Angela Notarnicola

• Ph.D.
• Researcher at University of Bari Aldo Moro

Rhizarthrosis is the most frequent form of osteoarthritis and is responsible for pain, disability and reduced functionality. The aim of the study is to investigate the clinical effects of shock wave treatment in patients suffering from arthritis of the first finger. A prospective clinical study was designed, in which 72 patients affected by rhizart...

Background: Rhizarthrosis is the most frequent form of osteoarthritis and is responsible for pain, disability and reduced functionality. Recent studies support the possibility of providing Extracorporeal Shock Wave Treatment in patients suffering from osteoarthritis. Shock wave biostimulation may be able to modulate joint inflammation and stimulate...

Plantar fasciitis is one of the most common causes of foot pain; in 35% of cases, it is also associated with bone edema of the heel. The aim of this study was to investigate the relationship between bone edema and the outcomes of temperature-controlled high-energy adjustable multi-mode emission laser (THEAL) and/or exercises in patients with planta...

Plantar fasciitis is one of the most common causes of foot pain; in a significant percentage it is also associated with bone edema of the heel. A prospective randomized clinical trial was designed, in which 48 patients suffering from plantar fasciitis, with or without bone edema, were treated with temperature controlled high energy adjustable multi...

Infection is an uncommon side effect of arthroscopic surgery, and this percentage is higher in anterior cruciate ligament reconstruction (ACLR) surgery, where graft and fixation devices are used. Infections can not only lead to high re-admission rates and poor functional recovery of the knee but can also have a significant negative impact on the pa...

This study aimed to verify the comparative effectiveness of shock wave therapy versus therapeutic exercise, including the possibility of combining both therapies, in patients who did not respond to the first treatment. A prospective randomized clinical trial was carried out, predicting the possibility of a cross-over between the two treatment optio...

Background: Proximal humeral fractures represent the third most common observed osteoporotic fracture; the treatment in three and four-part proximal humeral fractures in patients over 65 years is still controversial. Among the treatments described in literature, open reduction and internal fixation (O.R.I.F) and reverse shoulder arthroplasty (RSA)...

Background: Total hip arthroplasty (THA) is currently the best surgical option for hip osteoarthritis secondary to developmental hip dysplasia (DDH); it may be extremely challenging, because of the hypoplasic proximal metaphysis, pathological anteversion, and excessive cervico-diaphyseal angle of the neck at the femoral side. The purpose of this r...

Epicondylitis has an incidence of 3% in the population. Epicondylitis seems to affect women more frequently than men and it is most common at the age of 35-50 years. Repetitive manual labor, handling of loads > 20 kg or heavy tools > 1 kg, working postures with upper limbs stretched forward, repetition of torsion-rotation movements, the use of a co...

Background: Osteoporotic acetabular fractures frequently involve the quadrilateral plate (QP), a flat and thin bone constituting the medial wall of the acetabulum. This study aims to assess the impact of the quality of osteoporotic QP fractures reduction on the patients' functional recovery, at 24 months follow-up. Methods: Patients referring wi...

Background and aim of the work: Women graduated and engaged in the scientific world are in increasing numbers. The present study aimed to analyze the gender difference in nursing scientific publication and to understand the trend in nursing science is the same or different to that reported in other scientific disciplines. Methods: We considered...

Background and aim of the work: Since December 2019, a new infectious disease known as Coronavirus disease (Covid-19) has rapidly spread globally until it has been declared a pandemic by the World Health Organization. At the same time, if we consider the University context, there is little attention paid during basic nursing education to emergency...

Irisin is a myokine produced by skeletal muscle during exercise in both mice and humans. We previously showed that irisin treatment ameliorates immobility-induced osteoporosis and muscular atrophy in mice. Data in humans showed a positive association between irisin and bone mineral density (BMD) in athletes and a population of healthy children. How...

