RESUMEN
OBJECTIVE: To describe the effect of customized foot orthoses (FOs) on the kinematic, kinetic and EMG features in patients with RA, tibialis posterior (TP) tenosynovitis and associated pes plano valgus. METHODS: Patients with RA and US-confirmed tenosynovitis of TP underwent gait analysis, including three-dimensional (3D) kinematics, kinetics, intramuscular EMG of TP and surface EMG of tibialis anterior, peroneus longus, soleus and medial gastrocnemius. Findings were compared between barefoot and shod with customized FO conditions. RESULTS: Ten patients with RA with a median (range) disease duration of 3 (1-18) years were recruited. Moderate levels of foot pain and foot-related impairment and disability were present with moderately active disease states. Altered timing of the soleus (P = 0.05) and medial gastrocnemius (P = 0.02) and increased magnitude of tibialis anterior (P = 0.03) were noted when barefoot was compared with shod with FO. Trends were noted for reduced TP activity in the contact period (P = 0.09), but this did not achieve statistical significance. Differences in foot motion characteristics were recorded for peak rearfoot eversion (P = 0.01), peak rearfoot plantarflexion (P < 0.001) and peak forefoot abduction (P = 0.02) in the shod with FOs compared with barefoot conditions. No differences in kinetic variables were recorded. CONCLUSION: This study has demonstrated, for the first time, alterations in muscle activation profiles and foot motion characteristics in patients with RA, pes plano valgus and US-confirmed TP tenosynovitis in response to customized FOs. Complex adaptations were evident in this cohort and further work is required to determine whether these functional alterations lead to improvements in patient symptoms.
Asunto(s)
Artritis Reumatoide/fisiopatología , Electromiografía/métodos , Ortesis del Pié , Pie/fisiopatología , Marcha/fisiología , Músculo Esquelético/fisiopatología , Tenosinovitis/fisiopatología , Artritis Reumatoide/complicaciones , Artritis Reumatoide/rehabilitación , Fenómenos Biomecánicos , Diseño de Equipo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Contracción Muscular/fisiología , Tenosinovitis/complicaciones , Tenosinovitis/rehabilitación , Grabación en Video , Caminata/fisiologíaRESUMEN
BACKGROUND: Flexor tenosynovitis accounts for nearly 10% of all hand infections and, if untreated, can have devastating consequences. Late presentation often requires operative intervention that requires open drainage and irrigation of the flexor tendon sheath with prolonged rehabilitation. OBJECTIVE: We report the use of closed-catheter irrigation system with the On-Q delivery system that allows for simultaneous in situ antibiotic and pain control for outpatient treatment of flexor tenosynovitis. METHODS: The On-Q delivery system was placed in 6 consecutive patients who met the criteria of all 4 Knavel signs. They all underwent open drainage and closed irrigation system with 0.25% bupivacaine and 250 mg cefazolin over a 1-week period. RESULTS: In all 6 patients, there was no use of narcotic analgesics or oral antibiotics upon discharge. Postoperative hand therapy and range of motion was initiated on postoperative day 1. There was satisfactory progression of range of motion and hand therapy. CONCLUSIONS: This initial clinical case series supports the use of the closed irrigation delivery system with in situ antibiotic and analgesic delivery for more rapid rehabilitation of patients with flexor tenosynovitis.
Asunto(s)
Antibacterianos/administración & dosificación , Dolor/tratamiento farmacológico , Tenosinovitis/cirugía , Adulto , Atención Ambulatoria , Humanos , Masculino , Manejo del Dolor , Tenosinovitis/tratamiento farmacológico , Tenosinovitis/rehabilitación , Irrigación TerapéuticaAsunto(s)
Mordeduras y Picaduras/complicaciones , Mano/fisiología , Modalidades de Fisioterapia , Recuperación de la Función , Erizos de Mar , Tenosinovitis/rehabilitación , Animales , Mordeduras y Picaduras/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Tenosinovitis/etiología , Tenosinovitis/fisiopatologíaRESUMEN
BACKGROUND: Upper limb pain is common among working-aged adults and a frequent cause of absenteeism. AIMS: To systematically review the evidence for workplace interventions in four common upper limb disorders. METHODS: Systematic review of English articles using Medline, Embase, Cinahl, AMED, Physiotherapy Evidence Database PEDro (carpal tunnel syndrome and non-specific arm pain only) and Cochrane Library. Study inclusion criteria were randomized controlled trials, cohort studies or systematic reviews employing any workplace intervention for workers with carpal tunnel syndrome, non-specific arm pain, extensor tenosynovitis or lateral epicondylitis. Papers were selected by a single reviewer and appraised by two reviewers independently using methods based on Scottish Intercollegiate Guidelines Network (SIGN) methodology. RESULTS: 1532 abstracts were identified, 28 papers critically appraised and four papers met the minimum quality standard (SIGN grading + or ++) for inclusion. There was limited evidence that computer keyboards with altered force displacement characteristics or altered geometry were effective in reducing carpal tunnel syndrome symptoms. There was limited, but high quality, evidence that multi-disciplinary rehabilitation for non-specific musculoskeletal arm pain was beneficial for those workers absent from work for at least four weeks. In adults with tenosynovitis there was limited evidence that modified computer keyboards were effective in reducing symptoms. There was a lack of high quality evidence to inform workplace management of lateral epicondylitis. CONCLUSIONS: Further research is needed focusing on occupational management of upper limb disorders. Where evidence exists, workplace outcomes (e.g. successful return to pre-morbid employment; lost working days) are rarely addressed.
