Italian consensus conference on guidelines for conservative treatment on lower limb muscle injuries in athlete.

Provide the state of the art concerning (1) biology and aetiology, (2) classification, (3) clinical assessment and (4) conservative treatment of lower limb muscle injuries (MI) in athletes. Seventy international experts with different medical backgrounds participated in the consensus conference. They discussed and approved a consensus composed of four sections which are presented in these documents. This paper represents a synthesis of the consensus conference, the following four sections are discussed: (i) The biology and aetiology of MIs. A definition of MI was formulated and some key points concerning physiology and pathogenesis of MIs were discussed. (ii) The MI classification. A classification of MIs was proposed. (iii) The MI clinical assessment, in which were discussed anamnesis, inspection and clinical examination and are provided the relative guidelines. (iv) The MI conservative treatment, in which are provided the guidelines for conservative treatment based on the severity of the lesion. Furthermore, instrumental therapy and pharmacological treatment were discussed. Knowledge of the aetiology and biology of MIs is an essential prerequisite in order to plan and conduct a rehabilitation plan. Another important aspect is the use of a rational MI classification on prognostic values. We propose a classification based on radiological investigations performed by ultrasonography and MRI strongly linked to prognostic factors. Furthermore, the consensus conference results will able to provide fundamental guidelines for diagnostic and rehabilitation practice, also considering instrumental therapy and pharmacological treatment of MI. Expert opinion, level IV

SLAP lesion in overhead athletes

http://www.ester.ee/record=b490536

Accurate diagnosis of low back pain

Background : There is few reports evaluated accurately the pain generator of low back pain in elite athletes. The purpose of this report was to show case series and to investigate the cause of unidentified low back pain of elite athletes. Methods : Twenty-three adult elite athletes consulted our sports spine clinic to seek a second opinion for low back pain between April 2013 and March 2016. Their cause of low back pain had not been identified by nearby doctor. Spine surgeons had diagnosed using diagnostic injection and STIR-MRI and the final diagnosis made by the spine surgeon were collected. Results : The mean age of 23 patients (16 male, 7 female) was 30.4 years. The most common sport played was baseball. The final diagnosis made by a spine surgeon was as follows : disc related low back pain (n = 12), facet joint arthritis (n = 5), vertebral endplate injury (n = 4), early-stage lumbar spondylolysis (n = 1), supraspinous ligament injury (n = 1). Conclusions : A thorough medical interview, careful physical examination, appropriate diagnostic imaging, and injection block examination can effectively identify the cause of low back pain

Thermal Capsulorrhaphy of the Shoulder: Literature Review and Clinical Outcome for One Collegiate Tennis Player

Glenohumeral joint instability is a clinical problem in both the athletic and general populations. When 3 months of conservative physical therapy treatments fail to stabilize the lax shoulder joint, surgery is indicated. Recently thermal capsulorrhaphy, an arthroscopic procedure that uses a heat probe to shrink redundant capsular tissue, has been offered as one alternative to tighten the lax glenohumeral joint capsule. There are numerous published reports describing the effects of thermal energy on joint capsular tissue, but only a few clinical outcome studies have been published regarding thermal capsulorrhaphy of the shoulder. Some initial reports of this surgical technique seem to be favorable for reducing shoulder instability in the overhead athlete and general population, but no long-term studies have been done to determine the efficacy of this surgical intervention. The purpose of this independent study was to review recent literature regarding thermal capsulorrhaphy, compare existing protocols, and to present an 18 month post operative clinical outcome of one collegiate tennis athlete who under went the thermal capsulorrhaphy procedure to his serving shoulder. The findings of this study indicate that no one protocol has been established for this patient popUlation. The clinical outcome for the subject in this study was less than favorable as he was not able to return to playing collegiate tennis. Several of the contributing factors to this poor clinical outcome were identified, which included: too short of immobilization period following thermal capsulorrhaphy, no physical therapy interventions for 6 weeks postoperatively, and the performance of resisted shoulder extension exercises at six weeks postoperatively. A physical therapist\u27s understanding of collagen maturation process is imperative in designing a rehabilitation program for patients who have undergone thermal capsulorrhaphy of the shoulder because the ultimate tensile strength of the shrunk capsule is unknown at this time. Early physical therapy intervention and careful monitoring of patient range of motion to prevent re-stretching of the glenohumeral capsule are also crucial to a successful clinical outcome. Only more long-term clinical outcomes will determine if this will become the gold standard for treating shoulder instability

