bims-ricfun Biomed News
on Rehabilitation ICF
Issue of 2026–05–10
eighty papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica
  1. Efficacy of IPACK block combined with intra-articular steroid injection in advanced knee osteoarthritis: a retrospective cohort study.
  2. Diagnostic Musculoskeletal Ultrasound in the Evaluation of the Medial Hamstrings.
  3. Efficacy of Ultra-high and High Molecular Weight Cross-Linked Hyaluronic Acids Compared with Saline in Knee Osteoarthritis: A Randomized Controlled Trial.
  4. Efficacy of botulinum toxin type a for treating chronic low back pain: a systematic review and metanalysis.
  5. Influence of Pain on Rotator Cuff Muscle Size and Function: A Case-Control Study with Ultrasound Assessment of Cross-Sectional Area and Tendon Thickness.
  6. Intra-articular adipose-derived cell therapies for knee osteoarthritis: a systematic review of randomized controlled trials.
  7. Longitudinal Changes in Patient-Reported Outcomes Following Carpal Tunnel Release: A Retrospective Cohort Study.
  8. Time-Dependent Efficacy and Safety of Percutaneous Treatments for Lateral Epicondylitis: A Systematic Review and Network Meta-Analysis.
  9. Effects of Neuromuscular Physiotherapy on Pain, Range of Motion, and Function in Shoulder-Related Disorders: A Meta-Analysis and Systematic Review.
  10. Pain Unraveled: Kinesio Taping as a Novel Approach to Myofascial Pain Management.
  11. Comparison of the efficacy of hyaluronic acid vs corticosteroids, platelet-rich plasma, and physical therapy in chronic shoulder pain:: a systematic review and a frequentist network metanalysis.
  12. Do Preoperative Intra-Articular Steroid Injections Affect the Choice of Surgical Procedures for Thumb Carpometacarpal Osteoarthritis?
  13. A Systematic Critical Appraisal of Clinical Practice Guidelines for Non-Pharmacological ‎Conservative Management of Complex Regional Pain Syndrome (CRPS) Using the ‎AGREE-II Instrument.
  14. Current Perspective on Orthobiology Applications for the Treatment of Intervertebral Disc Degeneration (IDD)-A Narrative Review.
  15. Hyaluronic Acid Injections for Knee Osteoarthritis.
  16. Assessment of adverse events and safety associated with intra-articular platelet-rich plasma injections compared to other injectates for knee osteoarthritis: A systematic review and meta-analysis.
  17. Quantitative Imaging Biomarkers of PRP-Induced Tendon Remodelling in Chronic Tendinopathy: Review and Single-Centre Experience with Ultrasound Radiomics and MRI T2 Profiling.
  18. [Advances and development trends in non-surgical treatment of knee osteoarthritis].
  19. Evaluating the Efficacy of Virtual Reality Exergaming in Frozen Shoulder Rehabilitation: A Randomized Clinical Trial.
  20. Prevalence of Carpal Tunnel Syndrome During Pregnancy in Iran.
  21. Time to return to sports in football players recovering from lower limb soft tissue injuries: a systematic review with meta-analysis.
  22. Ultrasonographic assessment of shoulder muscle thickness and isokinetic strength in patients with rotator cuff tendinopathy: A cross-sectional study.
  23. Olive-Derived Extracts and Bioactive Compounds for Pain Management in Osteoarthritis and Degenerative Knee Pain: A Systematic Review and Meta-Analysis.
  24. Evaluation of the Efficacy of Transdermal Buprenorphine in Chronic Low Back Pain: A Meta-Analysis of Randomized Clinical Trials.
  25. The relationship between shoulder pain and joint position sense, postural control, tactile sensation, and muscle strength in chronic hemiplegia.
  26. Total Proximal Interphalangeal Joint Arthroplasty as a Treatment for Advanced Boutonniere Deformity of the Finger.
  27. The effect of Baduanjin on pain, balance, function and kinesiophobia in individuals with knee osteoarthritis: A randomized controlled trial.
  28. Enhancing adherence and outcomes in rotator cuff-related shoulder pain: A randomized trial of individualized exercise sequencing.
  29. Impact of Coracoacromial Ligament Thickness on Shoulder Impingement Syndrome: A Cross-Sectional Magnetic Resonance Imaging Study.
  30. Medicine regenerative versus steroids: time to reconsider treatment of chronic inflammatory pain.
  31. Does Surgical Technique Matter? A Retrospective Analysis of Five-Year Outcomes After Arthroscopic vs. Open Femoroacetabular Impingement Syndrome Correction.
  32. Dissociation Between Clinical and Ultrasonographic Response After Radial Shock Wave Therapy in Refractory Plantar Fasciitis.
  33. Is Exercise Enough? Evidence from Controlled Clinical Trials on Rehabilitation with and Without Adjunct Modalities for Musculoskeletal Disorders.
  34. Asymptomatic Rotator Cuff Tendinopathy in Elderly Diabetics: Is Routine Magnetic Resonance Imaging Evaluation of the Shoulder Warranted?
  35. Wrist Circumference-Dependent Thresholds for the Median Nerve in Carpal Tunnel Syndrome: A Cross-Cohort Comparison.
  36. Treatment of thoracic posterior cutaneous nerve entrapment syndrome using an ultrasound-guided erector spinae plane block.
  37. Adding reciprocal inhibition to conventional physiotherapy for adhesive capsulitis of the shoulder in Bangladesh: a study protocol for a randomised controlled trial evaluating pain, function and range of motion.
  38. SPORT: A Novel Biopsychosocial Framework for Chronic Low Back Pain in a Young Athlete - A Case Report.
  39. Cold intolerance after hand injury: Mechanisms, measurement challenges, and implications for clinical management.
  40. Rest Before Physical Therapy Is Not Necessary to Achieve Bony Healing of Lumbar Spondylolysis in Adolescent Athletes.
  41. Efficacy and Safety of a Defined Two-Dose Protocol of Autologous Platelet-Rich Plasma (PRP) Injection for Refractory Chronic Non-Healing Wounds: A Prospective Clinical Study.
  42. Sustaining Physical Activity in Chronic Obstructive Pulmonary Disease: A Qualitative Study of Perspectives on a Personalized Community-Based Physical Activity Program (PICk UP).
  43. Intraoperative component size adjustment is associated with pain-free recovery and good knee flexion after patient-specific instrumentation-assisted medial pivot TKA.
  44. Therapeutic Efficacy of Different Bladder Monotherapies Versus Multimodal Therapy in Patients with Interstitial Cystitis/Bladder Pain Syndrome.
  45. Nonsurgical interventions for lumbar spinal stenosis with neurogenic claudication: A systematic review and network meta-analysis.
  46. Comprehensive systematic review and meta-analysis of the semitendinosus muscle and tendon: global morphometry, sex differences, and surgical implications.
  47. The Efficacy of Personalized Pulmonary Rehabilitation Programs on Recovery Outcomes in COPD Patients During Acute Exacerbations.
  48. Pulsed Electromagnetic Field Therapy in People with Knee Osteoarthritis: A Systematic Review and Meta-Analysis.
  49. Physiotherapist-led treatment for femoroacetabular impingement syndrome (the PhysioFIRST study): an assessor-blinded, limited disclosure randomised controlled trial.
  50. A comprehensive review of ultrasonographic imaging in athletic elbow injuries: a compartment-based approach.
  51. Outcomes of Conservative Versus Surgical Treatment of Adolescent Pelvic and Hip Avulsion Fractures: A Systematic Review and Meta-Analysis.
  52. Comparative effectiveness of different core muscle training regimens for chronic non-specific low back pain: a systematic review and meta-analysis.
  53. Endoscopic Pubic Symphysectomy for Refractory Osteitis Pubis Provides Positive Functional Outcomes and High Return-to-Sport Rate at a Minimum 2-Year Follow-Up.
  54. Kinesiophobia Affect Postural Control Strategies During Jump Landing in Athletes With Chronic Ankle Instability: A Cross-Sectional Study.
  55. Trapeziectomy With Hemi-Abductor Pollicis Longus and SutureTape InternalBrace: A Technical Note and Case Series.
  56. Amygdala and nucleus accumbens activation are associated with treatment choice in knee osteoarthritis: an fMRI study.
  57. Determining the Minimal Number of Passive Hip and Knee Joint Movement Repetitions Recommended for the Stiff Rectus Femoris Muscle Due to Osgood-Schlatter Disease.
  58. Predictors of successful viscosupplementation in osteoarthritis of the knee.
  59. Role of Imaging in Femoroacetabular Impingement Syndrome: From Pathomechanics to Patient-Specific Management.
  60. Management of cubital tunnel syndrome - A survey of UK specialist clinical practice.
  61. Effectiveness of Proximal Interphalangeal Joint Block Orthosis and Metacarpophalangeal Joint Block Orthosis in the Management of Trigger Finger: A Prospective Observational Study.
  62. Hip Arthroscopy in Femoroacetabular Impingement Syndrome With Versus Without Low Back Pain and Lumbar Spine Pathology Shows Comparable Outcomes at Minimum 5-Year Follow-Up.
  63. Extended Reality in Rehabilitation Medicine: A Systematic Review.
  64. Up to 10-Year Follow-Up of Thin Polyethylene Liners in Total Hip Arthroplasty.
  65. Static and dynamic ultrasound assessment of peripheral meniscal lesions: diagnostic value and clinical applications.
  66. Evaluation of an Office-Based Protocol for Pelvic Pain and Function in Female Patients with Chronic Pelvic Pain.
  67. Impact of Treatment Duration on the Effectiveness of Opioid Analgesia: A Systematic Review and Meta-Analysis.
  68. Complex Regional Pain Syndrome Triggered by Snake Bite: Diagnostic Utility of Triple-Phase Single-Photon Emission Computed Tomography-Computed Tomography Bone Scan-Case Report.
  69. Digital splinting for acute closed bony mallet finger: A case series.
  70. [Effect of bone-setting manipulation on lower extremity alignment in patients with varus knee osteoarthritis].
  71. Functional Resilience in Chronic Low Back Pain: Dissociating Magnetic Resonance Imaging Abnormalities From Real-World Disability in the Wakayama Spine Study.
  72. What aspects of pain and functional outcomes contribute to patient satisfaction 1 year after surgery within total hip and total knee arthroplasty populations? A registry-based cohort study.
  73. Differences in lower-limb alignment and muscle strength between the sexes during distance-specific single-leg hop tasks.
  74. Viscosupplementation in Degenerative Joint Disease: Current Evidence, Indications, and Clinical Outcomes.
  75. Knee extensor muscles of active older adults with knee osteoarthritis are smaller and weaker but not more fatigable than healthy older adults: Relevance to physical function.
  76. Return to Sport in Professional Athletes With Borderline Hip Dysplasia After Hip Arthroscopy for Femoroacetabular Impingement.
  77. Clinical and Radiographic Factors Affecting the Outcomes of Decompression Surgery in Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) Classification Type C Degenerative Lumbar Spondylolisthesis.
  78. The Role of Peripheral Nerve Stimulation for the Treatment of Neuropathic Pain Following Brachial Plexus Injury: A Scoping Review of Neuromodulation Modalities.
  79. Esketamine for Postoperative Multimodal Analgesia in Laparoscopic Surgery: A Systematic Review and Meta-Analysis.
  80. Adherence to clinical guidelines in treating degenerative disorders of the supraspinatus tendon: A descriptive baseline analysis of surgical vs. conservative approaches in a 12-month observational study.
  1. BMC Anesthesiol. 2026 May 07.
    Efficacy of IPACK block combined with intra-articular steroid injection in advanced knee osteoarthritis: a retrospective cohort study.
    Halil Ibrahim Altun, Salim Taner Gözükızıl.
       BACKGROUND: Knee osteoarthritis is a major cause of chronic pain and functional limitation, particularly in advanced stages. Intra-articular steroid injections and genicular nerve interventions are commonly used for pain control; however, these methods mainly target the anterior knee and may not sufficiently relieve pain originating from the posterior capsule. The infiltration between the popliteal artery and the capsule of the knee (IPACK) block is a regional anesthesia technique that provides posterior knee analgesia without causing motor weakness. Evidence regarding its effectiveness in chronic, non-surgical knee osteoarthritis is limited. This study aimed to evaluate whether adding an ultrasound-guided IPACK block to intra-articular steroid injection improves pain and functional outcomes in patients with advanced knee osteoarthritis.
    METHODS: This retrospective observational cohort study included 98 patients with Kellgren-Lawrence stage 3-4 knee osteoarthritis who had persistent pain despite conservative treatment. Patients received either intra-articular steroid injection alone (IASI group, n = 50) or intra-articular steroid injection combined with an IPACK block (IASI+IPACK group, n = 48). Pain severity was assessed using the Numeric Rating Scale (NRS), and functional status was evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Evaluations were performed at baseline, 1 month, and 6 months after the procedure. Non-parametric tests were used for statistical analysis, and p < 0.05 was considered significant.
    RESULTS: Both groups showed significant improvement in NRS and WOMAC scores at 1 and 6 months compared with baseline (p < 0.05). The IASI+IPACK group demonstrated greater pain reduction at 1 month and significantly better WOMAC Function and Total scores at both follow-up visits compared with the IASI group (p < 0.05). Although scores increased slightly between 1 and 6 months in both groups, outcomes remained improved compared with baseline. No major complications were observed during the follow-up period. However, minor adverse events were not systematically recorded due to the retrospective nature of the study.
    CONCLUSIONS: Adding an IPACK block to intra-articular steroid injection may provide additional benefit in early pain relief and functional improvement in patients with advanced knee osteoarthritis. This combined approach appears to be a safe and useful option for patients who are not surgical candidates or are awaiting arthroplasty.
    TRIAL REGISTRATION: ClinicalTrials.gov, NCT07269444. Retrospectively registered on 20 November 2025.
    Keywords:  IPACK block; Intra-articular injection; Knee osteoarthritis; Nerve block; Steroid; Ultrasound guidance
    DOI:  https://doi.org/10.1186/s12871-026-03896-8
  2. Int J Sports Phys Ther. 2026 ;21(5): 568-574
    Diagnostic Musculoskeletal Ultrasound in the Evaluation of the Medial Hamstrings.
    Robert C Manske, Chris Wolfe, Phil Page, Michael Voight.
      Hamstring muscle injuries are among the most common lower-extremity injuries in active individuals. Hamstring injuries follow a consistent pattern with a consistent medical history, which includes a sudden, explosive type of movement (sprinting, kicking, jumping, or lunging). The onset of pain is usually acute in the posterior thigh. They may describe a "pop," "snap," or sensation as if someone kicked them in the back of the thigh. An accurate diagnosis of medial hamstring overuse, partial tears, or ruptures is essential for appropriate treatment planning and optimizing patient outcomes. Diagnostic musculoskeletal ultrasound (MSKUS) offers a portable, real-time, and cost-effective alternative that is gaining traction in rehabilitation and sports medicine settings. MSKUS has emerged as a valuable, non-invasive imaging modality for evaluating hamstring injuries, including tendinopathy, muscle strains (partial tears), and ruptures. MSKUS is excellent at detecting changes in tendon and muscle composition and continuity. This manuscript will review the utility of MSKUS in evaluating medial hamstring tendon and muscle injuries, including anatomy, common injury mechanisms, sonographic techniques, and clinical implications for the rehabilitation profession. By integrating MSKUS into clinical practice, providers can improve diagnostic accuracy, enhance diagnostic confidence, monitor healing progression, and guide rehabilitation strategies to achieve optimal patient outcomes for those with hamstring injuries. # Level of Evidence 5.
    Keywords:  dynamic imaging; medial hamstring; muscle tear; musculoskeletal ultrasound; rehabilitation; semimembranosus; semitendinosus
    DOI:  https://doi.org/10.26603/001c.161263
  3. JB JS Open Access. 2026 Apr-Jun;11(2):pii: e25.00341. [Epub ahead of print]11(2):
    Efficacy of Ultra-high and High Molecular Weight Cross-Linked Hyaluronic Acids Compared with Saline in Knee Osteoarthritis: A Randomized Controlled Trial.
    Supakit Kanitnate, Pattaranatcha Charnwichai, Yot Tanariyakul, Nattapol Tammachote.
       Introduction: Intra-articular hyaluronic acid (HA) injections are widely used for knee osteoarthritis (OA) to reduce pain and improve function. The efficacy of cross-linked HA over placebo remains debated. This study aimed to compare the efficacy of 2 single-injection, ultra-high, and high molecular weight (HMW) cross-linked HAs against a saline placebo for symptomatic knee OA.
    Methods: We conducted a single-center, double-blind, randomized, placebo-controlled trial with 24-week follow-up. A total of 276 patients with primary knee OA were randomized into 3 groups: ultra-high MW HA (Hyruan ONE), HMW HA (hylan G-F 20), and saline. All participants received a single intra-articular injection. Primary outcomes were visual analog scale (VAS) pain scores at rest and during motion at weeks 1 to 24 and the change from baseline over the 24-week period. Secondary outcomes included the modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form-36 (SF-36), Lequesne index, Time Up and Go (TUG) test, and active knee flexion at weeks 2, 4, 12, and 24. Patients who did not improve could receive a rescue corticosteroid injection, after which they were excluded from further analysis.
    Results: No significant differences in pain reduction were observed between the HA and saline groups at rest (p = 0.92) and during motion (p = 0.99). All groups showed significant improvement in VAS scores over 24 weeks (p < 0.0001). Modified WOMAC scores were also similar among the 3 groups (p > 0.05). All groups had comparable outcomes for the SF-36 (p = 0.91), Lequesne index (p = 0.93), TUG test (p = 0.48), and knee flexion (p = 0.90). The rates of rescued corticosteroid injections rates were similar across the 3 groups (17% vs. 21% vs. 25%, p = 0.98).
    Conclusions: Ultra-high and HMW cross-linked HA injections did not provide superior pain or functional outcomes compared with saline for knee OA. These findings provided high-level evidence challenging the clinical benefit of cross-linked HAs. Consequently, the cost-effectiveness is uncertain and warrants formal economic evaluation.
    Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
    DOI:  https://doi.org/10.2106/JBJS.OA.25.00341
  4. Eur J Clin Pharmacol. 2026 May 07. pii: 143. [Epub ahead of print]82(6):
    Efficacy of botulinum toxin type a for treating chronic low back pain: a systematic review and metanalysis.
    Bharath Kumar G, Mantu Jain, Bikash Ranjan Meher, Biswa Mohan Padhy, Harshal Sakale, Santosh Kumar.
       BACKGROUND: Chronic low back pain (CLBP) is a leading cause of pain and disability worldwide. Most cases are nonspecific, lacking a clear pathological cause, and management remains challenging. Botulinum toxin type A (BoNT-A), a neurotoxin that blocks acetylcholine release and reduces muscle hyperactivity, has been studied in CLBP with inconsistent results. This meta-analysis aimed to determine the efficacy of BoNT-A compared with placebo or saline in the management of nonspecific CLBP.
    METHODS: A comprehensive search of PubMed, Embase, Cochrane Library, and the WHO ICTRP databases was conducted for randomized controlled trials (RCTs) involving adults with nonspecific CLBP who received BoNT-A or placebo injections and were registered in PROSPERO (CRD42024559735). The primary outcome was pain response, defined as a ≥ 50% reduction in VAS score, while the secondary outcome was functional improvement. A random-effects model was used to calculate pooled risk ratios (RR) with 95% confidence intervals (CI).
    RESULTS: Five eligible RCTs involving 177 participants were analyzed. BoNT-A improved pain response compared with placebo [RR = 2.09, 95% CI: 1.11-3.95; p = 0.02; I2 = 62%]. Functional outcomes also favored BoNT-A [RR = 2.25, 95% CI: 1.09-4.67; p = 0.03; I2 = 69%]. Sensitivity analyses confirmed robustness. Exploratory meta-regression suggested a possible decrease in pain effect with longer follow-up, while functional outcomes showed no significant association; dose was not a significant moderator. Risk of bias was low in one trial, some concerns in three, and high in one. Certainty of evidence was low for both outcomes.
    CONCLUSION: BoNT-A may improve pain and functional outcomes in nonspecific CLBP, although the certainty of evidence is low. Exploratory analyses suggested a possible decline in pain benefit over time, and safety data are limited. Larger, high-quality RCTs are needed to confirm these findings.
    Keywords:  Botulinum Neurotoxin A; Functional improvement; Meta-analysis; Nonspecific CLBP; VAS Score
    DOI:  https://doi.org/10.1007/s00228-026-04073-z
  5. Int J Sports Phys Ther. 2026 ;21(5): 527-541
    Influence of Pain on Rotator Cuff Muscle Size and Function: A Case-Control Study with Ultrasound Assessment of Cross-Sectional Area and Tendon Thickness.
    Dirk Kokmeyer, Lori Thein Brody, Jace Brown, Shane Koppenhaver, Charles Thigpen.
       Background: Rotator cuff weakness is common in patients with shoulder pain, but the underlying causes are unclear when tendons are structurally intact. Atrophy is well established after full-thickness tears, but it is uncertain whether rotator cuff muscle cross-sectional area (CSA) differs in painful shoulders without rupture. Distinguishing structural atrophy from pain-related inhibition has important implications for rehabilitation.
    Purpose: The purpose of this study was to compare supraspinatus (SS) and infraspinatus (IS) CSA and SS tendon thickness between painful and asymptomatic shoulders. Secondary aims were to evaluate the influence of limb dominance on CSA, strength, and endurance, and to examine relationships between CSA, strength, and endurance.
    Study Design: Cross-sectional case-control study.
    Methods: Twenty-four participants (12 with unilateral shoulder pain recruited from an outpatient orthopedic clinic, 12 age- and sex-matched asymptomatic community-based controls) were enrolled. Participants in the shoulder pain group presented with chronic symptoms and MRI-confirmed intact rotator cuff tendons. Exclusion criteria included prior surgery or MRI-confirmed full-thickness tears. Demographics and patient-reported outcomes were collected. Ultrasound was used to measure the CSA of the SS and IS tendons and the SS tendon thickness. Isometric strength of the external rotators (ER) and full can was assessed with handheld dynamometry, and endurance with the Posterior Shoulder Endurance Test (PSET). Mixed-model ANOVAs examined group × dominance effects on CSA, tendon thickness, strength, and endurance outcomes; ANCOVA and regression explored the contributions of pain and CSA.
    Results: CSA and tendon thickness did not differ between groups or sides (all p >0.19). Painful dominant shoulders showed significantly lower ER (p = 0.003), full can strength (p = 0.003), and endurance (p = 0.021) compared with contralateral and control shoulders. Adjusting for pain eliminated group differences in strength, with pain accounting for 36-56% of the variance. Regression showed that SS CSA predicted full can strength and IS CSA predicted ER strength, but neither predicted endurance. PSET deficits persisted after adjusting for pain.
    Conclusion: Rotator cuff CSA and tendon thickness were preserved in individuals with shoulder pain, yet strength and endurance deficits were evident. Weakness was more closely related to pain-mediated inhibition than structural atrophy, while endurance appeared to be influenced by scapular stabilizer function. These findings suggest that early rehabilitation may emphasize pain reduction and neuromuscular control before progressive strengthening.
