Method of treating musculoskeletal disorders caused by labour activity

FIELD: medicine.

SUBSTANCE: method involves doing therapeutic exercises and pulsed ultrasonic therapy at a pulse length of 10 ms. That is combined with the magnetic stimulation of the shoulder girdle muscles: m. trapezius m. deltoideus, m. supraspinatus, m. infraspinatus on the involved side. That involves the exposure in accordance with a stable technique with using paired pulses of the length of 220±20 mcs at a pulse repetition frequency of 25±5 pulse/min and a pulse-to-pulse spacing of 80 ms for 3 min per one field. The exposure intensity is 70-90% of the maximum magnetic induction amplitude 1,300 mT. The total length of the procedure is 12 minutes. Then 30 minutes later, mud therapy is conducted by applications on the involved shoulder joint. A mud cake temperature makes 38-40 degrees, and the length of the exposure makes 20 minutes. The mud therapy is followed by ultrasonic therapy. The exposure covers the rotator cuff and attachment points of the tendons - m. supraspinatus, m. infraspinatus, m. teres minor on the involved side. The exposure follows a labile technique at an intensity of 0.2-0.4 W/cm2 for 2 minutes per each field at the total length of the procedure of 8 minutes. The procedures are daily. The therapeutic course is 8-10 procedures.

EFFECT: method enables clinical effectiveness by recovering the motor activity of the involved extremity and prolongs the remission, prevents the progression of the biomechanical and neurodystrophic disorders, and formation of neurological complications.

1 ex, 4 tbl, 1 dwg

 

The invention relates to medicine, namely to physiotherapy and occupational pathology, and can be used for rehabilitation treatment of persons with work-related musculoskeletal disorders in the shoulder girdle area, due to work-related physical and functional stress.

Professionally due to diseases of the musculoskeletal system is one of the most important places in the overall morbidity[1, 2, 3, 4]. Resulting from work activity restriction of the functional activity of shoulder girdle impairs hemodynamic and trophic situation in the region of the upper limb, which may be accompanied by chronic pain syndrome, aggravation of degenerative articular process-tendon apparatus, defeat neuromuscular structures, the formation of complications such as contractures of the joints, tunnel syndromes. This contributes to a prolonged course of disease, reduction of social and industrial activity of the patients.

Treatment of musculo-skeletal disorders, usually complex. Among the drugs widely used analgesic and nonsteroidal anti-inflammatory drugs [5], including in the form of medicated blocks [6, 7] and injection-free methods introduction the medicament is i.i.d. substances through the application of Dimexidum [8]. For relieving pain some authors consider the appropriate use of pharmacological agents that stimulate the production of components of connective tissue, inhibiting their degradation and thereby preventing the progression of degenerative diseases of all structures of the musculoskeletal system (slow-acting anti-inflammatory or structure-modifying means, the so-called protective agents). It is proved that the use of chondroprotective "Arthritis" and "Alflutop" when articular pathology contributes to the relief of pain, increased mobility of the affected joints by improving the condition of the articular cartilage (have a positive effect on metabolism in cartilage) [9, 10]. However, among the disadvantages of these methods can be noted a greater duration of treatment, the possible negative impact of drugs on the functional state of the mucosa of the gastrointestinal tract, allergic reactions. Along with these medications do not provide regression of musculoskeletal disorders caused by damage to the neuromuscular apparatus (violation of the biomechanics of the shoulder joint is one of the leading manifestations of musculo-skeletal disorders). Because the efficacy of periarticular blockages in the shoulder joint depends on the accuracy of the spine of the drug this method imposes additional requirements for correct application of topical diagnosis, qualifications of medical staff, the observance of sanitary-epidemic regime. Among the adverse reactions caused by periarticular injection of glucocorticosteroids is known such as a system of vegetative and resorptive effects (hypertension, hyperglycemia), degenerative and mechanical damage tendons with frequent procedures (the conduct series of injections more than 1 time in 3 months).

To restore the biomechanics of the affected shoulder joint proposed methods of treatment involving the conduct of medical physical culture, which can increase initially decreased muscle tone, increase range of motion in affected joints [11]. The disadvantage of this method is the impossibility of its use in patients with severe pain, low efficiency in the presence of contractures.

Therapeutic physical culture in complex with such physical factors as laser radiation, magnetic field, can significantly affect the volume of active movements of the shoulder joint, hemodynamic situation in the shoulder girdle area. Thus, the method involving the combined effect of infrared laser radiation in a pulse mode with a frequency of 0 Hz and static magnetic field (magnetic flux density of 50 MT) on the area of the paravertebral zones, shoulder BAHT in combination with physiotherapy (included techniques and postisometric automatizations relaxation shortened muscles) and basic drug therapy (baralgin, diclofenac) provides relief of pain, activation of microcirculation processes, correction of biomechanical changes due to the effect on muscles that retains all the properties of contractility, but devoid of resistance antagonists on the background of preliminary voltage periarticular structures [12]. However, therapeutic effect of the application of this method to the greatest extent expressed in relation to short and spastic muscles and does not impact on hypotonie and hippotraginae muscle, joint and tendon education affected area that does not allow you to rebuild pathological motor stereotype.

A number of authors suggest methods of influence on the area affected soft tissues of joints using pulses of infrasonic waves [13]. Rapid clinical effect of extracorporeal shock wave therapy reduces pain, relieves muscle spasm, improving circulation in the affected area, razryhlyaya fibrotic foci, destroyed the microcrystals of calcium salts) could allow her to find wide application in the pathology of musculoskeletal devices is A. But this method has a number of contraindications: bleeding disorders, thrombophlebitis, pregnancy, cysts, granulomas formations in the area of impact, the use of shock wave therapy is prohibited on the area of projection of the growth zones (metaphysi) bones, regions, closely bordering edges (lung tissue), the area of the skull (except TMJ), the projection area of the intestine, the main (large) vessels. Along with these possible side effects (formation of point hemorrhages in the skin, bruising, local swelling). The presence of massive celtificate in the thickness of the tendon is fraught with its breakthrough in the surrounding synovial cavity (shoulder joint or subacromial bag), which entails the development of a rapid inflammatory microcrystalline reaction from the synovial membrane (“acute painful shoulder”).

