KINESIO en la WEB

Resumen: Tendonitis is a common diagnosis in sports medicine. The traditional view of tendonitis is a tendon injury resulting from repetitive mechanical load with a subsequent inflammatory response. The English literature from 1966 to the present on the etiology, diagnosis, and treatment of tendonitis was evaluated. There is some scientific support in the literature for the diagnosis of tenosynovitis and tendinosis as a pathologic entity. Actual inflammation of tendon tissue consistent with tendonitis has not been seen clearly in patho-anatomic studies. Conclusive evidence confirming that repetitive mechanical load is a major etiologic factor could not be found. Similarly, strength deficits, inflexibility, and improper equipment have not been studied in a controlled prospective manner. Other factors such as age and tendon vascularity have been consistently correlated with these injuries although their overall importance remains difficult to assess. There are no controlled studies on treatment through physical therapy aimed at flexibility and/or strengthening. Treatment with anti-inflammatory drugs has been studied extensively. However, only nine of 32 studies are prospective and placebo controlled. Some pain relief was found in five of the nine controlled studies, but healing of the tendon problem was not studied in these short follow-up studies. Twenty-three studies on steroid injections were found. Eight were prospective and placebo controlled studies, with three showing beneficial effects of the injection at follow-up. It was concluded that much of the pathology and etiology of tendonitis remains unclear. The possibility must be considered that current treatment methods may not significantly affect the natural history.[volver]

Título en Inglés: Shoulder joint kinetics during the push phase of wheelchair propulsion.

Autor/es: Kulig-K; Rao-SS; Mulroy-SJ; Newsam-CJ; Gronley-JK; Bontrager-EL; Perry-J

Lugar: University of Southern California, Department of Biokinesiology and Physical Therapy, Los Angeles, USA.

Fuente: Clin-Orthop. 1998 Sep(354): 132-43

ISSN: 0009-921X

Idioma: ENGLISH

Resumen: The purpose of this investigation was to quantify the forces and moments at the shoulder joint during free, level wheelchair propulsion and to document changes imposed by increased speed, inclined terrain, and 15 minutes of continuous propulsion. Data were collected using a six-camera VICON motion analysis system, a strain gauge instrumented wheel, and a wheelchair ergometer. Seventeen men with low level paraplegia participated in this study. Shoulder joint forces and moments were calculated using a three-dimensional model applying the inverse dynamics approach. During free propulsion, peak shoulder joint forces were in the posterior (46 N) and superior directions (14 N), producing a peak resultant force of 51 N at an angle of 185 degrees (180 degrees = posterior). Peak shoulder joint moments were greatest in extension (14 Newton-meters [Nm]), followed by abduction (10 Nm), and internal rotation (6 Nm). With fast and inclined propulsion, peak vertical force increased by greater than 360%, and the increase in posterior force and shoulder moments ranged from 107% to 167%. At the end of 15 minutes of continuous free propulsion, there were no significant changes compared with short duration free propulsion. The increased joint loads documented during fast and inclined propulsion could lead to compression of subacromial structures against the overlying acromion.[volver]

Título en Inglés: Prediction of 10 repetition maximum for short-arc quadriceps exercise from hand-held dynamometer and anthropometric measurements.

Autor/es: Walsworth-M; Schneider-R; Schultz-J; Dahl-C; Allison-S; Underwood-F; Freund-J

Lugar: U.S. Army-Baylor University Graduate Program in Physical Therapy, Academy of Health Sciences, Fort Sam Houston, TX, USA.

Fuente: J-Orthop-Sports-Phys-Ther. 1998 Aug; 28(2): 97-104

ISSN: 0190-6011

Idioma: ENGLISH

Resumen: Short-arc quadriceps exercise are commonly prescribed in physical therapy for strengthening knee extensor musculature. Determining the appropriate starting resistance has traditionally been a trial-and-error procedure. Therefore, developing an expedient method of estimating the correct starting resistance may lead to a more accurate exercise prescription. The primary purpose of this study was to establish a technique for predicting an individual's 10 repetition maximum (10 RM) based on hand-held dynamometer (HHD) strength recording and additional anthropometric predictor variables. Fifty healthy subjects (31 males and 19 females), aged 22-53 years, participated in the study. A prediction equation for determining 10 RM using HHD strength recording, weight, gender, and age was developed. By implementing this equation, clinicians can predict a normal, healthy, young to middle-aged adult's 10 RM within +/- 4.17 kg with a 95% confidence level (SEE = 2.13 kg).[volver]

Título en Inglés: Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure.

Autor/es: Roos-EM; Roos-HP; Lohmander-LS; Ekdahl-C; Beynnon-BD

Lugar: Department of Physical Therapy, University of Lund, Sweden.

