bims-ricfun Biomed News
on Rehabilitation ICF
Issue of 2025–12–14
ninety-one papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica
  1. Low Back Pain Triggering Cubital Tunnel Syndrome? An Unexpected Clinical Twist.
  2. Ultrasound-Guided Suprapatellar Pouch vs. Medial Midpatellar Injection: A Cadaveric Validation.
  3. Ultrasonographic Insight Into Wrist Extensor Tendons' (Injury and Variants).
  4. Re. Akrivos VS, Koutalos AA, Varitimidis SE. Association between carpal tunnel syndrome and shoulder pain: a case-control study.
  5. Comparison of Different Treatment Strategies for Long Head of Biceps Tendon in Rotator Cuff Repair: A Review.
  6. Re-Examining the Dimensionality of a Disability Assessment Tool Using Exploratory Structural Equation Modeling (ESEM): A Preliminary Study in Low Back Pain.
  7. Relational rehabilitation: competencies and qualities needed in psychosocial rehabilitation when responding to hope and hopelessness.
  8. Competitive athletes' psychological and emotional experiences of injury rehabilitation: a scoping review.
  9. Ultrasound-Guided Lumbar Plexus Injection: A Cadaveric Validation.
  10. Sural Nerve Entrapment in Postoperative Scar Tissue: A Case of Successful Management With Hydrodissection After Calcaneal Fracture Repair.
  11. Symptom Improvement in a Patient With Chronic Pronator Teres Syndrome Treated With Ultrasound-Guided Hydrodissection and Manual Therapy: A Case Report.
  12. Conservative Management of Focal Chondral Lesions of the Knee and Ankle: Current Concepts.
  13. Efficacy and safety of a single intra-articular injection of mannitol-combined hyaluronan in patients with knee osteoarthritis - A double-blinded randomized clinical study.
  14. The "Nail File Sign": A Report of Three Cases With Varied Etiologies.
  15. Progress in the clinical use of bone marrow aspirate concentrate for knee osteoarthritis: an expert opinion.
  16. Anterior nerves of the knee (ANK) block: A novel motor sparing fascial plane block for analgesia of the knee: Observational cohort study.
  17. Combined flexor sheath and gastrocnemius aponeurosis flap for the treatment of chronic calcified Achilles tendon rupture: a case report.
  18. Calf Strains in Athletes: A Narrative Review of Management, Injury Grading, and Return to Sport.
  19. Acute massive rotator cuff tear and biceps tendon dislocation following posterior shoulder dislocation: A case report.
  20. Rehabilitation in Amyotrophic Lateral Sclerosis: Recommendations for Clinical Practice and Further Research.
  21. Letter to the editor: outcome comparison of arthroscopic latissimus dorsi tendon transfer and muscle advancement for irreparable rotator cuff tear: a systematic review.
  22. The Diagnosis and Management of Pudendal Neuralgia.
  23. Intra- and Postoperative Botulinum Toxin Injection in Postsurgical Pain Management: A Literature Review.
  24. [Role of training in biofeedback - an associated system of 3D video analysis of movements in comprehensive rehabilitation programs for patients after total knee arthroplasty].
  25. Comparative Diagnostic Accuracy of MRI and Ultrasound in Meniscal Tear Detection: Evaluating Reliability and Limitations Against Arthroscopic Outcomes.
  26. Musculoskeletal Digital Therapeutics and Digital Health Rehabilitation: A Global Paradigm Shift in Orthopedic Care.
  27. All-arthroscopic repair of talar-sided anterior talofibular ligament insertion tears using knotless anchors: A retrospective case series.
  28. Glucodynia.
  29. Editorial: Insights in rehabilitation for musculoskeletal conditions 2023/2024.
  30. Complementary Role of Ultrasound and Clinical Features in Assessing Carpal Tunnel Syndrome Severity: A Cross-Sectional Study.
  31. Load Management After Gluteal Tendon Repair: A Controlled Laboratory Study.
  32. Inveterate Section of Deep Flexor in Pediatric Hand, Periosteum Clues.
  33. Biceps brachii regional shear modulus following elbow flexion exercises at different muscle lengths.
  34. Radial Extracorporeal Shock Wave Therapy Decreases Hand Spasticity After Stroke.
  35. Assessment properties of the Visual Analogue scale, Numeric Rating Scale, Face Pain Scale, and Pain Intensity Subscale of the Brief Pain Inventory in Albanian population with low back pain.
