Publications by authors named "Teresa Venditto"

19 Publications

  • Page 1 of 1

Sagittal spinal alignment in patients with ankylosing spondylitis by rasterstereographic back shape analysis: an observational retrospective study.

Eur J Phys Rehabil Med 2020 Apr 10;56(2):191-196. Epub 2020 Feb 10.

Department of Anatomy, Histology, Forensic Medicine and Orthopedics, La Sapienza University, Rome, Italy.

Background: Ankylosing spondylitis (AS) is a chronic-inflammatory disorder involving the sacroiliac-joints, spine, and spinal ligaments. A proper understanding of the sagittal plane alignment and posture is essential in managing deformities of the spine.

Aim: The aim of this study was to evaluate the differences in sagittal plane alignment between patients with AS and healthy subjects by means of rasterstereography and to analyze the relationship between clinical assessments and postural features.

Design: Observational retrospective study.

Setting: This study took place from January 2012 to April 2014 at the rheumatologic out-patient clinic, Umberto I Hospital, Rome, Italy.

Population: Forty-six healthy subjects and twenty-five AS patients were enrolled in the study.

Methods: Spinal posture was measured by the rasterstereographic system Formetric 4D. Trunk inclination, kyphosis angle, lordosis angle, cervical and lumbar plumbline distance, and sagittal pelvic alignment were analyzed. Differences between the two groups in postural parameters were compared (primary outcomes). Multiple regression analysis was used to evaluate if postural parameters could be predicted by the Bath Ankylosing Spondylitis Metrology Index (BASMI) that is a composite index of spinal mobility, disease duration and body mass index (secondary outcomes).

Results: Patients with AS showed a significant increase in the kyphosis angle and the cervical plumbline distance and a significant reduction in the lordosis angle and the sagittal pelvic alignment when compared to healthy subjects. According to multiple regression analysis, BASMI influenced the kyphosis angle value with a standardized coefficient β of 1.93, the lordosis-angle value with a standardized coefficient β of -2.79 and sagittal pelvic alignment value with a standardized coefficient-β of -2.93.

Conclusions: Rasterstereography has proved to be a valid tool in monitoring change in spinal structure in AS patients and has shown a strong correlation with clinimetric parameters of AS (BASMI). Future studies are needed, with a greater number of patients, in order to better characterize the evidently existing relationship between postural changes in AS patients and rasterstereography.

Clinical Rehabilitation Impact: Rasterstereography has proved to be a valid tool in monitoring postural changes in AS patients and has shown a strong correlation with clinical evaluations. Therefore, the assessment of postural characteristics using the rasterstereographic system before and after a specific exercise program would be a reliable and valid advice without exposing subjects to high doses of radiations.
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http://dx.doi.org/10.23736/S1973-9087.20.05993-6DOI Listing
April 2020

Prediction of Responsiveness of Gait Variables to Rehabilitation Training in Parkinson's Disease.

Front Neurol 2019 2;10:826. Epub 2019 Aug 2.

Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.

Gait disorders represent one of the most disabling features of Parkinson's disease, which may benefit from rehabilitation. No consistent evidence exists about which gait biomechanical factors can be modified by rehabilitation and which clinical characteristic can predict rehabilitation-induced improvements. The aims of the study were as follows: (i) to recognize the gait parameters modifiable by a short-term rehabilitation program; (ii) to evaluate the gait parameters that can normalize after rehabilitation; and (iii) to identify clinical variables predicting improvements in gait function after rehabilitation. Thirty-six patients affected by idiopathic Parkinson's disease in Hoehn-Yahr stage 1-3 and 22 healthy controls were included in the study. Both clinical and instrumental (gait analysis) evaluations were performed before and after a 10-weeks rehabilitation treatment. Time-distance parameters, lower limb joint, and trunk kinematics were measured. At baseline evaluation with matched speed, almost all gait parameters were significantly different between patients and healthy controls. After the 10-weeks rehabilitation, most gait parameters improved, and spatial asymmetry and trunk rotation normalized. Multiple linear regression of gender combined with Unified Parkinson's Disease Rating Scale-III predicted both ΔSpeed and ΔStep length of both sides; gender combined with Unified Parkinson's Disease Rating Scale-II predicted ΔCadence; age combined with Hoehn-Yahr score and disease duration predicted Δtrunk rotation range of motion. Impaired gait parameters are susceptible to improvement by rehabilitation, and younger men with Parkinson's disease who are less severely affected and at early disease stage are more susceptible to improvements in gait function after a 10-weeks rehabilitation program.
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http://dx.doi.org/10.3389/fneur.2019.00826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688512PMC
August 2019

Rotator Cuff Degeneration: The Role of Genetics.

