Giuseppe Maccagnano

Comparison of shock wave therapy and nutraceutical composed of Echinacea angustifolia, alpha lipoic acid, conjugated linoleic acid and quercetin (perinerv) in patients with carpal tunnel syndrome.

Even though the initial treatment of carpal tunnel syndrome (CTS) is conservative, knowledge of the clinical effects of supplements and of some methods of physiotherapy is still preliminary. Many biological mechanisms can support the administration of shock wave therapy (ESWT) or of alpha lipoic acid (ALA) based nutraceutical, conjugated linoleic acid (GLA), anti-oxidants and Echinacea angustifolia for CTS. The shock waves reduce the nerve compression, produce an anti-inflammatory action, and accelerate the regeneration of neuropathy. ALA and GLA induce antioxidant protective actions, reduce inflammation, promote neuroregeneration, and decrease pain. The Echinacea modulates the endogenous cannabinoid system. The aim of study is to verify the efficiency of shock wave therapy versus nutraceutical composed of ALA, GLA, and Echinacea in CTS. Sixty patients were enrolled in this study and they were randomly assigned to one of two treatments. Both groups showed significant improvements in pain, symptoms’ severity and functional scores, and electrodiagnostic results until the sixth month. We verified a trend to a better pain regression in the nutraceutical group. The presence of the medicinal Echinacea represents an added value to the antioxidant effect in ALA and GLA, which can justify this result. ESWT or the association of ALA, GLA, and Echinacea proved to be two effective treatments for controlling symptoms and improving the evolution of CTS.

Methylsulfonylmethane and boswellic acids versus glucosamine sulfate in the treatment of knee arthritis: Randomized trial.

Until now glucosamine sulfate (GS) has been the most widely used supplement and has been shown to be efficacious in the treatment of osteoarthritis (OA). Methylsulfonylmethane (MSM) and boswellic acids (BA) are new effective supplements for the management of inflammation and joint degeneration, according to previous experimental studies. The aim of our study is to test the effectiveness of association of MSM and BA in comparison with GS in knee arthritis. In this prospective randomized clinical trial, MEBAGA (Methylsulfonylmethane and Boswellic Acids versus Glucosamine sulfate in the treatment of knee Arthritis), 120 participants affected by arthritis of the knee were randomly assigned to an experimental group (MB group) or a control group (GS group) treated for 60 days with 5 g of MSM and 7.2 mg of BA or with 1500 mg of GS daily, respectively. At the 2-month (T1) and 6-months (T2) follow-up , the efficacy of these two nutraceuticals was assessed using the visual analog pain scale (VAS) and the Lequesne Index (LI) for joint function, along with the use of anti-inflammatory drugs (non-steroidal anti-inflammatory drugs and anti-cyclooxygenase-2). The repeated measures ANOVA analysis shows that for VAS, LI, and the use of anti-inflammatory drugs scores there are improvements due to the time in the two groups (respectively, F = 26.0; P <0.0001; F = 4.15; P = 0.02; F = 3.38; P = 0.04), with a tendency to better values for the MB group at T2. On the basis of these preliminary data, we could support the efficacy of the MSM in association with BA in the treatment of OA. These results are consistent with the anti-inflammatory and chondroprotective effects previously occurred in experimental studies. This new combination of integration (MSM and BS) has presented good results and satisfactory in comparison with GS, until now the cornerstone of the treatment of arthritis in according to guidelines.

Returning to sport after anterior cruciate ligament reconstruction in amateur sports men: a retrospective study

BACKGROUND According to the literature, 95% of professional athletes return to their sport after anterior cruciate ligament (ACL) reconstruction surgery. The main objective of this study was to verify the return to sport after ACL reconstruction in a homogenous group of amateur sportsmen and sportswomen in a series of Italian patients. MATERIALS AND METHODS We designed a retrospective study in which we analyzed the amateur sports patients operated for ACL reconstruction. We verified whether they had returned to sporting activities by comparing the pre- and post-operative Tegner activity scores. We then analyzed the average time to restart the sporting activity and the Lysholm and International Knee Documenting Committee (IKDC) scores. RESULTS We analyzed 80 subjects: 47.5% restarted a sports activity, on average after eight months, with a significant reduction of their competitive level or physical commitment, as expressed by the Tegner activity score (pre-operative: 6.9; post-operative: 3.9; p<0.01). The functional knee recovery was good, as expressed by the average score of the Lyshom Knee Scoring Scale (93.5) and the IKDC (74.7). CONCLUSIONS In the literature, a return to sport for international case studies and amateur sports is higher than our data. In our population we found the lack of information provided by the medical staff at discharge and follow-up. The assessment at a short-term follow up allowed us to verify that at the end of the post-surgical rehabilitation program the patients were uninformed about the timing and the ability to resume a sporting activity. An efficacious relationship between orthopedic doctor, physiotherapist and a doctor in motorial science may ensure proper treatment the patient after ACL reconstruction. It is important to guarantee the restarting of the sports activity to have a better quality of life in amateur sports. Level of evidence: V.

