Site of maximum neovascularisation correlates with the site of pain in recalcitrant mid-tendon Achilles tendinopathy

Man Ther. 2010 Oct;15(5):463-8. doi: 10.1016/j.math.2010.03.011. Epub 2010 Apr 28.


Background: Neovascularisation is associated with pain in Achilles tendinopathy (AT). The anatomical relationship between ultrasound (US)-defined indicators of tendinopathy and clinically determined pain sites has not been investigated.

Purpose: To measure the spatial correlation between the sites of maximum palpated tenderness, site of patient-indicated pain, maximum US-determined neovascularisation and maximum antero-posterior tendon thickness in patients with chronic recalcitrant AT (CRAT).

Methods: A custom-designed measuring apparatus and clinical examination were used to measure the sites of maximum tenderness and subjectively defined pain on 29 tendons from patients diagnosed with mid-tendon CRAT. All tendons had been previously non-responsive to eccentric loading. Maximal neovascularisation and tendon thickness were measured by US scanning in conjunction with the measuring device.

Results: A significant association exists between clinically determined pain and neovascularisation (r = 0.85, p < 0.001), patient reported pain (r = 0.91, p < 0.001), maximal tendon thickness (r = 0.91, p < 0.001), maximal thickness and maximal neovascularisation (r = 0.86, p < 0.001).

Conclusion: Sites of subjectively defined pain, clinically palpated tenderness, tendon thickness and neovascularisation are anatomically associated. Palpation can be reliably used as a clinical guide when planning interventions in patients with CRAT.

MeSH terms

  • Achilles Tendon / blood supply*
  • Achilles Tendon / diagnostic imaging*
  • Achilles Tendon / injuries
  • Adult
  • Chronic Disease
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neovascularization, Pathologic / diagnostic imaging*
  • Pain Measurement
  • Reproducibility of Results
  • Statistics, Nonparametric
  • Surveys and Questionnaires
  • Tendinopathy / diagnostic imaging*
  • Ultrasonography