Whole-body vibration therapy does not improve the peripheral nerve regeneration in experimental model.

OBJECTIVES: Whole-body vibration (WBV) is commonly used to improve motor function, balance and functional performance, but its effects on the body are not fully understood. The main objective was to evaluate the morphometric and functional effects of WBV in an experimental nerve regeneration model. METHODS: Wistar rats were submitted to unilateral sciatic nerve crush and treated with WBV (4-5 weeks), started at 3 or 10 days after injury. Functional performances were weekly assessed by sciatic functional index, horizontal ladder rung walking and narrow beam tests. Nerve histomorphometry analysis was assessed at the end of the protocol. RESULTS: Injured groups, sedentary and WBV started at 3 days, had similar functional deficits. WBV, regardless of the start time, did not alter the histomorphometry parameters in the regeneration process. CONCLUSIONS: The earlier therapy did not change the expected and natural recovery after the nerve lesion, but when the WBV starts later it seems to impair function parameter of recovery.

Changing Concepts for the Diagnosis of Carpal Tunnel Syndrome in Powerlifting Athletes with Disabilities.

Objective To examine the prevalence of carpal tunnel syndrome in powerlifting athletes with disabilities. Methods The present study evaluated the presence and intensity of pain (numerical scale), nocturnal paresthesia (self-report), and nerve compression (Tinel and Phalen signs) in wheelchair- and non-wheelchair-bound powerlifting athletes with disabilities. The clinical diagnosis of carpal tunnel syndrome was confirmed by the presence of two or more signs/symptoms. Results In total, 29 powerlifting athletes with disabilities were evaluated. None of the athletes reported the presence of pain or nocturnal paresthesia. The Tinel sign was present in 1 (3.45%) wheelchair-bound athlete. A positive Phalen test was present in 3 (10.35%) athletes (1 wheelchair-bound and 2 non-wheelchair-bound). Concurrent positive Tinel sign and Phalen sign tests were found in 2 (6.89%) athletes (1 wheelchair-bound and 1 non-wheelchair-bound). Conclusion Carpal tunnel syndrome was clinically diagnosed in 2 (6.89%) out of 29 powerlifting athletes with disabilities.

Changing Concepts for the Diagnosis of Carpal Tunnel Syndrome in Powerlifting Athletes with Disabilities / Mudando os conceitos para o diagnóstico da Síndrome do Túnel do Carpo em atletas do halterofilismo do esporte adaptado

Abstract Objective To examine the prevalence of carpal tunnel syndrome in powerlifting athletes with disabilities. Methods The present study evaluated the presence and intensity of pain (numerical scale), nocturnal paresthesia (self-report), and nerve compression (Tinel and Phalen signs) in wheelchair- and non-wheelchair-bound powerlifting athletes with disabilities. The clinical diagnosis of carpal tunnel syndrome was confirmed by the presence of two or more signs/symptoms. Results In total, 29 powerlifting athletes with disabilities were evaluated. None of the athletes reported the presence of pain or nocturnal paresthesia. The Tinel sign was present in 1 (3.45%) wheelchair-bound athlete. A positive Phalen test was present in 3 (10.35%) athletes (1 wheelchair-bound and 2 non-wheelchair-bound). Concurrent positive Tinel sign and Phalen sign tests were found in 2 (6.89%) athletes (1 wheelchair-bound and 1 non-wheelchair-bound). Conclusion Carpal tunnel syndrome was clinically diagnosed in 2 (6.89%) out of 29 powerlifting athletes with disabilities.

Resumo Objetivo Examinar a prevalência da síndrome do túnel do carpo em atletas do halterofilismo do esporte adaptado. Métodos Este estudo avaliou a presença e a intensidade da dor (escala numérica), a parestesia noturna (autorrelato), e a compressão nervosa (sinais de Tinel e de Phalen) em atletas do halterofilismo do esporte adaptado em cadeira de rodas e sem cadeira de rodas. O diagnóstico clínico da síndrome do túnel do carpo foi confirmado pela presença de dois ou mais sinais/sintomas. Resultados Vinte e nove atletas de halterofilismo de esporte adaptado foram avaliados. Nenhum dos atletas relatou a presença de dor ou parestesia noturna. O sinal de Tinel estava presente em 1 (3,45%) atleta de cadeira de rodas. O teste de Phalen positivo estava presente em 3 (10,35%) atletas (1 em cadeira de rodas e 2 sem cadeira de rodas). Testes positivos de sinais de Tinel e de Phalen foram encontrados concomitantemente em 2 (6,89%) atletas (1 em cadeira de rodas e 1 sem cadeira de rodas). Conclusão A síndrome do túnel do carpo foi diagnosticada clinicamente em 2 (6,89%) dos 29 atletas com deficiência física.

Interference of the Carpal Tunnel syndrome symptoms on occupational performance / Interferência dos sintomas da síndrome do Túnel do Carpo no desempenho ocupacional

ABSTRACT BACKGROUND AND OBJECTIVES: The Carpal Tunnel syndrome is characterized as the compression syndrome with the highest incidence in the population, impairing the upper limbs and, consequently, occupational performance. The objective of this study was to identify the symptoms of the compression syndrome and the impact of the disease on upper extremity disorders in relation to occupational performance. METHODS: This is a quantitative study with a descriptive approach, conducted with adults, both male and female, diagnosed with Carpal Tunnel syndrome. There was an initial evaluation to identify pain, edema, paresthesia, sensitivity alteration, and muscle weakness. The Disabilities of the Arm, Shoulder and Hand was used to assess the performance of fine motor activities as well as broader movements that require motor skills. This study used only the part of the instrument that evaluates the severity of symptoms concerning the week before the interview and other implications as pain, discomfort and weakness, difficulty in moving the upper limb, and to sleep. RESULTS: Fifteen adults diagnosed with the Carpal Tunnel syndrome participated in this study (27 affected limbs), being the dominant side the most undermined. The main complaint was pain, with higher intensity at night, followed by paresthesia. The Carpal Tunnel syndrome also compromises occupational performance, especially in activities using hands, and in sleep quality. CONCLUSION: It was noticed that the Carpal Tunnel syndrome interferes with occupational performance, as well as that pain is the main complaint.

