Nail disorders associated with cast immobilization of the forearm and wrist: report of two cases and review of the literature

Abstract Cast immobilization is used in the management of various injuries of joints and/or limbs. A variety of nail disorders have been reported in association with cast immobilization of the forearm and wrist among a limited number of patients so far. The mechanism was not clearly identified in some of these cases. Here, the authors report two patients with nail disorders appeared after the removal of immobilization cast of forearm and wrist and review the literature.

Effects of physical exercise on the cartilage of ovariectomized rats submitted to immobilization / Efeitos do exercício físico sobre a cartilagem de ratas ooforectomizadas submetidas à imobilização

ABSTRACT Objective To analyze the effects of physical exercise on cartilage histomorphometry in osteoporosis-induced rats subjected to immobilization. Methods We used 36 Wistar rats that were separated into six groups: G1, G2 and G3 submitted to pseudo-oophorectomy, and G4, G5 and G6 submitted to oophorectomy. After 60 days at rest, G2, G3, G5 and G6 had the right hind limbs immobilized for 15 days, followed by the same period in remobilization, being free in the box to G2 and G5, and climb ladder to G3 and G6. At the end of the experiment, the rats were euthanized, their tibias bilaterally removed and submitted to histological routine. Results There was significant increase in thickness of the articular cartilage (F(5;29)=13.88; p<0.0001) and epiphyseal plate (F(5;29)=14.72; p<0.0001) as the number of chondrocytes (F(5;29)=5.11; p=0.0021) in ovariectomized rats, immobilized and submitted to exercise. In the morphological analysis, degeneration of articular cartilage with subchondral bone exposure, loss of cellular organization, discontinuity of tidemark, presence of cracks and flocculation in ovariectomized, immobilized and free remobilization rats were found. In ovariectomized and immobilized remobilization ladder rats, signs of repair of the cartilaginous structures in the presence of clones, pannus, subcortical blood vessel invasion in the calcified zone, increasing the amount of isogenous groups and thickness of the calcified zone were observed. Conclusion Exercise climb ladder was effective in cartilaginous tissue recovery process damaged by immobilization, in model of osteoporosis by ovariectomy in rats.

RESUMO Objetivo Analisar os efeitos do exercício físico sobre a histomorfometria da cartilagem de ratas induzidas à osteoporose e submetidas à imobilização. Métodos Foram utilizadas 36 ratas Wistar separadas em seis grupos: G1, G2 e G3 submetidas à pseudo-ooforectomia e G4, G5 e G6, à ooforectomia. Após 60 dias em repouso, G2, G3, G5 e G6 tiveram o membro posterior direito imobilizado por 15 dias, seguido pelo mesmo período em remobilização, sendo livres na caixa para G2 e G5, e de subida em escada para G3 e G6. Ao final do experimento, as ratas foram eutanasiadas, e suas tíbias foram retiradas bilateralmente e submetidas à rotina histológica. Resultados Houve aumento significativo de espessura da cartilagem articular (F(5;29)=13,88; p<0,0001) e da placa epifisária (F(5;29)=14,72; p<0,0001), bem como do número de condrócitos (F(5;29)=5,11; p<0,0021) em ratas ooforectomizadas, imobilizadas e submetidas ao exercício em escada. Nas análises morfológicas, verificaram-se degeneração da cartilagem articular com exposição de osso subcondral, perda da organização celular, descontinuidade da tidemark, presença de fissuras e floculações em ratas ooforectomizadas, imobilizadas e com remobilização livre. Nas ratas ooforectomizadas, imobilizadas e com remobilização em escada, observaram-se sinais de reparação das estruturas cartilaginosas com presença de clones, pannus, invasão de vasos sanguíneos subcorticais na zona calcificada, aumento da quantidade de grupos isógenos e espessura da zona calcificada. Conclusão O exercício físico de subida em escada mostrou-se efetivo no processo de recuperação do tecido cartilaginoso danificado pela imobilização, em modelo de osteoporose por ooforectomia em ratas.

