bims-ricfun Biomed News
on Rehabilitation ICF
Issue of 2026–01–11
57 papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica
  1. MRI and histological features of supraspinatus tendon degeneration in rotator cuff tears: An underexplored perspective.
  2. Ozone injections reduce pain in knee osteoarthritis: a systematic review and meta-analysis.
  3. Correlating Ultrasound Echogenicity of the Abductor Pollicis Brevis and Median Nerve Cross-Sectional Area in the Setting Carpal Tunnel Syndrome: A Pilot Study.
  4. Short- vs. long-axis ultrasound-guided injections for the proximal and distal parts of the posterior interosseous nerve: a cadaveric study.
  5. The Use of Botulinum Toxin in Pre-pubic Aponeurotic Complex Injuries: A Case Series.
  6. Active versus passive rehabilitation after flexor tendon repair: clinical outcomes and shear wave elastography monitoring in a randomized pilot study.
  7. Current Non-operative Management of Shoulder Pathologies: A Narrative Review.
  8. [Seeking a New Radiological Measure to Predict Rotator Cuff Tears: Investigating the Coracoclavicular Distance in an MRI-Based Study].
  9. Efficacy of Exercise in the Sitting Position Compared with Exercise in the Standing Position in Obese Patients with Knee Osteoarthritis.
  10. Clinical Role of Corticosteroids Versus Platelet Rich Plasma Injections in the Management of Carpal Tunnel Syndrome: a Narrative Review.
  11. Ultrasound-guided botulinum toxin type A for shoulder pain: a meta-analysis of randomized controlled trials.
  12. Role of Alpha-Lipoic Acid as a Co-adjuvant Treatment with Surgical Decompression of Carpal Tunnel Syndrome: A Retrospective Study.
  13. Ultrasound-Guided Dextrose Hydrodissection for Mixed Sensory-Motor Wartenberg's Syndrome Following a Healed Scaphoid Fracture: A Case Report.
  14. Diagnostic Musculoskeletal Ultrasound in the Evaluation of the Knee Menisci.
  15. Subcutaneous extensor tendon rupture caused by Kienböck disease complicated by carpal tunnel syndrome: A case report.
  16. The role of radiography and MRI as screening tools and outcome measures in clinical trials of knee osteoarthritis: a perspective on the current status and outlook.
  17. Ultrasound-Guided Hydrodissection for Dorsal Scapular Nerve Entrapment: A Technical Report on the Scalene and Scapular Approaches.
  18. Effectiveness of Hydrodilatation for Adhesive Capsulitis in Patients With Pre-existing Rotator Cuff Tears.
  19. Comparison of Extracorporeal Radial Shock Wave Different Doses On Carpal Tunnel Syndrome: A Preliminary Study.
  20. Platelet-Rich Plasma Does Not Improve Pain or Function in Patients With Lateral Epicondylitis as Compared With Placebo: A Meta-analysis of Randomized Clinical Trials.
  21. Efficacy of botulinum toxin type A in myogenic temporomandibulardisorders: a single arm, prospective, pilot study.
  22. Clinical application of multi-parameter ultrasonic assessment for grading rotator cuff injuries: development and validation of a novel scoring system.
  23. Peripheral Nerve Syndromes at the Elbow: A Review of Current Treatments.
  24. Dynamic Step-Down Tasks Reveal Altered Lower Limb Biomechanics in Chronic Ankle Instability.
  25. Functional Outcome of Intra-articular Platelet-Rich Plasma in the Treatment of Frozen Shoulder.
  26. Initial safety outcomes of adipose-derived mesenchymal stem cell for rotator cuff tear: A 3-year pilot trial.
  27. Ulnar Nerve Cross-sectional Area among Ulnar Neuropathy Patients and Healthy Subjects - A Study in Hospital-based Population of Eastern India.
  28. Unusual Case of Lateral Knee Pain: Magnetic Resonance Imaging Evidence of Isolated Lateral Patellotibial Ligament Enthesopathy.
  29. Expert consensus on glucocorticoids injection for knee osteoarthritis.
  30. Grade 1 to 2 Thumb Ulnar Collateral Ligament Injuries in Athletes Requiring Surgery After Stress Testing: A Report of 2 Cases.
  31. Flexor Tendon Injuries in Zone 3: A Comprehensive Review and Case Report on Flexor Digitorum Profundus Rupture of the Middle Finger.
  32. Clinical Outcomes of Arthroscopic Treatment for Triangular Fibrocartilage Complex Lesions in Adolescent Elite Athletes.
  33. Impact of Proximal Conjoint Tendon Injury on Return to Play in the BF-ST Complex: A Prospective MRI-Based Study.
  34. [Simultaneous Ruptures of All Four Extensor Mechanism Tendons in Both Knees: a Rare and Challenging Case in a Chronic Kidney Disease Patient].
  35. [Efficacy of Intra-Articular Platelet-Rich Plasma in Knee Osteoarthritis: a Systematic Review and Meta-Analysis].
  36. Minimal Clinically Important Difference After Triamcinolone Acetonide Injection for Knee Osteoarthritis.
  37. Current Concepts in the Management of Achilles Tendon Injuries.
  38. Platelet-rich plasma versus hyaluronic acid injection following arthrocentesis for temporomandibular joint disorders under sedation: a comparative clinical study.
  39. Shear Wave Elastography of Normal Flexor Tendons of the Fingers and Its Clinical Application for the Diagnosis of Reruptured Tendons After Primary Repair.
  40. Diagnostic Accuracy and Reliability of Dynamic Handheld Ultrasound Testing in Detecting Anterior Cruciate Ligament Tears: A Cadaveric Study.
  41. Physical Activity Safe in People With Low Back Pain.
  42. Optimizing Perioperative Outcomes in Liver Transplantation: The Role of Inpatient Rehabilitation.
  43. Effects of different kinesiology taping applications on Pain, muscular Fitness, Proprioception, Mobility, Functionality, and disability in patients with lumbar disc herniation.
  44. Hip Microinstability: Current Concepts in Diagnosis, Surgical Management, and Outcomes A Narrative Review.
  45. Correlation Between Instrumented Timed Up and Go Test Performance and Muscle Strength in Knee and Hip Osteoarthritis: An Exploratory, Cross-Sectional Study.
  46. Conditioning Electrical Stimulation for Patients with Moderate or Severe Carpal Tunnel Syndrome: Double Blinded Randomized Controlled Trial.
  47. Continuous Passive Motion in the Rehabilitation of a Comminuted Patellar Fracture Following Delayed Physiotherapy Initiation: A Case Report.
  48. Ultrasound-Guided Ossicle Excision for Chronic Osgood-Schlatter Disease and Sinding-Larsen-Johansson Syndrome: A Case Series and Review of the Literature.
  49. Which MRI signs truly predict subscapularis tears? A multivariate analysis of 278 arthroscopic cases.
  50. Recent Advances in Therapeutic Approaches for Knee Osteoarthritis: a Narrative Review.
  51. A Novel Case of Trigger Finger Caused by A1 Pulley Calcification Successfully Treated With Ultrasound-Guided Prolotherapy: A Case Report and Literature Review.
  52. Outcomes of Simultaneous Open Triangular Fibrocartilage Complex Repair with Extensor Carpi Ulnaris Stabilisation.
  53. The effect of exercıse program on exercıse perceptıon and fear of movement ın low back paın.
  54. Cooled Radiofrequency Ablation Versus Cryoneurolysis of the Genicular Nerves for the Symptomatic Pain Management in Knee Osteoarthritis: A Prospective, Randomized, Single-Blinded Clinical Trial.
  55. Geometric and biomechanical perspectives on ulnar nerve compression in cubital tunnel syndrome: pathomechanics and surgical strategies.
  56. Rethinking the disc: from degenerative narrative to adaptive potential.
  57. Entrapment of the median nerve within the radius following diaphyseal antebrachial fractures treated with nail osteosynthesis in two paediatric patients.
  1. J Back Musculoskelet Rehabil. 2026 Jan 08. 10538127251412238
    MRI and histological features of supraspinatus tendon degeneration in rotator cuff tears: An underexplored perspective.
    P Bhavadharani, Vidya Chikkarahalli Srikantaiah, V Sheshagiri, H T Srinivas, Vidya Gowdappa Doddawad.
      BackgroundThe supraspinatus muscle and tendon are an integral part of shoulder joint function and stability. The supraspinatus tendon is one of the four tendons forming the rotator cuff in the shoulder. Supraspinatus tendon tear is a frequent lesion that occurs due to various causes like lifting heavy objects, falls onto the shoulder, a dislocation of the shoulder, swimming, trauma, sports injury, occupational activity and degenerative change. Smoking, hypercholesterolemia, and hereditary predisposition are all established risk factors for developing RC tears, which affect the age dependent tendon degeneration process. Only a few articles were found discussing the histological characteristics of degenerative change of the supraspinatus tendon in rotator cuff tears.ObjectiveTo evaluate the histological characteristics of degenerative changes in the supraspinatus tendon associated with rotator cuff tears.MethodsRotator cuff disease is a major cause of shoulder pain and shoulder dysfunction in adults; not every patient is symptomatic, though. We examined morphological features of human surgical specimens of the supraspinatus tendon in patients with full thickness tears of the rotator cuff.ResultsHistological analysis of the surgical specimen revealed significant degenerative changes, including disorganization and tearing of the collagen fiber bundles, sparingly distributed, rounded tenocytes, and increased vascularity (neovascularization) within the tendon matrix.ConclusionThese findings provide direct evidence of intrinsic tendon degeneration as a key pathological factor in full thickness rotator cuff tears, which may be helpful for future research on the pathophysiology of the condition.
    Keywords:  Rotator cuff injuries; histopathology; magnetic resonance imaging; supraspinatus; tendon degeneration
    DOI:  https://doi.org/10.1177/10538127251412238
  2. Med Gas Res. 2026 Sep 01. 16(3): 286-292
    Ozone injections reduce pain in knee osteoarthritis: a systematic review and meta-analysis.
    Pedro Iván Arias-Vázquez, Rosa Giannina Castillo-Avila, Karen Hernández-Gil, Mauro Nicolás Guzzardo, Duilio Román Guzzardo.
      The only intra-articular injections recommended by international guidelines for the treatment of knee osteoarthritis are injections of corticosteroids and hyaluronic acid; nonetheless, other substances including ozone, dextrose and platelet-rich plasma are also used in clinical. Intra-articular injections of ozone have been reported to have anti-inflammatory mechanisms and clinical benefits similar to intra-articular injections of corticosteroids in patients with knee osteoarthritis; however, this treatment has not been evaluated in a meta-analysis. The objective of this review is to evaluate the effectiveness of intra-articular injections of ozone for reducing pain and improving function in individuals with knee osteoarthritis when compared with intra-articular injections of corticosteroids. An online search was performed using the electronic databases PubMed, EMBASE, Central Cochrane and Web of Science, for controlled clinical trials that compared intra-articular injections of ozone and intra-articular injections of corticosteroid in the treatment of knee osteoarthritis. Seven clinical trials were included in this review, gathering 409 individuals with knee osteoarthritis. In the pooled analysis, ozone injections were found to be more effective in reducing pain in the short and medium terms than corticosteroids injections. Similarly, function improvement in the medium term was observed in favor of ozone injections. Our results suggest that ozone injections represent a good alternative to corticosteroids injections for reducing pain in the short and medium terms in individuals with knee osteoarthritis. Nonetheless, definitive conclusions could not be drawn due to the limited quality of the included studies. Better quality clinical trials are needed to strengthen the evidence and confirm these results.
    Keywords:  anti-inflammatory effect; antioxidant effect; cartilage; corticosteroids; intra-articular injection; knee; osteoarthritis; osteoarthrosis; oxygen-ozone; ozone
    DOI:  https://doi.org/10.4103/mgr.MEDGASRES-D-25-00088
  3. WMJ. 2025 ;124(5): 471-474
    Correlating Ultrasound Echogenicity of the Abductor Pollicis Brevis and Median Nerve Cross-Sectional Area in the Setting Carpal Tunnel Syndrome: A Pilot Study.
    Ragav Sharma, Peter Kane Connelly.
       INTRODUCTION: Carpal tunnel syndrome is the most common peripheral entrapment neuropathy, often associated with structural and functional changes in the median nerve and thenar muscles. Neuromuscular ultrasound is increasingly used to complement nerve conduction studies in carpal tunnel syndrome evaluation, yet its potential for assessing muscle integrity remains underexplored. This pilot study examined correlations between median nerve cross-sectional area (MNCSA) and abductor pollicis brevis (APB) muscle characteristics on ultrasound.
    METHODS: Veterans were enrolled at the Clement J. Zablocki VA Medical Center from July to November 2023. Inclusion criteria were age ≥18 years, carpal tunnel syndrome confirmed by nerve conduction studies, and planned carpal tunnel release. Exclusion criteria included prior carpal tunnel release, upper limb trauma or surgery, hand deformities, peripheral neuropathy, and diabetes. Ultrasound images of the median nerve and APB were obtained. Using Adobe Photoshop, APB echogenicity (grayscale value, black/white ratio) and cross-sectional area in longitudinal and transverse views were calculated and analyzed for correlation with MNCSA.
    RESULTS: Ten participants were included. Strong negative correlations were observed between MNCSA and APB cross-sectional area in longitudinal and transverse views (Pearson coefficients, -0.51 and -0.50, respectively). Weak to moderate positive associations were found between MNCSA and APB echogenicity values (0.32 and 0.24, respectively).
    CONCLUSIONS: APB characteristics on ultrasound, including echogenicity and cross-sectional area, may serve as complementary indicators of carpal tunnel syndrome. Future research should include larger samples, control groups, and assessment of correlations with carpal tunnel syndrome severity on nerve conduction studies.
  4. J Med Ultrason (2001). 2026 Jan 06.
    Short- vs. long-axis ultrasound-guided injections for the proximal and distal parts of the posterior interosseous nerve: a cadaveric study.
    Wei-Ting Wu, Chia-Ching Chen, Ke-Vin Chang, Shih-Wei Huang, Levent Özçakar.
       PURPOSE: Posterior interosseous nerve (PIN) syndrome is an uncommon neuropathy that may mimic lateral epicondylitis. High-resolution ultrasound aids its diagnosis by revealing nerve swelling, while ultrasound-guided injection is increasingly employed for decompression. Nevertheless, the influence of injection axis on injectate distribution remains unclear. This study aimed to compare the spread characteristics and accuracy of short-axis vs. long-axis ultrasound-guided injections at the proximal and distal PIN using cadaveric validation.Kindly check and confirm the city name is correctly identified in affiliation [6].It is correctly identified.  METHODS: Ten cadaveric limbs were randomized to short-axis (n = 5) or long-axis (n = 5) injections. Ultrasound parameters, including fascicle count, cross-sectional area, and surrounding muscle or tendon thickness, were recorded. Proximal and distal injections were performed separately with 5 mL of injectate. Subsequent dissection assessed target infiltration and spread dimensions (length, width).
