[Show abstract][Hide abstract] 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.
Full-text · Article · Feb 2015 · European journal of physical and rehabilitation medicine
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] ABSTRACT: Currently the application of shock wave therapy (SWT) in musculoskeletal disorders has been primarily used in the treatment of tendinopathies (proximal plantar fasciopathy, lateral elbow tendinopathy, calcific tendinopathy of the shoulder, and patellar tendinopathy, etc.) and bone defects (delayed-and non-union of bone fractures, avascular necrosis of femoral head, etc.). Although the mechanism of their therapeutic effects are still unknown, the majority of published papers have shown positive and beneficial effects of using SWT as a treatment for musculoskeletal disorders, with a success rate ranging from 65% to 91%, while the complications are low or negligible. The purpose of this paper is to inform the reader about the published data on the clinical application of SWT in the treatment of musculoskeletal disorders. In this paper, with the help of a literature review, indications and success rates for SWT in the treatment of musculoskeletal disorders are outlined, while adequate SWT parameters (e.g., rate of impulses, energy flux density, etc.) are defined according to the present state of knowledge.
Full-text · Article · Mar 2014 · European journal of physical and rehabilitation medicine
[Show abstract][Hide abstract] ABSTRACT: Whiplash injuries continue to have significant societal cost; however, the mechanism and location of whiplash injury is still under investigation. Predicting neck response and injury resulting from motor vehicle accidents is essential to improving occupant protection. Recently, the upper cervical spine ligaments, particularly the alar ligament, have been identified as a potential whiplash injury location .
[Show abstract][Hide abstract] ABSTRACT: The term ‘whiplash’ has been used to describe a mechanism of injury and the various clinical manifestations as a consequence of the injury. Moreover, signs and symptoms have been designated the ‘whiplash syndrome’. In 1995, the Quebec Task Force (QTF) on Whiplash-Associated Disorders (WAD) adopted the following definition of whiplash: ‘whiplash is an acceleration-deceleration mechanism of energy transfer to the neck. It may result from rear-end or side-impact motor vehicle collisions, but can also occur during diving or other mishaps. The impact may result in bony or soft-tissue injuries (whiplash-injury), which in turn may lead to a variety of clinical manifestations called Whiplash Associated Disorders’.
[Show abstract][Hide abstract] ABSTRACT: Whiplash usually stands for a syndrome characterized by a soft tissue lesion of the neck (muscles, ligaments, capsules, intervertebral disk, spinal marrow, nerve roots, veins and arteries, sympathetic system).
[Show abstract][Hide abstract] ABSTRACT: Until recently, there was no consensus on the definition of whiplash. According to the Quebec Task Force (QTF) on whiplash-associated disorders (WAD), “whiplash is an acceleration-deceleration mechanism of energy transfer to the neck. It may result from rear-end or side-impact motor vehicle collisions, but can also occur during diving or other mishaps. The impact may result in bony or soft-tissue injuries (whiplash-injury), which in turn may lead to a variety of clinical manifestations called Whiplash-Associated Disorders.” Patients with whiplash can be classified by the severity of signs and symptoms: Grade 0 means no complaints or physical signs; Grade 1 indicates neck complaints (such as pain, tenderness, and stiffness) but no physical signs; Grade 2 indicates neck complaints and musculoskeletal signs (such as a decreased range of motion or muscle weakness); and Grade 3 and Grade 4 indicate neck complaints and, respectively, neurological signs (such as sensory deficit) or fracture or dislocation.
[Show abstract][Hide abstract] ABSTRACT: The anterior faces of the cervical column is composed by a median portion made of the overlapping of the vertebral bodies which include the intervertebral disks on top of the bodies. This median portion is at first narrowed on the top (15 mm) and is progressively broadened toward the bottom, reaching 25–30 mm at the last cervical metamer.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To evaluate the effect of the Shock wave therapy (SWT) on functional improvements and reduction of pain, and what is rate of disappearance of calcifications after therapy at 6 month follow up. DATA SOURCES: Articles were searched from the COCHRANE LIBRARY, MEDLINE, EMBASE, CINAHL and OVID DATABASE. STUDY SELECTION: We included randomized controlled trials from 1992 to 2011 and their quality was assessed using the PEDro scale. DATA EXTRACTION: Studies were evaluated by two independent reviewers for their methodological quality. If disagreement arose the plan was that it would be settled by a third reviewer. Then data were extracted and cross-checked for accuracy. The reviewers were not blinded to the authors of the articles. DATA SYNTHESIS: In studies of Hearnden, Hsu, Cacchio and Cosentino the resorption of calcifications was evaluate using meta-analysis because in them there were two groups of treatment, while the studies of Peters and Gerdesmeyer were analyzed descriptively because they considered three groups of treatment. Fixed and random effects models were used to meta-analyze total and partial resorption ratios and to assess heterogeneity the I2 statistics were calculated. CONCLUSIONS: We found a clinical improvement with a pooled Total Resorption Ratio of 27.19 (95% CI: 7.20-102.67) and a pooled Partial Resorption Ratio of 16.22 (95% CI: 3.33-79.01). SWT increases shoulder function, reduces pain, and it is effective in dissolving calcifications. These results were maintained over the following 6 months.
