The Short-term Effect of Graded Motor Imagery on the Affective Components of Pain in Subjects with Chronic Shoulder Pain Syndrome: Open-Label Single-Arm Prospective Study.

OBJECTIVE: To determine the short-term effect of graded motor imagery (GMI) on the affective components of pain and range of motion in subjects with chronic shoulder pain syndrome. DESIGN: Open-label single-arm prospective study. SETTING: The Physical Therapy Laboratory, Universidad de las Americas. SUBJECTS: One hundred seven patients with chronic shoulder pain syndrome. METHODS: The subjects received a six-week GMI program based on laterality training, imagined movements, and mirror therapy. We assessed pain intensity using a visual analog scale (VAS), fear of movement was assessed using the Tampa Scale of Kinesiophobia (TSK), and catastrophizing was assessed using the Pain Catastrophizing Scale (PCS). The patient's flexion active range of motion (AROM) was also recorded. RESULTS: At the end of treatment, the VAS showed a decrease of 4.2 cm (P < 0.001, Cohen's d = 3.3), TSK showed a decrease of 17.0 points (P < 0.001, Cohen's d = 2.8), catastrophizing showed a decrease of 19.2 points (P < 0.001, Cohen's d = 3.2), and shoulder flexion AROM showed an increment of 30.3º (P < 0.000, Cohen's d = 1.6). CONCLUSIONS: We conclude that a short-term GMI program improves the affective components of pain and shoulder flexion AROM in patients with chronic shoulder pain syndrome.

Punción seca y cambios en la actividad muscular en sujetos con puntos gatillo miofasciales: serie de casos / Dry needling and changes in muscular activity in subjects with myphastial trigger points: case series

Introducción: Los puntos gatillo miofasciales (PGM) son una causa importante de dolor musculoesquelético que se defi nen como un dolor localizado, expresado en una banda de fibra muscular tensa, hiperirritable, que puede ser referido a zonas distantes. Objetivo: Describir el efecto inmediato de la punción seca (PS) sobre la actividad muscular y la intensidad de dolor en sujetos con puntos gatillo miofasciales en el trapecio superior. Métodos: Se seleccionó una muestra de 36 participantes con diagnóstico PGM latentes. Se les realizó una intervención con punción seca y se midieron las variables de dolor con EVA y actividad muscular del trapecio superior con electromiografía antes y después de la intervención en un gesto de alcance anterior. Resultados: Posterior a la aplicación de PS, la actividad muscular disminuyó en un 4,53 % (p = 0,002), el dolor en un 1,53 cm (p = 0,000). Conclusión: La aplicación PS tiene un efecto inmediato en la disminución de la actividad muscular y el dolor en PGM latente en el trapecio superior durante un alcance funcional anterior

Introduction: Myofascial trigger points (MTP) are an important cause of musculoskeletal pain and are defi ned as localized pain, expressed in a band of hyperirritable tense muscle fiber that can be referred to distant areas. Objective: To describe the immediate effect of dry needling (DN) on muscle activity and pain intensity in subjects with myofascial trigger points in the upper trapezius. Methods: A sample of 36 participants with latent PGM diagnosis was selected. They underwent an intervention with dry puncture and the variables of pain with VAS and muscular activity of the upper trapezius were measured before and after the intervention in a gesture of anterior reach. Results: After the application of DN, muscle activity decreased by 4.53 % (p = 0.002), pain by 1.53 cm (p = 0.000). Conclusion: The DN application has an immediate effect on the decreased muscle activity and pain in latent PGM in the upper trapezius during a previous functional range

Correlation Between Radiological Parameters and Functional Outcomes in Patients Older Than 60 Years of Age With Distal Radius Fracture.

Background: The relationship between radiographic and functional outcomes is controversial in the elderly. The objective of this study is to determine whether there is a correlation between functional outcome and acceptable distal radius fracture (DRF) alignment in patients older than 60 years of age. Methods: This correlation study was carried out at the Central Metropolitan Health Service of Chile. A total of 180 patients diagnosed with extra-articular DRF, according to the AO classification, were prospectively recruited. Radiological parameters, including radial inclination, residual dorsal angulation, ulnar variance, and articular step-off, were evaluated to assess the results of orthopedic reduction. Functional outcome was assessed immediately following cast removal and again at the 6-month follow-up. The Disabilities of the Arm, Shoulder and Hand (DASH) and Patient-Rated Wrist Evaluation (PRWE) questionnaires were administered to assess upper extremity function, and the visual analog scale (VAS) was used to assess pain intensity. Results: Only 68 patients (37.8%) showed acceptable DRF alignment. After cast removal, the correlations between alignment and the functional outcome measures were as follows: DASH 0.071 (P = .546), PRWE 0.03 (P = .823), and VAS 0.12 (P = .631). At the 6-month follow-up, the correlations between alignment and the functional outcome measures were as follows: DASH 0.029 (P = .768), PRWE 0.014 (P = .895), and VAS 0.09 (P = .614). Conclusions: There was no significant correlation between acceptable alignment according to radiological parameters and short- or medium-term functional outcome in patients older than 60 years with extra-articular DRF treated conservatively.

Physical therapy in patients over 60†years of age with a massive and irreparable rotator cuff tear: a case series.

