bims-ricfun Biomed News
on Rehabilitation ICF
Issue of 2025–12–28
fifty-one papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica
  1. Current Perspectives on Platelet-Rich Plasma Injections for Knee Osteoarthritis: How to Optimize Clinical Outcomes.
  2. Bilateral Flexor Carpi Ulnaris Enthesopathy Uncovered by Ultrasound: Highlighting the Role of Early Imaging.
  3. Botulinum Toxin Combined with Robot-Assisted Therapy for Post-Stroke Spasticity: A Systematic Review.
  4. Brachioradialis muscle pain: a common source of underdiagnosed or misdiagnosed forearm pain.
  5. Initial site of calcifications in rotator cuff tendons: A sonographic observational study.
  6. Screening Saves Hands: Detecting Silent Carpal Tunnel Syndrome in Mucopolysaccharidosis.
  7. Thenar Muscle Atrophy: Clinical, Electrodiagnostic, and Ultrasound Features in 197 Patients.
  8. Acromiohumeral Distance as a Diagnostic and Prognostic Biomarker for Shoulder Disorders: A Systematic Review-Acromiohumeral Distance and Shoulder Disorders.
  9. Neuromuscular and proprioceptive exercises for knee osteoarthritis: building balance, stability, and patient confidence.
  10. Anatomical and Functional Changes After Surgical Treatment of Carpal Tunnel Syndrome: A Review.
  11. Effects and safety of vibration therapy in knee osteoarthritis rehabilitation: an umbrella review of systematic reviews.
  12. Segmental Zoster Paresis With Comorbid Carpal Tunnel Syndrome.
  13. Simultaneous Carpal Tunnel Syndrome and Guyon's Canal Syndrome Caused by a Lipoma Arising From the Flexor Tenosynovium: A Case Report.
  14. Respiratory and peripheral muscle ultrasound, including shear-wave elastography, for sarcopenia screening in COPD.
  15. Carpal Tunnel Release Versus Local Corticosteroid Injection for Carpal Tunnel Syndrome: A Meta-Analysis of Randomized Controlled Trials.
  16. Pronator quadratus sutured or not after ORIF by anterior plate: Ultrasound control of its interest in the protection of the Flexor Pollicis Longus.
  17. Repurposing osteoporosis medications for other diseases: a narrative review by the European Calcified Tissue Society (ECTS).
  18. Intra-articular injection of high versus low molecular weight hyaluronic acid in adhesive capsulitis; randomized trial.
  19. Safety and clinical performance of intra-articular high-purity sodium hyaluronate injection in patients with knee osteoarthritis: a 28-week post-market clinical follow-up study.
  20. Carpal Tunnel Release Postoperative Pain Management: A Systematic Review of Randomized Controlled Trials.
  21. Ulnar nerve dimensions at entrapment sites in cadavers.
  22. Mechanism of muscle activation in the protection of knee joint injury during jogging.
  23. Effectiveness of platelet-rich plasma in pain management of osteoarthritis with developmental dysplasia of the hip: a double-blind, randomized controlled trial.
  24. Effects of a Scapular-Focused Exercise Protocol for Patients with Rotator Cuff-Related Pain Syndrome-A Randomized Clinical Trial.
  25. Achilles tendon ruptures in National Basketball Association players: A sequential video analysis of injury mechanisms and biomechanical patterns.
  26. Circumferential Repair Versus Labral Base Refixation for the Treatment of Symptomatic Femoroacetabular Impingement Syndrome: A Systematic Review and Narrative Synthesis.
  27. Effects on Exercise Tolerance and Functional Outcomes of Eccentric versus Concentric Aerobic Exercise in People with COPD: A Systematic Review and Meta-Analysis.
  28. Anatomical Study of the Biceps Sheath for Safe and Accurate Unguided Anterior Shoulder Injections.
  29. Public Health.
  30. Efficacy and safety of interventions for Fibromyalgia syndrome comorbid with Irritable bowel syndrome: systematic review.
  31. Atypical Calcific Tendinitis Involving Teres Minor Which Affects Overhead Movement: A Case Report.
  32. Clinical assessments are valid to grade ligament injury severity compared to ultrasound imaging in patients with acute lateral ankle sprains: a cross-sectional study.
  33. Finger growth plate injuries in adolescent sport climbers: A scoping review.
  34. Navicular fractures in elite athletes-2025 international foot and ankle sports consensus and systematic review.
  35. Overall rehabilitation prognosis for the level of functioning following moderate to severe acquired brain injury: a study using routinely collected health record data.
  36. Ultrasound Evaluation of Upper Facial Muscles to Guide Botulinum Toxin Application.
  37. Effectiveness of Hyperbaric Oxygen Therapy for Musculoskeletal Pain Syndromes: A Systematic Review.
  38. Physical activity and diurnal variation have no impact on plasma microRNA-140 expression levels in patients with knee osteoarthritis and healthy controls.
  39. The Impact of Patient-Controlled Analgesia Combined with Self-Management Training on Pain Modulation in Diabetic Patients with Chronic Knee Pain.
  40. Safety profile comparison of intra-articular corticosteroids, hyaluronic acid, platelet-rich plasma, and cell-based injections for knee osteoarthritis: A systematic review and meta-analysis by the ESSKA Orthobiologics Initiative.
  41. Exploring the Role of Bipolar Thermal Radiofrequency in Complex Multi-pattern Post-stroke Spasticity: Clinical Insights From a Case Report With Combined Botulinum Toxin Type A Therapy.
  42. Retrospective analysis of ultrasound-guided hydrodistension in patients with post-traumatic adhesive capsulitis of the shoulder.
  43. Diagnostic evaluation and nonoperative management of Lisfranc injuries in athletes.
  44. Pericapsular nerve group phenol neurolysis for refractory metastatic hip pain: a case series.
  45. 2-Year clinical outcomes following combined iliotibial band and gluteus medius percutaneous ultrasound tenotomy in refractory GTPS.
  46. Assessment of ultrasound-guided continuous genicular nerve radiofrequency for the management of persistent post-arthroplasty knee pain.
  47. Ultrasound Guidance to Augment Needle Electromyography Precision in the Complex Nerve Injury Setting.
  48. Artificial Intelligence Analysis of Symmetry and Emotions in Facial Palsy Patients After Botulinum Toxin A Injections.
  49. The Management of Neurological Injuries Following Total Hip Arthroplasty.
  50. The usefulness of tuning-fork-assisted vibration sensation as a proprioceptive measurement method in cases of acute anterior talofibular ligament rupture: A single-center study.
  51. [Descending genicular artery embolization to reduce chronic pain after total knee replacement].
  1. Open Access J Sports Med. 2025 ;16 179-186
    Current Perspectives on Platelet-Rich Plasma Injections for Knee Osteoarthritis: How to Optimize Clinical Outcomes.
    Jaydeep Dhillon, Dylan Parry, Matthew J Kraeutler.
      Knee osteoarthritis (OA) is a common degenerative joint disease affecting approximately 22% of adults over the age of 40 and is a major contributor to pain and disability worldwide. Platelet-rich plasma (PRP) has gained attention as a biologic treatment for this pathology due to its potential in modulating inflammation. This narrative review evaluates the current evidence on PRP for knee OA, comparing its efficacy to hyaluronic acid (HA), corticosteroids, and bone marrow aspirate concentrate (BMAC). High-quality studies consistently demonstrate that PRP provides superior pain relief and functional improvement compared to HA and corticosteroids and offers comparable results to BMAC. PRP is effective across all Kellgren-Lawrence grades, with the greatest benefits seen in early to moderate OA. Three-injection regimens appear more effective than single injections, and while both leukocyte-rich and leukocyte-poor formulations are used, no clear consensus exists on which is superior. Despite promising short- and mid-term outcomes, variability in preparation methods and limited long-term evidence remain important limitations. Current literature suggests that PRP may be a safe and potentially effective nonoperative option for managing knee osteoarthritis, though further high-quality, standardized studies are needed to confirm its long-term efficacy and optimal application.
    Keywords:  intra-articular injections; knee osteoarthritis; leukocyte-poor PRP; leukocyte-rich PRP; orthobiologics; platelet-rich plasma
    DOI:  https://doi.org/10.2147/OAJSM.S567695
  2. Am J Phys Med Rehabil. 2025 Nov 17.
    Bilateral Flexor Carpi Ulnaris Enthesopathy Uncovered by Ultrasound: Highlighting the Role of Early Imaging.
    Hilmi Berkan Abacıoğlu, Ayşe Gül Uygan, Ahmet Furkan Çolak, Berkay Yalçınkaya, Murat Kara.
      
    Keywords:  Ultrasonography; inflammation; tendinitis; tendon; wrist
    DOI:  https://doi.org/10.1097/PHM.0000000000002906
  3. Toxins (Basel). 2025 Nov 25. pii: 569. [Epub ahead of print]17(12):
    Botulinum Toxin Combined with Robot-Assisted Therapy for Post-Stroke Spasticity: A Systematic Review.
    Salvatore Facciorusso, Stefania Spina, Mirko Filippetti, Rajiv Reebye, Gerard E Francisco, Andrea Santamato.
      (1) Background: Post-stroke spasticity limits motor recovery and independence. Combining botulinum toxin type-A (BoNT-A) injection with intensive, task-specific robot-assisted therapy (RAT) might enhance neuroplasticity and functional gains, but its additive effect and optimal timing are uncertain. (2) Methods: We systematically searched major medical databases and trial registries up to April 2025 for randomized controlled trials in adults with post-stroke spasticity comparing botulinum toxin type-A injection plus RAT with toxin injection plus conventional therapy, or RAT alone with RAT combined with toxin injection. Risk of bias was assessed using the RoB 2 tool, and findings were synthesized narratively. (3) Results: Seven trials (n = 229) were included. Across all studies, toxin treatment reduced spasticity within groups, whereas additional spasticity reduction with RAT versus conventional rehabilitation was inconsistent. In contrast, several lower-limb trials reported greater improvements in walking capacity and balance when RAT was added, while upper-limb trials showed comparable motor recovery across treatment arms with occasional advantages in strength and movement quality. A pilot four-arm study suggested that starting RAT around four weeks after injection may maximize upper-limb motor gains. (4) Conclusions: The combination of BoNT-A with RAT appears safe and is particularly promising for gait rehabilitation, but further research is needed to define optimal timing and protocols.
    Keywords:  botulinum toxin; robot-assisted therapy; spasticity; stroke
    DOI:  https://doi.org/10.3390/toxins17120569
  4. Korean J Pain. 2025 Dec 22.
    Brachioradialis muscle pain: a common source of underdiagnosed or misdiagnosed forearm pain.
    Kyung-Hoon Kim.
      The brachioradialis (BR) muscle is a long, large, fusiform muscle on the lateral side of the forearm. It originates from the lateral distal humerus and inserts to the base of the styloid process of the radius. The function of the BR muscle is to flex the elbow, especially with the hand in a neutral position, to pronate and supinate the forearm, and to support wrist extension, especially gripping or picking up something. BR muscle pain arises from repetitive overuse, sudden overloading, and direct blow. Common painful daily activities include putting a cup back down after drinking, opening doors, shaking hands, and using a screwdriver or hammer. The two most common symptoms of BR muscle pain are a sharp and shooting pain during activity and an aching pain at rest from the lateral elbow through the forearm, back of the hand, and thumb and index finger, as well as tightness. Differential diagnosis considers lateral epicondylitis (tennis elbow), radial tunnel syndrome, de Quervain's tenosynovitis, carpal tunnel syndrome, trigger thumb, writer's cramp, and cervical radiculopathy. BR muscle pain is common in patients with subacromial impingement syndrome. Basic conservative treatment includes rest, ice, compression, and elevation (RICE), as well as medication. Stretching exercise for the BR muscle is helpful. Injection techniques, such as myofascial injection or botulinum muscle injection, are also recommended. BR muscle pain is one of the common sources of underdiagnosed and misdiagnosed forearm pain.
    Keywords:  Differential Diagnosis; Elbow; Fascia; Forearm; Intramuscular Injections; Myalgia; Radiculopathy; Shoulder Impingement Syndrome; Spasm; Tennis Elbow; Thumb; Wrist
    DOI:  https://doi.org/10.3344/kjp.25139
  5. J Int Med Res. 2025 Dec;53(12): 3000605251407440
    Initial site of calcifications in rotator cuff tendons: A sonographic observational study.
    Sang Hoon Lee, Hyun Hee Choi, Min Cheol Chang.
      BackgroundThis study aimed to investigate the initial site of calcification development in rotator cuff tendons using serial ultrasonographic evaluations.MethodsA total of 21 patients with de novo calcifications were included. Ultrasonography was used to assess calcifications in the rotator cuff tendons. The distance from the tendon insertion on the humerus to the calcification site was measured, along with the long and short diameters and the long-to-short diameter ratio.ResultsIn 19 patients (90%), calcifications were in direct contact with the tendon insertion on the humerus. In the remaining two patients (10%), the calcifications were located 1 mm proximal to the tendon insertion site. The mean long and short diameters of the calcifications were 9.4 ± 4.6 and 2.7 ± 1.2 mm (range: 3.0-17.0 and 1.0-4.5 mm), respectively. The mean long-to-short diameter ratio was 2.4 ± 2.2 mm (range: 1.8-10.0 mm). Regarding shoulder disorders, 1, 7, and 13 patients had a rotator cuff tendon tear, calcific tendinitis, and adhesive capsulitis, respectively.ConclusionsCalcifications in the rotator cuff tendons appear to originate at the tenoperiosteal junction or in close periosteal proximity and extend along the tendon axis.