Efeitos da terapia combinada com ácido zoledrônico e propranolol na resistência mecânica em um modelo de rato com osteoporose por desuso / Effect of combined treatment with zoledronic acid and propranolol on mechanical strength in an rat model of disuse osteoporosis

Resumo Objetivos: Investigar os efeitos aditivos do agente antirreabsorção ácido zoledrônico (ZOL), isolado e em combinação ao propranolol (PRO), em um modelo de rato com osteoporose por desuso. Métodos: Usou-se um modelo de pata traseira direita de rato privada de descarga de peso para estudar as consequências da falta de descarga de peso sobre o esqueleto durante várias condições, como missões espaciais e repouso prolongado no leito em idosos. Ratos Wistar machos de três meses de idade foram submetidos à imobilização da pata traseira direita (IPTD) por 10 semanas para induzir à osteopenia; em seguida, foram divididos aleatoriamente em quatro grupos: 1 – IPTD para controle positivo; 2 – IPTD mais ZOL (50 μg/kg, dose única intravenosa); 3 – IPTD mais PRO (0,1 mg/kg, via subcutânea, cinco dias na semana); 4 – IPTD mais PRO (0,1 mg/kg, via subcutânea, cinco dias na semana) mais ZOL (50 μg/kg, dose única intravenosa) por outras 10 semanas. Um grupo de ratos não imobilizados foi usado como controle negativo. No fim do tratamento, os fêmures foram removidos e testaram-se a porosidade do osso e suas propriedades mecânicas, além do peso seco e das cinzas do osso. Resultados: No que diz respeito à melhoria da resistência mecânica da diáfise femoral média, a terapia combinada com ZOL mais PRO foi mais eficaz do que a monoterapia com ZOL ou PRO. Além disso, a terapia combinada com ZOL mais PRO foi mais eficaz na melhoria do peso seco do osso e preservou melhor a porosidade do osso cortical do que a monoterapia com ZOL ou PRO em ratos submetidos à imobilização da pata traseira direita. Conclusões: Esses dados sugerem que a terapia combinada com ZOL mais PRO deve ser recomendada para o tratamento da osteoporose por desuso.

Abstract Objectives: A model that uses right hind-limb unloading of rats is used to study the consequences of skeletal unloading during various conditions like space flights and prolonged bed rest in elderly. This study was aimed to investigate the additive effects of antiresorptive agent zoledronic acid (ZOL), alone and in combination with propranolol (PRO) in a rat model of disuse osteoporosis. Methods: In the present study, 3-month-old male Wistar rats had their right hind-limb immobilized (RHLI) for 10 weeks to induce osteopenia, then were randomized into four groups: (1) RHLI positive control, (2) RHLI plus ZOL (50 μg/kg, i.v. single dose), (3) RHLI plus PRO (0.1 mg/kg, s.c. 5 days per week), (4) RHLI plus PRO (0.1 mg/kg, s.c. 5 days per week) plus ZOL (50 μg/kg, i.v. single dose) for another 10 weeks. One group of non-immobilized rats was used as negative control. At the end of treatment, the femurs were removed and tested for bone porosity, bone mechanical properties, and bone dry and ash weight. Results: With respect to improvement in the mechanical strength of the femoral mid-shaft, the combination treatment with ZOL plus PRO was more effective than ZOL or PRO monotherapy. Moreover, combination therapy using ZOL plus PRO was more effective in improving dry bone weight and preserved the cortical bone porosity better than monotherapy using ZOL or PRO in RHLI rats. Conclusions: These data suggest that this combined treatment with ZOL plus PRO should be recommended for the treatment of disuse osteoporosis.

