Valter Santilli

Sapienza University of Rome, Roma, Latium, Italy

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Publications (90)256.32 Total impact

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    ABSTRACT: Objective: traumatic neuroma is a pathological condition of peripheral nervous system consisting of localized proliferation of injured nerve elements. The symptoms depend on the type of involved nerve (motor and/or sensitive) and on the site and the extension of the lesion. Ultrasound is the best tool to depict the morphology of nerve, especially in traumatic conditions. We present a study aimed to assess the correlation between the degree of nerve function and the ultrasound morphology of neuromas. Patients and methods: we retrospectively evaluated 18 patients with neuromas (not transected) occurred after a closed nerve trauma evaluated with clinical and ultrasound assessment. The clinical evaluation was related to the % of increase of cross sectional area as detected by nerve ultrasound respect to normal nerve. Results: we observed that dimensions of neuromas are not related to function until neuroma have cross sectional area 5 times enlarged respect to normal nerve, in this case recovery never occurs. Conclusion: our study failed to clear detect a relation between cross sectional area enlargement of neuroma and nerve function, but showed a cut off beyond which prognosis is negative. This result provide some useful information for prognosis, nevertheless we believe that future perspective studies are needed to better understand the timing of developing neuromas and its evolution.
    Clinical neurology and neurosurgery 11/2015; 139:314-318. DOI:10.1016/j.clineuro.2015.10.034 · 1.13 Impact Factor
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    ABSTRACT: Studies have analyzed three-dimensional complex motion of the shoulder in healthy subjects or patients undergoing total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA). No study to date has assessed the reaching movements in patients with TSA or RSA. Twelve patients with TSA (Group A) and 12 with RSA (Group B) underwent kinematic analysis of reaching movements directed at four targets. The results were compared to those of 12 healthy subjects (Group C). The assessed parameters were hand-to-target distance, target-approaching velocity, humeral-elevation angular velocity, normalized jerk (indicating motion fluidity), elbow extension and humeral elevation angles. Mean Constant score increased by 38 points in Group A and 47 in Group B after surgery. In three of the tasks, there were no significant differences between healthy subjects and patients in the study groups. Mean target-approaching velocity and humeral-elevation angular velocity were significantly greater in the control group than in study groups and, overall, greater in Group A than Group B. Movement fluidity was significantly greater in the controls, with patients in Group B showing greater fluidity than those in Group A. Reaching movements in the study groups were comparable, in three of the tasks, to those in the control group. However, the latter performed significantly better with regard to target-approaching velocity, humeral-elevation angular velocity and movement fluidity, which are the most representative characteristics of reaching motion. These differences, that may be related to deterioration of shoulder proprioception after prosthetic implant, might possibly be decreased with appropriate rehabilitation. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of Biomechanics 07/2015; 48(12). DOI:10.1016/j.jbiomech.2015.07.002 · 2.75 Impact Factor
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    ABSTRACT: The aim of the study was to identify the main aspects involved in patient selection, the choice of therapeutic agents and the safety profile, as well as the medico-legal and organizational aspects of intra-articular injection therapies for osteoarthritis. A committee of 10 experts from Italian universities, public hospitals, territorial services, research institutes and patient associations was set up. Fifty-two clinicians from a large number of Italian medical centers specialized in intra-articular injection therapy took part in a Delphi process aimed at obtaining consensus statements among the participants. Large consensus was obtained for statements grouped under the following main themes: treatment indications; drug/medical device choice; treatment efficacy; and appropriate setting. The consensus statements developed by a large number of experts may be used as a practical reference tool to help physicians treat osteoarthritis patients by means of intra-articular injection therapies.
    Annali dell'Istituto superiore di sanita 04/2015; 51(2):131-8. DOI:10.4415/ANN_15_02_11 · 1.11 Impact Factor

