Clinical use of percutaneous needle electrolysis in musculoskeletal injuries: A critical and systematic review of the literature

Objective: To review the current scientific evidence for the clinical use of percutaneous needle electrolysis (PNE) in musculoskeletal conditions. Methods: A systematic electronic search was performed in biomedical databases. Only clinical studies on human subjects using PNE on musculoskeletal pathologies were included. Methodological quality and risk of bias were assessed using the methodological index for non-randomized studies (MINORS). Treatment protocols were described, and primary outcomes (pain, injury-related function, and tissue structure) were compared against other treatment modalities or control groups in short (<1 month), mid (1-3 months) and long term (>3 months).ResultsTwenty-one studies met eligibility criteria (14 comparative studies and 7 case series). Sixty-two percent were at moderate to high risk of bias. PNE was applied in a wide range of injury types (mostly tendon-related), and application protocols were heterogeneous in terms of dosage (intensity: 0.35-6mA; time: 9-90sec), frequency (from twice a week to once every 2 weeks) and treatment duration (1-10 weeks). PNE showed moderate effects on pain at short and mid-term compared to active exercise interventions alone and sham needling. There is limited evidence that PNE improves injury-related function compared to other treatment modalities and no evidence of tissue structure improvement after PNE application.ConclusionThere is paucity of high-quality clinical studies about PNE in musculoskeletal conditions and lack of consensus about treatment indications and application protocols. Although a moderate effect on pain at short and mid-term has been documented, further research is needed. (AU)

Slipping rib syndrome: A clinical and dynamic-sonographic entity. A serial cases report.

BACKGROUND: Slipping rib syndrome (SRS) consists of false or floating rib hypermobility, which can force the ribs to come into contact with each other. OBJECTIVE: We aimed to examine each case by dynamic ultrasound to determine their ultrasound characteristics and analyze the clinical features of patients with SRS in order to better manage and follow them up. METHODS: Retrospectively, we collected 14 case series presenting to SRS between June 2016 and September 2018. The diagnosis was clinical and confirmed by dynamic ultrasound maneuvers. RESULTS: The mean age was 35.00 ± 10.66 years and 64.29% was male. The pain mechanism was caused by repetitive movements or a traumatic event. Dynamic ultrasound was considered a very useful tool for the diagnosis. Different conservative treatments were applied in most cases. Eco-guided infiltration was also an option. CONCLUSIONS: SRS should initially be based on a clinic suspicion in order to achieve a correct diagnosis and management. It is an underdiagnosed syndrome, so these case series contribute to our knowledge regarding this syndrome.

Muscle Activation and Distribution during Four Test/Functional Tasks: A Comparison between Dry-Land and Aquatic Environments for Healthy Older and Young Adults.

BACKGROUND: The use of rehabilitation protocols carried out in water has been progressively increasing due to the favorable physical properties of the water. Electromyography allows one to register muscle activity even under water. AIM: To compare muscle activity between two groups (healthy young adults (HYA) and healthy older adults (HOA)) in two different environments (dry land and aquatic) using surface electromyography during the execution of four different test/functional movements. METHODS: Analytical cross-sectional study. HYA and HOA carried out four functional tasks (Step Up and Down, Sit To Stand test, Gait Initiation and Turns During Gait) in two different environments (dry land and aquatic). Absolute and relative muscle activation was compared between each group and between each environment. In addition, the stability of the measured was calculated through a test-retest (ICC 2:1). RESULTS: Within the same environment there were significant differences between young and older adults in three of the four functional tasks. In contrast, in the gait initiation, hardly any significant differences were found between the two groups analysed, except for the soleus and the anterior tibial. Measurement stability ranged from good to excellent. CONCLUSIONS: Level of the musculature involvement presents an entirely different distribution when the test/functional task is performed on dry land or in water. There are differences both in the relative activation of the musculature and in the distribution of the partition of the muscles comparing older and young adults within the same environment.

Surface electromyography during physical exercise in water: a systematic review.

BACKGROUND: Aquatic exercise has been widely used for rehabilitation and functional recovery due to its physical and physiological benefits. However, there is a high variability in reporting on the muscle activity from surface electromyographic (sEMG) signals. The aim of this study is to present an updated review of the literature on the state of the art of muscle activity recorded using sEMG during activities and exercise performed by humans in water. METHODS: A literature search was performed to identify studies of aquatic exercise movement. RESULTS: Twenty-one studies were selected for critical appraisal. Sample size, functional tasks analyzed, and muscles recorded were studied for each paper. The clinical contribution of the paper was evaluated. CONCLUSIONS: Muscle activity tends to be lower in water-based compared to land-based activity; however more research is needed to understand why. Approaches from basic and applied sciences could support the understanding of relevant aspects for clinical practice.

Electromyographic responses during time get up and go test in water (wTUG).

The aim of this study was to use sEMG to measure the neuromuscular activity during the TUG task in water, and compare this with the responses for the same task on land. Ten healthy subjects [5 males and 5 females [mean ± SD]: age, 22.0 ± 3.1 yr; body mass, 63.9 ± 17.2 kg. A telemetry EMG system was used on the following muscles on the right side of the body: the quadriceps - rectus femoris [RF], long head of the biceps femoris [BF], tibialis anterior [TA], gastrocnemius medialis [GM], soleus [SOL], rectus abdominis [RA] and erector spinae [ES]. Each subject performed the TUG test three times with five minutes recover between trials in water and on dry land. The % MVC was significantly different (p < 0.05) for majority of the muscles tested during the TUG water compared to dry land. % MVC of RF [p = 0.003, t = 4.07]; BF [p = 0.000, t = 6.8]; TA [p = 0.005, t = 5.9]; and SOL [p = 0.048, t = 1.98]; RA [p = 0.007, t = 3.45]; and ES [p = 0.004, t = 3.78]. The muscle activation of the trunk and the lower limb [VM RF, BF, TA, GM and SOL] were lower in water compared to dry land, when performing a TUG test.