Effects of immobilization and remobilization on the ankle joint in Wistar rats

A sprained ankle is a common musculoskeletal sports injury and it is often treated by immobilization of the joint. Despite the beneficial effects of this therapeutic measure, the high prevalence of residual symptoms affects the quality of life, and remobilization of the joint can reverse this situation. The aim of this study was to analyze the effects of immobilization and remobilization on the ankle joint of Wistar rats. Eighteen male rats had their right hindlimb immobilized for 15 days, and were divided into the following groups: G1, immobilized; G2, remobilized freely for 14 days; and G3, remobilized by swimming and jumping in water for 14 days, performed on alternate days, with progression of time and a series of exercises. The contralateral limb was the control. After the experimental period, the ankle joints were processed for microscopic analysis. Histomorphometry did not show any significant differences between the control and immobilized/remobilized groups and members, in terms of number of chondrocytes and thickness of the articular cartilage of the tibia and talus. Morphological analysis of animals from G1 showed significant degenerative lesions in the talus, such as exposure of the subchondral bone, flocculation, and cracks between the anterior and mid-regions of the articular cartilage and the synovial membrane. Remobilization by therapeutic exercise in water led to recovery in the articular cartilage and synovial membrane of the ankle joint when compared with free remobilization, and it was shown to be an effective therapeutic measure in the recovery of the ankle joint.

Limb immobilization alters functional electrophysiological parameters of sciatic nerve

Immobilization, used in clinical practice to treat traumatologic problems, causes changes in muscle, but it is not known whether changes also occur in nerves. We investigated the effects of immobilization on excitability and compound action potential (CAP) and the ultrastructure of the rat sciatic nerve. Fourteen days after immobilization of the right leg of adult male Wistar rats (n=34), animals were killed and the right sciatic nerve was dissected and mounted in a moist chamber. Nerves were stimulated at a baseline frequency of 0.2 Hz and tested for 2 min at 20, 50, and 100 Hz. Immobilization altered nerve excitability. Rheobase and chronaxy changed from 3.13±0.05 V and 52.31±1.95 µs (control group, n=13) to 2.84±0.06 V and 59.71±2.79 µs (immobilized group, n=15), respectively. Immobilization altered the amplitude of CAP waves and decreased the conduction velocity of the first CAP wave (from 93.63±7.49 to 79.14±5.59 m/s) but not of the second wave. Transmission electron microscopy showed fragmentation of the myelin sheath of the sciatic nerve of immobilized limbs and degeneration of the axon. In conclusion, we demonstrated that long-lasting leg immobilization can induce alterations in nerve function.

Effects of immobilization on rat skeletal muscle tissue

This paper offers a literature review on the effects of immobilization on rat skeletal muscle tissue. The authors were unanimous with regard to the reduction in muscle mass, cross-section area and myonuclei in the muscles studied, especially in relation to the alteration in the regulation of the protein synthesis and degradation process as well as an alteration in the activity of oxidative enzymes caused by immobilization. With regard to the muscle fiber type, most authors report having found a greater amount of type 2 fibers over type 1 fibers, thereby implying an alteration in the contractile function of the affected muscle. These findings suggest greater degradation and/or substitution of tonic (postural or type 1) fibers by phasic (rapid contraction or type 2) fibers. Thus, the present study suggests that, regardless of the method employed, immobilization has harmful effects on skeletal muscle tissue in rats.

Adaptações neuromusculares de flexores dorsais e plantares a duas semanas de imobilização após entorse de tornozelo / Dorsiflexor and plantarflexor neuromuscular adaptations at two-week immobilization after ankle sprain