    Level of Evidence: 3.
    Keywords:  endurance; shoulder pain; strength
    DOI:  https://doi.org/10.26603/001c.160558
  6. Front Med (Lausanne). 2026 ;13 1771008
    Intra-articular adipose-derived cell therapies for knee osteoarthritis: a systematic review of randomized controlled trials.
    Joelington Dias Batista, Ludimila Dias Silva, Jobson Dias Batista, Gabrielly Santos Pereira, Marcelo Lourenço da Silva.
       Introduction: Knee osteoarthritis is a leading cause of chronic pain, functional limitation, and disability worldwide, imposing a substantial socioeconomic burden. Despite advances in conservative management and intra-articular therapies, many patients experience limited or transient symptomatic relief, underscoring the need for biologically based interventions. Intra-articular adipose-derived cell therapies, including adipose-derived mesenchymal stem or stromal cells (ADSCs), stromal vascular fraction (SVF), and microfragmented adipose tissue (MFAT), have emerged as regenerative strategies aimed at modulating inflammation and joint homeostasis. This systematic review evaluated the efficacy, structural effects, and safety of intra-articular adipose-derived cell-based therapies for knee osteoarthritis in adults.
    Methods: Randomized controlled trials published between 2015 and 2025 were identified through systematic searches of PubMed, Embase, Scopus, and Web of Science. Eligible studies compared ADSCs, SVF, or MFAT with placebo, hyaluronic acid, platelet-rich plasma, corticosteroids, or conservative care, and reported outcomes on pain, function, imaging-based structural changes, and safety.
    Results: Nineteen randomized controlled trials met inclusion criteria. Across studies, adipose-derived interventions, particularly ADSC-based therapies, produced clinically meaningful reductions in pain and improvements in functional outcomes assessed by WOMAC, KOOS, and visual analog scales.
    Discussion: Several ADSC and SVF trials reported favorable magnetic resonance imaging findings, including improvements in cartilage quality, although consistent cartilage regeneration was not demonstrated. MFAT trials yielded heterogeneous results, often showing symptomatic benefits comparable to established injective therapies but limited structural effects. No serious treatment-related adverse events were reported. Intra-articular adipose-derived cell therapies are safe and provide meaningful pain relief and functional improvement in selected patients, with ADSCs showing the most consistent clinical signals.
    Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251241498, Identifier: CRD420251241498.
    Keywords:  adipose-derived cell therapy; adipose-derived mesenchymal stromal cells; intra-articular injection; knee osteoarthritis; systematic review
    DOI:  https://doi.org/10.3389/fmed.2026.1771008
  7. J Hand Surg Am. 2026 May 08. pii: S0363-5023(25)00512-X. [Epub ahead of print]
    Longitudinal Changes in Patient-Reported Outcomes Following Carpal Tunnel Release: A Retrospective Cohort Study.
    Kosuke Saito, Mitsuhiro Okada, Shunpei Hama, Yusuke Miyashima, Hidetomi Terai.
       PURPOSE: Although carpal tunnel release (CTR) is a common procedure for carpal tunnel syndrome (CTS), few studies define the postoperative recovery timeline for CTR. Therefore, we aimed to investigate the timing to achieve a clinically meaningful improvement and the timing for reaching a plateau in improvement in patient-reported outcome measurements (PROMs) after CTR for CTS. Second, we compared the improvement trend in PROMs with that of nerve conduction studies.
    METHODS: We conducted a retrospective study of patients who underwent CTR for CTS. This study included 82 patients. We collected PROMs, including Quick Disabilities of the Arm, Shoulder, and Hand and the Symptom Severity Scale and Functional Status Scale of the Boston Carpal Tunnel Questionnaire, at the following intervals: preoperative baseline and at 3, 6, 9, 12, 18, and 24 months after surgery. We evaluated trends in the improvements in PROMs to determine the period for achieving a clinically meaningful recovery and the recovery plateau. Additionally, we performed nerve conduction studies at 6, 9, 12, 18, and 24 months.
    RESULTS: Quick Disabilities of the Arm, Shoulder, and Hand, Symptom Severity Scale, and Functional Status Scale scores improved more than the minimum clinically important differences 6-9 months after CTR. These scores reached a recovery plateau approximately 12-14 months after CTR. The distal latency of sensory nerve action potential and compound muscle action potential reached a plateau at approximately 18 months after surgery.
    CONCLUSIONS: The scores improved more than the minimum clinically important differences at 6-9 months after CTR and plateaued at 12-14 months in PROMs. The improvement plateau of nerve conduction studies is delayed compared with PROMs. These findings can assist in counseling patients about expected recovery patterns. Postoperative electrodiagnostic testing should not be performed because electrophysiological recovery is delayed compared to clinical improvement.
    TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic Ⅳ.
    Keywords:  Carpal tunnel syndrome; carpal tunnel release; minimum clinically important difference; patient-reported outcome measurements; plateau
    DOI:  https://doi.org/10.1016/j.jhsa.2025.09.011
  8. J Pain Res. 2026 ;19 604185
    Time-Dependent Efficacy and Safety of Percutaneous Treatments for Lateral Epicondylitis: A Systematic Review and Network Meta-Analysis.
    Yisha Xu, Wenting Lin, Ziyi Qi, Zheng Yan, Qianjun Yan, Jiawen Xu, Lianguo Wu.
       Purpose: Recent reviews on lateral epicondylitis management frequently focus on single modalities or isolated outcomes. This study systematically evaluates the time-dependent efficacy and safety of eight percutaneous treatments (placebo, corticosteroids, platelet-rich plasma [PRP], autologous blood [AB], hyaluronic acid, botulinum toxin [BT], dextrose prolotherapy [DPT], and dry needling [DN]) for lateral epicondylitis.
    Patients and Methods: Four databases (PubMed, Embase, the Cochrane Library, and Web of Science) were searched for randomized controlled trials. Outcomes (pain intensity, functional disability, grip strength) were evaluated across short- (<1 month), mid- (1-3 months), and long-term (>6 months) intervals. Data were synthesized via network meta-analysis using mean differences (MD) or standardized mean differences (SMD) and SUCRA probabilities.
    Results: Forty-one trials (N=3,285) were included. Corticosteroids showed substantial efficacy for short-term pain relief (MD -1.62, 95% CI -2.52 to -0.72) but were associated with a long-term rebound effect. DPT demonstrated notable advantages for mid-term pain reduction (MD -1.73, 95% CI -2.85 to -0.60) and functional recovery. BT was associated with a potential negative trend in mid-term grip strength compared to placebo, whereas AB showed better outcomes than BT in head-to-head comparisons. For long-term outcomes, regenerative approaches like PRP, along with DN and BT, appeared to provide sustained pain relief.
    Conclusion: The therapeutic efficacy of percutaneous treatments appears to be time-dependent. Corticosteroids may be considered for rapid short-term relief, while DPT shows potential advantages for mid-term recovery. For long-term management, PRP and DN may offer sustained analgesia, potentially avoiding the grip strength deficits occasionally associated with BT.
    Keywords:  dextrose prolotherapy; dry needling; grip strength; pain management; platelet-rich plasma; tennis elbow
    DOI:  https://doi.org/10.2147/JPR.S604185
  9. Pain Res Manag. 2026 ;2026(1): e3157666
    Effects of Neuromuscular Physiotherapy on Pain, Range of Motion, and Function in Shoulder-Related Disorders: A Meta-Analysis and Systematic Review.
    Yingkai Zhang, Dan Lu, Yan Lan.
      Shoulder-related disorders are highly prevalent, with the global incidence being on the rise. Neuromuscular rehabilitation aims to optimize muscle function and motor performance by modulating the neuromuscular system, which comprises the central and peripheral nervous systems. This study aimed to synthesize evidence on neuromuscular rehabilitation for shoulder disorders, evaluating its effects on pain, range of motion, and shoulder function. English-language literature was retrieved from the PubMed, Cochrane, and Embase databases up to June 2025 via search terms such as "Shoulder," "Neuromuscular," and "Rehabilitation". The inclusion criterion was randomized controlled trials that used neuromuscular rehabilitation techniques for shoulder diseases. The primary outcome was pain improvement, and secondary indicators included joint range of motion and function. The effect size was the standardized mean difference (SMD) and 95% confidence interval (CI). Heterogeneity was evaluated via I2. Neuromuscular therapy significantly reduced pain (SMD [95% CI] = -2.82 [-4.79, -0.85]), with greater improvements than did the control (SMD [95% CI] = -0.75 [-1.35, -0.15]). Improvements were observed in shoulder flexion, extension, abduction, and external rotation, with external rotation showing the most significant benefit versus controls. Neuromuscular therapy improved functional scores (SMD [95% CI] = -1.95 [-3.71, -0.19]) and outperformed the control (SMD [95% CI] = -0.65 [-1.25, -0.05]). This study revealed that neuromuscular physical therapy can effectively relieve pain in patients with shoulder disorders, improve joint mobility, and enhance function. These findings support its use as an adjunctive therapy in conventional rehabilitation.
    Keywords:  adhesive capsulitis; postmastectomy lymphedema; proximal humerus fracture; rotator cuff tendinopathy; subacromial impingement syndrome
    DOI:  https://doi.org/10.1155/prm/3157666
  10. Curr Pain Headache Rep. 2026 May 02. pii: 60. [Epub ahead of print]30(1):
    Pain Unraveled: Kinesio Taping as a Novel Approach to Myofascial Pain Management.
    Prateek Mittal, Saurabh Mittal.
       PURPOSE OF REVIEW: Myofascial pain syndrome (MPS) is a musculoskeletal system disorder that is exceedingly painful and distinct from other chronic pain syndromes. MPS can occur on its own or in conjunction with other muscle disorders. Symptoms of MPS include tense bands in muscles, weakening at the afflicted region, radial or repeated pain, restricted range of motion (ROM), and hot and red skin. In addition, symptoms of MTrPs include tense bands in muscles, weakening at the afflicted region, radial or repeated pain, restricted range of motion (ROM), and/or hot and red skin. Kenzo Kase, a Japanese chiropractor, invented Kinesiology Tape (KT) in the 1970s, with a potential role in modulating pain, enhancing muscle function and improving ROM. This review aims to examine the underlying mechanisms of MPS and evaluate current therapeutic strategies, with particular emphasis on the mechanism and clinical application of KT in managing MPS.
    RECENT FINDINGS: Recent literature highlights the advances in understanding the pathophysiology of MTrP, conventional therapies and their limitations. KT is a dynamic, stretchable tape that resembles human skin which may be utilised to treat pain and muscle activity as well as increase range of motion (ROM). The majority of the time, KT is used in the treatment and prevention of sports injuries. Clinical studies report improvements in pain intensity, muscle flexibility, and ROM following KT application in individuals with MPS, particularly in sports and rehabilitation settings. MPS is a complex pain disorder requiring multimodal management. KT represents a promising non-invasive intervention that may address both pain and functional restoration through neurophysiological and biomechanical mechanisms. While clinical findings are promising, regulatory protocols are yet to be standardised to ensure long term safety and efficacy of KT in the treatment of MPS.
    Keywords:  Kinesio Taping; Kinesiology; Myofascial pain syndrome; Range of motion
    DOI:  https://doi.org/10.1007/s11916-026-01498-0
  11. Arch Phys Med Rehabil. 2026 Apr 30. pii: S0003-9993(26)00688-X. [Epub ahead of print]
    Comparison of the efficacy of hyaluronic acid vs corticosteroids, platelet-rich plasma, and physical therapy in chronic shoulder pain:: a systematic review and a frequentist network metanalysis.
    Annachiara Marra, Andrea Uriel de Siena, Carmine Iacovazzo, Angela Rita Bianco, Francesco Squillacioti, Maria Vargas, Pasquale Buonanno.
       OBJECTIVE: To compare the effectiveness of injected low- and high-molecular-weight hyaluronic acid (HA-LMW, HA-HMW) vs corticosteroids (CCS), placebo- or physical therapy (PT), on pain at rest (Prest), at night (Pnight), and during activity (Pact), range of motion (ROM), functional status (FS), and quality of life (QoL) in patients with chronic Sp, at 3 (3mo) and 6 months (6mo) follow-up.
    DATA SOURCES: A systematic literature search was conducted through October 2024 across MEDLINE, Embase, and Cochrane CENTRAL.
    STUDY SELECTION: Fourteen studies were included: 12 randomized controlled trials and 2 prospective cohort studies that compared at least two of the treatments of interest in adults with chronic shoulder pain (Sp).
    DATA EXTRACTION: Two reviewers independently extracted data related to the outcomes.
    DATA SYNTHESIS: A frequentist network meta-analysis with mean differences (MD) and standardized mean differences (SMD) was performed; p<0.05 was statistically significant. PT reduced Prest compared to HA-HMW (MD = -3.02, p<0.01 at 3mo; MD = -2.08, p<0.01 at 6mo) and HA-LMW (MD = -1.95, p<0.01 at 6mo) in tendinopathy. PT showed greater reduction than both HA formulations in Pnight and Pact at 6mo in tendinopathy. No differences were observed between HA-HMW and HA-LMW for pain outcomes considering shoulder different diseases. HA improved adduction and internal rotation at 3mo considering shoulder different disease; PT was superior for flexion and external rotation at 6mo in tendinopathy. Stratified by pathology, HA-HMW showed moderate efficacy in adhesive capsulitis. HA-HMW improved FS compared to HA-LMW at 3mo. CCS improved abduction in shoulder disease due to different causes.
    CONCLUSIONS: PT provides greater pain control for Sptendinopathy, particularly for Prest, Pnight, and Pact at both 3mo and 6mo. HA may contribute to improved QoL and specific ROM parameters. Further high-quality studies are required to consolidate these findings.
    Keywords:  arthrosis; chronic pain; frozen shoulder; hyaluronic acid; pain medicine; shoulder pain
    DOI:  https://doi.org/10.1016/j.apmr.2026.04.026
  12. J Hand Surg Am. 2026 May 07. pii: S0363-5023(26)00130-9. [Epub ahead of print]
    Do Preoperative Intra-Articular Steroid Injections Affect the Choice of Surgical Procedures for Thumb Carpometacarpal Osteoarthritis?
    Shingo Komura, Akihiro Hirakawa, Hitoshi Hirose, Atsushi Kawaguchi, Yoshiki Ito, Haruhiko Akiyama.
       PURPOSE: This study investigated the influence of preoperative intra-articular steroid injections on surgical outcomes of trapeziectomy with ligament reconstruction and tendon interposition (LRTI) arthroplasty and arthrodesis and aimed to determine whether preoperative steroid injections affect the choice of surgical procedures for treating painful thumb carpometacarpal osteoarthritis.
    METHODS: We analyzed 49 and 51 thumbs treated with LRTI arthroplasty and arthrodesis, respectively. Preoperative intra-articular steroid injections were used for 12 and 15 thumbs in the LRTI and arthrodesis groups, respectively. Clinical outcomes were measured before surgery, 3 months after surgery, and at final follow-up using the Disabilities of the Arm, Shoulder, and Hand score, Hand20 questionnaire score, Kapandji score, and visual analog scale scores for pain, grip strength, and pinch strength. In the LRTI group, the trapezial space height and ratio were evaluated. In the arthrodesis group, the bone union rate and time to union were assessed. Radiological and clinical outcomes of both groups based on the use of steroid injections were compared at each time point. Chronological changes were also analyzed.
    RESULTS: Intra-articular steroid injections did not affect radiological outcomes, including the trapezial space height and ratio in the LRTI group and bone union in the arthrodesis group. Significant differences in clinical outcomes of both groups based on the use of steroid injections were not observed during follow-up. Chronological analyses revealed that grip strength and pinch strength in the steroid injection subgroup were less improved than those in the no steroid injection subgroup of the LRTI group. Conversely, no significant differences in clinical outcome improvements were observed in these subgroups of the arthrodesis group.
    CONCLUSIONS: Intra-articular steroid injections did not affect radiological and clinical outcomes of LRTI arthroplasty and arthrodesis. Both procedures are indicated for painful thumb carpometacarpal osteoarthritis after steroid injections.
    TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
    Keywords:  Arthrodesis; carpometacarpal osteoarthritis; intra-articular steroid injection; outcomes; thumb; trapeziectomy with ligament reconstruction and tendon interposition arthroplasty
    DOI:  https://doi.org/10.1016/j.jhsa.2026.01.024
  13. J Eval Clin Pract. 2026 Jun;32(4): e70417
    A Systematic Critical Appraisal of Clinical Practice Guidelines for Non-Pharmacological ‎Conservative Management of Complex Regional Pain Syndrome (CRPS) Using the ‎AGREE-II Instrument.
    Erfan Shafiee, Joy MacDermid, Tara Packham, Ruby Grewal, David Walton, Maryam Farzad.
       PURPOSE: Several clinical practice guidelines (CPGs) have been developed for complex regional pain syndrome (CRPS). The aim of our study was to appraise CPGs for non-pharmacological conservative management of CRPS.
    MATERIALS AND METHODS: We systematically searched five electronic databases, from inception to January 2025, to include CPGs that focused on non-pharmacological conservative management of CRPS. We used AGREE-II to evaluate the quality of the CPGs. Recommendations, aims, and treatment algorithms of the CPGs were presented in a narrative format, thematic analysis, and matrixes to summarise, categorise, and compare the findings of the guidelines.
    RESULTS: Nine CPGs met the inclusion criteria, including three updated versions of previously published guidelines. After accounting for updates, six unique guidelines were appraised. Two were rated as high-quality, two as moderate-quality, and two as low-quality. All CPGs scored > 60% in the AGREE-II domains of scope/purpose and clarity of presentation, while rigour of development was the lowest-scoring domain, with only two guidelines achieving ≥ 60%. No guideline addressed updating procedures. The most common interventions recommended by CPGs were pain management (100%) followed by functional restoration (83%), stress-loading (67%), psychotherapy (67%), edema management (67%), gentle active movements (67%), vocational rehabilitation (67%), normal functional activities (67%), general PT interventions (67%), and isometric-isotonic strengthening (67%).
    CONCLUSION: The methodological quality of many CPGs for non-pharmacological management of CRPS is low, particularly in the domain of rigour of development. Recommendations across guidelines are variable, often lacking detail, consistency, and integration of supporting evidence. Pain management, functional restoration, and inter/multidisciplinary care were the most commonly recommended considerations, while guidance on treatment frequency, dosage, and implementation strategies was limited.
    Keywords:  CRPS; clinical practice guidelines; complex regional pain syndrome; conservative treatment; guideline; rehabilitation
    DOI:  https://doi.org/10.1111/jep.70417
  14. Medicina (Kaunas). 2026 Apr 15. pii: 758. [Epub ahead of print]62(4):
    Current Perspective on Orthobiology Applications for the Treatment of Intervertebral Disc Degeneration (IDD)-A Narrative Review.
    Gianluca Conza, Maria Consiglia Trotta, Chiara Mastronardi, Alfonso Nocera, Annalisa Itro, Gabriele Martin, Gabriella Toro, Caterina Claudia Lepre, Marina Russo, Giuseppe Toro.
      Background and Objectives: Low back pain (LBP) is a leading cause of disability worldwide and is frequently associated with intervertebral disc degeneration (IVDD). Current therapeutic strategies are primarily symptomatic and do not restore native disc biology, largely due to the avascular nature of the intervertebral disc and the hostile inflammatory and mechanical microenvironment that characterizes degeneration. The aim of this study is to provide an updated and clinically oriented overview of the pathophysiology of IVDD and to evaluate the current evidence on mesenchymal stem cells (MSCs) and platelet-rich plasma (PRP)-based therapies. Materials and Methods: A focused narrative literature review was performed to evaluate current evidence on MSC- and PRP-based therapies for intervertebral disc degeneration (IVDD). The search was conducted in PubMed. Only studies in English were considered eligible. Results: Mesenchymal stem cells (MSCs) demonstrated regenerative and immunomodulatory effects primarily through paracrine mechanisms, enhancing extracellular matrix synthesis and reducing inflammation and apoptosis. MSC-derived extracellular vesicles emerged as a promising cell-free alternative, potentially overcoming limitations related to cell survival and safety. Platelet-rich plasma (PRP) showed anabolic and anti-inflammatory properties, promoting disc cell proliferation and matrix production, particularly in early-stage degeneration. Clinical studies, including randomized trials, reported significant improvements in pain and function for both MSC and PRP therapies, with favourable safety profiles. However, heterogeneity in treatment protocols and limited long-term data remain significant limitations. Orthobiologic therapies represent a minimally invasive option for patients with discogenic low back pain refractory to conservative treatment. Patient selection is crucial and should consider degeneration stage, disc viability, and clinical presentation. PRP is primarily indicated in early-stage degeneration (Pfirrmann II-III), whereas MSC-based therapies may be considered in selected patients with more advanced but still viable discs. Based on current evidence, a stepwise approach is proposed, progressing from conservative management to PRP, MSCs, and ultimately surgery. Orthobiologics should be integrated within a multimodal strategy including rehabilitation. Conclusions: MSCs and PRP represent a promising and, eventually, complementary orthobiologic therapies for IVDD. PRP is primarily effective in early degenerative stages as a biologic stimulator, whereas MSCs may provide regenerative benefits in more advanced but still viable discs. Further studies are necessary to standardize protocols and confirm long-term efficacy and safety.
    Keywords:  PRP; intervertebral disc degeneration; low back pain; mesenchymal stem cells; orthobiology; regenerative medicine; spine
    DOI:  https://doi.org/10.3390/medicina62040758
  15. Am Fam Physician. 2026 Apr;113(4): 307
    Hyaluronic Acid Injections for Knee Osteoarthritis.
    Henry C Barry.
      
  16. PM R. 2026 May 08.
    Assessment of adverse events and safety associated with intra-articular platelet-rich plasma injections compared to other injectates for knee osteoarthritis: A systematic review and meta-analysis.
    Hirotaka F Nakagawa, James Kim, Judy Rabinowitz, Walter I Sussman.
       OBJECTIVE: To evaluate adverse events (AEs) associated with intra-articular platelet-rich plasma (IA-PRP) injections for knee osteoarthritis (KOA) and compare their rates with those of intra-articular corticosteroids (IA-CS), hyaluronic acid (IA-HA), and normal saline (IA-NS).
    LITERATURE SURVEY: A systematic search of PubMed, Embase, and Cochrane Library databases identified randomized controlled trials (RCTs) published after 2015. Studies were included if they reported AEs related to IA-PRP injections for KOA and provided comparator data for IA-CS, IA-HA, or IA-NS.
    METHODOLOGY: Data on AEs were extracted and categorized into mild knee pain and swelling, severe knee pain requiring withdrawal, knee stiffness, other musculoskeletal (MSK) events, non-MSK events, and severe AEs. A random-effects meta-analysis was performed to calculate odds ratios (OR) with 95% confidence intervals (CI) for AE rates in IA-PRP versus comparator groups. Subgroup analysis was conducted to evaluate the effects of leukocyte concentration on AE rates.
