bims-ricfun Biomed News
on Rehabilitation ICF
Issue of 2025–11–30
63 papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica
  1. Neuroanatomical changes in the median nerve following surgical release in moderate-to-severe carpal tunnel syndrome.
  2. Tailoring BoNT A treatment and assessment across recovery stages after stroke: a report of four clinical cases.
  3. Nurses' functional status assessments using the International Classification of Functioning, Disability, and Health across hospital types in Japan: A cross-sectional study.
  4. Effects of Pilates Matwork Core Exercises on Functioning in Middle-Aged Adult Women with Chronic Nonspecific Low Back Pain Through Flexion Relaxation Phenomenon Analysis: A Pilot RCT.
  5. Functional Effects of BoNT-A Application in Masseter Muscle in Patients with Symptoms of Bruxism.
  6. Ultrasound-guided injection of the rotator interval synovial lining: A cadaveric validation.
  7. Early Botulinum Toxin Type A Injection May Improve Motor Recovery in Patients with Post-Stroke Spasticity: A Secondary Analysis from a Longitudinal Cohort Study.
  8. New Ultrasonographic Parameter for Diagnosing Carpal Tunnel Syndrome: The Median Nerve-to-Ulnar Artery Cross-Sectional Area Ratio.
  9. Surgical repair vs. non-operative management of acute Achilles tendon ruptures: Current evidence and controversies.
  10. Ultrasound elastography to guide compression therapy for gastrocnemius trigger points in runners.
  11. Cystoscopic injection of botulinum toxin for urgency incontinence.
  12. Genetic Susceptibility to Sport-Related Muscle Injuries: Insights from the Literature and Novel Gene Candidates.
  13. Myval, Pulmonary and Cardiac Rehabilitation, Pulmonary Embolism….
  14. Botulinum Toxin in the Therapy of Chronic or Relapsing Plantar Fasciitis-A Descriptive Review.
  15. Post-operative Achilles Tendinopathy Following Surgical Repair of Achilles Tendon Rupture Treated With Platelet-Rich Plasma: A Report of Two Cases.
  16. Is Exercise-based cardiac rehabilitation for adults with atrial fibrillation effective? A Cochrane Review summary with commentary.
  17. Virtual reality-based functional recovery in burn population: a systematic review.
  18. Early Rehabilitation Versus Conventional Approaches in Post-Traumatic Hand Injuries with Multiple Lesions: Clinical Outcomes and Future Directions.
  19. Impact of strength training on physical function, biomechanical variables, and pain management in older adults with knee osteoarthritis: a randomized controlled trial.
  20. The Effect of Humeral Head Depressor Strengthening on Individuals with Subacromial Impingement Syndrome.
  21. Dual pathology in lateral elbow pain: the overlooked role of posterior interosseous nerve compression in refractory lateral epicondylitis.
  22. Knee Osteoarthritis: Current Insights Into Pathophysiology and Non-surgical Management Options.
  23. Bilateral Distal Quadriceps Tendon Rupture in a Young Male Following Minimal Trauma: First Presentation of Primary Hyperparathyroidism Due to a Parathyroid Adenoma.
  24. Artificial Intelligence for the Diagnosis and Management of Patellofemoral Instability: A Comprehensive Review.
  25. Effectiveness of genicular nerve block on pain and disability in chronic knee osteoarthritis: a randomized double blinded placebo controlled trial.
  26. Is It Just Carpal Tunnel Syndrome? Mimics From Hand to Shoulder and Systemic to Vascular Sources.
  27. Management of Facial Paralysis Following Skull Base Surgery: A Comprehensive Narrative Review.
  28. Personalized Adipofascial Flap: A Game-Changer for Post-Traumatic Ulnar Nerve Neuropathy at the Wrist and Elbow.
  29. Immersive virtual reality as a complementary tool in Achilles tendon rehabilitation: A proposal for sport-specific return.
  30. Hidden Adaptations: Ultrasound Evidence of Intrinsic Foot and Tendon Changes in Basketball Players with Hallux Limitus.
  31. Patellar socket technique for chronic quadriceps tendon repair: maximizing graft efficiency.
  32. Editorial: Physical Examination and Rehabilitation of Fasciae and Muscles in Sports Injuries.
  33. Advancements in Understanding Spasticity: A Neuromusculoskeletal Modeling Perspective.
  34. REVIEW OF INTRA-OPERATIVE TECHNIQUES TO ASSESS REDUCTION QUALITY IN TIBIAL PLATEAU FRACTURES.
  35. A systematic review and meta-analysis of randomized controlled trials on the effect of various therapeutic interventions on sacroiliac joint dysfunction.
  36. Pediatric Neuromuscular Ultrasound to Augment the Diagnostic Capabilities for Scapular Winging.
  37. Diagnostic Accuracy of Electrodiagnostic Comparative Latency Studies of Carpal Tunnel Syndrome: Single Test and Concordance Between Multiple Tests.
  38. Ultra-low-dose CT in extremity fracture detection: A systematic review and meta-analysis.
  39. Psilocybin and Chronic Pain: A New Perspective for Future Pain Therapists?
  40. Effect of Early Extracorporeal Shockwave Therapy on Postoperative Pain and Functional Recovery After Intramedullary Nailing: An Open-Label Randomized Controlled Trial.
  41. Association of balance with kinesiophobia and physical function in knee osteoarthritis.
  42. Ultrasound Guided Erector Spinae Plane Block for Pain Management in the Emergency Department: A Scoping Review.
  43. Rotator Cuff Imaging Abnormalities in Asymptomatic Shoulders: A Systematic Review.
  44. Effect of prescribing and deprescribing oxycodone on pain and function in a mouse model of osteoarthritis: impact of polypharmacy and sex on response.
  45. Clinical effect and mechanism of aerobic exercise for knee osteoarthritis: a mini review.
  46. Clinical Outcomes of a Novel A5/A4 Pulley Security Suture in the Treatment of Zone 1 FDP Avulsion Fracture.
  47. The Role of Myofascial Release Techniques as an Adjunct to Other Therapies in Knee Osteoarthritis: A Systematic Review.
  48. Comment on: "The Comparison of Efficacy of Bilateral Type I Versus Type II Pectoral Nerve Block Applied with Ultrasound-Guided for Postoperative Analgesia in Gynecomastia Surgeries".
  49. Impact of the Pilates Method on Quality of Life and Functional Well-Being in Women with Osteoporosis: Protocol for a Randomized Controlled Trial.
  50. Fascial and muscle ultrasound parameters unchanged after stretching or eccentric training in young men with hamstring tightness.
  51. Exploring the experience and needs of postoperative rehabilitation management for elderly patients with osteoporotic vertebral compression fractures after percutaneous vertebroplasty: a qualitative study.
  52. Treatment of Rotator Cuff Tears: Around the World From Partial Thickness to Irreparable.
  53. Applicability of Lung Ultrasound During Weaning From Mechanical Ventilation: A Systematic Review.
  54. The efficacy of an eight-week core stability exercise program in suspended and stable conditions on the muscle activation and functional disability of amateur soccer players with non-specific chronic low back pain.
  55. Hand function in immune-mediated inflammatory rheumatic diseases: assessment and rehabilitation approaches.
  56. "Integrative physiotherapy in burn rehabilitation: Innovations in physical, psychological, and technological interventions - A narrative review".
  57. Feasibility of Integrating Pilates with Conventional Kinesiotherapy for Managing Chronic Low Back Pain: A Pilot Study.
  58. Correction: Does surgery reduce knee osteoarthritis, meniscal injury and subsequent complications compared with non-surgery after ACL rupture with at least 10 years follow-up? A systematic review and meta-analysis.
  59. Modafinil for Promoting Wakefulness in Critically Ill Patients: Current Evidence and Perspectives.
  60. Medial meniscal stabilizers, variants, and injuries of the knee.
  61. Comparison of Pain Relief from platelet-rich plasma, Steroid, and Saline Injections in Chronic Shoulder Impingement using Visual Analog Scale.
  62. Impact of hybrid closed-wedge high tibial osteotomy on mechanical loading during gait in patients with medial knee osteoarthritis.
  63. Gait and gluteus medius alterations after Trochanteric-Entry intramedullary nailing: A retrospective quantitative analysis : Gait and gluteus medius alterations after Trochanteric-Entry intramedullary nailing: A retrospective quantitative analysis.
  1. Arch Phys Med Rehabil. 2025 Nov 20. pii: S0003-9993(25)01054-8. [Epub ahead of print]
    Neuroanatomical changes in the median nerve following surgical release in moderate-to-severe carpal tunnel syndrome.
    José Antonio Expósito-Tirado, José María Delgado-Mendilivar, Jorge Angulo-Gutiérrez, Martí Peirau-Gabarrell, Juana Díaz-Del-Río, Julio Salvador-Camacho, María Del Carmen García-Serrano, Rogelio Del-Pino-Algarrada, Juan Manuel Praena-Fernández, Gloria Patricia Vergara-Diaz.
       OBJECTIVE: To primarily assess neuroanatomical changes following CTS surgical release and their association with patient symptoms and functional status; secondarily, to determine the optimal time point for evaluating therapeutic outcomes.
    DESIGN: Prospective quasi-experimental study with a follow-up period of 6 months.
    SETTING: Physical medicine and rehabilitation institutional practice in an outpatient setting.
    PARTICIPANTS: 34 patients diagnosed with moderate-to-severe CTS by ultrasound, who underwent surgical release between May 2022 and July 2023.
    INTERVENTIONS: Median nerve surgical release.
    MAIN OUTCOME MEASURES: Ultrasound was used to assess the cross-sectional area (CSA) and flattening ratio (FR) of the median nerve before surgery and at 15 days, three months, and six months postoperatively. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was administered to assess symptom severity and functional status.
    RESULTS: Of the participants, 73.6% were women, with a median age of 48.8 years (42.5-53.3). Before surgery, CSA at the carpal tunnel inlet measured 14.3 mm² (IQR 13-17) and at the outlet 10 mm² (IQR 9-11); the FR was 3.1 (2.5; 3.7). The CSA at the inlet was the only parameter to show consistent improvement at all follow-up points: 15 days (p=0.001), three months (p<0.001), and six months (p<0.001). BCTQ scores for symptom severity and functional status showed significant reduction at three and six months (p<0.001).
    CONCLUSION: A reduction in the elevated CSA of the median nerve was observed following CTS surgical release, with the optimal evaluation point being three months postoperatively. This anatomical improvement was associated with decreased symptom severity and improved functional status.
    Keywords:  carpal tunnel syndrome; cross-sectional area; flattening ratio; median nerve; ultrasound
    DOI:  https://doi.org/10.1016/j.apmr.2025.10.027
  2. J Med Life. 2025 Oct;18(10): 967-975
    Tailoring BoNT A treatment and assessment across recovery stages after stroke: a report of four clinical cases.
    Miruna Săndulescu, Delia Cinteză, Daniel Ionuţ Răducan, Daniela Poenaru, Claudia-Gabriela Potcovaru, Horia Păunescu, Oana Andreia Coman.
      Achieving effective spasticity management in post-stroke patients remains a significant therapeutic challenge. It requires the anticipation and management of multiple potential complications through a complex, individualized therapeutic approach. The therapeutic goals in stroke-related spasticity vary considerably depending on the intensity and duration of spasticity, as well as the degree of motor control in the affected limb segments. This study presents four clinical case reports involving patients with post-stroke spasticity ranging from grade 1+ to 4 on the Modified Ashworth Scale (MAS), each exhibiting a distinct temporal profile of symptom progression and levels of motor control in affected limbs. All patients received conservative rehabilitation therapy in conjunction with botulinum toxin (BoNT-A) administration. Spasticity assessment is essential for evaluating treatment efficacy and for planning and refining rehabilitation strategies. Employing case-appropriate functional clinical scales facilitates dynamic assessment and quantification of motor deficits, thereby enabling precise definition and ongoing monitoring of therapeutic goals. Given the heterogeneous functional status of patients with post-stroke spasticity, therapeutic objectives and evaluation strategies must be tailored accordingly. BoNT-A therapy necessitates a patient-specific approach concerning dosing and injection intervals. Repeated BoNT-A treatment in cases of severe spasticity produced sustained reductions in limb pain and mitigated periarticular tissue damage. In patients with mild spasticity and preserved motor function, functionality reached substantial recovery, as reflected in outcomes from appropriately selected functional measures, with injections spaced at intervals exceeding three months and employing progressively lower doses.
    Keywords:  abobotulinum toxin; functional assessment; functional outcome; post-stroke spasticity
    DOI:  https://doi.org/10.25122/jml-2025-0151
  3. Belitung Nurs J. 2025 ;11(6): 777-785
    Nurses' functional status assessments using the International Classification of Functioning, Disability, and Health across hospital types in Japan: A cross-sectional study.
    Kanako Yamamoto.
       Background: In Japan, patients receiving treatment in advanced acute care hospitals often cannot return home immediately and require ongoing hospitalization. Sequential support is crucial to facilitate long-term recovery and community reintegration. Therefore, functional assessments should extend beyond physical function to include daily activities and participation. However, how nurses across different hospital types in Japan evaluate patients' functional status using a standardized framework remains unclear.
    Objective: This study examined how nurses in hospitals with varying care functions assess patients' functional status, focusing on the application of the International Classification of Functioning, Disability, and Health (ICF) framework.
    Methods: A cross-sectional survey with a qualitative component was conducted in accordance with the STROBE guidelines. Participants were 200 registered nurses in Japan, each with at least three years of clinical experience. Data were collected from February to March 2025 through an online survey using a commercial research firm's verified panel of licensed nurses. Quantitative data were analyzed using descriptive statistics, chi-square tests, and one-way analysis of variance (ANOVA). In addition, open-ended responses were analyzed qualitatively to capture contextual perspectives on functional assessment.
    Results: No significant differences were observed in discharge planning practices among the four hospital types. The Functional Independence Measure was most frequently used in recovery-phase hospitals (p <0.001). Across all hospital types, assessments focused primarily on body functions and structures, while activities and participation domains received comparatively less attention. Qualitative analysis indicated that the focus of patient handovers varied by hospital function, reflecting institutional roles and priorities.
    Conclusion: Although discharge planning practices were comparable across hospital types, functional assessments remained concentrated on physical aspects, with limited attention to broader domains critical for long-term recovery. These findings highlight the need for a more comprehensive and standardized use of the ICF framework to support patients' social reintegration and continuity of care across healthcare settings.
    Keywords:  Japan; delivery of health care; functional status; hospitalization; hospitals; patient discharge; patient handoff
    DOI:  https://doi.org/10.33546/bnj.4123
  4. J Funct Morphol Kinesiol. 2025 Nov 06. pii: 433. [Epub ahead of print]10(4):
    Effects of Pilates Matwork Core Exercises on Functioning in Middle-Aged Adult Women with Chronic Nonspecific Low Back Pain Through Flexion Relaxation Phenomenon Analysis: A Pilot RCT.
    Nicola Marotta, Alessandro de Sire, Federica Pisani, Michele Mercurio, Ennio Lopresti, Lorenzo Scozzafava, Andrea Parente, Giorgio Gasparini, Umile Giuseppe Longo, Antonio Ammendolia.
