports Med. 2004;32(2):462–469. https://doi.org/10.1177/0095399703258714Nirschl R.P. Tennis elbow. Orthop. Clin. North Am. 1973;4:787–800.Nirschl R.P. Tennis elbow. Orthop. Clin. North Am. 1973;4:787–800.Martin S., Sanchez E. Anatomy and biomechanics of the elbow joint. Semin. Musculoskelet. Radiol. 2013;17(5):429–436. https://doi.org/10.1055/s-0033-1361587Martin S., Sanchez E. Anatomy and biomechanics of the elbow joint. Semin. Musculoskelet. Radiol. 2013;17(5):429–436. https://doi.org/10.1055/s-0033-1361587Ma K.L., Wang H.Q. Management of Lateral Epicondylitis: A Narrative Literature Review. Pain Res. Manag. 2020;2020:6965381. https://doi.org/10.1155/2020/6965381Ma K.L., Wang H.Q. Management of Lateral Epicondylitis: A Narrative Literature Review. Pain Res. Manag. 2020;2020:6965381. https://doi.org/10.1155/2020/6965381Keijsers R., de Vos R.J., Kuijer P.P.F., van den Bekerom M.P., van der Woude H.J., Eygendaal D. Tennis elbow. Shoulder Elbow. 2019;11(5):384–392. https://doi.org/10.1177/1758573218797973Keijsers R., de Vos R.J., Kuijer P.P.F., van den Bekerom M.P., van der Woude H.J., Eygendaal D. Tennis elbow. Shoulder Elbow. 2019;11(5):384–392. https://doi.org/10.1177/1758573218797973Kannus P., Józsa L. Histopathological changes preceding spontaneous rupture of a tendon: a controlled study of 891 patients. J. Bone Joint Surg. 1991;73(10):1507–1525. https://doi.org/10.2106/00004623-199173100-00009Kannus P., Józsa L. Histopathological changes preceding spontaneous rupture of a tendon: a controlled study of 891 patients. J. Bone Joint Surg. 1991;73(10):1507–1525. https://doi.org/10.2106/00004623-199173100-00009Doran A., Gresham G.A., Rushton N., Watson C. Tennis elbow: a clinicopathologic study of 22 cases followed for 2 years. Acta Orthop. Scand. 1990;61:535–538. https://doi.org/10.3109/17453679008993577Doran A., Gresham G.A., Rushton N., Watson C. Tennis elbow: a clinicopathologic study of 22 cases followed for 2 years. Acta Orthop. Scand. 1990;61:535–538. https://doi.org/10.3109/17453679008993577Pattanittum P., Turner T., Green S., Buchbinder R. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst. Rev. 2013;2013(5):CD003686. https://doi.org/10.1002/14651858.cd003686.pub2Pattanittum P., Turner T., Green S., Buchbinder R. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst. Rev. 2013;2013(5):CD003686. https://doi.org/10.1002/14651858.cd003686.pub2Li A., Wang H., Yu Z., Zhang G., Feng S., Liu L., Gao Y. Platelet-rich plasma vs corticosteroids for elbow epicondylitis: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(51):e18358. https://doi.org/10.1097/md.0000000000018358Li A., Wang H., Yu Z., Zhang G., Feng S., Liu L., Gao Y. Platelet-rich plasma vs corticosteroids for elbow epicondylitis: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(51):e18358. https://doi.org/10.1097/md.0000000000018358Kraushaar B.S., Nirschl R.P. Tendinosis of the elbow (tennis elbow): clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J. Bone Joint Surg. 1999;81(2):259–278. https://doi.org/10.2106/00004623-199902000-00014Kraushaar B.S., Nirschl R.P. Tendinosis of the elbow (tennis elbow): clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J. Bone Joint Surg. 1999;81(2):259–278. https://doi.org/10.2106/00004623-199902000-00014Coombes B.K., Bisset L., Vicenzino B. A new integrative model of lateral epicondylalgia. Br. J. Sports Med. 2009;43(4):252–258. https://doi.org/10.1136/bjsm.2008.052738Coombes B.K., Bisset L., Vicenzino B. A new integrative model of lateral epicondylalgia. Br. J. Sports Med. 2009;43(4):252–258. https://doi.org/10.1136/bjsm.2008.052738Arnoczky S.P., Tian T., Lavagnino M, Keri Gardner, Paul Schuler, Patrick Morse. Activation of stress-activated protein kinases (SAPK) in tendon cells following cyclic strain: the effects of strain frequency, strain magnitude, and cytosolic calcium. J. Orthop. Res. 2002;20(5):947–952. https://doi.org/10.1016/s0736-0266(02)00038-4Arnoczky S.P., Tian T., Lavagnino M, Keri Gardner, Paul Schuler, Patrick Morse. Activation of stress-activated protein kinases (SAPK) in tendon cells following cyclic strain: the effects of strain frequency, strain magnitude, and cytosolic calcium. J. Orthop. Res. 2002;20(5):947–952. https://doi.org/10.1016/s0736-0266(02)00038-4Allander E. Prevalence, incidence, and remission rates of some common rheumatic diseases or syndromes. Scand. J. Rheumatol. 1974;3(3):145–153. https://doi.org/10.3109/03009747409097141Allander E. Prevalence, incidence, and remission rates of some common rheumatic diseases or syndromes. Scand. J. Rheumatol. 1974;3(3):145–153. https://doi.org/10.3109/03009747409097141

The authors declare that there are no conflicts of interest present.