bims-ricfun Biomed News
on Rehabilitation ICF
Issue of 2026–03–29
95 papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica
  1. Behind the Veil: uncovering the cause of saphenous nerve entrapment.
  2. Autologous platelet-rich plasma versus hyaluronic acid, corticosteroids or saline for knee osteoarthritis: can blood draw volume serve as a proxy for platelet dose? A systematic review and meta-analysis.
  3. Commonalities in rehabilitation data across diverse health conditions: a comparison of seven large European databases.
  4. Efficacy and safety of intra-articular mesenchymal stem cell-based therapies in knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials.
  5. A Narrative Review of Perioperative Peripheral Nerve Injuries After Major Surgery: Clinical Recognition, Electrodiagnostic Evaluation, and Rehabilitation Implications.
  6. Frequency of Aerobic Exercise and Association with Pain and Function in Older Adults with Knee Osteoarthritis: A Cross-Sectional Study.
  7. Whole-Body Cryostimulation in Complex Regional Pain Syndrome: A Case Study.
  8. Clinical outcomes of isolated ulnar shortening osteotomy for ulnar impaction syndrome with concomitant distal radioulnar joint instability.
  9. ICF rehabilitation set responsiveness after total knee arthroplasty: a retrospective study.
  10. Eccentric exercise therapy for medial epicondylitis: A systematic review of clinical outcomes.
  11. Impact of Physiotherapy Intervention on Pain, Quality of Life, and Function in Low Back Pain Associated With Piriformis Syndrome: Protocol for Systematic Review.
  12. A Novel Measurement of Altered Achilles Subtendon Load Sharing 6-12 Months Following Rupture.
  13. Return-to-Work After Carpal Tunnel Release Across Surgical Techniques: A Narrative Review.
  14. Innovative Management of Spastic Shoulder Contractures: A Retrospective Cohort Analysis of Combined Percutaneous Cryoneurolysis and Tenotomy.
  15. Limitations of Single-Time-Point Assessments in Carpal Tunnel Neuropathic Pain Studies.
  16. Comparative Effectiveness of Ultrasound Guided Ozone (O2-O3) and Corticosteroid Injections for Sacroiliac Joint Dysfunction: A Multicenter Clinical Trial.
  17. Post-discharge outcome measurement tools in occupational therapy for people with acquired brain injury in Japan: a scoping review.
  18. Preoperative tests before cubital tunnel decompression in 2025.
  19. Knee Osteoarthritis (KOA) Severity Influences Proximal Femoral Biomechanics and Predicts Pertrochanteric Fracture Instability: A Retrospective Radiographic Study.
  20. Lumbar radiofrequency ablation for lumbar facet joint pain.
  21. Therapeutic dissociation of CGRP-targeted treatments in migraine and complex regional pain syndrome.
  22. Culturally Tailored Rehabilitation Approach "After zone III Flexor Tendon Tenolysis in the Index and Middle Fingers: A Case Report.
  23. Rock, paper, scissors: Resolving the conflicting results of randomized trials involving corticosteroid, platelet rich plasma (PRP) and placebo injections.
  24. A review of research progress of mirror therapy in peripheral nerve injury.
  25. Can hip extensor strength influence the knee osteoarthritis severity? A cross-sectional analysis.
  26. Botulinum Toxin Treatment of Stiff Person Syndrome-A Critical Review and Update.
  27. A Prospective Randomized Study Comparing Glenohumeral and Subacromial Corticosteroid Injections in the Management of Primary Frozen Shoulder.
  28. Restoration of Muscle Function Following Distal Biceps Tendon Reinsertion: A Narrative Review.
  29. Neurofunctional Assessments in Lumbar Spondylosis: Outcomes After Rehabilitation Treatment.
  30. The efficacy and safety of platelet rich plasma and hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis.
  31. MRI Assessment of Median Nerve Size in Patients with Proximate Electrodiagnostic Studies.
  32. Outcomes after Acute Perilunate Injuries: A Single-Center Experience Over 30 Years.
  33. A Pilot Study Investigating Clinical and Functional Outcomes of Novel Double-Coil rPMS in Knee Osteoarthritis.
  34. Efficacy of Intra-articular Platelet-Rich Fibrin Injection for Periarthritis of the Shoulder: A Pilot Study.
  35. Optimizing the Interventional Management of Meralgia Paresthetica: From Scythe to Scepter.
  36. Intradiscal Procedures for Discogenic Low Back Pain: Considerations and Implications - A Narrative Review.
  37. Comparison of CT-guided platelet-rich plasma versus steroid/anesthetic injection for treatment of sacroiliac joint pain: a randomized, single-blinded, controlled trial.
  38. HipE Study-Hip Embolization for Pain Control in Hip Osteoarthritis and Greater Trochanteric Pain Syndrome: 12 Months Follow-Up.
  39. TFCC Foveal Reconstruction for Chronic DRUJ Instability Using a Single Limb Tendon Graft Technique: A Minimum 32-month Follow-up Study.
  40. Atypical Fusions Radioscapholunate/Lunotriquetral: Open vs Arthroscopic.
  41. Driving Safety After Hip Injections: Brake Response Times.
  42. [Ultrasound-Guided Injection of the Thoracolumbar Fascia in the Treatment of Low Back Pain: Methodological Approach and Anatomical Study].
  43. Conservative Management of Acute Anterior Cruciate Ligament Rupture in Recreational Athletes: A Pilot Case Series.
  44. Does Platelet-Rich Plasma Speed Recovery After Acute Lateral Ankle Sprain? A Prospective Comparative Study Among Athletes.
  45. Elbow Varus posteromedial rotatory instability: Reflections from a multidimensional perspective.
  46. Genicular Artery Embolization for Knee Osteoarthritis: Do Degradable Starch Microspheres Offer a New Therapeutic Option?
  47. Balneotherapy and Manual Therapy of Key Myofascial Trigger Points as Therapeutic Integration for COPD Associated with Myofascial Pain Syndrome: A Case Series.
  48. Congenital Genu Recurvatum: Report of Two Cases.
  49. Acute Calcific Periarthritis Beyond the Shoulder: A Case Report of Fifth MCP Involvement.
  50. Bertolotti joint-related cyst: illustrative case.
  51. Platelet-rich plasma for treatment of knee osteoarthritis: a narrative review.
  52. Ultrasound-guided intra-muscular botulinum toxin A in athletes with chronic adductor-related groin-pain: A retrospective observational study.
  53. Intradiscal platelet-rich plasma for discogenic low back pain: a prospective cohort study of early clinical outcomes and quantitative MRI findings.
  54. Effect of the Center Bridge-Type Knee Orthosis on the External Knee Adduction Moment During Gait in Patients with Knee Osteoarthritis.
  55. Clinical and Metabolic Predictors of Response to Focused Extracorporeal Shockwave Therapy in Rotator Cuff Tendinopathy: A Retrospective Cohort Study.
  56. Peripheral Nerve Ultrasound Findings in Leprosy: A Scoping Review of Echogenicity, Cross-Sectional Area, and Vascularization Across 15 Studies.
  57. Comparative Analysis of the Effects of Functional Magnetic Stimulation and Interferential Current on Pain Control in Patients With Knee Osteoarthritis.
  58. Hip Arthroscopy in Patients With Acetabular Dysplasia: A Systematic Review of Clinical Outcomes at Long-term Follow-up.
  59. Sex and Gender in Chronic Obstructive Pulmonary Disease: Does It Matter?
  60. Impact of therapeutic exercises on pain-related outcomes in patients with knee osteoarthritis: an umbrella review of 116 systematic reviews.
  61. What is the prevalence of extra-articular and intra-articular magnetic resonance imaging findings in football players with and without hip and/or groin pain? A cross-sectional study of 166 football players.
  62. Addition of immersive virtual reality-mediated programs with conventional physiotherapy on quality of life in knee osteoarthritis - A protocol of a randomized controlled trial.
  63. Prediction of Inpatient Rehabilitation Length, Discharge Destination and Home-Care Needs After Total Hip and Knee Arthroplasty for Osteoarthritis: A Follow-Up Study on 1.679 Patients.
  64. Radiofrequency ablation for the treatment of chronic pain after knee arthroplasty: protocol for a randomized, double-blind study.
  65. Hand injuries associated with mobile phone use: A systematic review.
  66. Strengthening and Targeted Rehabilitation for Optimal Neuromuscular Gains for chronic BACK pain (STRONG-BACK): protocol for a randomised controlled trial in participants with primary nociceptive pain drivers.
  67. Effectiveness of kinesio tape in people with low back pain. A systematic review with meta-analysis.
  68. The effectiveness of respiratory training as a preventive strategy against cognitive decline: a mini review.
  69. Is Swimming the Most Complete Sport? A Multidimensional Reappraisal.
  70. Serum Sickness After Cosmetic Botulinum Toxin Type A Injections.
  71. Efficacy of Sling Exercise Training Compared to Standard Physiotherapy to Improve Muscle Strength, Joint Range of Motion and Functional Outcomes Following Total Knee Arthroplasty: A Pilot Randomized Controlled Trial.
  72. Effectiveness of high-voltage radiofrequency on suprascapular nerve for the treatment of chronic shoulder pain.
  73. The Effect of a Novel Achilles Brace on Concentric and Eccentric Achilles Tendon Loading During Tendon Tear Mechanisms.
  74. The Prevalence of Focal Carpal Chondromalacia Concurrent With Chronic Dynamic Scapholunate Instability.
  75. Smartphone-derived joint angular velocities in sit-to-stand motion provide a spatiotemporal marker for symptomatic knee osteoarthritis.
  76. Critically appraised papers: Adding a very-low-calorie weight loss diet to exercise does not improve pain in people with hip osteoarthritis compared with exercise alone [commentary].
  77. Shoulder muscle synergies before and after reverse total shoulder arthroplasty.
  78. Efficacy and safety of non-invasive brain stimulation for chronic low back pain: a systematic review and meta-analysis of randomised controlled trials.
  79. Policy Implications of Placebo Bandage for Carpal Tunnel Syndrome.
  80. Neurophysiological Mechanisms of Neuropathic Pain and Their Clinical Implications: A Primer for the Peripheral Nerve Surgeon.
  81. Macro- and Micro-Morphological Properties of the Rotator Cuff Structures in the Chronic Stage of Tendinopathy in Para Swimmers.
  82. Clinical value of biomechanics and magnetic resonance imaging in the evaluation of knee osteoarthritis.
  83. Therapeutic Role of Concentrated Growth Factors in the Management of Chronic Heel Tendinopathies: A Prospective Interventional Study.
  84. Mechanical equilibrium of the ankle joint: Implications for Achilles tendon injury.
  85. Impact of 8-Week Pilates Program on Lumbar Flexion-Relaxation Dynamics and Functional Outcomes in Women with Chronic Low Back Pain.
  86. A Narrative Review of Shockwave Therapy in Plantar Fasciitis.
  87. A comprehensive descriptive analysis of hip and knee radiographic osteoarthritis in the UK Biobank in relation to joint pain, joint site interrelationships, obesity, race and deprivation: Findings from 59,475 individuals.
  88. Ultrasound-Guided Atelocollagen Injection for Chronic Pain After Spinal Surgery: A Retrospective Cohort Study.
  89. Critically appraised paper: In adults with burns, adding inspiratory muscle training to pulmonary rehabilitation increased respiratory muscle strength, pulmonary function and functional capacity [commentary].
  90. Peripheral nerve enlargement in patients with diabetic sensorimotor polyneuropathy: A systematic review and meta-analysis.
  91. Effect of Variable Priority Cognitive-Motor Dual-Task Training on Cognitive and Physical Function in Older Adults: A Systematic Review.
  92. Mobilization with movement enhances early rehabilitation outcomes in knee osteoarthritis: a six-week randomized controlled trial.
  93. Editorial Commentary: Balancing Pain Relief and Function With Iliopsoas Tendon Treatment and Concomitant Hip Arthroscopy for the Internal Snapping Hip.
  94. Effects of 3 Cycles of Progressively Higher Doses of botulinum Toxin on Sagittal Kinematic Gait Parameters in People with Multifocal Spasticity After Stroke: A Prospective Cohort Study.
  95. Does Guidance Technique Influence Success? A Double-Blind Randomized Controlled Trial Comparing the Precision and Efficacy of Image-Guided and Palpation-Guided PRP Therapy for TMJ Disorders.
  1. Acta Neurol Belg. 2026 Mar 21.
    Behind the Veil: uncovering the cause of saphenous nerve entrapment.
    Hilmi Berkan Abacıoğlu, Ahmet Furkan Çolak, Berkay Yalçınkaya, Büşra Çulha, Alpaslan Fatih Kaynar, Murat Kara.
      
    Keywords:  Injection; Neuropathy; Peripheral nerve; Ultrasound
    DOI:  https://doi.org/10.1007/s13760-026-03035-7
  2. Int Orthop. 2026 Mar 21.
    Autologous platelet-rich plasma versus hyaluronic acid, corticosteroids or saline for knee osteoarthritis: can blood draw volume serve as a proxy for platelet dose? A systematic review and meta-analysis.
    Christopher J Centeno, Dustin R Berger, Andrew J Pelle, Ehren Dodson, Philippe Hernigou, Matthew B Murphy.
       PURPOSE: To compare platelet-rich plasma (PRP) with hyaluronic acid (HA), corticosteroid (CS), or saline placebo (NS) for symptomatic knee osteoarthritis (OA) and to assess whether total blood-draw volume, a proxy for platelet dose, is associated with treatment effect.
    METHODS: Following PRISMA, randomized controlled trials comparing intra-articular PRP with HA, CS, or NS were identified. Random-effects meta-analyses estimated mean differences (MDs) in pain (VAS) and function (WOMAC) at six and twelve months. Risk of bias was assessed with RoB 2.0 and certainty of evidence with GRADE. Subgroup analyses stratified PRP vs HA trials by total blood draw volume (< 40 mL vs ≥ 40 mL).
    RESULTS: Sixty-two trials (n = 4,969) were included. PRP improved VAS and WOMAC versus HA, CS, and NS at six months and remained superior versus HA and CS at twelve months (insufficient studies for twelve-month PRP vs NS). In PRP vs HA trials, blood draw volume ≥ 40 mL was associated with larger improvements in six-month WOMAC (P = 0.004) and twelve-month VAS (P = 0.029). Heterogeneity was substantial (I2 > 90% for most analyses), and evidence certainty ranged from moderate to very low.
    CONCLUSION: PRP provides superior patient-reported pain and function outcomes compared with HA, CS, and NS through six months, with benefits maintained to twelve months versus HA and CS in longer-term trials. Blood-draw volume may be a useful alternate when platelet dose is unreported.
    Keywords:  Blood volume; Knee osteoarthritis; Meta-analysis; Platelet dose; Platelet-rich plasma; Regenerative orthopaedics
    DOI:  https://doi.org/10.1007/s00264-026-06782-7
  3. J Rehabil Med. 2026 Mar 23. 58 jrm45495
    Commonalities in rehabilitation data across diverse health conditions: a comparison of seven large European databases.
    Carlotte Kiekens, Helena Burger, Paolo Capodaglio, Maria G Ceravolo, Esther Janssen, Greta Jurenaite, Calogero Malfitano, Federico Pennestri, Ruud Selles, Gianluca M Tartaglia, Stefano Negrini.
       OBJECTIVE: To investigate whether rehabilitation data share common characteristics across different health conditions and care settings within the EU Horizon PREPARE project.
    DESIGN: Qualitative content analysis, with a comparative study of existing clinical databases.
    SUBJECTS/PATIENTS: Individuals with hand and wrist disorders, idiopathic scoliosis, intermittent claudication, lower limb amputation, Parkinson's disease or Parkinsonism, hip or knee replacement, and temporomandibular disorders.
    METHODS: Seven rehabilitation-oriented clinical databases were analysed using the International Classification of Functioning, Disability and Health (ICF) framework. Variables were categorized as outcomes, modifiers, or baseline measurements. Commonalities and differences across data domains were identified through iterative consensus meetings among PREPARE partners.
    RESULTS: Substantial heterogeneity was observed in data type and depth. Pain and quality of life were the most commonly reported outcomes, whereas discharge status and participation-related measures were rarely reported. The most prevalent modifiers were pharmacological treatments, orthoses or prostheses, and exercise-based interventions. All databases reported baseline information on diagnosis, anthropometry, and demographics; however, assessments of gait autonomy and daily activities were inconsistently documented.
    CONCLUSION: Despite some overlapping domains, rehabilitation data collection remains fragmented and predominantly focused on biomedical aspects. Greater standardization and systematic inclusion of psychosocial and contextual variables are needed for robust predictive modelling and personalized rehabilitation.
    DOI:  https://doi.org/10.2340/jrm.v58.45495
  4. Clin Rheumatol. 2026 Mar 21.
    Efficacy and safety of intra-articular mesenchymal stem cell-based therapies in knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials.
    Guy Awad, Jean-Pierre Saad, Ali Hamyeh, Marc Boutros.
       BACKGROUND: Knee osteoarthritis (OA) causes significant chronic pain and disability. Current non-operative treatments are largely symptom-modifying. While intra-articular mesenchymal stem cell (MSC) therapies are promising, randomized controlled trials (RCTs) report inconsistent results due to heterogeneity in cell sources, preparations, and techniques.
    METHODS: We searched PubMed, Scopus, Cochrane Library, and Google Scholar through December 10, 2025. Peer-reviewed RCTs evaluating intra-articular stem cell-based therapies for knee OA were included. Primary analyses compared MSCs versus controls across pain, function, structure, and safety. Subgroup and sensitivity analyses explored heterogeneity by preparation, source, comparator, follow-up, age, and injection guidance.
    RESULTS: Twenty-eight RCTs were included. MSC therapies significantly improved pain: ΔVAS (MD -1.67; p = 0.007), post-treatment VAS (MD -3.55; p = 0.01), and KOOS pain (MD 15.37; p = 0.03). Functional gains occurred in KOOS ADL (MD 12.84; p = 0.04), KOOS sports (MD 11.76; p < 0.001), and KOOS symptoms (MD 15.16; p = 0.02). WOMAC, KOOS quality of life, and Lequesne Index showed no significant differences. Benefits were more consistent with culture-expanded preparations, bone marrow sources, saline controls, and ultrasound guidance. ΔVAS remained significant after excluding short follow-up studies; ΔVAS and KOOS pain remained significant in older cohorts. MRI-based WORMS scores were non-significant, indicating no consistent structural benefit. Safety analyses revealed higher rates of injection-site pain (RR 2.04; p = 0.0005), joint swelling (RR 3.39; p = 0.0003), and other adverse events (RR 1.26; p = 0.01). Serious complications (e.g., infection) were uncommon and non-significant.
    CONCLUSION: Current evidence suggests stem cell-based therapies serve a primarily symptom-modifying rather than structure-modifying role. Higher frequencies of local reactions must be weighed against symptomatic benefits. Larger, standardized trials are needed to identify optimal preparations and patient profiles for consistent clinical benefit.
    KEY POINTS: • Intra-articular stem cell-based therapies demonstrate modest improvements in pain outcomes in knee osteoarthritis compared with control injections across randomized controlled trials, although results vary across cell preparations, comparators, and study conditions. • Symptomatic and functional improvements were observed in several KOOS domains, particularly activities of daily living, sports, and symptoms, with benefits appearing more consistent in selected subgroups rather than uniformly across all stem cell interventions. • Structural changes on MRI (WORMS) were not significantly improved, suggesting that current evidence supports symptomatic relief rather than consistent disease-modifying effects on joint structure. • Stem cell injections were associated with increased local reactions such as injection-site pain and joint swelling, while serious complications remained uncommon, indicating a generally manageable but non-negligible safety profile.
    Keywords:  Function; Intra-articular injection; KOOS; Knee Osteoarthritis; MRI; Mesenchymal stem cells; Meta-analysis; Pain; Safety; Stem Cell–Based Therapy; Subgroup analysis; WOMAC
    DOI:  https://doi.org/10.1007/s10067-026-08042-w
  5. Cureus. 2026 Feb;18(2): e103887
    A Narrative Review of Perioperative Peripheral Nerve Injuries After Major Surgery: Clinical Recognition, Electrodiagnostic Evaluation, and Rehabilitation Implications.
    Jaime Vallejos G, Bruno Fajardo C.
      Perioperative peripheral nerve injuries (PPNIs) are complications of surgical and procedural care and may cause neuropathic pain and motor or sensory deficits that delay functional recovery. This narrative review summarizes common patterns of PPNI involving the extremities, practical bedside recognition, the role and timing of electrodiagnostic testing, and key rehabilitation considerations. Upper-limb involvement most often affects the brachial plexus, ulnar nerve, and median nerve. In contrast, lower-limb presentations commonly involve the lateral femoral cutaneous, sciatic, and common fibular nerves, often in the setting of prolonged procedures and positioning. Electrodiagnostic studies complement the clinical examination by refining localization, distinguishing conduction block from axonal injury, and informing prognosis and follow-up planning. From a rehabilitation perspective, early detection supports prompt mitigation of ongoing compression or traction, symptom management, protection of insensate tissues, and timely functional strategies (including orthoses and task-oriented therapy) while recovery is monitored over time.
    Keywords:  electrodiagnosis; electromyography; iatrogenic injury; nerve conduction studies; patient positioning; perioperative nerve injury; peripheral neuropathy; rehabilitation
    DOI:  https://doi.org/10.7759/cureus.103887
  6. Life (Basel). 2026 Mar 03. pii: 405. [Epub ahead of print]16(3):
    Frequency of Aerobic Exercise and Association with Pain and Function in Older Adults with Knee Osteoarthritis: A Cross-Sectional Study.
    Narucha Komolsuradej, Punyaphat Boonlertwanich, Nakrop Klaylian, Kanyawee Hiranchunha, Danunai Malang, Phruksawan Intharak, Pimmada Sangkaew, Suppakorn Bandrapiwat, Siwaluk Srikrajang.
      Knee osteoarthritis is a leading cause of pain and functional limitation in older adults, and exercise is widely recommended as a core component of conservative management; however, the optimal frequency of aerobic and strengthening exercise remains unclear. This cross-sectional study aimed to examine the association between exercise frequency, pain, and functional outcomes in older adults with knee osteoarthritis. Participants aged ≥60 years with a clinical diagnosis of knee osteoarthritis were recruited from a tertiary university hospital in Thailand. Exercise frequency over the previous four weeks was categorized as none, 1-2 times per week, 3-6 times per week, or every day. Outcomes were assessed using the Thai version of the modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Brief Pain Inventory. Nonparametric analyses and multivariable regression analyses adjusted for age, body mass index, and comorbidities were performed. A total of 140 participants were included, of whom 68.6% reported engaging in aerobic exercise, and 56.4% performed knee-strengthening exercises. Higher frequency of aerobic exercise was significantly associated with lower pain severity, reduced pain interference, and better WOMAC total and subdomain scores (p < 0.05). A graded association pattern was observed, with the greatest benefits seen in participants performing aerobic exercise 3-6 times per week. No significant associations were identified between knee strengthening exercise frequency and pain and functional outcomes. These findings suggest that frequent aerobic exercise is associated with reduced pain and improved function in older adults with knee osteoarthritis, supporting its role in primary care and rehabilitation management.
    Keywords:  aerobic exercise; knee osteoarthritis; knee-strengthening; older adults; pain
    DOI:  https://doi.org/10.3390/life16030405
  7. J Clin Med. 2026 Mar 11. pii: 2142. [Epub ahead of print]15(6):
    Whole-Body Cryostimulation in Complex Regional Pain Syndrome: A Case Study.
