Intraoperative checking of the first ray rotation and sesamoid position through sonographic assistance.

INTRODUCTION: Hallux valgus (HV) deformity affects the orientation of the metatarsophalangeal (MTP) joint in three planes. Displacement in the coronal plane results in axial rotation of the first metatarsal, with progressive subluxation of the first MTP joint. Multiple techniques have been described to correct the malrotation itself. However, none of them have checked intraoperatively the final position of the first metatarsal head and sesamoids previous to the fixation of the Lapidus procedure or first metatarsal bone osteotomies. The aim of this article is to describe a novel technique to check the first ray rotation and sesamoids position through sonographic assistance. MATERIALS AND METHODS: Before fixation of the Lapidus procedure, with the ankle in maximal dorsiflexion, the surgeon takes the linear ultrasound probe and places it on the sole to visualize the sesamoids, which should be viewed at the same level, with the flexor hallucis longus (FHL) centered between both. Once the ideal position of the head of the first ray has been achieved, temporary fixation with K-wires is performed over the first TMT joint and M1-M2 joint for further sonographic verification of the sesamoids beneath the first metatarsal head. The height of the sesamoids relative to the second metatarsal head should be checked by sonographic control too. RESULTS: Four patients were included. Three females and one male. Their mean age was 76.4 years (R 61-72). Their mean BMI was 29 (R 27.5-32.24). The mean IMA (intermetatarsal angle) was 18.2 (R 17.2-19) degrees and the mean MPA (metatarsophalangeal angle) was 50 (R 36-63) degrees. CONCLUSIONS: Sonographic assistance, is a widely available, inexpensive, and comparative imaging technique that can guide the first ray rotation and sesamoids position in HV surgery, theoretically improving radiological outcomes.

Mapeo sonográfico de los nervios de la cara medial del tobillo y del pie / Sonographic mapping of the nerves of the medial side of the ankle and foot

El uso de los ultrasonidos en el examen, la identificación y el intervencionismo de las diferentes ramas nerviosas del tobillo y del pie son una herramienta de gran apoyo en el ámbito clínico. En la actualidad, la ecografía es un método que se ha ido universalizando en el mundo de la podología, bien por su mayor accesibilidad debido al abaratamiento de los costes, a los avances tecnológicos y a sus beneficios de inocuidad, fácil disponibilidad para el examen inmediato y su aplicación dinámica en la evaluación de las diferentes estructuras anatómicas. El presente trabajo trata de presentar a la comunidad podológica una descripción detallada del mapeo mediante ecografía de los nervios en cara medial del pie. Entendemos que esta descripción puede ayudar a los profesionales en el diagnóstico de las patologías de atrapamiento nervioso a dicho nivel, así como en procedimientos mínimamente invasivos guiados ecográficamente en dicha área anatómica.(AU)

The use of ultrasound in clinical practice is a great tool for the examination, identification and intervention of the different nerve branches in the foot and ankle. Nowadays, sonography is an exploratory method that has been universally expanded in podiatry because of lowering of costs associated to its use, technological progresses and its benefits of safety, disposal for the inmediate clinical exam and its dynamic application in the evaluation of different structures. The aim of the present paper is to present to the podiatry community a detailed description of sonographic mapping of the nerves in the medial side of the ankle. It is intended to help professionals involved in the management of foot ankle disorders regarding the diagnosis of entrapment neuropathies at this level and also to help with minimally invasive treatments sonographically guided.(AU)

Ultrasound Examination of the Ligament Complex Within the Medial Aspect of the Ankle and Foot.

To properly diagnose and treat injuries to the ankle or foot, the physician must have good anatomical knowledge of the ligaments involved. The bundles can be distinguished and identified by ultrasound examination of the medial aspect, but this may be a challenging task. In the present illustrated study, we discuss how a detailed ultrasound examination can be made of the different ligaments within the medial aspect of the ankle and foot.

Ultrasonographic and Histological Correlation after Experimental Reconstruction of a Volumetric Muscle Loss Injury with Adipose Tissue.

Different types of scaffolds are used to reconstruct muscle volume loss injuries. In this experimental study, we correlated ultrasound observations with histological findings in a muscle volume loss injury reconstructed with autologous adipose tissue. The outcome is compared with decellularized and porous matrix implants. Autologous adipose tissue, decellularized matrix, and a porous collagen matrix were implanted in volumetric muscle loss (VML) injuries generated on the anterior tibial muscles of Wistar rats. Sixty days after implantation, ultrasound findings were compared with histological and histomorphometric analysis. The muscles with an autologous adipose tissue implant exhibited an ultrasound pattern that was quite similar to that of the regenerative control muscles. From a histological point of view, the defects had been occupied by newly formed muscle tissue with certain structural abnormalities that would explain the differences between the ultrasound patterns of the normal control muscles and the regenerated ones. While the decellularized muscle matrix implant resulted in fibrosis and an inflammatory response, the porous collagen matrix implant was replaced by regenerative muscle fibers with neurogenic atrophy and fibrosis. In both cases, the ultrasound images reflected echogenic, echotextural, and vascular changes compatible with the histological findings of failed muscle regeneration. The ultrasound analysis confirmed the histological findings observed in the VML injuries reconstructed by autologous adipose tissue implantation. Ultrasound can be a useful tool for evaluating the structure of muscles reconstructed through tissue engineering.

