bims-ricfun Biomed News
on Rehabilitation ICF
Issue of 2026–05–03
78 papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica
  1. Comparison of ultrasound-guided dry needling and platelet-rich plasma injection in the management of refractory lateral epicondyle tendinopathy.
  2. Short-Term Clinical Outcomes of Platelet-Rich Plasma Injections in Patients With Rotator Cuff Tendinopathy and Partial-Thickness Rotator Cuff Tears.
  3. Botulinum Toxin as Targeted Neuromodulation in Complex Regional Pain Syndrome: An Anatomy-Informed Mechanistic Review.
  4. Surgical Versus Conservative Management for Carpal Tunnel Syndrome: An Updated Systematic Review of Randomised Trials.
  5. Lipoma Arborescens Revisited: Diagnostic and Interventional Value of Ultrasound.
  6. Clinical Outcomes of Pregabalin Therapy in Adults with Type I Complex Regional Pain Syndrome: A Case Series.
  7. Peripheral Nerve Stimulation at the Infrapatellar Saphenous Nerve for the Treatment of Chronic Knee Pain With Kellgren-Lawrence Grade 4: A Retrospective Case Series.
  8. Long-Term Clinical Outcomes and Patient Satisfaction Following Ultrasound-Guided Hydrodissection for Carpal Tunnel Syndrome : Long-Term Outcomes and Satisfaction after Ultrasound-Guided Hydrodissection for CTS.
  9. Deciphering 5th-Digit Sesamoiditis During Hand Ultrasound Examination.
  10. Ultrasound Examination for a Dicey Dimpling in an Infant Thigh.
  11. Role of high-resolution dynamic ultrasonography in the evaluation of posterior interosseous nerve compression at radial tunnel: a prospective case-control study.
  12. Editorial. The simplicity and complexity of carpal tunnel syndrome.
  13. Extinct-ing the Stone Age (Blind) Practice with Ultrasound.
  14. Differences in recovery time between trapeziectomy and carpometacarpal joint replacement: meta-analysis.
  15. Which functional activities matter most to the patients during the first six months after hip or knee arthroplasty: a survey study.
  16. USMSIT/NMUSIT Fundamental Guide on Diagnostic and Interventional Shoulder Ultrasonography.
  17. Subacromial bursitis is associated with short-term response to ultrasound-guided corticosteroid injection in rotator cuff disorders.
  18. Costoclavicular Approach to the Infraclavicular Brachial Plexus for Peripheral Nerve Stimulation in Treating Refractory Complex Regional Pain Syndrome Case Report.
  19. Incidence and Patient-Level Risk Factors for Complex Regional Pain Syndrome Following Cubital Tunnel Surgery.
  20. Complex Regional Pain Syndrome Following CO₂ Laser Labioplasty: A Case Report and Multimodal Interventional Management.
  21. Platelet-Poor Plasma: A Novel Treatment for Acute Quadriceps Muscle Injuries.
  22. The relationship between the cross-sectional area of the ulnar nerve and severity of ulnar neuropathy at the elbow: A systematic review.
  23. Radiofrequency Ablation as a Treatment for Symptomatic Bertolotti's Syndrome (Lumbosacral Pseudoarticulation): A Case Report.
  24. Metformin for knee osteoarthritis in overweight and obese adults: a systematic review and meta-analysis of efficacy, safety, and disease-modifying anti-inflammatory potential.
  25. Rehabilitation and surgical management after biceps tendon rupture in the only functional upper limb of a multilimb amputee with osseointegration.
  26. Comparing the effect of off-loading knee brace with and without local muscle vibration on clinical and biomechanical outcomes in patients with medial knee osteoarthritis: A randomized clinical trial.
  27. The role of muscle ultrasound in stroke rehabilitation: a review of calf muscle alterations and clinical implications.
  28. Restoring shoulder function after osteoporotic fracture using a novel double-coil rPMS protocol: A case report with functional and radiological follow-up.
  29. Platelet-Rich Plasma and Stem Cell Therapies for Musculoskeletal Rehabilitation: Current Evidence on Dosing, Activation, and Functional Performance.
  30. Reconstructing Social Participation in Rural Communities: A Qualitative Study of Community Nursing Practice.
  31. Shockwave Therapy for Midportion and Insertional Achilles Tendinopathy: A Nail in the Coffin? A Systematic Review With Meta-Analysis.
  32. Superior Cluneal Nerve Entrapment: An Overlooked Cause of Low Back Pain and the Role of Nerve Blocks.
  33. Expanding Pulmonary Rehabilitation Beyond Chronic Obstructive Pulmonary Disease and Long COVID: ITS ROLE IN COMPARATIVE EVIDENCE.
  34. Efficacy and Safety of Platelet-Rich Plasma in Knee Osteoarthritis: Umbrella Meta-Analysis Based on Clinical Evidence, Methodological Quality and Therapeutic Positioning.
  35. Neuromuscular Characteristics Associated with Knee Instability in Osteoarthritis and After Total Knee Replacement: A Systematic Review and Meta-Analysis.
  36. Extensor apparatus of the knee: anatomy and injury patterns.
  37. Intra-articular allogeneic adipose-derived mesenchymal stromal cell injections for stage III knee osteoarthritis: a double-blind placebo-controlled trial with 60-month follow-up.
  38. Video Game-Based Electromyographic Biofeedback Interventions in Patients With Knee Osteoarthritis: A Clinical Trial.
  39. Comparative efficacy of mind-body exercises for treating chronic obstructive pulmonary disease: a systematic review and network meta-analysis.
  40. Novel Ultrasound-Guided Popliteal Fascial Retinaculum Injection for Symptomatic Knee Osteoarthritis: A Technical Report With Cadaveric Dye-Distribution Study and Step-by-Step Procedural Description.
  41. Relationship between pre-operative central sensitization and post-operative outcome after arthroscopic rotator cuff repair-longitudinal outcomes over 2 post-operative years.
  42. Comparative efficacy of repetitive peripheral magnetic stimulation and transcutaneous electrical nerve stimulation in upper trapezius myofascial pain syndrome.
  43. TECAR Therapy in Pelvic Floor Rehabilitation for Women with Pelvic Pain: A Case-Control Study.
  44. Gait kinematics and kinetics in patients with different grades of meniscus injury: A cross-sectional study.
  45. Morphometric and topographic analysis of the flexor carpi radialis tendon, its tunnel, and the median nerve: an MRI-based anatomical guide for wrist interventions.
  46. How does patient-specific unicompartmental knee arthroplasty influence squatting biomechanics at mid-term follow up?
  47. Clinical and early biochemical responses to botulinum toxin type-A in refractory masticatory myofascial pain: a pilot single-arm study.
  48. Intradiscal Platelet-Rich Plasma Delivery via Modified Transdural Interlaminar Computed Tomography-Guided Access in Severe L5-S1 Disc Collapse: A Technical Case Report.
  49. Anterior Interosseous to Ulnar Nerve Transfer with an Ultrasound-Guided Short-Incision.
  50. Comparison of Treatment Outcomes From 6 Weeks of Home-Based Kinesio Taping and Transcutaneous Electrical Nerve Stimulation Combined With Self-Applied Myofascial Stretching in Adults With Carpal Tunnel Syndrome.
  51. Physical Exam for Athletic Shoulder Injuries in Adolescent Patients.
  52. Management of Ulnar Nerve Irritation by Pisiformectomy: A Clinical Anatomical Study.
  53. Should Prognostic Indicators and Management Strategies for Adhesive Capsulitis Consider Diabetes Status? A Structured Narrative Review.
  54. A Comparative Study of Intra-articular Steroid Injection Alone Versus Steroid Injection Combined with Hydroplasty and Manipulation in the Treatment of Frozen Shoulder.
  55. Impact of Acetabular Labral Tear Location on Patient-Reported Outcomes and Conversion to Total Hip Arthroplasty After Hip Arthroscopy With an 8-Year Minimum Follow-up.
  56. Contracted and relaxed quadriceps muscle thickness: A marker for muscle strength and probable sarcopenia?
  57. A systematic review of surgical treatment of reverse shoulder arthroplasty associated acromial and scapular spine stress fractures.
  58. Comparative analysis of different mobility aids in the early accelerated rehabilitation phase following acute achilles tendon repair surgery: a prospective cohort study.
  59. The role of quadriceps strength and quadriceps-focused rehabilitation following medial meniscus posterior root repair: a systematic review.
  60. Distal nerve transfers for ulnar nerve reinnervation and hand function restoration.
  61. Testosterone Therapy and Associated Rates of Tendon Tear and Surgical Repair: A Retrospective Analysis.
  62. Non-Pharmacological Pulmonary Rehabilitation in Patients with Pneumoconiosis: A Systematic Review.
  63. Do Hip Precautions Matter After Posterior Approach Total Hip Arthroplasty With Capsular Repair? A Randomized Control Trial.
  64. Diagnostic accuracy of magnetic resonance imaging for subscapularis tendon tears: a comparison with intraoperative arthroscopic findings.
  65. Physical Activity Knowledge in People With Knee Osteoarthritis Before and After Participation in an Education and Exercise Therapy Programme.
  66. Comparison of Ozone Injection and Extracorporeal Shockwave Therapy in the Treatment of Chronic Lateral Epicondylitis.
  67. Concomitant Tibiofemoral and Posterior Patellofemoral Joint Dislocation: A Case Report.
  68. outcomes of acute total hip arthroplasty (THA) in the management of acetabular fractures: a case series.
  69. Sensorimotor dysfunction does not predict pain-related cognition, but proprioception is associated with pain catastrophizing and pain self-efficacy in people with lower limb tendinopathy: A cross-sectional study.
  70. Botulinum Toxin Chemodenervation for Treating Chronic Sunburn-Induced Painful Peripheral Neuropathy: A Case Report.
  71. Impact of enhanced recovery after surgery protocols on patient-reported outcomes and satisfaction following shoulder arthroplasty: a systematic review.
  72. Botulinum Toxin Type A Injections in the Bladder Wall-An Effective Treatment for Urinary Incontinence with Low Long-Term Adherence.
  73. Adding Self-directed Psychological Support to Usual Rehabilitation Following Anterior Cruciate Ligament Reconstruction Did Not Increase Return-to-Sport Rates at 12 Months. Results From the BAck iN the Game (BANG) Randomized Controlled Trial.
  74. Point-of-care Ultrasound for Diagnosis and Management of Chronic Inflammatory Monoarthropathy of the Shoulder after Combined Influenza and COVID-19 Vaccination: A Case Report.
  75. [Viscosupplementation with High Molecular Weight Hyaluronic Acid for Hip Osteoarthritis: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials].
  76. Middle East Pain Registry (MEPAIN): Feasibility Study of Chronic Pain Registry and Pilot Phase Results : Middle East Pain Registry (MEPAIN).
  77. The pelvic femoral angle in flexed-seated position analysis predicts impingement risk of total hip arthroplasty: Defining hip joint hypermobility and true hip hyperflexion.
  78. A Tale of Two Shoulders: Comparative Outcomes of Coracohumeral Ligament Release With and Without Percutaneous Peripheral Nerve Stimulation in Adhesive Capsulitis.
  1. Clin Shoulder Elb. 2026 Apr 28.
    Comparison of ultrasound-guided dry needling and platelet-rich plasma injection in the management of refractory lateral epicondyle tendinopathy.
    Mustafa Mert Terzi, Yusuf Kıratlıoğlu, Uğur Bezirgan, Mehmet Armangil.
       Background: This prospective randomized study aimed to compare the clinical effectiveness of ultrasound-guided dry needling and platelet-rich plasma injections in patients with refractory lateral epicondyle tendinopathy.
    Methods: Fifty patients (25 in each group) diagnosed with refractory lateral epicondyle tendinopathy were randomized to receive either ultrasound-guided dry needling or platelet-rich plasma injection. Patients were evaluated before treatment and at 1, 3, and 6 months after the intervention using the visual analog scale, the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, the Patient-Rated Tennis Elbow Evaluation, and grip strength measurements. All procedures were performed under continuous ultrasound guidance.
    Results: Both groups showed significant improvements in pain, function, and grip strength over time. There were no significant differences in grip strength between the groups at any time point. However, patients treated with platelet-rich plasma showed superior outcomes in pain and functional scores, particularly at the 6-month follow-up. No complications were observed in any of the patients.
    Conclusions: Both ultrasound-guided dry needling and platelet-rich plasma injections are effective options for refractory lateral epicondyle tendinopathy. Platelet-rich plasma may offer greater clinical benefit, particularly in pain reduction and functional improvement. Further research with larger cohorts is required to establish optimal treatment protocols.
    Level of evidence: I.
    Keywords:  Conservative treatment; Dry needling; Platelet-rich plasma; Tennis elbow; Ultrasonography
    DOI:  https://doi.org/10.5397/cise.2025.01389
  2. Cureus. 2026 Mar;18(3): e105855
    Short-Term Clinical Outcomes of Platelet-Rich Plasma Injections in Patients With Rotator Cuff Tendinopathy and Partial-Thickness Rotator Cuff Tears.
    Yoshiaki Nagumo, Hajime Inoue.
       INTRODUCTION: Platelet-rich plasma (PRP) has been increasingly applied for rotator cuff pathology; however, clinical evidence regarding its short-term efficacy remains limited. This study evaluated the effectiveness of a single PRP injection for rotator cuff injury.
    METHODS: This single-center retrospective study analyzed 25 cases managed between August 2024 and August 2025 to evaluate the effectiveness of a single PRP injection for rotator cuff injury. Pain was assessed using the visual analog scale (VAS), and shoulder function was assessed using Shoulder 36 (Version 1.3) at baseline and at one, two, and three months.
    RESULTS: Mean VAS decreased from 7.48 at baseline to 4.76 at one month, 4.40 at two months, and 3.16 at three months, with significant improvements at all follow-up time points compared with baseline (paired t-test, p < 0.001). At three months, 20 of 25 cases (80.0%) achieved a VAS improvement of ≥2 points, and 16 of 25 cases (64.0%) achieved a ≥50% reduction from baseline. In the Shoulder 36, the domains of pain, range of motion, muscle strength, general health perception, and activities of daily living improved over time; pain and muscle strength improved significantly from one month, and range of motion, general health perception, and activities of daily living improved significantly at two and three months (all p < 0.05), whereas the sports ability domain did not reach statistical significance. No significant associations were observed between three-month improvements in VAS or Shoulder 36 and the interval from symptom onset to the first PRP injection, baseline Ultrasound Shoulder Pathology Rating Scale (USPRS) grade, or prior treatment (no treatment, hyaluronic acid, or corticosteroid). Retreatment was performed in six cases (24.0%), and PRP was selected in all cases; baseline characteristics and three-month VAS improvement did not differ significantly between cases with and without retreatment.
    CONCLUSION: In this single-center retrospective cohort of 25 cases, a single PRP injection was associated with significant improvements in VAS and multiple Shoulder36 domains over three months, and no apparent complications were observed during follow-up.
    Keywords:  joints; non-surgical shoulder treatment; platelet rich plasma; prp therapy; regenerative medicine therapies; regenerative orthopedics; rotator cuff tears; rotator cuff tendon; shoulder injuries
    DOI:  https://doi.org/10.7759/cureus.105855
  3. Toxins (Basel). 2026 Mar 27. pii: 160. [Epub ahead of print]18(4):
    Botulinum Toxin as Targeted Neuromodulation in Complex Regional Pain Syndrome: An Anatomy-Informed Mechanistic Review.
    Areerat Suputtitada.
      Complex regional pain syndrome (CRPS) is a heterogeneous and disabling chronic pain condition characterized by maladaptive neuroplasticity involving persistent peripheral nociceptive input, autonomic dysregulation, and central sensitization. Despite increasing clinical use, the role of botulinum toxin in CRPS remains controversial, with inconsistent outcomes reported across studies. This review synthesizes mechanistic, translational, and clinical evidence suggesting that these apparent inconsistencies may be partly explained by heterogeneity in anatomical targeting and route of administration rather than absence of biological efficacy. Available evidence suggests that botulinum toxin may exhibit its most consistent therapeutic signal when delivered to neural structures directly implicated in dominant CRPS pathophysiology, particularly the sympathetic nervous system and proximal somatic afferents, whereas superficial or non-specific delivery strategies appear to yield more variable responses. Importantly, differences across anatomical targets should not be interpreted as evidence of comparative effectiveness, as observed variation may reflect phenotype selection, procedural heterogeneity, confounding, and differences in outcome reporting. By integrating experimental data, randomized trials, and case-based clinical evidence, an anatomy-informed, route-specific neuromodulation framework is proposed to reconcile existing findings and inform future research. This mechanism-informed perspective is intended to guide rational trial design and phenotype-aligned clinical application of botulinum toxin in CRPS, rather than to provide a definitive evidence-closing synthesis.
    Keywords:  botulinum toxin; complex regional pain syndrome; neuromodulation; nociplastic pain; pain phenotyping; sympathetic nervous system
    DOI:  https://doi.org/10.3390/toxins18040160
  4. Brain Sci. 2026 Apr 08. pii: 399. [Epub ahead of print]16(4):
    Surgical Versus Conservative Management for Carpal Tunnel Syndrome: An Updated Systematic Review of Randomised Trials.
    Sara Masiero, Pasquale Arcuri, Paolo Boccolari, Elena Zorzi, Alessandro Vio, Tracy Fairplay, Davide Zanin, Fabio Vita, Danilo Donati, Roberto Tedeschi.
      Background: Carpal tunnel syndrome (CTS) is one of the most common entrapment neuropathies. While surgical decompression is widely considered the definitive treatment, conservative options remain clinically relevant, particularly for symptom relief and functional recovery in the short term. Objectives: To update the evidence comparing surgical versus non-surgical interventions for CTS, assessing pain, function, and clinical recovery. Design: Systematic review of randomised controlled trials (RCTs). Data Sources and Methods: Six databases (CENTRAL, MEDLINE, Embase, Cochrane Neuromuscular Register, ClinicalTrials.gov, and WHO ICTRP) were searched for RCTs published between November 2022 and January 2025. Risk of bias was assessed with RoB 2.0 and certainty of evidence with GRADE. Due to clinical heterogeneity, a narrative synthesis was performed. Results: Four RCTs (n = 1158) were included. Corticosteroid injection and percutaneous electrical nerve stimulation (PENS) appeared to provide faster symptom relief than surgery at short-term follow-up. However, surgery was associated with a higher probability of sustained recovery at 12-18 months (RR 1.36; 95% CI 1.19-1.56). Evidence for PENS was limited to one female-only trial, which restricts generalisability. Certainty of evidence was moderate for long-term outcomes and low for short-term results and safety. Conclusions: The available evidence suggests that surgery may offer more durable long-term recovery, whereas corticosteroids and PENS may be useful for short-term symptom relief. These findings should be interpreted with caution given the limited number of trials and the risk of bias in most included studies. Treatment choice should align with patient goals and recovery timelines. Registration: PROSPERO (CRD420250650789).
    Keywords:  carpal tunnel syndrome; evidence-based rehabilitation; functional recovery; nerve decompression; surgical versus conservative management
    DOI:  https://doi.org/10.3390/brainsci16040399
  5. Ultrasound Q. 2026 Jun 01. pii: e00742. [Epub ahead of print]42(2):
    Lipoma Arborescens Revisited: Diagnostic and Interventional Value of Ultrasound.
    Hasan Ocak, Hilmi Berkan Abacioğlu, Berkay Yalçinkaya, Ahmet Furkan Çolak, Kübranur Demirel Sarikaya, Alp Çetin.
      
    Keywords:  effusion; knee; pain; suprapatellar bursa; ultrasonography
    DOI:  https://doi.org/10.1097/RUQ.0000000000000742
  6. J Pain Res. 2026 ;19 591680
    Clinical Outcomes of Pregabalin Therapy in Adults with Type I Complex Regional Pain Syndrome: A Case Series.
    Wen-Yuan Chang, Cheng-Chiang Chang, Yung-Tsan Wu, Tsung-Ying Li.
       Background: Complex regional pain syndrome (CRPS) is a challenging pain disorder that may follow local trauma or central nervous system injury. Complex regional pain syndrome with identifiable nerve injury is classified as type II while cases without are classified as type I. Evidence regarding the effectiveness of pregabalin in treating complex regional pain syndrome remain limited. The study presents three cases of complex regional pain syndrome successfully treated with pregabalin.
