No description available.

O trabalho realizado estudou experimentalmente os efeitos do ultra-som terapêutico na prevenção de aderências tendinosas e no reparo tendíneo. Foi selecionado para o estudo o tendão flexor profundo do 3º dedo na transição das zonas 3 e 4 da pata dianteira direita de coelho. Foram utilizados 30 coelhos fêmeas adultas jovens, com peso corporal médio de 2,7 Kg, divididos em 3 grupos (A, B e C) de 10 animais, sob anestesia para a produção da lesão no tendão, feita por escarificação com o uso do bisturi e o esmagamento num segmento de 5 mm de diâmetro, utilizando um dispositivo de carga de 15 Kg, durante 10 minutos. As patas foram imobilizadas com órtese de material termoplástico durante todo o período experimental (21 dias). O ultra som terapêutico foi iniciado no 3º PO, e continuado por 7 dias consecutivos, com 5 minutos de duração. Foi empregado um ultra-som terapêutico, regulado na freqüência de 3 MHz, no modo contínuo, sendo que a intensidade de 0,2 W/'CM POT.2' foi aplicada nos animais do grupo A, 0,4 W/'CM POT.2' no grupo B e ultra-som desligado como placebo no grupo C. No 21º PO os animais foram sacrificados, e o tendão submetido à análise histológica. Os resultados foram submetidos à análise estatística e demonstraram que houve uma menor formação de aderência no grupo A. A aceleração do reparo tendinoso foi observada em todos os grupos / The work accomplished studied experimentally the effects of therapeutics ultrasound in prevention of tendon adherences and in tendon repair. The deep flexor tendon of the 3rd finger between zones 3 and 4 of a rabbit's right fore-foot was selected for the study. Thirty young adult female rabbits, with a body weight average of 2.7 Kg, divided into 3 groups (A, B, and C) of 10 animals each, were used. The tendon injury was made, under the effect of anesthesia, by reaming with the use of a scalpel, and the 5mm diameter crushing was made by the use of a device of 15 Kg load for 10 minutes. The feet were immobilized with orthesis made of thermoplastic material during all the experiment period (21 days). A therapeutics ultrasound, set at the frequency of 3 MHz, was applied. The intensity of 0.2 W/'CM POT.2' was applied to the animals of group A; 0.4 W/'CM POT.2' to the group B; and the equipment was off when applied to group C as a placebo. The therapeutics ultrasound was started in the 3rd PO and kept on for 7 consecutive days, with a duration of 5 minutes. On the 21st day the animals were sacrificed; the tendon was analysed histologically. The results were analysed statistically and showed that there was a minor adherence formation in group A. The acceleration of the tendon repair was observed in all groups

O trabalho realizado estudou experimentalmente os efeitos do ultra-som terapêutico na prevenção de aderências tendinosas e no reparo tendíneo. Foi selecionado para o estudo o tendão flexor profundo do 3º dedo na transição das zonas 3 e 4 da pata dianteira direita de coelho. Foram utilizados 30 coelhos fêmeas adultas jovens, com peso corporal médio de 2,7 Kg, divididos em 3 grupos (A, B e C) de 10 animais, sob anestesia para a produção da lesão no tendão, feita por escarificação com o uso do bisturi e o esmagamento num segmento de 5 mm de diâmetro, utilizando um dispositivo de carga de 15 Kg, durante 10 minutos. As patas foram imobilizadas com órtese de material termoplástico durante todo o período experimental (21 dias). O ultra som terapêutico foi iniciado no 3º PO, e continuado por 7 dias consecutivos, com 5 minutos de duração. Foi empregado um ultra-som terapêutico, regulado na freqüência de 3 MHz, no modo contínuo, sendo que a intensidade de 0,2 W/'CM POT.2' foi aplicada nos animais do grupo A, 0,4 W/'CM POT.2' no grupo B e ultra-som desligado como placebo no grupo C. No 21º PO os animais foram sacrificados, e o tendão submetido à análise histológica. Os resultados foram submetidos à análise estatística e demonstraram que houve uma menor formação de aderência no grupo A. A