Muscle injury: physiopathology, diagnostic, treatment and clinical presentation

O tecido muscular esquelético possui a maior massa do corpo humano, com 45% do peso total. As lesões musculares podem ser causadas por contusões, estiramentos ou lacerações. A atual classificação separa as lesões entre leve, moderada e grave. Os sinais e sintomas das lesões grau I são edema e desconforto; grau II, perda de função, gap e equimose eventual; grau III, rotura completa, dor intensa e hematoma extenso. O diagnóstico pode ser confirmado por: ultrassom - dinâmico, barato, porém examinador-dependente; tomografia ou ressonância magnética - maior definição anatômica, porém estático. A fase inicial do tratamento se resume ao protocolo PRICE. AINH, ultrassom terapêutico, fortalecimento e alongamento após a fase inicial e amplitudes de movimento sem dor são utilizados no tratamento clínico. Já o cirúrgico possui indicações precisas: drenagem do hematoma, reinserção e reforço musculotendíneos.Skeletal muscle tissue has the largest mass in the human body, accounting for 45% of the total weight. Muscle injuries can be caused by bruising, stretching or laceration. The current classification divides such injuries into mild, moderate and severe. The signs and symptoms of grade I lesions are edema and discomfort; grade II, loss of function, gaps and possible ecchymosis; and grade III, complete rupture, severe pain and extensive hematoma. The diagnosis can be confirmed by: ultrasound, which is dynamic and cheap, but examiner dependent; and tomography or magnetic resonance, which gives better anatomical definition, but is static. Initial phase of the treatment can be summarized as the "PRICE" protocol. NSAIDs, ultrasound therapy, strengthening and stretching after the initial phase and range of motion without pain are used in clinical treatment. On the other hand, surgery has precise indications: hematoma drainage and muscle-tendon reinsertion and reinforcement

Tratamento por ondas de choque nas doenças musculoesqueléticas e consolidação óssea – Análise qualitativa da literatura

ResumoO tratamento por ondas de choque é uma opção na ortopedia. O mecanismo exato pelo qual funcionam as ondas de choque para tratar doenças musculoesqueléticas não é conhecido. O objetivo deste trabalho é fazer a análise qualitativa da efetividade do tratamento por ondas de choque em pacientes com patologias musculoesqueléticas e pseudoartroses. A pesquisa foi feita nas bases de dados Cochrane Library, Medline e Lilacs. Encontrou 39 estudos que relatam o tratamento por ondas de choque de doenças musculoesqueléticas. Os resultados são muito variados, assim como os tipos de protocolo. Os estudos que avaliaram a efetividade do tratamento por ondas de choque para epicondilite lateral, tendinopatias do ombro, osteoartrose do joelho, osteonecrose da cabeça do fêmur e bursite trocanteriana relataram resultados inconsistentes para a melhoria dos pacientes. Os que avaliaram pacientes com tendinopatia calcária, fascite plantar, tendinopatia do tendão calcâneo e patelar e pseudoartrose mostraram benefício. O tratamento por ondas de choque é um método seguro e não invasivo para os casos crônicos em que os convencionais não tenham sido satisfatórios e deve ser associado aos outros métodos de tratamento das tendinopatias. Novos estudos de qualidade são necessários.AbstractShockwave treatment is an option within orthopedics. The exact mechanism through which shockwaves function for treating musculoskeletal diseases is unknown. The aim of this study was to make a qualitative analysis on the effectiveness of shockwave treatment among patients with musculoskeletal pathological conditions and pseudarthrosis. Searches were conducted in the Cochrane Library, Medline and Lilacs databases. Thirty‐nine studies that reported using shockwave treatment for musculoskeletal diseases were found. Their results varied greatly, as did the types of protocol used. The studies that evaluated the effectiveness of shockwave treatment for lateral epicondylitis, shoulder tendinopathy, knee osteoarthrosis, femoral head osteonecrosis and trochanteric bursitis reported inconsistent results for most of their patients. Those that evaluated patients with calcifying tendinopathy, plantar fasciitis, Achilles tendinopathy, patellar tendinopathy and pseudarthrosis showed benefits. Shockwave treatment is a safe and non‐invasive method for chronic cases in which conventional techniques have been unsatisfactory and should be used in association with other treatment methods for tendinopathy. Further quality studies are needed

