RESUMO
INTRODUCTION: Cervical longus tendonitis is a type of disease with neck pain as the main clinical manifestation. Because the front of the cervical longus muscle is adjacent to the esophagus and pharynx, this disease is often accompanied by pharyngeal pain and pain when swallowing. Clinical and imaging doctors often have an incomplete understanding of it, and this disease is often confused with other diseases that cause neck pain. PATIENT CONCERNS: A 33-year-old Chinese woman was the patient. Suffering from severe neck pain and significantly limited activity, accompanied by left shoulder pain, occasionally dizziness, headache and other symptoms, the pain is significantly aggravated when doing swallowing action. DIAGNOSIS: Tendonitis of the long neck muscle. INTERVENTIONS: Given the patient's condition, we used acupuncture combined with massage therapy as a symptomatic treatment. OUTCOMES: After 10 days of treatment, the symptoms were better than before, and no pain was seen in the swallowing movements such as drinking water (Fig. 2C and D). LESSONS: Because the clinical reports of diseases are rare, the treatment methods are limited, and acupuncture combined with massage is an effective method for the treatment of tendonitis of the cervical long muscle, to dredge the meridians, promoting blood circulation, removing blood stasis and relieving pain.
Assuntos
Terapia por Acupuntura , Tendinopatia , Adulto , Feminino , Humanos , Pescoço , Músculos do Pescoço , Cervicalgia/etiologia , Cervicalgia/terapia , Cervicalgia/diagnóstico , Tendinopatia/complicações , Tendinopatia/terapia , Tendinopatia/diagnósticoRESUMO
Tratamento conservador é indicado nas tendinopatias, roturas parciais e nas roturas totais completas em pacientes com baixa demanda funcional ou sem condições clínicas para cirurgia. No caso do insucesso deve-se indicar o tratamento cirúrgico.
Tratamento conservador
1)Retirar os fatores de risco causadores da rotura (evitar esforço com o membro superior elevado): Substituição de atividades que utilizem o membro superior acima de 90°, suspensão das atividades repetitivas, uso de gelo (fase aguda) e calor (após a fase aguda) e métodos fisioterapêuticos de calor (ultrassom, laser, ondas curtas, etc.) são indicados. A acupuntura pode auxiliar no alívio imediato da dor, mas o retorno do quadro álgico se dá tão logo seja descontinuada, caso não seja acompanhada de outros métodos de reequilíbrio muscular
2)Analgesia e medidas anti-inflamatórias: uso de analgésicos simples ou opioides; utilização de anti-inflamatório não esteroide; uso de anti-inflamatórios por via sistêmica (intramuscular); fisioterapia; e acupuntura
3)Restabelecimento da amplitude de movimentos articulares (exercícios ativos e passivos). Alongamento capsular. Sabe-se que a retração capsular, mesmo em pequenas proporções, produz aumento do impacto entre o tubérculo maior e o acrômio anterior, pela alteração das forças que elevam o membro superior. O retorno da mobilidade passiva e ativa completa, com elevação de 180°, rotação externa de 90° e rotação interna ao nível de T8, determina, per se, alívio dos sintomas dolorosos
4) Fortalecimento do Manguito Rotador (MR) para restaurar o mecanismo depressor da cabeça do úmero (exercícios isométricos, isotônicos e de coordenação motora). Reforço muscular: Exercícios isométricos e de contra resistência de músculos que estão localizados abaixo do centro de rotação da articulação estão indicados após a obtenção de articulação indolor e com mobilidade articular completa. Esse grupo de músculos é formado por rotadores internos e externos e pela musculatura ao redor da escápula (serrátil anterior, romboides, levantador da escápula e grande dorsal). A biomecânica demonstra que o reforço desses grupos musculares possibilita que a cabeça do úmero se afaste dinamicamente do acrômio, aliviando o fenômeno de compressão. Um dos exercícios mais importantes para tal objetivo é o popular “serrote”, em que o paciente imita o ato de serrar, com peso de 2 a 4 kg na mão. Esse movimento faz com que a musculatura escapular trabalhe com melhor tonicidade, permitindo completa rotação da escápula no momento da elevação do membro superior, o que possibilita que o acrômio também se incline, diminuindo a maior parte do impacto com o tubérculo maior. O deltoide e todo o manguito rotador devem, também, secundariamente, ser reforçados. O tratamento conservador deve ser mantido por um período de no mínimo 3 meses, podendo ser prolongado na dependência da melhora clínica.
Tratamento cirúrgico O tratamento cirúrgico é indicado nas lesões parciais (não-transfixantes) nos casos de insucesso do tratamento conservador, bem conduzido e por um período suficiente (geralmente de três a seis meses). O tratamento cirúrgico como primeira indicação para lesões completas (transfixantes), do supraespinal ou do subescapular, ou ainda aqueles com uma ruptura crônica, mas com disfunção recente do ombro, em indivíduos até 60 anos. As lesões maciças podem ser definidas de duas maneiras: aquelas que têm o diâmetro maior que 5cm ou aquelas com rupturas completas de dois ou mais tendões. As lesões maciças não significam, necessariamente, irreparabilidade também tem como primeira opção o tratamento cirúrgico.
