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ABSTRACT BACKGROUND AND OBJECTIVES: The primary protocol for the control of temporomandibular disorders prioritizes reversible and less invasive measures. However, conservative treatment is sometimes ineffective. Therefore, the use of hyaluronic acid has been suggested as a therapeutic alternative to verify the effectiveness of the hyaluronic acid in patients who are not responsive to the most conservative treatments, helping them in the control of pain. This article aims to perform a literature review on the efficacy of this substance in the treatment of internal changes of the temporomandibular joint. CONTENTS: The search strategy used the Pubmed portal and the Web of Science database for the last 10 years. We included articles in English that evaluated the efficacy of the hyaluronic acid in the intra-articular disorders of temporomandibular joint, and excluded articles from literature review, clinical case reports, theses, and dissertations. Fifteen studies, classified as randomized clinical trials, prospective and retrospective studies, case-control, pilot study, and systematic reviews were selected. The hyaluronic acid is of fundamental importance in the function and lubrication of joint tissues due to its high molecular weight. When degenerative and inflammatory changes are present, their concentration and molecular weight are diminished, and the injection of this acid raises these levels, which can generate pain relief. CONCLUSION: Intra-articular therapy with hyaluronic acid is effective in the reduction of symptomatologic levels and the functional restoration of the temporomandibular joint.

RESUMO JUSTIFICATIVA E OBJETIVOS: O protocolo primário de controle das disfunções temporomandibulares prioriza as medidas reversíveis e menos invasivas. Entretanto, o tratamento conservador mostra-se, algumas vezes, ineficaz, e como alternativa terapêutica, tem sido sugerido o uso de ácido hialurônico para com isso, verificar a sua efetividade em pacientes não responsivos aos tratamentos mais conservadores e poder ajudá-los no controle da dor. O objetivo deste estudo foi rever na literatura a eficácia dessa substância no tratamento das alterações internas da articulação temporomandibular. CONTEÚDO: A estratégia de busca utilizou o portal eletrônico Pubmed e a base de dados Web of Science, nos últimos 10 anos. Foram incluídos artigos em inglês que avaliaram a eficácia do ácido hialurônico nas desordens intra-articulares da articulação temporomandibular, e excluídos artigos de revisão de literatura, relatos de casos clínicos, teses e dissertações. Foram selecionados 15 estudos, classificados como ensaios clínicos randomizados, estudos prospectivos e retrospectivos, caso-controle, estudo piloto e revisões sistemáticas. O ácido hialurônico tem importância fundamental na função e lubrificação dos tecidos articulares, devido ao seu alto peso molecular. Quando alterações degenerativas e inflamatórias estão presentes, sua concentração e peso molecular estão diminuídos, e a injeção desse ácido eleva esses níveis, o que pode gerar alívio da dor. CONCLUSÃO: A terapia intra-articular com ácido hialurônico é efetiva na diminuição dos níveis sintomatológicos e no restabelecimento funcional da articulação temporomandibular.

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Os deslocamentos condilares da Articulação Temporomandibular (ATM) correspondem à perda de contato parcial ou total entre as duas superfícies ósseas articulares, na qual se refere o côndilo ultrapassa anteriormente a eminência articular. Entretanto, quando este se mantém à frente da eminência, necessitando de redução clínica, corresponde ao quadro clínico de luxação. O deslocamento geralmente é ocasionado por trauma ou hipermobilidade mandibular, assim como fatores agravantes: anatomia articular desfavorável, espasmos musculares, flacidez nos ligamentos articulares, desordens psicogênicas, síndromes, abertura bucal excessiva ao bocejar, rir, comer e em tratamentos odontológicos prolongados. Este trabalho apresenta dois casos clínicos em pacientes com histórico de luxação recidivante e crônico da ATM, em que o tratamento proposto de forma inicial utilizou a injeção de sangue autógeno (hemartrocentese) por representar uma forma menos invasiva. Dessa forma, visamos expor a aplicabilidade dessa modalidade de tratamento que se mostra como uma alternativa eficaz e conservadora para luxação recidivante crônica da ATM... (AU)

Condylar displacement of Temporomandibular Joint (TMJ) corresponds to the loss of partial or total contact between the two articular bone surfaces, in which the condyle surpasses the articular eminence. However, when the condyle remains ahead of the eminence, requiring clinical reduction, it corresponds to the clinical scenario of dislocation. TMJ dislocation is usually caused by trauma or mandibular hypermobility, as well as aggravating factors: unfavorable joint anatomy, muscle spasms, sagging of joint ligaments, psychogenic disorders, syndromes, excessive mouth opening while yawning, laughing, eating, and prolonged dental treatments. This paper presents two clinical cases of patients with history of recurrent and chronic TMJ dislocation, where the initial treatment was the injection of autogenous blood (hemartrocentesis) because it represented a less invasive modality. Thus, we aim to expose the applicability of this technique that is shown to be an effective and conservative alternative for chronic TMJ dislocation... (AU)

