Добірка наукової літератури з теми "Myofascial decompression"

Object Initial management for lumbar pseudomeningoceles entails the closed external drainage of cerebrospinal fluid (CSF) with or without blood patch application. The presence of longstanding pseudomeningoceles and those associated with nonmicroscopic dural tears can be more problematic. Additionally the failure of nonoperative measures may necessitate surgery. Ideally the procedure should involve repairing the dural defect, removing the encapsulated cavity of the pseudomeningocele, and obliterating the extraspinal dead space to minimize the recurrence of the problem. Methods The authors describe a technique performed in 12 patients with large (> 5-cm-diameter) pseudomeningoceles referred for management following the failure of less aggressive measures. Diagnosis was based on symptoms of lumbar wound swelling, postural headaches, back and leg pain, and was confirmed by imaging studies. In all patients subarachnoid CSF drainage and initial operative attempts to obliterate the pseudomeningocele had failed. They were treated between July 1990 and July 1998. The cause of the pseudomeningoceles was lumbar discectomy (four patients), lumbar decompression (one patient), lumbar decompression and placement of instrumentation (five patients), and intradural procedures (two patients). Their mean age was 47.9 years (range 20–67 years), and they presented at a mean of 5.5 months postoperatively (range 3 weeks–37 months). In all cases there was a satisfactory repair of the pseudomeningocele, dead space obliteration, and long-term symptomatic resolution. Conclusions Lumbar myofascial advancement for this problem is a useful technique in cases of symptomatic pseudomeningoceles. This technique requires the medial advancement of the musculofascial units of the paravertebral muscles for a layered closure over the exposed spinal canal with obliteration of the pseudomeningocele.

Cervical compressive myelopathy commonly occurs due to degeneration or disc herniation. The persons with cervical meylopathy are usually advised for surgical decompression. Person with signs of cervical cord compression was treated with myofacial release and found to be improved in signs as well as the symptoms. Total 34 numbers of similar cases (31 males and 3 females) age ranging from 25 to 61 years were treated by myofascial release of periscapular soft tissue structures over last 2 & ½ years (2017 to 2020) and found to return back to their activities after 6 months of follow up.

OBJECT Idiopathic trigeminal neuralgia (iTN) is a neurological condition treated with pharmacotherapy or neurosurgery. There is a lack of comparative papers regarding the outcomes of neurosurgery in patients with iTN. The objective of this study was to investigate sensory thresholds and masticatory function in 78 patients with iTN who underwent microvascular decompression (MVD) or balloon compression (BC), and compare these treatments with carbamazepine and 30 untreated healthy controls. METHODS The authors conducted a case-controlled longitudinal study. Patients were referred to 1 of 3 groups: MVD, BC, or carbamazepine. All patients were evaluated before and after treatment with a systematic protocol composed of a clinical orofacial questionnaire, Research Diagnostic Criteria for temporomandibular disorders, Helkimo indices, and a quantitative sensory-testing protocol (gustative, olfactory, cold, warm, touch, vibration, superficial, and deep pain thresholds). RESULTS Both MVD and BC were effective at reducing pain intensity (p = 0.012) and carbamazepine doses (p < 0.001). Myofascial and articular complaints decreased in both groups (p < 0.001), but only the patients in the MVD group showed improvement in Helkimo indices (p < 0.003). Patients who underwent MVD also showed an increase in sweet (p = 0.014) and salty (p = 0.003) thresholds. The sour threshold decreased (p = 0.003) and cold and warm thresholds increased (p < 0.001) in patients after MVD and BC, but only the patients who underwent BC had an increase in touch threshold (p < 0.001). CONCLUSIONS Microvascular decompression and BC resulted in a reduction in myofascial and jaw articular complaints, and the impact on masticatory function according to Helkimo indices was greater after BC than MVD. MVD resulted in more gustative alterations, and both procedures caused impairment in thermal thresholds (warm and cold). However, only BC also affected touch perception. The sensorial and motor deficits after BC need to be included as targets directly associated with the success of the surgery and need to be assessed and relieved as goals in the treatment of iTN.

ObjectiveOsteopathic physicians, or doctors of osteopathic medicine (DOs), routinely counsel patients on the clinical benefits of breastfeeding in their capacity as medical doctors. However, when a mother presents with a complaint of feeding difficulty in her newborn, osteopathic physicians are uniquely equipped to assess and treat the infant with osteopathic manipulative treatment (OMT).MethodsOMT is the practice of manual medicine developed by A.T. Still in the late 19th century, founded on the principle that the human body's structure and function are reciprocally interrelated. The osteopathic discipline encompasses a variety of musculoskeletal techniques, ranging from gentle myofascial release to high-velocity/low-amplitude thrusts. A complete osteopathic assessment of a breastfeeding infant should include evaluation of the skull and cranial base, cervical spine, thoracic spine, oral cavity and tongue, hyoid bone, and mandible.ResultsAll treatments directed at newborns, infants, and children are very gentle, following the tissues in their position of ease to allow for a release of the restriction. A variety of techniques can be employed, including condylar decompression, Still technique for cervical spine dysfunction, balancing of the hyoid bone, myofascial release of the thoracic inlet, and treatments in the cranial field.ConclusionOsteopathic manipulation should be initiated when the first-line interventions do not result in improved nursing, and other causes such as hypoglycemia or maternal factors have been excluded.

