DASH Scale Research Articles

Using an Autograft from the Fibula Diaphysis in the Surgical Treatment of Patients with Fractures of the Proximal Humerus on the Background of Critical Osteoporosis

The frequency of unsatisfactory results of surgical treatment of patients with a fracture of the proximal humerus remains high and is up to 40 %. This is primarily due to the early instability of the metal structure against the background of osteoporosis and as a consequence of non-fusion of the fracture and the formation of a false joint. The aim of the study was to evaluate the effectiveness and safety of a new surgical method for treating patients with a fracture of the proximal humerus against the background of critical osteoporosis. After the approval of the local ethics Committee, 2 groups of 10 patients were formed in the clinic: the patients of main group were operated by the proposed method; the group of clinical comparison was operated by the standard method. In all clinical cases, fractures of the proximal humerus were consolidated on control radiographs. VAS assessment the pain syndrome in the early postoperative period showed that there were no statistically significant differences in the shoulder joint area in the groups. Three months after surgery, when assessing the volume of movement in the shoulder joint (without the participation of the scapula), there was a statistically significant improvement in the main group: abduction – by 35° and external rotation – by 25° (p<0.05). When assessing the range of motion of the operated shoulder joint using the ASES scale, a statistically significant improvement was observed in the main group by 11.6 points after 3 months after surgery. According to the assessment of the patient›s functional recovery according to the DASH scale, the indicators in the main group were statistically significantly better, which indicates a complete recovery of the shoulder joint function. Thus, the use of the proposed new method, in comparison with other known technologies for surgical treatment of fractures of the proximal humerus, allows achieving a more rigid and stable fixation of bone fragments in the aftermath of trauma and the presence of regional osteoporosis.

Anterior Shoulder Instability with Type IX Superior Labral Anterior to Posterior (SLAP) Lesion–about a Clinical Case

Lesions of the superior labrum anterior to posterior (SLAP) are often associated with repetitive movements of the shoulder above the head or traumatic history. Types V to X lesions are much rarer, and their prevalence has not yet been described in the literature. In this regard, we report the clinical case of a 34-year-old man, who reported multiple episodes of anterior dislocation of the right shoulder, which he reduced on its own. The patient described onset of instability after a fall with the upper limb in extension and abduction, 2 years before presentation to the authors. An arthro-magnetic resonance was performed that showed a rupture of the upper labrum that extending through the anterior to posterior region reaching the lower edge of the glenoid, with damage to the cartilage at the anterior portion of the glenoid. Surgical treatment was proposed, with di-agnostic arthroscopy and arthroscopic suture of the labrum using anchors. Four years after surgery, the patients presented with no pain complaints, without new episodes of dislocation. At physical examination, he presented a symmetrical range of motion, negative apprehension tests and negative rotator cuff strength tests. In the assessment of symptoms on the DASH scale, pre-surgery the patient obtained a score of 39.2, and four years later scored 1.6. In summary, although rare, extensive SLAP lesions are cause of significant morbidity for the patient and cause of accelerated degenera-tion of the glenohumeral joint, so surgical treatment, preferably arthroscopic, is recommended, with good clinical results.

Partial Tears of the Pectoralis Major Muscle

Summary. Partial tear of the pectoralis major muscle (PMM) is an extremely rare injury, but it needs to be studied.
 Objective: to carry out a comparative analysis of the clinic, diagnosis and treatment of patients with complete and partial tears of the PMM.
 Materials and Methods. A retrospective analysis of 9 patients with partial tears of the PMM who underwent surgical and conservative treatment at the Department of Microsurgery and Reconstructive Surgery of Upper Extremity of the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine” (Kyiv) from 2008 to 2018 was performed. The mean age of patients with partial tear of the PMM was 37.4±10.8 years (16 to 42 years); 8 were males and 1 was female. The follow-up period after surgical or conservative treatment was 12±2.8 months. The greatest number of injuries occurred during the bench press exercises – 55.6% (5 patients); on the uneven bars – 22.2% (2 patients) and in everyday life – 22.2% (2 patients).
 Results. Follow-up examination revealed that 55.6% (5 patients) had injuries of tendon-muscle transition IIC, 33.3% (3 patients) – of tendon part II D, and 11.1% (1 patient) – of muscle II B according to the Cordasco 2020 classification. All the patients deny taking steroids to increase muscle mass. Surgical treatment was performed within 10-643 days after the injury. Two operated on patients had acute injuries (up to 8 weeks after the trauma), and 3 had chronic injuries (more than 8 weeks after the trauma). The results on both the Quick DASH scale and the Subjective Evaluation of Patients with Pectoralis Major Muscle Injuries Questionnaire were negative in both groups during initial treatment. One year after the treatment, excellent and good results were observed in the operated on group; the conservative group showed unsatisfactory results. We did not note any complications after surgical interventions in operated on group of patients.
 Conclusions. Partial tears of the PMM require more careful differentiation and additional examination methods. Physically active patients with isolated tears of the PMM need surgical treatment. Such treatment gives excellent and good results, while conservative treatment – unsatisfactory. Due to the small number of patients in our study, partial PMM tears require further investigation.