    RESULTS: Ultrasound findings were comparable between the groups with no significant differences in cross-sectional area or muscle/tendon thickness. On dissection, all injections achieved successful proximal and distal PIN infiltration. At the proximal level, short-axis injections produced significantly greater infiltration width (43.6 ± 6.2 mm vs. 24.3 ± 13.2 mm, p = 0.032), while infiltration length was not significantly different (88.8 ± 17.4 mm vs 77.1 ± 37.1 mm, p = 0.690). At the distal level, both infiltration length (81.0 ± 24.4 mm vs. 67.7 ± 37.4 mm, p = 0.548) and width (28.2 ± 10.9 mm vs. 22.5 ± 8.8 mm, p = 0.548) were numerically greater with short-axis injections, although the differences did not reach statistical significance.
    CONCLUSION: Both short- and long-axis ultrasound-guided injections consistently achieved target infiltration of the PIN. The short-axis approach provided broader proximal spread, which may enhance circumferential perineural coverage, whereas the distal injections showed no significant differences between techniques. These findings support the reliability of both approaches, while highlighting a potential advantage of short-axis guidance at the proximal forearm.
    Keywords:  Intervention; Neuropathy; Pain; Tennis elbow; Ultrasonography
    DOI:  https://doi.org/10.1007/s10396-025-01611-7
  5. J Orthop Case Rep. 2025 Dec;15(12): 398-405
    The Use of Botulinum Toxin in Pre-pubic Aponeurotic Complex Injuries: A Case Series.
    Andrea Bisciotti, Gian Nicola Bisciotti, Alessio Auci, Alessandro Bisciotti, Gabriella Cassaghi, Federica Parra Maria.
       Introduction: Injuries of the pre-pubic aponeurotic complex (PPAC) are a significant cause of groin pain syndrome. These injuries tend to have limited self-healing capacity because the injured area is kept apart by opposing forces exerted by the rectus abdominis (RA) and adductor longus muscles. Recently, botulinum toxin type A (BTX-A) has been successfully used in a case report describing a patient with PPAC injuries. This study aims to evaluate the efficacy of BTX-A in a series of patients with PPAC injuries.
    Materials and Methods: Ten male athletic subjects with PPAC injuries underwent infiltrative therapy with BTX-A at the level of the RA and adductor longus, followed by an 8-week rehabilitation program.
    Results: Ultrasound assessment performed after the rehabilitation program showed that 9 subjects (90%) achieved complete restitutio ad integrum of the PPAC injury area, while 1 subject (10%) exhibited partial repair. At 12 months of follow-up, 9 patients (90%) returned to sports activity, 8 (80%) at the same level, and 1 (10%) at a lower level, but not due to residual pain. No adverse effects were recorded.
    Conclusion: BTX-A infiltrative therapy appears to be a safe, effective, and promising treatment for PPAC injuries, enabling a quick return to sporting activity.
    Keywords:  Botulinum toxin; groin pain syndrome; pre-pubic aponeurotic complex
    DOI:  https://doi.org/10.13107/jocr.2025.v15.i12.6572
  6. Arch Orthop Trauma Surg. 2026 Jan 07. 146(1): 29
    Active versus passive rehabilitation after flexor tendon repair: clinical outcomes and shear wave elastography monitoring in a randomized pilot study.
    Merve Demirci, Fatma Hazal Temiz Erguden, Yavuz Sahbat, Onur Bugdayci, Ozgur Baysal, Canan Sanal.
       INTRODUCTION: Flexor tendon injuries of the hand often result in significant functional impairment. Rehabilitation protocols after surgical repair are critical for optimizing outcomes, yet the comparative effects of active versus passive rehabilitation remain debated. Shear wave elastography (SWE) offers an objective imaging method to monitor tendon stiffness, but its role in hand tendon recovery is not well established. This study aimed to compare functional outcomes between active and passive rehabilitation protocols, while exploring the potential utility of SWE in monitoring tendon healing.
    MATERIALS AND METHODS: In this randomized controlled pilot trial, patients undergoing flexor tendon repair were assigned to either active (AR) or passive (PR) rehabilitation protocols. Functional outcomes were assessed using grip strength, pinch strength, dexterity tests, and validated questionnaires (SF-12, Duruoz Hand Index, Modified Hand Injury Severity Score). Tendon stiffness was measured longitudinally with SWE. Group comparisons and correlations between stiffness and clinical outcomes were analyzed.
    RESULTS: 20 patients with 34 tendons completed 12-week follow-up. Both AR and PR groups showed significant functional improvements over time (p < 0.05). No significant intergroup differences were observed in grip strength, pinch strength, dexterity, or patient-reported outcomes. SWE measurements did not significantly differ between groups or time points. Functional recovery was achieved without parallel increases in stiffness, and correlations between SWE and clinical parameters were inconsistent.
    CONCLUSIONS: Both active and passive rehabilitation protocols supported early functional recovery following flexor tendon repair. SWE provided objective monitoring of tendon healing but did not consistently correlate with functional outcomes. These findings highlight the multifactorial nature of tendon recovery and suggest that SWE may complement, but not replace, clinical assessment in postoperative rehabilitation. Larger cohorts and extended follow-up are needed.
    TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05598918. Registered on 28 October 2022.
    Keywords:  Clinical outcomes; Flexor tendons; Rehabilitation; Shear wave elastography; Tendon stiffness
    DOI:  https://doi.org/10.1007/s00402-025-06172-5
  7. Cureus. 2025 Dec;17(12): e98500
    Current Non-operative Management of Shoulder Pathologies: A Narrative Review.
    Ricardo A Vargas-Figueroa, Derick Rodríguez-Reyes, Hiram E Luigi Martinez, Amanda S Vazquez-Lloret, Rafael Señeriz Ortiz.
      Shoulder disorders, including rotator cuff-related pain, adhesive capsulitis, impingement, glenohumeral osteoarthritis (GHOA), acromioclavicular (AC) pathology, instability, and biceps/superior labrum anterior to posterior (SLAP) lesions, are prevalent causes of pain, disability, and healthcare utilization. Contemporary care emphasizes non-operative strategies as first-line management, with surgery reserved for refractory symptoms or specific structural indications. The researcher conducted a systematized narrative review of adult non-operative management for common shoulder pathologies. Targeted searches of Medical Literature Analysis and Retrieval System Online (MEDLINE) (via PubMed), the Cochrane Library, and guideline repositories (American Academy of Orthopaedic Surgeons (AAOS)/American Shoulder and Elbow Surgeons (ASES)/American Physical Therapy Association (APTA)/American College of Rheumatology (ACR)) were performed from 2010 to October 2025. The researcher prioritized clinical practice guidelines, Cochrane and systematic reviews (including network meta-analyses), and randomized trials. Studies focused on non-operative interventions with patient-centered outcomes were qualitatively synthesized by pathology; no quantitative pooling was performed. Exercise-based rehabilitation is the cornerstone across conditions, producing clinically meaningful pain and functional gains and, in subacromial pain, outcomes comparable to surgery. For adhesive capsulitis, intra-articular corticosteroid, hydrodilatation, and suprascapular nerve block yield short-term benefits that are greatest when paired with mobilization and stretching. In GHOA, individualized range of motion (ROM) maintenance and strengthening, activity adaptation, and time-limited injections (corticosteroid; hyaluronic acid with variable evidence) dominate care; platelet-rich plasma remains investigational. For instability, early ROM followed by rotator cuff/scapular strengthening and proprioceptive training is standard, with bracing for select athletes. Acute low-grade AC injuries respond to brief sling use.
    Keywords:  acromioclavicular joint; biceps tendinopathy; glenohumeral osteoarthritis; idiopathic adhesive capsulitis; physical therapy modalities; rotator cuff pathology; rotator cuff tears; selective non-operative management; shoulder instability; slap tear
    DOI:  https://doi.org/10.7759/cureus.98500
  8. Acta Chir Orthop Traumatol Cech. 2026 Jan;92(6): 336-342
    [Seeking a New Radiological Measure to Predict Rotator Cuff Tears: Investigating the Coracoclavicular Distance in an MRI-Based Study].
    Hakan Eskara, Batuhan Gencer, Abdulkadir Durdi, Tayfun Aman, Tuhan Kurtulmus.
       PURPOSE OF THE STUDY: Rotator cuff tears are a common disease and various radiological measurement methods are still being investigated to make the diagnosis. The aim of this study was to investigate whether the coracoclavicular distance is associated with rotator cuff tears.
    MATERIAL AND METHODS: Shoulder magnetic resonance imaging (MRI) examinations of 101 patients who underwent shoulder arthroscopy due to rotator cuff tears and 158 patients with normal MRI findings were evaluated retrospectively. Coracohumeral distance, acromiohumeral distance and supraspinatus volume were measured.
    RESULTS: When the acromiohumeral distance, coracoclavicular distance and supraspinatus volume were compared between the groups, each measurement was found to be statistically significantly lower in the tear group (Group 2) (p<0.001). In the analysis of ROC for the detection of full-thickness supraspinatus tear, the following findings were observed: if the coracoclavicular distance measured less than 12.4mm, a sensitivity of 89% and specificity of 73% were determined. Similarly, if the acromiohumeral distance measured less than 7.5mm, a sensitivity of 73% and specificity of 84% were determined. In full-thickness supraspinatus tears, if the supraspinatus volume measured below 51 cm3, a sensitivity of 89% and specificity of 72% were determined.
    CONCLUSIONS: Our study, conducted on a limited population, demonstrated that coracoclavicular distance is a significant metric for detecting supraspinatus tears. We believe that we have identified a new parameter that may be useful in the diagnosis of rotator cuff tears.
    Keywords:  acromiohumeral distance; coracoclavicular distance; supraspinatus tears.; supraspinatus volüme
    DOI:  https://doi.org/10.55095/achot2025/002
  9. Acta Med Indones. 2025 Oct;57(4): 466-473
    Efficacy of Exercise in the Sitting Position Compared with Exercise in the Standing Position in Obese Patients with Knee Osteoarthritis.
    Tirza Zainuddin Tamin, Clements Clements.
       BACKGROUND: Knee osteoarthritis (OA) is a degenerative condition that causes pain, swelling, and stiffness, affecting a person's ability to move freely. Non-weight-bearing therapeutic exercise programs provide better pain reduction and improve joint function compared with conventional exercise programs. This study compared the effectiveness of therapeutic exercises in sitting versus standing positions in reducing pain, improving knee function, and enhancing quality of life in obese patients with OA.
    METHODS: Fifty-four obese women aged 50-80 years were randomly assigned to one of two exercise program groups, either sitting or standing. Members of each group participated in a 12-week intervention consisting of aerobics, hip stretching and strengthening, and balance exercises. Sessions lasted 45 minutes, three times per week, increasing by 30 minutes every four weeks. Pain was assessed using the Numerical Rating Scale, knee function was measured with the Knee Injury and Osteoarthritis Outcome Score, and quality of life was assessed with the 12-Item Short Form Survey. Measurements were taken at baseline and every four weeks during the intervention.
    RESULTS: When compared with the standing position group, the sitting position group showed significantly less pain and better knee function as determined by NRS and KOOS, as well as better physical quality of life (p<0.05). In contrast, the standing position group had a better mental quality of life.
    CONCLUSION: Therapeutic exercises in a sitting position are more effective in reducing pain, improving knee function, and enhancing physical quality of life in OA. However, standing exercises contribute more to mental well-being.
    Keywords:  exercise therapy; knee osteoarthritis; obesity; weight-bearing exercise program
  10. Curr Pain Headache Rep. 2026 Jan 08. 30(1): 20
    Clinical Role of Corticosteroids Versus Platelet Rich Plasma Injections in the Management of Carpal Tunnel Syndrome: a Narrative Review.
    Alan D Kaye, Yusra Soorya, Bushirat A Abubakar, Razan Fj Qamar, Shilpadevi Patil, Sahar Shekoohi.
      
    Keywords:  Carpal tunnel syndrome; Corticosteroids; Median nerve compression; Platelet-rich plasma injections; Regenerative medicine
    DOI:  https://doi.org/10.1007/s11916-025-01462-4
  11. BMC Musculoskelet Disord. 2026 Jan 08. 27(1): 14
    Ultrasound-guided botulinum toxin type A for shoulder pain: a meta-analysis of randomized controlled trials.
    Shiying Zhuang, Xiaoli Zhang, Cheng Lin, Zhizhuo Wang.
       BACKGROUND: Shoulder pain is a very common symptom. A number of studies have demonstrated that botulinum toxin type A is effective in relieving shoulder pain. Therefore, this systematic review and meta-analysis aimed to synthesize scientific evidence and quantify the combined effects of ultrasound-guided botulinum toxin type A on shoulder pain.
    METHODS: A comprehensive literature search was conducted in databases such as PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Information Database (CNKI), Wanfang database, and VIP database (VIP) using the keywords "ultrasound", "Botulinum toxin type A", and "shoulder pain". Two reviewers independently reviewed the studies, extracted data from eligible studies, and assessed the risk of bias. A random-effects model was used to calculate the standardized mean difference (SMD) and 95% confidence interval (CI) for Visual Analog Scale (VAS), Upper Extremity Fugl-Meyer Assessment (UEFMA), Range of Motion (ROM), Modified Barthel Index (MBI). Funnel plots and sensitivity analyses were also employed to evaluate the four outcome indicators above.
    RESULTS: Out of retrieved 854 records, ten studies (involving 533 patients) were finally included. Pooled analysis showed that ultrasound-guided botulinum toxin type A was associated with large improvements in shoulder pain (SMD = -1.1; 95% CI -1.47 to -0.73; P < 0.001), UEFMA score (SMD = 1.43; 95% CI 0.49 to 2.37; P = 0.003), ROM of shoulder flexion (SMD = 1.28; 95% CI 0.63 to 1.93; P < 0.001) and external rotation (SMD = 1.66; 95%CI, 0.83 to 2.48; P < 0.001). Mild improvements were observed in ROM of shoulder abduction (SMD = 0.8; 95%CI 0.18 to 1.43; P = 0.01) and MBI score (SMD = 1.33; 95% CI 0.22 to 2.43; P = 0.02).
    CONCLUSIONS: Our meta-analysis has shown ultrasound-guided BoNT-A injections have potential benefits for reducing shoulder pain and improving upper limb function, range of motion, and quality of life. However, these findings should be interpreted cautiously due to small sample size, measured differences, substantial heterogeneity and possible publication bias. More high-quality studies with large sample size are needed to assess long-term efficacy, strengthening the evidence that ultrasound-guided BoNT-A facilitates the reduction of shoulder pain.
