Epidemiology of Musculoskeletal Injuries in Adult Athletes: A Scoping Review

Background and Objectives: Sport-related musculoskeletal injuries (MSK-Is) are a common health issue in athletes that can lead to reduced performance. The aim of this scoping review was to synthetize available evidence on injury incidence rates (IIRs), types, and sites that affect the musculoskeletal (MSK) system of adult athletes. Materials and Methods: We performed a scoping review on the Pubmed database limiting our search to 33 Olympic sports. Results: We identified a total of 1022 papers, and of these 162 were examined in full for the purpose of this review. Archery was the sport with the highest risk of injuries to the upper extremities, marathons for the lower extremities, and triathlon and weightlifting for the body bust. In the majority of the sports examined, muscle/tendon strain and ligament sprain were the most common MSK-Is diagnoses, while athletics, karate, and football were the sports with the highest IIRs, depending on the methods used for their calculations. Conclusions: Our scoping review highlighted the general lack and dishomogeneity in the collection of data on MSK-Is in athletes

Post-traumatic complex regional pain syndrome: Clinical features and epidemiology

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that occurs after a tissue injury (fractures, sprain, surgery) of the upper or lower extremities. A clear pathophysiological mechanism has not been established yet and different patterns are considered to play a role in the genesis of the disease. The diagnosis is made by different diagnosis criteria and a gold standard has not been established yet. Incidence of CRPS is unclear and large prospective studies on the incidence and prevalence of CRPS are scarce. The aim of this review is to give an overview on the prevalent data regarding this chronic syndrome

Treatment of complex regional pain syndrome

Complex Regional Pain Syndrome (CRPS) is a multifactorial and disabling disorder with complex etiology and pathogenesis. Goals of therapy in CRPS should be pain relief, functional restoration, and psychological stabilization, but early interventions are needed in order to achieve these objectives. Several drugs have been used to reduce pain and to improve functional status in CRPS, despite the lack of scientific evidence supporting their use in this scenario. They include anti-inflammatory drugs, analgesics, anesthetics, anticonvulsants, antidepressants, oral muscle relaxants, corticosteroids, calcitonin, bisphosphonates, calcium channel blockers and topical agents. NSAIDs showed no value in treating CRPS. Glucocorticoids are the only anti-inflammatory drugs for which there is direct clinical trial evidence in early stage of CRPS. Opioids are a reasonable second or third-line treatment option, but tolerance and long term toxicity are unresolved issues. The use of anticonvulsants and tricyclic antidepressants has not been well investigated for pain management in CRPS. During the last years, bisphosphonates have been the mostly studied pharmacologic agents in CRPS treatment and there are good evidence to support their use in this condition. Recently, the efficacy of intravenous (IV) administration of neridronate has been reported in a randomized controlled trial. Significant improvements in VAS score and other indices of pain and quality of life in patients who received four 100 mg IV doses of neridronate versus placebo were reported. These findings were confirmed in the open-extension phase of the study, when patients formerly enrolled in the placebo group received neridronate at the same dosage, and these results were maintained at 1 year follow-up. The current literature concerning sympathetic blocks and sympathectomy techniques lacks evidence of efficacy. Low evidence was recorded for a free radical scavenger, dimethylsulphoxide (DMSO) cream (50%). The same level of efficacy was noted for vitamin C (500 mg per day for 50 days) in prevention of CRPS in patients affected by wrist fracture. In conclusion, the best available therapeutic approach to CRPS is multimodal and is based on the use of several classes of drugs, associated to early physiotherapy. Neridronate at appropriate doses is associated with clinically relevant and persistent benefits in CRPS patients

Gel electrophoresis and immunoblotting for the detection of casein proteolysis in cheese

The whole N fraction of six samples of hard and semi-hard pressed cheeses was analysed using PAGE, polyacrylanzide gel isoelectric focusing and immunoblotting with polyclonal antibodies against beta- and alpha(s1)-casein. The origin of some electrophoretic bands corresponding to peptides produced from the enzymic degradation of the casein fractions was established. A number of these peptides were also present in the in vitro hydrolysates of casein with plasmin and chymosin. Thus, it was also possible to determine which casein was the source of each peptide and which enzymes were active in cheese. Compared with the traditional Coomassie staining procedures, immunoblotting is more sensitive and specific, making the interpretation of each electrophoretic profile easy. Thus, it was also possible to obtain a clear picture of the state of each casein fraction in a cheese variety. Two main peptides were isolated from the pH 4.6-insoluble N fraction of Parmigiano-Reggiano using DEAE-cellulose chromatography and identified, from the amino acid sequence of the N- and C-terminal ends, as gamma(3)-casein ( (beta-casein(f108-209)) and alpha(s1)-PL1 (alpha(s1)-casein(f80-199). In both cases, a Lys-X bond was hydrolysed, indicating the action of a trypsin-like enzyme in beta- and alpha(s1)-casein hydrolysis during the ripening of this variety of hard pressed cheese

