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Honbo ES, Mattfeld R, Khadavi M, Podesta L. Clinical Rationale and Rehabilitation Guidelines for Post Biologic Therapy. Phys Med Rehabil Clin N Am 2023; 34:239-263. [DOI: 10.1016/j.pmr.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Athletes are subject to traumatic and repetitive stress injuries at the elbow joint as a result of high levels of forces imparted across the elbow. Injuries can be acute to the point of tissue failure, or chronic as a result of repetitive overuse. Complete restoration of elbow function must be achieved to allow the athlete to return to their prior level of function. Systematic and progressive rehabilitation programs can help avoid overstressing healing tissues. Treatment programs are designed to restore full motion, muscular strength, endurance, and neuromuscular control. Multiphased rehabilitation programs are designed to restore function in the athlete's elbow.
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Affiliation(s)
- Kevin E Wilk
- Champion Sports Medicine-Physiotherapy Associates, Birmingham, AL, USA; American Sports Medicine Institute, 805 St. Vincent's Drive, Suite G100, Birmingham, AL, USA.
| | - Christopher A Arrigo
- Advanced Rehabilitation, 4539 South Dale Mabry, Suite 100, Tampa, FL 33611, USA; MedStar Sports Medicine, Washington, DC, USA
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Jiang X, Savchenko O, Li Y, Qi S, Yang T, Zhang W, Chen J. A Review of Low-Intensity Pulsed Ultrasound for Therapeutic Applications. IEEE Trans Biomed Eng 2019; 66:2704-2718. [DOI: 10.1109/tbme.2018.2889669] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Leite SN, Andrade TAMD, Masson-Meyers DDS, Leite MN, Enwemeka CS, Frade MAC. Phototherapy promotes healing of cutaneous wounds in undernourished rats. An Bras Dermatol 2015; 89:899-904. [PMID: 25387494 PMCID: PMC4230658 DOI: 10.1590/abd1806-4841.20143356] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 01/16/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Various studies have shown that phototherapy promotes the healing of cutaneous wounds. OBJECTIVE To investigate the effect of phototherapy on healing of cutaneous wounds in nourished and undernourished rats. METHODS Forty rats, 20 nourished plus 20 others rendered marasmus with undernourishment, were assigned to four equal groups: nourished sham, nourished Light Emitting Diode treated, undernourished sham and undernourished Light Emitting Diode treated. In the two treated groups, two 8-mm punch wounds made on the dorsum of each rat were irradiated three times per week with 3 J/cm2 sq cm of combined 660 and 890 nm light; wounds in the other groups were not irradiated. Wounds were evaluated with digital photography and image analysis, either on day 7 or day 14, with biopsies obtained on day 14 for histological studies. RESULTS Undernourishment retarded the mean healing rate of the undernourished sham wounds (p < 0.01), but not the undernourished Light emission diode treated wounds, which healed significantly faster (p < 0.001) and as fast as the two nourished groups. Histological analysis showed a smaller percentage of collagen in the undernourished sham group compared with the three other groups, thus confirming our photographic image analysis data. CONCLUSION Phototherapy reverses the adverse healing effects of undernourishment. Similar beneficial effects may be achieved in patients with poor nutritional status.
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Comparação entre o laser de baixa potência, ultrassom terapêutico e associação, na dor articular em ratos Wistar. REVISTA BRASILEIRA DE REUMATOLOGIA 2014. [DOI: 10.1016/j.rbr.2014.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Warden SJ, Bennell KL, McMeeken JM, Wark JD. Can conventional therapeutic ultrasound units be used to accelerate fracture repair? PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/ptr.1999.4.2.117] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Freitas RPDA, Barcelos APMD, Nóbrega BMD, Macedo AB, Oliveira ARD, Ramos AMDO, Vieira WHDB. Laserterapia e microcorrente na cicatrização de queimadura em ratos: terapias associadas ou isoladas? FISIOTERAPIA E PESQUISA 2013. [DOI: 10.1590/s1809-29502013000100005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Este estudo teve o objetivo de investigar se há diferenças entre as terapias associadas e isoladas do laser e microcorrentes no reparo de lesão por queimadura em ratos. Um total de 40 animais foi dividido aleatoriamente em quatro grupos: grupo controle (GC); grupo microcorrente (GM), grupo laser (GL) e grupo laser/microcorrente (GLM), tratados com laser associado a microcorrentes. Após lesões térmicas induzidas no dorso do animal, foi realizado um total de dez dias de tratamento. Amostras do tecido foram coletadas para estudo histopatológico semiquantitativo com Hematoxilina Eosina e Tricrômico de Masson. Foram utilizados os testes de Kruskal-Wallis e post-hoc de Dunn. Houve diferença significativa entre os grupos para a produção de fibroblastos (p=0,0003), colágeno (p=0,0153), neoangiogênese (p=0,0031) e anexos cutâneos (p=0,0004). Na análise histológica semiquantitativa, o GLM apresentou valores menores nos parâmetros histológicos de presença de colágeno, número de fibroblastos e anexos cutâneos (p<0,05) em relação às terapias isoladas, exceto para a neoangiogênese, cujos valores da terapia associada foram semelhantes aos grupos de terapia com modalidade única. Apesar do laser e da microcorrente separadamente terem efeitos benéficos para a cicatrização tecidual, a associação das modalidades parece ter diminuído a ação de reparo. No entanto, sugere-se que a associação destes recursos parece diminuir os efeitos do tratamento quando se comparam os grupos de modalidade única.
