Effect of Stretching Combined With Ultrashort Wave Diathermy on Joint Function and Its Possible Mechanism in a Rabbit Knee Contracture Model.

OBJECTIVE: The aim of this study was to investigate the therapeutic effect of stretching combined with ultrashort wave on joint contracture and explore its possible mechanism. DESIGN: Thirty-two rabbits underwent unilateral immobilization of a knee joint at full extension to cause joint contracture. At 6 wks after immobilization, the rabbits were randomly divided into the following four groups: natural recovery group, stretching treatment group, ultrashort wave treatment group, and combined treatment group. For comparison, eight control group animals of corresponding age were also examined. The effect of stretching and ultrashort wave treatment on joint contracture was assessed by measuring the joint range of motion, evaluating the collagen deposition of joint capsule and assessing the mRNA and protein levels for transforming growth factor ß1 in the joint capsule. RESULTS: The combined treatment group led to the best recovery of joint function. The combined treatment with stretching and ultrashort wave was more effective than stretching or ultrashort wave treatment alone against the synovial thickening of suprapatellar joint capsule, the collagen deposition of anterior joint capsule, and the elevated expression of transforming growth factor ß1 in the joint capsule. CONCLUSIONS: Stretching combined with ultrashort wave treatment was effective in improving joint range of motion, reducing the biomechanical, histological, and molecular manifestations of joint capsule fibrosis in a rabbit model of extending joint contracture.

FSTL1 as a Potential Mediator of Exercise-Induced Cardioprotection in Post-Myocardial Infarction Rats.

Exercise training has been reported to ameliorate heart dysfunction in both humans and animals after myocardial infarction (MI), but the underlying mechanisms are poorly understood. Follistatin-like1 (FSTL1) is a cardioprotective factor against ischemic injury and is induced in cardiomyocytes and skeletal muscle in ischemic and hypoxic conditions. To test the hypothesis that FSTL1 may be a molecular link between exercise and improved heart function post MI, we subjected MI-rats, induced by left coronary artery ligation, to two modes of exercise: intermittent aerobic exercise (IAE) or mechanical vibration training (MVT), for four weeks and examined the relevance of FSTL1 to exercise-mediated cardiac effects. Exercise improved the functional performance, reduced fibrosis of MI-hearts and induced FSTL1 expression, the TGFß-Smad2/3 signaling and angiogenesis in myocardium. In gastrocnemius, exercise increased the cross-sectional area of myocytes and FSTL1 expression. Importantly, exercise increased circulating FSTL1 levels, which were positively correlated with the skeletal muscle FSTL1 expression and negatively correlated with heart fibrosis. Overall, the IAE was more effective than that of MVT in cardioprotection. Finally, exogenous FSTL1 administration directly improved angiogenesis as well as functionality of post-MI hearts. Taken together, we have demonstrated that FSTL1 is a potential mediator of exercise-induced cardioprotection in post-MI rats.

Lisis de adherencias epidurales (Parte 2). Técnica intervencionista / No disponible

La técnica lisis de adherencias epidurales se basa en la introducción de catéteres a través de agujas especiales con una técnica determinada para permitir colocar soluciones en lugares de difícil acceso, con el objeto de resolver cuadros crónicos de fibrosis o inflamación. Las soluciones como hialuronidasa y solución fisiológica hipertónica principalmente permiten provocar la lisis de las adherencias resultantes de la patología. Se desarrollan en esta publicación las distintas alternativas para aplicar correctamente la técnica en los distintos niveles de la columna vertebral. La técnica ha evolucionado desde la inyección a través de agujas de Tuhoy convencionales de soluciones con alguna propiedad neurolítica hasta las modernas agujas y catéteres con mapeo que permiten posicionar a distancia la solución deseada cerca de la raíz y/o el foramen indicados. Las dolencias y consultas médicas afectan más frecuentemente el segmento sacrolumbar pero las distintas entidades nosológicas, que derivan en tratamientos clínicos y quirúrgicos, pueden provocar dolor en el canal raquídeo, discos, estructuras vegetativas o en las raíces en cualquier segmento de la columna. Muchas de estas patologías especialmente después de tratamientos quirúrgicos provocan cuadros inflamatorios y adherencias epidurales, que evolucionan frecuentemente a cuadros de dolor crónico. Toda la fisiopatología e indicación de la presente técnica se desarrolla en la Parte 1 de esta publicación. En esta publicación describimos las técnicas para realizar las técnicas de lisis de adherencias a todos los niveles de la columna vertebral. Se explica minuciosamente la técnica caudal, lumbar, torácica y cervical, las soluciones que se administran, que catéteres en cada caso, la técnicas kinesiológicas de frotado neural y el mapeo epidural. Todas las técnicas explicadas son acompañadas al final de la publicación por una “Galería de Imágenes”. Se indica, el uso adecuado de las imágenes, las diferencias de volumen en cada caso, diagramas y posturas kinésicas recomendadas. Asimismo en cada caso se dan los tips para evitar las posibles complicaciones (AU)

