1,721,029 research outputs found
Conservative management of tendinopathy: an evidence-based approach
Full text linkTendinopathy is one of the most frequent overuse injuries associated with sport. It is a failure of a chronic healing response associated with both chronic overloaded and unloaded states. Although several conservative therapeutic options have been proposed, very few of them are supported by randomized controlled trials. Eccentric exercises provide excellent clinical results both in athletic and sedentary patients, with no reported adverse effects. Combining eccentric loading and low-energy shock wave therapy produces higher success rates compared with eccentric training alone or shock wave therapy alone. High-volume injection of normal saline solution, corticosteroids, or anesthetics can reduce pain and improve long-term function in patients with Achilles or patellar tendinopathy. The use of injectable substances such as platelet-rich plasma, autologous blood, polidocanol, and corticosteroids in
and around tendons is not support by strong clinical evidence. Further randomized controlled trials are necessary to define the best conservative management of tendinopath
Role of percutaneous distal metatarsal osteotomy for the management of hallux valgus deformity.
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New options in the management of tendinopathy.
No full textTendon injuries can be acute or chronic, and caused by intrinsic or extrinsic factors, either alone or in combination. Tendinopathies are a common cause of disability in occupational medicine and account for a substantial proportion of overuse injuries in sports. Tendinopathy is essentially a failed healing response, with haphazard proliferation of tenocytes, abnormalities in tenocytes, with disruption of collagen fibres and subsequent increase in noncollagenous matrix. The scientific evidence base for managing tendinopathies is limited. What may appear clinically as an "acute tendinopathy" is actually a well advanced failure of a chronic healing response in which there is neither histologic nor biochemical evidence of inflammation. In this review we report the new options for the management of tendinopathy, including eccentric exercises, extracorporeal shockwave therapy, injections (intratendinous injections of corticosteroids, aprotinin, polidocanol platelet-rich plasma, autologous blood injection, high-volume injections) and surgery. Open surgery aims to excise fibrotic adhesions, remove areas of failed healing and make multiple longitudinal incisions in the tendon to detect intratendinous lesions, and to restore vascularity and possibly stimulate the remaining viable cells to initiate cell matrix response and healing. New surgical techniques aim to disrupt the abnormal neoinnervation to interfere with the pain sensation caused by tendinopathy. These procedures are intrinsically different from the classical ones in present use, because they do not attempt to address directly the pathologic lesion, but act only to denervate them. They include endoscopy, electrocoagulation, and minimally invasive stripping. Further randomized controlled trials are necessary to clarify better the best therapeutic options for the management of tendinopathy
Osteoporotic vertebral fractures: current concepts of conservative care.
No full textIntroduction: Osteoporotic vertebral compression fractures (VCFs) are a growing public health problem with important socio-economic effects in western countries. In the USA, 10 million people over 50 suffer from osteoporosis. In these patients, 1.5 million annual fractures have been registered, and 50% of these are vertebral compression.
Sources of data: We performed a comprehensive search of PubMed, Medline, Cochrane, CINAHL and Embase databases using various combinations of the keywords ‘osteoporosis’, ‘vertebral compression fractures’, ‘brace’, ‘bracing’, ‘orthosis’, ‘conservative management’ and ‘rehabilitation’ over the years 1966– 2011. All articles relevant to the subject were retrieved, and their bibliographies were hand searched for further references in the context of conservative management of osteoporotic vertebral fractures.
Areas of agreement: Conservative management for patients with osteoporotic vertebral fractures includes bed rest, pain medication, physiotherapy and bracing.
Areas of controversy: A conservative management for patients with osteoporotic VCFs s has not been standardized. The utility of vertebral augmentation techniques has been questioned by recent randomized controlled trials.
Growing points: Randomized controlled trials are being performed worldwide on vertebral augmentation techniques.
Areas timely for developing research: Although spinal orthoses are commonly used for the management of patients with osteoporotic vertebral fractures, in the literature there is only one randomized controlled trial on bracing for this condition. While the best conservative management for subjects with osteoporotic VCFs s is not defined and standardized, no conclusions on the superiority of vertebral augmentation techniques over conservative management can be drawn
Rating systems for evaluation of the elbow.
