RESUMO
Abstract: Introduction: exercise programs can reduce pain and improve functionality in patients with degenerative spondylolisthesis and chronic low back pain. However, there is still no consensus surrounding the superiority of any specific routine for exercise-induced trophic changes of lumbar muscles. The aim was to compare the changes in the primary lumbar stabilizing muscle thickness after spine stabilization exercises and flexion exercises in patients with spondylolisthesis and chronic low back pain. Material and methods: prospective, longitudinal and comparative study was carried out. Twenty-one treatment-naive patients with a diagnosis of both chronic low back pain and degenerative spondylolisthesis over the age of 50 were included. A physical therapist taught participants either spine stabilization exercises or flexion exercises to execute daily at home. The thickness of the primary lumbar muscles was measured through ultrasound (at rest and contraction) at baseline and three months. A Mann-Whitney U test and Wilcoxon signed-rank test were performed for comparisons, and Spearman's rank correlation coefficients were calculated for associations. Results: we did not find statistically between the exercise programs: all patients presented significant changes in the thickness of the multifidus muscle but in none of the other evaluated muscles. Conclusion: there is no difference between spine stabilization exercises and flexion exercises after three months in terms of the changes in muscle thickness evaluated by ultrasound.
Resumen: Introducción: el ejercicio reduce el dolor y mejora la funcionalidad en pacientes con dolor crónico lumbar y espondilolistesis degenerativa. Sin embargo, no existe a la fecha un consenso sobre la superioridad de algún programa de ejercicio para inducir cambios tróficos de los músculos estabilizadores lumbares, por lo que el objetivo fue comparar el trofismo de estos músculos mediante ultrasonido, con dos programas de ejercicio distintos: estabilización vertebral versus ejercicios flexores. Material y métodos: estudio prospectivo, longitudinal y comparativo, en veintiún pacientes mayores de 50 años, con dolor crónico lumbar y espondilolistesis degenerativa. Se entrenó a los pacientes para la ejecución diaria de ejercicio: estabilización lumbar o ejercicios flexores, los cuales fueron asignados por aleatorización como parte de un ECA en desarrollo. El trofismo muscular fue evaluado mediante ultrasonido al inicio y a tres meses. Las pruebas de U de Mann-Whitney y prueba de Wilcoxon se usaron para comparaciones entre grupos y para correlaciones se usaron los coeficientes de correlación de Spearman. Resultados: todos los pacientes presentaron ganancia en el trofismo de los músculos multífidos a tres meses, pero sin diferencias entre grupos de tratamiento. No se detectaron cambios significativos en el resto de los músculos evaluados. Conclusión: no encontramos diferencia significativa entre los ejercicios de estabilización lumbar y los ejercicios flexores, a tres meses de seguimiento, en términos de los cambios tróficos medidos por ultrasonido de los músculos estabilizadores lumbares.
RESUMO
INTRODUCTION: exercise programs can reduce pain and improve functionality in patients with degenerative spondylolisthesis and chronic low back pain. However, there is still no consensus surrounding the superiority of any specific routine for exercise-induced trophic changes of lumbar muscles. The aim was to compare the changes in the primary lumbar stabilizing muscle thickness after spine stabilization exercises and flexion exercises in patients with spondylolisthesis and chronic low back pain. MATERIAL AND METHODS: prospective, longitudinal and comparative study was carried out. Twenty-one treatment-naive patients with a diagnosis of both chronic low back pain and degenerative spondylolisthesis over the age of 50 were included. A physical therapist taught participants either spine stabilization exercises or flexion exercises to execute daily at home. The thickness of the primary lumbar muscles was measured through ultrasound (at rest and contraction) at baseline and three months. A Mann-Whitney U test and Wilcoxon signed-rank test were performed for comparisons, and Spearman's rank correlation coefficients were calculated for associations. RESULTS: we did not find statistically between the exercise programs: all patients presented significant changes in the thickness of the multifidus muscle but in none of the other evaluated muscles. CONCLUSION: there is no difference between spine stabilization exercises and flexion exercises after three months in terms of the changes in muscle thickness evaluated by ultrasound.
