bims-ricfun Biomed News
on Rehabilitation ICF
Issue of 2026–05–17
83 papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica
  1. Not All Carpal Tunnel Syndrome Is Inflammatory-Even in Autoimmune Disease: Ultrasound Unmasks a Mechanical/Anatomical Culprit.
  2. Efficacy of ultrasound-guided intra-articular hyaluronic acid injection in the management of adhesive capsulitis: a randomized controlled trial.
  3. Subacromial bursitis: current evidence and future directions in injection-based therapies-A narrative review.
  4. Optimizing soft tissue injury rehabilitation: PEACE & LOVE with vs without cryotherapy-protocol for a sham-controlled randomized trial in acute lateral ankle sprain.
  5. Platelet-rich plasma and stem cell therapies for spondylosis: a systematic review of randomized controlled trials.
  6. Air-Containing Hip Paralabral Cyst: An Unusual Cause of Rectus Femoris Tendon Rupture.
  7. Platelet-rich plasma plus hyaluronic acid vs platelet-rich plasma intra-articular injections for knee osteoarthritis: A systematic review and meta-analysis.
  8. Impact of modified Henry approach with preservation of Flexor Carpi Radialis Tendon Sheath on wrist function in the treatment of distal radius fractures.
  9. Platelet-rich plasma therapy for low back pain: A comprehensive systematic review and meta-analysis.
  10. Efficacy of arthrocentesis and PRP in TMJ osteoarthritis patients.
  11. Ultrasonographic parameters comparison for pre- and postoperative carpal tunnel syndrome release: A single-center prospective study.
  12. Platelet-Rich Plasma Accelerates the Return to Sport in Athletes with Acute Muscle Injuries: A Systematic Review and Statistical Fragility Index-Based Meta-Analysis of Randomized Controlled Trials.
  13. Trends in prevalence and disability burden of main rheumatic and musculoskeletal diseases in France 2008-2022.
  14. Comparison of platelet-rich plasma injection versus corticosteroid injection for the treatment of frozen shoulder in Asia: A systematic review and meta-analysis of randomized controlled trials.
  15. Preoperative two-step test predicts independent ambulation one week after total hip arthroplasty.
  16. Ultrasound-Guided Hydrodissection for Peripheral Neuropathy: An Evidence-Based Intervention Whose Time Has Finally Come.
  17. Multidisciplinary management of pain and function in a patient with bilateral thumb hypoplasia undergoing multiple reconstructive procedures.
  18. Zone II Flexor Tendon Repair - Number of Strands, Technique, and Postoperative Rehabilitation: A Narrative Review.
  19. The One-Year Postoperative Trajectories of Knee Joint Angle Recovery During Walking After Total Knee Arthroplasty in Women: A Cross-Sectional Study.
  20. Editorial Commentary: Return to Sport Is Not the Finish Line: Raising the Bar for Long-Term Outcomes After Hip Arthroscopy in Athletes.
  21. Iliopsoas Cross-Sectional Area at the Psoas Valley is Associated with Surgically Treated Femoroacetabular Impingement Syndrome: A CT-based Case-Control Study.
  22. Modified Ultrasonographic Classification of Tendinous Mallet Injuries Based on a Combination with Wang Classification Highlighting Lateral Band Involvement.
  23. Ultrasound-Guided Hydrodissection for Carpal Tunnel Syndrome with Bifid Median Nerve and Persistent Median Artery: An Imaging-Based Case Report with Alpha-2 Macroglobulin.
  24. CT-guided injection in coccydynia: outcome prediction using MRI findings and CT-injection characteristics.
  25. Sonographic Diagnosis of Flexor Tendon Incarceration by a Malunited Fracture Fragment: A Case Report.
  26. Rapid Radiographic Improvement in Large Multilobulated Shoulder Calcific Tendinitis After Ultrasound-Guided Prolotherapy and Adjunctive Nutritional and Metabolic Support: A Case Report.
  27. Imaging findings of sports-related acute core muscle injuries.
  28. Triceps surae morphology and ankle functionality 2 years after Achilles tendon rupture repair: traditional vs early rehabilitation.
  29. The efficacy of strength exercise dosage on pain and disability in people with low back pain: a systematic review of randomized controlled trials.
  30. Comparative effectiveness of physical therapy interventions in adults with rotator cuff tendinopathy: a systematic review and network meta-analysis.
  31. Painful Biceps Vincula: An Unrecognized Cause of Anterior Shoulder Pain.
  32. Repeated Measurements of Ultrasound Median Nerve Cross-Sectional Area Are Associated with Symptomatic and Functional Improvement after Carpal Tunnel Release.
  33. Partial Articular Supraspinatus Tendon Avulsion (PASTA) Repair: Transtendinous Technique.
  34. Comparative effectiveness of percutaneous needle electrolysis and shockwave therapy in subscapularis tendinopathy: a randomized clinical trial.
  35. Surgical management of recalcitrant lateral epicondylitis: indications, techniques, and outcomes.
  36. Nerve Conduction and F-wave Findings in Patients With Postoperative Numbness After Reverse Shoulder Arthroplasty: A Case Series.
  37. Postpartum Parsonage-Turner Syndrome with Hourglass Constrictions and Spontaneous Recovery without Surgical Intervention.
  38. Nonoperative treatment of an anterior Achilles partial tear with load management and percutaneous electrolysis in an amateur basketball player. One year follow-up.
  39. Role of Ultrasonography and Magnetic Resonance Imaging in Diagnosing Shoulder Pathologies: A Prospective Observational Study.
  40. Beyond arthroplasty conversion: Rethinking failure after hip arthroscopy for femoroacetabular impingement syndrome.
  41. Sonographic Normal Values for Ulnar Nerve Cross-Sectional Area.
  42. Effectiveness of maintenance interventions promoting physical activity following exercise therapy for chronic conditions: an umbrella review.
  43. Research progress of diffusion tensor imaging in lumbar degenerative diseases: a narrative review.
  44. Coracoid bending for refractory anterior upper arm pain after reverse total shoulder arthroplasty.
  45. Achilles tendon rupture does not significantly reduce career longevity in professional soccer players compared with matched controls.
  46. Nutritional status, abdominal muscle thickness, and functional outcomes in patients with subacute to chronic stroke.
  47. Wheelchair to Walking: Quadruple Arthroplasty of Hip and Knee Joints in a Patient with Severe Ankylosing Spondylitis.
  48. Teaching the ICF or using the ICF to teach? Lessons from first-time clinical practice.
  49. Effects of Massage on Pain, Muscle Co-Contraction, and Knee Loading in Medial Knee Osteoarthritis: A Randomized Controlled Trial Protocol.
  50. Clinical and Electrophysiological Assessment of Peripheral Nerve Function After Transradial Angiography: A Prospective Study.
  51. Asymptomatic Abnormalities in the Knee, Shoulder, and Ankle Joints of Collegiate Athletes: A Cross-Sectional MRI-Based Comparative Study.
  52. Sustained functional recovery one year after TFCC debridement with adjuvant umbilical cord-mesenchymal stem cells and secretome therapy: a case report.
  53. Outcome domains of patient-reported outcome measures used in randomised controlled trials for older adults with non-specific low back pain: a systematic review.
  54. Comparative Effectiveness of Combined Orthotic and Physiotherapy Interventions Versus Monotherapy in the Management of Knee Osteoarthritis on Clinical Parameters: A Systematic Review of Randomized Controlled Trials.
  55. Cognitive Impairment as a Putative Mechanism of Self-Management Failure in Chronic Obstructive Pulmonary Disease: A Conceptual Narrative Review.
  56. Characteristics of the upper trapezius muscle in patients with chronic shoulder impingement syndrome: a comparative study.
  57. Relationship Between Cam Lesion Size, Its Excision, and Hip Osteoarthritis Progression: A Contralateral-Controlled Study Using Joint Space Width After Unilateral Hip Arthroscopy.
  58. Extension block pinning with percutaneous intramedullary reduction for dorsal PIP joint fracture-dislocation of the finger.
  59. Obturator internus avulsion in adolescents: a rare pattern of pelvic avulsion injury.
  60. Upright MRI Follow-Up for Decompression and Interlaminar Stabilization in Low-Grade L4/L5 Spondylolisthesis Suggests Reduced Reoperation Rates Compared With Fusion or Decompression Alone.
  61. Extracorporeal Shock Wave Therapy in Chronic Lateral Elbow Tendinopathy: A Systematic Review.
  62. What Is the Best Surgical Treatment for Ulnar Styloid Impaction Syndrome? - A Systematic Review.
  63. Subchondral bone marrow aspirate concentrate injection improves clinical outcomes and reduces bone marrow lesions in knee osteoarthritis: 12-month retrospective analysis.
  64. Is it Really Less Painful to Undergo Total Hip Arthroplasty than Total Knee Arthroplasty?
  65. Delayed sciatic nerve branch injury following a gluteal stab wound presenting as intrinsic foot muscle denervation: A case report.
  66. Brachial Plexopathy: When You Hear Hooves, Think Horses Not Zebras!
  67. Pathogenesis, Diagnostic Advances, and Therapeutic Management of Chronic Obstructive Pulmonary Disease: A Narrative Review.
  68. Effect of combined anteversion on outcomes in total hip replacement.
  69. [Efficacy of celecoxib, diclofenac, etoricoxib, ibuprofen, ketoprofen and naproxen in low back pain with or without nerve root pain: Systematic review of literature and meta-analysis of randomized controlled trials].
  70. Impact of the timing of initiation of a smartphone-based application on very short-term postoperative satisfaction after total hip arthroplasty: a prospective observational study.
  71. Osteochondritis Dissecans of the Capitellum in the Young Athlete.
  72. Efficacy of exercise and opioid interventions in improving pain and functioning outcomes in acute low back pain: a systemic review.
  73. Efficacy and safety of elective primary total elbow arthroplasty in the last 25 years: a systematic review.
  74. Sono-Anatomy and Histology of the Deep Fasciae in the Upper Limb.
  75. Clinical outcomes of genicular artery embolization for knee osteoarthritis in an indian observational cohort: the GENIE study.
  76. POCUS to Evaluate for Achilles Tendon Involvement in Ankle Lacerations.
  77. Comparative outcomes of single versus multiple trigger finger releases: a propensity score matched cohort study.
  78. Efficacy of Active Exercises to Improve Range of Motion in Knee Joint After Total Knee Arthroplasty. A Randomized Controlled Trial.
  79. The correlation between torn supraspinatus tendon thickness and commonly used radiological predictive factors for repairability in rotator cuff tears.
  80. Keeled versus pegged glenoid components in total shoulder arthroplasty for primary osteoarthritis: a meta-analysis.
  81. Return to Sport and Functional Outcomes After Minimally Invasive Zadek Osteotomy for Insertional Achilles Tendinopathy in Young Athletes: A Retrospective Case Series.
  82. Likelihood of secondary surgery due to osteoarthritis following ankle fracture fixation: a systematic review.
  83. Snapchat-Based Structured Education Reduces Kinesiophobia and Improves Psychological Readiness and Perceived Knee Function Following Anterior Cruciate Ligament Reconstruction: A Quasi-Experimental Study.
  1. Pain Pract. 2026 Jun;26(5): e70165
    Not All Carpal Tunnel Syndrome Is Inflammatory-Even in Autoimmune Disease: Ultrasound Unmasks a Mechanical/Anatomical Culprit.
    Hilmi Berkan Abacıoğlu, Berkay Yalçınkaya, Ahmet Furkan Çolak, Alp Çetin.
      
    Keywords:  dextrose; hand; intervention; neuropathy; ultrasound
    DOI:  https://doi.org/10.1111/papr.70165
  2. J Rehabil Med. 2026 May 15. 58 jrm44901
    Efficacy of ultrasound-guided intra-articular hyaluronic acid injection in the management of adhesive capsulitis: a randomized controlled trial.
    Chih-Ya Chang, Ching-Ting Chen, Yung-Hsiang Lin, Chi-Fu Chiang, Yi-Wen Mao, Li-Wei Chou.
       OBJECTIVE: To compare the efficacy and safety of ultrasound-guided intra-articular hyaluronic acid injection versus supervised rehabilitation in patients with frozen-phase adhesive capsulitis.
    DESIGN: Single-center, parallel-group, randomized controlled trial with 26-week follow-up.
    SUBJECTS/PATIENTS: Forty-six adults aged 40-70 years with clinically and radiologically confirmed frozen-phase adhesive capsulitis.
    METHODS: Participants were randomly assigned to receive either three weekly ultrasound-guided intra-articular hyaluronic acid injections or supervised physical therapy twice weekly for six weeks. Outcomes assessed at baseline and at weeks 4, 6, 8, and 26 included the Shoulder Pain and Disability Index (SPADI) and shoulder range of motion.
    RESULTS: Both groups achieved significant within-group improvements in SPADI and range of motion over 26 weeks (all p < 0.01 vs. baseline). No statistically significant between-group differences were observed in total SPADI or its pain and disability subscales at any follow-up time point (all p > 0.05). At week 26, the hyaluronic acid group's mean total SPADI decreased from 43.0 ± 17.7 to 16.1 ± 12.8 (p < 0.01), while the rehabilitation group improved from 52.0 ± 18.4 to 23.2 ± 21.8 (p < 0.01). Pain subscores were reduced by 64.3% (hyaluronic acid) and 56.1% (rehabilitation); function subscores decreased by 60.9% and 54.8%, respectively (all p < 0.01). Both groups showed significant gains in active and passive flexion, abduction, and external rotation, without significant between-group differences (all p > 0.05). No treatment-related adverse events were observed.
    CONCLUSION: Ultrasound-guided hyaluronic acid injection and supervised rehabilitation produced comparable and clinically meaningful improvements in pain, function, and shoulder mobility in frozen-phase adhesive capsulitis.
    DOI:  https://doi.org/10.2340/jrm.v58.44901
  3. Ann Med. 2026 Dec;58(1): 2673146
    Subacromial bursitis: current evidence and future directions in injection-based therapies-A narrative review.
    Jiaxing Ding, Sida Liu, Peilong Jiang, Huajun Jiang, Feng Han, Wei Qu.
       OBJECTIVE: To review the anatomical and physiological characteristics of subacromial bursitis (SAB), clarify its pathogenesis and commonly used imaging diagnostic methods, and summarize the clinical efficacy, current application status, and future research directions of various injectable agents for SAB.
    METHODS: This narrative review performed a non-systematic literature search in PubMed and Web of Science for injection therapies for SAB and related conditions , focusing on clinical trials and systematic reviews.
    RESULTS: Corticosteroids (CS) remain the most widely used, providing robust short-term pain relief but with potential long-term complications. Randomized controlled trials suggest hyaluronic acid, nonsteroidal anti-inflammatory drugs, and hypertonic glucose offer alternative or adjunctive options. Emerging biologics like platelet-rich plasma (PRP) and interleukin-1 antagonists show promise but low-quality evidence. Ultrasound guidance enhances injection precision, and combining injection with physical rehabilitation optimizes outcomes.
    CONCLUSION: The choice of injectable agent requires balancing CS's rapid effects against safer but less established alternatives. Future research should validate PRP, HA, IL-1Ra, and hypertonic glucose via large RCTs, develop combination strategies (e.g., CS+HA), integrate advanced ultrasound techniques (e.g., hydrodissection), and identify patient-specific factors (e.g., inflammatory endotypes, concomitant rotator cuff pathology) for personalized treatment.
    Keywords:  Hyaluronic acid; Subacromial bursitis; corticosteroids; platelet-rich plasma; review; shoulder pain; ultrasonography, interventional
    DOI:  https://doi.org/10.1080/07853890.2026.2673146
  4. Trials. 2026 May 11.
    Optimizing soft tissue injury rehabilitation: PEACE & LOVE with vs without cryotherapy-protocol for a sham-controlled randomized trial in acute lateral ankle sprain.
    Polok Halder, Md Zahid Hossain, Md Asfan Afroz Akash, Joy Saha, Md Feroz Kabir, K M Amran Hossain, Sharmila Jahan, Kabir Hossain, Tofajjal Hossain, Ehsanur Rahman.
       BACKGROUND: Acute lateral ankle sprains, especially those affecting the anterior talofibular ligament (ATFL), are one of the most frequent injuries in athletes and active adults. These injuries cause pain, swelling, functional restriction, and high recurrence. The PEACE & LOVE framework discourages the use of cryotherapy, yet ice remains widely used in sports and rehabilitation practice. To date, there is limited high-quality evidence evaluating the effect of cryotherapy within this framework. This trial is designed to investigate whether adding cryotherapy to PEACE & LOVE rehabilitation improves outcomes compared with sham cryotherapy.
    METHODS: This single-center, parallel-group, sham-controlled randomized clinical trial will include 60 physically active adults (aged 18-40 years) with grade I-II acute lateral ankle sprains sustained within 48 h. Recruitment has not commenced and is planned from March to May 2026. Follow-up assessments will continue through 12 weeks post-randomization. Participants will be randomly assigned (1:1) to receive either PEACE & LOVE plus cryotherapy (0-4 °C, 20 min, three times daily for 72 h) or PEACE & LOVE plus sham cryotherapy (identical packs at ~20-25 °C with insulation). The primary outcome is pain intensity measured by the Numeric Pain Rating Scale (NPRS) at day 7. Secondary outcomes are functional recovery measured by the Lower Extremity Functional Scale (LEFS) at day 14, week 4, and week 12; ankle swelling assessed by figure-of-eight measurement at baseline and day 7; ankle dorsiflexion via the Weight-Bearing Lunge Test (WBLT) at baseline, week 4, and week 12; short-term analgesic use (paracetamol log, day 0-7); and re-injury rates assessed at week 4 and week 12. Analyses will follow the intention-to-treat principle using ANCOVA adjusted for baseline scores, reporting effect sizes and 95% confidence intervals.
    DISCUSSION: This trial will be the first sham-controlled randomized study to evaluate cryotherapy as an adjunct to the PEACE & LOVE framework in acute ankle sprain. Findings will clarify whether cryotherapy provides clinically meaningful benefits in pain relief, function, and recurrence prevention, and may guide evidence-based rehabilitation practice.
    TRIAL REGISTRATION: Clinical Trial Registry India (CTRI): CTRI/2024/09/073357. Registered on April 9, 2024.
    Keywords:  Ankle injuries; Athletic injuries; Cryotherapy; Randomized controlled trials as topic; Rehabilitation; Sprains and strains
    DOI:  https://doi.org/10.1186/s13063-026-09755-8
  5. Eur Spine J. 2026 May 16.
    Platelet-rich plasma and stem cell therapies for spondylosis: a systematic review of randomized controlled trials.
    Ruoyi Emma Zhang, Amirzeb Aurangzeb, Dinesh Sirisena.
       BACKGROUND: Spinal spondylosis - including degenerative disc disease, facet arthropathy, and stenosis - is a leading cause of chronic spinal pain. Regenerative biologics such as platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and mesenchymal cell therapies are increasingly used, yet evidence remains inconsistent. This systematic review synthesizes randomized controlled trials (RCTs) evaluating biologic injections for degenerative spinal conditions.
    METHODS: MEDLINE, Embase, and Cochrane CENTRAL databases were searched from inception to September 22, 2025. Only RCTs evaluating PRP, BMAC, mesenchymal stem/stromal cells (MSCs), or mesenchymal precursor cells (MPCs) for degenerative spinal pain were included. Outcomes included pain, function, imaging, and adverse events. Risk of bias was assessed using Cochrane RoB 2.
    RESULTS: Thirteen RCTs met eligibility. For lumbar radiculopathy, four trials showed that corticosteroids provided faster early relief, but PRP produced significantly greater improvement at 3-6 months, with higher proportions achieving clinically meaningful pain and ODI reduction. In facetogenic pain, lumbar facet PRP surpassed steroids at 6 months, whereas cervical facet outcomes were similar across groups. Evidence for intradiscal PRP was mixed: one large RCT showed no benefit versus saline; smaller trials reported delayed functional gains. While autologous BMAC and MSC preparations did not demonstrate superiority over sham controls for primary pain and functional outcomes (Levi 2025, Vadalà 2025), allogeneic MPCs demonstrated significant, durable improvements in both pain and disability compared to saline through 36 months, particularly when delivered in a hyaluronic acid vehicle (Amirdelfan 2021). In contrast, a large multicenter RCT demonstrated that allogeneic MPCs significantly increased the proportion of patients achieving ≥ 10-15-point ODI improvement and durable pain reduction over 12-36 months (Amirdelfan 2021). Across all studies, adverse events were minimal, though one case of spondylodiscitis followed intradiscal PRP.
    CONCLUSION: PRP provides durable mid-term benefit for lumbar radiculopathy and lumbar facet pain, while intradiscal PRP, BMAC, and autologous MSCs show limited efficacy. Allogeneic MPCs are the most promising cell-based therapy but remain investigational. Standardization of biologic preparation and larger, multicenter RCTs are needed.
    Keywords:  Bone marrow aspirate concentrate; Degenerative disc disease; Mesenchymal precursor cells; Mesenchymal stromal cells; PRP; Platelet-rich plasma; Spondylosis
    DOI:  https://doi.org/10.1007/s00586-026-09997-9
  6. Am J Phys Med Rehabil. 2026 Apr 24.
    Air-Containing Hip Paralabral Cyst: An Unusual Cause of Rectus Femoris Tendon Rupture.
    Berkay Yalçınkaya, Ahmet Furkan Çolak, Hilmi Berkan Abacıoğlu, Murat Kara, Levent Özçakar.
      
    DOI:  https://doi.org/10.1097/PHM.0000000000003022
  7. Adv Clin Exp Med. 2026 May 11.
    Platelet-rich plasma plus hyaluronic acid vs platelet-rich plasma intra-articular injections for knee osteoarthritis: A systematic review and meta-analysis.
    Marcin Tomaszewski, Jacek Smereka, Mahdi Al-Jeabory, Piotr Fudalej, Michał Pruc, Maciej W Krupowies, Zuzanna Gaca, Łukasz Szarpak.
       BACKGROUND: Knee osteoarthritis (KOA) is a common condition characterized by pain, stiffness, and reduced function, significantly impacting quality of life.
    OBJECTIVES: This study aimed to evaluate the combined use of platelet-rich plasma (PRP) and hyaluronic acid (HA) compared to PRP alone in treating KOA. The hypothesis was that PRP + HA would provide superior outcomes in pain relief and functional improvement due to their complementary biological effects.
    MATERIAL AND METHODS: A systematic review and meta-analysis were conducted according to PRISMA guidelines. The analysis included 11 trials with a total of 892 participants. The studies compared the efficacy of PRP + HA compared to PRP alone. Key outcomes evaluated were changes in the visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Inter-national Knee Documentation Committee (IKDC) scores at 1, 3, 6, 12, and 24 months post-treatment.
