Acupotomy treatment for finger joint contracture after immobilization: Case report.

INTRODUCTION: Contractures frequently occur in the finger joints after immobilization. This report describes the effect of acupotomy treatment in patients with joint contracture due to immobilization of the finger joints. PATIENT CONCERNS AND CLINICAL FINDINGS: Case 1 was of a 39-year-old male patient who had flexion limitation of the left thumb and difficulty in grasping. Case 2 was of a 41-year-old female patient who had flexion limitation of the right index finger and difficulty in typing. Stiffness occurred after tendon repair surgery and cast immobilization in both cases. In Case 1, the patient had limited flexion movement of the first metacarpophalangeal and interphalangeal joints after 5 weeks of immobilization of the left thumb in a cast. In Case 2, the patient had limited flexion movement after 3 weeks of immobilization of the second proximal interphalangeal joint of the left hand in a cast. DIAGNOSIS, INTERVENTIONS, AND OUTCOMES: We diagnosed both patients with finger joint contracture due to immobilization. Conservative treatment for approximately 4 weeks did not lead to improvement in either patient. Acupotomy is the key treatment for improving movement in Korean Medicine. Therefore, acupotomy was performed, and joint stiffness markedly improved without adverse events. Both patients reported that the daily use of the damaged fingers became comfortable. CONCLUSION: We found that acupotomy may be effective for finger joint contracture due to improper immobilization. We suggest it as a simple and safe treatment for joint contracture.

Stretching After Heat But Not After Cold Decreases Contractures After Spinal Cord Injury in Rats.

BACKGROUND: Contractures are a prevalent and potentially severe complication in patients with neurologic disorders. Although heat, cold, and stretching are commonly used for treatment of contractures and/or spasticity (the cause of many contractures), the sequential effects of these modalities remain unclear. QUESTIONS/PURPOSES: Using an established rat model with spinal cord injury with knee flexion contracture, we sought to determine what combination of heat or cold before stretching is the most effective for treatment of contractures derived from spastic paralyses and investigated which treatment leads to the best (1) improvement in the loss of ROM; (2) restoration of deterioration in the muscular and articular factors responsible for contractures; and (3) amelioration of histopathologic features such as muscular fibrosis in biceps femoris and shortening of the joint capsule. METHODS: Forty-two adolescent male Wistar rats were used. After spasticity developed at 2 weeks postinjury, each animal with spinal cord injury underwent the treatment protocol daily for 1 week. Knee extension ROM was measured with a goniometer by two examiners blinded to each other's scores. The muscular and articular factors contributing to contractures were calculated by measuring ROM before and after the myotomies. We quantitatively measured the muscular fibrosis and the synovial intima length, and observed the distribution of collagen of skeletal muscle. The results were confirmed by a blinded observer. RESULTS: The ROM of heat alone (34° ± 1°) and cold alone (34° ± 2°) rats were not different with the numbers available from that of rats with spinal cord injury (35° ± 2°) (p = 0.92 and 0.89, respectively). Stretching after heat (24° ± 1°) was more effective than stretching alone (27° ± 3°) at increasing ROM (p < 0.001). Contrastingly, there was no difference between stretching after cold (25° ± 1°) and stretching alone (p = 0.352). Stretching after heat was the most effective for percentage improvement of muscular (29%) and articular (50%) factors of contractures. Although quantification of muscular fibrosis in the rats with spinal cord injury (11% ± 1%) was higher than that of controls (9% ± 0.4%) (p = 0.01), no difference was found between spinal cord injury and each treatment protocol. The total synovial intima length of rats with spinal cord injury (5.9 ± 0.2 mm) became shorter than those of the controls (7.6 ± 0.2 mm) (p < 0.001), and those of stretching alone (6.9 ± 0.4 mm), stretching after heat (7.1 ± 0.3 mm), and stretching after cold (6.7 ± 0.4 mm) increased compared with rats with spinal cord injury (p = 0.01, p = 0.001, and p = 0.04, respectively). The staining intensity and pattern of collagen showed no difference among the treatment protocols. CONCLUSIONS: This animal study implies that heat or cold alone is ineffective, and that stretching is helpful for the correction of contractures after spinal cord injury. In addition, we provide evidence that heat is more beneficial than cold to increase the effectiveness of stretching. CLINICAL RELEVANCE: Our findings tend to support the idea that stretching after heat can improve the loss of ROM and histopathologic features of joint tissues. However, further studies are warranted to determine if our findings are clinically applicable.

