The Impact of Fascial Manipulation® on Posterior Shoulder Tightness in Asymptomatic Handball Players: A Randomized Controlled Trial.

This prospective study aimed to determine the impact of Fascial Manipulation® by Stecco (FM) on the range of motion (ROM) of internal rotation (IR) and horizontal adduction (HADD) in asymptomatic handball players, representing significant risk factors for shoulder injuries. A randomized controlled trial was conducted, with participants randomly assigned to either the investigated group (N = 29) receiving a single session of FM or the control group (N = 27) receiving no treatment. The ROM for IR and HADD were measured before, immediately after, and one month after the FM session. The investigated group experienced a statistically significant acute increase in glenohumeral IR (14 degrees, p < 0.001) and HADD (14 degrees, p < 0.001) compared to the control group (p < 0.001). The positive effects of FM persisted one month post-treatment, with increased IR ROM by 12 degrees (p < 0.001) and HADD ROM by 11 degrees (p < 0.001). Participants in the investigated group reported lower subjective tightness/stiffness immediately after (p < 0.001) and one month after treatment (p = 0.002) compared to the control group. This study demonstrates that a single application of FM effectively improves glenohumeral ROM in the dominant throwing shoulder of asymptomatic handball players. It highlights the immediate and sustained positive effects of FM on IR and HADD. These findings support the use of FM as an effective method for enhancing shoulder ROM and reducing subjective tightness/stiffness. The study was registered at ClinicalTrials.gov (NCT06009367).

The impact of COVID-19 pandemic on the rehabilitation of patients after arthroscopic knee surgery at IPRM in UCM Maribor, Slovenia.

OBJECTIVES: We wanted to analyze the impact of the pandemic on the treatment and rehabilitation of these patients. BACKGROUND: The COVID-19 pandemic has had a major impact on medical services globally and it also affected the field of elective surgery and rehabilitation medicine. Among the most common procedures is the arthroscopic knee surgery, which is an intervention that warrants postoperative physical therapy. METHODS: The study included 105 patients subdivided in three groups, namely those treated before the pandemic, those treated during lockdown and those treated during the pandemic. We compared the decline in the number of patients and the rehabilitation outcome of the referred patients. The rehabilitation outcome was assessed by measuring the range of knee flexion. RESULTS: There were 132 patients included in the analysis of the decline in the number of referred patients during the pandemic. The decline was 36 %. Out of these patients, 105 were included in the analysis of the effectiveness of rehabilitation, and we demonstrated that there were no statistically important differences in improvement among the groups (p=0.246). CONCLUSION: Shorter treatment due to the COVID-19 pandemic did not have a statistically significant effect on the achieved knee flexion, but we noticed a reduction in the number of patients referred to our ward after knee arthroscopy (Tab. 6, Ref. 14).

The consequences of COVID-19 outbreak on outpatient rehabilitation services: a single-center experience in Slovenia.

