Physiotherapy Intervention for Joint Hypermobility in Three Cases with Heritable Connective Tissue Disorders

peer reviewedIntroduction: In Joint Hypermobility Syndromes, chronic pain is the most disabling symptom. Its origin can be multiple (i.e. subluxations, sprains, pathologies of tendons, ligaments, peripheral nerves, multiple operations). The goal of this article was intended to discuss appropriate physiotherapy in hyperlax patients. Patients and Method: The recovery process was analyzed in three cases (Marfan Syndrome, Ehlers-Danlos Syndrome and Osteogenesis Imperfecta). Hypermobility was assessed using the Brighton scale, pain using the Visual Analogue Scale and quality of life using the Medical Outcome Study Short Form-36. Bone density was evaluated by QDR X-ray absorptiometry. We emphasized that it was important to avoid stretching and to train the patient within a controlled range of motion. Submaximal eccentric exercises within a safe range of motion were incorporated to increase the active control of the joint positioning. Thus, in one patient, isokinetic rehabilitation was successfully undertaken. Each treatment had to be adapted to the individual patient and had to include specific home exercises. Conclusion: In each case, physiotherapy gave good results in relation to pain, quality of life and stability of rehabilitated joints. Safety must be assured and specific evaluations such osteodensitometry, cardiac explorations and interventions of bracing, proprioceptive and functional strengthening can be very helpful

Tendon and tendinopathy

peer reviewedThe tendon, connective fibrous tissue, mechanically responsible for the transmission of strength of muscles to bones, is a dynamic entity which, according to the constraints, restructures permanently and, thanks to various metabolic and mechanical changes. This review describes the histology, vascularization and innervation of the healthy tendon. In addition, the biomechanics and tendinous physiological responses, as well as the pathophysiology of tendinopathy are exposed. © 2014 Elsevier Masson SAS.Le tendon, tissu conjonctif fibreux, mécaniquement responsable de la transmission de la force des muscles vers les os, constitue une entité dynamique qui, en fonction des contraintes, se restructure en permanence et, ce, grâce à diverses modifications métaboliques et mécaniques. Cette revue décrit l’histologie, la vascularisation et l’innervation du tendon sain. De plus, la biomécanique et les réponses physiologiques tendineuses, ainsi que la physiopathologie de la tendinopathie y sont abordées

Physiologie de la disparition du réflexe de Hoffmann consécutive à l’augmentation de l’intensité de stimulation

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Hyaluronic acid and tendon lesions

peer reviewedIntroduction: Recently, the viscoelastic properties of hyaluronic acid on liquid connective tissue have been proposed for the treatment of tendinopathies. Some fundamental studies show encouraging results on hyaluronic acid’s ability to promote tendon gliding and reduce adhesion as well as to improve tendon architectural organisation. Some observations also support its use in a clinical setting to improve pain and function. This literature review analyses studies relating to the use of hyaluronic acid in the treatment of tendinopathies. Methods: This review was constructed using the Medline database via Pubmed, Scopus and Google Scholar. The keywords hyaluronic acid, tendon and tendinopathy were used for the research. Results: In total, 27 articles (in English and French) on the application of hyaluronic acid to tendons were selected for their relevance and scientific quality, including eight for the 'in vitro' part, three for the 'in vivo' animal part and six for the human section. Conclusions: Preclinical studies demonstrate encouraging results: HA permits tendon gliding, reduces adhesions, creates better tendon architectural organisation and limits inflammation. These laboratory observations appear to be supported by limited but encouraging short-term clinical results on pain and function. However, controlled randomised studies are still needed

Platelet-rich plasma (PRP) to treat chronic patellar tendinopathies: comparison of a single versus two closely-timed injections

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Valeurs de références de l’analyse en mode multi-MUP du multifidus dorso-lombaire

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Multimodal evoked potentials for functional quantification and prognosis in multiple sclerosis

peer reviewedFunctional biomarkers able to identify multiple sclerosis (MS) patients at high risk of fast disability progression are lacking. The aim of this study was to evaluate the ability of multimodal (upper and lower limbs motor, visual, lower limbs somatosensory) evoked potentials (EP) to monitor disease course and identify patients exposed to unfavourable evolution. One hundred MS patients were assessed with visual, somatosensory and motor EP and rated on the Expanded Disability Status Scale (EDSS) at baseline (T0) and about 6 years later (T1). The Spearman correlation (rS) was used to evaluate the relationship between conventional EP scores and clinical findings. Multiple (logistic) regression analysis estimated the predictive value of baseline electrophysiological data for three clinical outcomes: EDSS, annual EDSS progression, and the risk of EDSS worsening. In contrast to longitudinal correlations, cross-sectional correlations between the different EP scores and EDSS were all significant (0.33 ≤ rS < 0.67, p < 0.001). Baseline global EP score and EDSS were highly significant predictors (p < 0.0001) of EDSS progression 6 years later. The aseline global EP score was found to be an independent predictor of the EDSS annual progression rate (p < 0.001), and of the risk of disability progression over time (p < 0.005). Based on a ROC curve determination, we defined a Global EP Score cut off point (17/30) to identify patients at high risk of disability progression illustrated by a positive predictive value of 70 %. This study provides a proof of the concept that electrophysiology could be added to MRI and used as another complementary prognostic tool in MS patients

« Myosite » focale de la loge antéro-externe de la jambe : à propos d’un cas

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