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Abstract(s)
Introdução: A Tenossinovite de Quervain é caracterizada por um espessamento das
bainhas tendinosas do primeiro compartimento dorsal da mão, afetando diretamente os
respetivos tendões, que estarão sujeitos a um aumento da resistência no seu normal
deslizamento.
Pretende-se com esta dissertação abordar os possíveis tratamentos não-cirúrgicos
alternativos dado que estes ainda são objeto de discussão, uma vez que existe pouca
evidência de elevada qualidade dos mesmos. Note-se que, o objetivo primordial deste
estudo prende-se com a realização de uma breve análise das diferentes técnicas terapêuticas
conservadoras que possam vir a ser utilizadas, tendo em vista, se possível, a evicção de
tratamentos mais invasivos como as infiltrações de corticosteroides e, em última instância,
a cirurgia.
Os tratamentos não-cirúrgicos através da imobilização e das injeções de corticosteroides
não foram o objeto principal do estudo.
A presente dissertação procura também elucidar a comunidade científica relativamente a
esta patologia e eventuais tratamentos.
Materiais e métodos: Procedeu-se a uma pesquisa online nas seguintes bases de dados:
(a) PubMed; (b) Cochrane Library; (c) Physiotherapy Evidence Database (PEDro) e (d)
ClinicalKey até 1 de outubro de 2019. Foram utilizadas as seguintes palavras-chave: “De
Quervain disease” (MESH); “Quervain’s tenosynovitis” e “Quervain”. No final do processo
de seleção, totalizam-se 13 artigos para análise nesta dissertação.
Resultados: São abordadas e analisadas as seguintes técnicas terapêuticas: (1) kinesio
taping; (2) fonoforese; (3) low level laser therapy; (4) ultrassons; (5) acupuntura; (6)
mechanical diagnosis and therapy; (7) mobilization with movement; (8) mobilização de
tecidos moles assistida por instrumentos; (9) fisioterapia e (10) escleroterapia.
Os estudos apontam para resultados divergentes quanto à eficácia das diferentes
modalidades terapêuticas. Existe uma melhor evolução do quadro clínico dos pacientes
quando expostos a tratamentos que envolvam associação de terapêuticas, nomeadamente,
quando recorrem a exercícios programados e/ou a imobilização do punho e primeiro dedo. Algumas das técnicas demonstraram resultados promissores, nomeadamente, a utilização
de kinesio taping; fisioterapia; e, em menor grau, o uso de mobilization with movement,
ultrassons e da técnica mechanical diagnosis and therapy.
As restantes técnicas apesar de demonstrarem que podem ter um papel benéfico, suscitam
questões insanáveis que dificultam a interpretação dos resultados obtidos.
Conclusão: Face aos resultados, a abordagem mais correta será uma combinação de
terapias, nomeadamente recorrendo a exercícios programados e/ou imobilização. O uso de
kinesio taping poderá vir a ser incluído na marcha terapêutica. A abordagem inicial deverá
compreender as terapêuticas menos invasivas e que impliquem menor impacto nas
atividades da vida diária, para depois se prosseguir com a marcha terapêutica de acordo
com as necessidades do paciente.
