bims-ricfun Biomed News
on Rehabilitation ICF
Issue of 2026–02–22
sixty papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica
  1. Long-term outcomes of cooled versus conventional radiofrequency ablation of genicular nerves for chronic knee osteoarthritis pain: A randomised comparative study.
  2. What are the effects of rehabilitation interventions following surgical or non-surgical management of ankle fractures in adults? - A Cochrane review summary with commentary.
  3. Epidural Platelet-Rich Plasma Long-Term Outcome Is Better Than Steroid for Prolapsed Lumbar Intervertebral Discs: A Meta-Analysis of Randomized Controlled Trials.
  4. Effects of Adding Thoracic Extension Exercises or Thoracic Kinesio Taping to Shoulder Exercises on Pain and Function in Adults with Subacromial Pain Syndrome: A Randomized Controlled Trial.
  5. Multimodal Ultrasound Imaging for Pre- and Postoperative Evaluation of Carpal Tunnel Syndrome.
  6. Correlation Between Ultrasound and Nerve Conduction Study Findings in Evaluating Carpal Tunnel Syndrome.
  7. Global clinical trial landscape of stem cell-based therapies for osteoarthritis: trends and translational implications.
  8. The effects of pulsed electromagnetic field therapy on pain and physical functions in patients with soft tissue injuries: a systematic review of randomised controlled trials.
  9. Efficacy and Safety of Dextrose Prolotherapy Versus Corticosteroid Injections in Plantar Fasciitis: A Systematic Review and Meta-Analysis.
  10. [Efficacy and safety of platelet-rich plasma and hyaluronic acid in knee osteoarthritis: A systematic review of the literature].
  11. Conservative management of Madelung deformity: a case report.
  12. Lower limb biomechanics in femoroacetabular impingement syndrome, asymptomatic cam morphology, and controls during bilateral and single-leg squatting.
  13. Peripheral Nerve Ultrasound-guided Intervention: From the Basics to Sonosurgery.
  14. Efficacy and safety of μ1-opioid receptor agonist (Taphalgin®) for emergency analgesia in outpatient practice.
  15. Serum biomarkers reflecting progression of knee osteoarthritis: a stage-based evaluation of TGF-β3, ADAMTS-4, ADAMTS-5, and MMP-13.
  16. A systematic review and meta-analysis on surgery for lumbar disc herniation: optimal timing of surgery, return to work and outcomes compared with conservative management.
  17. Timing rehabilitation according to chronotype: An overlooked variable?
  18. Does the preoperative presence of central sensitization affect sleep quality and pain after total knee arthroplasty?
  19. Two-year outcomes of ultrasound-guided percutaneous tenotomy for long head of the biceps tendinopathy.
  20. Effects of percutaneous platelet-rich plasma injection on return-to-play after acute hamstring muscle injury: systematic review and meta-analysis.
  21. Medical Cannabis for the Treatment of Peripheral Neuropathy due to Diabetes: A Systematic Review.
  22. Effectiveness of physical therapy techniques for cancer-related pain: a systematic review.
  23. Intra-Articular PRP for Grade 2 Degenerative Meniscus Lesions; Radiological and Clinical Outcomes.
  24. Perilunate Dislocations With Median Nerve Involvement: Importance of Early Diagnosis and Surgical Intervention-A Case Series.
  25. Mid-part of adductor canal: Is it the optimal injection site for performing adductor canal block? A cadaver-based injection study.
  26. Triangular Fibrocartilage Complex Injuries in Racquet Sport Players: Prevalence, Management, and Outcomes.
  27. Incidence proportion of complex regional pain syndrome (CRPS) after distal radius fracture: a population-based register study.
  28. Double Crush Syndrome in Surgically-Treated Lumbosacral Radiculopathy: Prevalence, Risk Factors, and Clinical Implications.
  29. Postoperative infraspinatus contractility is associated with acromiohumeral distance after arthroscopic rotator cuff repair.
  30. Assessing Patient Characteristics That Prolong the Need for Total Hip Arthroplasty Following Surgeon-Administered Intra-articular Corticosteroid Injections.
  31. Systematic review and meta-analysis of laser physical agent for pain and disability in rotator cuff tendinopathy: subgroup analysis and meta-regression exploration of randomized control trials.
  32. Hip Arthroscopy With Concomitant Endoscopic Gluteus Medius/Minimus Repair.
  33. Ultrasound-based classification and rehabilitation of biceps femoris T-junction injuries.
  34. Safety and Feasibility of Genicular Artery Embolization with Degradable Starch Microspheres for Knee Osteoarthritis: A One Year Experience and Preliminary Clinical Results.
  35. Robot-assisted rehabilitation following total knee arthroplasty: A meta-analysis of pain, strength, and functional recovery outcomes.
  36. Exploring Diaphragmatic Ultrasonography as a Diagnostic Tool for Hyperinflation in COPD Patients: A protocol study.
  37. Tendon versus nerve transfers - balancing hand function in upper extremity high nerve injuries.
  38. Group-based versus individual-based circuit training in elderly women with knee osteoarthritis: study protocol for a non-inferiority randomized controlled trial.
  39. Risk Factor Analysis of Residual Low Back Pain After Unilateral Biportal Endoscopic Discectomy in Patients With Lumbar Disc Herniation.
  40. Patient- and disease-specific factors associated with atrophy of the intrinsic muscles of the ulnar nerve in cubital tunnel syndrome.
  41. Clinical Outcomes of Flexor Tenolysis Following Zone 2-3 Flexor Tendon Repair: A Retrospective Review.
  42. Anatomical relationship of the suprascapular and axillary nerves to the glenohumeral joint and its surgical significance: a systematic review.
  43. Association of pain sensitization with prefrontal cortex activation and movement patterns during single- and dual-task walking in people with knee osteoarthritis.
  44. From rescuer to patient: a trauma surgeon's skiing injury journey.
  45. Update of guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopedic Association Part 1: preventive measures, diagnostics, and non-surgical treatment of subacromial pain syndrome.
  46. Exercise for multidirectional instability of the shoulder.
  47. Update on US-guided Interventional Procedures for Tendinopathies.
  48. Evaluation of the effects of extremity elongation on brachial plexus nerves via intraoperative neuromonitoring in patients undergoing reverse total shoulder arthroplasty.
  49. Comparative effectiveness of minimally invasive therapies for plantar fasciitis: a systematic review and network meta-analysis.
  50. Effectiveness of exercise therapy for osteoarthritis: an overview of systematic reviews and randomised controlled trials.
  51. Comment to the article: The value of inspiratory muscle training on poststroke sarcopenia and its effect on rehabilitation outcomes.
  52. Return-to-sport following lateral ankle sprain: Connecting scientific frameworks and real-world protocols of elite sports teams.
  53. Clinical Utility of Physical Examination Findings in Pediatric and Adolescent Acute Spondylolysis.
  54. Optimizing women's health: pelvic floor considerations in sports and physical activity.
  55. Rehabilitation protocols after arthroscopic rotator cuff repair: A survey of active members of the Korean Shoulder and Elbow Society.
  56. Observational Evaluation of Muscle Echointensity and EMG Insertional Activity in Poststroke Spasticity.
  57. Exploring the anatomical basis of piriformis syndrome: A systematic review.
  58. Enhancing participation with power-assist device: An exploratory study in manual wheelchair users.
  59. Return to work rates of workers compensation patients with lumbar radiculopathy following epidural steroid injection.
  60. Corrigendum to "Roc-based validation of palmar sensory latency in Carpal tunnel syndrome diagnosis". [J. Electromyogr. Kinesiol. 87 (2026) 103112].
  1. Indian J Anaesth. 2026 Jan;70(1): 265-271
    Long-term outcomes of cooled versus conventional radiofrequency ablation of genicular nerves for chronic knee osteoarthritis pain: A randomised comparative study.
    Abhirup Nayak, Debolina Gosh, Gargi Nandi, Indira R Kasar.
       Background and Aims: Chronic knee pain due to osteoarthritis is a prevalent cause of disability. Radiofrequency ablation (RFA) of genicular nerves is a promising approach for alleviating pain and improving function in knee osteoarthritis. This study compares the long term efficacy of cooled and conventional RFA in managing chronic knee pain and disability by observing and comparing pain relief and improvement in functional disability up to 24 months postprocedure.
    Methods: Forty patients aged >50 years with Kellgren-Lawrence grade 3 and 4 were enroled. Fluoroscopic-guided genicular nerve ablation was performed on 30 patients: 15 with cooled RFA and 15 with conventional RFA, following positive diagnostic blocks. Pain (Numeric Rating Scale (NRS) and functionality (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC score) were assessed at 3, 6, 12, 18, and 24 months. Chi-square test, independent t-test, and paired t-test were used for the statistical analysis. The P ≤0.05 was considered statistically significant.
    Results: At 3 months, the Group cooled RFA demonstrated significantly greater reductions in NRS (73.33% vs 53.33%) compared to the Group conventional RFA. Improvement in the WOMAC functional score was found to be better at 3 months in the Group conventional RFA (73.33% vs 66.66%), but at 6-month and subsequent follow-up, the Group cooled RFA had better improvement in functional score. These differences persisted till 24 months, with NRS P < 0.001 and WOMAC P < 0.001 from 6 months onwards. Inter-group comparisons showed significant advantages for cooled RFA in both pain reduction and functional outcomes.
    Conclusions: Cooled radiofrequency ablation offers superior long-term benefits in pain relief and functional improvement compared to conventional.
    Keywords:  Chronic pain; cooled RFA; denervation; fluoroscopy; osteoarthritis knee; quality of life; radiofrequency ablation
    DOI:  https://doi.org/10.4103/ija.ija_573_25
  2. Turk J Phys Med Rehabil. 2025 Dec;71(4): 607-609
    What are the effects of rehabilitation interventions following surgical or non-surgical management of ankle fractures in adults? - A Cochrane review summary with commentary.
    Haydar Gök.
      
    DOI:  https://doi.org/10.5606/tftrd.2025.17411
  3. Spine Surg Relat Res. 2026 Jan 27. 10(1): 36-42
    Epidural Platelet-Rich Plasma Long-Term Outcome Is Better Than Steroid for Prolapsed Lumbar Intervertebral Discs: A Meta-Analysis of Randomized Controlled Trials.
    Rieva Ermawan, Hubertus Corrigan, Muhammad Setya Fachreza, Grendi Mercy, Agiona Angeline, Bayu Sakti Jiwandono, Ibnu Yudistiro, Muhammad Abdulhamid.
       Background: Prolapsed lumbar intervertebral disc (IVD) is a prevalent spinal cause of low back pain associated with radicular pain. Platelet-rich plasma (PRP) has emerged as a potential alternative to epidural steroid injections. This review aimed to compare the efficacy of epidural PRP and epidural steroid injections in treating low back pain due to prolapsed lumbar IVD, assessed using a pain scale and Oswestry's disability index (ODI).
    Methods: A systematic search of 4 databases (PubMed, Scopus, ScienceDirect, and Cochrane Central Register of Controlled Trials) up to July 2024 for randomized controlled trials comparing epidural PRP with steroids. Risk of Bias 2 was used for bias assessment. Pain and ODI mean differences (MDs) were calculated using RevMan v5.4. Heterogeneity was measured using I2, with random or fixed effects applied accordingly. The combined outcome progression of pain and ODI scores were computed using STATA/MP 17.0 software.
    Results: Three trials (n=132) were included. At 1 month, epidural steroid injections showed lower pain scores than PRP (standard MD=1.04, 95% confidence interval [CI]: 0.63-1.46, p<0.00001, I2=0%). At 6 months, epidural PRP injection demonstrated greater pain relief (MD=-1.51, 95% CI: -1.98 to -1.05, p<0.00001, I2=0%) and lower ODI (MD=-9.71, 95% CI: -16.63 to -2.78, p=0.006, I2=75%). Epidural steroids showed significant worsening in pain score (1 vs 3 months, p=0.001; 3 vs 6 months, p=0.003).
    Conclusions: Epidural PRP provides sustained and gradual improvement of pain and ODI for patients with prolapsed lumbar IVD over months of follow-up, while steroids provide initial relief at 1 month but are associated with worsening at later follow-ups.
    Keywords:  epidural; lumbar; meta-analysis; platelet-rich plasma; prolapsed disc; steroid
    DOI:  https://doi.org/10.22603/ssrr.2025-0007
  4. J Shoulder Elbow Surg. 2026 Feb 18. pii: S1058-2746(26)00081-9. [Epub ahead of print]
    Effects of Adding Thoracic Extension Exercises or Thoracic Kinesio Taping to Shoulder Exercises on Pain and Function in Adults with Subacromial Pain Syndrome: A Randomized Controlled Trial.
    Elif Umay Altaş, Müge Kırmızı, Aynur Şahin, Ayşenur Yüksel, Eylem Çağla Danacı, Filiz Meryem Sertpoyraz, Sevtap Günay Uçurum.
       BACKGROUND: In subacromial pain syndrome (SAPS), a common cause of shoulder pain, thoracic spine targeted interventions have been associated with improvements in shoulder outcomes. This study aimed to investigate the effects of adding thoracic extension exercises (TEE) or thoracic kinesio taping (KT) to shoulder exercises (SE) on shoulder pain, disability, active range of motion (AROM), and strength in adults with SAPS.
    METHODS: Seventy-five adults with SAPS were randomized into three groups. Group A and Group B received TEE and KT in addition to SE, respectively, while Group C received only SE. All exercises were performed five days a week for three weeks. KT was applied every three days, for a total of five applications. Assessments included shoulder pain intensity (Visual Analog Scale, VAS), pressure pain threshold (PPT) of the upper trapezius and pectoralis major (algometer), self-reported disability (Disabilities of the Arm, Shoulder, and Hand, DASH) and health status (Short Form-36), AROM (universal goniometer), isometric strength of the shoulder (hand-held dynamometer), and thoracic kyphosis (inclinometer).
    RESULTS: Pain decreased by approximately 3.1-4.4 cm on the VAS, DASH scores improved by 20-23 points, and shoulder AROM increased by 7-50° across groups (p<0.05). PPT increased by 2.7-7.2 kg/cm2 in measures showing statistically significant improvement (p<0.05). Isometric shoulder strength increased in Groups A and B (p<0.05), whereas no significant strength changes were observed in Group C (p>0.05). Between-group comparisons demonstrated greater improvements in PPT of the pectoralis major and shoulder abductor and adductor strength in the groups receiving thoracic interventions compared with SE alone (p<0.05).
    CONCLUSION: Although all interventions improved most outcomes, adding TEE or KT to SE resulted in greater improvements in pain sensitivity and shoulder muscle strength, with no superiority between TEE and KT. Longer-term studies are warranted.
    LEVEL OF EVIDENCE: Level II, Randomized Controlled Trial, Treatment Study.
    Keywords:  Exercise Therapy; Kinesiology Tape; Shoulder Joint; Subacromial Impingement Syndrome; Thoracic Vertebrae
    DOI:  https://doi.org/10.1016/j.jse.2026.02.001
  5. Acad Radiol. 2026 Feb 13. pii: S1076-6332(26)00065-6. [Epub ahead of print]
    Multimodal Ultrasound Imaging for Pre- and Postoperative Evaluation of Carpal Tunnel Syndrome.
    Chengrong Wu, Wenfei Wang, Xinya Xie, Yunyue Wang, Jingjing Mu.