aceleração do reparo tendinoso foi observada em todos os grupos / The work accomplished studied experimentally the effects of therapeutics ultrasound in prevention of tendon adherences and in tendon repair. The deep flexor tendon of the 3rd finger between zones 3 and 4 of a rabbit's right fore-foot was selected for the study. Thirty young adult female rabbits, with a body weight average of 2.7 Kg, divided into 3 groups (A, B, and C) of 10 animals each, were used. The tendon injury was made, under the effect of anesthesia, by reaming with the use of a scalpel, and the 5mm diameter crushing was made by the use of a device of 15 Kg load for 10 minutes. The feet were immobilized with orthesis made of thermoplastic material during all the experiment period (21 days). A therapeutics ultrasound, set at the frequency of 3 MHz, was applied. The intensity of 0.2 W/'CM POT.2' was applied to the animals of group A; 0.4 W/'CM POT.2' to the group B; and the equipment was off when applied to group C as a placebo. The therapeutics ultrasound was started in the 3rd PO and kept on for 7 consecutive days, with a duration of 5 minutes. On the 21st day the animals were sacrificed; the tendon was analysed histologically. The results were analysed statistically and showed that there was a minor adherence formation in group A. The acceleration of the tendon repair was observed in all groups

Mellan år 2020 och år 2021 registrerades 381 operationer av böjsenskador i Sverige. Rehabiliteringsprocessen efter en böjsenskada är lång och kräver kontinuerlig uppföljning. Uppföljningen sker genom mätningar av böj- och sträckförmågan i de fingrar som patienten opererat. Mätningarna utförs i nuläget manuellt med goniometer, där vinklarna i fingrarnas leder mäts, en gång per vecka på en handkirurgisk mottagning. Handkirurgiska kliniken på Södersjukhuset i Stockholm efterfrågade ett digitalt mätverktyg som skulle göra det möjligt för patienten att på ett tillförlitligt sätt mäta vinklarna hemma i stället för på kliniken. Målet med projektet var således att skapa ett mätverktyg som mäter vinklarna med ett mätfel på högst 5 grader. Ett mätverktyg utvecklades som utför mätning av vinklar med hjälp av en bild användaren tagit. Mätverktyget är kompatibelt med Androidenheter och kan implementeras i en redan existerande Androidapplikation. Tester visade att mätverktyget har ett mätfel med ett medelvärde på 5 grader eller lägre för proximala interfalangealleden och distala interfalangealleden. Vidare var medelfelet 7,3 grader respektive 6,4 grader för metakarpofalangealleden vid böjt respektive sträckt finger, samt 10 grader för totalt aktivt rörelseomfång (total active motion). / Between 2020 and 2021, 381 operations for flexor tendon injuries were registered in Sweden. The rehabilitation following surgery is long and requires continuous monitoring. Presently the monitoring is done through manual measurements of the patients flexing and extending capability of the fingers affected. The measurement is performed at a hand surgery department with a handheld goniometer, initially once a week. The hand surgery department at Södersjukhuset in Stockholm requested a digital tool that allows the patient to reliably measure the angles of the fingers bending and stretching capability at home instead of at the clinic. The objective of the project was therefore to create a measurement tool that measures these angles with a maximum error of 5 degrees. A measurement tool was developed where the measurement of angles takes place from an image taken by the user. The measurement tool is compatible with Android devices and can be implemented in an existing Android application. Tests showed that the measurement tool has a mean measurement error of 5 degrees or less for the proximal interphalangeal joint and the distal interphalangeal joint. In addition, the mean error was 7.3 degrees and 6.4 degrees for the metacarpophalangeal joint, bent and stretched respectively, and 10 degrees for total active motion.

