4,538 research outputs found

    Pre-Operative Outpatient Physical Therapy Of A Torn Rotator Cuff And Peripheral Nerve Injury Caused By Anterior Shoulder Dislocation: A Case Report

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    Background: Due to the high degree of available range of motion of the Glenohumeral joint, it is highly susceptible to instability and injury. 98% of all traumatic shoulder dislocations are anterior. Rotator cuff injuries and peripheral nerve injuries are commonly associated with traumatic anterior shoulder dislocations. Very little literature exists on pre-operative PT. Purpose: To investigate the effectiveness of pre-operative physical therapy (PT) management including passive range of motion, joint mobilization and exercises for a patient with both a torn rotator cuff and suspected neuropraxic peripheral nerve injury.https://dune.une.edu/pt_studcrposter/1006/thumbnail.jp

    A multi-center, double-blind, randomized, placebo-controlled trial protocol to assess Traumeel injection vs dexamethasone injection in rotator cuff syndrome : the TRAumeel in ROtator cuff syndrome (TRARO) study protocol

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    Background: Shoulder pain is a common musculoskeletal symptom with a wide range of potential causes; however, the majority of conditions can be managed with conservative treatment. The aim of this study is to assess the efficacy and safety of Traumeel injections versus corticosteroid injections and placebo in the treatment of rotator cuff syndrome and bursitis and expand the current evidence base for the conservative treatment of rotator cuff syndrome. Methods/Design: This is a multi-center, randomized, double-blind, 16-week, three-arm, parallel-group, active-and placebo-controlled trial to assess the efficacy and safety of Traumeel 2 ml injection versus dexamethasone 8 mg injection versus placebo (saline solution). Patients will be randomly allocated to Traumeel, dexamethasone or placebo in a 2: 2: 1 randomization. After 1 week screening, patients will receive 3 injections at weekly intervals (days 1, 8 and 15) with additional follow-up assessments on day 22, a telephone consultation in week 9 and a final visit at week 15. Male and female patients aged 40 to 65 years, inclusive, will be recruited if they have acute episodes of chronic rotator cuff syndrome and/or bursitis. Patients with calcifications in the shoulder joint or a complete rotator cuff tear will be excluded. At least 160 patients will be recruited. All subacromial injections will be performed under ultrasound guidance utilizing a common technique. The only rescue medication permitted will be paracetamol (acetaminophen), with usage recorded. The primary endpoint is change from baseline in abduction-rotation pain visual analog scale (0-100 mm scale, 0 corresponds to no pain and 100 to extreme pain) at day 22 (Traumeel injections versus dexamethasone injections) for active external rotation. Secondary efficacy parameters include range of motion, disability of arm, shoulder, hand score and patient's/investigator's global assessment. Clinical efficacy will be assessed as non-inferiority of Traumeel with respect to dexamethasone regarding the primary efficacy parameter. Discussion: It is hoped that the results of this trial will expand the treatment options and evidence base available for the management of rotator cuff disease

    I.S.Mu.L.T - Rotator cuff tears guidelines

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    Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources

    Platelet-rich plasma for the treatment of partial rotator cuff tears

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    Rotator cuff tears are a common injury impacting a large and diverse group of patients and refer to a partial or full discontinuation of one or more of the muscles or tendons comprising the shoulder complex. It may occur as a result of traumatic injury, applied weight, overuse, or intrinsic degeneration over a period of years. The incidence of rotator cuff tears has been found to increase with age. Though not a life-threatening condition, rotator cuff tears adversely affect the quality of one's lifestyle causing significant pain, weakness, and limitation of motion that hinders a person from performing routine daily activities as adequately and frequently as desired. Data from cadaveric studies suggest that as many as 65% of individuals over the age of 70 have a partial-thickness rotator cuff tear. Oftentimes, rotator cuff tears are asymptomatic which can make diagnosis and early treatment challenging. The decision to pursue operative versus conservative management is often controversial. Though surgical intervention may provide more immediate pain relief and functional improvement, it portends a higher risk of morbidity than conservative measures, particularly with an older demographic of patients. Moreover, surgical repair is often followed by long recovery periods and has variable outcomes. A number of conservative treatment options are currently being utilized for the management of partial rotator cuff tears including oral medication, corticosteroid injection, and targeted physical therapy. This review seeks to assess an innovative, biologic approach to treating partial rotator cuff tears using autologous platelet-rich plasma (PRP). The use of PRP for the conservative management of both degenerative and acutely injured tissues is quickly becoming a more popular option within the clinical community. PRP treatment has received significant attention from the media and has been used by several professional athletes as a means of expediting the healing process. The appeal of PRP stems from the fact that it is produced from a patient's own blood. After a blood sample is obtained, it is placed into a centrifuge, a tool used to separate the blood into its many components. A large concentration of platelet-enriched plasma can then be collected and augmented before administration to an injured area of bone or soft tissue, such as a tendon or ligament. Platelets contain an abundance of growth factors essential for cellular recruitment, proliferation, and specialization required for the healing process. PRP is given to a patient via an injection, often under ultrasound assistance for more precise placement. This study reviewed a collection of current literature on the efficacy of PRP in rotator cuff repair. Published studies have generally illustrated a general trend towards effectiveness, suggesting PRP may improve patient outcomes and prevent the need for surgery in patients with partial rotator cuff tears. Study designs and results have proved to be inconsistent at times. However, further clinical investigation is required to validate the use of PRP as an additional non-surgical treatment option