    Keywords:  BoNT-A; Injection; Meta-analysis; Quality of life; ROM; Shoulder pain; Ultrasound-guided; Upper limb function
    DOI:  https://doi.org/10.1186/s12891-025-09347-8
  12. J Hand Surg Asian Pac Vol. 2026 Jan 05.
    Role of Alpha-Lipoic Acid as a Co-adjuvant Treatment with Surgical Decompression of Carpal Tunnel Syndrome: A Retrospective Study.
    Sergi Barrera-Ochoa, Jose Antonio Prieto-Meré, Ester Mora, Julio Adrían Martinez-Garza, Gerardo Méndez, Gustavo Sosa.
      Introduction: Surgical decompression remains the gold standard for managing severe carpal tunnel syndrome (CTS). However, perioperative pain and incomplete symptom resolution persist in some patients. Alpha-lipoic acid (ALA), a neuroprotective antioxidant, has shown potential benefits in neuropathic conditions. This retrospective study evaluates the clinical and electrophysiological effects of ALA as an adjunctive therapy in CTS management. Methods: We retrospectively analysed 164 patients with electrodiagnostically confirmed CTS who underwent open surgical decompression. Patients were divided into three groups: Group A (surgery only), Group B (surgery plus postoperative ALA) and Group C (pre- and postoperative ALA). Outcomes were assessed using the visual analogue scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), analgesic consumption and nerve conduction studies, with follow-up at 6 weeks, 6 months and 12 months. Results: ALA-treated patients showed statistically significant improvements in VAS scores, BCTQ subscales and analgesic consumption compared to controls. Only the group receiving both pre- and postoperative ALA achieved clinically meaningful improvements, exceeding the established MCID thresholds for both symptom severity (0.76 points) and functional status (0.32 points). Electrophysiological parameters, such as motor conduction velocity, also improved more in ALA-treated groups. Conclusions: Adjunctive use of ALA in CTS surgery was associated with statistically significant, yet clinically modest, improvements in pain, function and electrophysiology. These findings support further investigation of ALA as a low-risk, potentially beneficial coadjuvant in CTS treatment protocols. Level of Evidence: Level III (Therapeutic).
    Keywords:  Alfa-lipoid acid; Carpal tunnel syndrome; Decompression; Neuroprotective; Neurotrophic
    DOI:  https://doi.org/10.1142/S2424835526500104
  13. Diagnostics (Basel). 2026 Jan 04. pii: 156. [Epub ahead of print]16(1):
    Ultrasound-Guided Dextrose Hydrodissection for Mixed Sensory-Motor Wartenberg's Syndrome Following a Healed Scaphoid Fracture: A Case Report.
    Yonghyun Yoon, King Hei Stanley Lam, Jeimylo C de Castro, Jihyo Hwang, Jaeyoung Lee, Teinny Suryadi, Anwar Suhaimi, Chun-Wei Kang, Jaeik Choi, Seungbeom Kim.
      Background and Clinical Significance: Wartenberg's syndrome (cheiralgia paresthetica) is classically described as a pure sensory neuropathy of the superficial branch of the radial nerve (SBRN). However, in rare circumstances, dynamic mechanical irritation around the radial styloid may produce an atypical clinical phenotype with concurrent motor impairment, broadening the clinical significance of recognizing motion-related compression mechanisms. Case Presentation: A 35-year-old woman presented with persistent dorsoradial wrist pain and numbness, accompanied by progressive weakness of thumb extension, five years after a conservatively treated nondisplaced scaphoid fracture. Neurological examination demonstrated sensory loss in the SBRN distribution and Medical Research Council (MRC) grade 3/5 strength of the extensor pollicis longus (EPL). Nerve conduction studies revealed a markedly prolonged EPL motor latency (4.5 ms; normal ≤ 2.5 ms) with preserved sensory conduction. High-resolution ultrasound showed focal enlargement of the SBRN (cross-sectional area 0.13 cm2) and, critically, dynamic snapping of the nerve over the radial styloid that reproduced the patient's symptoms. The patient underwent ten weekly sessions of ultrasound-guided hydrodissection with 5% dextrose. After treatment, the pain Visual Analog Scale improved from 8/10 to 0/10 and EPL strength recovered to MRC 5/5. Follow-up nerve conduction studies demonstrated normalization of EPL motor latency (2.1 ms), and repeat ultrasound confirmed resolution of SBRN enlargement and snapping. Conclusions: This case expands the phenotype of Wartenberg's syndrome to include mixed sensory-motor involvement associated with dynamic SBRN snapping at the radial styloid. Dynamic ultrasound was pivotal for identifying the motion-dependent mechanism, and ultrasound-guided 5% dextrose hydrodissection achieved complete sensory and motor recovery as a minimally invasive and effective treatment option.
    Keywords:  Wartenberg’s syndrome; dextrose hydrodissection; dynamic ultrasound; peripheral neuropathy; radial nerve entrapment; scaphoid fracture; superficial branch of radial nerve
    DOI:  https://doi.org/10.3390/diagnostics16010156
  14. Int J Sports Phys Ther. 2026 ;21(1): 108-114
    Diagnostic Musculoskeletal Ultrasound in the Evaluation of the Knee Menisci.
    Robert C Manske, Chris Wolfe, Phil Page, Michael Voight.
      The menisci of the knee are situated between the femur and the tibia. There are two (medial and lateral) wedge-shaped fibrocartilage discs that help to transmit compressive, shear, and rotational loads through the knee. Meniscus injuries are common in sports and activities of daily living that require squatting and pivoting. Acute meniscus injury is more common in sports that involves pivoting and cutting. These acute tears can occur in conjunction with other injuries, such as tears of the anterior cruciate and medial collateral ligaments, whereas older individuals may have a degenerative tear. An older, more seasoned meniscus may be more prone to tears even during what appear to be simple activities, such as getting off the floor or squatting to garden. Accurate diagnosis of meniscus injuries is essential for appropriate treatment planning and optimizing patient outcomes. Diagnostic musculoskeletal ultrasound (MSKUS) offers a portable, real-time, and cost-effective alternative, gaining traction in rehabilitation and sports medicine settings. MSKUS has emerged as a valuable, non-invasive imaging modality for evaluating meniscus injuries, including meniscus tears and their structural properties, composition and continuity. This manuscript will review the utility of MSKUS in evaluating medial and lateral meniscus injuries, including anatomy, common injury patterns, sonographic techniques, and clinical implications for rehabilitation professionals. Diagnosis of acute meniscus injury by physical examination is often challenging and is frequently misdiagnosed. By integrating MSKUS into clinical practice, providers can improve diagnostic accuracy, enhance diagnostic confidence, monitor healing progression, and guide rehabilitation strategies to achieve optimal patient outcomes for those with knee meniscus injuries.
    Level of evidence: V.
    Keywords:  dynamic imaging; knee; meniscus; musculoskeletal ultrasound; rehabilitation
    DOI:  https://doi.org/10.26603/001c.154564
  15. Medicine (Baltimore). 2026 Jan 09. 105(2): e47001
    Subcutaneous extensor tendon rupture caused by Kienböck disease complicated by carpal tunnel syndrome: A case report.
    Yoshiaki Tomizuka, Soya Nagao, Koji Tanimoto, Kana Okugawa, Hiroko Shiraishi, Tomonori Kinoshita, Shunsuke Ueno, Kazuyoshi Nakanishi.
       RATIONALE: Subcutaneous extensor tendon rupture caused by Kienböck disease is rare. Only 22 cases have been reported in the English literature since 1986.
    PATIENT CONCERNS: A 74-year-old male experienced numbness of his right hand for several years and was unable to extend his right middle and ring finger 2 months before consultation.
    DIAGNOSES: Physical examination revealed no pain in his right wrist, but was unable to extend the middle and ring fingers. He also had numbness of the thumb, index, middle, and radial side of the ring finger. Plain radiography and computed tomography revealed osteoarthritis of the wrist and segmental lunate bone. Ultrasonography revealed disruption of the extensor tendon, indicating that the lunate bone volar fragment did not interfere with the flexor tendons and median nerve. Magnetic resonance imaging suggested extensor tendon rupture. Nerve conduction studies showed delayed distal motor latencies of the abductor pollicis brevis muscle. We diagnosed subcutaneous rupture of the extensor tendons of the middle and ring fingers caused by stage Ⅳ Kienböck disease complicated by carpal tunnel syndrome.
    INTERVENTIONS: A 2-portal endoscopic carpal tunnel release was performed under general anesthesia. A dorsal curved incision was made. The dorsal fragment of the lunate punctured the capsule, and the extensor digitorum communis (EDC) tendon of the middle, ring, and little fingers, and the extensor indicis proprius tendons were ruptured. The dorsal fragment of the lunate bone was removed and the EDC tendon of the middle finger was transferred to that of the index finger. The combined EDC tendons of the ring and little fingers were transferred to the extensor digitorum minimi tendon.
    OUTCOMES: The numbness and extension restriction of the middle and ring fingers had improved at 2 years postoperatively. Dorsal and volar flexion were up to 60°.
    LESSONS: Dorsal lunate bone fragments associated with advanced Kienböck disease can cause extensor tendon rupture. When ultrasonography confirms that the volar fragment of the lunate bone does not impinge upon the median nerve or flexor tendons, surgical intervention on the volar fragment may be unnecessary. Computed tomography, magnetic resonance imaging, and ultrasonography are valuable for accurate assessment and preoperative planning.
    Keywords:  Kienböck disease; carpal tunnel syndrome; case report; extensor tendon rupture
    DOI:  https://doi.org/10.1097/MD.0000000000047001
  16. Ther Adv Musculoskelet Dis. 2026 ;18 1759720X251411062
    The role of radiography and MRI as screening tools and outcome measures in clinical trials of knee osteoarthritis: a perspective on the current status and outlook.
    Frank W Roemer, Jamie E Collins, Marc C Hochberg, Andrew J Kompel, Luis E Diaz, Daichi Hayashi, Mohamed Jarraya, David J Hunter, Ali Guermazi.
      To present an overview of the current role of imaging in clinical trials of knee osteoarthritis (OA), focusing on radiography and magnetic resonance imaging (MRI) in the context of their role as both inclusion criteria and structural outcome measures. A non-systematic literature search (PubMed) was performed, starting with a list of terms including the title of the current manuscript, followed by multiple search terms. The identified methodologies, findings, concepts, and recommendations were organized into a systematic framework, providing an overview of the current and future role of imaging in OA clinical trials. Conventional radiography is the most commonly used modality for the evaluation of OA in clinical trials of disease-modifying OA drugs (DMOADs). Radiography is used to define the severity of structural disease and to measure joint space width as an inclusionary criterion, and has also been employed as an outcome measure. Limitations include a lack of reproducibility, a lack of sensitivity, specificity, and responsiveness regarding structural progression, and an insufficient ability to depict diagnoses of exclusion. MRI is more sensitive and specific in assessing tissue damage and its progression. Using abbreviated imaging protocols and rapid image assessment, MRI may be applied at screening. Quantitative and semiquantitative approaches have been commonly used as outcome measures, and both have advantages and disadvantages. Reasons for the failure of past DMOAD trials are multifold and include patient selection based on imaging and application of imaging outcome measures that are either not sufficiently sensitive to change or are difficult to reliably reproduce longitudinally.
    Keywords:  MRI; clinical trials; knee; osteoarthritis; radiography
    DOI:  https://doi.org/10.1177/1759720X251411062
  17. Cureus. 2025 Dec;17(12): e98571
    Ultrasound-Guided Hydrodissection for Dorsal Scapular Nerve Entrapment: A Technical Report on the Scalene and Scapular Approaches.
    King Hei Stanley Lam, Abdallah El-Sayed Allam, Wai Wah Mark Lai, Daniel Chiung-Jui Su, Yonghyun Yoon, Manal Hassanien.
      Dorsal scapular nerve (DSN) entrapment is a common yet often underdiagnosed cause of chronic interscapular and neck pain. Ultrasound-guided hydrodissection has emerged as a minimally invasive and effective treatment, utilizing fluid to separate the nerve from constricting fascial structures. This technical report provides a detailed, step-by-step guide for two primary approaches to DSN hydrodissection: the proximal (scalene) approach and the distal (scapular) approach. The scalene approach targets the nerve within the middle scalene muscle, its most common site of entrapment, while the scapular approach targets the nerve as it courses deep to the levator scapulae and rhomboid muscles along the medial scapular border. We describe the requisite patient positioning, sonographic anatomy, key landmarks for nerve identification, and the in-plane injection technique for each method. A standardized injectate of 10 mL containing triamcinolone acetonide (40 mg) and lidocaine in saline is used for both. This report serves as a comprehensive technical reference for pain physicians and interventionalists seeking to enhance the precision, safety, and efficacy of ultrasound-guided interventions for DSN entrapment syndrome, a common yet underdiagnosed cause of chronic interscapular and neck pain.
    Keywords:  chronic neck pain; chronic pain management; dorsal scapular nerve entrapment; interscapular pain; middle scalene; nerve entrapment; technical report; ultrasound scanning; ultrasound-guided hydrodissection; ultrasound-guided nerve block
    DOI:  https://doi.org/10.7759/cureus.98571
  18. Cureus. 2025 Dec;17(12): e98492
    Effectiveness of Hydrodilatation for Adhesive Capsulitis in Patients With Pre-existing Rotator Cuff Tears.
    Aishwarya Prakash, Hussain Selmi, Shiva Namdeo, Tressa Amirthanayagam, Daoud Makki.
