Plan de intervención fisioterápico en un paciente con luxaciones recidivantes de hombro post artroscopia de Bankart

Introducción. La articulación glenohumeral es la más móvil del cuerpo y a la vez la más inestable, por ello cuenta con elementos estabilizadores pasivos y activos que trabajan conjunta y coordinadamente para asegurarle a la articulación dicha estabilidad. Cuando estos mecanismos fallan pueden producirse luxaciones que conllevan daño anatómico y déficits propioceptivos, a su vez estos déficits podrán dar lugar a luxaciones de repetición, entrando así en un círculo vicioso. La artroscopia de Bankart es la técnica de elección cuando el daño anatómico es muy grande y necesita tratamiento fisioterápico posterior a la intervención. Objetivos. Plantear un plan de intervención fisioterápica basado en la evidencia científica actual para un paciente que sufría luxaciones recidivantes, intervenido mediante artroscopia de Bankart. Metodología. Diseño intrasujeto (n=1) de tipo AB. En función de la valoración inicial se plantea un tratamiento fisioterápico en dos fases que está destinado a aliviar el dolor, normalizar el rango de movimiento (ROM) y la fuerza muscular y al entrenamiento de la estabilización glenohumeral para conseguir un nivel de función óptimo. Desarrollo. Se consiguió una disminución en el dolor y un aumento en el ROM y la fuerza muscular, así como se mejoró el control motor. Conclusiones. El plan de intervención fisioterápica se ha mostrado eficaz para el tratamiento post cirugía de Bankart en el caso descrito

Factors associated with depression and anxiety in adults =60 years old during the CPVID-19 pandemic: a systematic review

COVID-19 represents a threat to public health and the mental health of the aged population. Prevalence and risk factors of depression and anxiety have been reported in previous reviews in other populations; however, a systematic review on the factors associated with depression and anxiety in older adults is not currently present in the literature. We searched PubMed, Embase, Scopus, ProQuest Psychology Database, Science Direct, Cochrane Library and SciELO databases (23 February 2021). The results were obtained by entering a combination of MeSH or Emtree terms with keywords related to COVID-19, elderly, depression and anxiety in the databases. A total of 11 studies were included in the systematic review. Female gender, loneliness, poor sleep quality and poor motor function were identified as factors associated with both depression and anxiety. Aspects related to having a stable and high monthly income represent protective factors for both depression and anxiety, and exercising was described as protective for depression. This study synthesised information and analysed the main factors associated with depression and anxiety in the older population during the COVID-19 pandemic. However, the cross-sectional design of most of the included studies does not allow a causal relationship between the factors analysed and depression or anxiety

Differences in Myofascial Trigger Points and Algometry in Craniocervical Muscles among Children with and without Headache: A Comparative Study

Background: Headache is the most frequent neurological symptoms in children. The relationship between craniocervical muscles and headache has been studied in adults, however, studies in children are limited. Objectives: The present study aimed to examine and compare the presence of active and latent myofascial triggers points in head, neck, and shoulder muscles and pain pressure thresholds in children with headache and healthy controls. Methods: A comparative study with non experimental design was conducted. A total of 126 participants between 3 and 16-years-old were recruited. Subjects were divided into two groups: Children with headaches (who had suffered it in the last three months) and children without a headache. Anthropometric data, presence and number of latent or active myofascial trigger points, and pressure pain threshold in craniocervical muscles were compared between both groups. Results: A total of 19 symptomatic and 107 asymptomatic children were studied. The present study evidenced significant differences in the symptomatic group for the presence of both active and latent myofascial trigger points in the upper trapezius, sternocleidomastoid, suboccipital, and splenium muscles. No significant differences in the presence of myofascial trigger points in masseter and temporalis muscles were found. No statistically significant differences were found in algometry data between both groups. Conclusion: Despite the fact that pressure pain threshold did not present any differences between both groups, children with headache presented a greater number of active or latent myofascial trigger points in craniocervical muscles

Precision of ultrasound-guided versus anatomical palpation-guided needle placement of the ulnar nerve at the cubital tunnel: a cadaveric study