    Methods: We retrospectively reviewed clinical data of patients diagnosed with complex regional pain syndrome at a single medical center in Taiwan between January 2022 and July 2025. Diagnosis was based on the Budapest criteria and confirmed with three-phase bone scintigraphy.
    Results: Three adult patients were included. All patients demonstrated clinical improvement in pain, quality of life, and rehabilitation adherence. One patient showed radiographic improvement on follow-up three-phase bone scan.
    Conclusion: Pregabalin appears to be a safe and potentially beneficial therapeutic option for complex regional pain syndrome and merits consideration as first-line pharmacotherapy within multidisciplinary treatment paradigms.
    Keywords:  complex regional pain syndrome; pain; pregabalin; three-phase bone scan
    DOI:  https://doi.org/10.2147/JPR.S591680
  7. Pain Med Case Rep. 2026 Apr;10(2): 95-100
    Peripheral Nerve Stimulation at the Infrapatellar Saphenous Nerve for the Treatment of Chronic Knee Pain With Kellgren-Lawrence Grade 4: A Retrospective Case Series.
    Aaron Mates.
       BACKGROUND: Chronic knee pain associated with advanced osteoarthritis (OA) presents a significant challenge in pain management, especially when conservative treatments fail to provide relief.
    CASE REPORT: Four patients with chronic knee pain due to Kellgren-Lawrence OA grade 4 (severe) classification were selected for permanent implantation of the Freedom® Peripheral Nerve Stimulation (PNS) System at the infrapatellar saphenous (IPS) nerve. Pain reduction and responder rates were assessed before and after treatment. Long-term follow-up data were collected to evaluate pain relief, function, quality of life, and medication usage. All 4 patients experienced > 50% pain relief following the trial period, significantly reducing mean pain scores from baseline. Long-term follow-up revealed sustained pain reduction and functional improvement, with no reported adverse events associated with the procedure.
    CONCLUSIONS: PNS targeting the IPS nerve with the Freedom PNS System demonstrates efficacy and safety in managing chronic knee pain associated with Kellgren-Lawrence OA grade 4 classification.
    Keywords:  Kellgren-Lawrence grade 4; Peripheral nerve stimulation; chronic knee pain; infrapatellar saphenous nerve
  8. Galen Med J. 2025 ;14 e3638
    Long-Term Clinical Outcomes and Patient Satisfaction Following Ultrasound-Guided Hydrodissection for Carpal Tunnel Syndrome : Long-Term Outcomes and Satisfaction after Ultrasound-Guided Hydrodissection for CTS.
    Ronza R Alsaffar, Zeyad Tareq Kareem, Farah N Abbas.
      Carpal Tunnel Syndrome (CTS) is popular conditions in where compression of the median nerve causes symptoms such as pain, numbness, and hand weakness in the hand. Current treatments provide varying degree of symptom relief; however, most are limited by short term response or long recovery. Ultrasound-Guided Hydrodissection (USGH) has emerged as a minimally invasive alternative for treating CTS, allowing precise injection of fluid around the median nerve under real-time ultrasound guidance to enhance nerve mobility. Complications of USGH are rare and mild, including short term pain, swelling, or bruising at the injection site. Because of the precision afforded by ultrasound guidance, serious complications, such as nerve damage or infection, are rare. This review aimed to evaluate the long-term clinical outcomes and patient satisfaction after USGH for CTS.
    Keywords:  Carpal Tunnel Syndrome; Hydrodissection; Median Nerve; Pain; Ultrasound-Guided Therapy
    DOI:  https://doi.org/10.31661/gmj.v14i.3638
  9. Int J Rheum Dis. 2026 May;29(5): e70671
    Deciphering 5th-Digit Sesamoiditis During Hand Ultrasound Examination.
    Berkay Yalçınkaya, Hilmi Berkan Abacıoğlu, Ahmet Furkan Çolak, Adalet Elçin Yıldız, Levent Özçakar.
      
    DOI:  https://doi.org/10.1111/1756-185x.70671
  10. J Med Ultrasound. 2026 Jan-Mar;34(1):34(1): 120-121
    Ultrasound Examination for a Dicey Dimpling in an Infant Thigh.
    Levent Özçakar, Ahmad Jasem Abdulsalam, Hakan Atalar, Bayram Kaymak.
      
    DOI:  https://doi.org/10.4103/jmu.JMU-D-24-00006
  11. J Hand Surg Eur Vol. 2026 Apr 26. 17531934261443138
    Role of high-resolution dynamic ultrasonography in the evaluation of posterior interosseous nerve compression at radial tunnel: a prospective case-control study.
    Sanjoth Basavaraj, Vinay Raju, Deepthi Paraj, Anil K Bhat, Ashwath Acharya.
       INTRODUCTION: Radial tunnel syndrome is a dynamic compressive neuropathy of the posterior interosseous nerve often misdiagnosed as lateral epicondylitis. This study aimed to appraise the role of high-resolution dynamic ultrasonography in diagnosing radial tunnel syndrome by assessing nerve compression in different forearm positions.
    METHODS: In this prospective case-control study, 28 patients with radial tunnel syndrome and 56 matched healthy volunteers underwent dynamic ultrasonography. The anteroposterior (AP) diameter and cross-sectional area (CSA) of the posterior interosseous nerve were measured proximal to the Arcade of Frohse and the AP diameter was measured within the tunnel in the pronated, neutral and supinated forearm positions. The measurements were compared with those of the volunteers and the unaffected side of the patients.
    RESULTS: An increase in the AP diameter in both the pronation and neutral forearm positions, as well as a larger CSA during forearm pronation, was observed proximal to the Arcade of Frohse in patients compared with volunteers. The increase in the AP diameter within the radial tunnel was significant in all three forearm positions. Comparison of the affected and unaffected sides revealed posterior interosseous nerve compression, with an increased AP diameter in the neutral forearm position. Twenty-five patients who were recalcitrant to non-operative treatment underwent surgical decompression and the Arcade of Frohse was the most common site of compression. At the 12 month follow-up, 24 patients achieved excellent to good results.
    CONCLUSION: Dynamic ultrasonographic assessment of changes in the AP diameter and CSA is an effective diagnostic tool for identifying radial tunnel syndrome. Although the Arcade of Frohse is the primary site of compression, it is crucial to address all compression structures in the radial tunnel during surgery.
    LEVEL OF EVIDENCE: IV.
    Keywords:  extensor carpi radialis brevis; musculoskeletal ultrasound; nerve compression syndromes; nerve entrapment syndromes; neuropathic pain; neurosonography; radial neuropathy; radial tunnel syndrome
    DOI:  https://doi.org/10.1177/17531934261443138
  12. J Hand Surg Eur Vol. 2026 May;51(5): 548-549
    Editorial. The simplicity and complexity of carpal tunnel syndrome.
    Jane E McEachan.
      
    DOI:  https://doi.org/10.1177/17531934261433793
  13. J Med Ultrasound. 2026 Jan-Mar;34(1):34(1): 122
    Extinct-ing the Stone Age (Blind) Practice with Ultrasound.
    Mustafa Güngör Albayrak, İlksu Alara Temuçin, Ahmad Jasem Abdulsalam, Murat Kara.
      
    DOI:  https://doi.org/10.4103/jmu.JMU-D-24-00011
  14. BJS Open. 2025 Mar 05. pii: zrag040. [Epub ahead of print]10(2):
    Differences in recovery time between trapeziectomy and carpometacarpal joint replacement: meta-analysis.
    Lauren Y Chong, Olivia J Hartrick, Chetan Khatri, Ciaran Sandhu, Sumedh Bele, Jeremy Rodrigues, Conrad Harrison.
       BACKGROUND: Thumb-base osteoarthritis is a common degenerative condition that produces symptoms including pain and reduced hand function. Trapeziectomy is the mainstay surgical intervention following failure of conservative management and steroid injection, with carpometacarpal (CMC) joint replacement anticipating faster recovery time and return to work. However, there is limited evidence on recovery following both surgeries, which affects patient counselling and future research design.
    METHODS: A preregistered (CRD42023450865) systematic review of the literature was conducted according to the PRISMA guidelines. Disability of the Arm, Shoulder and Hand (DASH) questionnaire scores, grip strength, and key pinch strength scores were obtained at different timepoints during follow-up. Standardized mean changes (SMC) were calculated and pooled through random-effects meta-analysis before being plotted at monthly timepoints.
    RESULTS: Of 63 articles eligible for inclusion, 25 studies were included in the meta-analysis. Subgroup analyses were conducted comparing types of trapeziectomy, joint replacement implants, and immobilization protocols. At the 1-month follow-up, joint replacement was associated with a trend of improvement in the DASH score, whereas trapeziectomy was associated with a deterioration. At 12 months, joint replacement showed a trend of greater improvement in hand function than trapeziectomy. Key pinch strength returned to baseline function at 1.5 months after joint replacement, compared with 6 months after trapeziectomy. Newer dual-mobility implants were associated with a quicker trend of recovery in DASH and key pinch strength than single-mobility implants. However, confidence intervals overlapped considerably, and most study arms had a high risk of bias, so these findings should not be considered statistically significant.
    CONCLUSION: This study shows a trend towards faster early recovery after CMC joint replacement compared with trapeziectomy, although the evidence remains limited. Randomized clinical trials with systems to frequently capture patient-reported outcomes data are required to study the temporal course of recovery for both surgeries.
    Keywords:  hand function; post-operative recovery; thumb-base osteoarthritis
    DOI:  https://doi.org/10.1093/bjsopen/zrag040
  15. Musculoskelet Sci Pract. 2026 Apr 22. pii: S2468-7812(26)00083-4. [Epub ahead of print]84 103567
    Which functional activities matter most to the patients during the first six months after hip or knee arthroplasty: a survey study.
    Motahareh Karimijashni, Marie Westby, Paul E Beaulé, Tim Ramsay, Forough Abtahi, Simon Garceau, Stéphane Poitras.
       PURPOSE: There is little understanding of which activities patients undergoing hip or knee arthroplasty prioritize at different time points after surgery. Thus, we conducted this study aimed to explore key functional activities from patients' perspectives at different timepoints during the first six months after hip or knee arthroplasty.
    METHODS: A survey was conducted at The Ottawa Hospital in Ottawa, Canada. Patients who underwent hip or knee arthroplasty due to osteoarthritis (OA) were recruited. This survey used a repeated cross-sectional design with four independent cohorts defined by time since surgery. A validated self-report questionnaire based on the activity and participation components of the International Classification of Functioning, Disability, and Health (ICF) core set for osteoarthritis was used. We classified functional activities as key if at least 75% of patients rated them as important and at least 15% reported difficulty performing them.
    RESULTS: Among the 1170 patients invited to participate, 953 completed the questionnaire. This included 503 individuals who underwent hip arthroplasty and 450 who underwent knee arthroplasty, yielding response rates of 86.6% and 86.5%, respectively. The hip arthroplasty group had a mean age of 65 years (SD 10), with 51.1% female participants and a mean BMI of 28.3 (SD 5.6) kg/m2. In the knee arthroplasty group, the mean age was 68 years (SD 9), 51.3% were female, and the mean BMI was 31.1 (SD 6.4) kg/m2. Patients identified 24 key functional activities and 25 non-key functional activities within 2 weeks, at six, 13, and 26 weeks post-arthroplasty. Patients highlighted different key activities across various stages following arthroplasty, with a decline in the number of key activities over time. At 2 weeks, patients primarily prioritized basic mobility and essential self-care activities, such as getting in and out of bed, rolling over, sitting and standing, short-distance walking, and performing dressing and bathing tasks. By 6 weeks, priorities expanded to include more advanced daily activities, such as squatting, walking on different surfaces and longer distances, carrying objects, going up and down stairs, and completing domestic tasks like shopping and housework. At 13 weeks, priorities narrowed toward higher-level mobility, such as lifting heavy objects and long-distance walking. By 26 weeks, patients demonstrated a further narrowing of priorities as they regained independence; activities such as squatting, lifting heavy objects, walking longer distances and on different surfaces, and negotiating stairs were the most consistently important.
    CONCLUSION: The study identified how patients' perspective on key activities changed over different recovery stages following arthroplasty. During the acute recovery phase, patients focused on simpler activities, progressing to more advanced activities. The findings revealed similar key activities between patients undergoing hip and knee arthroplasty. Understanding what matters most to patients enables clinicians to assess outcomes more accurately as well as adapt interventions that align with patients' needs to optimize time to recovery.
    Keywords:  Functional priorities; Knee and hip arthroplasty; Osteoarthritis
    DOI:  https://doi.org/10.1016/j.msksp.2026.103567
  16. J Med Ultrasound. 2026 Jan-Mar;34(1):34(1): 1-8
    USMSIT/NMUSIT Fundamental Guide on Diagnostic and Interventional Shoulder Ultrasonography.
    Ke-Vin Chang, Wei-Ting Wu, Yuan-Yuan Tsai, Shao-Yu Chi, Kamal Mezian, Vincenzo Ricci, Mathieu Boudier-Revéret, Levent Özçakar.
      High-resolution ultrasound (US) has become an indispensable tool in evaluating and managing shoulder pain. It offers real-time visualization of tendons, ligaments, bursae, and joint recesses while enabling dynamic assessment and image-guided intervention. Building on the EURO-MUSCULUS/USPRM framework, this guideline presents a standardized, anatomy-based approach to diagnostic and interventional shoulder ultrasonography. Developed under the educational mission of the Ultrasound and Musculoskeletal/Neuromuscular Sonography Initiative in Taiwan - through its flagship programs Ultrasound Musculoskeletal Workshop in Taiwan (USMSIT) and Neuromuscular Ultrasound Workshop in Taiwan (NMUSIT) - the protocol integrates didactic instruction, live demonstration, and structured hands-on training to ensure reproducible and clinically relevant examinations. The guideline details systematic scanning of the long head of the biceps, subscapularis, acromioclavicular joint, supraspinatus, infraspinatus, teres minor, and posterior glenohumeral joint. It is also supplemented by tripartite visual documentation comprising cadaveric dissection, regional illustrations, and paired US images from both high-end and handheld devices. Characteristic sonographic findings for common shoulder pathologies - including biceps peritendinous effusion, acromioclavicular arthropathy, calcific tendinopathy, rotator cuff tears, and subacromial-subdeltoid bursitis - are described. In addition, practical pearls for US-guided interventions such as the long head of the biceps tendon, acromioclavicular joint, subdeltoid bursa, and posterior glenohumeral injections are provided. Emphasizing the principle of "diagnosis ahead of intervention," this guideline bridges educational precision and procedural application-fostering consistent training as well as safer and more effective management of shoulder disorders. Its standardized image - anatomy framework further facilitates integration into artificial intelligence - assisted systems for automated view recognition and measurement. Therefore, it aims to advance clinical, educational, and research endeavors in musculoskeletal ultrasonography.
    Keywords:  Diagnosis; intervention; pain; rotator cuff; ultrasound
    DOI:  https://doi.org/10.4103/jmu.JMU-D-25-00156
  17. Phys Sportsmed. 2026 Apr 28. 1-6
    Subacromial bursitis is associated with short-term response to ultrasound-guided corticosteroid injection in rotator cuff disorders.
    Kemal Faruk Koruklu, Murat Karkucak, Gamze Kilic, Erhan Capkin.
       OBJECTIVE: Rotator cuff disorders (RCD) are among the most common causes of shoulder pain and functional limitation in clinical practice. Ultrasound (US)-guided subacromial corticosteroid injections are frequently used as a conservative treatment option for symptom relief in these patients. This study aimed to investigate the impact of subacromial bursitis on treatment outcomes following these injections.
    METHODS: This single-center observational study included 55 adult patients diagnosed with RCD who underwent US-guided subacromial corticosteroid injections. Patients were categorized into two groups based on the presence of subacromial bursitis, as determined by ultrasound imaging. The primary outcome was the change in pain intensity, measured by the Visual Analog Scale (VAS). Secondary outcomes included changes in shoulder function (Constant-Murley Score, CMS), disability (Shoulder Pain and Disability Index, SPADI), and shoulder range of motion (ROM). Comparative statistical analyses were conducted to assess pre- and post-injection changes between groups.
    RESULTS: Patients with subacromial bursitis showed significantly greater improvements in pain (VAS, p = 0.009), shoulder function (CMS, p < 0.001), disability (SPADI, p < 0.001), and ROM (p < 0.001) at the three-week follow-up compared to those without bursitis. Apart from age, no significant differences were observed in sex, symptom duration, or baseline clinical scores (VAS, CMS, SPADI, ROM) (all p > 0.05).
    CONCLUSION: Subacromial bursitis may be associated with a better short-term response to US-guided corticosteroid injections in RCD patients and could serve as a potential predictive marker for favorable outcomes. However, further studies are needed to confirm these findings and assess long-term effects.
    Keywords:  Shoulder pain; rotator cuff disorders; subacromial bursitis; subacromial corticosteroid injections; ultrasonography
    DOI:  https://doi.org/10.1080/00913847.2026.2666842
  18. Pain Med Case Rep. 2026 Apr;10(2): 85-90
    Costoclavicular Approach to the Infraclavicular Brachial Plexus for Peripheral Nerve Stimulation in Treating Refractory Complex Regional Pain Syndrome Case Report.
    Emma Fu, Chase Beal, Hesham Elsharkawy.
       BACKGROUND: In cases of complex regional pain syndrome (CRPS) that are refractory to conservative treatment, interventional therapies, such as neuromodulation, including peripheral nerve stimulation (PNS), may be considered as a treatment option. PNS has proven effective when applied to the brachial plexus. The anatomical positioning of the infraclavicular brachial plexus cords allows for targeting via either the conventional paracoracoid approach or the novel costoclavicular approach. The latter approach can be an excellent option to cover the plexus, as it clusters the brachial plexus cords at a more superficial level.
    CASE REPORT: We present the case of a 58-year-old woman who developed type 2 CRPS following a work-related wrist injury. Initially, she had ulnar nerve and tendon injury for which she received a series of surgeries. After failing conservative therapy, she underwent PNS with significant relief.
    CONCLUSIONS: Our case demonstrates the successful use of PNS to the brachial plexus via the novel costoclavicular approach to the infraclavicular brachial plexus for the management of refractory CRPS.
    Keywords:  Complex regional pain syndrome; case report; infraclavicular brachial plexus; peripheral nerve stimulation
  19. J Hand Surg Glob Online. 2026 Jul;8(4): 101028
    Incidence and Patient-Level Risk Factors for Complex Regional Pain Syndrome Following Cubital Tunnel Surgery.
    Stephen J Perle, Nicholas C Bank, Sarah Conlon, Alexander D Jeffs, Stephen M Himmelberg, J Megan M Patterson, Reid W Draeger.
       Purpose: Complex regional pain syndrome (CRPS) is a debilitating complication reported after upper-extremity surgeries, yet its incidence following isolated cubital tunnel surgery (CuTS) remains undefined. This study aimed to estimate the incidence of CRPS after isolated CuTS and to identify independent patient-level risk factors.
    Methods: A retrospective cohort study was conducted using the TriNetX research database. Patients who underwent a single isolated CuTS between 2000 and 2024 were identified. One-year cumulative incidences of CRPS type I and type II were calculated, excluding individuals with additional upper-extremity trauma or surgery within 1 year before or after CuTS. Separately, multivariable Cox proportional hazards models were performed in the overall CuTS population to evaluate associations between pertinent demographic and clinical factors and time to CRPS development, allowing prior upper-extremity injury and procedural history to be assessed as potential predictors.
    Results: The query identified 9,719 patients who met inclusion criteria. At 1 year after surgery, the incidences of CRPS type I and type II were 0.20% and 0.13%, respectively. Women were associated with significantly increased hazard of CRPS I but not CRPS II (HR: 2.16, 95% CI: 1.47-3.17). Preexisting fibromyalgia and polyneuropathy were independently associated with increased hazards of both CRPS subtypes. Prior upper-extremity nerve injury and prior forearm or wrist surgery were associated with increased risk of CRPS I, whereas previous proximal nerve injury and sedative-, hypnotic-, or anxiolytic-related disorders were associated with increased risk of CRPS II.
