Cross-sectional study of the prevalence of hyperextension of the first metatarsophalangeal joint and its relationship to onycholysis in women with hallux valgus.

BACKGROUND: Hallux Valgus (HV) deformity is associated with misalignment in the sagittal plane that affects the first toe. However, the repercussions of the first toe hyperextension in HV have been scarcely considered. The purpose of this study was to provide evidence of the association between first-toe hyperextension and the risk of first toenail onycholysis in HV. METHODS: A total of 248 HV from 129 females were included. The extension of 1st MTP joint was measured while the patient was in the neutral position of the hallux using a two-branch goniometer. The classification of the HV severity stage was determined by the Manchester visual scale, and the height of the first toe in the standing position was measured using a digital meter. An interview and clinical examination were performed to collect information on the presence of onycholysis of the first toe. RESULTS: Of the 248 HV studied, 100 (40.3%) had onycholysis. A neutral extension > 30 degrees was noted in 110 (44.3%) HV. The incidence of onycholysis was higher in HV type C than in type B (p = 0.044). The probability of suffering onycholysis in the right foot was 2.3 times greater when the neutral position was higher than 30 degrees (OR = 2.3; p = 0.004). However, this was not observed in the left foot (p = 0.171). Onycholysis was more frequent in HV with more than 2 cm height of the first toe (p < 0.001). For both feet, the probability of suffering onycholysis was greater for each unit increase in hallux height (right foot OR = 9.0402, p = 0.005; left foot OR = 7.6633, p = 0.010). CONCLUSIONS: The incidence of onycholysis appears to be significantly associated with HV showing more than 30º extension, and more than 2 cm height of the first toe. Height and hyperextension of the first toe together with first toenail pathology should be mandatory in the evaluation of HV.

Scoliosis induced by costotransversectomy in minipigs model.

Aim To validate surgical costotransversectomy as a technique for creating a scoliosis model in minipigs and to assess whether differences in approach (posterior medial approach, posterior paramedial approach and anterior approach by video-assisted thoracoscopy) lead to differences in the production of spinal deformity. Creation of disease models in experimental animals, specifically in minipigs, is controversial, as no appropriate technique has been reported. Methods Surgical costotransversectomy was performed in 11 minipigs using 3 different approaches: posterior medial approach (4 animals, group I), posterior paramedial approach (3 animals, group II) and anterior approach by videothoracoscopy (4 animals, group III). A conventional x-ray study was performed in the immediate postoperative period. Follow-up lasted for 4 months. Specimens were humanely killed according to current protocols, and a second x-ray study was performed. A deformation was measured using the Cobb angle and direct observation of the rotational component. Results Data from group I revealed a scoliosis deformation of 27º-41º (mean 34.5º) with a macroscopic rotational component. No deformity (<10º) or rotational component was observed in groups II and III. Only a posterior medial costotransversectomy produced a significant deformity in minipigs and established a valid model for studying scoliosis in these animals. Conclusion Only a posterior medial costotransversectomy produces a significant deformity in minipigs and establish a valid model for studying scoliosis in these animals. A tensegrity model would elucidate such results and harmonize disparate conclusions. Further investigation is needed to demonstrate the reliability of tensegrity principles for spinal biomechanics.

Pharmacology of Ischemia-Reperfusion. Translational Research Considerations.

Ischemia-reperfusion (IRI) is a complex physiopathological mechanism involving a large number of metabolic processes that can eventually lead to cell apoptosis and ultimately tissue necrosis. Treatment approaches intended to reduce or palliate the effects of IRI are varied, and are aimed basically at: inhibiting cell apoptosis and the complement system in the inflammatory process deriving from IRI, modulating calcium levels, maintaining mitochondrial membrane integrity, reducing the oxidative effects of IRI and levels of inflammatory cytokines, or minimizing the action of macrophages, neutrophils, and other cell types. This study involved an extensive, up-to-date review of the bibliography on the currently most widely used active products in the treatment and prevention of IRI, and their mechanisms of action, in an aim to obtain an overview of current and potential future treatments for this pathological process. The importance of IRI is clearly reflected by the large number of studies published year after year, and by the variety of pathophysiological processes involved in this major vascular problem. A quick study of the evolution of IRI-related publications in PubMed shows that in a single month in 2014, 263 articles were published, compared to 806 articles in the entire 1990.

