bims-ricfun Biomed News
on Rehabilitation ICF
Issue of 2025–12–21
71 papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica
  1. A dynamic ultrasound-based framework for diagnosing subacromial impingement and predicting response to guided injection: the CHANG protocol.
  2. Evidence-Based interventional approaches for management of knee osteoarthritis: A mini-review.
  3. Association of central sensitization features with clinical, sonographic, and electrophysiological outcomes in carpal tunnel syndrome.
  4. A systematic review and meta-analysis on the use of diagnostic ultrasound in guiding corticosteroid injections for shoulder pain (subacromial/ subdeltoid bursa).
  5. Return to Play After Achilles Tendon Rupture: Comparing Operative and Nonoperative Approaches in Athletes.
  6. Parasports for cerebral palsy: Thinking and 'prescribing' beyond the Paralympics.
  7. Comparing the efficacy of ultrasound-guided versus anatomical localization for corticosteroid injection in the treatment of carpal tunnel syndrome: A systematic review and meta-analysis.
  8. Retraction: Investigating the association between diabetes and carpal tunnel syndrome: A systematic review and meta-analysis approach.
  9. Physiatrists and/vs. allied health professionals: echoing from Türkiye.
  10. Feasibility and Preliminary Effectiveness of a Mobile App-Based Personalized Exercise Program in Older Patients With Chronic Knee Osteoarthritis: Pilot Randomized Controlled Trial.
  11. Neuropathic pain in knee osteoarthritis: functional burden beyond cartilage thickness-a cross-sectional study.
  12. Comparing the efficacy of ultrasound-guided versus anatomical localization for corticosteroid injection in the treatment of carpal tunnel syndrome: a systematic review and meta-analysis.
  13. Assessment of Effectiveness of Bupivacaine Trigger-Point Injections in Trapezius Myofascial Pain Syndrome: a Retrospective Study.
  14. Web Impingement Syndrome of the Ankle: A Rare Cause of Persistent Post-traumatic Pain.
  15. Development and content validity of the evaluation of multidimensional functioning and risks in aging scale.
  16. "Intraoperative pillar corticosteroid injection": does it improve clinical outcomes after carpal tunnel release surgery? A double-blind, randomized controlled study.
  17. Recovery Stages After Multiligament Knee Reconstruction.
  18. Effects of dry needling combined with exercise on knee osteoarthritis at 6 month follow up a randomized clinical trial.
  19. Early Effects of Kinesio Taping on Clinical Outcomes in Patients With Arthroscopic Rotator Cuff Repair: A Double-Blind, Randomized Controlled Trial.
  20. A CASE REPORT OF BERTOLOTTI SYNDROME INCIDENTALLY COEXISTING IN A 12 YEAR MALE WITH HISTORY OF PERINEAL BONE TRAUMA.
  21. Bucket-Handle Meniscus Tears: Epidemiology, Diagnosis, Management, and Outcomes.
  22. Anatomic Multiligament Knee Reconstruction With Biceps Femoris Tendon and Medial Meniscal Repair.
  23. Annals Video Summary - Efficacy and Safety of Bisphosphonates for Complex Regional Pain Syndrome: A Systematic Review and Meta-analysis.
  24. The Use of Steroid Injections for Hand and Wrist Pathologies.
  25. Letter to the editor: "Outcome comparison of arthroscopic latissimus dorsi tendon transfer and muscle advancement for irreparable rotator cuff tear: a systematic review".
  26. Evaluating the efficacy of intragastric botulinum toxin a injections with two different quantities and sites for obesity.
  27. Surgical Decompression of Pudendal Neuralgia Due to Entrapment Beneath a Bifurcate Piriformis Muscle: A Case Report.
  28. Author reply to letter re: "Focal extracorporeal shockwave therapy in shoulder calcific tendinopathy: A retrospective observational study of sonographic prognostic factors".
  29. Asymmetry in fractional anisotropy of the corticospinal tract correlates with measures of body structure/function and activity in the chronic phase after stroke.
  30. Revisiting pain inhibition in knee osteoarthritis: central dysregulation and the paradox of resilience.
  31. Ultrasound-Guided Anterograde Carpal Tunnel Release: Anatomical Landmarks of the Distal Boundary - A Cadaveric Study.
  32. Trapeziectomy Versus Carpometacarpal Arthroplasty for Basilar Thumb Arthritis: A Narrative Review of Comparative Outcomes.
  33. The role and challenge of knee cartilage MRI in early diagnosis of knee osteoarthritis: a literature review.
  34. [Key role of biomechanical properties and material selection in rotator cuff repair].
  35. [Research progress on enhanced recovery after posterior cruciate ligament reconstruction].
  36. Knee and ankle biomechanics during recovery from primary, secondary, and bilateral anterior cruciate ligament injuries: a quasi-experimental study.
  37. Two-tendon accessory fusion of the pes anserinus: coalescence of accessory semitendinosus and gracilis tendons in a left knee.
  38. Rehabilitation needs and challenges in Gaza strip (Palestine) after the ceasefire: A call for coordinated action.
  39. Skeletal muscle architecture: is it related with aerobic capacity?
  40. Management of functional epiphora with botulinum toxin: a injection after lacrimal surgery.
  41. Ultrasonographic Evaluation of Peripheral Nerves for Early Diagnosis of Guillain-Barré Syndrome: A Case-Control Study.
  42. [Endoscopic-assisted median nerve decompression combined with one-stage tendon transfer for reconstruction of thumb abduction in treatment of severe carpal tunnel syndrome].
  43. Data-driven diagnosis and clinical presentation of high tone pelvic floor dysfunction.
  44. Exploring the Therapeutic Potential of Intravenous Lidocaine: A Narrative Review on Postoperative Pain Management and Opioid Reduction.
  45. Comparative study of thoracolumbar fascia changes in weightlifters with and without low back pain.
  46. Efficacy and Emerging Role of Suprascapular Nerve Block for Pain Management after Shoulder Surgeries.
  47. Dry needling versus platelet-rich plasma in myofascial pain: A randomized trial.
  48. Meniscal Flap Tears on MRI: Patterns of Fragment Migration and Associated Lesions.
  49. Sensitivity of Structural and Mechanical Markers of Muscle and Tendon Damage Responses After Eccentric Plantar Flexor Exercise.
  50. Skeletal muscle thickness and echo intensity may reflect the risk of malnutrition and physical dysfunction in acutely hospitalized older patients.
  51. Reporting GUideline for Intervention DEscription in Rehabilitation (GUIDE-Rehab): a tool to open the 'black box' of rehabilitation complex interventions.
  52. Management of Rotational Instability After Anterior Cruciate Ligament Reconstruction.
  53. [Sarcopenia in Senior Subjects with Hip Fracture: Study of Prevalence, Correlation with Obesity, and Ultrasonography of the Rectus Femoris Muscle].
  54. Deep learning-based assessment of paraspinal muscle degeneration and its relationships to muscle function and disability outcomes in chronic low back pain: a prospective study.
  55. Evaluating National Imaging Guidelines for Rotator Cuff Assessment After Shoulder Dislocation in Adults Aged 40-60 Years.
  56. High-Fat Dairy and Cognitive Health: What Are the Alternatives?
  57. Immersive Virtual Reality-Based Rehabilitation for Upper Limb Recovery in Acute and Subacute Stroke Patients: A Feasibility Study.
  58. Relationship between paraspinal sarcopenia and clinical outcomes of intervertebral disc degeneration patients following unilateral biportal endoscopy discectomy.
  59. Comparative effectiveness of laser, PRP, splinting, and ESWT versus corticosteroid injection in lateral epicondylitis: a randomized controlled trial.
  60. Relationship between hip flexor tightness and low back pain in non-care-seeking individuals.
  61. [Research progress on augmentation repair of anterior talofibular ligament under arthroscopy].
  62. High-frequency ultrasound examination of acute ankle joint ligament injury and concomitant lesions.
  63. Bilateral trapezium and multiple metacarpal base fractures: An uncommon case report.
  64. Sex-related differences in circulating inflammatory cytokines in knee osteoarthritis: a prospective clinical study.
  65. Anatomical Variations of Palmaris Longus Muscle and Its Clinical Implications: a Cadaveric Study.
  66. Therapeutic Footwear for Medial Knee Osteoarthritis: Individualizing Midsole Stiffness Enhances Intended Kinetic Changes.
  67. Ultrasonographic Assessment of Posterior Shoulder Capsule Thickness in Baseball Pitchers: A Validation Study.
  68. Applying the Knowledge-to-Action Framework to Implement and Evaluate an Evidence-Based Functional Exercise Program for Elderly Patients After Total Knee Arthroplasty: A Mixed-Methods Study.
  69. Clinical Practice Guideline for Stroke Rehabilitation in Korea-Part 2: Rehabilitation for Motor and Sensory Function (2024).
  70. Biomechanical associations with bone stress injuries in running: A scoping review.
  71. Physiotherapy management of multiple sclerosis.
  1. Med Ultrason. 2025 Dec 12. 27(4): 498-499
    A dynamic ultrasound-based framework for diagnosing subacromial impingement and predicting response to guided injection: the CHANG protocol.
    Ke-Vin Chang, Wei-Ting Wu, Levent Özçakar.
      .
    DOI:  https://doi.org/10.11152/mu-4563
  2. J Pak Med Assoc. 2025 Dec;75(12): 1992-1995
    Evidence-Based interventional approaches for management of knee osteoarthritis: A mini-review.
    Muhammad Tawab Khalil, Umer Younas, Osama Ahmed, Farooq Azam Rathore.
      Knee osteoarthritis (KOA) has a prevalence of 3.5% in Southeast Asian region. It is associated with pain and disability, affecting women more than men. Multiple nonsurgical treatment options are available for pain management including oral analgesics, physical modalities, and interventional procedures (intra-articular injections, and denervation of knee joint). The evidence regarding various types of interventional procedures varies in literature. This mini review aims to present the latest evidence regarding interventional procedures for management of patients with KOA. The interventions can be broadly classified into Interventions with regenerative potential (e.g. platelet rich plasma, stem cell injections etc) and Interventions without regenerative potential (intra-articular steroid injections, denervation of knee joint etc). Intra-articular corticosteroids may be used in patients with KOA for short term relief . Nerve ablation techniques may provide moderate, short-term pain relief especially in advanced KOA, but the evidence is limited. Interventions with regenerative potential like PRP may be effective in pain relief and function, but there is heterogeneity in studies. Current evidence shows that MSCs may be promising for KOA, but it is still in an experimental phase.
    Keywords:  Platelet-Rich Plasma; Mesenchymal Stem Cells; Hyaluronic Acid; Botulinum Toxins, Type A; Knee Joint; Rehabilitation; Pain Measurement; Intra-Articular Injections.
    DOI:  https://doi.org/10.47391/JPMA.25-108
  3. Musculoskelet Sci Pract. 2025 Dec 18. pii: S2468-7812(25)00220-6. [Epub ahead of print]81 103472
    Association of central sensitization features with clinical, sonographic, and electrophysiological outcomes in carpal tunnel syndrome.
    Feyza Nur Yücel, Emre Ata.
       OBJECTIVE: Carpal tunnel syndrome (CTS), the most common nerve entrapment, is increasingly linked to changes in pain processing, including central sensitization (CS). However, how CS measures relate to tests such as sonography and electrodiagnostic studies (EDX) remains unclear.
    METHODS: This cross-sectional study included 60 patients with clinically and electrodiagnostically confirmed CTS and 20 healthy controls. Pain sensitization was evaluated using the pressure pain threshold (PPT) at four anatomical sites, and the Central Sensitization Inventory (CSI). Sonographic assessments captured median nerve cross-sectional area (CSA), ΔCSA values, thenar muscle thickness, and nerve echogenicity. Mixed-effects models were used for repeated-site measures (PPT and CSA/Δ), and sex-adjusted ANCOVA was used to analyse single-site outcomes. Pearson correlations were used to assess relationships among sensitization measures, sonographic findings, and EDX parameters.
    RESULTS: CTS patients had lower PPT values at all sites and higher CSI scores than controls (p < .05). Mixed-effects modelling confirmed reduced PPT and greater, site-dependent CSA enlargement in CTS. PPT at the carpal tunnel and thenar region correlated negatively with CSAmax and CSAinlet, and positively with motor amplitude. CSI correlated positively with functional disability and neuropathic pain features, but not with pain intensity. Sensitization parameters did not differ across CTS severity grades.
    CONCLUSION: This study shows that objective structural and electrophysiological markers are associated with central pain processes that contribute to the pathophysiology of CTS. These results underline the importance of assessing CTS through multiple dimensions, including structural and functional nerve changes and pain sensitization.
    Keywords:  Carpal tunnel syndrome; Central sensitization; Central sensitization inventory; Electrodiagnostic study; Pressure pain threshold; Sonography
    DOI:  https://doi.org/10.1016/j.msksp.2025.103472
  4. J Pak Med Assoc. 2025 Dec;75(12): 1937-1947
    A systematic review and meta-analysis on the use of diagnostic ultrasound in guiding corticosteroid injections for shoulder pain (subacromial/ subdeltoid bursa).
    Aamir Safdar Khan, Munir Khan, Muhammad Siddiqui, Amna Aamir Khan, Mubarra Rao.
       OBJECTIVE: To assess the efficacy of diagnostic ultrasound-guided corticosteroid injections in subacromial/subdeltoid bursa in the management of shoulder pain.
    Methods: The systematic review and meta-analysis was conducted from November 2023 to February 2024 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, and comprised search on Cochrane Central Register of Controlled Trials, Excerpta Medica dataBASE, Scopus and PubMed databases for randomised controlled and/or clinical trials involving adult patients with shoulder pain/subacromial impingement/bursitis, comparing ultrasound-guided corticosteroid injections versus blind injections, and published in the English language between January 2003 and August 2023. Quality assessment was performed using the Physiotherapy Evidence Database scale, and meta-analysis was performed using MedCalc software.
    RESULTS: Of the 72 full-text articles assessed, 11(15.3%) were analysed. There was a definite short-term effectiveness of ultrasound-guided corticosteroid injections in reducing pain, as assessed by visual analogue scale scores (p <0.001 at 6 weeks; p<0.05 at 12 week and 33 week) and improved range of motion in flexion, abduction, internal and external rotation (p<0.001-0.05). While meta-analysis confirms significant pooled effects for pain scores and range of motion outcomes at 6 weeks, long-term efficacy remained inconclusive due to heterogeneity across studies and limited long-term follow-up research on the subject.
    Conclusion: Evidence supported short-term efficacy of ultrasound-guided corticosteroid injections for shoulder pain management, but robust trials with extended followup periods and larger cohorts are needed to establish their long-term effectiveness.
    Keywords:  Ultrasonography, Interventional ultrasound, Shoulder pain, Corticosteroids, Shoulder impingement syndromes.
    DOI:  https://doi.org/10.47391/JPMA.25-20274
  5. Cureus. 2025 Nov;17(11): e96783
    Return to Play After Achilles Tendon Rupture: Comparing Operative and Nonoperative Approaches in Athletes.
    Laith Fada, Alexander Mazzorana, Zachary A Grand, Greg Jacobs.
      Achilles tendon rupture is a debilitating injury with significant implications for athletic performance and career longevity. Historically, operative repair was considered the gold standard, but advances in early functional rehabilitation have challenged this paradigm, with non-operative management demonstrating comparable rerupture and functional outcomes. This narrative review synthesizes evidence comparing operative and nonoperative strategies in athletes, emphasizing rehabilitation, return-to-play (RTP) outcomes, and long-term sequelae. Operative repair offers marginal advantages in preserving tendon length and explosive power but carries surgical risks such as adhesions and wound complications. Nonoperative management, utilizing modern functional protocols, achieves comparable rerupture rates and patient satisfaction while minimizing operative morbidity. It appears that the quality of rehabilitation and early management offers promising results in RTP, comparable to those of surgery.
    Keywords:  achilles tendon rupture; athletes; non-operative rehabilitation; operative management; return to play
    DOI:  https://doi.org/10.7759/cureus.96783
  6. Dev Med Child Neurol. 2025 Dec 17.
    Parasports for cerebral palsy: Thinking and 'prescribing' beyond the Paralympics.
    Julia E Hanes, Joel J Ewert, Amalie Holmsen-Wong, Peter Rosenbaum, Ram Mishaal, Dynai Eilig.