J Bone Joint Surg Am 2019 Apr;101(7):600-605

Department of Anatomy, Histology, Legal Medicine, and Orthopaedics, Sapienza, University of Rome, Rome, Italy.

Background: The literature is certain regarding the multifactorial etiology of rotator cuff degeneration. However, it remains unclear if rotator cuff degeneration exclusively depends on intrinsic and extrinsic factors or if it is also genetically determined. We compared the health status of cuff tendons, evaluated with a magnetic resonance imaging (MRI) study, between elderly monozygotic and dizygotic twins with the aim of separating the contributions of genetics from shared and unique environments.

Methods: The rotator cuff tendon status was assessed using the Sugaya classification by MRI. Heritability, defined as the proportion of total variance of a specific characteristic in a particular population due to a genetic cause, was calculated as twice the difference between the intraclass correlation coefficients for monozygotic and dizygotic pairs. The influence of shared environment, which contributes to twin and sibling similarity, was calculated as the difference between the monozygotic correlation coefficient and the heritability index.

Results: We identified 33 pairs of elderly twins: 17 monozygotic pairs and 16 dizygotic pairs, with a mean age (and standard deviation) of 64.62 ± 3.32 years. The polychoric correlation was 0.62 in monozygotic twins and 0.53 in dizygotic twins. The calculated heritability index was 0.18 (18%), and the contribution was 0.44 (44%) for the shared environment and 0.38 (38%) for the unique environment.

Conclusions: The role of genetics in rotator cuff degeneration is quantified by our study on elderly monozygotic and dizygotic twins; however, it is only partial with respect to the contribution of shared and unique environments.
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http://dx.doi.org/10.2106/JBJS.18.00761DOI Listing
April 2019

The effects of rotator cuff tear on shoulder proprioception.

Int Orthop 2019 01 14;43(1):229-235. Epub 2018 Sep 14.

Department of Anatomy, Histology, Legal Medicine and Orthopedics, Sapienza, University of Rome- Shoulder and Elbow Surgery Unit, Polo Pontino (ICOT), Latina, Italy.

Purpose: To evaluate the effects of rotator cuff tear (RCT) and its severity on shoulder proprioception.

Methods: We studied 132 consecutive patients (67 M-65 F; mean age ± SD, 66.03 ± 9.04; range, 43-78) who underwent arthroscopic rotator cuff repair. Tear size was determined intra-operatively. The control group included 82 subjects (38 M-44 F; mean age ± SD, 65.87 ± 8.06; range, 41-75) with no RCT. All participants, wearing an eye mask, were submitted to the evaluation of the joint position sense (JPS) at 30°, 60°, 90°, 120°, and 150° of shoulder forward flexion during the sitting position, using a digital inclinometer securely attached to the subject's arm using hook-and-loop straps. The passive placement and active replacement method was used; the order of the tested angles was randomly selected. The entire test was repeated three times. The error score, by averaging the three trials, was measured as the absolute difference between the target angle and the observed angle. Statistics were performed.

Results: The intraclass correlation coefficient for all degrees of flexion movement measured was > 0.90, exhibiting a very high correlation. We found significant differences between cases and controls regarding the results of joint position sense error at all measurements (p < 0.05). According to RCT size, we found significant differences between groups at 30° (F = 27.27, p < 0.001), 90° (F = 5.37, p = 0.006), 120° (F = 10.76, p < 0.001), and 150° (F = 30.93, p < 0.001) of shoulder flexion; in details, patients with massive RCT showed greater absolute error value than those with both small and large RCT at 30°, 90°, 120°, and 150° of shoulder flexion (p < 0.05).