    Conclusions: CRPS following isolated CuTS is exceedingly rare, with an overall 1-year incidence rate of approximately 0.33%. However, identifiable patient-level risk factors, including female sex, preexisting polyneuropathy and fibromyalgia, selected upper-extremity nerve injuries and surgical procedures, were independently associated with increased risk. These findings provide a uniquely large estimate of CRPS risk following CuTS, offering important insight for preoperative counseling and individualized risk stratification.
    Type of study/level of evidence: Prognosis II.
    Keywords:  Complex regional pain syndrome; Cubital tunnel surgery; Cubital tunnel syndrome; Risk factors; Ulnar nerve decompression
    DOI:  https://doi.org/10.1016/j.jhsg.2026.101028
  20. Cureus. 2026 Apr;18(4): e107979
    Complex Regional Pain Syndrome Following CO₂ Laser Labioplasty: A Case Report and Multimodal Interventional Management.
    Joseph A Veraza, Mabel Z Almeida.
      Complex Regional Pain Syndrome (CRPS) is an uncommon and potentially debilitating neuropathic pain condition that may develop after surgical or iatrogenic nerve injury. Although CRPS predominantly affects the extremities, pelvic and perineal involvement is rare and poorly characterized. We report the case of a 54-year-old woman who developed CRPS following CO₂ laser labioplasty performed as part of a combined gynecologic surgical procedure. The patient presented with progressive neuropathic pain, allodynia, vasomotor and trophic skin changes, and motor impairment predominantly affecting the perineal region and right lower limb. Structural pathology was excluded by imaging. The diagnosis of CRPS was established using the Budapest Criteria. Initial pharmacologic therapy and a selective pudendal nerve block provided limited and transient relief. A multimodal interventional strategy combining repeated caudal epidural blocks, intravenous lidocaine and magnesium sulfate, and epidural preservative-free ketamine resulted in complete pain resolution, reversal of trophic changes, and full functional recovery. This case highlights CRPS as a potential complication of CO₂ laser labioplasty and supports early, mechanism-based multimodal interventional management in refractory cases, particularly when central sensitization is suspected.
    Keywords:  budapest criteria; caudal epidural block; co2 laser surgery; complex regional pain syndrome type 1; ketamine anesthesia; labioplasty; perineal injuries
    DOI:  https://doi.org/10.7759/cureus.107979
  21. Clin J Sport Med. 2026 Apr 27.
    Platelet-Poor Plasma: A Novel Treatment for Acute Quadriceps Muscle Injuries.
    Ryan C Kruse, Kyle J Biscoglia, Krit Petrachaianan.
       OBJECTIVE: To evaluate the efficacy of platelet-poor plasma (PPP) for the treatment of acute quadriceps muscle strains.
    DESIGN: Cohort study.
    SETTING: Outpatient Sports Medicine Clinic.
    PARTICIPANTS: Consecutive patients from January 2021 to January 2023 with an acute quadriceps muscle injury were included.
    INTERVENTIONS: Quadriceps muscle strain PPP injection.
    MAIN OUTCOME MEASURES: Number of days until return to full unrestricted participation in sport.
    RESULTS: Thirty-seven consecutive patients were included. Twelve (32%) of patients were female. The rectus femoris muscle was most commonly involved (73%), followed by the vastus medialis (21.6%). In total, 48.7% of injuries were modified British Athletics Muscle Injury Classification grade 3b. On average, patients returned to full activity 30 days (±15) postinjury when including all injury grades. One recurrent quadriceps muscle injury was seen within 12 months postinjury.
    CONCLUSIONS: Platelet-poor plasma may be considered an effective treatment for acute quadriceps muscle injuries with a low injury recurrence rate, and may expedite time until return to activity.
    Keywords:  orthobiologics; platelet-poor plasma; platelet-rich plasma; quadriceps; regenerative medicine
    DOI:  https://doi.org/10.1097/JSM.0000000000001460
  22. J Plast Reconstr Aesthet Surg. 2026 Apr 23. pii: S1748-6815(26)00235-4. [Epub ahead of print]117 104-114
    The relationship between the cross-sectional area of the ulnar nerve and severity of ulnar neuropathy at the elbow: A systematic review.
    Isabelle M L P Kamm, Nadine Boers, Godard C W de Ruiter, J Henk Coert.
       BACKGROUND: Ulnar neuropathy at the elbow (UNE) is the second most prevalent neuropathy of the upper extremity after median neuropathy. Although ultrasonography (US) is increasingly used in the diagnosis of UNE, it is not clear whether it can discriminate between stages of disease severity. This study aimed to investigate the correlation between ultrasonographic findings and UNE severity.
    METHODS: A systematic literature review was conducted according to PRISMA guidelines. PubMed, Embase, and Cochrane databases were searched to identify articles reporting on the relationship between US measurements and UNE severity, determined by either clinical symptoms or electrodiagnostic studies. The QUADAS-2 tool was used to assess risk of bias. Due to study variability, qualitative data synthesis was performed.
    RESULTS: In total, clinical data of 2165 patients, including US data of 2647 ulnar nerves, were represented in 15 studies. All studies evaluating the maximum cross-sectional area (CSAMAX) in relation to either clinical or electrophysiological severity reported significant associations. Regarding CSA measurements at specific anatomical locations (i.e., the level of the medial epicondyle and proximal and distal to the medial epicondyle), mixed results were found.
    CONCLUSION: Our findings support the value of CSAMAX as an ultrasonographic marker for diagnosing UNE and assisting clinicians in grading its severity.
    Keywords:  Cross-sectional area; Cubital tunnel syndrome; Ulnar nerve; Ulnar neuropathy at the elbow; Ultrasonography
    DOI:  https://doi.org/10.1016/j.bjps.2026.04.022
  23. Pain Med Case Rep. 2026 Apr;10(2): 107-109
    Radiofrequency Ablation as a Treatment for Symptomatic Bertolotti's Syndrome (Lumbosacral Pseudoarticulation): A Case Report.
    Christine Kerr, Lee Nguyen, Robert Dodds, Scott Pritzlaff, Paul K Cheng.
       BACKGROUND: Bertolotti's syndrome (BS) is an underrecognized cause of chronic low back pain, arising from a lumbosacral transitional vertebra with pseudoarticulation to the sacrum or ilium. Conservative management often fails, and surgical resection is typically considered. Radiofrequency ablation (RFA) is well established for facetogenic pain, but literature on bipolar RFA for BS is scarce.
    CASE REPORT: We present 2 patients with symptomatic BS who failed conservative therapies but experienced significant relief after bipolar RFA of the pseudoarticulation. Patient A achieved 80% pain relief, maintained at 7 months postprocedure. Patient B reported substantial initial improvement that persisted at 50% for 2 months before surgical referral. Both underwent fluoroscopically guided bipolar RFA targeting the pseudoarticulation.
    CONCLUSIONS: Bipolar RFA may be a promising minimally invasive option for BS, offering broader, more continuous lesions suited for irregular joint anatomy. Further studies are warranted to confirm its efficacy and long-term outcomes.
    Keywords:  Bertolotti; back pain; bipolar radiofrequency ablation; pseudojoint; radiofrequency ablation
  24. Inflammopharmacology. 2026 Apr 27.
    Metformin for knee osteoarthritis in overweight and obese adults: a systematic review and meta-analysis of efficacy, safety, and disease-modifying anti-inflammatory potential.
    Santenna Chenchula, Krishna Chaitanya Amerneni, R Padmavathi, K Anitha, Mohan Krishna Ghanta, Shriraam Karunakaran, Shubham Atal, Sunil Kumar, Pavani Saggurthi, Shoibam Jenifa, K Mythili Bai, Madhavrao Chavan, Balakrishnan Sadasivam.
       INTRODUCTION: Knee osteoarthritis (OA) is a degenerative joint disease involving progressive cartilage loss, subchondral bone remodelling, and inflammation. This systematic review and meta-analysis aimed to assess the efficacy and safety of metformin in reducing knee pain and adverse events among overweight and obese adults with symptomatic knee OA.
    METHODS: We systematically searched PubMed, Scopus, and CENTRAL from inception to August 2025. Eligible randomised controlled trials (RCTs) compared oral metformin with placebo or standard care in adults with BMI ≥ 25 kg/m2 and symptomatic knee OA. Primary outcomes were pain reduction (standardised mean difference) and gastrointestinal (GI) adverse events (risk ratio). Risk of bias was assessed using the Cochrane ROB 2 tool, publication bias using the Doi plot and LFK index, and evidence certainty using the GRADE-pro approach.
    RESULTS: Seven studies (n = 1237) were included: six RCTs and one observational study. Meta-analysis included only RCTs. Metformin significantly reduced knee pain compared with controls (SMD: - 0.42; 95% CI: - 0.62 to - 0.21; I2 = 95%). Sensitivity analysis excluding an outlier study produced a consistent effect (SMD: - 0.54; 95% CI: - 0.74 to - 0.33; I2 = 91%). Based on GRADE assessment, the certainty of evidence for pain reduction was high. Metformin increased the risk of mild, non-serious gastrointestinal adverse events (RR: 1.97; 95% CI: 1.06-3.67; I2 = 0%), with moderate certainty due to imprecision.
    CONCLUSIONS: Metformin provides clinically meaningful pain reduction in overweight/obese adults with knee OA but increases mild, non-serious gastrointestinal adverse events. These findings support metformin as a promising disease-modifying therapy for metabolically complex OA phenotypes; longer-duration trials with structural endpoints are warranted.
    Keywords:  Disease-modifying; Knee osteoarthritis; Metformin; Obesity; Overweight
    DOI:  https://doi.org/10.1007/s10787-026-02218-1
  25. PM R. 2026 Apr 26.
    Rehabilitation and surgical management after biceps tendon rupture in the only functional upper limb of a multilimb amputee with osseointegration.
    Nicholas Robinson, Eda Shi, Deion Ellis, Danielle Melton.
      
    DOI:  https://doi.org/10.1002/pmrj.70132
  26. J Rehabil Assist Technol Eng. 2026 Jan-Dec;13:13 20556683261440481
    Comparing the effect of off-loading knee brace with and without local muscle vibration on clinical and biomechanical outcomes in patients with medial knee osteoarthritis: A randomized clinical trial.
    Mahsa Zangi, Mahmood Bahramizadeh, Mobina Khosravi, Farzam Farahmand, Mokhtar Arazpour, Koorosh Barati.
       Background: Medial knee osteoarthritis (KOA) is a prevalent degenerative joint disease causing pain and functional impairment. Off-loading knee braces reduce pain but may decrease muscle activity, leading to weakness. Integrating local muscle vibration (LMV) into off-loading braces may enhance muscle activation and clinical outcomes.
    Objective: To design a portable LMV system synchronized with gait phases and compare its efficacy to a conventional off-loading brace in patients with medial KOA.
    Methods: In this randomized clinical trial, 16 patients with medial KOA were assigned to either an LMV-equipped off-loading brace group or a conventional brace group for 4 weeks. Clinical outcomes (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], Visual Analog Scale [VAS]) and biomechanical parameters (knee adduction moment [KAM1, KAM2], impulse, range of motion [ROM], cadence, stride length) were assessed pre- and post-intervention using validated questionnaires and a motion analysis system.
    Results: The LMV-equipped brace group demonstrated a significantly greater reduction in KAM impulse (-24.79% vs. -7.68%, p=0.050) and improved knee ROM (p=0.048) compared to the conventional brace group. Significant improvements in WOMAC (p=0.001) and VAS (p=0.011) scores were observed in the LMV group, indicating enhanced functional status and pain relief.
    Conclusion: The LMV-equipped off-loading brace provides superior biomechanical (KAM impulse, ROM) and clinical outcomes compared to conventional braces, offering a promising intervention for medial KOA.
    Keywords:  knee adduction moment; knee osteoarthritis; local muscle vibration; off-loading knee brace; pain management
    DOI:  https://doi.org/10.1177/20556683261440481
  27. Front Neurol. 2026 ;17 1785196
    The role of muscle ultrasound in stroke rehabilitation: a review of calf muscle alterations and clinical implications.
    Ying Shi, Chuanxiong Li.
       Background: Post-stroke morphological and structural alterations in lower-leg muscles-including changes in muscle thickness, pennation angle, fascicle length, and echo intensity-are key factors contributing to gait impairment and functional disability in stroke survivors. Conventional clinical assessments, such as the Modified Ashworth Scale and Fugl-Meyer Assessment, are limited by subjectivity and an inability to quantify intramuscular structural changes. Musculoskeletal ultrasonography, as a non-invasive, real-time, and quantitative imaging tool, has emerged as a valuable technique for evaluating post-stroke muscle alterations.
    Objective: This systematic review aims to synthesize the literature published in the past 5 years on the application of musculoskeletal ultrasound-including B-mode, shear wave elastography, dynamic ultrasound, and quantitative ultrasound-in assessing morphological and functional changes of lower-leg muscles in stroke patients, and to explore its correlations with clinical outcomes and its utility in guiding rehabilitation interventions.
    Methods: PubMed, CNKI, and Wanfang Data were searched from January 2020 to December 2025 following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies were included if they were original research involving stroke patients, utilized ultrasound to assess lower-leg muscles, and reported at least one morphological or functional parameter.
    Results: A total of 8 studies published between 2020 and 2025 were included. The most frequently assessed muscles were the gastrocnemius and tibialis anterior. Compared with the non-paretic side or healthy controls, the paretic lower-leg muscles commonly exhibited reduced muscle thickness and cross-sectional area, altered pennation angle, shortened fascicle length, increased echo intensity (indicating fat infiltration or fibrosis), and elevated shear wave velocity or Young's modulus (indicating increased stiffness). These ultrasound parameters showed significant correlations with clinical measures of spasticity (e.g., Modified Ashworth Scale), motor function (e.g., Fugl-Meyer Assessment), and muscle strength. Ultrasound was also effectively used to monitor treatment responses, including changes following botulinum toxin injection and rehabilitation training.
    Conclusion: Musculoskeletal ultrasonography is a promising imaging modality for objectively assessing structural and biomechanical alterations in lower-leg muscles after stroke. Recent evidence from the past 5 years confirms its value in providing insights into the pathophysiology of post-stroke muscle changes, correlating with functional outcomes, and guiding personalized rehabilitation. Future efforts should focus on establishing standardized imaging protocols to enhance clinical applicability and cross-study comparability.
    Keywords:  elastography; lower leg muscles; morphology; muscle spasticity; musculoskeletal ultrasonography; rehabilitation assessment; stroke
    DOI:  https://doi.org/10.3389/fneur.2026.1785196
  28. Trauma Case Rep. 2026 Apr;62 101328
    Restoring shoulder function after osteoporotic fracture using a novel double-coil rPMS protocol: A case report with functional and radiological follow-up.
    Vincenzo Di Modica, Giuseppe J Sciarrone.
       Background: Post-traumatic shoulder stiffness is a frequent complication following humeral fracture surgery, particularly in elderly osteoporotic patients. Even after radiographic fracture healing, persistent functional limitation may occur, especially in patients unable to complete structured postoperative rehabilitation. Osteoporosis further complicates rehabilitation due to bone fragility and the increased risk of re-fracture.
    Case report: A 76-year-old woman with severe osteoporosis presented nine months after surgical fixation of a humeral head fracture (Neer one-part, treated with K-wires) with secondary shoulder stiffness, characterized by severe pain, functional limitation, muscle weakness, and sleep disturbances. Radiographs obtained at presentation confirmed fracture union without secondary displacement. A four-month non-invasive rehabilitation program based on a combined repetitive peripheral magnetic stimulation (rPMS) protocol, using a novel double-coil static applicator and a dynamic handheld applicator, was prescribed. After two months, marked clinical improvement was observed: pain intensity decreased from 9/10 to 1/10, muscle strength improved from 1/5 to 4/5, and sleep disturbances resolved. Serial MRI scans demonstrated a progressive reduction of bone marrow edema and complete resolution of intra-articular effusion, while functional testing confirmed near-complete recovery of shoulder function.
    Conclusions: This case illustrates that a combined approach using the novel double-coil and handheld rPMS may represent a feasible non-invasive adjunct in the management of persistent postoperative shoulder stiffness in elderly osteoporotic patients. While clinical and radiological improvement was observed, causal inference remains limited in a single-case design, and these findings should be confirmed in future controlled studies.
    Keywords:  Humeral fracture; MRI monitoring; Osteoporosis; Rehabilitation
    DOI:  https://doi.org/10.1016/j.tcr.2026.101328
  29. Orthop Rev (Pavia). 2026 ;18 160607
    Platelet-Rich Plasma and Stem Cell Therapies for Musculoskeletal Rehabilitation: Current Evidence on Dosing, Activation, and Functional Performance.
    Ali Obaid, Ali Burianek, Alexander Marshall, Andre Smith, Bradley Hickey.
       Background: Musculoskeletal disorders are one of the most common causes that lead to disability throughout the world and routinely present with only limited or short-term symptom relief following traditional treatments. Recent developments, such as platelet-rich plasma (PRP) and mesenchymal stem/stromal cell (MSC) interventions, are being used as regenerative biologic adjuncts in musculoskeletal medicine, yet significant variability exists in preparation strategies, activation methods, and dosing protocols. In addition, clinical interpretation remains limited by inconsistent biologic characterization and protocol variability.
    Objective: A comprehensive review of current clinical evidence regarding dosing parameters, activation methods, and functional outcomes of PRP and MSC therapies for musculoskeletal recovery, focusing on protocol variability and clinical reproducibility.
    Methods: A structured literature search was conducted using predefined search terms in PubMed, BMJ Journals, and SpringerLink to identify human clinical studies evaluating platelet-rich plasma and mesenchymal stem cell therapies for musculoskeletal conditions. Studies published between January 2016 and December 2025 were screened. An updated search extending through December 31, 2025 identified additional records published after February 2025; however, none met the predefined inclusion criteria.
    Results: Five controlled trials featuring PRP or MSC techniques met inclusion criteria. Significant heterogeneity was observed across studies in biologic preparation techniques, leukocyte content, activation methods, cell expansion protocols, dosing regimens, and follow-up duration. While improvements in pain and functional scores were reported across both types of interventions, dose-response relationships were inconsistently evaluated and direct protocol comparisons were limited.
    Conclusion: Although regenerative biologic therapies such as PRP and MSC are associated with improvements in musculoskeletal rehabilitation, significant variability and inconsistent reporting in dosing, activation, and preparation limit generalizability and reproducibility. Prospective clinical trials featuring standardized biologic characterization and uniform reporting frameworks are necessary to begin defining evidence-informed dosing recommendations and rehabilitation delivery.
    Keywords:  Biologic Dosing and Activation; Mesenchymal Stem/Stromal Cells (MSCs); Musculoskeletal Rehabilitation; Platelet-Rich Plasma (PRP); Protocol Variability and Standardization
    DOI:  https://doi.org/10.52965/001c.160607
  30. Cureus. 2026 Mar;18(3): e106101
    Reconstructing Social Participation in Rural Communities: A Qualitative Study of Community Nursing Practice.
    Ryuichi Ohta, Akiko Yata.
      Introduction Participation is a central outcome in community-based rehabilitation, particularly in aging societies where social isolation among older adults is increasing. Community nurses have emerged as key facilitators of social participation in community settings. However, the mechanisms through which community nurses reconstruct participation in everyday practice remain insufficiently understood. This study aimed to clarify how community nurses reconstruct and facilitate participation in community-based rehabilitation. Methods This retrospective qualitative study analyzed activity logs and reflective practice records documented by three community nurses working in a rural Japanese community between January and December 2025. Thematic analysis following Braun and Clarke's framework was conducted. Participation episodes were identified and analyzed to examine how participation emerged and was facilitated in everyday community practice. Identified activities were also interpreted with reference to the participation concept of the International Classification of Functioning, Disability and Health (ICF). Results A total of 134 participation episodes were identified across multiple participation domains, including community life, recreation and leisure, interpersonal relationships, and digital communication. Four themes were identified: (1) creating participation-ready environments, (2) facilitating reciprocal roles and resident empowerment, (3) reconstructing participation through personal narratives and identity, and (4) bridging participation barriers through relational and structural support. Participation emerged as a relational and dynamic process embedded in everyday community interactions. Conclusions Community nurses play a critical role in reconstructing participation in community-based rehabilitation by facilitating relational engagement, enabling meaningful social roles, and reducing participation barriers. These findings provide empirical insights into how participation can be operationalized in community practice and highlight the potential of participation-oriented approaches in aging societies.
