Curso Temporal de los Efectos Agudos de una Sesión de Estiramiento Muscular en Sujetos Jóvenes y Sanos / Time Course of the Acute Effects of a Muscle Stretching Session in Young and Healthy Subjects

Introducción. La duración de los efectos agudos del estiramiento muscular y su relación con el volumen total de estiramiento es un tema controversial. Método. Se distribuyeron aleatoriamente 29 varones jóvenes y deportistas en tres grupos: Control, "protocolo corto" (5 estiramientos x 30' segundos) y "protocolo largo" (10 estiramientos x 30 segundos). Para medir el efecto se usó el Active Knee Extension Test en forma previa y posterior a los 0, 3, 7, 12, 18 y 25 minutos. Cada medición se grabó en video, y se identificó el rango máximo de estiramiento con el software Kinovea. Se realizó comparación pre y postintervención entre grupos e inter grupo. Se incorporó análisis post hoc en medidas repetidas. Resultados. No hubo diferencias en la medición preintervención entre los grupos (P=0,266). Ambos protocolos tuvieron cambios significativos (P<0,007) respecto del grupo control (P=0,65). Todas las mediciones postintervención comparadas con la preintervención presentan diferencias en el protocolo corto (P≤0,018) y largo (P≤0,009). Hubo diferencia entre el grupo control con el de protocolo corto (P≤0,014) y control con protocolo largo (P≤0,004) para todas las mediciones, y una diferencia entre ambos protocolos en el post inmediato (P=0,033) pero no para las mediciones posteriores (P≤0,139). Conclusión. Un protocolo de 150 segundos de estiramiento estático en isquiotibiales en varones asintomáticos jóvenes, presenta efectos por al menos 25 minutos. Al duplicar a 300 segundos sólo presenta diferencia en la medición inmediatamente posterior. Por lo tanto, ambos protocolos son igualmente efectivos, pero el protocolo corto es más eficiente.

Background. The duration of the acute effects of muscle stretching and its relationship with the total volume of stretching is a controversial issue. Methods. 29 young male athletes were randomly distributed into three groups: control, "short protocol" (5 stretches x 30'') and "long protocol" (10 stretches x 30''). To measure the effect, the Active Knee Extension Test was used before and after 0, 3', 7', 12', 18' and 25'. Each measurement was videotaped, and the maximum range of stretch was identified using the Kinovea software. A pre-post intervention comparison was made between groups and inter groups. Post hoc analysis was incorporated into repeated measures. Results. There were no differences in the pre-intervention measurement between the groups (P=0.266). Both protocols had significant changes (P<0.007) compared to the control group (P=0.65). All post-intervention measurements compared to pre-intervention present differences in the short (P≤0.018) and long (P≤0.009) protocol. There was a difference between the control group with the short protocol (P≤0.014) and the control group with the long protocol (P≤0.004) for all measurements, and a difference between both protocols in the immediate post (P=0.033) but not for the measurements. subsequent measurements (P≤0.139). Conclusion. A protocol of 150'' of static stretching in hamstrings in asymptomatic young men, presents effects for at least 25'. When doubling at 300'', it only presents a difference in the immediately subsequent measurement. Therefore, both protocols are equally effective, but the short protocol is more efficient.

Clinimetric properties of the knee extension prone test (KEPT): A new method to assess knee hyperextension deficit.

INTRODUCTION: The knee extension prone test (KEPT) can be a low-cost and affordable alternative for this assess knee hyperextension deficit. OBJECTIVE: To analyze concurrent validity and reliability of a new method for assessing knee extension prone (knee extension prone test; KEPT). METHODS: Participants were divided into two groups: Group 1 comprised healthy participants (HG) and Group 2 comprised participants with a history of knee injury (IG). Two examiners performed the following evaluations: (1) lateral knee goniometry, (2) anterior tibial inclinometry, (3) lateral photogrammetry in supine, (4) lateral photogrammetry in prone, and (5) KEPT. Concurrent validity was analyzed by Pearson's linear correlation coefficient (r), and intra- and inter-examiner reliability were analyzed by intraclass correlation coefficient (ICC). RESULTS: KEPT demonstrated good intra-examiner (ICC = 0.85, 95% CI = 0.75-0.89) and excellent inter-examiner (ICC = 0.92, 95% CI = 0.88-0.94) reliability. The standard error of measurement was 0.47° and 1.30° and the minimum detectable change was 2.35° and 6.5° for intra- and inter-examiner agreement, respectively. Concurrent validity of KEPT ranged from moderate to good (r = 0.54-0.78, p < 0.01). CONCLUSION: KEPT is a valid and reliable method for assessing knee hyperextension deficit in both healthy individuals and patients with knee injuries.

Ratio between maximum jaw opening and lateral excursion in brazilians with and without temporomandibular disorder / Razão entre abertura máxima e excursão lateral mandibular em brasileiros com e sem disfunção temporomandibular

Background: Mandibular movements (MM) can offer important information regarding temporomandibular joint health. Objective: Evaluate MM and the ratio between maximum jaw opening and mandibular lateral excursion in Brazilians with and without temporomandibular disorder (TMD). Methods: A cross-sectional study was conducted with 801 individuals between five and 80 years. All individuals answered a screening questionnaire; and MM were measured using digital calipers. The Mann-Whitney test was used to compare the differences between the sexes and groups with and without TMD. The Kruskal-Wallis test was used to determine differences in MM among age groups. Results: MM were smaller in individuals with TMD than in those without TMD. The ratio between jaw opening and lateral excursion was 5.23 in women without TMD and 5.59 in women with TMD. In males, the ratio was 4.75 and 5.52 in individuals without and with TMD, respectively. Conclusion: MM are smaller in Brazilians with TMD, whereas the ratio between jaw opening and lateral excursion is larger.