Infection rates of arthroscopic procedures have been consistently reported at approximately 1% and are even less common in shoulder arthroscopy (0.3%). We are unaware of any prior reports of infection associated with an arthroscopic-assisted latissimus dorsi transfer and report on a 60-year-old male who experienced this event. At the 2-month follow...

Background: Studies on the relationship between sport and smoking among adolescents and young adults reported contradictory results: some findings indicate that sport is a protective factor against smoking initiation, while other studies documented the inclination to unhealthy habits among athletes. The aim of this study was to evaluate smoking pr...

Background: CrossFit is a strength and conditioning training program, that begin very popular in the last ten years. One of the most concerned characteristics of model is the high intensity activity performed under fatigue conditions that was proposed as potential risk of injuries; current literature on this topic was not conclusive. The purpose o...

Introduction: Though TRX suspension training and CrossFit are similar methods of functional training, until now the differences in the effects on body composition and motor skills are not known. Methods: A sample of CrossFitters and TRXers was enrolled and evaluated at the beginning of the study and after 6 months. body mass index (BMI), waist-to-h...

Introduction: There are four principles positions in soccer: goalkeepers, defenders, midfielders and forwards. Midfielders run longer distances than the others; defenders dribble shorter distances, whilst forwards perform significantly more sprints. These different performance requirements could be better achieved when supported by optimal physical...

Chronic rhinosinusitis associated with nasal polyposis (RSCwNP) affects 4% of the general population. As chronic condition, it requires chronic pharmacological treatment, whereas the surgical approach becomes necessary in obstructive and/or complicated cases. Intranasal and systemic corticosteroids (CS) represent the “Gold Standard” treatment for R...

The aim of this study is to evaluate the predictive efficacy of the radiographic parameters and the relationship between the radiographic results and the clinical data. We carried out a retrospective study analyzing the data of 225 pediatric patients with forearm fractures treated conservatively. Two orthopaedists examined 4 different radiographic...

Introduction: The aims of study were: 1) to verify the effectiveness of different stretching methods and training; 2) to compare the effects with only training on the flexibility of joints in basketball players. Methods: 30 males basketball players (age: 17±1yrs; BMI: 23.4±3.1), divided into 2 groups (15 experimental group - EG - and 15 control...

The physiotherapy treatment of low back pain (LBP) with physical stimulation offers different possibilities of application. Until now, the physical therapies used in LBP are laser therapy, ultrasonotherapy and currents. We conducted a clinical trial in order to verify whether shockwave therapy, which is very effective in treating tendinopathies and...

Intravascular papillary endothelial hyperplasia is a rare benign vascular lesion of the skin and subcutaneous tissues, characterized by a reactive proliferation of endothelial cells that can present de novo in normal blood vessels (primary intravascular papillary endothelial hyperplasia), but it can also develop from a pre-existing vascular process...

The aim of this study is to investigate the effects of extracorporeal shock wave therapy (ESWT) on muscle rheological and functional properties in a population of young athletes. Thirty-two football and basketball players were recruited and randomized into two groups. The athletes underwent three sessions of therapy administered every five days to...

Purpose Considering that musculo-skeletal system and nervous system reciprocally are connected by the presence of proprioceptors and interoceptors, the aim of this study was to investigate the relationship between emotional stability and posture. Methods We recruited 100 healthy volunteers (age 30.2 ± 9.8 years) who regularly practiced physical ac...

Purpose: It is well known that total knee replacement surgery decreases pain and improves function, but the effect on postural assessment needs to be studied better with the use of new technological devices. Total knee arthroplasty (TKA) improves motor coordination and stability of the knee. On the other hand, changing joint functionality can modi...

Irisin, a novel myokine produced in response to physical exercise by skeletal muscle, displays anabolic effect on bone and can improve the bone-loss-induced osteoporosis in hind limb suspended mice. It is well known that muscles positively impact the skeleton and in different sports, including soccer, total body bone mineral density (TB-BMD) is ele...