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Wilk KE, Macrina LC, Cain EL, Dugas JR, Andrews JR. Rehabilitation of the Overhead Athlete's Elbow. Sports Health 2012; 4:404-14. [PMID: 23016113 PMCID: PMC3435939 DOI: 10.1177/1941738112455006] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The activities required during overhead sports, particularly during baseball pitching, produce large forces at the elbow joint. Injuries to the elbow joint frequently occur in the overhead athlete because of the large amount of forces observed during the act of throwing, playing tennis, or playing golf. Injuries may result because of repetitive overuse, leading to tissue failure. Rehabilitation following injury or surgery to the throwing elbow is vital to fully restore normal function and return the athlete to competition as quickly and safely as possible. Rehabilitation of the elbow, whether following injury or postsurgical, must follow a progressive and sequential order, building on the previous phase, to ensure that healing tissues are not compromised. Emphasis is placed on restoring full motion, muscular strength, and neuromuscular control while gradually applying loads to healing tissue. In addition, when one is creating a rehabilitation plan for athletes, it is imperative to treat the entire upper extremity, core, and legs to create and dissipate the forces generated at each joint.
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Wood VT, Pinfildi CE, Neves MAI, Parizoto NA, Hochman B, Ferreira LM. Collagen changes and realignment induced by low-level laser therapy and low-intensity ultrasound in the calcaneal tendon. Lasers Surg Med 2010; 42:559-65. [PMID: 20662033 DOI: 10.1002/lsm.20932] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVE The treatment of calcaneal tendon injuries requires long-term rehabilitation. Ultrasound (US) and low-level laser therapy (LLLT) are the most used and studied physical agents in the treatment of tendon injuries; however, only a few studies examined the effects of the combination of US and LLLT. Therefore, the purpose of this study was to investigate which treatment (the exclusive or combined use of US and LLLT) most effectively contribute to tendon healing. STUDY DESIGN/MATERIALS AND METHODS This was a controlled laboratory study with 50 rats whose Achilles tendon was injured by direct trauma. The rats were randomly divided into five groups and treated for 5 consecutive days, as follows: group 1 (control) received no treatment; group 2 was treated with US alone; group 3 was treated with LLLT alone; group 4 was treated first with US followed by LLLT; and group 5 was treated first with LLLT followed by US. On the sixth post-injury day, the tendons were removed and examined by polarized light microscopy. The organization of collagen fibers was assessed by birefringence measurements. Picrosirius-stained sections were examined for the presence of types I and III collagen. RESULTS There was a significantly higher organization of collagen fibers in group 2 (US) than in the control group (P = 0.03). The amount of type I collagen found in groups 2 (US), 3 (LLLT), and 5 (LLLT + US) was significantly higher than that in the control group (P <or= 0.01), but no significant differences were found between treatment groups. There were no differences in the amount of type III collagen between groups. CONCLUSION Ultrasound, LLLT, and the combined use of LLLT and US resulted in greater synthesis of type I collagen; US was also effective in increasing collagen organization in the early stages of the healing process.
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Affiliation(s)
- Viviane T Wood
- Division of Plastic Surgery, Universidade Federal de São Paulo (UNIFESP), CEP 04023-002 Sao Paulo, SP, Brazil.
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Caetano KS, Frade MAC, Minatel DG, Santana LA, Enwemeka CS. Phototherapy improves healing of chronic venous ulcers. Photomed Laser Surg 2010; 27:111-8. [PMID: 19196110 DOI: 10.1089/pho.2008.2398] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE We tested the hypothesis that LED phototherapy with combined 660-nm and 890-nm light will promote healing of venous ulcers that failed to respond to other forms of treatment. BACKGROUND DATA A variety of dressings, growth factors, and adjunct therapies are used to treat venous ulcers, but none seems to yield satisfactory results. MATERIALS AND METHODS We used a randomized placebo-controlled double-blind study to compare a total of 20 patients divided with 32 chronic ulcers into three groups. In group 1 the ulcers were cleaned, dressed with 1% silver sulfadiazine (SDZ) cream, and treated with placebo phototherapy (<.03 J/cm(-3)) using a Dynatron Solaris 705 phototherapy research device. In group 2 the ulcers were treated similarly but received real phototherapy (3 J/cm(-2)) instead of placebo. In group 3 (controls), the ulcers were simply cleaned and dressed with SDZ without phototherapy. The ulcers were evaluated with digital photography and computer image analysis over 90 d or until full healing was attained. RESULTS Ulcers treated with phototherapy healed significantly faster than controls when compared at day 30 (p +/- 0.01), day 60 (p +/- 0.05), and day 90 (p +/- 0.001), and similarly healed faster than the placebo-treated ulcers at days 30 and 90 (p +/- 0.01), but not at day 60. The beneficial effect of phototherapy was more pronounced when the confounding effect of small-sized ulcers was removed from the analysis. Medium- and large-sized ulcers healed significantly faster with treatment (>or=40% rate of healing per month) than placebo or control ulcers (p +/- 0.05). CONCLUSION Phototherapy promotes healing of chronic venous ulcers, particularly large recalcitrant ulcers that do not respond to conventional treatment.
