Alexandre Marcio Marcolino

Comparative effects of wavelengths of low-power laser in regeneration of sciatic nerve in rats following crushing lesion

Peripheral nerves are structures that, when damaged, can result in significant motor and sensory disabilities. Several studies have used therapeutic resources with the aim of promoting early nerve regeneration, such as the use of low-power laser. However, this laser therapy does not represent a consensus regarding the methodology, thus yielding controversial conclusions. The objective of our study was to investigate, by functional evaluation, the comparative effects of low-power laser (660xa0nm and 830xa0nm) on sciatic nerve regeneration following crushing injuries. Twenty-seven Wistar rats subjected to sciatic nerve injury were divided into three groups: group sham, consisting of rats undergoing simulated irradiation; a group consisting of rats subjected to gallium–aluminum–arsenide (GaAlAs) laser at 660xa0nm (10xa0J/cm2, 30xa0mW and 0.06xa0cm2 beam), and another one consisting of rats subjected to GaAlAs laser at 830xa0nm (10xa0J/cm2, 30xa0mW and 0.116xa0cm2). Laser was applied to the lesion for 21xa0days. A sciatic functional index (SFI) was used for functional evaluation prior to surgery and on daysxa07, 14, and 21 after surgery. Differences in SFI were found between group 660xa0nm and the other ones at the 14th day. One can observe that laser application at 660xa0nm with the parameters and methods utilised was effective in promoting early functional recovery, as indicated by the SFI, over the period evaluated.

Assessment of Functional Recovery of Sciatic Nerve in Rats Submitted to Low-Level Laser Therapy with Different Fluences. An Experimental Study

Peripheral nerve lesions caused sensory and motor deficits along the distribution of the injured nerve. Numerous researches have been carried out to enhance and/or accelerate the recovery of such lesions. The objective of this study was to assess the functional recovery of sciatic nerve in rats subjected to different fluences of low-level laser therapy (LLLT). Thirty-six animals were randomly divided into four groups: one consisting of sham rats and three others irradiated with progressive fluencies of 10xa0J/cm2, 40xa0J/cm2 and 80xa0J/cm2 of laser AsGaAl (830xa0nm) for 21 consecutive days. They were evaluated by the Sciatic Functional Index (SFI) method. The crush injury was performed by using a portable device with dead weight of 5,000xa0g whose load was applied for 10xa0min. A digital camera was used to record the footprints left on the acrylic track, before surgery and after, on the 7th, 14th, and 21st days. The results also showed that on the 7th day, there was a difference between the groups irradiated with 40xa0J/cm2, when compared with the sham group (pu2009<u20090.05). On the 14th day the groups irradiated with 40xa0J/cm2 and 80xa0J/cm2 also presented better results when compared with sham, however, on the 21st day, no inter-group difference was found (pu2009>u20090.05). It was possible to observe that the LLLT at fluency of 40xa0J/cm2 and 80xa0J/cm2 had a positive influence on the acceleration of the functional nerve recovery.

Effectiveness of low-level laser therapy for patients with carpal tunnel syndrome: design of a randomized single-blinded controlled trial

BackgroundCarpal tunnel syndrome is the most common neuropathy in the upper extremity, resulting from the compression of the median nerve at wrist level. Clinical studies are essentials to present evidence on therapeutic resources use at early restoration on peripheral nerve functionality. Low-level laser therapy has been widely investigated in researches related to nerve regeneration. Therefore, it is suggested that the effect of low-level laser therapy associated with other conservative rehabilitation techniques may positively affect symptoms and overall hand function in compressive neuropathies such as carpal tunnel syndrome. The aim of this study is to evaluate the effectiveness of low-level laser therapy in addition to orthoses therapy and home orientations in patients with carpal tunnel syndrome.Methods/DesignPatients older than 18u2009years old will be included, with clinical diagnosis of carpal tunnel syndrome, excluding comorbidies. A physiotherapist will conduct intervention, with a blinding evaluator. Randomization will be applied to allocate the patients in each group: with association or not to low-level laser therapy. All of them will be submitted to orthoses therapy and home orientations. Outcome will be assessed through: pain visual analogic scale, Semmes Weinstein monofilaments™ threshold sensibility test, Pinch Gauge™, Boston Carpal Tunnel Questionnaire and two point discrimination test.DiscussionThis paper describes the design of a randomized controlled trial, which aim to assess the effectiveness of conservative treatment added to low-level laser therapy for patients with carpal tunnel syndrome.Trial registrationBrazilian Clinical Trials Registry (ReBec) - 75ddtf / Universal Trial Number: U1111-1121-5184

