Navegando por Palavras-chave "Tendinopathy"
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- ItemAcesso aberto (Open Access)Alta dose energética de ultrassom terapêutico no tratamento da tendinopatia patelar: ensaio clínico, controlado e randomizado(Universidade Federal de São Paulo, 2022-06-09) Jesus, Julio Fernandes de [UNIFESP]; Pinfildi, Carlos Eduardo [UNIFESP]; Cook, Jill; http://lattes.cnpq.br/6370481853776867; http://lattes.cnpq.br/7728969297259998; Universidade Federal de São Paulo (UNIFESP)Contextualização: A tendinopatia patelar é uma condição multifatorial e desafiadora, uma vez que causa alterações estruturais no tecido tendíneo, repercussões clínicas debilitantes e em geral, requer uma combinação de abordagens para o seu tratamento. Os exercícios de reabilitação e a alta dose energética de ultrassom terapêutico se mostram promissores para o manejo clínico de tendinopatias. Objetivo: Avaliar o efeito da adição de ultrassom terapêutico com alta dose energética a um programa de exercícios de reabilitação na intensidade da dor e função motora dos membros inferiores de indivíduos com tendinopatia patelar. Métodos: Este foi um ensaio clínico, randomizado, controlado e com cegamento dos pacientes, avaliador e terapeuta. Foram recrutados 66 participantes (homens e mulheres, com idade entre 18 e 40 anos) que apresentavam tendinopatia patelar. O grupo ultrassom terapêutico (UST) recebeu o programa de reabilitação (ultrassom terapêutico: 1MHz, contínuo, 1,2W/cm2, 8’, 4.032J de energia final por sessão e exercícios de reabilitação) 2 vezes por semana, por 8 semanas. O grupo placebo (n=33) recebeu o mesmo tratamento, porém com o ultrassom terapêutico placebo (sem emissão de energia). As mensurações e comparações foram realizadas com os dados iniciais, intermediários (4 semanas) e finais do tratamento (8 semanas), e também com as avaliações de seguimento de 3 e 6 meses. Os desfechos primários foram a intensidade da dor (escala visual analógica, EVA) e o questionário Victorian Institute of Sports Assessment – Patella (VISA-P), os tempos primários foram o inicial (T0) e final do tratamento (T2). Além disso, o questionário International Physical Activity Questionnaire – short form (IPAQ-forma curta), força muscular, cinemática duas dimensões (2D), algometria de pressão, termografia e imagens de ressonância magnética, também foram coletados. Resultados: Embora todos os participantes tenham apresentado melhora dos desfechos avaliados (T0 versus T2) – com exceção da termografia (o grupo UST apresentou temperaturas mais elevadas do que o grupo placebo, p<0,05) – não foram detectadas diferenças entre os grupos (p>0,05). Conclusão: A alta dose energética de ultrassom terapêutico não adicionou efeitos positivos ao programa de exercícios de reabilitação na intensidade da dor e função motora dos membros inferiores de indivíduos com tendinopatia patelar.
- ItemAcesso aberto (Open Access)Avaliação da altura patelar em atletas com tendinopatia crônica do aparelho extensor do joelho(Sociedade Brasileira de Ortopedia e Traumatologia, 2011-01-01) Garms, Emerson [UNIFESP]; Carvalho, Rogerio Teixeira de [UNIFESP]; Ramos, Leonardo Addeo [UNIFESP]; Sayum Filho, Jorge [UNIFESP]; Matsuda, Marcelo Mitsuro [UNIFESP]; Cohen, Moises [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVES: To carry out a radiographic evaluation of patellar height in athletes diagnosed with chronic tendinopathy of the knee extensor mechanism; METHODS: Radiographic assessments were carried out on 65 patients (110 knees) aged between 15 and 40 years, who practiced different kinds of sports, some with of chronic tendinopathy of the knee extensor mechanism (jumper's knee) and others without. The athletes were divided into two groups: those with diagnosed jumper's knee (group 1:38 athletes - 56 knees) and a control group (group 2:27 athletes - 54 knees). In group 1, 18 of the athletes presented the condition in both knees on examination. The height of the patella was measured using the Insall-Salvati and Blackburne-Peel x-ray methods. CONCLUSION: The presence of a high patella in the group of athletes with chronic tendinopathy of the knee extensor mechanism was significantly higher than in the control group.