Visual- spatial capacity: gender and sport differences in young volleyball and tennis athletes and non-athletes

BackgroundIn the general population visual-spatial ability is better in males, due to the influence of biological and socio-cultural factors. We know that sport activity improves motor skills. The aim of this work is to determine if these gender differences exist in young athletes. The orientation test described by Terzi and standardized by Cesaroni, used to measure spatial ability, was carried out on 60 volleyball or 60 tennis athletes as well as on 60 non-sporting subjects.ResultsThe data analysis revealed a worse performance for non-athletes in comparison with athletes in both components of test (p < 0.0001; p = 0.04), with no differences between the volleyball and tennis groups. As far as gender comparison is concerned, as expected in the non- sport group the males presented better values (p < 0.001; p = 0.006). However in both sports groups there weren’t any gender differences in either part of the test (p = 0.18; p = 0.056).ConclusionsThese results confirm that during athletic preparation in volleyball and tennis the specific training is able to develop spatial ability. Besides, boys and girls have similar performance demands and training experience. It appears that this specific training could be responsible for modifying gender differences in performance of spatial ability during adolescence.

Peripheral neuropathy after hip replacement failure: is vanadium the culprit?

In September, 2011, a 70-year-old man was admitted to our orthopaedics department. In 2005 he had been fi tted with a total right hip prosthesis with a ceramic-on-ceramic bearing couple; the cotyloid metal back and the stem were made of a titanium-aluminium-vanadium alloy (Antega stem and Plasmacup SC, B Braun Aesculap, Melsungen, Germany). The patient had experienced increasing pain over the previous 3 years, with progressive loss of function of the right coxofemoral joint, associated in the last 3 months with reduced sensitivity and strength of both legs. On the proximal third of the right thigh, a diff use blackish pigmentation appeared about 2 years earlier; 2 months before his referral a fi stula had developed, exuding a black fl uid. On examination, the patient had a minimal range of motion of the right hip (because of in-tense pain), a sensory-motor defi ciency aff ecting both legs, and grey-green staining of the central part of the tongue. Laboratory test results did not show signs of haemato-logical, infectious, metabolic, or immune disease. CT respect to the acetabular cavity, and rupture of the ceramic insert. Electroneurographic testing of the peroneal and sural nerves showed bilateral sensory-motor axonal neuro-pathy of moderate–severe grade; tonal audio metric tests showed bilateral sensorineural hearing loss. Suspecting a periprosthetic metallosis, biological fl uid metal analyses was done. Compared with Italian reference values, there were high concentrations of: vanadium in blood (6∙1 μg/L), serum (5∙8 μg/L), and urine (56∙0 μg/L); aluminium in serum (18∙0 μg/L) and urine (78∙0 μg/L); and titanium in urine (35∙0 μg/L; see also appendix).

Effects of Extracorporeal Shock Wave Therapy on Functional and Strength Recovery of Handgrip in Patients Affected by Epicondylitis

Extracorporeal shock wave therapy (ESWT) is effective in the treatment of tendinopathy. We designed a prospective observational clinical study to assess the correlation between clinical and functional measures and recovery of strength after ESWT for epicondylitis. We analyzed 26 patients. We measured progressive improvement in visual analogue scale values (p < 0.0005) and Mayo Elbow Performance Index scores (p = 0.004) for the pathologic limb. Monitoring of handgrip failed to reveal changes in values at any follow-up (p > 0.05). We found no correlation between degree of clinical function and muscle deficit during follow-up. After ESWT, there was a tendency toward a decrease in grip strength, especially in the dominant limb. This could be related to the effects of ESWT, which reduces spasticity in painful hypertonic muscles. These data may be useful in defining the expectations for function during ESWT for epicondylitis, particularly for elite athletes.