Closest to the present invention is a method of treating musculoskeletal disorders of the shoulder joint (shoulder blade periarthritis), involving the integrated use of inactivation of trigger points by injection of diprospan, exposure to ultrasound with hydrocortisone on their skin projection, manual therapy and physical therapy [14]. The effect of ultrasound was performed on the area of projection of painful muscle upl is tiny in the muscles of the shoulder girdle. The application of this methodological approach provides regression muscle pain, inflammation in areas of dystrophic changes of the muscles, improving tonusa-power characteristics of the muscles involved in the pathological process. However, this method cannot ensure the impact on dystrophic modified tendon-capsular structures of the rotator cuff of the shoulder joint and, as a consequence, the impact on the prognosis of the disease.

Muscular-skeletal disorders, including work-related, involvement in the pathological process of a number of systems (muscles that provide movement in the shoulder joint, tendons, muscles, experiencing maximum load with industrial activity, the shoulder joint capsule, a violation of hemicircular and trophicity of the soft tissues of the shoulder girdle) requires pathogenetically grounded approach to medical facilities.

New technical problem - increasing the effectiveness of treatment of work-related musculo-skeletal disorders due to restoration of motor activity of the limb by using a combination of myostimulating factors that contribute to maintaining for a longer time of treatment results, to prevent possible progression biomechanical and neurodystrophic bre the deposits and the formation of neurological complications.

To solve the problem in the treatment of musculo-skeletal disorders in the shoulder joint, due to employment, including physical therapy and ultrasound therapy in a pulsed mode with a pulse duration of 10 MS, additionally spend FMS muscles of the shoulder girdle: m. Trapezius m. deltoideus, m. supraspinatus m. the infraspinatus on the patient side stable method using paired pulses of 220±20 μs, when the frequency of sending pulses of 25±5 imp./min and time interval between pulses 80 MS for 3 minutes on one field, when the intensity of 70-90% of the maximum amplitude of the magnetic induction (1300 MT), the total duration of the procedure 12 minutes, then 30 minutes after pulsed magnetic therapy the patient receives mud application on the affected shoulder joint at a temperature of mud cakes 38-40 degrees for 20 minutes, and ultrasonic therapy is carried out immediately after the mud acting on the region of the shoulder joint capsule and the insertion of the tendons of the muscles - m. supraspinatus m. infraspinatus m. teres minor on the patient side of the labile technique, the intensity of 0.2-0.4 W/cm2within 2 minutes on each field, the total procedure time is 8 minutes, the treatment includes 8-10 procedures carried out daily.

The method implemented is tlaut as follows.

Exclude tendon ruptures of the rotator cuff muscles of the shoulder joint by conducting magnetic resonance imaging of the shoulder joint. During examination of patients to determine the degree of biomechanical disorders of the affected shoulder joint, localization neurodystrophic foci in functionally overloaded muscles and their tendons, identify the muscles with reduced tonus force characteristics by assessing their tone, strength, elektrokineticheskoi activity.

Patients daily allograpta exercise therapy with the development of the affected shoulder and hand massage the neck area and the area of the affected shoulder joint and shoulder.

FMS lipotropina muscles of the shoulder girdle (m. trapezius m. deltoideus, m. supraspinatus m. infraspinatus) on the patient side is held in a stable manner (inductor establish contact with the patient lying on his stomach) using paired pulses of 220±20 μs, when the frequency of sending pulses of 25±5 counts/min and the time interval between pulses of 80 MS for 3 minutes on one field (one field is the area of the motor points of the muscles) when the intensity of 70-90% of the maximum amplitude of the magnetic induction (1300 MT). Patients with severe pain intensity is 50% of the maximum amplitude of the magnetic induction (1300 MT). General cont littlest procedure 12 minutes.

After 30 minutes of pulsed magnetic therapy the patient receives mud application on the affected shoulder joint at a temperature of mud cakes 38-40 degrees for 20 minutes.

Immediately after the mud bath therapy ultrasound therapy on the region of the shoulder joint capsule and tendon attachment functionally overloaded muscles (short rotators of the shoulder - m. supraspinatus m. infraspinatus m. teres minor) at patient side labile methodology at the intensity of 0.2-0.4 W/cm, pulse mode (pulse duration 10 MS), for 2 minutes on each field with the total procedure time is 8 minutes.

The treatment consists of 8-10 daily complex effects.

Pulsed magnetic field can provide a good therapeutic effect in musculo-skeletal disorders, as has neuromuscularly, vasoactive effects, activates biochemical processes functional microcirculatory system and transcapillary transfer, as the systems supporting the delivery of oxygen to tissues and indirectly influencing enzymes that catalyze reactions of electrogenesis and electrophysiological processes in the nervous and muscular tissues, accelerates reparative processes [15]. Elektrokineticheskie activity of tissues (as unspecialized, that is specialized, muscle), being realized through the activity of enzyme systems and energy complexes as cellular membranes and cytoplasm of the cells is determined by the functional state of the microcirculatory system with intracapillary transfer, as the systems supporting the delivery of oxygen to tissues and indirectly influencing enzymes that catalyze reactions of electrogenesis.

Particularly important pathogenetic importance of structural-functional changes in the tendon-ligament and articular elements are implemented compensatory-adaptive and destructive processes in the musculoskeletal system. Therefore, in the treatment of musculo-skeletal disorders requires the use of such physical factors that would ensure action on the connective tissue (connective tissue formation region of the shoulder joint and shoulder) with rejuvenation of its cellular composition and fibrous structures, called to prevent the formation of coarse-fibered tissue and resorption of scars. These factors include ultrasound and mud [16, 17]. The basis of local changes are the emergence of micro-massage of the tissues, loosening, increased microcirculation and regional blood flow, increased vascular and epithelial permeability, the acceleration of the diffusion and exchange processes./p>

Thus, myostimulating impact by increasing the functional activity of the muscle and tendon-ligament apparatus of the shoulder joint, the intensification of the processes of regional hemodynamics can improve the tone, the efficiency of the muscles of the shoulder girdle and to ensure maximum efficiency in terms of correct biomechanical abnormalities in work-related musculo-skeletal disorders, tropicaltuna factors will allow for regression neurodystrophic disorders of the shoulder joint, and their integrated application - to restore locomotor activity in the shoulder joint to retain the industrial activity of the patients.