The effect of physical training on locomotive apparatus in elderly people

Alterações fisiológicas que ocorrem no aparellho locomotor devido ao envelhecimento como perda de massa muscular, perda do equilíbrio corporal, diminuição da massa óssea e osteoartrose causam limitações às atividade da vida diária do idoso, comprometendo sua qualidade de vida e o tornando mais frágil e dependente. Idosos que realizam atividade física periodicamente tem melhor independência funcional e melhor qualidade de vida do que aquele sedentário. Esse artigo aborda as principais alterações fisiológica do processo de envelhecimento e realiza uma revisão da literatura atual sobre os efeitos que o exercício físico causa no aparelho locomotor do idoso, especificando qual a melhor forma de prescrever atividade física nessa faixa etária.Physiological changes taking place on the locomotive apparatus as a result of aging, such as muscular mass loss, body balance loss, reduced bone mass and osteoarthrosis cause limitations to the daily activities of elderly people, compromising their quality of life and making them weaker and dependent. Aged people who regularly practice physical activities have a higher level of functional independence and a better quality of life than the sedentary ones. This article addresses the key physiological changes with aging and provides a review of current literature about the effects of physical exercises on the locomotive apparatus of elderly individuals, specifying the best ways to prescribe physical exercises to this age group

Uso do gelo nas lesões traumáticas do esporte

The use of ice on traumatic injuries is a very useful therapeutic modality, mainly on muscleskeletal injuries. However, when used in an incorrect way, without knowledge of neuro-physiological, muscular and vascular phenomena, as well as about its different forms of application, it can cause unpleasant consequences, which can be irreversible. According to several writers, the use of crushed ice, contained in a plastic bag, seems to evidentiate greater efficiency, and the suggested period of application can vary from 15 to 20 minutes; after this period local vasodilatation will occur. Each application can be repeated after intervals of 20 minutes. This matter is an open field for new investigations, which need to be more elucidatingO uso do gelo nas afecções traumáticas é uma modalidade terapêutica utilíssima, particularmente nas lesões músculo-esqueléticas. Entretanto, se aplicado de forma incorreta, sem conhecimento dos fenômenos neuro-fisiológicos, musculares e vasculares, assim como das diferentes formas de aplicações, poderá também trazer conseqüências desagradáveis, muitas vezes irreversíveis. Segundo vários autores, o gelo picado, em saco plástico, parece evidenciar maior eficiência, e o tempo de aplicação aconselhável é de 15 a 20 minutos, após o que ocorrerá vasodilatação reflexa local. Cada aplicação pode ser repetida após 20 minutos de intervalo. Trata-se de um campo aberto para novas investigações, que devem por sua vez, ser mais esclarecedora

