Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 76
Filtrar
1.
J Orthop Surg Res ; 14(1): 234, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337441

RESUMO

BACKGROUND: Acute injuries of the hamstring muscle complex (HMC) type 3b (interfascicle/bundle-tear) are frequently observed in various sports disciplines both in elite and recreational sport. The treatment of choice of acute HMC injuries type 3b is a progressive physiotherapeutic exercise programme. Besides this, there is currently only insufficient scientific evidence to support other treatment methods, including local infiltrations and injections of platelet-rich-plasma. Very recently, it was demonstrated that extracorporeal shock wave therapy (ESWT) may accelerate regeneration after acute skeletal muscle injury. The aim of the present study is to test the hypothesis that the combination of radial ESWT (rESWT) and a specific rehabilitation program (RP) is effective and safe in treatment of acute HMC injury type 3b in athletes, and is statistically significantly more effective than the combination of sham-rESWT and RP. METHODS: We will perform a double blind, randomized, sham-controlled clinical trial at the clinic KinEf Kinesiología Deportiva, Ciudad Autónoma de Buenos Aires, Argentina. Forty patients with acute HMC injury type 3b will be randomly allocated to receive either rESWT (nine rESWT sessions; three sessions per week; 2500 radial extracorporeal shock waves (rESWs) per session; energy density depending on what the patient tolerates) or sham-rESWT. In addition, all patients will receive a specific rehabilitation program that will last for 8 weeks. The primary outcome measure will be the individual time (days) necessary to return to play. Secondary outcomes will include the presence or absence of reinjury during a time period of 6 months after inclusion into the study. DISCUSSION: Because of the lack of adequate treatment options for acute HMC injury type 3b in athletes and particularly the high reinjury rate, we hypothesize that the results of this trial will be of importance and have impact on clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT03473899 . Registered March 22, 2018.


Assuntos
Atletas , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/reabilitação , Tratamento por Ondas de Choque Extracorpóreas/métodos , Músculos Isquiotibiais/lesões , Adolescente , Adulto , Traumatismos em Atletas/terapia , Terapia Combinada/métodos , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Placebos , Estudos Prospectivos , Lesões dos Tecidos Moles/reabilitação , Lesões dos Tecidos Moles/terapia , Resultado do Tratamento , Adulto Jovem
2.
Zhonghua Shao Shang Za Zhi ; 35(5): 351-355, 2019 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-31154732

RESUMO

Objective: To investigate the early diagnosis method of pulmonary embolism in patients with skin and soft tissue defects after trauma. Methods: From January 2011 to July 2014, 5 patients with skin and soft tissue defects and pulmonary embolism after trauma were admitted to Department of Plastic Surgery and Burns of the Affiliated Drum Tower Hospital of Nanjing University Medical School, including 4 males and 1 female, aged 26-68 years. The medical records of the 5 patients were retrospectively analyzed. Hierarchical screening of patients with suspected pulmonary embolism was performed after admission for 4-45 days. Computed tomography pulmonary angiography (CTPA) was performed immediately in 2 patients who had hemodynamic disorder and were able to tolerate CTPA, and pulmonary embolism was confirmed. Clinical risk assessment was conducted for the other 3 patients who had no obvious hemodynamic disorder and only had clinical manifestations of pulmonary embolism such as chest tightness and dyspnea. Among the 3 patients, two of them were assessed as high risk possibility by clinical risk assessment and diagnosed with pulmonary embolism by CTPA immediately. The other one patient's clinical risk assessment was moderate risk possibility, but D-dimer was positive, and the patient was diagnosed with pulmonary embolism by CTPA immediately. Wound exudation of all patients was collected within 1 week after admission for microbial culture, and wound debridement and skin grafting were performed according to the wound condition. The color Doppler ultrasonography of blood vessel on lower extremity was performed to determine deep venous thrombosis of lower extremity after appearance of symptoms of pulmonary embolism. The patient was immediately given urokinase or recombinant tissue plasminogen activator by intravenous infusion for thrombolysis after definite diagnosis of pulmonary embolism. The activated partial thromboplastin time (APTT) was monitored after treatment, and standardized anticoagulation began when APTT was equal to or lower than 70 seconds. The treatment results of patients, D-dimer measurement value, bed time before definite diagnosis of pulmonary embolism, number of patients underwent wound debridement during hospitalization, definite diagnosis time of pulmonary embolism after wound debridement, and number of patients with deep venous thrombosis of lower extremity and wound infection were recorded. Results: Wounds with skin and soft tissue defects of all patients were completely healed, all skin grafts survived well, pulmonary embolism recovered well after timely treatment, and the trunk and branches of involved pulmonary artery recovered blood supply. The course of disease ranged from 1 month to 3 months. The measurement value of D-dimer was 2.4-31.7 mg/L, and the measurement values of D-dimer of 4 patients were equal to or higher than 5.0 mg/L. The bed time before definite diagnosis of pulmonary embolism was 4-46 days, with an average of 23.2 days. Four patients underwent wound debridement during hospitalization. The definite diagnosis time of pulmonary embolism after the wound debridement was 14-40 days, with an average of 20.5 days. Four patients were diagnosed with deep venous thrombosis of lower extremity. All patients had wound infection, and the bacteria causing wound infection included Pseudomonas aeruginosa of 2 cases, Staphylococcus aureus of 2 cases, and Enterococcus faecalis of 1 case. Conclusions: In the diagnosis process of pulmonary embolism in patients with skin and soft tissue defects after trauma, D-dimer positive, long-term bed rest, experiencing operation during hospitalization, and with deep vein thrombosis and wound infection can be regarded as the key points for diagnosis. When a patient has clinical symptoms of pulmonary embolism and the above conditions, the clinician should promptly perform hierarchical screening, select the corresponding examination to confirm pulmonary embolism, and immediately perform thrombolysis for the patient with pulmonary embolism according to the patient's tolerance, thereby improving patient survival rate.


