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Tomasz Poboży

Kategoria: Patient Knowledge (EN)

Evidence-informed orthopaedic information for patients in English: symptoms, injuries, diagnostics, treatment, surgery and recovery.

  • Ultrasound After a Muscle Injury — When Is It Worth Doing?

    Polish version

    Ultrasound is most useful after a muscle injury when the result may change management: for example when pain is severe, there is a substantial haematoma or weakness, a larger tear is suspected, or the clinician needs to determine whether the injury extends into the aponeurosis or tendon. Imaging is often unnecessary after a mild, typical strain. Ultrasound is particularly good for superficial muscles and dynamic assessment, whereas MRI may be more informative for deep injuries, tendon-origin injuries or marked loss of function.

    What can ultrasound show after a muscle injury?

    Normal muscle has an organised fibre pattern and visible connective-tissue septa on ultrasound. Injury can disrupt this architecture and produce focal fibre discontinuity, swelling, a haematoma or a change in muscle contour. In larger tears, ultrasound may also help define the extent of the defect and the relationship between the injured tissue ends.

    The exact location of the injury matters. Prognosis and treatment can differ between damage confined to muscle fibres and injury involving the myotendinous junction, aponeurosis or tendon. Modern sports-medicine classifications therefore pay attention to connective-tissue involvement rather than describing an injury only as a “small” or “large” tear.

    Does ultrasound need to be performed immediately?

    There is no single ideal hour or day for every muscle injury. A very early scan may underestimate a small lesion because haematoma and other tissue changes evolve over time. Conversely, prompt assessment can be important after a major injury, pronounced weakness or suspected tendon rupture because the result may affect the next step in treatment.

    In practice, ultrasound is often performed during the first few days when there is a specific clinical question. If symptoms and the initial scan do not agree, or the clinical picture changes, the examination can be repeated. This is one of ultrasound’s practical advantages: the same structure can be reassessed during healing without radiation exposure.

    When is ultrasound particularly useful?

    • after sudden pain during sprinting, jumping, kicking or forceful muscle lengthening;
    • when bruising, a palpable lump or a palpable defect develops after injury;
    • when there is clear weakness compared with the opposite side;
    • when muscle injury needs to be distinguished from tendon injury or another superficial soft-tissue problem;
    • when symptoms persist despite appropriately conducted treatment;
    • for follow-up of a larger haematoma, healing process or selected post-traumatic complications.

    How does an orthopaedic surgeon choose between ultrasound and MRI?

    These tests are not simply competitors; they often answer different questions. Ultrasound provides high-resolution imaging of superficial tissues, allows side-to-side comparison, can assess a muscle during movement and compression, and is convenient for serial follow-up. Its performance is more operator-dependent, however, and deep structures can be difficult to evaluate.

    MRI covers a larger anatomical field and depicts deep tissues more comprehensively. It is particularly useful when a substantial injury is suspected, when the proximal tendon origin may be involved, when there may be tendon avulsion from bone, when the clinical picture is unclear, or when detailed anatomy is required for operative planning. In severe hamstring injuries, MRI is especially valuable when proximal tendon-origin injury is suspected.

    Can ultrasound tell exactly when it is safe to return to sport?

    No. Imaging is only one part of the decision. Even when ultrasound shows healing, return to running, strength training or multidirectional sport should also reflect pain, range of motion, strength, tolerance of progressively increasing load and the demands of the specific activity.

    Research links some imaging features with time away from sport, but an image alone cannot reliably identify one exact day on which return becomes safe. A follow-up scan should therefore not replace functional assessment.

    How are muscle tears usually treated?

    Most partial muscle injuries are treated without surgery. Early management aims to control pain and excessive tissue bleeding, followed by a progressive return of movement, strength and load tolerance. Prolonged complete immobilisation is usually not beneficial; the loading programme should match the location and severity of the injury.

    Surgery is considered mainly for selected complete ruptures, tendon injuries with clinically important displacement, or other situations in which the injury anatomy makes a satisfactory result with non-operative treatment less likely.

    When does a muscle injury need urgent assessment?

    Urgent assessment is warranted when pain is very severe or rapidly worsening, swelling is large and increasing quickly, there is pronounced loss of strength, visible deformity, numbness, pallor or coolness of the limb. A large haematoma deserves particular caution in someone taking anticoagulant medication. Increasing pain that is disproportionate to the injury together with tense swelling can indicate compartment syndrome and requires immediate evaluation.

    The key point: imaging must fit the symptoms

    Musculoskeletal ultrasound is most useful when it follows from the history and clinical examination rather than being ordered “just in case”. It can answer many focused questions about muscle injury quickly, but not every episode of pain after exercise represents a tear and not every injury requires imaging.

    Back to: Muscle and Tendon Injuries

    See also: Diagnostic Tests

    References

    1. Palermi S, Scavone A, Anzà M, et al. Diagnostic ultrasound of muscle injuries: what the sports medicine clinician should know. British Journal of Sports Medicine. 2025;59(24):1759–1770. DOI: 10.1136/bjsports-2025-110255.
    2. Marrero AM, Mazza LA, Cedola N, et al. MRI and US in Hamstring Sports Injury Assessment: Anatomy, Imaging Findings, and Mechanisms of Injury. RadioGraphics. 2025;45(5). DOI: 10.1148/rg.240061.
    3. Martin RL, Cibulka MT, Bolgla LA, et al. Hamstring Strain Injury in Athletes. J Orthop Sports Phys Ther. 2022;52(3):CPG1–CPG44. DOI: 10.2519/jospt.2022.0301.

    This information is educational and does not replace an individual medical consultation.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Can You Kneel After Total Knee Replacement?

    Polish version

    Yes. Once a total knee replacement has healed properly, kneeling is generally not considered harmful to the implant. For many patients it is still uncomfortable or difficult because of scar tenderness, numb skin, pressure sensitivity, stiffness or fear of putting weight through the operated knee. Kneeling should not be attempted on a fresh or incompletely healed wound, and the timing of return should reflect wound healing and the individual postoperative plan.

    Can kneeling damage a knee replacement?

    A common concern is whether direct pressure through the knee can loosen or damage the prosthesis. Available evidence does not indicate that kneeling, once healing is complete, is harmful to a normally functioning total knee replacement. The American Academy of Orthopaedic Surgeons likewise notes that kneeling may be uncomfortable after total knee arthroplasty but is not considered damaging to the implant.

