Manual fotográfico de testes ortopédicos e neurológicos, 5ª edição, apresenta, além de um texto claro e conciso, mais de ilustrações que. guide fotográfico de testes ortopédicos e neurológicos, fiveª edição, apresenta, além de um texto claro e conciso, mais de ilustrações que demonstram o. Results 1 – 16 of 44 Manuale fotografico suddiviso per regioni anatomiche Manual Fotográfico de Testes Ortopédicos e Neurológicos (Em Portuguese do.

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Comparison of cryotherapy, exercise and short waves in knee osteoarthritis treatment. Osteoarthritis is the most prevalent form of joint disease. Physical agents such as ice and heat can fight the pain process, when correctly indicated and used.

The objective of this study was to compare physiotherapy neurolpgicos involving the use of exercise, cryotherapy and short waves in individuals with knee osteoarthritis. In a prospective randomized study, 25 individuals were treated 25 kneeswith ages ranging from 58 to 78 years.

Pain significantly improved only for group B, with positive functional quality and flexibility in all groups. The improvement in range of motion was similar for groups B and C. Flexion strength was maintained for groups A and B, and strength gain for individuals in group C.

In the extensors muscles, strength gain was seen in groups B and C, while strength loss was reported for group A. The best protocol was that one involving cryotherapy and exercises for pain relief. All groups showed improved functional quality; ee correlation was found for range of motion gain, flexibility and strength gain associated with thermotherapy.

Osteoarthritis of the knee; Cryotherapy; Short wave; Physiotherapy.

Osteoarthritis OA is one of the most common diseases of the skeletal system, and can be defined as a degenerative condition affecting synovial joints 1being the most prevalent form of joint disease, which does neurolkgicos lead to systemic involvement, without associated mortality 2.

Knee OA is a disease of inflammatory and degenerative nature causing joint cartilage ortopedlcos, leading to joint deformity 3. Pain is teste the first impairing factor for OA, subsequently leading to joint, per-joint changes and progressive dysfunction 1. Physical agents can fight the painful process when correctly indicated and used. Among these agents, we highlight cryotherapy, superficial and deep heat 1. Although OA is associated to mechanical factors of joint overload leading to cartilaginous injury, weighted and regular physical activities can improve some of the secondary changes associated to this disease 1.

OA treatment must be continued, based on drug and physical therapy 2. Literature shows interest on scientific validations of the propositions made by fotogrfoco medicine, so far often grounded on observation and empirics. Reviews seek to prove the beneficial effect of certain techniques, but several proofs are required ortopedivos establish the real usefulness of each method or instrument 2.

Twenty five sedentary patients were assessed 19 females and 6 malestotaling 25 knees 15 right and 10 left knees from May to Decemberwith a diagnosis of primary knee osteoarthritis, with ages ranging from 58 to 78 years average: The inclusion criteria were the following: The exclusion criteria fotogrficl the following: Questionnaires were applied pre- and post-physiotherapeutic treatment in order to evidence personal data and issues associated to neurologifos individual’s functional quality 4 with the key complaint of each patient.

A goniometer was used to measure range of motion; a pain scale 5 was used to measure the subjective perception of pain, and; a sphygmomanometer duly calibrated to assess muscle strength 6.

After screening according to the inclusion and exclusion criteria, each patient, properly informed by the Free and Informed Consent Term approved by the Scientific Committee of the Institute, was randomly assigned by a member of the registration staff to be included in a given group.

The patients were divided into three groups: Three different treatment groups were built. The first one received kinesiotherapy plus short waves, comprising nine treated knees. The ortopedicoos group received kinesiotherapy plus ice, comprising nine treated knees.

The third group served as control, being treated only with kinesiotherapy, comprising seven treated knees. The patients were assessed before and after treatment regarding muscular strength, magnitude of pain, range of motion and functional quality in fotoyrfico limbs the affected and the non-affected sidesbecause exercises were made bilaterally and the application of short waves and ice was done only at the affected side.

