bims-ricfun Biomed News
on Rehabilitation ICF
Issue of 2026–01–25
fifty-six papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica
  1. Comparison of the effectiveness of platelet-rich plasma (PRP) injection and steroid injection in patients with bilateral moderate carpal tunnel syndrome: a prospective randomized controlled trial.
  2. [Expert consensus on rehabilitation following arthroscopic surgery for femoroacetabular impingement syndrome (2025 edition)].
  3. Clinical Challenges in Managing Shoulder Osteoarthritis and Suprascapular Neuropathy.
  4. Rehabilitation outcomes of older persons within the context of the International Classification of Functioning, Disability and Health (ICF): a systematic review.
  5. Long-Term Efficacy of Intra-Articular Platelet-Rich Plasma in Knee Osteoarthritis: A 6-Year Follow-up of a Prospective Cohort.
  6. Effects of Motor Imagery on Movement-Based Fear in Musculoskeletal Conditions: A Critically Appraised Topic.
  7. Orthopedic Rehabilitation Following Complex Repair of the Flexor and Extensor Tendons, Artery, and Nerve: A Case Report.
  8. Management of the Infrapatellar Fat Pad in Total Knee Arthroplasty: A Comprehensive Review of Recent Evidence.
  9. [Should carpal tunnel syndrome treatment start with surgery or an injection?]
  10. Evolution of Carpal Tunnel Syndrome Treatment: A Narrative Review.
  11. Qualitative and quantitative situational characteristics of muscle strains in sports: a systematic review and meta-analysis.
  12. Improving anterior cruciate ligament reconstruction outcomes using a unified return-to-sport communication framework.
  13. Unusual Triggering of the Finger Caused by Distal Flexor Tendinopathy: Successful Treatment With Ultrasound-Guided Prolotherapy.
  14. Anatomical Investigation of the Gluteus Medius Muscle Innervation and Its Topographical Correspondence With Myofascial Trigger Points.
  15. Anatomical Variations of the Neurovascular Structures of the Hand and the Clinical Significance.
  16. Intra-Articular vs Medial Branch Pulsed Radiofrequency in the Management of Lumbar Facet Joint-Related Low Back Pain: A Prospective Randomized Trial.
  17. Is there a need to modify the anatomical targets for genicular nerve ablation in prosthetic knees compared with native knees? A cadaveric study.
  18. Prophylactic triple neurectomy during open tension-free inguinal hernia repair: a clinical trial for the prevention of chronic postoperative pain.
  19. Assessment of Subepidermal Low-Echogenic Band via High-Frequency Ultrasound for Evaluating the Efficacy of Platelet-Rich Plasma Injection in Treating Facial Skin Photoaging: A Case Series.
  20. Comment on: "Longitudinal Associations Between Baseline Sarcopenia and Knee Osteoarthritis Progression and Risk of Knee Replacement" - Intramuscular Fat Infiltration: A Hidden Covariate in the Sarcopenia-Knee Osteoarthritis Association? Leveraging OAI MRI Data for Adjustment.
  21. Intrapalm nerve transfers to improve intrinsic hand function in isolated ulnar or median nerve injuries: illustrative cases.
  22. Reconsidering periosteal denervation: Anatomical redundancy and the limits of single-target interventions.
  23. Combining Robotics and Microbiome Science to Treat Unusual Post-Herpetic Neuralgias Resembling Complex Regional Pain Syndrome.
  24. Efficacy of Combined Intra-Articular Hyaluronic Acid and Ketorolac versus Ketorolac Alone in the Treatment of Adhesive Capsulitis: A Randomized Controlled Trial.
  25. Mapping the Existing Return-to-Sport Criteria After Pectoralis Major Tendon Injury in Different Sports: A Scoping Review for Getting Back to the Game.
  26. Persistent scapular dyskinesis after arthroscopic rotator cuff repair: a prospective study.
  27. Mesenchymal stem cell-based therapy for osteoarthritis: a systematic review and meta-analysis of clinical outcomes and functional recovery.
  28. Effect of Eccentric Control Exercises on Patients with Frozen Shoulder and Mild to Moderate Disability: A Single-Group Pre-Post Study.
  29. Robotic Ultrasound-Guided Musculoskeletal Injections: The Next Frontier in Precision Medicine.
  30. Effects of different exercise interventions on lower back pain: a systematic review and meta-analysis.
  31. Goals and expectations of older persons recovering from a hip fracture during geriatric rehabilitation: a qualitative study.
  32. The effects of amputation on functioning, satisfaction and health-related quality of life of adults with brachial plexus injury; a scoping review.
  33. Acute Repair of Latissimus Dorsi and Teres Major Tendon Tears.
  34. Efficacy and safety of erector spinae plane block in non-specific low back pain: an exploratory systematic review.
  35. Outcomes of Simultaneous Bilateral, Staged Bilateral, and Unilateral Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Systematic Review and Meta-analysis.
  36. Botulinum toxin for endometriosis-associated chronic pelvic pain: a randomised, double-masked, parallel, phase 2 trial.
  37. Wrist-arthroscopy treatment of carpal bone cysts.
  38. A Multivariate Analysis of Radiographic Healing in Pediatric Athletes Diagnosed With Spondylolysis.
  39. The Adaptive Proximal Scaphoid Implant: Long-Term Follow-Up.
  40. Hip Spine Syndrome: Management of Patients With Concurrent Hip and Spine Degenerative Pathologies.
  41. Short-Term Clinical Outcomes of Platelet-Rich Plasma Therapy in Patellofemoral Chondromalacia: Evaluating Pain Reduction and Functional Improvement in a Six-Month Retrospective Study.
  42. Preprocedural superomedial pain localization as a predictor for short-term clinical improvement after cooled radiofrequency ablation in advanced knee osteoarthritis.
  43. A Randomized Controlled Trial of 1-Year Clinical Outcomes of a Single Platelet-Rich Plasma Injection Versus Corticosteroid for the Treatment of Lateral Elbow Tendinopathy.
  44. Analgesic effect of intravenous nefopam for postoperative pain in spine surgery: a meta-analysis of RCTs.
  45. Ultrasound-Based Assessment of Shoulder Soft Tissue Alterations in Young Adults Performing Upper Limb Weight Training: A Cross-Sectional Study.
  46. Robotic-assisted restricted kinematic alignment in total knee arthroplasty: A multicenter retrospective assessment of coronal phenotypes and early postoperative outcomes.
  47. Minimally Invasive Interventional Management of Pudendal Neuralgia: A Narrative Review.
  48. Muscle Quality and Post-THA Falls: Interpreting the Clinical Impact of Gluteus Medius Fatty Infiltration.
  49. Intra-articular Hyaluronic Acid for Knee Osteoarthritis: Stabilizing Utilization Trends Amid Conflicting Clinical Practice Guidelines.
  50. Methotrexate for Osteoarthritis: What Does the Evidence Say?
  51. Postural stability impairments in non-athletic individuals after anterior cruciate ligament reconstruction: a cross-sectional study.
  52. DIP joint is ankle joint, PIP joint is knee joint, and MCP joint is hip joint - Treat them accordingly.
  53. Analysis of balance in adults with chronic axial spinal pain receiving medial branch block or radiofrequency ablation procedures.
  54. The Use of Botulinum Toxin Injections in Peripheral Neuropathic Pain: A Systematic Review of Efficacy and Safety Outcomes.
  55. [Central mechanism of the short-needling method for treating knee osteoarthritis based on EEG signals].
  56. Anterior Cruciate Ligament Rupture with Concurrent Gastrocnemius Tear: A Case Report of a Rare Pattern of Injury.
  1. Injury. 2026 Jan 09. pii: S0020-1383(26)00005-7. [Epub ahead of print]57(3): 113018
    Comparison of the effectiveness of platelet-rich plasma (PRP) injection and steroid injection in patients with bilateral moderate carpal tunnel syndrome: a prospective randomized controlled trial.
    Üzeyir Cansever, Şebnem Koldaş Doğan, İclal Erdem Toslak, Meral Bilgilisoy Filiz, Naciye Fusün Toraman.
       BACKGROUND AND OBJECTIVE: To compare the effectiveness of platelet-rich plasma (PRP) injection, corticosteroid injection, and wrist splinting in patients with bilateral moderate carpal tunnel syndrome (CTS) using clinical, electrophysiological, and radiological parameters.
    MATERIAL AND METHODS: This randomized controlled study included 45 patients with bilateral moderate carpal tunnel syndrome, divided equally into three groups: PRP + splint, steroid + splint, and splint-only (control). Assessments were conducted pre-treatment and at 1 and 6 months post-treatment using VAS scores (pain and numbness), pinch and grip strength, QuickDASH questionnaire, EMG, and MRI.
    RESULTS: VAS scores significantly improved in all groups at both follow-ups, with greater reductions in night pain and numbness in the PRP and steroid groups versus control. All groups showed improved strength at month 1; by month 6, grip strength improved only in the PRP group, while pinch strength improved in both PRP and steroid groups. While A significant reduction in the Quick DASH symptom score was observed in the PRP and steroid groups, EMG findings improved significantly in all groups. MRI showed a significant decrease in palmar bowing in the PRP and steroid groups.
    CONCLUSION: While both PRP and steroid injections were more effective than splinting alone in improving symptoms and function, PRP demonstrated some indications of more sustained benefits, particularly at the 6-month follow-up.
    Keywords:  Carpal tunnel syndrome; Magnetic resonance imaging; Platelet rich plasma; Steroid
    DOI:  https://doi.org/10.1016/j.injury.2026.113018
  2. Zhonghua Yi Xue Za Zhi. 2026 Jan 20. 106(3): 221-230
    [Expert consensus on rehabilitation following arthroscopic surgery for femoroacetabular impingement syndrome (2025 edition)].
    Spine and Hip Joint Study Group of the Sports Medical Branch of the Chinese Medical Association
      Femoroacetabular impingement syndrome (FAIS) is a prevalent hip disorder, and arthroscopic surgery has emerged as the preferred treatment modality, which has been rapidly adopted in clinical practice across China. Rehabilitation plays a pivotal role in ensuring functional recovery, normal daily activities, and return to sports for orthopedic surgery patients. However, standardized protocols and evidence-based guidelines for perioperative rehabilitation following FAIS arthroscopic surgery remain lacking in China. This expert group organized specialists to develop a rehabilitation consensus for patients with femoroacetabular impingement syndrome (FAIS) requiring arthroscopic surgery, based on systematic literature review, evidence quality assessment, and clinical rehabilitation practice, using the modified Delphi method. The consensus addresses three key aspects: basic principles and common methods, critical issues in rehabilitation intervention, and considerations for special populations. Specifically, it covers fundamental rehabilitation principles, common assessment methods, preoperative rehabilitation, psychological rehabilitation, and postoperative rehabilitation (including phased rehabilitation and progression criteria, pain management, muscle function training, joint range of motion training, weight-bearing training, the clinical value of platelet-rich plasma injections, and return-to-sport criteria). Additionally, it includes rehabilitation considerations for patients of different age groups and those undergoing various surgical approaches, totaling 13 recommendations. This consensus aims to provide evidence-based guidance for clinicians and rehabilitation therapists, facilitating personalized and comprehensive rehabilitation management for FAIS patients undergoing arthroscopic surgery.
    DOI:  https://doi.org/10.3760/cma.j.cn112137-20250523-01269
  3. Cureus. 2025 Dec;17(12): e99345
    Clinical Challenges in Managing Shoulder Osteoarthritis and Suprascapular Neuropathy.
    José Eduardo Sousa, Nuno Madureira, Paula Freire, Matilde Rodrigues, Andreia Morgado.
      Chronic shoulder pain is a common and multifactorial condition. Suprascapular nerve neuropathy, although relatively uncommon, may lead to pain, weakness, and muscle atrophy as a result of extrinsic compression, trauma, or inflammation. When it occurs in the presence of glenohumeral osteoarthritis, overall shoulder function may be further compromised, complicating both diagnostic assessment and therapeutic decision-making. We report the case of a 56-year-old man with a three-year history of chronic left shoulder pain and progressive proximal weakness, despite multiple courses of physiotherapy. His only relevant precedent trauma was a traumatic brain injury 20 years earlier. Physical examination revealed atrophy of the supraspinatus and infraspinatus muscles, reduced strength in lateral elevation and external rotation, and diffuse pain during shoulder maneuvers. Plain radiographs demonstrated glenohumeral osteoarthritis without evidence of significant rotator cuff arthropathy. Ultrasound imaging showed joint effusion, a paralabral cyst, and features of advanced osteoarthritis. Electroneuromyography revealed denervation of the supraspinatus and infraspinatus muscles, consistent with suprascapular neuropathy at the suprascapular notch. Glenohumeral arthrocentesis provided only transient symptomatic relief, and the patient was subsequently referred for orthopedic evaluation for potential reverse shoulder arthroplasty. This case highlights the importance of recognizing the potential interplay between suprascapular neuropathy and glenohumeral osteoarthritis in patients presenting with chronic shoulder pain. It also emphasizes the diagnostic value of integrated imaging and electrophysiological assessment to guide appropriate management and optimize patient outcomes.
    Keywords:  muscle atrophy; shoulder arthritis; shoulder pain management; shoulder rehabilitation; suprascapular neuropathy
    DOI:  https://doi.org/10.7759/cureus.99345
  4. Eur Geriatr Med. 2026 Jan 21.
    Rehabilitation outcomes of older persons within the context of the International Classification of Functioning, Disability and Health (ICF): a systematic review.
    Veerle H E W Brouwer, Henk Jan Schuijt, Johanna M A Visser-Meily, Wilco P Achterberg, Eléonore F van Dam van Isselt.
       PURPOSE: With the ageing population, more older persons require rehabilitation following (sub)acute functional decline. The International Classification of Functioning, Disability and Health (ICF) model offers a biopsychosocial framework to address complexities of rehabilitation in this population. This systematic review investigates which ICF components have been reported in rehabilitation research involving older persons, which rehabilitation outcomes have been reported, and whether, and how associations between ICF components and rehabilitation outcomes have been described.