      The landscape of care for individuals with cerebral palsy (CP) has evolved far beyond 'fixing' impairments toward a life course, biopsychosocial approach aimed at enhanced functioning. Parasports remain an underutilized tool to encourage and facilitate physical activity achievement while filling gaps in traditional medical and therapeutic thinking about this new way of delivering services. This narrative review synthesizes evidence spanning multiple sports and gross motor function levels, where parasports demonstrate measurable benefits across all domains of the International Classification of Functioning, Disability and Health. Given the rich array of parasport options, it remains challenging to determine appropriate recommendations across the spectrum of function seen in individuals with CP and related disabilities. We outline sport eligibility based on gross motor function and available adaptations. Rather than viewing parasport as an option for 'athletic' children, evidence supports treating it as an essential element of comprehensive care-uniquely combining therapeutic physical activity benefits with social inclusion, identity development, and community integration.
    DOI:  https://doi.org/10.1111/dmcn.70115
  7. Medicine (Baltimore). 2025 Dec 12. 104(50): e46460
    Comparing the efficacy of ultrasound-guided versus anatomical localization for corticosteroid injection in the treatment of carpal tunnel syndrome: A systematic review and meta-analysis.
    Xu Zhao, Dan Hao, Feng Sun, Hanxu Li, Yu Hou.
       BACKGROUND: Carpal tunnel syndrome (CTS) remains a pervasive condition, often resulting in functional impairment and pain. There has been growing interest in refining treatment modalities to improve patient outcomes. This study examines whether ultrasound guidance enhances the efficacy and safety of corticosteroid injections for CTS compared to traditional injections based on anatomical landmarks.
    METHODS: This meta-analysis was conducted in strict accordance with the PRISMA guidelines. We employed the patient, intervention, comparison, outcome (PICO) framework to establish a comprehensive search strategy across several databases, with no language restrictions. Inclusion and exclusion criteria were meticulously defined to ensure the relevance and quality of the data. Independent reviewers conducted a rigorous selection and quality assessment process, including sensitivity analyses and publication bias evaluation, to synthesize the available evidence. Data analysis was meticulously carried out using Stata software, version 17 (StataCorp LLC, College Station).
    RESULTS: Six studies were included after a thorough search and selection process. Ultrasound-guided interventions significantly reduced Boston Carpal Tunnel Questionnaire symptom severity scores [SMD = -0.77, confidence interval (CI): -1.02 to -0.52, P < .01] and improved functional status scores (SMD = -0.36, CI: -0.60 to -0.12, P < .01) compared to the anatomical localization. Additionally, the incidence of nerve injury was lower in the ultrasound group (OR = 0.18, CI: 0.06 to 0.55, P < .01). Sensitivity analysis confirmed the robustness of these findings, and no publication bias was detected.
    CONCLUSIONS: Ultrasound-guided corticosteroid injections provide significant improvements in symptom severity and functional outcomes for CTS patients, with a safer profile regarding nerve injury. These findings support the clinical preference for ultrasound guidance, with further validation needed from larger-scale trials.
    Keywords:  carpal tunnel syndrome; corticosteroid; injection techniques; meta-analysis; ultrasound
    DOI:  https://doi.org/10.1097/MD.0000000000046460
  8. PLoS One. 2025 ;20(12): e0338989
    Retraction: Investigating the association between diabetes and carpal tunnel syndrome: A systematic review and meta-analysis approach.
    PLOS One Editors
      
    DOI:  https://doi.org/10.1371/journal.pone.0338989
  9. Eur J Phys Rehabil Med. 2025 Dec 18.
    Physiatrists and/vs. allied health professionals: echoing from Türkiye.
    Levent Özçakar, İlker Yağci.
      
    DOI:  https://doi.org/10.23736/S1973-9087.25.09323-2
  10. JMIR Mhealth Uhealth. 2025 Dec 16. 13 e71073
    Feasibility and Preliminary Effectiveness of a Mobile App-Based Personalized Exercise Program in Older Patients With Chronic Knee Osteoarthritis: Pilot Randomized Controlled Trial.
    Yu Jin Im, Jihong Choi, Sol-A Choi, Jeong-Yi Kwon, Jong Geol Do.
       Background: Knee osteoarthritis is a prevalent cause of disability among older adults, emphasizing the need for effective and accessible self-management strategies. Mobile app-based personalized exercise programs predominantly overcome the barriers associated with traditional approaches.
    Objective: This study aimed to evaluate the feasibility and preliminary efficacy of a 6-week mobile app-based self-exercise program that incorporates a multimonitoring system, weekly progress tracking, and dynamic exercise adjustments used by physiotherapists, and compares them with those of a conventional paper-based self-exercise program in older patients with chronic knee osteoarthritis.
    Methods: A total of 29 participants aged ≥60 years with chronic knee pain and radiographic evidence of osteoarthritis were randomized at a 2:1 ratio to either the intervention (19/29, 66%; mobile app-based program) or control (10/29, 34%; paper-based program) group. The mobile app delivered a personalized exercise program, which was tailored by physiotherapists based on remote monitoring of patient-reported symptoms. Feasibility outcomes included retention, adherence, and satisfaction rates, as well as safety. Preliminary clinical outcomes included changes from baseline to 6 weeks in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score, Numeric Rating Scale (NRS) pain, and other functional measures.
    Results: A total of 26 participants (n=16, 62% intervention and n=10, 38% control) completed the 6-week assessment, with retention rates of 84% and 100%, respectively. No adverse events were reported. Adherence was high in the intervention group, with 69% exercising ≥5 days per week and 88% reporting high satisfaction. The intervention group exhibited significant reductions in the WOMAC total score (median change -11.00, 95% CI -23.00 to -2.50; P=.01) and NRS pain score (mean change -2.12, 95% CI -3.13 to -1.11; P<.001).
    Conclusions: The mobile app-based personalized exercise program was feasible, safe, and well-accepted among older patients with knee osteoarthritis. High adherence and satisfaction support the practicality of this approach, and preliminary improvements in pain and function suggest potential clinical benefit. A larger, adequately powered trial is warranted to confirm the effectiveness of digital self-exercise interventions for knee osteoarthritis management.
    Keywords:  digital health; mHealth; mobile health; multimonitoring; osteoarthritis; pain; physical function; quality of life
    DOI:  https://doi.org/10.2196/71073
  11. BMC Res Notes. 2025 Dec 13.
    Neuropathic pain in knee osteoarthritis: functional burden beyond cartilage thickness-a cross-sectional study.
    P Shadan Javad, Ravi Gaur, Nitesh Manohar Gonnade, T K Abins, Nagma Sheenam, M K Jamshiya Ashraf.
       OBJECTIVE: Knee osteoarthritis (OA) is a common degenerative condition leading to pain and disability. While structural changes such as cartilage loss are central to OA pathology, neuropathic pain (NP) may also contribute to symptom severity and outcomes. This study cross-sectional study aimed to evaluate the association between femoral cartilage thickness and NP in patients with knee OA, and to assess its impact on pain, function, and quality of life.
    RESULTS: Sixty patients with knee OA were evaluated and classified into NP and non-NP groups using the painDETECT questionnaire (30 per group). Compared with non-NP patients, those with NP reported significantly higher pain scores (VAS: 4.70 vs. 3.37, p < 0.001), worse functional impairment (WOMAC: 71.0 vs. 55.9, p = 0.002), and lower quality of life across several SF-36 domains, particularly Role Emotional (p = 0.004) and Bodily Pain (p < 0.001). Femoral cartilage thickness at the medial condyle, intercondylar area, and lateral condyle did not differ significantly between groups. Trends toward higher obesity, more physically demanding occupations, and greater Kellgren-Lawrence severity were observed among NP patients. These findings suggest that NP adversely influences pain and function in knee OA independent of cartilage thickness, underscoring the importance of early identification and targeted management.
    Keywords:  Cartilage thickness; Functional outcome; Neuropathic pain; Osteoarthritis; Quality of life; Ultrasonography
    DOI:  https://doi.org/10.1186/s13104-025-07589-2
  12. Langenbecks Arch Surg. 2025 Dec 18. 411(1): 31
    Comparing the efficacy of ultrasound-guided versus anatomical localization for corticosteroid injection in the treatment of carpal tunnel syndrome: a systematic review and meta-analysis.
    Shibo Fang, Hongbo Duan.
       BACKGROUND: Carpal Tunnel Syndrome (CTS) remains a pervasive condition, often resulting in functional impairment and pain. This study examines whether ultrasound guidance enhances the efficacy and safety of corticosteroid injections for CTS compared to traditional injections based on anatomical landmarks.
    METHODS: This meta-analysis was conducted in accordance with PRISMA guidelines. We performed a systematic search of PubMed, Embase, Web of Science, and the Cochrane Library up to September 19, 2023. Randomized controlled trials (RCTs) comparing ultrasound-guided(US) versus landmark-guided(LM) corticosteroid injections for CTS were included. Data were synthesized using a random-effects model.
    RESULTS: Eight RCTs were included in the analysis. US was associated with a significant reduction in BCTQ symptom severity scores (Standardized Mean Difference [SMD] = -0.32, 95% CI -0.44 to -0.20; I²=0%) and functional status scores (SMD = -0.21, 95% CI -0.31 to -0.10; I²=0%). Nerve injury events were rare; while the direction of effect favored US, the evidence was too sparse to permit a reliable pooled estimate.
    CONCLUSIONS: US corticosteroid injections provide modest, consistent improvements in symptoms and function over landmark techniques. Safety signals directionally favor US, but adverse-event data are sparse and not definitive.
    Keywords:  Anatomical localization; Carpal tunnel syndrome; Corticosteroid injection; Meta-Analysis; Ultrasound-Guided
    DOI:  https://doi.org/10.1007/s00423-025-03926-y
  13. Maedica (Bucur). 2025 Sep;20(3): 555-559
    Assessment of Effectiveness of Bupivacaine Trigger-Point Injections in Trapezius Myofascial Pain Syndrome: a Retrospective Study.
    S R Dhole, B D Kamble, D Bisoi, D Satapathy, D Vandana, S Anish, K Prafull, K Karnakar, Manulata.
       Background: Myofascial pain syndrome (MPS) of the trapezius is a common cause of chronic neck and shoulder pain. Among various treatments, trigger point injections (TPIs) using local anesthetics like bupivacaine are frequently administered, though clinical evidence supporting their use remains limited.
    Objective: To evaluate the efficacy of bupivacaine trigger-point injections in patients with trapezius myofascial pain syndrome.
    Methods: A retrospective record review of 69 patients diagnosed with trapezius MPS and treated with (0.25%) bupivacaine TPIs in a tertiary care center was conducted. Pain was assessed using the visual analog scale (VAS) and functionality using the neck pain and disability index (NPD) at four time points: pre-injection, immediately after injection, two weeks and one month post-injection. Repeated measures ANOVA and post-hoc analysis were used to evaluate statistical significance.
    Results: Significant reductions in VAS and NPD scores were observed over time (p < 0.001). The mean VAS decreased from (6.10) to (2.64) and mean NPD from (31.7) to (12.8) over one month. Most patients (n = 65, 94.2%) experienced no adverse effects. Overall, 48 (70.6%) of patients were satisfied with the treatment.
    Conclusion: Bupivacaine trigger point injections are effective and safe for pain relief and functional improvement in trapezius MPS.
    Keywords:  bupivacaine; trapezius myofascial pain syndrome (TMPS); trigger-point injections
    DOI:  https://doi.org/10.26574/maedica.2025.20.3.555
  14. Cureus. 2025 Nov;17(11): e97012
    Web Impingement Syndrome of the Ankle: A Rare Cause of Persistent Post-traumatic Pain.
    Anis Soualili, Adel Arfi, Hamza Retal, Mohamed Khalil Khabet, Redouane Kadi.
      Web impingement syndrome of the ankle is a rare and often underdiagnosed cause of persistent post-traumatic pain, mainly due to limited awareness of its clinical and radiological presentation. We report the case of a 54-year-old woman who presented with chronic ankle pain and limited mobility after a traumatic injury. Despite favorable healing of the osseous and ligamentous injuries on imaging, she continued to experience significant pain and functional limitation seven months later, necessitating further diagnostic workup. Clinical evaluation revealed localized tenderness over the anterior aspect of the ankle, along with a restricted range of motion, particularly in dorsiflexion. Imaging studies, including MRI, demonstrated joint effusion and identified an intra-articular fibrous band within the anterior talocrural recess, causing mechanical impingement and contributing to the patient's symptoms. The patient underwent arthroscopic resection of the fibrous tissue, which resulted in gradual and sustained symptomatic improvement, with restoration of function during follow-up. This case highlights the importance of considering web impingement syndrome in the differential diagnosis of persistent post-traumatic ankle pain, particularly when standard imaging studies are inconclusive. Early recognition of this condition is essential to prevent chronic functional impairment and guide appropriate management. Arthroscopic intervention offers a minimally invasive and effective treatment option, leading to significant symptomatic relief and improved joint mobility. Increased awareness among orthopedic surgeons and radiologists can facilitate timely diagnosis and optimize patient outcomes in similar cases.
    Keywords:  ankle arthroscopy; ankle impingement; chronic ankle pain; fibrous band; post-traumatic pain; talocrural joint; web impingement syndrome
    DOI:  https://doi.org/10.7759/cureus.97012
  15. PeerJ. 2025 ;13 e20108
    Development and content validity of the evaluation of multidimensional functioning and risks in aging scale.
    José Fierro-Marrero, Álvaro Reina-Varona, Joaquín Pardo-Montero, Alba Paris-Alemany, Roy La Touche.
       Introduction: Rising life expectancy has led to an increased prevalence of age-related conditions such as pain, dementia, and falls. To address these challenges, healthcare systems require efficient tools to identify which health domains are preserved or impaired in older adults. Existing frailty instruments present both conceptual and operational limitations. Therefore, there is a need to shift toward domain-specific evaluations of functioning and potential risks, aligned with established protocols such as the Comprehensive Geriatric Assessment and framed within the International Classification of Functioning, Disability and Health (ICF). This study aimed to develop the Evaluation of Multidimensional Functioning and Risks in Aging (EMFRA) scale, encompassing four assessment domains: physical function, cognitive function, emotional status, and social situation.
    Methods: The EMFRA scale was developed by identifying potential items through a comprehensive literature review and expert input. The first preliminary version was validated by a panel of 15 experts, who assessed the scale's clarity, coherence, and relevance using a 5-point Likert scale. Cognitive interviews were then conducted with 10 clinicians and 10 older adults to evaluate the comprehensibility and practical applicability of the second preliminary version.
    Results: Following the literature review, 24 items were grouped into four domains (six items per domain), each supported by evidence linking them to health-related adverse outcomes. Expert evaluation showed substantial agreement on comprehension, coherence, and relevance (Aiken's V >0.7) for all but two items-language and fear-which were excluded. Cognitive interviews led to the exclusion of one additional item (sedentarism) and further refinement of the remaining items. These changes were incorporated into the final version of EMFRA, enhancing its usability and comprehensiveness.
    Conclusion: EMFRA provides a multidimensional framework for assessing functioning and risks in older adults, capturing physical, cognitive, emotional, and social factors. The inclusion of end-user feedback ensured the scale's practical relevance. However, the current version of EMFRA should not yet be used in clinical practice, as further psychometric validation is required to confirm its utility.
    Keywords:  Aging; Content validity; Frailty; Functioning; Geriatrics; Older adults; Scale development; Validity; Vulnerability
    DOI:  https://doi.org/10.7717/peerj.20108
  16. BMC Musculoskelet Disord. 2025 Dec 13.
    "Intraoperative pillar corticosteroid injection": does it improve clinical outcomes after carpal tunnel release surgery? A double-blind, randomized controlled study.
    Panithan Tuntiyatorn, Chanakarn Rojpitipongsakorn, Siraphat Ponghunsa, Thepparat Kanchanathepsak, Tulyapruek Tawonsawatruk.
      The purpose of this study was to assess the therapeutic effects of intraoperative direct pillar corticosteroid injection in patients with carpal tunnel syndrome(CTS) who underwent open carpal tunnel release (OCTR) surgery. A prospective randomized controlled trial was conducted on 62 patients with carpal tunnel syndrome. Two intraoperative pillar injection solutions were compared: the lidocaine with triamcinolone acetonide and the lidocaine alone. Injections were administered at two points each at the scaphoid and trapezium bones in the radial pillar area, and at the hamate and pisiform bones in the ulna pillar area. Post-operatively, there were no significant differences in patient satisfaction, functional outcomes and pillar pain between the groups. Notably, the resolution time for pillar pain was prolonged in the steroid group. Conclusion Intraoperative corticosteroid pillar injection is not an effective option for preventing pillar pain symptoms. Level of evidence Level I.Trial registration The trial was registered in the Thai Clinical Trials Registry (TCTR) database. The identification number is TCTR20211130003, date of registration 30/11/2021.
