Age-Related Differences on the Enhancement of Non- Dominant Hand Motor Function After Parallel Intervention of Anodal Tdcs and Motor Task: A TMS Study.

Age-related differences on the enhancement of non- dominant hand motor function after parallel intervention of anodal tdcs and motor task: a TMS study.

Br J Sports Med. 2013 Jul; 47(10): x-e3
Kakoura E, Baka K, Katsoulaki M, Dang M, Fotiou S, Nowicky A

Healthy ageing is accompanied by cognitive and functional deficits which result in decreased ability to respond quickly and accurately to different stimuli. Whilst a general decline is observed in manual dexterity and hand motor function of older adults affecting their daily life, learning ability is almost completely intact. NIBS techniques such as tDCS has been found to have effective results by enhancing cortical excitability and motor learning and function in the younger adults. The purpose of this study was to further investigate any improvements in non-dominant hand motor function, examining the effects of tDCS alongside a motor skill rehabilitation task (MSRT) in motor learning in the ageing brain, focusing on any age-related differences.Thirty-two healthy subjects (YAs: n=20, mean age= 24.4± 2.03; OAs: n=12, mean age= 64.3± 9.56) participated in this double-blinded, sham-controlled study, undertaking a single session of either anodal or sham tDCS on the non- dominant M1. The MSRT was carried out as an outcome measure to investigate any changes in hand function, speed and accuracy, with TPR scores indicating level of MSRT performance. TMS was used to detect any changes in cortical excitability of the non-dominant hemisphere, measuring the MEPs of the non-dominant APB. The cortical excitability assessment through paired-pulse TMS was based on Kujirai protocol, measuring the SICI/F) and the LICI/F at predetermined delays. At baseline, behavioural functional tasks were carried out to evaluate speed and accuracy of the participant before intervention. The statistical data analysis was carried out using mixed analysis of ANOVA (P<0.05).There were significant differences between the type of tDCS application (anodal versus sham) regarding the APB MEP responses detected by TMS (P= 0.03). Also, a significant effect of age was found on overall TPR scores with younger individuals obtaining lower scores than the older (P =0.003), indicating better MSRT performance. Another outcome was the significant improvement level of the MSRT for all groups across the time intervals (P<0.001). However, no significant age- related differences found concerning the overall facilitation or inhibition.Though some findings did not reach at a statistical significance level, a-tDCS coupled with MSRT did ameliorate motor performance and therefore suggests that brain stimulation can enhance motor function in the ageing brain, facilitating motor learning through a-tDCS. Further research into neurorehabilitation can continue to contribute to the understanding of normal ageing and confirm the positive impacts of a-tDCS alongside motor tasks for ageing individuals as well as its potential as a poststroke intervention. Additionally this research could be used further as a post-traumatic sport rehabilitation because of the impact on the healthy younger groups. HubMed – rehab


Arthoscopic reduction and fixation of fractures of the greater humeral tuberosity in athletes: a case series.

Br J Sports Med. 2013 Jul; 47(10): v-e3
Tsikouris G, Intzirtis P, Zampiakis E, Plessas S, Taprantzis L, Kourougenis P, Tsikouris D, Tsikouris L

Arthroscopy is nowadays a well-establish method to treat a wide range of injuries and overuse syndromes of the shoulder. The role of arthroscopy is extremely important for the treatment of soft-tissue injuries and specific-type fractures of the estimate the applicability of shoulder arthroscopy as an effective method for the treatment of fractures of the greater tuberosity in athletes. PATIENTSMETHODS: Twelve athletes (six professional-six recreational, four skiers-two horse riders-two motorcycle racers-one cyclist-one football player-one hardle jumper-one judoka, eight males-four females) with a mean age of 29 (20-45) years, sustaining an avulsion fracture of the greater humeral tuberosity were treated arthroscopically over a 5-year period. Nine were managed acutely and three as malunion and rotator cuff dysfunction cases. For the imaging evaluation, standard plain radiographs (anteroposterior and axillary views), CT scans (with 3D reconstruction) and MRI were performed. In three patients the fragment dislocation was found ?5?mm, in four was 6-10?mm and in two was more than 10?mm. Anchors were used to fix the avulsed fragment. In nine patients, accompanying soft-tissue lesions (seven rotator cuff tears and two Bankart lesions) were recognized and properly treated. Postoperatively a shoulder abduction brace 30° was applied for six weeks and a careful rehabilitation plan was utilized. Passive external rotation exercises were started immediately.During the follow up period no major complication was observed. Radiographic outcome was assessed on plain X-rays. No patient developed non-union. All patients achieved UCLA scores over 30 at six months. Professionals returned to practicing at 10-12 weeks with customized programs. All athletes returned to their pre-operative activity level with no residual pain.The investigation of indications of shoulder arthroscopy is a continuous process. Surgical familiarity is important to perform advanced techniques in shoulder arthroscopy. Arthroscopic treatment of minimally displaced greater tuberosity fractures should be considered for athletes or people who perform overhead activities.Arthroscopic treatment of fractures of the greater humeral tuberosity can offer excellent functional results and permits the treatment of concomitant critical lesions. HubMed – rehab


Exuberant inflammatory reaction after an infiltration of platelet-rich plasma (prp).

