Hi guys! In this video, I'm going to look at whether or not you need a scan when you've got
Achilles tendinopathy. I'm going to look at how we diagnose Achilles tendinopathy. Then, I'm going to
look at what scans may be useful. We're gonna look at what scans can tell you and also what scans
can't tell you. So, my name is Maryke. I'm one of the physiotherapists from treatmyachilles.com,
where you can get online physiotherapy assessment as well as treatment for your Achilles injuries.
Have a look at the description of this video if you want to have a link to our website. Good! So,
how do we diagnose Achilles tendinopathy? It's mostly done through carefully listening to what
a patient tells you, because the symptoms of when they have pain, where they have pain – all of that
tells you whether it's a tendinopathy or not. And then there's some clinical tests you can do. So,
interestingly enough, there was a group of researchers – I think it was 2013 – where
they looked at ten of the different clinical tests that clinicians use in practice. And they wanted
to see which ones were the most accurate. And they found that the two simplest ones were … gave the
best results, which, one is if the patient comes in and tells you, points to the mid-portion of
the tendon, “This is where I get my pain,” and the second was if you palpate at the tendon,
you could feel like ... that what felt like a swollen lump in it. So, you didn't need any fancy
tests or anything; all you needed to know was the patient to tell you where they feel the pain,
and if it correlated with the tendon, that was pretty accurate, combined with feeling that
lump or swollen area in the tendon. But that said, scans can be useful sometimes. Now, what
scans can be useful? X-ray is a waste of time and money. I don't know why people are sending people,
patients, for X-rays for Achilles tendinopathy. They do it sometimes to see if there's heel spurs.
Now, a heel spur is a little bony growth on the back of the heel. To be honest, there are loads
of people walking around with the heel spurs and absolutely no problems with their tendons.
And long after you're better from your Achilles tendinopathy, you'll still have your heel spur.
So, heel spurs in my opinion is really a useless thing to look for, and you shouldn't get stuck
on it. So, stay away from X-rays; it can't show you anything about the tendons; it only tells
you about bones. Ultrasound scans are extremely useful; they can show you the tendon structure,
they can show you the thickness of the tendon, if there's areas in the tendon that's been injured,
it can show you the blood flow through the tendon, which is significant because when you've got a
tendinopathy, you may see little extra blood vessels that's grown into the tendon, and they
think that may be linked to why you get the pain as well. So yes, ultrasound scans, extremely
useful for tendinopathies. MRI scans – just as useful for tendinopathies. Only difference is, you
can't see the blood flow through the tendons, but when they looked at whether ultrasound scans or
MRI scans are better for diagnosing, to be honest, they’re very similar. Both of them
can give you false positives, which means that it can show that there's pathology in the tendon when
actually there isn't. Although I would actually want to challenge that, because we know you can
get a tendinopathy that doesn't give you symptoms. So, I'm not entirely sure we would be saying that
that's a false positive. They can give you false negatives though, that they don't show up tendon
pathology and then, if you scan in a slightly different way or something, then actually there
is tendon pathology. So, no test is ever hundred percent accurate, but the ultrasound and the MRI
scans can show you really ... they're the best things we've got so far. Interestingly, with the
ultrasound scans as well, they now ... Some of the scanners can actually show you … they can measure
tendon stiffness. So, what we know is, when you've got a tendinopathy, the tendon stiffness
decreases. We're not quite sure yet how to use that in clinic – what it means when we measure
that – but we're hoping that one day it can show us how much a tendon has recovered, but we haven't
got enough data for that yet. So, what can scans show us? Why would we want to go for scans? One,
it can definitely confirm the diagnosis. It could show you the tendon pathology and everything in
there, and it can be really useful for patients where the tendon’s just not getting better. I
always send patients for a scan if we've done 12 weeks of rehab and they're just not progressing or
they – even within the first few weeks – it’s just not doing what I'm expecting it to do,
because there are other things that can pretend to be a tendinopathy. So, for instance, your
plantaris tendon in some people can rub against the tendon – against their Achilles tendon. You
can have tears in your Achilles tendon, or the fasciae next to it, that can feel very similar
to a tendinopathy. So, it can be useful to rule those things out if the person isn't getting
better. What it can't tell you is how severe your injury is or how long it will take for you to
recover. We don't have predictive values yet like those. It can show you there's tendon pathology,
but it can't tell you whether you can get better or not, or whether you're going to need surgery
or not; we're just not that good yet. And we haven't … It all depends on rehab, to be honest,
what you do with the tendon afterwards. Excellent! So, let me know if you've got any questions. And
if you need more help with your Achilles injury, you're always welcome to consult
us via video call – the link to our websites in the description of this video. Take care!