    Keywords:  Carpal tunnel release; Carpal tunnel syndrome; Corticosteroid; Injections; Pain; Postoperative complications; Treatment outcome.
    DOI:  https://doi.org/10.1186/s12891-025-09393-2
  17. Arthroscopy. 2025 Dec;pii: S0749-8063(25)00603-6. [Epub ahead of print]41(12): 4965-4967
    Recovery Stages After Multiligament Knee Reconstruction.
    Warren W Nielsen, Jill K Monson, Robert F LaPrade, Andrew G Geeslin.
      Multiligament knee injuries are severe limb-threatening injuries involving a tear of two or more of the major knee ligaments including the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and fibular (lateral) collateral ligament/posterolateral corner. Anatomic reconstructions can help restore joint stability, which is complemented by a postoperative rehabilitation program to maximize knee function. The postoperative recovery will likely be extended compared with single-ligament procedures and usually involves robust precautions. However, it can be started the day after the reconstruction procedure to include initiation of knee motion. The goals are similar to those of single-ligament procedures including gradual recovery of motion, strength, and load capacity; as well as symptom control, restoration of cardiovascular fitness, and long-term joint protection. These are achieved through a protocolized rehabilitation program that involves four phases: recovery phase, transition phase, rebuild phase, and restore phase. Their goals and milestones are incremental to achieve optimal patient outcomes. With a team-based approach to protocolized recovery between the patient, surgeon, and rehabilitation team, patient function and return to activities can be maximized.
    DOI:  https://doi.org/10.1016/j.arthro.2025.09.001
  18. Sci Rep. 2025 Dec 18. 15(1): 44117
    Effects of dry needling combined with exercise on knee osteoarthritis at 6 month follow up a randomized clinical trial.
    Aida Agost-González, Isabel Escobio-Prieto, María de Los Ángeles Cardero-Durán, Ángel Rufino Yáñez-Álvarez, Carlos Fernández-Morales, Manuel Albornoz-Cabello.
      Therapeutic exercise has been recommended for people with knee osteoarthritis; however, it can be combined with other treatments, such as dry needling. The aim of this study was to analyze and compare the results of pain, functionality, strength, range of motion and kinesiophobia in subjects with knee osteoarthritis, after treatment with dry needling of the popliteus muscle combined with an exercise program, compared to only performing an exercise program. This study was registered in the Clinical Trials Registry ClinicalTrials.gov (code: NCT06816940). A total of 38 participants were randomly divided into two groups: the experimental group, who conducted dry needling and therapeutic exercise (n = 18), and the control group, who performed therapeutic exercise and simulated dry needling (n = 20). The intervention lasted three weeks: dry needling was applied once per week, and the exercise program was performed four times per week. Variables such as pain, functionality, neuropathic pain, stiffness, range of motion, strength, pain catastrophizing and kinesiophobia were evaluated pre/post intervention and after 3/6 months. Significant between-group differences favoring the experimental group were observed, including maximum pain (VAS: mean change 30 [95% CI 18.4-42.0], p < 0.001) and functional disability (WOMAC: mean change 16.0 [95% CI 7.9-23.9], p < 0.001), with additional improvements observed in other measures. These findings suggest that popliteus muscle dry needling added to exercise showed better results in pain, functionality, strength, pain catastrophizing and kinesiophobia improvement in patients with knee osteoarthritis at 6-month follow-up compared to exercise alone.
    Keywords:  Dry needling; Knee osteoarthritis; Pain; Popliteus muscle; Therapeutic exercise
    DOI:  https://doi.org/10.1038/s41598-025-27821-0
  19. Sports Health. 2025 Dec 14. 19417381251397956
    Early Effects of Kinesio Taping on Clinical Outcomes in Patients With Arthroscopic Rotator Cuff Repair: A Double-Blind, Randomized Controlled Trial.
    Muhammed I Hsan Kodak, Anıl Özüdoğru, Hakkı Çağdaş Basat, Figen Tuncay.
       BACKGROUND: Kinesio tape (KT) is being applied increasingly in physical therapy and rehabilitation. This trial aimed to examine the effect of KT in terms of functional outcomes in people undergoing arthroscopic rotator cuff repair (ARCR).
    HYPOTHESIS: KT after ARCR will reduce pain and edema.
    STUDY DESIGN: A double-blind, randomized controlled trial.
    LEVEL OF EVIDENCE: Level 1b.
    METHODS: A total of 45 patients who underwent ARCR were assigned randomly to 1 of 3 groups: KT (n = 15), sham taping (ST, n = 15), and control (n = 15). Participants received a conservative physiotherapy program. The physiotherapy program, which was conservative in nature, covered the first 7 weeks after surgery. In addition to the program, patients in the KT group were also treated with KT, while those in the ST group received ST. Pain levels (visual analog scale), edema, and functional scores (Western-Ontario Rotator Cuff Index, Modified Constant-Murley Shoulder Score, Revised Oxford Shoulder Score, and Shoulder Pain and Disability Index) were evaluated at regular intervals throughout the treatment.
    RESULTS: Baseline characteristics of the groups were similar (P > 0.05). All evaluation parameters showed significant improvement over time in all 3 groups (P < 0.05). There were no differences between the groups in any of the parameters when analyzed for group × time interactions (P > 0.05).
    CONCLUSION: This study found no efficacy of KT after ARCR in reducing pain and edema and improving shoulder function in the short- or medium-term.
    CLINICAL RELEVANCE: Clinicians should not expect additional short- or medium-term benefits from KT in reducing pain and edema or improving shoulder function after ARCR.
    Keywords:  kinesio tape; pain; rotator cuff; shoulder arthroscopy
    DOI:  https://doi.org/10.1177/19417381251397956
  20. Ann Ib Postgrad Med. 2025 Aug 31. 23(2): 126-128
    A CASE REPORT OF BERTOLOTTI SYNDROME INCIDENTALLY COEXISTING IN A 12 YEAR MALE WITH HISTORY OF PERINEAL BONE TRAUMA.
    M A Soneye, T A Ajadi.
       Introduction: Bertolotti's Syndrome (BS) is a rare cause of low back pain in adolescents, often associated with lumbosacral transitional vertebrae (LSTV). This condition results in structural changes at the lumbosacral junction, leading to pain through altered biomechanics and pseudoarthrosis. Due to its rarity and overlapping symptoms with other lumbar pathologies, BS is frequently undiagnosed.
    Case Presentation: This case report discusses a 12-year-old male patient that developed BS following trauma to the perineal region, presenting with low back pain and difficulty walking. Imaging studies revealed an enlarged left transverse process of the L5 vertebra articulating with the sacrum, consistent with Type II LSTV according to the Castellvi classification.
    Conclusion: This case highlights the importance of considering BS in the differential diagnosis of low back pain in young patients, particularly in the context of trauma. While conservative management can offer significant relief, surgical intervention may be necessary in refractory cases. Early diagnosis and tailored treatment are crucial for optimal outcomes, and further research is needed to establish standardized treatment guidelines and improve patient care.
    Keywords:  Bertolotti Syndrome; Conservative management; Corticosteroid injection.; Lower back pain; Lumbosacral transitional vertebra
  21. JBJS Rev. 2025 Dec 01. 13(12):
    Bucket-Handle Meniscus Tears: Epidemiology, Diagnosis, Management, and Outcomes.
    Phara Ross, Magnolia Livingston, Shreya M Saraf, John R Miller, Mary K Mulcahey.
      » Bucket-handle meniscus tears (BHMTs) are complex injuries that often cause mechanical symptoms such as locking, restricted motion, and pain, with high prevalence in active individuals and those with concomitant anterior cruciate ligament (ACL) injuries.» BHMTs may occur acutely from trauma or pivoting movements, often in association with ACL injuries, or develop chronically from degenerative changes. Bucket-handle tears of the medial meniscus are most common, while lateral BHMTs are less frequent but more often seen in younger athletes with ACL tears. Typical symptoms include pain, locking, swelling, and restricted motion. Risk factors such as meniscal morphology, ligamentous laxity, tibial slope, obesity, malalignment, and high-impact sports increase susceptibility and may influence outcomes.» Nonoperative treatment may be suitable for selected low-demand patients or those who medically are not operative candidates, or patients with asymptomatic chronic tears who have significant knee arthritis. Patients should also be informed that nonoperative treatment carries the risk of accelerated osteoarthritis and knee instability.» Surgical repair, using either inside-out or all-inside techniques, is preferred when feasible and has been shown to improve functional outcomes and delay the onset of osteoarthritis. Both approaches restore meniscal load transmission, though failure rates vary.» Postoperative rehabilitation strategies remain heterogeneous. Gradual and accelerated protocols differ in timelines for weight-bearing, bracing, and return to sport, yet both aim to restore range of motion, strength, and dynamic stability.» While short-term and mid-term outcomes are promising following meniscal repairs, long-term data are limited. Optimizing repair techniques and defining rehabilitation protocols are essential for improving survivorship and functional recovery after BHMT repair.
    DOI:  https://doi.org/e25.00144
  22. Video J Sports Med. 2025 Nov-Dec;5(6):5(6): 26350254251375083
    Anatomic Multiligament Knee Reconstruction With Biceps Femoris Tendon and Medial Meniscal Repair.
    Benjiman J Wilebski, Luke V Tollefson, Dustin R Lee, Matthew T Rasumussen, Robert F LaPrade.
       Background: Multiligament knee injuries are defined as tears of ≥2 of the following ligament structures: anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), posteromedial corner, or posterolateral corner (PLC). These injuries occur in various settings and may be associated with knee dislocations.
    Indications: The literature has reported that anatomic technique and a single-;stage approach for treating multiligament knee injuries are optimal because they may lead to improved outcomes. An anatomic double-;bundle PCL reconstruction is suggested to improve knee kinematics compared with a single-;bundle PCL reconstruction.
    Technique Description: The technique described was used to surgically reconstruct the ACL, PCL, and PLC, and to repair the medial meniscus and biceps femoris tendon. Neurolysis of the common peroneal nerve and dissection of the biceps femoris tendon were performed through the release of scar tissue. Tunnel drilling for the anatomic reconstruction of the PLC, PCL, and ACL was completed. The double bundle PCL reconstruction was performed with Achilles and tibialis anterior tendon allografts, the ACL reconstruction utilized a bone-;patellar tendon-bone autograft, and the PLC reconstruction was performed with a split Achilles tendon allograft. Final graft tensioning and fixation were performed in sequence as the PCL anterolateral bundle, the PCL posteromedial bundle, the ACL, the fibular collateral ligament (FCL), the popliteus tendon, and the popliteofibular ligament. A medial meniscal repair was performed with an all-;inside suture device, and the biceps femoris tendon repair was performed with 2 suture anchors on the fibular head.
    Results: Improved outcomes have been reported with single-;stage anatomic reconstructions of multiligament knee injuries, with early initiation of rehabilitation. Acute (<6 weeks) versus late-;stage surgical intervention has been discussed to have equivalent postoperative outcomes. A consensus statement described that the timing of surgery should be performed on a case-;by-;case basis, depending on patient factors.
    Discussion/Conclusion: The literature on multiligament knee reconstruction performed in a single stage continues to demonstrate improved outcomes. The technique described restores native knee biomechanics through anatomic-;based reconstructions of the ACL, PCL, FCL, popliteofibular ligament, and popliteus tendon.
    Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
    Keywords:  anterior cruciate ligament reconstruction; biceps femoris repair; double bundle posterior ligament reconstruction; multiligament knee injuries; posterolateral corner reconstruction
    DOI:  https://doi.org/10.1177/26350254251375083
  23. Ann Intern Med. 2025 Dec 16. e2504827VS
    Annals Video Summary - Efficacy and Safety of Bisphosphonates for Complex Regional Pain Syndrome: A Systematic Review and Meta-analysis.
      
    DOI:  https://doi.org/10.7326/ANNALS-25-04827-VS
  24. Cureus. 2025 Nov;17(11): e97104
    The Use of Steroid Injections for Hand and Wrist Pathologies.
    Rosemary J Bell, Rebecca Cervenak, Molly I Flint, Genevieve E Perrins, Amelia Dickinson, Aishwarya Ghosh, Shamim Umarji.
      Common hand pathologies that fail conservative management can be treated with corticosteroid injections. There are limited guidelines on the use of corticosteroids for hand and wrist pathologies. We aim to review the current practice of corticosteroid use and examine the available evidence regarding their efficacy and safety. A comprehensive literature review of PubMed and Cochrane databases was carried out from inception until present. Studies looking at the use of corticosteroids in common hand conditions in adults were included. Data on the dosage and timing of use of corticosteroids, side effects and complications were extracted. This evidence is summarised and compared with the current British and American guidelines. Corticosteroid injection into the wrist and hand are largely felt to be safe, with significant side effects uncommon. There are reported isolated cases of serious and irreversible complications such as necrotising fasciitis and flexor tendon rupture. The dosage of corticosteroid varied depending on the choice of steroid, but studies recommended a maximum of four injections a year, at a minimum three-month interval. The most appropriate choice of corticosteroids for all pathologies was betamethasone or methylprednisolone; however, this was largely based on weak evidence. Corticosteroids are used commonly for hand and wrist pathologies, but there is variable and conflicting evidence regarding the optimal dosage, timing, efficacy and safety profile of these medications. There is currently no evidence-based guidelines for treatment, with data being largely derived from larger joints. Further targeted research is needed to address this gap.
    Keywords:  carpal tunnel syndrome; corticosteroid; de quervain's tenosynovitis; hand and wrist pain; intraarticular injection; osteoarthritis (oa); trigger finger disorder
    DOI:  https://doi.org/10.7759/cureus.97104
  25. Int J Surg. 2025 Dec 19.
    Letter to the editor: "Outcome comparison of arthroscopic latissimus dorsi tendon transfer and muscle advancement for irreparable rotator cuff tear: a systematic review".
    Yidan Zhang, Xinyue Ren, Min Feng.
      
    DOI:  https://doi.org/10.1097/JS9.0000000000004400
  26. PLoS One. 2025 ;20(12): e0339259
    Evaluating the efficacy of intragastric botulinum toxin a injections with two different quantities and sites for obesity.
    Tien-Yow Chuang, Cheng-Hung Chiu, I-Wen Penn, Cheng-Di Chiu.
       INTRODUCTION: Intragastric injections of botulinum toxin A (BTX-A) have shown promise in aiding weight reduction among obese patients, with a favorable safety profile and minimal adverse effects; however, the inconsistent results from prior studies highlight the need to examine key factors in the research of intragastric injection of botulinum toxin A, such as the dosage of BTX-A, the number and placement of injections. This study examines the efficacy of varying high doses, multi-gastric sites botulinum toxin A injections for weight control.
    MATERIALS AND METHODS: A total of 103 patients aged 18-65 with a BMI ≥ 25 kg/m² were assigned to four groups receiving endoscopic BTX-A injections at varying doses and sites: Group 1 (400 IU, fundus and body), Group 2 (300 IU, fundus and body), Group 3 (400 IU, antrum and body), and Group 4 (300 IU, antrum and body). Baseline comparisons used ANOVA, while a mixed model assessed the interaction among injection site, dose, and time on outcomes.
    RESULTS: Baseline measures showed no group differences in bodyweight, BMI, or body fat. The mixed model indicated significant reductions in bodyweight, BMI, and body fat with gastric fundus and body injections. Site and dose interactions significantly affected bodyweight (p = 0.024) and body fat (p = 0.041), but not BMI.
    CONCLUSIONS: Endoscopic intragastric BTX-A injections effectively reduce body weight, BMI, and body fat, particularly with injections in the fundus and body regions.
    DOI:  https://doi.org/10.1371/journal.pone.0339259
  27. JBJS Case Connect. 2025 Oct 01. 15(4):
    Surgical Decompression of Pudendal Neuralgia Due to Entrapment Beneath a Bifurcate Piriformis Muscle: A Case Report.
    Ameya V Belamkar, Joshua T Finerty, Allison R Garden, Manuel A Romero Padron, Joshua S Everhart.
       CASE: A 33-year-old woman with a 1-year history of right gluteal and pelvic pain due to entrapment of the pudendal nerve by a bifurcate piriformis muscle underwent piriformis tenotomy, pudendal neurolysis, and sciatic neurolysis by an open posterolateral hip approach. At 32-week follow-up, the patient was free of deep gluteal pain and all pudendal neuralgia symptoms.
