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OBJECTIVE: To compare the functional (daytime) use to the nightly use of an orthosis for patients affected by trapeziometacarpal osteoarthritis (OA). DESIGN: Randomized, controlled single-blind trial. SETTING: The rheumatology outpatient clinic of the University. PARTICIPANTS: Sixty participants diagnosed with trapeziometacarpal OA. INTERVENTIONS: Participants were randomly assigned into 2 groups: a functional group that used a functional hand-based thumb immobilization orthosis during activities of daily living and a night-time group that used the same orthosis at night. MAIN OUTCOMES MEASURES: The patients were evaluated at baseline and after 45, 90, 180, and 360 days considering: pain at the base of the thumb and in the hand, range of motion of the thumb, grip, and pinch strength, manual dexterity, and hand function. RESULTS: The groups were homogeneous at the beginning of the trial. No statistically significant difference was observed between groups over time for trapeziometacarpal pain (P=.646). For general hand pain, no statistically significant difference was found between groups over time (P=.594). Although both groups improved from baseline, there were no statistically significant differences between the groups in the vast majority of the assessed parameters. Statistically significant differences between the groups were found only in the following outcomes: thumb palmar abduction of the right hand (P=.023), pick-up test with closed eyes of the right hand (P=.048), and tripod grip strength of the right hand (P=.006). CONCLUSIONS: Both groups showed improvement in pain and function from baseline to the end of the intervention. However, there were no reported differences in these outcomes after a 1-year follow-up between the functional (daytime) and night-time use of orthosis in patients with trapeziometacarpal OA. This suggests that both types of usage can be offered to patients.

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Objetivo: evaluar la rehabilitación funcional de la ATM en pacientes con osteoartrosis, con abordaje neuromuscular. La osteoartrosis se caracteriza por la degeneración del cartílago articular y la cortical ósea, que conduce a dolor e inmovilidad. Se incluyó a 8 mujeres entre 20 y 42 años de edad con dolor en la región orofacial, signos de oclusión disfuncional e imágenes compatibles con trastornos degenerativos en ATM. Clínicamente se evaluó el dolor y la oclusión y, mediante tecnología electrónica, se obtuvieron datos objetivos de los movimientos de apertura-cierre y lateralidades, la velocidad de apertura-cierre mandibulares y de los ruidos articulares. Las mediciones fueron realizadas al inicio y al finalizar el tratamiento de estabilización mandibular con una ortosis neuromuscular. Para determinar la significación estadística se utilizaron el Student`s test de comparaciones múltiples y el análisis de varianza, ANOVA, de un factor. Las diferencias entre medias se consideraron significativas con p <0.05. Los resultados demostraron ausencia de dolor en el 100% de los casos al primer mes de tratamiento. Se incrementaron la apertura bucal (6,73 mm promedio), ambas lateralidades (P=0.0023), velocidad en apertura y en cierre (no estadísticamente significativo). Después de estabilizar la mandíbula se redujo la frecuencia de los ruidos. En conclusión, la oclusión dental disfuncional es el principal factor etiológico de la artrosis de la ATM. El establecimiento de una oclusión fisiológica produce la descompresión de la ATM, aumenta el rango de los movimientos mandibulares y disminuye significativamente el dolor (AU)

Objective: to evaluate the functional rehabilitation of the TMJ in patients with osteoarthritis, with a neuromuscular approach. Osteoarthrosis is characterized by degeneration of articular cartilage and bone cortex, which leads to pain and immobility. Eight women between 20 and 42 years of age with pain in the orofacial region, signs of dysfunctional occlusion, and images consistent with degenerative TMJ disorders were included. Clinically, pain and occlusion were evaluated and, using electronic technology, objective data were obtained on the opening-closing movements and lateralities, the opening-closing speed of the jaws and joint noises. Measurements were made before and at the end of the mandibular stabilization treatment with a neuromuscular orthosis. To determine the statistical significance, the Student`s multiple comparisons test and the analysis of variance, ANOVA, of one factor were used. The differences between means were considered significant with p <0.05. The results showed absence of pain pain in 100% of cases in the first month of treatment. Mouth opening (6.73 mm average), both lateralities (P = 0.0023), opening and closing speed (not statistically significant) were increased. After stabilizing the jaw the noise frequency value was reduced. In conclusion, dysfunctional dental occlusion is the main etiologic factor of TMJ osteoarthritis. Establishing a physiological occlusion causes TMJ decompression, increases the range of mandibular movements, and significantly decreases pain (AU)