Fuente: J-Orthop-Sports-Phys-Ther. 1998 Aug; 28(2): 88-96

ISSN: 0190-6011

Idioma: ENGLISH

Resumen: There is broad consensus that good outcome measures are needed to distinguish interventions that are effective from those that are not. This task requires standardized, patient-centered measures that can be administered at a low cost. We developed a questionnaire to assess short- and long-term patient-relevant outcomes following knee injury, based on the WOMAC Osteoarthritis Index, a literature review, an expert panel, and a pilot study. The Knee injury and Osteoarthritis Outcome Score (KOOS) is self-administered and assesses five outcomes: pain, symptoms, activities of daily living, sport and recreation function, and knee-related quality of life. In this clinical study, the KOOS proved reliable, responsive to surgery and physical therapy, and valid for patients undergoing anterior cruciate ligament reconstruction. The KOOS meets basic criteria of outcome measures and can be used to evaluate the course of knee injury and treatment outcome.[volver]

Título en Inglés: Scapulothoracic muscle fatigue associated with alterations in scapulohumeral rhythm kinematics during maximum resistive shoulder elevation.

Autor/es: McQuade-KJ; Dawson-J; Smidt-GL

Lugar: Program in Physical Therapy, New York Medical College, Valhalla 10595, USA.

Fuente: J-Orthop-Sports-Phys-Ther. 1998 Aug; 28(2): 74-80

ISSN: 0190-6011

Idioma: ENGLISH

Resumen: Clinical examinations and biomechanical analysis of the shoulder often include an assessment of the scapulohumeral rhythm. It is important to understand factors which may affect the scapulohumeral rhythm so that optimal diagnostic and therapeutic strategies can be devised. The purpose of this study was to determine if the scapulohumeral rhythm, when assessed under dynamic conditions, is altered as a result of a fatigue-inducing exercise. Twenty-five subjects were required to elevate their arm against maximum resistance until they were no longer able to completely elevate their arm. Three-dimensional kinematics were measured using an electromagnetic tracking system. Electromyographic activity was recorded from the upper trapezius, lower trapezius, serratus anterior, and the middle deltoid muscles. Power frequency spectrum using the Fast Fourier Transform and the root mean square signal amplitudes were determined for each muscle. The scapulohumeral rhythm was determined using least squares regressions of humeral elevation to scapular upward rotation for 20% intervals (phases) of elevation for each subject. The results showed that during the midrange of elevation to maximum elevation [phases 3-5 (60-150 degrees)], the scapulohumeral rhythm decreased with fatigue, and that the decrease in the scapulohumeral rhythm was associated with myoelectric indicators of fatigue (median power frequency). The study suggests that shoulder fatigue affects the way in which the scapula moves concomitantly with the humerus. Fatigue tends to result in increased motion of the scapula, which alters the scapulohumeral rhythm.[volver]

Título en Inglés: Rehabilitation after subcutaneous transposition of the ulnar nerve: immediate versus delayed mobilization.

Autor/es: Weirich-SD; Gelberman-RH; Best-SA; Abrahamsson-SO; Furcolo-DC; Lins-RE

Lugar: Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, USA.

Fuente: J-Shoulder-Elbow-Surg. 1998 May-Jun; 7(3): 244-9

ISSN: 1058-2746

Idioma: ENGLISH

Resumen: We studied 36 patients who had clinical signs and symptoms consistent with cubital tunnel syndrome and in whom nonoperative management failed. These patients underwent anterior subcutaneous transposition of the ulnar nerve followed by either immediate (20 patients) or delayed (16 patients) mobilization. All patients were evaluated with an outcomes assessment questionnaire, and 35 of the 36 were given repeat physical examinations. After surgery, there were no significant differences between the two groups in pain relief, weakness, or patient satisfaction (71% of the immediate mobilization group and 74% of the delayed group) were satisfied. Secondary quantitative outcomes such as grip strength, lateral pinch, or two-point discrimination were also not significantly different between the groups. Both groups had a statistically significant improvement in first dorsal interosseous and adductor pollicis muscle strength. In the immediate mobilization group, however, patients returned to work and resumed activities of daily living earlier (median 1 month) than patients in the delayed mobilization group (median 2.75 months). Therefore, we conclude that anterior subcutaneous transposition provides a high degree of satisfaction and relief of symptoms regardless of when mobilization is initiated. However, immediately mobilizing the patient significantly influenced how early the patient returned to work and resumed activities of daily living.[volver]

Título en Inglés: Ipsi- or contralateral patellar tendon graft in anterior cruciate ligament revision surgery. A comparison of two methods.

Autor/es: Kartus-J; Stener-S; Lindahl-S; Eriksson-BI; Karlsson-J

Lugar: Department of Orthopaedics, Norra Alvsborgs Hospital, Goteborg, Sweden.

