Rotator cuff tendinopathies and partial‑thickness tears are common causes of shoulder pain, particularly in adults over 40, with a significant impact on quality of life and work capacity. While conservative treatment remains the first‑line approach, a substantial proportion of patients experience suboptimal outcomes. In recent years, regenerative therapies have emerged as promising alternatives or adjuncts to traditional treatment, aiming to promote tendon healing, reduce pain, and delay or avoid surgical intervention. This review critically evaluates the current evidence on regenerative interventions, including corticosteroid injections, hyaluronic acid, prolotherapy, platelet‑rich plasma (PRP), and cell‑based therapies such as bone marrow aspirate (BMA) and adipose‑derived mesenchymal stem cells (AD‑MSCs). Among these, leukocyte‑poor PRP (LP‑PRP) demonstrates the most consistent results in pain relief and functional improvement, with sustained effects observed for up to 12 months. Prolotherapy and hyaluronic acid, particularly in high‑molecular‑weight formulations, also show favorable short‑term results. Conversely, corticosteroids provide only transient analgesia and may negatively affect tendon healing if administered postoperatively. Cell‑based therapies have shown encouraging preliminary findings, including structural tendon improvement and reduction in lesion size. However, current studies are limited by methodological heterogeneity, small sample sizes, and short follow‑up periods, precluding definitive conclusions. This article emphasizes the need for individualized treatment selection based on patient profile, clinical severity, and access to therapy. Although some regenerative strategies are becoming more accessible, many remain experimental and should be restricted to research protocols until further high‑quality evidence becomes available. Therapeutic decisions should involve shared decision‑making, clearly addressing benefits, limitations, costs, and safety profiles of each modality.

La nicotina retarda el proceso de cicatrización y eleva los niveles de la enzima mieloperoxidasa (MPO), que tiene un papel fundamental en la producción de especies reactivas de oxígeno durante el proceso inflamatorio. La fotobiomodulación con láser (FBM) es uno de los agentes electrofísicos más utilizados en el tratamiento del tendón calcáneo, sin embargo sus efectos sobre la actividad de la MPO carecen de mayor elucidación. Este estudio objetivó evaluar los efectos de la FBM sobre la actividad de la MPO después de lesión del tendón calcáneo en ratones expuestos al humo de cigarrillo. Se utilizaron 34 ratones Wistar, machos, con 90 días de vida. Después de 14 días de exposición al humo de cigarrillo, los animales fueron divididos en tres grupos experimentales: grupo de control (GC, n=12), no sometido a la lesión o tratamiento; grupo sham (GSh, n=10), sometido a la lesión parcial del tendón calcáneo y a la simulación de la FBM láser; y el grupo FBM láser (GFBM, n=12), sometido a la lesión parcial del tendón calcáneo y tratado con FBM láser, en el primer minuto después de la lesión. La FBM disminuyó los niveles de actividad de MPO en el GFBM en comparación con el GSh (GC: 1,38±0,69 pg/ml; GSh: 3,78±1,09pg/ml; GFBM: 2,58±0,93pg/ml, p<0,005). Se concluye que la FBM láser aplicada inmediatamente después de la lesión del tendón calcáneo atenúa la actividad inflamatoria aguda en ratones expuestos al humo de cigarrillo.

OBJECTIVES: To evaluate the clinical characteristics, ground reaction force (GRF), and function of the plantar muscles and dorsiflexors of the ankle in runners with and without Achilles tendinopathy (AT) and in nonrunners. METHODS: Seventy-two participants (42 men, 30 women; mean age: 37.3±9.9 years) were enrolled in this crosssectional study and divided into three groups: AT group (ATG, n=24), healthy runners’ group (HRG, n=24), and non-runners’ group (NRG, n=24). Both ankles were evaluated in each group. The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale was used for clinical and functional evaluation. GRF was evaluated using force plates and muscle strength was evaluated using an isokinetic dynamometer. RESULTS: The AOFAS scores were lower in the ATG. The strike impulse was higher in the ATG than in the HRG and NRG. However, GRF was similar among the groups. The ATG exhibited lower total work at 120o /s speed than the HRG. The peak torque in concentric dorsiflexion was lower in the NRG than in the ATG and HRG. The peak torque and total work in concentric plantar flexion were lower in the NRG than in the ATG. The peak torque and total work in eccentric plantar flexion were lower in the NRG than in the ATG and HRG. CONCLUSION: Runners with AT showed higher strike impulse, lower muscle strength of the plantar flexors, and higher clinical and functional damage.

