Effects of an exercise program plus manual therapy in a patient with failed neck surgery syndrome: A case report.

BACKGROUND: Patients who have undergone cervical surgery may present pain and dysfunction in the upper limb, which is often referred to as failed neck surgery syndrome. Little is known about the effects of an exercise program plus manual therapy in the treatment of prolonged neuropathic pain of the upper quadrant in a patient with failed neck surgery. CASE DESCRIPTION: A 66-year-old woman consulted for neuropathic pain and dysfunction during grasping activities, as a result of failed neck surgery after 12 months. Clinical, functional, and electromyographic measurements were recorded at baseline and after treatment. The patient underwent a treatment for six weeks based on manual therapy for the upper limb and cervical spine and an exercise program for the scapular muscles, rotator cuff and wrist extensor muscles. OUTCOMES: Positive clinically significant changes were observed in the Neuropathic Pain Questionnaire (DN4) (baseline = 7 points; post-treatment = 4 points), Neck Disability Index (NDI) (baseline = 36; post-treatment = 18 points), QuickDASH (baseline = 78; post- treatment = 32 points), Upper Limb Neurodynamic Test 1 (ULNT-1) (baseline = 75°; post- treatment = 42°) and grip strength (GS) (baseline = 23 kgf; post-treatment = to 32 kgf). Improvements in the surface electromyographic (sEMG) activity of the upper trapezius (UT), infraspinatus (IS) and radial wrist extensors (RWE) muscles also seemed to occur after treatment. CONCLUSION: Treatment helped relieve neuropathic pain, decrease neck disability, and improve general upper limb function.

Muscle responses during radial nerve-biased upper limb neurodynamic test in asymptomatic individuals: a cross-sectional study.

This laboratory cross-sectional study aimed at explore the muscle response (MR) of the upper trapezius, infraspinatus, biceps brachii and extensor carpi radialis brevis (ECRB) during the radial nerve-biased upper limb neurodynamic test (RN-ULNT) in healthy participants. Myoelectric activity was stage-by-stage recorded during two sequencing variants of the RN-ULNT: S1, in which elbow extension was the last movement; and S2, in which wrist flexion was the last movement. Final elbow and wrist joint angle and sensory response (SR) in five zones (Z1-Z5) were also registered. MR was qualitatively categorized as 'absent' (No-MR), 'true' (TMR) or 'uneven' (UMR). In both sequences, significant increases in muscle activity occurred mostly during shoulder abduction and elbow extension (p ≤ 0.009). Also, elbow extension but not wrist flexion increased the activity of the ECRB muscle (p ≤ 0.009). S2 showed significantly higher upper trapezius (p = 0.04) and biceps brachii (p = 0.036) muscle activity during wrist flexion, and higher report of SR in Z1 and Z4 (p < 0.001) compared to S1. Only the ECRB muscle showed significant differences in the MR type between S1 and S2 (TMR, p = 0.016; UMR, = 0,012). Our results may be useful in the assessment of upper limb musculoskeletal disorders.

Pressure pain threshold mappings of the infraspinatus muscle in chronic unilateral shoulder pain patients do not reflect generalized hypersensitivity.

OBJECTIVES: Increased mechanical sensitivity has been observed on the unaffected side in chronic pain conditions, suggesting generalized or widespread hypersensitivity. However, this cannot be considered as a universal response since this hypersensitivity is inconsistent across muscle pain pathologies. The aim of this study was to assess generalized hypersensitivity in chronic unilateral shoulder pain, using pressure pain threshold (PPT) mappings of the infraspinatus muscle. The proposed evaluation is based on the assessment of PPT on a limited subset of sites, reducing potential habituation or sensitization effects. METHODS: Twenty-nine patients with unilateral shoulder pain (USP) and twenty-seven healthy volunteers were recruited. PPT was assessed using a manual pressure algometer. Six sites distributed over the infraspinatus muscle were assessed, and three repetitions were performed at each site. Mappings were derived using two-dimensional interpolation. RESULTS: Lower PPT values were found in the symptomatic side in comparison with the asymptomatic side at all assessment sites (estimated difference: 1.42 ±â€¯0.10 kgf/cm2, p < 0.001), but there were no differences among the asymptomatic side of USP patients and any of the sides in healthy volunteers (largest estimated difference: 0.17 ±â€¯0.28 kgf/cm2, p = 0.927). Furthermore, the medial region of the infraspinatus muscle showed higher mechanical sensitivity in both healthy volunteers and USP patients. CONCLUSIONS: These results suggest that USP does not induce generalized hypersensitivity, in contrast with previously reported findings. Physiotherapists could take these results into account for the assessment and treatment of patients with USP.

