bims-ricfun Biomed News
on Rehabilitation ICF
Issue of 2026–03–22
sixty-one papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica
  1. Abductor Tendon Tears in the Native and Prosthetic Hip.
  2. Surgery vs Corticosteroid Injections for Carpal Tunnel Syndrome.
  3. The Withered Arm: Thomas Hardy's chronicle of complex regional pain syndrome.
  4. 18-Month Recovery From Carpal Tunnel Syndrome Is More Frequent After Surgery Than After Corticosteroid Injections.
  5. Improved Outcomes With Platelet-Rich Plasma for Treating Extra-articular Hip Pathology Especially Greater Trochanteric Pain Syndrome and Hamstring Injury: A Systematic Review of Randomized Controlled Trials.
  6. Therapeutic Evaluation of Intra-articular Platelet-Rich Plasma, Steroid, and Viscosupplement Injections for Sacroiliitis: A Retrospective Comparative Study.
  7. Comparative Analysis of Ultrasound and MRI in Diagnosing Rotator Cuff Injuries in a Tertiary Care Setting.
  8. Evaluation and Surgical Management of Adult Spastic Hip and Knee Deformities.
  9. Shoulder injection of platelet-rich plasma versus corticosteroids in rotator cuff tendinopathies.
  10. Intradiscal mesenchymal stem cell therapy for degenerative disc disease: a systematic review and meta-analysis of randomized trials.
  11. Cadaveric analyses of injectate distribution patterns in ultrasound-guided rotator interval, dual-target, and posterior glenohumeral injections.
  12. Early sensory stabilization and metabolic modulation shape recovery in complex regional pain syndrome.
  13. From smartphone to sonography: visualizing the 'text neck' epidemic.
  14. [Rehabilitation guidelines and specifications for traumatic spinal cord injury (2025 edition)].
  15. Return-to-Play Criteria Following Lower Limb Muscle Injuries in Soccer: A Systematic Review with Evidence Synthesis.
  16. Rectus femoris deformations on M-mode ultrasonography as a reliable indicator of muscle strength in individuals with knee osteoarthritis: A cross-sectional study.
  17. Effectiveness of ultrasonography-guided pericapsular nerve group block in patients with adhesive capsulitis resistant to conservative treatment: A prospective observational study.
  18. Management of Pregnancy-related Hand and Upper-extremity Conditions and Trauma: Pain Control, Anesthesia, and Other Perioperative Considerations.
  19. Statistically Significant Results Favored in Abstracts of Platelet Rich Plasma Treatment of Knee Osteoarthritis: A Systematic Review and Spin Analysis.
  20. Editorial Commentary: A Signal Through the Noise: Platelet-Rich Plasma's Promise for Extra-articular Hip Pathology.
  21. Emerging Biologics in Lumbar Disc Degeneration: PRP, Stem Cell Therapy, and Pharmacotherapy in Mobility Restoration and Rehabilitation.
  22. Immobilization versus Early Active Mobilization after Zone 5-6 extensor tendon repair.
  23. Temporal changes in quadriceps and hamstring strength and flexibility following total knee arthroplasty.
  24. [Irreparable rotator cuff tears].
  25. Systematic review of injections for acute ankle sprains.
  26. Perineural Administration of Botulinum Toxin for Chronic Pain Management: A Narrative Review.
  27. Effect of hamstring-targeted physiotherapy on low back pain and muscle viscoelastic properties in elite adolescent rowers: A single-blind randomized controlled trial.
  28. Case Report: Application of extracorporeal shockwave therapy in medial epicondylitis with concomitant ulnar nerve instability: a case series with long-term follow-up.
  29. Digital interventions for improving quality of life and physical function in adults aged 50 and over living with rheumatic and musculoskeletal diseases.
  30. Knee osteoarthritis in the intact- and amputation-side knees of UK military personnel and veterans with traumatic unilateral transtibial limb loss 8- and 11-years post-injury: the ADVANCE cohort.
  31. Balloon-based exercise enhances abdominal activation: a comparison between one expert and one novice with chronic low back pain.
  32. Effects of Wearable Devices on Parkinson Disease: Systematic Review and Meta-Analysis of Randomized Controlled Trials Within the International Classification of Functioning, Disability, and Health Framework.
  33. Ultrasound-guided retinaculum release with a needle scalpel for de Quervain's disease: a cadaveric pilot observation.
  34. Ultrasound Diagnosis and Novel Surgical Management of Iliac Crest Enthesopathy.
  35. Functional Goals of Individuals with Cervical Spinal Cord Injury undergoing Surgical Reconstruction for Elbow Extension and their Representation in Standard Assessments.
  36. Self-Management, Fear of Movement, and Pain in Working Adults with Low Back Pain: A Qualitative Longitudinal Study.
  37. Nutritional Implications of Methotrexate in Osteoarthritis: A Systematic Review and Meta-Analysis.
  38. Comparative Effectiveness of Nonsteroidal Anti-inflammatory Drugs and Glucocorticoids in Managing Postoperative Pain Syndrome.
  39. Repeated Genicular Artery Embolization Using Permanent Microspheres for Severe Osteoarthritis and Postsurgical Pain.
  40. A 16-Year Longitudinal Study of Long-term Clinical and Radiographic Outcomes in Dorsal Proximal Interphalangeal Joint Fracture-Dislocations.
  41. A Classification of Extra-articular Distal Radius Fractures With Associated Injuries.
  42. The Effect of the Lateral Wedge Insoles on Cumulative Loads and Changes in Physical Activity of Patients With Knee Osteoarthritis.
  43. Biopsychosocial Factors Affecting Disability in Individuals with Chronic Nonspecific Low Back Pain: A Cross-Sectional Study.
  44. Honey Phonophoresis as an Adjunctive Multimodal Intervention in Knee Osteoarthritis: A Case Report.
  45. Musculoskeletal Treatments: Injection Therapies.
  46. Frailty-Modulated Outcomes After Microscopic Versus Unilateral Biportal Endoscopic Decompression for Degenerative Lumbar Spinal Stenosis Without Instability.
  47. MRI Diagnosis of Gymnast's Wrist (Distal Radial Physeal Stress Injury).
  48. Nonpharmacologic and Nonsurgical Treatment of Low Back Pain in Adults.
  49. Erratum. Experiences and Perceptions of Older People With Chronic Low Back Pain After 8 Weeks of a Specific Group-Based Exercise: Qualitative Analysis of the ESCAPE Trial.
  50. Influence of Synovial Fluid Biochemical Markers on Clinical Outcomes Following Arthroscopic and Non-Arthroscopic Patients with Knee Osteoarthritis.
  51. PRICE (Protection, Rest, Ice, Compression, Elevation) vs. PEACE and LOVE (Protection, Elevation, Avoid anti-inflammatories, Compression, Education and Load, Optimism, Vascularization, Exercise) in adolescent lateral ankle sprain rehabilitation: a randomized prospective comparative study of muscle strength and dynamic balance.
  52. Effects of Dance Interventions on Physical Function in Healthy Older Adults: A Systematic Review and 3-Level Meta-Analysis.
  53. Long-term relief of CRPS-associated limb dystonia with ketamine infusion.
  54. [Effect assessment of acupotomy on myofascial pain syndrome of trapezius muscle based on portable shear wave elastography].
  55. Evaluation of temporomandibular joint and masticatory muscles in fibromyalgia: A cross-sectional ultrasonographic study.
  56. Self-Inflicted Wrist Injuries in Flexor Tendon Zone V: Clinical Patterns, Management Strategies, and Outcomes.
  57. Editorial Commentary: Periportal Capsulotomies Create Significant Axial Distraction in Hip Arthroscopy and Should be Repaired in Certain Hip Phenotypes.
  58. Conservative Treatments May Show No Significant Differences for Partial-Thickness Rotator Cuff Tears: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials.
  59. Thumb Fractures and Associated Injuries: An Evidence Based Review to Guide Treatment.
  60. Treatment of Operative Acetabular Fractures in an Aging Population: Fixation versus Acute Arthroplasty versus Delayed Arthroplasty.
  61. Less is More in Acute Perilunate Injuries? Early Success with Arthroscopic-Assisted Fixation of the Proximal Row Without Ligament Repair.
  1. Orthop Clin North Am. 2026 Apr;pii: S0030-5898(25)00157-9. [Epub ahead of print]57(2): 105-113
    Abductor Tendon Tears in the Native and Prosthetic Hip.
    Emmett J Cleary, Luke Spencer-Gardner.
      Gluteal tendon tears are an increasingly recognized source of laterally based hip pain. These tendon tears are typically degenerative in nature and require careful history, physical examination, and imaging interpretation for accurate diagnosis. After a trial of nonoperative management, open or endoscopic repair can predictably improve pain, though expected functional improvement is correlated to the degree of preoperative muscle atrophy. The authors advocate for an open double-row suture technique to reliably visualize the full extent of the tear, restore the anatomic footprint of the avulsed tendons, and achieve stable fixation.
    Keywords:  Abductor; Arthroplasty; Gluteus; Hip; Repair; Tear; Tendon
    DOI:  https://doi.org/10.1016/j.ocl.2025.12.001
  2. Am Fam Physician. 2026 Feb;113(2): 110
    Surgery vs Corticosteroid Injections for Carpal Tunnel Syndrome.
    Diana Ly-Liu, Jose-Luis Andreu, Domingo Ly-Pen.
      
  3. Br J Pain. 2026 Mar 13. 20494637261435123
    The Withered Arm: Thomas Hardy's chronicle of complex regional pain syndrome.
    Roxaneh Zarnegar.
      
    Keywords:  chronic illness; chronic pain; complex regional pain syndrome; ethnography; polypharmacy
    DOI:  https://doi.org/10.1177/20494637261435123
  4. Am Fam Physician. 2026 Mar;113(3): online
    18-Month Recovery From Carpal Tunnel Syndrome Is More Frequent After Surgery Than After Corticosteroid Injections.
    Henry C Barry.
      
  5. Arthroscopy. 2026 Jan;42(1): 310-325
    Improved Outcomes With Platelet-Rich Plasma for Treating Extra-articular Hip Pathology Especially Greater Trochanteric Pain Syndrome and Hamstring Injury: A Systematic Review of Randomized Controlled Trials.
    Benjamin D Kuhns, Nils Becker, Absolon Reyes-Cordova, Matthew J Strok, Roger Quesada-Jimenez, Ady H Kahana-Rojkind, Benjamin G Domb.
       PURPOSE: To perform a systematic review evaluating indications, preparation methods, and outcomes of randomized controlled trials (RCTs) involving platelet-rich plasma (PRP) injections for extra-articular hip pathology.
    METHODS: A literature review was performed using the PubMed-MEDLINE, Embase, and Cochrane databases. Only RCTs evaluating extra-articular PRP hip injections were included. Study design, patient and disease characteristics, PRP processing methodology using the Platelet-Activation-White blood cell (PAW) classification, and patient-reported outcomes were analyzed. Study quality was assessed by the revised Cochrane risk-of-bias tool for randomized trials (RoB2). Meta-analyses were performed for studies evaluating the same pathology with comparable outcome metrics.
    RESULTS: Eleven RCTs (581 hips) were included with a focus on hamstring (five studies, 4 acute muscular injury; 208 patients, 1 chronic proximal tendinopathy; 17 patients), greater trochanteric pain syndrome or abductor tendinopathy (five studies; 263 patients), and piriformis (one study; 60 patients) pathology. PRP yielded superior outcomes compared to control groups for at least one time point in three RCTs (60%) on gluteal tendinopathy and two RCTs (50%) evaluating return to sport rate following acute hamstring injury. Meta-analyses found high heterogeneity (I2 = .92) in greater trochanteric pain syndrome (GTPS) studies with a significant treatment effect for the modified Harris Hip Score favoring PRP (P = .005) compared to control groups (P = .08). There was lower heterogeneity for hamstring studies (I2 = .65) and a significant treatment effect favoring PRP with an 8-day shorter return to sport (P = .005).
    CONCLUSIONS: All RCTs found improvements in pain and function following PRP injection with clinically relevant outcome thresholds and meta-analyses favoring PRP when treating GTPS and hamstring pathology. While there is substantial heterogeneity in study design, PRP formulations, control groups, outcome metrics, and follow-up time, all reviewed RCTs showed comparable or superior outcomes with PRP compared to controls.
    LEVEL OF EVIDENCE: Level I, systematic review of Level I randomized controlled trials.
    DOI:  https://doi.org/10.1002/arj.70024
  6. Cureus. 2026 Mar;18(3): e105097
    Therapeutic Evaluation of Intra-articular Platelet-Rich Plasma, Steroid, and Viscosupplement Injections for Sacroiliitis: A Retrospective Comparative Study.
    Pasala Jayavardhan Yadav, Gils Thampi, Nagakumar J S.
      Introduction Sacroiliitis is a well-recognized cause of axial low back pain and significantly contributes to chronic cases seen in orthopedic and pain clinics. While intra-articular corticosteroid injections provide established short-term symptom relief, their long-term effectiveness remains variable. Platelet-rich plasma (PRP) has emerged as a biological alternative with regenerative potential, and viscosupplementation using hyaluronic acid offers viscoelastic and anti-inflammatory effects that may enhance joint function. This study aimed to compare the therapeutic efficacy of intra-articular corticosteroid, PRP, and viscosupplement injections in treating sacroiliitis. Materials and methods This retrospective comparative study included 60 adults with clinically and magnetic resonance imaging (MRI)-confirmed sacroiliitis who were treated between January 2022 and December 2024. Patients received one of the following treatments: fluoroscopy-guided intra-articular injection of 40 mg methylprednisolone acetate combined with lidocaine (steroid group; n=20), 5 mL of autologous PRP prepared using a standardized double-spin centrifugation protocol (PRP group; n=20), or intra-articular hyaluronic acid viscosupplementation (viscosupplement group; n=20). Pain and functional status were assessed using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) at baseline, one week, one month, three months, and six months. Statistical analysis was conducted using repeated measures and one-way analysis of variance (ANOVA). Results Baseline VAS scores were comparable among the steroid (7.9±0.8), PRP (7.8±0.9), and viscosupplement (7.8±0.7) groups (p>0.05). The steroid group demonstrated greater early pain reduction at one week (4.6±0.9) compared to the PRP (6.2±0.8) and viscosupplement (5.8±0.9) groups. At six months, the PRP group showed the greatest improvement, with a mean VAS of 3.8±1.0, followed by the viscosupplement group (4.3±1.1), while the steroid group had higher scores (5.1±1.2) (p<0.05). Similarly, the mean ODI at six months was lowest in the PRP group (31.9±6.8%), followed by the viscosupplement (35.6±7.2%) and steroid groups (40.3±7.5%) (p<0.05). All groups showed significant improvement from baseline (p<0.001). No major complications were observed. Conclusion Intra-articular injections of corticosteroids, PRP, and viscosupplements effectively reduce pain and disability in sacroiliitis. Corticosteroids provide rapid early symptom relief, while PRP demonstrates superior mid-term improvement. Viscosupplementation offers sustained clinical benefits and represents a safe and effective therapeutic alternative.