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The aim of this study was to investigate the influence of a specific, kinesiotherapy-based rehabilitation program on the various symptoms of osteoarthrosis (OA), following group treatment. Thirty-one individuals, of both sexes, aged over 50 years and with medical diagnosis of OA, underwent 16 sessions, twice a week, totaling eight weeks, of a specific rehabilitation protocol based on group kinesiotherapy. Primary OA symptoms were assessed (directly related to the disease: OA symptoms, trunk flexibility, balance and pain), and so were secondary ones (indirectly related to the disease: signs of depression and anxiety, and quality of life). Data were tested through Student's t test or Wilcoxon's test, and contingencies of categorical data were analyzed using McNemar's test. There was an improvement in all primary symptoms of OA after the kinesiotherapy protocol was applied. Signs of anxiety and depression improved only in contingency, when risk stratification was taken into account. In addition, physical components of quality of life also showed improvement, which did not occur with mental components though. Therefore, the kinesiotherapy-based rehabilitation program was capable of positively influencing all primary symptoms, and only some aspects of secondary OA symptoms.

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PURPOSE: Glenohumeral osteoarthritis (GHOA) is a common cause of pain and functional disability of the shoulder. Despite the limited evidence, there are several options for the treatment of this pathology. The aim of this article is to provide current information on the characteristics of the disease and the pathophysiology, evidence based on medical and surgical treatments with emphasis on the rehabilitation process. METHODS: It was performed with an extensive literature review, mainly clinical practice guidelines, randomized controlled trials, reviews, focusing on the rehabilitation management. RESULTS: There are few clinical practice guidelines that address GHOA as a pathology with unique characteristics. Evidence based treatment recommendations are mostly supported by low-quality evidence and experts' opinions, with few high levels of evidence studies guiding treatment decisions. CONCLUSIONS: Despite the lack of good quality evidence, rehabilitation programs have proven to be efficient and reliable, and this revision provides information and recommendations in this field. Implication of Rehabilitation Glenohumeral osteoarthritis is a common cause of pain and functional disability of the shoulder There are few clinical practice guidelines that address Glenohumeral Osteoarthritis as a pathology with unique characteristics, and recommendations for rehabilitation and therapeutic exercise are poor The paper provides current information on the characteristics of the disease, its rehabilitation process, and could be of interest for rehabilitation professionals to direct their practices in this field.

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STUDY DESIGN: Clinical measurement. INTRODUCTION: The Moberg Pick-up Test (MPUT) was previously used to evaluate functional performance in patients with hand inflammatory disease. This is the first study using the MPUT in hand osteoarthritis (OA). PURPOSE OF THE STUDY: Compare the functional performance (MPUT) in hand OA patients and healthy controls. METHODS: Fifty hand OA patients and 50 controls were assessed using the MPUT, AUSCAN and Cochin questionnaires, grip and pinch strength, pain using a visual analog scale and a Likert scale regarding difficulty to perform MPUT. RESULTS: In the MPUT evaluation, the OA group presented a statistically significant difference from the control group. The OA group spent more time executing test. The grip and pinch strength measurements showed higher values for the control group. The OA group reported a greater difficulty than the control group in performing the test. CONCLUSION: The MPUT is a short and easy to apply test, which can be safely used to assess the functional performance of the hand OA. LEVEL OF EVIDENCE: II.

