Capacidade funcional e déficits do controle postural em mulheres com síndrome da dor no grande trocânter / Functional capacity and deficits in postural control in women with greater trochanteric pain syndrome

Objetivo: Estabelecer a capacidade física e alterações do controle postural (COP) durante o apoio unipodal estático e dinâmico em mulheres com Síndrome de Dor no Grande Trocânter (SDGT). Métodos: Foram avaliadas 36 mulheres, sedentárias, maiores de 45 anos. Destas, 18 tinham diagnóstico de SDGT (Grupo Dor - GD) e 18 sem queixas álgicas (Grupo Controle - GC). Todas responderam ao questionário Victorian Institute of Sports Assessment for Gluteal Tendinopathy (VISA-G) para análise da capacidade física relacionada a dor lateral do quadril, e foram submetidas à avaliação do controle postural na plataforma de força, em apoio unipodal estático e dinâmico (mini agachamentos). Os dados foram comparados e correlacionados, com significância estatística estabelecida 5%. Resultados: As participantes do GD apresentaram alto índice de dor (7), por 10 meses e baixa capacidade funcional (54,44 pontos no VISA-G). Na análise do controle postural estático, GD mostrou piores resultados para a área de oscilação do COP (p= 0,04) e maior amplitude de oscilação médio-lateral (p= 0,03). Na avaliação dinâmica, os resultados da amplitude médio-lateral (p= 0,02) e velocidade antero posterior (p= 0,04) foram maiores no GD, mas o COP foi pior no GC (p= 0,01). Conclusão: Mulheres com SDGT tem baixa capacidade funcional e pior controle postural estático e dinâmico. Estas variáveis devem ser avaliadas para estabelecer novas estratégias de prevenção e reabilitação em mulheres com SDGT

Objective: To establish physical capacity and changes in postural control (PCO) during static and dynamic single-legged support in women with Greater Trochanter Pain Syndrome (GTPS). Methods: A total of 36 sedentary women over 45 years of age were evaluated. Of these, 18 had a diagnosis of GTPS (Pain Group - DG), and 18 had no pain complaints (Control Group - CG). All participants answered the Victorian Institute of Sports Assessment for Gluteal Tendinopathy (VISA-G) questionnaire to analyze their physical capacity regarding lateral hip pain. Therefore, were submitted to the evaluation of postural control on the force platform in static and dynamic single-legged support (mini squats). The data were compared and correlated, with statistical significance established at 5%. Results: The participants in the DG presented a high pain index (7) for 10 months and low functional capacity (54.44 points in the VISA-G). In the analysis of static postural control, DG showed worse results for the Center of Pressure (COP) oscillation area (p= 0.04) and greater amplitude of mediolateral oscillation (p= 0.03). In the dynamic evaluation, the results of the mediolateral amplitude (p= 0.02) and anteroposterior velocity (p= 0.04) were higher in the DG, but the COP was worse in the CG (p= 0.01). Conclusion: Women with GTPS have lower functional capacity and worse static and dynamic postural control. These variables should be evaluated to establish new prevention and rehabilitation strategies for women with GTPS

Greater trochanteric pain syndrome in women: Analysis of magnetic resonance, sagittal alignment, muscular strength and endurance of the hip and trunk.

INTRODUCTION: There are many studies on the Greater Trochanteric Pain Syndrome (GTPS), however its relationship with radiographic and biomechanics parameters is not established. OBJECTIVE: To compare the magnetic resonance images (MRI) of the hip, radiographic parameters of sagittal alignment (pelvic incidence, sacral slope and lumbar lordosis), muscular strength and endurance in women with and without GTPS. METHODS: Forty women, age over 45, IMC <30 Kg/m2 and sedentary, were recruited and distributed in two groups: GTPS group (GTPSG, n = 20) and Control group (CG, n = 20). All participants underwent MRI scans and X-ray for sagittal alignment analysis in the hip and performed tests for muscular strength and endurance of the hip and trunk. RESULTS: No differences were found between the GTPSG and CG for the frequency of tendinopathy (P = .30), peritendinitis (P = .10), bursitis (P = .68) and enthesitis (P = .15), however the gluteus medius tendon tear was more prevalent in GTPSG (P = .05). There were no differences in radiographic parameters for pelvic incidence (P > .05), sacral slope (P > .05) and lumbar lordosis (P > .05). The GTPSG showed lower strength of all hip muscle groups (abductors, adductors, flexors, extensors and rotators; P < .01 for all), as well as lower endurance in the Supine Bridge test and Prone bridge test (P < .01). CONCLUSION: The results of the MRI and radiographic parameters did not differentiate women with and without GTPS. However, the evaluation of muscle strength and endurance can establish the difference between groups.

Neurotrophin expression and histomorphometric evaluation in Wistar rats subjected to neural mobilization after compression of the median nerve.

OBJECTIVE: To evaluate the neurotrophin mRNA expression and axon count in the median nerve of Wistar rats submitted to neural mobilization (NM) after nerve compression. METHODS: Eighteen animals were randomly divided into G1 (nerve compression only), G2 (NM for 1 min), and G3 (NM for 3 min). For NM, the animals were anesthetized and the right scapula received the mobilization, adapted as indicated for humans, on alternate days, from the third to the 13th postoperative (PO) day, totaling six days of therapy. On the 14th PO day, animals were anesthetized and euthanized. Fragments of the median nerve, distal to the compression procedure, were removed for histomorphometric analysis and expression of neurotrophins, nerve growth factor (NGF), and brain-derived neurotrophic factor (BDNF) by RT-PCR. RESULTS: Histomorphometric analysis revealed differences in the number of axons in the injured side, which was significantly lower in the injured limb nerve compared to the control limb, whereas the RT-PCR analysis showed no significant differences in the expression of NGF or BDNF. CONCLUSION: NM treatment did not affect median nerve regeneration, which maintained normal recovery rates.