      Objectives: Pilates is frequently recommended for patients with Chronic Nonspecific Low Back Pain (CNLBP) due to its potential to enhance posture, muscle strength, trunk flexibility, and stability. However, to date, there is no robust evidence supporting the effectiveness of Pilates in managing CNLBP. This study aimed to assess the effects of 8 × 8 Pilates Matwork core exercises on pain and functioning in middle-aged adult women with CNLBP, through a flexion relaxation phenomenon (FRP) analysis. Methods: We included middle adult women (n = 21) with diagnosis of CNLBP and a Numeric Rating Scale (NRS) > 4. The experimental group underwent a treatment of eight Pilates Matwork sessions, biweekly for 4 weeks, lasting about 40 min. The control group underwent standardized exercises used for managing CNLBP. Outcome measures included NRS, Oswestry Disability Index (ODI), Quebec Back Pain Disability Scale (QBPDS), and the FRP ratio via surface electromyography during trunk maximum flexion. We evaluated the participants at the baseline (T0), at the end of the 4-week treatment (T1), and at 4 weeks after the end of the treatment, at 8 weeks from the baseline (T2). Results: In this pilot RCT, 21 middle-aged adult women affected by CNLBP were randomly allocated with a ratio of 1:1 in the Pilates group, and in parallel in the control group. The experimental group showed a significant improvement in ODI and QBPDS scores compared to the control group, maintained at follow-up for ODI, along with an NRS reduction at T2. About FRP, Pilates has proven to be comparable to conventional treatment, showing no significant difference in FRR at T1 and T2. Only the experimental group exceeded the 9.5 cutoff at T2, as a protective predictive index for CNLBP. Conclusions: This pilot RCT provided preliminary evidence that Pilates might be an effective rehabilitation method, enhancing functioning and pain management in middle-aged adult women affected by CNLBP. The FRP study proves to be efficient in translating clinical assessments into rehabilitation assessment measures.
    Keywords:  chronic non-specific low back pain; flexion relaxation phenomenon analysis; pilates
    DOI:  https://doi.org/10.3390/jfmk10040433
  5. Toxins (Basel). 2025 Oct 31. pii: 540. [Epub ahead of print]17(11):
    Functional Effects of BoNT-A Application in Masseter Muscle in Patients with Symptoms of Bruxism.
    Krystian Matusz, Artur Drużdż, Natalie Górna, Mariusz Glapiński, Małgorzata Gałczyńska-Rusin, Agata Czajka-Jakubowska, Michał Michalak, Agnieszka Przystańska.
      Bruxism, defined as a repetitive jaw-muscle activity characterized by clenching or grinding of teeth and/or by bracing or thrusting of the mandible, is a prevalent behavior affecting up to 22% of adults worldwide. While traditionally viewed as a disorder, current understanding recognizes bruxism as a behavior that may have both positive and negative consequences. Objective assessment methods for evaluating the effectiveness of interventions in symptomatic patients remain limited. This article presents the first longitudinal study using myotonometry to quantify changes in masseter muscle following botulinum toxin type A (BoNT-A) treatment in patients with symptoms of bruxism. In total, 57 patients were recruited and their masseter muscle tone, stiffness, elasticity, relaxation time, and creep parameters were measured. Measurements were performed at baseline, 3 weeks, and 3 months post-injection during both rest and maximum voluntary contraction. BoNT-A treatment produced significant improvements in all biomechanical parameters, with the greatest effects observed in patients with the highest baseline muscle values. The objective biomechanical changes correlated with the duration of BoNT-A's therapeutic effects. These findings establish myotonometry as a valuable tool for objective assessment of masticatory muscle function and demonstrate that BoNT-A produces measurable, long-lasting biomechanical changes in masseter muscle parameters, supporting its possible clinical application in this challenging condition.
    Keywords:  incobotulinumtoxinA; masticatory muscles
    DOI:  https://doi.org/10.3390/toxins17110540
  6. Shoulder Elbow. 2025 Nov 24. 17585732251398732
    Ultrasound-guided injection of the rotator interval synovial lining: A cadaveric validation.
    Vincenzo Ricci, Giorgio Tamborrini, Raphael Micheroli, Marco Becciolini, Mihaela Stegert, Erik Deman, Ke-Vin Chang, Magdalena Müller-Gerbl, Adib Zendehdel, Levent Özçakar, Felix Margenfeld.
       Introduction: Ultrasound-guided injections of the rotator interval (RI) are commonly performed in clinical practice targeting the anatomical interface between the long head of the biceps tendon (LHBT) and the biceps reflection pulley (BRP). Herewith, cadaveric validation of the exact placement of the injectate inside the synovial compartment of the RI is lacking in the pertinent literature. The purpose of this study was to investigate the correct placement and the spread patterns of different dye volumes within the synovial space of the RI of the shoulder in cadaveric samples.
    Method: The RI of both shoulders of two cadavers (1 male, 1 female, Thiel's embalming technique) was injected with blue-colored dye under ultrasound guidance, using the in-plane technique and lateral-to-medial approach. Targeting the LHBT-BRP interface, 0.5 mL and up to 1.5 mL of blue dye were injected, respectively, in both cadavers. The bursal tissue overlying the RI was also injected in both cadavers using 1.0 mL of yellow dye. Subsequently, a layer-by-layer anatomical dissection was performed to test the placement and spread of the blue dye within the synovial space of the RI.
    Results: The blue dye was correctly placed within the synovial sheath of the RI in all cadaveric shoulders (4/4), and no communication with the overlying bursal cavity was identified. A distal spread of the dye around the extracapsular portion of the LHBT was observed in all cadaveric samples. Notably, proximal spread of the blue dye inside the (capsular space and the synovial cavity of the) glenohumeral joint was identified only in shoulders which were injected with 1.5 mL of volume (2/4). The anatomical exploration of the RI demonstrated the presence of a double-layer synovial lining with an inner lumen and a fenestrated proximal edge located below the BRP. Three-dimensional and multiplanar reconstruction computed tomography (CT) scans demonstrated a mean value of 32.5 mm for the length of the capsular tunnel (CaT) of the LHBT.
    Conclusion: Under ultrasound guidance, the double-layered synovial sheath of the shoulder RI can be injected. The mixture may spread distally, around the extracapsular segment of the LHBT, and proximally inside the capsulosynovial space of the glenohumeral joint.
    Level of evidence: Basic Science, Level V; Cadaveric/Anatomy Study.
    Keywords:  Shoulder; intervention; rotator cuff; synovitis; ultrasonography
    DOI:  https://doi.org/10.1177/17585732251398732
  7. Toxins (Basel). 2025 Nov 13. pii: 558. [Epub ahead of print]17(11):
    Early Botulinum Toxin Type A Injection May Improve Motor Recovery in Patients with Post-Stroke Spasticity: A Secondary Analysis from a Longitudinal Cohort Study.
    Alessandro Picelli, Andrea Santamato, Michela Cosma, Alessio Baricich, Carmelo Chisari, Marzia Millevolte, Cristina Del Prete, Ilenia Mazzù, Rita Di Censo, Nicola Smania, Mirko Filippetti.
      Spasticity after stroke impairs motor control, delays recovery, and reduces quality of life. Botulinum toxin type A is the first-line treatment, but it is often administered in the chronic phase, potentially limiting its impact on rehabilitation. Emerging evidence suggests that earlier treatment may enhance recovery, though functional benefits remain uncertain. We conducted a secondary analysis of a multicenter, open-label, longitudinal cohort study to investigate whether the timing of the first botulinum toxin type A injection influences outcomes in post-stroke patients naïve to this treatment. All participants received botulinum toxin injections combined with conventional rehabilitation. Assessments were performed at baseline and at 4, 12, and 24 weeks post-injection. The primary outcome was muscle tone; secondary outcomes included motor strength, sensorimotor recovery, and global disability. Statistical analyses used mixed-effects models and trend tests. Patients treated within 90 days of stroke onset showed greater reductions in spasticity at 4 and 12 weeks compared with later treatment. Despite having more severe baseline impairments, early treated patients demonstrated faster and more pronounced improvements in upper-limb strength, sensorimotor recovery, and global disability. Early toxin administration is associated with enhanced reduction in spasticity and improved motor recovery, particularly in patients with severe initial deficits.
    Keywords:  botulinum toxins; muscle spasticity; rehabilitation; therapeutics
    DOI:  https://doi.org/10.3390/toxins17110558
  8. Medicina (Kaunas). 2025 Nov 08. pii: 2002. [Epub ahead of print]61(11):
    New Ultrasonographic Parameter for Diagnosing Carpal Tunnel Syndrome: The Median Nerve-to-Ulnar Artery Cross-Sectional Area Ratio.
    Junhee Lee, So-Youn Chang, Joon Shik Yoon.
      Background and Objectives: Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy. Ultrasonography is a widely used diagnostic method for CTS, and the median-to-ulnar nerve cross-sectional area ratio (MUR) is a well-known parameter. However, the ulnar nerve may be affected by various conditions of the median nerve; therefore, we considered finding further parameters. The aim of the study is to identify the correlation between the median nerve-to-ulnar artery cross-sectional area ratio (MUAR) and existing ultrasonographic parameters used as diagnostic indicators of CTS. Materials and Methods: Sixty-seven wrists from forty-two patients who were diagnosed with CTS by electrodiagnostic studies within 4 years before enrollment were retrospectively analyzed in this study. The median nerve cross-sectional area (CSA), ulnar nerve CSA, and ulnar artery CSA at full dilation were measured. In addition to well-defined CTS ultrasonographic parameters, the MUAR were calculated. All measurements were gathered at three levels. The reproducibility was evaluated through intraclass correlation coefficients (ICCs) and Bland-Altman plots. Results: The MUAR at the carpal tunnel inlet showed a strong positive correlation with the MUR at the same level (ρ = 0.738, p < 0.05) and the median nerve wrist forearm ratio (ρ = 0.541, p < 0.05). In addition, the MUAR at the carpal tunnel outlet presented a strong positive correlation with MUR at the carpal tunnel inlet (ρ = 0.528, p < 0.05). The MUAR at 12 cm proximal to the distal wrist crease showed a strong positive correlation with the MUR at the corresponding level (ρ = 0.613, p < 0.05). Intra-rater and inter-rater reliability showed a high degree of agreement (ICCs > 0.90). Conclusions: This study demonstrates correlations between known CTS parameters and MUAR and suggests the possibility of MUAR as a reliable CTS diagnostic tool. Further research is recommended to validate these findings.
    Keywords:  carpal tunnel syndrome; median nerve-to-ulnar artery cross-sectional area ratio; ultrasonography
    DOI:  https://doi.org/10.3390/medicina61112002
  9. J Orthop Surg (Hong Kong). 2025 Sep-Dec;33(3):33(3): 10225536251401838
    Surgical repair vs. non-operative management of acute Achilles tendon ruptures: Current evidence and controversies.
    Raymonde Dahdouh, Karim Areslan, Katherine Atallah, Mohammad Badra, Ramzi Moucharafieh.
      The Achilles tendon is one of the most robust tendons of the human body, and unfortunately, the most ruptured. Historically, surgical management was the golden standard, aiming to restore baseline activity with low re-rupture rates. With the development of new functional rehabilitation protocols, the paradigm started shifting towards nonoperative approaches, to avoid surgical complications. Moreover, the introduction of adjunct therapies, such as low-level laser therapy, extracorporeal shockwave therapy, or plasma-rich-protein injections, widened the scope of treatment. While both surgical and nonoperative approaches have demonstrated comparable outcomes, an ideal treatment algorithm is still a subject of debate. This literature review meticulously studies major trends in surgical and nonoperative management of acute Achilles tendon ruptures, describing most prevalent techniques and protocols, comparative results, and complication rates. It also highlights the latest updates on the use of adjunct therapies and injections, aiming to guide clinical decision making in treating this common injury.
    Keywords:  Achilles tendon; extracorporeal shockwave therapy; human body; low-level light therapy; nonoperative treatment; rupture; tendon injuries
    DOI:  https://doi.org/10.1177/10225536251401838
  10. Sci Rep. 2025 Nov 25. 15(1): 41950
    Ultrasound elastography to guide compression therapy for gastrocnemius trigger points in runners.
    Ingrid C Landfald, Michał Podgórski, Łukasz Olewnik.
      Myofascial pain syndrome (MPS) is one of the most common musculoskeletal pain disorders affecting athletes. This is an important clinical issue because MPS has a negative impact on athlete achievement as with sporting injuries. We screened 44 amateur runners who ran ≥ 50 km/week and reported running-related lower-leg pain. Thirty runners with gastrocnemius myofascial trigger points (MTrPs; 21 men, 9 women; mean ages 36 and 33 years) underwent B-mode ultrasonography and strain elastography. Ischemic compression was applied to identified MTrPs, with sonographic reassessment after each cycle and at 24 h. Ankle dorsiflexion range of motion (ROM) was measured with a goniometer; no diagnostic threshold was applied. Among 44 runners screened, gastrocnemius MTrPs were diagnosed in 30 (68%); 14/44 had no MTrPs. In those 30 participants, 103 MTrPs were identified (mean 4.7 per person by palpation; 3.4 by ultrasonography). After the first compression course, 75/103 MTrPs were no longer detectable. 21/103 were visible only on elastography with reduced stiffness, and 7/103 remained both palpable and sonographically visible. At 24-h follow-up, none of the 75 eliminated or 21 elastography-only MTrPs recurred; 5/7 persistent MTrPs were deactivated after a second session. Elastography aided the diagnosis of MTrPs in the gastrocnemius muscle of amateur runners and allowed for more objectified control of MTrPs compression therapy.
    Keywords:  Articular; Elasticity imaging techniques; Gastrocnemius; Myofascial pain syndromes; Pain management; Range of motion; Running; Trigger points; Ultrasonography
    DOI:  https://doi.org/10.1038/s41598-025-25902-8
  11. Tidsskr Nor Laegeforen. 2025 Nov 25. 145(14):
    Cystoscopic injection of botulinum toxin for urgency incontinence.
    Siv Svennevik Myhr, Hjalmar A Schiøtz.
       Background: Urgency incontinence is a common condition that can be difficult to treat. Cystoscopic injection of botulinum toxin into the bladder wall is a treatment option when conservative treatment has failed. The aim of the study was to evaluate the treatment outcomes and clinical benefits of botulinum toxin injection.
    Material and method: We performed a retrospective record-based study at the Department of Gynaecology, Vestfold Hospital, of women who received intravesical botulinum toxin for urgency incontinence in the period 2014 - 2022 after failing to respond to conservative treatment. The primary endpoint was treatment satisfaction. Secondary endpoints were self-reported continence, repeated injections, treatment interval and complications.
    Results: A total of 167 women received treatment, with 403 injections administered. At the outpatient follow-up six months post-injection, 297/391 (76 %) reported being satisfied with the treatment and 272/384 (71 %) reported having regained continence. One or more complications were recorded in 79 of 395 (20 %) injections: 48 urinary tract infections, 25 cases requiring catheterisation due to impaired bladder emptying, and 6 cases of pain.
    Interpretation: Cystoscopic injection of botulinum toxin may be useful when conservative treatment for urgency incontinence has not led to adequate improvement. However, the method is not without risk of complications.
    DOI:  https://doi.org/10.4045/tidsskr.25.0247
  12. Int J Mol Sci. 2025 Nov 19. pii: 11175. [Epub ahead of print]26(22):
    Genetic Susceptibility to Sport-Related Muscle Injuries: Insights from the Literature and Novel Gene Candidates.
    Agata Leońska-Duniec.