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STUDY DESIGN: Cross-sectional descriptive study. INTRODUCTION: Osteoarthritis (OA) is the most prevalent musculoskeletal disease in the adult and older adult populations. The use of orthoses to stabilize the thumb's articular complex is one of the most common conservative management strategies. Despite substantial research about this topic, there is insufficient evidence about the optimal use of orthoses to inform clinical practice, contributing to practice variations within and across health professionals. PURPOSE OF THE STUDY: To identify the prescription patterns, design preferences, and barriers for the use of orthotic devices among Brazilian health care professionals involved in the treatment of patients with OA of the basal thumb joint. METHODS: An electronic questionnaire was sent to occupational therapists, physiotherapists, and rheumatologists across Brazil through professional association mailing lists. Survey included questions about orthosis design, materials, and barriers to the use of orthotic interventions. Respondents indicated their use based on photographs of 25 orthoses models that were selected through bibliographic review and expert consultation. Descriptive statistics, the chi-square test for independence, and the Fisher exact test were used to compare differences among orthotic prescription preferences, barriers, and challenges observed amidst the 3 participants' professional classes. RESULTS: There was no consensus about orthotic prescription among 275 professionals who answered the survey. About 69% of participants reported the use of multiple orthosis during treatment of patients with thumb OA. Results suggest significant variations in the number of joints included and stabilization strategies adopted, with a preference for orthotics made in rigid materials and involving the wrist, carpometacarpal, and metacarpophalangeal joints (P < .001). The lack of knowledge about orthotic options, institutional regulations, and policies were the major barriers reported by respondents (P < .01). CONCLUSION: A plentiful variety of different orthoses designs were observed in this study, and the prescriptions made by 3 professional classes showed differences regarding types of stabilization, joint involvement, and positioning. Despite the existence of clinical trials suggesting benefits for specific custom-made design models, our results indicated widespread clinical variation in practices and preferences. LEVEL OF EVIDENCE: Not applicable.

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BACKGROUND: Hip and knee osteoarthritis are important causes of pain and disability among older people. Education and strength training can alleviate symptoms and avoid functional deterioration. AIM: To assess muscle strength, fall risk and quality of life of older people with osteoarthritis and the effects of physiotherapy education and strength training on these variables. MATERIAL AND METHODS: Thirty participants aged 78 ± 5 years (63% women) were randomly assigned to receive physiotherapy (Controls), physiotherapy plus education (Group 1) and physiotherapy plus strength training (group 2). At baseline and after 16 weeks of intervention, patients were evaluated with the Senior Fitness Test, Timed Up and Go and Quality of Life score short form (SF-36). RESULTS: During the intervention period, Senior Fitness Test and Timed Up and Go scores improved in all groups and SF-36 did not change. The improvement in Senior Fitness Test and Timed Up and Go was more marked in Groups 1 and 2 than in the control group. CONCLUSIONS: Education and strength training improve functional tests among older people with osteoarthritis.

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OBJECTIVE: to evaluate the results from surgery with computer-assisted navigation in cases of total knee arthroplasty. METHOD: a total of 196 patients who underwent total knee arthroplasty with computer-assisted navigation were evaluated. The extension and flexion spaces (gaps) were evaluated during the operation and the alignment after the operation was assessed. The Knee Society Score (KSS) questionnaire for assessing patient's function was applied preoperatively and postoperatively after a mean follow-up of 22 months. RESULTS: in all, 86.7% of the patients presented good alignment of the mechanical axis (less than 3◦ of varus or valgus in relation to the mechanical axis) and 96.4% of the patients presented balanced flexion and extension gaps. Before the operation, 97% of the patients presented poor or insufficient KSS, but after the operation, 77.6% presented good or excellent KSS. CONCLUSION: the navigation system made it possible to achieve aligned and balanced implants, with notable functional improvement among the patients. It was found to be useful in assessing, understanding and improving knowledge in relation to performing arthroplasty procedures...

OBJETIVO: avaliar os resultados das cirurgias assistidas por navegação (CAN) nas artroplastias totais de joelho. MÉTODO: foram avaliados 196 pacientes submetidos à artroplastia total de joelho com auxílio da navegação por computador. Avaliados no intraoperatório os espaços (gaps) de extensão e de flexão, o alinhamento pós-operatório e o questionário funcional da Knee Society Score (KSS) pré-operatório e pós-operatório com seguimento médio de 22 meses. RESULTADOS: dos pacientes, 86,7% apresentaram bom alinhamento do eixo mecânico (dentro de 3◦ de varo ou valgo em relação ao eixo mecânico) e 96,4% apresentaram ambos os gaps de flexão e extensão balanceados. No pré-operatório, 97% dos pacientes apresentavam KSS funcional ruim ou insuficiente, no pós-operatório 77,6% apresentavam KSS funcional bom ou excelente. CONCLUSÃO: a navegação proporcionou a obtenção de implantes alinhados e balanceados com importante melhoria da função nos pacientes. Foram evidenciados sua utilidade no estudo, o entendimento e o aperfeiçoamento do conhecimento na execução das artroplastias...