RESUMO JUSTIFICATIVA E OBJETIVOS: A síndrome do Túnel do Carpo caracteriza-se por ser a compressiva de maior incidência na população, comprometendo os membros superiores e, consequentemente o desempenho ocupacional. O objetivo deste estudo foi identificar os principais sintomas da síndrome compressiva e o impacto da doença nas desordens da(s) extremidade(s) superior(es) em relação ao desempenho ocupacional. MÉTODOS: Trata-se de um estudo quantitativo com abordagem descritiva, realizado com pessoas adultas diagnosticadas com síndrome do Túnel do Carpo, de ambos os sexos. Houve a realização de avaliação inicial para identificar dor, edema, parestesia, alteração da sensibilidade e fraqueza muscular. O Disabililies of the Arm, Shoulder and Hand também foi usado para avaliar a capacidade de realizar movimentos motores finos, bem como movimentos mais amplos e que exigem capacidades motoras. No presente estudo, utilizou-se apenas a parte do instrumento que avalia a gravidade dos sintomas em relação à semana anterior da entrevista, além de outras implicações como dor, desconforto, fraqueza, dificuldade em mover o membro superior e dificuldade para dormir. RESULTADOS: Participaram do estudo 15 pessoas com síndrome do Túnel do Carpo, totalizando 27 membros acometidos, sendo o lado dominante o mais comprometido. A queixa principal foi a dor, com maior intensidade no período noturno, seguida de parestesia. A síndrome compromete o desempenho ocupacional, principalmente em atividades envolvendo as mãos, e na qualidade do sono. CONCLUSÃO: Percebeu-se que é uma síndrome compressiva que interfere no desempenho ocupacional, além de constatar que a dor é a principal queixa.

The action of sericin protein on initial nerve repair, associated or not with swimming in wistar rats / Ação da proteína sericina no reparo nervoso inicial, associada ou não à natação, em ratos wistar / Acción de la proteína sericina en la reparación nerviosa inicial, asociada o no a la natación, en ratones wistar

ABSTRACT Objective: To analyze the effects of sericin treatment, associated or not with swimming with load exercise, on initial sciatic nerve repair after compression in Wistar rats. Methods: Forty animals were divided into five groups: control, injury, injury-sericin, injury-swimming and injury-sericin-swimming. During the axonotmesis procedure, the sericin was applied to the injury-sericin and injury-sericin-swimming groups. The injury-swimming and injury-sericin-swimming groups performed the swimming with load exercise for five days, beginning on the third postoperative day (PO), and were evaluated for function, nociception and allodynia. Euthanasia was performed on the 8th PO day and fragments of the nerve were collected and prepared for quantitative and descriptive analysis in relation to the total amount of viable nerve fibers and non-viable nerve fibers, nerve fiber diameter, axon diameter and myelin sheath thickness. Results: There was no significant improvement in the sciatic functional index up to the eighth day. The Von Frey test of the surgical scar and plantar fascia indicated a reduction in pain and allodynia for the injury-swimming and injury-sericin-swimming groups. The morphological analysis presented similar characteristics in the injury-sericin, injury-swimming and injury-sericin-swimming groups, but there was a significant difference in the number of smaller non-viable nerve fibers in the injury-swimming and injury-sericin-swimming groups as compared to the others. Conclusions: Isolated sericin protein presented proinflammatory characteristics. There was improvement of allodynia and a decrease in the pain at the site of the surgical incision, possibly linked to an aquatic effect. There was no acceleration of nerve repair on the eighth day after the injury. Level of Evidence I; High quality randomized clinical trial with or without statistically significant difference, but with narrow confidence intervals.

RESUMO Objetivo: Analisar os efeitos do tratamento da sericina, associada ou não ao exercício de natação com sobrecarga, sobre o reparo inicial do nervo isquiático após compressão em ratos Wistar. Métodos: Foram separados 40 animais em cinco grupos, sendo eles: controle; lesão; lesão-sericina; lesão-natação e lesão-sericina-natação. Durante o procedimento de axonotmese, a sericina foi aplicada sobre a lesão nos grupos lesão-sericina e lesão-sericina-natação. Os grupos lesão-natação e lesão-sericina-natação realizaram o exercício de natação com sobrecarga durante cinco dias, iniciando no terceiro dia pós-operatório (PO), sendo avaliados quanto à função, nocicepção e alodinia. A eutanásia foi realizada no oitavo dia PO, sendo que dois fragmentos do nervo foram coletados e preparados para análise quantitativa e descritiva em relação a quantidade total de fibras nervosas viáveis, não viáveis, diâmetro da fibra nervosa, do axônio e espessura da bainha de mielina. Resultados: No índice funcional isquiático não houve melhora significativa até o oitavo dia. O teste de Von Frey na cicatriz cirúrgica e fáscia plantar indicaram redução do quadro álgico e alodinia para os grupos lesão-natação e lesão-sericina-natação. A análise morfológica apresentou características semelhantes nos grupos lesão-sericina, lesão-natação e lesão-sericina-natação, porém houve diferença significativa das fibras nervosas não viáveis menores nos grupos lesão-natação e lesão-sericina-natação em relação aos demais. Conclusões: A proteína sericina isolada apresentou características pró-inflamatórias. Houve melhora da alodinia e diminuição do quadro álgico no local da incisão cirúrgica relacionadas a possível efeito aquático. Não houve aceleração do reparo nervoso no oitavo dia após a lesão. Nível de Evidência I; Estudo clínico randomizado de alta qualidade com ou sem diferença estatisticamente significante, mas com intervalos de confiança estreitos.