Introdução: Os movimentos mandibulares (MM) podem oferecer informações importantes sobre a articulação temporomandibular. Objetivo: Avaliar os MM e a relação entre abertura máxima e excursão lateral mandibular em brasileiros com e sem disfunção temporomandibular (DTM). Métodos: Estudo transversal com 801 brasileiros entre cinco e 80 anos. Os indivíduos responderam um questionário de triagem; e os MM foram medidos com paquímetro digital. O teste de Mann-Whitney foi utilizado para comparar diferenças entre sexos e grupos com e sem DTM. O teste de Kruskal-Wallis foi aplicado para determinar diferenças nos MM entre faixas etárias. Resultados: Os MM foram menores nos indivíduos com DTM. A razão entre abertura mandibular e excursão lateral foi de 5,23 em mulheres sem DTM e 5,59 em mulheres com DTM. Nos homens, a proporção foi de 4,75 e 5,52 em indivíduos sem e com DTM, respectivamente. Conclusão: Os MM são menores em brasileiros com DTM, enquanto que a relação entre abertura mandibular e excursão lateral é maior.

Analysis of the presence and influence of Glenohumeral Internal Rotation Deficit on posterior stiffness and isometric shoulder rotators strength ratio in recreational and amateur handball players.

OBJECTIVE: To determine whether recreational and amateur handball players exhibit Glenohumeral Internal Rotation Deficit (GIRD), and if it is accompanied by posterior stiffness and changes in shoulder rotators strength. DESIGN: Cross-Sectional Study; SETTING: Research laboratory. PARTICIPANTS: Indoor and beach handball players, members of handball teams or engaged in some handball recreational group. MAIN OUTCOME MEASURES: Range of motion (ROM) of internal rotation (IR) and horizontal adduction (HA), and isometric internal and external rotators strength. Based on the ROM of internal rotation, they were allocated to groups with and without GIRD. RESULTS: The dominant shoulder of GIRD group obtained a lower ROM of IR compared to the non-dominant shoulder of the same group (p < 0.01) and to the dominant (p = 0.02) and non-dominant (p = 0.01) shoulders of the group without GIRD. Less horizontal adduction was observed in both groups (p = 0.01), as well as greater external rotator strength (p = 0.01) and external/internal rotators strength ratio (p < 0.04) in the dominant shoulder. The rotators strength ratio was greater in GIRD group (p < 0.01). CONCLUSIONS: The present study showed the dominant shoulder had greater posterior stiffness and external rotator strength, regardless of GIRD. Also the group with GIRD showed higher rotators strength ratio.

Cervical spine range of motion, posture and electromyographic activity of masticatory muscles in temporomandibular disorders / Amplitude de movimento articular cervical, postura e atividade eletromiográfica da musculatura mastigatória na disfunção temporomandibular / Rango del movimiento articular de la columna cervical, postura y actividad electromiográfica de la musculatura masticatoria en la disfunción temporomandibular

Abstract Introduction: Temporomandibular joint disorders (TMD or TMJD) involve clinical problems and symptoms affecting the temporomandibular joint (TMJ) and associated structures. The temporomandibular joints are anatomically connected to the cervical region, where cervical spine movements occur simultaneously to masticatory muscle activation and jaw movements. Objective: Our study sought to assess the relationship between the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), surface electromyography (sEMG) of the masticatory muscles, posture and cervical flexibility in women with TMD. Method: Fifty women with an average age of 27.0 ± 6.37 years, diagnosed with TMD according to RDC/TMD, were assessed for craniocervical posture, cervical flexibility and sEMG of the masticatory muscles. Results: There were no differences in jaw function limitations, depression, pain level and its interference in work ability and daily activities, posture and sEMG between TMD diagnoses or between muscle classification (p > 0.05). Depression scores were higher among participants with biarticular dysfunction (p = 0.023). The group with bruxism exhibited a higher pain level at assessment (p = 0.001) and a greater reduction in work ability (p = 0.039). Subjects with muscular and mixed TMD showed less cervical rotation to the right when compared with those with articular TMD. Conclusion: There was no difference in posture or sEMG values for TMD diagnoses, joint and muscle dysfunctions and the presence of bruxism. Muscle dysfunction is associated with reduced cervical rotation to the right. Jaw function limitations did not interfere in posture or sEMG and depression was associated with pain.

Resumo Introdução: A disfunção temporomandibular (DTM) compreende alterações clínicas e sintomas que envolvem a articulação temporomandibular (ATM) e estruturas associadas. A ATM possui conexões anatômicas com a região cervical, onde os movimentos das vértebras cervicais ocorrem simultaneamente com a ativação dos músculos mastigatórios e dos movimentos da mandíbula. Objetivo: O objetivo foi verificar a relação entre achados do Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) com a eletromiografia de superfície (EMGs) da musculatura mastigatória, postura e flexibilidade cervical em mulheres com DTM. Método: Cinquenta mulheres com DTM, pelo RDC/TMD, com idade média de 27,0 ± 6,37 anos foram avaliadas quanto à postura craniocervical, flexibilidade cervical e EMGs da musculatura mastigatória. Resultados: Não houve diferença quanto às limitações relacionadas à função mandibular (LRFM), depressão, grau de dor e interferência no trabalho e atividades diárias, postura e EMGs entre os diagnósticos de DTM e entre a classificação muscular (p > 0,05). O comprometimento biarticular apresentou maior depressão (p = 0,023). O grupo com bruxismo apresentou maior grau de dor no momento (p = 0,001), e maior comprometimento na capacidade de trabalhar (p = 0,039). A DTM muscular e mista tiveram menor rotação à direita em comparação ao diagnóstico articular. Conclusão: Os diagnósticos de DTM, os variados comprometimentos articulares e musculares e a presença de bruxismo não apresentaram diferença quanto à postura e a EMGs. O comprometimento muscular está associado a uma menor rotação cervical à direita. As LRFM não interferiram na postura e na EMGs. A depressão tem associação com a dor.