       OBJECTIVE: To evaluate the value of combining high-frequency ultrasound, sound touch elastography (STE), and ultramicro angiography (UMA) for the diagnosis and short-term postoperative follow-up of carpal tunnel syndrome (CTS) patients.
    METHODS: This prospective study enrolled 50 CTS patients (78 wrists), classified by severity into mild (n = 22), moderate (n = 32), and severe (n = 24) groups, along with 35 healthy volunteers (70 wrists) as controls. All participants underwent multimodal ultrasound examination combining high-frequency ultrasound, STE, and UMA to measure median nerve cross-sectional area (CSA), shear wave velocity (SWV), and color pixel percentage (CPP) within 2 cm proximal to the carpal tunnel inlet. Patients with moderate and severe CTS underwent carpal tunnel release surgery followed by repeat ultrasound evaluation at 3 months postoperatively. Statistical comparisons included the following: (1) ultrasound parameters between preoperative CTS patients and controls; (2) parameter differences across severity subgroups; (3) pre-versus postoperative changes in CTS patients; and (4) diagnostic performance of individual and combined parameters for CTS identification.
    RESULTS: Significant elevations in median nerve CSA, SWV, and CPP were observed at the carpal tunnel inlet in the CTS group compared to controls (all P < 0.001). Among CTS patients, CPP demonstrated progressive increases with severity across all subgroups (all P < 0.001). CSA was significantly larger in severe cases than in mild and moderate wrists (P < 0.001), while SWV values were higher in both moderate and severe cases compared to mild CTS (all P < 0.001). Receiver operating characteristic (ROC) analysis indicated that the combination of CSA, SWV, and CPP provided optimal diagnostic accuracy for CTS with area under the curve (AUC) of 0.990, with 96.2% sensitivity and 98.6% specificity. Postoperative assessment at 3 months revealed significant reductions in all three parameters compared to preoperative values (all P < 0.001).
    CONCLUSION: Multimodal ultrasound provides clinical value in carpal tunnel syndrome by supporting early diagnosis and severity stratification, and it may serve as a useful tool for short-term postoperative monitoring.
    Keywords:  Carpal tunnel release; Carpal tunnel syndrome; Color pixel percentage; Sound touch elastography; Ultramicro angiography
    DOI:  https://doi.org/10.1016/j.acra.2026.01.035
  6. Cureus. 2026 Jan;18(1): e101588
    Correlation Between Ultrasound and Nerve Conduction Study Findings in Evaluating Carpal Tunnel Syndrome.
    Shohel Ahmed, Mohammad Moniruzzaman, Saleh Ahmad, Nusrat M Nipun, Md Jouel Ahamed, Monia Hafiz, Suriya Shahaly.
      Background Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, caused by median nerve compression within the carpal tunnel, leading to pain, numbness, and functional impairment. Nerve conduction studies (NCS) remain the diagnostic gold standard, while ultrasonography (US) offers a non-invasive complementary modality. This study evaluated the correlation and agreement between US and NCS in CTS. Methodology In this cross-sectional study conducted at Dhaka Medical College Hospital from August 2021 to September 2022, 48 symptomatic patients (one hand per patient) underwent standardized NCS (motor distal latency (mDL), amplitude (mAMP), velocity (mCV), sensory distal latency (sDL), amplitude (sAMP), velocity (sCV)) and US at the inlet using a 16-MHz linear probe, with the sonographer blinded to clinical and NCS findings. CTS severity was graded by Bland's scale (NCS) and cross‑sectional area (CSA) thresholds (US). Spearman correlation assessed associations and Cohen's kappa quantified inter-modality agreement, with significance set at p-values <0.05. Results According to the NCS, 4 (8.3%) patients were normal, 12 (25.0%) were mild, 21 (43.7%) were moderate, and 11 (22.9%) were severe. CSA was positively correlated with mDL (r = 0.667, p < 0.001) and sDL (r = 0.670, p < 0.001) and negatively correlated with sAMP (r = -0.624, p < 0.001) and sCV (r = -0.536, p < 0.001); correlations with mAMP and mCV were not significant. The US and NCS grades were strongly correlated (r = 0.810, p < 0.001). Overall agreement between US and NCS severity was moderate (κ = 0.60, p < 0.001). Conclusions US appears to be a practical and reliable adjunct to NCS for evaluating and grading CTS, particularly in resource-limited settings or when NCS are not readily feasible. Larger multicenter studies are needed to further validate its role and refine diagnostic thresholds.
    Keywords:  bangladesh; carpal tunnel syndrome; cross-sectional area; median nerve; nerve conduction studies; ultrasonography
    DOI:  https://doi.org/10.7759/cureus.101588
  7. Front Cell Dev Biol. 2026 ;14 1757935
    Global clinical trial landscape of stem cell-based therapies for osteoarthritis: trends and translational implications.
    Xin Li, Yue Zhao, Dongsheng Guo, Chen Yan, Jian Zhang, Lin Cheng, Yuefu Dong.
       Objective: Osteoarthritis (OA) is a leading cause of pain and disability worldwide, yet disease-modifying treatments remain limited. This study aimed to map the global registry landscape of interventional clinical trials of stem cell-based therapies for OA and summarize temporal, geographic, and design trends.
    Methods: We conducted a systematic, registry-based landscape analysis of interventional clinical trials assessing stem cell therapies for osteoarthritis. Trial records were obtained from the Informa Pharmaprojects platform. Two researchers extracted and summarized trial characteristics, including year, phase, geographic distribution, target joint, cell source or type, autologous versus allogeneic strategy, administration route, outcome measures, and trial status. We then performed a descriptive trend analysis.
    Results: We identified a total of 224 eligible trials. The number of trials has steadily increased over time, with broad international participation. Most studies focused on knee osteoarthritis and used intra-articular administration. Mesenchymal stem cell-based products dominated, encompassing both autologous and allogeneic approaches, with growing attention to scalable allogeneic strategies. Primary endpoints were typically patient-reported pain and functional measures, while imaging and biomarker outcomes were often secondary. Published evidence syntheses suggest potential benefits in terms of pain and function, but conclusions are frequently limited by heterogeneity, risk of bias, and relatively short follow-up durations.
    Conclusion: The number of stem cell-based clinical trials for osteoarthritis is increasing globally, but heterogeneity in study designs and incomplete public reporting limit reliable conclusions about efficacy. Future research should prioritize standardizing products and protocols, employing more rigorous comparators and feasible blinding, extending follow-up periods, and ensuring transparent reporting to facilitate clinical translation.
    Keywords:  clinical trials; mesenchymal stem cells; osteoarthritis; regenerative medicine; stem cell therapy
    DOI:  https://doi.org/10.3389/fcell.2026.1757935
  8. Front Sports Act Living. 2026 ;8 1694944
    The effects of pulsed electromagnetic field therapy on pain and physical functions in patients with soft tissue injuries: a systematic review of randomised controlled trials.
    Cheryl Shu Ming Chia, Sai-Chuen Fu, Violet Man-Chi Ko, Josephine Wing Hei Lai, Meng Zhou, Patrick Shu-Hang Yung, Samuel Ka-Kin Ling.
       Background: Foot and ankle diseases are highly prevalent in both the general and athletic populations, frequently resulting in pain, impaired physical function, and a decreased quality of life. Pulsed Electromagnetic Field (PEMF) therapy has shown beneficial effects on pain by reducing inflammation and improving circulation, yet its efficacy in treating foot and ankle soft-tissue pathologies remains unclear. This systematic review aimed to evaluate the impact of PEMF therapy on pain and physical function among individuals with foot and ankle soft-tissue pathologies.
    Methods: A systematic literature search was conducted across Medline, Embase, Emcare (Ovid Nursing & Allied Health), Allied and Complementary Medicine Database (AMED), and Web of Science from database inception to May 15, 2025. Additional searches were performed using Google Scholar and clinical trial registries. Two reviewers independently screened studies and extracted data on pain and physical function outcomes.
    Results: Four randomised controlled trials (RCTs), comprising a total of 243 participants with a mean age of 48.79 years, were included in the review. In three of the four trials, PEMF therapy was administered alongside another conservative intervention, such as shockwave therapy, heel pads, or eccentric exercise, and compared to the conservative treatment alone. Only one study investigated the isolated effects of PEMF therapy vs. sham stimulation. Among the included studies, three reported statistically significant reductions in pain in the intervention groups compared to controls (p < 0.05). However, only one of three studies demonstrated a significant improvement in physical function following PEMF therapy (p < 0.05). Large heterogeneity in terms of treatment protocols and intervention parameters was observed across the studies which may limit the comparability of outcomes. No serious adverse events were reported; only minor skin redness was documented as a side effect.
    Conclusion: PEMF therapy appears safe and effective for reducing pain in individuals with various foot and ankle soft-tissue pathologies. However, the findings on the PEMF therapy in improving physical function remain inconclusive. Future research should focus on a large-scale, standardised setting, including the PEMF therapy protocol, to evaluate the efficacy of PEMF therapy on both pain and functional outcomes in this specific population.
    Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251076499, PROSPERO CRD420251076499.
    Keywords:  Achilles tendon; ankle sprains; foot and ankle; pulsed electromagnetic field (PEMF); soft-tissue injuries/pathology; tendinopathy
    DOI:  https://doi.org/10.3389/fspor.2026.1694944
  9. J Foot Ankle Res. 2026 Mar;19(1): e70135
    Efficacy and Safety of Dextrose Prolotherapy Versus Corticosteroid Injections in Plantar Fasciitis: A Systematic Review and Meta-Analysis.
    Ruaa Mustafa Qafesha, Hammam Anas Ishreiteh, Adli Luay Nassourah, Omar Islam Tawil, Doaa Mashaly.
       BACKGROUND: Plantar fasciitis (PF) is a common cause of heel pain that affects the health-related quality of life of many individuals and has various treatment options. Two effective interventions are corticosteroid (CS) injections and dextrose prolotherapy (DP). This study aimed to compare the efficacy and safety of DP and CS in patients with PF systematically.
    METHODS: Relevant studies, including those comparing DP and CS for treating PF, were identified by searching electronic databases until August 2025. The visual analog scale (VAS) pain score, foot function index (FFI), and plantar fascia thickness (PFT) were compared between the groups in the short term (0.5-1 month) and mid-term (3 months). Statistical analyses were performed via RevMan 4.5.1, and p < 0.05 was considered statistically significant.
    RESULTS: Five RCTs and two cohort studies, with a total of 567 patients, were included in the meta-analysis. The analysis revealed that at the short-term follow-up (1 month), corticosteroid injections were more effective at reducing the VAS pain scores than dextrose prolotherapy for general VAS score (MD = 1.85, 95% CI [0.05, 3.64], p = 0.04), the VAS score at the first step in the morning (MD = 1.26, 95% CI [0.49, 2.02], p = 0.001), and the VAS score for pain while walking (MD = 1.85, 95% CI [0.68, 3.02], p = 0.002). Similarly, at the short-term follow-up (1 month), the analysis revealed a significantly greater reduction in the FFI score (MD = 18.81, 95% CI [0.06, 37.55]) and PFT (MD = 0.26 mm, 95% CI [0.07, 0.45]) in the CS group than in the DP group. At 3 months, the analysis revealed a significant decrease in the FFI score (p = 0.003) in the DP group compared with the CS group, whereas no significant difference was observed in the VAS scores or PFT.
    CONCLUSION: In patients with plantar fasciitis, CS injections had greater efficacy than DP did in the short term; however, their efficacy became similar in the mid-term follow-up, with DP outperforming CS in terms of foot function. Further trials with standardized protocols and long-term follow-ups are needed to address potential biases.
    Keywords:  corticosteroid injection; dextrose prolotherapy; foot function; meta‐analysis; pain; plantar fascia thickness; plantar fasciitis
    DOI:  https://doi.org/10.1002/jfa2.70135
  10. Rehabilitacion (Madr). 2026 Feb 17. pii: S0048-7120(26)00002-2. [Epub ahead of print]60(1): 100960
    [Efficacy and safety of platelet-rich plasma and hyaluronic acid in knee osteoarthritis: A systematic review of the literature].
    K T González-Sierra, L A Gómez.
      Knee osteoarthritis is one of the leading causes of disability worldwide and represents a major public health concern. Currently, metabolic and inflammatory factors are recognized as pathogenic elements to the extent that osteoarthritis has been redefined as a condition characterized by "low-grade chronic inflammation." In this context, interest has grown in regenerative medicine therapies such as platelet-rich plasma (PRP) and hyaluronic acid (HA), used either individually or in combination. The aim of this study was to synthesize recent evidence on the efficacy and safety of these interventions in the treatment of knee osteoarthritis. A systematic review of the literature published between 2018 and 2024 was conducted in PubMed, Scopus, and ScienceDirect, using terms related to osteoarthritis, PRP, and HA. Six studies meeting the eligibility criteria were selected. The results showed that PRP provided superior benefits in pain reduction and functional improvement compared with HA, particularly in long-term follow-up. Combined therapy with PRP + HA demonstrated additional advantages in some studies, both in clinical efficacy and safety. Regarding safety, the combination was associated with a lower frequency of adverse events such as hypertension and proteinuria. In conclusion, PRP emerges as a more effective therapeutic option than HA for knee osteoarthritis, while the combination of PRP + HA may offer complementary benefits. However, methodological heterogeneity limits comparisons across studies, underscoring the need for research with larger sample sizes and standardized protocols for PRP preparation and administration.
    Keywords:  Hyaluronic acid; Knee osteoarthritis; Medicina regenerativa; Osteoartrosis de rodilla; Plasma rico en plaquetas; Platelet-rich plasma; Regeneración tisular; Regenerative medicine; Tissue regeneration; Ácido hialurónico
    DOI:  https://doi.org/10.1016/j.rh.2026.100960
  11. Physiother Theory Pract. 2026 Feb 20. 1-9
    Conservative management of Madelung deformity: a case report.
    Ozan Gür, Betül Çiftçi.
       INTRODUCTION: Various surgical techniques have been developed for the management of Madelung deformity. However, there is inadequate information about conservative treatment for Madelung deformity. This case report demonstrates the role of conservative treatment in a particular case where there were no known etiological factors of Madelung deformity and discusses its outcomes.
    CASE PRESENTATION: A 30-year-old female patient presented with deformity and pain in her right wrist. Physical examination indicated a volar displacement of the right hand, a dorsal prominence of the ulna, and restricted joint motion in the wrist. The radiographs revealed a radially inclined radius and a triangular carpal configuration. According to these findings, the right wrist was diagnosed with Madelung deformity.
    OUTCOMES: Following conservative treatment including splinting, activity modification, therapeutic ultrasound, cold packs, and exercise, assessments at weeks 8 and 12 showed significant improvements for the patient. The patient reported no pain at rest or at night, with activity pain decreasing from an initial 5/10 to 2/10 on the Visual Analogue Scale. While range of motion improved, except for radial deviation, it remained lower in the affected wrist compared to the unaffected side. Although there was a slight decrease in range of motion from week 8 to week 12, it remained higher than baseline measurements. The grip strength values, initially at 80% of the unaffected side, exhibited an increase but did not reach the level of the unaffected side. Scores from the Patient-Rated Wrist Evaluation and the Quick Disability of the Arm, Shoulder, and Hand questionnaires showed reductions compared to baseline at weeks 8 and 12, surpassing the 14-point minimal clinically important difference. However, the week 12 assessment indicated an increase in survey results relative to week 8.