The use of bone bridges in transtibial amputations

OBJETIVO: Descrever a técnica da osteoperiosteoplastia em adultos e apresentar a variação para a utilização em crianças, procurando demonstrar sua aplicabilidade como opção nas amputações transtibiais eletivas. CASUÍSTICA E MÉTODOS: O artigo apresenta um estudo prospectivo de 15 amputações transtibiais realizadas entre 1992 e 1995 em que se utilizou a técnica da osteoperiosteoplastia. A idade dos pacientes variou de 8 a 48 anos, com média de 22,53 anos. A técnica consistiu na confecção de um cilindro de periósteo retirado da tíbia, contendo fragmentos de osso cortical presos ao mesmo, para promover uma sinostose tibiofibular na extremidade distal do coto de amputação. Observou-se que os fragmentos de osso cortical eram dispensáveis quando a técnica foi empregada em crianças, pela maior capacidade osteogênica do periósteo. Isto levou a uma variação da técnica original, que consiste numa periosteoplastia sem a utilização de fragmentos de osso cortical. RESULTADOS: O tempo médio despendido com a técnica, sem variação significativa entre adultos e crianças, foi de 171 minutos. A adaptação da prótese definitiva dos pacientes foi obtida entre 20 e 576 dias, com média de 180 dias. Revisões da técnica empregada foram necessárias em três amputações (20%). CONCLUSÃO: A técnica encontra aplicação nas amputações transtibiais em que o comprimento final do coto seja próximo da transição musculotendínea do gastrocnêmio e nas revisões de cotos de amputação de crianças onde a técnica mostrou ser efetiva na prevenção das lesões decorrentes do excessivo crescimento ósseo.We sought to describe the bone bridge technique in adults, and present a variation for use in children, as well as to present its applicability as an option in elective transtibial amputations. This paper presents a prospective study of 15 transtibial amputations performed between 1992 and 1995 in which the bone bridge technique was employed. The patients' ages ranged from 8 to 48 years, with an average of 22.5 years. This technique consisted of the preparation of a cylinder of periosteum extracted from the tibia and with cortical bone fragments attached to it to promote a tibiofibular synostosis on the distal extremity of the amputation stump. We noted that the cortical bone fragments were dispensable when the technique was employed in children, due to the increased osteogenic capacity of the periosteum. This led to a variation of the original technique, a bone bridge without the use of the cortical bone fragments. RESULTS: The average time spent with this procedure, without any significant variation between adults and children, was 171 minutes. The adaptation to the definitive prosthesis was accomplished between 20 and 576 days, with an average of 180 days. Revision of the procedure was necessary in 3 amputations. CONCLUSIONS: This technique may be employed in transtibial amputations in which the final length of the stump lies next to the musculotendinous transition of the gastrocnemius muscle, as well as in the revision of amputation stumps in children, where the procedure has been shown to be effective in the prevention of lesions due to excessive bone growth

Peptide glutamine supplementation for tolerance of intermittent exercise in soccer players

OBJECTIVE: To investigate whether supplementation of carbohydrate together with peptide glutamine would increase exercise tolerance in soccer players. METHODS: Nine male soccer players (mean age: 18.4 ± 1.1 years; body mass: 69.2 ± 4.6 kg; height: 175.5 ± 7.3 cm; and maximum oxygen consumption of 57.7 ± 4.8 ml.kg-1.min-1) were evaluated. All of them underwent a cardiopulmonary exercise test and followed a protocol that simulated the movements of a soccer game in order to evaluate their tolerance to intermittent exercise. By means of a draw, either carbohydrate with peptide glutamine (CARBOGLUT: 50g of maltodextrin + 3.5g of peptide glutamine in 250 ml of water) or carbohydrate alone (CARBO: 50g of maltodextrin in 250 ml of water) was administered in order to investigate the enhancement of the soccer players' performances. The solution was given thirty minutes before beginning the test, which was performed twice with a one-week interval between tests. RESULTS: A great improvement in the time and distance covered was observed when the athletes consumed the CARBOGLUT mixture. Total distance covered was 12750 ± 4037m when using CARBO, and 15571 ± 4184m when using CARBOGLUT (p<0.01); total duration of tolerance was 73 ± 23 min when using CARBO and 88 ± 24 min when using CARBOGLUT (p<0.01). CONCLUSION: The CARBOGLUT mixture was more efficient in increasing the distance covered and the length of time for which intermittent exercise was tolerated. CARBOGLUT also reduced feelings of fatigue in the players compared with the use of the CARBO mixture alone

Peptide glutamine supplementation for tolerance of intermittent exercise in soccer players