    SYNTHESIS: Thirty-two RCTs published articles, involving 1268 IA-PRP-treated knees, met inclusion criteria. AEs were reported in 18.7% of IA-PRP cases, with mild knee pain and swelling being the most common (10.6%). Compared to IA-HA, IA-PRP had significantly higher rates of mild knee pain and swelling (p < .001). Subgroup analysis revealed that this difference was significant only for leukocyte-rich IA-PRP (p < .05), whereas leukocyte-poor IA-PRP showed no significant difference compared to IA-HA (p = .51). Knee stiffness was more frequent in IA-PRP versus IA-NS (p = .031). There were no significant differences in other AE categories, and no severe AEs were reported across any groups.
    CONCLUSIONS: IA-PRP injections are associated with mild, transient AEs such as knee pain and swelling, particularly with leukocyte-rich PRP formulations. These symptoms typically resolve without intervention. Leukocyte-poor IA-PRP showed a similar safety profile to IA-HA. No severe AEs were observed, supporting the overall safety of IA-PRP for KOA. Clinicians should counsel patients on the likelihood of mild postprocedure symptoms, especially with high leukocyte formulations, while considering IA-PRP as a treatment option.
    DOI:  https://doi.org/10.1002/pmrj.70141
  17. Diagnostics (Basel). 2026 Apr 20. pii: 1233. [Epub ahead of print]16(8):
    Quantitative Imaging Biomarkers of PRP-Induced Tendon Remodelling in Chronic Tendinopathy: Review and Single-Centre Experience with Ultrasound Radiomics and MRI T2 Profiling.
    Živa Miriam Geršak, Karlo Pintarić, Jernej Vidmar, Vladka Salapura.
      Platelet-rich plasma (PRP) is widely used as a second-line treatment for chronic tendinopathy that persists despite structured conservative care, yet outcomes and imaging correlates remain heterogeneous. This review outlines PRP biology and preparation, summarises quantitative imaging techniques for monitoring tendon response, and presents the experience of a single centre integrating these methods into routine supraspinatus and lateral elbow PRP workflows. PRP is described as an autologous platelet concentrate with variable leukocyte and fibrin content, with leukocyte-rich formulations commonly selected for chronic tendinopathy. Quantitative approaches-including ultrasound shear-wave elastography and radiomics, MRI T2/T2* mapping, CT-based bone metrics, PET/CT, and optical techniques-offer numerical biomarkers of tendon structure, mechanics, and inflammation but are rarely implemented in PRP trials. At the authors' centre, leukocyte-rich PRP is injected under ultrasound guidance after failed physiotherapy, and follow-up combines validated questionnaires with grey-level run-length matrix texture analysis of ultrasound and 3.0 T MRI T2 distribution profiling. A pilot ultrasound study in supraspinatus and common extensor tendinosis showed uniform short-term clinical improvement and significant changes in most texture features, with selected parameters correlating with symptom relief. A prospective supraspinatus cohort demonstrated significant six-month clinical gains in both tendinosis and small partial-thickness tears, whereas only the tendinosis group exhibited T2 profile convergence toward asymptomatic patterns. These data indicate that quantitative ultrasound radiomics and whole-length T2 profiling are feasible imaging biomarkers that capture PRP-induced tendon remodelling beyond qualitative imaging and may help tailor PRP protocols to specific tendon phenotypes.
    Keywords:  T2 mapping; US radiomics; chronic tendinopathy; platelet-rich plasma; quantitative imaging biomarkers
    DOI:  https://doi.org/10.3390/diagnostics16081233
  18. Zhongguo Gu Shang. 2026 Apr 25. 39(4): 325-8
    [Advances and development trends in non-surgical treatment of knee osteoarthritis].
    Rui He.
      
    Keywords:  Biomechanics; Individualized rehabilitation; Knee osteoarthritis; Non-surgical treatment; Osteoporosis
    DOI:  https://doi.org/10.12200/j.issn.1003-0034.20260382
  19. Games Health J. 2026 May 09. 2161783X261447613
    Evaluating the Efficacy of Virtual Reality Exergaming in Frozen Shoulder Rehabilitation: A Randomized Clinical Trial.
    Amir Bisadi, Mohammad H Mahrooz, Mehdi Heidari, Basir Majdoleslami, Reza Minaei, Soheil Mehdipour.
      Objective: Frozen shoulder is a common condition causing shoulder pain and stiffness, with conventional therapies often hindered by low adherence due to their repetitive and painful nature. This randomized clinical trial aimed to evaluate the clinical effectiveness of immersive virtual reality (VR) exergaming in frozen shoulder rehabilitation.Materials and Methods: Fifty-four patients with primary frozen shoulder were randomly assigned to a VR therapy (VRT) group or a conventional therapy (CT) group. Both groups underwent 18 sessions over 6 weeks, consisting of 20 minutes of continuous passive motion exercises followed by 20 minutes of either VR exergaming or conventional functional exercises. We chose Beat Saber for the VR intervention, a rhythm game in which players slice blocks in sync with music. Its "level editor" allowed us to customize block patterns to simulate therapeutic shoulder movements.Results: Primary outcomes included passive range of motion (PROM) in external rotation, abduction, and flexion. Secondary outcomes assessed shoulder function (Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire) and resting pain (visual analog scale [VAS]). Assessments were conducted at baseline, postintervention, and 12 weeks after the trial. Both groups showed significant improvements in PROM, DASH, and VAS scores compared with baseline (P < 0.001). Between-group analysis revealed no significant differences in DASH (P = 0.483) or VAS (P = 0.220). However, the VRT group achieved superior abduction (P = 0.015) and flexion (P = 0.031), with no significant difference in external rotation (P = 0.637).Conclusion: These findings suggest VR exergaming is a promising adjunct to CT for frozen shoulder. Further studies are needed to investigate the influence of VR game design on rehabilitation outcomes.
    Keywords:  exergaming; frozen shoulder; rehabilitation; virtual reality
    DOI:  https://doi.org/10.1177/2161783X261447613
  20. J Hand Surg Glob Online. 2026 Jul;8(4): 101025
    Prevalence of Carpal Tunnel Syndrome During Pregnancy in Iran.
    Hesam Alitaleshi, Mojtaba Baroutkoub, Hossein Safaei, Mosayeb Soleymani.
       Purpose: Carpal tunnel syndrome (CTS) is a common musculoskeletal disorder during pregnancy, second only to back pain. Although the prevalence in the general population is approximately 4%, a prevalence of up to 43% has been reported in pregnant women. This review aimed to assess and summarize reported point-prevalence estimates of CTS among pregnant women in Iran.
    Methods: Five observational studies conducted in Iran were included. Diagnostic approaches varied across studies. Clinical diagnosis was defined as the presence of characteristic symptoms (paresthesia, numbness, nocturnal symptoms in the median nerve distribution) with or without positive provocative tests (Tinel and/or Phalen). Electrodiagnostic confirmation required abnormal nerve conduction velocity and/or EMG findings consistent with median nerve compression at the wrist. Data were extracted for the entire sample, including trimester, parity, bilateral involvement, and diagnostic tools.
    Results: A total of 2065 pregnant women were assessed across the included studies. Based on clinical criteria, the estimated prevalence of CTS during pregnancy in Iran was approximately 10.5%. Subjective symptoms were reported in 10.84%, objective signs in 10.31%. Electrodiagnostic tests (EMG and nerve conduction velocity) confirmed CTS in 5.67% of these 2065 pregnant women. Bilateral involvement was observed in 47.7% of symptomatic patients. The highest prevalence was observed in the third trimester (64.4%), and most affected women were experiencing their first pregnancy (55%).
    Conclusions: Reported prevalence of CTS during pregnancy in Iranian studies varies substantially depending on diagnostic criteria and study design. Although this variability does not indicate systematic underdiagnosis or inconsistent reporting, it highlights methodological heterogeneity across studies. Importantly, there is a paucity of high-quality evidence addressing optimal treatment strategies for CTS during and after pregnancy, underscoring the need for well-designed clinical studies in this area.
    Type of study/level of evidence: Prognostic III.
    Keywords:  Carpal tunnel syndrome; EMG-NCV; Median nerve compression; Pregnancy; Prevalence
    DOI:  https://doi.org/10.1016/j.jhsg.2026.101025
  21. BMJ Open Sport Exerc Med. 2026 ;12(2): e003245
    Time to return to sports in football players recovering from lower limb soft tissue injuries: a systematic review with meta-analysis.
    Jente Wagemans, Elaheh Ahmadi, Jan Taeymans, Jeroen Van Eetvelt, Geert Van Neylen, Peter Catteeuw, Heiner Baur, Dirk Vissers.
       Objectives: Depict football players' average times to return to sports (RTS) after non-contact lower limb soft-tissue injuries.
    Design: Systematic review with meta-analysis.
    Data sources: PubMed, WoS, Scopus, PEDro, Google Scholar and Cochrane Central Register of Controlled.
    Eligibility criteria for selecting studies: We included records investigating time to return to sports in football players suffering from non-contact lower limb soft-tissue injuries.
    Data synthesis: Time to return to sports was the main outcome. We appraised the quality of the included studies with the QualSyst tool for quantitative research. A random-effects model was wielded for the meta-analyses.
    Results: 39 studies were included. Time to return to match (RTM) for ligament injuries ranged from 43 days (lateral collateral ligament) to 249.6 days (ACL rupture and repair (ACLR); RTM for muscle injuries ranged from 21 days (hamstring muscle injury) to 69.1 days (soleus); RTM for tendon injuries ranged from 29.4 days (patella tendinopathy) to 220.4 days (Achilles tendon rupture). Time to return to training (RTT) for ligament injuries is also longest for ACLR (212.9 days) and lowest for lateral ankle sprain (19.9 days); RTT for muscle injuries ranged from 8 days (hamstring muscle injury grade 0 to 65.3 days (HMI grade 3)); popliteus tendinopathy (11 days) had lowest RTT among tendon injuries, groin pain had the longest (45 days).
    Conclusions: This review provides an overview of RTS times-expressed as RTT and RTM-for lower limb injuries in football players. Our results also underscore the existing variability in wielded RTS definitions and injury classifications.
    Keywords:  Football; Injury; Rehabilitation; Sports medicine
    DOI:  https://doi.org/10.1136/bmjsem-2026-003245
  22. Clin Biomech (Bristol). 2026 May 03. pii: S0268-0033(26)00121-X. [Epub ahead of print]137 106866
    Ultrasonographic assessment of shoulder muscle thickness and isokinetic strength in patients with rotator cuff tendinopathy: A cross-sectional study.
    Dilara Kara, Levent Özçakar, Taha İbrahim Yıldız, Serdar Demirci, Gazi Huri, İrem Düzgün.
       BACKGROUND: Alterations in shoulder muscle thickness and strength are believed to be associated with rotator cuff (RC) tendinopathy. Previous studies have mainly focused on measuring the supraspinatus tendon thickness in relevant patients with shoulder pain. This study examined differences in shoulder muscle thickness and RC strength in the symptomatic and asymptomatic shoulders of patients with RC tendinopathy.
    METHODS: Thirty-five patients with unilateral RC tendinopathy were included in this study. Muscle thickness of the supraspinatus, infraspinatus, deltoid, and combined middle trapezius+rhomboid was measured via ultrasonography, while RC strength (internal rotator [IR] and external rotator [ER]) at 60°/s and 180°/s was assessed using an isokinetic device.
    FINDINGS: No significant differences were found in muscle thickness (supraspinatus p = .342; infraspinatus, p = .746; deltoid p = .112; middle trapezius+rhomboid, p = .378), RC strength (ER 60°/s p = .283; IR 60°/s p = .337; ER 180°/s p = .334; IR 180°/s p = .141), or ER/IR strength ratios (60°/s p = .857; 180°/s p = .379) between symptomatic and asymptomatic shoulders. Significant correlations ranging from weak-to-high were found between supraspinatus, infraspinatus, and deltoid thickness and RC strength (r = 0.354-0.732, p < .05). A moderate correlation was observed between middle trapezius+rhomboid thickness and shoulder ER strength (r = 0.620-0.625, p < .001), but no correlation with IR strength (p > .05).
    INTERPRETATION: Patients with RC tendinopathy exhibited similar shoulder muscle thickness, ER and IR strength, and ER/IR strength ratios between symptomatic vs. asymptomatic shoulders. Additionally, shoulder muscle thickness appears to be associated with shoulder rotator strength.
    Keywords:  Deltoid; Infraspinatus; Shoulder pain; Sonography; Supraspinatus
    DOI:  https://doi.org/10.1016/j.clinbiomech.2026.106866
  23. Mol Nutr Food Res. 2026 May;70(9): e70490
    Olive-Derived Extracts and Bioactive Compounds for Pain Management in Osteoarthritis and Degenerative Knee Pain: A Systematic Review and Meta-Analysis.
    Desirée Victoria-Montesinos, Pablo Barcina-Pérez, Ana María García-Muñoz.
      This study aimed to evaluate the effects of olive-derived extracts and bioactive compounds on pain outcomes and, secondarily, to summarize their reported effects on physical function and related outcomes in adults with osteoarthritis (OA) or degenerative knee/joint pain. A systematic search was conducted in PubMed/MEDLINE, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials. Randomized controlled trials and other human intervention studies evaluating orally and/or topically administered olive-derived extracts or isolated olive bioactive compounds in individuals with OA or chronic degenerative knee/joint pain were included. The search identified 666 records; after screening, 6 studies met the eligibility criteria, and 3 randomized controlled trials were included in the meta-analysis. Most studies reported reductions in pain following supplementation with olive-derived extracts or isolated bioactive compounds. Meta-analysis suggested a modest reduction in pain compared with control conditions (standardized mean difference = 0.40, 95% CI 0.06-0.75), although this estimate should be interpreted cautiously given the small number of pooled trials and the heterogeneity across interventions. Evidence regarding physical function was more heterogeneous and was therefore synthesized narratively. These findings suggest that olive-derived bioactive compounds may contribute to modest pain reduction, although the available evidence remains limited and preliminary.
    Keywords:  live leaf extract; meta‐analysis; olive‐derived bioactives; osteoarthritis; pain management; polyphenols
    DOI:  https://doi.org/10.1002/mnfr.70490
  24. Pain Pract. 2026 Jun;26(5): e70155
    Evaluation of the Efficacy of Transdermal Buprenorphine in Chronic Low Back Pain: A Meta-Analysis of Randomized Clinical Trials.
    Anna Karla do Nascimento Souza, Eduardo Silva Reis Barreto, César Romero Antunes Júnior, Gabriel Teles de Oliveira Piñeiro, Durval Campos Kraychete.
       OBJECTIVE: To evaluate the efficacy of transdermal buprenorphine for treating pain in patients with chronic low back pain (CLBP), with additional assessment of sleep quality and adverse events.
    METHODS: A systematic literature search was conducted in PubMed, Scopus, Embase, and Cochrane CENTRAL up to June 2025. Randomized controlled trials (RCTs) comparing transdermal buprenorphine with placebo in adults with CLBP were included. Pain intensity was the primary outcome; secondary outcomes were sleep quality and adverse events. This review followed PRISMA guidelines and was registered in PROSPERO (CRD42024629751).
    RESULTS: Six RCTs, including 698 patients, were analyzed. Transdermal buprenorphine did not significantly reduce pain intensity compared to placebo (Mean Difference = -0.32; 95% CI: -1.04 to 0.40; p = 0.380; I2 = 77.4%). However, a small but statistically significant improvement in sleep quality was found (Standardized Mean Difference = -0.24; 95% CI: -0.37 to -0.10; p < 0.001; I2 = 28%). Adverse events were more frequent in the buprenorphine group, although not statistically significant for total adverse events (RR = 1.98; 95% CI: 0.97 to 4.02; p = 0.060).
    CONCLUSION: These findings suggest a limited benefit of transdermal buprenorphine for pain relief in CLBP. While sleep quality may improve slightly, the potential for increased adverse events must be considered. Current evidence does not support the routine use of transdermal buprenorphine for CLBP due to insufficient analgesic effect and possible safety concerns.
    Keywords:  buprenorphine; chronic pain; low back pain; randomized controlled trials as topic; transdermal patch
    DOI:  https://doi.org/10.1111/papr.70155
  25. BMC Neurol. 2026 May 04.
    The relationship between shoulder pain and joint position sense, postural control, tactile sensation, and muscle strength in chronic hemiplegia.
    Beril Kütükcü, Metehan Yana.
       OBJECTIVE: The aim of this study is to investigate the relationship between shoulder pain and joint position sense, postural control, tactile sensation, and muscle strength in chronic hemiplegic stroke patients.
    METHODS: The study was designed as a cross-sectional descriptive study, with 78 individuals with chronic stroke (48 males, 30 females). The participants were divided into two groups: those with shoulder pain and those without. Assessments were performed on the affected upper limb and included shoulder proprioception (inclinometer), postural control (Postural Assessment Scale for Stroke Patients (PASS-T)), tactile sensation (Semmes-Weinstein Monofilament test), gross grip strength (dynamometer), and pinch grip strength (pinch meter).
    RESULTS: The findings of the study revealed significant differences between individuals with and without shoulder pain across joint position sense, postural control, tactile sensation, and grip strength (all p < 0.05). Effect size analyses indicated that these differences ranged from small-to-moderate (d = 0.49-0.75) to large-to-very large (d ≥ 0.98), supporting the clinical relevance of the observed group differences.
    CONCLUSIONS: This study demonstrated that shoulder pain is significantly associated with motor and sensory functions in chronic hemiplegic individuals. It also underscores the necessity for rehabilitation programs to be tailored according to individuals' pain conditions, emphasizing the critical role of this factor in patient recovery processes.
    TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06793852. Registered on January 21, 2025.
    Keywords:  Muscle Strength; Pain; Postural Control; Proprioception; Sensation; Stroke
    DOI:  https://doi.org/10.1186/s12883-026-04924-3
  26. Cureus. 2026 Apr;18(4): e106317
    Total Proximal Interphalangeal Joint Arthroplasty as a Treatment for Advanced Boutonniere Deformity of the Finger.
    Jakub Florek, Patryk Kawa, Filip Georgiew, Oles Petrovych, Krystian Mleczko.
      Boutonniere deformity results from damage to the central band and structures stabilizing the finger's extensor apparatus, leading to flexion of the proximal interphalangeal (PIP) joint and hyperextension of the distal interphalangeal (DIP) joint. Untreated or delayed diagnosis of boutonniere deformity results in progression of both deformity and degenerative changes in the PIP joint. In advanced, chronic deformities (Burton IV), surgical treatment includes arthrodesis or PIP joint replacement. In the presented case, a 29-year-old right-handed man presented with a persistent boutonniere deformity of the fifth finger of his right hand and pain that limited his function. The patient had two finger injuries, 13 and 11 years earlier. X-rays of the injuries revealed no fractures, and the finger was immobilized. After the immobilization of the second injury was removed, the patient experienced mild pain and observed a gradual worsening of the finger deformity. Upon admission to the orthopedic clinic, examination revealed 55° of flexion in the PIP joint, 30° of hyperextension of the DIP joint, complete lack of motion in the PIP joint. Mobility in the DIP joint was complete. X-rays revealed advanced degenerative changes in the PIP joint. The patient underwent implantation of a cementless, semi-constrained PIP endoprosthesis (Interphalangeal Proximal Prosthesis (IPP2); 3S Ortho, Lyon, France) and central band reconstruction. Postoperative immobilization lasted six weeks, followed by intensive rehabilitation. Fifteen weeks after surgery, 50° of flexion and a 5° of extension deficit were achieved in the PIP joint, with full DIP mobility. After 21 weeks, the PIP joint flexion range increased to 85°, and the pain completely resolved. The patient returned to full manual dexterity and physical activity. Chronic boutonniere deformity can lead to progression of PIP joint arthrosis and significant impairment of hand function. PIP joint arthroplasty combined with extensor reconstruction is a valuable alternative to arthrodesis in patients requiring preserved mobility and grip precision. A properly selected treatment method and early, intensive rehabilitation allow for excellent functional outcomes.
    Keywords:  boutonniere deformity; degenerative disease; hand; pip; proximal interphalangeal joint; surgical treatment; total arthroplasty
    DOI:  https://doi.org/10.7759/cureus.106317
  27. J Back Musculoskelet Rehabil. 2026 May 07. 10538127261448996
    The effect of Baduanjin on pain, balance, function and kinesiophobia in individuals with knee osteoarthritis: A randomized controlled trial.
    Ali Yildirim, Zeynep Hosbay, Adnan Aksoy.
      BackgroundKnee osteoarthritis (knee OA) is a common degenerative joint disease associated with pain, functional limitation, and balance impairment. Baduanjin, a traditional mind-body exercise involving slow, coordinated movements and breathing control, has been suggested to improve neuromuscular function. This randomized controlled trial investigated the effects of adding face-to-face and online Baduanjin to structured exercise therapy on pain, function, balance, and kinesiophobia in individuals with knee OA.MethodsSixty-six participants aged 40-70 years with radiographic knee OA (Kellgren-Lawrence grade II-III) were randomly assigned to three groups: structured exercise plus face-to-face Baduanjin, structured exercise plus online Baduanjin, or structured exercise alone. Interventions were performed three times weekly for 12 weeks. Outcomes were assessed at baseline, week 6, and week 12 using the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Berg Balance Scale (BBS), Timed Up and Go Test, Tampa Scale for Kinesiophobia, and 30-Second Sit-to-Stand Test.ResultsBoth Baduanjin groups showed significant improvements in VAS, WOMAC, BBS, Timed Up and Go, kinesiophobia, and sit-to-stand performance at weeks 6 and 12 (p < 0.05). The structured exercise group improved mainly in VAS and WOMAC function scores (p < 0.05).ConclusionsBoth face-to-face and online Baduanjin approaches were associated with improvements in pain, balance, mobility, and functional outcomes when added to structured exercise therapy in individuals with knee OA. Online delivery showed trends comparable to those in clinical outcomes.
    Keywords:  Baduanjin; exercise therapy; knee osteoarthritis; telerehabilitation
    DOI:  https://doi.org/10.1177/10538127261448996
  28. J Back Musculoskelet Rehabil. 2026 May 04. 10538127261445293
    Enhancing adherence and outcomes in rotator cuff-related shoulder pain: A randomized trial of individualized exercise sequencing.
    Beom Chang Baek, Nackhwan Kim.