INTRODUÇÃO: A entorse de tornozelo é uma lesão de alta incidência comumente tratada com períodos de imobilização, levando a adaptações estruturais e funcionais dos músculos atuantes nesta articulação. OBJETIVO: Identificar as adaptações dos músculos flexores dorsais e flexores plantares após duas semanas de imobilização em sujeitos que sofreram entorse de tornozelo. MÉTODOS: Onze indivíduos (seis mulheres e cinco homens) acometidos por entorse de tornozelo grau II foram submetidos a 14 dias de imobilização por tala gessada. Após a retirada da imobilização, foram realizadas avaliações bilaterais de (1) perimetria da perna, (2) amplitude de movimento (ADM) do tornozelo, (3) torque isométrico máximo de flexores dorsais e flexores plantares em sete ângulos do tornozelo e (4) ativação eletromiográfica dos músculos tibial anterior (TA), sóleo (SO) e gastrocnêmio medial (GM). Os resultados obtidos no segmento imobilizado foram comparados com os do segmento saudável contralateral através de um teste t de Student pareado (p < 0,05). RESULTADOS: O segmento imobilizado apresentou redução (1) da circunferência nas regiões proximais da perna, (2) da ADM de flexão dorsal e plantar, (3) do torque isométrico máximo de flexores dorsais e plantares e (4) do sinal eletromiográfico do TA em todos os ângulos articulares e do SO nos maiores comprimentos musculares. Não houve diferença no sinal eletromiográfico do músculo GM. CONCLUSÃO: Um período relativamente curto de imobilização (duas semanas) prejudica a funcionalidade dos músculos flexores dorsais e flexores plantares do tornozelo.

INTRODUCTION: Ankle sprains are a kind of injury with high incidence that is usually treated with an immobilization period, leading to structural and functional adaptation in the muscles around this joint. PURPOSE: To identify the dorsiflexor and plantarflexor muscles adaptations after two weeks of immobilization in subjects who suffered ankle sprain. METHODS: Eleven subjects (six women and five men) who suffered a second degree ankle sprain underwent 14 days of ankle joint immobilization with a plaster cast. After removal of the plaster cast, the following bilaterally evaluations were obtained: (1) leg circumference; (2) ankle joint range of motion (ROM); (3) maximal isometric torque of plantar and dorsiflexors obtained in seven different angles; and (4) electromyographic signals of the tibialis anterior (TA), gastrocnemius medialis (GM) and soleus (SO) muscles. Results obtained in the immobilized side were compared to the contralateral healthy side with a paired Student's t-test (p<0.05). RESULTS: Immobilized side presents decrease (1) at the proximal leg circumference, (2) in dorsiflexor and plantarflexor ROM, (3) in dorsiflexor and plantarflexor maximal isometric torque and (4) in electromyographic signal of the TA at all joint angles and at the longest muscle lengths in SO. There was no alteration in the electromyographic signal of the GM muscle. CONCLUSION: A relatively short immobilization period (two weeks) impairs the functionality of ankle dorsiflexor and plantarflexor muscles.

Alterações morfométricas em músculo respiratório de ratos submetidos à imobilização de pata / Morphometric alterations in respiratory muscle of rats submitted to paw immobilization

A imobilização é um recurso frequentemente utilizado na prática clínica, sendo comum em patologias álgicas e nas fraturas. O objetivo deste estudo foi analisar a influência do processo de imobilização em músculo do sistema respiratório, o diafragma. O experimento foi efetuado com 12 ratos Wistar machos divididos em dois grupos, controle e imobilizado. O procedimento de imobilização foi realizado através de um método alternativo de imobilização por fita adesiva, sendo mantida por duas semanas. Analisou-se a morfometria das fibras do diafragma com coloração de hematoxilina e eosina. Ao compararmos o diâmetro médio das fibras musculares do diafragma dos animais imobilizados (47,15μm ± 0,329μm) em relação ao controle (54,67μm ± 0,396μm), encontramos diferença estatística entre os grupos (p < 0,0001). Considerando os dados encontrados, foi possível concluir que a imobilização de pata, no modelo utilizado, foi capaz de gerar hipotrofia da musculatura respiratória, assim como um quadro geral de redução de massa corporal do animal.