    METHODS: A comprehensive search was conducted in three databases. Studies involving older persons (mean or median age ≥ 70 years) undergoing post-acute rehabilitation, with health data linked to the ICF model and rehabilitation outcomes, were included. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) by two independent reviewers.
    RESULTS: Seven studies involving 896 patients were included. Associations were found between ICF components, particularly body functions and activities and participation, and improved functional independence and quality of life. Environmental factors also contributed to outcomes, whereas personal factors did not appear, reflecting their absence from the formal ICF coding structure.
    CONCLUSION: This review shows that body functions and activities and participation are most consistently linked to clinical outcomes in older persons, reflecting their central role in functional independence and quality of life. Environmental factors were examined less often, yet contextual factors (including personal factors) remain important for understanding recovery and personalized care. These findings clarify which ICF-based functional profiles are routinely captured and support more structured, person-centred assessment across the rehabilitation trajectory. Further research should include personal factors and longer-term outcomes.
    Keywords:  Biopsychosocial model; Geriatric; International Classification of Functioning Disability and Health (ICF); Rehabilitation; Rehabilitation for older persons; Rehabilitation outcomes
    DOI:  https://doi.org/10.1007/s41999-026-01406-0
  5. J Orthop Res. 2026 Jan;44(1): e70139
    Long-Term Efficacy of Intra-Articular Platelet-Rich Plasma in Knee Osteoarthritis: A 6-Year Follow-up of a Prospective Cohort.
    Mir Shahid Ul Islam, Altaf Hussain, Najmul Huda, Amit Saraf, Sandeep Bishnoi, Hemant Kumar.
      This prospective study evaluated the long-term efficacy, radiographic progression, and predictors of deterioration in patients with knee osteoarthritis (KOA) treated with intra-articular platelet-rich plasma (PRP) injections. Seventy-eight patients (118 knees) with Kellgren-Lawrence (KL) grade I-III KOA received 3 monthly PRP injections and were followed at 4 and 6 years. Pain and function were assessed with the Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiographic progression, analgesic use, and predictors of clinical worsening were analysed using linear mixed-effects modeling and survival analysis. At 4 years, significant improvements were observed in VAS (6.72 ± 1.82 to 4.47 ± 1.32, p < 0.0001) and WOMAC (58.32 ± 17.58 to 39.67 ± 10.37, p < 0.0001). By 6 years, outcomes regressed toward baseline (VAS 6.31 ± 1.47, p = 0.079; WOMAC 56.45 ± 14.35, p = 0.41). Benefits were more sustained in KL I-II compared with KL III, who showed earlier decline and greater analgesic use. KL progression was the strongest predictor of worsening (β = +14.2 WOMAC points, p < 0.001), with each baseline KL grade increase adding +6.5 WOMAC points (p = 0.002); BMI also contributed modestly (p = 0.018). Survival analysis showed KL III had a 3.1-fold higher failure risk than KL I (median 3.5 vs. 5.1 years, p < 0.001). PRP provides meaningful symptom relief and functional improvement for up to 4 years in mild-to-moderate KOA, but benefits decline by 6 years, particularly in advanced disease.
    DOI:  https://doi.org/10.1002/jor.70139
  6. J Sport Rehabil. 2026 Feb 01. 35(2): 188-194
    Effects of Motor Imagery on Movement-Based Fear in Musculoskeletal Conditions: A Critically Appraised Topic.
    Megan E Pearcy, Gemma E Leonard, Megan E Palfrey, Lindsay A Carroll, Katherine A Bain.
       CLINICAL SCENARIO: The presence of movement-based fear during rehabilitation negatively impacts injury recovery, quality of performance, and perceived disability. While current evidence supports using graded motor imagery (GMI) to reduce movement-based fear in patients with complex regional pain syndrome and chronic neck pain, the effects of GMI on reducing movement-based fear in patients undergoing physical therapy (PT) for an upper- or lower-extremity musculoskeletal injury are unclear.
    CLINICAL QUESTION: Does incorporating GMI with traditional PT rehabilitation result in decreased movement--based fear compared with traditional PT alone for individuals with an extremity-related musculoskeletal condition?
    METHODS: A thorough literature search was conducted in April 2025 to analyze randomized controlled trials. Databases searched include: Cochrane, CINAHL, PubMed, PEDro, and SPORTDiscus. Articles meeting criteria following the title and abstract review were further analyzed using the PEDro scale for quality. Those receiving a score of at least 6/10 were selected for inclusion in this article.
    SUMMARY OF KEY FINDINGS: (1) Articles included reported greater improvements in fear-related outcomes among individuals who received GMI treatment compared to traditional PT alone for patients with adhesive capsulitis (Fear Avoidance Beliefs Questionnaire, P = .014), posttraumatic elbow stiffness (Tampa Scale of Kinesiophobia, P = .01), and post-Total Knee Arthroplasty (Tampa Scale of Kinesiophobia, P < .01). (2) Nonmovement-based fear outcome measures, such as shoulder abduction, active range of motion, visual analog scale, Shoulder Pain and Disability Index, and Western Ontario and McMaster Universities Arthritis Index also improved.
    CLINICAL BOTTOM LINE: GMI combined with traditional PT interventions may be useful for decreasing movement-based fear and improving range of motion, strength, and functional outcomes in patients with frozen shoulder, posttraumatic elbow stiffness, and Total Knee Arthroplasty.
    STRENGTH OF RECOMMENDATION: Based on the Strength of Recommendation Taxonomy, a grade of A is recommended based on the quality of evidence provided in the articles included in this Critically Appraised Topic. More research should be conducted to determine optimal treatment parameters for different patient populations.
    Keywords:  graded motor imagery; kinesiophobia; lower extremity; physical therapy; upper extremity
    DOI:  https://doi.org/10.1123/jsr.2025-0213
  7. Cureus. 2025 Dec;17(12): e99643
    Orthopedic Rehabilitation Following Complex Repair of the Flexor and Extensor Tendons, Artery, and Nerve: A Case Report.
    Aydan Novruzova.
      Simultaneous injury of both the flexor and extensor tendons of the hand is a rare condition that can lead to significant functional impairment and is often accompanied by arterial and nerve damage. This study aims to share the clinical outcomes of the rehabilitation process following a complex hand injury. Surgical repair was performed on a patient with injuries to the flexor and extensor tendons, as well as the radial artery and median nerve, followed by an intensive and structured rehabilitation program. The rehabilitation protocol was initiated with early passive movements and later progressed to include controlled active exercises, sensory training, and muscle strengthening. Functional outcomes were evaluated over a short-term follow-up period of 12 weeks using objective clinical measures, including range of motion and grip strength. Although validated functional outcome scales such as the Disabilities of the Arm, Shoulder, and Hand or Patient-Rated Wrist Evaluation were not applied, meaningful improvements in functional hand use were observed. This case highlights that in situations where tendon, nerve, and arterial injuries occur concurrently, early and controlled rehabilitation plays a critical role in functional recovery alongside surgical treatment. However, long-term follow-up is required to fully evaluate nerve regeneration and sustained functional outcomes.
    Keywords:  complex hand injury; early and controlled rehabilitation; mid-position splint; orthopedic rehabilitation; tendon repair
    DOI:  https://doi.org/10.7759/cureus.99643
  8. Cureus. 2025 Dec;17(12): e99350
    Management of the Infrapatellar Fat Pad in Total Knee Arthroplasty: A Comprehensive Review of Recent Evidence.
    Ege Islatince, Sridhar R Sampalli.
      Surgical management of the infrapatellar fat pad (IPFP) during total knee arthroplasty remains debated: excision may improve exposure but risks tendon changes and pain, while preservation protects soft tissues yet limits visualisation. This review synthesises randomised trials and meta-analyses (2020-2025) comparing IPFP excision versus preservation. Outcomes, including anterior knee pain, functional scores such as Knee Society Score (KSS) and the Knee Injury and Osteoarthritis Outcome Score-Quality of Life subscale (KOOS-QoL), range of motion (ROM), patellar tendon length, and Insall-Salvati ratio (ISR), were evaluated at less than or equal to three months and 6-12 months. Evidence shows modest tendon shortening after excision without lasting differences in pain, function, or mobility. Preservation may offer small early recovery benefits, but long-term outcomes are equivalent. Intraoperative decisions should balance exposure needs with potential early advantages of preservation.
    Keywords:  anterior knee pain; fat pad excision; fat pad preservation; functional outcomes; hoffa's fat pad; infrapatellar fat pad; knee surgery; patellar tendon length; rehabilitation; total knee arthroplasty
    DOI:  https://doi.org/10.7759/cureus.99350
  9. Ned Tijdschr Geneeskd. 2025 Dec 02. pii: D8668. [Epub ahead of print]169
    [Should carpal tunnel syndrome treatment start with surgery or an injection?]
       OBJECTIVE: Surgery and corticosteroid injections are established treatments for carpal tunnel syndrome (CTS), but the optimal treatment strategy remains unclear. The DISTRICTS aimed to compare the efficacy of surgery with injection.
    DESIGN: Open-label, randomised controlled trial in the Netherlands.
    METHOD: CTS patients were randomly assigned to start treatment with either surgery or an injection. Additional treatments were allowed. The primary outcome was the proportion of patients who recovered-defined as a score of fewer than eight points on the 6-item CTS scale at 18 months.
    RESULTS & CONCLUSION: 934 participants were enrolled. The recovery rate in the surgery group was 61% and significantly higher than the 45% recovery rate in the injection group. In patients with CTS, initiating treatment with surgery offers a higher chance of recovery after 18 months compared to starting with a corticosteroid injection.
  10. NeuroSci. 2026 Jan 12. pii: 10. [Epub ahead of print]7(1):
    Evolution of Carpal Tunnel Syndrome Treatment: A Narrative Review.
    Đula Đilvesi, Bojan Jelača, Aleksandar Knežević, Željko Živanović, Veljko Pantelić, Jagoš Golubović.
      Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment disorder, with a lifetime prevalence estimated at approximately 10%. This narrative review explores the historical evolution, current management strategies, and emerging trends in CTS diagnosis and treatment. Early recognition of CTS led to the development of conservative interventions, including splinting, corticosteroid injections, and physical therapy, aimed at alleviating median nerve compression and associated symptoms. The advent of open carpal tunnel release established surgery as the definitive treatment for moderate-to-severe CTS, with subsequent refinements-such as mini-open and endoscopic techniques-focused on minimizing tissue trauma and expediting recovery. Comparative studies demonstrate similar long-term efficacy between surgical modalities, though endoscopic approaches often provide faster short-term recovery. Advances in diagnostic imaging, including high-resolution ultrasound, have improved early detection and dynamic assessment of median nerve compression. Emerging therapies, such as regenerative biologics, neuromobilization, and minimally invasive surgical innovations, offer promising adjuncts to current care. Despite substantial progress, further research is needed to clarify optimal patient selection, refine minimally invasive techniques, and explore regenerative interventions. This review underscores the importance of individualized, evidence-based, and patient-centered approaches to CTS management, integrating both established and emerging strategies to optimize functional outcomes and quality of life.
    Keywords:  carpal tunnel syndrome; corticosteroid injection; endoscopic carpal tunnel release; entrapment neuropathy; long-term outcomes; minimally invasive surgery; neuromobilization; open carpal tunnel release; physical therapy; regenerative therapy; ultrasound diagnosis; wrist splinting
    DOI:  https://doi.org/10.3390/neurosci7010010
  11. Br J Sports Med. 2026 Jan 20. pii: bjsports-2025-110327. [Epub ahead of print]
    Qualitative and quantitative situational characteristics of muscle strains in sports: a systematic review and meta-analysis.
    Luca Sophie Finnern, Jan Wilke, Steffen Willwacher, Kati Pasanen, Karsten Hollander, Dimitris Dalos, Goetz H Welsch, Tron Krosshaug, Pascal Edouard, Thomas Gronwald, Tim Hoenig.
       OBJECTIVES: To explore the injury-inciting situational characteristics of indirect and non-contact muscle injuries in sports, commonly referred to as muscle strains; and to investigate differences and similarities of injury patterns across muscle groups.
    DATA SOURCES: PubMed, Web of Science, SPORTDiscus and Google Scholar.
    ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies investigating injury-inciting situational characteristics (among others, injury contact mechanisms, joint positions, movement directions) of indirect and non-contact muscle injuries in sports through video recordings.
    RESULTS: Twenty-one studies reporting the injury-inciting situational characteristics of 728 indirect and non-contact muscle injuries were included. Non-contact mechanisms were more common (74%) than indirect contact mechanisms (26%). Most injuries were either running-related or occurred during sport-specific manoeuvres involving muscle-tendon unit length changes under active muscle contraction. For hamstring injuries, the most frequently reported injury kinematics comprised a knee joint position close to extension (underlying movement direction: flexion to extension) and a flexed hip joint position (underlying movement direction: variable). For adductor injuries, injury kinematics were characterised by rapid muscle lengthening due to hip extension, abduction and external rotation. For rectus femoris injuries, the observed injury kinematic comprised a flexing hip joint movement and extending knee joint movement. For calf injuries, the typical injury pattern comprised an ankle dorsiflexion movement with the knee being close to extension and the ankle in >10° dorsiflexion at the assumed injury time.
    CONCLUSION: This systematic review found distinct, identifiable injury patterns for indirect and non-contact muscle injuries. While similar situational characteristics were identified across injuries, some patterns were more specific to particular injury locations and sports.
    PROSPERO REGISTRATION NUMBER: PROSPERO registration number CRD42023472252.
    Keywords:  muscle; preventive medicine; sporting injuries; sports
    DOI:  https://doi.org/10.1136/bjsports-2025-110327
  12. Knee Surg Sports Traumatol Arthrosc. 2026 Jan 19.
    Improving anterior cruciate ligament reconstruction outcomes using a unified return-to-sport communication framework.
    John Nyland, Robert Prill, Jarod Richards, Robin Martin.