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Background: Hip and knee osteoarthritis are important causes of pain and disability among older people. Education and strength training can alleviate symptoms and avoid functional deterioration. Aim: To assess muscle strength, fall risk and quality of life of older people with osteoarthritis and the effects of physiotherapy education and strength training on these variables. Material and Methods: Thirty participants aged 78 ± 5 years (63% women) were randomly assigned to receive physiotherapy (Controls), physiotherapy plus education (Group 1) and physiotherapy plus strength training (group 2). At baseline and after 16 weeks of intervention, patients were evaluated with the Senior Fitness Test, Timed Up and Go and Quality of Life score short form (SF-36). Results: During the intervention period, Senior Fitness Test and Timed Up and Go scores improved in all groups and SF-36 did not change. The improvement in Senior Fitness Test and Timed Up and Go was more marked in Groups 1 and 2 than in the control group. Conclusions: Education and strength training improve functional tests among older people with osteoarthritis.

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La osteoartrosis es la enfermedad articular más frecuente y una de las principales causas de discapacidad en el adulto mayor. Se realizó un estudio descriptivo en el Hospital Militar Docente Mario Muñoz Monroy, de Matanzas, con el objetivo de describir la utilización de los medios físicos en la osteartrosis, durante el año 2012. Se estudiaron las variables: sexo, edad, articulación afectada, factores de riesgo, intensidad del dolor (Escala Visual Analógica) e incapacidad funcional (test de Waddel). La artrosis predominó en el sexo femenino y en edades superiores a 65 años. La articulación más afectada fue la rodilla y el sobrepeso fue el factor de riesgo más frecuente. La evolución de los pacientes con artrosis fue buena en el 71,8 por ciento, regular en el 21,3 por ciento y mala en el 6,9 por ciento. En la fase aguda la magnetoterapia combinada con el láser alcanzó la mayor cantidad de pacientes con buena evolución, en las fases subaguda y crónica fue el calor infrarrojo combinado con corrientes analgésicas.

The ostearthritis is the most common articular diseases and one of the main causes of disability in elder people. We carried out a descriptive study in the Teaching Military Hospital Mario Muñoz Monroy, of Matanzas, with the objective of describing the usage of physical means in cases of osteoarthritis during 2012. We studied the variables of gender, age, afected joint, risk factors, pain intensity (Analogical Visual Scale) and functional disability (Waddel test). The osteoarthritis was predominant in the female sex and in ages more than 65 years. The most affected joint was the knee, and overweight the most frequent risk factor. The evolution of the patients with osteoarthritis was good in 71,8 per cent, regular in 21,3 per cent and bad in 6,9 per cent. In the acute phase, the laser-combined magnetotherapy reached the biggest quantity of patients with a good evolution; in the sub-acute and chronic stages infrared heat with analgesic power reached the highest quantity.

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A osteoartrite (OA) é a causa mais frequente de doença crônica musculoesquelética, sendo sem dúvida a maior causa de limitação das atividades diárias entre os idosos. Atualmente, cerca de 40% dos adultos com idade superior a 70 anos sofrem de OA do joelho; destes, 80% apresentam limitações de movimento e em 25% as atividades diárias estão comprometidas. Nas últimas décadas têm ocorrido avanços na terapêutica da osteoartrite

Osteoarthritis (OA) is the most common cause of chronic musculoskeletal disease and the most prevalent reason for the limitation of daily activities of the elderly population. Currently, about 40% of adults aged over 70 suffer from OA of the knee. Of these, 80% suffer from limitations in motion and 25% are engaged to carry out their daily activities. In recent decades there have been advances in the treatment of osteoarthritis