  • Muscle & Nerve 03/2015; 52(3). DOI:10.1002/mus.24660 · 2.28 Impact Factor
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  • M Paoloni · E Tavernese · A Cacchio · V D' Orazi · F Ioppolo · M Fini · V Santilli · M Mangone ·
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    ABSTRACT: ultrasound (US) therapy improves symptoms in carpal tunnel syndrome (CTS) patients. Extracorporeal shock wave therapy (ESWT) uses acoustic energy to determine its clinical effects, as US--therapy do. to compare the short--term efficacy of US and ESWT on mild and moderate CTS STUDY DESIGN: Randomized controlled trial SETTING: University outpatient service POPULATION: Twenty--five patients with mild to moderate CTS, for a total of 42 wrists METHODS: Patients were randomized to receive US, cryo--US or ESWT, and were evaluated for pain and function before treatment started, at the end of treatment, and four and 12 weeks after the end of the treatment. significant improvement was noted in all groups for pain (p<0.05) and functionality (p<0.05). Patients in ESWT group show greater pain improvement at 12--weeks follow--up when compared with both US and cryo--US groups (p<0.05). patients affected by CTS might benefit from the application of US, cryo--US or ESWT. Benefits persist 3 months after the end of treatment. Clinicians might consider the possibility of a short--term non--surgical management for mild--to--moderate CT S.
    European journal of physical and rehabilitation medicine 02/2015; · 1.90 Impact Factor
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    ABSTRACT: Clinical research quantifies symptoms and signs of pain. To develop a brief outcome measure to assess foot and ankle conditions, the psychometric properties of a modified version of the original Foot Function Index (FFI) were examined. Eighty-six subjects with musculoskeletal foot and ankle disorders were enrolled. The internal consistency and test-retest reliability were evaluated by using Cronbach's α and intraclass correlation coefficient (ICC). Criterion validity was tested by Pearson's correlation coefficient between 17 items of the Italian FFI (17-IFFI) and the Lower Extremity Functional Scale (LEFS). The responsiveness was calculated using the receiver operating characteristic curve (ROC). Cronbach's Alpha was 0.95 (95% CI: 0.92, 0.99). The intra-interviewer and inter-interviewer ICC values were, respectively, 0.92 (95% CI: 0.88-10 0.96) and 0.90 (95% CI: 0.89-0.94). Correlations between the 17-IFFI scores and the LEFS scores were -0.564 and -0.456 at the initial and at the end of the treatment, respectively. The ROC analysis revealed an area under the curve of 0.732 (95% CI: 0.61-0.82) for the 17-IFFI and 0.633 (95% CI: 0.52-0.71) for the LEFS score. The 17-IFFI is a reliable and valid scale and we recommend its application to evaluate the effectiveness of a treatment in patients with musculoskeletal foot and ankle disorders. Copyright © 2014 Elsevier Ltd. All rights reserved.
    The Foot 10/2014; 25(1). DOI:10.1016/j.foot.2014.09.004
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    ABSTRACT: IntroductionAt least 25% of knee dislocations are associated with common fibular nerve injury. Usually diagnosis is based on clinical and neurophysiological findings. We assessed the role of nerve ultrasound in common fibular nerve injury.Materials and Methods Eight consecutive patients (6 men and 2 women, mean age 34 years) with knee luxation referred to our lab underwent clinical, neurophysiological, and ultrasound examination.ResultsIn all patients we observed a similar pattern: severe weakness (plegia or severe paresis), neurophysiological involvement of both fibular nerve branches and ultrasound evidence of increased fibular nerve area with hypoechogenicity. On follow-up evaluation, 6 patients remained stable, and 2 patients improved. The greater the ultrasound fibular nerve enlargement the worse the recovery.DiscussionNerve ultrasound was confirmed to be a useful diagnostic/prognostic tool in traumatic nerve lesions. A prompt US examination of the fibular nerve should be considered after any case of knee dislocation. © 2014 Wiley Periodicals, Inc.
    Muscle & Nerve 10/2014; 51(6). DOI:10.1002/mus.24472 · 2.28 Impact Factor
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    ABSTRACT: BACKGROUND: Segmental muscle vibration (SMV) improves motor performances in neurological conditions, including stroke. OBJECTIVE: To determine if SMV modifies upper limb muscular activity in chronic stroke patients performing a reaching movement. METHODS: We randomized 22 chronic stroke patients to an experimental group (EG; n = 12), receiving 10 sessions of exercise + 120 Hz SMV over the biceps brachii (BB) and the flexor carpi ulnaris (FCU) muscles, or to a control group (CG; n = 10) receiving exercise only. All subjects performed a reaching movement with the affected side before and 4 weeks after therapy ended. We recorded surface EMG activity of the anterior deltoid (AD), posterior deltoid (PD), BB, triceps brachii (TB), FCU and extensor carpi radialis (ECR) muscles. We calculated muscular onset times, modulation ratio, co-contractions and degree of contraction. RESULTS: After SMV, onset times of the PD (p = 0.03), BB (p = 0.02) and ECR (p = 0.04) in the EG were less anticipated than at baseline; the modulation ratio increased in AD (p = 0.003) and BB (p = 0.01); co-contractions decreased in the pairs BB/TB (p = 0.007), PD/BB (p = 0.004) and AD/BB (p = 0.01); and the degree of contraction decreased in BB (p = 0.01). CONCLUSIONS: The modulation of muscular function induced by SMV may aid to explain its action on smoothness and coordination of movements.
    Neurorehabilitation 09/2014; 35(3). DOI:10.3233/NRE-141131 · 1.12 Impact Factor
  • Valter Santilli · Andrea Bernetti · Massimiliano Mangone · Marco Paoloni ·
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    ABSTRACT: Sarcopenia is a condition characterized by loss of skeletal muscle mass and function. Although it is primarily a disease of the elderly, its development may be associated with conditions that are not exclusively seen in older persons. Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength and it is strictly correlated with physical disability, poor quality of life and death. Risk factors for sarcopenia include age, gender and level of physical activity. In conditions such as malignancy, rheumatoid arthritis and aging, lean body mass is lost while fat mass may be preserved or even increased. The loss in muscle mass may be associated with increased body fat so that despite normal weight there is marked weakness, this is a condition called sarcopenic obesity. There is an important correlation between inactivity and losses of muscle mass and strength, this suggests that physical activity should be a protective factor for the prevention but also the management of sarcopenia. Furthermore one of the first step to be taken for a person with sarcopenia or clinical frailty is to ensure that the sarcopenic patient is receiving correct and sufficient nutrition. Sarcopenia has a greater effect on survival. It should be important to prevent or postpone as much as possible the onset of this condition, to enhance survival and to reduce the demand for long-term care. Interventions for sarcopenia need to be developed with most attention on exercise and nutritional interventions.
    Clinical Cases in Mineral and Bone Metabolism 09/2014; 11(3):177-80.
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    ABSTRACT: We report the case of a 46-year-old woman with no known history for gluten sensitivity who presented severe heel pain, and was successfully managed with a gluten-free diet. Previously she had been unsuccessfully treated with several conservative remedies. The presence of musculoskeletal problems in patients with gluten sensitivity is not rare. To our knowledge, however, this is the first case report mentioning the successful management of plantar fasciitis with a gluten-free diet. The case report highlights the importance of considering gluten sensitivity among other possible differential diagnosis for musculoskeletal pain insensitive to traditional therapies.
    The Foot 09/2014; 24(3). DOI:10.1016/j.foot.2014.06.004
  • P. Mazzone · M. Paoloni · M. Mangone · V. Santilli · A. Insola · M. Fini · E. Scarnati ·
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    ABSTRACT: The pedunculopontine tegmental nucleus (PPTg) is a component of the locomotor mesencephalic area. In recent years it has been considered a new surgical site for deep brain stimulation (DBS) in movement disorders. Here, using objective kinematic and spatio-temporal gait analysis, we report the impact of low frequency (40 Hz) unilateral PPTg DBS in ten patients suffering from idiopathic Parkinson’s disease with drug-resistant gait and axial disabilities. Patients were studied for gait initiation (GI) and steady-state level walking (LW) under residual drug therapy. In the LW study, a straight walking task was employed. Patients were compared with healthy age-matched controls. The analysis revealed that GI, cadence, stride length and left pelvic tilt range of motion (ROM) improved under stimulation. The duration of the S1 and S2 sub-phases of the anticipatory postural adjustment phase of GI was not affected by stimulation, however a significant improvement was observed in the S1 sub-phase in both the backward shift of centre of pressure and peak velocity. Speed during the swing phase, step width, stance duration, right pelvic tilt ROM phase, right and left hip flexion-extension ROM, and right and left knee ROM were not modified. Overall, the results show that unilateral PPTg DBS may affect GI and specific spatio-temporal and kinematic parameters during unconstrained walking on a straight trajectory, thus providing further support to the importance of the PPTg in the modulation of gait in neurodegenerative disorders.
    Gait & posture 07/2014; 40(3). DOI:10.1016/j.gaitpost.2014.05.002 · 2.75 Impact Factor

