Effectiveness of neurodynamic treatment in managing lateral epicondylitis: a systematic review

Background Lateral epicondylitis, commonly known as “tennis elbow,” is a prevalent musculoskeletal condition affecting up to 3% of the population, primarily in individuals over 40 years old. It leads to pain and dysfunction at the lateral epicondyle, primarily involving the tendons of forearm extensor muscles, innervated by the radial nerve. Recent insights suggest a multifactorial etiology, questioning the traditional tendinopathy model. Neurodynamics, exploring nerve mechanics, emerges as a potential treatment approach. Methods A systematic review following PRISMA guidelines searched multiple databases for clinical trials investigating neurodynamic interventions for lateral epicondylitis. Inclusion criteria involved lateral epicondylitis patients receiving neurodynamic treatment, with pain, disability, and functional improvement as primary outcomes. Results Six studies met the inclusion criteria. Neurodynamic techniques, including radial nerve mobilization and home exercises, showed positive outcomes. Significant pain reduction, improved grip strength, and increased ulnar deviation angle were observed in several studies. However, heterogeneity in study design, follow-up durations, and small sample sizes limit conclusive evidence. Conclusion Neurodynamic treatment, particularly radial nerve mobilization, appears promising in alleviating pain and improving nerve mechanosensitivity in lateral epicondylitis. High-quality research is needed to establish its efficacy, considering the limitations in existing studies. A multidisciplinary approach and standardized patient inclusion criteria should be emphasized to advance the management of this condition

Long lasting facilitation of the rabbit cardiac Ca2+ channel: correlation with the coupling efficiency between charge movement and pore opening

AbstractFacilitation of Ca2+ entry into cells enhances Ca2+-activated events such as transmitter release and stimulation of second messenger systems. We have found a long lasting prepulse facilitation (up to 3-fold) of the cardiac Ca2+ channel α1C+β1b that lasts for tens of seconds without altering current kinetics. The voltage- and time-dependence of the installation of facilitation was characterized as well as the time- and use-dependence of the decay of facilitation. The degree of facilitation was correlated with the coupling efficiency between the charge movement and pore opening channels that were poorly coupled prior to facilitation exhibited the largest facilitation

Human osteoarthritic cartilage shows reduced in vivo expression of IL-4, a chondroprotective cytokine that differentially modulates IL-1β-stimulated production of chemokines and matrix-degrading enzymes in vitro

open10noThis work was supported by grants from Rizzoli Orthopaedic Institute (Ricerca Corrente); University of Bologna (RFO); MIUR (FIRB-RBAP10KCNS); “Cinque per mille” Funds. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.BACKGROUND: In osteoarthritis (OA), an inflammatory environment is responsible for the imbalance between the anabolic and catabolic activity of chondrocytes and, thus, for articular cartilage derangement. This study was aimed at providing further insight into the impairment of the anabolic cytokine IL-4 and its receptors in human OA cartilage, as well as the potential ability of IL-4 to antagonize the catabolic phenotype induced by IL-1β. METHODOLOGY/PRINCIPAL FINDINGS: The in vivo expression of IL-4 and IL-4 receptor subunits (IL-4R, IL-2Rγ, IL-13Rα1) was investigated on full thickness OA or normal knee cartilage. IL-4 expression was found to be significantly lower in OA, both in terms of the percentage of positive cells and the amount of signal per cell. IL-4 receptor type I and II were mostly expressed in mid-deep cartilage layers. No significant difference for each IL-4 receptor subunit was noted. IL-4 anti-inflammatory and anti-catabolic activity was assessed in vitro in the presence of IL-1β and/or IL-4 for 24 hours using differentiated high density primary OA chondrocyte also exhibiting the three IL-4 R subunits found in vivo. Chemokines, extracellular matrix degrading enzymes and their inhibitors were evaluated at mRNA (real time PCR) and protein (ELISA or western blot) levels. IL-4 did not affect IL-1β-induced mRNA expression of GRO-α/CXCL1, IL-8/CXCL8, ADAMTS-5, TIMP-1 or TIMP-3. Conversely, IL-4 significantly inhibited RANTES/CCL5, MIP-1α/CCL3, MIP-1β/CCL4, MMP-13 and ADAMTS-4. These results were confirmed at protein level for RANTES/CCL5 and MMP-13. CONCLUSIONS/SIGNIFICANCE: Our results indicate for the first time that OA cartilage has a significantly lower expression of IL-4. Furthermore, we found differences in the spectrum of biological effects of IL-4. The findings that IL-4 has the ability to hamper the IL-1β-induced release of both MMP-13 and CCL5/RANTES, both markers of OA chondrocytes, strongly indicates IL-4 as a pivotal anabolic cytokine in cartilage whose impairment impacts on OA pathogenesis.openAssirelli E.; Pulsatelli L.; Dolzani P.; Platano D.; Olivotto Eleonora .; Filardo G.; Trisolino G.; Facchini A.; Borzì R.M.; Meliconi R.Assirelli E.; Pulsatelli L.; Dolzani P.; Platano D.; Olivotto Eleonora .; Filardo G.; Trisolino G.; Facchini A.; Borzì R.M.; Meliconi R

Effectiveness of manual thoracic therapy in treating impingement syndrome: a systematic review

Background Impingement syndrome, a common cause of shoulder pain, often leads to functional limitations. Manual thoracic therapy is frequently employed as a non-surgical intervention, but its efficacy remains debated. This review assesses the impact of manual thoracic therapy on pain reduction and functional improvement in impingement syndrome. Methods A systematic review of randomized clinical trials was conducted, focusing on studies that applied manual thoracic therapy to patients with impingement syndrome. The primary outcomes were pain reduction and functional improvement. Studies were evaluated for methodological quality using the PEDro scale, with scores ≥ 6 indicating high quality. Results Nine studies met the inclusion criteria. All studies demonstrated high methodological quality (PEDro score ≥ 6). Pain reduction was consistent across studies, with an NPRS score reduction of 0.6 to 1.5 points immediately after treatment and up to 3.2 points at follow-up. Functionality improvements were statistically significant in some studies. However, the results showed limited homogeneity, and the majority of studies did not report substantial differences between intervention and placebo groups. Conclusion This review suggests that manual thoracic therapy may lead to pain reduction in impingement syndrome, with some evidence of functional improvement. However, the variability in manual therapy techniques and the limitations in research methodologies indicate a need for further controlled studies. These findings underscore the potential of manual therapy as a supplementary treatment but also highlight the necessity for more robust clinical trials to fully ascertain its effectiveness in clinical practice