Correlation of scapulothoracic muscle strength and functional activity in volleyball players

<p class="abstract"><strong>Background:</strong> Volleyball is the game in which upper extremities are mostly involved. This game needs repeated forceful high-speed upper limb activities required during training sessions and matches; which are reported to high incidence of shoulder injuries. This study is to correlate scapulothoracic muscle strength and functional activity in volleyball players.</p><p class="abstract"><strong>Methods:</strong> Study is cross sectional; correlational study was done with convenient sampling. Sample size was 55. Subjects were selected from all over Pune. Scapulothoracic muscles strength was measured (using the handheld dynamometer) in volleyball players which fitted in the inclusion and exclusion criteria and filled disabilities of the arm, shoulder and hand (DASH) scale by every participant included in study. Correlated evaluated data using spearman rho method.</p><p class="abstract"><strong>Results: </strong>Study shows that all muscle carry good strength. Statistical analysis shows no significance, p value for all tested muscle is (p>0.05). Also DASH scale shows lesser score which indicates lesser difficulty to do functional activities.</p><p class="abstract"><strong>Conclusions: </strong>This study proves that there is no correlation between scapulothoracic muscle strength and functional activity in volleyball players.</p>

Transcultural reliability and validity of an Italian language version of the Constant–Murley Score

Purpose: The present study was designed to carry out an Italian translation of the Constant–Murley Score (CMS-IT) and, subsequently, evaluate its reliability and validity. Methods: This study included adults diagnosed with any type of clinical shoulder dysfunction who could read and respond to the questionnaires. Those individuals who underwent surgeries of any kind on the affected shoulder during the previous 12 months and individuals with shoulder instabilities were excluded. All of the participants were evaluated by two operators, and the CMS-IT, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and visual analog scale (VAS) were administered. The internal consistency was evaluated using Cronbach’s α, whereas the intra-rater and inter-rater reliabilities were evaluated using the intraclass correlation coefficient (ICC). The validity of the construction was evaluated using Pearson’s correlation coefficient between the scores of the administered scales. Results: A population of 72 individuals participated in this study. The internal consistency of the CMS-IT showed a value of 0.81. The ICC values showed that inter- and intra-rater reliability were 0.994 and 0.963, respectively. CMS-IT is inversely correlated with the VAS (−0.55) and DASH (−0.47) scales. Conclusions: This study revealed that the CMS-IT contained good internal consistency and good reliability. The results suggested that the CMS-IT questionnaire is a reliable and valid tool for assessing the shoulder dysfunctions of the Italian population, and it deserves broad applications in both clinical practice and research contexts. The scale can also be used as an alternative to the current “gold standard” VAS and DASH.

