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Tendinopathy And Diabetes

The Link Between Diabetes And Tendon Problems - Dr. Russell Schierling

The Link Between Diabetes And Tendon Problems - Dr. Russell Schierling

TENDINOSIS AND ITS RELATIONSHIP TO DIABETES The IOC (International Olympic Committee) uses a number of organizations to research SPORTS INJURIES . One of these is the Australian Centre for Research into Sports Injury and it's Prevention. The current issue of the pain journal, Practical Pain Management, has an article about a study recently done by this group (Diabetes Patients May be at Increased Risk of Tendinopathy). Great article, but with what we know about DIABETES , should we be surprised by their findings? Not really. If you go back and re-read my article on KETOGENIC DIETS , you'll find a short (seven minute) video by Dr. Charles Mobbs about the fact that BLOOD SUGAR is quite possibly the number one factor in aging and disease. Not a shock considering I have been BLOWING THIS SAME HORN for years. The shocking part of all of this is that when you start looking at studies on virtually all diseases (even many of the so called " GENETIC " diseases) you'll find that they have their foundations in Blood Sugar. Note that this does not necessarily mean that your Blood Sugar levels are high --- at least according to our nation's 'normals' or at least initially. What it means is that no matter how hard your body tries, it will eventually lose its battle with its ability to metabolize the immense amounts of SUGAR and PROCESSED CARBOHYDRATE so ubiquitous to the SAD (Standard American Diet). Although I am one of those people who believes that when it comes to WEIGHT LOSS or battling chronic diseases such as Diabetes, diet trumps exercise ( HERE ) every time --- and it's not even close. This is not to say, however, that exercises is not valuable. It's just that you can't work out hard enough to compensate for a crappy diet. Case in point: "About 50% of patients with diabetes Continue reading >>

Is Tendon Pain Linked To Diabetes?

Is Tendon Pain Linked To Diabetes?

The tendons connect muscle to bone or to specific structures or organs—for example, the eye. Tendons are flexible but non-elastic cords made up of a specific type of protein, collagen. Tendons function to assist movement Examples of tendons include shoulder tendons (Teres minor, Infraspinatus, Supraspinatus and Subscapularis tendons); tendons in the arms (Deltoid, Biceps, Triceps, Brachioradialis, and Supinator tendons); wrist tendons (Flexor carpi radialis, Flexor carpi ulnaris, Extensor carpi radialis and Extensor carpi radialis brevis tendons); tendons in the hips and legs (Iliopsoas, Obturator internus, Adductor longus, brevis and magnus tendons and gluteus maximus/medius tendons; quadriceps, hamstrings and Sartorius tendons). There are also numerous tendons in the hands and feet including the Achilles tendons at the ankles. In Type 2 Diabetes (T2D), there are a number of tendon conditions that can be relatively common. For example, about 10-15% of people with T2D have Dupuytren’s contracture, a thickening, shortening and fibrosis of the tendons of the hand and trigger finger (also called flexor tenosynovitis). These conditions are usually associated with poor blood sugar control as well as by how long someone has been diagnosed with T2D (and T1D, by the way). The tendons can be covered by a sheath or non-covered. In tendons with a sheath (a thin, fibrous covering), the general term for inflammatory conditions is tenosynovitis while in those tendons without a sheath, the general term for inflammation is tendinitis. The most common conditions of tendons are:[1] Rotator cuff tendinopathy: The rotator cuff is located at the shoulder and allows the shoulder to rotate so that humans can throw, lift objects over the head and raise the arms. The tendinopathy may be due Continue reading >>