    CONCLUSION: Pudendal nerve entrapment by the piriformis is an uncommon cause of pudendal neuralgia that can be effectively treated with surgical intervention. We demonstrate an open posterolateral hip approach may provide significant pain relief and satisfactory improvements in patient-reported outcomes in management of this pathology.
    Keywords:  PROMs; bifurcate piriformis; female; pelvic pain; perineal pain; piriformis tenotomy; pudendal nerve entrapment; pudendal neuralgia; pudendal neurolysis; sciatic neurolysis; young adult
    DOI:  https://doi.org/e25.00382
  28. PM R. 2025 Dec 19.
    Author reply to letter re: "Focal extracorporeal shockwave therapy in shoulder calcific tendinopathy: A retrospective observational study of sonographic prognostic factors".
    Vincenzo Ricci, Levent Özçakar.
      
    DOI:  https://doi.org/10.1002/pmrj.70077
  29. Top Stroke Rehabil. 2025 Dec 18. 1-11
    Asymmetry in fractional anisotropy of the corticospinal tract correlates with measures of body structure/function and activity in the chronic phase after stroke.
    Tiago Voigt Gava, Sook-Lei Liew, Claudia da Costa Leite, Carlos Toyama, Nathália Helena Vieira Ribeiro, Adriana Bastos Conforto.
       BACKGROUND: Imaging biomarkers of corticospinal tract (CST) involvement show significant correlations with the upper extremity Fugl-Meyer Assessment (FMA) - a measure of body structure and function within the International Classification of Functioning, Disability, and Health framework (ICF) - particularly in the acute and subacute phases after stroke. However, the relationships between CST biomarkers and the FMA, as well as with ICF activity-level outcomes, remain insufficiently characterized.
    OBJECTIVE: This cross-sectional study investigated, in 36 individuals in the chronic phase after stroke, the correlation between three markers of CST integrity, (1) asymmetry in fractional anisotropy measured in the posterior limb of the internal capsule (FA-PLIC), (2) asymmetry in cerebral peduncle (CP) area, and (3) the CST lesion load, and outcomes of body function/structure and activity.
    METHODS: The participants were assessed with the FMA and the Wolf Motor Function Test (WMFT) consisting of a timed component (WMFT-Time) and the Functional Ability Scale (WMFT-FAS). Associations between imaging and clinical measures were analyzed with Pearson correlation coefficients.
    RESULTS: FA-PLIC asymmetry was significantly correlated with FMA (r = 0.33; p = 0.047) and WMFT-FAS (r = 0.35; p = 0.035), but not with WMFT-Time (r = 0.26; p = 0.120). No significant correlations were observed between CP area asymmetry or CST lesion load and any of the outcome measures.
    CONCLUSIONS: Our findings support FA-PLIC asymmetry as a biomarker of CST involvement, associated with the FMA and with the quality of movement during execution of functional tasks, in the chronic phase after stroke.
    Keywords:  Diffusion tensor imaging; cerebral peduncle area; chronic phase of stroke; lesion load; upper limb paresis
    DOI:  https://doi.org/10.1080/10749357.2025.2605292
  30. Pain. 2026 Jan 01. 167(1): 244-245
    Revisiting pain inhibition in knee osteoarthritis: central dysregulation and the paradox of resilience.
    Chung-Hsin Yeh, Shiuan-Chih Chen.
      
    DOI:  https://doi.org/10.1097/j.pain.0000000000003834
  31. Hand Surg Rehabil. 2025 Dec 11. pii: S2468-1229(25)00487-6. [Epub ahead of print] 102562
    Ultrasound-Guided Anterograde Carpal Tunnel Release: Anatomical Landmarks of the Distal Boundary - A Cadaveric Study.
    Marion Mutschler, Bérénice Moutinot, Olivier Marès.
       BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. Anterograde ultrasound-guided carpal tunnel release is now a widely adopted technique. However, identifying the distal limit of the transverse carpal ligament (TCL) on a longitudinal view remains challenging. This study investigates whether the 'V'-shaped structure seen on longitudinal ultrasound can serve as a reliable landmark for complete TCL release.
    MATERIALS AND METHODS: Ten fresh cadaveric upper limbs were examined. Four anatomical landmarks were identified and marked under ultrasound guidance, including the distal end of the 'V'-shaped structure seen on longitudinal view. An ultrasound-guided anterograde release of the transverse carpal ligament was then performed, advancing the instrument to the distal end of the V-shaped sonographic image. A final anatomical dissection verified the correspondence between ultrasound landmarks and underlying structures, particularly the superficial palmar arch.
    RESULTS: The distal end of the 'V'-shaped structure was consistently located distal to Kaplan's line and trapezium-hook of hamate line. It averaged 6.8 mm from the superficial palmar arch. In 5 of 10 cases, this distance was ≤5 mm, and in one case, the section came into contact with the superficial palmar arch without causing injury.
    CONCLUSION: The 'V'-shaped structure extends beyond the anatomical limits of the carpal tunnel. Despite its proximity to the superficial palmar arch, no vascular injury occurred. These findings support the need for continuous ultrasound guidance and highlight that the 'V' sign does not represent the true distal limit of the carpal tunnel. Larger in vivo studies are required to confirm these results and establish consistent longitudinal ultrasound landmarks for safe carpal tunnel release.
    Keywords:  Carpal Tunnel Syndrome; Ultrasound-guided; anatomy; anterograde release; cadaveric
    DOI:  https://doi.org/10.1016/j.hansur.2025.102562
  32. Cureus. 2025 Nov;17(11): e96871
    Trapeziectomy Versus Carpometacarpal Arthroplasty for Basilar Thumb Arthritis: A Narrative Review of Comparative Outcomes.
    Kavyansh Bhan, Dhruvi Chande, Nirav Valand, Janani Suresh, Shradha Prakash, Satyanarayana Pidikiti.
      Basilar thumb arthritis or thumb carpometacarpal (CMC) joint osteoarthritis is a common degenerative condition causing pain, weakness, and functional limitation, particularly among older populations and postmenopausal women. Surgical intervention is often required for advanced disease, with trapeziectomy and prosthetic arthroplasty being the two main approaches. Trapeziectomy, with or without ligament reconstruction and tendon interposition (LRTI), provides reliable long-term pain relief and functional restoration. Prosthetic arthroplasty aims to preserve thumb length, maintain biomechanics, and enable faster rehabilitation. This review synthesizes evidence comparing trapeziectomy-based procedures and CMC arthroplasty, focusing on pain, functional outcomes, strength, range of motion, complications, implant survival, rehabilitation, and patient satisfaction. Both approaches achieve excellent outcomes, with arthroplasty offering earlier functional gains but higher implant-specific complications and revision rates. Trapeziectomy remains a durable, cost-effective, and predictable treatment option. Individualized patient selection and shared decision-making are emphasized, and long-term comparative studies are needed to refine surgical guidelines.
    Keywords:  thumb basal joint arthroplasties; thumb carpometacarpal osteoarthritis; thumb cmc arthroplasty; trapeziectomy; trapezium-metacarpal joint
    DOI:  https://doi.org/10.7759/cureus.96871
  33. Semin Ultrasound CT MR. 2025 Dec 15. pii: S0887-2171(25)00085-X. [Epub ahead of print]
    The role and challenge of knee cartilage MRI in early diagnosis of knee osteoarthritis: a literature review.
    Hongbiao Sun, Yanqing Ma, Chenyuanying Long, Tianyi Xing, Junxian Liao, Qinling Jiang, Shaochun Xu, Xiang Wang, Yi Xiao, Shiyuan Liu.
      Osteoarthritis (OA) is one of the most prevalent diseases in society today, resulting in significant socio-economic costs, and knee osteoarthritis (KOA) is the most common type. Articular cartilage degeneration is the key pathological change of OA, and cartilage plays a vital role in early diagnosis. With the advancement of science and technology, MRI became widely used in KOA as a non-invasive imaging tool for direct display of articular cartilage. This article explores the advantages, limitations, and improvement strategies of knee cartilage MRI in early diagnosis of KOA, aiming to provide a comprehensive understanding of its clinical significance. Compositional MRI can detect changes in tissue biochemical components before morphological changes occur, and quantitative and semi-quantitative methods can systematically evaluate minor changes in cartilage, exploring new biomarkers for early detection. Under the guidance of deep learning, high-resolution 3D technology, and super-resolution reconstruction technology, cartilage can be assessed more accurately and quickly, accelerating clinical transformation and enabling early intervention and management in the early stage of reversible cartilage recovery. Knee cartilage MRI can help us better perform early diagnosis of KOA. We should grasp the cartilage MRI in the early stage of the disease, improve the early diagnosis and treatment process and diagnostic classification criteria, accelerate the development of deep learning algorithms and new scanning methods, and push new technologies to the clinic as soon as possible.
    Keywords:  Cartilage; Compositional MRI; Knee osteoarthritis; Quantitative MRI; Semi-quantitative MRI
    DOI:  https://doi.org/10.1053/j.sult.2025.12.001
  34. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Dec 15. 39(12): 1606-1614
    [Key role of biomechanical properties and material selection in rotator cuff repair].
    Xiangquan Cai, You Zhou.
       Objective: To summarize the biomechanical research progress of biomaterials in rotator cuff injury repair and to explore how biomaterials can restore the native histological and mechanical properties of the rotator cuff.
    Methods: The relevant literature at home and abroad was widely reviewed to analyze the biomechanical properties of synthetic biomaterials, naturally derived biomaterials, and tissue grafts in the repair of rotator cuff injuries.
    Results: Synthetic biomaterials [such as poly (lactic-co-glycolic acid) and polycaprolactone] can provide initial stable mechanical support due to their adjustable mechanical properties and degradation characteristics, while naturally derived biomaterials (such as collagen and hyaluronic acid) can promote cell adhesion and tissue integration due to their biocompatibility and bioactivity. Tissue grafts exhibit significant clinical utility by providing immediate mechanical stability and promoting tendon-to-bone healing. Three-dimensional bioprinting technology provides new possibilities for personalized repair of rotator cuff injuries by precisely controlling the spatial distribution and mechanical properties of biomaterials.
    Conclusion: Future studies should further optimize the design of bioprinting materials, cell sources, and scaffolds to achieve better mechanical properties and clinical efficacy of biomaterials in the repair of rotator cuff injuries.
    Keywords:  Rotator cuff injury; biomaterials; biomechanics; three-dimensional bioprinting
    DOI:  https://doi.org/10.7507/1002-1892.202506085
  35. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Dec 15. 39(12): 1591-1599
    [Research progress on enhanced recovery after posterior cruciate ligament reconstruction].
    Zhengliang Shi, Yanlin Li, Zhaohui Ruan, Hongmai Yang, Kaiquan Li, Ping Yuan, Wenting Tang, Rui Han.
       Objective: To summarize research progress on enhanced recovery after posterior cruciate ligament (PCL) reconstruction, clarify the core contradictions, effective intervention methods, and evaluation shortcomings in current clinical practice, and provide theoretical support for optimizing clinical rehabilitation strategies.
    Methods: Relevant domestic and international literature in recent years was systematically searched. The key technologies and challenges for enhanced recovery after PCL reconstruction were analyzed from three aspects: the core issues of enhanced recovery after PCL reconstruction, treatment strategies, and the post-reconstruction effectiveness evaluation system.
    Results: Enhanced recovery after PCL reconstruction mainly faces two core problems. First, there is a balance dilemma between graft tendon protection and knee joint function recovery: the tensile capacity of the graft tendon is weak in the early postoperative period, so excessive weight-bearing easily leads to relaxation, while overly conservative immobilization causes muscle atrophy and joint adhesion. Second, the return-to-sport rate is significantly affected by injury type and treatment method: patients with combined multiple ligament or meniscus injuries have a much lower return-to-sport rate than those with isolated PCL injury, and the risk of return-to-sport failure is higher. Current research mainly promotes rehabilitation from two aspects: physical therapy and surgical technology. Physical therapy runs through the perioperative period: preoperatively, muscle strength training, swelling control, and maintenance of joint range of motion are used to optimize surgical conditions; postoperatively, phased intervention is implemented. Surgical technology focuses on minimally invasive and anatomical approaches: arthroscopic surgery reduces injury, double-bundle reconstruction and internal tension-relief technology improve stability, and modified tunnel positioning and special surgical methods avoid the risk of "Killer Turn". Postoperative functional evaluation adopts multi-dimensional indicators: subjective evaluation relies on scales such as Lysholm and International Knee Documentation Committee (IKDC); objective evaluation assesses stability through Telos stress test and posterior drawer test; imaging evaluation takes MRI as the core; psychological evaluation is assisted by the Tampa scale of kinesiophobia-11 (TSK-11). However, there are obvious shortcomings, such as the lack of PCL-specific evaluation tools.
    Conclusion: Enhanced recovery after PCL reconstruction requires the integration of precise surgery, individualized rehabilitation, and comprehensive subjective and objective evaluation. In the future, biomaterials and digital technologies should be integrated to optimize the full-cycle management of PCL reconstruction, thereby improving functional recovery and the effect of return to sports.
    Keywords:  Posterior cruciate ligament reconstruction; enhanced recovery after surgery; return to sports
    DOI:  https://doi.org/10.7507/1002-1892.202508036
  36. Sao Paulo Med J. 2025 ;pii: S1516-31802026000100602. [Epub ahead of print]144(1): e2024497
    Knee and ankle biomechanics during recovery from primary, secondary, and bilateral anterior cruciate ligament injuries: a quasi-experimental study.
    Sérgio Loureiro Nuno, Carlos Romero-Morales, Daniel López-López, Marta Elena Losa-Iglesias, Ricardo Becerro-de-Bengoa-Vallejo, Juan Gómez-Salgado, João Guerra, Miguel Ángel Saavedra-García.
       BACKGROUND: Anterior cruciate ligament (ACL) tears are common knee injuries with a known but vague association with secondary joint injuries. The extent to which these injuries are preventable remains unclear.
    OBJECTIVE: This study aimed to assess the functional differences in knee and ankle dorsiflexion biomechanics with full loading on one leg and to understand whether it could be a key point as a progressive method in ACL reconstruction, considering both legs and three different groups.
    DESIGN AND SETTING: A quasi-experimental study of Medical Centers in an outpatient clinic in Portugal.
    METHODS: The Y balance test (YBT) was used to evaluate and analyze the association between ankle dorsiflexion range of motion (DF-ROM) and knee flexion. DF-ROM and knee flexion were used to compare the deficits between the operated and uninvolved limbs in all three groups (ACL-I, ACL-II, and ACL-III).
    RESULTS: Ankle DF-ROM and knee flexion assessed during the YBT were associated with higher knee flexion ROM, identifying individuals who were better prepared for the next phase of the guideline. The study results provide preliminary data for future studies that use prospective longitudinal research and involve large patient populations to establish prognostic biomechanical markers for determining long-term dynamic stability after ACL reconstruction.
    CONCLUSIONS: In the three groups with a history of ACL injury, compensations and kinematic asymmetries in dorsal flexion and knee flexion were observed in the operated and control legs both at 6 and 8 weeks of treatment.
    DOI:  https://doi.org/10.1590/1516-3180.2024.0497.R1.13072025
  37. Folia Morphol (Warsz). 2025 Dec 16.
    Two-tendon accessory fusion of the pes anserinus: coalescence of accessory semitendinosus and gracilis tendons in a left knee.
    Grzegorz Fibiger, Kamil Mozdzen, Arseniya Biazhko, Agnieszka Murawska, Tomasz Koziol, Konrad Malinowski, Jerzy A Walocha, Janusz Morys, Ilona Klejbor, Przemyslaw Pekala.
       BACKGROUND: The pes anserinus (PA) is one of the crucial structures in reconstructive orthopedic surgery. It comprises semitendinosus, gracilis, and sartorius tendons, which are often harvested to reconstruct other tendons, ligaments, and other soft tissue structures of joints. The morphology of PA is highly variable; therefore, the presence of an accessory or the lack of some tendons that create it may affect the whole reconstruction surgery. The purpose of this article is to present an unusual arrangement of PA and highlight the great variability of this structure.
    CASE REPORT: During the routine dissection of the knee area of a 70-year-old female, an unusual variant of PA was encountered. Morphometric parameters were assessed. A PA variant with an additional tendon of the gracilis muscle and an additional tendon of the semitendinosus muscle occurred in the left lower limb. Both tendons merged into a single band that descended and attached as a unified tendon on the medial surface of the tibia, slightly below the usual PA insertion site.
    CONCLUSIONS: Knowledge of possible anatomical variants of PA may be beneficial for surgeons as changes in its morphology can cause misinterpretation of tendons during surgeries and result in impaired treatment.