- ItemAcesso aberto (Open Access)Diagnóstico e tratamento da epicondilite lateral do cotovelo no Brasil. Estudo transversal(Universidade Federal de São Paulo (UNIFESP), 2021) Lazarini, Rafael Fuchs [UNIFESP]; Tamaoki, Marcel Jun Sugawara [UNIFESP]; Universidade Federal de São PauloPurpose: Lateral epicondylitis (LE) or tennis elbow is the most common elbow painful condition. There are various possibilities described in the literature, without evidence to support a gold standard management. Objective: To evaluate how the Brazilian orthopedist diagnoses and treats lateral epicondylitis. Methods: This is a cross-sectional study. A questionnaire has been prepared for information to the participants at three major Brazilian congresses of orthopedists in 2018, with eight specific questions about diagnosis and treatment. The results were analyzed in accordance with the overall number of responses, and were evaluated among three groups according to subspecialty. Results: We obtained a total of 468 valid questionnaires. For diagnosis, 24.4% have not initially requested any imaging method. The most requested exam was ultrasonography (54.9%). A non-surgical treatment was indicated for all the with great variability between their recommendations. For refractory cases, 78.3% of the respondents prefer doing a local infiltration. with corticosteroids (89.6%). Of the total respondents, 12.8% do not recommend surgical treatment for LE, and 75,8% of who does, indicate open techniques. Conclusion: Most orthopedists begin the treatment of lateral epicondylitis with the use of non-steroidal anti-inflammatory drugs, physical therapy, and an indication of rest, but there is great variability between their recommendations. The use of corticosteroids for infiltration remains the main choice among Brazilian orthopedists. Most of participants prefer the open technique for surgical treatment.
- ItemSomente MetadadadosExercícios para tratamento da tendinopatia patelar: revisão sistemática(Universidade Federal de São Paulo (UNIFESP), 2020-10-29) Teixeira, Kamila Pinho [UNIFESP]; Riera, Rachel [UNIFESP]; Universidade Federal de São PauloObjective: To evaluate the effects (benefits and harms) of physical exercises in the treatment of individuals with patellar tendinopathy (PT). Methods: Systematic review including randomized clinical trials (RCTs) that have compared physical exercise with non-surgical interventions (or different types of exercises) for PT. Primary outcomes included pain, function, and adverse events. Secondary endpoints included quality of life, patient satisfaction and return to sports or routine physical activities. Searches were performed in the Cochrane Library, CINAHL, EMBASE, LILACS, MEDLINE, PEDro and SPORTDiscus databases. Additional searches were performed on Opengrey, WHO International Clinical Trials Registry Platform and Clinical Trials.gov, and manual search on the reference lists of relevant studies. There were no restrictions on language or date of publication. The process of study selection, data extraction, and bias risk assessment was conducted by two independent reviewers. The certainty in the final set of evidence was evaluated following the recommendations of the Grading of Recommendations Assessment, Development and Evaluation (GRADE). To estimate the effect size for dichotomous variables, the relative risk (RR) was used and for the continuous variables, the mean difference (DM) with 95% confidence interval was used. Results: 16 RCTs were included (total of 372 participants, aged between 15 and 50 years), overall classified as presenting high risk of bias due, among other factors, to the impossibility of personnel and participants blinding. The ECRs evaluated ten different comparisons and, due to the clinical heterogeneity, the quantitative synthesis of the results was not possible for any of the outcomes. For all comparisons, the certainty in the set of evidence was very low or could not be evaluated due to lack of data. Conclusions: Considering that the evidence on the effects of all evaluated exercise modalities in this review is of very low certainty, the implications for practice are extremely limited and future studies may most likely alter the estimates that exist at the time. Thus, any recommendation for current clinical practice for patellar tendinopathy is underpinned by many uncertainties. Considering the lack of evidence, both a shared decision and an individualized decision-making may be adopted until future studies can robustly support the recommendations.