      Background Adhesive capsulitis (AC) is a chronic, debilitating condition characterized by pain and progressive stiffness of the shoulder joint. Hydrodilatation (HD) is a commonly used method of non-surgical management. However, its effectiveness in patients with rotator cuff pathology remains unclear. Objective The study aimed to evaluate and compare the clinical effectiveness of HD in patients with AC, with and without rotator cuff tears. A secondary objective was to assess clinical outcomes in patients with concurrent type 2 diabetes mellitus. Methods This retrospective cohort comprised 78 patients (six excluded due to loss to follow-up and two excluded due to incomplete data) who underwent HD between 2021 and 2024. Patients were stratified by rotator cuff integrity (intact n=60, partial-thickness tear n=10, full-thickness tear n=8). Pain (Visual Analog Scale (VAS)) and range of motion (ROM: abduction, flexion, and external rotation) were recorded at baseline, six weeks, three months, and six months. Change scores were analyzed using the Wilcoxon signed-rank and Kruskal-Wallis tests with Benjamini-Hochberg false discovery rate (FDR) correction. The primary endpoint was the change in abduction at three months. Results All groups demonstrated significant within-group improvements in pain and ROM (all p-values adjusted for multiple comparisons using the Benjamini-Hochberg FDR (p(FDR < 0.05), except flexion at six months in the full-thickness tear group (p(FDR) = 0.271). At three months, median abduction improvement was 80° (60-90) in the intact group vs 40° (20-75) in partial-thickness and 35° (17.5-70) in full-thickness tears (H=13.21, p(FDR)=0.005). External rotation gains were also greater in the intact group, most notably at three months (Z=3.91, p(FDR) = 0.002 vs partial-thickness). Pain reduction was observed in all groups, but reductions were greater in the intact versus full-thickness subgroup (three months: Z=-3.08, p(FDR)=0.014). Patients with diabetes demonstrated attenuated ROM recovery but similar pain improvement compared with non-diabetic patients. Conclusions HD provided meaningful pain relief across all patient subgroups in this retrospective cohort. However, rotator cuff integrity substantially influenced ROM recovery, with reduced gains in patients with partial- and full-thickness tears. Diabetic patients appeared to achieve less ROM improvement, although this subgroup was small, and findings should be interpreted cautiously. Pre-procedure imaging and individualised counselling are recommended.
    Keywords:  adhesive capsulitis; diabetic frozen shoulder; frozen shoulder; hydrodilatation; rotator cuff tears
    DOI:  https://doi.org/10.7759/cureus.98492
  19. NeuroRehabilitation. 2026 Jan 07. 10538135251407693
    Comparison of Extracorporeal Radial Shock Wave Different Doses On Carpal Tunnel Syndrome: A Preliminary Study.
    Ali Mohammed Hassan, Sarah Medhat Mohammed Kamel, Emad Aboelnasr, Fatma A Hegazy, Reham Alaa Elkalla, Mohamed A Raafat.
      BackgroundCarpal tunnel syndrome (CTS) represents the most common focal neuropathy in the upper limb. It occurs due to compression of the median nerve in the carpal tunnel. Various doses of radial extracorporeal shock wave therapy (rESWT) were used in previous studies; however, there is still controversy about the most effective dose of rESWT for treating CTS.ObjectivesTo compare and investigate the effectiveness of different doses of rESWT on the severity of symptoms, function and median nerve conduction velocity in patients with mild-to-moderate CTS.MethodsEighty-three participants (99 affected wrists) were assigned to three groups. Group A received 1000 shocks, Group B received 2000 shocks, and Group C received 1500 shocks. All participants received four sessions of rESWT, once a week over four weeks, in addition to conventional physical therapy. The Boston Carpal Tunnel Questionnaire (BCTQ) was used to investigate the severity of symptoms and functional level. The median nerve sensory conduction velocity and distal motor latency were measured. ANOVA was used for comparison between groups. Statistical significance was set at P < 0.05.ResultsAll groups showed significant improvements (p < 0.001). Group (C) showed the maximal improvement in symptom severity (p < 0.001) and functional level (p < 0.001), as well as the median nerve sensory conduction velocity (p < 0.001) and distal motor latency (p < 0.001).ConclusionThe combination of rESWT (1500 shocks) with the conventional physical therapy effectively reduces symptoms, improves function, nerve conduction velocity and distal motor latency as well in patients with mild-to-moderate CTS.
    Keywords:  Boston carpal tunnel questionnaire; carpal tunnel syndrome; nerve conduction velocity; shock wave
    DOI:  https://doi.org/10.1177/10538135251407693
  20. Am J Sports Med. 2026 Jan 08. 3635465251383039
    Platelet-Rich Plasma Does Not Improve Pain or Function in Patients With Lateral Epicondylitis as Compared With Placebo: A Meta-analysis of Randomized Clinical Trials.
    César Romero Antunes Júnior, Ramon Sampaio Souza Santos, Eduardo Silva Reis Barreto, Guilherme Neves Azevedo, Ewerton Borges de Souza Lima, Paulo Henrique Schmidt Lara, Alberto de Castro Pochini, Carlos Vicente Andreoli, Benno Ejnisman, Paulo Santoro Belangero.
       BACKGROUND: Lateral epicondylitis, commonly known as tennis elbow, is a prevalent musculoskeletal disorder characterized by pain and functional impairment. Platelet-rich plasma (PRP) has been proposed as a regenerative treatment, but its efficacy remains controversial.
    PURPOSE: To assess the efficacy and safety of PRP in improving pain and function in patients with lateral epicondylitis as compared with placebo through a systematic review and meta-analysis of randomized clinical trials (RCTs).
    STUDY DESIGN: Systematic review and meta-analysis of RCTs; Level of evidence: 1.
    METHODS: A comprehensive literature search was conducted in PubMed, Scopus, Embase, and Cochrane CENTRAL for RCTs comparing PRP with placebo in lateral epicondylitis. Primary outcomes included pain relief and functional improvement assessed at multiple time points (4, 8-12, and 24-26 weeks). Secondary outcomes included adverse events and grip strength. Statistical analyses used standardized mean difference (SMD), mean difference (MD), and risk ratios with 95% confidence intervals (95% CIs).
    RESULTS: Six RCTs with 355 patients were included. PRP did not provide significant pain relief at 4 weeks (SMD, 0.08; 95% CI, -0.17 to 0.34; P = .526), 8 to 12 weeks (SMD, -0.36; 95% CI, -0.99 to 0.27; P = .263), or 24 to 26 weeks (MD, -1.58; 95% CI, -4.74 to 1.58; P = .328). Functional improvement was also not significantly different at 4 weeks (SMD, 0.09; 95% CI, -0.18 to 0.37; P = .518), 12 weeks (SMD, -0.09; 95% CI, -0.39 to 0.21; P = .565), or 24 to 26 weeks (SMD, 0.13; 95% CI, -0.18 to 0.43; P = .413). No significant difference was found in adverse events (risk ratio, 1.66; 95% CI, 0.65-4.19; P = .287).
    CONCLUSION: PRP does not provide significant pain relief or functional improvement in patients with lateral epicondylitis in the current study of available RCTs as compared with placebo at all evaluated time points. These findings do not support PRP as a recommended treatment for this condition.
    Keywords:  lateral epicondylitis; pain management; platelet-rich plasma; tennis elbow
    DOI:  https://doi.org/10.1177/03635465251383039
  21. Front Rehabil Sci. 2025 ;6 1737706
    Efficacy of botulinum toxin type A in myogenic temporomandibulardisorders: a single arm, prospective, pilot study.
    Bruno Macedo de Sousa, Nansi López-Valverde, Carolina Ferreira, André Mariz de Almeida, Antonio López-Valverde, José A Blanco Rueda.
       Background: Myogenous temporomandibular disorders (TMDs) is commonly associated with myofascial pain and functional limitations. Botulinum toxin type A (BoNT-A) has shown potential in relieving chronic muscular pain.
    Methods: In this single arm, prospective, pilot study, 25 patients diagnosed with myofascial TMDs received a single bilateral intramuscular injection of 50 units of BoNT-A. Assessments using the Visual Analog Scale (VAS), Chronic Pain Index (CPI), Jaw Functional Limitation Scale (JFLS-8), and Oral Health Impact Profile (OHIP-14) were performed at baseline, 6 weeks, and 12 weeks post-treatment.
    Results: Significant reductions in pain (VAS: 6.84 ± 1.03 to 0.84 ± 0.94) and CPI (61.87 ± 8.12 to 9.86 ± 4.46) were observed. Functional improvement (JFLS-8: 5.82 ± 0.56 to 1.08 ± 0.51) and enhanced quality of life (OHIP-14: 24.56 ± 8.39 to 5.96 ± 2.79) were also significant. No adverse effects were reported.
    Conclusions: BoNT-A showed promising results in reducing pain and improving function in patients with myofascial pain in Temporomandibular Disorders (M-TMDs). However, the single-arm design, small sample size, and short follow-up limit causal inference and external validity. These findings should be interpreted as preliminary.Clinical Trial Registration: Clinicaltrials.gov, identifier NCT05651256.
    Keywords:  botulinum toxin type A; myofascial pain; pain management; quality of life; temporomandibular joint disorders
    DOI:  https://doi.org/10.3389/fresc.2025.1737706
  22. BMC Musculoskelet Disord. 2026 Jan 07.
    Clinical application of multi-parameter ultrasonic assessment for grading rotator cuff injuries: development and validation of a novel scoring system.
    Xiaona Cai, Chenying Su, Yu Zhan, Rongrong Miao, Chenxian Su.
       BACKGROUND: Rotator cuff injuries, a leading cause of shoulder pain and dysfunction, present significant diagnostic challenges. While MRI is the diagnostic gold standard, ultrasonography (US) offers a cost-effective alternative but lacks standardization. This study addresses this gap by developing and validating a novel multiparameter ultrasonic scoring system to increase the diagnostic accuracy and clinical applicability of shoulder ultrasonography for rotator cuff pathology.
    METHODS: A retrospective diagnostic accuracy study of 252 patients with suspected rotator cuff injury was analyzed. Independent predictors identified through multivariable logistic regression included tear width, tendon swelling, synovial effusion, and vascular score, which were integrated into a weighted composite scoring system. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis.
    RESULTS: The scoring system demonstrated excellent discriminative ability, with an area under the ROC curve (AUC) of 0.92. An optimal diagnostic threshold of > 4 points yielded a sensitivity of 82.2% and a specificity of 94.0%. This system enabled risk stratification into three tiers. Multivariate analysis confirmed tear width, degree of tendon swelling, synovial effusion, and vascular score as key diagnostic indicators.
    CONCLUSION: This ultrasonic scoring system introduces a standardized, quantitative approach to rotator cuff diagnostics, designed to reduce interobserver variability and enhance diagnostic reliability. By stratifying patients into risk categories, it facilitates personalized treatment planning. However, as this represents the initial development and internal validation phase, further prospective and external validation studies are warranted to confirm its broader applicability.
    Keywords:  Multiparameter ultrasonic assessment; Novel scoring system; Rotator cuff injuries
    DOI:  https://doi.org/10.1186/s12891-026-09487-5
  23. Arch Bone Jt Surg. 2025 ;13(12): 800-806
    Peripheral Nerve Syndromes at the Elbow: A Review of Current Treatments.
    Domenick Bartoletti, Aavni Gupta, William Bohne, Sean Gresham, Kassem Ghayyad, Amir R Kachooei.
      Peripheral nerve compression syndromes at the elbow include Cubital Tunnel Syndrome (CuTS), Radial Tunnel Syndrome (RTS), Posterior Interosseous Syndrome (PINS), Pronator Teres Syndrome (PTS), and Anterior Interosseous Nerve Syndrome (AINS). These conditions, though rare compared to carpal tunnel syndrome, can cause debilitating motor and sensory deficits. This review aims to consolidate the latest evidence about treatments to improve therapeutic outcomes and provide clinical recommendations. Conservative treatment is usually first-line and includes physical therapy, splinting, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections. Despite limited evidence, NSAIDs remain widely used due to their cost-effectiveness. Corticosteroid injections offer potential short-term relief and diagnostic value, particularly in CuTS, where non-responders may require alternative diagnoses. Splinting shows variable success, with most patients reporting symptom improvement, while nerve glide exercises and patient education are essential for managing provocative movements. Surgical intervention is indicated when conservative treatments fail. The mainstay surgical therapy for elbow nerve entrapment is decompression. Still, new evidence suggests a difference between management for the various entrapments. Minimally invasive techniques have shown promising outcomes with reduced recovery times. Future research on elbow nerve entrapments should aim to establish a treatment algorithm and to advance minimally invasive techniques.
    Keywords:  Conservative treatment; Cubital tunnel syndrome; Diagnosis; Peripheral nerve compression syndromes; Surgical decompression
    DOI:  https://doi.org/10.22038/ABJS.2025.87645.3996
  24. J Foot Ankle Res. 2026 Mar;19(1): e70102
    Dynamic Step-Down Tasks Reveal Altered Lower Limb Biomechanics in Chronic Ankle Instability.
    Nader Farahpour, Usef Mohammadi Yaghoubi, Shawn Robbins, Paul Allard, Gabriel Moisan.
       BACKGROUND: Accurate knowledge about biomechanical alterations in chronic ankle instability (CAI) during dynamic movements may inform rehabilitation strategies.
    OBJECTIVE: To identify movement patterns associated with CAI injury during a step-down task.
    METHOD: Seventeen participants with CAI and 17 healthy controls performed a step-down task from heights of 20 and 40 cm. Lower limb joint angles, range of motion (ROM), moments, and power were measured. The one-dimensional statistical parametric mapping (SPM) test compared groups across the entire task (0%-100%).
    RESULTS: At 20 cm height, the CAI group exhibited greater hip abduction angles (0%-2%, p = 0.024 and 21%-77%, p = 0.014) but smaller hip abduction (7%-13%, 19%-20%, and 47%-64% (p < 0.05)), hip external rotation (8%-12% and p = 0.04), knee abduction (7%-30%, p = 0.001 and 49%-53%, p = 0.024), and ankle external rotation moments (7%-42% and p = 0.001). At 40 cm height, the CAI group showed greater hip abduction (44%-100% and p = 0.005), reduced ankle eversion (4%-12% and p = 0.012) angles, and smaller hip abduction, hip external rotation, knee abduction, ankle plantarflexion, and external rotation moments (all p < 0.05). No between-group differences were observed for the ROMs and power (p > 0.05).
    CONCLUSION: CAI individuals exhibited greater hip abduction, less ankle eversion, and smaller muscle moments, which are associated with an increased risk of injury. Rehabilitation should emphasize strengthening the hip muscles to mitigate the risk of injury.
    Keywords:  chronic ankle instability; joint motion; landing; lower limb; muscle moments; step‐down
    DOI:  https://doi.org/10.1002/jfa2.70102
  25. J Orthop Case Rep. 2025 Dec;15(12): 379-385
    Functional Outcome of Intra-articular Platelet-Rich Plasma in the Treatment of Frozen Shoulder.
    Gautham Saravanan, Prabhakaran Anbalagan, Ashok Ramanujam, Umar Farook.
       Introduction: Frozen shoulder, also known as adhesive capsulitis, is a condition marked by persistent shoulder pain and limited range of motion. Platelet-rich plasma (PRP) has recently gained attention as a biologically active therapy capable of enhancing tissue repair and regeneration.
    Objective: This study aimed to assess the impact of intra-articular PRP injections on functional recovery in individuals with frozen shoulder.
    Materials and Methods: A prospective interventional study was performed involving 30 patients who had not responded to standard conservative therapies. Each participant received a single PRP injection and was monitored at intervals of 1 week, 1 month, 3 months, and 6 months. Pain and functional outcomes were measured using the visual analog scale (VAS) and disabilities of the arm, shoulder, and hand (DASH) scores. Subgroup analyses examined the effects of age, diabetes status, and duration of symptoms.