      The poor outcomes for many athletes who attempt to return to sports at high-performance levels post-anterior cruciate ligament (ACL) reconstruction are concerning. Unless the surgeon and rehabilitation team communicate using a shared language from a common return-to-sport plan problem-solving and decision-making perspective, treatment outcomes have a high failure risk. Development and use of a shared language, such as that provided by the International Classification of Functioning, Disability and Health (ICF) framework is recommended. This editorial discusses the need for the surgeon and rehabilitation team to better appreciate differing viewpoints, be active listeners and display professional empathy. In addition to time and physical performance impairment-based evaluations, greater consideration for athlete sex, age, socioeconomic and sociocultural personal and environmental factors may improve outcomes. Long-term outcome success through the achievement of sustainable, high-performance levels and decreased re-injury rates is more likely to occur when all unique factors that may adversely influence individual athlete recovery have been identified and effectively managed.
    Keywords:  communication; function; rehabilitation; return to sports; teamwork
    DOI:  https://doi.org/10.1002/ksa.70276
  13. Cureus. 2025 Dec;17(12): e99605
    Unusual Triggering of the Finger Caused by Distal Flexor Tendinopathy: Successful Treatment With Ultrasound-Guided Prolotherapy.
    Yonghyun Yoon, Ji Hyo Hwang, Jaeyoung Lee, Teinny Suryadi, Anwar Suhaimi, Jaehyun Shim, King Hei Stanley Lam.
      Trigger finger (TF), traditionally viewed as a stenosing tenosynovitis at the A1 pulley, is commonly treated with corticosteroid injections or pulley release. This case report describes a 61-year-old female with a refractory TF who did not respond to a previous corticosteroid injection. Diagnostic imaging revealed insertional tendinopathy of the flexor digitorum superficialis and flexor digitorum profundus with bony spurs, rather than pathology at the A1 pulley. The patient was successfully treated with two sessions of ultrasound-guided prolotherapy directed at the tendon entheses, resulting in complete resolution of triggering and pain. This case challenges the conventional model and suggests that insertional flexor tendinopathy can be a primary cause of TF, warranting a paradigm shift in diagnosis and treatment toward enthesis-focused approaches.
    Keywords:  enthesopathy; insertional tendinopathy; prolotherapy; trigger finger; ultrasound
    DOI:  https://doi.org/10.7759/cureus.99605
  14. Biomed Res Int. 2026 ;2026 7544057
    Anatomical Investigation of the Gluteus Medius Muscle Innervation and Its Topographical Correspondence With Myofascial Trigger Points.
    Roberto Procópio Pinheiro, Daniela Andrea Medina Macaya, Ana Maria Itezerote, Samir Omar Saleh, Flávio Hojaij, Mauro Andrade, Alfredo Luiz Jacomo, Flavia Emi Akamatsu Jacomo.
       Background and Purpose: Hip pain, a common complaint among adults that often causes functional disability, can be caused by femoroacetabular impingement, labral injuries, stress fractures of the femoral neck, avascular necrosis of the femoral head, osteoarthritis of the femoroacetabular joint, hip fractures, greater trochanteric pain syndrome, pathology of the lumbar spine and sacroiliac joint, and myofascial pain syndrome (MPS). MPS is characterized by the presence of hyperirritable nodules, known as myofascial trigger points (MTPs), within muscles and fascia. MTPs limit the range of motion of the joints. Moreover, they induce a local contraction response triggered by mechanical stimulation. The stimulation of MTPs induces pain and sensory changes that can be localized or referred. The MTPs present in the gluteus medius muscle play a role in inducing patellofemoral pain, pain in the lower limbs, anterior region of the knee and thigh, and lower back; however, the anatomy of MTPs remains to be elucidated. This study is aimed at relating the entry points of the superior gluteal nerve into the gluteus medius muscle with the MTPs described in the literature via anatomical dissection.
    Method: Twenty gluteus medius muscles of 10 adult cadavers were divided into four areas: posterosuperior, posteroinferior, anterosuperior, and anteroinferior. The distribution of the nerve branches was classified according to these predetermined areas. Statistical analyses were performed using Poisson distribution and logarithmic link function, followed by Bonferroni multiple comparisons (p < 0.05).
    Results: All areas of the gluteus medius were innervated by the branches of the superior gluteal nerve. A significantly greater number of nerve entry points was observed in Areas II and IV (posterosuperior and anteroinferior, respectively).
    Conclusion: The areas of penetration of the superior gluteal nerve correspond to the clinically described MTPs.
    Keywords:  anatomy; gluteus medius muscle; myofascial; nerves; trigger points
    DOI:  https://doi.org/10.1155/bmri/7544057
  15. Cureus. 2025 Dec;17(12): e99862
    Anatomical Variations of the Neurovascular Structures of the Hand and the Clinical Significance.
    Slobodan Kapor, Predrag Bjelogrlic, Valentina Simic, Drazan Eric, Suncica Kapor, Fraser Chisholm, Enis Cezayirli, Darko Laketic.
      Background Anatomical variations in the neurovascular structures of the hand have critical implications for surgical procedures, diagnostic accuracy, and nerve conduction studies. This study examined the morphology of the superficial palmar arch (SPA), the course of common digital palmar (CDP) arteries relative to Kaplan's line, and the prevalence and types of Berrettini anastomosis. Methods Thirty-six embalmed cadaveric upper limbs (18 right, 18 left) from the Universities of Belgrade and St Andrews were dissected following standard anatomical protocols. Specimens with visible trauma or deformity were excluded. The SPA was classified as complete or incomplete. Origins of CDP artery distances from Kaplan's line were measured and analyzed for sex differences using the t- test (p < 0.05). Median-ulnar nerve communications were identified and categorized as Type I (ulnar to median), Type II (median to ulnar), or Type III (bidirectional/multiple). Results Complete SPAs were observed in 55.6% (n=20) of specimens, predominantly in males, while 44.4% (n=16) showed incomplete patterns, more frequently in females. CDP arteries were significantly farther from Kaplan's line in male specimens (p < 0.05). The Berrettini anastomosis was present in 33.3% (n=12) of hands, with Type III being most common (66.7%, n=8/12), and no Type I anastomoses were identified. Conclusions Our findings highlight clinically significant variations in hand neurovascular anatomy, with notable sex-based differences in SPA configuration and arterial topography. The frequent occurrence of complex Berrettini anastomoses underscores the importance of detailed anatomical awareness to avoid complications in hand surgery and to enhance diagnostic procedures.
    Keywords:  berrettini anastomosis; digital arteries; hand anatomy; kaplan’s line; nerve communication; superficial palmar arch
    DOI:  https://doi.org/10.7759/cureus.99862
  16. Turk Neurosurg. 2025 Oct 27.
    Intra-Articular vs Medial Branch Pulsed Radiofrequency in the Management of Lumbar Facet Joint-Related Low Back Pain: A Prospective Randomized Trial.
    Burak Erken, Suat Demir, İpek Saadet Edipoğlu.
       AIM: Lumbar facet joint (LFJ)-originated pain is one of the important causes of chronic low back pain. Pulsed radiofrequency (PRF) therapy, unlike conventional radiofrequency ablation, provides neuromodulatory effect with minimal tissue destruction. In this study, we aimed to compare the efficacy of intra-articular PRF (IA-PRF) and medial branch PRF (MB-PRF) in the treatment of facet joint-related low back pain.
    MATERIAL AND METHODS: In this prospective observational study, 116 patients with ≥50% pain relief after diagnostic intra-articular anesthetic injection were included. Patients underwent IA-PRF (n = 60) or MB-PRF (n = 56). Pain and disability were assessed using the Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI) at baseline and 1 and 6 months post-treatment.
    RESULTS: Both groups showed significant improvements in NRS and ODI scores at 1 and 6 months (p 0.001). In the IA-PRF group, NRS scores improved from 6.55 ± 0.65 to 3.23 ± 0.43 (1 month) and 3.70 ± 0.46 (6 months); ODI scores improved from 49.70 ± 3.75 to 25.13 ± 1.66 and 26.90 ± 2.13, respectively. In the MB-PRF group, NRS scores decreased from 6.43 ± 0.66 to 3.13 ± 0.33 (1 month) and 3.57 ± 0.49 (6 months); ODI scores decreased from 49.18 ± 3.49 to 24.71 ± 1.34 (1 month) and 26.68 ± 2.20 (6 months). No significant intergroup differences were observed at follow-ups (p 0.05). No complications occurred.
    CONCLUSION: IA-PRF and MB-PRF are effective and safe in treating LFJ-induced pain after 6 months of follow-up. Significant pain control and functional improvement were achieved with both methods, with no significant difference between them regarding clinical efficacy. Our findings suggest that treatment selection should be individualized according to patient characteristics. Randomized studies with large samples and long-term follow-up are needed to improve the level of evidence in this field.
    DOI:  https://doi.org/10.5137/1019-5149.JTN.49271-25.2
  17. Reg Anesth Pain Med. 2026 Jan 22. pii: rapm-2025-107379. [Epub ahead of print]
    Is there a need to modify the anatomical targets for genicular nerve ablation in prosthetic knees compared with native knees? A cadaveric study.
    Fodjeu Gaspary, Catherine Wydemans Behets, Julie Manon, Cedric Dongmo Mayopa, Olivier Cornu, Loïc Fonkoue.
       BACKGROUND: Joint replacement is standard of care for chronic knee osteoarthritis, but can cause persistent postsurgical pain. Radiofrequency denervation helps treat chronic knee pain, though its effectiveness is lower in patients with knee arthroplasty than in those with native knees. Our goal was to compare genicular nerve targets in native and prosthetic cadaveric knees and see if targets need modification after arthroplasty.
    METHODS: 10 native and 10 prosthetic knees from deceased donors underwent latex arterial injection and detailed dissection of the genicular nerves, comparing their origin, course, target points, diameter, and proximity with arterial blood vessels.
    RESULTS: Minimal differences among genicular nerve targets were observed between the two groups. The prosthetic knees had fibrotic adhesions of the infrapatellar branch of the saphenous nerve (IPBSN) due to previous surgery, potentially causing postsurgical neuromas and neuritis. The average nerve diameter at target points was smaller in prosthetic than native knees. The distance from the target point to the joint line was shorter for the superomedial genicular nerve in the prosthetic knee group (4.00±0.43 cm vs 4.53±0.75 cm, p=0.005). Nine native and eight prosthetic knees lacked an arterial branch near the target point of the superolateral genicular nerve (SLGN).
    CONCLUSION: Prosthetic knees share comparable genicular nerve anatomic locations with native knees but exhibit smaller nerve diameters and fibrosis of the IPBSN. The absence of a nearby arterial branch to the SLGN may reduce ultrasound targeting accuracy. Anatomical differences alone, however, do not fully explain the diminished pain relief observed after radiofrequency ablation.
    Keywords:  CHRONIC PAIN; Lower Extremity; Pain Management; Peripheral Nerves; Radiofrequency Ablation
    DOI:  https://doi.org/10.1136/rapm-2025-107379
  18. Updates Surg. 2026 Jan 22.
    Prophylactic triple neurectomy during open tension-free inguinal hernia repair: a clinical trial for the prevention of chronic postoperative pain.
    Yasser A Orban, Yasmine Hany Hegab, Abd Elwahab M Hamed, Hasnaa Metwally, Reham Zakaria, Abdalla Mohamed Goda, Yasser Baz.
      Postoperative chronic inguinal pain is a common postoperative complication after open inguinal hernia repair e.g. ilioinguinal nerve entrapment is a common cause of chronic pain which may adversely affect the patients' life. Triple neurectomy (ilioinguinal, iliohypogastric, and genital branch of genitofemoral) seems to be beneficial in preventing such pain, but it may carry the risk for numbness and hypoesthesia. This is a randomized clinical trial, which took place between January 2024 and January 2025, including all patients who were operated on by open inguinal hernioplasty either with triple neurectomy or with nerve preservation. A questionnaire filled by patients either written or by telephone to assess the severity of pain was obtained three months or more after surgery. Fifty one patients were included in nerve preservation group, while 59 patients were included in neurectomy group. Eleven patients in the nerve preservation group suffered from pain of variable severity. Six, four, and one patients had mild, moderate, and sever pain, respectively. In the neurectomy group only three patients had mild pain. There was a significant difference (p = 0.008) between the two groups. At time of questionnaire, the number of patients suffered from numbness in the nerve preservation group was 7 patients versus 10 patients in the neurectomy group, which was statistically non-significant, p value = 0.641. Prophylactic triple neurectomy provides the advantage of decreasing chronic postoperative pain after open inguinal hernia surgery. While our findings are promising, further studies with larger populations are needed before recommending triple neurectomy as a standard step during inguinal hernioplasty.Clinical trial registrationNCT06327763 registered on Mar 25, 2024.
    Keywords:  Chronic postoperative pain; Inguinal hernia; Neurectomy
    DOI:  https://doi.org/10.1007/s13304-025-02497-3
  19. J Cosmet Dermatol. 2026 Jan;25(1): e70684
    Assessment of Subepidermal Low-Echogenic Band via High-Frequency Ultrasound for Evaluating the Efficacy of Platelet-Rich Plasma Injection in Treating Facial Skin Photoaging: A Case Series.
    Wenjue Ye, Tong Liu, Wei Zhang, Sicheng Peng, Yong Liao.
       BACKGROUND: Facial skin photoaging manifests as wrinkles, laxity, roughness, enlarged pores, telangiectasia, pigmentation, and dermal structural changes. Histologically, dermal collagen degradation and dermal-epidermal junction disruption form the subepidermal low-echogenic band (SLEB) on ultrasound. Platelet-rich plasma (PRP) injection promotes skin regeneration but lacks objective imaging biomarkers.
    OBJECTIVE: To objectively evaluate the structural efficacy of PRP for facial photoaging by quantifying SLEB width and dermal thickness changes via high-frequency ultrasound (HFUS), alongside skin analyzer assessments.
    METHODS: This retrospective case series included 10 patients (Glogau I-III) receiving three monthly PRP injections. The treatment utilized a standardized dual-step protocol: manual precision injection targeting the deep dermis, followed by mechanical mesogun injection for uniform superficial coverage. SLEB width and dermal thickness were measured at four facial sites using HFUS before and 1 month after treatment. A skin analyzer assessed skin parameters. A comprehensive clinical evaluation was conducted using the Glogau classification and Global Aesthetic Improvement Scale (GAIS) for efficacy and patient satisfaction assessment.