Conclusions: RCT provokes an alteration of shoulder proprioception, evaluated as the loss of joint position sense, and the impairment is related to tear severity.
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http://dx.doi.org/10.1007/s00264-018-4150-1DOI Listing
January 2019

Reliability of the Cervical Spine Device for the Assessment of Cervical Spine Range of Motion in Asymptomatic Participants.

J Manipulative Physiol Ther 2018 05;41(4):342-349

Department of Anatomical, Histological, Forensic Medicine and Orthopedic Science, Sapienza University of Rome, Rome, Italy.

Objective: The purpose of this study was to assess the inter- and intra-assessor reliability of the cervical spine device (Formetric, DIERS International GmbH, Schlangenbad, Germany) in measuring cervical range of motion.

Methods: The cervical spine device was used to measure the cervical range of motion of 65 asymptomatic participants. Flexion-extension, right and left rotation, and right and left lateral flexion were analyzed. Two different assessors performed the measurements on the same day to estimate inter-assessor reliability and 2 days later to examine intra-assessor reliability. Intra-assessor and inter-assessor reliability was assessed using the intraclass correlation coefficient (ICC). The standard error of measurement (SEM) and the smallest detectable difference (SDD) were also estimated.

Results: Inter-assessor reliability ICCs for flexion + extension and total lateral flexion movements were >0.90. The ICCs for rotation movements and for left lateral flexion were >0.70. The ICCs for flexion (0.64), extension (0.58), and right lateral flexion (0.56) indicated moderate correlation. Mean SEMs ranged from 2.28° (SDD = 6.31°) for left rotation to 8.08° (SDD = 22.38°) for total rotation. As for intra-assessor test-retest reliability, all ICCs were >0.70. Mean SEMs ranged from 3.14° (SDD = 8.70°) for total lateral flexion to 7.50° (SDD = 20.77°) for extension.

Conclusion: Both inter- and intra-observer reproducibility correlation values are moderate to high for measurements obtained using the cervical spine device.
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http://dx.doi.org/10.1016/j.jmpt.2018.01.003DOI Listing
May 2018

Comparison Between Extracorporeal Shock Wave Therapy and Intra-articular Hyaluronic Acid Injections in the Treatment of First Carpometacarpal Joint Osteoarthritis.

Ann Rehabil Med 2018 Feb 28;42(1):92-100. Epub 2018 Feb 28.

Department of Physical Medicine and Rehabilitation, Sapienza University of Rome, Rome, Italy.

Objective: To compare extracorporeal shockwave therapy (ESWT) with hyaluronic acid (HA) intra-articular injections in terms of pain relief, improvement in hand function, and strength in subjects with first carpometacarpal (CMC) joint osteoarthritis.

Methods: Fifty-eight patients received either focused ESWT or HA injection once a week for 3 consecutive weeks. In the ESWT group, 2,400 consecutive pulses were performed during each treatment session using a frequency of 4 Hz and an energy flux density of 0.09 mJ/mm. The HA group underwent one cycle of three injections of 0.5 cm HA. The main outcome measures were pain and hand function as measured by the visual analogue scale (VAS) and Duruoz Hand Index (DHI), respectively. The secondary outcomes were grip and pinch strength. Each assessment was performed at baseline, at the end of treatment, and at 3- and 6-month follow-up visits.

Results: According to VAS and DHI scores, a significant change in test performance was observed over time in both groups (p<0.001), with a greater average improvement in painful symptomatology at the 6-month follow-up in the ESWT group. A significant improvement in strength was observed in both groups, but the ESWT group showed better results on the pinch test starting immediately at the end of treatment.

Conclusion: The use of ESWT in patients with first CMC joint osteoarthritis leads to a reduction in pain, an improvement in pinch test performance that persists for at least 6 months, and a decrease in hand disability up to the 6-month follow-up visit.
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http://dx.doi.org/10.5535/arm.2018.42.1.92DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852235PMC
February 2018

Aetiopathogenesis of cuff-tear arthropathy: Could juvenile joint laxity be considered a predisposing factor?

Int Orthop 2018 05 23;42(5):1113-1117. Epub 2017 Dec 23.

Department of Anatomy, Histology, Legal Medicine and Orthopedics, Sapienza, University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.

Purpose: Although many hypotheses have been formulated, aetiopathogenesis of cuff-tear arthropathy (CTA) is still motive for discussion. Since prevalence of CTA is notoriously higher in women, as is joint hypermobility, we hypothesised a possible correlation between the two conditions.