Fuente: Am-J-Sports-Med. 1998 Jul-Aug; 26(4): 499-504

ISSN: 0363-5465

Idioma: ENGLISH

Resumen: Twenty-four patients who underwent anterior cruciate ligament revision surgery were studied postoperatively (12 with reharvested ipsilateral patellar tendon grafts and 12 with contralateral patellar tendon grafts). For comparison purposes, 12 matched patients with primary anterior cruciate ligament reconstruction, who had been operated on using the same technique by the same surgeons, were chosen. The median time since the first reconstruction was 57 months (range, 15 to 132) in the ipsilateral tendon group and 54 months (range, 20 to 108) in the contralateral tendon group. Follow-up examination showed that there were no significant differences in total KT-1000 arthrometer side-to-side measurements between the groups, but the Lysholm score was higher for patients with contralateral tendon grafts than for patients with ipsilateral grafts. Only two patients with ipsilateral grafts were classified as having excellent or good results. Functional testing outcomes were similar for all groups, and magnetic resonance imaging screening showed no differences between the reharvest and primary harvest groups in terms of length, width, thickness, or donor site gap of the patellar tendon. However, there were two major complications in the group with revision surgery with the ipsilateral reharvested patellar tendon. Reharvesting the ipsilateral patellar tendon resulted in lower functional scores and a higher rate of complications than revision with the contralateral patellar tendon or primary anterior cruciate ligament reconstruction.[volver]

Título en Inglés: Preoperative physical therapy in primary total knee arthroplasty.

Autor/es: Rodgers-JA; Garvin-KL; Walker-CW; Morford-D; Urban-J; Bedard-J

Lugar: Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, USA.

Fuente: J-Arthroplasty. 1998 Jun; 13(4): 414-21

ISSN: 0883-5403

Idioma: ENGLISH

Resumen: In order to evaluate the efficacy of preoperative physical therapy for patients undergoing elective primary total knee arthroplasty, 10 patients completed 6 weeks of physical therapy before surgery (PT group). Ten patients served as controls (C group). Subjects were tested at baseline (PT only), before surgery, 6 weeks after surgery, and 3 months after surgery using the Hospital for Special Surgery knee rating scale, range of motion, thigh circumference, walking speed, Cybex II isokinetic knee flexion, and extension testing, and computed tomography scanning for cross-sectional muscle area. Hospital stay and need for physical therapy after inpatient rehabilitation were also compared. Physical therapy produced modest gains in isokinetic flexion strength in these severely arthritic knees but no difference in extension strength. The decrease in isokinetic strength after surgery was not affected by preoperative physical therapy. Muscle area did not decrease significantly for the PT group, but it did decrease for the C group after surgery. While postoperative strength differences could not be demonstrated, preoperative physical therapy preserved thigh muscle area after surgery. The clinical significance of this finding is uncertain. Consequently, this study failed to support the routine use of preoperative physical therapy in knee replacement surgery.[volver]

Título en Inglés: [The rehabilitation of elderly amputees]

Título Original: La reeducation des amputes ages.

Autor/es: Welraeds-D

Lugar: Centre de Traumatologie et de Readaptation, U.L.B.

Fuente: Rev-Med-Brux. 1998 Jun; 19(3): 125-9

ISSN: 0035-3639

Idioma: FRENCH; NON-ENGLISH

Resumen: Rehabilitation of elderly amputees raises several issues. Taking into account that amputations are frequently performed in elderly patients, with vascular diseases, it seems relevant to ask whether it is preferable to perform an amputation and quickly rehabilitate the patient or to attempt revascularisation and save the patient's limb. The knowledge of the outcome of amputation is crucial for the choice of treatment. Therefore, we discuss limb amputation in old patients in terms of epidemiology, aetiology, functional characteristics, specific problems and results with regards to expectations. Types and characteristics of prostheses, as well as rehabilitation and cost-effectiveness are briefly discussed. It is concluded that amputation is a mutilating procedure which carries for the elderly a poor outcome in terms of rehabilitation. Consequently any surgical procedure that may spare the limb should be preferred.[volver]

Título en Inglés: Adhesive capsulitis of the shoulder: an open study of 40 cases treated by joint distention during arthrography followed by an intraarticular corticosteroid injection and immediate physical therapy.

Autor/es: Laroche-M; Ighilahriz-O; Moulinier-L; Constantin-A; Cantagrel-A; Mazieres-B

Lugar: Rheumatology Department, Rangueil Teaching Hospital, Toulouse, France.