Asunto(s)
Síndrome del Túnel Carpiano/rehabilitación , Enfermedades Profesionales/rehabilitación , Dolor/rehabilitación , Codo de Tenista/rehabilitación , Tenosinovitis/rehabilitación , Extremidad Superior , Adulto , Periféricos de Computador , Ergonomía , Humanos , Enfermedades Profesionales/fisiopatología , Salud Laboral , Medicina del Trabajo/métodos , Dolor/etiología , Guías de Práctica Clínica como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Lugar de Trabajo/organización & administraciónRESUMEN
Gender-specific care of musculoskeletal impairments is increasingly important in women's health. This is most relevant and of paramount importance as it relates to identification and management of musculoskeletal and peripheral neurologic disorders of pregnancy, delivery, and postpartum. The specific anatomic and physiologic changes of pregnancy predispose to a specific set of diagnoses. Virtually all women experience some degree of musculoskeletal discomfort during pregnancy. This article provides an overview of the more common pregnancy-related musculoskeletal conditions and includes a discussion of epidemiology, risk factors, diagnosis, prognosis, and management.
Asunto(s)
Parto Obstétrico/efectos adversos , Enfermedades Musculoesqueléticas/fisiopatología , Complicaciones del Embarazo/fisiopatología , Trastornos Puerperales/fisiopatología , Ejercicio Físico/fisiología , Femenino , Humanos , Dolor de la Región Lumbar/fisiopatología , Dolor de la Región Lumbar/rehabilitación , Extremidad Inferior/fisiopatología , Enfermedades Musculoesqueléticas/rehabilitación , Síndromes de Compresión Nerviosa/fisiopatología , Síndromes de Compresión Nerviosa/rehabilitación , Dolor Pélvico/fisiopatología , Dolor Pélvico/rehabilitación , Pelvis/anatomía & histología , Pelvis/inervación , Periodo Posparto/fisiología , Embarazo , Complicaciones del Embarazo/rehabilitación , Trastornos Puerperales/rehabilitación , Tenosinovitis/fisiopatología , Tenosinovitis/rehabilitaciónRESUMEN
STUDY DESIGN: Clinical case report. OBJECTIVES: To describe a manual physical therapy examination and intervention approach for a patient with radial-sided wrist pain. BACKGROUND: A 55-year-old woman with a 2-year history of chronic right wrist and forearm pain was referred to physical therapy with a diagnosis of de Quervain's disease. Her current symptoms were present for 6 weeks despite primary care management with wrist splinting and medications. Previous episodes were partially resolved following occupational therapy treatments. METHODS AND MEASURES: Examination of the patient's wrist and hand revealed isolated radiocarpal, intercarpal, and carpometacarpal joint dysfunctions. Evaluation of the cervical spine, shoulder, and elbow were negative. Impairment-based treatment was provided during 8 visits over a 4-week period. These treatments consisted of manual physical therapy techniques and self-mobilizations applied to the radiocarpal, intercarpal, and carpometacarpal joints. RESULTS: The initial treatment session decreased the patient's numeric pain rating scale (NPRS) from 7/10 to 4/10 and improved her functional rating on the Patient-Specific Functional Scale (PSFS) from an average of 4/10 to 8.2/10. At treatment completion, she achieved a pain-free state (NPRS, 0/10) and nearly full function (PSFS, 9.8/10). These results were maintained at a long-term follow-up performed 10 months after treatment. CONCLUSION: Several diagnoses have the potential for causing or referring pain into the radial wrist and forearm region, often times mimicking de Quervain's disease. An impairment-based manual physical therapy model may be an effective approach in identifying joint dysfunctions and managing patients with radial wrist pain.