    Findings: After 6 months, there was a 75.3% reduction in pain scores and a 72.1% improvement in functional scores. Patients who were younger, non-diabetic, or had symptoms for <6 months experienced more favorable outcomes. Multivariate analysis confirmed age, diabetes, and symptom duration as significant outcome predictors.
    Conclusion: Intra-articular PRP injections appear to significantly reduce pain and enhance function in patients with frozen shoulder, with the most pronounced benefits observed in early-stage, younger, non-diabetic individuals. Despite certain study limitations, these results highlight PRP's potential as an effective treatment alternative.
    Keywords:  Platelet-rich plasma; adhesive capsulitis; frozen shoulder; intra-articular injection
    DOI:  https://doi.org/10.13107/jocr.2025.v15.i12.6566
  26. J Orthop. 2026 Mar;73 206-212
    Initial safety outcomes of adipose-derived mesenchymal stem cell for rotator cuff tear: A 3-year pilot trial.
    Parisa Nejati, Nahid Masoumi Shahre Babak, Amir Sobhani Eraghi, Lida Nejati, Kimia Didehvar, Ali Mazaherinezhad, Nahid Nafisi, Naser Amini, Mohammad Taghi Joghataei.
       Background: Rotator cuff injuries are the underlying cause of shoulder pain in 65-70 % of the patients over the age of 50. A novel therapeutic approach is stem cell therapy, which promises to heal. This study represents one of the first long-term safety evaluations of autologous adipose-derived mesenchymal stem cells (MSCs) in human subjects with total rotator cuff tear, with a specific focus on potential adverse effects.
    Methods: This study was designed as a pilot safety phase within a broader clinical trial framework. Ten patients with full-thickness rotator cuff tears were enrolled. Autologous mesenchymal stem cells (MSCs), derived from adipose tissue, were injected directly into the torn tendons under ultrasound guidance. Patients were monitored over a 36-month period to assess safety outcomes. These included complete blood count (CBC), inflammatory markers-erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)-radiological imaging (X-ray and MRI), pain assessment via visual analog scale (VAS), and functional status through validated questionnaires.
    Results: No systemic or local adverse events were reported during the 36-month follow-up, indicating a favorable safety profile. The CBC parameters after three years compared to the baseline measurement: hemoglobin [mean = 13.92 (SD = 1.32) vs. 13.85 (1.34)], red blood cells [mean = 4.97 (SD = 0.31) vs. 5.11 (0.31)], white blood cells [mean = 6.05 (SD = 2.06) vs. 6.01 (1.70)], platelets [mean = 248.8 (SD = 2.76) vs. 246.9 (2.50)]. The inflammatory markers were also within the normal range as following: ESR [mean = 7 (SD = 1.22) vs. 6.4 (2.48)] and CRP [mean = 0.2 (SD = 0.70) vs. 0.3 (SD = 0.89)]. Pain intensity and functional status improved compared to baseline: VAS [3.6 (SD = 1.17) vs 8.5 (1.93)], WORC [34.17 (SD = 3.31) vs 47.53 (SD = 2.56)], DASH [32.95 (SD = 2.45) vs 50.71 (SD = 4.34)].The shoulder X-ray and MRI did not show any significant pathology in the soft or bony tissues of the shoulder joint over the follow-ups.
    Conclusion: Injection of autologous MSCs derived from adipose tissue is safe in treating total rotator cuff tear. These findings support the initiation of larger-scale trials to further investigate the therapeutic potential and efficacy of MSCs in tendon regeneration.
    Keywords:  Adipose tissue; Mesenchymal stem cell; Rotator cuff; Safety; Shoulder; Tendon tear
    DOI:  https://doi.org/10.1016/j.jor.2025.12.025
  27. J Orthop Case Rep. 2025 Dec;15(12): 348-354
    Ulnar Nerve Cross-sectional Area among Ulnar Neuropathy Patients and Healthy Subjects - A Study in Hospital-based Population of Eastern India.
    Anasuya Ghosh, Swarnava Tarafdar, Tandra Ghosh, Amit Kumar.
       Introduction: Ultrasound (US) examinations of the ulnar nerve and measurement of cross-sectional area (CSA) are now used to diagnose cases of ulnar neuropathy. However, the CSA values vary across the population. The present study was planned to prepare a preliminary dataset of ulnar CSA among the symptomatic ulnar neuropathy patients diagnosed by electrodiagnostic studies at our institute and compare the values with those of healthy volunteers.
    Materials and Methods: A hospital-based case-control study was conducted, which included 20 diseased upper limbs diagnosed with ulnar neuropathy and 40 non-neuropathic upper limbs as controls. They all underwent an US examination of the ulnar nerve in both upper limbs. The demographic data, nerve CSA at five predetermined locations, swelling and flattening ratios were compared and analyzed.
    Results: The mean values of ulnar CSA at the medial epicondyle, 5 cm proximal and distal to it, at mid-forearm, and at the wrist were 11.5 ± 2.38 mm2, 7.43 ± 1.47 mm2, 6.17 ± 1.42 mm2, 5.78 ± 2.53 mm2, and 4.67 ± 2.3 mm2, respectively, in ulnar neuropathy patients. All the values were statistically significantly higher in cases than in controls. The swelling and flattening ratios were statistically significantly higher in ulnar neuropathy cases than in controls.
    Conclusion: This study presents a data set of ulnar nerve CSA and some other parameters for the ulnar neuropathy patients and the normative values of ulnar nerve CSA in healthy subjects for the population of West Bengal (Eastern India). This data might be helpful for the diagnosis and management of ulnar neuropathy in this region.
    Keywords:  Ulnar nerve; forearm; measurement; medial epicondyle; ultrasound; wrist
    DOI:  https://doi.org/10.13107/jocr.2025.v15.i12.6556
  28. J Orthop Case Rep. 2025 Dec;15(12): 183-186
    Unusual Case of Lateral Knee Pain: Magnetic Resonance Imaging Evidence of Isolated Lateral Patellotibial Ligament Enthesopathy.
    Mayank Srivastava, Namdev Seth, Rajnand Kumar, Ajay Bharti, Harikesh Yadav.
       Introduction: Patellofemoral stability is maintained by a complex interplay of osseous, muscular, and ligamentous structures, with the retinacular system playing a central role. While the medial patellofemoral and patellotibial ligaments are well characterized, the lateral patellotibial ligament (LPTL) has been less frequently described, and isolated pathology involving this structure is rarely reported in the literature.
    Case Report: We report the case of a 23-year-old athletic male presenting with a 2-week history of activity-related lateral knee pain without preceding trauma. Clinical examination revealed focal tenderness at the tibial attachment of the LPTL without effusion, instability, or meniscal signs. Magnetic resonance imaging (MRI) demonstrated linear thickening of the lateral patellar retinaculum extending from the inferolateral patella to the anterolateral proximal tibia, consistent with the LPTL, which appeared thickened compared to the medial counterpart. Associated bone marrow edema at the tibial attachment near Gerdy's tubercle suggested enthesopathy. Other intra-articular structures were normal. The patient was treated conservatively with physiotherapy, activity modification, and non-steroidal anti-inflammatory drugs, resulting in significant symptomatic improvement.
    Conclusions: This case highlights isolated LPTL enthesopathy as a rare but important cause of lateral knee pain in athletes. Recognition of this entity on MRI is essential to prevent misdiagnosis and to facilitate appropriate conservative management.
    Keywords:  Patellofemoral stability; enthesopathy; knee magnetic resonance imaging; lateral patellotibial ligament; overuse injury
    DOI:  https://doi.org/10.13107/jocr.2025.v15.i12.6500
  29. J Orthop Surg Res. 2026 Jan 08. 21(1): 25
    Expert consensus on glucocorticoids injection for knee osteoarthritis.
    Ye Huang, Peilai Liu.
      Knee osteoarthritis (KOA), a degenerative disorder characterized by compromised physical function and diminished quality of life, imposes substantial burdens on patients, families, healthcare systems, and society. Stepwise therapeutic approach, initiated after first-line non-pharmacological interventions such as weight loss, exercise, and physical therapy, remains the cornerstone of KOA management, with glucocorticoids (GCs) injections widely adopted for rapid and effective pain relief. However, the absence of comprehensive guidelines or consensus documents specifically addressing GC applications has led to inconsistent clinical practices. To address this gap, a multidisciplinary panel of Chinese KOA experts developed this consensus through iterative discussions, synthesizing current evidence and domestic clinical experience. The final document outlines 22 recommendations encompassing GC selection, target population, timing of administration, dosing frequency and contraindications, aiming to standardize evidence-based GC utilization in KOA care.
    Keywords:  Glucocorticoids; Injection; Knee osteoarthritis; Pain relief; Stepwise therapeutic approach
    DOI:  https://doi.org/10.1186/s13018-025-06363-1
  30. JBJS Case Connect. 2026 Jan 01. 16(1):
    Grade 1 to 2 Thumb Ulnar Collateral Ligament Injuries in Athletes Requiring Surgery After Stress Testing: A Report of 2 Cases.
    Katherine A Banner, Matthew E Koepplinger, Hannah A Dineen, James M Saucedo, Dean W Smith, Kyle R Woerner, Ashton S Mansour.
       CASE: A 19-year-old baseball player and a 16-year-old golfer presented with persistent thumb pain and instability after prolonged nonoperative management and magnetic resonance imaging (MRIs) showing grade 1 to 2 thumb ulnar collateral ligament (UCL) injuries (typically treated nonoperatively). Both underwent fluoroscopic stress examinations showing significant UCL instability, opted to undergo operative repair, and were able to return to play.
    CONCLUSION: A fluoroscopic stress examination should be performed in patients with low-grade injuries reported on MRI but with continued symptoms, especially in young athletes. If the stress examination shows significant asymmetric widening and the patient is unable to grip properly, surgery may be indicated.
    Keywords:  MRI; UCL sprain; UCL tear; athlete; fluoroscopic stress testing; pain; restricted ROM; thumb instability; thumb ulnar collateral ligament; young adult
    DOI:  https://doi.org/e25.00451
  31. J Orthop Case Rep. 2025 Dec;15(12): 46-56
    Flexor Tendon Injuries in Zone 3: A Comprehensive Review and Case Report on Flexor Digitorum Profundus Rupture of the Middle Finger.
    Nirav Mungalpara, Dmitriy Peresada, Alfonso Mejia.
       Introduction: Isolated rupture of the flexor digitorum profundus tendon within flexor zone 3 is exceptionally rare and easily mistaken for the far more common zone 1 "Jersey finger" lesion. To the best of our knowledge, only two such middle-finger cases have been documented over the past six decades. Reporting this case, together with a literature synthesis, highlights the diagnostic pitfalls and supports timely, tendon-preserving intervention.
    Case Report: A 65-year-old right-hand-dominant White male felt a sudden snap in his right palm while restraining a dog leash, followed by an inability to flex the distal interphalangeal joint of the middle finger. Clinical examination showed loss of the tenodesis effect, but plain radiographs excluded fracture. Initial exploration aimed at tendon reinsertion in zone 1 revealed an intact insertion, prompting proximal extension of the incision. A complete mid-substance rupture was identified in zone 3, approximately one centimeter proximal to the origin of the lumbrical muscle. Primary repair was performed using a four-strand cruciate core technique reinforced with circumferential epitendinous sutures. Post-operative rehabilitation employed early-motion protocols. Twelve months after surgery, the patient regained full strength, achieved a total active finger motion of 230°, and reported 95 percent functional recovery.
    Conclusion: This case illustrates how a concealed zone 3 rupture can masquerade as a distal avulsion, emphasizing the need for high clinical suspicion and, when feasible, pre-operative ultrasonography or magnetic resonance imaging to guide incision planning. Early direct repair within days of injury provided an excellent functional result, underscoring that prompt recognition prevents unnecessary grafting or transfer procedures. By adding the first modern case of isolated middle-finger zone 3 rupture and proposing a minimum reporting dataset, this report broadens surgeons' awareness of an uncommon injury and supports evidence-based management strategies that may preserve grip strength and hand function across orthopedic practice.
    Keywords:  Tendon injury; flexor digitorum profundus; flexor zone 3 of hand; tendon graft; tendon repair; tendon transfer
    DOI:  https://doi.org/10.13107/jocr.2025.v15.i12.6450
  32. J Clin Med. 2025 Dec 28. pii: 234. [Epub ahead of print]15(1):
    Clinical Outcomes of Arthroscopic Treatment for Triangular Fibrocartilage Complex Lesions in Adolescent Elite Athletes.
    Michele Davide Maria Lombardo, Min Cheol Chang, Loris Pegoli.
      Objectives: The triangular fibrocartilage complex (TFCC) is critical for wrist stability. The incidence of TFCC injury among adolescent athletes is rising due to increased participation in high-demand sports. Here, we investigated the therapeutic outcomes of arthroscopic TFCC repair in adolescent elite athletes. Methods: We retrospectively recruited 24 elite adolescent athletes (mean age 15.5 ± 1.3 years) treated arthroscopically for peripheral TFCC tears between March 2018 and January 2025. Clinical outcomes-including numeric rating scale (NRS) for pain, grip strength, wrist range of motion (ROM), DASH scores, and physical exam tests-were collected preoperatively and at 6-month follow-up. Statistical analysis included paired t-tests for continuous variables and chi-square tests for categorical comparisons. Results: At 6 months postoperatively, the mean NRS decreased from 6.9 ± 1.2 to 0.6 ± 0.7, grip strength increased from 26.3 ± 6.9 kg to 40.8 ± 5.6 kg, and all measured ROMs and DASH scores improved significantly. Positive findings on ballottement, Waiter's, and piano key tests decreased significantly. There were no major complications. All athletes returned to their pre-injury sport levels. Conclusions: Arthroscopic peripheral TFCC repair in adolescent elite athletes is a safe, minimally invasive, and effective treatment, leading to rapid pain relief, functional recovery, and return to sport with their pre-injury sport levels.
    Keywords:  adolescent; arthroscopy; athlete; injury; sports; triangular fibrocartilage complex
    DOI:  https://doi.org/10.3390/jcm15010234
  33. Diagnostics (Basel). 2026 Jan 05. pii: 166. [Epub ahead of print]16(1):
    Impact of Proximal Conjoint Tendon Injury on Return to Play in the BF-ST Complex: A Prospective MRI-Based Study.
    Makoto Wada, Takumi Okunuki, Takeshi Sugimoto, Yasuhito Tanaka, Tsukasa Kumai.