    RESULTS: At baseline, no significant differences in VAS scores were observed between the 2 groups (5.82 ±2.71 for PRP + HA vs 5.66 ±2.96 for PRP). By the 6-month follow-up, PRP + HA showed a more substantial reduction in VAS scores (-2.83 ±1.60 vs -2.56 ±1.66; standardized mean difference (SMD) = -1.08, 95% confidence interval (95% CI): -2.22 to 0.05; p < 0.001), with the largest improvement seen at 24 months (-2.7 ±0.2 for PRP + HA vs 0.4 ±0.23 for PRP; SMD = -14.10, 95% CI: -17.41 to -10.79; p < 0.001). WOMAC scores at 12 months also favored the PRP + HA group (-25.26 ±15.24 vs -19.6 ±14.20; SMD = -0.95; p = 0.01). IKDC scores showed no significant differences between groups.
    CONCLUSION: The combination of PRP and HA provides superior pain relief and functional improvement compared to PRP alone, particularly at 6 and 24 months. These findings support the inclusion of PRP + HA in KOA treatment protocols and warrant further investigation into its long-term benefits.
    Keywords:  hyaluronic acid (HA); knee; knee osteoarthritis (KOA); meta-analysis; platelet-rich plasma (PRP)
    DOI:  https://doi.org/10.17219/acem/209523
  8. Arch Orthop Trauma Surg. 2026 May 15. pii: 183. [Epub ahead of print]146(1):
    Impact of modified Henry approach with preservation of Flexor Carpi Radialis Tendon Sheath on wrist function in the treatment of distal radius fractures.
    Dang Ma, Jiaqing Ji, Yimin Zhu, Xue Fang, Yanben Wang, Jian Fan.
       OBJECTIVE: To compare the clinical efficacy of a modified Henry approach (preserving the FCR tendon sheath) versus the traditional approach (incising the sheath) for distal radius fractures (DRFs) treated with volar locking plates, and to evaluate the outcomes within 12 months postoperatively.
    METHODS: A retrospective cohort study was conducted on 165 patients with unstable DRFs who underwent volar locking plate fixation from January 2023 to March 2025, who were retrospectively divided into the Preservation Group (n = 79, FCR tendon sheath preserved via the modified approach) and the Control Group (n = 86, FCR tendon sheath incised via the traditional approach). Perioperative indicators, radiological parameters, Visual Analog Scale (VAS) scores, Disabilities of the Arm, Shoulder and Hand (DASH) scores, grip strength, wrist range of motion (ROM) and complications were compared at the follow-up time points of 1 week, 1, 2, 3, 6 and 12 months postoperatively.
    RESULTS: There were no significant differences in baseline data and postoperative radiological reduction quality between the two groups (P > 0.05). The Preservation Group had significantly lower VAS scores at all follow-up time points (P < 0.001), and lower DASH scores from 1 week to 6 months (P < 0.001), with no statistical difference at 12 months (P = 0.550). Grip strength of the Preservation Group was significantly superior at all time points from 1 month to 12 months (P < 0.05), while wrist ROM was significantly better at 1 and 2 months (P < 0.001), with no significant differences at 3, 6 and 12 months (P > 0.05). The Preservation Group had a significantly lower incidence of tendon adhesion (2.5% vs. 11.6%, P < 0.05) and overall complication rate (11.4% vs. 23.3%, P < 0.05) than the Control Group. No radial artery injury or complex regional pain syndrome (CRPS) occurred in either group.
    CONCLUSION: The modified Henry approach preserving the FCR tendon sheath significantly improves early postoperative pain relief and functional recovery, with sustained benefits in pain and grip strength up to 12 months. This technique does not increase surgical difficulty, reduces complication risk, and follows the ERAS principle, showing high clinical value.
    Keywords:  Distal radius fracture; Flexor Carpi Radialis Tendon Sheath; Tendon adhesion; Wrist function recovery
    DOI:  https://doi.org/10.1007/s00402-026-06326-z
  9. J Back Musculoskelet Rehabil. 2026 May 09. 10538127261448983
    Platelet-rich plasma therapy for low back pain: A comprehensive systematic review and meta-analysis.
    Xiaolong Pei, Chunhua Liu, Jiayan Wang, Huajian Lin, Zegen Ye, Liqin Wang, Binbin Wu, Yue Jin.
      BackgroundLow back pain (LBP) is a major global disability, yet the promise of regenerative medicine using platelet-rich plasma (PRP) remains debated.ObjectiveTo systematically evaluate the efficacy of PRP injections in reducing pain intensity and pain-related disability in patients with LBP.MethodsA systematic search of PubMed, Embase, and the Cochrane Library identified randomized controlled trials evaluating the effects of PRP on low back pain. The primary outcomes were changes in pain intensity, measured by the Visual Analog Scale (VAS) or Numeric Rating Scale (NRS), and pain-related disability, assessed using the Oswestry Disability Index (ODI) or the Roland-Morris Disability Questionnaire (RMDQ), at follow-ups of 1 week and 1, 2, 3, 4, and 6 months. A random-effects model was applied for the meta-analysis.ResultsThis meta-analysis of 15 RCTs (740 patients) showed that PRP injections significantly reduced pain (SMD: -1.32; 95% CI: -2.06 to -0.59; P = 0.001) and reduced pain-related disability (SMD: -1.04; 95% CI: -1.66 to -0.41; P < 0.001) compared to controls. Significant benefits were observed at 1, 2, 3, and 6 months. Subgroup analysis showed significant improvement in discogenic pain at 1 month, but later effects were inconsistent, whereas non-discogenic pain improved consistently across all time points.ConclusionsPRP injections reduced LBP and reduced pain-related disability for up to 6 months. For discogenic pain, a significant benefit was detected at 1 month, whereas longer-term effects could not be reliably demonstrated due to high heterogeneity, while non-discogenic pain improved consistently at 6 months. However, these findings should be interpreted cautiously due to substantial heterogeneity across studies.
    Keywords:  low back pain; meta-analysis; platelet-rich plasma; randomized controlled trial
    DOI:  https://doi.org/10.1177/10538127261448983
  10. Bioinformation. 2026 ;22(2): 1004-1008
    Efficacy of arthrocentesis and PRP in TMJ osteoarthritis patients.
    Cheena Singh, Ashish Kalawat, Kiran Kumari, Abhigyan Manas, Madhuri S Sale, Pushkar Gupta, Rajat Misurya.
      Arthrocentesis has emerged as a well-established minimally invasive procedure for temporomandibular joint osteoarthritis (TMJ-OA). Conservative therapies often provide limited and short-term symptomatic relief. Therefore it is of interest to assess the clinical efficacy of arthrocentesis combined with platelet-rich plasma (PRP) injection in reducing pain and recovering mandibular function in patients with TMJ osteoarthritis. Hence, total 38 patients diagnosed with TMJ-OA underwent arthrocentesis followed by intra-articular injection of autologous PRP. Clinical outcomes assessed included pain intensity using the Visual Analog Scale (VAS) and maximum mouth opening at 1, 3 and 6 months. Arthrocentesis combined with PRP provides sustained pain relief and functional improvement in TMJ-OA.
    Keywords:  Arthrocentesis; mandibular function; pain management; platelet-rich plasma (PRP); temporomandibular joint osteoarthritis
    DOI:  https://doi.org/10.6026/973206300221004
  11. Medicine (Baltimore). 2026 May 08. 105(19): e48577
    Ultrasonographic parameters comparison for pre- and postoperative carpal tunnel syndrome release: A single-center prospective study.
    Kai-Xing Alvin Lee, Yu-Fang Chen, Chen-Wei Yeh, Tsung-Yu Ho, Wei-Chih Wang, Dung-Huan Liu, Pei-Ching Wu, Cheng-En Hsu, Yung-Cheng Chiu.
      Carpal tunnel syndrome (CTS) is a prevalent condition characterized by median nerve compression, impacting a significant portion of the population worldwide. While neurophysiological testing has been traditionally employed for diagnosis, recent advancements in ultrasonography have shown promise in offering a noninvasive alternative. In this study, we aimed to evaluate the mid-term postoperative statistical changes of the median nerve and flexor retinaculum, share our ultrasonographic measurement methodologies for standardized reporting, and suggest a set of ultrasonographic parameters for postoperative tracking. A prospective cohort of 18 patients with 24 CTS-affected hands underwent comprehensive evaluations including ultrasonography, nerve conduction studies, and functional assessments before and 6 months after surgical intervention. Various ultrasonographic parameters such as cross-sectional area (CSA), bowing of the flexor retinaculum, displacement of median nerve, and flattening ratio were measured at inlet and outlet levels of the carpal tunnel. Additionally, functional outcomes including grip strength, pinch strength, disabilities of the arm, shoulder, and hand score (DASH), visual analog scale (VAS), and World Health Organization Quality of Life score (WHOQOL) were assessed. A total of 18 patients (24 wrists) with CTS were included in this study. In this study, there were 15 females and 3 males, with 12 single-sided surgeries and 6 double-sided surgeries. The mean age was 45 years old with a mean duration of symptoms of 26 months. There were no complications and no reoperations during the follow-up period. Improvements in all postoperative parameters were recorded, with statistically significant improvements noted in CSA at outlet level, bowing of the flexor retinaculum at outlet level, displacement of median nerve at inlet and outlet level, flattening ratio at the outlet level and functional scores. The primary contribution of this study lies not in individual ultrasonographic parameters but in the integration of CSA at the outlet, flexor retinaculum bowing, and median nerve displacement into a unified, clinically feasible assessment framework. This streamlined protocol is rapid, reproducible, and suitable for routine postoperative monitoring, offering greater clinical utility than single-parameter evaluation.
    Keywords:  bowing; carpal tunnel syndrome; cross sectional area; displacement; flattening ratio; ultrasonography
    DOI:  https://doi.org/10.1097/MD.0000000000048577
  12. Sports Med Open. 2026 May 12. pii: 55. [Epub ahead of print]12(1):
    Platelet-Rich Plasma Accelerates the Return to Sport in Athletes with Acute Muscle Injuries: A Systematic Review and Statistical Fragility Index-Based Meta-Analysis of Randomized Controlled Trials.
    Alessandro Bensa, Gae Fattini Fellini, Angelo Boffa, Alberto Grassi, Kristian Samuelsson, Giuseppe Filardo.
       BACKGROUND: Muscle lesions are common sport injuries resulting in prolonged absence from sport activity and long rehabilitation periods. The aim of this systematic review and meta-analysis was to quantify the clinical benefits of platelet-rich plasma (PRP) injections in treating acute muscle injuries.
    METHODS: The search was conducted on PubMed, Cochrane Library, and Web of Science in January 2026. The PRISMA guidelines were used. Inclusion criteria were: randomized controlled trials (RCTs) published in English comparing PRP injections with control (rehabilitation or placebo) for the treatment of acute muscle injuries. The outcomes analysed were: time to return to sport (RTS), Visual Analogue Scale (VAS) for pain, re-injury and complication rates. Two sub-analyses were performed, one on the double-blind RCTs and one on the RCTs focusing on hamstrings. A fragility analysis was performed using the fragility index (FI) and the continuous FI (CFI). The quality of each article was assessed using the Cochrane RoB 2 and the GRADE tools.
    RESULTS: Among the 4969 articles retrieved, nine RCTs (474 patients) were included. PRP provided faster RTS both in the overall analysis (p < 0.001, mean difference (MD) = 7.5, CFI = 188) and in the two sub-analyses (p < 0.001, MD = 8.8, CFI = 67 and p = 0.001, MD = 7.5, CFI = 97 respectively), as well as superior VAS improvement in the hamstring sub-analysis (p = 0.006, MD = 0.4, CFI = 22). No difference was found in terms of re-injury and complication rates between the two groups (FI = 5 and FI = 7, respectively). The evaluation using the RoB 2 tool showed that four studies had a "low risk" of bias and five had a "high risk" of bias. The GRADE evaluation showed a limited quality of evidence of the analysed outcomes.
    CONCLUSION: PRP produced a faster RTS compared to controls in acute muscle injury patients, both in the overall analysis and in the sub-analyses. PRP was able to produce a statistically higher pain relief only in the hamstring subgroup, while no difference was found in terms of re-injury and complication rates, suggesting a similar safety profile when compared to rehabilitation alone and placebo. The fragility analysis supported the benefits in terms of RTS, although the high-quality literature addressing this topic remains limited, warranting caution in the interpretation of the current results.
    Keywords:  Athletes; Muscle; PRP; Platelet-rich plasma; Return to sport
    DOI:  https://doi.org/10.1186/s40798-026-01017-w
  13. RMD Open. 2026 05 11. pii: e006584. [Epub ahead of print]12(2):
    Trends in prevalence and disability burden of main rheumatic and musculoskeletal diseases in France 2008-2022.
    Joel Coste, Laure Carcaillon-Bentata, Jean-Marie Robine, Anne-Priscille Trouvin, Jennifer Humphreys, Francis Guillemin.
       OBJECTIVE: To assess prevalence, associated disability and pain burden of the main rheumatic and musculoskeletal diseases (RMDs): rheumatoid and non-rheumatoid inflammatory arthritis, knee, hip and other peripheral joint osteoarthritis, osteoporosis, low back and neck pain, as well as their trends over 15 years in France.
    SETTING: Two large nationwide representative surveys conducted in France in 2008 and 2022 that similarly and comprehensively assessed chronic conditions and disabilities.
    PARTICIPANTS: 20 724 participants aged ≥25 years in Disability Healthcare Household Survey (2008) and 18 562 in Autonomy Survey (2022).
    MAIN OUTCOME MEASURES: Disability and pain profiles with 10 indicators were constructed using the International Classification of Functioning, Disability and Health framework. A multistep approach based on a conceptual model was used to estimate the prevalence and disability burden of RMDs and their trends, controlling for age, education level, obesity and comorbidities.
    RESULTS: Prevalence of knee osteoarthritis and low back pain increased by >50% between 2008 and 2022, while rheumatoid arthritis (both sexes), non-rheumatoid arthritis and neck pain (men) and hip osteoarthritis (women) increased by 25%-50%; osteoporosis remained stable. Large increases in obesity and comorbidities, massively present in RMDs, including cardiovascular and mental disorders, contributed to increasing overall disability for all RMDs. After controlling for comorbidities, the disability burden increased (notably but not exclusively with mobility activities and pain) for low back pain and knee osteoarthritis and decreased for others except rheumatoid arthritis and neck pain, which remained stable.
    CONCLUSIONS: Prevalence of most RMDs increased between 2008 and 2022, causing a higher disability burden, partly due to rising levels of obesity and comorbidities. These results should inform surveillance and policies for the development of RMD preventive measures given the massive increase in chronic conditions.
    Keywords:  Epidemiology; Prevalence; Public Health
    DOI:  https://doi.org/10.1136/rmdopen-2025-006584
  14. Tzu Chi Med J. 2026 Apr-Jun;38(2):38(2): 164-173
    Comparison of platelet-rich plasma injection versus corticosteroid injection for the treatment of frozen shoulder in Asia: A systematic review and meta-analysis of randomized controlled trials.
    Hendrawan Chandra Kusuma, Mario Daniel Simatupang, Jesica Ery, Sabrina Danica, Billy Leoprayogo, Woo-Yong Lee.
      This study investigates the therapeutic performance of intra-articular platelet-rich plasma (PRP) versus intra-articular corticosteroid injections, specifically evaluating outcomes within Asian demographic groups. This review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 statement. We assessed study quality with the Cochrane Risk of Bias 2 (RoB2) tool, Review Manager (RevMan) 5.4 for the meta-analysis, and GRADE analysis to assess the certainty of evidence. Our review includes 14 studies, with 11 analyzed through meta-analysis, involving 1295 patients. However, the included studies were limited to populations from India and Pakistan. In the short term, there were no significant differences between the PRP and corticosteroid groups in pain and disability scores. However, the PRP group showed significantly greater improvements in some aspects of range of motion (ROM). In the mid-term, the PRP group had significantly lower Visual Analog Scale (VAS) (mean difference [MD]: -9.67; 95% confidence interval [CI]: -19.36, -0.08), Disabilities of the Arm, Shoulder and Hand (DASH) (MD: -10.47, 95% CI: -20.82, -0.13), and Shoulder Pain and Disability Index (SPADI) scores (MD: -17.92, 95% CI: -28.14, -7.69) compared to corticosteroids, as well as greater ROM improvements across multiple measures (all P < 0.05). In the mid-long term, pooled analysis indicated that VAS (MD: -21.13, 95% CI: -33.35, -8.91), DASH (MD: -10.25, 95% CI: -16.87, -3.64), and SPADI scores (MD: -17.81, 95% CI: -30.89, -4.73) were significantly lower in the PRP group than in corticosteroids. Although PRP shows no immediate advantage over corticosteroids in pain and disability, it improves short-term ROM and provides superior mid- to mid-long-term outcomes. However, results should be interpreted cautiously due to high heterogeneity, varying RoB, and moderate to very low GRADE certainty.
    Keywords:  Adhesive capsulitis; Corticosteroid injection; Frozen shoulder; Platelet-rich plasma
    DOI:  https://doi.org/10.4103/tcmj.TCMJ-D-25-00008
  15. Int Orthop. 2026 May 12.
    Preoperative two-step test predicts independent ambulation one week after total hip arthroplasty.
    Saki Matsumoto, Masanori Fujii, Naoki Higashijima, Yasuo Takei, Koichiro Kishikawa, Yosuke Oba, Masaya Ueno, Shunsuke Kawano, Tadatsugu Morimoto.
       PURPOSE: To identify preoperative physical performance and muscle quality factors associated with independent ambulation one week after total hip arthroplasty (THA).
    METHODS: This retrospective study included 102 patients (102 hips) who underwent primary unilateral THA via a posterior approach between June 2024 and June 2025. Patients were classified into independent (n = 54) and dependent (n = 48) ambulation groups according to their ability to walk 50 m without walking aids one week after THA. Preoperative assessments included the 30-s chair-stand test, two-step test, one-leg stance time, and Timed Up and Go test, as well as computed tomography-derived muscle attenuation values. Multivariable logistic regression was performed to identify independent predictors of independent ambulation.
    RESULTS: The independent ambulation group was younger and performed better on all four physical function tests (all p < 0.05). Muscle attenuation values differed only for the rectus femoris (p = 0.003). In multivariable analysis, the two-step value was the sole independent predictor of independent ambulation (per 0.1-unit increase: OR 1.33; 95% CI 1.02-1.74; p = 0.026). The optimal cutoff value was 0.95, with a sensitivity of 75%, specificity of 76%, and area under the receiver operating characteristic curve of 0.81.
    CONCLUSION: Preoperative two-step test performance independently predicted independent ambulation one week after THA. A two-step value of 0.95 may help identify patients at risk of delayed walking recovery and facilitate preoperative risk stratification.
    Keywords:  Independent ambulation; Muscle quality; Rehabilitation; Total hip arthroplasty; Two-step test
    DOI:  https://doi.org/10.1007/s00264-026-06836-w
  16. Cureus. 2026 Apr;18(4): e106578
    Ultrasound-Guided Hydrodissection for Peripheral Neuropathy: An Evidence-Based Intervention Whose Time Has Finally Come.
    King Hei Stanley Lam, Yonghyun Yoon, Daniel Chiung-Jui Su, Teinny Suryadi, Anwar Suhaimi, Yung Tsan Wu.
      Peripheral neuropathy remains a prevalent and challenging clinical condition, with management strategies traditionally centered on pharmacologic and neuromodulatory approaches. While these interventions play essential roles, an additional minimally invasive, evidence-based procedure warrants greater recognition: ultrasound-guided perineural hydrodissection. This editorial presents a contemporary perspective on hydrodissection as a key tool within the peripheral neuropathy treatment algorithm. High-resolution ultrasound enables precise injection of solutions, such as 5% dextrose, to release nerves from surrounding compressive structures. The rationale is supported by animal models demonstrating the vulnerability of nerves to even mild compression, and the therapeutic goal is to restore the function of the nervi nervorum and vasa nervorum through mechanical release and potential metabolic effects. Recent systematic reviews and meta-analyses have established hydrodissection as a safe and effective intervention, particularly for focal entrapment neuropathies such as carpal tunnel syndrome. Its role as a bridge between conservative care and invasive surgery is especially relevant for patients with length-dependent peripheral neuropathies who develop superimposed entrapments. Wider recognition of this technique is essential for providing a complete and contemporary picture of interventional options for refractory neuropathic pain.
    Keywords:  carpal tunnel syndrome; dextrose; hydrodissection; interventional; minimally invasive surgical procedures; nerve compression syndromes; pain management; peripheral nervous system diseases; regenerative medicine; ultrasonography
    DOI:  https://doi.org/10.7759/cureus.106578
  17. Rehabilitacion (Madr). 2026 May 12. pii: S0048-7120(26)00026-5. [Epub ahead of print]60(4): 100984
    Multidisciplinary management of pain and function in a patient with bilateral thumb hypoplasia undergoing multiple reconstructive procedures.
    M García-Ruiz, A J Guerra-Cabrera, S B Romero-de-la-Higuera, F J Gallego-Peñalver.
      Congenital thumb hypoplasia impairs hand function. Surgical reconstruction may cause long-term muscle overload and chronic pain. A 33-year-old woman with a history of bilateral thumb hypoplasia, treated during childhood, developed myofascial pain. Ultrasound examination confirmed trigger points and hypertrophy in the brachialis and finger flexor muscles. Injections of botulinum toxin type A (BoNT-A, 60U) reduced pain by 60% for four months without compromising functional capacity. Biomechanical adaptations post-reconstruction cause myofascial pain. BoNT-A is effective. BoNT-A aids pain management in thumb reconstruction. Ultrasound enhances diagnosis.
    Keywords:  Botulinum toxins type A; Ecografía; Myofascial pain syndromes; Plastic surgery procedures; Procedimientos de cirugía plástica; Pulgar hipoplásico; Síndromes de dolor miofascial; Thumb hypoplastic; Toxina botulínica tipo A; Ultrasonography
    DOI:  https://doi.org/10.1016/j.rh.2026.100984
  18. Orthop Rev (Pavia). 2026 ;18 161329
    Zone II Flexor Tendon Repair - Number of Strands, Technique, and Postoperative Rehabilitation: A Narrative Review.
    Elyssa Kiwan, Rita Saad, Joseph Najjar, Johnny Saadeh, Rima Osman, Anthony Akleh, Omar Al Fakih, Wendy Ghanem, Ramzi Moucharafieh, Mohamad Badra.