RESUMEN Objetivo: Analizar los efectos del tratamiento de la sericina, asociada o no al ejercicio de natación con sobrecarga, sobre la reparación inicial del nervio isquiático después de compresión, en ratones Wistar. Métodos: Se separaron 40 animales en cinco grupos, siendo: control; lesión; lesión-sericina; lesión-natación y lesión-sericina-natación. Durante el procedimiento de axonotmesis, la sericina fue aplicada sobre la lesión en los grupos lesión-sericina y lesión-sericina-natación. Los grupos lesión-natación y lesión-sericina-natación realizaron el ejercicio de natación con sobrecarga durante cinco días, iniciándose en el tercer día postoperatorio (PO), siendo evaluados cuanto a la función, nocicepción y alodinia. La eutanasia fue realizada en el octavo día PO, siendo que dos fragmentos del nervio fueron recolectados y preparados para análisis cuantitativo y descriptivo, con relación a la cantidad total de fibras nerviosas viables, no viables, diámetro de la fibra nerviosa, del axón y espesor de la vaina de mielina. Resultados: En el índice funcional isquiático no hubo mejoría significativa hasta el octavo día. La prueba de "Von Frey" en la cicatriz quirúrgica y la fascia plantar indicaron reducción del cuadro álgico y alodinia, para los grupos lesión-natación y lesión-sericina-natación. El análisis morfológico presentó características similares en los grupos lesión-sericina, lesión-natación y lesión-sericina-natación, pero hubo diferencia significativa de las fibras nerviosas no viables menores en los grupos lesión-natación y lesión-sericina-natación con relación a los demás. Conclusiones: La proteína sericina aislada presentó características proinflamatorias. Hubo mejora de la alodinia y disminución del cuadro álgico en el lugar de la incisión quirúrgica, relacionadas al posible efecto acuático. No hubo aceleración de la reparación nerviosa en el octavo día después de la lesión. Nivel de Evidencia I; Ensayo clínico aleatorizado de alta calidad con o sin diferencia estadísticamente significativa, pero con intervalos de confianza estrechos.

Long-Term Regular Eccentric Exercise Decreases Neuropathic Pain-like Behavior and Improves Motor Functional Recovery in an Axonotmesis Mouse Model: the Role of Insulin-like Growth Factor-1.

Although training programs with regular eccentric (ECC) exercise are more commonly used for improving muscular strength and mobility, ECC exercise effects upon functional recovery of the sciatic nerve has not yet been determined. After sciatic nerve crush, different mice groups were subjected to run on the treadmill for 30 min at a speed of 6, 10, or 14 m/min with - 16° slope, 5 days per week, over 8 weeks. During the training time, neuropathic pain-like behavior (mechanical and cold hyperalgesia) was assessed and functional recovery was determined with the grip strength test and the Sciatic Functional and Static indexes (SFI and SSI). After 9 weeks, triceps surae muscle weight and morphological alterations were assessed. Tumor necrosis factor alpha (TNF-α), interleukin-1ß (IL-1ß), interleukin-4 (IL-4), interleukin-1Ra (IL-1Ra), insulin-like growth factor-1 (IGF-1) levels, and markers pro- and anti-inflammatory and regeneration, respectively, were quantified in the muscle and sciatic nerve on day 14 post-crushing. Exercised groups presented less neuropathic pain-like behavior and better functional recovery than non-exercised groups. Biochemically, ECC exercise reduced TNF-α increase in the muscle. ECC exercise increased sciatic nerve IGF-1 levels in sciatic nerve crush-subjected animals. These findings provide new evidence indicating that treatment with ECC might be a potential approach for neuropathy induced by peripheral nerve injury.

Analysis of the muscle tissue of Wistar rats submitted to the sciatic nerve compression model and cryotherapy / Análise do tecido muscular de ratos Wistar submetidos ao modelo de compressão do nervo isquiático e à crioterapia

ABSTRACT Objective: To evaluate the effects of right sciatic nerve compression and cryotherapy on muscle tissue. Methods: We used 42 male Wistar rats, subdivided in the following Groups Control, Injury 3, Injury 8 and Injury 15 submitted to nerve compression and euthanized in the 3rd, 8th and 15th day after surgery. The Cryotherapy Injury 3 was entailed treatment with cryotherapy by immersion of the animal in recipient for 20 minutes during 1 day, then animals were euthanized at the 3rd day after surgery, and the Cryotherapy Injury 8 and the Cryotherapy Injury 15 was treated for 6 days, and euthanized at the 8th and 15th day after surgery. Functional evaluation was performed by the grasping strength of the right pelvic limb. The right tibialis anterior muscles were evaluated for mass, smaller diameter and cross-sectional area. In the Cryotherapy Injury 8 and the Cryotherapy Injury 15 groups, the hydroxyproline was dosed in the right soles. Results: In the compression there was a significant difference in the Injury Groups compared with the Control Group (p<0.05). In the smaller diameter, the compression in Control Group was higher than Injury 8 (p=0.0094), Injury 15 (p=0.002) and Cryotherapy Injury 15 (p<0.001) groups. The comparison between groups with euthanasia in the same post-operative period, a significant difference (p=0.0363) was seen in day 8th after surgery, and this result in Cryotherapy Injury Group was greater than Injury Group. In the fiber area, Control Group was also higher than the Injury 8 (p=0.0018), the Injury 15 (p<0.001) and the Cryotherapy Injury 15 (p<0.001). In hydroxyproline, no significant difference was seen between groups. Conclusion: Nerve damage resulted in decreased muscle strength and trophism, the cryotherapy delayed hypotrophy, but this effect did not persist after cessation of treatment.

