Ejercicio para el Síndrome de Dolor Patelofemoral (SDPF) / Exercise for treating patellofemoral pain syndrome

Fuente
Este artículo es originalmente publicado en:
 http://www.ncbi.nlm.nih.gov/pubmed/25603546
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010387.pub2/abstract
De:
van der Heijden RA¹, Lankhorst NE, van Linschoten R, Bierma-Zeinstra SM, van Middelkoop M.
 Cochrane Database Syst Rev. 2015 Jan 20;1:CD010387. doi: 10.1002/14651858.CD010387.pub2.
Todos los derechos reservados para:
Copyright © 1999–2015 John Wiley & Sons, Inc. All Rights Reserved

Abstract

BACKGROUND:
Patellofemoral pain syndrome (PFPS) is a common knee problem, which particularly affects adolescents and young adults. PFPS, which is characterised by retropatellar (behind the kneecap) or peripatellar (around the kneecap) pain, is often referred to as anterior knee pain. Thepain mostly occurs when load is put on the knee extensor mechanism when climbing stairs, squatting, running, cycling or sitting with flexed knees.Exercise therapy is often prescribed for this condition.

OBJECTIVES:
To assess the effects (benefits and harms) of exercise therapy aimed at reducing knee pain and improving knee function for people with patellofemoral pain syndrome.

SEARCH METHODS:
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (May 2014), the Cochrane Central Register of Controlled Trials (2014, Issue 4), MEDLINE (1946 to May 2014), EMBASE (1980 to 2014 Week 20), PEDro (to June 2014), CINAHL (1982 to May 2014) and AMED (1985 to May 2014), trial registers (to June 2014) and conference abstracts.

SELECTION CRITERIA:
Randomised and quasi-randomised trials evaluating the effect of exercise therapy on pain, function and recovery in adolescents and adults with patellofemoral pain syndrome. We included comparisons of exercise therapy versus control (e.g. no treatment) or versus another non-surgical therapy; or of different exercises or exercise programmes.

DATA COLLECTION AND ANALYSIS:
Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. Where appropriate, we pooled data using either fixed-effect or random-effects methods. We selected the following seven outcomes for summarising the available evidence: pain during activity (short-term: ≤ 3 months); usual pain (short-term); pain during activity (long-term: > 3 months); usual pain (long-term); functional ability (short-term); functional ability (long-term); and recovery (long-term).

MAIN RESULTS:
In total, 31 heterogeneous trials including 1690 participants with patellofemoral pain are included in this review. There was considerable between-study variation in patient characteristics (e.g. activity level) and diagnostic criteria for study inclusion (e.g. minimum duration of symptoms) and exercise therapy. Eight trials, six of which were quasi-randomised, were at high risk of selection bias. We assessed most trials as being at high risk of performance bias and detection bias, which resulted from lack of blinding.The included studies, some of which contributed to more than one comparison, provided evidence for the following comparisons: exercise therapy versus control (10 trials); exercise therapy versus other conservative interventions (e.g. taping; eight trials evaluating different interventions); and different exercises or exercise programmes. The latter group comprised: supervised versus home exercises (two trials); closed kinetic chain (KC) versus open KC exercises (four trials); variants of closed KC exercises (two trials making different comparisons); other comparisons of other types of KC or miscellaneous exercises (five trials evaluating different interventions); hip and knee versus knee exercises (seven trials); hip versus knee exercises (two studies); and high- versus low-intensity exercises (one study). There were no trials testing exercise medium (land versus water) or duration of exercises. Where available, the evidence for each of seven main outcomes for all comparisons was of very low quality, generally due to serious flaws in design and small numbers of participants. This means that we are very unsure about the estimates. The evidence for the two largest comparisons is summarised here.Exercise versus control. Pooled data from five studies (375 participants) for pain during activity (short-term) favoured exercise therapy: mean difference (MD) -1.46, 95% confidence interval (CI) -2.39 to -0.54. The CI included the minimal clinically important difference (MCID) of 1.3 (scale 0 to 10), indicating the possibility of a clinically important reduction in pain. The same finding applied for usual pain (short-term; two studies, 41 participants), pain during activity (long-term; two studies, 180 participants) and usual pain (long-term; one study, 94 participants). Pooled data from seven studies (483 participants) for functional ability (short-term) also favoured exercise therapy; standardised mean difference (SMD) 1.10, 95% CI 0.58 to 1.63. Re-expressed in terms of the Anterior Knee Pain Score (AKPS; 0 to 100), this result (estimated MD 12.21 higher, 95% CI 6.44 to 18.09 higher) included the MCID of 10.0, indicating the possibility of a clinically important improvement in function. The same finding applied for functional ability (long-term; three studies, 274 participants). Pooled data (two studies, 166 participants) indicated that, based on the 'recovery' of 250 per 1000 in the control group, 88 more (95% CI 2 fewer to 210 more) participants per 1000 recovered in the long term (12 months) as a result of exercise therapy. Hip plus knee versus knee exercises. Pooled data from three studies (104 participants) for pain during activity (short-term) favoured hip and knee exercise: MD -2.20, 95% CI -3.80 to -0.60; the CI included a clinically important effect. The same applied for usual pain (short-term; two studies, 46 participants). One study (49 participants) found a clinically important reduction in pain during activity (long-term) for hip and kneeexercise. Although tending to favour hip and knee exercises, the evidence for functional ability (short-term; four studies, 174 participants; and long-term; two studies, 78 participants) and recovery (one study, 29 participants) did not show that either approach was superior.