    That does not mean every patient will kneel easily. A review of function after total knee replacement found that 60–80% of patients reported some difficulty with kneeling or avoided it. Importantly, the perception that “I cannot kneel” does not always match the person’s actual ability to perform the task when it is assessed directly.

    Why can kneeling remain difficult after surgery?

    • Scar tenderness — direct pressure on the front of the knee may remain uncomfortable for a long time.
    • Skin numbness — small cutaneous sensory branches can be divided during the surgical approach, leaving an area of reduced sensation, often lateral to the scar. This commonly becomes less troublesome with time but may not disappear completely.
    • Pressure pain — even a well-functioning knee can remain sensitive on a hard surface.
    • Limited range of motion — deeper kneeling requires sufficient flexion, although range of motion does not explain all of the difference between people who kneel and those who avoid it.
    • Fear of damaging the implant — some patients never try because they believe kneeling is prohibited.
    • Other musculoskeletal limitations — the opposite knee, hip, spine, muscle weakness or difficulty getting back up from the floor may be more limiting than the replaced knee itself.

    When can you start trying?

    There is no single date that is appropriate for everyone. The key prerequisite is complete wound healing. Do not put direct pressure on a fresh scar, a wound that is still draining, an area with a scab, increasing redness or marked tenderness. Some centres advise waiting several months, while others allow gentle attempts earlier once the wound is fully healed. Differences reflect surgical technique, the course of healing and the rehabilitation plan.

    Function and safety are more useful than the calendar alone. Before kneeling, the patient should have stable walking, adequate strength and the ability to lower themselves toward the floor and get up again safely.

    How can kneeling be reintroduced safely?

    First attempts are best made in a controlled setting with a stable support for the hands. A soft mat, thick pad or cushion can reduce focal pressure on the front of the knee. There is no need to move immediately into a deep kneeling position or stay on the knees for a prolonged period.

    A sensible progression is to begin with brief contact on a soft surface, then gradually increase time and load as long as pain and swelling are not increasing. When the main difficulty is getting down to the floor and standing up again rather than kneeling itself, practising those transitions with a physiotherapist can be useful. Studies suggest that instruction and task-specific practice can improve actual kneeling ability.

    Is a large amount of knee flexion required?

    Greater flexion makes some kneeling positions easier, but it is not the only requirement. Some patients with good range of motion still avoid kneeling because of tenderness or fear, while others can achieve a functional kneel despite only moderate flexion. The flexion angle alone therefore does not predict whether kneeling will be comfortable.

    Does the type of implant or surgery matter?

    The influence of incision type, implant design and patellar resurfacing has been studied, but the findings do not provide a simple way to predict kneeling ability. A meta-analysis of 36 studies found some associations between surgical technique and kneeling, while also emphasising the need for better randomised evidence. There is no good basis for selecting an implant solely to optimise this one activity.

    If regular kneeling is essential for work, gardening, a hobby or religious practice, it is worth discussing this before surgery. It should form part of the conversation about realistic functional goals after knee replacement.

    What about kneeling after partial knee replacement?

    Kneeling can also be difficult after unicompartmental knee replacement, although available evidence suggests that appropriate instruction may improve the ability to perform the task. Those findings should not be transferred automatically to every total knee replacement because the extent of surgery and biomechanics differ.

    When should kneeling be avoided and the knee assessed?

    Kneeling should be postponed when the wound has not fully healed or when symptoms suggest a postoperative complication. Earlier assessment is particularly important for:

    • drainage from or separation of the wound,
    • increasing redness and marked warmth around the operated knee,
    • fever together with worsening knee symptoms,
    • sudden or rapidly increasing pain and swelling,
    • new instability or a clear deterioration in function,
    • calf pain and swelling, especially if accompanied by shortness of breath or chest pain, which requires urgent medical assessment.

    Kneeling is only one part of returning to function

    Patients after knee replacement also ask about driving, work and sport. Each activity requires a different combination of strength, control and tolerance. Someone who can walk several kilometres comfortably may still dislike pressure on the scar while kneeling. Conversely, difficulty kneeling does not by itself mean that the knee replacement is functioning poorly.

    Key points for an orthopaedic surgeon

    After a well-healed total knee replacement, kneeling itself is not generally considered harmful to the implant. The more common barriers are scar tenderness, numbness, pressure pain, stiffness and fear of damaging the prosthesis. Return should be gradual, initially on a soft surface, and only once the wound has healed. Increasing pain, swelling, wound problems or other warning signs should be assessed before kneeling is resumed.

    Back to: Before and After Orthopaedic Surgery

    References

    • Wylde V, Artz N, Howells N, Blom AW. Kneeling ability after total knee replacement. EFORT Open Rev. 2019;4(7):460–467. DOI: 10.1302/2058-5241.4.180085.
    • Nadeem S, Mundi R, Chaudhry H. Surgery-related predictors of kneeling ability following total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Relat Res. 2021;33:36. DOI: 10.1186/s43019-021-00117-z.
    • Wallace SJS, Berger RA. Most Patients Can Kneel After Total Knee Arthroplasty. J Arthroplasty. 2019;34(5):898–900. DOI: 10.1016/j.arth.2019.01.047.
    • American Academy of Orthopaedic Surgeons. Total Knee Replacement. OrthoInfo. Accessed 10 September 2026.

    This information is educational and does not replace an individual medical consultation.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Tarsal Tunnel Syndrome — What Causes Numbness in the Sole?

    Polish version

    Burning, tingling or numbness in the sole can result from compression of the tibial nerve or its branches within the tarsal tunnel, the space on the inner side of the ankle. These symptoms do not automatically mean tarsal tunnel syndrome, however. Similar complaints can arise from the lumbar spine, other peripheral nerves or structures within the foot. Diagnosis therefore depends on the history, clinical examination and appropriately selected tests rather than on any single investigation.

    The tarsal tunnel lies behind and below the medial malleolus. Tendons, blood vessels and the tibial nerve pass through it; the nerve then divides into branches supplying much of the sole. Symptoms can develop when the available space becomes restricted or when the nerve is compressed locally by another structure.

    Which symptoms fit tarsal tunnel syndrome?

    The most typical complaints are felt around the medial ankle and on the sole. Patients may describe burning, tingling, numbness, electric-shock sensations or shooting pain. Symptoms can radiate into the heel, arch or toes.