Chronic ulcers of the lower limbs represent a significant social and economic burden. Diabetes is a strong risk factor for development of chronic lesions. Adult stem cells and growth factors derived from the adipose tissue are among the most promising therapeutic strategies for hard to heal wounds. Fat grafts have been used for several decades to t...

Background: This survey aimed to investigate the perception of Italian Paediatricians regarding the promotion of physical activity. Methods: From January to May 2015, a survey was conducted among family paediatricians working in Puglia, interviewed by a standardised questionnaire, that investigated demographic information, participation in sport...

Objectives Tenosynovial chondromatosis is an uncommon type of chondro-dysplasia of synovial and connective tissue. We report a case of a patient with a primary right wrist extra-articular chondromatosis extending to the flexor and the extensor compartments. Methods Until now, there has been no study describing double surgical access for such a cas...

Dupuytren’s disease is a debilitating disease of the hand characterized by nodules on the surface of the palm with progressive loss of finger extension. The chosen forms of treatment are infiltrative and surgical. Conservative treatment could be useful but few studies have been carried out and these regarded mainly stretching exercises and thermo-t...

We previously showed that Irisin, a myokine released from skeletal muscle after physical exercise, plays a central role in the control of bone mass. Here we report that treatment with recombinant Irisin prevented bone loss in hind-limb suspended mice when administered during suspension (preventive protocol) and induced recovery of bone mass when mi...

Background: Shock wave treatment is used for several orthopedic diseases and there are different devices available. Until now, there have been no experimental studies on the effects of these different generators. Methods: We carried out an experimental study to compare the effects of three focused generators (electro-magnetic, piezoelectric and...

Osteoporosis and hypertension are two widespread diseases, which share many of the same risk factors such as advanced age, early menopause, smoking, and physical inactivity. The aim of this study is to examine the association between fragility fractures, anti-hypertensive drugs (subgroup C02, according to the Anatomical Therapeutic Chemical classif...

To compare the effectiveness of Doctor Tecar Therapy™ with that of laser therapy in the management of low back pain (LBP), a total of 60 patients with LBP were enrolled. The participants were randomly divided into two groups: a Tecar group (experimental group, 30 subjects), and a laser group (control group, 30 subjects). AH the subjects received 10...

Sclerostin, negative regulator of bone formation, has been originally known as an osteocyte product. Recently, it has been also detected in hypertrophic chondrocytes, distinctive cells of avascular cartilage which is invaded by capillaries and then replaced by vascularized bone. Thus, we hypothesized that sclerostin, in addition to its role already...

Two nuclear genes, ACTN3, encoding for the α-actinin skeletal muscle isoform 3, and ACE encoding the angiotensin-converting enzyme, have both been associated with quantitative physical performance traits in the general population. The purpose of our study was to assess the association between the two nuclear gene variants, R577X (rs1815739) in ACTN...

Cardiopathies and osteoporosis are inter-related due to pathogenetic, hormonal, genetic features as well as an increased risk of fragility. An important feature is attributed to the process of atherosclerosis, which is responsible for an osteopenia effect and degeneration of vascular walls. To date the study populations have been limited. To verify...

IntroductionRotator cuff tears commonly necessitate surgical repair; however, the optimal technique for repair continues to be investigated. Recently, double-row repairs have been considered an alternative to single-row repair, allowing a greater coverage area for healing and a possibly stronger repair. AimWe performed a study to compare single-row...

Background: The risk of infectious mononucleosis among athletes is quite debated. Some personal observations seem to suggest an increase risk of mononucleosis among athletes, because they attend always close settings with an high probability of respiratory pathogens transmission; overtraining has been also proposed as risk factor. Study design:...

In the literature there is no clear evidence of a relationship between thyropathies and fragility fractures. The aim of our study is to define the prevalence of thyroid disease in a study sample made up of subjects with fragility fractures and from the same geographical area. We retrospectively studied the “hospital discharge records” (HDR) in the...