    Paolo Piterà, Alberto Camedda, Elisa Prina, Eleonora Franzini Tibaldeo, Gabriele Baccalaro, Paolo Capodaglio.
      Background/Objectives: Complex Regional Pain Syndrome (CRPS) is a debilitating pain condition with complex pathophysiology and limited treatment efficacy. Whole-body cryostimulation (WBC) has shown promising results in other chronic pain syndromes, but no studies to date have examined its use in CRPS. To evaluate the safety, feasibility, and potential benefits of WBC in a female patient with CRPS of the ankle. Methods: A 65-year-old female outpatient with type I CRPS at the right ankle underwent 15 WBC sessions (3 min at -110 °C) over two weeks, without any concurrent pharmacological or rehabilitative interventions. Assessments at baseline and post-intervention included standardized measures of pain (VAS, SF-MPQ), disability (PDI), catastrophizing (PCS), mobility (TUG, Chair Stand Test), strength and ROM (goniometry, MRC), psychosocial status (SF-36, WHO-5, PSQI, BDI, STAI), and MRI of the right knee and ankle. Results: Post-treatment, the patient showed substantial improvements in pain (VAS -66.7%, SF-MPQ -51.7%), function (TUG -31.8%), muscle strength, psychological well-being, and quality of life. MRI and edema measurements indicated stabilization or regression of inflammatory features. No adverse effects were reported. Conclusions: This case suggests that WBC may represent a safe, well-tolerated, non-pharmacological intervention for CRPS, with potential to improve pain, function, and well-being.
    Keywords:  Complex Regional Pain Syndrome (CRPS); Whole-Body Cryostimulation (WBC); chronic pain; non-pharmacological intervention; pain management; rehabilitation
    DOI:  https://doi.org/10.3390/jcm15062142
  8. J Plast Surg Hand Surg. 2026 Mar 24. 61 44-50
    Clinical outcomes of isolated ulnar shortening osteotomy for ulnar impaction syndrome with concomitant distal radioulnar joint instability.
    Xing Gao, Aozhengzheng Dong, Jingxin Li, Changliang Ma, Wencui Li, Jianquan Liu, Zhiqin Deng, Zhe Zhao.
       BACKGROUND: This study aimed to evaluate the clinical outcomes and changes in distal radioulnar joint (DRUJ) stability in patients with ulnar impaction syndrome (UIS) combined with DRUJ instability, treated with ulnar shortening osteotomy (USO) without concomitant triangular fibrocartilage complex (TFCC) repair.
    MATERIALS AND METHODS: Between November 2017 and December 2024, a total of 16 patients (7 males, 9 females; mean age, 40 ± 12 years) underwent USO combined with wrist arthroscopy, followed by structured rehabilitation and regular follow-up. Clinical outcomes were assessed using ulnar variance, the Ballottement test, visual analog scale (VAS) for pain, Disabilities of the Arm, Shoulder, and Hand (DASH) score, modified Mayo wrist score, Patient-Rated Wrist Evaluation (PRWE), grip strength, and wrist range of motion. Preoperatively, all patients had positive Ballottement tests, and TFCC injuries were confirmed by arthroscopy.
    RESULTS: At the final follow-up (mean, 31 months), ulnar variance was significantly reduced, and VAS, DASH, modified Mayo wrist score, PRWE, and grip strength all showed marked improvement. DRUJ stability was restored in all patients, with the Ballottement test converting to negative.
    CONCLUSIONS: These findings suggest that isolated USO effectively treats UIS with concurrent DRUJ instability and achieves satisfactory clinical outcomes without the need for simultaneous TFCC repair.
    TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.
    DOI:  https://doi.org/10.2340/jphs.v61.45517
  9. Front Rehabil Sci. 2026 ;7 1784781
    ICF rehabilitation set responsiveness after total knee arthroplasty: a retrospective study.
    Dong Wang, Long Xu, Xin Wang, Yujiao He, Jinlong Cui, Shuhua Zhou, Yin Tong, Feng Gao, Huijun Du, Wei Fan.
       Introduction: The International Classification of Functioning, Disability and Health-Rehabilitation Set (ICF-RS) is a standardized tool for multidimensional rehabilitation assessment, but its responsiveness in post-total knee arthroplasty (TKA) inpatient settings remains underexplored.
    Methods: A retrospective single-center cohort study was conducted on 47 patients who underwent primary unilateral TKA and received inpatient rehabilitation in Changsha, China (January 2023-December 2024). ICF-RS scores (30 categories) were assessed at admission and discharge. Responsiveness was evaluated using Wilcoxon signed-rank tests with Benjamini-Hochberg FDR correction. Response counts (improved/stable/worsened) were the primary outcome presentation.
    Results: Of 30 ICF-RS categories, 27 showed 100% data completeness; 3 social/sexual items had substantial missingness. Following rehabilitation, 23 categories demonstrated statistically significant improvement after FDR correction. Consistent directional improvement was observed in mobility (d450 Walking: 24/47 improved), self-care (d510-d540), and pain (b280: 26/47 improved) domains. The total score decreased from 47.51 ± 13.59 to 35.81 ± 11.38 (Cohen's d = 1.51). Notably, b710 (joint mobility) showed no responsiveness (0/47 improved, 1/47 worsened), despite expected clinical range-of-motion gains.
    Discussion: ICF-RS demonstrates responsiveness to post-TKA inpatient rehabilitation for most functional domains. The lack of change in b710 highlights a limitation of generic assessment tools for capturing localized physical impairments in single-joint conditions, suggesting the need for complementary condition-specific measures. The study context-where ICF-RS scores influence reimbursement-underscores the importance of assessment integrity considerations in function-based payment implementations.
    Keywords:  disability and health; international classification of functioning; measurement properties; rehabilitation; responsiveness; total knee arthroplasty
    DOI:  https://doi.org/10.3389/fresc.2026.1784781
  10. Complement Ther Med. 2026 Mar 24. pii: S0965-2299(26)00047-6. [Epub ahead of print]98 103364
    Eccentric exercise therapy for medial epicondylitis: A systematic review of clinical outcomes.
    Zhi Huang See, Ching Ee Loo, Zulkarnain Jaafar.
       BACKGROUND: Medial epicondylitis, a tendinopathy of the flexor-pronator origin, remains less studied than lateral epicondylitis, especially regarding exercise-based interventions. Eccentric exercise has demonstrated benefits in other tendinopathies, but its role in medial epicondylitis has not been systematically evaluated.
    OBJECTIVE: To synthesize clinical evidence on the effectiveness of eccentric exercise in reducing pain and improving function in medial epicondylitis.
    METHODS: Following PRISMA guidelines, five databases (PubMed, Web of Science, Scopus, SPORTDiscus, Google Scholar) were searched from inception to January 2025. Clinical studies evaluating eccentric loading of the wrist flexor-pronator musculature as a primary intervention component for medial epicondylitis were included. Two reviewers independently screened the records, extracted the data, and assessed the risk of bias.
    RESULTS: Five studies (n = 143 patients) were included, comprising randomized controlled trials (RCT), pre-post studies, and comparative analyses. Eccentric exercise was associated with significant within-group reductions in pain and improvements in functional outcomes across included studies. Between-group superiority was demonstrated in one RCT. Combined interventions showed superior outcomes compared with ultrasound in one trial, while other comparative studies demonstrated significant within-group improvements without clear between-group differences. Sustained pain relief and functional improvement at 11-year follow-up were reported in a single uncontrolled study. Heterogeneity in intervention protocols and small sample sizes precluded meta-analysis.
    CONCLUSION: Current evidence suggests that eccentric exercise may reduce pain and improve function in medial epicondylitis, particularly when incorporated into multimodal conservative management. However, the overall certainty of evidence remains low, and larger high-quality randomized trials are required to confirm these findings.
    Keywords:  Eccentric exercise; Golfer’s elbow; Medial epicondylitis; Rehabilitation; Tendinopathy
    DOI:  https://doi.org/10.1016/j.ctim.2026.103364
  11. JMIR Res Protoc. 2026 Mar 24. 15 e72350
    Impact of Physiotherapy Intervention on Pain, Quality of Life, and Function in Low Back Pain Associated With Piriformis Syndrome: Protocol for Systematic Review.
    Nikita Deshmukh.
       Background: Piriformis syndrome is a neuromuscular condition with hip and buttock pain and other symptoms, including referred pain towards the lower back and leg and radiating towards the foot's medial aspect. Similarly, low back pain caused by piriformis syndrome is undetected or difficult to diagnose because of similar symptoms of lumbar disc herniation, lumbar stenosis, or radiculopathy, as well as neurogenic pain. A study conducted in 2013 found 2910 patients experienced low back pain with sciatica, which is the most common cause of low back pain, because of piriformis muscle stiffness. The prevalence of low back pain in piriformis syndrome is 5%-36%. It is more commonly seen in women than men.
    Objective: This systematic review protocol seeks to identify evidence whether physiotherapy interventions effectively relieve pain, improve functional outcomes, and enhance quality of life among individuals experiencing low back pain associated with piriformis syndrome.
    Methods: This review will analyze randomized controlled trials (RCTs) that include physiotherapy for patients with low back pain linked to piriformis syndrome. The included studies must report on pain levels or improvements in function related to quality-of-life outcomes. Searches will take place using Google Scholar, Pubmed/MEDLINE, the Cochrane Library, and PEDro for articles published from January 2014 to January 2025. Two reviewers will individually check the studies, choose relevant ones, and collect data while assessing quality using the Cochrane risk of bias tool. We will provide a narrative summary of the findings, concentrating on data about pain management, functional improvement, and quality of life enhancements.
    Results: This review will synthesize knowledge focusing on pain, quality of life and functions in low back pain, which is associated with piriformis syndrome. A synthesis of the findings will be conducted to determine which components of the interventions identified were the most advantageous to the patient population.
    Conclusions: The systematic review protocol is designed to identify the effectiveness of physiotherapy interventions for managing low back pain in piriformis syndrome. This analysis will review RCTs with evidence-based recommendations on reducing pain, improving function, and enhancing quality of life.
    Keywords:  affected quality of life; back discomfort; buttock pain; low back pain; misdiagnosed; neuromuscular condition; physiotherapy intervention; piriformis; sciatica
    DOI:  https://doi.org/10.2196/72350
  12. J Orthop Res. 2026 Apr;44(4): e70182
    A Novel Measurement of Altered Achilles Subtendon Load Sharing 6-12 Months Following Rupture.
    Kathryn S Strand, Todd J Hullfish, Maggie M Wagner, Devyn Russo, Max Zawel, Douglas E Schaubel, Casey Jo Humbyrd, Josh R Baxter.
      Achilles tendon ruptures cause muscle-tendon structural and functional deficits that persist years after the initial injury. A healthy Achilles tendon contains three semi-independent subtendons that slide relative to each other during muscle contractions in healthy adults. However, such sliding decreases postinjury as load sharing-likely caused by intratendinous adhesions-increases between adjacent subtendons. This study quantifies changes in subtendon load sharing 6-12 months following Achilles tendon rupture when patients are cleared by their surgeon to fully return to physical activities. We combined transverse plane ultrasound imaging with neuromuscular electrical stimulation of individual triceps surae muscles and applied a Kanade-Lucas-Tomasi point tracking algorithm to characterize subtendon behavior. We developed a surrogate measure of subtendon load sharing by quantifying differences in point displacement trajectory angles between select regions within the tendon cross section. In patients recovering from rupture injuries (n = 19), subtendon load sharing significantly increased in the injured tendon compared to the contralateral uninjured side during lateral gastrocnemius (p = 0.0094), medial gastrocnemius (p = 0.021), and soleus stimulations (p = 0.048). These differences were not present between right and left legs in the uninjured cohort (n = 17). Linear regression analysis also revealed that the presence of tendon injury was significantly associated with subtendon load sharing, with injured tendons showing up to a 44% decrease in subtendon independence compared to the contralateral uninjured tendon during gastrocnemius stimulations. Statement of Clinical Significance: These results propose a novel biomarker of tendon health and suggest muscle-dependent changes in subtendon function following Achilles tendon rupture.
    Keywords:  Achilles tendon; rupture; subtendons; ultrasound
    DOI:  https://doi.org/10.1002/jor.70182
  13. Medicina (Kaunas). 2026 Mar 17. pii: 557. [Epub ahead of print]62(3):
    Return-to-Work After Carpal Tunnel Release Across Surgical Techniques: A Narrative Review.
    Christian A Lobos, Kyle Wilcox, Thomaz De Campos Silva, Shea Wilcox.
      Carpal Tunnel Syndrome (CTS) is the most common upper-limb entrapment neuropathy and remains a major contributor of work-related disability. While Carpal Tunnel Release (CTR) reliably improves symptoms, functional recovery is less consistently reported. Return-to-Work (RTW) has emerged as a practical functional outcome, but definitions and reporting remain heterogeneous. We conducted a narrative review of English-language studies reporting RTW or work-absence outcomes following open, endoscopic, ultrasound-guided, ultraminimally invasive, and microinvasive CTR techniques. Due to variability in study design and RTW definitions, findings were synthesised descriptively. Across the literature, RTW durations progressively shortened as procedural invasiveness decreased. Open CTR commonly reported RTW at four to six weeks, endoscopic techniques at two to four weeks, and ultrasound-guided approaches at approximately 10-21 days. Recent ultraminimally invasive and microinvasive systems frequently reported RTW within one to two weeks when performed under local anaesthesia. These findings highlighted RTW as a meaningful functional benchmark and underscore the role of imaging-guided access minimisation in accelerating postoperative recovery.
    Keywords:  Return-to-Work; carpal tunnel release; carpal tunnel syndrome; microinvasive surgery; minimally invasive surgery; ultrasound-guided surgery
    DOI:  https://doi.org/10.3390/medicina62030557
  14. Toxins (Basel). 2026 Mar 11. pii: 137. [Epub ahead of print]18(3):
    Innovative Management of Spastic Shoulder Contractures: A Retrospective Cohort Analysis of Combined Percutaneous Cryoneurolysis and Tenotomy.
    Paul Winston, Mahdis Hashemi, Fraser MacRae, Samuel Herzog, Maxime Billot, Romain David.
      Shoulder spasticity is a common consequence of upper motor neuron lesions and may be associated with soft tissue contractures, limiting functional recovery. While both cryoneurolysis and tendon lengthening procedures are used individually in refractory cases, their combined effect has not been clearly established. It is consequently necessary to assess the efficacy of combining cryoneurolysis and percutaneous pectoral tenotomy in reducing shoulder spasticity and improving passive range of motion in patients with refractory shoulder spasticity and contracture. This retrospective, single-centre cohort study included 15 adults (≥19 years) with chronic shoulder spasticity and clinically confirmed musculotendinous contracture, previously treated with botulinum toxin injections without sufficient functional response, and free of pharmacological effects (last injection >4 months prior). All patients underwent cryoneurolysis targeting motor branches to the pectoral muscles. Outcomes included Modified Ashworth Scale (MAS) and shoulder Passive Range Of Motion (PROM). The combined approach provided significant improvements in spasticity severity for shoulder flexion (p < 0.01) and abduction (p < 0.01), and significant improvements in maximum PROM for shoulder flexion (p < 0.0001) and abduction (p < 0.0001). Combining cryoneurolysis and pectoral tenotomy appears feasible, safe, and clinically beneficial in selected patients with both spasticity and tendon contracture. Cryoneurolysis addresses the neural component, while tenotomy may restore mechanical excursion. This sequential diagnostic and therapeutic approach may enhance personalized management of mixed spastic-contracture shoulder limitations and could be applicable to other joints.
    Keywords:  acquired brain injury; cerebral palsy; cryoneurolysis; multiple sclerosis; spasticity; stroke; tenotomy
    DOI:  https://doi.org/10.3390/toxins18030137
  15. Ann Indian Acad Neurol. 2026 Mar 17.
    Limitations of Single-Time-Point Assessments in Carpal Tunnel Neuropathic Pain Studies.
    Taner Dandinoğlu, Erkan Kaya.
      
    DOI:  https://doi.org/10.4103/aian.aian_1073_25
  16. J Clin Med. 2026 Mar 17. pii: 2285. [Epub ahead of print]15(6):
    Comparative Effectiveness of Ultrasound Guided Ozone (O2-O3) and Corticosteroid Injections for Sacroiliac Joint Dysfunction: A Multicenter Clinical Trial.
    Ridvan Isik, Muhammed Zahid Sahin, Emre Uzun, Ferhat Ege, Kemal Nas.
      Background/Objectives: Sacroiliac joint (SIJ) dysfunction is a common yet frequently underdiagnosed cause of chronic low back pain. This study aimed to compare the clinical effectiveness of ultrasound-guided corticosteroid and ozone injections in patients with chronic low back pain due to SIJ dysfunction. Methods: This comparative clinical study included 64 patients with chronic sacroiliac joint (SIJ) dysfunction who received ultrasound-guided SIJ injections with either corticosteroid (n = 31) or ozone (n = 33). Participants had a mean age of 45.0 ± 7.7 years, and the sex distribution was 42/22 (female/male). Pain intensity was assessed using the Numeric Rating Scale (NRS), disability using the Oswestry Disability Index (ODI), and quality of life using the Short Form-12 Physical (PCS) and Mental (MCS) Component Summary scores. Outcomes were evaluated at baseline, 3 months, and 6 months. Longitudinal changes were analyzed using two-way repeated-measures ANOVA (group × time) with Bonferroni-adjusted post hoc comparisons. Effect sizes were calculated using Cohen's d. Normality and homoscedasticity were assessed (Shapiro-Wilk and Levene tests), and baseline comparisons were performed using appropriate parametric or non-parametric tests. Results: Both treatments significantly improved pain, disability, and quality of life at 3 months (p < 0.01). However, improvements were significantly greater and more durable in the ozone group across all outcomes at both 3 and 6 months (p < 0.01). At 6 months, between-group differences favored ozone for NRS (mean difference -2.81; Cohen's d = -2.36), ODI (-6.05; d = -1.46), SF-12 PCS (+4.24; d = 1.24), and SF-12 MCS (+4.22; d = 0.83). A ≥50% pain reduction was achieved at 3 months in 97.0% of ozone-treated patients versus 45.2% of corticosteroid-treated patients (p < 0.01) and persisted at 6 months in 18.2% and 0% of patients, respectively (p < 0.05). The magnitude of improvement in the ozone group exceeded commonly reported Minimal Clinically Important Difference (MCID) thresholds for chronic low back pain outcomes, supporting clinical relevance. Conclusions: Ultrasound-guided ozone injection provided greater and more durable improvements in pain relief, functional status, and quality of life compared with corticosteroid injection in patients with SIJ dysfunction.
    Keywords:  corticosteroids; low back pain; ozone; sacroiliac joint; ultrasonography
    DOI:  https://doi.org/10.3390/jcm15062285
  17. PeerJ. 2026 ;14 e20765
    Post-discharge outcome measurement tools in occupational therapy for people with acquired brain injury in Japan: a scoping review.
    Nozomi Oyama, Shigeharu Aoki, Tracey Williams-Macklin, Andrew Bateman.
       Purpose: Outcome measurement is fundamental to rehabilitation practice; however, the tools commonly used in occupational therapy after Acquired Brain Injury (ABI) may not adequately capture the complex needs of individuals living in the community. This scoping review synthesised the outcome measures employed in post-discharge occupational therapy in Japan and identified the core concepts they assess.
    Method: A comprehensive search of nine databases was conducted without restrictions on publication year or language. Search strategies were developed using relevant keywords, and four independent reviewers applied predefined inclusion and exclusion criteria to ensure methodological rigour.
    Results: Of the 1,188 abstracts screened, 985 articles were excluded, leaving 104 for full-text review. Ultimately, 44 studies met the eligibility criteria, yielding 32 distinct outcome measures. The Functional Independence Measure (FIM) (29.5%) was most frequently applied, followed by the Frenchay Activities Index (FAI) (9.0%), the Life Space Assessment (LSA) (7.7%), and the Barthel Index (BI) (7.7%). Categorisation of the 11 most frequently used tools according to the International Classification of Functioning, Disability, and Health (ICF) revealed a strong emphasis on mobility (26%) and self-care (18%).
    Discussion: These findings reflect both the influence of Japan's ageing population on assessment priorities and a critical gap in which participation, cognition, and broader psychosocial outcomes remain underrepresented. Broader and more comprehensive assessment strategies are required to address the diverse realities of community life following ABI.
    Keywords:  Acquired brain injury (ABI); Japan; Occupational Therapy; Outcome measurement tool; Rehabilitation
    DOI:  https://doi.org/10.7717/peerj.20765
  18. J Hand Surg Eur Vol. 2026 Mar 25. 17531934261434155
    Preoperative tests before cubital tunnel decompression in 2025.
    Ryckie G Wade, Gráinne Bourke.
      Despite the burden to patients and society, there are no diagnostic criteria for cubital tunnel syndrome. Our survey shows that 93% of surgeons order preoperative tests (mostly electrodiagnostics only, which is discordant with expert consensus). Moreover, six in 10 still operate when test results are normal. The diagnostic pathway for cubital tunnel syndrome must be standardized.Level of evidence: IV.
    Keywords:  Cubital tunnel syndrome; MRI; electrodiagnostics; nerve compression; neurophysiology; ulnar neuropathy; ultrasound
    DOI:  https://doi.org/10.1177/17531934261434155
  19. Medicina (Kaunas). 2026 Mar 01. pii: 469. [Epub ahead of print]62(3):
    Knee Osteoarthritis (KOA) Severity Influences Proximal Femoral Biomechanics and Predicts Pertrochanteric Fracture Instability: A Retrospective Radiographic Study.
    Seyed Ali Hashemi, Bahram Abedini, Hossein Hosseini, Shayan Yousufzai, Christos Koutserimpas, Georgi P Georgiev, George Tiantafyllou, Eva Diomidous, George Tsakotos, Ioannis Paschopoulos, Fotios Kantas, Maria Piagkou.
      Background and Objectives: Intertrochanteric hip fractures (ITFs) are common in older adults and frequently coexist with knee osteoarthritis (KOA). Although both conditions share key biomechanical risk factors, the specific relationship between KOA severity and ITF stability has not been well defined. Recent evidence suggests that degenerative knee changes may alter lower-limb load distribution and increase susceptibility to unstable fracture patterns. This study evaluated whether KOA severity, graded using the Kellgren-Lawrence (KL) system, is associated with ITF stability according to the 2018 AO/OTA classification. Materials and Methods: A retrospective observational study was conducted on 138 patients with IHFs treated between 2018 and 2023. KOA severity was assessed using KL grades I-IV on non-weight-bearing anteroposterior knee radiographs. Lateral wall thickness (LWT) was measured using the Hsu method, with <20.5 mm indicating fracture instability. Statistical analyses included correlation, linear regression, logistic regression, and receiver operating characteristic (ROC) curve analysis to examine the association between KL grade and fracture stability. Results: Among 138 patients, 98 (71.0%) had unstable ITFs. Advanced KOA was significantly more common in the unstable group (KL III 45.9%, KL IV 48.0%; p < 0.001). KL grade showed a significant inverse correlation with LWT (Pearson's r = -0.394, p < 0.001). Each one-grade increase in KL severity was associated with a 3.8 mm reduction in LWT (p < 0.001). In multivariable logistic regression, KL grade remained an independent predictor of fracture instability (adjusted OR = 4.9, 95% CI: 2.8-8.8, p < 0.001), whereas age and comorbidities were not significant. ROC analysis demonstrated good discriminatory power (AUC = 0.79). A KL ≥ III threshold achieved 95% sensitivity and 56% specificity for predicting instability. Conclusions: Higher KOA severity is strongly associated with unstable ITF patterns. KL grade independently predicts instability and may serve as a simple, accessible radiographic indicator of biomechanical vulnerability and fracture risk in older adults. Incorporating KOA severity into the preoperative evaluation may enhance risk stratification, guide selection of fixation strategy, and support individualized rehabilitation planning.
