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Wang S, Sha P, Zhao X, Tao Z, Liu S. Peritendinous adhesion: Therapeutic targets and progress of drug therapy. Comput Struct Biotechnol J 2024; 23:251-263. [PMID: 38173878 PMCID: PMC10762322 DOI: 10.1016/j.csbj.2023.11.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Peritendinous adhesion (PA) is one of the most common complications following hand surgery and characterized with abnormal hyperplasia of connective tissue and excessive deposition of extracellular matrix. Subsequently, various clinical symptoms such as chronic pain, limb dyskinesia and even joint stiffness occur and patients are always involved in the vicious cycle of "adhesion - release - re-adhesion", which seriously compromise the quality of life. Until present, the underlying mechanism remains controversial and lack of specific treatment, with symptomatic treatment being the only option to relieve symptoms, but not contributing no more to the fundamentally rehabilitation of basic structure and function. Recently, novel strategies have been proposed to inhibit the formation of adhesion tissues including implantation of anti-adhesion barriers, anti-inflammation, restraint of myofibroblast transformation and regulation of collagen overproduction. Furthermore, gene therapy has also been considered as a promising anti-adhesion treatment. In this review, we provide an overview of anti-adhesion targets and relevant drugs to summarize the potential pharmacological roles and present subsequent challenges and prospects of anti-adhesion drugs.
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Affiliation(s)
| | | | | | - Zaijin Tao
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Hanghai Jiao Tong University School of Medicine, Shanghai 200233, China
| | - Shen Liu
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Hanghai Jiao Tong University School of Medicine, Shanghai 200233, China
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Rodrigues M, Barbosa RI, Neves LMS, Kuriki HU, Gonçalves ECD, Santos ARS, Dutra RC, Marcolino AM. Therapeutic ultrasound ameliorates hyperalgesia and edema on CFA-induced persistent inflammatory response in mice. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2023; 73:626-634. [PMID: 36075468 PMCID: PMC10533980 DOI: 10.1016/j.bjane.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The present study investigated the effects of pulsed and continuous ultrasound (USP and USC) in edema and hyperalgesia after chronic inflammatory process induced by Complete Freund's Adjuvant-CFA and analyzing the relationship of the application frequency of ultrasound, in pro- and anti-inflammatory cytokine production. METHODS Forty-five animals were divided into 9 groups; all animals from groups 2 to 9 were subjected to a persistent inflammation model induced by CFA in mice. We report the effects and the underlying action mechanisms of USP and USC in the animals which were irradiated two, three or five times a week on the left hind paw. The analyses performed in this study were: evaluation of hind paw edema through the plethysmometer, evaluation of thermal hyperalgesia through withdrawal test using a water container at 44.5°C (± 0.5°C), and the plantar region of the left paw which was removed for analysis of cytokines. RESULTS Our results showed that USP and USC consistently reduced paw edema, and pulsed ultrasound showed a higher significant effect than the continuous mode. Moreover, groups with irradiation frequency of five times a week presented an inhibition of the edema, and groups with frequency of three or two times a week reduced mainly hyperalgesia, in comparison with the control group. The beneficial effects of the US then seem to be associated with upregulation of anti- and pro-inflammatory mediators, such as IL-10 and IL-6, respectively. CONCLUSION This study provided evidence that ultrasound constitutes an important non-pharmacological intervention for the management of inflammatory and pain states.