      Physical activity is widely recognized for its health benefits; however, it also increases the risk of musculoskeletal soft tissue injuries, with muscle-related cases constituting a considerable proportion. These injuries impair well-being, athletic performance, and career longevity while creating substantial social and economic burdens. Their multifactorial etiology involves internal and external risk factors, and evidence suggests a heritable component influencing tissue integrity, recovery, and overall susceptibility. While genetic contributions to ligament and tendon damage are relatively established, knowledge regarding muscle injuries remains limited. This review critically summarizes current evidence on polymorphisms associated with sport-related muscle injury susceptibility. A systematic search of PubMed, Scopus, and Web of Science identified studies examining genetic markers in physically active individuals with documented muscle injuries. To date, 37 single nucleotide polymorphisms in 32 genes have been significantly linked to injury risk, recurrence, severity, and recovery. These genes cluster into categories involving muscle structure, growth and regeneration, metabolism, inflammatory and stress responses, membrane stability, signaling, and vascular regulation. By integrating available findings and outlining knowledge gaps, this review highlights promising directions for advancing personalized prevention and rehabilitation strategies in sports medicine.
    Keywords:  genetic susceptibility; injury prevention; injury risk; physical activity; polymorphisms; skeletal muscles; sports genetics
    DOI:  https://doi.org/10.3390/ijms262211175
  13. Anatol J Cardiol. 2025 Nov;29(12): 674
    Myval, Pulmonary and Cardiac Rehabilitation, Pulmonary Embolism….
    Çetin Erol.
      
    DOI:  https://doi.org/10.14744/AnatolJCardiol.2025.12
  14. Biomedicines. 2025 Oct 28. pii: 2647. [Epub ahead of print]13(11):
    Botulinum Toxin in the Therapy of Chronic or Relapsing Plantar Fasciitis-A Descriptive Review.
    Daniela Poenaru, Claudia-Gabriela Potcovaru, Andreea Dumitrescu, Livia Alexandra Ion, Roxana Nartea, Delia Cinteza.
      Background. Plantar fasciitis is a degenerative condition that may follow a chronic or recurrent course. Injectable agents are frequently employed to alleviate pain and restore function. Recently, botulinum toxin (BoNT) has gained particular attention for its analgesic properties, positioning it as a promising therapeutic option for the management of plantar fasciitis. Method. We conducted a literature review to evaluate studies on BoNT administration in plantar fasciitis, aiming to define the target tissues, optimal doses, methods of administration, and associated adverse effects. Results. The evidence suggests that BoNT provides significant short- and long-term analgesic benefits when administered either intrafascially or intramuscularly, with outcomes comparable to or exceeding those of corticosteroids. Conclusion. Further high-quality studies are warranted to compare BoNT with other therapeutic modalities, such as PRP and extracorporeal shockwave therapy (ESWT).
    Keywords:  botulinum toxin; intrafascial; intramuscular; plantar fasciitis
    DOI:  https://doi.org/10.3390/biomedicines13112647
  15. Cureus. 2025 Oct;17(10): e95250
    Post-operative Achilles Tendinopathy Following Surgical Repair of Achilles Tendon Rupture Treated With Platelet-Rich Plasma: A Report of Two Cases.
    Jake Van Weezep, Daniella Rivera, Alexander Kim.
      Post-operative Achilles tendinopathy (AT) can cause persistent, debilitating posterior ankle pain. The optimal treatment for recalcitrant AT following surgical repair of Achilles tendon rupture has not been well-established. Conservative management includes early weight-bearing and mobilization with structured physical therapy (PT) and a progressive return to activity. Despite completion of conservative measures, symptoms may persist long after surgical repair. Platelet-rich plasma (PRP) has been shown to effectively treat painful MSK conditions, including AT. There have been no published studies assessing the efficacy or safety of PRP injections to treat post-operative AT after repair of tendon rupture. We present two cases of refractory AT after surgical repair of a ruptured Achilles tendon treated with ultrasound (US) guided PRP injections.
    Keywords:  achilles repair; achilles rupture; achilles tendinopathy; achilles tendon injury; platelet-rich plasma/prp; post-op pain management
    DOI:  https://doi.org/10.7759/cureus.95250
  16. Turk J Phys Med Rehabil. 2025 Sep;71(3): 402-405
    Is Exercise-based cardiac rehabilitation for adults with atrial fibrillation effective? A Cochrane Review summary with commentary.
    Özge Keniş Coşkun, Duygu Geler Külcü.
      
    DOI:  https://doi.org/10.5606/tftrd.2025.16517
  17. Int J Burns Trauma. 2025 ;15(5): 190-201
    Virtual reality-based functional recovery in burn population: a systematic review.
    Hafiz Muddassir Riaz, Muhammad Naveed Babur, Haroon Mansha, Muhammad Sanaullah, Idrees Ahmed Zahoor, Saleh Shah.
       OBJECTIVE: To evaluate the effectiveness of virtual reality-based interventions in promoting functional recovery among individuals with burn injuries.
    DATA SOURCES: PubMed/Medline, Scopus, Ovid, CINAHL, PEDro, Google Scholar, and Cochrane Library.
    METHODS: Multiple data sources were explored from beginning to March 31, 2024, with study design of randomized clinical trials describing Range of Motion, enhanced ability for self-care (ADLs) and independence, quality of life in adult with burn injury. ROM was primarily measured using goniometers and electronic digital goniometers to assess the degrees of movement at affected joints before and after VR-based rehabilitation sessions. Two independent authors analyzed the results and selected the data. Cochrane Criteria Risk of Bias version 2 was used to measure risk of bias. Patient demographics, treatment regimen and outcome measuring tool, results and change in the patients' conditions were also extracted. Each study was appraised to check the level of evidence.
    RESULTS: 8 publications were selected with a total of 293 patients included in these studies. Level of evidence analysis revealed that 8 studies were classified as level of evidence A2. The lowest PEDro score was 6 for one study only while other studies scored 7, 8, and 9 accordingly. In this review, seven studies were categorized as low risk of bias, while one study had some risk of bias. Our results showed that virtual reality can increase range of motion, enhanced ability for Self-Care (ADLs) and independence, improved quality of life in patients with burn injury, though strength of conclusion for mobility and ADLs was moderate.
    CONCLUSION: Preliminary evidence indicates that virtual reality "V.R." interventions could be beneficial in promoting functional recovery in patients with burn injuries. The studies reviewed suggest Virtual Reality can reduce pain during rehabilitation, improve range of motion, and increase patient engagement. However, the limited number of studies and the variability in VR methods and outcome measures restrict the generalizability of these findings. Further rigorous research with standardized protocols is needed to validate these results and guide clinical practice. Future investigations should aim for larger sample sizes and longer follow-up periods to thoroughly evaluate the effectiveness of VR in burn rehabilitation.
    Keywords:  Burn survivor; exergaming; functional mobility; gamification; physiotherapy; virtual reality
    DOI:  https://doi.org/10.62347/XLAP3706
  18. Medicina (Kaunas). 2025 Nov 19. pii: 2063. [Epub ahead of print]61(11):
    Early Rehabilitation Versus Conventional Approaches in Post-Traumatic Hand Injuries with Multiple Lesions: Clinical Outcomes and Future Directions.
    Adriana Serban, Andreea Grosu-Bularda, Eliza-Maria Bordeanu-Diaconescu, Georgiana-Ozana Tache, Marius Stoica.
      Background and Objectives: Complex hand injuries often lead to long-term functional impairment and require structured rehabilitation following surgery. While early rehabilitation may improve outcomes by preventing stiffness and adhesions, it can also increase pain and psychological distress. In contrast, delayed rehabilitation may offer short-term comfort but risks slower recovery. The study aimed to compare the outcomes of early versus delayed rehabilitation through a four-phase therapeutic protocol, with standardized assessments at baseline, 4 weeks, and 12 weeks. Materials and Methods: This study included 90 patients with complex hand trauma who underwent emergency surgical intervention followed by a structured rehabilitation program. Key parameters included active range of motion (TAM), grip strength, pain (VAS), edema, hand function (QuickDASH), and anxiety levels (GAD-7). Statistical analysis was used to evaluate differences in physical and psychological recovery over time between the two rehabilitation approaches. Results: This study demonstrated that both early and delayed postoperative rehabilitation significantly improved physical and psychological outcomes in patients with complex hand trauma. However, early rehabilitation was associated with faster resolution of edema, quicker gains in functional mobility, and earlier improvement in grip strength, despite causing higher initial levels of pain and anxiety. Conversely, delayed rehabilitation resulted in lower early pain and anxiety but showed slower functional recovery. Subgroup analysis revealed that patients with flexor tendon injuries benefited most from early rehabilitation in terms of mobility, strength, and anxiety reduction, while those with multifocal or complex injuries achieved greater long-term pain relief. Conclusions: As rehabilitation continues to evolve, the adoption of personalized, multimodal, and technologically integrated strategies holds promise for improving both the speed and quality of recovery while addressing the psychological and functional dimensions of patient care. Overall, the study supports early, structured, and individualized rehabilitation protocols, emphasizing a multidisciplinary approach that integrates both physical and psychological recovery strategies.
    Keywords:  delayed rehabilitation; early rehabilitation; hand injuries; hand trauma; rehabilitation program
    DOI:  https://doi.org/10.3390/medicina61112063
  19. J Bodyw Mov Ther. 2025 Dec;pii: S1360-8592(25)00319-5. [Epub ahead of print]45 229-237
    Impact of strength training on physical function, biomechanical variables, and pain management in older adults with knee osteoarthritis: a randomized controlled trial.
    Felipe Marrese Bersotti, Reniery Pereira da Silva, Márcia Barbanera, Klaus Magno Becker, Márcio Fagundes Goethel, Ulysses Fernandes Ervilha.
       BACKGROUND/OBJECTIVES: This study investigated the effects of a 12-session, 4-week strength training protocol on pain, stiffness, and function in individuals with knee osteoarthritis (OA).
    METHODS: The interventions included low-load (20 % 1RM) and high-load (70 % 1RM) exercises, targeting different muscle groups. Participants were divided into three groups: low-load knee-only (K20), high-load knee-only (K0), and high-load knee and hip (HK70). Outcomes were assessed using isokinetic dynamometry, the WOMAC index, and the Timed Up and Go (TUG) test, with comparisons made pre- and post-intervention.
    RESULTS: All groups experienced significant pain reduction and improved WOMAC scores for pain and function, and were maintained for up to 12 months. The HK70 group showed significant strength improvements in knee flexion and extension across all velocities, while the K70 group demonstrated similar gains at lower speeds. The K20 group achieved limited strength improvements, mainly in knee extension at slower speeds, and was the only group to show reduced stiffness. No significant differences were observed in the TUG test, likely due to participants' initial mobility levels.
    CONCLUSIONS: Short-term strength training effectively reduces pain and enhances function in knee OA patients. Both low- and high-load exercises offer benefits, with high-load protocols boosting strength and low-load exercises reducing stiffness. These findings highlight the importance of personalized strength training in OA management to promote pain relief, strength maintenance, and functional improvement.
    IMPLICATIONS: These findings support the use of strength training at different intensities to tailor interventions for symptom relief and functional improvement in individuals with knee osteoarthritis.
    Keywords:  Aged; Exercise; Knee osteoarthritis
    DOI:  https://doi.org/10.1016/j.jbmt.2025.08.018
  20. Medicina (Kaunas). 2025 Nov 19. pii: 2061. [Epub ahead of print]61(11):
    The Effect of Humeral Head Depressor Strengthening on Individuals with Subacromial Impingement Syndrome.
    Utku Kurtaran, Tuba Yerlikaya, Barış Yenen, Ahmet Özgül.
      Background and Objectives: Subacromial pain syndrome (SAPS) is one of the most common musculoskeletal problems affecting the shoulder joint. In this study, we aimed to investigate the effectiveness of a rehabilitation program targeting humeral head depressor muscles on symptoms in individuals with SAPS. Materials and Methods: Participants were sequentially assigned to study and control groups in a quasi-randomized design. While the control group received standard physical therapy and rehabilitation, the study group underwent a combined progressive exercise program, including humeral head depressor strengthening, peri-articular muscle exercises, scapular stabilization, and proprioceptive training. Acromio-humeral distance (AHD) and tendon thickness measurements were evaluated via ultrasonography (USG), while pain intensity, upper-extremity disability, and kinesiophobia were measured using the VAS and McGill Pain Questionnaire, DASH-T, and the Fear Avoidance Beliefs Questionnaire, respectively. Results: Both the study and control groups showed statistically significant increments in AHD compared to the baseline. The first and final measurements changed from 7.92 mm to 10.54 mm and from 7.72 mm to 8.41 mm, respectively. However, the increase in AHD was greater in the study group relative to the control group, and the value was statistically significant. The study group showed significant improvements in pain and disability. Kinesiophobia levels, on the other hand, decreased in both groups, but a greater decrease was observed in the study group. Conclusions: In this study, both the study and control groups showed an increase in AHD, but the combined exercise program targeting humeral head depressor muscles resulted in a greater improvement. Reduced tendon thickness indicated the eased motion of the rotator cuff, supporting the improvements in pain and disability. The program had a positive impact on psychosocial parameters, including pain-related kinesiophobia. Given the limited literature on the effects of such exercises on AHD and tendon thickness, this study provides an original contribution. Clinical Trial Registration: ClinicalTrials.gov identifier: NCT07228455.
    Keywords:  humeral head depressors; rotator cuff; shoulder rehabilitation; ultrasound imaging
    DOI:  https://doi.org/10.3390/medicina61112061
  21. Ir J Med Sci. 2025 Nov 26.
    Dual pathology in lateral elbow pain: the overlooked role of posterior interosseous nerve compression in refractory lateral epicondylitis.
    Ömer Faruk Bucak, Umit Yalcin, Cigdem Cinar, Evrim Coskun.
       BACKGROUND: Refractory lateral epicondylitis (LE) cannot be fully explained by tendon degeneration alone. Posterior interosseous nerve (PIN) compression has been suggested as an overlooked cause of persistent pain. This study investigated the prevalence and clinical significance of PIN involvement in refractory LE, focusing on neuropathic features and their electrodiagnostic correlations.
    METHODS: We conducted a cross-sectional study of 62 patients (18-65 years) with refractory LE, defined as symptoms lasting > 6 months despite standard conservative and interventional treatment. Clinical assessments comprised the Visual Analogue Scale (VAS), Douleur Neuropathique-4 (DN4), and Patient-Rated Tennis Elbow Evaluation (PRTEE). Provocative tests, motor deficits, nocturnal pain, paresthesia, and Frohse tenderness were systematically recorded. EMG was performed by a blinded neurophysiologist using standard diagnostic criteria for PIN.
    RESULTS: PIN was detected in 19 of 62 patients (30.6%). Demographics were comparable, but repetitive high-force work and smoking were significantly more common in the PIN group (p < 0.05). These patients reported higher pain (median VAS 9.0 vs. 7.0) and DN4 scores (4.0 vs. 2.0; both p < 0.001). Nocturnal pain, distal/proximal forearm pain, Frohse tenderness, and paresthesia were strongly associated with PIN (all p < 0.001). PRTEE scores showed greater disability (p < 0.001).
    CONCLUSION: PIN compression is a frequent and clinically significant comorbidity in refractory LE, affecting nearly one-third of patients. Recognizing this condition is essential because persistent symptoms may be driven by neuropathic pain mechanisms rather than tendon degeneration alone. Incorporating targeted clinical screening and selective EMG evaluation may enhance diagnostic accuracy, prevent unnecessary interventions, and support more individualized treatment strategies.
    Keywords:  Electromyography; Lateral epicondylitis; Neuropathic pain; Posterior interosseous nerve syndrome
    DOI:  https://doi.org/10.1007/s11845-025-04195-w
  22. Cureus. 2025 Oct;17(10): e95302
    Knee Osteoarthritis: Current Insights Into Pathophysiology and Non-surgical Management Options.