Assessment of the effects of kinesio-taping in addition to conventional physiotherapy methods on upper extremity functions, quality of life and emotional state in patients with chronic rotator cuff syndrome

Aim: Shoulder joint is important for the functional capacity of the upper extremity. A big part of the functionality in this joint is created by rotator cuff muscles. Rotator cuff injuries are the primary reason for shoulder induced pain and injuries. The purpose of this study is to assess the effects of kinesio-taping in addition to conventional physiotherapy methods on upper extremity function, quality of life and emotional state in patients with chronic rotator cuff syndrome. Material and Method: Our study was conducted on 92 (64 female-28 male) patients with rotator cuff syndrome (RCS). The patients were randomly grouped in two. The first group was given conventional therapy, while kinesio taping was applied to the second group twice a week in addition to conventional physiotherapy techniques. Each patient was assessed before and after treatment with DASH (the disabilities of the arm, shoulder and hand) scale, SF-36 (short form-36) scale, VAS (visual analogue scale) score and BECK depression inventory. Each group was compared in terms of treatment efficiency both within the group and with the other group and statistical analyses were made. Results: Statistically significant decrease was found in both groups in terms of both pre-treatment and post-treatment DASH and VAS assessments. SF-36 scores were found to increase statistically significantly. When post-treatment scores were compared, statistically significant difference was found between the two groups. No statistically significant difference was found in both groups in terms of BECK depression inventory scores. Conclusion: It was concluded that when applied in addition to conventional physiotherapy techniques in clinic, kinesio taping treatment was an effective treatment method in terms of developing upper extremity functions, increasing quality of life in patients and decreasing pain.

Effect of Cognitive Behavioral Therapy on Functional Outcomes in Patients with Stroke

Upper extremity impairment is a common motor deϑicit after a stroke, and 30– 60% of stroke sufferers have disability and inability to use their affected upper extremity in their daily lives. Stroke survivors with cognitive dysfunctions are most likely to be dependent in activities of daily living. Further deterioration is possible as a result of limitation in activities. Psychiatric problems are also common among stroke survivors. This may delay recovery process and further impair cognitive function due to adaptations to unhealthy lifestyles or noncompliance to rehabilitation. Cognitive behavioral training (CBT) increase blood supply to 20% of different brain areas, and facilitation of internancial neurons activity. Cognitive behavioral training (CBT) act as Incentive therapy focuses on active participation, self-esteem, motivational features such as score keeping, and competition. The ultimate objective of physiotherapy is for patients to return to full independence and their former occupations.The purpose of this study was to investigate the effect of cognitive behavioral training on functional outcomes in stroke patients.Forty stroke patients from both sexes participated in this study 20 patients for each group. Random distribution for patients to 2 groups; Group (A) exposed cognitive behavioral therapy for 60 min and selected physical therapy program for 30 min, every other day for 24 sessions, total duration of session (90 min). Control group (B) received the same selected physical therapy program for 60 min, every other day for 24 sessions total duration of session (60 min). Changing in affected upper extremity motor impairment were measured (Dash scale, Wolf scale and Jammar hand dynamometer). The result of our study was improvement of motor functions were signiϑicantly greater in the study group than the control group (p=0.0001).

Comperative outcomes of the patients undergoing percutaneous and open trigger finger release

The aim of this study was to compare patients who underwent open or percutaneous trigger finger release in terms of clinical outcomes, time to return to activities, and recurrence. The records of patients who underwent percutaneous and open trigger finger release between 2012 and 2018 at two different hospitals in the same city were retrospectively reviewed. The patients were divided into two groups: 33 patients who underwent percutaneous trigger finger release (Group PR) and 48 patients who underwent open release of A1 pulley (Group OR). The clinical classification of cases was done according to the Quinnell classification. The functional outcomes of the patients were evaluated according to the Quick DASH scale. The mean age of the patients was 55.95 ± 11.73 (27–82) years; 71.6% (n = 58) were female. The left side was involved in 56.8% (n = 46) patients, and 81 patients underwent percutaneous or open trigger finger release with a mean follow-up duration of 37.40 ± 16.22 (12–72) months. The time to start daily activities was shorter in Group PR than in Group OR, and the difference was statistically significant (p < 0.001). A comparison of the upper extremity functional scores between the two groups revealed no statistically significant difference (PR; 15.21 ± 6.17, PO; 12.99 ± 6.89, p = 0.142). Although the rate of complications was higher in Group OR, there was no statistically significant difference between the two groups (PR; 12.12%, PO: 20.83%, p = 0.217). Percutaneous trigger finger release can be preferred in adult trigger finger surgery due to increased risks regarding wound healing and infections associated with advanced age, presence of diabetes and inflammatory arthritis, and the expectation of rapid return to daily activities.