    • numbness or tingling mainly affects the sole rather than the top of the foot,
    • symptoms may worsen with prolonged standing, walking or running,
    • pressure or percussion behind the medial malleolus may reproduce tingling into the foot,
    • pain may feel burning or electrical rather than purely mechanical,
    • more advanced cases can produce sensory loss and, much less often, weakness of the small muscles of the foot.

    The symptom pattern alone is not enough for diagnosis. Tarsal tunnel syndrome can be confused with plantar fasciopathy, S1 radiculopathy and other neuropathies of the foot. Pain that is most prominent with the first steps in the morning and is centred at the medial heel may point instead toward plantar fascia overload.

    What can compress the tibial nerve?

    The cause is not always obvious. Reduced space within the tunnel may follow injury and scarring, bony changes, tendon-sheath inflammation, a ganglion or another space-occupying lesion. Varicose veins and other vascular abnormalities, accessory muscles and foot deformity that alters local mechanics have also been described.

    For that reason, the aim of assessment is not simply to label the problem as “nerve compression”, but—when possible—to identify what is causing the compression. This can directly influence treatment: a ganglion, post-traumatic scarring and a syndrome without a clear structural lesion are not managed in exactly the same way.

    How is the diagnosis made?

    The first step is to define the exact sensory distribution and how the symptoms are provoked. Examination includes sensation, strength, sites of tenderness, foot alignment and whether pressure or percussion over the tibial nerve behind the medial malleolus reproduces typical paraesthesia. At the same time, the clinician should look for evidence of another explanation such as lumbosacral radiculopathy or a generalised polyneuropathy.

    A review in EFORT Open Reviews emphasised that there is no single test that can diagnose tarsal tunnel syndrome with complete certainty. Clinical findings should be integrated with imaging and, where appropriate, nerve-conduction studies or electromyography.

    What can nerve ultrasound show?

    Ultrasound can trace the tibial nerve around the ankle and through the tarsal tunnel, assess its calibre and internal appearance, and look for a local cause of compression. It can also reveal neighbouring abnormalities such as a ganglion, tendon-sheath inflammation, selected vascular abnormalities, accessory muscles or post-traumatic change. A further advantage is dynamic assessment while the ankle moves or symptoms are provoked locally.

    Ultrasound is not a rule-out test. In a 2026 study of 26 feet with tarsal tunnel syndrome confirmed clinically and electrophysiologically, nerve ultrasound detected abnormalities with a sensitivity of about 65% when the commonly used nerve cross-sectional-area threshold of 11.8 mm² was applied. In other words, a normal ultrasound does not exclude tarsal tunnel syndrome.

    The same study noted that, when ultrasound was abnormal, nerve swelling was often seen within the tunnel itself rather than only just proximal to the presumed compression. This supports scanning the nerve over a sufficiently long segment and comparing its appearance within the tunnel with more proximal portions.

    Is EMG necessary?

    Nerve-conduction studies and electromyography can provide objective information about the function of the tibial nerve and its branches, and can help distinguish local compression from radiculopathy or polyneuropathy. Their sensitivity is also limited, however. A normal result should not automatically end the diagnostic process when the history and examination continue to strongly suggest an entrapment neuropathy.

    When are MRI or CT useful?

    MRI is particularly helpful when deeper tissues need more detailed assessment, a space-occupying lesion is suspected, or the clinical examination and ultrasound do not provide a clear answer. In a small surgical series, MRI identified the site of compression in 23 of 28 feet, but it did not always identify the specific cause, including some varices or small vascular branches compressing the nerve.

    CT has less value for assessing the nerve itself, but it can be useful when a bony cause is suspected—for example deformity, an osteophyte, a consequence of fracture or another osseous abnormality whose anatomy matters for treatment planning.

    What else should be considered?

    Burning or numbness in the foot does not always originate in the tarsal tunnel. Depending on the distribution and character of symptoms, the differential diagnosis includes S1 radiculopathy, polyneuropathy, plantar fasciopathy, stress fracture and more distal focal neuropathies of the foot. Forefoot pain and tingling that radiate into adjacent toes, especially in tight footwear, may suggest Morton’s neuroma instead.

    How is tarsal tunnel syndrome treated?

    Treatment depends mainly on the cause and on the degree of nerve dysfunction. When there is no progressive neurological deficit and no clear lesion that requires removal, management usually starts non-operatively: reducing the loading that reproduces symptoms, modifying footwear or using an orthotic when appropriate, treating pain, and addressing relevant mechanical factors of the foot.

    An injection around the tarsal tunnel may be considered in selected patients, particularly when a local inflammatory component or swelling is suspected. Because the nerve and vessels lie close together, ultrasound guidance allows direct control of needle position. This is not, however, a universal treatment for every tibial neuropathy.

    When does an orthopaedic surgeon consider surgery?

    Surgical decompression is considered mainly when clinically important symptoms persist despite appropriate non-operative treatment and there is credible evidence that the nerve is actually being compressed within the tarsal tunnel. The indication is stronger when a specific cause can be identified, such as a ganglion, post-traumatic scar or another space-occupying lesion.

    Reported rates of good surgical outcomes vary widely. The result cannot be promised on the basis of one positive provocative test or one ultrasound image. Better outcomes have been reported when symptoms have been present for a shorter time, the cause of compression is clear and the clinical findings are concordant. Long-standing neuropathy with established nerve damage may not fully recover even after the compression has been removed.

    Which symptoms need faster assessment?

    • progressive weakness of the toes or foot muscles, especially with a new gait disturbance,
    • rapidly worsening or extensive sensory loss after a recent ankle injury,
    • marked swelling after injury accompanied by increasing pain and numbness,
    • a cold, pale or blue foot or other signs of impaired blood flow,
    • fever, redness, warmth and increasing swelling suggesting infection,
    • numbness affecting both feet or multiple limb regions, which may indicate a generalised problem rather than compression of one local nerve.

    What is the practical takeaway?

    Tarsal tunnel syndrome is worth considering when burning, tingling and numbness mainly affect the sole and relate to the region behind the medial malleolus. The key is to establish whether the symptoms truly fit tibial nerve compression and, where possible, identify the cause. Ultrasound can be very useful, but a normal scan does not exclude neuropathy. Likewise, an isolated abnormal EMG or MRI finding should not be interpreted without clinical correlation.