      Background/Objectives: Proximal hamstring injuries involving the biceps femoris-semitendinosus (BF-ST) conjoint tendon (CT) often exhibit delayed healing, yet the prognostic significance of CT involvement and intratendinous injury morphology has not been fully clarified. This study aimed to determine whether full-layer CT injury, particularly bilateral involvement in Zone C, prolongs return-to-play (RTP) in competitive rugby athletes. Methods: This prospective study evaluated 41 university rugby players with acute BF-ST complex injuries using clinical examination, ultrasonography, and MRI. Injuries were classified by Type (I: full-layer CT; II: BFLH-only; III: ST-only), Zone (A-E), and Grade (0-3). RTP was defined as unrestricted return to team training or match play. Group differences were analyzed using ANOVA or non-parametric tests with appropriate post hoc corrections. Results: Type I injuries required significantly longer RTP (11.4 ± 4.8 weeks) than Type II (5.3 ± 2.4 weeks) and Type III (4.0 ± 1.7 weeks), confirming the strong impact of CT involvement on prognosis. In Zone C, bilateral full-layer CT involvement was associated with an approximately twofold longer RTP duration compared with unilateral BFLH-side injuries, indicating that intratendinous tissue disruption influences recovery. These findings highlight the importance of early MRI-based assessment to identify clinically relevant tendon involvement patterns. Conclusions: Full-layer CT injuries, particularly bilateral intratendinous patterns in Zone C, markedly prolong RTP compared with isolated BFLH or ST injuries. An MRI-based classification incorporating injury type, zone, and extent of CT involvement provides clinically valuable prognostic information and may enhance RTP decision-making.
    Keywords:  athlete rehabilitation; biceps femoris–semitendinosus complex (BT-ST complex); conjoint tendon; hamstring injury; intratendinous injury; magnetic resonance imaging (MRI); musculotendinous junction (MTJ); return to play (RTP)
    DOI:  https://doi.org/10.3390/diagnostics16010166
  34. Acta Chir Orthop Traumatol Cech. 2026 Jan;92(6): 362-366
    [Simultaneous Ruptures of All Four Extensor Mechanism Tendons in Both Knees: a Rare and Challenging Case in a Chronic Kidney Disease Patient].
    Ali Can Koluman, Suleyman Emre Salmanoglu, Cemal Kural.
      We report a rare and remarkable case of simultaneous bilateral injuries to all four extensor mechanism tendons in a 39-year-old male with a history of diabetes and chronic kidney disease. Physical examination revealed pronounced swelling, palpable gaps above and below both patellae, and complete loss of active knee extension. Imaging confirmed complete ruptures of the right quadriceps and left patellar tendons, alongside partial ruptures of the left quadriceps and right patellar tendons. Surgical repair was performed using suture anchors to ensure secure tendon reattachment. Postoperatively, both knees were immobilized with hinged braces for six weeks, followed by a structured rehabilitation program. At the 12-month follow-up, the patient demonstrated full recovery, with complete restoration of knee range of motion and muscle strength.
    Keywords:  chronic kidney disease.; extensor tendons rupture; knee
    DOI:  https://doi.org/10.55095/achot2025/040
  35. Acta Chir Orthop Traumatol Cech. 2025 Dec;92(5): 247-258
    [Efficacy of Intra-Articular Platelet-Rich Plasma in Knee Osteoarthritis: a Systematic Review and Meta-Analysis].
    Matúš Sloviak, Michal Štefančík, Jiří Gallo.
       PURPOSE OF THE STUDY: The treatment of knee osteoarthritis (KOA) must be comprehensive and personalised. Administration of platelet-rich plasma (PRP) is one of the interventions that has been investigated for a long time. Professional medical societies have so far failed to adopt a clear and consistent stance on this therapy, despite a number of randomized clinical trials (RCTs) conducted in the past. The aim of our review was to evaluate the results of RCTs published over the last 5 years. We do believe that a meta-analysis based on the best of the available studies will help articulate the national position on this treatment modality.
    MATERIAL AND METHODS: Our review covers all RCTs evaluating the effect of PRP on KOA that were published between 2020 and 2024. PubMed, OVID and Scopus databases were searched for the relevant data. The effect of PRP administration was evaluated using the total WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), VAS (Visual Analogue Scale) pain and IKDC (International Knee Documentation Committee) scores at time periods up to 6 weeks, at 3 and 6 months. The level of bias was assessed with the use of the Cochrane Risk of Bias 2. Cochrane RevMan Web was used for data analysis. The guidelines of PRISMA 2020 (Preferred Reporting Items of Systematic Reviews and Meta-Analyses) were followed.
    RESULTS: Eighteen RCTs with a total of 971 patients were included in the meta-analysis. The meta-analysis revealed that the patients with KOA reported a systematic subjective improvement seen on the WOMAC, IKDC and VAS pain scores after intra-articular administration of PRP. Importantly, the results reached their peak and the values exceeded the minimal clinically important difference at 3 and 6 months after administration. When compared to placebo and hyaluronic acid, the intra-articular administration of PRP achieved better results.
    DISCUSSION AND CONCLUSIONS: Intra-articular administration of PRP in the treatment of KOA is a popular treatment modality appreciated by orthopaedic surgeons, rheumatologists as well as patients. Depending on the initial assessment, the PRP treatment offers pain relief for up to 12 months after administration, together with a marked improvement in function of the affected knee. Even though the PRP is frequently administered in the clinical practice, it is not recommended by prestigious professional medical societies because of its relatively small effect and the absence of knowledge concerning the optimal patient responding reliably to this method. In our study, however, a consistent pain relief and functional improvement was shown in KOA patients after the PRP administration, experienced over a period of months. We therefore assume that based on our findings the Czech Society for Orthopaedics and Traumatology and the Czech Society of Rheumatology could enlist PRP among the recommended non-operative KOA treatment modalities.
    Keywords:  ACP; PRP; hyaluronic acid; intraarticular; knee osteoarthritis; metaanalysis; minimal clinically important difference.; non-operative treatment; systematic review
    DOI:  https://doi.org/10.55095/achot2025/023
  36. Clin J Sport Med. 2026 Jan 07.
    Minimal Clinically Important Difference After Triamcinolone Acetonide Injection for Knee Osteoarthritis.
    Jesse M Galina, Meghan L Morley, Sibtain Mustafa, Sophia Bisson, Nomi S Weiss-Laxer, Mohammad Nadir Haider, Leslie J Bisson.
       OBJECTIVE: This study aimed to define the minimal clinically important difference (MCID) after triamcinolone acetonide (TA) injections for knee osteoarthritis, see if the value changes over time, and report the proportion of patients achieving MCID monthly for 6 months.
    STUDY DESIGN: Retrospective case series; level of evidence, 4.
    SETTING: One large university-affiliated practice (13 providers).
    PATIENTS OR PARTICIPANTS: Two hundred seventy-seven patients receiving TA (40 mg) with 4cc 1% lidocaine for knee osteoarthritis (OA) were retrospectively reviewed.
    INTERVENTION: Patients receiving TA (40 mg) with 4cc 1% lidocaine for knee OA.
    MAIN OUTCOME MEASURE: Knee Injury and Osteoarthritis Outcome Score (KOOS) preinjection and monthly for 6 months. MCID values, representing moderate clinical improvement, were calculated as 0.5 standard deviations from preinjection scores.
    RESULTS: Of 277 injections (116 men, 161 women; mean age 61.3 years), MCID values varied across KOOS subscales (7.98-12.35). At the 1-month through 6-month follow-ups, the proportion of patients reaching the MCID on the KOOS pain scale was 50.5%, 47.7%, 36.2%, 37.1%, 44.8%, and 39.4%, respectively. Twenty-three percent of patients received a repeat injection within 6 months. Patients who did not meet the calculated MCID for pain by 1 month had a 2.19 times higher odds ratio of receiving a repeat injection within 6 months.
    CONCLUSIONS: This study establishes MCID values for KOOS subscales in patients with knee OA receiving TA injections using a distribution-based method, which are similar regardless of duration of follow-up within 6 months. Patients can expect significant pain improvement within the first month, with declining effects thereafter. Lack of early pain improvement correlates with a higher likelihood of repeat injection, supporting the need for follow-up assessments to guide ongoing treatment.
    Keywords:  corticosteroid; injection; knee; minimal clinically important difference; osteoarthritis; treatment
    DOI:  https://doi.org/10.1097/JSM.0000000000001412
  37. Niger Med J. 2025 Jul-Aug;66(4):66(4): 1301-1314
    Current Concepts in the Management of Achilles Tendon Injuries.
    Tamunokuro Ezekiel Diamond, Mike Tochi Achor.
      Achilles tendon injuries are commonly encountered in orthopaedic practice. The Achilles tendon is prone to rupture, and this negatively imparts ambulation. The diagnosis is clinical. Treatment options have evolved from conservative to surgeries, however there is no consensus on the most superior option of treatment. This narrative review aims to highlight the evolution in clinical diagnosis and treatment of Achilles tendon ruptures and discuss the current evidence in the treatment with emphasis on outcome measures of each treatment modality. Relevant studies on Achilles tendon ruptures with emphasis on treatment options, their strengths and weaknesses were reviewed. The treatment of Achilles tendon rupture has evolved from conservative options to surgeries. The surgical options include open repair, percutaneous repair, endoscopic repair, and ultrasound-guided repair. However, there is still no consensus on the most superior option for treating Achilles tendon injuries. Each method has its pros and cons. Conservative treatment has the appeal of the absence of scars, low cost and shorter duration of hospital stay. However, ankle stiffness, and late return to work are important drawbacks. Open surgery has the advantage of early return to function and low re-intervention rates. Surgical scars, likelihood of infection and cost are major disadvantages. Appropriate patient selection guided by the severity of the injury, the age of the patient, pre-injury status, work demand for the patient, experience of the surgeon, available resources, local soft tissue condition, and the patient's preferences are key to successful outcome.
    Keywords:  Achilles Tendon Injuries; Current Concepts; Management
    DOI:  https://doi.org/10.71480/nmj.v66i4.878
  38. Oral Maxillofac Surg. 2026 Jan 10. 30(1): 15
    Platelet-rich plasma versus hyaluronic acid injection following arthrocentesis for temporomandibular joint disorders under sedation: a comparative clinical study.
    Muntadher Salih Mahdi, Muhanned Salah Abdulsattar.
       OBJECTIVE: Temporomandibular joint disorders (TMDs) are a common source of orofacial pain and dysfunction. Arthrocentesis of the temporomandibular joint (TMJ) is a minimally invasive treatment that can be augmented with intra-articular injections. This study aimed to compare the clinical efficacy of platelet-rich plasma (PRP) versus hyaluronic acid (HA) injections following TMJ arthrocentesis in patients with TMDs unresponsive to conservative therapy.
    METHODS: Sixty patients (72 joints) were randomized into three equal groups. Group A underwent arthrocentesis with Ringer's lactate (RL) alone (control), Group B received PRP injection post-arthrocentesis, and Group C received HA injection post-arthrocentesis. Pain intensity (VAS), maximum mouth opening (MMO), and TMJ sounds were evaluated at baseline, 1 week, 12 weeks, and 24 weeks. Repeated-measures ANOVA and chi-square tests were used for analysis (p < 0.05).
    RESULTS: All groups showed significant improvements in pain and MMO over time. Mean VAS pain scores decreased from ~ 4.8 to < 1.0 at 24 weeks (p < 0.001), while MMO increased from ~ 32 mm to ~ 40 mm (p < 0.001). No significant differences were found between the PRP and HA groups in pain or function at any follow-up point, nor between either treatment group and the control group. TMJ clicking resolved or improved in > 95% of joints across all groups. No adverse events were recorded.
    CONCLUSION: TMJ arthrocentesis alone provides substantial pain relief and functional gains. PRP and HA did not confer additional benefit over lavage alone within the 6-month timeframe. Further studies are required to assess any potential long-term differences.
    Keywords:  Arthrocentesis; Hyaluronic acid; Platelet-rich plasma; Temporomandibular joint disorder
    DOI:  https://doi.org/10.1007/s10006-025-01502-8
  39. J Hand Surg Am. 2026 Jan;pii: S0363-5023(25)00636-7. [Epub ahead of print]51(1): 74-82
    Shear Wave Elastography of Normal Flexor Tendons of the Fingers and Its Clinical Application for the Diagnosis of Reruptured Tendons After Primary Repair.
    Julie Mercier, Mireille Moser, Sébastien Durand.
       PURPOSE: Shear wave elastography quantifies tissue stiffness. This study aimed to assess the stiffness of the flexor tendons of the fingers under physiological conditions in healthy individuals and compare the results with cases of tendon rupture.
    METHODS: Twenty-two healthy volunteers were enrolled in this study. Shear wave speed (SWS) measurements of the flexor tendons were obtained in three positions (rest, extension, and flexion) by two independent observers. The effects of laterality, fingers, time (repeating the measurements at 0, 2.5, and 5 min after initial positioning in extension), age, and sex were analyzed. Additionally, eight patients with tendon rupture after primary repair were assessed, and their SWS values were compared with those of healthy volunteers.
    RESULTS: We observed statistically significant differences in SWS values between rest and extension, as well as between rest and flexion. Tendon size also showed a statistically significant effect. Excellent inter-rater reliability was found between the two observers' measurements. Notably, the difference in SWS between a ruptured tendon and the contralateral healthy tendon of the same digit was considerably greater than the difference between any two healthy fingers.
    CONCLUSIONS: This study establishes a reference standard for SWS values in healthy flexor tendons and demonstrates the potential of shear wave elastography as a diagnostic tool for detecting tendon rupture in vivo. A standardized protocol is required for its reliability and reproducibility.
    TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IV.
    Keywords:  Diagnosis of ruptured tendon; flexor tendons of the fingers; shear wave elastography
    DOI:  https://doi.org/10.1016/j.jhsa.2025.11.005
  40. Arch Bone Jt Surg. 2025 ;13(12): 823-830
    Diagnostic Accuracy and Reliability of Dynamic Handheld Ultrasound Testing in Detecting Anterior Cruciate Ligament Tears: A Cadaveric Study.
    Yuzuru Sakakibara, Vasundhara Mathur, David O Osei-Hwedieh, Rohan Bhimani, Atta Taseh, Soheil Ashkani-Esfahani, Miho J Tanaka.
       Objectives: Anterior cruciate ligament (ACL) injuries can go undetected in the initial encounter, and delayed diagnosis can cause instability and an elevated risk of osteoarthritis. We hypothesized that dynamic testing under handheld ultrasound assessments of ACL insufficiency offers high diagnostic accuracy and reliability.
