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We present the case of a 71 year male patient with right upper limb amputation who presented to an orthopaedic clinical hospital for increased pain in the hip area associated with decreased range of motion which interfered with most of his daily activities. Patient was evaluated in an interdisciplinary team by rehabilitation and orthopaedic specialists and was scheduled for surgery after a pre rehabilitation period. Acute phase included the first week post-surgery in which early mobilization was initiated with transfer training and verticalization. Weight-bearing as tolerated was indicated on the operated limb from postoperative day 1 and the use of an axillary crutch on the functional upper limb. Walking was supervised by a physical-therapist in the first days post-surgery. Neuromuscular electrical stimulation was associated in order to promote muscle strength and static cryotherapy was applied every 4 hours on the operated limb. At day 7 the patient was discharged with a functional autonomy sufficient for his home activities. The patient was given a precise protocol to follow until control a reevaluation at 6 weeks postsurgery. By the end of the 8 week post-surgery the patient was able to demonstrate reliable gait patterns and was permitted to wean assistive devices. At 6 month follow up the patient was able to restore all functional activities with satisfying results regarding functional scores. Our case report suggests that THA can be indicated for a broader spectrum of patients without posing a major risk regarding the rehabilitation program if supervised properly in an interdisciplinary team [ABSTRACT FROM AUTHOR]

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Total knee arthroplasty is a frequently met replacement procedure for patients with degenerative knee disease. The main purpose of the intervention is to provide pain relief and to promote range of motion and joint stability for patients in which conservative options such as pharmacological treatment or physical therapy can’t accomplish any more an adequate symptom alleviation. Most guidelines regarding the first stage of the rehabilitation process recommend early mobilization in order to gain as quickly as possible functional independence, and also to promote muscle strength and coordination. This should be done from the first day post-surgery, depending on the patients compliance. In the subacute stage, the emphasis is put on maintaining a progression of the weight-bearing status, and promoting normal walking without the use of an assistive device. Patient education will be focused on changes that need to be made in a domestic environment and also modifications regarding social and professional activities. The third phase of the rehabilitation process focuses on limb symmetry and equal weight bearing which represent absolute objectives that need to be obtained. Balance exercises will include progression from bilateral to unilateral, and integration of unstable surfaces if possible associated with cardiovascular training. This phase of the rehabilitation process is considered to be completed once all realistic functional goals are achieved. [ABSTRACT FROM AUTHOR]

Multiple knee ligament injuries represent a signifi cant traumatic event with an important functional prejudice which involves the injury of at least two of the four major ligaments of the knee. Management of such injury requires a thorough assessment and an interdisciplinary approach.The rehabilitation program will be constructed in accordance to the severity of the lesion and the patients expectations. The higher the goals and a more pronounced injury will results in a higher degree of involvement from the rehabilitation team. In case of cruciate ligament injury associated with a collateral ligament injury the rehabilitation program is based mostly on the same principles as for a cruciate ligament intervention, with the fi rst phase of the rehabilitation protocol being governed by an early protection phase due to the fact that early weight-bearing is considered a risk for later instability of the knee and influence over the healing tissue, while the second phase of protocol is characterised by gait restoration and maintaning balance and coordination. Multiple ligament injuries often necessitate longer rehabilitation periods, regaining full activity level being estimated at around 1 year post surgery. The purpose of the paper is to analyse the optimal modality of constructing a rehabilitation program for multiple ligament injuries and whether a consensus regarding protocol and procedures can be obtained. [ABSTRACT FROM AUTHOR]