    CONCLUSION: Implementation of conservative treatment for Madelung deformity resulted in symptom alleviation and enhancement of the patient's condition.
    Keywords:  Case report; Madelung deformity; conservative treatment; rehabilitation; wrist
    DOI:  https://doi.org/10.1080/09593985.2026.2635042
  12. Gait Posture. 2026 Feb 14. pii: S0966-6362(26)00039-1. [Epub ahead of print]126 110131
    Lower limb biomechanics in femoroacetabular impingement syndrome, asymptomatic cam morphology, and controls during bilateral and single-leg squatting.
    Celine E Luijendijk, Evy Meinders, Basilio Am Gonçalves, Claudio Pizzolato, David J Saxby, Laura E Diamond.
       BACKGROUND: Femoroacetabular impingement syndrome (FAIS) is a movement-related disorder and causing hip and/or groin pain in young active adults. Movement patterns in individuals with FAIS may be modifiable through conservative management. Identifying biomechanical differences between cohorts with asymptomatic cam morphology (FAIM) and FAIS could reveal relevant treatment targets. This study compared lower limb kinematics and kinetics between FAIS, FAIM, and healthy controls during double- (DLS) and single-leg squats (SLS).
    METHODS: Whole-body motion and ground reaction forces were synchronously recorded during five DLS and five SLS. Joint angles, moments, and spatiotemporal parameters (mean squat velocity and maximum squat depth) were compared between groups using a one-way repeated measures ANOVA with statistical parametric mapping (SPM).
    RESULTS: During DLS, there were no differences in hip or knee kinematics, or hip, knee, or ankle moments. The FAIM group had less ankle dorsiflexion than controls during both descent and ascent (P < .01). During SLS, the FAIM group had greater hip flexion than the FAIS group (P < .01), and the FAIS group had greater external hip rotation than controls (P < .01) and a greater hip abduction moment than the FAIM group (P < .01).
    CONCLUSION: The greater demands of SLS may require those with FAIS to perform it differently to those without symptoms, regardless of the presence of cam morphology. Given all groups squatted to a similar depth, hip biomechanics - including flexion, rotation, and abduction moments - may be a more relevant target for rehabilitation.
    Keywords:  Biomechanics; FAI syndrome; Hip joint; Kinematics; Kinetics; Squat
    DOI:  https://doi.org/10.1016/j.gaitpost.2026.110131
  13. Semin Musculoskelet Radiol. 2026 Feb;30(1): 28-32
    Peripheral Nerve Ultrasound-guided Intervention: From the Basics to Sonosurgery.
    Hannes Gruber, Thomas Le Corroller, Elisabeth Skalla-Oberherber.
      Ultrasound-guided intervention of peripheral nerves is a new and promising branch of sonography. It offers minimally invasive therapeutic solutions with relatively little effort and has thus become an alternative to surgical procedures for managing entrapment neuropathies. It has shown considerable success in treating carpal tunnel syndrome, as well as other neuropathies caused by compression or focal strangulations. Sonosurgery, in particular, has become established as a validated reliable alternative to both open and endoscopic surgery. This review article critically examines the historical development of peripheral nerve ultrasound-guided intervention, leading ultimately to sonosurgery, and describes potential future uses.
    DOI:  https://doi.org/10.1055/a-2737-7207
  14. Saudi J Anaesth. 2026 Jan-Mar;20(1):20(1): 23-26
    Efficacy and safety of μ1-opioid receptor agonist (Taphalgin®) for emergency analgesia in outpatient practice.
    Alexey G Voloshin, Kseniya N Avetisova, Natal'ya V Smirnova.
       Background: A new peptide analgesic, a highly selective μ1-opioid receptor agonist (Taphalgin®) has shown the high efficacy in treating acute postoperative and chronic oncological pain, it appears to be a promising option for the treatment of patients with severe pain in outpatient clinics.
    Methods: Prospective observational study with a control period 4 hours after a single injection. The onset and peak of the analgesic effect, duration of effect, patient satisfaction and tolerability of therapy were assessed.
    Results: A total of 37 patients participated in the study. The pain intensity before the injection was 8.9 ± 1.2 according to numeric rating scale. Causes of severe pain included: radicular, oncologic and lumbar pain, vertebral fractures, joint injuries, tendon ruptures and others (e.g., hip fracture, nerve injury). Up to 95% of patients were already receiving pain therapy from non-steroidal anti-inflammatory drugs to strong opioids. After injection, pain intensity decreased with a peak at 30-45 minutes from 8.9±1.2 to 3.2±2.8 (P ≤ 0.0001) points on numeric rating scale and lasted for more than 3 hours. There was no difference in pain intensity at rest and with movement. Adverse events were reported in 19 of 37 patients (51.3%). Most adverse events were non-serious, did not require treatment and resolved on their own.
    Conclusions: The μ1-opioid receptor agonist Taphalgin® demonstrates high efficacy, ease of use, rapid onset of effect and good tolerability in patients with severe pain syndrome in outpatient settings.
    Keywords:  Acute pain; ambulatory care; oligopeptides; pain management
    DOI:  https://doi.org/10.4103/sja.sja_486_25
  15. BMC Musculoskelet Disord. 2026 Feb 14.
    Serum biomarkers reflecting progression of knee osteoarthritis: a stage-based evaluation of TGF-β3, ADAMTS-4, ADAMTS-5, and MMP-13.
    Omer Esmez, Zubeyde Ercan, Secil Yılmaz, Meryem Sedef Doğru.
      
    Keywords:  ADAMTS-4; ADAMTS-5; Kellgren–Lawrence grading; Knee osteoarthritis; MMP-13; Serum biomarkers; TGF-β3
    DOI:  https://doi.org/10.1186/s12891-026-09613-3
  16. Brain Spine. 2026 ;6 105917
    A systematic review and meta-analysis on surgery for lumbar disc herniation: optimal timing of surgery, return to work and outcomes compared with conservative management.
    Shaman Ambaliya, Felix De Bruyn, Bart Depreitere.
       Introduction: It has been estimated that between 50 and 90 % of the general population will suffer from low back pain at some point in their lives. 5 %-10 % of this patient population also experiences back-related leg pain caused by underlying spinal pathology such as lumbar disc herniations (LDH). Management options for LDH-related radicular pain include conservative treatment and lumbar disc surgery, the latter of which may be associated with prolonged work absenteeism and substantial socioeconomic consequences. To date, no universal consensus exists regarding the best treatment choice for patients experiencing LDH-related pain. Furthermore no agreement is found regarding the optimal timing of surgery and return to work after surgery leading to the aforementioned societal burden.
    Aim: To evaluate the evidence related to the following topics concerning lumbar disc herniations (LDHs): the comparison between surgical and non-surgical management of LDHs, the optimal timing of lumbar disc surgery and the optimal return to work time after surgery.
    Methods: A comprehensive search strategy was used to search Scopus, Web of Science, Embase, Pedro, PubMed, CINAHL (via EBSCO), Cochrane central register of controlled trials (CENTRAL), Clinical Trials Registry Platform (ICTRP) and Clinicaltrials.gov for articles concerning the comparison between surgical and non-surgical management, the optimal timing of surgery and return to work after surgery for LDHs. Grey literature and unpublished data was screened via Google Scholar. Risk of bias and methodological quality were independently assessed by two reviewers using the RoB 2 tool and the ROBINS-I tool by Cochrane. Random-effects meta-analyses were performed for outcomes where sufficient methodological and clinical homogeneity was present.
    Results: 15 randomized controlled trials (RCTs), 18 prospective cohort studies (PCS), 8 retrospective cohort studies and 5 hybrid studies were identified providing information concerning our research topics. Meta-analysis of RCTs demonstrated that surgery resulted in better outcomes at short term evaluation in patients suffering from acute sciatica, at long-term (>1 year) follow-up the outcomes of surgery were however comparable with conservative care. Discectomy results in significantly better outcomes than non-surgical techniques developed for treating LDHs. No universal consensus can be found throughout the literature regarding the optimal timing of surgery. Early return to work after surgery for LDHs does not result in inferior outcomes.
    Conclusion: Surgery leads to a better decrease in leg pain and disability at short-term follow-up when compared with as usual conservative care, at long-term follow-up outcomes after surgery become comparable with conservative care. Discectomy remains to be the gold standard for treating sciatica when compared with non-surgical treatment modalities. Optimal timing of surgery should be determined for each patient individually through a process of shared decision making. There is no evidence suggesting increased risk of reherniation associated with early return to work.
    Keywords:  Disc herniation surgery; Lumbar disc herniation; Meta analysis; Return to work; Systematic review; Timing of surgery
    DOI:  https://doi.org/10.1016/j.bas.2025.105917
  17. Chronobiol Int. 2026 Feb 19. 1-8
    Timing rehabilitation according to chronotype: An overlooked variable?
    Aslı Çalışkan Uçkun, Özlem Yener, Ömer Faruk Demir, Mehmet Ali Sünme, Rüstem Celil, Buğra İnce.
      Hand injuries frequently cause significant functional limitations, and patient engagement plays a crucial role in rehabilitation outcomes. Chronotype represents an individual's inherent preference for activity timing and has been linked to variations in physical performance, pain sensitivity, and cognitive abilities; yet its impact within rehabilitation contexts remains insufficiently studied. This study aimed to investigate whether functional performance, pain, edema, and therapist-rated participation during the morning and afternoon rehabilitation sessions differ according to patients' chronotypes following hand injuries. A prospective observational study was conducted with 46 patients (mean age 39.9 ± 17.1 y) undergoing hand rehabilitation. Chronotype was assessed using the Morningness-Eveningness Questionnaire, and each participant attended two rehabilitation sessions on consecutive days - one in the morning (09:00) and one in the afternoon (16:00). Outcome measures included grip strength, the Nine-Hole Peg Test (NHPT), the Visual Analog Scale (VAS) for pain, physiotherapist-rated VAS for participation, metacarpophalangeal (MCP) joint circumferential edema, and QuickDASH scores. Data were analyzed using a three-way mixed-model repeated-measures ANOVA. Chronotype distribution was 41.3% morning-type, 45.7% intermediate-type, and 13.0% evening-type. Morning and intermediate types demonstrated significantly better NHPT performance in the morning sessions (p < 0.05), whereas evening types showed numerically better performance in the afternoon sessions, although this difference did not reach statistical significance. Intermediate and evening types exhibited significantly higher pain VAS scores in the afternoon sessions (p < 0.01). No significant chronotype-related differences were observed in grip strength, edema, or participation scores. This study is among the first to examine the effects of chronotype on hand injury rehabilitation. The findings suggest that scheduling rehabilitation in alignment with a patient's chronotype may enhance functional performance. However, to generalize these findings, studies with larger sample sizes, more homogeneous chronotype distributions, long-term follow-up, and inclusion of cognitive function assessments are needed.
    Keywords:  Chronotype; circadian rhythm; hand injuries; rehabilitation
    DOI:  https://doi.org/10.1080/07420528.2026.2633238
  18. Turk J Phys Med Rehabil. 2025 Dec;71(4): 489-495
    Does the preoperative presence of central sensitization affect sleep quality and pain after total knee arthroplasty?
    Başak Mansız-Kaplan, Umut Öktem, İbrahim Bozkurt, Durmuş Ali Öçgüder.
       Objectives: This study aims to investigate the presence of central sensitization before total knee arthroplasty (TKA) in patients with knee osteoarthritis, to explore its relationship with sleep quality after this surgery, and to evaluate postoperative pain intensity, neuropathic pain, anxiety, depression, and functional status.
    Patients and methods: Between May 2022 and May 2023, a total of 31 patients (8 males, 23 females; mean age: 68.1±2.8 years; range, 62 to 73 years) who underwent a radiographic examination, had Stage 3-4 osteoarthritis based on the Kellgren-Lawrence classification, and had TKA indications at the discretion of the orthopedic surgeon were included in this single-center, one-group, quasi-experimental, prospective study. The Central Sensitization Inventory (CSI) and International Physical Activity Questionnaire-Short Form (IPAQ) were used to evaluate patients scheduled for TKA due to osteoarthritis of the related joint. The Visual Analog Scale (VAS), painDETECT, the Pittsburgh Sleep Quality Index (PSQI), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Hospital Anxiety and Depression Scale were applied to all patients preoperatively and at one and three months postoperatively.
    Results: The postoperative PSQI, VAS, and painDETECT scores were significantly higher in those with central sensitization compared to non-central sensitization group after surgery (p<0.001). The CSI score had a positive correlation with the PSQI, VAS, and painDETECT scores, and a negative correlation with the preoperative IPAQ score (p<0.05).
    Conclusion: Our study results suggest that, in patients with knee osteoarthritis waiting for TKA, central sensitization status has an adverse impact on postoperative pain and sleep quality.
    Keywords:  Arthroplasty; central sensitization; knee osteoarthritis; neuropathic pain; sleep quality.
    DOI:  https://doi.org/10.5606/tftrd.2025.15481
  19. Int Orthop. 2026 Feb 16.
    Two-year outcomes of ultrasound-guided percutaneous tenotomy for long head of the biceps tendinopathy.
    Süleyman Kaan Öner, Enes Alptekin Canli, Mehmet Korkmaz, Nihat Demirhan Demirkıran.
       BACKGROUND: The long head of the biceps tendon (LHBT) is a common source of anterior shoulder pain, particularly in older adults, and may persist despite conservative treatment. Arthroscopic tenotomy is effective but requires an operating room, anaesthesia, and postoperative restrictions, which may be suboptimal in elderly or comorbid patients. Ultrasound-guided percutaneous LHBT tenotomy has emerged as a minimally invasive alternative, yet long-term clinical outcomes remain insufficiently reported. This study aimed to evaluate two-year pain, functional, and sleep-quality outcomes following ultrasound-guided percutaneous LHBT tenotomy in patients with isolated LHBT tendinopathy.
    METHODS: This retrospective case series included 51 consecutive patients (mean age 61.8 ± 4.8 years) with MRI-confirmed isolated LHBT tendinopathy who underwent ultrasound-guided percutaneous tenotomy between 2022 and 2024. Pain (VAS), functional scores (ASES and Constant-Murley), and sleep quality (PSQI) were assessed at baseline and at three, six, 12, and 24 months. Repeated-measures ANOVA or Friedman tests were used for longitudinal analysis, with effect sizes reported as partial eta-squared. Complications and patient satisfaction were recorded at the final follow-up.
    RESULTS: All outcome measures improved significantly at each postoperative time point compared with baseline (p < 0.001). Mean VAS decreased from 6.84 ± 1.29 to 2.16 ± 0.89 at 24 months (η2 = 0.71), with 92.1% achieving the minimal clinically important difference (MCID). Functional outcomes improved markedly (ASES: 35.7 → 85.1; Constant-Murley: 60.4 → 82.5), both with large effect sizes (η2 = 0.68 and 0.64). PSQI improved from 9.2 ± 3.1 to 4.8 ± 2.2 (η2 = 0.56), reducing clinically significant sleep disturbance from 78.4% to 29.4%. Four patients (7.8%) developed asymptomatic Popeye deformity; no major complications occurred. Patient satisfaction at 24 months was 88.2%.
    CONCLUSIONS: Ultrasound-guided percutaneous LHBT tenotomy is a safe, minimally invasive, and effective procedure that provides durable improvements in pain, function, and sleep quality over two years, with a low complication rate. It represents a valuable alternative to arthroscopic tenotomy in appropriately selected patients.