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Affiliation(s)
- Kelly Steinkopf Caetano
- Department of Bioengineering, Faculty of Medicine, University of São Paulo, Ribeirão Preto, Brazil
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Low-intensity pulsed ultrasound modulates shear stress induced PGHS-2 expression and PGE2 synthesis in MLO-Y4 osteocyte-like cells. Ann Biomed Eng 2010; 39:378-93. [PMID: 20820919 DOI: 10.1007/s10439-010-0156-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Accepted: 08/25/2010] [Indexed: 02/01/2023]
Abstract
Fluid shear stress (SS) has been shown to be a prevailing physiological stimulus in the regulation of bone cell metabolism and so are the exogenous biomechanical forces, like ultrasound (US) and vibration. The purpose of this study is to elaborate the interplay of laminar fluid SS with low-intensity pulsed US in the regulation of prostaglandin H synthase 2 (PGHS-2) and prostaglandin E2 (PGE2). Murine long bone osteocyte-like (MLO-Y4) cells were exposed to various regimes of US (1.5 Hz, 30 mW/cm2) and SS (19 dyn/cm2) alone and sequentially. Changes in PGHS-2 gene expression levels were quantified at 3 and 24 h using real-time RT-PCR. PGE2 levels in the culture media were measured using enzyme immunoassay at 3 and 24 h. PGE2 levels significantly increased after exposure to SS for 3 and 24 h by 2.17±0.02 and 5.47±0.42-fold, respectively, compared to control cells. A 20 min US treatment prior to SS significantly increased SS PGE2 levels 2.95±0.18 and 2.90±0.50-fold at 3 and 24 h, respectively. US also significantly increased PGHS-2 mRNA levels in cells exposed to SS. SS caused a 2.74 ± 0.49-fold increase in PGHS-2 mRNA levels at 3 h and a significant 3.70±0.25-fold increase at 24 h relative to control. A 20 min US treatment caused 1.35±0.49 and 2.44±0.82-fold increase in PGHS-2 mRNA levels in cells exposed to SS at 3 and 24 h, respectively. These results indicate that combining US with SS may have a more anabolic benefit for bone tissue than either stimulus alone.
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Radpasand M, Owens E. Combined Multimodal Therapies for Chronic Tennis Elbow: Pilot Study to Test Protocols for a Randomized Clinical Trial. J Manipulative Physiol Ther 2009; 32:571-85. [DOI: 10.1016/j.jmpt.2009.08.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 05/23/2009] [Indexed: 11/26/2022]
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De Oliveira RF, Oliveira DAAP, Monteiro W, Zangaro RA, Magini M, Soares CP. Comparison between the effect of low-level laser therapy and low-intensity pulsed ultrasonic irradiation in vitro. Photomed Laser Surg 2008; 26:6-9. [PMID: 18248154 DOI: 10.1089/pho.2007.2112] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare the effect of low-level laser therapy (LLLT) and low-intensity pulsed ultrasound (LIPUS) on fibroblast cell culture. Several methods, including ultrasound treatment and LLLT, are being used to facilitate tissue repair and healing processes. MATERIALS AND METHODS L929 fibroblast cell cultures were irradiated with low-level laser energy and LIPUS. Cultures irradiated with ultrasound were divided into five groups: group 1: control (did not receive irradiation); group 2: 0.2 W/cm(2) in pulsed mode at 10% (1:9 duty cycle); group 3: 0.6 W/cm(2) in pulsed mode at 10% (1:9 duty cycle); group 4: 0.2 W/cm(2) in pulsed mode at 20% (2:8 duty cycle); and group 5: 0.6 W/cm(2) in pulsed mode at 20% (2:8 duty cycle). Cultures irradiated with laser energy were divided into three groups: group 1: control (did not receive irradiation); group 2: 6 J/cm(2); and group 3: 50 mJ/cm(2). Each group was irradiated at 24-h intervals, with the following incubation periods post-irradiation: 24, 48, and 72 h; after each irradiation cycle the cultures were analyzed using MTT [3-(4.5-dimethylthiazol-2-yl)-2.5 diphenyltetrazolium bromide]. RESULTS Analysis of results after LLLT and LIPUS demonstrated that the effect of laser therapy on fibroblast cell culture was greater than that of LIPUS (p < 0.05). CONCLUSION Results demonstrated that LLLT significantly increased fibroblastic activity more than LIPUS. Therefore, in the first and second phases of tissue repair, laser treatment may be more effective than ultrasound treatment.