      Zone II flexor tendon injuries remain among the most technically demanding challenges in hand surgery. The confined anatomy, dual-tendon configuration, and complex pulley system render this region particularly vulnerable to adhesion formation, repair gapping, and stiffness. Over the past decades, advances in multistrand core suture techniques, epitendinous augmentation, and early controlled mobilization protocols have markedly improved repair strength and postoperative function. This narrative review synthesizes current evidence on surgical techniques and rehabilitation strategies in Zone II tendon repair, emphasizing the interplay between biomechanical stability and functional mobility. It explores the anatomical and biomechanical considerations unique to Zone II, evaluates the evolution from traditional two-strand to modern four- and six-strand repairs, and discusses the critical contribution of epitendinous sutures to tensile strength and tendon glide. Additionally, it reviews the rationale and safety of pulley venting, delineating when partial A2 or A4 release may be beneficial. Finally, the review examines postoperative rehabilitation protocols, from immobilization to early passive and active motion; and their relative effects on rupture risk, adhesion formation, and range of motion. Despite technological progress, optimal management still requires individualized decision-making that balances repair robustness with safe mobilization to achieve the best possible functional outcome.
    Keywords:  Flexor tendons; epitendinous sutures; no man’s land; number of strands; zone II flexor tendon injury
    DOI:  https://doi.org/10.52965/001c.161329
  19. J Arthroplasty. 2026 May 13. pii: S0883-5403(26)00503-6. [Epub ahead of print]
    The One-Year Postoperative Trajectories of Knee Joint Angle Recovery During Walking After Total Knee Arthroplasty in Women: A Cross-Sectional Study.
    Chun-Hao Fan, Jui-Hung Hsu, Pei-An Yu, Chi-Lung Chen, Robert Wen-Wei Hsu, Wei-Hsiu Hsu.
       BACKGROUND: Total knee arthroplasty (TKA) effectively alleviates pain in end-stage knee osteoarthritis; however, postoperative functional recovery, particularly gait restoration, remains variable. Although knee range of motion (ROM) typically recovers early after surgery, its relationship with patient-reported outcomes such as the Knee injury and Osteoarthritis Outcome Score (KOOS) is inconsistent. Understanding how dynamic knee joint kinematics during walking evolve over time and relate to perceived function may provide sensitive recovery indicators.
    METHODS: Women who underwent unilateral primary TKA were assessed at three, six, nine, and 12 months postoperatively. A three-dimensional gait analysis was used to quantify knee joint angles during walking, and KOOS subscales were collected concurrently. A one-dimensional statistical parametric mapping was applied to examine temporal changes in knee joint kinematics and their associations with KOOS outcomes.
    RESULTS: Knee muscle strength, walking speed, and all KOOS subscales improved progressively over the first postoperative year. Knee joint kinematics of the operated limb stabilized by approximately three months, with minimal subsequent changes. There were no significant inter-limb differences observed, except for greater terminal swing knee flexion in the non-operated limb at three months. Notably, knee flexion angles of the operated limb during the swing phase (approximately 55.0 to 75.0% of the gait cycle) significantly predicted all KOOS subscales except sports/recreation.
    CONCLUSION: These findings indicate that dynamic knee joint angles during walking, rather than static ROM measures, are closely associated with perceived knee function after TKA. Gait-based kinematic assessments may serve as valuable objective markers for monitoring recovery and guiding rehabilitation.
    Keywords:  Functional outcomes; Gait analysis; Knee kinematics; Total knee arthroplasty
    DOI:  https://doi.org/10.1016/j.arth.2026.05.013
  20. Arthroscopy. 2026 May 11.
    Editorial Commentary: Return to Sport Is Not the Finish Line: Raising the Bar for Long-Term Outcomes After Hip Arthroscopy in Athletes.
    Jay Moran, Andrew E Jimenez.
      In athletes with femoroacetabular impingement syndrome (FAIS), return-to-sport (RTS) rates are generally high at short- to mid-term follow-up after hip arthroscopy. However, there is significant heterogeneity and lack of standardization of RTS definitions across the literature, limiting meaningful comparison across studies. At long-term follow-up, patterns of sports participation, performance expectations, and physical capacity evolve, and traditional binary RTS definitions may not adequately capture the quality or durability of athletic participation. Recent evidence suggests that although more than 80% of athletes may continue to participate in sport at long-term follow-up after hip arthroscopy, participation occurs across a spectrum ranging from unlimited pain-free activity to modified participation or continued play despite persistent symptoms. Persistent hip pain, followed by new injuries to a separate body region or lifestyle changes, remains the primary reason for inability to sustain long-term sport participation. In contrast, continued sports participation, particularly at a pain-free level, represents a key determinant of patient satisfaction and is closely associated with achieving a patient acceptable symptom state at long-term follow-up. Ultimately, RTS as a binary outcome may overestimate true recovery and fail to reflect clinically meaningful long-term outcomes in this population. Using more precise RTS definitions that evaluate continued participation and integrate level of competition with sport- and sex-specific considerations are essential to better define long-term success following hip arthroscopy in athletes.
    DOI:  https://doi.org/10.1002/arj.70217
  21. Int Orthop. 2026 May 13.
    Iliopsoas Cross-Sectional Area at the Psoas Valley is Associated with Surgically Treated Femoroacetabular Impingement Syndrome: A CT-based Case-Control Study.
    Enejd Veizi, Nurdan Çay, Ahmet Fırat, Ayşegül Fırat.
       INTRODUCTION: The iliopsoas muscle passes immediately anterior to the hip joint and lies in close proximity to the acetabular labrum at the level of the psoas valley. This anatomical relationship suggests that local muscle morphology may be associated with symptomatic hip pathology. The present study investigated the association between iliopsoas cross-sectional area at the psoas valley, adjacent osseous morphology, and surgically treated symptomatic hip-pathologies.
    METHODS: In this retrospective case-control study, 92 adult patients who underwent hip arthroscopy between 2019 and 2024 and had preoperative computed tomography (CT) imaging were compared with 50 age- and sex-matched controls without documented hip pain who had CT scans obtained for non-hip-related indications. Three-dimensional CT reconstructions were used to measure retroinguinal and psoas-valley morphometric parameters, including iliopsoas crosssectional area at the level of the psoas valley. Multivariable logistic regression adjusted for age and body mass index was performed for variables that differed between groups.
    RESULTS: The groups did not differ significantly in age, sex, body mass index, or side. The lacuna musculorum ratio was higher in the surgical cohort than in controls (0.5 ± 0.1 vs. 0.4 ± 0.1; p < 0.001). Iliopsoas cross-sectional area at the psoas valley was smaller in the surgical cohort (12.5 ± 3.2 cm2 vs. 13.7 ± 2.8 cm2; p = 0.025). In multivariable analysis, a higher lacuna musculorum ratio (OR:1.094, 95% CI 1.026-1.167; p = 0.006) and a smaller iliopsoas cross-sectional area (OR:0.998, 95% CI 0.996-1.000; p = 0.039) remained associated with membership in the surgically treated cohort.
    CONCLUSION: Smaller iliopsoas cross-sectional area at the psoas valley was more often associated with surgically treated hip pathologies. These findings support a possible anatomical relationship between anterior hip soft-tissue morphology and symptomatic hip pathology, but they do not establish a protective causal effect of greater iliopsoas muscle bulk against labral injury.
    Keywords:  Anatomy; Femoroacetabular impingement syndrome; Hip; Hip arthroscopy; Iliopsoas
    DOI:  https://doi.org/10.1007/s00264-026-06844-w
  22. J Hand Surg Asian Pac Vol. 2026 May 12.
    Modified Ultrasonographic Classification of Tendinous Mallet Injuries Based on a Combination with Wang Classification Highlighting Lateral Band Involvement.
    Jihae Lee, Suk Ha Jeon, Sanglim Lee.
      Background: Although ultrasonography is useful for assessing soft-tissue injuries, its role in classifying tendinous mallet injuries remains underdefined. This study aimed to propose a modified ultrasonographic classification system that combines Wang's classification with additional subtypes emphasising lateral band involvement to improve diagnostic accuracy and prognostic assessment. Methods: A retrospective cross-sectional study was performed on 36 patients with acute closed tendinous mallet injuries of the fingers. All patients underwent ultrasonographic evaluation. Based on the modified classification, Wang Type B was subdivided into Subtype B1 (complete terminal tendon rupture) and Subtype B2 (rupture of either the radial or ulnar slip of the lateral band). Clinical outcomes were recorded at a minimum of 4 months of follow-up. Data on pinch strength, pain, extension lag and functional scores were analysed to compare outcomes across the three injury types. Results: Fifteen Type B1, eight Type B2, and 13 Type C injuries were identified. In all types, as the length of the injured tendon increased, pinch strength relative to the contralateral side was significantly weaker. Additionally, the injured tendon was significantly longer in Type C injuries than in Type B1 and B2 injuries. As the length of the injured tendon increased, pinch strength relative to the contralateral side decreased across all injury types. Nevertheless, the pain score, functional score and initial extension lag did not show statistically significant variations amongst injury types. Crawford criteria showed that Types B2 and C injuries were mostly graded as 'excellent' or 'fair', whereas Type B1 injuries were more often classified as 'poor' or 'fair'. Conclusions: The modified ultrasonographic classification provides a more detailed framework for assessing tendinous mallet injuries by integrating Wang's classification and distinguishing partial lateral band ruptures. This approach enhances diagnostic precision and may improve functional prognostication. Level of Evidence: Level IV (Diagnostic).
    Keywords:  Classification system; Lateral band rupture; Mallet finger; Tendon injury; Ultrasonography
    DOI:  https://doi.org/10.1142/S2424835526500244
  23. Diagnostics (Basel). 2026 Apr 30. pii: 1362. [Epub ahead of print]16(9):
    Ultrasound-Guided Hydrodissection for Carpal Tunnel Syndrome with Bifid Median Nerve and Persistent Median Artery: An Imaging-Based Case Report with Alpha-2 Macroglobulin.
    Jeimylo C de Castro, Daniel Wang, Jeffrey Strakowski, Yonghyun Yoon.
      Introduction: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity and results from compression of the median nerve within the fibro-osseous carpal tunnel. Anatomical variants such as a bifid median nerve (BMN) and a persistent median artery (PMA) may increase tunnel occupancy and complicate both diagnosis and treatment. High-resolution musculoskeletal ultrasound enables detailed evaluation of these anatomical variations and facilitates image-guided interventions. Ultrasound-guided hydrodissection has emerged as a minimally invasive technique capable of mechanically releasing perineural adhesions and restoring nerve mobility. Alpha-2 macroglobulin (A2M), an autologous plasma protease inhibitor with anti-inflammatory and cytokine-binding properties, has recently been explored as a biologic adjunct in musculoskeletal conditions. Case Presentation: We report the case of a 60-year-old right-handed woman who presented with a one-year history of numbness, paresthesia, and pain within the median nerve distribution of her dominant hand. Ultrasound examination demonstrated a bifid median nerve accompanied by a persistent median artery and perineural edema within the proximal carpal tunnel. The patient underwent three weekly sessions of ultrasound-guided hydrodissection using autologous A2M prepared through the APEX filtration system. The patient reported progressive clinical improvement following treatment. Grip strength increased from 12 kg at baseline to 22 kg at week twelve. Follow-up ultrasound performed ten months after treatment showed restoration of median nerve fascicular architecture and normalization of nerve morphology, findings consistent with interval structural improvement. Discussion: This case highlights the role of ultrasound in the integrated evaluation and management of CTS with anatomical variants, including diagnosis, procedural guidance, and longitudinal assessment. Conclusions: Ultrasound-guided hydrodissection with A2M may represent a feasible minimally invasive approach in selected patients; however, further prospective studies are required to determine its safety and therapeutic efficacy.
    Keywords:  alpha-2 macroglobulin; bifid median nerve; carpal tunnel syndrome; case report; persistent median artery; ultrasound-guided hydrodissection
    DOI:  https://doi.org/10.3390/diagnostics16091362
  24. Eur Radiol. 2026 May 13.
    CT-guided injection in coccydynia: outcome prediction using MRI findings and CT-injection characteristics.
    Georg Wilhelm Kajdi, Thomas Marth, Christoph Germann, Mazda Farshad, Reto Sutter.
       OBJECTIVES: To analyze pain relief for chronic coccydynia after CT-guided, pericoccygeal ropivacaine and triamcinolone injection over time and to investigate possible imaging predictors of successful and maintained pain relief.
    MATERIALS AND METHODS: In this retrospective study, chronic coccydynia patients receiving CT-guided pericoccygeal injections with ropivacaine and triamcinolone were assessed for pain relief post-injection, using a numeric rating scale (NRS, 0-10) and percentage pain reduction (PPR, %). Patients were followed up until pain recurrence. Two radiologists assessed MRI findings prior to, and contrast distribution during CT injection. Imaging predictors for successful pain relief at 1 month (PPR ≥ 50%) combined with maintained pain relief for at least 3 months post-injection were investigated using logistic regression analysis.
    RESULTS: 63 patients (mean age 44.6 ± 12.5 years) were evaluated. Average pain dropped from initially 6.3 to 3.0 (average PPR 53.2 ± 37.5%) 15 min post-injection, and to 2.9 (average PPR 55.2 ± 41.4%) one month post-injection (all p < 0.001). One month post-injection, 41 patients (65%) reported PPR ≥ 50%. Pain relief persisted on average for 6 months. Three months post-injection, 32/63 patients (50.8%) reported maintained pain relief. Fluid-sensitive sequence (FSS)-hyperintensity of the sacro-/intercoccygeal synchondrosis, coccyx subluxation and a bony spicule were the only significant predictors (odds ratios: 3.5-5.1) of successful and maintained pain relief (all p ≤ 0.031).
    CONCLUSION: CT-guided pericoccygeal injection with ropivacaine and triamcinolone allowed successful pain relief in 65% of chronic coccydynia patients, with a PPR of 55% and persistence of 26 weeks on average. Odds of successful and maintained pain relief increased with the presence of a bony spicule, subluxation and FSS-hyperintensity of the synchondrosis.
    KEY POINTS: Question Imaging predictors of successful pain relief in chronic coccydynia patients receiving pericoccygeal ropivacaine and triamcinolone injections are unknown. Findings A bony spicule, subluxation, and sacro-/intercoccygeal fluid-sensitive sequence hyperintensity on MRI were significant predictors of successful pain relief for ≥ 3 months. CT-contrast distribution did not influence pain relief. Clinical relevance CT-guided pericoccygeal injections with ropivacaine and triamcinolone offer successful pain relief in chronic coccydynia; the presence of a bony spicule, subluxation, and sacro-/intercoccygeal fluid-sensitive sequence hyperintensity was predictive of pain relief.
    Keywords:  CT; Coccydynia; Coccyx; MRI; Pain assessment
    DOI:  https://doi.org/10.1007/s00330-026-12615-3
  25. Diagnostics (Basel). 2026 Apr 23. pii: 1260. [Epub ahead of print]16(9):
    Sonographic Diagnosis of Flexor Tendon Incarceration by a Malunited Fracture Fragment: A Case Report.
    Yuan-Chen Chang, Yu-Te Lin, Yu-Hsuan Cheng.
      Background and Clinical Significance: Post-traumatic finger stiffness is frequently attributed to soft tissue adhesions; however, mechanical obstruction from occult osseous structures remains a rare but critical differential diagnosis in adults. Case Presentation: This report describes a 56-year-old female presenting with severe, refractory stiffness of the little finger eight months after a proximal phalanx fracture. Despite extensive conservative therapy, active and passive flexion at the proximal and distal interphalangeal joints remained locked in extension. While conventional radiographs demonstrated bony union, musculoskeletal ultrasonography (MSUS) revealed an occult protruding malunited fragment incarcerating the flexor tendons. Dynamic MSUS provided real-time evidence of mechanical impingement by demonstrating proximal muscle contraction without distal tendon excursion. Intraoperatively, initial soft tissue tenolysis failed to restore motion; further exploration guided by MSUS evidence successfully identified a sharp bone spike. Subsequent ostectomy resulted in immediate restoration of functional range of motion. This case underscores the limitations of static imaging in evaluating the dynamic gliding mechanism and highlights the valuable role of MSUS in identifying mechanical functional obstructions. Conclusions: Early sonographic evaluation should be considered for refractory post-traumatic stiffness to prevent prolonged, ineffective conservative care and to guide definitive surgical management.
    Keywords:  case report; finger stiffness; post-fracture malunion; tendon incarceration; ultrasound
    DOI:  https://doi.org/10.3390/diagnostics16091260
  26. Cureus. 2026 Apr;18(4): e106864
    Rapid Radiographic Improvement in Large Multilobulated Shoulder Calcific Tendinitis After Ultrasound-Guided Prolotherapy and Adjunctive Nutritional and Metabolic Support: A Case Report.
    Yonghyun Yoon, Jaeyoung Lee, Jaewoo Lim, Ji Hyo Hwang, Teinny Suryadi, Anwar Suhaimi, King Hei Stanley Lam.
      Calcific tendinitis of the shoulder is a common disorder characterized by calcium hydroxyapatite deposition within or near the rotator cuff tendons. Although the condition is often self-limited, large multilobulated calcific deposits may be less responsive to conservative treatment and can prompt consideration of more invasive procedures. We report a case of a 49-year-old man who presented with acute severe right shoulder pain, sleep disturbance, and marked functional limitation. At presentation, pain was 10/10 on the visual analog scale, and the shoulder range of motion could not be formally assessed because of severe pain. Plain radiographs demonstrated a large multilobulated calcific deposit measuring approximately 3 cm in the subacromial region, with a smaller adjacent calcification. Ultrasound-guided prolotherapy was performed using a solution of 10% dextrose with a final lidocaine concentration of 0.2%, with 5 mL injected into the glenohumeral joint and 5 mL into the subacromial space. Adjunctive management included hydration, physical therapy, activity modification, and adjunctive nutritional and metabolic support consisting of vitamin C, vitamin D, magnesium, methylsulfonylmethane, and L-arginine. At two weeks, pain improved to 2/10; passive range of motion was nearly full; active range of motion was full, with only mild pain at terminal motion; and follow-up radiographs demonstrated near-complete resorption of the calcific deposit. Although causality cannot be established from a single case, this report suggests that selected patients with calcific tendinitis may experience rapid improvement with a multimodal nonoperative strategy incorporating adjunctive nutritional and metabolic support before escalation to invasive treatment.
    Keywords:  calcific tendinitis; nutritional and metabolic support; prolotherapy; shoulder; ultrasound-guided injection
    DOI:  https://doi.org/10.7759/cureus.106864
  27. Skeletal Radiol. 2026 May 09.
    Imaging findings of sports-related acute core muscle injuries.
    Lawrence M White, Ali M Naraghi, Rakesh Mohankumar, Robert R Bleakney.
      Sports-related core muscle injuries are a common cause of acute and chronic groin and lower abdominal pain in athletes, particularly in activities involving cutting, kicking, and rotational movements. These injuries encompass a broad spectrum of musculoskeletal pathology affecting the abdominal wall, pelvis, and proximal thigh, frequently with overlapping clinical presentations that complicate diagnosis and management. Variability in terminology and injury classification further contributes to diagnostic complexity, underscoring the importance of precise and consistent imaging characterization. Accurate imaging evaluation plays a central role in defining the location, extent, and pattern of injury, informing clinical decision-making and supporting return-to-play planning. This article reviews the imaging features of sports-related core muscle injuries with emphasis on relevant anatomy, biomechanics, and a structured, anatomy-based imaging approach. Management considerations relevant to each injury pattern are discussed within the corresponding sections. Specific injury patterns discussed include side strains, hip pointers, rectus abdominis strains, and acute adductor-related core muscle injuries. By integrating detailed anatomic knowledge with injury mechanisms and characteristic imaging appearances, this review provides a practical framework to support consistent, clinically meaningful interpretation of core muscle injuries and effective communication with referring clinicians involved in the care of athletes.
    Keywords:  Abdominal wall; Adductor longus; Adductors; Athletic; Core muscles; External oblique; Injury; Internal oblique; MRI; Pyramidalis; Rectus abdominis; Sports; UItrasound
    DOI:  https://doi.org/10.1007/s00256-026-05239-7
  28. J Appl Physiol (1985). 2026 May 14.
    Triceps surae morphology and ankle functionality 2 years after Achilles tendon rupture repair: traditional vs early rehabilitation.
    Jeam Marcel Geremia, Gustavo do Nascimento Petter, Emmanuel Souza da Rocha, Alexandre Mayer, Viviane Bortoluzzi Frasson, Maarten Frank Bobbert, Marco Aurélio Vaz.
      Achilles tendon rupture impairs the functional performance of the triceps surae muscle-tendon unit. However, long-term effects of different rehabilitation programs on these impairments remain unclear. This study evaluated the long-term effects of early rehabilitation versus cast immobilization after Achilles tendon repair. We also examined whether the uninjured side could serve as a reference for the "healthy" side. Males with previous Achilles tendon rupture (n=20) and a group of healthy male controls (CTR; n=10) participated. Achilles tendon rupture participants included a short-term physical therapy group (STPT; n=10) and a plaster cast group (PC; n=10). Triceps surae morphology of the injured leg and ankle functionality of both injured groups was compared with that of the uninjured leg and with that of CTR legs. No between-group differences were found in the patient-reported outcomes. The injured side presented lower heel rise height, plantar flexors strength, gastrocnemius medialis thickness, calf volume, and shorter fascicle length than CTR. On the injured side, the STPT preserved ankle range of motion and showed greater plantar flexion and total range of motion than the PC. We employed a computational model that demonstrated that tendon elongation was the main determinant of heel rise height deficit. The uninjured side presented lower heel rise height than the CTR group. Despite favorable patient-reported outcomes, long-term structural and functional deficits persist after Achilles tendon rupture, regardless of rehabilitation approach. Findings suggest that the rehabilitation programs used did not fully restore muscle-tendon function and highlight limitations of using the uninjured side as a control.
    Keywords:  Calcaneal tendon; early mobilization; heel rise height; injury; muscle-tendon deficits
    DOI:  https://doi.org/10.1152/japplphysiol.00958.2025
  29. Eur Spine J. 2026 May 11.
    The efficacy of strength exercise dosage on pain and disability in people with low back pain: a systematic review of randomized controlled trials.
    Gabriel Mader de Oliveira, Luana Rocha Paulo, Bianca Martins Lourenço, Flávio de Castro Magalhães, Vinícius Cunha Oliveira.