    Keywords:  aged; community health nursing; health promotion; qualitative research; rehabilitation; rural population; social isolation; social participation
    DOI:  https://doi.org/10.7759/cureus.106101
  31. J Orthop Sports Phys Ther. 2026 May;56(5): 282-299
    Shockwave Therapy for Midportion and Insertional Achilles Tendinopathy: A Nail in the Coffin? A Systematic Review With Meta-Analysis.
    Vasileios Korakakis, Roula Kotsifaki, Yiannis Sotiralis, Peter Malliaras.
      OBJECTIVE: To evaluate the effects of shockwave therapy (SWT) for Achilles tendinopathy compared to sham-SWT as a monotherapy or co-intervention or no treatment. DESIGN: Intervention systematic review with meta-analysis of randomized controlled trials (RCTs). LITERATURE SEARCH: AMED, CINAHL, Web of Science, MEDLINE, EMBASE, SPORTDiscus, Cochrane CENTRAL, clinical trial registries, and gray literature were searched between February 14 and February 24, 2025. STUDY SELECTION CRITERIA: Criteria included RCTs assessing radial or focused SWT (with or without co-interventions) in adults with Achilles tendinopathy. DATA SYNTHESIS: We conducted a random-effects meta-analysis. We assessed risk of bias using the Cochrane Risk of Bias 2 tool and certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. RESULTS: Nine RCTs (n = 557) were included. For insertional Achilles tendinopathy, SWT showed no clinically meaningful benefit over sham (low-moderate certainty), with consistent findings across all outcomes and sensitivity/subgroup analyses. For midportion Achilles tendinopathy, all meta-analyses (very low and moderate certainty) showed no significant differences in disability or pain between SWT and control interventions at all timepoints. There was very low-certainty evidence of a clinically meaningful effect of radial SWT on short- and long-term improvements in disability and pain compared to sham or wait-and-see controls. One trial (midportion Achilles tendinopathy) showed benefit over sham-SWT but did not report success of participant blinding. Subgroup analyses revealed no clear advantage for either radial or focused SWT. Two Achilles tendon ruptures were reported following focused SWT. CONCLUSION: There was no clinically meaningful benefit of SWT in pain and disability for Achilles tendinopathy, with evidence ranging from very low to moderate certainty. Because most effect estimates are based on very low- and low-certainty data, the true effects may change with future high-quality trials. At present, SWT should not be considered a routine treatment for either insertional or midportion Achilles tendinopathy, and alternative treatments should be prioritized. J Orthop Sports Phys Ther 2026;56(5):282-299. Epub 27 March 2026. doi:10.2519/jospt.2026.13985.
    Keywords:  evidence synthesis; modality; musculoskeletal rehabilitation; passive treatment; tendon pathology
    DOI:  https://doi.org/10.2519/jospt.2026.13985
  32. Pain Med Case Rep. 2026 Apr;10(2): 143-146
    Superior Cluneal Nerve Entrapment: An Overlooked Cause of Low Back Pain and the Role of Nerve Blocks.
    Anthony Reyes, Chandan Saini, Weibin Shi, Hong Wu.
       BACKGROUND: Low back pain is a leading cause of disability; superior cluneal nerve entrapment (SCN-E) is an underdiagnosed etiology. SCN-E mimics common pain generators such as lumbar radiculopathy, facet joint dysfunction, and sacroiliac joint pain, thus leading to diagnostic challenges and delayed treatment.
    CASE REPORTS: We describe 2 cases of SCN-E with distinct predisposing factors, including spinal scoliosis. A 74-year-old woman with a history of polymyalgia rheumatica presented with persistent low back pain and buttock pain despite standard treatments. A 77-year-old man with prior lumbar laminectomies reported chronic low back pain and right hip pain refractory to previous interventions. Both patients underwent ultrasound-guided superior cluneal nerve blocks, resulting in significant pain relief, thereby confirming SCN-E as the pain generator.
    CONCLUSION: These cases highlight the importance of recognizing SCN-E in patients with refractory low back pain, particularly in those with altered spinal biomechanics. Ultrasound-guided SCN blocks serve as both a diagnostic tool and a therapeutic intervention, facilitating targeted pain management.
    Keywords:  Superior cluneal nerve entrapment; altered spinal biomechanics; case series; spinal scoliosis; superior cluneal nerve block
  33. J Cardiopulm Rehabil Prev. 2026 May 01. 46(3): 155-157
    Expanding Pulmonary Rehabilitation Beyond Chronic Obstructive Pulmonary Disease and Long COVID: ITS ROLE IN COMPARATIVE EVIDENCE.
    Tetsuro Maeda, Abebaw Mengistu Yohannes.
      
    DOI:  https://doi.org/10.1097/HCR.0000000000001054
  34. Clin Pract. 2026 Apr 14. pii: 75. [Epub ahead of print]16(4):
    Efficacy and Safety of Platelet-Rich Plasma in Knee Osteoarthritis: Umbrella Meta-Analysis Based on Clinical Evidence, Methodological Quality and Therapeutic Positioning.
    María Ángeles Ventura-García, Tesifón Parrón-Carreño, David Lozano-Paniagua, Bruno José Nievas-Soriano, Antonio Fernando Murillo-Cancho, Elena María Gázquez-Aguilera, Delia Cristobal-Cañadas.
      Background/Objectives: Despite being a standard biological therapy for knee osteoarthritis, inconsistent results across studies-due to varied protocols-have obscured the clinical standing of platelet-rich plasma. This meta-analysis evaluates the efficacy and safety of PRP for pain, function, and adverse events, and examines the potential benefits of combining it with hyaluronic acid. Methods: An umbrella review was conducted following the PRIOR (Preferred Reporting Items for Umbrella Reviews) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. Meta-analyses evaluating PRP in knee osteoarthritis were included. Quantitative estimates of pain, function, and safety were extracted. Random-effects models were applied when possible. Methodological quality was assessed using AMSTAR 2, and study overlaps were assessed using the CCA method. Publication bias was analyzed using a funnel plot. Results: The meta-analyses included consistently showed the superiority of PRP over hyaluronic acid and placebo in reducing pain and improving function. Pooled estimates indicated clinically relevant improvements, especially in mild-to-moderate osteoarthritis. The combination of PRP and hyaluronic acid demonstrated superior functional recovery and a potential reduction in adverse events compared to PRP monotherapy. The overall safety profile was favorable. Conclusions: PRP is an effective and safe therapy for knee osteoarthritis, with consistent evidence of superiority over conventional intra-articular treatments. Combined PRP and HA administration suggests superior clinical efficacy compared to monotherapy. Standardization of protocols and appropriate patient selection will be key in future clinical guidelines.
    Keywords:  PRP; hyaluronic acid; knee osteoarthritis; platelet-rich plasma; regenerative medicine; umbrella review
    DOI:  https://doi.org/10.3390/clinpract16040075
  35. Clin Pract. 2026 Apr 14. pii: 74. [Epub ahead of print]16(4):
    Neuromuscular Characteristics Associated with Knee Instability in Osteoarthritis and After Total Knee Replacement: A Systematic Review and Meta-Analysis.
    Ariane P Lallès, Luisa Cedin, Markus A Wimmer.
      Background/Objectives: Knee joint instability is frequently reported in individuals with knee osteoarthritis (OA) and may persist after total knee replacement (TKR), where it represents a leading cause of revision. However, neuromuscular factors associated with knee instability remain poorly understood. This systematic review and meta-analysis aimed to compare neuromuscular characteristics between individuals with stable and unstable knees in OA and TKR populations. Methods: PubMed, CENTRAL, Scopus, and EMBASE were searched from inception to 10 January 2025. Studies comparing neuromuscular outcomes between stable and unstable knees were included. Neuromuscular parameters included: muscle strength, muscle power, muscle activation pattern, and joint stiffness. Where appropriate, pooled standardized mean differences (SMD) were calculated using random-effects models. Certainty of evidence was evaluated using the GRADE approach. Results: Nineteen studies (16 OA, 3 TKR; n = 7369 participants) were included, with eleven studies eligible for meta-analysis. OA individuals with unstable knees demonstrated significantly lower limb muscle strength compared with stable counterparts (SMD = -0.49, 95% CI -0.81 to -0.16, p = 0.003). Muscle co-contraction did not differ significantly between groups (SMD = 0.12, 95% CI -0.70 to 0.94, p = 0.77). The overall certainty of evidence was rated as very low. Conclusions: Knee instability in OA populations is associated with reduced lower limb muscle strength, although evidence quality is limited and findings regarding neuromuscular control strategies remain inconclusive. Evidence in TKR populations is scarce. Future studies should investigate muscle activation patterns and dynamic joint stabilization during functional tasks to clarify the neuromuscular mechanisms underlying knee instability.
    Keywords:  knee instability; knee laxity; knee osteoarthritis; muscle co-contraction; muscle strength; total knee arthroplasty
    DOI:  https://doi.org/10.3390/clinpract16040074
  36. Skeletal Radiol. 2026 Apr 30.
    Extensor apparatus of the knee: anatomy and injury patterns.
    Dyan Flores, Angela Atinga, Christopher Beaulieu, Erin F Alaia, Linda Probyn.
      The extensor mechanism of the knee is essential for maintaining normal daily function and for activities such as walking and athletic performance. It comprises the quadriceps muscles and tendon, patella and peripatellar fat pads, patellofemoral joint and retinacula, patellar tendon, and tibial tuberosity. Disruption of any component can result in pain, instability, or loss of active extension. Owing to its superficial location and continuous biomechanical loading, it is particularly vulnerable to acute trauma, repetitive microtrauma, chronic degeneration, and traction apophysitis in the pediatric population. Imaging is essential for accurately differentiating between diagnoses and guiding management. Radiographs remain indispensable for assessing patellar height, fracture morphology, and skeletal variants, while computed tomography (CT) is a reliable preoperative tool for defining fracture configuration, comminution, and articular involvement. Ultrasound (US) offers dynamic, high-resolution evaluation of tendons and retinacula, facilitating differentiation of partial from complete tears and assessment of postoperative integrity. Magnetic resonance imaging (MRI) provides comprehensive characterization of soft tissues, bone marrow, cartilage, and associated intra-articular pathology, and is central to preoperative planning in complex injuries and patellofemoral instability. In addition to diagnosis, imaging findings directly influence treatment decisions, including fracture fixation strategies, tendon repair or augmentation, and treatment selection. Postoperative imaging plays a vital role in monitoring healing, detecting complications such as construct elongation, re-tear, hardware irritation, and recurrent instability, and guiding rehabilitation. This review highlights the radiological anatomy and injury patterns of the knee extensor mechanism, emphasizing that integrated use of radiographs, ultrasound, and MRI enables accurate, clinically relevant assessment.
    Keywords:  Extensor mechanism; Imaging; Knee; Patella; Patellar tendon; Quadriceps tendon
    DOI:  https://doi.org/10.1007/s00256-026-05196-1
  37. Stem Cells Transl Med. 2026 Apr 27. pii: szag018. [Epub ahead of print]15(5):
    Intra-articular allogeneic adipose-derived mesenchymal stromal cell injections for stage III knee osteoarthritis: a double-blind placebo-controlled trial with 60-month follow-up.
    Hanan Jafar, Osama Samara, Diana Shahin, Fadwa Daoud, Dana Al-Hattab, Aseel Samara, Lina Al Lawama, Mohammed Hamdan, Huda Qubbaj, Bareqa Salah, Abdalla Awidi.
      Knee osteoarthritis (KOA) is a progressive degenerative joint disease with limited treatment options that effectively modify disease progression. This study evaluates the safety and efficacy of allogeneic adipose-derived mesenchymal stromal cells (ADMSCs) injected under ultrasound guidance in patients with symptomatic stage III KOA. In this single-site, randomized, double-blind, placebo-controlled trial, patients were assigned to receive either 2 doses of allogeneic expanded ADMSCs, administered 2 weeks apart (Arm A, mean total dose: 69.58 × 106 ADMSCs), or 2 equal-volume normal saline injections (Arm B). Blinding was maintained for 12 months, after which follow-up of Arm A continued to 60 months. Treatment efficacy was assessed using normalized Knee Injury and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Osteoarthritis Index at 6, 12, 24, 36, 48, and 60 months, while magnetic resonance imaging (MRI) evaluations were performed at baseline and 12 months. A total of 29 subjects (21 in Arm A, 8 in Arm B) completed the study. Adverse events in Arm A were mild and transient, including localized pain and swelling. Patients in Arm A demonstrated significant improvements in clinical scores compared to baseline, with highly significant differences at 6, 12, 24, and 36 months (P < .0001). MRI assessments at 12 months revealed structural improvement (P < .02). However, clinical improvements declined steadily after 36 months, with scores nearing baseline at 60 months. These findings suggest that allogeneic ADMSC therapy is safe and provides sustained clinical and structural benefits for up to 3 years. Larger trials are needed to optimize dosing and assess long-term efficacy.
    Keywords:  cartilage regeneration; cellular therapy; knee osteoarthritis; mesenchymal stromal cells; regenerative medicine
    DOI:  https://doi.org/10.1093/stcltm/szag018
  38. Cureus. 2026 Mar;18(3): e105993
    Video Game-Based Electromyographic Biofeedback Interventions in Patients With Knee Osteoarthritis: A Clinical Trial.
    Mandeep Kaur, Eileen Krepkovich, James Patrie, Neal Richardson, Aaron Olowin, Amelia S Bruce Leicht, Xavier D Thompson, Susan Saliba, Joe Hart.
       INTRODUCTION: Exercise is considered the most effective, non-drug treatment for reducing pain and improving movement in patients with knee osteoarthritis (OA). The current study aimed to compare the efficacy of incorporating a Knee Biofeedback Rehabilitation Game for Osteoarthritis Therapy (KneeBRIGHT) (Barron Associates, Inc., Charlottesville, VA, USA) device into a 10-week rehabilitation course in patients diagnosed with knee OA.
    METHODS: This clinical trial used a parallel, prospective, single-blind, randomized controlled design. Participants were randomly allocated to the KneeBRIGHT (n = 17) or the control (n = 17) group. Quadriceps muscle strength, perceived knee function using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee (IKDC) scale, and balance were measured prior to and immediately following the rehabilitation program. The KneeBRIGHT group did exercises using the electromyography (EMG)-based video games, while the control group performed the same traditional exercises without the video games. All patients attended a combination of in-clinic and home-based interventions for 10 weeks. Participants were interviewed at the end of the study.
    RESULTS: Thirty-four patients participated in the study. The KneeBRIGHT group showed an improvement in KOOS quality of life (QOL) (p = 0.002), while the control group demonstrated improvements in KOOS symptoms (p < 0.001), pain (p = 0.009), activities of daily living (ADL; p = 0.005), KOOS sports (p = 0.002), and KOOS QOL (p = 0.016) compared to the baseline. No differences in quadriceps strength were found. The key themes from the interviews indicated that the KneeBRIGHT games are motivating and are an effective alternative to regular exercises.
    CONCLUSIONS: Patients exhibited improvements in perceived knee function and exhibited increased quadriceps strength using KneeBRIGHT games compared to traditional rehabilitation exercises. Playing video games may help maintain patient motivation and can be done at home independently, effectively reinforcing the therapeutic effect of exercises.
    Keywords:  interventions; knee osteoarthritis; muscle strength; quality of life; video games
    DOI:  https://doi.org/10.7759/cureus.105993
  39. Clin Rehabil. 2026 Apr 29. 2692155261444584
    Comparative efficacy of mind-body exercises for treating chronic obstructive pulmonary disease: a systematic review and network meta-analysis.
    Qian Gao, Peijun Li, Xiaoyu Han, Yifan Lv, Jun Wang, Huifang Tang, Yuhong Zhang, Xiaodan Liu, Weibing Wu.
      ObjectiveThe comparative effectiveness of various mind-body exercises for chronic obstructive pulmonary disease remains unclear. This study aimed to compare and rank different mind-body interventions for improving objective and subjective outcomes in patients with chronic obstructive pulmonary disease.Data sourcesWe systematically searched PubMed, Web of Science, EMBASE, Cochrane Library, and Scopus.MethodsRandomised controlled trials assessing mind-body exercises for chronic obstructive pulmonary disease were included. A network meta-analysis was performed using Stata 16.0. The protocol was registered with PROSPERO (CRD42024592835).ResultsThirty-seven studies involving 3179 participants and nine interventions were analysed. Regarding objective outcomes, Pilates plus pulmonary rehabilitation showed the largest improvement in exercise capacity. For pulmonary function, Pilates plus pulmonary rehabilitation significantly improved forced expiratory volume in the first second as a percentage of the predicted value and forced expiratory volume in the first second/forced vital capacity, while Yoga demonstrated superior effects on forced expiratory volume in the first second and forced vital capacity. Regarding subjective outcomes, Tai Chi, alone or combined with pulmonary rehabilitation, was superior in reducing dyspnea, while Tai Chi plus pulmonary rehabilitation and Qigong showed the greatest benefits for health-related quality of life.ConclusionsMind-body exercises are beneficial for chronic obstructive pulmonary disease management. Pilates plus pulmonary rehabilitation stands out for improving objective outcomes, particularly exercise capacity and pulmonary function, whereas Tai Chi, alone or combined with pulmonary rehabilitation, emerges as the most effective intervention for subjective outcomes, including dyspnea and health-related quality of life.
    Keywords:  Chronic obstructive pulmonary disease; dyspnea; exercise capacity; health-related quality of life; mind-body exercises; pulmonary function
    DOI:  https://doi.org/10.1177/02692155261444584
  40. Cureus. 2026 Apr;18(4): e107760
    Novel Ultrasound-Guided Popliteal Fascial Retinaculum Injection for Symptomatic Knee Osteoarthritis: A Technical Report With Cadaveric Dye-Distribution Study and Step-by-Step Procedural Description.
    Sang-Hyun Kim, U-Young Lee, Yonghyun Yoon, Teinny Suryadi, Daniel Chiung-Jui Su, Wei-Chuan Wang, King Hei Stanley Lam.
      Knee osteoarthritis (OA) is increasingly understood as a whole-joint disorder involving not only articular cartilage but also synovium, capsule, ligaments, tendon insertions, and adjacent periarticular soft tissues. Fascial and interfascial tissues have attracted growing interest in musculoskeletal medicine because of their continuity, force-transmission properties, sensory innervation, and potential relevance to pain generation and movement dysfunction. We describe a novel ultrasound-guided posteromedial knee injection targeting the posteromedial fascial-periarticular convergence zone, referred to operationally in this report as the "popliteal fascial retinaculum." This term is used as a descriptive procedural framework rather than a formally established anatomical structure. This convergence region involves the semimembranosus insertion, popliteus, oblique popliteal ligament (OPL), posterior capsule, proximal superficial medial collateral ligament (MCL), and adjacent popliteal fascial layers. The technique uses a structured scanning sequence beginning with transverse safety mapping of the popliteal neurovascular bundle, followed by posteromedial landmark identification and longitudinal localization of the target convergence zone. A 5-inch 22-gauge spinal needle is advanced in plane under real-time ultrasound guidance, and 30 mL of 5% dextrose with 0.1% lignocaine is distributed across five predefined target planes. Cadaveric feasibility was assessed in four lower limbs using 30 mL of 0.1% methylene blue delivered under ultrasound guidance according to the described technique. Gross layered dissection demonstrated dye staining of the intended target structures together with substantial extension into adjacent fascial, periarticular, perineural, and perivascular planes, with proximal interfascial spread along the posterior thigh. Histologic confirmation of intraneural or intravascular spread was not performed. These findings support preliminary anatomical feasibility of regional access and spread, but do not establish selective targeting, procedural safety, histologic precision, or clinical efficacy. This technical report describes a reproducible ultrasound-guided posteromedial knee injection technique supported by cadaveric dye-distribution findings, detailed sonoanatomic landmarks, and procedural video documentation. The technique appears anatomically plausible and technically feasible as a regional interfascial-periarticular access approach, but further prospective work is needed to determine reliability, safety, mechanism, targeting specificity, and clinical effectiveness.
    Keywords:  5% dextrose; cadaveric dye-distribution study; hydrodissection; knee osteoarthritis; popliteal fascia; popliteus; posteromedial knee; semimembranosus; technical report; ultrasound-guided injection
    DOI:  https://doi.org/10.7759/cureus.107760
  41. JSES Int. 2026 May;10(3): 101684
    Relationship between pre-operative central sensitization and post-operative outcome after arthroscopic rotator cuff repair-longitudinal outcomes over 2 post-operative years.
