Effect of physical therapy intervention on thickness and ratio of the sternocleidomastoid muscle and head rotation angle in infants with congenital muscular torticollis: A randomized clinical trial (CONSORT).

BACKGROUND: Early diagnosis as well as treatment is important in management of congenital muscular torticollis (CMT). The purpose of this study was to find an effective physical therapy modality to improve the sternocleidomastoid (SCM) muscle thickness, the ratio of the SCM muscle thickness on the affected side to that on the non-affected side (A/N ratio), and head rotation in infant under 3 months of age diagnosed with CMT. METHODS AND ANALYSIS: A single-blind, randomized clinical trial was conducted. Participants were assigned in one of the 3 study groups through randomization. The treatment was performed 3 times a week for 30 minutes until the head tilt was ≤5 degrees. Group 1 was treated by handling for active or active-assist movement, group 2 was treated with passive stretching, and group 3 was treated with thermotherapy. For general characteristics, a χ2 test and 1-way analysis of variance were used. Intragroup differences were analyzed using a paired t test, and intergroup differences were analyzed using an age-adjusted analysis of covariance. RESULTS: After the intervention, there was no significant difference between groups in terms of SCM thickness on the affected side and A/N ratio (P > .05). Degree of head rotation on the affected side showed significant differences between groups (P < .05), with Group 2 showing significantly better results than group 1 and group 3 (P < .05, both). CONCLUSION: Passive stretching treatment was more effective than other treatments of this study for improvement in degree of head rotation in CMT infants under 3 months of age. TRIAL REGISTRATION: The trial is registered at the Institutional Review Board of Sahmyook University (IRB number, 2-7001793-AB-N-012019103HR) and the Clinical Research Information Service (CRiS; registry number, KCT0004862).

The association between changes in pressure pain sensitivity and changes in cardiovascular physiological factors associated with persistent stress.

OBJECTIVES: To evaluate the possible association between pressure pain sensitivity of the chest bone (PPS) and cardiovascular physiological factors related to persistent stress in connection with a three-month PPS-guided stress-reducing experimental intervention programme. METHODS: Forty-two office workers with an elevated PPS (≥ 60 arbitrary units) as a sign of increased level of persistent stress, completed a single-blinded cluster randomized controlled trial. The active treatment was a PPS (self-measurement)-guided stress management programme. Primary endpoints: Blood pressure (BP), heart rate (HR) and work of the heart measured as Pressure-Rate-Product (PRP); Secondary endpoints: Other features of the metabolic syndrome. RESULTS: PPS decreased and changes in PPS after the intervention period were significantly associated with HR, PRP, body mass index (BMI) and visceral fat index (all correlation coefficients > 0.2, p < 0.05). Compared to the control cluster group, the active cluster group obtained a significant reduction in PPS, Low-density lipoprotein (LDL) cholesterol and total number of elevated risk factors (p < 0.05). On an individual level, significant and clinically relevant between-group reductions were observed in respect to BP, HR, PRP, total and LDL cholesterol, and total number of elevated risk factors (p < 0.05). CONCLUSIONS: The stress intervention method applied in this study induced a decrease in PPS which was associated with a clinically relevant decrease in resting blood pressure, heart rate, work of the heart and serum cholesterols.

Semiología de la mama / Semiology of the breast

En la anamnesis se destacan algunos datos de importancia tales como edad, antecedentes ginecoobstétricos y en especial la edad al momento del primer parto y los antecedentes familiares de carcinoma mamario. Con respecto a los síntomas y signos de mayor frecuencia y envergadura, se detallan los siguientes: a) dolor cuyas principales características y posibles interpretaciones se discuten. b) tumor, considerado primero con síntoma al ser detectado por la paciente y en relación al cual se investiga el tiempode evolución, el ritmo de crecimiento, su asociación a dolor y la forma en que fue descubierto. Posteriormente se enfoca como signo cuya descripción debe consignarse tamaño, forma, límites, ubicación, consistencia y movilidad o adherencia a planos vecinos. c) descarga por el pezón abordada también desde el punto de vista anamnéstico, registrando su calidad, espontaneidad, tiempo de evolución y buscándola en el exámen físico , para precisar su tipo, número de conductos que secretan, uni o bilateralidad, facilidad con que escurre. Se describen las lesiones que con mayor frecuencia producen derrame y sus características habituales según tipo de lesión que los produce. Se discuten las posibilidades de malignidad de acuerdo al tipo de descarga. En forma breve se analizan también otros motivos de consulta tales como malformaciones, masa axilares, alteraciones cutáneas, etc. Se describe la manera correcta de realizar una anamnesis y un examen físico completo con inspección y palpación de la mama y de las regiones ganglionares accequibles. Sólo después de cumplida esta primera etapa que remata en la formulación de una hipótesis diagnóstica bien fundada, se está autorizado para solicitar exámenes complementarios adecuados, oportunos y bien seleccionados que confirmen o descarten la existencia de una patología mamaria y en el caso del carcinoma, que permitan conocer su grado de extensión

[Functional anatomy of shoulder-arm pain (author's transl)]. / Funktionelle anatomie des Schulter-Arm-Schmerzes.

The treatment of pains felt in the shoulder-arm region depends on the pathogenesis of the individual case. For this reason the functional anatomical conditions which can cause pain in various diseases are first described. This is followed by a presentation of the pathophysiological mechanisms of the causation of pain. The shoulder girdle is a functional skeletal motor unit which includes joints and muscles of the arm, neck and trunk. Disturbances of one structural element of the shoulder girdle are reflected as muscular distortion of the entire shoulder girdle and possibly also of the neighboring parts of the body communicating with the shoulder girdle. Shoulder-arm pain can arise in principle from two different sources: stimulation of pain receptors (receptor pain, physiological excitation of pain) and by functional disturbance of pain conducting and pain producing neuronal structures.