    Keywords:  AO/OTA classification; Kellgren–Lawrence; fracture stability; hip fracture biomechanics; intertrochanteric fracture; knee osteoarthritis; lateral wall thickness
    DOI:  https://doi.org/10.3390/medicina62030469
  20. Nursing. 2026 Apr 01. 56(4): 29-35
    Lumbar radiofrequency ablation for lumbar facet joint pain.
    Kathleen Pecoraro.
       ABSTRACT: Low back pain is a common and potentially debilitating disorder. Pain due to lumbar facet joint pathology is estimated to occur in 15% to 45% of those with low back pain. Radiofrequency ablation (RFA) is a common interventional pain management procedure used to treat lumbar facet joint disease (LFJD). RFA is available for patients when conservative treatment has been unsuccessful. A major benefit to RFA is the diminished need for the use of opioid and other potentially harmful medications. RFA also has the potential to prevent the need for more invasive treatment. The procedures necessary prior to RFA and RFA itself are performed in outpatient settings and allow patients to quickly return to their normal activities post procedure. This article describes the risk factors, pathophysiology, diagnosis, treatment, and nursing considerations of a patient with LFJD. The steps to an RFA and the RFA procedure itself are also discussed.
    Keywords:  facet joint; facet joint denervation; low back pain; lumbar pain; medial branch block; medial branch radiofrequency neurotomy; pain management; radiofrequency ablation; zygapophyseal joint
    DOI:  https://doi.org/10.1097/NSG.0000000000000341
  21. Cephalalgia. 2026 Mar;46(3): 3331024261430857
    Therapeutic dissociation of CGRP-targeted treatments in migraine and complex regional pain syndrome.
    Filipa Dourado Sotero, Isabel Pavão Martins.
      
    Keywords:  CGRP; complex regional pain syndrome; migraine
    DOI:  https://doi.org/10.1177/03331024261430857
  22. J Hand Surg Glob Online. 2026 May;8(3): 100977
    Culturally Tailored Rehabilitation Approach "After zone III Flexor Tendon Tenolysis in the Index and Middle Fingers: A Case Report.
    Samir Awaad, Osama Sherifi, Sana Al Katheri, Salwa Fallatah, Aljawharah Alfuraydi, Hanadi Hamzah.
      Considerable challenges may occur with neglected zone III flexor tendon injuries due to muscle weakness, adhesion formation, and functional impairment. Surgical tenolysis often is required to restore tendon gliding and hand function We report a 32-year-old man with severe disability of the right hand following a childhood flexor tendon injury at age 2. Absence of follow-up rehabilitation resulted in dense adhesions in the index and middle fingers and marked muscle weakness. The patient underwent tenolysis followed by a staged rehabilitation program incorporating early mobilization, progressive strengthening, and culturally adapted exercises, including prayer-related gestures (Tasbeeh) and the "Arabic Coffee Protocol" to enhance engagement, dexterity, and fine motor coordination. Intraoperatively, full active finger flexion was achieved successfully and demonstrated on the operating table before wound closure. Following rehabilitation, the patient was able to perform a full fist, reflecting a transition from reliance on the ring and little fingers to the involvement of all digits. At follow-up, the patient reported subjective improvement in confidence and social participation. This case highlights the value of integrating culturally relevant interventions within structured rehabilitation for neglected hand injuries.
    Keywords:  Culturally adapted rehabilitation; Hand flexor tendon injury; Neglected zone III; Tasbeeh; Tenolysis
    DOI:  https://doi.org/10.1016/j.jhsg.2026.100977
  23. JSAMS Plus. 2025 Jun;5 100081
    Rock, paper, scissors: Resolving the conflicting results of randomized trials involving corticosteroid, platelet rich plasma (PRP) and placebo injections.
    John W Orchard.
       Objective: To explore whether there is evidence of a rock-paper-scissors phenomenon in injections for various musculoskeletal conditions whereby platelet rich plasma (PRP) injections outperform corticosteroid injections (CSI) in randomized trials, corticosteroid outperforms placebo whereas PRP does not outperform placebo.
    Methods: Narrative review searching for examples of musculoskeletal conditions which have high level evidence of this proposed rock-paper-scissors phenomenon.
    Results: High quality studies or reviews could be found for lateral epicondylitis (tennis elbow), knee osteoarthritis, rotator cuff tendinopathy and plantar fasciitis suggestive of a rock-paper-scissors phenomenon. This was consistently in the direction of PRP injections having superior results to corticosteroid injections, corticosteroid injections having superior results to placebo, but then evidence that PRP injections were not superior to placebo. The most consistent result of the triumvirate was that PRP injections consistently outperformed corticosteroid injections in the medium-term (4 to 12 months).
    Discussion: There appears to be somewhat of a rock-paper-scissors phenomenon for four common musculoskeletal conditions, with the significant limitation that this was a finding of a narrative review, limited by a non-systematic search protocol. The underlying explanation is that PRP is superior to corticosteroid in the medium-term (but not the short-term), corticosteroid is superior to placebo in the short-term (only) with PRP not being superior to placebo in either short- or medium-term in well-blinded trials. The most likely explanation for this phenomenon is that corticosteroid injections are helpful for musculoskeletal conditions in the short term (≤8 weeks) but are actually harmful in the medium-term (3 months and beyond). Systematic reviews which further explore this phenomenon are justified to help provide practical evidence-based advice on when to, if ever, use PRP and corticosteroid injections for musculoskeletal conditions.
    Keywords:  Injections; Knee osteoarthritis; Plantar fasciitis; Rotator cuff tendinopathy; Tennis elbow
    DOI:  https://doi.org/10.1016/j.jsampl.2024.100081
  24. Front Neurol. 2026 ;17 1740020
    A review of research progress of mirror therapy in peripheral nerve injury.
    Chengqi Duan, Hongxia Gan, Xiujian Zhuo, Yanping Xiao, Xiaobo Chen.
       Background: Mirror therapy, as a novel rehabilitation approach, has been widely applied in the treatment of various diseases, including post-stroke limb dysfunction, unilateral neglect, peripheral facial paralysis, complex regional pain syndrome, and childhood cerebral palsy.
    Purpose: This study aims to investigate the effectiveness of mirror therapy in treating peripheral nerve injuries, expand the scope of diseases to which mirror therapy can be applied, and provide a novel treatment strategy for peripheral nerve injuries.
    Methods: This study conducted a comprehensive search and analysis of relevant clinical research on mirror therapy for peripheral nerve injuries, providing theoretical and clinical basis for the application of mirror therapy in the treatment of peripheral nerve injuries.
    Results: Based on a comprehensive analysis of seven clinical studies, it can be concluded that mirror therapy (MT) has a positive effect on improving motor function.
    Conclusion: Mirror therapy is characterized by its simplicity, economy and non-invasiveness. It is an effective rehabilitation technique for treating peripheral nerve injuries and is suitable for low-cost, long-term home-based rehabilitation. It can be combined with conventional therapies to jointly promote the recovery of motor functions and accelerate the plastic regeneration of nerves.
    Keywords:  mirror neuron system; mirror therapy; nerve regeneration; neuroplasticity; peripheral nerve injury
    DOI:  https://doi.org/10.3389/fneur.2026.1740020
  25. Int J Rehabil Res. 2026 Mar 23.
    Can hip extensor strength influence the knee osteoarthritis severity? A cross-sectional analysis.
    Babina Rani, Mehak Singla, Ashish Tyagi, Shivam Sharma, Md Salman Ahmed, Binod K Pandey, Mandeep S Dhillon.
      Knee osteoarthritis (KOA) is a prevalent musculoskeletal disorder characterized by pain, functional impairment, and structural degeneration. While quadriceps and hip abductor weakness are well-established in KOA, the role of hip extensor strength remains underexplored despite its biomechanical importance in lower limb alignment and joint loading. This cross-sectional study aimed to examine whether hip extensor strength differs between asymptomatic individuals and symptomatic KOA patients, and its relationship with pain, function, and radiographic severity. Adults aged 45-70 years (N = 112; 56 asymptomatic, 56 symptomatic for KOA) were included. Pain, function, and hip extensor strength were evaluated using Visual Analogue Scale, Western Ontario and McMaster Universities Osteoarthritis Index and modified sphygmomanometer respectively; radiographic severity was graded by Kellgren-Lawrence system. Between-group differences were analyzed using the Mann-Whitney U test, associations by Spearman's correlation, and multiple linear regression adjusted for age, gender, and BMI. Symptomatic participants demonstrated significantly lower bilateral hip extensor strength than asymptomatic subjects (P < 0.001). Lower strength was associated with greater pain, poorer function, and higher Kellgren-Lawrence grades (P < 0.05). Strength reductions were more pronounced in females across radiographic grades. After adjustment, age and gender were significantly associated with strength in the asymptomatic group, whereas only gender remained significant in the symptomatic group. These findings highlight hip extensor strength as a clinically relevant yet underemphasized factor associated with symptom and structural severity in KOA. Targeted strengthening warrants exploration as a rehabilitation component; however, causality cannot be inferred from this cross-sectional design, and longitudinal studies are needed to establish its effect on clinical or structural outcomes.
    Keywords:  knee osteoarthritis; muscle strength; radiography
    DOI:  https://doi.org/10.1097/MRR.0000000000000702
  26. Toxins (Basel). 2026 Mar 05. pii: 130. [Epub ahead of print]18(3):
    Botulinum Toxin Treatment of Stiff Person Syndrome-A Critical Review and Update.
    Ava Grace Tohidian, Samira Marie Comtesse, Shahroo Etemadmoghadam, Bahman Jabbari.
      Stiff person syndrome (SPS) is an autoimmune disorder with muscle stiffness and spasms, for which current therapies provide incomplete relief. Botulinum neurotoxin (BoNT) has been explored as an adjunctive symptomatic treatment. The aim of this review was to critically evaluate the clinical evidence for BoNT therapy in SPS. Using Medline, Scopus and Google Scholar, we identified nine reports that were published up to 1 January 2026. English articles and articles with information on study type, type/dose of BoNT and treatment results were included. One study was double-blind and placebo-controlled, one was retrospective and seven were single-case reports, comprising 46 patients. Open-label trials used botulinumtoxin-A (Botox, Dysport or Xeomin), while the blind study applied abobotulinumA (Dysport). All but one study (a case report) demonstrated motor improvement and a reduction in painful spasms associated with patient satisfaction. Reported doses ranged from 300 to 800 units for onabotulinumtoxinA and incobotulinumtoxinA and from 700 to 1000 units for abobotulinumtoxinA. The literature highlights the need for randomized clinical trials in larger cohorts, with careful selection of dose, injection sites, and adjunct physiotherapy, as well as an evaluation of early BoNT therapy in SPS. The novelty of this review lies in its critical synthesis of reported data and inclusion of most recent reports.
    Keywords:  abobotulinumtoxinA; botulinum neurotoxin; botulinum toxin; incobotulinumtoxinA; onabotulinumtoxinA; physiotherapy; stiff person syndrome
    DOI:  https://doi.org/10.3390/toxins18030130
  27. Cureus. 2026 Feb;18(2): e104057
    A Prospective Randomized Study Comparing Glenohumeral and Subacromial Corticosteroid Injections in the Management of Primary Frozen Shoulder.
    Namkumpeung Lungalang, Kumar Shantanu, Devarshi Rastogi, Brij Mohan Patel, Ashish Kumar, Shatakshi Pant.
      This prospective randomized comparative study evaluated the clinical efficacy of glenohumeral (GH) versus subacromial (SA) corticosteroid injections in managing primary frozen shoulder. The study was conducted at a tertiary care center in North India between 2023 and 2025. Sixty patients aged 20-70 years with stage 1 primary frozen shoulder, unresponsive to at least six weeks of conservative treatment, were included. Participants were randomly allocated to receive either a GH or SA injection containing triamcinolone, lidocaine, and saline. Each followed a standardized home-based exercise program. Outcomes were assessed at baseline and at 4, 8, and 12 weeks post-injection using the visual analogue scale (VAS), Constant-Murley score, and shoulder range of motion (ROM) parameters. These included forward (FWD) flexion, abduction, and internal and external rotation. Both GH and SA injections resulted in statistically significant improvements across all parameters over time (p < 0.0001). Comparative analysis revealed no significant difference between groups in pain relief, activities of daily living (ADLs), or internal rotation. However, GH injections showed significantly superior improvement in FWD flexion, abduction, and external rotation compared with SA injections. The findings suggest that both injection sites are effective for pain relief and functional improvement in primary frozen shoulder. Intra-articular GH injections may offer greater benefits for restoring specific shoulder movements, particularly those most affected by capsular fibrosis.
    Keywords:  adhesive capsulitis; constant-murley score; corticosteroid therapy; glenohumeral injection; primary frozen shoulder; range of motion; subacromial injection
    DOI:  https://doi.org/10.7759/cureus.104057
  28. J Clin Med. 2026 Mar 22. pii: 2430. [Epub ahead of print]15(6):
    Restoration of Muscle Function Following Distal Biceps Tendon Reinsertion: A Narrative Review.
    Michał Harasymczuk, Ewa Bręborowicz, Aleksandra Bartkowiak-Graczyk, Anna Madziewicz, Tomasz Balcerek, Leszek Romanowski.
      Background/Objectives: Distal biceps tendon rupture (DBTR) significantly impairs upper-limb function, particularly in movements requiring elbow flexion and forearm supination. This condition continues to attract clinical interest due to its complex biomechanics, evolving surgical strategies, and the growing emphasis on comprehensive rehabilitation. Contemporary evidence highlights the value of a multidisciplinary approach that integrates precise surgical repair with structured, progressive physiotherapy to optimize outcomes effectively. Methods: We performed a comprehensive review of the literature by searching PubMed/MEDLINE, and a narrative review format was adopted to synthesize the available evidence. Results: Studies comparing single-incision and double-incision techniques show that both achieve excellent outcomes, although the decision should be tailored to patient-specific factors, surgeon expertise, and the reported complication risk, which may vary between 5% and 63%. Regardless of technique, restoring tendon integrity is essential for regaining normal strength and supination capability. Rehabilitation following DBTR repair relies on a phased and carefully monitored program. Early physiotherapy focuses on a controlled range of motion and the prevention of stiffness while protecting the repair. As healing progresses, strengthening exercises targeting the biceps, triceps, and brachialis are introduced, alongside endurance training to enhance overall functional capacity. Evidence strongly supports early mobilization protocols, where active motion and graded resistance are initiated within the first postoperative week, resulting in faster and more complete functional recovery compared to prolonged immobilization. Conclusions: Long-term outcomes after DBTR repair are consistently favorable. Most patients return to full activity or sport at an average of 5.4 months, although timelines vary with rehabilitation intensity and baseline fitness. Notably, 93-100% recover their pre-injury activity level, including participation in competitive sports.
    Keywords:  comparative analysis; distal biceps tendon rupture; evidence-based practice; functional outcomes; muscle function restoration; supination and flexion strength; surgical approaches
    DOI:  https://doi.org/10.3390/jcm15062430
  29. J Funct Morphol Kinesiol. 2026 Mar 09. pii: 114. [Epub ahead of print]11(1):
    Neurofunctional Assessments in Lumbar Spondylosis: Outcomes After Rehabilitation Treatment.
    Andreea Ancuta Talinga, Roxana Ramona Onofrei, Ada-Maria Codreanu, Alexandra Laura Mederle, Veronica Aurelia Romanescu, Marius-Zoltan Rezumes, Oana Suciu, Dan-Andrei Korodi, Claudia Borza.
      Background: Lumbar spondylosis is a frequent cause of chronic low back pain, often associated with radiculopathy. Although imaging evaluation is widely used, it does not always reflect the degree of functional impairment of the nerve roots. Electrophysiological assessments, such as nerve conduction studies (NCS) and surface electromyography (sEMG), can provide additional information on neuromuscular function under conservative treatment. Methods: This quasi-experimental study included 60 patients with lumbar spondylosis and 25 healthy subjects, who underwent clinical, imaging, and electrophysiological assessments. NCS and sEMG parameters were assessed in the patient group before and six months after rehabilitation treatment. The control group was assessed only once, at baseline. We analyzed the nerve conduction velocity of the tibial and peroneal nerves and the sEMG activity of the tibialis anterior muscle bilaterally. Statistical analysis used nonparametric tests, Spearman's coefficient, and Hodges-Lehmann estimates. Results: Compared to the control group, patients presented increased residual latencies and reduced CMAP amplitude and motor conduction velocity values (p < 0.001). After rehabilitation treatment, significant improvements in NCS parameters were observed, with decreased latencies and increased CMAP amplitude and motor conduction velocity bilaterally (p < 0.001). Also, sEMG amplitude and recruitment pattern scores increased significantly at the 6-month follow-up (p ≤ 0.004). Correlations between electrophysiological parameters and the severity of imaging changes were limited, with modest associations for left tibial latencies (ρ = 0.401-0.467; p < 0.050). Conclusions: In patients with lumbar spondylosis, rehabilitation treatment was associated with functional improvements in nerve conduction velocity parameters and muscle activity.
    Keywords:  chronic pain; conservative treatment; electromyography; exercise therapy; low back pain; lumbar spondylosis; muscle activation; nerve conduction studies; nerve conduction velocity; peroneal nerve; rehabilitation; tibial nerve
    DOI:  https://doi.org/10.3390/jfmk11010114
  30. Front Surg. 2026 ;13 1725534
    The efficacy and safety of platelet rich plasma and hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis.
    Feimeng An, Huiqiang Wu, Junqian Wang, Genli Zhang, Kai Yan, Feng Wu, Jianzhong Wang, Haibin Zhang.
       Purpose: To investigate the efficacy and safety of intra-articular injection ratio of platelet rich plasma (PRP) and hyaluronic acid (HA), and provide evidence-based strategies for the treatment of knee osteoarthritis (KOA).
    Methods: Search PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang databases to retrieve literature published from the beginning of database establishment to October 2024. Include in published randomized controlled trials (RCTs) or cohort studies. The research subjects are KOA patients, with the experimental group receiving intra-articular injection of PRP and the control group receiving intra-articular injection of HA. Quality evaluation of the inclusion of Cochrane Handbook risk assessment tools using RevMan5 Perform meta-analysis on outcome measures using three software.
    Results: 18 articles were included, with a total of 1,326 patients. PRP showed significantly better WOMAC scores at 6 months (SMD=-8.32, P < 0.0001) and 12 months (SMD=-3.15, P < 0.0001), superior IKDC scores at 6 months (SMD=0.85, P = 0.004), and greater pain reduction on VAS at 3 months (SMD=-0.56, P < 0.0001) and 6 months (SMD=-0.85, P < 0.0001). EQ-VAS scores also favored PRP at 2 months (SMD=0.20, P = 0.04) and 12 months (SMD=0.35, P = 0.001). No significant differences were found in adverse events (OR = 1.31, P = 0.21) or patient satisfaction (MD = 1.60, P = 0.08), indicating comparable safety profiles.
    Conclusion: PRP has a good clinical therapeutic effect on KOA. Based on this meta-analysis, compared with simple intra-articular injection of HA, PRP can improve WOMAC score, VAS score, and IKDC index score after 6 months of treatment, and enhance patients' health status. In terms of the incidence of adverse events, the safety of the two treatment options is similar.
    Keywords:  hyaluronic acid; intra-articular injection; knee osteoarthritis; meta-analysis; platelet rich plasma
    DOI:  https://doi.org/10.3389/fsurg.2026.1725534
  31. J Bone Joint Surg Am. 2026 Mar 24.
    MRI Assessment of Median Nerve Size in Patients with Proximate Electrodiagnostic Studies.
    Wen-Chih Liu, Chih-Hsuan Wung, F Joseph Simeone, Kyle R Eberlin, Neal C Chen.
       BACKGROUND: Carpal tunnel syndrome (CTS) diagnosis has traditionally relied on electrodiagnosis (EDX) to confirm the diagnosis and to assess severity. Ultrasound has shown potential in measuring median nerve cross-sectional area (CSA) for CTS diagnosis, and magnetic resonance imaging (MRI) can be used for wrist soft-tissue evaluation. This study explored the correlation between CTS diagnosis and median nerve CSA measured on MRI at different wrist levels.
    METHODS: A retrospective review of an electronic medical record database identified patients who underwent both wrist MRI and EDX within a 90-day interval between January 2000 and December 2022. Median nerve CSA was measured on axial T2-weighted images at 3 levels: proximal to the carpal tunnel inlet (the distal radioulnar joint [DRUJ]), the inlet, and the outlet. Continuous variables are presented as means ± standard deviations. A logistic regression model was constructed to evaluate the diagnostic accuracy of median nerve CSA, at the 3 anatomical levels, in identifying CTS. Empirical cut point estimation determined optimal cutoffs and corresponding areas under the receiver operating characteristic curve (AUCs).
    RESULTS: Sixty-eight patients (76 wrists; mean age, 51.4 ± 14.2 years; male-to-female ratio, 26 to 50; 59 White patients, 8 Hispanic patients, and 1 Asian patient) were included. The mean median nerve CSA in the EDX-negative group compared with the EDX-positive group was 10.6 ± 3.4 versus 11.7 ± 4.0 mm2 (p = 0.248) at the DRUJ level, 11.1 ± 3.1 versus 14.4 ± 5.1 mm2 (p = 0.007) at the inlet level, and 9.8 ± 2.4 versus 11.0 ± 5.2 mm2 (p = 0.833) at the outlet level. The inlet CSA cutoff for CTS was 11.3 mm2 (AUC = 0.67), with a sensitivity of 74% and a specificity of 60%.
    CONCLUSIONS: MRI-based measurements of median nerve CSA, particularly at the inlet level, suggest that relying solely on CSA measurements may not be an optimal diagnostic strategy for CTS in patients with equivocal clinical symptoms. Even with MRI and highly standardized measurement protocols, only poor-to-fair diagnostic accuracy was achieved. This study raises questions about the diagnosis of CTS based on CSA measurements.
    LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
    DOI:  https://doi.org/10.2106/JBJS.25.00787
  32. J Wrist Surg. 2026 Apr;15(2): 116-125
    Outcomes after Acute Perilunate Injuries: A Single-Center Experience Over 30 Years.
    Eric C Mitchell, Assaf Kadar, Spencer Chambers, Ruby Grewal.
       Background: Perilunate fracture-dislocations represent a spectrum of devastating wrist injuries. They typically involve high-energy mechanisms, occur in young patients and are relatively uncommon. Our current knowledge on this rare wrist pathology is limited as most studies involve small retrospective case series and limited follow-up.
    Purpose: The purpose of this study was to examine the functional, radiographic, and patient reported outcomes after perilunate injuries and evaluate surgical practice trends over time.
    Materials and Methods: A retrospective review identified 123 patients who had open reduction and internal fixation of an acute perilunate injury at a single academic centre over a 30-year study period. Post-operative functional, patient-reported, and radiographic outcomes were assessed. The association of various surgical and injury-related variables on outcomes was examined using independent t -tests and ANOVA testing, with post-hoc analysis. Significance was set at p  < 0.05.
    Results: Fourty-seven patients participated with a mean follow-up of 14 years. All patients underwent urgent or semi-urgent operative intervention with a dorsal or combined approach. At final follow-up, mean patient-rated wrist evaluation score was 24.2, visual analogue scale pain score was 2.4, flexion-extension arc was 56% of the contralateral side and grip strength was 76%. Patients who underwent re-operation or injured their dominant hand had worse outcomes. Only 9% of patients were unable to return to their same job or a similar job as a result of their injury.
