Comparison Between Extracorporeal Shock Wave Therapy and Intra-articular Hyaluronic Acid Injections in the Treatment of First Carpometacarpal Joint Osteoarthritis

ObjectiveTo compare extracorporeal shockwave therapy (ESWT) with hyaluronic acid (HA) intra-articular injections in terms of pain relief, improvement in hand function, and strength in subjects with first carpometacarpal (CMC) joint osteoarthritis.MethodsFifty-eight patients received either focused ESWT or HA injection once a week for 3 consecutive weeks. In the ESWT group, 2,400 consecutive pulses were performed during each treatment session using a frequency of 4 Hz and an energy flux density of 0.09 mJ/mm2. The HA group underwent one cycle of three injections of 0.5 cm3 HA. The main outcome measures were pain and hand function as measured by the visual analogue scale (VAS) and Duruoz Hand Index (DHI), respectively. The secondary outcomes were grip and pinch strength. Each assessment was performed at baseline, at the end of treatment, and at 3- and 6-month follow-up visits.ResultsAccording to VAS and DHI scores, a significant change in test performance was observed over time in both groups (p<0.001), with a greater average improvement in painful symptomatology at the 6-month follow-up in the ESWT group. A significant improvement in strength was observed in both groups, but the ESWT group showed better results on the pinch test starting immediately at the end of treatment.ConclusionThe use of ESWT in patients with first CMC joint osteoarthritis leads to a reduction in pain, an improvement in pinch test performance that persists for at least 6 months, and a decrease in hand disability up to the 6-month follow-up visit

Reliability of transcranial magnetic stimulation-related measurements of tibialis anterior muscle in healthy subjects

Objective: The main purpose of this study was to determine the reliability of transcranial magnetic stimulation (TMS)-related measurements linked to the corticospinal control of the tibialis anterior (TA) muscle in healthy subjects. Methods: Inter-investigator and intra-investigator (within-session with a 1.5-h interval; between-session with a 4-week interval) reliability of the motor threshold, recruitment curve with its slope and MEP area at the plateau, MEP latency, maximum MEP (MEPmax) area, and duration of the maximum and minimum silent period (SPmax and SPmin) were assessed in 50 (29 men and 21 women) healthy subjects (mean age 44.8 years, range 22-74 years) using intraclass correlation coefficients (ICC), standard error of measurement (SEM) and smallest real difference (SRD). Results: The high ICC values and lower SEM and SRD values indicate a good intra- and inter-investigator reliability for motor threshold (ICC range 0.94-0.98), MEP latency (ICC range 0.79-0.93), SPmax (ICC range 0.89-0.95) and SPmin (ICC range 0.79-0.81) in healthy subjects. Conclusions: These results suggest that the TMS-related measurements investigated are reliable in healthy subjects. Significance: These data could be useful in further studies on cortical excitability changes, such as those induced by therapeutic interventions (e.g. rehabilitative treatment). © 2008 International Federation of Clinical Neurophysiology

Long-term efficacy of a short period of taping followed by an exercise program in a cohort of patients with patellofemoral pain syndrome

Patellofemoral pain syndrome (PFPS) is a common source of anterior knee pain. While treatment for PFPS may be successful in the short term, long-term results are less promising. The purpose of this study was to record long-term pain and functionality outcomes following rehabilitation in patients affected by PFPS. A prospective cohort study of 44 patients with a diagnosis of PFPS and an activation imbalance between the vastus medialis obliquus (VMO) and vastus lateralis (VL) muscles were enrolled. Patients underwent patellar taping (2 weeks) followed by a rehabilitation program lasting until the end of the third month. Primary outcome measures were pain and the functional level of the patellofemoral joint. Secondary outcome measures were surface electromyographic (sEMG) onset timing of the VMO/VL during seated knee extension and squat and isometric knee extensor muscle strength. Significant differences in all the outcome measures were observed between the affected and unaffected sides before treatment. The pain score significantly decreased both posttreatment (Delta=-4.7; 95% CI=-5.4 to -3.9) and at the 12-month follow-up (Delta=-5.5; 95% CI=-6.1 to -4.8), while the functional level significantly increased both posttreatment (Delta=24; 95% CI=18.3 to 30.2) and at the 12-month follow-up (Delta=26; 95% CI=21.4 to 30.6). Post-treatment, 35/44 patients (79.5%) and 31/44 patients (70.5%) achieved normal sEMG onset timing of the VMO and VL in the seated knee extension exercise and in the squat exercise, respectively. A short period of patellar taping followed by an exercise program results in long-lasting pain control in PFPS associated with muscular dysfunction

Mirror Therapy for Chronic Complex Regional Pain Syndrome Type 1 and Stroke

[No abstract available

Extracorporeal shock wave therapy and ultrasound therapy improve pain and function in patients with carpal tunnel syndrome. A randomized controlled trial

BACKGROUND: 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. AIM: 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. RESULTS: 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). CONCLUSION: patients affected by CTS might benefit from the application of US, cryo--US or ESWT. Benefits persist 3 months after the end of treatment. CLINICAL REHABILITATION IMPACT: Clinicians might consider the possibility of a short--term non--surgical management for mild--to--moderate CT S

Reliability of TMS-related measures of tibialis anterior muscle in patients with chronic stroke and healthy subjects