Immobilization is a frequently used procedure in clinical practice and common in pain diseases and fractures. This study examined the influence of immobilization in a muscle-related respiratory system, the diaphragm. This experiment was conducted with twelve male rats divided into two groups, control and immobilized with an alternative method of restraining by tape, kept for two weeks. We analyzed the morphometry of the diaphragm muscle fibers with hematoxylin/eosin staining. Statistical difference was found (p < 0.0001) when the average diameter of the diaphragm muscle fibers of immobilized animals (47.15μm ± 0.329μm) was compared to the ones in the control group (54.67μm ± 0.396μm). Considering the results, it can be concluded that the immobilization of the animal paw in the used model was able to produce hypotrophy of respiratory musculature, as well as a general framework for reducing the mass of the animal.

Effects of glycine on haemostatic changes in stressed immobilized rats

Administration of antioxidants aimed at reducing oxidative stress induced haemostatic disorders is recommended in chronic immobilization. This study was conducted to investigate the effects of glycine supplementation on haemostatic changes in chronic immobilization stress in rats. Rats were divided into normal control group, stressed [immobilized] rats, glycine-treated group and glycine-treated +stressed [immobilized] group, Platelets aggregation, Prothrombin Time [PT], Activated Partial Thromboplastin Time [APTT], as well as plasma levels of fibrinogen [fibrinogen], Fibrinogen Degradation Products [FDP] and malondialdehyde [MDA] were assessed. Immobilization stress is associated with significant reduction of PT and APTT with significant increase in platelets aggregation as well as plasma levels of fibrinogen, FDP and MDA. On the other hand glycine supplementation for immobilized rats resulted in significant prolongation of PT and APTT with significant decrease in platelets aggregation as well as plasma levels of fibrinogen, FDP and MDA. In addition, in normal rats glycine administration induced significant reduction in platelets aggregation with prolongation of APTT. PT and plasma levels of fibrinogen and FDP were significantly changed. Chronic immobilization stress s associated with increased platelets aggregation, hypercoagulability and increased free radical production. Glycine counteracted the oxidative insult in immobilization stress and ameliorated these disorders accompanying this condition

Metabolic effects of melatonin supplementation in stressed immobilized rats

Therapeutic interventions aimed at reducing metabolic perturbances are recommended in chronic immobilization stress via administration of melatonin. This study was conducted to evaluate the effects of melatonin supplementation on carbohydrate and lipoproteins metabolism in chronic stressed immobilized rats. A total of 32 male albino rats [150-250 grams, each] were divided into 4 equal groups; control group, stressed immobilized group, melatonin-supplemented group and melatonin supplemented + stressed immobilized group. Fasting blood glucose level and rate of glucose uptake by skeletal muscle [diaphragm] were investigated. Also plasma levels of triglyceride [TG], total cholesterol [TC], low density lipoprotein-cholesterol [LDL-C], high density lipoprotein-cholesterol [HDL-C] and malondialdehyde [MDA] were measured. Stressed immobilized group showed significant hyperglycemia associated with decreased glucose uptake by diaphragm. In addition, plasma levels of TG, TC, LDL-C and MDA were significantly increased. But the level of HDL-C in plasma was decreased significantly. Melatonin supplementation for stressed immobilized rats resulted in significant increase of glucose uptake by diaphragm, as well as HDL-C. On the other hand blood, glucose level, TG, TC, LDL-C and MDA were significantly decreased. In addition melatonin supplementation for normally fed rats produced significant increase of glucose uptake by diaphragm with significant reduction of plasma levels of TG, TC and LDL-C. Melatonin supplementation could ameliorate the metabolic disturbances in carbohydrate and lipoproteins metabolism in chronic immobilization stress in rats

Fracturas vertebrales por osteoporosis: tratamiento incruento / Osteoporotic vertebral fractures: conservative treatment

El tratamiento inicial de las fracturas vertebrales por osteoporosis es conservador. Su objetivo es calmar el dolor con drogas analgésicas y diferentes tipos de ortesis como el corsé en extensión de Jewett. El reposo en cama está indicado solamente al comienzo y se debe evitar la inmovilización prolongada. La fisioterapia (ejercicios) es una gran ayuda porque disminuye la pérdida ósea y mejora el estado del raquis disminuyendo el dolor y las deformaciones.