    Mohammed Elmajee, Mahmoud Mersal, Bibi Zehra, Walid Ben Nafa, Ahmed Elsayed, Osama Embaby, Ahmed Elbioumy, Ahmed Elmahdi, Abdelrahman Embabi, Mohamed Youssef.
      Knee osteoarthritis (OA) is a highly prevalent degenerative joint disorder, characterised by the progressive breakdown of articular cartilage (AC), remodelling of subchondral bone, synovial inflammation, and osteophyte formation. These pathological changes collectively lead to chronic pain, joint stiffness, and functional impairment, significantly diminishing patients' quality of life. This review synthesises contemporary evidence on the pathophysiological mechanisms underpinning knee OA and critically appraises the efficacy of current conservative treatment strategies. Non-pharmacological interventions, such as weight reduction and structured exercise programmes, have consistently demonstrated substantial benefits in alleviating pain and improving functional outcomes. Pharmacological therapies, notably non-steroidal anti-inflammatory drugs (NSAIDs), offer effective symptom relief, while intra-articular interventions, including corticosteroid and hyaluronic acid injections, provide short-term pain control; however, their long-term efficacy remains uncertain. Emerging treatments, such as disease-modifying osteoarthritis drugs (DMOADs), genicular artery embolisation (GAE), and anabolic agents, have shown promising preliminary results, although their precise roles within conservative management require further validation through robust clinical trials. Despite the growing array of therapeutic options, significant challenges persist in optimising conservative management strategies for knee OA. The need for individualised, multimodal approaches that account for patient-specific factors is increasingly recognised. This review highlights the importance of tailored management pathways and emphasises the urgent need for continued research to refine and advance non-surgical interventions for individuals living with knee OA.
    Keywords:  cartilage degeneration; conservative management of knee deformity; disease-modifying osteoarthritis drugs; intra-articular injections; knee osteoarthritis; mesenchymal stem cells; platelet-rich plasma; synovial inflammation
    DOI:  https://doi.org/10.7759/cureus.95302
  23. J Orthop Case Rep. 2025 Nov;15(11): 227-230
    Bilateral Distal Quadriceps Tendon Rupture in a Young Male Following Minimal Trauma: First Presentation of Primary Hyperparathyroidism Due to a Parathyroid Adenoma.
    Karim Mustapha Naja, Roland Becker.
       Introduction: Bilateral quadriceps tendon rupture (BQTR) is rare and typically occurs in older adults or in the presence of systemic disease.
    Case Report: A 30-year-old previously healthy male presented with acute inability to extend both knees after missing a step while descending stairs. Clinical examination and ultrasound confirmed complete BQTRs. Initial blood tests revealed hypercalcemia (value: 3.96 mmol/L; ref: 2.15-2.55) with normal renal function. Parathyroid hormone was elevated (1908 pg/mL; ref: 15-65). Neck magnet resonance imaging demonstrated a solitary hypoechoic nodule consistent with a parathyroid adenoma. The patient underwent bilateral tendon repair and parathyroidectomy during the same admission. Biochemical parameters normalized postoperatively, and the patient reported resolution of longstanding musculoskeletal aches.
    Conclusion: In young patients with tendon rupture after minimal trauma, clinicians should consider metabolic and endocrine causes. Early identification and treatment of primary hyperparathyroidism can prevent further musculoskeletal injury and improve quality of life.
    Keywords:  Quadriceps tendon rupture; bilateral; metabolic bone disease; parathyroid adenoma; primary hyperparathyroidism
    DOI:  https://doi.org/10.13107/jocr.2025.v15.i11.6364
  24. Diagnostics (Basel). 2025 Nov 18. pii: 2918. [Epub ahead of print]15(22):
    Artificial Intelligence for the Diagnosis and Management of Patellofemoral Instability: A Comprehensive Review.
    Italian Orthopaedic Research Society (IORS)
      Patellofemoral instability (PFI) is a multifactorial orthopedic condition affecting predominantly young and active individuals. Accurate diagnosis and personalized treatment planning remain challenging due to the complex interplay of anatomical and biomechanical factors. Recently, artificial intelligence (AI), particularly machine learning (ML) and deep learning (DL), has gained attention for its role in musculoskeletal imaging and orthopedics care. This review explores the current and potential applications of AI in diagnosis and management of PFI. A total of 11 relevant articles were identified and included in the review. Articles originated from six countries, with China having the most contributions (n = 4), followed by Finland (n = 3), and Korea, Japan, USA and Portugal with 1 each. In the results section, findings are grouped into three themes: (A) Diagnosis, (B) Outcomes and Complications and (C) Challenges, Limitations and Future Directions. The review also discussed advancements in automated image analysis, predictive modeling and outcome prediction. Overall, AI has the potential to improve consistency, efficiency, and personalization of care in patients with PFI, although still requiring technological developments for implementation in daily practice. Existing studies are limited by small datasets, methodological heterogeneity, and lack of external validation. Future research should focus on multicenter data integration, explainable AI frameworks, and clinical validation to enable translation into routine orthopedic practice.
    Keywords:  CT; MRI; Rx; artificial intelligence; deep learning; machine learning; patellofemoral instability
    DOI:  https://doi.org/10.3390/diagnostics15222918
  25. Clin Rheumatol. 2025 Nov 28.
    Effectiveness of genicular nerve block on pain and disability in chronic knee osteoarthritis: a randomized double blinded placebo controlled trial.
    Ali Etka Binici, Berna Günay, Duygu Geler Külcü, Nilgün Mesci.
       INTRODUCTION/OBJECTIVES: This study aimed to evaluate whether ultrasound-guided genicular nerve block (GNB) provides superior pain relief and functional improvement in patients with knee osteoarthritis (OA) compared to a placebo procedure. Additionally, it investigated whether the inclusion of a corticosteroid enhances the efficacy of the block.
    MATERIALS AND METHODS: Eighty-one patients diagnosed with knee OA according to the American College of Rheumatology criteria were enrolled in this prospective, randomized, double-blind, placebo-controlled study. Participants were randomly assigned to one of three groups: GNB with local anesthetic (group 1), GNB with local anesthetic plus corticosteroid (group 2), or a placebo procedure (group 3). All patients followed a standardized daily knee exercise program. Primary outcome measure was pain severity evaluated by the Visual Analog Scale (VAS) and pressure pain threshold (PPT) measured with an algometer, secondary outcome measure was disability and function level evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the 40-m fast-paced walk test. Assessments were conducted at baseline, as well as at the 1st week and 1st month following the intervention.
    RESULTS: A total of 75 patients completed the study. All three groups demonstrated statistically significant improvements in VAS scores at both the 1st week (p-values for groups 1, 2, and 3: < 0.0001, < 0.0001, and 0.039, respectively) and the 1st month (p-values: 0.001, < 0.001, and 0.007, respectively) compared to baseline. Both treatment groups showed significantly greater improvements than the placebo group at both follow-up points (p = 0.001). Significant improvements in medial patella PPT, WOMAC scores, and the 40-m fast-paced walk test were observed in groups 1 and 2 (p < 0.05), but not in group 3. No statistically significant differences were found between groups 1 and 2 for any of the outcome measures (p > 0.05).
    CONCLUSION: In patients with knee OA, GNB leads to reduced pain and disability and improved physical capacity, regardless of whether corticosteroids are used as an adjuvant. Key Points • Ultrasound-guided genicular nerve block appears to be an effective treatment option for reducing pain and improving function in patients with knee osteoarthritis. • Adding corticosteroids to the local anesthetic during the procedure did not provide any additional benefit in terms of pain relief or functional improvement.
    Keywords:  Disability; Genicular nerve block; Gonarthrosis; Knee osteoarthritis; Pain
    DOI:  https://doi.org/10.1007/s10067-025-07818-w
  26. Instr Course Lect. 2026 ;75 277-290
    Is It Just Carpal Tunnel Syndrome? Mimics From Hand to Shoulder and Systemic to Vascular Sources.
    Etienne Flamant, Michael Patrick Foy, Julio Cesar Castillo Tafur, Joseph Frank Michalski, Alfonso Mejia, Mark H Gonzalez.
      Carpal tunnel syndrome (CTS) is a common condition affecting up to 3.7% of the population, with patients typically presenting for evaluation of numbness, pain, or hand weakness. When evaluating symptoms suggestive of CTS, it is essential that surgeons consider clinical entities that mimic CTS. It is important to define the characteristics of CTS mimics, assess their incidence, discuss diagnostic means to differentiate them from CTS, and guide selection of appropriate therapies.
  27. Audiol Res. 2025 Nov 12. pii: 155. [Epub ahead of print]15(6):
    Management of Facial Paralysis Following Skull Base Surgery: A Comprehensive Narrative Review.
    Laura Maria De Luca, Sergio Cannova, Sebastiana Lai, Marco Accolla, Alice Barbazza, Lea Calò, Davide Rizzo, Pierangela Tramaloni, Marco Bonali, Ignacio Javier Fernandez, Francesco Bussu.
       OBJECTIVES: Facial paralysis is a devastating yet frequent complication of skull base surgery, significantly impacting quality of life through functional impairments and psychosocial consequences. Management is complex and requires an individualized approach based on duration of paralysis, etiology and extent of nerve injury, overall prognosis, and rehabilitative goals. This review provides a comprehensive overview of current strategies for managing post-skull base surgery facial paralysis.
    METHODS: A narrative review of the literature was performed, analyzing surgical reanimation techniques (nerve grafting, nerve transfers, regional and free muscle transfers), static procedures for facial symmetry and ocular protection, and non-surgical interventions such as physical therapy, botulinum toxin injections, and psychological support. Key criteria guiding treatment selection, including muscle viability and timing since injury, were examined.
    RESULTS: Dynamic surgical approaches remain central to restoring movement. Nerve grafting and transfers are effective when viable musculature is present, whereas regional or free muscle transfers are required in long-standing paralysis with irreversible atrophy. Static procedures provide adjunctive improvements in resting symmetry and eye protection. Non-surgical strategies, including rehabilitation therapy and botulinum toxin, enhance functional outcomes and reduce synkinesis. Psychological counseling addresses the profound emotional burden associated with facial disfigurement. Across modalities, individualized treatment planning is crucial.
    CONCLUSIONS: Management of facial paralysis after skull base surgery demands a multidisciplinary, patient-centered approach. Combining surgical and non-surgical interventions optimizes functional and aesthetic outcomes, helping restore both facial movement and psychosocial well-being.
    Keywords:  brainstem injury; facial paralysis; facial reanimation; house-brackmann scale; multidisciplinary approach; nerve grafting; neuromuscular retraining; physical therapy; skull base surgery; sunnybrook facial grading system
    DOI:  https://doi.org/10.3390/audiolres15060155
  28. J Pers Med. 2025 Nov 01. pii: 521. [Epub ahead of print]15(11):
    Personalized Adipofascial Flap: A Game-Changer for Post-Traumatic Ulnar Nerve Neuropathy at the Wrist and Elbow.
    Alessandro Greco, Martina Bizzarri, Lucian Lior Marcovici, Alessia Pagnotta.
      Introduction: Post-traumatic and post-surgical ulnar nerve neuropathies at the elbow and wrist remain challenging conditions often associated with significant sensory and motor impairment. Traditional approaches such as neurolysis alone may be insufficient, especially in complex or recurrent cases. Adipofascial flaps have shown promising outcomes in peripheral nerve surgery. The aim of this study was to evaluate the outcomes of 13 patients with severe ulnar neuropathies who were treated with a size- and shape-personalized adipofascial flap for nerve coverage. Materials and Methods: We retrospectively analyzed 13 patients treated between May 2020 and May 2024 for severe post-traumatic or post-surgical ulnar neuropathies. All underwent surgical decompression, external neurolysis, and adipofascial flap coverage. Pre- and postoperative outcomes were assessed with clinical and neurological evaluations and using the QuickDASH and NRS pain scores. Discussion: All patients showed improvement in pain and sensory-motor function, including those with complications, supporting the role of flap coverage in neuroprotection. This is the first study to describe the use of adipofascial flaps for pseudo-palsy and painful neuroma-in-continuity of the ulnar nerve at the elbow and wrist level. Conclusions: Adipofascial flaps represent a safe, technically feasible, and effective option in complex ulnar nerve injuries, providing both mechanical and biological support. Despite the small cohort, the results suggest strong clinical potential across varied injury patterns.
    Keywords:  adipofascial flap; nerve compression; neurolysis; peripheral nerve coverage; post-traumatic neuropathy; ulnar nerve; ulnar nerve palsy; vascularized adipofascial flap
    DOI:  https://doi.org/10.3390/jpm15110521
  29. Rehabilitacion (Madr). 2025 Nov 21. pii: S0048-7120(25)00067-2. [Epub ahead of print]60(1): 100947
    Immersive virtual reality as a complementary tool in Achilles tendon rehabilitation: A proposal for sport-specific return.
    A Aldardour, S Alna'amneh.
      
    DOI:  https://doi.org/10.1016/j.rh.2025.100947
  30. J Clin Med. 2025 Nov 17. pii: 8154. [Epub ahead of print]14(22):
    Hidden Adaptations: Ultrasound Evidence of Intrinsic Foot and Tendon Changes in Basketball Players with Hallux Limitus.
    Samuel Eloy Gutiérrez-Torre, Nerea Molina-Hernández, Álvaro García-Vázquez, César Calvo-Lobo, David Rodríguez-Sanz, Ricardo Becerro-de-Bengoa-Vallejo.
      Background: Hallux limitus (HL) is a restriction of first metatarsophalangeal joint dorsiflexion, commonly linked to foot biomechanics-related disorders or trauma, increasing sports injury risk. It involves plantar fascia tension, compensations, and tendon adaptations. Rehabilitative ultrasound imaging (RUSI) accurately assesses musculoskeletal changes, supporting physiotherapy evaluation and the study of HL-related structural adaptations. Objectives: Comparing the thickness and cross-sectional area (CSA) of flexor hallucis brevis (FHB), flexor digitorum brevis (FDB), abductor hallucis (AbH), and quadratus plantae (QP) muscles, as well as the thickness of the plantar fascia (PF), Achilles tendon (AT), and plantar calcaneal fat pad (CFP), between participants with and without HL. Methods: Case-control study included 80 basketball players recruited from semi-professional teams by consecutive non-probabilistic sampling. Participants were divided into two groups: an HL group (n = 40) and a healthy group (n = 40). Musculotendinous parameters were assessed using RUSI. Results: The FDB, FHB, AB, and QP showed significant reductions in thickness and CSA at rest and at contraction in the HL group. PF thickness increased in participants with HL, while CFP thickness decreased significantly. Significance was established at (p < 0.05). Conclusions: HL participants exhibited reduced muscle size and CSA, increased PF, and lower CFP thicknesses, indicating adaptive tissue alterations.
    Keywords:  basketball players; foot; hallux limitus; ultrasound
    DOI:  https://doi.org/10.3390/jcm14228154
  31. Arch Orthop Trauma Surg. 2025 Nov 27. 145(1): 520
    Patellar socket technique for chronic quadriceps tendon repair: maximizing graft efficiency.
    Pasquale Porcelli, Kristijan Zoccola, Simone Cambursano, Riccardo Giai Via, Fortunato Giustra, Alessandro Massè, Marcello Capella.
       BACKGROUND: Chronic quadriceps tendon ruptures (CQTR) result in tendon retraction, fibrosis and tissue loss, often precluding direct repair. Traditional transosseous techniques require large length grafts and full-thickness patellar tunnels, increasing the risk of fractures.
    OBJECTIVE: To present and evaluate a new surgical technique for reconstruction of CQTRs using an ipsilateral semitendinosus (ST) autograft fixed through a proximal patellar socket and Endobutton® fixation, thus minimizing graft wastage and fracture risk.