Should we think about wrist extensor after flexor tendon repair

Objective: To evaluate the activity of wrist extensor muscle, correlating with wrist motion during gripping after flexor tendon repair. Design: Cross-sectional clinical measurement study. Setting: Laboratory for biomechanics and rehabilitation. Subjects: A total of 11 patients submitted to rehabilitation by early passive motion of the fingers with wrist flexion position were evaluated after 8 weeks of fingers flexor tendon repair and 11 healthy volunteers, all ranging from 20 to 37 years of age. Intervention: Volunteers performed an isometric standardized gripping task. Main measures: We used electrogoniometry to analyze wrist range of motion and surface electromyography, considering 100% maximum voluntary contraction to represent the amplitude of electromyographic activity of the extensor carpi radialis and flexor digitorum superficialis. Results: Patients with flexor tendon repair showed co-activation deficit between wrist extensor (extensor carpi radialis) and flexor finger muscles (flexor digitorum superficialis) during gripping in the intermediate phase of rehabilitation, despite some recovering mobility for wrist extension (p ≤ 0.05). A moderate correlation between range of motion and extensor carpi radialis was present only for injured group (r = 0.32). Total active motion score, which represents finger active excursion, was regular or poor in 65% of cases, all with nerve repair associated. Conclusion: Wrist extensors have an important synergist role at handgrip, although some imbalance can be present after flexor tendon repair. These preliminary findings suggest that emphasis could be directed to add synergistic wrist motion in rehabilitation protocols after flexor tendon repair. Future studies with early active rehabilitation are necessary.

Avaliação funcional retrospectiva de pacientes com fratura proximal de úmero fixada com placa com parafusos de ângulo fixo para região proximal no úmero

Proximal humeral fractures are common injuries leading to severe functional restrictions and complications for patients. Today, there are several surgical alternatives aimed at achieving better injury stabilization by means of osteosynthesis techniques, depending on injury severity. One of these is the fixed-angle plate fixation of the proximal humerus. This bone fixation system is intended to preserve the biologic integrity of the humeral head associated with a safe anatomical reduction, employing several fixating screws with angle stability, thereby allowing an early mobilization of the fractured limb. Eleven patients with proximal humeral fractures treated with the method of fixed-angle plate fixation of the proximal humerus in the period of 2004 to 2005 were retrospectively studied. The patients were subjected to the Constant questionnaire and the DASH index for functional assessment. The results showed some residual dysfunction at the upper end after this type of trauma, even using a fixed-angle plate fixation of the proximal humerus, which notably provides a safe fixation, associated to physical therapy.

Influence of volar and dorsal static orthoses in different wrist positions on muscle activation and grip strength in healthy subjects