BACKGROUND: The COVID-19 pandemic was the reason for closing down all non-urgent outpatient services in hospitals treating COVID-19 patients. The lockdown and reorganization of medical units also altered the accessibility to outpatient rehabilitation services. AIM: The focus of interest in our report lies in the evaluation of the outpatient rehabilitation treatment accessibility at our center in the time of the COVID-19 pandemic. DESIGN: Cross-sectional observational study. SETTING: Outpatients Rehabilitation Unit at University Medical Centre Maribor (UMC Maribor), Slovenia. POPULATION: Patients with diverse pathologies referred to outpatient rehabilitation. METHODS: The data were gathered retrospectively at the Institute of Physical and Rehabilitation Medicine (IPRM) at the UMC Maribor. The search included all the patients treated at IPRM in the pre-COVID and COVID period from March 16 to August 31 in 2019 and 2020. The data for the period including the lockdown (March 16 to August 31, 2020) and the period after the lockdown (June 1 to August 31, 2020) was analyzed and compared to the same timeframes in 2019. We were interested in the magnitude of decline in the total number of patients, the number of the first and follow-up visits, the number of sessions and in the profile and pathologies of patients comparing pre-COVID and COVID period. The χ2 and Fisher's Exact test were used in the analysis. RESULTS: With the lockdown period included there was a 44% decline in the total number of patients, a 71.1% decline in the number of sessions, a 42% decline of the first visits and a 60.9% decline of follow-up visits. When comparing the pre-COVID and COVID period after the lockdown, a 28.5% decline in the number of patients treated in 2020 compared to 2019 was observed. By analyzing the number of sessions in the pre-COVID and COVID period after the lockdown there was a 46.6% decline. No statistically significant difference was found in the age groups between the two periods (X2=9.466; P=0.05). The difference for the first and follow-up visits in 2019 and 2020 proved to be statistically significant (P<0.001), as well as the difference in percentage of patients in the acute and chronic group (P=0.037). CONCLUSIONS: Our findings showed how COVID-19 outbreak hindered the accessibility to outpatient rehabilitation service. Not only has the number of patients substantially reduced in the year 2020 compared to 2019, but also the number of sessions and number of first and follow-up visits declined. The demographic structure of the patients remained the same. CLINICAL REHABILITATION IMPACT: This study adds evidence at the level of health services about lower standard of care in the physical and rehabilitation medicine field for patients experiencing disabling conditions in the time of COVID-19.

An advanced stage of carpal tunnel syndrome - is night-time splinting still effective?

OBJECTIVES: There is no consensus on whether conservative treatment with night splints is indicated also in moderate and severe stages of carpal tunnel syndrome (CTS). The goal of this study was to compare the efficacy of night-time splinting at different stages of CTS. MATERIAL AND METHODS: Forty-five patients with electrodiagnostic (EDX) features of CTS included in the study were divided into 2 groups based on nerve conduction studies. The patients in the first group had only median nerve sensory fiber involvement, whereas the patients in the second group had also motor fiber involvement. The custom-made volar night splint was the only treatment for all of the included patients. The patients were assessed before the fabrication of orthosis and after 12 weeks of its use. The parameters measured were hand grip strength and the Visual Analogue Scale for pain and paraesthesia. The patients further completed the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and a shorter version of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH). RESULTS: In the first group, a statistically significant improvement was established in paraesthesia and hand grip strength (p = 0.019, p = 0.024, respectively), but there was no statistically significant improvement in pain, and the results of both BCTQ and QuickDASH. In the second group, a statistically significant improvement was found in paraesthesia, the BCTQ Symptom Severity Scale and QuickDASH results (p = 0.008, p < 0.001, p = 0.011, respectively), whereas no statistically significant improvement was established in pain, hand grip strength and the BCTQ Functional Status Scale. However, when comparing the change in the outcome measures between the 2 groups, no statistically significant differences were found. CONCLUSIONS: This study has shown that 12-week night-time splinting is beneficial not only for patients with mild CTS but also for those with advanced CTS, and those awaiting surgical treatment. Therefore, splinting is recommended for all patients with CTS. Int J Occup Med Environ Health. 2020;33(6):771-80.

Primary surgical repair of acute Achilles tendon rupture: comparative results of three surgical techniques.

PURPOSE: To determine which of the three surgical techniques for acute unilateral complete rupture of Achilles tendons in use at the University Clinical Centre Maribor gives the best short-term functional results. METHODS: In the retrospective analysis of the results of 3 surgical techniques, 262 patients of which 244 (93.1%) were men (mean age 41.6 ± 10.0 years, range 21.5-83.0 years) operated on during the period from 2000 to 2008 were included. Group A (open technique with fascial augmentation) included 42 (16%) patients, group B (original modification of percutaneous suturing according to Cretnik and Kosanovic) included 159 (60.7%) patients, and group C (original percutaneous fixation with two embracing and crossed loops according to Kruscic) included 61 (23.3%) patients. The rehabilitation protocol for group C included use of individually manufactured closed ankle functional orthosis, which replaced the plaster cast after 2 weeks of immobilization and permits early ankle range-of-motion exercising and full weight bearing. The functional outcome and incidence of postsurgical complications were analysed from medical records covering the period of 6 months. RESULTS: Patients from group C achieved the best functional results in the shortest time. The duration of immobilization (5.3 ± 0.1 weeks) and use of crutches (5.3 ± 0.5 weeks) were the shortest. The ability to rise up on toes on the affected leg, to walk on toes and heels, and duration of restriction of physical activities including sports were shorter than in the other two groups (p < 0.001 for all variables). Two reruptures were experienced in group B, one in group C, and none in group A. CONCLUSIONS: Good functional results and a relatively small number of postsurgical complications advocate the use of percutaneous suturing techniques. The best and fastest functional recovery was attained in the group treated with the original technique of percutaneous fixation with two embracing and crossed thread loops according to Kruscic.