  • Abstracts of the 30th International Congress of Clinical Neurophysiology (ICCN) of the IFCN; 06/2014
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    ABSTRACT: Background: Rotator cuff tear (RCT) has a multifactorial etiology. We hypothesized that obesity may increase the risk of RCT and influence tear size. Materials and methods: A case-control design study was used. We studied 381 consecutive patients (180 men, 201 women; mean age ± standard deviation, 65.5 ± 8.52 years; range, 43-78 years) who underwent arthroscopic rotator cuff repair. Tear size was determined intraoperatively. The control group included 220 subjects (103 men, 117 women; mean age ± standard deviation, 65.16 ± 7.24 years; range, 42-77 years) with no RCT. Body weight, height, and bicipital, tricipital, subscapularis, and suprailiac skinfolds of all participants were measured to obtain body mass index (BMI) and the percentage of body fat (%BF). For the purposes of the study, the 601 participants were divided into 2 groups by BMI (group A, BMI ≥ 25; group B, BMI < 25). The odds ratios (ORs) were calculated to investigate whether adiposity affects the risk of RCT. Data were stratified according to gender and age. Multiple linear regression analyses were applied to explore the association between obesity and tear size. Results: The highest ORs for both men (OR, 2.49; 95% confidence interval, 1.41-3.90; P = .0037) and women (OR, 2.31; 95% confidence interval, 1.38-3.62; P = .0071) were for individuals with a BMI ≥ 30; 69% (N = 303) of group A and 48% (N = 78) of group B had RCTs. Patients with RCT had a BMI higher than that of subjects with no RCT in both groups (P = .031, group A; P = .02, group B). BMI and %BF significantly increased from patients with a small tear (BMI, 27.85; %BF, 37.63) to those with a massive RCT (BMI, 29.93; %BF, 39.43). Significant differences were found (P = .004; P = .031). Conclusions: Our results provide evidence that obesity, measured through BMI and %BF, is a significant risk factor for the occurrence and severity of RCT.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 06/2014; 23(11). DOI:10.1016/j.jse.2014.03.016 · 2.29 Impact Factor
  • D. Coraci · V. Santilli · G. Granata · I. Paolasso · H. Tsukamoto · L. Padua ·

