[Physical rehabilitation for osteochondrosis of the cervical and thoracic spine in elderly and senile people (Stage 3).]

The concept of a multidisciplinary approach to the treatment of osteochondrosis in elderly and senile patients by specialists of various profiles using medicinal and non-medicinal methods is especially relevant today, therefore, it is necessary to develop and put into practice various options for the combined use of physical rehabilitation means at different stages of rehabilitation treatment of elderly and senile patients with osteochondrosis of the cervical and thoracic spine. The dynamics of clinical manifestations of osteochondrosis after rehabilitation treatment relative to the age of patients in groups showed that the effectiveness of the technique is much higher in elderly patients, in contrast to senile patients and centenarians. The study revealed no significant complications and side effects when using this technique, which allows us to recommend it as a means of secondary prevention of diseases of the cervical and thoracic osteochondrosis, especially in the presence of contraindications to the use of non-steroidal anti-inflammatory drugs and glucocorticoids. The technique can be recommended for use in fitness clubs, athletic halls and medical and physical education dispensaries.

Non-Small Cell Lung Carcinoma: Clinical Reasoning in the Management of a Patient Referred to Physical Therapy for Costochondritis.

Background and Purpose: Chest pain, a frequent complaint for seeking medical care, is often attributed to musculoskeletal pathology. Costochondritis is a common disorder presenting as chest pain. Initial physical therapist examination emphasizes red flag screening. Reexamination throughout the episode of care is critical, particularly when patients are not progressing and/or in the presence of complex pain presentations. The purpose of this case report is to describe the clinical reasoning process in the management of a patient referred to physical therapy with a medical diagnosis of costochondritis. Case Description: A 59-year-old woman presented with a 5-month history of left-sided chest pain that had progressed to include the cervical and shoulder regions. She reported multiple psychosocial stressors; a depression screen was positive. She reported a history of asthma and smoking and improvement in recent fatigue, coughing, dyspnea, and sweating. At the initial visit, shoulder, cervical, and thoracic active and passive range of motion and joint mobility testing reproduced her pain. Allodynia was present throughout the painful areas in the left upper quarter. Outcomes: The patient demonstrated improvement over 30 days (4 visits). On her fifth visit (day 35), she reported an exacerbation of her chest and upper extremity pain and noted increased fatigue, sweating, dyspnea, and loss of appetite. Even though her pain was again reproduced with musculoskeletal testing, the physical therapist contacted the patient's physician regarding the change in presentation. A subsequent chest computed tomography scan revealed a non-small cell lung adenocarcinoma. Discussion: Cancer can masquerade as a musculoskeletal condition. This case highlights the importance of screening, clinical reasoning, and communication throughout the episode of care, particularly in the presence of chronic pain and psychosocial stressors.

Return to sporting activity after osteochondral autograft transplantation for Freiberg disease in young athletes.

INTRODUCTION: Freiberg disease is defined as osteochondrosis of the metatarsal head and typically occurs in adolescents with sporting activity. This study aimed to evaluate the sporting activity of young athletes after osteochondral autograft transplantation (OAT) for Freiberg disease. MATERIALS AND METHODS: OAT for Freiberg disease was conducted in 12 consecutive patients between August 2008 and November 2014. The present study evaluated 10 of these patients who both undertook sporting activity preoperatively and were teenagers at the time of surgery. Clinical evaluations were performed based on the Japanese Society for Surgery of the Foot lesser metatarsophalangeal-interphalangeal scale (JSSF scale) and range of motion (ROM) of the operated metatarsophalangeal joint preoperatively and at the final follow-up (mean 24.6 months). Whether patients were able to return to sporting activity and time until return to sporting activity were evaluated, including the Halasi score to reflect the level of sporting activity. Regarding symptoms at the donor knee, the Lysholm knee scale score was evaluated at the final follow-up. RESULTS: The mean JSSF scale showed a significant improvement at the final follow-up (p < 0.01). The mean ROM in extension and flexion improved at the final follow-up (p < 0.01, and p < 0.05, respectively). All patients were able to return to sporting activity at a mean time of 3.5 months postoperatively and the Halasi score showed no significant change. The mean Lysholm knee scale score was 97.9 (range 89-100) points at the final follow-up. CONCLUSIONS: All young athletes who underwent OAT for Freiberg disease achieved early return to almost equal sporting activity postoperatively and exhibited a significant improvement of the ROM of the metatarsophalangeal joint with almost no knee pain.

