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Purpose of our study was to evaluate the behavior of the lumbar spine of young athletes in the supine and standing position, taking into account all postural changes that the spine undergoes during physiological load, any alterations and any discrepancies in the detection of pathology between the two positions. Between August 2008 and October 2009, we evaluated 40 sportsman (20 men and 20 women) with symptoms of lumbar pain. All subjects underwent MRI with a dedicated scanner of 0.25 Tesla (G-Scan, Esaote Biomedica, Genoa, Italy) either in the conventional supine position, either in the weight-bearing position. Spin echo T1w and fast spin echo T2w images were acquired with a dedicated receiving coil for the lumbar spine (group B). Three radiologists, blinded on history and clinical examination of subjects, assessed, in consensus, variations of lumbar lordosis angle, of lumbo-sacral angle and presence of pathology on images acquired in both positions, in different sequences and in different planes. Conventional supine MRI was positive for pathology 30/40 while weight-bearing MRI was positive in 39/40 respectively. In particular, the evaluation in the weight-bearing position allowed, in 9 cases to detect diseases that would have remained unrecognized if the evaluation had been performed only in the supine position. Compared to MRI in the supine position, weight-bearing MRI showed changes of the lumbo-sacral angle in 31/40 subjects and of lumbar lordosis angle in all 40 subjects. Imaging the lumbar spine in weight-bearing position with a dedicated MRI scanner and a dedicated coil might allow identification of pathology that may be overlooked if imaging patients only in the supine position.

La sindrome del piriforme è caratterizzata da una lombalgia con interessamento del gluteo e con possibile irradiazione all'arto inferiore; può essere definita come una patologia dovuta ad intrappolamento, compressione o irritazione del nervo sciatico a livello del muscolo piriforme con o senza deficit neurologici. In questo studio è stata valutata l'efficacia della sinergia terapeutica tra laser Neodimio:YAG e rieducazione funzionale nella riduzione del dolore e nel miglioramento dell'indipendenza funzionale in una paziente affetta da sindrome del piriforme.

Osteoarthritis does not mean a degenerative articular process only but a pathologic expression of wear, inflammation and immunological imbalance of the joints. Our study has the aim to demonstrate the effectiveness of eco-guidate infiltrations with high molecular weight associated with administration of oral chondroprotective supplements (glucosamine solfate, chondroitin sulphate, hydrolyzed collagen type II, hyaluronic acid and L carnitine fumarate) in comparison with the only treatment with ecoguided infiltrations with hyaluronic acid in patients suffering from primary osteoarthiritis of the hip.

Obiettivo. Scopo dello studio era valutare l’elasticità del tendine del sovraspinato nella spalla sintomatica di pazienti con sospetto clinico di rottura unilaterale della cuffia dei rotatori, e comparare i reperti riscontrati con quelli dell’ecografia convenzionale (ultrasound, US) e della risonanza magnetica (RM). Metodi. Nel periodo compreso tra gennaio e dicembre 2009 sono state esaminate da un radiologo entrambe le spalle di 58 pazienti (età media: 46 anni; range 32-58 anni) sia con modulo elastosonografico in real-time che in B-mode tramite uno stesso ecografo (EUB - Hitachi 7500), usando una sonda lineare a elevata frequenza (13 MHz). L’elasticità delle fibre tendinee del sovraspinato è stata valutata mediante uno score semiquantitativo di colori differenti rappresentanti tessuto rigido (blu) e tessuto via via più elastico (verde, giallo, rosso). I reperti riscontrati con elastosonografia ed ecografia convenzionale sono stati valutati separatamente da un secondo radiologo e quelli della spalla affetta comparati successivamente con quelli riscontrati a un esame RM eseguito in un arco temporale compreso tra 2 e 4 settimane dopo l’esame ecografico. L’esame RM è stato valutato da un terzo radiologo in cieco sul risultato dell’esame ecografico precedentemente eseguito. Risultati. Usando come gold-standard l’esame RM, l’elastosonografia ha correttamente diagnosticato in sette pazienti una lesione parziale rilevata come semplice tendinosi dall’esame B-mode verosimilmente a causa della presenza di tessuto di granulazione intralesionale ad ecostruttura simile a quella del tendine circostante. Inoltre, tre casi di lesione intratendinea riscontrati con l’US sono risultati essere, sia all’elastosonografia che alla RM, una lesione a tutto spessore. In tutti i casi (58/58) i reperti dell’esame RM hanno confermato quelli dell’elastosonografia, anche se in alcuni casi l’ampiezza della lesione appariva maggiore in RM, presumibilmente a causa dell’elevato segnale aggiuntivo dato dall’edema perilesionale. Conclusioni. L’esame elastosonografico è un metodo sensibile per la diagnosi di lesioni del tendine del sovraspinato, in particolare di quelle parziali e a tutto spessore su base degenerativa.