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Affiliation(s)
- Rodrigo Franco De Oliveira
- Laboratório de Dinâmica de Compartimento Celular, Instituto de Pesquisa e Desenvolvimento (IP&D), UNIVAP, São José dos Campos, São Paulo, Brazil
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Ng GYF, Fung DTC. The effect of therapeutic ultrasound intensity on the ultrastructural morphology of tendon repair. ULTRASOUND IN MEDICINE & BIOLOGY 2007; 33:1750-4. [PMID: 17630094 DOI: 10.1016/j.ultrasmedbio.2007.05.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 03/19/2007] [Accepted: 05/20/2007] [Indexed: 05/16/2023]
Abstract
This study evaluated the effects of ultrasound intensity on the ultrastructural morphology of Achilles tendon healing. Twenty Sprague-Dawley rats with surgically hemi-transected Achilles tendons were randomly assigned into four groups of 0, 0.5, 1.2 and 2 W/cm(2) for ultrasound treatment, with five rats in each group. The treatments were administered with 1 MHz continuous ultrasound daily starting from day 5 after injury. On day 30, ultrathin slides of the Achilles tendons were prepared and examined with transmission electron microscopy. Results showed that the mean collagen fibril size of all treatment groups was higher than the control (p < 0.05). There was no significant difference in the collagen fibril size among the treatment groups. These findings suggest that therapeutic ultrasound can enhance the maturation of collagen fibrils of repairing tendons, and this was not dependent on the intensity of ultrasound applied.
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Affiliation(s)
- Gabriel Y F Ng
- Orthopaedic and Microscopy Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
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Peers KHE, Lysens RJJ. Patellar tendinopathy in athletes: current diagnostic and therapeutic recommendations. Sports Med 2005; 35:71-87. [PMID: 15651914 DOI: 10.2165/00007256-200535010-00006] [Citation(s) in RCA: 166] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Formerly known as 'jumper's knee', patellar tendinopathy gives rise to considerable functional deficit and disability in recreational as well as professional athletes. It can interfere with their performance, often perseveres throughout the sporting career and may be the primary cause to end it. The diagnosis of patellar tendinopathy is primarily a clinical one but new imaging techniques, such as Doppler ultrasonography, may provide additional diagnostic value. Current therapeutic protocols are characterised by wide variability ensuing from anecdotal experience rather than evidence. Moreover, numerous reports in recent years have shattered previous doctrines and dogmatic belief on tendon overuse. Histopathological and biochemical evidence has indicated that the underlying pathology of tendinopathy is not an inflammatory tendinitis but a degenerative tendinosis. Consequently, pain in chronic patellar tendinopathy is not inflammatory in nature, but its exact origin remains unexplained. In pursuit of pathology- and evidence-based management, conservative therapy should be shifted from anti-inflammatory strategies towards a complete rehabilitation with eccentric tendon strengthening as a key element. If conservative management fails, surgery is opted for. However, considering the heterogeneity of surgical procedures and the absence of randomised studies, no conclusive evidence can be drawn from the literature regarding the effectiveness of surgical treatment for patellar tendinopathy. Parallel with the improved knowledge on the pathophysiology and pain mechanisms in patellar tendinopathy, new treatment strategies are expected to emerge in the near future.
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Affiliation(s)
- Koen H E Peers
- Department of Physical Medicine and Rehabilitation, Gasthuisberg and Pellenberg University Hospitals, Leuven, Belgium.
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Abstract
This article examines basic tendon biomechanics, the anatomy and mechanics of digital flexor tendons, and the digital flexor pulley system. It also explores the various models that have tried to simulate the motion of the flexor tendons and several testing modalities that have been used. Finally, clinical applications are considered, including the biomechanics of flexor tendon repairs and tendon transfers. As we reach limits in the care of flexor tendon injuries, research into molecular, biochemical, and micromechanical methods of tendon repair will become the forefront of future investigation.
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Affiliation(s)
- Howard J Goodman
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th Street, Brooklyn, NY 11219, USA.
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Abstract
Rotator cuff problems are among the most commonly encountered disorders of the shoulder, and are commonly seen by primary care physicians. Their exact mechanism for susceptibility to injury remains unclear; however, with an understanding of the shoulder's anatomy and biomechanics, we are better able to treat the insults incurred on the cuff. Early recognition, proper treatment, and appropriate follow-up may expedite healing and prevent the occurrence of further injury or complications.
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Affiliation(s)
- Douglas G Browning
- Wake Forest University School of Medicine, Wake Forest University Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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Goldberg DJ, Sarradet D, Hussain M, Krishtul A, Phelps R. Clinical, histologic, and ultrastructural changes after nonablative treatment with a 595-nm flashlamp-pumped pulsed dye laser: comparison of varying settings. Dermatol Surg 2004; 30:979-82. [PMID: 15209786 DOI: 10.1111/j.1524-4725.2004.30301.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The flashlamp-pulsed dye laser has been used for nonablative dermal remodeling. OBJECTIVE We conducted a study analyzing the clinical, histologic, and electron microscopic findings after treatment with different flashlamp-pulsed dye laser settingss in the same subject. RESULTS Most subjects showed mild to moderate improvement after flashlamp-pulsed dye laser laser treatment. There was no statistical difference in the clinical, histologic, or electron microscopic findings with a variety of laser treatment settings. CONCLUSION Nonablative dermal remodeling can be accomplished with not only a variety of different technologies, but also with the same laser using markedly different settings.