    Back to: Foot and Ankle Conditions

    See also: Peripheral Nerves

    References

    • Holtz B-O, Ceanga M, Behnert A, Marquardt R, Geis C, Axer H. Nerve Ultrasound for the Diagnosis of Tarsal Tunnel Syndrome: Findings in 26 Clinically and Electrophysiologically Confirmed Feet. J Clin Med. 2026;15(5):1699. DOI: 10.3390/jcm15051699.
    • Rodríguez-Merchán EC, Moracia-Ochagavía I. Tarsal tunnel syndrome: current rationale, indications and results. EFORT Open Rev. 2021;6(12):1140–1147. DOI: 10.1302/2058-5241.6.210031.
    • de Souza Reis Soares O, Duarte ML, Brasseur J-L. Tarsal Tunnel Syndrome: An Ultrasound Pictorial Review. J Ultrasound Med. 2022;41(5):1247–1272. DOI: 10.1002/jum.15793.
    • Kim K, Kokubo R, Isu T, Nariai M, Morimoto D, Kawauchi M, Morita A. Magnetic Resonance Imaging Findings in Patients with Tarsal Tunnel Syndrome. Neurol Med Chir (Tokyo). 2022;62(12):552–558. DOI: 10.2176/jns-nmc.2022-0118.

    This information is educational and does not replace an individual medical consultation.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Why Surgery Is Not Based on an MRI Result Alone

    Polish version

    An MRI report is one piece of the diagnostic puzzle, not an indication for surgery by itself. Treatment decisions concern a particular patient: their pain, functional limitation, clinical examination, course of symptoms and treatment goals. The same MRI finding can have very different significance in two different people.

    An imaging finding is not always the source of pain

    MRI is highly sensitive and often shows age-related or degenerative changes that may not cause symptoms. Degenerative meniscal changes, spinal-disc abnormalities and rotator cuff tendon changes can all be present in people without pain. Finding an abnormality is therefore not the end of the diagnostic process. The finding still has to match the location, character and mechanism of the patient’s symptoms.

    Five questions an orthopaedic surgeon considers before a treatment decision

    1. Does the imaging finding match the symptoms?

    A lesion described on MRI should fit the location of pain, loss of movement, weakness or instability. If the report concerns a different part of the joint from the area that is painful and reproduces symptoms on examination, the association may be incidental.

    2. Does the clinical examination support that explanation?

    Range of motion, strength, stability, swelling and provocative tests help determine whether an MRI abnormality has functional significance. MRI also cannot show everything that happens during movement or weight bearing.

    3. Have the actual images been reviewed, not only the report?

    The radiology report is important, but treatment planning also benefits from reviewing the images themselves. Location, extent, tissue quality, associated abnormalities and whether the finding genuinely explains the clinical problem can all matter.

    4. Was MRI the right test for the question?

    MRI does not replace X-rays when limb alignment, the weight-bearing joint space or the severity of some degenerative changes needs to be assessed. Nor does it replace dynamic ultrasound when the question concerns a snapping tendon, movement of a structure or a targeted image-guided procedure. The investigation should be chosen to answer the clinical question, not the other way around.

    5. Is surgery likely to improve the problem that actually matters to the patient?

    Even a genuine structural lesion does not always require an operation. Its natural history, the response to appropriate non-operative treatment, procedural risk and the patient’s functional goal all need to be considered. Surgery makes sense when there is a plausible mechanism for the symptoms and a reasonable likelihood that the procedure can change it.

    When can MRI before consultation be particularly useful?

    MRI can be very valuable after selected injuries, when an intra-articular lesion is suspected, in possible osteonecrosis, an occult fracture not seen on X-ray, infection or a tumour, and when earlier assessment and treatment have not explained persistent symptoms. That does not mean MRI should be the first test for every painful knee, shoulder or hip.

    How should imaging be brought to a consultation?

    • bring the actual images — on disc, another storage medium or through a working online viewer — rather than only a printed report,
    • bring previous X-rays, ultrasound or MRI when comparison over time may be useful,
    • note exactly where the pain occurs, which movements provoke it and what it prevents you from doing,
    • summarise previous treatment and what effect it actually had.

    The central principle

    We do not operate on an image. We treat a clinical problem, and MRI is one tool for understanding that problem and planning management. The best decision comes from combining the history, physical examination and appropriately interpreted imaging.

    Back to: Diagnostic Tests

    References

    • Poboży T, Konarski W, Janowski K, Michalak K, Poboży K, Domańska-Poboża J. Ultrasonographic Assessment of Meniscus Damage in the Context of Clinical Manifestations. Medicina. 2025;61(8):1339. DOI: 10.3390/medicina61081339.
    • Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811–816. DOI: 10.3174/ajnr.A4173.
    • Culvenor AG, Øiestad BE, Hart HF, Stefanik JJ, Guermazi A, Crossley KM. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med. 2019;53(20):1268–1278. DOI: 10.1136/bjsports-2018-099257.
    • Teunis T, Lubberts B, Reilly BT, Ring D. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. J Shoulder Elbow Surg. 2014;23(12):1913–1921. DOI: 10.1016/j.jse.2014.08.001.

    This material is educational and does not replace an individual medical consultation.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Lateral Ankle Pain — Could It Be the Peroneal Tendons?

    Polish version

    Pain on the outer side of the ankle, particularly behind or just below the lateral malleolus, may come from the peroneal tendons. It often becomes more noticeable when walking on uneven ground, running, rising onto the toes or after an ankle sprain. Similar symptoms can also arise from ligaments, joint cartilage, bone or the sural nerve, so pain location alone is not a diagnosis.

    What are the peroneal tendons?

    The peroneus longus and peroneus brevis tendons run together behind the lateral malleolus. They help stabilise the foot and ankle, especially during weight bearing on uneven surfaces, and are held within their groove by the retinaculum. Problems can include tendinopathy, longitudinal splitting or tearing, tenosynovitis, or instability in which the tendons snap or move out of their normal position.

    Which symptoms are typical?

    • pain and tenderness behind the lateral malleolus or along the outer border of the foot,
    • pain that increases on uneven ground, during running or with resisted eversion of the foot,
    • swelling along the course of the tendons,
    • a snapping sensation or audible click behind the ankle,
    • recurrent feelings of instability after previous ankle sprains.

    A sudden snap after injury can indicate retinacular damage with tendon subluxation. By contrast, persistent lateral ankle pain without one clear injury is more often associated with overload, foot alignment, recurrent sprains or chronic tendon damage.