    Conclusions: Overall, patients retain a relatively high level of function and report low pain scores long-term after perilunate injuries. Multi-centre, prospective studies are required going forward.
    Keywords:  patient-reported outcomes; perilunate dislocation; perilunate injuries; wrist surgery
    DOI:  https://doi.org/10.1055/a-2500-9895
  33. Biomedicines. 2026 Mar 20. pii: 722. [Epub ahead of print]14(3):
    A Pilot Study Investigating Clinical and Functional Outcomes of Novel Double-Coil rPMS in Knee Osteoarthritis.
    Roman Bednár, Martina Flašková, Nicole Fejková.
      Background: Knee osteoarthritis (KOA) is one of the leading causes of chronic pain and long-term disability worldwide. Despite its high prevalence, KOA remains underrepresented in repetitive peripheral magnetic stimulation (rPMS) research. While total knee arthroplasty remains the definitive treatment, there is a growing need for non-invasive approaches to reduce symptoms in patients seeking conservative alternatives or awaiting surgery. Methods: Thirty patients with KOA underwent a non-invasive treatment program consisting of eight sessions of double-coil repetitive peripheral magnetic stimulation (rPMS) over three weeks. Outcome measures included pain intensity assessed by the Visual Analog Scale (VAS), functional ability evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Timed Up and Go test (TUG), and joint mobility measured as knee flexion and extension. Clinical relevance was evaluated using the Minimal Clinically Important Difference (MCID), and subgroup analyses were performed according to Kellgren-Lawrence (KL) grade. Results: Double-coil rPMS was associated with statistically and clinically significant improvements in all outcomes. MCID responder rates exceeded 80% for VAS and TUG, exceeded 70% for WOMAC, and approached 50% for joint mobility outcomes. Subgroup analysis indicated that patients with lower KL grades experienced greater pain reduction, whereas those with higher grades showed greater functional gains. Conclusions: Double-coil rPMS provided preliminary evidence of potential clinical benefit as a non-invasive approach in patients with KOA. Given the single-arm pilot design, the findings should be interpreted cautiously and require confirmation in adequately powered randomized controlled trials with longer follow-up.
    Keywords:  double-coil rPMS configuration; knee joint; osteoarthritis; repetitive peripheral magnetic stimulation
    DOI:  https://doi.org/10.3390/biomedicines14030722
  34. Cureus. 2026 Feb;18(2): e103948
    Efficacy of Intra-articular Platelet-Rich Fibrin Injection for Periarthritis of the Shoulder: A Pilot Study.
    Ankit Hooda, Hariprasad Seenappa, Tarun Kumar Somisetty Venkata Sai, Nagakumar J S, Nulaka Harish.
      Background Periarthritis of the shoulder (adhesive capsulitis) is a common and disabling condition characterized by pain and progressive restriction of shoulder motion. Conventional treatment modalities often provide inconsistent long-term outcomes. Platelet-rich fibrin (PRF) is an autologous biological product with regenerative and anti-inflammatory properties, though evidence for its intra-articular use in periarthritis remains limited. Objective To evaluate the clinical outcomes and safety of a single intra-articular injectable PRF (i-PRF) injection in patients with periarthritis of the shoulder. Methods This prospective single-arm interventional pilot study included 30 patients with periarthritis of the shoulder of less than six months' duration. All patients received a landmark-guided intra-articular i-PRF injection (approximately 3-4 mL) prepared using low-speed centrifugation (700 RPM, 60g at radius 110 mm, 3 minutes). Outcomes were assessed using the visual analog scale (VAS), Shoulder Pain and Disability Index (SPADI), and shortened Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) at baseline, immediate post-procedure, and at 2, 4, 8, and 12 weeks. Statistical analysis was performed using repeated measures analysis of variance (ANOVA). Results All patients completed the 12-week follow-up. Mean VAS scores improved significantly from 7.8 ± 1.2 at baseline to 1.5 ± 0.7 at 12 weeks (81% improvement, Cohen's d = 6.45, P < 0.001). SPADI scores improved from 68.5 ± 10.2 to 22.5 ± 6.3 (67% improvement, Cohen's d = 5.42), and QuickDASH scores from 65.3 ± 11.5 to 21.8 ± 7.1 (67% improvement, Cohen's d = 4.71) (P < 0.001 for both). Active range of motion improved significantly: forward flexion by 78.3°, abduction by 75.7°, and external rotation by 32.5° (all P < 0.001). Progressive improvement was observed at all follow-up intervals. No serious adverse events were reported. Conclusions Intra-articular PRF injection was associated with significant and sustained improvement in pain and functional outcomes in periarthritis of the shoulder, with an excellent safety profile. These preliminary findings support further randomized controlled studies to establish definitive efficacy.
    Keywords:  adhesive capsulitis; autologous blood-derived orthobiologics; periarthritis shoulder; platelet-rich fibrin; regenerative medicine therapies; shoulder stiffness
    DOI:  https://doi.org/10.7759/cureus.103948
  35. J Pediatr Orthop. 2026 Mar 23.
    Optimizing the Interventional Management of Meralgia Paresthetica: From Scythe to Scepter.
    Burak T Başoluk, Hilmi B Abacioğlu, Murat Kara.
      
    DOI:  https://doi.org/10.1097/BPO.0000000000003265
  36. J Pain Res. 2026 ;19 579829
    Intradiscal Procedures for Discogenic Low Back Pain: Considerations and Implications - A Narrative Review.
    Min Cheol Chang, Seoyon Yang.
      Discogenic low back pain (DLBP) is a prevalent contributor to chronic low back pain, often resulting from intervertebral disc degeneration associated with inflammation. Various intradiscal therapeutic procedures have been developed to address DLBP, including intradiscal steroid injections, methylene blue injections, platelet-rich plasma (PRP) injections, intradiscal electrothermal therapy (IDET), and both continuous (CRF) and pulsed (PRF) radiofrequency techniques. Intradiscal therapeutic procedures refer to minimally invasive interventions targeting the intervertebral disc, typically performed through percutaneous access under fluoroscopic or computed tomography guidance. These procedures aim to modulate nociceptive signaling or reduce intradiscal inflammation to relieve pain. This review aims to evaluate the existing evidence regarding the efficacy of intradiscal procedures for DLBP while assessing their potential risks, particularly concerning the acceleration of disc degeneration. Although certain interventions, specifically PRP and PRF, have yielded promising results in alleviating DLBP, the overall number of studies reporting positive therapeutic outcomes remains insufficient, and most lack long-term follow-up data. Significant concerns also arise regarding the potential for disc degeneration owing to needle insertion associated with intradiscal therapeutic procedures. Furthermore, IDET and CRF techniques can result in thermal injury to the disc. Evidence from discography studies suggests that disc degeneration may be accelerated, especially when larger needles are employed during the procedure. In addition, repeated interventions may lead to further intradiscal injury and accelerate disc degeneration. Despite these concerns, we propose that performing the procedure once or twice using a thin needle may be justifiable for patients with severe DLBP. Taken together, current evidence suggests that while selected intradiscal procedure, such as PRP and PRF, may provide transient benefit, heterogeneity in study design, short follow-up durations, and procedural risks limit definitive recommendations for routine clinical use. Future high-quality, long-term studies are crucial to enhance our understanding of the therapeutic benefits and associated risks of these interventions.
    Keywords:  discogenic pain; discography; low back pain; procedure; pulsed radiofrequency
    DOI:  https://doi.org/10.2147/JPR.S579829
  37. AJNR Am J Neuroradiol. 2026 Mar 24. pii: ajnr.A9307. [Epub ahead of print]
    Comparison of CT-guided platelet-rich plasma versus steroid/anesthetic injection for treatment of sacroiliac joint pain: a randomized, single-blinded, controlled trial.
    Miriam E Peckham, Zachary L McCormick, Ghazaleh Safazadeh, Troy A Hutchins, Ruth C Carlos, Lubdha M Shah.
       BACKGROUND AND PURPOSE: Low back pain (LBP) is a leading cause of disability and health care costs in the U.S., with the sacroiliac joint (SIJ) implicated in up to 30% of cases. Treatments such as steroid/anesthetic injection (SAI) and opioids offer short-term relief but are associated with systemic side effects and potential for dependency. Platelet-rich plasma (PRP), a biologically active autologous treatment, has demonstrated regenerative and anti-inflammatory properties that may offer a safer and more durable alternative, with some promise seen in the spine on prior trials. This study aimed to compare clinical effectiveness of CT-guided PRP versus SAI for SIJ-mediated low back pain using robust inclusion criteria.
    MATERIALS AND METHODS: This single-blinded, randomized controlled trial enrolled 44 adult patients with chronic SIJ pain confirmed by ≥50% pain relief following anesthetic block. Participants were then randomized to receive either PRP or SAI by CT-guidance, with outcomes assessed over 3 months. Primary outcome was change in numeric rating scale (NRS) pain scores. Secondary outcomes included modified Oswestry disability questionnaire, SF-12 quality-of-life metrics, functional mobility, and opioid use.
    RESULTS: Forty participants (20 per arm) remained for analysis at 3 months with both groups showing significant pain reduction (PRP vs. SAI; -3.0 ± 3.2 vs. -1.8 ± 2.4 mean change ± SD, p=.24). SAI produced greater early relief, while PRP demonstrated more sustained improvement, including a non-significant trend toward higher responder rates (≥50% NRS reduction; 60% vs. 35%, p=.11) and greater gains in disability and physical quality of life at 3 months outcome assessment.
    CONCLUSIONS: PRP and SAI both improved SIJ-related LBP, with PRP demonstrating a slower onset but potentially more durable benefit. PRP appears to be a viable, safe alternative to corticosteroids in managing chronic SIJ pain. Larger trials with longer follow-up are warranted to validate these findings and inform clinical guidelines.
    DOI:  https://doi.org/10.3174/ajnr.A9307
  38. Cardiovasc Intervent Radiol. 2026 Mar 23.
    HipE Study-Hip Embolization for Pain Control in Hip Osteoarthritis and Greater Trochanteric Pain Syndrome: 12 Months Follow-Up.
    Frederico Cavalheiro, Pedro Marinho Lopes, Filipa Sousa, Pedro Sousa, Daniela Linhares, Nuno Neves.
       PURPOSE: To evaluate the safety and efficacy of Transarterial Musculoskeletal Embolization (TAME) for pain relief and function improvement in hip Osteoarthritis (OA) and Greater trochanteric pain syndrome (GTPS).
    MATERIALS AND METHODS: This is a prospective single-arm, single-center study conducted from March 2023 to February 2025. TAME was performed using imipenem/cilastatin as the embolic agent in mild to severe hip OA and GTPS. Pain levels, stiffness, and functional limitation were assessed at baseline and at 1, 3, 6, and 12 months after the procedure using the Visual Analogue Scale (VAS) and the Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC). Clinical success was defined as a ≥ 50% reduction from baseline in either the WOMAC total score or VAS score at follow-up assessments. Adverse events were recorded according to CIRSE Classification System for Complications.
    RESULTS: TAME was performed in 49 patients; 37 patients have completed the 12-month follow-up, of whom 31 had hip OA and 6 had pure GTPS. Compared to baseline, significant improvements were observed at 12 months in VAS scores (7.84 ± 1.28 vs. 3,97 ± 2.40, p < 0.001), total WOMAC scores (54.36 ± 11.60 vs. 24.25 ± 14.28), WOMAC pain subscale (11.09 ± 3.10 vs. 4.71 ± 2.95, p < 0.001), WOMAC stiffness (3.21 ± 2.08 vs. 0.25 ± 1,30, p < 0.001), and WOMAC physical function (39.46 ± 9.20 vs. 18.09 ± 10.98, p < 0.001). Only 2 grade 1a adverse events were reported (groin hematomas). Clinical success was achieved in 73% of patients. No statistically significant differences were found between the OA subgroup and the pure GTPS subgroup.
    CONCLUSION: TAME is a safe and effective intervention for mild to severe OA and/or GTPS at midterm follow-up.
    Keywords:  Embolization; Greater trochanter pain syndrome; Hip; Musculoskeletal; Osteoarthritis ; Pain management
    DOI:  https://doi.org/10.1007/s00270-026-04403-9
  39. J Wrist Surg. 2026 Apr;15(2): 147-153
    TFCC Foveal Reconstruction for Chronic DRUJ Instability Using a Single Limb Tendon Graft Technique: A Minimum 32-month Follow-up Study.
    Bo Liu, Rebecca Qian Ru Lim.
       Purpose: In patients with symptomatic chronic distal radio-ulnar joint (DRUJ) instability with irreparable triangular fibrocartilage complex (TFCC), reconstruction with a tendon graft is indicated. We performed a follow-up study with a minimum 32-month follow-up in a bid to propose an arthroscopic TFCC anatomical reconstruction technique using a single limb of tendon graft as a viable option for patients with irreparable TFCC and chronic symptomatic DRUJ instability.
    Materials and Methods: Between 2015 and 2021, eight (four females, four males) patients with an average age of 29.5 years underwent this novel technique. Standard wrist arthroscopy portals were used. The palmaris longus was harvested with one end fashioned into an oblong-shaped tendon ball and secured with sutures. A bone tunnel was created at the metaphyseal region of the distal ulnar in the direction of the center of the fovea. The free end of the tendon graft was fed through the 6R portal and pulled via this bone tunnel to restore the foveal footprint. The wrist range of motion (ROM), grip strength, Patient-Rated Wrist Evaluation (PRWE), Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH), and Mayo Wrist Score (MWS) were used for evaluation pre-surgery and at follow-up.
    Results: At a minimum follow-up of 32 months (mean 77.5 months, range 32-105 months), DRUJ was stable in all patients. Comparing pre- and postoperative data, there was improvement with significant p -values in grip strength as compared with contralateral wrist (84 to 107%), PRWE (34.5 to 4.3), Q-DASH (28.2 to 3.4), and MWS (75 to 95). The average duration of the operation was 69.3 minutes (range 52-95 minutes).
    Conclusion: TFCC foveal reconstruction using a single limb of tendon graft is a viable arthroscopic technique in patients with symptomatic chronic DRUJ instability and irreparable TFCC.
    Level of Evidence: Level IV, Therapeutic.
    Keywords:  distal radio-ulnar joint instability (DRUJ instability); fovea reconstruction; tendon graft; triangular fibrocartilage complex (TFCC); wrist arthroscopy
    DOI:  https://doi.org/10.1055/a-2640-4354
  40. Hand Clin. 2026 May;pii: S0749-0712(25)00115-5. [Epub ahead of print]42(2): 163-172
    Atypical Fusions Radioscapholunate/Lunotriquetral: Open vs Arthroscopic.
    Shannon Tse, Christopher O Bayne.
      Although radioscapholunate (RSL) and lunotriquetral (LT) fusions are less commonly performed than other limited carpal fusions, they can relieve pain, correct deformity, and restore function for appropriately selected patients with wrist arthritis or instability. Distal scaphoid excision and triquetrum excision may improve range of motion in patients undergoing RSL fusion. Although complete LT coalitions are often asymptomatic, LT fusion may be considered to eliminate motion at the pseudoarthrosis site and relieve pain for symptomatic patients. Arthroscopic approaches may improve visualization and minimize soft tissue disruption but are technically challenging and may be associated with a steep learning curve.
    Keywords:  Arthroscopic; Lunotriquetral fusion; Open; Partial wrist arthrodesis; Radioscapholunate fusion; Technique; Wrist fusion
    DOI:  https://doi.org/10.1016/j.hcl.2025.12.007
  41. Ir Med J. 2026 Mar 19. 119(3): 46
    Driving Safety After Hip Injections: Brake Response Times.
    F Kenny, N Christodoulou, A AdeConde, A Sidhu, J Brillantes, J O'Byrne.
       Aims: Hip inflammatory conditions such as trochanteric bursitis and osteoarthritis significantly impact functional ability. While hip arthroplasty is common, hip injections are a less invasive pain management option for these conditions. Concerns about driving safety post-injection have led to guidelines advising against driving for 12-24 hours. This study assesses brake response time (BRT) before and after hip injections to determine driving fitness.
    Methods: In this prospective study, 55 patients scheduled for steroid and local anaesthetic hip injections at a National Orthopaedic Hospital were recruited. BRT was measured using a brake response machine both before and 30 minutes after the injection. Pain levels were assessed using the Visual Analog Scale (VAS). Paired t-tests compared pre- and post-injection BRT and VAS scores.
    Results: This study included 64 hips in patients with a mean age of 61.6 years. There was no significant difference in mean BRT pre- and post-injection (0.83 vs 0.84 seconds, p = 0.856). VAS scores significantly decreased post-injection (4.94 vs 3.52, p = 0.0243).
    Discussion: BRT was unaffected post-hip injection, suggesting patients can safely drive after receiving one. This result can impact patient experience of attending for an injection. Larger future studies assessing other driving factors are recommended.
  42. Acta Chir Orthop Traumatol Cech. 2026 Mar;93(1): 15-21
    [Ultrasound-Guided Injection of the Thoracolumbar Fascia in the Treatment of Low Back Pain: Methodological Approach and Anatomical Study].
    Tomáš Novotný, Ondřej Naňka, Daniel Nalos, Kamal Mezian.
       PURPOSE OF THE STUDY: To develop an anatomically verified protocol for ultrasound-guided analgesic interventions targeting the thoracolumbar fascia region for the treatment of both acute and chronic back pain.
    MATERIAL AND METHODS: One cadaver was embalmed using the Fix-4-Life method, which preserves tissue properties suitable for subsequent ultrasound visualization. Under ultrasound guidance, a needle was inserted to the thoracolumbar fascia at the level of the transverse process of the fourth lumbar vertebra. Upon contact with the transverse process, 5 ml of diluted red latex dye was injected. The distribution of the injected fluid was then observed through anatomical dissection.
    RESULTS: This cadaveric study confirmed that ultrasound-guided injection into the middle layer of the thoracolumbar fascia is both accurate and technically feasible. The dye demonstrated substantial potential to spread within the targeted area, distributing mediolaterally among the structures of the m. erector trunci and cranio-caudally over a range exceeding 10 cm, encompassing nearly four spinal segments.
    DISCUSSION: Back pain of various etiologies remains a major interdisciplinary challenge. Refining therapeutic techniques may improve the outcomes. The thoracolumbar fascia represents a promising target for delivering local anesthetics, depot corticosteroids, and next-generation hyaluronic acid derivatives.
    CONCLUSIONS: This study confirms the accuracy and feasibility of ultrasound-guided interventions targeting the thoracolumbar fascia.
    Keywords:  post spinal surgery syndrome; spine; thoracolumbar fascia.; ultrasound-guided interventions; vertebrogenic pain syndrome
    DOI:  https://doi.org/10.55095/achot2025/036
  43. Cureus. 2026 Feb;18(2): e103860
    Conservative Management of Acute Anterior Cruciate Ligament Rupture in Recreational Athletes: A Pilot Case Series.
    María Balboa-Alonso, Jose-Manuel Gonzalo-Orden, David Corral-Fontecha, Susana Gomez-González, Luis Díaz-Gállego, Jorge Salvador-Marín, Oscar Balboa-Arregui.
       BACKGROUND AND AIM: Surgical anterior cruciate ligament reconstruction (ACLR) remains the standard treatment for acute anterior cruciate ligament (ACL) rupture in highly active individuals but entails surgical risks, prolonged recovery, and incomplete return to sport in some cases. Conservative approaches enhanced with biologics, such as platelet-rich plasma (PRP) or autologous conditioned serum (ACS), have gained interest as potential alternatives in selected patients. This study aimed to describe ligament healing, clinical stability, and short-term return to sport in recreational athletes with acute ACL rupture treated conservatively with intra-articular PRP or ACS plus structured rehabilitation.
    METHODS: This retrospective pilot case series included eight recreational athletes (four females, median age 32 years) with magnetic resonance imaging (MRI) and clinically confirmed acute ACL rupture (<4 weeks from trauma) who opted for non-operative care. All received four ultrasound-guided intra-articular injections of PRP (GPS III; Warsaw, IN: Zimmer Biomet) or ACS (Orthokine) over six weeks, followed by a standardized rehabilitation protocol. MRI evaluation at 21-24 weeks assessed ACL continuity (grade 0-3). Clinical assessment included the pivot-shift test graded according to the International Knee Documentation Committee (IKDC) grading system, instrumented Lachman testing, the Tegner Activity Scale (TAS), and the International Knee Documentation Committee (IKDC) score at 24 weeks.
    RESULTS: MRI showed restored ACL continuity in all patients (grade 0 in 7/8; grade 1 in 1/8). Post-treatment pivot-shift testing showed grade 0 in 7/8 patients and grade 1 in 1/8 patients, while the Lachman test was negative in all patients. All patients returned to recreational sports within six months post-injury. No re-ruptures or complications were observed during a minimum six-month follow-up after return to sport.
    CONCLUSIONS: This study shows that intra-articular biologics (PRP or ACS) combined with structured rehabilitation were associated with MRI continuity, clinical stability, and safe return to sport at six months in recreational athletes with acute ACL rupture. This conservative treatment could be considered an alternative, and further investigation is warranted.
    Keywords:  anterior cruciate ligament; autologous conditioned serum; conservative treatment; mri; platelet-rich plasma; recreational athletes
    DOI:  https://doi.org/10.7759/cureus.103860
  44. Foot Ankle Int. 2026 Mar 17. 10711007261422252
    Does Platelet-Rich Plasma Speed Recovery After Acute Lateral Ankle Sprain? A Prospective Comparative Study Among Athletes.
    Gil Genuth, Peter Stavrou, Chris Brown, Lukas D Iselin.
       BACKGROUND: Acute lateral ankle sprains are among the most common musculoskeletal injuries, accounting for up to 20% of all sports-related injuries and a leading cause of time lost from athletic participation. Although most cases respond to conservative care, 20% to 40% of athletes develop persistent pain, recurrent sprains, or chronic instability. Biologic therapies such as platelet-rich plasma (PRP) have gained interest for their potential to accelerate ligament healing, but evidence in acute athletic ankle sprains remains limited.
    METHODS: This study was designed as a nonmasked randomized controlled trial of consecutively recruited patients presenting with acute lateral ankle sprain. This prospective comparative study enrolled 40 athletic patients (mean age 33.1 years; 50% male) who sustained an acute lateral ankle sprain and presented within 2 weeks of injury. All patients engaged in ≥3 sports sessions weekly, including 8 professional athletes. Participants were randomized to conventional treatment with rest, ice, compression, elevation (RICE) and physiotherapy (n = 20) or the same regimen plus 3 leukocyte-poor PRP injections administered at weekly intervals (n = 20). Primary outcomes were functional and pain assessment using Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Pain Interference (PI) computer adaptive tests at baseline, 6, and 12 months. The secondary outcome was time to return to unrestricted sport.
    RESULTS: Baseline PROMIS scores were similar between groups. PROMIS PF improved from 42.6 to 69.8 in the control group and from 43.0 to 71.4 in the PRP group by 12 months, whereas PROMIS PI decreased from 61.2 to 38.4 and 60.8 to 37.4, respectively. Both groups exceeded established minimal clinically important differences by 6 months, with no significant between-group differences at 6 or 12 months (PF, P = .68; PI, P = .74). Median time to unrestricted sports return was significantly shorter with PRP (14.5 weeks, 95% CI 13.1-15.9) compared to controls (17.8 weeks, 95% CI 16.2-19.4; P = .042). At 12 months, 3 PRP patients (15%) and 5 controls (25%) underwent surgery for persistent instability, consistent with published rates of failed conservative management.