No preview · Article · Mar 2013 · Archives of physical medicine and rehabilitation
[Show abstract][Hide abstract] ABSTRACT: Electro-medical equipment is widely used in order to treat bony and muscular disorders and some neurological disease in rehabilitation. However, the scientific evidence regarding the safety and efficacy of this equipment is meagre and contradictory. We have studied the subject, taking into account current
regulations for the management and use of this electro-medical equipment. Following the criteria for Evidence Based Medicine, we have analysed the international literature so as to evaluate the evidence for physical energy in different clinical applications. Because the vast quantity of publications dealing with this material, priority was given to peer-reviewed articles and randomised trials. The publications were divided into categories according to disorder, so as to illustrate how some may provide positive proof whereas others require further study.
Full-text · Article · Dec 2012 · Giornale italiano di medicina del lavoro
[Show abstract][Hide abstract] ABSTRACT: Background
Extracorporeal shock-wave therapy (ESWT) represents a valid intervention in the treatment of people with supraspinatus calcifying tendinitis (SCT), but there is limited evidence for the useful range of ESWT doses.Objective
The aim of this study was to compare 2 different ranges of energy flux density in treatment of SCT with ESWT.DesignThis study was designed as a single-blind randomized clinical trial.SettingThis study was performed in a university hospital.PatientsForty-six patients with SCT were randomly assigned to 2 groups that received different therapeutic energy doses of ESWT: (1) group A received ESWT at an energy level of 0.20 mJ/mm(2), and (2) group B received ESWT at an energy level of 0.10 mJ/mm(2).InterventionThe treatment protocol consisted of 4 sessions performed once a week.MeasurementsThe change in mean Constant Murley Scale (CMS) scores at 3 and 6 months was the primary endpoint. The change in the mean visual analog scale (VAS) scores from baseline to 3 and 6 months after the intervention and radiographic change in size of calcium deposits were evaluated as secondary endpoints. At 12 months, pain relief was assessed using a numeric rating scale. RESULTS: /b>Significant clinical improvement based on mean CMS scores was observed after 6 months in group A (X=79.43, SD=10.33) compared with group B (X=57.91, SD=6.53). Likewise, after 6 months, a significant decrease in VAS scores was found in group A (X=2.09, SD=1.54)] compared with group B (X=5.36, SD=0.78). Calcific deposits disappeared in the same percentage of patients in both groups.LimitationsThe small sample size and lack of a control group were limitations of the study. CONCLUSIONS:/b>In ESWT for SCT, an energy level of 0.20 mJ/mm(2) appears to be more effective than an energy level of 0.10 mJ/mm(2) in pain relief and functional improvement.
No preview · Article · Jun 2012 · Physical Therapy
[Show abstract][Hide abstract] ABSTRACT: The mechanism of action of non-steroidal anti-inflammatory drugs (NSAIDs), to which ketoprofen belongs, is based on their cyclo-oxigenase (COX) inhibiting action, concerning both subtype COX-1 constitutive isoform and COX-2 inducible isoform. Ketoprofen administration may be carried out by oral and parenteral routes as well as by topical application, which includes transdermic patch use. Following a synthetic description of the results obtained by several investigators on ketoprofen use, the Authors present a new formulation of the ketoprofen patch obtained by the so called DermaLight Technology.
According to such a technique, the active principle is dissolved in oil components and dispersed inside an anhydrous polymeric matrix made up of styrene-isoprene-styrene (SIS), which is an elastic and flexible material that provides a gentle adhesion to the skin, maintains an elevated ketoprofen concentration and induces a strong thrust that favours the crossing of the skin by the drug; in addition, the patch is fit to be applied to the various areas of the body, including the joints.