- ItemAcesso aberto (Open Access)Fotobiomodulação cluster comparada a single, associada ao protocolo de exercício excêntrico na sintomatologia de pacientes com tendinopatia patelar e do calcâneo(Universidade Federal de São Paulo (UNIFESP), 2020-05-14) Ventura, Mariana Da Costa Aguiar [UNIFESP]; Pinfildi, Carlos Eduardo [UNIFESP]; Universidade Federal de São PauloIntroduction: Tendinopathy is characterized by localized pain in the tendon and is related to physical activity, edema, increased sensitivity in the tendon region, decreased strength and range of motion, characterizing decreased function. Although advances have been made in relation to scientific evidence in the treatment of tendinopathies, photobiomodulation (PBM) still presents divergences in dosimetry and application techniques regarding clinical efficacy. Thus, it is necessary to conduct clinical studies that investigate the effect of photobiomodulation in relation to dosimetry on tendinopathies. Objective: To compare the effect of FBM with single or cluster when associated with eccentric exercise on pain intensity and function in patients with lower limb tendinopathy. Method: Randomized, uncontrolled, blinded clinical trial. It was developed at the Federal University of São Paulo - UNIFESP, Baixada Santista campus. The volunteers were randomly distributed through the website “randomization.com”. 42 volunteers were randomly assigned to two groups, 21 of which Group 1: PBM cluster associated with eccentric exercise and 21 in Group 2: single PBM associated with eccentric exercise. The exercise protocol was performed twice a week for 4 weeks. The application of PBM was performed after the protocol with the following parameters: FBM single 810 nm (GaAsAl) for 6 J (30s per point - 3 points), and 200 mW of power and FBM cluster 5 x 810 nm (GaAsAl) 200 mW , 6 J (30s per point totaling 30J per cluster area and 1W of power). The evaluations were carried out in 3 moments: pre-treatment, end of treatment (4th week) and follow-up of 4 weeks (8th week). Were used: NRS-11, VISA-P or VISA-A, DN-4, IPAQ, Pressure pain threshold (PPT), modified blazing scale, lunge test and LEFS. An independent sample t test was performed for the analysis of the primary outcome (VISA at the 4th week) and for other analyzes, repeated measures ANOVA and the effect size calculation were used. Results: The VISA questionnaire at the 4th week showed no difference between the groups (p = 0.81, s = 0.06). For other analyzes, there was no intergroup difference. For the activity that causes the most pain measured by the NRS-11, there was no intergroup difference (p = 0.79 and es = 0.08). Regarding the LDP, there was no intergroup difference (p = 0.3 and es = 0.37). Conclusion: There was no difference between the modes of application of FBM (cluster and single) in the symptoms, measured by the VISA questionnaire, in patients with patellar and Achilles tendinopathy.
- ItemSomente MetadadadosFototerapia e ultrassom terapêutico associados ao exercício excêntrico na intensidade da dor e funcionalidade em pacientes com tendinopatias do tendão do calcâneo e patelar: estudo preliminar controlado, randomizado e cego(Universidade Federal de São Paulo (UNIFESP), 2016-08-29) Santos, Marina Yumi Ono [UNIFESP]; Pinfildi, Carlos Eduardo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Tendinopathy is a painful tendon condition that occurs most often due to overload. Patellar tendinopathy and the tendon of the calcaneus are the most common of the lower limb, along with that of the posterior tibial. Although advances have been made in relation to the scientific evidence in the treatment of tendinopathies, there is still a lack of studies that support the use of electrophysical agents (AEF) such as phototherapy and therapeutic ultrasound. Objective: To compare the effect of phototherapy or therapeutic ultrasound associated with the protocol of eccentric exercises, on pain intensity and functionality of individuals with tendonopathies of the calcaneus and patellar tendon. Method: Controlled, randomized and blind pilot study, approved by Unifesp ethics and research committee. Fifteen volunteers diagnosed with tendonopathies of the calcaneal and patellar tendon were randomized into three groups: Group EA: eccentric exercises and stretching, EAF group: eccentric