Supine scapular punch: An exercise for early phases of shoulder rehabilitation?

BACKGROUND: Serratus anterior strengthening generally appears in shoulder rehabilitation protocols. This study's aim was to measure electromyographic activity of the serratus anterior, upper trapezius, and infraspinatus muscles during the Supine Scapular Punch exercise in healthy volunteers and those with unilateral shoulder pain. METHODS: Fifty-four participants were included and grouped as without (n = 34, age = 25.8 years) or with unilateral shoulder pain (n = 20, age = 26.3 years, visual analogue scale = 4.15 cm). Electromyographic activity of the serratus anterior, upper trapezius, and infraspinatus muscles was assessed during Supine Scapular Punch (four phases: P1 = press up concentric, P2 = Supine Scapular Punch concentric, P3 = Supine Scapular Punch eccentric, P4 = press up eccentric) performed under two conditions, with and without additional load. FINDINGS: Overall muscle activity during P1 and P4 was negligible (< 10% maximal voluntary isometric contractions). During P2 and P3, no statistically significant differences in serratus anterior and upper trapezius muscle activity were found between groups, with moderate to high serratus anterior activity (28.94% to 44.3%) and very low upper trapezius activity (< 6%). Upper trapezius/serratus anterior activity ratios ranged from 0.09 to 0.18. Overall infraspinatus muscle activity was always very low (< 10%). INTERPRETATION: The Supine Scapular Punch induces moderate to high serratus anterior muscle activity with very low upper trapezius and infraspinatus activation. Based on these results, the Supine Scapular Punch is a safe exercise that can be used in the early phases of shoulder rehabilitation.

Effect of pain neuroscience education and transcutaneous electrical nerve stimulation on trigeminal postherpetic neuralgia. A case report.

INTRODUCTION: Postherpetic neuralgia (PHN) is a complex neuropathic painful condition in which pain is a direct consequence of the response to peripheral nerve damage experienced during herpes zoster attack. PHN is the most common chronic complication of herpes zoster and it causes considerable suffering, affecting the physical functioning and psychological well-being of patients. OBJECTIVE: To describe the effect of a conservative treatment using pain neuroscience education (PNE) and transcutaneous electrical nerve stimulation (TENS) in a patient with trigeminal PHN. CASE DESCRIPTION: A 67-year-old woman sought care for pain, dysfunction, and sensory loss in the left jaw. The assessment included: 1) pain, using the numerical pain rating scale (NPRS), pressure pain threshold (PPT), Douleur Neuropathique 4 (DN4), McGill Pain Questionnaire (MPQ), Graded Chronic Pain Scale (GCPS), and classic body charts of the cranial region; 2) somatosensory function, by means of mechanical detection threshold (MDT) and pressure pain threshold (PPT); 3) jaw function, using the Jaw Functional Limitation Scale-20 (JFLS-20); and 4) psychosocial features, by means of the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorders Questionnaire-7 (GAD-7). Treatment consisted of 12 sessions of PNE and TENS. OUTCOMES: After treatment, a clinically significant improvement in NPRS, DN4, MDT, GCPS, and PHQ-9 was observed. CONCLUSION: In this case report, a treatment based on the combination of PNE and TENS seemed to have contributed to improving pain, sensory abnormalities, and jaw function. Psychosocial factors also showed a trend to improve after the treatment.

Effect of different postures of the scapular girdle and arm on the pressure pain threshold in the infraspinatus muscle.

