Are craniocervical flexion test and the pectoralis minor index useful tests for patients with subacromial pain syndrome? / Are craniocervical flexion test and the pectoralis minor index useful tests for patients with subacromial pain syndrome?

Cervical disorders and the shortening of the pectoralis minor are advocated to play an important role in patients with subacromial pain syndrome, despite the absence of evidence. This study aimed to compare the deep cervical flexor muscle function and the shortening of the pectoralis minor between patients with subacromial pain syndrome and controls. Secondarily, this study aimed to analyze the relationship of clinical tests with pain and disability among patients. This is a case-control study with 32 patients with subacromial pain syndrome [mean age: 33 ± 6.9 years; sex: 22 (65.6%) men; right dominance: 31 (96.9%)] and 32 controls matched for age, sex, handedness, and affected side. Participants filled the Numerical Pain Rating Scale, the Shoulder Pain and Disability Index; and performed the clinical tests which were compared between patients and controls. Pectoralis minor length of the patient's group (median = 9.0) was similar to the controls (median = 9.7) (U = 421.5; p = 0.22). The deep neck muscle function presented no statistical difference between patients and controls (χ2 = 4.319; p = 0.504). There was no statistically significant correlation between clinical tests and patient self-reported measures. Therefore, deep cervical flexor muscle and the pectoralis minor muscle were not impaired in patients with subacromial pain syndrome and did not show a relationship with self-reported measures.

Distúrbios cervicais e o encurtamento do músculo peitoral menor são apontados como tendo um papel importante em pacientes com síndrome da dor subacromial, apesar da ausência de evidências. Este estudo teve como objetivo comparar a função dos músculos flexores cervicais profundos e o encurtamento do músculo peitoral menor entre pacientes com síndrome da dor subacromial e controles. Secundariamente, este estudo objetivou analisar a relação dos testes clínicos com a dor e incapacidade entre os pacientes com síndrome da dor subacromial. Trata-se de um estudo caso-controle com 32 pacientes com síndrome da dor subacromial [idade: 33 ± 6,9 anos; sexo: 22 (65,6%) homens; dominância direita: 31 (96,9%)] e 32 controles pareados por idade, sexo, lateralidade e lado afetado. Os participantes preencheram a Numerical Pain Rating Scale, o Shoulder Pain and Disability Index, realizaram os testes clínicos e os resultados dos pacientes e controles foram comparados. O comprimento do músculo peitoral menor no grupo de pacientes (mediana = 9,0) foi semelhante ao grupo controle (mediana = 9,7) (U = 421,5; p = 0,22). A função do músculo flexor cervical profundo não apresentou diferença estatística entre pacientes e controles (χ2 = 4,319; p = 0,504). Não houve correlação estatisticamente significativa entre os testes clínicos e as medidas relatadas pelos pacientes. Portanto, o músculo flexor cervical profundo e o músculo peitoral menor não foram prejudicados em pacientes com síndrome da dor subacromial e não mostraram relação com medidas autorreferidas.

Clinical and surgical implications of the pulmonary azygos lobe: a systematic review / Implicaciones clínicas y quirúrgicas del lóbulo ácigos pulmonar: una revisión sistemática

SUMMARY: Azygos lobe is one of the most common pulmonary variations. Although numerous studies discuss to the clinical and surgical implications of anatomical variations, there are few investigations about this topic. The aim of this study was to discuss the anatomy of the pulmonary azygos lobe and its possible clinical and surgical correlations. In this systematic review, a total of 48 results were found between 1968 and 2020. After application of eligibility criteria, 16 articles were included to analysis. Our results showed there were no reports of surgery complications in azygos lobe presence. In all articles that described the anatomical variation, the pulmonary azygos lobe received tertiary segmental branches. Among the surgical implications in the presence of the azygos lobe, complications are of low complexity. It is necessary to teach about this anatomical variation in medical schools in cadavers. Emphasizing the obvious morphological modifications in the superior mediastinum.

RESUMEN: El lóbulo ácigos es una de las variaciones pulmonares más comunes. Aunque numerosos estudios discuten las implicaciones clínicas y quirúrgicas de las variaciones anatómicas, existen pocas investigaciones sobre este tema. El objetivo de este estudio fue discutir la anatomía del lóbulo ácigos pulmonar y sus posibles correlaciones clínicas y quirúrgicas. En esta revisión sistemática se encontraron un total de 48 resultados entre los años 1968 y 2020. Después de la aplicación de los criterios de elegibilidad, 16 artículos fueron incluidos para análisis. Nuestros resultados mostraron que no hubo informes de complicaciones quirúrgicas en presencia del lóbulo ácigos. En todos los artículos que describieron la variación anatómica, el lóbulo ácigos pulmonar recibió ramas segmentarias terciarias. Dentro de las implicaciones quirúrgicas en presencia del lóbulo ácigos, las complicaciones son de baja complejidad. En las escuelas de medicina es necesaria la enseñanza en cadáveres de esta variación anatómica, destacando las evidentes modificaciones morfológicas en el mediastino superior.

Study of the effects of kinesthetic motor imagery in patients with heart failure.