    Keywords:  accessory gracilis tendon; accessory semitendinosus tendon; anatomy; orthopedics; pes anserinus
    DOI:  https://doi.org/10.5603/fm.109705
  38. J Public Health Res. 2025 Oct;14(4): 22799036251405348
    Rehabilitation needs and challenges in Gaza strip (Palestine) after the ceasefire: A call for coordinated action.
    Anis Jellad, Amr Chaabeni, Helmi Ben Saad.
      Tens of thousands of people suffered serious, life-altering injuries as a result of the humanitarian and health crises caused by the fighting in the Gaza Strip (Palestine) (October 2023-October 2025). The rehabilitation system is on the verge of collapse due to the majority of rehabilitation facilities collapsing, the scarcity of assistive technology, and the severe lack of qualified personnel. As a key element of Gaza's recovery, this brief report emphasized the urgent need for concerted international action to develop rehabilitation capability. It suggests creating a task force headed by the UN and co-chaired by the World Health Organization and an impartial donor. The task force would be organized around four operational pillars: workforce development, infrastructure and sanitation, logistics and supply chains, and clinical rehabilitation services. Restoring trauma and wound care services, reopening facilities for orthotics and prosthetics, tele-rehabilitation, and growing community-based rehabilitation programs are among the priority initiatives. Using focused strategies to engage the Palestinian diaspora could improve sustainability and capacity building. Resolving the interrelated problems of functional disability, public health decline, and infrastructure destruction calls for a coordinated, transparent, and data-driven strategy. Therefore, in order to restore autonomy, dignity, and long-term resilience for Gaza's damaged population, rehabilitation must be integrated into larger humanitarian, rebuilding, and public health efforts.
    Keywords:  capacity building; disaster response; genocide; health systems strengthening; multisectoral collaboration; telemedicine
    DOI:  https://doi.org/10.1177/22799036251405348
  39. Ir J Med Sci. 2025 Dec 20.
    Skeletal muscle architecture: is it related with aerobic capacity?
    Figen Dağ, Orhan Güvener, Özlem Bölgen Çimen.
       BACKGROUND: Muscle architecture, including thickness, pennation angle, and fascicle length, underpins function and adaptation, but its relationship with aerobic capacity in young adults remains unclear.
    OBJECTIVE: To compare lower extremity muscle architecture and aerobic capacity between regularly exercising and non-exercising young adults, and to examine associations between architectural parameters and maximal oxygen uptake(VO₂max).
    METHODS: Fifty-two healthy participants (18-35 years) were included:26 in the exercise group (EG) and 26 in the non-exercise group(NEG). The EG had been performing supervised exercise at the university fitness center for 6-18 months, at least three times per week, whereas the NEG had not engaged in any structured exercise for at least six months. Ultrasound imaging was used to assess muscle thickness, pennation angle, and fascicle length of the rectus femoris(RF), vastus intermedius(VI), vastus medialis(VM), vastus lateralis(VL), tibialis anterior(TA), hamstring, gastrocnemius medialis(GM), and gastrocnemius lateralis(GL). VO₂max, as an indicator of aerobic capacity, was assessed using open-circuit spirometry during a treadmill test.
    RESULTS: VO₂max was significantly higher in the EG(46.95 ± 6.23 mL·kg⁻¹·min⁻¹) than in the NEG(37.29 ± 5.07; p < 0.001). Pennation angles of the VI (p = 0.002), VL (p = 0.003), and TA (p = 0.023) were greater in the EG. VO₂max correlated positively with muscle thickness (RF, VI, VL, TA), VI pennation angle, and TA fascicle length (p < 0.05).
    CONCLUSIONS: Regular exercise appears to promote architectural adaptations in lower-extremity muscles that may support improved aerobic capacity. Muscle architecture may therefore represent a meaningful physiological marker of training status in young adults.
    Keywords:  Aerobic capacity; Fascicule length; Muscle architecture; Muscle thickness; Pennate angle
    DOI:  https://doi.org/10.1007/s11845-025-04226-6
  40. Int Ophthalmol. 2025 Dec 17. 46(1): 33
    Management of functional epiphora with botulinum toxin: a injection after lacrimal surgery.
    Melek Mutlu Sönmez, Ceren Cemre Beyca, Esma Ecem Ersoy, Fehim Esen.
       PURPOSE: To evaluate the efficacy of botulinum toxin-A (BoNTA) injection for treating functional epiphora after lacrimal surgery.
    MATERIALS AND METHODS: Patients with persistent epiphora following anatomically successful 3-snip punctoplasty or external dacryocystorhinostomy (ex-DCR) received transconjunctival BoNTA injections into the lacrimal gland. Symptom severity and tear production were assessed using the Munk score, Schirmer I test, and Watery Eye Quality of Life (WeQoL) questionnaire at baseline, and at 1, 3 months, and final follow-up after injection. Outcomes were compared pre- and post-injection and between surgical subgroups.
    RESULTS: The study included 41 eyes of 32 patients (20 ex-DCR, 21 punctoplasty). Mean follow-up was 26.06 ± 0.7 months. All outcome measures (Munk score, Schirmer I, and WeQoL) showed significant improvement after both the first and last BoNTA injections. Improvements at 1 and 3 months were similar. The ex-DCR group required fewer injections (2.75 ± 0.1 vs. 3.13 ± 0.12; p = 0.003) with longer intervals between treatments (6.1 ± 0.1 vs. 5.4 ± 2 months; p = 0.02). At the 3-month follow-up after final injections, all scores were significantly better in the ex-DCR group (p < 0.05 for most comparisons).
    CONCLUSION: BoNTA injection is an effective short-term treatment for functional epiphora after lacrimal surgery, particularly with more durable results following ex-DCR compared to punctoplasty.
    Keywords:  Botulinum toxin-A; Dacryocystorhinostomy; Functional epiphora; Punctoplasty
    DOI:  https://doi.org/10.1007/s10792-025-03910-x
  41. Health Sci Rep. 2025 Dec;8(12): e71655
    Ultrasonographic Evaluation of Peripheral Nerves for Early Diagnosis of Guillain-Barré Syndrome: A Case-Control Study.
    Gholamreza Shamsaei, Mitra Sadrian, Amir Hossein Karimi, Shooka Mohammadi.
       Background and Aim: Guillain-Barré syndrome (GBS) is an acute immune-mediated neuropathy in which early diagnosis remains challenging because nerve conduction studies (NCS) may appear normal in the first few days after onset. Ultrasonography (US) has recently gained attention as a non-invasive tool for evaluating peripheral nerve pathology. This study aimed to assess the usefulness of ultrasonographic cross-sectional area (CSA) measurement of peripheral nerves for the early diagnosis of GBS in Iranian patients within 2 weeks of GBS symptom onset.
    Methods: In this case-control study, 150 participants were enrolled, including 75 patients with GBS and 75 healthy controls matched for age and sex. Patients were referred to Golestan Hospital (Ahvaz, Iran) between November 2023 and June 2025 with less than 2 weeks of GBS onset. All participants underwent demographic and clinical assessments, NCS, and US evaluations of the ulnar and median nerves.
    Results: Each group of participants (patients or controls) comprised 47 men and 28 women. The mean age of the patients with GBS was 43.8 ± 10.9 years. Statistically significant mean differences were found in all measured variables of the ulnar and median nerves, including ultrasonographic CSAs and NCS parameters (F-wave latency and persistence, motor nerve conduction velocity (MCV), sensory nerve conduction velocity (SCV), sensory nerve action potentials (SNAP), distal motor latency (DML), and compound muscle action potential (CMAP)), between patients with GBS and those in the control group (p < 0.05). The mean ultrasonographic CSAs of the ulnar and median nerves were significantly larger in patients with GBS than in the control group (p < 0.05).
    Conclusion: Sonographic measurement of the CSA of the ulnar and median nerves differentiates early-stage GBS patients from healthy controls and may support early diagnosis. The combination of US and NCS provides complementary information that facilitates early recognition of GBS.
    Keywords:  Guillain–Barré syndrome; electrophysiology; median nerve; nerve conduction studies; peripheral nerves; ulnar nerve; ultrasonography
    DOI:  https://doi.org/10.1002/hsr2.71655
  42. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Dec 15. 39(12): 1510-1515
    [Endoscopic-assisted median nerve decompression combined with one-stage tendon transfer for reconstruction of thumb abduction in treatment of severe carpal tunnel syndrome].
    Jiaxing Sui, Yong Yang, Zhenzhong Wang, Xingjian Huang, Xuanyu Jiang, Lihui Zhang, Haiyang Li.
       Objective: To investigate the effectiveness of endoscopic-assisted median nerve decompression with one-stage extensor indicis proprius (EIP) tendon transfer for reconstruction of thumb abduction in patients with severe carpal tunnel syndrome (CTS).
    Methods: The clinical data of 12 patients with severe CTS who met the selection criteria between December 2019 and December 2024 were retrospectively analyzed. There were 2 males and 10 females with an average age of 55.4 years ranging from 35 to 67 years. The symptom duration of CTS was 12-120 months (mean, 48.7 months) and the thenar muscle atrophy duration was 6-48 months (mean, 13.4 months). The median nerve was released with the help of endoscope, and the EIP tendon was transferred to reconstruct the abduction function of the thumb. The operation time and complications were recorded. Two-point discrimination, palmar abduction angle of the thumb, radial abduction angle of the thumb, and pinch force of the thumb were measured and compared before operation and at last follow-up, and the effectiveness was evaluated by Kapandji score and Disabilities of the Arm, Shoulder and Hand (DASH) score. The satisfaction of the operation was evaluated at last follow-up.
    Results: All surgeries were successfully completed with a mean operation time of 54 minutes (range, 45-68 minutes). All patients were followed up 6-50 months, with an average of 15.3 months. There was no complications such as wound infection, scar pain of wrist, or tendon rupture of transposition, and there were 3 cases of mild limitation of finger extension in the donor site of index finger. At last follow-up, two-point discrimination, palmar abduction angle of the thumb, radial abduction angle of the thumb, Kapandji score, and DASH score were significantly better than those before operation ( P<0.05), but there was no significant difference in thumb pinch force between pre- and post-operation ( P>0.05). The evaluation of surgical satisfaction showed that 7 cases were very satisfied and 5 cases were satisfied.
    Conclusion: The combination of endoscopic-assisted median nerve decompression and one-stage EIP tendon transfer effectively improves hand function and quality of life in patients with severe CTS by restoring thumb abduction and alleviating neurological symptoms.
    Keywords:  Carpal tunnel syndrome; endoscopes; neurolysis; reconstruction of abduction function of thumb; severe
    DOI:  https://doi.org/10.7507/1002-1892.202508049
  43. Am J Obstet Gynecol. 2025 Dec 17. pii: S0002-9378(25)00933-0. [Epub ahead of print]
    Data-driven diagnosis and clinical presentation of high tone pelvic floor dysfunction.
    Sara R Till, Andrew Schrepf, Anne Arewasikporn, Anna L Kratz, Stacey A Missmer, Sawsan As-Sanie.
       BACKGROUND: Despite widespread agreement that high tone pelvic floor dysfunction (HTPFD) is highly prevalent among women with pelvic pain, there is no consensus regarding standardized assessment strategy or diagnostic criteria. Furthermore, there is scant primary data regarding clinical presentation of HTPFD and most existing literature related to symptoms is based on expert opinion rather than patient-reported data. The lack of consensus in diagnostic assessment and data regarding clinical presentation associated with this condition creates substantial barriers to improving clinical identification and evaluating efficacy of treatment strategies.
    OBJECTIVE: To identify a pelvic myofascial tenderness score that corresponded to patient-reported reproduction of pain and to compare clinical presentation of patients with and without HTPFD.
    STUDY DESIGN: Cross-sectional study of 612 patients presenting to a chronic pelvic pain referral center from July 2019 to January 2023. Patients complete comprehensive questionnaires prior to first visit and undergo standardized physical examination, including palpation of six pelvic muscle sites (bilateral pubococcygeus, iliococcygeus, obturator internus) at first visit. Receiver operating characteristic (ROC) curve analyses were performed to identify a pelvic myofascial tenderness score that corresponded to patient-reported pain reproduction on palpation of pelvic floor muscles. Comparative analyses were performed to explore differences in clinical presentation associated with HTPFD.
    RESULTS: Summative score of >12/60 on palpation of pelvic floor muscles demonstrated good accuracy by ROC analyses (sensitivity 82.3%; specificity 79.1) for patient-reported pain reproduction and compared favorably to previously used methods for classifying HTPFD. Using >12/60 tenderness score as diagnostic threshold for HTPFD, 389 (63.6%) patients were categorized as having HTPFD and 223 (36.4%) as no HTPFD. Compared to patients without HTPFD, those with HTPFD were more likely to experience persistent pain with at least 14 pain days per month (odds ratio [OR] 2.32, 95% confidence interval [CI] 1.60, 3.35, p<.001). They were more likely to report pain exacerbation with physical activity, including exercise (OR 1.69, 95% CI 1.21, 2.32, p=.002) and walking (OR 1.85, 95% CI 1.32, 2.60, p<.001). Patients with HTPFD were more likely to describe pain as "heavy feeling in the pelvis" and report that pain radiated to other body regions and was associated with nausea and vomiting (all p<.001). Patients with HTPFD reported significant worse sexual function with more severe and consistent dyspareunia, pain occurring during and continuing 24 hours following intercourse, and were more likely to interrupt or avoid intercourse due to pain (all p<.001).
    CONCLUSION: HTPFD should be considered when patients report summative tenderness of >12/60 on palpation of six pelvic floor muscles. HTPFD is associated with more persistent pain that may radiate to other body regions and is exacerbated by physical activity. Dyspareunia and impaired sexual function appear to be hallmark symptoms of HTPFD.
    Keywords:  chronic pelvic pain; dyspareunia; female sexual dysfunction; levator ani syndrome; myofascial pelvic floor dysfunction; nociplastic pain; pelvic floor muscle tenderness; pelvic myofascial pain
    DOI:  https://doi.org/10.1016/j.ajog.2025.12.036
  44. Pain Manag Nurs. 2025 Dec 13. pii: S1524-9042(25)00331-5. [Epub ahead of print]
    Exploring the Therapeutic Potential of Intravenous Lidocaine: A Narrative Review on Postoperative Pain Management and Opioid Reduction.
    Jeffry Takla, Milanie Milan, Reina Ibrahim, Gaelle Nafeh, Adam Roumani.
       OBJECTIVE: This study aimed to evaluate the efficacy and safety of intravenous (IV) lidocaine as an alternative analgesic approach in the management of postoperative pain.
    METHODS: A PubMed search was conducted using keywords related to intravenous lidocaine and opioid use in postoperative pain management. We focused on randomized controlled trials and clinical trials published in the past 10 years. Two independent reviewers screened titles, abstracts, and full texts, providing justifications for any exclusions. Of the 44 articles initially identified, 20 met the inclusion criteria and were included in the final analysis and summary tables.
    DISCUSSION: The review revealed conflicting evidence regarding the efficacy of IV lidocaine with some studies reporting significant reductions in opioid consumption, improved pain relief, and enhanced recovery parameters, while others questioned its benefit in reducing opioid consumption. Variability in lidocaine dosing regimens, surgical settings, and patient populations may contribute to the discrepancies observed in the literature. Challenges and limitations in the interpretation of study findings, including methodological issues and potential biases, were discussed.
    CONCLUSION: IV lidocaine for postoperative pain management shows mixed and inconclusive results, with both potential benefits and limitations, indicating that no definitive conclusion can be drawn and further research is needed to establish its efficacy.
    Keywords:  Analgesic efficac; Intravenous lidocaine; Opioid-sparing analgesia; Postoperative pain management; Randomized controlled trials
    DOI:  https://doi.org/10.1016/j.pmn.2025.11.015
  45. PLoS One. 2025 ;20(12): e0338718
    Comparative study of thoracolumbar fascia changes in weightlifters with and without low back pain.
    Emma Feng Ming Zhou, Carmelo Pirri, Xiaoxiao Zhao, Juhua Peng, Tao Wen, Jianhui Fang, Chufeng Zhou, Siu Ngor Fu, Carla Stecco.
       BACKGROUND: Thoracolumbar fascia (TLF) is thought to be linked to low back pain (LBP). This cross-sectional study aimed to investigate the difference in TLF thickness and stiffness between elite weightlifters with and without chronic LBP.