Diabetes Patients May Be At Increased Risk Of Tendinopathy

Diabetes Patients May Be At Increased Risk Of Tendinopathy

Diabetes Patients May Be At Increased Risk of Tendinopathy By Joseph J. Ruane, DO and Thomas G. Ciccone For patients living with type 2 diabetes, regular exercise is a key to keeping blood sugar levels normal.1 However, musculoskeletal complications oftentimes sabotage a healthy exercise regimen. About 50% of patients with diabetes have to stop exercising because of musculoskeletal pain, and tendinopathy is typically the delineating factor.2 Now a new study has found that people with diabetes are at far higher risk of developing tendinopathy compared with people without diabetes.3 Duration of disease and thicker tendons appear to be associated with tendinopathy in diabetes. These associations may help clinicians better understand tendinopathy as a whole, as well as why it happens and how it can be avoided. A team of Australian researchers conducted a meta-analysis, searching for studies that included at least one tendon-related and one diabetes-related variables, and excluding any studies that did not use a control group.3 After sorting through over a 1,000 papers, they focused their review to 31 studies. The researchers found that people with diabetes were more than 3 times at risk of developing tendinopathy compared to controls (Odds Radio: 3.67), regardless if the tendinopathy was diagnosed by imaging or clinical criteria. In addition, diabetes was more prevalent in people with tendinopathy than in those without tendinopathy (OR 1.30). In 6 studies, patients with diabetes and co-occurring tendinopathy had a longer duration of diabetes compared to patients with diabetes but no tendinopathy (Medium duration, 5.26 years). Whether this suggests long-term diabetics are at higher risk for tendinopathy is a supposition, though. The results point to an interesting associati Continue reading >>

Is There An Association Between Tendinopathy And Diabetes Mellitus? A Systemic Review Andanalysis

Is There An Association Between Tendinopathy And Diabetes Mellitus? A Systemic Review Andanalysis

Tom A Ranger, Andrea M Y Wong, Jill L Cook, Jamie E Gaida Ranger TA et al. Br J Sports Med 2016; 50: 982-989 The prevalence of Diabetes in our population is increasing, as is the morbidity and mortality associated with this chronic disease. As a primary care provider, we are well aware of the role lifestyle plays in the development and control of Type 2 diabetes mellitus. For this reason, the guidelines recommend exercise and diet as first line treatment for this condition. It has been shown that up to 50% of participants who quit exercise as part of their management do so because of musculoskeletal symptoms. So the question arises: Does tendinopathy, a condition that reduces exercise tolerance, have a role to play in lack of adherence to an exercise program in diabetics? Earlier studies have shown that hyperglycemia does change the collagen cross-linking of tendons and reduced their proteoglycan content (Reddy, 2003) leading to weakened tendons and predisposing them to tendinopathy. This study investigated the potential association between diabetes and tendinopathy by systematically reviewing and meta-analysing case control, cross sectional, and studies that considered both of these conditions. In total 31 studies were selected for the final analysis with good attention paid to exclusion criteria and reduction of bias. Confounding variables were identified: age, sex, adiposity, statin use and hyperglycemia. There is observational evidence that statins may induce tendinopathy (Marie I, Arthritis Rheum 2008;59:367-72) as well as an association between adiposity and tendinopathy (Gaida, Arthritis Rheum 2009; 61 840-9). This systematic review showed that diabetics had greater than three times the odds of tendinopathy compared to controls; and people with tendinopathy had Continue reading >>

High Glucose Alters Tendon Homeostasis Through Downregulation Of The Ampk/egr1 Pathway

High Glucose Alters Tendon Homeostasis Through Downregulation Of The Ampk/egr1 Pathway