Técnica de dog en extensión bilateral aplicada en una dorsalgia aguda: a propósito de un caso / No disponible

Objetivo: Describir las principales características de aplicación de la técnica de dog en extensión bilateral (TDEB), la cual puede ser utilizada para la reducción de lesiones grupales de flexión bilateral, utilizada para el tratamiento de un paciente con dorsalgia aguda. Material y Métodos: Aplicamos un protocolo de evaluación osteopático en una paciente de 35 años, por un cuadro de dorsalgia aguda, valorada mediante pruebas ortopédicas, de inspección, palpación, movilización global y analítica. Aplicamos como tratamiento la TDEB sobre el segmento en lesión. Resultados: Los resultados obtenidos han sido favorables, dado que se ha restablecido la movilidad, tanto a nivel global como segmentario, y se ha atenuado el dolor percibido por la paciente tras la aplicación de la TDEB. Conclusiones: Una correcta restructuración de la movilidad de los segmentos hipomóviles devuelve la función a los mismos, y produce efectos clínicos favorables, mejorando el estado de salud del paciente (AU)

No disponible

Effect of anesthetizing individual compartments of the stifle joint in horses with experimentally induced stifle joint lameness.

OBJECTIVE: To evaluate the effects of sequential anesthesia of the individual compartments of the equine stifle joint on lameness induced by intra-articular deposition of interleukin (IL)-1ß. ANIMALS: 6 horses. PROCEDURES: For each horse, baseline hind limb lameness was first evaluated. A randomly selected compartment of 1 stifle joint was then injected with IL-1ß to induce synovitis and lameness; subsequently, the same compartment was anesthetized with 2% mepivacaine hydrochloride, and lameness was reevaluated. Two weeks later, baseline lameness was evaluated, and lameness was similarly induced; thereafter, the 2 synovial compartments of the stifle joint not injected with IL-1ß were anesthetized sequentially in random order (ie, first and second blocks); lameness was evaluated after each block. Finally, the IL-1ß-treated compartment was anesthetized (third block); lameness was again evaluated. This second experiment was repeated for the contralateral stifle joint 2 weeks later. Throughout the study, lameness was quantified objectively by assessing vertical pelvic movement asymmetry with a wireless, inertial sensor-based system. RESULTS: Intra-articular deposition of IL-1ß induced lameness in all injected limbs. In the first experiment, anesthesia of the compartment injected with IL-1ß resulted in a significant decrease in lameness, with vertical pelvic movement asymmetry approaching baseline. In the second experiment, lameness improved significantly after the second and third blocks and was almost completely abolished after all 3 synovial compartments were anesthetized. CONCLUSIONS AND CLINICAL RELEVANCE: In horses, lameness caused by a lesion in 1 compartment of a stifle joint can be improved more by instillation of local anesthetic solution into that compartment than by anesthesia of the other compartments.

