Carlos Romero Morales

Ultrasound evaluation of intrinsic plantar muscles and fascia in hallux valgus: A case-control study.

AbstractA cross-sectional area (CSA) and thickness reduction of the abductor hallucis (AbH) is shown in subjects with hallux valgus (HV). To date, other soft-tissue structures have not been researched in relation with HV. The aim of this study was to compare the CSA and thickness of the intrinsic plantar muscles and fascia (PF) between feet with and without HV. Therefore, a cross-sectional and case-control study was performed using B-mode with an iU22 Philips ultrasound system and a 5 to 17-MHz transducer. The CSA and thickness were measured for the AbH, flexor digitorum brevis (FDB) and flexor hallucis brevis (FHB), and also the thickness for the anterior, middle, and posterior PF portions. A convenience sample of 40 feet, 20 with HV and 20 without HV, was recruited from a clinical and research center. A multivariate regression analysis using linear regression was performed to evaluate the ultrasound imaging measurements (&agr; = 0.05). Consequently, statistically significant differences were observed between the groups (P < 0.05) for the AbH and FHB thickness, and CSA reduction, and also the plantar fascia thickness increase in favor of the HV group. On the contrary, the FDB thickness and CSA did not show statistically significant differences (P ≥ 0.05). In conclusion, the CSA and thickness of the AbH and FHB intrinsic plantar muscles are reduced, whereas the thickness of the anterior, middle, and posterior PF portions are increased, in subjects with HV compared with those without HV.

Interrater Reliability in the Clinical Evaluation of Myofascial Trigger Points in Three Ankle Muscles

OBJECTIVE The purpose of this study was to evaluate interrater reliability in the diagnosis of myofascial trigger points (MTrPs) in the tibialis anterior, peroneus brevis, and extensor digitorum longus muscles. METHODS A reliability research study was performed. Three physical therapists with clinical experience in myofascial pain functioned as raters and randomly and bilaterally evaluated the ankles of 40 subjects in the Madrid public health care system. The absence or presence of MTrPs, nodules in taut bands, patterns of referred pain, local twitch response (LTR), and jump-sign were evaluated. RESULTS We calculated the pairwise interrater agreement and κ-value concordance of the presence or absence of trigger points (55%-85%; κ = 0.12-0.60), palpable nodules in taut bands (63%-90%; κ = 0.24-0.60), referred pain (63%-85%; κ = 0.20-0.54), and jump sign (62%-89%; κ = 0.15-0.72) in the 3 studied muscles. The LTR could only be evaluated in the tibialis anterior (43%-70%; κ = 0.05-0.21), and evaluation was not possible for the other muscles. CONCLUSIONS Three blinded raters were able to reach acceptable pairwise interrater agreement (percentage of agreement value ≥70%) for the presence or absence of MTrPs and LTR in the tibialis anterior, as well as for nodules in taut bands, referred pain, and the jump sign for the extensor digitorum longus. The peroneus brevis showed a wide percentage of agreement value, ranging from 31% to 82%. The results of this study showed that expert raters can agree, with slight-to-moderate concordance, with regard to the clinical testing of muscle trigger points by direct palpation of the 3 muscles studied: the tibialis anterior, the extensor digitorum longus, and the peroneus brevis. Interrater reliability seems to be muscle dependent, especially with regard to the depth of the muscle.

Ultrasonography Comparison of Peroneus Muscle Cross-sectional Area in Subjects With or Without Lateral Ankle Sprains

OBJECTIVE The purpose of this study was to quantify the cross-sectional area (CSA) of the peroneus brevis, the peroneus longus, and connective tissue; to compare these measures in participants with and without lateral ankle sprains (LAS); and to determine the intraexaminer reliability of the protocol used to acquire these measures. METHODS A cross-sectional case-control study was undertaken. B-mode ultrasound imaging was performed to measure the resting CSA and circular perimeter of the muscles and connective tissue and the total area and ratio between the CSA of the peroneus longus and the peroneus brevis. The imaging was performed for 56 feet, 28 with LAS and 28 without LAS (the mean numbers ± SD of total LAS, grade-I LAS and grade-II LAS were 4.1 ± 3.6, 2.71 ± 3.2, and 1.39 ± 0.9, respectively). A univariate correlation analysis using Pearson (r) and the Kendall tau_b (τB) coefficients was performed to evaluate the ultrasound imaging measurements (α = 0.05). RESULTS Statistically significant differences (P < .05) were observed between the 2 groups, with a moderate negative correlation for the circular perimeter of the peroneus longus (P = .001; r = -0.444) and a weak association for the CSA of the peroneus longus (P = .002; τB = - 0.349), the ratio between the CSA of the peroneus longus and the peroneus brevis (P = .008; τB = -0.293), and the circular perimeter of connective tissue (P = .013; τB = -0.277). CONCLUSIONS The peroneus longus CSA is reduced in participants with LAS compared with that in participants without LAS. The intraexaminer reliability of the ultrasonography protocol was excellent when quantifying the peroneus brevis and the peroneus longus muscle tissues and acceptable when quantifying connective tissue.

