The results of this study show that both traditional ECC and HSR yield positive, equally good, lasting clinical results in patients with Achilles tendinopathy and that the latter tends to be associated with greater patient satisfaction after 12 weeks but not after 52 weeks.

Muscle haematomas (MH) represent 10-25% of all bleeds in patients with severe haemophilia. We performed a cross-sectional survey on current practice in the management of MH with participation from 22 consultants. The respondents reported 492 MH/year, corresponding an average of 25/centre, mostly associated with trauma. Iliopsoas (55%), calf (18%) and thigh (18%) bleeds were scored as most serious. Half of the respondents distinguished between contusion and strains, whereas the majority (68.2%) did not categorize bleedings as intra- or intermuscular, although 77.3% routinely used ultrasound. Half of the respondents used a standard protocol for the management of MH. Twenty of 22 (90.9%) respondents offered physiotherapy in the hospital following MH, with no clear consensus on timing and type of treatment. In a theoretical case, for a 70-kg patient with a soleus triceps haematoma, the average initial dose of factor VIII was 2730 U (range: 1750-4000) twice daily for 3-5 days. In a similar case of a patient with inhibitors, 31.8% reported first-line and only use of either recombinant factor VIIa (rFVIIa) or activated prothrombin complex concentrate (APCC), while 36.4% switched between bypassing agents. Using rFVIIa, the median dose was 100 μg/kg (range: 85-270) and with APCC, the median dose was 70 U kg(-1) (range: 50-100). The majority (68.2%) did not use antifibrinolytics. Resolution of pain (81.8% & 77.3%) was regarded as the key clinical marker of arrest of bleeding as compared with diminished swelling and improved range of motion. The survey outlines limited consensus in the management of MH in patients with haemophilia and highlights potential topics for future studies.

Muscle haematoma represents 10-25% of bleeds in patients with severe haemophilia. There is limited consensus on diagnostic or treatment strategies and little knowledge about the natural history of muscle haematoma and optimal treatment goals. The aim of this review was to perform a systematic description of the natural history of muscle haematoma in healthy athletes, focusing on diagnosis, classification and treatment options. Publications and educational textbooks on management of sports injuries were used as data source. Muscle haematomas occur following contusion, strain, or laceration and can be categorized as mild, moderate, or severe. Muscle haematoma may be inter- or intramuscular. In healthy athletes, the healing process takes 20-40 days. Optimal diagnosis includes history, physical examination (inspection, palpation, active and passive range of motion (ROM) test, muscle length test, isometric strength test, biomechanical examination, full spinal examination, peripheral nerve test and slump test), ultrasound, MRI or CT. Treatment is conducted based on: (i) super-acute stage, control of the bleeding and minimizing the size of the haematoma; (ii) acute stage, restoration of pain-free ROM; (iii) subacute stage, functional rehabilitation; and (iv) gradual return to normal activity. Treatment and preventive strategies include RICE (rest, ice, compression and elevation), protected mobilization, stretching and strengthening exercises, manual therapy (articular, neural and soft tissue mobilization and massage), correction of movement dysfunction, functional rehabilitation and electro-therapeutic interventions. The study reviews the natural history of muscle haematoma and state-of-the-art diagnosis and treatment in healthy athletes. Results may be useful to optimize diagnosis and treatment of muscle haematoma in patients with haemophilia.

The exact injury mechanism of Achilles tendinopathy remains unknown, but sliding of fascicles relative to each other during loading may be an important factor. This study validated the motion of ultrasound speckles against actual tendon movement using tantalum beads as reference markers. In addition, the effect of different knee joint angles (ie, muscle activation) on tendon tissue shear and displacement during a single heel rise was investigated. The 10 male participants had tantalum beads inserted in the tendon during surgery for a unilateral Achilles tendon rupture at least 1 year prior to the study. Ultrasound speckle displacement in the tissue surrounding the bead correlated strongly with displacement of the bead (R2 ≥ .9987). Speckle tracking systematically underestimated the displacement of the tendon tissue with a typical error of 1.1%‐2.7%. There was a significant difference in displacement between the superficial and deep tendon layer for the 3 exercises in the healthy, but not in the surgically repaired Achilles tendon. The displacement difference was significantly greater when performing heel rises with the knee flexed 100° compared to knee flexed 40°. In conclusion, speckle tracking appears to be a valid approach to investigate intratendinous displacement.