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Affiliation(s)
- Mariana Rodrigues
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Ciências da Reabilitação, Departamento de Ciências da Saúde, Laboratório de Avaliação e Reabilitação do Aparelho Locomotor, Araranguá, SC, Brazil
| | - Rafael I Barbosa
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Ciências da Reabilitação, Departamento de Ciências da Saúde, Laboratório de Avaliação e Reabilitação do Aparelho Locomotor, Araranguá, SC, Brazil
| | - Lais M S Neves
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Ciências da Saúde, Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Ribeirão Preto, SP, Brazil
| | - Heloyse U Kuriki
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Ciências da Reabilitação, Departamento de Ciências da Saúde, Laboratório de Avaliação e Reabilitação do Aparelho Locomotor, Araranguá, SC, Brazil
| | - Elaine C D Gonçalves
- Universidade Federal de Santa Catarina, Centro Araranguá, Departamento de Ciências da Saúde, Laboratório de Autoimunidade e Imunofarmacologia, Araranguá, SC, Brazil
| | - Adair R S Santos
- Universidade Federal de Santa Catarina, Centro de Ciências Biológicas, Departamento de Ciências Fisiológicas, Laboratório de Neurobiologia da Dor e Inflamação, Florianópolis, SC, Brazil
| | - Rafael C Dutra
- Universidade Federal de Santa Catarina, Centro Araranguá, Departamento de Ciências da Saúde, Laboratório de Autoimunidade e Imunofarmacologia, Araranguá, SC, Brazil
| | - Alexandre M Marcolino
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Ciências da Reabilitação, Departamento de Ciências da Saúde, Laboratório de Avaliação e Reabilitação do Aparelho Locomotor, Araranguá, SC, Brazil.
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de Sousa ACT, da Rocha ÍBP, de Carvalho AFM, de Freitas Coelho NPM, Feitosa MCP, Barros EML, Arisawa EALS, de Amorim MRL. Comparative Study Between Low Level Laser and Therapeutic Ultrasound in Second Intention Ulcers Repair in Mice. J Lasers Med Sci 2018; 9:134-138. [PMID: 30026899 DOI: 10.15171/jlms.2018.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: An ulcer is an injury that affects the skin and has many causes. Healing is a way of protecting the body against any infectious agent that tries to infect you through the wound. Low level laser (LLL) in the treatment of ulcers, aims at maintaining the stability of the physiological process of tissue repair and ultrasound (US) acts by increasing the elasticity of tissue and scarring. The aim of this study was to analyze the effects of LLL and US in wound healing of ulcers induced in mice. Methods: In this experimental study, a sample of 36 guinea pigs was divided into 6 groups of 6 mice, 2 groups as control (C7) and (C14), 2 treated with laser (GL7) and (GL14) and the others 2 treated with ultrasound (GU7) and (GU14). The ulcer was induced and after 7 days, 6 mice from each group were sacrificed to obtain the histological sections for analysis, and the remaining 6 mice from each group continued under treatment and in day 14, they were sacrificed to obtain histologic specimens while macroscopic image was also carried out. Results: Three aspects were analyzed, the percentage of wound regression where it was observed that there was a significant difference in the first 7 days. Regarding the inflammatory process, it was observed that in the first 7 days GL7 and GU7 improved significantly and within 14 days of the experimental period GU14 showed a significant difference when compared to C14. The number of fibroblasts present in the GL at 7 days showed a significant difference compared to the others, and at 14 days, the US group had a significant difference compared to the other groups. Conclusion: Thus, it was evident that the US had more effective results with anti-inflammatory action, better organization and increased deposition of collagen and fibroblasts. Therefore, it can be concluded that other studies are consistent with this taking into account the laser must be used during the early days of the initial healing process and the US during the end of this process.
