Bone marrow edema syndrome is a severely disabling painful condition without a defined treatment ... more Bone marrow edema syndrome is a severely disabling painful condition without a defined treatment and related to pathogenetic mechanisms not yet clearly recognized. We report the case of a 59-year-old post-menopausal woman, affected by bone marrow edema associated with early osteonecrosis of the femoral head with secondary appearance of a rare migrant bone edema of the hip acetabulum. Clinical evaluation and magnetic resonance imaging were used to monitor the outcome of the patient. Pre-treatment clinical evaluation revealed pain upon stepping with the left limb, reduced range of motion of spine and hip, and hip pain during passive rotation. Magnetic resonance imaging showed diffuse signal alteration of the head and neck of the left femur in relation to bone edema, associated with an unclear small cephalic area of the femoral head suggestive of initial osteonecrosis. A further computed tomography scan was performed that did not reveal any alterations in bone profile, interruption of the cortex, or trabecular bone collapse. We immediately started a multimodal conservative treatment administering neridronate (100 mg, intravenously) combined with calcium and vitamin D supplementation and biophysical therapies (magnetotherapy and extracorporeal shockwave therapy). We also instructed the patient not to bear the load on the affected lower limb during standing and walking, using crutches. After 2 months, a notable regression of pain with improvement in mobility was observed. Magnetic resonance imaging revealed complete regression of edema at the head and neck of the femur; however, the new appearance of acetabular bone edema of the ipsilateral acetabular roof was detected. After 4 months, a third magnetic resonance imaging showed the disappearance of the femoral head and acetabular roof defects as well as the complete clinical recovery of the patient. An early diagnosis and intervention are essential to conservatively treat cases of bone marrow edema syndrome.
The evolution and the increasing interest in sport medicine have been powerful drives to improve ... more The evolution and the increasing interest in sport medicine have been powerful drives to improve the state of art in many aspects, from basic science through diagnosis, treatment, rehabilitation and return to sport.
Orienteering races usually develop in wooded lands with large differences in slopes. In addition ... more Orienteering races usually develop in wooded lands with large differences in slopes. In addition to the climbs, long descents are frequently covered. Therefore, lower limb muscular strength is necessary to sustain these challenges on rough terrains (1). Eight male orienteers of junior Italian team (OR; age, 19±1.6yr), 8 cross country track and fields experienced runners (TF; 20±4.5yr), and 8 sedentary persons (control group CG; 23±2.7yr), all with right lower limb dominance volunteered. Between groups, no age-, weight-, height-, and BMI-related differences were found (ANOVA, p>0.05). Each participant performed and an isokinetic dynamometer measured 5 repetitions of right and left knee flexion and extension at the angular speeds of 60-120-180-240-300deg/sec respectively. The ratios of peak torques between knee flexors and extensors were also computed, at each angular speed. Descriptive statistics were calculated within subject, group, movement, angular speed, and side. For each movement, the effects of group and side, and group×side interactions on peak torques at different speeds were compared by ANOVA (statistical significance 5%). On average within group, flexor and extensor muscles of the right knee were stronger than those of contralateral limb, but no significant differences were found. Side-related differences were similar in all groups (p>0.05). In both sides and movements at each angular speed, OR performed larger peak torques than TF and CG (p<0.001). For each angular velocity, the ratios between flexors and extensors were larger in OR (p<0.001). For orienteers, overcoming natural obstacles, and engaging eccentric work of knee muscles when running downhill could represent effective training tools. Data could be of interest for athletes, coaches, physical therapists, and physicians to set efficient training plans, to prevent trauma, and to define rehabilitation treatments. Further investigations should be extended to other muscular districts, and to other sports.