INTRODUCCIÓN: el ejercicio reduce el dolor y mejora la funcionalidad en pacientes con dolor crónico lumbar y espondilolistesis degenerativa. Sin embargo, no existe a la fecha un consenso sobre la superioridad de algún programa de ejercicio para inducir cambios tróficos de los músculos estabilizadores lumbares, por lo que el objetivo fue comparar el trofismo de estos músculos mediante ultrasonido, con dos programas de ejercicio distintos: estabilización vertebral versus ejercicios flexores. MATERIAL Y MÉTODOS: estudio prospectivo, longitudinal y comparativo, en veintiún pacientes mayores de 50 años, con dolor crónico lumbar y espondilolistesis degenerativa. Se entrenó a los pacientes para la ejecución diaria de ejercicio: estabilización lumbar o ejercicios flexores, los cuales fueron asignados por aleatorización como parte de un ECA en desarrollo. El trofismo muscular fue evaluado mediante ultrasonido al inicio y a tres meses. Las pruebas de U de Mann-Whitney y prueba de Wilcoxon se usaron para comparaciones entre grupos y para correlaciones se usaron los coeficientes de correlación de Spearman. RESULTADOS: todos los pacientes presentaron ganancia en el trofismo de los músculos multífidos a tres meses, pero sin diferencias entre grupos de tratamiento. No se detectaron cambios significativos en el resto de los músculos evaluados. CONCLUSIÓN: no encontramos diferencia significativa entre los ejercicios de estabilización lumbar y los ejercicios flexores, a tres meses de seguimiento, en términos de los cambios tróficos medidos por ultrasonido de los músculos estabilizadores lumbares.
Assuntos
Dor Lombar , Espondilolistese , Humanos , Dor Lombar/diagnóstico por imagem , Dor Lombar/terapia , Espondilolistese/diagnóstico por imagem , Estudos Prospectivos , Terapia por Exercício , MúsculosRESUMO
Range of motion (ROM) measured objectively in nodal hand osteoarthritis (NHOA) is missing. Evaluation of collateral ligaments by ultrasound (US) is unknown in NHOA also. To compare ROM in interphalangeal joints in housewives with nodal OA, with a control group by a digital system using angle to voltage (Multielgon). The second objective was to assess correlation between collateral radial and ulnar ligaments thickness and ROM. For this cross-sectional observational study, we assessed 60 hands with symptomatic NHOA and 30 hands of healthy housewives matched for age. We obtained clinical and demographic characteristics (a complete standardized physical examination of hand joints, DASH questionnaire, pain surveys, gross grasp hand goniometer, and ROM measurements by Multielgon. Presence of synovitis, power Doppler signal, osteophytes, and collateral ligaments thickness was evaluated by US. We used descriptive statistics, Spearman correlation, X2 test, t test and odds ratio. Significant less gross grasp and ROM in the right hand were observed in NHOA (p = 0.01 for both). Presence of OA, painful joints, disease duration, and score DASH were significant correlated with reduced ROM (OR 4.12, 4.12, 1.04 and 1.09, respectively). Reduced ROM was statistical significant in thumb MCP and IP joints, second and third DIP in dominant hand. There was no association between collateral radial and ulnar ligaments and reduced ROM. Synovitis and osteophytes were more prevalent in OA group. Multielgon demonstrated the pattern of reduced ROM in nodal OA of housewives particularly in MCP and IP thumb joints, second and third distal interphalangeal joints.
Assuntos
Artrometria Articular/instrumentação , Articulações dos Dedos/fisiopatologia , Articulação Metacarpofalângica/fisiopatologia , Osteoartrite/fisiopatologia , Adulto , Idoso , Estudos de Casos e Controles , Ligamento Colateral Ulnar/diagnóstico por imagem , Ligamento Colateral Ulnar/patologia , Estudos Transversais , Feminino , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/patologia , Humanos , Articulação Metacarpofalângica/diagnóstico por imagem , Articulação Metacarpofalângica/patologia , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Osteoartrite/patologia , UltrassonografiaRESUMO
We aim to study the educational impact of a clinical anatomy workshop in 1st-year orthopedic and rheumatology fellows. First-year rheumatology fellows (N = 17) and a convenience sample of 1st-year orthopedic fellows (N = 14) from Mexico City in the 9th month of training participated in the study. The pre- and the post- workshop tests included the same 20 questions that had to be answered by identification or demonstration of relevant anatomical items. The questions, arranged by anatomical regions, were asked in five dynamic stations. Overall, the 31 participants showed an increase of correct answers, from a median of 6 (range 1 to 12) in the pre-workshop test, to a median of 14 (range 7 to 19) in the post-workshop test. In the pre-workshop test, the correct median answers were 7 (range 2 to 12) in the orthopedic fellows and 5 (range 1 to 10) in the rheumatology fellows (p = 0.297). Corresponding scores in the post-workshop were 15 (range 10 to 19) and 12 (range 7 to 18) (p = 0.026) showing a significant difference favoring the orthopedic group. Our clinical anatomy workshop was efficacious, in the short term, as a teaching instrument for 1st-year orthopedic and rheumatology fellows. The post-workshop scores, although significantly improved in both groups, particularly in the orthopedic fellows, were still suboptimal. Further refinements of our workshop might yield better results.