    What else can cause pain in the same area?

    The differential diagnosis includes lateral ligament injury after a sprain, fracture of the ankle or the base of the fifth metatarsal, an osteochondral lesion of the talus, ankle impingement, sural nerve irritation and pain arising from more distal joints of the foot. After an acute injury, this is why an X-ray is often the first imaging test rather than ultrasound.

    See also: Ankle Injuries.

    How is the problem assessed?

    Clinical examination

    The exact site of tenderness, muscle strength, ankle stability, foot alignment and reproduction of pain with resisted movement all matter. When tendon snapping is suspected, the tendons should also be assessed while the ankle is moving.

    X-ray

    After a recent injury, radiographs help exclude a fracture. They may also show bony anatomy that contributes to impingement or chronic overload, but they do not usually assess the tendons themselves adequately.

    Ultrasound

    Ultrasound can show tendon continuity and structure, fluid within the tendon sheath and tendon behaviour during movement. Dynamic assessment is especially useful when snapping or subluxation behind the lateral malleolus is suspected. A normal ultrasound, however, does not exclude every subtle abnormality.

    MRI

    MRI can help define the extent of tendon injury while also assessing cartilage, ligaments, bone marrow and other deeper structures. The choice between ultrasound and MRI depends on the clinical question; the two tests can be complementary.

    How are peroneal tendon problems treated?

    Overuse-related symptoms and stable partial injuries are usually treated non-operatively first. Management may include temporarily reducing activities that provoke pain, progressive strengthening and ankle-control exercises, footwear modification and, in selected cases, an orthotic or a short period of immobilisation. Return to running should depend on strength, stability and the tendon’s response to loading rather than simply on the number of days that have passed.

    Analgesic or anti-inflammatory medication may be appropriate for selected patients, but it does not repair a damaged tendon. Tendon-sheath injections are considered selectively; image guidance is advisable, and steroid should not be injected into the tendon itself. Evidence for injections in this region remains limited.

    More about image-guided procedures: Injection Treatments.

    When does an orthopaedic surgeon consider surgery?

    Surgery is considered mainly for complete or extensive tendon tears, recurrent subluxation, persistent weakness or pain that continues despite appropriate non-operative treatment. The procedure depends on whether the main problem lies in the tendon itself, the retinaculum, the groove behind the lateral malleolus or associated ankle instability.

    Warning signs

    Earlier assessment is needed after an injury if the foot cannot be loaded, there is an obvious deformity, swelling is increasing rapidly, sensation or circulation is impaired, there is an open wound, fever develops with marked local redness, or a sudden snap is followed by clear weakness of the foot. The ability to take a few steps does not by itself rule out a significant injury.

    Back to: Foot and Ankle Conditions

    More about: Tendons and Enthesopathies

    References

    • van Dijk PAD, Miller D, Calder J, et al. The ESSKA-AFAS international consensus statement on peroneal tendon pathologies. Knee Surg Sports Traumatol Arthrosc. 2018;26(10):3096–3107. DOI: 10.1007/s00167-018-4971-x.
    • Ghandour S, Mercer RW, Strahan JA, et al. Diagnostic accuracy of MRI and US for peroneal tendon tears: a systematic review and meta-analysis. Eur Radiol. 2025. DOI: 10.1007/s00330-025-11472-w. PubMed.
    • Dombek MF, Lamm BM, Saltrick K, Mendicino RW, Catanzariti AR. Peroneal tendon tears: a retrospective review. J Foot Ankle Surg. 2003;42(5):250–258.

    This material is educational and does not replace an individual medical consultation.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Radial Tunnel Syndrome — Lateral Elbow Pain Without Numbness

    Polska wersja

    Radial tunnel syndrome can cause deep pain on the outer side of the elbow and upper forearm, usually without numbness in the fingers. The symptoms often resemble tennis elbow, but tenderness is typically located several centimetres below the lateral epicondyle. Diagnosis requires caution because no single test can confirm the syndrome on its own.

    Where is the nerve compressed?

    Around the elbow, the radial nerve divides into a superficial branch and a deep branch, which continues as the posterior interosseous nerve. The deep branch passes through a tunnel formed by muscles and fibrous bands in the proximal forearm. The region of the supinator muscle is one of the more common sites of compression.

    Pain is the dominant feature in radial tunnel syndrome. Clear finger drop or wrist drop suggests a more significant motor lesion of the posterior interosseous nerve or radial nerve and warrants more prompt investigation.

    Which symptoms can suggest radial tunnel syndrome?

    • deep, dull or burning pain on the lateral side of the elbow and upper forearm,
    • tenderness usually 3–5 cm below the lateral epicondyle of the humerus,
    • pain aggravated by forearm supination, gripping or repetitive hand work,
    • pain with resisted middle-finger extension or resisted supination,
    • usually no typical numbness of the skin of the hand or fingers.

    Radial tunnel syndrome or tennis elbow?

    In tennis elbow, maximal tenderness is usually directly over the lateral epicondyle at the origin of the wrist extensors. In radial tunnel syndrome, the most painful point is more often distal to the epicondyle, along the course of the nerve. The two problems can coexist, and a single provocative test does not settle the diagnosis.

    How is it diagnosed?

    Clinical examination

    The location of pain, muscle strength, sensation, range of motion of the neck and elbow, and reproduction of symptoms during specific resisted movements are all important. The differential diagnosis includes extensor tendinopathy, radiocapitellar joint disease, cervical radiculopathy and radial nerve compression at another level.

    EMG and nerve conduction studies

    Electrophysiological studies may be normal in a typical pain-dominant radial tunnel syndrome. They are more useful when there is objective weakness and the clinician needs to assess a motor nerve lesion or distinguish the problem from radiculopathy.

    Ultrasound and MRI

    Ultrasound can show the course of the nerve, changes in its calibre, compression by a cyst or another lesion, and can provide dynamic assessment. MRI can help identify a space-occupying lesion and signs of muscle denervation. Normal imaging, however, does not exclude a clinical pain syndrome.

    How does treatment begin?

    Management usually starts by reducing repetitive movements that provoke pain, particularly forceful gripping, forearm supination and work with the elbow extended. Ergonomic modification, graded exercise, soft-tissue treatment and work on mobility and strength may help, provided the programme does not continually provoke symptoms.