    Keywords:  corticosteroid injection; hyaluronic acid; oswestry disability index; platelet-rich plasma; sacroiliac joint; sacroiliitis; viscosupplementation; visual analog scale
    DOI:  https://doi.org/10.7759/cureus.105097
  7. J Pharm Bioallied Sci. 2025 Dec;17(Suppl 5): S3630-S3632
    Comparative Analysis of Ultrasound and MRI in Diagnosing Rotator Cuff Injuries in a Tertiary Care Setting.
    Sudhakar Pandya, Poonam Dabhade, Bromesh Sanghvi, Harsh Anadkat, Vivek Amritbhai Patel, Kaival Malav Shah, Nikhil Vaidya.
       Aim: The aim of this study is to assess the diagnostic accuracy of ultrasonography in comparison to magnetic resonance imaging for evaluating rotator cuff injuries, while also examining the reliability of ultrasonography as a primary imaging technique.
    Materials and Methods: A prospective observational study of 84 individuals focused on those with shoulder pain indicating rotator cuff disease. After an ultrasound, all patients had an MRI. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy were calculated for tendon and bursal structures.
    Results: The findings indicate that ultrasound exhibited the highest sensitivity for identifying supraspinatus tears at 83.85%. Additionally, it showed a notable specificity in assessing subscapularis (94.74%), biceps tendon (96.65%), and bursitis-related conditions. A statistically significant correlation was observed in the evaluation of the subscapularis using MRI, with a P value of 0.048.
    Conclusion: The high specificity and accessibility of this imaging tool underscore its importance as a primary option, while MRI continues to play a crucial role in addressing complex or posterior shoulder pathologies.
    Keywords:  Diagnostic accuracy; MRI; rotator cuff injury; shoulder pain; ultrasonography
    DOI:  https://doi.org/10.4103/jpbs.jpbs_1527_25
  8. JBJS Rev. 2026 Mar 01. 14(3):
    Evaluation and Surgical Management of Adult Spastic Hip and Knee Deformities.
    Kitty Y Wu, Emmanouil Grigoriou, Peter C Rhee.
      » Thorough patient presurgical counseling should emphasize individual patient goals, which may include improving ambulation, reducing reliance on orthoses, alleviating pain, or facilitating caregiver support.» Careful physical examination is essential to differentiate whether the primary cause of dysfunction is weakness, spasticity, or both.» Diagnostic adjuncts including botulinum toxin, short-acting blocks, instrumented gait analysis, and dynamic electromyography provide valuable insight and guide operative decisions.» Surgical treatment must be individualized, with nerve-based procedures indicated for pure spasticity and tendon lengthening, tenotomy, or joint procedures being required to treat soft tissue and joint contractures.
    DOI:  https://doi.org/e25.00227
  9. Scand J Rheumatol. 2026 Mar 18. 1-8
    Shoulder injection of platelet-rich plasma versus corticosteroids in rotator cuff tendinopathies.
    S Bouden, C Jebali, S Ben Dhia, L Rouached, O Saidane, I Mahmoud, R Tekaya, A Ben Tekaya, L Abdelmoula.
       OBJECTIVE: To compare the efficacy of corticosteroid and platelet-rich plasma (PRP) injections on pain and function in chronic, non-ruptured rotator cuff tendinopathies.
    METHOD: In a 9 month prospective randomized trial, 52 patients were assigned to receive either corticosteroid (n = 26) or PRP (n = 26) injections. Pain was assessed using a visual analogue scale (VAS), and function was evaluated with shortened Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH) and Shoulder Pain and Disability Index (SPADI) scores at baseline, 1 week, and 3 months. Adverse events were documented.
    RESULTS: The mean age was 62.3 ± 8.3 years, with 84.6% being female. Pain reduction was comparable between groups at 1 week (p = 0.49). At 3 months, corticosteroids achieved significantly greater pain relief (ΔVAS 3.35 vs 1.75; p = 0.02), confirmed by multivariate analysis (p = 0.01). Functional improvement was similar between groups; a non-significant trend favouring corticosteroids for QuickDASH was observed but not confirmed by multivariate analysis. Both treatments were well tolerated, with mild and transient adverse events: post-injection pain (PRP 73.1% vs CTC 53.8%) and local oedema (PRP 30.8% vs CTC 38.5%).
    CONCLUSION: Corticosteroids were more effective for pain reduction at 3 months, while PRP provided equivalent functional improvement. PRP may be an alternative for patients with corticosteroid contraindications.
    TRIAL REGISTRATION: Clinicaltrials.gov (NCT07094178).
    DOI:  https://doi.org/10.1080/03009742.2026.2620888
  10. Asian Spine J. 2026 Mar 17.
    Intradiscal mesenchymal stem cell therapy for degenerative disc disease: a systematic review and meta-analysis of randomized trials.
    Ahmad Jabir Rahyussalim, Satria Wisnu Murti, Rudi Thenggono, Faiza Al Khalifa Calista.
       Study Design: Systematic review and meta-analysis.
    Purpose: To investigate the efficacy and safety of intradiscal mesenchymal stem cell (MSC) injection for patients with degenerative disc disease (DDD).
    Overview of Literature: DDD is a common cause of chronic low-back pain (CLBP). Studies have shown that MSC therapy may have the potential to reverse the degenerative process. However, the evidence remains inconclusive.
    Methods: A comprehensive search of Europe PMC, Cochrane Library, Scopus, and Medline was conducted up to April 30, 2025, using relevant keywords. Randomized controlled trials (RCTs) comparing intradiscal MSC injections with sham/placebo in patients with DDD were included. Random-effects models were used to calculate the odds ratios and mean differences (MDs).
    Results: Seven RCTs were included. MSC injection was associated with significantly greater reductions in Visual Analog Scale pain scores (MD, 6.67; 95% confidence interval [CI], -9.31 to -4.02; p<0.00001, I2=29%) and Oswestry Disability Index (ODI) (MD, -4.05%; 95% CI, -5.24 to -2.87; p<0.00001, I2=32%) compared with sham/placebo. The magnitude of improvement increased with longer followup. No significant differences were observed between groups in treatment-emergent adverse events (AEs), serious AEs, treatment discontinuation due to AEs, or mortality.
    Conclusions: Intradiscal MSC injection appears to be a safe and effective therapy, offering modest improvements in pain and function for patients with CLBP due to DDD who do not respond to conservative treatments.
    Keywords:  Intervertebral disc degeneration; Low back pain; Lumbar spine; Mesenchymal stem cells; Meta-analysis
    DOI:  https://doi.org/10.31616/asj.2025.0354
  11. Insights Imaging. 2026 Mar 18. pii: 77. [Epub ahead of print]17(1):
    Cadaveric analyses of injectate distribution patterns in ultrasound-guided rotator interval, dual-target, and posterior glenohumeral injections.
    Ondřej Naňka, Kamal Mezian, Ke-Vin Chang, Wei-Ting Wu, Vincenzo Ricci, Levent Özçakar.
       OBJECTIVES: Intra-articular corticosteroid injection is a standard treatment for adhesive capsulitis and is commonly performed via the rotator interval or posterior glenohumeral approaches, with prior evidence favoring the former. Injectate distribution varies by technique. Additionally, a dual-target approach combining rotator interval and subdeltoid bursal injections has been proposed for subacromial impingement. This study compared dye distribution among rotator interval, dual-target, and posterior glenohumeral injection techniques.
    MATERIALS AND METHODS: This cadaveric study evaluated dye spread in 18 shoulders from nine embalmed cadavers. Three ultrasound-guided techniques were assessed: rotator interval injection (15 mL), dual-target injection (10 mL rotator interval + 5 mL subdeltoid bursa), and posterior glenohumeral injection (15 mL). Following the injection, systematic dissection was performed. Staining of the subdeltoid bursa, long head of the biceps tendon sheath, anterior glenohumeral capsule, and posterior glenohumeral capsule was graded as absent, partial, or extensive.
    RESULTS: Extensive staining of the biceps tendon sheath and anterior glenohumeral capsule was observed in all shoulders receiving rotator interval or dual-target injections, whereas posterior glenohumeral injections showed inconsistent coverage of these structures. Reliable subdeltoid bursal infiltration occurred only in the dual-target group (5/6 shoulders). The posterior glenohumeral capsule was most consistently and extensively stained following posterior glenohumeral injection (6/6), with moderate coverage in the rotator interval and dual-target groups. Infraspinatus infiltration was uncommon and observed only after posterior glenohumeral injection.
    CONCLUSION: The injection technique markedly influences shoulder injectate distribution. Rotator interval and dual-target approaches preferentially address anterior structures, the dual-target technique ensures subdeltoid bursal coverage, and the posterior approach most consistently infiltrates the posterior glenohumeral capsule. Technique selection should be guided by the predominant pathological target in adhesive capsulitis and related disorders.
    CRITICAL RELEVANCE STATEMENT: Dual-target and rotator interval approaches reliably infiltrate the anterior capsule, making them suitable for adhesive capsulitis with biceps long head pathology, whereas the posterior glenohumeral approach primarily covers the posterior capsule and is less suitable for concomitant anterior shoulder disorders.
    KEY POINTS: The injection technique determines the injectate distribution in the shoulder. Dual-target and rotator interval injections ensure anterior capsule infiltration. The posterior approach best targets the posterior capsule.
    Keywords:  Intervention; Pain; Rotator cuff; Shoulder; Ultrasonography
    DOI:  https://doi.org/10.1186/s13244-026-02255-y
  12. Pain. 2026 Apr 01. 167(4): 990-991
    Early sensory stabilization and metabolic modulation shape recovery in complex regional pain syndrome.
    Chung-Hsin Yeh, Shiuan-Chih Chen.
      
    DOI:  https://doi.org/10.1097/j.pain.0000000000003876
  13. Med Ultrason. 2026 Mar 18. 28(1): 5-6
    From smartphone to sonography: visualizing the 'text neck' epidemic.
    Ahmad Jasem Abdulsalam, Vincenzo Ricci, Levent Özçakar.
      
    DOI:  https://doi.org/10.11152/mu-4596
  14. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2026 Mar 15. 40(3): 343-357
    [Rehabilitation guidelines and specifications for traumatic spinal cord injury (2025 edition)].
    Professional Committee Of Spine And Spinal Cord Injury Rehabilitation China Association Of Rehabilitation Of Disabled Persons, Professional Committee Of Spine Chinese Association Of Rehabilitation Medicine, The Second Medical-Rehabilitation Integration Working Committee Chinese Association Of Rehabilitation Medicine, Spine And Spinal Cord Injury Repair Study Group The Third Professional Committee Of Neurorestoratology Chinese Medical Doctor Association.
       Objective: To address the lack of unified group standards, inconsistent rehabilitation service processes, and waste of rehabilitation resources in the field of traumatic spinal cord injury (TSCI) rehabilitation in China, a standardized rehabilitation specifications for TSCI was established based on the 2017 expert consensus, the latest evidence-based medical evidence, and the International Classification of Functioning, Disability and Health (ICF) framework.
    Methods: Led by the China Rehabilitation Research Center and funded by the National Key Research and Development Program of China and the Capital Health Research and Development of Special Funds, this guideline was developed by experts from multiple renowned domestic institutions, drawing on international experience and combining it with clinical practice in China.
    Results: Rehabilitation Guidelines and Specifications for Traumatic Spinal Cord Injury (2025 Edition) clarifies the terminology and definitions of TSCI and specifies standards for the entire process, including pre-hospital first aid, emergency management, clinical diagnosis, acute phase clinical treatment, rehabilitation assessment, and rehabilitation therapy. It details rehabilitation protocols such as physical therapy (motor therapy), occupational therapy, vocational rehabilitation, social rehabilitation, and psychological rehabilitation. Furthermore, it provides specific rehabilitation management strategies for common complications involving the respiratory system, bowel, bladder, cardiovascular system, as well as pain, spasticity, and pressure injuries.
    Conclusion: This guideline is applicable to medical and health institutions at all levels involved in the diagnosis and treatment of TSCI. Early, accurate, and standardized rehabilitation treatment can effectively reduce disability rates, restore limb function, and improve patients' quality of life. The formulation of this guideline provides a significant basis for the standardized treatment and rehabilitation of TSCI patients in China.
    Keywords:  Traumatic spinal cord injury; complication management; group standard; rehabilitation guideline; rehabilitation therapy
    DOI:  https://doi.org/10.7507/1002-1892.202601061
  15. Sports Med. 2026 Mar 18.
    Return-to-Play Criteria Following Lower Limb Muscle Injuries in Soccer: A Systematic Review with Evidence Synthesis.
    Javier Pecci, Nicol van Dyk, Gregory D Myer, Borja Sañudo.
       OBJECTIVE: The objective was to systematically identify and categorize return-to-play (RTP) domains and criteria used following muscle injuries in male soccer players, and to describe the certainty of the evidence according to the number, design and methodological quality of the studies implementing RTP criteria within each domain.
    METHODS: In total, six databases were searched up to 10 March 2024. Studies reporting RTP criteria for hamstring, adductor, quadriceps, and calf injuries, as well as general criteria for all muscle injuries, were included. The certainty of evidence for RTP criteria was assessed on the basis of the studies citing each criterion.