Introduction: Quervain’s Tenosynovitis is characterized by a thickening of the tendon sheath of the first dorsal compartment of the hand, directly affecting the respective tendons, which will be subject to an increase in resistance in their normal gliding. This dissertation intends to address possible alternative non-surgical treatments as these are still under discussion, since there is little high-quality evidence from them. Note that the primary objective of this study concerns a brief analysis of the different conservative therapies techniques that may be used, with the aim to, if possible, avoid more invasive treatments such as corticosteroid infiltrations and, ultimately, surgery. The non-surgical treatments through immobilization and corticosteroid injections were not the main object of the study. This dissertation also seeks to elucidate the scientific community regarding this pathology and possible treatments. Materials and methods: An online search was carried out on the following databases: (a) PubMed; (b) Cochrane Library; (c) Physiotherapy Evidence Database (PEDro) and (d) ClinicalKey until October 1, 2019. The following keywords were used: “De Quervain disease” (MESH); "Quervain’s tenosynovitis" and "Quervain". At the end of the selection process, there were a total of 13 articles for analysis in this dissertation. Results: The following therapeutic techniques are addressed and analysed: (1) kinesio taping; (2) phonophoresis; (3) low level laser therapy; (4) ultrasounds; (5) acupuncture; (6) mechanical diagnosis and therapy; (7) mobilization with movement; (8) instrument assisted soft tissue mobilization; (9) physiotherapy and (10) sclerotherapy. The studies point to divergent results regarding the effectiveness of the different therapeutic modalities. There is a better evolution of the clinical picture of the patients when exposed to treatments involving combination of therapies, namely, when they resort to scheduled exercises and/or the immobilization of the wrist and thumb. Some of the techniques have shown promising results, namely, the use of kinesio taping; physiotherapy; and, to a lesser extent, the use of mobilization with movement, ultrasounds and the mechanical diagnosis and therapy technique. The remaining techniques, despite showing that they can play a beneficial role, raise insatiable questions that make it difficult to interpret the results obtained. Conclusion: In view of the results, the best correct approach would be a combination of therapies, namely using scheduled exercises and/or immobilization. The use of kinesio taping may be included in the therapeutic gait. It should start with less invasive treatments that have the less impact on the activities of daily living, and scale according to the patient's needs.
Introduction: Quervain’s Tenosynovitis is characterized by a thickening of the tendon sheath of the first dorsal compartment of the hand, directly affecting the respective tendons, which will be subject to an increase in resistance in their normal gliding. This dissertation intends to address possible alternative non-surgical treatments as these are still under discussion, since there is little high-quality evidence from them. Note that the primary objective of this study concerns a brief analysis of the different conservative therapies techniques that may be used, with the aim to, if possible, avoid more invasive treatments such as corticosteroid infiltrations and, ultimately, surgery. The non-surgical treatments through immobilization and corticosteroid injections were not the main object of the study. This dissertation also seeks to elucidate the scientific community regarding this pathology and possible treatments. Materials and methods: An online search was carried out on the following databases: (a) PubMed; (b) Cochrane Library; (c) Physiotherapy Evidence Database (PEDro) and (d) ClinicalKey until October 1, 2019. The following keywords were used: “De Quervain disease” (MESH); "Quervain’s tenosynovitis" and "Quervain". At the end of the selection process, there were a total of 13 articles for analysis in this dissertation. Results: The following therapeutic techniques are addressed and analysed: (1) kinesio taping; (2) phonophoresis; (3) low level laser therapy; (4) ultrasounds; (5) acupuncture; (6) mechanical diagnosis and therapy; (7) mobilization with movement; (8) instrument assisted soft tissue mobilization; (9) physiotherapy and (10) sclerotherapy. The studies point to divergent results regarding the effectiveness of the different therapeutic modalities. There is a better evolution of the clinical picture of the patients when exposed to treatments involving combination of therapies, namely, when they resort to scheduled exercises and/or the immobilization of the wrist and thumb. Some of the techniques have shown promising results, namely, the use of kinesio taping; physiotherapy; and, to a lesser extent, the use of mobilization with movement, ultrasounds and the mechanical diagnosis and therapy technique. The remaining techniques, despite showing that they can play a beneficial role, raise insatiable questions that make it difficult to interpret the results obtained. Conclusion: In view of the results, the best correct approach would be a combination of therapies, namely using scheduled exercises and/or immobilization. The use of kinesio taping may be included in the therapeutic gait. It should start with less invasive treatments that have the less impact on the activities of daily living, and scale according to the patient's needs.
Description
Keywords
Medicina Física e de Reabilitação Tenossinovite de Quervain Tratamento Conservador