RESUMO Objetivo: Avaliar os efeitos da compressão nervosa do isquiático direito e da crioterapia no tecido muscular. Métodos: Foram utilizados 42 ratos Wistar machos, subdivididos nos Grupos Controle, Lesão 3, Lesão 8 e Lesão 15, submetidos a compressão nervosa e eutanasiados, respectivamente, no 3°, 8° e 15° dias pós-operatório; Lesão Crioterapia 3, tratado com crioterapia, por imersão durante 20 minutos, por 1 dia, e eutanasiados no 3° dia pós-operatório; e Lesão Crioterapia 8 e Lesão Crioterapia 15, tratados durante 6 dias e eutanasiados no 8° e 15° dias pós-operatório. A avaliação funcional foi realizada pela força de preensão do membro pélvico direito. Os músculos tibiais anteriores direitos foram avaliados quanto a massa, menor diâmetro e área de secção transversa. Em Lesão Crioterapia 8 e Lesão Crioterapia 15, foi dosada a hidroxiprolina nos sóleos direitos. Resultados: Na preensão, houve diferença significativa nos Grupos Lesão quando comparados ao Grupo Controle (p<0,05). No menor diâmetro, o Grupo Controle foi maior que Lesão 8 (p=0,0094), Lesão 15 (p = 0,002) e Lesão Crioterapia 15 (p<0,001). Na comparação entre os grupos com eutanásia no mesmo pós-operatório, houve diferença significativa (p=0,0363) no 8° pós-operatório, sendo Lesão Crioterapia maior que Lesão. Na área das fibras, o Grupo Controle também foi maior que Lesão 8 (p=0,0018), Lesão 15 (p<0,001) e Lesão Crioterapia 15 (p<0,001). Na hidroxiprolina, não houve diferença significativa entre os grupos. Conclusão: A lesão nervosa resultou na diminuição da força e em trofismo muscular, e a crioterapia retardou a hipotrofia, porém este efeito não se manteve após o tratamento cessar.

Carpal tunnel syndrome: mobilization and segmental stabilization / Mobilização neural e estabilização segmentar na síndrome do túnel do carpo

Abstract Introduction: Carpal tunnel syndrome is a compressive neuropathy, frequently seen in women. Conservative treatment for carpal tunnel syndrome focuses on control of symptoms and the nervous path, due to the possibility of double compression. Objective: To assess whether a protocol with emphasis on motor control techniques, including segmental cervical stabilization and neural mobilization, has better results in mechanical reorganization and reduction of symptoms when compared with classic therapeutic exercise techniques in the conservative treatment of carpal tunnel syndrome. Methods: This pilot study was a randomized, double-blind clinical trial, involving 11 women with an average age of 54 (± 6) years, allocated to either a classical kinesiotherapy group (CG) or experimental group (EG). The intervention spanned 12 weeks, with assessments prior to and following therapy, using the monofilament test, handgrip dynamometer, and BCTQ, DASH, and PRWE questionnaires. All normally distributed data was analysed with Student's T-tests. Results: Both groups exhibited an increase in grip strength and relief of symptoms with improved functionality. There was a significant reduction in sensitivity noted in the CG group, and a significant increase in grip strength observed in the EG group. Conclusion: The experimental protocol group exhibited better results in mechanical reorganization, reflected in increased strength, sensitivity, and improved functionality, when compared to the group with conventional therapeutic exercise, but without the same symptomatic reduction.

Resumo Introdução: Compreende a Síndrome do Túnel do Carpo (STC) uma neuropatia compressiva frequente em mulheres. No tratamento conservador, a ênfase é dada ao controle da sintomatologia e ao trajeto nervoso devido à hipótese de dupla compressão. Objetivo: Avaliar se um protocolo com ênfase nas técnicas de controle motor, constituído por estabilização segmentar cervical e mobilização neural, apresentam melhores resultados na reorganização mecânica e redução dos sintomas quando comparado com técnicas de cinesioterapia clássica. Métodos: Estudo piloto de um ensaio clínico randomizado duplo cego, em 11 mulheres, alocadas em Grupo Cinesioterapia clássica (GC), e Grupo Experimental (GE). A intervenção foi de 12 semanas, com avaliações no pré e pós, por meio da estesiometria, dinamometria de preensão palmar e aplicação dos questionários BCTQ, DASH e PRWE. Resultados: Ambos aumentaram a força de pinça com alívio da sintomatologia e melhora da funcionalidade. Houve diminuição da sensibilidade no GC e aumento significativo da força de preensão palmar no GE. Conclusão: O grupo do protocolo proposto apresentou melhores resultados na reorganização mecânica, com reflexo no aumento da força, da sensibilidade e melhora da funcionalidade, quando confrontado ao grupo com cinesioterapia convencional, porém sem o mesmo impacto para a redução dos sintomas.