High glucose alters tendon homeostasis through downregulation of the AMPK/Egr1 pathway Scientific Reports volume 7, Articlenumber:44199 (2017) Diabetes mellitus (DM) is associated with higher risk of tendinopathy, which reduces tolerance to exercise and functional activities and affects lifestyle and glycemic control. Expression of tendon-related genes and matrix metabolism in tenocytes are essential for maintaining physiological functions of tendon. However, the molecular mechanisms involved in diabetic tendinopathy remain unclear. We hypothesized that high glucose (HG) alters the characteristics of tenocyte. Using in vitro 2-week culture of tenocytes, we found that expression of tendon-related genes, including Egr1, Mkx, TGF-1, Col1a2, and Bgn, was significantly decreased in HG culture and that higher glucose consumption occurred. Down-regulation of Egr1 by siRNA decreased Scx, Mkx, TGF-1, Col1a1, Col1a2, and Bgn expression. Blocking AMPK activation with Compound C reduced the expression of Egr1, Scx, TGF-1, Col1a1, Col1a2, and Bgn in the low glucose condition. In addition, histological examination of tendons from diabetic mice displayed larger interfibrillar space and uneven glycoprotein deposition. Thus, we concluded that high glucose alters tendon homeostasis through downregulation of the AMPK/Egr1 pathway and the expression of downstream tendon-related genes in tenocytes. The findings render a molecular basis of the mechanism of diabetic tendinopathy and may help develop preventive and therapeutic strategies for the pathology. People with diabetes mellitus (DM) are susceptible to tendinopathy and tendon rupture 1 , 2 . Diabetic tendons are characterized by weaker mechanical properties than non-DM tendons, including lower stiffness, maximum load, Youngs modulus, a Continue reading >>

Tendon Pain Linked To Type 2 Diabetes

Tendon Pain Linked To Type 2 Diabetes

People with type 2 diabetes are more than three times as likely to have tendon pain compared to those without diabetes People with tendinopathy are 30 percent more likely to have diabetes than those without tendon pain Tendinopathy is not the same condition as tendinitis; treatment for tendinopathy needs to break the cycle of injury and optimize collagen production so the tendon can regain normal strength By Dr. Mercola Tendinopathy refers to pain that occurs in and around your tendons (your tendons connect your muscles to your bones). Typically, tendinopathy is the result of overuse or repetitive movements, but in people with type 2 diabetes chronically elevated blood sugar levels may increase the risk. A recent systematic review and meta-analysis published in the British Journal of Sports Medicine shed light on this association, providing "strong evidence that diabetes is associated with higher risk of tendinopathy." More than 30 studies were analyzed, which showed not only is tendinopathy more prevalent in people with diabetes, but the opposite also holds true in that diabetes is more prevalent in people with tendinopathy.1 Type 2 Diabetes May Triple Your Risk of Tendon Pain The study revealed that people with type 2 diabetes are more than three times as likely to have tendon pain compared to those without diabetes. Further, people with tendinopathy are 30 percent more likely to have diabetes than those without tendon pain. There are multiple reasons why this association deserves increased attention, not the least of which is the fact that tendinopathy can be quite painful and may interfere with a person's quality of life. Beyond this, there is evidence that Achilles tendinopathy in diabetics may lead to increased forefoot pressure and the development of plantar fore Continue reading >>

Type 2 Diabetes Linked To Tendon Pain

Type 2 Diabetes Linked To Tendon Pain

Pain is often a partner of diabetes, with studies indicating that anywhere from 20% to 60% of people with diabetes live with chronic pain. And while pain from conditions such as diabetic neuropathy (nerve damage) or peripheral arterial disease are often the culprit, new research out of Australia shows that people with Type 2 diabetes are more than three times as likely as those without diabetes to have tendon pain. Physical activity is an important part of controlling blood sugar levels, but musculoskeletal pain can interfere with a persons ability and willingness to stick with an exercise program. In fact, according to some estimates , as many as 50% of people with diabetes stop exercising due to this type of pain. Because chronically high blood sugar can increase the risk of developing tendinopathy (painful and inflamed tendons), researchers from several universities in Australia conducted a meta-analysis (analysis of data from several clinical trials) to investigate the potential association between tendon pain and Type 2 diabetes. They focused on 31 studies, 26 of which concentrated on people with diabetes and 5 of which centered on people with diagnosed tendinopathy. When they combined and reexamined the data, the researchers found that people with Type 2 diabetes were 3.67 times more likely to have tendinopathy than those without diabetes, and those with tendinopathy were 1.3 times more likely to have Type 2 diabetes. Those with diabetes were also more likely to have thickened tendons, a common feature of tendinopathy. Those who had tendinopathy and diabetes had generally been diagnosed with diabetes for longer than those who had diabetes but no tendon problems, which may suggest that the risk of tendinopathy increases with the number of years that youve had diab Continue reading >>