Br J Sports Med. 2013 Jul; 47(10): e3
Kaux JF, Croisier JL, Léonard P, Goff CL, Crielaard JM

BACKGROUND : PRP, obtained from centrifuged autologous blood, contains a large quantity of growth factors, which may enhance tissue healing processes. Local infiltration of PRP represents a relatively new treatment for tendinopathies. To date, no side effects have been reported after infiltration of PRP to treat tendinopathy.(1) CASE REPORT : A 35-year-old patient had a right upper patellar tendinopathy which was resistant to all of the conservative treatments for more than six months. The patient was a type 1 diabetic (well controlled). He benefited from an intratendinous infiltration of 6 mL of PRP (8.105 platelets/mm 3, almost no red or white blood cells) without local anaesthetic. Immediately following the infiltration, local cryotherapy was performed for 15 minutes. NSAIDs were avoided, but class-1 or -2 pain-killers were authorised if necessary. A standardised sub-maximal eccentric rehabilitation should be started 1 week after. However, the patient experienced local swelling with erythema, increased heating and pain which appeared just underneath the patella, but without biological inflammatory syndrome. A great Doppler signal in a thicker patellar tendon was observed by US, but there was no sign of local infectious disease demonstrated by either CT or MRI. However, the local inflammation did not decrease after a progressive 3-week treatment of local cryotherapy, local and oral NSAIDs and colchicine 1 mg. Thus, an insidious infection was suspected, even though there was neither evidence of biological inflammatory syndrome or sign of infectious lesion on imagery examination. An antibiotic therapy (rifampicine 600 mg+minocycline 100 mg) was initiated for 3 months. Finally, a 3-phase bone scintigraphy suggested the presence of a complex regional pain syndrome type 1 treated by a classical physical therapy and concomitant class-2 pain killers. The evolution was favourable after 6 months of symptomatic treatment, and the pain decreased to a level similar to that before the infiltration of PRP.This case report calls attention to potential side effects that are linked to this new therapy by infiltration of platelet rich plasma in case of tendinopathy, in particular when used in patients with type 1 diabetes. Thus, the balance between benefits and risks must be carefully evaluated before using this treatment in patients with type 1 diabetes. HubMed – rehab


Proximal sartorius tendon rupture as a cause of traumatic anterior hip pain-a case report of a professional footballer.

Br J Sports Med. 2013 Jul; 47(10): e3
Kumar B, Sirisena D, Rayner M

Sartorius injuries are seldom mentioned in medical literature. Thus developing an evidence-based management plan for sartorius muscle and tendon injuries can be challenging. In this case a grade 3 tear of the proximal sartorius tendon was identified in a player following a high-velocity contact injury to the pelvis during a professional match.The athlete was able to continue playing for a further 30 minutes following the injury, but ultimately increasing pain and restriction in hip movements forced him to limp off. Examination revealed localised swelling, bruising and tenderness at the site of contact to the left anterior-superior iliac spine (ASIS), and painful muscle contraction. This was managed to good effect as a presumed muscle contusion, but with recurrence of symptoms, further swelling, bruising and limping by half time in the subsequent match one week later. The presumed contusion was thought to have deteriorated forming a suspected 10cm muscle haematoma. The merits of blind and sonography-guided aspiration were considered, and the latter option was chosen.Ultrasonography revealed soft tissue oedema and injury to the proximal sartorius tendon, and aspiration was therefore not attempted. A subsequent MRI scan demonstrated a grade 3 sartorius tendon tear at its insertion to the ASIS with 3cm separation. With no specific guidance available in the medical literature, consensus of opinion was to continue with conservative management. Rehabilitation methods were modified according to the new findings. Given importance of this player in the team and the next match being a cup final a week later, a pragmatic approach was taken to allowing him to play; he played effectively for one hour before he showed signs of limping. He went on to have three, weekly Prolotherapy injections into the site of the tear in order to facilitate healing in the off-season. Progressive rehabilitation of his thigh resulted in return to uninhibited play within six weeks. DISCUSSION/ CONCLUSIONS: ? The history and physical examination findings, as well as initial good response to conservative treatment of a presumed simple contusion provided our medical team false assurance and a small delay in the diagnosis of this rare injury. ? Attaining the exact diagnosis allowed a more hands-on and bespoke rehabilitation program, as well as informed decision-making as to suitability to play in a crucial match. ? The rarity of this injury and negligible functional deficit that results from a ruptured proximal sartorius tendon following good rehabilitation perhaps accounts for the paucity of medical literature available. ? We ask the audience to consider a sartorius tendon rupture in the differential diagnosis of acute anterior hip pain. HubMed – rehab