       OBJECTIVE: This systematic review aimed to evaluate the effects of strength exercise dosages on pain and disability in individuals with low back pain.
    DESIGN: Systematic review of randomized controlled trials.
    DATA SOURCES: MEDLINE, PEDro, EMBASE, Cochrane Library, AMED, and PsycINFO.
    ELIGIBILITY CRITERIA: Randomized controlled trials comparing strength exercises of any dosage with minimal interventions for pain and disability in individuals with low back pain of any duration. Two reviewers independently screened trials, extracted data, assessed quality, and evaluated evidence using the GRADE framework. Mean differences with 95% CIs were reported.
    RESULTS: Eight trials were included in the qualitative analysis, five in the quantitative analysis. All studies included in the meta-analysis compared exercise to minimal interventions. No studies regarding specific spine conditions or with pain duration of less than three months were included. Lumbar extension exercises (specific exercises; pain: -19.6 [-25.4 to -13.7]; disability:-12.5 [-14.9 to -10.1]), higher exercise intensities (> 60% 1 RM; pain: -19.3 [-27.0 to -11.6]; disability: -14.2 [-15.7 to -12.8]), lower frequencies (= once per week; pain: -19.3 [-27.0 to -11.6]; disability: -11.8 [-16.2 to -7.5]), and shorter treatment durations (< 3 months; pain: -19.9 [-26.0 to -13.8]; disability: -13.4 [-15.2 to -11.6]) presented statistically significant results in the reduction of both outcomes. Confidence on the evidence was low to very low.
    CONCLUSION: Our results demonstrated statistically significant results that strength exercises with high intensity, low frequency, and that focus on back extensor muscles have effect on reducing pain and disability in patients with chronic non-specific low back pain. Overall evidence quality was low to very low. Future research should improve reporting of exercise variables in order to refine dosage recommendations.
    PROSPERO AND OPEN SCIENCE FRAMEWORK REGISTRATION NUMBERS: CRD42024500944. OSF DOI: https://doi.org/10.17605/OSF.IO/D34TJ .
    Keywords:  Exercise; Low back pain; Resistance training; Systematic review
    DOI:  https://doi.org/10.1007/s00586-026-09901-5
  30. Br J Sports Med. 2026 May 14. pii: bjsports-2025-110024. [Epub ahead of print]
    Comparative effectiveness of physical therapy interventions in adults with rotator cuff tendinopathy: a systematic review and network meta-analysis.
    Stefano Giuseppe Lazzarini, Francesco Bettariga, Bianca Mosconi, Luca Maestroni, Claudio Cordani, Enrico Bandini, Fulvio Dal Farra, Pedro Lopez, Chiara Arienti.
       OBJECTIVE: To compare the effects of different physical therapy interventions and identify the most effective intervention on pain, function, quality of life (QoL) and adverse events (AEs) in adults with rotator cuff (RC) tendinopathy.
    DESIGN: Systematic review and network meta-analysis (NMA) of randomised clinical trials (RCTs).
    DATA SOURCES: Seven databases and two trial registries were searched up to March 2024.
    ELIGIBILITY CRITERIA FOR SELECTING STUDIES: RCTs comparing physical therapy interventions to any other physical therapy intervention, sham, placebo, waiting list or no treatment on pain, function, QoL and AEs in adults with RC tendinopathy.
    DATA SYNTHESIS: A frequentist NMA using a random-effects model was performed. Risk of bias and certainty of the evidence were assessed using the revised Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development and Evaluation approach, respectively.
    RESULTS: 89 RCTs (5532 participants) were included. Exercises targeting the shoulder muscles may reduce pain (standardised mean difference (SMD) -0.79, 95% CI -1.33 to -0.26) and improve function (SMD 0.74, 95% CI 0.34 to 1.14) compared with no treatment but the evidence is very uncertain. Exercises targeting shoulder and scapular muscles in addition to percutaneous electrolysis (SMD -1.58, 95% CI -2.68 to -0.48) and to trigger point dry needling (SMD 3.10, 95% CI 1.99 to 4.22) seem to be the most effective interventions on pain and function at the end of treatment, respectively.
    CONCLUSION: Most of the interventions identified may not be superior to isolated shoulder exercises alone, which might be considered a reasonable first-line approach, but the evidence is very uncertain and most interventions are informed by limited data. High-quality research is needed to improve evidence of physical therapy interventions in adults with RC tendinopathy.
    PROSPERO REGISTRATION NUMBER: CRD42024527176.
    Keywords:  Physical Therapy Modalities; Rehabilitation; Rotator cuff; Shoulder; Tendinopathy
    DOI:  https://doi.org/10.1136/bjsports-2025-110024
  31. J Orthop Case Rep. 2026 May;16(5): 463-467
    Painful Biceps Vincula: An Unrecognized Cause of Anterior Shoulder Pain.
    Alex E White, Matthew R Bryan, Christopher Fenelon, Samuel A Taylor, Stephen J O'Brien.
       Introduction: Vincula of the long head of the biceps tendon are an underrecognized entity. Very few studies have described the characteristics of symptomatic vincula following long head of biceps tendon auto-rupture or tenotomy.
    Materials and Methods: A retrospective case series was performed at a single institution. All patients who underwent shoulder arthroscopy and were noted to have a painful vinculum of the long head of the biceps tendon with partial or complete long head of the biceps tendon rupture between January 01, 2016, and December 31, 2020, were included. Patients were excluded if they underwent shoulder arthroplasty, open reduction internal fixation, or a glenohumeral joint stabilization procedure.
    Results: Eighteen consecutive patients with a long head of biceps tendon vincula noted during arthroscopy were identified. Ten patients were female (55%), with a mean age of 53 years (standard deviation [SD] 24.1). Of those with pre-operative magnetic resonance imaging available (n = 15), none reported the presence of a vinculum. Thirteen patients (72%) were found to have pathological vincula. Of these, seven patients were found to have a thickened vinculum tethering the long head of the biceps tendon. The most common reported pre-operative physical examination findings were bicipital tunnel tenderness to palpation (75%) and a positive O'Brien sign (50%). No patients experienced intraoperative or post-operative complications.
    Conclusion: The clinical significance of the long head of the biceps tendon vincula has not been previously described. In a subset of patients with anterior shoulder pain in the setting of long head of biceps tendon auto-rupture or prior tenotomy, a thickened long head of biceps tendon vincula can produce clinically significant symptoms of pain.
    Keywords:  Biceps tendon; Level of evidence: IV, Case series, Biceps tendon, Vincula, Arthroscopy; arthroscopy; vincula
    DOI:  https://doi.org/10.13107/jocr.2026.v16.i05.7330
  32. J Hand Surg Asian Pac Vol. 2026 May 12.
    Repeated Measurements of Ultrasound Median Nerve Cross-Sectional Area Are Associated with Symptomatic and Functional Improvement after Carpal Tunnel Release.
    Ryan T Lin, Shaquille Charles, Hannah Ong, Madalyn Kostyal, John R Fowler.
      Background: The potential for ultrasound (US) to be used as an objective measurement of improvement after carpal tunnel release is poorly understood. The purpose of this study is to evaluate whether measurements of US cross-sectional area (CSA) of the median nerve in the postoperative recovery period are associated with improvement of Boston Carpal Tunnel Questionnaire (BCTQ) scores for the Symptom Severity Scale (SSS) and Functional Severity Scale (FSS). Methods: A total of 167 wrists from 137 patients who underwent CTR with availability of US and BCTQ at 2-weeks, 6-weeks, 6-months and 1-year postoperatively were analysed. The primary outcome measurement was the ability to achieve the minimal clinically important difference (MCID) for relative changes in BCTQ. Regression analysis was performed using generalised estimating equations. Either Pearson correlation or Spearman correlation was used at each timepoint to determine the relationship between median nerve CSA and BCTQ scores. Results: Median nerve CSA was found to be significantly associated with achieving MCID cutoff values for SSS (p = 0.002) and FSS (p = 0.041). In men, a postoperative CSA of <10 mm2 was associated with improvements in both FSS and SSS. In women, a postoperative CSA of <10 mm2 was associated with improvements in SSS and a postoperative CSA of <8 mm2 was associated with improvements in FSS. The Spearman correlation coefficient was significant between median nerve CSA and SSS scores at the 2-week and 6-week follow-up timepoints. Conclusions: Measurements of US median nerve CSA in the postoperative setting can provide an objective measure and are independently associated with BCTQ score improvement that achieves MCID. US measurements at the 2-week postoperative timepoint are most correlated with symptomatic patient-reported outcome measures. Thus, in carpal tunnel release patients with poor early outcomes, US may help rule out persistent CTS and guide further treatment or diagnosis. Level of Evidence: Level III (Therapeutic).
    Keywords:  Boston carpal tunnel questionnaire; Carpal tunnel release; Median nerve cross-sectional area; Minimal clinically important difference; Ultrasound
    DOI:  https://doi.org/10.1142/S2424835526500335
  33. Video J Sports Med. 2026 May-Jun;6(3):6(3): 26350254251408069
    Partial Articular Supraspinatus Tendon Avulsion (PASTA) Repair: Transtendinous Technique.
    Brittany Ammerman, Karen Sutton.
       Background: Partial articular supraspinatus tendon avulsion (PASTA) lesions are a common cause of shoulder pain and dysfunction. Transtendinous repair is a surgical technique used to restore tendon integrity while preserving intact tendon and minimizing iatrogenic tendon damage.
    Indications: This technique is indicated in patients with symptomatic, partial-thickness rotator cuff tears who have failed conservative management.
    Technique Description: The PASTA transtendinous technique repair is performed in the beach-chair position. The articular-sided tear is visualized, debrided, and 2 suture anchors are placed percutaneously through the tendon into the rotator cuff footprint. The sutures are passed in a boxed mattress configuration, and knot-tying is performed arthroscopically on the bursal side of the cuff, securing the tendon back to its footprint and preserving intact tendon fibers.
    Results: This construct demonstrates stable fixation of the tendon to its native footprint, with preservation of tendon integrity. Postoperatively, patients undergo a structured rehabilitation protocol. Return to full activity/sport is expected at approximately 4 to 6 months.
    Discussion/Conclusion: Transtendinous repair of PASTA lesions provides a reliable method for restoring native tendon integrity, while preserving intact tendon fibers. This technique minimizes tendon trauma compared with traditional "take-down" rotator cuff repair techniques, maintains native anatomy, and facilitates anatomic healing with good functional recovery.
    Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
    Keywords:  partial articular supraspinatus tendon avulsion lesion; partial-thickness rotator cuff; rotator cuff; shoulder arthroscopy; transtendinous repair
    DOI:  https://doi.org/10.1177/26350254251408069
  34. Pain Manag. 2026 May 12. 1-14
    Comparative effectiveness of percutaneous needle electrolysis and shockwave therapy in subscapularis tendinopathy: a randomized clinical trial.
    Adrian Kużdżał, Małgorzta Smoter, Gracjan Olaniszyn, Bartłomiej Bogdański, Tomasz Halski, Robert Trybulski.
       OBJECTIVES: To evaluate whether adding ultrasound-guided percutaneous needle electrolysis (PNE) to extracorporeal shockwave therapy (ESWT) and therapeutic exercise improves short-term outcomes in adults with imaging-confirmed subscapularis tendinopathy.
    METHODS: This assessor-blinded, randomized, parallel-group clinical trial included 30 participants randomly allocated (1:1) to PNE+ESWT+exercise (n = 15) or ESWT+exercise (n = 15) for 8 weeks. Primary outcomes were pain (VAS), upper-limb disability (DASH), and tendon stiffness; secondary outcomes were pressure pain threshold, internal rotation range of motion and strength, cross-sectional area, tissue perfusion, Tenascin-C, and ultrasound tendon integrity findings.
    RESULTS: Compared with ESWT+exercise, PNE+ESWT+exercise produced significant improvements in tendon stiffness (between-group difference in change, -31.29 N/m [95% CI, -36.65 to -25.93]; interaction p < .001), DASH disability (-3.91 points [95% CI, -5.84 to -1.97]; p < .001), pressure pain threshold (10.01 kPa [95% CI, 9.07 to 10.94]; p < .001), internal rotation range of motion (5.29° [95% CI, 4.18 to 6.39]; p < .001), internal rotation strength (1.53 kgF [95% CI, 1.15 to 1.92]; p < .001), cross-sectional area (-0.99 mm2 [95% CI, -1.20 to -0.79]; p < .001), and Tenascin-C (19.90 pg/mL [95% CI, 7.63 to 32.17]; p = .002).
    CONCLUSIONS: Adding PNE to ESWT, manual therapy, and exercise was associated with greater short-term improvements in upper-limb disability, tendon properties, and shoulder mechanical performance. Pain improved in both groups, without a between-group difference.
    CLINICAL TRIAL REGISTRATION: The www.isrctn.com identifier is ISRCTN66866842.
    Keywords:  Tendinopathy; electrolysis; physical therapy modalities; randomized controlled trial; shockwave therapy
    DOI:  https://doi.org/10.1080/17581869.2026.2669520
  35. Clin Shoulder Elb. 2026 May 12.
    Surgical management of recalcitrant lateral epicondylitis: indications, techniques, and outcomes.
    Tae-Yeong Kim, Bong Kyu Kim, Jun-Beom Lee, Jung-Taek Hwang.
      Lateral epicondylitis is a common cause of lateral elbow pain. Although most patients improve with nonoperative treatment, a subset develops persistent symptoms requiring surgical intervention. Various surgical techniques-including open and arthroscopic debridement, percutaneous tenotomy, and tendon repair-have been described; however, the optimal surgical strategy remains controversial. This review summarizes current evidence regarding surgical techniques and clinical outcomes, with particular emphasis on the role of tendon repair in patients with high-grade common extensor tendon tears. Overall, surgical treatment yields satisfactory outcomes, with success rates exceeding 80%-90%. Increasing evidence suggests that the severity of tendon tearing plays an important role in surgical decision-making. In particular, tears involving ≥50% of tendon thickness appear to represent a clinically meaningful threshold for considering tendon repair rather than debridement alone.
    Keywords:  Magnetic resonance imaging; Tendon injuries; Tendon repair; Tennis elbow
    DOI:  https://doi.org/10.5397/cise.2026.00388
  36. Cureus. 2026 Apr;18(4): e106811
    Nerve Conduction and F-wave Findings in Patients With Postoperative Numbness After Reverse Shoulder Arthroplasty: A Case Series.
    Shotaro Teruya, Kazuhiro Ikeda, Hiroki Yamada, Hiromitsu Tsuge, Akira Ikumi, Shinzo Onishi.
       BACKGROUND: Neurologic symptoms such as ulnar-sided numbness can occur after reverse shoulder arthroplasty (RSA), and the lesion level may not be uniform across patients. This case series aimed to describe postoperative numbness and electrophysiological findings, with an exploratory assessment of F-wave findings in addition to standard nerve conduction studies.
    METHODS: We retrospectively analyzed patients who underwent RSA and had both preoperative and postoperative nerve conduction studies. Postoperative numbness was assessed clinically at six weeks. Motor and sensory conduction studies (MCS/SCS) in the ulnar nerve distribution and F-wave parameters were evaluated. F-wave abnormality was defined as either 1) prolongation of the minimum F-wave latency with a pre-to-post change of ≥2.0 ms or 2) reduced F-wave persistence of 50% or less.
    RESULTS: Thirteen patients were included. Postoperative numbness was observed in four patients (30.8%). Overall, five patients (38.5%) met the criteria for F-wave abnormality. F-wave abnormalities were observed in three of four patients with postoperative numbness and in two of nine patients without numbness. Two patients met electrodiagnostic criteria for cubital tunnel syndrome, and both had postoperative numbness. Additionally, two patients demonstrated isolated F-wave abnormalities with normal MCS/SCS, which may indicate electrophysiological changes not captured by conventional distal conduction studies alone.
    CONCLUSIONS: In this case series of RSA patients, postoperative ulnar-sided numbness showed heterogeneous electrophysiological patterns. F-wave assessment, combined with MCS/SCS, may provide supplementary electrophysiological information in cases with normal distal conduction findings. Larger studies with longitudinal follow-up are warranted to clarify symptom-electrophysiology relationships and clinical implications.
    Keywords:  cubital tunnel syndrome; f-wave; nerve conduction studies (ncs); postoperative numbness; reverse shoulder arthroplasty (rsa)
    DOI:  https://doi.org/10.7759/cureus.106811
  37. Eur J Case Rep Intern Med. 2026 ;13(5): 006571
    Postpartum Parsonage-Turner Syndrome with Hourglass Constrictions and Spontaneous Recovery without Surgical Intervention.
    Joanna I Choi-Klier.
       Introduction: Parsonage-Turner syndrome (PTS), also known as neuralgic amyotrophy, is an uncommon neurologic disorder characterised by acute onset upper extremity pain followed by muscle weakness, atrophy and paraesthesias. Severity of symptoms is variable and can involve any peripheral motor nerves of the brachial plexus. Its occurrence in the immediate postpartum period is exceedingly uncommon.
    Case description: A 31-year-old G1P1002 with a twin gestation underwent an emergency caesarean delivery for non-reassuring foetal status of twin B following a spontaneous vaginal delivery of twin A. Her pregnancy was complicated by A2 gestational diabetes. Shortly after surgery, the patient experienced right arm numbness, followed by two weeks of severe pain. Upon resolution of pain, she developed profound weakness in the posterior interosseous nerve (PIN) distribution of the right hand. Physical examination revealed loss of finger extension at the metacarpophalangeal joints, weak thumb extension and loss of wrist extension, with decreased sensation to light touch in the radial four digits. Wrist flexion was preserved. Electromyography demonstrated right posterior PIN neuropathy; specialised MR neurography identified multiple hourglass constrictions, pathognomonic for PTS.
    Discussion: The patient was managed conservatively with analgesics, a trial of corticosteroids, electrical stimulation and occupational therapy. Eleven months after symptom onset, finger extension returned spontaneously.
    Conclusion: This case highlights the presentation of PTS in the immediate postpartum period following caesarean delivery. Recognition of characteristic clinical features and imaging findings is crucial for accurate diagnosis. Conservative management can result in full functional recovery, though symptom resolution may be delayed.
    LEARNING POINTS: Parsonage-Turner syndrome should be considered in postpartum patients presenting with acute severe upper extremity pain followed by weakness, as the condition may be misdiagnosed as cervical radiculopathy, peripheral nerve compression or carpal tunnel syndrome.Hourglass constriction lesions identified on MR neurography are considered pathognomonic for neuralgic amyotrophy, but the presence of these lesions does not necessarily mandate early surgical intervention.Spontaneous neurologic recovery may occur even in patients with hourglass constriction lesions, supporting the importance of individualised management and careful longitudinal reassessment before proceeding to operative treatment.
    Keywords:  Parsonage-Turner syndrome; hourglass constriction; neuralgic amyotrophy; posterior interosseous nerve palsy; postpartum neuropathy
    DOI:  https://doi.org/10.12890/2026_006571
  38. Physiother Theory Pract. 2026 May 11. 1-10
    Nonoperative treatment of an anterior Achilles partial tear with load management and percutaneous electrolysis in an amateur basketball player. One year follow-up.
    Guido Fabián Gómez-Chiguano, Gabriel Rabanal-Rodríguez, Daniel Albert-Lucena, Oscar Madruga-Armada, Gustavo Plaza-Manzano, Marcos José Navarro-Santana.
       BACKGROUND: Partial tears of the Achilles tendon, particularly those affecting the anterior fibers, are rare and often underdiagnosed. Additionally, management remains controversial, especially in active individuals seeking to avoid surgery.
    CASE DESCRIPTION: A 32-year-old amateur basketball player sustained an acute partial tear of the anteromedial Achilles tendon near the insertional region, confirmed by high-resolution ultrasound. The lesion was characterized by hypoechoic fiber disruption, tendon thickening, and neovascularization, without complete tear. Nonoperative management was initiated, consisting of activity modification, bilateral heel lifts, and a progressive, pain-guided loading program. Ultrasound-guided percutaneous electrolysis (PE) was introduced as an adjunct intervention to modulate pain and stimulate local tissue remodelling. Six PE sessions were performed over four months, followed by a structured progression exercise program.
    OUTCOMES: The patient demonstrated progressive improvement in function and pain. VISA-A (The Victorian Institute of Sport Assessment-Achilles) score increased from 4/100 at baseline to 100/100 at 48 weeks. Dorsiflexion range (lunge test) and heel-rise endurance recovered to near-symmetry with the contralateral limb. Palpation pain decreased from 8/10 to 2/10, and morning pain resolved entirely. Final ultrasound revealed tendon reorganization with a hyperechoic appearance and reduced neovascularization.
    CONCLUSION: This case highlights that a rare insertional partial Achilles tear can be effectively managed with a simple, individualized loading program, reinforcing mechanotherapy as the key component of rehabilitation. The adjunctive use of ultrasound-guided percutaneous electrolysis may enhance outcomes, suggesting a potentially efficient alternative to more complex treatment approaches.
    Keywords:  Achilles tear; nonoperative treatment; partial tear; percutaneous electrolysis; therapeutic exercise
    DOI:  https://doi.org/10.1080/09593985.2026.2672012
  39. Cureus. 2026 Apr;18(4): e106977
    Role of Ultrasonography and Magnetic Resonance Imaging in Diagnosing Shoulder Pathologies: A Prospective Observational Study.
    Rohini Chaudhari, Pranit B Pantawane, Sourabh Zambre, Pankaj Badarkhe, Payal M Badarkhe.