Plantar Fascia Enthesopathy Is Highly Prevalent In Diabetic Patients Without Peripheral Neuropathy And Correlates With Retinopathy And Impaired Kidney Function

Plantar Fascia Enthesopathy Is Highly Prevalent In Diabetic Patients Without Peripheral Neuropathy And Correlates With Retinopathy And Impaired Kidney Function

Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Plantar fascia enthesopathy is highly prevalent in diabetic patients without peripheral neuropathy and correlates with retinopathy and impaired kidney function Affiliation Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy Affiliation Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy Affiliation Department of Medical and Surgical Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy Affiliation Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy Affiliation Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy Affiliation Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy Affiliation Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy Affiliation Department of Health Sciences, University of Catanzaro Magna Graecia, Catanzaro, Italy Affiliation Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy Continue reading >>

Experimental Diabetes Alters The Morphology And Nano-structure Of The Achilles Tendon

Experimental Diabetes Alters The Morphology And Nano-structure Of The Achilles Tendon

Experimental Diabetes Alters the Morphology and Nano-Structure of the Achilles Tendon Affiliations: Inter-institutional Doctorate Program in Morphological Science, Federal University of Cear / Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, Department of Physical Therapy, Federal University of Ceara, Fortaleza, Cear, Brazil, Tendon Research Group, Fortaleza, Cear, Brazil Affiliation: Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil Affiliation: Department of Physics, Faculty of Physics, Federal University of Ceara, Fortaleza, Cear, Brazil Affiliations: D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil, National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil Affiliations: D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil, National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil Affiliations: Inter-institutional Doctorate Program in Morphological Science, Federal University of Cear / Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil Affiliation: Inter-institutional Doctorate Program in Morphological Science, Federal University of Cear / Federal University of Rio de Janeiro, Rio de Janeiro, Brazil Although of several studies that associate chronic hyperglycemia with tendinopathy, the connection between morphometric changes as witnessed by magnetic resonance (MR) images, nanostructural changes, and inflammatory markers have not yet been fully established. Therefore, the present study has as a hypothesis that the Achilles tendons of rats with diabe Continue reading >>

Tendon Pain Linked To Type 2 Diabetes

Tendon Pain Linked To Type 2 Diabetes

January 29, 2016 / 9:10 PM / 2 years ago (Reuters Health) - Exercise is important to managing type 2 diabetes, but the condition may also make a person prone to tendon pain, which can interfere with exercise, researchers say. Based on an analysis of past studies, researchers found that people with type 2 diabetes are more than three times as likely as those without the disease to have tendon pain, known as tendinopathy. And people with diagnosed tendinopathy have 30 percent higher odds of having diabetes. The findings may indicate a problem healthcare providers need to be aware of, the studys senior author said. People with diabetes are more likely to develop tendinopathy, but the opposite is also true - people with tendinopathy are more likely to have undiagnozed diabetes, Jamie Gaida told Reuters Health in an email. Tendinopathy is a problem for two key reasons, he said. First, feeling pain during movements that load the tendon is unpleasant, and second, having a painful tendon stops you being physically active. People with diabetes should absolutely be physically active, as it is one of the most effective treatments for diabetes, said Gaida, an assistant professor and physiotherapist at the University of Canberra in Australia. Tendinopathy refers to injuries and inflammation of the tendons, the soft tissues that connect muscles to bones, usually due to overuse or repetitive movements. Having injured tendons may make it difficult to stick with exercise programs, which are essential for management of diabetes. One past research review has also linked diabetes and increased risk of tendinopathies, the authors of the new study note in the British Journal of Sports Medicine. To examine the relationship further, Gaida and colleagues reviewed 31 previous studies. Twenty-si Continue reading >>

Can My Diabetes Cause Problems With My Tendons?

Can My Diabetes Cause Problems With My Tendons?

