Integration of Rehabilitation and Acupuncture in the Treatment of a Professional Musician with Temporomandibular Joint Dysfunction

Diagnosis, Treatment, and Management of Painful Scar: A Narrative Review

Painful scars can develop after surgery or trauma, with symptoms ranging from a minor itch to intractable allodynia. The problem of the painful scar may involve both intraneural and extraneural structures, requiring a systematic approach to diagnosis and treatment of this neuropathic pain condition that can impact quality of life and function profoundly. In this review, we outline the algorithm for the diagnosis, management, medical and surgical treatment of painful scars.

Case study: Pilot testing of a local acupuncture intervention protocol for burn scars

BACKGROUND

Following burn injury and a prolonged duration of healing, scars may become hypertrophic, causing movement restriction, increased scar thickness, colour and pliability, and symptoms such as pain and itch. Acupuncture has emerged as a potentially beneficial treatment for neuroinflammation, which perpetuates the negative features of hypertrophic scars. The aim of this study was to pilot test an evidence-based methodology for applying and measuring the clinical effects of localised acupuncture for symptomatic scars, in a patient with a healed burn injury.

METHODS

A 71-year-old caucasian male presented with a hypertrophic scar that was painful and itchy after burn injury and subsequent skin grafting. He received acupuncture and massage treatment local to his scar as per the local (verum) group of the author's clinical trial under recruitment. Needles were inserted around the circumference of the skin grafted area and adjacent to areas of raised scar tissue within the grafted area and stimulated via bi-directional rotation. Outcome measures included a Numerical Rating Scale (NRS) for pain and itch, Patient and Observer Scar Assessment Scale (POSAS) self-assessment component and SF36 quality-of-life measure to capture any non-specific acupuncture effects.

CONCLUSION

Acupuncture applied locally around the scar was associated with short-term relief of symptoms and significantly reduced his subjective outcome measure scores relating to scar thickness, redness and pliability out to six months after injury. Some short-term increase in symptoms occurred on several occasions following treatment; however, treatment was well tolerated supporting the use of this protocol for a larger future clinical trial.

LAY SUMMARY

Following injury to the skin, scars can become raised, red and reduce movement. Other common symptoms may include pain and itch. Previous studies suggest acupuncture may help symptomatic scars, but more research is needed to confirm this with larger samples of patients.This case study tested the active treatment protocol for a clinical trial using acupuncture on symptomatic scars. A 71-year-old white man had a burn scar on his torso after a workplace accident. His treatment involved scar massage and local acupuncture. The acupuncture needles were inserted around the skin graft borders and thickened bands of scar tissue.Outcomes were measured using surveys recording symptoms, scar characteristics and quality of life. These were used to assess treatment effect and how well the protocol was tolerated. Over the course of treatment both pain and itch improvedThis case report showed that the treatment protocol was well tolerated, and that local acupuncture was associated with improved scar symptoms and physical characteristics up to six months after injury.

Level of awareness of dentists about the role of physiotherapy in temporomandibular disorders: a pilot study in Riyadh, Saudi Arabia

Background

Physiotherapy (PT) is a distinguished developing profession. It has a crucial role in treating temporomandibular disorders (TMD) as an effective intervention to reduce pain and improve TMD symptoms. Not all dentists are aware of the importance of collaboration with physiotherapists (PTs).Therefore, this study aimed to assess the level of dentists’ awareness about the role of PT in treating TMD, identify dentists’ willingness to collaborate with PTs, and create collaboration awareness. This cross-sectional study included Saudi dentists in Riyadh. An online survey was used to assess dentist’s awareness and their readiness to collaborate with PTs.

Results

Out of 1500 dentists, only 162 participated in the survey. About 46.9% of dentists were aware that PT can treat TMD. Generally, there was lack of awareness about the benefits of PT among dentists (61.8%), and 59.9% was not aware that the evidence suggested that PT can improve TMD symptoms. Only 29% referred patients to PT. Upon the completion of the survey, almost all dentists (97.5%) were likely to refer patients with TMD to PT, and 90.7% of them showed interest to learn more about collaborating with PTs.

Conclusion

The study concluded that, although 46.9% of the dentists are aware about the role of PT in treating TMD, there is a lack of awareness about the benefits of PT among the majority of them. The study helped to extend the awareness of surveyed dentists about the collaboration and multidisciplinary approach.

Teaching Acupuncture: The Brazilian Medical Residency Programme

Acupuncture has had a successful story in Brazil. With its use in the public health system supported by legislation since 1988, its recognition as a medical specialty in 1995 enabled the introduction of an annual board examination and the creation of an official Medical Residency Programme. Since then, medical acupuncture has developed considerably, mostly through its massive spread into the Brazilian public health system. Brazil is the only country outside China that has created a Medical Residency Programme on Acupuncture. The 2-year programme consists of 5760 training hours, beginning with major clinical areas (internal medicine, neurology, orthopaedics and gynaecology) during 24 weeks in the first year. The residents study and practice acupuncture using the traditional Chinese Medicine approach and also the biomedical model. Specialists educated by this programme are therefore expected to have an optimum knowledge of both Western and Eastern medicine. Since it was first created, nine public health institutions have adopted the residency programme on acupuncture so, rather than being an alternative therapy, acupuncture has become an easily accessible and well-accepted conventional medical resource in Brazil.