    RESULTS: Out of 58,057 records, 135 studies met the inclusion criteria. Strength and pain criteria are the most cited tests for determining RTP clearance following hamstring injuries, particularly criteria related to between-limb knee flexors/extensors strength symmetry and no pain during soccer-specific actions. Range of motion criteria (active knee extension, passive and active straight leg raise, and Askling-H tests) and subjective readiness demonstrated the highest certainty of evidence in RTP decision making after hamstring injuries. RTP criteria following adductor injuries showed a moderate-to-very-low certainty of evidence across domains. Criteria for quadriceps and calf injuries ranged from low to very low evidence, while general lower limb muscle injury criteria had only very low evidence. Following adductor injuries, the highest evidence (moderate) was shown by pain assessments and completing at least one full team training session.
    CONCLUSIONS: Symmetry between limbs in knee flexor and extensor strength combined with no pain during soccer-specific actions were the most frequently implemented RTP criteria for hamstring injuries. In addition, range of motion evaluation (i.e., active knee extension, passive and active straight leg raise, and Askling-H tests) and subjective readiness assessments have been more consistently employed in higher-quality intervention studies than other domains following hamstring injuries in soccer players. Pain assessments, completing at least one full team training session and restoring strength levels are the most cited criteria for RTP following adductor injuries. The evidence base describing RTP criteria for quadriceps and calf injuries is limited and is not implemented in randomized controlled trials with high methodological quality, highlighting the need for further robust research in these domains.
    TRIAL REGISTRATION NUMBER: PROSPERO CRD42022363836.
    DOI:  https://doi.org/10.1007/s40279-026-02404-9
  16. J Orthop Sci. 2026 Mar 19. pii: S0949-2658(26)00082-5. [Epub ahead of print]
    Rectus femoris deformations on M-mode ultrasonography as a reliable indicator of muscle strength in individuals with knee osteoarthritis: A cross-sectional study.
    Siting Ye, Fangzheng Lin, Wei Fu, Jing Wang, Xiaohui Zhang, Shudong Chen, Dingkun Lin.
       BACKGROUND: Real-time ultrasound monitoring of muscle architecture changes during dynamic contractions is gaining traction as a practical tool for neuromuscular functional assessment.
    PURPOSE: This study aimed to assess the muscle thickness (MT) and deformation velocity of rectus femoris (RF) for predicting muscle strength capacity, evaluating their predictive validity and clinical feasibility.
    METHODS: Twenty-three elderly individuals with knee osteoarthritis (KOA) were examined. The thickness of the muscle at rest (MTrest) and at maximal voluntary isometric contraction (MTcontraction), the velocity from rest state to maximum contraction (Velocityactivation) and the velocity from maximal contraction to rest state (Velocityrelaxation) were obtained by M-mode ultrasound. Maximum flexor and extensor strength were measured using an isokinetic dynamometer, the gold-standard assessment tool.
    RESULTS: MTrest and MTcontraction were significantly correlated with extension strength, also showed correlations with flexion strength. Velocityactivation correlated significantly with both strength (extension: r = 0.742; flexion: r = 0.707). Velocityactivation, but not MT, remained a statistically significant predictor of both extension and flexion strength in multivariate regression models (extension: adjusted R2 = 0.381; flexion: adjusted R2 = 0.314).
    CONCLUSIONS: The deformation of RF, as measured by M-mode ultrasound, provides a visualization method for assessing extension and flexion strength. Velocityactivation showed a significant correlation with both extension and flexion strength. Furthermore, it improved the prediction of thigh muscle strength beyond muscle thickness (MT) alone. Assessing the deformation of RF by M-mode ultrasound may be valuable for detecting alterations in muscle strength and function throughout the disease process in individuals with knee osteoarthritis (KOA).
    Keywords:  Activation velocity; M-mode ultrasound; Muscle strength
    DOI:  https://doi.org/10.1016/j.jos.2026.02.015
  17. Medicine (Baltimore). 2026 Mar 20. 105(12): e48118
    Effectiveness of ultrasonography-guided pericapsular nerve group block in patients with adhesive capsulitis resistant to conservative treatment: A prospective observational study.
    Bora Uzuner, Selma İşler, Sertaç Ketenci, Dilek Durmuş.
      This prospective observational study aimed to evaluate the effectiveness of ultrasonography-guided pericapsular nerve group block (PENG-b) in shoulder pain, function, and kinesiophobia in patients with adhesive capsulitis (AC) resistant to conservative treatment. Sixty-one patients diagnosed with resistant AC were included in this study. Thirty-one patients received PENG-b followed by mobilization (Group 1), while 30 received only mobilization therapy (Group 2). All patients underwent mobilization therapy thrice a week for 6 weeks, targeting ≥80% shoulder range of motion (ROM). Pain was assessed using the Visual Analog Scale, function using the Disabilities of the Arm, Shoulder, and Hand questionnaire and Modified Constant-Murley Score, ROM via goniometry, and kinesiophobia using the Tampa Scale. Group 1 reached the targeted ROM in 10.3 ± 1.6 sessions (range 6-12), whereas all patients in Group 2 required 18 sessions (P < .001). Both groups showed significant posttreatment improvements in Visual Analog Scale, ROM, Modified Constant-Murley Score, Disabilities of the Arm, Shoulder and Hand, and kinesiophobia scores (P < .001). However, Group 1 demonstrated significantly superior outcomes across all measures compared to Group 2 (P < .001). Pain relief was also observed within 24 hours after injection in Group 1. PENG-b provided rapid pain relief and enhanced the effectiveness of subsequent mobilization therapy, resulting in better functional recovery and reduced kinesiophobia within a shorter timeframe. These findings suggest that PENG-b is a safe and effective pre-rehabilitation intervention for patients with AC who are unresponsive to conventional treatments.
    Keywords:  adhesive capsulitis; function; kinesiophobia; pain; pericapsular nerve group block
    DOI:  https://doi.org/10.1097/MD.0000000000048118
  18. Orthop Clin North Am. 2026 Apr;pii: S0030-5898(25)00161-0. [Epub ahead of print]57(2): 143-149
    Management of Pregnancy-related Hand and Upper-extremity Conditions and Trauma: Pain Control, Anesthesia, and Other Perioperative Considerations.
    Kailey Mansour, Olivia Feltner, Alexa Swailes, William J Weller, Austin Murphy.
      Upper-extremity conditions, including carpal tunnel syndrome, de Quarvians disease, trigger finger, and joint laxity, are common during pregnancy and are related to hormonal fluctuations and fluid shifts. These conditions generally respond well to conservative management with medications, bracing, and corticosteroid injection. However, surgery should be offered during pregnancy if nonoperative treatment fails. Regional and local anesthesia decreases fetal anesthetic exposure, minimizes airway issues, and assists postoperative pain control. Pregnant patients with trauma should be evaluated for extremity injury, and appropriate imaging should be obtained while minimizing pelvic radiation exposure. Surgical management should include fixation techniques with minimal radiation exposure.
    Keywords:  Anesthesia; Carpal tunnel syndrome; Pregnancy; Steroid; Trauma; de Quervians
    DOI:  https://doi.org/10.1016/j.ocl.2025.12.005
  19. Arthroscopy. 2026 Jan;42(1): 349-360
    Statistically Significant Results Favored in Abstracts of Platelet Rich Plasma Treatment of Knee Osteoarthritis: A Systematic Review and Spin Analysis.
    Genaro D Fullano, Michael D Greenstein, Emma L Klosterman, Matthew J Hartwell.
       PURPOSE: To assess the prevalence and associated variables of spin bias in the abstracts of systematic reviews and meta-analyses of knee osteoarthritis (KOA) treatment with intra-articular platelet-rich plasma (PRP).
    METHODS: PubMed and Embase were queried for peer-reviewed systematic reviews with or without meta-analysis reporting on intra-articular PRP treatment of KOA. Two authors independently analyzed the abstracts for the 15 most common types of spin by comparing details within the abstract to the full manuscript. Methodological quality was appraised using A Measurement Tool to Assess Systematic Reviews, Version 2 scoring. Descriptive statistics were used for spin and A Measurement Tool to Assess Systematic Reviews, Version 2 scores. Logistic regression and categorical association tests (Fisher's and chi-square) assessed the effect of study characteristics on the presence of spin.
    RESULTS: One or more forms of spin were found in 92% (45/49) of evaluated abstracts. The most common form of spin identified was type 11, "conclusion focuses selectively on statistically significant efficacy outcome," which was identified in 63% (31/49) of studies. A Measurement Tool to Assess Systematic Reviews, Version 2 ratings were high for 10% (5/49) of studies, moderate in 8% (4/49), low in 27% (13/49), and critically low in 55% (27/49). Decreasing level of evidence was associated with inappropriate extrapolation spin (odds ratio = 2.528, 95% confidence interval 1.037-6.161, P = .041).
    CONCLUSIONS: Spin bias is highly prevalent in the abstracts of systematic reviews and meta-analyses of intra-articular PRP to treat KOA. Findings should be interpreted in the context of the subjective scoring system used to assess spin. A lower level in the hierarchy of evidence was associated with the presence of inappropriate extrapolation spin. Identified spin tended to favor the use of PRP in treating KOA.
    CLINICAL RELEVANCE: In the present study, abstract conclusions were found to have a high prevalence of spin. Identifying and understanding spin aids in the critical appraisal of research with implications for clinical decision making in the usage of PRP.
    DOI:  https://doi.org/10.1002/arj.70027
  20. Arthroscopy. 2026 Jan;42(1): 326-328
    Editorial Commentary: A Signal Through the Noise: Platelet-Rich Plasma's Promise for Extra-articular Hip Pathology.
    Joseph C Brinkman, M Lane Moore, Jorge Chahla.
      Platelet-rich plasma (PRP) continues to generate both excitement and skepticism within orthopaedics and sports medicine. As a biologic derived from autologous blood, PRP offers an appealing, minimally invasive option for treating musculoskeletal pathology through the delivery of concentrated growth factors and cytokines. Evidence across orthopaedic subspecialties remains mixed, however, with studies showing variable efficacy and inconsistent methodologies. Recent data on PRP use for extra-articular hip pathology, particularly greater trochanteric pain syndrome, hamstring injuries, and piriformis syndrome show encouraging improvements in pain and function, including faster return to sport and favorable patient-reported outcomes. Yet, significant heterogeneity in study design, PRP preparation, and control interventions limits generalizability and hinders clear clinical guidance. These inconsistencies mirror similar challenges in PRP research for a variety of other orthopaedic pathologies, underscoring the need for standardized preparation protocols and consistent reporting frameworks. Despite these limitations, a signal of efficacy persists within the data, suggesting PRP may indeed provide meaningful benefit for select extra-articular hip conditions. As surgical alternatives for these pathologies often carry substantial morbidity, continued refinement of PRP formulations and methodology represents a promising step toward establishing biologics as reliable, evidence-based tools in orthopaedic care.
    DOI:  https://doi.org/10.1002/arj.70045
  21. J Spine Res Surg. 2026 ;8(1): 14-21
    Emerging Biologics in Lumbar Disc Degeneration: PRP, Stem Cell Therapy, and Pharmacotherapy in Mobility Restoration and Rehabilitation.
    Andre Aabedi, Devendra K Agrawal.
      Lumbar disc degeneration is a leading contributor to chronic low back pain and functional limitation worldwide, driven by progressive extracellular matrix breakdown, disc dehydration, inflammation, and cellular senescence. Conventional treatments-including pharmacotherapy, physical rehabilitation, and surgery-primarily address symptoms rather than the underlying degenerative cascade and often fail to restore disc structure or long-term mobility. Emerging biologic therapies have gained attention for their potential to modify disease progression and promote regeneration. This narrative review examines current evidence surrounding platelet-rich plasma, mesenchymal stem cell therapies, peptide analogs, and evolving pharmacologic agents in the management of lumbar disc degeneration, with particular emphasis on mobility restoration and rehabilitation integration. platelet-rich plasma and mesenchymal stem cell-based interventions demonstrate moderate improvements in pain and functional outcomes with generally favorable safety profiles, though durable structural regeneration remains unproven. Peptide analogs and molecular agents show promising preclinical regenerative and anti-inflammatory effects but lack robust human data and regulatory approval. Pharmacologic strategies targeting inflammatory and catabolic pathways may complement biologic therapies but remain largely investigational. The integration of biologics with structured rehabilitation and progressive loading appears critical for optimizing functional recovery. Despite encouraging advances, significant limitations persist, including heterogeneous protocols, limited high-quality randomized trials, and insufficient long-term data. Future research should prioritize standardization, comparative effectiveness studies, and multimodal treatment models to clarify the role of biologic therapies in restoring mobility and function in lumbar disc degeneration.
    Keywords:  Biologic therapies; Discogenic low back pain; Lumbar disc degeneration (LDD); Mesenchymal stem cells (MSCs); Platelet-rich plasma (PRP); Regenerative medicine; Rehabilitation integration
    DOI:  https://doi.org/10.26502/fjsrs0097
  22. Hand Surg Rehabil. 2026 Mar 16. pii: S2468-1229(26)00078-2. [Epub ahead of print] 102641
    Immobilization versus Early Active Mobilization after Zone 5-6 extensor tendon repair.
    Ümit Varlı, Kubilay Erol, Anıl Koca, Can Yener, İlknur Naz.
       BACKGROUND: Extensor tendon injuries in the dorsal hand are prevalent due to the superficial location of the tendons and limited surrounding soft tissue. Early active mobilization (EAM) protocols are increasingly being adopted; however, comparative data with traditional immobilization methods remain scarce.
    PURPOSE: This study aims to compare the short-term functional outcomes and return-to-work times between EAM and immobilization following zone 5-6 extensor tendon repairs.
    STUDY DESIGN: A retrospective cohort study.
    METHODS: We analyzed twenty-six patients with isolated zone 5-6 extensor tendon injuries (EAM: n = 12; immobilization: n = 14). Range of motion was assessed using a goniometer, while grip strength was measured with a hand dynamometer. Data on return-to-work times and physiotherapy sessions were collected. Statistical analyses included parametric and non-parametric tests, effect sizes (Cohen's d), and interaction analyses based on occupation type and dominant hand involvement. A post-hoc power analysis was performed for total active motion.
