Risk of Anticoagulation in Gluteal Compartment Syndrome After Surgical Intervention.

Gluteal compartment syndrome (GCS) is a rare form of acute compartment syndrome. There are some causes, such as prolonged periods of immobilization and traumatic or iatrogenic events. We report two cases of gluteal compartment syndrome after orthopedic surgical intervention for fracture stabilization. The patients were both hypocoagulated due to the presence of two mechanical heart valves. Despite early treatment, both patients remained with neurological deficits. Orthopedic and trauma surgeons must be aware of the possibility of gluteal compartment syndrome in perioperative patients. Recognizing and managing risk factors such as hypocoagulation is crucial for its prevention.

Are non-starters accumulating enough load compared with starters? Examining load, wellness, and training/match ratios of a European professional soccer team.

BACKGROUND: The aims of the study were to: (i) compare accumulated load and wellness between starters and non-starters of a European professional soccer team; (ii) analyze the relationships between wellness and load measures and; (iii) compare training/match ratio (TMr) of external and internal load between starters and non-starters. METHODS: Ten players were considered starters while seven were classified as non-starters over a 16-week period in which six training sessions and match day (MD) were considered in each weekly micro-cycle. The following measures were used: wellness (fatigue, quality of sleep, muscle soreness, stress, and mood); load (rated of perceived exertion (RPE), session-RPE (s-RPE), high-speed running (HSR), sprinting, accelerations (ACC) and decelerations (DEC)). Accumulated wellness/load were calculated by summing all training and match sessions, while TMr was calculated by dividing accumulated training load by match data for all load measures and each player. Mann-Whitney U test was used for wellness variables, while independent T-test was used for the remaining variables to compare groups. Moreover, relationships among variables were explored using the Spearman's Rho correlation coefficient. RESULTS: The main results showed that non-starters presented higher significant values for fatigue (p < 0.019; g = 0.24) and lower significant values for duration (p < 0.006; ES = 1.81) and s-RPE (p < 0.001; ES = 2.69) when compared to starters. Moreover, positive and very large correlation was found between quality of sleep and RPE, while negative and very large correlation were found between stress and deceleration, and mood and deceleration (all, p < 0.05). Finally, non-starters presented higher values in all TMr than starters, namely, RPE (p = 0.001; g = 1.96), s-RPE (p = 0.002; g = 1.77), HSR (p = 0.001; g = 2.02), sprinting (p = 0.002; g = 4.23), accelerations (p = 0.001; g = 2.72), decelerations (p < 0.001; g = 3.44), and duration (p = 0.003; g = 2.27). CONCLUSIONS: In conclusion, this study showed that non-starters produced higher TMr in all examined variables despite the lower match and training durations when compared with starters, suggesting that physical load was adjusted appropriately. Additionally, higher RPE was associated with improved sleep while higher number of decelerations were associated with decreased wellness, namely, stress and mood for non-starters.

The relationship between wellness and training and match load in professional male soccer players.

The aims of this study were to: (i) analyse the within-microcycle variations in professional soccer players; (ii) analyse the relationships between wellness and training and match load demands; (iii) analyse the relationships between match-day (MD) demands and wellness during the following day (MD+1); and (iv) analyse the relationships between MD and wellness during the day before match-play (MD-1). Thirteen professional soccer players (age: 24.85±3.13 years) were monitored daily over 16-weeks for wellness and training and match-play intensity. The daily wellness measures included fatigue, quality of sleep, muscle soreness, mood and stress using a 1-5 scale. Internal intensity was subjectively measured daily using the rating of perceived exertion (RPE) and the multiplication of RPE by session duration (s-RPE). While external intensity was quantified utilising high-speed running, sprinting, and acceleration and deceleration metrics. Data was analysed from each training session before (i.e., MD-5) or after the match (i.e., MD+1). Repeated measures ANOVA or Friedman ANOVA was used to analyse the aims (i) where Spearman correlation was applied to analyse the relationships between the aims (ii) and (iii) between sleep quality and training intensity. The main results for aim (i) showed that MD+1 presented the lowest values for wellness variables (p < 0.05). While MD-1 presented the lowest internal and external load values (for all variables), with MD presenting the highest values (p < 0.05). Regarding aim (ii), the main result showed significant large negative correlations between fatigue and s-RPE (r = -0.593; p = 0.033). Considering aim (iii), significant small to very large negative correlations were found for sleep quality, fatigue and muscle soreness with all internal and external variables (p < 0.05). Lastly, the main results for aim (iv) showed large negative correlations for fatigue and session duration; fatigue and s-RPE; muscle soreness and session duration; muscle soreness and s-RPE; and muscle soreness and decelerations (p < 0.05, for all). The main conclusions were that MD had an influence on wellness and internal and external training intensity, notably MD-1 and MD+1 were most affected. In this regard, a tendency of higher internal and external intensity on MD was associated with lower wellness measures of sleep quality, muscle soreness and fatigue on MD+1.