    Keywords:  Biceps tendinopathy; Long head of the biceps tendon; Percutaneous tenotomy; Shoulder pain; Ultrasound-guided tenotomy
    DOI:  https://doi.org/10.1007/s00264-026-06751-0
  20. Br J Sports Med. 2026 Feb 18. pii: bjsports-2025-110683. [Epub ahead of print]
    Effects of percutaneous platelet-rich plasma injection on return-to-play after acute hamstring muscle injury: systematic review and meta-analysis.
    Hirotaka Nakagawa, Patrick Krochmal, Ian Thomas, Judy B Rabinowitz, Ryan C Kruse, Robert Bowers, Walter I Sussman.
       OBJECTIVE: To evaluate the effectiveness and safety of platelet-rich plasma (PRP) for acute hamstring injuries, with attention to return-to-play (RTP) time, reinjury rates and adverse events.
    DESIGN: Systematic review and meta-analysis of randomised controlled trials (RCTs). Risk of bias was assessed using the Cochrane tool; certainty of evidence was evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation).
    DATA SOURCES: Databases included Embase, MEDLINE, Web of Science, Elsevier and Cochrane Central searched through March 2025.
    ELIGIBILITY CRITERIA: RCTs comparing PRP to control treatments for acute hamstring injuries were included. Non-randomised and chronic tendinopathy studies were excluded.
    RESULTS: Six RCTs (n=277) were included. PRP reduced RTP time versus control (mean difference -8.6 days; 21.4 vs 30.0 days; 95% CI -3.04 to -0.03; p=0.045), though heterogeneity was high (I²=94.1%). Reinjury (15% vs 16%; p=0.722) and adverse event rates (1% vs 0%; p=0.687) did not differ. Certainty of evidence was rated as low to moderate due to risk of bias and imprecision.
    CONCLUSION: PRP may shorten RTP in acute hamstring injuries, especially when image-guided. Reinjury risk appears unchanged. Further trials are needed to confirm these findings and standardise biological use in muscle injuries.
    PROSPERO REGISTRATION NUMBER: CRD420251109346.
    Keywords:  Athletic Injuries; Hamstring Muscles; Platelet-rich plasma; Soccer; Ultrasonography
    DOI:  https://doi.org/10.1136/bjsports-2025-110683
  21. Cannabis Cannabinoid Res. 2026 Feb 19. 25785125261425444
    Medical Cannabis for the Treatment of Peripheral Neuropathy due to Diabetes: A Systematic Review.
    Justin J Sherman, Daniel M Riche.
       INTRODUCTION: This systematic review evaluated randomized controlled trials (RCTs) conducted specifically in participants with diabetes and painful peripheral neuropathy to assess the effectiveness and safety of medical cannabis, isolated cannabinoids, or nationally approved cannabis-based medicines as adjuvant treatment, compared with placebo or baseline.
    MATERIALS AND METHODS: Controlled clinical studies and RCTs in adults with diabetic peripheral neuropathy were eligible. Animal and in vitro studies were excluded. We searched PubMed, Google Scholar, Cochrane Library, and Scopus and screened 15,377 records; 35 full-text articles were assessed for eligibility, and 4 RCTs were included in the qualitative synthesis.
    RESULTS: Three of four studies reported statistically significant reductions in neuropathic pain with cannabinoid-based interventions compared with placebo, whereas one trial did not demonstrate superiority. In two trials using vaporized or sublingual Δ9-tetrahydrocannabinol (THC), doses in the range of approximately 16-18 mg were associated with clinically meaningful pain relief in participants. Adverse effects, including dizziness and cognitive symptoms, were common but generally mild-to-moderate, and discontinuations due to adverse effects varied across studies.
    DISCUSSION/CONCLUSION: Evidence from four small, heterogeneous RCTs suggests that cannabinoid-based therapies may reduce pain in some patients with diabetic peripheral neuropathy; however, the limited number of studies, variability in formulations and comparators, and risk of bias preclude firm conclusions regarding efficacy. Observed THC doses around 16-18 mg/day delivered via vaporized or sublingual routes should be viewed as preliminary, hypothesis-generating ranges rather than definitive recommendations. Larger, contemporary RCTs with rigorous risk-of-bias control, standardized outcomes, and detailed safety reporting are needed.
    Keywords:  adjuvant treatment; diabetes; medical cannabis; neuropathic pain
    DOI:  https://doi.org/10.1177/25785125261425444
  22. Front Rehabil Sci. 2026 ;7 1680725
    Effectiveness of physical therapy techniques for cancer-related pain: a systematic review.
    Iser Alejandro González-Ramírez, Xavier Oswaldo Molina-López, Leonardo Enrique Bermeo-Gualán, Nuria Bonsfills-García, Elena Velarde-Fernández, Vanesa Abuín-Porras.
       Background: Cancer-related pain is a frequent and disabling symptom that negatively affects function and quality of life. Physiotherapy interventions are increasingly used as adjuvant treatments to alleviate pain and improve functional recovery in oncology patients.
    Objective: To evaluate the scientific evidence on the effectiveness of physiotherapy interventions in reducing cancer-related pain and improving functional outcomes.
    Methods: A systematic review was conducted following PRISMA 2020 guidelines (PROSPERO ID: CRD42026542801). Searches were performed in PubMed, Cochrane, CINAHL, and PEDro databases between January 30 and February 15, 2025, including randomized controlled trials published in English or Spanish with PEDro scores ≥ 6.
    Results: Eight randomized controlled trials published between 2020 and 2024 met the inclusion criteria, encompassing 514 participants. Interventions included resistance and aerobic exercise, sensorimotor training, electrotherapy, and multimodal rehabilitation programs. Most studies reported significant reductions in pain intensity, improvements in functional capacity and quality of life, and no serious adverse effects. The methodological quality of the included trials was moderate to high.
    Conclusions: Physiotherapy interventions, particularly structured exercise and electrotherapy, appear to be effective and safe adjuvant strategies that may contribute to improvements in pain-related and functional outcomes in people with cancer. The available evidence predominantly addresses neuropathic pain associated with chemotherapy-induced peripheral neuropathy. Nevertheless, heterogeneity among protocols and small sample sizes limit the strength of conclusions, underscoring the need for additional high-quality randomized controlled trials.
    Systematic Review Registration: PROSPERO CRD42026542801.
    Keywords:  cancer survivorship; electrotherapy; exercise therapy; oncologic rehabilitation; pain management
    DOI:  https://doi.org/10.3389/fresc.2026.1680725
  23. Sisli Etfal Hastan Tip Bul. 2025 ;59(4): 469-475
    Intra-Articular PRP for Grade 2 Degenerative Meniscus Lesions; Radiological and Clinical Outcomes.
    Yigit Atalay, Osman Tugrul Eren, Raffi Armagan.
       Objectives: This study was conducted to evaluate the radiological and clinical results of platelet-rich plasma (PRP) therapy in degenerative meniscal lesions.
    Methods: Seventy patients with pain and grade 2 degenerative meniscal lesions on MRI (Magnetic Resonance Imaging) were included in the study. All patients underwent Knee Injury and Osteoarthritis Score (KOOS), Tegner-Lysholm, International Knee Documentation Committee Score (IKDC), Visual Analog Scale (VAS) clinical scores, and MRI scans before and 6 months after the injection.
    Results: There was a statistically significant increase in Tegner-Lysholm, KOOS, and IKDC scores after the procedure (p=0.001; p<0.01), and a statistically significant decrease in VAS score after the procedure (p=0.001; p<0.01). However, no statistically significant difference was observed in MRI parameters (p>0.05).
    Conclusion: It has been shown that the use of intra-articular PRP in painful degenerative meniscal lesions improves knee functions and helps reduce pain. However, no significant difference was observed in MRI controls. The results of our study indicate that the use of intra-articular PRP injection in patients with grade 2 meniscus degeneration improves clinical scores but does not result in significant improvement in degeneration as measured by MRI.
    Keywords:  Meniscus degeneration; Meniscus tears; Non-operative; PRP; Platelet-rich plasma; Regenerative medicine
    DOI:  https://doi.org/10.14744/SEMB.2025.40359
  24. Clin Case Rep. 2026 Feb;14(2): e72043
    Perilunate Dislocations With Median Nerve Involvement: Importance of Early Diagnosis and Surgical Intervention-A Case Series.
    Nomina Pradhan, Ujal Pradhan.
      Perilunate dislocation in the wrist is a rare injury yet challenging and is missed in 25% of cases on initial presentation. We present two cases of carpal injury. First case is a delayed presentation of perilunate dislocation with median nerve compression and ipsilateral fracture of shaft of radius. The second case is acute presentation of transcaphoid fracture, perilunate dislocation with median nerve compression. Both the patients underwent open reduction and internal fixation with percutaneous K-wires with first case via solar approach and second via dorsal approach. Both patients demonstrated near-normal wrist motion and satisfactory functional recovery by 3 months of follow-up, with no early recurrence of dislocation. Early diagnosis and prompt intervention by surgery is crucial to prevent complications and poor outcome.
    Keywords:  carpal injuries; carpal tunnel; median nerve compression; perilunate dislocation; wrist
    DOI:  https://doi.org/10.1002/ccr3.72043
  25. Indian J Anaesth. 2026 Jan;70(1): 244-250
    Mid-part of adductor canal: Is it the optimal injection site for performing adductor canal block? A cadaver-based injection study.
    Sandeep Diwan, Divesh Arora, Ghansham Biyani, S Shivaprakash, Prakash Mane, John Magesh Kumar.
       Background and Aims: Adductor canal block (ACB) has emerged as a selective sensory technique to provide pain relief to the anterior aspect of the knee joint. Despite a large amount of available literature, the ideal site for performing ACB remains debatable. With the use of ultrasound, it is now possible to define the exact location of the adductor canal (AC). The objectives of our cadaveric study were to examine the nerves captured by methylene blue dye (MBD) and the stain pattern of the nerves within the AC following mid-AC injection.
    Methods: We scanned the thigh area of six lightly embalmed cadavers (12 specimens) and marked the midpoint of the AC using ultrasound and injected 10 mL of (MBD) at this level. Thirty minutes later, all the specimens were dissected to document the frequency and stain pattern of various nerves traversing through the AC.
    Results: The vastoadductor membrane and saphenous nerve got stained heavily (+3) in all twelve specimens, while the nerve to vastus medialis stained heavily (+3) in four and moderately (+2) in eight specimens. Both the medial cutaneous nerve of the thigh and the intermediate cutaneous nerve of the thigh were stained moderately (+2) in four and two specimens, respectively. There was no spread of the dye into the distal femoral triangle area.
    Conclusions: Injection of MBD in the sonographically located mid part of the AC consistently involved the saphenous nerve and nerve to vastus medialis, and hence may be the optimal site for performing ACB.
    Keywords:  Adductor canal; cadavers; knee surgery; methylene blue dye; nerve block; saphenous nerve; ultrasonography; vastus medialis
    DOI:  https://doi.org/10.4103/ija.ija_673_25
  26. Hand (N Y). 2026 Feb 15. 15589447261416993
    Triangular Fibrocartilage Complex Injuries in Racquet Sport Players: Prevalence, Management, and Outcomes.
    Anagh Astavans, Indeevar R Beeram, Dawn M LaPorte.
       BACKGROUND: Triangular fibrocartilage complex (TFCC) injuries are common in athletes and may lead to substantial pain and functional limitations. This study characterizes TFCC injuries in athletes, particularly those involved in racquet sports. We also report on treatment patterns, patient outcomes, and risk factors for TFCC injury.
    METHODS: Patients with soft tissue injuries of the wrist at our institution in the last 9 years were screened for diagnosis of TFCC injury associated with racquet sports. Patients were excluded if there was no record of treatment or follow-up after diagnosis. Retrospective chart review was performed to collect data on demographics, injury and treatment specifics, return to baseline activity (RTBA) time after initiating treatment, and complications.
    RESULTS: Of 700 patients diagnosed with TFCC injury, 23.1% sustained injury during sports. Twenty-five (15.4%) were playing a racquet sport, most commonly tennis (n = 21). Five patients were excluded according to exclusion criteria. Fifty-five percent of the included patients were men, adolescents, and played their sport competitively. Seventy-five percent injured their dominant wrist, with 35% sustaining an ulnar-sided tear. Fifteen patients were treated nonoperatively through wrist immobilization and therapy. Of the 5 surgically treated patients, 4 underwent arthroscopic debridement while 1 underwent open repair. Seventeen patients (12 nonoperative and all surgical) were able to RTBA (average time: 134 days), of which only one had pain recurrence.
    CONCLUSIONS: Triangular fibrocartilage complex injuries disproportionately affect tennis players but favorably resolved from nonoperative treatment in 73.3% of cases and from surgery in all cases. Prior TFCC pathology and age above 50 were associated with no RTBA.
    Keywords:  conservative management; racquet sports; surgical debridement; surgical repair; tennis; triangular fibrocartilage complex tear; wrist injury
    DOI:  https://doi.org/10.1177/15589447261416993
  27. Acta Orthop. 2026 Feb 20. 97 105-109
    Incidence proportion of complex regional pain syndrome (CRPS) after distal radius fracture: a population-based register study.
    Pernille Melbye, That Minh Pham, Niels-Peter Brøchner Nygaard, Carsten Hanshelge Kock-Jensen, Per Hviid Gundtoft, Bjarke Viberg.
       BACKGROUND AND PURPOSE:  One of the most severe complications of distal radius fractures (DRF) is the development of complex regional pain syndrome (CRPS). The incidence proportion (IP) of CRPS following DRF varies widely in the literature. Our aim is to report the incidence proportion of CRPS in DRF patients, subgrouping on age, sex, and treatment choice, and secondarily to assess development over time.
    METHODS:  Data was extracted from the Danish National Patient Register on patients > 18 years diagnosed with a DRF (S525) in the period 1998-2017.
    RESULTS:  There were 247,128 DRF in 203,533 patients with a mean age of 61 years. 75% were females. Within 1 year, 493 DRF patients developed CRPS corresponding to a 1-year IP of 0.20% and with an incidence density of 0.57/100,000/year. Median time from DRF to diagnosis was 89 days (SD 73). The IP ranged from 0.01% to 0.39% between age groups with the 30-65-year-olds having the highest incidence proportion. The surgically treated group had an IP of 0.31% and the non-surgical group had an IP of 0.17%. CRPS was slightly more common in women than men (0.21% vs 0.16%). We found a decrease in IP after 2010 from 0.24% to 0.14%.
    CONCLUSION:  There was a low IP of CRPS diagnosis after DRF treatment with an observed higher IP in the 30-65-year-olds and in surgically treated patients. We consider this to be a minimum IP due to possible undiagnosed cases, but the overall results may be closer to the clinical reality than previous studies.
    DOI:  https://doi.org/10.2340/17453674.2026.45443
  28. Spine Surg Relat Res. 2026 Jan 27. 10(1): 112-119
    Double Crush Syndrome in Surgically-Treated Lumbosacral Radiculopathy: Prevalence, Risk Factors, and Clinical Implications.
    William J Karakash, Henry Avetisian, Matthew C Gallo, Chimere O Ezuma, Jeffrey C Wang, Raymond J Hah, Ram K Alluri.