La terapia dell’algodistrofia

L’algodistrofia è una condizione multifattoriale ad eziologia e patogenesi complessa. I principali obiettivi della terapia dell’algodistrofia sono il miglioramento della sintomatologia dolorosa, il ripristino funzionale e la stabilizzazione dello stato ansioso-depressivo. L’approccio interdisciplinare è riconosciuto come il più pragmatico, disponibile e conveniente, ma fondamentale è la precocità della terapia. Le tecniche interdisciplinari di gestione del dolore sottolineano come il recupero funzionale possa essere la terapia più efficace, andando ad agire sull’alterata elaborazione centrale e/o la normalizzazione dell’ambiente distale. La mobilizzazione precoce deve essere quindi incoraggiata con esercizi attivi e passivi che consentano di mantenere l’escursione articolare evitando la rigidità e la perdita del trofismo e della forza muscolare. Diversi farmaci sono stati utilizzati per migliorare la sintomatologia dolorosa e lo stato funzionale nell’algodistrofia, nonostante la man - canza di un’evidenza scientifica a sostegno del loro utilizzo. Essi comprendono gli antinfiammatori, gli analgesici, gli anestetici, gli anticonvulsivanti, gli antidepressivi, i miorilassanti, i corticosteroidi, la calcitonina, i bisfosfonati, i blocchi del simpatico e gli agenti topici. Tra i farmaci antinfiammatori solo i glucocorticoidi posseggono un’evidenza scientifica diretta, ma solo nella fase iniziale della patologia. Gli oppioidi sono una ragionevole opzione di trattamento di seconda o di terza scelta, anche se la tolleranza e la tossicità a lungo termine costituiscono ancora delle problematiche irrisolte. Gli anticonvulsivanti e gli antidepressivi triciclici non sono mai stati studiati per il trattamento dell’algodistrofia, e le evidenze a loro sostegno sono soltanto aneddotiche. La classe farmacologica che a tutt’oggi offre le maggiori garanzie di efficacia è quella dei bisfosfonati. Il loro razionale d’impiego ha fatto inizialmente riferimento all’efficacia analgesica nel trattamento di alcune patologie scheletriche (morbo di Paget, malattia metastatica scheletrica) e, più recentemente, alla dimostrazione che i bisfosfonati interferiscono positivamente con l’edema midollare osseo e la sintomatologia dolorosa in alcune patologie flogistiche articolari. Aldilà della modalità di azione, negli ultimi 15-20 anni sono molti gli studi e le esperienze cliniche che hanno dimostrato l’efficacia di diversi bisfosfonati, soprattutto se somministrati per La terapia dell’algodistrofia Giuseppina Resmini1, Chiara Ratti2, Gianluca Canton2, Luigi Murena2, Antimo Moretti3, Giovanni Iolascon3 1Centro per lo Studio dell’Osteoporosi e delle Malattie Metaboliche dell’Osso U.O. Ortopedia e Traumatologia - A.O. Ospedale di Treviglio-Caravaggio (BG) 2Clinica Ortopedica, Università di Trieste 3Dipartimento Multidisciplinare di Specialità Medico-Chirurgiche e Odontoiatriche Seconda Università di Napoli 15 L a t e r a p i a d e l l ’ a l g o d i s t r o f i a FIGURA 2. Efficacia del trattamento con neridronato EV versus placebo. Risultati della open extension phase dello studio, quando i pazienti arruolati nel gruppo placebo passavano al trattamento con neridronato alla stessa posologia del gruppo trattato. 80 60 40 20 – 10 1 10 20 30 40 Giorni p = 0.0001 p < 0.0001 Neridronato 100 mg x 4 Wash out via endovenosa e a dosaggi elevati, nel migliorare la sintomatologia dolorosa e il deficit funzionale nei pazienti con algodistrofia, con un buon profilo di sicurezza e tollerabilità. Tuttavia, spesso, questi stessi studi sono stati sponsorizzati e basati su pochi pazienti. Studi randomizzati con calcitonina vs placebo non hanno riportato risultati significativi. Mancano dimostrazioni di efficacia relative ai blocchi del simpatico ed alle tecniche di simpaticec- FIGURA 1. Efficacia del trattamento con neridronato EV versus placebo. 80 60 40 20 1 10 20 30 40 Giorni VAS, media + DS VAS, media (DS) p = 0.043 p < 0.0001 Placebo Neridronato 16 L a t e r a p i a d e l l ’ a l g o d i s t r o f i a tomia. Deboli prove di efficacia per il dimetilsolfossido (DMSO) ad uso topico sono state registrate sui segni di flogosi, ma non sulla sintomatologia dolorosa. In termini preventivi l’utilizzo di vitamina C, in ragione delle sue proprietà antiossidanti, sembra essere in grado di ridurre l’incidenza di algodistrofia nei soggetti con frattura di polso. Recentemente, in uno studio randomizzato controllato condotto su 82 pazienti affetti da CRPS di tipo 1 è stata evidenziata l’efficacia della somministrazione endovenosa di neridronato. Una significativa diminuzione della sintomatologia dolorosa (VAS) e un significativo miglioramento della qualità di vita sono stati osservati nei pazienti affetti da algodistrofia alla mano o al piede che hanno ricevuto 400 mg di neridronato per via endovenosa nell’arco di 10 giorni versus placebo (Figura 1). La stessa tendenza è stata osservata anche nella fase di estensione dello studio in aperto, quando i pazienti del gruppo placebo hanno ricevuto neridronato allo stesso dosaggio (Figura 2). Una rivalutazione dei pazienti a un anno di distanza non ha mostrato segni clinici residui o recidivanti di algodistrofia. In conclusione, l’approccio terapeutico più condiviso è di tipo multimodale e si fonda sull’impiego di diverse classi di farmaci associato ad un intervento riabilitativo precoce. Il neridronato ha dimostrato un significativo beneficio, clinicamente rilevante e persistente, nel trattamento dell’algodistrofia, agendo sia sulla modulazione del dolore sia sulla qualità dell’osso coinvolto

