A rare case of Enchondromatosis of the knees and hands with involvement of Hoffa's fat pad and peri-articular soft-tissues

We report a case of a 56-year old man with chronic pain in both knees for several years. This patient had already undergone surgery on his left knee in 2002 after an x-ray showed multiple lytic and well margined lesions in the distal femur and proximal tibia with ground-glass matrix, involving Hoffa's fat pad and the patellar ligament. Histology was consistent with an enchondroma. The most recent MRI examination showed enchondromatosis involving both knees with bilateral extension into Hoffa's fat pad and the patellar ligament. Subsequently, we performed an additional radiographic examination of the hands and feet, as well as an MRI of both hands to identify other possible enchondromas in the most common sites for this disease. Enchondromatosis with soft tissue involvement is extremely rare, and involvement of Hoffa's fat pad has not been reported in the scientific literature. The clinical presentation of this case and the general aspects of Enchondromatosis are discussed

Evaluation of lumbar pain with weight-bearing MRI: Preliminary experience.

PURPOSE/INTRODUCTION: To assess the usefulness of weight-bearing examination of the lumbar spine performed with a dedicated MRI scanner in the evaluation of patients with clinical evidence of lumbar pain. MATERIALS AND METHODS: Between August 2008 and July 2009, 40 patients with clinical evidence of lumbar pain (group A) and a similar number of healthy volunteers (group B) were submitted to MRI examination of lumbar spine. Spin echo T1w and fast spin echo T2w images were acquired with a 0.25 Tesla scanner (G-Scan, Esaote Spa, Genoa, Italy) in both weight-bearing position and conventional supine position. A dedicated receiving coil for the lumbar spine was used. Three radiologists, blinded on history and clinical examination of subjects, assessed, in consensus, variations of lumbar lordosis angle and presence of pathology on images acquired in both positions, in different sequences and in different planes. RESULTS: In group A, conventional supine MRI was positive for pathology in 30/40 cases while weight-bearing MRI was positive in 39/40 cases. In all cases of group B, no signs of pathology was found in both positions. Weight-bearing MRI showed modifications of lumbar lordosis angle in all cases of both groups in respect to conventional supine MRI. DISCUSSION/CONCLUSION: Imaging the lumbar spine in weight-bearing position with a dedicated MRI scanner and a dedicated coil could allow identification of pathology which could be overlooked if imaging patients only in the supine position

MR imaging of entrapment neuropathies of the shoulder

LEARNING OBJECTIVES: To describe the MRI features of most common entrapment neuropathies of the shoulder: - Parsonage-Turner syndrome - quadrilateral space syndrome (axillary neuropathy) - suprascapular nerve syndrome BACKGROUND: Entrapment neuropathies are characterized by alteration of nerve function secondary to compression by mechanical or dynamic forces. The compression may be acute, chronic or intermittent. Not infrequently compressive neuropathies are related to space-occupying lesions such as tumors, cysts, inflammatory processes, or post-traumatic conditions. IMAGING FINDINGS: The MR imaging appearance of Parsonage-Turner syndrome is quite characteristic, with marked edema in the affected muscles of the shoulder, most commonly those innervated by the suprascapular nerve, although deltoid muscle can also be compromised. MR imaging of quadrilateral space syndrome may reveal fatty atrophy or edema isolated to the teres minor muscle. MR imaging of suprascapular nerve syndrome is established when edema or fatty changes of supraspinatus and/or infraspinatus muscle is present along with a cyst or ganglion in the spinoglenoid or suprascapular notch. CONCLUSION: MRI is a powerful diagnostic imaging tool in the diagnosis of entrapment neuropathies of the shoulder and underlying causes, thus excluding other possible causes of shoulder pain. Moreover, MRI may recognize active changes of denervation in muscle from chronic denervation muscle changes or “fatty atrophy” in isolation, and therefore it may change treatment and management

Pain perception and stabilometric parameters in people with chronic low back pain after a pilates exercise program: A randomized controlled trial