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Affiliation(s)
- Aline Carla Teles de Sousa
- Graduates of Physical Therapy, Integral Diferencial College (DeVry/FACID), R. Veterinário Bugija Brito, 1354 - Horto Florestal Teresina - PI, Brazil
| | - Ítalo Bruno Paiva da Rocha
- Graduates of Physical Therapy, Integral Diferencial College (DeVry/FACID), R. Veterinário Bugija Brito, 1354 - Horto Florestal Teresina - PI, Brazil
| | - Ana Flávia Machado de Carvalho
- PhD in Biometrics Engineering, Vale do Paraíba University (UNIVAP). Prof. PhD. depute of Integral Diferencial College (DeVry/FACID). R. Deputado Afonso Gil, 5498, Santa Lia, Teresina - PI, Brazil
| | | | | | - Esmeralda Maria Lustosa Barros
- Specialist in Applied Microbiology Science Health, Federal of Piauí University (UFPI). Av. Joaquim Ribeiro, 1291 - Centro. CEP: 64.001-480 Teresina - PI, Brazil
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Montgomery L, Elliott SB, Adair HS. Muscle and Tendon Heating Rates with Therapeutic Ultrasound in Horses. Vet Surg 2015; 42:243-9. [DOI: 10.1111/j.1532-950x.2013.01099.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 12/01/2011] [Indexed: 11/27/2022]
Affiliation(s)
- Leslie Montgomery
- Department of Large Animal Surgery; University of Tennessee Equine Medical Center; Knoxville, Tennessee
| | - Sarah B. Elliott
- Department of Large Animal Surgery; University of Tennessee Equine Medical Center; Knoxville, Tennessee
| | - H. Steve Adair
- Department of Large Animal Surgery; University of Tennessee Equine Medical Center; Knoxville, Tennessee
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Geetha K, Hariharan NC, Mohan J. Early ultrasound therapy for rehabilitation after zone II flexor tendon repair. Indian J Plast Surg 2014; 47:85-91. [PMID: 24987210 PMCID: PMC4075224 DOI: 10.4103/0970-0358.129629] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In our Institute, most of the patients treated for hand injuries were industrial workers with poor compliance. For rehabilitation after zone II flexor tendon repair, we had tried various early mobilization protocols. As these protocols demanded a degree of commitment from the patients, our results were suboptimal. Hence, to improve the results, we implemented a new rehabilitation protocol by administering the pulsed ultrasound therapy during the early phase of tendon healing. MATERIALS AND METHODS This is a prospective study done over a period of five years from January 2008 to January 2013. A total of 100 patients and 139 digits with zone II flexor tendon injuries were studied. After randomization, we administered pulsed ultrasound therapy of different frequencies and intensities for a total of 72 patients and 99 digits and formulated three groups. The results of ultrasound treated cases were compared with each other and with the results of cases treated by immobilization protocol. The results were analyzed using 'Original Strickland' criteria. RESULTS 72% excellent-good results in ultrasound (Group 1) protocol, 75% excellent-good results in ultrasound (Group 2) protocol, and 77% excellent-good results in ultrasound (Group 3) protocol were achieved. There was no case of rupture in the first two groups. The rupture rate was 7% in ultrasound (Group 3) protocol. Only 25% excellent-good results were obtained in the immobilization protocol. CONCLUSION After zone II flexor tendon repair, pulsed ultrasound therapy during the early rehabilitation phase is safe and effective. The results are comparable to early mobilization protocols.
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Affiliation(s)
- Krishnamurthy Geetha
- Department of Plastic and Reconstructive Surgery, Institute for Research and Rehabilitation of Hand, Govt. Stanley Hospital, Chennai, Tamil Nadu, India
| | - Narayanan Chandramouli Hariharan
- Department of Plastic and Reconstructive Surgery, Institute for Research and Rehabilitation of Hand, Govt. Stanley Hospital, Chennai, Tamil Nadu, India
| | - Jagannathan Mohan
- Department of Plastic and Reconstructive Surgery, Institute for Research and Rehabilitation of Hand, Govt. Stanley Hospital, Chennai, Tamil Nadu, India
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Kavaguchi De Grandis A, Boulocher C, Viguier E, Roger T, Sawaya S. Ultrasonograph and clinical quantitative characterization of tendinopathy by modified splitting in a goat model. ScientificWorldJournal 2012; 2012:472023. [PMID: 22997496 PMCID: PMC3444857 DOI: 10.1100/2012/472023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 07/16/2012] [Indexed: 12/03/2022] Open
Abstract
A tendinopathy is a clinical condition characterized by activity-related pain, focal tendons tenderness, and intratendinous imaging changes. This study characterizes a surgically induced tendinopathy in a goat model with a noninvasive in vivo longitudinal followup based on physical examination and US. Cross-sectional area (CSA) is the most objective feature for the evaluation of tendinopathy in correlation with clinical findings. The deep digital flexor tendon (DDFT) of the left hind limb of six goats was isolated and scarified by a modified splitting. Pain and lameness at walk and trot were evaluated. External width and thickness of tendon region were measured by calipers. CSA and the ratio lesion/tendon CSA were obtained at days 0, 7, 21, 42, and 84 by US. The highest value of global functional score was obtained at day 7, then decreased until day 40 and was not significantly different from day 0 at the end of the study. The external width recovered a normal value at the end of the study, but the external thickness was still significantly increased (P < 0.05). Peritendinous oedema was observed at day 7, but intratendinous lesions were visible only at day 21 as a focal hypo to anechoic area. At day 84, two tendons still presented visible lesions. US examination was reproducible, specific, and provided complementary information to the global functional score. A standardized focal tendinopathy was induced in goats. This experimental model of focal tendinopathy could be used to study the effect of different treatments.