    Keywords:  Shoulder joint; pain management; pathology; tendinopathy; ultrasonography
    DOI:  https://doi.org/10.1177/03000605251407440
  6. Hand Surg Rehabil. 2025 Dec 24. pii: S2468-1229(25)00489-X. [Epub ahead of print] 102564
    Screening Saves Hands: Detecting Silent Carpal Tunnel Syndrome in Mucopolysaccharidosis.
    Renu Ambardar, Ahmad J Abdulsalam, Sarah Y Alkandari, Diaa Shehab.
      
    Keywords:  Mucopolysaccharidosis; early detection; electrodiagnosis; pediatric carpal tunnel syndrome; ultrasound
    DOI:  https://doi.org/10.1016/j.hansur.2025.102564
  7. Neurol Int. 2025 Dec 11. pii: 201. [Epub ahead of print]17(12):
    Thenar Muscle Atrophy: Clinical, Electrodiagnostic, and Ultrasound Features in 197 Patients.
    Lisa B E Shields, Vasudeva G Iyer, Stephen Furmanek, Yi Ping Zhang, Christopher B Shields.
       BACKGROUND/OBJECTIVES: Atrophy of the thenar muscles (abductor pollicis brevis [APB], opponens pollicis [OP], and flexor pollicis brevis [FPB]) is most commonly caused by carpal tunnel syndrome (CTS). It may also occur following injury to the recurrent motor branch of the median nerve, proximal median nerve neuropathy, medial cord/lower trunk plexopathy, T1 radiculopathy, ventral horn cell disorder at C8 or T1, disuse atrophy, or congenital aplasia. Clinical observation of flattening of the thenar eminence coupled with electrodiagnostic (EDX) and ultrasound (US) studies is valuable in determining the etiology of thenar atrophy. This study describes clinical, EDX, and US findings in a large cohort of patients with thenar muscle atrophy.
    METHODS: This is a review of 197 patients (226 hands) with thenar atrophy who underwent EDX and US studies. Patients were divided into those with total thenar atrophy (all three thenar muscles were atrophic) or partial thenar atrophy (atrophy of one or two thenar muscles) based on clinical and US findings.
    RESULTS: Of the 226 hands, 174 (77.0%) had partial thenar atrophy, 217 (96.0%) had sensory loss, and all hands demonstrated weakness of the APB and OP muscles on examination. A total of 220 (97.3%) hands had EDX evidence of severe median nerve entrapment at the carpal tunnel. The compound muscle action potentials (CMAPs) of the APB muscle and sensory nerve action potentials (SNAPs) were absent in 186 (82.3%) and 212 (93.8%) hands, respectively. US study showed hyperechoic APB and OP muscles in 225 (99.6%) hands. The Heckmatt grade, determined by US, was 3 in 152 (67.3%) hands, showing increased muscle echogenicity with loss of architecture and reduced bone reflection.
    CONCLUSIONS: In patients with thenar muscle atrophy, EDX studies were not always conclusive for confirming CTS due to an absence of SNAP and CMAP over the APB and second lumbrical muscles. In these cases, US is important to confirm the cause of thenar atrophy.
    Keywords:  carpal tunnel syndrome; electrodiagnostic study; median nerve; neurology; thenar muscle atrophy; ultrasound
    DOI:  https://doi.org/10.3390/neurolint17120201
  8. J Funct Morphol Kinesiol. 2025 Dec 15. pii: 478. [Epub ahead of print]10(4):
    Acromiohumeral Distance as a Diagnostic and Prognostic Biomarker for Shoulder Disorders: A Systematic Review-Acromiohumeral Distance and Shoulder Disorders.
    Luis Alfonso Arráez-Aybar, Carlos Miquel García-de-Pereda-Notario, Luis Palomeque-Del-Cerro, Juan José Montoya-Miñano.
      Objectives: The acromiohumeral distance (AHD) is widely used to evaluate subacromial pathology, particularly rotator cuff-related disorders. However, substantial heterogeneity exists across studies in imaging protocols, measurement definitions, and diagnostic thresholds. This systematic review aimed to synthesize current evidence on AHD measurement methods, assess reliability and diagnostic performance across imaging modalities, and examine the clinical relevance of AHD as both a structural and functional biomarker. Methods: A systematic search of PubMed, Web of Science, and SciELO (January 2006-May 2025) was conducted following PRISMA 2020. Eligible studies reported quantitative AHD measurements using ultrasound, MRI, or radiography in adults. Two reviewers independently conducted screening, extraction, and QUADAS-2 assessments. Due to heterogeneity, results were narratively synthesized. Results: Twenty-nine studies met the inclusion criteria. Definitions of AHD and imaging procedures varied substantially. Ultrasound showed the most consistent intra- and inter-observer reliability, whereas MRI and radiography demonstrated greater protocol-dependent variability. Reduced AHD values were frequently associated with full-thickness rotator cuff tears, while larger values typically characterized asymptomatic individuals. Several studies also reported reductions in AHD during arm elevation, supporting its interpretation as a functional parameter influenced by scapular motion and neuromuscular control. Conclusions: AHD is a reliable and clinically informative measure when acquired using standardized protocols, with Ultrasound demonstrating the highest reproducibility. Its sensitivity to positional and dynamic factors supports its role as both a structural and functional biomarker. Further research should prioritize standardized imaging procedures, dynamic assessment methods, and evaluation of emerging technologies to improve the diagnostic and prognostic value of AHD.
    Keywords:  acromiohumeral distance; diagnostic accuracy; imaging; rotator cuff tear; shoulder pain; subacromial space; ultrasound
    DOI:  https://doi.org/10.3390/jfmk10040478
  9. J Surg Case Rep. 2025 Dec;2025(12): rjaf1011
    Neuromuscular and proprioceptive exercises for knee osteoarthritis: building balance, stability, and patient confidence.
    Sarah S Joseph, George Ampat.
      Knee osteoarthritis (OA) is a degenerative joint disease characterized by pain, reduced mobility, and diminished quality of life. While surgical interventions and joint injections are common, exercise remains central to non-operative management. However, increased pain during exercise can lead to non-compliance, often due to instability. Therefore, any exercise regimen should address this instability to improve compliance. The ARISE neuromuscular program is a proprioceptive-based exercise program designed to address instability while increasing strength. A 67-year-old male with knee OA, initially seeking an injection, was counseled to use the ARISE program. At the 3-month follow-up, his pain reduced from 7/10 to 2/10, and his sit-to-stand performance improved from 10 to 17 repetitions within 30 s. This case supports the use of non-operative, proprioceptive-based neuromuscular programs to improve function, reduce symptoms, and potentially reduce the need for surgical intervention in individuals with knee OA.
    Keywords:  knee; neuromuscular exercise; osteoarthritis; proprioception
    DOI:  https://doi.org/10.1093/jscr/rjaf1011
  10. Cureus. 2025 Dec;17(12): e99904
    Anatomical and Functional Changes After Surgical Treatment of Carpal Tunnel Syndrome: A Review.
    Evangelos E Tzanis, John Vlamis, Sophia A Syngouna, Evangelos Sakellariou, Angeliki Kyriakou, Loukia Fragkopoulou.
      Carpal tunnel syndrome (CTS) is a common condition resulting from the compression of the median nerve within the carpal tunnel (CT), leading to sensory and motor deficits in the hand. This review synthesizes current literature on the anatomical and functional changes following surgical intervention for CTS. Surgical treatment, primarily through carpal tunnel release (CTR), has been shown to alleviate symptoms for many patients; however, variability exists regarding the extent of anatomical recovery and functional improvement. Analyzing key studies, we observe that while most patients experience significant relief from pain and sensory symptoms, some may continue to report functional limitations. The prevailing conclusion is that while surgical intervention addresses compression, the extent of anatomical recovery, such as nerve conduction velocity and morphological changes in hand structure, remains underexplored. The evidence indicates that although surgical treatment generally yields positive outcomes, it often falls within the framework of statistical analysis that relies on reported outcomes without rigorous control measures. As such, further controlled studies are necessary to better elucidate the relationship between anatomical alterations and functional recovery post-surgery. The review emphasizes the need for a comprehensive approach in future research that not only focuses on statistical outcomes but also incorporates qualitative assessments of patient functionality and anatomical restoration. Ultimately, a deeper understanding of these domains will enhance the predictive models for recovery and guide clinical practices for individuals suffering from CTS. This analysis seeks to bridge existing gaps and inspire future studies aimed at optimizing therapeutic strategies for CTS.
    Keywords:  anatomical changes; carpal tunnel syndrome; conservative surgical; diagnosis; epidemiology; pathophysiology; postoperative recovery; risk factors; symptoms; treatment
    DOI:  https://doi.org/10.7759/cureus.99904
  11. PeerJ. 2025 ;13 e20455
    Effects and safety of vibration therapy in knee osteoarthritis rehabilitation: an umbrella review of systematic reviews.
    Yan Peng, Mohd Azzuan Ahmad, Yulong Xie, Zhenkun Xu, Siaw Chui Chai.
       Objective: Knee osteoarthritis (KOA) is a prevalent degenerative joint disease characterized by pain, stiffness, and limited mobility, substantially impairing quality of life. Vibration therapy has gained attention as a promising nonpharmacological intervention for KOA management. However, existing systematic reviews report inconsistent findings regarding its efficacy and safety. This umbrella review synthesizes evidence from published systematic reviews to provide a comprehensive evaluation of vibration therapy in KOA.
    Methods: A systematic search was conducted in four electronic databases: PubMed, Physiotherapy Evidence Database (PEDro), Web of Science, and Embase, with the search completed in January 2025. Eligible systematic reviews, with or without meta-analyses, examining the effects of vibration therapy in KOA were included. Two independent reviewers screened titles and abstracts, assessed full text eligibility, and extracted data on study characteristics, interventions, and clinical outcomes. The methodological quality of the included reviews was assessed using the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool, and reviews were categorized as high, moderate, or low quality. Study overlap was evaluated using the Corrected Covered Area (CCA) method to quantify redundancy. Findings were synthesized qualitatively, focusing on outcomes related to pain intensity, physical function, functional mobility and KOA-related disability.
    Results: Six systematic reviews published between 2015 and 2022 met the inclusion criteria, of which five included meta-analyses. In total, 22 unique primary trials were cumulatively analysed. The average AMSTAR-2 score was 65.7%, ranging from 56% (moderate) to 81% (high quality). The CCA analysis revealed a high degree of overlap (15%) across the reviews, indicating redundancy in primary studies but also reinforcing consistency in evidence. Commonly reported outcomes included the Visual Analogue Scale, muscle strength, Berg Balance Scale, Six Minute Walk Test, Timed Up and Go test, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The majority of reviews reported favourable effects of vibration therapy on WOMAC physical function and pain intensity, while fewer reviews supported improvements in functional performance and muscle strength.
    Conclusion: Vibration therapy appears to be a promising adjunct to conventional rehabilitation for KOA, particularly for improving physical function and knee pain. However, inconsistent evidence regarding its effects on functional performance and muscle strength underscores the need for further high-quality research. Future studies should determine optimal vibration parameters and explore underlying mechanisms to establish evidence based clinical guidelines.
    Review Registration: PROSPEROCRD42024620119.
    Keywords:  Clinical outcomes; Knee osteoarthritis; Pain; Physical function; Rehabilitation; Systematic review; Umbrella review; Vibration therapy
    DOI:  https://doi.org/10.7717/peerj.20455
  12. Cureus. 2025 Nov;17(11): e97150
    Segmental Zoster Paresis With Comorbid Carpal Tunnel Syndrome.
    Rachel M Bristow, Charis Won, Nissy Lee, Dwight Scott, Joseph E Brooks.
      This case report involves a 63-year-old male who presented with acute right deltoid weakness following a shingles outbreak in the C6 dermatome, with a chronic history of carpal tunnel syndrome. Notably, the patient had an overuse injury to his shoulder and received a cortisone injection prior to the shingles outbreak. Electrodiagnostic (EDX) testing initially revealed right C6 acute/subacute cervical radiculitis and right severe median neuropathy at the wrist with significant axonal loss. Repeat EDX studies five months following the onset of shoulder paresis showed improved motor recruitment and reinnervation of the C6 lesion, while the median neuropathy findings remain unchanged. This case highlights the diagnostic complexity of concurrent proximal and distal nerve pathologies, often referred to as double crush syndrome, as well as considerations for management and natural history of segmental zoster paresis.
    Keywords:  carpal tunnel syndrome; edx; electrodiagnostic studies; electromyography; emg; herpes zoster; segmental zoster paresis; varicella-zoster virus (vzv)
    DOI:  https://doi.org/10.7759/cureus.97150
  13. Cureus. 2025 Nov;17(11): e97379
    Simultaneous Carpal Tunnel Syndrome and Guyon's Canal Syndrome Caused by a Lipoma Arising From the Flexor Tenosynovium: A Case Report.
    Kazuhiro Ikeda, Hiromitsu Tsuge, Shotaro Teruya, Ryunosuke Watanabe, Shinzo Onishi.
      Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy. While most cases are idiopathic, secondary CTS due to space-occupying lesions such as tumors is relatively uncommon. We report a rare case of simultaneous compression of the median nerve and the dorsal cutaneous branch of the ulnar nerve by a small lipoma arising from the flexor tenosynovium. Magnetic resonance imaging clearly demonstrated the lesion within the carpal tunnel and near Guyon's canal. Surgical excision led to resolution of median nerve symptoms, whereas ulnar sensory disturbance persisted due to involvement of the unrecognized dorsal cutaneous branch of the ulnar nerve. The patient later developed cubital tunnel syndrome, and concurrent compression of the dorsal cutaneous branch of the ulnar nerve complicated neurological assessment. This case emphasizes the need for comprehensive assessment and early MRI evaluation in atypical or unilateral CTS.