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Objetivo: Relatar os resultados com médio prazo de seguimento após a implantação de Arthrosurface-HemiCap em pacientes com diagnóstico de hállux rígidus (HR). Método: Onze pacientes foram submetidos à artroplastia parcial da primeira metatarso-falangeana. Seis mulheres e cinco homens com idade média de 51,9 anos (46 a 58 anos) e média de seguimento pós-operatório de 3,73 anos (3-4 anos); foram classificados através do sistema de Kravitz e avaliados pelas escalas da american orthopaedic foot and ankle society (AOFAS) para hállux, visual analog scale (VAS) – analógico funcional de dor - e pela amplitude de movimento da primeira articulação metatarsofalangeana no periodo pré-operatório, pós-operatório de seis meses e pós-operatório atual. Resultados: Os resultados revelam melhora significativa dos três parâmetros analisados no estudo, tanto para análise global como para comparações pré e pós-operatórias individuais. A análise comparativa de cada variável nos períodos pós--operatórios de seis meses e atual não mostram diferença estatística o que indica manutenção dos parâmetros durante esse intervalo. Conclusão: A hemiartroplastia da primeira metatarsofalangeana é opção reprodutível e segura para o tratamento cirúrgico do hállux rígidus II e III, com significativa melhora dos parâmetros avaliados para a população estudada. Nível de Evidência IV, Série de casos.

Objective: To report the results of medium-term follow-up after deploying arthrosurface-Hemicap in patients with diagnosis of hállux rígidus (HR). method: eleven patients underwent partial arthroplasty of the first metatarsal-phalangeal joint. six women and five men with an average age 51.9 years (46 to 58 years) and average postoperative follow-up of 3.73 years (3-4 years); were classified through the Kravitz system and evaluated by the american orthopaedic foot and ankle society (aofas) scales for hallux, visual analogical scale (vas) – analog functional pain - and motion range in the first metatarsal joint in preoperative, postoperative after six months and present post-operative. Results: the results show significant improvement of the three analyzed parameters, both for overall analysis and for pre and post-operative comparisons individually. the comparative analysis of each variable in the six months and the current postoperative periods do not show statistically significant differences, indicating maintenance of parameters during this interval. conclusion: hemiarthroplasty of first metatarsophalangeal joint is a reproducible and safe option for the surgical treatment of hállux rígidus II and III, with significant improvement of the evaluated parameters for the studied population. Level of Evidence IV, Case Series.

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Objetivos: Avaliar a correlação entre os parâmetros radiográficos e as avaliações funcionais de pacientes com osteoartrose do ombro submetidos à artroplastia do ombro e descrever os resultados funcionais deste procedimento em nosso serviço. Métodos: Foram avaliados 21 pacientes (22 ombros) que realizaram artroplastias do ombro entre 1998 e 2010 e que apresentassem tempo mínimo de seguimento de 12 meses. A avaliação clínica foi realizada através das escalas de Constant-Murley, UCLA, EVA e da medida do arco de movimento ativo. Aferimos parâmetros radiográficos pré-operatórios (distância entre o topo da cabeça e o úmero e o acrômio, migração superior, inclinação do colo,“offset” medial, subluxação do úmero, erosão da glenóide) e pós-operatórios (inclinação da haste, migração dos componentes e sinais de soltura). Resultados: Os pacientes apresentaram melhora significativa em todos os parâmetros avaliados: flexão (p=0,0083), abdução (p=0,0266), rotação externa (p=0,0062), Constant-Murley (p=0,0001), UCLA (p<0,0001) e EVA (p=0,0002). A migração superior do úmero e as escalas de UCLA e de Constant-Murley apresentaram uma correlação significativa (p=0,0480 e p=0,0110, respectivamente). Os demais parâmetros radiográficos não demonstraram correlação com os resultados clínicos. Conclusão: a migração superior do úmero está relacionada a uma piora dos indicadores funcionais. Nível de Evidência IV, Série de Casos.

Objectives: To evaluate the correlation between radiographic parameters and functional assessments of patients with osteoarthritis of the shoulder who underwent shoulder arthroplasty and describe the functional outcomes of this procedure in our institution. Methods: we evaluated 21 patients (22 shoulders) who underwent shoulder arthroplasty between 1998 and 2010 with a minimum follow-up of 12 months. Clinical evaluation was performed using the Constant-Murley scale, UCLA, VAS and measuring the arc of active motion. We analysed preoperative radiographic parameters (distance from the top of the head and the humerus and the acromion, superior migration, neck angulation, medial “offset”, subluxation, glenoid cavity erosion) and postoperatively we evaluated rod inclination, migration of components and loosening. Results: patients showed significant improvement in all parameters: flexion (p = 0.0083), abduction (p = 0.0266), external rotation (p = 0.0062), Constant-Murley (p = 0.0001 ), UCLA (p < 0.0001) and VAS (p = 0.0002). The superior migration of the humerus showed a significant correlation with UCLA and Constant-Murley scores (p = 0.0480 and p = 0.0110, respectively). The other radiographic parameters had no correlation with the clinical outcomes. Conclusion: the superior migration of the humerus is related to a worsening of clinical scores. Level of Evidence IV, Case Series.