    RESULTS: The EAM group exhibited significantly higher values for metacarpophalangeal, distal interphalangeal, and total active motion at discharge compared to the immobilization group (p = 0.035, p = 0.001, p = 0.007), with large effect sizes. However, there were no significant differences in grip strength, return-to-work times, or the number of physiotherapy sessions (p > 0.05). Additionally, occupation type and hand dominance did not significantly influence return-to-work outcomes. The post-hoc power for total active motion was calculated at 91.2%. Importantly, no tendon ruptures were reported.
    CONCLUSION: Early active mobilization following zone 5-6 extensor tendon repair significantly enhances short-term range of motion without increasing complication rates. Grip strength and return-to-work outcomes remain comparable to those observed with immobilization. These findings advocate for early active mobilization as a safe and effective rehabilitation approach.
    Keywords:  early active mobilization; extensor tendon; immobilization; rehabilitation
    DOI:  https://doi.org/10.1016/j.hansur.2026.102641
  23. J Orthop. 2026 Jun;76 4-10
    Temporal changes in quadriceps and hamstring strength and flexibility following total knee arthroplasty.
    Saidan Shetty, Bincy M George, Mohandas Rao Kg, Sharath K Rao, Sandeep Vijayan.
       Purpose: Quadriceps and hamstring dysfunction is well-documented in individuals with knee osteoarthritis (OA) and after total knee arthroplasty (TKA). While strength deficits are often studied, changes in muscle flexibility and their influence on postoperative recovery remain less understood.
    Objective: This study aimed to evaluate temporal changes in quadriceps and hamstring strength and flexibility from the preoperative stage to one year following TKA and to compare with those of healthy controls.
    Methods: Individuals with knee OA scheduled for TKA were assessed for quadriceps and hamstring strength using a handheld dynamometer and for flexibility using standardized muscle length tests. Measurements were obtained preoperatively and at 6 weeks, 3 months, 6 months, and 12 months postoperatively, and were compared with age- and sex-matched healthy controls. Statistical significance was set at p < 0.05.
    Results: Preoperatively, quadriceps and hamstring strength were significantly reduced compared with controls (p < 0.001). Strength declined further at 6 weeks post-TKA, particularly in the quadriceps. Significant improvements were observed from 3 to 12 months postoperatively (p < 0.001). At 12 months, quadriceps and hamstring strength remained significantly lower than controls (p < 0.001). Quadriceps and hamstring flexibility was significantly reduced postoperatively (p < 0.05) and demonstrated gradual improvement over time, corresponding with strength recovery.
    Conclusion: Quadriceps and hamstring strength and flexibility improved substantially during the first postoperative year following TKA; however, residual quadriceps deficits persisted relative to healthy controls. These findings highlight the need for early and progressive rehabilitation strategies emphasizing long-term quadriceps strengthening and flexibility training to optimize postoperative outcomes.
    Keywords:  Hamstring; Muscle flexibility; Muscle strength; Quadriceps; Rehabilitation; Total knee arthroplasty
    DOI:  https://doi.org/10.1016/j.jor.2026.03.008
  24. Ugeskr Laeger. 2026 Mar 16. pii: V05250438. [Epub ahead of print]188(12):
    [Irreparable rotator cuff tears].
    Maria Wisam Kino, Jamal Bech Bouknaitir, Jeppe Vejlgaard Rasmussen, Bo Sanderhoff Olsen, Adam Witten, Kristoffer Weisskirchner Barfod.
      Irreparable rotator cuff tears show increasing incidence with age. In symptomatic cases, first-line therapy should be a minimum of six months of physical training, as many improve over time. Reparability is evaluated clinically and by MRI - assessing tendon retraction, fatty infiltration, and muscle atrophy. If symptoms persist, surgical treatment is considered: reverse shoulder arthroplasty is generally offered to older patients (> 60 years), while joint-preserving procedures such as tendon transfer or superior capsular reconstruction may be suitable for younger patients (less-than 60 years), as argued in this review.
    DOI:  https://doi.org/10.61409/V05250438
  25. Musculoskelet Surg. 2026 Mar 17.
    Systematic review of injections for acute ankle sprains.
    Christopher Frey, Anant Shukla, Emily Adydan, Nicholas Strasser.
      Lateral ankle sprains are a common injury that can result in morbidity in terms of pain and time away from work or sport. Although it is typically self-resolving, treatments to expedite or enhance healing may be beneficial. One modality utilized by health care practitioners is the injection of therapeutic compounds. The purpose of this study is to determine the impact of injections of local anesthetics, platelet-rich plasma (PRP), and hyaluronic acid (HA) on patients with lateral ankle sprains. Systematic Review; Level of evidence 3. A comprehensive literature search was conducted in PubMed, Embase, Web of Science, Scopus, and the Cochrane Library on December 17th, 2024, by the Health Sciences Research Librarian. A total of 10 studies were included. 5 pertained to local anesthetic injections and demonstrated a favorable impact on recovery time. 3 manuscripts used PRP with 2 of the 3 finding improvements in the intervention group relative to the control up to 24 weeks from the injury. 2 manuscripts pertained to hyaluronic acid injections and one of the studies found relative improvements compared to the control in terms of pain control. Injections of PRP, hyaluronic acid, and local anesthetics may be able to improve recovery time and pain control for lateral ankle sprains; however, there remains a need for high-quality research to make recommendations for clinical practice.
    Keywords:  Anesthetic; Ankle sprain; Hyaluronic acid; Platelet-rich plasma; Procaine; Return to sport
    DOI:  https://doi.org/10.1007/s12306-026-00951-y
  26. Pain Res Manag. 2026 ;2026(1): e6539538
    Perineural Administration of Botulinum Toxin for Chronic Pain Management: A Narrative Review.
    Théo Belaise, Mélanie Kremer, Bernard Poulain, Ipek Yalcin, Yohann Bohren.
       BACKGROUND: Neuropathic pain occurs as a direct consequence of a lesion or a disease affecting the somatosensory system. Because of the limited therapeutic arsenal, it is difficult to treat. Nevertheless, pain relief has been demonstrated in multiple clinical trials treating neuropathic pain patients with subcutaneous or intradermal administrations of botulinum toxin. However, this type of administration route shows limits; for example, the painful area may be too large for subcutaneous administration, or administration discomfort would be intolerable for direct injection into the painful area. For these reasons, alternative routes have been investigated, including the perineural one.
    OBJECTIVE: In the present review, we critically assess currently available clinical studies on perineural botulinum toxin administration for chronic pain treatment. We also discuss its possible underlying mechanisms and compare it to those of subcutaneous botulinum toxin administration.
    RESULTS: Studies demonstrated that perineural injection of botulinum toxin is an interesting alternative for the treatment of chronic pain, both for reducing pain intensity and improving quality of life. In addition to few reported side effects, compared to other pharmacological interventions, its strength also lies in its long-lasting effects.
    CONCLUSION: Despite promising results, the limited available literature cannot recommend this route of administration over others. More significant results and randomized controlled clinical trials are needed to support with confidence this route of administration.
    Keywords:  Botulinum toxin; neuropathic pain; perineural injection
    DOI:  https://doi.org/10.1155/prm/6539538
  27. J Back Musculoskelet Rehabil. 2026 Mar 16. 10538127261432694
    Effect of hamstring-targeted physiotherapy on low back pain and muscle viscoelastic properties in elite adolescent rowers: A single-blind randomized controlled trial.
    Onur Atakan Sekibağ, Şule Hantal.
      BackgroundLow back pain (LBP) is highly prevalent among adolescent rowers and may be influenced by altered trunk-pelvic mechanics and hamstring characteristics. Hamstring-targeted physiotherapy interventions are widely used in clinical practice; however, comparative evidence regarding their effects on muscle mechanical properties and LBP in adolescent rowing populations is limited.ObjectiveTo compare the effects of ballistic hamstring stretching, hamstring extender exercise, and kinesiotaping on hamstring viscoelastic properties, low back pain, and athletic performance in elite adolescent rowers.MethodsThis single-blind, parallel-group randomized controlled trial included 60 elite male adolescent rowers (aged 14-18 years) with chronic low back pain, and participants were randomly assigned to three groups for a twelve-week program performed during training sessions four times per week. All outcomes were assessed at baseline and week 12, including hamstring viscoelastic properties measured using a handheld myotonometer, pain intensity assessed with the Numeric Pain Rating Scale, and athletic performance evaluated by the 2000-m rowing ergometer and standing long jump tests. Data were analyzed using age-adjusted analysis of covariance (ANCOVA).ResultsAfter adjustment for baseline values and age, both exercise-based interventions were associated with more favorable changes in hamstring viscoelastic properties and greater reductions in pain intensity compared with kinesiotaping (p < 0.001). Between-group differences in athletic performance were statistically significant but modest.ConclusionHamstring-focused exercise interventions were associated with greater improvements in muscle mechanical properties and reductions in LBP compared with kinesiotaping in adolescent rowers. These findings support the inclusion of active hamstring exercises in rehabilitation programs for athletes with LBP.
    Keywords:  Low back pain; adolescent rowers; exercise; kinesiotaping; myotonometry; randomized controlled trial; viscoelastic properties
    DOI:  https://doi.org/10.1177/10538127261432694
  28. Front Rehabil Sci. 2026 ;7 1677404
    Case Report: Application of extracorporeal shockwave therapy in medial epicondylitis with concomitant ulnar nerve instability: a case series with long-term follow-up.
    Larisa Ryskalin, Federica Fulceri, Francesco Busoni, Elisa Colomo, Paola Soldani, Marco Gesi.
       Background: Medial epicondylitis is an overuse syndrome characterized by degeneration of the flexor-pronator tendons in the elbow, resulting from repetitive forced wrist flexion and forearm pronation. Due to its anatomical location, medial epicondylitis patients may also feature ulnar nerve instability, which can exacerbate symptoms and negatively impact treatment outcomes. Although conservative treatments remain the cornerstone of care for managing medial epicondylitis, the optimal treatment method remains an open question.
    Objective: To evaluate the effects of a combined extracorporeal shockwave therapy (ESWT) protocol on pain, symptom severity, and functional outcomes in medial epicondylitis patients with concomitant ulnar nerve instability.
    Design: Retrospective case series study with two-year post-treatment follow-up.
    Setting: Center for Rehabilitative Medicine "Sport and Anatomy", University of Pisa.
    Interventions: Patients underwent a combined ESWT using the Duolith SD1 ultra device (Storz Medical AG., Switzerland), consisting of sequential focal (0.15-0.20 mJ/mm2, 5-6 Hz, 1,000 shocks) and radial (1.3-1.8 mJ/mm2, 14 Hz, 2,000 shocks) shockwave application per session. Each patient received three to five weekly sessions.
    Participants: Medial epicondylitis patients with concomitant ulnar nerve involvement who underwent a combined ESWT protocol between September 2019 and May 2023.
    Main outcome measures: Pain severity and upper limb disability were assessed with the numerical rating scale, the shortened Disabilities of the Arm, Shoulder and Hand questionnaire, and the Ulnar Neuropathy at the Elbow Questionnaire. Patient treatment satisfaction was evaluated with the Roles and Maudsley score.
    Results: Of the reviewed 15 consecutive medical charts, only three subjects fulfilled the inclusion criteria. Two patients showed a marked decrease in pain and improved functionality scores at all time points; one patient remained unchanged throughout the study; no adverse effects were observed.
    Conclusions: This retrospective study suggests that ESWT may be efficacious and safe for treating medial epicondylitis patients with concurrent ulnar nerve instability. Prospective studies with a larger sample size are needed to warrant the present results.
    Keywords:  combined shockwave therapy; disability; elbow tendinopathy; medial elbow pain; ulnar nerve; upper extremity
    DOI:  https://doi.org/10.3389/fresc.2026.1677404
  29. Cochrane Database Syst Rev. 2026 Mar 16. 3 CD016341
    Digital interventions for improving quality of life and physical function in adults aged 50 and over living with rheumatic and musculoskeletal diseases.
    Ana Rita Henriques, Carolina Andrade, Sofia Silvério Serra, Teresa Costa, Elsa Mateus, Monserrat Conde, Nuno Mendonça, Diederik De Cock, Ana Maria Rodrigues.
       OBJECTIVES: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the effectiveness of digital health interventions, compared with usual care, non-digital structured intervention, or no intervention, in improving quality of life and physical function among community-dwelling adults (i.e. people living in the community) aged 50 years or over, diagnosed with osteoarthritis, osteoporosis, low-back pain, rheumatoid arthritis, or polymyalgia rheumatica.
    DOI:  https://doi.org/10.1002/14651858.CD016341
  30. Arch Phys Med Rehabil. 2026 Mar 12. pii: S0003-9993(26)00577-0. [Epub ahead of print]
    Knee osteoarthritis in the intact- and amputation-side knees of UK military personnel and veterans with traumatic unilateral transtibial limb loss 8- and 11-years post-injury: the ADVANCE cohort.
    Fraje Ce Watson, Oliver O'Sullivan, Alex N Bennett, Susie Schofield, Diana Toderita, Fearghal P Behan, Christopher J Boos, Nicola T Fear, Paul Cullinan, Harriet Kemp, Anthony Mj Bull.
       OBJECTIVE: To compare knee osteoarthritis in people with unilateral transtibial (UTT) limb loss (LL) between (i) intact- and amputation-side knees, and (ii) ∼8-years and ∼11-years post-LL, and report knee osteoarthritis in reference population.
    DESIGN: Inception cohort SETTING: UK military PARTICIPANTS: Volunteers with UTT LL (n=36) and matched controls (n=36).
    INTERVENTIONS: N/a.
    MAIN OUTCOME MEASURES: Kellgren-Lawrence (KL; 0-4 [none-severe]) score and Knee injury and Osteoarthritis Outcome Score (KOOS; 100-0 [no problems-severe problems]) for Pain and Symptoms.