Atribuciones profesionales en el ejercicio para la salud de la Sociedad Española de Medicina del Deporte / Professional attributions in the exercise for the health of the Spanish Society of Sports Medicine

La práctica regular de ejercicio físico es extraordinariamente efectiva en el manejo de un número creciente de patologíascrónicas algunas de ellas con una prevalencia de magnitud pandémica, por lo que la sociedad debe asumir la incorporaciónde la actividad física como estrategia de salud para prevenir y para servir como tratamiento complementario de la enfermedad.La medicina y la fisioterapia tienen un papel primordial en el manejo del ejercicio para la salud y también, fuera de la sanidad,las titulaciones de ciencias de la actividad física y el deporte ocupan un papel muy destacado en este ámbito de trabajo.Desde la sanidad, la medicina y la fisioterapia tienen un papel primordial en el manejo del ejercicio para la salud y también,fuera de la sanidad, las titulaciones de ciencias de la actividad física y el deporte ocupan un papel muy destacado en la pro-moción y ejecución de estrategias para el fomento de la salud.Estas profesiones han venido ocupando una posición en el abordaje de este problema que, en algunas ocasiones, ha supuestopuntos de fricción respecto a su papel, responsabilidades y función. Por otra parte, existe la necesidad de resolver la cuestiónde los ámbitos competenciales de las profesiones manteniendo la voluntad de reconocer simultáneamente los crecientesespacios competenciales compartidos interprofesionalmente y los muy relevantes espacios específicos de cada profesión.Este documento parte de la necesidad de abordar la incorporación del ejercicio en la prevención y manejo de la enfermedadde una forma sólida y consistente, considerando la aportación de las profesiones implicadas desde la óptica del trabajo mul-tidisciplinar y con una colaboración no conflictiva sino cooperativa, transparente y respetuosa y, siempre, con el objetivo deservir a la sociedad de la forma más efectiva posible, definiendo de una forma clara cuáles con las atribuciones profesionalesde la medicina, de la fisioterapia y de las ciencias...(AU)

The regular practice of physical exercise is extraordinarily effective in the management of a growing number of chronic diseases,some of them with a prevalence of pandemic magnitude, for which the society must assume the incorporation of physicalactivity as a health strategy to prevent and to serve as a complementary treatment of the disease.Not only medicine and physiotherapy play a fundamental role in the management of exercise for health but also, outside ofhealth, Sports science and physical education degree is crucial in this field of work.From a health point of view, medicine and physiotherapy have a primary role in the management of exercise for health andalso, outside of health, sports science and physical education degree occupy a very prominent role in the promotion andimplementation of strategies for the promotion of health.These professions have been occupying a position in addressing this problem that, on some occasions, has led to points offriction with respect to their role, responsibilities and function. On the other hand, there is a need to resolve the question ofthe professions’ areas of competence while maintaining the will to simultaneously recognize the growing areas of competenceshared interprofessionally and the highly relevant areas specific to each profession.This document is based on the need to address the incorporation of exercise in the prevention and management of disease ina solid and consistent way, considering the contribution of the professions involved from the perspective of multidisciplinarywork and with a non-conflictual but cooperative, transparent and respectful collaboration. In addition, this collaborationshould always aim at serving society in the most effective way possible, clearly defining the professional attributions of me-dicine, physiotherapy and physical activity and sport sciences in everything related to the use of exercise as a tool for health.(AU)

Is Dry Needling Applied by Physical Therapists Effective for Pain in Musculoskeletal Conditions? A Systematic Review and Meta-Analysis.

OBJECTIVE: The main objective of this systematic review and meta-analysis was to determine the short-, medium-, and long-term effectiveness of dry needling (DN) applied by physical therapists to myofascial trigger points for the treatment of pain. METHODS: PubMed, Scopus, SportDiscus, and Web of Science databases were searched from their inception to February 2020. Randomized controlled trials that compared DN with other treatments or placebo and measured pain with a visual analog Scale or another numerical pain rating scale were included. Two authors used a personalized form to collect the following data relevant to the objectives of the review from each article independently: study design, purpose, sample size, diagnosis, characteristics of DN intervention, characteristics of placebo intervention, outcome measures, period of assessment, body region, DN technique, and number of sessions. The initial search identified 1771 articles. After the selection, 102 articles were assessed for eligibility; 42 of these articles measuring pain were used for the meta-analysis. Four meta-analyses were performed according to the follow-up period from the last reported treatment. RESULTS: This meta-analysis found a large effect to decrease pain within 72 hours (standardized mean difference [SMD] = -0.81; 95% CI = -1.21 to -0.40), a moderate effect in 1 to 3 weeks (SMD = -0.69; 95% CI = -1.02 to -0.35), a large effect in 4 to 12 weeks (SMD = -0.85; 95% CI = -1.30 to -0.40), and a large effect in 13 to 24 weeks (SMD = -0.81; 95% CI = -1.64 to -0.03). The risk of bias was generally low; however, the heterogeneity of the results downgraded the level of evidence. CONCLUSIONS: Low-quality evidence that the immediate to 72-hour (large) effect, 4- to 12-week (large) effect, 13- to 24-week (large) effect, and moderate-quality 1- to 3-week (moderate) effect suggested that DN performed by physical therapists was more effective than no treatment, sham DN, and other therapies for reducing pain. IMPACT: DN is commonly used by physical therapists to treat musculoskeletal pain, and it is very important for physical therapists to know the clinical conditions and time periods for which DN is effective in reducing pain in their patients.

Ultrasound of iliotibial band syndrome.

Iliotibial band syndrome or friction syndrome is an overuse disorder of the lateral knee. It is commonly reported in athletes, such as runners and cyclists, and refers to pain related to physical activity. The diagnosis is based on clinical history and physical assessment. Imaging, including ultrasound, is mainly performed in recurrent or refractory cases. The purpose of this paper is to review the etiology, diagnosis, and therapy of iliotibial band syndrome with a focus on ultrasound imaging and ultrasound-guided treatment. Ultrasound findings include soft-tissue edematous swelling or discrete fluid collection, suggestive of bursitis, between the iliotibial band and the lateral femoral epicondyle. The thickening of the iliotibial band has been inconsistently reported. Treatment varies according to the disease phase and, in the acute phase, consists of rest, physical therapy, and anti-inflammatory medications. Ultrasound-guided local steroid injections are effective in relieving symptoms.

Whole-Body-Vibration Training and Balance in Recreational Athletes With Chronic Ankle Instability.