OBJECTIVES: This study aimed to correlate a higher Pelvic-Trochanteric Index (PTI) with an increased varus of the femoral neck with greater trochanteric pain syndrome (GTPS). The secondary objective was to check whether the pelvic width changes with age. METHODS: A prospective study was conducted to compare female patients diagnosed with GTPS (case group) with asymptomatic female participants (control group) from March 2011 to June 2017. On an anteroposterior pelvic radiograph, lines were drawn by two radiologists, and the PTI (ratio of the distance between the greater trochanters and distance between the iliac crests) was defined and the femoral neck-shaft angle was measured. RESULTS: Data collected based on radiographs of 182 female patients (cases) and 150 female participants (controls) showed that the mean PTI was 1.09 (SD=0.01) in the case group and 1.07 (SD=0.01) in the control group (p<0.05), regardless of age. The distance between iliac crests increased with age (p<0.05) in symptomatic and asymptomatic individuals. It was also found that the mean femoral neck-shaft angle was 130.6° (SD=0.59) and progression of the varus angulation occurred with age in both groups, with a significance level of 5%. CONCLUSIONS: The PTI was higher in patients with GTPS. The femoral neck-shaft angle does not differ between individuals with and without GTPS; however, it does decrease with age. The pelvic width tends to increase with aging in symptomatic or asymptomatic individuals; therefore, the increase in the pelvic width and decrease in the femoral neck-shaft angle can be interpreted as normal in aging women, which could alter the biomechanics of the hips and pelvis.

Introdução: A dor no ombro é muito comum e o tratamento preferencial é a fisioterapia. Objectivo: Avaliar a efectividade da mobilização passiva na dor, força,amplitude de movimento e/ou função no tratamento de indivíduos com tendinopatias da coifa ou síndrome de colisão do ombro por meio de revisão sistemática de literatura. Métodos: Os estudos foram pesquisados na PubMed, Cochrane Library, Scielo, PEDro e Web of Science. Dois investigadores analisaram os artigos para determinar os trabalhos a incluir. A qualidade metodológica desses foi avaliada por meio da escala de PEDro e feita a sua caracterização detalhada. Resultados: Os resultados sugerem que a mobilização passiva quando aplicada em conjunto com outros tratamentos leva a significativa diminuição da dor e a melhoria da força e função. Conclusão: A mobilização passiva aplicada em conjunto com outros tratamentos parece ser uma mais valia no tratamento de tendinopatias da bainha rotadora e síndrome de colisão do ombro. São necessários mais estudos que confirmem esses resultados.

Purpose: To find ultrasound prognostic factors for shoulder pain. Methods: This was an observational, prospective study, comparing the evolution of ultrasound findings with clinical outcomes, in patients with shoulder pain. Data were collected in two appointments, from February 2018 to March 2021. Two-tailed non-parametric statistics were used, and p values <0.05 were considered significant. Results: A total of 79 participants were included in this study (median age 59 years, range 24-70, 61 women). A positive Doppler signal on tendons (p = 0.002) and absent tendon heterogeneity (p = 0.01) were associated with the patient's self-reported improvement. Tendon calcifications with poorly defined contours (p = 0.03) and sparse distribution (p = 0.001) were associated with VAS improvement. A reduction in the number of calcifications (p = 0.004), in the supraspinatus tendon thickness (p = 0.01), in subacromial effusions (p = 0.03), and in color Doppler grade (p = 0.02), between initial and follow-up exams, was found in patients with an improved DASH outcome. Conclusion: A positive Doppler signal on shoulder tendons can be a marker for a better prognosis in shoulder pain. Poorly defined and sparsely distributed calcifications can also indicate a better course of the disease.

Shoulder pain is a common problem in clinical practice, with data in the literature showing an increased prevalence and stronger consequences with age, reaching an annual cumulative incidence of 2.4% in the age group from 45 to 64 years, with a higher incidence in women. The shoulder is one of the most frequent sites of musculoskeletal pain. There are multiple causes, but rotator cuff and subacromial pathologies are predominant. Pathologies of the glenohumeral and acromioclavicular joints, as well as referred pain, especially of cervical origin, are also pointed out as frequent etiologies. The rotator cuff is an usual site for degenerative tendinopathy, a common cause for shoulder pain which most often affects the supraspinatus; it may progress to partial or full-thickness tendon tear. Subacromial conflict has been recognized since Neer as a cause for tendinopathy and rotator cuff tear. Calcifying tendinitis has generally a more favorable course, being able to resolve completely and spontaneously, and predominates at a younger age. It involves the deposition of calcium hydroxyapatite crystals, more frequently in the supraspinatus and infraspinatus, but the etiopathogenesis is controversial; it seems to occur as a primary tendinopathy reactive to ischemia or mechanical factors in a viable tendon, in a cycle including fibrocartilaginous metaplasia of tenocytes, crystal deposition and resorption, and tendon repair. But not all calcifications are symptomatic. Calcifications with a diameter greater than 1.5 cm, with an ill-defined contour, and associated with Doppler signal and subacromial effusion have been described as related to symptoms, but only in a few studies. This research project was aimed to validate clinical tests in the determination of the level of pain and disability and to search for ultrasound characteristics in rotator cuff calcifications, or another marker or set of ultrasound markers, which allow for the prediction of symptoms and, in addition, to determine the prognosis. The dimension of calcifications was particularly focused. The project included a case-control observational study to identify characteristics associated with shoulder pain, and a longitudinal observational study to look for prognostic factors. Relevant aspects on the physical examination of patients with shoulder pain were also investigated, by an observational cross-sectional study. A total of 140 patients and 62 controls were enrolled (median age 56 years, 155 women), and inflammatory pathology was excluded. The evaluation comprised a DASH questionnaire (Disabilities of the Arm, Shoulder and Hand outcome measure), a physical examination and an ultrasound exam with recording of the size, morphology and location of calcifications, Doppler signal, changes in echotexture, rotator cuff tears and joint or subacromial effusion. P-values < 0,05 were considered significant. On the clinical evaluation of the patients, a linear regression model with six independent variables (age, gender, complaints on dominant side, palm-up test, range of motion in active flexion and external rotation) was found capable of predicting 44% of the variability of the DASH score (R = 0.665; p < 0.001). A calcification size ≥ 6 mm was associated with shoulder pain (p = 0.02), but only in younger subjects (< 56 years). In older subjects (≥ 56 years), a distance to the tendon insertion ≥ 6 mm was also associated with pain (p = 0.009). Pain was also associated with a positive Doppler signal (p = 0.003), the number of calcifications (p = 0.02), alterations in the tendon echotexture (p < 0.001), bone irregularity or thickening at the insertion of the supraspinatus and subscapularis tendons (p < 0.05) and rotator cuff tears (p = 0.001). Subacromial effusion was only found in symptomatic subjects (p = 0.002). Follow-up of patients suggested a better prognosis when a tendinous Doppler signal or when poorly defined or sparsely distributed calcifications were present. Clinical improvement was associated with a reduction in the Doppler signal and subacromial effusion, when present on first exam, suggesting a role in the pathophysiological mechanism of pain. An algorithm was proposed, based on a set of specific ultrasonographic criteria, which makes it possible to classify the sample of this study for rotator cuff pathology likely to cause pain, with a sensitivity of 69% and a specificity of 92%.