    Analgesic or anti-inflammatory medication can be used in appropriately selected patients. A targeted injection is sometimes used diagnostically or therapeutically, but evidence for durable benefit is limited. Ultrasound guidance improves control of needle placement, although technical accuracy alone does not confirm the diagnosis.

    When does an orthopaedic surgeon consider surgery?

    Surgical decompression may be considered in selected patients with well-documented, persistent pain despite appropriately conducted non-operative treatment, or when compression by a specific structure has been demonstrated. Outcomes are not uniformly predictable. A systematic review published in 2026 highlighted substantial variation in diagnostic criteria and surgical techniques, making it difficult to identify a single best operative approach.

    Red flags

    Prompt assessment is warranted for new finger or wrist drop, progressive grip weakness, sensory loss after injury, marked swelling or deformity of the elbow, worsening pain with fever and redness, or signs of impaired circulation in the hand. These findings should not be attributed simply to “overuse.”

    Back to: Peripheral Nerves

    See also: Elbow Conditions

    References

    • Wolf JM, Patel R, Ghosh K. Radial Tunnel Syndrome: Review and Best Evidence. J Am Acad Orthop Surg. 2023;31(15):e667–e674. DOI: 10.5435/JAAOS-D-23-00314.
    • Levina Y, Dantuluri PK. Radial Tunnel Syndrome. Curr Rev Musculoskelet Med. 2021;14:205–213. DOI: 10.1007/s12178-021-09703-w.
    • Raymond B, Cueto RJ, Mazudie Ndjonko LC, et al. Clinical Outcomes of Operative Management for Radial Tunnel Syndrome According to Surgical Approach: A Systematic Review. Hand (N Y). 2026;21(1):24–31. DOI: 10.1177/15589447251315761.

    This information is educational and does not replace an individual medical consultation.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Why Does Musculoskeletal Ultrasound Compare Both Sides?

    Polska wersja

    Comparing the painful side with the asymptomatic side can help distinguish an individual anatomical feature from a true abnormality. It is not, however, an automatic deciding test. The opposite limb may contain asymptomatic changes, and some disorders are bilateral.

    Each patient provides their own reference point

    Reference ranges for tendon thickness or nerve size are useful, but they do not capture the full range of biological variation. Comparing both sides can show whether a difference is pronounced in that particular patient. This is especially useful when the finding is subtle or lies close to the boundary of what is considered normal.

    What can an orthopaedic surgeon compare during ultrasound?

    • tendon thickness and internal structure,
    • nerve cross-sectional area and echogenicity,
    • the amount of fluid in a bursa or tendon sheath,
    • how a structure behaves during movement,
    • vascularity on Doppler imaging,
    • bony contours and anatomical relationships.

    Side-to-side comparison is most useful when the images are obtained in the same plane, with a similar limb position and identical machine settings. Otherwise, an apparent asymmetry may reflect technique rather than disease.

    Ultrasound is not only a static image

    One of the advantages of musculoskeletal ultrasound is the ability to observe tissues in real time. A tendon may snap only during a particular movement, a nerve may change position as a joint bends, and tissue impingement may appear only in a specific position. Comparing both sides during the same manoeuvre can therefore be more informative than comparing two isolated still images.

    Why is the other side not always a “healthy control”?

    Imaging abnormalities can occur without pain. This applies, among other things, to degenerative changes in tendons, entheses and menisci. Conversely, a disorder may affect both sides even when symptoms are present only on one side. A symmetrical appearance therefore does not exclude disease, and asymmetry by itself does not prove that the source of pain has been identified.

    The image must be matched to the exact site of symptoms

    The greatest value comes from combining three elements: the history, physical examination and ultrasound findings. If an abnormality is located where the patient hurts, changes during the movement that provokes symptoms and fits the clinical mechanism, it becomes more likely to be relevant. If it is incidental and does not correspond to the symptoms, it should not determine treatment on its own.

    This approach was also important in a study of 430 patients evaluating meniscal abnormalities with ultrasound, co-authored by Tomasz Poboży. Ultrasound was treated as one component of the clinical assessment, with attention to the type of symptoms and the limitations of the method.

    When can side-to-side comparison be misleading?

    • after a previous injury or operation on the currently asymptomatic side,
    • in bilateral or systemic disorders,
    • when the limb or transducer position is not equivalent on both sides,
    • when the difference lies within normal biological variation,
    • when the visible abnormality does not match the location of symptoms.

    Practical takeaway

    The opposite side is a valuable reference, but it does not replace knowledge of anatomy, diagnostic criteria or examination of the patient. Good ultrasound practice is not about finding any asymmetry. The question is whether the observed difference actually explains the symptoms and whether it should change further management.

    Back to: Diagnostic Tests

    More about: MSK Ultrasound and Ultrasound-Guided Procedures

    References

    • Poboży T, Konarski W, Janowski K, Michalak K, Poboży K, Domańska-Poboża J. Ultrasonographic Assessment of Meniscus Damage in the Context of Clinical Manifestations. Medicina. 2025;61(8):1339. DOI: 10.3390/medicina61081339.
    • European Society of Musculoskeletal Radiology. Musculoskeletal ultrasound technical guidelines. Current technical recommendations and regional scanning protocols.

    This material is educational and does not replace an individual medical consultation.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Why Do Weight-Bearing X-Rays Show More?

    Polish version · Explore Diagnostic Tests

    A weight-bearing X-ray shows a joint under conditions that are closer to standing and walking than an image taken while lying down. Body weight may reveal joint-space narrowing, loss of alignment, collapse of the foot arch or instability that is less apparent on a non-weight-bearing image. This does not mean that every patient should have standing radiographs.

    The same knee can look different standing and lying down

    Articular cartilage is not directly visible on a standard X-ray. Its condition is assessed indirectly, among other features, by the width of the space between the bones. When a patient stands, load brings the joint surfaces together. If cartilage loss is uneven, narrowing may become more apparent in this position.

    It matters not only whether the joint space is narrower, but also where the narrowing occurs and how the limb axis behaves under load. Weight-bearing radiographs can therefore be important when assessing knee osteoarthritis and planning treatment. The image still needs to be interpreted alongside pain, range of motion, stability and everyday function.

    In the foot, loading can change the entire geometry

    The foot is a dynamic structure. When standing, the height of the arches, the position of the metatarsals and heel, and the relationships between joints all change. In hallux valgus, flatfoot, hindfoot deformity or suspected midfoot instability, a non-weight-bearing image may underestimate the true extent of the problem.

