ROUNDS RESPONSE.
Rounds is your vehicle for sharing your orthopaedic skills and experience. Your response to Rounds will be published in a future issue of Body Cast. We invite you to suggest questions for this column. Please address all submissions to: The Editor, Body Cast, 18 Wynford Drive, Suite 715A, North York, Ontario, M3C 3S2.

This Issue's Rounds Question -
Please tell us: What advice or tips would you give a patient wearing a figure of eight bandage for a fractured clavicle?
(Question submitted by J.P. Piche and Wendy Fast, Saskatoon)
(responses to be published in next issue)

In the last issue of Body Cast, Rounds asked: What is the difference between Achilles tendonitis and Achilles tendonosis?

The following answers were received:

From Brad DeWagner:
Achilles tendonitis and tendonosis are two very common conditions occurring in the heel, and are very often associated with runners. These pathologies are often lumped together and labelled Achilles tendonopathy.

Achilles tendonitis is an inflammation of the Achilles tendon, often manifesting itself during or following activity. This inflammation is generally short-lived. Over time and with repeated trauma, this condition often leads to a degeneration of the tendon (Achilles tendenosis) where it may develop microscopic tears. This may present itself with associated pain or have little in the way of symptoms initially, until it may present itself as a rupture.

From Ed Clancey and Neil Lockyer:
Achilles tendonitis: the Achilles tendon is the large tendon at the back of the ankle. It connects the large calf muscle (Gastrocnemius and Soleus) to the heel bone (Calcaneus) and provides the power in the push-off phase of the gait cycle (walking and running).

Achilles tendonitis can be either acute, meaning is occurs for a period of a few days, or chronic, which occurs over a longer period of time. The condition can either be at the attachment of the tendon to the heel or, more typically, around 4 cm above the heel mid portion.

Symptoms: gradual onset of pain, pain at the onset of exercise, pain eases with rest, tenderness on palpation.

Achilles tendonitis is an overuse injury. Too much too soon is the basic cause of overuse injuries.

Achilles tendonosis: The progressive degeneration of the Achilles tendon in which the tendon loses its organized structure and is likely to develop microscopic tears. Sometimes the degeneration involves the site where the Achilles tendon attaches to the heel bone. In rare cases, chronic degeneration with or without pain may result in rupture of the tendon.

Symptoms: when the disorder progresses to degeneration, the tendon may become enlarged and may develop nodules in the area where the tissue is damaged.

From Janet Cannon and Mike Walker:
The difference between Achilles tendonitis and tendonosis is that tendonitis of the Achilles is the inflammation of the large tendon at the back of the ankle. It is an overuse injury.

Over time, tendonitis can develop into tendonosis, which is the degeneration of the tendon. It is the development of microscopic tears in the tendon itself.

From Lhea Burk:
Achilles tendonitis causes inflammation and degeneration of the Achilles tendon. This should not be left unattended as the tendon can become ruptured.

Achilles tendonosis is chronic overuse that can contribute to degeneration and thickening of the tendon.

Responses were also received from: R. Aceron, L. Arseneau, T. Bellon, MJ. Buchner, J. Carragher, M. Christenson, E. Christiansen, R. Chun, A. Crossman, D. Edwards, W. Fast, H. Fehr, A. Gale, D. Gauthier, A. Gibbs, M. Gillingham, R. Grenier, S. Groulx, L. Head, S. Jankowski, B. Lavallee, B. Letourneau, C. Longphee, L. Lough, L. MacDonald, B. Manley, G. Marshall, B. Matheson, A. Minoo, J. Movasseli, E. Oborowsky, R. Pagay, R. Passmore, J.P. Piche, J. Pike, P. Power, J. Punwassie, L. Pizzale, B. Rawlings, V. Robichaud, E. Seguin, B. Sheppard, S. Shivpaul, A. Tarambikos, C. Thompson, A. Wentzell, H. Wong, N. Yao, and T Yorke.