       Introduction: Double crush syndrome (DCS) refers to compressive neuropathy at multiple sites along a peripheral nerve (PN), yet its relevance in the lower extremity remains poorly defined. This study aimed to (1) determine the prevalence of PN lesions in patients undergoing surgery for lumbosacral radiculopathy (LR), (2) identify commonly affected nerves, (3) assess associated risk factors, and (4) evaluate the DCS hypothesis by comparing the incidence of PN lesions in patients undergoing surgery for LR versus matched controls.
    Methods: A retrospective cohort study was conducted using the PearlDiver database (2010-2022) to identify adult patients who underwent lumbar decompression and/or fusion for LR. PN lesions diagnosed within two years before or after surgery were categorized by nerve. Univariate logistic regression was used to identify risk factors. A matched control cohort without LR was created using propensity score matching to evaluate the DCS hypothesis.
    Results: Of 650,562 patients undergoing surgery for LR, 32,909 (5.1%) were diagnosed with a PN lesion, with 60.6% occurring before and 38.4% after surgery. The most commonly affected nerves were the sciatic (31.7%), plantar (16.1%), and peroneal (11.2%). Risk factors for PN lesions included female gender (odds ratio [OR]: 1.22), age 50-59 years (OR: 1.23) and 60-69 years (OR: 1.17), and higher comorbidity burden with Elixhauser Comorbidity Index ≥5 (OR: 1.50). Comorbid conditions associated with increased risk included complex regional pain syndrome (OR: 3.33), fibromyalgia (OR: 1.73), and osteoarthritis (OR: 1.61). Compared to matched controls, patients with LR were significantly more likely to develop a PN lesion (OR: 3.10).
    Conclusions: PN lesions affect over 5% of patients undergoing surgery for LR and are significantly more common than in controls, supporting the DCS hypothesis in the lower extremity. Clinicians should maintain a broad differential diagnosis when evaluating radicular symptoms, especially in patients with high comorbidity burden or recurrent postoperative pain.
    Keywords:  double crush syndrome; lower extremity neuropathy; lumbar decompression; lumbar fusion; lumbosacral radiculopathy; peripheral nerve lesion; peripheral neuropathy; tarsal tunnel syndrome
    DOI:  https://doi.org/10.22603/ssrr.2025-0140
  29. Eur J Orthop Surg Traumatol. 2026 Feb 19. 36(1): 111
    Postoperative infraspinatus contractility is associated with acromiohumeral distance after arthroscopic rotator cuff repair.
    Ryuta Oishi, Nariyuki Mura, Kyosuke Hoshikawa, Tomohiro Uno, Issei Yuki, Hiroshi Satake, Yuya Takakubo, Michiaki Takagi.
       OBJECTIVE: To investigate whether infraspinatus muscle contractility improves following arthroscopic rotator cuff repair (ARCR) and its impact on postoperative acromiohumeral distance (AHD).
    METHODS: In this prospective case series, 61 shoulders with posterosuperior rotator cuff tears involving at least a full-thickness supraspinatus tear, with or without extension into the infraspinatus tendon (mean age: 66.4 ± 7.7 years; 31 men, 30 women) were followed for 1 year after ARCR. Shoulders with subscapularis tears or re-tears were excluded. Muscle contractility was measured using real-time tissue elastography (activity value = elasticity difference between rest and contraction), while AHD was assessed radiographically at 0° and 60° abduction.
    RESULTS: The infraspinatus activity value increased significantly (0.52 ± 0.25 to 0.76 ± 0.28; p < 0.05) and showed positive correlations with AHD at 0° (r = 0.424, p < 0.05) and 60° abduction (r = 0.587, p < 0.05), with postoperative AHD increasing by approximately 1 mm at both angles at 1 year. Supraspinatus muscle contractility demonstrated no significant correlations. In the multivariable regression analysis, the infraspinatus activity value and its Goutallier grade were independently associated with postoperative AHD.
    CONCLUSION: Improvement in infraspinatus muscle contractility was associated with postoperative AHD, suggesting a potential role of infraspinatus function in postoperative glenohumeral mechanics.
    Keywords:  Acromiohumeral distance; Arthroscopic rotator cuff repair; Glenohumeral mechanics; Infraspinatus muscle; Muscle activity; Strain elastography
    DOI:  https://doi.org/10.1007/s00590-026-04662-9
  30. J Am Acad Orthop Surg Glob Res Rev. 2026 Feb 01. 10(2):
    Assessing Patient Characteristics That Prolong the Need for Total Hip Arthroplasty Following Surgeon-Administered Intra-articular Corticosteroid Injections.
    David M Keller, Alexandra M Selberg, Ian S Hong, Alicia R Chen, Christian G Zapf, Jaclyn M Jankowski, Frank A Liporace, Richard S Yoon.
       PURPOSE OF STUDY: Although intra-articular corticosteroid hip injections may only delay an inevitable surgery, patient-specific factors and individual psychosocial factors that might dissuade immediate surgery are not fully understood. The purpose of this study was to understand the diverse reasons that patients elect to undergo hip injections and the various timelines to total hip arthroplasty (THA).
    METHODS: A retrospective review was conducted at a single academic medical center identifying all consecutive patients who had undergone fluoroscopically guided intra-articular surgeon-administered corticosteroid hip injections between June 2018 and February 2023. Data collected included baseline demographics, hip radiographic variables, duration of postinjection pain relief, and if THA was performed. Univariate and multivariate logistic regression analyses identified predictors associated with undergoing THA within 6 and 12 months postinjection.
    RESULTS: A total of 93 patients (22 bilateral) with average age of 59.8 ± 1.6 years and body mass index of 31.0 ± 6.3 kg/m2 were reviewed. Reasons for hip injection included the following: 39% due to fear or anxiety of THA; 33% for diagnostic purposes, primarily to discern if the pain stemmed from another source such as the lumbar spine or knee. Most patients showed advanced osteoarthritis: 44% Kellgren-Lawrence (K-L) grade 3 and 35% K-L grade 4. After injection, the average reported pain relief duration was 3.8 ± 4.9 months. Smoking markedly increased the likelihood of undergoing THA within 6 months (OR = 10.889; P = 0.001) and 12 months (OR = 6.375; P = 0.008).
    CONCLUSION: This study elucidated the multifaceted reasons patients opt for conservative management through corticosteroid hip injections. The value of patient-centered care is emphasized in managing hip osteoarthritis, as shown in the high patient retention rates postinjection.
    DOI:  https://doi.org/e25.00242
  31. Disabil Rehabil. 2026 Feb 20. 1-16
    Systematic review and meta-analysis of laser physical agent for pain and disability in rotator cuff tendinopathy: subgroup analysis and meta-regression exploration of randomized control trials.
    Long-Huei Lin, Pei-Yu Chou, Nai-Wen Hsu, Hsin-I Chen, Jun Tong Dong, Chih-Chung Chen.
       INTRODUCTION: Laser therapy is increasingly used in the management of rotator cuff tendinopathy; however, the comparative effectiveness of different laser types and treatment parameters remains unclear. This study aimed to evaluate the effects of low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) on pain and disability.
    METHODS: A systematic search of PubMed, Medline-Ovid, PEDro, and ClinicalTrials.gov was conducted from inception to July 2025. Randomized controlled trials comparing LLLT or HILT with placebo laser, exercise-based interventions, or other physical agents were included. Pain and disability outcomes were pooled using random-effects models. Subgroup and meta-regression analyses explored the influence of laser type, treatment regimen, control conditions, emission mode, wavelength, treatment duration, session frequency, and study quality.
    RESULTS: Laser therapy significantly reduced pain (Hedges' g = -0.701) and disability (Hedges' g = -0.691). HILT showed greater effect sizes than LLLT across outcomes. Pulsed-mode LLLT showed significant effect on pain reduction. Meta-regression analyses did not identify significant associations between sessions per week and treatment outcomes.
    CONCLUSION: HILT, applied alone or as an adjunctive therapy, provides significant benefits for pain and disability in rotator cuff tendinopathy, whereas standalone LLLT shows limited effectiveness. Further studies should examine long-term outcomes and standardized laser dosing.
    Keywords:  Rotator cuff; laser therapy; low-level laser therapy; meta-analysis; shoulder impingement syndrome
    DOI:  https://doi.org/10.1080/09638288.2026.2632917
  32. Video J Sports Med. 2026 Jan-Feb;6(1):6(1): 26350254251368932
    Hip Arthroscopy With Concomitant Endoscopic Gluteus Medius/Minimus Repair.
    Thomas E Moran, Harish Kesavan, Eric Y Hu, Shane J Nho.
       Background: Gluteus medius and minimus tears can lead to significant lateral hip pain, abductor weakness, and functional impairment. These tears are more frequently seen in middle-aged and older adults. These tears typically involve the anterolateral portion of the tendon footprint on the greater trochanter and can range in degree and severity. Gluteus medius and minimus tears most commonly develop due to chronic tendinous degeneration but may also arise as a result of acute trauma. Endoscopic repair has emerged as a more minimally invasive alternative to open techniques, offering effective tendon reattachment via suture anchors with reduced surgical morbidity. Additionally, concomitant arthroscopic intervention may allow for intra-articular pathology to be addressed, which may further improve patient outcomes.
    Indications: Indications for endoscopic gluteus medius and/or minimus repair include partial-thickness tearing, leading to significant pain and functional deficits that are recalcitrant to conservative management. While full-thickness and retracted tears may also be approached endoscopically, this technique may be particularly suited for cases with smaller tears and minimal fatty infiltration.
    Technique Description: A standard anterolateral portal and a modified mid-anterior portal are established with fluoroscopic assistance. After intra-articular pathology is addressed, the greater trochanteric space is accessed. The torn tendon is identified and debrided, and the tendon footprint is exposed and prepared with a burr. The gluteal tendon is repaired to its attachment on the greater trochanter with suture anchors.
    Results: Endoscopic gluteus medius and/or minimus repair has demonstrated improvement in pain and function over short-term postoperative follow-up. An endoscopic approach may reduce the surgical morbidity relative to what is conferred by an open approach.
    Discussion/Conclusion: Gluteus medius and/or minimus tears may be effectively treated endoscopically. This approach may minimize surgical morbidity compared with an open approach and allows for concomitant treatment of intra-articular pathology.
    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:  endoscopic repair; gluteus medius; gluteus minimus; lateral hip pain
    DOI:  https://doi.org/10.1177/26350254251368932
  33. Front Sports Act Living. 2026 ;8 1735177
    Ultrasound-based classification and rehabilitation of biceps femoris T-junction injuries.
    Kevin Cronin, Fearghal Kerin.
      The T-junction represents the interface between the long and short heads of the biceps femoris, comprising superficial myo-tendinous and deeper myo-aponeurotic connective-tissue components. Injury to this region is frequently under-recognised on MRI and associated with prolonged recovery and recurrence. A new ultrasound-based classification system is proposed, defining five subtypes according to structural involvement, myofascial extension, haematoma formation, and dynamic behaviour during resisted contraction. This classification system does require testing in vivo to establish validity. Ultrasound provides superior spatial resolution and allows direct assessment of tendon continuity and motion between the long and short heads. Rehabilitation strategies are aligned with injury subtype and guided by ultrasound findings rather than time alone. The approach integrates early protection and reactivation with progressive restoration of intermuscular coordination, strength, and high-speed load tolerance. The framework provides a structured method for diagnosis, prognosis, and rehabilitation planning in athletes with T-junction injuries of the biceps femoris.
    Keywords:  T-junction; classification; hamstring; injury; ultrasound
    DOI:  https://doi.org/10.3389/fspor.2026.1735177
  34. Cardiovasc Intervent Radiol. 2026 Feb 17.
    Safety and Feasibility of Genicular Artery Embolization with Degradable Starch Microspheres for Knee Osteoarthritis: A One Year Experience and Preliminary Clinical Results.
    Aleksejs Zolovkins, Gianluigi Orgera, Giuseppe Campagna, Miltiadis Krokidis, Andrea Marcello Tipaldi, Eleonora Latini, Edoardo Ronconi, Michele Rossi.
       PURPOSE: To evaluate the clinical efficacy and safety of genicular artery embolization (GAE) using degradable starch microspheres in patients with moderate to severe knee osteoarthritis (OA) refractory to conservative therapies.
    MATERIALS AND METHODS: Sixteen patients (19 knees) with Kellgren-Lawrence grade 1-4 osteoarthritis and persistent symptoms despite standard therapies were treated with genicular arteries embolization procedure using degradable starch microspheres. Adverse events were recorded using the CIRSE classification system. Pain and function were assessed using the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, 48 h, 1 month, 6 months, and 12 months. Clinical success was defined as ≥ 50% improvement in both VAS and WOMAC scores from baseline.
    RESULTS: No minor or major complications were observed. Transient skin changes around the treated knee were observed in all patients and resolved spontaneously within 2 h. Clinical success was achieved in 89,5% of knees at 48 h, in 84,2% at 1 month, and in 68,4% at 6 and 12 months. Mean VAS scores decreased from 7.2 ± 1.1 to 2.5 ± 1.3 at 1 month (p < 0.0001) and to 3.3 ± 1.5 at 6-12 months (p < 0.0001). WOMAC scores improved from 68.4 ± 9.2 to 25.1 ± 10.4 at 1 month (p < 0.0001) and to 38.4 ± 11.6 at 6-12 months (p < 0.0001).
    CONCLUSION: GAE using degradable starch microspheres is a safe and effective minimally invasive treatment for symptomatic relief and functional improvement in patients with moderate to severe knee OA refractory to other therapies. Evidence level 3.
    Keywords:  Degradable starch microspheres; Embolization; Genicular artery; Knee osteoarthritis; Minimally invasive therapy
    DOI:  https://doi.org/10.1007/s00270-026-04369-8
  35. J Orthop. 2026 Apr;74 412-418
    Robot-assisted rehabilitation following total knee arthroplasty: A meta-analysis of pain, strength, and functional recovery outcomes.
    Quintin Norris, Vraj Amin, Samuel Hovland, McKenzie D Brandt, Darius Moezzi.
       Aims: Robot-assisted rehabilitation (RAR) has emerged as a novel strategy to enhance recovery after total knee arthroplasty (TKA). This meta-analysis evaluates the impact of RAR on postoperative pain, muscle strength, range of motion (ROM), and functional recovery in comparison with conventional physical therapy (PT).
    Methods: A systematic search through October 2025 across PubMed, EMBASE, CINAHL, Web of Science, Cochrane CENTRAL, ProQuest Dissertations & Theses, Google Scholar, and ClinicalTrials.gov identified randomized controlled trials (RCTs) comparing RAR versus conventional PT after primary TKA. Outcomes were pooled using random-effects models, and risk of bias was assessed with the Cochrane tool.
    Results: Six RCTs (309 patients; 155 intervention, 154 control) met inclusion, with overall moderate quality and low-to-moderate risk of bias. Pooled analysis showed no significant differences in ROM for knee extension at 1 week (MD: 0.38, p = 0.54) or 2 weeks (MD: 0.41, p = 0.47), or knee flexion at 1 week (MD: 1.55, p = 0.45). Knee extension strength was also comparable (MD: 0.01, p = 0.88), though knee flexion strength was significantly improved with RAR (MD: 0.09, p < 0.0001). No significant difference was observed in postoperative pain (MD: -10.77, p = 0.13), walking speed (MD: 0.05, p = 0.36), or length of stay (MD: -1.57, p = 0.23).
    Conclusion: RAR after TKA produced outcomes similar to PT across ROM, pain, strength, walking speed, and length of stay, with only knee flexion strength showing significant improvement. Restricting to RCTs and TKA-only populations yielded more conservative results than prior reviews, likely reducing bias. However, additional large-scale, long-term trials are needed to define durability, cost-effectiveness, and optimal candidates.
