Efectividad de la inclusión de la punción seca de los puntos de gatillo miofasciales en el dolor tras la cirugía de hombro

Lo que la mayoría de las personas llaman “el hombro” es realmente un conjunto de varias articulaciones que se combinan con tendones y músculos para permitir el movimiento en la extremidad superior, desde rascarse la espalda hasta hacer un lanzamiento de pelota. No obstante, la movilidad puede llevar a problemas como inestabilidad o compresión del tejido blando o las estructuras óseas, con el resultado de dolor, el cual puede aparecer en reposo o en movimiento, continuo o temporal, siendo el dolor de hombro sumamente limitante y molesto para la persona que lo padece. El diagnóstico diferencial del dolor de hombro es a veces difícil debido a que cualquier dolor que se asiente en esta región anatómica afecta a menudo a la articulación de forma que pareciera que en ella tiene su origen. El dolor muscular está presente en el 90% de pacientes que acuden a las clínicas del dolor, y en un alto porcentaje de pacientes que presentan dolor de hombro. Aunque el síndrome de dolor miofascial es una de las causas más frecuentes de dolor músculo-esquelético, algunos autores han cuestionado su propia existencia, a pesar que se estima está presente hasta en un 87% de pacientes que acuden a consultas especializadas de dolor. La musculatura representa el 50% del peso corporal del hombro por lo que su afección debe ser considerada relevante..

Exercises and Dry Needling for Subacromial Pain Syndrome: a Randomized Parallel- Group Trial.

This randomized clinical trial investigated the effectiveness of exercise vs. exercise plus trigger point dry needling (TrP-DN) in subacromial pain syndrome. A randomized parallel-group trial, with 1-year follow-up was conducted. Fifty subjects with subacromial pain syndrome were randomly allocated to receive exercise alone or exercise +TrP-DN. Participants in both groups were asked to perform an exercise program of the rotator cuff muscles twice daily for 5 weeks. Further, patients allocated to the exercise +TrP-DN group also received dry needling to active TrPs in the muscles reproducing shoulder symptoms during the 2nd and 4th sessions. The primary outcome was pain-related disability assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Secondary outcomes included mean current pain and the worst pain experienced in the shoulder during the previous week. They were assessed at baseline, one week, and 3, 6, and 12 months after the end of treatment. Analysis was by intention to treat with mixed ANCOVA adjusted for baseline outcomes. At 12 months, 47 (94%) patients completed follow-up. Statistically larger improvements (all, P<0.01) in shoulder disability was found for the exercise +TrP-DN group at all follow up periods [post: Δ -20.6 (-23.8 to -17.4); 3 months: Δ -23.2 (-28.3 to -18.1); 6 months: Δ -23.6 (-28.9 to -18.3); 12 months: Δ -13.9 (-17.5 to -10.3). Both groups exhibited similar improvements in shoulder pain outcomes at all follow-up periods. The inclusion of TrP-DN to an exercise program was effective for improving disability in subacromial pain syndrome. No greater improvements in shoulder pain were observed.pre-print2407 K

Effects of Low-Load Exercise on Post-needling Induced Pain After Dry Needling of Active Trigger Point in Individuals with Subacromial Pain Syndrome.

Background: Application of dry needling is usually associated to post-needling induced pain. Development of post-needling intervention targeting to reduce this adverse event is needed. Objective: To determine the effectiveness of low-load exercise on reducing post-needling induced-pain after dry needling of active trigger points (TrPs) in the infraspinatus muscle in subacromial pain syndrome.pre-print3778 K

Perceived pain extent is not associated with widespread pressure pain sensitivity, clinical features, related-disability, anxiety, or depression in women with episodic migraine

Objective: People with migraine present with varying pain extent and an expanded distribution of perceived pain may reflect central sensitization. The relationship between pain extent and clinical features, psychological outcomes, related-disability and pressure pain sensitivity in migraine has been poorly investigated. Our aim was to investigate whether the perceived pain extent, assessed from pain drawings, relates to measures of pressure pain sensitivity, clinical, psychological outcomes, and related-disability in women with episodic migraine. Methods: Seventy-two women with episodic migraine completed pain drawings which were subsequently digitized allowing pain extent to be calculated utilising novel software. Pressure pain thresholds (PPT) were assessed bilaterally over the temporalis muscle (trigeminal area), the cervical spine (extra-trigeminal area) and tibialis anterior muscle (distant pain-free area). Clinical features of migraine, migraine relateddisability (migraine disability assessment questionnaire, MIDAS), anxiety and depression (Hospital Anxiety-Depression Scale, HADS) were also assessed. Spearman rho correlation coefficients were computed to reveal correlations between pain extent and the remaining outcomes. Results: No significant associations were observed between pain extent and PPTs in trigeminal, extra-trigeminal or distant pain-free areas, migraine pain features, or psychological variables including anxiety or depression and migraine related-disability. Conclusions: Pain extent within the trigemino-cervical area was not associated with any of the measured clinical outcomes and not related to the degree of pressure pain sensitization in women with episodic migraine. Further research is needed to determine if the presence of expanded pain areas outside of the trigeminal area can play a relevant role in the sensitization processes in migraine.pre-print764 K

Imaging with ultrasound in physical therapy: What is the PT’s scope of practice? A competency-based educational model and training recommendations.