      BackgroundAdherence to exercise remains a challenge in rotator cuff-related shoulder pain (RCRSP).ObjectiveThis study compared an individualized exercise sequence with a content-matched random sequence on pain, disability, and adherence in adults with chronic RCRSP.MethodsIn a single-center randomized controlled trial, 55 participants with chronic RCRSP were assigned to an individualized, algorithm-based sequencing protocol or to a random sequence of the same 13 home-based exercises (24 sessions over four weeks). The primary outcome was the Shoulder Pain and Disability Index (SPADI) total score at eight weeks. Secondary outcomes included pain intensity, the Korean version of the Disabilities of the Arm, Shoulder and Hand questionnaire (K-DASH), and range of motion. Adherence, defined as completed cycles, was a key measure.ResultsForty-eight participants (87.3%) completed the eight-week follow-up. Group baseline characteristics were similar. Intervention fidelity was confirmed, with distinct sequencing patterns between groups (p < 0.05). Adherence was higher in the individualized group (media4.0 cycles) than in the random sequencing group (median 1.0 cycle; p < 0.001). This difference corresponded to greater improvement in the primary outcome and all secondary outcomes across follow-ups (all post hoc p < 0.001). Linear mixed-effects models also showed a steeper rate of functional improvement (K-DASH and range of motion) in the individualized group.ConclusionIndividualized sequencing was associated with superior adherence and improved outcomes. Interpretation requires caution: the large treatment effect was likely mediated by adherence, and the low compliance in the random sequencing group may not reflect usual practice.
    Keywords:  exercise therapy; pain; physical therapy; shoulder; therapeutic exercise
    DOI:  https://doi.org/10.1177/10538127261445293
  29. Health Sci Rep. 2026 May;9(5): e72021
    Impact of Coracoacromial Ligament Thickness on Shoulder Impingement Syndrome: A Cross-Sectional Magnetic Resonance Imaging Study.
    Pooneh Dehghan, Seyedhassan Langari, Fatemeh Ghiasi, Mojtaba Majdifar, Mohammad Hassabi, Fereshteh Fahim Dejban, Donya Moshrefiaraghi.
       Background and Aims: Shoulder impingement syndrome (SIS) is a common cause of shoulder pain and dysfunction. This study explored the association between coracoacromial ligament (CAL) thickness and SIS using magnetic resonance imaging (MRI).
    Methods: This cross-sectional MRI-based observational study involved 47 patients aged 18-70 years with shoulder pain. T2 fat-saturated sagittal MRI views were used to measure CAL thickness at proximal and distal portions by two radiologists. Statistical analyses included t-tests, χ 2 tests, and Pearson's correlation, with significance set at p < 0.05.
    Results: Mean proximal CAL thickness was 1.24 mm (SD = 0.44 mm), and distal thickness was 1.50 mm (SD = 0.72 mm). Patients with SIS had significantly greater thickness at proximal (1.36 mm vs. 1.05 mm, p = 0.002, d = 0.82) and distal (1.78 mm vs. 1.12 mm, p = 0.001, d = 0.92, 95% CI: 0.39-0.93). Males showed greater distal thickness (1.62 mm) than females (1.34 mm, p = 0.04, d = 0.45). Age did not correlate with thickness (p > 0.71). Subacromial bursitis (70.21%, p < 0.001) and acromioclavicular (AC) joint osteophytes (68.09%, p = 0.003) were prevalent and associated with SIS.
    Conclusion: CAL thickness, particularly at the distal portion, was strongly associated with SIS, independent of age but varying by gender. Measuring CAL thickness may aid SIS diagnosis.
    Keywords:  coracoacromial ligament; magnetic resonance imaging; shoulder impingement syndrome; shoulder pain
    DOI:  https://doi.org/10.1002/hsr2.72021
  30. Minerva Anestesiol. 2026 May 06.
    Medicine regenerative versus steroids: time to reconsider treatment of chronic inflammatory pain.
    Maurizio Marchesini, Wassim Raffoul, Massimo Allegri.
       BACKGROUND: Chronic musculoskeletal and spinal pain is a major clinical challenge. Corticosteroid (CS) injections provide rapid analgesia, but it is typically short-lived and may have adverse tissue-related effects. The most commonly used regenerative treatment is platelet-rich plasma (PRP), which modulates inflammation and extracellular matrix turnover and partly affects nociceptive signalling. PRP also has potential for longer-term disease-modifying benefits. This review compares PRP with CS in key musculoskeletal joints and spinal pain indications with focus on effectiveness, durability, and safety.
    METHODS: We conducted a review with a systematic search of PubMed/MEDLINE, Embase, Scopus, Cochrane Library, Web of Science, and Google Scholar (January 2000 - March 2025). English-language randomized controlled trials (RCTs) and prospective studies evaluating PRP versus CS (± local anesthetic) in osteoarthritis, tendinopathies, and spinal pain (discogenic, facet/zygapophyseal, sacroiliac joint, radicular) were included. The primary outcomes were pain intensity, function, and durability. Safety information was extracted when reported. Given the heterogeneity in the PRP formulations (leukocyte-poor/leukocyte-rich, platelet dose, activation), target tissues, and follow-up, the findings were synthesized qualitatively according to anatomical region and integrated with mechanistic evidence.
    RESULTS: Across indications, CS showed an early advantage at 2-8 weeks, whereas PRP demonstrated superior pain and functional outcomes at ≥3-6 months. In plantar fasciitis and osteoarthritis of the knee, PRP outperformed CS at 3-12 months. In gluteal tendinopathy, benefits of PRP emerged by 12 weeks. For cervical/lumbar facet and sacroiliac joint pain, PRP yielded more durable relief up to 6 months. In epidural approaches, PRP was non-inferior in the short term and in some studies superior by 24 weeks, and intradiscal PRP showed encouraging longer-term signals. Both strategies were generally safe, although local/systemic adverse events were more frequent with CS. Outcome variability was partly attributable to heterogeneity of PRP products.
    CONCLUSIONS: For inflammatory-degenerative musculoskeletal and spinal conditions, PRP seems to offer more persistent benefits than CS, while CS is valuable for rapid short-term analgesia. Treatment selection should be guided by phenotype. Standardization of PRP protocols (composition, dose, activation) and high-quality multicentre RCTs are still needed. Conceptualizing PRP as primarily an immuno-inflammatory modulator drug in pain therapy rather than strictly "regenerative" may better explain its longer-term effects.
    DOI:  https://doi.org/10.23736/S0375-9393.26.19712-0
  31. Orthop Rev (Pavia). 2026 ;18 160839
    Does Surgical Technique Matter? A Retrospective Analysis of Five-Year Outcomes After Arthroscopic vs. Open Femoroacetabular Impingement Syndrome Correction.
    Amir Ghafarian, Muaaz Wajahath, Noah Hodson, Ali Mehaidli, Trevor North.
       Background: Femoroacetabular impingement syndrome (FAIS) is a major cause of chronic hip pain and early osteoarthritis. Surgical correction, traditionally via open surgical dislocation and increasingly via hip arthroscopy, aims to restore hip function by correcting bony morphology. While both techniques address cam and pincer lesions, the long-term implications of the surgical approach and specific impingement morphology on five-year structural outcomes, including hip instability, osteoarthritis (OA) progression, and conversion to total hip arthroplasty (THA), remain poorly defined.
    Methods: We conducted a retrospective cohort study using the TriNetX US Collaborative Network, analyzing de-identified electronic medical records from 2,725 patients (2,321 arthroscopic, 404 open) who underwent FAIS correction between 2003 and 2023 with a minimum five-year follow-up. Patients were grouped by surgical approach (Arthroscopic vs. Open) and morphology (Cam-only vs. Pincer-only vs. Mixed). Primary outcomes were five-year cumulative incidence and time-to-event incidence (Hazard Ratio, HR) of hip instability/dislocation, hip OA, and THA conversion.
    Results: In patients with mixed FAIS morphology, the arthroscopic approach was associated with a significantly lower risk of instability/dislocation (3.7% vs. 11.6%; HR 0.393, p<0.001) compared to the open approach. Conversely, the open approach demonstrated a lower incidence of hip OA (4.6% vs. 7.8%; HR 2.320, p=0.001 favoring open). Although the overall five-year THA incidence was equal (2.4%), arthroscopy had a significantly higher hazard of conversion (HR 6.112, p=0.004). Subgroup analysis found no statistically significant difference in instability, OA, or THA rates between cam and pincer morphologies within either the arthroscopic or open cohort.
    Conclusion: Surgical approach significantly impacts five-year structural outcomes in FAIS correction. Arthroscopy offers superior early joint stability, but the open approach may be associated with a more protective effect against long-term OA progression. Impingement morphology (cam vs. pincer) did not independently influence these five-year outcomes. These findings support a trade-off between approaches and highlight the need for tailored surgical selection to optimize joint preservation.
    Keywords:  Hip arthroscopy; cam impingement; femoroacetabular impingement syndrome; hip osteoarthritis; open surgical dislocation; pincer impingement; surgical technique; total hip arthroplasty
    DOI:  https://doi.org/10.52965/001c.160839
  32. J Clin Med. 2026 Apr 17. pii: 3068. [Epub ahead of print]15(8):
    Dissociation Between Clinical and Ultrasonographic Response After Radial Shock Wave Therapy in Refractory Plantar Fasciitis.
    Manuel Novo Rigueiro, Fabio Pires Pereira, Ignacio Lete Achirica, Antonio Gómez Caamaño, Francisco Javier Rodríguez Rigueiro, Jesús Rodríguez Figueroa, Arturo González Quintela, Ignacio Novo Veleiro.
      Background: Chronic plantar fasciitis refractory to conservative treatment is a frequent cause of persistent heel pain and functional limitation. Although radial extracorporeal shock wave therapy (rESWT) has shown potential benefit, the relationship between clinical improvement and structural ultrasonographic changes remains unclear. The aim of this study was to evaluate the clinical, functional, and ultrasonographic outcomes associated with rESWT in patients with refractory plantar fasciitis. Methods: We conducted a prospective observational single-center study including 287 patients with plantar fasciitis refractory to conservative treatment for at least 6 months and confirmed by ultrasonography (plantar fascia thickness >4 mm). All patients received four weekly sessions of rESWT. Pain intensity (visual analog scale [VAS]), foot function (Foot Function Index [FFI]), quality of life (EQ-5D), and plantar fascia thickness were assessed at baseline and 3 months after treatment. Results: Significant improvements were observed in pain (mean VAS change, -3.73 points), function (mean FFI-disability change, -32.37 points), and quality of life (improvement in at least one EQ-5D dimension in 81.5% of patients) (all p < 0.001). The mean reduction in plantar fascia thickness was 0.14 mm. Most responders (71.8%) showed clinical improvement despite the absence of a relevant structural change, defined as a reduction in plantar fascia thickness <0.5 mm. In multivariate analysis, physically demanding occupations were associated with a lower probability of response (odds ratio, 0.32; 95% confidence interval, 0.17-0.63). The prognostic model showed moderate discrimination (area under the curve, 0.71). Conclusions: In this observational cohort, rESWT was associated with improvements in pain, function, and quality of life in patients with refractory plantar fasciitis. Clinical improvement frequently occurred despite minimal changes in plantar fascia thickness, suggesting that ultrasonographic thickness may not adequately reflect symptomatic evolution. However, the absence of a control group prevents causal interpretation of these findings.
    Keywords:  heel pain; prognosis; treatment outcome; ultrasonography
    DOI:  https://doi.org/10.3390/jcm15083068
  33. Life (Basel). 2026 Apr 07. pii: 608. [Epub ahead of print]16(4):
    Is Exercise Enough? Evidence from Controlled Clinical Trials on Rehabilitation with and Without Adjunct Modalities for Musculoskeletal Disorders.
    Bindiya Rawat, Yajuvendra Singh Rajpoot, Sohom Saha, Vasile-Cătălin Ciocan, Alina-Mihaela Cristuta, Suchishrava Choudhary, Prashant Kumar Choudhary, Carmina-Mihaela Gorgan, Constantin Sufaru, Nicolae Lucian Voinea.
       BACKGROUND: Musculoskeletal disorders (MSDs) are a major contributor to global disability. Exercise-based rehabilitation is widely recommended as first-line management; however, in clinical practice, it is frequently combined with adjunct therapeutic modalities, and the incremental effectiveness of these approaches remains unclear. The present review addressed the research question: Do adjunct modalities provide additional benefits beyond exercise-based rehabilitation alone in individuals with musculoskeletal disorders?
    METHODS: This systematic review was conducted according to PRISMA 2020 guidelines and prospectively registered in the PROSPERO database (registration number CRD420261309183). Electronic searches were performed in PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials to identify controlled clinical trials evaluating exercise-based rehabilitation delivered alone or combined with adjunct modalities. Outcomes included pain, functional disability, physical performance, strength, structural or imaging-based measures, biomechanical variables, injury risk, and work-related outcomes. Due to methodological heterogeneity across studies, a structured narrative and tabular synthesis were performed.
    RESULTS: Twenty-one controlled clinical trials were included, encompassing tendinopathies (n = 7), knee osteoarthritis (n = 5), post-ACL reconstruction (n = 2), chronic spinal pain (n = 3), sarcopenia (n = 2), low bone mass (n = 2), and occupational musculoskeletal conditions (n = 1), with sample sizes ranging from 22 to 823 participants. Pain outcomes were reported in 18 studies (86%) and functional outcomes in 16 studies (76%). Exercise-based rehabilitation consistently produced clinically meaningful improvements across studies, whereas adjunct modalities demonstrated short-term advantages in a limited number of trials but rarely showed sustained long-term superiority.
    CONCLUSIONS: Evidence from controlled clinical trials indicates that exercise-based rehabilitation is an effective primary intervention for improving pain, functional capacity, and physical performance across diverse musculoskeletal conditions. Adjunct modalities may provide condition-specific or short-term benefits but do not consistently enhance long-term outcomes beyond structured exercise programs.
    Keywords:  low back pain; musculoskeletal health; neuromuscular training; osteoarthritis; sarcopenia; tendinopathy
    DOI:  https://doi.org/10.3390/life16040608
  34. Malays Orthop J. 2026 Mar;20(1): 30-40
    Asymptomatic Rotator Cuff Tendinopathy in Elderly Diabetics: Is Routine Magnetic Resonance Imaging Evaluation of the Shoulder Warranted?
    T P Gupta, B Sirohi, M A Jafri, S Rai.
       Introduction: The occurrence of rotator cuff tendinopathy, which is invariably symptomatic, increases as populations age, being largely observed among patients with diabetes. The objective of the present study is to find out the occurrence of rotator cuff tendinopathy in elderly diabetic patients who were asymptomatic, composed of healthy individuals and those with diabetes mellitus.
    Materials and methods: The participants in this study included 87 elderly diabetic patients and 56 controls (mean age: 69.3±4.9 and 71.8±3.6, respectively), who were asymptomatic from shoulder. All patients underwent shoulder MRI examination using 1.5 tesla MRI.
    Results: We recorded greater tendons thickness in the diabetic patients as compared with the controls (supraspinatus tendon: 6.6±0.7mm vs 5.3±0.8mm, p<0.001; biceps tendon: 3.9±0.7mm vs 3.1±0.8mm, p<0.002). Moreover, higher incidence of supraspinatus tendon tear was noted in diabetics as compared to biceps tendon (major tears: 32 (36.7%) vs 6 (10.7%), p=0.052; minor tears: 51 (58.6%) vs 11 (19.6%), p=0.032).
    Conclusions: The present study suggests that age-related rotator cuff tendinopathy is more prevalent among patients with diabetes. Therefore, MRI is an investigation of choice for early detection i.e., at pre-symptomatic stages of rotator cuff tendinopathy, as the patients may develop symptoms later.
    Keywords:  MRI shoulder, diabetes; asymptomatic rotator cuff tendinopathy; pericapsulitis shoulder
    DOI:  https://doi.org/10.5704/MOJ.2603.004
  35. J Brachial Plex Peripher Nerve Inj. 2026 Jan;21(1): e7-e12
    Wrist Circumference-Dependent Thresholds for the Median Nerve in Carpal Tunnel Syndrome: A Cross-Cohort Comparison.
    Tom B G Olde Dubbelink, Federica Ginanneschi, Paolo Falsetti, Jan Meulstee, Ronald H M A Bartels, Wim I M Verhagen.
       Background: Considerable between-center variability exists in the upper limit of normal (ULN) for the cross-sectional area (CSA) of the median nerve (MN) used to support the diagnosis of carpal tunnel syndrome (CTS).
    Objective: To evaluate whether a Dutch wrist circumference-dependent (WCD) equation for the ULN of MN CSA provides comparable classification of abnormal CSA in Italian and Dutch CTS populations.
    Methods: Wrist circumference (WC) and MN CSA were measured in 55 Italian (85 wrists) and 175 Dutch (175 wrists) patients with CTS. Abnormal wrists were identified using three thresholds: ULN9 (9 mm 2 ), ULN11 (11 mm 2 ), and a WCD equation ( y  = 0.88 * x - 4, with y as ULN in mm 2 x as WC in cm). Findings were compared with electrodiagnostic results.
    Results: No significant differences in WC or MN CSA were observed between groups. The proportion of abnormal wrists in the Italian and Dutch populations, respectively, was 83.5 and 78.3% (ULN9, p  = 0.321), 49.4 and 50.3% (ULN11, p  = 0.895), and 61.1 and 55.4% (WCD, p  = 0.379). Among 12 Italian patients with small wrists, abnormal results were found in 75.0% (ULN9), 25.0% (ULN11), and 66.7% (WCD). All Italian patients had abnormal electrodiagnostic testing results, compared with 66.3% of Dutch patients ( p  < 0.0001).
    Conclusion: The WCD ULN for MN CSA yielded similar results in Italian and Dutch patients with CTS, and may be particularly useful in individuals with smaller wrists.
    Keywords:  carpal tunnel syndrome; median nerve; ultrasonography; upper limit of normal; wrist circumference
    DOI:  https://doi.org/10.1055/a-2837-4022
  36. BMJ Case Rep. 2026 May 08. pii: e268847. [Epub ahead of print]19(5):
    Treatment of thoracic posterior cutaneous nerve entrapment syndrome using an ultrasound-guided erector spinae plane block.
    Takahiro Minamii, Shogo Shirota, Hiroaki Nishioka.
      Posterior cutaneous nerve entrapment syndrome (POCNES) is a rare and often overlooked cause of chronic paravertebral back pain. Treatment options for POCNES are not well established. Herein, we describe a teenage patient with a 3-month history of left parascapular pain and dysaesthesia unresponsive to analgesics or physiotherapy. Physical examination revealed a hyperalgesic and hypoaesthetic area lateral to the eighth thoracic vertebra. Imaging and laboratory tests showed no significant findings. A trigger-point injection provided temporary pain relief, which aided in diagnosing POCNES, although the relief was short-lived. We then performed an ultrasound-guided erector spinae plane (ESP) block, which effectively resolved the patient's pain without recurrence. Diagnosing POCNES requires a high level of suspicion, thorough history-taking and focused physical examination to identify its neuropathic features. The ultrasound-guided ESP block may be a treatment option for managing POCNES.
    Keywords:  General practice / family medicine; Pain; Pain (neurology)
    DOI:  https://doi.org/10.1136/bcr-2025-268847
  37. BMJ Open. 2026 May 04. 16(5): e108667
    Adding reciprocal inhibition to conventional physiotherapy for adhesive capsulitis of the shoulder in Bangladesh: a study protocol for a randomised controlled trial evaluating pain, function and range of motion.
    Md Rifatur Rahman, Polok Halder, Md Emran Hossain, Md Ashfaquzzaman, Md Nasim Mahmud, Rana Chandra Paul, Md Sabuj Sheikh, K Zaman Utshab, Md Mahmudul Hasan, Muhammad Millat Hossain.
       INTRODUCTION: Adhesive capsulitis (frozen shoulder) is a common condition characterised by pain, stiffness and reduced function. While conventional physiotherapy (typically comprising joint mobilisation, stretching, strengthening and electrotherapy) is widely used, there is limited evidence for the effectiveness of advanced neuromuscular techniques such as the reciprocal inhibition technique (RIT). This study aims to evaluate the impact of incorporating RIT into standard physiotherapy compared with standard physiotherapy alone in individuals with adhesive capsulitis.
    METHODS AND ANALYSIS: This is a double-blind, randomised controlled trial. 30 adults aged 30-70 years with clinically confirmed adhesive capsulitis will be recruited from a tertiary rehabilitation centre in Dhaka, Bangladesh. Participants will be randomly allocated to receive either RIT combined with conventional physiotherapy or conventional physiotherapy alone, with both groups undergoing 12 treatment sessions over 4 weeks. The primary outcome is pain intensity at 4 weeks post-randomisation, measured by the Numeric Pain Rating Scale. Secondary outcomes include shoulder range of motion (abduction, internal and external rotation, assessed with a universal goniometer), functional ability (Shoulder Pain and Disability Index) and muscle strength (abduction, internal and external rotation, measured by hand-held dynamometry). Blinded assessors will conduct evaluations at baseline and after the intervention. Data will be analysed using intention-to-treat principles. Between-group comparisons will be made using linear mixed models with fixed effects for group, time and group-by-time interaction, and a random intercept for participants to account for repeated measurements. Within-group changes will be estimated from the models.
    ETHICS AND DISSEMINATION: This trial has received ethical clearance from the Institutional Review Board of the Institute of Physiotherapy, Rehabilitation & Research (approval number BPA-IPRR/IRB/18/02/2025/32). Results will be disseminated through peer-reviewed publications and international conferences in accordance with Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. By addressing a significant evidence gap, this study may establish RIT as an effective and affordable adjunct to standard physiotherapy for managing adhesive capsulitis.
    TRIAL REGISTRATION NUMBER: CTRI/2025/06/089288 [Registered on: 23/06/2025].
    Keywords:  Musculoskeletal disorders; PAIN MANAGEMENT; Pain management; Physical Therapy Modalities; REHABILITATION MEDICINE; Randomized Controlled Trial
    DOI:  https://doi.org/10.1136/bmjopen-2025-108667
  38. Int J Sports Phys Ther. 2026 ;21(5): 542-555
    SPORT: A Novel Biopsychosocial Framework for Chronic Low Back Pain in a Young Athlete - A Case Report.
    James Swift.
       Background and Purpose: Chronic low back pain (CLBP) is a disabling injury for athletes with an unclear pathway to return to sport (RTS). Biopsychosocial (BPS) treatment can address the complex needs of athletes recovering from injury by considering the interplay between body and mind. Current BPS models lack specific guidelines for clinicians. This case report presents and applies a novel BPS framework, SPORT (Systematic Progressive Overload Rehabilitation Training) to a young athlete with CLBP.
    Description: An accomplished 18-year-old male athlete who engaged in soccer, football, and powerlifting presented with CLBP. The symptoms originated with kicking and worsened for 13 months. Despite five months of treatment from clinicians, there was no RTS or improvement in pain and disability. The SPORT framework consisting of 18 evidence-based principles was implemented. The outcomes tracked were strength, sport participation, and reported pain and function.
    Outcomes: A 17-week intervention resulted in strength gains as measured by performances on the squat and deadlift. Squat improved from 45 lb to 335 lb. Deadlift improved from 45 lb to 385 lb. The subject's recreational sport participation increased from inactivity to 45 minutes of play for five consecutive days. He improved from daily pain and disability to near pain-free living and function. Seven weeks post treatment, post-case outcomes included a 435 lb squat, 465 lb deadlift, participation in recreational sports, sustained improvements in pain and function, and successful flare-up management.