OBJECTIVE: The aim was to investigate the acute effect of kinesthetic motor imagery of the 2-minute walk test on hemodynamic and cardiopulmonary variables in patients with heart failure. METHODS: Twenty participants were recruited for the analysis of these variables before and after the execution and imagination of the 2-minute walk test, with the number of laps executed and imagined being recorded. RESULTS: The main results observed showed that (1) there was no difference in the number of laps executed and imagined (p=0.41), indicating that the participants actually imagined the test and (2) the motor imagery of the 2-minute walk test immediately increased (p<0.001) the heart and respiratory rates. CONCLUSION: The motor imagery seems to have acute effects on the cardiopulmonary anticipatory responses of a patient with heart failure.

Acute effect of different duration times of application of myofascial release on quadriceps femoris strength: A randomized clinical trial.

OBJECTIVES: To evaluate the effect of Miofascial Release (MFR) on knee extensors strength, at different duration times of application. METHOD: 51 healthy individuals were randomly assigned to one of three groups (3min, 5min or placebo) in this randomized clinical trial. The knee extensors strength was assessed in two conditions: pre and post-intervention, using an isokinetic dynamometer, at speeds of 60° and 120°/s. MFR was applied on the anterior surface of the thigh for 3min or 5 min, according to the experimental groups. The placebo group underwent through the application of a non-therapeutic gel, associated with 3min of a light touch on the skin. Peak torque, total work and mean power were the isokinetic variables analyzed through a multivariate analysis of variance (MANOVA) with p ≤ 0.05. RESULTS: Our findings suggest a main effect and interaction between moments (pre and post-intervention) and speeds (60° and 120°/s) for total work and mean power (p < 0.01). Likewise, main effect and interaction of speed were observed for peak torque (p < 0.01). There were no significant differences for the other analyzed variables. CONCLUSION: No significant main effect of MFR were detected in any of the proposed application time on peak torque, total work and mean power, in the knee extensors, compared to the placebo group.

Análise cinemática da marcha com medidas normalizadas e não-normalizadas em indivíduos hígidos: um estudo experimental / Kinematic gait analysis with normalized and non-normalized measurements in healthy individuals: an experimental study

O objetivo deste estudo foi analisar as possíveis relações entre a variável antropométrica comprimento dos membros inferiores e de passada na marcha, com valores naturais e normalizados, em velocidade auto-selecionada e acrescida de 50%, em indivíduos adultos jovens. Foram avaliados 32 sujeitos hígidos adultos entre 18-25 anos. Os deslocamentos corporais nas duas velocidades foram registrados através da técnica de cineantropometria, utilizando o software Skillspector® para quantificar o comprimento da passada entre as médias dos dados normalizadas e não-normalizadas, do segmento direito e do segmento esquerdo. A comparação entre os valores médios das passadas normalizadas e não-normalizadas, nas diferentes velocidades, foi realizada por meio do teste t student (p < 0,05), assim como o grau de associação entre o comprimento da passada e o comprimento do membro inferior, realizada pelo teste de correlação de Pearson (p < 0,05). Sendo assim, nosso estudo constatou uma correlação positiva entre as variáveis estudadas, nas duas velocidades e, uma diferença entre a passada com dados normalizados e não normalizados, em ambas as velocidades. (AU)

The aim of this study was to analyze the possible relationships between the anthropometric variable length of the lower limbs and gait stride, with natural and normalized values, at self-selected speed and increased by 50%, in young adult individuals. 32 healthy adult subjects aged 18-25 years were evaluated. Body movements at both speeds were recorded using the kinanthropometry technique, using the Skillspector® software to quantify the stride length between the normalized and nonnormalized data averages for the right and left segments. The comparison between the mean values of normalized and non-normalized strides, at different speeds, was performed using the Student t test (p < 0.05), as well as the degree of association between stride length and lower limb length, performed by the Pearson correlation test (p < 0.05). Thus, our study found a positive correlation between the variables studied, at both speeds, and a difference between the stride with normalized and non-normalized data, at both speeds. (AU)

Immediate effects of myofascial release maneuver applied in different lower limb muscle chains on postural sway.

BACKGROUND: There is little evidence about the myofascial release maneuver (MLM) targeting the fascial tissue and its effect on postural balance. This study investigated the immediate effects of the MLM in different lower limb muscle chains on the postural sway of healthy men. METHODS: Sixty-three healthy men (27.2 ± 4.7 years) were randomly assigned to 7 groups (n = 9 each) to receive MLM applied to the lower limb muscle chains (anterior, posterior, medial, lateral, anterior/posterior, and medial/lateral) or placebo intervention. Skin pressure during the 3-min MLM was determined by the visual analog scale between 5 and 7 as previously assessed on participants. Posturography analysis of the elliptical area (Area) and average velocity (Vavg) of the center-of-pressure displacement was performed before and immediately after the MLM in single-leg support and with eyes closed. RESULTS: A two-way repeated measures analysis of variance showed no interaction effect of factors group and time (Area: p = 0.210, ω2 = 0.004; Vavg: p = 0.358, ω2 < 0.001). Within-factor main effect of time was observed for both Area (p < 0.001, ω2 = 0.038) and Vavg (p < 0.001, ω2 = 0.028), with decreased Area and Vavg after all interventions. No between-factor main effect of group was observed for Area or Vavg (MLM or placebo, p = 0.188 or higher). CONCLUSION: MLM applied to the lower limb muscle chains showed no immediate specific effects on postural sway in healthy men. Pre-post effects of MLM were not different from those elicited by a superficial massage. MLM in lower limb muscle chains is not advocated for an immediate improvement of postural balance in this population.