Resumen Introducción: La disfunción temporomandibular (DTM) incluye alteraciones clínicas y síntomas que involucran la articulación temporomandibular (ATM) y estructuras asociadas. La ATM posee conexiones anatómicas con la región cervical donde los movimientos de las vértebras cervicales ocurren simultáneamente con la activación de los músculos masticatorios y de los movimientos de la mandíbula. Objetivo: Verificar la relación entre la presencia de hallazgos de Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) con la electromiografía superficial (EMG) de la musculatura masticatoria, postura y flexibilidad cervical en mujeres con DTM. Método: Cincuenta mujeres con DTM, por el RDC/TMD, con edad promedio de 27,0 ± 6,37 años fueron evaluadas en cuanto a la postura craniocervical, flexibilidad cervical y EMG de la musculatura masticatoria. Resultados: No hubo diferencia en las limitaciones relacionadas con la función mandibular (LRFM), depresión, grado de dolor e interferencia en el trabajo y actividades diarias, postura y EMG entre los diagnósticos de DTM y entre la clasificación muscular (p > 0,05). La disfunción biarticular presentó mayores puntuaciones de depresión (p = 0,023). El grupo con bruxismo presentó mayor grado de dolor (p = 0,001), y mayor reducción en la capacidad de trabajo (p = 0,039). La DTM muscular y mixta tuvieron menor rotación a la derecha en comparación con el diagnóstico articular. Conclusión: Los diagnósticos de DTM con los variados comprometimientos articulares y musculares y la presencia de bruxismo no presentaron diferencias en cuanto a la postura y la EMG. El comprometimiento muscular está asociado a una menor rotación a la derecha de la cervical. Las LRFM no interfirieron en la postura y la EMG, y la depresión estuvo asociada con el dolor.

Reduced flexion rotation test in women with chronic and episodic migraine.

OBJECTIVE: To compare flexion rotation test and global active cervical mobility in women with chronic migraine, episodic migraine, and headache-free controls. The influence of neck pain-related disability on the flexion rotation test was also analyzed. METHODS: Women with chronic migraine (n=25), episodic migraine (n=30), and those who were headache-free (n=30) were evaluated. Upper cervical mobility was measured using the flexion rotation test and global active mobility was assessed using the cervical range of motion device. Neck pain related-disability was assessed using the Neck Disability Index. Statistical analyses were performed using a MANOVA test, prevalence ratios, and linear regression. RESULTS: Chronic (right, MD: -15°; 95%CI: -21° to -11°; left, MD: -13°; 95%CI: -20° to -12°) and episodic (right, MD: -8°; 95%CI: -13° to -4°; left, MD: -8°; 95%CI: -12° to -5°) migraine groups achieved lower flexion rotation test mobility bilaterally than headache-free women. Only chronic migraine was associated with a lower global cervical range of motion compared to that of headache-free women during flexion, (MD: -8°; 95%CI: -15° to -1°), extension (MD: -13°; 95%CI: -20° to -4°), right lateral flexion (MD: -4°; 95%CI: -9° to -0.2°), left lateral flexion (MD: -6°; 95%CI: -10° to -2°), right rotation (MD: -9°; 95%CI: -15° to -4°), and left rotation (MD: -8°; 95%CI: -13° to -2°). Migraine was associated with a 2.85-fold increase in the risk of a positive flexion rotation test. Flexion Rotation Test was influenced by disability-related neck pain (R2=19.1; p=0.001). CONCLUSION: Women with migraine have a lower upper cervical range of motion than headache-free women. Women with chronic migraine demonstrated reduced global cervical range of motion when compared to headache-free women. Migraine was associated with in increased likelihood of a positive Flexion Rotation Test. Reduction in mobility was influenced by migraine frequency and disability-related neck pain.

Static or dynamic stretching program does not change the acute responses of neuromuscular and functional performance in healthy subjects: a single-blind randomized controlled trial / Programa de alongamento estático ou dinâmico não altera as respostas agudas do desempenho neuromuscular e funcional de sujeitos saudáveis: ensaio controlado randomizado e cego / Un programa de estiramientos estáticos o dinámicos no modifica las respuestas agudas del rendimiento neuromuscular y funcional en individuos sanos: ensayo ciego controlado de distribución aleatoria

Abstract The purpose of this study was to compare the effects of a single hamstring static or dynamic stretching session and a 10-session stretching program on the range of motion, neuromuscular performance and functional performance of healthy subjects. Forty-five, healthy, active men were divided into three groups: control; static stretching and dynamic stretching. There were no significant differences in ratings between the experimental and control groups for any of the variables (p > 0.05). It can be concluded that neither a single session of hamstring static or dynamic stretching nor a 10-session stretching program affected range of motion, neuromuscular or functional performance.

Resumo A proposta deste estudo foi comparar os efeitos de uma única sessão de alongamento estático ou dinâmico dos isquiotibias e dez sessões do programa de alongamento na amplitude de movimento e desempenho neuromuscular e funcional de indivíduos saudáveis. Quarenta e cinco homens ativos e saudáveis, foram distribuídos em três grupos: controle, alongamento estático e alongamento dinâmico. Não houve diferença significativa entre os grupos experimentais e controle para todas as variáveis (p >0,05). Pode-se concluir que nem uma única sessão de alongamento estático e dinâmico dos isquiotibiais, nem 10 sessões do programa de alongamento afetaram a amplitude de movimento e o desempenho neuromuscular e funcional.

Resumen El propósito de este estudio fue comparar los efectos de una sola sesión de estiramientos estático o dinámico en los isquiotibiales, y diez sesiones del programa de estiramiento en el rango de movimiento y rendimiento neuromuscular y funcional de individuos sanos. Cuarenta y cinco hombres activos y sanos fueron divididos en tres grupos: control, estiramiento estático y estiramiento dinámico. No hubo ninguna diferencia considerable entre los grupos experimentales y de control respecto a todas las variables (p >0,05). Se puede concluir que ni una sola sesión de estiramiento estático o dinámico de los isquiotibiales ni 10 sesiones del programa de estiramiento afectaron al rango de movimiento ni al rendimiento neuromuscular y funcional.