Patch adhesiveness reduces skin irritation due to multiple applications and to long-term use, as the DermaLight Technology minimises keratinocytes exfoliation. In pharmacokinetic studies carried out on pigs ketoprofen has been demonstrated to reach deep tissues, where the drug was detected in much higher concentrations, with respect to plasma levels, 12 hours following its application. Experimental studies carried out on rats have shown that ketoprofen patch significantly reduces the edema induced by chronic inflammation. The ulcerogenic effect of ketoprofen patch is then compared with that shown by oral administration of the drug. UD50 values of ketoprofen patch were 49.9 mg/kg and 48.9 mg/kg for the stomach and the small intestine, respectively, whereas UD50 values of oral ketoprofen were 3.6 mg/kg and 3.7 mg/kg, respectively.
The Authors conclude by stating that ketoprofen patch is both a good alternative and a safe modality of administration, with special reference to patients who are prone to gastrointestinal disorders.
Full-text · Article · Jul 2011 · European review for medical and pharmacological sciences
[Show abstract][Hide abstract] ABSTRACT: Initial treatment of trapeziometacarpal osteoarthritis (TMO) often consists of intra-articular injection of corticosteroids or hyaluronic acid. Several studies have shown that ultrasound (US)-guided injections demonstrate greater precision and effectiveness when compared to blind techniques. The aim of our study was to describe a simple and reliable procedure of US-guided intra-articular injection of hyaluronic acid solution in patients with TMO. Thirty-one patients with TMO received one administration per week, for 3 weeks, of US-guided intra-articular injection with 1 ml of hyaluronic acid solution. Patients were evaluated before treatment and at 1, 3, and 6 months after the first injection with visual analog scale (VAS) score and Duruöz Hand Index (DHI). One month after the end of treatment, subjective patient response to therapy was evaluated using a 6-point Likert scale. A statistically significant VAS score reduction was observed at 1 and 3 months after the end of treatment (P<0.01) but not at 6-month follow-up (P=0.6). No statistically significant difference was found on the DHI total score at 1- (P=0.08), 3- (P=0.1) and 6-month (P=0.9) follow-ups. One month after the end of treatment, 29 (93.5%) patients reported a Likert scale score of "1" or "2." The described US-guided technique of trapeziometacarpal joint injection is easy to perform and revealed excellent accuracy. Nevertheless, intra-articular injections of hyaluronic acid provided significant pain relief only for a 6-month follow-up period and did not improve hand function. No pain relief was detected at 6-month follow-up, suggesting that periodic injections should be required to gain long-term effectiveness.
No preview · Article · Mar 2011 · Clinical Rheumatology
[Show abstract][Hide abstract] ABSTRACT: To determine the effect on pain, function, and ultrasonographic findings of ultrasonography-guided Baker's cyst aspiration followed by corticosteroid injection in a group of patients with Baker's cyst secondary to knee osteoarthritis.
Prospective observational study.
Twenty-six subjects participated in this study. Clinical and instrumental evaluations were performed at baseline (T0), 1 wk (T1), and 4 wks (T2) after procedure. Mean Visual Analog Scale scores significantly dropped after the procedure (T0 = 6.2 [1.2]; T1 = 4.48 [1.5]; T2 = 4.32 [1.3]; T0 vs. T1 and P < 0.0001). A significant difference between preprocedure and postprocedure Western Ontario and McMaster Universities scores was found for pain (P < 0.0001) but not for joint stiffness (P = 0.7239) and disability (P = 0.6318). Ultrasonographic evaluation showed a significant reduction for both axial (P = 0.006) and sagittal (P = 0.01) areas of Baker's cyst, but no correlation was found between pain relief and Baker's cyst volume reduction.
Cyst aspiration with corticosteroid injection give pain relief and cyst volume reduction in patients with Baker's cyst and concomitant knee osteoarthritis. However, when compared with current literature, our results are similar to those obtained with intra-articular knee corticosteroid injection.
Full-text · Article · Dec 2010 · American journal of physical medicine & rehabilitation / Association of Academic Physiatrists
[Show abstract][Hide abstract] ABSTRACT: Management of footdrop in severe Charcot-Marie-Tooth (CMT) patients is a challenge owing to the combination of quadriceps muscle weakness, distal muscular atrophy, sensory impairment and poor soft tissue resistance to the placement of an orthotic device. We present a case study of a patient who gradually became unable to use his ankle-foot orthoses because they hampered the compensative movements required to stabilize his knees passively and caused pain. The aim of this report is to describe orthotic management in such a severe CMT case and to present a new orthotic device that we devised for the footdrop in this patient. We provided him with 3 different footdrop devices, each of which was highly elastic to allow knee hyperextension, and left him free to decide which one to use: 1) the silicone-ankle-foot orthoses were rapidly discarded because of pain; 2) the Codivilla support was not used because of discomfort and poor aesthetic appearance; 3) a new device, called the "Soft Footdrop Insert" (SFI), consisting of a sheet of Veolform, a reticulated polyolephinic foam, stuck to the counter of midcalf boots, was found to be effective, comfortable, pain-free and aesthetically acceptable, and was consequently used the vast majority of the time. At a 3-year follow-up, an instrumental gait analysis, in which ordinary shoes were compared with the Codivilla support and the SFI, revealed that both the Codivilla support and the SFI controlled footdrop more effectively than ordinary shoes and increased swing and mean velocity; in addition, the SFI yielded the best gait performances. We think that a soft, invisible device, such as the SFI, may satisfy the needs of CMT patients and improve compliance with orthoses-wearing for footdrop.