Example 1

Patient F., 39 years old, master of manicure, was admitted with a diagnosis of work-related musculo-skeletal disorders, subacromial syndrome on the right. Upon receipt complained of pain in the right shoulder joint and the upper third of the right shoulder, especially when the movements, restriction of motor activity of the right shoulder joint. From the anamnesis: work for 20 years associated with long hours of staying in a forced posture, state dynamic strain muscles of the right shoulder girdle. Not previously treated (only rubbing in the home). Notes the deterioration in the period after them 1.5 years.

When magnetic resonance study showed signs of osteoarthritis acromiale-clavicle joint right, tenosynovitis and dystrophic changes in the supraspinatus muscle on the right, impingement syndrome. At the time of receipt of the violation of life in the pathology of the shoulder on questionnaire Shoulder Disability Questionnaire totaled 11 points (moderate impairment), in accordance with the questionnaire evaluation of the Ucla shoulder Shoulder Assessment - 10 points. Pain 7 points on the visual analogue scale increases with the resistance of active abduction of the right shoulder.

When orthopedic tests he was diagnosed with S-shaped scoliosis of the cervical-thoracic spine, expressed antalgic limitation of function of the right shoulder joint (moving in the direction of 80°, flexion 80°, extension 20°, external rotation 60°, the institution of the hands behind the head is limited to 2 points). A positive test of Dawbarn right (the average symptom painful arc), symptom leaning hands and symptom Leclerc negative. Acromiale-clavicle test positive on both sides, basipetally on the right, a symptom of Joba positive to the right. We found a decrease in muscle tone of the rotator cuff on the right (reading myotonometry for m. deltoideus 0.3 kg/cm2alone and 0.7 kg/cm2when muscle tension, for m. supraspinatus 0.2 kg/cm2alone and 0.4 kg/cm2when the voltage of the mouse is s, m. infraspinatus 0.3 kg/cm2alone and 0.6 kg/cm2when muscle tension) when the asymmetry factor compared with the healthy side KA=45-60% at rest and KA=37-50% when muscle tension). Moderately severe malnutrition rotators of the shoulder (m. deltoideus 2 points, m. supraspinatus 2 points, m. infraspinatus 2 points). Show a decline in the strength of the muscles of the rotator cuff: m. deltoideus right up to 3 points, m. supraspinatus to 2 points, m. infraspinatus up to 4 points).

The patient revealed neurodystrophic manifestations in the determination of the threshold of pain sensitivity PBC revealed a significant decrease in the area places of attachment functionally overloaded muscle m. supraspinatus right (3.2 kg/cm2), m. infraspinatus right (3.6 kg/cm2), m. teres minor (3,9 kg/cm2compared to the healthy side (neurodystrophic foci are absent, PBC=8,7-9,0 kg/cm2). Is also determined by the presence of severe pain coracoid process of the scapula on the right and acromiale-clavicle joints, more pronounced on the right. When electroneuromyographic study of muscles revealed asymmetry amplitude electromyograms arbitrary maximum voltage supraspinatus muscle at 45% (right 294 µv, left 539 µv) and the deltoid muscle by 32% (right 1437 µv, left 2113 µv). The amplitude of the M response during stimulation of n. axillaris 5,02 MB, n. accessories 10,6 MB, terminal latency 3,37 MS for n. axillaris, 1,93 MS is La n. accessories.

The patient received treatment according to the proposed method, including 10 daily combined impacts of: physical therapy, FMS, mud therapy and ultrasound therapy.

After treatment the violation of life in the pathology of the shoulder on questionnaire Shoulder Disability Questionnaire was 5 points (weakly expressed human), in accordance with the questionnaire evaluation of the Ucla shoulder Shoulder Assessment - 28 points (slight impairment). Pain at rest disappeared during exercise in the right upper limb no more than 3 points on the visual analogue scale, not increases with the resistance of active abduction of the right shoulder.

After treatment, the patient reported increased range of motion in the shoulder joint (moving in the direction of 140°, flexion 160° extension 30°, external rotation to 90°, the institution of the hands behind the head, perhaps in full, slightly painful), thoracic and lumbar regions, a sense of ease and no pain. Sample of Dawbarn right (the average symptom painful arc) and acromiale-clavicle test negative, basipetally test and the symptom of Joba slabopolozhitelnym right.

Increased tone of the muscles of the rotator cuff on the right (reading myotonometry for m. deltoideus 0.6 kg/cm2alone and 0.9 kg/cm2when muscle tension, for m. supraspinatus 0.4 kg/cm2alone and 0.7 is g/cm 2when muscle tension, m. infraspinatus 0.5 kg/cm2alone and 0.8 kg/cm2when muscle tension) when the asymmetry factor compared with the healthy side KA=17-25% alone and KA=14-20% when muscle tension). Decreased degree of malnutrition rotators of the shoulder (m. deltoideus, m. supraspinatus and m. infraspinatus) to 1 point. Significantly improved power characteristics of the muscles of the rotator cuff: m. deltoideus and m. supraspinatus right 4 points, m. infraspinatus 5 points.

Changed the status of neurodystrophic zones: significantly decreased the degree of their pain (pain threshold m. supraspinatus right to 5.3 kg/cm2), m. infraspinatus right (5.5 kg/cm2), m. teres minor (6.0 kg/cm2). Pain coracoid process of the scapula on the right and acromiale-clavicle joints are not shown.

When conducting electroneuromyographic studies of pathological changes in the studied nerves and muscles are not revealed: the amplitude of electromyograms arbitrary maximum voltage supraspinatus muscle on the right 667 mV, left 713 µv when the asymmetry factor of 6% and deltoids right 2192 µv, left 2581 µv when the asymmetry factor of 15%. The amplitude of the M response during stimulation of n. axillaris of 10.0 MV, n. accessories 17,6 MB, terminal latency 2,44 MS for n. axillaris, of 1.65 MS for n. accessories.