Determinación de rangos de movimiento del miembro superior en una muestra de estudiantes universitarios mexicanos / Determination of Range of Motion for Upper Limbs in a Sample of Mexican University Students / Determinação de Rangos de Movimento do Membro Superior em uma Amostra de Estudantes Universitários Mexicanos

Resumen Introducción: Esta investigación se realizó en la Universidad Autónoma de Ciudad Juárez, en la División Multidisciplinaria de la Ciudad Universitaria, con una muestra de estudiantes del programa de Ingeniería Industrial y de Sistemas. Su objetivo fue crear una base de datos que contuviera información sobre los rangos de movimientos (ROMS) del miembro superior de una muestra de jóvenes estudiantes. Materiales y métodos: Se utilizó un inclinómetro de burbuja marca Baseline® y el kit antropométrico Rosscraft®. El diseño de la investigación fue de tipo descriptivo, cuantitativo y transversal, y se tomó una muestra de 50 estudiantes; la determinación de los ROMS consistió en medir a cada uno de los participantes para, posteriormente, capturar y analizar los datos a través del software Minitab17®, para determinar medidas de tendencia central y la existencia de diferencia significativa entre los ROMS de hombres y mujeres. Resultados: Se determinó el límite de rango de movimiento para las articulaciones del codo, hombro, muñeca y antebrazo, encontrando que no existe evidencia de diferencia significativa entre los ROMS de los hombres y las mujeres del estudio, a excepción de la abducción en el hombro derecho. Conclusión: Los datos recopilados en esta investigación pueden ser utilizados para el diseño de áreas de trabajo que se adecúen a las necesidades del usuario, de forma que se evite la presencia de lesiones músculo-esqueléticas y se logre la reducción de la fatiga física en los trabajadores.

Abstract Introduction: This research was carried out at the Universidad Autonoma de Ciudad Juarez, División Multidisciplinaria Ciudad Universitaria, with a sample of students of the Industrial and Systems Engineering Program. With the objective of creating a database containing information about the ranges of motion (ROMS) of the upper limb. Materials and Methods: Upper limb ROMS estimation was developed using a bubble inclinometer Baseline® and the Rosscraft® anthropometric kit. The design of the research was descriptive, quantitative and transversal. A sample of 50 students was taken; the determination of the ROMS consisted in measuring each of the participants and, subsequently, the data were captured and analyzed through Minitab17® software, in order to obtain measures of central tendency and the existence of significant difference between the ROMS of men and women. Results: The Range of motion limit for the elbow, shoulder, wrist and forearm joints was determined, finding that there is no evidence of a significant difference between ROMS of men and women in the study, with the exception of abduction in the right shoulder. Conclusion: The data collected in this research can be used to design workspaces that fit the needs of the user, with the aim to avoid the presence of musculoskeletal injuries and reduce physical fatigue among workers.

Resumo Introdução: Esta pesquisa se realizou na Universidad Autónoma de Ciudad Juárez, Divisão Multidisciplinar Cidade Universitária, com uma amostra de estudantes do programa de Engenharia Industrial e de Sistemas. Com o objetivo de criar uma base de dados que contenha informação sobre os rangos de movimentos (ROMS) do membro superior de uma amostra de jovens estudantes. Materiais e métodos: Se utilizou um inclinómetro de borbulha marca Baseline® e o kit antropométrico Rosscraft®. O desenho da pesquisa foi de tipo descritivo, quantitativo e transversal, se tomou uma amostra de 50 estudantes; a determinação dos ROMS consistiu em medir a cada um dos participantes y posteriormente os dados foram capturados e analisados através do software Minitab17®, para determinar medidas de tendência central e a existência de diferença significativa entre os ROMS de homens e mulheres. Resultados: Se determinou o limite de rango de movimento para as articulações do cotovelo, ombro, pulso e o antebraço, encontrando que não existe evidência de diferença significativa entre os ROMS dos homens e as mulheres do estudo, a excepção da abdução no ombro direito. Conclusão: Os dados compilados nesta pesquisa podem ser utilizados no desenho das áreas de trabalho que se adequem às necessidades do usuário, de forma que se evite a presença de lesões musculoesqueléticas, e consiga-se a redução da fadiga física nos trabalhadores.

Ligamentous reconstruction of the interosseous membrane of the forearm in the treatment of instability of the distal radioulnar joint.

OBJECTIVES: To measure the quality of life and clinical outcomes of patients treated with interosseous membrane (IOM) ligament reconstruction of the forearm, using the brachioradialis (BR), and describe a new surgical technique for the treatment of joint instability of the distal radioulnar joint (DRUJ). METHODS: From January 2013 to September 2016, 24 patients with longitudinal injury of the distal radioulnar joint DRUJ were submitted to surgical treatment with a reconstruction procedure of the distal portion of the interosseous membrane or distal oblique band (DOB). The clinical-functional and radiographic parameters were analyzed and complications and time of return to work were described. RESULTS: The follow-up time was 20 months (6-36). The ROM averaged 167.92° (93.29% of the normal side). VAS was 2/10 (1-6). DASH was 5.63/100 (1-18). The time to return to work was 7.37 months (3-12). As to complications, one patient had an unstable DRUJ, and was submitted to a new reconstruction by the Brian-Adams technique months. Currently, he has evolved with improved function, and has returned to his professional activities. Three other patients developed problems around the transverse K-wire and were treated with its removal, all of whom are doing well. CONCLUSION: The new approach presented in this study is safe and effective in the treatment of longitudinal instability of the DRUJ, since it has low rate of complications, as well as satisfactory radiographic, clinical, and functional results. It allows return to social and professional activities, and increases the quality of life of these patients.