Assuntos
Lesões do Manguito RotadorRESUMO
Objective: To evaluate the effect of transcutaneous electrical nerve stimulation (C-TENS) in the rehabilitation of rotator cuff injury. Methods: A total of 60 patients diagnosed with mild to moderate rotator cuff injury were randomly divided into the control group and test group. Both groups received conventional rehabilitation treatment including physical therapy, joint mobilization, interventional therapy, and family recovery training. The test group additionally received TENS treatment on the upper area 4 or 5 of the wrist, based on the wrist-ankle acupuncture (WAA) theory. The results of the visual analogue scale (VAS), shoulder range of motion (ROM), and Constant-Murley score (CMs) were collected before and after the 1st treatment and after the 5th treatment. The differences of those indicators between the two groups were analyzed statistically. Results: The VAS scores of measurement points after treatment were all improved compared with those at baseline. There was a significant difference between the two groups after the 1st and the 5th treatment (p < 0.05), and the improvements in the test group were better than those in the control group. The ROM of flexion, extension, abduction, adduction, internal rotation, and external rotation after the 1st treatment and 5th treatment in both groups were all improved compared with those at baseline. There was no significant difference between two groups. The CMs of the two groups after the 5th treatment were all improved compared with those at baseline. There was no significant difference between two groups. No adverse events occurred during the treatment. Conclusion: Electrical stimulation on the wrist combined with conventional rehabilitation is more effective in relieving pain than the conventional rehabilitation alone. Electrical stimulation on the wrist combined with conventional rehabilitation has no obvious effect in improving shoulder joint mobility and shoulder function.
Assuntos
Terapia por Acupuntura , Lesões do Manguito Rotador , Adulto , Idoso , Analgésicos , Tornozelo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manguito Rotador , Lesões do Manguito Rotador/terapia , Resultado do Tratamento , PunhoRESUMO
OBJECTIVE: To observe the therapeutic effect of electro-acupuncture on tendon healing and functional recovery of rotator cuff injury in rats and explore the therapeutic mechanism of electro-acupuncture. METHODS: Ninety SD rats were randomly divided into electro-acupuncture group, model group and blank control group, and models of rotator cuff injury were established in the former two groups.The rats in electro-acupuncture group was treated with electro-acupuncture after the operation, and those in the other two groups received no treatment.The right forefoot thermal withdrawal latency (TWL), the contents of IL-1ß, IL-6 and TNF-α in the synovial fluid and the maximum tension load of supraspinatus tendon were measured at 2, 4 and 8 weeks after the operation. RESULTS: TWL in the model group was significantly lower than that in the blank control group and electro-acupuncture group at 2, 4 and 8 weeks after the operation (P < 0.05).At all these time points, the contents of IL-1ß, IL-6 and TNF-α in the synovial fluid were significantly higher in the model group than in the blank control group and electro-acupuncture group (P < 0.05).At 2 weeks, the maximum load in electro-acupuncture group and model group were significantly lower than that in the blank control group (P < 0.05).At 4 and 8 weeks after the operation, the maximum pull load was significantly greater in electro-acupuncture group than in the model group (P < 0.05). CONCLUSIONS: Electro-acupuncture treatment not only effectively reduces the expression of inflammatory factors to relieve pain, but also promotes the repair of damaged tissue to improve the biomechanical properties of rotator cuff in the rat models.
Assuntos
Terapia por Acupuntura , Lesões do Manguito Rotador , Animais , Fenômenos Biomecânicos , Modelos Animais de Doenças , Ratos , Ratos Sprague-Dawley , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , CicatrizaçãoRESUMO
BACKGROUND: Rotator cuff disease (RCD) consists of subacromial impingement syndrome, rotator cuff tendinopathy or tendinitis, partial or full rotator cuff tear, calcific tendinitis, and subacromial bursitis. Acupuncture has been suggested as a meaningful nonsurgical intervention for managing shoulder pain and dysfunction. However, previous reviews have not completely addressed the role of acupuncture in the management of RCDs. The objective of this systematic review is to evaluate the effectiveness and safety of acupuncture for managing symptoms in patients with RCD. METHODS: We will search the following databases from their inception to November 30, 2019: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine (AMED), Physiotherapy Evidence Database (PEDro), 3 Chinese databases (China Academic Journal Full-text Database (CAJ), China Doctoral Dissertations Full-text database and China Masters' Thesis Full-text Database), 6 Korean databases (Korean studies Information Service System (KISS), National Digital Science Library (NDSL), Research Information Sharing Service (RISS), Korean Medical Database (KMBASE), Korea Institute of Science and Technology Information (KISTI), Oriental Medicine Advanced Searching Integrated System (OASIS)), and 3 trial registries (ClinicalTrials.gov, International Standard Randomized Controlled Trials Number (ISRCTN) Registry, WHO International Clinical Trials Registry Platform (ICTRP)). We will include randomized controlled trials of acupuncture for RCD. There will be no restrictions related to setting or location. The primary outcome is pain intensity and shoulder dysfunction measured on validated scales within 12 weeks. Quality assessment will be performed using the Cochrane risk of bias tool. Dichotomous outcomes will be presented as risk ratios (RR), and continuous outcomes will be presented as weighted or standardized mean differences (SMD). Each outcome will be calculated with 95% confidence intervals. DISCUSSION: The updated evidence that would be provided by this review will offer useful information for patients and practitioners, and also have implications for future studies and the development of clinical practice guidelines of RCD.Registration: Open Science Framework (OSF) Preregistration. 2019, December 5. osf.io/n2e6t.