CONTEXT: Deficits in the propioceptive system of the ankle contribute to chronic ankle instability (CAI). Recently, whole-body-vibration (WBV) training has been introduced as a preventive and rehabilitative tool. OBJECTIVE: To evaluate how a 6-week WBV training program on an unstable surface affected balance and body composition in recreational athletes with CAI. DESIGN: Randomized controlled clinical trial. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: Fifty recreational athletes with self-reported CAI were randomly assigned to a vibration (VIB), nonvibration (NVIB), or control group. INTERVENTION(S): The VIB and NVIB groups performed unilateral balance training on a BOSU 3 times weekly for 6 weeks. The VIB group trained on a vibration platform, and the NVIB group trained on the floor. MAIN OUTCOME MEASURE(S): We assessed balance using the Biodex Balance System and the Star Excursion Balance Test (SEBT). Body composition was measured by dual-energy x-ray absorptiometry. RESULTS: After 6 weeks of training, improvements on the Biodex Balance System occurred only on the Overall Stability Index ( P = .01) and Anterior-Posterior Stability Index ( P = .03) in the VIB group. We observed better performance in the medial ( P = .008) and posterolateral ( P = .04) directions and composite score of the SEBT in the VIB group ( P = .01) and in the medial ( P < .001), posteromedial ( P = .002), and posterolateral ( P = .03) directions and composite score of the SEBT in the NVIB group ( P < .001). No changes in body composition were found for any of the groups. CONCLUSIONS: Only the VIB group showed improvements on the Biodex Balance System, whereas the VIB and NVIB groups displayed better performance on the SEBT.

Lesiones deportivas versus accidentes deportivos. Documento de consenso. Grupo de prevención en el deporte de la Sociedad Española de Medicina del Deporte (SEMED-FEMEDE) / Sports injuries versus sports accidents. Consensus document. Group of prevention in the sport of the Spanish Society of Sports Medicine (SEMED-FEMEDE)

La práctica deportiva tiene numerosos efectos beneficiosos sobre la salud y el bienestar de las personas, pero también puede tener efectos negativos, entre los que se encuentran los accidentes y las lesiones. Establecer las diferencias entre lesión y accidente deportivo es de vital importancia desde el punto de vista médico-legal y ayudará a clarificar la regulación jurídica del deporte en estos aspectos. Por ello, el objetivo de este documento es establecer un consenso sobre lo que entendemos por lesión deportiva y sobre qué tipos de lesiones pueden calificarse como accidente deportivo. Se vienen utilizando diferentes criterios, muy dispares, para definir las lesiones deportivas, así como para clasificarlas, lo que lleva a que los datos epidemiológicos no puedan extrapolarse de unos a otros. Así, para unos son todas aquellas que requieren asistencia médica; otros consideran que existe una lesión cuando hay daño corporal que obliga al deportista a abandonar o modificar una o más sesiones de entrenamiento o competición; otros autores entienden que una lesión deportiva debe combinar la necesidad de asistencia médica con la pérdida de tiempo de las actividades deportivas; y finalmente algunos estiman que una lesión deportiva es cualquier problema físico sufrido por un deportista durante el entrenamiento o la competición, independientemente de la necesidad de atención médica y de la pérdida de tiempo de actividades deportivas. Bajo el punto de vista de este consenso, una lesión deportiva es un problema físico debido a una alteración de la integridad de los tejidos que se produce como resultado de la práctica de actividad física o deporte, y que altera la capacidad absoluta o relativa de practicar deporte, independientemente de que requiera atención de personal sanitario o que conlleve ausencias o modificaciones en las sesiones de entrenamiento o en las competiciones. Puede aparecer de forma súbita, en el caso de las lesiones agudas, o tener un comienzo lento y progresivo, en el caso de lesiones por sobrecarga o sobreuso. Un accidente deportivo es una lesión corporal, no intencionada por parte del accidentado, de inicio repentino, provocada por un traumatismo o una carga que supere los límites fisiológicos, y que acontece durante una actividad deportiva identificable. Las causas de los accidentes varían en función de la modalidad deportiva, del terreno donde se practica el deporte, del material deportivo, etc. Todas las lesiones agudas (por traumatismos, malos gestos técnicos o cargas que superen los límites fisiológicos y provoquen un daño tisular) deben ser consideradas como accidentes deportivos, y aquellas en las que el daño tisular aparece en un determinado momento y es progresivo, pudiendo manifestarse clínicamente o no (sobrecargas de repetición), quedan excluidas de lo que entendemos por accidente deportivo

Sports practice has many beneficial effects on the health and well-being of people, but it can also have negative effects between those tha are accidents and injuries. Establishing the differences between injury and sports accident is of vital importance from the medical-legal point of view and will help to clarify the legal regulation of sport in these aspects. Therefore, the purpose of this document is to establish a consensus on what we understand as sports injury and what kind of injuries can be classified as sports accidents. Different criteria have been used, very differente, to define sports injuries, and to classify them, so that epidemiological data cannot be extrapolated from some study to other. Thus, for some are all those that require medical assistance; Others consider that there is an injury when there is bodily injury that forces the athlete to leave or modify one or more training session or competition; another group of authors understand that a sports injury must combine the need for medical assistance with the loss of time from sports activities; finally, others estimate that a sports injury is any physical problem suffered by an athlete during training or competition, regardless of the need for medical attention and loss of time from sports activities. From our point of view, a sports injury is a physical problem due to an alteration of the integrity of the tissues that occurs as a result of the practice of physical activity or sport, and that alters the absolute or relative capacity to practice sport, independently of the fact that it requires attention of sanitary personnel or that it involves absences or modifications in training sessions or competitions. It can appear suddenly, in the case of acute injuries or have a slow and progressive onset, in the case of overload or overuse injuries. A sports accident is a bodily injury, unintentional by the injured person, of sudden onset, caused by trauma or a load that exceeds physiological limits and that occurs during an identifiable sports activity. The causes of accidents depend on the sport modality, sports playground, sports equipment, etc. All acute injuries (due to trauma, incorrect sport technique or loads that exceed physiological limits and cause tissue damage) should be considered as sports accidents and those in which the tissue damage appears at a certain time and is progressive, being able to manifest itself clinically or not (repeated overloads), are excluded from what we understand by sports accidents

Contraindicaciones para la práctica deportiva. Documento de consenso de la Sociedad Española de Medicina del Deporte (SEMED-FEMEDE) / Contraindications of sports practice. Consensus document of the SPANISH Society of Sports Medicine (SEMED-FEMEDE)