    METHODS: With the knee flexed at 90° and a thigh tourniquet, the ipsilateral ST is harvested through a medial incision, reinforced with FiberWire®-2 sutures, doubled and measured diametrically. A midline anterior approach exposed the chronic tendon defect, which must be debrided to the healthy margins. Three cavities are created in the proximal patella with an incannulated drill, each 5 mm laterally and medially and 7-8 mm centrally, only in the proximal part, to accommodate the thickness of the graft. The rest of the quadriceps is reinforced with FiberWire®-5 Krakow sutures. Using transport sutures, the prepared ST graft is inserted into the tendon via a Pulvertaft weft, inserted into the central cavity, stretched and secured over the distal patellar cortex with an Endobutton®. Krakow sutures for the native tendon and a FiberTape® loop around the loop of the graft are passed through the respective tunnels and tied over the anterior patella. Intraoperative flexion confirms the stability of the construct; fluoroscopy verifies the height of the patella and the position of the Endobutton®.
    CONCLUSIONS: This proximal socket technique minimises the use of grafts and patellar stress, reliably restoring extensor mechanism function in CQTRs, offering a safe alternative to full transosseous tunnel methods.
    Keywords:  Autologous semitendinosus tendon; CQTRs; Chronic quadriceps tendon rupture; Graft augmentation; Patellar socket; Quadriceps tendon repair; ST graft
    DOI:  https://doi.org/10.1007/s00402-025-06138-7
  32. Bioengineering (Basel). 2025 Nov 12. pii: 1238. [Epub ahead of print]12(11):
    Editorial: Physical Examination and Rehabilitation of Fasciae and Muscles in Sports Injuries.
    Carmelo Pirri, Nathaly Gaudreault.
      Sport injuries remain one of the most pervasive challenges in sport medicine, affecting athletes across disciplines and levels of performance [...].
    DOI:  https://doi.org/10.3390/bioengineering12111238
  33. J Clin Med. 2025 Nov 15. pii: 8092. [Epub ahead of print]14(22):
    Advancements in Understanding Spasticity: A Neuromusculoskeletal Modeling Perspective.
    Mohammad S Shourijeh, Argyrios Stampas, Shuo-Hsiu Chang, Radha Korupolu, Gerard E Francisco.
      Spasticity, a complex consequence of upper motor neuron lesions, poses challenges for clinical assessment due to its neural and mechanical origins. Traditional scales like the Modified Ashworth and Tardieu Scales provide subjective, context-limited insights, often missing spasticity's dynamic nature. Neuromusculoskeletal (NMS) modeling offers objective, quantitative insights by integrating patient-specific muscle-tendon properties, reflex dynamics, and multi-joint biomechanics. This scoping review examines advancements in spasticity modeling, comparing mechanical, neurological, and integrated approaches, and their applications in conditions like cerebral palsy and stroke. We highlight barriers to clinical translation, including computational demands and regulatory challenges, and propose future directions, such as real-time simulation and machine learning integration, to enhance personalized assessment and treatment.
    Keywords:  cerebral palsy; computational modeling; gait analysis; muscle-tendon mechanics; neuromusculoskeletal modeling; reflex hyperexcitability; spasticity; spinal cord injury; stroke rehabilitation
    DOI:  https://doi.org/10.3390/jcm14228092
  34. Georgian Med News. 2025 Sep; 120-123
    REVIEW OF INTRA-OPERATIVE TECHNIQUES TO ASSESS REDUCTION QUALITY IN TIBIAL PLATEAU FRACTURES.
    U Mahajan, M Yousaf, F Jalil, A Afridi, M Akhtar, H Yousaf, A Hilal, A Asif, M Khan, A Dureja, M Ali, M Hussaini.
      Achieving anatomical reduction in tibial plateau fractures is essential to restore joint congruity and minimize long-term complications. Intraoperative assessment remains challenging, especially in complex fracture patterns, prompting the evolution of various imaging and adjunctive techniques. This narrative review summarizes advancements in intraoperative tools used for evaluating reduction in tibial plateau fractures. Techniques discussed include 2D fluoroscopy, intraoperative 3D imaging, arthroscopy, and emerging adjuncts such as 3D printing and cone-beam CT. We conducted a targeted literature search across PubMed, Embase, and Scopus (2000-2025) to identify studies reporting on the clinical application, diagnostic utility, and limitations of intraoperative imaging modalities in tibial plateau fracture management. 2D fluoroscopy remains widely used but is limited in detecting subtle incongruities. Intraoperative 3D imaging enhances accuracy and may reduce reoperations. Arthroscopy offers direct joint visualization, especially useful for assessing depression and posterior injuries. Emerging tools like 3D printing and cone-beam CT present novel intraoperative aids but require further validation. This review provides a consolidated overview of intraoperative strategies described in the literature. By highlighting the current capabilities and limitations of available technologies, we aim to inform ongoing clinical practice and future directions in fracture management.
  35. J Bodyw Mov Ther. 2025 Dec;pii: S1360-8592(25)00366-3. [Epub ahead of print]45 627-638
    A systematic review and meta-analysis of randomized controlled trials on the effect of various therapeutic interventions on sacroiliac joint dysfunction.
    Pinky Jangra, Jaspreet Kaur, Manoj Malik, Monika Rani.
       BACKGROUND AND OBJECTIVE: Sacroiliac joint dysfunction is the most common condition associated with low back pain which leads to pain and disability. Therefore, the aim of this study was to perform a systematic review and meta-analysis on efficacy of physical therapy interventions in sacroiliac joint dysfunction.
    METHODOLOGY: Randomized controlled trials on sacroiliac joint dysfunction, using physiotherapy as an intervention were evaluated for changes in pain and disability. Three different towere searched to find out the relevant studies using Advanced search strategy. The methodological quality of the studies was assessed by PEDro scale and Cochrane risk of bias tool. For meta-analysis, mean and standard deviation value were extracted from each study and analyzed as a random effect model on four interventions that are muscle energy technique, mobilization, exercises, and taping. Review manager 5.3 software was used.
    RESULT: The result of the study showed a statistically significant improvement of muscle energy technique on pain (-1.88, p = 0.009) and mobilization on pain (-0.90, p = 0.003), exercise on pain (-1.13, p = 0.004), and exercise on disability (-5.37, p < 0.001). However, there was non-significant result of taping on pain and muscle energy technique, mobilization and taping on disability.
    CONCLUSION: It can be concluded that physiotherapy interventions are effective in managing the pain, and restoring the functional disability of the patients suffering from sacroiliac joint dysfunction. MET and Exercises were found to be more effective in reducing pain than Mobilization in treating sacroiliac joint dysfunction and only Exercises are effective in improving the disability in SIJD. Therefore a combined approach may be more beneficial.
    Keywords:  Exercises; MET; Manipulations; Mobilization; Physical therapy interventions; Physiotherapy treatment; Sacroiliac joint dysfunction
    DOI:  https://doi.org/10.1016/j.jbmt.2025.09.019
  36. J Clin Ultrasound. 2025 Nov 26.
    Pediatric Neuromuscular Ultrasound to Augment the Diagnostic Capabilities for Scapular Winging.
    Melanie J White, James B Meiling, Katie Cossette, Nicholas A Pulos, Amy E Rabatin.
      Scapular winging (SW) describes abnormal scapular mechanics from weak stabilizing muscles or altered neural innervation. While electromyography (EMG) helps differentiate between myo- or neuropathic SW etiologies and determine the extent of muscle involvement, pediatric EMG may be limited due to the high risk of surrounding structures, small body habitus, and pain tolerance. Herein is a case of pediatric SW following anterior neck lymphadenopathy resection in which EMG was limited. Neuromuscular ultrasound (NMUS) showed asymmetric trapezius thinning and hyperechogenicity, revealing more expansive involvement than was previously known. NMUS is a painless, validated tool to augment the diagnostic capability of EMG and clarify the extent of neuromuscular involvement in SW from both a prognostic and rehabilitation point of view.
    Keywords:  neuromuscular ultrasound; pediatric; scapular winging; spinal accessory mononeuropathy
    DOI:  https://doi.org/10.1002/jcu.70147
  37. Diagnostics (Basel). 2025 Nov 14. pii: 2888. [Epub ahead of print]15(22):
    Diagnostic Accuracy of Electrodiagnostic Comparative Latency Studies of Carpal Tunnel Syndrome: Single Test and Concordance Between Multiple Tests.
    Ahmad R Abuzinadah.
      Background: The optimal number of electrodiagnostic tests required to confirm carpal tunnel syndrome (CTS) has not been systematically evaluated. While single comparative latency study (COLS) is commonly used, it remains unclear whether diagnostic accuracy improves when concordance between multiple COLSs is required. Methods: We retrospectively reviewed the electrodiagnostic data of patients referred to our center with upper limb symptoms. Diagnostic accuracy was assessed for individual COLSs-median-ulnar mixed palmar latency difference (palmdiff), median-ulnar ring finger latency difference (ringdiff), and median-radial thumb latency difference (thumbdiff)-and for concordance between two COLSs. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated within diabetes mellitus (DM) and non-DM groups. Results: We included 538 patients, of whom 305 had CTS and 109 had DM. Among patients without DM, the PPV ranged from 87.6% to 92.6% for single COLS and 94.1% to 94.8% for concordance between two abnormal COLSs. When only patients with symptom durations of >6 months were considered, the PPV of concordance between two abnormal COLSs was consistently 100%. Among patients with DM who were younger than 60 years, the PPV for a single COLS was >89%, and that for concordance between two abnormal COLSs was >94%, whereas in those aged ≥60 years, PPVs dropped to 71%-83% for both strategies, and specificity remained high (>90%) only for concordance between two abnormal COLSs. Conclusions: Concordance between two abnormal COLSs enhances diagnostic precision for CTS, particularly in patients without DM and in patients with DM under 60 years of age. In patients with DM aged ≥60 years, the diagnostic accuracy of COLSs was low.
    Keywords:  carpal tunnel; diagnosis; electrodiagnostic; predictive value
    DOI:  https://doi.org/10.3390/diagnostics15222888
  38. Emerg Radiol. 2025 Nov 26.
    Ultra-low-dose CT in extremity fracture detection: A systematic review and meta-analysis.
    Vanessa Veltre, Gabrielle Feher, Christian Pecoraro, Jonathan Elias, Peter Mahany, Judah Goldschmiedt.
      To compare the diagnostic accuracy and radiation doses of ultra-low-dose CT (ULD-CT) versus standard-dose CT (SD-CT) in patients with suspected limb joint fractures.
    METHODS: A systematic review and meta-analysis were conducted following 2020 PRISMA guidelines. Five databases (PubMed, Cochrane, Embase, Scopus, Web of Science) were screened for studies directly comparing ULD-CT to SD-CT diagnostic accuracy for limb joint fractures. Studies used 320-row detector CT scanners with ULD-CT protocols (80 kVp, 4-52 mAs) versus conventional protocols (120 kVp, 50-150 mAs). Bivariate random effects meta-analysis was used to pool sensitivity and specificity estimates. Dose-length product (DLP) reductions were compared directly.
    RESULTS: Four prospective studies comprising 674 patients met inclusion criteria. ULD-CT demonstrated pooled sensitivity of 97.6% and specificity of 99.6% (AUC 99.0%), while SD-CT showed sensitivity of 99.4% and specificity of 99.1% (AUC 98.9%). Subgroup analysis revealed no significant differences in sensitivity (p = 0.300) or specificity (p = 0.486). ULD-CT achieved radiation dose reductions of 87-99% across all anatomical regions.
    CONCLUSIONS: ULD-CT offers significant radiation dose reduction with diagnostic accuracy comparable to SD-CT for limb joint fracture detection. Further multicenter studies are warranted to consolidate evidence across anatomical regions.
    Keywords:  Diagnostic accuracy; Extremity imaging; Fracture detection; Radiation dose reduction; Ultra-low-dose CT
    DOI:  https://doi.org/10.1007/s10140-025-02419-1
  39. Med Sci (Basel). 2025 Nov 20. pii: 277. [Epub ahead of print]13(4):
    Psilocybin and Chronic Pain: A New Perspective for Future Pain Therapists?
    Silvia Natoli, Arturo Cuomo, Maurizio Marchesini, Livio Luongo, Giuliano Lo Bianco, Vittorio Andrea Guardamagna, Shigeki Yamaguchi.
       BACKGROUND: Chronic pain affects nearly one in five adults worldwide and remains a major healthcare burden due to its persistence, multidimensional impact, and resistance to conventional therapies. The opioid crisis has further highlighted the urgent need for safer and more effective alternatives. Psilocybin, a serotonergic psychedelic compound, has re-emerged as a potential therapeutic option for chronic pain given its effects on neuroplasticity, neuroinflammation, and emotional regulation.
    METHODS: This narrative review synthesized evidence from published preclinical and clinical studies. The focus was on the mechanisms of action of psilocybin, animal models of neuropathic and inflammatory pain, and early human trials exploring its effects on pain, mood, and quality of life.
    RESULTS: Preclinical studies demonstrated that psilocybin promotes synaptogenesis via BDNF-TrkB signalling, modulates 5-HT2A receptor activity, and reduces neuroinflammatory processes, leading to persistent analgesic and anxiolytic effects. Animal models of chemotherapy-induced neuropathy and inflammatory pain showed long-lasting antinociceptive responses. Clinical studies, though limited, reported improvements in depression, anxiety, resilience, and quality of life in patients with advanced cancer and chronic conditions, with preliminary evidence of analgesic benefit.
    CONCLUSIONS: Psilocybin shows promise as a multidimensional therapy for chronic pain, addressing both sensory and affective components. However, ethical issues, safety concerns, and regulatory barriers necessitate careful management, and robust randomized controlled trials are essential to confirm efficacy and guide clinical translation.
    Keywords:  chronic pain; hallucinogens; neuroinflammation; neuronal plasticity; pain management; psilocybin
    DOI:  https://doi.org/10.3390/medsci13040277
  40. Life (Basel). 2025 Nov 03. pii: 1704. [Epub ahead of print]15(11):
    Effect of Early Extracorporeal Shockwave Therapy on Postoperative Pain and Functional Recovery After Intramedullary Nailing: An Open-Label Randomized Controlled Trial.
    Yonghyun Yoon, Jihyo Hwang, Jaeyoung Lee, King Hei Stanley Lam, Jeimylo C de Castro, Hyeongjik Kim, Dongyeun Sung, Seungbeom Kim, MinJae Lee, Chanwool Park.
       BACKGROUND/OBJECTIVES: Intramedullary (IM) nailing for hip fractures can cause iatrogenic abductor muscle injury, leading to pain and functional impairment. This study evaluated whether early extracorporeal shockwave therapy (ESWT) safely accelerates recovery.
    METHODS: In this open-label randomized controlled trial, 51 patients (≥50 years; intention-to-treat: ESWT n = 26; control n = 25) received either standard postoperative care (control) or standard care plus three ESWT sessions. The primary outcome was pain (Visual Analog Scale, VAS); the secondary outcome was hip function (modified Harris Hip Score, mHHS), assessed at 3, 6, and 12 months.
    RESULTS: Linear mixed-effects modeling showed significantly faster pain reduction in the ESWT group (group × time β = 0.086 points/month; p = 0.027), corresponding to an additional 1.0-point VAS reduction over 12 months. Functional improvement (mHHS) did not reach statistical significance (group × time β = 0.485; p = 0.462). No ESWT-related adverse events were observed.
