Management of Ankle Charcot Neuroarthropathy: A Systematic Review

Background: Charcot neuroarthropathy is a non-infective, destructive process occurring in patients rendered insensate by peripheral neuropathy, which is caused mainly by diabetes. Repetitive trauma from standing and walking provides a neuro-traumatic stimulus that leads to dislocation, or peri-articular fracture, or both, within the ankle. This review concentrates on the management protocols regarding the ankle only. Methods: A Pubmed search for clinical trials performed to manage ankle Charcot neuroarthropathy and a systematic review of these articles were undertaken. Results: Twenty papers met the inclusion criteria: four of them describe non-surgical management, while the rest show different surgical management options of ankle Charcot neuroarthropathy. Conclusions: Surgical algorithms for the treatment of CN of the ankle are based almost entirely on level four. There is inconclusive evidence concerning the timing of treatment and the use of different fixation methods. Instability and ulceration are the main precursors for surgical interventions. Prospective series and randomized studies, albeit difficult to perform, are necessary to support and strengthen current practice.

Capillaroscopic Evidence of Microvascular Damage in Volleyball Players

Volleyball players experience repetitive stress that involves their hands and, in particular, their fingers. Literature reports that repetitive trauma can lead to local vascular abnormalities, such as reduced capillarization and lower resting blood flow. These anomalies could be related to the presence of dysfunctional endothelium. The aim of this study is to correlate the capillaroscopic findings by nailfold video capillaroscopy (NVC) to volleyball practice in order to early detect possible anomalies and perform an adequate follow-up to avoid damages that could negatively affect sport practice and the players’ health status. In this study, 38 subjects were enrolled, 19 volleyball players and 19 healthy non-players as a comparison group. In almost all the players, we found capillaroscopic alterations of the “aspecific pattern” type without substantial gender differences. We may assume that the repeated traumas involving players’ fingers can negatively modify their microcirculation. Based on these observations, it could be a desirable clinical practice to screen professional volleyball players with NVC in order to implement preventive strategies aimed at protecting the health of athletes.

Non-traumatic myositis ossificans of the Right masseter muscle: a case report and review of the literature

Myositis ossificans (MO) is a rare disease in which ossification develops in the muscle or soft tissue. MO traumatica is recognized by ossification of the soft tissues after acute or repetitive trauma, burns, or surgical procedures. In the head and neck region, masseter is most commonly involved muscle.

Piomiosite del cingolo scapolare con focolai polmonari multipli e sepsi da MRSA

The paper describes the case of a 14-year-old girl with intense right shoulder pain and severe signs of local and systemic inflammation. Magnetic resonance imaging revealed a pyomyositis of right shoulder girdle muscles. Blood culture was found positive for methicillin-resistant Staphylococcus aureus (MRSA) and the chest computed tomography scan revealed nodular infiltrates in both pulmonary fields resulting from septic embolism. A prolonged antibiotic therapy according to antibiogram allowed the complete recovery. Pyomyositis is a deep pyogenic infection of the skeletal muscle tissue and is most commonly caused by Staphylococcus aureus species. In the described case, repetitive trauma due to karate may have caused the initial muscle cell damage with subsequent haematoma, which subsequently becomes colonised by bacteria during a transient bacteraemia. There is an increasing prevalence of pyomyositis in temperate climates and in the last few years MRSA has emerged as a pathogen within the community (CA-MRSA) also in healthy people. An early diagnosis is important to avoid local and systemic complications.

Assessment of fractional anisotropy outcomes in combat sport athletes with mild traumatic brain injury

The practice of combat sports increases the risk of suffering white matter injuries. That is why, it is required the early damage detection to determine to what extent the athlete may be active preserving their performance and health status. The integrity of the white matter can be quantitatively characterized in diffusion tensor images, using fractional anisotropy. This study aims at characterizing the fractional anisotropy of white matter injuries in combat athletes that are exposed to repetitive trauma and also, to detect changes in fractional anisotropy between cerebral hemispheres with and without lesions. It is proposed a global and structural analysis of the hemispheres, as well as the selection of ROI in the lesions. 14 athletes, from Boxing, Karate and Taekwondo sports, participated. The sample was divided into two groups of seven subjects each: Injured (23.428${\pm}$4.157 years old) and Healthy (24.285${\pm}$5.023 years old) paired by sport denomination. Diffusion tensor images were used to obtain FA values in the analysis of the hemispheres and lesions. Global and structural analysis of the hemispheres did not detect the presence of white matter lesions; however, the use of ROI selection permitted maximum approximation of the injuries location. It also improved the breakdown of FA values as it allows a local analysis of the lesion. As an additional result, there were found ROIs values, FA$_{med}=0.454{\pm}0.062$, which exceed the average fractional anisotropy of the white matter. The cohesion of acute and chronic phase lesions were found in the same subject. The apparently contradictory results in FA values are related to the stage of the lesions.