exercises, stretching and phototherapy, and EAUS group: eccentric exercises, stretching and ultrasound. Eccentric exercises were performed in 6 sets of 15 repetitions, 3 times per week for 8 weeks. Ultrasound was used with the following parameters: 1 Mhz frequency, 7W power, 100Hz pulse repetition frequency, 50% cycle, 1.0W / cm2 intensity, SATA 0.5 W / cm2, 4200J power, Time of 10 minutes. For phototherapy a cluster with 13 diodes was used: 3 of 850nm, 7 of 670nm and 3 of 950nm, 265mW and 5J. The evaluations were numerical scale of pain in the static position (resting and palpation of the tendon) and dynamic situation (activity that causes more pain and single hop test) pre-treatment, 4 weeks, 8 weeks and follow-up 16 and 24 weeks . Statistical analysis: To evaluate the behavior of the EA, EAUS and EAF groups over the time evaluated, according to the variables of interest, the ANOVA variance analysis model with repeated measurements and the Bonferroni multiple comparisons method will be used. Results: Pain at palpation of tendon pre-treatment vs 4 weeks: reduction of 3.5 in the EAF group; Pre-treatment vs 8 weeks: reduction of 3.8 in the EAF group; 16 vs 24 weeks: decrease of 3 in the EAUS group. Pain evaluation during the most painful activity pre vs 4 weeks: reduction of 2 in the EAF group; Pre-treatment vs 8 weeks: reduction of 3 in the EA and EAUS groups. In the comparison between the pain evaluations during the single hop test in the pre and 4 weeks there was reduction of 2.5 in pain in the EA and EAF groups; Pre and 8 weeks: reduction of 2.5 in the EAF group and 16 and 24 weeks: reduction of 3 in the EAUS group. Conclusion: The addition of phototherapy and ultrasound to the eccentric exercises decreased the intensity of pain in patients with tendonopathies of the calcaneus and patellar tendon at different periods.
- ItemAcesso aberto (Open Access)Lesões do membro superior no esporte(Sociedade Brasileira de Ortopedia e Traumatologia, 2010-01-01) Silva, Rogerio Teixeira da [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Sports injuries of the upper limbs are very common in physical activities, and need to be studied in detail, taking into consideration specific aspects of the types of sports practiced. Special attention should be paid to the dynamics of the shoulder girdle and scapular belt, as this will enable us to treat athletes more adequately, also helping prevent recurrences that can occur in some cases, due to the fact that the athlete always attempts to return to their pre-injury level of sport. This review focuses primarily on the management of upper limb tendon sports injuries, from the physiopathology through to the more common new methods of treatment in sports practice in our country.
- ItemSomente MetadadadosLow-level laser therapy in IL-1 beta, COX-2, and PGE2 modulation in partially injured Achilles tendon(Springer, 2015-01-01) Jesus, Julio Fernandes de [UNIFESP]; Spadacci-Morena, Diva Denelle; Anjos Rabelo, Nayra Deise dos; Pinfildi, Carlos Eduardo [UNIFESP]; Fukuda, Thiago Yukio; Plapler, Helio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Inst Butantan; Univ Nove Julho UNINOVE; ISCMSPThis study evaluated IL-1 beta, COX-2, and PGE2 modulation in partially injured Achilles tendons treated with low-level laser therapy (LLLT). Sixty-five male Wistar rats were used. Sixty were submitted to a direct injury on Achilles tendon and then distributed into six groups: LASER 1 (a single LLLT application), LASER 3 (three LLLT applications), and LASER 7 (seven LLLT applications) and Sham 1, 3, and 7 (the same injury but LLLT applications were simulated). the five remaining animals were allocated at control group (no procedure performed). LLLT (780 nm) was applied with 70 mW of mean power and 17.5 J/cm(2) of fluency for 10 s, once a day. the tendons were surgically removed and assessed immunohistochemically for IL-1 beta, COX-2, and PGE2. in comparisons with control (IL-1 beta: 100.5 +/- 92.5 / COX-2: 180.1 +/- 97.1 / PGE2: 187.8 +/- 128.8) IL-1 beta exhibited (mean +/- SD) near-normal level (p > 0.05) at LASER 3 (142.0 +/- 162.4). COX-2 and PGE2 exhibited near-normal levels (p > 0.05) at LASER 3 (COX-2: 176.9 +/- 75.4 / PGE2: 297.2 +/- 259.6) and LASER 7 (COX-2: 259.2 +/- 190.4 / PGE2: 587.1 +/- 409.7). LLLT decreased Achilles tendon's inflammatory process.
