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Syphilis of tendon — Clinical Guidelines

Overview

Syphilis can affect tendons, leading to tenosynovitis or other inflammatory conditions, though specific syphilis-related tendon pathology is not extensively detailed in the provided abstracts. The focus here is on general tendon injuries and their management, with implications for syphilis-related complications inferred from broader tendon injury literature.

Diagnosis

Clinical Presentation: Pain, swelling, and functional impairment around the affected tendon 15 18.

Diagnostic Imaging: Ultrasound is validated for diagnosing tendon injuries, including those potentially exacerbated by systemic conditions like syphilis 15.

Laboratory Tests: Serological tests for syphilis (RPR, VDRL, TPHA) are crucial for diagnosing syphilis, which may indirectly affect tendon health 23.

Management

Conservative Management: Limited use of nonsteroidal anti-inflammatory drugs (NSAIDs) and avoidance of corticosteroid injections for chronic conditions 18.

Physical Therapy: Essential for rehabilitation, focusing on mechanical load and mobilization to enhance healing 17 28.

Biologic Augmentation: Emerging therapies include platelet-rich plasma (PRP) and mesenchymal stem cell-derived exosomes to promote healing 14 5 7 8.

Scaffolds and Biomaterials: Use of engineered scaffolds with growth factors (e.g., GDF-7) to enhance tendon-bone interface healing 9 11.

Special Populations

Pregnancy: Limited data; conservative management preferred due to potential risks of systemic treatments 18.

Elderly: Mechanical loads and biologic augmentation may be particularly beneficial given slower healing rates 17.

Comorbidities: Fluoroquinolone use should be monitored due to increased risk of tendon injury 23.

Key Recommendations

Utilize Ultrasound for Early Diagnosis of Tendon Injuries (Evidence: Moderate 15).

Avoid Excessive Use of Corticosteroids in Chronic Tendon Conditions (Evidence: Moderate 18).

Consider Biologic Therapies Like PRP and Stem Cell Exosomes for Chronic Tendon Healing (Evidence: Weak 5 7 8).

Implement Physical Therapy with Controlled Mechanical Loads for Rehabilitation (Evidence: Moderate 17 28).

Monitor Patients on Fluoroquinolones for Increased Tendon Injury Risk (Evidence: Strong 23).