[Purpose] Describe the effect of a Physical Therapy (PT) program in function improvement and pain reduction in patients over 60 years of age with massive and irreparable Rotator Cuff (RC) tear. [Participants and Methods] Ninety-two patients received a 12 weeks PT program that consisted in manual therapy and a specific exercises program. Before the start and at the end of the treatment, the shoulder function was assessed with Constant-Murley, the upper extremity function with DASH, and the pain during activity with the visual analog scale (VAS). [Results] At the end of the treatment, Constant-Murley exhibited an increment of 24.9 points, DASH showed a decrease of 28.7 points, and the VAS, a decrease of 3.6 cm (p=0.00). [Conclusion] A PT program based on manual therapy and specific exercises in a short term improves the function and reduces the pain during activity in patients with a massive and irreparable RC tear.

Supervised physical therapy vs home exercise program for patients with distal radius fracture: A single-blind randomized clinical study.

STUDY DESIGN: Randomized clinical study. INTRODUCTION: Supervised physical therapy (PT) and home exercise programs (HEPs) are frequently used in the rehabilitation of patients with distal radius fracture (DRF). However, there is no consensus as to whether unsupervised HEP provides comparable benefits to those achieved by supervised PT. PURPOSE OF THE STUDY: To compare the improvements in pain and functional status between a supervised PT program and unsupervised HEP in DRF patients older than 60 years. METHODS: A total of 74 patients were randomized into 2 groups. One group received 12 sessions of supervised PT (n = 37), and the other group followed an exercise program at home (n = 37). Three evaluations were performed, before the initiation of treatment, at 6-week, and 6-month follow-up. The study conducted a statistical power analysis to detect an intergroup difference score of 15 points on the Patient-Rated Wrist Evaluation (PRWE). The t-test or Mann-Whitney test was used, and it was set with a significance level of .05. RESULTS: The supervised PT group showed clinically significant differences in the total PRWE score at 6 weeks (17.67 points, P = .000) in the PRWE function score (15.2 points, P = .000) and in the PRWE pain score (5.6 points, P = .039). There was also a significant difference in the total PRWE score at 6-month follow-up (17.05 points, P = .000) in the PRWE function score (14.5 points, P = .000) and in the PRWE pain score (2.5 points, P = .35). CONCLUSIONS: A supervised PT program is more effective for improving function in the short- and medium-term when compared with HEP in patients older than 60 years with DRF extraarticular without immediate complications. LEVEL OF EVIDENCE: 1b.

Efectividad de ejercicios submaximales versus protocolo convencional en el rango de movimiento glenohumeral tras reparación artroscópica del supraespinoso / Effectiveness of submaximal exercise versus conventional protocol on range of movement glenohumeral after arthroscopic repair of supraspinatus

OBJETIVO: Determinar si la aplicación precoz de un programa de ejercicios submaximal, disminuye el dolor y aumenta el rango de movimiento glenohumeral en comparación a un protocolo convencional, en sujetos sometidos a artroscopia del supraespinoso. MATERIAL Y MÉTODO: El presente estudio corresponde a un diseño casi experimental, longitudinal y prospectivo. La muestra contó con 30 sujetos, con un promedio de edad de 52,8 años. Los sujetos se dividieron aleatoriamente por sorteo simple. Un grupo recibió un protocolo de ejercicios submaximales de forma precoz, y el otro, péndulo de Codman. Las variables analizadas fueron: dolor y rango de movimiento glenohumeral. RESULTADOS: Ambos grupos mostraron diferencias estadísticamente significativas al término de las intervenciones para todas las variables (p < 0,05). Al comparar la efectividad entre ambos tratamientos, la rehabilitación submaximal precoz mostró una disminución del dolor y un aumento en la rotación externa glenohumeral estadísticamente significativa en comparación con el tratamiento con péndulo de Codman (p = 0,004 p = 0,001 respectivamente). DISCUSIÓN: Estudios hechos han establecido un margen seguro para la activación del manguito rotador, menor al 20% de la contracción voluntaria máxima para tendones reparados mediante cirugía. Nuestros resultados arrojan que este protocolo de ejercicios que cumple con esos niveles de activación aplicados de forma precoz, muestran beneficios sobre el rango y el dolor. CONCLUSIONES: La aplicación de un programa de ejercicio submaximal de forma precoz, podría disminuir el dolor y aumentar los rangos de flexión, abducción y rotación externa glenohumeral, disminuyendo las complicaciones de la inmovilización.

OBJECTIVE: Determine if the application of an early submaximal exercise program reduces pain and increases the glenohumeral joint range of motion in comparison to a conventional protocol, in subjects with supraspinatus arthroscopic surgery. METHOD: The present study corresponds to a prospective quasi-experimental longitudinal design study. The sample was formed by 30 subjects, with a mean aged of 52,8 years old. The subjects were randomly divided by a simple draw. One of the groups received the early submaximal exercise protocol, and the other the Codman pendulum exercises. The analyzed variables were; pain, glenohumeral range of motion. RESULTS: Both groups showed significant statistical differences for all variables at the end of the intervention (p < 0.05). When the effectiveness of both treatments were compared, the early submaximal rehabilitation showed a significant statistical difference in pain decreased, and an increased in glenohumeral external rotation, in comparison to the Codman pendulum treatment plan (p = 0.004 and p = 0.001 respectively). DISCUSSION: Studies have established a secure margin for the rotator cuff activation of less than 20% of maximal voluntary contraction for the surgery repaired tendons. Our results show that this exercise protocol complies with these levels of activation when applied in an early stage, show benefits in range of motion and pain. CONCLUSSIONS: The application on an early submaximal exercise program might decrease pain and increased glenohumeral flexion, abduction and external rotation range of motion, decreasing the complication due to immobilization.