Stretch too far: rectus sheath haematoma secondary to repetitive trauma and increased intra-abdominal pressure

A 26-year-old man presented with a 4-week history of right lower quadrant abdominal pain which was managed conservatively at home with ibuprofen. Three days later, he presented to the emergency department with worsening pain and swelling following an episode of coughing and slipping in the bathroom. Following his admission, CT angiography showed an active bleed into a 4.6×6.7×11 cm right rectus sheath haematoma, just inferior to the umbilicus. The patient was then referred to interventional radiology for an angiogram and coil embolisation. A superselective branch angiogram showed contrast extravasation from a medial branch of the right inferior epigastric artery, successfully embolised without incident.

Infraspinatus atrophy due to Bennett lesion causing suprascapular nerve palsy

We report the case of a 19-year-old professional volleyball player who presented with right shoulder pain exacerbated during sports activity. On physical examination, infraspinatus atrophy was evident. As the clinical setting suggested suprascapular nerve entrapment syndrome, shoulder MR and later CT were performed. The results showed radiological signs of subacute-chronic infraspinatus muscle denervation and a Bennett lesion of the shoulder, presumably due to chronic repetitive trauma during the classical overhead swing in volleyball. The patient agreed to surgical treatment, and arthroscopic decompression was achieved. After months of rehabilitation, the pain gradually subsided, the infraspinatus muscle recovered its trophism, and the patient progressively returned to her regular sports activity.

New and Emerging Risk Factors in Occupational Health

Workplace health and safety is constantly evolving both in developed and developing countries. Under the tumultuous development of technology, working environments are changing, leading to the onset of new occupational hazards and unprecedented risk conditions deriving from the new ways of organizing work. At the same time, progress in medical science, with the knowledge in the fields of genetics, metabolomics, big data, and smart technologies, makes it possible to promptly identify and treat risk conditions that would have escaped notice in the past. Personalized occupational medicine represents the frontier of prevention in the workplace, from the perspective of total worker health and the sustainability of resources. The contributions to this Special Issue range from chemical, physical, and biological to psychosocial risks, and from the search for new ways to control long-known risks, such as mercury toxicity, to observations of the most frequent pathologies in the workplace in the last twenty years, such as repetitive trauma diseases, immunodeficiency transmitted as a result of biological injuries, and violence and psychological trauma in the workplace. New insights are needed in occupational health and safety practice to address the new challenges in this field.

Treatment of a Chronic, Nonhealing Neuropathic Ulcer in a Pediatric Patient With Spinal Dysraphism: A Case Report

A neuropathic ulcer results from repetitive trauma to a hyposensitive distal extremity, usually on a weight-bearing bony prominence. In addition to neuropathy, deformities and adapted walking patterns increase the risk of these wounds in children with spinal dysraphism. Information about treatment strategies for these wounds is limited. PURPOSE: The purpose of this case study was to describe the management of a chronic, nonhealing neuropathic ulcer on the dorsum of the left foot of an 11-year-old boy with spinal dysraphism. METHODS: Autologous platelet-rich plasma (PRP), obtained using a double centrifuge technique, was applied weekly underneath a nonadherent dressing and a below-knee plaster of paris cast. Complete non–weight-bearing was encouraged. RESULTS: The patient presented with a 9 cm2 wound and a Pressure Ulcer Scale for Healing (PUSH 3.0) score of 13, which was of 6 months’ duration. For the first 3 weeks, the autologous PRP and plaster cast were applied weekly. After 3 weeks, the wound was 2.25 cm2 (PUSH score 7) and treatment was changed to moistened saline dressings underneath the cast. The wound was healed after 5 weeks. No adverse effects were observed. CONCLUSION: Studies are needed to evaluate the safety and effectiveness of autologous PRP in neuropathic ulcer management in pediatric populations and to obtain evidence for optimal management of these wounds in persons with spinal dysraphism.