ESWT in ARCO stages I and II may help to prevent progression of the area of avascular necrosis and manage pain.

Background: Pes anserine bursitis strongly affects quality of life in patients with osteoarthritis. Treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy, and injections of corticosteroid, with highly variable responses; recovery can take 10 days to 36 months. Mesotherapy is a minimally invasive technique consisting of subcutaneous injections of bioactive substances. The goal is to modulate the pharmacokinetics of the injected substance and prolong the effects at a local level.Objective: To evaluate the effects of mesotherapy with diclofenac for anserine bursitis associated with knee osteoarthritis.Methods: One hundred and seventeen patients with anserine bursitis associated with grade II Kellgren-Lawrence knee osteoarthritis, assessed by clinical, radiographic, and ultrasonographic examination, were evaluated and treated. They were randomly divided into two groups (A, mesotherapy; B, control). Group A completed nine sessions of mesotherapy with sodium diclofenac (25 mg/1 mL; Akis®, IBSA, Lugano, Switzerland), 1 mL for each session, three times per week. Group B received 21 oral administrations of sodium diclofenac (50 mg; Voltaren®, Novartis, Parsippany, NJ), once a day for 3 weeks. Primary outcome measures were pain intensity assessed by visual analogue scale (VAS), along with ability to perform activities of daily living, ability to participate in sports, level of pain, symptoms, and quality of life, as assessed by the Knee injury and Osteoarthritis Outcome Score. These measures were performed before and after the treatment period and at 30 and 90 days' follow up.Results: In both groups pain level decreased significantly after the treatment period. Ultrasonography showed a reduction of the hypoechoic area related to anserine bursitis only in group A.Conclusion: Administration of conventional NSAIDs (diclofenac) by mesotherapy is effective in managing anserine bursitis in knee osteoarthritis in the short term and mid-term. These observations could be of interest for efforts to reduce the adverse effects of oral administration of anti-inflammatory drugs.

The aim of this study was to evaluate the efficacy of the treatment of chronic ulcers with unfocused shock waves. Between March 2009 and February 2012 we studied a group of 124 patients, aged between 28 and 80 years, with serious wounds arisen over three months and who met the inclusion criteria for treatment. The patients were randomly divided into groups A and B, both treated with unfocused ESWT but with an average energy density for each impulse equal to 0.10 m.l/mm' in group A (total energy equal to 1.7 mJ for each shot) and an average energy density for each impulse equal to 0.04 m.I/mm-in group B (total energy equal to 3.3 mJ for each shot). The pulses were administered at a frequency of 4 Hz in both groups. Wounds were classified according to: location, width, length, percentage of granulation tissue, necrotic tissue, fibrous tissue, presence of bacterial exudation and pain (assessed by VAS). Their evolution was monitored by photo capture. The patients were treated with a frequency of 1 session every 7 days for 7 weeks. During the treatment period, the possible occurrence of side effects was monitored. Before treatment the wounds in group A had an average area equal to 3.85 em-and the average value of the VAS pain scale was equal to 5.8 (range 2-9); the wounds in group B had an average area equal to 3.4 ern" and the average value ofthe VAS pain scale was equal to 5.7 (range 3-9). At the end of the treatment protocol the mean area in group A decreased by 80% (final mean area 0.93 em"), and the average pain on VAS scale dropped by 79%; the mean area in group B decreased by 67% (final mean area 1.2 ern") and the average score on VAS scale dropped by 48%. None of the treated patients experienced adverse reactions to treatment. None of the treated wounds developed infection during treatment. In conclusion, shock waves can act on difficult wounds, stimulating the reparative physiological process; therefore it represents an effective and safe procedure to accelerate the healing process, reducing the operating costs and avoiding more complex interventions.Chronic ulcers are complex wounds that do not heal spontaneously and are usually associated with local and systemic predisposing factors (1).Wound healing is a dynamic process influenced by homeostatic balance, inflammatory and matrixsynthesis process, and by an appropriate process

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Several treatments have been proposed for the management of spasticity. The injection of botulinum toxin type A is considered the gold standard treatment and appears to be safe and effective. The combination between botulinum toxin type A (BTX-A) and physiotherapy (FKT) is thought to be able to enhance the effects. The aim of this study was to assess the effectiveness of the administration of botulinum toxin type A when combined with a specific rehabilitation protocol in subjects with focal spasticity. 44 subjects were randomly divided into two groups (A and B).All subjects underwent ECO and EMG guided BTX-A injection. After the injection group A underwent a complex rehabilitation protocol with functional electrical stimulation, functional bandaging, manual therapy, cognitive sensory motor training and focal vibration on the treated muscle; group B made functional rehabilitation at home.Both groups improved spasticity, pain and function in the first month after the inoculation (T1) but only in group A an improvement at the follow up performed in the subsequent 9 months was observed.According to the results, it may be suggested that the inoculation of Botulinum toxin A should be properly placed within a specific rehabilitation program.