OBJETIVOS: Mensurar a qualidade de vida e os resultados clínico-funcionais dos pacientes submetidos à reconstrução ligamentar de membrana interóssea (MIO) do antebraço com o uso do braquioestilorradial (BR) e descrever uma nova técnica cirúrgica. MÉTODO: De janeiro de 2013 a setembro de 2016, 24 pacientes com lesão longitudinal da articulação radioulnar distal (ARUD) foram submetidos ao tratamento cirúrgico de reconstrução da porção distal da membrana interóssea ou distal oblique band (DOB). Foram analisados os parâmetros clínico-funcionais e radiográficos e descritos as complicações e o tempo de retorno ao trabalho. RESULTADOS: O tempo de seguimento foi de 20 meses [6-36]. A ADM foi em média 167,92° (93,29% do lado normal). A VAS foi 2/10 [1-6]. O DASH foi de 5,63/100 [1-18]. O tempo de retorno ao trabalho foi de 7,37 meses [3-12]. Quanto às complicações, um paciente evoluiu com instabilidade da ARUD e foi submetido a nova reconstrução pela técnica de Brian-Adams. Evoluiu com melhoria funcional e retornou às atividades profissionais. Outros três pacientes evoluíram com problemas ao redor do fio de Kirschner transverso à ARUD e foram tratados com a remoção desse, todos evoluíram bem. CONCLUSÃO: A nova abordagem apresentada neste estudo demonstrou-se segura e eficaz no tratamento da instabilidade longitudinal da ARUD, já que apresentou baixa taxa de complicações, bem como resultados radiográficos, clínicos e funcionais satisfatórios, o que melhorou a qualidade de vida desses pacientes.

Ligamentous reconstruction of the interosseous membrane of the forearm in the treatment of instability of the distal radioulnar joint / Reconstrução da membrana interóssea do antebraço no tratamento da instabilidade da articulação da radioulnar distal

ABSTRACT Objectives: To measure the quality of life and clinical outcomes of patients treated with interosseous membrane (IOM) ligament reconstruction of the forearm, using the brachioradialis (BR), and describe a new surgical technique for the treatment of joint instability of the distal radioulnar joint (DRUJ). Methods: From January 2013 to September 2016, 24 patients with longitudinal injury of the distal radioulnar joint DRUJ were submitted to surgical treatment with a reconstruction procedure of the distal portion of the interosseous membrane or distal oblique band (DOB). The clinical-functional and radiographic parameters were analyzed and complications and time of return to work were described. Results: The follow-up time was 20 months (6-36). The ROM averaged 167.92° (93.29% of the normal side). VAS was 2/10 (1-6). DASH was 5.63/100 (1-18). The time to return to work was 7.37 months (3-12). As to complications, one patient had an unstable DRUJ, and was submitted to a new reconstruction by the Brian-Adams technique months. Currently, he has evolved with improved function, and has returned to his professional activities. Three other patients developed problems around the transverse K-wire and were treated with its removal, all of whom are doing well. Conclusion: The new approach presented in this study is safe and effective in the treatment of longitudinal instability of the DRUJ, since it has low rate of complications, as well as satisfactory radiographic, clinical, and functional results. It allows return to social and professional activities, and increases the quality of life of these patients.

RESUMO Objetivos: Mensurar a qualidade de vida e os resultados clínico-funcionais dos pacientes submetidos à reconstrução ligamentar de membrana interóssea (MIO) do antebraço com o uso do braquioestilorradial (BR) e descrever uma nova técnica cirúrgica. Método: De janeiro de 2013 a setembro de 2016, 24 pacientes com lesão longitudinal da articulação radioulnar distal (ARUD) foram submetidos ao tratamento cirúrgico de reconstrução da porção distal da membrana interóssea ou distal oblique band (DOB). Foram analisados os parâmetros clínico-funcionais e radiográficos e descritos as complicações e o tempo de retorno ao trabalho. Resultados: O tempo de seguimento foi de 20 meses [6-36]. A ADM foi em média 167,92° (93,29% do lado normal). A VAS foi 2/10 [1-6]. O DASH foi de 5,63/100 [1-18]. O tempo de retorno ao trabalho foi de 7,37 meses [3-12]. Quanto às complicações, um paciente evoluiu com instabilidade da ARUD e foi submetido a nova reconstrução pela técnica de Brian-Adams. Evoluiu com melhoria funcional e retornou às atividades profissionais. Outros três pacientes evoluíram com problemas ao redor do fio de Kirschner transverso à ARUD e foram tratados com a remoção desse, todos evoluíram bem. Conclusão: A nova abordagem apresentada neste estudo demonstrou-se segura e eficaz no tratamento da instabilidade longitudinal da ARUD, já que apresentou baixa taxa de complicações, bem como resultados radiográficos, clínicos e funcionais satisfatórios, o que melhorou a qualidade de vida desses pacientes.

Late evaluation of patients undergoing manipulation of the knee after total arthroplasty / Avaliação tardia dos pacientes submetidos à manipulação do joelho após artroplastia total

ABSTRACT Objective: We compared gains in range of motion in patients who underwent manipulation within 12 weeks of total knee arthroplasty (TKA) and after this period. We also evaluated maintenance of the arc obtained from knee manipulation in late follow-up, along with factors associated with poorer outcomes. Method: The study was divided into two groups according to the time after TKA; the surgeries took place between January 2008 and December 2014. Results: When comparing the range of motion between early and late manipulations, the group that underwent manipulation within 12 weeks of the TKA exhibited better outcomes, but these were not statistically significant. We observed that 14.3% of cases retained the same range attained at the time of manipulation. In late evaluation after manipulation, 47.7% of the sample had a range of less than 90 degrees. The significant risk factors for recurrence of knee stiffness in the long term are poor range of motion before TKA and before manipulation, female sex, and secondary arthritis. Conclusion: Women previously diagnosed with secondary osteoarthritis and poor range of motion before TKA or manipulation are at higher risk for late stiffness. Level of Evidence III, Retrospective Comparative Study.

RESUMO Objetivo: Comparar o ganho de arco de movimento entre os pacientes submetidos à manipulação antes de 12 semanas pós-artroplastia total do joelho (ATJ), e depois desse período. Além disso, avaliar tardiamente a manutenção do arco obtido com a manipulação do joelho e fatores relacionados com os piores resultados. Método: O estudo foi dividido em dois grupos, de acordo com o tempo pós-ATJ. Os procedimentos ocorreram entre janeiro de 2008 e dezembro de 2014. Resultados: Quando comparamos os arcos de movimento entre as manipulações precoces e tardias, o grupo submetido à manipulação em 12 semanas da ATJ apresentou melhores resultados, porém, sem significância estatística. Foi observado que 14,3% dos casos mantiveram a mesma amplitude alcançada no momento da manipulação. Na avaliação tardia, 47,7% da amostra obtiveram amplitude menor que 90 graus. Os fatores de risco significantes para recidiva tardia de rigidez são arco de movimento ruim antes da ATJ e antes da manipulação, sexo feminino e artrites secundárias. Conclusão: Mulheres com diagnóstico prévio de osteoartrite secundária e com arco ruim antes da ATJ ou da manipulação têm maior risco de rigidez tardia. Nível de Evidência III, Estudo Retrospectivo Comparativo.