Assuntos
Embolia Pulmonar/diagnóstico , Transplante de Pele , Lesões dos Tecidos Moles/reabilitação , Lesões dos Tecidos Moles/cirurgia , Adulto , Idoso , Queimaduras/reabilitação , Queimaduras/cirurgia , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ativador de Plasminogênio Tecidual , Cicatrização
3.
Phys Ther Sport ; 34: 227-237, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30388671

RESUMO

OBJECTIVE: Strength training acute programme variables (APVs) can impact tibiofemoral joint injury outcomes. Exercise descriptors (EDs; e.g. patient-position) specify configurations within which APVs are applied. Evidence-based practice depends on adequate reporting of APVs and EDs to replicate strength training interventions in clinical practice. This systematic review assessed APV and ED reporting for adults with tibiofemoral joint injury (anterior cruciate ligament (ACL)/posterior cruciate ligament (PCL)/medial collateral ligament (MCL)/lateral collateral ligament (LCL)/meniscus/hyaline cartilage (HC)). METHODS: PRISMA guidelines were followed. Specific key-term combinations were employed and database searches performed. Descriptive/observational/experimental studies were included (2006-2018). Studies needed to report pre-defined APVs or EDs for ≥51% of all exercises to be included. Frequency counts were made of studies adequately reporting APVs and EDs. RESULTS: Sixteen articles were included (ACL = 13; meniscus = 3). No PCL/MCL/LCL/HC articles were identified. Of nine APVs, five and four were consistently reported by the majority of ACL (≥7) and meniscal (≥2) studies, respectively. Of eight EDs, four were consistently reported by the majority of both ACL (≥8) and meniscal (≥2) studies. CONCLUSION: Many APVs and EDs were not adequately reported. Future studies should better document APVs and EDs for higher standards of intervention reporting and enhanced translation of research to clinical practice.


Assuntos
Terapia por Exercício , Traumatismos do Joelho/reabilitação , Treinamento de Resistência , Lesões dos Tecidos Moles/reabilitação , Lesões do Ligamento Cruzado Anterior/reabilitação , Humanos , Articulação do Joelho
4.
Zhonghua Shao Shang Za Zhi ; 34(5): 266-270, 2018 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-29804424

RESUMO

Objective: Strategy for wound repair of skin and soft tissue defect and systematic rehabilitation treatment for functional reconstruction of patients with severe burn or trauma on knees. Methods: From January 2015 to October 2016, 26 patients with skin and soft tissue defect on knees after severe burn or trauma were hospitalized in our unit. Among these patients, 14 patients had patellar ligament defect, and 16 patients had knee joint capsule defect. Wound debridement was operated on 1 to 3 days after admission. After debridement, the area of skin and soft tissue defect ranged from 10 cm×7 cm to 42 cm×18 cm. Vacuum sealing drainage (VSD) treatment was performed after debridement, and flap transplantation operation was performed after VSD treatment for 5 to 7 days. Defects of nine patients were treated with local rotation flaps. Seven patients with skin and soft tissue defects on knees and knee joint capsule defects of 5 cm×3 cm to 9 cm×7 cm were treated with free anterolateral femoral flaps combined with fascia lata. Ten patients with skin and soft tissue defects on knees and patellar ligament defects of 6 cm×3 cm to 12 cm×4 cm were treated with free anterolateral femoral flaps combined with iliotibial tract. The area of flaps ranged from 11 cm×9 cm to 22 cm×15 cm. After flap transplantation operation, functional reconstruction of knee joint was carried out according to early, continuous, and sequential systematic rehabilitation treatment strategy. The pain degree and function of knee joint of patients were scored by the International Knee Documentation Committee (IKDC) Knee Evaluation Form before operation and 12 months after operation. The knee joint flexion and extension degrees of patients were measured by joint protractor in 2 weeks and 12 months after operation. The color Doppler ultrasound was used to evaluate integrity of knee joint capsule and continuity of patellar ligament of patients in 6 and 12 months after operation. Results: All flaps of 26 patients survived well, and wounds healed completely after the operation. Distal parts of flaps of 2 patients treated with free anterolateral femoral flaps had local necrosis after the operation, and their wounds healed after debridement and transplantation of autologous intermediate split-thickness skin graft of thigh. The IKDC Knee Evaluation Form score of patients was (79±8) points in 12 months after operation, which was significantly higher than (64±7) points before operation (t=7.20, P<0.05). The flexion degree of knee joint of patients was (117±10)° in 12 months after operation, which was significantly larger than (35±8)° in 2 weeks after operation (t=32.65, P<0.05). The extension degree of knee joint of patients was (12±9)° in 12 months after operation, which was significantly smaller than (61±9)° in 2 weeks after operation (t=19.63, P<0.05). In 6 and 12 months after operation, 9 patients treated with local rotation flaps had good integrity of knee joint capsule and continuity of patellar ligament; 7 patients treated with free anterolateral femoral flaps and fascia lata had good integrity of knee joint capsule; 10 patients treated with free anterolateral femoral flaps and iliotibial tract had good continuity of patellar ligament. During follow-up of 12 months, all flaps survived well; knees of all patients had good appearance; knee joints functioned normally. Conclusions: Good appearance and function of knees can be achieved by repairing wound of skin and soft tissue defect on knees after severe burn or trauma with local rotation flaps or free anterolateral femoral flaps with fascia lata or iliotibial tract plus systematic rehabilitation treatment of knee joint in early stage after flap transplantation operation.