Lesiones deportivas de la muñeca y mano / Sports injuries of the wrist and hand

El objetivo de este trabajo es exponer de un modo sistemático, las lesiones deportivas más frecuentes o más graves de la mano y la muñeca, presentando los tratamientos basados en métodos sencillos y seguros. Las lesiones de la mano representan una gran proporción de todas las lesiones que acuden a los servicios de urgencias (aproximadamente un tercio). En los deportistas, son particularmente frecuentes las lesiones por avulsión del flexor profundo, el dedo en martillo (lesión cerrada más común del deportista), las roturas de la placa volar, o las lesiones de los ligamentos colaterales. Se revisan además las tendinitis y tendinosis, luxaciones tendineas a distintos niveles, neuropatías de los nervios mediano, cubital y colaterales digitales, síndrome de impactación cubito carpiano, esguinces, fracturas y luxaciones articulares, deformidades más comunes de los dedos (Boutonnière, Jersey finger, mallet finger y dedo caído), los esguinces e inestabilidades carpianas y las lesiones del fibrocartílago triangular. La evaluación de las lesiones óseas debe iniciarse con unas radiografías simples. La TAC debe reservarse para la comprensión de las lesiones óseas complejas. La ecografía y la resonancia para el estudio de los tejidos blandos. Se exponen los tratamientos más comunes con la idea de que sirva como una guía rápida para enfocar estas lesiones a pie de pista. La mayoría de mecanismos de lesión de las manos relacionados con el deporte se pueden prevenir. La literatura actual sugiere que los esfuerzos dirigidos al cambio de reglas en los distintos deportes para conseguir entornos de juego más seguros, así como los cambios en la educación y formación de entrenadores, deportistas y personal sanitario minimizan los riesgos de lesión

The aim of this work is to expose systematically the most frequent or severe sports injuries of the hand, presenting treatments based on simple and safe. Hand injuries account for a large proportion of injuries treated in the emergency departments (approximately one third). In athletes, particularly frequent avulsion injuries are deep flexor, mallet finger (closed most common injury of the athlete), the volar plate ruptures, or collateral ligament injuries. Tendinitis and tendinosis, tendinous dislocations at different levels, neuropathy of median, ulnar and digital collateral, impactation ulnar carpal syndrome, sprains, fractures and joint dislocations, common deformities of the fingers (Boutonnière, Jersey finger, mallet finger and thumb down), carpal instabilities, sprains and injuries of the triangular fibrocartilage are reviewed. The evaluation of bone lesions should start with a plain radiographs. The CT-scan should be reserved for the understanding of complex bone lesions. Ultrasound and MRI are recommended for the study of soft tissue injuries. The most common treatment protocols are addressed that constitutes a rapid guide to assess all these lesions at the course. Most injury mechanisms related to the different hand lesions in sports are preventable. The current literature suggests that some efforts should be done to change rules in different sports to get safer playing environments. Changes in the education and training of coaches, athletes and healthcare personnel are needed to minimize the risk of injury

Mal posición de tornillos pediculares lumbares que producen radiculalgia mecánica postoperatoria con estimulación neurofisiológica intraoperatoria normal: el valor de la estimulación neurofisiológica del trayecto del tornillo / Mau posicionamento de parafusos pediculares lombares que produzem radiculalgia mecânica pós-operatória com estimulação neurofisiológica intraoperatória normal: o valor da estimulação neurofisiológica no trajeto do parafuso / Misplacement of lumbar pedicular screws that produce postoperative mechanical radiculalgia with normal intraoperative neurophysiological stimulation: the value of neurophysiological stimulation at the pedicular mid-track

OBJETIVO: Valorar una exploración neurofisiológica que identifique estos casos intraoperatoriamente y evite la mal posición de tornillos pediculares. MÉTODOS: En 293 pacientes intervenidos de escoliosis por vía posterior con tornillos pediculares y técnica "free hand", se implantaron 6.739 tornillos. De estos, ocho pacientes (2,7%), con edad promedio de 24 años, presentaron dolor radicular lumbar postoperatorio. En la TC postoperatoria se encontraron 10 tornillos lumbares (2L1-3L2-4L3-1L4) con prominencia mínima en la parte inferior del pedículo. Se evaluaron los umbrales de EMG del tornillo y del trayecto. RESULTADOS: En cirugía inicial no se detectaron anomalías en la palpación del trayecto, ni en el control radioscópico, ni alteraciones neurofisiológicas en la estimulación neurofisiológica con t-EMG. Todos presentaron dolor radicular en bipedestación y sedestación que remitía con reposo en cama. Los tornillos fueron retirados quirúrgicamente a los 37 días en promedio (R:4-182). En esta cirugía se repitió la monitorización neurofisiológica y volvió a mostrar valores normales (> 11mA). Tras la retirada de los tornillos, se realizó estimulación del trayecto que mostró en la parte media, umbrales por debajo de los valores normales (3,9-10,7mA). Tras un seguimiento promedio de 4,4 años (R:2,6-6.8), cinco pacientes referían tener molestias radiculares ocasionales y uno tenía déficit motor mínimo en la extremidad afectada. CONCLUSIONES: Se presenta un tipo de mal posicionamiento de tornillo pedicular lumbar que produce radiculalgia en bipedestación-sedestación y que no es detectado con monitorización convencional. La estimulación neurofisiológica del trayecto en la zona media, tras retirada del tornillo pedicular, produjo umbrales bajos de estimulación. Se recomienda estimulación sistemática del trayecto antes de la inserción del tornillo pedicular lumbar.

