Pain and muscles properties modifications after botulinum toxin type a (BTX-A) and radial extracorporeal shock wave (rESWT) combined treatment

Background and Objective: Spasticity (most common disability in upper motor neuron syndrome or UMNS) caused an inability of patients’ to perform daily activities and a decrease inquality of life. One of the promising methods nowadays, but still not widely used in everyday practice, for spasticity reduction is extracorporeal shock wave. The aim of this study was to evaluate the objective clinical effects of combined treatment botulinum toxin type A and radial Extracorporeal Shock Wave Therapy in spasticity post stroke. Methods: We considered 30 subjects (14 female and 16 male) with post stroke spasticity of Biceps Brachii, Superficial Flexor Digitorum, Gastrocnemius Medialis and Lateralis and we divided patients into two groups (group A received botulinum toxin injection and physiotherapy while group B received botulinum toxin injection, rESWT and physiotherapy). Assessments were performed before treatment (t0), after 1 (t1), 2 (t2) e 3 (t3) months using Modified Ahworth Scale, Visual Analogical Scale for pain and MyotonPro® device (to assessed myometric evaluation of muscles tone and stiffness). Results: Visual Analogical Scale, Modified Ahworth Scale, muscles tone and stiffness statistically decreased until t3 in the group A and in the group B, but the differences between the two groups were significant at the t1 only. Conclusion: Radial Extracorporeal Shock Wave Therapy could be an effective physical treatment aimed at the reduction of upper and lower limbs spasticity and could lead to the improvement of trophic conditions of the spastic muscles in post-stroke

Therapeutic exercise and radiofrequency in the rehabilitation project for hip osteoarthritis pain: a case series.

BACKGROUND: Severe hip osteoarthritis is responsible for disabling pain and functional impairment of the joint. Although total hip arthroplasty (THA) is a successful treatment, some patients have multiple comorbidities that represent contraindications for THA. Conventional drug therapies are often ineffective or responsible for numerous side effects. For these patients, it is difficult to draw up an acceptable rehabilitation path, as the main limitation is intense pain. New rehabilitation strategies need to be developed that relieve pain and improve articular function. The combination of traditional treatments such as education and therapeutic exercise with innovative, minimally-invasive therapies such as continuous radiofrequency (CRF) appears to reduce hip pain by determining the neurolysis of the joint. AIM: The aim of our study was to describe the reduction in pain and improvements in joint function when CRF is combined with the therapeutic exercise in rehabilitation of patients with severe hip osteoarthritis. DESIGN: Case series study. SETTING: Rehabilitation service outpatients. POPULATION: Twenty-five patients with severe hip osteoarthritis causing disabling pain and with contraindications to THA, and for whom conventional drug therapies were ineffective or responsible for numerous side effects. METHODS: The study design included: initial clinical-functional assessment using the Harris Hip Score (HHS), the Numeric Rating Scale (NRS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); a pre-lesion anaesthetic block; hip neuroablation with CRF; a three-week kinesitherapy protocol (3 sessions per week); two further assessments using the same scales one month (T1) and six months (T2) after CRF. RESULTS: Improvements at T1 and T2 follow-ups, after CRF (p=0.000) were recorded for articular pain and function. However, results at T2 were worse than those at T1 (p=0.000). CONCLUSIONS: CRF combined with therapeutic exercise in rehabilitation of severe hip osteoarthritis is an attractive option for significant pain relief as it allows patients to carry out kinesitherapy more easily. CLINICAL REHABILITATION IMPACT: CRF could represent a valid alternative in the rehabilitation of patients with severe hip osteoarthritis especially when other therapeutic approaches are unworkable

La radiofrequenza continua come primo step del progetto riabilitativo della coxartrosi avanzata

La coxartrosi è una patologia molto frequente nei pazienti anziani ed è responsabile di dolore cronico e di impotenza funzionale. La termoablazione dell’anca con radiofrequenza è un trattamento antalgico efficace, sicuro e pressoché privo di controin- dicazioni 2,3. Essa consiste nell’ablazione tramite termocoagulazione dei rami sensitivi intra-articolari del nervo femorale e del nervo otturatorio. Lo copo dello studio è stato quello descrivere gli effetti del trattamento combinato e sequenziale della termoablazione dell’anca seguito dalla riabilitazione al fine di ridurre il dolore e migliorare la funzionalità articolare in pazienti con severa coxartrosi. Sono stati reclutati 25 pazienti, tre con coxartrosi bilateralmente tutti sottoposti a neuroablazione dell’anca con Radiofrequenza continua e a successivo protocollo riabilitativo di chinesiterapia della durata di tre settimane (3 sedute a settimana). Sono stata valutata in questi pazienti rispettivamente ad un mese (T1) e sei mesi (T2) dalla procedura di radiofrequenza le scale Harris Hip Score(HHS), Numeric Rating Scale (NRS) e Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). È stato registrato un miglioramento del dolore e della funzionalità articolare sia al T1 che al T2 (p=0.000). Conclusioni La radiofrequenza continua ha consentito di limitare notevolmente il dolore da coxartrosi, rendendo il percorso riabilitativo molto più agevole ed efficace nel recupero funzionale. I due interventi terapeutici possono dunque integrarsi, potenziandosi vicendevolmente

Could the presence of heel spur be a prognostic factor for outcome of extracorporeal shock wave therapy for plantar fasciitis?

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The legal concept of the environment and systemic vision

Il capitolo analizza la nozione giuridica di ambiente utilizzando un approccio sistemico