No full textINTRODUCTION:
Many scoring systems have been used for elbow disorders. However, only few of these have been validated, and many assess only few aspects of elbow function.
METHODS:
A literature search was performed using the keyword 'elbow' in combination with 'scoring system', 'outcome assessment', 'elbow disorder' and 'clinical evaluation'.
RESULTS:
Eighteen scoring systems are currently available for the evaluation of elbow disorders. Each of them evaluates the elbow performance using specific variables, including both objective and subjective criteria. All these scoring systems are presented.
DISCUSSION:
Although many scoring systems have been used to evaluate elbow function, we are still far from a single outcome evaluation system which is reliable, valid and sensitive to clinically relevant changes, takes into account both patients' and physicians' perspective and is short and practical to use.
CONCLUSION:
Further studies are required to evaluate the reliability, validity and sensitivity of the elbow scoring systems used in the common clinical practice
Osteoporotic vertebral fractures: current concepts of conservative care.
No full textINTRODUCTION:
Osteoporotic vertebral compression fractures (VCFs) are a growing public health problem with important socio-economic effects in western countries. In the USA, 10 million people over 50 suffer from osteoporosis. In these patients, 1.5 million annual fractures have been registered, and 50% of these are vertebral compression.
SOURCES OF DATA:
We performed a comprehensive search of PubMed, Medline, Cochrane, CINAHL and Embase databases using various combinations of the keywords 'osteoporosis', 'vertebral compression fractures', 'brace', 'bracing', 'orthosis', 'conservative management' and 'rehabilitation' over the years 1966-2011. All articles relevant to the subject were retrieved, and their bibliographies were hand searched for further references in the context of conservative management of osteoporotic vertebral fractures.
AREAS OF AGREEMENT:
Conservative management for patients with osteoporotic vertebral fractures includes bed rest, pain medication, physiotherapy and bracing.
AREAS OF CONTROVERSY:
A conservative management for patients with osteoporotic VCFs s has not been standardized. The utility of vertebral augmentation techniques has been questioned by recent randomized controlled trials.
GROWING POINTS:
Randomized controlled trials are being performed worldwide on vertebral augmentation techniques.
AREAS TIMELY FOR DEVELOPING RESEARCH:
Although spinal orthoses are commonly used for the management of patients with osteoporotic vertebral fractures, in the literature there is only one randomized controlled trial on bracing for this condition. While the best conservative management for subjects with osteoporotic VCFs s is not defined and standardized, no conclusions on the superiority of vertebral augmentation techniques over conservative management can be drawn
Musculoskeletal problems in soccer players: current concepts.
No full textSoccer is the most popular sport worldwide, with about 200 million players, both professionals and amateurs. Because of its popularity, it has been often proposed to be able to prevent or cure health problems around the world. Although participation in football leads to significant physical benefits such as improving well-being, extending life expectancy and reducing the likelihood of several major non-communicable diseases, the possibility to incur in soccer injuries must be considered. On average, an elite football player suffers from 1.5-7.6 injuries each 1,000 hours of training and 12-35 injuries each 1000 hours of match. Several risk factors for soccer injuries have been described. The most important of them are the level of play (the risk appears to be higher in professional than amateur players); the exercise load; and the standard of training. The injury prevention program "The 11", developed with the support of the Federation Internationale de Football Association (FIFA), aims to reduce the impact of intrinsic injury risk factors in soccer, and it has been validated in that sport. A successive modified version of "The 11" ("The 11+") has been also shown to be effective in preventing injuries in young female soccer players. The FIFA 11+ provided more than 40% of reduction of the risk of injury. Several factors can be related to the risk of injury during sport. Therefore different exercises or factors might have been responsible for efficacy of the FIFA 11+ to prevent injuries. Several improvements have been surely achieved in the last ten years, but further investigation is needed to improve the benefits of playing soccer on human health
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