BACKGROUND: Mechanosensitivity changes and trigger points in the infraspinatus muscle are associated with several painful conditions of the upper limb. The aim of this study was to assess the effect of different postures of the upper quadrant on the pressure pain threshold (PPT) of the infraspinatus muscle. METHODS: This was an observational, cross-sectional study. Fifty-four subjects with and without shoulder pain (Asymptomatic subjects = 27, mean age 26.9 ± 4.92 years, BMI 23.73 ± 3.87), (symptomatic subjects = 27, mean age 27.6 ± 3.68 years, BMI 24.35 ± 3.86) were evaluated with a pressure algometer on the infraspinatus muscle belly, in four different positions of the upper quadrant: rest position (P1), passive scapular retraction position (P2), cervical contralateral inclination position (P3), and suprascapular nerve provocation position (P4). The assessed side was randomly chosen and all measurements were taken in sitting position. RESULTS: No differences were observed between groups. The within-group analysis showed differences for both factors: "Positions" (F = 69.91; p = 0.001) and the interaction "Positions^Group" (F = 3.36; p = 0.02). The pairwise post-hoc analysis showed differences for the retracted position (P2) compared to others P1 (p = 0.001), P3 (p = 0.001), and P4 (p = 0.001), with higher PPT results achieved on the retracted position. Differences between P4 vs. P1 (p = 0.03) were also observed, with higher values for P4. CONCLUSION: Placing the scapular girdle in a passive scapular retraction position significantly reduces the pressure sensitivity at the infraspinatus muscle. Physiotherapists can take into account these results when assessing and treating patients with upper quadrant pain syndromes.

Movilización pasiva continua en pacientes con artroplastia de rodilla / Continuous passive motion in knee arthroplasty patients

Introducción: La artroplastia total de rodilla es el recurso terapéutico para pacientes con artrosis severa y gran incapacidad física. Sin embargo, muchos evolucionan con dolor y déficit funcional. En este estudio, se utiliza un tratamiento con movilización pasiva continua a partir de los 10 días de la cirugía. Materiales y Métodos: Se incluyó a 60 pacientes que fueron asignados, en forma aleatoria, a 2 grupos (30 en cada grupo). Al grupo 1 (G1, 23 mujeres) se le aplicó un protocolo de tratamiento convencional y, al grupo 2 (G2, 17 mujeres), el mismo programa y la adicción de un equipo de movimiento pasivo continuo a los 10 días de la intervención. Se evaluaron el dolor, la movilidad articular, la fuerza muscular y la función (WOMAC y prueba TUG). Resultados: No se observaron diferencias estadísticamente significativas en los parámetros estudiados, aunque sí una tendencia a la mejoría en el G2. En este grupo, la fuerza de extensión de la rodilla fue mayor y también hubo una correlación basal entre la fuerza y la prueba TUG. Conclusiones: El uso diferido de la movilización pasiva continua mejoró la fuerza de extensión de la rodilla y el rendimiento en la prueba TUG, aunque sin diferencias significativas entre ambos grupos. No se observaron efectos adversos. Nivel de Evidencia: I

Introduction: Total knee arthroplasty (TKA) is a valid therapeutic option for patients with severe arthritis and physical disability. However, many TKA patients develop pain and functional impairment. In our study, we used a continuous passive motion (CPM) device for exercise starting 10 days after surgery. Materials and Methods: The study population consisted of 60 patients, who were randomized into 2 groups. Group I (GI: 30 patients, 23 females) underwent the standard treatment and group II (GII, 30 patients, 17 females) underwent the standard treatment plus CPM starting 10 days after surgery. We evaluated pain, range of motion (ROM), extension muscle strength, and function (WOMAC and TUG tests). Results: All compared parameters yielded no statistically significant differences. A greater trend toward improvement was observed in GII regarding some parameters: greater extension muscle strength and a baseline correlation between flexion strength and the TUG test. Conclusions: The use of CPM starting 10 days after of surgery improved the extension muscle strength and produced better TUG test results, although without any statistically significant difference with the standard procedure. No adverse effects were observed. Level of Evidence: I

Lateral epicondylalgia: A primary nervous system disorder.

Lateral epicondylalgia (LE) is the most common chronic painful condition affecting the elbow in the general population. Although major advances have been accomplished in recent years in the understanding of LE, the underlying physiopathology is still a reason for debate. Differences in clinical presentation and evolution of the symptoms among patients, suggest the need for revisiting the current knowledge about subjacent mechanisms that attempt to explain pain and functional loss. Previous models have suggested that the condition is mainly a degenerative tendinopathy, associated with changes in pain pathways and the motor system. The hypothesis of this work is that LE is the clinical manifestation of a primary nervous system disorder, characterized by an abnormal increase in neuronal activity and a subsequent loss of homeostasis, which secondarily affects the musculoskeletal tissues of the elbow-forearm-hand complex. A new model for LE is presented, supported by an in-deep analysis of basic sciences, epidemiological and clinical studies.

