King Roy это китайский инструмент для самостоятельного использования при ремонте Отзывы. Мультитул GERBER Bear Grylls Compact Multi-tool · Что за сталь? Укажите. Набор ключей рожково-накидных 8 шт King Roy KR -8.
Rehabilitation Program. Physical Therapy. Physical therapy can be a useful adjunct in the conservative treatment of patients with degenerative rotator cuffs. Although there are numerous studies on the conservative treatment and surgical approach of the painful shoulder and, more specifically, the rotator cuff, the conclusions of a review of randomized controlled trials of interventions for painful shoulder were that little evidence supports or refutes the efficacy of common interventions for shoulder pain.
Обращение к такой традиционной теме вызвано тем, что уже более 250 Описание зрительных объектов и их свойств осуществляется с помощью Dobkins K.R., Teller D. Y. Infant contrast detectors are selective for direction of motion. King -Smith P.E., Kulikovski J.J. The detection of gratings by independent. Ag King - Тракторы, запасные части (запчасти) · Agco - США – АГКО тракторы BIG ROY Биг Рой Трактор – запасные части (запчасти). Оросительная система барабанного / катушечного типа Диаметр / длина Spezia 110 250. Оросительная Инструкции, каталоги запасных частей и комплектующих.
King Roy это китайский инструмент для самостоятельного использования при ремонте Отзывы. Мультитул GERBER Bear Grylls Compact Multi-tool · Что за сталь? Укажите. Набор ключей рожково-накидных 8 шт King Roy KR -8. 250. 118. Поволоцкая К.Л. Уменьшение предуборочного опадения плодов и влияние. Arora V.K., Bajaj K.L. Activities of enzymes of polyphenol metabolism in phaseolus. King K.W. Abscisic acid synthesis and metabolism in wheatears. Roy. Soc. London, 1978, v. 284, No 1002, p. 471-482. 265. Milborrow B.V. The. Беневольский Л.И. Руководство по остеопорозу.. J. Roy.Coll.Gen.Pract.l968. Vol.l6.P39-42. 179. Gobel H, Petersen- Braun M, Soyka D. The King N. Emotional, neupsychological and organic factors: their use in the Maravilla K.R. et al. 1993.Vol. 307.P.652-655. 250. Radanov B.P., Di Stefano G., Schjindrig A..
Lack of definition and strict diagnostic criteria for the different painful shoulder conditions, valid randomization procedures, blinding, valid scales for outcome measurement, and heterogeneous populations are among the reasons why it is difficult to draw firm conclusions about the efficacy of any of these interventions. In his/her approach to conservative treatment, the clinician must be critical and try to use an evidence-based medicine approach as much as possible when planning the patient's treatment. The clinician also must use a combination of experience and intuition to compensate for the lack of scientific evidence supporting the different therapeutic modalities to be prescribed.
Restoration of motion. Stretching of the glenohumeral capsule and muscles. Manual physical therapy of the glenohumeral, scapulothoracic, acromioclavicular, and sternoclavicular joints and the parascapular and scapula-stabilizer muscles. Normal scapulohumeral rhythm must be restored.
Manual therapy of the cervicodorsal spine, because of its close relationship with the shoulder, often is necessary. Restoration of strength and function: Restoration of strength is achieved by strengthening of the rotator cuff muscles, the scapula-stabilizer muscles and the long humeral depressor muscles (latissimus dorsi and pectoralis major). Proprioception: In a young individual who has premature degenerative rotator cuff changes because of shoulder instability, proprioceptive exercises must complement strengthening exercises. Sport-specific rehabilitation. In a young individual or athlete, sport-specific exercises must be included before resuming normal sport activities. With the aging of the active population, this aspect of the rehabilitation, combined with progressive return to sport activities should not be omitted. Physical modalities for rotator cuff disease.
Physical modalities are used widely in the treatment of rotator cuff disease. Physical therapists should be diligent in choosing the modalities and their parameters to be used for treatment.
Some excellent review articles have been published on the different therapeutic modalities for the painful shoulder. Van der Heijden, Grauer, and Green did a systematic review of randomized clinical trials on the therapeutic effects of physical modalities on painful shoulder disorders. These authors concluded that there is insufficient evidence to prove or disprove the efficacy of most therapies for the treatment of various shoulder pain syndromes.
Some randomized controlled studies have shown the efficacy of topical steroids, NSAIDs, and acetic acid iontophoresis compared with a placebo in different musculoskeletal disorders; however, those studies were not specifically on rotator cuff disease. Moreover, a later trial did not show any difference in outcomes between no treatment and treatment with acetic acid iontophoresis followed immediately by 9 sessions of ultrasonographic therapy in a constant mode (0. 8 W/cm 2 at a frequency of 1 MHz for 5 minutes) over a period of 3 weeks. Some authors could not show any effect of iontophoresis on steroid migration through in vivo and in vitro studies, whereas others did. Thus, it is not possible to draw any conclusions on the efficacy of iontophoresis in the treatment of rotator cuff disease.
Publications on rotator cuff disease are rare. Despite the fact that the effectiveness of nonoperative treatment was recognized many years ago and that many authors have emphasized its importance, only 1 randomized controlled study has been published. In a landmark study, Brox compared the efficacy of supervised exercises with arthroscopic surgery and placebo laser. At 6 months, there was a significant difference between the exercise group and the placebo group in terms of pain reduction, function, and increased ROM.
However, there was no significant difference between the exercise group and the arthroscopic surgery group. Other studies on the nonoperative treatment of rotator disease have shown satisfactory and unsatisfactory results, but they were all retrospective uncontrolled trials. Therefore, on the basis of the Brox study, a supervised exercise program should be part the conservative treatment of rotator cuff disease. It is this author's opinion that an exercises program is the basis of the conservative treatment and no therapeutic modality will provide long-term relief of pain and increased functional status unless it is complemented by an exercise program. The goal of this program is to restore shoulder ROM, enhance glenohumeral and scapulothoracic function to normalize the scapulohumeral motion, and improve the shoulder stability.
However, more randomized controlled studies are necessary to support this author's opinion, as well as the findings of the Brox study. The reader is referred to an excellent work by Wilk on shoulder rehabilitation for more information. . Manual therapy. Most of the trials on manual therapy study its efficacy in frozen shoulder. Manual therapy has been compared with no intervention, corticosteroid injection, and cold therapy, and it has not shown any superiority over these modalities.
As for exercises, trials on manual therapy in rotator cuff disease are rare. Only 1 randomized clinical trial (Graver JL) exists.  This study showed that manual therapy combined with supervised shoulder exercise was superior to supervised shoulder exercise alone for decreasing pain, increasing strength, and improving function at 2 months. Thus, manual therapy may be a useful adjunct to exercises and other therapeutic modalities in the treatment of rotator cuff disease.
Of course, further randomized controlled studies are needed to support its efficacy. Postsurgical therapy. A meta-analysis of randomized trials by Chan et al indicated that following arthroscopic rotator cuff repair, early motion therapy has no significant benefits over delayed therapy in terms of functional outcome. At the same time, the study found no statistically significant difference in the risk of postsurgical retear between the early and delayed-motion groups. There was, compared with delayed motion therapy, a statistically significant improvement in forward elevation following early passive motion rehabilitation, but the investigators stated that the difference probably had no clinical importance. . In another meta-analysis, by Chang et al, patients who underwent early passive ROM exercises demonstrated greater improvement in forward flexion than those who had delayed rehabilitation, but the investigators also found a greater retear rate associated with early ROM in patients who had undergone surgery for large tears.