      Background Shoulder pain is a common musculoskeletal complaint with diverse etiologies involving rotator cuff, labral, and periarticular structures. Accurate imaging is essential for diagnosis and management. Ultrasonography (USG) and magnetic resonance imaging (MRI) are widely used modalities, each with distinct advantages and limitations. The aim of this study was to compare the diagnostic performance of USG and MRI in evaluating shoulder pathologies, particularly rotator cuff tears, using surgical or arthroscopic findings as the reference standard where available, and to assess their complementary roles in clinical practice. Methods This prospective observational study included 75 patients presenting with shoulder pain, restriction of movement, or instability. All patients underwent USG and MRI of the affected shoulder using standardized protocols. USG and MRI examinations were interpreted independently by experienced musculoskeletal radiologists. Readers were blinded to the findings of the other imaging modality at the time of reporting; however, relevant clinical history regarding the symptomatic side was available, consistent with routine diagnostic practice. Radiologists were not blinded to surgical outcomes at the time of final correlation, as surgical findings were used as the reference standard in the operative subgroup. Imaging findings were compared between modalities and correlated with surgical or arthroscopic findings where available. Diagnostic performance parameters, including sensitivity and specificity, were calculated in the surgically verified subgroup (n=34). Interobserver agreement for USG and MRI interpretations was not formally assessed. Statistical analysis was performed using the chi-square test, with p<0.05 considered statistically significant. Results The study population showed a male predominance (52/75; 69.3%) and greater involvement of the right shoulder (54/75; 72.0%). Trauma was the most common etiological factor, observed in 44/75 patients (58.7%). Bursitis or joint effusion (32/75; 42.7%) and rotator cuff tears (29/75; 38.7%) were the most frequently detected pathologies. MRI demonstrated higher sensitivity than USG for detecting overall rotator cuff tears (96.5% vs. 87.0% sensitivity) and full-thickness rotator cuff tears (100% vs. 88.0% sensitivity). MRI also showed higher specificity for rotator cuff tear detection (90.0% vs. 82.0%). Additionally, MRI was superior in detecting labral and instability-related lesions. However, the difference in diagnostic performance between USG and MRI was not statistically significant (χ²=17.07, p=0.105). Conclusion USG is a reliable first-line imaging modality for evaluating common shoulder pathologies, while MRI provides superior characterization of complex soft-tissue and intra-articular lesions. A combined imaging approach optimizes diagnostic accuracy and clinical decision-making.
    Keywords:  labral lesions; magnetic resonance imaging; rotator cuff tear; shoulder pain; ultrasonography
    DOI:  https://doi.org/10.7759/cureus.106977
  40. Knee Surg Sports Traumatol Arthrosc. 2026 May 13.
    Beyond arthroplasty conversion: Rethinking failure after hip arthroscopy for femoroacetabular impingement syndrome.
    Xia Qu, Ming Yi, Dujiang Yang, Bo Chen.
      Hip arthroscopy is increasingly used in the management of femoroacetabular impingement syndrome (FAIS), yet the definition of treatment failure remains unsettled. In response to the recent study by Mygind-Klavsen et al., we argue that conversion to total hip arthroplasty (THA), although clinically important, is a late and highly selective endpoint that does not capture the broader spectrum of unsuccessful hip preservation. Patients who remain symptomatic, fail to achieve clinically meaningful improvement, or undergo revision without THA are not represented by arthroplasty conversion alone. We further question whether conventional radiographic variables such as alpha angle, lateral joint-space width, and Tönnis grade are sufficient to explain failure in a condition as structurally and biologically heterogeneous as femoroacetabular impingement syndrome. Recent evidence suggests that cartilage status, composite risk stratification, and technique-related factors may be more informative for long-term survivorship than conventional morphology alone. Finally, the long registry period analysed in the target article spans different technical eras, raising the possibility that treatment-era effects were conflated with patient-related risk. In our view, the study provides a useful registry-based estimate of THA conversion after hip arthroscopy, but its findings should not be interpreted as establishing the dominant determinants of failure in contemporary hip-preservation practice.
    Keywords:  femoroacetabular impingement syndrome; hip arthroscopy; hip preservation; total hip arthroplasty; treatment failure
    DOI:  https://doi.org/10.1002/ksa.70440
  41. J Clin Neurophysiol. 2026 May 12.
    Sonographic Normal Values for Ulnar Nerve Cross-Sectional Area.
    Marianne T Luetmer, James B Meiling, Eric J Sorenson, Ruple S Laughlin, Andrea J Boon.
       PURPOSE: Neuromuscular ultrasound, including cross-sectional area measurements, adds diagnostic value to the clinical and electrodiagnosis evaluation of ulnar neuropathy at the elbow. Previously published reference values for ulnar nerve size vary widely. Our objective was to establish age-specific reference values for ulnar nerve cross-sectional area at multiple sites in asymptomatic adults for our laboratory.
    METHODS: Healthy adult subjects without neuromuscular symptoms or disease were recruited from our tertiary referral electromyogram laboratory and staff. Ulnar nerve cross-sectional area measurements were made in short axis at the wrist, forearm, cubital tunnel, retrocondylar groove, 2 cm proximal to the medial epicondyle, and mid-upper arm with the elbow flexed to 90°. Dynamic neuromuscular ultrasound evaluated for subluxation and dislocation at the medial epicondyle. Results were stratified by age group (younger than 40, 40-60, and older than 60 years) with at least 20 subjects per sex per group, as well as by sex, body mass index, and handedness. The upper limit of normal was established as two standard deviations above the mean.
    RESULTS: One hundred forty-two subjects (ages 18-84, mean 47.7 years) were included. Cross-sectional area significantly increased with age at all sites except the wrist. Cross-sectional area cut-offs at the retrocondylar groove were 10.0, 10.9, and 11.4 mm 2 , respectively, by age group. Ratios comparing retrocondylar groove and cubital tunnel to arm and forearm were calculated. Thirty-two percent had subluxation or dislocation in at least one limb.
    CONCLUSIONS: Age-specific cross-sectional area cut-offs and ratios may facilitate a more nuanced interpretation and diagnostic value when used in conjunction with clinical and electrodiagnosis evaluation of ulnar neuropathy at the elbow.
    Keywords:  Electromyography; Mononeuropathy; Reference value; Ulnar nerve; Ulnar neuropathy at the elbow; Ultrasound
    DOI:  https://doi.org/10.1097/WNP.0000000000001265
  42. Br J Sports Med. 2026 May 14. pii: bjsports-2025-110444. [Epub ahead of print]
    Effectiveness of maintenance interventions promoting physical activity following exercise therapy for chronic conditions: an umbrella review.
    Alexander Luijk, Alessio Bricca, Sofie Rath Mortensen, Pætur Holm, Graziella Zanger, Charlotte Simonÿ, Søren T Skou, Thomas Lund, Lars Hermann Tang.
       OBJECTIVE: To investigate the effectiveness of maintenance interventions postexercise therapy on physical activity (PA), physical function, fitness, health-related quality of life, adverse events, hospitalisation and return to work in people with chronic conditions.
    DESIGN: In this umbrella review, a narrative synthesis was conducted. Risk of bias was assessed using the Risk of Bias in Systematic Reviews tool. The quality and certainty of evidence were evaluated using Grading of Recommendation, Assessment, Development and Evaluation.
    DATA SOURCES: Medline, Embase and CINAHL were searched from inception to 20 August 2024.
    ELIGIBILITY CRITERIA: Systematic reviews of randomised controlled trials (RCTs) investigating the effectiveness of maintenance interventions following exercise therapy in people with chronic conditions.
    RESULTS: From 10 931 results, 19 systematic reviews (136 unique RCTs) were included. Reviews included people with chronic respiratory disease (n=64), cardiovascular disease (n=54), chronic low back pain (n=4) or knee/hip osteoarthritis (n=14). Most reviews had an unclear risk of bias (n=10). We identified three types of maintenance interventions based on delivery mode: primarily digital, primarily inperson and a mixed category comprising exclusively digital, inperson or hybrid delivery. Beneficial effects were found for digital health interventions on subjective PA (standardised mean difference (SMD) 0.37, 95% CI 0.05 to 0.69, low certainty), but no beneficial effects were found for inperson booster sessions (very low to low certainty). Mixed maintenance interventions showed beneficial effects for health-related quality of life (MD 0.28 points 95% CI 0.05 to 0.52; SMD 0.22 95% CI 0.03 to 0.41; MD -2.69 points 95% CI -4.49 to -0.9; moderate certainty), objective PA (SMD 2.14 95% CI 0.9 to 3.38, low certainty) and objective physical function (SMD 0.48 95% CI 0.19 to 0.77, low certainty). We found no effect or inconsistent effects for fitness, adverse events, hospitalisation and return-to-work (low to moderate certainty).
    CONCLUSION: Maintenance interventions may help people continue to be physically active and improve physical function and health-related quality of life. However, this is based on low certainty of evidence. The remaining outcomes were generally inconsistent or indicated no effects. Digital maintenance interventions show some beneficial effects for PA but higher-quality studies are needed across various chronic conditions.
    PROSPERO REGISTRATION NUMBER: CRD42024579734.
    Keywords:  Noncommunicable Diseases; Physical Therapy Modalities; Physical activity; Rehabilitation; Review
    DOI:  https://doi.org/10.1136/bjsports-2025-110444
  43. J Orthop Surg Res. 2026 May 12.
    Research progress of diffusion tensor imaging in lumbar degenerative diseases: a narrative review.
    Nan Zhang, Zemin Zhao, Jinlin Tian, Yang Xu.
      Degenerative diseases of the lumbar spine are a common cause of chronic low back pain and neurological dysfunction. Their pathological basis involves not only microscopic structural damage to the intervertebral discs but also microscopic injury to adjacent nerves and muscle tissues. Diffusion tensor imaging (DTI), which relies on the anisotropic properties of water molecule diffusion, enables non-invasive, quantitative assessment of microscopic structural changes in intervertebral discs, nerve fiber bundles, and muscle tissues. Studies have shown that DTI-related parameters-fractional anisotropy (FA), apparent diffusion coefficient (ADC), and other parameters show a strong correlation with the degree of degeneration, nerve compression, and clinical symptoms in lumbar degenerative diseases such as intervertebral disc degeneration, lumbar disc herniation, and stenosis of the spinal canal and intervertebral foramen. These parameters can provide imaging evidence for identifying the affected segment and evaluating treatment efficacy. This review summarizes the recent advances in the application of DTI in lumbar degenerative diseases, with the aim of providing a reference for the clinical application of DTI and future research.
    Keywords:  Artificial intelligence; Diffusion tensor imaging; Intervertebral disc degeneration; Lumbar degenerative disease; Lumbar disc herniation; Lumbar foraminal stenosis; Lumbar spinal stenosis; Paraspinal muscle changes
    DOI:  https://doi.org/10.1186/s13018-026-06924-y
  44. JSES Rev Rep Tech. 2026 Aug;6(3): 100750
    Coracoid bending for refractory anterior upper arm pain after reverse total shoulder arthroplasty.
    Naoko Mizuno, Yuki Kotani, Shigeto Nakagawa, Kenji Hayashida.
      
    Keywords:  Anterior upper arm pain; Conjoint tendon; Coracoid bending; Coracoid process; Humeral distalization; Reverse total shoulder arthroplasty
    DOI:  https://doi.org/10.1016/j.xrrt.2026.100750
  45. Knee Surg Sports Traumatol Arthrosc. 2026 May 10.
    Achilles tendon rupture does not significantly reduce career longevity in professional soccer players compared with matched controls.
    Haneef Abdullah Khan, Amina Khan, Ashley Rosenberg, Adil Ather.
       PURPOSE: To compare the career longevity of professional soccer players after achilles tendon rupture (ATR) with that of an uninjured matched control cohort.
    METHODS: A retrospective analysis of ATR cases in professional male athletes from the English Premier League and English Championship was performed. Each athlete with ATR was matched to three control athletes who had not sustained ATR. The analysis included all identified ATR cases, including those who failed to return to professional competition. Statistics were compiled for each year until retirement or study end.
    RESULTS: A total of 36 players with ATR were matched to 108 controls. The return-to-professional play rate following ATR was 91.7%. The mean career length after ATR was 4.9 ± 3.3 years, while that of the matched control athletes was 3.4 ± 3.5 years (p = 0.045). After ATR, an athlete had a 33% lower risk of retirement compared with the matched control athlete, which approached statistical significance (hazard ratio [HR] = 0.67; 95% confidence interval [CI], 0.45-1.00; p = 0.051). Significant subsequent non-ATR injuries were documented in 24.1% of control athletes during the follow-up period. At 5 years after ATR, 58.3% of athletes had retired from professional soccer, while 70.4% of the matched cohort were retired (p = 0.259). By 10 years, 83.3% of the ATR cohort had retired compared with 91.7% of the matched cohort (p = 0.270). Within the ATR cohort, re-rupture occurred in seven players (19.4%) but did not significantly affect career length (HR = 0.80; p = 0.622). Age at ATR remained the strongest predictor of retirement (HR = 1.27 per year; p < 0.001).
    CONCLUSION: Professional male soccer players who sustained ATR demonstrated comparable career longevity to a matched player cohort, with a trend toward longer survival in those who successfully return to play. ATR did not significantly shorten professional careers in this elite population. This likely reflects the efficacy of modern rehabilitation, a potential selection effect, and the high non-ATR injury burden observed in the control group.
    LEVEL OF EVIDENCE: Level III.
    Keywords:  achilles tendon rupture; career length; football; professional athletes; soccer; sport retirement
    DOI:  https://doi.org/10.1002/ksa.70420
  46. Front Neurol. 2026 ;17 1794367
    Nutritional status, abdominal muscle thickness, and functional outcomes in patients with subacute to chronic stroke.
    Esra Şahingöz Bakırcı, Yasin Coşkun, Tuğba Alışık.
       Background: Nutritional status is an important determinant of rehabilitation outcomes after stroke; however, its relationship with abdominal muscle morphology remains unclear. Given the role of abdominal muscles in trunk stability, postural control, and functional mobility, this study aimed to evaluate the association between nutritional status, abdominal muscle thickness, and functional recovery in patients with subacute to chronic stroke.
    Methods: In this prospective observational study, patients with subacute to chronic stroke who were admitted to an inpatient rehabilitation program were evaluated at baseline and after a 4-week rehabilitation program. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF), reflecting screening-defined nutritional risk. Abdominal muscle thicknesses of the external oblique, internal oblique, and transversus abdominis were measured by ultrasonography on the non-paretic side. Clinical, functional, cognitive, and biochemical parameters were recorded at baseline and discharge. The primary outcome was functional independence at discharge, assessed by the Barthel Index.
    Results: Sixty patients were included, of whom 38 had normal nutritional status and 22 were classified as having nutritional risk based on the MNA-SF. Significant within-group improvements in motor recovery and mobility were observed in both groups following rehabilitation (p < 0.05). Although both groups demonstrated improvements, patients with normal nutritional status had higher functional independence levels at both baseline and post-treatment assessments. Baseline abdominal muscle thicknesses were similar between groups (p > 0.05) and did not change significantly after rehabilitation (p > 0.05). Multivariable analysis showed that nutritional risk was independently associated with lower discharge Barthel Index scores (B = -2.99, 95% CI -5.65 to -0.33, p = 0.028), after adjustment for prespecified covariates. In contrast, nutritional risk was not independently associated with discharge cognitive outcomes (MMSE) or mobility outcomes (FAC and mRS).
    Conclusion: In patients with subacute to chronic stroke, functional recovery during rehabilitation appears to be associated with nutritional risk, whereas no significant association was observed with abdominal muscle thickness. Although muscle thickness remained unchanged, screening-defined nutritional risk was independently associated with functional independence at discharge. These findings underscore the importance of early nutritional screening and comprehensive evaluation during stroke rehabilitation.
    Keywords:  Prognostic Nutritional Index; abdominal muscles; mini nutritional assessment; nutritional status; stroke rehabilitation; ultrasonography
    DOI:  https://doi.org/10.3389/fneur.2026.1794367
  47. J Orthop Case Rep. 2026 May;16(5): 227-232
    Wheelchair to Walking: Quadruple Arthroplasty of Hip and Knee Joints in a Patient with Severe Ankylosing Spondylitis.
    Remington C Crossnoe, Varun M Trivedi, Sterling J DeShazo, Reagan L Crossnoe.
       Introduction: Ankylosing spondylitis (AS) is a chronic inflammatory disease that can lead to progressive joint ankylosis, most commonly affecting the spine and hips. Severe cases may result in functional autoarthrodesis of multiple lower extremity joints, significantly impairing mobility and quality of life. Although total hip and knee arthroplasty are well-described individually in AS, management of simultaneous multi-joint ankylosis in extreme flexion deformity is rarely reported.
    Case Report: We report the case of a 23-year-old male with advanced AS resulting in bilateral hip and knee autoarthrodesis fixed in severe flexion, rendering him wheelchair-bound for 3 years. He underwent four staged arthroplasty procedures over the course of 1 year, consisting of bilateral total hip arthroplasties followed by bilateral total knee arthroplasties, with approximately 8-week intervals between procedures. Significant intraoperative challenges included absent normal joint anatomy, extreme flexion deformities (hips 80-85° and knees 70-75°), and complex patient positioning. The hips were addressed through an anterolateral approach, and the knees through a medial parapatellar approach with adjunctive osteotomies and soft-tissue releases as needed. Postoperatively, the patient underwent intensive rehabilitation and subsequent manipulation under anesthesia to improve the range of motion. Functional outcome measures demonstrated substantial improvement, with hip disability and osteoarthritis outcome score increasing from 6.9 to 61.3, Harris Hip Score from 15 to 63, and knee injury and osteoarthritis outcome score from 9 to 41.
    Conclusion: Staged total hip and knee arthroplasty in severe AS with autoarthrodesis can result in meaningful functional recovery. Careful pre-operative planning, staged reconstruction, and tailored rehabilitation are essential to optimize outcomes and minimize complications in these complex cases.
    Keywords:  Arthroplasty; ankylosing spondylitis; autoarthrodesis; case report; flexion contracture; spontaneous
    DOI:  https://doi.org/10.13107/jocr.2026.v16.i05.7266
  48. S Afr J Physiother. 2026 ;82(2): 2311
    Teaching the ICF or using the ICF to teach? Lessons from first-time clinical practice.
    Ilse du Plessis, Lunelle Pienaar, Heather Talberg.
       Background: Clinical education is central to physiotherapy training, yet many students enter their first placements with limited experience in holistic clinical reasoning. The International Classification of Functioning, Disability and Health (ICF) provides a biopsychosocial framework for understanding functioning, yet its use in early clinical education remains underexplored.
    Objectives: This study aimed to investigate second-year physiotherapy students' self-reported understanding and application of the ICF following first time clinical exposure within a redesigned clinical course.
    Method: A quantitative cross-sectional descriptive study was conducted. All second-year physiotherapy students completing their first clinical placements in 2023 and 2024 at a South African university were invited to complete a self-developed survey. The survey assessed perceived understanding and application of ICF components using Likert-scale and categorical items. Descriptive statistics were used for analysis.
    Results: Of the 138 eligible students, 106 responded (76.9%). Students reported improved perceived understanding of the ICF, with retrospective ratings increasing from a mean of 6 before placement to 9 after placement. Confidence in applying the ICF was high (mean = 8).
    Conclusion: Early clinical exposure structured around the ICF may support the development of holistic reasoning and encourage students to move beyond impairment-focused thinking.
    Clinical implications: Embedding the ICF into early placements may strengthen patient-centred clinical reasoning.
    Keywords:  International Classification of Functioning, Disability and Health; clinical reasoning; early clinical placements; patient-centred care; physiotherapy education; undergraduate students
    DOI:  https://doi.org/10.4102/sajp.v82i2.2311
  49. J Pain Res. 2026 ;19 584510
    Effects of Massage on Pain, Muscle Co-Contraction, and Knee Loading in Medial Knee Osteoarthritis: A Randomized Controlled Trial Protocol.
    Fuwei Pan, Min Zhang, Guangyuan Zhang, Jie Hang Lu, Bo Chen, Ge Wang, Shangzeng Wang, Hongsheng Zhan.
       Background: Increased joint loading and muscle co-contraction during gait contribute to the progression of knee osteoarthritis (OA). Although massage benefits for knee OA are documented, evidence based on objective biomechanical outcomes remains limited. This study aims to investigate the effects of massage on pain, muscle co-contraction and joint loading after a 12-week intervention in patients with medial knee OA.
    Methods/Design: This parallel, two-arm randomized controlled trial will enroll 56 participants with medial knee OA. Participants will be randomly assigned to either a Massage group or a Healthcare Education group for a 12-week intervention delivered twice weekly. The massage protocol will use standardized Shi's manual therapy techniques targeting periarticular knee soft tissues, including the quadriceps, hamstrings, and surrounding structures. The primary outcome is the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes include WOMAC stiffness and function, antagonist muscle co-contraction, knee kinetics and kinematics (including the external knee adduction moment [EKAM]), and temporospatial gait parameters. Outcomes will be assessed at baseline and after the 12-week intervention.
    Discussion: This is the first randomized controlled trial to simultaneously evaluate the midterm (12-week) effects of massage on pain, muscle co-contraction and EKAM. The findings may provide novel evidence on the biomechanical mechanisms of massage beyond traditional subjective assessments and have important implications for developing individualized, mechanism-oriented rehabilitation strategies.
    Trial Registration: International Traditional Medicine Clinical Trial Registry: ITMCTR2025001524.
    Keywords:  knee loading; knee osteoarthritis; massage; muscle co-contraction; randomized controlled trial
    DOI:  https://doi.org/10.2147/JPR.S584510
  50. Anatol J Cardiol. 2026 May 14.
    Clinical and Electrophysiological Assessment of Peripheral Nerve Function After Transradial Angiography: A Prospective Study.
    Taner Dandinoğlu, Hüseyin Kozan, Altuğ Güner, Olgun Deniz, Erkan Kaya.
       BACKGROUND: Transradial angiography (TRA) is widely used in contemporary coronary procedures. Although clinically apparent peripheral nerve injury after TRA is uncommon, subclinical nerve involvement may go unrecognized. This study aimed to objectively assess peripheral nerve function after TRA using neurological examination, standardized neuropathic pain questionnaires, and nerve conduction studies (NCS).
    METHODS: This prospective, single-center observational study included consecutive patients undergoing transradial coronary angiography. A total of 107 patients were analyzed. Neurological examination was performed within 24-48 hours after the procedure. Neuropathic symptoms were evaluated using the Douleur Neuropathique en 4 (DN4) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) questionnaires. Bilateral nerve conduction studies of the median, ulnar, and radial nerves were performed 1 month after TRA, and side-to-side comparisons were conducted.
    RESULTS: Side-to-side differences were observed in selected nerve conduction parameters. These electrophysiological changes predominantly involved the radial nerve on the procedure side, characterized by lower sensory amplitude, reduced conduction velocity, and decreased motor amplitude (P < .05). Median and ulnar nerve conduction findings were largely comparable between sides. Douleur Neuropathique en 4 and LANSS scores were in normal ranges and not associated with nerve conduction parameters. No clinically evident local or neurological complications were detected during follow-up.
    CONCLUSION: Transradial angiography may be associated with mild, procedure-side predominant radial nerve conduction changes detectable by NCS, without clinically evident neuropathy. Objective electrophysiological assessment may therefore help identify underrecognized subclinical nerve involvement following TRA.
    DOI:  https://doi.org/10.14744/AnatolJCardiol.2026.6273
  51. Diagnostics (Basel). 2026 Apr 29. pii: 1335. [Epub ahead of print]16(9):
    Asymptomatic Abnormalities in the Knee, Shoulder, and Ankle Joints of Collegiate Athletes: A Cross-Sectional MRI-Based Comparative Study.