Comparison of virtual reality rehabilitation and conventional rehabilitation in Parkinson’s disease: a randomised controlled trial

ObjectiveTo compare a 6-week virtual reality (VR) rehabilitation programme with a conventional rehabilitation programme in patients with Parkinson’s disease. DesignProspective, single-blinded, randomised controlled trial. SettingOutpatients. ParticipantsFifty-one patients with Parkinson’s disease were assigned at random to a VR rehabilitation programme or a conventional rehabilitation programme. InterventionsBoth programmes ran for 6 consecutive weeks, with a 40-minute session three times per week. Main outcome measuresThe Balance Berg Scale (BBS) was used to measure balance. Secondary outcome measures were: Dynamic Gait Index (DGI) to evaluate ability to adapt gait to complex walking tasks; Disabilities of the Arm, Shoulder and Hand (DASH) scale to measure performance of the upper limb; and Short Form 36 (SF-36) to evaluate quality of life. ResultsThe VR rehabilitation programme led to an increase in BBS score {45.6 [standard deviation (SD) 7.9] vs 49.2 (SD 8.1), mean difference 3.6, 95% confidence interval (CI) 1.3 to 5.9; P=0.003}, DGI score [18.7 (SD 4.7) vs 20.2 (SD 4.2), mean difference 1.6, 95% CI 0.6 to 2.5; P=0.003] and SF-36 mental composite score [37.7 (SD 11.4) vs 43.5 (SD 9.2), mean difference 5.8, 95% CI 0.4 to 11.3; P=0.037], and a decrease in DASH scale score [29.6 (SD 17.5) vs 21.6 (SD 15.1), mean difference −7.9, 95% CI −13.7 to −2.2; P=0.009]. In contrast, the conventional rehabilitation programme only led to a decrease in DASH scale score [30.3 (SD 18.1) vs 25.1 (SD 15.8), mean difference −5.2, 95% CI −8.8 to −1.5; P=0.007]. ConclusionThese findings suggest that rehabilitation is useful in Parkinson’s disease, and the VR rehabilitation programme was more effective in determining overall improvement than the conventional rehabilitation programme. Clinical trial registration number: NCT02807740.

American Shoulder and Elbow Surgeons Standardized Assessment Form: Russian Cross-Cultural Adaptation and Validation

American Shoulder and Elbow Surgeons Standardized Assessment Form (ASES) is one of the most widely used shoulder outcome reporting measure. However, it has not been validated in the Russian language. Purpose of this study is a cross-cultural adaptation and validation of the ASES. Materials and methods. The group of 93 patients with various shoulder pathology (39 males and 54 females) with median age of 49 years was included into the study. In the first stage the authors performed language and cultural adaptation of the ASES questionnaire to obtain a Russian version maximally matching the original. Further the authors studied the psychometric properties of the questionnaire (reliability, validity, responsiveness), the effects of maximum and minimum values (floor and ceiling effects) and estimated the coefficients of internal consistency of Cronbach’s alpha and reproducibility. 20 patients were selected to assess reproducibility by test-retest method, those patients filled out the ASES questionnaire at first appointment with an orthopedic trauma surgeon and repeatedly in 7 days; the obtained data was evaluated by an intra-class correlation coefficient (ICC). In the framework of the present research the authors assessed the validity of the obtained scale, including the correlation of the scores of the examined questionnaire with the scores by the DASH questionnaire validated in the Russian Federation to check criteria validity. Results. The study resulted in obtaining the assessment scale fully matching the original ASES version with minor linguistic and cultural features. The ASES median results was Me = 68.7 [32.6; 93.8]; no maximum and minimum scores were obtained. The Russian version of the questionnaire has good psychometric properties with internal consistency of Cronbach alpha 0.72. The overall intra-class correlation coefficient (ICC) of the ASES questionnaire was 0.95 (p0.05). There were no statistically significant differences between the general group and the test-retest group by gender, age and type of shoulder pathology. Correlation coefficient obtained in the scope of the present research between the ASES and DASH scales was 0.9, and the GRI index was 2.8. Conclusion. Russian version of the ASES questionnaire has good psychometric properties and may be recommended to evaluate functional status of patients with shoulder joint pathology and treatment dynamics.