    Keywords:  Exoskeleton; Functional recovery; Muscle strength; Pain; Robot-assisted rehabilitation; Systematic review; Total knee arthroplasty
    DOI:  https://doi.org/10.1016/j.jor.2026.02.023
  36. Tunis Med. 2025 Apr 05. 103(4): 413-417
    Exploring Diaphragmatic Ultrasonography as a Diagnostic Tool for Hyperinflation in COPD Patients: A protocol study.
    Hela Cherif, Chirine Moussa, Islam Mejri, Salma Mokaddem, Soumaya Debiche, Manel Ben Fradj, Zied Moatemri, Mohamed Ridha Charfi.
       INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a widespread global health problem marked by chronic inflammation, emphysematous lung damage, and persistent airflow limitation. In COPD, hyperinflation exacerbates respiratory muscle weakness by causing diaphragmatic dysfunction. Diaphragmatic ultrasonography (US) is a non-invasive tool for evaluating diaphragmatic function, which may provide insight into the severity of hyperinflation in COPD. The purpose of this study is to evaluate the effectiveness of diaphragmatic ultrasonography in assessing lung hyperinflation in patients with COPD .
    METHODS: A diagnostic cross-sectional investigation will be carried out in two Tunisian pulmonology centers. COPD patients aged ≥40 years with confirmed diagnosis via spirometry and stable clinical status will be included. Exclusion criteria are other chronic respiratory diseases, neuromuscular diseases, or obesity. Diaphragmatic ultrasonography and whole-body plethysmography will be performed on the patients. During deep inspiration and forceful expiration, the diaphragmatic thickness and thickening fraction will be measured. RV > upper limit of normal (ULN) indicates lung hyperinflation. Pearson's or Spearman's correlation will be used to assess relationships between plethysmographic parameters and diaphragmatic ultrasound results. Diaphragmatic ultrasonography's diagnostic thershold for hyperinflation will be determined using ROC (receiver operating characteristic) curves.
    CONCLUSION: If proven effective, diaphragmatic ultrasound could be a practical and cost-effective alternative to plethysmography for diagnosing hyperinflation in COPD.
    Keywords:  COPD; Diaphragm Dysfunction; Diaphragmatic Ultrasonography; Hyperinflation; Respiratory Function; Respiratory Muscles
    DOI:  https://doi.org/10.62438/tunismed.v103i4.5531
  37. J Hand Surg Eur Vol. 2026 Feb 19. 17531934261416300
    Tendon versus nerve transfers - balancing hand function in upper extremity high nerve injuries.
    Florian S Frueh, Liron Duraku, Christopher J Dy, Amy M Moore, Dominic M Power.
      IntroductionHigh peripheral nerve injuries disrupt the balance between flexor and extensor muscle groups and result in significant impairment of strength, coordination and dexterity. Primary nerve repair is widely accepted as the optimal treatment following transection injury, but outcomes after high-level nerve reconstruction remain unpredictable. Prolonged denervation commonly leads to irreversible muscle atrophy, limiting the potential for meaningful distal functional recovery despite technically successful nerve repair.Reconstructive strategies:Different surgical strategies are available to restore motor function after high peripheral nerve injuries. Tendon transfers have long been regarded as the reference standard for reconstructing lost muscle function, offering predictable and relatively early restoration of key movements. However, tendon transfers may compromise muscle balance, excursion, and fine motor control. Nerve transfers have emerged as an alternative strategy, aiming to prevent motor loss by reinnervating native muscles. While nerve transfers may better preserve physiological patterns of movement, they require prolonged periods for reinnervation and depend on patient factors, timing, and access to rehabilitation.Review focusMore recent reconstructive strategies seek to combine the advantages of both techniques, offering 'the best of both worlds' through hybrid approaches that integrate tendon and nerve transfers. This expert opinion review discusses the current opportunities and challenges associated with these hybrid strategies in the management of high upper extremity peripheral nerve injuries. The biomechanical principles, indications and limitations of tendon transfers, nerve transfers and combined approaches are compared, with particular attention to timing, patient selection, and functional goals.
    Keywords:  High nerve injury; median nerve; nerve transfer; radial nerve; tendon transfer; ulnar nerve; upper limb nerve reconstruction
    DOI:  https://doi.org/10.1177/17531934261416300
  38. Trials. 2026 Feb 16. 27(1): 157
    Group-based versus individual-based circuit training in elderly women with knee osteoarthritis: study protocol for a non-inferiority randomized controlled trial.
    Clécio Lima-Lopes, Amanda Virginia Souza Lima Lopes, Rebeca Cajueiro Azevedo, Francis Trombini-Souza, Tarcísio Fulgêncio Alves da Silva.
       BACKGROUND: Knee osteoarthritis (KOA) is one of the most prevalent health issues, affecting approximately 67% of women over 60 years old. Clinical guidelines recommend individualized muscle training to treat this condition. However, a lack of human and financial resources hinders the delivery of this treatment. In response to this limitation, group training may be an alternative. Although a few studies have compared group and individual exercise for knee OA, none have tested the non-inferiority of group-delivered circuit training specifically in elderly women. Therefore, this study aims to compare the non-inferiority of a group-delivered muscle training program to the same individually delivered training in clinical and functional aspects in elderly women with KOA.
    METHODS: This is a randomized controlled non-inferiority trial with two arms, parallel groups, blinded evaluator, conducted in Petrolina-PE, evaluating women aged 60 or older. Participants randomly assigned will undergo an 8-week training, either in individual sessions (control group-IB) or as part of a group (intervention group-GB) of four participants, supervised by a physical therapist. Blind assessments at baseline, immediately post-intervention, and 4 weeks post-intervention will include feasibility, safety, and satisfaction analysis of the training program; pain; quality of life; and physical function. Data will be analyzed using the Statistical Package for Social Sciences (SPSS) version 22. Estimated marginal means of each clinical and functional outcome for both groups (IB and GB) will be compared using mixed-effects generalized linear models. The primary analysis will test our main hypothesis that group training is non-inferior to individualized training regarding the primary outcome: relative reduction (%) in the WOMAC questionnaire pain subscale. Confidence intervals of 95% will be calculated. A significance level of p < 0.05 will be adopted in all analyses.
    DISCUSSION: Expected results suggest that a group-based approach is not inferior to an individual one in this population.
    TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-5bq9jh3. Registered on 18 August 2023. Link: http://www.ensaiosclinicos.gov.br ; Universal Trial Number (UTN) of World Health Organization: U1111-1289-2580.
    Keywords:  Elderly; Exercise therapy; Knee osteoarthritis
    DOI:  https://doi.org/10.1186/s13063-025-09161-6
  39. Med Sci Monit. 2026 Feb 16. 32 e951644
    Risk Factor Analysis of Residual Low Back Pain After Unilateral Biportal Endoscopic Discectomy in Patients With Lumbar Disc Herniation.
    Zhifeng Cheng, Tao Tang, Shenliang Chen, Jiafeng Hong, Haonan Lu, Hao Xu, Bo Hu.
      BACKGROUND Unilateral biportal endoscopy (UBE) is a novel surgical treatment for lumbar disc herniation (LDH). Some patients experience persistent residual low back pain (rLBP) after surgery. We aimed to identify risk factors for rLBP after UBE. MATERIAL AND METHODS This retrospective study analyzed 203 patients with LDH who underwent UBE in our department between January 2020 and August 2024. Inclusion criteria were a diagnosis of LDH treated by UBE and at least 1 year of follow-up. Exclusion criteria were severe spinal infection, previous spinal surgery, severe systemic disease, or incomplete follow-up data. Two groups were established based on visual analog scale scores at 1 year postoperatively: rLBP (score ≥3) and non-rLBP (score <3). Demographic characteristics, clinical outcomes, and imaging features were compared between groups. Logistic regression analyses were performed to identify rLBP risk factors. RESULTS There were 44 patients in the rLBP group (mean age, 52.59 years; ~43.2% women) and 159 patients in the non-rLBP group (mean age, 49.66 years; ~55.3% women). Postoperative rLBP was observed in 21.7% (44/203) of patients. Multivariate logistic regression analysis identified severe preoperative low back pain (P<0.001), high-grade facet joint osteoarthritis (FJOA) (P=0.005), and Modic type 1 changes (P=0.04) as independent risk factors for postoperative rLBP. CONCLUSIONS In patients with LDH, severe preoperative low back pain, high-grade FJOA, and Modic type 1 changes are predictive factors for rLBP after UBE. These parameters may be useful indicators for surgical decision-making and providing targeted treatment in high-risk populations.
    DOI:  https://doi.org/10.12659/MSM.951644
  40. J Orthop. 2026 May;75 12-16
    Patient- and disease-specific factors associated with atrophy of the intrinsic muscles of the ulnar nerve in cubital tunnel syndrome.
    Kenichi Asano, Katsuyuki Iwatsuki, Hiroki Yokoyama, Marie Mabuchi, Michiro Yamamoto.
       Introduction: Patients presenting with severe neuropathy are less likely to recover after surgery for cubital tunnel syndrome. The purpose of this study was to investigate patient- and disease-specific factors associated with atrophy at presentation of the intrinsic muscles innervated by the ulnar nerve.
    Methods: A retrospective data of patients with cubital tunnel syndrome were included in the study. Paralysis of the intrinsic muscles was evaluated as muscle atrophy of the first dorsal interossei, adductor pollicis, or abductor digiti minimi. The muscle atrophy group comprised 64 patients with atrophy of the intrinsic muscles. The non-atrophy group comprised 57 patients without intrinsic muscle atrophy at presentation. Univariate and multivariate regression analyses were conducted to assess patient factors including age, sex, body mass index, disease duration, comorbidities (diabetes mellitus and cervical spondylosis), and other elbow disorders (osteoarthritis of the elbow, presence of a ganglion, and cubitus varus or valgus deformity). A radiographic evaluation of elbow osteoarthritis was conducted using the Broberg and Morrey classification; osteophytes of the ulna were also assessed.
    Results: Through univariate analysis, patients in the muscle atrophy group were identified as being significantly older, with significantly longer disease duration and more osteophytes of the ulna, than those in the non-atrophy group. Cervical spondylosis and osteoarthritis of the elbow were more frequently observed in the muscle atrophy group than in the non-atrophy group. Multivariate analysis identified patient's age as an independent risk factor related to atrophy of the intrinsic muscles, while other factors were not significant association.
    Conclusion: There was no association between the intrinsic muscle atrophy in cubital tunnel syndrome and elbow osteoarthritis. Older patients with cubital tunnel syndrome were more likely to present with atrophy of the intrinsic muscles of the ulnar nerve. Knowledge of the factors associated with severe neuropathy may allow for earlier diagnosis and therapeutic intervention.
    Keywords:  Cubital tunnel syndrome; Diagnosis; McGowan classification; Muscle atrophy; Patient-specific factors; Severity
    DOI:  https://doi.org/10.1016/j.jor.2026.02.013
  41. J Hand Surg Glob Online. 2026 May;8(3): 100941
    Clinical Outcomes of Flexor Tenolysis Following Zone 2-3 Flexor Tendon Repair: A Retrospective Review.
    Christian Shigley, Annie Squires, Chelsea Boe, Jerry I Huang.
       Purpose: Adhesions and finger stiffness are common complications following zone 2 and zone 3 flexor tendon repairs. When active finger flexion recovery has plateaued, flexor tenolysis can be an effective surgical option. However, literature reporting the outcomes of flexor tenolysis is scarce.
    Methods: Medical records were reviewed for patients who underwent flexor tenolysis after primary repair over a 10-year period. Clinical outcomes, including active range of motion, total active motion, pain scores, and composite flexion, were assessed after surgery.
    Results: 68 digits in 31 patients met study criteria. At the 12-week follow-up, total active motion improved considerably from 146.8° to 183.5°, and active range of motion at the proximal interphalangeal joint increased from 46.1° to 60.0°. Composite flexion improved from 2.5 to 1.9 cm from the distal palmar crease. Half of the digits achieved excellent or good outcomes based on the Modified Strickland score. Reoperation was the most common complication. Flexor tendon rupture occurred in 3% of cases.
    Conclusions: Flexor tenolysis can be effective for improving motion following tendon repair, particularly in primary procedures and isolated tendon injuries. Revision tenolysis, dual tendon repairs, and associated digital nerve injuries were associated with poorer outcomes.
    Clinical relevance: Flexor tenolysis offers meaningful, though modest, improvements in motion for patients with stiffness after zone 2-3 flexor tendon repair, reinforcing its role as a valuable secondary procedure when recovery plateaus. This study further clarifies which patient and injury characteristics predict better or poorer outcomes, helping surgeons counsel patients more accurately and tailor expectations for recovery.
    Keywords:  Flexion contracture; Flexor tenolysis; Trauma
    DOI:  https://doi.org/10.1016/j.jhsg.2025.100941
  42. Surg Radiol Anat. 2026 Feb 16. 48(1): 69
    Anatomical relationship of the suprascapular and axillary nerves to the glenohumeral joint and its surgical significance: a systematic review.
    Mohd Maqbool, Kamil Khan, Anjali Aggarwal, Khushbu Sharma.
       PURPOSE: The suprascapular (SSN) and axillary (AXN) nerves are vital for shoulder mobility and are at notable risk for injury during glenohumeral surgeries due to their proximity to key anatomical landmarks. This systematic review evaluates their anatomical positioning relative to the glenohumeral joint and highlights the clinical significance of these relationships in shoulder procedures.
    METHODS: A thorough literature search across PubMed, MEDLINE, and Google Scholar (2018-2025) yielded 424 studies. After applying inclusion criteria, 21 articles-including clinical, cadaveric, and systematic reviews-were selected to assess nerve pathways, anatomical variations, injury rates, and surgical relevance.
    RESULTS: The pooled incidence of SSN injury was 0.03 (95% CI: 0.00-0.08), indicating an extremely low occurrence across studies. In contrast, the pooled incidence of AXN injury was 0.07 (4%) [95% CI: 0.01-0.18], reflecting a higher but still uncommon risk. Meta-regression showed a significant association between longer follow-up duration and increased reporting of AXN injuries (p = 0.0005), whereas this relationship was not significant for SSN injuries (p = 0.3612). Significant publication bias was detected for both nerves (AXN: p = 0.0016; SSN: p < 0.0001). Overall, AXN injuries occurred in approximately 1% of cases-more frequent than SSN injuries, which were nearly absent in pooled analysis.
    CONCLUSION: Anatomical variability in the SSN and AXN significantly influences the likelihood of nerve injury during shoulder surgery. Utilizing preoperative imaging, tailoring surgical approaches to individual anatomy, and employing intraoperative nerve monitoring are essential strategies for minimising nerve damage. Enhanced anatomical education-through cadaveric dissection and surgical simulation-should be emphasised to reinforce knowledge. These findings support adopting nerve-sparing, patient-specific surgical techniques to improve safety and outcomes in shoulder procedures.
    Keywords:  Anatomical variations; Axillary nerve; Gleno-humeral joint; Shoulder surgery; Suprascapular nerve
    DOI:  https://doi.org/10.1007/s00276-026-03837-7
  43. J Pain. 2026 Feb 18. pii: S1526-5900(26)00049-0. [Epub ahead of print] 106231
    Association of pain sensitization with prefrontal cortex activation and movement patterns during single- and dual-task walking in people with knee osteoarthritis.