Fuente: Rev-Rhum-Engl-Ed. 1998 May; 65(5): 313-9

ISSN: 1169-8446

Idioma: ENGLISH

Resumen: OBJECTIVE: To evaluate the short- and long-term efficacy of joint distention during arthrography followed by an intraarticular corticosteroid injection then by high-intensity physical therapy and use of an abduction splint in an open study of 40 patients with adhesive capsulitis of the shoulder. METHODS: Patients were evaluated on D0, D5 (i.e., before discharge) and D30 for pain severity assessed using a four-point scale (0-3) and for passive ranges of abduction, internal rotation and external rotation of the shoulder. RESULTS: Mean pain severity improved significantly from 2.18 +/- 0.6 (mean +/- SD) on D0 to 1.74 +/- 0.5 on D5 (P: 0.01) and 0.92 +/- 0.5 on D30 (P: 0.02). Passive range of abduction increased significantly from 44.8 degrees +/- 1.54 degrees on D0 to 68 degrees +/- 15 degrees on D5 (P: 0.05), whereas the difference between D5 and D30 (71 degrees +/- 13 degrees) was not significant (P: 0.8). Similarly, passive range of external rotation increased significantly from 4.3 degrees +/- 0.6 degree on D0 to 13.5 degrees +/- 0.5 degree on D5 (P = 0.04) and showed a nonsignificant increase from D5 to D30 (17 degrees +/- 13 degrees, P: 0.2). CONCLUSION: Joint distention during arthrography followed by an intraarticular corticosteroid injection then by high-intensity physical therapy significantly improved pain and passive range of motion within the first five days, and these gains were sustained after one month.[volver]

Título en Inglés: The effect of joint mobilization as a component of comprehensive treatment for primary shoulder impingement syndrome.

Autor/es: Conroy-DE; Hayes-KW

Lugar: Northwestern University Medical School, Programs in Physical Therapy, Chicago, IL, USA.

Fuente: J-Orthop-Sports-Phys-Ther. 1998 Jul; 28(1): 3-14

ISSN: 0190-6011

Idioma: ENGLISH

Resumen: Primary shoulder impingement syndrome is a common shoulder problem which, if treated ineffectively, can lead to more serious pathology and expensive treatment. This study examined whether subjects receiving joint mobilization and comprehensive treatment (hot packs, active range of motion, physiologic stretching, muscle strengthening, soft tissue mobilization, and patient education) would have improved pain, mobility, and function compared with similar patients receiving comprehensive treatment alone. Subjects were eight men and six women (mean age = 52.9 years) with primary shoulder impingement syndrome (superolateral shoulder pain, decreased active humeral elevation, limited overhead function). Following random assignment to experimental (N = 7) and control groups (N = 7), three blinded evaluators tested 24-hour pain (visual analog scale), pain with subacromial compression test (visual analog scale), active range of motion (goniometry), and function (reaching forward, behind the head, and across the body in an overhead position) before and after nine treatments. One-tailed analyses of covariance (baseline values as covariates) showed that the experimental group had less 24-hour pain and pain with subacromial compression test but no differences in range of motion and function (Mann-Whitney U) compared with controls. The experimental group improved on all variables, while the control group improved only on mobility and function (one-tailed, paired t tests; Wilcoxon matched pairs). Age, side of dominance, duration of symptoms, treatment attendance, exercise quality, and adherence had no effect on the outcomes. Results may be affected by inadequate sample size, minimal capsular tightness, insensitive functional scale, nonspecific motion measurements, position at which mobilization treatment was given, or a strong effect of comprehensive treatment. Mobilization decreased 24-hour pain and pain with subacromial compression test in patients with primary shoulder impingement syndrome, but larger replication studies are needed to assess more clearly mobilization's influence on motion and function.[volver]

Título en Inglés: Postoperative rehabilitation following total shoulder arthroplasty.

Autor/es: Brown-DD; Friedman-RJ

Lugar: Department of Physical Therapy, Medical University of South Carolina, Charleston, USA.

Fuente: Orthop-Clin-North-Am. 1998 Jul; 29(3): 535-47

ISSN: 0030-5898

Idioma: ENGLISH

Resumen: It is essential that patients receive proper rehabilitation following a total shoulder arthroplasty. This should ideally include a preoperative visit that includes the specified therapist, patient, and primary caregiver. The rehabilitative process is an individual program, and the protocol described is suggested as a guide for the therapist. The order of the exercises listed is more important than the time at which they are started, with an emphasis on maximizing motion prior to aggressive strengthening.[volver]

Título en Inglés: Indications, technique, and results of shoulder arthroplasty in osteonecrosis.

Autor/es: Hattrup-SJ

Lugar: Department of Orthopedic Surgery, Mayo Clinic-Scottsdale, Arizona, USA.

