Effectiveness of physiotherapy in the treatment of excessive lateral pressure syndrome after anterior cruciate ligament reconstruction - preliminary report

BACKGROUND

The excessive lateral pressure syndrome is a common complication following anterior cruciate ligament (ACL) reconstruction is. It may lead to premature wear of the articular surfaces of the femur and patella. The aim of the study was to assess the effectiveness of physiotherapy in the treatment of excessive lateral pressure syndrome after ACL reconstruction.

MATERIAL AND METHODS

A total of 18 patients (4 women, 14 men) after arthroscopic ACL reconstruction were enrolled (age: 16 -54 years). The patients were randomly divided into two groups: experimental (Group E, 9 people), who attended therapy, and control (group C, 9 people). The distance between the lateral edge of the patella and the lateral condyle of femur was measured with an ultrasound scanner in both extremities. The experimental group patients attended 12 treatment sessions of the.Neurac method. A single session lasted 45 minutes.

RESULTS

The baseline examination of both groups showed statistically significant excessive lateral pressure in the operated extremity in relation to the non-operated one in every angular position. At the same time, the quadriceps femoris of the operated extremity was found to be significantly weaker than its counterpart. On completion of the rehabilitation, statistically significant differences in quadriceps strength were recorded in the experimental group compared to the baseline examination while there were no significant differences in the control group. An intergroup comparison did not reveal any significant differences in quadriceps strength. There were also no significant differences in the severity of lateral pressure syndrome before and after the therapy in either group.

CONCLUSIONS

1. Rehabilitation improved quadriceps femoris, strength; it did not, however, decrease excessive lateral pressure syndrome. 2. The rehabilitation programme is not sufficient in conservative treatment of excessive lateral pressure syndrome.

Lateral abdominal muscle size at rest and during abdominal drawing-in manoeuvre in healthy adolescents

Lateral abdominal wall muscles in children and adolescents have not been characterised to date. In the present report, we examined the reliability of the ultrasound measurement and thickness of the oblique external muscle (OE), oblique internal muscle (OI) and transverse abdominal muscle (TrA) at rest and during abdominal drawing-in manoeuvre (ADIM) on both sides of the body in healthy adolescents. We also determined possible differences between boys and girls and defined any factors-such as body mass, height and BMI-that may affect the thickness of the abdominal muscles. B-mode ultrasound was used to assess OE, OI and TrA on both sides of the body in the supine position. Ultrasound measurements at rest and during ADIM were reliable in this age group (ICC3,3 > 0.92). OI was always the thickest and TrA the thinnest muscle on both sides of the body. In this group, an identical pattern of the contribution of the individual muscles to the structure of the lateral abdominal wall (OI > OE > TrA) was observed. At rest and during ADIM, no statistically significant side-to-side differences were demonstrated in either gender. The body mass constitutes between 30% and <50% of the thickness differences in all muscles under examination at rest and during ADIM. The structure of lateral abdominal wall in adolescents is similar to that of adults. During ADIM, the abdominal muscles in adolescents react similarly to those in adults. This study provided extensive information regarding the structure of the lateral abdominal wall in healthy adolescents.

Assessment of the influence of Saunders traction and transcutaneous electrical nerve stimulation on hand grip force in patients with neck pain

BACKGROUND

Spinal pain syndromes are among the most frequent causes of ill health. Long-lasting sustained overload results in a critical decrease in the distance between neighbouring vertebrae and radiation of pain. The aim of this study was to assess the effect of cervical traction and the TENS method on the strength of painless grip and maximum strength of the arm flexors.

MATERIAL AND METHODS

The study included 45 patients with overload-induced cervical pain, ranging in age from 21 to 66 years. The patients underwent a therapy based on the Saunders traction device and the TENS method. The traction force was regulated so that the patient would feel noticeable but painless traction. The TENS procedure was performed using the conventional method. The patients were divided into three groups. The Saunders traction device was used in the first group, transcutaneous electrical nerve stimulation and traction were applied in the second group, while the patients in the third group were received TENS only. Each patient underwent 10 treatment sessions with intervals between sessions not exceeding three days.

RESULTS

The results showed the greatest improvement in the strength of painless hand grip. Maximum strength increased only on the left side in the group which received only the traction treatment.

CONCLUSIONS

The use of the Saunders cervical traction device produced an increase in painless hand grip strength in patients with cervical spine pain. Both treatments had a limited effect on maximum hand grip strength.

Butler’s neuromobilizations combined with proprioceptive neuromuscular facilitation are effective in reducing of upper limb sensory in late-stage stroke subjects: a three-group randomized trial

Question: Are Butler’s neuromobilizations combined with proprioceptive neuromuscular facilitation and traditional post-stroke therapy more effective in reducing affected upper extremity sensory deficits in late-stage stroke subjects than proprioceptive neuromuscular facilitation combined with traditional therapy or traditional therapy alone?

Design: Pretest—posttest three-group randomized clinical experimental design.

Participants: A total of 96 late-stage stroke subjects were randomly assigned to three groups.

Intervention: The therapeutic programme in the control group was based on traditional post-stroke methods. The second group (experimental 1) received in addition individual therapy based on the proprioceptive neuromuscular facilitation method. The third group (experimental 2) received a combination: traditional therapeutic programme plus individual proprioceptive neuromuscular facilitation exercises plus neuromobilization of the affected upper extremity. All groups received 18 training sessions lasting about 45 minutes each.

Outcome measures: Assessment of the two-point discriminatory sense (distance between the tips of the compass when the subject indicated two-point sensation), stereognosia (identification up to 10 objects by touch) and thermaesthesia (using hot and cold cylinders on dermatomes C6—C8) were performed.

Results: Analysis of change scores showed that two-point discriminatory sense for experimental group 2 was significantly better than that in the two other groups (P<0.001). Similar results were registered for thermaesthesia (experimental 2 versus experimental 1 P<0.01; experimental 2 versus control P<0.001). For stereognosia the only significant difference was found between experimental group 2 and the control group (P<0.05).

Conclusion: In our subjects, application of Butler’s neuromobilizations combined with proprioceptive neuromuscular facilitation showed greater effectiveness in reducing sensory deficits than proprioceptive neuromuscular facilitation or traditional therapy alone.

The value of synovectomy of the knee in the treatment of rheumatoid arthritis

The goal of the present study is to evaluate the usefulness of synovectomy of the knee joint in patients with rheumatoid arthritis. Synovectomy of the knee is the most common lower limb operation performed in patients with rheumatoid arthritis. Depending on the stage of the disease, the symptoms, and the degree of intra-articular changes in the radiological image, there are indications for performing both early and late synovectomy. The progress of the disease is not dependent on its duration, but on the aggressiveness and dynamics of the rheumatoid process. The authors present the advantages of early synovectomy, which halts the progress of the disease and protects the joint from destruction. After early synovectomy one obtains an average of 75% good outcomes, while after late synovectomy the percentage of positive outcomes is about 70%. The authors point out the effectiveness and low level of invasiveness of arthroscopic synovectomy, thanks to which the progress of the disease can be checked and monitored. Another possible therapy is chemical synovectomy, with the specific action of radioisotopes: synoviorthosis with laser irradiation. The authors emphasize that an important factor in obtaining good outcome after every synovectomy is rehabilitation, during which the range, frequency of exercise, and physicotherapeutic procedures are established, depending on the stage of advancement of the rheumatoid process.