    Keywords:  carpal tunnel syndrome; dorsal cutaneous branch of the ulnar nerve; guyon canal syndrome; lipoma; occult; tenosynovium; tumor
    DOI:  https://doi.org/10.7759/cureus.97379
  14. Front Nutr. 2025 ;12 1687103
    Respiratory and peripheral muscle ultrasound, including shear-wave elastography, for sarcopenia screening in COPD.
    Zeyang Dong, Jie Chen, Jin Ge, Mengyao Zhao, Yuke Zhao, Sihui Zheng, Jian Ye, Xixi Sun, Bin Huang.
       Background: Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of sarcopenia, which contributes to disease progression and poor clinical outcomes. Ultrasound offers a noninvasive and effective way to assess muscle structure and function. This study aimed to evaluate the diagnostic utility of two-dimensional ultrasound (2D-US) and shear wave elastography (SWE) for detecting sarcopenia in COPD patients.
    Methods: In this prospective, single-center study, 76 COPD patients were enrolled and classified into sarcopenia and non-sarcopenia groups based on diagnostic criteria. All participants underwent 2D-US to assess the thickness of the diaphragm (DTei), intercostal muscles (ICMTei), rectus abdominis (RAT), rectus femoris (RFT), and biceps brachii (BBT); as well as the cross-sectional area of the rectus femoris (RF-CSA), and biceps brachii (BB-CSA). Additionally, respiratory muscle function parameters, including diaphragm thickening fraction (DTF), diaphragm excursion (DE), and intercostal muscle thickening fraction (ICMTF), were also measured. Where feasible, SWE was performed on 42 patients to measure the shear wave velocity (SWV) of each muscle. Multivariable logistic regression identified independent predictors of sarcopenia, and diagnostic performance was evaluated using ROC curve analysis.
    Results: Between April and July 2025, 76 COPD patients were enrolled in the study assess ultrasound screening sarcopenia in COPD patients, and 30 healthy subjects were recruited in the reproducibility study. In the repeatability assessment, the ICC values for all parameters ranged from 0.851 to 0.994. In the sarcopenia screening study, significant differences were observed between groups for multiple parameters, including DTei, DE, RFT, RF-CSA, BB-CSA, D-SWV, ICM-SWV, RA-SWV, and BB-SWV (all p < 0.05). Logistic regression identified ICMTF (OR = 6.738), BBT (OR = 6.231), DTF (OR = 3.505), DE (OR = 0.312), RF-CSA (OR = 0.127), and BB-CSA (OR = 0.009) as independent predictors of sarcopenia (AUC = 0.956). After including SWE parameters, RA-SWV (OR = 19.171), BB-SWV (OR = 4.837), RF-CSA (OR = 0.263), DTei (OR = 0.197), and ICM-SWV (OR = 0.165) were identified as additional predictors, improving diagnostic accuracy (AUC = 0.961).
    Conclusion: Combining morphological and elasticity-based ultrasound parameters provides a reliable, non-invasive method for diagnosing sarcopenia in COPD patients. This approach may help guide early interventions and personalized management strategies.
    Keywords:  COPD; muscle ultrasound; nutritional assessment; respiratory muscle; sarcopenia
    DOI:  https://doi.org/10.3389/fnut.2025.1687103
  15. JB JS Open Access. 2025 Oct-Dec;10(4):pii: e25.00211. [Epub ahead of print]10(4):
    Carpal Tunnel Release Versus Local Corticosteroid Injection for Carpal Tunnel Syndrome: A Meta-Analysis of Randomized Controlled Trials.
    Remy Daou, Mohammad Daher, Rami El Abiad, Amer Sebaaly.
       Background: Carpal tunnel release (CTR) or local corticosteroid injection (LCI) is used for the management of carpal tunnel syndrome (CTS). While some practitioners start with CTR right away, others tend to begin with LCI. Both approaches are widely used, and individual randomized controlled trials (RCTs) have disagreed about the superiority of one approach over the other for CTS management. Therefore, a meta-analysis of RCTs would be helpful in informing clinicians.
    Methods: PubMed, Cochrane, and Google Scholar (pages 1-20) were searched up until August 8, 2025. Inclusion criteria consisted of English or non-English language RCTs comparing CTR with LCI in the management of CTS. The studied outcomes were management failure, improvement in symptoms, and improvement in function at several postoperative timepoints.
    Results: Twelve RCTs representing a total of 1799 patients, with 880 undergoing CTR and 919 undergoing LCI, were included. There was no difference in failure rates between the 2 groups at 1, 3, and 6 months; function improvement at 3 and 6 months; and symptoms improvement at 3 months. However, the LCI group had a higher rate of failure at 1 year (odds ratio [OR] = 18.41; p = 0.01) and latest follow-up (OR = 5.38; p = 0.003), and the CTR group had a better improvement in symptoms at 6 months (standardized means difference [SMD] = 0.39; p = 0.03) and 1 year (SMD = 0.30; p = 0.01).
    Conclusion: This meta-analysis revealed that CTR and LCI were equivalent management options for CTS for the first 6 months after treatment. However, CTR was superior at longer follow-up.
    Level of Evidence: Level I. See Instructions for Authors for a complete description of levels of evidence.
    DOI:  https://doi.org/10.2106/JBJS.OA.25.00211
  16. Orthop Traumatol Surg Res. 2025 Dec 20. pii: S1877-0568(25)00421-9. [Epub ahead of print] 104572
    Pronator quadratus sutured or not after ORIF by anterior plate: Ultrasound control of its interest in the protection of the Flexor Pollicis Longus.
    François Saade, Camille Bouteille, Raphael Escande, Matthieu Guyard, Philippe Schiele.
       BACKGROUND: Distal radius fractures are common upper limb injuries. Open reduction and internal fixation (ORIF) using a volar plate via the Henry approach often involves myotomy of the Pronator Quadratus (PQ) muscle, which may or may not be sutured postoperatively. The value of PQ repair remains debated, particularly regarding functional outcomes and protection of the Flexor Pollicis Longus (FPL) tendon.
    OBJECTIVE: To compare the ultrasonographic healing of the PQ muscle with and without repair after volar plating, and to assess its potential role in FPL tendon protection. The hypothesis of our study was that the absence of PQ muscle suturing did not alter the plate-FPL distance, functional outcomes, or complications compared to sutured PQ.
    METHODS: We conducted a retrospective single-center study (October 2024-April 2025) including 48 patients with displaced distal radius fractures (AO A2) treated by ORIF. Twenty-three underwent PQ repair, and 25 did not. Ultrasonographic evaluations and clinical assessments were performed at final follow-up. Primary outcomes included PQ morphology and FPL-plate distance on ultrasound. Secondary outcomes comprised range of motion, grip/pinch strength, QuickDASH score, patient satisfaction, return to activity, and complications.
    RESULTS: Ultrasonography showed significantly greater distances between the radius/FPL and plate/FPL in the non-repair group. PQ was morphologically thicker in the non-repair group, although not significantly. Functional outcomes favored the non-repair group in most metrics (VAS, ROM, QuickDASH), but without statistical significance. Two complications (carpal tunnel syndrome, tenosynovitis) occurred in the repair group only.
    CONCLUSION: Our results support the view that PQ repair after volar plating of distal radius fractures does not provide significant functional or protective advantages. The critical factor in preventing tendon complications remains correct plate placement relative to the watershed line. Future research should focus on prospective, multicenter, randomised studies with larger cohorts and longer follow-up to confirm these results.
    LEVEL OF EVIDENCE: III.
    Keywords:  Anterior plate fixation; Distal radius plate; Pronator quadratus repair; Volar locking plate; Volar plate fixation
    DOI:  https://doi.org/10.1016/j.otsr.2025.104572
  17. Bone. 2025 Dec 23. pii: S8756-3282(25)00381-3. [Epub ahead of print] 117769
    Repurposing osteoporosis medications for other diseases: a narrative review by the European Calcified Tissue Society (ECTS).
    Polyzois Makras, Maria P Yavropoulou, Athanasios D Anastasilakis, Natasha M Appelman-Dijkstra, John J Carey, Anda Mihaela Naciu, Julien Paccou, Tim Rolvien, Elizabeth M Winter, Socrates E Papapoulos, Willem F Lems.
       PURPOSE: This narrative review explores the therapeutic potential of repurposing medications originally developed or approved for osteoporosis to treat non-osteoporotic conditions. Given their pharmacologic profiles and safety data, these agents offer promising therapeutic alternatives in both rare and common diseases with unmet clinical needs.
    PRINCIPAL RESULTS: Evidence from preclinical models, observational data, and randomised trials supports the repositioning of several osteoporosis drugs. Cyclic etidronate has shown efficacy in halting arterial calcification progression in pseudoxanthoma elasticum. Pamidronate has demonstrated symptom improvement in adult chronic nonbacterial osteitis. Neridronate is approved only in Italy for complex regional pain syndrome type I. Denosumab has shown therapeutic effects in Langerhans cell histiocytosis and has structural benefits in erosive hand osteoarthritis and rheumatoid arthritis. Parathyroid hormone analogues (rhPTH [1-84] and teriparatide) improve calcium-phosphate homeostasis in chronic and genetic hypoparathyroidism. Calcilytics, though originally discontinued for osteoporosis, show emerging promise in autosomal dominant hypoparathyroidism. In contrast, zoledronic acid has not demonstrated consistent clinical benefit in knee osteoarthritis. Strontium ranelate, despite showing structure-modifying effects in osteoarthritis, is no longer marketed due to safety concerns. Alendronate and denosumab in fibrous dysplasia yielded mixed results, with concerns about rebound effects after denosumab withdrawal.
    CONCLUSIONS: Repurposing osteoporosis medications represents a cost-effective, timely strategy to expand treatment options across diverse clinical indications. While promising outcomes have been demonstrated-particularly in rare diseases-rigorous, indication-specific clinical trials are essential to confirm efficacy, safety, and long-term outcomes. The accumulated pharmacologic and clinical experience with these agents offers a strong foundation for their continued exploration beyond osteoporosis.
    Keywords:  Osteoporosis; Repositioning; Repurposing; Treatment
    DOI:  https://doi.org/10.1016/j.bone.2025.117769
  18. Future Sci OA. 2026 Dec;12(1): 2581460
    Intra-articular injection of high versus low molecular weight hyaluronic acid in adhesive capsulitis; randomized trial.
    Mahshad Mir, Rezvaneh Mohebbi, Ghader Mohammadnezhad, Seyed Ahmad Raeissadat, Alireza Parhizgar, Hadi Esmaily.
       BACKGROUND: Adhesive capsulitis (AC) is a chronic inflammatory condition with limited range of motion (ROM) in the glenohumeral joint. The main goals in managing AC are pain reduction and returning joint function. Intra-articular hyaluronic acid (HA) has been considered a safe modality in AC. This study compared the effectiveness of intra-articular injection of low molecular weight (LMW) with high molecular weight (HMW) HA in patients with AC.
    METHODS: Fifty-six patients with AC were randomized in this triple-blinded clinical trial. All underwent standard physical therapy. The outcomes were visual analog scale (VAS), Oxford shoulder score (OSS), active ROM, and patient satisfaction at 4, 12, and 24 weeks.
    RESULTS: No significant differences were detected in between-group variables at baseline. Both groups showed marked improvement in VAS, OSS, and ROM over time. At four weeks LMW-HA group had lower pain (P = 0.049). Conversely, the trend of VAS at 12-week and 24-week endpoints favors HMW-HA (Baseline to endpoint: -5.48 ± 1.68 and -3.91 ± 1.31 reduction in VAS as the primary outcome, P < 0.001). Satisfaction had significantly improved in both groups.
    CONCLUSION: HMW-HA was associated with greater pain reduction and functional improvement compared with LMW-HA.
    TRIAL REGISTRATION: The trial protocol was registered at the Iranian Registry of Clinical Trials (IRCT), a WHO Primary Register setup (registration No: IRCT20170608034390N4; First registration date: 01/01/2020).
    Keywords:  Adhesive capsulitis; frozen shoulder; hyaluronic acid; physical therapy; ultrasound-guided injection
    DOI:  https://doi.org/10.1080/20565623.2025.2581460
  19. Clin Rheumatol. 2025 Dec 24.
    Safety and clinical performance of intra-articular high-purity sodium hyaluronate injection in patients with knee osteoarthritis: a 28-week post-market clinical follow-up study.
    Cheng-Fong Chen, Ching-Ting Chen, Yung-Hsiang Lin, Chi-Fu Chiang, Yi-Wen Mao.
       OBJECTIVES: Intra-articular hyaluronic acid (HA) is a widely used treatment for knee osteoarthritis (OA), offering localized symptomatic relief with minimal systemic exposure. This post-market clinical follow-up (PMCF) study aimed to evaluate the safety and clinical performance of a high-purity sodium hyaluronate formulation in a real-world population with symptomatic knee OA.
    METHODS: In this prospective, single-arm, open-label post-market follow-up study, 65 patients with radiographically confirmed knee OA received three weekly intra-articular injections of a high-purity sodium hyaluronate formulation (1.5%, 15 mg/mL). Patients were followed through Week 28. The primary outcome was safety, assessed by adverse event (AE) monitoring and vital signs. Secondary assessments included radiographic Kellgren-Lawrence (KL) grading as part of structural safety monitoring, resting knee pain, and patient satisfaction, both assessed using 100-mm visual analog scales (VAS).