Muito além do consultório: uma análise multifacetada da marcha em pacientes neurológicos / Beyond the office: a multifaceted gait analysis in neurological patients

Introdução: A marcha pode ser definida como um padrão cíclico, na postura bípede, que utiliza os membros inferiores para propulsão do corpo. No campo da Neurologia, a marcha no exame físico representa sinais na avaliação neurológica, que auxiliam no fechamento de diagnósticos. No ambiente clínico, em especial nos consultórios, o refinamento da avaliação da marcha fica restrita a experiência do clínico, pois o espaço muitas vezes é reduzido, o tempo inadequado para avaliação. Poucos relatos na literatura abordaram a referida questão. Objetivo: Discutir os principais pontos da análise de marcha de interesse dos neurologistas, no consultório. Metodologia: Nessa revisão narrativa, foram levantados 32 artigos e, aplicados os critérios de elegibilidade, foram selecionados 6 artigos. A avaliação da marcha no consultório deve respeitar critérios, pois pode acarretar vieses dos parâmetros da marcha e dificultar a análise global. Conclusão: Por isso, há necessidade de maiores discussões, no âmbito do consultório, para melhor avaliar os parâmetros da marcha. (AU)

Introduction: Gait can be defined as a cicle pattern in biped posture that use to lower limb to body propulse. In Neurology, the physical exam of gait represents a neurological signal. This fact can help in the diagnosis conclusion. In a clinical setting and medical office, the critical evaluation is restricted to the physician´s expertise. The space of doctor´s room is often reduced and inappropriate time for evaluation. Objective: This study aimed to discuss the main points of gait analysis in neurological outpatients. Methods: In this narrative review, 32 articles were analyzed, and after included criteria, 6 articles were selected. In neurology medical office must respected criteria to no promote bias of gait parameter and complicate global assessment. Conclusion: Therefore, there is a need for further discussions, within the scope to better assess the gait parameters. (AU)

Reabilitação do polegar reimplantado: avaliação dos resultados funcionais em uma unidade de saúde no Rio de Janeiro / Rehabilitation of the replanted thumb: evaluation of functional results in a health unit in Rio de Janeiro

Introdução: O polegar é o dedo de maior importância funcional da mão, por isso a justificativa de reimplantação e reabilitação do mesmo. Objetivo: Realizar uma análise retrospectiva dos resultados, via revisão de prontuários de pacientes submetidos à reimplante de polegar, realizados pelo Serviço SOS-Reimplante do Hospital Estadual Adão Pereira Nunes. Metodologia: Trata-se de um estudo retrospectivo com amostra de conveniência, abrangendo o período entre janeiro de 2010 a dezembro de 2015, realizado através de prontuários de pacientes submetidos a processo de reimplante de polegar, atendidos no Serviço de Terapia Ocupacional/TO-Mão no Hospital estadual Adão Pereira Nunes, em Duque de Caxias, Rio de Janeiro. Foram coletadas informações sociodemográficas, além de força muscular, sensibilidade e tempo de reabilitação. Resultados: Foram revisados 63 prontuários de pacientes submetidos a procedimento de reimplante de polegar, na faixa etária de 18 a 65 anos. Quanto ao local do acidente, 76,1% dos casos foi decorrente de acidente de trabalho e 23,2% acidentes domésticos. Ao observamos à lateralidade da lesão, 92% dos pacientes eram destros, enquanto o polegar com maior número de lesões foi o esquerdo, com um total de 82,5% pacientes. Quanto ao nível da lesão, 25,3% pacientes sofreram lesão na falange proximal, 20,8% pacientes sofreram lesão na região da interfalangeana, e 53,9% dos pacientes apresentaram lesão na falange distal. Dentre os reencaminhados para nova avaliação, 28,5% pacientes, foram submetidos a outros procedimentos cirúrgicos. Houve ganho de força em global em 88,2% dos pacientes em de sensibilidade. Conclusão: A maioria dos pacientes que sofreram reimplante do polegar conseguiram obter ganho de força muscular e sensibilidade, conseguirem retornar as suas atividades laborais, com um tempo de reabilitação que variou de 4 a 14 meses. (AU)

Introduction: The thumb is the greatest functional finger of the hand, which is justifies its replantation and rehabilitation. Objective: To carry out a retrospective analysis of the medical records of patients undergoing thumb reimplantation, performed by the SOS-Reimplantation Service of the State Hospital Adão Pereira Nunes. Methodology: This is a retrospective study with a convenience sample, covering the period between January 2010 and December 2015, conducted thorough medical records of patients undergoing the process of thumb replantation, attended at the Occupational Therapy Service / TO - Hand at the Adão Pereira Nunes State Hospital, in Duque de Caxias, Rio de Janeiro. Sociodemographic information was collected, in addition to muscle strength, sensitivity, and rehabilitation time. Results: 63 medical records of patients who underwent thumb reimplantation procedure, aged 18 to 65 years, were reviewed. As for the accident site, 76.1% of the cases were due to occupational accidents and 23.2% to domestic accidents. When observing the laterality of the lesion, 92% of the patients were righthanded, while the thumb with the largest number of lesions was left, with a total of 82.5% patients. As for the level of the lesion, 25.3% of patients suffered an injury to the proximal phalanx, 20.8% of patients suffered an injury to the interphalangeal region, and 53.9% of the patients had lesions to the distal phalanx. Among those referred for further evaluation, 28.5% of patients underwent other surgical procedures. There was overall strength gain in 88.2% of patients in sensitivity. Conclusion: Most patients who underwent thumb reimplantation were able to obtain gains in muscle strength and sensitivity, being able to return to their work activities, with a rehabilitation time that varied from 4 to 14 months. (AU)

High-velocity, low-amplitude manipulation (HVLA) does not alter three-dimensional position of sacroiliac joint in healthy men: A quasi-experimental study.