This technique consists in the use of catheters and special needles to introduce solutions into difficult access sites in order to treat fibrosis or chronic inflammation conditions. Solutions such as hyaluronidase and hypertonic saline solution can be used for the lysis of adhesions caused by the pathology. This paper refers to different alternatives to correctly apply the technique at different spine levels. The technique has evolved from the conventional Tuhoy solution needles with some neurolitic properties to modern mapping needles and catheters that permit to position the desired solution at a distance, close to the desired root and/or foramen. The most frequently affected area is the sacrolumbar segment, but different nosological entities that require clinical or surgical treatments may cause pain in the spinal canal, discs, vegetative structures or roots in any spinal segment. Many of these pathologies, most particularly after surgical treatments, cause inflammatory conditions and epidural adhesions that frequently lead to chronic pain. The pathophysiology and indication of this technique is developed in Part 1 of this publication. This paper describes the techniques to perform lysis of adhesions at all spine levels. A thorough description is made of the caudal, lumbar, thoracic and cervical technique, the solutions administered, the catheters that are used in each case and physical therapy techniques for neural and epidural mapping. All techniques described are illustrated by an “Image gallery” for each procedure. The appropriate use of images is indicated with volume differences in each case. Tips for preventing complications are given (AU)

Use of the novel myokinetic stretching technique to ameliorate fibrotic mass in congenital muscular torticollis: an experimenter-blinded study with 1-year follow-up.

OBJECTIVE: To investigate the effect of the myokinetic stretching technique (MST) on morphological changes and associated clinical outcomes. METHOD: Infantile torticollis (N=32, 17 males) between 1 and 5 months of age (50.56 +/- 20.74 days) were treated with the MST for approximately 30 minutes per session, 5 times a week at university hospital. Diagnostic real-time ultrasound imaging was used on both unaffected and affected sides before and after the treatment to measure the sternocleidomastoid (SCM) muscle thickness of the involved area. Range of motion, head symmetry, and plagiocephaly with radiographs were determined. Data were analyzed using unpaired and paired t-test at p< 0.05. RESULTS: A significant reduction in SCM muscle thickness was observed after the intervention (p< 0.05). This morphological change was associated with significant improvements in passive cervical range of motion and head symmetry (p< 0.05). The mean intervention duration was 53.59 +/- 25.12 days to completely resolve the mass. These effects continued to exist one year post-intervention. CONCLUSIONS: This was the first clinical evidence that demonstrated the efficacy of MST for improving cervical motion and muscle thickness in infants with congenital muscular torticollis as well as shortening the treatment duration.

How to treat the stiff total knee arthroplasty?: a systematic review.

BACKGROUND: Multiple modalities have been used to treat the stiff TKA, including manipulation under anesthesia (MUA), arthroscopy, and open arthrolysis. QUESTIONS/PURPOSES: We reviewed the literature to address three questions: (1) How many degrees of ROM will a stiff TKA gain after MUA, arthroscopy, and open arthrolysis? (2) Does the timing of each procedure influence this gain in ROM? (3) What is the number of clinically important complications for each procedure? METHODS: We performed a PubMed search of English language articles from 1966 to 2008 and identified 20 articles, mostly Level IV studies. RESULTS: For patients who have arthrofibrosis after TKA, the gains in ROM after MUA and arthroscopy (with or without MUA) are similar. Open arthrolysis seems to have inferior gains in ROM. MUA is more successful in increasing ROM when performed early but still may be effective when performed late. Arthroscopy combined with MUA still is useful 1 year after the index TKA. The numbers of clinically important complications after MUA and arthroscopy (with or without MUA) are similar. CONCLUSIONS: Stiffness after TKA is a common problem that can be improved with MUA and/or arthroscopic lysis of adhesions with few complications. The low quality of available literature makes it difficult to develop treatment protocols. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Static progressive stretch improves range of motion in arthrofibrosis following total knee arthroplasty.

