Stephen Bird

1: In my mind myxoid and mucoid degeneration are the same thing and I use it when a cystic area appears in a collagen tendon as part of a degenerative phase tendinosis.
Tenomalacia is different as this refers to the softening of the tendon “compressibility” which occurs during the disrepair phase of tendinosis. With tenomalacia the tendon collagen is still visible, however the tendon is swollen, hyoechoic and soft when compressed.
With myxoid / mucoid degeneration there is no collagen visible, just an anechoic cystic space.

Personally I use myxoid

2: Kerry Thoirs did her Phd on this topic and came up with the same measurement as you use for carpal tunnel and the median nerve (10 square mm)
I also informally use the wrist to forearm ratio from the carpal tunnel as well. I measure the nerve proximally where it is sitting on the medial head of triceps in the Struthers canal area. This is my reference measurement and then I measure it where it is most swollen in the cubital tunnel and if me second measurement is 1.4 times bigger than my first one I call it swollen.

3: Many people have a fibrous band at the arcade of Frohse and I think of this as a normal variant, but it is a predisposing factor for PIN entrapment. If the patient has this variant and then a job or sport that uses resisted supination then they will develop neural oedema and symptoms. I only mention it if there are symptoms. So 2 people can have a fibrous band and on examination we will see kinking of the nerve with resisted supination, however one mat stay asymptomatic and the other mat develop symptoms due tot he activities they choose to undertake.
It is just like a Steide process of the talus or a large os trigonometry. A regular person may never develop symptoms but the ballerina can have her career ended by posterior ankle impingement when she does On Point training.

4: If you are at the myxoid degeneration stage you have degenerative phase tendinosis and the road back is difficult. The pain will burn out but the tendon may never recover to normal.
We have always used steroid for this and I think that times are changing slowly for the better as regenerative medicine starts to become more widely accepted. Personally I think it makes sense to look at an anabolic pathway out of tendinosis with physiotherapy loading exercises and other anabolic interventions like PRP, prolotherary etc.

I think this is the way of the future, however here in Australia we are very well paid by Medicare to stick steroid into and around tendons, however there is no Medicare support for PRP.

I wonder why we do steroid rather than regenerative medicine interventions !!!

In other parts of the world where there is no financial bias toward steroid use there is a greater use of PRP etc. The financial framework does certainly determine the way medicine is delivered to some extent in all countries.

I think we will see a slow and steady drift toward anabolic biased therapies in the future (not likely before I retire !)


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