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BACKGROUND AND OBJECTIVES:The aim of this study was to identify the existence of a relationship between the type of locus of health control and the variables associated with the occurrence of non-specific chronic low back pain (NCLBP), in addition to assessing the relationship between the level of disability in the development of functional activities and the level of kinesiophobia with the type of locus found in patients. METHODS: 40 individuals with a mean age of 54.1±7.1 years were evaluated. On a single occasion, the questionnaires Multidimensional Scale of Locus of Health Control (MSLHC), Tampa (kinesiophobia), and Roland-Morris (disability) were applied for the acquisition of qualitative variables, analyzed to identify possible relationships between these and the type of locus of health control. RESULTS:The present results showed no correlation between the type of locus and the specific individual variables genders (p<0.722), health insurance (p<0.449), education (p<0.968), monthly income (p<0.655), smoking (p<0.877), physical activity (p<0.077), and marital status (p<0.346), demonstrating homogeneity of the sample. There was no relationship between the type of locus and the degree of kinesiophobia (p<0.745). A significant relationship has been demonstrated between the locus of internal control and the level of disability (p<0.031). CONCLUSION: The type of locus of health control presented by most patients with NCLBP was the internal, related to higher levels of disability, and not associated with levels of kinesiophobia or individual variables.

Left internal thoracic artery fistula draining to left pulmonary artery is an extremely rare complication following myocardial revascularization. It may cause recurrent angina, dyspnea, heart failure, endocarditis, among other conditions. It should always be considered in the absence of a clear cause for the onset of these symptoms after myocardial revascularization. The diagnosis is made by coronary angiography, and most patients are treated by surgical or percutaneous closure of the fistula. CASE REPORTA 73-year-old white male patient with a history of systemic arterial hypertension and coronary artery bypass grafting six years ago using the following grafts: left internal thoracic (mammary) artery to anterior descending artery, sequential saphenous vein to the 1 st and 2 nd left marginal arteries and saphenous vein to the 1 st diagonal artery. The patient presented with asthenia and progressive exertional dyspnea, which has been getting worse over the last few months even on mild exertion. He had been taking captopril 150 mg/d, hydrochlorothiazide 25 mg/d, and acetylsalicylic acid 200 mg/d. The cardiovascular physical examination was normal, except for a fourth heart sound (S4). His lungs were found to be clean. First-degree atrioventricular block and left anterior hemiblock was seen on ECG. The echocardiogram revealed only left ventricular hypertrophy and diastolic disfunction. Myocardial ischemia investigation was performed through stress/rest myocardial perfusion scintigraphy. The scan ( fig.1) showed low uptake of the radiopharmaceutical (Tc-99 sestamibi) in the anteroseptal region on stress, which returned to normal at rest, a finding consistent with anteroseptal ischemia. Coronary angiography and left ventriculography were thus performed, showing patency of all grafts and a 70% obstruction of the right coronary artery. However, a large fistula arising at the initial portion of the left mammary artery draining to the left pulmonary artery was detected ( fig. 2 e 3). This fistula resulted in a significant steal of flow from the anterior descending artery, thought to be the cause of the anteroseptal ischemia. A surgical ligation of the fistula was performed, and the patient was discharged from the hospital. During the oneyear follow-up period, the patient was free of the symptoms which led to his hospitalization.We report a patient who developed dyspnea on mild exertion six years after coronary artery bypass graft surgery (CABG). Myocardial ischemia was documented by radionuclide imaging, and coronary angiography showed patency of all grafts and a large fistula between the left internal thoracic artery (LITA) and the left pulmonary artery (LPA). The patient was submitted to surgical closure of the fistula and made an excellent recovery.