    Methods: Ten fresh-frozen knee specimens were evaluated in three conditions: (1) intact ACL, (2) complete ACL deficiency, and (3) ACL and Anterolateral ligament (ALL) deficiency. Dynamic testing under ultrasound was performed while simulating the Lachman test (tibial anterior translation with 0 and 100N, at 20 degrees knee flexion) and pivot shift test (internal rotation torque with 0 and 10Nm). The probe was placed at the anterior medial (AM) and lateral (AL) joint line, and anterior translation of the tibia (ΔD) relative to the femur was calculated. Intra-observer and inter-observer reliability were calculated, and receiver operating characteristic (ROC) curve analysis was performed for an ideal cutoff point for detecting knee instability.
    Results: From the AM view, ACL-deficient and ACL+ALL-deficient conditions significantly increased ΔD of the tibia during anterior loading compared to the intact ACL condition. The median ΔD values of the tibia in AM view with anterior drawer load were 0.64 (-0.10, 2.67) mm (intact ACL), 4.76 (2.46, 7.21) mm (ACL deficiency), and 3.88 (2.08, 7.23) mm (ACL+ALL deficiencies). The area under the ROC curve identifying ACL deficiency was 0.89 (95%CI, 0.66-0.97) in the AM view with anterior loading simulating the Lachman test. The optimal cut-off value to distinguish between the intact and ACL-deficient condition for anterior tibial translation with loading was 2.6 mm (sensitivity=80%, specificity=90%).
    Conclusion: Dynamic examination of the knee using portable handheld ultrasound from an AM view has high sensitivity and specificity in diagnosing ACL injury.
    Keywords:  ACL; Athletic injuries; Injuries; Knee instability; Lachman test; Ultrasonography
    DOI:  https://doi.org/10.22038/ABJS.2025.87885.3980
  41. JAMA. 2026 Jan 09.
    Physical Activity Safe in People With Low Back Pain.
    Shravya Pant.
      
    DOI:  https://doi.org/10.1001/jama.2025.23014
  42. Clin Transplant. 2026 Jan;40(1): e70432
    Optimizing Perioperative Outcomes in Liver Transplantation: The Role of Inpatient Rehabilitation.
    Laura Malmut, Sarah M Eickmeyer, Jacqueline Neal, Kim Barker, Julie Lanphere, Leslie Rydberg.
      Liver transplantation is the definitive treatment for individuals with end-stage liver disease. However, a range of medical and physical complications frequently arise following transplantation, which can hinder a patient's overall recovery. Post-operative rehabilitation is often necessary to support and enhance functional outcomes. This review explores the role of early mobilization and inpatient rehabilitation, outlines the rehabilitation process, defines the role of the physiatrist and the interdisciplinary rehabilitation team, and examines the potential functional gains for liver transplant recipients who undergo inpatient rehabilitation.
    Keywords:  general surgery; liver transplantation; recovery of function; rehabilitation
    DOI:  https://doi.org/10.1111/ctr.70432
  43. Ir J Med Sci. 2026 Jan 09.
    Effects of different kinesiology taping applications on Pain, muscular Fitness, Proprioception, Mobility, Functionality, and disability in patients with lumbar disc herniation.
    Elif Umay Altaş, Hilal Uzunlar, Ecem Beytorun, Eylem Çağla Danacı, Filiz Meryem Sertpoyraz, Sevtap Günay Uçurum.
       OBJECTIVE: This study aimed to compare the effects of different kinesiology taping techniques added to a standard treatment regimen.
    METHODS: Ninety patients with disc herniation were grouped into three groups: physical therapy + star taping (Group 1), physical therapy + I-taping (Group 2), and physical therapy alone (Group 3). Pain intensity, pressure pain threshold (PPT), back extensor muscle strength and endurance, proprioception, lumbar lordosis angle (LLA), lumbar range of motion, functional level, and disability level were assessed. All measurements were recorded before treatment, immediately after treatment, and at the 12-week follow-up.
    RESULTS: In Group 3, an improvement was observed in pain intensity, disability, functionality, joint range of motion, and proprioception at 60° and extension. In addition to improvements observed in Group3, Groups1 and 2 showed significant improvements in PPT, extensor muscle strength, LLA, and 45° proprioception (p < 0.05). Group1 exhibited an increase in LLA compared to baseline (p < 0.05). Compared to Group3, disability decreased in Group1, while extensor muscle strength increased in Group2. At the 12-week follow-up, LLA increased in Group1 but decreased in Group2 compared to post-treatment measurements (p < 0.05).
    CONCLUSION: The addition of kinesiology taping to standard physical therapy has been shown to provide additional benefits for pressure pain threshold, extensor muscle strength, 45-degree proprioception, and lumbar lordosis angle in patients with LDH. Selecting specific taping techniques based on clinical goals may increase the effectiveness of treatment programs.
    CLINICAL TRIALS REGISTRATION NUMBER: NCT06777095 (retrospectively registered).
    Keywords:  Chronic pain; Disability; Lumbar disc disease; Mobility physical fitness; Proprioception; Taping
    DOI:  https://doi.org/10.1007/s11845-025-04250-6
  44. Open Access J Sports Med. 2025 ;16 205-221
    Hip Microinstability: Current Concepts in Diagnosis, Surgical Management, and Outcomes A Narrative Review.
    Alan D Villegas Meza, Michael Nocek, Nicholas A Felan, Alyson Speshock, Ioanna K Bolia, Marc J Philippon.
       Background: Hip microinstability-subtle, symptomatic femoral head translation without dislocation-compromises the labral suction seal and accelerates chondrolabral wear. Clinical overlap with femoroacetabular impingement syndrome (FAIS) and borderline dysplasia delays recognition.
    Purpose: To synthesize contemporary evidence on definitions, diagnosis, imaging, management, and outcomes in hip microinstability and to propose a phenotype-guided framework grounded in the labrum-capsule-ligamentum teres (LT) stability continuum.
    Study Design: Narrative review.
    Methods: Peer-reviewed literature (2000-2025) focusing on biomechanical investigations, comparative cohorts, meta-analyses, and consensus statements on microinstability, hip capsular management, borderline dysplasia, and LT pathology.
    Results: A four-pillar diagnostic approach improves accuracy. The Abduction-Hyperextension-External Rotation (AB-HEER) and Hyperextension-External Rotation (HEER) tests provide the highest single-test accuracy among exam maneuvers, whereas the prone instability test offers high specificity to rule in. The femoroepiphyseal acetabular roof (FEAR) index aids in risk stratification for borderline dysplasia but is position-sensitive. Arthroscopy with labral preservation and complete hip capsular closure improves patient-reported outcomes (PROs) and survivorship relative to non-closure. Iatrogenic cam over-resection can precipitate microinstability; femoral head-neck remplissage is a revision option to restore contour and sealing mechanics. In borderline dysplasia, both arthroscopy and periacetabular osteotomy (PAO) improve PROs when selection is phenotype-guided; PAO trends toward lower total hip arthroplasty (THA) conversion when undercoverage is the primary driver. Early postoperative circumduction is associated with lower rates of adhesion-related reoperation. Return-to-sport (RTS) decisions are criteria-based rather than time-based across successful programs.
    Conclusion: A seal-first, close-second strategy, situated within a stability continuum, underpins contemporary care. Standardized definitions, objective laxity metrics, multicenter registries, and microinstability-specific rehabilitation/RTS batteries are needed to refine indications and improve durability; evidence specific to labral augmentation in microinstability remains limited.
    Clinical Relevance: Precise phenotyping and capsular stewardship reduce the risk of revision hip arthroscopy and conversion to total hip arthroplasty, inform sport-specific counseling, and align with joint-preservation goals in young, active patients.
    Level of Evidence: V (Narrative Review).
    Keywords:  Hip arthroscopy; Hip capsule; femoroacetabular impingement; labral repair; microinstability; sports medicine
    DOI:  https://doi.org/10.2147/OAJSM.S505874
  45. Sensors (Basel). 2025 Dec 25. pii: 142. [Epub ahead of print]26(1):
    Correlation Between Instrumented Timed Up and Go Test Performance and Muscle Strength in Knee and Hip Osteoarthritis: An Exploratory, Cross-Sectional Study.
    Mathilde Pelletier Visa, Lech Dobija, Anargyros Verdilos, Aurélien Mullez, Vivien Reynaud, Paul Gignoux, Frederic Costes, Emmanuel Coudeyre.
      Muscle weakness is a key contributor to functional limitation in individuals with hip (HOA) or knee osteoarthritis (KOA). Identifying accessible and objective tools to estimate muscle strength could improve clinical assessment and rehabilitation monitoring. This exploratory cross-sectional study investigated the relationship between parameters derived from the instrumented Timed Up and Go test (iTUG), and isokinetic quadriceps and hamstring strength in individuals with KOA or HOA. Thirty-six participants with KOA and 21 with HOA were assessed. Quadriceps and hamstring peak torques were measured at 60°/s using an isokinetic dynamometer. The iTUG was performed with a sacrum-mounted inertial measurement unit. Correlations between iTUG parameters and lower-limb muscle strength were weak-to-moderate in KOA (r = -0.398 to -0.516, p < 0.05) and moderate-to-strong in HOA (r= -0.537 to -0.843, p < 0.05). Total iTUG duration strongly correlated with the traditional stopwatch TUG (r = 0.91, p < 0.01), suggesting that the classic stopwatch-based TUG may offer comparable clinical insights to certain iTUG-derived temporal metrics. The iTUG test reflects lower-limb muscle weakness, especially in HOA, with vertical push-off power and temporal metrics showing the strongest relationships. These results support the use of iTUG as an accessible tool for estimating muscle weakness when isokinetic testing is unavailable. However, these findings should be interpreted with caution given the small sample size.
    Keywords:  chronic disease; hip osteoarthritis; knee osteoarthritis; muscle strength; timed up and go test
    DOI:  https://doi.org/10.3390/s26010142
  46. Ann Neurol. 2026 Jan 08.
    Conditioning Electrical Stimulation for Patients with Moderate or Severe Carpal Tunnel Syndrome: Double Blinded Randomized Controlled Trial.
    Central and Northern Alberta Peripheral Nerve Injury Research Consortium
       OBJECTIVE: Carpal tunnel syndrome (CTS) can drastically impair one's ability to work and interferes with activities of daily living. We recently demonstrated that, in rodents, conditioning electrical stimulation (CES) delivered to the nerve 7 days prior to surgery imparts a conditioning lesion-like effect by accelerating the rate of regeneration along the entire length of the nerve. The goal of this study is to test the hypothesis that CES could accelerate nerve regeneration and improve function in patients with moderate or severe CTS.
    METHODS: Using a double-blind randomized controlled study design, patients received surgery + CES or surgery + sham stimulation. They were evaluated at regular intervals for 12 months following intervention. Primary outcome was motor unit number estimation (MUNE), supplemented with secondary outcomes including motor and sensory nerve conduction studies, Semmes Weinstein Monofilaments, and Moberg Pick-Up Test.
    RESULTS: Sixty-four participants were randomized to either the treatment or control groups. There was no significant demographic or physiological difference at baseline between the groups. No major adverse event was found with treatment. Following intervention, there was significantly greater increase in MUNE of 62 ± 71 in the treatment group compared to 25 ± 66 in the controls after 12 months. In the treatment group, there was correspondingly better physiological and functional recovery and hand dexterity compared with the controls.
    INTERPRETATION: CES is a safe, feasible, and efficacious treatment to improve nerve reinnervation and functional outcomes in patients with moderate or severe CTS. This may open future possibilities for more effective treatment for other peripheral nerve injuries. ANN NEUROL 2026.
    DOI:  https://doi.org/10.1002/ana.78155
  47. Clin Case Rep. 2026 Jan;14(1): e71806
    Continuous Passive Motion in the Rehabilitation of a Comminuted Patellar Fracture Following Delayed Physiotherapy Initiation: A Case Report.
    Mohammad Ali, Timothy Miller.
      Comminuted patellar fractures are challenging injuries, and delays in post-operative physiotherapy significantly increase the risk of arthrofibrosis and long-term disability, particularly in resource-limited settings. A 40-year-old male with multiple comorbidities presented 53 days after open reduction and internal fixation (ORIF) for a comminuted patellar fracture, suffering severe knee stiffness. Initial assessment revealed profound functional impairment: knee flexion limited to 10°, a Visual Analog Scale (VAS) pain score of 8/10, a Kujala score of 19/100, and a Lysholm score of 7/100. A 4-week rehabilitation program consisting of supervised Continuous Passive Motion (CPM) (1 h/day, 4 days/week) and a structured home exercise program was implemented. CPM parameters were progressed based on pain (VAS ≤ 4) and tolerance. After 4 weeks, the patient achieved 110° of knee flexion, pain reduced to 0/10 at rest and 3/10 with movement, and functional scores improved dramatically (Kujala: 69/100; Lysholm: 76/100). This case demonstrates that a combined CPM and home exercise protocol can yield substantial functional recovery even when rehabilitation is initiated late following a complex patellar fracture. It highlights a feasible and effective intervention model for resource-constrained environments where delayed rehabilitation is common.
    Keywords:  case report; continuous passive motion; knee stiffness; patellar fracture; physiotherapy; post‐operative rehabilitation
    DOI:  https://doi.org/10.1002/ccr3.71806
  48. Clin J Sport Med. 2026 Jan 05.
    Ultrasound-Guided Ossicle Excision for Chronic Osgood-Schlatter Disease and Sinding-Larsen-Johansson Syndrome: A Case Series and Review of the Literature.
    Angel Dolores-Rodriguez, Patrick Krockmal, Seth L Sherman, Christine Townsend, Walter I Sussman.
       OBJECTIVE: To describe a novel, minimally invasive, ultrasound-guided technique for excision of ununited ossicles in patients with chronic Osgood-Schlatter disease (OSD) and Sinding-Larsen-Johansson syndrome (SLJS) who failed conservative management.
    DESIGN: Retrospective case series.
    SETTING: Ambulatory surgical center.
    PATIENTS: Five skeletally mature patients (ages 16-44 years), including competitive athletes and adults with chronic anterior knee pain due to OSD (n = 3) or SLJS (n = 2), all of whom remained symptomatic despite standard conservative treatments.
    MAIN INDEPENDENT VARIABLE: Ultrasound-guided resection of intratendinous ossicles using a TX-bone device under local anesthesia, followed by a structured rehabilitation protocol.
    MAIN OUTCOME MEASURES: Pain relief, ability to return to sport or prior activity, and functional recovery at 2 to 12 weeks postprocedure.
    RESULTS: All 5 patients successfully underwent ultrasound-guided ossicle excision without perioperative complications. Each reported meaningful pain reduction and returned to unrestricted activities within 2 to 12 weeks. Follow-up ranged from 6 to 14 months, with sustained symptom relief and return to prior sport participation. Outcomes compared favorably with open and arthroscopic techniques described in the literature.