La función principal de la medicina del deporte es el cuidado de la salud del deportista, no solo desde el punto de vista del tratamiento, sino también desde el de la prevención. Los reconocimientos médicos para la aptitud deportiva, una de las atribuciones principales de esta especialidad, están destinados a descubrir patologías, enfermedades o alteraciones que pueden afectar a la salud, y abarcan desde las situaciones que pueden desencadenar incidentes mortales hasta las que, sin poner en riesgo la vida, pueden afectar la salud o el rendimiento del deportista. La realización adecuada de reconocimientos para el deporte implica el diagnóstico de problemas médicos que deben analizarse, entre otros puntos de vista, desde la óptica de la aptitud para la práctica deportiva, y el médico encargado debe disponer de una guía que le oriente sobre la decisión de autorizar o no la práctica de deporte, y en caso de no autorización, la temporalidad de esta y el riesgo asumible de participación en algunos deportes. Las contraindicaciones para la práctica deportiva mejor conocidas son las de origen cardiovascular, tratadas extensamente en la literatura, pero también existen contraindicaciones del resto de aparatos y sistemas del organismo, entendiendo que el deportista es un ser completo y que el ejercicio físico afecta a todo su conjunto. Este documento, además de recoger dichas contraindicaciones, analiza los aspectos legales que afectan a los profesionales en los que recae la responsabilidad de realizar los reconocimientos y los aspectos documentales que les son propios

Main purpose of sports medicine is reaching the health care of the athlete, not only from the point of view of treatment, but also from the point of view of prevention. The performance of preparticipation medical sports evaluation, one of the main attributions of this specialty, is aimed at the discovery of pathologies, diseases or alterations that may affect health. They might range from situations that can trigger deadly incidents, to those without putting life at risk, can affect the health or performance of the athlete. Adequate implementation of preparticipation medical sports evaluation implies the diagnosis of medical problems that must be analyzed, from other points of view such as the perspective of fitness for sport practice. In addition, the doctor in charge must have a guide for clearance for sports practice. In case of non-authorization, time for non-sports activities must be recommended in order to decrease injury risks. Cardiovascular pathologies are the best known contraindications in sport practice, treated extensively in the literature. However, there are also contraindications secondary to problems or issues of the rest of apparatus organs and systems of the organism, knowing that the athlete represents an entity in which physical exercise affects all their sets. This document highlights those contraindications already discussed above and analyzes the legal aspects of sports practice contraindications. Medical professionals are responsible for managing the pre-participation medical sports evaluation as well as the documentary aspects that support it

Cross Sectional Area of the Supraspinatus Muscle and Acromio-humeral Distance in Overhead Athletes With and Without Shoulder Pain: A Cross-sectional Study.

CONTEXT: The supraspinatus muscle has an important role in the stabilization of the glenohumeral joint. Identifying abnormalities concerning its size and the subacromial space in the presence of pain may be relevant to provide more specific treatments focused on the etiology of pain. OBJECTIVE: To determinate whether painful shoulder causes changes in the supraspinatus cross-sectional area (CSA) and the acromio-humeral distance (AHD) between overhead athletes. DESIGN: Cross-sectional study. SETTING: University campus and local sports clubs' Physical Therapist room. PARTICIPANTS: 81 male overhead athletes were divided into 2 groups according to the presence of shoulder pain and clinical symptoms. MAIN OUTCOME MEASURES: Ultrasonography measurements of the supraspinatus CSA and the AHD in 2 groups of overhead athletes with and without pain. RESULTS: In the pain group, the CSA was significantly smaller compared with the no pain group. No differences between groups were found in the AHD measurement. CONCLUSIONS: Shoulder pain in overhead athletes was associated with a reduction in their supraspinatus muscle CSA, but not in the AHD. These findings suggest that muscle atrophy exists in the presence of pain. However, in active overhead athletes, the AHD is not clearly reduced in overhead athletes with shoulder pain. Further studies are needed to understand this condition.

Application of a model to analyze shoulder biomechanics in adult patients with spinal cord injury when walking with crutches in two different gait patterns.

BACKGROUND: Specific biomechanical models have been developed to study gait using crutches. Clinical application of these models is needed in adult spinal cord injury (SCI) population walking with different patterns of gait with crutches to prevent overuse shoulder injuries. OBJECTIVE: To apply a biomechanical model in a clinical environment to analyze shoulder in adult SCI patients walking with two different patterns of gait with crutches: two point reciprocal gait (RG) and swing-through gait (SG). METHODS: Load cells were fixed to the distal ends and forearm cuffs of a pair of crutches. An active markers system was used for kinematics. Five cycles for each gait pattern were analyzed applying a biomechanical model of the upper limbs. Fifteen subjects with SCI were analyzed. RESULTS: The flexo-extension range of motion was significantly greater when using SG (p < 0.01). Similarly, the superior, posterior and medial forces were significantly stronger for SG in all 3 directions. Flexion, adduction and internal rotation torques were also greater in SG (p < 0.01). CONCLUSIONS: A biomechanical model was successfully applied to study shoulder biomechanics in adult patients with SCI walking with crutches in two different gait patterns. Greater loads exerted on the shoulder walking with SG were confirmed compared to RG.

Consenso sobre utilización de las infiltraciones en el deporte. Documento de Consenso de la Sociedad Española de Medicina del Deporte / Consensus on use of infiltration in sport. Document of Consensus of the Spanish Society of Sports Medicine