AUTHORS' CONCLUSIONS:
This review has found very low quality but consistent evidence that exercise therapy for PFPS may result in clinically important reduction in pain and improvement in functional ability, as well as enhancing long-term recovery. However, there is insufficient evidence to determine the best form of exercise therapy and it is unknown whether this result would apply to all people with PFPS. There is some very low quality evidence that hip plus knee exercises may be more effective in reducing pain than knee exercise alone.Further randomised trials are warranted but in order to optimise research effort and engender the large multicentre randomised trials that are required to inform practice, these should be preceded by research that aims to identify priority questions and attain agreement and, where practical, standardisation regarding diagnostic criteria and measurement of outcome.
PMID: 25603546 [PubMed - in process]

Ejercicio para el Síndrome de Dolor Patelofemoral (SDPF)

31 ensayos heterogéneos, incluyendo 1690 participantes con SDPF fueron incluidos en esta revisión. Siete medidas de resultado fueron incluidas y resumidas a partir de la evidencia disponible: dolor durante la actividad (a corto plazo: ≤ 3 meses); dolor habitual (a corto plazo); dolor durante actividades (a largo plazo; > 3 meses); dolor habitual (a largo plazo); habilidad funcional (a corto plazo); habilidad funcional (a largo plazo); y recuperación (a largo plazo). Fue incluida en esta revisión literatura hasta Junio de 2014.

La evidencia del ejercicio versus control se encuentra a favor de la terapia de ejercicio, siendo esta clínicamente importante a la hora de reducir el dolor durante las actividades y el dolor habitual, en mejoras de la habilidad funcional en corto plazo y largo plazo, e incluso mejores valores en lo que respecta a la recuperación de los síntomas en el largo plazo. La evidencia de la combinación de ejercicios de rodilla y cadera provee una importante reducción clínica del dolor durante la actividad y del dolor habitual en el corto plazo, así como del dolor durante actividades en el largo plazo, comparado con los ejercicios de rodilla por si solos.

Debido a la baja calidad de los estudios, los autores concluyen que más ensayos clínicos aleatorizados debiesen realizarse, incluyendo investigación orientada a, entre otras cosas, establecer estándares de criterios diagnósticos y de medidas de resultados.

> De: Van der Heijden et al., Cochrane Database Syst Rev (2015) (Publ. antes de impresión). Todos los derechos reservados: John Wiley & Sons, Ltd. Pincha aquí para acceder al resumen de Pubmed.. Traducido por Pedro Castex

Fuente
Este artículo es originalmente publicado en:
http://www.raynersmale.com/blog/2015/2/7/lumbar-disc-herniation-with-radiculopathy-a-case-study

Lumbar disc herniation with radiculopathy - a case study

“Sally”, was a 23-year-old Swedish backpacker who presented with a three-month history of low back pain and more recently right leg pain. Sally was referred from the Emergency department to Outpatient Physiotherapy within a large public hospital. She had presented to ED on six occasions since May for worsening pain.

Mechanism of injury

Sally couldn't recall a single event relating to the onset of her back pain. In the weeks prior to developing back pain she had been working casually as a waitress and did find bending over tables a strain. The pain began in her lower back quite centrally and with time is starting radiating straight down the back of her right thigh and into her calf, stopping at the ankle.

Leer el artículo completo aquí 

Shoulder Surgery in Contact Athletes: Decision Making

una publicación de Orthopaedic Principles.

Inserciones distales del tendón semimembranoso: RM con correlación anatómica / Distal insertions of the semimembranosus tendon: MR imaging with anatomic correlation

Fuente
Este artículo es originalmente publicado en:
http://www.ncbi.nlm.nih.gov/pubmed/24549828
http://link.springer.com/article/10.1007%2Fs00256-014-1830-9
http://www.anatomia-fisioterapia.es/es/es/component/content/article/28-articles/systems/musculoskeletal/lower-extremity/knee/1045-las-inserciones-distales-del-tendon-del-semimembranoso
De:
De Maeseneer M¹, Shahabpour M, Lenchik L, Milants A, De Ridder F, De Mey J, Cattrysse E.
Skeletal Radiol. 2014 Jun;43(6):781-91. doi: 10.1007/s00256-014-1830-9. Epub 2014 Feb 19.

Todos los derechos reservados para:
© Springer International Publishing AG, Part of Springer Science+Business Media

Abstract

OBJECTIVE:

The purpose of this study is to investigate the distal insertions of the semimembranosus tendon with MR imaging, correlated with findings in cadavers.