    METHODS: Forty-six elite weightlifters (aged 16-26 years; 23 with chronic bilateral LBP) were recruited. TLF thickness was measured in all participants, while stiffness was assessed in 17 of them (aged 19-25 years; 9 with chronic bilateral LBP). Investigations were conducted at the L3 level, about 2 cm lateral to midline, using ultrasound. Bright mode and shear wave elastography (SWE) mode were employed to measure the thickness and Young's modulus (as an indicator of stiffness) of TLF, respectively. Analyses of covariates (ANCOVAs) were employed to compare the differences in TLF thickness and stiffness between LBP and non-LBP groups, controlling for pre-determined confounding factors. Repeated ANCOVAs were performed to investigate the side-to-side differences in TLF thickness and stiffness in weightlifters with and without LBP. The significance level was set as p ≤ 0.05.
    RESULTS: The mean thickness and stiffness of TLF were 1.63 ± 0.38 mm and 47.77 ± 13.26 kPa on the dominant, and 1.88 ± 0.60 mm and 48.09 ± 12.62 kPa on the non-dominant sides respectively. The stiffness of the TLF on the dominant side was 42.4% higher in the LBP group compared to the non-LBP control (mean difference (MD) =16.55 kPa > MDC95, p = 0.005, Cohen's d = 1.58). No significant differences were detected in TLF thickness (p > 0.05). Additionally, LBP was found to be a factor influencing the side-to-side differences in stiffness but not in thickness. Specifically, the thickness of the non-dominant side was 15.3% higher than the dominant side (MD = 0.25 mm > MDC95, p < 0.001, Cohen's d = 0.63), which was not detected in stiffness.
    CONCLUSION: Chronic LBP in elite weightlifters was associated with significantly higher TLF stiffness but unchanged thickness, suggesting stiffness is a more informative indicator of TLF health than thickness. Addressing stiffness in prevention and rehabilitation programs may improve weightlifters' performance and career longevity.
    DOI:  https://doi.org/10.1371/journal.pone.0338718
  46. Curr Pain Headache Rep. 2025 Dec 15. 30(1): 6
    Efficacy and Emerging Role of Suprascapular Nerve Block for Pain Management after Shoulder Surgeries.
    Alan D Kaye, Alexia J Enache, Grace C Wester, Landyn Johnson, Megan Gremillion, Austin S Thomassen, Shahab Ahmadzadeh, Sonja A Gennuso, Joseph Drinkard, Sahar Shekoohi.
       PURPOSE OF REVIEW: Postoperative pain management is an important aspect of shoulder surgery as it directly influences patient recovery, satisfaction, and the overall success of surgical interventions. While the interscalene nerve block (ISB) has been the standard approach for managing pain in these procedures, it is accompanied by a range of adverse effects, including phrenic nerve paralysis and respiratory complications. These drawbacks can complicate recovery and limit rehabilitation efforts.
    RECENT FINDINGS: In recent years, the suprascapular nerve block (SSNB) has gained use as a promising alternative for postoperative analgesia in shoulder surgeries, particularly in arthroscopic procedures. This review focuses on a comprehensive analysis of the SSNB, exploring its mechanism of action and comparing its efficacy, safety, and clinical benefits to the ISB. Evidence suggests that SSNB effectively targets the suprascapular nerve, which innervates key structures of the shoulder, providing adequate analgesia with a decreased risk of complications typically associated with ISB. The SSNB is also advantageous in the context of ongoing efforts within healthcare to identify safer, effective opioid-sparing pain management strategies. As the demand for effective pain relief continues to grow, the SSNB stands out as a viable option that could transform the approach to postoperative pain management in shoulder surgery.
    Keywords:  Interscalene nerve block (ISB); Postoperative pain management; Regional anesthesia; Shoulder surgery; Suprascapular nerve block (SSNB)
    DOI:  https://doi.org/10.1007/s11916-025-01456-2
  47. Bioinformation. 2025 ;21(8): 2927-2930
    Dry needling versus platelet-rich plasma in myofascial pain: A randomized trial.
    Jyoti Rani, Manisha Lakhanpal Sharma, Siddharth Srivastava, Swati Goel, Yashobanta Biswal, Ashu Rani.
      The efficacy of dry needling (DN) and platelet-rich plasma (PRP) in managing trigger points in Myofascial Pain Dysfunction Syndrome (MPDS). Hence, Twenty-two patients were equally divided into DN and PRP groups and evaluated using the Pain Disability Questionnaire (PDQ), Numerical Rating Scale (NRS), maximum mouth opening (MMO) and tenderness at baseline, post-treatment, 4 weeks and 12 weeks. Both groups showed significant improvement in pain and function, but PRP demonstrated superior effectiveness in reducing pain and enhancing jaw mobility at follow-ups. Thus, we show that PRP may be a more effective long-term treatment for MPDS compared to dry needling.
    Keywords:  MPDS; PRP; chronic pain; dry needling; trigger points
    DOI:  https://doi.org/10.6026/973206300212927
  48. J Comput Assist Tomogr. 2025 Dec 18.
    Meniscal Flap Tears on MRI: Patterns of Fragment Migration and Associated Lesions.
    Ezgi S Bayraktar, Atilla H Cilengir, Tugce Ekici, Fatma E Can, Cemal Kazimoglu, Ozgur Tosun.
       OBJECTIVE: Displaced fragments in meniscal flap tears may be challenging to detect radiologically but are clinically relevant for treatment planning. This study aimed to characterize fragment migration patterns on MRI and evaluate associated intra-articular pathologies.
    METHODS: In this retrospective analysis of 89 knee MRIs performed between January 2018 and May 2022, patients with confirmed meniscal flap tears were assessed for tear location, fragment displacement direction, and associated findings, including cartilage defects, ligament injuries, bone marrow edema, osteophytes, osteochondral lesions, and joint effusion. Statistical associations between tear features and accompanying pathologies were evaluated.
    RESULTS: Inferior coronary recess was the most frequent displacement site, especially in medial tears (68.8%, P=0.007). Medial tears more often had cartilage defects (66.3%, P=0.024) and osteochondral lesions (55.0%, P=0.015). Posterior horn involvement predominated, and ACL tears were strongly associated with intercondylar notch displacement (77.8%, P=0.001).
    CONCLUSION: Meniscal flap tears are most commonly located in the posterior horn of the medial meniscus and tend to displace into the inferior coronary recess. Their frequent association with cartilage damage, osteochondral lesions, and ACL injuries underscores the importance of careful MRI evaluation to support surgical decision-making.
    Keywords:  flap tear; knee joint; magnetic resonance imaging; meniscal injuries
    DOI:  https://doi.org/10.1097/RCT.0000000000001843
  49. J Strength Cond Res. 2025 Dec 17.
    Sensitivity of Structural and Mechanical Markers of Muscle and Tendon Damage Responses After Eccentric Plantar Flexor Exercise.
    Ecaterina Vasenina, David H Fukuda, Jack J Livingston, Brandi B Antonio, Ashley A Herda, Lauren Colby Mangum, Jeffrey R Stout.
       ABSTRACT: Vasenina, E, Fukuda, DH, Livingston, JJ, Antonio, BB, Herda, AA, Mangum, LC, and Stout, JR. Sensitivity of structural and mechanical markers of muscle and tendon damage responses following eccentric plantar flexor exercise. J Strength Cond Res XX(X): 000-000, 2025-This study aimed to investigate the acute structural and functional responses of the calf musculature and Achilles tendon following an eccentric exercise-induced muscle damage (EIMD) protocol and to evaluate the sensitivity of diverse assessment tools. Twenty young, recreationally active men performed a unilateral EIMD protocol consisting of 4 × 50 heel drops plus a final set to failure wearing a weighted vest equal to 40% of body mass, while the contralateral leg served as a control. Assessments included gastrocnemius and Achilles tendon thickness and length (ultrasound), calf circumference, pressure pain threshold, isometric strength, myotonography, and global/local pain ratings. Measurements were collected at baseline and 0, 24, 48, and 72 h postexercise. Significant visit × leg interactions (p < 0.05) were observed across most markers. Gastrocnemius thickness increased by 22.4% immediately after and remained 12.9% elevated at 72 h. Achilles tendon thickness decreased by 21.7% postexercise, while tendon length increased by 12%. Isometric strength declined 15-25% at 24-48 h. Calf creep and relaxation times also decreased >15% across time points. Numerical Pain Rating Scale peaked at 48 h (mean increase of +37 points). Pressure pain threshold was significantly lower in the intervention leg at all time points (p < 0.01). Eccentric plantar flexor exercise induced significant changes in muscle-tendon structure and function. Gastrocnemius thickness, tendon morphology, strength, myotonographic properties, and pain ratings were among the most sensitive indicators. These findings highlight the value of using a multimodal battery, including ultrasound, myotonography, strength testing, and pain ratings, to comprehensively monitor recovery after eccentric exercise.
    Keywords:  EIMD; gastrocnemius; myotonography; ultrasound
    DOI:  https://doi.org/10.1519/JSC.0000000000005319
  50. Eur Geriatr Med. 2025 Dec 17.
    Skeletal muscle thickness and echo intensity may reflect the risk of malnutrition and physical dysfunction in acutely hospitalized older patients.
    Akito Yoshiko, Hirotaka Nakashima, Masaaki Nagae, Tomomichi Sakai, Yosuke Matsui, Hiroyuki Umegaki.
       PURPOSE: Ultrasound is a bedside assessment tool used in some medical specialties. Studies have used this modality for the assessment of the skeletal muscle in hospitalized older patients for whom functional tests and imaging assessment by magnetic resonance imaging and computed tomography are not feasible. This study aimed to investigate whether skeletal muscle thickness (MT) and echo intensity (EI) obtained via ultrasonography are parameters for detecting the risk of malnutrition and physical conditions in acutely hospitalized older patients.
    METHODS: Fifty-nine men and women (31 men, 28 women; 84.4 ± 5.7 years) hospitalized for acute care were included. B-mode ultrasonographic images were obtained within 1 week of admission. MT and EI were measured in the rectus femoris (RF), vastus lateralis (VL), and vastus intermedius (VI) muscles. We utilized the Mini Nutritional Assessment-Short Form (MNA-SF), handgrip strength, calf circumference, the Barthel Index (BI), instrumental activities of daily living (ADL) scale, and the clinical frailty scale (CFS) to determine malnutrition and physical conditions in the participants.
    RESULTS: Stepwise regression analysis showed that the MNA-SF, BI, IADL, handgrip strength, calf circumference, and CFS scores were explained by MT in the VL and EI in the VI and RF (adjusted R2 = 0.13-0.29, P < 0.05). The receiver operating characteristic analysis revealed that the MT and EI detect malnutrition, decreased ADL, and lower handgrip strength (area under the curve was 0.19-0.76, P < 0.05).
    CONCLUSION: These results suggest that the MT and EI in the quadriceps may reflect malnutrition risk and physical conditions in acutely hospitalized older patients.
    Keywords:  Acutely hospitalized older patients; Echo intensity; Malnutrition; Muscle thickness; Physical dysfunction
    DOI:  https://doi.org/10.1007/s41999-025-01384-9
  51. BMJ Evid Based Med. 2025 Dec 13. pii: bmjebm-2025-113997. [Epub ahead of print]
    Reporting GUideline for Intervention DEscription in Rehabilitation (GUIDE-Rehab): a tool to open the 'black box' of rehabilitation complex interventions.
    RCTRACK Executive Committee
      In 2023, the World Health Assembly adopted a resolution to strengthen rehabilitation within health systems, calling for rehabilitation research. Within health, the term rehabilitation has multiple meanings, including a core strategy, a sector, a service and an intervention. The latter has been defined as complex and characterised as a 'black box', similar to complex interventions in other fields. The existing reporting guidelines are not sufficiently effective in describing interventions within the rehabilitation field. We developed the GUideline for Intervention DEscription in Rehabilitation (GUIDE-Rehab) to address these challenges.According to the Enhancing the QUAlity and Transparency Of health Research Network, we followed a Delphi process with multiple Consensus Meetings and piloting and used ACcurate COnsensus Reporting Document for reporting. The background research involved 21 papers. We based GUIDE-Rehab on the Rehabilitation Treatment Specification System, developed over 15 years of research to improve rehabilitation description; the definition of rehabilitation for research purposes; and the Template for Intervention Description and Replication reporting guideline. 68 representatives from global rehabilitation stakeholders (scientific societies, journals, evidence and methods groups), including individuals with lived experience of disability, from 26 countries across all continents and economies, participated. The piloting involved 17 chief editors, 7 research groups and participants from 10 scientific meetings.The complete version comprises 16 items, while the version for uncontrolled studies includes 13. The short version (10 items for text, 6 for appendix) helps reduce the manuscripts' length. The GUIDE-Rehab graphical illustration (nine items) facilitates the intervention description. GUIDE-Rehab will assist in the reporting of interventions in rehabilitation to enhance clinical research and support clinical implementation.
    Keywords:  Physical and Rehabilitation Medicine; Rehabillitation
    DOI:  https://doi.org/10.1136/bmjebm-2025-113997
  52. Video J Sports Med. 2025 Nov-Dec;5(6):5(6): 26350254251374176
    Management of Rotational Instability After Anterior Cruciate Ligament Reconstruction.
    Dileepa Banagala, Ying Ren Mok, Jhulia Kawachi Cruz, Dave Lee Yee Han.
       Background: Femoral tunnel malposition is a leading cause of anterior cruciate ligament (ACL) graft failure, accounting for 63% of cases. Accurate tunnel placement and proper alignment of the reconstructed ACL are essential for restoring knee stability. Vertical femoral tunnels can cause persistent rotational instability despite an intact ACL graft. The transtibial technique, commonly used for tunnel creation, often results in suboptimal graft positioning, contributing to instability. Extra-articular procedures, such as lateral extra-articular tenodesis (LET), have been shown to improve rotational stability.
    Indications: This case-based technique paper illustrates the management of rotational instability in the setting of vertical ACL grafts, tailored to patients' symptoms and activity levels.
    Technique Description: We discuss 2 cases of patients with vertical femoral tunnels who sustained bucket-handle tears of the medial meniscus despite having intact ACL grafts. The aim is to highlight surgical decision-making between revision ACL reconstruction (ACLR) + LET and isolated LET in patients with vertical ACL grafts and medial meniscal bucket-handle tears.
    Results: The first case involves a low-demand patient who presented with a single episode of knee instability and locking 13 years after ACLR. The management was a medial meniscal repair using a hybrid technique and a LET to improve rotational stability.The second case features a highly active patient involved in pivoting sports who reported multiple episodes of knee instability 9 years after ACLR. The management was revision ACLR with a quadriceps tendon autograft, medial meniscal repair using a hybrid technique, and LET.
    Discussion/Conclusion: Studies have shown that vertical ACL grafts can restore anteroposterior stability but may lead to long-term rotational instability. The combination of ACL revision and LET is beneficial for patients with persistent instability and high activity levels. Isolated LET can be effective in patients with low functional demands and intact grafts. By carefully selecting patients and planning surgery appropriately, knee stability can be effectively restored through a targeted treatment approach, leading to enhanced patient-reported function, increased physical activity, and improved psychological readiness to return to sports.
    Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
    Keywords:  anterior cruciate ligament revision; lateral extra-articular tenodesis; medial meniscal bucket-handle tear; medial meniscal repair; vertical anterior cruciate ligament
    DOI:  https://doi.org/10.1177/26350254251374176
  53. Rev Bras Ortop (Sao Paulo). 2025 Oct;60(5): s00451813002
    [Sarcopenia in Senior Subjects with Hip Fracture: Study of Prevalence, Correlation with Obesity, and Ultrasonography of the Rectus Femoris Muscle].
    Maurício Rodrigues Miyasaki, Juliano Casonatto, Carolina Morgato de Mello Miyasaki, Bruno Leguizamón Baruki, Yano Altomar de Sá, Rodrigo Antonio Carvalho Andraus.
       Objective: To determine the prevalence of probable sarcopenia in senior patients with hip fractures and to evaluate the correlation between ultrasound measurements of the rectus femoris (RF) muscle, obesity, and the diagnosis of sarcopenia.
    Methods: The present study included 65 participants aged ≥ 60 years old admitted due to hip fractures. We administered the Strength, Assistance with Walking, Rising from a Chair, Climbing Stairs, and Falls (SARC-F) questionnaire, and measured the calf circumference and handgrip strength. We also assessed the thickness and cross-sectional area of the bilateral RF muscle using ultrasound.