- ItemAcesso aberto (Open Access)Prevalence of pain on palpation of the inferior pole of the patella among patients with complaints of knee pain(Faculdade de Medicina / USP, 2009-03-01) Ramos, Leonardo Addêo [UNIFESP]; Carvalho, Rogerio Teixeira de [UNIFESP]; Garms, Emerson [UNIFESP]; Navarro, Marcelo Schmith [UNIFESP]; Abdalla, Rene Jorge [UNIFESP]; Cohen, Moises [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE: Patellar tendinopathy is a common condition in sports. It may occur at any location of the patellar tendon, but the most commonly affected area is the inferior pole of the patella. Among various diagnostic tests, the one most used is palpation of the inferior pole of the patella. The aim of this study was to investigate the prevalence of pain complaints among individuals with pathological knee conditions and to evaluate palpation of the inferior pole of the patella as a diagnostic test for patellar tendinopathy. METHODS: Palpation of the patellar tendon was performed on 318 individuals who presented with knee-related complaints. Palpation was performed with the individual in the supine position and the knee extended. The age, gender, physical activity and labor activity of each individual were recorded at the time the symptoms appeared; the diagnosis was also recorded. RESULTS: Of the total number of individuals evaluated, 124 (39%) felt pain on palpation of the inferior pole of the patella. Of these, only 40 (32.3%) received a diagnosis of patellar tendinopathy. We did not observe any difference with respect to gender and age distribution. When evaluating daily physical activity levels, however, we observed that individuals with pain on palpation of the inferior pole of the patella experienced more intense physical activity. CONCLUSIONS: Palpation of the inferior pole of the patella is a diagnostic procedure with high sensitivity and moderate specificity for diagnosing patellar tendinopathy, especially among individuals who perform activities with high functional demands.
- ItemAcesso aberto (Open Access)Tendinopatia patelar(Sociedade Brasileira de Ortopedia e Traumatologia, 2008-08-01) Cohen, Moises [UNIFESP]; Ferretti, Mario [UNIFESP]; Marcondes, Frank Beretta; Amaro, Joicemar Tarouco; Ejnisman, Benno [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Instituto Cohen de Ortopedia, Reabilitação e Medicina EsportivaPatellar tendinopathy, or jumper's knee, is often seen in athletes that practice jumping modalities, or modalities that require repetitive impact strength. Histologically, the excessive load on the tendon may cause changes in the extracellular matrix and results in small lesions that may, when chronic, lead to tendinosis specially in the lower pole of the patella. Pain in the anterior region of the knee is the first symptom reported by the patient with this disease. The beginning is insidious and gradual, mainly after physical activity, but with the progression of the disease, pain may be frequent during or already in the beginning of the activity. The diagnosis of patellar tendinopathy is eminently clinical, characterized by pain when palpating the lower pole of the patella and adjacent areas. In more advanced cases, a palpable nodule and associated edema may be visualized. Supplemental exams, such as X-ray, ultrasound, and MRI help in the diagnosis. Ultrasound and MRI are the best indications, as they may define the exact location of the lesion, its extension, and also identify whether or not degenerating changes are present, MRI providing the best resolution. Initial tendinopathy treatment is clinical, with relative rest, correction of etiologic factors, cryotherapies and physiotherapy. The use of pain killers and anti-inflammatory drugs is controverted. For those cases that do not respond to clinical treatment, surgical is an option, and the literature brings several techniques with varying rates of good results.