    RESULTS: Post-treatment, HFUS revealed significant reductions in SLEB width (average decrease 29%-47%, all p < 0.001) and increases in dermal thickness (average increase 24%-51%, all p ≤ 0.003). Skin analyzer showed significant improvements in Pores, Wrinkles, Brown Spots, and Red Areas (all p < 0.05). Clinical evaluations confirmed significant improvement in Glogau classification (p < 0.01) and high patient satisfaction (100% reported improvement on GAIS). No serious adverse events were observed; only transient erythema/edema and mild pain were reported.
    CONCLUSION: HFUS is a reliable, non-invasive tool for assessing PRP efficacy. SLEB width reduction serves as a sensitive, objective imaging biomarker, providing structural evidence for PRP's ability to improve photoaging damage.
    Keywords:  dermal thickness; high‐frequency ultrasound; platelet‐rich plasma; skin photoaging; subepidermal low‐echogenic band
    DOI:  https://doi.org/10.1111/jocd.70684
  20. Arthritis Rheumatol. 2026 Jan 21.
    Comment on: "Longitudinal Associations Between Baseline Sarcopenia and Knee Osteoarthritis Progression and Risk of Knee Replacement" - Intramuscular Fat Infiltration: A Hidden Covariate in the Sarcopenia-Knee Osteoarthritis Association? Leveraging OAI MRI Data for Adjustment.
    Huihui Wu, Zhi Wang, Liang Guo.
      
    DOI:  https://doi.org/10.1002/art.70059
  21. J Neurosurg Case Lessons. 2026 Jan 12. pii: CASE25744. [Epub ahead of print]11(2):
    Intrapalm nerve transfers to improve intrinsic hand function in isolated ulnar or median nerve injuries: illustrative cases.
    Kevin Kuan-I Lee, Ken Kuan-Wei Chen, Johnny Chuieng-Yi Lu.
       BACKGROUND: Proximal ulnar and median nerve injuries with Sunderland grade IV or V disruptions often lead to incomplete recovery of intrinsic hand muscles despite partial sensory and extrinsic motor recovery. However, traditional nerve transfers provide inconsistent intrinsic reinnervation. Persistent intrinsic deficits impair fine motor skills, such as pinch and grasp strength, and may necessitate secondary interventions.
    OBSERVATIONS: Four patients with complete, isolated proximal ulnar or median nerve injuries underwent intrapalm donor nerve transfers. Procedures included transfer of the opponens pollicis motor branch to the terminal division of the deep motor branch of the ulnar nerve and the abductor digiti quinti motor branch to the thenar branch of the median nerve. All patients showed functional improvements in pinch and grip strength postoperatively. None required secondary tendon transfers, and no donor site morbidity was observed. In 3 ulnar nerve cases, Froment's sign converted from positive to negative. In the median nerve case, visible thumb abduction was restored.
    LESSONS: Intrapalm donor nerve transfers show effective options for restoring intrinsic hand function and improving fine motor skills in patients with isolated proximal ulnar or median nerve injuries. https://thejns.org/doi/10.3171/CASE25744.
    Keywords:  case series; intrinsic hand; median nerve injury; nerve transfer; ulnar nerve injury
    DOI:  https://doi.org/10.3171/CASE25744
  22. Interv Pain Med. 2026 Mar;5(1): 100724
    Reconsidering periosteal denervation: Anatomical redundancy and the limits of single-target interventions.
    Kartik Sonawane.
      
    Keywords:  Articular nerves; Bone pain; Cutaneous nerve injury; Knee osteoarthritis; Nutrient foramina; Periosteal innervation; Subchondral pain; Total knee arthroplasty
    DOI:  https://doi.org/10.1016/j.inpm.2025.100724
  23. Pain Pract. 2026 Feb;26(2): e70119
    Combining Robotics and Microbiome Science to Treat Unusual Post-Herpetic Neuralgias Resembling Complex Regional Pain Syndrome.
    Muhammad Ameer Hamza, Noor Un Nisa.
      
    DOI:  https://doi.org/10.1111/papr.70119
  24. J Shoulder Elbow Surg. 2026 Jan 16. pii: S1058-2746(26)00028-5. [Epub ahead of print]
    Efficacy of Combined Intra-Articular Hyaluronic Acid and Ketorolac versus Ketorolac Alone in the Treatment of Adhesive Capsulitis: A Randomized Controlled Trial.
    Sorawut Thamyongkit, Pratantat Charoenchaipong, Praman Fuangfa, Rachaporn Taweesakulvashra, Nadhaporn Saengpetch.
       BACKGROUND: Intra-articular corticosteroids are widely used for adhesive capsulitis, but alternatives are needed for patients with contraindications. Hyaluronic acid (HA) and ketorolac have shown individual benefits. However, evidence on their combination remains limited.
    OBJECTIVE: To compare the efficacy of combined moderate-molecular-weight (MMW) HA and ketorolac versus ketorolac alone in adhesive capsulitis.
    METHODS: In this randomized, double-blind, controlled trial, 56 patients were allocated to HA+ketorolac (n=28) or ketorolac-only (n=28). Each received a single intra-articular injection followed by standardized rehabilitation. Outcomes included the Thai Shoulder Pain and Disability Index (SPADI), visual analogue scale (VAS) pain score, passive range of motion (PROM), and analgesic use, assessed at baseline and 2, 6, 12, and 24 weeks.
    RESULTS: Both groups improved significantly in SPADI and VAS pain score over time, with no between-group differences at any visit (24-week SPADI: 9.8±12.5 vs 12.1±17.8; p=0.932; VAS pain score: 0.8±1.1 vs 1.4±2.2; p=0.501). The HA+ketorolac group demonstrated greater recovery in specific ROM planes, including significantly better external rotation at 24 weeks (mean difference 9°, 95% CI 0-18; p = 0.039) and greater improvement in adduction at both 2 weeks (mean difference 5°, 95% CI 0-10; p = 0.039) and 24 weeks (mean difference 8°, 95% CI 2-14; p = 0.012). Analgesic consumption was comparable between groups, and no serious adverse events were reported.
    CONCLUSION: Both HA+ketorolac and ketorolac alone significantly improved pain and function in adhesive capsulitis. Combination therapy provided small but statistically significant advantages in the recovery of external rotation and adduction. Both treatments are viable options, especially in patients for whom corticosteroids are contraindicated.
    Keywords:  adhesive capsulitis; frozen shoulder; hyaluronic acid; intra-articular injection; ketorolac; randomized controlled trial
    DOI:  https://doi.org/10.1016/j.jse.2025.12.007
  25. Sports Health. 2026 Jan 22. 19417381251408058
    Mapping the Existing Return-to-Sport Criteria After Pectoralis Major Tendon Injury in Different Sports: A Scoping Review for Getting Back to the Game.
    Shivam Sharma, Rod Whiteley, Babina Rani, Steve Sartori, Happy Sharma, Tim J Gabbett.
       CONTEXT: It is estimated that only 50% of athletes who sustain pectoralis major tendon injuries return to sport (RTS) despite successful treatment. This limited RTS rate may be due to absence of standardized RTS criteria for such patients. Evidence suggests a significant heterogeneity in RTS guidance across various studies, leading to inconsistency in clinical advice.
    OBJECTIVE: To examine the existing RTS criteria used in pectoralis major tendon injury in different sporting populations.
    DATA SOURCES: A comprehensive literature search with defined keywords was conducted in electronic databases including PubMed, Scopus, EBSCO (via CINAHL complete), Web of Science, Embase, and grey literature (e.g., Opengrey.com) to include studies published from inception until May 2024.
    STUDY SELECTION: Studies investigating the RTS outcome after pectoralis major injury managed surgically and/or conservatively in various sporting athletes were included. All studies included were in English language.
    STUDY DESIGN: Scoping review.
    LEVEL OF EVIDENCE: Level 4.
    DATA EXTRACTION: Details of population age, sex, type of sports, injury mechanism (contact/noncontact), management technique, rehabilitation protocol, outcomes assessed, RTS criteria used, mean RTS duration, number of athletes returned to play, athletes reaching preinjury performance level, and re-injury rate were extracted.
    RESULTS: The literature search identified 1707 studies; 39 studies were included for the final review. A total of 1129 injured athletes (1 female were recorded from the included studies with a mean age of 30.1 years. Regarding RTS criteria, no established criterion for this injury exists in the literature. Strength assessment, range of motion, functional outcomes, and pain were the measures used most in clearing the athlete to continue sport.
    CONCLUSION: Despite the increasing number of athletes sustaining this injury, current evidence reports marked variability in RTS recommendations, with no universally accepted or validated criteria identified. Therefore, for now, both objective and subjective parameters should be used to aid RTS decision making.
    Keywords:  athletes; pectoralis major injury; return-to-sport; shoulder
    DOI:  https://doi.org/10.1177/19417381251408058
  26. JSES Int. 2026 Mar;10(2): 101420
    Persistent scapular dyskinesis after arthroscopic rotator cuff repair: a prospective study.
    Michele Mercurio, Erminia Cofano, Claudia Mancuso, Lorena Paola, Alessandro Imbrogno, Matteo Mantovani, Filippo Familiari, Giorgio Gasparini, Olimpio Galasso.
       Background: The supraspinatus plays a critical role in stabilizing the glenohumeral joint and facilitating arm elevation. The biomechanical disruption caused by supraspinatus tears changes the normal force couple balance between the deltoid and rotator cuff muscles, often resulting in superior migration of the humeral head and altered scapulohumeral rhythm (SHR). This study aims to prospectively compare the shoulder kinematics of patients preoperatively and after arthroscopic rotator cuff repair using magnetic inertial measurement units with a motion analysis system.
    Methods: A prospective study was conducted with data collection on 21 patients who underwent shoulder arthroscopy for rotator cuff tear repair. Preoperatively and at a minimum 12-month follow-up, each patient was evaluated using the range of motion (ROM) assessment and the Constant-Murley Score (CMS). Patients were examined using the ShowMotion 3D kinematic tracking system (NCS Lab, Modena, Italy), which uses wireless wearable noninvasive magnetic and inertial measurement units sensors to assess the three-dimensional kinematics of the shoulder. For each plane of elevation (ie, flexion and abduction), the SHR was described by 3 scapulothoracic rotations (ie, protraction-retraction, mediolateral rotation, and posterior-anterior tilting) as a function of humeral anteflexion or humeral abduction.
    Results: Active flexion and external rotation ROM showed statistically significant improvement (P = .039 and P = .006, respectively). CMS pain, strength, and total showed statistically significant improvement (P = .039 and P = .006, respectively). All the patients showed a nonstatistically significant difference of the SHR along the entire ROM between pre- and postoperative evaluation. The P value in flexion and abduction was >.05; the only statistically significant value was on tilt at 60° in flexion (P = .044).
    Conclusion: A persistent scapular dyskinesis was observed after arthroscopic rotator cuff repair. Despite a statistically significant improvement reported for active flexion, active external rotation, and for the total CMS, scapular dyskinesis is not resolved with surgery and may contribute to worse long-term outcomes. Further biomechanical and clinical research studies are needed to define specific rehabilitation programs, to maximize outcomes, and to prevent possible cause of reinjury of the rotator cuff repaired.
    Keywords:  Arthroscopic cuff repair; Scapular dyskinesis; Scapulohumeral rhythm; Shoulder; Shoulder kinematic; Supraspinatus
    DOI:  https://doi.org/10.1016/j.jseint.2025.101420
  27. Front Cell Dev Biol. 2025 ;13 1746471
    Mesenchymal stem cell-based therapy for osteoarthritis: a systematic review and meta-analysis of clinical outcomes and functional recovery.
    Jincheng Wang, Hao Xue, Mingfei Shi, Renshou Chen.
       Backgrounds: This study aimed to evaluate the efficacy and safety of mesenchymal stem cell (MSC) therapy for osteoarthritis (OA) through a systematic review and meta-analysis of randomized controlled trials (RCTs), focusing on patient-reported pain and functional outcomes.
    Methods: A comprehensive literature search was conducted across multiple databases including PubMed, Embase, Web of Science, and Cochrane Library from inception to 1st October 2025. RCTs comparing intra-articular MSC injections with control interventions (placebo, hyaluronic acid, or other active treatments) in adult OA patients were included. Primary outcomes were changes in pain intensity measured by Visual Analog Scale (VAS) and functional improvement assessed by International Knee Documentation Committee (IKDC) score. Secondary outcomes included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, Lysholm score, and Tegner activity scale. Data were pooled using random-effects models and expressed as mean differences (MD) with 95% confidence intervals (CI).
    Results: Eleven RCTs involving 811 patients were included. MSC therapy demonstrated significant reduction in VAS pain scores compared to controls (MD -4.08, 95% CI -5.56 to -2.61, p < 0.00001), with the most pronounced effects at 24-month follow-up (MD -3.31, 95% CI -5.18 to -1.44, p = 0.0005). Significant improvements were observed in IKDC scores (MD 2.88, 95% CI 0.28 to 5.47, p = 0.03), WOMAC index (MD -11.05, 95% CI -15.97 to -6.14, p < 0.0001), Lequesne index (MD -5.32, 95% CI -5.91 to -4.74, p < 0.00001), Lysholm score (MD 5.07, 95% CI 1.86 to 8.29, p = 0.002), and Tegner activity scale (MD 0.44, 95% CI 0.25 to 0.62, p < 0.00001). The therapeutic effects showed a time-dependent pattern, with maximal benefits observed at 24-month follow-up across all outcome measures.
    Conclusion: Intra-articular MSC injection is an effective treatment for osteoarthritis, providing significant and durable improvements in pain relief, functional recovery, and activity levels up to 24 months post-treatment. The time-dependent nature of clinical benefits suggests a potential disease-modifying mechanism of action. MSC therapy represents a promising regenerative approach for OA management that warrants further investigation in large-scale trials.