O gel de plasma rico em plaquetas propicia a regeneração da cartilagem articular do joelho de ovelhas / Platelet-rich plasma gel promotes regeneration of articular cartilage in knees of sheeps

Objetivo: Avaliar a regeneração da cartilagem articular em defeitos osteocondrais do joelho induzidos pelo plasma rico em plaquetas (PRP) autógeno. Métodos: Defeitos osteocondrais produzidos no sulco troclear de ambos os joelhos de dez ovelhas foram preenchidos com PRP autógeno à direita e deixados vazios à esquerda. Avaliação macroscópica e histológica foram efetuadas 12 semanas mais tarde. Os resultados foram avaliados por um escore geral de ambas as avaliações macroscópica e histológica comparativamente entre os lados por meio do teste pareado de Wilcoxon. Resultados: o aspecto macroscópico não foi uniforme entre os animais, nem diferiu entre os joelhos direitos e esquerdos (p=0,03125); em nenhum caso o tecido regenerado se nivelou com a cartilagem normal circundante. Ao exame histológico, cartilagem aparentemente normal não foi detectada em nenhum joelho, mas uma cartilagem pouco diferenciada estava presente em sete joelhos direitos e em três joelhos esquerdos. Tecido fibrocartilaginoso estava presente nos joelhos restantes, com diferença significante no escore geral entre os joelhos direitos e esquerdos (p=0,0313). Conclusão: o PRP como usado neste estudo tem propriedades reparativas da cartilagem articular no joelho de ovelhas, principalmente por estimular a formação de tecido fibrocartilaginoso. Trabalho Experimental.

Objective: To assess the regeneration of osteochondral defects in the joint cartilage of the knee induced by autologous platelet-rich plasma (PRP). methods: osteochondral defects produced in the trochlear groove of both knees of ten sheep; defects of the right knees were filled with autologous PRP and the left knees were left unfilled. macroscopic and microscopic evaluation was carried out 12 week later. the results were evaluated by the total score of both macroscopic and microscopic evaluations comparing the two sides through the wilcoxon paired test. Results: macroscopic appearance was not uniform among animals, nor was it different between the right and left knees (p=0.3125), and in no case the regenerated tissue was equal to the normal surrounding cartilage. At histological examination, apparently normal cartilage was not detected in any knee, but a poorly differentiated cartilage was present in 7 right knees, compared to 3 left knees. Fibrocartilaginous tissue was present in most of the remaining knees, with a significant difference in the overall score between right and left knees (p=0.0313). conclusion: the pRp as used in this study has reparative properties of the joint cartilage of sheep knees, mostly by stimulating the formation of a fibrocartilaginous tissue. Laboratory Investigation.

Sever's disease: a prospective study of risk factors.

BACKGROUND: Sever's disease, also known as calcaneal apophysitis, is thought to be an inflammation of the apophysis of the heel, which is open in childhood. This condition has been commented on and looked at in a retrospective manner but has not been examined systematically. We assembled the most commonly cited theoretical causative models identified from the literature and tested them to determine whether any were risk factors. METHODS: Children with Sever's disease were compared with a similarly aged nonsymptomatic population to determine whether identifiable risk factors exist for the onset of Sever's disease. Areas raised in the literature and, hence, compared were biomechanical foot malalignment, as measured by Root et al-type foot measurements and the Foot Posture Index; ankle joint dorsiflexion, measured with a modified apparatus; body mass index; and total activity and types of sport played. RESULTS: Statistically significant but small odds ratios were found in forefoot to rearfoot determination and left ankle joint dorsiflexion. CONCLUSIONS: This study suggests that there is no evidence to support that weight and activity levels are risk factors for Sever's disease. The statistically significant but clinically negligible odds ratio (0.93) on the left side for decreased ankle joint dorsiflexion and statistically significant and clinically stronger odds ratio bilaterally for forefoot to rearfoot malalignment suggest that biomechanical malalignment is an area for further investigation.