Methods: One hundred thirty-three (n = 133) consecutive patients with glenohumeral osteoarthritis [48 men, 85 women; mean age (SD) 72.32 (7.05)] were divided into two groups: Groups 1 (CTA) and 2 (concentric shoulder arthropathy) comprised 71 (22 men, 49 women) and 62 (26 men, 36 women), respectively. The presence of current or previous joint hypermobility was assessed using two standardised methodologies: the Beighton criteria score, and a five-item self-report questionnaire. Data were submitted to statistical analysis.

Results: A moderate association between Beighton criteria and the five-item self-report (φ = 0.481, p < 0.001) was detected. Beighton criteria led to a diagnosis of joint hypermobility in 16 patients (22.5%) in Group 1 and 15 (24.2%) in Group 2. According to five-item self-report questionnaire, juvenile joint laxity was diagnosed in 11 (15.5%) and 12 (19.4%) patients in Groups 1 and 2, respectively. No significant association between groups and the Beighton criteria [χ(1) = 0.051, p = 0.82] and five-item self-report questionnaire [χ(1) = 0.67, p = 0.41] was found.

Conclusion: Juvenile joint hyperlaxity is not a predisposing factor for cuff arthropathy. Further studies will be needed to explain CTA aetiopathogenesis.

Levels Of Evidence: III.
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http://dx.doi.org/10.1007/s00264-017-3718-5DOI Listing
May 2018

Ultrasound guided injection of a painful knee osteoarthritis with medial meniscus extrusion: a case series study.

Muscles Ligaments Tendons J 2017 Apr-Jun;7(2):331-337. Epub 2017 Sep 18.

Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Board of Physical Medicine and Rehabilitation, "Sapienza" University, Rome, Italy.

Background: Meniscal subluxation results in the natural history of knee osteoarthritis (OA). Periarticular infiltration should minimize possible complications related to penetration of corticosteroids into the joint space in the treatment of knee OA.According to pain relief and improvement of function, the aim of this study is to evaluate the effectiveness of perimeniscal corticosteroid ultrasound guided injection in knee OA.

Methods: Thirty-two patients received an injection of 0.5 ml of methylprednisolone-acetate around perimeniscal tissues. Outcome measures were pain relief and knee function, assessed by Visual Analogue Scale (VAS) [24, 29, 30] measured at rest (VAS-R) and during stairs climbing (VAS-C) and by Italian-Western Ontario and McMaster Universities (WOMAC) scale. Clinical evaluation was performed at baseline, at 1 and 4 weeks of follow-up.

Results: Mean baseline values of VAS-R and VAS-C were 6.79 ± 1.17 and 7.6 ± 1.39, respectively. All subjects showed a significant reduction in pain over time (p<0.001). Mean baseline values of WOMAC pain, stiffness and physical function were 5.56 ± 1.32, 4.39 ± 1.91 and 4.63 ± 2.31, respectively. According to WOMAC stiffness and physical function was not found a significant improvement over time (p> 0.05).

Conclusion: Corticosteroid perimeniscal ultrasound guided injection can be considered as an adjunct to core treatment for the relief of moderate to severe pain in people with knee OA.

Level Of Evidence: IV.
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http://dx.doi.org/10.11138/mltj/2017.7.2.331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725183PMC
September 2017

The role of diabetes mellitus and BMI in the surgical treatment of ankle fractures.

Diabetes Metab Res Rev 2018 02 7;34(2). Epub 2017 Nov 7.

Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy.

Background: Open reduction and internal fixation is the standard treatment for displaced ankle fractures. However, the presence of comorbidities such as diabetes mellitus and body mass index (BMI) are associated with poor bone quality, and these factors may predict the development of postoperative complications. The study aim was to assess the role of diabetes mellitus and BMI in wound healing in patients younger than 65 years who were surgically treated for malleoli fractures.

Methods: Ninety patients, aged from 18 to 65 years old, with surgically treated ankle fracture, were retrospectively enrolled. Patients were classified in two groups: patient with diabetes and patients without diabetes (insulin-dependent and noninsulin dependent). All patients were assessed for wound complications, Visual Analogue Scale and Foot and Ankle Disability Index (FADI) were assessed for all patients. Logistic regression was used to identify the risk of wound complications after surgery using the following factors as explanatory variables: age, gender, duration of surgery, BMI, hypercholesterolemia, smoking history, diabetes mellitus, and high blood pressure.