    RESULTS: At Baseline, ∼8-years after LL, mean age was 32.9±4.2-years. Participants used dynamic-passive prosthetic limbs for daily activities and exercise. At Baseline, KL was not different between intact- and amputation-side knees (p=0.220). At Follow-up, KL was worse on the amputation-side compared to intact-side knee (p=0.021). Rank biserial correlation indicated that, for a randomly chosen pair, the amputation-side knee was 67% more likely to have a higher KL score than the intact-side knee. On both the intact- and amputation-side knees, KL was not different between Baseline and Follow-up (p=0.706 and p=0.138). KOOS Pain and Symptoms were not different between intact- and amputation-side knees at Baseline (Pain: median 100.0 vs. 100.0, p=0.253; Symptoms: median 90.0 vs. 86.5 p=0.573) or Follow-up (Pain: median 94.4 vs. 97.2, p=0.291; Symptoms: median 90.0 vs. 90.0 p=0.247). KOOS Pain (p=0.619 and p=0.557) and Symptoms (p=0.664 and p=0.580) were not different between Baseline and Follow-up for the intact- and amputation-side knees.
    CONCLUSIONS: For the first time, we have compared osteoarthritis of the intact- and amputation-side knee of people with UTT LL. Contrary to current opinion, radiographic osteoarthritis was worse on the amputation-side knee 11-years post-LL. Modern military populations may be unique in their access to rehabilitation and prosthetic technology, resulting in different patterns of osteoarthritis. Clinical care should focus on the intact- and amputation-side knee of people with UTT LL.
    Keywords:  combat trauma; knee osteoarthritis; limb loss; transtibial
    DOI:  https://doi.org/10.1016/j.apmr.2026.02.497
  31. J Phys Ther Sci. 2026 Mar;38(3): 147-151
    Balloon-based exercise enhances abdominal activation: a comparison between one expert and one novice with chronic low back pain.
    Hiraku Nagahori, James Kenyon, Kai-Yu Ho.
      [Purpose] While forced exhalation with balloon-blowing has been reported to facilitate abdominal muscle activity, few studies have examined its effects using imaging. We aimed to compare abdominal muscle morphology across three conditions, end-inspiration, end-forced expiration, and end-forced expiration with balloon-blowing, between a balloon-blowing exercise expert and a novice with chronic low back pain, assessed using ultrasound imaging. [Participants and Methods] A 61-year-old male expert and a 51-year-old male novice participated. The thicknesses of the transversus abdominis, internal oblique, and external oblique were measured using ultrasound imaging during end-inspiration, end-forced expiration, and end-forced expiration with balloon-blowing. The thickness and contraction ratios, calculated by dividing the thickness at end-forced expiration by that at end-inspiration, were compared within and between participants. [Results] The expert demonstrated a 1.33 mm thicker transversus abdominis and a 4.95 mm thicker internal oblique than those of the novice at end-inspiration. Balloon-blowing increased all muscle thicknesses in both participants compared with end-inspiration. The contraction ratios of the muscles during forced expiration with balloon blowing were 1.14- to 1.80-fold higher than the ratios at end-forced expiration in both participants. [Conclusion] These findings suggest the potential usefulness of balloon-blowing for activating abdominal muscles, especially in individuals with chronic low back pain.
    Keywords:  Internal oblique; Transversus abdominis; Ultrasound
    DOI:  https://doi.org/10.1589/jpts.38.147
  32. J Med Internet Res. 2026 Mar 18. 28 e85914
    Effects of Wearable Devices on Parkinson Disease: Systematic Review and Meta-Analysis of Randomized Controlled Trials Within the International Classification of Functioning, Disability, and Health Framework.
    Jiarong Wu, Wanli Zang, Mingqing Fang, Ningkun Xiao, Xianzuo Zhang, Su Wang, Qiuxia Zhang.
       BACKGROUND: Parkinson disease (PD) impairs gait, balance, and quality of life, and wearable devices have been proposed to support rehabilitation, but evidence for their clinical efficacy remains uncertain.
    OBJECTIVE: This study aimed to evaluate, within the International Classification of Functioning, Disability, and Health (ICF) framework, the effects of wearable-device interventions on gait performance, balance, and health-related quality of life in people with PD by conducting a systematic review and meta-analysis of randomized controlled trials (RCTs).
    METHODS: We searched PubMed, Web of Science, Cochrane Library, Embase, and ClinicalTrials.gov from inception to November 18, 2025, for RCTs in people with PD comparing wearable-device interventions with control conditions. We used Hartung-Knapp random-effects models to pool mean differences (MDs) or standardized mean differences (SMDs) and reported 95% prediction intervals when ≥3 studies were pooled. Risk of bias was assessed using the Cochrane Risk of Bias (RoB) tool, and certainty of evidence was rated using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
    RESULTS: Nine RCTs involving 260 participants were included. Wearable devices produced a small improvement in stride length (MD 0.10 meter, 95% CI 0.03-0.17), but there was no clear benefit for the 10-Meter Walk Test time (MD 0.04 second, 95% CI -0.06 to 0.15). Double support time showed no reduction (MD -1.59% gait cycle, 95% CI -3.79 to 0.61). Freezing of gait (Freezing of Gait Questionnaire [FOG-Q] and New Freezing of Gait Questionnaire [NFOG-Q]) did not significantly improve (SMD -0.24, 95% CI -0.72 to 0.24). Motor severity (Unified Parkinson Disease Rating Scale Part III [UPDRS III]) showed a small, nonsignificant trend favoring wearable devices (MD -2.16 points, 95% CI -4.39 to 0.07). For balance, pooled results from the Berg Balance Scale (BBS), Mini Balance Evaluation Systems Test (Mini-BESTest), and Performance-Oriented Mobility Assessment Balance Subscale (POMA balance) suggested a borderline effect (SMD 0.48, 95% CI -0.02 to 0.98). Wearable devices did not meaningfully improve Parkinson Disease Questionnaire (PDQ) scores (SMD -0.28, 95% CI -0.74 to 0.17), EQ-5D utility (MD 0.10, 95% CI -0.24 to 0.44), or Falls Efficacy Scale-International (FES-I) scores (MD -0.04, 95% CI -1.10 to 1.02). Prediction intervals frequently crossed the null, suggesting effects may vary by setting and population.
    CONCLUSIONS: Wearable device interventions for Parkinson disease produced a small improvement on average in stride length, with no consistent benefits for other gait outcomes, balance, or patient-centered outcomes. By integrating ICF mapping with Hartung-Knapp meta-analysis, prediction intervals, and GRADE, and avoiding pooling of conceptually distinct gait measures used in prior reviews, this review clarifies where evidence is most consistent, supports using wearables as adjuncts to rehabilitation, and underscores the need for larger, longer RCTs with standardized outcomes to determine who benefits and how to implement them.
    TRIAL REGISTRATION: PROSPERO CRD42024585686; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024585686.
    Keywords:  International Classification of Functioning, Disability and Health (ICF); balance function; gait performance; meta-analysis; wearable devices
    DOI:  https://doi.org/10.2196/85914
  33. Med Ultrason. 2026 Mar 18. 28(1): 122-123
    Ultrasound-guided retinaculum release with a needle scalpel for de Quervain's disease: a cadaveric pilot observation.
    Chia-Ching Chen, Wei-Ting Wu, Ke-Vin Chang, Shih-Wei Huang, Levent Özçakar.
      
    DOI:  https://doi.org/10.11152/mu-4602
  34. Orthop Clin North Am. 2026 Apr;pii: S0030-5898(25)00164-6. [Epub ahead of print]57(2): 165-177
    Ultrasound Diagnosis and Novel Surgical Management of Iliac Crest Enthesopathy.
    Blake A Barton, Anthony A Mascioli, David D Spence, Nahum M Beard.
      Iliac crest enthesopathy is an uncommon cause of function-limiting lateral hip pain with limited literature addressing its diagnosis and management. We present a case series of 8 adult patients with iliac crest/proximal gluteal pathology (6 degenerative, 1 posttraumatic, and 1 neoplastic) that highlights diagnostic challenges in this region. Our cases demonstrate the utility of musculoskeletal ultrasonography in both diagnosis and treatment of iliac crest enthesopathy. After reviewing relevant literature, we describe a novel ultrasound-guided surgical approach used in 5 patients in whom conservative therapies failed. This technique offers a minimally invasive alternative for managing recalcitrant iliac crest enthesopathy.
    Keywords:  Enthesitis; Gluteal tendinopathy; Hip pain; Iliac crest; Musculoskeletal ultrasound; Tenotomy; Ultrasound-guided surgery
    DOI:  https://doi.org/10.1016/j.ocl.2025.12.008
  35. Arch Phys Med Rehabil. 2026 Mar 13. pii: S0003-9993(26)00608-8. [Epub ahead of print]
    Functional Goals of Individuals with Cervical Spinal Cord Injury undergoing Surgical Reconstruction for Elbow Extension and their Representation in Standard Assessments.
    Chantal Wunderlin, Sabrina Koch-Borner, Ursina Arnet, Silvia Schibli.
       OBJECTIVE: This study aims to examine the most frequently pursued goals among individuals with cervical spinal cord injury (cSCI) undergoing posterior deltoid-to-triceps transfer, and to assess the extent to which these goals are represented in existing questionnaires and assessments.
    DESIGN: Retrospective observational study SETTING: Spinal cord Injury rehabilitation centre in Switzerland PARTICIPANTS: 47 participants (37 male, 10 female) with cSCI, levels of injury C4-C6, mean age of 33.4 years (SD 10.7 years), 4.8 years (SD 6.7 years) between injury and surgical reconstruction.
    INTERVENTIONS: In total, 307 goals were consolidated into 32 activities of daily living (ADLs). The goals were additionally categorized according to the Activity and Participation component of the International Classification of Functioning, Disability and Health (ICF), and by three functional workspaces (below, at and above shoulder level). The frequency of each ADL, ICF category, and workspace was determined across all goals and stratified by levels of injury. The 15 most most frequently ADLs were compared with the items from existing questionnaires and assessments.
    MAIN OUTCOME MEASURE: Not applicable.
    RESULTS: The most frequently pursued ADLs were "performing a transfer" (15%), "taking an object from the shelf" (14%), followed by "operating a manual wheelchair" and "dressing upper body" (each 7%). These rankings remained consistent across different ICF categories and levels of injury. Most of the ADLs happen "below shoulder level" (47%), then "above shoulder level" (32%) and "at shoulder level" (21%). Among existing questionnaires and assessments, the Van Lieshout Test showed the highest overlap (33%) with the 15 most relevant ADLs.
    CONCLUSION: An active elbow extension is crucial not only for overhead activities, but also for activities below shoulder level. Existing questionnaires and assessments insufficiently cover the most frequently pursued ADLs, emphasizing the need for a tailored tool for individuals with cSCI undergoing surgical reconstruction of active elbow extension.
    Keywords:  Goals; Patient Reported Outcome Measures; Quadriplegia; Rehabilitation; Spinal Cord Injuries; Surgical Procedures; Surveys and Questionnaires; Upper extremity
    DOI:  https://doi.org/10.1016/j.apmr.2026.02.504
  36. J Pain Res. 2026 ;19 549844
    Self-Management, Fear of Movement, and Pain in Working Adults with Low Back Pain: A Qualitative Longitudinal Study.
    Minna Roine, Eira Karvonen, Matti Munukka, Ari Heinonen, Pirjo Vuoskoski.
       Purpose: The present study explored the experiences of working individuals with low back pain regarding self-management, fear of movement and pain during a 12-month follow-up period after receiving either direct access (DA) or conventional physical therapy.
    Patients and Methods: Data were collected through electronic questionnaires containing open-ended questions on physical therapy, fear of movement and pain. These were administered at baseline (after the initial physical therapy visit) and at 3-, 6-, and 12- month follow-ups. Participants were clients from real-life clinical settings in primary care or emergency departments. Fifteen participants completed all follow-ups; ten from DA and five from conventional physical therapy.
    Results: Two distinct client types emerged: the pilot, who actively engaged in recovery with support from the physical therapist, and the passenger, who adopted a more passive approach by avoiding pain-inducing activities. These types were reflected in two main categories: 1) "Understanding my pain", with three subcategories: Nature of my pain, Daily living with my pain, and Knowing the cause of my pain, and 2) "Managing my pain", with three subcategories: Ownership of my recovery, Courage to be active, and Relieving pain.
    Conclusion: The findings underscore the individualized nature of self-management, fear of movement and pain experiences over 12 months follow-up. While personal strategies varied, guidance from physical therapist appeared instrumental in supporting the adoption of an active pilot-like role in recovery.
    Keywords:  direct access; musculoskeletal; physical activity; qualitative content analysis; rehabilitation
    DOI:  https://doi.org/10.2147/JPR.S549844
  37. Rev Recent Clin Trials. 2026 Mar 16.
    Nutritional Implications of Methotrexate in Osteoarthritis: A Systematic Review and Meta-Analysis.
    Saud Nayef Salem Aldanyowi, Abdulsalam Mohammed Aleid, Yousef Khalaf A Alghamdi, Hasan Ali Abdullah AlAidarous, Zainab Mohammed Aleid.
       INTRODUCTION: Osteoarthritis (OA) is a prevalent degenerative joint condition with limited treatment options targeting disease modification. Methotrexate (MTX), widely used in rheumatoid arthritis for its anti-inflammatory properties, may offer similar benefits in OA. However, its effectiveness and nutritional implications in OA remain uncertain.
    METHODS: We conducted a systematic review and meta-analysis following PRISMA guidelines, registered in PROSPERO (CRD42024592121). We searched PubMed, Web of Science, OVID, and Cochrane Central up to August 2024 for randomized controlled trials comparing MTX with placebo in OA patients. Risk of bias was assessed using the Cochrane RoB 2 tool, and data were synthesized using Review Manager (RevMan) 5.4.
    RESULTS: Four trials involving 416 participants were included. MTX significantly reduced pain at 3 months (SMD = -0.33, p = 0.006) and 6 months (SMD = -0.53, p = 0.0004), and stiffness at 6 months (SMD = -0.48, p < 0.0001). No significant improvement in physical function was found in the primary analysis (SMD = -1.07, p = 0.09), but sensitivity analysis excluding one high-risk study showed a modest benefit (SMD = -0.34, p = 0.01). Adverse events were consistent with low-dose MTX use. No study reported folate levels, but folate supplementation is recommended to mitigate MTX-related nutritional risks.
    DISCUSSION: MTX appears to offer symptom relief in OA and may enhance function in select patients. Nutritional monitoring, particularly folate status, should accompany MTX therapy.
    CONCLUSION: MTX shows promise as an adjunct therapy for OA. Larger, long-term trials incorporating nutritional parameters are warranted.