La infiltración es una opción terapéutica, utilizada para el tratamiento de diversas patologías, que consiste en la administración inyectada en localizaciones precisas de diferentes sustancias. Pueden tener un efecto analgésico y/o antiinflamatorio y curativo. Su uso es frecuente en el tratamiento de muchas lesiones de tejidos blandos como bursitis, sinovitis, fascitis plantar, esguinces, lesiones musculares, tendinopatías y lesiones condrales y deben de ir precedido del correspondiente diagnóstico. Casi todas las infiltraciones tienen efectos secundarios locales, leves y, en algunas ocasiones, sistémicos y pueden presentar algunas contraindicaciones específicas que dependen de la sustancia administrada. La mayor parte de los efectos adversos son debidos a uso inapropiado del medicamento. Los principios activos más utilizados son: Anestésicos locales que producen un alivio inmediato del dolor, como lidocaína y bupivacaína. Se pueden usar solos o en combinación con corticosteroides ejerciendo un efecto combinado analgésico inmediato del dolor local y un efecto terapéutico de mayor duración. Corticoides cuya propiedad fundamental es una acción antiinflamatoria muy potente. Los más utilizados son betametasona, metilprednisolona y triamcinolona. Ácido hialurónico, utilizado en el tratamiento de patologías articulares, especialmente la artrosis de rodilla y las condromalacias. Lubrifica las articulaciones y parece tener efectos directos sobre la función de las células sinoviales y el líquido sinovial. Escleroterapia, que es la introducción de una sustancia química en la luz de los vasos sanguíneos, provocando una obliteración y fibrosis secundaria. Está indicada fundamentalmente en las tendinopatías con proliferación vascular. Biorreguladores: Estimulan la curación al modular o activar diversas sustancias implicadas. Plasma rico en plaquetas: plasma autólogo que contiene más concentración de plaquetas que la sangre normal que segregan una gran cantidad de factores de crecimiento. Proloterapia, que consiste en la infiltración de sustancias que estimulan la regeneración y reparación de los tejidos. Otros: Antiinflamatorios no esteroideos, factores de crecimiento, células madre y terapias relacionadas

Infiltration is a therapeutic option used for the treatment of various diseases, which comprises injected administration into precise locations of different substances. They may have an analgesic and / or anti-inflammatory and healing effect. Its use is common in the treatment of many soft tissue injuries such as bursitis, synovitis, plantar fasciitis, sprains, muscle injuries, tendinopathies and chondral injuries and must be preceded by the appropriate diagnosis. Almost all local infiltrations have mild side effects and, sometimes, these may be systemic and may have some specific contraindications depending on the administered substance. Most of the adverse effects are caused by improper use of the drug. The most used active substances are: local anesthetics that produce immediate pain relief, such as lidocaine and bupivacaine. They can be used alone or in combination with corticosteroids producing an immediate analgesic combined effect on local pain and a therapeutic effect of longer duration. Corticosteroids, whose main property is a very powerful anti-inflammatory action. The most used are betamethasone, methylprednisolone and triamcinolone. Hyaluronic acid, used in the treatment of joint diseases, particularly knee osteoarthritis and chondromalacias/chondropathias . It lubricates joints and appears to have direct effects on the function of synovial cells and synovial fluid. Sclerotherapy, which is the introduction of a chemical substance in the light of the blood vessels, causing obliteration and secondary fibrosis. It is indicated mainly in tendinopathies with vascular proliferation. Biorregulators: They stimulate healing when modulate or activate various involved substances. Platelet-rich plasma: autologous plasma containing more platelet concentration that normal blood, secreting a large amount of growth factors. Prolotherapy, it consists in substances infiltration that stimulate regeneration and tissue repair. Other: Nonsteroidal anti-inflammatory drugs, growth factors, stem cells and related therapies

Utilidad de la ultrasonografía en el diagnóstico de dolor de codo secundario a plica sinovial / Utility of ultrasonography in the diagnosis of elbow´s pain secondary to synovial plica

Introducción: El dolor en el epicóndilo lateral del codo es uno de los síntomas clínicos más frecuentes en la extremidad superior. La presencia de la plica sinovial como causa de chasquido doloroso en el codo fue descrito por primera vez por Clarke. Esta plica es una estructura anatómica normal, remanente del desarrollo embriológico de la membrana articular sinovial, pero cuando ésta se encuentra engrosada, es una causa potencial de dolor de codo. Caso clínico: Se presenta el caso clínico de un varón de 42 años, médico traumatólogo, sin antecedente de interés, con dominancia derecha, que practica de forma habitual el pádel y el golf. Diagnosticado de epicondilitis pero sin respuesta al tratamiento conservador durante 9 meses y tras estudio mediante ecografía y RM se objetiva la presencia de una plica sinovial en el codo, que mediante artroscopia se extirpó con buenos resultados. Discusión: La plica sinovial en el codo suele estar infradiagnosticada por tratarse de una entidad poco conocida para el clínico, lo que dificulta el diagnóstico diferencial. Además debido a las características del proceso, que produce escasos signos subjetivos y objetivos, suele etiquetarse erróneamente como epicondilitis lateral rebelde al tratamiento. Para conseguir los mejores resultados en el alivio del dolor y la recuperación de la funcionalidad articular, se debe descartar patología asociada y el tratamiento quirúrgico debe ir acompañado de una rehabilitación específica. Conclusión: La presencia de plica sinovial en el codo es una causa de dolor de codo habitualmente mal diagnosticada. La ultrasonografía es una herramienta útil para el diagnóstico de esta entidad (AU)

Introduction: Lateral elbow pain is one of the most common pain syndromes of the upper extremity. The presence of synovial fold or radial fringe as the cause of painful snapping elbow was first described by Clarke. This plica is a normal anatomic structure, embryological development like remaining articular synovial membrane, but when it is thickened, is a potential cause elbow pain. Case report: The case of a 42 year old male, orthopedic doctor has no history of interest, right dominance, practicing regularly paddle, tennis and golf. He was diagnosed as radial epicondylitis, but with no response to the conservatory management. Ultrasound and MR imaging found the presence of synovial fold in the elbow. This fold was removed arthroscopically, and resulting in pain relief. Discussion: The synovial fold in the elbow is often under diagnosed because it is a little known, making it difficult differential diagnosis. Also due to the characteristics of the process that produces few subjective and objective signs, often erroneous labeled as lateral epicondylitis resistant to treatment. For best results in relieving pain and recovery of joint function, exclude associated pathology and surgical treatment should be accompanied by a specific rehabilitation. Conclusion: The presence of synovial plica in the elbow is one of the most under-diagnosed causes of a painful elbow. The ultrasound is a useful tool for the diagnosis of this entity (AU)

[Adherence to a mediterranean diet and sport performance in a elite female athletes futsal population]. / ADHESIÓN A LA DIETA MEDITERRÁNEA Y RENDIMIENTO DEPORTIVO EN UN GRUPO DE MUJERES DEPORTISTAS DE ÉLITE DE FÚTBOL SALA.