Sehnenverletzungen machen ca. 30 % der muskuloskelettalen Beschwerden aus. Repetitive Überlastung wird häufig als Ursache diskutiert. Dabei entstehende strukturelle Schäden können die Kapazität der Sehne, mechanische Belastung zu tolerieren, reduzieren. Das exzentrische Protokoll nach Alfredson sowie das „heavy slow resistance training“ sind häufig genutzte Formen der Trainingstherapie. Jedoch zeigen diese Protokolle bisher kaum Nachweise für strukturelle Anpassung. Eine trainingsinduzierte Zunahme der Sehnensteifigkeit könnte die Sehne widerstandsfähiger machen und vor Überlastung schützen, da die Beanspruchung (Sehnendehnung) bei gegebener Belastung reduziert wird. Bei gesunden Probanden führte das „high-loading“ Protokoll, das mit einer hohen Dehnungsmagnitude arbeitet, ausgelöst durch ca. 90 % der maximal willkürlichen Kontraktionskraft der Plantarflexoren, sowie einer Dauer von 3 Sek., zu positiven strukturellen Anpassungen. Die vorliegende Arbeit zeigt erstmals, dass sich tendinopathische Achillessehnen bei ausreichend hohem mechanischen Stimulus ähnlich gesunden Sehnen anpassen. Im Vergleich zum exzentrischen Training sowie passiver Therapie führte nur das high-loading Protokoll zu einer Hypertrophie der Sehne sowie einer Zunahme der Sehnensteifigkeit, während es in allen drei Gruppen gleichermaßen zu klinisch-funktionellen Verbesserungen kam. Das dabei angewandte mobile Trainingsgerät bewies in einer separaten Studie exzellente Reliabilität sowie Effektivität (Kraft/Sprunghöhe). Weiters wurden Asymmetrien zwischen der betroffenen/nicht-betroffenen Seite untersucht. Größtenteils zeigten sich im Vergleich zu Gesunden ähnlich ausgeprägte Asymmetrien. Die Effekte auf diese Asymmetrien durch Training waren eher gering. Eine Reduzierung der Asymmetrien ging nicht notwendigerweise einher mit einer klinisch-funktionellen Verbesserung. Insgesamt liefern die Ergebnisse wichtige Erkenntnisse bezüglich einer neuartigen Behandlungsmethode der Achillestendinopathie, die durch die hervorgerufene Verbesserung von Sehneneigenschaften sowohl für die Rehabilitation als auch Prävention zu empfehlen ist. / Tendon injuries account for approximately 30 % of musculoskeletal consultations. Repetitive overload is identified commonly as initial cause implicating structural impairments. Hence, the capacity of the tendon to tolerate mechanical load might be attenuated. In Achilles tendinopathy, Alfredsons ´eccentric exercise protocol and heavy slow resistance training are frequently applied exercise interventions both leading to clinical and functional improvements. However, evidence for eliciting structural adaptation is lacking. An exercise-induced increase in tendon stiffness might improve the tendon `s capacity to tolerate loading and thus reduce future damage as tendon strain at a given force is reduced. In healthy subjects, the high-loading protocol applying high tendon strain induced by highly intensive muscle contractions (i.e., at 90 % of maximum voluntary isometric contraction) with 3 seconds time-under-tension has led to positive adaptations (i.e., increased cross-sectional area and stiffness). This thesis first provides evidence that tendinopathic Achilles tendons do adapt comparable to healthy tendons given that an adequate mechanical stimulus was applied. High-loading led to tendon hypertrophy and an increase in tendon stiffness compared to eccentric exercise or passive therapy, while clinical/functional improvements have been detected in all the three groups. In a separate trial, the applied mobile training device showed excellent reliability and effectiveness (strength/jump height). Further, inter-limb asymmetries have been investigated showing comparable levels except for vascularization compared to healthy subjects. Therapeutic interventions had only small effects regarding pronounced asymmetry reductions whereas a reduction in asymmetry did not necessarily correlate with an improvement in tendon health. In conclusion, the findings of the present thesis provide valuable evidence for high-loading as a novel exercise treatment in Achilles tendinopathy.