    Soyoung Lee, Ehyun Kim, Tuhina Neogi, Baekdong Cha, Claudio L Ferre, Meryem Yücel, Deepak Kumar.
      Pain sensitization may contribute to heightened prefrontal cortex (PFC) activity during walking in people with knee osteoarthritis (OA), especially under cognitively demanding conditions. We examined associations of central and peripheral pain sensitization with PFC activation and walking performance during single- and dual-task walking. Forty-eight individuals with symptomatic knee OA completed single-task walking (STW) and dual-task walking (DTW) with serial-7 subtraction. Central and peripheral sensitization were indexed by pressure pain threshold (PPT) at the wrist and knee, respectively. Oxygenated hemoglobin (HbO2) in bilateral PFC was recorded using functional near-infrared spectroscopy. Gait speed, step duration variability, stride length variability, and serial-7 accuracy were assessed. Linear mixed-effects models tested group (lowest vs highest PPT tertile) by task (STW vs DTW) interactions on HbO2 and performance, adjusting for age, sex, and BMI. When stratified by wrist PPT, participants (72.9% female, mean age 64.8±7.2 years) showed significant group-by-task interactions for HbO2 in left dorsolateral PFC (p=0.03, η²p=0.10) and stride length variability (p=0.01, η²p=0.16). When stratified by knee PPT, gait speed showed a significant interaction (p=0.02, η²p=0.11). No other comparisons reached statistical significance. Across walking tasks, the most centrally sensitized group exhibited moderately higher PFC activation (Cohen's d≈0.6-0.7) than the least sensitized group. Central pain sensitization in knee OA is associated with greater recruitment of PFC resources and more variable gait under walking and dual-task conditions. Central sensitization may represent a therapeutic target to reduce executive control demands and improve gait in people with knee OA.
    Keywords:  Pain sensitization; dual-task; functional near-infrared spectroscopy (fNIRS); knee osteoarthritis; prefrontal cortex; walking
    DOI:  https://doi.org/10.1016/j.jpain.2026.106231
  44. Br J Sports Med. 2026 Feb 13. pii: bjsports-2025-111333. [Epub ahead of print]
    From rescuer to patient: a trauma surgeon's skiing injury journey.
    Xu Sun, Jian Zhang.
      
    Keywords:  Accidental Injuries; Quadriceps Muscle; Rehabilitation; Skiing
    DOI:  https://doi.org/10.1136/bjsports-2025-111333
  45. Acta Orthop. 2026 Feb 16. 97 91-98
    Update of guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopedic Association Part 1: preventive measures, diagnostics, and non-surgical treatment of subacromial pain syndrome.
    Frederik O Lambers Heerspink, Egbert J D Veen, Oscar Dorrestijn, Cornelis P J Visser, Maarten J C Leijs, Dennis Van Poppel, Peter A Stroomberg, Ramon P G Ottenheijm, Jan W Kallewaard, Tjerk J W De Ruiter, Henk A Martens, Femke M Janssen, Tessa Geltink, Matthijs S Ruiter, Jos J A M Van Raaij.
       BACKGROUND AND PURPOSE:  In 2013, the first clinical practice guideline for subacromial pain syndrome (SAPS) was developed in the Netherlands to support healthcare professionals. SAPS refers to non-traumatic, non-rheumatologic shoulder complaints that are particularly painful during arm elevation. It includes conditions such as supraspinatus tendinosis, calcific tendinitis, and degenerative supraspinatus tears. Over 50,000 patients annually consult orthopedic surgeons for these issues. In response to new evidence and clinical needs, an updated guideline was developed. Part 1 addresses prevention, diagnosis, imaging, and non-surgical treatment. Using a multidisciplinary, evidence-based approach, the guideline aims to answer key clinical questions around SAPS.
    METHODS:  Initiated by the Dutch Orthopedic Society, the guideline committee identified knowledge gaps through group sessions. Each module was based on a PICO-formatted key question and reviewed by professionals from different fields. The AGREE and GRADE methods were applied to ensure a systematic evaluation of evidence, leading to conclusions and recommendations.
    RESULTS:  (i) Inform patients about the potential positive effects of a healthy lifestyle and encourage gradual exercise within sport and work. (ii) Perform a cluster of physical diagnostic tests to diagnose SAPS. (iii) Perform ultrasonography in patients with clinical suspicion of (partial thickness) rupture of the supraspinatus tendon. Consider MRI if ultrasound is not available or inconclusive. (iv) Consider barbotage for symptomatic calcific tendinosis, preferably with corticosteroid injection in the bursa, if a previous corticosteroid injection was ineffective. (v) Consider a subacromial corticosteroid injection (with a local anesthetic) to enable exercise therapy in patients with severe complaints that impair their ability to participate in exercise therapy. (vi) Consider suprascapular nerve block for patients with therapy-resistant SAPS when other non-surgical treatment is ineffective.
    CONCLUSION:  The updated guideline provides multidisciplinary recommendations for physical examination, imaging, and conservative management of SAPS.
    DOI:  https://doi.org/10.2340/17453674.2026.45365
  46. Cochrane Database Syst Rev. 2026 Feb 18. 2 CD015450
    Exercise for multidirectional instability of the shoulder.
    Masaki Karasuyama, Takaki Imai, Masafumi Gotoh, Junichi Kawakami, Takashi Ariie, Shuhei Yamamoto.
       RATIONALE: Multidirectional shoulder instability is characterised by symptomatic subluxation or dislocation in at least two directions, often affecting young, active individuals. Although exercise therapy is commonly recommended as a first-line treatment, its benefits and harms remain uncertain.
    OBJECTIVES: To assess the benefits and harms of exercise therapy in people with multidirectional instability of the shoulder.
    SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database), Clinicaltrials.gov and the World Health Organization Clinical Trials Registry Platform (ICTRP), unrestricted by date or language until May 2025.
    ELIGIBILITY CRITERIA: We planned to include randomised controlled trials involving participants with traumatic or nontraumatic multidirectional instability and assessing the effects of exercise therapy compared with placebo, no treatment, waiting list, or usual care.
    OUTCOMES: The critical outcomes were planned to include overall pain, shoulder disability (measured by validated self-reported scores), participant-rated global assessment of treatment success, health-related quality of life, withdrawals due to adverse events, and the occurrence of adverse events. We planned to extract data at the end of the intervention (primary time point) and at the last follow-up after the end of the intervention.
    RISK OF BIAS: We planned to independently assess the risk of bias for each study using the RoB 2 tool.
    SYNTHESIS METHODS: We planned to synthesise results for each outcome within each comparison using a meta-analysis where possible. We planned to use GRADE to assess the certainty of the evidence for each outcome.
    INCLUDED STUDIES: We screened 1899 records after removing duplicates. After title and abstract screening, we excluded 1882 records and assessed 17 full-text articles for eligibility. Of these, we excluded 16 articles for the following reasons: ineligible intervention (n = 13), ineligible study design (n = 2), and ineligible population (n = 1). Therefore, we did not identify any completed randomised controlled trials that met our inclusion criteria. An ongoing study that aims to compare an exercise intervention with a waiting-list control in individuals with multidirectional shoulder instability may provide evidence regarding the benefits and harms of exercise therapy in this population in the future. We contacted the investigators of the ongoing study and received a response indicating that the study had recently commenced; however, no results were yet available.
    SYNTHESIS OF RESULTS: We did not find any randomised controlled trials.
    AUTHORS' CONCLUSIONS: As there are no published randomised controlled trials that have assessed the benefits and harms of exercise therapy in people with multidirectional instability of the shoulder, the value of this treatment is currently uncertain. Future randomised controlled trials should compare exercise therapy with a placebo, no treatment, waiting list, or usual care control, and ideally blind both participants and outcome assessment.
    FUNDING: This Cochrane review had no dedicated funding.
    REGISTRATION: Protocol (2023) DOI: 10.1002/14651858.CD015450/full.
    DOI:  https://doi.org/10.1002/14651858.CD015450.pub2
  47. Semin Musculoskelet Radiol. 2026 Feb;30(1): 3-13
    Update on US-guided Interventional Procedures for Tendinopathies.
    Pierluigi Glielmo, Domenico Albano, Salvatore Gitto, Joniada Petromilo, Alessandra Miceli, Carmelo Messina, Luca Maria Sconfienza.
      Tendinopathies are a leading cause of chronic musculoskeletal pain and functional limitation. When conservative measures fail, ultrasound-guided interventions are safe, minimally invasive alternatives to surgery. These procedures include injections of corticosteroids or platelet-rich plasma, percutaneous needle tenotomy, percutaneous irrigation of calcific deposits, and mechanical release techniques. Although some interventions are well established in clinical practice, others are only supported by limited or emerging evidence. Ultrasound plays a central role by enabling precise targeting of pathologic tissues and adjacent structures. This review provides an updated overview of current ultrasound-guided interventional procedures for tendinopathies, focusing on their mechanisms, clinical indications, and evidence base.
    DOI:  https://doi.org/10.1055/a-2732-7824
  48. BMC Musculoskelet Disord. 2026 Feb 19.
    Evaluation of the effects of extremity elongation on brachial plexus nerves via intraoperative neuromonitoring in patients undergoing reverse total shoulder arthroplasty.
    Dağhan Koyuncu, Alper Şükrü Kendirci, Ali Erşen.
      
    Keywords:  brachial plexus; intraoperative neurophysiological monitoring; limb lengthening; peripheral nerve injuries; shoulder prosthesis
    DOI:  https://doi.org/10.1186/s12891-026-09633-z
  49. Sci Rep. 2026 Feb 14.
    Comparative effectiveness of minimally invasive therapies for plantar fasciitis: a systematic review and network meta-analysis.
    Cheng Hao Tien, Min Chi Chiu, Yi Ling Shen, Yun Chen Ko, Jason Jiunshiou Lee.
      Plantar fasciitis is a common and often disabling condition that affects both general and athletic populations, with chronic cases significantly impairing function and quality of life. Although a wide range of conservative and non-invasive, and minimally invasive treatments are available, the absence of direct comparative evidence has limited clarity about which interventions offer the most durable benefits. We conducted a systematic review and network meta-analysis of 63 randomized controlled trials including 4170 participants to evaluate extracorporeal shock wave therapy, prolotherapy, and injection-based therapies including platelet-rich plasma, botulinum toxin A, corticosteroids, autologous blood, and local anaesthetics. Across short-, mid-, and long-term follow- up, botulinum toxin A provided the greatest short-term improvements in pain and plantar fascia thickness, where prolotherapy was most effective for sustained pain relief. Corticosteroids injection yielded the largest short-term function gains, while platelet-rich plasma supported the long-term improvements in both function and plantar fascia thickness. Extracorporeal shock wave therapy demonstrated broad efficacy across all domains and timepoints. These findings provide updated comparative evidence to guide clinical decision-making, suggesting that treatment strategies for plantar fasciitis should be tailored to symptom duration and therapeutic goals rather than defaulting to one intervention alone. Systematic review registration: PROSPERO CRD420250641285.
    Keywords:  Conservative therapy; Minimally invasive therapies; Plantar fasciitis; Systematic review, and network meta-analysis
    DOI:  https://doi.org/10.1038/s41598-026-40038-z
  50. RMD Open. 2026 Feb 17. pii: e006275. [Epub ahead of print]12(1):
    Effectiveness of exercise therapy for osteoarthritis: an overview of systematic reviews and randomised controlled trials.
    Tim Schleimer, Florian Teichert, Marius Henriksen, Rebekka Doeding, Tiziano Innocenti, Helena Brisby, Matthias C Klotz, Marianne Korinth, Patrick J Owen, Dawid Pieper, Daniel L Belavy.
       OBJECTIVE: To provide an overview of the effects of exercise for osteoarthritis.
    DESIGN: Overview.
    DATA SOURCES: Medline, Embase, Epistemonikos, PEDro, Cochrane and registries from inception to 8 November 2025.
    ELIGIBILITY CRITERIA: Reviews comparing exercise with placebo, no intervention or other interventions on pain and function for osteoarthritis. Supplementary trials were included to update inconclusive areas.
    DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed bias. Data were standardised to a 0-100 scale and reanalysed using random-effects meta-analysis. Certainty was rated using Grading of Recommendations Assessment, Development and Evaluation.
    RESULTS: Five reviews (κ=100; n=8631) and 28 supplementary trials (knee/hip κ=23, hand κ=3, ankle κ=2; n=4360) were included. Evidence indicated small, short-term effects of exercise versus placebo (mean difference -10.8, 95% CI -19.1 to -2.6) and no-treatment (-12.4, 95% CI -15.6 to -9.2) for knee osteoarthritis pain, but certainty was very low and effects in larger or longer-term trials were smaller. Moderate evidence suggested negligible effects in hip (-6.7 95% CI -9.3 to -4.0) and small effects in hand (-10.0 95% CI -15.5 to -4.5) osteoarthritis. Varying certainty evidence indicated comparable outcomes to education, manual therapy, analgesics, injections and arthroscopy. Single trials in selected populations showed exercise was less effective than knee osteotomy (12.4 95% CI 4.7 to 20.2) and joint replacement (knee 17.1 95% CI 10.4 to 23.8; hip 24.2 95% CI 18.2 to 30.2) at longer term.
    CONCLUSION AND RELEVANCE: Evidence on exercise for osteoarthritis remains largely inconclusive, suggesting negligible or short-lasting small effects comparable to, or less effective than, other treatments. These findings question its universal promotion and highlight the need to revisit research priorities and clinical discussions around its worthwhileness.
    REGISTRATION: CRD42023446888.
    Keywords:  Osteoarthritis; Osteoarthritis, Knee; Physical Therapy Modalities; Rehabilitation
    DOI:  https://doi.org/10.1136/rmdopen-2025-006275
  51. Turk J Phys Med Rehabil. 2025 Dec;71(4): 620-621
    Comment to the article: The value of inspiratory muscle training on poststroke sarcopenia and its effect on rehabilitation outcomes.
    Selda Çiftci İnceoğlu, Aylin Ayyıldız, Banu Kuran.
      
    DOI:  https://doi.org/10.5606/tftrd.2025.16290
  52. Phys Ther Sport. 2026 Feb 11. pii: S1466-853X(26)00020-9. [Epub ahead of print]78 101899
    Return-to-sport following lateral ankle sprain: Connecting scientific frameworks and real-world protocols of elite sports teams.
    Jente Wagemans, Bart Dingenen, Bruno Tassignon.
      Lateral ankle sprains (LAS) are the most common lower-limb sports injuries and demonstrate high recurrence rates. Although several return-to-sport (RTS) frameworks exist, empirical, sport-specific criteria remain limited. Clinicians rely on heterogeneous or incomplete assessment strategies. This paper aims to answer how current RTS guidelines for LAS compare to RTS protocols in elite sports teams; and how RTS decision-making after LAS can be optimised by connecting conceptual frameworks and real-life protocols. Elite teams' protocols (n = 6) demonstrated large variability in RTS-phases, progression, and assessment strategies. Only one StARRT domain (specific tests) was universally assessed. All teams evaluated ankle range of motion, muscle function, jumping/hopping, and agility (PAASS framework). Psychological readiness, proprioception, contextual modifiers and ability to complete a full training were deficient in the protocols. Most protocols approached RTS with phases. Both literature and practice relied heavily on isolated tests, with minimal integration of sport-specific, continuous RTS assessments. Optimising RTS after LAS requires shifting from reductionist, single-time-point testing toward a complex-systems approach embedded across the RTS continuum. Clinicians should integrate progressive on-field rehabilitation, continuous monitoring across a broader range of factors influencing risk and readiness. Aligning frameworks with practical, phase-based protocols may enhance decision-making, reduce recurrence risk and facilitate return to performance.