Results: In total, 38.9% of patients showed wound complications. Of them, 17.1% were nondiabetics and 82.9% were diabetics. We observed a significant association between DM and wound complications after surgery (P = .005). Logistic regression analysis revealed that DM (P < .001) and BMI (P = .03) were associated with wound complications. The odds of having a postoperative wound complication were increased 0.16 times in the presence of diabetes and 1.14 times for increasing BMI.

Conclusion: This study showed that diabetes mellitus and higher BMI delay the wound healing and increase the complication rate in young adult patients with surgically treated bimalleolar fractures.
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http://dx.doi.org/10.1002/dmrr.2954DOI Listing
February 2018

The influence of playing surface on injury risk in italian elite rugby players.

Muscles Ligaments Tendons J 2017 Jan-Mar;7(1):180-185. Epub 2017 May 10.

Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, "Sapienza" University of Rome, Italy.

Background: There is a growing interest in the use of artificial turf surfaces in rugby. In particular, artificial surfaces may be an useful means of increasing participation in the sport by allowing greater usage of a given pitch, especially in regions where natural turf pitches are difficult to maintain.

Methods: The incidence of site, nature, cause, and severity of training and match injuries was prospectively recorded in two professional teams (one equipped with World Rugby certified third generation artificial turf and the other with natural grass over the 2014-2015 season).

Results: A total of 23,840 minutes of exposure was displayed for the whole sample, 1,440 minutes during matches and 22,400 during training sessions. We recorded 37 (48%) traumatic injuries and 39 (52%) overuse injuries. For traumatic injuries, we did not find significant differences in the overall risk injury between grass and artificial turf considering match exposure and training sessions. For overuse injuries, there were significant differences in the overall risk injury between grass and artificial turf considering match exposure (p=0.03) and training sessions (p=0.02).

Conclusion: In elite Italian rugby players, artificial turf seems to be safe in regards to traumatic injury while it seems to be a risk factor for overuse injuries.

Level Of Evidence: II.
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http://dx.doi.org/10.11138/mltj/2017.7.1.180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505587PMC
May 2017

Erratum.

Acta Orthop 2016 10 14;87(5):538. Epub 2016 Jul 14.

a Department of Orthopedics and Traumatology, Shoulder and Elbow Unit ;

Results - Total alcohol consumption, wine consumption, and duration of alcohol intake were higher in both men and women with RCT than in both men and women in the control group. Excessive alcohol consumption was found to be a risk factor for the occurrence of RCT in both sexes (men: OR =3.0, CI: 1.5-6.0, p < 0.001; women: OR =3.6, CI: 1.7-7.8, p < 0.001). Massive tears were associated with a higher intake of alcohol (especially wine) than smaller lesions.
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http://dx.doi.org/10.1080/17453674.2016.1210559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5016916PMC
October 2016

Assessing the Cervical Range of Motion in Infants With Positional Plagiocephaly.

J Craniofac Surg 2016 Jun;27(4):1060-4

*Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I †Board of Physical Medicine and Rehabilitation, Department of Anatomy, Histology, Forensic Medicine and Orthopedics, "Sapienza" University, Rome ‡Don Carlo Gnocchi ONLUS Foundation, Milan, Italy.

Purpose: To determine if infants with positional plagiocephaly have limitations of active and passive cervical range of motion measured with simple and reliable methods.

Methods: The examiners assessed bilateral active and passive cervical rotations and passive cervical lateral flexion. Cervical assessment was performed twice by 2 different physicians to assess intertester reliability. To assess intratester reliability the first investigator performed a second examination 48 hours after the first one.

Results: One-hundred nine subjects were analyzed; 70.7% of the sample had head positional preference on the right, while 29.3% had head positional preference on the left (χ 35.52, P <0.001). Cervical rotations and lateral flexion showed reliable levels of agreement for intra and intertester reliability.