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Affiliation(s)
- David J Goldberg
- Skin Laser and Surgery Specialists of New York and New Jersy, Hackensack, New Jersey, USA.
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Sun S, Cho M. Human Fibroblast Migration in Three-Dimensional Collagen Gel in Response to Noninvasive Electrical Stimulus. II. Identification of Electrocoupling Molecular Mechanisms. ACTA ACUST UNITED AC 2004; 10:1558-65. [PMID: 15588415 DOI: 10.1089/ten.2004.10.1558] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cell adhesion and migration is regulated by a series of coordinated and integrated molecular mechanisms. In the accompanying article (Sun et al., Tissue Eng. 10, 1548, 2004), we demonstrate and characterize the human fibroblast movement in three-dimensional (3D) collagen gel induced by non-invasive electrical stimulus. The molecular mechanisms mediating 3D cell migration in response to physical stimuli including noninvasive electrical stimulus remain to be elucidated, however. Here we report that induced human fibroblast movement in 3D collagen gel is both integrin and Ca2+ dependent. Treatment of cells with anti-integrin antibodies prevents electrically induced cell movement. More interestingly, whereas the absence of extracellular Ca2+ suppresses cell movement, inhibition of the cell surface receptor-coupled phospholipase C (PLC) completely prevents 3D cell migration, suggesting molecular association between integrin, PLC, and intracellular Ca2+. Coupling of external electrical stimulus to PLC activation appears to be the primary event required to induce cell migration, while Ca2+ influx across the plasma membrane regulates the sustained cell movement. On the basis of the rather small strength (0.1 V/cm) of electrical stimulus used in this study, activation of the electrically operated voltage-gated Ca2+ channels is unlikely, but the mechanically operated stretch-activated cation channels appear to mediate Ca2+ influx. Elucidation of the electrocoupling molecular mechanisms involved in 3D cell movement could lead to controlled and designed manipulation of 3D cell adhesion and migration.
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Affiliation(s)
- Shan Sun
- Department of Bioengineering, University of Illinois, Chicago, Illinois 60607, USA
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Clinical, Histologic, and Ultrastructural Changes after Nonablative Treatment with a 595-nm Flashlamp-Pumped Pulsed Dye Laser. Dermatol Surg 2004. [DOI: 10.1097/00042728-200407000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ozkan N, Altan L, Bingöl U, Akln S, Yurtkuran M. Investigation of the Supplementary Effect of GaAs Laser Therapy on the Rehabilitation of Human Digital Flexor Tendons. ACTA ACUST UNITED AC 2004; 22:105-10. [PMID: 15165384 DOI: 10.1089/104454704774076154] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the effect of laser photostimulation in rehabilitation of human digital flexor tendons with a placebo-controlled double-blind prospective study model. BACKGROUND DATA Low-energy laser therapy has been applied in several rheumatoid and soft tissue disorders with a varying rate of success and it has also been shown to have a positive effect on tendon healing in animal experiments, but no clinical study on laser photostimulation in the treatment of human tendons has been reported to date. MATERIALS AND METHODS This study was performed in a total of 25 patients with 41 digital flexor tendon injuries in five anatomical zones. In Group I (21 digits in 13 patients), whirlpool and infrared GaAs diode laser with a frequency of 100 Hz. was applied between the 8th and 21st days postoperatively and all patients were given the Washington rehabilitation program until the end of the 12th week. In Group II (20 digits in 12 patients), the same treatment protocol was given but the laser instrument was switched off during applications. RESULTS The results of the study showed a significant improvement in the laser-treated group only for the parameter of edema reduction (p < 0.01) but the difference between the two groups was non-significant for pain reduction, hand grip strength, and functional evaluation performed according to Strickland and Buck-Gramcko systems using total active motion and fingertip-to distal palmar crease distance parameters (p > 0.05). CONCLUSIONS Significant improvement obtained in edema reduction both immediately and 12 weeks after supplementary GaAs laser application in our study has been interpreted as an important contribution to the rehabilitation of human flexor tendon injuries because edema is known to have a detrimental effect on functional recovery during both early and late stages of tendon healing. However, our study has failed to show a significant positive effect of supplementary GaAs laser application on the other functional recovery parameters of human flexor tendon injury rehabilitation and we suggest further clinical study in this topic be done using different laser types and dosages in order to delineate the role of this promising treatment modality.