OBJECTIVE: To investigate whether supplementation of carbohydrate together with peptide glutamine would increase exercise tolerance in soccer players. METHODS: Nine male soccer players (mean age: 18.4 ± 1.1 years; body mass: 69.2 ± 4.6 kg; height: 175.5 ± 7.3 cm; and maximum oxygen consumption of 57.7 ± 4.8 ml.kg-1.min-1) were evaluated. All of them underwent a cardiopulmonary exercise test and followed a protocol that simulated the movements of a soccer game in order to evaluate their tolerance to intermittent exercise. By means of a draw, either carbohydrate with peptide glutamine (CARBOGLUT: 50g of maltodextrin + 3.5g of peptide glutamine in 250 ml of water) or carbohydrate alone (CARBO: 50g of maltodextrin in 250 ml of water) was administered in order to investigate the enhancement of the soccer players' performances. The solution was given thirty minutes before beginning the test, which was performed twice with a one-week interval between tests. RESULTS: A great improvement in the time and distance covered was observed when the athletes consumed the CARBOGLUT mixture. Total distance covered was 12750 ± 4037m when using CARBO, and 15571 ± 4184m when using CARBOGLUT (

Maximal oxygen uptake of male professional soccer players, 2012-2015, at the end of four preseasons training

Purpose: We hypothesized that the aerobic capacity of soccer players was well developed and maintained during the competitive season and that a short rest period in the off-season would not be sufficient to significantly affect V̇O2max in these players. Methods: A total of 211 soccer athletes (age range, 17-34 years) being 71 professional juniors and 113 professional adults were compared with a control group of 27 non-professionals soccer players. All players performed cardiopulmonary exercise testing on a treadmill.Results: The results showed that a large number of soccer players had  V̇O2max levels incompatible with the status of professional athletes in this sport. The results between the players were: The player’s juniors presented average V̇O2max (56.2 mL.min-1.kg-1) significantly higher (P < 0.05) of that the professional players (53.3 mL.min-1.kg-1) and controls  (amateur, 50.4 mL.min-1.kg-1). However, a large number of the adult (67%) and juniors  (42%) professionals players presented values of V̇O2max near to the values covered for the control group.Conclusions:  The study verified a great number of soccer players, considered of the elite, with values below that it is recommended for players of this competitive level. It seems that preseason training was not enough to achieve compatible V̇O2max levels for most players

Rehabilitation for traumatic hemipelvectomy

A hemipelvectomia traumática constitui um evento raro, catastrófico, cujos mecanismos de lesão e prognóstico são bem descritos na literatura. O crescente número de acidentes motociclísticos têm elevado a prevalência desta amputação, definindo o grupo de vítimas como jovens do sexo masculino sem comorbidades. Acarreta múltiplas seqüelas físicas, psicológicas e sociais. Através da reabilitação, o paciente poderá recuperar a independência funcional. A protetização é de grande valia, uma vez que os pacientes são jovens e com prognóstico de marcha. Neste relato é apresentado o caso de uma vítima de hemipelvectomia traumática do sexo feminino, que se tornou independente para as atividades da vida diária após processo de reabilitação, que incluiu a prótese, com melhora da qualidade de vida observada sob diversos aspectos. A protetização adequada não devolveu à paciente todas as funções perdidas com a amputação, mas se constituiu em um instrumento capaz de melhorar a qualidade de vida.Traumatic hemipelvectomy is a rare and well described level of amputation. The recent increase in the number of motorcycle traffic accidents has contributed to the growth of the hindquarter amputations. Victims are usually young men without previous diseases. Multiple injuries are expected and lead to physical and psychosocial disabilities, destruction of self-image and loss of independence on activities of daily living (ADL). Early rehabilitation program ables the patient to prevent deformities and to recovering functional abilities. Prosthesis prescription has great value to improve physical conditions. In this report, we present a case of a traumatic hemipelvectomy that happened to a female patient who completely restored independence for ADL and gained quality of life after rehabilitation program. Prosthesis represent a possibility of functional recovery for the amputee although such equipments cannot replace the lost limb during all activities