  36. Effect of simplified exercise program on quality of life, biomarkers, pain and muscle strength of individuals with knee osteoarthritis.
  37. Differences in the Outcomes of Early Active Mobilization Following Flexor Tendon Repair Between Zone 1 and Distal Zone 2 Injuries.
  38. Patellar Tendon Reconstruction With Achilles Allograft: A Technical Note.
  39. Balance Exercise Parameters for Rehabilitation of Adult Chronic Ankle Instability: A Systematic Review of Randomised Controlled Trials.
  40. Therapeutic Exercise Progression in Patients with Nonspecific Low Back Pain: A Systematic Review.
  41. Osteitis condensans ilii masquerading as sacroiliitis: a case report of an underdiagnosed condition.
  42. Fatty infiltration and cross-sectional area as indicators of muscle mass in osteoporosis: a meta-regression study.
  43. When Does a Rotator Cuff Tear Hurt? A Critical Review of the Literature.
  44. EXPRESS: Evaluation of Stress Biomarkers in individuals with Migraine or Tension-Type headached before and after Botulinum Toxin Injection.
  45. Does Concomitant Biceps Tenotomy Affect Shoulder Proprioception and Strength? A Prospective Intra‑Individual Comparison After Arthroscopic Rotator Cuff Repair.
  46. Evaluating the efficacy and tolerability of the oral combination of alpha lipoic acid and vitamin B complex preparation in carpal tunnel syndrome: a single center, randomized, double-blind, placebo-controlled trial.
  47. Exercises plus intra-articular injection for knee osteoarthritis: a systematic review with meta-analysis.
  48. Associations between muscle stiffness, muscle co-activation, and balance in older individuals with knee osteoarthritis: a cross-sectional study.
  49. Arthroscopic Subacromial Decompression vs. Physical Therapy for Stage II Shoulder Impingement Syndrome: A Comparative Review of Functional and Social Impact.
  50. Measurement properties of the sit-to-stand test in community-dwelling people with chronic obstructive pulmonary disease: a COSMIN systematic review.
  51. Achilles' tendon stretch during walking in hinged controlled ankle motion boots.
  52. Effect of taping on pain and function in athletes with Patellofemoral pain syndrome: a systematic review and meta-analysis.
  53. The role of ultrasonography of the brachial plexus in differentiating between Parsonage-Turner syndrome and neuroborreliosis. A pictorial review.
  54. The diagnostic value of a subcoracoid effusion in ultrasound assessment of rotator cuff tears.
  55. A Wearable System for Knee Osteoarthritis: Based on Multimodal Physiological Signal Assessment and Intelligent Rehabilitation.
  56. Effect of Postoperative Immobilization Method on Outcomes Following Triangular Fibrocartilage Complex Transosseous Foveal Repair: Long-Arm Cast Versus Muenster Brace.
  57. Functional Profiles and Baseline Correlates of Hand Function Change in Youth with Unilateral Cerebral Palsy Following Constraint-Induced Movement Therapy.
  58. Patient-Centred and Daily Life-Oriented Botulinum Toxin Treatment for Stroke Survivors with Upper Extremity Spasticity-Effects and Practical Aspects.
  59. Botulinum toxin A for chronic neurovascular and myofascial facial pain: a comprehensive case report.
  60. Failed Back Syndrome or Extra-Spinal Sciatica? Ischiofemoral Syndrome as a Cause of Persistent Radicular Pain After 4 Lumbar Spine Surgeries.
  61. Hybrid Tightrope-PEEK Dual Fixation for Distal Biceps Tendon Reinsertion in High-Performance Athletes: A Prospective Case Series.
  62. Analysis of the association between lumbar paraspinal muscle atrophy, facet joint degeneration, and degenerative lumbar scoliosis.
  63. Infratuberositary Derotational Tibial Osteotomy for Anterior Knee Pain in Patients with Pathological External Tibial Torsion: A Novel Technique.
  64. Anatomical Considerations in the Twin Block Technique for the Treatment of Masticatory Myofascial Pain: An Anatomical Review.
  65. Towards the strategies of return to sport after lateral ankle Sprain: a systematic review.
  66. Additional Benefits of Creatine Supplementation with Physical Therapy and Resistance Exercise in Knee Osteoarthritis: A Randomized Controlled Trial.