OBJETIVO: Avaliar a exploração neurofisiológica que identifica esses casos no intraoperatório e que evite o mal posicionamento de parafusos pediculares. MÉTODOS: Em 293 pacientes submetidos à intervenção para escoliose por via posterior com parafusos pediculares e técnica "free hand", foram implantados 6.739 parafusos. Do total, oito pacientes (2,7%) com média de idade de 24 anos, tiveram dor radicular lombar no pós-operatório. Na TC depois da cirurgia, foram encontrados 10 parafusos lombares (2L1-3L2-4L3-1L4) com proeminência mínima na parte inferior do pedículo. Foram avaliados os limiares EMG do parafuso e do trajeto. RESULTADOS: Na cirurgia inicial, não foram detectadas anomalias à palpação do trajeto nem no controle radioscópico; também não se verificaram alterações neurofisiológicas na estimulação neurofisiológica com t-EMG. Todos os pacientes tiveram dor radicular em posição ortostática e sentada, que passava com o repouso na cama. Os parafusos foram retirados cirurgicamente aos 37 dias, em média (R:4-182). Nesta cirurgia repetiu-se a monitoração neurofisiológica, que voltou a mostrar valores normais (> 11mA). Depois da retirada dos parafusos, realizou-se estimulação do trajeto que mostrou, na parte média, limiares inferiores aos valores normais (3,9-10,7mA). Depois de acompanhamento médio de 4,4 anos (R:2,6-6.8), cinco pacientes relatavam incômodos radiculares ocasionais e um tinha déficit motor mínimo no membro afetado. CONCLUSÕES: Apresenta-se um tipo de mal posicionamento de parafuso pedicular lombar que produz radiculalgia em posição ortostática e sentada, que não é detectado pela monitoração convencional. A estimulação neurofisiológica do trajeto na zona média, depois da retirada do parafuso, produziu limiares baixos de estimulação. Recomenda-se a estimulação sistemática do trajeto antes da inserção do parafuso pedicular lombar.

OBJECTIVE: To carry out a neurophysical evaluation that can identify these cases during surgery, and that prevents misplacement of pedicular screws. METHODS: A total of 6739 screws were placed in 293 patients submitted to scoliosis correction via the posterior route with pedicular screws using the freehand technique. Of this total, eight patients (2.7%), with a mean age of 24 years, developed postoperative radiculopathy. Lumbar CT scans showed 10 misplaced lumbar screws (2L1-3L2-4L3-1L4), with minimal protrusion of the lower part of the screw. EMG thresholds of the screw and track were evaluated. RESULTS: In the initial surgery, no anomalies were detected on palpation of the screw track or in the radioscopic control; neither were any neurophysiological alterations detected in the neurophysiological stimulation with t-EMG. All the patients had radicular pain in the standing and seated positions, which disappeared when lying on the bed. The screws were surgically removed at an average of 37 days after surgery (range: 4-182). In this surgical procedure, the neurophysiological monitoring was repeated, again showing normal thresholds (>11mA). After screw removal, stimulation of the probe within the track showed very low thresholds (range: 3.9-10.7 mA) at mid pedicular track. After a mean follow-up time of 4.4 years (Range: 2.6-6.8), five patients reported occasional radicular discomfort, and had minimal motor deficit in the affected limb. CONCLUSIONS: A type of misplacement of lumbar pedicle screws is presented that produces radicular pain in the standing and seated positions, and that may not be detected by conventional monitoring. Neurophysiological stimulation of the mid pedicular track, after removal of the screw, produces low stimulation thresholds. Systematic stimulation of the track prior to insertion of the lumbar pedicular screw is recommended.

Changes in a patient with neck pain after application of ischemic compression as a trigger point therapy.