    RESULTS: No serious treatment-related adverse events (AEs) were reported. Mild, transient joint pain and swelling occurred in two participants (3.1%) and resolved without intervention. VAS pain scores improved significantly from baseline (41.5 ± 23.1 mm) to Week 6 (17.6 ± 19.6 mm, p < 0.001) and Week 28 (12.7 ± 17.3 mm, p < 0.001). Median KL grade remained stable (median 2, IQR 2-3) over the study period, with no acute or unexpected structural changes. At Week 28, 88.1% of participants reported being satisfied or very satisfied.
    CONCLUSIONS: Intra-articular injection of high-purity sodium hyaluronate was well tolerated and associated with significant pain reduction and high patient satisfaction, with no radiographic signs of acute or unexpected structural deterioration. These findings support the use of this high-purity HA formulation as a safe and effective option for symptomatic management of knee OA in real-world clinical practice.
    TRIAL REGISTRATION: This study was registered at ClinicalTrials.gov (Identifier: NCT05881317; registered May 31, 2023). Key Points • High-purity intra-articular sodium hyaluronate was well tolerated, with only mild, self-resolving adverse events. • Significant and sustained reduction in knee pain was observed through 28 weeks of follow-up. • Radiographic Kellgren-Lawrence grades remained stable at both short-term and mid-term safety evaluations. • Most patients reported high satisfaction, supporting the formulation as a safe and effective real-world option for symptomatic knee osteoarthritis.
    Keywords:  Hyaluronic acid; Intra-articular injection; Knee osteoarthritis; Pain management; Post-market clinical follow-up
    DOI:  https://doi.org/10.1007/s10067-025-07891-1
  20. J Hand Surg Glob Online. 2026 Jan;8(1): 100642
    Carpal Tunnel Release Postoperative Pain Management: A Systematic Review of Randomized Controlled Trials.
    Saksham Pruthi, Justin Rehder, Matthew Toedt, Raymond Okeke, Brian Mailey.
       Purpose: The management of postoperative pain after carpal tunnel release (CTR) has evolved over the years. This article reviews various approaches to pain management in the literature.
    Methods: An electronic search was conducted using PubMed, Google Scholar, and SCOPUS for studies on CTR pain management using either preoperative, perioperative, or postoperative tools. Only randomized controlled trials were included in the narrative review. Articles included in the study evaluated patients diagnosed with carpal tunnel syndrome, underwent CTR, and had preoperative, perioperative, or postoperative intervention evaluated as a primary end point. Duration and quantity of opioids, and patient-reported pain scales, such as the visual analog scale, were calculated and compared.
    Results: During the study period between 2015 and 2022, 10 randomized controlled trials met the inclusion criteria. Of these, studies were analyzed as either preoperative, perioperative, or postoperative means of managing pain. When these techniques were compared with opioid usage, no notable differences were found in pain ratings between patients who were given opioids for pain management compared with those provided with these nonopioid pain management options.
    Conclusions: This review highlights the effectiveness of various preoperative, perioperative, and postoperative interventions for pain management after CTR. Although opioids are the current standard for pain management after CTR, our study highlights interventions that are as effective, if not more so, as opioids at lowering pain scores with this procedure.
    Clinical relevance: The success of the studied alternatives in reducing pain outcomes for CTR can help mitigate the number of opioids prescribed to patients for the procedure. Given the current opioid epidemic plaguing the nation, understanding the efficacy of all other nonaddictive alternatives for pain management with CTR is imperative.
    Keywords:  Carpal tunnel; Opioids; Pain; RCT
    DOI:  https://doi.org/10.1016/j.jhsg.2024.08.016
  21. Surg Radiol Anat. 2025 Dec 22. 48(1): 28
    Ulnar nerve dimensions at entrapment sites in cadavers.
    Anasuya Ghosh, Grace Suganya.
       PURPOSE: The ulnar nerve might undergo compression due to traumatic or non-traumatic pathological conditions or altered anatomy within the extent of the distal arm to the proximal hand, leading to ulnar neuropathy. There are certain anatomical sites where the increased ulnar nerve cross-sectional area (CSA) values indicate probable compression and can be diagnosed by the high-resolution Ultrasonography (USG) or Magnetic Resonance Imaging (MRI) in symptomatic patients. The ulnar nerve CSA varies across the population, and there is limited data available for the Indian population. Hence, we aimed to evaluate the CSA measurement of the ulnar nerve in various predefined anatomical sites.
    METHODS: The CSA of the ulnar nerve was studied in 64 (34 Male, 30 Female) formalin-fixed cadaveric upper limbs in various predefined anatomical sites. The statistical analysis was done using Microsoft Excel and Stata 12 software.
    RESULTS: The average CSA of the ulnar nerve was 4.77 ± 2.21 mm2 at the level of the medial epicondyle and 2.21 ± 0.86 mm2 at the level of the wrist. The CSA values were higher in males than in females. This study has also reported the distances of the branch points of the ulnar nerve supplying the flexor carpi ulnaris and flexor digitorum profundus muscles, the dorsal cutaneous and palmar cutaneous branches from the nearest bony landmarks.
    CONCLUSION: Thus, this study provides a baseline value of ulnar nerve CSA for the East Indian population, which might help clinicians to diagnose ulnar neuropathy.
    Keywords:  Cadaver; Cross-sectional area; Morphology; Ulnar nerve
    DOI:  https://doi.org/10.1007/s00276-025-03798-3
  22. Knee. 2025 Dec 19. pii: S0968-0160(25)00329-1. [Epub ahead of print]59 104307
    Mechanism of muscle activation in the protection of knee joint injury during jogging.
    Jiangtao Ruan, Kai Cui, Yangyang Meng, Xia Xiao.
       BACKGROUND: It is important to understand the role of muscle activation in knee joint protection against the injuries, such as meniscus tear, cartilage wear, and ligament damage, often caused by muscle weakness, improper running posture, or overtraining. Research on the finite element knee model with muscles has not been reported yet, nor have there been any biomechanical explorations on the internal tissues of knee joint with muscle activation.
    OBJECTIVE: To explore the mechanism of muscle activation in jogging for the protection against knee joint injuries based on the stress fields of the knee internal tissues.
    METHODS: A finite element knee joint model with muscles (Vastus lateralis, vastus medialis, and vastus intermedius) was established. The stress fields of knee internal tissues during jogging were numerically simulated and investigated to explore the mechanism of muscle activation in knee protection against injury.
    RESULTS: Activation of muscle forces reduces peak stress on joint tissues, diminishes stress concentration, and enhances the load-bearing capacity of the knee joint. The proportion of contact area in the lateral tissues is increased, which means activating the muscle forces adjusts the load-bearing mode of the knee joint by involving the lateral tissues to participate in sharing the loads with the medial tissues, thus improve the stability of the knee joint.
    CONCLUSION: Activation of muscle forces in jogging improves the load-bearing capacity and stability of the knee joint by reducing peak stress on joint tissues, decreasing the proportion of concentrated area, increasing the contact area in lateral tissues, and involving lateral tissues in sharing loads with medial tissues.
    Keywords:  Jogging; Knee joint model with muscles; Muscle activation; Stress fields
    DOI:  https://doi.org/10.1016/j.knee.2025.104307
  23. J Hip Preserv Surg. 2025 Dec;12(4): 230-236
    Effectiveness of platelet-rich plasma in pain management of osteoarthritis with developmental dysplasia of the hip: a double-blind, randomized controlled trial.
    Yusuke Okanoue, Masahiko Ikeuchi, Junpei Dan, Yuki Teranishi.
      This study evaluates the efficacy of administering platelet-rich plasma (PRP) compared to hyaluronic acid (HA) for pain management hip osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH). It highlights PRP treatment as a slightly more effective or equivalent treatment for reducing hip pain in such cases. From 2019 to 2021, a double-blind, randomized controlled trial was conducted with 42 patients who consented to participate. They were divided into two groups: one receiving intra-articular PRP injections and the other HA injections. The primary focus of the study was pain relief, measured using the pain-Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-pain scores over a 24-week period. Functionality was assessed as a secondary outcome. The results showed significant pain reduction in both PRP and HA groups compared to their baseline pain levels. Notably, the PRP treatment group exhibited a marginally higher improvement in pain-VAS scores (38.5) than the HA group (18.7; P = .041). However, the difference in WOMAC-pain scores between the groups was not statistically significant (4.3 for PRP vs. 2.9 for HA; P = .245). The Kellgren-Lawrence grade was the only factor significantly associated with the improvement in pain-VAS scores within the PRP group. The study finds that PRP treatment is at least as effective as HA treatment in reducing hip pain for OA secondary to DDH. Treatment with PRP showed notably better pain-VAS scores compared to HA, highlighting its potential. Therefore, intra-articular PRP injections are a viable alternative to HA for effectively reducing pain in OA secondary to DDH.
    DOI:  https://doi.org/10.1093/jhps/hnaf008
  24. J Funct Morphol Kinesiol. 2025 Dec 09. pii: 475. [Epub ahead of print]10(4):
    Effects of a Scapular-Focused Exercise Protocol for Patients with Rotator Cuff-Related Pain Syndrome-A Randomized Clinical Trial.
    Cristina Dos Santos, Isabel Bastos de Almeida, Mark A Jones, Ricardo Matias.
      Background: Current clinical practice still lacks consistent evidence in the physiotherapy management of rotator cuff-related pain syndrome (RCS). The purpose of this trial was to compare the effectiveness of a scapular-focused treatment with and without real-time electromyographic biofeedback (EMGBF) to a control therapy in patients with RCS, in the short-term. Methods: 60 patients with RCS were divided into three groups: the scapular-focused exercise protocol group (P_G n = 20), the scapular-focused exercise protocol with EMGBF group (P+EMGBF_G n = 20), and the control therapy group (CT_G n = 20). Values of pain and function [Shoulder Pain and Disability Index (SPADI) questionnaire, complemented by the Numeric Pain Rating Scale (NPRS) and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire], scapular stabilizer neuromuscular control (SSNC), scapular stabilizer activation onset (SSAO), dynamic scapular alignment, range of motion (ROM), and glenohumeral flexor and abductor muscle strength (GMS) were assessed at baseline and after 6 weeks and compared within and between groups. Results: There were significant differences in pain and function, SSNC, SSAO, dynamic scapular alignment, ROM, and GMS in all groups between the initial and 6-week assessments. However, the P+EMGBF_G showed superior results in pain and function, SSNC, and dynamic scapular alignment than the CT_G and superior results in SSNC than the P_G. The P_G had superior results in pain and function and dynamic scapular alignment than the CT_G. Conclusions: This trial supports the use of a scapular-focused exercise protocol as a comparative approach that effectively improves pain and function in patients with rotator cuff-related shoulder pain syndrome. These results in pain and function were shown to be independent of the use of EMGBF.
    Keywords:  activities of daily living; electromyography; feedback; rotator cuff injuries; scapula; shoulder pain
    DOI:  https://doi.org/10.3390/jfmk10040475
  25. Knee Surg Sports Traumatol Arthrosc. 2025 Dec 26.
    Achilles tendon ruptures in National Basketball Association players: A sequential video analysis of injury mechanisms and biomechanical patterns.
    Ogün Köyağasıoğlu, Yavuz Lima.
       PURPOSE: Achilles tendon ruptures (ATR) are severe injuries in professional basketball, yet in-game mechanisms and biomechanical patterns remain insufficiently described. The purpose of the study is to characterise biomechanical patterns and basketball-specific contexts of ATR using sequential video analysis.
    METHODS: A systematic search identified 27 confirmed ATR cases between 1970 and 2025 in the NBA league. Contextual factors (court location, playing situation, movement and speed) were analysed for all cases. Frame-by-frame biomechanical assessment was conducted for 17 injuries (63%) with adequate video quality, documenting trunk, hip, knee and ankle angles of the injured limb at initial contact (IC) and the injury frame (IF).
    RESULTS: All ruptures occurred during closed-chain movements, mostly with noncontact mechanisms (81.5%), during offensive play actions (85.2%), at low horizontal speeds (63%) and moderate vertical speeds (44.4%). The most frequent action was the take-off/acceleration phase of running (74%), followed by the beginning jump (14.8%) and landing (7.4%). At the IC, players were in forefoot contact, the sagittal plane orientation of the trunk was 18.2° flexed, while the hip was 12.3° extended, the knee was 42.2° flexed and the ankle was 5.6° plantar flexed on the injured side. At IF, players displayed a more flexed torso (27.5°, 9.3° change from IC; p < 0.001), a more extended hip (26.8°, 14.5° change from IC; p = 0.001), a less flexed knee (26.7°, 15.5° change from IC; p = 0.004) and a more dorsiflexed ankle (41.6°, 47.2° change from IC; p < 0.001).
    CONCLUSIONS: Our study described basketball-specific movement patterns among NBA players who sustained ATRs. Supported the observations of forefoot loading and rapid dorsiflexion of the ankle joint, and introduced new concepts, extension movement of lower limb elements proximal to the ankle joint and proximal elongation of the musculotendinous complex. These findings enhance understanding of basketball-specific ATR mechanisms and may inform targeted prevention strategies such as combining eccentric calf training with functional exercises focusing on lumbopelvic and knee stability, while targeting explosive forefoot contact acceleration manoeuvres.