Silencing NTPDase3 activity rehabilitates the osteogenic commitment of post-menopausal stem cell bone progenitors.

BACKGROUND: Endogenously released adenine and uracil nucleotides favour the osteogenic commitment of bone marrow-derived mesenchymal stromal cells (BM-MSCs) through the activation of ATP-sensitive P2X7 and UDP-sensitive P2Y6 receptors. Yet, these nucleotides have their osteogenic potential compromised in post-menopausal (Pm) women due to overexpression of nucleotide metabolizing enzymes, namely NTPDase3. This prompted us to investigate whether NTPDase3 gene silencing or inhibition of its enzymatic activity could rehabilitate the osteogenic potential of Pm BM-MSCs. METHODS: MSCs were harvested from the bone marrow of Pm women (69 ± 2 years old) and younger female controls (22 ± 4 years old). The cells were allowed to grow for 35 days in an osteogenic-inducing medium in either the absence or the presence of NTPDase3 inhibitors (PSB 06126 and hN3-B3s antibody); pre-treatment with a lentiviral short hairpin RNA (Lenti-shRNA) was used to silence the NTPDase3 gene expression. Immunofluorescence confocal microscopy was used to monitor protein cell densities. The osteogenic commitment of BM-MSCs was assessed by increases in the alkaline phosphatase (ALP) activity. The amount of the osteogenic transcription factor Osterix and the alizarin red-stained bone nodule formation. ATP was measured with the luciferin-luciferase bioluminescence assay. The kinetics of the extracellular ATP (100 µM) and UDP (100 µM) catabolism was assessed by HPLC RESULTS: The extracellular catabolism of ATP and UDP was faster in BM-MSCs from Pm women compared to younger females. The immunoreactivity against NTPDase3 increased 5.6-fold in BM-MSCs from Pm women vs. younger females. Selective inhibition or transient NTPDase3 gene silencing increased the extracellular accumulation of adenine and uracil nucleotides in cultured Pm BM-MSCs. Downregulation of NTPDase3 expression or activity rehabilitated the osteogenic commitment of Pm BM-MSCs measured as increases in ALP activity, Osterix protein cellular content and bone nodule formation; blockage of P2X7 and P2Y6 purinoceptors prevented this effect. CONCLUSIONS: Data suggest that NTPDase3 overexpression in BM-MSCs may be a clinical surrogate of the osteogenic differentiation impairment in Pm women. Thus, besides P2X7 and P2Y6 receptors activation, targeting NTPDase3 may represent a novel therapeutic strategy to increase bone mass and reduce the osteoporotic risk of fractures in Pm women.

Changes in Muscle Thickness after 8 Weeks of Strength Training, Electromyostimulation, and Both Combined in Healthy Young Adults.

The aim of this study was to verify and compare the effects of electromyostimulation training (EMS), strength training (ST), and both combined (STEMS), through the analysis of the elbow flexors muscle thickness. Forty subjects (24.45 ± 3.53 years), were randomly divided equally in 4 groups: 3 experimental groups and 1 control group. Each experimental group was submitted to one of three interventions, either an ST protocol, an EMS protocol, or a STEMS protocol. The control group (CG) did not perform any type of physical activity. Ultrasonography (US) was used to measure muscle thickness (MT) at 50 and 60% of the distance between the acromion and the olecranon. The results showed a significant difference in the elbow flexors muscle thickness after 8 weeks, both in the STG, EMSG, and STEMSG, but not in the CG. However, no significant differences were observed between the intervention protocols. It seems that an increase in MT can be obtained using either with ST, EMS, or both combined, however, the results doesn't support the overlap of one method in relation to the others. EMS can be another interesting tool to induce muscle hypertrophy, but not necessarily better.

A Novel Approach to Training Monotony and Acute-Chronic Workload Index: A Comparative Study in Soccer.