OBJECTIVE: To describe the immediate effects of ischemic compression (IC) as a trigger point therapy in a case of a patient with neck pain. The application of IC is a safe and effective method to successfully treat elicited myofascial trigger points. The purpose of this method is to deliberate the blockage of blood in a trigger point area in order to increase local blood flow. This washes away waste products, supplies necessary oxygen and helps the affected tissue to heal. In this case study, we treated a 27-year-old female patient with a medical report of neck pain for at least four months. The physical examination revealed a neck pain and stiffness at the left side and pain increases when moving the neck. An active myofascial trigger point was found in the left trapezius muscle. The following data were recorded: active range of motion of cervical rachis measured with a cervical range of motion instrument, basal electrical activity of the left trapezius measured with electromyography, and pressure tolerance of the myofascial trigger point measured with visual analogue scale, assessing local pain evoked by the application of 2.5 kg/cm2 pressure with an analogue algometer. RESULTS: Immediately after application of the IC, all measured parameters improved compared to base line. The application of IC has been shown effective in the treatment of myofascial trigger points in a patient with neck pain. The results show a relation between active range of motion of cervical rachis, basal electrical activity of the trapezius muscle and myofascial trigger point sensitivity. CONCLUSIONS: In this case of a patient with neck pain, active range of motion of cervical rachis, basal electrical activity of the trapezius muscle and myofascial trigger point sensitivity gaining short-term positive effects with the application of one single ischemic compression session. Nevertheless, randomized controlled double-blinded studies should be conducted in future to examine the effectiveness of this ischemic compression technique in case of the presence of myofascial trigger points in the neck.

Lesiones deportivas en los grinders de una tripulación de la Copa América durante 2004-2007 / Sports injuries in the grinders of an America´s cup sailing crew between 2004-2007

Objetivo: El propósito de este trabajo epidemiológico es describir de modo prospectivo las lesiones específicas ocurridas entre los grinders de una tripulación de Copa América durante las horas de competición. Métodos: Todas las lesiones sufridas por los 9 grinders de una misma tripulación fueron registradas durante las competiciones correspondientes a los 8 Actos de preparación (2004-2007) de la 32 ed. de Copa del América 2007 y la Copa Louis Vuitton. La edad media de los grinders se sitúa en 24,7 años (19-30). Las lesiones fueron clasificadas entraumáticas y por sobrecarga, agudas y crónicas. Se registraron la localización anatómica y el tipo diagnóstico de lesión. Resultados: En total se registraron 30 lesiones en 9 grinders. Un total de 6 tripulantes presentaron más de una lesión durante el estudio. La incidencia global fue de 9,09 lesiones/1000 horas de competición. Las lesiones por sobrecarga alcanzaron el 70% (nº:21) y las traumáticas el 30% (nº:9). Del total, 14 lesiones fueron clasificadas como crónicas, es decir, correspondieron a reactivaciones de antiguas lesiones. Se observaron 16 lesiones agudas o de nueva aparición. Del total de lesiones, el 50% se presentaron en la cintura escapular y en la columna cervical y el 30% en la extermidad superior. Según el tipo diagnóstico, las lesiones más frecuentes fueron las lesiones musculares funcionales (nº:15; 50%), seguido de sobrecargas articulares con sinovitis(nº:8; 26,7%) y las tendinopatías (nº:7; 23,3%). Conclusiones: El análisis prospectivo de las lesiones sufridas por los grinders durante America’s Cup indica que estos tripulantes tienen un alto riesgo de lesiones aunque su severidad es leve. Las lesiones se concentran en la cintura escapular, columna cervical y extremidad superior. Algún programa de prevención en esas localizaciones debería ser implementado en estos atletas (AU)

Objective: This epidemiological work was aimed at describing the specific injuries occurred in grinders of an America’s Cup yachting crew during competition hours throughout to the preparatory acts of the 32 nd America’s Cup 2007 and the Louis Vuitton Cup. Methods: All injuries suffered by sailors in grinder position were prospectively registered from October 2004 to June 2007. This period included 8 preparatory acts of the 32 nd America’s Cup 2007 and the Louis Vuitton Cup. There were 9 grinders with an average age of 24, 7 years (19-30). Injuries were classified as traumatic and secondary to overuse. Injuries were also considered either acute orchronic. Anatomic location of injury and the diagnosis type were registered. Results: A total of 30 injuries in 9 athletes were registered during the period of study. A group of 6 sailors showed more than one injury. None of the 9 grinders were free from any injury along the four competition years. Overall incidence was 9,09 injuries/1000 competition hours. Overuse injuries account for the 70% (nº:21) and traumatic for 30% (nº:9). The most common anatomic location was the shoulder girdle (50%), being the region most frequently affected. The most frequent injuries were found to be functional muscular injuries (nº:15; 50%), followed by joint injuries such as strains with synovitis (nº:8; 26,7%) and tendinopathies (nº:7; 23,3%). Conclusions: Grinders who participate in America’s Cup are exposed to a high risk of overuse injuries, although the severity of injuries is low. Specific programs for the most affected anatomic areas should be incorporated. This particular group should be included in strict monitoring programs for injury prevention and specific physical training (AU)

Síndrome de Haglund / Haglund syndrome

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