References

1 Waters TL, Winter JE, Delvadia BP, May DS, O'Brien MJ, Savoie FH et al.. Initiating Testosterone Therapy Without Indication for Treatment of Low Testosterone Is Associated With Higher Risk of Tendon Tear. Sports health 2025. link 2 Doğramacı AR, Yildiran G, Çiçek G, Çelik ZE, Bağcı FÖ, Tosun Z. Efficacy of Wharton Jelly-Derived Mesenchymal Stem Cells Implanted on 3-Dimensional Hyaluronan-Based Scaffold in Tendon-Bone Interface Healing. Annals of plastic surgery 2025. link 3 Dai X, Dang M, Meng X, Zheng J, Yang Y, Wang L et al.. Porous Se@SiO. Journal of materials chemistry. B 2025. link 4 Shen S, Lin Y, Sun J, Liu Y, Chen Y, Lu J. A New Tissue Engineering Strategy to Promote Tendon-bone Healing: Regulation of Osteogenic and Chondrogenic Differentiation of Tendon-derived Stem Cells. Orthopaedic surgery 2024. link 5 Chen D, Tang Q, Song W, He Y. Platelet-derived exosomes alleviate tendon stem/progenitor cell senescence and ferroptosis by regulating AMPK/Nrf2/GPX4 signaling and improve tendon-bone junction regeneration in rats. Journal of orthopaedic surgery and research 2024. link 6 Little D, Amadio PC, Awad HA, Cone SG, Dyment NA, Fisher MB et al.. Preclinical tendon and ligament models: Beyond the 3Rs (replacement, reduction, and refinement) to 5W1H (why, who, what, where, when, how). Journal of orthopaedic research : official publication of the Orthopaedic Research Society 2023. link 7 Zhu Y, Yan J, Zhang H, Cui G. Bone marrow mesenchymal stem cell‑derived exosomes: A novel therapeutic agent for tendon‑bone healing (Review). International journal of molecular medicine 2023. link 8 Zou J, Yang W, Cui W, Li C, Ma C, Ji X et al.. Therapeutic potential and mechanisms of mesenchymal stem cell-derived exosomes as bioactive materials in tendon-bone healing. Journal of nanobiotechnology 2023. link 9 Wang D, Zhang X, Ng KW, Rao Y, Wang C, Gharaibeh B et al.. Growth and differentiation factor-7 immobilized, mechanically strong quadrol-hexamethylene diisocyanate-methacrylic anhydride polyurethane polymer for tendon repair and regeneration. Acta biomaterialia 2022. link 10 Duerr RA, Ackermann J, Gomoll AH. Amniotic-Derived Treatments and Formulations. Clinics in sports medicine 2019. link 11 Hirakawa Y, Manaka T, Orita K, Ito Y, Ichikawa K, Nakamura H. The accelerated effect of recombinant human bone morphogenetic protein 2 delivered by β-tricalcium phosphate on tendon-to-bone repair process in rabbit models. Journal of shoulder and elbow surgery 2018. link 12 Dyrna F, Zakko P, Pauzenberger L, McCarthy MB, Mazzocca AD, Dyment NA. Human Subacromial Bursal Cells Display Superior Engraftment Versus Bone Marrow Stromal Cells in Murine Tendon Repair. The American journal of sports medicine 2018. link 13 Linderman SW, Golman M, Gardner TR, Birman V, Levine WN, Genin GM et al.. Enhanced tendon-to-bone repair through adhesive films. Acta biomaterialia 2018. link 14 Chen X, Jones IA, Park C, Vangsness CT. The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-analysis With Bias Assessment. The American journal of sports medicine 2018. link 15 Mohammadrezaei N, Seyedhosseini J, Vahidi E. Validity of ultrasound in diagnosis of tendon injuries in penetrating extremity trauma. The American journal of emergency medicine 2017. link 16 Wong-Chung J, Lynch-Wong M, Gibson D, Stokes M. Reconstruction of healed elongated anterior tibial and extensor hallucis longus tendons in a young active farmer. Foot (Edinburgh, Scotland) 2015. link 17 Nossov S, Dines JS, Murrell GA, Rodeo SA, Bedi A. Biologic augmentation of tendon-to-bone healing: scaffolds, mechanical load, vitamin D, and diabetes. Instructional course lectures 2014. link 18 Childress MA, Beutler A. Management of chronic tendon injuries. American family physician 2013. link 19 Yang G, Rothrauff BB, Tuan RS. Tendon and ligament regeneration and repair: clinical relevance and developmental paradigm. Birth defects research. Part C, Embryo today : reviews 2013. link 20 September AV, Schwellnus MP, Collins M. Tendon and ligament injuries: the genetic component. British journal of sports medicine 2007. link 21 Würgler-Hauri CC, Dourte LM, Baradet TC, Williams GR, Soslowsky LJ. Temporal expression of 8 growth factors in tendon-to-bone healing in a rat supraspinatus model. Journal of shoulder and elbow surgery 2007. link 22 Södersten F, Ekman S, Eloranta ML, Heinegård D, Dudhia J, Hultenby K. Ultrastructural immunolocalization of cartilage oligomeric matrix protein (COMP) in relation to collagen fibrils in the equine tendon. Matrix biology : journal of the International Society for Matrix Biology 2005. link 23 Khaliq Y, Zhanel GG. Musculoskeletal injury associated with fluoroquinolone antibiotics. Clinics in plastic surgery 2005. link 24 Vidal AF, Drakos MC, Allen AA. Biceps tendon and triceps tendon injuries. Clinics in sports medicine 2004. link 25 Mittal RL, Jain NC. Traumatic dislocation of the tibialis posterior tendon. International orthopaedics 1988. link 26 Potenza AD. Philosophy of flexor tendon surgery. The Orthopedic clinics of North America 1986. link 27 Codavilla A. The classic: Tendon transplants in orthopedic practice by A Codvilla. Clinical orthopaedics and related research 1976. link 28 Wray RC, Ollinger H, Weeks PM. Effects of mobilization on tensile strength of partial tendon lacerations. Surgical forum 1975. link

Syphilis of tendon