Laser triangulation measurements of scoliotic spine curvatures.

BACKGROUND: The main purpose of this research was to develop a new method for differentiating between scoliotic and healthy subjects by analysing the curvatures of their spines in the cranio-caudal view. METHODS: The study included 247 subjects with physiological curvatures of the spine and 28 subjects with clinically confirmed scoliosis. The curvature of the spine was determined by a computer analysis of the surface of the back, measured with a non-invasive, 3D, laser-triangulation system. The determined spinal curve was represented in the transversal plane, which is perpendicular to the line segment that was defined by the initial point and the end point of the spinal curve. This was achieved using a rotation matrix. The distances between the extreme points in the antero-posterior (AP) and left-right (LR) views were calculated in relation to the length of the spine as well as the quotient of these two values LR/AP. All the measured parameters were compared between the scoliotic and control groups using the Student's t-Test in case of normal data and Kruskal-Wallis test in case of non-normal data. Besides, a comprehensive diagram representing the distances between the extreme points in the AP and LR views was introduced, which clearly demonstrated the direction and the size of the thoracic and lumbar spinal curvatures for each individual subject. RESULTS: While the distances between the extreme points of the spine in the AP view were found to differ only slightly between the groups (p = 0.1), the distances between the LR extreme points were found to be significantly greater in the scoliosis group, compared to the control group (p < 0.001). The quotient LR/AP was statistically significantly different in both groups (p < 0.001). CONCLUSIONS: The main innovation of the presented method is the ability to differentiate a scoliotic subject from a healthy subject by assessing the curvature of the spine in the cranio-caudal view. Therefore, the proposed method could be useful for human posture diagnostics as well as to provide a long-term monitoring of scoliotic spine curvatures in preventive and curative clinical practice at all levels of health care.

Efficacy of combined physical and occupational therapy in patients with conservatively treated distal radius fracture: randomized controlled trial.

AIM: To evaluate the efficacy of combined physical and occupational therapy in comparison with physical therapy alone in patients with conservatively treated distal radius fracture. METHODS: Sixty-one participants, conservatively treated after a distal radius fracture, were included in a randomized and single-blind trial. Group A had physical therapy only (n = 31) and group B had physical and occupational therapy (n = 30). The assessment was performed three times: upon inclusion in the study in the first week after removal of the cast (T1), immediately after the end of the rehabilitation (T2), and 1 month after completing the rehabilitation (T3). The passive wrist range-of-motion, grip strength, and Disabilities of Arm, Shoulder and Hand (DASH) score were used as rehabilitation outcomes. RESULTS: Rehabilitation outcomes were analyzed using two-way mixed analysis of variance. The effect of time was statistically significant (p < 0.001) for all outcomes. The group (therapy) factor was statistically significant for grip strength only (p = 0.038). The interaction effect was statistically significant for rotation (p = 0.034) and grip strength (p = 0.021). A comparison between time points T3:T1 showed statistically significant difference in grip strength in favor of group B 67 % (95 % CI 60-74 %) versus group A 53 % (95 % CI 45-61 %), p = 0.024. CONCLUSION: The combined therapy resulted in a statistically significant increase of grip strength in comparison with isolated physical therapy in the period of 12-16 weeks after the fracture. This effectiveness was not confirmed with DASH score results.