The proprioception and neuromuscular stability of the basal thumb joint

OBJECTIVES The basal thumb joint, or the first carpometacarpal joint (CMC1) is an enigmatic construction. The concavo-convex shape of the CMC1 and wide range of movement, allows for both precision and power grips and is particularly susceptible to the development of osteoarthritis. Previous theories regarding the development of CMC1 osteoarthritis have focused on the role of gender, excessive joint load and ligament laxity as causative factors. An emerging theory is the role of proprioception and sensorimotor functions that act to maintain adequate joint equilibrium. This concept constitutes the basis of this thesis with the intent on examining both healthy and osteoarthritic joints. Using microscopic, biomechanical and neurophysiological methods, we address the hypothesis that CMC1 holds proprioceptive and neuromuscular properties that are integral for proper thumb function. METHODS Patients with CMC1 osteoarthritis that were treated surgically with complete trapeziectomy and suspension arthroplasty were included. Two CMC1 ligaments were collected from these subjects: the anterior oblique ligament (AOL) and the dorsal radial ligament (DRL). Following immunofluorescent triple staining techniques using markers p75, PGP9.5 and DAPI, the ligamentous innervation and mechanoreceptor populations were analyzed (study I-II). In study III, biomechanical assessment of the role of isometric muscle load on CMC1 was performed by a FASTRAK® motion tracking device. In study IV, two intrinsic (the first dorsal interosseous muscle; DI, abductor pollicis brevis; APB,) and two extrinsic muscles (extensor pollicis longus; EPL, abductor pollicis longus, APL) were examined in healthy subjects using electromyographic (EMG) analysis during functional thumb tasks. Post-stimulus reactions following stimulation of the DRL were analyzed for each muscle and each thumb position. RESULTS The CMC1 ligaments investigated displayed a varying degree of innervation. AOL presented with little innervation and was mainly composed of incoherent connective tissue and scarce collagen fibers, whereas DRL presented with abundant innervation and well-organized collagen (study I). Unclassifiable mechanoreceptors were the most frequent type of receptor found in AOL and DRL. No significant difference in the innervation between the proximal and distal portions of these osteoarthritic ligaments was identified (study II). The first dorsal interosseous muscle (FDI or DI) produced the highest level of distal migration and the least dorsoradial translation of the base of the first metacarpal. APL was identified as the main destabilizer as it increases dorsoradial misalignment (study III). Following stimulation of the DRL, significant (p<0.05) post-stimulus changes were found in all four muscles (DI, APB, APL, EPL) and positions tested. A mass inhibitory reaction was observed during tip pinch whilst key pinch produced rapid co-contractions. During palmar pinch a rapid inhibitory response was evoked in antagonistic muscles (study IV). CONCLUSIONS Ligaments from osteoarthritic patients displayed alterations in distribution and type of mechanoreceptors as compared to previous studies on normal joints. The results reinforce DRL’s proprioceptive and stabilizing role for the CMC1 joint. Isometric load of CMC1 indicates that DI promotes joint congruency by reducing dorsoradial translation, whereas APL acts in an opposing manner as a destabilizing force. Ligamento-muscular reflexes were observed following the stimulation of DRL. Thus, the dorsoradial ligament, in addition to being the primary static stabilizer of the joint, also possesses proprioceptive qualities. The post-stimulus reactions detected in DI, APB, APL and EPL are indicative of protective ligamento-muscular pathways, which facilitate neuromuscular functions and the maintenance of joint stability. CLINICAL RELEVANCE Patients with CMC1 osteoarthritis constitute a large group. Their symptoms are of varying severity, where some can be addressed within the scope of primary care units, whilst others are in need of operative treatment. Patients with CMC1 osteoarthritis often present with impaired neuromuscular functions, reduced range of motion, weakness, joint and ligamentous pathology as well as pain, which affect their daily activities. Understanding the proprioceptive and neuromuscular characteristics of the basal thumb joint is therefore essential in deciphering the complex pathophysiology of the basal thumb joint