  67. Does tendon healing after isolated supraspinatus tendon repair influence clinical outcomes?
  68. Impact of Physical Rehabilitation on Endometriosis and Adenomyosis-Related Symptoms: A Systematic Review and Meta-Analysis.
  69. The role of collagen pathologies and ligamentous laxity in lumbar disc herniation and its recurrence: a systematic review and meta-analysis.
  70. Frequency and Outcomes of Distal Radioulnar Joint Dislocation Associated With Distal Radius Fractures in the Elderly.
  71. 3D-MRI evaluation of cartilage thickness changes and their location in the patellofemoral joint after open wedge high tibial osteotomy for knee osteoarthritis: A retrospective cohort study.
  72. Methotrexate osteopathy in rheumatoid arthritis.
  73. Effects of Resistance Training on Motor and Cognitive Function in Older Adults with Alzheimer's Disease: A Systematic Review.
  74. The effectiveness of dry heat treatment (fluidotherapy) in patients with distal radius fracture followed conservatively: a single-blinded, randomized controlled clinical study.
  75. Congenital muscular torticollis: Diagnosis, management, and prognosis in the pediatric population.
  76. Severe knee osteoarthritis is associated with histological and ultrastructural changes in the semitendinosus tendon.
  77. Peripheral nerve stimulation of the trochanteric branch of the femoral nerve to treat greater trochanteric pain syndrome.
  78. Prevalence of Ulnar Nerve Dislocation Among Division I Collegiate Baseball Players.
  79. Thigh Muscle Changes in the ACL-Deficient Knee: A 4-Year Longitudinal MRI Study of 1,207 Patients.
  80. Tailoring the surgical approach to Chiari I malformation with Intraoperative Ultrasounds: Advantages, limitations, and controversies.
  81. The Burden of Shoulder and Elbow Injuries in Wrestling: A Systematic Review of Incidence, Injury Types, and Competition-Level Comparisons.
  82. Botulinum toxin underuse in older stroke survivors with spasticity: a nationwide population-based cohort study.
  83. Structural Preservation Without Functional Recovery: Physiotherapy Reflections on Early Neuromuscular Electrical Stimulation and Passive In-Bed Cycling.
  84. Rumination catastrophism and pain in injured athletes.
  85. Update on clinical trials of intra-articular disease-modifying osteoarthritis drugs inducing cartilage regeneration.
  86. Clinical Outcomes of Repeated Sodium Polynucleotide Injections in Knee Osteoarthritis: Large-Scale, Retrospective Cohort Study.
  87. Immune Mechanisms and Pain in Intervertebral Disc Degeneration.
  88. Outcomes Following Stem Cell-Based Therapies for Hip Osteoarthritis: A Scoping Review.
  89. Is resistance training with external loads superior to unloaded exercise in the management of chronic low back pain? A systematic review and meta-analysis.
  90. Sex differences in fall circumstances and injury biomechanics among older adults: A narrative review.
  91. A Review of Exercise Interventions for Rehabilitation in Drug-Dependent Individuals.
  1. Pain Pract. 2026 Jan;26(1): e70111
    Low Back Pain Triggering Cubital Tunnel Syndrome? An Unexpected Clinical Twist.
    Ahmet Furkan Çolak, Berkay Yalçınkaya, Hilmi Berkan Abacıoğlu, Hasan Ocak, Alp Çetin.
      
    Keywords:  injection; median nerve; neuropathy; ulnar nerve; ultrasound
    DOI:  https://doi.org/10.1111/papr.70111
  2. Pain Pract. 2026 Jan;26(1): e70115
    Ultrasound-Guided Suprapatellar Pouch vs. Medial Midpatellar Injection: A Cadaveric Validation.
    Kamal Mezian, Ondřej Naňka, Ke-Vin Chang, Wei-Ting Wu, Vincenzo Ricci, Levent Özçakar.
      
    Keywords:  joint pain; musculoskeletal diseases; sonography
    DOI:  https://doi.org/10.1111/papr.70115
  3. Pain Pract. 2026 Jan;26(1): e70116
    Ultrasonographic Insight Into Wrist Extensor Tendons' (Injury and Variants).
    Beytullah Yazar, Abdullah Emre Uğur, Mahmud Fazıl Aksakal, Alpaslan Fatih Kaynar, Levent Özçakar.