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BACKGROUND: Following shoulder arthroplasty, any well-planned rehabilitation program should include muscle strengthening. However, it is not always clear how different external loads influence shoulder kinematics in patients with shoulder prostheses. The objective of this study was to describe shoulder kinematics and determine the contribution of the scapulothoracic joint to total shoulder motion of patients with total and reverse shoulder arthroplasties and of healthy individuals during rehabilitation exercises (anteflexion and elevation in the scapular plane) using different loading conditions (without external load, 1 kg and elastic resistance). METHODS: Shoulder motions were measured using an electromagnetic tracking device. A force transducer was used to record force signals during loaded conditions using elastic resistance. Statistical comparisons were made using a three-way repeated-measures analysis of variance with a Bonferroni post hoc testing. FINDINGS: The scapula contributed more to movement of the arm in subjects with prostheses compared to healthy subjects. The same applies for loaded conditions (1 kg and elastic resistance) relative to unloaded tasks. For scapular internal rotation, upward rotation and posterior tilt no significant differences among groups were found during both exercises. Glenohumeral elevation angles during anteflexion were significantly higher in the total shoulder arthroplasty group compared to the reverse shoulder arthroplasty group. INTERPRETATION: Differences in contribution of the scapula to total shoulder motion between patients with different types of arthroplasties were not significant. However, compared to healthy subjects, they were. Furthermore, scapular kinematics of patients with shoulder arthroplasty was influenced by implementation of external loads, but not by the type of load.

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The aim of this study was to compare the knee kinematics of anterior cruciate ligament reconstructed (ACL-R) and healthy subjects (CG) during gait and classify the status of normality. Ten healthy and six ACL-R subjects had their gait analyzed at 60 fps. 3D knee angles were calculated and inserted into three separate matrices used to perform the principal component (PC) analysis. The scores of PCs retained in each analysis were used to calculate the standard distances (SD) of each participant in relation to the center of the CG. The PC scores of the three planes were used in a logistic regression to define normality. In the sagittal plane there was no difference between groups. In the frontal and transverse planes ACL-R subjects showed higher SD values than CG. PCs identified that ACL-R subjects showed increased adduction, internal and external rotation. All these subjects had their gait classified as abnormal by logistic regression. Therefore, in the studied ACL-R subjects the gait pattern did not return to normal levels after surgery. This may lead to degenerative injuries, as osteoarthritis, in the future.

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Trapeziometacarpal osteoarthritis is a common pathology resulting in severe impairments in daily living activities. Many procedures have been described in the treatment of stages Eaton II, III and IV. Bibliographical research evidences that other techniques could not improve the results of the simple trapeziectomy. A surgical technique with an arthroscopically assisted total resection of the trapezium is described. This technique is carried out with a 2.7-mm arthroscope, using the conventional portals (1R and 1U) and a fluoroscan. Surgery ends with soft dressings and rehabilitation begins immediately. In the last 9 years, we treated more than 70 patients. Video-assisted total trapeziectomy offers a simple technique with sufficient postoperative comfort that allows an early return to the daily living activities.

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O objetivo deste estudo, de cunho empírico analítico do tipodescritivo exploratório, foi observar as características clínicofuncionaisde 15 idosos com diagnóstico médico de osteoartrose de joelho, com idade ≥ a 60 anos, de ambos os gêneros, voluntários,moradores de Florianópolis, selecionados de forma não probabilística intencional. Utilizou-se a escala linear de dor e o questionário de McGill para verificar a intensidade e a qualidade da dor e ainda as medidas do ângulo “Q” e das amplitudes ativa e passiva de flexão e extensão do joelho de cada um dos sujeitos. Observou-se, pormeio de estatística descritiva, que a média de peso dos sujeitos foide 76,8 kg, caracterizando-os como idosos com excesso de peso, já que a média da altura do grupo foi de 1,50 m. A mediana da intensidade da dor foi de 7,5 (S = 2,94) com média do número de descritores de qualidade de dor de 19. Esses parâmetros de alta intensidade da dor, somados a mediana das medidas do ângulo “Q”do joelho (21 graus), o quartil superior de 23 graus, e a média defl exão ativa de 111 graus e extensão ativa de 170 graus, caracterizam o grupo, como sujeitos que apresentam alteração postural e funcional mecânica desta articulação, com riscos de comprometera sua independência funcional, limitando-os significativamente na habilidade individual de levantar de uma cadeira, permanecer em pé confortavelmente, caminhar, subir e descer escadas. Identificar as alterações posturais, funcionais e de dor causadas por esta patologia é deveras relevante, possibilitando desta forma, a utilização destas medidas clínico-funcionais como parâmetro para o estudodos efeitos de tratamentos de correção e prevenção da evolução das deformidades posturais e da mecânica articular do joelho de idosos com osteoartrose de joelhos.