Assessment of effectiveness of intra articular autologous platelet rich plasma injection in the management of adhesive capsulitis of shoulder joint

Background: It was reported that platelet rich plasma injection is effective in the management of pain in adhesive capsulitis. Platelet rich plasma injection has multiple uses in the field of medical sciences. Objectives: The present study was undertaken to observe the effectiveness of intra articular autologous platelet rich plasma injection in the management of adhesive capsulitis of shoulder joint. Methods: The present study involved 30 patients within the age group of 30 to 60 years of age were included. Both males (n=12) and females (n=18) were present in the study. DASH score and visual analogue scores were assessed in the patients with 8 weeks follow up. Data was collected pre injection, post injection after four weeks. Results: There was a significant decrease in the scores of DASH and Visual analogue scale scores followed by the intervention.

First experience of arthroscopic treatment of patients with false joint of the middle third scaphoid bone of the hand

Introduction. Fractures of the scaphoid bone are the most frequent among wrist bone fractures and in 10 15% of cases they end with the development of a false joint. The pain is a restriction of movements in the wrist joint, a decrease in the strength of the hand, significantly limiting the working capacity of patients, as a rule, of young and middle age. In recent years, arthroscopic techniques have been widely used to treat non-union scaphoid in the middle third of the rook. Experience in the treatment of false joints of the scaphoid with the use of arthroscopic techniques in the N.N. Priorov National Medical Research Center of Traumatology and Orthopaedics is presented in this review.&#x0D; Aim of Study: studying the effectiveness of arthroscopy during the healing of the non-union of the scaphoid bone. &#x0D; Material and methods. In the department of microsurgery and hand injuries. NN. Priorova Ministry of Health of the Russian Federation from 2015 to 2018. 28 patients were treated with non-union scaphoid bone localized in the middle third of the bones body. The clinical examination included: measurement of movements in the wrist joint, the strength of the fist grasp; assessment of pain syndrome on a visual analogue scale (VAS), data from the DASH questionnaire; X-ray of the carpal joint in three projections (straight, lateral, ), computed tomography. &#x0D; Results. Consolidation of the non-union scaphoid was achieved in 24(86%) patients within 8 weeks after surgery. Consolidation did not occur in 4 (14%) patients.&#x0D; Long-term results 6 months after surgery were followed up in 15 patients. The range of motion in the wrist joint was an extension of 68 (from 45 to 90), the volume of active flexion of the hand, respectively,66 (from 55 to 90. Pain syndrome on a visual analogue scale (VAS) 1.5points (from 1 to 3 points). Fist grasp strength 6 months after surgery was 41 kg (from 25 to 57 kg). DASH scale after surgery 10.5 points (from 5.5 to 16.3 points).&#x0D; Conclusion. Arthroscopic resection of the pseudarthrosis of the middle third of the bone with the plastic of the crushed spongy bone autograft from the ileal wing allows for consolidation of the scaphoid bone within 8 weeks. The first experience testifies to the effectiveness of this method and the need for further research in this direction, the analysis of long-term results.

Effect of Physiotherapy Protocol on Post Burn Upper Limbs' Function

Introduction: Burns of the hand have devastating consequences not only for the functional outcome but also for the esthetic appearance. Post burn functional disabilities of the upper extremity are better prevented than treated. Aim: this study aimed to evaluate the effect of physiotherapy protocol on upper limbs’ function post burn. Design: A quasi-experimental (time series) design submitted to meet the aim of the study. Subjects: A purposive sample of 27 male and female adult patients with 2nd degree burn in hand assigned in the current study which was carried out in Burn Department and its outpatient clinic of General hospital at Minia city. Tools: Four tools were utilized to collect data of this study; demographic questionnaire, Disabilities of the Arm, Shoulder and Hand Scale (DASH), Manual Muscle testing, and Vancouver Scar Assessment Scale (VSS). Results: Twenty seven adult 2nd degree burned patients with mean age 36.0 ± 11.22 are included in the study. Gradual improvement of the upper limbs' function measured through DASH scale was observed after application of physiotherapy protocol, this appear through significant decrease in complain from severe dysfunction among 25.9% after 2 months to 0% after 6 months; significant increase in muscle force (22.2%, 59.3%) and prominent improvement of burn scar measured by VSS. Conclusions: The data suggest that the upper limbs' function post burns can be improved by preventive nursing interventions including early range of motion, anti-contracture positioning and splinting of hand which has positive effects on burn scar. Recommendations: regular training programs to keep nurses in burn units updated with the evidence-based practices and array interventions for reducing burn scar and improving limbs' function and therefore patients' productivity.