Técnica de dog en extensión bilateral / Dog technique in bilateral extension

La técnica de Dog en Extensión Bilateral (TDEB) es un procedimiento de tratamiento osteopático estructural, donde se realiza una fuerza de empuje controlado (thrust) sobre el paciente, con el objetivo de restaurar la fisiología articular de los segmentos vertebrales con movilidad restringida, para influir sobre los reflejos nociceptivos, y reducir o eliminar el dolor y la facilitación medular asociada. Aunque es considerada una técnica osteopática estructural, tiene gran importancia en el área visceral, puesto que, a través de los ganglios ortosimpáticos laterovertebrales del sistema nervioso vegetativo, que se sitúan próximos a los cuerpos vertebrales, se inician procesos de estimulación a distancia sobre sus órganos diana. Por ello, la aplicación de este procedimiento de manipulación consigue, no sólo estimular mecánicamente los segmentos vertebrales mediante el deslizamiento de sus carillas articulares, sino también inducir un estímulo ortosimpático visceral. Esta técnica tiene riesgos asociados que deberían conocerse y evitarse, y su eficacia ha sido demostrada, por lo que se recomienda su aplicación en los casos que presenten indicaciones para ello (AU)

The Bilateral Extension Dog technique (BEDT) is a structural osteopathic treatment procedure, where a thrust force is exerted on the patient, with the objective of restoring the joint physiology of the vertebral segments with restricted mobility, to Influence nociceptive reflexes, and reduce or eliminate pain and associated spinal cord facilitation. Although it is considered a structural osteopathic technique, it has great importance in the visceral area, since, through the laterovertebral orthosympathetic ganglia of the vegetative nervous system, which are placed close to the vertebral bodies, processes of remote stimulation are initiated on the target organs. Therefore, the application of this manipulation procedure not only mechanically stimulates the vertebral segments by sliding the joint facets, but also induces a visceral orthosympathetic stimulus. This technique has associated risks that should be known and avoided, and its efficacy has been demonstrated, so it is recommended to apply in cases that have indications for it (AU)

Immediate effect of thermal capsulorrhaphy on glenohumeral joint mobility.

OBJECTIVES: To evaluate the effects of anterior thermal capsulorrhaphy of the glenohumeral joint by monitoring changes of magnitudes of the anterior and posterior displacements of the humeral head and ranges of motion of abduction and rotation in fresh cadaver shoulders. DESIGN: Single session repeated-measures design. BACKGROUND: Following thermal shrinkage anterior and posterior displacements of the head of humerus were decreased. However, no studies were focused on the ranges of motion of abduction and rotation of the shoulder joint immediately. The mobility of abduction and rotation are also important indexes for glenohumeral function. METHODS AND MEASURES: Nine fresh frozen shoulder specimens were used. The dorsal and ventral displacements of humeral head and ranges of motion of abduction and rotation of glenohumeral joint before and after thermal capsulorrhaphy were performed and monitored. Changes after thermal treatment in these linear and angular displacement variables were calculated as outcome measures. RESULTS: After anterior thermal capsulorrhaphy, significant (P < 0.001) decreases were found in displacements (-1.80 mm in dorsal direction and -1.24 mm in ventral direction), rotation range of motion (-3.93 degrees in lateral rotation and -2.60 degrees in medial rotation), and abduction range of motion (-3.15 degrees ). CONCLUSIONS: The results from cadaveric experiments showed that anterior thermal capsulorrhaphy immediately reduced the dorsal and ventral displacements and ranges of abduction and rotation of glenohumeral joint by a small amount. RELEVANCE: Radiofrequency electrosurgical system combined with arthroscopy has the potential to decrease the translations of the humeral head as well as the rotational range of motion of the glenohumeral joint.

A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders.

We investigated if low level laser therapy (LLLT) of the joint capsule can reduce pain in chronic joint disorders. A literature search identified 88 randomised controlled trials, of which 20 trials included patients with chronic joint disorders. Six trials were excluded for not irradiating the joint capsule. Three trials used doses lower than a dose range nominated a priori for reducing inflammation in the joint capsule. These trials found no significant difference between active and placebo treatments. The remaining 11 trials including 565 patients were of acceptable methodological quality with an average PEDro score of 6.9 (range 5-9). In these trials, LLLT within the suggested dose range was administered to the knee, temporomandibular or zygapophyseal joints. The results showed a mean weighted difference in change of pain on VAS of 29.8 mm (95% CI, 18.9 to 40.7) in favour of the active LLLT groups. Global health status improved for more patients in the active LLLT groups ( relative risk of 0.52; 95% CI 0.36 to 0.76). Low level laser therapy with the suggested dose range significantly reduces pain and improves health status in chronic joint disorders, but the heterogeneity in patient samples, treatment procedures and trial design calls for cautious interpretation of the results.