Load is a multifactorial construct, but usually reduced to parameters of volume and intensity. In the last decades, other constructs have been proposed for assessing load, but also relying on relationships between volume and intensity. For example, Foster's Training Monotony has been used in athletes' load management simply by computing mean weekly load divided by its standard deviation, often multiplied by session rate of perceived exertion. Meanwhile, the Acute to Chronic Workload Ratio (ACWR) has been debated by the sport scientists as a useful monitoring metric and related to so-called injury prevention. None of these models includes parameters that are representative of training specificity, namely load orientation. The aim of this study is to present broader conceptual approaches translated by new indices for assessing Intraweek Training Monotony (ITM) and Acute to Chronic Workload Index (ACWI) while incorporating load orientation, session duration and weekly density (frequency normalized) in addition to parameters related to proxies of external and/or internal load. Our ITM and Foster's Training Monotony were similar in terms of average values, but very different for individualized analysis, illustrating how average values may be deceiving. While Foster's model provided clusters of values, ITM provided more scattered, individualized data. ACWI and ACWR provided very distinct qualitative information, and the two models were uncorrelated. Therefore, the models incorporating training load orientation presented in this study provide distinct and not redundant information when compared to previous models. More importantly, ITM and ACWI are metrics that are compatible to each other and might fit to coaches' monitoring targets in the short and medium terms, respectively. Because our models include several parameters, including load orientation, we contend that might provide a more complete monitoring tool. However, we suggest they are used for intraindividual comparisons and not so strongly for interindividual comparisons.

Are Heart Rate and Rating of Perceived Exertion Effective to Control Indoor Cycling Intensity?

Indoor cycling's popularity is related to the combination of music and exercise leading to higher levels of exercise intensity. It was our objective to determine the efficacy of heart rate and rating of perceived exertion in controlling the intensity of indoor cycling classes and to quantify their association with oxygen uptake. Twelve experienced males performed three indoor cycling sessions of 45 min that differed in the way the intensity was controlled: (i) oxygen uptake; (ii) heart rate; and (iii) rating of perceived exertion using the OMNI-Cycling. The oxygen uptake levels were significantly higher (p = 0.007; µp2 = 0.254) in oxygen uptake than heart rate sessions. Oxygen uptake related to body mass was significantly higher (p < 0.005) in the oxygen uptake sessions compared with other sessions. Strong correlations were observed between oxygen uptake mean in the oxygen uptake and rating of perceived exertion sessions (r =0.986, p < 0.0001) and between oxygen uptake mean in the oxygen uptake and heart rate sessions (r = 0.977, p < 0.0001). Both heart rate and rating of perceived exertion are effective in controlling the intensity of indoor cycling classes in experienced subjects. However, the use of rating of perceived exertion is easier to use and does not require special instrumentation.

Effects of Plyometric Versus Optimum Power Load Training on Components of Physical Fitness in Young Male Soccer Players.

PURPOSE: The current study aimed to compare the effects of plyometric (PT) versus optimum power load (OPL) training on physical performance of young high-level soccer players. METHODS: Athletes were randomly divided into PT (horizontal and vertical drills) and OPL (squat + hip thrust exercises at the load of maximum power output) interventions, applied over 7 weeks during the in-season period. Squat and countermovement jumps, maximal sprint (10 and 30 m), and change of direction (COD; agility t test) were the pretraining and posttraining measured performance variables. Magnitude-based inference was used for within- and between-group comparisons. RESULTS: OPL training induced moderate improvements in vertical squat jump (effect size [ES]: 0.97; 90% confidence interval [CI], 0.32-1.61) and countermovement jump (ES: 1.02; 90% CI, 0.46-1.57), 30-m sprint speed (ES: 1.02; 90% CI, 0.09-1.95), and COD performance (ES: 0.93; 90% CI, 0.50-1.36). After PT training method, vertical squat jump (ES: 1.08; 90% CI, 0.66-1.51) and countermovement jump (ES: 0.62; 90% CI, 0.18-1.06) were moderately increased, while small enhancements were noticed for 30-m sprint speed (ES: 0.21; 90% CI, -0.02 to 0.45) and COD performance (ES: 0.53; 90% CI, 0.24-0.81). The 10-m sprint speed possibly increased after PT intervention (small ES: 0.25; 90% CI, -0.05 to 0.54), but no substantial change (small ES: 0.36; 90% CI, -0.40 to 1.13) was noticed in OPL. For between-group analyses, the COD ability and 30-m sprint performances were possibly (small ES: 0.30; 90% CI, -0.20 to 0.81; Δ = +1.88%) and likely (moderate ES: 0.81; 90% CI, -0.16 to 1.78; Δ = +2.38%) more improved in the OPL than in the PT intervention, respectively. CONCLUSIONS: The 2 different training programs improved physical performance outcomes during the in-season period. However, the combination of vertically and horizontally based training exercises (squat + hip thrust) at optimum power zone led to superior gains in COD and 30-m linear sprint performances.