    Na Jiang, Hanqi Wang, Xinyu Zhang, Jia Chen, Gang Wei, Fuhua Yan, Xiaokai Li, Yong Lu.
      Background: Asymptomatic structural joint abnormalities are prevalent among athletes, yet studies on their multi-joint distribution and comparisons with low-activity controls remain lacking. This article evaluated the prevalence and characteristics of asymptomatic structural abnormalities across joints in collegiate athletes compared with controls using 3.0-T MRI. Methods: The cross-sectional study enrolled 53 asymptomatic elite collegiate athletes (high physical activity, HPA) and 84 healthy volunteers (low physical activity, LPA) aged 18-25 years. All participants were asymptomatic with no history of joint trauma or surgery. Generalized estimating equation (GEE) logistic regression was employed to identify independent risk factors for joint abnormalities after evaluation. Results: A total of 666 joints were analyzed. Participants with at least one joint abnormality were significantly more common in the HPA group than LPA group (49.1% vs. 6.0%, p < 0.001). At the joint level, overall abnormality prevalence was 13.5% versus 2.2%, respectively. In the HPA group, knee joints were the most frequently affected (24.2%), predominantly involving meniscal lesions. Shoulder pathologies consisted exclusively of supraspinatus tendon lesions (6.8%), while ankle abnormalities were primarily bone marrow edema (5.9%). GEE analysis identified high physical activity (adjusted OR = 5.23; 95% CI: 1.55-17.71; p = 0.008) and elevated BMI (adjusted OR = 1.09 per kg/m2; 95% CI: 1.03-1.15; p = 0.001) as independent risk factors. Conclusions: Asymptomatic abnormalities are highly prevalent and demonstrate intra-individual clustering across multiple joints. MRI-based surveillance represents a promising strategy for early risk identification and injury prevention.
    Keywords:  asymptomatic states; athletes; magnetic resonance imaging; sports medicine
    DOI:  https://doi.org/10.3390/diagnostics16091335
  52. Int J Surg Case Rep. 2026 May;138(5): 1699-1704
    Sustained functional recovery one year after TFCC debridement with adjuvant umbilical cord-mesenchymal stem cells and secretome therapy: a case report.
    Jecky Chandra, Cynthia Retna Sartika, Rima Haifa, Nisa Zulfani, Naura Nisrina Salsabila, Ditta Kalyani Devi, Naifa Dhea Hardiani.
       Introduction and Importance: Triangular fibrocartilage complex (TFCC) tears can significantly impair wrist stability and daily function. Regenerative medicine, particularly mesenchymal stem cell-based therapy, may complement traditional surgical approaches such as debridement with synovectomy to enhance recovery.
    Presentation of Case: This report presents the 1-year follow-up of a 41-year-old male with a TFCC tear previously treated with debridement synovectomy followed by intra-articular umbilical cord-derived mesenchymal stem cells (UC-MSCs) and UC-MSC-derived secretome. UC-MSCs were selected for their regenerative potential and well-established roles in tissue repair. Clinical evaluations were performed pretreatment, at 6 months, and at 12 months. Outcomes were assessed using magnetic resonance imaging (MRI), the Visual Analogue Scale (VAS), and the Disabilities of the Arm, Shoulder and Hand (DASH) score. At 12 months, the patient maintained a VAS score of 0, indicating complete and sustained pain resolution. Functional improvement continued, with the DASH score progressing from 12 at 6 months to 5.8 at 12 months. MRI findings demonstrated stable postoperative healing without recurrent injury or degenerative change.
    Clinical Discussion: One-year follow-up shows near-complete restoration of daily wrist function. No adverse events related to UC-MSC or secretome administration occurred. These results suggest that UC-MSC-based therapy may provide durable regenerative benefits when used as an adjuvant to debridement with synovectomy.
    Conclusion: One year after surgery supplemented with UC-MSC and secretome therapy, the patient demonstrates sustained pain relief and progressive functional recovery. This case supports the potential role of UC-MSC-based therapy in enhancing long-term outcomes in TFCC injury, warranting further investigation.
    Keywords:  adjuvant regenerative therapy; case report; pain and functional recovery; secretome; triangular fibrocartilage complex (TFCC) tear; umbilical cord-derived mesenchymal stem cells (UC-MSCs)
    DOI:  https://doi.org/10.1097/RC9.0000000000000410
  53. Age Ageing. 2026 May 04. pii: afag116. [Epub ahead of print]55(5):
    Outcome domains of patient-reported outcome measures used in randomised controlled trials for older adults with non-specific low back pain: a systematic review.
    Tony S H Chiu, Jae Q J Liu, Edmond C M Wong, Jeffrey C Y Ng, Alessandro Chiarotto, Katie de Luca, Richard Xu, Fabianna de Jesus-Moraleida, Manuela L Ferreira, Arnold Y L Wong.
       OBJECTIVE: To summarise outcome domains and patient-reported outcome measures used in randomised controlled trials involving older adults with non-specific low back pain.
    METHODS: Seven databases were searched from inception to January 2025. Two independent reviewers screened articles, extracted data and categorised patient-reported outcome measures into outcome domains using the Dodd et al. 38-item framework, where pain outcomes for non-specific pain are classified as 'general outcome', which we have relabelled as 'pain' for clarity. Frequencies of patient-reported outcome measure use and domain coverage were analysed. Adherence to core outcome set domains (physical functioning, pain and health-related quality of life) and core outcome measurement set for non-specific low back pain was evaluated.
    RESULTS: From 57 included trials, 74 patient-reported outcome measures were identified across nine outcome domains. Physical functioning (n = 80, 36%) and pain (n = 57, 26%) were the most frequently assessed. The most frequently used patient-reported outcome measures were the Roland-Morris Disability Questionnaire and the Visual Analogue Scale. Measures for physical functioning, pain and health-related quality of life were used in 91%, 86% and 23% of studies, respectively. Only 14% addressed all three-core outcome set domains; none adhered fully to the core outcome measurement set.
    CONCLUSIONS: Trials involving older adults with non-specific low back pain mainly evaluated pain and physical functioning, with limited coverage of other patient-centred domains. Future research should prioritise: (i) standardising outcome measurement with valid, reliable and responsive instruments; and (ii) developing and validating comprehensive, multi-domain outcome measures.
    Keywords:  clinical trials; nonspecific low back pain; older adults; outcome measures; systematic review
    DOI:  https://doi.org/10.1093/ageing/afag116
  54. Health Sci Rep. 2026 May;9(5): e72049
    Comparative Effectiveness of Combined Orthotic and Physiotherapy Interventions Versus Monotherapy in the Management of Knee Osteoarthritis on Clinical Parameters: A Systematic Review of Randomized Controlled Trials.
    Mahsa Zangi, Mahmood Bahramizadeh, Mobina Khosravi, Rasha Atlasi, Mokhtar Arazpour, Koorosh Barati.
       Background and Aims: Knee osteoarthritis (OA) is a common degenerative joint disease affecting 22.9% of individuals over 40 years of age, causing pain and functional impairment. Orthotic devices and physiotherapy are standard treatments, but their combined effectiveness compared with that of monotherapy is unclear. This systematic review aimed to evaluate the effectiveness of combined orthotic and physiotherapy interventions versus monotherapy in improving clinical (e.g., pain, function) and quality of life (QOL) outcomes in knee OA patients.
    Methods: Following the PRISMA 2020 guidelines, a comprehensive search was conducted across four databases for studies published until September 7, 2025. The review included Randomized Controlled Trials (RCTs) that specifically compared the outcomes of combined orthotic and physiotherapy interventions versus monotherapy. A narrative synthesis was performed due to the heterogeneity among the studies.
    Results: Four RCTs involving 240 participants were included. Monotherapy with orthotics or physiotherapy significantly improved clinical parameters such as pain and function. Combined interventions showed enhanced benefits in some cases, although the results varied. The risk of bias ranged from low to moderate in RCTs.
    Conclusion: Both orthotic and physiotherapy interventions are effective for knee OA, with combined approaches potentially offering additional benefits. However, heterogeneity and bias limit the certainty of the evidence. Future research should focus on large-scale, stratified RCTs to enhance the generalizability of the findings and inform personalized treatment strategies.
    Keywords:  function; knee osteoarthritis; orthosis; pain; physiotherapy; quality of life
    DOI:  https://doi.org/10.1002/hsr2.72049
  55. J Clin Med. 2026 May 06. pii: 3550. [Epub ahead of print]15(9):
    Cognitive Impairment as a Putative Mechanism of Self-Management Failure in Chronic Obstructive Pulmonary Disease: A Conceptual Narrative Review.
    Maryam M Almulhem, Rayan A Siraj.
      Background/Objectives: Chronic obstructive pulmonary disease (COPD) management increasingly relies on patient self-management; however, medication non-adherence, inhaler misuse, delayed exacerbation recognition, and suboptimal engagement in pulmonary rehabilitation remain highly prevalent across disease stages. Cognitive impairment is increasingly recognised in this population, particularly in moderate-to-severe disease and in those with greater systemic burden, yet it is most often treated as a descriptive comorbidity rather than a determinant of disease control. Methods: This conceptual narrative review synthesises biological, neuropsychological, and clinical evidence to examine the extent to which cognitive impairment contributes to variability in self-management performance and clinical outcomes, and to propose a structured framework linking disease burden, neurocognitive vulnerability, behavioural execution, and downstream outcomes. Results: COPD-related processes-including chronic hypoxaemia, hypercapnia, systemic inflammation, oxidative stress, vascular comorbidity, and recurrent exacerbations-provide biologically plausible pathways to neurocognitive vulnerability. Reported deficits in executive function, attention, working memory, processing speed, and visuomotor integration may affect the execution of cognitively demanding tasks central to disease management, including inhaler technique, medication adherence, symptom appraisal, and sustained participation in pulmonary rehabilitation. Across studies, cognitive impairment is consistently associated with inhaler errors, reduced adherence and independence, rehabilitation dropout, impaired symptom recognition, increased healthcare utilisation, functional decline, and mortality. Conclusions: Collectively, these findings support the interpretation that cognitive vulnerability may act as an intermediary mechanism through which disease burden translates into behavioural instability and adverse outcomes. Although this framework remains hypothesis-generating, it provides a coherent basis for future longitudinal and interventional studies to formally evaluate the mediating role of cognition in disease management and outcome trajectories.
    Keywords:  COPD; cognitive impairment; self-management; treatment adherence; visuomotor function
    DOI:  https://doi.org/10.3390/jcm15093550
  56. Sci Rep. 2026 May 11.
    Characteristics of the upper trapezius muscle in patients with chronic shoulder impingement syndrome: a comparative study.
    Chun-Kai Tang, Chia-Feng Lu, Shin-Yi Chiou, Yi-Fen Shih.
      The upper trapezius (UT) muscle is critical for proper scapular kinematics, yet the role of intrinsic UT muscle characteristics remains unclear. Our study aimed to compare UT muscle quality (echo intensity, EI), morphology (thickness change), and tone and stiffness between patients with CSIS and controls. This observational study recruited 30 participants with unilateral CSIS (27.5 ± 5.5 years old; pain duration 23.0 ± 19.7 months) and 30 controls (24.4 ± 3.0 years old) from the community. B-mode ultrasound was utilized to measure UT EI and muscle thickness at rest and during maximal contraction. Myotonometry assessed oscillation frequency (tone) and dynamic stiffness at rest and during 60° shoulder flexion. Data were analyzed using analysis of covariance (age). The CSIS group exhibited greater UT muscle EI than controls on both affected and unaffected sides (p = 0.007, 95% Confidence Interval [CI]: 2.135-12.894). The CSIS group exhibited greater muscle tone and stiffness during 60° shoulder flexion, including elevated oscillation frequency (p = 0.005, 95% CI: 0.351-1.873) and dynamic stiffness (p = 0.006, 95% CI: 10.678-61.782) than the controls. Our results suggest that patients with CSIS had bilateral deficits in muscle quality and muscle tone during active tasks. These findings provide objective evidence of altered intrinsic muscle characteristics and mechanical properties in the UT of patients with CSIS.Trial registration: The protocol of this study was approved by the Institutional Review Board of National Yang Ming Chiao Tung University and prospectively registered with ClinicalTrials.gov (NCT06472349).
    Keywords:  Echo intensity; Muscle quality; Muscle thickness; Muscle tone; Myotonometry; Ultrasound imaging
    DOI:  https://doi.org/10.1038/s41598-026-46757-7
  57. Orthop J Sports Med. 2026 May;14(5): 23259671261434247
    Relationship Between Cam Lesion Size, Its Excision, and Hip Osteoarthritis Progression: A Contralateral-Controlled Study Using Joint Space Width After Unilateral Hip Arthroscopy.
    Emre Acar, Selahaddin Aydemir, Gürhan Tükel, Özgür Aydın, Ümit Ali Karabağ, Mehmet Emin Arayıcı, Onur Hapa.
       Background: The effect of hip arthroscopy on the natural progression of osteoarthritis is still unclear.
    Purpose: To clarify the relationship between unilateral hip arthroscopy, the size of the cam lesion, and its excision on the progression of hip osteoarthritis.
    Study Design: Cohort study; Level of evidence, 3.
    Methods: A total of 105 patients who underwent unilateral hip arthroscopy due to femoroacetabular impingement and had a minimum of 2 years of follow-up were included. Joint space width (JSW) measurements were made at the medial (MJW), lateral (LJW), and central (CJW) aspects of the sourcil line on anteroposterior supine pelvis radiographs. The alpha angle (α) was measured using preoperative and early postoperative Dunn 45° radiographs.
    Results: LJW decreased and was more obvious in men than in women in the operated hips. All LJWs, MJWs, and CJWs decreased on the contralateral nonoperated hips (P < .05). The operated sides had higher MJW compared with the contralateral nonoperated sides (3.58 ± 0.75 mm vs 3.34 ± 0.6 mm; P = .02) and a lower decrease of medial joint space compared with contralateral sides (Δ1, -0.05 mm; Δ3, -0.3 mm; P = .00). At the final follow-up, central joint space was greater in the operated hips compared with the contralateral hips in patients with higher preoperative alpha angle (α0) (≥0.1 mm vs <0.1 mm; preoperative α, 81 vs 79; P = .03).
    Conclusion: Patients treated with unilateral hip arthroscopy demonstrated a decrease in the LJW, while nonoperated sides had a decrease in all 3 widths, leading to a greater joint space in the operated hip, especially at the MJW. Furthermore, patients having more severe cam deformity preoperatively had better preservation of CJW.
    Keywords:  femoroacetabular impingement; hip arthroscopy; joint width; patient-reported outcome
    DOI:  https://doi.org/10.1177/23259671261434247
  58. J Clin Orthop Trauma. 2026 Jul;78 103457
    Extension block pinning with percutaneous intramedullary reduction for dorsal PIP joint fracture-dislocation of the finger.
    J Terrence Jose Jerome, Rahul Dubepuria.
       Background: Dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint can cause chronic pain, stiffness, and loss of motion. We present a minimally invasive method-extension block pinning combined with percutaneous intramedullary reduction and fixation-for unstable dorsal PIP fracture-dislocations and evaluate its radiologic and functional outcomes.
    Methods: Twenty consecutive patients with acute unstable dorsal PIP joint fracture-dislocations and persistent post-reduction subluxation were treated with this technique. In the treated cohort, volar articular involvement ranged from 30% to 70%. The procedure combines extension block K-wire pinning with intramedullary percutaneous reduction and supplementary fixation, allowing early motion. Range of motion (ROM), pain (VAS), Disabilities of the Arm, Shoulder, and Hand (DASH) scores, fingertip-to-palm distance, radiographic congruency, and complications were recorded and analyzed. Confidence intervals were calculated for key continuous variables.
    Results: At a mean follow-up of 18 months (range, 6-36), all fractures united with maintained reduction. Mean articular step-off improved from 2.1 mm preoperatively to 0.5 mm postoperatively (p < 0.001). Mean PIP joint motion increased from 5° to 84° (p < 0.001). VAS pain improved from 6.2 to 0.6, and DASH from 28 to 5 (both p < 0.001). Eighteen joints achieved <1 mm step-off at final follow-up; two had mild incongruity without symptoms. No infections, hardware failures, or recurrent subluxations occurred.
    Conclusion: This combined percutaneous technique appears to be a reproducible, minimally invasive option for selected unstable dorsal PIP fracture-dislocations, restoring articular congruity while permitting early mobilization. The findings demonstrate promising functional and radiological outcomes; however, given the retrospective design, small sample size, and absence of a control group, these results should be interpreted as preliminary and hypothesis-generating. Prospective comparative studies are required to validate these observations.
    Level of evidence: IV - Therapeutic case series.
    Keywords:  Early mobilization; Extension block pinning; Intramedullary reduction; PIP joint fracture-dislocation; Percutaneous fixation
    DOI:  https://doi.org/10.1016/j.jcot.2026.103457
  59. Skeletal Radiol. 2026 May 12.
    Obturator internus avulsion in adolescents: a rare pattern of pelvic avulsion injury.
    Saloni Dagar, Mohamed Said, Eric Daniel Fornari, Terry L Levin.
      Obturator internus (OI) avulsion at its pelvic origin is an exceptionally rare cause of acute hip and groin pain in adolescents and is often radiographically occult. We report two adolescent boys with acute, severe hip pain and inability to ambulate after distinct mechanisms; one during a basketball jump without direct trauma and the other following a direct fall onto the hip. In both cases, pelvic and hip radiographs were normal. Magnetic resonance imaging established the diagnosis and revealed a strikingly similar constellation of findings in both patients: medial displacement and bowing of the OI away from the pelvic side wall with extensive muscle edema along its course extending through the sciatic notch, interposed fluid at the pelvic attachment, associated ipsilateral gluteus minimus edema, and a small-to-moderate hip effusion. Critically, a focal area of T1 hyperintensity deep to the displaced OI consistent with hemorrhage supported traumatic avulsion and helped distinguish this entity from infectious or inflammatory processes. Both patients were treated nonoperatively with protected weightbearing, activity modification, and physical therapy, with return to high activity at 1 year and 2.5 years. This report highlights a rare injury with a distinct and reproducible MR pattern that should alert radiologists and treating clinicians, enabling timely diagnosis and avoiding unnecessary investigations.
    Keywords:  Adolescents; Obturator internus; Pelvic MRI; Pelvic avulsion injury
    DOI:  https://doi.org/10.1007/s00256-026-05244-w
  60. Int J Spine Surg. 2026 May 13. pii: 8881. [Epub ahead of print]
    Upright MRI Follow-Up for Decompression and Interlaminar Stabilization in Low-Grade L4/L5 Spondylolisthesis Suggests Reduced Reoperation Rates Compared With Fusion or Decompression Alone.
    Julia E Reich, Andrei Slavici, Juan M Vinas-Rios, M Arabmotlagh, Kai Hoffeld, Katharina Frey, Michael Rauschmann, Vincent J Heck.
       PURPOSE: While spinal fusion is the standard treatment for symptomatic low-grade spondylolisthesis, evidence on motion-preserving alternatives such as decompression with interlaminar stabilization (D+ILS) remains limited. This study aims to descriptively evaluate clinical and radiological outcomes after D+ILS at L4/L5 under strict inclusion criteria, with a specific focus on dynamic spinal assessment using upright magnetic resonance imaging (MRI).
    METHODS: This prospective observational study involved 30 patients with degenerative low-grade spondylolisthesis at L4/L5 treated with D+ILS using the Coflex interlaminar stabilization device. Further inclusion criteria included symptomatic spinal canal stenosis, significant pain relief following facet joint injections, maintained disc height, and unsuccessful conservative treatment. Outcomes were assessed using functional upright MRI and validated questionnaires.
    RESULTS: The cohort consisted of 13 women and 17 men with a mean age of 69 ± 9 years and an average follow-up of 43 ± 7 months. At last follow-up, upright MRI showed preserved segmental alignment without signs of increased translational motion, along with reductions in spinal canal stenosis and facet cysts. Radiological progression of facet joint osteoarthritis and disc degeneration was mild. Spinopelvic parameters and multifidus muscle morphology remained largely unchanged. Clinically, there were significant improvements in pain, functional disability, and ambulation. One patient (3%) required reoperation for symptomatic adjacent segment degeneration.
    CONCLUSION: This study is the first to assess D+ILS in a strictly selected cohort using upright MRI to evaluate postoperative mechanics at mid-term follow-up under physiological load. Our findings suggest that D+ILS may be a feasible motion-preserving treatment concept in carefully selected patients with stable L4/L5 spondylolisthesis. However, given the exploratory design and small cohort, these observations should be interpreted as descriptive and hypothesis generating and warrant confirmation in controlled trials.
    Keywords:  coflex implant; degenerative spondylolisthesis; interlaminar device; interlaminar stabilization; low back pain; spinal stenosis
    DOI:  https://doi.org/10.14444/8881
  61. Orthop J Sports Med. 2026 Apr;14(4): 23259671261420423
    Extracorporeal Shock Wave Therapy in Chronic Lateral Elbow Tendinopathy: A Systematic Review.
    Verbeke Amélie, Vanwalleghem Ella.
       Background: Lateral elbow tendinopathy (LET) is a common musculoskeletal disorder caused by overuse, resulting in microtrauma to the extensor tendons. Because of its complex pathophysiology and high recurrence rate, LET poses significant treatment challenges. The effectiveness of extracorporeal shock wave therapy (ESWT) in treating LET remains controversial.
    Purpose: To evaluate the therapeutic benefits of ESWT by comparing its effects to those of both placebo ESWT and conventional physical therapy.
    Study Design: Systematic review; Level of evidence, 1.
    Methods: A systematic review of randomized controlled trials (RCTs) was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The primary outcome measure was pain, assessed using the visual analog scale. Secondary outcome measures included maximal grip strength, Disabilities of the Arm, Shoulder and Hand score, Patient-Rated Tennis Elbow Evaluation (PRTEE) score, and Roles and Maudsley score. The risk of bias for each included study was assessed using the Cochrane risk of bias tool.
    Results: Eleven RCTs were included, of which only 4 studies had a low risk of bias. Among these 4 studies, Aldajah et al (2022) demonstrated significant benefits of ESWT in pain reduction, muscle strength, and function. Guler et al (2018) observed improvements within the ESWT group, but no significant differences compared to placebo. Karaca et al (2022) found no significant differences in pain, grip strength, and PRTEE scores. Staples et al (2008) reported no statistically significant differences in pain and function between the ESWT and placebo groups.