Fuente: Orthop-Clin-North-Am. 1998 Jul; 29(3): 445-51

ISSN: 0030-5898

Idioma: ENGLISH

Resumen: The most common causes of osteonecrosis of the humeral head are steroid use and trauma. Corticosteroids produce osteonecrosis by alterations in fat metabolism, and trauma, by injury to the anterolateral ascending artery. The need for replacement surgery is influenced by stage and extent of the disease, as well as a history of trauma. Results of replacements are superior in steroid-induced osteonecrosis compared to posttraumatic osteonecrosis.[volver]

Título en Inglés: Scheuermann's kyphosis in adolescents and adults: diagnosis and management.

Autor/es: Tribus-CB

Lugar: Orthopaedic Surgery, University of Wisconsin Medical School, Madison, WI 53792, USA.

Fuente: J-Am-Acad-Orthop-Surg. 1998 Jan-Feb; 6(1): 36-43

ISSN: 1067-151X

Idioma: ENGLISH

Resumen: Scheuermann's thoracic kyphosis is a structural deformity classically characterized by anterior wedging of 5 degrees or more of three adjacent thoracic vertebral bodies. Secondary radiographic findings of Schmorl's nodes, endplate narrowing, and irregular endplates confirm the diagnosis. The etiology remains unclear. Adolescents typically present to medical attention because of cosmetic deformity; adults more commonly present because of increased pain. The indications for treatment are similar to those for other spinal deformities, namely, progression of the deformity, pain, neurologic compromise, and cosmesis. The adolescent with pain associated with Scheuermann's kyphosis usually responds to physical therapy and a short course of anti-inflammatory medications. Bracing has been shown to be effective in controlling a progressive curve in the adolescent patient. For the adult who presents with pain, the early mainstays of treatment are physical therapy, anti-inflammatory medications, and behavioral modification. In patients, either adolescent or adult, with a progressive deformity, refractory pain, or neurologic deficit, surgical correction of the deformity may be indicated. Surgical correction should not exceed 50% of the initial deformity. Distally, instrumentation should be extended beyond the end vertebral body to the first lordotic disk to prevent the development of distal junctional kyphosis.[volver]

Título en Inglés: Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis.

Autor/es: Alfredson-H; Pietila-T; Jonsson-P; Lorentzon-R

Lugar: Department of Orthopaedic Surgery, University Hospital of Northern Sweden, Umea, Sweden.

Fuente: Am-J-Sports-Med. 1998 May-Jun; 26(3): 360-6

ISSN: 0363-5465

Idioma: ENGLISH

Resumen: We prospectively studied the effect of heavy-load eccentric calf muscle training in 15 recreational athletes (12 men and 3 women; mean age, 44.3 +/- 7.0 years) who had the diagnosis of chronic Achilles tendinosis (degenerative changes) with a long duration of symptoms despite conventional nonsurgical treatment. Calf muscle strength and the amount of pain during activity (recorded on a visual analog scale) were measured before onset of training and after 12 weeks of eccentric training. At week 0, all patients had Achilles tendon pain not allowing running activity, and there was significantly lower eccentric and concentric calf muscle strength on the injured compared with the noninjured side. After the 12-week training period, all 15 patients were back at their preinjury levels with full running activity. There was a significant decrease in pain during activity, and the calf muscle strength on the injured side had increased significantly and did not differ significantly from that of the noninjured side. A comparison group of 15 recreational athletes with the same diagnosis and a long duration of symptoms had been treated conventionally, i.e., rest, nonsteroidal antiinflammatory drugs, changes of shoes or orthoses, physical therapy, and in all cases also with ordinary training programs. In no case was the conventional treatment successful, and all patients were ultimately treated surgically. Our treatment model with heavy-load eccentric calf muscle training has a very good short-term effect on athletes in their early forties.[volver]

Título en Inglés: Spinal complications in osteogenesis imperfecta: 47 patients 1-16 years of age.

Autor/es: Engelbert-RH; Gerver-WJ; Breslau-Siderius-LJ; van-der-Graaf-Y; Pruijs-HE; van-Doorne-JM; Beemer-FA; Helders-PJ

Lugar: Department of Pediatric Physical Therapy, University Hospital for Children and Youth, Wilhelmina Children's Hospital, Utrecht, The Netherlands.

