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Bong D.A.,Instituto Poal Of Reumatologia | Saenz I.,University of Barcelona
Current Rheumatology Reviews | Year: 2011

The ligaments of the wrist, ankle and foot play a critical role in the static and dynamic stabilization of the joints of these regions. The advent of high resolution ultrasound has markedly improved the evaluation of pathologic alterations of the structure by enabling direct visualization. In the wrist region, the focus is on the extrinsic ligaments, those ligaments that have their origin in the bones of the forearm and insert on the carpal bones, that include the radio-scaphoid, radioscaphocapitate, long radio-lunate (LRL), the short radio-lunate and radiotriquetral. The anatomy, sonoanatomy and sonopathology of the ankle ligaments (deltoid, anterior and posterior talofibular and calcaneofibular), anterior aspect of the ankle syndesmosis and the spring ligament complex are reviewed. Finally, the ligamentous anatomy of the forefoot is detailed as an understanding of this region is key to evaluation of its important sonopathologies. © 2011 Bentham Science Publishers Ltd. Source

Martinez-Puig D.,Bioiberica S.A. Palafolls | Moller I.,Instituto Poal Of Reumatologia | Chetrit C.,Bioiberica S.A. Palafolls
Mediterranean Journal of Nutrition and Metabolism | Year: 2013

A prospective, randomized, double-blind, placebo-controlled study was designed with 40 healthy individuals with joint discomfort. The effect of oral supplementation with a natural product containing hyaluronic acid included in a yoghurt matrix was evaluated in terms of functional and quality-of-life parameters. An isokinetic dynamometer was used to measure maximum muscle strength, total work and mean power. Participants were divided into 2 groups (n = 20) and ate yoghurt that was either supplemented or not supplemented with the hyaluronic acid product daily for a period of 90 days. The increase in the maximum peak torque of the knee extensors compared to baseline values was 7.6 ± 7.6 Nm for the supplemented yoghurt group and 2.5 ± 4.7 Nm for the control group at 180 /s (P = 0.0582), and 6.5 ± 5.8 Nm for the supplemented yoghurt group and -1.0 ± 7.1 Nm for the control group at 240 /s (P < 0.05). The same pattern of response was observed in total work and in mean power (P < 0.05). Differences were less pronounced in the knee flexors. No differences were detected in the Lequesne score and SF-36 survey except for the social functioning subscale at 1 month follow-up. This prospective placebo-controlled nutritional study confirmed that 3 months of oral administration of a natural product containing HA (Mobilee™) in healthy individuals with joint discomfort of the knee provides improvements in muscle strength. © 2012 Springer-Verlag Italia. Source

Hochberg M.C.,University of Maryland Baltimore County | Martel-Pelletier J.,University of Montreal | Monfort J.,Servei de Reumatologia | Monfort J.,IMIM Hospital del Mar Medical Research Institute | And 14 more authors.
Annals of the Rheumatic Diseases | Year: 2016

Objectives To compare the efficacy and safety of chondroitin sulfate plus glucosamine hydrochloride (CS+GH) versus celecoxib in patients with knee osteoarthritis and severe pain. Methods Double-blind Multicentre Osteoarthritis interVEntion trial with SYSADOA (MOVES) conducted in France, Germany, Poland and Spain evaluating treatment with CS+GH versus celecoxib in 606 patients with Kellgren and Lawrence grades 2-3 knee osteoarthritis and moderate-To-severe pain (Western Ontario and McMaster osteoarthritis index (WOMAC) score ≥301; 0-500 scale). Patients were randomised to receive 400 mg CS plus 500 mg GH three times a day or 200 mg celecoxib every day for 6 months. The primary outcome was the mean decrease in WOMAC pain from baseline to 6 months. Secondary outcomes included WOMAC function and stiffness, visual analogue scale for pain, presence of joint swelling/effusion, rescue medication consumption, Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT-OARSI) criteria and EuroQoL-5D. Results The adjusted mean change (95% CI) in WOMAC pain was -185.7 (-200.3 to -171.1) (50.1% decrease) with CS+GH and -186.8 (-201.7 to -171.9) (50.2% decrease) with celecoxib, meeting the non-inferiority margin of -40: -1.11 (-22.0 to 19.8; p=0.92). All sensitivity analyses were consistent with that result. At 6 months, 79.7% of patients in the combination group and 79.2% in the celecoxib group fulfilled OMERACT-OARSI criteria. Both groups elicited a reduction >50% in the presence of joint swelling; a similar reduction was seen for effusion. No differences were observed for the other secondary outcomes. Adverse events were low and similarly distributed between groups. Conclusions CS+GH has comparable efficacy to celecoxib in reducing pain, stiffness, functional limitation and joint swelling/effusion after 6 months in patients with painful knee osteoarthritis, with a good safety profile. Source