Rehabilitation following microfracture for chondral injury in the knee.

Full-thickness chondral defects in the knee are common, and these articular cartilage lesions may present in various clinical settings and at different ages. Articular cartilage defects that extend full thickness to subchondral bone rarely - by providing a suitable environment for new tissue formation and takes advantage of the body's own healing potential. Proper surgical technique and rehabilitation improve the success rate of the microfracture procedure. The goals are to alleviate the pain and disability that can result from chondral lesions and restore joint conformity, thereby preventing late degenerative changes in the joint.

[The use of nitric-silica mineral water in combined rehabilitative therapy of musculotonic dorsopathy syndromes].

Nitric-silica baths had beneficial myoadaptive and analgesic effect on patients with reflex dorsopathy syndromes. Balneotherapy combined with the treatment by sinusoidal modulated currents, massage, and remedial gymnastics was efficacious in alleviating musculotonic and orthopedic problems in patients with lumbar osteochondrosis. This effect was more pronounced than with the use of gas-bubble baths due to the improvement of trophic processes in the muscular tissue of the affected back and limb regions.

Conservative treatment for osteochondrosis of the humeral capitellum.

BACKGROUND: Conservative treatment is recommended for the early stage of osteochondrosis of the humeral capitellum. However, the outcome of conservative treatment has not been well documented. HYPOTHESIS: Osteochondrosis of the humeral capitellum detected at an early stage responds well to conservative treatment. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We retrospectively reviewed 176 patients with osteochondrosis of the humeral capitellum. There were 134 lesions that were stage I (radiolucent area) in patients with a mean age of 11.5 years and 42 lesions that were stage II (nondisplaced fragments) in patients with a mean age of 13.9 years based on anteroposterior radiographs of the elbow in 45 degrees of flexion. Conservative treatment was performed on 101 patients. The remaining 75 patients did not follow the authors' advice. Conservative treatment consisted of discontinuation of heavy use of the elbow for at least 6 months. Follow-up radiographs were taken at 1-month intervals. At a mean follow-up of 24 months, all patients were evaluated clinically and radiographically. RESULTS: Conservative management produced healing in 90.5% of stage I lesions and 52.9% of stage II lesions. The mean period required for healing was 14.9 months in stage I and 12.3 months in stage II. Sixty-six of 84 (78.6%) stage I patients and 9 of 17 (52.9%) stage II patients returned to competitive-level baseball. Of the 75 patients who did not follow our advice, healing was observed in 17 (22.7%). The healing rate was higher for the 101 patients who followed our advice as opposed to the 75 patients who did not. CONCLUSION: Osteochondrosis of the humeral capitellum can be successfully treated conservatively if treatment is begun in an early stage of the disease.

Rehabilitation after bursoscopic treatment of Osgood-Schlatter disease--preliminary report.

BACKGROUND: The aim of this study was to describe program and effects of rehabilitation after bursocopic treatment of Osgood-Schlatter disease, carried out in order to alleviate effects of operation and to prevent renewed overloads and damages near the distal patellar ligament insertion. MATERIAL AND METHODS: Described rehabilitation program was employed from April 2003 to August 2005 to 11 children and youth at the age of 8 to 19 years (mean age 15 years, 8 boys and 3 girls), after bursoscopy of bursa infrapatellaris profunda. RESULTS: In nine of eleven patients pain has completely disappeared and they came back to recreational and amateur sport activity. In one patient pain only alleviated and one has given up rehabilitation. Pain was estimated after 3 months of rehabilitation, after that time every patient came back to physical education classes, after 4 months from bursoscopy five of them came back to the discipline of sport they practiced before operation. CONCLUSIONS: 1. Bursoscopic treatment of Osgood-Schlatter disease with proper rehabilitation decreases the complaints characteristic for this illness. 2. This kind of treatment also helps preventive procedure against repeated overloads and damages near distal patellar ligament attachment.

Multiple osteochondroses of bilateral knee joints: a case report.