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Affiliation(s)
- Neslihan Ozkan
- Atatürk Rehabilitation Center, Rheumatic Disease and Hydrotherapy Section, Uludağ University Medical Faculty, Bursa, Turkey
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Demir H, Menku P, Kirnap M, Calis M, Ikizceli I. Comparison of the effects of laser, ultrasound, and combined laser + ultrasound treatments in experimental tendon healing. Lasers Surg Med 2004; 35:84-9. [PMID: 15278933 DOI: 10.1002/lsm.20046] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Therapeutic ultrasound (US) and laser (L) treatments accelerate and facilitate wound healing, and also have beneficial effects on tendon healing. This randomized control study was designed to evaluate the effects of low-intensity US and low-level laser therapy (LLLT) on tendon healing in rats. STUDY DESIGN/MATERIALS AND METHODS Eighty-four healthy male Swiss-Albino rats were divided into three groups consisting of 28 rats, the left Achilles tendons were used as treatment and the right Achilles tendons as controls. The right and left Achilles tendons of rats were traumatized longitudinally. The treatment was started on postinjury day one. We applied the treatment protocols including low-intensity US treatment in Group I (US Group), Sham US in Group II (SUS Group), LLLT in Group III (L Group), Sham L in Group IV (SL Group), US and LLLT in Group V (US + L Group), and Sham US and Sham L in Group VI (SUS + SL Group). The US treatment was applied with a power of 0.5 W/cm2, a frequency of 1 MHz, continuously, 5 minutes daily. A low-level Ga-As laser was applied with a 904 nm wavelength, 6 mW average power, 1 J/ cm2 dosage, 16 Hz frequency, for 1 minute duration, continuously. In the control groups, the similar procedures as in the corresponding treatment groups were applied with no current (Sham method). The treatment duration was planned for 9 days (sessions) in all groups, except the rats used for biochemical evaluation on the 4th day of treatment, which were treated for 4 days. We measured the levels of the tissue hydroxyproline for biochemical evaluation on the 4th, 10th, and 21st days following the beginning of treatment and the tendon breaking strength on the 21st day following the beginning of treatment for biomechanical evaluation. Seven rats in each group were killed on the 4th, 10th, and 21st days for biochemical evaluation and on the 21st day for biomechanical evaluation. RESULTS The hydroxyproline levels were found to be significantly increased in the treatment groups on the 10th and 21st days compared to their control groups (P < 0.05). In comparison of the treatment groups on the 4th, 10th, and 21st days of the treatment, the levels of tissue hydroxyproline were found to be more increased in combined US+L Group compared with US Group and L Group, but the difference was not significant (P > 0.05). In comparison of the tendon breaking strengths, it was found as significantly increased in the treatment groups compared with their control groups (P < 0.05), although there was no significant difference between the treatment groups. CONCLUSIONS Although US, L, and combined US + L treatments increased tendon healing biochemically and biomechanically more than the control groups, no statistically significant difference was found between them. Also we did not find significantly more cumulative positive effects of combined treatment. As a result, both of these physical modalities can be used successfully in the treatment of tendon healing.
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Affiliation(s)
- Huseyin Demir
- Erciyes University Medical Faculty, Department of Physical Medicine & Rehabilitation, Kayseri, Turkey.
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Abstract
Patellar tendinopathy is a common and serious condition in athletes. Although there have been many advances in the understanding of the histopathology, imaging, and surgical outcomes in this condition in the past decade, successful management of athletes with patellar tendinopathy remains a major challenge for both the practitioner and patient. There is a definite need for further prospective studies into etiological factors and randomized controlled trials into treatment choices.
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Affiliation(s)
- Stuart J Warden
- Centre for Sports Medicine Research and Education, University of Melbourne, Victoria 3010, Australia
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Abstract
Tendon conditions cause a great deal of morbidity in both elite and recreational athletes, and outcome of treatment is often unsatisfactory. Evidence that the common clinical conditions (e.g., Achilles, patellar, elbow and rotator cuff tendinopathies) are due to tendinosis has been present for many years, yet the misnomer "tendinitis" is still widely used for these conditions in clinical practice. Clinical practice remains very different from evidence-based recommendations [8], but this is a common challenge in medical practice. Thus, in addition to further research in an area of medicine rife for such endeavor, there must be attention to knowledge translation--ensuring that the patient benefits from what is already known.
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Affiliation(s)
- Karim Khan
- Department of Family Medicine, University of British Columbia, School of Human Kinetics, Vancouver, BC, Canada.
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Ng COY, Ng GYF, See EKN, Leung MCP. Therapeutic ultrasound improves strength of achilles tendon repair in rats. ULTRASOUND IN MEDICINE & BIOLOGY 2003; 29:1501-1506. [PMID: 14597348 DOI: 10.1016/s0301-5629(03)01018-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The purpose of this study was to evaluate the effects of therapeutic ultrasound on structural properties and functional performance of Achilles tendon healing. Thirty Sprague-Dawley rats with surgical hemitransected Achilles tendon were studied. Ten were treated daily with 1 MHz continuous ultrasound at 1.0 W/cm2 for 4 min, 11 at 2.0 W/cm2 for 4 min and nine served as control without treatment. Achilles functional index (AFI) was recorded preoperatively and on postoperative days 3, 10 and 30. On day 30, the rats were sacrificed and Achilles tendons were tested for load-relaxation, stiffness and ultimate tensile strength (UTS). Results showed that UTS of both low-dose (p=0.023) and high-dose (p=0.002) groups was significantly greater than in controls. No significant differences in AFI (p=0.179), load-relaxation (p=0.205) and stiffness (p=0.842) were found among groups. These findings suggested that both low- and high-dose therapeutic ultrasound accelerate the healing process of ruptured tendon.
