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US-guided percutaneous treatment of shoulder calcific tendonitis: some clarifications are needed.
No full textWe read with great interest the article (1) by Dr Serafini and colleagues on ultrasonography (US)-guided percutaneous treatment of calcific tendinosis, which appeared in the July 2009 issue of Radiology. However, we have some concerns about their article:
Because calcific tendonitis is a self-limited condition, the assessment of outcomes in the treated population without an adequate control group could introduce a bias in the determination of response to therapy. In addition, a more objective imaging evaluation with radiography (2) or US (3) is required to determine the outcome of treatment and compare it with others. Without an adequate control, it is not obvious whether the reported success is due to spontaneous improvement, the local anesthetic, the two-needle treatment, the applied steroid, or a combination of factors.
The study group is not well characterized. The classification of calcific tendinosis (eg, as done by Gärtner and Simons [2]) has not been reported. Type III calcifications in the Gärtner and Simons classification system showed a high probability of spontaneous resolution (4), and patients with them have been excluded in a number of clinical trials (5–7). We are surprised at the complete absence of calcified supraspinatus tendons in this series of patients.
There are limited clinical follow-up data. Although this is a case control study, the 1-month, 3-month, and 1-year results may have clinical relevance. We are also concerned with the comparison of results at 5 years to those at 10 years since so many patients were lost to follow-up. Moreover, the reason for these losses is not explained.
We hope the authors can clarify their rationale for the study design limitations we have noted and clarify their approach to follow-up
A DEDICATED SYSTEM FOR MOVEMENT ANALYSIS
No full textObjectification of human movement in healthy and pathological conditions is currently desirable in many fields such as rehabilitation, orthopaedics, kinesiology and sports science. Although many systems have been developed for movement analysis their complexity greatly reduces their routine application, particularly in the clinical setting. This paper describes a new movement analysis system, based on image analysis and software object recognition. This system tracks and reconstructs the 3D pose and movements of a body region by using images acquired by 4 webcams and then by using image processing and computer vision techniques. As an example we describe the system applied to the recording of hand and finger pose and movements. However, following the same logical approach, it is possible to use it for other specific systems (such as shoulder, elbow, knee, ankle)
Objective Functional Assesment in the Deficient and Reconstructed ACL- A Short Review
No full textArthroscopic reconstruction of anterior cruciate ligament (ACL) has evolved to less invasive,
more anatomical approaches. Consequently, post-operative rehabilitation has likewise become more
progressive and innovative. On the other hand, few objective, functional criteria are used to determine
when patients with ACL reconstruction can return to sports activities. In recent years technologies in
the field of functional evaluation have been enormously developed, allowing an easier and more accurate
assessment of knee motion during athletic activities. Thus, the purpose of this paper is to summarize
the evidence from biomechanical studies on ACL-related research, encouraging orthopedic surgeons,
physiatrists, physiotherapists and athletic trainers with related background to better understand
biomechanics, injury aetiology, prevention, rehabilitation, stability assessment, and adaptations after
reconstruction for patients with ACL injury. Level of Evidence: 5 - Narrative Revie
Radial shock wave therapy for lateral epicondylitis: a prospective randomised controlled single-blind study
No full textDevelopment and validation of a new visa questionnaire (VISA-H) for patients with proximal hamstring tendinopathy.
No full textBackground There is a need for a patient-reported outcome (PRO) questionnaire to evaluate patients with proximal hamstring tendinopathy (PHT).
Objective To develop a PRO questionnaire based on VISA questionnaire forms for patients with PHT.
Methods Item generation, item reduction, item scaling and evaluation of the psychometric properties were used to develop a questionnaire to assess the severity of symptoms, function and ability to play sports in patients with PHT and healthy subjects. The final version, named Victorian Institute of Sport Assessment-Proximal Hamstring Tendons (VISA-H), consisted of eight questions that measured the domains of pain, function and sporting activity. The psychometric properties of a questionnaire were estimated in a population of non-surgical (n=20) and surgical (n=10) patients, as well as in healthy subjects (n=30).
Results The VISA-H questionnaire displayed a high degree of internal consistency, with a Cronbach α of 0.84. (The test–retest reliability was high for all groups of participants with an intraclass correlation coefficient ranging from 0.90 to 0.95.) The VISA-H exhibited a high correlation with the Nirschl phase rating scale (r ranging from −0.75 to −0.89) and a generic tendon grading system proposed by Curwin and Stanish (r ranging from −0.70 to −0.88). Also, the responsiveness was higher for the VISA-H questionnaire with an area under the curve of 0.90 and a minimum clinically important difference of 22 points.
Conclusions The VISA-H is a PRO questionnaire with high psychometric properties for measuring pain, function and sporting activity in patients with PHT
Injured athletes returning to sports: the rate of force development as an adjunctive predictor for decision making
No full textCLINICAL APPLICATION OF SHOCK WAVE THERAPY (SWT) IN MUSCULOSKELETAL DISORDERS
No full textCurrently the application of shock wave therapy (SWT) in musculoskeletal disorders has been primarily used in the treatment of tendinopathies (proximal plantar fasciopathy, lateral elbow tendinopathy, calcific tendinopathy of the shoulder, and patellar tendinopathy, etc.) and bone defects (delayed- and non-union of bone fractures, avascular necrosis of femoral head, etc.). Although the mechanism of their therapeutic effects are still unknown, the majority of published papers have shown positive and beneficial effects of using SWT as a treatment for musculoskeletal disorders, with a success rate ranging from 65% to 91%, while the complications are low or negligible. The purpose of this paper is to inform the reader about the published data on the clinical application of SWT in the treatment of musculoskeletal disorders. In this paper, with the help of a literature review, indications and success rates for SWT in the treatment of musculoskeletal disorders are outlined, while adequate SWT parameters (e.g., rate of impulses, energy flux density, etc.) are defined according to the present state of knowledge
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