O laser de baixa potência é recomendado para o tratamento das tendinopatias apesar dos resultados contraditórios no que se refere a dose de energia ideal, comprimento de onda e tempo de aplicação. O objetivo desse estudo foi avaliar os efeitos da laserterapia e do exercício excêntrico na tendinopatia do tendão calcanear comum de ratos Wistar. Foram utilizados 48 ratos machos adultos. Os animais foram distribuídos aleatoriamente em quatro grupos (L=laser; E=exercício excêntrico; LE=laser e exercício excêntrico, e R=repouso). Após 24h da indução de tendinopatia unilateral, foi iniciada laserterapia (904nm/3J/cm2) e/ou exercício excêntrico (caminhada em declive; esteira com 15o de inclinação; 12m/min; 50min/dia) que permaneceu por 20 dias. Aos 3, 7, 14 e 21 dias após indução da lesão, três ratos de cada grupo foram submetidos à eutanásia, e os tendões foram obtidos para análises histológica e morfométrica. Não houve diferença entre grupos nem entre tempos nas características hemorragia (p=0,4154), formação de aderência fibrinosa (p=0,0712) e organização das fibras colágenas (p=0,2583) e do tecido conjuntivo (p=0,1046). Considerando os grupos, independentemente do tempo, foi observado que o exercício excêntrico ocasionou espessamento do epitendão (p=0,0204), que foi menor no grupo submetido à laserterapia. A análise histológica revelou diferença (p=0,0032) na quantidade de células inflamatórias ao longo do tempo, sendo observado em maior quantidade no grupo apenas exercitado. Esse resultado foi confirmado pela análise morfométrica, que demonstrou haver interação significativa (grupos x tempo) nessa característica, na qual o exercício excêntrico aumentou (p=0,0014) o infiltrado inflamatório ao longo do tempo (3 e 21 dias), porém, quando associado à laserterapia, ocorreu redução da reação inflamatória. Por outro lado, a associação dos tratamentos ocasionou maior angiogênese observada nas análises morfométrica (p=0,0000) e histológica (p=0,0006), quando comparada com os demais grupos, enquanto a aplicação isolada do laser de baixa potência reduziu essa característica ao longo do tempo. Os animais mantidos em repouso foram os que apresentaram menor (p=0,0000) quantidade de fibroblastos, na análise morfométrica, porém na avaliação histológica foi observada interação significativa entre grupo e tempo (p=0,0024). Maior quantidade de fibroblastos foi observada nos grupos E, L e LE, no 7o, 14o e 21o dias, respectivamente. Os animais que receberam laserterapia e foram exercitados apresentaram maior (p=0,0000) quantidade de fibras colágenas ao longo do tempo. A laserterapia na dose de 3J e comprimento de onda de 904nm, iniciada 24h após indução cirúrgica de tendinopatia em ratos Wistar é adequada para angiogênese e para evitar o espessamento do tendão, que pode estar relacionado com a intensidade do processo inflamatório. Quando associada ao exercício excêntrico, a terapia apresenta a vantagem de aumentar a quantidade de fibras colágenas, reduzir a aderência fibrinosa e infiltrado inflamatório, apesar de prolongar a angiogênese. Portanto, o exercício excêntrico realizado concomitantemente com a laserterapia melhora as propriedades histológicas do tendão lesionado.