Assuntos
Terapia por Acupuntura/métodos , Manguito Rotador , Síndrome de Colisão do Ombro/terapia , Dor de Ombro/terapia , Tendinopatia/terapia , Terapia por Acupuntura/efeitos adversos , Humanos , Força Muscular , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Projetos de Pesquisa , Avaliação da Capacidade de Trabalho , Metanálise como AssuntoRESUMO
OBJECTIVE@#To observe the therapeutic effect of electro-acupuncture on tendon healing and functional recovery of rotator cuff injury in rats and explore the therapeutic mechanism of electro-acupuncture.@*METHODS@#Ninety SD rats were randomly divided into electro-acupuncture group, model group and blank control group, and models of rotator cuff injury were established in the former two groups.The rats in electro-acupuncture group was treated with electro-acupuncture after the operation, and those in the other two groups received no treatment.The right forefoot thermal withdrawal latency (TWL), the contents of IL-1β, IL-6 and TNF-α in the synovial fluid and the maximum tension load of supraspinatus tendon were measured at 2, 4 and 8 weeks after the operation.@*RESULTS@#TWL in the model group was significantly lower than that in the blank control group and electro-acupuncture group at 2, 4 and 8 weeks after the operation (@*CONCLUSIONS@#Electro-acupuncture treatment not only effectively reduces the expression of inflammatory factors to relieve pain, but also promotes the repair of damaged tissue to improve the biomechanical properties of rotator cuff in the rat models.
Assuntos
Animais , Ratos , Terapia por Acupuntura , Fenômenos Biomecânicos , Modelos Animais de Doenças , Ratos Sprague-Dawley , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , CicatrizaçãoRESUMO
RESUMEN El objetivo de este trabajo es investigar la experiencia de los fisioterapeutas formados en microeletrólisis percutánea sport y conocer la cantidad de aplicaciones realizadas semanalmente, los efectos adversos presentados y el nivel de satisfacción de los terapeutas con sus pacientes. Se realizó una encuesta que evaluó la opinión y la experiencia de profesionales certificados en microelectrolisis percutánea sport. Los datos fueron obtenidos a través de la plataforma virtual SurveyMonkey, enviando por correo electrónico una invitación a 1.096 fisioterapeutas de América Latina. Respondieron el cuestionario 315 profesionales, entre los cuales 165 (56,51%) atienden de uno a cinco pacientes por semana. Las respuestas sobre efectos adversos fueron: nunca he tenido complicaciones (56,79% - 159 respuestas); choque hipotensivo (19,64% - 55 respuestas.); alergia al metal (5,36% - 15 respuestas). Los sitios/patologías a que más se aplican la microelectrolisis percutánea sport son: tendón rotuliano (10,77% - 198 respuestas.); tendón de aquiles (9,58% - 176 respuestas); tendón supraespino (9,36% - 172 respuestas.); fascitis plantar/espolón calcáneo (8,05% - 148 respuestas.); y puntos-gatillo (7,18% - 132 respuestas.). La satisfacción de los profesionales fue: satisfecho (51,87% - 152 respuestas) y muy satisfecho (40,96% - 120 respuestas). Las respuestas de los pacientes fueron: satisfecho (61,90% - 182 respuestas) y muy satisfecho (29,93% - 88 respuestas). La técnica MEP se aplica principalmente en tendinopatías y produce resultados satisfactorios y muy satisfactorios tanto para los pacientes como para los terapeutas, con baja presencia de efectos adversos.
RESUMO O objetivo do trabalho é pesquisar sobre a experiência dos fisioterapeutas formados em MEP Sport, conhecer a quantidade de aplicações realizadas semanalmente, os efeitos adversos que tenham sido apresentados e o nível de satisfação dos terapeutas com seus pacientes. Realizou-se uma enquete de perguntas mistas que avaliam a opinião e experiência de profissionais certificados em MEP Sport. Os dados foram obtidos por meio da plataforma virtual SurveyMonkey, enviando por correio eletrônico um convite a 1.096 fisioterapeutas da América Latina. Responderam 315 profissionais, destes, 165 (56,51%) atendem de um a cinco pacientes por semana. As respostas sobre efeitos adversos foram: nunca tive complicações (56,79% - 159 respostas); choque hipotensivo (19,64% - 55 respostas.); alergia ao metal (5,36% - 15 respostas). Os locais/patologias em que mais se aplicam MEP são: T. rotuliano (10,77% - 198 respostas.); T. Aquiles (9,58% - 176 respostas.); T. supraespinhoso (9,36% - 172 respostas.); fascite plantar/esporão calcâneo (8,05% - 148 respostas.); e pontos gatilhos (7,18% - 132 respostas.). A satisfação dos profissionais foi: satisfeito (51,87%, 152 respostas.) e muito satisfeito (40,96%, 120 respostas). As respostas dos pacientes foram: satisfeito (61,90%, 182 respostas.) e muito satisfeito (29,93%, 88 respostas). A técnica MEP é aplicada principalmente em tendinopatías e produz resultados satisfatórios e muito satisfatórios tanto para os pacientes quanto para os terapeutas, com baixa presença de efeitos adversos.