Assuntos
Queimaduras/reabilitação , Queimaduras/cirurgia , Traumatismos do Joelho/reabilitação , Traumatismos do Joelho/cirurgia , Ligamento Patelar/lesões , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões dos Tecidos Moles/reabilitação , Lesões dos Tecidos Moles/cirurgia , Cicatrização , Desbridamento , Fascia Lata , Retalhos de Tecido Biológico , Humanos , Articulação do Joelho/fisiopatologia , Pessoa de Meia-Idade , Ligamento Patelar/cirurgia , Amplitude de Movimento Articular , Procedimentos Cirúrgicos Reconstrutivos/reabilitação , Transplante de Pele
5.
Physiotherapy ; 104(1): 136-141, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28778609

RESUMO

OBJECTIVE: To validate the Rehabilitation Adherence Measure for Athletic Training (RAdMAT) for use in clinic-based physiotherapy. DESIGN AND PROCEDURE: Single group, prospective study conducted over the course of the participants' rehabilitation. Clinic-based adherence was measured by participant attendance at physiotherapy appointments, the 16-item RAdMAT (three subscales) and the three-item SIRAS questionnaire. The SIRAS was evaluated after each physiotherapy treatment and the RAdMAT either at the completion of their treatment or at end of the eight week study period. Both questionnaires were completed by the physiotherapist. PARTICIPANTS: 108 participants with soft tissue injuries of the shoulder. RESULTS: The percentage of adherence for the three different adherence measures was high ranging from 89% to 95%. Large significant correlations were found between the SIRAS and the RAdMAT total score, and the RAdMAT factor 1; and amongst the RAdMAT total and its three subscales. Medium strength correlations existed between the SIRAS and the other two RAdMAT subscales. Small significant correlations occurred between percentage of attendance, and RAdMAT factors 2 and 3. CONCLUSION: The strength of the correlations between the RAdMAT and the SIRAS provide evidence for the RAdMAT and its three subscales comprising a valid and comprehensive assessment tool for measuring patient adherence to clinic-based physiotherapy. Registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612000611820).


Assuntos
Cooperação do Paciente/estatística & dados numéricos , Modalidades de Fisioterapia/normas , Lesões do Ombro/reabilitação , Lesões dos Tecidos Moles/reabilitação , Inquéritos e Questionários/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Adulto Jovem
6.
Bull Soc Pathol Exot ; 111(2): 121-125, 2018.
Artigo em Francês | MEDLINE | ID: mdl-30789235

RESUMO

The accidental loss of fingertip soft tissues, which may expose tendons and bones, is a common injury in emergency departments. If these lesions are poorly treated, they can impair fine motor skills and tactile sensitivity of the fingertips. The study was conducted on 30 patients (24 males and 6 females) with 32 soft tissue defects of the fingertip treated in emergency plastic surgery with local pedicled flap at the Plastic Surgery Department of Saint Paul Hospital Hanoi from 01/2016 to 06/2017. The most common cause of injury (21/30) was occupational accidents. At the time of the accident, 12 patients did not have personal protective equipment (PPE). Among 18 patients who had one, eight had incomplete equipment. Of 32 implanted skin flaps, 31 survived completely without necrosis or infection, only one being affected by epidermolysis. Postoperative evaluation showed excellent motor skills for 31/32 fingers and a sensitivity restoration at S4 level for 27/32. Workplace accident is the main cause of fingers soft tissue defects. Covering the fingers soft tissue defects with local pedicled flap in emergency preserves the fine motor function and the delicated tactile sensation of the fingers.