    LEVEL OF EVIDENCE: Level IV, retrospective case series.
    Keywords:  achilles tendon; basketball; injury mechanism; kinematics; movement patterns
    DOI:  https://doi.org/10.1002/ksa.70249
  26. Orthop J Sports Med. 2025 Dec;13(12): 23259671251389140
    Circumferential Repair Versus Labral Base Refixation for the Treatment of Symptomatic Femoroacetabular Impingement Syndrome: A Systematic Review and Narrative Synthesis.
    Matey Juric, Koorosh Kashanian, Darius L Lameire, Hassaan Abdel Khalik, Audrey Champagne, Tim Dwyer, Daniel B Whelan, Jaskarndip Chahal.
       Background: Hip arthroscopy is a common surgical treatment method for femoroacetabular impingement syndrome (FAIS) and typically involves labral repair. Suture limbs can either be placed around (circumferential repair technique) or through (labral base refixation [LBR] technique) the labrum; however, there remains a lack of consensus regarding the superiority of either technique.
    Purpose: To evaluate and narratively synthesize the available evidence on patient-reported outcome measure (PROM) scores of LBR and circumferential repair in patients undergoing hip arthroscopy and labral repair for FAIS.
    Study Design: Systematic review; Level of evidence, 4.
    Methods: A systematic electronic search of MEDLINE, Embase, and the Cochrane Library was carried out on July 21, 2024. All English-language randomized controlled trials, comparative studies, and case series on adults with symptomatic FAIS were eligible for inclusion.
    Results: A total of 12 studies with 1488 patients were included in the analysis. Overall, 9 cohorts with 1035 patients and a mean age of 33.1 years were included in the circumferential repair group, and 6 cohorts with 453 patients and a mean age of 32.3 years were included in the LBR group.Both the circumferential repair and LBR techniques were associated with significant improvements on PROMs, including the mHHS (modified Harris Hip Score), HOS-ADL (Hip Outcome Score-Activities of Daily Living), HOS-SSS (Hip Outcome Score-Sports-Specific Subscale), NAHS (Non-Arthritic Hip Score), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), and VAS (visual analog scale). Postoperative scores were commonly >80 points across measures, with mean improvements of 20 to 30 points in function and 2 to 4 points in pain. Reported rates of revision surgery and conversion to total hip arthroplasty were low across both techniques, generally <10%, although some variability existed between studies.
    Conclusion: Both techniques led to improved PROM scores after hip arthroscopy for the management of FAIS. Given the heterogeneity and predominance of lower level evidence, future high-quality comparative studies are warranted.
    Keywords:  hip arthroscopy; labral repair; suture techniques; systematic review
    DOI:  https://doi.org/10.1177/23259671251389140
  27. Int J Chron Obstruct Pulmon Dis. 2025 ;20 4061-4078
    Effects on Exercise Tolerance and Functional Outcomes of Eccentric versus Concentric Aerobic Exercise in People with COPD: A Systematic Review and Meta-Analysis.
    Garbiñe Magunagoikoetxea-Comins, María Encarnación Jiménez-García, Monica Pérez-Ferreiro, Teresa E Fernandez-Pardo.
       Introduction and Objectives: Chronic obstructive pulmonary disease (COPD) is associated with peripheral muscle weakness, dyspnoea and decreased exercise tolerance. Eccentric aerobic exercise (ECC), characterised by contractions during muscle stretching, is becoming an alternative to concentric aerobic exercise (CON) in this population, due to its reduced cardiorespiratory demand. The main objective of this systematic review, following the PRISMA criteria, is to determine the benefits of ECC versus CON on exercise tolerance in people with COPD.
    Methods: A literature search was conducted in PubMed, Cochrane, Google Scholar and PEDro databases until March 2025. Only randomised controlled trials published in the last 10 years and with exercise tolerance and functional outcomes analysed were included.
    Results: Six randomised controlled trials were included (n=154), with good methodological quality (PEDro 6-7) and moderate certainty of evidence. The ECC showed benefits compared to CON in improvement of quadriceps strength (-0.15 [-0.51, 0.22] p=0.43); reduction of dyspnoea (-0.74 [-1.15, -0.34] p <0.001) and lower limb fatigue (-2.29, p < 0.001), a higher work rate (-0.48 [-1.07, 0.12] p =0.12), improvements in Timed Up and Go (TUG) (-2.03 [-2.90, -0.16] p< 0.001) and decrease heart rate (-14.37 [-18.24, -10.50] p < 0.01), suggesting increased cardiorespiratory efficiency. In contrast, the CON showed an improvement in endurance time (1.05 [0.45, 1.64] p<0.01) and oxygen saturation (1.79 [0.62, -2.97] p < 0.01) (IC 95%).
    Conclusion: ECC is presented as an effective and safe strategy to improve exercise tolerance in people with COPD in terms of saturation, dyspnoea, fatigue and heart rate, while CON improves endurance time. However, further studies are required to confirm its long-term functional benefits and its applicability in other pathologies and also treatment protocols are needed to standardize the use of eccentric exercise.
    Keywords:  COPD; aerobic exercise; downhill; eccentric
    DOI:  https://doi.org/10.2147/COPD.S558167
  28. Clin Anat. 2025 Dec 26.
    Anatomical Study of the Biceps Sheath for Safe and Accurate Unguided Anterior Shoulder Injections.
    Shimizu Keigo, Yoko Tabira, Tatsuya Harano, Mitsuru Tanaka, Seiichi Inoue, Hisashi Nakamura, Kenta Murotani, Koichi Watanabe.
      The tendon of the long head of the biceps brachii (LHBT) contributes to shoulder joint stability, but can become a source of shoulder pain because of trauma or degeneration. Injection of local anesthetics into the biceps sheath (BS) is an effective treatment for managing anterior shoulder pain and is widely performed clinically; however, the accuracy of unguided injections remains low. This study aimed to clarify the anatomical characteristics of the BS and identify the optimal injection site to improve the accuracy and safety of unguided anterior shoulder injections. Eight 5% formalin-fixed cadavers (16 shoulders) and 1 Thiel-embalmed cadaver were examined at Kurume University School of Medicine. Morphological measurements and histological evaluations were performed on cadaveric shoulders. In addition, ultrasound examinations were performed on 28 shoulders from 14 healthy adults. Vascular distribution around the BS was evaluated using latex injection in the Thiel-embalmed cadaver. The mean BS length in cadavers was 36.2 ± 8.4 mm, and the mean width was 9.4 ± 1.2 mm; these were not significantly different than those in live subjects. Macroscopic observations confirmed continuity between the BS and the shoulder joint capsule. The anterior circumflex humeral artery ran along the lateral aspect of the LHBT, while the transverse humeral ligament was located approximately 23 mm proximal to the BS. The BS is continuous with the joint capsule, and injections into the BS allow intra-articular delivery of medication. The optimal injection site is approximately 1.5 transverse fingerbreadths distal to the superomedial edge of the greater tubercle and medial to the LHBT. This location minimizes the risk of injuring the anterior circumflex humeral artery and the extended tendon of the subscapularis muscle while improving the accuracy of needle placement.
    Keywords:  biceps sheath; cadaver; joint capsule; ultrasound; unguided injections
    DOI:  https://doi.org/10.1002/ca.70069
  29. Alzheimers Dement. 2025 Dec;21 Suppl 6 e099148
    Public Health.
    Shirley Dumassais, Walter Wittich.
       BACKGROUND: Individuals living with deafblindness can face complex cognitive and psychological challenges that can significantly affect their daily functioning, independence, and overall quality of life. Despite these challenges, there is a notable lack of standardized cognitive assessments that are both accessible and suitable for this population, limiting the ability to accurately assess their cognitive and psychological health. Developing such measures requires a foundational understanding of which aspects of cognitive and psychological functioning are most affected by deafblindness. To address this gap, this study aimed to identify and categorize core mental functions relevant to individuals with deafblindness using the International Classification of Functioning, Disability, and Health (ICF) framework.
    METHOD: A multi-method approach was used, integrating a systematic literature review, an expert survey, and a qualitative study. The systematic review included 147 studies, from which 314 outcome measures were identified. The international expert survey involved 105 professionals who answered an online survey. The international qualitative study consisted of online interviews and focus groups with 72 individuals with deafblindness and/or their caregivers who shared their lived experiences. Identified meaningful concepts from the collected data were linked to ICF categories.
    RESULT: Commonly identified functions across all three research methods included (b114) orientation, (b117) intellectual functions, (b126) temperament and personality, (b130) energy and drive, (b134) sleep, (b147) psychomotor functions, (b152) emotional functions, (b156) perceptual functions, (b164) higher-level cognitive functions, (b167) mental functions of language, and (b180) experience of self and time. The systematic literature review and the qualitative study additionally highlighted (b140) attention, (b144) memory and (b160) thought functions.
    CONCLUSION: Integrating lived experience, literature, and expert survey data identified consistent mental function categories relevant to deafblindness, supporting the ICF framework's applicability for standardizing functional assessments in research and clinical settings while building the basis for the development of standardized cognitive assessment priorities for international use. The literature review provided insight into existing including individuals with deafblindness. The expert survey captured professional insights on observed client experiences and areas for improvement in practice. The qualitative study offered a detailed exploration of how cognitive and psychological health is affected by deafblindness from the lived experience perspective.
    DOI:  https://doi.org/10.1002/alz70860_099148
  30. Clin Rheumatol. 2025 Dec 22.
    Efficacy and safety of interventions for Fibromyalgia syndrome comorbid with Irritable bowel syndrome: systematic review.
    Mai A Elkalla, Yousef G Ali, Mohamed M Ewais, Ahmed S Taha, Mohab Sherif.
       BACKGROUND: Fibromyalgia syndrome (FMS) and irritable bowel syndrome (IBS) frequently coexist, compounding disease burden and complicating treatment approaches. Despite the prevalence of this comorbidity, evidence on effective management strategies remains scarce.
    OBJECTIVE: This systematic review evaluates the efficacy and safety of oral pharmacological and dietary interventions for patients diagnosed with both FMS and IBS, following PRISMA guidelines.
    METHODS: A systematic literature search was performed on September 12, 2024, utilizing the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), Web of Science, EMBASE, and Ovid to identifying randomized control trials evaluating interventions for FMS comorbid with IBS. The outcome encompassed pain reduction, global well-being, depressive symptoms, health-related quality of life, and safety profiles.
    RESULTS: The initial search yielded 784 studies, with 364 retrieved after applying inclusion criteria. Following duplicate removal and further screening, five randomized control trials met eligibility criteria. Of these, three were included in the meta-analysis. These trials investigated the effects of pharmacological agents, dietary modifications, and probiotics on pain and quality-of-life measures in patients with FMS-IBS comorbidity. Meta-analysis showed a statistically significant reduction in pain Visual Analog Scale (VAS) scores in groups receiving cyclobenzaprine and pregabalin, while probiotics demonstrated no significant benefit over placebo. Dietary interventions showed mixed results, providing symptom relief in selected patients. Adverse effects were highest in the cyclobenzaprine 30 mg group but were generally well tolerated in other interventions.
    CONCLUSION: Pharmacological treatments appear effective in reducing pain associated with FMS and IBS. Dietary interventions, such as monosodium glutamate (MSG) elimination, may benefit specific subgroups, while probiotics showed limited efficacy.
    Keywords:  Cyclobenzaprine; Fibromyalgia syndrome (FMS); Irritable bowel syndrome (IBS); Pain reduction; Pregabalin; Systematic review
    DOI:  https://doi.org/10.1007/s10067-025-07861-7
  31. J ISAKOS. 2025 Dec 18. pii: S2059-7754(25)00673-X. [Epub ahead of print] 101055
    Atypical Calcific Tendinitis Involving Teres Minor Which Affects Overhead Movement: A Case Report.
    Sawarin Voravitvet, Puttinan Pingpitayakul, Pinprapha Boonhyad, Phob Ganokroj.
      Calcific tendinitis is a common cause of shoulder pain, with the supraspinatus tendon most frequently affected. In contrast, involvement of the teres minor tendon is exceptionally rare. We report an unusual case of a 55-year-old woman experiencing persistent left shoulder pain for six months, exacerbated by overhead activities. Clinical examination revealed point tenderness over the posterolateral shoulder and restricted abduction and external rotation. Imaging identified a 1.8 cm calcification within the teres minor tendon. Given the unresponsiveness to non-operative treatments, arthroscopic removal of calcifications and teres minor tendon repair was performed, resulting in pain-free motion and a return to overhead activities. Postoperative MRI confirmed tendon integrity and absence of calcification recurrence. This case highlights the importance of considering atypical presentations of calcific tendinitis, particularly in the context of isolated posterior shoulder pain. Recognition of this rare tendon involvement is essential to avoid misdiagnosis and to guide appropriate surgical planning when conservative measures fail. Furthermore, this report demonstrates that arthroscopic intervention, including targeted debridement and teres minor tendon repair, can yield excellent clinical outcomes even with unusual presentation. Raising awareness of such rare cases may support earlier diagnosis and tailored treatment, ultimately improving patient outcomes. LEVEL OF EVIDENCE: Level V, Case report.
    Keywords:  Arthroscopic rotator cuff repair; Calcific tendinitis; Impingement; Overhead activity; Shoulder; Teres Minor
    DOI:  https://doi.org/10.1016/j.jisako.2025.101055
  32. Phys Ther Sport. 2025 Dec 19. pii: S1466-853X(25)00204-4. [Epub ahead of print]77 95-103
    Clinical assessments are valid to grade ligament injury severity compared to ultrasound imaging in patients with acute lateral ankle sprains: a cross-sectional study.