    Bone marrow mesenchymal stem cells do not enhance intra-synovial tendon healing despite engraftment and homing to niches within the synovium

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    Intra-synovial tendon injuries display poor healing, which often results in reduced functionality and pain. A lack of effective therapeutic options has led to experimental approaches to augment natural tendon repair with autologous mesenchymal stem cells (MSCs) although the effects of the intra-synovial environment on the distribution, engraftment and functionality of implanted MSCs is not known. This study utilised a novel sheep model which, although in an anatomically different location, more accurately mimics the mechanical and synovial environment of the human rotator cuff, to determine the effects of intra-synovial implantation of MSCs

    Does a SLAP lesion affect shoulder muscle recruitment as measured by EMG activity during a rugby tackle?

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    Background: The study objective was to assess the influence of a SLAP lesion on onset of EMG activity in shoulder muscles during a front on rugby football tackle within professional rugby players. Methods: Mixed cross-sectional study evaluating between and within group differences in EMG onset times. Testing was carried out within the physiotherapy department of a university sports medicine clinic. The test group consisted of 7 players with clinically diagnosed SLAP lesions, later verified on arthroscopy. The reference group consisted of 15 uninjured and full time professional rugby players from within the same playing squad. Controlled tackles were performed against a tackle dummy. Onset of EMG activity was assessed from surface EMG of Pectorialis Major, Biceps Brachii, Latissimus Dorsi, Serratus Anterior and Infraspinatus muscles relative to time of impact. Analysis of differences in activation timing between muscles and limbs (injured versus non-injured side and non injured side versus matched reference group). Results: Serratus Anterior was activated prior to all other muscles in all (P = 0.001-0.03) subjects. In the SLAP injured shoulder Biceps was activated later than in the non-injured side. Onset times of all muscles of the noninjured shoulder in the injured player were consistently earlier compared with the reference group. Whereas, within the injured shoulder, all muscle activation timings were later than in the reference group. Conclusions: This study shows that in shoulders with a SLAP lesion there is a trend towards delay in activation time of Biceps and other muscles with the exception of an associated earlier onset of activation of Serratus anterior, possibly due to a coping strategy to protect glenohumeral stability and thoraco-scapular stability. This trend was not statistically significant in all cases

    The Painful Long Head of the Biceps Brachii: Nonoperative Treatment Approaches

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    Pain associated with the long head of the biceps (LHB) brachii seems to be increasingly recognized in the past 4 to 5 years. The LHB has long been considered a troublesome pain generator in the shoulder. Abnormality involving the LHB brachii has long been an area of debate, with Codman in 1934 even questioning the specificity of the diagnosis of biceps tendinitis. Biceps tendon abnormality is often associated with rotator cuff impingement. Shoulder pain originating from the biceps tendon can be debilitating, causing a severe decrease in shoulder function. As a result of the frequent clinical presentation of biceps pain, there is currently a great deal of interest regarding the diagnosis, treatment, and prevention of biceps abnormality. This article describes a classification system of LHB pain and discusses nonoperative treatment concepts and techniques for the painful LHB

    Exposure of a tendon extracellular matrix to synovial fluid triggers endogenous and engrafted cell death: A mechanism for failed healing of intrathecal tendon injuries