A lack of normative data for transcranial magnetic stimulation (TMS)-related measures of the lower limb muscles in patients with stroke prevents us from understanding whether changes in TMS-related measures are induced by treatment or are due to their variability and/or the natural evolution of the disease. The purpose of this study was to determine the reliability of three TMS-related measures: motor threshold (MT), motor evoked potential latency (MEP Lat) and MEP amplitude (MEP Amp), linked to the corticospinal control of the tibialis anterior (TA) muscle in sixteen patients with chronic stroke and in sixteen aged-matched healthy subjects. Test-retest reliability was estimated using the intraclass correlation coefficient (ICC) with its 95% confidence interval (95% CI) and standard error of measurement (SEM). In healthy subjects the reliability of all the TMS-related measures yielded an ICC >= 0.75. Similar reproducibility levels were found in patients with chronic stroke, with the exception of MEP Amp on the paretic side (ICC = 0.38). These results suggest that the TMS-related measures investigated are reliable both in healthy subjects and, with the exception of MEP Amp on the paretic side, in patients with chronic stroke. (C) 2011 Elsevier B.V. All rights reserved

Postural Evaluation in Sports and Sedentary Subjects by Rasterstereographic Back Shape Analysis

Posture is defined as the position of the body in space, the aim of which is to maintain balance, both in static and dynamic conditions. Our purpose was to study various postural variables involved in postural adaptations of athletes practicing symmetric and asymmetric sports at professional level. Methods: Patients include sedentary subjects, competitive athletes practicing symmetrical and asymmetrical sports. Postural evaluation of the three different groups was performed using the rasterstereographic-system Formetric-4D. Results: 157 subjects were recruited. From the comparison between subjects playing symmetrical and asymmetrical sports, arises a statistically significant difference on cervical (p = 0.041) and lumbar (p = 0.047) fl&egrave;che of Stagnara, with higher values for symmetrical athletes&rsquo; group. Hemipelvis torsion (p = 0.031) and lumbar fl&egrave;che (p &le; 0.001) of Stagnara are higher in symmetrical athletes&rsquo; group (sedentary). Hemipelvis torsion, cervical and lumbar fl&egrave;che resulted to be higher among athletes (sedentary) (p = 0.016, p = 0.003, p = 0.027). Conclusions: In addition to the competitive sports&rsquo; medical examination, a screening with rasterstereographic-system Formetric-4D is suggested to all sedentary subjects, without serious skeletal pathologies which want to start athletic activity. Rasterstereographic-system Formetric-4D is also suggested to all athletes practicing sports, with the aim to identify eventual unknown postures, consequent to reiterated repetition of specific movements

Hand movement parameters calculated by the LEAP based Virtual Glove

Hand rehabilitation therapy is fundamental in the recovery process for patients suffering from post-stroke or postsurgery impairments. Beside traditional approaches, that require the presence of therapist during the sessions (with high costs and subjective measurements), alternative approaches can be employed. A novel multi-sensor approach, the Virtual Glove (VG), is based on the simultaneous use of two LEAP motion controllers to track the hand motion and to reconstruct a numerical hand model in real time. In this paper, we illustrate how the VG can be used to calculate and represent graphically static and dynamic hand numerical parameters used to assess the Ranges Of Motion (ROM) of the hand articulations, which are the basis for objective evaluation of a rehabilitation task

Intramuscular Oxygen-Ozone Therapy in the Treatment of Acute Back Pain With Lumbar Disc Herniation A Multicenter, Randomized, Double-Blind, Clinical Trial of Active and Simulated Lumbar Paravertebral Injection

STUDY DESIGN: Multicenter randomized, double-blind, simulated therapy-controlled trial in a cohort of patients with acute low back pain (LBP) due to lumbar disc herniation (LDH). OBJECTIVE: To assess the benefit of intramuscular-paravertebral injections of an oxygen-ozone (O2O3) mixture. SUMMARY OF BACKGROUND DATA: Recent findings have shown that O2O3 therapy can be used to treat LDH that fails to respond to conservative management. However, these findings are based on intradiscal/intraforaminal O2O3 injection, whereas intramuscular-paravertebral injection is the technique used most in clinical practice in Italy and other Western countries. METHODS: Sixty patients suffering from acute LBP caused by LDH was randomized to an intramuscular O2O3 or control group. Patients were observed up to assess pain intensity, LBP-related disability, and drug intake (15 [V2] and 30 [V3] days after treatment started, and 2 weeks [V4], and 3 [V5] and 6 [V6] months after treatment ended). RESULTS: A significant difference between the 2 groups in the percentage of cases who had become pain-free (61% vs. 33%, P < 0.05) was observed at V6. Patients who received O2O3 had a lower mean pain score than patients who received simulated therapy throughout the observation period. A significant improvement was observed in LBP-related disability in the study group patients when compared with the control group patients. Active O2O3 therapy was followed by a significantly lower number of days on nonsteroidal anti-inflammatory drugs at V2 and V3 and by a lower number of days at V4. No adverse events were reported. CONCLUSION: Treatment of LBP and sciatica is a major concern. Although the natural history of acute LBP is often self-limiting, conservative therapies are not always effective; in such cases, O2O3 intramuscular lumbar paravertebral injections, which are minimally invasive, seem to safely and effectively relieve pain, as well as reduce both disability and the intake of analgesic drugs