    Jente Wagemans, Chris Bleakley, Heiner Baur, Ron Clijsen, Ahmed Amine El Oumri, Jan Taeymans, Kevin Kuppens, Dirk Vissers.
       OBJECTIVES: To determine accuracy of clinical examination in grading ankle ligament sprain severity, using ultrasound (US) imaging as the reference standard.
    DESIGN: Cross-sectional study.
    SETTING: Rehabilitation centre.
    PARTICIPANTS: Sixty-eight athletes with an acute lateral ankle sprain (LAS) (<15 days).
    MAIN OUTCOME MEASURES: We performed clinical examinations to grade injury severity: anterior drawer test (ADT), talar tilt test (TTT), palpation and bruising, and patient's perception. Ultrasound imaging (US) was subsequently undertaken as reference standard. We also evaluated combinations of stress tests with palpation and bruising using a believe the negative (BTN) or positive (BTP) approach. We used Cohen's Kappa and Weighted Kappa to analyse agreement between clinical and US grading.
    RESULTS: ADT and TTT demonstrated moderate agreement with US for grading ATFL (ĸ = 0.547) and CFL injuries (ĸ = 0.507), and Palpation & bruising to grade CFL injury (ĸ = 0.529). Clustering TTT with palpation & bruising increased agreement with BTN approach (ĸ = 0.609). Patients' perception showed slight agreement (ĸ = 0.037) with US.
    CONCLUSION: Manual stress tests demonstrate moderate utility for grading grade ATFL and CFL injury severity; combining these tests with palpation (BTN approach) yields higher agreement. US can support more precise grading and should be implemented to enhance ligament injury severity grading after LAS.
    Keywords:  Clinical tests; Diagnostics; Lateral ankle sprain; Rehabilitation; Severity grading; Ultrasound imaging
    DOI:  https://doi.org/10.1016/j.ptsp.2025.12.004
  33. PM R. 2025 Dec 22.
    Finger growth plate injuries in adolescent sport climbers: A scoping review.
    Ashwin Jaini, Jessica Lu, Asher Smuek, Raymond Chou.
      This scoping review aims to better characterize finger growth plate injuries in adolescent sport climbers and to create a diagnostic and management algorithm for adolescent climbers after a finger growth plate injury. PubMed, EMBASE, and ScienceDirect databases were queried to identify articles from database inception to July 2024 for inclusion. The following search terms were used: (epiphys* OR physis OR physeal OR metaphys* OR "growth plate*") AND (climb*). Studies that examined adolescent sport climbers with a diagnosis of finger growth plate injury were included. Demographic and clinical information, injury characteristics, imaging and treatment modalities, and outcome data were extracted and pooled from all included studies. Eleven studies were included. In total, 149 physeal stress injuries occurred in 98 adolescent climbers with a mean age of 14 years and range of 10 to 18 years. A total of 146 injuries (98%) occurred at the proximal interphalangeal joint. Of these injuries, 74% were fractures, of which 97% occurred at the epiphysis. Baseline radiograph was the most used imaging modality for initial diagnosis of fracture. Treatment ranged from complete rest (21%) to surgical intervention (8%). Overall, return to sport time ranged from 2 weeks to 6 months, and 91% were able to return to climbing. Epiphyseal fractures are the most common growth plate injury reported in adolescent climbers. Identification of these injuries with clinical history and timely diagnostic imaging is critical to return to sport.
    DOI:  https://doi.org/10.1002/pmrj.70068
  34. Knee Surg Sports Traumatol Arthrosc. 2025 Dec 26.
    Navicular fractures in elite athletes-2025 international foot and ankle sports consensus and systematic review.
    IFASC Committee Members
       PURPOSE: Navicular injuries are a significant concern in athletics, often leading to prolonged recovery periods and risks of further complications. Navicular stress fractures, in particular, have gained recognition as common injuries among athletes, especially in high-impact sports. The management of navicular injuries remains controversial, lacking standardised treatment protocols. The purpose of the present systematic review and consensus process was to provide up-to-date recommendations on workup and diagnosis, operative and nonoperative treatments, and the return-to-sport (RTS) for elite athletes with navicular fractures.
    METHODS: A consensus process was conducted using a modified Delphi technique with two rounds of questionnaires. 'General consensus' was defined as 75%-85% agreement, 'strong consensus' as 86%-99% agreement, and 'unanimous consensus' as 100% agreement. In addition, a systematic review was conducted evaluating the workup, treatment and postoperative management of Navicular injuries in athletes.
    RESULTS: Thirty-four consensus statements were established regarding the diagnosis, management and RTS following navicular fractures in elite athletes; 10 achieved unanimous consensus, 21 reached strong consensus and 2 did not reach consensus. Across 319 athletes identified in the systematic review, those treated surgically returned to sport at a mean of 8.2 weeks postoperatively, with 98.7% resuming competition. The panel reached a strong consensus that athletes should remain nonweightbearing for 4-6 weeks following surgery and may expect to return to full sport within 4-6 months, supported by corresponding timelines in the literature.
    CONCLUSION: Athletes sustaining navicular fractures can typically expect a functional recovery, with most returning to play within 4-6 months after surgery. The consensus recommendations provide the first standardised, evidence-based framework for postoperative progression, including a 4-6 week nonweightbearing phase and structured rehabilitation milestones. These findings guide clinicians in optimising recovery and RTS outcomes in elite athletes.
    LEVEL OF EVIDENCE: Level V.
    Keywords:  athlete; fracture; midfoot; navicular
    DOI:  https://doi.org/10.1002/ksa.70243
  35. Acta Neurol Belg. 2025 Dec 22.
    Overall rehabilitation prognosis for the level of functioning following moderate to severe acquired brain injury: a study using routinely collected health record data.
    Uwe M Pommerich, Peter W Stubbs, Jørgen Feldbæk Nielsen.
       BACKGROUND: Acquired brain injury (ABI) includes conditions such as cerebral stroke or traumatic brain injury and is a major cause of disability. People with ABI are one of the largest groups requiring rehabilitation. Rehabilitation prognosis is an important component for goal setting and life planning. The population average prognosis (overall prognosis) and its variation describes the contextual course of health outcomes. Here, we provide the overall rehabilitation prognosis of Danish patients with moderate to severe ABI who underwent comprehensive post-acute inpatient rehabilitation.
    METHODS: Routinely collected electronic health record data were extracted for adults with ABI, who were admitted to a Danish highly specialised rehabilitation facility between March 2011 and December 2022. Data were deterministically linked on an individual level where necessary. The Functional Independence Measure and Early Functional Ability scale were the rehabilitation outcomes estimated across demographic and clinical candidate predictors. In addition, the probability of a missing rehabilitation outcome assessment was investigated with logistic regression models.
    RESULTS: We included 6571 rehabilitation patients. Most patients were admitted due to ischaemic (48%) and haemorrhagic stroke (16%), or traumatic brain injury (12%); approx. 40% required total assistance on admission. Patients were discharged with a median (IQR) total, motor and cognitive FIM score of 106 (67-117), 80 (47-89), and 26 (19-30), respectively. Patients improved a median (IQR) of 20 (6-40) points on the FIM, or 0.4 (0.1-0.7) points per day of rehabilitation. Persistent limitations at discharge were observed for memory and problem solving. Functional improvements were similar across ABI types. The highest likelihood of a missing rehabilitation outcome assessments was observed in patients with moderate rehabilitation needs, short rehabilitation stays and long onset-admission intervals.
    CONCLUSIONS: The present study provides estimates for the overall rehabilitation prognosis for patients with moderate to high rehabilitation needs, undergoing post-acute ABI rehabilitation in a highly specialised inpatient rehabilitation facility. In our large and diverse cohort, we provide estimates for overall rehabilitation outcomes, including probabilities for missing rehabilitation outcome assessments. The provided estimates may inform future prognosis research studies in similar populations or enable comparisons with other healthcare settings.
    Keywords:  Activities of daily living; Cerebrovascular disease; Electronic health record; Functioning; Hypoxia; Prognosis research; Rehabilitation hospital; Subacute
    DOI:  https://doi.org/10.1007/s13760-025-02973-y
  36. Toxins (Basel). 2025 Dec 14. pii: 595. [Epub ahead of print]17(12):
    Ultrasound Evaluation of Upper Facial Muscles to Guide Botulinum Toxin Application.
    Dominika Jaguś, Anna Pawłowska, Robert Krzysztof Mlosek.
       BACKGROUND: Botulinum toxin injection is one of the most common esthetic procedures, yet complications may occur due to anatomical variability or suboptimal injection technique. This study aimed to evaluate the upper facial muscles using ultrasound, focusing on inter- and intraindividual variability.
    METHODS: The study involved volunteers aged 21-40 years, excluding those with prior facial treatments, trauma, or muscle disorders. The muscles examined included the occipitofrontalis (frontal belly), procerus, corrugator supercilii, and orbicularis oculi. Muscle thickness and distance from the epidermis were measured using high-frequency ultrasound. Statistical analyses included descriptive statistics, correlation with age and BMI, sex comparisons, and symmetry assessment.
    RESULTS: A total of 127 participants (103 women and 24 men) were enrolled, with a mean age of 28.8 ± 4.4 years. Age showed no significant correlation with muscle thickness or depth, supporting the internal consistency of the studied age group. BMI showed moderate correlations with the depth of the selected forehead muscles. Males showed greater thickness in the frontal and procerus muscles. Relative side-to-side asymmetry coefficients reached 40% for both thickness and depth, indicating notable individual laterality.
    CONCLUSIONS: The study provides normative ultrasound parameters for the upper facial muscle in healthy adults. The results demonstrate significant anatomical variability depending on sex, BMI, and facial laterality, supporting individualized ultrasound-guided approaches for botulinum toxin injection.
    Keywords:  botulinum toxin; intra- and interindividual variability; ultrasound imaging; upper facial muscles
    DOI:  https://doi.org/10.3390/toxins17120595
  37. Muscles. 2025 Dec 16. pii: 63. [Epub ahead of print]4(4):
    Effectiveness of Hyperbaric Oxygen Therapy for Musculoskeletal Pain Syndromes: A Systematic Review.
    Sebastián Eustaquio Martín Pérez, Eduardo Iboleón Laynez, José Antonio Acevedo Rodríguez, María Isabel Maggioni Torres, Roberto Pérez Betancort, Antón Díaz Rodríguez, Diego Cabezos Alonso, Carlos García Camacho, Isidro Miguel Martín Pérez.
       BACKGROUND: Musculoskeletal pain syndromes (MPSs) represent a major cause of disability and reduced quality of life, and conventional therapeutic approaches often provide only partial or temporary relief. Hyperbaric oxygen therapy (HBOT) delivered as 100% oxygen at 1.3-2.5 ATA, has been proposed to modulate inflammatory processes and enhance tissue repair. This review evaluated the effectiveness of HBOT on pain, function, quality of life, and physiological outcomes in individuals with MPS.
    METHODS: This systematic review was conducted in different databases between June 30 and 30 September 2025, following PRISMA guidelines and was previously registered in PROSPERO (CRD420251073730). Studies published in English, Spanish, or Portuguese evaluating HBOT as a standalone or adjunctive intervention were included. Methodological quality and risk of bias were assessed using PEDro, NIH, and RoB 2.0 tools, and certainty of evidence was graded with GRADE.
    RESULTS: Eighteen studies (17 RCTs and 1 case series; n = 671) were included. HBOT protocols ranged from 3 to 60 sessions, lasting 60-90 min, at approximately 1.3-2.5 ATA. Consistent reductions in pain and modest functional improvements were observed in fibromyalgia and postoperative conditions such as knee arthroplasty and peripheral nerve repair, with associated improvements in quality of life and inflammatory markers. Results for delayed-onset muscle soreness and acute ligament injuries were inconsistent.
    CONCLUSIONS: HBOT may provide adjunctive benefits in musculoskeletal pain syndromes, yet the current evidence remains limited. Standardized treatment protocols and high-quality trials are needed to better define its clinical applicability.
    Keywords:  fatigue; hyperbaric oxygen therapy; muscles; pain; rehabilitation; sports
    DOI:  https://doi.org/10.3390/muscles4040063
  38. Osteoarthr Cartil Open. 2026 Mar;8(1): 100720
    Physical activity and diurnal variation have no impact on plasma microRNA-140 expression levels in patients with knee osteoarthritis and healthy controls.
    Tommy Frøseth Aae, Rune Bruhn Jakobsen, Mai Britt Dahl, Asbjørn Årøen, Per-Henrik Randsborg, Myrthle Slettvåg Hoel, Øystein Bjerkestrand Lian.
       Objective: This study aimed to determine whether physical activity or diurnal variation influence circulating microRNA-140-3p (miR-140-3p) and miR-140-5p expression levels in patients with knee osteoarthritis (OA) compared to healthy controls.
    Method: Twenty-one patients with knee OA and ten healthy controls ran on a treadmill for 20 ​min and blood samples were taken prior to and after running. To assess diurnal variation, blood samples were drawn at six different times during a 24-h period. RNA was extracted from plasma and used for cDNA synthesis. Expression levels were assessed with real-time quantitative polymerase chain reaction and compared between patients and controls.
    Results: All participants had detectable expression levels of miR-140-3p and miR-140-5p. A paired analysis could not demonstrate statistically significant differences between the groups.