Assuntos
Traumatismos dos Dedos/cirurgia , Traumatismos Ocupacionais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Transplante de Pele , Retalhos Cirúrgicos/transplante , Acidentes de Trabalho/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Traumatismos dos Dedos/epidemiologia , Traumatismos dos Dedos/reabilitação , Dedos/patologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Traumatismos Ocupacionais/epidemiologia , Traumatismos Ocupacionais/reabilitação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/reabilitação , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Transplante de Pele/métodos , Transplante de Pele/reabilitação , Transplante de Pele/estatística & dados numéricos , Lesões dos Tecidos Moles/epidemiologia , Lesões dos Tecidos Moles/reabilitação , Lesões dos Tecidos Moles/cirurgia , Tato/fisiologia , Resultado do Tratamento , Vietnã/epidemiologia , Adulto Jovem
7.
Arch Phys Med Rehabil ; 99(9): 1890-1899, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29138050

RESUMO

OBJECTIVE: To assess the effects on functional outcomes and treatment adherence of wearable technology and serious games (ie, interactive computer applications with specific purposes useful in the "real world") currently used in physical rehabilitation of patients after traumatic bone and soft tissue injuries. DATA SOURCES: PubMed, EMBASE, Cochrane Library, and Current Index to Nursing and Allied Health Literature were searched without publication date restrictions for the terms wearable, serious game, videogame or mobile application, and rehabilitation, exercise therapy, and physiotherapy. STUDY SELECTION: The search yielded 2704 eligible articles, which were screened by 2 independent reviewers. Studies comparing serious games to standard therapy were included. DATA EXTRACTION: Methodology and results of the studies were critically appraised in conformity with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SYNTHESIS: Twelve articles were included, all of which tested "off-the-shelf" games. No studies on "wearable-controlled" games or games specifically developed for rehabilitation could be included. Medical conditions included postoperative rehabilitation and acute traumatic injuries. All studies were of low to moderate quality. Only 2 studies found beneficial effects of serious games compared to conventional therapy. One of 3 studies reporting pain scores found beneficial effects of serious games compared to physiotherapy. One of 5 trials reporting treatment adherence found a statistically significant advantage in the game group compared to conventional physiotherapy. Because of heterogeneity in study design and outcome measures, pooling of data was not possible. CONCLUSIONS: Serious games seem a safe alternative or addition to conventional physiotherapy after traumatic bone and soft tissue injuries. Future research should determine their validity and effectiveness in rehabilitation therapy, next to their cost-effectiveness and effect on treatment adherence.


Assuntos
Fraturas Ósseas/reabilitação , Jogos Recreativos , Lesões dos Tecidos Moles/reabilitação , Jogos de Vídeo , Dispositivos Eletrônicos Vestíveis , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia por Exercício/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Modalidades de Fisioterapia , Resultado do Tratamento
8.
Oper Orthop Traumatol ; 29(2): 125-137, 2017 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-28314869

RESUMO

AIM OF SURGERY: Reconstruction of the most important ligamentous and osseus structures of the elbow after terrible triad injury via the radial head to the lateral collateral ligament complex (LCL) and if necessary beginning at the coronoid process. The aim is a stable concentrically guided elbow with early functional follow-up treatment. The approach depends on the intraoperatively tested stability. INDICATIONS: Osteoligamentous terrible triad injury pattern with or without subluxation position following reduction and temporary immobilization. CONTRAINDICATIONS: Inoperable due to comorbidities. Concentric elbow with radial head fracture without impairment of pronation/supination, coronoid fragment <50% and stable range of motion up to 30°. OPERATIVE TECHNIQUE: Lateral access according to Kaplan or Kocher in order to address the anterior capsule/coronoid tip. Stabilization of the radial head with mini fragment screws and plates or radial head prosthesis. Osseous reinsertion of the LCL at its origin with transosseous sutures/bone anchors on the radial epicondyle of the humerus. In cases of persisting instability (hanging arm test) treatment with lateral movement fixation and/or the medial collateral ligaments from medial. FOLLOW-UP TREATMENT: Immobilization in upper arm plaster cast in the first postoperative days, active assistive pain-adapted movement therapy in the cast from postoperative day 1 and after 6-8 weeks resistive therapy in the whole elbow. RESULTS: Control of 15 terrible triad patients (mean age 45.9 years, range 20-87 years) after 9.6 months (range 2.6-31.6 months), extent of movement flexion/extension 131/14/0°, pronation/supination 78/0/67°. Arthrolysis after an average of 38 weeks in 4 patients, signs of joint arthrosis in 8, heterotopic ossification in 7 and neuropathic complaints in the region of the ulnar nerve in 1 patient. Early functional therapy with reproducible results by stabilization of osteoligamentous structures.