Efeitos sobre o tecido ósseo e cartilagem articular provocados pela imobilização e remobilização em ratos Wistar / Effects of immobilization and remobilization on bone tissue and cartilage in Wistar rats

Longos períodos de imobilização conduzem à perda óssea e de propriedades do osso, e sua recuperação depende de vários fatores; além disso, a imobilização pode causar ulcerações no tecido cartilaginoso articular devido a alterações como perda de proteoglicanas, de massa e volume totais da cartilagem. O objetivo deste estudo foi verificar alterações histológicas, do tecido ósseo periarticular e da cartilagem articular, provocadas pela imobilização e remobilização de membros posteriores de ratos Wistar. Foram utilizados 12 ratos Wistar, divididos em dois grupos: GI - (n = 6): 15 dias com o membro posterior esquerdo imobilizado em plantiflexão, sendo o membro direito o controle; GR - (n = 6): período de 15 dias de remobilização livre na gaiola, associado a três séries diárias de alongamento do músculo sóleo esquerdo por 30 segundos. Foram avaliados no tecido ósseo as medidas de espessura do osso cortical, diâmetro do canal medular e número de osteócitos; no tecido cartilaginoso, foram mensurados a espessura média da cartilagem e o número de condrócitos. Como resultado, observou-se que para GI não houve alterações significativas na espessura do osso (p = 0,1156) nem no diâmetro do canal medular (p = 0,5698), mas diminuição significativa dos osteócitos em relação ao contralateral (p = 0,0005); em GR também houve decréscimo no número de osteócitos (p = 0,0001), mas as diferenças na espessura (p = 0,1343) e diâmetro do canal medular (p = 0,6456) mantiveram-se não significantes. Para os dados de cartilagem articular não houve diferenças significativas para as amostras, tanto na espessura da cartilagem para GI (p = 0,6640) e GR (p = 0,1633), quanto no número de condrócitos em GI (p = 0,9429) e GR (p = 0,1634). Conclui-se que duas semanas de imobilização e remobilização produziram apenas diminuição significativa no número de osteócitos nos ratos imobilizados; esse número continuou a diminuir mesmo nos animais remobilizados.

Long immobilization periods lead to bone and properties loss, and its recovery depends on many factors. Besides that, immobilization can cause ulcerations in the articular cartilage tissue due to alterations, such as loss of proteoglycans and total cartilage mass and volume. The aim of this study was to verify histological alterations of the periarticular bone tissue and articular cartilage caused by immobilization as well as remobilization of hinder limbs of Wistar rats. Twelve Wistar rats were divided in two groups: GI - (n=6): 15 days with the left hinder limb immobilized at plantiflexion, with the right limb being the control; GR - (n=6): used a 15 day-period of free remobilization in the cage, associated with 3 daily stretching bouts of the left soleus muscle for 30 seconds. The measures of the cortical bone thickness, diameter of the medular channel and number of condrocites were evaluated; in the cartilage tissue, the cartilage mean thickness and the number of condrocites were measured. The results showed that for GI there were no significant alterations in the bone thickness (p=0.1156), nor in the medular channel diameter (p=0.5698), but there was significant decrease of the osteocytes compared with the counter-lateral side (p=0.0005); in GR decrease in the number of osteocytes (p=0.0001) was also observed, but the differences in thickness (p=0.1343) and medular channel diameter (p=0.6456) remained non-significant. There were no significant differences for the articular cartilage data for the samples, neither in the cartilage thickness for GI (p=0.6640) and GR (p=0.1633); concerning the number of condrocites in GI (p=0.9429) and GR (p=0.1634). It is concluded hence that two weeks of immobilization and remobilization produced only significant decrease in the number of osteocytes in the immobilized rats and continued to decrease even in the remobilized animals.