Pilates experience vs. muscle activation during abdominal drawing-in maneuver.

The purpose of this study was to compare the activation of deep abdominal and spine stabilizer muscles of subjects with and without Pilates experience. Twenty-three subjects were divided into a no-experience group (n = 13) and an experienced group (n = 10). The subjects performed three 12-s drawing-in maneuver trials at 50% TrA/IO maximal voluntary contraction (MVC). The experienced group presented greater activation of both muscles than the no-experience group (62% vs. 32% MVC for the TrA/IO, and 52% vs. 12% MVC for the LD, p < 0.001). The no-experience group had higher variability among trials and did not reach 50% MVC for the TrA/IO, while the experienced group was able to reach and keep the TrA/IO activation at or above 50% MVC. Pilates experience and muscle activation were strongly associated. Pilates trained subjects were able to sustain concomitant abdominal and low back muscle contraction during the drawing-in maneuver, while subjects with no Pilates experience were not able to reach the same levels of abdominal activation and did not present significant low back muscle co-activation.

Effects of scapular taping in young adults with shoulder pain and scapular dyskinesis.

OBJECTIVE: To assess the immediate effects of scapular taping on pain, isometric force, and the level of activation of several scapular girdle muscles in individuals with shoulder pain and scapular dyskinesis. MATERIALS AND METHODS: Ten individuals with shoulder pain during arm elevation and scapular dyskinesis were included and evaluated by using a visual analogue scale (VAS), pressure algometry, dynamometry, and surface electromyography. All assessments were performed before and immediately after the application of scapular taping. RESULTS: Scapular taping did not change the electromyographic activity of the upper trapezius muscle (p = 0.041, IC95%: -0.8256 to 10.8752). The positive effects of taping application were related to pain reduction (p = 0.025) and improvement in pressure algometry in the middle deltoid muscle (p = 0.020, IC95%:-1.8910 to -0.0490). Maximal isometric force did not change after the application of taping (flexo-abduction p = 0.4136, external rotation p = 0.4261). Significant correlations were noted between the VAS and pressure pain threshold (PPT) for the upper trapezius muscle (r = -0.6643, p = 0.0361) as well as for the PPT measures of the middle deltoid and infraspinatus muscles before (r = 0.9491, p = 0.0001) and after (r = 0.9006, p = 0.0004) the application of taping. CONCLUSION: Scapular taping was not effective for inducing changes in the electromyographic activity of the upper trapezius, lower trapezius, and serratus anterior muscles, nor in altering the isometric force of shoulder flexo-abduction and external rotation. However, taping was effective at improving the pressure algometry values of the middle deltoid. Significant correlations between the pressure algometry of the middle deltoid and infraspinatus muscles, both before and after the application of scapular taping, were noted.

Análisis de equivalencia entre cuatro escalas de evaluación funcional del hombro en pacientes operados del manguito de los rotadores y en pacientes con diagnóstico de hombro doloroso. Estudio transversal y observacional / Equivalence analysis between four shoulder function assessment scales in patients undergoing rotator cuff surgery and patients diagnosed with painful shoulder syndrome. Cross sectional and observational study

Introducción: El objetivo del presente estudio fue analizar el grado de confiabilidad concurrente entre cuatro escalas de valoración funcional en pacientes operados del manguito de los rotadores y en pacientes con diagnóstico de hombro doloroso. Materiales y métodos: Se estudiaron 40 pacientes: 23 operados por la rotura del manguito de los rotadores y 17 con diagnóstico de hombro doloroso. Las escalas utilizadas fueron: 1) prueba de la Universidad de California de los Angeles (UCLA), 2) prueba sencilla del hombro (Simple Shoulder Test, SST), 3) prueba de Constant y Murley (C-M) y 4) escala del Colegio Americano de Cirujanos de Hombro y Codo (ASES). Se aplicaron todas las escalas a los 40 pacientes y se calculó el coeficiente de correlación intraclase (CCI) y el intervalo de confianza (IC) del 95% entre las escalas. Se consideró significativo un valor de p < 0,05. Resultados: En 26 casos (65%) el hombro afectado fue el dominante. Los CCI (IC 95%) entre las escalas fueron: SST contra Constant 0,39 (-15,3; 0,68); contra ASES 0,29 (-0,34; 0,62) y contra UCLA 0,56 (0,17; 0,77). Constant contra ASES 0,834 (0,69; 0,91) y contra UCLA 0,706 (0,44; 0,85). ASES contra UCLA 0,679 (0,39; 0,83). Conclusiones: Se observó una confiabilidad concurrente nula entre SST y C-M y entre SST y ASES; y moderada entre SST y UCLA, entre C-M y UCLA y entre ASES y UCLA. La confiabilidad concurrente más alta fue entre C-M y ASES; por lo tanto, es esperable que usando ambas escalas puedan obtenerse resultados similares (AU)