This descriptive exploratory study aimed at observing clinical and functional characteristics of 15 elderly people diagnosed withknee osteoarthrosis, aged ≥ 60 years, both genders, voluntaries,residents in Florianópolis selected by nonprobability sampling. The linear scale of pain and the McGill questionnaire were used to verify the intensity and quality of pain, and also measurement of “Q” angle and active and passive amplitude of flexion and extension movement of the knee in each subject. It was observed through descriptive statistic that subjects mean weight was 76.8 kg, characterizing then as overweight elderly people, since mean height of the group was 1.50 m. The median pain intensity score was 7.5 (S = 2.94),and mean descriptors of pain quality was 19. These high intensity parameters of pain added up to the median of “Q”angles (21°), the superior quartile (23°) and mean of active fl exion (111°) and theactive extension (170°) showed that the group had knee postural and mechanical functional alterations, with risks to compromise their functional independence, limiting significantly their individualability to stand up from the chair, stand comfortably, walk, go upand down the stairs. To identify the postural, functional and painalterations caused by this pathology is indeed relevant, allowingthe use of clinical and functional measurements as a parameterfor the study of effects of corrective treatments and prevention of postural deformities and mechanical knee alterations of elderly with osteoarthritis of the knee.

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Se presenta la segunda parte de un artículo publicado en julio de 1990. Se sigue la evolución durante 14 años y se cuenta que ha pasado durante este tiempo. se hace énfasis en el valor de un nuevo programa de ejercicios en el manejo de la artrosis y se evalúan los resultados obtenidos que se califican de muy buenos.

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Objetivo: Valorar un programa de rehabilitación integral de 6 meses de duración en gonartrosis mediante un estudio descriptivo, prospectivo, autocontrolado.Pacientes: Treinta y nueve mujeres con edad promedio de 57 años (variación 47-65) con gonartrosis unilateral y bilateral en 24 (61 por ciento) y 15 (39 por ciento) respectivamente.Medidas efectuadas: Velocidad de marcha, dolor con EVA, fuerza muscular isométrica de cuadríceps con diagrama de cuerpo libre, disminución de peso, gasto metabólico por sesión de ejercicio aeróbico, cuantificación del consumo de analgésicos. Métodos utilizados: Alineación articular, disminución de carga articular, incremento de absorbentes de carga, fortalecimiento de cuadríceps, acondicionamiento físico y enseñanza de protección articular. Resultados: Se incrementó la velocidad de la marcha inicial de 1.15 m/s en promedio a 1.29m/s a expensas de mayor longitud del paso; la disminución de peso en promedio alcanzó 7 por ciento en las pacientes con sobrepeso y/o obesidad; la fuerza muscular isométrica de cuadríceps se incrementó en 75 por ciento a los 3 meses y 120 por ciento a los 6 meses; el uso de analgésicos disminuyó de 3 tomas al día a 1 sola dosis en 54 por ciento de los casos, a 2 dosis en 15 por ciento y 31 por ciento dejaron de usarlo. Se consideró al programa con excelentes resultados en 30 por ciento de los casos, 35 por ciento como buenos, 25 por ciento regulares y 10 por ciento malos. Conclusiones: Es aconsejable que los programas de rehabilitación sean de tipo integral, tratando de modificar el mayor número de variables, ya que la gonartrosis es un problema cuya evolución depende de varios factores y su tratamiento no debería descansar sólo en medicación analgésica.

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