ABSTRACT This work aims to recollect information about the experience of physical therapists trained in MEP Sport, to know how many treatments they did per week, the adverse effects that might have appeared and the patients and therapists' satisfaction. A mixed multiple choice survey with the option of choosing one or more alternatives to assess the opinion and experience of physical therapists trained in MEP Sport was carried out. SurveyMonkey was used for data collection. The invitations were sent by email to 1.096 physical therapists of Latin America. The survey was answered by 315 professionals, of whom 165 (56,51%) treat 1 to 5 patients per week. The answers about adverse effects were: I've never had adverse effects: 159 answers (56,79%), Hypotensive shock: 55 answers (19,64%), Allergy to metal 15 answers (5,36%). The most common areas/conditions where the MEP is applied are: Patellar tendon (10,77% - 198 answ.), Achilles tendon, (9,58% - 176 answ.), Supraspinatus tendon (9,36% - 172 answ.), Plantar fasciitis/Calcaneal spurs (8,05% - 148 answ.), Trigger points (7,18% - 132 answ.). The professionals' satisfaction was: Satisfied (51,87%, 152 answ.) and Very Satisfied (40,96%, 120 answ.). Patients' satisfaction was: Satisfied (61,90%, 182 answ.) and Very satisfied (29,93%, 88 answ.). MEP is applied mainly in tendinopathies and produces satisfactory and very satisfactory results, both for patients and professionals, with low incidence of adverse effects.
Assuntos
Humanos , Eletrólise/efeitos adversos , Eletrólise/métodos , Inquéritos e Questionários , Modalidades de Fisioterapia , Satisfação do Paciente , Tendinopatia/terapiaRESUMO
OBJECTIVE: To verify the clinical therapeutic effects on shoulder joint pain of rotator cuff injury treated with electroacupuncture (EA) and Mulligan's mobilization. METHODS: A total of 120 patients of shoulder joint pain of rotator cuff injury were randomized into an EA group, a rehabilitation group and a combined therapy group, 40 cases in each one. In the EA group, EA was applied to Jianzhen (SI 9), Jianliao (TE 14), Jianyu (LI 15), Tianzong (SI 11), Jianqian (extra) and Binao (LI 14) in the affected side. Of these acupoints, Jianliao (TE 14) and Jianyu (LI 15), Jianzhen (SI 9) and Tianzong (SI 11) were stimulated with Han's electric apparatus. In the rehabilitation group, Mulligan's mobilization was used, including scapular mobilization, static joint mobilization and dynamic joint mobilization. In the combined therapy group, EA was used in combination with Mulligan mobilization. The treatment was given once a day in each group, 5 sessions a week, totally for 6 weeks. The pain intensity of shoulder joint (VAS), the University of California at Los Angeles shoulder rating scale (UCLA) and the range of motion (ROM) of shoulder joint were evaluated before and 6 weeks after treatment separately. The adverse reactions were recorded in each group. RESULTS: VAS scores were all reduced, UCLA scores increased and ROM improved after treatment as compared with those before treatment in the patients of the three groups (all P<0.05). After treatment, VAS score, UCLA score and ROM in the combined therapy group were remarkably improved as compared with those in the EA group and the rehabilitation group (all P<0.05). Regarding the improvements of VAS and UCLA scores, the results in the EA group were better than those in the rehabilitation group (both P<0.05). Regarding ROM improvement, the results in the rehabilitation group were superior to those in the EA group (all P<0.05). There was no adverse reaction in the two groups. CONCLUSION: The combined therapy of EA and Mulligan's mobilization relieves shoulder joint pain of rotator cuff injury, better than the simple application of either EA or Mulligan's mobilization.
Assuntos
Eletroacupuntura , Modalidades de Fisioterapia , Lesões do Manguito Rotador/terapia , Dor de Ombro/terapia , Terapia Combinada , Humanos , Amplitude de Movimento Articular , Articulação do Ombro , Resultado do TratamentoRESUMO
We undertook a comparison evaluation of outcomes after 2 different high-volume image-guided injection (HVIGI) procedures performed under direct ultrasound guidance in patients with chronic noninsertional Achilles tendinopathy. In group A, the HVIGI involved high-volume (10 mL of 1% lidocaine combined with 40 mL of saline) and no dry needling. In group B, the HVIGI involved a smaller volume (10 mL of 1% lidocaine combined with 20 mL of saline) and dry needling of the Achilles tendon. A total of 34 patients were identified from the clinical records, with a mean overall age of 50.6 (range 26 to 83) years and an overall mean follow-up duration of 277 (range 49 to 596) days. The change between the preinjection and postinjection Victorian Institute of Sports Assessment-Achilles scores of 33.4 ± 22.5 points in group A and 6.94 ± 22.2 points in group B, was statistically significant (p = .002). In group A, 3 patients (16.7%) required surgical treatment compared with 6 patients (37.5%) in group B requiring surgical treatment (p = .180). Our results indicated that a higher volume without dry needling compared with a lower volume with dry needling resulted in greater improvement in noninsertional Achilles tendinopathy. However, confounding factors mean it is not possible to categorically state that this difference was solely due to different injection techniques.