Percutaneous electrical stimulation has been performed for years with only the assistance of anatomical landmarks. The development of real-time ultrasonography guidance has improved the precision and safety of these percutaneous interventions. Despite ultrasound-guided and palpation-guided procedures being performed routinely for targeting nerve tissues in the upper extremity, the precision and safety of these techniques are unknown. The aim of this cadaveric study was to determine and compare the precision and safety of ultrasound-guided versus palpation-guided needling procedure with and without the handpiece of the ulnar nerve on a cadaveric model. Five physical therapists performed a series of 20 needle insertion tasks each (n = 100), 10 palpation-guided (n = 50) and 10 ultrasound-guided (n = 50) on cryopreserved specimens. The purpose of the procedure was to place the needle in proximity to the ulnar nerve at the cubital tunnel. The distance to target, time performance, accurate rate, number of passes, and unintentional puncture of surrounding structures were compared. The ultrasound-guided procedure was associated with higher accuracy (66% vs. 96%), lower distance from needle to the target (0.48 ± 1.37 vs. 2.01 ± 2.41 mm), and a lower frequency of perineurium puncture (0% vs. 20%) when compared with the palpation-guided procedure. However, the ultrasound-guided procedure required more time (38.33 ± 23.19 vs. 24.57 ± 17.84 s) than the palpation-guided procedure (all, p < 0.001). Our results support the assumption that ultrasound guidance improves the accuracy of needling procedures on the ulnar nerve at the cubital tunnel when compared with palpation guidance

Restriction of Mouth Opening, Reduction in Pressure Pain Thresholds and Activation of Myofascial Trigger Points in Mandibular and Cervical Regions after Root Canal Therapy: A Quasi-Experimental Study

Background: In daily clinical practice, patients often refer temporomandibular or cervical complaints after different oral procedures, especially in lengthy procedures that can result in iatrogenic postures or trauma that can affect the temporomandibular joint (TMJ). This study aimed to evaluate the clinical and functional changes of the temporomandibular joint (TMJ) and cervical region immediately after a session of root canal therapy. Methods: Twenty-nine subjects who received a session of root canal therapy were included. Clinical assessments included mouth opening, cervical mobility, pain intensity, pressure pain thresholds (PPTs), and myofascial trigger points (MTrPs) of the jaw and neck muscles. Results: After the intervention, a significant reduction in mouth opening (41.90 mm; SD = 6.21) was observed compared to baseline (46.28 mm; SD = 6.17) (p p p = 0.002–0.026) were demonstrated after the intervention. Conclusions: A session of root canal therapy can produce an immediate significant reduction in mouth opening, PPTs, and cervical mobility, and an increase in MTrPs. The risk can be higher if there is a previous TMJ limitation

A New Quantitative Tool for the Ultrasonographic Assessment of Tendons: A Reliability and Validity Study on the Patellar Tendon

Ultrasound is widely used for tendon assessment due to its safety, affordability, and portability, but its subjective nature poses challenges. This study aimed to develop a new quantitative analysis tool based on artificial intelligence to identify statistical patterns of healthy and pathological tendons. Furthermore, we aimed to validate this new tool by comparing it to experts’ subjective assessments. A pilot database including healthy controls and patients with patellar tendinopathy was constructed, involving 14 participants with asymptomatic (n = 7) and symptomatic (n = 7) patellar tendons. Ultrasonographic images were assessed twice, utilizing both the new quantitative tool and the subjective scoring method applied by an expert across five regions of interest. The database contained 61 variables per image. The robustness of the clinical and quantitative assessments was tested via reliability analyses. Lastly, the prediction accuracy of the quantitative features was tested via cross-validated generalized linear mixed-effects logistic regressions. These analyses showed high reliability for quantitative variables related to “Bone” and “Quality”, with ICCs above 0.75. The ICCs for “Edges” and “Thickness” varied but mostly exceeded 0.75. The results of this study show that certain quantitative variables are capable of predicting an expert’s subjective assessment with generally high cross-validated AUC scores. A new quantitative tool for the ultrasonographic assessment of the tendon was designed. This system is shown to be a reliable and valid method for evaluating the patellar tendon structure

In vivo effects of joint movement on nerve mechanical properties assessed with shear-wave elastography: a systematic review and meta-analysis

Peripheral nerves are subjected to mechanical tension during limb movements and body postures. Nerve response to tensile stress can be assessed in vivo with shear-wave elastography (SWE). Greater tensile loads can lead to greater stiffness, which can be quantified using SWE. Therefore, this study aimed to conduct a systematic review and meta-analysis to perform an overview of the effect of joint movements on nerve mechanical properties in healthy nerves. The initial search (July 2023) yielded 501 records from six databases (PubMed, Embase, Scopus, Web of Science, Cochrane, and Science Direct). A total of 16 studies were included and assessed with a modified version of the Downs and Black checklist. Our results suggest an overall tendency for stiffness increase according to a pattern of neural tensioning. The main findings from the meta-analysis showed a significant increase in nerve stiffness for the median nerve with wrist extension (SMD [95%CI]: 3.16 [1.20, 5.12]), the ulnar nerve with elbow flexion (SMD [95%CI]: 2.91 [1.88, 3.95]), the sciatic nerve with ankle dorsiflexion (SMD [95%CI]: 1.13 [0.79, 1.47]), and the tibial nerve with both hip flexion (SMD [95%CI]: 2.14 [1.76, 2.51]) and ankle dorsiflexion (SMD [95%CI]: 1.52 [1.02, 2.02]). The effect of joint movement on nerve stiffness also depends on the nerve segment, the amount of movement of the joint mobilized, and the position of other joints comprised in the entirety of the nerve length. However, due to the limited number of studies, many aspects of nerve behavior together with the effect of using different ultrasound equipment or transducers for nerve stiffness evaluation still need to be fully investigated