    Discussion: The subject presented with unique challenges which required a holistic approach to RTS. SPORT provided tools for managing his CLBP. Future studies could compare SPORT to other treatments for CLBP in young athletes, ideally on a larger scale and with diverse populations.
    Conclusion: The case presents the creation and application of an original BPS framework, resulting in reductions in pain and a RTS in a young athlete suffering from CLBP.
    Level Of Evidence: 4.
    Keywords:  SPORT framework; athlete rehabilitation; back pain; biopsychosocial; chronic low back pain; physical therapy; return to sport
    DOI:  https://doi.org/10.26603/001c.160513
  39. J Clin Orthop Trauma. 2026 Jun;77 103450
    Cold intolerance after hand injury: Mechanisms, measurement challenges, and implications for clinical management.
    Victoria Vespa, Yoshiki H Kawase, Kayla Doughty, Allison Tenfelde.
      Cold intolerance of the hand is characterized by an exaggerated or painful response to cold exposure in an injured or affected extremity. It is a common and often disabling consequence of hand trauma and occurs across a wide range of injuries, including fractures, nerve injuries, and vascular insults. Patients frequently describe pain, numbness, stiffness, color change, and reduced dexterity when exposed to cold environments. The prevalence of cold intolerance following significant hand injury is high. Several studies report that up to 80-90% of patients develop cold-related symptoms after significant hand trauma. Symptoms begin early after injury and may persist for years or even lifelong in some individuals. The underlying mechanisms are likely multifactorial and include both vascular dysregulation and peripheral nerve injury, resulting in abnormal vasoreactivity and altered sensory signaling. Several assessment tools have been developed, including patient-reported questionnaires such as the Cold Intolerance Symptom Severity (CISS) score and objective cold-stress testing. Although these tools allow symptoms to be quantified, patient-reported symptom severity does not consistently correlate with objective vascular measurements. Clinically, cold intolerance can substantially affect hand function, work tolerance, and quality of life. Management remains largely symptomatic and includes cold avoidance, protective strategies, rehabilitation, and selected pharmacologic or procedural interventions. Emerging treatments such as digital botulinum toxin injections have shown early promise in small case series. This review summarizes the current understanding of the mechanisms, measurement challenges, and clinical management of cold intolerance after hand injury, with the aim of improving recognition and counseling in everyday hand surgery practice.
    Keywords:  Cold intolerance; Hand injuries; Hyperesthesia; Pain; Peripheral nerve injuries
    DOI:  https://doi.org/10.1016/j.jcot.2026.103450
  40. Orthop J Sports Med. 2026 Apr;14(4): 23259671261421595
    Rest Before Physical Therapy Is Not Necessary to Achieve Bony Healing of Lumbar Spondylolysis in Adolescent Athletes.
    Emily A Sweeney, Anastasia Fischer, Madison Brna, Lisa Martin, Jingzhen Yang, Mitchell Selhorst.
       Background: Bony healing rates of spondylolysis on magnetic resonance imaging (MRI) are low, and it is unknown how timing of physical therapy (PT) affects healing.
    Hypothesis: It was hypothesized that (1) initiating PT immediately after spondylolysis diagnosis would not have a negative effect on the healing of active lumbar spondylolysis on MRI in adolescent athletes and (2) baseline characteristics, as well as follow-up measures of pain and function, would not be associated with healing on 3-month MRI.
    Study Design: Randomized controlled trial; Level of evidence, 2.
    Methods: This multicenter trial randomized adolescent athletes with lumbar spondylolysis to Immediate PT or Rest Before PT. A blinded radiologist assessed changes in edema and lysis on the initial and 3-month MRIs to determine healing. No rigid bracing was used in any participant.
    Results: A total of 53 participants (25 in the Immediate PT group and 28 in the Rest Before PT group) completed a baseline and 3-month follow-up MRI. At 3 months, 81% of participants demonstrated healing on MRI, 8% demonstrated no change, and 11% demonstrated worsened findings. Participants in the Immediate PT group were not more likely to have worse findings on the 3-month MRI than the Rest Before PT group (P = .30). Participants who had healing on 3-month MRI were more likely to be pain-free at that time (97.6% pain-free) than those whose MRI findings did not change or worsened (67% pain-free; P = .01). Participants whose MRI demonstrated healing were less likely to experience a recurrence of pain within 12 months (7.3% recurrence of pain) compared with those whose MRI showed no change or worsened (50% recurrence pain; P = .02).
    Conclusion: Prolonged rest may not be necessary to promote healing on MRI in adolescent athletes with lumbar spondylolysis. PT can begin immediately without negatively affecting healing of spondylolysis on MRI.
    Registration: NCT05505981.
    Keywords:  isthmic spondylolysis; lumbar spine; magnetic resonance imaging (MRI); pediatrics
    DOI:  https://doi.org/10.1177/23259671261421595
  41. Int Wound J. 2026 May;23(5): e70932
    Efficacy and Safety of a Defined Two-Dose Protocol of Autologous Platelet-Rich Plasma (PRP) Injection for Refractory Chronic Non-Healing Wounds: A Prospective Clinical Study.
    Nathathai Wanchutrirat, Kamonwan Jenwitheesuk, Kriangsak Jenwitheesuk, Wiyada Punjaruk, Palakorn Surakunprapha, Kengkart Winaikosol, Pattama Punyawong, Pimthawan Vachirodom, Kaweesak Saothonglang, Weerin Sawangkajohn, Thitinan Kasetthat.
      Chronic non-healing wounds represent a major global public health challenge. Their persistence is frequently attributed to localized biological deficits that cause them unresponsive to conventional therapeutic modalities. While Platelet-Rich Plasma (PRP) has demonstrated promising results as an adjunctive treatment by delivering highly concentrated growth factors, its clinical application is currently impeded by a lack of clinical standardization, particularly optimal injection frequency, interval, and dosage. The aim of this study is to rigorously evaluate the efficacy and safety of a specific, non-intensive two-dose PRP injection protocol for accelerating the reduction of wound area in patients with various types of refractory chronic wounds. We conducted a prospective, single-arm, pretest-posttest study enrolling 18 patients with refractory non-healing wounds, defined as lesions persisting for a minimum period of 4 weeks which had failed to achieve definitive closure under optimized standard care. Autologous high-concentration PRP was injected intradermally around the wound margin at baseline (Day 0) and again 3 weeks later (Day 21). Wound area was digitally measured at baseline and subsequently at 7, 11 and 15 weeks. The primary outcome was the mean reduction in wound area (cm2) at the 15-week follow-up, assessed using a Paired Samples t-test. The mean patient age was 57.89 ± 15.64 years, and wounds had a mean chronicity of 15.83 ± 19.05 months. The PRP preparation achieved a mean platelet concentration 8.5 times greater than the peripheral blood threshold (first injection) and 7.0 times greater than the threshold (second injection), confirming high therapeutic quality. Analysis of the total cohort demonstrated a statistically significant reduction in mean wound area from baseline 27.41 ± 70.38 cm2 to 15 weeks 21.5 ± 68.96 cm2. Three patients (16.67%) achieved complete epithelialization. Subgroup trends suggested diabetic and venous ulcers responded more favourably than radiation-induced ulcers. The protocol was safe, with no systemic or severe localized adverse events observed among participants. The defined two-dose PRP injection protocol provides a clinically effective and safe adjunctive therapy that significantly promotes wound area reduction in challenging chronic non-healing wounds. This reproducible, low-frequency protocol offers a rationale for standardization in advanced wound care, warranting validation through future large-scale Randomized Controlled Trials (RCTs).
    Keywords:  PRP; PRP injection; chronic wound; platelet rich plasma; wound healing
    DOI:  https://doi.org/10.1111/iwj.70932
  42. Phys Ther. 2026 May 08. pii: pzag051. [Epub ahead of print]
    Sustaining Physical Activity in Chronic Obstructive Pulmonary Disease: A Qualitative Study of Perspectives on a Personalized Community-Based Physical Activity Program (PICk UP).
    Patrícia Rebelo, Dina Brooks, Alda Marques.
       IMPORTANCE: Sustaining pulmonary rehabilitation (PR) benefits in community-dwelling individuals with chronic obstructive pulmonary disease (COPD) is challenging.
    OBJECTIVE: The objective of this study was to explore the experiences of individuals with COPD participating in a PersonalIzed CommUnity-based Physical Activities program (PICk UP) and to identify which behavioral change techniques supported sustained physical activity.
    DESIGN: This was a qualitative pre-post intervention study (NCT04223362 | NCT04711057).
    SETTING: The study was conducted in a community setting.
    PARTICIPANTS: This study recruited individuals with COPD assigned to the PICk UP intervention.
    INTERVENTION: Participants enrolled in a 6-month, post-PR, community-based program comprising gym, senior exercise classes, pool exercise classes, or Chi Kung.
    MAIN OUTCOME AND MEASURES: Participants' perspectives on impacts of the PICk UP program, motivators, facilitators and barriers to adherence were collected through pre-post focus groups. Data were analyzed using deductive and inductive reflexive thematic analysis. The "capability, opportunity, motivation, behavior" (COM-B) framework was used to identify behavioral change techniques.
    RESULTS: Fifteen individuals with COPD participated (14 male, 70 (8) years, FEV1 57.1% (18.1%) predicted). Five main themes emerged, focusing on physical activity choice, barriers, facilitators, effects, and suggestions: (1) one size doesn't fit all; (2) organizational factors and system-level support enabling adherence; (3) it doesn't come easy; (4) a positive feedback cycle sustained physical, psychological and social benefits; and (5) the more, the merrier. The PICk UP intervention supported physical activity through 13 behavioral change techniques, across 5 intervention types (education, persuasion, training, environmental restructuring and enablement), collectively addressing all 6 components influencing behavior.
    CONCLUSIONS: Individuals with COPD reported lasting PR benefits after the PICk UP and were willing to remain physically active. Participants emphasized the importance of diverse physical activity options and support from peers, health, and fitness professionals.
    RELEVANCE: To sustain physical activity beyond PR, interventions should prioritize intersectoral partnerships and embed ongoing social support. These findings underscore PICk UP's effectiveness, positioning it as a promising and replicable model for promoting long-term physical activity in individuals with COPD.
    Keywords:  Chronic Obstructive; Community Resources; Community integration; Physical Activity; Pulmonary Disease; Qualitative research
    DOI:  https://doi.org/10.1093/ptj/pzag051
  43. J Orthop. 2026 Jun;76 335-340
    Intraoperative component size adjustment is associated with pain-free recovery and good knee flexion after patient-specific instrumentation-assisted medial pivot TKA.
    Masashi Kubota, Tsuneari Takahashi, Hironao Shioiri, Shuhei Hiyama, Mitsuharu Nakashima, Tatsuya Kubo, Takumi Matsumoto.
       Background: Predictors of achieving both pain relief and sufficient knee flexion after patient-specific instrumentation (PSI)-assisted medial pivot total knee arthroplasty (MP-TKA) have been insufficiently studied. This study aimed to identify predictors of achieving pain-free recovery and good knee flexion 1 year after PSI-assisted MP-TKA.
    Methods: This single-center retrospective cohort study included patients with knee osteoarthritis who underwent PSI-assisted MP-TKA and completed a minimum 1-year follow-up. The primary outcome was achieving both knee flexion ≥120° and a numerical rating scale (NRS) pain score ≤1.0 at 1 year postoperatively. Baseline characteristics, radiographic parameters, postoperative knee range of motion (ROM), anteroposterior (AP) laxity, osteotomy thickness, and agreement between PSI-planned and implanted component sizes were evaluated. Variables associated with the outcome in univariate analysis were entered into multivariable logistic regression to identify independent predictors.
    Results: A total of 64 knees were analyzed, including 21 in the Good outcome group and 43 in the Non-Good group. Overall intraoperative component size adjustment was more frequent in the Good outcome group than in the Non-Good group (81.0% vs 44.2%). Most intraoperative adjustments involved tibial downsizing. In univariate analyses, overall intraoperative component size adjustment, greater patient height, greater preoperative knee extension deficit, and larger AP translation at 90° flexion 1 year postoperatively were associated with favorable outcomes. In multivariable logistic regression analysis including preoperative and intraoperative variables, intraoperative component size adjustment was an independent predictor of achieving pain-free and good flexion recovery (OR = 4.32, 95% CI 1.07-17.45, p = 0.040). Other factors, including patient height and preoperative knee extension deficit and postoperative AP translation, were not independently associated with the outcome.
    Conclusion: Intraoperative component size adjustment was associated with achieving pain-free and good flexion recovery after MP-TKA. These findings highlight the critical role of intraoperative decision-making in achieving optimal functional outcomes.
    Level of evidence: III (retrospective cohort study).
    Keywords:  Medial pivot; Patient-specific instrumentation; Postoperative pain; Range of motion; Total knee arthroplasty
    DOI:  https://doi.org/10.1016/j.jor.2026.04.013
  44. Biomedicines. 2026 Apr 06. pii: 834. [Epub ahead of print]14(4):
    Therapeutic Efficacy of Different Bladder Monotherapies Versus Multimodal Therapy in Patients with Interstitial Cystitis/Bladder Pain Syndrome.
    Wan-Ru Yu, Jia-Fong Jhang, Yuan-Hong Jiang, Hann-Chorng Kuo.
      Purpose: This study compared the therapeutic efficacy of different bladder monotherapies and multimodal therapy in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). Materials and methods: In total, 190 patients with a confirmed diagnosis of IC/BPS were treated with different bladder therapies. The bladder monotherapies included intravesical platelet-rich plasma (PRP) injection (n = 60), intravesical botulinum toxin A (BoNT-A) injection (n = 33), intravesical hyaluronic acid (HA) instillation (n = 36), and low-energy shock wave (LESW) bladder therapy (n = 61). Multimodal therapy (MMT) was provided to patients who had unsuccessful initial bladder treatment targeting chronic inflammation, urothelial dysfunction, bladder pain, pelvic floor muscle pain, psychological stress, and lower urinary tract dysfunction. The treatment outcome was assessed using self-reported Global Response Assessment scores at 3 months and during the follow-up time points after bladder treatment. Results: Thirty-one patients received MMT. The 3-month success rates of bladder therapy were 55.0% for PRP injection, 57.6% for BoNT-A injection, 50.0% for HA instillation, 46.7% for LESW bladder therapy, and 58.1% for MMT. The success rates of bladder monotherapy decreased after 6 months. However, the success rate of MMT increased at 9 (67.7%) and 12 (73.1%) months. Patients treated with MMT exhibited improvement in glomerulation grade after cystoscopic hydrodistention. Only patients with successful treatment outcomes after MMT had improvement in bladder pain severity and pelvic floor muscle pain parameters. Conclusions: Bladder monotherapy such as PRP injection, BoNT-A injection, HA instillation, and LESW bladder therapy had successful treatment outcomes in patients with IC/BPS. In patients who had unsuccessful initial bladder therapy, the 3-month success rate of MMT was 58.1% and sustained improvement with time, particularly in the improvement of bladder pain and PFM pain severity.
    Keywords:  bladder inflammation; bladder pain syndrome; cystitis; treatment
    DOI:  https://doi.org/10.3390/biomedicines14040834
  45. Integr Med Res. 2026 Sep;15(3Part A): 101321
    Nonsurgical interventions for lumbar spinal stenosis with neurogenic claudication: A systematic review and network meta-analysis.
    He Chen, Xun Chen, Jiufei Fang, Wei Wang, Jiarong Fan, Yuan Xie, Hanwei Lun, Zhishun Liu.
       Background: Lumbar spinal stenosis (LSS) with neurogenic claudication is a common cause of chronic pain and disability, but the comparative efficacy of nonsurgical interventions remains uncertain. This network meta-analysis evaluated and compared these interventions.
    Methods: PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials (RCTs) evaluating nonsurgical interventions for LSS with neurogenic claudication. The primary outcome was short-term pain, defined as change in pain intensity from baseline to immediately after treatment. Secondary outcomes included long-term pain (≥6 months after randomization), short- and long-term function, short- and long-term walking distance assessed by walking tests, and short-term response rate. Bayesian random-effects network meta-analyses were performed, and results were reported as mean differences (MDs) with 95% credible intervals (CrIs).
    Results: Thirty-five RCTs involving 3147 participants were included. Low-certainty evidence indicated that, compared with placebo, acupuncture was associated with clinically important short-term improvements in pain (MD -10.02, 95% CrI -18.49 to -0.23) and function (MD -14.39, 95% CrI -25.26 to -3.69). Pairwise meta-analysis also suggested that acupuncture was associated with clinically important long-term pain reduction and statistically significant improvement in long-term function versus placebo. No other interventions showed clear benefits over placebo for pain or function. No intervention showed clear improvement in walking distance versus placebo or other interventions in the short or long term. All estimates were associated with substantial uncertainty.
    Conclusion: The evidence was characterized by substantial uncertainty, with certainty ranging from low to very low. Although acupuncture showed potential benefit, the findings remain inconclusive and highlight the need for rigorously designed, high-quality RCTs.
    Protocol registration: CRD42025649922.
    Keywords:  Lumbar spinal stenosis; Network meta-analysis; Neurogenic claudication; Nonsurgical interventions
    DOI:  https://doi.org/10.1016/j.imr.2026.101321
  46. Knee. 2026 May 05. pii: S0968-0160(26)00160-2. [Epub ahead of print]61 104480
    Comprehensive systematic review and meta-analysis of the semitendinosus muscle and tendon: global morphometry, sex differences, and surgical implications.
    Kamil Możdżeń, Grzegorz Fibiger, Monika Chowaniec, Julia Michalska, Aleksandra Korzeniowska, Peter Wikiera, Agnieszka Murawska, Michał Malczak, Dawid Plutecki, Kacper Stolarz, Antonia Nowak, Jerzy Andrzej Walocha, Przemysław Pękala, Tomasz Kozioł.
       BACKGROUND: The semitendinosus tendon (STT) is one of the most commonly harvested autografts for anterior cruciate ligament reconstruction. However, morphometric data describing its anatomical variability remain inconsistent across studies.
    PURPOSE: To systematically review and quantitatively synthesize available evidence on the morphometric characteristics of the semitendinosus muscle and tendon across different populations and sexes.
    METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Fifty-three studies were included overall. Of these, 46 studies with extractable quantitative data contributed to the meta-analysis, comprising 3,134 measured STTs, while 7 additional studies were included in the qualitative synthesis only.
    RESULTS: The pooled mean STT length across all studies was 27.41 cm (95% CI: 26.73-28.09). Shorter tendons were observed in females compared with males (26.57 cm vs 28.99 cm) and in Asian populations compared with European and North American cohorts (26.19 cm vs 28.79 cm and 27.93 cm, respectively). Cadaveric studies reported shorter lengths (25.56 cm) compared with intraoperative (28.16 cm) and ultrasound measurements (29.59 cm). The tendinous portion within the muscle belly averaged 11.75 cm, while the distal tendon from the musculotendinous junction to the pes anserinus measured 15.22 cm.
    CONCLUSION: This meta-analysis provides a comprehensive synthesis of STT morphology across populations. The findings highlight population- and sex-related variability and provide anatomical reference data that may assist in understanding STT morphology in the context of ligament reconstruction.
    Keywords:  ACL clinical anatomy; ST; STT; Semitendinosus muscle; Semitendinosus tendon; Surgery
    DOI:  https://doi.org/10.1016/j.knee.2026.104480
  47. J Vis Exp. 2026 Apr 14.
    The Efficacy of Personalized Pulmonary Rehabilitation Programs on Recovery Outcomes in COPD Patients During Acute Exacerbations.
    Yi Wei, Xiujuan Chai, Liping Luo, Jing Xia.
      Pulmonary rehabilitation (PR) is a core component of chronic obstructive pulmonary disease (COPD) management; however, its implementation during acute exacerbations remains variable, particularly with respect to individualized approaches. This study aimed to evaluate the association between inpatient personalized PR and recovery-related clinical outcomes in hospitalized patients with acute exacerbations of COPD (AECOPD). A single-center retrospective cohort study was conducted at a tertiary care hospital between January 2021 and June 2024. Hospitalized patients aged ≥40 years with spirometry-confirmed COPD who experienced AECOPD and completed an inpatient personalized PR program were included. The rehabilitation program was initiated within 48-72 h of clinical stabilization and tailored based on baseline symptom burden, functional capacity, dyspnea severity, oxygen saturation, and exercise tolerance. Primary outcomes included changes in the COPD assessment test (CAT), modified medical research council (mMRC) dyspnea scale, and 6-minute walk test (6MWT) distance from baseline to program completion. Secondary outcomes included length of hospital stay and 30-day readmission rates. A total of 200 patients were included in the analysis. Mean CAT scores decreased from 25.4 ± 4.6 at baseline to 17.2 ± 3.8 following rehabilitation (p < 0.001). Mean mMRC dyspnea scores improved from 3.1 ± 0.8 to 2.0 ± 0.7 (p < 0.001). Functional exercise capacity increased, with the mean 6MWT distance improving from 210 ± 68 m to 310 ± 75 m (p < 0.001). The average length of hospital stay was reduced from 10.5 ± 3.2 days to 6.3 ± 2.1 days (p < 0.001), and 30-day readmission rates decreased from 25% to 10% (p < 0.001). In this retrospective cohort, inpatient personalized PR implemented during AECOPD was associated with improvements in symptom burden, dyspnea severity, functional exercise capacity, and selected healthcare utilization outcomes.
    DOI:  https://doi.org/10.3791/69801
  48. Medicina (Kaunas). 2026 Apr 02. pii: 677. [Epub ahead of print]62(4):
    Pulsed Electromagnetic Field Therapy in People with Knee Osteoarthritis: A Systematic Review and Meta-Analysis.
    Yu-Shan Chang, Chieh-Yu Lin, Wan-Chi Huang.
      Background and Objectives: Knee osteoarthritis (KOA) is a major cause of global disability. The efficacy of a non-invasive treatment, pulsed electromagnetic field (PEMF) therapy, remains debated. This systematic review and meta-analysis evaluate PEMF's effectiveness on KOA, exploring the influence of device parameters. Materials and Methods: We systematically searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) from 2015 to 2025. Nine RCTs with a total of 457 patients were included. Primary outcomes were pain (Visual Analog Scale-VAS) and function (Western Ontario and McMaster Universities Osteoarthritis Index-WOMAC). Data were pooled using a random-effects model with subgroup analyses based on PEMF amplitude and frequency. Results: No significant improvement in VAS pain or total WOMAC scores was found at one month. However, time-dependent effects were observed. WOMAC-pain improved significantly at 18-21 days (MD = -1.63, 95% CI: -2.43 to -0.82, I2 = 28%) but not at one month. Conversely, WOMAC-stiffness (MD = -1.11, 95% CI: -1.386 to -0.85, I2 = 0%) and daily activity (MD = -3.39, 95% CI: -4.81 to -1.97, I2 = 0%) improved significantly only at the one-month. Objective functional measures did not improve, and the overall risk of bias across studies was high. The efficacy of PEMF is also influenced by the amplitude and frequency. Conclusions: PEMF efficacy for KOA is nuanced, with benefits dependent on timing and device parameters. High frequency gives fast pain relief; high amplitude builds function. Though statistically significant, these improvements may not reach thresholds for clinical meaningfulness. Significant heterogeneity in treatment protocols is a major barrier to clear conclusions. Standardized, large-scale RCTs are needed to determine optimal parameters and confirm PEMF's clinical role.