Imobilização prolongada e remobilização da articulação fêmoro-tíbio-patelar de ratos: estudo clínico e microscópico / Experimental immobilization and remobilization rat knee joints: clinical and microscopic study

Trinta e quatro ratos foram alocados em quatro grupos experimentais: sem imobilização (G1), com imobilização do joelho direito por 45 dias (G2), com imobilização e remobilização com atividade livre por cinco semanas (G3), imobilização e remobilização com atividade livre e natação por cinco semanas (G4). A imobilização interferiu negativamente na marcha e amplitude articular e o G4 apresentou melhor evolução na marcha nos cinco primeiros dias, em relação ao G3. Após esse período, a evolução foi similar. Os componentes do G2 apresentaram rigidez articular, não observada em G3 e G4. Histologicamente, a imobilização promoveu aumento da espessura da cápsula articular, evidenciada pela presença do tecido conjuntivo fibroso que substituiu o tecido adiposo no G2, mas em menor proporção em G3 e G4. A imobilização determinou perda de proteoglicanos da matriz cartilaginosa, aumento do número de condrócitos, dispostos de forma irregular, aumento da espessura da cartilagem calcificada, irregularidade da superfície articular, proliferação de tecido conjuntivo no espaço intra-articular e aumento da espessura do osso subcondral. O G3 apresentou maior número de alterações na cartilagem e osso subcondral, quando comparado com G4. A imobilização degenerou as células sinoviais, indicando diminuição da produção de fluido sinovial e do suprimento nutricional à cartilagem. Tanto a atividade livre quanto sua associação com a natação favoreceram o retorno das condições biomecânicas e da cápsula articular, anteriores à imobilização.

Thirty-four rats were randomly allocated into one of four experimental groups: without immobilization (G1), immobilization of the right knee joint for 45 days (G2), immobilization and remobilization with free activity for 5 weeks (G3), and immobilization and remobilization with free activity and swimming program for 5 weeks (G4). The immobilization was prejudicial to march and flexibility articular. Animals from G4 showed a better march evolution on the first five days as compared to those from G3. After that periods, march evolution were similar in both G3 and G4. Animals from G2 showed rigid joint while in those from G3 and G4 the articular movement was close to normal. The histological analysis pointed out that immobilization led to increase in articular capsule thickness evidenced by the presence of fibrous connective tissue replacing adipose tissue in G2, but proportionally less in G3 and G4. It was observed that immobilization determined loss of proteoglycans from the cartilaginous matrix, increase in the number of regularly arranged condrocytes, increase in calcified cartilage thickness, irregularity in the articular surface, proliferation of connective tissue in the intra-articular space and increase in subchondral bone thickness. The animals from G3 showed a greater number of alterations in both articular cartilage and subchondral bone, as compared to those from G4. Immobilization degenerated synovial cells indicating decreased synovial fluid production and reduced nutritional supplying to the cartilage. The free cage activity and its association with swimming influenced positively the return of biomechanics and articular capsule morphologic conditions to those before immobilization.

Intervención de terapia ocupacional en síndrome de inmovilización instaurado / Intervention of occupational therapy in restored syndrome of immbilization

El síndrome de inmovilización causa múltiples complicaciones en las personas mayores siendo las complicaciones motoras las que ocasionan mayor dificultad en su manejo, por lo que el diseño de equipo adaptado y las modificaciones ambientales por parte del Terapeuta ocupacional, facilitan el manejo y confort del paciente, así como la tarea al cuidador a cargo y al resto del equipo profesional. El presente artículo analiza la intervención del Terapeuta Ocupacional y lo fundamenta en el marco teórico de referencia rehabilitador.

The immobilization syndrome causes to manifold complications in the greater people being the motor complications, those that cause greater difficulty in their handling, reason why the environmental design of adapted equipment and modifications on the part of the occupational therapist, facilitate the handling and comfort of the patient, as well as, facilitates the task to the caretaker to position and the rest of the professional equipment. The present I articulate analyzes the intervention of the occupational therapist and it within the framework bases it theoretical of rehabilitador reference.