The impact of high-velocity, low-amplitude (HVLA) manipulations on the behavior of sacroiliac joint (SIJ) mobility in individuals submitted to an osteopathic intervention has not been sufficiently investigated. Furthermore, there is no standard agreement on the description of the acute effects of HLVA with regards to the mobility of the SIJ through three-dimensional motion analysis. The purpose of this study was to analyse possible alterations in the mobility of the SIJ pre- and post-manipulation of the ilium bone in healthy men. Thirty healthy male patients aged between 18 and 35 years were examined and divided into two groups: manipulation (MN) and placebo (PL) groups. SIJ movement was assessed through a three-dimensional motion analysis system before and after osteopathic manipulation of the anterior ilium bone, during hip flexion. Statistical analysis was performed using the Kolmogorov-Smirnov normality test, and Fisher's exact test was used to observe associations of interest in the mobility of the SIJ. Finally, the t-test was used to analyse values of mobility of the SIJ pre- and post-manipulation (p < 0.05). Non-significant differences were observed in SIJ mobility. In MN the means were pre-manipulation right SIJ 39.98 mm ±â€¯10.82 [CI - 29.16-50.8] and post- 42.85 mm ±â€¯27.17 [CI - 15.68-70.02] with p = 0.61. Pre-manipulation left SIJ 41.73 mm ±â€¯15.34 [CI 10.89-82.99] and post- 39.97 mm ±â€¯14.70 [CI - 24.67-54.07] with p = 0.39. HVLA does not alter the mobility of SIJ under these conditions. Further studies under different conditions, with patients that report pain, are required to fully understand the behavior of the SIJ after HVLA manipulation.

Immediate effect of myofascial release on range of motion, pain and biceps and rectus femoris muscle activity after total knee replacement.

OBJECTIVES: The role of a myofascial release (MFR) on flexion contractures after total knee arthroplasty (TKA) has not yet been elucidated. Therefore, the purpose of this study was to determine its immediate effect on such patients. METHODS: In this A-B single subject experimental study, 33 TKA's patients with knee flexion contracture had their gluteal, posterior fascia lata, posterior crural and plantar fasciae released. Patients' knee range of motion (KROM), pain and muscle electric activity were assessed pre- and post-intervention. RESULTS: An increase in electric activity of the biceps femoris muscle was identified after treatment (pre RMS = 0.087 ± 0.066 V; post RMS = 0.097 ± 0.085 V; p = 0.037). Mean gain of KROM was 5.72 ± 6.27, correspondent to an 11.9% improvement (p = 0.01). Eight subjects had their pain decreased on 56.9% (p = 0.04). CONCLUSIONS: MFR increased muscle activity, reduced pain and improved the KROM of TKA patients. Thus, MFR is a useful resource of rehabilitation after TKA.

Cardiac autonomic response after cranial technique of the fourth ventricle (cv4) compression in systemic hypertensive subjects.

OBJECTIVE: The aim of this study was to compare blood pressure (BP) behavior and heart rate variability (HRV) among hypertensive stage I and normotensive individuals who were submitted to the cranial technique of the 4th ventricle compression (CV4), an osteopathic technique. METHODS: In this experimental controlled study, thirty men between 40 and 60 years old were evaluated and divided into two groups: normotensive (NT) and hypertensive (HT). The CV4 maneuver was applied in both groups and BP was measured at 5 (five) different stages: pre and post-intervention, 5, 10 and 15min after technique. Time-frequency parameters were obtained from measurements of RR intervals. Data were analyzed using an ANOVA two-way for analysis of the condition factor (NT and HT) and times with p-value ≤ .05. RESULTS: There was a reduction in the BP of the HT group. A significant intergroup difference (p = .01) was noticed, with respect to the standard deviation of successive normal R-R intervals (SDNN) values, mainly between pre-intervention and 15min stages. Concerning root mean square of the mean squared differences (RNSSD) values, the highlights were differences between pre-intervention and 10min (p = .01) only in the NT group. There was an increase in high frequencies (HF) values and a low frequencies (LF) attenuation in both groups at all different stages. CONCLUSION: The data showed a BP reduction in the HT group in pre-intervention/15min and an increase in parasympathetic activity and decreased sympathetic activity in both groups. This suggests a change in the sympathetic-vagal balance. However, further studies are needed to elucidate the data on BP reduction mechanisms with CV4.

Prevalence of Playing-related Musculoskeletal Disorders in String Players: A Systematic Review.