The mode method is based on the results of clinical observation of 48 patients with a Professor who sionline due to musculo-skeletal disorders (lesions of tendons and rotator cuff muscles of the shoulder from the physical and functional overstrain), including 28 women (58%) and 20 men (42%) aged from 29 to 49 years (mean age was 38,1±5.3 years). The control group (clinical and physiological indicators, comparable with the main group) consisted of 16 patients who underwent therapy with the development of the affected shoulder joint, ultrasound therapy on the area of the painful muscle seals muscles of the shoulder girdle. All patients history of production were due to regular exercise, including weight lifting, repetitive motion, prolonged stay in a forced working posture, inadequate static and dynamic load on the shoulder belt. Typically, the clinical manifestation of the disease was associated with static or kinetic loads. In 90% of cases of pathological changes related to "working limbs and in 10% of patients with clinical symptoms of different severity was observed in both shoulder joints.

Evaluation of orthopedic status was carried out by determining the volume of active movements of the shoulder joints, pain threshold (PBC) tendon pain areas with altimetry, the presence and degree of muscular-tonic disorders using myotonometry and global electromyography m. deltoideus, m. supraspinatus and m. the infraspinatus, the registration of structural changes is of licevyh joints and rotator cuff of the shoulder using magnetic resonance imaging, the presence and severity of neurological complications by assessing neurological status and using the stimulation electromyography n. axillaris, n. accessories. The quality of life of patients was assessed using questionnaires violations of activity in the pathology of the shoulder Shoulder Disability Questionnaire and Evaluation of the Ucla shoulder Shoulder Assessment.

In the observed patients leading clinical sign were biomechanical disorders. Range of motion in the affected shoulder joint was limited in all planes, most suffered the abduction and rotation (Fig.1). External rotation was detected when fixed to the chest and bent in the elbow joint at 90° hand. Limitation of internal rotation was determined by determining the level of the spinous process, which can take the thumb of the patient with active institution his hands behind his back. Half of the patients were found positive symptom falling hands (pain, decreased strength of the deltoid muscles).

All patients demonstrated a violation of tanoso-power characteristics of the rotator cuff muscles of the shoulder (table.1, 2). They were most often manifested by hypotension muscle on the affected side (readings myotonometry for m. deltoideus 0,68±0.4 kg/cm2alone and 0.92±0.5 kg/cm2when muscle tension, for m. supraspinatus 0,47±0.3 kg/cm2alone and 0,76±0.4 kg/cm2when the voltage of the mouse is s, m. infraspinatus 0,53±0.3 kg/cm2alone and 0.84±0.4 kg/cm2when muscle tension). Recorded a decrease in the strength of the rotators of the shoulder on the affected side: m. deltoideus 3,2±0,4 points, m. supraspinatus to 2.6±0.15 points, m. the infraspinatus to 4.1±0.3 points. The restriction of the functional load off from a new stereotype muscle movements led to the formation of their malnutrition (table.2).

Palpation revealed tenderness in the projection acromiale-clavicle joint, the coracoid process, the lesser tubercle greater tubercle of the exit points of the axillary nerve, shoulder, tenderloin (PL.3).

All patients acromiale-clavicle sample was positive was detected symptom painful arc, with 64% of patients were found to have average symptom painful arc (positive test of Dawbarn), sometimes with lead pain did not arise, but the lowering of arm was very painful. Conducting resistive tests confirmed in all patients, the lesions of the tendons of the rotator cuff muscles of the shoulder. For example, a positive symptom of Joba (in 96% of cases) testified to the damage to the tendon of the supraspinatus muscle was recorded (in 34% of patients) pain when the resistance of active external rotation of the shoulder, which is characteristic lesion of tendon infraspinatus and small round muscle. In 46% of patients were positive bicipitalis samples (presence of boleznennom the palpation of the tendon of the biceps muscle in the projection libparanoia furrows and pain when you try to flatten the shoulder with elbow extended his hand), testified to the defeat of the tendons of the biceps. Virtually all patients with palpation of area podkrovelnogo joint was determined symptom "crepitate" (the equivalent of this symptom is the "crunch" in the field podkrovelnogo joint during active movements).

According to the results of magnetic resonance tomography examination of all patients were recorded signs impingement syndrome (syndrome compression of rotators in subacromial space), structural changes fibro-cartilage formation shoulder joint in the form of arthrosis of the shoulder, acromiale-clavicle joints, enthesopathy and partial rupture of the tendon of the short rotators of the shoulder, supercoiling and subdeltoid bursitis, tenosynovitis muscles of the rotator cuff, dystrophic changes deltoid (57%), supraspinatus (82%) and small round muscle (73%).

The characteristics of electrogenesis neuro-motor apparatus of the upper extremities revealed a decrease in the amplitude of the electrical activity of muscles of the shoulder girdle (m. deltoideus, m. supraspinatus and m. infraspinatus) according to electroneuromyography on the patient side, the most often (89%) met low electrical activity of the deltoid and supraspinatus muscles (PL.4). According to stimulation of nerve conduction in 23% of cases a decrease in the amplitude call the data of muscle potentials (M-responses) during stimulation of motor points n. axillaris, n. accessories. Rate parameters were within normal limits.

Thus, work-related mikrotravmatizatsiya soft tissues of the shoulder and shoulder joint contributed to the emergence of myotonica, biomechanical disorders. Growth trend similar violations contributed to the reduction of movement in the shoulder joint, the formation of a new pathological dynamic stereotype and, as a consequence, the development of degenerative process in tendons and muscles, with the greatest overload (for abduction and rotation of the shoulder).

The main group consisted of 48 patients with professionally due to musculo-skeletal disorders receiving treatment in accordance with the new method. The control group consisted of 16 patients who underwent therapy with the development of the affected shoulder joint, ultrasound therapy on the area of the painful muscle seals muscles of the shoulder girdle.

After treatment according to the proposed method, most of the patients of the main group (78%) pain syndrome disappeared alone, the rest was poor (no more than 3 points on the visual analogue scale). Not marked intensification of pain during exercise on the working limb, conducting resistive tests (resistance active movement in a sick shoulder sousta is (e). In the control group analgesic effect was recorded by the end of treatment (moderate pain syndrome was detected in half of the patients when performing resistance tests, the intensity of pain in 45% of patients reached 5-7 points).