Análisis de equivalencia entre cuatro escalas de evaluación funcional del hombro en pacientes operados del manguito de los rotadores y en pacientes con diagnóstico de hombro doloroso: estudio transversal y observacional / Shoulder outcome measures: 4 functional scales and concurrent reliability

Introducción: El objetivo del presente estudio fue analizar el grado de confiabilidad concurrente entre cuatro escalas de valoración funcional en pacientes operados del manguito de los rotadores y en pacientes con diagnóstico de hombro doloroso. Materiales y métodos: Se estudiaron 40 pacientes: 23 operados por la rotura del manguito de los rotadores y 17 con diagnóstico de hombro doloroso. Las escalas utilizadas fueron: 1) prueba de la Universidad de California de los Ángeles (UCLA), 2) prueba sencilla del hombro (Simple Shoulder Test, SST), 3) prueba de Constant y Murley (C-M) y 4) escala del Colegio Americano de Cirujanos de Hombro y Codo (ASES). Se aplicaron todas las escalas a los 40 pacientes y se calculó el coeficiente de correlación intraclase (CCI) y el intervalo de confianza (IC) del 95 por ciento entre las escalas. Se consideró significativo un valor de p < 0,05. Resultados: En 26 casos (65 or ciento) el hombro afectado fue el dominante. Los CCI (IC 95 por ciento) entre las escalas fueron: SST contra Constant 0,39 (-15,3; 0,68); contra ASES 0,29 (-0,34; 0,62) y contra UCLA 0,56 (0,17; 0,77). Constant contra ASES 0,834 (0,69; 0,91) y contra UCLA 0,706 (0,44; 0,85). ASES contra UCLA 0,679 (0,39; 0,83). Conclusiones: Se observó una confiabilidad concurrente nula entre SST y C-M y entre SST y ASES; y moderada entre SST y UCLA, entre C-M y UCLA y entre ASES y UCLA. La confiabilidad concurrente más alta fue entre C-M y ASES; por lo tanto, es esperable que usando ambas escalas puedan obtenerse resultados similares.

Background: The purpose of our study was to compare the concurrent reliability of 4 commonly used outcome scales for rotator cuff surgery and shoulder pain syndrome. Methodology: 16 female and 7 male patients with rotator cuff surgery, and 7 female and 10 male patients with shoulder pain syndrome were analyzed. Four professionals blindly applied the following scales: Simple Shoulder Test (SST), Constant and Murley Scale (Constant), University of California Los Angeles Shoulder Score (UCLA) and American Shoulder andElbow Surgeons Shoulder Score Index (ASES). The Intraclass correlation coefficient (ICC) and 95 por cento Confidence Interval (CI) and p < 05 significance level were used for statistical purposes. Results: The dominant shoulders were affected in 65 por cento of the patients. The ICC(CI 95 por cento) between scales was: SSTvs Constant 0.39 (-15.3; 0.68) .064, vs ASES 0.29 (-0.34; 0.62); vs UCLA 0.56 (0.17; 0.77). Constant vsASES 0.834(0.69; 0.91); vs UCLA 0.706 (0.44; 0.85) and ASES vs UCLA 0.679 (0.39; 0.83). Conclusions: Our study found no concurrent reliability between SST and C-M, and between SST and ASES. Reliability was moderate between SST and UCLA, between C-M and UCLA and between ASES and UCLA. The highest reliability was observed comparing C-M and ASES. We estimate that when using both scales, the results obtained should be similar.