    Keywords:  Disease-modifying agents; joint pain; methotrexate; osteoarthritis.
    DOI:  https://doi.org/10.2174/0115748871406171251115072808
  38. Prague Med Rep. 2026 ;127(1): 3-14
    Comparative Effectiveness of Nonsteroidal Anti-inflammatory Drugs and Glucocorticoids in Managing Postoperative Pain Syndrome.
    Medina Jeenbaeva, Akylbek Shakirov, Ibragim Atabaev, Akylbek Burkanov, Zarema Boronchieva.
      The purpose of this study was to investigate the effectiveness of nonsteroidal anti-inflammatory drugs and glucocorticosteroids in reducing postoperative pain syndrome. For this purpose, information about postoperative pain syndrome was searched in PubMed, ResearchGate, Scopus, Web of Science, and Google Scholar databases for 2016-2024. Depending on the duration, it is classified into acute (up to 3 months) and chronic (3 months or more). Postoperative pain syndrome occurs due to tissue damage, the development of an inflammatory process, and a violation of nerve conduction. Risk factors include severe preoperative pain; mental disorders; anxiety; comorbidities; low income; lack of social support. Effective treatment of postoperative pain syndrome is the main factor for further recovery and a comfortable life of the patient. High-quality anaesthesia helps to cope with pain even at the acute stage and prevents chronicity of the process. Nonsteroidal anti-inflammatory drugs and glucocorticoids in multimodal anaesthesia provide optimal anaesthesia in the postoperative period. They have anti-inflammatory, analgesic, and antiemetic effects. Prevention includes the appointment of preventive multimodal anaesthesia, the selection of minimally invasive surgical access to reduce the area of tissue injury; psychological support of patients at all stages of treatment; the appointment of rehabilitation interventions in the acute period. It was concluded that for adequate anaesthesia of postoperative pain, it is necessary to use nonsteroidal anti-inflammatory drugs and glucocorticoids as part of multimodal anaesthesia, because when used independently, they have an insufficient analgesic effect.
    Keywords:  Analgesics; Interference; Multimodal anaesthesia; Nociceptors; Sensitisation
    DOI:  https://doi.org/10.14712/23362936.2026.1
  39. Cardiovasc Intervent Radiol. 2026 Mar 18.
    Repeated Genicular Artery Embolization Using Permanent Microspheres for Severe Osteoarthritis and Postsurgical Pain.
    A Taheri Amin, A Hübner, L Abu-Gharbieh, E Kemmer, P Krüselmann, F Ziayee, L M Wilms, C B Fink, K Jannusch, P Minko.
       PURPOSE: To investigate reperfusion after genicular artery embolization (GAE) in patients with severe osteoarthritis (OA) or persistent pain after total knee replacement (post-TKR), who did not achieve clinical improvement after initial GAE, and to evaluate the clinical efficacy of repeat GAE (reGAE).
    MATERIALS AND METHODS: This prospective observational study included patients with radiographically severe OA or post-TKR pain. GAE was performed using permanent microspheres. Clinical outcome was assessed at 6 weeks, 3, 6, 9, and 12 months using the numeric rating scale (NRS). Minimal clinically important difference (MCID) was defined as an improvement of at least 2 points compared with baseline. Patients failing to achieve MCID at 6 months underwent reGAE. Angiographic blush size before and after embolization during GAE and reGAE was measured and compared.
    RESULTS: In 55 patients (87 GAEs), a median of 4 (range, 2-6) vessels was treated, with a median total embolic volume of 4.5 mL (1.5-10.1 mL). After initial GAE, 23 patients (42%) achieved MCID. Following reGAE at 6 months, an additional 20 patients (36%) reached MCID, with sustained efficacy up to 6 months after reGAE (p ≤ 0.0001); 12 patients (22%) remained non-responders. Quantitative angiographic analysis demonstrated a significant increase in blush size within previously treated vessels, necessitating reGAE (p ≤ 0.0001).
    CONCLUSION: After GAE using permanent microspheres, reperfusion of previously treated vessels was observed at 6 months in all patients failing to achieve MCID. ReGAE increased the proportion of clinical responders, supporting its role as an effective additive treatment strategy in severe OA and post-TKR pain.
    Keywords:  Double GAE; Embolization; GAE; Genicular Artery Embolization; Repeat-GAE; Reperfusion in GAE; knee OA
    DOI:  https://doi.org/10.1007/s00270-026-04410-w
  40. Hand (N Y). 2026 Mar 16. 15589447261424449
    A 16-Year Longitudinal Study of Long-term Clinical and Radiographic Outcomes in Dorsal Proximal Interphalangeal Joint Fracture-Dislocations.
    Panu H Nordback, Marjut Westman, Eero Waris.
       BACKGROUND: Dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint often lead to stiffness, pain, and post-traumatic osteoarthritis (PTOA). This study evaluated long-term clinical outcomes and radiographic PTOA following surgical treatment of unstable PIP fracture-dislocations.
    METHODS: We conducted a retrospective cohort study of 25 patients (27 fingers) treated with extension block pinning for unstable dorsal PIP fracture-dislocations between 2000 and 2009. Follow-ups in 2010 and 2021 assessed active range of motion (AROM) in PIP and distal interphalangeal (DIP) joints, grip strength, and pain. Postoperative radiographs were analyzed for articular surface involvement and step-off. Post-traumatic osteoarthritis was graded using Kellgren-Lawrence, Kallman, and Osteoarthritis Research Society International scales by 3 blinded hand surgeons, with intraobserver and interobserver reliability assessed.
    RESULTS: Over a follow-up of up to 16 years, PIP AROM remained stable. Patients aged ≥45 had reduced PIP AROM and more frequent pain. Greater pain was also seen in those with >0.5 mm articular step-off or advanced radiographic osteoarthritis (OA). Osteoarthritis progression was associated with reduced PIP AROM and residual step-off. The Kallman scale showed the most significant OA progression, especially with ≥50% joint surface involvement. Osteoarthritis grading showed substantial intraobserver and interobserver reliability.
    CONCLUSION: Long-term function after extension block pinning of dorsal PIP joint fracture-dislocations remained, though age over 45 years and residual step-off predicted reduced AROM, pain, and OA progression.
    Keywords:  finger injury; fracture-dislocation; long-term outcome; post-traumatic osteoarthrosis; proximal interphalangeal joint
    DOI:  https://doi.org/10.1177/15589447261424449
  41. J Hand Surg Am. 2026 Mar 16. pii: S0363-5023(26)00141-3. [Epub ahead of print]
    A Classification of Extra-articular Distal Radius Fractures With Associated Injuries.
    Galal Hegazy, Mahmoud Seddik, Rashed Emam El-Sadek, Tarek Mansour, Elsayed Shaheen, Ibrahem El-Sebaey, Mohammed Alnahas, Mohamed Elhalawany, Abdulhamid Elzoghby, Mohamed Abdelaziz, Ahmed Darweash.
       PURPOSE: To develop a classification system for extra-articular distal radius fractures (DRFs) integrating radiographic parameters of instability, ulnar fractures, distal radioulnar (DRU) joint disruption, and carpal involvement and to evaluate its reliability.
    METHODS: A multicenter study across three university-affiliated orthopedic centers identified 1,239 extra-articular DRFs from 3,784 radiographs. Radiographic features were categorized into four domains: (1) DRF instability (radial inclination <15°, radial height loss ≥5 mm, dorsal angulation >15° in dorsally displaced fractures or volar tilt >15° in volarly displaced fractures, or metaphyseal comminution); (2) distal ulnar fractures (simple vs comminuted); (3) DRU joint disruption (bony vs soft tissue); and (4) carpal involvement. A hierarchical classification system with four types and eight subtypes was developed: Type I (isolated DRFs: IA stable, IB unstable), type II (ulnar fracture: IIA simple, IIB comminuted), type III (DRU joint disruption: IIIA bony, IIIB soft tissue), and type IV (carpal involvement: IVA isolated, IVB with DRU joint disruption). Reliability was assessed using a stratified random sample of 80 cases (10 per subtype) independently reviewed by six trained observers (two per center). Reliability was determined using Cohen's kappa with 95% confidence intervals.
    RESULTS: Reliability testing of the classification system across centers demonstrated mean k values ranging from 0.81 to 0.88 for Type I (IA and IB), Type IIA (simple ulnar), and Type IIIA (bony DRU joint) subtypes and mean k values ranging from 0.75 to 0.79 for Types IIB (comminuted ulnar), IIIB (soft tissue DRU joint), IVA (carpal only), and IVB (carpal + DRU joint).
    CONCLUSIONS: This classification system provides reliable and reproducible classification of extra-articular DRFs with meaningful inter- and intraobserver reliability across all fracture types.
    CLINICAL RELEVANCE: This proposed classification may improve comparability across studies and assist in clinical management and evidence synthesis for extra-articular DRFs.
    Keywords:  Carpus; classification; distal radioulnar joint; distal radius fracture; ulna
    DOI:  https://doi.org/10.1016/j.jhsa.2026.02.009
  42. J Appl Biomech. 2026 Mar 12. 1-6
    The Effect of the Lateral Wedge Insoles on Cumulative Loads and Changes in Physical Activity of Patients With Knee Osteoarthritis.
    Chen Xu, Yosuke Ishii, Goki Kamei, Akinori Nekomoto, Takato Hashizume, Saeko Okamoto, Riko Okinaka, Kexin Zhu, Yoshitaka Iwamoto, Yuko Nakashima, Masakazu Ishikawa, Makoto Takahashi, Nobuo Adachi.
      Knee pain in patients with knee osteoarthritis leads to decreased physical activity. The knee adduction moment impulse is closely related to pain, multiplied by the number of steps per day, reflecting the cumulative knee adductor load (CKAL). The intervention of lateral wedge insole (LWI) can relieve pain by reducing the CKAL, but changes in physical activity have not been investigated. This study aimed to determine the effect of the LWI on the CKAL and changes in physical activity. Twenty-one patients with knee osteoarthritis were enrolled in our study. The knee adduction moment impulse was estimated by a VICON system without LWI (baseline) and with LWI immediately (T0) at the initial visit and 3 months after intervention (T1). An accelerometer was worn for 8 days to monitor daily steps and activity. The physical activity was performed at baseline and T1. Pain was evaluated at baseline, T0, and T1. Pain and CKAL were reduced significantly after the intervention of the LWI. The knee adduction moment impulse at T0 and T1 was reduced compared with the baseline. There was no significant change in daily steps. However, physical activity significantly decreased in terms of the total duration of activity, standing, and periods of standing and walking.
    Keywords:  cumulative knee adductor load; knee adduction moment impulse; knee pain; wearable sensor
    DOI:  https://doi.org/10.1123/jab.2024-0152
  43. J Pain Res. 2026 ;19 590191
    Biopsychosocial Factors Affecting Disability in Individuals with Chronic Nonspecific Low Back Pain: A Cross-Sectional Study.
    İrem Canli, Anıl Özüdoğru.
       Purpose: Chronic nonspecific low back pain (CNLBP) is a multifactorial condition influenced by clinical, physical, and psychological factors and is associated with pain, impaired balance, reduced muscle performance, kinesiophobia, and altered spinal mechanics. This cross-sectional study aimed to identify the clinical, psychological, and physical performance-related factors associated with disability in individuals with CNLBP.
    Patients and Methods: A total of 252 individuals diagnosed with CNLBP were included in the study. Each individual was evaluated using the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), Biodex balance device, Five Times Sit and Stand Test (FTSST), Tampa Kinesiophobia Scale (TKS), Timed Up and Go Test (TUG), goniometric measurement, Beck Depression Inventory (BDI), and spinal mouse. Relationships between variables were examined using multiple linear regression was performed to identify independent predictors of disability.
    Results: Significant correlations were found between ODI and VAS, TKS, BDI, lumbar range of motion values, FTSST, static and dynamic balance values, TUG, and spinal evaluations. In addition, these related parameters explained 81.1% of the variance of ODI score, according to the results of linear regression analysis. In addition, according to the results of linear regression analysis, VAS activity, TKS, FTSST, lumbar extension angle, TUG, spinal posture score, spinal control score, static anteroposterior, and dynamic overall balance score were found to be independent predictors of ODI score. Our study showed that activity pain intensity, kinesiophobia level, lower extremity muscle strength, static anteroposterior and dynamic total balance score, lumbar extension angle, functional status, spinal posture, and spinal control score were predictors of disability level in individuals with CNLBP.
    Conclusion: Activity pain, kinesiophobia, lower extremity strength, lumbar extension, functional status, spinal posture and control, and balance were independent predictors of disability in individuals with CNLBP. These factors should be considered when developing evaluation and treatment programs for CNLBP.
    Keywords:  balance; disability; pain; posture
    DOI:  https://doi.org/10.2147/JPR.S590191
  44. Int Med Case Rep J. 2026 ;19 592408
    Honey Phonophoresis as an Adjunctive Multimodal Intervention in Knee Osteoarthritis: A Case Report.
    Mohamed M Ahmed, Nada Alomairy, Ehab Yones Elbendary, Azza A Al Areefy, Mozdalifah Elnaeem, Abdulraouf Ayoub, Wafaa Mahmoud Amin.
       Purpose: To clarify the clinical, imaging, and laboratory changes after application of honey phonophoresis combined with conventional physiotherapy in a patient with knee osteoarthritis (OA).
    Patients and Methods: A 55-year-old male with Grade II medial knee osteoarthritis presented with chronic pain, morning stiffness, and functional limitations. Baseline assessment included pain intensity, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), musculoskeletal ultrasound (MSK-US) evaluation of medial femoral cartilage thickness, and systemic inflammatory markers. The patient underwent a four-week multimodal physiotherapy program consisting of honey phonophoresis applied to the medial tibiofemoral compartment, transcutaneous electrical nerve stimulation (TENS), and supervised quadriceps strengthening exercises.
    Results: Following the intervention, pain intensity decreased from 8/10 to 4/10, and the total WOMAC score improved from 58/96 to 43/96. MSK-US demonstrated increased medial femoral cartilage thickness on both longitudinal (0.26 to 0.30 cm) and transverse (0.20 to 0.26 cm) posterior views. Systemic inflammatory markers also improved, with C-reactive protein decreasing from 8.08 to 5.2 mg/L and erythrocyte sedimentation rate from 29 to 18 mm/h. No adverse events were observed.