    CONCLUSIONS: Early postoperative ESWT is a safe adjunctive therapy that accelerates pain relief after IM nailing for hip fractures. Although functional improvements were not statistically significant, pain reduction may facilitate early mobilization and rehabilitation.
    Keywords:  extracorporeal shockwave therapy; functional recovery; hip fracture; intramedullary nailing; postoperative pain; randomized controlled trial
    DOI:  https://doi.org/10.3390/life15111704
  41. J Bodyw Mov Ther. 2025 Dec;pii: S1360-8592(25)00353-5. [Epub ahead of print]45 387-392
    Association of balance with kinesiophobia and physical function in knee osteoarthritis.
    Ayşe Merve Ata, Onur Kara, Baran Tuncer, Bedriye Mermerci.
       OBJECTIVE: Balance appears to be affected by several neuromuscular variables, and there is conflicting evidence related balance and kinesiophobia in patients with lower extremity osteoarthritis (OA). The purpose of this study was to investigate the potential association between static and dynamic balance abilities, kinesiophobia, and lower extremity functions in knee OA patients.
    METHODS: A total of 43 patients with knee OA were included in this cross-sectional study. The visual analog scale (VAS) was used to evaluate the degree of pain. The patients were assessed using the Berg Balance Scale (BBS), the Tampa Scale for Kinesiophobia (TSK), and the Western Ontario McMaster Universities Osteoarthritis (WOMAC). The thickness of the femoral cartilage, quadriceps muscle, and rectus abdominis muscle was measured by ultrasound. Posturography was used for analyzing both static and dynamic postural control.
    RESULTS: Patients were divided into high and low risk groups based on BBS scores. The group with a high fall risk had greater pain levels at rest (p = 0.002) and activity (p = 0.007), higher kinesiophobia levels (p < 0.001), higher WOMAC total (p = 0.001), pain (p = 0.002), stiffness (p = 0.006), and physical function scores(p = 0.001), as well as worse balance assessments (p < 0.001). TSK and WOMAC total score were independent predictors of BBS for clinical parameters (r2 = 0.626), and LOS anterior was an independent predictor of BBS for balance parameters (r2 = 0.091), according to linear regression analysis.
    CONCLUSIONS: The existence of kinesiophobia and balance difficulties in these patients highlights the importance of rehabilitation interventions to decrease participation restrictions and disability. Therefore, as OA pain and associated dysfunctions appear to be multidimensional in nature, a more comprehensive biopsychosocial approach to knee OA treatment is needed.
    Keywords:  Kinesiophobia; Knee; Osteoarthritis; Postural balance
    DOI:  https://doi.org/10.1016/j.jbmt.2025.09.010
  42. J Emerg Med. 2025 Sep 17. pii: S0736-4679(25)00373-7. [Epub ahead of print]80 95-103
    Ultrasound Guided Erector Spinae Plane Block for Pain Management in the Emergency Department: A Scoping Review.
    Richard J Gawel, Zhengqiu Zhou, Claudia Urban, Joshua Middleton, Michael Shalaby.
       BACKGROUND: The ultrasound-guided erector spinae plane block (ESPB) is a relatively new regional anesthesia technique increasingly used in the emergency department (ED) for multimodal analgesia.
    OBJECTIVES: To summarize the existing literature on ESPBs performed by emergency physicians (EPs).
    METHODS: Following PRISMA-ScR guidelines, we searched five databases (PubMed/MEDLINE, Embase, Web of Science, Scopus, and CINAHL) from inception to June 10, 2025. Records were screened in duplicate, and data were extracted for quantitative and qualitative synthesis in accordance with best practices.
    RESULTS: Of 157 unique records, 42 articles met inclusion criteria, reporting 341 ESPBs performed on 279 patients. Most studies were case reports (25 articles, 60%) or small case series (8 articles, 19%), with only six randomized clinical trials (14%). Common indications included visceral abdominal pain (18 articles, 43%), rib fractures (8 articles, 19%), and low back pain (4 articles, 9.5%). Technical approaches varied widely in terms of block laterality, patient positioning, and transducer type. Adverse events were infrequent (9 cases, 3.2%), with only one suspected case of local anesthetic systemic toxicity (0.4%).
    CONCLUSIONS: Emergency physician-performed ESPBs are increasingly described for diverse indications, but the current evidence base is limited and heterogeneous. Further research should focus on standardizing techniques, enhancing safety monitoring, and conducting high-quality studies to support broader implementation in emergency medicine.
    Keywords:  Emergency Medicine; Erector Spinae Plane Block; Nerve Block; Pain Management; Ultrasound-Guided Regional Anesthesia
    DOI:  https://doi.org/10.1016/j.jemermed.2025.09.021
  43. J Orthop Sports Phys Ther. 2025 Dec;55(12): 1-16
    Rotator Cuff Imaging Abnormalities in Asymptomatic Shoulders: A Systematic Review.
    Sharon Sanders, Thomas Ibounig, Romi Haas, Mark Jones, Lasse Rämö, Sean Docking, Teppo Järvinen, Simo Taimela, Tammy Hoffmann, Rachelle Buchbinder.
      OBJECTIVE: To estimate the prevalence of rotator cuff (RC) imaging abnormalities (tendinopathy, partial-thickness tear, full-thickness tear, or calcification) on radiograph, ultrasound, computed tomography, or magnetic resonance imaging (MRI) in asymptomatic adult shoulders. STUDY DESIGN: Systematic review. LITERATURE SEARCH: Ovid MEDLINE, Embase, CINAHL, and Web of Science (searched September 1, 2024), with forward and backward citation searches. STUDY SELECTION CRITERIA: We included studies reporting the prevalence of RC abnormalities on imaging of asymptomatic shoulders. DATA SYNTHESIS: Due to heterogeneity, data were synthesized without meta-analysis. Risk of bias was assessed using a tool for prevalence studies. Certainty of evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: After screening 3801 records and 188 studies in full text, we included 53 studies (29 ultrasound, 24 MRI) across population-based, miscellaneous, and athlete populations. The certainty of evidence was low to very low. For full-thickness tears, prevalence on ultrasound was 11% to 17% in 2 population-based samples (1631 shoulders), 0% to 35% across 14 studies of miscellaneous populations (3390 shoulders), and 0% to 22% across 4 studies of athlete populations (346 shoulders). On MRI, the prevalence was 20% in 1 population-based study (20 shoulders), 0% to 14% across 10 studies of miscellaneous populations (490 shoulders), and 0% to 11% across 12 studies of athlete populations (326 shoulders). For tendinopathy and/or partial-thickness tears, the prevalence on ultrasound was 34% in 1 population-based sample (539 shoulders), 0% to 47% across 11 studies of miscellaneous populations (1971 shoulders), and 7% to 70% across 4 studies of athlete populations (346 shoulders). On MRI, the prevalence was 65% in 1 population-based sample (20 shoulders), 0% to 100% across 10 studies of miscellaneous populations (490 shoulders), and 6% to 96% across 13 studies of athlete populations (426 shoulders). CONCLUSION: Across studies with low- to very low-certainty of evidence, the prevalence of RC imaging abnormalities in asymptomatic shoulders ranged from 0% to 100%. J Orthop Sports Phys Ther 2025;55(12):1-16. Epub 5 November 2025. doi:10.2519/jospt.2025.13611.
    Keywords:  full-thickness tear; magnetic resonance imaging; partial-thickness tear; prevalence; tendinopathy; ultrasound imaging
    DOI:  https://doi.org/10.2519/jospt.2025.13611
  44. bioRxiv. 2025 Oct 23. pii: 2025.10.22.684045. [Epub ahead of print]
    Effect of prescribing and deprescribing oxycodone on pain and function in a mouse model of osteoarthritis: impact of polypharmacy and sex on response.
    John Mach, Carina L Blaker, Bryony Winters, Yo Otsu, Elizabeth C Clarke, Heather Allore, Brent Vander Wyk, Kevin Winardi, Roderick Peel, Charlie W Gregson, Neda Assareh, Michelle Kourieh, Sarah N Hilmer.
      Osteoarthritis and polypharmacy are common in older adults. While not consistent with guidelines, opioid analgesia is commonly prescribed to older adults with osteoarthritis and other causes of chronic non-cancer pain. Long term use of opioids is associated with tolerance, addiction, loss of efficacy and adverse events. Thus, deprescribing (reducing or ceasing) opioids is often required. The effect of polypharmacy on the efficacy and safety of opioid prescribing and deprescribing in this setting is poorly understood. Here we aimed to assess the effects of chronic oxycodone, as monotherapy and in polypharmacy (oxycodone, citalopram, simvastatin, oxybutynin, and metoprolol), and of deprescribing oxycodone, on allodynia, physical and cognitive function, and daily activities in middle-aged, osteoarthritic male and female C57BL/6J mice (n=11-15/ group). Only oxycodone monotherapy reduced mechanical allodynia after 6 weeks of treatment. Chronic polypharmacy with oxycodone transiently increased mechanical allodynia in the injured limb and caused marked reductions in mobility, maximum walking speed, activities of daily living, and increased anxiety. Polypharmacy also altered daily activities detected by an automated animal behaviour recognition cage. Sex differences in treatment response were observed in frailty measurements and activity over 23 hours. Deprescribing oxycodone was well tolerated and did not alter physical or cognitive function but did reverse some of the daily activity changes and mechanical allodynia in polypharmacy treated animals only. This clinically relevant preclinical model provides an opportunity to understand the effects of prescribing and deprescribing opioids in older adults with osteoarthritis, including the impact of comedications and sex.
    DOI:  https://doi.org/10.1101/2025.10.22.684045
  45. Front Physiol. 2025 ;16 1708750
    Clinical effect and mechanism of aerobic exercise for knee osteoarthritis: a mini review.
    Hao-Yu Hu, Lu-Ning Jia, Wen-Yu Zhao, Sheng-Jie Guo, Zhi-Min Fang, Xi-Yue Li, Yi-Li Zheng, Pei-Jie Chen.
      Knee osteoarthritis (KOA) is a prevalent degenerative joint disease characterized by pain, dysfunction, and stiffness, significantly impairing quality of life. While various interventions exist, aerobic exercise stands out as a safe and effective core treatment. This review synthesizes current evidence on the therapeutic benefits and underlying mechanisms of aerobic exercise for KOA. We recommend low-to-moderate intensity aerobic training (RPE 11-14) for KOA patients, performed 3-4 times per week for 30-60 min, for at least 6 weeks. Recommended modalities include gentle exercises like Wuqinxi, Baduanjin, and yoga, or water-based exercises and swimming, which can offer additional benefits for weight management. The therapeutic effects of aerobic exercise on KOA are multifaceted. Mechanistically, it modulates inflammatory responses by balancing pro- and anti-osteoclastogenic cytokines and inhibiting inflammatory signaling pathways, thereby alleviating pain and promoting cartilage repair. Additionally, aerobic exercise contributes to weight control, reducing knee joint load and improving cartilage health. It also provides appropriate mechanical loading to facilitate osteogenesis and preserves muscle mass, particularly in the lower extremities, mitigating muscle loss and reducing joint pressure. Despite these benefits, the precise exercise modalities, patterns, and intensities for different KOA grades remain to be fully defined and require further clinical validation. Future research should focus on quantifying exercise prescriptions to optimize anti-inflammatory effects, muscle preservation, and cartilage regeneration, as well as exploring the potential of combining aerobic exercise with other training types to enhance outcomes.
    Keywords:  aerobic exercise; biological mechanism; exercise therapy; knee osteoarthritis; knee pain
    DOI:  https://doi.org/10.3389/fphys.2025.1708750
  46. J Hand Surg Asian Pac Vol. 2025 Dec;30(6): 656-661
    Clinical Outcomes of a Novel A5/A4 Pulley Security Suture in the Treatment of Zone 1 FDP Avulsion Fracture.
    Gökhan Ünlü, Hakan Ertem, Ethem Ayhan Ünkar, Mehmet Baydar, Kahraman Öztürk, Osman Orman.
      Background: In patients with a zone 1 flexor digitorum profundus (FDP) avulsion fracture, we suture the FDP tendon to the A5 or A4 pulley using an absorbable suture as an adjunct to standard surgical fixation. This minimises the proximal retraction force of the tendon during the early postoperative period. The aim of this study is to report the clinical outcomes of this approach. Methods: This is a retrospective study of all patients who underwent this technique over a 2-year period between January 2020 and December 2022. Patients aged 18-65 with isolated zone 1 FDP avulsion fracture and who complied with physical therapy and follow-up protocols were included. Demographic information, injury details, surgical methods and postoperative outcomes, including range of motion (ROM), Strickland score, grip strength and Quick disabilities of hand, shoulder and arm (Quick-DASH) score were measured. Results: Eight patients (three females, five males; average age 45.75) were included. Injuries occurred in the ring finger (3) and little finger (5), with sports-related injuries being the most common cause (4). Surgical methods varied, including K-wire, pull-out techniques and combinations of these techniques. At 1-year follow-up, the average active ROM was 87.5° ± 10.9° in the proximal interphalangeal (PIP) joint and 46.9° ± 11.5° in the distal interphalangeal (DIP) joint. Strickland score was excellent in two patients, good in four and fair in two. Grip strength averaged 78.12% of the contralateral side. Quick-DASH scores averaged 14.6 ± 6.8. No tendon ruptures or implant failures were observed. Conclusions: The absence of rupture and satisfactory functional outcomes suggest that this technique is a viable option for treating zone 1 FDP avulsion fracture. Further studies with larger sample sizes and longer follow-up periods are warranted. Level of Evidence: Level IV (Therapeutic).
    Keywords:  Jersey finger; Open reduction; Pulley; Security suture; Tendon
    DOI:  https://doi.org/10.1142/S2424835525500675
  47. Health Sci Rep. 2025 Nov;8(11): e71507
    The Role of Myofascial Release Techniques as an Adjunct to Other Therapies in Knee Osteoarthritis: A Systematic Review.
    Farnaz Farshchi, Nader Farshchi, Reza Abdi Hamzeh Kalayi.
       Background and Aim: Myofascial dysfunctions have been recognized as a pain-causing component in knee osteoarthritis (KOA). Recently, clinicians have focused on various therapeutic techniques targeting fascia. The myofascial release technique (MRT) aimed to address fascial restrictions and myofascial trigger points to improve range of motion (ROM) and muscle function before rehabilitation or physical activity. This systematic review aimed to evaluate the effectiveness and safety of MRT in individuals with KOA, to provide an evidence-based foundation for their clinical application.
    Methods: PRISMA guidelines were performed for this review. Randomized or non-randomized controlled trials were systematically collected from PubMed, Scopus, Web of Science, Science Direct, Google Scholar, and ProQuest from their inception until May 2025. The methodological quality of the articles was assessed using the PEDro checklist.
    Results: Of the 789 records identified, 12 were deemed relevant. The studies exhibited a mean quality score of 4-5 (acceptable) in six studies, a mean quality score of 3 (poor) in one study, and a mean quality score of 6-8 in five studies. The duration of MRT treatment ranged from 3 to 12 sessions, with most studies administering 12 sessions over a period of 2-6 weeks. The outcome measures included pain levels, knee flexion ROM, functional disability, muscle strength, quality of life, knee alignment, and dynamic knee valgus. Five trials compared MRT combined with conventional therapies to a conventional physiotherapy group alone, two trials compared MRT combined with conventional therapies to an MRT group alone, and five trials compared MRT to other therapeutic techniques.
    Conclusion: MRT, when used as an adjunct to conventional therapies or corrective exercises, was found to be more effective in reducing pain, enhancing functional ability, and improving knee range of motion in individuals with KOA. However, MRT alone did not demonstrate consistent superiority over other manual therapy techniques. Due to the concurrent use of multiple interventions in most studies, the specific contribution of MRT remains uncertain. Thus, MRT may be considered a potentially beneficial complementary therapy, but further high-quality studies are needed to establish its standalone efficacy.