How can I prevent and treat tendon damage? If you have diabetes and you hurt when you move, it might be due to problems with your tendons. They're cord-like bands that connect your muscles to your bones. The high blood sugar levels that may go along with your disease play a role in stirring up your tendon trouble. You have tendons all over your body, including in your shoulders, arms, wrists, hips, knees, and ankles . They transfer the force from your muscles to your bones so you can move. If your diabetes isn't under control, your tendons can thicken and become more likely to tear. Tendon damage in type 1 and type 2 diabetes happens because of substances called advanced glycation end products (AGEs). They form when protein or fat mixes with sugar in your bloodstream. Normally, your body makes AGEs at a slow and steady pace. But when you have diabetes, the extra sugar in your blood cranks up the speed, which affects your tendons. Tendons are made from a protein called collagen. AGEs form a bond with it that can change the tendons' structure and affect how well they work. For instance, they could get thicker than normal and might not be able to hold as much weight as they used to. As a result, your odds of getting a tear in one of your tendons go up. Some tendon problems you could get if you don't get your diabetes under control are: Frozen shoulder : Stiffness and pain that happens when a capsule that surrounds tendons and ligaments in your joint thickens up. Rotator cuff tears: Damage to the tendons and muscles that surround your shoulder joint, including the supraspinatus muscle. Trigger finger: Your finger becomes stuck in a bent position and straightens with a snap, like the sound of a trigger being pulled. Carpal tunnel syndrome : You get numbness, tingling, and w Continue reading >>

Occurrence Of Tendon Pathologies In Metabolic Disorders

Occurrence Of Tendon Pathologies In Metabolic Disorders

Occurrence of tendon pathologies in metabolic disorders Department of Medicine and Science of Aging, University G. dAnnunzio, Chieti-Pescara, Italy and 2BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain Search for other works by this author on: Department of Medicine and Science of Aging, University G. dAnnunzio, Chieti-Pescara, Italy and 2BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain Search for other works by this author on: Department of Medicine and Science of Aging, University G. dAnnunzio, Chieti-Pescara, Italy and 2BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain Search for other works by this author on: Department of Medicine and Science of Aging, University G. dAnnunzio, Chieti-Pescara, Italy and 2BioCruces Health Research Institute, Cruces University Hospital, Barakaldo, Spain Search for other works by this author on: Rheumatology, Volume 52, Issue 4, 1 April 2013, Pages 599608, Michele Abate, Cosima Schiavone, Vincenzo Salini, Isabel Andia; Occurrence of tendon pathologies in metabolic disorders, Rheumatology, Volume 52, Issue 4, 1 April 2013, Pages 599608, This article reviews the pathogenetic role of metabolic disorders, which are of paramount relevance to the progression of tendon damage. In diabetes, the prevalence of rheumatological diseases is high, mainly because of the deleterious effects of advanced glycation end products that deteriorate the biological and mechanical functions of tendons and ligaments. In heterozygous familial hypercholesterolaemia, most patients develop Achilles xanthomatosis, a marker of high risk for cardiovascular disease caused by cholesterol deposition in the tendons. Tendon degeneration has also been observed in non-familial h Continue reading >>

People With Type 2 Diabetes Have Greater Risk Of Tendon Pain, Study Suggests

People With Type 2 Diabetes Have Greater Risk Of Tendon Pain, Study Suggests

People with type 2 diabetes have greater risk of tendon pain, study suggests People with type 2 diabetes have greater risk of tendon pain, study suggests Adding vildagliptin and protein preload could benefit metformin-treated men with type 2 diabetes, study reports 25 January 2016 People with type 2 diabetes are more likely to have tendon pain, which might affect adherence to exercise regimes, new research suggests. Researchers at Monash University, Melbourne observed that people with type 2 diabetes are over three times more likely to be diagnosed with tendon pain, known as tendinopathy, compared to people without diabetes. Tendinopathy occurs when tendons, the soft tissues that connect bones to muscles, become inflamed or injured, often due to repetitive movements or overuse. This condition can make exercise harder, which is important for the management of diabetes . In this new study, published in the British Journal of Sports Medicine, the researchers highlighted that people with type 2 diabetes might be susceptible to tendinopathy because of prolonged high blood sugar levels . Lead researcher Jamie Gaida and colleagues conducted a meta-analysis of 31 previous studies. 26 focused on people with type 2 diabetes, while five focused on people with diagnosed tendinopathy. They found that people with type 2 diabetes were three times more likely to develop tendinopathy compared to people without diabetes, while people with tendinopathy were 30 per cent more likely to have diabetes. Furthermore, people with diabetes and tendinopathy had a longer duration of diabetes, while type 2 diabetic participants also had thicker tendons than control participants, which is often seen in tendinopathy. Gaida told Reuters Health: "Tendinopathy is a problem for two key reasons. First, fe Continue reading >>