INTRODUCTION: Low energy intake may lead to the loss of muscle mass, menstrual dysfunction, increased risk of fatigue, injures and the need for prolonged recovery process. OBJECTIVES: 1) To analyse the adherence to the Mediterranean diet of a elite female athletes futsal population, 2) To analyse the relationship between the Dietary Mediterranean index, body composition and sport performance, and 3) To analyse if the differences in the index of adherence to the Mediterranean diet generates test differences in sports performance and body composition. METHODS: The adherence to a Mediterranean Diet, body composition test, isokinetic test, vertical jump test (CMJ and SJ), kicking ball, speed test and test Repeated Sprint Ability (RSA) was measured. RESULTS: we found that 7 out of 12 players (58.33%) showed a low index and 5 of the 12 players (41.67%) showed a means index. We found that 7 out of 12 players (58.33%) showed a low index and 5 of the 12 players (41.67%) below the optimum index. Moreover, this adhesion index did not correlate with the values of the body composition or athletic performance test. No significant differences between the players that scored below the optimal index with those with a low level of adhesion were observed. However, mass fat (%) correlated to the ability to repeat sprint. CONCLUSIONS: Low levels of adherence to the Mediterranean diet was observed in futsal players, the values shown in the KIDMED questionnaire did not correlate with the performance of the players nor body composition.

Introducción: Baja ingesta de energía puede dar lugar a la pérdida de masa muscular, disfunciones menstruales, un aumento del riesgo de la fatiga, lesión así como la necesidad de un proceso prolongado de recuperación. Objetivos: 1) Analizar el nivel de adherencia al Patrón de Dieta Mediterráneo en un grupo de mujeres deportistas profesionales de fútbol sala, 2) analizar el grado de relación entre el Patrón Dietético Mediterráneo, la composición corporal y el rendimiento deportivo y, 3) analizar si el actual grado de adherencia a la dieta mediterránea establece diferencias en los test de rendimiento deportivo y sobre la composición corporal. Métodos: Se valoró el PDM, test de composición corporal, test isocinético, test salto vertical (CMJ y SJ), golpeo de balón, test de velocidad y test Repeated Sprint Ability (RSA). Resultados: se observó que 7 de los 12 jugadoras (58,33%) mostró un patrón bajo y 5 de las 12 jugadoras (41,67%) un patrón medio. Por otro lado, estos patrones de adherencia no correlacionoraon con los valores de composición corporal ni con los test de rendimiento deportivo. No se observaron diferencias significativas entre las jugadoras que tenían un grado medio de adherencia con las que tenían un patrón bajo de adhesión. Sin embargo, la cantidad de grasa total (%) parece tener un efecto determinante en la capacidad de repetir sprint. Conclusión: Se observan bajos niveles de adhesión a la dieta mediterránea, los valores mostrados en el cuestionario KIDMED no se han relacionado con el rendimiento de las deportistas ni con el estado de la composición corporal.

Adhesión a la dieta mediterránea y rendimiento deportivo en un grupo de mujeres deportistas de élite de fútbol sala / Adherence to a Mediterranean diet and sport performance in a elite female athletes futsal population

Introducción: Baja ingesta de energía puede dar lugar a la pérdida de masa muscular, disfunciones menstruales, un aumento del riesgo de la fatiga, lesión así como la necesidad de un proceso prolongado de recuperación. Objetivos: 1) Analizar el nivel de adherencia al Patrón de Dieta Mediterráneo en un grupo de mujeres deportistas profesionales de fútbol sala, 2) analizar el grado de relación entre el Patrón Dietético Mediterráneo, la composición corporal y el rendimiento deportivo y, 3) analizar si el actual grado de adherencia a la dieta mediterránea establece diferencias en los test de rendimiento deportivo y sobre la composición corporal. Métodos: Se valoró el PDM, test de composición corporal, test isocinético, test salto vertical (CMJ y SJ), golpeo de balón, test de velocidad y test Repeated Sprint Ability (RSA). Resultados: se observó que 7 de los 12 jugadoras (58,33%) mostró un patrón bajo y 5 de las 12 jugadoras (41,67%) un patrón medio. Por otro lado, estos patrones de adherencia no correlacionaron con los valores de composición corporal ni con los test de rendimiento deportivo. No se observaron diferencias significativas entre las jugadoras que tenían un grado medio de adherencia con las que tenían un patrón bajo de adhesión. Sin embargo, la cantidad de grasa total (%) parece tener un efecto determinante en la capacidad de repetir sprint. Conclusión: Se observan bajos niveles de adhesión a la dieta mediterránea, los valores mostrados en el cuestionario KIDMED no se han relacionado con el rendimiento de las deportistas ni con el estado de la composición corporal (AU)

Introduction: Low energy intake may lead to the loss of muscle mass, menstrual dysfunction, increased risk of fatigue, injures and the need for prolonged recovery process. Objectives: 1) To analyse the adherence to the Mediterranean diet of a elite female athletes futsal population, 2) To analyse the relationship between the Dietary Mediterranean index, body composition and sport performance, and 3) To analyse if the differences in the index of adherence to the Mediterranean diet generates test differences in sports performance and body composition. Methods: The adherence to a Mediterranean Diet, body composition test, isokinetic test, vertical jump test (CMJ and SJ), kicking ball, speed test and test Repeated Sprint Ability (RSA) was measured. Results: we found that 7 out of 12 players (58.33%) showed a low index and 5 of the 12 players (41.67%) showed a means index. We found that 7 out of 12 players (58.33%) showed a low index and 5 of the 12 players (41.67%) below the optimum index. Moreover, this adhesion index did not correlate with the values of the body composition or athletic performance test. No significant differences between the players that scored below the optimal index with those with a low level of adhesion were observed. However, mass fat (%) correlated to the ability to repeat sprint. Conclusions: Low levels of adherence to the Mediterranean diet was observed in futsal players, the values shown in the KIDMED questionnaire did not correlate with the performance of the players nor body composition (AU)

Echographic and kinetic changes in the shoulder joint after manual wheelchair propulsion under two different workload settings.