Under the influence of treatment in patients of the main group revealed significant dynamics of tanoso-power characteristics of the muscles of the shoulder girdle and shoulder. All patients had decreased asymmetry of muscle tone by increasing the source of decreased tone of the rotators of the shoulder on the affected side (PL.1), while the increase of the values at rest was 78%, with a maximum arbitrary reduction of 39%. In the control group the increase in values initially decreased muscle tone was at rest 27%, with a maximum arbitrary voltage is 16%. In the main group were also statistically significant increase in the strength of the deltoid and supraspinatus muscles (on average by 1.1 points), as well as reducing the degree of malnutrition (table.2). In the control group was also observed increase in the strength of the investigated muscles, but its value did not exceed 0.5 points. Significant decrease in the degree of hypotrophy of muscles of the shoulder girdle in the control group were noted.

Significantly (on average by 25-30%) increased volume of active movements in the affected shoulder joint (figs.1). The symptom painful the arc became negative in 53% of patients. In 36% of cases the amount of motion in the affected shoulder joint has almost reached control values (abstraction was 168,7±13,4°, extension 37±8,5°). In the control group, the volume of active movements increased by 10-15%.

In contrast to the control group of patients of the main group had significantly decreased the degree of neurodystrophic disorders: in 26% of patients bicipitalis samples became negative. Significantly decreased pain in the projection acromiale-clavicle joint (acromiale-clavicle test was positive after treatment, only half of the patients), the coracoid process, the lesser tubercle greater tubercle of the exit points of the axillary nerve, shoulder, tenderloin, and the threshold of pain sensitivity in the area of painful muscular seals in functionally loaded muscles of the shoulder girdle of the working limb (on average 1.5-2.0 times) (table.3).

When evaluating electrogenesis of the shoulder muscles in patients of the main group after treatment, the increase of the initial reduced amplitude parameters (amplitude EMG arbitrary maximum voltage m. deltoideus, m. supraspinatus at 60-75%, p<0,01). In the control group the increase in amplitude parameters of the muscles of the shoulder belt does not exceed 30% (table.4).

Clinically integrated in accordance with the scale of Assessment of the Ucla shoulder Shoulder Assessment" is defined, that is Marnie score was 24 to 27 points (weakly expressed human), in the control group 15-18 points (moderately expressed human). After treatment the violation of life in the pathology of the shoulder on questionnaire Shoulder Disability Questionnaire none of the patients did not exceed 5-6 points (minor violations), in the control group was 11-14 points.

Thus, clinical testing revealed a positive effect of the combined treatment according to the proposed method, including FMS, mud applications, and the impact of ultrasound in the proposed regime on the biomechanical situation, tonusa-force characteristics of the muscles in the involved shoulder girdle. The relief of such violations helps to increase range of motion in the affected shoulder joint and hence increased production activity of the patients.

Sources of information

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Table 1
Muscle tonem. supraspinatusm. deltoideusm. infraspinatus
At restD/lP/lD/lP/lD/lP/l
0,25±0,040,44±0,13*0,32±0,060,66±0,05*0,33±0,070,51±0,09*
When an arbitrary voltage0,48±0,140,73±0,21*0,72±0,080,91±0,12*0,63±0,210,87±0,41*

Table 2
MusclesStrengthHypotrophy of muscles of the shoulder
D/lP/lD/lP/l
m. deltoideus3,6±0,134,7±0,11*1,32±0,140,61±0,08*
m. supraspinatus3,2±0,214,3±0,15*1,67±0,070,65±0,07*

Table 3
Pain pointsPBC
D/lP/l
Muscle aream. deltoideus3.04 from±0,36,12±0,5**
m. supraspinatus2,25±0,2of 5.34±0,3**
m. infraspinatus4,16±0,4between 6.08±0,4*
Tendon zonethe coracoid process of the scapula2,19±0,23,14±0,5*
acromiale-clavicle joint2,37±0,33,71±0,4*

Table 4
The investigated muscleAndcf(µv)p
Before the treatmentAfter the treatment
m. deltoideus321,5+71,8543,6±92,4*<0,05
m. supraspinatus254,2±28,3TP 442.6±45,8*<0,05

A method of treating musculo-skeletal disorders in the region of the shoulder joint, due to employment, including physical therapy and ultrasound therapy in a pulsed mode with a pulse duration of 10 MS, characterized in that it further conduct FMS facial muscles, improve shoulder girdle: m. trapezius m. deltoideus, m. supraspinatus m. the infraspinatus on the patient side stable method using paired pulses of 220±20 μs, the frequency of sending pulses of 25±5 counts/min and the time interval between pulses of 80 MS for 3 minutes on one field at the intensity of 70-90% of the maximum amplitude of the magnetic induction 1300 MT, the total duration of the procedure 12 minutes, then, after 30 minutes of pulsed magnetic therapy the patient receives mud application on the affected shoulder joint at a temperature of mud cakes 38-40°C for 20 minutes, and ultrasonic therapy is carried out immediately after the mud, acting on the region of the shoulder joint capsule and tendon attachment of muscles - m. supraspinatus m. infraspinatus m. teres minor on the patient side of the labile technique intensity of 0.2-0.4 W/cm2within 2 minutes on each field with the total procedure time is 8 minutes, the treatment includes 8-10 treatments produced daily.



 

Same patents:

FIELD: medicine.

SUBSTANCE: present invention refers to compounds having formula III such as below, wherein: Q represents C(Y3) or N; R represents H, -R1, -R1-R2-R3, -R1-R3 or -R2-R3; R1 represents heteroaryl or heterocyclyl each of which is optionally substituted by one or more C1-6alkyls, hydroxyC1-6alkyls, oxogroups or halogenC1-6alkyls; R2 represents -C(=O), -O, -C(R2')2, -C(R2')2C(=O), -C(R2')2C(=O)NR2', C(R2')2 N(R2')C(=O), -C(=NH), -C(R2')2NR2' or -S(=O)2; each R2' independently represents H or C1-6alkyl; R3 represents H or R4; R4 represents C1-6alkyl, C1-6alkoxygroup, aminogroup, C1-6alkylaminogroup, di(C1-6alkyl)aminogroup, heterocyclyl, C1-10alkylheterocycloalkyl, heterocycloalkylC1-10alkyl each of which is optionally substituted by one or more C1-6alkyls, C1-6alkylaminogroups, di(C1-6alkyl)aminogroups, hydroxygroups, hydroxyC1-6alkyls, C1-6alkoxygroups, oxogroups or halogenC1-6alkyls; X represents CH; X' represents CH; and the rest symbols have values as specified in the patent claim. The compounds of formula III inhibit Bruton's tyrosine kinase (Btk). There are also described compositions containing the compounds of formula III, and at least one carrier, thinner or excipient, and a method for producing the compound of formula X in accordance with the following procedure.