    Conclusion: Although some studies report positive effects of ESWT, the evidence remains inconclusive. Future research should focus on optimizing ESWT protocols, addressing potential biases, and identifying patient subgroups that would benefit most from this treatment. ESWT may be a valuable adjunct to physical therapy in managing chronic LET.
    Keywords:  ESWT; aging athlete; chronic lateral elbow tendinopathy lateral epicondylitis; elbow; extracorporeal shock wave therapy; forearm; lateral elbow tendinopathy; physical therapy modalities; physical therapy/rehabilitation; shock wave therapy; tennis elbow
    DOI:  https://doi.org/10.1177/23259671261420423
  62. J Hand Surg Asian Pac Vol. 2026 May 12.
    What Is the Best Surgical Treatment for Ulnar Styloid Impaction Syndrome? - A Systematic Review.
    Mauro Maniglio, Andreas Weber, Christina Wanivenhaus, Pietro DI Summa, Lisa Reissner, Andreas Schweizer.
      Background: Ulnar styloid triquetrum impaction syndrome (USTI) is a rare cause of ulnar-sided wrist pain resulting from a mechanical conflict between an elongated ulnar styloid and the carpal bones. Despite various surgical options, there is no consensus on the optimal treatment. This study aims to systematically review and synthesise the available literature on the surgical treatment of USTI, focussing on clinical presentation, surgical techniques, outcomes and complications. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Four databases (PubMed, Medline, Embase and Ovid) were searched for publications through May 2025 using terms related to USTI. Inclusion criteria were studies in English, French or German reporting surgically treated cases in adult patients. Outcomes assessed included pain, range of motion, grip strength, patient-reported outcome measures (PROMS) and patient satisfaction. Study quality was rated using OCEBM Levels of Evidence. Results: Twelve studies (two cohort, five case series and five case reports) were included. The majority were retrospective and of low methodological quality (Level 4 or 5). Surgical techniques included partial ulnar styloid resection (n = 8), complete resection (n = 2) and osteotomies (n = 2), with variable approaches to triangular fibrocartilage complex (TFCC) management. Postoperative outcomes generally showed pain relief, although data on range of motion, grip strength and PROMS were inconsistently reported. Complication rates were generally low, and patient satisfaction was high (when recorded). Conclusions: Surgical treatment of USTI yields good clinical outcomes in selected patients; however, the literature is limited by methodological weaknesses and heterogeneity in surgical technique and outcome reporting. Prospective studies with standardised measures are needed to optimise management strategies. Level of Evidence: Level III (Therapeutic).
    Keywords:  Long ulnar styloid; Stylocarpal impaction; Ulnar styloid carpal impaction; Ulnar styloid impaction syndrome; Ulnar styloid resection; Ulnar styloid triquetral impaction
    DOI:  https://doi.org/10.1142/S2424835526500311
  63. J Orthop Surg Res. 2026 May 14.
    Subchondral bone marrow aspirate concentrate injection improves clinical outcomes and reduces bone marrow lesions in knee osteoarthritis: 12-month retrospective analysis.
    Sohaib Hasan Abdullah Ezzi, Hao Ding, Song Wu, Muhammad Adil Malik, Malek Mohammed Ali Alshabi, Wenxiu Zhang, Xu Cao, Junjie Huang.
       PURPOSE: This study had two primary aims: (1) to evaluate the clinical efficacy of fluoroscopically-guided subchondral autologous bone marrow aspirate concentrate (BMAC) injection for reducing pain and improving function in patients with knee osteoarthritis (OA)-associated bone marrow lesions (BMLs), we hypothesized significant improvements across validated outcome measures at 12 months; and (2) to assess early radiologic changes in BML severity using MRI, hypothesizing a significant reduction in MOAKS scores at 3 months. Secondary aims evaluated subgroup differences by age and body mass index (BMI), with age stratified as ≤ 50, 50-60, 60-70, and > 70 years, and hypothesizing superior outcomes in younger patients and those with lower BMI.
    METHODS: Retrospective evaluation of consecutive patients aged ≥ 18 years, with symptomatic knee OA and MRI-confirmed femoral or tibial subchondral BMLs, who underwent treatment between September 2022 and March 2024, with 12-month follow-ups ending in March 2025. Inclusion required BMI 18-30 kg/m2, neutral/varus limb alignment without deformity, intact cruciate ligaments/menisci, and no intra-articular injections within 12 months. Exclusion criteria included infection, BMI > 30 kg/m2, ligament/meniscal injuries, or prior cellular therapy. Autologous BMAC was harvested from the posterior superior iliac crest, concentrated via density gradient centrifugation, and injected subchondrally under C-arm fluoroscopy. Primary outcomes included the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Visual Analog Scale (VAS) at baseline and at 1, 3, 6, and 12 months. The secondary outcome was the MRI Osteoarthritis Knee Score (MOAKS) at baseline and at 3 months. Repeated measures ANOVA/Friedman tests were used; p < 0.05 was considered significant.
    RESULTS: 62 patients (mean age 57.7 ± 12.9 years; 56.5% female; mean BMI 24.4 ± 3.7 kg/m2; 12-month follow-up) demonstrated significant improvements across all KOOS subscales (p < 0.001), WOMAC (p < 0.001), and VAS (p < 0.001) versus baseline. MOAKS scores reduced significantly at 3 months (p < 0.001). Patients with BMI < 24 kg/m2 showed superior KOOS-pain improvement at 12 months (p = 0.043) and within this group, MOAKS scores significantly improved at 3 months (p < 0.001). Patients ≤ 60 years exhibited greater VAS reduction at 1 month (p = 0.021) than those > 70 years.
    CONCLUSION: In this retrospective case series, fluoroscopically guided subchondral BMAC injection was associated with significant and sustained clinical improvement in pain and function over 12 months, alongside an early reduction in MRI-detected bone marrow lesion severity at 3 months. Because MRI assessment was limited to the early postoperative period, no conclusions can be drawn regarding the durability of structural changes or lesion resolution. These findings are encouraging and warrant confirmation in randomized controlled trials incorporating longer-term and quantitative MRI follow-up.
    LEVEL OF EVIDENCE: IV.
    Keywords:  Bone marrow aspirate concentrate; Bone marrow lesions; Osteoarthritis; Subchondral injection; Total knee arthroplasty
    DOI:  https://doi.org/10.1186/s13018-026-06814-3
  64. J Arthroplasty. 2026 May 08. pii: S0883-5403(26)00476-6. [Epub ahead of print]
    Is it Really Less Painful to Undergo Total Hip Arthroplasty than Total Knee Arthroplasty?
    Manjot Singh, Dagny E Scannell, Aidan P McAnena, Joyce Harary, Peter L Schilling, Wayne E Moschetti.
       BACKGROUND: Severe hip and knee osteoarthritis can produce major pain, pain-related disability, and functional limitations. While total hip (THA) and knee (TKA) arthroplasties can provide pain relief in these populations, an assessment and comparison of their postoperative course of improvement in pain scores is lacking.
    METHODS: In this retrospective review, patients who underwent unilateral THA or TKA between November 2018 and December 2023 and used a web-based home therapy program were included. In total, 1,373 THA and 1,428 TKA patients were included. Daily Visual Analog Scale (VAS) pain scores (0 to 10) were followed from 30 days preoperatively to 90 days postoperatively across all patients. Mean pre- and post-operative plateaus in pain scores were compared across all cohorts using multivariate linear regression analyses. The THA patients had lower mean age, percent women, and mean body mass index (P < 0.05).
    RESULTS: Preoperatively, THA patients reported a 0.7 point higher mean pain score (P < 0.001). Within one week of surgery, THA patients noted a 1.8 points larger drop in pain scores. Postoperatively, THA patients noted an earlier drop (within the first versus within the second week) and plateau (58 versus 77 days) in pain scores and had a 0.9 point lower mean plateau pain score (P < 0.001) than TKA patients. After stratification by history of narcotics use, THA and TKA patients who reported preoperative narcotics use had a 0.6 point and 0.4 point higher mean preoperative pain score, respectively (P < 0.001). These patients achieved an earlier plateau in pain scores across both cohorts (THA: 53 versus 58 days; TKA: 54 versus 78 days), but had a 1.1 and 1.1 point higher mean postoperative pain score, respectively (P < 0.001).
    CONCLUSION: While THA patients had more severe pain preoperatively, they experienced more immediate improvements in their pain outcomes, achieved an earlier plateau in their scores, and had lower postoperative pain than TKA patients. Preoperative narcotics use significantly worsened the postoperative course for both cohorts.
    Keywords:  Narcotic Use; Pain; THA; TKA; Total Hip Arthroplasty; Total Knee Arthroplasty
    DOI:  https://doi.org/10.1016/j.arth.2026.04.109
  65. Radiol Case Rep. 2026 Aug;21(8): 2977-2981
    Delayed sciatic nerve branch injury following a gluteal stab wound presenting as intrinsic foot muscle denervation: A case report.
    Bahman Rasuli, Elaheh Zaremehrjerdi, Milad Haji Agha Bozorgi, Ali Forat Yazdi.
      Penetrating injuries to the gluteal region may result in occult peripheral nerve damage. Delayed presentation and nonspecific symptoms can lead to missed or late diagnosis, increasing the risk of irreversible muscle denervation and functional impairment. A 40-year-old previously healthy man presented with progressive left foot paresthesia and gait disturbance six months after sustaining a stab wound to the left buttock. Initial emergency management focused on hemorrhage control and wound closure, while early neurologic symptoms were overlooked. MRI of the left foot demonstrated diffuse edema and signal alteration within the intrinsic foot muscles, consistent with denervation injury. Retrospective clinical correlation revealed a penetrating gluteal injury, implicating a sciatic nerve branch injury as the underlying cause. This case emphasizes the importance of considering peripheral nerve injury in patients with penetrating trauma along the anatomic course of major nerve bundles. Early neurologic evaluation, appropriate imaging, and a multidisciplinary approach are essential to prevent delayed diagnosis and irreversible muscle atrophy.
    Keywords:  Intrinsic foot muscles; MRI; Muscle denervation; Penetrating trauma; Peripheral nerve injury; Sciatic nerve injury
    DOI:  https://doi.org/10.1016/j.radcr.2026.04.021
  66. Pain Pract. 2026 Jun;26(5): e70171
    Brachial Plexopathy: When You Hear Hooves, Think Horses Not Zebras!
    Abdullah Emre Uğur, Beytullah Yazar, Levent Özçakar.
      
    DOI:  https://doi.org/10.1111/papr.70171
  67. Int J Chron Obstruct Pulmon Dis. 2026 ;21 599148
    Pathogenesis, Diagnostic Advances, and Therapeutic Management of Chronic Obstructive Pulmonary Disease: A Narrative Review.
    Shidong Wang, Hongyan Han, Xiaoyan Hu, Kangjie Hong.
      Chronic obstructive pulmonary disease (COPD) is a leading global cause of morbidity and mortality, now recognized as a complex, heterogeneous disorder driven by environmental exposures, genetic susceptibility, immune dysregulation, and accelerated lung aging rather than solely by airflow limitation. This shift in understanding has fundamentally altered perspectives on its development and treatment. This narrative review synthesizes recent advances from 141 studies identified through a structured literature search of PubMed and Web of Science. It explores the molecular and cellular mechanisms of COPD pathogenesis and the resulting structural and functional lung changes. The review highlights innovations in diagnostics, including advanced imaging, physiological assessments, and biomarkers that enable more precise patient classification beyond spirometry. Progress in pharmacotherapy includes personalized inhaled therapies and targeted anti-inflammatory agents, while non-pharmacological approaches such as pulmonary rehabilitation and digital health technologies are increasingly integral to comprehensive management. Despite these advances, challenges persist, including inconsistent early detection, a lack of disease-modifying treatments, and significant variability in disease course and treatment response. This review provides a cohesive overview of current knowledge, identifies ongoing research needs, and outlines priorities for advancing personalized, mechanism-based care for COPD patients.
    Keywords:  airway inflammation; chronic obstructive pulmonary disease; emphysema; inhaled therapy; precision medicine; pulmonary rehabilitation
    DOI:  https://doi.org/10.2147/COPD.S599148
  68. Bioinformation. 2026 ;22(2): 1103-1108
    Effect of combined anteversion on outcomes in total hip replacement.
    Sanjul Bansal, Amol Kawde, Abhishek Keshav, Kartikeya Singh, Pratima Nagale, Sachin Parmar.
      Osteonecrosis of the femoral head is a debilitating disease where the bone tissue dies as a result of impaired blood flow, which affects young adults and in most cases, it leads to collapse in the absence of surgical intervention. In this analytical cross-sectional study, 30 patients with osteonecrosis of the femur head were compared to determine the treatment outcomes of operative management using total hip arthroplasty (THA) and conservative treatment over 18 months. Operative group showed considerably better results with a change in Modified Harris Hip Score of 457 to 756 at 6 months compared to 467 to 687 in the conservative group (p=0.02). At 6 months, the operative group (7.2+1.3 to 2.5+0.9) had lower pain than the conservative group (7.5+1.1 to 3.8+1.1) according to Visual Analog Scale (p=0.01). The rates of radiological union were higher in the operative group (95% vs 70% at 6 months, p=0.04), showing that THA offers a far better functional outcome, pain relief and bone healing than conservative treatment of osteonecrosis of the femoral head.
    Keywords:  Osteonecrosis; conservative treatment; modified harris hip score; total hip arthroplasty
    DOI:  https://doi.org/10.6026/973206300221103
  69. Therapie. 2026 Apr 21. pii: S0040-5957(26)00060-0. [Epub ahead of print]
    [Efficacy of celecoxib, diclofenac, etoricoxib, ibuprofen, ketoprofen and naproxen in low back pain with or without nerve root pain: Systematic review of literature and meta-analysis of randomized controlled trials].
    Paul Alfieri, Marie Landry, Rémy Boussageon.
       OBJECTIVES: To assess the efficacy of naproxen, ibuprofen, ketoprofen, diclofenac, etoricoxib and celecoxib in low back pain with or without radiculalgia.
    METHOD: Systematic review and meta-analysis of randomised controlled trials (RCTs) using the REB method. Eligibility criteria were RCTs assessing the painkiller efficacy of the aforementioned non-steroidal anti-inflammatory drugs (NSAIDs) administered orally versus placebo, in acute and chronic low back pain with or without radiculalgia. The literature search was conducted on Medline, Cochrane Central Register of Controlled Trials, and ClinicalTrial.gov until 31/12/2024. The risks of bias were assessed using the tool Risk of Bias 2 (RoB2) from the Cochrane collaboration. In addition to the qualitative analysis using the REB method, a quantitative analysis was conducted using Review Manager v5.4. The standardised mean differences (SMD) were calculated with a 95% confidence interval (95% CI). Statistical significance was met if the P-value was<0.05.
    RESULTS: A total of 11 RCTs were identified: 6 concerned acute low back pain and 5 chronic low back pain. Six were at low risk of bias for pain intensity, and 4 at low risk of bias for functional capacity; 5 were at high risk of bias for pain intensity and 5 at high risk of bias for functional capacity. Three thousand seven hundred eighty-four (3784) patients were included: 2142 suffered from chronic low back pain and 1642 from acute low back pain. The REB analysis concluded "solid evidence of efficacy" for diclofenac in acute low back pain. For the ibuprofen in acute low back pain without radiculalgia, the results were "conclusive to be confirmed". For the naproxen in acute low back pain with radiculalgia, the results were "conclusive to be confirmed". For the other treatments and indications, the conclusion was "lack of evidence".
    DISCUSSION: This review has several limitations: a small number of trials that evaluated NSAIDs versus placebo, which limits the interpretation of possible publication bias by the interpretation of funnel plots. More than half of the selected trials aimed to evaluate a different active ingredient or treatment, with the NSAIDs studied primarily used as comparators. Only trials published in French and English were included, which may have introduced selection bias. Furthermore, the results of the RCTs often focused on secondary rather than primary endpoints. Of the 6 NSAIDs studied, only diclofenac showed solid evidence of efficacy on pain intensity in acute low back pain. Ibuprofen and Naproxen showed conclusive evidence requiring confirmation. For the other drugs, there was no evidence of efficacy according to the REB method. For all the analyses, the magnitude of the effect was small and not clinically relevant. It is necessary to conduct new RCTs to confirm the clinical interest of NSAIDs in acute and chronic low back pain.
    Keywords:  Anti-inflammatoire non stéroïdien; Essais contrôlés randomisés; Lombalgie; Low back pain; Meta-analysis; Méta-analyse; Non-steroidal anti-inflammatory drugs; Randomised controlled trials; Revue de la littérature; Systematic review
    DOI:  https://doi.org/10.1016/j.therap.2026.04.003
  70. BMC Musculoskelet Disord. 2026 May 12.
    Impact of the timing of initiation of a smartphone-based application on very short-term postoperative satisfaction after total hip arthroplasty: a prospective observational study.
    Tsutomu Nakayama, Sachiyuki Tsukada, Naoyuki Hirasawa.
       BACKGROUND: This prospective observational study included patients undergoing primary total hip arthroplasty (THA). Shortened hospital stays after THA have increased the importance of patient self-management and early engagement in rehabilitation. Smartphone-based digital health applications are increasingly used in perioperative care; however, the clinical value of preoperative initiation remains unclear. To examine whether preoperative initiation of a smartphone-based physiotherapy support application improves postoperative patient satisfaction and behavioral outcomes compared with postoperative initiation in patients undergoing primary THA.
    METHODS: This prospective single-center observational study included patients who underwent primary THA between October 2024 and March 2025. Patients were classified into preoperative or postoperative application initiation groups based on the timing of use. The preoperative group started use at a mean of 19.3 ± 6.4 days before surgery (range: 7 to 30 days), while the postoperative group began use on postoperative day 1. Allocation was determined by smartphone ownership, patient preference, and timing of institutional implementation. Those who began application use one day before surgery were excluded. The primary outcome was the dissatisfaction score of the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). Secondary outcomes included the Forgotten Joint Score-12 (FJS-12) and stages of behavior change. Outcomes were assessed preoperatively and at 1 week, 1, 3, and 6 months postoperatively.
    RESULTS: A total of 137 patients were analyzed. The preoperative initiation group demonstrated a lower JHEQ dissatisfaction score at 1 week postoperatively compared with the postoperative group (mean difference: -10.4, 95% confidence interval (CI): -19.62 to -1.20; unadjusted p = 0.03; adjusted p = 0.15 after Bonferroni correction). The effect size at 1 week was Cohen's d = 0.39 (95% CI: 0.04 to 0.74). No significant between-group differences were observed at later time points or in FJS-12 scores. At 1 month, behavior change stage distributions differed between groups (p = 0.02).
    CONCLUSIONS: Earlier (preoperative) initiation of a smartphone-based physiotherapy support application was associated with a clinically relevant reduction in patient dissatisfaction at one week postoperatively and more favorable early behavioral readiness for rehabilitation. Shifting the timing of digital health support to the preoperative phase, thereby facilitating earlier exposure to education and guidance, may enhance the early postoperative patient experience and facilitate engagement. The clinical magnitude of this effect was supported by the effect size and confidence interval at the initial recovery stage.
    Keywords:  Digital health; Patient satisfaction; Physiotherapy; Smartphone application; Total hip arthroplasty
    DOI:  https://doi.org/10.1186/s12891-026-09959-8
  71. J Am Acad Orthop Surg. 2026 Jun 01. 34(11): e1495-e1502
    Osteochondritis Dissecans of the Capitellum in the Young Athlete.
    Joseph S Tramer, Rebecca M Haley, Paul M Saluan.
      Osteochondritis dissecans of the capitellum is an uncommon but notable cause of elbow pain in the young athlete. Although the exact pathogenesis of this condition is not completely understood, repetitive microtrauma, such as in throwing athletes or gymnasts, can predispose these groups to developing osteochondral lesions. Patients may present with laterally based elbow pain, swelling, or loss of range of motion. Initial screening radiographs can often detect these lesions, with MRI key to determining the exact lesion size, location, and stability. Treatment depends on multiple factors and may include a period of rest, particularly in stable lesions. Surgery is more often recommended in patients with unstable lesions or loose bodies or those who have persistent lesions despite a course of nonsurgical management. Historically, isolated osteochondritis dissecans removal and débridement yielded suboptimal results in the medium to long term, especially in larger and more laterally based lesions. Osteochondral autograft or allograft transplantation allows for more anatomic restoration of capitellar anatomy and has become the preferred treatment for larger, unstable defects with promising outcomes and return to activity.
    DOI:  https://doi.org/10.5435/JAAOS-D-25-00800
  72. Br J Gen Pract. 2026 May;pii: bjgp26X745089. [Epub ahead of print]76(suppl 1):
    Efficacy of exercise and opioid interventions in improving pain and functioning outcomes in acute low back pain: a systemic review.
    Hamid Hashemi.
       BACKGROUND: Low back pain is a very common condition with significant healthcare and economic consequences. The acute form (<3 months duration) often progresses to the well-researched chronic state. Acute low back pain is less well understood but managing it more effectively may help address the growing burden of the chronic condition.
    AIM: This systematic review aimed to assess the evidence for the efficacy of exercise and opioid therapies to manage pain and function in acute low back pain using validated patient-reported outcome measures.
    METHOD: Literature searches were performed of the databases, Web of Science, Pubmed, and Scopus, and a significant risk of bias analysis was performed on the results.
    RESULTS: After screening 1110 papers, 22 randomised controlled trials were included for review. Eighteen studies assessing various exercise interventions showed some evidence that they can improve pain and functioning outcomes up to 6 weeks from pain onset. Four opioid trials found limited evidence to support their use in managing acute low back pain. Risk of bias was found to be high for most of the exercise-based studies. Two opioid studies had a low risk of bias and two had some concerns.
    CONCLUSION: Trials for exercise interventions lacked the robustness to make reliable conclusions, although they indicated possible benefits of their use for improving pain and functional outcomes up to 6 weeks. Opioid interventions cannot be recommended for managing acute low back pain. More high-powered randomised controlled trials with lower risk of bias are required to make more meaningful conclusions.
    DOI:  https://doi.org/10.3399/bjgp26X745089
  73. J Shoulder Elbow Surg. 2026 May 12. pii: S1058-2746(26)00262-4. [Epub ahead of print]
    Efficacy and safety of elective primary total elbow arthroplasty in the last 25 years: a systematic review.
    Dimitris Challoumas, Tin-Ning Wong, Brendan Barrett, Jack Tierney, Christopher P Little, Christopher A Peach.
       BACKGROUND: This systematic review evaluates the efficacy and safety of elective primary total elbow arthroplasty (TEA).