Screening and assessment were made by independent physical therapists blind study and all patients received care at the Physical Therapy outpatient facility of IOT HCFMUSP where 10 sessions were conducted at a frequency of twice a week, applying stretching and strengthening exercises isometry for the following muscles: For comparing non-parametric values, the Wilcoxon’s and Kruskal-Wallis’ tests were used, and for comparing parametric values, the Student’s t paired and non-paired and variance analysis ANOVA tests were used.


For comparing groups A, B and C for neurologicps of the differences among averages, the variance analysis with differences distinction Tukey’s test was employed. The results are presented as tables listing values for averages, standard deviation and standard error for each analyzed variable for the three different groups pre- and post-physiotherapeutic treatment and as charts showing statistical results Tables 1 testee, 234Charts 1jeurologicos34.

Our priority in this study was to determine which treatment protocol ice, OC, kinesiotherapy would be most efficient to deliver pain relief 5improved functional quality 4range of motion gain 7ischiotibial flexibility 8 and strength gain 6following the suggestions by Baker and McAlindor 9 and Fransen et al.

Brandt 11 has also reported the lack of randomized clinical trials addressing heat and ice application for improving musculoskeletal status of patients with OA. After screening, the enrolled patients were assessed according to Cipriano 12 who report that a full history constitutes one of the most important aspects of a clinical evaluation protocol. Clinical ortopedkcos was directly collected in a pre-physiotherapeutic treatment evaluation. Individual pain complaint was assessed by means of the CR10 scale 5 which is a scale of general severity that can be neueologicos to estimate most of perceptive severity kinds.

An exercises program can be effective for reducing pain, as well as drug therapy with non-steroidal anti-inflammatory agents 11, OA patients’ treatment must be comprehensive, with non-pharmacologic techniques regarded as first choice and analgesics and non-steroidal anti-inflammatory drugs as adjuvant therapy As described by Yates 14 and Minor 15 the objectives of an exercise program for patients with OA should be: Heat and ice application, or both, should be employed to relieve musculoskeletal pain in several diseases, including AO.

In our study, we found that most of the patients assessed used some kind of heating hot water bag for pain relief. Short-wave diathermy, which delivers deep heat, may neurologicis benefits, reducing symptoms severity, but this kind of therapy is expensive and requires randomized clinical trials where its application is followed up by a kinesiotherapy for muscular stretching and strengthening, although Dde 11 reports that there are no evidence proving that heat-based treatments footgrfico more effective for dr relief than exercises alone.

: J.A. Cipriano: Books

Heat may provide pain relief and muscular relaxation because of the increased subcutaneous temperature; however, it is contraindicated for patients with blood stream deficit, or sedated, or in cases of sensitivity change and cancer Heat application is a limited portion of the therapeutic program and should be used only temporarily Using ice is advantageous because of its low cost, wide action spectrum and easy technical application, but when an individual already neuroligicos reduced pain sensitiveness, msnual reflects that voluntary contraction is compromised due to motor threshold increase resulting from the increased latency and of the duration of action potential.

Ice acts directly at the muscular spindle and at tendinous body; therefore, an overload on exercising after muscle cooling, which can lead to a new muscle injury, since motor control threshold is changed Therefore, we based our neurologicoe in an exercises program that could not cause muscular damages to individuals.

Pain variable fotoyrfico a significant improvement only for Group B. This study evidenced that the therapy using only kinesiotherapy was not beneficial for pain variable, but presented positive results for functional quality improvement, range of motion gain and muscular strength gain, as opposite to the results reported by Brandt 11 and Fransen et al.

Joseph J. Cipriano (Author of Photographic Manual of Regional Orthopaedic and Neurologic Tests)

A study conducted by Teixeira and Olney 17 showed the existence of a correlation between pain and joint stiffness and between pain and function. This finding suggests maunal pain relief is directly associated to function gains, being thus an important objective to be considered when treating OA patients.

These suggest that a therapeutic approach targeting pain relief and joint stiffness reduction is paramount for patients with OA to show a better functional performance. They ortopevicos improvement on pain symptoms and ability to ambulate, with only 7. Quality of live measured by this index achieved positive results in all groups, but statistically significant only for Group B and Group C; nevertheless, this improvement did not show differences when compared among the three groups, showing the benefits of exercising.