EFFECT: compositions are effective for modulating Btk activity and treating diseases related to Btk hyperactivity, and can be used for treating inflammatory and autoimmune diseases related to disturbed B-cell proliferation, such as rheumatoid arthritis.

22 cl, 2 tbl, 260 ex

FIELD: medicine.

SUBSTANCE: what is described is a biomaterial having a multi-dimensional structure and comprising differentiated MSCs tissue and demineralised bone matrix, wherein the above demineralised bone matrix is dispersed in the differentiated MSCs tissue; a method for preparing and using the same is also presented.

EFFECT: biomaterial is processed as needed and has the mechanical properties required for implantation into the natural involved region.

17 cl, 6 dwg, 2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to balneology. A balneological agent for treating and preventing various diseases is prepared by the gradual and sequential mixing at room temperature of yellow clay, natural brine of Bolshoy Tambukan Lake, sage essence, dimethyl sulphoxide in certain relations.

EFFECT: agent possesses the more prominent therapeutic effect.

5 tbl, 2 ex

FIELD: food-processing industry.

SUBSTANCE: treatment is preceded by measuring a blood lymphocyte percentage. If the measured value is more than 35%, that is combined with point massage and administration of acyclovir. The point massage is performed with fingers. The points IV.9, XI.34, VII.60, III.36 are exposed. The 10-day therapeutic course of acyclovir administration is prescribed. Acyclovir is administered in a dose of 400mg 4 times a day.

EFFECT: relieving clinical manifestations of arthritis, reducing time of treatment taking into account the immune state.

3 ex

FIELD: medicine.

SUBSTANCE: according to the method, the affected joints are exposed. The exposure is performed by electrophoresis with 2% pentoxifylline. The pentoxifylline solution is introduced from an anode at current intensity 15 mA. The 15-minute introduction is performed at current density 0.05-0.1 mA/cm2. The therapeutic course is 10 procedures.

EFFECT: method is non-invasive, easy to implement; it reduces the length of treatment.

1 ex

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention relates to field of pharmaceutics and represents pharmaceutical depot, made for introduction by intra-articular injection into joint of subject, suffering from osteoarthritis, which contains microparticles or nanoparticles, composed of N-{5-[(cyclopropylamino)carbonyl]-2-methylphenyl}-3-fluoro-4-[pyridin-2-ylmethoxy)benzamide or its pharmaceutically acceptable salt and biodegradable copolymer lactic acid-glycolic acid.

EFFECT: invention provides controlled release of active agent and long action without toxic side effects.

13 cl, 5 ex, 3 tbl, 9 dwg

FIELD: medicine.

SUBSTANCE: invention represents a drug for treating osteoarthrosis presented as a soft dosage form, containing glucosamine and methyl salicylate as active substances, and additive agents.

EFFECT: enhanced anaesthetic action and lower toxicity of methyl salicylate.

10 cl, 1 tbl, 4 ex

FIELD: medicine.

SUBSTANCE: composite application of therapeutic preparations is combined with a laser therapy. A basic anti-inflammatory preparation is presented by methotrexate administered subcutaneously in a dose of 15mg once a week, and folic acid administered orally in a dose of 5mg a week. Movalis is additionally prescribed in the form of intramuscular injections in a dose of 15mg once a day. The laser therapy is differentiated depending on a degree of the disease, a degree of endothelial dysfunction manifestation, namely a von Willebrand factor (vWF), haemostasis system activity indices, namely activated partial thromboplastin time (APTT), prothrombin time (PTT), thrombin clotting time (TCT), antithrombin III (AT III), protein C. If observing the degree I of the disease, APTT 30.6±1.5 sec or more, PTT 19.2±0.9 sec or more, TCT 15.1±0.7 sec or more, AT III 92.8±7.6% or more, protein C 0.92±0.02 or more, vWF 108.9±9.6% or less, 6-8 daily procedures of the intravenous laser blood irradiation, on the first day for 15 minutes at wavelength 0.365mcm, on the following day for 5 minutes at wavelength 0.405mcm, radiant power at a light guide end 1.5-2.0mV in a continuous mode; the procedures are alternated every second day. The degrees II and III of the disease, APTT 22.2±5.5 sec or less, PTT 12.8±1.7 sec or less, TCT 11.2±0.9 sec or less, AT III 85.4±1.1% or less, protein C 0.84±0.02 and less, vWF 133.5±2.2% or more, require performing 10 daily procedures of the intravenous laser blood irradiation, on the first day for 15 minutes at wavelength 0.365mcm, on the following day for 5 minutes at wavelength 0.405mcm, radiant power at the light guide end 1.5-2.0mV in a continuous mode; the procedures are alternated every second day.

EFFECT: method enables reducing the clinical manifestations of the disease, provides higher effectiveness of the drug therapy by involving the pathological processes in the haemostasis system.

1 tbl, 3 ex

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention refers to new compounds of formula IV, VIII-A and X, and to their pharmaceutical acceptable salts possessing the inhibitory activity on PI3-kinase (phosphoinositide-3-kinase). In compounds of formula IV and IX and Wd is specified in a group consisting of, , , and each of which can be substituted. In formula VIII-A, the group Wd represents the group or , wherein Ra is hydrogen, R11 is amino; in compound IV, Wa2 represents CR5; Wa3 represents CR6; Wa4 represents N or CR7; in compound IX, Wa1 and Wa2 independently represent CR5, N or NR4, and Wa4 independently represents CR7 or S, wherein no more than two neighbouring atoms in a ring represent atom or sulphur; Wb5 represents N; B represents a grouping of formula II, as well as in case of compound IV, B means C1-C10alkyl, C3-C10cycloalkyl, C3-C10heterocycloalkyl having one to six ring heteroatoms specified in N, O and S; in case of compound IX, B also means C1-C10alkyl, C3-C10cycloalkyl or 6-merous heterocycloalkyl having nitrogen atom; Wc represents C6-C10aryl or 5-18-merous heteroaryl having one or more ring heteroatoms specified in N, O and S, or phenyl or 6-merous heteroaryl respectively is equal to an integer of 0, 1, 2, 3 or 4; X is absent or represents -(CH(R9))z-, respectively; z is equal to 1; Y is absent. The other radical values are specified in the patent claim.