Radial forearm free flap in head and neck cancer treatment: may dermal substitutes have a role in minimizing the donor site morbidity?

Head and neck cancer treatment often involves the need for extensive soft tissues removal and a subsequent reconstructive phase in order to close the defect. Free flap reconstruction is a safe and effective reconstructive option in head and neck surgery. The radial forearm free flap (RFFF) has been widely used as a reliable reconstructive solution as it provides thin soft tissues, particularly useful to reconstruct the oral cavity and other head and neck regions. The donor site defect resulting after the free flap harvesting inevitably needs to be managed as it can potentially lead to complications or functional and aesthetic impairment. Several closure techniques of the donor site have been described, and among these, two of the most frequently used are the full-thickness skin graft (FTSG) and the cellular dermal matrix (ADM). The aim of this study was to compare the donor site functional morbidity and aesthetic outcomes in two cohorts of patients treated with FTSG and ADM after RFFF reconstruction for head and neck cancer. Two groups were treated with Integra (group 1) and FTSG (group 2), to manage the radial free flap donor site after head and neck reconstruction. The patients were evaluated with patient self-assessment scale (P-SAS) and observer self-assessment scale (O-SAS) after 1 year and with the disabilities of the arm, shoulder, and hand (DASH) score. A total of 21 patients, aged between 52 and 84 years (mean, 72.3 years) underwent RFFF reconstruction after head and neck cancer resection during the study period. The P-SAS showed an average score of 21.3 in group 1 and 8.3 in group 2 while the O-SAS registered an average score of 18.8 and 9.7, respectively, without statistically significant differences. The DASH scale showed an average score of 28.7 in group 1 and 13.1 in group 2, reaching a statistically significant value (p = 0.5). No significant statistical difference in terms of aesthetic outcomes between the use of Integra and FTSG was recorded. The DASH score results suggest that the Integra reconstructive strategy seemed to be associated with the better overall final result when compared with that in the FTSG group. The dermal substitute appeared to provide a faster healing time and can be safe and effective also for wide defects. In our study, we can conclude that the use of the dermal substitute when dealing with RFFF donor site repair can be considered more pleasant both from subjective and objective points of view when compared to the FTSG alone. Level of evidence: Level IV, therapeutic study.

EFFICACY OF THE REHABILITATION PLAN BASED ON THE THEORY OF MUSCULAR SPIRALS IN PATIENTS WITH SCAPULOHUMERAL PAIN SYNDROME ACCORDING TO SHEAR WAVE ELASTOGRAPHY DATA

The scapulohumeral pain syndrome (frozen shoulder) is an umbrella term for various pathological conditions characterized by pain and limited range of motion in the shoulder joint that considerably reduces a person’s ability to work and impairs the quality of life. The most common etiological factors are: load on the muscles of the shoulder girdle, traumatic injuries of the shoulder joint in patient’s history and overstretching and partial tearing of the ligaments of the shoulder joint, vertebral radiculopathy with the development of reflex and dystrophic disorders in the corresponding muscles, ligaments and joint capsule. The goal of our work was to compare the efficacy of the rehabilitation plans based on standard approaches and rehabilitation plans based on the theory of muscle spirals in patients with the severe pain syndrome and scapulohumeral periarthritis. Materials and methods. We studied 98 patients with scapulohumeral periarthritis. At the first stage of the treatment, all patients received a medical blockade in sites of marked inflammation of para-articular structures. Then, the patients were divided into 2 groups: the patients of group I received a standard rehabilitation in accordance with the recommended regimens using physiotherapy and exercise therapy. The patients of group II took the patient-centred rehabilitation course based on the theory of muscle spirals and the complex effect on spastic muscles. Pain intensity was assessed by visual analogue scale and DASH scale, muscle stiffness was evaluated by compression and shear wave elastography. Results and conclusions. The dynamic changes of pain reduction in patients of group II demonstrated the significant intensity of pain, and a rapid restoration of joint function. The findings of shear wave elastometry showed no difference between the stiffness of the shoulder muscles in the group II after the course of rehabilitation and healthy muscles. Thus, the use of patient-centred rehabilitation plans based on the theory of muscle spirals and a complex effect on spastic muscles enables to achieve a more pronounced effect compared to the standard rehabilitation approaches.