Extracorporeal shock wave therapy (ESWT) is widely used for calcific tendonitis of the shoulder. The initial rationale for this therapy was to break the calcification, but this effect does not always occur. To date, we do not know how calcifications evolve or why they may be less responsive to the action of the shock waves. One hundred and seventy-...

High energy laser therapy (HELT) could be a new alternative treatment for lower back pain (LBP), which is a significant public health problem. Nevertheless, differences between the various light waves of HELT have not yet been fully researched. Sixty-six patients with lower back pain were treated using a high energy laser therapy. They were randomi...

The effects of treatment with shock waves (SW) on osteoblastic cells have already been described. Furthermore, the effects of treatment with SW are also determined by the contextual stimulation of other cell lines, in particular of mesenchymal cells. This is the first experimental study of stimulation of a human mesenchymal stem cell line, taken fr...

Study Design Single-blind randomized trial. Background Extracorporeal shockwave therapy (ESWT) has been shown to produce good results in the treatment of subacromial impingement syndrome (SAIS). The efficacy of a combined administration of ESWT and isokinetic exercise (IE) has not yet been studied. Objectives To evaluate the efficacy of focused E...

Extracorporeal Shock Wave Therapy (ESWT), after its first medical application in the urological field for lithotripsy, nowadays represents a valid therapeutical tool also for many musculoskeletal diseases, as well as for regenerative medicine applications. This is possible thanks to its mechanisms of action, which in the non-urological field are no...

Until now glucosamine sulfate (GS) has been the most widely used supplement and has been shown to be efficacious in the treatment of osteoarthritis (OA). Methylsulfonylmethane (MSM) and boswellic acids (BA) are new effective supplements for the management of inflammation and joint degeneration, according to previous experimental studies. The aim of...

Background: According to the literature, 95% of professional athletes return to their sport after anterior cruciate ligament (ACL) reconstruction surgery. The main objective of this study was to verify the return to sport after ACL reconstruction in a homogenous group of amateur sportsmen and sportswomen in a series of Italian patients. Materials...

Increased risk of osteoporosis and its clinical significance in patients with diabetes is controversial. This study aims to increase the data which are available regarding the prevalence of diabetes mellitus in patients affected by fragility fracture in Italy. We retrospectively studied Hospital Discharge Data (HDD) in the Apulian database for the...

Irreducible posterolateral dislocations of the knee are rare lesions, generally caused by high-energy trauma inducing rotational stress and a posterior and lateral displacement of the tibia. In these conditions, the interposition of abundant soft tissue inside the enlarged medial joint space prevents spontaneous reduction or non-surgical treatment...

Background: in soccer, balance ability is important to reduce non-contact injuries. The effect of footwear on balance is poorly understood in this sport. Soccer boots and futsal trainers need to guarantee a good grip on compliant surfaces. Running shoes are designed to reduce friction on rigid su rfaces. The purpose of the present study was to inv...

Even though the initial treatment of carpal tunnel syndrome (CTS) is conservative, knowledge of the clinical effects of supplements and of some methods of physiotherapy is still preliminary. Many biological mechanisms can support the administration of shock wave therapy (ESWT) or of alpha lipoic acid (ALA) based nutraceutical, conjugated linoleic a...

Background The protein Runt-relatede Transcription Factor 2 (Runx2) promotes the expression of most genes of the bone matrix proteins at the early stage of osteoblast differentiation, leading the cells to acquire an osteoblastic phenotype. Runx2 interacts with the Transforming Growth Factor β (TGF-β) and Bone Morphogenetic Proteins (BMPs) pathways....

Extracorporeal shock wave therapy is very widely used for the management of tendinopathies and plantar fasciitis. The aim of the study is to determine whether there are prognostic factors that may influence the outcome of extracorporeal shock wave therapy for these diseases. Three hundred fifty-five patients were analyzed 2 months after shock wave...