    Keywords:  knee osteoarthritis; osteoarthritis; pulsed electromagnetic field; pulsed electromagnetic field therapy; systematic review
    DOI:  https://doi.org/10.3390/medicina62040677
  49. Br J Sports Med. 2026 May 04. pii: bjsports-2025-110986. [Epub ahead of print]
    Physiotherapist-led treatment for femoroacetabular impingement syndrome (the PhysioFIRST study): an assessor-blinded, limited disclosure randomised controlled trial.
    Joanne L Kemp, Mark J Scholes, Anne J Smith, Sally L Coburn, Richard R T Johnston, Denise M Jones, Michael A Girdwood, Matthew G King, Benjamin F Mentiplay, Danilo De Oliveira Silva, Marcella Pazzinatto, Anthony G Schache, Diogo A Gomes, Georgia M Coburn, Kay M Crossley.
       OBJECTIVE: We evaluated the effect of physiotherapist-led treatment with targeted-strengthening (STRENGTH) compared with physiotherapist-led treatment with standardised-stretching (STRETCH) on hip-related quality of life (QOL) and patient-perceived Global Rating of Change (GROC) at 6 months in people with femoroacetabular impingement (FAI) syndrome.
    METHODS: Assessor-blind, limited disclosure, parallel, superiority randomised controlled trial. Participants aged 18-50 years with FAI syndrome were recruited and randomly allocated (1:1 ratio) to receive 6 months of STRENGTH or STRETCH treatment. Primary outcomes were change in (1) hip-related QOL (International Hip Outcome Tool-33 (iHOT-33, 0-100 points)); and (2) GROC-pain and GROC-function at 6 months. Secondary analysis included dichotomised GROC ('improved' and 'not improved') and hip muscle strength. Analyses were by intention to treat.
    RESULTS: 154 participants (STRENGTH n=79 (53% women, mean 35 (SD 9) years); STRETCH n=75 (45% women, mean 36 (SD 9) years)) were included. There was no difference between groups for change in hip-related QOL (mean difference (95% CI) 0.2 (-5.9 to 6.3)) or patient-perceived global improvement (GROC-pain 0.2 (-0.2 to 0.7), p=0.23; GROC-function 0.3 (-0.1 to 0.6)) at 6 months. 72% of STRENGTH were improved for GROC-pain (OR 2.36 (1.15 to 4.84)) compared with 52% of STRETCH. STRENGTH had greater improvements than STRETCH in hip strength. Both groups improved in iHOT-33 over 6 months (STRENGTH 19.2 (15.7 to 22.8), STRETCH 20.8 (17.1 to 24.5) points).
    CONCLUSION: There was no superior physiotherapist-led treatment to improve hip-related QOL in people with FAI syndrome, but secondary analysis indicated that targeted strengthening resulted in greater improvements in perceived pain and hip muscle strength at 6 months. Hip-related QOL improved in both groups by clinically meaningful amounts.
    TRIAL REGISTRATION NUMBER: ACTRN12617001350314.
    Keywords:  Exercise; Hip; Physical Therapy; Sports medicine
    DOI:  https://doi.org/10.1136/bjsports-2025-110986
  50. Skeletal Radiol. 2026 May 08.
    A comprehensive review of ultrasonographic imaging in athletic elbow injuries: a compartment-based approach.
    Dong Rak Kwon, EunKuk Kim.
      Elbow injury rates are markedly higher among collegiate athletes than in the general population; however, this elevated incidence is largely driven by overhead throwing sports and does not represent a uniform risk across all athletes. Elbow disorders represent a significant diagnostic challenge in sports medicine due to the intricate anatomy of the joint. High-resolution ultrasonography has become an indispensable first-line imaging modality, offering superior spatial resolution for superficial structures and the unique capability for real-time dynamic assessment. This review illustrates the ultrasonographic spectrum of common elbow injuries in athletes, including epicondylopathy, ulnar collateral ligament insufficiency, and nerve entrapment syndromes. By employing a systematic, compartment-based approach categorizing findings into anterior, medial, lateral, and posterior zones, radiologists can ensure a comprehensive evaluation. Particular emphasis is placed on dynamic maneuvers such as valgus stress for ulnar collateral ligament stability and flexion-extension for ulnar nerve subluxation, which provide functional insights that are often unavailable on static magnetic resonance imaging. Furthermore, emerging adjunctive techniques, such as sonoelastography, may provide complementary information on tissue stiffness and integrity, potentially improving lesion characterization in specific athletic elbow conditions. Understanding these imaging patterns is crucial for accurate diagnosis and optimized management in athletes.
    Keywords:  Artificial intelligence; Athletic injuries; Dynamic assessment; Elbow joint; Ultrasonography
    DOI:  https://doi.org/10.1007/s00256-026-05241-z
  51. J Pediatr Orthop. 2026 May 06.
    Outcomes of Conservative Versus Surgical Treatment of Adolescent Pelvic and Hip Avulsion Fractures: A Systematic Review and Meta-Analysis.
    PRiSM Hip Research Interest Group
       BACKGROUND: Avulsion fractures of the pelvis and hip primarily affect active adolescents. Although most cases are successfully treated with nonoperative management, surgical intervention may be indicated as displacement and risk for nonunion increase. The literature remains heterogeneous and limited by small comparative cohorts. This study summarizes available evidence comparing outcomes after nonoperative and operative treatment, with particular attention to displacement.
    METHODS: A literature search of Ovid Medline, Embase, Scopus, the Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov was completed in July 2024. Patient characteristics, type of activity at the time of injury, displacement distance, treatment modality, complications, and patient outcomes were recorded for specific fracture types, as available.
    RESULTS: Twenty-four eligible studies were identified and contributed a total of 852 fractures in 849 patients (mean age 14.4±1.7 y, 79% male) for analysis. The most common fracture sites were the anterior superior iliac spine (ASIS, 33.1%) and anterior inferior iliac spine (AIIS, 30.4%), followed by the ischial tuberosity (ISCH, 15.5%), lesser trochanter (LT, 13.5%), and iliac crest (IC, 7.5%). Overall, 86.6% of fractures were managed nonoperatively, and 13.4% were managed surgically. In displacement-stratified cohorts, ISCH fractures with displacement >15 mm achieved high functional scores with both operative and nonoperative treatment, although pseudoarthrosis occurred in some nonoperatively treated cases with minimal functional limitation. ASIS fractures with displacement >15 mm showed similar transient complications before resolution to excellent outcomes in both treatment groups, but faster RTS with the operative management alone. Rates of persistent pain were highest in ISCH fractures (27.3% surgically, 10.9% nonoperatively) and AIIS fractures treated nonoperatively (13.8%). Return to sport was achieved in nearly all cases, with surgically treated ISCH fractures requiring the longest recovery periods (6 mo).
    CONCLUSION: Both nonoperative and operative management result in favorable outcomes for most adolescent pelvic avulsion fractures. Although displacement frequently influences surgical decision-making, current evidence does not establish a validated threshold at which outcomes reliably diverge. Before displacement can be considered a reliable surgical indication, higher-quality evidence demonstrating superior outcomes at clear displacement thresholds is needed.
    LEVEL OF EVIDENCE: Level III.
    Keywords:  adolescent athletes; apophyseal injuries; fracture displacement; nonoperative management; operative management; pelvic avulsion fractures; sports injuries
    DOI:  https://doi.org/10.1097/BPO.0000000000003305
  52. Front Med (Lausanne). 2026 ;13 1814834
    Comparative effectiveness of different core muscle training regimens for chronic non-specific low back pain: a systematic review and meta-analysis.
    Yang Liu, Yueyong Yu, Fan Lu, Junxuan Liu.
       Objective: To systematically evaluate and compare the relative effectiveness of different core muscle training modalities in alleviating pain and improving function in individuals with chronic non-specific low back pain (CNLBP).
    Methods: Chinese and English language databases were systematically searched for randomized controlled trials involving individuals with CNLBP. Intervention groups received core training either alone or combined with other therapies, while control groups received usual rehabilitation or other exercise interventions. Primary outcomes were pain intensity and disability scores. Risk of bias was assessed using the Cochrane RoB 2.0 tool. A random-effects meta-analysis was performed using RevMan 5.4 software, with subgroup analyses conducted to examine the moderating effects of intervention type and intervention duration. Forest plots and funnel plots were generated using MATLAB-R2024.
    Results: Fifteen randomized controlled trialswere included. Meta-analysis revealed that core training significantly improved pain (SMD = -0.56, 95% CI: -1.08 to -0.03) and function (SMD = -0.81, 95% CI: -1.38 to -0.25). subgroup analyses indicated that combined interventions significantly improved function (SMD = -0.96, P = 0.002), although the test for subgroup differences between combined and single-modality interventions was not statistically significant (P = 0.96), and intervention durations of ≥ 8 weeks were associated with more pronounced analgesic effects. The overall quality of evidence was rated as "low," primarily due to risk of bias and high heterogeneity.
    Conclusion: Current direct comparative evidence suggests that augmenting core training with additional rehabilitative components may confer greater benefits for functional improvement, while extending the intervention duration beyond eight weeks may optimize pain relief. Clinical decisions regarding training modality selection should be individualized based on the patient's primary treatment goal. Further high-quality research is warranted to strengthen the evidence base for comparisons between specific training modalities.
    Systematic review registration: [https://www.crd.york.ac.uk/PROSPERO/view/CRD420251031252], identifier [CRD420251031252].
    Keywords:  breathing training; chronic non-specific low back pain; core exercise; core stability; pilates; sling exercise therapy
    DOI:  https://doi.org/10.3389/fmed.2026.1814834
  53. Arthroscopy. 2026 May 04.
    Endoscopic Pubic Symphysectomy for Refractory Osteitis Pubis Provides Positive Functional Outcomes and High Return-to-Sport Rate at a Minimum 2-Year Follow-Up.
    Roger Quesada-Jimenez, Ady H Kahana-Rojkind, Elizabeth G Walsh, Benjamin G Domb.
       PURPOSE: To evaluate the outcomes of endoscopic pubic symphysectomy as a treatment for refractory osteitis pubis with a minimum 2-year follow-up, and to present a return-to-sport (RTS) subanalysis of this patient population.
    METHODS: Prospectively collected data were retrospectively analyzed for patients who underwent endoscopic pubic symphysectomy as treatment for osteitis pubis between May 2012 and September 2021. Included patients had completed preoperative and a minimum of 2-year postoperative questionnaires for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports-Specific Subscale, International Hip Outcome Tool (iHOT-12), visual analog scale, and patient satisfaction. The minimal clinically important difference was calculated for the mentioned patient-reported outcomes and included in the analysis. For the subanalysis, sport participation was defined as participation within 1 year of surgery, and RTS rates were calculated for the overall cohort and for the subset of patients who attempted to return postoperatively.
    RESULTS: A total of 14 (93.3%) out of 15 patients were included in the study. All patients experienced symptom relief with a significant improvement in mHHS (P < .05), NAHS (P < .05), iHOT-12 (P < .01), and a high patient satisfaction rate with a mean satisfaction of 8.5 ± 2.7. A high percentage of patients reached the calculated minimal clinically important difference for mHHS, NAHS, Hip Outcome Score-Sports-Specific Subscale, and iHOT-12. Twelve patients (85.7%) reported sports participation. The overall RTS rate was 75%. Of the 9 patients who attempted to return, all (100%) successfully resumed sport within 1 year postoperatively, while 3 (25%) patients chose not to attempt RTS due to a desire to prevent symptoms.
    CONCLUSIONS: Endoscopic pubic symphysectomy for refractory cases of osteitis pubis yielded significant improvement in mHHS, NAHS, iHOT-12, and a high patient satisfaction, reaching clinical important thresholds at a high rate at a minimum 2-year follow-up. All patients who attempted to return to sport were able to return to sport participation within 1 year of the surgery.
    LEVEL OF EVIDENCE: Level IV, retrospective case series.
    DOI:  https://doi.org/10.1002/arj.70075
  54. Health Sci Rep. 2026 May;9(5): e72266
    Kinesiophobia Affect Postural Control Strategies During Jump Landing in Athletes With Chronic Ankle Instability: A Cross-Sectional Study.
    Sarah Jafari, Sedigheh Sadat Naimi, Zahra Ebrahimabadi, Marzieh Mortezanejad, Reihaneh Aakary Kachoosangy, Sanaz Shanbehzadeh.
       Background and Aims: Altered postural control has been observed in chronic ankle instability (CAI). Kinesiophobia (fear of re-injury) has been identified as a factor influencing postural stability. Therefore, postural control was assessed during jump landing among CAI athletes with and without kinesiophobia, as well as healthy controls.
    Methods: A total of 60 participants were recruited, including 40 individuals with CAI and 20 healthy controls. The CAI group was subdivided into two cohorts: 20 subjects with kinesiophobia (Tampa Scale of Kinesiophobia score > 37) and 20 without kinesiophobia. All participants performed a single-leg jump landing task on a force plate. The following postural stability metrics were calculated: time to stabilization (TTS), and the mean and standard deviation of center of pressure (COP) displacement and velocity in the anterior-posterior (AP), medial-lateral (ML), and total directions.
    Results: CAI subjects with kinesiophobia exhibited longer TTSs in the AP (p = 0.019), vertical, and total directions (p < 0.001, p = 0.015, p = 0.002) than healthy subjects. Additionally, CAI subjects with kinesiophobia demonstrated a significant increase in the velocity of COP displacement in the AP and ML directions (p < 0.001, p = 0.004). These individuals showed greater variability in the velocity of COP displacement in the AP direction and in COP displacement in the ML direction than healthy subjects (p < 0.001). Also, CAI with kinesiophobia group presented less variability in the velocity of COP displacement in the ML direction than other groups (p < 0.001, p = 0.026). CAI with kinesiophobia group needed more time and more velocity in the AP direction than without kinesiophobia group (p = 0.003).
    Conclusion: Individuals with a high fear of re-injury may perceive the jump landing task as threatening, requiring more time to land and regain stability. This fear can restrict the variability of velocity in the ML direction, resulting in decreased control over the AP direction due to limitations on managing degrees of freedom.
    Keywords:  avoidance behaviour; chronic ankle instability; dynamic stability; fear; jumping; postural control
    DOI:  https://doi.org/10.1002/hsr2.72266
  55. Plast Reconstr Surg Glob Open. 2026 Mar;14(3): e7538
    Trapeziectomy With Hemi-Abductor Pollicis Longus and SutureTape InternalBrace: A Technical Note and Case Series.
    Richard Lachaux, Marie-Anne Poumellec, André-Pierre Uzel, Thierry Balaguer, Olivier Camuzard, Elise Lupon.
       Background: Trapeziometacarpal osteoarthritis (rhizarthrosis) is a common cause of thumb pain and functional impairment. Although trapeziectomy remains the gold standard for pain relief, postoperative first metacarpal migration and scaphometacarpal impingement have led to the development of stabilization techniques. These procedures, however, are often technically demanding and lack consensus.
    Methods: We describe a simplified suspensionplasty technique combining trapeziectomy with a hemi-abductor pollicis longus tendon and SutureTape InternalBrace reinforcement. A single-center retrospective study included 6 patients with Dell stage II-IV rhizarthrosis treated between January 2018 and March 2025 by a single experienced level IV surgeon (Tang and Giddins classification). Outcomes included pain (visual analog scale), function using the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, key and grip pinch strength, Kapandji opposition score, and radiographic trapezial index. Pre- and postoperative values were compared.
    Results: At a mean follow-up of 36 months, pain significantly decreased from 8.0 ± 0.89 to 1.83 ± 1.47. The QuickDASH score improved from 67.0 ± 15.08 to 17.83 ± 8.80. Key pinch strength increased from 4.07 ± 1.86 to 5.02 ± 2.37 kg, and grip strength increased from 18.0 ± 5.93 to 23.67 ± 6.38 kg. The Kapandji score improved from 7.67 ± 0.82 to 9.67 ± 0.52. The trapezial index decreased from 0.407 ± 0.053 to 0.311 ± 0.078. No major subluxations were observed, and no revision procedures were required.
    Conclusions: This simplified InternalBrace-reinforced suspensionplasty seems safe, reproducible, and effective for pain relief and functional improvement in trapeziometacarpal osteoarthritis. Larger prospective studies are needed to confirm long-term outcomes.
    DOI:  https://doi.org/10.1097/GOX.0000000000007538
  56. Arthroplasty. 2026 May 04. pii: 32. [Epub ahead of print]8(1):
    Amygdala and nucleus accumbens activation are associated with treatment choice in knee osteoarthritis: an fMRI study.
    Fabiola Ojeda, Gerard Martínez-Vilavella, Laura Blanco-Hinojo, Joan Deus, Laura Tío, Jordi Monfort.
       BACKGROUND: Pain in knee osteoarthritis (KOA) often shows a limited correlation with radiographic severity, complicating clinical assessment and highlighting the relevance of central pain mechanisms. Functional magnetic resonance imaging (fMRI) enables the investigation of brain regions such as the amygdala and nucleus accumbens, which are increasingly recognized as key components of the affective-motivational dimension of chronic pain and may show differential activation across clinical treatment contexts. This study is part of the HOLOA Project (Clinical and virtual examination of patients for holistic and objective description of the osteoarthritis progression mechanisms).
    METHODS: We conducted a cross-sectional observational study nested within the HOLOA cohort. Thirty-one patients with KOA (20 managed conservatively [CM] and 11 observed in the surgical treatment context) with Kellgren Lawrence (KL) grades 2-3 were included. Participants underwent two fMRI paradigms involving pressure stimulation (Knee Interline and Tibial Surface tests). Clinical assessment included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), and Numeric Rating Scale (NRS). Group comparisons and correlation analyses were performed to examine associations between clinical measures and brain activation patterns.
    RESULTS: Groups were broadly comparable with no statistically significant differences in demographic or radiographic severity measures. These patients showed higher WOMAC and PCS scores, indicating greater functional impairment and pain catastrophizing. Across the whole cohort, painful stimulation elicited robust activation of classical pain-processing regions, while no significant amygdala or nucleus accumbens activation was observed at the group level. However, nucleus accumbens activity was positively associated with PCS scores. In between-group analyses, patients observed in the surgical treatment context exhibited significant bilateral amygdala activation during Tibial Surface stimulation, which was absent in the conservatively managed group, and reported higher post-test NRS scores.
    CONCLUSION: Limbic system activation and pain catastrophizing were associated with the surgical treatment context in patients with knee osteoarthritis within a similar range of radiographic severity. The observed involvement of the amygdala and nucleus accumbens underscores the relevance of affective-motivational and cognitive processes in chronic KOA pain. These findings support the value of integrating clinical, psychological, and neurobiological perspectives when interpreting symptom burden and treatment context in knee osteoarthritis.
    Keywords:  Amygdala; Central sensitization; FMRI; Nucleus accumbens; Osteoarthritis; Pain catastrophizing; Total knee replacement
    DOI:  https://doi.org/10.1186/s42836-026-00382-x
  57. Children (Basel). 2026 Mar 27. pii: 460. [Epub ahead of print]13(4):
    Determining the Minimal Number of Passive Hip and Knee Joint Movement Repetitions Recommended for the Stiff Rectus Femoris Muscle Due to Osgood-Schlatter Disease.
    Naoki Ikeda, Ayumi Yoshikawa, Shota Yamaguchi, Takuya Nishioka, Genko Karasawa, Takayuki Inami.
       BACKGROUND/OBJECTIVES: Osgood-Schlatter disease (OSD) is a common overuse condition in adolescents characterized by increased stiffness of the rectus femoris muscle, which contributes to pain and functional limitations around the knee. We investigated whether repeating 10 min passive joint movements of the hip and knee produces additional immediate reductions in elevated rectus femoris (RF) stiffness in adolescents with OSD.
    METHODS: Fifteen patients (10-14 years of age) diagnosed with bilateral OSD were included. The legs of the participants were randomly assigned to either the intervention or the non-intervention side (control). The intervention side received two sets of 10 min of passive joint movement to the hip and knee, while the control side rested. RF stiffness was measured before the intervention and immediately after one and two sets of passive joint movements.
    RESULTS: On the intervention side, RF stiffness decreased significantly from pre to post-1 and from pre to post-2; however, RF stiffness did not differ significantly between post-1 and post-2. None of the parameters changed significantly on the control side (rest condition).
    CONCLUSIONS: Passive joint exercise beyond one repetition (one set for 10 min) did not result in a further decrease in RF stiffness and is likely unnecessary for RF muscle stiffness due to OSD.
    Keywords:  acute effect; manual therapy; muscle elasticity; shear modulus; shear wave elastography
    DOI:  https://doi.org/10.3390/children13040460
  58. PM R. 2026 May 08.
    Predictors of successful viscosupplementation in osteoarthritis of the knee.
    Anish Rana, Garret Waterstradt, Kenneth Dale King, Samia Lopa, Maya N Hatch, Jennifer Paul, Nathan Barford.
       BACKGROUND: Knee osteoarthritis (OA) is a common cause of disability among older adults. Common treatments include intra-articular corticosteroids (IACS) and viscosupplementation (VS). However, many insurance carriers either decline to cover VS or require prior IACS failure. Limited data exist on whether IACS response can guide VS use.
    OBJECTIVE: To determine whether response to IACS predicts subsequent response to VS, and whether age, gender, body mass index (BMI), and OA severity are associated with VS outcomes.
    DESIGN: Retrospective cohort study.
    SETTING: Outpatient physical medicine and rehabilitation clinics at a tertiary-care academic medical center.
    PARTICIPANTS: Four hundred sixty three adult patients (≥18 years) with primary knee OA who received both IACS and VS injections.
    INTERVENTIONS: Primary independent variable was response to IACS. Additional variables were age, gender, BMI, and OA severity.
    MAIN OUTCOME MEASURES: Primary outcome was pain relief following VS, categorized as favorable (>33% relief) or unfavorable (≤ 33% relief ).
    RESULTS: The favorable response rate to VS among IACS nonresponders was 55% (95% confidence interval [CI]: 48%-62%) compared to 72% (95% CI: 67%-76%) in IACS responders (p < .001). IACS response was associated with higher odds of VS response (odds ratio [OR] = 2.10, 95% CI: 1.41-3.12, p < .001), which remained significant after adjusting for age, gender, BMI, and OA severity (OR = 2.25, 95% CI: 1.54-3.28, p <.001). BMI and age were not independently associated with VS response; however, both demonstrated a nonsignificant trend toward lower odds of response (BMI: OR = 0.88 per 5 kg/m2, 95% CI: 0.77-1.01, p = .08; age: OR = 0.95 per 5 years, 95% CI: 0.87-1.04, p = .24). No significant associations were observed for gender or OA severity.