Wind Instrumentalists and Temporomandibular Disorder: From Diagnosis to Treatment

INTRODUCTION

Temporomandibular disorders (TMD) involve the presence of pain or dysfunction on certain areas of the Cranio-Cervico-Mandibular Complex (CCMC), such as the masticatory muscles, the temporomandibular joint (TMJ) and associated structures like the postural muscles of the cervical region, can be considered as a sub-group of musculoskeletal disorders. Wind instrument players, as a consequence of their musical performance and its relation with the CCMC, can develop a TMD associated to muscle hyperactivity of certain elevator muscles, or even an increase of the intra-articular pressure in the functioning of the TMJ throughout musical activity.

AIM

The objective of this paper is to describe the necessary and elementary steps in the diagnoses and treatment of a wind instrumentalist with a temporomandibular disorder, with the introduction of infrared thermography during this procedure. This case study also has the purpose of presenting the usefulness of piezoresistive sensors in the analysis of the clarinettists' embouchure.

METHODOLOGY

A Caucasian, 30-year-old female clarinettist was assessed through a clinical examination following the Diagnostic Criteria for TMD (RDC/TMD), as a complementary tool of diagnosis, a thermal imaging infrared camera, Flir E60 (Wilsonville, OR, USA), was used in order to analyse the above referred articular and muscular regions. The complementary examination protocol implemented with this clarinet player also involved the analyses of the embouchure with the support of piezoresistive sensors.

RESULTS

The clinical outcomes resulting from this work were based on the RDC/TMD diagnoses indicated that the clarinet player had an internal derangement on both TMJ, with an osteoarthritis on the left TMJ and an anterior disc displacement with reduction on the right TMJ. The infrared thermograms that were analysed, verified the existence of a temperature differential of the anterior temporal muscle (0.1 °C), the TMJ (0.1 °C) and the masseter muscle (0.7 °C), and after the occlusal splint therapy the asymmetry related to the master muscle reduced to 0.3 °C. The high pitches can reach values of 379 g of force induced to the tooth 21 comparing to the 88 g of force applied on tooth 11. The embouchure force measurements consistently presented greater forces during the higher notes, followed by the medium notes and finally the low notes and this happened with higher pressures being transmitted always to tooth 21.

CONCLUSION

Performing arts medicine should understand the major importance of the dentistry field in the daily life of a professional musician, and the significance of implementing routine screening procedures of dental examinations, with infrared thermograms examination of distinct areas of the CCMC, as well as the use of sensors on the analyses of an eventual asymmetrical embouchure. Employing these techniques in dentistry will create the chance of preventing the overuse of some anatomical structures, with an early diagnosis and the correct monitoring of these areas.

The Application of Tensegrity Massage in a Professionally Active Musician - Case Report

PURPOSE

The purpose of our study was to present options for the application of tensegrity massage to manage pain caused by the overload of soft tissues in musicians.

DESIGN

Tensegrity massage was applied to a 34-year-old male violinist.

METHODS

The methodology included a correct positioning and tensegrity massage with individually designed procedure.

FINDINGS

After therapy, the patient achieved complete pain relief, and relaxation of muscles in the shoulder girdle and free part of the upper arm. The analgesic effect lasted for 6 months after the end of therapy.

CONCLUSIONS

Massage is an effective method in eliminating pain caused by the overload of soft tissues. If used regularly before physical effort, it can prevent muscle overload.

CLINICAL RELEVANCE

The presented massage procedure is an effective therapy in pain caused by the overload of soft tissues in musicians and it can be one of the elements of complex physiotherapy in active musicians.

Effects of massage therapy and occlusal splint therapy on mandibular range of motion in individuals with temporomandibular disorder: a randomized clinical trial

OBJECTIVE

The purpose of this study was to investigate the effects of massage therapy compared with occlusal splint therapy on mandibular range of motion (ROM) in individuals with temporomandibular disorder (TMD) and compare the results with ROM obtained in a group of individuals without this disorder.

METHODS

A blinded randomized clinical trial was conducted. Twenty-eight volunteers with TMD were randomly distributed into either a massage therapy group or an occlusal splint group. Both treatments were provided for 4 weeks. Fourteen individuals without TMD were consecutively allocated to a comparison group. Fonseca anamnestic index was used to characterize TMD and allocate the volunteers to either of the intervention groups or asymptomatic comparison group. Mandibular ROM was evaluated before and after treatment using a digital caliper. Two-way repeated-measures analysis of variance with a post hoc Bonferroni testing was used for intergroup and intragroup comparisons (level of significance was set to 5%). Cohen d was used to calculate the effect size.

RESULTS

In the intragroup analysis, significant increases in ROM were found for all measures in both the massage and occlusal splint groups (P < .05). A small to moderate clinical effect of treatment with the occlusal splint was found regarding right and left lateral excursion in comparison with the massage therapy and asymptomatic comparison groups (0.2 <d < 0.5).

CONCLUSION

Massage therapy on the masticatory muscles and the use of an occlusal splint lead to an increase in mandibular ROM similar to that of the asymptomatic comparison group with regard to maximum active mouth opening and both right and left excursion in individuals with TMD.