    Conclusions: Plasma miR-140-3p and miR-140-5p expression levels were found in all samples; however, the expression levels were not affected by physical activity and did not show diurnal variation. The observation of stable miR-140 expression supports its potential as a reliable biomarker for OA, providing a methodological foundation for future diagnostic and translational studies.
    Keywords:  Biomarker; Diurnal variation; MicroRNA; Osteoarthritis; Physical activity
    DOI:  https://doi.org/10.1016/j.ocarto.2025.100720
  39. J Pain Res. 2025 ;18 6769-6777
    The Impact of Patient-Controlled Analgesia Combined with Self-Management Training on Pain Modulation in Diabetic Patients with Chronic Knee Pain.
    Xizhen Zhao, Zhihong Huang, Zhongliang Su, Huijie Zhou, Lingmin Chen.
       Background: Chronic knee osteoarthritis is a debilitating condition characterized by persistent knee pain and functional impairment. This study aimed to evaluate the impact of Patient-Controlled Analgesia (PCA) combined with self-management training on postoperative pain management in diabetic and non-diabetic patients with chronic knee pain.
    Methods: We conducted a cohort study of 100 patients (40 diabetic, 60 non-diabetic) undergoing knee replacement surgery. Participants were assigned to receive either PCA with self-management training or standard care. Pain was assessed using VAS scores, and self-management ability was evaluated with a preliminary DSSMET. The impact of PCA and diabetes status on these outcomes was evaluated using multivariate regression models (multiple linear and logistic), which adjusted for confounding variables. All analyses were performed in SPSS 25.0 with statistical significance set at p < 0.05.
    Results: The results showed that baseline characteristics showed no age difference between groups, but diabetic patients had shorter discharge times and higher blood glucose levels (P<0.001). VAS scores indicated higher pain in diabetic patients (P<0.001), with significant pain reduction in the PCA subgroup (P=0.036). The DSSMET showed good reliability (Cronbach's α =0.87) and validity (four-factor structure). Furthermore, PCA was associated with effective pain relief, with this effect being most pronounced in diabetic patients.
    Conclusion: This study developed a preliminary tool to evaluate self-management ability in chronic knee pain patients and investigated the effect of PCA combined with self-management training on pain relief. The results suggest that this combined intervention may effectively relieve pain, particularly in diabetic patients. Furthermore, high patient engagement and adherence indicate good acceptability of the combined PCA and self-management protocol.
    Keywords:  diabetes mellitus; knee; osteoarthritis; pain management; rehabilitation; self-management
    DOI:  https://doi.org/10.2147/JPR.S537565
  40. Knee Surg Sports Traumatol Arthrosc. 2025 Dec 26.
    Safety profile comparison of intra-articular corticosteroids, hyaluronic acid, platelet-rich plasma, and cell-based injections for knee osteoarthritis: A systematic review and meta-analysis by the ESSKA Orthobiologics Initiative.
    Alessandro Bensa, Andrea Piano, Giacomo Arthur Fumagalli, Laura de Girolamo, Lior Laver, Jérémy Magalon, Mikel Sánchez, Thomas Tischer, Giuseppe Filardo.
       PURPOSE: The aim was to compare the safety profiles of corticosteroids (CS), hyaluronic acid (HA), blood-derived products based on platelet concentrates (for simplicity indicated as PRP - platelet-rich plasma - being PRP the most common product), and cell-based therapies (namely products exploiting the therapeutic function of mesenchymal stromal cells and other cell populations, either expanded or prepared at the point of care) for knee osteoarthritis (OA) injective treatment.
    METHODS: The literature search was conducted on PubMed, Cochrane, and Web of Science according to PRISMA guidelines on clinical studies reporting adverse events of CS, HA, PRP, or cell-based therapies. Number of patients with adverse events and number and type of adverse events were collected for each treatment. A meta-analysis was conducted for each product on the total, non-severe, severe adverse events, and on the infection rate.
    RESULTS: Out of 848 included studies, 559 reported data on the adverse events in 76,061 patients and were used for the meta-analysis. These studies included 7121 patients treated with CS, 51,146 patients with HA, 11,941 patients with PRP, and 5853 patients with cell-based therapies. The rates of patients reporting at least one adverse event were 11.0% for CS, 10.5% for HA, 8.7% for PRP, and 14.7% for cell-based therapies. The mean number of total adverse events per treated patient was 0.21 for CS, 0.13 for HA, 0.05 for PRP, and 0.19 for cell-based therapies, with a significant difference in each individual comparison (p < 0.001) except for CS versus cell-based therapies. The same trend was observed for non-severe adverse events. The rates of severe adverse events were 1.1% for CS, 0.7% for HA, 0.3% for PRP, and 0.5% for cell-based therapies, while infection rates were 0.4% for CS, 0.1% for HA, 0.3% for PRP, and 0.4% for cell-based therapies.
    CONCLUSION: CS, HA, PRP, and cell-based therapies for knee OA have different safety profiles. PRP presented the lowest total adverse event rate, followed by HA, cell-based therapies, and CS. The same trend was observed for non-severe adverse events. PRP demonstrated the lowest rate of severe adverse events, followed by cell-based therapies, HA, and CS, while HA showed the lowest infection rate followed by PRP, CS, and cell-based therapies.
    LEVEL OF EVIDENCE: Level IV.
    Keywords:  adverse events; infection; knee; osteoarthritis; safety
    DOI:  https://doi.org/10.1002/ksa.70230
  41. Cureus. 2025 Nov;17(11): e97613
    Exploring the Role of Bipolar Thermal Radiofrequency in Complex Multi-pattern Post-stroke Spasticity: Clinical Insights From a Case Report With Combined Botulinum Toxin Type A Therapy.
    Carlos Cordero-García, Marta Lopera Martínez, Blanca Cabaleiro Burguillos, María Del Mar Saenz de Tejada Sánchez.
      Post-stroke spasticity significantly impairs quality of life by hindering functional abilities and increasing dependency. Common treatments include botulinum toxin type A (BoNTA) injections. BoNTA is effective for spasticity management, but some situations may require alternative approaches. This case report explores the role and efficacy of bipolar thermal radiofrequency in complex multi-pattern post-stroke spasticity. A 44-year-old man experienced increased left-sided spasticity five years post-stroke, despite initial success with BoNTA. The patient exhibited left hemiparesis with severe spasticity in the left limbs (Modified Ashworth Scale (MAS) score 2 to 4 in several muscle groups) and was treated with high doses of incobotulinumtoxinA. Combined treatment with bipolar thermal radiofrequency was implemented to redistribute the dose among other muscles, achieving a more comprehensive approach for better outcomes. It resulted in immediate spasticity reduction in elbow flexors (MAS 2 to 0). Four weeks post-treatment, the patient reported pain disappearance (visual analogue scale (VAS) 0) and reduced spasticity (MAS 0-3 in several muscle groups). In conclusion, thermal radiofrequency enhances outcomes in post-stroke spasticity, potentially improving functionality and quality of life. As one of the first cases reported, our findings highlight its feasibility and potential benefit. Further research is needed to explore broader applications.
    Keywords:  botulinum toxin; high-dose; incobotulinumtoxina; neurolysis; radiofrequency; spasticity; stroke
    DOI:  https://doi.org/10.7759/cureus.97613
  42. Musculoskelet Surg. 2025 Dec 24.
    Retrospective analysis of ultrasound-guided hydrodistension in patients with post-traumatic adhesive capsulitis of the shoulder.
    F Vita, D Donati, L Langone, F Origlio, R Tedeschi, M Miceli, S M Stella, S Galletti, C Faldini.
       BACKGROUND: Adhesive capsulitis (AC) is a painful shoulder condition characterized by limited motion due to fibrosis and contracture of the joint capsule. Secondary AC frequently occurs after upper limb fractures and immobilization, delaying recovery.
    METHODS: This retrospective study analyzed 11 patients with post-traumatic AC (< 3 months) following non-displaced humeral fractures treated conservatively with a median immobilization period of 25 days. The cohort included seven men and four women (mean age 52.6 years), five of whom also had rotator cuff injuries. Treatments involved hydrodistension, with glenohumeral drainage in seven cases and subacromial bursa drainage in four cases. Range of motion (ROM), pain (VAS), and functionality (DASH) were assessed at baseline, 1-, 2-, and 3-month post-treatment.
    RESULTS: Significant improvements in ROM were seen across all planes: flexion increased from 80° to 150°, extension from 15° to 60°, abduction from 55° to 160°, internal rotation from 10° to 85°, and external rotation from 10° to 80° (all p < 0.001). Pain levels (VAS) decreased from a mean score of 8 at baseline to 3 at 3 months (p < 0.001), and functional capacity (DASH) improved from a score of 45-10 (p < 0.001). Among the five patients with rotator cuff injuries, despite improved ROM and pain, strength deficits persisted, leading to subsequent arthroscopic repairs.
    CONCLUSION: Hydrodistension resulted in significant improvements in ROM, pain relief, and functionality, suggesting it is a promising treatment for post-traumatic AC. Early intervention may aid faster recovery after shoulder immobilization.
    Keywords:  Adhesive capsulitis; Hydrodistension; Post-traumatic; Rotator cuff injury; Shoulder immobilization
    DOI:  https://doi.org/10.1007/s12306-025-00937-2
  43. Knee Surg Sports Traumatol Arthrosc. 2025 Dec 26.
    Diagnostic evaluation and nonoperative management of Lisfranc injuries in athletes.
    IFASC Committee
       PURPOSE: Lisfranc injuries present diagnostic and therapeutic challenges, particularly in elite athletes. The 2024 International Foot and Ankle Sports Consensus (IFASC) conducted an expert consensus and systematic review to establish evidence-based guidelines for the identification, classification and nonoperative management of these injuries in high-performance athletes.
    METHODS: A modified Delphi process involving 32 international orthopaedic foot and ankle surgeons was conducted through four iterative survey rounds. Consensus thresholds were general (75%-85%), strong (86%-99%) and unanimous (100%). A concurrent systematic review was performed, encompassing clinical studies reporting outcomes for bony and ligament Lisfranc injuries in athletes.
    RESULTS: Seven consensus statements were unanimous, and six were strong. Diagnostic agreement included: (1) mechanism of injury via axial compression or twisting through a plantarflexed foot; (2) midfoot tenderness, pain with squeeze test and inability to bear weight; (3) bilateral weight-bearing radiographs for initial imaging and (4) computed tomography (CT) or magnetic resonance imaging (MRI) for low-grade instability. Experts unanimously agreed that stable, nondisplaced injuries with intact ligaments on MRI may be managed nonoperatively with close monitoring. Systematic review findings demonstrated that ligament injuries predominated in male athletes, with 96.8% returning to sport at 2.8 versus 4.5 months for bony injuries.
    CONCLUSION: Lisfranc injuries in elite athletes remain challenging to diagnose and manage due to low-grade injury presentations and high return-to-play demands. This consensus and systematic review establish clear diagnostic and nonoperative treatment guidelines, emphasizing the importance of mechanism-based suspicion, thorough physical examination and early weight-bearing imaging. Stable, nondisplaced ligament injuries without significant MRI findings can be treated nonoperatively, with most athletes safely returning to sport within 6-10 weeks and minimal complications. In contrast, unstable or displaced injuries continue to require surgical fixation to restore alignment and prevent long-term dysfunction. Collectively, these findings provide a standardized framework that supports accurate diagnosis, evidence-based decision-making and efficient recovery in athletes with Lisfranc injuries.
    LEVEL OF EVIDENCE: Level V.
    Keywords:  Lisfranc; athlete; fracture; midfoot; sports
    DOI:  https://doi.org/10.1002/ksa.70244
  44. J Pain Symptom Manage. 2025 Dec 22. pii: S0885-3924(25)01013-9. [Epub ahead of print]
    Pericapsular nerve group phenol neurolysis for refractory metastatic hip pain: a case series.
    Diana Pérez-Moreno, Mauricio Forero, Ángel M Juárez-Lemus, Javier Mora-Arteaga.
       BACKGROUND: Cancer-related hip pain due to tumor infiltration is challenging, especially in patients with limited life expectancy. While ultrasound-guided pericapsular nerve group (PENG) phenol neurolysis has been reported in isolated cases, systematic evidence on effectiveness and safety remains limited.
    METHODS: We conducted a prospective case series of three patients with refractory metastatic hip pain who underwent ultrasound-guided PENG phenol neurolysis using 10 mL of 10% non-glycerinated phenol, with six-week follow-up. Assessments were performed at baseline, 10 minutes, 24 hours, and Weeks 1, 2, 4, and 6 using validated measures: pain intensity (Visual Analog Scale [VAS]), neuropathic pain (Douleur Neuropathique 4 [DN4]), opioid consumption (oral morphine milligram equivalents [MME]), and function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]). Adverse events were predefined as new motor deficit, persistent sensory loss, infection, bleeding, or vasovagal reaction, and were monitored with serial neurochecks for 4 hours post-procedure and at each follow-up through Week 6.
    RESULTS: All patients-bedbound at baseline with VAS 10/10-experienced rapid and marked analgesia, with VAS scores of 1-2 within 10 minutes and sustained relief through six weeks. DN4 scores fell below the diagnostic threshold (≤3) in all cases. Daily opioid consumption decreased by 47-77%, and all patients achieved assisted ambulation within 24 hours. No motor weakness occurred; the only adverse event was mild, transient anterior-hip hypoesthesia.
    CONCLUSION: Ultrasound-guided PENG phenol neurolysis (10% phenol) may be a valuable motor-sparing option for refractory cancer-related hip pain in selected palliative care patients. These preliminary findings warrant evaluation in larger, controlled studies.