    CONCLUSION: Leukocyte-poor PRP did not improve PROMIS Pain Interference, PROMIS Physical Function, or overall return to sport rates compared with conventional care. Although a statistically significant and clinically meaningful acceleration in time to return to sport with a moderate effect size was observed, this outcome was exploratory and underpowered, and larger prospective trials are required for confirmation.
    Keywords:  Patient-Reported Outcome Measures (PROMIS); acute lateral ankle sprain; ankle injuries; athletes; platelet-rich plasma (PRP); return to sport
    DOI:  https://doi.org/10.1177/10711007261422252
  45. Sci Prog. 2026 Jan-Mar;109(1):109(1): 368504261436105
    Elbow Varus posteromedial rotatory instability: Reflections from a multidimensional perspective.
    Shengkun Han, Pingyi Dong, Jingrui Zhao, Yuandong Liu, Yanxia Yin, Bo Yu.
      Varus posteromedial rotatory instability (VPMRI) is one of the types of complex elbow instability, which was initially proposed by O 'Driscoll in 2003. Its typical clinical manifestations are anteromedial coronoid fracture (AMCF), injury of lateral collateral ligament complex (LCL), widening of the lateral humeroradial space, and subluxation of the coronoid process relative to the medial edge of the humeral trochlea. However, it presents diagnostic challenges due to its low incidence, complex mechanisms of injury, and radiography reveals only isolated coronoid process fractures without obvious joint space mismatch. In addition to this, the current best treatment plan for VPMRI is still controversial. Misdiagnosis and mistreatment may lead to complications such as post-traumatic arthritis, heterotopic ossification, and joint stiffness. Therefore, enhancing recognition and suspicion of VPMRI and investigating its injury mechanism, treatment strategies, surgical approaches, and internal fixation methods are essential. This narrative review conducts retrospective analysis from different perspectives, and provides imaging examples and related schematic diagrams, aiming to provide a certain reference for the precise diagnosis and treatment of VPMRI.
    Keywords:  Varus posteromedial rotatory instability; anteromedial coronoid fracture; complex elbow instability; ligament injury; surgical treatment
    DOI:  https://doi.org/10.1177/00368504261436105
  46. Cardiovasc Intervent Radiol. 2026 Mar 21.
    Genicular Artery Embolization for Knee Osteoarthritis: Do Degradable Starch Microspheres Offer a New Therapeutic Option?
    Ali Dablan.
      
    DOI:  https://doi.org/10.1007/s00270-026-04425-3
  47. Healthcare (Basel). 2026 Mar 20. pii: 788. [Epub ahead of print]14(6):
    Balneotherapy and Manual Therapy of Key Myofascial Trigger Points as Therapeutic Integration for COPD Associated with Myofascial Pain Syndrome: A Case Series.
    Giovanni Barassi, Maurizio Panunzio, Loris Prosperi, Celeste Marinucci, Antonio Moccia, Davide Pio Fratta, Floriana Cristinziano, Michele Pio Della Rovere, Pier Enrico Gallenga.
      Background: Chronic Obstructive Pulmonary Disease (COPD) is a common condition that can cause dyspnea, pain, and biomechanical-postural alterations, especially when overlapping with Myofascial Pain Syndrome (MPS). Balneological rehabilitation medicine can help manage COPD and MPS, but it lacks homogeneity and detailed descriptions of effective therapeutic protocols. Therefore, we conducted a case series to preliminarily evaluate the clinical effects of a detailed and codified approach, called Bio-Physico-Metric Integrated Thermal Care (BPM-ITC), for COPD+MPS. Methods: 10 patients were observed while undergoing 20 sessions of BPM-ITC in 4 weeks. Patients were assessed before and after the protocol using the Medical Research Council (MRC) dyspnea scale, Numeric Pain Rating Scale (NPRS), and the Bio-Postural Questionnaire (BPQ) for bio-physical health status. Treatments included manual therapy of key myofascial trigger points combined with crenotherapy, steam inhalations, mud therapy, vascular path, and water-based motor re-education. Results: At the end of the protocol, clinically relevant improvements were observed in almost all parameters considered in single observed cases; overall statistical analysis of the data highlighted significant positive effects in concomitance with the BPM-ITC protocol. Conclusions: The BPM-ITC protocol was followed by significant clinical improvements in the observed cases, suggesting its potential as a complementary approach for COPD+MPS. Further studies on this topic are recommended.
    Keywords:  balneology; chronic obstructive pulmonary disease; manual therapy; physical therapy; rehabilitation; trigger points
    DOI:  https://doi.org/10.3390/healthcare14060788
  48. Adv Neonatal Care. 2026 Apr 01. 26(2): 136-140
    Congenital Genu Recurvatum: Report of Two Cases.
    Homa Babaei, Pourang Mohammadi, Nasim Bagheri Moheb.
       BACKGROUND: Congenital hyperextension of the knee joint is a rare malformation with a variety of names, principally genu recurvatum of knee, backward bending of the knee, and dislocation of knee. Abnormal anterior hyperextension position and limitation of flexion of tibiofemoral joint are the classical clinical presentation in an infant at birth. The accurate etiology of the malformation is undetermined. Congenital genu recurvatum (CGR) can occur as an isolated entity or can present in association with other congenital abnormalities like talipes equinovarus, developmental dysplasia of the hip, hindfoot, and forefoot abnormalities.
    CLINICAL FINDINGS: Two baby girls were born in our institution with abnormal position of the knees that one of them was isolated and the other associated with developmental dysplasia of hip.
    PRIMARY DIAGNOSIS: Based on clinical presentation and X-ray findings, diagnosis of CGR was proved for them.
    INTERVENTIONS: They were treated with early gentle manipulation, serial casting, and splinting at the first days of birth.
    OUTCOMES: Postnatal management of the CGR is conservative. Surgical treatment is the last option.
    PRACTICE RECOMMENDATIONS: Newborns with CGR should be evaluated to determine the cause and plan treatment. Symptoms include pain, joint instability, limb length difference, and cosmetic concerns. A full physical examination with bilateral comparison is essential. Radiology helps measure recurvatum in terms of bone and ligament involvement. Knowing the cause guides proper treatment.
    Keywords:  congenital genu recurvatum; hyperextension of knee; knee dislocation
    DOI:  https://doi.org/10.1097/ANC.0000000000001343
  49. Clin J Sport Med. 2026 Mar 25.
    Acute Calcific Periarthritis Beyond the Shoulder: A Case Report of Fifth MCP Involvement.
    Anahis Davidian, Madison Nygren, Jeffery Leggit.
       ABSTRACT: Acute calcific periarthritis (ACP) is a self-limiting periarticular process caused by calcium hydroxyapatite crystal deposition, most commonly affecting the shoulder and rarely involving the hand. We present a case of a 33-year-old woman with acute pain and swelling of the right fifth metacarpophalangeal joint after minor trauma. Radiographs and ultrasonography confirmed periarticular calcification consistent with ACP. The patient was treated with NSAIDs, corticosteroids, and immobilization, resulting in full recovery. This case highlights ACP's diagnostic challenge at atypical sites, where it mimics infection or gout. Recognizing characteristic imaging is essential for accurate diagnosis and effective management.
    Keywords:  acute calcific periarthritis; corticosteroids; fifth metacarpophalangeal joint; hand; hydroxyapatite deposition; nonsteroidal anti-inflammatory drugs; radiography; ultrasound; ultrasound-guided barbotage
    DOI:  https://doi.org/10.1097/JSM.0000000000001436
  50. J Neurosurg Case Lessons. 2026 Mar 16. pii: CASE25948. [Epub ahead of print]11(11):
    Bertolotti joint-related cyst: illustrative case.
    William D Chow, Robert J Spinner, Kimberly K Amrami, Benjamin D Elder, Michael P Steinmetz.
       BACKGROUND: Bertolotti syndrome is an underrecognized cause of chronic low back pain. Back pain generated from Bertolotti syndrome is believed to result from altered weight dissipation mechanics and/or instability of the pseudoarticulation, while local nerve root compression may result in radiculopathy. Here, the authors describe the findings of a patient with treatment-refractory low back pain found to have a cystic lesion arising from a Bertolotti joint causing L5 nerve root compression. To their knowledge, this has not been previously described in the literature.
    OBSERVATIONS: Despite early recognition of Bertolotti syndrome, the patient's back pain remained resistant to many years of both conservative and surgical management. The novel finding of a cyst arising from the pseudoarticulation complicated the management. The patient is scheduled to undergo further surgery this year.
    LESSONS: This case highlights a pseudocyst associated with a Bertolotti joint. The cyst introduced additional clinical uncertainty to what is already an uncommon and difficult to treat condition. Resection of the Bertolotti joint failed to improve the patient's symptoms. Postoperatively, a complex hemorrhagic pseudocyst was seen on imaging, possibly due to the pseudoarticulation with persistent motion. Ongoing efforts to characterize Bertolotti syndrome and its associated imaging findings are necessary to better optimize management strategies in these patients. https://thejns.org/doi/10.3171/CASE25948.
    Keywords:  Bertolotti joint; cyst; lumbosacral transitional vertebrae
    DOI:  https://doi.org/10.3171/CASE25948
  51. Front Pain Res (Lausanne). 2026 ;7 1791542
    Platelet-rich plasma for treatment of knee osteoarthritis: a narrative review.
    Samuel L Patton, Kelsey Gustafson, Matt Castinado, Usman Latif, Dawood Sayed, Talal W Khan, Christopher M Lam.
      Osteoarthritis is the most common cause of arthritis, a pervasive condition affecting various joints within the human body. The culmination of various factors resulting in degradation and damage of healthy cartilage initiates the cascade of degenerative changes which contribute to the development of this condition, affecting about 73% of all adults older than age 55. Various treatments are available to help treat this condition. Prevention often includes the utilization of physical therapy, exercise, and weight management while treatment of the resultant joint pain includes bracing, medications, and interventional treatments including steroid and visco supplementation techniques. Within the past two decades, particular interest has developed in utilizing regenerative methods for treatment of these degenerative conditions. One such treatment is platelet rich plasma. Here we review the salient conceptions of this treatment and provide a brief overview of the evidence and healthcare impact regarding its utilization.
    Keywords:  interventional pain; knee osteoarthritis; pain management; platelet-rich plasma (PRP); regenerative medicine
    DOI:  https://doi.org/10.3389/fpain.2026.1791542
  52. JSAMS Plus. 2025 Jun;5 100105
    Ultrasound-guided intra-muscular botulinum toxin A in athletes with chronic adductor-related groin-pain: A retrospective observational study.
    Julien Orhan, Romain Garofoli, Émilie Alperin, Fabien Ladauge, Jennifer Zauderer, Guillaume Paris, François Rannou, Christelle Nguyen, Marie-Martine Lefèvre-Colau.
       Introduction: Chronic adductor-related groin pain (AP) is a frequent and disabling sport condition. Intra-muscular injection of botulinum toxin A may have positive effects on pain in some chronic tendinitis. We aimed to describe the short-term evolution of pain, activity limitations and quality of life, after an injection of the adductor longus with botulinum toxin A, as an add-on therapy to standard of care in patients with chronic AP.
    Method: We conducted a retrospective observational single-centered study. We included individuals with clinical and MRI chronic AP, for whom medical and/or surgical treatments have failed and who were treated with an intra-muscular injection of botulinum toxin A (100 units of botulinum toxin A in the adductor longus) under ultrasound guidance. Participants were assessed 50 days after injection for pain using a numerical rating scale (NRS) and for activity limitations and quality of life using the Copenhagen Hip and Groin Outcome Score (HAGOS). Participants were also asked to self-report adverse events.
    Results: We included 20 participants. Mean age was 34.3 (11.7) years and mean symptom duration was 48.9 (61.6) months. Mean pain decreased from 55.3 (SD [22.4] before injection to 38.3 [21.7], 50 days after injection (p ​= ​0.027). Each of the 6 HAGOS subscales improved before and after injection. No serious adverse events were self-reported by the patients included in the main analysis.
    Conclusion: In this retrospective uncontrolled trial, we observed a numerical decrease in pain intensity in individuals with chronic AP 50 days after intra-muscular botulinum toxin A injection in the adductor longus.
    Keywords:  Adductor enthesopathy; Botulinum toxin; Chronic athletic pubalgia; Groin pain
    DOI:  https://doi.org/10.1016/j.jsampl.2025.100105
  53. Sci Rep. 2026 Mar 24.
    Intradiscal platelet-rich plasma for discogenic low back pain: a prospective cohort study of early clinical outcomes and quantitative MRI findings.
    Xiaohan Pan, Gang Peng, Qi Yao, Zeyu Liu, Xiaojun Zhang, Wei Jiang, Jie Hao.
      Discogenic low back pain (DLBP) is a major cause of disability. Platelet-rich plasma (PRP) has shown regenerative potential in preclinical models, but clinical results remain heterogeneous and early biological responses in humans are incompletely understood. We conducted a prospective cohort study (November 2023-October 2024) to evaluate early clinical outcomes and quantitative MRI (qMRI) changes after intradiscal PRP injection for DLBP. Symptom scores (VAS, ODI and FRI) and qMRI measures (whole-disc T2 and vertebral marrow fat fraction in adjacent vertebrae) were assessed at baseline and at 1, 3 and 6 months. A composite minimal clinically important difference (MCID) was predefined as a ≥ 30% reduction from baseline in both VAS and ODI. Longitudinal changes were analyzed using linear mixed-effects models, and baseline-to-6-month changes were correlated using Pearson tests. Forty-five patients were recruited and 29 completed follow-up. VAS, ODI and FRI decreased significantly over time (all P < 0.001), and 79.3% achieved the composite MCID at 6 months. Vertebral marrow fat fraction adjacent to the treated disc declined significantly (P < 0.001) and correlated with improvements in VAS, ODI and FRI (r ≈ 0.46-0.56; P < 0.01), whereas changes in whole-disc T2 were small and not associated with symptom change. No treatment-related complications were observed. Intradiscal PRP appeared safe and clinically promising over 6 months, with qMRI suggesting an early effect on the peridiscal metabolic environment.
    Keywords:  Discogenic low back pain; Fat fraction; Platelet-rich plasma; Quantitative MRI; T2 mapping
    DOI:  https://doi.org/10.1038/s41598-026-42909-x
  54. Clin Interv Aging. 2026 ;21 558427
    Effect of the Center Bridge-Type Knee Orthosis on the External Knee Adduction Moment During Gait in Patients with Knee Osteoarthritis.
    Kosuke Nakano, Yasuhiro Mine, Junji Katsuhira, Kantaro Yamauchi, Masateru Kitashiro, So Nomoto, Nobuhiro Asano.
       Purpose: This study aimed to investigate the biomechanical effects of a center bridge-type knee orthosis prescribed for patients with knee osteoarthritis (OA) based on real-time, direct quantification of external knee adduction moment (EKAM), a key mechanical indicator associated with progression of knee OA.
    Patients and Methods: To evaluate the effect of the center bridge-type knee orthosis, 17 patients with knee OA performed level-ground walking under two conditions: with and without the orthosis. Each participant completed gait trials in both conditions in a randomized order. Additionally, 18 healthy older individuals were assessed during free walking for comparisons. The analysis focused on the gait stance phase, during which substantial mechanical loading was exerted on the knee joint. Gait data were obtained using a six-axis force-torque sensor.
    Results: In patients with knee OA, wearing the orthosis significantly reduced EKAM during the loading response compared with that in the no-orthosis condition. Furthermore, EKAM values in patients wearing the orthosis became comparable to those in healthy participants during the loading response and pre-swing phases. No significant differences in gait parameters, such as walking speed or stride length, were observed between groups or conditions.
    Conclusion: These findings suggest that in patients with OA, achieving EKAM values comparable to those in healthy individuals would require a valgus corrective moment at least 5.34 times greater than that produced by the center bridge-type knee orthosis. Clinically, this indicates that current orthotic designs may provide insufficient mechanical offloading, and that further structural refinements are required to enhance valgus correction and achieve more effective reduction of medial knee loading during gait.
    Keywords:  force-torque sensor; loading response; stance phase; valgus corrective moment; walking biomechanics
    DOI:  https://doi.org/10.2147/CIA.S558427
  55. Med Sci (Basel). 2026 Feb 27. pii: 114. [Epub ahead of print]14(1):
    Clinical and Metabolic Predictors of Response to Focused Extracorporeal Shockwave Therapy in Rotator Cuff Tendinopathy: A Retrospective Cohort Study.
    Sveva Maria Nusca, Eleonora Latini, Gabriele Santilli, Gioia Beccarini, Valerio Bova, Flavia Santoboni, Valter Santilli, Giorgio Felzani, Fabrizio Perroni, Mariachiara Vulpiani, Davide Sisti, Mario Vetrano.
       BACKGROUND: Rotator cuff tendinopathy is a major cause of shoulder pain and disability. Focused extracorporeal shockwave therapy (ESWT) is an established conservative treatment option; however, the predictive factors influencing the treatment response remain poorly characterized.
    OBJECTIVES: To identify clinical, demographic, and metabolic predictors of pain reduction and functional improvement at four months following focused ESWT in patients with supraspinatus tendinopathy, with the goal of informing individualized treatment planning and early prognostic counseling.
    METHODS: This retrospective cohort study analyzed patients with supraspinatus tendinopathy (calcific and non-calcific) treated with focused ESWT at a university rehabilitation center between June 2020 and December 2025. Outcomes were assessed at baseline and 4-month follow-up using the Visual Analog Scale (VAS), Roles and Maudsley, and Constant-Murley scores. Change score analysis with covariate adjustment and backward stepwise selection were performed to identify predictors of clinical improvement.
    RESULTS: A total of 239 patients (97 males [40.6%], 142 females [59.4%]; mean age 60.2 ± 11.5 years; mean BMI 25.5 ± 4.0 kg/m2) were included, of whom 101 (42.3%) had calcific tendinopathy. Significant improvements were observed in all outcomes: VAS decreased from 6.50 ± 1.35 to 3.96 ± 2.09 (p < 0.001; Cohen's d = 1.24), and Constant-Murley score increased from 60.38 ± 14.53 to 75.88 ± 15.52 (p < 0.001; Cohen's d = 1.07). Patient-reported satisfaction (Roles and Maudsley score) showed a 91.2% success rate (excellent or good outcomes). Regression analysis identified baseline severity as the strongest predictor of improvement in all models. BMI emerged as a significant predictor of functional recovery (β = -0.95, p < 0.001 for Constant-Murley change), with each 1 kg/m2 increase associated with approximately 1-point less improvement.
    CONCLUSIONS: Baseline clinical severity and body mass index were consistent predictors of ESWT effectiveness in rotator cuff tendinopathy. A lower BMI was associated with greater functional improvement, highlighting a potentially modifiable factor for treatment optimization. These findings support personalized treatment planning and early prognostic counseling in clinical practices.
    Keywords:  body mass index; extracorporeal shockwave therapy; predictive factors; rehabilitation; rotator cuff tendinopathy; supraspinatus
    DOI:  https://doi.org/10.3390/medsci14010114
  56. Clin Cosmet Investig Dermatol. 2026 ;19 588595
    Peripheral Nerve Ultrasound Findings in Leprosy: A Scoping Review of Echogenicity, Cross-Sectional Area, and Vascularization Across 15 Studies.
    Hendra Gunawan, Rais Khairuddin, Risa Miliawati Nurul Hidayah, Harry Galuh Nugraha, Atta Kuntara, Fatimah Amalia.
       Background: Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae and Mycobacterium lepromatosis, primarily affecting the skin and peripheral nerves. Neuropathy in leprosy can result in significant disability, making early detection crucial. Ultrasound offers a non-invasive method to detect neuropathy by assessing echogenicity, cross-sectional area (CSA), and peripheral nerve vascularity.
    Objective: This review aimed to map and synthesize diagnostic role of peripheral nerve ultrasound, focusing on echogenicity, cross-sectional area, and vascularization, in detecting leprosy-related neuropathy.
    Methods: This scoping review was conducted in accordance with the PRISMA-ScR guidelines and included 15 studies assessing echogenicity, CSA, and vascularity in leprosy patients (sample sizes ranging from 20-308 participants).
    Results: Ultrasound consistently identified nerve abnormalities across 15 studies, including hypoechogenicity and fascicular pattern loss (up to 72% of nerves), CSA enlargement, and Doppler vascularity (11-45%) correlating with active inflammation. Reported CSA cut-offs (10-50 mm2) yielded sensitivities of 63-90% and specificities of 67-100% across studies. Ultrasound demonstrated superior sensitivity over clinical palpation and nerve conduction studies for subclinical neuropathy detection.
    Conclusion: This scoping review demonstrates ultrasound's utility for early leprosy-related neuropathy detection. Ultrasound shows superior sensitivity over clinical palpation for subclinical involvement, particularly valuable for household contacts and pure neural leprosy. However, methodological heterogeneity precludes definitive diagnostic thresholds. Future research should standardize protocols and validate ultrasound parameters to optimize clinical application and disability prevention in endemic regions.
    Keywords:  early detection; leprosy; peripheral nerve; ultrasound
    DOI:  https://doi.org/10.2147/CCID.S588595
  57. Cureus. 2026 Feb;18(2): e104073
    Comparative Analysis of the Effects of Functional Magnetic Stimulation and Interferential Current on Pain Control in Patients With Knee Osteoarthritis.
    Ena Gogić, Edina Tanović, Damir Čelik, Alen Džubur, Nadina Kurtanović, Amela Džubur, Aldijana Kadrić, Dževad Vrabac, Amir Merdović.
       OBJECTIVE: The objective of this study is to compare the analgesic effects of functional magnetic stimulation (FMS) and interferential current therapy (IFC) in patients with knee osteoarthritis (KOA) before and after treatment.
    METHODS: This prospective pilot study included 30 patients with KOA, who were randomly assigned to two groups: FMS (n = 15) and IFC (n = 15). Both groups received 20 treatment sessions over four weeks. Pain intensity was assessed using the visual analog scale (VAS) pre- and post-treatment. Non-parametric statistical tests were applied due to the small sample size and non-normal distribution of the data.
    RESULTS: In the FMS group, the median VAS score decreased significantly from pre-intervention (Me = 7.0; IQR, 5.0-7.0) to post-intervention (Me = 2.0; IQR, 1.0-2.0), with z = -3.43, p < 0.001. In the IFC group, there was also a significant decrease in the median VAS score from pre-intervention (Me = 7.0; IQR, 5.5-8.0) to post-intervention (Me = 5.0; IQR, 4.0-6.0), z = -3.47, p < 0.001. The Mann-Whitney U test demonstrated a statistically significant difference; the median ΔVAS was significantly higher in the FMS group (Me = 4; IQR, 3.5-6.0) than in the IFC group (Me = 2; IQR, 1.0-2.0) (U = 45, Z = -4.576, p < 0.001).
    CONCLUSION: FMS may be a more effective non-invasive treatment option for pain reduction in patients with KOA compared with IFC.
    Keywords:  functional magnetic stimulation; interferential current therapy; knee osteoarthritis; pain management; physical therapy; visual analog scale
    DOI:  https://doi.org/10.7759/cureus.104073
  58. Am J Sports Med. 2026 Mar 25. 3635465261429491
    Hip Arthroscopy in Patients With Acetabular Dysplasia: A Systematic Review of Clinical Outcomes at Long-term Follow-up.
    Chandler A Sparks, Ty L Monty, Joseph C Brinkman, Kristen I Barton, Shane J Nho.