    Keywords:  function; knee osteoarthritis; myofascial release; pain; range of motion
    DOI:  https://doi.org/10.1002/hsr2.71507
  48. Aesthetic Plast Surg. 2025 Nov 24.
    Comment on: "The Comparison of Efficacy of Bilateral Type I Versus Type II Pectoral Nerve Block Applied with Ultrasound-Guided for Postoperative Analgesia in Gynecomastia Surgeries".
    Xiaowei Liu, Yang Wang.
      
    DOI:  https://doi.org/10.1007/s00266-025-05483-7
  49. Healthcare (Basel). 2025 Nov 17. pii: 2950. [Epub ahead of print]13(22):
    Impact of the Pilates Method on Quality of Life and Functional Well-Being in Women with Osteoporosis: Protocol for a Randomized Controlled Trial.
    Sara García-Bravo, Cristina García-Bravo, Marta Gil-Manglano, MªPilar Rodríguez-Pérez, Ana Poveda-García, Elisabet Huertas-Hoyas.
       INTRODUCTION: Osteoporosis is a major public health concern among postmenopausal women, characterized by decreased bone mineral density and microarchitectural deterioration, which lead to fragility fractures, pain, functional impairment, sleep disturbances, and a reduced quality of life. Exercise, particularly strength, weight-bearing, and balance training, represents a key non-pharmacological approach to prevention and management. Pilates, a low-impact, core-centered method increasingly incorporated into rehabilitation settings, appears especially suitable for women with osteoporosis. However, high-quality randomized controlled trials concurrently evaluating its effects on pain, balance, sleep, autonomy, and health-related quality of life remain scarce.
    OBJECTIVE: To examine the efficacy and feasibility of a Pilates-based exercise program in improving pain, balance, sleep quality, functional autonomy, and quality of life in postmenopausal women with osteoporosis.
    METHODS: A single-blind, parallel-group, randomized controlled trial will be conducted over 12 weeks at Physiocare Madrid (Spain). A total of 126 (63 per group) postmenopausal women aged 50-80 years, diagnosed with osteoporosis by densitometry or with a prior fragility fracture, will be randomly assigned (1:1; OxMaR software, version 2014) to one of two groups: (a) Experimental group: supervised Pilates mat sessions, 60 min, twice weekly for 12 weeks; or (b) Control group: ergonomics education for activities of daily living, two 60 min sessions held six weeks apart. Outcome assessors will remain blinded to group allocation. Evaluations will be conducted at baseline and post-intervention. Outcome measures will include balance and mobility (Timed Up and Go Test; Functional Reach Test), functional autonomy (Functional Independence Measure), pain intensity (Visual Analog Scale), sleep quality (Pittsburgh Sleep Quality Index), health-related quality of life (WHOQOL-BREF; QUALEFFO-41), and treatment satisfaction (CSQ-8). Feasibility parameters (recruitment, adherence, retention, and safety) will also be monitored. Data will be pseudonymized and analyzed descriptively to estimate variability and preliminary effects, informing the design of a definitive trial.
    EXPECTED RESULTS: It is hypothesized that Pilates will produce clinically meaningful improvements in balance, pain, sleep quality, and health-related quality of life compared with ergonomics education, with acceptable feasibility and safety outcomes.
    CONCLUSIONS: This randomized controlled trial will provide initial evidence regarding the efficacy and feasibility of Pilates as a complementary rehabilitation strategy for women with osteoporosis and provide key parameters to optimizing a future adequately powered trial.
    ETHICS AND DISSEMINATION: This study will be conducted in accordance with the principles of the Declaration of Helsinki and has been approved by the Human Ethics Committee of Universidad Rey Juan Carlos. Potential risks will be minimized, and any adverse events will be systematically recorded and addressed.
    Keywords:  Pilates; functional well-being; osteoporosis; quality of life; women
    DOI:  https://doi.org/10.3390/healthcare13222950
  50. J Bodyw Mov Ther. 2025 Dec;pii: S1360-8592(25)00327-4. [Epub ahead of print]45 286-294
    Fascial and muscle ultrasound parameters unchanged after stretching or eccentric training in young men with hamstring tightness.
    Pornpimol Muanjai, Wirasinee Srijunto, Sirawee Chaovalit, Mantas Mickevicius, Nongnuch Luangpon.
       INTRODUCTION: Hamstring tightness has been associated with significant mobility impairments and potential health issues. However, the effects of long-duration stretching (LS) on structural adaptations and joint extensibility remain unclear and underexplored. This study aimed to investigate the effects of stretching on fascia thickness (FT), muscle ultrasound characteristics, and leg flexibility in young men with hamstring inflexibility.
    METHODS: Sixty-eight physically active young men (22.0 ± 1.7 years) were randomly assigned to one of four groups: LS (60s × 60), standard stretching (SS; 30s × 6), eccentric exercise (ECC), or control (CON). FT, muscle ultrasound characteristics, and leg flexibility-assessed via the straight leg raise (SLR) and knee-to-wall (KTW) tests-were measured before and after a 6-week intervention period.
    RESULTS: Significant increases in SLR were observed following the intervention, with improvements of 9.8° (d = 1.53), 5.7° (d = 0.96), 5.5° (d = 1.10), and 3.5° (d = 0.60) for the LS, SS, ECC, and CON groups, respectively (all p < 0.05). A significant main effect of time, in the absence of a time-by-group interaction, was found for KTW, fascicle length of the biceps femoris (BF), and subcutaneous thickness of both the BF and medial gastrocnemius muscles. Conversely, no significant changes were detected in FT or echo intensity as a result of the intervention.
    CONCLUSION: LS did not produce superior improvements in flexibility, fascicle length, or FT compared to SS or ECC after six weeks. A 5-min SS session is recommended as an effective, time-efficient approach for improving range of motion in individuals with mild hamstring tightness.
    Keywords:  Fascia thickness; Fascicle length; Leg flexibility; Muscle tightness; Range of motion
    DOI:  https://doi.org/10.1016/j.jbmt.2025.08.026
  51. BMC Geriatr. 2025 Nov 27.
    Exploring the experience and needs of postoperative rehabilitation management for elderly patients with osteoporotic vertebral compression fractures after percutaneous vertebroplasty: a qualitative study.
    Wei Kang, Junwei Shi, Yang Long, Li Li, Wei Xu.
       BACKGROUND: Percutaneous vertebroplasty (PVP) is a critical intervention for rapidly alleviating pain and restoring vertebral stability in elderly patients with osteoporotic vertebral compression fractures postoperative rehabilitation management, covering both in-hospital and postdischarge phases, has received growing attention due to shortened in-hospital recovery periods and the ongoing challenge of managing underlying osteoporosis. However, elderly patients face dual challenges: fragmented adherence to in-hospital rehabilitation due to shortened stays, and inconsistent engagement in postdischarge rehabilitation due to socioeconomic barriers and osteoporosis management gaps. In October 2024, this study investigated comprehensive rehabilitation management protocols spanning from hospital admission to postoperative follow-up in elderly osteoporotic vertebral compression fracture patients. This research aims to elucidate patients' perspectives on rehabilitation management, ultimately facilitating enhanced postoperative functional recovery and mitigating osteoporotic fracture recurrence.
    METHOD: We implemented a qualitative descriptive methodology incorporating face-to-face semistructured interviews. Twenty-four patients were consecutively recruited, with 20 participants meeting the inclusion criteria and completing qualitative investigations in the Orthopedics departments of a tertiary hospital in Shanghai between October and December 2024. Follow-up interviews were conducted with 15 participants through in-person outpatient visits and five via telephone consultations. Three trained researchers administered six predetermined interview questions to each participant through these dual modalities. All interviews were audio-recorded and systematically analyzed via content analysis with NVivo software (version 12).
    RESULTS: Six key themes were identified regarding patients' postoperative rehabilitation experiences and needs: establishment of rehabilitation beliefs, heightened perceived benefits of external support, physical dysfunction, negative rehabilitation beliefs, low-quality management environments, aging and comorbidities. The findings revealed both facilitating and hindering factors in postoperative rehabilitation management while emphasizing the importance of establishing personalized multidisciplinary teams in rehabilitation management.
    CONCLUSION: This study suggests that clear guidance regarding postoperative rehabilitation exercises and multidisciplinary management protocols including individualized exercise plans, collaborative multidisciplinary rehabilitation strategies, and the development of smart devices may be important for healthcare providers in supporting patients' rehabilitation management. Based on participants' experiences, these approaches show potential for contributing to the alleviation of postoperative movement-related anxiety and fear of falls.
    Keywords:  Aged Population; Osteoporosis; Osteoporotic vertebral compression fractures; PVP (Percutaneous Vertebroplasty); Rehabilitation management
    DOI:  https://doi.org/10.1186/s12877-025-06667-1
  52. Instr Course Lect. 2026 ;75 195-206
    Treatment of Rotator Cuff Tears: Around the World From Partial Thickness to Irreparable.
    Zaamin B Hussain, Kier Maddox Blevins, Jesse Seilern Und Aspang, Eric R Wagner.
      The management of rotator cuff tears has evolved significantly with advances in the understanding of natural history, as well as treatment options and surgical techniques for repair, augmentation, and replacement. It is important to provide a comprehensive overview of current treatment options for rotator cuff tears, emphasizing the importance of individualized decision making based on tear characteristics, tissue quality, and functional goals. Nonsurgical treatment remains a viable first-line approach for many degenerative tears. Arthroscopic repair should be performed when repairable. When not repairable, pain-reducing procedures such as isolated biceps management, subacromial balloon, and tuberoplasty should be considered. Tendon transfers, patch augmentation, superior capsule reconstruction, and reverse shoulder arthroplasty are options that can help improve function. A thorough understanding of the indications, limitations, and expected outcomes of each modality is essential.
  53. Physiother Res Int. 2026 Jan;31(1): e70128
    Applicability of Lung Ultrasound During Weaning From Mechanical Ventilation: A Systematic Review.
    André Luiz Lisboa Cordeiro, Geruza Oliveira Santos, Jennifer Beatriz Barbosa Silva, João Pedro Cruz de Souza Monteiro, Ruan Pablo Carmo Dos Santos, Luiz Alberto Forgiarini Júnior.
       BACKGROUND AND PURPOSE: Lung ultrasound (LUS) is increasingly used in the Intensive Care Unit (ICU) setting. However, its actual role in supporting the weaning process from mechanical ventilation remains uncertain as the ideal timing for extubation is still difficult to determine. This study aimed to review the use of lung ultrasound as a potential predictor of weaning from artificial ventilation.
    METHODS: This is a systematic review conducted using the PECOS strategy with searches in the PubMed, CENTRAL, LILACS, CINAHL and Cochrane databases using the descriptors mechanical ventilation, artificial ventilation, extubation, lung ultrasound, thoracic ultrasound and weaning combined with the Boolean operators AND OR.
    RESULTS: Fourteen articles were identified after full-text reading. Among them, four studies suggested that lung ultrasound may be useful in aiding weaning, three reported limited accuracy in predicting extubation outcomes, and one was inconclusive. Different protocols were applied, such as LUS (six regions), modified LUSm, and the BLUE protocol. Reported sensitivity ranged from 66% to 97%-100% and specificity from 37.4% to 96%.
    DISCUSSION: The included studies applied heterogeneous methodologies and cut-off values for sensitivity and specificity, limiting direct comparison and generalization. Despite these differences, findings suggest that lung ultrasound shows potential as an adjunctive tool in predicting weaning outcomes, although further standardized research is needed to clarify its clinical applicability.
    Keywords:  artificial ventilation; extubation; lung ultrasound; thoracic ultrasound; weaning
    DOI:  https://doi.org/10.1002/pri.70128
  54. J Bodyw Mov Ther. 2025 Dec;pii: S1360-8592(25)00321-3. [Epub ahead of print]45 190-198
    The efficacy of an eight-week core stability exercise program in suspended and stable conditions on the muscle activation and functional disability of amateur soccer players with non-specific chronic low back pain.
    Mehdi Aslani, Farhad Ranjbarzadeh Yamchi, Esmaeil Mozafaripour.
       INTRODUCTION: Low back pain (LBP) is a prevalent musculoskeletal disorder in soccer players. Core stability exercises are suggested to be effective in alleviating LBP, but the most effective method remains unclear. This study aims to compare the effects of eight weeks of core stability exercises in unstable and stable conditions on trunk muscle activation and functional disability in soccer players with non-specific chronic LBP.
    METHOD: Forty-five athletes with non-specific chronic LBP were randomly divided into three groups: unstable condition exercises, stable condition exercises, and a control group. Subjects in the intervention groups trained three times a week for 8 weeks. Electromyography activity of selected muscles and functional disability levels were assessed using athletes' disability assessment questionnaire. Data were analyzed using ANCOVA.
    RESULTS: After eight weeks of interventions, there was a significant difference in electromyography activity and functional disability among the three groups (p < 0.05). Exercises in unstable conditions showed superior results compared to stable exercises and the control group.
    CONCLUSION: Exercises performed under unstable conditions were more effective in improving muscle activity and functional disability in subjects with LBP compared to stable exercises and no intervention. Incorporating instability into exercise routines may be beneficial for managing LBP.
    Keywords:  Core stability; Electromyography; Exercise therapy; Low back pain; Suspension training
    DOI:  https://doi.org/10.1016/j.jbmt.2025.08.020
  55. Rheumatol Int. 2025 Nov 22. 45(12): 277
    Hand function in immune-mediated inflammatory rheumatic diseases: assessment and rehabilitation approaches.
    Umida Khojakulova, Olena Zimba, Mariusz Korkosz, Burhan Fatih Kocyigit.
      Inflammatory rheumatic diseases (IRDs) are chronic autoimmune conditions that affect a variety of organs and systems. These disorders have a major impact on hand function, restricting independence in daily activities and lowering quality of life. They are characterized by significant reductions in the hand's fine motor skills, grip strength, and coordination capacities. These impairments in hand function have a detrimental influence on physical capability, psychological adjustment, and occupational productivity. Since IRDs are chronic and progressive, early detection, continuous follow-up, and multifaceted rehabilitation strategies are essential. Self-report measures and performance-based assessments are utilized to evaluate hand function. Furthermore, imaging techniques, including ultrasonography, magnetic resonance imaging, and dual-energy computed tomography, provide an objective evaluation of subclinical inflammation and structural damage. Rehabilitation approaches, as a complement to medical care, play an important role in maintaining and enhancing hand function. Multicomponent therapies, including exercise, splinting, occupational therapy, manual therapy, massage, and patient education, are beneficial for preserving functional gains. Future research is anticipated to concentrate on discovering biomarkers for early diagnosis, creating sensor-based digital evaluation tools and telerehabilitation programs, and developing individualized, AI-powered rehabilitation procedures. These developments will make a substantial contribution to preserving hand function and enhancing the quality of life for IRD patients.
    Keywords:  Arthritis; Hand; Hand grip strength; Hand strength; Pinch strength; Rehabilitation; Rheumatic diseases
    DOI:  https://doi.org/10.1007/s00296-025-06043-7
  56. J Bodyw Mov Ther. 2025 Dec;pii: S1360-8592(25)00301-8. [Epub ahead of print]45 74-82
    "Integrative physiotherapy in burn rehabilitation: Innovations in physical, psychological, and technological interventions - A narrative review".
    Amany Gomaa Atiaa, Shehab M Abd E-Kader, Doha El-Sayed Ellakwa.