Evaluation of the efficacy of ropivacaine injection in the anterior and middle scalene muscles guided by ultrasonography in the treatment of Thoracic Outlet Syndrome.

A clinical, placebo-controlled, randomized, double-blind trial with two parallel groups. to evaluate the efficacy of ropivacaine injection in each belly of the anterior and middle scalene muscles, guided by ultrasonography, in the treatment of Nonspecific Thoracic Outlet Syndrome (TOS) compared to cutaneous pressure. 38 patients, 19 in the control group (skin pressure in each belly of the anterior and middle scalene muscles) and 19 in the intervention group (ropivacaine). Subjects with a diagnosis of Nonspecific Thoracic Outlet Syndrome, pain in upper limbs and/or neck, with no radiculopathy or neurological involvement of the limb affected due to compressive or encephalic root causes were included. The primary endpoint was functionality, evaluated by the Disabilities of the Arm, Shoulder, and Hand - DASH scale validated for use in Brasil. The time of the evaluations were T0 = before the intervention; T1 = immediately after; T2 = 1 week; T3 = 4 weeks; T4 = 12 weeks; for T1, the DASH scale was not applied. Concerning the DASH scale, it is possible to affirm with statistical significance (p> 0.05) that the intervention group presented an improvement of functionality at four weeks, which was maintained by the 12th week. In practical terms, we concluded that a 0.375% injection of ropivacaine at doses of 2.5 ml in each belly of the anterior and middle scalene muscles, guided by ultrasonography, in the treatment of Nonspecific Thoracic Outlet Syndrome helps to improve function.

Therapeutic Alliance in a Single Versus Group Rehabilitative Setting After Breast Cancer Surgery: Psychological Profile and Performance Rehabilitation.

The survival rate of women after breast cancer has improved significantly worldwide. More attention should be paid to the rehabilitation intervention after surgery. Cancer rehabilitation helps breast cancer survivors maintain the highest possible physical, social, psychological, and vocational function in the limits that are imposed by the cancer and its treatments. The aim of our research was to determine the rehabilitative setting that promotes greater efficacy of the rehabilitation. A double-blind, randomized controlled trial with 45 patients enrolled was conducted. All participants were randomized into two groups: single rehabilitative training (N = 22) and group rehabilitative training (N = 23). Outcomes were assessed for each group before treatment (T0), after first 6 weeks of rehabilitative treatment (T1), and after 3 months (T2). All patients underwent the same rehabilitation treatment, but the setting differed between single and group rehabilitative training, which included four to five patients each and evaluated using Minnesota Multiphasic Personality Inventory (MMPI-2), Working Alliance Inventory Patient form (WAIP), Disabilities of Arm, Shoulder and Hand Questionnaire (DASH), and visual analog scale (VAS). Two patients dropped out in the single treatment group. In the within-group analysis at the three evaluation times, on the VAS, a significant reduction in pain was reported and maintained at the follow-up, as was observed for the DASH and WAIP scales. In the between-group analysis WAIP and Bond scale scores differed significantly in favor of the single treatment. In the group treatment, the Psychopathic Deviate, Masculine/Feminine, and Social Discomfort scales of the MMPI-2 correlated with WAIP Tot at T1. There was an association between the Correction, Hysteria, Paranoid, and Schizophrenia MMPI-2 scales and Δ VAS T0T1 in the total sample. Proposing the same rehabilitative intervention in both breast cancer groups, our results showed significant reduction in pain and good functional recovery of the upper limb, which did not depend on the setting (single or group). However, with single rehabilitation treatment, patients developed a better therapeutic alliance and experienced a more comfortable environment.

Tendon Subluxation After Surgical Release of the First Dorsal Compartment in De Quervain Disease.