Safety and effectiveness of cantharidin-podophylotoxin-salicylic acid in the treatment of recalcitrant plantar warts.

The aim of our study was to evaluate the efficacy and safety of topical cantharidin–podophylotoxin–salicylic acid (CPS) treatment of recalcitrant plantar warts (RPW). This study was carried out in a health center in the city of A Coruña (Spain) between January and December 2013. A total of 75 patients completed all the stages of the research process. Information related to treatment with CPS and adverse effects was abstracted from medical records. Of 93 potential patients identified, 75 had at least one follow‐up visit or telephone call after treatment and were included in this study. Patients experienced an average of 5.4 visits until complete resolution of their plantar wart occurred, although CPS was not applied at every visit. Fifty‐four patients required one application to eliminate the wart and 21 patients required two applications/patient. Seventy‐seven percent of patients experienced blistering – an expected therapeutic side effect. All patients experienced some form of an adverse event, the most common being pain (81.3%) and significant blistering (15%). Other side effects were rare (18.7%) and included pruritus, possible mild infection, significant irritation, and bleeding. All patients reported treatment, supporting our results that CPS is a safe and efficacious treatment modality for RPW and should be considered when symptomatic infection necessitates treatment.

The concurrent validity and reliability of the Leg Motion system for measuring ankle dorsiflexion range of motion in older adults

Background New reliable devices for range of motion (ROM) measures in older adults are necessary to improve knowledge about the functional capability in this population. Dorsiflexion ROM limitation is associated with ankle injuries, foot pain, lower limb disorders, loss of balance, gait control disorders and fall risk in older adults. The aim of the present study was to assess the validity and reliability of the Leg Motion device for measuring ankle dorsiflexion ROM in older adults. Methods Adescriptive repeated-measures study was designed to test the reliability of Leg Motion in thirty-three healthy elderly patients older than 65 years. The subjects had to meet the following inclusion and exclusion criteria in their medical records: older than 65 years; no lower extremity injury for at least one year prior to evaluation (meniscopathy, or fractures) and any chronic injuries (e.g., osteoarthritis); no previous hip, knee or ankle surgery; no neuropathic alterations and no cognitive conditions (e.g., Alzheimer’s disease or dementia). Participants were recruited through the person responsible for the physiotherapist area from a nursing center. The subjects were evaluated in two different sessions at the same time of day, and there was a break of two weeks between sessions. To test the validity of the Leg Motion system, the participants were measured in a weight-bearing lunge position using a classic goniometer with 1° increments, a smartphone with an inclinometer standard app (iPhone 5S®) with 1° increments and a measuring tape that could measure 0.1 cm. All testing was performed while the patients were barefoot. The researcher had ten years of experience as a physiotherapist using goniometer, tape measure and inclinometer devices. Results Mean values and standard deviations were as follows: Leg Motion (right 5.15 ± 3.08; left 5.19 ± 2.98), tape measure (right 5.12 ± 3.08; left 5.12 ± 2.80), goniometer (right 45.87° ± 4.98; left 44.50° ± 5.54) and inclinometer app (right 46.53° ± 4.79; left 45.27° ± 5.19). The paired t-test showed no significant differences between the limbs or between the test and re-test values. The test re-test reliability results for Leg Motion were as follows: the standard error of the measurement ranged from 0.29 to 0.43 cm, the minimal detectable difference ranged from 0.79 to 1.19 cm, and the intraclass correlation coefficients (ICC) values ranged from 0.97 to 0.98. Conclusions The results of the present study indicated that the Leg Motion device is a valid, reliable, accessible and portable tool as an alternative to the classic weight-bearing lunge test for measuring ankle dorsiflexion ROM in older adults.

Comparison of hand grip strength and upper limb pressure pain threshold between older adults with or without non-specific shoulder pain

Background There is a high prevalence of non-specific shoulder pain associated with upper limb functional limitations in older adults. The purpose of this study was to determine the minimal clinically important differences (MCID) of grip strength and pressure pain threshold (PPT) in the upper limb between older adults with or without non-specific shoulder pain. Methods A case-control study was carried out following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. A sample of 132 shoulders (mean ± SD years) with (n = 66; 76.04 ± 7.58) and without (n = 66; 75.05 ± 6.26) non-specific pain were recruited. The grip strength and PPT of the anterior deltoid and extensor carpi radialis brevis (ECRB) muscles were assessed. Results There were statistically significant differences (mean ± SD; P-value) for anterior deltoid PPT (2.51 ± 0.69 vs 3.68 ± 0.65, kg/cm2; P < .001), ECRB PPT (2.20 ± 0.60 vs 3.35 ± 0.38 kg/cm2; P < .001) and grip strength (20.78 ± 10.94 vs 24.63 ± 9.38 kg; P = .032) between shoulders with and without non-specific pain, respectively. Discussion The MCID of 1.17 kg/cm2, 1.15 kg/cm2 and 3.84 kg were proposed for anterior deltoid PPT, ECRB PPT and grip strength, respectively, to assess the upper limb of older adults with non-specific shoulder pain after treatment. In addition, univariate and multivariate (linear regression and regression trees) analyses may be used to consider age distribution, sex, pain intensity, grip strength and PPT in older adults including clinical and epidemiological studies with non-specific shoulder pain.