Precision and safety of ultrasound-guided versus palpation-guided needle placement on the patellar tendon: a cadaveric study

For decades, needling interventions have been performed based on manual palpation and anatomic knowledge. The increasing use of real-time ultrasonography in clinical practice has improved the accuracy and safety of needling techniques. Although currently ultrasound-guided procedures are routinely used for patellar tendon pathology, e.g., during percutaneous electrolysis, the accuracy of these procedures is still unknown. This study used a cadaveric model to compare and evaluate both the accuracy and safety of ultrasound-guided and palpation-guided needling techniques for the patellar tendon. A total of five physical therapists performed a series of 20 needle insertion task each (n = 100), 10 insertions based on manual palpation (n = 50) and 10 insertions guided with ultrasound (n = 50) to place a needle along the interface between the patellar tendon and Hoffa’s fat pad. All procedures were performed on cryopreserved knee specimens. Distance to the targeted tissue, time of the procedure, accurate rate of insertions, number of passes, and unintentional punctured structures between both applications (with and without ultrasound guiding) were compared. The results revealed higher accuracy (100% vs. 80%), a lower distance from needle to the targeted tissue (0.25 ± 0.65 vs. 2.5 ± 1.9 mm), longer surface of contact with the needle (15.5 ± 6.65 vs. 4.7 ± 7.5 mm), and a lower frequency of patellar tendon puncture (16% vs. 52%, p < 0.001) with the ultrasound-guided procedure as opposed to palpation-guided one. Nevertheless, the ultrasound-guided procedure took longer (54.8 ± 26.8 vs. 23.75 ± 15.4 s) and required more passes (2.55 ± 1.9 vs. 1.5 ± 0.95) to be conducted than the palpation-guided procedure (all, p < 0.001). According to these findings, the accuracy of invasive procedures applied on the patellar tendon is higher when conducted with ultrasound guidance than when conducted just on manual palpation or anatomical landmark. These results suggest that ultrasound could improve the clinical application of invasive procedures at the fat-patellar tendon interface. Due to the anatomical features of the targeted tissue, some procedures require this precision, so the use of ultrasound is recommended

Application of Percutaneous Needle Electrolysis Does Not Elicit Temperature Changes: An In Vitro Cadaveric Study

Percutaneous needle electrolysis (PNE) consists of the ultrasound-guided application of a galvanic electrical current through a solid filament needle. One proposed therapeutic mechanism for this intervention is a potential thermal effect. The aim of this study was to investigate if the application of PNE induces changes in temperature in different cadaveric musculoskeletal tissues. A repeated measure experimental cadaveric study was designed with 10 cryopreserved knees (5 men, 5 women). Sterile stainless-steel needles of 40 mm length and 0.30 mm caliber were used in this study. An ultrasound-guided needling puncture was performed in the targeted tissue (patellar tendon, infra-patellar fat, and vastus medialis muscle). Additionally, the tip of the needle was placed next to the thermometer sensor at the minimum possible distance without direct contact with it. The temperature differences before and after different applications were measured. The applications were: three applications for 3 s of 3 mA of intensity (3:3:3) when the tendon was the targeted tissue, three applications for 3 s of 1.5 mA of intensity (1.5:3:3) when the fat or muscle was the targeted tissue, and 24 s of 1 mA of intensity (1:24:1) in all tissues. No statistically significant Group*Time interactions were found in any tissue (tendon: F = 0.571, p = 0.459, ŋ2 = 0.03; fat pad: F = 0.093; p = 0.764, ŋ2 = 0.01; muscle: F = 0.681; p = 0.420, ŋ2 = 0.04). Overall, no changes in temperature were observed between both applications in the tendon (3:3:3 vs. 1:24:1) and fat/muscle (1.5:3:3 vs. 1:24:1) tissues. The application of two different percutaneous needle electrolysis protocols did not produce appreciable thermal changes in the tendon, fat, and muscle tissues of human cadavers. The results from the current cadaver study support that a thermal effect should not be considered as a mechanism of clinical action regardless of the targeted human tissue when applying percutaneous needle electrolysis since no changes in temperature after its application were observed