Mobilização neural aplicada em diferentes locais sobre a compressão do nervo isquiático de ratos Wistar / Neural mobilization applied at different sites on the sciatic nerve compression in Wistar rats

Introdução: a mobilização neural é uma técnica que visa restituir a função do sistema nervoso, contudo há ainda desconhecimento sobre o local mais apropriado. Objetivos: avaliar os efeitos da mobilização neural no tratamento da compressão do nervo isquiático de ratos Wistar, e comparar os diferentes locais de aplicação. Métodos: 24 ratos Wistar foram submetidos à compressão do nervo isquiático direito, e separados em quatro grupos: lesão (GL), mobilização neural no lesionado (GPD), mobilização neural no membro contralateral (GPE) e mobilização neural no membro ipsilateral a lesão (GEP). Foram realizadas avaliações funcionais pelo tempo de elevação da pata (TEP) e dolorímetro digital de Von Frey, após a última avaliação, o nervo isquiático foi seccionado para análise histológica. Resultados: houve diferença entre o GL (23,54) e GPE (23,98) na avaliação do TEP (p=0,028), na avaliação nociceptiva e histológica não houve diferenças significativas (p>0,05). Conclusão: a mobilização neural no membro contralateral foi prejudicial, enquanto o tratamento no membro acometido e no membro ipsilateral não apresentou diferença significativa.

Introduction: neural mobilization is a technique that aims to restore the function of the nervous system, yet there still lack of knowledge about the most appropriate place. Objectives: to evaluate the effects of neural mobilization in the treatment of sciatic nerve compression Wistar rats, and compare the different application sites. Methods: 24 Wistar rats were right sciatic nerve compression, and separated into four groups: injury (GL), neural mobilization in the injured (GPD), neural mobilization in the contralateral limb (GPE) and neural mobilization in the ipsilateral limb injury (GEP). Functional assessments were performed at paw elevation time (TEP) and digital Von Frey dolorimeter after the last evaluation, the sciatic nerve was sectioned for histological analysis. Results: there was a difference between the GL (23.54) and GPE (23.98) in the evaluation of the TEP (p=0.028), in nociceptive and histological evaluation no significant differences (p>0.05). Conclusion: the neural mobilization held in the contralateral limb was harmful, while treating the affected and ipsilateral limb showed no significant difference.

Neuroprotective Effect of Natural Products on Peripheral Nerve Degeneration: A Systematic Review.

Peripheral nerve injury (PNI) is a serious public health problem that is linked with motor, sensory and autonomic deficits. Given the fact that this type of disorder leads to a decreased quality of life in most patients and adherence of available drugs is limited and have adverse effects, we investigated the efficacy of natural products in a PNI model. The search terms plants, medicinal, nerve regeneration, nerve crush, sciatic nerve as well as MeSH terms or free-text words were used to retrieve English language articles in PubMed, Scopus, Web of Science and LILACS published until July 2015. After sciatic nerve crush, natural products have improved significantly motor performance, sensory function and electrical conductance measured over weeks. Among the pharmacological targets suggested by the action of natural products, there were citations on the activation of the antiapoptotic signaling pathway, modulation in the expression of pro-inflammatory cytokines and neurotrophic factors. The systematic review provides scientific evidence that natural products are pharmacologically effective in the treatment of PNI such as sciatic nerve crush.

Rescuing axons from degeneration does not affect retinal ganglion cell death

After a traumatic injury to the central nervous system, the distal stumps of axons undergo Wallerian degeneration (WD), an event that comprises cytoskeleton and myelin breakdown, astrocytic gliosis, and overexpression of proteins that inhibit axonal regrowth. By contrast, injured neuronal cell bodies show features characteristic of attempts to initiate the regenerative process of elongating their axons. The main molecular event that leads to WD is an increase in the intracellular calcium concentration, which activates calpains, calcium-dependent proteases that degrade cytoskeleton proteins. The aim of our study was to investigate whether preventing axonal degeneration would impact the survival of retinal ganglion cells (RGCs) after crushing the optic nerve. We observed that male Wistar rats (weighing 200-400 g; n=18) treated with an exogenous calpain inhibitor (20 mM) administered via direct application of the inhibitor embedded within the copolymer resin Evlax immediately following optic nerve crush showed a delay in the onset of WD. This delayed onset was characterized by a decrease in the number of degenerated fibers (P<0.05) and an increase in the number of preserved fibers (P<0.05) 4 days after injury. Additionally, most preserved fibers showed a normal G-ratio. These results indicated that calpain inhibition prevented the degeneration of optic nerve fibers, rescuing axons from the process of axonal degeneration. However, analysis of retinal ganglion cell survival demonstrated no difference between the calpain inhibitor- and vehicle-treated groups, suggesting that although the calpain inhibitor prevented axonal degeneration, it had no effect on RGC survival after optic nerve damage.

Properties of the tibialis anterior muscle after treatment with laser therapy and natural latex protein following sciatic nerve crush.

INTRODUCTION: In this study we evaluated the characteristics of the tibialis anterior muscle after sciatic nerve crush and treatment with low-level laser therapy (LLLT) or the protein from natural latex (P1). METHODS: We studied the following 6 groups of male Wistar rats: control (CG); exposed nerve (EG); injured nerve (IG); injured nerve with LLLT (LG); injured nerve with P1 (PG); and injured nerve with P1 and LLLT (LPG). RESULTS: After 4 weeks, muscle morphology showed improvement in the treated groups; after 8 weeks, the treated groups resembled controls, especially the PG. Morphometry revealed muscle fiber atrophy after nerve injury, with time-dependent recovery. Histochemical analysis revealed increased intermediate fiber area. The PG was more similar to controls with NADH staining, whereas the LPG more closely resembled controls with SDH staining. CONCLUSION: Treatment using only P1 proved most efficient, revealing a negative interaction between P1 and LLLT.