    Results: We identified probable sarcopenia in 13 participants (20.6%). The mean RF thickness was 1.03 cm (standard deviation [SD] = 0.22) for the right thigh and 1.03 cm (SD = 0.23) for the left thigh. The mean cross-sectional area was 2.61 cm 2 (SD = 0.71) in the right thigh and 2.97 cm 2 (SD = 0.69) in the left thigh. The average calf circumference was 31 cm (SD = 4.29) for the right leg and 31 cm (SD = 4.31) for the left leg. We did not find correlations between ultrasound measurements of the RF muscle and potential sarcopenia. The diagnosis of probable sarcopenia was four times more likely in subjects who were overweight and had hip fractures.
    Conclusion: The prevalence of probable sarcopenia was 20.6%. There was no correlation between ultrasound measurements of the RF and the presence of sarcopenia. Overweight significantly increased fourfold the likelihood of probable sarcopenia in this population.
    Keywords:  hip fractures; obesity; sarcopenia; ultrasonography
    DOI:  https://doi.org/10.1055/s-0045-1813002
  54. Eur Radiol. 2025 Dec 17.
    Deep learning-based assessment of paraspinal muscle degeneration and its relationships to muscle function and disability outcomes in chronic low back pain: a prospective study.
    Pinzhen Chen, Ping Ye, Taotao Yang, Jun Zhao, Min He, Yanmeng Peng, Fei Luo, Cunhua Chen, Wei Chen, Long Qian, Jing Li, Guotai Wang, Wei Chen.
       OBJECTIVES: To investigate deep-learning (DL) model accuracy in quantifying multifidus (MF) and erector spinae (ES) fat fraction (FF) compared to Dixon MRI, and to explore the indirect effect of muscle function between muscle degeneration and disability outcomes in chronic low back pain (CLBP).
    MATERIALS AND METHODS: 96 CLBP and 86 healthy participants underwent 3 T MRI, muscle function assessment, Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and Short Form 36-Health Survey (SF-36). A DL-Otsu thresholding model quantified muscle FF and functional muscle volume from 3D T2_WI images, validated against Dixon-FF. Lin's concordance correlation coefficient (CCC), Bland-Altman, and Passing-Bablok analyses assessed the concordance between Otsu-FF and Dixon-FF. Partial correlations and mediation analysis examined associations among muscle degeneration, muscle function, and disability outcomes.
    RESULTS: Otsu-FF showed agreement with Dixon-FF (MF: CCC = 0.96, 95% CI: 0.95, 0.97; ES: CCC = 0.95, 95% CI: 0.94, 0.96; bias: MF = 0.009; ES = 0.021). Partial correlations revealed MF and ES FF correlated with disability scores (ODI/RMDQ: r = 0.25 to 0.49; SF-36: r = -0.42, -0.28, p < 0.01). Muscle endurance negatively correlated with ODI (r = -0.57, 95% CI: -0.65, -0.45) and RMDQ (r = -0.49, 95% CI: -0.61, -0.35), positively with SF-36 (r = 0.51, 95% CI: 0.38, 0.63) (p < 0.01). Muscle endurance showed indirect effects on associations between muscle FF and disability outcomes (mediation proportion: 27.12% to 100%).
    CONCLUSION: DL method accurately quantified muscle FF, closely matching Dixon results. Muscle FF correlated with disability outcomes in CLBP, with muscle endurance demonstrating a statistically indirect association within this relationship.
    KEY POINTS: Question What are the associations between the deep learning-derived paraspinal muscle degeneration index, muscle function, and lumbar disability outcomes among patients with chronic low back pain? Findings In chronic low back pain, deep learning-quantified higher fat fraction of paraspinal muscles correlated with worse lumbar disability outcomes, with muscle endurance demonstrating an indirect effect in this association. Clinical relevance Incorporating the fat fraction of multifidus and erector spinae muscles and muscle endurance assessment is helpful for targeting rehabilitation training in chronic low back pain, improving disability outcomes.
    Keywords:  Low back pain; Magnetic resonance imaging; Muscle endurance; Muscle strength; Paraspinal muscles
    DOI:  https://doi.org/10.1007/s00330-025-12171-2
  55. Cureus. 2025 Nov;17(11): e96840
    Evaluating National Imaging Guidelines for Rotator Cuff Assessment After Shoulder Dislocation in Adults Aged 40-60 Years.
    Max Moss, Matthieu Durand-Hill, Saneth Sellahewa, Dylan Griffiths, Sanjeeve Sabharwal.
       INTRODUCTION: Rotator cuff tears are a recognised complication of shoulder dislocation. The British Elbow and Shoulder Society (BESS) recommends further imaging via ultrasound (US) or MRI to assess for clinically significant cuff tears in patients aged 40-60 years. This study aims to produce supplementary evidence by assessing cuff tear incidence to help assess the utility of imaging and its impact on resources.
    METHODS: This was a retrospective observational study to assess imaging and management of patients aged 40-60 years presenting with shoulder dislocation. Data was collected for three years, 2021-2024. The number of patients undergoing MRI/US and the prevalence of cuff tear were collected. Patients were analysed for conservative or operative management.
    RESULTS: A total of 148 patients were collected (mean age 49.5 years, SD 6.5). Of these, 68 patients (45.9%) had further cross-sectional imaging via MRI/US, and of the 68 patients, 30 (44.1%) had radiologically reported rotator cuff tears. A total of 116 patients (78.4%) were followed up after dislocation. One patient proceeded to surgery for rotator cuff repair following diagnosis.
    CONCLUSION: This study highlights the high rate of imaging-detected rotator cuff tears following shoulder dislocation in patients aged 40-60 years, yet a very low rate of surgical intervention. A more symptom-guided imaging strategy may improve clinical relevance and reduce unnecessary use of advanced imaging resources.
    Keywords:  first-time shoulder dislocation; mri shoulder; recurrent shoulder dislocation; rotator cuff tears; ultrasound (u/s)
    DOI:  https://doi.org/10.7759/cureus.96840
  56. Neurology. 2026 Jan 27. 106(2): e214587
    High-Fat Dairy and Cognitive Health: What Are the Alternatives?
    Tian-Shin Yeh.
      
    DOI:  https://doi.org/10.1212/WNL.0000000000214587
  57. Physiother Res Int. 2026 Jan;31(1): e70151
    Immersive Virtual Reality-Based Rehabilitation for Upper Limb Recovery in Acute and Subacute Stroke Patients: A Feasibility Study.
    Benjamín Peralta-Wieland, Ricardo Vásquez-Torres, Marcos Maldonado-Díaz, Matias Yoma.
       BACKGROUND AND PURPOSE: Immersive virtual reality (IVR)-based rehabilitation provides high-intensity, engaging, task-oriented training and motor exploration for upper limb (UL) recovery post-stroke. However, its feasibility and dose-response in acute and subacute stroke patients remain unclear. The purpose of this study was to evaluate the feasibility, safety and dose-response of IVR-based rehabilitation for post-stroke UL recovery.
    METHODS: A pilot trial included 12 acute and subacute stroke patients (mean age 59.8 ± 14.2 years) with upper limb impairment randomized into two groups: Group A (10 IVR sessions + conventional rehabilitation [CR]) and Group B (20 IVR sessions + CR). Feasibility outcomes included adherence, usability (User Satisfaction Evaluation Questionnaire [USEQ], System Usability Scale [SUS]), system operability, and adverse effects. Motor outcomes, categorized by the International Classification of Functioning, Disability, and Health (ICF), assessed UL impairment (Fugl-Meyer Assessment, Medical Research Council scale), activity (Box and Block Test), and participation (Motor Activity Log 30). Blinded therapists conducted assessments at baseline, post-intervention, and 4-week follow-up. Dose-response was analyzed using Probability of Superiority (PS).
    RESULTS: Feasibility was high, reporting 98% adherence, favorable usability scores (USEQ: 81.6 ± 15; SUS: 77.5 ± 7.4), efficient setup time (5.14 ± 1.57 min), system stability (77.86 ± 6.78%) and no severe adverse effects. Clinically meaningful motor improvements were observed across all ICF domains in both groups. Although the sample size was insufficient for inferential testing, descriptive trends and PS values above 75% suggested a potential dose-response trend favoring higher IVR exposure.
    DISCUSSION: IVR-based rehabilitation showed high feasibility, safety, and improvements in motor recovery, with a dose-response trend favoring higher doses. These findings align with evidence that IVR enhances neuroplasticity-driven recovery through high-intensity, engaging, exploratory, and task-oriented upper limb training. Despite the small sample and brief follow-up, this study provides key data to guide larger trials on efficacy and optimal dosing.
    TRIAL REGISTRATION: ClinicalTrials.gov, https://clinicaltrials.gov/study/NCT07086365, NCT07086365.
    Keywords:  neuronal plasticity; stroke rehabilitation; upper extremity; virtual reality
    DOI:  https://doi.org/10.1002/pri.70151
  58. BMC Musculoskelet Disord. 2025 Dec 19.
    Relationship between paraspinal sarcopenia and clinical outcomes of intervertebral disc degeneration patients following unilateral biportal endoscopy discectomy.
    Rui Zhang, Xu Hu, Cheng Lin, Qinfeng Wang, Jie Xu, Shishui Lin, Shiguo Zhou.
      
    Keywords:  Intervertebral disc herniation; Paraspinal muscles; Paraspinal sarcopenia; chronic low back pain; Unilateral biportal endoscopy discectomy
    DOI:  https://doi.org/10.1186/s12891-025-09421-1
  59. Ir J Med Sci. 2025 Dec 16.
    Comparative effectiveness of laser, PRP, splinting, and ESWT versus corticosteroid injection in lateral epicondylitis: a randomized controlled trial.
    Adem Türköz, İlker İlhanli, Fazıl Kulakli, İlker Fatih Sari, Mihrinur Dilvin Türköz.
       BACKGROUND: Lateral epicondylitis is one of the most common musculoskeletal disorders of the upper extremity, characterized by lateral elbow pain and functional disability. Despite the wide range of available treatments, the comparative effectiveness of invasive and non-invasive interventions remains controversial.
    OBJECTIVE: To compare the short-term clinical effectiveness of low-level laser therapy (LLLT), platelet-rich plasma (PRP) injection, splinting, and extracorporeal shock wave therapy (ESWT) with corticosteroid (CS) injection in patients with lateral epicondylitis.
    METHODS: In this prospective, single-blind, randomized controlled trial, 98 patients with clinically diagnosed lateral epicondylitis were randomly assigned to five treatment groups: LLLT, PRP, splinting, ESWT, and CS injection. Clinical outcomes were assessed using the Numeric Rating Scale (NRS), Patient-Rated Tennis Elbow Evaluation (PRTEE), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and hand-grip strength (HGS). Assessments were performed at baseline, 1 month, and 3 months after treatment.
    RESULTS: All treatment groups demonstrated significant improvements in pain and function at 1 and 3 months (p < 0.05). HGS improved in all groups except PRP, where no significant gain was observed. No statistically significant differences were found between the groups across outcome measures.
    CONCLUSION: Conservative and injection-based modalities provided clinically meaningful short-term improvements in patients with lateral epicondylitis. While CS injection produced rapid analgesic effects, non-invasive interventions such as LLLT, splinting, and ESWT achieved comparable functional benefits without the risks of invasive therapy. Although PRP improved pain and functional scores, its limited effect on HGS suggests that it may be best considered as a supportive option in selected patients.
    Keywords:  Corticosteroid injections; Extracorporeal shock wave therapy; Laser therapy; Lateral epicondylitis; Platelet rich plasma; Splint
    DOI:  https://doi.org/10.1007/s11845-025-04229-3
  60. Clin Biomech (Bristol). 2025 Dec 13. pii: S0268-0033(25)00312-2. [Epub ahead of print]132 106739
    Relationship between hip flexor tightness and low back pain in non-care-seeking individuals.
    Kira Eimiller, Matthew Vraa, Kemery Sigmund, Matthew Zellmer.
       BACKGROUND: Low back pain (LBP) is a prevalent musculoskeletal condition with significant economic consequences (Wu et al., 2020). Despite evidence of functional limitations, non-care-seeking individuals with LBP remain an under-researched population (Vraa et al., 2022). Hip flexor tightness has been proposed as a potential contributor to LBP due to its role in altered biomechanics and compensatory lumbar movements (Kim & Shin, 2020). Tight hip flexors are frequently assumed to contribute to LBP, yet the nature of the relationship is unclear. The objective of this study was to examine the relationship between hip flexor tightness and LBP severity in individuals with and without LBP who have not sought medical care.
    METHODS: A cross-sectional study of 118 adults (aged 20-61) assessed hip flexor range of motion (ROM) using the Modified Thomas Test and low back pain severity using the Modified Oswestry Disability Index. Between-group comparisons and generalized linear models examined the relationship between ROM, LBP presence, and disability.
    FINDINGS: LBP participants had significantly reduced ROM (4 ± 9° vs. 8 ± 9°, p = 0.003). However, in the adjusted generalized linear model, only BMI remained a significant predictor of hip flexor ROM (p = 0.011), while LBP status was not independently associated with hip flexor ROM (p = 0.180).
    INTERPRETATION: Reduced hip flexor ROM was observed in non-care-seeking individuals with LBP but was not independently predictive after adjustment. BMI was the only significant factor associated with hip flexor ROM, underscoring the multifactorial nature of LBP.
    Keywords:  Hip flexor tightness; Low back pain; Modified Thomas test; Non-care-seeking
    DOI:  https://doi.org/10.1016/j.clinbiomech.2025.106739
  61. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Dec 15. 39(12): 1600-1605
    [Research progress on augmentation repair of anterior talofibular ligament under arthroscopy].
    Minyuan Zhang, Kaiquan Li, Hongmai Yang, Yanlin Li.
       Objective: To summarize the research progress on augmentation repair of anterior talofibular ligament (ATFL) under arthroscopy.
    Methods: The domestic and international studies from the past decade on augmentation repair techniques for the ATFL. The advantages and limitations of each approach were summarized and the outcomes of these augmentation repair techniques when applied to ATFL repair were evaluated.
    Results: Mechanical augmentation technique (suture tape or internal brace technique, double anchor enhancement technique) can increase the strength after ATFL repair, but it will increase the economic burden of the patients; bioenhanced repair technology (inferior extensor retinaculum enhancement, anterior tibiofibular ligament's distal fascicle transfer augmentation) can also increase the strength after ATFL repair, but it will damage the anatomical structure in the ankle cavity to a certain extent, and the surgery is difficult, and the operation time will prolong and also increase the incidence of perioperative complications. Regardless of the augmentation repair techniques used, the benefits are higher for patients with high exercise needs, and active postoperative rehabilitation is required to maximize the surgical effect.
    Conclusion: Although augmentation repair of ATFL offers several advantages, its use-whether augmentation should be employed and, if so, which technique is preferable-requires further study across patient subgroups owing to increased costs, potential disruption of ankle anatomy, and longer operation time.
    Keywords:  Anterior talofibular ligament injury; arthroscopy; augmentation repair technique; research progress
    DOI:  https://doi.org/10.7507/1002-1892.202508042
  62. BMC Med Imaging. 2025 Dec 18.
    High-frequency ultrasound examination of acute ankle joint ligament injury and concomitant lesions.
    Qirui Yu, Wenxian Yang, Dan Li, Yuhao Wang, Xueting Tang, Yunyun Shan, Weiyong Liu.
       AIM: To determine the diagnostic value of high-frequency ultrasonography in the assessment of anterior talofibular ligament (ATFL) injury and concomitant lesions.
    METHODS: We retrospectively analyzed the data of 1005 patients with acute, unilateral ATFL injuries diagnosed using high-frequency ultrasonography in our hospital between January 2021 and December 2024. We analyzed ATFL and calcaneofibular ligament (CFL) thickness in patients with right vs. left ankle injuries and those with complete vs. incomplete ATFL rupture. We also analyzed the damage to other supporting structures of the ankle to provide an imaging basis for clinical diagnosis and treatment.
    RESULTS: In patients with incomplete ATFL injury with concomitant CFL injury, the thickness of the left and right CFL was 1.75 ± 0.47 mm and 1.90 ± 0.58 mm, respectively (P < 0.01). The CFL thickness was 1.83 ± 0.54 mm and 2.13 ± 0.54 mm in patients with incomplete and complete ATFL injury, respectively (P < 0.001). The incidence of concomitant CFL and superior extensor retinaculum (SER) injuries significantly differed between patients with incomplete and complete ATFL rupture (P < 0.05).
    CONCLUSION: High-frequency ultrasonography is valuable for diagnosing acute ankle ligament injuries. CFL thickness was greater in patients with complete ATFL injury than in patients with incomplete ATFL injury. A trend toward increase CFL thickness on the right was noted, possibly due to right-sided dominance, though this requires further validation. ATFL injuries are frequently associated with concomitant CFL and SER injuries, and these structures should be carefully assessed during ultrasound examinations of acute ankle injuries.