OBJETIVO: Avaliar a expressão de RNAm de neurotrofinas e a contagem de axônios no nervo mediano de ratos Wistar submetidos à mobilização neural (MN) após compressão nervosa. MÉTODOS: Foram divididos aleatoriamente 18 animais em G1 (apenas compressão nervosa), G2 (MN por 1 minuto) e G3 (MN por 3 minutos). Para a MN, os animais foram anestesiados e o membro escapular direito recebeu a mobilização, adaptada da forma indicada para humanos, em dias alternados, do terceiro ao 13° dia de pós-operatório (PO), em seis dias de terapia. No 14° dia PO, os animais foram anestesiados e eutanasiados. Fragmentos do nervo mediano, distais ao procedimento de compressão, foram retirados para análise histomorfométrica e de expressão das neutrotrofinas, fator de crescimento do nervo (NGF) e fator de crescimento derivado do cérebro (BNDF) por RT-PCR. RESULTADOS: A análise histomorfométrica evidenciou diferenças no número de axônios nos lados lesionados, que foi significativamente menor no nervo do membro lesado comparado com o membro controle; por sua vez, a análise por RT-PCR não apontou diferenças significativas na expressão de NGF e nem de BNDF. CONCLUSÃO: O tratamento de MN não afetou a regeneração do nervo mediano, que manteve índices normais de recuperação.

Neurotrophin expression and histomorphometric evaluation in Wistar rats subjected to neural mobilization after compression of the median nerve / Expressão de neurotrofinas e avaliação histomorfométrica em ratos Wistar submetidos à mobilização neural após compressão do nervo mediano

ABSTRACT Objective: To evaluate the neurotrophin mRNA expression and axon count in the median nerve of Wistar rats submitted to neural mobilization (NM) after nerve compression. Methods: Eighteen animals were randomly divided into G1 (nerve compression only), G2 (NM for 1 min), and G3 (NM for 3 min). For NM, the animals were anesthetized and the right scapula received the mobilization, adapted as indicated for humans, on alternate days, from the third to the 13th postoperative (PO) day, totaling six days of therapy. On the 14th PO day, animals were anesthetized and euthanized. Fragments of the median nerve, distal to the compression procedure, were removed for histomorphometric analysis and expression of neurotrophins, nerve growth factor (NGF), and brain-derived neurotrophic factor (BDNF) by RT-PCR. Results: Histomorphometric analysis revealed differences in the number of axons in the injured side, which was significantly lower in the injured limb nerve compared to the control limb, whereas the RT-PCR analysis showed no significant differences in the expression of NGF or BDNF. Conclusion: NM treatment did not affect median nerve regeneration, which maintained normal recovery rates.

RESUMO Objetivo: Avaliar a expressão de RNAm de neurotrofinas e a contagem de axônios no nervo mediano de ratos Wistar submetidos à mobilização neural (MN) após compressão nervosa. Métodos: Foram divididos aleatoriamente 18 animais em G1 (apenas compressão nervosa), G2 (MN por 1 minuto) e G3 (MN por 3 minutos). Para a MN, os animais foram anestesiados e o membro escapular direito recebeu a mobilização, adaptada da forma indicada para humanos, em dias alternados, do terceiro ao 13° dia de pós-operatório (PO), em seis dias de terapia. No 14° dia PO, os animais foram anestesiados e eutanasiados. Fragmentos do nervo mediano, distais ao procedimento de compressão, foram retirados para análise histomorfométrica e de expressão das neutrotrofinas, fator de crescimento do nervo (NGF) e fator de crescimento derivado do cérebro (BNDF) por RT-PCR. Resultados: A análise histomorfométrica evidenciou diferenças no número de axônios nos lados lesionados, que foi significativamente menor no nervo do membro lesado comparado com o membro controle; por sua vez, a análise por RT-PCR não apontou diferenças significativas na expressão de NGF e nem de BNDF. Conclusão: O tratamento de MN não afetou a regeneração do nervo mediano, que manteve índices normais de recuperação.

Nociceptive and histomorphometric evaluation of neural mobilization in experimental injury of the median nerve.

The carpal tunnel syndrome is the most common peripheral neuropathy in the upper limb, but its treatment with conservative therapies such as neural mobilization (NM) is still controversial. The aim of this study was to investigate the efficacy of the NM as treatment in a model of median nerve compression. 18 Wistar rats were subjected to compression of the median nerve in the right elbow proximal region. Were randomly divided into G1 (untreated), G2 (NM for 1 minute), and G3 (NM for 3 minutes). For treatment, the animals were anesthetized and the right forelimb received mobilization adapted to humans, on alternated days, from the 3rd to the 13th day postoperatively (PO), totaling six days of therapy. Nociception was assessed by withdrawal threshold, and after euthanasia histomorphometric analysis of the median nerve was performed. The nociceptive evaluation showed in G2 and G3 delay in return to baseline. Histomorphometric analysis showed no significant differences in the variables analyzed. It is concluded that the NM was not effective in reducing nociceptive sensation and did not alter the course of nerve regeneration.