Introduction Orthoses are indicated for injuries of the wrist, although there is weak evidence for its influence on extensor muscle activation patterns. The purpose of this study was to compare two designs of volar and dorsal wrist orthoses in several positions, from flexion to extension, by surface electromyography wrist extensor muscle activation and grip strength in healthy subjects. Methods We analysed extensor carpi radialis brevis and longus, extensor carpi ulnaris and extensor digitorum comunis muscle activity by surface electromyography. The volunteers performed maximum and submaximum (50%) isometric grips, which were evaluated with a Jamar™ dynamometer using volar and dorsal orthoses with several positions of the wrist (0°, 15° and 30°), both in flexion and extension (pu2009<u20090.05). Results Our results showed a significant decrease in extensor muscle activation at 15° and 30° of wrist extension in both volar and dorsal orthoses at 100% and 50% of maximum task. A decrease was also found at rest at 15° of wrist flexion volar orthoses. Decreased grip strength was found at 15° and 30° of wrist flexion in both volar and dorsal orthoses. Conclusions Based on the results of this sample, we would suggest, as orthotic prescriptions, 15° or 30° wrist extension orthoses as a supporting therapeutic modality for performance in new studies with lateral epicondylitis in association with low-intensity grip activity; or 15° of wrist flexion volar orthoses for rest, depending on the chronicity of the disease and individual assessment. Future studies with symptomatic patients are needed to confirm these findings.

A study to compare two goniometric methods for measuring active pronation and supination range of motion

Introduction Movement of the forearm allows positioning the hand during several functional activities of daily living. Assessing range of motion of supination and pronation is essential for clinical identification of functional limitations, although many methods can be used. Confounding values can be found due to different techniques used by therapists. The purpose of this study was to compare two standard goniometric methods for measuring active range of motion of forearm pronation and supination, aiming to define its reliability and ease of use. Methods The study included 33 individuals, 13 injured and 20 non-injured volunteers. We analyzed two standard goniometric methods for measuring pronation and supination. For the first method, the volunteers had to hold a pencil as a guide for the movable arm of the goniometer and for the second method the movable arm was in contact with the distal dorsal surface of the wrist near the ulna head, and the hand was free. Two trained examiners performed the evaluations. Intraclass correlation coefficient and limits of agreement of Bland and Altman were used to analyze the data. Results Intraclass correlation coefficient values were excellent for both groups and movements at inter-rater and inter-methods comparison. Bland and Altman plots showed that, although excellent reliability, some data dispersion was present. Conclusion These data suggest that both methods could be used in clinical practice with excellent reliability. The goniometric method with the movable arm placed in contact with the distal dorsal surface of the wrist near the ulna head might be easier to perform and useful in cases where finger prehension is absent or weak, which would prevent the use of a pencil as reference.

Influence of the number of layers of paris bandage plasters on the mechanical properties speciments used on orthopedic splints

OBJECTIVEnTo evaluate the effects of varying numbers of layers of plaster of Paris bandages on the mechanical properties of specimens used on the construction of orthopedic splints.nnnMETHODSnRectangular plate-shaped and cylinder-shaped specimens were constructed and assigned to two groups simulating plaster slabs and cast and further divided into six subgroups according to the number of layers used: 3, 6, 8, 10, 12 and 14 layers. The specimens were subjected to either a three-point bending test (plates/slab) or compressive strength test (cylinders/cast). The following mechanical properties were evaluated: maximum load, elastic limit load and stiffness. Specimen weight was also calculated. Data was analyzed using Kruskal-Wallis and the least significant difference (LSD) tests.nnnRESULTSnPairwise comparisons of the subgroups 10x12 and 10x14 revealed significant differences for all mechanical properties (p<0.05). The results of this study suggest that when the goal is to construct appliances with high mechanical strength, regardless of weight, such as serial plaster slabs splints for stimulating tissue growth through the application of gradual load, splints made with plaster of Paris bandages with 12 or 14 layers should be preferred. For orthotic devices such as positioning orthotics, the use of 10 layers plaster bandages slab splints is advisable as they were found to have better correlation between mechanical strength and weight in comparison to those made wtih 6 or 8 layers.nnnCONCLUSIONnBased on the findings of this study, we suggest the use of 10 layers of plaster of Paris for the construction of orthopedic splints.