Assuntos
Articulação do Cotovelo/lesões , Articulação do Cotovelo/cirurgia , Fratura-Luxação/cirurgia , Traumatismo Múltiplo/cirurgia , Fraturas do Rádio/cirurgia , Lesões dos Tecidos Moles/cirurgia , Fraturas da Ulna/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Medicina Baseada em Evidências , Consolidação da Fratura , Humanos , Pessoa de Meia-Idade , Fraturas do Rádio/prevenção & controle , Estudos Retrospectivos , Lesões dos Tecidos Moles/reabilitação , Resultado do Tratamento , Ulna/lesões , Ulna/cirurgia , Fraturas da Ulna/reabilitação
9.
Clin J Pain ; 33(1): 71-86, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27022675

RESUMO

OBJECTIVE: To evaluate the effectiveness of passive physical modalities for the management of soft tissue injuries of the elbow. METHODS: We systematically searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials from 1990 to 2015. Studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. We included studies with a low risk of bias in our best evidence synthesis. RESULTS: We screened 6618 articles; 21 were eligible for critical appraisal and 9 (reporting on 8 randomized controlled trials) had a low risk of bias. All randomized controlled trials with a low risk of bias focused on lateral epicondylitis. We found that adding transcutaneous electrical nerve stimulation to primary care does not improve the outcome of patients with lateral epicondylitis. We found inconclusive evidence for the effectiveness of: (1) an elbow brace for managing lateral epicondylitis of variable duration; and (2) shockwave therapy or low-level laser therapy for persistent lateral epicondylitis. DISCUSSION: Our review suggests that transcutaneous electrical nerve stimulation provides no added benefit to patients with lateral epicondylitis. The effectiveness of an elbow brace, shockwave therapy, or low-level laser therapy for the treatment of lateral epicondylitis is inconclusive. We found little evidence to inform the use of passive physical modalities for the management of elbow soft tissue injuries.


Assuntos
Cotovelo/lesões , Modalidades de Fisioterapia , Lesões dos Tecidos Moles/reabilitação , Gerenciamento Clínico , Humanos , Revisão Sistemática como Assunto , Cotovelo de Tenista/reabilitação
10.
J Reconstr Microsurg ; 32(7): 562-70, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27326798

RESUMO

Background Reconstruction of the weight-bearing surface of the foot represents a challenging task. With very little scope to borrow glabrous tissue from adjacent areas means that achieving a "like for like" reconstruction is rarely possible. In this setting, alternative approaches need to be considered. In this article we present our experience with various differing designs of the anterolateral thigh flap (ALT) in the reconstruction of 20 large defects of the weight-bearing sole. Methods Twenty patients with complex soft tissue defects of the weight-bearing sole underwent reconstruction over a 5-year period. Five cases were complicated by osteomyelitis resulting in significant calcaneal defects. The follow-up period ranged from 8 to 48 months and outcomes were assessed by two-point discrimination and protective sensation, observation of gait, and the ability of the patient to return to wearing normal footwear. Results All flaps survived with the exception of two partial skin necrosis. Sensory nerve coaptation was performed in 12/20 cases. One patient underwent second-stage total calcaneal reconstruction with a fibula osteocutaneous flap. Five large defects were reconstructed with the split skin paddle technique to allow for direct donor-site closure. No evidence of postoperative ulceration was noted in any of the patients over the follow-up period and all were satisfied regarding the functional and aesthetic results achieved. Conclusion Complex defects of the weight-bearing sole can be successfully reconstructed using the free ALT flap resulting in very favorable functional outcomes. Even when calcaneal osteomyelitis has set in, excellent outcomes can be achieved.


Assuntos
Traumatismos do Pé/cirurgia , Retalhos de Tecido Biológico/irrigação sanguínea , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles/cirurgia , Coxa da Perna/cirurgia , Adolescente , Adulto , Idoso , Feminino , Traumatismos do Pé/fisiopatologia , Traumatismos do Pé/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Lesões dos Tecidos Moles/fisiopatologia , Lesões dos Tecidos Moles/reabilitação , Resultado do Tratamento , Suporte de Carga , Adulto Jovem
11.
Man Ther ; 22: 9-15, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26995777

RESUMO

BACKGROUND: A loss of internal rotation (IR) of the hip is associated with hip pathology. Improving IR may improve hip range of motion (ROM) or prevent hip pathology. OBJECTIVES: The purpose of this study was to compare the immediate effects of caudal mobilisation with movement (MWM) and caudal self-mobilisation with movement (SMWM) on young healthy male subjects with reduced IR of the hip. DESIGN: A randomised controlled trial was performed. Twenty-Two subjects were randomised into a MWM group (n = 6), SMWM group (n = 8) or a control group (n = 8). METHOD: The primary outcome measures included the functional internal rotation test (FIRT) for the hip and the passive seated internal rotation test (SIRT) for the hip. Outcomes were captured at baseline and immediately after one treatment of MWMs, SMWMs or control. RESULTS: A two-way analysis of variance (ANOVA), group × time interaction was conducted. The ANOVA revealed the only significant improvement was in the MWM group for the FIRT (p = 0.01), over the control group. Subjects with reduced IR of the hip who receive a single session of MWMs exhibited significantly improved functional IR of their hip than the control group. CONCLUSIONS: From the data presented, it can be suggested that caudal MWMs of the hip appear to have a positive effect on functional IR of healthy young hips. This may be due to addressing the positional fault theory or the arthrogenic muscular inhibition theory. SMWMs may be effective in augmenting treatments for patients waiting for hip operations.