Conclusions: The most limited range of motion in infants with positional plagiocephaly was cervical active rotation which affected more than 90% of patients. Passive cervical rotations and lateral flexion were limited in more than 60% of patients.
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http://dx.doi.org/10.1097/SCS.0000000000002644DOI Listing
June 2016

Association between alcohol consumption and rotator cuff tear.

Acta Orthop 2016 26;87(2):165-8. Epub 2015 Nov 26.

a Department of Orthopedics and Traumatology, Shoulder and Elbow Unit , Sapienza University , Rome , Italy. .

Background And Purpose: Long-term alcohol intake is associated with various negative effects on capillary microcirculation and tissue perfusion. We hypothesized that alcohol consumption might be a risk factor for both the occurrence and the severity of rotator cuff tears (RCTs).

Patients And Methods: A case-control study was performed. We studied 249 consecutive patients (139 men and 110 women; mean age 64 (54-78) years) who underwent arthroscopic rotator cuff repair. Tear size was determined intraoperatively. The control group had 356 subjects (186 men and 170 women; mean age 66 (58-82) years) with no RCT. All participants were questioned about their alcohol intake. Participants were divided into: (1) non-drinkers if they consumed less than 0.01 g of ethanol per day, and (2) moderate drinkers and (3) excessive drinkers if women (men) consumed > 24 g (36 g) per day for at least 2 years.

Results: Total alcohol consumption, wine consumption, and duration of alcohol intake were higher in both men and women with RCT than in both men and women in the control group. Excessive alcohol consumption was found to be a risk factor for the occurrence of RCT in both sexes (men: OR = 1.7, 95% CI: 1.2-3.9; women: OR = 1.9, 95% CI: 0.94-4.1). Massive tears were associated with a higher intake of alcohol (especially wine) than smaller lesions.

Interpretation: Long-term alcohol intake is a significant risk factor for the occurrence and severity of rotator cuff tear in both sexes.
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http://dx.doi.org/10.3109/17453674.2015.1119599DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4812079PMC
July 2016

17-Italian Foot Function Index with numerical rating scale: development, reliability, and validity of a modified version of the original Foot Function Index.

Foot (Edinb) 2015 Mar 13;25(1):12-8. Epub 2014 Oct 13.

Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, Rome, Italy.

Background: Clinical research quantifies symptoms and signs of pain.

Objective: To develop a brief outcome measure to assess foot and ankle conditions, the psychometric properties of a modified version of the original Foot Function Index (FFI) were examined.

Methods: Eighty-six subjects with musculoskeletal foot and ankle disorders were enrolled. The internal consistency and test-retest reliability were evaluated by using Cronbach's α and intraclass correlation coefficient (ICC). Criterion validity was tested by Pearson's correlation coefficient between 17 items of the Italian FFI (17-IFFI) and the Lower Extremity Functional Scale (LEFS). The responsiveness was calculated using the receiver operating characteristic curve (ROC).

Results: Cronbach's Alpha was 0.95 (95% CI: 0.92, 0.99). The intra-interviewer and inter-interviewer ICC values were, respectively, 0.92 (95% CI: 0.88-10 0.96) and 0.90 (95% CI: 0.89-0.94). Correlations between the 17-IFFI scores and the LEFS scores were -0.564 and -0.456 at the initial and at the end of the treatment, respectively. The ROC analysis revealed an area under the curve of 0.732 (95% CI: 0.61-0.82) for the 17-IFFI and 0.633 (95% CI: 0.52-0.71) for the LEFS score.

Conclusions: The 17-IFFI is a reliable and valid scale and we recommend its application to evaluate the effectiveness of a treatment in patients with musculoskeletal foot and ankle disorders.
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http://dx.doi.org/10.1016/j.foot.2014.09.004DOI Listing
March 2015

Misdiagnosis of plexiform neurofibroma of the medial plantar nerve: case report.

Foot (Edinb) 2014 Sep 12;24(3):143-5. Epub 2014 Jun 12.

Physical Medicine and Rehabilitation Unit, Sapienza University, Rome, Italy.