Assuntos
Tendão do Calcâneo , Terapia por Acupuntura , Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Tendinopatia/terapia , Adulto , Terapia Combinada , Feminino , Humanos , Injeções Intralesionais/métodos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Inquéritos e Questionários , Tendinopatia/tratamento farmacológico , Ultrassonografia de IntervençãoAssuntos
Pontos de Acupuntura , Terapia por Acupuntura , Peptídeo Relacionado com Gene de Calcitonina/metabolismo , Capsaicina/farmacologia , Músculo Esquelético , Óxido Nítrico Sintase/antagonistas & inibidores , Óxido Nítrico/metabolismo , Receptores de Peptídeo Relacionado com o Gene de Calcitonina/metabolismo , Células Receptoras Sensoriais/fisiologia , Fármacos do Sistema Sensorial/farmacologia , Pele , Tendinopatia/terapia , Vasodilatação , Animais , Humanos , MasculinoRESUMO
The case is presented of a 68-year-old man with calcifying tendonitis involving the lateral part of the gluteus medius. The presenting symptoms were chronic pain in the posterolateral region of the right hip and limitation of movement of the right hip. The patient was treated with acupuncture and small needle scalpel therapy. Three months after the procedure the patient was completely pain-free and had full range of motion. Radiographic evaluation revealed complete disappearance of the calcific deposits with no recurrence after 6 months. The use of combined acupuncture and small needle scalpel therapy to treat calcifying tendonitis of the gluteus medius may lead to a good clinical outcome without surgery.
Assuntos
Terapia por Acupuntura , Tendinopatia/terapia , Idoso , Calcinose , Humanos , Masculino , Amplitude de Movimento Articular , Tendinopatia/patologia , Tendinopatia/fisiopatologiaAssuntos
Pontos de Acupuntura , Terapia por Acupuntura , Tendinopatia/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To explore the effectiveness of naturopathic care (NC) on rotator cuff tendinitis using a prospective randomized clinical trial design. METHODS: Canadian postal workers with rotator cuff tendinitis for a duration of >6 weeks were randomized to receive NC (n = 43) or standardized physical exercises (PEs; n = 42) over 12 weeks. Participants in the NC group received dietary counseling, acupuncture, and Phlogenzym (2 tablets 3 times/day). The PE intervention group received passive, active-assisted, and active range of motion exercises and matched placebo. The primary outcome measure was the Shoulder Pain and Disability Index (SPADI), and secondary outcomes were the pain visual analog scale (VAS), Short Form 36 (SF-36), Measure Yourself Medical Outcomes Profile (MYMOP), and shoulder maximal range of motion. Participants and assessors were blinded to group and placebo allocation. RESULTS: Seventy-seven participants (87%) completed >or=8 weeks of the trial. Final total SPADI scores decreased by 54.5% (P < 0.0001) in the NC group and by 18% (P = 0.0241) in the PE group. Between-group differences in changes to SPADI scores showed statistically significant decreases in shoulder pain and disability in the NC group compared with the PE group (P < 0.0001). Significant differences between groups were also observed in the pain VAS, MYMOP, SF-36, and shoulder extension, flexion, and abduction, with the NC group showing superiority in each outcome. No serious adverse reactions were observed. CONCLUSION: NC and PE provided significant improvements, with greater improvement in shoulder function in the NC group compared with the PE group. Statistically significant improvements in quality of life measures were observed in the NC group as compared with the PE group.