OBJECTIVE: This systematic review aimed to assess the methodological quality of articles about the prevalence of playing-related musculoskeletal disorders (PRMDs) in string players and to identify the rate of prevalence and associated factors of PRMD. METHODS: Cross-sectional studies describing data on separate string players published in 5 different languages between January 1, 1980, and January 31, 2014, were included. The following databases were searched: MEDLINE, sciELO, and LILACS. Other sources and reference lists of published papers also were searched. The Loney Scale was used by 2 independent reviewers to evaluate the methodological quality, and only studies that achieved high scores were included. RESULTS: Of 1910 retrieved articles, 34 cross-sectional studies were selected for methodological assessment. However, only 8 studies reached satisfactory methodological quality scores. The prevalence rate of PRMD was alarmingly high, ranging from 64.1% to 90%. Women and older musicians were more affected in comparison to other instrumentalists. There seems to be a predominance of symptoms in the left upper limb in violinists and violists, whereas cellists and bassists report injuries in the right upper limb. CONCLUSIONS: Professional and amateur string players are subject to development of PRMD. Low response rates were the most observed source of bias, and there is still a lack of publications with high methodological quality in the literature.

Corona Mortis: anatomical and surgical description on 60 cadaveric hemipelvises.

OBJECTIVE: to report the prevalence of arterial corona mortis and to describe its surgical and clinical applicabilities. METHODS: We dissected 60 hemipelvises (50 men and 10 women) fixed in a 10% formalin solution for the purpose of gathering information on corona mortis. We measured the caliber and length of the obturator artery and its anastomotic branch with the aid of a digital caliper and submitted the data to statistical analyzes and comparisons with the GraphPad Prism 6 software. RESULTS: arterial corona mortis was present in 45% of the studied sample. The most common origin of the obturator artery was the internal iliac artery; however, there was one exceptional case in which it originated from the femoral artery. The caliber of the anastomotic branch was on average 2.7mm, whereas the caliber of the obturator artery was 2.6mm. CONCLUSION: the vascular connections between the obturator, internal iliac, external iliac and inferior epigastric arterial systems are relatively common over the upper pubic branch. The diameter and a trajectory of the anastomotic artery may vary. Thus, iatrogenic lesions and pelvic and acetabular fractures can result in severe bleeding that puts the patient's life at risk.

Corona Mortis: anatomical and surgical description on 60 cadaveric hemipelvises / Corona Mortis: descrição anatômica e cirúrgica em 60 hemipelvis cadavéricas

ABSTRACT Objective: to report the prevalence of arterial corona mortis and to describe its surgical and clinical applicabilities. Methods: We dissected 60 hemipelvises (50 men and 10 women) fixed in a 10% formalin solution for the purpose of gathering information on corona mortis. We measured the caliber and length of the obturator artery and its anastomotic branch with the aid of a digital caliper and submitted the data to statistical analyzes and comparisons with the GraphPad Prism 6 software. Results: arterial corona mortis was present in 45% of the studied sample. The most common origin of the obturator artery was the internal iliac artery; however, there was one exceptional case in which it originated from the femoral artery. The caliber of the anastomotic branch was on average 2.7mm, whereas the caliber of the obturator artery was 2.6mm. Conclusion: the vascular connections between the obturator, internal iliac, external iliac and inferior epigastric arterial systems are relatively common over the upper pubic branch. The diameter and a trajectory of the anastomotic artery may vary. Thus, iatrogenic lesions and pelvic and acetabular fractures can result in severe bleeding that puts the patient's life at risk.

RESUMO Objetivo: relatar a prevalência da corona mortis arterial e descrever suas aplicabilidades cirúrgicas e clínicas. Métodos: sessenta hemipelvises (50 homens e 10 mulheres) fixadas em uma solução de formalina a 10% foram dissecadas com o propósito de obter informações sobre a corona mortis. Medidas do calibre e comprimento da artéria obturatória e seu ramo anastomótico foram mensuradas com o auxílio de um paquímetro digital e submetidas a análises e comparações estatísticas no programa GraphPad Prism 6. Resultados: a corona mortis arterial esteve presente em 45% da amostra estudada. A origem mais comum da artéria obturatória foi da artéria ilíaca interna, porém, houve um caso excepcional no qual a artéria obturatória se originou da artéria femoral. O calibre do ramo anastomótico foi em média 2.7mm, enquanto que o calibre da artéria obturatória foi 2.6mm. Conclusão: as conexões vasculares entre os sistemas obturatório, ilíacos interno e externo e epigástrico inferior são relativamente comuns sobre o ramo superior da pube. O diâmetro e a trajetória dessa artéria anastomótica podem variar. Assim, lesões iatrogênicas, fraturas pélvicas e acetabulares podem resultar em hemorragias graves que colocam a vida do paciente em risco.