Giant Cell Tumor with Fracture of the Proximal Radius - Reconstructive Surgery with Radius Allograft.

INTRODUCTION: Giant cell tumor (GCT) of bone is a locally aggressive benign neoplasm that accounts for 4-10% of all primary bone tumors. It affects mostly young adults and occurs more frequently at the bones around the knee followed by the distal radius and the sacrum. Surgical treatment with curettage is the optimal treatment for local tumor control, but it can be associated to suboptimal functional outcome when located in periarticular regions. CASE REPORT: We describe a 47-year-old Caucasian female who presented with pain in the proximal third of the left forearm without history of traumatism. The study performed revealed a pathological fracture of the proximal radius associated with lytic lesion. The patient underwent excision and curettage of the lesion with preservation of the periosteum, filling with the left proximal radius (corpse) allograft and osteosynthesis with plate and screws. The anatomopathological examination revealed characteristics compatible with GCT. CONCLUSION: This case presents some unique features: The extremely rare location of the GCT at the proximal end of the radius, its initial presentation as a pathological fracture, and the type of treatment performed (reconstruction with the left proximal radius allograft-corpse), with good results.

Dupuytren's disease: where do we stand?

Dupuytren's disease is a fibroproliferative disease that involves collagen deposition, leading to hand contractures that ultimately affect hand mobility and grip strength.It is a benign disorder but can cause high morbidity by limiting daily activities.Many factors have been proposed for its aetiology: namely genetics, smoking, alcohol intake and diabetes. However, there is still controversy as to the main aetiological cause of the disease.Treatment is not yet uniform around the world and still varies with the surgeon's experience and preference.In this review, the authors review the pathogenesis and treatment options for Dupuytren's disease in an attempt to summarize the current state of the art. Cite this article: EFORT Open Rev 2019;4:63-69. DOI: 10.1302/2058-5241.4.180021.

APSI scaphoid hemiarthroplasty - long-term results / Hemiartroplastia do escafoide com APSI - resultados funcionais em longo prazo

ABSTRACT Objective: This study is aimed at evaluating the long-term results of proximal scaphoid hemiarthroplasty for post-traumatic avascular necrosis at this institution. Methods: Twelve patients who underwent this procedure were identified, and the mean follow-up time was 6.5 years (range: 5-8 years). All patients were male, with a mean age of 39 years (range: 28-55 years). In eight patients, the non-dominant limb was affected. The procedure was carried out through a dorsal approach and all patients underwent the same rehabilitation protocol. Cases were evaluated regarding complications, pain, range of motion, functional status (Mayo Wrist Score), and disability (QuickDASH Score). Results: No immediate post-operative complications, such as infection or dislocation of the implant, were observed. All patients presented with peri-implant osteolysis at follow-up, on a radiograph study. None of the patients was forced to abandon their previous professional activity, although about 50% required some type of adaptation at their workplace. The mean functional capacity was, according to the Mayo Wrist Score, of 67.5 points (range: 50-80), corresponding to a satisfactory degree of function. The QuickDASH disability score presented a mean of 25 (range: 3-47.7). Conclusion: The results of this series are in line with previously published studies about this technique. Hemiarthroplasty with a pyrocarbon implant is a safe technique for the treatment of post-fracture avascular necrosis of the scaphoid proximal pole. This technique allowed for satisfactory functional results at a mean follow-up of 6.5 years.

RESUMO Objetivo: Avaliar os resultados em longo prazo da hemiartroplastia do escafoide proximal no tratamento da osteonecrose avascular pós-traumática na instituição. Métodos: Foram identificados 12 pacientes submetidos a esse procedimento. O tempo médio de seguimento foi de 6,5 anos (entre cinco e oito). Todos os pacientes eram do sexo masculino, com média de 39 anos (entre 28 e 55). Em oito pacientes o membro afetado foi o não dominante. O procedimento foi feito por meio de uma abordagem dorsal e todos os pacientes foram submetidos ao mesmo protocolo de reabilitação. Todos os casos foram avaliados quanto à ocorrência de complicações, dor, amplitude de movimento, capacidade funcional (Mayo Wrist Score) e incapacidade (QuickDASH Score). Resultados: Não foram observadas complicações no período pós-operatório imediato, como infeção ou luxação do implante. No fim do período de seguimento, todos os casos apresentavam osteólise peri-implante no estudo radiográfico. Nenhum dos pacientes abandonou a sua atividade profissional prévia à cirurgia, embora em cerca de 50% dos casos tenha sido necessário algum tipo de adaptação no local de trabalho. A capacidade funcional média foi, de acordo com o Mayo Wrist Score, de 67,5 pontos (entre 50 e 80), correspondeu a um nível de função satisfatório. O escore de incapacidade QuickDASH apresentou uma pontuação média de 25 (entre 3 e 47,7). Conclusão: Os resultados desta série encontram-se em linha com os estudos publicados sobre essa técnica. A hemiartroplastia do escafoide com implante de pirocarbono é uma técnica segura para o tratamento da necrose avascular do polo proximal do escafoide após fratura. Essa técnica permitiu obter um resultado funcional satisfatório após uma média de 6,5 anos de seguimento.