Various exercise interventions, such as Pilates exercises and traditional physical therapy methods, are employed to decrease low back pain (LBP). Nonspecific low back pain (NSLBP) is distinct from LBP, however, as the distribution of pain is restricted to the region between the costal margin and the inferior gluteal. The aim of our randomized controlled trial was to evaluate the effects of a program of Pilates exercises on pain perception and stabilometric parameters in patients with NSLBP.Thirty-eight participants were randomly allocated, using a 1:1 scheme, to either the experimental group (EG) or control group (CG). The EG completed a 14-week program of Pilates exercises, performed thrice per week under the supervision of an exercise specialist, while the CG was managed with a social program only. Measures of posturography and Oswestry Disability Index (ODI) for pain perception were obtained at baseline (T0) and after the 14 weeks of intervention (T)1.Posturography measures improved for patients in the EG, with both eyes open and eyes closed (P\u200a<\u200a0.05). There were no statistical differences in posturography in the CG. ODI decreased significantly in both groups over the 14 weeks of the study protocol: EG, T0, 13.7\u200a\ub1\u200a5.0 compared with T1, 6.5\u200a\ub1\u200a4.0 (P\u200a<\u200a0.001); and CG, T0, 10.7\u200a\ub1\u200a7.8 compared with T1, 8.4\u200a\ub1\u200a7.8 (P\u200a<\u200a0.01). A greater extent of reduction in pain was achieved in the EG.The Pilates exercise program yielded improvements in pain and posturography outcomes. Our study also confirms the applicability of posturography in evaluating postural instability in patients with NSLBP. Due to our relatively small study group, future studies would be necessary to confirm our findings

Evaluation of Fitness and the Balance Levels of Children with a Diagnosis of Juvenile Idiopathic Arthritis: A Pilot Study

Background: Juvenile idiopathic arthritis is a main cause of physical disability and has high economic costs for society. The purpose of this study was to assess the fitness levels and the postural and balance deficits with a specific test battery. Methods: Fifty-six subjects were enrolled in this study. Thirty-nine healthy subjects were included in the control group and seventeen in the juvenile idiopathic arthritis group. All subjects were evaluated using a posturography system. The fitness level was evaluated with a battery of tests (Abalakov test, sit-up test, hand grip test, backsaver sit and reach, the toe touch test). An unpaired t-test was used to determine differences. Pearson's correlation coefficient was used to evaluate the correlation between the tests. Results: The battery of tests demonstrated that subjects in the juvenile idiopathic arthritis group have lower fitness levels compared to the control group. The juvenile idiopathic arthritis group showed low postural control with respect to the control group. Pearson analysis of the juvenile idiopathic arthritis group data showed significant correlations between variables. Pearson's results from the control group data showed a similar trend. Conclusions: The results suggest that the battery of tests used could be an appropriate tool. However, we highlight that these conclusions need to be supported by other studies with a larger population scale

Application of T-Thesys Therapy in post-operative recovery in knee-surgical interventions: A case study

T-Thesys therapy is an innovative treatment that can be used even in the presence of recent injuries. For this reason, we studied the T-Thesys use in the post-operative phase of the anterior cruciate ligament (ACL) reconstruction of the knee. For our study, we selected 51 patients for ACL surgery, and we divided participants in two groups: the Experimental Group (EG) and the Control Group (CG). The EG consisted of 34 patients (age: 26.9 ± 7.65 years) who underwent T-Thesys therapy after surgery, while the CG included 17 patients (age: 26.7 ± 6.8 years) who was not subjected to T-Thesys therapy after surgery. T-Thesys therapy was performed on a daily basis and participants' parameters were monitored throughout the treatment. For the EG, we did not find any significant differences, however, subjective disorders seemed to disappear, almost entirely, at the seventh application. The CG showed no significant differences, even in the subjective disorders investigated. Therefore, the therapeutic treatment associated with T-Thesys therapy seems to not show any efficacy compared to the surgical treatment alone. However, from our findings emerged differences which tend to highlight a better clinical response, a faster recovery time, an improvement on the quality of life in patients, and, moreover, a better use of the National Health System resources

EFFECTS OF A SPECIFIC TRAINING PROTOCOL ON POSTUROGRAPHIC PARAMETERS OF A TAEKWONDO ELITE ATHLETE AND IMPLICATIONS ON INJURY PREVENTION: A CASE STUDY