Knee injuries in young athletes include not only the typical adult bone injuries, ligament and cartilage, but also the growth plate lesions. Osteochondroses are idiopathic, self-limited disturbance of enchondral ossification in which a rapid growth spurt is present. The patella could be affected by two different kinds of osteochondroses: Kohler syndrome and Sinding-Larsen-Johansson. Here we are reporting the first case of simultaneous location of osteochondroses of the two ossification centers of both patella. A 9-year-old boy, competitive skater, presented a history of anterior knee pain involving both knees. Standard X-rays, axial patellar view, MRI and arthro-MR were performed. In order to follow the natural history of the pathology and the evolution of the healing, examinations at 2 years were repeated. We proposed the young skater a medical and a physiotherapeutic treatment based on unloading, isometric exercises, NSAID. As the symptoms improve a gradual return to competitive sports activity was allowed. The case mentioned above can be considered an atypical case because the patient suffered for a bilateral knee osteochondroses, involving simultaneously the primary ossification centre (Kohler syndrome) and the secondary ossification centre (Larsen syndrome) of the patella.

[Administration of ehf-therapy for rehabilitation of locomotor diseases].

Noise EHF radiation under low-frequency (10 Hz) modulation both in monovariant and in combination with spinal tractions promotes regression of neuro-orthopedic disorders. Good effects were achieved due to improvement of zonal hemodynamics, conditions of functioning of the neuromuscular and locomotor system of the spine and limbs, favourable shifts in biochemical and autonomic status of patients with lumbar osteochondrosis and osteoarthrosis.

A prospective, randomised study comparing two techniques of autologous chondrocyte implantation for osteochondral defects in the knee: Periosteum covered versus type I/III collagen covered.

INTRODUCTION: The results for autologous chondrocyte implantation (ACI) in the treatment of full thickness chondral defects in the knee are encouraging. At present two techniques have been described to retain the chondrocyte suspension within the defect. The first involves using a periosteal cover (ACI-P) and the second involves using a type I/III collagen membrane (ACI-C). To the authors knowledge there are no comparative studies of these two techniques in the current literature. We have therefore undertaken such a study to establish if there is a difference between the 2 techniques based on a clinical and arthroscopic assessment. METHODS: A total of 68 patients with a mean age of 30.52 years with symptomatic articular cartilage defects were randomised to have either ACI-P (33 patients) or ACI-C (35 patients). The mean defect size was 4.54 cm2. All patients were followed up at 24 months. RESULTS: A clinical and functional assessment showed that 74% of patients had a good or excellent result following the ACI-C compared with 67% after the ACI-P at 2 years. Arthroscopy at 1 year also demonstrated similar results for both techniques. However, 36.4% of the ACI-P grafts required shaving for hypertrophy compared with none for the ACI-C grafts at 1 year. DISCUSSION: This study has shown no statistical difference between the clinical outcome of ACI-C versus ACI-P at 2 years. A significant number of patients who had the ACI-P required shaving of a hypertrophied graft. We conclude that there is no advantage in using periosteum as a cover for retaining chondrocytes within an osteochondral defect; as a result we advocate the use of an alternative cover such as a manufactured type I/III collagen membrane.

[Current issues in x-ray diagnosis of cervical osteochondrosis in the course of medical rehabilitation].

The results of studying 500 patients with neurological manifestations of cervical osteochondrosis are presented. All the patients underwent in the vertical position X-ray studies in the frontal, lateral, and axial projections, as well as functional spondylography. The development of radiological signs in patients with cervical osteochondrosis and that of the morphological and functional signs of degenerative and dystrophic changes in the cervical spine are discussed. Comprehensive evaluation of osteochondrosis used criteria for cervical motor disorders and impaired disk amortizing and spinal fixing functions. The degree of intradural space compression was also estimated. The studies have yielded a new classification of osteochondrosis and recommendations at the stages of medical rehabilitation.

[Rehabilitation of patients with chronic prostatitis in combination with reflex syndromes of lumbar osteochondrosis]. / Vosstanovitel'noe lechenie bol'nykh khronicheskim prostatitom v sochetanii s reflektornymi sindromami poiasnichnogo osteokhondroza.