    Keywords:  cartilage repair; cell therapy; functional recovery; joint preservation; mesenchymal stem cells; meta-analysis; osteoarthritis; pain management
    DOI:  https://doi.org/10.3389/fcell.2025.1746471
  28. F1000Res. 2025 ;14 1257
    Effect of Eccentric Control Exercises on Patients with Frozen Shoulder and Mild to Moderate Disability: A Single-Group Pre-Post Study.
    Jishnu Mohan Mp, S Rajasekar Sannasi, Glenisha Ancita Dsouza, Praveen Kumar.
       Background: Frozen shoulder (FS) is a common musculoskeletal condition characterized by inflammatory contracture of the glenohumeral joint capsule, leading to restricted active and passive range of motion, particularly in external rotation. Eccentric control exercises have demonstrated effectiveness in managing various upper limb disorders, including subacromial impingement, tennis elbow, and rotator cuff tendinopathy. However, there is limited evidence on their efficacy in individuals with frozen shoulder. This study aimed to evaluate the effects of eccentric control exercises on pain, functional disability, range of motion, psychosocial outcomes, and patient satisfaction in individuals with FS and mild to moderate disability.
    Methods: A single-group pre-post design was used. Twenty patients with clinically diagnosed FS and mild to moderate disability participated. All underwent 20 sessions of supervised eccentric control exercises over four weeks. Outcome measures included the Shoulder Pain and Disability Index (SPADI), Numerical Pain Rating Scale (NPRS), shoulder range of motion (flexion, abduction, hand-behind-back, and external rotation), Tampa Scale of Kinesiophobia (TSK), and Pain Self-Efficacy Questionnaire (PSEQ). Assessments were conducted at baseline, post-intervention (4 weeks), and follow-ups at 3 and 6 months. A 6-point Likert scale was used to measure patient satisfaction post-intervention. Data were analyzed using Repeated Measures ANOVA.
    Results: All outcome measures showed statistically significant improvement post-intervention (p < 0.05), with the benefits maintained at the 3- and 6-month follow-ups. Effect size indices at 4 weeks demonstrated a large treatment effect across all variables, suggesting strong clinical relevance.
    Conclusions: Eccentric control exercises significantly improved pain, functional disability, range of motion, kinesiophobia, pain self-efficacy, and patient satisfaction in individuals with frozen shoulder and mild to moderate disability. These findings support the incorporation of eccentric training in rehabilitation programs for frozen shoulder.
    Keywords:  Shoulder condition; eccentric control exercises; eccentric training; frozen shoulder
    DOI:  https://doi.org/10.12688/f1000research.167369.1
  29. Int J Rheum Dis. 2026 Jan;29(1): e70557
    Robotic Ultrasound-Guided Musculoskeletal Injections: The Next Frontier in Precision Medicine.
    Ahmad Jasem Abdulsalam, Renu Ambardar, Sarah Y Alkandari.
      
    Keywords:  artificial intelligence; image‐guided surgery; injections; interventional; intra‐articular; minimally invasive; surgical procedures; ultrasonography
    DOI:  https://doi.org/10.1111/1756-185x.70557
  30. Front Physiol. 2025 ;16 1694330
    Effects of different exercise interventions on lower back pain: a systematic review and meta-analysis.
    Xingchi Liu, Wenbo Gao, Peirun Wu, Jiawang Huang, Jingjing Han, Xiuli Xu, Wanqiang Chen.
       Objective: Lower back pain (LBP) is the leading cause of disability worldwide. This study evaluates the pain relief and functional benefits of exercise interventions for affected individuals to inform clinical practice.
    Methods: We searched nine electronic databases for randomized controlled trials (RCTs) that examined exercise interventions for LBP.
    Results: We included 35 RCTs (n = 2,132). Exercise interventions were categorized into eight types: Pilates, yoga, core training, tai chi, walking, stretching, cycling, and deep-water running. Compared to usual care or other types of pain management interventions, exercise interventions demonstrated a significant overall difference in reducing pain (SMD = -0.81, 95% CI -0.91, -0.72; 17.31, P < 0.001). Subgroup analysis revealed that tai chi (SMD = -0.95), walking (MD = -1.05), and Pilates (MD = -1.14) exhibited the most significant analgesic effects. Regarding functional disability improvement, assessment using the Oswestry Disability Index showed significant efficacy for walking (MD = -6.34, P < 0.001), Pilates (MD = -4.73, P < 0.0001), and yoga (MD = -3.41, P = 0.002). However, assessment using the Roland-Morris Disability Questionnaire (RMDQ) indicated that only Pilates resulted in significant improvement (MD = -2.34, P < 0.001).
    Conclusion: Pilates, yoga, and walking reduce pain and improve function in non-specific LBP. Tai chi and core-stability training also achieve significant analgesia. The evidence for stretching and cycling remains inconclusive.
    Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251047326, identifier CRD420251047326.
    Keywords:  exercise intervention; low-back pain; meta-analysis; pain relief; rehabilitation
    DOI:  https://doi.org/10.3389/fphys.2025.1694330
  31. Eur Geriatr Med. 2026 Jan 17.
    Goals and expectations of older persons recovering from a hip fracture during geriatric rehabilitation: a qualitative study.
    G F Mattiazzo, Y M Drewes, P J M van de Velde, A H Ph Niggebrugge, M van Eijk, W P Achterberg.
       PURPOSE: Little is known about the expectations of patients with hip fracture regarding geriatric rehabilitation. We aimed to identify goals and expectations of older people regarding geriatric rehabilitation after a hip fracture in geriatric rehabilitation facilities.
    METHODS: A qualitative study of 20 community-dwelling older adults, who all underwent rehabilitation after hip fracture in skilled nursing facilities, was conducted using semi-structured interviews by phone. Data were analyzed using thematic content analysis. The themes were additionally arranged using the International Classification of Functioning, Disability and Health (ICF).
    RESULTS: The goals focused on the ICF key components of activity and participation and were described as returning to pre-fracture mobility, regaining independence in (I)ADL, returning to pre-fracture residence, and social and meaningful interactions. Expectations were related to environmental and personal factors. Environmental factors included aspects related to the care provided in rehabilitation facilities as well as the influence of informal caregivers. Personal factors focused on coping, adaptation skills, and self-efficacy.
    CONCLUSION: Patients undergoing rehabilitation have clear goals and expectations for their successful recovery. Meaningful interactions and support from the rehabilitation facility are important factors that can influence the recovery process. A patient-centered approach can be developed during goal setting by involving the patient and integrating their goals and expectations within the ICF model. This strategy maximizes the effectiveness in achieving these goals. Trial register and date of registration NL7491 04-02-2019.
    Keywords:  Geriatric rehabilitation; Goals and expectation; Hip fracture; ICF; Qualitative research
    DOI:  https://doi.org/10.1007/s41999-026-01405-1
  32. Disabil Rehabil. 2026 Jan 21. 1-15
    The effects of amputation on functioning, satisfaction and health-related quality of life of adults with brachial plexus injury; a scoping review.
    P N Domerchie, M J Passchier, I van Wijk, M Lange, K van Kammen, C K van der Sluis.
       PURPOSE: Brachial plexus injuries (BPI) significantly impact Health-Related Quality of Life (HRQoL) through limb malfunctioning, neuropathic and glenohumeral traction pain. Amputation emerges as a final intervention to alleviate traction pain, or eliminate a flail limb. This scoping review reveals insights on functioning, HRQoL and satisfaction of individuals with BPI and amputation, using the International Classification of Functioning, Disability and Health (ICF).
    MATERIALS AND METHODS: A literature search was conducted using the Cochrane database, PubMed, EMBASE, CINAHL and Web of Science for articles that reported HRQoL and/or functioning in adults with BPI who underwent amputation. Outcomes reflected ICF-domains body function and structure, activities and participation.
    RESULTS: Twenty articles, mostly case reports and retrospective studies, reported on less pain, no hindrance of a flail limb anymore, less anxiety and depression, more energy and less fatigue post-amputation (ICF body functions/structures), with less limitations in daily activities and more social interaction (ICF activities/participation). Individuals reported being satisfied with their decision to amputate. Downsides were scarcely reported.
    CONCLUSIONS: Current literature supports that amputation may improve HRQoL and functioning in individuals with BPI, more research is needed however.
    Keywords:  Brachial plexus injury; ICF; amputation; functioning; health-related quality of life; pain; satisfaction
    DOI:  https://doi.org/10.1080/09638288.2026.2618926
  33. Video J Sports Med. 2026 Jan-Feb;6(1):6(1): 26350254251351657
    Acute Repair of Latissimus Dorsi and Teres Major Tendon Tears.
    Cory Meixner, Julie Y Bishop, Jelle P van der List, Gregory L Cvetanovich.
       Background: Latissimus dorsi and teres major tendon tears are rare, typically occurring in high-level throwers but also from sudden shoulder extension or hyperabduction. While nonoperative management was previously preferred, recent literature favors operative repair, especially for complete, retracted tears.
    Indications: Recent literature suggests partial-thickness tears can be managed nonoperatively, allowing return to competitive play, while repair is recommended for higher-grade tears to restore full performance. This approach can also apply to young, active individuals seeking full shoulder function.
    Technique Description: Patient positioning is lateral decubitus with a bean bag, and an arm positioner aids exposure of the latissimus through arm abduction/internal rotation. A curvilinear incision is made over the tendon defect, avoiding the posterior armpit, angled toward the posteromedial humerus. Skin flaps are raised for muscle visualization, and the latissimus dorsi and teres major are mobilized, protecting the radial nerve/deep brachial artery and axillary nerve/posterior circumflex vessels, respectively. The humerus is palpated, and the bony footprint is exposed with blunt Hohmann retractors. Two to 3 unicortical buttons are placed 1 to 1.5 cm apart. No. 5 FiberWire and FiberTape are passed to facilitate a tension-slide technique. Sequential reduction is performed starting distally, reducing the tendon and tying each button. The wound is irrigated and closed in layers, and a waterproof dressing with a shoulder immobilizer is applied. Rehabilitation begins with 6 weeks of strict immobilization in a shoulder immobilizer, with pendulums and passive range of motion (ROM) exercises starting at 2 weeks. From 6 to 12 weeks, the sling is discontinued, and passive/active ROM exercises, light isometrics, and stretching are introduced. After 12 weeks, light overhead activities or throwing may begin, with full return to sport delayed until at least 6 months.
    Results: Recent studies show high return-to-sport rates (75%) for both nonoperative and operative treatments, with faster recovery nonoperatively. However, athletes treated surgically had no significant decline in performance, which was observed in those treated nonoperatively, suggesting limited healing of complete tears and compensation ability.
    Discussion/Conclusion: Repair of latissimus/teres major tears is a safe, dependable option to restore function and preoperative athletic activity, as well as minimize pain in professional or recreational athletes.
    Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
    Keywords:  athlete; latissimus dorsi; repair; tendon tear; teres major
    DOI:  https://doi.org/10.1177/26350254251351657
  34. Pain Manag. 2026 Jan 18. 1-11
    Efficacy and safety of erector spinae plane block in non-specific low back pain: an exploratory systematic review.
    Maroua Slouma, Samara Zarati, Maissa Abbes, Noureddine Litaiem.
       INTRODUCTION: There is a lack of consolidated evidence to definitively establish the efficacy and safety of ultrasound-guided erector spinae plane block (ESPB) for low back pain (LBP).Our review aimed to summarize the current published evidence regarding the analgesic efficacy and safety of ESPB in LBP.
    METHOD: We conducted a systematic review in accordance with the PRISMA guidelines. The review protocol has been registered in PROSPERO.
    RESULTS: The literature search yielded 21 potentially relevant publications. 232 articles were excluded. The number of patients treated with ESPB was 501. The ESPB's efficacy in reducing the patient's perceived pain was demonstrated in 216 of 345 cases on the first day, 270 of 319 cases in the first month, and 265 of 295 cases in the third month. Exacerbation of pain was reported by 2 patients in the first month after ESPB. Side effects were reported in 5 cases.
    CONCLUSION: Current evidence is limited to low-level studies. While preliminary findings showed that ESPB was a minimally invasive method that provided analgesia in patients with acute and chronic LBP with or without radicular pain, strong conclusions cannot be drawn. Future high-quality randomized controlled trials are necessary to guide clinical practice.
    PROTOCOL REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025646263 identifier is CRD42025646263.
    Keywords:  Erector spinae plane block; efficacy; nonspecific low back pain; radicular pain; safety
    DOI:  https://doi.org/10.1080/17581869.2026.2613794
  35. Am J Sports Med. 2026 Jan 21. 3635465251409347
    Outcomes of Simultaneous Bilateral, Staged Bilateral, and Unilateral Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Systematic Review and Meta-analysis.
    Napatpong Thamrongskulsiri, Jacob T Morgan, Felipe Casanova, Tomas F Vega, Alireza Mirahmadi, Jorge Chahla.
       BACKGROUND: Femoroacetabular impingement (FAI) is a common cause of hip pain, often treated with arthroscopy. The optimal approach among unilateral, staged bilateral, and simultaneous bilateral procedures remains unclear due to limited comparative data.
    PURPOSE: To compare clinical outcomes and complication rates among simultaneous bilateral, staged bilateral, and unilateral hip arthroscopy in patients with FAI syndrome.
    STUDY DESIGN: Systematic review and Meta-analysis; Level of evidence, 3.
    METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Scopus, and Ovid MEDLINE databases were searched through April 2025. Eligible comparative studies included patients with FAI undergoing hip arthroscopy via unilateral, simultaneous bilateral, or staged bilateral approaches and reported outcomes such as patient-reported scores, complications, and revision or conversion to total hip arthroplasty (THA).
    RESULTS: Nine studies with a total of 4040 hips were included. All surgical approaches showed significant improvements in pain and functional outcome scores. There were no statistically significant differences in postoperative visual analog scale score, Modified Harris Hip Score, Non-Arthritic Hip Score, International Hip Outcome Tool-12 score, rates of revision surgery, or conversion to THA among the 3 groups. Meta-analyses confirmed similar outcomes between staged and unilateral groups. Although 1 study reported a lower THA conversion rate in the simultaneous group, findings were inconsistent across the literature.
