284 research outputs found
Current practice in shoulder pathology : results of a web-based survey among a community of 1,084 orthopedic surgeons
No full textThe aim of this study was to report orthopedic surgeons' management of choice for difficult clinical scenarios of shoulder pathologies.
A web questionnaire was developed including four clinical scenarios of shoulder pathologies. Subsequently, opinions were solicited from more than 1,000 members of an international association of surgeons specialized in sports traumatology and knee surgery (ESSKA).
The response rate was 40% (412 questionnaires). For scenario 1, first anterior dislocation of the shoulder, the most indicated treatment for 71% of respondents was an arthroscopic Bankart repair (P < 0.001). For scenario 2, shoulder arthritis with concentric erosion and cuff tear, 38% chose a shoulder replacement, while 37% preferred a supraspinatus tendon repair in combination with long head of biceps (LHB) tenodesis or tenotomy. For scenario 3, large tendon tears with 70% fatty infiltration of the infraspinatus tendon and lateral LHB instability, 70% of surgeons considered that, among conservative treatments, hyaluronic acid injection was not an appropriate management. Arthroscopic rotator cuff repair, arthroscopic acromioplasty, and LHB tenotomy gained larger consensus (81, 80, and 79% of respondents, respectively). A double-row technique for rotator cuff repair was preferred to a single-row technique (P = 0.02). Scenario 4, adhesive capsulitis, split the respondents equally, with 51% in favor of a surgical approach and 49% in favor of a conservative approach (N.S.).
On-line questionnaires have the potential to improve knowledge about current trends in clinical practice and can help orthopedic surgeons to develop guidelines.
Level of evidence Cross-sectional; LevelV(expert opinion)
Efficacy and safety of eperisone in patients with low back pain : a double blind randomized study
No full textEperisone hydrochloride (4′-ethyl-2-methyl-3-piperidinopropiophenone hydrochloride) is an antispastic agent used for treatment of diseases characterized by muscle stiffness and pain. The aim of this research was to investigate the efficacy of eperisone in patients with acute low back pain and spasticity of spinal muscles. The study design was a randomized, double-blind (double-dummy) study in 160 patients with low back pain and no Rx finding of major spinal diseases, randomly assigned to a treatment with oral eperisone 100 mg three times daily (t.i.d.) or thiocolchicoside 8 mg twice daily (b.i.d.) for 12 consecutive days. Analgesic activity was evaluated by scoring "spontaneous pain" (VAS) and pain on movement and pression (4-digit scale), while muscle relaxant activity of the medication was evaluated by means of the "hand-to-floor" distance and the Lasegue's manoeuvre. All the measures were done at the inclusion day and after 3, 7 and 12 days of treatment. The two medications had comparable analgesic and muscle relaxant efficacy. Sponta-neous pain and pain on movement/pressure were significantly reduced by both treatments. Moreover, both eperisone- and thiocolchicoside-treated patients showed a clinically evident muscle relaxation as proved by a progressive reduction in the "hand-to-floor" distance and increase in the articular excursion (Lasegue's manoeuvre). Only 5% of eperisone-treated patients showed minor gastrointestinal side effects, while the incidence of side effects in the thiocolchicoside group was 21.25%. Moreover, in the thiocolchicoside-treated patients also diarrhoea was present, which reached a moderate intensity in some cases. In conclusions, eperisone represents a valuable and safer alternative to other muscle relaxant agents for treatment of low back pain
Sonographic versus radiographic measurement of subacromial space width
No full textPURPOSE: It was the purpose of the study to compare the accuracy of sonographic and radiographic measurement of the subacromial space width, and to verify its variations in relation to the morphology of the acromion, to age, to sex and to pathologies of the rotator cuff.
MATERIALS AND METHODS: We compared the radiographic and sonographic examinations for 200 consecutive shoulders. The shoulders examined were divided into 4 groups based on age and pathology of the rotator cuff.
RESULTS: We observed that the results obtained in the two different methods of measurement were comparable and statistically significant (p = 0.8). Furthermore, they are corresponded to the morphology of the acromion. Measurement of the subacromial space was in relation to acromial morphology, female sex and pathology of the cuff, but not in relation to age.
CONCLUSIONS: Sonography proved to be safe, accurate and useful in measuring the subacromial space, and comparable to what is obtained when radiography is used. We believe that measurement may be the useful completion of the sonographic evaluation of the shoulder. Furthermore, we believe that it may also support the most diffused radiographic measurement and its completion and confirmation. Sonography is certainly useful because of its simplicity of execution, rapidity of use, and measurement of the subacromial space can easily be carried out during routine sonographic evaluation of the shoulder
A comparative study on the effectiveness of two different devices in the management of developmental dysplasia of the hip in infants
No full textAIM:The aim of this paper was to compare the results of treatment of developmental dysplasia of the hip (DDH) with two different devices.
METHODS:In 118 DDH, authors employed, in a blinded randomized study, Teuffel-Mignon (TF) and Coxa-Flex (CF) devices. In this study checked 51 hips type IIC; 43 type IID; 15 type IIIA; 9 type IIIB, by Graf classification.
RESULTS:Hips Graf's type C were recovered in median 60.09 days, with TM in 50, with CF in 63,45; hips type D in 100 days, with TM in 58,50, with CF in 89.00; hips type IIIA in 103.60 days, with TM in 122, with CF in 94.50; hips type IIIB in 108.66 days, with TM in 121, with CF in 102.50.
CONCLUSION:The linear multiple regression model shows a statistically significant associations between outcome and pathological type (P value<0.001), age at diagnosis (P<0.001) and device (P<0.02). The statistical model shows that on average for each day of delay in the diagnosis is needed more than half a day for the patient to recover. The model confirmed that patients with more serious pathologies need more time to recover. Authors think that importance of the treatment of DDH isn't only the type of device employed, but a precise and correct sonographic diagnosis. Very important is starting the treatment as soon as possible, when the infant's bone of hip is more plastic and easy to treat. The authors' opinion is that employing a device instead of another isn't important, fundamental is the choice of the right device derived to a long time clinical experienc
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