Shockwaves can be defined as transient pressure oscillations which propagate in three dimensions and offer an increased pressure in a very short period of time. Biological effects of shockwave therapy have been proven to stimulate the release of angiogenic growth factors, and contribute to the improvement of blood supply which leads to the repair of bone and soft tissue. The role of ESWT in the treatment of chronic calcifying tendinitis of the rotator cuff has been evaluated in many studies. ESWT has been gaining attention as an alternative option to surgical excision of calcification or when other conservative options have not proven efficient. The main purpose for using ESWT in heel spur is to increase the local blood supply by inducing neovascularisation. This action influences the inflammatory process and furthermore stimulates the local metabolism. Also, shockwaves have been proposed as a possible treatment in early phases of femoral head necrosis in adults. In case of patellar tendinopathy in vitro studies have shown biological effects, while clinical effects remain unclear. Data suggests that ESWT associated with other physical modalities achieve realiable clinical importance of pain reduction in lateral epycondylitis. However there is still a lack of standardisation and a consensus is needed regarding frequency and intensity. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament lessions represent one of the most frequently met injuries of the knee, determining pain and instability and having a decisive impact over the patients functional level and quality of life. Regardless whether or not the decision of surgical intervention is made, patients with ACL tear are at higher risk of developing osteoarthritis, long term disability and an increased risk of additional meniscus tear. Literature data, although it offers a suffi cient amount of information on the subject, still presents debates on the advantages of one rehabilitation program over another. Achieving maximal range of motion as soon as possible is a main objective in ACL injuries, restrictions of mobility leading to prolonged rehabilitation periods. The are also discussions on the benefi ts of using open versus closed kinetic chain exercises, and also to what extend can the rehabititation program be accelerated in order to return the knee to the pre-injury state. The rehabilitation program must contain a multimodal approach composed of not only adapted kinetotherapy programs, but also associated modalities such as cryotherapy, neuromuscular stimulation, use of braces or hydrokinetotherapy in order to reduce pain and effusion and increase range of motion. The purpose of the present material is to analysis the existing data on the subject, and to evaluate the therapeutic benefi t of the rehabilitation modalities used in ACL injuries. [ABSTRACT FROM AUTHOR]

Introduction: The metabolic syndrome has become a public burden that raises numerous global healthcare issues, the search for new management strategies for these patients representing an ongoing concern. The study proposes the evaluation regarding the impact that therapeutic mineral waters and associated with dietary changes and adapted balneary programs may have over different metabolic conditions. Methods: We enrolled 237 patients with metabolic syndrome defi ned using 2017 IDF criteria that were monitored for a 12 day stay in the balneary resort. Biological levels were determined at admission and discharge. Additional anthropometric measures and nutrition aspects were determined. Crenotherapy was composed of different sources of mineral therapeutic waters with a composition that had a presence of hydrogen sulfi de (sulphurous mineral waters), bicarbonate, calcium, magnesium mineral waters. Results: Body mass index and waist circumference and blood pressure determined at admission presented reduced values at the end of the balneary cure (p<0.05). Nutritional aspects in the studied group revealed a tendency towards an unhealthy eating behavior, 65.82% of the patients being on a high meat consumption, and an insuffi cient amount of fruit and vegetables. Diminished values of fasting plasma glucose and HDlcholesterol were observed at discharge, while uric acid and tryglicerides did not present signifi cant differences at the end of the cure compare to admission. Conclusions: Balneotherapy can provide a reduction of the parameters that defi ne the metabolic syndrome. Due to its particular physical and chemical composition, mineral therapeutic waters used both internally and externally can represent an important tool in modulating the biological parameters responsible for the metabolic conditions. [ABSTRACT FROM AUTHOR]

Isolated lesser tuberosity fracture avulsion without an associated posterior shoulder dislocation or in the context of a three- or four-part proximal humerus fracture are extremely rare, with an estimated incidence rate of only 0.46 persons per 100,000. Diagnosis remains challenging, often leading to delayed treatment. In contrast with fractures of the greater tuberosity, there are no displacement guidelines to assist the surgeon in treatment decision-making for lesser tuberosity fractures. The aim of this study was to highlight diagnostic features as well as surgical treatment. We present a case of a 54-year-old male with an isolated lesser tuberosity fracture avulsion. We performed open reduction and osteosynthesis of the lesser tuberosity fragment with suture anchors and transosseous sutures. At 11-month follow-up the patient was able to normally perform his daily living and professional activities, had full, painless range of motion of the affected shoulder and regained almost full strength. [ABSTRACT FROM AUTHOR]