    Keywords:  Cancer pain; Palliative care; Pericapsular nerve group (PENG) block; Phenol neurolysis; Ultrasound-guided intervention
    DOI:  https://doi.org/10.1016/j.jpainsymman.2025.12.012
  45. Interv Pain Med. 2025 Dec;4(4): 100717
    2-Year clinical outcomes following combined iliotibial band and gluteus medius percutaneous ultrasound tenotomy in refractory GTPS.
    Ugur Yener, Mohamed Awad, Tahereh Naeimi, Kyle Max Mayblum, Sebastian H Lujan Varela, Joseph M Seldin, Hatice Begum Ciftci, Alaa Abd-Elsayed, Sayed Emal Wahezi.
       Background: Greater Trochanteric Pain Syndrome (GTPS) is a common cause of chronic lateral hip pain, often refractory to conservative medical management (CMM). Combined percutaneous ultrasound-guided tenotomy (PUT) of the gluteus medius (GMed) and iliotibial band (ITB) has shown promising one-year results, but data on long-term outcomes remain limited. This study evaluates two-year clinical outcomes in patients undergoing combined GMed and ITB PUT for recalcitrant GTPS.
    Methods: This retrospective cohort study included 69 patients (79 hips) treated with combined GMed and ITB PUT between January 2022 and August 2023. Baseline and follow-up data, collected for an average of 2-year, were obtained through chart review and structured phone interviews. The primary outcome was ≥50 % reduction in Numeric Rating Scale (NRS) pain scores. Secondary outcomes included side-lying tolerance, sitting-to-standing ability, responder rate and need for additional hip interventions. Responder status required both pain reduction and complete side-lying tolerance. Statistical significance was evaluated using paired t-tests with p < 0.05.
    Results: Median baseline Numeric Rating Scale (NRS) pain score was 10 interquartile range (IQR 9-10), decreasing significantly to 2 (IQR 1-4) at 1, 6, and 12 months, then increasing to 6 (IQR 4-10) at 24 months (p < 0.001 vs. baseline). Rates of ≥50 % improvement in NRS were 88.6 % at 1 month, 89.6 % at 6 months, 83.0 % at 12 months, and 59.5 % at 24 months. Side-lying tolerance improved from 21.5 % hips at baseline to 88.9 % reporting improvement at 1 month and 55.7 % at 24 months (p < 0.001). Sitting-to-standing ability showed sustained improvement at 81.0 % at 24 months. Composite responder rate declined from 88.6 % at 1 month to 57.0 % at 24 months. Subsequent invasive interventions were required in a minority of cases (2.5 % total hip arthroplasty; 11.4 % repeat TENEX).
    Conclusion: Combined PUT of the GMed and ITB provides durable pain relief and functional improvement in patients with refractory GTPS at two years post-procedure. Despite declining responder rates over time, this minimally invasive dual-target technique demonstrates a favorable safety profile and may delay or reduce the need for more invasive surgery. Further prospective studies are warranted to optimize patient selection and validate long-term efficacy.
    DOI:  https://doi.org/10.1016/j.inpm.2025.100717
  46. Eur Radiol. 2025 Dec 23.
    Assessment of ultrasound-guided continuous genicular nerve radiofrequency for the management of persistent post-arthroplasty knee pain.
    Rokia El Khalfi, Émilie Larribeau, Pablo Froidefond, Agathe Saint-Denis, Hélène Chiavassa-Gandois, Céline Goumarre, Antoine Filliole, Franck Lapègue, François Lafourcade, Viet-Tam Van, Nicolas Sans, Etienne Cavaignac, Marie Faruch-Bilfeld.
       OBJECTIVES: To evaluate the efficacy of continuous ultrasound-guided genicular nerve radiofrequency (GNRF) for managing persistent post-arthroplasty knee pain of unknown etiology.
    MATERIALS AND METHODS: In this single-center retrospective study, patients presenting with chronic knee pain following total knee arthroplasty, with no identifiable underlying cause and unresponsive to conventional treatments, underwent ultrasound-guided diagnostic nerve blocks followed by continuous GNRF targeting the supero-medial, supero-lateral, and infero-medial genicular nerves. Pain scores using a numeric rating scale (NRS) were assessed and compared at baseline, 1 month, and 6 months. The correlation between anesthetic nerve block test results and treatment efficacy was also analyzed.
    RESULTS: Twenty-three patients (mean age 69.9 ± 12.1 [SD], 9 men) were included between December 2021 and April 2024. At 1 month, the mean NRS score decreased from 8.0 ± 1.4 to 6.0 ± 3.4 [SD] (p = 0.01). Clinically significant pain reduction (≥ 2-point decrease) was observed in 47.8% of patients; 34.8% achieved a ≥ 50% reduction. At 6 months, the mean NRS score was 6.6 ± 3.0 [SD], with no statistically significant difference compared to baseline and 1-month NRS scores. No significant correlation was found between nerve block test outcomes and GNRF efficacy. No major complications were reported.
    CONCLUSION: Continuous ultrasound-guided GNRF appears to be a safe and effective minimally invasive option for chronic post-arthroplasty knee pain with no known underlying etiology.
    KEY POINTS: Question Persistent post-arthroplasty knee pain with no identified underlying etiology is frequent and often difficult to manage with conventional therapies. Findings Ultrasound-guided continuous GNRF provides clinically significant pain relief at 1 month and up to 6 months. Clinical relevance Prognostic nerve blocks did not correlate with radiofrequency outcomes.
    Keywords:  Genicular nerve; Pain management; Radiofrequency; Total knee arthroplasty
    DOI:  https://doi.org/10.1007/s00330-025-12140-9
  47. Muscle Nerve. 2025 Dec 22.
    Ultrasound Guidance to Augment Needle Electromyography Precision in the Complex Nerve Injury Setting.
    Nelson Saddler, Hannah Ro, Sean Bristol, Shahin Khayambashi, Michael J Berger.
      The rise in popularity of nerve transfer surgery in individuals with peripheral nerve and spinal cord injuries has elevated the importance of the preoperative electrodiagnostic examination. Needle electromyography (EMG) provides peripheral nerve surgeons with precise information about donor and recipient muscle health, aiding in decisions regarding surgical options, donor muscle viability, and timing of intervention. However, traditional anatomical landmarks for typical donor and recipient nerve-muscle combinations in nerve transfer surgery are either not well described in the literature or become less dependable in the presence of contracture, spasticity, or muscle atrophy and fibrosis. Ultrasound (US) can be a valuable tool to augment the needle EMG examination. Herein, we describe US approaches to improve the precision of the needle EMG examination for 10 muscles in the upper extremity and two muscles in the lower extremity that are routinely involved as either donors or recipients in nerve transfer surgery. The purpose is to provide a reference guide for the electrodiagnostic medicine specialist in the complex nerve injury setting. This includes information on surrounding anatomical structures for localization and those that should be avoided. Relevant US principles for EMG are discussed including: (1) the advantages and disadvantages of short-axis and long-axis views of the target muscle, emphasizing the predominant use of short-axis for adequate visualization of all surrounding structures and enhancing patient safety, (2) in-plane versus out-of-plane approaches, and (3) enhancing confidence in the precision of the needle EMG via the dynamic capability of US.
    Keywords:  needle electromyography; nerve transfer surgery; peripheral nerve injury; spinal cord injury; ultrasound
    DOI:  https://doi.org/10.1002/mus.70100
  48. Toxins (Basel). 2025 Dec 15. pii: 597. [Epub ahead of print]17(12):
    Artificial Intelligence Analysis of Symmetry and Emotions in Facial Palsy Patients After Botulinum Toxin A Injections.
    Seraina L C Müller, Chantal Zeier, Pablo Pfister, Nadia Menzi, Bita Tafrishi, Dirk J Schaefer, Jan A Plock, Tarek Ismail, Holger J Klein.
      Facial palsy affects millions worldwide. Botulinum toxin Type A (BoNT-A) is an established treatment for non-flaccid facial palsy, yet objective evidence remains limited. This study evaluates the effects of BoNT-A using AI-based tools and patient-reported outcome measures (PROMs). In this prospective observational study, patients with non-flaccid facial palsy received individualized BoNT-A injections. Exclusion criteria included age < 18, hypersensitivity to BoNT-A, or lack of follow-up. Assessments were conducted before and 3 weeks after treatment, including facial symmetry (Emotrics®), emotion expression (FaceReader™), and PROMs (FaCE and FDI). Eleven patients (mean age 50.1 ± 18 years) were included. BoNT-A significantly improved dynamic facial symmetry: eyebrow raising (p = 0.032), smile angle (p = 0.005), and lower lip height (p = 0.042). Emotion analysis showed no significant changes. PROMs revealed improvements in social well-being (FDI, p = 0.004) and aesthetic satisfaction (FaCE, p = 0.035), while functional FDI scores remained unchanged (p = 0.406). BoNT-A improves objective symmetry and patient satisfaction in non-flaccid facial palsy. The lack of change in emotional expression may reflect improved symmetry at the cost of dynamic muscle activation.
    Keywords:  Botulinum toxin; PROMs; artificial intelligence; facial palsy
    DOI:  https://doi.org/10.3390/toxins17120597
  49. J Bone Joint Surg Am. 2025 Dec 26.
    The Management of Neurological Injuries Following Total Hip Arthroplasty.
    Babar Kayani, John G Stammers, James Donaldson, Simon Newman, Chethan Jayadev, Jonathan Miles, John A Skinner, Michael Fox.
      ➢ Neurological injury remains the most common reason for ligation following total hip arthroplasty.➢ The main risk factors for neurological injury following total hip arthroplasty are preexisting spinal pathology, revision surgery, complex hip anatomy, female sex, surgeon inexperience, and excessive limb lengthening.➢ Postoperative pelvic computed tomographic scans may be used to assess component positioning and identify any compressive hematomas. Magnetic resonance imaging with a metal artifact reduction protocol may be used to evaluate architectural changes in the affected nerve.➢ Electromyography and nerve conduction studies may help to assess the level and grade of the nerve injury. These tests are most useful when performed in patients who show no signs of neurological improvement 3 to 6 weeks after surgery.➢ The mainstay of nonoperative management is supportive care with physical therapy, an ankle-foot orthosis, and neuropathic pain treatment.➢ The prognosis for a femoral nerve injury is generally more favorable than that for a sciatic nerve injury following total hip arthroplasty.
    DOI:  https://doi.org/10.2106/JBJS.25.00389
  50. Ulus Travma Acil Cerrahi Derg. 2025 Dec;31(12): 1203-1211
    The usefulness of tuning-fork-assisted vibration sensation as a proprioceptive measurement method in cases of acute anterior talofibular ligament rupture: A single-center study.
    Muhammed Can Ari, Nebi Köksal Yazgan, Cemal Kural, Emre Baca.
       BACKGROUND: This study aimed to investigate changes in vibration sensation in patients with anterior talofibular ligament (ATFL) rupture following acute ankle sprain and to assess its potential use as a proprioceptive assessment tool.
    METHODS: A 128 Hz tuning fork was applied to the ATFL region-identified as ruptured via ultrasound-while the ankle was positioned in inversion and plantar flexion. Vibration duration was measured using a stopwatch. Data were compared with those from a healthy population and from patients with lateral ankle edema following acute sprain without rupture. The study was prospectively designed.
    RESULTS: A total of 81 patients (48 male, 33 female) were included, with a mean age of 29.19 years. Among the 27 patients with ATFL rupture, nine had an additional calcaneofibular ligament (CFL) injury and five had an additional posterior talofibular ligament (PTFL) injury (Grade 2-3). The mean vibration duration in ATFL rupture patients was 5.72 seconds on the injured side and 7.87 seconds on the uninjured side, showing a statistically significant difference (p=0.001). At the 12-week follow-up, the mean vibration time improved to 7.65 seconds, which was also statistically significant (p=0.001).
    CONCLUSION: Proprioceptive impairment due to acute ATFL rupture was associated with reduced vibration sensation at the rupture site. As proprioception improved, vibration sensation also recovered. Therefore, vibration measurement using a tuning fork may serve as a practical proprioceptive assessment tool and an adjunctive diagnostic method.
    DOI:  https://doi.org/10.14744/tjtes.2025.48242
  51. Orv Hetil. 2025 Dec 21. 166(51): 2024-2028
    [Descending genicular artery embolization to reduce chronic pain after total knee replacement].
    Csaba Zsolt Oláh, Szabolcs Bábás, Zsuzsanna Oláh, Péter Tamáska.
      The prevalence of osteoarthritis is very high and most often affects the knee joint in addition to the hip. A new, innovative option in the treatment strategy of knee osteoarthritis is embolization of the descending genicular artery which arises from femoral artery. This procedure is most often performed in cases of knee osteoarthritis that does not respond to conservative treatment, but it can also be successfully used in cases of hemarthros or persistent pain following total knee replacement surgery. The procedure treats knee osteoarthritis pain by reducing synovial blood flow, which is believed to reduce knee pain associated with inflammation, neovascularity and neoinnervation. In our case report, we managed to significantly reduce severe pain following successful knee total endoprothesis surgery with selective embolization of the descending genicular artery, which did not improve with other treatments. Orv Hetil. 2025; 166(51): 2024-2028.
    Keywords:  fájdalom; genicular artery embolization; genicularis artéria embolisatio; knee osteoarthritis; pain; total knee replacement; térdprotézis; térdízületi osteoarthritis
    DOI:  https://doi.org/10.1556/650.2025.33446
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