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Affiliation(s)
- Christine O Y Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Kirkpatrick SJ, Hinds MT, Duncan DD. Acousto-optical Characterization of the Viscoelastic Nature of a Nuchal Elastin Tissue Scaffold. ACTA ACUST UNITED AC 2003; 9:645-56. [PMID: 13678443 DOI: 10.1089/107632703768247340] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A nondestructive, acousto-optical method for characterizing the mechanical loss factor of biological tissues and tissue scaffolds is presented and applied to the characterization of an elastin tissue scaffold derived from bovine nuchal ligament. The method relies on launching guided surface acoustic waves into the tissue scaffold with a small speaker and simultaneously illuminating a small region of the scaffold distant from the speaker with a low-power HeNe laser. The phase lag between the driving acoustic wave and the shift in the backscattered laser speckle pattern is determined as a measure of the mechanical loss factor of the scaffold, tan delta. Measurements of tan delta and elastic modulus were also made by traditional dynamic mechanical loading techniques. Through the central portion of the loading cycle, the elastic modulus of the elastin scaffold was 1.2 x 10(6) +/- 1 x 10(5) N x m(-2) (parallel to fiber orientation). The estimated value of tan delta in the direction parallel to the elastin fibers was 0.03 +/- 0.017 by traditional methods and 0.029 +/- 0.03 when using the acousto-optical method. In the direction perpendicular to fiber orientation, tan delta was measured as 0.14 +/- 0.056 by the acousto-optical method. Because of a lack of mechanical integrity, it was not possible to measure tan delta in the direction perpendicular to fiber orientation by traditional methods. The acousto-optical method may prove to be useful in the mechanical characterization of developing engineered tissues.
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Affiliation(s)
- Sean J Kirkpatrick
- Oregon Medical Laser Center, Providence St. Vincent Medical Center, Portland, Oregon 97225, USA.
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Almeida TF, Roizenblatt S, Benedito-Silva AA, Tufik S. The effect of combined therapy (ultrasound and interferential current) on pain and sleep in fibromyalgia. Pain 2003; 104:665-672. [PMID: 12927639 DOI: 10.1016/s0304-3959(03)00139-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Multidisciplinary treatment has proven to be the best therapeutic option to fibromyalgia (FM) and physiotherapy has an important role in this approach. Considering the controversial results of electrotherapy in this condition, the aim of this study was to assess the effects of combined therapy with pulsed ultrasound and interferential current (CTPI) on pain and sleep in FM. Seventeen patients fulfilling FM criteria were divided into two groups, CTPI and SHAM, and submitted to pain and sleep evaluations. Pain was evaluated by body map (BM) of the painful areas; quantification of pain intensity by visual analog scale (VAS); tender point (TP) count and tenderness threshold (TT). Sleep was assessed by inventory and polysomnography (PSG). After 12 sessions of CTPI or SHAM procedure, patients were evaluated by the same initial protocol. After treatment, CTPI group showed, before and after sleep, subjective improvement of pain in terms of number (BM) and intensity (VAS) of painful areas (P<0.001, both); as well as objective improvement, with decrease in TP count and increase in TT (P<0.001, both). Subjective sleep improvements observed after CTPI treatment included decrease in morning fatigue and in non-refreshing sleep complaint (P<0.001, both). Objectively, PSG in this group showed decrease in sleep latency (P<0.001) and in the percentage of stage 1 (P<0.001), increase in the percentage of slow wave sleep (P<0.001) and in sleep cycle count (P<0.001). Decrease in arousal index (P<0.001), number of sleep stage changes (P<0.05) and wake time after sleep onset (P<0.05), were also observed and no difference regarding pain or sleep parameters were verified after SHAM procedure. This study shows that CTPI can be an effective therapeutic approach for pain and sleep manifestations in FM.
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Affiliation(s)
- Tatiana F Almeida
- Department of Psychobiology, Universidade Federal de São Paulo, Rua Napoleão de Barros 925, Vila Clementino, 04024-002 São Paulo, SP, Brazil
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Acute and Chronic Tendon Injuries: Factors Affecting the Healing Response and Treatment. J Sport Rehabil 2003. [DOI: 10.1123/jsr.12.1.70] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective:Tendons have biomechanical properties based on collaborative remodeling of all their cells through normal lysis and synthesis. This review assesses factors that affect the healing response and presents solutions for rehabilitating acute and chronic tendon injuries.Data Sources:MEDLINE (1970–2002) and SPORTDiscus (1970–2002). Key words searched weretendon, tendinitis, tendinosis, tendinopathy, rehabilitation, ultrasound, NSAIDs, exercise, mobilization, aging, immobilization,andhealing.Data Synthesis:The biomechanical roles tendons play change throughout one’s lifetime and are influenced by maturation and aging, injury and healing, immobilization, exercise, medications, and therapeutic modalities. Suggestions from animal, case, and clinical studies are varied but provide solutions in the treatment of acute and chronic tendon injuries.Conclusions and Recommendations:All factors that affect the tendon structure should be considered in a rehabilitation program. Therapeutic exercise, medications, or therapeutic modalities should never be used as a stand-alone therapy.