Assuntos
Traumatismos em Atletas/reabilitação , Luxação do Quadril/reabilitação , Quadril/fisiopatologia , Modalidades de Fisioterapia , Amplitude de Movimento Articular/fisiologia , Rotação , Lesões dos Tecidos Moles/reabilitação , Adulto , Análise de Variância , Atletas , Inglaterra , Humanos , Masculino , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Futebol , Adulto Jovem
12.
J Manipulative Physiol Ther ; 38(7): 493-506, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26303967

RESUMO

OBJECTIVE: The purpose of this systematic review was to determine the effectiveness of passive physical modalities compared to other interventions, placebo/sham interventions, or no intervention in improving self-rated recovery, functional recovery, clinical outcomes and/or administrative outcomes (eg, time of disability benefits) in adults and/or children with soft tissue injuries and neuropathies of the wrist and hand. METHODS: We systematically searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials, accessed through Ovid Technologies, Inc, and CINAHL Plus with Full Text, accessed through EBSCO host, from 1990 to 2015. Our search strategies combined controlled vocabulary relevant to each database (eg, MeSH for MEDLINE) and text words relevant to our research question and the inclusion criteria. Randomized controlled trials, cohort studies, and case-control studies were eligible. Random pairs of independent reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with low risk of bias were synthesized following best evidence synthesis principles. RESULTS: We screened 6618 articles and critically appraised 11 studies. Of those, 7 had low risk of bias: 5 addressed carpal tunnel syndrome (CTS) and 2 addressed de Quervain disease. We found evidence that various types of night splints lead to similar outcomes for the management of CTS. The evidence suggests that a night wrist splint is less effective than surgery in the short term but not in the long term. Furthermore, a night wrist splint and needle electroacupuncture lead to similar outcomes immediately postintervention. Finally, low-level laser therapy and placebo low-level laser therapy lead to similar outcomes. The evidence suggests that kinesio tape or a thumb spica cast offers short-term benefit for the management of de Quervain disease. Our search did not identify any low risk of bias studies examining the effectiveness of passive physical modalities for the management of other soft tissue injuries or neuropathies of the wrist and hand. CONCLUSIONS: Different night orthoses provided similar outcomes for CTS. Night orthoses offer similar outcomes to electroacupuncture but are less effective than surgery in the short term. This review suggests that kinesio tape or a thumb spica cast may offer short-term benefit for the management of de Quervain disease.


Assuntos
Síndrome do Túnel Carpal/reabilitação , Traumatismos da Mão/reabilitação , Modalidades de Fisioterapia , Lesões dos Tecidos Moles/reabilitação , Traumatismos do Punho/reabilitação , Acidentes de Trânsito , Adulto , Síndrome do Túnel Carpal/diagnóstico , Criança , Comportamento Cooperativo , Medicina Baseada em Evidências , Feminino , Traumatismos da Mão/diagnóstico , Humanos , Terapia com Luz de Baixa Intensidade/métodos , Masculino , Ontário , Aparelhos Ortopédicos/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Lesões dos Tecidos Moles/diagnóstico , Revisão Sistemática como Assunto , Terapia por Ultrassom/métodos , Traumatismos do Punho/diagnóstico
13.
Arch Phys Med Rehabil ; 96(10): 1913-1923.e1, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26163944

RESUMO

OBJECTIVE: To investigate which orthosis results in (1) fewer complications; (2) the least extensor lag; and (3) the highest rates of treatment success according to the Abouna and Brown criteria for soft tissue mallet injury in adults. DATA SOURCES: Electronic databases AMED, CINAHL, Embase, MEDLINE, PubMed, OTseeker, and PEDro were searched from the earliest available date until September 16, 2014. STUDY SELECTION: Controlled trials evaluating orthosis type in the conservative management of mallet injury were included. Database searching yielded 1024 potential studies, of which 7 met inclusion criteria with a total of 491 participants. DATA EXTRACTION: Data were extracted using an author-designed extraction form by one reviewer, and accuracy was assessed by a second reviewer. The PEDro scale was used to assess methodological quality. DATA SYNTHESIS: Results were pooled using a random-effects model with inverse variance methods. Dichotomous outcomes are expressed as risk ratios (RRs) and 95% confidence intervals (CIs) and continuous outcomes as standardized mean differences and 95% CIs. There is moderate quality evidence that prefabricated orthoses had 3 times the risk of developing skin complications as compared with all other orthoses (RR, 3.17; 95% CI, 1.19-8.43; I(2)=47%) and nearly 7 times the risk of developing skin complications as compared with custom-made thermoplastic orthoses (RR, 6.72; 95% CI, 1.59-28.46; I(2)=0%). Treatment outcomes were found to be similar for treatment success when prefabricated orthoses were compared with custom-made orthoses (RR, .99; 95% CI, 0.80-1.22; I(2)=39%; very low quality evidence), as well as for extensor lag when custom-made thermoplastic orthoses were compared with other orthoses (standardized mean difference, .03; 95% CI, -.29 to .36; I(2)=0%; moderate quality evidence). CONCLUSIONS: Prefabricated orthoses were found to increase the risk of developing skin complications as compared with custom-made orthoses, but there were no differences in treatment success, failure, or extensor lag.