Analisis comparativo del número de neurofilamentos en nervios isquiáticos de rata sometidos a neuropraxia tratadas con láser de baja intensidad y ultrasonido terapéutico / Comparative analysis of the number of neurofilaments in rat sciatic nerve undergoing neuropraxia treated by low-level laser and therapeutic ultrasound

Es habitual que tras una compresión nerviosa se aplique terapia, ya sea, a través de laser de baja intensidad (LBI) o ultrasonido (US). El objetivo de este trabajo fue determinar la efectividad de dichos tratamientos para reparar el citoesqueleto neuronal evaluando la variación en el número de neurofilamentos. Se realizó un diseño experimental, en el cual se utilizaron 30 ratas que fueron separadas en 6 grupos: 1- control sano; 2- control lesionado; 3- irradiado con LBI 2J/cm2; 4- irradiado con LBI 10 J/cm2; 5- irradiado con US 0,5W/cm2 y 6- irradiado con US 1W/cm2. Con excepción del grupo 1 los especímenes fueron anestesiados y se les realizó la compresión del nervio isquiático derecho utilizando una presión de 40N durante 45 segundos. Veinticuatro horas después de la compresión se inició la irradiación con LBI y US, según protocolo. En nuestra investigación constatamos que el incremento en el número de neurofilamentos se relacionó con la dosis aplicada de LBI y US. El valor medio de neurofilamentos/0,25 mm2 obtenidos en cada grupo fue: 1 - 128; 2 - 100; 3 - 156; 4 - 140; 5 - 100; 6 - 148. La aplicación de LBI de y de US terapéutico aumenta el número de neurofilamentos en nervios isquiáticos de rata sometidos a neuropraxia, siendo el LBI más eficaz en comparación al US. Se agrega que estas terapias para inducir la regeneración del nervio lesionado se relacionan al tipo de protocolo utilizado, lo que demuestra la necesidad de establecer la adecuada dosis de irradiación con el propósito de obtener la mejor respuesta terapéutica.

Therapy by low-level laser (LLL) or ultrasound (US) are commonly used as treatment after nerve crush. The aim of this study was to determine the effectiveness of such treatments to repair the neuronal cytoskeleton evaluating the variation in the number of neurofilaments. For this an experimental design was performed, which involved 30 rats divided into 6 groups: 1 - control healthy; 2 - control injured; 3 - irradiated by LLL 2 J/cm2; 4 - irradiated by LLL 10 J/cm2; 5 - irradiated by US 0.5 W/cm2 and 6 - irradiated by US 1W/cm2. With the exception of group 1 all specimens were anesthetized and underwent right sciatic nerve compression using 40N pressure for 45 seconds. Twenty-four hours after compression irradiation was started by LLL and US according protocol. In our research we found that the increase in the number of neurofilaments was related to the applied dose of LLL and US. The average value of neurofilaments / 0.25 mm2 obtained in each group was: 1 - 128; 2-100; 3-156; 4-140; 5-100; 6-148. We concluded that the application of LLL and therapeutic US increases the number of neurofilaments in rat sciatic nerve undergoing neuropraxia, with LLL being more effective compared to the US. Furthermore we concluded that the effectiveness of therapies to induce regeneration of injured nerve is related to the type of protocol used, demonstrating the need to establish an adequate radiation dose with the purpose of obtaining the best therapeutic response, thus achieving successful treatment.

Action of therapeutic laser and ultrasound in peripheral nerve regeneration.

OBJECTIVE: To assess the efficacy of early therapeutic laser and ultrasound in the regeneration process of an injury in rats. METHODS: We used 24 rats. Eighteen underwent surgery for sciatic nerve compression by a hemostat above the popliteal fossa. The animals were divided into three groups of six animals each. Normal control group. GI: Injured control without therapeutic intervention. GII: laser ArGaAl therapeutic intervention. GIII: therapeutic intervention of Pulsed Ultrasound. We begin therapeutic interventions 24 hours after injury, with daily applications for a period of fourteen consecutive days. RESULTS: IN ASSESSING THE GIRTH OF THE MUSCLES OF THE RIGHT THEY, THE FOLLOWING AVERAGE DECREASE (IN MM) FOR EACH GI: 0.45, GII: 0.42, GIII: 0.40 In relation to travel time, both GII and GIII presented significant difference when compared to GI. In the final evaluation of the IFC, GII excelled in the GIII. As for the healing observed, a major great improvement was observed in GII and GIII. CONCLUSION: The results showed that nerve recovery was higher with the laser application. Level of evidence II, Therapeutic Studies - Investigation of the results of treatment.

Ação do laser terapêutico e do ultrassom na regeneração nervosa periférica / Action of therapeutic laser and ultrasound in peripheral nerve regeneration

OBJETIVO: Avaliar a ação precoce do laser terapêutico e do ultrassom no processo de regeneração de uma lesão experimental em ratos. MÉTODO: Utilizou-se 24 ratos. Dezoito foram submetidos ao procedimento cirúrgico de lesão do nervo ciático por compressão, através de uma pinça hemostática acima da fossa poplítea. Os animais foram divididos em três grupos com seis animais em cada. Grupo controle normal. GI: controle lesado sem intervenção terapêutica. GII: intervenção terapêutica do laser ArGaAl. GIII: intervenção terapêutica do ultrassom Pulsado. Iniciamos as intervenções terapêuticas 24 horas após a lesão, com aplicações diárias, por um período de quatorze dias consecutivos. RESULTADOS: Ao avaliar a perimetria dos músculos da coxa direita obteve-se os seguintes valores médios de diminuição (mm), para cada grupo GI: 0,45; GII: 0,42; GIII: 0,40. Quanto ao tempo de deslocamento tanto o GII e GIII apresentaram diferença significativa, quando comparados ao GI. Na avaliação final do IFC o GII sobressaiu ao GIII. Quanto a cicatrização observou-se grande melhora no GII e GIII. CONCLUSÃO: Os resultados evidenciaram que a recuperação nervosa foi maior com a aplicação do laser. Nível de evidência II, Estudos terapêuticos - Investigação dos resultados do tratamento.