    Keywords:  Ankle injury; Anterior talofibular ligament; High-frequency ultrasound
    DOI:  https://doi.org/10.1186/s12880-025-02123-z
  63. Jt Dis Relat Surg. 2026 Jan 01. pii: jdrs.2026.2372. [Epub ahead of print]37(1): 277-281
    Bilateral trapezium and multiple metacarpal base fractures: An uncommon case report.
    Yasin Erdoğan, Mert Karaduman.
      Although fractures of the trapezium are extremely rare, the bone plays a crucial role in grip and pinch movements of the hand. These fractures may be associated with a concomitant fracture of the first metacarpal base and dislocation of the carpometacarpal joint. A 19-year-old male presented with bilateral hand and wrist pain following a motorcycle accident. Imaging revealed a comminuted Walker type V trapezium fracture and a second metacarpal base fracture on the right side and a non-displaced Walker type IV trapezium fracture with second, third, and fourth metacarpal base fractures on the left. The left trapezium fracture was managed conservatively, while metacarpal fractures were treated with percutaneous Kirschner wire (K-wire) fixation. On the right, closed reduction and percutaneous K-wire fixation were applied for the comminuted trapezium and associated metacarpal base fractures. The patient achieved complete bone union at one-year follow-up with no range of motion limitation. However, hand grip and key pinch strength were below normative values bilaterally, likely due to trauma, with slightly better results on the nonoperatively treated side. In conclusion, this case emphasizes the importance of high clinical suspicion and advanced imaging in the diagnosis of trapezium fractures, particularly in high-energy trauma. Individualized treatment strategies based on fracture type and displacement can result in satisfactory radiological and functional outcomes even in complex bilateral cases.
    DOI:  https://doi.org/10.52312/jdrs.2026.2372
  64. Clin Rheumatol. 2025 Dec 18.
    Sex-related differences in circulating inflammatory cytokines in knee osteoarthritis: a prospective clinical study.
    Xiaohang Zhu, Pengfei Fu, Pingcheng Xu, Jiong Jiong Guo.
       BACKGROUND: Osteoarthritis (OA) is a multifactorial joint disorder in which inflammatory cytokines are increasingly recognized as key drivers of disease progression. Biological sex influences OA risk and severity, yet the underlying immunological mechanisms remain unclear.
    OBJECTIVE: To assess sex-related differences in circulating cytokine levels and explore their potential clinical implications in knee osteoarthritis (KOA).
    METHODS: In this prospective observational study, 80 KOA patients (40 men, 40 women) were enrolled. All participants discontinued nonsteroidal anti-inflammatory drugs and physical therapy for one month before blood sampling. Serum cytokine concentrations were quantified using a 12-plex multiplex assay, and clinical outcomes were evaluated with standardized pain and function scores.
    RESULTS: KOA patients exhibited elevated pro-inflammatory cytokines compared with reference values. Significant sex-based differences were observed for IL-1β (mean difference [MD] 31.9; 95% CI 3.5-60.4; P = 0.028), IL-5 (MD 6.3; 95% CI 2.2-10.5; P = 0.004), IL-6 (MD 9.3; 95% CI 1.5-17.1; P = 0.021), and TNF-α (MD 13.5; 95% CI 1.0-26.1; P = 0.035). Anti-inflammatory cytokines (IL-4, IL-10) remained within normal ranges without sex differences. Clinical scores (VAS, WOMAC, SF-36) did not significantly differ between sexes.
    CONCLUSION: Circulating IL-1β, IL-5, IL-6, and TNF-α show significant sex-related differences in KOA, independent of radiographic severity or symptom scores. These findings highlight potential biological mechanisms underlying sex disparities in OA and may inform more individualized diagnostic and therapeutic strategies. Key Points • Pro-inflammatory cytokines (IL-1β, IL-5, IL-6, TNF-α) showed significant sex-related differences in patients with knee osteoarthritis. • Anti-inflammatory cytokines (IL-4, IL-10) remained within reference ranges and did not differ between sexes. • Clinical scores (VAS, WOMAC, SF-36) were comparable between sexes, suggesting biochemical alterations may precede clinical manifestations. • Recognition of sex-specific cytokine patterns may help inform individualized assessment and management strategies in knee osteoarthritis.
    Keywords:  Cytokines; Inflammation; Knee osteoarthritis; Prospective observational study; Sex differences
    DOI:  https://doi.org/10.1007/s10067-025-07877-z
  65. Maedica (Bucur). 2025 Sep;20(3): 560-565
    Anatomical Variations of Palmaris Longus Muscle and Its Clinical Implications: a Cadaveric Study.
    Kumar Sambhav, Hare Krishna, Prabhjot Singh, Nikha Bhardwaj, Surajit Ghatak.
       Introduction: Palmaris longus (PL) is the most superficial flexor muscle of the anterior compartment of the forearm in humans, which exhibits frequent anatomical variance. It has been observed that the complete absence of PL is the most commonly reported variance, followed by reversed, duplicated and hypertrophied muscle variants. The incidence of the complete agenesis of PL varies from 0.6% to 26.6%. So, it may be considered as an inconstant muscle. It is known to be more commonly absent unilaterally than bilaterally. The prevalence of unilateral absence of the PL is more commonly found on the left side. Unilateral agenesis of the PL is relatively more widely encountered in males compared to females.
    Material and methods: During the routine cadaveric dissections at the Department of Anatomy, AIIMS, Jodhpur, we observed palmaris longus muscle variations in 64 upper limbs of 32 cadavers (22 males and 10 females).
    Results: We observed agenesis of the palmaris longus muscle in six (9.4%) upper limbs out of 64 cadaveric upper limbs. The bilateral absence of palmaris longus was observed in two cadavers (6.25%), while unilateral absence was also observed in two cadavers (6.25%). We also observed agenesis of the PL was more prevalent in males (11.33%) in comparison to females (5%).
    Conclusion: Palmaris longus is significant surgically as it is employed for various tendon graft procedures, lip augmentation, ptosis correction and management of facial palsy.
    Keywords:  anatomical variations; flexors of the forearm; palmaris longus agenesis; palmaris longus muscle; tendon grafts
    DOI:  https://doi.org/10.26574/maedica.2025.20.3.560
  66. J Orthop Res. 2026 Jan;44(1): e70110
    Therapeutic Footwear for Medial Knee Osteoarthritis: Individualizing Midsole Stiffness Enhances Intended Kinetic Changes.
    Baptiste Ulrich-Ischer, Alexis Cantaloube, Laurent Hoffmann, Brigitte M Jolles, Julien Favre.
      Progression of medial knee osteoarthritis (OA) has been associated with walking biomechanics, specifically with the knee adduction (KAM) and flexion (KFM) moments. Lower medial stiffness shoes (LMSS), that are shoes with the sole made of softer material medially than laterally, were proposed for disease management through KAM reductions. This study primarily tested the hypothesis that larger pKAM reductions can be achieved with stiffness ratios selected individually than with the smallest ratios of the LMSS. Secondarily, the proportions of individuals reducing the KAM or reducing the KAM without increasing the KFM were compared between the individualized and smallest ratios conditions. The two LMSS conditions were also compared with lateral wedge insoles. Walking biomechanics were recorded for 15 OA patients (8 males; 62.3 ± 9.6 years old) and 14 asymptomatic individuals (5 males; 53.6 ± 3.6 years old) wearing LMSS with various stiffness ratios and wedges. Larger decreases in KAM were obtained with individualized stiffness ratios (14.0%-16.4%) than with the two other interventions (6.7%-12.5%) (p < 0.001). The percentage of participants reducing the KAM without increasing the KFM was larger with individualized ratios compared to the smallest ratios in the OA group (14 vs. 6; p = 0.001) and compared to wedges in the asymptomatic group (13 vs. 6; p = 0.015). This exploratory study showed the potential of individualizing the stiffness ratios, particularly in terms of KAM reduction amplitude, percentage of individuals achieving specific modifications, and possibility to aim for more complex kinetic changes. Further work is necessary to assess the effect of individualized stiffness ratios on clinical outcomes.
    Keywords:  gait; kinematics and kinetics; knee; osteoarthritis; rehabilitation
    DOI:  https://doi.org/10.1002/jor.70110
  67. Sports Health. 2025 Dec 17. 19417381251401904
    Ultrasonographic Assessment of Posterior Shoulder Capsule Thickness in Baseball Pitchers: A Validation Study.
    Ryan W Paul, Suzanne S Long, Carlo Coladonato, Justin Ahrens, Aaron Hoback, Paul Buchheit, Joseph Rauch, Michael G Ciccotti, Steven B Cohen, Brandon J Erickson, Stephen J Thomas.
       BACKGROUND: A thickened posterior shoulder capsule may increase injury risk in baseball pitchers due to maladaptive shoulder biomechanics such as altered arthrokinematics, decreased internal rotation range of motion (ROM) and increased scapular upward rotation. While diagnostic ultrasound offers a reliable method of measuring posterior capsule thickness (PCT), it is currently unclear whether PCT thus measured is valid.
    HYPOTHESIS: Diagnostic ultrasound is a valid method for measuring PCT compared with magnetic resonance imaging (MRI).
    STUDY DESIGN: Cross-sectional.
    LEVEL OF EVIDENCE: Level 4.
    METHODS: Asymptomatic baseball pitchers recently drafted into professional baseball from a single organization were enrolled during the 2021 to 2024 seasons. Pitchers underwent both diagnostic ultrasound and shoulder MRI on the same day to minimize any acute changes in PCT. All shoulder ultrasounds were performed with a 15-MHz linear transducer. Posterior capsule was identified as the tissue immediately lateral to the tip of the labrum between the humeral head and rotator cuff. PCT was measured on axial MRI scans by a musculoskeletal radiologist blinded to the ultrasound measurements. Agreement between modalities was evaluated through Pearson correlations and Bland-Altman analysis.
    RESULTS: Overall, 25 drafted pitchers were included. PCT obtained via diagnostic ultrasound had a mean of 2.4 ± 0.6 mm while PCT obtained via MRI scan had a mean of 2.4 ± 0.8 mm. Ultrasound PCT and MRI PCT were strongly positively correlated (R = 0.945, R2 = 0.892, P < 0.001). The Bland-Altman plot demonstrated 95% limits of agreement of 0.55 mm between diagnostic ultrasound and MRI measurements of PCT.
    CONCLUSION: Measuring PCT with diagnostic ultrasound is a valid technique compared with the gold standard of MRI.
    CLINICAL RELEVANCE: Clinicians who wish to evaluate PCT in baseball pitchers may use this validated technique to quantify PCT and evaluate for potential contributors to glenohumeral internal rotation deficit.
    Keywords:  baseball; pitcher; posterior capsule; shoulder; ultrasound
    DOI:  https://doi.org/10.1177/19417381251401904
  68. Clin Interv Aging. 2025 ;20 2515-2534
    Applying the Knowledge-to-Action Framework to Implement and Evaluate an Evidence-Based Functional Exercise Program for Elderly Patients After Total Knee Arthroplasty: A Mixed-Methods Study.
    Zhuzhu Qin, Xinxin Ye, Huanju Liu, Yan Shen, Xiaoling Zou, Shi Qiu, Yuxuan Wu, Chenju Zhan.
       Purpose: This study aimed to develop a systematic, evidence-based rehabilitation intervention tailored for elderly patients undergoing TKA, informed by stakeholders, and evaluate its impact on patient outcomes.
    Patients and Methods: Guided by the Knowledge-to-Action (KTA) Framework, this study comprised two sequential phases. In the knowledge creation phase, we systematically synthesized evidence through comprehensive retrieval, critical appraisal, and integration of high-quality rehabilitation programs for elderly patients undergoing TKA from domestic and international literature. During the action cycle phase, expert panel discussions and stakeholder interviews were conducted to identify barriers and facilitators of implementation, culminating in the co-development of a finalized intervention program. A quasi-experimental study was subsequently implemented to assess its preliminary efficacy in this target population.
    Results: Fourteen high-quality sources were synthesized to form 17 evidence-based recommendations across six dimensions. Through expert panels and stakeholder interviews, a structured rehabilitation program was developed, addressing key barriers and implementation strategies. In the subsequent quasi-experimental study (n = 60), patients in the intervention group showed significantly better postoperative pain control, range of motion, and knee function compared to controls (all P < 0.05), with no baseline differences between groups.
    Conclusion: The evidence-based rehabilitation program significantly enhanced functional recovery parameters, and pain control efficacy compared to standard care. Implementation of this structured intervention framework demonstrates clinically meaningful improvements in early postoperative outcomes following TKA.
    Keywords:  elderly patients; evidence-based practice; functional exercise; knowledge to action process framework; rehabilitation; total knee arthroplasty
    DOI:  https://doi.org/10.2147/CIA.S550742
  69. Brain Neurorehabil. 2025 Nov;18(3): e7
    Clinical Practice Guideline for Stroke Rehabilitation in Korea-Part 2: Rehabilitation for Motor and Sensory Function (2024).
    KSNR Stroke CPG Writing Group
      This clinical practice guideline (CPG) is the second part of the fourth edition of the Korean Stroke Rehabilitation Guidelines, following the first part published in 2023. While, the first part addressed rehabilitation for motor function, while this second part focuses on both motor and sensory rehabilitation. Beginning with the fourth edition, significant methodological advancements have been introduced, transitioning from a consensus-based approach to an evidence-based framework using the Grading of Recommendations Assessment, Development, and Evaluation methodology. The target population encompasses adult stroke patients, both male and female, with ischemic and hemorrhagic stroke types included, while pediatric stroke cases are excluded from consideration. This guideline is primarily intended for physiatrists and specialized therapists who provide rehabilitation services to patients with stroke-related motor impairments and activities of daily living limitations across primary, secondary, and tertiary healthcare facilities. The development team consisted of eighteen stroke rehabilitation specialists and one expert in CPG development methodology. Key questions were formulated based on target population preferences and international stroke rehabilitation guidelines, with subsequent refinement by specialists responsible for each respective topic. Draft recommendations underwent a formal consensus process using the RAND-UCLA Appropriateness Method, followed by further refinement through public hearings and external expert evaluation.
    Keywords:  Biofeedback; Clinical Practice Guideline; Robotics; Shoulder Pain; Telerehabilitation
    DOI:  https://doi.org/10.12786/bn.2025.18.e7
  70. PM R. 2025 Dec 19.
    Biomechanical associations with bone stress injuries in running: A scoping review.
    Evan R Sirls, Elizabeth L Roux, Logan W Gaudette, Michelle M Bruneau, Richard W Willy, Adam S Tenforde.
      The purpose of this scoping review is to evaluate biomechanical variables associated with bone stress injuries (BSI) in active individuals who participate in running. The goal of identifying differences in biomechanics by anatomical location of injury, gender, and/or primary physical activity is to help inform clinical management of BSI. A structured literature search initiated in September 2024 resulted in 21 studies (16 retrospective and 5 prospective) that were included in the analysis. Among retrospective studies, several biomechanical factors were found to be associated with BSI isolated to a specific anatomical site of injury (tibia: increased absolute free moment, greater peak hip adduction, and greater peak rearfoot eversion; metatarsals: lateral angle of peak horizontal braking force, reduced force under the middle forefoot, and faster time to peak rearfoot eversion; navicular: increased rearfoot eversion excursion, increased rearfoot eversion velocity, and decreased forefoot abduction excursion). In prospective studies across lower extremity anatomical locations of BSI, higher vertical ground reaction force, higher peak ankle plantarflexion moment, and spatiotemporal factors including higher vertical center of mass excursion and lower step rate were associated with developing BSI. Heterogenicity in the existing literature limits our understanding of the relationship of biomechanical variables and BSI. Inconsistent methodology, populations, and study designs limit generalizability and the ability to make definitive conclusions. This review identified candidate biomechanical factors to address in populations with BSI and highlights the need for more standardized, prospective studies with broader populations to strengthen evidence-based clinical strategies for the management and prevention of BSIs.
    DOI:  https://doi.org/10.1002/pmrj.70059
  71. J Physiother. 2025 Dec 18. pii: S1836-9553(25)00139-0. [Epub ahead of print]
    Physiotherapy management of multiple sclerosis.
    Yvonne C Learmonth.
      
    Keywords:  Evidence review; Exercise; Multiple sclerosis; Physical therapy; Rehabilitation
    DOI:  https://doi.org/10.1016/j.jphys.2025.11.008
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