       BACKGROUND: Hip arthroscopy has shown satisfactory outcomes for the treatment of intra-articular pathology and femoroacetabular impingement syndrome (FAIS) in the setting of acetabular dysplasia at short- and mid-term follow-up. However, the long-term outcomes remain less understood.
    PURPOSE: To systematically review the literature to determine patient-reported outcomes (PROs), clinically significant outcome (CSO) achievement, reoperation rates, and predictors of failure in patients with acetabular dysplasia undergoing hip arthroscopy at long-term follow-up.
    STUDY DESIGN: Systematic review; Level of evidence, 4.
    METHODS: Three databases were searched around the following terms: hip arthroscopy, dysplasia, and long-term follow-up. Articles available in English, presenting original data, and reporting on a mean follow-up of ≥10 years after primary hip arthroscopy using either PROs, CSOs, or conversion to total hip arthroplasty (THA) and/or revision surgery were included. Quality assessment was completed using Methodological Index for Non-Randomized Studies (MINORS) assessment.
    RESULTS: Five studies (555 hips) were included in the systematic review: patients had a mean age of 30 to 41 years, 13% to 88% of patients were female, and follow-up ranged from 9.6 to 12 years. MINORS assessment ranged from 11 to 21. All studies included PROs and reported statistically significant improvement for most PROs. The most frequent PRO was the Modified Harris Hip Score (mHHS) (n = 5). All studies reported CSO achievement, with mHHS and Hip Outcome Score-Sport Specific (HOS-SS) being the most common (n = 4). Revision surgery and conversion to THA ranged from 2.6% to 15.2% and from 2.6% to 23.7%, respectively across dysplasia cohorts. The most common definition of failure was conversion to THA, and Tönnis angle was the most common predictor of failure. Four studies made comparisons to a nondysplasia group, with 1 study finding inferior HOS-SS and inferior achievement of Patient Acceptable Symptom State across multiple PROs in the dysplasia group. All 4 comparative studies found no differences in rates of revision surgery or conversion to THA between groups.
    CONCLUSION: Hip arthroscopy can reliably provide durable and clinically meaningful improvements for the treatment of intra-articular pathology and FAIS in patients with acetabular dysplasia at long-term follow-up, with comparable rates of revision surgery and conversion to THA to nondysplastic cohorts, although select dysplastic populations may demonstrate inferior patient-reported outcomes.
    Keywords:  femoroacetabular impingement; hip arthroscopy; hip dysplasia
    DOI:  https://doi.org/10.1177/03635465261429491
  59. J Pers Med. 2026 Mar 06. pii: 152. [Epub ahead of print]16(3):
    Sex and Gender in Chronic Obstructive Pulmonary Disease: Does It Matter?
    Christos Kyriakopoulos, Georgios Hillas, Antonia Assioura, Anastasia Papanikolaou, Vasileios Angelopoulos, Konstantinos Kostikas, Athena Gogali.
      Chronic obstructive pulmonary disease (COPD) is a major contributor to global respiratory morbidity and exhibits substantial sex- and gender-related differences in incidence, phenotype, pathophysiology, and outcomes across the life course. Historically regarded as a predominantly male disease due to higher smoking rates, COPD is now increasingly recognized among women, reflecting changing exposure patterns and enhanced diagnostic attention. Moreover, evidence indicates that women may be more biologically susceptible to the harmful effects of tobacco smoke and often develop COPD at younger ages. Clinical manifestations also differ, with women more frequently reporting dyspnea, anxiety, and depression, whereas men may exhibit more cough and sputum production. Imaging studies suggest that airway-predominant disease is more common in women, while men are more likely to demonstrate emphysema-predominant patterns. Furthermore, women face an increased risk of exacerbation, yet they are more likely to experience underdiagnosis or misdiagnosis. Treatment responses and comorbidity patterns also show sex- and gender-related variations. Despite these differences, most clinical guidelines and therapeutic strategies do not differentiate by sex and gender, highlighting a gap in personalized COPD management. Overall, growing evidence underscores the importance of incorporating sex and gender as biological and sociocultural variables in COPD research, diagnosis, and treatment. Recognizing sex/gender-specific risk profiles, symptom patterns, and disease phenotypes may improve early detection and enable more targeted, effective interventions. This narrative synthesis, derived from a meticulous search in PubMed and the critical selection of 74 articles from the 448 identified originally, integrates evidence from guideline statements, registry studies, mechanistic and preclinical research, imaging and physiology investigations, systematic reviews, and randomized controlled trials that report sex- and gender-disaggregated data.
    Keywords:  COPD; gender; personalized COPD management; sex
    DOI:  https://doi.org/10.3390/jpm16030152
  60. Front Pain Res (Lausanne). 2026 ;7 1717540
    Impact of therapeutic exercises on pain-related outcomes in patients with knee osteoarthritis: an umbrella review of 116 systematic reviews.
    Dmitriy Viderman, Sultan Kalikanov, Akerke Mazhibiyeva, Alua Shagirova, Malika Toleubekova, Mina Aubakirova, Yerkin G Abdildin.
       Background and objectives: Chronic knee pain is highly prevalent in various knee diseases. It significantly decreases patients' quality of life. Among non-surgical interventions, exercise is considered a promising approach for alleviating chronic knee pain. This umbrella review aimed to systematically synthesize and critically appraise evidence from recent systematic reviews on the effectiveness of therapeutic exercises for knee osteoarthritis across pain, physical function, quality of life, and biomechanical outcomes.
    Materials and methods: We searched for systematic reviews with/without meta-analyses in PubMed, Scopus, and Cochrane Library databases.
    Results: A total of 116 systematic reviews and meta-analyses were included, published predominantly after 2014. Interrater agreement was substantial (κ = 0.76). Methodological quality was generally low, with 81% of reviews rated low or critically low by AMSTAR-2. Most reviews focused on knee osteoarthritis (72%) and evaluated strength/resistance, aerobic, or mind-body exercises. Pain was the most frequently reported outcome, with improvement noted in 69 reviews, followed by physical function (44 reviews) and quality of life (22 reviews). However, biomechanical outcomes were infrequently assessed and often inconclusive. Across outcomes, positive findings were largely derived from reviews with methodological limitations, warranting cautious interpretation. Thus, the percentages reflect the distribution of reported effects, and the magnitude and reliability of these effects remain limited.
    Conclusions: Therapeutic exercises may help reduce pain, improve physical function and quality of life in patients with knee osteoarthritis. However, the overall certainty of evidence is limited by the variable methodological quality of the included systematic reviews. At present, no single type of therapeutic exercise can be considered the most effective for all individuals with knee osteoarthritis.
    Systematic Review Registration: https://osf.io/pqgrv/overview, doi: 10.17605/OSF.IO/PQGRV.
    Keywords:  AMSTAR-2; exercise therapy; joint function; knee biomechanics; qigong; tai chi
    DOI:  https://doi.org/10.3389/fpain.2026.1717540
  61. Hip Int. 2026 Mar 22. 11207000261416847
    What is the prevalence of extra-articular and intra-articular magnetic resonance imaging findings in football players with and without hip and/or groin pain? A cross-sectional study of 166 football players.
    Emma Buckthorpe, Joshua J Heerey, Tom Entwistle, Kay M Crossley, Alex Davies, Matthew G King, Mark J Scholes, Joanne L Kemp.
       AIM: The primary aim of this study was to describe the prevalence of MRI findings in football players with and without hip and/or groin pain (HGP).
    METHODS: We described the prevalence of extra-articular findings (including gluteal, hamstring, iliopsoas, rectus femoris; pubic) and intra-articular (including labral, cartilage, bone marrow oedema, subchondral and paralabral cysts, ligamentum teres) findings on MRI for 215 eligible hips with HGP (132 participants) and 68 eligible asymptomatic hips (34 participants). Imaging of the hip joint included radiographs and a non-contrast 3.0 Tesla MRI, performed at a single imaging centre.
    RESULTS: There was no difference between groups for prevalence of any extra-articular or intra-articular findings. Pubic (75-85%), labral (70-78%) and chondral (54-60%) findings were most common. ⅓ of hips demonstrated all 3 findings regardless of symptoms (33.5% in HGP group and 35.5% in control group). 96.7% of HGP participants and 95.6% of control participants had at least 1 finding.
    CONCLUSIONS: Our study found that prevalence of extra- and intra-articular hip MRI findings did not differ between football players with and without HGP. Football players with and without pain were likely to have multiple imaging findings in 1 hip. A thorough history and clinical examination should be used to contextualise any imaging findings.
    Keywords:  Athletes; football; hip; magnetic resonance imaging
    DOI:  https://doi.org/10.1177/11207000261416847
  62. J Educ Health Promot. 2026 ;15 51
    Addition of immersive virtual reality-mediated programs with conventional physiotherapy on quality of life in knee osteoarthritis - A protocol of a randomized controlled trial.
    Kamalakannan Rathinavel, Ajay Kumar, Rajasekar Sannasi, Prem Venkatesan.
       BACKGROUND: Knee osteoarthritis (OA) is a debilitating condition causing persistent pain that significantly impacts a patient's physical and psychological wellbeing, ultimately reducing their quality of life. Existing research predominantly compares immersive virtual reality (IVR) with passive treatments of electrotherapy, neglecting comparisons with active exercise-based conventional physiotherapy interventions. This trial investigates the effectiveness of IVR-mediated programs in addition to conventional physiotherapy on quality of life, fear of movement, and pain self-efficacy in knee OA.
    MATERIALS AND METHODS: This study has been planned to be conducted in a musculoskeletal outpatient department. A total of 96 patients will be screened for OA according to ACR criteria and randomly allocated to two groups: Group-A (IVR-based exercise program + conventional physiotherapy) and Group-B (conventional physiotherapy). The primary outcome would be Knee Injury and Osteoarthritis Outcome Score (KOOS), and the secondary outcomes are psycho-cognitive domains such as Tampa scale of kinesiophobia and pain self-efficacy and muscle strength and functional performance test. The patients will undergo 6 weeks of supervised exercise programs, and outcomes measures will be recorded before the first treatment session and post treatment at 6 weeks and follow-up at the 12th week and 24th week. Normality of the data will be analyzed using Kolmogorov-Smirnov test. Descriptive statistics will be expressed in either mean and standard deviation or median and 95% confidence interval based on normality. Effect Size Index (ESI) will be calculated for all the groups in postintervention after 6 weeks. Comparison of outcome measures will be done for both within and between group analyses at the different points of time with respective statistics using SPSS-20.0 program. A P value < 0.05 will be considered statistically significant.
    CONCLUSION: By identifying the most effective intervention in both physical and psychosocial impairments in managing OA knee, this study may be helpful for clinicians to opt the therapeutic intervention that treats OA knee patients suffering from pain, kinesiophobia, and compromised quality of life.
    Keywords:  Exercise; immersive virtual reality; kinesiophobia; knee osteoarthritis; pain self-efficacy; quality of life (QoL)
    DOI:  https://doi.org/10.4103/jehp.jehp_620_25
  63. J Clin Med. 2026 Mar 17. pii: 2294. [Epub ahead of print]15(6):
    Prediction of Inpatient Rehabilitation Length, Discharge Destination and Home-Care Needs After Total Hip and Knee Arthroplasty for Osteoarthritis: A Follow-Up Study on 1.679 Patients.
    Federico Pennestrì, Giuseppe Banfi, Catia Pelosi, Dario Grippa, Marta Valenti, Lucia Imperiali, Stefano Borghi, Stefano Negrini, Carlotte Kiekens, Valentina Tosto, Claudio Cordani, The Prepare Project Group.
      Background: Medical progress and sustainability pressures have made reducing hospital Length Of Stay (LOS) for total joint arthroplasty increasingly feasible and necessary. Monitoring rehabilitation duration and outcomes after surgical ward discharge needs equal attention. The aim of this retrospective, cohort study is to evaluate perioperative predictors of Inpatient Rehabilitation LOS (IRLOS), Discharge Destination (DD) (home versus residential care unit) and Need for Assistance at Discharge (NAD), in patients undergoing inpatient rehabilitation after total hip or knee arthroplasty in a high-volume, specialized research hospital. Methods: Electronic hospital datasets were employed to identify all adults with hip or knee osteoarthritis who received specialistic inpatient rehabilitation after total joint replacement between January and December 2019. Associations between demographic, clinical, surgical and functional variables and postoperative outcomes were examined using binary logistic regression for dichotomous outcomes (DD, NAD) and linear regression for continuous outcomes (IRLOS). Results: Based on a cohort of 1679 patients, we found various patient-related (age, working status, living alone, pre-existing comorbidities, osteoarthritic characteristics), surgical (duration of intervention, LOS, joint approach) and postoperative (hemoglobin levels, functional status) predictors. Overall, the regression models explained a modest but meaningful proportion of the variability in rehabilitation duration and post-discharge outcomes (R2 ranging from 0.12 to 0.34), resulting in marginal changes compared to a preliminary version of the same study on a smaller dataset. Conclusions: External validation on another cohort from the same hospital could be used to test the model's predictivity at the local level, supporting the continuity of care between an orthopedic hospital hub and outpatient care and rehabilitation. Gains in predictive capacity may follow from including local factors like the operating surgeon and team. Although these factors could significantly improve the model performance at the local level, they would not be generalizable in different settings.
    Keywords:  arthroplasty; hip; hospital records; knee; length of stay; osteoarthritis; rehabilitation; retrospective studies
    DOI:  https://doi.org/10.3390/jcm15062294
  64. Trials. 2026 Mar 25.
    Radiofrequency ablation for the treatment of chronic pain after knee arthroplasty: protocol for a randomized, double-blind study.
    Italo Gabriel Pisani-Zambrano, Josep María Segur-Vilalta, Jorge Orduña-Valls, Alejandro Rodríguez-Molinero.
       BACKGROUND: To date, there is no standard treatment for chronic pain after knee arthroplasty. Radiofrequency ablation of the sensory nerves in the knee has become a useful therapeutic approach; however, variability in terms of treatment approaches and anatomical targets causes difficulties in standardizing a reproducible and viable technique. The aim of this study is to determine if radiofrequency ablation of the nerves of the vastus medialis (NVM), vastus intermedius (NVI), vastus lateralis (NVL), and infrapatellar branch of the saphenous nerve (IPBSN) improves pain and disability from baseline to 3 months versus placebo in patients with post-knee arthroplasty pain.
    METHODS: This double-blind, placebo-controlled, randomized trial will be conducted in two hospitals in Catalonia, Spain. Patients will undergo anaesthetic blocks of nerve branches to determine radiofrequency candidacy. After adequate response to the anaesthetic blocks (≤ 50% of baseline pain levels for > 24 h), patients will be subjected to radiofrequency ablations or control simulations. Treatment responses will be evaluated using clinically validated questionnaires (Western Ontario McMaster Universities Osteoarthritis Index [WOMAC], visual numerical scale for pain, DN4 questionnaire for neuropathic pain, Hospital Anxiety and Depression Scale [HADS], Pain Catastrophizing Scale [PCS]). Follow-up outcome scores will be collected up to 12 weeks after radiofrequency ablation.
    DISCUSSION: The planned sample size is 86 patients. As of February 19, 2025, a total of 19 patients have been enrolled, and 12 have completed all study procedures.
    TRIAL REGISTRATION: NCT05920382.
    Keywords:  Chronic pain; Knee arthroplasty; Osteoarthritis; Protocol; Thermal radiofrequency ablation
    DOI:  https://doi.org/10.1186/s13063-026-09585-8
  65. Work. 2026 Mar 26. 10519815261421502
    Hand injuries associated with mobile phone use: A systematic review.
    Savannah C Braud, Melinda J Choi, Kyle Y Xu, Kashyap Komarraju Tadisina.
      BackgroundRepetitive hand movements during mobile device use, such as texting and typing, may lead to cumulative stress on hand structures and result in musculoskeletal conditions with potential surgical relevance. The increasing ubiquity of smartphone use raises concern for the development of overuse injuries, particularly among younger individuals and high-frequency users.ObjectiveTo systematically review and characterize surgically relevant hand and wrist pathologies associated with mobile phone use.MethodsWe conducted a systematic search of Embase, PubMed, and Scopus using terms related to mobile device use (e.g., "texting," "smartphone") and hand conditions requiring or potentially requiring surgical intervention (e.g., "de Quervain," "trigger thumb"). Studies were included if they reported hand or wrist injuries in mobile device users with surgical implications. Studies unrelated to hand anatomy or lacking relevance to surgical pathology were excluded. Abstract and full-text screening were followed by data extraction.ResultsOf 588 articles initially identified, 42 met inclusion criteria, representing over 67,000 individuals. The mean age across studies was 24.6 years. The most commonly reported surgically relevant conditions included de Quervain's tenosynovitis (n=9), carpal tunnel syndrome (n=6), tendinitis (n=4), and trigger finger (n=1). Across studies, increased mobile phone use was associated with a higher risk of developing these pathologies.ConclusionsAs mobile device usage continues to rise, recognition of surgically relevant hand injuries is essential. Preventive strategies and ergonomic interventions may reduce the burden of these injuries, particularly in younger and high-use populations.
    Keywords:  carpal tunnel syndrome; cumulative trauma disorders; ergonomics; hand injuries; smartphones; tenosynovitis; text messaging; wrist injuries
    DOI:  https://doi.org/10.1177/10519815261421502
  66. BMJ Open. 2026 Mar 24. 16(3): e115538
    Strengthening and Targeted Rehabilitation for Optimal Neuromuscular Gains for chronic BACK pain (STRONG-BACK): protocol for a randomised controlled trial in participants with primary nociceptive pain drivers.
    Maryse Fortin, Brent Rosenstein, Cleo Bertrand, Nicolas Vaillancourt, Alicia Wright, Chanelle Montpetit, Luciana Macedo, James Elliott, Chad E Cook, Yannick Tousignant-Laflamme, Jinhui Ma, M Gabrielle Pagé, Geoffrey Dover, Thien Thanh Dang-Vu, Michael H Weber.
       INTRODUCTION: Exercise therapy is the most recommended treatment for chronic low back pain (LBP), with evidence supporting modest effects, likely due to the heterogeneity of patient presentations. Evidence suggests that matching individuals to the most appropriate exercise type could improve outcomes. Systematic reviews also emphasise that effective exercise interventions should be patient centred, target paraspinal muscle health and be of sufficient duration. This study addresses these gaps using a targeted care approach to identify a homogenous sample that is more likely to respond to our interventions. The inclusion of a sample with predominant nociceptive pain profile will be performed with the integration of the Pain and Disability Drivers Management Model (PDDM) and the Lumbar Spine Instability Questionnaire (LSIQ). The primary aim of this two-arm randomised controlled trial is to compare the effectiveness of motor control plus isolated lumbar extension exercises (MC+ILEX, arm 1) to free-weight resistance training (arm 2) in reducing LBP-related disability. Secondary aims include examining whether changes in multifidus composition mediate disability improvements comparing intervention effects on muscle size and quality, strength, mobility, pain, quality of life, sleep, physical activity and satisfaction; exploring baseline LSIQ scores and sex/gender as moderators of treatment response; and investigating participants' perceptions and experiences of exercise therapy.
    METHODS AND ANALYSIS: A total of 106 participants will be recruited through primary and secondary care and randomised (1:1) to receive either MC+ILEX or free-weight resistance training. Both groups will complete 48 exercise sessions over 16 weeks. The primary outcome will be disability at 16 weeks, measured by the Oswestry Disability Index. Secondary outcomes include multifidus muscle composition and size, lumbar and gluteal muscle strength, hip range of motion, pain, physical and mental function, satisfaction and recovery, health-related quality of life, sleep quality and physical activity levels. Linear mixed-effects models will be used to assess primary and secondary outcomes. Regression analyses will explore whether baseline LSIQ scores moderate treatment effects on multifidus composition and other outcomes. A subsample of participants will undergo semistructured interviews before and after the intervention to explore their illness perceptions, illness mindsets, perceptions of exercise therapy, as well as their experiences and satisfaction with the two exercise interventions. Reflexive thematic analysis will be used to analyse qualitative data.
    ETHICS AND DISSEMINATION: This study received ethics approval from the Central Ethics Research Committee of the Quebec Minister of Health and Social Services (CCER-25-26-14). Results will be submitted to peer-reviewed journals and scientific meetings.
    TRIAL REGISTRATION NUMBER: ISRCTN14864451.
    Keywords:  Back pain; PUBLIC HEALTH; RADIOLOGY & IMAGING; REHABILITATION MEDICINE
    DOI:  https://doi.org/10.1136/bmjopen-2025-115538
  67. Eur J Phys Rehabil Med. 2026 Mar 24.
    Effectiveness of kinesio tape in people with low back pain. A systematic review with meta-analysis.
    Jacqueline Inostroza-Quiroz, Ricardo Solano-López, Claudio Bascour-Sandoval, Diana Buitrago-García, Jeritza Salazar, Sayén Huaiquilaf-Jorquera, Matías Rodríguez, María J Oliveros, Pamela Serón.
       BACKGROUND: Low back pain (LBP) is a common musculoskeletal condition. Kinesio Tape (KT) has been proposed as a non-pharmacological treatment, but its effectiveness remains unclear.
    EVIDENCE ACQUISITION: A systematic review with meta-analysis was conducted according to PRISMA. Searches were performed in MEDLINE-Ovid, Embase-Ovid, PEDro, CENTRAL, CINAHL, LILACS, and Scopus up to January 2025. Randomized controlled trials (RCTs) evaluating KT in individuals with LBP were included. The primary outcomes were functionality and pain intensity, and the secondary outcomes were range of motion and adverse events.
    EVIDENCE SYNTHESIS: Fifty-four RCTs involving 3479 participants were included. In acute LBP, KT improved functionality by 14.95% (95% CI: -31.40 to 1.50) compared with no intervention on the Oswestry Disability Index (ODI). In chronic LBP, KT improved functionality by 11.9% (95% CI -18.07 to -5.73) compared to no intervention, and 2.31% (95% CI -5.83 to -1.22) versus placebo, both on ODI, and 0.97 points in the Roland-Morris Questionnaire (95% CI -2.45 to 0.51) versus Micropore®. Physiotherapy improved 5.44% (95% CI -0.76 to 10.12) more than KT on ODI. In pregnant women, KT improved functionality by 1.45 points (95% CI -2.97 to 0.07) versus placebo and by 2.19 points (95% CI -4.35 to -0.03) versus no intervention on the Roland-Morris Questionnaire. In irradiated LBP, KT showed no benefit over placebo. For pain on the Visual Analog Scale, KT in acute LBP reduced pain intensity by 1.61 cm (95% CI: -2.54 to -0.08) compared with no intervention. In chronic LBP, KT was superior to no intervention by 1.93 cm (95% CI -2.17 to -1.69), to placebo 0.70 cm (95% CI -1.39 to -0.02), to Micropore® 1.03 cm (95% CI -1.76 to -0.31), and 0.95 cm (95% CI -2.04 to 0.12) more than physiotherapy. In pregnant women, KT reduced pain by up to 3.01 cm (95% CI -4.39 to -1.62) compared to placebo and by -1.78cm (95% CI -3.34 to -0.22) compared to no intervention. Finally, in LBP irradiated, KT decreased by 0.31cm (95% CI -1.23 to 0.60) more than placebo.
    CONCLUSIONS: KT may improve functionality and reduce pain in short-term LBP. However, its effects on long-term chronic and irradiated LBP remain limited, and further high-quality trials are needed.
    DOI:  https://doi.org/10.23736/S1973-9087.26.09064-7
  68. Front Rehabil Sci. 2026 ;7 1778837
    The effectiveness of respiratory training as a preventive strategy against cognitive decline: a mini review.