Tendon Pain Linked To Diabetes

Tendon Pain Linked To Diabetes

Home / Conditions / Type 2 Diabetes / Tendon Pain Linked to Diabetes Aggressive or inappropriate exercise may be a factor in connection between type 2 diabetes and tendonitis. Many rheumatological conditions may exacerbate the clinical course of diabetes mellitus; one such condition is tendonitis. Patients who have diabetes are much more prone to develop problems with tendons than those without diabetes, most likely due to the blood supply being more sparse to the tendons than normal. This means that very early diabetic changes in blood vessels may show up first in the tendons. Another plausible explanation for this is that high blood sugar may cause abnormal thickening of the tendons.The word tendinopathy itself refers to injuries and inflammation of the tendons, the soft tissues that connect muscles to bones, usually due to overuse or repetitive movements. Common forms of tendon damage, which are more predominant in patients with diabetes and prediabetes, are carpal tunnel syndrome, tarsal tendon syndrome and frozen shoulder. Many physicians and healthcare providers are unaware of the link between diabetes and tendonitis. Unfortunately, improving blood glucose does not always have an immediate effect on improving the issue. Past research has shown that patients with type 2 diabetes are more than three times as likely to develop some type of complication related to their tendons. A new study performed by Tom Ranger and associates looked further into the association between tendinopathy and diabetes; they performed a systematic review along with a meta-analysis of nine medical databases, which looked into patients with both diabetes and tendonitis. The researchers had a total of 31 studies with 26 of them including people with diabetes and five with tendinopathy. What Continue reading >>

Tendinopathy In Diabetes Mellitus Patients-epidemiology, Pathogenesis, And Management.

Tendinopathy In Diabetes Mellitus Patients-epidemiology, Pathogenesis, And Management.

Scand J Med Sci Sports. 2017 Aug;27(8):776-787. doi: 10.1111/sms.12824. Epub 2017 Jan 20. Tendinopathy in diabetes mellitus patients-Epidemiology, pathogenesis, and management. Headquarter, Hospital Authority, Hong Kong SAR, China. Chronic tendinopathy is a frequent and disabling musculo-skeletal problem affecting the athletic and general populations. The affected tendon is presented with local tenderness, swelling, and pain which restrict the activity of the individual. Tendon degeneration reduces the mechanical strength and predisposes it to rupture. The pathogenic mechanisms of chronic tendinopathy are not fully understood and several major non-mutually exclusive hypotheses including activation of the hypoxia-apoptosis-pro-inflammatory cytokines cascade, neurovascular ingrowth, increased production of neuromediators, and erroneous stem cell differentiation have been proposed. Many intrinsic and extrinsic risk/causative factors can predispose to the development of tendinopathy. Among them, diabetes mellitus is an important risk/causative factor. This review aims to appraise the current literature on the epidemiology and pathology of tendinopathy in diabetic patients. Systematic reviews were done to summarize the literature on (a) the association between diabetes mellitus and tendinopathy/tendon tears, (b) the pathological changes in tendon under diabetic or hyperglycemic conditions, and (c) the effects of diabetes mellitus or hyperglycemia on the outcomes of tendon healing. The potential mechanisms of diabetes mellitus in causing and exacerbating tendinopathy with reference to the major non-mutually exclusive hypotheses of the pathogenic mechanisms of chronic tendinopathy as reported in the literature are also discussed. Potential strategies for the management of ten Continue reading >>

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