Physical therapists employ ultrasound (US) imaging technology for a broad range of clinical and research purposes. Despite this, few physical therapy regulatory bodies guide the use of US imaging, and there are limited continuing education opportunities for physical therapists to become proficient in using US within their professional scope of practice. Here, we (i) outline the current status of US use by physical therapists; (ii) define and describe four broad categories of physical therapy US applications (ie, rehabilitation, diagnostic, intervention and research US); (iii) discuss how US use relates to the scope of high value physical therapy practice and (iv) propose a broad framework for a competency-based education model for training physical therapists in US. This paper only discusses US imaging— not ’therapeutic’ US. Thus, ’imaging’ is implicit anywhere the term ’ultrasound’ is used.pre-print847 K

Association of Neuropathic Pain Symptoms with Sensitization Related Symptomatology in Women with Fibromyalgia

We aimed to analyze potential correlations between S-LANSS and PainDETECT with proxies for pain sensitization, e.g., the Central Sensitization Inventory (CSI) and pressure pain hyperalgesia (construct validity), pain-related or psychological variables (concurrent validity) in women with fibromyalgia (FMS). One-hundred-and-twenty-six females with FMS completed demographic, pain-related variables, psychological, and sensitization outcomes as well as the S-LANSS and the PainDETECT questionnaires. S-LANSS was positively associated with BMI (r = 0.206), pain intensity (r = 0.206 to 0.298) and CSI score (r = 0.336) and negatively associated with all PPTs (r = −0.180 to −0.336). PainDETECT was negatively associated with age (r = −0.272) and all PPTs (r = −0.226 to −0.378) and positively correlated with pain intensity (r = 0.258 to 0.439), CSI (r = 0.538), anxiety (r = 0.246) and depression (r = 0.258). 51.4% of the S-LANSS was explained by PainDETECT (45.3%), posterior iliac PPT (0.2%) and mastoid PPT (5.9%), whereas the 56.4% of PainDETECT was explained by S-LANSS (43.4%), CSI (10.4%), and pain intensity (2.6%). This study found good convergent association between S-LANSS and PainDETECT in women with FMS. Additionally, S-LANSS was associated with PPTs whereas PainDETECT was associated with pain intensity and CSI, suggesting that both questionnaires assess different spectrums of the neuropathic and pain sensitization components of a condition and hence provide synergistic information

Cervical Multifidus Morphology and Quality Are Not Associated with Clinical Variables in Women with Fibromyalgia: An Observational Study

Objective. Some studies have reported the presence of histological alterations, such as myofiber disorganization and abnormalities in the number and shape of mitochondria, in patients with fibromyalgia syndrome (FMS). Although Ultrasound imaging (US) is used to quantitatively characterize muscle tissues, US studies in patients with FMS are lacking. Therefore, we aimed to describe morphological and qualitative cervical multifidus (CM) muscle US features in women with FMS and to assess their correlation with clinical indicators. Design. Observational study. Setting. AFINSYFACRO Fibromyalgia Association (Madrid, Spain). Subjects. Forty-five women with FMS participated. Methods. Sociodemographic variables (e.g., age, height, weight, body mass index) and clinical outcomes (e.g., pain as assessed on a numerical pain rating scale, evolution time, pain-related disability as assessed by the Fibromyalgia Impact Questionnaire) were collected. Images were acquired bilaterally at the cervical spine (C4–C5 level) and mea sured by an experienced examiner for assessment of muscle morphology (e.g., cross-sectional area, perimeter, and shape) and quality (mean echo intensity and intramuscular fatty infiltration). Side-to-side comparisons and a correla tional analysis were conducted. Results. No significant side-to-side differences were found for morphology or quality features (P > 0.05). None of the clinical indicators were associated with US characteristics (all, P > 0.05). Conclusion. Our results showed no side-to-side differences for CM morphology and quality as assessed with US. No associa tions between CM muscle morphology or quality and Fibromyalgia Impact Questionnaire, pressure pain threshold, numerical pain rating scale score, or evolution time were observed. Our preliminary data suggest that muscle mor phology is not directly related to pain and pain-related disability in women with FM