MATERIALS AND METHODS:

Four fresh cadaveric specimens were studied with 3-T MR imaging. Sequences included proton density (PD) sequences (TE, 13; TR, 4957; FOV, 170 × 170; matrix, 424 × 413; NA, 2; slice thickness, 2.5 mm) in the axial, coronal, and sagittal planes and 3D fast field echo (FFE) sequences (TR 9.4; TE 6.9; FOV, 159 × 105; matrix, 200 × 211; NA, 2; slice thickness, 0.57 mm). One specimen was dissected and three specimens were sectioned with a bandsaw in the axial, coronal, and sagittal plane. The sections were photographed and correlated with MR images. To standardize the analysis, the semimembranosus muscle and tendon were assessed at seven levels for the axial sections, and at three levels for the coronal and sagittal sections.

RESULTS:

Anatomic dissection revealed six insertions of the distal semimembranosus tendon: direct arm, anterior arm, posterior oblique ligament extension, oblique popliteal ligament extension, distal tibial expansion (popliteus aponeurosis), and meniscal arm. Axial MR images showed five of six insertions: direct arm, anterior arm, oblique popliteal ligament extension, posterior oblique ligament extension, and distal tibial expansion. SagittalMR images showed four of six insertions: direct arm, anterior arm, oblique popliteal ligament arm, and distal tibial expansion. Sagittal MR images were ideal for showing the direct arm insertion, but were less optimal than the axial images for showing the other insertions. The anterior arm was seen but volume averaging was present with the gracilis tendon. Coronal MR images optimally revealed the anterior arm, although magic angle artifact was present at its posterior aspect. The common semimembranosus tendon and meniscal arm were also well depicted. The division in anterior arm, direct arm, and oblique popliteal ligament arm was poorly seen on coronal images due to volume averaging.

CONCLUSIONS:

Although the anatomy of the distal semimembranosus tendon is complex, six different semimembranosus insertions can be identified on routine proton density and FFE sequences at 3 T. Analysis of images at defined levels in the three imaging planes simplifies MRinterpretation of the anatomy of the distal semimembranosus tendon.

PMID:

 

24549828

 

[PubMed - indexed for MEDLINE]

Las inserciones distales del tendón del semimembranoso

El tendón distal del semimembranoso (SM) es un componente importante del complejo posteromedial. La anatomía del tendón distal del SM es bastante compleja y se han descrito varias inserciones. El propósito de este estudio fue investigar la anatomía de imagen de las diferentes inserciones del tendón distal del SM.

Hablamos en general de seis diferentes inserciones del tendón del SM. 1) la inserción directa; desde el tendón común del SM a la cara posterior de la tibia 1cm por debajo de la articulación. 2) inserción anterior; desde el tendón común del SM desciende posteromedial a la tibia, inserta profundamente al ligamento colateral medial. 3) inserción del ligamento poplíteo oblicuo; desde el tendón común del SM al ligamento poplíteo oblicuo. 4) inserción del ligamento oblicuo posterior; la vaina pasa sobre el tendón del SM a nivel del espacio articular en dirección al ligamento oblicuo posterior. 5) inserción meniscal; desde el SM al ligamento coronario del cuerno posterior del menisco interno. 6) inserción distal; desde la parte distal el tendón del SM al músculo poplíteo.

Las conclusiones del autor dan una idea de la compleja anatomía de imagen del tendón distal del semimembranoso. Se pueden visualizar bien seis inserciones distales del tendón del semimembranoso cuando se combinan los hallazgos de imagen en los tres planos de imagen. Kiné Care (www.msk-ultrasound.com) anima a todos a estudiar este artículo en detalle, ya que contiene gran cantidad de información que podría ser útil para la práctica clínica.

> De: De Maeseneer et al., Skeletal Radiol 43 (2015) 781–791. Todos los derechos reservados: ISS 2014. Pincha aquí para acceder al resumen de Pubmed.. Traducido por Javier Gonzalez Iglesias

Lumbar Osteoarthritis Video

 Fuente
Este artículo es originalmente publicado en:
http://www.arthritis-health.com/video/lumbar-osteoarthritis-video

una publicación de Arthritis-health.

TIEMPO DE LIBERACION DEL TORNIQUETE EN ARTROPLASIA TOTAL DE RODILLA CEMENTADA / TIMING TOURNIQUET RELEASE IN CEMENTED TKA

Fuente
Este artículo es originalmente publicado en:
http://icjr.net/article_120_tourniquet_release.htm#.VOkQiPmG-nB

 Source

Zhang W, Liu A, Hu D, Tan Y, Al-Aidaros, M, Pan Z.  Effects of the timing of tourniquet release in cemented total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research 2014, 9:125  doi:10.1186/s13018-014-0125-0. http://www.josr-online.com/content/9/1/125 © 2014 Zhang et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

una publicación de International Congress for Joint Reconstruction.

Posterior Dislocation Sternoclavicular Classic-Everything You Need To Know - Dr. Nabil Ebraheim

Educational video describing the condition of posterior sternoclavicular joint dislocation.

 Fuente
Este artículo es originalmente publicado en:

http://youtu.be/9A3lU4ndQsc