OBJECTIVE: To assess the efficacy of early therapeutic laser and ultrasound in the regeneration process of an injury in rats. METHODS: We used 24 rats. Eighteen underwent surgery for sciatic nerve compression by a hemostat above the popliteal fossa. The animals were divided into three groups of six animals each. Normal control group. GI: Injured control without therapeutic intervention. GII: laser ArGaAl therapeutic intervention. GIII: therapeutic intervention of Pulsed Ultrasound. We begin therapeutic interventions 24 hours after injury, with daily applications for a period of fourteen consecutive days. RESULTS: In assessing the girth of the muscles of the right they, the following average decrease (in mm) for each GI: 0.45, GII: 0.42, GIII: 0.40 In relation to travel time, both GII and GIII presented significant difference when compared to GI. In the final evaluation of the IFC, GII excelled in the GIII. As for the healing observed, a major great improvement was observed in GII and GIII. CONCLUSION: The results showed that nerve recovery was higher with the laser application. Level of evidence II, Therapeutic Studies - Investigation of the results of treatment.

High-voltage electrical stimulation improves nerve regeneration after sciatic crush injury / Estimulação elétrica de alta voltagem favorece a regeneração nervosa após compressão do nervo isquiático

BACKGROUND: Peripheral nerve injury causes prolonged functional limitation being a clinical challenge to identify resources that accelerates its recovery. OBJECTIVES: To investigate the effect of high-voltage electrical stimulation (HVES) on the morphometric and functional characteristics of the regenerated nerve after crush injury in rats. METHODS: Twenty Wistar rats were randomly allocated into 4 groups: Control (CON) - without injury and without HVES; Denervated (D) - sciatic nerve crush only; Denervated + HVES - sciatic nerve crush and HVES; SHAM - without injury but HVES. The HVES and SHAM groups were stimulated (100 Hz; minimum voltage of 100 V, 20 μs, 100 μs interpulse interval) for 30 min/day, 5 days/week. The sciatic functional index (SFI) was evaluated before the injury and at the 7th, 14th and 21st postoperatory (PO) days. Neural components and the area density of connective tissue, blood vessels and macrophages were analyzed. RESULTS: Axonal diameter was higher on the HVES than on D group, reaching almost 80 percent above the control values after 21 days (p<0.05). Fiber diameter and myelin sheath thickness were higher on the HVES than on D group (p<0.05) reaching 96.5 percent and 100 percent of the control values, respectively. Functional recovery at the 14th PO day was better on group HVES. The macrophages and connective tissue area density was lower on the HVES group, while blood vessels number did not differ among groups. CONCLUSIONS: The HVES accelerated the functional recovery, potentiated the nerve fibers maturation and decreased macrophages and connective tissue area density, suggesting acceleration of neural repair.

CONTEXTUALIZAÇÃO: Lesões nervosas periféricas provocam limitação funcional prolongada, sendo um desafio para a clínica identificar recursos que acelerem sua recuperação. OBJETIVOS: Investigar a influência da estimulação elétrica de alta voltagem (EEAV) sobre a morfologia e a função do nervo regenerado após esmagamento em ratos. MÉTODOS: Vinte ratos Wistar foram divididos nos grupos: controle (CON) - sem lesão e sem EEAV; desnervado (D) - esmagamento do nervo isquiático; desnervado + EEAV (EEAV) - esmagamento do nervo e EEAV; SHAM - sem lesão, porém submetido à EEAV. Os grupos EEAV e SHAM foram estimulados (100 Hz, tensão mínima de 100 V; 20 μs e 100 μs interpulso) 30 min/dia, 5 dias/semana. O índice funcional do ciático (IFC) foi avaliado antes da lesão, nos 7º, 14º e 21º dias pós-operatório (PO). Componentes neurais, densidade de área de tecido conjuntivo, de vasos sanguíneos e macrófagos foram analisados. RESULTADOS: O diâmetro axonal foi maior no grupo EEAV que no grupo D, atingindo quase 80 por cento dos valores-controle após 21 dias (p<0,05). O diâmetro das fibras e espessura das bainhas de mielina foram maiores no grupo EEAV que no D (p<0,05), alcançando 96,5 por cento e 100 por cento dos valores-controle, respectivamente. A recuperação funcional no 14º dia PO foi melhor no grupo EEAV. A densidade de área de macrófagos e tecido conjuntivo foi menor no grupo EEAV, enquanto o número de vasos sanguíneos não diferiu entre os grupos. CONCLUSÕES: A EEAV acelerou a recuperação funcional, potencializou a maturação das fibras nervosas regeneradas e promoveu diminuição da densidade de área de macrófagos e tecido conjuntivo no nervo, sugerindo aceleração do reparo neural.

Avaliação do exercício físico como fator de analgesia em um modelo experimental de ciatalgia / Physical exercise assessment as an analgesia factor in a sciatica experimental model

OBJETIVO: Avaliar a eficácia do exercício físico (natação e salto) atuando na redução do quadro álgico de ratos submetidos a um modelo experimental de ciatalgia. MÉTODOS: 24 ratos Wistar foram divididos em quatro grupos: grupo Placebo (GP), grupo Natação (GN), grupo Natação 10 por cento (GN10) e grupo Salto (GS). Todos os grupos foram submetidos ao modelo de ciatalgia e avaliados em relação à dor pós-exercício pelo teste de incapacidade funcional e pelo filamento de Von Frey. RESULTADOS: Na comparação intragrupos houve diferenças significativas, para todos os grupos, nos momentos pós-lesão comparados com o pré-lesão, por ambos os instrumentos de avaliação. Com o filamento de Von Frey observou-se diferença significativa nos grupos GN10 e GS nos momentos finais de avaliação. Na comparação intergrupos não houve diferenças significativas com nenhum instrumento de avaliação. CONCLUSÃO: O tratamento com exercício físico não foi eficaz para reduzir o quadro álgico de ratos submetidos à ciatalgia.