    This is one reason why properly performed standing foot radiographs are often the basis for measurements before planned treatment. MRI and ultrasound answer different questions: they can show selected soft tissues more clearly, but they do not replace assessment of bony alignment under load.

    Loading can reveal instability

    Some joints and ligament-related relationships may appear normal until force is applied. Selected midfoot injuries are an example: separation between bones can become visible only during a safely performed weight-bearing examination. Stress radiographs use a similar principle, although they have separate indications and techniques.

    When is a standing X-ray not a good idea?

    After a recent injury with suspected unstable fracture, severe pain or inability to bear weight safely, standing should not be forced simply to obtain a supposedly better image. Safety comes first. Depending on the clinical situation, standard projections, comparison views, CT or MRI may be more appropriate.

    Technique matters

    Radiographs can be compared meaningfully only when the limb position and projection are sufficiently similar. Knee rotation, different degrees of flexion or uneven weight distribution can alter measurements. The label “weight-bearing X-ray” is therefore not enough: the examination needs to be performed in a way that answers the clinical question.

    How an orthopaedic surgeon chooses the X-ray projection

    There is no single universal X-ray series for all of orthopaedics. Assessment of knee osteoarthritis requires different projections from assessment of hallux valgus or an acute injury. A useful imaging request should not simply name the body region. It should indicate what is being assessed and whether evaluation under load is needed.

    Practical conclusion

    A standing X-ray is not automatically more accurate than one taken while lying down. It shows a different aspect of the problem: how bones and joints behave under body weight. It is most useful when that information could change the diagnosis, measurement or treatment plan.

    References

    • Expert Panel on Musculoskeletal Imaging. ACR Appropriateness Criteria® Chronic Knee Pain. Journal of the American College of Radiology. 2018;15(11S):S302–S312. DOI: 10.1016/j.jacr.2018.09.016.
    • Expert Panel on Musculoskeletal Imaging. ACR Appropriateness Criteria® Acute Trauma to the Foot. Journal of the American College of Radiology. 2020;17(5S):S46–S55. DOI: 10.1016/j.jacr.2020.01.022.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Orthopaedic Surgical Wound Care — When Should You Change the Dressing?

    Polish version · Before and After Orthopaedic Surgery

    The most important rule is to keep an orthopaedic surgical dressing clean and dry and to follow the wound-care instructions given for the specific procedure. Not every wound needs to be uncovered or redressed every day. A small amount of staining can be normal, but increasing drainage, separation of the wound edges, spreading redness, fever or worsening pain should prompt contact with the treating team.

    Why are wound-care instructions different after different operations?

    A wound after arthroscopy, fracture fixation or joint replacement may be closed with different materials and protected by different dressings. Drains, negative-pressure wound therapy, coexisting medical conditions and medicines that affect clotting can also change the plan. For that reason, written discharge instructions take priority over general advice.

    When should the dressing be changed?

    If the dressing is dry, sealed and adheres well, it can often remain in place for the period recommended by the orthopaedic surgeon or the dressing manufacturer. It should be changed sooner if it becomes wet, soiled, loose or if drainage reaches the edge. Specialist dressings and negative-pressure systems should not be removed independently unless this has been specifically advised.

    How can a dressing be changed safely?

    • Wash and dry your hands thoroughly before touching the dressing and again after the change.
    • Prepare a clean surface and the materials recommended at discharge.
    • Do not touch the surface of the new dressing that will lie directly against the wound.
    • Remove the old dressing gently without pulling on sutures, skin-closure strips or tissue adhesive.
    • Do not apply creams, ointments, powders or topical antibiotics to the wound unless they have been specifically prescribed.
    • If the wound looks different from before, note the change and contact the treating team when appropriate.

    Can the wound be washed or soaked?

    NICE guidance indicates that showering is generally safe from 48 hours after surgery. This is not a universal instruction to wet every wound or dressing: the type of closure, a drain, a negative-pressure dressing or an individual instruction from the surgeon may require a different approach. After showering, the area should be dried gently without rubbing.

    Bathing, swimming, sauna use and prolonged soaking require more caution. They are usually postponed until the skin has fully closed and the wound has been reviewed. Prolonged water exposure can soften the wound edges and increase the risk of contamination.

    What can be normal during the first few days?

    • a small, non-increasing blood stain or a small amount of clear or lightly pink fluid on the dressing;
    • moderate tenderness that is not progressively worsening;
    • mild swelling and bruising around the operated area;
    • a pulling sensation in the skin during movement.

    The direction of change matters more than a single appearance. Over time, the wound should become calmer, while drainage and pain should gradually decrease.

    When does the wound need prompt review?

    • redness, warmth or swelling that is spreading around the incision;
    • pain that is increasing rather than decreasing, especially after an initial improvement;
    • cloudy, thick or unpleasant-smelling drainage;
    • a dressing that repeatedly becomes rapidly soaked with blood or fluid;
    • separation of the wound edges or a visible deeper defect;
    • fever, chills or a clear deterioration in general wellbeing;
    • new numbness, limb weakness, pallor or blue discolouration of the fingers or toes.

    After an operation involving an implant, even a small but persistent wound discharge should not simply be left until a distant routine follow-up. Early assessment can help distinguish superficial irritation from a problem that requires treatment.

    When are sutures or staples removed?

    The timing depends on the anatomical site, skin tension, closure method and healing rate. Sutures, staples, tissue adhesive and closure strips should not be removed independently. The wound should be reviewed at the time specified in the discharge instructions even when it appears normal from the outside.

    What increases the risk of wound-healing problems?

    Closer observation may be appropriate in people with diabetes, tobacco use, impaired circulation, anticoagulant treatment, reduced immunity, obesity or a previous history of wound-healing problems. These factors do not mean that a complication will occur, but they may justify earlier review.

    References

    • National Institute for Health and Care Excellence. Surgical site infections: prevention and treatment. NICE guideline NG125. Published 11 April 2019; updated 19 August 2020. Recommendations.
    • Centers for Disease Control and Prevention. Surgical Site Infection Basics. Updated 11 April 2024. CDC information.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.

  • Pain at the Front of the Shoulder — Could the Biceps Tendon Be the Cause?