Peripheral neuropathies can have a plethora of origins including physical insults resulting from connective tissue compression and entrapment. Observational investigations, using biotensegrity focused dissections, have identified site-specific fascial structures that are hypothesised to afford integrity to neurovascular structures by providing appropriate tension and compression. These myofascial structures act as site-specific fascia tuning pegs. While these ‘tuning pegs’ are capable of having a whole body impact, this paper will look specifically at the local influences on pelvis and lower limb. The analogy of a fascia ‘tuning peg’, similar to the tuning peg of a string instrument, is adopted to help explain this unfamiliar concept. An ‘out of tune’ fascial system would lead to hypertonic and inhibited tissues, dissonant notes, one could say. Hypertonic tissues increase tensional forces acting within local and global networks leading to inappropriate densification of fascial structures, fibrosis and neurovascular fascial adhesions. Inhibited tissues, unable to generate sufficient force to ensure appropriate fascial integrity, lead to excessive compression on neurovascular structures like a dissonant note striking a wrong cord. Site-specific fascia tuning pegs provide appropriate frequency and note specific tension and compression ensuring combined forces operate in an omnidirectional manner resulting in pain free physiology, neurology and motion. The role of muscles in metabolism, physiology, heat production and motion is well described within the scientific literature. Less understood is the local role of myofascial structures providing mechanotransductive forces resulting in fascial expansive responses ensuring appropriate gliding and decompression of neurovascular structures. It is proposed that failure of site-specific fascia tuning pegs results in excessive compression, friction, inflammation, pathology, pain and changes in sensations. KEY WORDS: Biotensegrity, Fascia, Site specific fascia tuning pegs, Tensegrity, Neuropathy, Dynamic ischemia.

Trigeminal neuralgia (TN), the most common form of severe facial pain, may be confused with an ill-defined persistent idiopathic facial pain (PIFP). Facial pain is reviewed and a detailed discussion of TN and PIFP is presented. A possible cause for PIFP is proposed. (1) Methods: Databases were searched for articles related to facial pain, TN, and PIFP. Relevant articles were selected, and all systematic reviews and meta-analyses were included. (2) Discussion: The lifetime prevalence for TN is approximately 0.3% and for PIFP approximately 0.03%. TN is 15–20 times more common in persons with multiple sclerosis. Most cases of TN are caused by neurovascular compression, but a significant number are secondary to inflammation, tumor or trauma. The cause of PIFP remains unknown. Well-established TN treatment protocols include pharmacotherapy, neurotoxin denervation, peripheral nerve ablation, focused radiation, and microvascular decompression, with high rates of relief and varying degrees of adverse outcomes. No such protocols exist for PIFP. (3) Conclusion: PIFP may be confused with TN, but treatment possibilities differ greatly. Head and neck muscle myofascial pain syndrome is suggested as a possible cause of PIFP, a consideration that could open new approaches to treatment.

Background: Despite the evident progress in treating vertebral column degenerative diseases, the rate of a so-called “failed back surgery syndrome” associated with pain and disability remains relatively high. However, this term has an imprecise definition and includes several different morbid conditions following spinal surgery, not all of which directly illustrate the efficacy of the applied technology; furthermore, some of them could even be irrelevant. Objective: To evaluate and systematize the reasons for persistent pain syndromes following surgical nerve root decompression. Study Design: Prospective, nonrandomized, cohort study of 138 consecutive patients with radicular pain syndromes, associated with nerve root compression caused by lumbar disc herniation, and resistant to conservative therapy for at least one month. The minimal period of follow-up was 18 months. Setting: Hospital outpatient department, Russian Federation Methods: Pre-operatively, patients were examined clinically, applying the visual analog scale (VAS), Oswestry Disability Index (ODI), magnetic resonance imaging (MRI), discography and computed tomography (CT). According to the disc herniation morphology and applied type of surgery, all participants were divided into the following groups: for those with disc extrusion or sequester, microdiscectomy was applied (n = 65); for those with disc protrusion, nucleoplasty was applied (n = 46); for those with disc extrusion, nucleoplasty was applied (n = 27). After surgery, participants were examined clinically and the VAS and ODI were applied. All those with permanent or temporary pain syndromes were examined applying MRI imaging, functional roentgenograms, and, to validate the cause of pain syndromes, different types of blocks were applied (facet joint blocks, paravertebral muscular blocks, transforaminal and caudal epidural blocks). Results: Group 1 showed a considerable rate of pain syndromes related to tissue damage during the intervention; the rates of radicular pain caused by epidural scar and myofascial pain were 12.3% and 26.1% respectively. Facet joint pain was found in 23.1% of the cases. Group 2 showed a significant rate of facet joint pain (16.9%) despite the minimally invasive intervention. The specificity of Group 3 was the very high rate of unresolved or recurred nerve root compression (63.0%); in other words, in the majority of cases, the aim of the intervention was not achieved. The results of the applied intervention were considered clinically significant if 50% pain relief on the VAS and a 40% decrease in the ODI were achieved. Limitations: This study is limited because of the loss of participants to follow-up and because it is nonrandomized; also it could be criticized because the dynamics of numeric scores were not provided. Conclusion: The results of our study show that an analysis of the reasons for failures and partial effects of applied interventions for nerve root decompression may help to understand better the efficacy of the interventions and could be helpful in improving surgical strategies, otherwise the validity of the conclusion could be limited because not all sources of residual pain illustrate the applied technology efficacy. In the majority of cases, the cause of the residual or recurrent pain can be identified, and this may open new possibilities to improve the condition of patients presenting with failed back surgery syndrome. Key words: microdiscectomy, nucleoplasty, epidural scar, facet joint pain, recurrent herniation, myofascial pain