Assuntos
Traumatismos dos Dedos/reabilitação , Deformidades Adquiridas da Mão/reabilitação , Lesões dos Tecidos Moles/reabilitação , Contenções , Traumatismos dos Tendões/reabilitação , Humanos
14.
J Hand Ther ; 28(3): 314-7; quiz 318, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25990441

RESUMO

These authors describe how they use thermoplastic materials to augment home exercise programs for clients with chronic and post-surgical soft tissue dysfunction. They discuss how after thorough education is provided, this alternative tool may be given for patient use. -Victoria Priganc, PhD, OTR, CHT, CLT, Practice Forum Editor.


Assuntos
Terapia por Exercício/instrumentação , Complicações Pós-Operatórias , Lesões dos Tecidos Moles/reabilitação , Terapia de Tecidos Moles/instrumentação , Doença Crônica , Desenho de Equipamento , Humanos , Lesões dos Tecidos Moles/etiologia
15.
Man Ther ; 20(5): 646-56, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25920340

RESUMO

BACKGROUND: Exercise is a key component of rehabilitation for soft tissue injuries of the shoulder; however its effectiveness remains unclear. OBJECTIVE: Determine the effectiveness of exercise for shoulder pain. METHODS: We searched seven databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort and case control studies comparing exercise to other interventions for shoulder pain. We critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network (SIGN) criteria. We synthesized findings from scientifically admissible studies using best-evidence synthesis methodology. RESULTS: We retrieved 4853 articles. Eleven RCTs were appraised and five had a low risk of bias. Four studies addressed subacromial impingement syndrome. One study addressed nonspecific shoulder pain. For variable duration subacromial impingement syndrome: 1) supervised strengthening leads to greater short-term improvement in pain and disability over wait listing; and 2) supervised and home-based strengthening and stretching leads to greater short-term improvement in pain and disability compared to no treatment. For persistent subacromial impingement syndrome: 1) supervised and home-based strengthening leads to similar outcomes as surgery; and 2) home-based heavy load eccentric training does not add benefits to home-based rotator cuff strengthening and physiotherapy. For variable duration low-grade nonspecific shoulder pain, supervised strengthening and stretching leads to similar short-term outcomes as corticosteroid injections or multimodal care. CONCLUSION: The evidence suggests that supervised and home-based progressive shoulder strengthening and stretching are effective for the management of subacromial impingement syndrome. For low-grade nonspecific shoulder pain, supervised strengthening and stretching are equally effective to corticosteroid injections or multimodal care. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42013003928.


Assuntos
Terapia por Exercício/métodos , Síndrome de Colisão do Ombro/reabilitação , Dor de Ombro/reabilitação , Lesões dos Tecidos Moles/reabilitação , Gerenciamento Clínico , Feminino , Humanos , Masculino , Ontário , Medição da Dor , Guias de Prática Clínica como Assunto , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Síndrome de Colisão do Ombro/diagnóstico , Dor de Ombro/diagnóstico , Lesões dos Tecidos Moles/diagnóstico , Revisão Sistemática como Assunto , Resultado do Tratamento
16.
Man Ther ; 20(5): 633-45, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25892707

RESUMO

INTRODUCTION: Soft tissue injuries of the leg, ankle, or foot are common and often treated by exercise. The purpose of this study was to determine the effectiveness of exercise for the management of soft tissue injuries of the leg, ankle, or foot. METHODS: A systematic review of the literature was conducted. We searched five databases from 1990 to 2015. Relevant articles were critically appraised using Scottish Intercollegiate Guidelines Network (SIGN) criteria. The evidence from studies with low risk of bias was synthesized using the best-evidence synthesis methodology. RESULTS: We screened 7946 articles. We critically appraised ten randomized trials and six had a low risk of bias. The evidence suggests that for recent lateral ankle sprain: 1) rehabilitation exercises initiated immediately post-injury are as effective as a similar program initiated one week post-injury; and 2) supervised progressive exercise plus education/advice and home exercise lead to similar outcomes as education/advice and home exercise. Eccentric exercises may be more effective than an AirHeel brace but less effective than acupuncture for Achilles tendinopathy of more than two months duration. Finally, for plantar heel pain, static stretching of the calf muscles and sham ultrasound lead to similar outcomes, while static plantar fascia stretching provides short-term benefits compared to shockwave therapy. CONCLUSIONS: We found little evidence to support the use of early or supervised exercise interventions for lateral ankle sprains. Eccentric exercises may provide short-term benefits over a brace for persistent Achilles tendinopathy and plantar fascia stretching provides short-term benefits for plantar heel pain.