We aimed to determine whether dorsoulnar incision elevating radial flap and immobilization for the treatment of de Quervain disease have an advantage over simple midline incision and early mobilization, respectively, in terms of tendon subluxation and clinical outcomes. Forty-six patients with de Quervain disease were randomly divided into 2 groups (midline incision vs dorsoulnar incision) and 2 subgroups (immobilization vs early mobilization). Subluxation of intracompartmental tendons was measured in dynamic wrist positions at 12 and 24 weeks using ultrasonography. The DASH (Disabilities of the Arm, Shoulder, and Hand) and visual analog scale scores and grip and pinch strengths were evaluated. At 24 weeks, the tendons were displaced voloradially in wrist volar flexion (1.25 mm in midline incision vs 0.36 mm in dorsoulnar incision, P = 0.001), whereas the tendons were displaced dorsoulnarly in wrist extension (0.95 mm in midline incision vs 1.78 mm in dorsoulnar incision, P = 0.041). There were no significant differences in tendon displacement between early mobilization and immobilization groups. Clinical outcome measures showed no variation between the groups, and no significant correlation occurred with tendon subluxation. Dorsoulnar incision and postoperative immobilization do not have advantage over midline incision and early mobilization, respectively. However, tendon subluxation after release of the first dorsal compartment for de Quervain disease does not affect clinical outcomes.

Prevalence of Myofascial Trigger Points in Poststroke Patients With Painful Shoulders: A Cross-Sectional Study.

In patients with stroke, hemiplegic shoulder pain can be a major problem. One source of shoulder pain can be myofascial trigger points (MTrPs). To determine the prevalence of myofascial trigger points (MTrPs) and the correlation between MTrPs and pain and function in patients presenting with shoulder pain following a stroke. Cross-sectional study. Department of Physical Therapy. Fifty patients with stroke with shoulder pain. Not applicable. The prevalence of the MTrPs located in infraspinatus, supraspinatus, teres minor, and upper trapezius was studied, using the diagnosis criteria recommended by Simons et al. The pressure pain threshold was also evaluated. Pain and function were assessed with the Visual Analogue Scale (VAS) and the Disability of the Arm, Shoulder and Hand (DASH) scale, respectively. The prevalence of latent MTrPs was 68%, 92%, 40%, and 62% for supraspinatus, infraspinatus, teres minor, and upper trapezius muscle, respectively. The prevalence of active MTrPs was 34%, 50%, 12%, and 20% for supraspinatus, infraspinatus, teres minor, and upper trapezius muscle, respectively. Pain was moderately correlated with the prevalence of latent MTrPs (r = 0.35; P = .01) and active MTrPs (r = 0.31; P = .03) in the supraspinatus muscle. Disability was measured with the DASH scale and was moderately correlated with latent MTrPs in the infraspinatus (r = 0.31; P = .03) and active MTrPs of the supraspinatus (r = 0.32; P = .02). This study shows that the prevalence of MTrPs is high in patents following a stroke. MTrPs in this population are moderately associated with pain and function. II.

Correlación entre el acortamiento de la clavícula con la función de la extremidad torácica en pacientes operados por fractura de clavícula

Introduction The collarbone is the only bone that joins the axial skeleton with the appendicular, during the function of the thoracic limb a shortening implies a decrease in strength and function since it acts as a lever, where the greater the shortening, the smaller will be the force produced. Factors such as multifragmentation, bone loss and reabsorption of the edges of the fragments are some limiting to the restitution of the clavicular length. How much might a shortening of the collarbone affect the function of the upper limb? Material and methods A retrospective and non-probabilistic cross-sectional study was conducted in surgically treated clavicular fracture patients. Shortening was measured in millimeters on postoperative X-Ray, dash scale was subsequently applied to determine the degree of function. Results 12 patients, average age 37 ± 17.7 years. 2 women and 10 men. 5 on the right side and 7 left side. Statistical analysis was performed with Pearson correlation coefficient. Average shortening 13.32 ± 9.9 mm. Average scale of DASH 6.0 ± 3. Discussion Moderate correlation with limitation in function in shortenings 1 cm, as well as clinical significance on the DASH scale from 6 points, 4 less than what the literature marks. With this, it can be determined that patients managed with or without surgery, with a shortening 1 cm will have a considerable limitation in the function of the shoulder and upper limb.