APSI scaphoid hemiarthroplasty - long-term results.

OBJECTIVE: This study is aimed at evaluating the long-term results of proximal scaphoid hemiarthroplasty for post-traumatic avascular necrosis at this institution. METHODS: Twelve patients who underwent this procedure were identified, and the mean follow-up time was 6.5 years (range: 5-8 years). All patients were male, with a mean age of 39 years (range: 28-55 years). In eight patients, the non-dominant limb was affected. The procedure was carried out through a dorsal approach and all patients underwent the same rehabilitation protocol. Cases were evaluated regarding complications, pain, range of motion, functional status (Mayo Wrist Score), and disability (QuickDASH Score). RESULTS: No immediate post-operative complications, such as infection or dislocation of the implant, were observed. All patients presented with peri-implant osteolysis at follow-up, on a radiograph study. None of the patients was forced to abandon their previous professional activity, although about 50% required some type of adaptation at their workplace. The mean functional capacity was, according to the Mayo Wrist Score, of 67.5 points (range: 50-80), corresponding to a satisfactory degree of function. The QuickDASH disability score presented a mean of 25 (range: 3-47.7). CONCLUSION: The results of this series are in line with previously published studies about this technique. Hemiarthroplasty with a pyrocarbon implant is a safe technique for the treatment of post-fracture avascular necrosis of the scaphoid proximal pole. This technique allowed for satisfactory functional results at a mean follow-up of 6.5 years.

OBJETIVO: Avaliar os resultados em longo prazo da hemiartroplastia do escafoide proximal no tratamento da osteonecrose avascular pós-traumática na instituição. MÉTODOS: Foram identificados 12 pacientes submetidos a esse procedimento. O tempo médio de seguimento foi de 6,5 anos (entre cinco e oito). Todos os pacientes eram do sexo masculino, com média de 39 anos (entre 28 e 55). Em oito pacientes o membro afetado foi o não dominante. O procedimento foi feito por meio de uma abordagem dorsal e todos os pacientes foram submetidos ao mesmo protocolo de reabilitação. Todos os casos foram avaliados quanto à ocorrência de complicações, dor, amplitude de movimento, capacidade funcional (Mayo Wrist Score) e incapacidade (QuickDASH Score). RESULTADOS: Não foram observadas complicações no período pós-operatório imediato, como infeção ou luxação do implante. No fim do período de seguimento, todos os casos apresentavam osteólise peri-implante no estudo radiográfico. Nenhum dos pacientes abandonou a sua atividade profissional prévia à cirurgia, embora em cerca de 50% dos casos tenha sido necessário algum tipo de adaptação no local de trabalho. A capacidade funcional média foi, de acordo com o Mayo Wrist Score, de 67,5 pontos (entre 50 e 80), correspondeu a um nível de função satisfatório. O escore de incapacidade QuickDASH apresentou uma pontuação média de 25 (entre 3 e 47,7). CONCLUSÃO: Os resultados desta série encontram-se em linha com os estudos publicados sobre essa técnica. A hemiartroplastia do escafoide com implante de pirocarbono é uma técnica segura para o tratamento da necrose avascular do polo proximal do escafoide após fratura. Essa técnica permitiu obter um resultado funcional satisfatório após uma média de 6,5 anos de seguimento.

The influence of subcutaneous fat in the skin temperature variation rate during exercise

