Treatment of medial collateral ligament injuries of the knee with focused extracorporeal shockwave therapy: A case report

Medial collateral ligament (MCL) injuries are the most frequent ligamentous injuries of the knee. Focused extracorporeal shock wave therapy (f-ESWT) is progressively expanding its field of application to many musculoskeletal pathologies. Although there is evidence surrounding the efficacy of f-ESWT in tendinopathies, no studies have described the usefulness of ultrasound (US)-guided f-ESWT in the treatment of ligament injuries. Herein, we report a case of a MCL injury treated with f-ESWT. Moreover, our case shows the importance of using ultrasonography in determining the effect of treatment. A 60-year-old man with a focal area of lesion in the deep fibers underwent 4 weekly sessions of US-guided f-ESWT to the injured ligament area. His pain decreased to a visual analog scale (VAS) of 3 at the end of the treatment and was completely resolved at the 1-month follow-up visit, with these results being maintained at 4-month follow-up. The US examination showed an initial deposition of “newly formed tissue” at the site of previous injury of the proximal MCL insertion, and a reduction in MCL thickness together with an improvement in echostructure. Based on this result, we speculate that non-surgical ligament injuries could be a new indication for f-ESWT. However, further investigation on the effects of f-ESWT for ligament injuries is needed

Groin pain and iliopsoas bursitis: Always a cause-effect relationship?

Background and Objective: Iliopsoas bursitis (IB) is characterized by inflammation and enlargement of the iliopsoas bursa. Although this condition is often associated with degenerative or inflammatory arthritis, infections, trauma, overuse and impingement syndromes, osteonecrosis and hip replacement, the pathogenesis of IB remains uncertain. We present a case report of IB associated with moderate hip osteoarthritis (HOA). Methods: We present a case report of a 73-year-old man with chronic left hip pain that did not respond to conservative treatments. An ultrasonography examination of the left hip revealed fluid-induced distension of the iliopsoas bursa, which was treated with aspiration followed by a corticosteroid-anesthetic injection. Results: At the 30-day follow-up, despite an initial improvement in the patient's symptoms, both the pain and functional limitation returned, though not in association with bursa distension. The patient therefore underwent a total hip arthroplasty, which fully relieved the symptoms. Conclusion: We hypothesize that iliopsoas bursitis may, when associated with other pathological conditions, not be the only source of pain. It should, nevertheless, be considered for differential diagnosis purposes. © 2014 - IOS Press and the authors. All rights reserved

Numerical analysis of stacked geo-tubes

Geo-tubes and geo-containers are being increasingly used as marine structures for coastal protection and harbor construction. They represent an alternative solution compared to the traditional methods such as rock embankment and/or concrete units, with a significant reduction in cost and time. The tensile stress of stacked geo-tubes in immersed condition has been explored in this paper through numeri-cal modeling, considering that the main drawback for this kind of structures is the lack of definite design criteria. With the aim of increasing the knowledge of the shape of the tubes and of the tensile stress in the geotextiles after filling and load-ing, the analyses showed how these parameters may be influenced by many fac-tors, as the mutual distance of the geo-tubes, the interface friction and the level of filling of the geo-tubes

Dextrose prolotherapy for chronic tendinopathy: A scoping review

Introduction: Tendinopathy is a frequent source of musculoskeletal pain and disability. Between treatment options, prolotherapy, an injection treatment that aims to promote tissue healing, could play a role in symptomatic and functional improvement. The purpose of the study is to analyze current evidence about the effect of dextrose injections on clinical outcomes in patients with chronic tendinopathy. Methods: A literature search on MEDLINE (PubMed) and PEDro databases was conducted. All randomized controlled trials (RCTs) published in the last 10 years, with available abstracts, in English language, analyzing the effect of prolotherapy in human subjects with a diagnosis of chronic tendinopathy were considered. Methodological quality was assessed by PEDRO scale quality assessment tool. Results: Sixteen papers were included. Most of the RCTs were of medium to high quality. Based on the analyzed data, prolotherapy could represent an easy to access, cheap, safe and effective conservative treatment in rotator cuff tendinopathy and in epiconodylosis and could improve pain control in the medium to long-term, with encouraging data on function restoring in the long term. However, solutions preparation, procedural aspects and comparators were highly heterogeneous. Conclusion: Current evidence suggests that prolotherapy can results in improving symptoms in patients with tendinopathy, with no observed adverse reactions. However, few RCTs have been conducted; the results are not consistent enough and have a wide heterogeneity in their protocols so comparing data was not always possible. Therefore, further studies require a repeatable standardized procedure to confirm these positive preliminary results