    CONCLUSION: Simultaneous bilateral, staged bilateral, and unilateral hip arthroscopy offer comparable short- to midterm outcomes and complication rates in FAI patients. Simultaneous bilateral arthroscopy may represent a safe and efficient option for appropriately selected patients. Surgical approaches should be individualized based on patient symptoms, goals, and risk profile.
    REGISTRATION: PROSPERO (CRD420251039957).
    Keywords:  bilateral; hip arthroscopy; simultaneous; staged; unilateral
    DOI:  https://doi.org/10.1177/03635465251409347
  36. EClinicalMedicine. 2026 Jan;91 103740
    Botulinum toxin for endometriosis-associated chronic pelvic pain: a randomised, double-masked, parallel, phase 2 trial.
    Barbara Illowsky Karp, Hannah K Tandon, Ninet Sinaii, Jacqueline V Aredo, Vy T Phan, Noemi Salmeri, Jay P Shah, Melissa A Merideth, Pamela Stratton.
       Background: Chronic pelvic pain affects one in four women. Botulinum toxin, approved for chronic migraine and cervical dystonia pain, is an emerging treatment for other pain conditions. We evaluated intramuscular pelvic floor botulinum toxin injection in women with endometriosis-associated chronic pelvic pain and pelvic floor muscle spasm, hypothesising that botulinum toxin might reduce both spasm and pain.
    Methods: In this a randomised, double-masked, parallel, phase 2 trial, women with pelvic floor spasm and pain despite standard endometriosis-specific and pain treatment were randomily assigned 1:1 to injection of 100 Units onabotulinumtoxinA (15 participants) or saline placebo (14 participants) into pelvic floor muscles. The primary outcome was patient report of benefit or no benefit assessed 1 month after masked injection. Patients could choose an open injection from 1 to 12 months after masked injection. Secondary outcomes (pain rating, pain medication usage, effect duration, and other participant-reported measures) were compared to baseline ratings. This study is registered with ClinicalTrials.gov, NCT01553201.
    Findings: 29 participants were recruited between July 24, 2014 and May 8, 2018. All enrolled women completed the study. At 1 month, significantly more women in the toxin group reported benefit (11 (73%) of 15 vs 4 (29%) of 14; p = 0.027). Women receiving toxin attained a greater percent benefit (p = 0.034) and longer duration (p = 0.023) of pain relief. Those with at least moderate baseline pain had lower pain scores after toxin (p = 0.028). Benefit was present at 1 year in 16 of those requesting open injection (7 of 14 receiving placebo; 9 of 13 receiving toxin). 20 (77%) of 26 patients used less pain medication at 1-year (p < 0.0001), with 12 (92%) of 13 in the BoNT group and eight (62%) of 13 in the placebo group using less medication (p = 0.061). Adverse events were non-serious with no grade 3 or 4 adverse events or deaths, and were similar in both cohorts following masked and open injections.
    Interpretation: This study demonstrates the efficacy and safety of pelvic floor botulinum toxin injection for women with endometriosis-associated chronic pelvic pain and pelvic floor spasm.
    Funding: The study was supported by the Intramural Research Program of the U.S. National Institutes of Health (NIH). Allergan, Inc. provided study drug and independent monitoring funds under a Clinical Trial Agreement with NIH and had no other role in the study.
    Keywords:  Botulinum toxin; Chemodenervation; Chronic pelvic pain; Endometriosis; Pain; Pelvic pain
    DOI:  https://doi.org/10.1016/j.eclinm.2025.103740
  37. JPRAS Open. 2026 Mar;48 473-482
    Wrist-arthroscopy treatment of carpal bone cysts.
    Zhihu Ma, Xingsheng Zhang, Yantao Pei, Lei Zhu, Gang Wang, Yuliang Sun.
       Objective: To evaluate the therapeutic efficacy and clinical outcomes of wrist arthroscopy in the management of intraosseous carpal bone cysts through a retrospective analysis of surgical cases.
    Methods: A case series analysis was performed on 14 patients with intraosseous carpal bone cysts treated in the Department of Hand and Foot Surgery at Qilu Hospital of Shandong University between January 2019 and August 2022. The cyst distribution was as follows: 11 cases in the lunate bone, 1 case involving both the scaphoid and lunate bones, 1 case in the scaphoid bone, and 1 case in the hamate bone. Preoperative imaging assessments included standard radiography (X-ray), computed tomography (CT), and magnetic resonance imaging (MRI). All patients underwent wrist arthroscopic cyst debridement with autologous iliac bone grafting. Intraoperative evaluation of wrist stability was performed, followed by Kirschner wire fixation or external fixation as indicated. Pathological specimens were obtained for histopathological examination. Postoperative rehabilitation protocols were implemented under supervised guidance.
    Results: All patients were followed up for 3-6 months postoperatively. Following structured rehabilitation, significant alleviation of wrist pain was observed in all cases, with full functional recovery enabling a return to normal occupational activities.
    Conclusion: Wrist arthroscopic surgery combined with bone grafting represents an effective treatment modality for intraosseous carpal bone cysts, facilitating accurate pathological diagnosis and promoting rapid functional recovery when supplemented with postoperative rehabilitation.
    Keywords:  Bone grafting; Carpal bone cysts; Carpal instability; Carpal joint; Wrist arthroscopy
    DOI:  https://doi.org/10.1016/j.jpra.2025.11.032
  38. Orthop J Sports Med. 2026 Jan;14(1): 23259671251395322
    A Multivariate Analysis of Radiographic Healing in Pediatric Athletes Diagnosed With Spondylolysis.
    Niklaus P Zeller, Nicholas F Banfield, Rebecca Stone McGaver, Ryan P Cole, Christian A Dawson.
       Background: Spondylolysis is commonly seen in adolescent athletes with lumbar pain after acute or repetitive low back hyperextension. Nonoperative management and rest often lead to symptom resolution and return to sport in acute injuries. However, follow-up imaging confirming radiographic healing is rarely utilized.
    Purpose/Hypothesis: The purpose of this study was to investigate the relationship between age, sex, and radiographic healing in pediatric athletic patients with spondylolysis after nonoperative treatment. It was hypothesized that younger athletes would have better healing rates as older patients are closer to the end of bony growth.
    Study Design: Case series; Level of evidence, 4.
    Methods: A retrospective review was conducted of adolescent cases of spondylolysis treated by a single physician between September 1, 2022, and May 1, 2024. Patients included were <19 years of age, had a diagnosis of spondylosis as confirmed by magnetic resonance imaging with limited computed tomography (CT) imaging, and had a 3-month follow-up limited CT study. Patients diagnosed with chronic spondylosis or spondylolisthesis or treated surgically were excluded. Data collection included sex, date of birth, sports participation, date of injury and initial visit, fracture Hollenberg grade, fracture laterality, and fracture spinal level. Initial and 3-month follow-up limited CT imaging reports were also reviewed to evaluate healing status.
    Results: A total of 100 patients were included in the final analysis. The mean age at the time of injury was 15.0 years (range, 9-18 years). The most common spondylosis fracture grade seen was grade 2 (64%) across all age groups. After 3 months of nonoperative treatment, 93 fractures demonstrated partial or complete healing on follow-up imaging, whereas 7 fractures demonstrated no healing. No differences in healing rates were observed between the age groups or sexes. Notably, all the nonhealed fractures were bilateral, compared with 33 (35.5%) of the healed fractures (P = .001).
    Conclusion: The vast majority (93%) of acute adolescent spondylosis cases demonstrated radiographic healing after 3 months of nonoperative treatment.
    Keywords:  imaging; pediatrics; spondylolysis; sports medicine
    DOI:  https://doi.org/10.1177/23259671251395322
  39. Hand (N Y). 2026 Jan 18. 15589447251404959
    The Adaptive Proximal Scaphoid Implant: Long-Term Follow-Up.
    Massimo Corain, Andrea Colombo, Umberto Lavagnolo.
       BACKGROUND: Scaphoid proximal pole fracture with avascular necrosis is a surgical challenge, particularly in patients with high functional demand. An option is the pyrocarbon adaptive proximal scaphoid implant (APSI), replacing the necrotic proximal pole.
    METHODS: A long-term follow-up study of the early cases treated in our department was conducted. Thirty-six patients with a median follow-up time of 19 years (range, 11-25) were included in the analysis, performing clinical and radiological evaluations.
    RESULTS: Clinically, significant improvements were observed in mean pain Numeric Rating Scale (from 6.8 [SD 2.1] to 2 [2]), range of motion, grip strength measured with the Jamar dynamometer (from 18 [8] kg to 24 [9] kg), Disabilities of the Arm, Shoulder, and Hand score (from 66 [6.5] to 13.7 [6.4]), and Patient-Rated Wrist Evaluation score (from 73 [10] to 28 [12]). Radiographs showed good implant stability. No patient required implant removal.
    CONCLUSION: The APSI prosthesis proves effective long term in relieving pain, improving function, and preventing carpal collapse through stable biomechanical integration.
    Keywords:  arthroplasty; osteoarthritis; pyrocarbon; scaphoid fracture; wrist
    DOI:  https://doi.org/10.1177/15589447251404959
  40. J Am Acad Orthop Surg. 2026 Feb 01. 34(3): e315-e323
    Hip Spine Syndrome: Management of Patients With Concurrent Hip and Spine Degenerative Pathologies.
    Hai Van Le, Hania Shahzad, Eric Klineberg, Nate Heckmann, Zachary C Lum.
      Hip-spine syndrome (HSS) is characterized by the presence of concurrent hip and spine degenerative conditions. It can be further classified as simple, secondary, complex, or misdiagnosis. Patients may present with a myriad of symptoms, including low back pain, groin pain, radicular leg pain, and neurogenic claudication, with or without neurological deficits. Treatment of HSS is complex and involves a multidisciplinary team of spine surgeons, hip surgeons, pain physiatrists, and physical therapists. In treating HSS, it is imperative to first identify the primary pain generator through a thorough hip and spine examination and diagnostic and therapeutic injections. The decision whether to operate on the hip or spine first is multifaceted and depends on clinical, radiographic, and surgical considerations. In this article, we review the most recent literature on the management of patients with HSS, with an emphasis on surgical treatment.
    DOI:  https://doi.org/10.5435/JAAOS-D-25-00271
  41. Cureus. 2025 Dec;17(12): e99698
    Short-Term Clinical Outcomes of Platelet-Rich Plasma Therapy in Patellofemoral Chondromalacia: Evaluating Pain Reduction and Functional Improvement in a Six-Month Retrospective Study.
    Naif M Alhamam, Turki M Al Dayhur, Hajer E AlSaif, Ziyad S Aldhaif, Nujood A Alhomeni, Bashaer I Almulhim.
       BACKGROUND: Patellofemoral chondromalacia is a degenerative condition of the knee cartilage, leading to significant pain and functional impairment. Platelet-rich plasma (PRP) therapy has emerged as a promising treatment, leveraging its regenerative and anti-inflammatory properties. This study aimed to evaluate the effectiveness of PRP in reducing pain and improving knee function in patients with patellofemoral chondromalacia at the six-month follow-up.
    METHODOLOGY: A retrospective cohort study was conducted at Almoosa Specialist Hospital in Al-Ahsa, Eastern Province, Saudi Arabia. Medical records of 103 patients diagnosed with patellofemoral chondromalacia and treated with PRP were reviewed. Patients aged 18 years or older, diagnosed through clinical examination and imaging, and with a six-month follow-up were included. Data were collected on demographics, symptom duration, Outerbridge grade, and pre- and post-treatment scores on the Visual Analog Scale (VAS) and Anterior Knee Pain Scale (AKPS). Descriptive and inferential analyses were performed using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, New York, United States).
    RESULTS: The mean age of participants was 32.86±9.54 years. A total of 80 out of 103 participants (77.7%) were male. PRP treatment significantly reduced VAS scores from 6.42±2.52 to 1.19±1.73 (p<0.001) and improved AKPS scores from 81.17±11.71 to 89.96±7.21 (p<0.001) after six months. While 98.1% of patients showed improvement in VAS scores, 99% demonstrated enhanced AKPS scores. Age significantly influenced outcomes, with older patients showing greater functional improvement. However, the Outerbridge grade remained unchanged across the follow-up period.
    CONCLUSION: PRP injections were associated with a significant reduction in pain and improvement in knee function in patients with patellofemoral chondromalacia, particularly in middle-aged and older populations. Despite significant symptomatic relief, no structural changes in cartilage were observed over six months, as the Outerbridge grade remained unchanged in all patients (mean 2.30±0.79 before and after treatment; p=1.000). These findings support further investigation into the use of PRP as a non-surgical treatment option, warranting additional research to assess its long-term effects and comparative efficacy.
    Keywords:  anterior knee pain; knee function; non-surgical treatment; patellofemoral chondromalacia; prp therapy
    DOI:  https://doi.org/10.7759/cureus.99698
  42. BMC Musculoskelet Disord. 2026 Jan 21.
    Preprocedural superomedial pain localization as a predictor for short-term clinical improvement after cooled radiofrequency ablation in advanced knee osteoarthritis.
    Naofumi Hashiguchi, Atsuo Nakamae, Tsukasa Kanda, Kyohei Nakata, Akinori Nekomoto, Koji Takeda, Junya Tsukisaka, Nobuo Adachi.
      
    Keywords:  Cooled radiofrequency ablation; Genicular nerve; Knee osteoarthritis; Pain localization; Patient-reported outcomes
    DOI:  https://doi.org/10.1186/s12891-026-09506-5
  43. Orthop J Sports Med. 2026 Jan;14(1): 23259671251386862
    A Randomized Controlled Trial of 1-Year Clinical Outcomes of a Single Platelet-Rich Plasma Injection Versus Corticosteroid for the Treatment of Lateral Elbow Tendinopathy.
    John J Wilson, Kenneth S Lee, Rachel Erickson, Stephanie Kliethermes.
       Background: Platelet-rich plasma (PRP) treatment for chronic lateral elbow tendinopathy (LET) has increased because of its potential for prolonged symptom relief and improved function. Limited studies have definitively documented long-term benefits.