Fuente: Acta-Orthop-Scand. 1998 Jun; 69(3): 283-6

ISSN: 0001-6470

Idioma: ENGLISH

Resumen: We examined in a cross-sectional study, 47 children (mean age 7.7 (1-16) years) with osteogenesis imperfecta (OI) to find the prevalence of spinal deformities and to correlate these observations with anthropometry. The associations between dentinogenesis imperfecta, joint hypermobility and spinal deformities were also studied. Disproportion in stature in OI type I and type IV was mainly caused by spinal involvement, as evidenced by a greater decrease in body height than in leg length. In OI type I, the decrease in sitting height was mainly caused by platyspondyly, whereas in OI types III and IV, it was also caused by progressive scoliosis and kyphosis. Scoliosis was present in 22 children, and pathological kyphosis in 18, mainly in the severe OI types. Basilar impression was observed in 10 children, mainly in type III. Children with dentinogenesis imperfecta seemed to be prone to develop scoliosis, pathological kyphosis and basilar impression. Children with generalized joint hypermobility were less prone to develop scoliosis and basilar impression. Our observations may contribute to a better understanding of the risk factors for progressive spinal deformities in OI.[volver]

Título en Inglés: Biochemistry and biomechanics of healing tendon: Part I. Effects of rigid plaster casts and functional casts.

Autor/es: Stehno-Bittel-L; Reddy-GK; Gum-S; Enwemeka-CS

Lugar: Department of Physical Therapy Education, University of Kansas Medical Center, Kansas City 66160-7601, USA.

Fuente: Med-Sci-Sports-Exerc. 1998 Jun; 30(6): 788-93

ISSN: 0195-9131

Idioma: ENGLISH

Resumen: PURPOSE: Traditional treatment of surgically repaired Achilles tendons includes complete immobilization of the joint in rigid casts for 6 to 8 wk. We tested the use of functional polyurethane casts as an alternative to rigid plaster casts after experimental tenotomy and repair of the rabbit Achilles tendon. METHODS: After repair the limbs of 15 experimental rabbits were immobilized in a functional polyurethane cast for 15 d, while those of 14 controls were immobilized in traditional rigid plaster casts for the same period. RESULTS: Functional casting resulted in a 60% increase in total collagen in the neotendon compared with that in rigid casting (P < 0.05). Mature collagen cross-links declined 8% in the tendons with functional casts. The biomechanical parameters of the tendons changed with functional casting, showing a 20% increase in maximum load and 21% increase in maximum stress. CONCLUSIONS: These changes were noted without any cases of tendon re-rupture in either type of cast. Thus, functional casting following surgery of Achilles tendons appears to improve healing without significant risks of re-rupture.[volver]

Título en Inglés: Biochemistry and biomechanics of healing tendon: Part II. Effects of combined laser therapy and electrical stimulation.

Autor/es: Reddy-GK; Gum-S; Stehno-Bittel-L; Enwemeka-CS

Lugar: Department of Physical Therapy, University of Kansas Medical Center, Kansas City 66160-7601, USA.

Fuente: Med-Sci-Sports-Exerc. 1998 Jun; 30(6): 794-800

ISSN: 0195-9131

Idioma: ENGLISH

Resumen: PURPOSE: In previous studies we demonstrated that early mechanical loading and laser photo-stimulation independently promoted tendon healing. Thus, we tested the hypothesis that a combination of laser phototherapy and mechanical load would further accelerate healing of experimentally tenotomized and repaired rabbit Achilles tendons. METHODS: Following surgical tenotomy and repair, the tendons of experimental and control rabbits were immobilized in polyurethane casts for 5 d. The repaired tendons of experimental rabbits received mechanical load via electrical stimulation-induced contraction of the triceps surae for 5 d. In addition, experimental tendons were treated with daily doses of 1 J.cm-2 low intensity helium-neon laser throughout the 14-d experimental period. RESULTS: The combination of laser photostimulation and mechanical load increased the maximal stress, maximal strain, and Young's modulus of elasticity of the tendons 30, 13, and 33%, respectively. However, MANOVA revealed no statistically significant differences in these biomechanical indices of repair of control and experimental tendons. Biochemical assays showed a 32% increase in collagen levels (P < 0.05) and an 11% decrease in mature cross-links in experimental tendons compared with that in controls (P > 0.05). Electron microscopy and computer morphometry revealed no significant differences in the morphometry of the collagen fibers and no visible differences in the ultrastructure of cellular and matrical components of control and experimental tendons. CONCLUSIONS: These findings indicate that the combination of laser photostimulation and early mechanical loading of tendons increased collagen production, with marginal biomechanical effects on repaired tendons.[volver]

Título en Inglés: Continuous passive motion after repair of the rotator cuff. A prospective outcome study.

Autor/es: Lastayo-PC; Wright-T; Jaffe-R; Hartzel-J

Lugar: Department of Orthopaedics, University of Florida, Gainesville 32610, USA.