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Affiliation(s)
- A Kavaguchi De Grandis
- Université de Lyon et VetAgro Sup, Campus Vétérinaire de Lyon, UPSP ICE, 69280 Marcy l'Etoile, France.
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Abstract
Ultrasound is a therapeutic agent commonly used to treat sports-related musculoskeletal conditions, including tendon injuries or tendinopathy. Despite the widespread popularity of therapeutic ultrasound, few clinical studies have proved its efficacy. Several animal studies have been conducted to explore its effectiveness. In addition, a number of in vitro studies investigating the mechanisms underlying the ability of this physical modality to enhance tendon healing or to treat tendinopathy are in progress. There is strong supporting evidence from animal studies about the positive effects of ultrasound on tendon healing. In vitro studies have also demonstrated that ultrasound can stimulate cell migration, proliferation, and collagen synthesis of tendon cells that may benefit tendon healing. These positive effects of therapeutic ultrasound on tendon healing revealed by in vivo and in vitro studies help explain the physiologic responses to this physical modality and could serve as the foundation for clinical practice.
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Effect of Pulsed Electromagnetic Fields on Human Tenocyte Cultures From Supraspinatus and Quadriceps Tendons. Am J Phys Med Rehabil 2011; 90:119-27. [DOI: 10.1097/phm.0b013e3181fc7bc7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khanna A, Friel M, Gougoulias N, Longo UG, Maffulli N. Prevention of adhesions in surgery of the flexor tendons of the hand: what is the evidence? Br Med Bull 2009; 90:85-109. [PMID: 19395470 DOI: 10.1093/bmb/ldp013] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Despite advances in knowledge and refinements of technique, the management of flexor tendon injuries within the digital sheath continues to present a formidable challenge. This in turn has led to a massive expansion in search of modified surgical therapies and various adjuvant therapies, which could prevent adhesion formation without compromising digital function. SOURCES OF DATA A search of PubMed, Medline, CINAHL and Embase databases was performed using the keywords 'tendon adhesion prevention', 'tendon healing', 'adhesion prevention in tendons' and 'adjuvants for adhesion prevention'. Studies detailing the use of surgical, pharmacological and non-pharmacological agents for adhesion prevention in digital flexor tendons were identified, and their bibliographies were thoroughly reviewed to identify further related articles. This search identified 41 studies, which investigated the use of various pharmacological agents in adhesion prevention in digital tendons. AREAS OF AGREEMENT There is a need to develop and utilize an optimal method for the prevention of adhesions in the flexor tendons of the hand, due to post-surgical complications. AREAS OF CONTROVERSY Even though there have been significant advances in the prevention of adhesions in flexor tendons, it remains to be proved which, if any, of the current methods are the most beneficial. GROWING POINTS The only thing that appears clinically justified in adhesion prevention is the need for early post-operative mobilization of digits after tendon injury or repair but the best method of mobilization remains controversial. AREAS TIMELY FOR DEVELOPING RESEARCH Suggested changes in surgical techniques and various proposed pharmacological and non-pharmacological modalities need to withstand the test of adequately powered human trials, before their justification for potential benefit in clinical practice is accepted.
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Affiliation(s)
- Anil Khanna
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London E1 4DG, UK
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