    CONCLUSIONS: Response to IACS predicts subsequent response to VS in patients with knee OA. These findings may help guide treatment selection, though prospective studies are needed.
    DOI:  https://doi.org/10.1002/pmrj.70148
  59. Semin Musculoskelet Radiol. 2026 May 08.
    Role of Imaging in Femoroacetabular Impingement Syndrome: From Pathomechanics to Patient-Specific Management.
    Alexander F Heimann, Jose A Roshardt, Florian Schmaranzer, Reto Sutter.
       Abstract: Femoroacetabular impingement syndrome is a significant morphology-driven hip disorder in which abnormal osseous geometry and dynamic hip motion lead to intra- and/or extra-articular mechanical conflict. Repetitive impingement induces chondrolabral injuries, promoting early joint degeneration and representing a major pathway to osteoarthritis. Although cam and pincer morphologies and femoral torsion abnormalities are commonly observed on imaging, these features alone are not sufficient for diagnosis, requiring integration with clinical evaluation.
    Abstract: Imaging plays a pivotal role in assessing femoroacetabular impingement syndrome, from diagnosis to preoperative planning and postoperative follow-up. Conventional radiography remains indispensable for the primary assessment of hip morphology. Computed tomography provides high-resolution three-dimensional characterization of osseous structures and torsional alignment. Magnetic resonance imaging, including direct magnetic resonance arthrography and traction or position-specific protocols, allows detailed evaluation of chondrolabral lesions, cartilage integrity, and periarticular soft tissues. Quantitative cartilage imaging and three-dimensional modeling further enhance detection of early degeneration, motion-dependent impingement, and dynamic instability.
    Abstract: Accurate differentiation between impingement and instability is critical. Imaging findings guide planning, patient selection, and prognostication, supporting surgical interventions while minimizing risks. This review provides a structured overview of femoroacetabular impingement syndrome pathomechanics and imaging, highlighting conventional and advanced modalities, established and emerging diagnostic parameters, and their implications for patient-specific management.
    DOI:  https://doi.org/10.1055/a-2817-2932
  60. Shoulder Elbow. 2026 May 04. 17585732261446140
    Management of cubital tunnel syndrome - A survey of UK specialist clinical practice.
    Marcus Bateman, Emma Bamford, Nick Johnson, Amol Tambe.
       Introduction: The purpose of this survey was to establish the current UK practice in managing patients with cubital tunnel syndrome (CuTS), in order to design a future research trial on the effectiveness of night splints.
    Methods: We conducted a closed survey of the surgeon membership of the British Elbow & Shoulder Society and British Society for Surgery of the Hand in 2025.
    Results: We received 137 valid responses. The minimum criteria for diagnosis were intermittent sensory loss in the ring and little fingers (74%) and positive Tinel's test (63%). Nerve tests were required by 59%, with 72% of those accepting mild slowing of the ulnar nerve as diagnostic and 28% moderate slowing as the diagnostic threshold. The criteria for surgery were heterogenous. Only 15% trial night splints before surgery and 50% never recommend them. The criteria for urgent surgery were muscle wasting (77%), sensory deficit with objective motor weakness (72%), ulnar clawing (66%), severe nerve conduction loss (62%).
    Discussion: This survey highlights the lack of routine use of night splints and need for a high-quality effectiveness trial. The findings provide a snapshot of current UK practice that may be used to plan future trials involving patients with CuTS.
    Keywords:  Cubital tunnel syndrome; clinical practice; survey; treatment pathway; ulnar neuritis
    DOI:  https://doi.org/10.1177/17585732261446140
  61. Cureus. 2026 Mar;18(3): e106131
    Effectiveness of Proximal Interphalangeal Joint Block Orthosis and Metacarpophalangeal Joint Block Orthosis in the Management of Trigger Finger: A Prospective Observational Study.
    Mohit Kataruka, Jalil Sk, Souvik Bhattacharjee, Puja Sannyashi.
       BACKGROUND: Orthotic intervention is a non-invasive and commonly used treatment for trigger finger (TF). Among the various splinting options, the comparative effectiveness of proximal interphalangeal joint block orthosis (PIPJ-BO) and metacarpophalangeal joint block orthosis (MCPJ-BO) remains inadequately explored. This study compared the clinical effectiveness of PIPJ-BO and MCPJ-BO in reducing pain, symptom severity, and functional limitations in patients with TF.
    METHODS: A prospective observational study was conducted at a tertiary care hospital. Forty-six patients diagnosed with TF (Quinnell grade ≥2) were assigned to either PIPJ-BO (Group A) or MCPJ-BO (Group B). Both groups wore the orthosis 18 hours daily for eight weeks and performed tendon gliding exercises. Outcomes assessed at baseline, four weeks, and eight weeks included the Quinnell grade, Numeric Pain Rating Scale (NPRS), grip strength, and triggering episodes. Data were analyzed using Mann-Whitney U and Wilcoxon signed-rank tests.
    RESULTS: Both groups showed significant within-group improvements in Q-grade and NPRS over time (p < .001), with greater effect sizes in Group A. However, between-group differences at all time points were not statistically significant (p > .05). Grip strength improved numerically but not significantly.
    DISCUSSION: Both PIPJ-BO and MCPJ-BO were effective in the conservative management of TF. While intergroup differences were not statistically significant, PIPJ-BO showed a slightly greater reduction in symptoms. Early orthotic intervention remains beneficial and should be tailored to patient-specific factors.
    Keywords:  mcpj block; orthosis; pipj block; splinting; trigger finger
    DOI:  https://doi.org/10.7759/cureus.106131
  62. Arthroscopy. 2026 May 06.
    Hip Arthroscopy in Femoroacetabular Impingement Syndrome With Versus Without Low Back Pain and Lumbar Spine Pathology Shows Comparable Outcomes at Minimum 5-Year Follow-Up.
    Xin Niu, Zongping Xie.
       PURPOSE: To evaluate the patient-reported outcome measures (PROMs) of hip arthroscopy (HA) in patients with concomitant low back pain and lumbar spine pathology (LSP) compared with those without back concerns at a minimum of 5 year follow-up and determine the prevalence of low back pain (LBP) and LSP in Asian patients with femoroacetabular impingement syndrome (FAIS).
    METHODS: Patients with FAIS, who underwent primary HA for FAIS with labral repair by a single surgeon between July 2017 and October 2019 with minimum 5-year follow-up, were identified. Patients were placed into 3 groups based on presence of preoperative LBP and LSP. These groups included: group LBP (with LBP), group Both (with LBP and LSP), and group None (neither diagnosis). The presence of concomitant LSP was identified using preoperative imaging with a pathologic lumbar spine diagnosis. All patients included in the study were asked to complete the Harris Hip Score (HHS) and Visual Analog Scale (VAS). All patients enrolled in the study were asked to fill out this survey preoperatively, at 3 months postoperatively, and latest follow-up. Satisfaction ratings were collected. Patient-reported outcomes (PROs) were compared between groups, postoperative with preoperative, along with revision arthroscopy, and conversion to total hip arthroplasty (THA).
    RESULTS: The groups were similar in age (46.2 ± 14.4 years, 46.0 ± 15.5 vs 43.9 ± 13.8, P = .16), sex (55.4% female, 58.2% vs 55.4%,P = .91), and body mass index (23.4 ± 2.2 kg/m2, 23.6 ± 2.5 vs 23.1 ± 2.2, P = .93). Comparing HHS and VAS between groups, no significant differences were observed preoperatively and at 5-year follow-up (P ≥ 0.057). Postoperative PROs significantly improved compared with preoperative PROs in all groups at 5-year follow-up (P < .0001). The LBP, Both, and None groups showed comparable rates of any patient acceptable symptomatic state (PASS) (89.1%, 88.1% vs 90.1%, P = .86) at 5-year follow-up. No significant differences in the rates of revision or THA conversion were identified between groups (P = .45). The prevalence of LBP and LSP was 28.9% and 11.5% in the cohort, respectively.
    CONCLUSIONS: The patients with LBP and/or LSP undergoing HA achieved comparable PROs, achievement of PASS, and reoperation-free survivorship to patients with isolated FAIS at minimum 5-year follow-up. The prevalence of LBP and LSP was 28.9% and 11.5% in Asian patients with FAIS, respectively.
    LEVEL OF EVIDENCE: Level III, retrospective therapeutic comparative case series.
    DOI:  https://doi.org/10.1002/arj.70191
  63. Health Sci Rep. 2026 May;9 e72477
    Extended Reality in Rehabilitation Medicine: A Systematic Review.
    Jie Hao, Yao Yao, Ka-Chun Siu.
       Background and Aims: This systematic review synthesizes current evidence on the application of extended reality (XR) technologies, comprising virtual reality (VR), augmented reality (AR), and mixed reality (MR), in rehabilitation medicine, assessing their effects across diverse rehabilitation domains and clinical outcomes.
    Methods: A comprehensive search of three biomedical databases was conducted, yielding 58 randomized controlled trials that examined XR interventions in geriatric, neurological, orthopedic, and pediatric rehabilitation. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Results were qualitatively synthesized according to intervention characteristics and outcome measures.
    Results: The findings indicate that XR technologies can enhance rehabilitation outcomes, including improvements in motor and cognitive function, pain management, psychological well-being, and quality of life. XR interventions were shown to improve balance, strength, and cognitive and psychological function in older adults; facilitate motor recovery and reduce neuropathic pain in neurological populations; support postoperative rehabilitation and conservative interventions in orthopedic patients; and enhance engagement and therapeutic goals attainment in pediatric patients.
    Conclusion: XR technologies present a promising and innovative approach to rehabilitation, offering personalized and engaging therapeutic experiences. Clinicians should leverage XR technologies to empower patients and optimize clinical outcomes.
    Keywords:  function; health; immersion; physiatry; simulation; therapy
    DOI:  https://doi.org/10.1002/hsr2.72477
  64. J Arthroplasty. 2026 Apr 30. pii: S0883-5403(26)00424-9. [Epub ahead of print]
    Up to 10-Year Follow-Up of Thin Polyethylene Liners in Total Hip Arthroplasty.
    Jessica H Leipman, Neeku Salehi, Camilo Restrepo, Eric B Smith, James J Purtill, Yale A Fillingham.
       BACKGROUND: Using thin polyethylene liners with large-diameter femoral heads in total hip arthroplasty (THA) may decrease the risk of instability. This study investigated the one-to-10-year survivorship of thin highly crosslinked polyethylene (HXLPE) liners.
    METHODS: This was a retrospective cohort study of patients who underwent primary THA for osteoarthritis at a single institution. Patients who received an HXLPE liner with a thickness of 3.9, 5.9, or 7.9 mm and a variety of femoral head and cup sizes were included. Surgical information, patient-reported outcome measures, and one-to-10-year outcomes were collected. Of the 4,951 cases included, 92 utilized a 3.9 mm liner, 2,690 utilized a 5.9 mm liner, and 2,169 utilized a 7.9 mm liner, with respective mean lengths of follow-up of 4.5 years (range, 1.2 to 12.2), 6.1 years (range, 1.0 to 12.1), and 6.1 years (range, 1.0 to 12.4).
    RESULTS: There was no significant difference in revisions or reoperations among the cohorts. Among those revised, 7.9 mm liners were more likely to have instability as the revision indication when compared to 5.9 mm liners (0.1 versus 0.04%). The 3.9 mm group had no revisions for instability or polyethylene wear. At six months postoperatively, the Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS-JR) was significantly greater in patients who had a 3.9 mm liner (P = 0.004). At two, five, and 10 years postoperatively, HOOS-JR was equivalent across groups (P = 0.760, P = 0.098, P = 0.685, respectively). At five years, the 3.9 mm group had a significantly lower improvement in HOOS-JR (P = 0.036), but this difference equalized between groups at 10 years.
    CONCLUSION: Thin and standard-size HXLPE liners in THA have similar functional and clinical outcomes up to ten years postoperatively. Liners of 3.9 mm may safely be used while providing the benefit of reduced revision for instability.
    Keywords:  THA; survivorship; thin liner
    DOI:  https://doi.org/10.1016/j.arth.2026.04.089
  65. J Ultrason. 2026 Apr;26(104): 20260008
    Static and dynamic ultrasound assessment of peripheral meniscal lesions: diagnostic value and clinical applications.
    Benjamin Dallaudiere, Nicolas Bouguennec, Nicolas Graveleau, Philippe Meyer, Lionel Pesquer.
      Meniscal injuries are frequent findings in clinical practice and may arise from acute trauma, progressive degeneration, or joint instability. While MRI remains the gold-standard modality for identifying these lesions, ultrasound has emerged as a valuable complementary technique thanks to its accessibility, low cost, real-time capability, and ability to perform dynamic assessments at the point of care. Increasingly, clinicians and radiologists are relying on ultrasound to detect and characterize subtle meniscal abnormalities that might otherwise be missed or underestimated. This review summarizes the principal static and dynamic sonographic features associated with meniscal tears, complex disruptions, and unstable flap fragments. Particular attention is given to the identification of ramp lesions, which involve the meniscocapsular junction and can be challenging to diagnose using conventional imaging alone. The article also discusses the evaluation of meniscal extrusion, a key indicator of structural compromise and a predictor of osteoarthritic progression. By highlighting characteristic ultrasound patterns and demonstrating how dynamic maneuvers can enhance diagnostic confidence, this work underscores the expanding role of ultrasound as an efficient, patient-centered imaging tool that complements MRI and supports a more comprehensive assessment of meniscal mechanical pathology. These insights ultimately contribute to more accurate treatment planning and improved patient outcomes.
    Keywords:  meniscus; peripheral; ramp; tear; ultrasound
    DOI:  https://doi.org/10.15557/jou.2026.0007
  66. J Gynecol Obstet Hum Reprod. 2026 May 05. pii: S2468-7847(26)00106-6. [Epub ahead of print] 103206
    Evaluation of an Office-Based Protocol for Pelvic Pain and Function in Female Patients with Chronic Pelvic Pain.
    Allyson Shrikhande, Nairi Brown, Jasmine Ross, Jennifer Ezavin, Kimberlee Leishear, Rachelle Derosena, Gautam Shrikhande.
       INTRODUCTION: Chronic Pelvic Pain (CPP) is challenging to treat, with many patients living in pain for up to 15 years before finding suitable treatment. Patients frequently report sexual dysfunction, emergency room visits, opioid use, and impaired ability to work and perform everyday functions. Altogether, CPP is associated with reduced quality of life, presenting a need for additional treatment options.
    MATERIALS AND METHODS: We performed a retrospective cohort study in 1517 CPP patients who displayed trigger points, pelvic floor hypertonia, and tenderness of the levator ani sling. Patients also demonstrated tenderness along the pudendal nerve and posterior femoral cutaneous nerve at Alcock's canal and obturator canal bilaterally. These patients underwent a minimally invasive, office-based protocol involving six ultrasound-guided percutaneous pelvic peripheral nerve blocks and trigger point injections. Patients with data from an initial consult and a visit approximately three months following initiation of treatment were included. Patients with missing data were excluded.
    RESULTS: Patients demonstrated a 48.8% reduction in pain and significant improvement across all functional domains (P < 0.001). The proportion of patients reporting emergency room visits and opioid use decreased by 88.5% and 44.8%, respectively (P < 0.001). Sexual function improved by 16.7% (P < 0.001). Patients reported a 45.4% increase in 0 workdays missed from pain and a 93.2% increase in 0 hours of impaired productivity (P < 0.001).
    CONCLUSION: This procedure is associated with significant improvements in pain and quality of life metrics. Further analysis of its long-term efficacy, especially compared to a control group, is suggested.
    Keywords:  Chronic pelvic pain; female health; life quality; nerve block; pelvic rehabilitation
    DOI:  https://doi.org/10.1016/j.jogoh.2026.103206
  67. Br J Gen Pract. 2026 May 07. pii: BJGP.2025.0705. [Epub ahead of print]
    Impact of Treatment Duration on the Effectiveness of Opioid Analgesia: A Systematic Review and Meta-Analysis.
    Liesbeth Froentjes, Catherine Barrington, Rodger Craig, Mareiz Morcos, Dawn Wedman, Christina Korowynk, Michael Daniel Kelmer, Farah Campbell, Scott R Garrison.
      Background Opioid use can heighten pain perception over time. Aim To determine whether the effectiveness of opioid analgesia diminishes with treatment duration in those with chronic low back pain or osteoarthritis. Design and setting Systematic review (January 22, 2025) of randomized trials comparing opioids to placebo/opioid-minimized pain management strategies in those with chronic low back pain or osteoarthritis. Methods Random effects meta-analysis using MEDLINE, EMBASE, CENTRAL, and Scopus databases. OUTCOMES: Primary: Attainment of clinically important pain relief (≥ "moderate" or ≥30% improvement). Secondary: On-treatment pain (100-point scale). PRIMARY ANALYSIS: Difference in primary/secondary outcomes across short-term (≤4-weeks), intermediate-term (4-12 weeks), and long-term (≥12 weeks) subgroups. Results Twenty-seven trials were eligible for inclusion. Clinically important pain relief differed significantly between short, intermediate, and long-term treatment durations (P = 0.05). Opioid recipients were more likely to be responders in short-term trials (8 trials, RR 1.42, 95% CI 1.08 to 1.89, moderate-certainty evidence), but not in intermediate-term trials (3 trials, RR 1.04, 95% CI 0.84 to 1.30, low-certainty evidence), nor long-term trials (9 trials, RR 0.91, 95% CI 0.73 to 1.14, moderate-certainty evidence), which trended in favour of controls. The mean difference in pain scores failed to reach our definition of clinical significance (≥10-points) for any time point, but was statistically significant in the short and intermediate-term. Conclusion Although opioids likely provide meaningful pain relief over short durations (≤4 weeks), they appear to provide little or no benefit beyond placebo over longer periods, and may worsen pain control beyond 12-weeks.
    Keywords:  Chronic Pain; Opioid; Osteoarthritis
    DOI:  https://doi.org/10.3399/BJGP.2025.0705
  68. World J Nucl Med. 2026 Mar;25(1): 51-55
    Complex Regional Pain Syndrome Triggered by Snake Bite: Diagnostic Utility of Triple-Phase Single-Photon Emission Computed Tomography-Computed Tomography Bone Scan-Case Report.
    Osama Ragab, Haneen Alqattan, Manar Al Daas, Hany M A Elrahman.
      Complex regional pain syndrome (CRPS) is a chronic pain disorder with complex pathophysiology involving neurogenic inflammation and autonomic dysfunction. While CRPS is typically associated with trauma or surgery, its occurrence following a snakebite is extremely rare. We report the case of a 47-year-old man who developed persistent pain, swelling, and hypersensitivity in the left foot after a snakebite to the dorsum. Despite prompt administration antivenom and admission to the intensive care unit, the symptoms progressed without systemic infection. Magnetic resonance imaging (MRI) revealed evolving soft tissue inflammation, fat necrosis, and periostitis. Triple-phase bone scintigraphy with single-photon emission computed tomography/computed tomography (SPECT/CT) demonstrated increased perfusion and periarticular tracer uptake consistent with CRPS, while effectively excluding osteomyelitis and abscess. The diagnosis was established using the Budapest criteria, supported by clinical assessment and multimodal imaging, including evidence of evolving periostitis without cortical bone destruction. This case underscores the diagnostic challenge of CRPS in the absence of infection or trauma and highlights the crucial role of MRI and triple-phase bone scintigraphy with SPECT/CT in detecting early osseous involvement and guiding appropriate management.
    Keywords:  MRI; SPECT/CT; bone scan; complex regional pain syndrome; snake bite
    DOI:  https://doi.org/10.1055/s-0045-1812054
  69. J Hand Microsurg. 2026 Jul;18(4): 100461
    Digital splinting for acute closed bony mallet finger: A case series.
    Angela Cristina Prieto-Garzón, Juan José Martínez-Arboleda, Jhon Fredy Castañeda-López, Diego Fernando Rincón-Cardozo, Álvaro Antonio Kafury.
       Aim: To assess clinical, radiographic and functional outcomes of digital splinting in acute closed bony mallet finger injuries.
    Methodology: This Level IV case series included 19 patients with acute bony mallet finger. Patients with loss to follow-up, chronic injuries, open lesions, or unstable, irreducible, or clearly displaced distal interphalangeal (DIP) joint subluxations not corrected by splint positioning at presentation were excluded. All patients were treated with volar splint immobilisation of the DIP joint in extension for six weeks and followed for a minimum of 12 months. Extension deficit, range of motion, radiographic consolidation and classification (Wehbe and Schneider), and functional outcomes using the DASH score were assessed.
    Results: The average age of the patients was 33.6 years. The little finger was the most affected (52.6%). Most patients (84.2%) presented a fracture with an articular fragment greater than one-third of the articular surface. Overall satisfaction had a mean rating of 9.5 on a 0-10 scale (0 = lowest, 10 = highest). The mean DASH score was 4.3 ± 2.8. All fractures achieved bone consolidation, and no treatment-related complications were observed.
    Conclusions: Conservative digital splinting is a reasonable nonoperative option for acute bony mallet finger treated within four weeks of injury. Satisfactory consolidation and functional outcomes were observed in fractures with larger articular fragments and in selected cases of mild, splint-reducible distal interphalangeal joint subluxation. These findings do not extend to unstable or irreducible subluxations and should be interpreted within the constraints of a descriptive case series.
    Keywords:  Conservative treatment; Finger joint; Fracture; Hand; Splints; Treatment outcome
    DOI:  https://doi.org/10.1016/j.jham.2026.100461
  70. Zhongguo Gu Shang. 2026 Apr 25. 39(4): 329-35
    [Effect of bone-setting manipulation on lower extremity alignment in patients with varus knee osteoarthritis].
    Xi Li, Jian Zhang, Guohui Liu, Yunhao Liu, Zekun Zhang, Tianci Gao, Jingxi Wang, Yongwang Zhang, Shilin Yin, Lu Liu, Liqing Qi, Shuangqing Du.
       OBJECTIVE: To observe the effect of bone setting manipulation on the lower limb alignment in patients with varus knee osteoarthritis (KOA), and to elucidate the underlying therapeutic mechanism.
    METHODS: A total of 100 patients with KOA who received bone-setting manipulation between October 2022 and October 2023 were enrolled. Among them, there were 24 males and 76 females, the age ranged from 47 to 75 years with a mean age of (62.9±8.2) years and a disease course ranging from 0.25 to 20 years . All patients were treated with bone-setting manipulation on spine, hip joint, knee joint, and ankle joint.The Western Ontario and McMaster Universities osteoarthritis index (WOMAC) was adopted to evaluate knee joint function. Full-length weight-bearing X-rays of both lower extremities were performed on each patient before treatment and 2 weeks after treatment. The changes in the hip-knee-ankle (HKA) angle of both lower extremities at 2 weeks after treatment compared with those before treatment, as well as the changes in the gap between the HKA angles of both lower extremities before treatment and 2 weeks after treatment, were observed and recorded.