Nell’ultimo decennio sono stati fatti grossi passi in avanti nella chirurgia ricostruttiva legamentosa del ginocchio. La ricerca dei fattori che possono condurre al fallimento della ricostruzione del legamento crociato anteriore (LCA) ha aperto la strada allo studio di diverse strutture anatomiche come quelle posterolaterali, rimaste nella penombra per troppo tempo. Nonostante l’estrema variabilità delle strutture anatomiche posterolaterali, studi di dissezione anatomica hanno permesso di osservare come il legamento collaterale laterale (LCL), il popliteo ed il legamento popliteo-fibulare (LPF) risultino essere quasi costantemente presenti. Sono state inoltre chiarite le specifiche funzioni delle singole strutture, enfatizzando l’importanza del riconoscimento e del trattamento delle lesioni posterolaterali. Sebbene siano state descritte diverse tecniche chirurgiche per trattare le lesioni del PLC, ad oggi esistono ancora dubbi riguardo la loro diagnosi. In questa rivisitazione della letteratura, gli autori si propongono di discutere le recenti metodiche di diagnosi dell’instabilità posterolaterale di ginocchio

Aim. To assess the role of magnetic resonance (MR) imaging performed with a low-field scanner in the detection of floating meniscus sign as a consequence of sports-related trauma. Methods. Retrospective review of 2436 MR knee examinations executed, in 18 months, using a low-field scanner of 0.2T, was performed by three musculoskeletal radiologists of varying experience. Diagnostic criteria to define the presence of a complete floating meniscus were as codified in the literature, lithe thickness of the fluid signal band between the meniscus and tibial plateau was comprised in the range >= 3 mm and

Introduction: The femoro-acetabular impingement (FAI) is the result of a number of congenital or acquired pathologies of the hip and it has as main pathogenetic element an abnormal contact between the two joint components (acetabulum and proximal femoral epiphysis). Mainly male young adults, often athletes, are affected because of the repetition of gestures responsible for the conflict in these subjects. Classification: FAI has specific clinical and radiological characteristics and it can be classified into three types: 1. CAM type (femoral). 2. PINCER type (acetabular). 3. CAM-PINCER mixed-type. Diagnosis: It is based on medical hystory (young and active patients, diseases or previous hip surgery), on physical examination (reduced hip flexion and internal rotation) and on two classical tests: - provocative test for anterior impingement: flexion and internal rotation of the hip with the patient supine. - provocative test for posterior impingement: hip extension and external rotation with the patient prone. The instrumental confirmation of the diagnosis relies on: - Radiography (antero-posterior hip view, 45° axial view of the hip, “false profile” Lequesne view) - Computed Tomography: useful for assessing the centering of the femoral head in respect to the acetabulum and eventual bone promincences, but does not show fibro-cartilagineous alterations. - Magnetic Resonance Imaging an Arthro-MRI: more useful, compared to CT, for evaluating the intra-articular space, labral and cartilagineous lesions, and the presence of subchondral cysts. Treatment: If the conflict has already produced an overt arthritic degeneration, the only justified treatment is prosthetic replacement. If the disease is identified early it is possible indeed a conservative surgical treatment of articular heads in order to eliminate the causes of conflict and to re-delineate the anatomy of the joint. In particular, the aim of this surgery is: 1. to recreate a proper off-set head of the femur neck with removal of bone formation in the neck. 2. to eliminate neck retroversion. 3. to repair any associated injuries of the acetabular labrum and to treat, where possible, other joint injuries. Conclusions: FAI is a condition to suspect, recognize and diagnose in all its aspects at an early stage yet, as if it is addressed in time, it can be treated surgically with conservative techniques, but if the joint degeneration advances becoming excessive, a conservative surgical treatment becomes useless.

Gli AA dopo aver presentato i dati epidemiologici più importanti della TBC osteoarticolare, si soffermano sulla fisiopatologia, il quadro clinico e radiografico delle localizzazioni più frequenti sottolineando i segni clinici e radiografici tipici di queste lesioni e l’importanza della RM, specie se eseguita con mezzo di contrasto, nella diagnosi precoce della malattia. Vengono inoltre presi in considerazione gli aspetti evolutivi della malattia sia prima che dopo l’introduzione dei farmaci antitubercolari, la terapia medica ed il trattamento incruento e chirurgico delle varie forme. Gli AA concludono che la TBC è una malattia purtroppo sempre di attualità contrariamente a quanto si pensava alla fine degli anni settanta quando si diffuse la convinzione che essa fosse stata debellata. Importante è fare la diagnosi il più precocemente possibile, perché l’inizio precoce della terapia medica associata al trattamento ortopedico può assicurare la guarigione nel 90% dei

Inflammatory Bowel Disease (IBD) are commonly associated with rheumatic diseases of the joints. Sixty-five patients are selected during a 5-year study period. All Patients were analyzed with clinical, laboratory and radiographic exams. 38 patients had ulcerative colitis (mean age 42.1 years range:19-75) and 27 patients had Crohn's disease (CD) (mean age 37.2 years, range: 17-64 years). Arthritis occurred in 11 patients (17%): 7 with UC (18.4%) and 4 CD (14.8%). The mean age of patients with arthritis was 35 and mean disease duration of pain and limitation symptoms was 28 months. In 9 patients, arthritis appeared after the onset of bowel symptoms with mean duration of 20 months in UC and 24 months in CD; in two patients, arthritis preceded the onset of bowel symptoms some months before. The objective of this article is to establish to the incidence and clinical characteristics of arthritis in a group of patients suffering from CD and UC.

Major ortopaedic surgery and high energy trauma are often responsible of acute bleeding. Long bones and pelvis fractures are correlated with increased blood loss. The final consequence of a major bleeding is hypovolemic shock. The reduced oxygen tension of tissue could be responsible of heart attack, arrythmia, ictus, multi organ deficiency. For these reasons, it is important to immediately recognize and correct all potential bleeding in order to avoid complications. In orthopaedics the elective treatments in the managenment of hypovolemia are different. Blood banks and allogenic blood components have had an important impact on operative treatment and health care worldwide. erythropoietin has been shown in numerous studies to be ffective in raising the preoperative hematocrit and reducing the need for allogenic transfusion in major orthopaedic surgery. erythropoietin may be as good as or better than preoperative autologous donation. The aim of the present article is to describe a simple review of the literature based on our experience.