Tendinopatía aquilea y ejercicio excéntrico, una revisión narrativa

Objectives: The main objective of this bibliographical review is to know the most effective application according to the science of eccentric exercise (EE) when it comes to managing Aquilles Tendinopathy (AT). The secondary objectives are to know the differences between the sexes when receiving the treatment of eccentric exercise in the AT and to know the mechanism of action of EE in the AT. Methods: A literature search was made in the PubMed database. The following terms were used: “Tendinopathy”, “Tendinopathy treatment”, “Tendinopathy eccentric” “Tendinopathy eccentric exercise”, “Achilles tendinopathy”, “Achilles tendinopathy treatment”, “Achilles tendinopathy rehabilitation”, “Achilles tendinopathy physical therapy”, “Achilles tendinopathy exersice”, “Achilles tendinopathy eccentric”. We selected articles that provided methodological quality, scientific relevance, or a novel vision. Results: We found articles that support the application of EE as a treatment for AT and the recommended dosage. We found several articles that theorize about the effects of EE on AT. An article was found that differentiates the effects of EE in men and women in AT. Conclusions: EE is the treatment of choice in AT. The Alfedson protocol has the most scientific support. In the future it will be necessary to carry out studies of higher methodological quality on different exercise options. It is not clear what are the mechanisms of EE action in the TA. It is shown that the effects of EE in women are limited compared to men.

Efficacy of quadriceps vastus medialis dry needling in a rehabilitation protocol after surgical reconstruction of complete anterior cruciate ligament rupture

Background: Several new rehabilitation modalities have been proposed after anterior cruciate ligament (ACL) reconstruction. Among these, trigger point dry needling (TrP-DN) might be useful in the treatment of myofascial pain syndrome associated with ACL reconstruction to reduce pain intensity, increase knee flexion range and modify the mechanical properties of the quadriceps muscle during late-stage rehabilitation. To date, this is the first randomized clinical trial to support the use of TrP-DN in the early rehabilitation process after ACL reconstruction. The aim of this study was to determine the pain intensity, range of motion (ROM), stability, and functionality improvements by adding quadriceps vastus medialis TrP-DN to the rehabilitation protocol (Rh) provided to subacute ACL reconstructed patients. Methods: This randomized, single-blinded, clinical trial (NCT02699411) included 44 subacute patients with surgical reconstruction of complete ACL rupture. The patients were randomized into 2 intervention groups: Rh (n = 22) or Rh + TrP-DN (n = 22). Pain intensity, ROM, stability, and functionality were measured at baseline (A0) and immediately (A1), 24 hours (A2), 1 week (A3), and 5 weeks (A4) after the first treatment. Results: Comparing statistically significant differences (P ⩽ .001; Eta2 = 0.198–0.360) between both groups, pain intensity (at A1), ROM (at A1, A2, and A3), and functionality (at A2, A3, and A4) were increased. Nevertheless, the rest of measurements did not show significant differences (P > .05). Conclusion: Quadriceps vastus medialis TrP-DN in conjunction with a rehabilitation protocol in subacute patients with surgical reconstruction of complete ACL rupture increases ROM (short-term) and functionality (short- to mid-term). Although there was an increase in pain intensity with the addition of TrP-DN, this was not detected beyond immediately after the first treatment. Furthermore, stability does not seem to be modified after TrP-DN.

Effectiveness of median nerve neural mobilization versus oral ibuprofen treatment in subjects who suffer from cervicobrachial pain: a randomized clinical trial

Introduction Oral ibuprofen (OI) and median nerve neural mobilization (MNNM) are first line treatments for patients who suffer cervicobrachial pain (CP). OI may produce side effects which are not tolerated by all subjects who suffer CP, whereas MNNM has no known side effects. Therefore, the aim of this study was to assess the effectiveness of both treatments (OI vs. MNNM) in CP. Material and methods This investigation was a blinded parallel randomized clinical trial (NCT02593721). Sixty-two participants diagnosed with CP were recruited and randomly assigned to 2 groups (n = 31), which received MNNM or 1200 mg/day OI treatment for 6 weeks. The numeric rating scale for pain intensity was the primary outcome. The cervical rotation range of motion (CROM) and the upper limb function were the secondary outcomes. Results The results showed that OI treatment (η2 = 0.612–0.755) was clearly superior to MNNM (η2 = 0.816–0.821) in all assessments (p < 0.05) except for the CROM device results, which were equivalent to those of the MNNM group (p > 0.05). Three subjects were discharged because of OI side effects. Conclusions Oral ibuprofen may be superior to MNNM for pain reduction and upper limb function increase of subjects with CP. Nevertheless, both treatments were effective. Median nerve neural mobilization may be considered an effective non-pharmaceutical treatment option in subjects with CP. Regarding OI adverse effects, our findings challenge the role of pharmacologic versus manual therapy as possible treatments that may improve pain intensity and upper limb functionality in subjects with CP.