    Tsuyoshi Sasaki, Hitoshi Shitara, Masataka Kamiyama, Ryosuke Miyamoto, Fukuhisa Ino, Takuma Kachi, Kurumi Nakase, Tsuyoshi Ichinose, Noritaka Hamano, Kenji Takagishi, Hirotaka Chikuda.
       Background: Whether pre-operative central sensitization (CS) affects post-operative outcomes after arthroscopic rotator cuff repair (ARCR) remains unclear. This study aimed to evaluate the potential association between pre-operative CS and post-operative pain and function for 2 years in patients who underwent ARCR for small-to-medium rotator cuff tears.
    Methods: Sixty patients with small-to-medium full-thickness rotator cuff tears who underwent ARCR and were followed up for 24 months post-operatively were enrolled. The presence or absence of CS was evaluated using the Japanese version of the Central Sensitization Inventory (short form). Patients were divided into 2 groups according to the presence or absence of CS, with scores ≥10 defined as CS. Baseline demographic and radiologic factors (eg, smoking status, diabetes mellitus, occupation, tear size, and fatty infiltration) were recorded and compared between groups. Post-operative outcomes, including pain (numerical rating scale), shoulder range of motion, muscle strength, and clinical scores (Constant, American Shoulder and Elbow Surgeons), were assessed at 3, 6, 12, 18, and 24 months. Rotator cuff integrity was evaluated by magnetic resonance imaging (MRI) at 3, 6, 12, and 24 months post-operatively.
    Results: CS was present in 45% of patients. There were no significant differences in baseline demographic, clinical, or radiologic factors, as well as in pre-operative shoulder joint range of motion, strength, or pain between the groups with and without CS. Patients with CS exhibited significantly less improvement in pain on motion, abduction strength, and clinical scores at multiple time points up to 18 months; by 24 months, however, these differences had diminished.
    Conclusion: Pre-operative CS may be associated with delayed improvement in post-operative motion-related pain and clinical scores after ARCR, although its long-term impact appears limited. Clinicians should consider pre-operative CS among factors that may affect post-operative functional recovery, particularly in the first 18 months, with no apparent difference by 24 months.
    Keywords:  Arthroscopic rotator cuff repair; Central sensitization; Clinical scores; Physical function; Post-operative outcome; Shoulder pain
    DOI:  https://doi.org/10.1016/j.jseint.2026.101684
  42. Turk J Med Sci. 2026 ;56(2): 439-453
    Comparative efficacy of repetitive peripheral magnetic stimulation and transcutaneous electrical nerve stimulation in upper trapezius myofascial pain syndrome.
    Shahriyar Kalbiyev, Şehim Kutlay, Atilla Halil Elhan, Yeşim Kurtaiş Aytür, Aysun Genç.
       Background/aim: In this prospective, randomized, single-blind study, the effects of repetitive peripheral magnetic stimulation (rPMS) and transcutaneous electrical nerve stimulation (TENS) on pain intensity, functional status, and tissue elasticity were evaluated in patients with upper trapezius myofascial pain syndrome (MPS).
    Materials and methods: A total of 75 female patients were randomly allocated to three groups: rPMS, TENS, and sham rPMS. All participants were provided with an exercise program consisting of cervical range-of-motion (ROM), stretching, and strengthening exercises. Outcome measures included pain intensity assessed using the visual analog scale, pressure pain threshold (PPT), the Neck Disability Index, cervical ROM, SF-36 subscale scores, and ultrasound shear-wave elastography. All data were collected and compared before treatment, immediately after treatment, and 1 month after treatment.
    Results: Both rPMS and TENS significantly reduced pain intensity, increased PPT, and improved functional outcomes compared with the sham rPMS group. However, rPMS was associated with a greater increase in PPT compared with TENS (p = 0.013). A significant improvement in ROM was observed across all three groups for all neck positions, except for extension in the sham rPMS group. The rPMS group showed significant improvements in four SF-36 subscales compared with the sham rPMS group, whereas the TENS group showed no significant differences. Furthermore, improvements in physical functioning (p = 0.011) and mental health (p = 0.007) scores were significantly greater in the rPMS group than in the TENS group. A significant increase in muscle elasticity was observed only in the TENS group; no significant change was observed in the rPMS or sham rPMS groups.
    Conclusion: The findings may suggest that rPMS may be a promising noninvasive modality for the management of MPS. It may be used to reduce pain and improve functional outcomes in patients with MPS. Elastography findings may indicate that neurophysiological mechanisms contribute substantially to pain and dysfunction; however, mechanical stiffness cannot be excluded as a contributing factor. Longer follow-up studies are needed to determine the effectiveness of rPMS treatment protocols.
    Keywords:  Myofascial pain syndrome; TENS; repetitive peripheral magnetic stimulation; trigger points; ultrasound elastography
    DOI:  https://doi.org/10.55730/1300-0144.6178
  43. Int Urogynecol J. 2026 Apr 27.
    TECAR Therapy in Pelvic Floor Rehabilitation for Women with Pelvic Pain: A Case-Control Study.
    Daniela Caramazza, Monia Marturano, Vittoria Rizzitelli, Lediana Kamberaj, Lorenzo Vacca, Andrea Lombisani, Alfredo Ercoli, Giuseppe Campagna.
       INTRODUCTION AND HYPOTHESIS: Chronic pelvic pain (CPP) with pelvic floor muscle hypertonicity (PFMH) significantly impacts women's quality of life. The hypothesis is that TECAR therapy in standard pelvic floor rehabilitation would enhance pain reduction.
    METHODS: This retrospective case-control study included 138 women with CPP and PFMH treated between January and December 2022. Cases (n = 72) received multimodal rehabilitation with bipolar radiofrequency TECAR therapy; controls (n = 66) received standard rehabilitation alone (Kegel exercises, myofascial stretching, low-frequency electrical stimulation). Pain was measured using the Visual Analogue Scale (VAS) at baseline and 1 month after completion of the rehabilitation program. Multivariable logistic regression and receiver operating characteristic (ROC) analyses identified predictors and optimal treatment thresholds for clinically relevant pain reduction (ΔVAS ≥ 2).
    RESULTS: Both groups showed significant VAS reduction (p < 0.001), but the TECAR group achieved greater pain reduction (median VAS 8.0 → 3.0 vs 8.0 → 4.0; p < 0.001) and required fewer electrical stimulation sessions (7 vs 10, p < 0.001). In cases, the number of TECAR sessions was significantly associated with ΔVAS ≥ 2 in univariate (OR 1.36, 95%CI 1.01-1.83; p = 0.042) and multivariate models adjusted for baseline VAS, age, and BMI (OR 1.40, 95%CI 1.01-1.93; p = 0.041). No variables predicted response in controls. In cases, ROC analysis identified ≥ 6 TECAR sessions as the optimal threshold for meaningful improvement (AUC 0.80, sensitivity 66.7%, specificity 100%). No adverse events occurred.
    CONCLUSIONS: TECAR therapy enhances pelvic floor rehabilitation effectiveness in women with CPP and PFMH, providing superior pain relief with fewer invasive procedures. The six-session threshold may provide evidence-based guidance on treatment. These findings support the integration of TECAR into standard pelvic rehabilitation protocols.
    Keywords:  Chronic pelvic pain; Pelvic floor hypertonicity; Pelvic rehabilitation; Radiofrequency; TECAR therapy; Urogynecology
    DOI:  https://doi.org/10.1007/s00192-026-06537-3
  44. PLoS One. 2026 ;21(4): e0347740
    Gait kinematics and kinetics in patients with different grades of meniscus injury: A cross-sectional study.
    Xinya Lan, Yaping Li, Jiaxin Gao, Yongyi Xu, Qingping Su, Pan Xu, Jianhao Chen, Zhonghua Lin, Cai Jiang.
      Meniscal injuries are common and can alter knee biomechanics, increasing the risk of osteoarthritis. This study investigated the effects of unilateral meniscal injuries of different Stoller grades on gait kinematics and kinetics. A total of 158 participants were stratified by MRI into three groups: control group(Grade 0, n = 51), Grade I-II (n = 54), and Grade III (n = 53). Three-dimensional motion capture synchronized with force platforms was used to assess peak sagittal-plane joint angles, joint moments, and ground reaction forces. Multivariate analysis of covariance was applied to adjust for body mass index, Lysholm score, and walking speed. Compared with healthy controls, injured participants demonstrated reduced knee flexion, hip extension, and lower extremity joint moments, along with increased ankle dorsiflexion, knee extension, and hip flexion angles; anterior, posterior, and lateral ground reaction forces were also significantly decreased. Although no significant differences in joint moments or ground reaction forces were observed between Grade I-II and Grade III groups, deviations in joint angles increased gradually with the severity of injury. The most pronounced changes were seen in the knee extension angle, which rose by 309.0% in Grade III compared with the control group, and the hip extension angle, which decreased by 53.3% in Grade III compared with the control group. A 16.5% reduction in the knee flexion angle was also observed. These findings indicate that even mild meniscal injuries produce substantial gait kinetic deficits, while kinematic alterations become more pronounced with higher-grade injuries. The study highlights the value of integrating Stoller grading with objective gait analysis to identify functional impairments not captured by patient-reported outcomes. This comprehensive approach provides a biomechanical basis for early assessment and individualized rehabilitation strategies, supporting knee function preservation and potentially slowing long-term degenerative changes.
    DOI:  https://doi.org/10.1371/journal.pone.0347740
  45. Surg Radiol Anat. 2026 Apr 29. pii: 120. [Epub ahead of print]48(1):
    Morphometric and topographic analysis of the flexor carpi radialis tendon, its tunnel, and the median nerve: an MRI-based anatomical guide for wrist interventions.
    Seren Kaya, Yusuf Secgin, Deniz Senol, Oguzhan Harmandaoglu, Oguzhan Ozturk, Ömer Önbaş.
      
    Keywords:  Carpal tunnel; Flexor carpi radialis; Magnetic resonance; Median nerve; Trapezium
    DOI:  https://doi.org/10.1007/s00276-026-03887-x
  46. Knee. 2026 Apr 25. pii: S0968-0160(26)00161-4. [Epub ahead of print]61 104481
    How does patient-specific unicompartmental knee arthroplasty influence squatting biomechanics at mid-term follow up?
    Haithem M'barki, Etienne L Belzile, Martin Bédard, Michèle Angers, Katia Turcot.
       BACKGROUND: The potential advantages of patient-specific (PS) compared with off-the-shelf (OTS) unicompartmental knee arthroplasty (UKA) in terms of knee function remain unclear. Therefore, the aim of this study was to determine whether PS-UKA implant leads to superior improvement in terms of knee joint function compared with an OTS-UKA while performing a deep squat.
    METHODS: Twenty-two patients and 22 healthy individuals, matched for age and height, were recruited. Eight patients were operated with PS-UKA, and 14 patients with OTS-UKA. All patients were evaluated at a minimum follow up of 3 years post-surgery. Participants were instructed to squat as deeply as possible. Sagittal, frontal and transverse kinematics and kinetics were calculated for hip, knee and ankle joints. Co-contraction index was calculated for knee flexor and extensor muscles. Statistical Parametric Mapping was used to compare dependant variables.
    RESULTS: PS-UKA and OTS-UKA showed no significant differences in spatiotemporal, kinematic, or kinetic outcomes. Compared with controls, OTS-UKA displayed reduced knee flexion, lower hip and knee sagittal range of motion, decreased hip contribution, and increased ankle contribution to total support moment.
    CONCLUSION: The personalization of the implant did not demonstrate superior knee function compared with off-the-shelf UKA during squatting. The decrease in maximum knee flexion compared with the control group may be associated with fear of movement for both designs. In addition, PS-UKA and OTS-UKA patients adopted an ankle dominant strategy during squatting compared with the control group. Further analyses are required to validate these findings in other, more challenging functional tasks such as sit-to-stand and stairs negotiation.
    Keywords:  Mobile bearing; Motion analysis; Muscle activities; Patient-specific implant; Squat; Unicompartmental knee arthroplasty
    DOI:  https://doi.org/10.1016/j.knee.2026.104481
  47. BMC Oral Health. 2026 Apr 30.
    Clinical and early biochemical responses to botulinum toxin type-A in refractory masticatory myofascial pain: a pilot single-arm study.
    Salih Eren Meral, Ayşe Buruş, Sevilay Karahan, Nuray Bayrakçı, Yasemin Bayazıt.
       BACKGROUND: Masticatory myofascial pain (MMP) is a common subtype of temporomandibular disorders (TMD) characterized by muscle tenderness and pain during jaw function. Botulinum toxin type-A (BoNT-A) is often used for refractory cases unresponsive to conservative therapies; however, its biological mechanisms remain unclear. This exploratory pilot study aimed to evaluate both clinical outcomes and biochemical changes following BoNT-A injections in patients with refractory MMP.
    METHODS: Twenty-seven patients diagnosed with refractory MMP according to DC/TMD criteria received intramuscular BoNT-A injections into the masseter and temporalis muscles. Pain intensity (VAS), pressure pain threshold (PPT), maximum mouth opening (MMO), and oral health-related quality of life assessed using the OHIP-14 were recorded at baseline (T0) and 28 days post-treatment (T1). Serum and saliva samples were collected to measure inflammatory cytokines (IL-1β, IL-6, TNF-α) and neuropeptides (CGRP, NGF) using ELISA. Data were analyzed using the paired t-test or Wilcoxon signed-rank test, as appropriate.
    RESULTS: At 28 days, improvements were observed in pain (VAS, p < 0.001), PPT for the masseter and temporalis muscles (p < 0.001), and OHIP-14 scores (p < 0.001), while MMO remained unchanged. Changes in cytokine levels were smaller and more variable. In contrast, CGRP and NGF concentrations increased in both serum and saliva and showed the strongest evidence of change among the evaluated biomarkers.
    CONCLUSION: BoNT-A produced measurable clinical improvements and modulated biochemical profiles in refractory MMP. Similar trends observed in serum and saliva suggest that salivary biomarkers may provide a noninvasive approach for monitoring biochemical responses. Given the exploratory design and limited sample size, these findings should be interpreted with caution. Larger, controlled trials with extended follow-up are needed to clarify BoNT-A's mechanisms and long-term effects.
    TRIAL REGISTRATION: ClinicalTrials.gov (NCT06840730), retrospectively registered (2025-02-21).
    Keywords:  Biomarkers; Botulinum toxin type-A; Cytokines; Myofascial pain; Neuropeptides; Pain management; Temporomandibular disorders
    DOI:  https://doi.org/10.1186/s12903-026-08514-0
  48. Pain Med Case Rep. 2026 Apr;10(2): 223-226
    Intradiscal Platelet-Rich Plasma Delivery via Modified Transdural Interlaminar Computed Tomography-Guided Access in Severe L5-S1 Disc Collapse: A Technical Case Report.
    Zane Sherif, Kirralee Sherif.
       Background: Intradiscal platelet-rich plasma (PRP) has emerging evidence for the treatment of discogenic low back pain. However, procedural access becomes technically challenging at the L5-S1 level in the presence of severe disc collapse, steep lumbosacral lordosis, or high iliac crest morphology, which may preclude standard posterolateral or transforaminal trajectories.
    Case Report: A 42-year-old man with chronic discogenic low back pain demonstrated severe L5-S1 degeneration (modified Pfirrmann grade 6) with approximately 3-mm residual disc height, rendering conventional intradiscal access unsafe or impossible. A modified computed tomography-guided interlaminar trajectory passing briefly through the thecal sac was used to achieve intradiscal access. Two milliliters of ultra-high cell-count PRP was injected into the disc nucleus. During controlled needle withdrawal, small aliquots of PRP were deposited at the dural puncture sites to biologically reinforce the needle tract.
    Conclusions: Our case describes a technically feasible intradiscal PRP delivery route for end-stage L5-S1 disc collapse when all conventional access methods are obstructed. No postprocedure cerebrospinal fluid leak symptoms or neurological complications occurred, and early symptomatic improvement was reported. Further investigation is warranted to evaluate safety, reproducibility, and broader clinical applicability.
    Keywords:  Case report; PRP; disc collapse; intradiscal; transdural
  49. Hand Surg Rehabil. 2026 Apr 24. pii: S2468-1229(26)00111-8. [Epub ahead of print] 102674
    Anterior Interosseous to Ulnar Nerve Transfer with an Ultrasound-Guided Short-Incision.
    Lilly F Stadelmeier, Julius H A Asschenfeldt, Laura Hilbig-Vlatten, Arriyan S Dowlatshahi.
       INTRODUCTION: The anterior interosseous nerve (AIN) to ulnar nerve transfer is an established procedure for restoring intrinsic hand function in high ulnar nerve injury and severe cubital tunnel syndrome. Conventional techniques require extensive dissection along the distal forearm and across the wrist flexion crease, which may increase wound complications and delay recovery.
    METHODS: A modified ultrasound-guided, short-incision technique is described. Preoperative ultrasound is used to localize the AIN and the dorsal sensory branch of the ulnar nerve, enabling a targeted 4-cm incision proximal to the wrist crease. The AIN is mobilized and coapted to the ulnar motor fascicles over an extended contact length, with minimal epineurial fixation and optional biologic wrapping.
    RESULTS: The technique allows targeted exposure of the relevant structures while minimizing soft-tissue dissection and avoiding the wrist flexion crease. The extended coaptation provides an increased contact surface between donor and recipient nerve fibers.
    CONCLUSION: This ultrasound-guided, short-incision modification represents a reproducible and minimally invasive technical refinement of AIN-to-ulnar nerve transfer. Clinical outcome studies are required to determine its impact on morbidity and recovery.
    Keywords:  anterior interosseous nerve transfer; cubital tunnel syndrome; minimally invasive surgery; nerve transfer; ulnar nerve injury; ultrasound-guided technique
    DOI:  https://doi.org/10.1016/j.hansur.2026.102674
  50. Med Sci Monit. 2026 Apr 30. 32 e951932
    Comparison of Treatment Outcomes From 6 Weeks of Home-Based Kinesio Taping and Transcutaneous Electrical Nerve Stimulation Combined With Self-Applied Myofascial Stretching in Adults With Carpal Tunnel Syndrome.
    Wei-Hsien Hong, Chia-Ling Chen, Hsiu-Chen Lin, Sui-Foon Lo, Chia-Ming Chang.
      BACKGROUND Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, causing pain, numbness, and functional limitations. Home-based treatments have recently been receiving increasing attention. Kinesio taping (KT) and transcutaneous electrical nerve stimulation (TENS) are non-invasive physical therapy interventions. This study aimed to compare treatment outcomes from 6 weeks of home-based KT and TENS combined with myofascial stretching in adults with CTS. MATERIAL AND METHODS A single-blind randomized controlled trial was conducted. Of 42 CTS participants, 30 completed the study (12 of the 42 were lost to follow-up ) and were randomized to home-based KT (n = 15) or TENS (n = 15). Both groups received 6 weeks of physical interventions combined with self-applied myofascial stretching, followed by a 6-week follow-up, Outcomes were evaluated using the grip and pinch strengths, the Boston Carpal Tunnel Questionnaire (BCTQ), the visual analog scale (VAS), the Modified Moberg Pick-up Test (MMPUT), and 2-point discrimination (2PD). RESULTS Both groups had significant improvement in VAS, BCTQ, grip, and pinch strengths, 2PD, and MMPUT (P = 0.014, P < 0.001). Group × time interactions indicated that improvements over time differed between groups, with KT producing slightly greater gains in grip strength (P = 0.005), pain (P = 0.033), symptom severity (P < 0.001), and dexterity (P = 0.002) compared with TENS. CONCLUSIONS KT and TENS treatment both improved hand function and dexterity, decreased symptom severity and pain, with KT showing slightly greater benefits in grip strength, dexterity, symptom severity, and pain.
    DOI:  https://doi.org/10.12659/MSM.951932
  51. J Pediatr Soc North Am. 2026 May;15 100361
    Physical Exam for Athletic Shoulder Injuries in Adolescent Patients.
    John E Arvesen, Michael Kutschke, Katherine Lampe, Philip Wilson, Henry B Ellis.