Evaluation of knee range of motion: Correlation between measurements using a universal goniometer and a smartphone goniometric application.

BACKGROUND: Goniometers are commonly used to measure range of motion in the musculoskeletal system. Recently smartphone goniometry applications have become available to clinicians. OBJECTIVE: Compare angular measures using a universal goniometer and a smartphone application. METHODS: Thirty four healthy women with at least 20° of limited range of motion regarding knee extension were recruited. Knee flexion angles of the dominant limb were measured with a universal goniometer and the ROM© goniometric application for the smartphone. Three trained examiners compared the two assessment tools. RESULTS: Strong correlations were found between the measures of the universal goniometer and smartphone application (Pearson's correlation and interclass correlation coefficient > 0.93). The measurements with both devices demonstrated low dispersion and little variation. CONCLUSION: Measurements obtained using the smartphone goniometric application analyzed are as reliable as those of a universal goniometer. This application is therefore a useful tool for the evaluation of knee range of motion.

Avaliação da amplitude de movimento na Artrite Reumatoide: uma revisão de literatura / Motion range assessment in Rheumatoid Arthritis: a literature review

[{"text": "Objetivo: O objetivo desta revisão de literatura é descrever métodos de avaliação de ADM na AR, a fim\r\nde auxiliar na definição das principais limitações apresentadas pelos pacientes e, desta forma, contribuir para um tratamento específico às articulações mais acometidas. Método: A metodologia utilizada foi uma revisão crítica da literatura e a busca foi realizada através do portal da capes, e se restringiu às bases de dados da área da saúde. Além de utilizados os descritores estabelecidos pelo DeCS, "rheumatoid arthritis" e "mobility limitation", inseriu-se na busca o termo "range of motion". Resultados: Na revisão crítica da literatura, foi identificado um total de 774 artigos, dos quais, 446 foram pré-selecionados pelo conteúdo do título e do resumo. Destes, 403 foram excluídos após a leitura, por não preencherem os critérios de inclusão para este estudo. Dessa forma, foram selecionados 43 artigos, sendo estes resumidos de forma padronizada. Os estudos não trazem a ênfase ao estudo da mobilidade articular de indivíduos com AR, mas trazem em comum a inclusão da avaliação da ADM como uma maneira de acompanhar a evolução da doença diretamente à função das articulações, principalmente as mais comprometidas. Conclusão: Sugere-se o estudo completo do comprometimento articular, a fim de traçar propósitos de intervenção ou prevenção de deformidades geradas pela AR, que comprometem a qualidade de vida destes pacientes, e difundir\r\ntais práticas de avaliação entre a equipe multidisciplinar que acompanha este perfil, a fim de otimizar o plano de assistência a longo prazo, levando-se em conta a cronicidade da condição.", "_i": "pt"}, {"text": "Objective: The aim of this review is to describe the methods used for range of motion (ROM) assessment\r\nin Rheumatoid Arthritis (RA) in order to assist in the identification of the main limitations experienced by patients and thus contribute to the specific treatment of the most affected joints. Method: The methodology used was a critical review of the literature and the search was conducted in the capes portal, specifically in health care databases. The two MeSH descriptors "rheumatoid arthritis" and "mobility limitation" were used in the search, and also the term "range of motion". Results: A total of 774 articles were found in the review and 446 were preselected based on title and abstract contents. After reading, 403 articles did not meet the inclusion criteria set in the study and were excluded. Thus, 43 articles were selected, which are summarized in a standardized manner. The studies do not approach the mobility of joints of RA patients, but they have in common the inclusion of ROM assessment to monitor the disease in a manner that is directly related to the function of the joints, especially the most compromised ones.\r\nConclusion: We suggest the realization of thorough studies on joint involvement in order to outline interventions for preventing deformities generated by RA that compromise the quality of life of these patients. The studies could also contribute to disseminate such assessment practices among the multidisciplinary teams that provide assistance to these patients, optimizing the long-term care plan and taking into account the chronicity of the condition.", "_i": "en"}]

Effects of Anteroposterior Talus Mobilization on Range of Motion, Pain, and Functional Capacity in Participants With Subacute and Chronic Ankle Injuries: A Controlled Trial.

Objective: The purpose of this study was to measure the acute (1 session) and chronic effects (6 sessions) and the follow-up (2 weeks) of anteroposterior articular mobilization of the talus, grade III of Maitland, on the dorsiflexion range of motion (ROM), pain, and functional capacity of individuals with subacute and chronic traumatic injuries of the ankle. Methods: Thirty-eight volunteers, men and women, with a mean age of 40.8 years, with subacute and chronic ankle injuries participated. The volunteers were blinded to the study purpose and were allocated into the experimental group (EG) or sham group (SG). Dorsiflexion ROM, pain, and functional capacity were measured using the universal goniometer, visual analog scale, and Foot and Ankle Ability Measure, respectively. Measurements were taken on 4 different occasions: (1) baseline, (2) after the first session, (3) after the sixth session, and (4) at follow-up. Articular anteroposterior mobilization of the talus grade III of Maitland was applied to the EG, whereas manual contact was applied to the SG. Three series of 30 seconds each with a 30-second rest interval between the series were conducted. Results: Significant increases in ankle dorsiflexion ROM were observed only for the EG after the first (EG: 9.5 ± 1.1; SG: 7.6 ± 1.1) and sixth (EG: 12.8 ± 1.2; SG: 8.4 ± 1.2) sessions and were maintained at follow-up (EG: 13.2 ± 1.1; SG: 9.3 ± 1.3). Decreases in pain and improvements in functional capacity (FC) were identified for both groups after the first and sixth sessions (Pain, EG: 1.3 ± 0.5; SG: 1.8 ± 0.6 and EG: 0.7 ± 0.3; SG: 0.7 ± 0.3; FC, EG: 64.6 ± 3.5; SG: 67.4 ± 4.4 and EG: 79.9 ± 3.3; SG: 86.2 ± 3.3) and remained at follow-up (Pain, EG: 0.3 ± 0.2; SG: 0.5 ± 0.3; FC, EG: 86.8 ± 2.7; SG: 89.8 ± 3.7). Conclusion: Articular grade III mobilization improved ankle dorsiflexion ROM, when compared with the SG. Changes in pain and functional capacity were similar in both groups.