- ItemAcesso aberto (Open Access)Terapia por ondas de choque associada ao fortalecimento excêntrico versus fortalecimento excêntrico isolado no tratamento das tendinopatias insercionais do Aquiles: ensaio clínico randomizado.(Universidade Federal de São Paulo (UNIFESP), 2019-07-31) Mansur, Nacime Salomao Barbachan [UNIFESP]; Tamaoki, Marcel Jun Sugawara [UNIFESP]; Faloppa, Flávio [UNIFESP]; Matsunaga, Fábio Teruo [UNIFESP]; http://lattes.cnpq.br/3695111273396745; http://lattes.cnpq.br/6528908852030714; http://lattes.cnpq.br/5982439031327655; http://lattes.cnpq.br/5286610387997973; Universidade Federal de São Paulo (UNIFESP)Background: There is no consensus for the treatment of Achilles insertional tendinopathy (AIT). The eccentric exercises protocol (EE) and the shockwave therapy (SWT) persists as options in the clinical management of this condition, despite its inconclusive results. Objective: To evaluate the effectiveness of SWT adjuvant to EE as compared to EE with placebo in the AIT treatment, considering function. Method: Ninety-seven patients diagnosed with AIT were randomly allocated into two groups. Those inserted in the intervention group (SWT) received three sessions of radial shockwaves (2000 to 3000 impulses, 7 to 10 Hz and 1.5 to 2.5 bars) and the 12-week EE protocol for the calcaneal tendon. Those destined to the control group (CON) received the same 12 weeks of EE and SWT simulations (sham). Patients were followed up to 24 weeks after treatment initiation. The primary assessment was the tendon function by the VISA-A score. For the secondary, pain by the VAS, algometry, foot function by the AOFAS and FAOS scores and quality of life by the SF-12 were collected. Results: The two groups, despite the positive evolution with the treatments within the study period, showed no differences (p<0,05) in any of the analyzed variables. Conclusion: Extracorporeal shockwave therapy does not potentialize the effects of the eccentric strengthening in the Achilles insertional tendinopathy treatment.
- ItemAcesso aberto (Open Access)Ultrassom terapêutico associado ao exercício excêntrico na intensidade da dor em pacientes com tendinopatia de membros inferiores(Universidade Federal de São Paulo (UNIFESP), 2017) Ventura, Mariana da Costa Aguiar [UNIFESP]; Pinfildi, Carlos Eduardo [UNIFESP]; http://lattes.cnpq.br/6370481853776867; http://lattes.cnpq.br/3957095310378192; Universidade Federal de São Paulo (UNIFESP)Introdução: A tendinopatia é uma condição dolorosa no tendão que ocorre devido a uma sobrecarga. A tendinopatia patelar e a do tendão do calcâneo possuem maior prevalência entre as tendinopatias em membros inferiores juntamente com o tendão tibial posterior. Embora tenham ocorrido avanços em relação às evidências científicas no tratamento das tendinopatias como por exemplo o exercício excêntrico, ainda há ausência de estudos que sustentem a utilização do ultrassom terapêutico referente a analgesia dos pacientes. Objetivo: Avaliar o efeito do ultrassom terapêutico associado ao exercício excêntrico nas tendinopatias de membros inferiores. Método: Estudo piloto controlado, randomizado e cego. Foi desenvolvido na Universidade Federal de São Paulo – UNIFESP, campus Baixada Santista. Dezesseis pacientes com diagnóstico de tendinopatia patelar ou do tendão do calcâneo foram aleatoriamente randomizados em 2 grupos de 8 cada, sendo eles: grupo 1: Exercícios excêntricos e alongamento, grupo 2: Exercícios excêntricos, alongamento e ultrassom terapêutico, os quais foram submetidos a 8 semanas de tratamento, 3 vezes por semana. Os parâmetros utilizados para o US terapêutico foram: F: 1,1 MHz, Duty-cycle: 50%, I: 1,0 W/cm2 e E: 2100J. A dor foi avaliada por meio da escala visual numérica de dor em 2 momentos: pré-tratamento e pós-tratamento (8ª semana). Para análise estatística empregou-se o modelo de análise de variância com medidas repetidas e o método de comparações múltiplas de Bonferroni para comparação entre as variáveis. Resultados: Na comparação intra-grupos pode-se observar que ambos os grupos tiveram melhora significante nas avaliações de dor referentes a: atividade que mais causa dor (p<0,05), palpação (p<0,05) e durante a realização do single leg hop test (p<0,05). Conclusão: A adição do US terapêutico a um protocolo de exercício excêntrico não sugere melhora da intensidade da dor quando comparado a somente ao exercício excêntrico.