Traumatic Atlantoaxial Rotatory Subluxation in Adult: Case Report

Traumatic atlantoaxial rotatory subluxation (AARS) is generally found in pediatric patients, rarely found in adults, being a life-threatening condition especially when early diagnosis is not possible, which can lead to severe late neurological deficits.We describe a 38-year-old patient, victim of physical aggression caused by strangulation attempt who developed AARS, an uncommontraumatic cause. During the hospital care, the early diagnosis allowed us to institute a conservative treatment, which made the case uncommon, since most of the time surgical treatment is imperative. With the patient awake and under analgesia, a closed reduction was performed that promoted immediate pain relief, followed by a prescription of wearing a Philadelphia-type collar for 8 weeks. During the follow-up, cervical spine radiographies demonstrated no subluxation after removing the cervical collar. The patient was asymptomatic after 6months of treatment. This case supports the importance of nonoperative management of AARS in selected cases.

Effects of cervical mobilization and exercise on pain, movement and function in subjects with temporomandibular disorders: a single group pre-post test

ABSTRACT Objective To investigate the effect of a rehabilitation program based on cervical mobilization and exercise on clinical signs and mandibular function in subjects with temporomandibular disorder (TMD). Material and Methods: Single-group pre-post test, with baseline comparison. Subjects Twelve women (22.08±2.23 years) with myofascial pain and mixed TMD according to the Research Diagnostic Criteria for Temporomandibular Disorders. Outcome measures Subjects were evaluated three times: twice before (baseline phase) and once after intervention. Self-reported pain, jaw function [according to the Mandibular Functional Impairment Questionnaire (MFIQ)], pain-free maximum mouth opening (MMO), and pressure pain thresholds (PPTs) of both masseter and temporalis muscles were obtained. Baseline and post-intervention differences were investigated, and effect size was estimated through Cohen’s d coefficient. Results Jaw function improved 7 points on the scale after the intervention (P=0.019), and self-reported pain was significantly reduced (P=0.009). Pain-free MMO varied from 32.3±8.8 mm to 38±8.8 mm and showed significant improvement (P=0.017) with moderate effect size when compared to the baseline phase. PPT also increased with moderate effect size, and subjects had the baseline values changed from 1.23±0.2 kg/cm2 to 1.4±0.2 kg/cm2 in the left masseter (P=0.03), from 1.31±0.28 kg/cm2 to 1.51±0.2 kg/cm2 in the right masseter (P>0.05), from 1.32±0.2 kg/cm2 to 1.46±0.2 kg/cm2 in the left temporalis (P=0.047), and from 1.4±0.2 kg/cm2 to 1.67±0.3 kg/cm2 in the right temporalis (P=0.06). Conclusions The protocol caused significant changes in pain-free MMO, self-reported pain, and functionality of the stomatognathic system in subjects with myofascial TMD, regardless of joint involvement. Even though these differences are statistically significant, their clinical relevance is still questionable.

Immediate electromyographic changes of the upper limb muscles following cervical manipulation in a patient with essential tremor: a case report / Alterações eletromiográficas imediatas dos músculos dos membros superiores após manipulação cervical em uma paciente com tremor essencial: estudo de caso

Introduction and Objective: The purpose of this case report is to evaluate upper limb muscle electric behavior by surface electromyography before and after cervical manipulation in a patient with essential tremor. Methods: In 2009, essential tremor was diagnosed by a neurologist in a 25-year-old woman. Previous treatment included Paroxetine for a number of months, without alteration of her symptoms. The patient was assessed by surface electromyography of the upper limb muscles (flexor and extensor of the wrist, long heads of biceps and triceps) before and after being subjected to high-velocity, low-amplitude spinal manipulation to her mid cervical spine (C3-C4 level, 1 manipulation/side). Results: There was an increase of the median frequency rate and a decrease of the electrical activity of these muscles. Conclusion: This case study showed the cervical manipulation technique acutely modifying the electromyographic activity, increasing the median frequency, and decreasing the muscle recruitment of the upper limb. It suggests improved motor control during the tasks.