EFFECT: compounds can be used for treating such diseases, as cancer, bone disorders, an inflammatory or immune disease, diseases of the nervous system, metabolic disorders, respiratory diseases, thrombosis or cardiac diseases mediated by PI3-kinase.

68 cl, 11 dwg, 7 tbl, 55 ex

FIELD: medicine.

SUBSTANCE: composition 16-21ml consisting of a mixture of therapeutic preparations: Dona glucosamine sulphate 3.0 ml; ChondroGuard, or Mucosatum, or Chondrolon chondroitin sulphate - 2.0 ml; Alflutop 2.0 ml; Actovegin 4.0-5.0 ml; glucocorticosteroids Depo-Medrol 1.0-2.0 ml in the concentration of 40 mg/ml, or Diprospane 1.0-2.0 ml in the concentration of 7 mg/ml, or Metipred 1.0-2.0 ml in the concentration of 62.5 mg/ml; vitamins B1, B6, B12 Combilipen 2.0 ml, or Milgamma 2.0 ml, or Neurobion 3.0 ml; 95% or 70% ethanol 2.0-4.0 ml, is administered into a pathologically changed region. That is immediately followed by exposing the pathologically changed region and adjoining segments to a session of A shock-wave therapy in the following mode: pressure 1.2 - 4.0 bar, frequency 7-12 Hz, beat quantity 8000-14000 for 20-40 minutes. The complex procedures are performed within the course of 1-6 times every 7-10 days.

EFFECT: method enables the direct exposure on the pathologically changed region to achieve the optimum concentration of drug preparations therein with avoiding systemic prescription and preventing a risk of side effects.

3 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: method involves performing the following stages: - treating a nerve canal with sodium hypochlorite in the concentration of 0.5-5.25 wt %, in an amount of 1-20 ml for one root canal and activating with ultrasound at frequency 20-40 kHz; both one-stage activation with ultrasound accompanying the treatment, and alternating the sodium hypochlorite treatment and activation with ultrasound every 3-5 sec are possible, - treating with ozonised normal saline in the ozone concentration of 10 mcg to 60 mg per one litre, in an amount of 1-20 ml per 1 root canal and activating with ultrasound at frequency 20-40 kHz, - treating with aqueous chlorhexidine in the concentration of 0.12-2 wt %, in an amount of 1-20 ml per one root canal and activating with ultrasound at frequency 20-40 kHz; the above stages are intermitted with time intervals of no more than 3 minutes, and each stage lasts for 3 to 15 minutes.

EFFECT: high quality of treatment by preventing a post-filling aggravation and reducing the length of periodontal tissue regeneration; the method is easy-to-implement and efficient.

2 ex

FIELD: medicine.

SUBSTANCE: method involves an endoural ultrasonic exposure covering the middle ear tissues with the use of a therapeutic agent used as a medium; the medium is presented with solution of thiamphenicol glycinate acetylcisteinate. The ultrasonic exposure is generated at oscillating amplitude 40 mcm, frequency 26.5 kHz and length 15 sec with the course of 7 procedures performed daily.

EFFECT: method enables providing the higher therapeutic effectiveness in secretory otitis media by using the declared parameters of the ultrasonic exposure enabling to avoid injuries of the middle ear tissues, as well as providing higher bioavailability of the preparation possessing the wide spectrum of antibacterial preparation, antiadhesive, antioxidant, anti-inflammatory action.

1 ex

FIELD: medicine.

SUBSTANCE: cochlea is exposed to contact ultrasonic radiation (UR) through a postaural surface of the individual's head. Ultrasound amplitude is modulated by electric signal generated by microphone sound receiver. The microphone is arranged close to an ultrasonic transmitter providing the binarual effect. The electric output signals of the microphone are filtered within the frequency range of 0.5÷5 kHz; an ultrasonic oscillation frequency is set at a value of at least 100 kHz; an ultrasound intensity is set at a value of no more than 0.1 Wt/cm2; a radiation pressure is generated in the cochlea of not less than 2·10-4 Pa.

EFFECT: method enables restoring the sound sensation and compensating the middle ear dysfunction that is ensured by ultrasound modulation by the audio signal generated by the microphone and providing the required pressure in the cochlea.

2 dwg

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine and medical equipment, namely to obstetrics and gynaecology, and can be used for the local treatment of inflammatory diseases of the uterine cavity. The method is implemented by inserting a waveguide of a presented device in a protection enclosure into the uterine cavity. A taper base of a narrow portion of the enclosure leans on an external orifice of the cervical uterus to prevent accidental perforation of the uterus. An infusion system regulator is used to set the spray supply of a therapeutic solution into an irrigation canal of the ultrasonic device. Thereafter ultrasonic vibrations are generated, and the uterine cavity is treated with the sounded therapeutic solution. The exposure length is 3-5 minutes at the ultrasonic vibration frequency of 25 kHz, infusion rate approximately 100-150 ml/min. The total infusion volume is not less than 300 ml. The ultrasonic treatment enables providing the continuous outflow of the uterine discharge. The device comprises an US generator, an acoustic assembly, the waveguide with the protection enclosure, the infusion system for the therapeutic solution supply. The acoustic assembly and waveguide comprises the irrigation canal. A working tip of the waveguide represents a short cylinder having a diameter greater than the rest portion. The irrigation canal of the waveguide has a diameter of 2 mm. The protection metal thin-wall enclosure has a crimped distal end and drain holes and represents two cylindrical elements of various diameters connected by a taper junction with milled grooves arranged so that to enable the fluid access to the working tip cylinder, the length of which makes no more than 3 mm.

EFFECT: inventions provide the effective cleansing of the uterine cavity from infected and necrotised tissues with improved comfort and safety of the procedure with using no endoscopic equipment, cervical dilation manipulations and uterine pre-probing.

2 cl, 3 dwg, 3 ex

FIELD: medicine.