      
    Keywords:  dynamic imaging; extensor tendinitis; pain; spur; ultrasound
    DOI:  https://doi.org/10.1111/papr.70116
  4. J Hand Surg Eur Vol. 2025 Dec;50(11): 1556
    Re. Akrivos VS, Koutalos AA, Varitimidis SE. Association between carpal tunnel syndrome and shoulder pain: a case-control study.
    Martti Vastamäki.
      
    DOI:  https://doi.org/10.1177/17531934251375268
  5. Int J Gen Med. 2025 ;18 7309-7325
    Comparison of Different Treatment Strategies for Long Head of Biceps Tendon in Rotator Cuff Repair: A Review.
    Pingwen Lan, Zhi Fang, Bi Wu, Fuyuan Deng, Jianjun Zhang.
      Rotator cuff injuries are frequently associated with lesions of the long head of the biceps tendon (LHBT), and the management strategies for LHBT significantly influence shoulder function recovery and pain relief in patients. This review provides a comprehensive overview of the anatomical features of the LHBT and its relationship with rotator cuff pathologies. It critically compares the clinical efficacy and complications of various treatment strategies for LHBT, including preservation, partial resection, complete tenotomy, and tendon transfer repair. By integrating recent advancements in imaging and anatomical studies, the review explores how LHBT lesions affect shoulder joint stability and function, as well as the mechanisms through which different surgical strategies impact the prognosis of rotator cuff repairs. Through a systematic analysis of the current literature, this review aims to provide a theoretical basis and practical guidance for clinicians in developing individualized treatment plans for patients with rotator cuff injuries involving the LHBT.
    Keywords:  efficacy comparison; long head of biceps tendon; rotator cuff injury; shoulder function; treatment strategies
    DOI:  https://doi.org/10.2147/IJGM.S558023
  6. J Clin Med. 2025 Dec 02. pii: 8551. [Epub ahead of print]14(23):
    Re-Examining the Dimensionality of a Disability Assessment Tool Using Exploratory Structural Equation Modeling (ESEM): A Preliminary Study in Low Back Pain.
    Serhat Hayme, Derya Gökmen, Şehim Kutlay, Ayşe A Küçükdeveci.
      Background: Low back pain (LBP) profoundly impacts daily life, requiring assessment tools that capture its complex effects on the body and mind. This study explores a measurement tool designed to assess LBP disability, testing whether Exploratory Structural Equation Modeling (ESEM) better reveals its multidimensional nature compared to Confirmatory Factor Analysis (CFA). Methods: We analyzed data from 266 LBP patients using CFA and ESEM. The tool, developed from the items from existing scales, included 99 questions on body functions, activities, and participation. Using Mplus 8 software, we compared model fit and item connections. Results: Two main factors; "Body Functions" and "Activity-Participation" identified by CFA were tested using ESEM. While ESEM had slightly better fit compared to CFA model, many items linked across both factors which shows how pain and emotions overlap with daily activities. These results align with the International Classification of Functioning, Disability and Health (ICF) and reflect LBP's broad impact. Conclusions: ESEM offers a broader understanding of LBP's multidimensional nature compared with CFA, guiding clinicians to create a holistic management approach that address physical and psychosocial challenges. This preliminary study supports the use of ESEM in disability research, demonstrating its usefulness in identifying the multifaceted nature of LBP, therefore providing a broader perspective for assessment and management.
    Keywords:  CFA; ESEM; ICF; disability assessment; low back pain; multidimensionality
    DOI:  https://doi.org/10.3390/jcm14238551
  7. Med Health Care Philos. 2025 Dec 08.
    Relational rehabilitation: competencies and qualities needed in psychosocial rehabilitation when responding to hope and hopelessness.
    Camilla Højgaard Nejst, Femmianne Bredewold, Andries Baart, Chalotte Glintborg.