Asunto(s)
Artralgia/diagnóstico , Artralgia/rehabilitación , Examen Físico , Modalidades de Fisioterapia , Tenosinovitis/diagnóstico , Articulación de la Muñeca , Femenino , Humanos , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Tenosinovitis/rehabilitaciónRESUMEN
De Quervain's tenosynovitis is a tendonitis of the abductor pollicis longus and extensor pollicis brevis tendons. It commonly occurs as a result of overuse and is often seen in patients who perform repetitive activities. The occurrence of de Quervain's tenosynovitis in lymphedema has not been reported, nor has the management of de Quervain's tenosynovitis been discussed in the literature for patients whose lymphedema results from cancer or other disorders. Musculoskeletal conditions in lymphedema patients often require special considerations because these patients are more susceptible to infections and other complications. We describe the rehabilitation management of de Quervain's tenosynovitis in 2 patients with lymphedema secondary to breast carcinoma. Both patients responded to conservative management with a good clinical outcome. We conclude that a conservative initial management approach consisting of the continued wear of a compression garment, the fabrication of a custom-made thumb spica, occupational therapy with an emphasis on tendon gliding exercises, and prescription of a nonsteroidal anti-inflammatory drug is effective and safe.
Asunto(s)
Neoplasias de la Mama/complicaciones , Linfedema/complicaciones , Tenosinovitis/complicaciones , Tenosinovitis/rehabilitación , Pulgar , Femenino , Humanos , Inmovilización , Linfedema/terapia , Persona de Mediana Edad , Tenosinovitis/etiologíaRESUMEN
Tibialis anterior tenosynovitis is a rare orthopaedic condition that usually resolves with conservative treatment. Surgery may be required for chronic cases and endoscopy seems to be a valid therapeutic alternative. During debridement of the hypertrophic synovium, care must be taken to avoid damaging the extensor retinaculum to prevent potential postoperative bowstring phenomenon of the tendon.
Asunto(s)
Traumatismos del Tobillo/cirugía , Desbridamiento/métodos , Endoscopía/métodos , Golf/lesiones , Sinovectomía , Tenosinovitis/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Traumatismos de los Tendones/prevención & control , Tendones/patología , Tenosinovitis/rehabilitaciónRESUMEN
STUDY DESIGN: Case study. OBJECTIVES: To describe the use of conventional physical therapy interventions together with Mobilization With Movement (MWM) techniques in the treatment of an individual with a complicated scenario of de Quervain's tenosynovitis. BACKGROUND: The patient was a 61-year-old woman who presented with signs and symptoms consistent with de Quervain's tenosynovitis of the right hand. Range limitations in all motions of the right wrist and first carpometacarpal joint complicated her presentation. METHODS AND MEASURES: Physical therapy included conventional intervention with superficial heat, ice, iontophoresis, and transverse friction massage directed to the first dorsal tunnel. Conventional joint mobilization techniques addressed the motion limitations of the first carpometacarpal, radiocarpal, and midcarpal joints. In addition, MWM techniques were utilized to promote pain-free wrist and thumb mobility. The specific MWM techniques used with this patient involved active movements of the thumb and wrist superimposed on a passive radial glide of the proximal row of carpal bones. RESULTS: The described treatment regime, which involved conventional physical therapy interventions, along with MWM, aided in the complete resolution of this patient's impairments and functional limitations. CONCLUSION: The combination of conventional physical agents, exercise, and manual therapy, and the less conventional MWM techniques, proved successful with this patient. MWM involving the correction of minutejoint malalignments, coupled with active motion of the wrist and first carpometacarpal joints, was an effective and efficient adjunct physical therapy intervention. Because subtle changes injoint alignment may contribute to painful syndromes in the tendon complexes that cross a malaligned joint, use of MWM as a treatment technique warrants continued research.
Asunto(s)
Terapia por Ejercicio/métodos , Tenosinovitis/rehabilitación , Articulación de la Muñeca , Femenino , Humanos , Persona de Mediana Edad , Dimensión del Dolor , Rango del Movimiento Articular , Resultado del Tratamiento , Articulación de la Muñeca/fisiopatologíaRESUMEN
This retrospective study compares two methods used to treat de Quervain's disease: splintage with oral non-steroidal anti-inflammatory drugs (NSAIDs) and steroid injection. Patients were separated into three groups based on symptom severity: group I-minimal, group II-mild, and group III-moderate or severe. Three hundred and nineteen wrists in 300 patients were followed from one to six years. Fifteen of 17 patients with minimal symptoms were relieved with splintage and NSAIDs. However, only seven of 20 in Group II and two of eight in Group III treated similarly were relieved. Of the 249 patients in Group III treated with injections, 76% were completely relieved, 7% were improved, and 4% were not improved. We conclude that classification of patients' with de Quervain's disease based on their pre-treatment symptoms may assist surgeons in selecting the most efficacious treatment and in providing prognostic information to their patients.