The hand grip force test as a measure of physical function in women with fibromyalgia

Previous studies have reported the presence of muscle weakness in women with fibromyalgia syndrome (FMS) which is considered a risk factor for developing earlier disability and dependence during activities of daily life (ADL). We aimed to assess the relationship between hand grip force with sociodemographic, clinical, disease‐specific, cognitive, and physical function variables in women with FMS. One hundred twenty‐six women with FMS completed demographic (age, gender, height, weight, body mass index), pain‐related (pain history, pain intensity at rest and during ADL), disease‐ specific severity (Fibromyalgia Impact Questionnaire ‐FIQ‐S‐, Fibromyalgia Health Assessment Questionnaire ‐FHAQ‐, EuroQol‐5D, Pain Catastrophizing Scale ‐PCS‐, Pittsburgh Sleep Quality Index‐ PSQI‐, Pain Vigilance and Awareness Questionnaire ‐PVAQ‐, and Central Sensitization Inventory ‐CSI‐ ), psychological (Tampa Scale for Kinesiophobia, TKS‐11; Pain Vigilance and Awareness Questionnaire, PVAQ; Pain Catastrophizing Scale, PCS), and physical function (hand grip force, and Timed Up and Go Test, TUG). Hand grip force was associated with height (r = −0.273), BMI (r = 0.265), worst pain at rest (r = −0.228), pain during ADL (r = −0.244), TUG (r = −0.406), FHAQ (r = −0.386), EuroQol‐5D (r = 0.353), CSI (r = −0.321) and PSQI (r = −0.250). The stepwise regression analysis revealed that 34.4% of hand grip force was explained by weight (6.4%), TUG (22.2%), and FHAQ (5.8%) variables. This study found that hand grip force is associated with physical function indicators, but not with fear‐avoidance behaviors nor pain‐related features of FMS. Hand grip force could be considered as an easy tool for identifying the risk of fall and poorer physical health status.Vicerrectorado de Investigación - Universidad Camilo José Cel

Effects of Percutaneous Electrical Nerve Stimulation on Countermovement Jump and Squat Performance Speed in Male Soccer Players: A Pilot Randomized Clinical Trial

Abstract: It has been suggested that Percutaneous Electrical Nerve Stimulation (PENS) can increase muscle strength. No previous study has investigated changes in performance in semiprofessional soccer players. This study compares the effects of adding two sessions of PENS to a training program versus the single training program over sport performance attributes (e.g., jump height and squat speed) in healthy soccer players. A cluster-randomized controlled trial was conducted on twenty-three semiprofessional soccer players who were randomized into an experimental (PENS + training program) or control (single training program) group. The training program consisted of endurance and strength exercises separated by 15-min recovery period, three times/week. The experimental group received two single sessions of PENS one-week apart. Flight time and vertical jump height during the countermovement jump and squat performance speed were assessed before and after each session, and 30 days after the last session. Male soccer players receiving the PENS intervention before the training session experienced greater increases in the flight time, and therefore, in vertical jump height, after both sessions, but not one month after than those who did not receive the PENS intervention (F = 4.289, p = 0.003, η 2 p: 0.170). Similarly, soccer players receiving the PENS intervention experienced a greater increase in the squat performance speed after the second session, but not after the first session or one month after (F = 7.947, p < 0.001, η 2 p: 0.275). Adding two sessions of ultrasound-guided PENS before a training strength program improves countermovement jump and squat performance speed in soccer players

Short-Term Morphological Changes in Asymptomatic Perimandibular Muscles after Dry Needling Assessed with Rehabilitative Ultrasound Imaging: A Proof-of-Concept Study

Facial anatomical structures are not easily accessible to manual palpation. The aim of our study is to objectively assess temporomandibular joint and perimandibular muscles dimensions by means of sonographic measurements before and after dry needling (DN) in asymptomatic subjects. Seventeen subjects participated in this before-after study with a within-subject control. After random allocation, one side of the face was used for the intervention and the contralateral as control. DN was performed on the temporal, masseter, and sternocleidomastoid muscles. Each subject was examined bilaterally before, immediately after, and one month after the intervention through Rehabilitative Ultrasound Imaging (RUSI) of the temporomandibular articular disc and the three target muscles. Maximum mouth opening was measured at baseline and at one month. After a single DN session, articular disc thickness significantly decreased; muscles&rsquo; thicknesses (except for temporal thickness) significantly decreased immediately and at follow-up on the treated side; no significant changes resulted for the control side. The maximum mouth opening increased from 4.77 mm to 4.86 mm. RUSI may be useful to assess the dimensions and thickness of the temporomandibular disc and muscles before and after an intervention. DN influences muscle morphology, and it has a positive influence on mouth opening in the short term