    Polish version · Explore Shoulder Conditions

    Pain at the front of the shoulder can arise from the long head of the biceps tendon, but the source cannot be identified from pain location alone. Biceps tendon pathology often coexists with rotator cuff disease, labral lesions or injury to the structures that stabilise the tendon in the bicipital groove. Diagnosis therefore depends on combining symptoms, clinical examination and appropriately selected imaging.

    Where does the biceps tendon run in the shoulder?

    The biceps brachii has two proximal attachments around the shoulder. The long head originates near the superior glenoid and labrum, passes through the joint and then enters the bicipital groove of the humerus. Along this course it is stabilised by several structures, including fibres from the subscapularis and supraspinatus tendons and surrounding ligaments.

    This is why isolated “biceps tendinopathy” is not the only possible explanation. Pain may come from the tendon itself or its sheath, but also from a rotator cuff tear, a SLAP lesion, biceps tendon instability or another disorder within the shoulder joint.

    Which symptoms fit long-head biceps tendon pathology?

    • pain at the front of the shoulder, sometimes extending down the front of the upper arm;
    • pain that increases when raising the arm, working overhead, throwing or lifting an object;
    • pain when reaching behind the body, for example for a seat belt or while putting on a jacket;
    • tenderness over the bicipital groove;
    • sometimes painful snapping or clicking at the front of the shoulder.

    None of these findings is specific. Rotator cuff disease, frozen shoulder, acromioclavicular joint pathology and referred pain from the neck can produce a similar pattern. Speed’s test, Yergason’s test or tenderness over the groove may strengthen the suspicion, but a single positive test does not establish the diagnosis.

    A sudden pop and a bulge in the arm — could this be a rupture?

    An acute proximal biceps rupture may be accompanied by a pop, bruising and distal displacement of the muscle belly, producing a characteristic bulge lower in the upper arm. Pain can be substantial initially and then settle. Some patients are left with weakness during forearm supination, muscle cramping or a cosmetic concern.

    This appearance does not automatically mean surgery is required, particularly when the long head has ruptured and arm function remains good. The decision depends on age, activity level, the dominant arm, occupational demands and associated shoulder lesions.

    How is it assessed?

    Clinical examination

    The examination includes active and passive range of motion, rotator cuff strength, shoulder stability, the cervical spine, and sensation and strength throughout the limb. It is important to establish whether symptoms began after a single injury or developed with repetitive loading. Tendon snapping can suggest disruption of the structures that retain it in the groove, particularly near the subscapularis tendon.

    X-ray

    X-rays do not show the biceps tendon well, but they may reveal calcification, osteoarthritis, post-traumatic bony changes or another cause of shoulder pain. In an adult with persistent shoulder symptoms, radiographs are often a reasonable initial imaging study.

    Ultrasound

    Ultrasound can show the portion of the tendon within the groove, fluid around the tendon, thickening, partial or complete rupture and tendon displacement during movement. Dynamic scanning is useful when instability is suspected. The rotator cuff and subacromial-subdeltoid bursa can be assessed at the same examination.

    Ultrasound also has limitations. The intra-articular portion of the tendon and its attachment near the superior labrum are more difficult to assess completely. A normal appearance within the groove does not exclude pathology deeper inside the joint.

    MRI

    MRI can assess the biceps tendon together with the rotator cuff, cartilage, bone and other intra-articular structures. When a superior labral lesion is suspected, MR arthrography may be considered in selected cases. MRI is not necessary for every patient with anterior shoulder pain; it should answer a specific clinical question.

    How is biceps-related shoulder pain treated?

    Non-operative treatment

    Most overload-related symptoms are initially treated without surgery. This usually means temporarily reducing movements that clearly provoke pain rather than completely immobilising the shoulder, followed by a gradual return to loading. Rehabilitation may address range of motion, scapular control, rotator cuff exercises and progressive biceps strengthening.

    Analgesic or anti-inflammatory medication should be selected with other medical conditions and current medicines in mind. Cooling may reduce short-term symptoms after overload. If an injection is considered, it should follow a specific diagnosis. In selected situations medication can be placed into the tendon sheath under ultrasound guidance while avoiding injection into the tendon substance itself. Accurate needle placement does not by itself guarantee a durable clinical effect.

    When does an orthopaedic surgeon consider surgery?

    Surgery is considered mainly when appropriately conducted non-operative treatment does not restore acceptable function, when there is substantial tendon damage or instability, or when surgery is already planned for an associated rotator cuff or labral lesion. Common options include tenotomy, in which the damaged tendon is released, and tenodesis, in which it is detached from its intra-articular origin and fixed to the humerus. SLAP repair is reserved for appropriately selected patients.

    There is no single best procedure for everyone. Age, activity, cosmetic concerns, risk of cramping, occupational requirements and the other shoulder lesions all influence the choice.

    When is earlier assessment needed?

    • after an injury, the arm cannot be raised or there is clear new weakness;
    • the shoulder is deformed, markedly swollen or bruising is spreading quickly;
    • there is numbness, hand weakness, pallor or cooling of the limb;
    • pain is severe even at rest and is accompanied by fever, redness or deterioration in general condition;
    • shoulder pain occurs with shortness of breath, chest pressure or sudden general weakness.

    Key points

    Anterior shoulder pain can come from the long head of the biceps tendon, but associated pathology is common. Ultrasound is particularly useful for dynamic assessment of the tendon within the bicipital groove, whereas MRI better demonstrates intra-articular structures. For most patients, treatment begins with load modification and targeted rehabilitation; a decision about injection or surgery requires identification of the actual pain generator.

    References

    1. Poboży T et al. Clock-Face Sonography of the Glenoid Labrum: A Pictorial Technical Protocol for Patients Ineligible for MRI/MR Arthrography. Diagnostics. 2025;15(23):3031. DOI: 10.3390/diagnostics15233031. This publication includes assessment of the superior labrum and the region of the biceps attachment; it is not a treatment-effectiveness study for biceps tendinopathy.
    2. Lalehzarian SP, Agarwalla A, Liu JN. Management of proximal biceps tendon pathology. World Journal of Orthopedics. 2022;13(1):36–57. DOI: 10.5312/wjo.v13.i1.36. Full text.
    3. American Academy of Orthopaedic Surgeons. Biceps Tendinitis. Patient information prepared or reviewed by a member of the American Shoulder and Elbow Surgeons.

    Content prepared by: Tomasz Poboży - orthopaedic surgeon.