    RESULTS: A total of 89 patients were followed up at 2 weeks after treatment. The WOMAC score at 2 weeks after treatment was 23.0 (15.0, 31.0), which was lower than the preoperative score of 42.0 (34.3, 49.0), and the difference was statistically significant (P<0.001). There was no statistically significant difference in the HKA angles of the unaffected and affected sides between before treatment and 2 weeks after treatment(P>0.05). However, the absolute value of the HKA angle difference between the unaffected and affected sides at 2 weeks after treatment was 1.8 (0.8, 3.2)°, which was lower than that before treatment 2.1(1.0, 3.5)°, and the difference was statistically significant (P<0.05).
    CONCLUSION: Bone-setting manipulation is effective in reducing pain, stiffness, and improving joint function in patients with KOA. The therapeutic mechanism may be due to the correction of the subtle dislocation across the spine, hip, knee, and ankle, thereby reducing bilateral lower limb mechanical axis discrepancies and balancing weight distribution across both knee joints.
    Keywords:  Bone-setting manipulation; Curative effect evaluation; Knee osteoarthritis; Lower limb alignment; Varus deformity
    DOI:  https://doi.org/10.12200/j.issn.1003-0034.20240350
  71. Neurospine. 2026 Apr;23(2): 276-289
    Functional Resilience in Chronic Low Back Pain: Dissociating Magnetic Resonance Imaging Abnormalities From Real-World Disability in the Wakayama Spine Study.
    Masatoshi Teraguchi, Marinko Rade, Hiroshi Hashizume, Jeremy Fairbank, Yuyu Ishimoto, Keiji Nagata, Ryohei Kagotani, Shizumasa Murata, Hiroyuki Oka, Toshiko Iidaka, Sakae Tanaka, Noriko Yoshimura, Munehito Yoshida, Hiroshi Yamada.
       Objective: Low back pain (LBP) is common, yet many individuals maintain normal activities of daily living despite chronic symptoms and structural changes evident on imaging. We hypothesized that functional resilience, defined as preserved functional capacity despite pain and age‑typical degenerative changes, represents a meaningful clinical phenotype, and that function‑centered outcome measures would better discriminate disability status than structural imaging features.
    Methods: This study analyzed 347 participants reporting LBP from the Wakayama Spine Study (N=866). Maintained function was defined a priori as Oswestry Disability Index (ODI) ≤20%. We compared those with maintained function (n=220, 63.4%) to those with impairment (n=127) across demographics, lifestyle, metabolic components, physical performance (grip strength, gait speed), and lumbar magnetic resonance imaging (MRI) findings. Multivariable logistic regression among participants with LBP, including age, sex, obesity, metabolic factors, pain intensity, physical performance, and MRI phenotypes, was used to identify independent predictors of functional resilience.
    Results: Functional resilience was common: 63.0% of LBP participants had ODI ≤20%. Resilient individuals were younger (65.0±11.9 years vs. 74.6±10.9 years, p<0.001) with superior physical performance. In multivariable models, male sex predicted maintained function (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.03-3.00; p<0.05), while obesity (body mass index ≥25 kg/m2) was associated with reduced odds of resilience (OR, 0.50; 95% CI, 0.30-0.84; p<0.01). Standard MRI features, including disc degeneration, Modic changes, and Schmorl nodes, were not independently associated with functional status after adjustment, despite disc degeneration being highly prevalent even among resilient participants (95.4%).
    Conclusion: These data confirm that functional resilience is common in LBP and is not negated by the presence of structural MRI abnormalities. Among LBP patients, male sex and absence of obesity are independent predictors of maintained function, whereas standard MRI features do not independently predict functional status after age adjustment. Function-centered metrics (ODI, gait speed, grip strength) better discriminate functional status than structural imaging findings.
    Keywords:  Activities of daily living; Disc degeneration; Functional resilience; Low back pain; Normal activities of daily living; Obesity
    DOI:  https://doi.org/10.14245/ns.26520312.0156
  72. Acta Orthop. 2026 May 05. 97 265-271
    What aspects of pain and functional outcomes contribute to patient satisfaction 1 year after surgery within total hip and total knee arthroplasty populations? A registry-based cohort study.
    Marys Revaz, Thomas Perneger, Christophe Barea, Hermes H Miozzari, Didier Hannouche, Anne Lübbeke.
       BACKGROUND AND PURPOSE:  Patient satisfaction after total hip and knee arthroplasty (THA, TKA) is influenced by multiple factors, including patient-reported pain and function. We aimed to examine whether functional abilities or pain during specific activities are associated more than other aspects with satisfaction 1 year after THA and TKA.
    METHODS:  This cohort study included all primary elective THAs and TKAs performed between January 2012 and June 2022 at a tertiary care university hospital. Ordinal logistic regression models were used to assess associations between patient satisfaction and WOMAC Pain and Function summary scores and items, 1 year postoperatively.
    RESULTS:  1,772 THAs and 1,323 TKAs were included. Individually, all scores and items were associated with satisfaction. However, multivariable models revealed differences in the strength of association. Global pain score (odds ratio [OR] THA: 2.80, 95% confidence interval [CI] 2.40-3.29; TKA: 3.61, CI 2.96-4.44), pain while walking on the flat (OR THA: 1.79, CI 1.45-2.22; TKA: 1.74, CI 1.43-2.11), and pain going up or down stairs (OR THA: 1.64, CI 1.37-1.96; TKA: 1.68, CI 1.44-1.97) showed the strongest associations in both populations. Among THAs, activities walking on the flat (OR 1.41, CI 1.17-1.68), putting on socks (OR 1.29, CI 1.12-1.48), and ascending stairs (OR 1.26, CI 1.08-1.46) contributed most to satisfaction, whereas among TKAs, walking on the flat (OR 1.41, CI 1.18-1.69), rising from sitting (OR 1.32, CI 1.11-1.58), and getting in or out of a car (OR 1.31, CI 1.10-1.57) did.
    CONCLUSION:  After THA/TKA, patient satisfaction is associated with pain during basic daily tasks-especially walking and stair climbing. Key functional drivers differ by joint: socks and stairs matter for THA, rising from sitting and getting in/out of a car matter for TKA.
    DOI:  https://doi.org/10.2340/17453674.2026.45732
  73. J Phys Ther Sci. 2026 May;38(5): 206-210
    Differences in lower-limb alignment and muscle strength between the sexes during distance-specific single-leg hop tasks.
    Masumi Yoshimoto.
      [Purpose] This study examined the differences in lower-limb alignment and muscle strength between sexes during distance-specific single-leg hop (SLH) landings. SLH tasks are widely used in rehabilitation and return-to-sport decision-making; however, standardized progression criteria for hop distance are lacking. [Participants and Methods] A total of 59 healthy university participants performed SLH landings at distances set to 30, 50, and 80% of their height. The lower-limb alignment variables and isometric muscle strength were measured. Lower-limb kinematic variables were obtained using three-dimensional motion analysis, and isometric strength of the hip and knee muscles was measured using a handheld dynamometer. [Results] Females demonstrated greater hip flexion angles, lower hip adductor and abductor strength, and lower knee flexor and extensor strength compared to males. No differences were observed between the sexes in terms of vertical ground reaction force, knee valgus angle, or knee valgus moment. Females exhibited a hip-dominant landing strategy and lower strength in specific muscle groups. [Conclusion] The findings of this study highlight the importance of incorporating both movement instruction and strength training during rehabilitation for female athletes. These findings might establish clearer criteria for distance progression during SLH-based rehabilitation programs.
    Keywords:  Anterior cruciate ligament injury; Motion analysis; Single-leg hop
    DOI:  https://doi.org/10.1589/jpts.38.206
  74. Cureus. 2026 Apr;18(4): e106385
    Viscosupplementation in Degenerative Joint Disease: Current Evidence, Indications, and Clinical Outcomes.
    Maximiliano Cueva Pérez, Antonio Cueva Pérez, Antonio Cueva Aldana.
      Intra-articular hyaluronic acid (IA-HA), or viscosupplementation, remains a subject of ongoing debate in the non-surgical management of knee osteoarthritis. Despite conflicting clinical guidelines, its use continues to grow due to a favorable safety profile and its role in addressing the "treatment gap" for patients with Kellgren-Lawrence grades II and III. This structured narrative review identifies and synthesizes evidence from PubMed, Scopus, and recent clinical guidelines (2006-2026) to explore the physiological role of IA-HA, emphasizing its rheological properties and the dual mechanism of viscosupplementation and viscoinduction. We evaluate current clinical evidence, acknowledging the inherent heterogeneity of reported outcomes while discussing the potential for symptomatic relief that may, in selected populations, extend beyond the traditional six-month window. Furthermore, this work addresses the social and economic relevance of IA-HA, specifically its opioid-sparing benefits amidst the global opioid crisis and its potential to delay total knee arthroplasty (TKA). By refining patient selection and understanding the impact of molecular weight and combination therapies, clinicians can optimize outcomes. This review provides an evidence-based framework for integrating IA-HA into a multimodal joint preservation strategy to improve quality of life and reduce the global burden of degenerative joint disease.
    Keywords:  hyaluronic acid; joint preservation; knee osteoarthritis; osteoarthritis management; treatment gap; viscosupplementation
    DOI:  https://doi.org/10.7759/cureus.106385
  75. Osteoarthr Cartil Open. 2026 Jun;8(2): 100802
    Knee extensor muscles of active older adults with knee osteoarthritis are smaller and weaker but not more fatigable than healthy older adults: Relevance to physical function.
    Skylar C Holmes, Jane A Kent, Douglas N Martini, Carol Bigelow, Katherine A Boyer.
       Objective: While knee extensor (KE) muscle weakness (lower peak torque or power) is common with knee osteoarthritis (KOA), less is known about muscle fatigue (acute decrement in peak torque or power in response to contractile activity) and its impact on mobility in KOA. The aim of this study was to quantify KE muscle weakness, fatigue and mobility in response to a 30-min treadmill walk (30 MTW) in older adults with and without KOA.
    Method: Eighteen KOA (73±3 yr) and 18 healthy (71±3 yr,) participants completed a standardized 30 MTW to induce KE muscle fatigue and changes in mobility (Short Physical Performance Battery scores, SPPB). Peak torque and power (120°/s and 240°/s) were quantified pre- and post-30 MTW. Muscle size (maximal fatfree cross-sectional area; mCSA, cm2) and fat fraction were quantified using MRI, and specific power was calculated as peak muscle power/mCSA (Nm×cm-2). Habitual physical activity was quantified using accelerometry.
    Results: Lower KE peak and specific torque and power, SPPB and gait speed in KOA at baseline indicated weaker, smaller, fattier muscles, and compromised mobility compared with healthy adults. Muscle fatigue post-30 MTW was significant but did not differ by group. SPPB scores did not change post-30 MTW in either group.
    Conclusion: Older adults with and without KOA experienced KE muscle fatigue in response to a 30 MTW. While KOA were weaker and had lower physical function at baseline, muscle fatigue did not exacerbate these deficits, suggesting that interventions for mobility in individuals with KOA should continue to target muscle atrophy and weakness rather than fatigue.
    Keywords:  Fatigue; Magnetic resonance imaging; Mobility; osteoarthritis
    DOI:  https://doi.org/10.1016/j.ocarto.2026.100802
  76. Am J Sports Med. 2026 May 04. 3635465261439048
    Return to Sport in Professional Athletes With Borderline Hip Dysplasia After Hip Arthroscopy for Femoroacetabular Impingement.
    Tyler Uppstrom, Nicholas A Felan, Dane R G Lind, Grant J Dornan, Alyson Speshock, Marc J Philippon.
       BACKGROUND: Hip arthroscopy for femoroacetabular impingement (FAI) in professional athletes is associated with significant improvements in postoperative pain and function and a return-to-sport (RTS) rate >80%. However, RTS rate after hip arthroscopy for FAI in professional athletes with borderline dysplasia is unknown.
    PURPOSE: To assess RTS rates exclusively in professional athletes with borderline dysplasia after hip arthroscopy for treatment of FAI.
    STUDY DESIGN: Cohort study; Level of evidence, 3.
    METHODS: A total of 40 professional and Olympic athletes (42 hips) with borderline dysplasia (lateral center edge angle [LCEA] 18°-25°) underwent hip arthroscopy for FAI between 2005 and 2022. RTS was defined as competing in a single professional game at an equal level after surgery. Data were retrospectively obtained for each athlete from publicly available sport-specific data sources.
    RESULTS: The study included 42 hips. Patients undergoing primary hip arthroscopy demonstrated a 79% RTS rate, whereas patients undergoing revision hip arthroscopy demonstrated a 25% RTS rate (P = .006). Among athletes who successfully returned, RTS occurred at a median of 7.5 months (range, 3.1-24.3 months) after surgery. The mean age at the time of surgery was 28.9 years (range, 18-53.5 years). In total, 21 hips (50%) had an Outerbridge grade 3 or 4 defect at the time of surgery, and 10 (24%) underwent a microfracture procedure. Older age (P = .041) and history of previous hip arthroscopy (P = .008) were associated with a lower likelihood of return to professional sport. No statistically significant association was found between femoral version, LCEA, alpha angle, the presence of Outerbridge grade 3 or 4 defect, or minimum joint space and RTS.
    CONCLUSION: In the primary setting, professional athletes with borderline hip dysplasia who underwent hip arthroscopy for FAI demonstrated a 79% RTS rate. The mean time to return was 7.5 months, with older age and a history of prior hip arthroscopy predictive of a lower likelihood of RTS (25% RTS among revision cases). Hip arthroscopy for FAI in professional athletes with borderline dysplasia was effective for returning the majority of these athletes to their preoperative level, especially in the primary setting.
    Keywords:  FAI; borderline dysplasia; hip arthroscopy; return to sport
    DOI:  https://doi.org/10.1177/03635465261439048
  77. Cureus. 2026 Apr;18(4): e106456
    Clinical and Radiographic Factors Affecting the Outcomes of Decompression Surgery in Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) Classification Type C Degenerative Lumbar Spondylolisthesis.
    Atsushi Kawano, Kiyoshi Tarukado, Kazuya Yokota, Kazu Kobayakawa, Hirokazu Saiwai, Kenichi Kawaguchi, Yasuharu Nakashima.
      Introduction The optimal surgical strategy for Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) Type C remains controversial, particularly regarding decompression alone versus fusion surgery. Evidence focusing on outcomes after decompression alone in this subgroup is limited. This study evaluated clinical outcomes after decompression in patients with L4 degenerative spondylolisthesis classified as CARDS Type C and identified preoperative factors associated with postoperative walking function. Methods This retrospective analysis of prospectively collected data included 59 patients who underwent decompression surgery for lumbar spinal stenosis associated with L4 degenerative spondylolisthesis between April 2018 and March 2022 and were followed for at least one year. Thirty-four patients classified as CARDS Type C were analyzed. Clinical outcomes were assessed using visual analog scale scores for low back pain and leg pain, the Oswestry Disability Index, and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) preoperatively and at six months and one year postoperatively. Preoperative radiographic parameters, including slip distance, segmental motion, and spinopelvic alignment, were evaluated. Factors associated with changes in JOABPEQ walking function were analyzed using correlation analysis, stepwise multiple regression, and receiver operating characteristic (ROC) curve analysis. Results All clinical outcome measures showed significant improvements at six months and one year after surgery. Stepwise multiple regression identified two independent factors associated with poorer improvement in walking function: preoperative change in L4 slip distance and preoperative pelvic tilt (PT). ROC analysis for treatment effectiveness based on the JOABPEQ walking function score showed areas under the curve of 0.65 for slip distance change and 0.76 for PT, with optimal cutoff values of 4 mm and 30 degrees, respectively. Conclusions Decompression surgery provides generally favorable outcomes in CARDS Type C. However, postoperative improvement in walking function may vary depending on preoperative radiographic characteristics. Greater dynamic instability and increased PT were associated with limited functional recovery. These findings suggest that decompression alone may achieve favorable outcomes in selected patients with less dynamic instability and lower PT.
    Keywords:  decompression surgery; degenerative spondylolisthesis; lumbar spine; pelvic tilt; spinal instability
    DOI:  https://doi.org/10.7759/cureus.106456
  78. Hand (N Y). 2026 May 06. 15589447261437821
    The Role of Peripheral Nerve Stimulation for the Treatment of Neuropathic Pain Following Brachial Plexus Injury: A Scoping Review of Neuromodulation Modalities.
    Seeley Yoo, Jackson M Cathey, Kyle Steinbock, Edward Frails, Tara Dalton, Samantha Kaplan, C Rory Goodwin, Eliana Saltzman, Neill Y Li.
      A majority of patients with brachial plexus injuries (BPIs) develop neuropathic pain, which is not consistently resolved by medications or surgery. Peripheral nerve stimulation (PNS) shows promise as a supplemental treatment for BPI-associated pain, but comprehensive reviews analyzing its efficacy are limited. Therefore, this study aimed to summarize existing literature on the efficacy of PNS for treating BPI-associated neuropathic pain. A systematic literature search was performed in PubMed, Embase, and Web of Science, querying articles assessing PNS for treatment of neuropathic pain in adults with BPIs. Descriptive statistics and narrative syntheses summarized study characteristics, demographic and clinical data, and pain-related outcomes. Of 409 articles from the initial search, 9 met inclusion criteria. In 8 studies (88.9%), PNS was clinically effective in pain reduction. Of these, 5 (62.5%) used percutaneous electrode placement, 2 (25.0%) used open implantation, and 1 (12.5%) used transcutaneous stimulation. Peripheral nerve stimulation demonstrated pain-reduction capabilities in both preganglionic and postganglionic BPIs. These early findings show promise for PNS for treating refractory pain in patients with limited therapeutic options. Still, PNS for treating BPI-associated pain is an evolving and understudied field. Continued research is needed to better assess its indications, efficacy, and optimal settings to create a personalized pain-management approach.
    Keywords:  brachial plexus injury; neuropathic pain; percutaneous; peripheral nerve stimulation; postganglionic; preganglionic; transcutaneous
    DOI:  https://doi.org/10.1177/15589447261437821
  79. J Pain Res. 2026 ;19 597557
    Esketamine for Postoperative Multimodal Analgesia in Laparoscopic Surgery: A Systematic Review and Meta-Analysis.
    Jinze Li, Xiuqin Wang.
       Purpose: Postoperative pain management after laparoscopic surgery remains challenging. Esketamine, a potent N-methyl-D-aspartate receptor antagonist, may improve multimodal analgesia while mitigating opioid-related side effects. This meta-analysis evaluates the efficacy and safety of perioperative intravenous esketamine in adults undergoing laparoscopic surgery.
    Methods: We conducted a systematic review and meta-analysis of randomized controlled trials according to PRISMA guidelines. Databases were searched from inception to October 1, 2025. Primary outcomes were postoperative pain intensity (at rest and during movement at 24 hours) and 24-hour opioid consumption. Secondary outcomes included rescue analgesia, postoperative nausea and vomiting (PONV), hallucinations, and depressive symptoms. Data were pooled using random-effects models, and evidence certainty was assessed with GRADE.
    Results: Twenty-eight RCTs (3160 patients), all conducted in China, were included. Esketamine significantly reduced pain at rest (SMD -0.65, 95% CI -0.90 to -0.40) and during movement (SMD -0.64, 95% CI -1.09 to -0.19), and decreased 24-hour opioid consumption (SMD -16.83, 95% CI -31.60 to -2.05). It also reduced rescue analgesia requirements (RR 0.51, 95% CI 0.35 to 0.76) and PONV incidence (RR 0.76, 95% CI 0.63 to 0.93) without increasing hallucinations (RR 1.11, 95% CI 0.41 to 3.03). A reduction in postoperative depressive symptoms was observed (SMD -0.67, 95% CI -1.29 to -0.05). Subgroup analyses suggested greater analgesic benefit with low-dose regimens (<0.5 mg/kg) and in biliary surgeries. Evidence certainty was low to very low for primary outcomes. Twenty-eight RCTs (3160 patients), all conducted in China, were included, which may limit the generalizability of the findings. Esketamine was associated with reductions in pain at rest (SMD -0.65, 95% CI -0.90 to -0.40) and during movement (SMD -0.64, 95% CI -1.09 to -0.19), and decreased 24-hour opioid consumption (SMD -16.83, 95% CI -31.60 to -2.05), although substantial heterogeneity was observed. It also reduced rescue analgesia requirements (RR 0.51, 95% CI 0.35 to 0.76) and PONV incidence (RR 0.76, 95% CI 0.63 to 0.93) without increasing hallucinations (RR 1.11, 95% CI 0.41 to 3.03). A reduction in postoperative depressive symptoms was observed (SMD -0.67, 95% CI -1.29 to -0.05). Subgroup analyses suggested greater analgesic effects with low-dose regimens (<0.5 mg/kg) and in biliary surgeries. Evidence certainty was low to very low for primary outcomes.
    Conclusion: Perioperative intravenous esketamine may be associated with improvements in postoperative pain, opioid requirements, rescue analgesia, and PONV in laparoscopic surgery without increasing neuropsychiatric adverse events. However, the certainty of the evidence is low and substantial heterogeneity limits confidence in these estimates. Therefore, these findings should be interpreted with caution, and high-quality, international RCTs are needed to confirm efficacy and establish optimal dosing.
    Keywords:  esketamine; laparoscopic surgery; meta-analysis; postoperative pain; systematic review
    DOI:  https://doi.org/10.2147/JPR.S597557
  80. Shoulder Elbow. 2026 May 04. 17585732261442570
    Adherence to clinical guidelines in treating degenerative disorders of the supraspinatus tendon: A descriptive baseline analysis of surgical vs. conservative approaches in a 12-month observational study.
    Christopher J Hodgetts, Karl Vincent, Lee Daffin, Yvonne Learmonth.
       Background: Shoulder pain (SP) is prevalent, costly, and linked to low quality of life, high pain levels, disability, and mental health issues. Despite guidelines, orthopaedic surgeons vary in surgical indicators and clinical decision-making. This study investigates if clinicians adhere to guidelines in an observational study.
    Methods: In a French prospective multicentre study, four clinicians assessed patients with shoulder pain, recommended surgery or conservative management, and followed up at 4, 6, and 12 months. Comparative demographic and clinical data were used at baseline. Participants receiving surgery or conservative care within diagnostic and pain severity categories were compared to guidelines. An attrition analyses compared participants at baseline and 12-month follow-up.
    Results: Of 189 participants, the majority of impingement and tendinopathy diagnoses were managed conservatively. More full-thickness tear diagnoses were recommended for surgical repair, and those recommended for surgery had more severe pain. Participants with high SMS completion (≥80%) and low SMS completion (<80%) were similar at baseline (based on age, sex, education, pain severity, duration, and disability) and at 12-month follow-up.
    Conclusion: Clinicians recommended treatment in line with guidelines, emphasising rotator cuff tear presence and high pain intensity. Patients recommended surgery differed from those recommended conservative management, so future analyses should compare these treatment groups.
    Keywords:  Shoulder pain; clinical guidelines; longitudinal study; rotator cuff disorders
    DOI:  https://doi.org/10.1177/17585732261442570
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