Objective: The aim of the study was to review the available literature on the application of oxyg... more Objective: The aim of the study was to review the available literature on the application of oxygen-ozone therapy (OOT) in the treatment of low back pain (LBP), to understand its therapeutic potential and compare it with other available treatment options. Materials and methods: A systematic review was performed on the PubMed and Scopus databases, with the following inclusion criteria: (1) randomized controlled trials (RCTs), (2) published in the last 20 years, (3) dealing with OOT in patients with LBP and herniated disc, (4) comparing the results of OOT with those of other treatments. The risk of bias was assessed by the Cochrane Risk of Bias tool. Results: Fifteen studies involving 2597 patients in total were included. Patients in the control groups received different treatments, from oral drugs to other injections, instrumental therapy and even surgery: corticosteroids were used in 5 studies, analgesic therapy in 2 studies; placebo, microdiscectomy, laser-therapy, TENS and postural rehabilitation, percutaneous radiofrequency intradiscal thermocoagulation and psoas compartmental block were tested in the other trials. Looking at the quality of the literature, none of the studies included reached "good quality" standard, 3 were ranked as "fair" and the rest were considered "poor". Comparison of OOT results with other approaches showed that, in the majority of studies, OOT was superior to the control treatment, and also when compared to microdiscectomy, ozone showed non inferiority in terms of clinical outcomes. Conclusions: The analysis of literature revealed overall poor methodologic quality, with most studies flawed by relevant bias. However, OOT has proven to be a safe treatment with beneficial effects in pain control and functional recovery at short to medium term follow-up.
The social impact and economic burden of low back pain are well known among the medical community... more The social impact and economic burden of low back pain are well known among the medical community. A novel therapeutic approach is represented by oxygen-ozone therapy, whose anti-inflammatory effects could be especially useful in patients with herniated discs. The most common administration is through a palpation-guided injection technique, although the use of ultrasound guidance could allow a more precise delivery of the therapeutic substance close to the nerve root. To describe the clinical outcomes following US-guided periradicular injection of oxygen-ozone as a treatment option for low back pain associated to sciatica in patients affected by symptomatic L5-S1 disc herniation. Ultrasound-guided periradicular injection of oxygen-ozone in L5-S1 herniation is a safe and effective minimally invasive treatment, able to improve both low back and radiating pain.
Background and objectives. The use of Comprehensive Geriatric Assessment (GCA) reduces the advers... more Background and objectives. The use of Comprehensive Geriatric Assessment (GCA) reduces the adverse outcomes of hospitalization in the elderly. However. GCA utilizes “time-consuming” tools, which are unsuitable for an acute-care setting. We tested a new quick multidimensional assessment tool for older patients (ARM-A). We derived a Frailty Index (FI) by associating the items about the medical history and the 3-months mortality after discharge. The aim of the study was to verify the association between FI and the clinical complexity of the patients and between FI and the different outcomes of the hospitalization.
Abstract Rotator cuff lesions cause pain and functional deficit. Nonsurgical management is the f... more Abstract Rotator cuff lesions cause pain and functional deficit. Nonsurgical management is the first line of treatment in most patients. The goal of conservative treatment is to restore muscular balance with sufficient glenohumeral stability to promote good shoulder function and to avoid surgery.
Telemedicine was shown to be indispensable during the SARS-CoV-2 pandemic to ensure continuity of... more Telemedicine was shown to be indispensable during the SARS-CoV-2 pandemic to ensure continuity of care for fragile patients. We compared a telerehabilitation program versus an outpatient rehabilitation program in women with breast cancer undergoing quadrantectomy surgery. There were 56 women with breast cancer divided into two groups: the treatment group (TG), made up of 24 patients undergoing a remote rehabilitation project program; and the control group (CG), composed of 32 patients subjected to the same rehabilitation project program in an outpatient setting. At the time of enrollment (T0) and the end of the 8 weeks of treatment (T1), the following questionnaire scores were considered: numerical rating scale (NRS), Disabilities of the Arm, Shoulder and Hand questionnaire (Quick-DASH), Piper fatigue scale (PFS)m and Breast Cancer Therapy Functional Rating Scale (FACT-B). We observed that the CG showed greater improvements than the TG in upper limb function (7.8 ± 4.2 vs. 10.9 ± 4....