Introduction: Taekwondo elite athletes should have excellent qualities in several aspects of fitness, as well as peculiar postural characteristics in terms of balance and postural control, to achieve the best possible results during competitions. Moreover, it is known that taekwondo shows high risk of injury. The aim of this case study is to evaluate the effects of a specific training protocol on posturographic parameters of a taekwondo elite athlete in order to prevent the risk of injury. Materials and methods: The specific training protocol provided 2 months of general strength conditioning, which included pre-conditioning in the first 2 weeks, physical training to improve explosive strength, balance and postural control and athletic training to improve the combat technique. The experimental design included three assessment times: the pre-test (T0), the intermediate- test (T1) and the post-test (T2). Each test provided the same evaluations: anthropometric measurements, cervical ROM assessment and posturographic evaluation. Results: Stabilometric parameters showed a good balance and postural control both in T0 and T2. Baropodometric parameters showed a physiological load pressure distribution between the left and the right foot in T0 (left foot 54% - right foot 46%) as well as in T2 (left foot 45% - right foot 55%). The left forefoot-rearfoot ratio pressure showed no differences between T0 and T2 (p&gt;0.05); we found an improvement on the right forefoot-rearfoot ratio (p&lt;0.05). Cervical range of motion evaluation showed no significant variations from T0 to T2 (p&gt;0.05) on rotation and lateral bending movements; we found an improvement on the extension movement from T0 to T2 (p&lt;0.05), while the flexion movement decreased (p&gt;0.05). Conclusion: The presented case study showed that the experimental protocol improved the postural parameters of this taekwondo elite athlete. We believe that other athletes may adopt this protocol in order to improve own sports performance and to prevent injuries

Can tongue position and cervical ROM affect postural oscillations? A pilot and preliminary study

The tongue is considered an important part of the postural system, so it is fundamental to understand how it can interfere with the humans’ postural oscillations. The aim of this preliminary investigation is to understand the effects of different tongue position and cervical ROM on postural oscillations measured in a stabilometric test. Thirteen voluntary subjects were recruited (30.8 ± 9.7 yrs.; 173.6 ± 14.9 cm; 72.6 ± 15.6 kg) and tested in three different random tongue conditions: comfortable tongue position (CT), palatal spot position (ST) and low tongue position (LT). All tests were performed with open eyes. Stabilometric test were performed with a pressure platform. In addition, the cervical ROM was assessed in the CT condition to create a baseline measurement and to find out baseline relationship with cervical ROM and postural oscillations. Data analysis indicates no significant difference in CoP sway path length for CT / ST / LT (260.7 ± 106.5 mm / 236.9 ± 79.3 mm / 272.9 ± 89.3 mm, respectively). A moderate but significant correlation is present between postural oscillations and cervical rotation ROM (R = -0.59; p = .03), indicating that good postural oscillations are connected with a free ROM of the highest part of the body. The results of this preliminary investigation do not support the use of different tongue position during postural assessment to discriminate some postural interferences of the tongue. At the same time the results suggest the relationship between cervical ROM and stability. These results suggest the necessity to study more in deep this phenomenon with other specific class of subjects

Plantar fascia evaluation with a dedicated magnetic resonance scanner in weight-bearing position: our experience in patients with plantar fasciitis and in healthy volunteers.

Purpose. This study assessed the usefulness of upright weight-bearing examination of the ankle/hind foot performed with a dedicated magnetic resonance (MR)imaging scanner in the evaluation of the plantar fascia in healthy volunteers and in patients with clinical evidence of plantar fasciitis. Materials and methods. Between January and March 2009, 20 patients with clinical evidence of plantar fasciitis (group A) and a similar number of healthy volunteers (group B) underwent MR imaging of the ankle/hind foot in the upright weight-bearing and conventional supine position. A 0.25-Tesla MR scanner (G-Scan, Esaote SpA, Genoa, Italy) was used with a dedicated receiving coil for the ankle/hind foot. Three radiologists, blinded to patients’ history and clinical findings, assessed in consensus morphological and dimensional changes and signal intensity alterations on images acquired in both positions, in different sequences and in different planes.Results. In group A, MR imaging confirmed the diagnosis in 15/20 cases; in 4/15 cases, a partial tear of the plantar fascia was identified in the upright weight-bearing position alone. In the remaining 5/20 cases in group A and in all cases in group B, the plantar fascia showed no abnormal signal intensity. Because of the increased stretching of the plantar fascia, in all cases in group A and B, thickness in the proximal third was significantly reduced (p<0.0001) under upright weight-bearing compared with the supine position Conclusions. Imaging the ankle/hind foot in the upright weight-bearing position with a dedicated MR scanner and a dedicated coil might enable the identification of partial tears of the plantar fascia, which could be overlooked in the supine position