Introdução e Objetivo: O objetivo neste estudo de caso foi avaliar o comportamento elétrico dos músculos do membro superior, por eletromiografia, antes e após manipulação cervical em paciente com tremor essencial. Métodos: Uma mulher (25 anos) apresentou-se com tremor essencial, diagnosticado em 2009 por neurologista. Foi empregado tratamento prévio com Paroxetina por meses, sem diminuição dos sintomas. A paciente foi avaliada por eletromiografia dos músculos dos membros superiores (flexores e extensores do punho, cabeça longa do bíceps e do tríceps) antes e após manipulação de alta velocidade e baixa amplitude na cervical média (nível C3-C4, 1 manipulação para cada lado). Resultados: Observou-se aumento na frequência mediana e diminuição na atividade elétrica dos músculos avaliados. Conclusão: A técnica de manipulação cervical modificou de forma imediata a atividade eletromiográfica, aumentando a frequência mediana e diminuindo o recrutamento dos músculos do membro superior para a paciente estudada, sugerindo melhor controle motor durante a atividade proposta.

Quiropraxia / Chiropractic

Este artigo de revisão apresenta a quiropraxia, uma profissão na área da saúde que se ocupa do diagnóstico, tratamento e prevenção de condições neuromusculoesqueléticas, em especial algias vertebrais e sintomas associados. São abordadas inicialmente a definição e área da atuação, seguindo-se uma revisão da história da profissão no Brasil e no mundo. A formção profissional, que consiste de cursos superiores com quatro anos de duração é discutida. São apresentados os dois cursos superiores de Quiropraxia em atividade no Brasil, sua história e importância para a implantação da profissão no país. A avaliação biomecânica realizada por quiropraxistas é descrita, em especial técnicas de palpação articular, bem como os métodos terapêuticos utilizados por quiropraxistas, em especial a utilização de técnicas de terapia manual. A terapia de manipulação articular e seus efeitos fisiológicos são detalhados. Contra indicações e complicações são discutidos. Por fim, é feita uma breve revisão da literatura relativa a estudos clínicos sobre a eficácia do tratamento com quiropraxia.

This is a review about Chiropractic, a health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system, with a special emphasis on the treatment of vertebral pain and associated symptoms. The profession is initially defined and an overview of the history of chiropractic in the world as well as in Brazil is presented. Professional education, consisting of four years of university-level graduation programs is described. The two chiropractic programs in activity in Brazil are presented and their importance to the establishment of the profession in this country is discussed. The biomechanical evaluation performed by chiropractors is explained, with special emphasis on techniques of joint palpation. Treatment procedures used by chiropractors are summarized, particularly techniques of manual therapy. Spinal manipulation therapy and its physiological effects are then detailed. Contra-indications and complications are discussed. Finally, a brief review of the medical literature with respect to clinical trials on the efficacy of chiropractic therapy for the treatment of specific conditions is outlined.

Aspectos tomográficos da coluna cervical de equinos / Tomographic imaging of the cervical spine of horses

Descreveu-se a anatomia da região cervical de equinos adultos, com base em imagens obtidas no exame de tomografia computadorizada helicoidal realizado em peças anatômicas de equinos adultos. A tomografia computadorizada foi o método de imagem diagnóstica de escolha e possibilita as reconstruções de imagens tridimensionais e em outros planos anatômicos, como sagital e coronal. Todas as imagens foram adquiridas e avaliadas em filtro e janela para tecido ósseo. Observaram-se diferenças anatômicas e as particularidades normais das vértebras, principalmente da região occipitoatlantoaxial, a qual apresenta maior incidência de alterações.

The anatomy of the cervical spine of mature horses based on images obtained with a helical computed tomography examination performed on anatomic specimens was studied. Computed tomography was the diagnostic imaging method of choice and allowed three-dimensional reconstructions of images and other anatomical planes, such as coronal and sagittal. All images were acquired and evaluated in the filter and window to bone tissue. It was possible to demonstrate the anatomical differences and peculiarities of the normal vertebrae, particularly the occipito-atlantoaxial region, which has a higher incidence of changes to assist in the visualization of any change of the bone pattern on CT studies.