The influence of different non-articular proximal forearm orthoses (brace) widths in the wrist extensors muscle activity, range of motion and grip strength in healthy volunteers

PURPOSEnThe purpose this study was perform a biomechanical evaluation to compare the influence of commercial models of different non-articular proximal forearm orthoses widths (2.5 cm, 5.5 cm, 7.5 cm and 12.0 cm) in the extensor muscle activation, range of motion and grip strength in healthy subjects.nnnMETHODSnWas analyzed data from extensor carpi radialis, extensor carpi ulnares and extensor digitorum comunis using surface electromyography, simultaneous with a wrist electrogoniometer MiotecTM and a hydraulic dynamometer JamarTM. The sequence of tests with all the commercial orthoses models was randomized. Statistics analyses were performed by linear model with mixed effects.nnnRESULTSnAccording to our findings the non-articular proximal forearm orthoses (2.5 cm - narrowest) positioned close to lateral epicondyle provided lesser muscle activation on extensor carpi radialis brevis/longus and extensor digitorum comunis, decreased wrist extension and grip strength during submaximal grip task (p< 0.01).nnnCONCLUSIONSnA narrow non-articular proximal forearm orthosis positioned close to the lateral epicondyle might decrease the extensor muscle activation and therefore could reduce mechanical stress on its insertion, based on this sample. Clinical studies must be conducted to confirm these findings.

Fatigue of the wrist extensor muscles decreases palmar grip strength

O objetivo deste estudo foi avaliar os efeitos de um protocolo de fadiga dos musculos extensores de punho na forca de preensao e da pinca lateral atraves da dinamometria e eletromiografia de superficie (EMG). Foram selecionados 40 individuos do sexo masculino, divididos em dois grupos: preensao ou pinca lateral. O protocolo de fadiga foi baseado no teste de 1 Repeticao Maxima (1-RM), seguido da realizacao do movimento de extensao de punho repetidas vezes com carga de 75% da 1-RM. Os voluntarios realizaram as tarefas de preensao ou pinca lateral associadas a dinamometria. A EMG foi realizada para ambos os grupos, analisando o comportamento, segundo o protocolo, pela frequencia mediana (FM) do extensor radial do carpo (ERC), do extensor ulnar do carpo (EUC) e do flexor superficial dos dedos (FD). A dinamometria de preensao ou pinca lateral e a EMG foram realizadas antes e apos o protocolo de fadiga para ambos os grupos. O protocolo de fadiga foi eficaz na diminuicao da forca de preensao palmar (43,5±3,85 kgf inicial e 36,50±5,1 kgf final) e da pinca lateral (10,26±1,01 kgf inicial e 8,54±0,86 kgf final), bem como na diminuicao da FM, sugerindo uma condicao de fadiga do EUC no grupo preensao. Os achados do presente estudo possibilitam relacionar a fadiga dos extensores de punho a diminuicao de forca em atividades funcionais, como a preensao, o que pode implicar em disfuncoes musculoesqueleticas do membro superior.| The objective of this study was to evaluate the effects of a wrist extensor muscles fatigue protocol at the handgrip and lateral pinch strength through dynamometry and surface electromyography (EMG). Forty male individuals were divided into two groups: handgrip and lateral pinch group. The fatigue protocol was based on the 1 Maximal Repetition (1-MR) test, followed by wrist extension movement repeated multiple times with a load of 75% of 1-MR. The volunteers performed hand grip and lateral pinch with a dynamometer. Surface EMG was performed by both groups to analyze the behavior of median frequency (MF) during a fatigue protocol. The muscles extensor carpi radialis longus and brevis, extensor carpi ulnaris, extensor digitorum and flexor digitorum superficialis were analyzed. The strength and EMG evaluations were carried out before and after the fatigue protocol in both groups. The fatigue protocol was effective on hand grip strength reduction (43.5±3.85 kgf in baseline and 36.50±5.1 kgf final) and lateral pinch strength reduction (10.26±1.01 kgf in baseline and 8.54±0.86 kgf final) (p<0.05, 95% CI). At the EMG analysis, using median frequency, an ulnaris carpal extensor muscle fatigue at the handgrip group was evidenced. The findings indicate that wrist extensors fatigue can decrease the strength in functional activities such as handgrip, resulting in upper limb dysfunctions.