      In addition to a thorough history, a systematic approach to the shoulder exam is critical to understanding dysfunction in the shoulder in an adolescent athlete. Similar to other orthopaedic joint exams, a progression through inspection, palpation, strength, range of motion, and special testing can make a complex exam more efficient and reproducible. Specific to adolescents, shoulder complaints often result from physeal stress injuries, apophysitis, or hyperlaxity-related instability, conditions that are absent in skeletally mature patients. It is essential to recognize specific characteristics of the adolescent shoulder to distinguish them from pathologies commonly seen in adults. Familiarity with these diagnoses and appropriate tests can help the practitioner determine a reliable diagnosis and an optimal treatment plan.
    Key Concepts: (1)History and mechanism of injury will direct a more focused exam.(2)In adolescents, injuries involving the physis or apophysis are common, so clinical signs like physeal tenderness or pain caused by rotational movement should take priority over diagnoses usually found in adults.(3)The apprehension and relocation tests serve as the principal assessments for anterior traumatic unidirectional shoulder instability, whereas the load and shift test is particularly valuable in the evaluation of patients presenting with multidirectional instability.(4)Examination of throwing-shoulder pathology should not be limited to the shoulder alone as etiologies may stem from poor throwing mechanics, imbalances in the kinetic chain, or underlying scapular dysfunction.(5)Proper understanding and evaluation of scapular dysfunction are critical in a growing athlete to prevent recurrence of shoulder pain.
    Keywords:  Adolescents; Assessments; Athletes; Shoulder; Sports
    DOI:  https://doi.org/10.1016/j.jposna.2026.100361
  52. J Hand Surg Am. 2026 Apr 28. pii: S0363-5023(26)00225-X. [Epub ahead of print]
    Management of Ulnar Nerve Irritation by Pisiformectomy: A Clinical Anatomical Study.
    Jaroslav Pilný, Petr Hájek, Tomáš Janoušek, David Kachlík.
       PURPOSE: The goal of this anatomical clinical study is to clarify whether a simple pisiformectomy can provide sufficient decompression of the ulnar nerve along its entire course within the ulnar canal.
    METHODS: A simple pisiformectomy was performed in 20 cadaveric hands, followed by complete release of the ulnar nerve. The anatomical findings were subsequently correlated with clinical outcomes in 17 patients presenting with ulnar nerve irritation and pisotriquetral joint pain.
    RESULTS: Our anatomical results demonstrated that additional division of fibrous structures was not necessary in any specimen. At 12-month follow-up, clinical evaluation revealed a median improvement of 40.6 points in the Quick Disabilities of Arm, Shoulder & Hand score, whereas the visual analog scale improved by a median of 5 points.
    CONCLUSIONS: In patients with concomitant irritation of the pisotriquetral joint and compression of the ulnar nerve within the ulnar canal, pisiformectomy represents an effective treatment option addressing both conditions simultaneously.
    TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic IIB.
    Keywords:  Canalis ulnaris; Guyon canal; pisiformectomy; pisotriquetral joint; ulnar canal
    DOI:  https://doi.org/10.1016/j.jhsa.2026.03.002
  53. Physiother Res Int. 2026 Apr;31(2): e70211
    Should Prognostic Indicators and Management Strategies for Adhesive Capsulitis Consider Diabetes Status? A Structured Narrative Review.
    Sophia Vijay, Kalashree Hadya Ananda, Anupama Pathak, Noble Vavachan.
       BACKGROUND: Adhesive capsulitis (AC) is a debilitating condition with a higher prevalence and severity in individuals with diabetes mellitus (DM). Despite known associations, the impact of DM on AC prognosis and treatment responses remains underexplored. This structured narrative review synthesises current evidence using a structured search and selection approach to determine whether diabetes status impacts the course and treatment response of AC, and whether it should be considered when planning management strategies.
    METHODS: The current review conducted a structured literature review across four electronic databases (PubMed, Google Scholar, CINAHL, and Medline) using a specific search strategy. In total, 996 articles were screened using the PICO format; full-text screening was based on pre-set inclusion and exclusion criteria and included 10 studies in the review. Data were extracted, and a narrative synthesis was performed.
    RESULTS: The current review included 10 studies (5 retrospective, 5 prospective) with a total of 1128 participants from various countries. The mean age of participants ranged from 47 to 57 years. DM patients had higher baseline pain, restricted ROM, and poorer function. Six studies reported lesser improvements in DM groups for pain (p < 0.05), ROM (reduced flexion/external rotation, p < 0.01), and function (p < 0.05), across various validated scales. DM was identified as an independent prognostic factor using multivariable logistic regression analysis in three studies (odds ratios [ORs] 9.6-51.0). No study evaluated diabetes-specific management protocols.
    CONCLUSION: DM status appears to be associated with a poorer prognosis in AC and may warrant consideration for inclusion in prognostic models and management strategies.
    Keywords:  adhesive capsulitis; diabetes mellitus; disease management; frozen shoulder; prognosis; rehabilitation
    DOI:  https://doi.org/10.1002/pri.70211
  54. Cureus. 2026 Mar;18(3): e105746
    A Comparative Study of Intra-articular Steroid Injection Alone Versus Steroid Injection Combined with Hydroplasty and Manipulation in the Treatment of Frozen Shoulder.
    Aman Thakur, Bhanu P Singh, Yogesh Singh Parihar.
      Background Frozen shoulder (adhesive capsulitis) is a common cause of shoulder pain and disability in middle-aged adults, characterized by progressive pain and restriction of both active and passive range of motion. Despite multiple available treatment modalities, the optimal minimally invasive intervention remains controversial. Intra-articular corticosteroid injection and hydroplasty with manipulation are widely practiced techniques, yet comparative evidence remains inconsistent. Methods This randomized comparative study was conducted at a tertiary care hospital over 18 months. Eighty patients aged 40-60 years with unilateral frozen shoulder refractory to conservative treatment were randomly allocated into two groups: Group A received intra-articular methylprednisolone injection, and Group B underwent intra-articular corticosteroid injection combined with capsular distension (hydroplasty) followed by controlled shoulder manipulation. Outcomes were assessed using the Shoulder Pain and Disability Index (SPADI) at baseline and at two weeks, six weeks, three months, 4.5 months, and six months. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States), with p < 0.05 considered statistically significant. Results Both groups demonstrated statistically significant improvement in SPADI scores across all follow-up intervals. Hydroplasty with manipulation showed significantly greater improvement at three months (p = 0.001) and 4.5 months (p = 0.026). At six months, outcomes were comparable between groups (p = 0.457). No major complications were observed. Conclusion Both intra-articular corticosteroid injection alone and corticosteroid injection combined with capsular distension and manipulation resulted in significant improvement in pain and functional disability in patients with frozen shoulder. Hydroplasty with manipulation demonstrated superior mid-term functional improvement; however, no statistically significant difference between the two treatment protocols was observed at six months of follow-up.
    Keywords:  frozen shoulder; hydroplasty; intrarticular steroids; methylprednisolone; shoulder pain and disability index (spadi)
    DOI:  https://doi.org/10.7759/cureus.105746
  55. Orthop J Sports Med. 2026 Apr;14(4): 23259671261432671
    Impact of Acetabular Labral Tear Location on Patient-Reported Outcomes and Conversion to Total Hip Arthroplasty After Hip Arthroscopy With an 8-Year Minimum Follow-up.
    Jackson G Woodrow, Jeffrey S Mun, Brandon J Allen, Rachel L Poutre, Srish S Chenna, Rishi P Earla, Stephen M Gillinov, Bilal S Siddiq, Scott D Martin.
       Background: Acetabular labral tears are a common cause of hip pain. While larger tear size has been linked to worse outcomes after arthroscopic treatment, the influence of labral tear location remains incompletely understood.
    Purpose: To investigate how labral tear location affects functional outcomes, conversion to total hip arthroplasty (THA), and patient satisfaction after arthroscopy.
    Study Design: Cohort study; Level of evidence, 3.
    Methods: Patients who underwent primary hip arthroscopy were retrospectively sent online surveys at a minimum of 8 years after their surgery. Tear location was classified into superior, anterosuperior, and posterosuperior based on intraoperative findings. Outcomes included patient-reported outcome measures, conversion to THA, Patient Acceptable Symptom State improvement, and overall patient satisfaction. Unadjusted and adjusted logistic regression models were performed to identify potential confounding variables.
    Results: In total, 138 patients were included with a mean ± SD follow-up time of 11.1 ± 2.5 years. There was no significant difference in all postoperative patient-reported outcome measures across tear locations, although posterosuperior tears demonstrated lower mean outcomes as compared with superior and anterosuperior. Labral tear location was also not found to significantly influence rates of Patient Acceptable Symptom State achievement. Satisfaction was similar among superior, anterosuperior, and posterosuperior tear locations. THA conversion occurred in 20.9% of patients and was not independently associated with tear location after adjusting for confounders. Age was the strongest predictor of THA conversion, and tear size was also significant.
    Conclusion: Acetabular labral tear location was not found to be a significant predictor of functional or clinical outcomes after hip arthroscopy. However, while labral tear location was not predictive of conversion to THA, age and tear size were significant predictors of conversion.
    Keywords:  hip arthroscopy; labral tear; labral tear location; patient-reported outcomes
    DOI:  https://doi.org/10.1177/23259671261432671
  56. J Back Musculoskelet Rehabil. 2026 Apr 28. 10538127261444798
    Contracted and relaxed quadriceps muscle thickness: A marker for muscle strength and probable sarcopenia?
    Serpil Demir, Özlem Karataş, Burak Elçin, Nilüfer Balcı.
      BackgroundResting quadriceps muscle thickness (QMT) is known to be associated with muscle strength; however, the clinical relevance of contracted QMT in identifying muscle weakness has not been fully clarified.ObjectiveThis study aimed to investigate the relationship between resting and contracted QMT and isometric peak knee-extension torque (PT) and to evaluate the diagnostic value of contracted QMT in predicting probable sarcopenia (PS).MethodsForty-two individuals with PS and sixty-two healthy controls were evaluated. QMT and PT were compared between groups. Linear regression analyses examined the associations between QMT, handgrip strength (HGS), and appendicular skeletal muscle mass. Logistic regression and receiver operating characteristic (ROC) analyses assessed the diagnostic performance of contracted QMT.ResultsIndividuals with PS had lower contracted QMT and knee-extension strength than controls (all p < 0.01). Contracted QMT, rather than relaxed measurements, showed positive associations with HGS and appendicular skeletal muscle mass (ASMM) (all p < 0.05). Contracted QMT independently predicted PS (OR = 0.90, 95% CI: 0.82-0.99), and ROC analysis indicated moderate discriminatory performance (AUC range: 0.62-0.77).ConclusionsWhile both measurements were reduced in PS, contracted QMT showed a stronger association with muscle mass and strength. These findings suggest that contraction-based ultrasound parameters may serve as a preliminary and exploratory adjunct for identifying early functional decline. However, given the moderate discriminatory power, further standardization and external validation are required before routine clinical adoption.
    Keywords:  aging; muscle strength dynamometer; quadriceps muscle; sarcopenia; ultrasound imaging
    DOI:  https://doi.org/10.1177/10538127261444798
  57. JSES Rev Rep Tech. 2026 Aug;6(3): 100733
    A systematic review of surgical treatment of reverse shoulder arthroplasty associated acromial and scapular spine stress fractures.
    Ashley Isenberg, Jonathan Gagnon, Daniel Maunder, Scott Huff, Anand M Murthi.
       Background: Current treatment options for acromial and scapular spine fracture (ASF) after reverse total shoulder arthroplasty (rTSA) include nonoperative immobilization or surgical fixation, but optimal patient selection for each option remains unclear. We performed a descriptive analysis of operative vs. nonoperative treatment to identify patterns in fracture type, functional outcomes, and operative timing.
    Methods: We reviewed 11 studies reporting nonoperative and operative management of post-rTSA ASFs. Data were extracted based on fracture subtype, union rate, time to surgery, indication for surgery, and functional outcomes. We assessed heterogeneity in study design, baseline reporting, and sample size when making interstudy comparisons. Risk of bias was evaluated in accordance with the Joanna Briggs Institute method.
    Results: Eleven studies with a total of 88 surgically managed fractures were identified. Across 8 studies reporting union rates, the operative group achieved higher radiographic union (range, 69%-100%) than the nonoperative group (30%-79%), though only one study of acute Levy II/III patterns treated within 6 weeks of fracture demonstrated statistical significance. However, most studies reported that patient-reported outcomes were similar between the groups. In addition, surgical management was associated with a notable complication profile, including hardware failure and the need for secondary procedures. In most studies, surgical treatment was performed for fractures that did not respond to an initial trial of immobilization and persistent pain. Outcome measures varied and were often reported without baseline values. Small operative cohorts across all studies limited statistical power.
    Conclusion: In the studies included in this review, Levy type III fractures were treated surgically at a higher rate than other fracture types due to poor function and pain. Surgical management of ASFs was largely reserved for patients who failed nonoperative treatment. Improvement of functional outcomes in surgical intervention compared to nonoperative treatment was found only in acute surgical intervention. No statistically significant difference was found when comparing delayed surgical intervention and nonoperative treatment. Surgical management was associated with significantly higher union rates than nonoperative management. However, functional improvements were largely modest and comparable to nonoperative management in delayed cases, and the benefits of surgery must be weighed against a high complication rate. Double plate fixation was the predominant surgical technique for ASF after rTSA. The use of the Levy classification system and assessment of uniform functional outcomes in future studies would allow for stronger analysis of the comparative impacts of surgical and nonoperative treatment of ASF after rTSA.
    Keywords:  Acromial stress fracture; Levy classification system; Outcome; Reverse shoulder arthroplasty; Scapular spine fracture; Surgical management
    DOI:  https://doi.org/10.1016/j.xrrt.2026.100733
  58. J Orthop Surg Res. 2026 Apr 27. pii: 279. [Epub ahead of print]21(1):
    Comparative analysis of different mobility aids in the early accelerated rehabilitation phase following acute achilles tendon repair surgery: a prospective cohort study.
    Zhuoqi Wei, Zengzhen Cui, Yuan Cao, Xiuzhi Li, Yuliang Fu, Liangyu Bai, Yang Lv.
       BACKGROUND: The objective of this study was to evaluate and compare the safety, efficacy, and cost-effectiveness of different mobility aids during the early rehabilitation phase following surgical repair of acute Achilles tendon rupture (AATR).
    METHODS: This prospective cohort study included 198 patients who underwent surgical repair for AATR between April 2023 and February 2025, with 171 males (86.4%) and a mean age of 36.4 years. Based on the mobility aid used weeks 3-6 postoperatively, participants were categorized into four groups: Wheelchair (n = 43), Knee Scooter (n = 41), Axillary Crutches (n = 78), and Leg Support (LS) Walker (n = 36). Patients were scheduled for assessments at 2, 4, 6, 12, and 24 weeks, with an additional telephone follow-up conducted approximately one year after surgery. Primary outcomes included the rate of unplanned Emergency Department (ED) visits, the affected-to-unaffected (A: U) calf circumference ratio, and expected rehabilitation costs. Secondary outcomes encompassed the Visual Analog Scale, the Achilles Tendon Total Rupture Score, the American Orthopedic Foot & Ankle Society Ankle-Hindfoot Score, and time to key recovery milestones, including single-leg heel raise to 50% of contralateral side, return to light exercise, return to work, and return to pre-injury exercise. Continuous variables were analyzed using one-way ANOVA or Kruskal-Wallis test, and categorical variables using chi-square or Fisher's exact test, while linear mixed-effects models were employed for longitudinal outcomes.
    RESULTS: During the early rehabilitation phase (Weeks 3-6), unplanned ED visit rates differed significantly among the four groups (p = 0.032), with the Axillary Crutches showing significantly higher odds than the Wheelchair (OR = 8.24, 95% CI 1.16-58.53, p = 0.040). A significant difference in the A: U ratio was observed among the four groups at 6 weeks postoperatively (p = 0.037), and post-hoc comparisons showed significant differences for LS Walker vs. Wheelchair (p < 0.001), Axillary Crutches vs. Wheelchair (p = 0.002), and LS Walker vs. Knee Scooter (p = 0.038). The LS Walker and Axillary Crutches also demonstrated superior performance in VAS, ATRS, and AOFAS scores from Week 4 to Week 12, and achieved key recovery milestones significantly earlier (p < 0.001). Economic analysis revealed the lower direct treatment costs in the Axillary Crutches (477 RMB) and Knee Scooter (539 RMB), followed by the Wheelchair (664 RMB) and LS Walker (1126 RMB) (p < 0.001).
    CONCLUSIONS: LS Walker demonstrated superior efficacy in preserving muscle and accelerating functional recovery, while Knee Scooter offered a favorable profile for fall prevention and cost-effectiveness.
    TRIAL REGISTRATION: ClinicalTrials.gov (NCT04663542), registered on 22 September 2020.
    Keywords:  Accelerated rehabilitation; Acute Achilles tendon rupture; Mobility aids; Surgical repair
    DOI:  https://doi.org/10.1186/s13018-026-06881-6
  59. J Orthop Surg Res. 2026 Apr 29.
    The role of quadriceps strength and quadriceps-focused rehabilitation following medial meniscus posterior root repair: a systematic review.
    Wenqiang Zhao, Qiuyue Liu, Guolei Ren, Jie Xu, Changxu Han.
       BACKGROUND: Medial meniscus posterior root tear (MMPRT) can lead to biomechanical disruption of the medial compartment and accelerate the progression of osteoarthritis. Although surgical repair may improve pain and functional outcomes, postoperative rehabilitation is also considered important for recovery. The quadriceps plays a central role in knee joint stability, load distribution, and functional recovery, yet its role in rehabilitation following MMPR repair remains unclear. This study aimed to systematically summarize the available evidence regarding quadriceps strength and quadriceps-focused rehabilitation following MMPR repair.
    METHODS: Databases including PubMed, Embase, the Cochrane Library, Web of Science, Scopus, PEDro, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched from inception to June 2025. Studies were included if they involved patients who underwent medial meniscal posterior root (MMPR) repair and received quadriceps-focused rehabilitation. Methodological quality was assessed using the MINORS tool. Because of substantial heterogeneity in reported outcomes, only qualitative synthesis was performed. This study was registered with PROSPERO (CRD420251145452).
    RESULTS: Three studies involving 93 patients were included. All patients underwent transtibial pull-out repair and were followed for 1 year. Weaker preoperative quadriceps strength was associated with greater postoperative medial meniscal extrusion (MME) and progression of medial joint space narrowing (MJS). Protocols emphasizing quadriceps-focused rehabilitation, including isometric exercises, straight-leg raises, resistance training, and neuromuscular electrical stimulation, were generally associated with improved muscle strength, better functional scores (IKDC, KOOS, and Lysholm), and faster Timed Up and Go (TUG) recovery. In addition, groups with greater quadriceps strength or more quadriceps-focused rehabilitation tended to show less progression of MME and MJS on imaging. All studies had a MINORS score of 11, indicating acceptable clarity of study aims and follow-up, but limitations in prospective design and sample size estimation.
    CONCLUSION: Quadriceps-focused rehabilitation may play an important role in recovery following MMPR repair. Greater quadriceps strength was associated with better muscle strength, functional outcomes, and potentially more favorable structural findings. However, the current evidence is limited and mainly based on retrospective studies, so these findings should be interpreted cautiously. Further high-quality, multicenter prospective studies are needed to clarify the optimal role and components of quadriceps-focused rehabilitation after MMPR repair.
    Keywords:  Medial meniscus posterior root repair; Quadriceps; Rehabilitation; Systematic review
    DOI:  https://doi.org/10.1186/s13018-026-06877-2
  60. Brain Spine. 2026 ;6 106054
    Distal nerve transfers for ulnar nerve reinnervation and hand function restoration.
    Andrija Savić, Jovan Grujić, Aleksandar Djurdjević, Svetozar Stanković, Aleksa Mićić, Aleksandra Stojiljković, Branko Gaković, Milan Lepić, Nenad Novaković, Lukas Rasulić.
       Introduction: Ulnar nerve injuries lead to severe intrinsic hand muscle dysfunction and major impairment of grip, pinch, and quality of life. Distal nerve transfers have been introduced to overcome the limitations of conventional repair and grafting by shortening the regeneration distance and improving reinnervation of intrinsic muscles.