Arthrofibrosis is a relatively common complication after total knee arthroplasty that negatively affects function and quality of life. Static progressive stretching is a technique that has shown promising results in the treatment of contractures of the elbow, ankle, wrist and knee. This study evaluated a static progressive stretching device as a treatment method for patients who had refractory knee stiffness after total knee arthroplasty. Twenty-five patients who had knee stiffness and no improvement with conventional physical therapy modalities were treated with the device. After a median of 7 weeks (range, 3-16 weeks), the median increase in range of motion was 25 degrees (range, 8-82 degrees). The median gain in knee active flexion was 19 degrees (range, 5-80 degrees). Ninety-two percent of patients were satisfied with the results. The authors believe static progressive stretching devices may be an effective method for increasing the ranges of motion and satisfaction levels of patients who develop arthrofibrosis after total knee arthroplasty.

Manipulation with prolonged epidural analgesia for treatment of TKA complicated by arthrofibrosis.

Inability to achieve adequate range of motion (ROM) after total knee arthroplasty (TKA) represents a frustrating complication for both patient and surgeon. Manipulation under anesthesia is indicated in TKA having less than 90 degrees ROM after six weeks, with no progression or regression in ROM. A modified technique has evolved for patients with chronic regional pain syndrome (CRPS) symptoms or persistent stiffness after standard manipulation. A retrospective review was conducted to determine the efficacy of the modified technique, which uses epidural anesthesia continued for postoperative analgesia, hospital stay of one to three days, continuous passive motion (CPM) for two to three days, and daily physical therapy (PT). Between 1997 and 2003, 5714 TKAs were performed in 4106 patients. Manipulation using a standard technique was performed on 334 (5.8%) knees in 273 patients. Manipulation using a modified technique was performed on 65 (1%) knees in 60 patients. Age averaged 58 years and body mass index (BMI) averaged 34.39. Follow up averaged 18.4 months. ROM improved significantly from 71 degrees to 102 degrees (p < 0.0001). Knee Society pain, function, and total clinical scores all improved significantly (all p < 0.0001). Successful results were observed in 48 (74%) knees. Four (6%) additional knees achieved a successful result after a subsequent manipulation. Nine (14%) knees required component revision for treatment of persistent arthrofibrosis, which included one full revision, five polyethylene exchanges, and three revisions of femoral component and polyethylene. Two significant complications occurred: one subdural hematoma and one death due to pulmonary embolism. Although not without complications, manipulation under epidural anesthesia represents a viable option for treatment of persistent stiffness after TKA; 80% of these difficult cases achieved successful results.

Pulsoterapia com corticóide em fribrose sub-retiniana progressiva / Steroid pulsetherapy in progressive subretinal fibrosis

Uma criança de 10 anos, do sexo masculino, apresentou um caso raro de fibrose sub-retiniana progressiva.Inicialmente apenas o olho direito foi afetado.Sem tratamento, este processo evolui para formaçäo de uma extensa zona de fibrose sub-retiniana na área macular, com severo comprometimento visual.Após um ano e cinco meses apareceram lesöes coroidianas multifocais com deslocamento seroso macular no olho esquerdo, tendo sido precocemente tratadas com corticoesteróides.Houve resoluçäo rápida das lesöes, sem cicatrizaçäo sub-retiniana e o paciente manteve acuidade visual normal neste olho.

Ulceras por decúbito e Hidroterapia en las termas de Copahue / Decubitus ulcers and hydrotherapy in the Copahue Thermal Complex

Se presenta el caso de una niña de 9 años con paraparesia y escaras por decúbito de más de 6 meses de evolución, tratada con hidroterapia integral en las Termas de Copahue (Neuquén-Argentina). Mediante esta terapeútica pudimos observar una rápida y excelente respuesta, tanto de las lesiones cutáneas como de su cuadro general

Ulceras por decúbito e Hidroterapia en las termas de Copahue / Decubitus ulcers and hydrotherapy in the Copahue Thermal Complex

Se presenta el caso de una niña de 9 años con paraparesia y escaras por decúbito de más de 6 meses de evolución, tratada con hidroterapia integral en las Termas de Copahue (Neuquén-Argentina). Mediante esta terapeútica pudimos observar una rápida y excelente respuesta, tanto de las lesiones cutáneas como de su cuadro general