Bone marrow edema syndrome is a severely disabling painful condition without a defined treatment ... more Bone marrow edema syndrome is a severely disabling painful condition without a defined treatment and related to pathogenetic mechanisms not yet clearly recognized. We report the case of a 59-year-old post-menopausal woman, affected by bone marrow edema associated with early osteonecrosis of the femoral head with secondary appearance of a rare migrant bone edema of the hip acetabulum. Clinical evaluation and magnetic resonance imaging were used to monitor the outcome of the patient. Pre-treatment clinical evaluation revealed pain upon stepping with the left limb, reduced range of motion of spine and hip, and hip pain during passive rotation. Magnetic resonance imaging showed diffuse signal alteration of the head and neck of the left femur in relation to bone edema, associated with an unclear small cephalic area of the femoral head suggestive of initial osteonecrosis. A further computed tomography scan was performed that did not reveal any alterations in bone profile, interruption of the cortex, or trabecular bone collapse. We immediately started a multimodal conservative treatment administering neridronate (100 mg, intravenously) combined with calcium and vitamin D supplementation and biophysical therapies (magnetotherapy and extracorporeal shockwave therapy). We also instructed the patient not to bear the load on the affected lower limb during standing and walking, using crutches. After 2 months, a notable regression of pain with improvement in mobility was observed. Magnetic resonance imaging revealed complete regression of edema at the head and neck of the femur; however, the new appearance of acetabular bone edema of the ipsilateral acetabular roof was detected. After 4 months, a third magnetic resonance imaging showed the disappearance of the femoral head and acetabular roof defects as well as the complete clinical recovery of the patient. An early diagnosis and intervention are essential to conservatively treat cases of bone marrow edema syndrome.
The evolution and the increasing interest in sport medicine have been powerful drives to improve ... more The evolution and the increasing interest in sport medicine have been powerful drives to improve the state of art in many aspects, from basic science through diagnosis, treatment, rehabilitation and return to sport.
Orienteering races usually develop in wooded lands with large differences in slopes. In addition ... more Orienteering races usually develop in wooded lands with large differences in slopes. In addition to the climbs, long descents are frequently covered. Therefore, lower limb muscular strength is necessary to sustain these challenges on rough terrains (1). Eight male orienteers of junior Italian team (OR; age, 19±1.6yr), 8 cross country track and fields experienced runners (TF; 20±4.5yr), and 8 sedentary persons (control group CG; 23±2.7yr), all with right lower limb dominance volunteered. Between groups, no age-, weight-, height-, and BMI-related differences were found (ANOVA, p>0.05). Each participant performed and an isokinetic dynamometer measured 5 repetitions of right and left knee flexion and extension at the angular speeds of 60-120-180-240-300deg/sec respectively. The ratios of peak torques between knee flexors and extensors were also computed, at each angular speed. Descriptive statistics were calculated within subject, group, movement, angular speed, and side. For each movement, the effects of group and side, and group×side interactions on peak torques at different speeds were compared by ANOVA (statistical significance 5%). On average within group, flexor and extensor muscles of the right knee were stronger than those of contralateral limb, but no significant differences were found. Side-related differences were similar in all groups (p>0.05). In both sides and movements at each angular speed, OR performed larger peak torques than TF and CG (p<0.001). For each angular velocity, the ratios between flexors and extensors were larger in OR (p<0.001). For orienteers, overcoming natural obstacles, and engaging eccentric work of knee muscles when running downhill could represent effective training tools. Data could be of interest for athletes, coaches, physical therapists, and physicians to set efficient training plans, to prevent trauma, and to define rehabilitation treatments. Further investigations should be extended to other muscular districts, and to other sports.