    Research question: Can distal anterior interosseous nerve to deep motor branch of the ulnar nerve (AIN-to-UN-DMB) transfer restore intrinsic hand function and improve patient-reported quality of life in proximal ulnar nerve injuries?
    Material and methods: Twelve patients with proximal ulnar nerve injuries underwent distal AIN-to-UN-DMB transfer and were prospectively evaluated at 24 months postoperatively. Outcomes included intrinsic muscle strength graded by the BMRC scale, Egawa's sign, dynamometric assessment of grasp and pinch strength, and quality of life measured using the PNSQoL questionnaire.
    Results: At final follow-up, intrinsic muscle strength improved markedly: 27 muscles achieved M4 and 14 achieved M3 strength, compared with universal M0 preoperatively. Grasp strength increased from a mean of 42.3% to 82.5%, and pinch strength from 37.4% to 80.5% of the contralateral hand. Overall satisfactory functional recovery was achieved in 87.5% of patients. Mean PNSQoL score improved significantly from 47.7 preoperatively to 74.4 postoperatively (p < 0.001), with all patients reaching very good or excellent quality-of-life categories.
    Discussion and conclusion: Distal AIN-to-UN-DMB transfer enables meaningful restoration of intrinsic hand function, substantial gains in grasp and pinch strength, and significant improvement in quality of life, representing an effective reconstructive option for proximal ulnar nerve injuries.
    Keywords:  Distal nerve transfer; Ulnar nerve injury
    DOI:  https://doi.org/10.1016/j.bas.2026.106054
  61. Orthop J Sports Med. 2026 Apr;14(4): 23259671261430731
    Testosterone Therapy and Associated Rates of Tendon Tear and Surgical Repair: A Retrospective Analysis.
    Al-Hassan Dajani, Timothy P Liu, Guillermo Araujo-Espinoza, Kevin Muy, Seth Cope, Kristofer Jones, Thomas J Kremen.
       Background: Testosterone replacement therapy (TRT) use is increasing in both men and women with demonstrated benefits for muscle strength, sexual function, and well-being. However, previous studies have linked exogenous testosterone to elevated rates of tendon injury in upper and lower extremities. TRT has also been associated with higher rates of surgical repair and markedly elevated reoperation rates. Limited institutional data are available on tendon rupture rates and treatment trends.
    Purpose: To investigate the association between prescription TRT and tendon rupture risk, with a specific focus on rotator cuff tear (RCT) incidence and repair/revision rates at a single academic institution.
    Study Design: Cohort study; Level of evidence, 3.
    Methods: We queried 1 institution's electronic health records using International Classification of Diseases (ICD-10) codes for patients ≥18 years with tendon rupture and prescription TRT use within 90 days of injury between 2015 and 2023. Individuals with risk factors predisposing them to tendon injury were excluded. A subanalysis of RCT was performed using a chart review of a subgroup of TRT patients and propensity-matched controls. Outcomes of interest included rupture location and rate, and, for the RCT, tear severity and rates of surgical repair/revision. Outcomes were compared between TRT users and nonusers.
    Results: We identified 410 TRT users and 14,474 nonusers with tendon rupture. Men on TRT had significantly higher rupture rates (3.6% vs 1.3%; odds ratio [OR], 2.88 [95% CI, 2.59-3.20]) across all ages and races. No significant increase in tendon rupture rate was observed in women on TRT. RCTs were the most common injury (77%). In the RCT subanalysis (78 TRT users, 355 matched controls), TRT users underwent nonoperative intervention more frequently than nonusers (74.4% vs 46.7%; OR, 3.3 [95% CI, 1.91-5.72]). Tear severity and revision rates did not differ significantly between groups.
    Conclusion: TRT is associated with increased tendon rupture risk in men but not women, potentially due to sex-specific differences in dosing. TRT users with RCT were less likely to undergo arthroscopic repair compared with matched controls, despite similar distributions of tear severity.
    Keywords:  rotator cuff repair; rotator cuff tear; tendon rupture; testosterone
    DOI:  https://doi.org/10.1177/23259671261430731
  62. Adv Respir Med. 2026 Mar 31. pii: 22. [Epub ahead of print]94(2):
    Non-Pharmacological Pulmonary Rehabilitation in Patients with Pneumoconiosis: A Systematic Review.
    Madina B Baurzhan, Sayagul A Kairgeldina, Venera M Almatova, Alexandr E Gulyayev, Raushan S Dosmagambetova, Kanat K Tekebayev, Karashash Absatarova, Karlygash S Absattarova.
       BACKGROUND: Pneumoconiosis remains a major occupational lung disease associated with progressive respiratory impairment, reduced functional capacity, and diminished quality of life. Non-pharmacological rehabilitation has been increasingly proposed as a supportive intervention; however, evidence regarding its effectiveness remains heterogeneous.
    OBJECTIVE: This study aimed to systematically review and synthesize the available evidence on the effects of non-pharmacological rehabilitation interventions on functional capacity, quality of life, and psychological outcomes in patients with pneumoconiosis.
    METHODS: A systematic literature search was conducted in major electronic databases and grey literature sources in accordance with PRISMA 2020 guidelines. Studies evaluating non-pharmacological rehabilitation interventions in adults with pneumoconiosis were eligible for inclusion. Outcomes of interest included functional capacity, health-related quality of life, and psychological well-being. Due to methodological heterogeneity across studies, a qualitative synthesis was performed.
    RESULTS: Six studies met the predefined inclusion criteria and were included in the qualitative synthesis. The reviewed evidence suggests that structured rehabilitation interventions were associated with clinically meaningful improvements in functional capacity, particularly in structured rehabilitation programs, most consistently reflected by increases in six-minute walk distance exceeding established minimal clinically important differences in three studies. Improvements in health-related quality of life and selected psychological outcomes were also reported, although outcome measures and intervention protocols varied across studies. Significant improvements in exercise capacity, dyspnea severity, and health-related quality of life were reported.
    CONCLUSIONS: Non-pharmacological rehabilitation may provide clinically meaningful benefits for patients with pneumoconiosis, based on limited and heterogeneous evidence, particularly in terms of functional capacity and quality of life. Nevertheless, the current evidence base is limited by heterogeneity in study design and outcome reporting. Further high-quality, standardized trials are needed to strengthen the evidence and guide the clinical implementation of rehabilitation programs for occupational lung diseases.
    Keywords:  anxiety and depression; non-pharmacological therapy; occupational lung diseases; pneumoconiosis; pulmonary rehabilitation; quality of life; six-minute walk test; systematic review
    DOI:  https://doi.org/10.3390/arm94020022
  63. J Arthroplasty. 2026 Apr 27. pii: S0883-5403(26)00414-6. [Epub ahead of print]
    Do Hip Precautions Matter After Posterior Approach Total Hip Arthroplasty With Capsular Repair? A Randomized Control Trial.
    Aditya S Yadav, Ajay Potluri, Siddhartha Dandamudi, Harmanjeet Singh, Anne DeBenedetti, Omar Behery, Brett R Levine.
       BACKGROUND: The clinical efficacy of posterior hip precautions in preventing dislocation after primary posterior approach total hip arthroplasty (THA) remains uncertain. Such mobility restrictions may delay patients' return to daily activities and functional recovery. The aim of this study was to determine whether THA hip precautions impact hip dislocation rates.
    METHODS: We conducted a prospective, randomized study evaluating the effect of hip precautions on the risk of dislocation after primary THA. A total of 1,133 patients were enrolled and underwent posterior approach primary THA by multiple fellowship-trained surgeons at a single academic center between January 2016 and June 2025. Patients were randomized to either a restricted group, instructed to avoid hip flexion beyond 90°, adduction past midline, and internal rotation for six weeks postoperatively, or an unrestricted group without restraint to motion or activity. Demographics, surgical indications, and prosthesis data were recorded. The minimum follow-up for analysis was six weeks. The primary outcome was dislocation; secondary outcomes included perioperative complications and patient-reported outcomes. The unrestricted and restricted groups included 567 and 566 patients, respectively, with no significant demographic or surgical differences (all P > 0.245). Follow-up was similar between groups (mean, 1.3 ± 1.4 years; range, 0.1 to 8.6 years; P = 0.645). Statistical analyses used Fisher's exact test and t-tests using P < 0.05 for significance.
    RESULTS: Overall, ten dislocations (0.88%) were reported at 9.1 ± 10.5 months postoperatively, with six in restricted and four in unrestricted patients (odds ratio (OR): 0.60; 95% confidence interval (CI): 0.17 to 2.17; P = 0.547). Hip Disability and Osteoarthritis Outcome Scores Joint Replacement (HOOS JR) were statistically higher in the unrestricted group at six weeks (76.78 versus 74.48, P = 0.028) and three to six months (84.60 versus 81.54, P = 0.015), with no significant difference in baseline scores (51.98 versus 50.44, P = 0.130). There were no differences observed in 90-day complications or revisions (all P > 0.209).
    CONCLUSION: We could not detect any difference in dislocation risk following routine use of strict hip precautions following posterior approach THA with capsular repair. These precautions may unnecessarily limit early functional recovery, increase patient anxiety, and negatively impact patient-reported outcomes.
    DOI:  https://doi.org/10.1016/j.arth.2026.04.080
  64. J Orthop Surg Res. 2026 Apr 26.
    Diagnostic accuracy of magnetic resonance imaging for subscapularis tendon tears: a comparison with intraoperative arthroscopic findings.
    Gokhan Karademir, Sabri Kerem Diril, Onur Tunali, Yasemin Begum Topkarci, Ata Can Atalar.
       BACKGROUND: Subscapularis tendon (SSt) tears are frequently underdiagnosed by non-shoulder specialists. Delayed diagnosis may result in tendon retraction, muscle atrophy, and fatty degeneration, negatively affecting surgical outcomes. Magnetic resonance imaging (MRI) is widely used for preoperative evaluation, but its diagnostic accuracy for SSt tears remains controversial. This study aimed to evaluate the diagnostic performance of MRI in detecting SSt tears by comparing preoperative MRI findings with intraoperative arthroscopic findings.
    METHODS: A retrospective analysis was conducted on patients who underwent shoulder arthroscopy for rotator cuff pathology between January 2014 and December 2023. Preoperative MRI evaluations were performed by an experienced musculoskeletal radiologist, while intraoperative assessment was conducted by an orthopedic surgeon specialized in shoulder surgery and served as the reference standard. The sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy, prevalence, positive likelihood ratio, and negative likelihood ratio of MRI for detecting SSt tears were calculated with 95% confidence intervals (CIs).
    RESULTS: A total of 128 patients were included, with a mean age of 65.4 years. Intraoperatively, SSt tears were identified and repaired in 77 patients, while 51 patients had an intact tendon. MRI reports identified SSt tears in 48 patients and reported an intact tendon in 80 patients. The sensitivity and specificity of MRI for detecting SSt tears were 45.5% (95% CI 0.346-0.567) and 74.5% (95% CI 0.610-0.848), respectively. The positive predictive value was 72.9% (95% CI 0.587-0.837), and the negative predictive value was 47.5% (95% CI 0.368-0.585). The overall accuracy was 57.0% (95% CI 0.483-0.654). The prevalence of SSt tears was 60.2% (95% CI 0.514-0.684). The positive likelihood ratio was 1.78 and the negative likelihood ratio was 0.73. Among 77 arthroscopically confirmed tears, 70 were partial thickness tears and 7 were full thickness tears. All 42 false negatives occurred in partial-thickness tears.
    CONCLUSIONS: MRI demonstrated limited sensitivity in detecting SSt tears despite moderate specificity. These findings indicate that MRI alone may be insufficient for establishing a reliable diagnosis. Clinical examination findings should be integrated with imaging results in the assessment of patients with shoulder pain.
    Keywords:  Arthroscopy; Diagnostic accuracy; Rotator cuff; Shoulder; Subscapularis
    DOI:  https://doi.org/10.1186/s13018-026-06834-z
  65. Musculoskeletal Care. 2026 Jun;24(2): e70226
    Physical Activity Knowledge in People With Knee Osteoarthritis Before and After Participation in an Education and Exercise Therapy Programme.
    A Couper, M Pazzinatto, A M Ezzat, N F Taylor, J L Kemp, D De Oliveira Silva, C J Barton.
       OBJECTIVE: Few people with knee osteoarthritis meet the World Health Organization (WHO) physical activity guidelines, and knowledge of guidelines in this population is not well known. We examined (i) baseline knowledge of physical activity guidelines in people with knee osteoarthritis; (ii) change in knowledge following participation in an education and exercise therapy programme; and (iii) its association with programme adherence and physical activity participation.
    DESIGN: An observational cohort pre-post study including 1470 participants with knee osteoarthritis (72% female) from the Good Life with osteoArthritis from Denmark (GLA:D) Australia registry. Five multiple-choice questions assessed knowledge of the WHO physical activity guidelines at baseline and at 3 months post baseline. Programme adherence was self-reported and physical activity participation was assessed using the University of California, Los Angeles (UCLA) physical activity scale. Changes in overall knowledge score were assessed through the Wilcoxon test and changes within individual questions were assessed with McNemar's tests. Associations between variables were assessed using Spearman's correlations.
    RESULTS: The median physical activity knowledge score was 2/5 [IQR 1, 2] correct responses at both baseline and follow-up without change between time points (p = 0.080). Follow-up physical activity knowledge score was not associated with physical activity participation (rs = 0.020) or programme adherence (rs = 0.060). 61% of participants attended a minimum of 10 exercise and 2 education sessions.
    CONCLUSIONS: Knowledge of physical activity guidelines is limited among people with knee osteoarthritis and does not appear to change following participation in an education and exercise therapy programme. This large study indicates that physical activity knowledge may not drive physical activity behaviour in people with knee osteoarthritis.
    Keywords:  knee osteoarthritis; knowledge; physical activity
    DOI:  https://doi.org/10.1002/msc.70226
  66. Hand Surg Rehabil. 2026 Apr 28. pii: S2468-1229(26)00116-7. [Epub ahead of print] 102679
    Comparison of Ozone Injection and Extracorporeal Shockwave Therapy in the Treatment of Chronic Lateral Epicondylitis.
    Aslı Keleş Önal.
       BACKGROUND: Lateral epicondylitis is one of the most common causes of elbow pain, leading to functional impairment and decreased quality of life. Various non-surgical treatment modalities have been proposed; however, the comparative effectiveness of these treatments remains unclear. This study aimed to compare the therapeutic effectiveness of ozone therapy and extracorporeal shock wave therapy in patients with chronic lateral epicondylitis.
    METHODS: This retrospective cohort study was conducted at the Physical Medicine and Rehabilitation Department of Uşak Training and Research Hospital between 2022 and 2024. A total of 75 adult patients diagnosed with chronic lateral epicondylitis were included. Patients received either ozone therapy (one session per week for three weeks) or extracorporeal shock wave therapy(ESWT), and all procedures were performed by the same physician. Patient allocation was non-randomized and based on clinical decision-making. Pain severity was assessed using the Visual Analogue Scale (VAS) for rest, activity, sleep, and compression pain. Functional status and disability were evaluated using the Disabilities of the Arm, Shoulder and Hand questionnaire(DASH) and the Patient-Rated Tennis Elbow Evaluation(PRTEE). Assessments were performed at baseline, immediately after treatment, and at and at follow-up points of 1 month, 3 months, and 6 months post-treatment. A two-factor repeated-measures analysis of variance (group × time) with Bonferroni post-hoc correction was performed to analyze the main outcome variables.
    RESULTS: The ozone therapy group (n = 25, mean age 45.3 ± 6.5 years, 68% female) and the ESWT group (n = 26, mean age 47.0 ± 9.5 years, 80,8% female) were similar in terms of baseline demographic and clinical characteristics (p > 0.05). Both treatment groups showed statistically significant intra-group improvements in all outcome measures compared to baseline (p < 0.05 for all). When the two treatment methods were compared with each other, the ozone therapy group was found to be superior to the ESWT group at the 3rd and 6th months regarding pain at rest (3rd month: p < 0.05, 95% CI:-3.3 to -0.6; 6th month: p < 0.001, 95% CI: -3.4 to -1.1), pain during activity (3rd month: p < 0.05, 95% CI:-3.8 to -0.6; 6th month: p < 0.001, 95% CI: -4.4 to -1.2), and pain on manual compression (3rd month: p < 0.05, 95% CI:-3.8 to -0.6; 6th month: p < 0.05, 95% CI:-4.4 to -1.2). Additionally, in the ozone group, VAS scores during sleep at the 3rd and 6th months, PRTEE scores at the 1 st, 3rd, and 6th months, and DASH scores immediately post-treatment and at the 1 st, 3rd, and 6th months were observed to be more effective compared to the ESWT group (p < 0.05 for all comparisons, with 95% CIs provided in supplementary tables).
    CONCLUSIONS: Our study demonstrated that ozone injection may be an effective and potentially superior alternative treatment modality compared with extracorporeal shock wave therapy in the management of chronic lateral epicondylitis. However, prospective randomized controlled trials are needed to confirm these findings.
    Keywords:  elbow; extracorporeal shock wave therapy; functional outcomes; lateral epicondylitis; minimally invasive treatment; ozone therapy
    DOI:  https://doi.org/10.1016/j.hansur.2026.102679
  67. JBJS Case Connect. 2026 Apr 01. 16(2):
    Concomitant Tibiofemoral and Posterior Patellofemoral Joint Dislocation: A Case Report.
    Anderson Lee, Brandon Ponce, William Bohne, Arjun Minhas, Charlotte Orr, Matthew Lawless.
       CASE: This case report aims to highlight a rare injury of a combined right tibiofemoral and patellofemoral joint dislocation. The patient was found to have a partial quadriceps tendon rupture, lateral and medial-sided soft-tissue injuries, and avulsion of the anterior and posterior cruciate ligaments. Treatment involved lateral and medial-sided repairs, as well as repair of his partial quadriceps tendon tear, allowing eventual return to daily activities following extensive rehabilitation.
    CONCLUSION: Successful surgical repair and rehabilitation of a combined tibiofemoral and patellofemoral dislocation can restore stability and enable return to normal daily activities.
    Keywords:  anterior cruciate ligament; dislocation; knee; patella; patellofemoral; posterior cruciate ligament; tibiofemoral
    DOI:  https://doi.org/e25.00704
  68. Orthop Rev (Pavia). 2026 ;18 159615
    outcomes of acute total hip arthroplasty (THA) in the management of acetabular fractures: a case series.
    Abdullah Alzahrani, Ghada Alhamed, Abdullah Alghamdi, Abdulrahman Alqahtani, Raghad Alaujan, Ziad Aljaafri.
      Acetabulum fractures, often resulting from high-energy trauma, increasingly affect both younger and older adults, impacting hip joint function and quality of life. Acute total hip arthroplasty (THA) offers a critical solution, especially beneficial for elderly patients or those with poor bone quality. This case series presents six patients with varying medical histories, all experiencing significant hip-related injuries necessitating total hip arthroplasty (THA). Cases range from complex acetabular fractures due to falls or motor vehicle accidents to complications following previous surgical interventions. Surgical techniques adapted to each patient's specific fracture patterns and medical conditions, employing approaches such as the Extended Smith-Peterson, Kocher-Langenbeck, and modified Smith-Petersen. Outcomes were generally positive, with patients reporting significant pain relief and restored mobility.
    Keywords:  Acetabular fractures; mobility restoration; pain relief; postoperative complications; surgical approaches; total hip arthroplasty
    DOI:  https://doi.org/10.52965/001c.159615
  69. Phys Ther Sport. 2026 Apr 17. pii: S1466-853X(26)00042-8. [Epub ahead of print]79 101921
    Sensorimotor dysfunction does not predict pain-related cognition, but proprioception is associated with pain catastrophizing and pain self-efficacy in people with lower limb tendinopathy: A cross-sectional study.
    Jack Mest, Andrew Flood, Peter Preston, Gordon Waddington, Peter Malliaras, Angie M Fearon.
       OBJECTIVES: To investigate if sensorimotor function predicts pain-related cognition in people with lower limb tendinopathy.
    DESIGN: Single-cohort, cross-sectional study.
    SETTING: Sports and exercise research laboratory.
    PARTICIPANTS: Seventy-three participants with a diagnosed lower limb tendinopathy.