Manual wheelchair users with spinal cord injury (SCI) have a high prevalence of shoulder pain due to the use of the upper extremity for independent mobility, transfers, and other activities of daily living. Indeed, shoulder pain dramatically affects quality of life of these individuals. There is limited evidence obtained through radiographic techniques of a relationship between the forces acting on the shoulder during different propulsion conditions and shoulder pathologies. Today, ultrasound is widely accepted as a precise tool in diagnosis, displaying particularly effectiveness in screening the shoulder rotator cuff. Thus, we set out to perform an ultrasound-based study of the acute changes to the shoulder soft tissues after propelling a manual wheelchair in two workload settings. Shoulder joint kinetics was recorded from 14 manual wheelchair users with SCI while they performed high- and low-intensity wheelchair propulsion tests (constant and incremental). Shoulder joint forces and moments were obtained from inverse dynamic methods, and ultrasound screening of the shoulder was performed before and immediately after the test. Kinetic changes were more relevant after the most intensive task, showing the significance of high-intensity activity, yet no differences were found in ultrasound-related parameters before and after each propulsion task. It therefore appears that further studies will be needed to collect clinical data and correlate data regarding shoulder pain with both ultrasound images and data from shoulder kinetics.

Consenso sobre utilización de la vía parenteral en el deporte. El tratamiento de los trastornos por calor. Documento de Consenso de la Federación Española de Medicina del Deporte / Consensus on the use of parenteral route in sport. Heat illness treatment. Consensus document of Spanish Federation of Sports Medicine

El ejercicio físico provoca una elevación de la temperatura corporal, que en condiciones ambientales desfavorables (temperatura y humedad elevadas, radiación solar intensa o ausencia de viento) y otros factores provocan un mayor estrés térmico lo que puede conducir al deportista a una situación de deshidratación. Si no hay una adecuada reposición de líquidos y electrolitos que pueda desencadenar deshidratación y/o hiponatremia, se pueden producir efectos adversos sobre el rendimiento y también sobre la salud. Este documento de consenso presenta los cuadros clínicos relacionados con el calor que pueden aparecer durante la práctica de actividades deportivas y que pueden requerir el tratamiento urgente del paciente en el propio lugar de la actividad. Idealmente el tratamiento debe realizarse en un medio sanitario, pero la urgencia de algunos cuadros, puede requerir una actuación médica inmediata que, desde un punto de vista deontológico no puede demorarse aunque ello requiera desatender normas de origen deportivo, como las normas de lucha contra el dopaje y las normas de algunas federaciones que prohíben la utilización de la vía parenteral en deportistas. Se describen especialmente las indicaciones para uso de la administración parenteral de fluidos en el contexto deportivo para tratar la deshidratación, calambres musculares por esfuerzo, agotamiento por calor, síncope por calor, hiponatremia por esfuerzo y golpe de calor por esfuerzo. La administración de perfusiones endovenosas está indicada en tratamiento del golpe de calor y ante su sospecha diagnóstica, de forma inmediata, lo que no permite la demora en su aplicación y que se debe realizar en el propio terreno. Además, la perfusiones endovenosas están indicadas en el tratamiento del resto de situaciones patológicas cuando el estado de conciencia del paciente no permite la administración de fluidos orales o cuando se presentan nauseas o vómitos. Por último se describe la rehidratación como ayuda ergogénica con las ventajas e inconvenientes de las vías oral y parenteral (AU)

Exercise causes a rise in body temperature, which in unfavorable environmental conditions (high temperature and humidity, intense solar radiation or absence of wind) and other factors causes higher thermal stress which can cause a dehydration situation on the athlete. If there is no suitable replacement of fluids and electrolytes, which can cause dehydration and / or hyponatremia, adverse effects may occur on performance and health. This consensus document shows clinical symptoms related to heat that can occur while practicing sport activities and may require urgent treatment in the patient’s activity place. Ideally, treatment should be done in a sanitary environment, but the urgency of some symptoms may require immediate medical intervention which, due to the medical ethics involved, cannot be delayed even if this implies neglecting sports rules, such anti-doping rules or some federations regulations that forbid the use of parenteral route in athlete. Indications for using the parenteral fluids administration in sports are specially described, which are used to treat dehydration, exertional muscle cramps caused by effort, heat exhaustion, heat syncope, exertional hyponatremia and exertional heat stroke. The administration of intravenous infusions is indicated in the heat stroke treatment and must be immediately applied when its diagnosis is suspected, being no delay allowed and performing it in the field. Furthermore, intravenous infusions are indicated in the treatment of other pathological situations where the consciousn ess state of the patient does not permitoral administration of fluids or in case of nausea or vomiting. Finally, rehydration is described as an ergogenic aid with the advantages and disadvantages of oral and parenteral routes (AU)

Consenso sobre utilización de la vía parenteral en el deporte. Utilización de medicación homeopática, terapias biológicas y biorreguladoras. Documento de Consenso de la Federación Española de Medicina del Deporte / Consensus on use of parenteral via in sports. use of homeopathic medication, biological and bio-regulatory therapy. Document of consensus of the Spanish Federation of Sports Medicine

En la elección del medicamento más adecuado para tratar las lesiones deportivas hay que tener en cuenta el tipo y gravedad de la patología, el grado de incapacidad funcional, la evolución de los síntomas, la vía de administración, los efectos secundarios y las preferencias de los pacientes. Entre todos los recursos posibles, se encuentra la medicina complementaria y alternativa (homeopatía, fitoterapia, acupuntura, terapias biológicas y biorreguladoras, ...).Este documento de consenso sobre la aplicación de terapias inyectables en la Medicina del Deporte se basa en la reunión de expertos celebrada en noviembre de 2011 en Madrid y tiene el objetivo de mejorar la calidad asistencial y ayudar a los profesionales de la Medicina en la toma de decisiones terapéuticas. La mayoría de los biorreguladores son sustancias compuestas por diferentes elementos a diluciones homeopáticas que ejercen efectos específicos a nivel individual. Entre otras funciones, algunos de sus componentes son capaces de modular la inflamación y los síntomas de las lesiones, tienen acción analgésica, estimulan la cicatrización y pueden tener efectos hemostáticos contribuyendo a eliminar el estasis venoso y el edema. Su objetivo final es restaurar el funcionamiento normal de los mecanismos de regulación. Una de las vías de administración de las terapias biológicas y biorreguladoras es la parenteral (intradérmica, subcutánea, intraarticular, intramuscular o intravenosa y diferentes técnicas terapéuticas (bioacupuntura, mesoterapia, ...). La elección de la vía inyectable estará en función del tipo de patología, de la gravedad de la lesión, de las condiciones generales del paciente y, también, de la experiencia clínica del médico prescriptor. Estas terapias inyectables se pueden administrar solas, asociadas entre sí o junto a otros medicamentos o técnicas. La vía de administración del inyectable (intradérmica, subcutánea, intraarticular, intramuscular o intravenosa) así como la posología serán elegidas por el médico en función del tipo y gravedad de la patología. El nivel de evidencia científica que apoya el uso de estos medicamentos, se puede considerar aceptable y cada vez existen más publicaciones que apoyan su utilización. Por tanto, las terapias biológicas inyectables son una alternativa más en el tratamiento de las lesiones deportivas y sus efectos se pueden equiparar a los de otros medicamentos y, generalmente, carecen de efectos secundarios (AU)