Assuntos
Terapia por Exercício , Naturologia , Doenças Profissionais/terapia , Manguito Rotador/fisiopatologia , Dor de Ombro/terapia , Tendinopatia/terapia , Terapia por Acupuntura , Bromelaínas/uso terapêutico , Terapia Combinada , Dieta , Aconselhamento Diretivo , Avaliação da Deficiência , Combinação de Medicamentos , Emprego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/fisiopatologia , Avaliação de Resultados em Cuidados de Saúde , Medição da Dor , Serviços Postais , Estudos Prospectivos , Amplitude de Movimento Articular , Rutina/análogos & derivados , Rutina/uso terapêutico , Dor de Ombro/fisiopatologia , Tendinopatia/fisiopatologia , Tripsina/uso terapêuticoRESUMO
BACKGROUND: Rotator cuff tendinopathy and subacromial impingement syndrome present complex patomechanical situations, frequent difficulties in clinical diagnosis and lack of effectiveness in treatment. Based on clinical experience, we have therefore considered the existence of another pathological entity as the possible origin of pain and dysfunction. The hypothesis of this study is to relate subacromial impingement syndrome (SIS) with myofascial pain syndrome (MPS), since myofascial trigger points (MTrPs) cause pain, functional limitation, lack of coordination and alterations in quality of movement, even prior to a tendinopathy. MTrPs can coexist with any degenerative subacromial condition. If they are not taken into consideration, they could perpetuate and aggravate the problem, hindering diagnosis and making the applied treatments ineffective.The aims and methods of this study are related with providing evidence of the relationship that may exist between this condition and MPS in the diagnosis and treatment of rotator cuff tendonitis and/or SIS. METHOD/DESIGN: A descriptive transversal study will be made to find the correlation between the diagnosis of SIS and rotator cuff tendonitis, positive provocation test responses, the existence of active MTrPs and the results obtained with ultrasonography (US) and Magnetic Renonance Imaging (MRI). A randomized double blinded clinical trial will be carried out in experimental conditions: A Protocolized treatment based on active and passive joint repositioning, stabilization exercises, stretching of the periarticular shoulder muscles and postural reeducation. B. The previously described protocolized treatment, with the addition of dry needling applied to active MTrPs with the purpose of isolating the efficacy of dry needling in treatment. DISCUSSION: This study aims to provide a new vision of shoulder pain, from the perspective of MPS. This syndrome can, by itself, account for shoulder pain and dysfunction, although it can coexist with real conditions involving the tendons. TRIAL REGISTRATION: ISRCTN Number: 30907460.
Assuntos
Terapia por Acupuntura , Síndromes da Dor Miofascial/diagnóstico , Modalidades de Fisioterapia , Manguito Rotador/fisiopatologia , Síndrome de Colisão do Ombro/diagnóstico , Dor de Ombro/terapia , Tendinopatia/diagnóstico , Método Duplo-Cego , Humanos , Imageamento por Ressonância Magnética , Síndromes da Dor Miofascial/complicações , Síndromes da Dor Miofascial/fisiopatologia , Síndromes da Dor Miofascial/terapia , Medição da Dor , Projetos de Pesquisa , Fatores de Risco , Síndrome de Colisão do Ombro/complicações , Síndrome de Colisão do Ombro/fisiopatologia , Síndrome de Colisão do Ombro/terapia , Dor de Ombro/etiologia , Dor de Ombro/fisiopatologia , Tendinopatia/complicações , Tendinopatia/fisiopatologia , Tendinopatia/terapia , Resultado do Tratamento , UltrassonografiaRESUMO
OBJECTIVES: The aim of this study was to evaluate the efficacy of acupuncture as a treatment for chronic shoulder pain and to compare the efficacy of individualized acupuncture to fixed, standard point acupuncture treatment. DESIGN: The study was a single-blind randomized, controlled trial. SETTINGS/LOCATION: The study was conducted in an outpatient rheumatology clinic at the VA Medical Center of Philadelphia. SUBJECTS: The participants were adults with shoulder pain for at least 8 weeks with a diagnosis of osteoarthritis or rotator cuff tendonitis and a total Shoulder Pain and Disability Index (SPADI) score of > or =30. INTERVENTIONS: Thirty-one (31) subjects were randomized to one of three treatment groups: individualized acupuncture points according to the approaches of Traditional Chinese Medicine; fixed, standard acupuncture points conventionally used for shoulder pain; and sham nonpenetrating acupuncture. Subjects received 12 treatments over 6 weeks and were reassessed using the SPADI at the end of the 6 weeks. OUTCOME MEASURES: The primary outcome evaluated was the mean change in total SPADI score in each group from baseline to 6 weeks. RESULTS: After 6 weeks of treatment, the mean total SPADI score improved in all three groups, but the change was clinically significant (> or =10 points) only in groups 1 and 2 (-20.3 and -20.4, respectively, versus -6.5 in group 3). The treatment effects of groups 1 and 2 compared to the sham acupuncture group were -13.8 (95% confidence interval: -2.2 to -25.4, p < 0.015) and -13.9 (-2.0 to -25.8, p < 0.013), respectively. There was no difference between the individualized acupuncture and standardized acupuncture treatments. CONCLUSIONS: Acupuncture may be an effective treatment for chronic shoulder pain. There may be no difference in efficacy between individualized and standardized acupuncture treatment. This suggests that the use of standard points may make treatment easier for patient care and for further research studies.