Klippel-Trenaunay syndrome: a rare cause of disabling pain after a femoral fracture

Klippel-Trenaunay syndrome (KTS) is characterized by a cutaneous vascular nevus of the involved extremity, as well as bone and soft tissue hypertrophy of the extremity and venous malformations. We present the case of a 52-year-old man with a femoral fracture and a history of haemangiomas, limb bone hypertrophy and varicosity. The patient was finally diagnosed with KTS and treated in mini-invasive surgery by endomedullary fracture nailing in general anaesthesia. Clinical management was particularly demanding, not only because of the need to monitor the risk of haemorrhage and thrombosis but also because of the onset of a rare picture of neuropathic pain with hyperalgesia and allodynia, never previously reported in patients affected by KTS, that required the administration of major opioid drugs. According to our knowledge, this is the second case of KTS managed for femoral fracture. Unlike the previous report in literature, in this case a severe disabling neuropathic pain complicated the clinical management.

Irreducible posterolateral dislocation of the knee: A case report

Irreducible posterolateral dislocations of the knee are rare lesions, generally caused by high-energy trauma inducing rotational stress and a posterior and lateral displacement of the tibia. In these conditions, the interposition of abundant soft tissue inside the enlarged medial joint space prevents spontaneous reduction or non-surgical treatment by manipulation of the dislocation. Surgical treatment is therefore compulsory. We report the clinical case of a woman who suffered a subluxation of the knee while jogging. The case we describe is of interest because it shows that even less severe knee dislocations, like this subluxation caused by a low-velocity sports trauma, may present in an irreducible form requiring open surgery. Clinical-instrumental monitoring did not reveal any signs of vascular or nerve injury. Owing to the irreducibility of the lesion we were obliged to perform open surgery in order to free the joint from the interposed muscle tissue and repair medial capsule-ligament lesions. Repair of the damaged cruciate ligaments was deferred to a second stage, but ultimately rendered necessary by the persistence of joint instability and the need to address the patients functional needs. In the literature, different one- and two-step surgical options, performed by arthroscopy or arthrotomy, are reported for such related problems. The Authors discuss these various options and examine and discuss their own decision taken during the surgical work-up of this case.

Effects of training on postural stability in young basketball players

BACKGROUND in basketball, balance ability is important to reduce non-contact injuries. The purpose of the present study was to investigate the effect of training on balance. METHODS thirty-two healthy male volunteers were recruited from amateur basketball teams. They were asked to perform the Balance Error Scoring System BESS test in order to measure the number of stability errors in six conditions. The test was performed at the beginning of the season (T0) and after 12 weeks (T1). In both cases the test was carried out before (pre-session) and after a training session (post-session). RESULTS the comparison of the total BESS scores both pre- and post-session showed a statistically significant increase of stability errors at both T0 and T1 (T0: pre-session 8.6±6.1 errors, post-session 10.7±6.3 errors; t=-4.03; p=0.002) (T1: pre-session 7.2±3.8 errors, post-session 9.1±5.4 errors; t=-1.93; p=0.03). Between T0 and T1 we noticed a reduction of errors which reached a statistical significance during the pre-session time (t=2.75; p=0.0049). CONCLUSION stability improved after 12 weeks of training, even for those conditions for which no specific training was done to improve, such as on the soft surface and feet aligned in a tandem stance.

The Prevalence of Fragility Fractures in a Population of a Region of Southern Italy Affected by Thyroid Disorders.

In the literature there is no clear evidence of a relationship between thyropathies and fragility fractures. The aim of our study is to define the prevalence of thyroid disease in a study sample made up of subjects with fragility fractures and from the same geographical area. We retrospectively studied the “hospital discharge records” (HDR) in the Apulian Database for the period 2008–2013 in order to identify all those patients with fragility fractures that required hospitalization. After detecting the prevalent population, we identified the patients affected by thyroid disease. We observed that, between 2008 and 2013 in Apulia, 16,636 patients were affected by hyperthyroidism. In the same period there were 92,341 subjects with hypothyroidism. The incidence of fragility fractures was 4.5% in the population with hyperthyroidism. As regards the population with hypothyroidism, the incidence of fragility fractures was 3.7%. Furthermore, we assessed the statistical connection between thyroid disease and fragility fractures revealing a higher incidence in patients with hyperthyroidism and clinical hypothyroidism.