Zumba fitness requires aerobic repetition exercises, involving the whole body including the spine. Our study is aimed at verifying whether this sport may cause low back pain. Young healthy females were recruited. They were allocated to a "Zumba group" (n = 25) or an "inactivity control group" (n = 25). The Roland-Morris Disability, the Oswestry, th...

Arthroscopic technique for lateral release is the most widely used procedure for the correction of recurrent dislocations of the patella. In the relevant literature, several complications of lateral release are described, but the spontaneous patellar tendon rupture has never been suggested as a possible complication of this surgical procedure. Pate...

Open-book fractures of the pelvis are uncommon during childhood and require urgent treatment from the association with other abdominal, vascular or nervous injuries. The case discussed is an open-book fracture (type B1, Tile classification) associated with triradiate cartilage injury (type I, Salter-Harris classification) in an 11-year-old female....

Background: in basketball, balance ability is important to reduce non-contact injuries. The purpose of the present study was to investigate the effect of training on balance. Methods: thirty-two healthy male volunteers were recruited from amateur basketball teams. They were asked to perform the Balance Error Scoring System BESS test in order to...

Extracorporeal shock wave therapy (ESWT) is effective in the treatment of tendinopathy. We designed a prospective observational clinical study to assess the correlation between clinical and functional measures and recovery of strength after ESWT for epicondylitis. We analyzed 26 patients. We measured progressive improvement in visual analogue scale...

Background In literature there is a general consensus that the use of the mirror improves proprioception. During rehabilitation the mirror is an important instrument to improve stability. In some sports, such as dancing, mirrors are widely used during training. The purpose of this study is to evaluate the effectiveness of the use of a mirror on bal...

Background During osteoarthritis (OA), articular cartilage degradation is essentially due to the increase of the expression of pro-catabolic factors, such as nerve growth factor (NGF), interleukin-17 (IL-17) that activate the local synthesis of metalloproteases (mainly MMP-13) and aggrecanase (mainly ADAMTS-5) leading to the breakdown of type II co...

Due to a growing numbers of lateral fragility fractures of the femur and their high social costs the need to work out an effective strategy in order to find a better solution for these patients is warranted. From January 2010 to July 2011, we carried out a prospective randomized clinical study comparing the results of patients with femoral lateral...

The most common adverse effects associated with bisphosphonates are renal toxicity, acute-phase reactions, gastrointestinal toxicity, osteonecrosis of the jaw, transitory fever and uveitis. We report a unique adverse case of vasculitis induced by clodronate. A 61-year-old Caucasian woman developed bilateral renal ischemia after kyphoplasty and clod...

In the general population visual-spatial ability is better in males, due to the influence of biological and socio-cultural factors. We know that sport activity improves motor skills. The aim of this work is to determine if these gender differences exist in young athletes. The orientation test described by Terzi and standardized by Cesaroni, used to...

The application of laser therapy on soft tissue is used for pain relief, anti-inflammation action and biostimulation. The efficiency of High Energy Laser Therapy has not yet been studied on Achilles tendinopathy. The aim of the study is to evaluate the effectiveness of a flow of Cold air and High Energy Laser Therapy (CHELT) versus Extracorporeal S...

Chronic tendinopathies represent one of the most common causes of longterm pain and physical disability. Because of poor tendon vascularity and because of the istopathologic changes in the damaged area, tendon healing rate is relatively low compared with other connective tissues, inducing a poor clinical and functional outcome. For these reasons, b...

Background: Studies have shown the effectiveness of a few weekly pilates sessions as helping to reduce lower back pain (LBP). However many patients fear that physical activity can actually make the pain and disability worse. Design: We carried out this observational prospective clinical study to look at the effects that taking part in daily pila...

The development of metallosis as a complication following rupture of a hip replacement is known to occur as a result of contact with metal components of the prosthesis (1).In such cases, high cobalt (Co), chromium (Cr) and molybdenum (Mo) levels in the blood have been reported by several Authors (2).Recently, it has been stressed that the clinical...