Assuntos
Terapia por Acupuntura , Osteoartrite/terapia , Dor de Ombro/terapia , Tendinopatia/terapia , Pontos de Acupuntura , Adulto , Doença Crônica , Humanos , Medicina Tradicional Chinesa , Osteoartrite/complicações , Placebos , Manguito Rotador , Dor de Ombro/etiologia , Método Simples-Cego , Tendinopatia/complicaçõesRESUMO
Este trabalho foi baseado em um caso clínico de uma paciente do sexo feminino de 12 anos de idade e tenista profissional, a qual apresentava dor crônica e flogose na região distal do tendão calcâneo (tendinite do tendão de Aquiles - TTA) do lado esquerdo e com dificuldade de completar o ciclo da marcha. Estava com 28 dias sem treinar devido à dor. A paciente foi submetida ao tratamento combinado de eletroacupuntura (EAP) associado a cinesioterapia, segundo os princípios da Acupuntura Cinética (AC). Os parâmetros de avaliação foram: 1) a intensidade da dor por Escala Visual Analógica (Visual Analogue Scale - VAS); 2) a qualidade da marcha através da Análise da Marcha (AM). A paciente chegou ao atendimento sem apoiar o pé direito no chão devido ao intenso quadro álgico (VAS = 100) nas fases do toque do calcâneo e do apoio médio do pé que apresentava em pé esquerdo (VAS = 100 mm). Após a primeira sessão do tratamento de EAP com exercícios cinesioterápêuticos apresentou melhora da dor nas fases de toque do calcâneo (VAS = 20 mm) e apoio médio (VAS = 40 mm). Ao término de cinco sessões todos os movimentos já estavam completos e já não havia mais dor (VAS = 0). Este estudo sugere que a aplicação da EAP de acordo com os princípios da AC, pode ser um procedimento eficaz no combate da dor durante a reabilitação fisioterapêutica em atletas com TTA. Assim como, pode favorecer a recuperação precoce dos distúrbios agudos do sistema musculoesquelético sem comprometer a rotina de treinamento.
This work is based on a case report of a 12 years old female professional tennis player who presented a chronic pain and phlogosis at the distal region of the calcaneus tendon (Achilles Tendonitis AT) with difficulty to complete the gait cycle. The patient was 28 days without training because of the pain. The patient underwent to a combined treatment of electroacupuncture (EAP) and kinesiotherapy, according to the principles of the Kinetic Acupuncture (KA). The evaluation assessments were: 1) the pain intensity by Visual Analogue Scale (VAS); and 2) the quality of the gait according to the Gait Analysis (GA). The patient showed up for the first presentation without any support of the right foot on the floor. Since there was an intense pain (VAS = 100) in the step of the touch of the calcaneous (TC) and in the step of the support around the middle of the foot (SAMF) of the left foot. After the first session of treatment, the patient showed pain improvement in the steps of TC (VAS = 20mm) and SAMF (VAS = 40mm). After five sessions of treatment, patient was totally free from pain (VAS = 0) and all movements of the left foot were completed. This study suggests that the use of the EAP can be an efficient procedure to relieve pain during the physical therapy rehabilitation under the principles of KA in athlete with AT. Although, it is suggested this therapeutic approach can favour precocious recuperation of the acute disorders of the musculoskeletal system without compromising the training routine.
Assuntos
Acupuntura , Eletroacupuntura , TendinopatiaRESUMO
OBJECTIVE: To compare the effect of acupuncture with placebo transcutaneous electrical nerve stimulation (TENS) when added to the exercise treatment of rotator cuff tendinitis with respect to pain, shoulder movements and function. DESIGN: Prospective alternate allocation controlled trial. SETTING: Outpatient department. PATIENTS: Thirty-three patients (12 women and 21 men) were included in the study. All had clinically diagnosed rotator cuff tendinitis. INTERVENTION: Both groups underwent a standardized training programme. Each patient received in addition either 10 treatments with acupuncture or placebo TENS, 1-2 times per week. MAIN OUTCOME MEASURES: The parameters investigated were intensity of pain (measured with visual analogue scale), active, passive as well as functional movements in the shoulder (hand in neck (HIN) and pour out of a pot (POP)). Patients were tested before treatment, after treatment and at a six-month follow-up. Medicine intake, ability to lie on the affected side and sleep disturbances were evaluated. A subjective assessment was made after the treatment and at follow-up. RESULTS: Sixteen patients had acupuncture, 17 placebo TENS. Eight patients endured pain at rest in the placebo TENS group, and 10 in the acupuncture group. After treatment both groups improved, the improvement persisted at the six-month follow-up. Both groups increased range of movement. Except for the functional test HIN in the acupuncture group, there were no differences between the groups regarding other parameters investigated directly after treatment or at six-month follow-up. CONCLUSION: There is no difference between the effect of additional acupuncture treatment and placebo TENS in the treatment of rotator cuff tendinitis.