When choosing the most appropriate medication to treat sports injuries must take into account the disease type and severity, the degree of functional disability, the symptoms progression, the administration route, side effects and patients preferences must be taken into account. Among all possible resources, there is the complementary and alternative medicine (homeopathy, herbal medicine, acupuncture, bioregulatory and biologic therapies, ...).This consensus document on the implementation of injectable therapies in Sports Medicine is based on the experts meeting held in November2011 in Madrid and aims to improve the quality of care and assist medical professionals in making therapeutic decisions. Most bioregulators are composed of different substances to homeopathic dilutions elements which exert specific effects individually. Among other functions, some components can modulate inflammation and injury symptoms, they are analgesic, stimulate healing and may have hemostatic effects contributing to eliminate edema and venous stasisy. Their ultimate goal is to restore the normal functioning of the regulatory mechanisms. One route of administration of the biological and bioregulatory therapies is the parenteral (intradermal, subcutaneous, intraarticular, intramuscularor intravenous) and different therapeutic techniques (bioacupuncture, mesotherapy, ...). The choice of the injectable route will depend on the type of pathology, the injury severity, the patient’s general condition and also the clinical experience of the prescribing physician. These injectable therapies can be administered alone, associated with each other or with other medicines or techniques. The injectable administration route (intradermal, subcutaneous, intraarticular, intramuscular or intravenous) as well as the dosage will be chosen by the physician according to the type and severity of the pathology. The level of scientific evidence that supports the use of these drugs can be considered acceptable and there is a growing literature supporting its use. Therefore, injectable biologic therapies are an alternative in the treatment of sports injuries and their effects are comparable to those of other drugs and usually have no side effects (AU)

Efectividad de un programa de entrenamiento vibratorio en la mejora de la capacidad de salto / Effects of a vibration training program on the performance of the jump

El objetivo de este estudio ha sido analizar los efectos de 6semanas de entrenamiento vibratorio de cuerpo entero sobre la función muscular obtenida con variables de arquitectura muscular dinámica durante la fase de batida de un salto con contramovimiento. Formaron parte de la investigación un total de treinta y cinco varones físicamente activos, la muestra fue asignada de forma aleatoria en dos grupos de estudio, un grupo control (GC) formado por 16 hombres (Edad: 24,5 ±6,27 años, talla: 174,44 ± 5,35 cm y peso: 71,01 ± 7,94 kg) y un grupo experimental (GE) formado por 19 hombres (Edad: 22,11 ± 4,97 años; talla: 174,35 ± 4,36 cm y peso: 74,43 ±10,93 kg). Se encontraron diferencias significativas intra-grupo, en el salto máximo 1 en la variable h (p = 0.004) del GE acompañado de un incremento no significativo de los valores del pico de potencia y de la velocidad de despegue. En el salto máximo 2, se encontraron diferencias significativas en el GE en la altura del salto, en el pico de potencia y en la velocidad de despegue. Se encontraron diferencias significativas en el gastrocnemio medial de la pierna izquierda, observándose un incremento significativo de la velocidad angular de la fibra en el GE, con una diferencia en las medias de 4.512º/s en el GC y de 5.44º/s en el GE (p = 0.012). Por otro lado, en el GE se observó un incremento significativo en la velocidad de acortamiento de la fibra muscular, con una diferencia en las medias en el GC de 0,612 cm/s y de 0,922 cm/s en el GE. Con nuestros resultados podemos concluir que un entrenamiento de6 semanas mediante WBV, con cargas gravitacionales de 14,5a 32,6 g producto de fr de 30-45 Hz y duraciones de estímulos de 60 s con descansos de 60 s, modifica las características mecánicas del salto, y el comportamiento muscular de los gastrocnemios, de forma significativa del gastrocnemio medial de la pierna izquierda (AU)

The purpose of this study was to analyze the effects of 6weeks of whole body vibration training on muscle architecture dynamic variables obtained during the takeoff phase of a countermovement jump. Thirty-five males volunteered to participate in the study, the sample was randomly assigned into two study groups, a control group (CG) consisted of 16 subjects (age: 24.5 ± 6.27, height: 174.44 ± 5.35 and weight: 71.01 ± 7.94) and an experimental group (EG) consisting of 19 subjects (age: 22.11 ± 4.97, height: 174.35 ± 4.36 and weight: 74.43 ±10.93). We found intra-group differences in maximal jump 1in the variable h (p = 0.004) of GE accompanied by a non significant increase of the values of PP and Vzd. In the maximum jump 2, we were found significant differences in the GE in the hin the PP and Vzd. We also find significant differences in medial gastrocnemius of the left leg, observed a significant increase of the Vangle of the fiber in the GE, with a difference in the averages of 4.512 °/s in the GC and of 5.44 °/s in the GE (p = 0.012). In the GE showed a significant increase in the VLf and the difference in means in the GC of 0.612 cm/s and 0.922 cm/sin the GE. With our results we can establish that a 6 weeks of WBV, with gravitational loads from 14.5 to 32.6 g product of fr frequency range from 30-45 Hz and durations of stimulation of 60 s with rests of 60 s, modify the mechanical characteristics of the jump, and the gastrocnemius muscle behavior, significantly in the medial gastrocnemius of the left leg (AU)