OBJECTIVE: To evaluate the efficacy of physical exercise (swimming and jumping), with and without overload, working in reducing the pain of rats undergone to an experimental model of sciatica. METHODS: 24 rats were divided into four groups: Placebo (GP), Swimming Group (NG) Swimming 10 percent Group (GN10) and Leap Group (GS). All groups were submitted to the experimental sciatica model and assessed for pain post-exercise for the Functional Disability Test and the Von Frey filament. RESULTS: In comparison within groups there were significant differences in the moments after injury with the pre-injury, for both assessment instruments. With Von Frey filament was observed a significant difference in group GN10 and GS in the final moments of evaluation. In comparisons between groups were not statistically significant differences obtained with any assessment instrument. CONCLUSION: Treatment with physical exercise was not effective in reducing pain in rats subjected to experimental sciatica model.

ARTHROSCOPIC RELEASE OF THE SUPRASCAPULAR NERVE: SURGICAL TECHNIQUE AND EVALUATION OF CLINICAL CASES.

UNLABELLED: To describe a specific surgical technique for arthroscopic decompression of the suprascapular nerve (SSN) and evaluate its preliminary results. METHODS: Ten shoulders of nine patients were operated using a technique with portals differing from the already-known techniques, which did not use traction and made use of materials available within the public healthcare system. RESULTS: Among the ten shoulders of nine patients, eight were right shoulders and two were left shoulders. The mean age was 69.5 years. The UCLA score increased from 11.7 to 26.1 points over the postoperative follow-up of 16.6 months. The SF-36 questionnaire score was 122.9 and the raw pain scale value was 88%. CONCLUSION: Arthroscopic decompression of the SSN in accordance with the described technique is reproducible and less traumatic than the open techniques. The patients achieved improvements in many of the parameters evaluated, particularly with regard to pain. Arthroscopic decompression of the SSN may be a therapeutic option for pathological compression of the SSN.

Thermographic evaluation of hind paw skin temperature and functional recovery of locomotion after sciatic nerve crush in rats

INTRODUCTION: Peripheral nerves are often damaged by direct mechanical injury, diseases, and tumors. The peripheral nerve injuries that result from these conditions can lead to a partial or complete loss of motor, sensory, and autonomic functions, which in turn are related to changes in skin temperature, in the involved segments of the body. The aim of this study was to evaluate the changes in hind paw skin temperature after sciatic nerve crush in rats in an attempt to determine whether changes in skin temperature correlate with the functional recovery of locomotion. METHODS: Wistar rats were divided into three groups: control (n = 7), sham (n = 25), and crush (n = 25). All groups were subjected to thermographic, functional, and histological assessments. RESULTS: ΔT in the crush group was different from the control and sham groups at the 1st, 3rd and 7rd postoperative days (p<0.05). The functional recovery from the crush group returned to normal values between the 3rd and 4th week post-injury, and morphological analysis of the nerve revealed incomplete regeneration at the 4th week after injury. DISCUSSION: This study is the first demonstration that sciatic nerve crush in rats induces an increase in hind paw skin temperature and that skin temperature changes do not correlate closely with functional recovery.

Liberação artroscópica do nervo supraescapular: técnica cirúrgica e avaliação de casos clínicos / Arthroscopic release of the suprascapular nerve: surgical technique and evaluation of clinical cases

OBJETIVO: Descrever uma técnica cirúrgica própria de descompressão artroscópica do nervo supraescapular (NSE) e avaliar seus resultados preliminares. MÉTODOS: 10 ombros de nove pacientes foram operados com uma técnica que utiliza portais diferentes das técnicas conhecidas, não usa tração e faz uso de materiais disponíveis na rede pública de saúde. RESULTADOS: 10 ombros de nove pacientes, sendo oito à direita e dois à esquerda, com média de idade de 69,5 anos, apresentaram mudança no escore UCLA de 11,7 para 26,1 no seguimento de 16,6 meses de pós-operatório. O questionário SF-36 teve pontuação de 122,9 e a escala bruta de dor de 88 por cento. CONCLUSÃO: A descompressão artroscópica do NSE, segundo a técnica descrita, é reprodutível e menos traumática que as técnicas abertas. Os pacientes obtiveram melhora em vários parâmetros avaliados, principalmente no que se refere à dor. A descompressão artroscópica do NSE pode ser uma opção terapêutica para a patologia compressiva do NSE.

OBJECTIVE: To describe a specific surgical technique for arthroscopic decompression of the suprascapular nerve (SSN) and evaluate its preliminary results. METHODS: Ten shoulders of nine patients were operated using a technique with portals differing from the already-known techniques, which did not use traction and made use of materials available within the public healthcare system. RESULTS: Among the ten shoulders of nine patients, eight were right shoulders and two were left shoulders. The mean age was 69.5 years. The UCLA score increased from 11.7 to 26.1 points over the postoperative follow-up of 16.6 months. The SF-36 questionnaire score was 122.9 and the raw pain scale value was 88 percent. CONCLUSION: Arthroscopic decompression of the SSN in accordance with the described technique is reproducible and less traumatic than the open techniques. The patients achieved improvements in many of the parameters evaluated, particularly with regard to pain. Arthroscopic decompression of the SSN may be a therapeutic option for pathological compression of the SSN.