      Burn injuries represent a critical healthcare challenge. Contemporary burn care has achieved remarkable survival rates through advanced acute interventions, yet comprehensive rehabilitation remains essential for optimal physical and psychological recovery. However, despite numerous isolated studies on rehabilitation approaches, a systematic understanding of integrated physiotherapy interventions' effectiveness across multiple domains remains inadequately synthesized. This narrative review examined evidence from January 2015 to March 2024 across major databases (PubMed, Scopus, ScienceDirect, Google Scholar), analyzing physiotherapy interventions in burn rehabilitation through physical, psychological, technological, and cultural lenses. This analysis revealed that early mobilization combined with aerobic and resistance training significantly improved patient outcomes, with Functional Independence Measure scores increasing by up to 40 % and hospital stays reducing by approximately 30 %. Integration of psychological strategies, including cognitive-behavioral therapy and mindfulness activities, enhanced treatment adherence and mental wellness. Modern technological solutions, particularly tele-rehabilitation and virtual reality applications, demonstrated improved accessibility and engagement. Notably, culturally sensitive multidisciplinary approaches showed superior patient satisfaction and community reintegration outcomes. These findings underscore the critical importance of comprehensive physiotherapy interventions in burn rehabilitation while highlighting the need for future research focusing on equitable, culturally adaptive rehabilitation frameworks that integrate digital health technologies and cognitive rehabilitation approaches globally. This review aims to equip caregivers with up-to-date physiotherapeutic techniques for burn rehabilitation.
    Keywords:  Burn rehabilitation; Cultural adaptation; Early mobilisation; Multidisciplinary care; Physiotherapy; Psychological resilience; Tele-rehabilitation; Virtual reality
    DOI:  https://doi.org/10.1016/j.jbmt.2025.07.023
  57. J Orthop Case Rep. 2025 Nov;15(11): 374-380
    Feasibility of Integrating Pilates with Conventional Kinesiotherapy for Managing Chronic Low Back Pain: A Pilot Study.
    Shruti Mahajan, Khushwant Singh Rathore, Raghvendra Choubey, Ajeet Kumar Saharan, Namrata Srivastava, Anshul Gupta.
       Introduction: Chronic non-specific low back pain (CNSLBP) continues to pose a significant global health burden, often leading to persistent pain and functional limitations. Although conventional kinesiotherapy is a well-established approach in managing CNSLBP, the integration of Pilates a method emphasizing core stability, controlled movements, and neuromuscular re-education may offer additional therapeutic benefits. This pilot study aimed to assess the feasibility, safety, and preliminary clinical effects of combining Pilates-based exercises with conventional kinesiotherapy for individuals with CNSLBP.
    Materials and Methods: A single-group pre-post intervention design was employed. Thirty adults diagnosed with CNSLBP participated in an 8-week program integrating Pilates and kinesiotherapy. Feasibility metrics included recruitment rate, retention, session adherence, acceptability (participant feedback), and safety (adverse events). Clinical outcomes assessed pre- and post-intervention included pain intensity (visual analog scale), functional disability (Roland-Morris Disability Questionnaire), lumbar mobility (Modified-modified Schober's Test), and lumbo-pelvic flexibility (V-Sit and reach test).
    Results: The study achieved a high recruitment rate (85.71%) and strong retention (86.67%). Mean adherence across 24 sessions was 75.64% (standard deviation = 21.72), with no adverse events reported. Participant feedback indicated moderate-to-high acceptability (mean score: 3.77 ± 0.85). Statistically significant improvements (P < 0.0001) were observed in all clinical outcome measures, including reductions in pain and disability and enhancements in lumbar mobility and flexibility.
    Conclusion: The integration of Pilates with conventional kinesiotherapy is both feasible and safe for individuals with CNSLBP, demonstrating promising preliminary improvements in pain, function, and mobility. These findings support the need for larger-scale randomized controlled trials to further investigate the efficacy and long-term outcomes of this combined intervention approach.
    Keywords:  Chronic low back pain; Pilates; conventional kinesiotherapy; non-specific low back pain
    DOI:  https://doi.org/10.13107/jocr.2025.v15.i11.6406
  58. Br J Sports Med. 2025 Nov 26. 59(21): e3
    Correction: Does surgery reduce knee osteoarthritis, meniscal injury and subsequent complications compared with non-surgery after ACL rupture with at least 10 years follow-up? A systematic review and meta-analysis.
      
    DOI:  https://doi.org/10.1136/bjsports-2019-100765corr1
  59. Clocks Sleep. 2025 Oct 27. pii: 62. [Epub ahead of print]7(4):
    Modafinil for Promoting Wakefulness in Critically Ill Patients: Current Evidence and Perspectives.
    Sotirios Kakavas, Dimitrios Karayiannis.
      Critically ill patients are predisposed to developing cognitive dysfunction, excessive daytime sleepiness (EDS), and fatigue during their stay in the intensive care unit (ICU). Modafinil, a wakefulness-promoting agent, has demonstrated potential benefits in enhancing alertness, cognitive performance, and activity levels in various clinical populations. The present narrative review aims to systematically evaluate the existing literature regarding the administration of modafinil for the treatment of EDS and fatigue in the ICU context. A comprehensive literature search was performed using the Embase, MEDLINE, Web of Science, and Google Scholar databases, covering publications up to 20 June 2025. Studies investigating the use of modafinil to improve wakefulness in ICU patients were identified. A total of nine relevant studies were included, comprising two randomized controlled trials (RCTs), two case series, and five retrospective cohort studies (n = 950 patients). Four of these studies focused on patients with traumatic brain injury or post-stroke conditions, whereas the remaining studies addressed heterogeneous ICU populations. Preliminary evidence indicates that modafinil may enhance wakefulness in selected critically ill patients and potentially facilitate their participation in rehabilitative interventions, such as physical therapy. Nonetheless, robust conclusions regarding efficacy and safety remain limited by the small sample sizes and methodological constraints of the available studies. Consequently, further large-scale RCTs are warranted to elucidate the therapeutic role of modafinil in the management of EDS and hypoactivity among ICU patients.
    Keywords:  ICU; critically ill patients; excessive daytime sleepiness; modafinil; sleep disorders
    DOI:  https://doi.org/10.3390/clockssleep7040062
  60. Skeletal Radiol. 2025 Nov 23.
    Medial meniscal stabilizers, variants, and injuries of the knee.
    Mario Moreno, Andrew V Gomez, Edward Smitaman, Eric Y Chang.
      The stability and function of the medial meniscus is linked to the complex anatomy and biomechanics of the medial, posteromedial, and posterior knee capsuloligamentous structures, including the superficial medial collateral ligament, deep medial collateral ligament, posterior oblique ligament, semimembranosus tendon and its expansions including the oblique popliteal ligament, and the meniscocapsular and meniscotibial ligaments. These components provide static and dynamic stability against valgus stress, tibial rotation, and anterior tibial translation. Injuries to these structures can contribute to meniscal pathology including extrusion, ramp lesions, early cartilage degeneration, and failure of cruciate ligament reconstructions. MRI plays a crucial role in the evaluation of these structures, aiding in diagnosis and allowing for an understanding of injury patterns. However, anatomic variations and differences in classification schemes may create challenges, particularly with regard to ramp lesions which occur at the posteromedial meniscocapsular junction. These lesions are frequently associated with anterior cruciate ligament tears and are often underdiagnosed without careful imaging evaluation or special attention during arthroscopy. In this article, we will discuss the anatomy (including historical and contemporary perspectives) and injury patterns of the medial supporting structures, posteromedial corner, and posterior capsular junction of the medial meniscus of the knee with a focus on MRI. Recognition of nuanced anatomy and pathology of these stabilizing structures is essential for appropriate treatment planning and optimization of patient outcomes. Key Points 1) Medial meniscal stability relies on complex interactions between the superficial medial collateral ligament (sMCL), deep medial collateral ligament (dMCL), posterior oblique ligament (POL), semimembranosus tendon, and posteromedial meniscocapsular structures resisting valgus, rotational, and translational forces. 2) sMCL injuries often co-occur with anterior cruciate ligament (ACL) and posteromedial corner tears and precise localization is key. Proximal tears are most common, while distal tears may require surgery due to potential soft tissue interposition. 3) The semimembranosus tendon and expansions contribute to posteromedial knee stability and mobilization of the posterior horn of the medial meniscus during knee flexion, preventing meniscal impingement and tears. 4) Ramp lesions at the posteromedial meniscocapsular junction frequently accompany ACL tears and are difficult to detect without careful analysis on MRI and arthroscopy.
    Keywords:  Medial collateral ligament; Meniscocapsular ligament; Meniscotibial ligament; Oblique popliteal ligament; Posterior oblique ligament; Ramp lesions; Semimembranosus
    DOI:  https://doi.org/10.1007/s00256-025-05089-9
  61. J Orthop Case Rep. 2025 Nov;15(11): 427-432
    Comparison of Pain Relief from platelet-rich plasma, Steroid, and Saline Injections in Chronic Shoulder Impingement using Visual Analog Scale.
    Adnan Asif, J S R G Saran, N K Arun Kumar.
       Introduction: Shoulder impingement syndrome (SIS) is a common cause of chronic shoulder pain, often impairing daily function. Various subacromial injection therapies are employed, including corticosteroids and platelet-rich plasma (PRP), though their comparative efficacy remains under investigation.
    Aims and Objectives: This study aims to assess and compare the effectiveness of subacromial injections of PRP, corticosteroids, and normal saline on pain relief in chronic SIS using the Visual Analog Scale (VAS).
    Materials and Methods: This descriptive epidemiological study involved 150 patients aged over 40 years with shoulder pain lasting more than 3 months and positive clinical signs of impingement. Patients were randomly divided into three groups of 50 each: PRP Group, Steroid Group, and Normal Saline Group. A single subacromial injection was administered through the posterior approach. VAS scores were recorded during overhead activities at 4, 12, and 24 weeks post-injection.
    Results: All three groups were comparable in terms of demographic and baseline clinical characteristics. Significant pain reduction was observed in the PRP group across all follow-up intervals compared to the steroid and saline groups. The steroid group showed early pain relief, which diminished over time, while the saline group showed minimal change.
    Conclusion: PRP injections demonstrated superior and sustained pain relief in patients with chronic SIS compared to corticosteroids and saline. PRP offers a promising, minimally invasive treatment alternative with long-term benefits, whereas corticosteroids may be more suitable for short-term symptom control.
    Keywords:  Shoulder impingement syndrome; Visual Analog Scale; corticosteroid injection; platelet-rich plasma; subacromial injection
    DOI:  https://doi.org/10.13107/jocr.2025.v15.i11.6422
  62. Knee. 2025 Nov 27. pii: S0968-0160(25)00303-5. [Epub ahead of print]
    Impact of hybrid closed-wedge high tibial osteotomy on mechanical loading during gait in patients with medial knee osteoarthritis.
    Shota Imamura, Rui Tsukagoshi, Kei Setogawa, Takafumi Mizuno, Kazuhisa Kajihara, Hiroshi Nakayama, Naoki Sasanuma, Akira Sakaguchi, Kotaro Kawaguchi, Yuki Uchiyama, Kazuhisa Domen.
       BACKGROUND: Increased mechanical loading during gait is a risk factor for knee osteoarthritis (OA). An elevated knee adduction moment serves as an indicator of mechanical loading on the femorotibial (FT) joint. By contrast, increased knee flexion excursion and knee flexion moment are indicators of mechanical loading on the patellofemoral (PF) joint. Hybrid closed-wedge high tibial osteotomy (hybrid CWHTO) improves the static alignment of the FT and PF joints; however, the extent of changes in mechanical loading during gait remains unclear. Hence, this study aimed to evaluate the changes in the kinematics and kinetics of pre- and post-hybrid CWHTO and compare the outcomes with those observed in healthy controls.
    METHODS: This study included 14 patients with medial knee OA who underwent hybrid CWHTO and 21 healthy elderly controls. Gait was evaluated using two-dimensional motion analysis preoperatively and at 1 year postoperatively.
    RESULTS: The postoperative knee adduction moment was significantly reduced. However, no significant differences were found in knee flexion excursion and knee flexion moment between the preoperative and postoperative assessments. Both parameters remained lower than those observed in healthy elderly controls.
    CONCLUSION: Although the hybrid CWHTO effectively reduces knee adduction moments, thereby decreasing mechanical stress on the FT joint, it does not change knee flexion excursion or knee flexion moments. However, radiographic evaluation demonstrated changes in patellar height, suggesting that positional factors may influence PF joint mechanics independent of sagittal-plane measures. These findings highlight the need to incorporate targeted rehabilitation interventions focused on improving the sagittal plane mechanics.
    Keywords:  Gait analysis; Hybrid closed wedge high tibial osteotomy; Mechanical loading
    DOI:  https://doi.org/10.1016/j.knee.2025.11.011
  63. J Orthop Surg Res. 2025 Nov 26. 20(1): 1040
    Gait and gluteus medius alterations after Trochanteric-Entry intramedullary nailing: A retrospective quantitative analysis : Gait and gluteus medius alterations after Trochanteric-Entry intramedullary nailing: A retrospective quantitative analysis.
    Anil Agar, Sefa Key, Mustafa Yildirim.
       BACKGROUND: Trochanteric-entry intramedullary nailing (IMN) is widely used for the treatment of femoral shaft fractures. However, concerns remain regarding potential iatrogenic injury to the gluteus medius (GMed), a key hip abductor muscle essential for gait stability. Limited clinical studies have simultaneously investigated postoperative muscle morphology and gait biomechanics in this context. This retrospective study aimed to quantitatively evaluate gait and gluteus medius muscle alterations following trochanteric-entry intramedullary nailing in patients with healed femoral fractures.
    METHODS: This retrospective observational study included 50 adult patients who underwent trochanteric-entry IMN between January 2020 and January 2024. At the 12th postoperative month, bilateral evaluations of GMed muscle thickness (ultrasonography), plantar pressure distribution, and spatiotemporal gait parameters (step length and cadence) were performed using the WIN-TRACK gait analysis system (Medicapteurs, France). Comparisons between operated and contralateral limbs were conducted with paired tests. Correlation, regression, and receiver operating characteristic (ROC) analyses were performed to examine associations between morphological and functional measures.
    RESULTS: The operated limbs demonstrated significantly reduced step length (0.553 ± 0.051 m vs. 0.584 ± 0.045 m), cadence (104.6 ± 11.2 vs. 109.9 ± 10.8 steps/min), and GMed thickness (2.09 ± 0.28 cm vs. 2.27 ± 0.29 cm), all with p < 0.001. Plantar pressure variables, including maximum pressure, pressure-time integral, and contact area, were also significantly decreased on the operated side (p < 0.001). Effect size analyses revealed medium differences (Cohen's d: 0.48-0.63). Although step length showed weak positive correlations with GMed thickness and plantar loading parameters, regression (R² = 0.035, p = 0.643) and ROC analyses (AUC 0.46-0.53) indicated limited predictive accuracy.
    CONCLUSION: One year after trochanteric-entry IMN, patients exhibited persistent structural and functional asymmetries, including reduced step length, cadence, GMed thickness, and plantar pressure. Despite bone union and fracture healing, compensatory deficits remained evident. These findings highlight the need for postoperative rehabilitation protocols focusing on hip abductor strengthening, and gait re-education, as well as long-term monitoring of gluteus medius integrity.
    Keywords:  Femoral shaft fracture; Gait analysis; Gluteus medius; Intramedullary nailing; Trochanteric entry; Ultrasonography
    DOI:  https://doi.org/10.1186/s13018-025-06484-7
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