1,720,981 research outputs found
Ialuronidasi per la rigidità muscolare nella spasticità Hyaluronidase for muscle stiffness in spasticity
Full text linkBackground: Spasticity is a common neurological impairment after injury to the central nervous system, but the neural and biomechanical contributions to it are still poorly understood. Histopathological studies have demonstrated a generalized increase in extracellular connective tissue in spastic muscles, which can decrease its compliance, and reduce the threshold for stimulation of the spindle receptors. Here we propose and provide preliminary evidence for a novel hypothesis for exacerbation of spasticity in an immobilized limb - the hyaluronan hypothesis. We hypothesize that the extracellular connective tissue, which is composed chiefly of hyaluronan, becomes hyper-viscous and stiff in an immobilized limb due to its non-Newtonian properties.
Methods: In this case series, we assessed the safety, tolerability, and efficacy of human recombinant hyaluronidase, which hydrolyzes hyaluronan, in combination with saline in restoring tissue compliance. Twenty-one individuals, with moderate-severe upper limb spasticity affecting more than one joint, received multiple intramuscular injections of hyaluronidase-saline. Adverse effects were monitored over 15 weeks. The Modified Ashworth Scale (MAS) assessed reduction in spasticity while active and passive range of motion was assessed using quantitative video analysis of upper limb movement.
Findings: 21 participants were included. The procedure was well tolerated. Extensive safety monitoring in all patients revealed no clinically significant adverse events at 15 weeks. Treatment seemed to be effective at reducing spasticity in all twenty-one participants who received the injections (p<0.05 in 16 evaluation over 24 in passive ROM and 17 over 24 in active ROM). The measures of motor function (MAS) showed still improvement at 15 months (p=.000).
Interpretations: Subcutaneous administration of hyaluronidase-saline in a multiple sites was fairly safe and well tolerated in adult patients with spasticity; however, these results must be viewed as preliminary until data from blinded, controlled clinical trials are available
Poster 344 Botulinum Toxin Versus Fascial Manipulation Technique in the Treatment of Chronic Facial Pain
No full textDesign: Thirty patients with a diagnosis of chronic facial pain
associated with myofascial syndrome were randomly divided in 2
groups.
Participants: 22 women, 8 men; age range, 23-69 years.
Interventions: 15 subjects (11 women, 4 men; mean age, 44
years) were treated with botulinum toxin injections (group A) and
15 subjects (11 women, 4 men; mean age, 45 years) were treated
with 4 sessions of fascial manipulation technique (group B).
Main Outcome Measures: All the patients were assessed
with the Research Diagnostic Criteria for Temporomandibular
Disorders axis II (intensity of facial pain, limitation of activities of
daily living).
Results: The group A showed a decrease in pain (from 7.0 to 4.8 of
the visual analog scale) and in the masticatory pain (from 3.4 to 1.6).
Moreover, botulinum toxin injections permit quitting habits of
tooth grinding and clenching. There are no adverse effects with
botulinum, further, a “fixed” smile for about 6-8 weeks. In group B,
a reduction of pain intensity was evident (from 6.0 to 2.1). Significant
differences were found in rest pain between preintervention
and both postintervention and 1-month follow-up periods. Besides,
all the participants reported reductions in headache frequency and
intensity over time, although only in the group B was this improvement
statistically significant (88.5%). Surface electromyography
measured a decrease of frequency (V) and amplitude of muscle
activity in both groups but higher in group A.
Conclusions: Results from the present study support the efficacy
of BTX-A and fascial manipulation technique to reduce myofascial
pain symptoms in bruxism, and it is probably that using both the
methods could further improved the outcomes. A larger definitive
trial will be needed to confirm this hypothesis
Ultrasound imaging and Fascial Manipulation®: ‘Adding a twist’ on the ankle retinacula
No full textBackground: Retinacula of the ankle are thickening of the deep fascia of the leg (crural fascia) and foot i.e. inseparable structures. Recent studies report their crucial role in functional stability and proprioception of the ankle. Case presentation: A 38-yr-old Caucasian man -with a history of lateral malleolus fracture 12 years ago, obesity and right ankle osteoarthritis -was referred to a physiatrist for a right ankle pain that had significantly worsened over the last year. During walking, the patient experienced stinging pain in the area of tibialis anterior and peroneus tertius muscles, and the superior extensor retinaculum. Magnetic resonance imaging and ultrasonog-raphy showed clear thicknening (2.05 mm) of the oblique superomedial band of the inferior extensor retinac-ulum. Sonopalpation was performed to precisely evaluate/confirm the site of maximum pain. Foot function index (FFI) score was 42. Results: Subsequently, the patient was prescribed fascial manipulation, and he had clinical improvement after the first session (FFI: 21). At 1-month follow-up, the patient was still asymptomatic without any functional limitation (FFI: 24). US imaging confirmed the decreased thickness of the oblique superomedial band of the extensor retinaculum (1.35 mm). Conclusion: Fascial Manipulation (R) appears to be a useful tool to reduce thickness, stiffness, and pain in this case as displayed by the ultrasound Imaging
Ultrasound imaging and Fascial Manipulation® for rigid retinacula in two cases of complex regional pain syndrome
Full text linkComplex regional Pain Syndrome (CRPS) is a complex disease with articulate impact on the quality of life and its management is challenging. Ultrasound imaging can identify/assess different musculoskeletal structures that might have role in its pathogenesis. We present two cases of CRSP in whom B-mode ultrasonography and sonoelastography showed rigid retinacula associated with the symptomatology. Both patients were also/successfully treated with Fascial Manipulation
Poster 258: A New Treatment for the Ankle Sprain Outcomes
No full textObjective: The authors want to evaluate if specific alterations
of ankle retinacula can be evidenced in patients with
functional ankle instability (3 months) and if treatment
focused on the fascia could restore normal function to the
retinacula.
Design: An in vivo radiologic study by MRI was performed
on 20 patients to evaluate possible damage to the ankle
retinacula.
Setting: In those subjects (11 cases) with an evident alteration
of at least one of the retinacula, static posturography
was quantitatively measured and painful symptoms were
recorded using a specific questionnaire.
Interventions: These subjects were treated by the same
practitioner, according to the methodology of Fascial Manipulation
for 3 treatment sessions.
Main Outcome Measures: Evaluation with static posturography
and the questionnaire was repeated after treatment
and at the 1, 3, 6 months.
Results:: By MRI, the retinacula were clearly visible and
easily evaluated. They appeared as low signal intensity bands
with a mean thickness of 1 mm. In all patients, 4 types of
retinacular alterations were identified. After treatment, a
mean pain reduction of 32.2% was recorded (mean value of
VAS prior: 41/100; after 3: 8.8/100), together with a good
recovery of movement. The initial benefit was generally
maintained (mean value of VAS: 13/100) at a short-term
follow-up. Static posturography showed a significant difference
(P.05) in sway path between the first and the last
evaluation: initial mean sway path (msp) was 7.9 mm/sec and
final msp was 6.9 mm/sec, coinciding with patients’ reports
of an improved sense of balance.
Conclusions: Retinacula could be seen as a specialization
of the fascia for local, spatial proprioception of foot and ankle
movements. Their damage, during ankle sprains, could modify
the lines of forces within the fascia of the foot and leg,
altering the role of the fascial system in peripheral control of
articular motility. Restoring normal tension to the fascia
could improve proprioceptive activity of receptors
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