Acute effect of Kinesio Taping on knee pain and stability. Case report / Efeito agudo da Kinesio Taping na dor e estabilidade do joelho. Relato de caso

ABSTRACT BACKGROUND AND OBJECTIVES: Knee stability is critical for the execution of functional tasks, maintaining the joint within physiologic limits and preventing possible mechanical loads. A type of taping being increasingly used in recent years is Kinesio Taping, which is often used as resource to improve joint stability and decrease pain. This study aimed at evaluating the acute effect of Kinesio Taping on stability and pain in a patient with chronic knee instability. CASE REPORT: Male patient, 46 years old, with chronic knee instability due to late postoperative period of Anterior Cruciate Ligament injury, was evaluated during two functional activities (up/ down a stair and squat), before and immediately after Kinesio Taping. Evaluation tools were visual analog scale and videometry to evaluate knee varus angle peak during functional activities. There has been significant decrease (p<0.001) in mean knee varus angle peak during functional activities up/ down a stair (Pro-Kinesio: 189.4; Post-Kinesio: 186.2) and squat (Pre-Kinesio: 198.2; Post-Kinesio: 189.6). There has also been decrease in the visual analog scale for up/down a stair (Pre-Kinesio: 4; Post-Kinesio: 0) and squat (Pre-Kinesio: 3; Post-Kinesio: 0). CONCLUSION: Our results suggest that Kinesio Taping was effective to improve knee dynamic stability and decrease pain during functional activities of going up/down a stair and squat.

RESUMO JUSTIFICATIVA E OBJETIVOS: A estabilidade do joelho é fundamental para a execução de tarefas funcionais, mantendo a articulação dentro dos limites fisiológicos e evitando possíveis sobrecargas mecânicas. Um tipo de bandagem que vem ganhando destaque nos últimos anos é a Kinesio Taping, que é frequentemente usada como um recurso para melhorar a estabilidade articular e diminuir o quadro álgico. O objetivo deste estudo foi avaliar o efeito agudo do uso da Kinesio Taping na estabilidade e dor em paciente com instabilidade crônica de joelho. RELATO DO CASO: Paciente do sexo masculino, 46 anos, com instabilidade crônica de joelho, decorrente de pós-operatório tardio de lesão do ligamento cruzado anterior foi avaliado durante duas atividades funcionais (subida/descida no degrau e agachamento), antes e imediatamente após a Kinesio Taping. Os instrumentos de avaliação usados foram a escala analógica visual e a videometria para análise de pico do ângulo varo do joelho durante as atividades funcionais. Observou-se diminuição significativa (p<0,001) da média do pico de ângulo varo do joelho durante as atividades funcionais, subida/descida no degrau (Pré-Kinesio: 189,4; Pós-Kinesio: 186,2), e agachamento (Pré-Kinesio: 198,2; Pós-Kinesio: 189,6). Também houve diminuição da escala analógica visual, subida/descida no degrau (Pré-Kinesio: 4; Pós-Kinesio: 0) e agachamento (Pré-Kinesio: 3; Pós-Kinesio: 0). CONCLUSÃO: Os resultados do presente trabalho sugerem que a Kinesio Taping se mostrou eficaz na melhora da estabilidade dinâmica do joelho e diminuição da dor durante as atividades funcionais de subida/descida no degrau e agachamento.

Efeito imediato da técnica de mobilização nas interfaces fasciais profundas da região peitoral em pacientes submetidas à mastectomia / Immediate effect of deep fascia mobilization of the pectoral region in patients submitted to mastectomy

Introdução: O câncer de mama apresenta alta incidência, morbidade e mortalidade. Seu tratamento pode acarretar diferentes complicações, com repercussões físicas, emocionais e sociais. No âmbito da reabilitação das alterações musculoesqueléticas, condutas de prevenção e tratamento das complicações pós-operatórias têm merecido atenção especial, dentre elas podemos destacar as disfunções da cintura escapular e ombro. As abordagens terapêuticas miofasciais no tratamento das disfunções do ombro pós-operatórias podem favorecer o restabelecimento da função do membro superior. Objetivo: Analisar o efeito imediato da técnica de mobilização fascial profundas na dor e no arco de movimento (ADM) em mulheres submetidas à mastectomia. Métodos: Neste estudo pré e pós-intervenção em 28 mulheres mastectomizadas, com intercostobraquialgia e bloqueio de ADM para a flexão do braço, as pacientes foram submetidas à técnica de mobilização fascial profunda da região peitoral, em uma única intervenção de 10 segundos. A flexão do braço foi mensurada por meio da fotogoniometria e a dor avaliada pela escala analógica visual (EVA). Os dados de ADM foram analisados através do Teste T student com um nível de significância de 95% (p < 0,05). Resultados: A média da ADM pré-intervenção foi de 109,99o e pós de 146,08o (p = 0,001) com um percentual médio de melhora de 32% (± 24,26). A dor teve um percentual de redução pré e pós-intervenção de 60% (± 24,26). Os dados apontaram para um ganho de ADM e diminuição da dor nas disfunções do ombro decorrente da mastectomia. Conclusão: Novas investigações devem ser realizadas para avaliar os resultados da técnica de liberação miofascial profunda em outros movimentos do ombro, como também comparar com as demais estratégias cinesioterapêuticas no tratamento das disfunções do ombro em mulheres mastectomizadas. (AU)

