Changes in pH as a result of galvanic currents used in percutaneous needle electrolysis

Aim To determine whether sodium chloride electrolysis causes a change in the pH of tissues. Methods The effects of a 3 mA galvanic current has been evaluated, applied for 3 seconds and 3 repetitions (3:3:3). In vitro pH changes were evaluated in three experiments: 1) Eppendorf® tubes filled with Ringer's solution; 2) a very small volume of Ringer's solution (100µl); 3) Eppendorf® tubes filled with saline solution (NaCl 0.9%). The pH changes in the gastrocnemius of mice were evaluated, using the left limb as a control and the right limb for the intervention. The gastrocnemius muscles were ground up and the pH of each group was determined. Results In the in vitro experiments 1 and 2, no variation was observed in the pH of either the cathode in the Ringer's solution or the anode in the Ringer's solution (the variation did not exceed 16% in either of the cases, p> 0.05). In the third in vitro study, the pH after galvanic current application increased by 70% in the saline solution of the cathode and the anode pH decreased by 34% (p < 0.05 in both cases). In the in vivo experiments, no change in pH was obtained (% variation: 0.00 ± 0.00). Conclusions The galvanic current used in percutaneous needle electrolysis applying the 3:3:3 parameters generates very small changes in the pH, in the area near the needle, which the body is able to rapidly compensate for.

Ultrasound assessment of the external occipital protuberance in young adults. Clinical implications

Introduction The current lifestyle, related to the indiscriminate use of screens from early ages with sustained postures, can cause structural changes (osteophytes) to the upper trapezius enthesis on the external occipital protuberance. Such findings in the skull are rare and usually asymptomatic, especially in young adults. Therefore, it is important to analyze, evaluate and correlate these findings with the patient's symptoms. Musculoskeletal ultrasound is an ideal tool to enable the evaluation of these structural alterations. Description of the Exam Prone position avoiding cranio-cervical hyperextension. A linear probe is used with a low frequency range (8–10 Mhz) The scan used as a reference is the transverse exam of the bone prominence. Subsequently, this is confirmed with a longitudinal exam, which is used to measure the osteophyte. The normal reference value is <10 mm. Discussion The ultrasound exam described above enables the easily reproducible assessment and measurement of osteophytes and insertional soft tissue at this level to enhance treatment planning.

Acupuncture points and perforating cutaneous vessels identified in the upper limb using infrared thermography

Objective To verify the presence of perforating cutaneous vessels (PCV) among different acupuncture points (AP) of the upper limb by means of infrared thermography (IT). Material and Methods An analytical observational cross-sectional study examining the upper limb of volunteer subjects (n = 7). A total of 91 AP were analyzed, as well as 91 control points (CP), one for each AP. In each subject, first, the AP and their corresponding CP were marked and, second, the thermographic images were taken. The images were then processed using the Physio Thermal Imaging (PTI) software, observing the presence or absence of these PCV on the AP and corresponding CP. Results PCV were identified in 68.1% of the total 91 AP examined. However, despite the strong trend in the presence of PCV in the studied AP, certain AP did not display significant differences with their corresponding CP. Conclusions This study shows a certain correlation between the PCV and the AP chosen in this sample, due to the high presence of PCV in the AP. IT is a useful tool during physical therapy treatment procedures using acupuncture.

Ultrasound-guided percutaneous needle electrolysis and rehabilitation and reconditioning program following a hamstring injury reduces “return to play” time in professional soccer players: A case series

This case series follows the treatment protocol after a grade 2 injury to the proximal semitendinosus muscle using US-guided Percutaneous Needle Electrolysis (PNE) and Rehab & Reconditioning program (RRP) in two professional soccer players. The injury was diagnosed using magnetic resonance imaging (MRI) and ultrasound imaging. The players received one session of PNE 48 hours after the injury. The indoor's phase of the RRP started 24 hours after the PNE technique and then the player proceeded to perform an on-field's phase, following which the players returned to train with the team. The effectiveness of the program was measured by comparing the match-performance data collected through Global Positioning System (GPS) in two matches before and five matches after injury and with ultrasound imaging analyzing the evolution of the muscle injury. No adverse effects were identified during or after the US-Guided PNE technique. Both players missed a single competitive game because of injury (layoff= 16 and 14 days). The GPS variables studied showed similar values before and after injury. PNE and PRR protocol improves the results of the initial phase of muscle repair and reduces the time to return to training and return to play, maintaining the GPS parameters that the players need in high performance.

Acupuncture and electroacupuncture in the treatment of carpal tunnel syndrome: Systematic review

Introduction Carpal tunnel syndrome (CTS) is the most diagnosed compression neuropathy of the upper limb. In mild and moderate cases, the treatment is extensive and controversial, whereas severe cases receive surgical intervention. Objective To analyze the scientific evidence on the effectiveness of treatment of CTS using acupuncture and electroacupuncture. Methods The PRISMA declaration was followed. A literature search was performed using the following databases: Clinical Evidence BMJ, NICE, Cochrane Library, PubMed, PEDro, Science Direct, SciELO, Google Scholar. The search strategy used the terms “acupuncture”, “electroacupuncture” “carpal tunnel syndrome”. The inclusion criteria limited studies to English publications. The risk of bias was assessed for each study using the Cochrane scale. The level of evidence and the level of recommendation was determined using the SIGN scale. Results The search retrieved 698 articles in total. After applying the inclusion and exclusion criteria, 21 articles were included. The level of evidence of all the articles was medium-high. The level of recommendation was medium, and the risk of bias was neutral, with a tendency towards low bias. The articles included revealed symptomatic and neurophysiological improvements, both peripheral as well as central, due to the cerebral response that occurs associated with the function of the median nerve. Conclusion Acupuncture and electroacupuncture are a therapeutic option for mild to moderate CTS with a medium level of scientific evidence, tending towards a high level, and with a medium level of recommendation.