    Purpose: To assess the efficacy of a single intratendinous PRP injection compared to a corticosteroid injection for the treatment of LET.
    Study Design: Randomized controlled trial; Level of evidence, 1.
    Methods: In total, 48 participants (n = 50 elbows), aged 18 to 65 years, were randomly assigned to ultrasound-guided PRP (n = 26) or corticosteroid (control, n = 24) injection. Patient-Rated Tennis Elbow Evaluation (PRTEE) and Quick version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) were compared at baseline and 4, 8, 12, 16, 26, and 52 weeks. Secondary outcomes were assessed via grip strength, visual analog scale (VAS) scores, and overall satisfaction with treatment. Wilcoxon rank-sum tests and longitudinal analysis of covariance models were used to assess outcomes over time.
    Results: At 4 weeks, mean PRTEE scores were 47.6 ± 3.7 in the PRP group compared to 14.8 ± 3.9 in the CSI group (P < .001). At 8 weeks, PRTEE scores were 32.1 ± 3.7 for PRP and 15.2 ± 4.0 for CSI (P = .003). At 12 weeks, scores were 26.3 ± 3.9 for PRP versus 16.0 ± 4.1 for CSI (P = .07). By 26 weeks, mean scores favored PRP (17.7 ± 6.5 vs 35.3 ± 6.8; P = .07), and by 52 weeks, PRP scores remained lower (14.4 ± 6.3 vs 29.6 ± 6.3; P = .10). At 4 weeks, mean QuickDASH scores were 22.4 ± 1.1 in the PRP group versus 15.5 ± 1.1 in the CSI group (P < .001). At 8 weeks, PRP scores were 19.3 ± 1.1 compared to 15.8 ± 1.2 for CSI (P = .04). No significant differences were observed at 12 weeks (17.7 ± 1.1 vs 16.6 ± 1.2; P = .49) or 16 weeks (16.8 ± 1.1 vs 18.4 ± 1.2; P = .35). At 26 weeks, QuickDASH scores favored PRP (15.7 ± 1.6 vs 20.3 ± 1.7; P = .05), and this difference persisted at 52 weeks (14.0 ± 1.6 vs 18.6 ± 1.6; P = .05). However, VAS scores were on average 1.5 points lower in the PRP group across all time points.
    Conclusion: Our study demonstrated that corticosteroids resulted in greater short-term improvement, while PRP demonstrated superior longer-term outcomes at 6 and 12 months. PRP was associated with lower average VAS scores over time.
    Keywords:  biological healing enhancement; elbow; platelet rich plasma; tendinosis
    DOI:  https://doi.org/10.1177/23259671251386862
  44. Int J Physiol Pathophysiol Pharmacol. 2025 ;17(6): 177-187
    Analgesic effect of intravenous nefopam for postoperative pain in spine surgery: a meta-analysis of RCTs.
    Muhammad Parsa Pashazadeh, Zhale Nahavandi, Arad Ghorbani, Shahan Shakeri, Mina Abbasi, Sepehr Haghshoar, Shiva Sayedsalehi, Omid Salimi, Vida Hafezi, Yaser Khakpour, Zahra Farrokhi, Mahdyieh Naziri, Haleh Alizadeh, Niloofar Deravi.
       BACKGROUND AND OBJECTIVE: For the management of postoperative pain, opioids have typically been half their efficacy, but they are associated with notable side effects such as sedation, nausea, and respiratory depression. Nefopam is a non-opioid analgesic, within the benzoxazocine class, that has been suggested as an important adjunctive analgestic in multimodal analgesia (MMA). However, the extent to which analgesics outside of opioids are accepted as part of Enhanced Recovery After Surgery (ERAS) programs is controversial. The difficulty of predicting pain management outcome, considering the variability in postoperative pain, means that study of the analgesic effect of intravenous nefopam given different strategies, is essential in the use of nefopam for spinal surgery.
    METHODS: We completed a systematic search of PubMed, Scopus, and Google Scholar until July 20, 2025. We included randomized controlled trials (RCTs) that assessed intravenous nefopam for treating postoperative pain in patients who had spine surgery. The extracted data were pooled, and we performed a random-effects meta-analysis. Subgroup analyses were planned to compare bolus use, infusion use, and bolus plus infusion use.
    RESULTS: Seven RCTs, involving a total of 471 patients, were included in the eligibility criteria. The overall pooled analysis found no differences in postoperative pain scores between the nefopam and control conditions. The standardized mean difference (SMD) was -0.28 (95% confidence interval [CI]: -0.74 to 0.18), which indicated no difference in efficacy. The sub-group analysis found that bolus administration had the greatest analgesic effect (SMD = -0.70) and infusion or bolus + infusions had little or no clinical benefit. The infusion sub-group had the greatest heterogeneity (I2 = 86.9%) suggesting variability in studies for this delivery method.
    CONCLUSION: The use of intra-venous nefopam offers a small analgesic benefit in spine surgery, which is best seen when applied intermittently or as a bolus rather than as a continuous infusion. Though it is not particularly effective as a standalone agent, bolus does have potential as an adjunct and should be included as part of a more multimodal analgesia approach. Further high quality RCTs with larger sample sizes are warranted to better define the optimal application of nefopam and dosing in patients undergoing spinal surgery.
    Keywords:  Nefopam; analgesic; meta-analysis; pain; spine surgery; systematic review
    DOI:  https://doi.org/10.62347/LVMJ6188
  45. J Funct Morphol Kinesiol. 2026 Jan 01. pii: 23. [Epub ahead of print]11(1):
    Ultrasound-Based Assessment of Shoulder Soft Tissue Alterations in Young Adults Performing Upper Limb Weight Training: A Cross-Sectional Study.
    Juan José Montoya-Miñano, Carlos Miquel García-de-Pereda-Notario, Luis Palomeque-Del-Cerro, Luis Alfonso Arráez-Aybar.
      Background: The subacromial space, measured as the acromiohumeral distance (AHD), is a key determinant of shoulder biomechanics and injury risk. Athletes performing repetitive upper-limb resistance training are particularly exposed to cumulative tendon stress. Musculoskeletal ultrasound (US) enables dynamic, cost-effective assessment, yet its role in strength athletes remains underexplored. The aim of this study was to determine whether young adults engaged in regular upper-limb weight training present a narrower acromiohumeral distance and a higher prevalence of ultrasound-detected tendon abnormalities compared with non-weight-training individuals. Methods: We conducted a post hoc subanalysis of a cross-sectional cohort of 66 young adults (18-45 years; mean 29.6 ± 9.0 years; 27 men/39 women) evaluated with standardized shoulder US. Participants were classified as weight-training (n = 15; 36.2 ± 5.7 years; 11 men/4 women) or non-weight-training (n = 51; 27.6 ± 8.8 years; 16 men/35 women). AHD was measured in millimeters, and abnormalities of the supraspinatus, subscapularis, long head of the biceps tendon (LHBT), and subacromial-subdeltoid bursa were recorded. Between-group comparisons used Welch's t-test or χ2/Fisher's exact test; effect sizes were expressed as Cohen's d or odds ratios (OR). Multiple testing was corrected with the false discovery rate (FDR). Results: Weight-training participants exhibited a significantly smaller AHD (7.13 ± 0.54 vs. 7.49 ± 0.68 mm; t (28) = -2.12, p = 0.038; mean difference -0.36 mm, 95% CI -0.70 to -0.03; Cohen's d = -0.56). Supraspinatus tendinopathy was more prevalent in weight-training athletes (93.3% vs. 41.2%; OR 17.7, 95% CI 2.16-145.8; FDR-adjusted p = 0.003). Subscapularis tendinitis (40.0% vs. 17.6%; OR 3.58, 95% CI 1.00-12.88; FDR p = 0.14) and LHBT tenosynovitis (20.0% vs. 3.9%; OR 6.82, 95% CI 1.02-45.8; FDR p = 0.09) showed non-significant trends. Conclusions: Upper-limb weight training in young adults is associated with reduced AHD and a markedly higher prevalence of supraspinatus tendinopathy. Ultrasound proved valuable for early detection of structural and morphological alterations in shoulder soft tissues. Preventive strategies focusing on load management, exercise technique, and targeted strengthening should be prioritized.
    Keywords:  acromiohumeral distance; long head of the biceps tendon; rotator cuff tendinopathy; shoulder injuries; ultrasound diagnosis; weight training
    DOI:  https://doi.org/10.3390/jfmk11010023
  46. J Exp Orthop. 2026 Jan;13(1): e70646
    Robotic-assisted restricted kinematic alignment in total knee arthroplasty: A multicenter retrospective assessment of coronal phenotypes and early postoperative outcomes.
    Ravi Teja Rudraraju, Sanjay Bhalchandra Londhe, Ponnanna Karineravanda Machaiah, Supreet Bajwa, Kunal Aneja, Police Jayaram Reddy, Kanakanala Jangi Reddy, Dolly Singh.
       Purpose: The Coronal Plane Alignment of the Knee (CPAK) classification enables phenotype-based total knee arthroplasty (TKA), but its application in robotic-assisted TKA (RATKA) remains underexplored. We aim to describe the distribution of CPAK phenotypes in patients undergoing RATKA using a restricted kinematic alignment (rKA) protocol, evaluate alignment correction within rKA boundaries and report early postoperative functional outcomes. We hypothesized that RATKA would achieve alignment targets within the rKA range while demonstrating expected postoperative functional recovery.
    Methods: This multicenter retrospective study included 200 patients with primary knee osteoarthritis between June and November 2024 at five high-volume centres. All procedures followed a rKA protocol, with target correction within ±3° of constitutional alignment. CPAK distribution, demographic variations, achieved alignment and early postoperative functional outcomes measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Forgotten Joint Score (FJS) were analysed.
    Results: The cohort (mean age 62.9 years; 60.5% female) showed preoperative arithmetic hip-knee-ankle angle of -5.8° ± 4.6° and joint line obliquity of 173.2° ± 4.1°, predominantly varus (71.5% Type I). Type I alignment was more frequent in males (73.4%), females (70.2%) and those aged >61 years. Of the 71.5% CPAK Type I, 63.5% remained Type I with correction within 0° ± 3°, while 8% were corrected to Type II. All achieved alignment within rKA limits (mean postoperative hip-knee-ankle 173.0° ± 3.2°). Mean postoperative lateral distal femoral angle and medial proximal tibial angle were 85.1° and 87.7°, respectively. Significant improvements were observed in KOOS (80.9 ± 2.3 vs. 40.6 ± 3.5, p < 0.05) and FJS (75.9 ± 1.4 vs. 49.8 ± 1.3, p < 0.05) at 6 months. No early revisions occurred.
    Conclusion: RATKA performed with a rKA strategy, achieved postoperative alignment within planned rKA limits across CPAK phenotypes. Early functional outcomes at 6 months were satisfactory and consistent with expected postoperative recovery following TKA; however, in the absence of a comparator group, these improvements cannot be attributed solely to the robotic platform or alignment strategy.
    Level of Evidence: Level II, retrospective study.
    Keywords:  Coronal Plane Alignment of the Knee (CPAK); functional outcomes; phenotype‐based alignment; restricted kinematic alignment; robotic‐assisted total knee arthroplasty
    DOI:  https://doi.org/10.1002/jeo2.70646
  47. Curr Pain Headache Rep. 2026 Jan 19. 30(1): 22
    Minimally Invasive Interventional Management of Pudendal Neuralgia: A Narrative Review.
    Christopher M Lam, Christopher L Robinson, Kathryn Kuester, Jordan Lee Tate, Kiran Patel, Usman Latif.
       PURPOSE OF REVIEW: Chronic pelvic pain (CPP), affecting approximately 26% of women globally, is a multifactorial condition with causes including, but not limited to, gynecologic disorders, musculoskeletal disorders, and neuropathic disorders including pudendal neuralgia. A comprehensive evaluation and a multimodal treatment strategy - encompassing medical, minimally invasive non surgical, and surgical therapies - are essential for effective management. This narrative review explores current minimally invasive interventional management options for pudendal neuralgia causing CPP.
    RECENT FINDINGS: Pudendal nerve blocks demonstrated pain relief, but the duration of relief varied. Pulsed radiofrequency ablation revealed longer-lasting pain relief compared to pudendal nerve blocks, with several clinical trials and case reports supporting its efficacy. Additionally, neuromodulation techniques, including neuraxial and peripheral nerve neuromodulation, showed promising results in alleviating pain for patients who did not respond to conservative measures. While studies describe interventional therapy for pudendal neuralgia, there is a dearth of randomized controlled trials, which limits the ability to generalize treatment options for pudendial neuralgia. Despite this, current data suggest the possible benefit of interventional management of for pudendal neuralgia.
    Keywords:  Chronic pelvic pain; Interventional management; Nerve; Pudendal neuralgia
    DOI:  https://doi.org/10.1007/s11916-025-01434-8
  48. Geriatr Gerontol Int. 2026 Jan;26(1): e70334
    Muscle Quality and Post-THA Falls: Interpreting the Clinical Impact of Gluteus Medius Fatty Infiltration.
    Shenghong Chen.
      
    Keywords:  falls; fatty infiltration; muscle quality; total hip arthroplasty
    DOI:  https://doi.org/10.1111/ggi.70334
  49. JB JS Open Access. 2026 Jan-Mar;11(1):pii: e25.00335. [Epub ahead of print]11(1):
    Intra-articular Hyaluronic Acid for Knee Osteoarthritis: Stabilizing Utilization Trends Amid Conflicting Clinical Practice Guidelines.
    Chris J Lee, Albert H Lee, Wesley Day, Jonathan N Grauer.
       Background: Evidence has been mixed about the efficacy of intra-articular hyaluronic acid (HA) for knee osteoarthritis. This has led to conflicting clinical practice guidelines (CPGs) over the years. After the American Academy of Orthopaedic Surgeons (AAOS) issued a strong recommendation against HA in 2013, a claims-based study showed rapid decline in use. More recent endorsements from Osteoarthritis Research Society International (OARSI) in 2019 and the Veterans Affairs and Department of Defense (VA-DoD) in 2020 may have altered this trajectory. This study aimed to gauge contemporary utilization of HA knee injections.