LATE EVALUATION OF PATIENTS UNDERGOING MANIPULATION OF THE KNEE AFTER TOTAL ARTHROPLASTY.

OBJECTIVE: We compared gains in range of motion in patients who underwent manipulation within 12 weeks of total knee arthroplasty (TKA) and after this period. We also evaluated maintenance of the arc obtained from knee manipulation in late follow-up, along with factors associated with poorer outcomes. METHOD: The study was divided into two groups according to the time after TKA; the surgeries took place between January 2008 and December 2014. RESULTS: When comparing the range of motion between early and late manipulations, the group that underwent manipulation within 12 weeks of the TKA exhibited better outcomes, but these were not statistically significant. We observed that 14.3% of cases retained the same range attained at the time of manipulation. In late evaluation after manipulation, 47.7% of the sample had a range of less than 90 degrees. The significant risk factors for recurrence of knee stiffness in the long term are poor range of motion before TKA and before manipulation, female sex, and secondary arthritis. CONCLUSION: Women previously diagnosed with secondary osteoarthritis and poor range of motion before TKA or manipulation are at higher risk for late stiffness. Level of Evidence III, Retrospective Comparative Study.

OBJETIVO: Comparar o ganho de arco de movimento entre os pacientes submetidos à manipulação antes de 12 semanas pós-artroplastia total do joelho (ATJ), e depois desse período. Além disso, avaliar tardiamente a manutenção do arco obtido com a manipulação do joelho e fatores relacionados com os piores resultados. MÉTODO: O estudo foi dividido em dois grupos, de acordo com o tempo pós-ATJ. Os procedimentos ocorreram entre janeiro de 2008 e dezembro de 2014. RESULTADOS: Quando comparamos os arcos de movimento entre as manipulações precoces e tardias, o grupo submetido à manipulação em 12 semanas da ATJ apresentou melhores resultados, porém, sem significância estatística. Foi observado que 14,3% dos casos mantiveram a mesma amplitude alcançada no momento da manipulação. Na avaliação tardia, 47,7% da amostra obtiveram amplitude menor que 90 graus. Os fatores de risco significantes para recidiva tardia de rigidez são arco de movimento ruim antes da ATJ e antes da manipulação, sexo feminino e artrites secundárias. CONCLUSÃO: Mulheres com diagnóstico prévio de osteoartrite secundária e com arco ruim antes da ATJ ou da manipulação têm maior risco de rigidez tardia. Nível de Evidência III, Estudo Retrospectivo Comparativo.

Influência da manipulação osteopática na amplitude de rotação da coluna cervical em indivíduos com cervicalgia mecânica crônica / Influence of manipulation at range of rotation of the cervical spine in chronic mechanical neck pain

JUSTIFICATIVA E OBJETIVOS: A amplitude de movimento do pescoço pode ser reduzida pela presença de disfunções vertebrais e miofasciais, as quais podem ser tratadas pela manipulação osteopática por meio da técnica articulatória rítmica cervical. O objetivo deste estudo foi verificar se a manipulação osteopática, através da técnica articulatória rítmica gera aumento da amplitude de rotação cervical mensurada por fleximetria. MÉTODOS: A casuística foi constituída de 58 indivíduos de ambos os gêneros, com idade média de 36±6,5 anos, com cervicalgia mecânica crônica, que foram submetidos de maneira randomizada à fleximetria controle da rotação cervical, à manipulação osteopática, por meio da técnica articulatória rítmica, ao repouso de 5 minutos e à fleximetria estudo da rotação cervical. RESULTADOS: A comparação entre as médias das fleximetrias de rotação cervical através do teste t de Student para dados pareados, ao nível de significância de 0,05 (5%), mostrou que houve aumento significativo da rotação cervical em todos os casos (p<0,05) passando de 151,4º para 162,5º no arco total de movimento (aumento de 7,3%). CONCLUSÃO: Os resultados foram dentro do esperado, confirmando que a manipulação osteopática, através da técnica articulatória rítmica gerou aumento significativo da amplitude de rotação cervical em todos os casos, podendo servir de tratamento de doenças que se relacionam à redução da mobilidade vertebral, como cervicalgia e osteoartrite cervical.

BACKGROUND AND OBJECTIVES: Neck range of motion may be decreased by vertebral and myofascial dysfunctions, which may be treated with osteopathic manipulation through the cervical rhythmic articulatory technique. This study aimed at verifying whether osteopathic manipulation with rhythmic articulatory technique improves cervical rotation range measured by fleximetry. METHODS: The group was made up of 58 individuals of both genders, mean age of 36±6.5 years, with chronic mechanical neck pain, who were randomized to cervical rotation control fleximetry, to osteopathic manipulation through the rhythmic articulatory technique, to 5-minute rest and to cervical rotation study fleximetry. RESULTS: The comparison of cervical rotation fleximetry means through Student's t test for paired data at significance level of 0.05 (5%) has shown significant cervical rotation improvement in all cases (p<0.05), going from 151.4º to 162.5º in total movement arch (7.3% improvement). CONCLUSION: Results were as expected, confirming that osteopathic manipulation using the rhythmic articulatory technique generates significant improvement of cervical rotation range in all cases and may be an alternative to treat diseases related to vertebral mobility reduction, such as neck pain and cervical osteoarthritis.