Introduction: Thermography records the skin temperature, which can be influenced by: muscle mass and subcutaneous fat layer. Thus, the aim of this study was to investigate the influence of subcutaneous fat layer in the skin temperature variation rate, during exercise. Methods This is a short-longitudinal study that involved 17 healthy male trained volunteers. Volunteers were divided in two groups. The first called GP1 with nine volunteers (biceps brachii skinfold thickness < 4 mm) and the second called GP2 with eight volunteers (biceps brachii skinfold thickness from 4 to 8 mm). Both groups performed three sets with 16 repetitions of unilateral biceps brachii bi-set exercise with dominant arm (eight repetitions of biceps curls and another eight of biceps hammer curls, with dumbbells), and with load of 70% of 1RM. The rest time between sets was 90s. Results The skin temperature variation rate (variation of temperature / time) was 3.59 × 10-3 ± 1.47 × 10-3 °C/s for GP1 and 0.66 × 10-3 ± 4.83 × 10-3 °C/s for GP2 (p = 0.138) considering all moments. For the period after set 1 until the end of set 3, skin temperature variation rate was 5.11 × 10-3 ± 2.57 × 10-3 °C/s for GP1 and 1.88 × 10-3 ± 3.60 × 10-3 °C/s for GP2 (p = 0.048). Subcutaneous fat layer also influences the skin temperature at resting (p = 0.044). Conclusion Subjects with lower subcutaneous fat layer have a higher skin temperature variation rate during exercise than those with higher subcutaneous fat layer.

Using skin temperature and muscle thickness to assess muscle response to strength training / Utilizando a temperatura da pele e a espessura do músculo para avaliar a resposta ao treinamento de força / Uso de la temperatura de la piel y el espesor del músculo para evaluar la respuesta al entrenamiento de fuerza

ABSTRACTIntroduction:Several studies already reported the response of many biomarkers after strength training, but studies using low cost diagnostic imaging tools are rare.Objective:To evaluate the usage of skin temperature and muscle thickness (MT) to monitor muscle response (until 96 hours after) to high-intensity strength training.Methods:This is a short-term longitudinal study with 13 trained, healthy male volunteers. Volunteers performed five sets of biceps bi-set exercise with their dominant arm with dumbbells, with load of 70% of one-repetition maximum (1RM). The ultrasound (US) and thermal images were acquired before and immediately after the last set, 24, 48, 72 and 96 hours after exercise.Results:The analysis was divided in two stages: acute muscle response (until 24 hours after training) and delayed muscle response (from 24 to 96 hours after training). The elbow flexors thickness showed the peak value immediately after the last set of training. Skin temperature (on elbow flexors) and the elbow flexors thickness grew continuously from 24 to 96 hours after strength training. There is a high correlation (r=0.941, p=0.017) between skin temperature and muscle thickness from the end of exercise until 96 hours after strength training.Conclusions:The US images showed high sensibility for muscle physiological changes on the first 24 hours after exercise. On the other hand, the thermal images had higher sensibility for muscle physiological changes than US images from 24 to 96 hours after training.

RESUMOIntrodução:Vários estudos já relataram a resposta de muitos biomarcadores após treinamento de força, mas os estudos que utilizam ferramentas de diagnóstico por imagem de baixo custo são raros.Objetivo:Avaliar o uso da temperatura da pele e da espessura do músculo (EM) para monitorar a resposta muscular (até 96 horas após) ao treinamento de força de alta intensidade.Métodos:Este é um estudo longitudinal de curta duração com 13 voluntários treinados e saudáveis do sexo masculino. Os voluntários realizaram cinco conjuntos de exercícios bi--set para bíceps com o braço dominante, com halteres, com carga de 70% de uma repetição máxima (1RM). As imagens de ultrassom (US) e térmicas foram obtidas antes e imediatamente após a última série, 24, 48, 72 e 96 horas após o exercício.Resultados:A análise foi dividida em duas etapas: resposta muscular aguda (até 24h após o treino) e resposta muscular tardia (de 24h a 96h após o treino). A espessura dos flexores do cotovelo mostrou o valor de pico imediatamente após o último conjunto de treinamento. A temperatura da pele (nos flexores do cotovelo) e a espessura dos flexores do cotovelo aumentaram continuamente de 24h a 96h após o treinamento de força. Existe uma alta correlação (r = 0,941, p = 0,017) entre a temperatura da pele e a espessura do músculo desde o final do exercício até 96h após o treinamento de força.Conclusões:As imagens de US mostraram alta sensibilidade para alterações fisiológicas no músculo nas primeiras 24 horas após o exercício. Por outro lado, as imagens térmicas apresentaram maior sensibilidade para alterações fisiológicas do que as imagens de US entre 24h e 96h após o treinamento.