Asunto(s)
Betametasona/análogos & derivados , Betametasona/administración & dosificación , Naproxeno/administración & dosificación , Férulas (Fijadores) , Tenosinovitis/rehabilitación , Administración Oral , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intraarticulares , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tenosinovitis/clasificaciónAsunto(s)
Enfermedades Profesionales/rehabilitación , Dolor/etiología , Patología , Hombro , Tenosinovitis/rehabilitación , Diseño de Equipo , Humanos , Enfermedades Profesionales/fisiopatología , Postura , Rango del Movimiento Articular/fisiología , Hombro/fisiopatología , Tenis/lesiones , Tenosinovitis/fisiopatologíaRESUMEN
Thirteen female ballet dancers had an operative release of the flexor hallucis longus tendon because of isolated stenosing tenosynovitis, and the results were reviewed after a mean duration of follow-up of six years and six months (range, two to ten years). All of the patients danced at the advanced or professional level, and all had failed to respond to non-operative management. The mean age of the patients at the time of the operation was twenty years (range, thirteen to twenty-six years). Symptoms, which included pain and tenderness over the medial aspect of the subtalar joint, had been present for a mean of six months (range, two to twelve months) preoperatively and were exacerbated by jumping and by attempts to perform en pointe work. Crepitus was present in six patients, and triggering was present in three. No patient had evidence of a symptomatic os trigonum. Postoperatively, all patients participated in a formal physical-therapy program for a mean of nine weeks (range, four to thirteen weeks). All patients returned to dancing, within a mean of five months (range, two to nine months), and eleven reached a level of full participation in dancing without restriction. At the time of the most recent follow-up, all patients noted improvement compared with the pre-operative condition. Eight patients were professional ballet dancers, four were students at advanced ballet schools, and one had stopped performing ballet for reasons unrelated to the tenosynovitis of the flexor hallucis longus. In addition, two of the students had decided not to pursue careers in dancing because of persistent, but greatly diminished, symptoms. No complications were noted in this series. We concluded that an operative release of the flexor hallucis longus is effective for the treatment of isolated stenosing tenosynovitis in female ballet dancers who place high demands on the foot and ankle and for whom non-operative treatment has failed.
Asunto(s)
Tobillo/cirugía , Baile , Pie/cirugía , Tendones/cirugía , Tenosinovitis/cirugía , Adolescente , Adulto , Tobillo/fisiopatología , Constricción Patológica/etiología , Constricción Patológica/fisiopatología , Constricción Patológica/rehabilitación , Constricción Patológica/cirugía , Baile/lesiones , Femenino , Estudios de Seguimiento , Humanos , Métodos , Dolor/fisiopatología , Modalidades de Fisioterapia , Cuidados Posoperatorios , Estudios Retrospectivos , Articulación Talocalcánea/fisiopatología , Tendones/fisiopatología , Tenosinovitis/etiología , Tenosinovitis/fisiopatología , Tenosinovitis/rehabilitación , Resultado del Tratamiento , Soporte de PesoRESUMEN
This case report describes a 41-year-old female patient who had chronic de Quervain's tenosynovitis, which had progressed to include involvement of the cervical spine, shoulder girdle, and upper extremity. The patient complained of aching over the left scapula, a band of pain around the upper arm, and sharp shooting pain in the forearm, with numbness and tingling in the fingers. On examination, she had abnormal palpatory findings in the cervical spine, the shoulder quadrant maneuver was limited, and the upper-limb tension tests (neural structures) were positive. The case report demonstrates the use of an Australian approach to manual therapy as described by Maitland. This approach includes (1) development, refinement, and rejection of working hypotheses as to the possible cause(s) of a patient's symptoms; (2) development of a long-range treatment plan; and (3) use of data from treatment responses to guide further treatment selection.
Asunto(s)
Modalidades de Fisioterapia/métodos , Tenosinovitis/rehabilitación , Adulto , Australia , Vértebras Cervicales/fisiopatología , Femenino , Humanos , Palpación , Examen Físico , Postura , Rango del Movimiento Articular/fisiología , Articulación del Hombro/fisiopatología , Tenosinovitis/diagnóstico , Articulación de la Muñeca/fisiopatologíaRESUMEN
1. Rapid repetitive movements in connection with machine-pacing can lead to the development of upper limb disorders and repetitive strain injuries. 2. The main treatment of these disorders is rest and physiotherapy. 3. Operating VDUs is not a high risk occupation, but can lead to work-related upper limb disorders. 4. Occupational health nurses have a major part to play in preventing repetitive strain injuries in industry.