Kõõluste ülekoormusvigastuste konservatiivne ravi

Pikaajalised kõõluste ülekoormusvaevused ehk ülekoormustendopaatiad on sportlaste ja pidevalt sarnaseid tööliigutusi tegevate inimeste üks enam levinud ja häirivam probleem. Ülekoormustendopaatiate etioloogia, patogenees ja krooniliseks muutumine on ikka veel paljuski ebaselge. Senimaani ei ole isegi teada, kui suur roll on koormusel endal nende kaebuste tekkes. Kuna tendopaatiate etiopatogenees ei ole selge, on ka nende mitmekülgne ravi enam kliiniliste kogemuste pagasile toetuv kui teaduslikult tõestatud ja kontrollitud. Teaduslikult on tõestatud seos korikosteroidhormoonide süstete ja lihaskõõlusaparaadi ekstsentriliste harjutuste ehk pidurdusmehhanismil põhinevate liigutuste ravitoime. Teiste konservatiivsete ravimeetodite kohta puudub korrektsetel uuringutel põhinev analüüs või on saadud tulemused vasturääkivad. Eesti Arst 2005; 84 (10): 718–72

Oikea vai väärä(uskoinen) keskustelija?

Kommentt

Vertebral fractures - is there a valid concept for (osteoporosis) treatment recommendation today?

English abstrac

Arthroscopy for degenerative knee-a difficult habit to break?

Non peer reviewe

Pharmacological therapies for the prevention of fractures in men

Publisher Copyright: Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To determine the benefits and harms of bisphosphonates, parathyroid or parathyroid-related protein analogues, denosumab, and romosozumab therapy for the primary and secondary prevention of fractures in men.Peer reviewe

A positive viewpoint regarding arthroscopy for degenerative knee conditions

Non peer reviewe

Pathogenesis of Age-Related Osteoporosis: Impaired Mechano-Responsiveness of Bone Is Not the Culprit

BACKGROUND: According to prevailing understanding, skeletal mechano-responsiveness declines with age and this apparent failure of the mechano-sensory feedback system has been attributed to the gradual bone loss with aging (age-related osteoporosis). The objective of this study was to evaluate whether the capacity of senescent skeleton to respond to increased loading is indeed reduced as compared to young mature skeleton. METHODS AND FINDINGS: 108 male and 101 female rats were randomly assigned into Exercise and Control groups. Exercise groups were subjected to treadmill training either at peak bone mass between 47-61 weeks of age (Mature) or at senescence between 75-102 weeks of age (Senescent). After the training intervention, femoral necks and diaphysis were evaluated with peripheral quantitative computed tomography (pQCT) and mechanical testing; the proximal tibia was assessed with microcomputed tomography (microCT). The microCT analysis revealed that the senescent bone tissue was structurally deteriorated compared to the mature bone tissue, confirming the existence of age-related osteoporosis. As regards the mechano-responsiveness, the used loading resulted in only marginal increases in the bones of the mature animals, while significant exercise-induced increases were observed virtually in all bone traits among the senescent rats. CONCLUSION: The bones of senescent rats displayed a clear ability to respond to an exercise regimen that failed to initiate an adaptive response in mature animals. Thus, our observations suggest that the pathogenesis of age-related osteoporosis is not attributable to impaired mechano-responsiveness of aging skeleton. It also seems that strengthening of even senescent bones is possible--naturally provided that safe and efficient training methods can be developed for the oldest old

Responsiveness of different pain measures and recall periods in people undergoing surgery after a period of splinting for basal thumb joint osteoarthritis

Background Basal thumb joint osteoarthritis (OA) is a common painful condition of the hand often treated surgically if non-operative care does not provide sufficient pain relief. Many instruments are available to measure pain for this condition including single item and multidimensional measures. To inform our choice of instrument for the purpose of evaluating the value of surgery for people with thumb OA, the aim of this study was to compare the longitudinal validity and signal to noise ratio of a single item numeric rating scale (NRS) for pain and the Patient-rated Wrist and Hand Evaluation (PRWHE) pain subscale, and to assess if recall period affects longitudinal validity of the NRS pain and reported pain levels. Methods We invited 52 patients referred for surgical treatment of basal thumb joint OA to participate in this study. All wore a splint for six weeks followed by surgery. Pain during the past day, week, and month and the PRWHE were collected at baseline, operation day, and 3, 6, 9 and 12 months after surgery. Responsiveness was assessed with two methods: 1) using participant-reported global improvement and PRWHE function subscale as external anchors (longitudinal validity) and 2) comparing Standardized Response Means (SRM). Results The Spearman's rho between PRWHE pain and participant-reported global improvement was better (0.71) compared with NRS past day (0.55), past week (0.62), or past month (0.59). Similar findings were found with PRWHE function as anchor (Pearson's r for PRWHE pain 0.78; NRS past day 0.68; past week 0.73; past month 0.69). The SRM of PRWHE pain subscale (2.8) and NRS past week (2.9) outperformed pain past day (2.3) and month (2.4). Mean pain was 0.3 points (on a 0 to 10 scale) worse during past week when compared with past day and 0.3 worse during past month than during past week. Conclusions All studied pain measures captured the change in pain over time. For clinical trials, we recommend PRWHE pain subscale or NRS past week due to their better signal noise ratio.Peer reviewe