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Abstract Objectives: To evaluate local joint variables after intra-articular injection with triamcinolone hexacetonide in rheumatoid arthritis patients. Methods: We blindly and prospectively (baseline, 1, 4, 12 and 24 weeks) evaluated metacarpophalangeal, wrist, elbow, shoulder, knee and ankle joints after triamcinolone hexacetonide intra-articular injection by the following outcome measures: visual analogue scale 0–10 cm (VAS) for rest pain (VASR); VAS for movement pain (VASM); VAS for joint swelling (VASSw); flexion (FlexG) and extension (ExtG). Results: 289 patients (635 joints) were studied. VASSw (p < 0.001) and VASR (0.001 < p < 0.016) improved from T0 to T4, T12 and T24 for all joints. VASM improved from T0 to T4 (p < 0.021) for all joints; T0 to T12 (p < 0.023) for MCF and knee; T0 to T24 (p < 0.019) only for MCF and knee. FlexG improved from T0 to T4 (p < 0.001) for all joints; T0 to T12 (p < 0.001) and T0 to T24 (p < 0.02) only for MCF and knee. ExtG improved from T0 to T4 (p < 0.001) for all joints except for elbow; T0 to T12 (p = 0.003) for wrist, metacarpophalangeal and knee; and T0 to T24 (p = 0.014) for MCF and knee. Conclusion: VASSw responded better at short and medium term after IAI with triamcinolone hexacetonide in our sample of RA patients.

Resumo Objetivos: Avaliar variáveis articulares locais após a injeção intra-articular (IIA) de hexacetonido de triancinolona (HT) em pacientes com artrite reumatoide (AR). Métodos: Avaliaram-se de modo cego e prospectivo (inicial, 1, 4, 12 e 24 semanas) as articulações metacarpofalângica (MCF), punho, cotovelo, ombro, joelho e tornozelo após a IIA de HT à procura das seguintes medidas de desfecho: escala visual analógica (EVA) de 0 a 10 cm para dor em repouso (EVAr); EVA para dor ao movimento (EVAm); EVA para inchaço das articulações (EVAi); flexão (FlexG) e extensão (ExtG). Resultados; Estudaram-se 289 pacientes (635 articulações). A EVAi (p < 0,001) e a EVAr (0,001 < p < 0,016) melhoraram de T0 a T4, T12 e T24 em todas as articulações. A EVAm melhorou de T0-T4 (p < 0,021) em todas as articulações; T0-T12 (p < 0,023) na MCF e no joelho; T0-T24 (p < 0,019) apenas na MCF e no joelho. A FlexG melhorou de T0-T4 (p < 0,001) em todas as articulações; T0-T12 (p < 0,001) e T0-T24 (p < 0,02) apenas na MCF e no joelho. A ExtG melhorou de T0-T4 (p < 0,001) em todas as articulações, exceto no cotovelo; T0-T12 (p = 0,003) no punho, na MCF e no joelho; e T0-T24 (p = 0,014) na MCF e no joelho. Conclusão: A EVAi respondeu melhor em curto e médio prazos após a IIA de HT na presente amostra de pacientes com AR.

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OBJECTIVES: To evaluate local joint variables after intra-articular injection with triamcinolone hexacetonide in rheumatoid arthritis patients. METHODS: We blindly and prospectively (baseline, 1, 4, 12 and 24 weeks) evaluated metacarpophalangeal, wrist, elbow, shoulder, knee and ankle joints after triamcinolone hexacetonide intra-articular injection by the following outcome measures: visual analogue scale 0-10cm (VAS) for rest pain (VASR); VAS for movement pain (VASM); VAS for joint swelling (VASSw); flexion (FlexG) and extension (ExtG). RESULTS: 289 patients (635 joints) were studied. VASSw (p<0.001) and VASR (0.001

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BACKGROUND: Intra-articular corticosteroid injection is a common therapy for adhesive capsulitis, but there is a lack of prospective randomized controlled studies analyzing the efficacy of single injections applied blindly to accelerate improvement in pain and function. HYPOTHESIS: In patients with adhesive capsulitis, a single intra-articular corticosteroid injection without image control applied before the beginning of a physical therapy program will accelerate pain relief and recovery of function compared with oral nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 74 patients with primary adhesive capsulitis in the freezing stage were randomized to receive either intra-articular injections with betamethasone or oral NSAIDs. Clinical outcome was documented at baseline and after 2, 4, 8, and 12 weeks and comprised a visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) Shoulder Score, the abbreviated Constant-Murley score, and the abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) score for function. Passive range of motion was measured with a goniometer. RESULTS: Patients treated with corticosteroid injections achieved faster pain relief compared with control patients during the first 8 weeks after treatment (P < .001). However, no significant difference in pain was observed among the groups at final follow-up. Likewise, shoulder function and motion improved significantly in both groups at all follow-up points. Shoulder function scores and most motion parameters improved faster in the injection group up to week 8 (P < .001). Again, no significant differences in function or motion were seen at final follow-up. CONCLUSION: In patients with adhesive capsulitis, a single corticosteroid injection applied without image control provides faster pain relief and earlier improvement of shoulder function and motion compared with oral NSAIDs.

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