SUBSTANCE: composition 16-21ml consisting of a mixture of therapeutic preparations: Dona glucosamine sulphate 3.0 ml; ChondroGuard, or Mucosatum, or Chondrolon chondroitin sulphate - 2.0 ml; Alflutop 2.0 ml; Actovegin 4.0-5.0 ml; glucocorticosteroids Depo-Medrol 1.0-2.0 ml in the concentration of 40 mg/ml, or Diprospane 1.0-2.0 ml in the concentration of 7 mg/ml, or Metipred 1.0-2.0 ml in the concentration of 62.5 mg/ml; vitamins B1, B6, B12 Combilipen 2.0 ml, or Milgamma 2.0 ml, or Neurobion 3.0 ml; 95% or 70% ethanol 2.0-4.0 ml, is administered into a pathologically changed region. That is immediately followed by exposing the pathologically changed region and adjoining segments to a session of A shock-wave therapy in the following mode: pressure 1.2 - 4.0 bar, frequency 7-12 Hz, beat quantity 8000-14000 for 20-40 minutes. The complex procedures are performed within the course of 1-6 times every 7-10 days.

EFFECT: method enables the direct exposure on the pathologically changed region to achieve the optimum concentration of drug preparations therein with avoiding systemic prescription and preventing a risk of side effects.

3 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: method involves a course of 5-7 pulse ultrasonic procedures having an intensity of 0.2-0.4 W/cm2 of 5-7 minutes daily. That is combined with enzyme therapy with Longidaza 3,000 units 2 times a week for 1 month. Besides, Trilon B rectal suppositories 1,000 mg and Dimexidum 200 mg are administered daily for the night for 3 months. The bacteria are detected by a microscopic and microbiologic examination of ejaculate that is followed by a 4-6-week antibacterial therapy by administering an antibacterial preparation taking into account the microflora sensitivity.

EFFECT: such implementation of the method provides removing the prostate stones or decreasing the number thereof, reducing a probability of the inflammatory process in the prostate, ensuring a differentiated therapeutic approach by detecting the group of patients whom the antibacterial therapy is indicated to.

3 cl, 3 ex

FIELD: medicine.

SUBSTANCE: pathogenetic treatment of chronic tonsillitis and/or hypertrophy of palatine tonsils in preschool children suffering from lymphoproliferative syndrome is ensured by the palatine tonsils debridement. An interleukin-1β(IL-1β) level is measured in the palatine tonsils washing. If the measured value is less than 5.8 pg/ml, recombinant interleukin-1β (IL-1β) is to be administered orally by phonophoresis with the use of the Tonsillor MM apparatus. Two courses of 10 procedures every 14 days are performed. The clinical effectiveness is assessed if observing a positive dynamics of IL-1β measured in the palatine tonsils washing 17 and 41 days after the beginning of the immunomodulatory therapy.

EFFECT: higher clinical effectiveness ensured by the differentiated selection of children for carrying out the immunomodulatory therapy, reducing a rate of infectious involvements of the palatine tonsils in the declared group of patients by the pathogenetically reasoned application of recombinant IL-1β.

3 cl, 2 tbl, 1 ex

FIELD: medicine.

SUBSTANCE: method involves the combined exposure to ultrasound and electric current on a projection of the bladder. The ultrasonic exposure is carried out at the intensity of 0.2-0.4 W/cm2, frequency of 1 to 3 MHz. The electric pulse exposure involves amplitude modulated current in the frequency range of 100-250 Hz, at a basic frequency of 5-8 kHz for 10 minutes. The therapeutic course involves 8-12 procedures.

EFFECT: method prevents such complications of the bladder dysfunctions, as vesicoureteral reflux, chronic inflammatory renal and urinary diseases.

1 ex

FIELD: medicine.

SUBSTANCE: palatal tonsils are daily sanitated with antibacterial preparations selected in accordance with the bacteriological examination of oral smears for pathogenic microflora and antibiotic sensitivity with the tonsil lacunae washed for 10 days. Pre-anaesthesia is followed by the tonsil lacunae exposure to an ultrasonic disintegrator at a depth of a probe working area at an amplitude of 23-26 mc every second day for 5 days. That is followed by paratonsil administration of polyoxidonium in an adult dose of 6 mg every second day for 5 days; the therapeutic course is performed once a year.

EFFECT: method enables higher clinical effectiveness in chronic tonsillitis.

2 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: placenta hydrolyzate 1 ml mixed with lanolin 30 g before the procedure is applied on an anterior abdominal wall of a patient lying on his/her back in the projection of adhesions. That is followed by phonophoresis generated by UZT-1.07F ultrasonic therapeutic apparatus and sounded by an emitter of the diameter of 4 cm of the intensity of 0.4-0.6 W/cm2. The exposure mode is continuous; an emitter velocity is 1-1.5 cm/sec. The length of procedure is 5-7 minutes. The therapeutic course is 10 procedures.

EFFECT: reduced progression of abdominal adhesions and their manifestations by evident anti-inflammatory effect, reduced pain syndrome, higher adaptive body reserves.

3 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: method involves conducting a standard therapy, exposing to a magnetic field and doing a treadmill workout. The standard therapy involves following a stationary regimen, keeping a standard diet, administering Cytoflavin 10ml in normal saline 150ml, lipoic acid 25mg twice a day and Grandaxin 0.05 3 times a day. The treadmill workout involves as follows. The first workout: first two minutes at 1km/h, from 3rd to 15th minutes at 2km/h, from 16th to 17th minutes at 1km/h, from 18th to 30th minutes at 2km/h, from 31st to 32nd minute at 1km/h. The second work out: first two minutes at 1km/h, from 3rd to 15th minutes at 3km/h, from 16th to 17th minutes at 1km/h, from 18th to 30th minutes at 3km/h, from 31st to 32nd minute at 1km/h. From the 3rd to 10th work out: first two minutes at 3km/h, from 3rd to 30th minutes at 5km/h, from 31st to 32nd minute at 3km/h. The therapeutic course is 10 procedures. The patient is exposed to the magnetic field 30 minutes after the treadmill workout. That involves a transcranial bitemporal magnetic therapy by means of an headband adaptor of AMO-ATOS apparatus. On the first 3 procedures, the exposure is generated at frequency 5 Hz; on the 4-10th procedure - at frequency 10 Hz. The length of exposure is 10 minutes. The therapeutic course is 10 sessions.

EFFECT: method provides activating the cardiovascular functional reserves, reliable blood pressure decrease and stabilisation, body weight reduction, and improved adaptive body capabilities.

4 ex

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