Sensory properties of articular afferents following Mycoplasma arthritis in the chicken.

The physiological properties of joint capsule mechanical nociceptors of monoarthritic chickens (Gallus domesticus) were studied by recording the electrical activity from single C (Group IV) and A-delta (Group III) fibres dissected from the parafibular nerve. By injecting live Mycoplasma gallisepticum cultures into the ankle joint a typical mycoplasma arthritis was induced which was restricted to a single joint. During the early stage of the disease (7-21 days after infection) there was histopathological evidence of an acute synovitis and the fibres showed evidence of sensitisation. Sensitisation was observed in the significantly increased receptive field size, decreased response thresholds, increased response to joint movement both noxious and innocuous, but only in the C-fibres was there an increase in spontaneous activity. During the more chronic stage of the disease (49-56 days after infection) there was pathological evidence of prolonged synovitis but the sensory fibres responded normally to mechanical stimulation and joint movement. These changes in sensitivity of the joint capsule mechanical nociceptors provides peripheral neural evidence of possible pain experienced during the acute stage of the disease but not at the chronic stage when the disease might be in period of remission. The absence of any clear correlation between pathology and receptor activity demonstrates the difficulty of trying to predict nociceptive consequences in animals on the basis of histopathology.

[Sinusoidal modulated currents alone and in combination with carbon dioxide-hydrogen sulfide baths in juvenile rheumatoid arthritis]. / Sinusoidal'nye modulirovannye toki i ikh sochetanie s uglekislo-serovodorodnymi vannami pri iuvenil'nom revmatoidnom artrite.

The exposure of the thymus and articular fissure of the most affected joint to sinusoidal modulated currents proved more effective than only joint exposure. Adjuvant carbon dioxide-sulfurated hydrogen baths add to therapeutic effect of the currents.

Thermal capsular shrinkage for shoulder instability. Mid-term longitudinal outcome study.

We present the short- and medium-term clinical results of thermal shrinkage in selected groups of patients with multidirectional or capsular stretch-type instability. We treated 56 patients (61 shoulders) by laser-assisted capsular shrinkage (LACS) and 34 patients (38 shoulders) by radiofrequency (RF) capsular shrinkage. The two groups were followed for mean periods of 40 months and 23 months, respectively. In the LACS group the mean Walch-Duplay score improved to 90 points 18 months after the operation, but then declined to a plateau of about 80 points; 59% of patients considered their shoulders to be 'much better' or 'better' but there was a failure rate of 36.1%. For the RF group the mean Walch-Duplay and Constant scores were 80 points at the various follow-up times; 76.3% of patients considered their shoulder to be 'much better' or 'better'. RF failed in nine shoulders (23.7%). These results match some clinical series of patients with multidirectional instability, undergoing open inferior capsular shift, with a similar rate of failure. We believe that the minimal morbidity involved makes thermal shrinkage a viable alternative to open capsular shift in this difficult group of patients.

Chiropractic management of capsulitis and synovitis of the temporomandibular joint.

Localized inflammatory conditions (eg, synovitis and capsulitis) of the temporomandibular joint are commonly seen in clinical practice. Regardless of their frequency of occurrence, these conditions must be differentially diagnosed from conditions that also may cause pain in the temporomandibular joint region. Capsulitis or synovitis should be considered if such pain is present and historical, physical, and laboratory findings do not indicate a referred pain phenomena or systemic, tumorous, or infectious involvement. This article reviews the clinical characteristics, etiology, physical examination methods, treatment, and prognosis for capsulitis and synovitis, and three cases that illustrate these conditions are reported.