Introduction: Breast cancer has high incidence, morbidity and mortality and its treatment can result in different complication with physical, emotional and social repercussions. In musculoeskeletal rehabilitation, prevention and postoperative treatment of complications have been highlighted, especially in scapular girdle and shoulder. Myofascial technique in treatment of the shoulder dysfunctions can benefit the reestablishment in upper limb function. Objective: The aim of this study was to evaluate the effect of deep myofascial technique in pain and range of motion (ROM), in women post-surgery breast cancer. Methods: In this study pre and post intervention, 28 subjects with intercostobrachialgia and decreasing ROM were analyzed and submitted to only one intervention during 10 seconds in deep pectoral fascia. Arm flexion was evaluated using photogoniometric technique and for pain Visual Analogical Scale (VAS). ROM data was analyzed by Test T student with level of significance 95% (p < 0.05). Results: The mean of ROM pre-intervention was 109,9o and post 146,08o (p = 0.001) and ROM percentage gain 32% (± 24.26). There was 60% of pain percentage reduction between pre and post intervention. The results revealed increase of ROM and decrease of pain in shoulders dysfunction due to mastectomy. Conclusion: Further investigations should be performed to evaluate the results of deep myofascial technique in different shoulders movements, as well as to compare with other therapeutic exercise strategies to treat shoulder dysfunction of mastectomized women. (AU)

A influência do status socioeconômico sobre as habilidades motoras grossas nas crianças em idade escolar / The influence of socioeconomic status on gross motor skills in school-age children

O processo de desenvolvimento motor ocorre de acordo com o padrão estabelecido por fatores biológicos e também pela influência de fatores ambientais/sociais. O status socioeconômico familiar pode ser um importante fator interveniente nas possibilidades de adquirir as habilidades motoras fundamentais necessárias ao desenvolvimento geral da criança, com sérias implicações futuras. Este trabalho tem como objetivo analisar as possíveis relações entre status socioeconômico sobre as habilidades motoras grossas em indivíduos em idade escolar. Metodologicamente utilizamos uma revisão sistemática com as as palavras-chave (children, fundamental motor skills, motor skills, gross motor skills, motor ability, motor competence, gross motor competence, motor skill proficiency, socioeconomic status, low economic income) para identificar artigos de banco de dados eletrônicos Scopus e PubMed, resultando em 19 artigos que formaram esta revisão. Os critérios de inclusão foram: a) escolares com idades entre 6 e 15 anos; b) avaliação das habilidades motoras grossas; c) houvesse dois ou mais grupos da amostra classificados quanto ao status socioeconômico e d) crianças hígidas. Os principais resultados mostraram uma prevalência de crianças de alto status socioeconômico com maior pontuação nas habilidades motoras em relação às crianças de baixo status socioeconômico, mas este resultado não foi homogêneo. (AU)

The motor development process occurs according to the pattern established by biological factors and by environmental/social factors influence. Family socioeconomic status can be an important intervening factor in the possibilities of acquiring the fundamental motor skills necessary for the general development of the child, with serious future implications. This work aimed to analyze the possible relationships between socioeconomic status on gross motor skills in school age individuals. Methodologically, we used a systematic review with the following keywords (children, fundamental motor skills, motor skills, motor ability, motor competence, motor skill proficiency, socioeconomic status, low economic income) to identify data, resulting in 19 articles that composed this review. The inclusion criteria were: a) schoolchildren aged between 6 and 15 years; b) gross motor skills performance evaluation; c) two or more sample groups classified as socioeconomic status and d) healthy children. The main results showed a prevalence of high socioeconomic status children with higher scores in motor skills compared to low socioeconomic status children, but this result was not homogeneous. (AU)

Clinical features of a rare anatomical variation of the posterior tibial and fibular arteries / Aspectos clínicos de uma variação anatômica rara das artérias tibial posterior e fibular

Abstract The posterior tibial artery normally arises from tibial-fibular trunk at the popliteal fossa, together with the fibular artery. The classic course of the posterior tibial artery is to run between the triceps surae muscle and muscles of the posterior compartment of the leg before continuing its course posteriorly to the medial malleolus, while the fibular artery runs through the lateral margin of the leg. Studies of both arteries are relevant to the fields of angiology, vascular surgery and plastic surgery. To the best of our knowledge, we report the first case of an anastomosis between the posterior tibial artery and the fibular artery in their distal course. The two arteries joined in an unusual “X” format, before division of the posterior tibial artery into plantar branches. We also provide a literature review of unusual variations and assess the clinical and embryological aspects of both arteries in order to contribute to further investigations regarding these vessels.

Resumo A artéria tibial posterior e a artéria fibular se originam do tronco tibiofibular, na fossa poplítea. A trajetória clássica da artéria tibial posterior é correr entre o tríceps sural e os músculos do compartimento posterior da perna, e, então, seguir posteriormente ao maléolo medial. Já a artéria fibular corre na margem lateral da perna, seguindo profundamente aos músculos. O estudo dessas artérias é relevante para o campo da angiologia, cirurgia vascular e cirurgia plástica. O presente trabalho é o primeiro relato de caso de uma anastomose entre ambas artérias, na porção distal de suas trajetórias. Tais artérias se anastomosaram em formato de “X”, antes da divisão da artéria tibial posterior em ramos plantares. Foi feita uma revisão de literatura das variações de tais artérias, dando ênfase ao aspecto clínico e embriológico, de modo a contribuir para novas investigações sobre esses vasos.