Imobilidade / Immobility

A síndrome da imobilidade é representada por um conjunto de alterações que podem ocorrer no idoso, decorrentes de uma imobilização por período prolongado e cujas complicações poderão comprometer em muito a saúde, a qualidade de vida e a autonomia

Morphometric and ultrastructural changes in the sciatic nerve of the albino rat after a long period of immobilization of the knee and ankle joints

The sciatic nerve was used as a model to study the effect of a long period of immobilization on the peripheral nerves. Ten young adult male albino rats were used in this investigation. The left knee and ankle joints were immobilized for 12 weeks using a plaster cast. The contralateral right side was used as control. After removal of the cast, segments from the sciatic nerves of the immobilized and control sides were excised and processed for ultrastructural and morphometric studies. Morphometric study revealed that immobilization of the rat hind limb resulted in a highly significant reduction [43%] in the cross-sectional area of the sciatic nerve, a highly significant reduction [33%] in the total number of the myelinated fibers, a highly significant reduction [21%] in the mean diameter of the myelinated fibers and a highly significant increase [19%] in the myelinated fiber density/mm[2]. The size distribution of the myelinated fibers showed marked changes after immobilization. The statistical data showed a shift toward, the small size distribution and the small diameter myelinated fibers outnumbered the medium-sized and the large diameter fibers. Moreover, myelinated fibers with a diameter >15 micro were observed only in the experimental sciatic nerve. These results indicate that the small myelinated fibers were the least affected and may confirm the assumption that the motor fibers are those who are usually affected by immobilization. Ultrastructural observations revealed splitting of the myelin lamellae, presence of marked intramyelinic edematous clefts between the split myelin lamellae, infolded myelin loops and myelin degeneration. Changes in the axons included formation of myelin rings and figures in some of the larger axons, degeneration, compression, irregularity and shrinkage of axons. Degradation of myelin lipids was reflected by formation of large vacuoles and layered structures inside Schwann cells. These ultrastructural and morphometric changes may shed some light on a definite structural neural involvement in the mechanism underlying the immobilization-associated polyneuropathy

A New Case of Fatal Pulmonary Thromboembolism Associated with Prolonged Sitting at Computer in Korea

A newly reported, variant form of venous thromboembolism (VTE), named as "eThrombosis", occurred in a patient who maintained a prolonged sitting position at a computer. The patient fortunately recovered from the disease through early diagnosis and treatment. Recently however, the author experienced a new case of a 24-year-old Korean man who died due to "eThrombosis" after playing an Internet computer game continuously for about 80 hours. Based on this case, the author would like to warn heavy computer users of the risk of "eThrombosis", as they might also be at risk. Sitting for a long time at the computer results in an immobility that is a new and large risk factor of life-threatening VTE.

A tala imobilizadora de membro superior em pediatria e a infecção hospitalar: um estudo experimental / Pediatric upper extremity splint and hospital infection: nursing care in an experimental study

Estudo experimental que tem por objetivo demonstrar, através de fotografia, o que ocorre com uma tala imobilizadora de membros superiores, que é utilizada pela equipe de Enfermagem durante a infusão venosa pediátrica, quando submetida a ambiente similar ao de uma incubadora. O método experimental consistiu em estudo comparativo de fotografias de tala imobilizadora, antes e após 12 dias de utilização. A pesquisa foi desenvolvida em hospital do município do Rio de Janeiro, em 2001. O instrumento de coleta de dados utilizado foi uma ficha para anotação da data do início e do término da observação, acompanhada da respectiva documentação fotográfica desse processo. O resultado obtido após 30 dias de observação mostrou a tala coberta por fungos que cresceram e se proliferaram a ponto de cobrí-la quase totalmente. Os autores concuíram, a partir do referencial microbiológico, que a tala imobilizadora de membros superiores para infusão venosa pediátrica é, visivelmente e a olho nu, um fômite em potencial, e que, a partir dos resultados obtidos, alguns procedimentos relativos à utilização desse artefato precisam ser revistos pela equipe de Enfermagem, tendo em vista a profilaxia das infecções hospitalares