Effect of ultrasound-guided percutaneous neuromodulation applied to the femoral nerve on pain and range of motion in patients with anterior knee pain: A case study

Introduction Anterior knee pain (AKP) is one of the most frequent reasons for physical therapy consultations, remaining a difficult treatment challenge for professionals. The aim of this study was to evaluate the effects of an intervention using ultrasound-guided percutaneous neuromodulation (US-guided PNM) applied to the femoral nerve on pain and knee flexion range of motion (ROM), in patients with unilateral chronic anterior knee pain. Methods Eight patients received a single intervention of NMP-e on the femoral nerve of the symptomatic knee. The level of pain and ROM were measured before, immediately after and 24 hours after the intervention. Results A decrease in pain and an increase of ROM were observed after the intervention and at 24 hours. For pain values, a medium effect size was observed (ES = 0.63 ± 0.43) after the intervention, and a large effect size (ES = 1.73 ± 0.44) was found at 24h. Concerning ROM, the effect size was large at both moments (ES = − 1.30 ± 1.14; −1.76 ± 0.80, respectively). Conclusion A single intervention of US-guided PNM on the femoral nerve produces a decrease of pain and increases the ROM, which is greater 24h after the stimulation. Level of Evidence Level II-3.

Deep vein thrombosis after “Tennis Leg” injury: A clinical case

Background “Tennis leg” is a common lesion in sports with quick accelerations and stops, consisting of an injury to the fascia joining the soleus muscle with the medial gastrocnemius. In these cases, a differential diagnosis must be performed, considering possible complications such as a deep vein thrombosis (DVT) of the veins of the deep musculature of the lower leg. The aim of this clinical case is to alert professionals regarding possible complications of these injuries and to train professionals to detect a possible vascular problem. Case Description A 42 year old male who attends a physical therapy consultation 24 hours after suffering a “muscle pull” in the gastrocnemius. After a medical diagnosis of tennis leg he received appropriate standard regulated physical therapy treatment procedures. A follow-up ultrasound exam was performed eight days after the injury and at 14 days after a worsening of symptoms, at which point a vascular alteration was detected which was diagnosed and treated as DVT. Results The patient came for consultation and we observed a vascular alteration and therefore we referred the person to the emergency room, where he was diagnosed with DVT. Discussion DVT is a possible complication of gastrocnemius injuries. The present case describes a clinical presentation of DVT after 14 days evolution. It is essential to evaluate and reevaluate the clinical condition of the patient with all the diagnostic tools possible to detect possible red flags. Conclusion Ultrasound is an essential tool for the detection of possible complications after a musculoskeletal injury.

Effect of dry needling on submaximal strength and pain in patients with active myofascial trigger points in the rectus femoris: A case series

A myofascial trigger point (MTrP) is a hyperirritable area of a skeletal muscle, of nodular appearance on palpation and located in a taut band. One of the techniques for the treatment of MTrP is dry needling (DN). The aim of the present work was to determine whether treatment with DN is effective in terms of pain relief and improvement of muscle weakness. For this purpose, differences in the Visual Analog Scale (VAS) and the Brzycki Test were observed before and after treatment of an active MTrP of the rectus femoris. In total, 5 patients received the treatment, of which 80% showed an improvement in pain and an increase in submaximal strength. Although it is not possible to establish a causal relationship, the results appear consistent with our hypothesis that DN is able to generally improve the symptoms of pain and weakness that appeared in patients.

Ultrasound-Guided percutaneous neuromodulation in non-radiating low back pain

Background Low back pain is very common, affecting 15–20% of the population each year, and representing of the main causes of physical therapy consultations. Multiple treatments have been defined for chronic low back pain, however, the findings are still controversial, and therefore new and improved solutions are necessary for the population who suffers from low back pain. Aims To evaluate the effectiveness of ultrasound-guided percutaneous neuromodulation (US-guided PNM) in patients with non-radiating low back pain. Material and Methods An experimental study was performed in patients with non-radiating low back pain, between the months of march and may of 2018 at the F&S-Narón Physical Therapy clinic, in A Coruña. Functionality was evaluated via the Oswestry questionnaire and pain was evaluated using the visual analog scale (VAS). US-guided NMP was applied to stimulate the medial branch of a L2 posterior ramus and the iliohypogastric and ilioinguinal nerves, following the protocol described by Valera & Minaya, which consists of the application of a PES type current at 10Hz and 240 microseconds, during 15 seconds and for 6 applications. In total, 3 sessions were applied (sequence 1:7:7), once a week after the first week of initiating treatment. Results Initially, 12 patients participated in the study, aged between 32 and 59 years. The mean age was 41.4 years. Two of the patients abandoned the study due to personal reasons, unrelated to the research. The final sample consisted of 10 subjects, 50% of each sex. 80% of patients improved after the application of the treatment protocol. An important decrease in activity limitations was observed, from 14 to 4.35 points out of 100 according to the Oswestry questionnaire, and a decrease of 6.8 to 2.15 points out of 10 was observed on the VAS scale, which was statistically significant according to the Wilcoxon test (p < 0,05). Conclusions The ultrasound-guided percutaneous neuromodulation technique used was effective, obtaining positive results in relation to pain and functionality. Clinical studies are necessary with a greater sample size to confirm these findings.