Plexiform neurofibromas are benign tumors of the peripheral nerve. Diagnosis may be challenging, if they present mimicking other peripheral nerve pathologies. We report the case of a patient who had severe foot pain, which progressively hampered her walking ability, erroneously attributed to recurrent Morton's neuroma. Diagnosis of plexiform neurofibroma of her right medial plantar nerve was made 15 years after the appearance of symptoms. Pain and function recovered after radical neurotomy of the medial plantar nerve. A correct diagnosis is an essential starting point in the treatment of neurofibromas and a misdiagnosis may lead to an inappropriate treatment.
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http://dx.doi.org/10.1016/j.foot.2014.06.001DOI Listing
September 2014

The association between body fat and rotator cuff tear: the influence on rotator cuff tear sizes.

J Shoulder Elbow Surg 2014 Nov 4;23(11):1669-74. Epub 2014 Jun 4.

Department of Orthopaedics and Traumatology, Shoulder and Elbow Unit, Sapienza University, Rome, Italy.

Background: Rotator cuff tear (RCT) has a multifactorial etiology. We hypothesized that obesity may increase the risk of RCT and influence tear size.

Materials And Methods: A case-control design study was used. We studied 381 consecutive patients (180 men, 201 women; mean age ± standard deviation, 65.5 ± 8.52 years; range, 43-78 years) who underwent arthroscopic rotator cuff repair. Tear size was determined intraoperatively. The control group included 220 subjects (103 men, 117 women; mean age ± standard deviation, 65.16 ± 7.24 years; range, 42-77 years) with no RCT. Body weight, height, and bicipital, tricipital, subscapularis, and suprailiac skinfolds of all participants were measured to obtain body mass index (BMI) and the percentage of body fat (%BF). For the purposes of the study, the 601 participants were divided into 2 groups by BMI (group A, BMI ≥ 25; group B, BMI < 25). The odds ratios (ORs) were calculated to investigate whether adiposity affects the risk of RCT. Data were stratified according to gender and age. Multiple linear regression analyses were applied to explore the association between obesity and tear size.

Results: The highest ORs for both men (OR, 2.49; 95% confidence interval, 1.41-3.90; P = .0037) and women (OR, 2.31; 95% confidence interval, 1.38-3.62; P = .0071) were for individuals with a BMI ≥ 30; 69% (N = 303) of group A and 48% (N = 78) of group B had RCTs. Patients with RCT had a BMI higher than that of subjects with no RCT in both groups (P = .031, group A; P = .02, group B). BMI and %BF significantly increased from patients with a small tear (BMI, 27.85; %BF, 37.63) to those with a massive RCT (BMI, 29.93; %BF, 39.43). Significant differences were found (P = .004; P = .031).

Conclusions: Our results provide evidence that obesity, measured through BMI and %BF, is a significant risk factor for the occurrence and severity of RCT.
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http://dx.doi.org/10.1016/j.jse.2014.03.016DOI Listing
November 2014

Intensity and distribution of shoulder pain in patients with different sized postero-superior rotator cuff tears.

J Shoulder Elbow Surg 2014 Jun 27;23(6):807-13. Epub 2013 Dec 27.

Shoulder and Elbow Unit, Department of Orthopaedics and Traumatology, University Sapienza, Rome, Italy.

Background: The vast majority of studies regarding rotator cuff tears (RCTs) are focused on etiopathogenesis and treatments, but information on shoulder pain characteristics needs further investigation. We analyzed the intensity and distribution of shoulder pain in patients with different sizes of RCTs.

Methods: Two hundred eighty-five consecutive patients with postero-superior RCTs were enrolled for this study. Tear size was intraoperatively classified. Before surgery, all patients completed an upper limb pain map (dermatome map made by Keegan). Shoulder pain intensity was assessed with a visual analogue scale (VAS). Data were submitted to statistical analysis.

Results: Shoulder pain intensity caused by a RCT was greater in females (P = .024); it did not vary with the side nor with age. Pain intensity was less in massive tears (P < .05) and in patients whose pain was distributed only to the shoulder (P = .035). Furthermore, patients whose pain persisted for more than 6 months maintained the same pain intensity. Pain was localized predominantly on dermatomes C5-C6, was more diffuse in massive tears (P < .05), and rarely extended beyond the elbow. In the presence of intense shoulder pain, its precise distribution was not well-delimited.

Conclusion: Shoulder pain characteristics in patients with RCTs may be influenced by gender and size of tear. Cuff tear pain distribution principally involves the antero-lateral aspect of the shoulder with extension down the lateral surface of the arm to the elbow. Information about pain intensity and distribution in patients with RCTs may contribute to a more accurate diagnosis.