Physical Therapy Following Shoulder Rotator Cuff Repair

ABSTRACT Introduction Rotator cuff (RC) tears are one of the common causes of pain and disability in the upper extremity. Currently there are no fixed guidelines for choosing testing positions for shoulder range of motion measurement. Optimal rehabilitation following RC repair is yet to be defined. Purpose and Method The purpose was to inform about postoperative Physical therapy following rotator cuff repair, with the following objectives: To systematically review the content of clinical research, which addresses various physical therapy programs. To describe validity and responsiveness of different testing positions for goniometric measurement of shoulder active external rotation. To pilot test study procedures and estimating effects of a land-based and an aquatic exercise program. Results Fourteen studies were included in the systematic review. ROM measurements in sitting and supine positions correlated moderately (r= 0.40 - 0.53). The sitting position showed greater sensitivity to change with estimates of standardized response mean (SRM) and effect size (ES) (SRM: 0.66, 1.05 and ES: 0.50, 1.02) as compared to the supine position (SRM: 0.39, 0.74 and ES: 0.37, 0.76) at 3 and 12 months postoperatively, respectively. A total of 12 patients with a 67% recruitment rate, participated. Clinic visit adherence was 95%. No one was lost to follow-up. Both land-based and land plus aquatic exercise groups showed improved flexion AROM over time (Mean change= 21°, Standard Deviation (SD)= 25° and Mean change= 22°, SD= 33° respectively). For future studies, for having 80% power (α= 0.05, β= 0.20), and to detect 20% between-group difference, a total of 33 patients per group would be needed. Conclusions The systematic review found that exercise therapy including adjunctive interventions has small to moderate effect. 29% of the patients could not undergo active shoulder external rotation testing in supine, all patients could be tested in sitting. The sitting position has higher responsiveness than the supine position. Both land-based and aquatic exercise programs are shown to be feasible. To achieve power, we recommend future studies with larger sample size. Keywords Physical therapy, rotator cuff tear, land-based exercises, aquatic exercises, systematic review, pilot study

Vertebral augmentation with nitinol endoprosthesis: clinical experience with one year follow up in 40 patients

Aim: To assess safety, effectiveness and vertebral height restoration of prosthesis-assisted vertebroplasty during 1-year follow-up. Methods: 40 patients (36 females, mean age 73.6 years) were treated with percutaneous vertebral augmentation (PVA) performed by placement of nitinol implants. Fracture edema at MRI was required. All PVA were performed in local anesthesia with fluoroscopic-CT guidance. Implants were inserted through a bipedicular access. CT scan was performed to measure vertebral height (6 point) at baseline after the expanded implant was cemented and at 1-year follow up (f/u). Visual Analogue Scale (VAS) and Oswestry disability Index (ODI) were calculated before, after procedure. and at 1-year f/u (Mean:15 months). Results: No major complications occurred. 2 patients were lost at f/u. VAS and ODI were improved in 39 patients (97.5&#37;) (p&lt;0.0001 Wilcoxon test). Higher restoration values were in center measurement both in mid-coronal (3.9 mm, 3.0 SD) and in mid-sagittal reconstruction (4.7 mm, 3.6 SD). No significant height loss occurred over time. During follow-up no device change or migration was observed. 4 patients (10&#37;) had a spontaneous new vertebral fracture. Conclusions: Vertebral augmentation performed with nitinol endoprosthesis is a safe and effective procedure. PVA provides a long-lasting pain relief and vertebral height gain

Review of fiber-optic pressure sensors for biomedical and biomechanical applications

As optical fibers revolutionize the way data is carried in telecommunications, the same is happening in the world of sensing. Fiber-optic sensors (FOS) rely on the principle of changing the properties of light that propagate in the fiber due to the effect of a specific physical or chemical parameter. We demonstrate the potentialities of this sensing concept to assess pressure in biomedical and biomechanical applications. FOSs are introduced after an overview of conventional sensors that are being used in the field. Pointing out their limitations, particularly as minimally invasive sensors, is also the starting point to argue FOSs are an alternative or a substitution technology. Even so, this technology will be more or less effective depending on the efforts to present more affordable turnkey solutions and peer-reviewed papers reporting in vivo experiments and clinical trials.info:eu-repo/semantics/publishedVersio