RESUMENIntroducción:Varios estudios ya relataron la respuesta de muchos biomarcadores después de entrenamiento de fuerza, pero los estudios que utilizan herramientas de diagnóstico por imagen de bajo costo son raros.Objetivo:Evaluar el uso de la temperatura de la piel y del espesor del músculo (EM) para monitorear la respuesta muscular (hasta de 96 horas después) al entrenamiento de fuerza de alta intensidad.Métodos:Este es un estudio longitudinal de corta duración con 13 voluntarios entrenados y saludables del sexo masculino. Los voluntarios realizaron cinco conjuntos de ejercicios bi-set para bíceps con el brazo dominante, con pesas, con carga de 70% de una repetición máxima (1RM). Las imágenes de ultrasonido (US) y térmicas fueron obtenidas antes e inmediatamente después de la última serie, 24, 48, 72 y 96 horas después del ejercicio.Resultados:El análisis fue dividido en dos etapas: respuesta muscular aguda (hasta 24 horas después del entrenamiento) y respuesta muscular tardía (de 24 a 96 horas después del entrenamiento). El espesor de los flexores del codo mostró el valor de pico inmediatamente después del último conjunto de entrenamiento. La temperatura de la piel (en los flexores del codo) y el espesor de los flexores del codo aumentaron continuamente de 24 a 96 horas después del entrenamiento de fuerza. Existe una alta correlación (r = 0,941, p = 0,017) entre la temperatura de la piel y el espesor del músculo desde el final del ejercicio hasta 96 horas después del entrenamiento de fuerza.Conclusiones:Las imágenes de US mostraron alta sensibilidad para alteraciones fisiológicas en el músculo en las primeras 24 horas después del ejercicio. Por otro lado, las imágenes térmicas presentaron mayor sensibilidad para alteraciones fisiológicas que las imágenes de US entre 24 y 96 horas después del entrenamiento.

Cubital compressive neuropathy in the elbow: in situ neurolysis versus anterior transposition – comparative study / Neuropatia compressiva cubital no cotovelo: neurólise in situ versus transposição anterior–Estudo comparativo

Objective: To compare the results from two of the most commonly used surgical techniques: in situ decompression and subcutaneous transposition. The processes of patients treated surgically in a public university hospital between January 2004 and December 2011 were reviewed. Cases of proximal compression of the nerve, angular deformity of the elbow and systemic diseases associated with non-compressive neuropathy were excluded. Methods: Ninety-seven cases were included (96 patients). According to the modified McGowan score, 14.4% of the patients presented grade Ia, 27.8% grade II, 26.8% grade IIb and 30.9% grade III. In situ neurolysis of the cubital was performed in 64 cases and subcutaneous anterior transposition in 33. Results: According to the modified Wilson and Knout score, the results were excellent in 49.5%, good in 18.6%, only satisfactory in 17.5% and poor in 14.4%. In comparing the two techniques, we observed similar numbers of excellent and good results. Grades IIb and III were associated with more results that were less satisfactory or poor, independent of the surgical technique. Conclusion: Both techniques were shown to be efficient and safe for treating cubital tunnel syndrome...

Objetivo: Comparar os resultados de duas das técnicas cirúrgicas mais usadas, a descompressão in situ e a transposição subcutânea. Foram revistos os processos dos doentes tratados cirurgicamente num hospital universitário público entre janeiro de 2004 e dezembro de 2011. Foram excluídas compressões proximais do nervo, deformidades angulares do cotovelo e doenças sistêmicas associadas a neuropatia não compressiva. Metodos: Foram incluídos 97 casos (96 doentes). Segundo o escore modificado de McGowan, 14,4% dos pacientes encontravam-se no Grau Ia, 27,8% no II, 26,8% no IIb e 30,9% no III. A neurólise in situ do cubital foi feita em 64 casos e a transposição anterior subcutânea em 33. Resultados: Segundo o escore modificado de Wilson e Knout, os resultados foram excelentes em 49,5%, bons em 18,6%, apenas satisfatórios em 17,5% e pobres em 14,4%. Na comparação das duas técnicas observamos valores similares de resultados excelentes ou bons. Os graus IIb e III estão associados a mais resultados menos satisfatórios ou maus independentemente da técnica cirúrgica. Conclusão: As duas técnicas se revelam eficientes e seguras no tratamento do síndrome do túnel cubital...

Scapholunate ligament reconstruction using a flexor carpi radialis tendon graft.

PURPOSE: To review the results of scapholunate ligament reconstruction using a flexor carpi radialis tendon graft. METHODS: We performed a retrospective review of 22 patients with post-traumatic scapholunate instability who were treated with a modification of the Brunelli, a flexor carpi radialis tendon graft. RESULTS: The mean follow-up was 61 months. The average age was 40 years. The average loss of flexion was 23° and of extension was 22° compared with the contralateral side. Grip strength averaged 67% of the nonoperated side. All patients except 2 returned to work. Degenerative changes were seen in 3 patients at the time of revision. Complications occurred in 2 patients and included avascular necrosis of the scaphoid. CONCLUSIONS: Perfect biomechanical reconstruction might not be possible for scapholunate dissociation. Our results show, however, that ligament reconstruction led to satisfactory results from the patient's point of view. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Cubital compressive neuropathy in the elbow: in situ neurolysis versus anterior transposition - comparative study.