No preview · Article · Sep 2010 · European journal of physical and rehabilitation medicine
[Show abstract][Hide abstract] ABSTRACT: Cardiovascular diseases manifest similar age and sex distribution in the general population and have some commons risk factors with some neuropathies. The aim of this study is to verify whether standard nerve conduction studies show significant differences in a group of poststroke hemiplegic patients, when compared with a control group, in the hypothesis that stroke, as a primary cardiovascular event, could be strongly associated with peripheral nervous system disease. Nerve conduction studies were performed in 15 hemiplegic patients and 10 aged matched control subjects. Percentage of patients showing slowed ulnar and common peroneal motor nerve conduction and lower ulnar sensory nerve action potential was significantly higher in hemiplegic patients. These findings suggest that an overall increased risk of neuropathies could be detected among stroke patients.
Full-text · Article · Feb 2010 · Journal of clinical neurophysiology: official publication of the American Electroencephalographic Society
[Show abstract][Hide abstract] ABSTRACT: The authors of several studies have recommended extracorporeal shock-wave therapy as an alternative to surgical treatment for long-bone nonunions. This study was performed to compare the results of extracorporeal shock-wave therapy produced by two different devices with those of surgical treatment in the management of long-bone nonunions.
One hundred and twenty-six patients with a long-bone nonunion were randomly assigned to receive either extracorporeal shock-wave therapy (Groups 1 and 2) or surgical treatment (Group 3). The patients in the shock-wave groups received four treatments with 4000 impulses of shock waves with an energy flux density of 0.40 mJ/mm(2) (Group 1) or 0.70 mJ/mm(2) (Group 2). The patients in the three groups had similar demographic characteristics, durations of nonunion, and durations of follow-up. Radiographic results (the primary outcome) and clinical results (the secondary outcomes) were determined before and three, six, twelve, and twenty-four months after treatment.
The radiographic findings did not differ among the three groups of patients. At six months, 70% of the nonunions in Group 1, 71% of the nonunions in Group 2, and 73% of the nonunions in Group 3 had healed. Three and six months after treatment, the clinical outcomes in the two shock-wave groups were significantly better than those in the surgical group (p < 0.001). However, at both twelve and twenty-four months after treatment, there were no differences among the three groups, with the exception of the DASH score, which differed significantly between Groups 1 and 3 (p = 0.038) and between Groups 2 and 3 (p = 0.021) at twelve months.
Extracorporeal shock-wave therapy is as effective as surgery in stimulating union of long-bone hypertrophic nonunions and yields better short-term clinical outcomes.
Full-text · Article · Nov 2009 · The Journal of Bone and Joint Surgery
[Show abstract][Hide abstract] ABSTRACT: To describe the temporal, kinetic, kinematic, electromyographic and energetic aspects of gait in Charcot-Marie-Tooth patients with foot drop and plantar flexion failure.
A sample of 21 patients fulfilling clinical, electrodiagnostic and genetic criteria for Charcot-Marie-Tooth disease were evaluated by computerized gait analysis system and compared to a group of matched healthy subjects. Patients were classified as having isolate foot drop (group 1) and association of foot drop and plantar flexion failure (group 2).
While it was impossible to detect a reliable gait pattern when the group of patients was considered as a whole and compared to healthy subjects, we observed two distinctive gait patterns when patients were subdivided as group 1 or 2. Group 1 showed a gait pattern with some characteristics of the "steppage pattern". The complex motor strategy adopted by this group leads to reduce the swing velocity and to preserve the step length in spite of a high energy consumption. Group 2 displayed a "clumsy pattern" characterized by very slow gait with reduced step length, a broader support area and great reduction in the cadence. This group of patients is characterized by a low energy consumption and greater energy recovery, due above all to the primary deficit and the various compensatory mechanisms.
Such between-group differences in gait pattern can be related to both primary motor deficits and secondary compensatory mechanisms. Foot drop and plantar flexion failure affect the overall gait strategy in Charcot-Marie-Tooth patients.
Full-text · Article · Nov 2007 · Clinical Biomechanics