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    Aim: The purpose of this study was to investigate the effect of normal synovial fluid (SF) on exposed endogenous tendon-derived cells (TDC) and engrafted mesenchymal stem cells (MSCs) within the tendon extracellular matrix. Methods: Explants from equine superficial digital flexor (extra-synovial) and deep digital flexor tendons (DDFT) from the compressed, intra-synovial and the tensile, extra-synovial regions were cultured in allogeneic or autologous SF-media. Human hamstring explants were cultured in allogeneic SF. Explant viability was assessed by staining. Proliferation of equine monolayer MSCs and TDCs in SF-media and co-culture with DDFT explants was determined by alamarblue®. Non-viable Native Tendon matrices (NNTs) were re-populated with MSCs or TDCs and cultured in SF-media. Immunohistochemical staining of tendon sections for the apoptotic proteins caspase-3, -8 and -9 was performed. Results: Contact with autologous or allogeneic SF resulted in rapid death of resident tenocytes in equine and human tendon. SF did not affect the viability of equine epitenon cells, or of MSCs and TDCs in monolayer or indirect explant co-culture. MSCs and TDCs, engrafted into NNTs, died when cultured in SF. Caspase-3, -8 and -9 expression was greatest in SDFT explants exposed to allogeneic SF. Conclusions: The efficacy of cells administered intra-synovially for tendon lesion repair is likely to be limited, since once incorporated into the matrix, cells become vulnerable to the adverse effects of SF. These observations could account for the poor success rate of intra-synovial tendon healing following damage to the epitenon and contact with SF, common with most soft tissue intra-synovial pathologies

    Physical therapy of rotator cuff injuries of olympic weightlifters

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    From an injury-rate standpoint, Olympic weightlifting is a relatively safe sport. Despite that, a large number of repetitions, the ballistic nature of the lifts and the high forces sustained by the shoulder joint during their execution can lead to shoulder injuries, specifically rotator cuff injuries. The purpose of this paper was to investigate the scientifically proven physiotherapy methods and what their indications are when dealing with rotator cuff injuries of Olympic weightlifters. A qualitative literature review method was used, and the following online databases were included: PubMed, Scopus, Wiley, and PEDro in ResearchGate. The keywords in the literature search were: rotator cuff, shoulder, injury, physiotherapy, sport, weightlifting and Olympic weightlifting. The final analysis included fully published and accessible research papers in English from 2012 onwards, focusing on the physiotherapy of rotator cuff injuries. In total, 16 research papers were included in the final review. Management of rotator cuff injuries is a complex process, especially in sports with overhead movements. We found that the success and effectiveness of the physiotherapy process can be improved through a proper combination of kinesiotherapy, physical agent modalities, manual methods and other forms of therapy. The choice of the specific methods and their duration depends on the pathology of the individual injury. Further research focusing on Olympic weightlifting is needed to create precise and conclusive guidelines for rehabilitation, especially for sport specific phases occurring later in the rehabilitation process

    Особливості фізичної терапії при травмах ротаторної манжети плеча

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    Тема дипломної роботи: «Особливості фізичної терапії при травмах ротаторної манжети плеча». Обсяг роботи становить 70 сторінок, міститься 21 ілюстрація та 6 таблиць. Загалом опрацьовано 30 джерел. Метою даної роботи є розробити та обґрунтувати програму фізичної реабілітації після розриву ротаторної манжети плеча. Завдання: визначити причини та характер виникнення пошкоджень м’язів ротаторної манжети плеча. Систематизувати знання про сучасні методи і засоби діагностики та лікування травм ротаторної манжети плеча. Розробити програму фізичної реабілітації після артроскопічного лікування розриву ротаторної манжети плчеа. В роботі представлено огляд літератури з обраної теми, викладено загальну характеристику пошкоджень. Обґрунтувано механізми та причини виникнення травм плечового суглобу. Обґрунтувано особливості застосування методів і засобів фізичної терапії при травмах ротаторної манжети плеча. Описані механізми впливу:масажу, лікувальної фізичної культури,кінезітерапі, механотерапії, працетерапії,гідрокінезетерапії, кінезіотйпування та фізіотерапії. Зроблені висновки щодо ефективності застосування методів та засобів фізичної реабілітації при привмах ротаторної манжети плеча.Theme of the thesis: "Features of physical therapy in injuries of the rotator cuff of the shoulder" The work volume is 70 pages, it contains 21 illustrations and 6 tables. In total, 30 sources have been processed. The purpose of this work is to develop and substantiate the program of physical rehabilitation after the rupture of the rotator cuff of the shoulder. Objective: to determine the causes and nature of the damage to the muscles of the rotator cuff of the shoulder. To systematize knowledge about modern methods and means of diagnostics and treatment of injuries of the rotator cuff of the shoulder. Develop a program of physical rehabilitation after arthroscopic treatment of a rupture of a rotary cuff of a plc. The paper presents a review of the literature on the chosen topic, describes the general characteristics of the damage. Mechanisms and causes of shoulder joint injuries are substantiated. The peculiarities of application of methods and means of physical therapy during injuries of the rotator cuff of the shoulder are substantiated. Mechanisms of influence are described: massage, medical physical training, kinesitherapy, mechanotherapy, occupational therapy, hydrokinesis, kinesiotherapy and physiotherapy. Conclusions are made on the effectiveness of the application of methods and means of physical rehabilitation at the impeller of the rotator cuff of the shoulder