Fuente: J-Bone-Joint-Surg-Am. 1998 Jul; 80(7): 1002-11

ISSN: 0021-9355

Idioma: ENGLISH

Resumen: Despite the apparent success of continuous passive motion after soft-tissue procedures or joint replacements, its effect after repair of the rotator cuff is still unknown. The purpose of this prospective, randomized outcome study was to compare the results of continuous passive motion with those of manual passive range-of-motion exercises after repair of the rotator cuff. Thirty-one patients (thirty-two rotator cuffs) were randomly assigned to one of two types of postoperative management: continuous passive motion (seventeen patients) or manual passive range-of-motion exercises (fifteen patients). There were seventeen women and fourteen men, and the mean age was sixty-three years (range, thirty to eighty years). The patients were followed for a mean of twenty-two months (range, six to forty-five months). Five tears of the rotator cuff were small, eighteen were medium, and nine were large. All of the operations were performed by one surgeon. The patients who were managed with continuous passive motion used the device for the first four weeks postoperatively. The patients who were managed with manual passive range-of-motion exercises were assisted by a trained relative, friend, or home-care nurse. After the four-week period, the two groups were managed similarly for two to five months. According to the Shoulder Pain and Disability Index, a valid and reliable self-administered questionnaire, the treatment was extremely successful in both groups. The overall score was excellent for twenty-seven shoulders (84 per cent), good for two (6 per cent), fair for two (7 per cent), and poor for one (3 per cent). With the numbers available, we could detect no significant differences (p > 0.05) between the two groups with respect to the score according to the Index, pain (according to a visual-analog scale), range of motion, or isometric strength. Manual passive range-of-motion exercises were more cost-effective than continuous passive motion. The limited number of physical-therapy visits associated with the manual passive range-of-motion exercises in the present study appeared to be more cost-effective than a traditional physical-therapy schedule of three visits per week. Postoperative therapy with continuous passive motion or manual passive range-of-motion exercises appears to yield favorable results after repair of a small, medium, or large tear of the rotator cuff.[volver]

Título en Inglés: [Treatment of shoulder dislocation and the prevention of its recurrence]

Título Original: Traitement de la luxation d'epaule et prevention de la recidive.

Autor/es: Carlier-C; Pauwels-P; Putz-P

Lugar: Service de Chirurgie Orthopedique, C.H.U. Brugmann, U.L.B.

Fuente: Rev-Med-Brux. 1998 Feb; 19(1): 17-9

ISSN: 0035-3639

Idioma: FRENCH; NON-ENGLISH

Resumen: Shoulder dislocation is a frequent pathology with a high level of recurrences especially in young patients. One week immobilization in a Dessault dressing is sufficient if it is followed by free mobilization avoiding external rotation and abduction. A 6 weeks rehabilitation program seems to prevent recurrences.[volver]

Título en Inglés: Frozen shoulder syndrome: diagnostic and treatment strategies in the primary care setting.

Autor/es: Pearsall-AW; Speer-KP

Lugar: Department of Orthopaedic Surgery, University of South Alabama, Mobile 36617, USA.

Fuente: Med-Sci-Sports-Exerc. 1998 Apr; 30(4 Suppl): S33-9

ISSN: 0195-9131

Idioma: ENGLISH

Resumen: The term "frozen shoulder" has been used to describe an array of clinical conditions. The authors consider a patient as meeting the criteria of primary or secondary frozen shoulder syndrome if he/she has a clinical history of worsening painful shoulder motion loss of at least 1 month duration and a physical examination documenting painful restricted shoulder motion. In the evaluation of the patient with suspected FSS, initial screening shoulder radiographs are required to exclude other conditions. The physical examination of the frozen shoulder patient should include observation, cervical examination, assessment of range of motion, and the use of provocative testing. The treatment of the patient with FSS should include preventative education, various medications including NSAIDS and oral corticosteroids, physical therapy, and finally, for the patient with refractory symptoms, surgical intervention. For those patients necessitating surgical intervention, the authors recommend a selective arthroscopic capsular release.[volver]

Título en Inglés: Differential diagnosis of the hip vs. lumbar spine: five case reports.

Autor/es: Greenwood-MJ; Erhard-RE; Jones-DL

Lugar: School of Health and Rehabilitation Sciences, Department of Physical Therapy, University of Pittsburgh, PA, USA.

Fuente: J-Orthop-Sports-Phys-Ther. 1998 Apr; 27(4): 308-15

ISSN: 0190-6011

Idioma: ENGLISH

Resumen: With recent health care policy changes and the implementation of direct access in many states, physical therapists must be able to identify pathology that is beyond their scope of practice. The five case reports presented in this series required the differential diagnosis of hip vs. lumbar spine pathology. All of the cases required a referral from the physical therapist to either the patient's physician or a specialist because of abnormal screening test results. Each referral resulted in a new diagnosis of pathology that was beyond the scope of physical therapy. Cyriax's concepts of capsular and noncapsular patterns of joint restriction and the "Sign of the Buttock" proved useful in differentiating between hip and lumbar spine pathology in each patient. Our clinical experience indicates that utilizing the presence/absence of a capsular pattern and a "Sign of the Buttock" to screen out hip pathology in patients may be effective; however, further research is needed to support these claims.[volver]

Título en Inglés: The use of a back class teaching extension exercises in the treatment of acute low back pain in primary care.