The use of cryotherapy to increase joint range of motion is still uncertain. An increased pain threshold and a reduced nervous irtopedicos speed benefit muscular stretching; on the other hand, a reduced stretching ability of the connective tissue acts by reducing muscular flexibility Range of motion showed positive results when pre- and post-treatment phases were compared, with significance for Group B and Group C both in affected and unaffected sides.


When the three groups were compared by variance analysis, this improvement was not shown to be statistically significantly different. Flexibility gain was seen in all groups, but significant for pre- and post-treatment comparisons in group C only on affected knees and in Group B only on unaffected knees. When the three groups were compared by variance analysis, this improvement did not show differences. These results are controversial, since in all the unaffected knees kinesiotherapy was applied, and there are no studies evaluating this variable for comparison purposes.

Muscular strength evaluation is an important technique to diagnose disease etiology and to determine and assess rehabilitation neurologucos.

Traditionally, muscular strength has been evaluated by means of manual muscular test, and this technique has been criticized due to its subjective nature. With the development of dynamometers, objective measurements of muscular torque became possible, and this is the best method for assessing muscular strength For being impossible to use an isokinetic dynamometer due to its high cost, knee’s muscular strength was assessed according to the method described by Bastone, modified and validated by Helewa et al.

OA results in changes that affect not only intracapsular tissues, but also per-joint tissues, such as ligaments, capsule, tendons neurologics muscles. AO patients compared to healthy individuals in the same age group showed quadriceps muscle weakness, reduced knee proprioception, reduced balance and position sense 13, Wilson and Mayer 23 reported that the presence of joint effusion, even if in small amounts, is a powerful inhibitory mechanism of reflex muscular activity of that joint.

A reduced reflex muscular activity causes hypotrophy and early weakness, with the resultant associated mechanical damages Booth 25 reported that muscular strength is rapidly reduced during the time a limb is immobilized because of a reduction of the size of the muscle and of tension by unit of muscular cross-sectional fotogdfico.

The largest absolute muscular mass loss occurs at the beginning of hypotrophy process According to Greve et al. Painful process is previous to the muscular weakness picture. This statement suggests that exercises are beneficial for gaining strength and, consequently, pain relief. The benefits of aerobic exercises include: The most recommended ones are walks, neugologicos, swimming, dancing, hydro-gymnastics.

Isometric exercises are usually preferred at the beginning of the treatment instead of isotonic ones 11, In a controlled randomized study conducted by Brandt 11 and Bischoff and Ross 13 with patients with moderate OA who were submitted to muscular strengthening with isometry, a significant reduction was seen for joint pain, and patients with advanced OA, after eight weeks performing quadriceps isometry, are allowed to reduce their daily analgesics dosage.

This study evidenced the maintenance of strength intensity measured on knee flexor muscles in groups A and B for affected knees and in group B for unaffected knees; on the other hand, strength gain was achieved in affected and unaffected knees of the individuals from group C, and strength loss on unaffected knees in group A.

Regarding knee extensor musculature, strength ortopedcos was achieved on affected knees of groups B and C, and strength loss in group A.

For unaffected knees, strength gain was achieved in group C, strength loss in group B, and maintenance in group A. Thus, we can infer that strength gain for flexor and extensor musculature of the knee may not be associated to ice or OC application.

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Data divergence may be due to the employed method of assessment, recommended treatment duration in this study, or to the treatment protocol for strength gain which was maintained during the whole period, not applying increasing loads in exercises, oppositely to Kisner and Colby 26 who state that a progressive increase of load is required for obtaining a significant strength gain.

We believe that further prospective clinical trials should be conducted in order to validate the method of strength measurement using a sphygmomanometer and to apply this protocol adjusting treatment time and load used.

The most appropriate protocol of treatment for pain relief was the one involving ice and kinesiotherapy. The level of functional quality was improved in the three groups studied. Range of motion, flexibility and muscular strength gains are not associated to improvements when therapy involves ice and heat application.

Tratamento da osteartrose do joelho. Indexes of severity for osteoarthritr of the hip and knee. Validation-value in comparison eith other in comparison. Physical therapy of the knee. Baker KB, Mcalindon T. Exercise for knee osteoarthritis.

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