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Introduction: Low back pain appears in approximately two thirds of the population at some point in life and when it exceeds more than 12 weeks, it evolves to chronic low back pain. Chronic low back pain is considered one of the most common causes of disability and absence from work. A therapeutic technique that can be used as a treatment for chronic low back pain is neural mobilization, capable of restoring compromised neurological structures, restoring movement by improving the elasticity of neural tissue and adjacent tissues. Objective: To verify the effects of neural mobilization in patients with chronic low back pain. Material and methods: All articles were carefully evaluated in order to obtain concrete and reliable information. The databases used were Google Scholar, Scielo, Medline and PubMed due to the methodological quality and articles in the area of interest. The keywords “low back pain”, “chronic low back pain”, “neural mobilization” and “physiotherapeutic intervention” were combined in the most diverse possibilities, in English and Spanish translations. Results: 86 articles were found, nine of which were included in this review. They had a score ≥ 5 on the PEDro Scale, which methodologically qualifies the articles. After analyzing the results obtained through the selected articles, all the data collected, as well as their respective results, were described in a table that contains data from the articles. Conclusions: Neural mobilization reduces pain and improves the extensibility of tissues, causing a reduction in painful sensation and increased flexibility. Therefore, it is necessary to continue research in order to verify new results obtained through this type of intervention.

The pulley injuries are not common among the average population, but when the subject is climbing (sports or rock, bouldering or leading) it gets clear that is common and lead the athlete to a path of serious consequences. There are not many articles in the scientific literature that exposes the pulley injuries in climbers. That is why there is no prevention guideline about it.With the evolution of the sport, the graduation level of difficulty in climbing will raise. Eventually the exposition of the climber to higher loads will rise also. This can be a factor for increased hand and finger injuries, specifically pulley injuries. The pulley act as supporters to the fingers tendons and helps to optimize the finger flexion, keeping the tendons close to the bones [1]. The pulleys are divided into 5 annular pulleys and 3 cruciform pulleys [1,2]. The pulleys A2 and A4 gets more attention at the studies because they are strictly related with the insertion of the flexor digitorum profundus (FDP) and with the flexor digitorum superficialis (FDS), respectively. With this relation, the loads on these pulleys are higher due the traction of the finger flexor tendons. The objective of this short review and new concept is to induce a new line of clinical reasoning when analyzing and treating athletes of climbing. The Climbing GripsThere are two common grips described in literature when the subject is pulley injuries, the crimp grip and slope grip. In the crimp grip the proximal interphalangeal joint stays in flexion and the distal interphalangeal joint stays in hyperextension. In the slope grip both interphalangeal joints stay in flexion [3]. In 2006 Vigouroux et al.described the amount of force on pulleys and tendons that each grip generates. The crimp grip was able to generate 36 times more forces in crimp grip than in the slope grip. The electromyogram exam the FDP was the prime flexor at the crimp grip [3], but that is one way to interpret the values. The FDP showed more intensity of contraction activity, but that is explained by the fact of the distal interphalangeal joint being hyper-extended. The action of the FDP is flexion of the interphalangeal joint, if it is on passive insufficiency (hyperextension of the interphalangeal joint), the FDP will try harder to flex the distal interphalangeal joint. It shows how much strength the FDP does in the crimp grip, when the FDS does not make that much strength (it is not on passive insufficiency). So, the prime flexor at the crimp grip turns to be the FDS.

Embora a ciência tenha avançado na terapia da fibromialgia, o cotidiano do tratamento clínico ainda é bastante desafiador. Diante disso, o objetivo desse estudo é apresentar um novo protocolo de exercícios fáceis de aplicar, baseado no controle da dor e cansaço durante as intervenções por meio da percepção subjetiva de uma paciente com fibromialgia. Resultado: A nova proposta consistiu de exercícios físicos associados à percepção subjetiva de dor e cansaço para o controle da intensidade e volume dos exercícios. As avaliações ocorreram por meio da escala visual analógica para dor (EVA) e da escala de percepção subjetiva de esforço (BORG). As análises de dor e cansaço foram feitas antes, durante e logo após cada sessão. A intervenção teve duração de 24 semanas com frequência de duas vezes por semana. Após a avaliação inicial, a partir do diagnóstico, foi dado início ao protocolo de treinamento de força para todos os grupos musculares. Conclusão: O uso das variáveis dor e cansaço para determinar a intensidade e volume durante o protocolo de exercícios, resultou na melhora do quadro doloroso ao final da intervenção. Resultado que se manteve após seis meses da alta clínica. Permitindo a retomada da prática regular de exercícios físicos.