    Clinical Neurophysiology 06/2014; 125:S213. DOI:10.1016/S1388-2457(14)50698-0 · 3.10 Impact Factor
  • D. Coraci · V. Santilli · C. Erra · P. De Franco · L. Padua ·

    Clinical Neurophysiology 06/2014; 125(1):S216. DOI:10.1016/S1388-2457(14)50710-9 · 3.10 Impact Factor
  • F. Alviti · M. Mangone · M. Vanadia · C. Fiorentino · V. Santilli ·

    Annals of Physical and Rehabilitation Medicine 05/2014; 57:e280. DOI:10.1016/
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    ABSTRACT: To find more accurate indices that could affect decisions in spasticity treatment by investigating the relationship between ultrasonographic, electromyographic, and clinical parameters of the gastrocnemius muscle in adults with spastic equinus after stroke. Observational study. Two university hospitals PARTICIPANTS: Forty-three chronic stroke patients with spastic equinus. Not applicable. Ultrasonographic features were: spastic gastrocnemius muscle echo intensity, muscle thickness, and posterior pennation angle of the gastrocnemius medialis (GM) and lateralis (GL) in both legs. Electromyographic evaluation included compound muscle action potential (CMAP) recorded from the GM and GL of both legs. Clinical assessment of the spastic gastrocnemius muscle was performed with the modified Ashworth scale (MAS) and by measuring ankle passive dorsiflexion range of motion (PROM). Spastic muscle echo intensity was inversely associated with proximal (GM and GL P=0.002) and distal (GM and GL P=0.001) muscle thickness, pennation angle (GM P<0.001; GL P=0.010), CMAP (GM P=0.014; GL P=0.026), and ankle PROM (GM P=0.038; GL P=0.024). The pennation angle was directly associated with the proximal (GM and GL P<0.001) and distal (GM P=0.001; GL P<0.001) muscle thickness of the spastic gastrocnemius muscle. The MAS score was directly associated with muscle echo intensity (GM P=0.039; GL P=0.027) and inversely related to the pennation angle (GM and GL P=0.001), proximal (GM P=0.016; GL P=0.009), and distal (GL P=0.006) muscle thickness of the spastic gastrocnemius. Increased spastic muscle echo intensity was associated with reduced muscle thickness, posterior pennation angle, and CMAP amplitude in the gastrocnemius muscle. Building on previous evidence that these instrumental features are related to botulinum toxin response, these new findings may usefully inform spasticity treatment decisions.
    Archives of physical medicine and rehabilitation 04/2014; 95(8). DOI:10.1016/j.apmr.2014.04.011 · 2.57 Impact Factor
  • M Paoloni · V Santilli ·

    European journal of physical and rehabilitation medicine 04/2014; 50(2):207-8. · 1.90 Impact Factor