    Conclusion: Integration of honey phonophoresis with conventional physiotherapy in this single case may be associated with improvements in the patient's reported outcomes, cartilage ultrasound assessment, and inflammatory biomarkers in OA. Causal relationships cannot be inferred from a single case due to the uncontrolled, multimodal design; thus, imaging changes should be interpreted cautiously. The findings of this case are exploratory and hypothesis-generating, supporting further investigation through well-designed randomized controlled trials.
    Keywords:  c-reactive protein; cartilage thickness; erythrocyte sedimentation rate; honey phonophoresis; knee osteoarthritis; musculoskeletal ultrasound
    DOI:  https://doi.org/10.2147/IMCRJ.S592408
  45. FP Essent. 2026 Feb;561 14-22
    Musculoskeletal Treatments: Injection Therapies.
    Bradlee Sako, Kana Maeji Carter.
      Musculoskeletal conditions are often managed conservatively, and injection therapies can serve as a diagnostic and therapeutic adjunct in their management. Corticosteroids are commonly injected into joints and soft tissues for their anti-inflammatory properties in pain reduction. Although these injections are widely used, their potential long-term risks, including chondrotoxicity, require careful evaluation of their role in short-term pain relief. Based on current research, hyaluronic acid and prolotherapy may offer pain relief with a potentially lower risk profile compared with corticosteroids, but they are not typically covered by health insurance. Platelet-rich plasma has shown mixed but generally promising results for multiple indications, although its use is limited by out-of-pocket expense. Stem cell therapy remains largely experimental. Compared with landmark-guided techniques, ultrasound guidance offers clinicians increased injection accuracy, safety, and the ability to perform injections that previously required specialty referral.
  46. Spine (Phila Pa 1976). 2026 Mar 20.
    Frailty-Modulated Outcomes After Microscopic Versus Unilateral Biportal Endoscopic Decompression for Degenerative Lumbar Spinal Stenosis Without Instability.
    Basri Pür, Sinan Yılar, İbrahim Dağ, Salih Kaya.
       STUDY DESIGN: Retrospective observational cohort study.
    OBJECTIVE: To compare clinical outcomes and paraspinal muscle preservation between microscopic decompression and unilateral laminotomy for bilateral decompression (ULBD) using unilateral biportal endoscopy (UBE) in degenerative lumbar spinal stenosis (DLSS) without instability, and to assess the influence of frailty.
    SUMMARY OF BACKGROUND DATA: Both microscopic decompression and UBE-assisted ULBD are commonly used for DLSS, but comparative data addressing frailty and muscle preservation are limited.
    METHODS: A total of 180 patients with 1-2 level DLSS without instability were retrospectively analyzed and assigned to microscopic decompression (n=90) or UBE-assisted ULBD (n=90). Frailty was assessed using the modified Frailty Index-11. Outcomes included Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores for back and leg pain, evaluated preoperatively and at 12 months. Clinical success was defined as meaningful improvement in ODI. Paraspinal muscle injury was assessed on MRI by multifidus muscle atrophy and fatty infiltration. Inverse probability of treatment weighting was used for adjustment.
    RESULTS: Both techniques significantly improved ODI and VAS scores at 12 months (P<0.001). ODI improvement and clinical success were higher in the UBE group (92.2% vs. 78.9%; P=0.012). MRI demonstrated less multifidus atrophy and fatty infiltration after UBE. Frailty was negatively associated with functional improvement, with a significant interaction favoring UBE in frailer patients (P=0.018).
    CONCLUSIONS: Both techniques are safe and effective for DLSS without instability. However, UBE-assisted decompression provides superior functional outcomes and better paraspinal muscle preservation, particularly in frail patients.
    Keywords:  degenerative lumbar spinal stenosis; frailty; microscopic decompression; modified frailty index; oswestry disability index; unilateral biportal endoscopy
    DOI:  https://doi.org/10.1097/BRS.0000000000005696
  47. J Belg Soc Radiol. 2026 ;110(1): 27
    MRI Diagnosis of Gymnast's Wrist (Distal Radial Physeal Stress Injury).
    Amal El Madani, Lokmane Taihi.
      Gymnast's wrist is an uncommon stress‑related injury of the distal radial physis caused by repetitive axial loading in skeletally immature athletes. We report the case of a 16‑year‑old elite gymnast presenting with progressive wrist pain without acute trauma. Magnetic resonance imaging demonstrated focal widening of the volar distal radial physis with adjacent metaphyseal and epiphyseal bone marrow edema, consistent with a stress‑related physeal injury. Conservative management with activity modification and physical therapy resulted in symptom resolution. Teaching point: In young athletes with wrist pain, stress‑related physeal injury should be considered, and MRI allows early diagnosis and appropriate management.
    Keywords:  distal radius; gymnast’s wrist; magnetic resonance imaging; overuse injury; physis
    DOI:  https://doi.org/10.5334/jbsr.4212
  48. Am Fam Physician. 2026 Feb;113(2): 128-129
    Nonpharmacologic and Nonsurgical Treatment of Low Back Pain in Adults.
    Jeffrey Leggit, Brayson Pawelczyk.
      
  49. J Aging Phys Act. 2026 03 14. 1
    Erratum. Experiences and Perceptions of Older People With Chronic Low Back Pain After 8 Weeks of a Specific Group-Based Exercise: Qualitative Analysis of the ESCAPE Trial.
    Journal of Aging and Physical Activity
      
    DOI:  https://doi.org/10.1123/japa.2026-0082
  50. Orthop Rev (Pavia). 2026 ;18 158292
    Influence of Synovial Fluid Biochemical Markers on Clinical Outcomes Following Arthroscopic and Non-Arthroscopic Patients with Knee Osteoarthritis.
    Yanuarso, Ditta Kalyani Devi, Keri Lestari, Cynthia Retna Sartika, Karina Kalasuba, Rima Haifa, Lestari Mahardika Urbaningrum.
       Background: Osteoarthritis (OA) is a degenerative joint disorder that causes pain, stiffness, and functional impairment. Conventional treatments relieve symptoms but do not restore cartilage, limiting long-term efficacy. Cell-based therapies, including mesenchymal stem cells (MSCs) and MSC-derived secretome, have emerged as promising strategies for cartilage regeneration.
    Object: This study aimed to assess the therapeutic effects of UC-MSCs and UC-MSC-derived secretome in OA patients through both clinical outcomes and synovial fluid (SF) analyses.
    Methods: Eligible participants were divided into two groups; group who underwent arthroscopy and group who did not. All the participants received an intra-articular injection consisting of an initial 2 mL dose of UC-MSC secretome, followed by 10 million UC-MSCs, and two additional 2 mL doses of secretome administered biweekly. Synovial fluid samples were collected at baseline and 12 weeks post-treatment, centrifuged to obtain the supernatant, and analyzed for inflammatory cytokines and matrix-degrading markers using multiplex and ELISA assays. Clinical evaluations were conducted at 6- and 12-months post-treatment.
    Result: The results showed that UC-MSC therapy significantly improved functional outcomes in patients with knee osteoarthritis, as indicated by WOMAC scores up to six months. In vitro studies showed similar results, where co-culture of osteoarthritic synovial fluid-derived MSCs with UC-MSCs or UC-MSC secretome enhanced proliferation and differentiation while rapidly reducing pro-inflammatory cytokines (IL-1β, IFN-γ, IL-6, IL-12p70, IL-17A, IL-18) and MMPs (MMP1, MMP7, MMP13).
    Conclusion: Our findings support a two-stage therapeutic strategy in which UC-MSC secretome first alleviates inflammation, followed by UC-MSCs to promote cartilage regeneration. Post-injection rehabilitation or repeated MSC dosing may further enhance treatment efficacy, highlighting the potential of MSC-based therapies for knee OA management.
    Keywords:  : mesenchymal stem cell; biomarkers; inflammation; knee osteoarthritis; secretome; synovial fluid
    DOI:  https://doi.org/10.52965/001c.158292
  51. BMC Sports Sci Med Rehabil. 2026 Mar 17.
    PRICE (Protection, Rest, Ice, Compression, Elevation) vs. PEACE and LOVE (Protection, Elevation, Avoid anti-inflammatories, Compression, Education and Load, Optimism, Vascularization, Exercise) in adolescent lateral ankle sprain rehabilitation: a randomized prospective comparative study of muscle strength and dynamic balance.
    Matas Meškauskas, Saulius Rutkauskas, Miglė Misiūnienė, Juozas Žumbakys, Jūratė Tomkevičiūtė, Dalius Malcius, Emilis Čekanauskas.
      
    Keywords:  Acute lateral ankle ligament injury; Ankle instability; Biodex; Lateral ankle sprain; PEACE and LOVE; PRICE; Y balance test
    DOI:  https://doi.org/10.1186/s13102-026-01651-7
  52. J Am Med Dir Assoc. 2026 Mar 12. pii: S1525-8610(26)00054-X. [Epub ahead of print] 106164
    Effects of Dance Interventions on Physical Function in Healthy Older Adults: A Systematic Review and 3-Level Meta-Analysis.
    Jiamin Du, Junchen Wu, Zhijie Yan, Longqi Yu.
       BACKGROUND: As global population aging accelerates, maintaining physical function in older adults has emerged as a core public health challenge. Dance, a multimodal physical activity integrating cognitive challenges and social interaction, has been proven effective in improving health in older age. However, existing evidence is largely confined to validating efficacy, often plagued by selective outcome reporting, and lacks evidence-based consensus regarding optimal intervention protocols.
    OBJECTIVE: This study aimed to (1) systematically evaluate the effects of dance interventions on physical function in healthy older adults, (2) provide in-depth insight into the moderating effects of participant characteristics and intervention prescription parameters (eg, session duration, intervention period, frequency) and potential dose-response relationships, and (3) offer evidence-based grounds and practical recommendations for public health policymakers and community health instructors in developing health promotion programs for older adults.
    METHODS: PubMed, Web of Science, and EBSCO databases were searched up to November 10, 2025. In accordance with PICO principles, randomized controlled trials and quasi-experimental studies were included if they involved healthy adults older than 60 years (P), implemented dance interventions (I), compared them against any control group (C), and reported outcomes within the International Classification of Functioning, Disability and Health (ICF) framework (O). Literature screening and data extraction were conducted independently by 2 reviewers. Methodological quality was assessed using the Cochrane RoB 2.0 tool and PEDro scale, and evidence certainty was evaluated via the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. A 3-level random-effects model was employed to handle the dependency of effect sizes, with Hedges' $g$ selected as the effect index, followed by robustness checks. In addition, moderator analyses and meta-regression were conducted to explore potential influencing factors, combined with funnel plots and a modified Egger's test to assess publication bias.
    RESULTS: Twenty-four studies (1112 participants; 237 effect sizes) were ultimately included. These studies exhibited publication bias and low certainty of evidence. The 3-level meta-analysis indicated that dance interventions yielded significant medium-to-large improvements in physical function (Hedges' g = 0.635, P < .001), demonstrating effectiveness in both "body function" and "activities and participation" domains. Moderator analysis revealed that community-dwelling older adults derived significantly greater benefits compared with nursing home residents, and an 8-week intervention was sufficient to produce significant, cost-effective improvements. Meta-regression identified significant nonlinear relationships: (1) age followed an "inverted U-shaped" trend, with intervention effects peaking in the 70-75 age group; and (2) session duration peaked at approximately 20 minutes, with effect sizes declining beyond this threshold.
    CONCLUSIONS: Dance serves as an effective nonpharmacological strategy for promoting healthy aging. Based on current evidence, public health policymakers should prioritize resource allocation toward the 70- to 75-year-old community-dwelling population. Regarding dance prescription design, we advocate for an 8-week baseline cycle to generate significant benefits and highlight the potential value of short-duration models (∼20 minutes) in enhancing adherence and improving function. However, given that this single-session duration falls below traditional exercise physiology recommendations, future research must further elucidate the optimal "dose-response" mechanism of dance; until its biological plausibility is established, generalizing this specific duration as a standard should be approached with caution.
    Keywords:  Dance intervention; meta-analysis; older adults; physical function
    DOI:  https://doi.org/10.1016/j.jamda.2026.106164
  53. BMJ Case Rep. 2026 Mar 19. pii: e269687. [Epub ahead of print]19(3):
    Long-term relief of CRPS-associated limb dystonia with ketamine infusion.
    Abdulrahman AlZahrani, Danielle Weber-Adrian, May C Ong.
      Complex regional pain syndrome (CRPS) with associated dystonia is a severely debilitating condition often refractory to conventional management. We present a case report of three patients with chronic, treatment-refractory CRPS-related limb dystonia. Patients were treated with multiday intravenous ketamine infusions (target dose 30 mg/hour) every 3-6 months, supplemented with oral ketamine troches. This treatment protocol resulted in the complete resolution of dystonia in two patients and significant functional improvement in the third. The treatment was well-tolerated, with transient and manageable adverse events including nausea and hypertension. While these findings are limited due to the small sample size and lack of randomisation, this case report presents a potentially promising therapeutic approach for the treatment of CRPS-related motor complications in carefully selected patients with appropriate monitoring.
    Keywords:  Drugs: CNS (not psychiatric); Movement disorders (other than Parkinsons); Pain
    DOI:  https://doi.org/10.1136/bcr-2025-269687
  54. Zhongguo Zhen Jiu. 2026 Mar 12. 46(3): 321-327
    [Effect assessment of acupotomy on myofascial pain syndrome of trapezius muscle based on portable shear wave elastography].
    Yi Rao, Jian Zhao, Long Bao, Yuntu Wu, Ping Li, Xingli Zhao, Meichi Jiang, Jing Xiao.
       Objective: To provide the evidence for quantitative assessment of clinical diagnosis of myofascial pain syndrome (MPS) of trapezius muscle and the therapeutic effect of acupotomy, utilizing portable shear wave elastography (SWE).