    Th Zekis, E Grammatopoulou, D Tsimouris, V Sakellari, I Patsaki.
      Cognitive decline and dementia represent a growing global health burden, particularly among older adults and populations with cardiopulmonary and vascular risk factors. While physical exercise has been shown to exert protective effects on cognition, the role of respiratory muscle training (RMT) remains unclear. The aim of this review was to investigate the effects of RMT on cognitive function and cognitive decline. Respiratory muscle training has been implemented in older adults with elevated blood pressure, post-COVID-19 patients, patients with chronic obstructive pulmonary disease (COPD), and patients with obstructive sleep apnea (OSA). There is only preliminary evidence regarding the effectiveness of inspiratory muscle training (IMT) on cognitive function, with only one study reporting statistically significant between-group differences (i.e., respiratory muscle training vs. control) in specific cognitive domains. Although respiratory muscle training appears to be a potentially promising intervention for improving cognitive function, the current evidence is limited. Further well-designed randomized controlled trials are required to draw definitive conclusions regarding its preventive role in cognitive decline and dementia.
    Keywords:  aging; cognition; dementia; inspiratory muscle training; respiratory muscle training
    DOI:  https://doi.org/10.3389/fresc.2026.1778837
  69. Musculoskeletal Care. 2026 Mar;24(1): e70218
    Is Swimming the Most Complete Sport? A Multidimensional Reappraisal.
    Roberto Tedeschi.
      
    Keywords:  completeness in sport; physical literacy; rehabilitation; scoliosis; swimming
    DOI:  https://doi.org/10.1002/msc.70218
  70. Aesthet Surg J Open Forum. 2026 ;8 ojag027
    Serum Sickness After Cosmetic Botulinum Toxin Type A Injections.
    Danielle DeLuca-Pytell, Kathleen Dass, Gabriella Audia, Elena Busuito.
      Botulinum toxin type A (BoNT-A) is widely used in therapeutic and cosmetic settings for neuromuscular and aesthetic indications. Although generally well tolerated, reports of hypersensitivity reactions-ranging from localized erythema to systemic immune syndromes-underscore its immunological complexity. This case report and literature review demonstrates a novel case of serum sickness following cosmetic Botox® (onabotulinumtoxin-A, Allergan Aesthetics, an AbbVie company, Irvine, CA) administration, categorizes hypersensitivity reactions according to the Gell and Coombs classification (Types I-IV), explores the role of complexing proteins and formulation excipients, and highlights emerging clinical concerns. This will underscore the need for greater vigilance in identifying systemic immune responses to BoNT-A especially within the cosmetic medicine industry. Level of Evidence: 5 (Therapeutic).
    DOI:  https://doi.org/10.1093/asjof/ojag027
  71. Musculoskeletal Care. 2026 Mar;24(1): e70212
    Efficacy of Sling Exercise Training Compared to Standard Physiotherapy to Improve Muscle Strength, Joint Range of Motion and Functional Outcomes Following Total Knee Arthroplasty: A Pilot Randomized Controlled Trial.
    Nooshin Rajaeian, Bijan Rajaeian, Gholam Ali Ghasemi, Negin Ghasemi Kahrizsangi.
       BACKGROUND: Recovery following total knee arthroplasty (TKA) is frequently incomplete, highlighting the need for more effective rehabilitation approaches.
    METHODS: This single-blind pilot randomized controlled trial allocated 40 women undergoing unilateral total knee arthroplasty (TKA) to either Sling Training (ST) or Standard Physiotherapy Training (SPT) (1:1). Both groups completed supervised outpatient rehabilitation three times weekly for 8 weeks, beginning 1-week post-surgery. Outcomes included quadriceps and hamstring isometric strength, knee range of motion, and WOMAC total score, assessed at baseline and week 8 by a blinded assessor.
    RESULTS: Both groups improved significantly; however, ST produced larger gains in quadriceps strength (+60% vs. +30%), hamstring strength, knee flexion ROM (+19.2° vs. +12.2°), and WOMAC reduction (-41.9 vs. -35.7; p = 0.003). Approximately 90% of ST participants versus 75% of SPT participants exceeded the ≥ 12-point MCID threshold.
    CONCLUSION: Sling-based exercise training may offer superior early functional and strength recovery compared with standard physiotherapy after TKA, supporting its potential role as an adjunct to early rehabilitation. Larger, multi-centre trials are needed to confirm effectiveness and generalizability.
    TRIAL REGISTRATION: IRCT20221226056934N1.
    Keywords:  physiotherapy; rehabilitation; suspension exercise; total knee arthroplasty
    DOI:  https://doi.org/10.1002/msc.70212
  72. Interv Pain Med. 2026 Jun;5(2): 100752
    Effectiveness of high-voltage radiofrequency on suprascapular nerve for the treatment of chronic shoulder pain.
    J García-Amigo, B Cabaleiro-Burguillos, M P Contreras-Lozano, C Moñino Riquelme, C Cordero-García.
       Background: Chronic omalgia, which often results from a rotator cuff injury, is a common musculoskeletal condition. The literature supports the effectiveness of 45V pulsed radiofrequency for treating painful shoulders, as well as the effectiveness of high-voltage for certain painful conditions.
    Objective: Our main aim was to conduct a study investigating the use of 100V high-voltage pulsed radiofrequency in patients with chronic omalgia.
    Methods: We conducted a pre-post quasi-experimental study including 31 patients with chronic omalgia due to a muscle-tendon injury that did not respond to pharmacological treatment. Patients had to be over 18 years old, understand the invasive technique, and have previously experienced an effective suprascapular nerve block. During the initial consultation, we assessed pain levels using the Visual Analogue Scale (VAS) and the Shoulder Pain and Disability Index (SPADI). We then administered radiofrequency at 42° and 100V for 360s. Patients were re-evaluated using the VAS and SPADI scales at two, four, and six months.
    Results: The mean VAS score at the initial visit was 9.16 (95% CI: 8.90-9.42) out of 10 points. At two months, the mean score was 3.4 (1.15-5.65, 95% CI); at four months, it was 4.6 (2.54-6.66, 95% CI). At six months, the mean VAS score was 5.21 (4.40-6.02; 95% CI). The observed differences were statistically significant (p < 0.05). An initial assessment was performed using the SPADI scale, yielding a total pre-intervention score of 82.6%. Subsequently, at the six-month follow-up, the total SPADI score was 47%. The difference in the total SPADI score (pain and disability) was also statistically significant (p < 0.05).
    Conclusion: High-voltage pulsed radiofrequency (100V) applied to the suprascapular nerve is an innovative treatment that offers very promising results for treating chronic shoulder pain.
    DOI:  https://doi.org/10.1016/j.inpm.2026.100752
  73. Life (Basel). 2026 Mar 21. pii: 524. [Epub ahead of print]16(3):
    The Effect of a Novel Achilles Brace on Concentric and Eccentric Achilles Tendon Loading During Tendon Tear Mechanisms.
    Roni Gottlieb, Shai Greenberg, Asaf Shalom, Julio Calleja Gonzalez.
      (1) Achilles tendon rupture is one of the most severe lower-limb injuries, frequently occurring during movements involving maximal dorsiflexion with the knee at near-full extension. Preventive strategies are crucial, particularly for athletes engaged in high-risk sports such as basketball. (2) In this work, we examined the effect of a novel Achilles brace on Achilles tendon loading during concentric and eccentric mechanisms associated with tendon rupture. (3) Twenty-eight young basketball players performed tests under two conditions: with the adaptive brace and without it (control). Participants were divided into two groups (n = 14 in both). The first group assessed concentric Achilles loading by performing three plantar-flexor strength tests in three different joint configurations: maximal dorsiflexion with the knee flexed (FKF); injury mechanism position-full plantar flexion with the knee extended (FKE); and neutral ankle position with the knee extended (NKE). The number of maximal heel-raise repetitions performed before onset of fatigue was recorded. The second group assessed eccentric tendon loading by performing single-leg forced maximal-velocity dorsiflexion with the knee extended. In all tests, the time between maximal plantar flexion and maximal dorsiflexion, as well as the ankle range of motion, was analyzed using 2D video. Paired t-tests were used to compare braced and control conditions. In all tests, the ankle range of motion (ROM) did not differ significantly between brace and control conditions. Wearing the brace significantly improved plantar-flexor muscle strength only in the FKE test (31 ± 1.3 repetitions with brace vs. 21 ± 1.3 in control, p < 0.05). No significant differences were found for the FKF (27 ± 1.3 vs. 25 ± 1.3) or NKE (25 ± 1.3 vs. 24 ± 1.3) positions. During drop eccentric loading, wearing the brace resulted in a significantly slower transition time from plantar flexion to dorsiflexion (460 ± 60 ms with brace vs. 320 ± 30 ms in control, p < 0.001). (4) In brief, the novel Achilles brace was found to significantly reduces Achilles tendon load during both concentric and eccentric activities, but only in high-risk joint positions. These findings suggest that the brace provides mechanical protection, and may reduce the risk of Achilles tendon rupture, in athletes exposed to high tendon stress.
    Keywords:  Achilles tendon; ankle; concentric; eccentric; injury
    DOI:  https://doi.org/10.3390/life16030524
  74. J Hand Surg Glob Online. 2026 Mar;8(2): 100912
    The Prevalence of Focal Carpal Chondromalacia Concurrent With Chronic Dynamic Scapholunate Instability.
    Kian Steppe, Houshang Seradge, Kamran Steppe, Cyrus Steppe, Carrie Seradge, Winfred Parker.
       Purpose: There is a paucity of information regarding the prevalence of focal chondromalacia with chronic dynamic scapholunate instability (CDSI), and current treatment algorithms do not account for its presence. We aimed to determine the prevalence and distribution of chondromalacia in CDSI.
    Methods: We conducted a retrospective, longitudinal, cohort study of all wrist arthroscopies performed from January 2008 to December 2020. We included wrists with an arthroscopically confirmed primary diagnosis of CDSI. Patients were grouped based on the presence (CDSI+C) or absence (CDSI-C) of focal carpal chondromalacia. All ligament tears were debrided, and focal chondral lesions were treated with chondral shaving to partial carpectomy. We followed the Debride-First-Then-Wait protocol, which incorporates a waiting period for patients to assess if arthroscopic intervention alone is sufficient to return to normal daily activities. The surgeon considers the patient's perceived wellness when determining the need for a subsequent Dynadesis (tendon-to-tendon transfer through the distal scaphoid) or partial fusion.
    Results: Of 255 wrist arthroscopies, 164 wrists (155 patients) met the inclusion criteria. Focal chondromalacia was arthroscopically identified in 48% of wrists, with a notably higher occurrence in older patients and those with lunotriquetral ligament or triangular fibrocartilage tears. The most frequent sites of chondromalacia were the radial styloid (27%) and the scaphoid body (15%). Dynadeis was performed in 29% of wrists in the CDSI+C cohort and 47% in the CDSI-C cohort. Four percent of CDSI+C wrists necessitated partial wrist fusion.
    Conclusions: Focal chondromalacia is common in patients with CDSI. The presence of focal lesions alone did not notably decrease the efficacy of arthroscopic treatment as <50% of patients needed a secondary procedure (7.4-year follow-up). The distribution of focal chondromalacia suggests injuries to other wrist ligaments. We recommend using the Debride-First-Then-Wait protocol to aid in selecting a personalized and lower-risk treatment for CDSI.
    Type of study/level of evidence: Therapeutic IIb.
    Keywords:  Arthroscopy; Carpal chondromalacia; Carpal instability; Dynamic scapholunate instability; Scapholunate ligament tear
    DOI:  https://doi.org/10.1016/j.jhsg.2025.100912
  75. Commun Med (Lond). 2026 Mar 24.
    Smartphone-derived joint angular velocities in sit-to-stand motion provide a spatiotemporal marker for symptomatic knee osteoarthritis.
    Lok Chun Chan, Jin Yan, Yuli Charlie Zhang, Tianshu Jiang, Alex Yuning Zhang, Ho Hin Toby Li, Billy So, Wei Huang, Yongping Zheng, Ping-Keung Chan, Chunyi Wen.
       BACKGROUND: Knee osteoarthritis (OA) is a debilitating condition that compromises mobility and exacerbates knee pain, necessitating accurate and accessible diagnostic tools. Traditional motion capture technology, while effective, is often cost-prohibitive and limited to laboratory settings. In response, we developed a smartphone-based approach utilizing spatiotemporal analysis of joint angular velocities and angles in sit-to-stand (STS) motion to detect symptomatic knee OA.
    METHOD: We analyzed 2063 sagittal-viewed sit-to-stand motion videos from 309 participants and proposed a STS-D Index based on a deep learning model, STS Dynamics Net, which provides a nuanced quantification of joint dynamics and temporal interactions in trunk, knee, and ankle angles and velocities for detection of symptomatic knee OA.
    RESULTS: Here we show that joint angular velocities are a robust spatiotemporal biomarker for symptomatic knee OA detection (AUC 0.7759 ± 0.0219), not only do they outperform the STS pace (AUC 0.6554 ± 0.0268, p = 8.6×10-5) and maximum trunk angle (AUC 0.7025 ± 0.0253, p = 2.1×10-3) in diagnostic accuracy and rival the performance of gold-standard 3D marker-based systems (AUC 0.7855 ± 0.0229), but they also show significant correlations with WOMAC sub-scores (p < 0.0001). Furthermore, our analysis reveals a significant correlation between angular velocities and muscle volumes and fat-to-muscle ratios in the quadriceps and hamstrings, underscoring the role of muscle weakness in knee OA pathogenesis.
    CONCLUSIONS: This innovative approach has the potential to revolutionize knee OA detection, enabling reliable, cost-effective, and self-administered assessments in community settings and bridging the gap in accessible healthcare monitoring.
    DOI:  https://doi.org/10.1038/s43856-026-01537-2
  76. J Physiother. 2026 Mar 27. pii: S1836-9553(26)00008-1. [Epub ahead of print]
    Critically appraised papers: Adding a very-low-calorie weight loss diet to exercise does not improve pain in people with hip osteoarthritis compared with exercise alone [commentary].
    Melaine Ann Holden.
      
    DOI:  https://doi.org/10.1016/j.jphys.2026.01.009
  77. J Biomech. 2026 Mar 13. pii: S0021-9290(26)00107-7. [Epub ahead of print]201 113252
    Shoulder muscle synergies before and after reverse total shoulder arthroplasty.
    H Francalanci, N Holzer, F Moissenet, Y Cherni.
      Reverse total shoulder arthroplasty (rTSA) has become a standard treatment for symptomatic massive rotator cuff tears (MRCT). While clinical outcomes are generally satisfactory, significant variability in functional recovery raises questions about the extent of inter-individual neuromuscular adaptations and motor restoration. This study aimed to assess the neuromuscular impact of rTSA by analysing superficial shoulder muscle activity and synergies. Asymptomatic shoulders (n = 20) and symptomatic shoulders undergoing rTSA (n = 20) were assessed before and after surgery. Participants performed four functional tasks while surface electromyography was used to quantify muscle activity. Synergies of the anterior (DELTA), middle (DELTM), and posterior deltoid (DELTP), middle (TRAPM) and upper trapezius (TRAPS), and serratus anterior (SERRA) were computed. Symptomatic MRCT was associated with a significant increase in activity of DELTA (p = 0.014), DELTM, TRAPS, and SERRA (p < 0.001). Postoperatively, DELTM (p = 0.002), TRAPS (p = 0.039), and SERRA (p = 0.025) remained significantly more active. Although the number of muscle synergies (n = 2) remained stable across groups, significant differences in muscle weightings were found preoperatively for TRAPS and DELTP (p < 0.001). Also, cosine similarity increased postoperatively by 15.96% for synergy 1 and 37.42% for synergy 2, indicating a greater resemblance to the asymptomatic synergy pattern (p < 0.001). Changes in muscle activities and synergy patterns, marked by the emergence of compensatory roles for scapular stabilisers and the deltoid, highlight the disruption of motor control associated with MRCT. Following rTSA, motor coordination was substantially restored, supporting improved functional autonomy in daily tasks.
    Keywords:  Electromyography; Massive rotator cuff tear; Motor control; Reverse total shoulder arthroplasty; Synergies
    DOI:  https://doi.org/10.1016/j.jbiomech.2026.113252
  78. J Neuroeng Rehabil. 2026 Mar 27. pii: 104. [Epub ahead of print]23(1):
    Efficacy and safety of non-invasive brain stimulation for chronic low back pain: a systematic review and meta-analysis of randomised controlled trials.
    Ketao Du, Yifan Jiang, Jiaxin Pan, Marco Yiu Chung Pang, Jack Yingxiu Diao, Jae Qijing Liu, Qianwen Lan, Xiaomin Niu, Shengqian Jing, Jianghua Cheng.
      
    Keywords:  Chronic low back pain; Neuromodulation; Non-invasive brain stimulation; Repetitive transcranial magnetic stimulation; Transcranial direct current stimulation
    DOI:  https://doi.org/10.1186/s12984-026-01886-y
  79. NEJM Evid. 2026 Apr;5(4): EVIDe2600038
    Policy Implications of Placebo Bandage for Carpal Tunnel Syndrome.
    Karen C Smith, Jeffrey N Katz.
      
    DOI:  https://doi.org/10.1056/EVIDe2600038
  80. Ann Plast Surg. 2026 Apr 01. 96(4): 355-363
    Neurophysiological Mechanisms of Neuropathic Pain and Their Clinical Implications: A Primer for the Peripheral Nerve Surgeon.
    Erica B Lee, Aidan Weitzner, Rachana Suresh, Randal A Serafini, Sami Tuffaha.
       ABSTRACT: Chronic neuropathic pain is a serious and significant clinical challenge affecting more than 10% of the global population. Despite its prevalence, the precise mechanisms and reasons for the significant burden of neuropathic pain remain incompletely understood, in part due to the complexity of pain signaling circuits and their integration across the nervous system. Preclinical studies have identified 3 key intraneuronal processes that contribute to the persistent nociceptive barrage underlying neuropathic pain: ectopic discharges, primary afferent depolarization with dorsal root reflexes (PAD/DRRs), and autoreceptor-mediated excitation. Interventions that remove or silence the ectopic focus, restore normal inhibitory balance, or block specific ion channels involved in these mechanisms may dramatically improve outcomes. With a rising incidence of nerve injuries and amputations, the role for surgical and multidisciplinary interventions in managing chronic pain is expanding, making it critical for peripheral nerve surgeons treating these patients to understand these foundational mechanisms. The goal of this review is to synthesize our current understanding of these mechanisms, translating these insights into clinically relevant knowledge that may assist surgeons in patient counseling, treatment planning, and multidisciplinary care.
    Keywords:  autoreception; central sensitization; chronic pain; dorsal root reflexes; ectopic discharge; nerve; nerve injury; neuroma; neuropathic pain; nociceptive pain; pain; primary afferent depolarization
    DOI:  https://doi.org/10.1097/SAP.0000000000004713
  81. J Clin Med. 2026 Mar 13. pii: 2193. [Epub ahead of print]15(6):
    Macro- and Micro-Morphological Properties of the Rotator Cuff Structures in the Chronic Stage of Tendinopathy in Para Swimmers.
    Beata Pożarowszczyk-Kuczko, Oliwia Jabłońska, Bartłomiej Bogdański, Zofia Wróblewska, Sebastian Klich.
      Background/Objectives: This study aimed to characterize macro- and micro-morphological properties of the supraspinatus tendon (SST) in para swimmers during the chronic stage of rotator cuff tendinopathy, integrating ultrasound assessments of tendon thickness, peak spatial frequency radius (PSFR) for collagen organization, acromiohumeral distance (AHD), and occupation ratio to evaluate subacromial impingement risk. Methods: In a cross-sectional design, 43 elite para swimmers (aged 18-30 years, S7-S10 classes with lower extremity impairments) from Para Swimming Team Poland were divided into rotator cuff tendinopathy (RC; n = 22) and asymptomatic control (CON; n = 21) groups. Measurements on the dominant shoulder utilized B-mode ultrasound (Alpinion X-CUBE 90) to assess SST thickness at 5, 10, and 15 mm proximal to the greater tuberosity, PSFR via MATLAB-analyzed spatial frequency spectra, AHD, and occupation ratio. Two-way and one-way ANOVAs assessed group and measurement effects (p < 0.05); Pearson correlations examined the relationships between thickness and PSFR. Results: Para swimmers with tendinopathy exhibited greater SST thickness across sites (p < 0.001, η2 = 0.63), higher PSFR at all intervals (p ≤ 0.009, η2 = 0.53) peaking at 10 mm, wider AHD (p = 0.002, η2 = 0.21), and lower occupation ratio (p < 0.001, η2 = 0.44) versus controls. Strong positive correlations linked thickness and PSFR proximally (r = 0.75-0.79, p < 0.001). Conclusions: Chronic tendinopathy in para swimmers manifests as thickened SST with collagen disarray, altered subacromial space, and impingement risk, distinguishing pathological from healthy tendons. Integrated ultrasound metrics aid diagnosis and inform interventions for overhead athletes with locomotor disorders.
    Keywords:  overhead sport; overloading; peak spatial frequency radius; shoulder; thickness
    DOI:  https://doi.org/10.3390/jcm15062193
  82. Front Surg. 2026 ;13 1751286
    Clinical value of biomechanics and magnetic resonance imaging in the evaluation of knee osteoarthritis.
    Jun Zhou, Cheng Guo, Guifang Liu, Yaofei Liu.
       Objective: The aim of this study was to analyze the clinical value of biomechanics and magnetic resonance imaging (MRI) in the evaluation of knee osteoarthritis.
    Methods: Sixty patients diagnosed with knee osteoarthritis from June 2020 to November 2023 in our hospital were retrospectively selected as the study group. Fifty healthy subjects who underwent annual health checkups in our hospital during the same period were selected as the control group. A three-dimensional finite element model was constructed based on knee MRI images. The MRI parameters and biomechanical parameters of knee joints were compared between the two groups.
    Results: The mean Whole-Organ Magnetic Resonance Imaging Score (WORMS) of patients in the study group was (72.29 ± 16.92), significantly higher than that of (44.68 ± 16.95) in the control group. The contact area between the medial femoral cartilage and medial meniscus, the maximal von Mises stress on the medial meniscus, and the maximal von Mises stress on the femoral cartilage were significantly greater in the study group than in the control group. The area under the curves of MRI indicators and biomechanical indicators (contact area between the medial femoral cartilage and medial meniscus, the maximal von Mises stress on the medial meniscus, and the maximal von Mises stress on the femoral cartilage) for knee osteoarthritis were 0.8694, 0.7874, 0.6282, and 0.7650, respectively.
    Conclusion: WORMS and biomechanical parameters (medial femoral-meniscal contact area and peak stress) demonstrate good diagnostic value in knee osteoarthritis, with the maximal von Mises stress on the medial meniscus showing discriminatory power for disease severity. The combination of MRI and biomechanical analysis facilitates the assessment of knee osteoarthritis from both structural and functional perspectives, providing objective evidence for clinical diagnosis and treatment.
    Keywords:  biomechanics; clinical value; diagnostic efficacy; knee joint; magnetic resonance imaging; osteoarthritis
    DOI:  https://doi.org/10.3389/fsurg.2026.1751286
  83. Cureus. 2026 Feb;18(2): e103880
    Therapeutic Role of Concentrated Growth Factors in the Management of Chronic Heel Tendinopathies: A Prospective Interventional Study.
    Bhanu P Singh, Aman Thakur, Yogesh Singh Parihar.