De la Fuente J.,Clinica Pakea de Mutualia | Miguel-Perez M.I.,University of Barcelona | Balius R.,Consell Catala de lEsport | Guerrero V.,Clinica Pakea de Mutualia | And 2 more authors.
Journal of Clinical Ultrasound | Year: 2013

Background.: Carpal tunnel syndrome is a common condition frequently requiring surgical intervention. We describe a new minimally invasive surgical technique for carpal tunnel release utilizing ultrasound (US) visualization. Methods.: The technique was performed on 20 fresh frozen cadaver specimens. A surgical metallic probe with a "U"-shaped trough and upward curved distal tip was precisely positioned in the carpal tunnel with US guidance followed by division of the flexor retinaculum (FR) with a "V"-shaped scalpel. Results.: Complete division of the FR was confirmed by US. Dissection performed on the specimens confirmed complete release of FR and absence of neurovascular injury. The distance from the division of the FR to these structures, the "safety margins," was measured. Conclusions.: This new technique for carpal tunnel release appears to combine the safety and efficacy of open carpal tunnel surgery with the advantages of the minimally invasive techniques. © 2012 Wiley Periodicals, Inc. Source

Balius R.,Sport Catalan Council | Rodas G.,F.C. Barcelona Medical Services | Pedret C.,Clinica CMI Diagonal | Capdevila L.,Autonomous University of Barcelona | And 2 more authors.
Skeletal Radiology | Year: 2014

Objective: To assess the sensitivity of ultrasound in detecting soleus muscle lesions diagnosed on magnetic resonance imaging (MRI) and to characterize their location, ultrasound pattern, and evolution. Materials and methods: Ultrasound and MRI studies were performed between May 2009 and February 2013 on all patients who presented to the Medical Services Clinic of the Catalan Sport Council with the initial onset of sharp pain in the calf compatible with injury of the soleus muscle. An inter-observer ultrasound reliability study was also performed. Results: A total of 55 cases of soleus injury were studied prospectively (22 with right leg involvement, 33 left) by ultrasound and MRI, which was utilized as the “gold standard.” In MRI studies, 24 cases (43.7 %) had myofascial injuries that were localized in the posterior aponeurosis (PMF) in 15 cases (27.3 %) and in the anterior aponeurosis (AMF) in 9 (16.4 %). Thirty-one cases (56.3 %) were musculotendinous injuries, with 9 cases (16.4 %) in the medial aponeurosis (MMT), 11 cases (20 %) in the lateral aponeurosis (LMT), and 11 cases (20 %) in the central tendon (CMT). In comparison to MRI, ultrasound was able to detect injury to the soleus in 27.2 % of cases. No injuries were detected by ultrasound alone. Posterior myofascial injuries were more likely to be detected by ultrasound than anterior myofascial injuries or all types of musculotendinous injuries. Ultrasound patterns for each type of injury were described. Conclusion: Ultrasound is not a sensitive technique for detecting and assessing soleus traumatic tears compared with MRI, although the sensitivity is enhanced by a thorough anatomically based ultrasound examination. Timing of the ultrasound examination may be of importance. Each type of soleus injury appears to have a characteristic ultrasound pattern based on a defect of connective expansions, the existence of small myofascial filiform collections, and the rarefaction of the fibrillar area. © 2014, ISS. Source

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