The role of tuning fork in the evaluation of musculoskeletal disorders and pallesthesia: A scoping review.

BACKGROUND: Musculoskeletal and neurological conditions disorders are important conditions that need to be assessed in clinical practice. The tuning fork (TF) has been proposed as a practical tool to investigate suspected fractures and for the evaluation of pallesthesia in subjects with peripheral neuropathy. OBJECTIVE: the aim of this study is to define whether the tuning fork can be useful in the clinical evaluation of patients with musculoskeletal disorders and deep somatosensory dysfunctions. METHODS: This scoping review was performed in accordance with Joanna Briggs Institute. MEDLINE, Cochrane Library, PEDro, CINAHL, Web of Science, UpToDate, Scopus Database were consulted. RESULTS: 14 studies were included in the final analysis. Nine studies regard the use of tuning fork to detect fractures. If the tuning fork was used with a stethoscope, the test reached a high sensitivity ranging between 83% and 94%. Five studies investigated the tool to evaluate pallesthesia dysfunctions among which possible differences between biceps femoris strain and simple clinical rules for detecting peripheral neuropathy. CONCLUSION: The 128 Hz tuning fork could be potentially useful to detect some type of traumatic fractures. The Rydel-Seiffer tuning fork appears to be a useful tool for assessing potential nerve conduction deficits in the evaluation of pallesthesia.

Italian version of the Cumberland Ankle Instability Tool (CAIT-I).

STUDY DESIGN: Evaluation of the psychometric properties of a translated, culturally adapted questionnaire. OBJECTIVE: Translating, culturally adapting, and validating the Italian version of the Cumberland Ankle Instability Tool (CAIT-I). SUMMARY OF BACKGROUND DATA: Ankle sprains are one of the most common musculoskeletal injuries and can lead to chronic ankle instability (CAI). The International Ankle Consortium recommends the Cumberland Ankle Instability Tool (CAIT) as a valid and reliable self-report questionnaire assessing the presence and severity of CAI. At this moment, there is no validated Italian version of CAIT. METHODS: The Italian version of the CAIT (CAIT-I) was developed by an expert committee. Test-retest reliability of the CAIT-I was measured in 286 healthy and injured participants within a 4-9-day period, by using Intraclass Correlation Coefficients (ICC2,1). Construct validity, exploratory factor analysis, internal consistency and sensitivity were examined in a sample of 548 adults. Instrument responsiveness over 4 time points was determined in a subgroup of 37 participants. RESULTS: The CAIT-I demonstrated excellent test-retest reliability (ICC≥0.92) and good internal consistency (α = .84). Construct validity was confirmed. Identified cut-off for the presence of CAI was 24.75, with sensitivity= 0.77 and specificity= 0.65. There were significant differences across time for CAIT-I scores (P < .001), demonstrating responsiveness to change, but no floor or ceiling effects. CONCLUSION: The CAIT-I demonstrates acceptable psychometric performance as a screening and outcome measure. The CAIT-I is a useful tool to assess the presence and severity of CAI.

Diagnostic accuracy of clinical tests to rule out elbow fracture: a systematic review.

Elbow traumas represent a relatively common condition in clinical practice. However, there is a lack of evidence regarding the most accurate tests for screening these potentially serious conditions and excluding elbow fractures. The purpose of this investigation was to analyze the literature concerning the diagnostic accuracy of clinical tests for the detection or exclusion of suspected elbow fractures. A systematic review was performed using the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines. Literature databases including PubMed, Cumulative Index to Nursing and Allied Health Literature, Diagnostic Test Accuracy, Cochrane Library, the Web of Science, and ScienceDirect were searched for diagnostic accuracy studies of subjects with suspected traumatic elbow fracture investigating clinical tests compared to imaging reference tests. The risk of bias in each study was assessed independently by two reviewers using the Quality Assessment of Diagnostic Accuracy Studies 2 checklist. Twelve studies (4,485 patients) were included. Three different types of index tests were extracted. In adults, these tests were very sensitive, with values up to 98.6% (95% confidence interval [CI], 95.0%-99.8%). The specificity was very variable, ranging from 24.0% (95% CI, 19.0%-30.0%) to 69.4% (95% CI, 57.3%-79.5%). The applicability of these tests was very high, while overall studies showed a medium risk of bias. Elbow full range of motion test, elbow extension test, and elbow extension and point tenderness test appear to be useful in the presence of a negative test to exclude fracture in a majority of cases. The specificity of all tests, however, does not allow us to draw useful conclusions because there was a great variability of results obtained.

Combining a supervised and home-based task-oriented circuit training improves walking endurance in patients with multiple sclerosis. The MS_TOCT randomized-controlled trial.

BACKGROUND: Balance and mobility impairments are widespread in patients with Multiple Sclerosis (PwMS), even at an early stage. They can contribute to disability, physical deconditioning and reduced quality of life. Task-oriented is a training modality that may promote walking abilities and conditioning. However, the effects usually are short-lasting and exercising at home can have several barriers. This randomized controlled trial aimed to test the effectiveness of the combination of a 2-weeks in-person, supervised task-oriented circuit training (TOCT), followed by a 12-weeks home-based task-oriented program with monthly in-person visits. METHODS: 36 PwMS with EDSS 4-5.5 and unassisted walking have been randomly assigned to 10 supervised TOCT sessions over two weeks (Phase 1) followed by a 12-weeks home-based task-oriented program (Phase 2) or a delayed-treatment group. At the end of Phase 2, the delayed-treatment group (usual care) received the same TOCT protocol. Phase 1 was composed of six gait-based workstations and treadmill training, whereas Phase 2 was based on progressive task-oriented tasks practice at home with monthly visits to adjust activities levels. Six Minute Walk Test (6MWT), Timed 25-foot walk test (T25FW), Timed Up and Go test (TUG), Dynamic Gait Index (DGI), Modified Fatigue Impact Scale (MFIS), Multiple Sclerosis Walking Scale - 12 (MSWS-12), Multiple Sclerosis Impact Scale-29 (MSIS-29) and resting muscle oxygen consumption (rmVO2) were assessed as outcome measures at baseline, after Phase 1 and after Phase 2. Retention was tested on the whole sample at a 12-weeks follow-up. RESULTS: The entire sample completed the 2-weeks TOCT, whereas adherence was good for the 12-weeks home-based task-oriented program (6.2/10). The mean repetitions and level of difficulty of each task significantly increased after every timepoint. A superiority of task-oriented program was verified for 6MWT (F, 2,88 = 7.80; p<0.001) on usual care after the 12-weeks home-based program. Moreover, between-group differences were highlighted at the same point, even for T25FW, TUG and MSWS-12. RmVO2 and fatigue were significantly improved only in the experimental group. Positive effects on 6MWT were retained 12 weeks after the end of the protocol (p<0.001) in the whole sample. CONCLUSIONS: The combination of a supervised and self-managed task-oriented program enhances walking endurance with positive effects on walking ability, fatigue and resting muscle oxygen consumption in PwMS with unassisted walking. These preliminary results reflected how this intervention was effective for impairment and activity improvements; moreover, it was cardiorespiratory stressful and possibly reduced deconditioning.

Unicystic ameloblastoma of the mandible.

The aim of this work was to describe a case of unicystic ameloblastoma located in the left posterior mandibular body and angle of a 14-year-old Caucasian male. The tumour was described at clinical and histological level; moreover, its histopathological phenotype was depicted. Finally, the problems of differential diagnosis with odontogenic or congenital cyst and the most appropriate therapeutic procedures are discussed.