    Keywords:  Ankle injury; On-field rehabilitation; Return to spots; Sport-specific testing
    DOI:  https://doi.org/10.1016/j.ptsp.2026.101899
  53. Orthop J Sports Med. 2026 Feb;14(2): 23259671251408990
    Clinical Utility of Physical Examination Findings in Pediatric and Adolescent Acute Spondylolysis.
    James Wilkes, Sean Owens, Sulagna Sarkar, Ian Mcginnis, Margaret Bowen, Christina Master, Matthew Grady.
       Background: Previous research describes imaging via magnetic resonance imaging (MRI) as the gold standard for the diagnosis of spondylolysis after clinical examination. Existing literature on the accuracy of physical examination findings related to positive acute spondylolysis on MRI is limited.
    Purpose: To evaluate the diagnostic value of clinical examination maneuvers in assessing acute spondylolysis in adolescent athletes with low back pain related to positive radiographic findings.
    Study Design: Cohort study (Diagnosis); Level of evidence, 3.
    Methods: Data were abstracted from a sports medicine registry that prospectively collects data from the electronic health record (EHR) for patients seen for orthopaedic conditions across a regional health care network. Patients aged 8 to 18 years assessed for lumbar back pain via a standardized lumbar back pain assessment protocol and who had completed an MRI study between January 2019 and February 2024 were included. Patient information, pain duration, radiographic findings, and pain-associated physical assessment maneuvers were abstracted from the EHR.
    Results: Of 733 patients meeting study criteria, 260 (35.5%) had findings of acute spondylolysis on MRI. The mean age at initial evaluation was 14.8 years, with most patients (40.6%) presenting with 1 to 3 months of lumbar back pain. Overall, 94.2% of patients with acute spondylolysis on MRI had pain with hyperextension of the lumbar spine on physical examination, and 52.3% had pain with the single-leg hop maneuver. Those reporting pain with both hyperextension and single-leg hop had the highest prevalence of acute spondylolysis. Male patients, patients aged 13 to 14 years, and those presenting with 2 to 4 weeks of back pain had the highest prevalence of MRI-confirmed acute spondylolysis.
    Conclusion: This study evaluates the clinical accuracy of physical examination and patient characteristics associated with prevalence of acute spondylolysis in patients who present with lumbar back pain confirmed via MRI. A higher prevalence of acute spondylolysis was observed across several subgroups, including males, early to mid-adolescents, those with shorter symptom duration, and those demonstrating both hyperextension and single-leg hopping pain. Incorporating both maneuvers improved diagnostic accuracy for identifying acute spondylolysis. Findings demonstrate that both hyperextension and single-leg hopping pain may warrant advanced imaging to rule out acute spondylolysis as a cause of lumbar back pain.
    Keywords:  adolescent; pediatric; risk factors; spondylolysis
    DOI:  https://doi.org/10.1177/23259671251408990
  54. Front Sports Act Living. 2026 ;8 1707274
    Optimizing women's health: pelvic floor considerations in sports and physical activity.
    Arianna Bortolami, Giacomo Rossettini.
      
    Keywords:  clinical reasoning; decision making; evidence based; outcome; pain; physiotherapy; rehabilitation; sports
    DOI:  https://doi.org/10.3389/fspor.2026.1707274
  55. J Shoulder Elbow Surg. 2026 Feb 17. pii: S1058-2746(26)00085-6. [Epub ahead of print]
    Rehabilitation protocols after arthroscopic rotator cuff repair: A survey of active members of the Korean Shoulder and Elbow Society.
    Hyeon Jang Jeong, Jung-Youn Kim, Nam Su Cho, Chae-Gwan Kong, Jong-Ho Kim, Jin-Young Bang, Sang Don Shim, Sang-Jin Lee, Yong Beom Lee, Yon-Sik Yoo, Jae Hyung Lee, Young-Min Noh, Ho-Min Lee, Jong-Hun Ji, Chul Hong Kim, Tae-Yon Rhie, Jin-Young Park, Sung Min Kim, Tae Kang Lim.
       BACKGROUND: Despite the clinical importance of rehabilitation after arthroscopic rotator cuff repair (ARCR), standardized postoperative rehabilitation protocols are yet to be established. Therefore, this study aimed to investigate the current consensus on rehabilitation protocols after ARCR among active members of the Korean Shoulder and Elbow Society (KSES). We hypothesized that rehabilitation protocols would vary and that there might be a tendency to adjust rehabilitation based on the preoperative tear size and level of physical demand of the individual patient.
    METHODS: Between November 2023 and February 2024, an anonymous electronic survey questionnaire was distributed to 140 active members of the KSES under the auspices of the KSES Public Relations Committee. It assessed the surgeon's level of experience, rehabilitation protocols, and whether adjustments were made to the immobilization period based on tear size. Additionally, the clinical scenario of a medium-sized rotator cuff tear (RCT) was used to analyze the consensus on detailed rehabilitation protocols, including immobilization, postoperative pain management, and timing of return to daily activities.
    RESULTS: A total of 113 expert shoulder surgeons, with a mean clinical experience of 14.5 ± 7.6 years, responded to the survey (response rate 80.7%). All respondents reported using an abduction brace, and 92.9% adjusted the immobilization duration based on the tear size (r = 0.648, p < 0.001). In a medium-sized RCT scenario, 43.4% initiated rehabilitation during immobilization. Range of motion exercise was started after brace removal by 96.5% and strengthening by 80.5% at postoperative 3.1 ± 0.9 months. Patient-performed self-exercise was preferred over supervised physiotherapy or continuous passive motion machine. Analgesic use declined over time, with more pronounced reductions in opioids and acetaminophen than in non-steroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors. Injection therapy was considered by 76.1% of surgeons to manage pain that was not adequately controlled by oral analgesics. Return to work (85.8%) and sports activities (77.0%) were adjusted based on labor (r = 0.702, p < 0.001) and sports intensity (r = 0.367, p < 0.001), respectively.
    CONCLUSIONS: Despite variations in detailed protocols, the structured framework based on tear size and physical demands observed among the active members of the KSES, coupled with the preference for patient-directed rehabilitation and multimodal pain control, may suggest future efforts toward developing evidence-based and culturally adaptable rehabilitation guidelines. Further studies with higher levels of evidence are required to establish standardized and effective rehabilitation protocols.
    LEVEL OF EVIDENCE: V, Expert opinion.
    Keywords:  Arthroscopic rotator cuff repair; Pain management; Postoperative care; Questionnaire; Rehabilitation; Rotator cuff injury; Survey
    DOI:  https://doi.org/10.1016/j.jse.2026.01.013
  56. Muscle Nerve. 2026 Feb 18.
    Observational Evaluation of Muscle Echointensity and EMG Insertional Activity in Poststroke Spasticity.
    Rajiv Reebye, Ève Boissonnault, April Jeon, Mirko Filippetti, Gina McKernan, Oluwasanmi O Adenaiye, Alessandro Picelli, Michael C Munin.
       INTRODUCTION/AIMS: When spasticity occurs after a stroke, peripheral changes in spastic muscle architecture may develop. The primary objective was to determine if an association exists between spastic muscle echointensity (EI) measured by the Modified Heckmatt Scale (MHS) and changes in insertional activity detected by electromyography (EMG). The secondary aim was to investigate whether these changes are due to the effects of botulinum neurotoxin (BoNT).
    METHODS: A total of 55 patients with poststroke spasticity were enrolled from three outpatient spasticity clinics. Muscle EI and needle EMG insertional activity were assessed for 8 muscles in each subject. Chi-square tests or Fisher's exact tests for categorical variables were used to evaluate the association between muscle EI and EMG insertional activity, as well as the association between BoNT exposure and muscle changes.
    RESULTS: For MHS Grade 1-2 muscles, 91.7% had normal insertional activity compared to 46.4% of MHS Grade 3-4 muscles (p < 0.001). In muscles with abnormal insertional activity, reduced or absent insertional activity was seen in 67.3% of MHS 3-4 muscles compared to only 16.7% for MHS 1-2 muscles, while increased insertional activity was seen in 32.7% of MHS 3-4 muscles and 83.3% of MHS graded 1-2 muscles. Exposure to BoNT did not impact the observed association between MHS and abnormal EMG insertional activity.
    DISCUSSION: Increased EI is associated with abnormal EMG insertional activity. Exposure to BoNT does not explain the observed EI and EMG changes. Further research is needed to elucidate the significance and causes of muscle architectural and electromyographical transformation in poststroke spasticity.
    Keywords:  Modified Heckmatt Scale; echointensity; electromyography; muscle spasticity; ultrasonography
    DOI:  https://doi.org/10.1002/mus.70186
  57. Morphologie. 2026 Feb 13. pii: S1286-0115(26)00011-1. [Epub ahead of print]110(369): 101114
    Exploring the anatomical basis of piriformis syndrome: A systematic review.
    F Lopez Castellanos, V Feipel.
       INTRODUCTION: Piriformis syndrome remains underdiagnosed, particularly due to the anatomical complexity of the gluteal region. The aim of this study is to identify the anatomical variations most at risk for piriformis syndrome.
    METHODS: A systematic search was conducted in English in PubMed and Scopus between November 2024 and December 2025. The search covered various types of studies reporting extractable data on the anatomical aspects of piriformis syndrome. The selection process for this study was conducted by a single reviewer in accordance with PRISMA guidelines.
    RESULTS: A total of 16 studies were selected. Data analysis showed that anatomical variations of types A, B, C, D, and F according to the Beaton and Anson classification appear to be the most common. However, only types C and D of this classification, as well as the morphological variant of type A of the piriformis muscle, were clearly identified as the etiology of piriformis syndrome.
    CONCLUSION: Anatomical variations of the piriformis muscle and its relationship with the sciatic nerve are not uncommon and must be taken into account in the etiology of piriformis syndrome. Incorporating this anatomical data into an algorithm could enable earlier diagnosis and optimised treatment.
    Keywords:  Gluteal anatomy; Neuromuscular entrapment; Piriformis syndrome; Sciatica; Variations
    DOI:  https://doi.org/10.1016/j.morpho.2026.101114
  58. Clin Rehabil. 2026 Feb 20. 2692155261420658
    Enhancing participation with power-assist device: An exploratory study in manual wheelchair users.
    Dounia Bouazzaoui, Violaine Leynaert, Philippe Gallien, Adelie Leffray, Cassandra Chaldaureille, Alexis Homs, Anthony Gelis.
      ObjectiveTo evaluate the impact of acquiring a power-assist device on participation.DesignProspective multicenter cohort study.SettingThree physical medicine and rehabilitation outpatient centers.ParticipantsEighteen individuals with neurological impairments who primarily use manual wheelchairs for mobility.InterventionParticipants were followed throughout the process of acquiring a power-assisted mobility device, with assessments conducted at delivery, 3 months, and 6 months post-acquisition.Main outcome measuresParticipation (Wheelchair Outcome Measure), shoulder pain (Wheelchair User's Shoulder Pain Index), wheelchair skills (Wheelchair Skills Test Questionnaire), and satisfaction with the device (Quebec User Evaluation of Satisfaction with Assistive Technology). Evaluations were performed at baseline (pre-acquisition), delivery, and at 3 and 6 months.ResultsThirty-six participants were enrolled. Eighteen did not complete the study mostly due to funding difficulties and 18 completed the acquisition. Participation significantly increased, with WHOM scores rising from 19.33 ± 15.02 at baseline to 36.55 ± 17.06 at 3 months (p = 0.0001). WST-Q scores improved from 21.1 [19.9-23.7] at baseline to 25.2 [23.6-27.6] at 6 months (p = 0.0001). Although the overall WUSPI score did not change significantly, the mobility sub-score improved from 4.5 [0-9.2] at baseline to 0 [0-0] at 6 months (p = 0.03). Satisfaction with the device remained stable over time, with a consistent QUEST score of 3.3.ConclusionThe acquisition of a power-assist device may enhance participation, wheelchair skills, and reduce mobility-related shoulder pain in manual wheelchair users. Further comparative studies are needed to confirm these findings.
    Keywords:  Power-assisted wheelchair; participation; pushrim-activated power-assisted wheels
    DOI:  https://doi.org/10.1177/02692155261420658
  59. Interv Pain Med. 2026 Mar;5(1): 100736
    Return to work rates of workers compensation patients with lumbar radiculopathy following epidural steroid injection.
    Sean Pickard, David Speach, Kurt Hauber, Wesley Edwards, Andrea Baran, Alyssa Fedorko.
       Background: Low back injury is one of the leading causes of work-related injuries, disability, and lost productivity. Patients with lumbar radiculopathy are a subgroup of patients within work related low back injury. To our knowledge, there are few studies that specifically assessed the relationship between treating radiculopathy with an epidural injection and return to duty for injured workers. Treatments such as lumbar epidural steroid injection (ESI) that potentially expedite safe return to work could have cost-saving benefits by reducing the need for spine surgery while ameliorating an injured worker's pain and suffering.
    Objective: The objective of the study is to estimate the return-to-work rate in worker's compensation patients treated at a single academic site who were diagnosed with work related low back injury with lumbar radicular pain and treated with lumbar ESI.
    Methods: Electronic medical record data was obtained from the University of Rochester Clinical & Translational Science Institute in a retrospective review. Patients evaluated in the departments of Physical Medicine and Rehabilitation or Orthopaedics at a tertiary care medical center from January 1, 2012 to October 31, 2023. with at least one visit for lumbar radiculopathy, lumbar spinal stenosis and lumbar disc herniation were included in the study. Return to work rates were estimated from all workers treated with a lumbar ESI. Patient age, gender and number of injections were evaluated for their effect on RTW rate.
    Results: 23 of 222 patients treated with a lumbar ESI returned to work, this totaled 10.4 % of the subgroup (95 % CI: 6.7 %-15.1 %). There was insufficient evidence of an association between gender and return to work following treatment with a lumbar ESI (OR for male = 1.09, 95 % CI 0.44-2.69, p = 0.86). Similarly, there was no association between the number of injections and return to work. (OR for 3+ injections compared to 1-2 injections 0.73, 95 % CI 0.30-1.80, p = 0.49). However, we observed a decrease in likelihood of returning to work as age increases in patients treated with ESI (OR per 10 years of age = 0.51, 95 % CI 0.36-0.73, p = 0.0002).
    Conclusion: Return to work rates in worker's compensation patients were 10.4 % after treatment with lumbar ESIs. It appears that even with treatment of lumbar ESIs, worker's compensation patients with lumbar radiculopathy had a low chance of returning to work.
    DOI:  https://doi.org/10.1016/j.inpm.2026.100736
  60. J Electromyogr Kinesiol. 2026 Feb 19. pii: S1050-6411(26)00024-6. [Epub ahead of print]87 103128
    Corrigendum to "Roc-based validation of palmar sensory latency in Carpal tunnel syndrome diagnosis". [J. Electromyogr. Kinesiol. 87 (2026) 103112].
    Nur Türkmen, Senanur Giray, Simay Tavacı.
      
    DOI:  https://doi.org/10.1016/j.jelekin.2026.103128
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