Efetividade do Programa de Fisioterapia Aquática na amplitude de movimento em idosas / Effectiveness of aquatic physical therapy program in the range of motion in elderly

O objetivo deste estudo foi verificar os efeitos de um programa de fisioterapia aquática na amplitude de movimento em mulheres idosas. Estudo quase-experimental, sem grupo-controle, com 16 idosas, avaliadas em três momentos da intervenção. Verificou-se que o programa de fisioterapia aquática produziu efeitos expressivos no ganho da amplitude de movimento em todas as articulações e eixos de movimentos estudados, além do engajamento de pessoas idosas em atividades físicas importante para essa fase da vida.(AU)

The aim of this study was to investigate the effects of a program of aquatic physical therapy on range of motion in older women. Quasi-experimental study without a control group, with 16 elderly, assessed at three time points of intervention. It was found that the program of aquatic physical therapy produced significant effects in the gain range of motion in all joints and axes movements studied, beyond the engagement of older people in this important stage of life physical activities.(AU)

Efetividade do Programa de Fisioterapia Aquática na amplitude de movimento em idosas / Effectiveness of aquatic physical therapy program in the range of motion in elderly

O objetivo deste estudo foi verificar os efeitos de um programa de fisioterapia aquática na amplitude de movimento em mulheres idosas. Estudo quase-experimental, sem grupo-controle, com 16 idosas, avaliadas em três momentos da intervenção. Verificou-se que o programa de fisioterapia aquática produziu efeitos expressivos no ganho da amplitude de movimento em todas as articulações e eixos de movimentos estudados, além do engajamento de pessoas idosas em atividades físicas importante para essa fase da vida.

The aim of this study was to investigate the effects of a program of aquatic physical therapy on range of motion in older women. Quasi-experimental study without a control group, with 16 elderly, assessed at three time points of intervention. It was found that the program of aquatic physical therapy produced significant effects in the gain range of motion in all joints and axes movements studied, beyond the engagement of older people in this important stage of life physical activities.

Immediate effect of a single anteroposterior talus mobilization on dorsiflexion range of motion in participants with orthopedic dysfunction of the ankle and foot.

OBJECTIVE: The purpose of this study was to determine the immediate effects of a single anteroposterior mobilization of the talus on the active dorsiflexion range of motion (ROM) in participants with different orthopedic foot and ankle injuries. METHODS: This study included 30 male and female participants aged 18 to 50 years with unilateral orthopedic foot and ankle dysfunction. All participants underwent 3 sets of active dorsiflexion ROM measurement in both ankles. Measurements included baseline, post-first treatment, and post-second treatment values. Participants received either joint mobilization or manual contact (control) on the affected ankle. Active dorsiflexion ROM was assessed using a biplanar goniometer with participants in the prone position and 90° of knee flexion. RESULTS: Both groups (joint mobilization and manual contact) showed increased active dorsiflexion ROM. However, the mean difference of dorsiflexion measurements before and after mobilization was greater than before and after control treatment. CONCLUSION: A single session of articular mobilization of the talus did not significantly increase dorsiflexion ROM in participants with orthopedic dysfunctions of the ankle and foot compared with a manual contact procedure.

Reavaliação do ombro doloroso em atletas de beisebol após tratamento conservador / Reassessment of painful shoulders among baseball players after conservative treatment

OBJETIVO: O objetivo deste trabalho foi avaliar os resultados da reabilitação nos jogadores de beisebol que possuíam dor e déficit de rotação medial no ombro. MÉTODOS: Dos 55 atletas avaliados no período de abril a junho de 2009, observou-se que 20 atletas tinham dor em algum momento do arremesso. Eles foram orientados a realizar um programa de reabilitação com exercícios para alongamento da cápsula posterior e reforço dos músculos da cintura escapular, especialmente os rotadores laterais. Dezoito pacientes seguiram as orientações, dois perderam o seguimento. Os parâmetros avaliados foram: dor, amplitude de movimento e força pré e pós o término do programa. RESULTADOS: Na avaliação final, em comparação com a inicial, observamos: aumento em média da elevação de 10º (p = 0,001), de três níveis vertebrais da rotação medial (p < 0,001), aumento de 20º da rotação medial a 90º de abdução (p < 0,001) e um aumento de 26º do arco de rotação (p < 0,001). Com relação à força, foi evidente a melhora da força de elevação com aumento de 3kgf (p = 0,002) e da força de rotação lateral com aumento de 1kgf (p = 0,020). Dos 18 atletas estudados, a dor melhorou em 16, dois atletas permaneceram com dor e foram submetidos à ressonância magnética, na qual foram evidenciadas lesões de tratamento cirúrgico. CONCLUSÃO: O programa de reabilitação realizado com os jogadores de beisebol foi efetivo, possibilitando aumento da rotação medial, da elevação, do arco de rotação e das forças de elevação e rotação lateral, consequentemente havendo melhora da dor na maioria dos atletas.

OBJECTIVE: The objective of this study was to evaluate the rehabilitation results among baseball players who presented pain and medial rotation deficit in their shoulders. METHODS: Out of 55 baseball players assessed between April and June 2009, it was observed that 20 presented pain at some instant during throwing movements. They were advised to undergo a rehabilitation program with exercises to stretch the posterior capsule and reinforce the muscles of the scapular belt, especially the lateral rotators. Eighteen patients followed the advice, while two were lost from the follow-up. The parameters evaluated were: pain, range of motion, strength before the program and strength after the end of the program. RESULTS: Comparing the initial and final assessments, we observed mean increases as follows: 10º of elevation (p = 0.001); three vertebral levels of medial rotation (p < 0.001); 20º of medial rotation at 90º abduction (p < 0.001); and 26º of range of motion (p < 0.001). Regarding strength, elevation force increased by 3 kgf (p = 0.002) and lateral rotation force increased by 1 kgf (p = 0.020). Out of the 18 baseball players studied, the pain level improved in 16, while two continued to present pain and underwent magnetic resonance imaging, which showed lesions for surgical treatment. CONCLUSION: The rehabilitation program conducted among the baseball players was effective and enabled increases in medial rotation, elevation, range of motion and strength of elevation and lateral rotation, consequently producing pain improvements in most of the players.