Segmental stabilization and muscular strengthening in chronic low back pain: a comparative study

OBJECTIVE: To contrast the efficacy of two exercise programs, segmental stabilization and strengthening of abdominal and trunk muscles, on pain, functional disability, and activation of the transversus abdominis muscle (TrA), in individuals with chronic low back pain. DESIGN: Our sample consisted of 30 individuals, randomly assigned to one of two treatment groups: segmental stabilization, where exercises focused on the TrA and lumbar multifidus muscles, and superficial strengthening, where exercises focused on the rectus abdominis, abdominus obliquus internus, abdominus obliquus externus, and erector spinae. Groups were examined to discovere whether the exercises created contrasts regarding pain (visual analogical scale and McGill pain questionnaire), functional disability (Oswestry disability questionnaire), and TrA muscle activation capacity (Pressure Biofeedback Unit = PBU). The program lasted 6 weeks, and 30-minute sessions occurred twice a week. Analysis of variance was used for inter- and intra-group comparisons. The significance level was established at 5 percent. RESULTS: As compared to baseline, both treatments were effective in relieving pain and improving disability (p<0.001). Those in the segmental stabilization group had significant gains for all variables when compared to the ST group (p<0.001), including TrA activation, where relative gains were 48.3 percent and -5.1 percent, respectively. CONCLUSION: Both techniques lessened pain and reduced disability. Segmental stabilization is superior to superficial strengthening for all variables. Superficial strengthening does not improve TrA activation capacity.

Análise radiográfica da coluna cervical em indivíduos assintomáticos submetidos a tração manual / Radiographic analysis of the cervical spine in healthy individuals submitted to manual traction

OBJETIVO: Avaliar, radiograficamente, o efeito da tração manual sobre o comprimento da coluna cervical. MATERIAIS E MÉTODOS: Cinqüenta e cinco participantes de ambos os gêneros - 12 masculinos (22 por cento) e 43 femininos (78 por cento) - sem história de distúrbios cervicais contituíram a amostra deste estudo. Eles foram submetidos a dois procedimentos radiológicos, um antes e outro durante a tração manual sustentada por 120 segundos. As distâncias entre as bordas anteriores e posteriores da segunda à sétima vértebras cervicais foram mensuradas e comparadas antes e durante a tração manual. RESULTADOS: A mediana da distância anterior antes da tração foi de 8,40 cm e durante a tração aumentou para 8,50 cm (p=0,002). A mediana da distância posterior antes da tração foi de 8,35 cm e durante a tração aumentou para 8,50 cm (p<0,001). CONCLUSÃO: Os resultados demonstraram que a aplicação da tração manual promoveu aumento estatisticamente significante do comprimento da coluna cervical em indivíduos assintomáticos.

OBJECTIVE: To evaluate radiographically the effect of manual traction on the length of the cervical spine in healthy individuals. MATERIALS AND METHODS: The sample of the present study included 55 individuals - 12 men (22 percent) and 43 women (78 percent) - with no previous history of cervical disorders, submitted to two radiological procedures previously and during manual traction sustained for 120 seconds. Distances between the anterior and posterior edges from the second to the seventh cervical vertebrae were measured and compared before and during manual traction. RESULTS: The median of pre-traction anterior length was 8.40 cm, increasing to 8.50 cm during the traction (p=0.002); and the median of pre-traction posterior length was 8.35 cm, increasing to 8.50 cm during traction (p<0.001). CONCLUSION: Application of manual traction resulted in a statistically significant increase in the length the cervical spine in healthy individuals.

As funções do controle postural durante a postura ereta / The function of postural control during standing

O controle postural e o controle do arranjo dos segmentos corporais baseado em informacoes dos sistemas visual, vestibular e somatossensorial. Acredita-se que o nivel de importancia das informacoes...

Estudo expirimental comparativo da flexäo entre duas técnicas de estabilizaçäo da coluna cervical de Rogers e Bohlman / Comparative experimental study of cervical spine flexion by Rogers and Bohlman techniques of stabilization

Existem diversas maneiras de fixar a coluna cervical instavél por via posterior. Testaram-se através de ensaios de flexäo 20 peças anatômicas de coluna cervical, obtidas de cadáveres humanos, divididas em dois grupos distintos quanto ao modo de fixaçäo da coluna cervical, técnica de Rogers ou de Boalman. Em todas as colunas foi criada uma instabilidade tipo traçäo-flexäo entre a quinta e a sexta vértebras cervicais. Os ensaios foram realizado em máquina universal de ensaios mecânicos com dispositivo apropriado. Este estudo revelou que a técnica de Bohlman é mais segura, protegendo melhor o local de instabilidade da coluna cervical. Quanto ao desvio angular, a rigidez e o limite de ruptura, näo houve diferença estatística significante entre as duas técnicas testadas.