    CONCLUSIONS: This case series is the first to describe an ultrasound-guided technique for excision of chronic, symptomatic OSD and SLJS ossicles. The approach demonstrated rapid recovery, excellent pain relief, and favorable functional outcomes. Further prospective studies with larger cohorts are warranted to validate efficacy and long-term safety.
    Keywords:  Osgood–Schlatter disease; Sinding-Larsen-Johansson syndrome; Tenex; anterior knee; percutaneous; tenotomy; ultrasound
    DOI:  https://doi.org/10.1097/JSM.0000000000001410
  49. Arch Orthop Trauma Surg. 2026 Jan 07. 146(1): 31
    Which MRI signs truly predict subscapularis tears? A multivariate analysis of 278 arthroscopic cases.
    Michael Marsalli, Ernesto Donoso, Marco Cartaya, Juan de Dios Errázuriz.
       PURPOSE: To determine the diagnostic performance of magnetic resonance imaging (MRI) for subscapularis (SSC) tendon tears, identify the strongest independent MRI predictors, and evaluate the accuracy of MRI in predicting tear size.
    METHODS: A retrospective cohort study of patients who underwent arthroscopic rotator cuff repair was conducted. From a total of 376 surgeries, 278 patients met the inclusion criteria. All patients had a preoperative 1.5-T MRI. A blinded shoulder surgeon and a musculoskeletal radiologist independently evaluated six MRI signs for SSC rupture. Arthroscopic findings served as the gold standard. Diagnostic performance metrics (accuracy and predictive value) were calculated, and a multivariate logistic regression was performed to identify independent predictors.
    RESULTS: Arthroscopy confirmed an SSC tear in 99 of 278 patients (35.6%). For the radiologist, overall accuracy was 73%; for the surgeon, it was 70%. Performance was substantially higher for complete tears than for partial tears, with a positive predictive value for partial tears of only 24%. Multivariate logistic regression identified two independent predictors of an SSC tear: tendon hyperintensity on axial images (OR 3.97, p < 0.001) and a "naked" lesser tuberosity on sagittal images (OR 4.83, p = 0.029). A simplified diagnostic model based on these two signs achieved an accuracy of 75.5%, with 74.7% sensitivity and 76.0% specificity.
    CONCLUSION: MRI performance is poor for diagnosing partial SSC tears but good for complete tears. Tendon hyperintensity (axial) and a naked lesser tuberosity (sagittal) are the strongest independent predictors of an SSC tear. A simplified diagnostic model focusing on these two signs may offer a more efficient and accurate approach to preoperative assessment.
    Keywords:  Diagnostic accuracy; Logistic regression; Magnetic resonance imaging; Predictive value; Rotator cuff; Subscapularis
    DOI:  https://doi.org/10.1007/s00402-025-06175-2
  50. Biomol Ther (Seoul). 2026 Jan 01. 34(1): 80-101
    Recent Advances in Therapeutic Approaches for Knee Osteoarthritis: a Narrative Review.
    Md Solayman Hossain, Hyun Jae Lee, Rajib Hossain, Chang Moo Kim, Choong Jae Lee, Sun-Chul Hwang.
      Knee osteoarthritis (KOA) is a progressive and chronic musculoskeletal condition that continues to be the leading cause of disability worldwide. Conventional treatment approaches for the management of KOA largely focus on symptom alleviation rather than halting or reversing disease progression. However, recent advancements have highlighted the integrated interplay of mechanical stress, inflammation, cellular senescence, and chondrocyte dysfunction in the progression of KOA, in turn prompting new therapeutic strategies. Therefore, emerging interventions such as regenerative medicine, gene therapy, senolytic, platelet-rich plasma (PRP), disease-modifying osteoarthritis drugs (DMODs), and biologics have broadened the therapeutic options. Additionally, natural compounds demonstrated potential in KOA treatment with promising chondroprotective and anti-inflammatory effects. Moreover, digital technologies and clinical and molecular phenotyping enhanced early diagnosis, monitoring, and personalized management of the disease. Therefore, the current narrative review focuses on the molecular insights, clinical outcomes and prospects for the rapidly evolving landscape of current and emerging treatment approaches for the management of knee osteoarthritis (KOA).
    Keywords:  Disease-modifying drugs; Gene therapy; Knee osteoarthritis
    DOI:  https://doi.org/10.4062/biomolther.2025.203
  51. Cureus. 2025 Nov;17(11): e98189
    A Novel Case of Trigger Finger Caused by A1 Pulley Calcification Successfully Treated With Ultrasound-Guided Prolotherapy: A Case Report and Literature Review.
    Yonghyun Yoon, Ji Hyo Hwang, Jaehyun Shim, Rowook Park, Jaeyoung Lee, King Hei Stanley Lam.
      Trigger finger is commonly attributed to thickening of the A1 pulley or flexor tendons. Although calcific tendinitis is well recognized in regions such as the shoulder, calcification within the A1 pulley itself is extremely rare and seldom reported as a primary cause of triggering. We describe a 43-year-old woman who presented with painful triggering of the right little finger, accompanied by morning stiffness, snapping, and focal tenderness with warmth over the volar metacarpophalangeal (MCP) joint. Radiographs and high-resolution ultrasonography revealed a calcific deposit in the superficial layer of the A1 pulley, with surrounding hypervascularity on Doppler imaging. The patient underwent three sessions of ultrasound-guided prolotherapy in conjunction with physiotherapy and night splinting, which led to complete resolution of pain, stiffness, and triggering. This case identifies A1 pulley calcification as a rare but distinct etiology of trigger finger and highlights the diagnostic utility of ultrasonography in detecting this lesion. Moreover, it demonstrates that ultrasound-guided prolotherapy can provide an effective, minimally invasive alternative to surgical release, particularly when standard conservative management fails. Ultrasound-guided prolotherapy was selected as the primary intervention, instead of corticosteroid injection (CI), given its potential to promote tissue repair and resorption of calcific deposits, which are less effectively addressed by corticosteroids whose effect is primarily anti-inflammatory. Symptom improvement was observed after each biweekly session, with complete resolution achieved four weeks after the initial intervention. In addition to pain reduction documented by the Visual Analog Scale (VAS), the patient experienced the elimination of morning stiffness and snapping and restoration of full finger range of motion (ROM) following the final prolotherapy session.
    Keywords:  a1 pulley; calcific tendinitis; calcific tendinopathy; prolotherapy; stenosing tenosynovitis; trigger finger; ultrasound-guided intervention
    DOI:  https://doi.org/10.7759/cureus.98189
  52. J Hand Surg Asian Pac Vol. 2026 Jan 05.
    Outcomes of Simultaneous Open Triangular Fibrocartilage Complex Repair with Extensor Carpi Ulnaris Stabilisation.
    Mehek Gupta, Ellen Y Lee, David M K Tan.
      Background: Triangular fibrocartilage complex (TFCC) disruption and extensor carpi ulnaris (ECU) instability are common concomitant injuries. This study presents outcomes of simultaneous open TFCC repairs with ECU stabilisation. Methods: This retrospective cohort study reviewed patients with symptomatic distal radio-ulnar joint (DRUJ) instability and ECU subluxation who underwent simultaneous open repair of the TFCC and ECU stabilisation between 2014 and 2016. Patients were diagnosed clinically, and TFCC tear and ECU subluxation were confirmed using magnetic resonance imaging (MRI) and ultrasound (US), respectively. All patients initially underwent therapy, and surgery was offered to those with persistent symptoms. Open foveal repair of the TFCC was performed using suture anchors, while ECU stabilisation was done by deepening of the ECU groove and subsheath reconstruction. Data collected included demographics, injury details, pre- and post-surgical symptoms, range of motion, grip strength and the modified Mayo wrist score (MMWS). Results: Eleven patients were included in the study. They presented with ulnar-sided wrist pain that limited their activities of daily living. All could recall a specific injury prior to the onset of symptoms. All patients had improvement in measured outcomes after surgery. The preoperative difference in mean arc of motion between the injured and uninjured wrist improved after surgery. The mean grip strength of the injured wrist compared to the uninjured wrist improved from 72% to 93%. The mean MMWS improved from 66.4 before surgery to 92.7 after surgery. Ten of eleven patients were pain-free at the last review, and all could carry out daily activities comfortably. The follow-up duration averaged 18 months (range: 3 months-4 years). Conclusions: The outcomes of simultaneous open repair of the TFCC and stabilisation of the ECU are excellent. Patients with DRUJ instability should be screened for ECU instability, and both pathologies should be addressed simultaneously. Level of Evidence: Level IV (Therapeutic).
    Keywords:  Distal radioulnar joint (DRUJ) instability; ECU subsheath reconstruction; Extensor carpi ulnaris (ECU) subluxation; Triangular fibrocartilage complex (TFCC); Ulnar-sided wrist pain
    DOI:  https://doi.org/10.1142/S2424835526500049
  53. Eur Spine J. 2026 Jan 09.
    The effect of exercıse program on exercıse perceptıon and fear of movement ın low back paın.
    Mine Arğali Deniz, Burcu Özüberk, Feray Soyupek.
      
    Keywords:  Exercise barriers; Exercise benefits; Fear of movement; Flexibility; Low back pain
    DOI:  https://doi.org/10.1007/s00586-025-09720-0
  54. Cureus. 2025 Dec;17(12): e98323
    Cooled Radiofrequency Ablation Versus Cryoneurolysis of the Genicular Nerves for the Symptomatic Pain Management in Knee Osteoarthritis: A Prospective, Randomized, Single-Blinded Clinical Trial.
    Panagiotis Tsiplakos, Andreas Panagopoulos, Konstantinos Katsanos, Nikolaos Parchas, Evangelia Christodoulou, John Lakoumentas, Dimitris Karnabatidis, John Gliatis.
       PURPOSE: Knee osteoarthritis (KOA) is a common disease that significantly affects the quality of life of patients. Among several nonsurgical methods of symptomatic treatment, cooled radiofrequency ablation (CRFA) and cryoneurolysis (CRYO) have gained traction recently. This study compared the two methods in their capacity to reduce pain and improve clinical outcomes in patients with KOA.
    METHODS: This was a prospective, randomized, single-blinded clinical trial that included 25 patients with KOA in each group. The classic targets of the superior lateral and medial genicular and inferior medial genicular nerves were used, as well as the medial (retinacular) genicular branch from the vastus intermedius. Patients were evaluated using the Numerical Pain Scale (NRPS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Oxford Knee Score (OKS) at baseline and at one, three, and six months post-intervention.
    RESULTS: Both methods were able to reduce pain and display improved clinical outcomes in all three post-intervention evaluations. However, at the six-month mark, CRFA showed a clear advantage: NRPS decreased from a baseline mean of 7 to 3.1 (compared to 6.2 for cryoneurolysis); KOOS improved from a baseline mean of 45.4 to 64 (compared to 56 for cryoneurolysis); OKS improved from a baseline mean of 20 to 33 (compared to 26 for cryoneurolysis). No serious procedure-related adverse events were reported.
    CONCLUSIONS: Both CRFA and cryoneurolysis of the genicular nerves are effective treatment options for KOA symptoms. However, CRFA displays a more durable therapeutic effect after the one-month period, with a clear advantage at the six-month evaluation.
    Keywords:  cooled radiofrequency ablation; cryoneurolysis; genicular nerves; knee osteoarthritis; persistent knee pain
    DOI:  https://doi.org/10.7759/cureus.98323
  55. Ann Med Surg (Lond). 2026 Jan;88(1): 422-435
    Geometric and biomechanical perspectives on ulnar nerve compression in cubital tunnel syndrome: pathomechanics and surgical strategies.
    Tianyou Hu, Hongxiang Zhou.
      Cubital tunnel syndrome (CuTS) is the second most common upper extremity nerve entrapment disorder, characterized by compression of the ulnar nerve at the elbow. Traditional surgical classifications have emphasized anatomical depth or technical complexity, but they inadequately account for the geometric and biomechanical factors influencing nerve tension, strain, and recovery. This review introduces a geometric model that conceptualizes the ulnar nerve's trajectory during elbow flexion as a sharply angled triangle, where greater curvature correlates with higher mechanical stress and elongation. Surgical strategies are reclassified based on their degree of geometric correction: noncorrective, indirect corrective, and direct path reconfiguration. We critically analyze the biomechanical implications and clinical outcomes of each technique, supported by dynamic imaging, cadaveric data, and neurophysiological metrics such as motor conduction velocity and grip strength recovery. Submuscular transposition achieves the most complete path realignment and consistently demonstrates superior functional results. The review also highlights gaps in current literature, particularly the lack of quantifiable biomechanical outcome measures such as nerve curvature, strain, and excursion. We propose a new classification system and recommend incorporating geometric metrics into future surgical planning and comparative studies. By reframing surgical choices around path correction rather than procedural nomenclature, this model offers a more precise, individualized approach to CuTS management.
    Keywords:  cubital tunnel syndrome; minimally invasive surgical procedures; nerve regeneration; surgical procedures; ulnar nerve
    DOI:  https://doi.org/10.1097/MS9.0000000000004348
  56. Br J Sports Med. 2026 Jan 05. pii: bjsports-2025-110872. [Epub ahead of print]
    Rethinking the disc: from degenerative narrative to adaptive potential.
    Rilind Shala.
      
    Keywords:  Exercise; Health; Rehabilitation
    DOI:  https://doi.org/10.1136/bjsports-2025-110872
  57. BMJ Case Rep. 2026 Jan 05. pii: e265860. [Epub ahead of print]19(1):
    Entrapment of the median nerve within the radius following diaphyseal antebrachial fractures treated with nail osteosynthesis in two paediatric patients.
    Lucas Emil Jørgensen Østergaard, Erisela Qerama, Mats Bue, Maiken Stilling.
      Antebrachial fractures are common among paediatric patients. Some exhibit neurological symptoms, making it initially challenging to determine nerve injury severity. We present two paediatric cases of median nerve entrapment within the radius following mid-shaft antebrachial fractures. Both cases showed persistent sensory and motor deficits, paraesthesia and pain in the distribution area of the median nerve after nail osteosynthesis. Nerve conduction studies and ultrasound suggested nerve entrapment at the fracture site, leading to surgical exploration and nerve autograft repair at 12 months (case 1) and nerve allografting at 34 months (case 2) post injury. At 18 months follow-up, case 1 had regained full sensory function but showed no clinical signs of motor reinnervation. Case 2 regained normal motor function, but sensory function remained impaired at 39 months follow-up. Early recognition and intervention of nerve injuries are crucial for improving the likelihood of better outcomes and minimising the risk of disabling sequelae.
    Keywords:  Clinical neurophysiology; Fracture Fixation, Intramedullary; Intramedullary Nailing; Orthopaedics; Trauma CNS /PNS
    DOI:  https://doi.org/10.1136/bcr-2025-265860
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