    METHODS: A comprehensive literature search identified studies reporting functional and safety outcomes of primary elective TEA in ≥10 cases in the last 25 years. Studies reporting data on acute TEA for trauma and revision TEA were excluded. Primary outcomes included function, pain, and range of motion (ROM). Secondary outcomes were revision, reoperation rates and other complications. Revision and all efficacy outcomes were pooled separately for short-, mid- and long-term follow-up, which were based on mean follow-up of included studies.
    RESULTS: A total of 76 studies were included with a total of 4254 TEAs (mean age 59 years). The main indication was rheumatoid arthritis (RA). Meaningful improvements were observed in all efficacy outcomes (weighted means): at long-term follow-up (>5 years of mean follow-up), pain visual analogue scale (VAS) was 1.9 points, Mayo Elbow Performance Score (MEPS) was 82 points, disabilities of the arm, shoulder and hand (DASH) scale was 43 points and total flexion-extension and pronation-supination arcs were 106 and 137 degrees, respectively. Weighted mean late survivorship (at least 7 years of mean follow-up; revision as endpoint) was 86.3%; weighted mean deep infection was 3.2%, all-cause reoperation 16.8%, periprosthetic fracture (intra- and/or postoperative) 6.8%, persistent ulnar nerve paraesthesia/dysaesthesia 5.8% and dislocation of unlinked implants 5%. Subgroup analyses of RA/inflammatory arthritis patients found similar efficacy and safety outcomes to the overall population. All outcomes were very similar between unlinked and semi-constrained prostheses except for a slightly higher reoperation rate in favour of the semi-constrained group (weighted mean 18.6% vs 15%).
    CONCLUSION: Elective primary TEA confers meaningful benefits with regard to pain relief, function and ROM, however, it is associated with high revision and reoperation rates which remain static over the past decades.
    Keywords:  elbow replacement; outcomes; rheumatoid elbow; semi-constrained; survivorship; unlinked
    DOI:  https://doi.org/10.1016/j.jse.2026.04.055
  74. J Ultrasound Med. 2026 May 13.
    Sono-Anatomy and Histology of the Deep Fasciae in the Upper Limb.
    Carmelo Pirri, Nina Pirri, Lucia Petrelli, Veronica Macchi, Andrea Porzionato, Raffaele De Caro, Carla Stecco, Levent Özçakar.
      The deep fascia of the upper limb represents a pivotal anatomical structure essential for effective force transmission, dynamic compartmentalization and musculoskeletal stability. Its composition (rich in type I collagen fibers) enables both mechanical resilience and functional adaptability, crucial for the upper limb's complex movements. Recent advancements in high-resolution ultrasonography, complemented by anatomical/histological studies, have provided unprecedented insights into the fascia's microarchitecture and clinical significance. This paper delivers a simple and systematic guide as regards the sono-anatomy of deep fasciae in the upper limbs, including brachial, antebrachial and palmar fasciae as well as their continuity with adjacent structures. Integrating anatomical, histological and sonographic evidence, this article sheds light on the clinical relevance of fascia-centric approaches applied in rehabilitative and surgical treatments.
    Keywords:  arm; deep fascia; finger; forearm; hand; shoulder; ultrasonography
    DOI:  https://doi.org/10.1002/jum.70292
  75. Clin Radiol. 2026 Apr 16. pii: S0009-9260(26)00137-6. [Epub ahead of print]98 107361
    Clinical outcomes of genicular artery embolization for knee osteoarthritis in an indian observational cohort: the GENIE study.
    K Damodharan, V H Prasadaswamy, S H Majety, P Mohandas.
       AIMS: The GENIE Study (Genicular Artery Embolization: Indian Experience) evaluates real-world effectiveness and safety of GAE in an Indian cohort.
    MATERIALS AND METHODS: This ambispective, single-centre observational study included patients who underwent GAE for symptomatic knee OA. Pain (Visual analogue score - VAS) and functional outcomes (Western Ontario and McMaster Universities Osteoarthritis Index - WOMAC) were assessed at baseline and follow-up timepoints up to 18 months. Safety outcomes included procedure-related adverse events, complications, repeat GAE, and conversion to total knee replacement (TKR).
    RESULTS: A total of 122 patients were analysed. The majority of the patients (n=110, 90.2%) had advanced OA (mean Kellgren-Lawrence (KL) grade 3.8) making this study one of the very few to report outcomes of GAE in a large cohort of advanced OA patients. An average of 3.55 genicular vessels were embolized using permanent particulate embolic agents. VAS decreased from 8.79 ± 1.27 to 4.15 ± 2.54 at 18 months (mean reduction 4.64 ± 2.72; p<0.001). WOMAC improved from 76.64 ± 11.08 to 42.03 ± 18.93 (mean improvement 34.61 ± 17.55). Improvements were sustained through 18 months. Adverse events were mostly minor; TKR conversion remained low (1.6-4.1%). Minimal Clinically Important Difference (MCID) achievement was high at Week 2 (VAS 97.5%, WOMAC 94.3%) and remained substantial at 18 months (VAS 90.3%, WOMAC 76.7%), indicating sustained clinical benefit.
    CONCLUSIONS: The GENIE Study demonstrates that GAE is a safe, effective, and durable minimally invasive treatment for knee OA in the Indian population. These findings reinforce its potential role within non-surgical OA management algorithms.
    DOI:  https://doi.org/10.1016/j.crad.2026.107361
  76. POCUS J. 2026 May;11(1): 89-91
    POCUS to Evaluate for Achilles Tendon Involvement in Ankle Lacerations.
    Ana Ruiz Castaneda, Gretel Rodriguez, Olivia Peña, Paul Khalil.
      Achilles tendon injury is uncommon in children but is often caused by direct trauma to the posterior ankle. The diagnosis of Achilles tendon involvement after injury may be inadequate when based solely on physical examination findings. There is limited literature describing the identification of Achilles tendon injury in the pediatric population with point of care ultrasound (POCUS). This case series describes two patients with ankle lacerations in whom Achilles tendon involvement was evaluated using POCUS.
    Keywords:  Achilles tendon rupture; Ankle lacerations; POCUS; Point of care ultrasound
    DOI:  https://doi.org/10.24908/pocusj.v11i01.20121
  77. J Hand Surg Eur Vol. 2026 May 10. 17531934261448109
    Comparative outcomes of single versus multiple trigger finger releases: a propensity score matched cohort study.
    Ramin Shekouhi, Yash Singh, Brandon Byrd, Mairin Guidry, Mary M Holohan, Mark A Maier, Harvey Chim.
       INTRODUCTION: Trigger finger (TF) release is one of the most common procedures in hand surgery. It is not clear whether outcomes differ when multiple digits are released in the same operating session. The present study aimed to compare outcomes between patients undergoing single digit and multiple digit TF release.
    METHODS: We conducted a retrospective cohort study using the TriNetX database (https://trinetx.com/) to identify patients undergoing trigger finger release between 2010 and 2025. Patients were categorized into single digit and multiple digit release groups. Postoperative complications within 90 days, as defined by International Classification of Diseases, 10th revision codes, including hand pain, stiffness, haematoma, delayed wound healing and need for flexor tenolysis, were assessed. To minimize confounding, cohorts were balanced using 1:1 propensity score matching for demographics and comorbidities.
    RESULTS: A total of 119,306 patients undergoing trigger finger release were identified. After 1:1 propensity score matching, 48,840 patients were included in each cohort with well-balanced baseline demographics and comorbidities. Compared with single-digit release, multiple-digit release was associated with significantly higher rates of postoperative pain (1.92% vs. 1.00%; RR 1.92; 95% CI: 1.72 to 2.14; p < 0.001), joint stiffness or contracture (6.82% vs. 3.03%; RR 2.25; 95% CI: 2.12 to 2.39; p < 0.001), and subsequent flexor tenolysis (1.06% vs. 0.80%; RR 1.32; 95% CI: 1.16 to 1.51; p < 0.001). Complex regional pain syndrome was rare and observed only in the multiple-digit cohort (0.04%).
    CONCLUSION: Multiple-digit trigger finger release in a single operative session is associated with higher rates of postoperative pain, joint stiffness and need for flexor tenolysis compared with single-digit release, even after adjustment for demographics and comorbidities.
    LEVEL OF EVIDENCE: III.
    Keywords:  Database; hand surgery; tendinopathy; trigger digit; trigger finger
    DOI:  https://doi.org/10.1177/17531934261448109
  78. Physiother Res Int. 2026 Jul;31(3): e70228
    Efficacy of Active Exercises to Improve Range of Motion in Knee Joint After Total Knee Arthroplasty. A Randomized Controlled Trial.
    Lisbeth Mogensen, Torben Rasmussen, Julie Rasmussen, Stig Molsted.
       BACKGROUND AND PURPOSE: After total knee arthroplasty (TKA), not everybody gains a sufficient joint mobility. The objective of this study was to investigate the effects of high-frequency (HF) versus low-frequency (LF) self-managed knee flexion exercises in individuals with reduced flexion after a TKA.
    METHODS: The study was a randomized controlled trial in adults with a TKA within 6 to 26 weeks and knee flexion ≤ 105° who participated in an 18-day inpatient rehabilitation program. Patients were randomized to additional self-managed HF (eight flexion and extension exercises per day) versus LF (two flexion and extension exercises per day). The primary outcome was knee flexion change. Secondary outcomes were changes of knee extension, Six-Minute Walk Test, 30 Second Chair-Stand Test, pain using Numeric Rating Scale, and Knee Injury and Osteoarthritis Outcome Score.
    RESULTS: The participants (n = 83) were 65 (SD 8.8) years old and 70% were women. The HF (n = 44) and LF (n = 39) groups performed knee flexions 5.3 (1.4) and 1.7 (0.3) times/day, respectively. The flexion increased 14.2 [11.6; 16.7]° with HF versus 10.1 [8.6; 11.6]° with LF, with 4.1° difference between groups (p = 0.007). Secondary outcomes increased in the two groups without differences between the groups.
    DISCUSSION: In individuals with reduced joint mobility after TKA, HF self-managed knee flexion exercises were associated with a positive change in flexion compared with LF, though the between-group difference was smaller than expected.
    TRAIL REGISTRATION: The study was registered on ClinicalTrials.gov (NCT06188091).
    Keywords:  exercise; range of motion; rehabilitation; total knee arthroplasty
    DOI:  https://doi.org/10.1002/pri.70228
  79. BMC Musculoskelet Disord. 2026 May 13.
    The correlation between torn supraspinatus tendon thickness and commonly used radiological predictive factors for repairability in rotator cuff tears.
    Chang-Lin Wu, Poyu Chen, Cheng-Pang Yang, Chen-Heng Hsu, You-Hung Cheng, Joe Chih-Hao Chiu.
       BACKGROUND: Pre-operative imaging evaluation is critical in determining the correct surgical indication and healing rate of rotator cuff repairs. While factors like supraspinatus (SSP) muscle fatty infiltration (FI), tangent sign, remnant tendon length, and acromiohumeral distance (AHD) are well-recognized to predict the reparability of SSP, a comprehensive understanding of the interplay between various torn tendon characteristics, like remnant tendon thickness, remains limited.
    STUDY DESIGN: Level III, Retrospective cohort study.
    METHODS: A retrospective analysis was conducted on 200 patients who underwent rotator cuff-related surgery. Preoperative radiographs and MRI scans were assessed independently by two observers. Patients were classified as either repairable or irreparable based on the extent of SSP FI (reparable is defined as SSP muscle FI of Goutallier stage ≦ 2, while irreparable is defined as SSP muscle FI of Goutallier stage > 2, reflecting common surgical decision-making for procedures beyond standard repair). The study's primary aim was to explore the correlation between pre-operative imaging parameters and the established radiographic definition of irreparable SSP tears (SSP muscle FI of Goutallier > 2), which guides initial surgical planning. The statistical analysis was performed.
    RESULTS: Out of the 200 cases, 156 were repairable, and 44 were irreparable. Significant differences were observed in remnant SSP tendon length, tear size, and tendon thickness between the two groups. The mean SSP tendon thickness was 4.6 ± 0.7 mm in the repairable group and 3.4 ± 0.8 mm in the irreparable group. Using ROC analysis, a cut-off value of 3.9 mm for irreparable SSP tendon thickness was determined. A significant decrease in SSP tendon thickness was also associated with SSP Goutallier Stage > 2 muscle FI, positive SSP tangent sign, and modified Patte 3 SSP tear. Positive digitation signs were prevalent in 81% of Lafosse type I and II, and 100% in Lafosse type III and IV subscapularis (SSC) tears. SSP remnant tendon thickness significantly decreased when in SSC tear more than Lafosse type I, SSC FI > 1, and a positive digitation sign.
    CONCLUSIONS: This study highlights the interrelationships between radiographic parameters and their impact on SSP reparability. A remnant SSP tendon thickness of > 3.9 mm appears to be an independent predictor of reparability, demonstrating good sensitivity and specificity in this study.
    Keywords:  Irreparable tears; Muscle fatty infiltration; Remnant tendon length; Reparability; Rotator cuff tears; Tendon thickness
    DOI:  https://doi.org/10.1186/s12891-026-09951-2
  80. Clin Shoulder Elb. 2026 May 13.
    Keeled versus pegged glenoid components in total shoulder arthroplasty for primary osteoarthritis: a meta-analysis.
    Marc Boutros, Guy Awad, Jean-Pierre Saad, Zina Smadi, Reina Al Khatib, Raphael Bou Rached, Bassem Elhassan.
       Background: Glenoid fixation strongly influences longevity and outcomes in anatomic total shoulder arthroplasty. Keeled and pegged designs are common, but comparative evidence for function, range of motion, and survivorship is inconsistent.
    Methods: A systematic search of PubMed, Scopus, the Cochrane Library, and Google Scholar was conducted from database inception through December 2025. Thirteen comparative studies (n=3,219) met the inclusion criteria. Evaluated outcomes included patient-reported outcome measures (American Shoulder and Elbow Surgeons [ASES], Constant-Murley score, Simple Shoulder Test [SST], visual analog scale [VAS] pain scores), shoulder range of motion (flexion, external rotation, internal rotation), and implant-related outcomes, including failure and revision. Follow-up ranged from short to long-term (up to 26 years).
    Results: Across pooled analyses, no significant differences were observed between pegged and keeled glenoid components in ASES (P=0.69), Constant-Murley (P=0.61), SST (P=0.74), or VAS pain scores (P=0.88). Postoperative flexion (P=0.61) and external rotation (P=0.35) were comparable between groups. Pegged glenoid components demonstrated a statistically significant but small improvement in internal rotation (mean difference, 1.60°; 95% CI, 0.54°-2.66°; P=0.003). Revision rates were significantly lower with pegged glenoid components compared with keeled designs (risk ratio, 0.49; 95% CI, 0.28-0.86; P=0.01), while overall failure rates did not differ significantly between groups (P=0.07).
    Conclusions: Both designs yield similar pain relief, functional gains, and shoulder motion across most patient-reported outcome measures. Pegged components show lower revision risk and slightly better internal rotation, although survivorship findings are primarily supported by observational evidence. Selection should be individualized to anatomy, bone quality, and surgical factors, not expectations of superior overall function.
    Level of evidence: IV.
    Keywords:  Glenoid cavity; Implant survival; Osteoarthritis; Prosthesis design; Shoulder arthroplasty
    DOI:  https://doi.org/10.5397/cise.2025.01480
  81. Foot Ankle Orthop. 2026 Apr;11(2): 24730114261446302
    Return to Sport and Functional Outcomes After Minimally Invasive Zadek Osteotomy for Insertional Achilles Tendinopathy in Young Athletes: A Retrospective Case Series.
    Gil Genuth, Peter Stavrou, Chris Brown, Lukas D Iselin.
       Background: Insertional Achilles tendinopathy (IAT) is a common cause of posterior heel pain in active individuals and athletes. Traditional open surgical techniques are effective but associated with notable morbidity and prolonged rehabilitation. Minimally invasive Zadek osteotomy (MIS Zadek) has emerged as a tendon-preserving alternative aimed at reducing soft tissue disruption and facilitating early recovery. This study evaluated clinical and functional outcomes of MIS Zadek in young, athletic patients with IAT.
    Methods: This retrospective single-centre case series included patients younger than 55 years who underwent MIS Zadek for symptomatic IAT between 2022 and 2024, with a minimum follow-up of 18 months. All patients were physically active before symptom onset. Procedures were performed according to the technique described by Kaplan et al. Primary outcomes included return-to-sport time, Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), and PROMIS Pain Interference (PI). Secondary outcomes included visual analogue scale (VAS) pain scores, radiographic union, and complications. PROMIS outcomes were evaluated against established minimal clinically important difference thresholds.
    Results: Fifteen athletic patients (mean age, 37.2 ± 9.1 years; 10 males, 5 females) with no relevant comorbidities were included with a minimum 18-month follow-up. All patients returned to their preinjury level of sport at a mean of 4.2 ± 1.1 months. Radiographic union was achieved in all cases at a mean of 10.2 ± 2.1 weeks. PROMIS Physical Function improved from 39.6 ± 5.8 preoperatively to 52.4 ± 6.1 at 3 months and 59.1 ± 5.0 at final follow-up (P < .001), whereas PROMIS Pain Interference decreased from 63.9 ± 6.4 to 51.2 ± 6.0 and 45.1 ± 5.0, respectively (P < .001). VAS pain scores improved from 7.1 ± 1.2 to 1.8 ± 1.1 at final follow-up (mean change -5.3, 95% CI -6.0 to -4.6; P < .001). Two minor complications (13%) were observed.
    Conclusion: MIS Zadek was associated with meaningful pain relief, functional improvement, and return to sport in athletic patients with IAT in this cohort. These findings suggest that it may represent a viable tendon-preserving surgical option. Prospective comparative studies are needed to further evaluate its role relative to alternative treatments.
    Level of Evidence: Level IV, therapeutic case series.
    Keywords:  PROMIS outcomes; Zadek osteotomy; athletic population; insertional Achilles tendinopathy; minimally invasive surgery; return to sport
    DOI:  https://doi.org/10.1177/24730114261446302
  82. J Orthop Surg Res. 2026 May 13.
    Likelihood of secondary surgery due to osteoarthritis following ankle fracture fixation: a systematic review.
    Rebecca Beni, Adrian Kendal, Diego Agustín Abelleyra Lastoria, Conor Hennessy, Simon Abram, James Masters, Matthew L Costa.
       BACKGROUND: Ankle fractures are common injuries that can lead to long-term complications, including post-traumatic osteoarthritis. The rate of surgical intervention for osteoarthritis following fracture fixation is unclear. Understanding the burden of subsequent procedures is essential to inform patients and guide treatment strategies. This review investigates the risk of surgical interventions for osteoarthritis after surgical fixation of ankle fractures.
    METHODS: We performed a systematic review following PRISMA 2020 and registered the protocol in PROSPERO (CRD42024615284). We included studies of adults (≥ 16 years) with acute ankle fractures treated surgically who later required operative treatment for osteoarthritis. Two reviewers independently performed data extraction and risk-of-bias assessment (Newcastle-Ottawa Scale). Because of clinical and methodological heterogeneity, we synthesised findings narratively.
    RESULTS: From 2,425 records screened, eight cohort studies (n = 133,367) met inclusion criteria. The reported risk of ankle fusion or replacement due to osteoarthritis ranged from 0 to 4.2%, with mean follow-up ranging from 17 months to 21 years. One large registry study contributed the majority of patients.
    CONCLUSIONS: Reported rates of re-intervention for post-traumatic ankle osteoarthritis are low in the short to medium term but interpretation is limited by heterogeneity, generally short follow-up, and reliance on a single large registry cohort. High-quality, long-term studies are needed to determine the true lifetime burden and modifiable risk factors.
    Keywords:  Ankle fracture; Ankle fusion; Ankle replacement; Post-traumatic osteoarthritis; Reoperation; Systematic review
    DOI:  https://doi.org/10.1186/s13018-026-06928-8
  83. J Clin Med. 2026 Apr 29. pii: 3385. [Epub ahead of print]15(9):
    Snapchat-Based Structured Education Reduces Kinesiophobia and Improves Psychological Readiness and Perceived Knee Function Following Anterior Cruciate Ligament Reconstruction: A Quasi-Experimental Study.
    Abdullah H AlMuhaya, Thamer Alshahrani, Abdulsalam Alshammari, Salman Alsudairi, Mai Aldera, Dalia M Alimam.
      Background/Objectives: Psychological barriers, particularly kinesiophobia and diminished psychological readiness, represent critical yet undertreated obstacles to a successful return to sport following anterior cruciate ligament reconstruction (ACLR). Scalable, preference-aligned educational interventions capable of addressing these barriers during early rehabilitation are lacking. We aimed to evaluate the effectiveness of structured educational content delivered via Snapchat, as an adjunct to standard ACLR rehabilitation, in reducing kinesiophobia (primary outcome) and improving psychological readiness and perceived knee function (secondary outcomes). Methods: A total of 120 adults with clinically elevated kinesiophobia (TSK-17 > 37) undergoing post-operative ACLR rehabilitation were enrolled in a quasi-experimental, two-arm study with non-randomized allocation at the clinic-branch level at two branches of the same sports rehabilitation clinic (Joint Clinics, Riyadh, Saudi Arabia). Branch allocation assigned 60 participants to each group (intervention and control). The intervention group received 12 weekly structured educational videos via Snapchat alongside standard rehabilitation; the control group received standard rehabilitation alongside general ACLR information videos via Snapchat. TSK-17, ACL-RSI, and IKDC were assessed at baseline and at 12 weeks. Primary analysis used ANCOVA covarying baseline scores, complemented by mixed repeated measures ANOVA and intent-to-treat analysis. Results: Both groups improved across all outcomes; the intervention group demonstrated significantly greater gains. ANCOVA revealed significant between-group differences favoring the intervention for TSK-17 (adjusted mean difference = -2.82; d = 0.54; p < 0.001; d represents Cohen's d calculated from adjusted mean differences and pooled SD), ACL-RSI (+8.06; d = 0.77; p < 0.001), and IKDC (+8.90; d = 0.54; p = 0.002). Mean video completion was 82.8% among intervention participants. Intent-to-treat analyses using Multiple Imputation confirmed all findings. Conclusions: Snapchat-based structured education was associated with improvements in kinesiophobia, psychological readiness, and perceived knee function among the 102 analyzed participants (control n = 52; intervention n = 50) of the 120 enrolled. High engagement supports preference-based digital delivery as a scalable adjunct to standard rehabilitation.
    Keywords:  digital health; fear avoidance; psychological readiness; rehabilitation; return to sport; social media
    DOI:  https://doi.org/10.3390/jcm15093385
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