    MAIN OUTCOME MEASURES: We measured proprioception (active movement extent discrimination apparatus), unilateral balance (Y-balance test), bipedal postural control (sensory organization test) and lower limb muscle strength in a single laboratory visit. Pain-related cognition was assessed using the Tampa Scale of Kinesiophobia (TSK-11), fear of pain questionnaire, pain catastrophizing scale, pain self-efficacy scale. Linear regression analysis was conducted to determine whether sensorimotor function was predictive of pain-related cognition.
    RESULTS: Sensorimotor function was not predictive of kinesiophobia (p = 0.24, ΔR2 = 0.06), fear of pain (p = 0.97, ΔR2 = 0.01), pain catastrophizing (p = 0.1) or pain self-efficacy (p = 0.18, ΔR2 = 0.06) after controlling for age, sex, disability and pain intensity. Proprioceptive ability was associated with pain catastrophizing (μ = -5.52, p = 0.02) and pain self-efficacy (β = 23.05, p = 0.046).
    CONCLUSIONS: Collectively, sensorimotor factors did not predict pain-related cognition. However, when considering sensorimotor factors individually, proprioceptive ability was associated with both pain catastrophizing and self-efficacy but not fear.
    Keywords:  Exercise; Pain; Psychology; Rehabilitation; Tendinopathy/tendinitis; Tendon
    DOI:  https://doi.org/10.1016/j.ptsp.2026.101921
  70. Pain Med Case Rep. 2026 Apr;10(2): 121-125
    Botulinum Toxin Chemodenervation for Treating Chronic Sunburn-Induced Painful Peripheral Neuropathy: A Case Report.
    Kevin Gilbert, Tigran Kesayan.
       BACKGROUND: We present a rare case of sunburn-induced chronic neuropathic pain that was successfully treated with onabotulinumtoxinA (Ona A).
    CASE REPORT: Due to a sunburn, a 21-year-old man developed painful dysesthesias and allodynia lasting more than 2 years on a 15 cm x 12 cm area of his chest. He was treated with 100 units of Ona A which was repeated at 12 weeks and then 200 units at 24 weeks. His pain reduced from 6/10 to 4/10 after the first 2 injections and to 3/10 after the third. He continued to improve to near resolution.
    CONCLUSION: Ona A's effect may be primarily peripheral, due to a decrease in the local release of nociceptive neurotransmitters. However, Ona A can be taken up by the neuron and pass multiple synapses; this may have led to a reduction in pain at the dorsal root ganglion, or more proximally. Lastly, a toxin-induced decrease of afferent mechanical and nociceptive input may have led to a central "wind-down" phenomenon.
    Keywords:  Onabotulinumtoxin; botox; case report; central sensitization; peripheral sensitization; sunburn-induced neuropathic pain
  71. JSES Rev Rep Tech. 2026 Aug;6(3): 100725
    Impact of enhanced recovery after surgery protocols on patient-reported outcomes and satisfaction following shoulder arthroplasty: a systematic review.
    Hussayn Shinwari, Asmaar Butt, Hanan Taimur Shinwari, Zakariya Mouyer, Saran Singh Gill, Abith Ganesh Kamath, Kapil Sugand.
       Background: As shoulder arthroplasty volume rises globally, evidence on optimal perioperative rehabilitation and analgesia remains limited. This systematic review evaluated enhanced recovery after surgery postoperative strategies on patient-reported outcomes and satisfaction.
    Methods: PubMed, Embase, MEDLINE, Global Health, and Cochrane Library were searched per Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. Studies undergoing total shoulder arthroplasty or reverse total shoulder arthroplasty (RTSA) were included. Interventions: rehabilitation timing and analgesic protocols. Outcomes: American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), Single Assessment Numeric Evaluation (SANE), range of motion, Quality of Recovery-15, and satisfaction.
    Results: Eighteen studies including 1,722 patients (total shoulder arthroplasty: n = 7; RTSA: n = 2; mixed: n = 9) were analyzed. Delayed rehabilitation after RTSA improved early pain scores (ASES pain 26.3 ± 16.3 vs. 16.7 ± 11.6 at 6 months; P = .01) and overall function (ASES total 40.2 ± 20.1 vs. 30.0 ± 18.8; P = .04), without affecting long-term outcomes (ASES 88-90, SST 9.8-9.9, SANE 85-88 at 12 months). Opioid-sparing and opioid-free protocols achieved equivalent functional recovery (ASES 74-89, SST 6-9, SANE 24-28 change-from-baseline) and consistently higher patient satisfaction (86-97%) at 2-6 weeks. Continuous interscalene blocks and liposomal bupivacaine provided effective analgesia (Quality of Recovery-15 postoperative day 3: 124.5-132.0), with trends toward improved early recovery. Across studies, range of motion outcomes (forward flexion 126-146° and external rotation 57-62°) were comparable, indicating multiple enhanced recovery after surgery strategies can deliver similar functional and patient-reported outcomes while enhancing early recovery and satisfaction.
    Conclusion: Functional recovery following shoulder arthroplasty appeared robust across diverse rehabilitation and analgesic strategies. Delayed rehabilitation offered early pain advantages, and opioid-sparing approaches enhanced patient satisfaction without compromising outcomes. These findings supported a personalized, patient-centered approach to postoperative care and highlight the need for further high-quality comparative trials.
    Keywords:  Analgesia protocols; Enhanced recovery after surgery; Functional recovery; Interscalene nerve block; Opioid-sparing; Patient-reported outcomes; Postoperative rehabilitation; Shoulder arthroplasty
    DOI:  https://doi.org/10.1016/j.xrrt.2026.100725
  72. Toxins (Basel). 2026 Apr 01. pii: 170. [Epub ahead of print]18(4):
    Botulinum Toxin Type A Injections in the Bladder Wall-An Effective Treatment for Urinary Incontinence with Low Long-Term Adherence.
    Francisco Cruz, Martin C Michel, Yasuhiko Igawa.
      Botulinum toxin type A (BoNT/A) injection into the bladder wall is a milestone in the treatment of urinary incontinence in patients with neurogenic detrusor overactivity (NDOi) or overactive bladder syndrome (OABi) who are refractory to or unable to tolerate oral or transdermal therapies. However, the efficacy of BoNT/A is hampered by the low long-term adherence of patients to a treatment that requires repeated bladder injections under cystoscopy control. The discontinuation is particularly evident among incontinent patients with spontaneous voluntary voiding, regardless of whether the cause is NDOi or OABi, although clearly more marked among the latter group. In addition to the bother and pain associated with repeated cystoscopies, these patients show low tolerance to the high incidence of urinary tract infections (UTIs) and transient urinary retention, the two most common adverse events. Fewer injection points may render treatments less painful, apparently without reducing efficacy, but will not avoid the need for repeated cystoscopies, and no studies have demonstrated that such modification increases adherence. Eventually, accessing the bladder wall for BoNT/A administration via a transabdominal approach, under real-time ultrasound guidance, may overcome trans-urethral limitations, but the technique's reproducibility remains unknown. An intensive investigation is ongoing to identify aids that facilitate the passage of the large, fragile BoNT/A molecule across the urothelium to reach the bladder nerves without injections. Electromotive Drug Administration (EMDA) of BoNT/A demonstrated efficacy and safety over a 6-year follow-up in NDOi patients at a single center, but the results were not reproduced at other institutions. The application of shock waves to the bladder using shock waves generated by Extracorporeal Shock Wave Lithotripsy (ESWL) machines to tear the urothelium and facilitate the passage of BoNT/A instilled in the bladder is ingenious, but the experience is very limited. Dimethyl sulfoxide, liposomes, and thermal-reversal hydrogel to deliver the toxin failed in pilot trials. BoNT/A in nano-formulations has high heat stability, resistance to pH changes, and to enzymatic degradation. Extended efficacy in dermal and intramuscular pilot applications is promising but needs to be replicated in the bladder.
    Keywords:  bladder administration; botulinum toxin; neurogenic detrusor overactivity; overactive bladder; urinary incontinence
    DOI:  https://doi.org/10.3390/toxins18040170
  73. J Orthop Sports Phys Ther. 2026 May;56(5): 310-320
    Adding Self-directed Psychological Support to Usual Rehabilitation Following Anterior Cruciate Ligament Reconstruction Did Not Increase Return-to-Sport Rates at 12 Months. Results From the BAck iN the Game (BANG) Randomized Controlled Trial.
    Anne Fältström, Henrik Hedevik, Clare L Ardern, Joanna Kvist.
      OBJECTIVE: To evaluate the efficacy of internet-delivered psychological support-the BAck iN the Game (BANG) intervention-after anterior cruciate ligament reconstruction (ACLR) for improving return to sport (RTS). DESIGN: Randomized controlled trial. METHODS: Participants aged 15-30 years, who were playing contact or noncontact pivoting sports at least twice per week prior to anterior cruciate ligament (ACL) injury and intending to return to pivoting sports after ACLR, were included. Participants were randomized to either usual care (UC; standard postoperative treatment) plus the BANG intervention (BANG+UC group) or UC alone (UC group). The intervention was a 24-week internet-delivered psychological support program, codesigned with athletes and clinicians, and based on cognitive behavioral therapy principles. Participants reported sports participation fortnightly after ACLR, and functional and psychological outcomes at 3, 6, and 12 months. Knee function was measured at 12 months after ACLR. New injuries were registered up to 24 months after ACLR. The primary outcome was RTS at the 12-month follow-up. RESULTS: One hundred sixty-one participants were included: 80 in the BANG+UC group and 81 in the UC group. The RTS rate at 12 months was 36% in both groups, with no significant differences in the proportion of those who RTS (risk ratio, 1.01; 95% confidence interval, 0.59-1.73; P = .971) or in functional and psychological outcomes. Twelve participants sustained new ACL injuries (6 in each group), with no between-group differences. CONCLUSION: There was no effect of internet-delivered psychological support on the RTS rate, readiness to RTS, or subsequent knee injuries beyond usual postoperative care for people with ACLR. J Orthop Sports Phys Ther 2026;56(5):310-320. Epub 2 March 2026. doi:10.2519/jospt.2026.13749.
    Keywords:  ACL; fear; knee; psychological; return to sport
    DOI:  https://doi.org/10.2519/jospt.2026.13749
  74. J Med Ultrasound. 2026 Jan-Mar;34(1):34(1): 102-104
    Point-of-care Ultrasound for Diagnosis and Management of Chronic Inflammatory Monoarthropathy of the Shoulder after Combined Influenza and COVID-19 Vaccination: A Case Report.
    Matthew Rong Jie Tay, Harpreet Sangha.
      Shoulder injury related to vaccine administration (SIRVA) is a rare but preventable injury, resulting in severe shoulder pain. It is thought to be due to improper needle placement into the surrounding shoulder structures and can result in serious and debilitating injury. This case report describes a patient who developed a rare case of chronic inflammatory nonseptic monoarthropathy after combined influenza and COVID-19 vaccination. The diagnosis was suspected using point-of-care ultrasound, with findings of cortical erosions of the humeral head, which was confirmed with magnetic resonance imaging. After a primary autoimmune condition was excluded, the patient underwent ultrasound-guided intra-articular corticosteroid injection of the shoulder, which provided good pain relief. The role of ultrasound has not been reported in SIRVA-related conditions. Point-of-care ultrasound can potentially be useful in the evaluation and management of SIRVA-related shoulder pathologies.
    Keywords:  Arthritis; case report; musculoskeletal conditions; pain; rheumatology; vaccination
    DOI:  https://doi.org/10.4103/jmu.jmu_64_24
  75. Rev Bras Ortop (Sao Paulo). 2026 Feb;61(1): s00461819580
    [Viscosupplementation with High Molecular Weight Hyaluronic Acid for Hip Osteoarthritis: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials].
    Tales Pasqualotto, Eric Pasqualotto, Leonardo Salvatore Migliardi, Laura Lunelli, Letícia Oliveira Lunelli, Renan Vinicius Romano Martinelli.
       Objective: To evaluate the efficacy and safety of high molecular weight hyaluronic acid (HMWHA) versus other therapies for hip osteoarthritis (OA) management.
    Methods: The present systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials (RCTs) comparing HMWHA versus other therapies (corticosteroids, platelet-rich plasma, saline, or low molecular weight hyaluronic acid) for hip OA treatment were included. Mean differences (MDs) or standardized mean differences (SMDs) were calculated for continuous outcomes with 95% confidence intervals (CIs).
    Results: Four RCTs were included, involving 823 patients with hip OA, of whom 408 (49.5%) were treated with HMWHA. The mean age of the patients was 60.1 (±10.21) years. No significant differences were observed between groups for pain (SMD -0.30 points; 95% CI -1.60 to 0.99), Lequesne index (MD 1.30 points; 95% CI -8.83 to 11.44), WOMAC total (MD -9.26 points; 95% CI -51.33 to 32.56), WOMAC stiffness (MD -0.93 points; 95% CI -12.30 to 10.45), WOMAC physical function (MD -0.15 points; 95% CI -7.24 to 7.60), and patient global self-assessment (MD -1.95 points; 95% CI -27.49 to 23.59).
    Conclusion: No significant differences were observed between HMWHA and other treatments regarding pain relief and functional recovery in patients with hip OA. However, further high-quality RCTs are needed to evaluate the HMWHA in the treatment of hip OA.
    Keywords:  hip; hyaluronic acid; osteoarthritis
    DOI:  https://doi.org/10.1055/s-0046-1819580
  76. Galen Med J. 2025 ;14 e3807
    Middle East Pain Registry (MEPAIN): Feasibility Study of Chronic Pain Registry and Pilot Phase Results : Middle East Pain Registry (MEPAIN).
    Habib Zakeri, Mohammad Radmehr, Aliasghar Karimi, Leala Montazeri, Pegah Pedramfard, Parisa Mahdiyar, Farnaz Hemati, Atiyeh Ebrahimi, Sogand Sadeghi, Saba Moalemi.
       Background: Chronic pain is a significant public health concern due to its long-term disabling effects. To support systematic data collection and improve patient management, the Middle East Pain Registry (MEPAIN) was developed. This study outlines the registry's design, evaluates its feasibility, and presents initial findings from its pilot phase.
    Materials and Methods: MEPAIN was launched on July 21, 2024, with data collected via the Zigorat® software platform through January 22, 2025 for this pilot study. Each patient record included demographic details, pain characteristics (pattern, location, intensity), physical exam findings, imaging results, diagnoses, interventions, and follow-up data.
    Results: A total of 3,903 patients were registered during the six-month pilot. The cohort was 59.5% female, with a mean age of 53.5 ± 14.8 years; 50.2% were Iranian and 49.5% Omani. Lumbar radiculopathy was the most frequent diagnosis. Osteoarthritis and carpal tunnel syndrome predominated among females, while lumbar radiculopathy and discogenic pain were more common in younger patients. Iranians reported higher pain intensity during exacerbations, while Omanis showed greater prevalence of discogenic pain, spinal stenosis, carpal tunnel syndrome, and failed back surgery syndrome. Paresthesia was the most frequently reported symptom, and transforaminal epidural steroid injection was the most common procedure performed.
    Conclusion: The MEPAIN registry successfully captures comprehensive clinical and procedural data on patients with chronic pain in the Middle East. It offers a robust platform for clinical evaluation and research, supporting future efforts to tailor pain management strategies in regional populations.
    Keywords:  Chronic Pain; Low Back Pain; Middle East; Pain; Registry
    DOI:  https://doi.org/10.31661/gmj.v14i.3807
  77. Orthop Traumatol Surg Res. 2026 Apr 23. pii: S1877-0568(26)00152-0. [Epub ahead of print] 104731
    The pelvic femoral angle in flexed-seated position analysis predicts impingement risk of total hip arthroplasty: Defining hip joint hypermobility and true hip hyperflexion.
    Thomas Aubert, Russell J Bodner.
       BACKGROUND: Although total hip arthroplasty (THA) is highly successful, standard cup orientation does not prevent all impingement-related complications. Functional planning integrates spinopelvic motion, but flexed-seated definitions of hip hypermobility remain unclear. We aimed to define clinically relevant flexed-seated femur-pelvis motion thresholds and test their association with simulated impingement and anteversion safe-zone constraints.
    HYPOTHESIS: The existence of a pathological hip mobility threshold, independent of other risk factors for impingement with standard cup positioning, would provide additional evidence supporting the need to define a personalized cup orientation when planning total hip arthroplasty.
    METHODS: This retrospective consecutive cohort included 728 primary THA candidates with preoperative standing and flexed-seated lateral radiographs. Measured variables were spinopelvic tilt (SPT), pelvic incidence (PI), lumbar lordosis (LL), lumbar flexion, standing pelvic-femoral angle (PFAstanding), flexed-seated pelvic-femoral angle (PFAflexed-seated), and ΔPFA. The primary endpoint was simulated impingement at 40/20°. Secondary endpoints were impingement at 40/15° and patient-specific anteversion corridor metrics (minimum anteversion without anterior impingement, maximum anteversion without posterior impingement, safe-zone width = max-min, and corridor collapse when width ≤0). ROC analysis evaluated ΔPFA discrimination; logistic regression identified independent predictors. Within ΔPFA ≥110°, three mechanistic phenotypes were defined: high standing PFA only (≥200°), low flexed-seated PFA only (≤90°), and both.
    RESULTS: ΔPFA discriminated impingement at 40/20° (AUC 0.79). At ΔPFA 110°, specificity was 94.4%, PPV 69.1%, sensitivity 34.7%, and NPV 80.0%, identifying a small high-risk subgroup. Compared with ΔPFA <110°, ΔPFA ≥110° was associated with higher adverse spinopelvic mobility (ΔSPT ≥20°: 76.9% vs 9.0%; OR 33.63, p < 0.001), higher impingement at 40/15° (78.8% vs 25.0%; OR 9.41, p < 0.001) and 40/20° (71.9% vs 19.9%; OR 10.02, p < 0.001), and smaller safe-zone width (median 4° vs 28°, p < 0.001). In multivariable analysis, ΔSPT ≥20° (OR 10.72, p < 0.001) and ΔPFA ≥110° (OR 2.56, p = 0.0032) independently predicted 40/20° impingement. Within ΔPFA ≥110°, the low flexed-seated phenotype had the highest corridor collapse (56.5%) and impingement rates (40/20°: 78.3%; 40/15°: 80.4%). Very low PFAflexed-seated (especially <80-85°) identified extreme outliers with frequent absence of an impingement-free corridor.
    CONCLUSIONS: In flexed-seated analysis, ΔPFA ≥110° is a practical preoperative marker of elevated impingement risk, while low absolute PFAflexed-seated (≤85°, especially <80°) identifies the highest-risk hyperflexion outliers with corridor collapse. Combining ΔPFA and flexed-seated PFA phenotyping may improve patient-specific cup orientation planning before THA.
    LEVEL OF EVIDENCE: IV; retrospective study.
    Keywords:  Component impingement; Hip hypermobility; Hip spine relationship; Spinopelvic mobility; Total hip arthroplasty planning; Total hip replacement
    DOI:  https://doi.org/10.1016/j.otsr.2026.104731
  78. Pain Med Case Rep. 2026 Apr;10(2): 169-172
    A Tale of Two Shoulders: Comparative Outcomes of Coracohumeral Ligament Release With and Without Percutaneous Peripheral Nerve Stimulation in Adhesive Capsulitis.
    Rohan Gogoi, Saiyid Mahmood, Adam Betcher, Sayed Wahezi.
       BACKGROUND: When traditional treatments for adhesive capsulitis (AC) fail, new modalities, such as percutaneous tenotomy of the coracohumeral ligament (CHL), can provide meaningful relief and improved function. However, it remains unclear which patients will benefit, and which will continue to experience pain.
    CASE REPORT: A 59-year-old woman experienced significant pain relief and improved function after CHL release via Tenex® (Tenex Health, Lake Forest, CA) for AC of the right shoulder. Two years later, she developed AC in the left shoulder and underwent the same Tenex procedure. However, this time, her symptoms did not improve. She then received percutaneous peripheral nerve stimulation (PNS) targeting the left axillary and suprascapular nerves using the SPRINT system (SPR Therapeutics, Cleveland, OH), leading to durable pain relief and improved function at a 12-month follow-up.
    CONCLUSIONS: Our case highlights the evolving treatment landscape of AC and underscores the need for further research into the optimal roles of Tenex and PNS in its management.
    Keywords:  Adhesive capsulitis; SPRINT; Tenex; neuromodulation; percutaneous tenotomy
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