Autor/es: Underwood-MR; Morgan-J

Lugar: Centre for Primary Care, Department of Postgraduate Medicine, University of Keele, UK.

Fuente: Fam-Pract. 1998 Feb; 15(1): 9-15

ISSN: 0263-2136

Idioma: ENGLISH

Resumen: BACKGROUND: Back extension exercises are commonly recommended to treat acute low back pain. Evidence of their beneficial effect is, however, weak. OBJECTIVES: We aimed to demonstrate a benefit of teaching back extension exercises in addition to usual GP care for acute low back pain. METHODS: Patients with acute simple low back pain of less than 28 days duration, presenting to a GP, were randomized either to attend a back class or to receive conventional management. Outcome was measured using changes in the Oswestry disability score and visual analogue pain scale (VAS) on six occasions during 1 year and also a VAS and patient assessment of degree of disability during the previous 6 months at 1 year. RESULTS: Seventy-five patients were recruited. The principal outcome measures showed no difference between the two groups. The treatment group reported less chronic disability at 1 year (50% versus 14%, P < 0.007). CONCLUSIONS: A treatment effect has not been demonstrated, but some patients who would otherwise have reported mild pain were pain free after 1 year. This approach to treating back pain has not been shown to be effective. More much larger studies, with more intensive treatment, are required in order to decide whether physical therapy in primary care is beneficial as treatment for acute back pain.[volver]

Título en Inglés: Home or supervised rehabilitation following anterior cruciate ligament reconstruction: a randomized controlled trial.

Autor/es: Beard-DJ; Dodd-CA

Lugar: School of Physiotherapy, Faculty of Health Sciences, University of Sydney, NSW, Australia.

Fuente: J-Orthop-Sports-Phys-Ther. 1998 Feb; 27(2): 134-43

ISSN: 0190-6011

Idioma: ENGLISH

Resumen: Rehabilitation following anterior cruciate ligament (ACL) reconstruction is varied. Patients are usually prescribed an independent home exercise program, although some patients may attend physical therapy for additional supervised exercise. It is not known whether additional supervised exercise provides any further benefit. The purpose of this study was to compare efficacy for two types of rehabilitation following ACL reconstruction. A randomized controlled trial of 31 ACL-reconstructed patients was used to test the hypothesis that a home program plus supervised rehabilitation (Group S) is more effective than a home program (Group H) alone. Function, activity level, anterior tibial translation, and muscle strength were measured preoperatively and at 3 and 6 months postoperatively. Improvement of function, activity level, muscle strength, and anterior tibial translation was evident in both groups, but no significant differences were found between groups even though the sample size was sufficient to detect small treatment effects. It was concluded that supervised exercise, in addition to a home program, has minimal extra benefit for patients who have undergone ACL reconstruction.[volver]

Título en Inglés: The effect of injury chronicity and progressive rehabilitation on single-incision arthroscopic anterior cruciate ligament reconstruction.

Autor/es: Larkin-JJ; Barber-Westin-SD

Lugar: Cincinnati Sportsmedicine and Orthopaedic Center, Ohio, USA.

Fuente: Arthroscopy. 1998 Jan-Feb; 14(1): 15-22

ISSN: 0749-8063

Idioma: ENGLISH

Resumen: We conducted a prospective study on 50 consecutive patients who received a single-incision arthroscopic patellar tendon autograft reconstruction for anterior cruciate ligament (ACL) rupture. The purposes were to determine if differences existed in results between patients with acute and chronic ACL ruptures, and if a progressive rehabilitation program could safely return patients to sports activities early without compromising knee stability. Forty-two patients (84%) returned for follow-up a mean of 31 months postoperatively. Twenty-one patients had acute ruptures, and 21, chronic ruptures. A progressive rehabilitation program was used by 28 patients (67%) who met strict criteria, which allowed early return to running and sports activities. The results were rated with the Cincinnati Knee Rating System. We found no effect of either injury chronicity or time to return to activity for 21 factors, including anterior-posterior displacement, patellofemoral crepitus, range of knee motion, quadriceps muscle strength, symptoms, functional limitations, or the patient rating of outcome. Using arthrometer and pivot-shift test data, 30 knees (71%) had a functional reconstruction; 8 knees (19%) had partial function; and 4 knees (10%) failed. Patients expressed satisfaction with the operation as follows: 23 (55%) rated their overall knee condition as normal; 16 (38%), very good; and 3 (7%), good. No patients rated their knee condition as fair or poor.[volver]