Musculoskeletal pain is highly prevalent and a significant contributor to global disability and disease, with most countries reporting neck and low back pain as a leading cause of disability. The use of the complementary therapy, dry cupping and its modified technique, myofascial decompression are becoming an increasingly popular modality utilised by manual and physical therapists in western clinical practice, aimed at reducing musculoskeletal pain and improving mobility. The aim of this thesis was to investigate the efficacy of dry cupping techniques in the treatment of musculoskeletal pain and improving range of motion. Firstly, this research critically evaluated the evidence from randomised controlled trials through a systematic review and meta-analysis to determine the efficacy and safety of western dry cupping methods. A systematic literature search was performed from March until April 2018, for randomised controlled trials (RCT) pertaining to musculoskeletal pain or reduced range of motion, treated with dry cupping. Outcomes were pain, functional status, range of motion and adverse events. Risk of bias and quality of evidence was assessed using the modified Downs & Black checklist and GRADE. A total of 21 RCTs with 1049 participants were included. Overall, the quality of evidence was fair, with a mean Downs & Black score of 18/28. Low-quality evidence revealed that dry cupping had a significant effect on pain reduction for chronic neck pain (MD, -21.67; 95% CI, -36.55, to -6.80) and low back pain (MD, -19.38; 95%CI, -28.09, to -10.66). Moderate-quality evidence suggested that dry cupping improved functional status for chronic neck pain (MD, -4.65; 95%CI, -6.44, to -2.85). For range of motion, low quality evidence revealed a significant difference when compared to no treatment (SMD, -0.75; 95%CI, -0.75, to 0.32). Dry cupping was found to be effective for reducing pain in patients with chronic neck pain and non-specific low back pain. However, definitive conclusions regarding the effectiveness and safety of dry cupping for musculoskeletal pain and range of motion were unable to be reached due to the low to moderate quality of evidence. Secondly, this research aimed to test the feasibility of a randomised controlled crossover trial comparing dry cupping techniques to provide recommendations for future research. The study compared myofascial decompression (dry cupping with active movement) with static dry cupping (dry cupping with no movement) and an active movement protocol (control) and assessed pressure pain threshold and range of motion. This study’s findings suggest that dry cupping techniques improve both pain threshold and range of motion; however, it is unknown whether myofascial decompression is superior to active movement only and could be investigated in future studies. This thesis provides a critical review of the available evidence for the use of dry cupping therapy for musculoskeletal conditions. For definitive conclusions on the efficacy of dry cupping, further systematic reviews and meta-analyses are required as larger dry cupping randomised controlled trials are published. Furthermore, this thesis provides a basis for future research to be undertaken, specifically investigating the efficacy of myofascial decompression for the treatment of musculoskeletal pain and improving range of motion.

Compartment syndrome is defined by high pressures in a closed myofascial compartment, which affects initially the muscles and later the nerves and vessels. The hand is rarely affected, but if treated suboptimally, it results to a permanent loss of function. Eleven compartments are included in the hand and wrist. Diagnosis of compartment syndrome of the hand remains challenging. Pain out of proportion of injury and excessive swelling should raise suspicion towards a compartment syndrome. Intracompartmental pressure measurement contributes to the diagnosis, but it is not always reliable. Once the diagnosis of acute compartment syndrome has been made, decompression of all compartments is mandatory, in order to achieve a good outcome. Failing to manage this emergent condition properly leads to a significant hand disability. Our chapter includes the following sections: 1. Introduction. A brief description of the hand compartment syndrome is presented. 2. Anatomy. Special considerations regarding hand compartments are presented, 3. Etiology. 4. Diagnosis. Signs and symptoms are reported, as well as guidelines of the technique of intracompartmental pressure measurement. 5. Treatment. Faciotomies’ indications and operative technique are described in details. 6. Conclusion. Appropriate figures of the clinical image and surgical decompression are presented as well.