      This study explores how rehabilitation professionals engage with the dynamic nature of hope in acquired brain injury rehabilitation, identifying the qualities and competencies needed to respond with care. Using a qualitative design, data were collected through focus groups and individual interviews with cross-disciplinary professionals at a Danish rehabilitation centre. Reflexive thematic analysis revealed four distinct episodes of hope, each demanding a different response. Drawing on the concepts of 'relational caring' and 'practicing presence', and engaging with empirical data, essential qualities and competencies were revealed: being present, attuned, giving and sharing time, moving along, faithfully staying with, and embracing powerlessness and uncertainty. We conclude that current rehabilitation competency frameworks, such as Wade (Clin Rehabil 34(8):995-1003, 2020) and the Rehabilitation Competency Framework as reported by World Health Organization (Rehabilitation Competency Framework, World Health Organization, Geneva, 2020), fail to capture the more nuanced competencies required to address hopelessness in rehabilitation practice. This indicates that acknowledging and validating the full dynamics of hope and hopelessness within the frameworks shaping rehabilitation practice is essential to recognising the comprehensive range of qualities and competencies needed by rehabilitation professionals. This encompasses the capacity to navigate the shifting nature of hope as well as endure and 'stay with' the person in need during hardship. Specifically, education of rehabilitation professionals could gain from integrating the theoretical framework from relational caring and presence theory as a supplement to the International Classification of Functioning, disability and Health (ICF), enabling professionals to effectively navigate the psychosocial and existential dimensions of hope in their practice.
    Keywords:  Hope; Practicing presence; Psychological rehabilitation; Qualitative research; Rehabilitation competencies; Relational caring
    DOI:  https://doi.org/10.1007/s11019-025-10310-6
  8. Syst Rev. 2025 Dec 08. 14(1): 244
    Competitive athletes' psychological and emotional experiences of injury rehabilitation: a scoping review.
    Hazel R Jaekel, Courtney A De Barro, Alyson J Crozier, Grant R Tomkinson, Nicola D Ridgers.
       BACKGROUND: Sporting injuries have a psychological impact on competitive athletes, though most research focusses on the time of injury and returning to play. A greater understanding of the impact of injury rehabilitation programs on athletes is required. This scoping review synthesised the current peer-reviewed literature on the psychological and emotional experiences of competitive athletes undergoing injury rehabilitation.
    METHOD: A systematic search of the PsycInfo, SportDiscus, MEDLINE, and Scopus electronic databases was conducted using keywords relating to psychology, rehabilitation, athletes, and injuries from January 1980 to April 2024. Studies that focussed on mental or psychological wellbeing during injury rehabilitation among competitive athletes aged ≥18 years who had suffered a musculoskeletal or soft-tissue injury were eligible for inclusion.
    RESULTS: In total, 64 studies were included, with 61% using a cross-sectional design. There was considerable variability in the definitions of injuries, competitive athletes, and injury severity in the included studies. The results highlighted the injury rehabilitation process is an emotional experience and while minimal psychological support was offered during rehabilitation, the level of social support received by athletes may positively and/or negatively impact their experience. Numerous coping strategies used during rehabilitation were identified, including goal setting.
    CONCLUSION: The findings suggest that despite injury rehabilitation resulting in a range of emotions for athletes, minimal psychological support is offered, though positive social support can benefit experiences. Due to significant variation in definitions, including injury severity, it is difficult to draw consistent conclusions about athletes' rehabilitation experiences. Future research should explore dynamic responses to injury throughout rehabilitation where possible. This information is critical for supporting competitive athletes' mental or psychological wellbeing during injury rehabilitation.
    Keywords:  Athletes; Athletic injuries; Coping skills; Emotions; Goals; Mental health; Social support; Sport
    DOI:  https://doi.org/10.1186/s13643-025-02986-x
  9. Diagnostics (Basel). 2025 Nov 27. pii: 3017. [Epub ahead of print]15(23):
    Ultrasound-Guided Lumbar Plexus Injection: A Cadaveric Validation.
    Ondřej Naňka, Kamal Mezian, Ke-Vin Chang, Wei-Ting Wu, Vincenzo Ricci, Levent Özçakar.
      Ultrasound (US) has gained increasing acceptance for evaluating the axial spine, including the lumbar region. While its accuracy for superficial structures such as facet joints and medial branches has been validated, evidence supporting its use for deeper targets, such as the lumbar plexus, remains limited. This cadaveric study aimed to assess the feasibility of US-guided lumbar plexus injection. A fresh-frozen female cadaver with a body mass index of 23 kg/m2, prepared using the "Fix-for-Life" technique, was utilized. Using a 2-5 MHz curved linear transducer (HS30; Samsung Medison, Seoul, Republic of Korea), injections were performed with an in-plane approach under continuous needle visualization. A 20-gauge, 7 cm spinal needle was used to deliver 5 mL of green dye targeting the L3 and L4 nerve roots. Dissection confirmed that L3 injection achieved dye spread to the extraforaminal region, whereas L4 injection demonstrated anterior dye distribution adjacent to the intervertebral foramen. The main limitations included the use of a single specimen and acoustic shadowing from articular processes, which impeded visualization of neural structures. This study demonstrates the feasibility of US-guided lumbar plexus injection and supports its potential application in clinical pain management, although further validation with larger sample sizes is warranted.