    Methods: A total of 49 subjects (including 21 cases of unilateral trapezius MPS, 20 cases of bilateral trapezius MPS and 8 healthy subjects) were recruited, including 98 trapezius samples. According to whether pain occurred or not, they were divided into an observation group (61 samples) and a control group (37 samples). The cases in the observation group were subdivided into an observation subgroup 1 (14 samples) and an observation subgroup 2 (47 samples) based on whether acupotomy was received. In the observation subgroup 1, under ultrasound guidance, only 1 intervention with acupotomy was performed to release the deep and superficial fascia layers of the trapezius muscle. In the observation subgroup 2 and the control group, no treatment was delivered. Before treatment, the shear modulus (G-value) and the score of visual analogue scale (VAS) were compared between the observation group and the control group, and the receiver operating characteristic (ROC) curve was plotted to determine the optimal diagnostic threshold of trapezius MPS. The G-value and VAS score were compared before and after treatment in the observation subgroup 1, and the therapeutic effect of acupotomy was assessed.
    Results: The G-value and VAS score in the observation group were higher than those in the control group (P<0.05) before treatment. For the diagnosis of trapezius MPS, the optimal diagnostic threshold of G-value was 9.08 kPa, yielding a specificity of 83.78% and a sensitivity of 75.41%. In the observation subgroup 1, both G-value and VAS score decreased after treatment in comparison with those before treatment (P<0.05).
    Conclusion: Acupotomy may improve the elasticity of the trapezius muscle and obtain the immediate therapeutic effect on trapezius MPS in patients. The portable SWE holds the promise for the objective evaluation of clinical diagnosis and therapeutic effect on trapezius MPS.
    Keywords:  acupotomy treatment; myofascial pain syndrome; portable shear wave elastography; quantitative assessment of pain; trapezius muscle
    DOI:  https://doi.org/10.13703/j.0255-2930.20241219-k0003
  55. Musculoskelet Sci Pract. 2026 Mar 18. pii: S2468-7812(26)00064-0. [Epub ahead of print]83 103548
    Evaluation of temporomandibular joint and masticatory muscles in fibromyalgia: A cross-sectional ultrasonographic study.
    Ömer Kuzu, Merve Çakır, Furkan Çakır, Ayşe Merve Ata, Berke Aras.
       OBJECTIVE: Temporomandibular joint (TMJ) and masticatory muscles, which are likely to be affected in patients with fibromyalgia (FM), have not been objectively evaluated together previously. The aim of this study was to compare sonographic measurements of TMJ and masticatory muscle thickness between FM patients and healthy controls, and to evaluate the relationship between these parameters and clinical features.
    METHODS: The study included 38 patients with FM and 38 healthy controls. The thickness of the masticatory muscles (masseter and temporalis) and TMJ disc space were evaluated bilaterally using ultrasonography, and the mean values of both sides were used for analysis. The severity of FM was assessed using the Fibromyalgia Impact Questionnaire (FIQ), anxiety with the Beck Anxiety Inventory, depression with the Beck Depression Inventory, sleep quality with the Pittsburgh Sleep Quality Index, and the presence and severity of temporomandibular disorder with the Fonseca Anamnestic Index.
    RESULTS: Both at rest and during maximal jaw clenching, the mean sonographic thickness of the masseter and temporalis muscles was significantly thicker in the FM group compared to the control group (all p < 0.05). The mean sonographic thickness of the closed-mouth TMJ disc space was also significantly thicker in the FM group (p < 0.05). In addition, there was a positive correlation between the masseter muscle thickness at rest and FIQ.
    CONCLUSION: This study showed that the masticatory muscles and TMJ disc space of patients with FM were thicker compared to healthy controls, and increased masseter muscle thickness was associated with poorer quality of life.
    Keywords:  Fibromyalgia; Masticatory muscle thickness; Temporomandibular joint; Ultrasonography
    DOI:  https://doi.org/10.1016/j.msksp.2026.103548
  56. Cureus. 2026 Feb;18(2): e103658
    Self-Inflicted Wrist Injuries in Flexor Tendon Zone V: Clinical Patterns, Management Strategies, and Outcomes.
    María F Hernández Pérez, Andrea Navalón Calzada, Aarón Gonzalez Espinosa, Alfonso Sandoval Polito, Colin A Ramirez Díaz, Emilio Mondragón Rosas, Dulce M Luquin López, Edson O Romero Cázares, José Emiliano González Flores.
      Self-inflicted wrist injuries, particularly those involving flexor tendon zone V, constitute a distinct and clinically challenging subset of upper-extremity trauma with profound surgical, functional, and psychosocial implications. For every suicide, many involve wrist lacerations capable of compromising tendinous, neural, and vascular structures and resulting in long-term disability. Despite their clinical relevance, the literature remains fragmented, with no universally accepted definition of "spaghetti wrist," a term originally described in early surgical series of extensive volar wrist lacerations, and no standardized management framework. This narrative review critically synthesizes current evidence on epidemiology, injury mechanisms, classification systems, clinical assessment, management strategies, rehabilitation, complications, and outcomes. PubMed/MEDLINE, Scopus, and Google Scholar were searched for English- and Spanish-language studies published between January 2005 and January 2025, including cohort studies, case series, case reports, and reviews addressing self-inflicted injuries involving flexor tendon zone V. Extracted variables encompassed epidemiologic patterns, injury characteristics, classification systems, including the Verdan flexor tendon zone framework and heterogeneous "spaghetti wrist" definitions, diagnostic and outcome assessment tools, surgical and non-surgical management, rehabilitation protocols, and functional recovery. Findings were synthesized qualitatively to identify recurring patterns, areas of consensus, and persistent knowledge gaps. Available evidence indicates that these injuries predominantly affect young adults, frequently men, with a high prevalence of psychiatric comorbidity. Injury patterns characteristically involve the dominant hand acting upon the non-dominant wrist and demonstrate extensive multistructural compromise. Flexor tendons are almost universally injured, while neurovascular involvement varies but serves as the principal determinant of long-term functional prognosis. Substantial heterogeneity in reported outcomes reflects inconsistencies in injury definitions, surgical techniques, rehabilitation strategies, and evaluative metrics. Psychiatric factors further influence recurrence risk, adherence to therapy, and return-to-work trajectories. Self-inflicted flexor tendon zone V injuries, therefore, represent a complex and heterogeneous clinical entity. Although advances in microsurgical repair and structured rehabilitation have improved functional recovery, prognosis remains guarded in the presence of neurovascular damage. Standardized definitions, validated outcome measures, and integrated multidisciplinary care, encompassing surgical, rehabilitative, and psychiatric domains, are essential to enhance interstudy comparability and optimize patient-centered outcomes.
    Keywords:  flexor tendon injury; functional outcomes; hand trauma; neurovascular repair; patient-reported outcomes; rehabilitation protocols; self-inflicted wrist injury; spaghetti wrist; suicide attempt; zone v laceration
    DOI:  https://doi.org/10.7759/cureus.103658
  57. Arthroscopy. 2026 Jan;42(1): 151-152
    Editorial Commentary: Periportal Capsulotomies Create Significant Axial Distraction in Hip Arthroscopy and Should be Repaired in Certain Hip Phenotypes.
    Vehniah K Tjong.
      Strategies to minimize damage to the iliofemoral ligament in hip arthroscopy for the treatment of femoroacetabular impingement syndrome have spawned increased curiosity among sports surgeons. Gone are the days when a large T-type capsulotomy or even capsulectomy is performed without some closure. Consensus to repair interportal capsulotomies seems strong. Under scrutiny now is whether the same rules apply to smaller periportal capsulotomies. If we continue to abide by our principles to respect anatomy and restore biomechanical properties, then capsular preservation should be upheld, especially in patients who need it the most.
    DOI:  https://doi.org/10.1002/arj.70035
  58. Arthroscopy. 2026 Jan;42(1): 273-292
    Conservative Treatments May Show No Significant Differences for Partial-Thickness Rotator Cuff Tears: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials.
    Gaoming Liu, Yuming Yao, Chunwu Zhang, Xu Liu, Shengwu Yang, Jingyue Su, Yusheng Li, Wenfeng Xiao, Zhenhan Deng.
       PURPOSE: To evaluate pain relief, functional recovery, and tear size progression following different conservative treatments for partial-thickness rotator cuff tears.
    METHODS: This study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Data sources including PubMed, the Cochrane Library, Embase, Scopus, and Web of Science were searched from January 1, 2005, to December 30, 2024. The search strategy employs the terms (rotator cuff AND (tear OR injury)) AND (partial OR incomplete). Only randomized controlled trials investigating conservative treatments specifically for partial-thickness rotator cuff tears are included. The revised Cochrane risk-of-bias tool for randomized controlled trials (RoB 2) was utilized to assess the methodological quality.
    RESULTS: Sixteen studies were included in the network meta-analysis. The network meta-analysis results comprised mean improvements in Visual Analog Scale, American Shoulder and Elbow Surgeons score, and Constant-Murley score at various follow-up time points. Platelet-rich plasma (PRP) was the most frequently reported conservative treatment, followed by steroids, sodium hyaluronate, and normal saline. When compared with normal saline, other conservative treatments showed no statistically significant differences in mean improvements across the three scoring systems at different follow-up periods. Subgroup analysis restricted to Level I randomized controlled trials or subacromial injection studies yielded similar network meta-analysis results. Both rank probability plots and cumulative probability rankings consistently identified the combination of PRP and sodium hyaluronate as the highest-ranked treatment. The results regarding tear size could not be pooled for analysis due to substantial heterogeneity across studies, although PRP appeared to show a potential for promoting tear healing.
    CONCLUSIONS: PRP represents the most frequently reported conservative treatment for partial-thickness rotator cuff tears. Compared with normal saline, none of the conservative therapies show statistically significant improvements in pain relief or functional recovery across all follow-up periods.
    LEVEL OF EVIDENCE: Level II, systematic review and network meta-analysis of Level I and II randomized controlled trials.
    DOI:  https://doi.org/10.1002/arj.70022
  59. J Hand Surg Am. 2026 Mar 20. pii: S0363-5023(26)00120-6. [Epub ahead of print]
    Thumb Fractures and Associated Injuries: An Evidence Based Review to Guide Treatment.
    Brian W Yang, Robin N Kamal, Lauren M Shapiro.
      Fractures of the thumb encompass a diverse spectrum of injury patterns, each requiring nuanced consideration of various treatment strategies. Associated conditions include injuries to the ulnar collateral ligament and radial collateral ligament of the metacarpophalangeal joint, which can significantly impact thumb stability and function. Although extra-articular fractures of the thumb metacarpal and phalanges are more tolerant of residual deformity due to compensatory movement of the carpometacarpal joint, intra-articular fractures, including Bennett and Rolando fractures, often benefit from surgical intervention to restore articular congruity. This review provides an updated analysis of the treatment and fixation options for thumb fractures and associated ligamentous injuries.
    Keywords:  Bennett fracture; RCL; Rolando fracture; UCL; metacarpal; phalanx; thumb fracture
    DOI:  https://doi.org/10.1016/j.jhsa.2026.02.001
  60. Orthop Clin North Am. 2026 Apr;pii: S0030-5898(25)00159-2. [Epub ahead of print]57(2): 123-130
    Treatment of Operative Acetabular Fractures in an Aging Population: Fixation versus Acute Arthroplasty versus Delayed Arthroplasty.
    Rock Hwang.
      Posttraumatic osteoarthritis is one of the most common complications following open reduction and internal fixation of acetabular fractures. Total hip arthroplasty is a well-accepted option for posttraumatic arthritis in the setting of previously treated acetabular fractures. However, the incidence of acetabular fractures continues to increase in the aging population. This poses challenges including osteoporosis and the emphasis on early mobilization. Questions remain regarding the major differences in outcomes of delayed total hip arthroplasty versus acute "fix-and-replace." This review aims to compare outcomes between these treatment algorithms for displaced acetabular fractures.
    Keywords:  Acetabular fracture; Osteoarthritis; Pelvic fracture; Total hip arthroplasty; Trauma
    DOI:  https://doi.org/10.1016/j.ocl.2025.12.003
  61. Hand Surg Rehabil. 2026 Mar 14. pii: S2468-1229(26)00077-0. [Epub ahead of print] 102640
    Less is More in Acute Perilunate Injuries? Early Success with Arthroscopic-Assisted Fixation of the Proximal Row Without Ligament Repair.
    Jonathan Persitz, Anne Doi, Sam Keshen, Andrea Chan, Norah Matthies, Ryan Paul.
       PURPOSE: To evaluate the short-term safety and clinical effectiveness of arthroscopic-assisted reduction with percutaneous proximal-row stabilization performed without intrinsic ligament repair for acute perilunate injuries.
    METHODS: Patients with acute, isolated perilunate injuries treated by a single surgeon between 2021 and 2025 were prospectively enrolled. All underwent arthroscopic-assisted reduction and percutaneous proximal-row stabilization without intrinsic ligament repair. Clinical evaluation included objective functional assessment and patient-reported outcome measures. Radiographic analysis included measurement of the scapholunate interval, scapholunate, radiolunate and radioscaphoid angles, dorsal scaphoid translation, fracture union, and presence of degenerative changes.
    RESULTS: Ten male patients (36 ± 14 years) were treated at a mean of 5 ± 3 days post-injury; 40% presented with median neuropathy. Eight injuries were Mayfield stage III and two stage IV, with five fracture-dislocation patterns. At a mean 14-month follow-up, patients demonstrated favorable early outcomes (Disabilities of the Arm, Shoulder and Hand score 7 ± 10, Modified Mayo Wrist Score 89 ± 7, Patient-Rated Wrist Evaluation 14.6 ± 15.1, and Visual Analog Scale pain score 0.4 ± 1), near-symmetric motion and grip strength, and maintained radiographic alignment (mean scapholunate gap 2.3 ± 0.8 mm). All fractures united, there were no post-operative complications, and all manual laborers returned to unrestricted work at 28 ± 16 weeks.
    CONCLUSION: Arthroscopic-assisted reduction and percutaneous proximal-row fixation without ligament repair appears feasible and safe, yielding excellent short-term functional and radiographic outcomes with minimal morbidity. Larger studies with longer follow-up are needed to determine long-term durability.
    PROSPECTIVE CASE SERIES: Level IV.
    Keywords:  Arthroscopy; Carpus; Fixation; Ligament; Perilunate
    DOI:  https://doi.org/10.1016/j.hansur.2026.102640
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