Tensões e (dis)tensões no processo de recuperação física de jogadores de futebol profissional no Rio de Janeiro: a visão do fisioterapeuta / Las tensiones y (dis)tensiones en el proceso de recuperación física de jugadores de fútbol profesional de Rio de Janeiro: desde la mirada del fisioterapeuta / Tensions and (dis)tensions in the process of physical recovery of professional football players in Rio de Janeiro: a physical therapist's vision

RESUMO Este estudo analisa o papel dos fisioterapeutas, identificando eventuais problemas éticos ou sociais que ocorram durante o seu trabalho no clube de futebol, tais como pressões sofridas e momentos de tensões vividos por estes profissionais. Esta pesquisa possui um caráter qualitativo, o instrumento utilizado para a coleta de dados foi a entrevista semiestruturada. Foram gravados relatos de oito fisioterapeutas dos clubes de futebol profissional da primeira divisão do Estado do Rio de Janeiro. Os dados foram analisados qualitativamente por meio da análise de conteúdo e, objetivamente, duas categorias foram identificadas a posteriori, e foram destacadas das falas dos entrevistados: as pressões que partiam dos próprios atletas e as pressões que partiam dos clubes na figura dos dirigentes. Os resultados apontaram que essas pressões existem e vêm de todas as partes, de seus dirigentes nos clubes, de jogadores e até mesmo do próprio departamento de Medicina Esportiva. Este processo, inequivocamente, resulta em períodos de conflito e tensões dentro do ambiente de trabalho, tais como: a aceleração da reabilitação de um atleta sem que ele esteja apto a jogar. Isso é apontado como um dos principais aspectos no comprometimento da saúde dos atletas e o impedimento de realizar um trabalho mais qualificado por parte dos profissionais de fisioterapia.

RESUMEN En este artículo se analizó el rol de los fisioterapeutas, señalando los principales problemas éticos o sociales que ocurren durante su trabajo en un club de fútbol, tales como presiones sufridas y momentos de tensiones vividos por dichos profesionales. Este estudio es de carácter cualitativo, para la recolección de datos se utilizó la entrevista semiestructurada. Se grabaron ocho relatos de fisioterapeutas de clubes de fútbol profesional de primera división del Estado de Rio de Janeiro. Se analizaron los datos cualitativamente mediante el análisis del contenido, y objetivamente se identificaron dos categorías a posteriori, y se puso de relieve de los relatos de los entrevistados: las presiones de los propios atletas y las presiones de los clubes, mediante sus dirigentes. Los resultados señalaron que hay presiones de todas partes, de los dirigentes de los clubes, de los jugadores incluso del propio departamento de Medicina Deportiva. Este proceso inequívocamente resulta en periodos de conflicto y tensiones dentro del ambiente laboral, tales como la aceleración de la rehabilitación del atleta sin que esté listo para volver a jugar. A ello se señala como uno de los principales aspectos en el comprometimiento de la salud de los atletas y en la imposibilidad de los profesionales de fisioterapia en realizar un trabajo con una mejor calidad.

ABSTRACT The purpose of this study is to analyze the role of physical therapists, identifying possible ethical or social problems occurred during their work at football clubs, such as pressures suffered and moments of tension experienced by these professionals. This research is qualitative in nature with a semi-structured interview being the instrument used to collect data. Reports provided by eight physical therapists from professional football clubs in the first division of the state of Rio de Janeiro were recorded. The data were objectively and qualitatively analyzed by means of Content Analysis. Two categories were retrospectively identified with two statements given by the respondents being underlined: the pressures that originate from their own athletes and the pressures that come from the club management. The results showed that these pressures exist and come from all areas; from the clubs in the form of their directors and players and even from their own Sports Medicine department. This process unequivocally results in periods of conflicts and tensions within the working environment, namely: the acceleration of an athlete's rehabilitation without he/she being able to play. This aspect is earmarked as one of the main aspects of athletes' health being compromised and of the obstacles in the way of physiotherapy professionals performing more competent work.

Clinical features of a rare anatomical variation of the posterior tibial and fibular arteries.

The posterior tibial artery normally arises from tibial-fibular trunk at the popliteal fossa, together with the fibular artery. The classic course of the posterior tibial artery is to run between the triceps surae muscle and muscles of the posterior compartment of the leg before continuing its course posteriorly to the medial malleolus, while the fibular artery runs through the lateral margin of the leg. Studies of both arteries are relevant to the fields of angiology, vascular surgery and plastic surgery. To the best of our knowledge, we report the first case of an anastomosis between the posterior tibial artery and the fibular artery in their distal course. The two arteries joined in an unusual "X" format, before division of the posterior tibial artery into plantar branches. We also provide a literature review of unusual variations and assess the clinical and embryological aspects of both arteries in order to contribute to further investigations regarding these vessels.

A artéria tibial posterior e a artéria fibular se originam do tronco tibiofibular, na fossa poplítea. A trajetória clássica da artéria tibial posterior é correr entre o tríceps sural e os músculos do compartimento posterior da perna, e, então, seguir posteriormente ao maléolo medial. Já a artéria fibular corre na margem lateral da perna, seguindo profundamente aos músculos. O estudo dessas artérias é relevante para o campo da angiologia, cirurgia vascular e cirurgia plástica. O presente trabalho é o primeiro relato de caso de uma anastomose entre ambas artérias, na porção distal de suas trajetórias. Tais artérias se anastomosaram em formato de "X", antes da divisão da artéria tibial posterior em ramos plantares. Foi feita uma revisão de literatura das variações de tais artérias, dando ênfase ao aspecto clínico e embriológico, de modo a contribuir para novas investigações sobre esses vasos.