[Assess of patients' functional condition with rheumatoid arthritis before and after physical therapy treatment]. / Ocena stanu funkcjonalnego chorych na reumatoidalne zapalenie stawów przed i po zastosowaniu fizykoterapii.

UNLABELLED: The aim of this study was to assess the impact of duration of disease and age on the functional condition of patients and also healing effectiveness in different duration of disease and age. MATERIAL AND METHODS: The study involved 31 patients with rheumatoid arthritis aged 40-70 years, with duration of disease 5-20 years. In this group was used following physical therapy technique: cryotherapy, ultrasound therapy, laser therapy, electrical stimulation TENS, iontophoresis, diadynamic and magnetic therapy. Before and after the treatment motor capacity was estimated using Health Assessment Questionnaire (HAQ). RESULTS: The presented results indicate improvement of measured parameters and increasement of patients independence after therapy, especially with duration of disease 5-10 years aged 60-70 years. CONCLUSIONS: Susceptibility of anti pain treatment using physical therapy increase with increasing duration of disease. Therapy influence on functional condition of patient decreasing with duration of disease.

[Tender points and trigger points--differences and similarities]. / Tender points i trigger points--róznice i podobienstwa.

Two main types of myalgia that are not inflammatory are fibromyalgia (FB) and myofasical pain (MFP). In both of them during diagnosing tender points (characteristic for fibromyalgia) and trigger points (MTrP--characteristic for myofasical pain) are of key importance. A great degree of similarity together with the inability to differentiate between those points result in wrong diagnosis and, as a consequence, failure of therapy. Additional difficulties are caused by the lack of unity in nomenclature, as in literature the term tender point and trigger point are used interchangeably. Moreover, some centres question the existence of fibromyalgia and myofascial pain as separate pain entities.

[The Polish model of physiotherapeutic conduct in rheumatoid arthritis and recommendation of Ottawa Panel]. / Polskie podejscie fizjoterapeutyczne usprawniania w reumatoidalnym zapaleniu stawów a zalecenia Panelu Ottawskiego.

THE AIM: The aim of the research was to evaluate how the suggestions of the Ottawa Panel are implemented with regard to the patents suffering from rheumatoid arthritis in Poland. MATERIAL AND METHOD: in the research there was a test group of 41 people (33 women and 8 men) with rheumatoid arthritis. The criterion that was decisive in this study was the phase of reemission of the illness and whether the patient was taking part in physiotherapeutic treatment. The age of the subjects varied from 25 and 79 (the average age was 53.11). The average duration of the illness was 12.17 years. The research was conducted from November 2006 until September 2007 in Wiktor Dega Orthopedic-Rehabilitation Clinical Hospital (O-RSK4) in Poznan and in 22nd Military Rehabilitation Hospital in Ciechocinek. RESULTS: It was shown in the tested group there was a deep correlation between the joints with movement restrictions and the ones that caused most pain (r = 0.6086 for sum of painful joints with those with movement restrictions). Any link between the presence of deformation within the lower limb and exercising the suggested elements of gait during rehabilitation has not been found. Similarly, there was no dependence between the presence of deformations in the upper limb and the appropriate physiotherapeutic treatment. However, only in one patient the physical treatment recommended by the Panel was not used at all. CONCLUSIONS: The majority of the Ottawa Panel recommendations is implemented in the Polish model. A big part of patients has access to rehabilitation and usually the physical treatment techniques that proved to be the most beneficial are used. However, certain changes should be introduced to kinesis therapy, which tends to be focused more on joint deformation than on global work on the improvement of functionality and thus--the quality of patient's life.

[Myofacial pain and tension-type headache]. / Bóle miesniowo-powieziowe a napieciowy ból glowy.

The current epidemiological data indicate that at least 20% of the adult population suffer from frequent and returning headaches. The latest classification elaborated by the International Headache Society (IHS) distinguishes more than 80 different kinds of headaches in 14 groups (the second edition). The statistics show that about 30-78% of the cause of these disorders is the tension-type headache (NBG), which turns into chronic state (PNBG) of about 3%. The etiology and the likelihood mechanism of rising this kind of pain is being discussed for many years now and it awakes many controversies. At present, the research workers agree that the peripheral pain mechanism is responsible for rising NBG however at the base of PNBG lies the persistent activation of the peripheral nociceptors by intervention of which it comes to stimulation of central neurons. In confirmation of the muscular origin of NBG and the attempt of stating the new course to take with patients there are works of Simons and co-workers that describe myofascial pain. Myofascial pain is explained as a state of functional disorders which is bred by active trigger points (which breed pain after a fixed pattern) and latent points that being about disorders without pain effect. The treatment of myofascial pain is based on restoring the proper biochemistry and physiological length of the myofascials elements.

[The current state of knowledge about pathomechanism of tennis elbow]. / Aktualny stan wiedzy na temat patomechanizmu tzw. lokcia tenisisty.

The term tennis elbow applies to the state in which the patient feels pain in the area of lateral epicondyle and concomitantly suffers from strength disorders together with diminished capability of the upper limb. Even a very brief look at the specialist literature reveals that there is a number of terms for this particular pain unit. Throughout many years this pain was linked with the inflammation of the common extensors tendon. Presently there is a widespread agreement that this painful condition is connected with the degeneration in the area of common extensors tendon, in particular the extensor carpi radialis brevis. A closer consideration of the pathomechanism of the tennis elbow points to the fact that this seemingly simple pain unity is a complex problem. Moreover, it shows how important the nuances in patients opinion are and how such details can influence not only the diagnose but also the treatment.

Piriformis muscle syndrome.

Sciatica is characterized by radiating pain from the sacro-lumbar region to the buttocks and down to the lower limb. The causes of sciatica usually relate to degenerative changes in the spine and lesions to the intervertebral discs. Secondary symptomatic sciatica may by caused by metastases to the vertebra, tuberculosis of the spine, tumors located inside the vertebral channel, or entrapment of the sciatic nerve in the piriformis muscle. The piriformis syndrome is primarily caused by fall injury, but other causes are possible, including pyomyositis, dystonia musculorum deformans, and fibrosis after deep injections. Secondary causes like irritation of the sacroiliac joint or lump near the sciatic notch have been described. In the general practice the so-called posttraumatic piriformis muscle syndrome is common. The right treatment can be started following a thorough investigation into the cause of symptoms.