Objective: The aim of the study was to review the available literature on the application of oxyg... more Objective: The aim of the study was to review the available literature on the application of oxygen-ozone therapy (OOT) in the treatment of low back pain (LBP), to understand its therapeutic potential and compare it with other available treatment options. Materials and methods: A systematic review was performed on the PubMed and Scopus databases, with the following inclusion criteria: (1) randomized controlled trials (RCTs), (2) published in the last 20 years, (3) dealing with OOT in patients with LBP and herniated disc, (4) comparing the results of OOT with those of other treatments. The risk of bias was assessed by the Cochrane Risk of Bias tool. Results: Fifteen studies involving 2597 patients in total were included. Patients in the control groups received different treatments, from oral drugs to other injections, instrumental therapy and even surgery: corticosteroids were used in 5 studies, analgesic therapy in 2 studies; placebo, microdiscectomy, laser-therapy, TENS and postural rehabilitation, percutaneous radiofrequency intradiscal thermocoagulation and psoas compartmental block were tested in the other trials. Looking at the quality of the literature, none of the studies included reached "good quality" standard, 3 were ranked as "fair" and the rest were considered "poor". Comparison of OOT results with other approaches showed that, in the majority of studies, OOT was superior to the control treatment, and also when compared to microdiscectomy, ozone showed non inferiority in terms of clinical outcomes. Conclusions: The analysis of literature revealed overall poor methodologic quality, with most studies flawed by relevant bias. However, OOT has proven to be a safe treatment with beneficial effects in pain control and functional recovery at short to medium term follow-up.
The social impact and economic burden of low back pain are well known among the medical community... more The social impact and economic burden of low back pain are well known among the medical community. A novel therapeutic approach is represented by oxygen-ozone therapy, whose anti-inflammatory effects could be especially useful in patients with herniated discs. The most common administration is through a palpation-guided injection technique, although the use of ultrasound guidance could allow a more precise delivery of the therapeutic substance close to the nerve root. To describe the clinical outcomes following US-guided periradicular injection of oxygen-ozone as a treatment option for low back pain associated to sciatica in patients affected by symptomatic L5-S1 disc herniation. Ultrasound-guided periradicular injection of oxygen-ozone in L5-S1 herniation is a safe and effective minimally invasive treatment, able to improve both low back and radiating pain.
Background and objectives. The use of Comprehensive Geriatric Assessment (GCA) reduces the advers... more Background and objectives. The use of Comprehensive Geriatric Assessment (GCA) reduces the adverse outcomes of hospitalization in the elderly. However. GCA utilizes “time-consuming” tools, which are unsuitable for an acute-care setting. We tested a new quick multidimensional assessment tool for older patients (ARM-A). We derived a Frailty Index (FI) by associating the items about the medical history and the 3-months mortality after discharge. The aim of the study was to verify the association between FI and the clinical complexity of the patients and between FI and the different outcomes of the hospitalization.
Abstract Rotator cuff lesions cause pain and functional deficit. Nonsurgical management is the f... more Abstract Rotator cuff lesions cause pain and functional deficit. Nonsurgical management is the first line of treatment in most patients. The goal of conservative treatment is to restore muscular balance with sufficient glenohumeral stability to promote good shoulder function and to avoid surgery.
Telemedicine was shown to be indispensable during the SARS-CoV-2 pandemic to ensure continuity of... more Telemedicine was shown to be indispensable during the SARS-CoV-2 pandemic to ensure continuity of care for fragile patients. We compared a telerehabilitation program versus an outpatient rehabilitation program in women with breast cancer undergoing quadrantectomy surgery. There were 56 women with breast cancer divided into two groups: the treatment group (TG), made up of 24 patients undergoing a remote rehabilitation project program; and the control group (CG), composed of 32 patients subjected to the same rehabilitation project program in an outpatient setting. At the time of enrollment (T0) and the end of the 8 weeks of treatment (T1), the following questionnaire scores were considered: numerical rating scale (NRS), Disabilities of the Arm, Shoulder and Hand questionnaire (Quick-DASH), Piper fatigue scale (PFS)m and Breast Cancer Therapy Functional Rating Scale (FACT-B). We observed that the CG showed greater improvements than the TG in upper limb function (7.8 ± 4.2 vs. 10.9 ± 4....
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