OBJECTIVE: To compare the results from two of the most commonly used surgical techniques: in situ decompression and subcutaneous transposition. The processes of patients treated surgically in a public university hospital between January 2004 and December 2011 were reviewed. Cases of proximal compression of the nerve, angular deformity of the elbow and systemic diseases associated with non-compressive neuropathy were excluded. METHODS: Ninety-seven cases were included (96 patients). According to the modified McGowan score, 14.4% of the patients presented grade Ia, 27.8% grade II, 26.8% grade IIb and 30.9% grade III. In situ neurolysis of the cubital was performed in 64 cases and subcutaneous anterior transposition in 33. RESULTS: According to the modified Wilson and Knout score, the results were excellent in 49.5%, good in 18.6%, only satisfactory in 17.5% and poor in 14.4%. In comparing the two techniques, we observed similar numbers of excellent and good results. Grades IIb and III were associated with more results that were less satisfactory or poor, independent of the surgical technique. CONCLUSION: Both techniques were shown to be efficient and safe for treating cubital tunnel syndrome.

OBJETIVO: Comparar os resultados de duas das técnicas cirúrgicas mais usadas, a descompressão in situ e a transposição subcutânea. Foram revistos os processos dos doentes tratados cirurgicamente num hospital universitário público entre janeiro de 2004 e dezembro de 2011. Foram excluídas compressões proximais do nervo, deformidades angulares do cotovelo e doenças sistêmicas associadas a neuropatia não compressiva. METODOS: Foram incluídos 97 casos (96 doentes). Segundo o escore modificado de McGowan, 14,4% dos pacientes encontravam-se no Grau Ia, 27,8% no II, 26,8% no IIb e 30,9% no III. A neurólise in situ do cubital foi feita em 64 casos e a transposição anterior subcutânea em 33. RESULTADOS: Segundo o escore modificado de Wilson e Knout, os resultados foram excelentes em 49,5%, bons em 18,6%, apenas satisfatórios em 17,5% e pobres em 14,4%. Na comparação das duas técnicas observamos valores similares de resultados excelentes ou bons. Os graus IIb e III estão associados a mais resultados menos satisfatórios ou maus independentemente da técnica cirúrgica. CONCLUSÃO: As duas técnicas se revelam eficientes e seguras no tratamento do síndrome do túnel cubital.

Percutaneous needle fasciotomy in Dupuytren's contracture: is it a viable technique?

The aim of this retrospective study was to evaluate the results of 44 percutaneous needle fasciotomies for Dupuytren's contracture, performed from March 2005 to June 2010. The mean age of the 36 patients was 58 years and the mean follow-up period was 28 months. The assessment was based on the clinical records and clinical evaluation. Pre-operative and postoperative total passive extension deficit and complications were registered. Recurrence and patient satisfaction were also noted. The results in stage I and II of Tubiana were interesting, with an average improvement of more than 70%. For more severe deformities, the correction obtained was not so satisfactory and decreased significantly over time. The cumulative rate of minor complications was significant (11/44) but there were no major complications or permanent sequelae. Most of the patients were satisfied with the result and would recommend the procedure or would be willing to repeat it if necessary. The recurrence rate was 9%. Percutaneous needle fasciotomy appeared in this study as a minimally invasive, simple and fast technique with low morbidity. These features make this technique a valid alternative in mild stages of Dupuytren's disease.

Subjective outcome of reconstruction of the adult acquired neurological equinovarus foot.

A retrospective study was done of the subjective outcome of surgical correction of a spastic equinovarus foot deformity in 27 adult patients with acquired spastic hemiplegia. The mean age of the patients was 49 years and the mean follow-up period was 29 months. The patients were submitted to individualized soft-tissue surgery intended to correct their deformities and rebalance the affected joints, and subsequently subjected to a standard rehabilitation protocol. The assessment was based on the clinical records and on a questionnaire sent to the patients about relevant aspects of their gait, lifestyle and untoward effects and complications. The results have shown that patients experience frank improvement in terms of gait, orthostatic posture, self-esteem and quality of life. Transient or permanent adverse effects occurred in 11 of the 27 patients. The changes induced by surgery to reduce the imbalance and deformity of the foot have a considerable impact on independence and quality of life of these patients despite the high rate of complications.