Assuntos
Anatomia/educação , Competência Clínica , Educação de Pós-Graduação em Medicina , Ortopedia/educação , Reumatologia/educação , Bolsas de Estudo , Humanos , MéxicoRESUMO
Alkaptonuria is a rare, hereditary metabolic disorder in which a deficiency in the homogentisate 1,2-dioxygenase enzyme results in an accumulation of homogentisic acid. Deposition of excess homogentisic acid in different intra- and extra-articular structures with high content of connective tissue causes brownish-black pigmentation and weakening, ultimately resulting in tissue degeneration and finally osteoarthritis. Ochronotic arthropathy is considered a rapidly progressive, disabling condition in which weight-bearing joints and the thoracolumbar spine are predominantly affected. Patients often require multiple joint replacements, such as in the case of the patient presented here. At present, there is no definitive cure for ochronosis, and management is predominantly symptomatic.
Assuntos
Alcaptonúria/diagnóstico por imagem , Artropatias/diagnóstico por imagem , Ocronose/diagnóstico por imagem , Alcaptonúria/complicações , Humanos , Artropatias/complicações , Masculino , Pessoa de Meia-Idade , Ocronose/complicações , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Ultrasonography (US) in the last decade has gained interest for the study of the hip, with its known advantages over other imaging techniques, although the acoustic window of this joint is small. It is useful to differentiate pathology intra of extra-articular, guide local corticosteroid infiltration and monitoring of the response to systemic or local treatment. It has application in patients with hip osteoarthritis, rheumatoid arthritis and spondyloarthritis, also the prosthetic hip.
La ultrasonografía (US) en la última década ha cobrado interés para el estudio de la cadera, con sus conocidas ventajas sobre otras técnicas de imagen, a pesar de que la ventana acústica de esta articulación sea pequeña. Es de gran utilidad para diferenciar patología intra de la extra articular, guiar la infiltración local de glucocorticoides y monitoreo de la respuesta a tratamiento sistémico o local. Tiene aplicación tanto en la cadera de pacientes con osteoartritis, artritis reumatoide y espondiloartritis como en la cadera protésica.
Assuntos
Humanos , Quadril/patologia , Quadril , Ultrassonografia , Artrite Reumatoide , Espondilartrite , Osteoartrite do QuadrilRESUMO
Due to the anatomical distribution and function, striated muscle is susceptible to injury especially traumatic requiring imaging methods for diagnosis, the degree of disease and establish the extent possible recovery time. Ultrasonography is a method that has gained an important place in the evaluation of muscle to be safe, affordable, and by allowing static and dynamic assessment of the muscle. The current classification of muscle injuries seen by Ultrasonography has limitations because it does not allow an adequate correlation between the percentage of condition and prognosis.
Debido a la distribución anatómica y función, el músculo estriado es susceptible de sufrir lesiones sobre todo traumáticas que requieren de métodos de imagen para determinar el diagnóstico, el grado de afección y establecer en la medida de lo posible el tiempo de recuperación. La Ultrasonografía es un método que ha ido ganando un lugar preponderante en la evaluación del músculo por ser inocua, de bajo costo, así como por permitir una evaluación estática y dinámica del músculo. La clasificación actual de lesiones musculares vistas por Ultrasonografía tiene limitantes porque no permite fundamentar una adecuada correlación entre el porcentaje de afección y el pronóstico.
Assuntos
Humanos , Doenças Musculares , Músculos/lesões , Músculos , Ultrassonografia , Músculo EstriadoRESUMO
Over the last few years, a growing number of rheumatologists has taken great interest in ultrasonography for its well known advantages and wide spectrum of validated applications in daily rheumatological practice. Most rheumatologists actively performing ultrasonography have had a training experience mainly based on attendance in sonographic courses and/or in radiological or rheumatological units. At present, in Mexico ultrasonography has a still limited diffusion among rheumatologists even if it may play a key role as a first line imaging technique also because of the restricted availability for rheumatic patients for other imaging modalities. This report describes the Mexican experience in education and training on musculoskeletal ultrasound. In 2003, the Mexican School of Musculoskeletal Ultrasound of the Mexican College of Rheumatology (ECOMER) was founded with the intention of joining efforts to launch musculoskeletal ultrasound in Mexico. Essential requirements shared by all the members of ECOMER include: to own an ultrasound machine, to incorporate ultrasonography into clinical daily practice and to keep up-to-date in musculoskeletal ultrasound. The motto of ECOMER is una clara imagen de la reumatologia which means a clear picture of rheumatology. The statute of ECOMER can be read in its web site: www.ecomer.org.mx. This web site also provides a forum for case discussion, consultation and image review.