The Orthopedic Multidimensional Prognostic Index (Ortho-MPI) was performed and validated in order to ameliorate the decision-making process as regards the elderly with hip or neck femur fractures. A retrospective study was performed. 95 patients 65 years old and over with a diagnosis of hip or femur fracture were enrolled. A standardized comprehens...

The incidence of Achilles tendinopathy is very high in young female gymnasts (17.5 %). According to literature, ecography screenings show the tendons thickening, but at the same time it does not reveal a direct link to the clinical picture. The neovessels are involved in the pathophysiological process of Achilles tendinopathy. For this reason, we w...

Research is on-going to identify new methods of biostimulation to increase the effect of botulinum toxin type A (BTX-A) in the treatment of spasticity. The Spasticity treated by Botulinum Toxin and ESWT (SBOTE) study is a prospective, randomized controlled trial assessing the effectiveness of extracorporeal shock wave therapy (ESWT) given immediate...

Introduction: Extracorporeal shockwave therapy (ESWT) produces good results in the treatment of insertional Achilles tendinopathy. The efficacy of combined administration of dietary supplements with ESWT has not yet been studied. Methods: In this prospective, randomized clinical trial, Shock Waves therapy and Arginine for Achilles Tendinopathy (...

Previous studies support the fact that extracorporeal shockwave (SW) induces angiogenesis and improves symptoms in patients affected by limb ischemia. The aim of this study was to evaluate the effects of SW therapy in patients with peripheral artery disease (PAD). Twenty-two patients were enrolled in this study and were randomly assigned into two g...

Background In overhead sports like volleyball, the onset of a rotator cuff tendinopathy due to functional overload is a common observation. An angiofibroblastic etiopathogenesis has been hypothesized, whereby a greater anaerobic metabolism occurs in critical zones of the tendon with a lower degree of vascularization; this would induce collagen and...

Radial shock waves therapy (RSWT) differs from extracorporeal shock waves therapy (ESWT) in that it produces a non-focused wave that is dissipated radially at the skin. Few studies have yet explored the effects of RSWT on bone tissue. Osteoblasts in culture flasks were studied by polymerase chain reaction after treatment with RSW (500 impulses, 0.0...

There is currently great interest in the use of Extracorporeal Shock Wave Therapy (ESWT) and in clarifying the mechanisms of action in tendon pathologies. The success rate ranges from 60% to 80% in epicondylitis, plantar fasciitis, cuff tendinitis, trocanteritis, Achilles tendinitis or jumper's knee. In contrast to urological treatments (lithotrips...

Background: Total knee arthroplasty (TKA) is often associated with a severe local inflammatory reaction which, unless controlled, leads to persistent pain up to one year after surgery. Standard and accelerated rehabilitation protocols are currently being implemented after TKA, but no consensus exists regarding the long-term effects. Biophysical st...

Hip and neck femur fracture surgery was associated with high post-operative mortality and poor functional results. The decision-making process with regards to the elderly with hip or neck femur fractures was of great importance, requiring consideration of ethical, medico legal and economic factors in addition to the purely medical ones. An importan...

Klippel-Trenaunay syndrome (KTS) is characterized by a cutaneous vascular nevus of the involved extremity, as well as bone and soft tissue hypertrophy of the extremity and venous malformations. We present the case of a 52-year-old man with a femoral fracture and a history of haemangiomas, limb bone hypertrophy and varicosity. The patient was finall...

Ceramic bearings in total hip arthroplasty (THA) have been introduced in clinical practice to minimize the problem of polyethylene particle-induced osteolysis. The aim of the study is to report the results of 68 consecutive alumina-on-alumina THAs done in 61 patients for avascular necrosis (AVN) of the femoral head. In all implants a press-fit cup...

In recent years, the application of fibrin sealant has been shown to be efficacious in the management of intraoperative and postoperative hemostasis. We designed a prospective randomized controlled clinical trial to assess the efficacy of two different dosages of fibrin sealant (5 and 10 ml) in patients undergoing total knee arthroplasty, as compar...