A combined treatment is proposed for patients with chronic prostatitis attended by reflex syndromes of lumbar osteochondrosis. The treatment consists in postisometric relaxation, massage of the prostate and transrectal mobilization of the pelvic ligaments. The results achieved in 106 patients proved that the proposed combined treatment is effective in compound pathology of the pelvic region.

Osteocondrosis de¡ astrágalo

Frecuentemente, asociamos las necrosis óseas podológicas a la edad de crecimiento ósea y aunque esto es cierto en la mayor parte de los pacientes, en algunas ocasiones, a lo largo de nuestra carrera profesional, podemos encontrar ciertos casos que deberemos afrontar, elaborando un diagnóstico preciso, solicitando las pruebas complementarias oportunas, tratando la patología de forma interdisciplinar con otros profesionales de la salud e interviniendo con distintos tratamientos podológicos. Presentamos un caso clínico de osteocondrosis avascular de la tróclea astragalina, que se trató en primer lugar quirúrgicamente en un intento de revascularización, y que posteriormente abordamos con tratamiento ortopodológico (AU)

[Treatment and rehabilitation measures concerning degenerative dystrophic changes of the cervical spine in elderly patients]. / Lechebno-reabilitatsionnye meropriiatiia pri degenerativno-distroficheskykh izmeneniiakh v sheinom otdele pozvonochnika u bol'nykh pozhilogo vozrasta.

The results of treatment 300 elderly aged patients with cervical spine syndromes enabled us to develop the most effective treatment-and-rehabilitation programs with manual therapy involved, determine stages of the therapy course of such patients. The results of the complex treatment were better in comparison with the traditional treatment mainly based on pharmacotherapy. That allows us to recommend it to wide clinical use as the treatment agreeable to the modern standards.

Disability levels of college-aged men with a history of Osgood-Schlatter disease.

Osgood-Schlatter disease (OSD), which is a traction apophysitis of the tibial tuberosity, is one of the most common orthopedic conditions that adolescent athletes will encounter. Adolescent athletes with OSD typically present with pain, swelling, and tenderness over the tibial tuberosity that worsens with athletic activity. Few published reports have described the effects of OSD on the disability levels of athletes beyond adolescence. Therefore, the purpose of this study was to assess the disability levels of college-aged male subjects (n = 25, mean age = 20.3 years) who have a history of OSD and compare their status to a control group of healthy male subjects with no history of OSD (n = 25, mean age = 20.4 years) matched by intercollegiate sport and age. The mean time from being diagnosed with OSD to participation in this study was 7.6 +/- 2.4 years for subjects in the OSD group. All subjects completed the Knee Outcome Survey Activities of Daily Living Scale and Sports Activity Scale, which served as our measure of disability. The results indicated that subjects with a history of OSD scored significantly lower than subjects in the control group on both the Knee Outcome Survey Activities of Daily Living Scale and Sports Activity Scale, indicating that subjects with OSD experienced higher levels of disability than subjects in the control group.

[Effect of combined psychocorrection on dynamics of pain syndrome and psychological status of patients with spinal osteochondrosis]. / Vliianie kompleksnoi psikhokorrektsii na dinamiku bolevogo sindroma i psikhologicheskii status bol'nykh osteokhondrozom pozvonochnika.

AIM: To study effectiveness of a new psychocorrection method (combined use of neuroleptic trifluoperasine and psychorelaxation therapy using biological feedback) in rehabilitation of patients with long-term pain syndrome provoked by spinal osteochondrosis (SOC) to determine predictors of response to this method of psychocorrection. MATERIAL AND METHODS: 132 patients with SOC and associated pain syndrome were examined using pain assessing methods and psychological tests. RESULTS: Psychocorrection including neuroleptic significantly raises the efficacy of SOC treatment and relieves pain, hypochondric fixations and depressive disorders. The reduction of pain syndrome intensity in the course of psychocorrection correlates with attenuation of hypochondric disorders and inclination to fixation. As to predictors of the treatment effect, the strongest relief of pain in psychocorrection was achieved in patients with hypochondric and anxiodepressive disorders. CONCLUSION: Combined psychocorrection comprising minimal doses of neuroleptic trifluoperasine and psychorelaxation is effective in the treatment of SOC patients with long-term pain syndrome.