Assuntos
Terapia por Exercício/métodos , Recuperação de Função Fisiológica/fisiologia , Lesões dos Tecidos Moles/reabilitação , Acidentes de Trânsito/estatística & dados numéricos , Traumatismos do Tornozelo/reabilitação , Feminino , Traumatismos do Pé/reabilitação , Humanos , Escala de Gravidade do Ferimento , Traumatismos da Perna/reabilitação , Masculino , Ontário , Medição da Dor , Guias de Prática Clínica como Assunto , Lesões dos Tecidos Moles/diagnóstico , Revisão Sistemática como Assunto , Resultado do Tratamento
17.
Ann Biomed Eng ; 43(2): 388-403, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25352440

RESUMO

Skeletal muscles can be injured by their own contractions. Such contraction-induced injury, often accompanied by delayed onset of muscle soreness, is a leading cause of the loss of mobility in the rapidly increasing population of elderly people. Unlike other types of muscle injuries which hurt almost exclusively those who are subjected to intensive exercise such as professional athletes and soldiers in training, contraction induced injury is a phenomenon which may be experienced by people of all ages while performing a variety of daily-life activities. Subjects that experience contraction induced injury report on soreness that usually increases in intensity in the first 24 h after the activity, peaks from 24 to 72 h, and then subsides and disappears in a few days. Despite their clinical importance and wide influence, there are almost no studies, clinical, experimental or computational, that quantitatively relate between the extent of contraction induced injury and activity factors, such as number of repetitions, their frequency and magnitude. The lack of such quantitative information is even more emphasized by the fact that contraction induced injury can be used, if moderate and controlled, to improve muscle performance in the long term. Thus, if properly understood and carefully implemented, contraction induced injury can be used for the purpose of personalized training and recovery programs. In this paper, we review experimental, clinical, and theoretical works, attempting towards drawing a more quantitative description of contraction induced injury and related phenomena.


Assuntos
Contração Muscular , Músculo Esquelético/lesões , Lesões dos Tecidos Moles/etiologia , Animais , Humanos , Modelos Biológicos , Músculo Esquelético/fisiologia , Sarcômeros/fisiologia , Lesões dos Tecidos Moles/fisiopatologia , Lesões dos Tecidos Moles/reabilitação
18.
Klin Khir ; (5): 56-8, 2014 May.
Artigo em Ucraniano | MEDLINE | ID: mdl-25675770

RESUMO

The experience of application of various methods of closure was presented for the head and neck cutaneous wound surfaces after elective operative interventions. The variant of the postoperative results estimation and optimization of the wounds healing by primary closure was proposed.


Assuntos
Cicatriz/prevenção & controle , Procedimentos Cirúrgicos Dermatológicos/reabilitação , Lesões dos Tecidos Moles/reabilitação , Técnicas de Sutura/reabilitação , Adulto , Feminino , Cabeça/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/cirurgia , Reepitelização/fisiologia , Pele/lesões , Lesões dos Tecidos Moles/cirurgia , Lesões dos Tecidos Moles/terapia , Adesivos Teciduais/uso terapêutico
19.
Klin Khir ; (10): 63-6, 2014 Oct.
Artigo em Russo | MEDLINE | ID: mdl-25675793

RESUMO

Possibilities of clinical application of a three dimensional osteoprogenitoral transplant (TDOPT), background of autologous mesenchymal stromal cells (MCK), were studied for treatment of the extremity bone defects. Twelve patients were included in the investigation, in whom the defects of brachial, femoral, tibial and the heel bones were revealed. In 8 patients a cicatricial-ulcerative defects of soft tissues were present over the bone defects. TDOPT in a kind of "chips" were applied in tangential bone defects, while in full defects they were applied in a kind of blocks. For substitution of the soft tissue defects the fascio-cutaneous and muscular flaps on pedicles were used. Possibility of the TDOPT application in the treatment of the bone tissue defects and their high efficacy were substantiated.


Assuntos
Fraturas Ósseas/terapia , Transplante de Células-Tronco Mesenquimais/métodos , Células-Tronco Mesenquimais/fisiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões dos Tecidos Moles/cirurgia , Adulto , Diáfises/lesões , Fêmur/lesões , Fraturas Ósseas/reabilitação , Fraturas Ósseas/cirurgia , Humanos , Masculino , Células-Tronco Mesenquimais/citologia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/reabilitação , Lesões do Ombro , Lesões dos Tecidos Moles/reabilitação , Lesões dos Tecidos Moles/terapia , Retalhos Cirúrgicos , Tíbia/lesões , Transplante Autólogo , Resultado do Tratamento
20.
Hand Clin ; 29(4): 501-5, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24209949

RESUMO

Selecting the appropriate treatment method for hand fractures is challenging due to the wide spectrum of presentation and the enormous array of surgical and nonoperative treatment options. Unfortunately, the scientific evidence to help guide decision making is not of high quality. Because of this, the surgeon must rely on a few basic principles to guide treatment. This article provides an overview of the scientific evidence, and discusses the principles and rationale used to treat hand fractures.


Assuntos
Fraturas Ósseas/cirurgia , Traumatismos da Mão/cirurgia , Lesões dos Tecidos Moles/cirurgia , Fraturas Ósseas/reabilitação , Fraturas Ósseas/terapia , Traumatismos da Mão/reabilitação , Traumatismos da Mão/terapia , Humanos , Lesões dos Tecidos Moles/reabilitação , Lesões dos Tecidos Moles/terapia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA