Rehabilitation management of a triceps surae muscle injury in a young male with haemophilia A and high-titre inhibitors.

Haemophilia A is a rare inherited hematologic disorder characterized by a deficit of coagulation factor VIII. It is associated with frequent episodes of musculoskeletal bleedings that occur mainly inside joints and secondly inside muscles. The majority of intramuscular hematomas respond well to conservative protocols, based on rehabilitation techniques and appropriate haemostatic coverage; surgery is limited to refractory cases. This manuscript describes the management of an intramuscular bleeding in a young patient with severe haemophilia A and high-titre inhibitors. A multidisciplinary approach directed by a physiatrist and combining surgical intervention, use of bypassing agents and rehabilitation treatment allowed to successfully managing this case, leading to a complete functional recovery. Given the lack of consensus on the treatment of intramuscular bleedings in haemophiliac patients, this case report provides an example of successful management for such conditions, which require a multidisciplinary approach in which the physiatrist plays a key role.

Management of osteitis pubis in athletes: rehabilitation and return to training - a review of the most recent literature.

Osteitis pubis is a common cause of chronic groin pain, especially in athletes. Although a precise etiology is not defined, it seems to be related to muscular imbalance and pelvic instability. Diagnosis is based on detailed history, clinical evaluation, and imaging, which are crucial for a correct diagnosis and proper management. Many different therapeutic approaches have been proposed for osteitis pubis; conservative treatment represents the first-line approach and provides good results in most patients, especially if based on an individualized multimodal rehabilitative management. Different surgical options have been also described, but they should be reserved to recalcitrant cases. In this review, a critical analysis of the literature about athletic osteitis pubis is performed, especially focusing on its diagnostic and therapeutic management.

Analysis of Dental Malocclusion and Neuromotor Control in Young Healthy Subjects through New Evaluation Tools.

The presence of a correlation between stomatognathic and postural systems has been investigated by different authors trying to identify a possible influence of dental occlusion on body posture and balance. The aim of this study was to evaluate the relationship between dental occlusion and neuromuscular control in a healthy young population using modern evaluation tools. 25 subjects (9 males and 16 females, aged 23 to 44) were evaluated for dental occlusion, particularly in relation to overjet and overbite parameters, anterior and posterior crossbite, scissor bite, mandibular crowding, molar and canine class, and deviation of the median dental line. Neuromotor control was assessed using two different types of stabilometric platforms in both monopodalic and bipodalic equilibriums (Prokin-B and MF-Stability, Tecnobody, Italy). All subjects were evaluated with and without cotton rolls positioned between the upper and lower arches at the premolar level in order to temporarily eliminate any pathological contact. In all 25 subjects, no statistically significant differences were revealed between the evaluations performed with and without cotton rolls in all the analyzed conditions (in static, in dynamics, with open and closed eyes). This study did not find a significant correlation between dental occlusion and neuromuscular control in a young and healthy population.

Extracorporeal shockwaves therapy versus hyaluronic acid injection for the treatment of painful non-calcific rotator cuff tendinopathies: preliminary results.

BACKGROUND: Rotator cuff tendinopathy is the most common cause of painful shoulder. The treatment is mainly conservative and several therapeutic approaches have been proposed, including NSAIDs, physiotherapy, injections and physical therapies. The aim of the current study was to compare the clinical effectiveness of low molecular weight hyaluronic acid (LMW-HA) injection versus low-energy extracorporeal shock-wave therapy (ESWT) until 3 months of follow-up for the management of painful non-calcific rotator cuff tendinopathies, evaluating also the trend over time between the groups. METHODS: A total of 34 patients affected by painful rotator cuff tendinopathy were randomly divided into 2 groups of 17 individuals. The first group (group A; mean age 58.2 years) underwent 3 injections of LMW-HA (Hyalgan®, 500-730 kDa), while in the second group (group B; mean age 58.5 years) the treatment protocol consisted of 4 sessions of low-energy ESWT. Pain level and function were assessed with the DASH and Constant-Murley questionnaires. Parameters were evaluated at baseline (V0), at the end of the treatment (V1) and after 3 months of follow-up (V2). RESULTS: Patients of both groups achieved statistically significant improve in pain and function (P<0.0001). Clinical outcome shows a different trend in time between group A and group B for DASH and Constant-Murley questionnaires. CONCLUSIONS: LMW-HA and low-energy ESWT are effective and safe in patients suffering from non-calcific rotator cuff tendinopathy until 3 months of follow-up. Intra-articular injections of LMW-HA provide prompt clinical improvement compared to ESWT, which results in more gradual improvement over time.