      Background Chronic heel tendinopathies, including plantar fasciitis, Achilles tendinopathy, retrocalcaneal bursitis, and Haglund deformity, are among the most common causes of persistent heel pain and functional limitation in adults. Increasing evidence suggests that these conditions represent degenerative failed-healing responses rather than purely inflammatory processes, which explains the limited long-term effectiveness of conventional anti-inflammatory therapies. Concentrated growth factors (CGFs), a second-generation autologous platelet concentrate, provide a dense fibrin matrix enriched with biologically active growth factors that may enhance tendon regeneration and functional recovery. Objective To evaluate the clinical efficacy and safety of autologous concentrated growth factor injections in the management of chronic heel tendinopathies refractory to conservative treatment. Methods A prospective interventional study was conducted on 50 adult patients (>30 years) diagnosed with chronic heel tendinopathies of more than three months' duration who had failed standard conservative management. Autologous CGF was prepared from venous blood without anticoagulants and injected locally at the site of maximal tenderness under aseptic conditions. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) score for functional evaluation at baseline, one month, three months, and six months post-injection. Statistical analysis was performed using paired t-tests or Wilcoxon signed-rank tests as appropriate, with a p-value <0.05 considered statistically significant. Results The mean baseline VAS score of 7.30 ± 0.89 demonstrated a statistically significant reduction to 5.52 ± 0.65 at one month and to 3.94 ± 0.79 at three months (p < 0.001), with sustained improvement observed at six months. Functional outcomes improved in parallel, with AOFAS scores progressing from poor baseline levels (≤53) to good and excellent categories at subsequent follow-ups. The most pronounced clinical improvement was observed in patients with plantar fasciitis, though favorable outcomes were noted across all diagnostic subgroups. No major complications, including infection or tendon rupture, were recorded. Conclusion Autologous concentrated growth factor injections provide significant and sustained pain relief and functional improvement in patients with chronic heel tendinopathies. By addressing the underlying degenerative pathology, CGF therapy represents a safe and biologically rational regenerative treatment option. Further randomized controlled trials with larger sample sizes are recommended to establish definitive treatment guidelines.
    Keywords:  achilles tendinopathy; concentrated growth factors; heel tendinopathy; plantar fasciitis; regenerative therapy
    DOI:  https://doi.org/10.7759/cureus.103880
  84. Clin Biomech (Bristol). 2026 Mar 19. pii: S0268-0033(26)00082-3. [Epub ahead of print]136 106827
    Mechanical equilibrium of the ankle joint: Implications for Achilles tendon injury.
    Ra''ad M Khair, Afet Mustafaoglu, Yu Chou Lin, Maria Sukanen, Taija Finni.
       BACKGROUND: A longer Achilles tendon (AT) moment arm (MA) relative to the foot length requires less muscle force for a given plantarflexion moment, thereby lowering mechanical load on the tendon. We examined whether the AT and foot MA lengths in healthy (N = 28) differ from height and body mass matched individuals with AT tendinopathy (N = 28) and rupture (N = 29). We hypothesized that a longer AT MA has a protective effect on tendon loading with the patient groups having smaller MA compared to asymptomatic individuals.
    METHODS: MAs were assessed using 2-D image-based method. AT MA was defined as the shortest distance from the centre line of action of the AT to the line between malleoli. Ratio of ankle lever was calculated by dividing AT by Foot MAs.
    FINDINGS: AT MA was longer in healthy than either the tendinopathy (mean difference 3.86 mm, p = 0.02) or rupture group (5.41 mm, p < 0.001). Foot MA was not statistically different between the groups (p = 0.06). Ratio of ankle lever differed between groups with the healthy group showing higher ratio compared to both the tendinopathy group (0.04, p = 0.001), and the rupture group (0.06, p < 0.001). AT and Foot MAs correlated with body mass and height, whereas the ratio of ankle lever did not.
    INTERPRETATION: A longer AT relative to foot MA length may improve the tendon's safety factor by reducing mechanical stress. This ratio may serve as an accessible intrinsic risk factor for AT injuries, even when assessed only using simple 2-D anatomical measures.
    Keywords:  Achilles tendon; Ankle lever arm; Anthropometrics; Injuries; Rupture; Tendinopathy
    DOI:  https://doi.org/10.1016/j.clinbiomech.2026.106827
  85. J Funct Morphol Kinesiol. 2026 Feb 20. pii: 85. [Epub ahead of print]11(1):
    Impact of 8-Week Pilates Program on Lumbar Flexion-Relaxation Dynamics and Functional Outcomes in Women with Chronic Low Back Pain.
    Ana Ferri-Caruana, Lluís Raimon Salazar-Bonet, Marco Romagnoli, Walter Staiano.
      Objectives: While Pilates exercise is commonly prescribed for chronic low back pain (CLBP), its effect on normalizing the lumbar flexion-relaxation ratio (FRR) remains unclear. This trial examined whether an 8-week Pilates exercise program (PEP) modifies FRR magnitude and side-to-side asymmetry in women with CLBP and explored associations with trunk kinematics, pain, and functional capacity. Methods: In a randomized controlled pre-test-post-test training design, ninety-six women with CLBP (55.8 ± 5.4 y) were allocated to a PEP group (n = 49) or a usual-care control group (n = 47). The PEP included two supervised 60-minute mat sessions per week over eight weeks. Surface electromyography of the right and left erector spinae and trunk flexion range of motion (TFRoM), measured via inertial sensors, were recorded during the standardized flexion-extension task pre- and post-intervention. Pain intensity (Visual Analog Scale) and functional capacity (Low Back Outcome Score, LBOS) were assessed concurrently. Results: Two-way repeated-measures ANOVA revealed no group × time interaction for global FRR (p = 0.454) or TFRoM (p = 0.745). FRR asymmetry increased by 11% in the PEP group (p = 0.033), with no change observed in the controls (p = 0.143). Compared to the controls, the PEP group exhibited a 30% reduction in pain (p = 0.003) and a 13.4% improvement in LBOS (p < 0.001) compared to the control group (all ps > 0.228). Conclusions: An 8-week Pilates intervention reduces pain and improves functional capacity in women with CLBP but does not restore lumbar extensor relaxation. The observed increase in FRR asymmetry may reflect compensatory or maladaptive redistribution.
    Keywords:  asymmetry; core stability; electromyography; rehabilitation; trunk mobility
    DOI:  https://doi.org/10.3390/jfmk11010085
  86. J Funct Morphol Kinesiol. 2026 Mar 17. pii: 123. [Epub ahead of print]11(1):
    A Narrative Review of Shockwave Therapy in Plantar Fasciitis.
    Yunfeng Sun, Caterina Fede, Xiaoxiao Zhao, Federico Giordani, Hannes Müller-Ehrenberg, Carmelo Pirri, Carla Stecco.
      This narrative review synthesizes evidence from 108 studies to provide the first comprehensive overview of extracorporeal shockwave therapy (ESWT) for plantar fasciitis across three key domains. First, assessment methodologies were evaluated, identifying 36 distinct tools classified into six categories, including pain (with the Visual Analog Scale being the most frequently used), function (most commonly the Foot Function Index), plantar fascia thickness, and other measures. Second, treatment protocols were analyzed, revealing commonly applied parameters of 2000 impulses per session and an energy flux density of 0.2 mJ/mm2 or 3.0 bar. Third, the comparative status of ESWT relative to other interventions was examined. Across 18 alternative treatments, corticosteroid injections, platelet-rich plasma (PRP), dextrose prolotherapy, laser therapy, and ultrasound were the most frequently compared modalities. ESWT and comparator interventions demonstrated differential advantages across specific outcomes; however, these findings cannot be directly translated into clinical recommendations, due to the limitations of the available evidence. By consolidating fragmented data, the present review clarifies the current research landscape and provides a foundational reference to support outcome evaluation and individualized treatment selection.
    Keywords:  ESWT; foot pain; plantar fascia; plantar fasciitis; shockwave
    DOI:  https://doi.org/10.3390/jfmk11010123
  87. medRxiv. 2026 Mar 17. pii: 2026.03.15.26348416. [Epub ahead of print]
    A comprehensive descriptive analysis of hip and knee radiographic osteoarthritis in the UK Biobank in relation to joint pain, joint site interrelationships, obesity, race and deprivation: Findings from 59,475 individuals.
    A Hashmi, S Scott, M Jung, F R Saunders, R Ebsim, J S Gregory, L Arbeeva, A E Nelson, N C Harvey, C Lindner, R M Aspden, T Cootes, J H Tobias, B G Faber.
       Objectives: Patients with osteoarthritis (OA) affecting multiple joints have poorer health outcomes than those without, yet most research examines isolated joints, leaving a gap in multi-joint disease. This study aimed to describe radiographically defined hip (rHOA) and knee OA (rKOA) within UK Biobank (UKB), exploring interrelationships across joints, and associations with joint pain, obesity, race and deprivation.
    Methods: Automated machine learning was applied to left and right hip and knee dual-energy X-ray absorptiometry scans. Radiographic OA (rOA) was defined as custom grades ≥2. Joint pain was assessed through self-reported questionnaires. Descriptive statistics summarised the population characteristics. Logistic regression models examined bilateral and cross-joint associations, as well as associations with joint pain. Adjustments were made for age, sex, race, height, weight and deprivation. Other models examined the associations between body size and OA.
    Results: Among 59,475 individuals (mean age 65 years; 52.8% female), rHOA prevalence was 4,098 (6.9%)) and 4,841 (8.1%) for the right and left joints, respectively. The corresponding estimates for rKOA were 3,750 (6.3%) and 4,220 (7.1%). Overall, increasing grades of rOA and number of joints affected were more strongly associated with joint pain. Regarding joint-interrelationships, bilateral associations were stronger at the knee, whereas cross-joint associations (hip-knee) were weaker. Associations with BMI and height differed between the hip and knee.
    Conclusions: Radiographic hip and knee OA exhibit distinct patterns of interrelationship, associations with symptoms and risk factors, suggesting heterogeneity in disease process and the need for joint-specific treatment.
    Key Messages: What is already known on this topic?: Osteoarthritis (OA) commonly affects the hip and knee and is associated with pain and disability, with recognised risk factors such as age, obesity and deprivation.Increasing interest in multi-joint OA challenges the traditional concept of lower-limb OA as a monoarthritis, but most research examines joints in isolation.Genetic evidence suggests that hip and knee OA may differ in underlying mechanisms, yet population-scale comparisons are limited.What this study adds?: Among 59,574 individuals, this study identifies that radiographic OA captures structurally and clinically relevant disease with increasing severity and greater number of joints affected, positively associated with chronic joint pain.Radiographic hip and knee OA demonstrated strong bilateral but weaker cross-joint associations, indicating preferential within-joint symmetry.Risk factors differed by anatomical site with BMI and weight strongly associated with knee OA and weakly associated with hip OA. Height showed the opposite associations.How this study might affect research, practice or policy?: These findings support that hip and knee OA may partially represent different disease processes rather than a single condition.Clinical practice should consider cumulative joint involvement and joint-specific risk factors.Future research should consider the development of more targeted treatment to prevent multi-joint progression.
    DOI:  https://doi.org/10.64898/2026.03.15.26348416
  88. J Pain Res. 2026 ;19 549827
    Ultrasound-Guided Atelocollagen Injection for Chronic Pain After Spinal Surgery: A Retrospective Cohort Study.
    Hangaram Kim, Seungpyo Nam, Kaehong Lee, Seungcheol Yu, Jee Youn Moon, Jeongsoo Kim.
       Background: Chronic pain after spinal surgery (CPSS), formerly known as failed back surgery syndrome (FBSS), is a persistent and complex condition that often resists conventional treatments. Recent attention has turned toward paraspinal muscle degeneration as a contributing factor. Injectable type I porcine atelocollagen, known for its anti-adhesive and regenerative properties, has been proposed as a potential intervention, but clinical evidence remains scarce. This study aimed to evaluate the effect of ultrasound-guided atelocollagen injection into paraspinal muscles for patients with CPSS and to identify potential predictors of treatment response.
    Methods: This single-center retrospective cohort study was conducted at a tertiary academic institution. 34 adult patients (≥20 years) with a diagnosis of lumbosacral CPSS who received ultrasound-guided purified porcine atelocollagen injections between October 2020 and December 2023 and completed 3-month follow-up without concurrent interventional procedures or medication escalation were included in the analysis. The injection was performed into the paraspinal muscles at the surgical level. The primary outcome was change in pain intensity on the 11-point numeric rating scale (NRS) at 3 months post-treatment. A composite outcome was defined as a ≥1-point reduction in NRS or a Patient Global Impression of Change (PGIC) score of 4 or 5. Exploratory analyses were conducted to identify potential predictive factors.
    Results: The mean NRS score significantly decreased by 1.62 points (95% CI 0.91-2.33, p<0.001) at 3 months after atelocollagen injection compared to baseline. Neither univariable nor multivariable logistic regression analysis revealed any significant predictive factors for a positive composite outcome. When comparing the responder and non-responder groups based on the composite outcome, the proportion of patients taking anticonvulsants or antidepressants was significantly higher in the non-responder group (54.2% vs 100%, p = 0.028).
    Conclusion: Ultrasound-guided atelocollagen injection into the paraspinal muscles was associated with pain reduction in patients with CPSS. Although the absence of a control group limits causal interpretation, this suggests that atelocollagen injection may have potential as an adjunctive or investigational treatment option for this patient population.
    Keywords:  atelocollagen; chronic pain; interventional; paraspinal muscles; persistent spinal pain syndrome; ultrasonography
    DOI:  https://doi.org/10.2147/JPR.S549827
  89. J Physiother. 2026 Mar 27. pii: S1836-9553(26)00003-2. [Epub ahead of print]
    Critically appraised paper: In adults with burns, adding inspiratory muscle training to pulmonary rehabilitation increased respiratory muscle strength, pulmonary function and functional capacity [commentary].
    Fang Liu, Alice Jones.
      
    DOI:  https://doi.org/10.1016/j.jphys.2026.01.003
  90. Diabetes Res Clin Pract. 2026 Mar 24. pii: S0168-8227(26)00145-2. [Epub ahead of print]235 113226
    Peripheral nerve enlargement in patients with diabetic sensorimotor polyneuropathy: A systematic review and meta-analysis.
    Nadine Boers, Brett Hahn, Anne Merijn Eligh, Isabel C Jongen, Willem D Rinkel, J Henk Coert.
      This study aimed to summarize evidence on peripheral nerve enlargement in patients with diabetes, with and without diabetic sensorimotor polyneuropathy (DSP), compared with healthy controls. PubMed and Embase were systematically searched for ultrasound studies measuring the cross-sectional area (CSA) of peripheral nerves in patients with diabetes with and without DSP. The primary outcome was the weighted inter-group mean difference in CSA at all reported upper- and lower extremity sites. Forty-seven studies were identified, of which 41 were included in the meta-analyses. Patients with diabetes without DSP showed significantly larger CSA values than healthy controls at 3 of 11 anatomical locations, all located in the lower extremity. Patients with diabetes and DSP demonstrated increased CSA compared with controls at 9 of 14 sites, particularly at distal compression sites of the median and tibial nerves. Compared with patients with diabetes without DSP, those with DSP had significantly larger CSA values at 14 of 21 sites, with the greatest difference observed 4-5 cm proximal to the medial malleolus (pooled mean difference + 5.26 mm2, 95% CI 0.94-9.57). In conclusion, peripheral nerve CSA is increased in diabetes and further enlarged in the presence of DSP, with the largest effects at distal compression sites.
    Keywords:  Diabetes Mellitus; Diabetic Polyneuropathy; Diagnostic Imaging; Peripheral Nerve Disease; Peripheral Neuropathy
    DOI:  https://doi.org/10.1016/j.diabres.2026.113226
  91. Brain Sci. 2026 Mar 13. pii: 308. [Epub ahead of print]16(3):
    Effect of Variable Priority Cognitive-Motor Dual-Task Training on Cognitive and Physical Function in Older Adults: A Systematic Review.
    Xiao Yu, Roxana Dev Omar Dev, Maizatul Mardiana Harun.
      Background: With advancing age, cognitive control and postural-gait regulation decline, while dual-task interference intensifies, leading to restricted mobility and increased fall risk. Variable-priority cognitive-motor dual-task training (VPDT) enhances attentional flexibility and task integration by systematically shifting attentional allocation during training. However, its effects on cognitive and physical function remain unclear. Objective: To review the effects of VPDT on cognitive and physical function in older adults. Method: A comprehensive database search was conducted in the PubMed, Embase, Cochrane, Web of Science, PsycInfo, and CINAHL databases from inception to April 2025, relevant articles were selected, data were extracted using a PICO framework and synthesized narratively. Result: Eight controlled trials (n = 284) were included. Across studies, VPDT was generally associated with improvements in functional balance and mobility outcomes, while between-group differences versus fixed-priority dual-task training (FPDT) were inconsistent. Cognitive outcomes were sparsely reported (only one trial), and psychosocial outcomes were assessed in only a small subset of studies, precluding firm inferences regarding cognitive or psychosocial benefits. Overall risk of bias was predominantly "some concerns," with two studies rated "high risk," and overall certainty of evidence ranged from low to moderate due to risk of bias, small samples, and heterogeneity in protocols and outcomes. Conclusions: VPDT may improve physical function in older adults, particularly balance and mobility, but current evidence does not demonstrate a consistent incremental advantage over FPDT. Confidence in comparative effects remains limited due to small sample sizes, risk-of-bias concerns, and heterogeneity in intervention design and outcome measurement.
    Keywords:  balance; dual-task training; gait; mobility; older adults; variable-priority
    DOI:  https://doi.org/10.3390/brainsci16030308
  92. Chiropr Man Therap. 2026 Mar 22.
    Mobilization with movement enhances early rehabilitation outcomes in knee osteoarthritis: a six-week randomized controlled trial.
    Shahnaz Hasan, Amir Iqbal, Abeer Ramadan Ibrahim, Reham H Diab, Zaheen A Iqbal, Tabinda Hasan, Shahnawaz Anwer, Ahmad H Alghadir.
      
    Keywords:  Isometric training; Knee osteoarthritis; Manual therapy; Mobilization with movement; Quadriceps strength; Rehabilitation
    DOI:  https://doi.org/10.1186/s12998-026-00636-0
  93. Arthroscopy. 2026 Mar 24.
    Editorial Commentary: Balancing Pain Relief and Function With Iliopsoas Tendon Treatment and Concomitant Hip Arthroscopy for the Internal Snapping Hip.
    Shane J Nho, Ty L Monty, Chandler A Sparks.
      Internal snapping hip (ISH) is a relatively rare pathology in which the iliopsoas tendon "snaps" over anterior hip structures, causing pain and debilitation to patients. Although conservative management is routinely successful, patients will occasionally progress past the conservative measures and opt for surgical management. The advent of arthroscopy in treating hip pathology has provided a novel avenue in treating this patient population; however, identifying the specific technique that balances adequate symptomatic relief while preserving biomechanical function has proven difficult in recent literature. The progression of treatment for this pathology has focused on total tenotomies in the past; however, any tenotomizing procedure is not without its complications. Thus, other more preservative approaches have been explored in recent studies, attempting to mitigate as much iatrogenic musculotendinous damage as possible, which theoretically should limit complications and improve patient outcomes. Iliopsoas tunnel deepening with concomitant hip arthroscopy is an exciting new adjunct to hip arthroscopy. It may prove to be an adequate approach for treating ISH in specific patient populations with future studies corroborating its success and complication rates.
    DOI:  https://doi.org/10.1002/arj.70101
  94. NeuroRehabilitation. 2026 Mar 23. 10538135261431336
    Effects of 3 Cycles of Progressively Higher Doses of botulinum Toxin on Sagittal Kinematic Gait Parameters in People with Multifocal Spasticity After Stroke: A Prospective Cohort Study.
    Clara Selves, Gaëtan Stoquart, Thierry Lejeune, Thierry Deltombe, Stéphanie Dehem.
      IntroductionGait kinematic analysis is essential for evaluating walking quality and efficacy of interventions. Spastic gait varies among individuals, even when they present similar postural gait patterns. While previous studies have reported functional gait improvements following repeated botulinum toxin-A (BT-A) injections, effects on gait kinematics remain unclear.MethodsThis prospective cohort study assessed sagittal gait kinematics in adults with chronic stroke-related multifocal spasticity, who received three cycles of progressively higher doses of Inco BT-A (400, 600, and 800 U). Quantified gait analysis (QGA) was performed before and after the first injection cycle and after the last. To account for inter-individual variability, sagittal kinematic variables that best reflected individual postural gait patterns were identified.ResultsTwenty-five participants were included. Sagittal kinematic improvements were not observed after the first injection cycle but became apparent after the third. Significant improvements were observed in two postural gait patterns: pes equinus during stance, with a mean increase in ankle dorsiflexion of 3° (SD = 6°, p = 0.008), and stiff knee gait, with a mean increase in knee flexion during swing of 7° (SD = 7°, p < 0.001).ConclusionThis study showed effects of progressively higher doses of BT-A on sagittal knee and ankle kinematics in individuals with multifocal spasticity after chronic stroke, suggesting that three cycles of progressively higher doses are necessary to achieve measurable kinematic improvements. These results align with functional gains from our larger study, underscoring the importance of individualized gait assessments in clinical decision-making on post-stroke spastic gait.
    Keywords:  botulinum toxin type a; gait analysis; kinematics; muscle spasticity; stroke
    DOI:  https://doi.org/10.1177/10538135261431336
  95. J Pharm Bioallied Sci. 2026 Jan-Mar;18(1):18(1): 50-52
    Does Guidance Technique Influence Success? A Double-Blind Randomized Controlled Trial Comparing the Precision and Efficacy of Image-Guided and Palpation-Guided PRP Therapy for TMJ Disorders.
    K Pazhanivel, Vasumathi Thiruvengadam, Balaji Sivalingam, Nagappan Nagappan, Vedhavani Muthaiyan, M K Vigneshwaran.
       Objective: To compare the precision, clinical efficacy, and patient-reported outcomes of ultrasound-guided (USG) versus palpation-guided (PG) platelet-rich plasma (PRP) injections for temporomandibular joint (TMJ) disorders.
    Materials and Methods: In this randomized, double-blind, controlled trial, 64 patients with TMJ osteoarthritis or disc displacement without reduction were allocated to receive a single PRP injection via either USG (n = 32) or PG (n = 32) technique. The primary outcome was injection accuracy, confirmed by immediate fluoroscopic contrast verification. Secondary outcomes included maximal mouth opening (MMO), pain intensity on a visual analog scale (VAS), Mandibular Function Impairment Questionnaire (MFIQ) scores, and Global Perceived Effect (GPE) assessed at baseline 1, 3, and 6 months.
    Results: Injection accuracy was significantly higher in the USG group (100%) compared to the PG group (68.8%, P < 0.001). A significant time-by-group interaction was found for MMO (P = 0.012) and VAS pain (P = 0.023). While both groups improved from baseline at all follow-ups (P < 0.001), the USG group demonstrated significantly greater improvement in MMO at 3 months (41.5 vs. 38.4 mm, P = 0.038) and 6 months (42.8 vs. 39.0 mm, P = 0.009). The USG group also reported significantly lower VAS pain and MFIQ scores and higher GPE ratings at 6 months (all P < 0.05). No serious adverse events occurred.
    Conclusion: USG ensures perfect intra-articular PRP placement and is associated with significantly superior medium-term functional outcomes and patient satisfaction compared to the PG technique. USG should be considered the preferred method for administering biologic injections into the TMJ.
    Keywords:  Injections; intra-articular; platelet-rich plasma; temporomandibular disorders
    DOI:  https://doi.org/10.4103/jpbs.jpbs_1721_25
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