Levels Of Evidence: Level III, cross sectional study.
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http://dx.doi.org/10.1016/j.jse.2013.09.011DOI Listing
June 2014

Clinical improvement and resorption of calcifications in calcific tendinitis of the shoulder after shock wave therapy at 6 months' follow-up: a systematic review and meta-analysis.

Arch Phys Med Rehabil 2013 Sep 13;94(9):1699-706. Epub 2013 Mar 13.

Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, Rome, Italy.

Objectives: To evaluate the effectiveness of shock wave therapy (SWT) for functional improvement and the reduction of pain in patients with calcific tendinitis of the shoulder, and to determine the rate of disappearance of calcifications after therapy at 6 months' follow-up.

Data Sources: Articles were searched from the Cochrane Library, MEDLINE, Embase, CINAHL, and Ovid database.

Study Selection: We included randomized controlled trials from 1992 to 2011, and their quality was assessed using the Physiotherapy Evidence Database (PEDro) scale.

Data Extraction: Studies were evaluated by 2 independent reviewers for their methodologic quality. Disagreements were settled by a third reviewer. Data were then extracted and cross-checked for accuracy. The reviewers were not blinded to the authors of the articles.

Data Synthesis: In 4 of the 6 studies included for review, the resorption of calcifications was evaluated using meta-analysis because the studies had 2 treatment groups, while the other 2 studies were analyzed descriptively because they had 3 treatment groups. Fixed- and random-effects models were used to meta-analyze total and partial resorption ratios, and I(2) statistics were calculated to assess heterogeneity.

Conclusions: We found a clinical improvement with a pooled total resorption ratio of 27.19 (95% confidence interval [CI], 7.20-102.67) and a pooled partial resorption ratio of 16.22 (95% CI, 3.33-79.01). SWT increases shoulder function, reduces pain, and is effective in dissolving calcifications. These results were maintained over the following 6 months.
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http://dx.doi.org/10.1016/j.apmr.2013.01.030DOI Listing
September 2013

Extracorporeal shock-wave therapy for supraspinatus calcifying tendinitis: a randomized clinical trial comparing two different energy levels.

Phys Ther 2012 Nov 28;92(11):1376-85. Epub 2012 Jun 28.

Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, School of Medicine, "La Sapienza" University of Rome, Rome, Italy.

Background: Extracorporeal shock-wave therapy (ESWT) represents a valid intervention in the treatment of people with supraspinatus calcifying tendinitis (SCT), but there is limited evidence for the useful range of ESWT doses.

Objective: The aim of this study was to compare 2 different ranges of energy flux density in treatment of SCT with ESWT.

Design: This study was designed as a single-blind randomized clinical trial.

Setting: This study was performed in a university hospital.

Patients: Forty-six patients with SCT were randomly assigned to 2 groups that received different therapeutic energy doses of ESWT: (1) group A received ESWT at an energy level of 0.20 mJ/mm², and (2) group B received ESWT at an energy level of 0.10 mJ/mm².

Intervention: The treatment protocol consisted of 4 sessions performed once a week.

Measurements: The change in mean Constant Murley Scale (CMS) scores at 3 and 6 months was the primary endpoint. The change in the mean visual analog scale (VAS) scores from baseline to 3 and 6 months after the intervention and radiographic change in size of calcium deposits were evaluated as secondary endpoints. At 12 months, pain relief was assessed using a numeric rating scale.

Results: Significant clinical improvement based on mean CMS scores was observed after 6 months in group A (X=79.43, SD=10.33) compared with group B (X=57.91, SD=6.53). Likewise, after 6 months, a significant decrease in VAS scores was found in group A (X=2.09, SD=1.54) compared with group B (X=5.36, SD=0.78). Calcific deposits disappeared in the same percentage of patients in both groups.

Limitations: The small sample size and lack of a control group were limitations of the study.

Conclusions: In ESWT for SCT, an energy level of 0.20 mJ/mm² appears to be more effective than an energy level of 0.10 mJ/mm² in pain relief and functional improvement.
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http://dx.doi.org/10.2522/ptj.20110252DOI Listing
November 2012