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Principles and Techniques in Rehabilitation of the Athlete's Foot: Part I—Introduction of Concepts and Achilles' Tendon Rehabilitation. TECHNIQUES IN FOOT & ANKLE SURGERY 2003. [DOI: 10.1097/00132587-200303000-00009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Fernandes M, Alves G, Souza J. Efeito do ultra-som terapêutico em tendinite experimental de eqüinos: estudo clínico, ultra-sonográfico e histopatológico de dois protocolos. ARQ BRAS MED VET ZOO 2003. [DOI: 10.1590/s0102-09352003000100005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Avaliaram-se dois protocolos de ultra-som no tratamento de lesões do tendão flexor digital superficial (TFDS). Foram estudados 18 eqüinos, nos quais foi injetada uma solução de colagenase a 0,25% no TFDS esquerdo, à altura do terço médio da região metacarpiana. Os eqüinos foram divididos em: grupo A - tratado por ultra-som (UST) na freqüência de 3 MHz e intensidade de 1W/cm², no modo contínuo, por seis minutos; grupo B - tratado na mesma freqüência, intensidade e tempo, no modo pulsado; e grupo C - controle. Os tratamentos foram iniciados 48h após a indução da lesão, totalizando oito sessões. Os eqüinos foram estudados por 40 dias, avaliando-se o quadro clínico e a regressão dos sintomas. Por meio de exames ultra-sonográficos semanais avaliaram-se a área transversal e a ecogenicidade da lesão para estabelecimento do índice de severidade (IS). A lesão resultou em aumento médio de 1,5cm na circunferência da região metacarpiana, resposta à pressão digital de leve a moderada e grau de claudicação de 1 a 3. A regressão dos sintomas ocorreu, em média, nove dias no grupo A, 12 dias no grupo B e 21 dias no grupo C. O percentual de regressão no IS aos 40 dias foi de 42,5, 57,7 e 34,1, respectivamente. A avaliação histológica mostrou neovascularização pronunciada e maior atividade fibroblástica nos grupos tratados (A e B) comparados ao grupo-controle. Estes resultados sugerem que o UST é efetivo na redução dos sintomas clínicos da tendinite.
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Khan KM, Cook JL, Taunton JE, Bonar F. Overuse tendinosis, not tendinitis part 1: a new paradigm for a difficult clinical problem. PHYSICIAN SPORTSMED 2000; 28:38-48. [PMID: 20086639 DOI: 10.3810/psm.2000.05.890] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Overuse tendinopathies are common in primary care. Numerous investigators worldwide have shown that the pathology underlying these conditions is tendinosis or collagen degeneration. This applies equally in the Achilles, patellar, medial and lateral elbow, and rotator cuff tendons. If physicians acknowledge that overuse tendinopathies are due to tendinosis, as distinct from tendinitis, they must modify patient management in at least eight areas. These include adaptation of advice given when counseling, interaction with the physical therapist and athletic trainer, interpretation of imaging, choice of conservative management, and consideration of whether surgery is an option.
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Affiliation(s)
- K M Khan
- Allan McGavin Sports Medicine Centre, University of British Columbia, Vancouver, BC, V6T 1Z1, CAN.
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Abstract
OBJECTIVE The objective of this study was to evaluate the effectiveness of the pulsed dye laser (585 nm, 450 ms) in the treatment of sun induced wrinkles. DESIGN Patients had one pulsed dye laser (585 nm) treatment. The treated areas were assessed by the following methods: grading of skin wrinkles at 6 weeks, 12 weeks, and 6-14 months after treatment by blinded observers and by light and electron microscopy. SETTING An ambulatory care center at Abbott Northwestern Hospital (ANH) and the Laser & Skin Surgery Center of Northern California (LSSCNC). PATIENTS Twenty patients were treated, half with mild to moderate and half with moderate to severe sun induced skin wrinkles. RESULTS At last follow up 90% (9/10) of the mild to moderate wrinkles and 40% (4/10) of the treated patients with moderate to severe wrinkles had clinically observable improvement in their sun induced skin wrinkles. Histologic examinations of the treated areas showed a superficial dermal band of well organized elastin and collagen fibers replacing pre-treatment elastic tissue. Increased cellularity and mucin deposition was consistent with dermal collagen remodeling.
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Affiliation(s)
- B D Zelickson
- University of Minnesota, Skin Specialists Inc., Abbott Northwestern Hospital Laser Center, Minneapolis, Minnesota 55414, USA
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