    Methods: All patients aged 18 years and older diagnosed with knee osteoarthritis were identified from the 2010Q1-2023Q1 PearlDiver database. The percentage of patients receiving intra-articular HA relative to the number of patients diagnosed for knee osteoarthritis was calculated quarterly. Linear regression analyses were segmented by 2 key CPG inflection points: 2013Q3 AAOS' recommendation against HA injections and the 2019Q4 endorsements. Analyses were also stratified by provider specialty. Statistical significance was set at p < 0.05.
    Results: A total of 16,581,526 knee OA patients were identified, among which HA knee injections were performed for 1,886,788 (11.4%). For the post-2013 AAOS CPG period (2013Q3-2019Q3), injection rates decreased (-0.10% per quarter; p < 0.001). However, following OARSI/VA-DoD endorsement (2019Q4-2023Q1), the slope leveled to -0.003% per quarter; p = 0.921. Through the study period, utilization declined for both women and men and both younger and older patients (<50 years old and ≥ 50 years old) (p < 0.001 for all). Utilization declined among orthopaedic surgeons, nonoperative musculoskeletal specialists, and primary care physicians, while utilization increased among pain medicine physicians (p < 0.001 for all).
    Conclusions: Intra-articular HA injection use decreased after the 2013 CPG from AAOS but has stabilized after more positive 2019 and 2020 CPGs from OARSI/VA-DoD. Notably, practice patterns are diverging patterns across specialties, suggesting variabilities in use.
    Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.
    DOI:  https://doi.org/10.2106/JBJS.OA.25.00335
  50. Drugs Aging. 2026 Jan 22.
    Methotrexate for Osteoarthritis: What Does the Evidence Say?
    Marina De Castro Fidalgo E Costa, Frederique Ponchel, Kierran Flack, Philip G Conaghan, Sarah R Kingsbury.
      Osteoarthritis (OA) is a leading cause of disability worldwide, characterised by chronic pain and reduced quality of life. Despite its prevalence, pharmacotherapy options remain limited. Inflammation has emerged as a promising target, with anti-inflammatory agents used in other rheumatological conditions, such as methotrexate (MTX), being explored for OA treatment. MTX is a cornerstone therapy in rheumatoid arthritis (RA), owing to its broad immunomodulatory properties and well-established clinical efficacy. This review summarises evidence from seven randomised controlled trials and two observational studies investigating MTX in knee and hand OA. Studies varied considerably in terms of sample size, study population, MTX dosage and follow-up duration. Overall, study outcomes were conflicting in terms of MTX effect on OA symptoms. However, trials with larger sample sizes and higher MTX doses (> 15 mg/week) consistently reported benefits for pain in knee and hand OA, with a favourable safety profile, supporting MTX as a potential OA treatment. There is still a need for further research to refine dosing strategies, assess longer term use and evaluate cost-effectiveness. Given the complex heterogeneity of OA, stratification by OA phenotype, particularly consideration of local and systemic inflammation, may also be important to underpin selection of a population most likely to respond to MTX treatment. Considerations for the use of MTX in older adults, where comorbidities and polypharmacy may impact use, will also be essential for clinical implementation.
    DOI:  https://doi.org/10.1007/s40266-025-01276-4
  51. BMC Sports Sci Med Rehabil. 2026 Jan 20.
    Postural stability impairments in non-athletic individuals after anterior cruciate ligament reconstruction: a cross-sectional study.
    Gürkan Demi̇rtaş, Hilal Yağar, Emin Kürşat Bulut, Kadir Eren Bi̇çer.
      
    Keywords:  Balance; Knee joint; Proprioception; Recovery of function; Sedentary behavior
    DOI:  https://doi.org/10.1186/s13102-026-01543-w
  52. J Hand Microsurg. 2026 Mar;18(2): 100400
    DIP joint is ankle joint, PIP joint is knee joint, and MCP joint is hip joint - Treat them accordingly.
    J Terrence Jose Jerome.
      
    Keywords:  Ankle joint; DIP joint; Hip joint; Knee joint; MCP joint; PIP joint
    DOI:  https://doi.org/10.1016/j.jham.2025.100400
  53. PM R. 2026 Jan 19.
    Analysis of balance in adults with chronic axial spinal pain receiving medial branch block or radiofrequency ablation procedures.
    Matthew Carter, John D Ralston, Robert Burnham, Jennifer Laxshimalla, Lisa Jasper, JuliAnn Thai, Ashley D Smith.
       BACKGROUND: Medial branch blocks (MBB) and radiofrequency ablations (RFA) are common diagnostic, prognostic, and interventional procedures performed for the management of cervical and lumbar spine facetogenic pain. Although these procedures have established utility as pain management strategies, it is unclear if the disruption in function of the medial branch nerve leads to patient balance impairment.
    OBJECTIVE: (1) To determine if there was a difference in postural balance, measured using a head mountable physiological vibration acceleration (Phybrata) sensor, between those pursuing cervical or lumbar MBBs/RFAs compared to an asymptomatic healthy cohort (HC). (2) To determine differences in balance and sensory reweighting prior to and following MBBs/RFAs, and the association with clinical measures of pain and balance using the 4-Stage Balance Test.
    DESIGN: Quasiexperimental study with matched controls.
    SETTING: Community multidisciplinary chronic musculoskeletal pain practice.
    PARTICIPANTS: Sixty individuals with chronic axial back pain and 60 age-/gender-matched healthy individuals.
    INTERVENTIONS/MAIN OUTCOME MEASURES: Standing balance measures recorded with the Phybrata sensor, subjective report of pain (numerical rating scale), and clinical measures of balance (4-Stage Balance Test) were analyzed before and after participants underwent MBBs/RFAs and compared to an asymptomatic HC.
    RESULTS: Participants with axial spinal pain of facet joint origin (≥ 50% relief post MBB/RFA) demonstrated balance degradation when standing with eyes closed, when compared to participants with nonspecific axial spinal pain (< 50% pain relief) or HCs - both prior to and following MBBs/RFAs. Following MBBs/RFAs, participants undergoing C2/3 procedures demonstrated increased postural sway. The remainder of participants with axial spinal pain did not show any further balance deficits, with corresponding sensory reweighting adaptation. Phybrata measures were not associated with pain location or pain intensity prior to or after MBBs/RFAs.
    CONCLUSIONS: These results suggest the risk of developing significant balance impairments following MBB/RFA procedure of either the cervical (excluding C2/3) or lumbar spine is low, although residual balance deficits remain.
    DOI:  https://doi.org/10.1002/pmrj.70083
  54. Pain Res Manag. 2026 ;2026 7701940
    The Use of Botulinum Toxin Injections in Peripheral Neuropathic Pain: A Systematic Review of Efficacy and Safety Outcomes.
    Domenico Antonio Restivo, Andrea Calderone, Angelo Quartarone, Rocco Salvatore Calabrò, Antongiulio Bruschetta.
      Peripheral neuropathic pain (PNP), a chronic condition resulting from nerve damage and characterized by altered sensory signaling and central sensitization, poses significant therapeutic challenges. Botulinum toxin (BTX), known for neuromuscular blockades, also exhibits analgesic properties, prompting its investigation for PNP management. However, existing evidence regarding its efficacy and safety is fragmented. This systematic review aimed to synthesize current data on BTX injections for PNP. Guided by PRISMA and the neuromatrix theory, major databases (PubMed, Web of Science, Cochrane, Embase, Scopus, EBSCOhost) were searched up to March 2025. Included studies evaluated BTX (primarily type A) in adults with PNP using validated pain outcomes and reported safety, covering designs from randomized controlled trials (RCTs) to observational research. Independent reviewers performed data extraction and quality assessment using risk of bias tools. This review has been registered on Prospero with the following number: CRD420251022222. The patient groups studied (1343 participants: 547 males and 632 females) showed substantial variability in age, diagnosis, and treatment setting. Results indicated BTX use across diverse PNP etiologies (e.g., trigeminal neuralgia, painful diabetic neuropathy (DN), postherpetic neuralgia, and phantom limb pain) and across multiple countries. RCTs often reported statistically significant reductions in pain intensity and improvements in related outcomes compared with placebo, although effect sizes were heterogeneous and sample sizes were generally modest. Nonrandomized studies suggested similar trends but frequently presented moderate to serious risk of bias. Adverse events were usually mild and transient, most often localized injection-site reactions or temporary facial asymmetry in cranial applications, while serious complications were rare but could not be excluded with confidence because of incomplete safety reporting. Overall, BTX may offer clinically meaningful benefit for selected PNP subtypes, particularly trigeminal neuralgia and painful DN, yet the certainty of evidence remains low to moderate due to study limitations and methodological diversity. Routine use in PNP therefore requires cautious, individualized consideration rather than broad generalization.
    Keywords:  botulinum toxin; efficacy; injection techniques; neurotransmitter release; pain management; peripheral neuropathic pain; safety
    DOI:  https://doi.org/10.1155/prm/7701940
  55. Zhongguo Zhen Jiu. 2026 Jan 12. 46(1): 29-38
    [Central mechanism of the short-needling method for treating knee osteoarthritis based on EEG signals].
    Yi Ren, Huiying Wu, Weike Li, Qi Zeng, Yanling Liu.
       Objective: To explore the central mechanism of the short-needling method for treating knee osteoarthritis (KOA) based on electroencephalogram (EEG) signals.
    Methods: Thirty-one KOA patients were recruited as the KOA group, and 31 age-, sex-, and BMI-matched healthy subjects were recruited as the healthy group. The KOA group received "short-needling" therapy at Neixiyan (EX-LE5), Dubi (ST35), Yinlingquan (SP9), Zusanli (ST36), and Liangqiu (ST34) on the affected side, once daily, 6 consecutive days as a treatment course, with a 1-day break between treatment courses, for a total of 4 treatment courses. Western Ontario and McMaster Universities osteoarthritis index (WOMAC) score was assessed before and after treatment; the levels of inflammatory cytokines (interleukin-1β [IL-1β] and tumor necrosis factor-α [TNF-α]) in synovial fluid were measured; the relative power of resting-state EEG signals (Delta, Theta, Alpha, Beta, Gamma frequency bands) and EEG network topological indexes (global clustering coefficient, global efficiency, mean degree, and network density) were analyzed in KOA patients before and after treatment and in healthy subjects.
    Results: (1) Compared before treatment, the KOA group showed significantly reduced WOMAC scores in joint pain, stiffness, physical function, and total scores after treatment (P<0.001); IL-1β and TNF-α levels in synovial fluid were also significantly reduced (P<0.001). (2) In the Theta band, compared before treatment, the relative power in 10 brain regions was decreased significantly after treatment in the KOA group (P<0.05, P<0.01); except for the prefrontal cortex, the relative power in other regions of the KOA group remained higher than the healthy group before treatment (P<0.01). In the Beta band, compared before treatment, the relative power in all regions except the prefrontal cortex increased after treatment in the KOA group (P<0.05, P<0.01); before treatment, KOA patients had lower relative power in the left/right frontal lobes, left/right parietal, central parietal region, left/right temporal, and occipital lobes compared to the healthy group (P<0.01). (3) Compared with the healthy group, the KOA group showed abnormally enhanced functional connectivity in Theta and Gamma bands in the prefrontal cortex before treatment; after treatment, this abnormal connectivity was attenuated. (4) Compared before treatment, the global clustering coefficient, mean degree, and global efficiency in the Theta band networks of the prefrontal cortex decreased significantly after treatment (P<0.05), approaching levels of the healthy group (P>0.05); all four topological metrics before treatment in the KOA group were significantly higher than those in the healthy group (P<0.01). (5) The relative Theta power in the left frontal lobe was positively correlated with the difference in WOMAC score before and after treatment (P<0.05); the relative Gamma power in the right frontal lobe was negatively correlated with the difference in WOMAC score before and after treatment (P<0.05).
    Conclusion: The short-needling method could effectively improve joint function in KOA patients, reduce slow-wave Delta activity, increase fast-wave Beta activity, and regulate abnormally enhanced brain functional connectivity networks. These EEG changes are correlated with WOMAC score.
    Keywords:  central mechanism; electroencephalogram (EEG); knee osteoarthritis (KOA); neuroelectrophysiology; short-needling method
    DOI:  https://doi.org/10.13703/j.0255-2930.20240902-k0001
  56. Reports (MDPI). 2026 Jan 09. pii: 22. [Epub ahead of print]9(1):
    Anterior Cruciate Ligament Rupture with Concurrent Gastrocnemius Tear: A Case Report of a Rare Pattern of Injury.
    Su Jin Lee, Khang Duy Ricky Le, Roger Davies.
      Background, Clinical Significance: Anterior cruciate ligament (ACL) injuries are common, however the occurrence of concurrent gastrocnemius muscle tears is exceptionally rare. Given this, the diagnosis and management of this pattern of injury is poorly characterised, with lack of current clinically relevant classification systems and evidence-based guidelines to guide treatment. Early recognition is essential. with advanced imaging critical to guiding the diagnosis and management of patients with this pattern of injury. Case presentation: A 39 year old man presented with acute right knee swelling, pain and difficulty weightbearing following a sports-related fall. Clinical examination was suspicious for an ACL injury. Magnetic Resonance Imaging (MRI) of the knee demonstrated the disrupted and displaced ACL fibres, with extensive peri-cruciate oedema around the expected position of the ACL. It was associated with partial avulsion of the medial gastrocnemius origin and incomplete avulsion of the lateral gastrocnemius origin. The patient was referred for an urgent orthopaedics review and is currently on trial of conservative management. Conclusions: In this case report and review of the literature, we evaluate the current understanding of the complexities of combined musculoskeletal injuries and limitations of existing classifications in providing accurate diagnosis and management strategies. Given the rarity of this presentation, the case underscores the lack of evidence-based recommendations for early management, particularly in young, active individuals who are at risk of significant long-term functional impact.
    Keywords:  anterior cruciate ligament injury; gastrocnemius tear; orthopaedic surgery; sporting injury; sprots medicine
    DOI:  https://doi.org/10.3390/reports9010022
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