Domino Effect: mechanic factors role

The rapid onset of the Domino Effect following the first Vertebral Compression Fracture is a direct consequence of the mechanical variations that affect the spine when physiological curves are modified. The degree of kyphosis influences the intensity of the Flexor Moment; this is greater on vertebrae D7, D8 and on vertebrae D12, L1 when the spine flexes. Fractures of D7, D8, D12 and L1 are, by far, the most frequent and also the main cause of the mechanical alterations that can trigger the Domino Effect. For these considerations vertebrae D7, D8, D12 and L1 have to be taken in consideration as “critical". In the case of critical clinical vertebral fractures it is useful to provide an indication for minimally invasive surgical reduction or intrasomatic stabilization. When occurs a fracture of a “critical vertebra”, prompt restoration of the heights leads to a reduction in the Kyphosis Index and therefore in the Flexor Moment, not only of the fractured vertebra but also, in turn, of all the other metameres which, even if morphologically still intact, are structurally fragile; so, through the restoration of the mechanical vertebral proprieties, we can reduce the risk of the Domino Effect. At the same time the prompt implementation of osteoinductive therapy is indispensable in order to achieve rapid and intense reconstruction of the trabecular bone, the strength of which increases significantly in a short period of time. Clinical studies are necessary to confirm the reduction of the domino effect following a fragility fracture of "critical vertebrae" with the restoration of the mechanical properties together with anabolic therapy

Effectiveness of teriparatide treatment on back pain-related functional limitations in individuals affected by severe osteoporosis: a prospective pilot study

Introduction. Vertebral fractures have been associated with back pain, functional limitations and reduced health-related quality of life (HRQoL). Teriparatide is the first effective anabolic agent that demonstrated to significantly reduce the risk of vertebral fracture by 65%, as compared to placebo. The aims of this study were to evaluate the effectiveness of teriparatide treatment on back pain-related functional limitations and to investigate on patients HRQoL. Materials and methods. In this prospective observational pilot study osteoporotic patients, who were prescribed teriparatide therapy and a supplementation of calcium and vitamin D, were asked to answer to two self-administered questionnaires: the Spine Pain Index (SPI) and the SF-12 (at the recruitment, after 6, 12, and 18 months). Results. Fifty-two women were evaluated (mean age of 70.58 yrs). The mean SPI score passed from 50.01 at baseline to 32.20 at 18 months. The mean SF-12 PCS score passed from 30.00 at baseline to 36.79 at 18 months, while the mean SF-12 MCS score was already within the normality range at baseline, constantly improving during the 18 months. Conclusion. In conclusion, 18 months of treatment with teriparatide has to be considered an effective therapeutic option for women with severe osteoporosis and vertebral fractures, in a real-life clinical setting, to improve both back pain related disability and quality of lif