Assuntos
Terapia por Acupuntura , Manguito Rotador/fisiopatologia , Tendinopatia/terapia , Estimulação Elétrica Nervosa Transcutânea , Adulto , Idoso , Terapia Combinada , Terapia por Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Articulação do Ombro/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Distúrbios do Início e da Manutenção do Sono/terapia , Tendinopatia/fisiopatologia , Resultado do TratamentoRESUMO
Este trabalho se baseia no estudo do tratamento de lesoes desportivas atraves da Acupuntura Cinetica, que é um metodo sistematico o qual associa a Acupuntura á Cinesioterapia durante a reabilitaçao do sistema musculo-esqueletico, potencializando os elementos moduladores do movimento, atraves da propriocepçao. Tal associaçao visa preparar a estrutura lesada para receber o estimulo fisioterapico, considerando que a Acupuntura é capaz de :inibir o ciclo espasmo-dor, melhorando as valencias fisicas e a performance do fuso muscular e tendinoso durante os movimentos. Alem disso, a Acupuntura promove sinergismo com a Cinesioterapia na recuperaçao do movimento, pois o estimulo acupuntural pode ser de açao prolongada atraves da manutençao da inserçao de agulhas pou sementes em postos especificos, durante o tratamento. Neste estudo, foram incluidos 31 casos de atletas de diversas modalidades(tenis, futebol, voleibol, ginastica olimpica, capoeira, balé e jiu-jitsu) portadores de disturbios locomotores, tais como: tendinite de tendao de Aquiles, lombalgia, dorsalgia, torcicolo, tenossinovite, Sindrome de Tunel do Carpo, Sindrome do Pronador, contusao muscular, Tennis elbow e gonalgia por lesao de minisco; sendo 13 homens e 18 mulheres, com faixa etaria compreendida entre 11 e 40 anos. Todos apresentavam dificuldade na realizaçao de atividade fisica por presença da dor, que prejudicavam o seu desempenho geral. Os parametros de avaliaçao dos resultados foram: Escala Visual Analogiva(EVA) da intensidade da dor(0-10 mm,sendo ) sem dor e 10 pior dor); Escala de Avaliaçao Numerica(EAN) de melhora clinica em relaço a dor(MCRD) (0-100 por cento, sendo 0 sem melhora e 100 por cento a melhora total; e o numero de sessoes (NS) que influenciam indiretamente a performance geral do atleta. A taxa media de reduçao da intensidade da dor calculada com dados da EVA...
Assuntos
Humanos , Masculino , Feminino , Adulto , Terapia por Acupuntura , DorRESUMO
Acupuncture has gained increasing attention in the treatment of chronic pain. The lack of a satisfying placebo method has made it impossible to show whether needling is an important part of the method or whether the improvement felt by the patient is due to the therapeutic setting and psychological phenomena. Also, the effectiveness of acupuncture has not been demonstrated sufficiently. We treated 52 sportsmen with rotator cuff tendinitis in a randomised single-blind clinical trial using a new placebo-needle as control. Patients were treated for 4 weeks. The primary endpoint of the trial was the change in the modified Constant-Murley-score from the baseline. Assessment of the treatment outcome was made by experienced orthopaedists not informed of the treatment allocation. Acupuncture with penetration of the skin was shown to be more effective than a similar therapeutic setting with placebo needling in the treatment of pain. The acupuncture-group improved 19.2 Constant-Murley-score points (SD 16.1, range from -13 to 50), the control-group improved 8.37 points (SD 14.56, range from -20 to 41), (P=0.014; C.I. 2.3;19.4). This study showed that needling is an important part of the acupuncture effect in the treatment of chronic shoulder pain in athletes. No conclusions can be derived from this study concerning the importance of choosing points and the rules of Traditional Chinese Medicine. Using the new placebo method as control for other ailments could improve the evidence of specific acupuncture effects beyond pain treatment.
Assuntos
Analgesia por Acupuntura , Manguito Rotador , Tendinopatia/terapia , Analgesia por Acupuntura/efeitos adversos , Analgesia por Acupuntura/instrumentação , Adulto , Traumatismos em Atletas/fisiopatologia , Desenho de Equipamento , Feminino , Humanos , Masculino , Medição da Dor , Placebos , Método Simples-Cego , Inquéritos e Questionários , Tendinopatia/etiologia , Tendinopatia/fisiopatologiaRESUMO
RATIONALE AND OBJECTIVES: The author analyzes findings of consistency of rotator-cuff calcifications found at ultrasound (US)-guided needle treatment compared with findings of plain radiography, US, and computed tomography (CT). METHODS: Twenty patients had rotator-cuff calcifications (mean diameter, 1.5 cm; range, 1.1-2.6 cm) resistant to conservative therapy. At needle treatments, the consistency was assessed as hard or soft (slurry calcific deposit). In each imaging examination, the calcifications were divided into two groups. In radiographs, calcifications were divided into "well-defined" and "ill-defined." In US, they were divided into calcifications with acoustic shadow and calcifications with a faint shadow or no shadow. On CT, they were divided into homogeneous or nonhomogeneous calcifications. At CT, the density of the calcifications also was determined. The findings of consistency obtained at needle treatments were compared with the findings of plain radiography, US, and CT. RESULTS: At needle treatments, 45% (9 of 20) of the calcifications were soft or nearly liquid, and 55% (11 of 20) were hard. On plain radiographs, 67% (6 of 9) were as soft and 64% (7 of 11) as hard. On sonograms, 77% (7 of 9) were soft and 82% (9 of 11) were hard. On CT images, 77% (7 of 9) were soft and 91% (10 of 11) were hard; CT attenuation values were 77% (7 of 9) and 91% (10 of 11), respectively. CONCLUSIONS: Ultrasound and CT were reliable in predicting the consistency of rotator-cuff calcifications. Computed tomography attenuation values were the most accurate, and plain radiographs were the least accurate.