    Keywords:  injection; lumbar plexus; pain; sonography; spinal nerve
    DOI:  https://doi.org/10.3390/diagnostics15233017
  10. Cureus. 2025 Nov;17(11): e96069
    Sural Nerve Entrapment in Postoperative Scar Tissue: A Case of Successful Management With Hydrodissection After Calcaneal Fracture Repair.
    Yonghyun Yoon, King Hei Stanley Lam, Ji Hyo Hwang, Dongyeun Sung, Jaeyoung Lee, Teinny Suryadi, Daniel Chiung-Jui Su.
      Sural nerve entrapment is a recognized yet frequently overlooked etiology of persistent lateral ankle and heel pain following lower extremity trauma or surgery. This report describes a case of refractory sural nerve entrapment within scar tissue that persisted after calcaneal fracture repair and subsequent hardware removal, which was successfully managed with ultrasound-guided hydrodissection. A 31-year-old male presented with refractory right heel pain following open reduction and internal fixation (ORIF) for a calcaneal fracture and subsequent elective hardware removal. Physical examination revealed allodynia and hyperesthesia along the surgical scar, accompanied by a positive jump sign. Diagnostic ultrasonography confirmed entrapment of the sural nerve within adjacent hypoechoic scar tissue. The diagnosis was dynamically confirmed using sonoguided digital palpation (SDP), which precisely reproduced the patient's characteristic pain at the site of nerve-scar adhesion. The patient subsequently underwent two sessions of ultrasound-guided hydrodissection with 5% dextrose in water (D5W). He experienced significant and immediate pain relief after the first procedure, reporting over 90% symptom resolution following the second session, which was sustained at follow-up. This case highlights that sural nerve entrapment should be considered in the differential diagnosis of persistent lateral heel pain following calcaneal surgery, even after hardware removal. A comprehensive diagnostic workup incorporating dynamic ultrasound with SDP can reliably identify and confirm the symptomatic site of entrapment. Ultrasound-guided hydrodissection represents a safe, effective, and minimally invasive therapeutic option that can facilitate substantial symptom relief and functional improvement, potentially obviating the need for more extensive surgical interventions.
    Keywords:  calcaneus fracture; hydrodissection; nerve entrapment; neuropathic pain treatment; post surgical scar; post-surgical neuropathy; post-surgical pain; sonoguided digital palpation; sural nerve; ultrasound-guided intervention
    DOI:  https://doi.org/10.7759/cureus.96069
  11. Cureus. 2025 Nov;17(11): e95978
    Symptom Improvement in a Patient With Chronic Pronator Teres Syndrome Treated With Ultrasound-Guided Hydrodissection and Manual Therapy: A Case Report.
    Yusuke Nishimaki, Masashi Kawabata, Atsuro Yamazaki, Wataru Iwamoto.
      Pronator teres syndrome (PTS) is an uncommon neuropathy caused by compression of the median nerve at the proximal forearm, resulting in paresthesia and pain in the radial digits. Although conservative management is typically the preferred initial approach, chronic and refractory cases often require multimodal treatment strategies. A 55-year-old female truck driver presented with a five-year history of persistent bilateral numbness and pain radiating from the palms to the distal phalanges. Physical examination revealed positive pronator compression and bilateral upper limb neurodynamic tests, with a numerical rating scale (NRS) score of 8/10. Palpation during ultrasound imaging demonstrated localized tenderness and radiating pain around the pronator teres and median nerve. Cervical pathology and carpal tunnel syndrome were excluded. The patient underwent ultrasound-guided hydrodissection of the median nerve at the pronator teres level every two weeks, combined with manual mobilization and a prescribed home-based exercise program. Symptomatic relief was achieved after the first session, and after four treatment sessions over two months, the NRS score improved from 8/10 to 3/10. Functional recovery was achieved, and the patient successfully maintained symptom control through continued adherence to the home-based exercise program. This report highlights the potential effectiveness of a multimodal strategy for addressing chronic PTS. Ultrasound-guided hydrodissection may improve mobility of the median nerve by reducing perineural restrictions, while manual mobilization and gliding exercises are likely to provide complementary therapeutic effects. Given the chronicity of the patient's condition, the early and sustained response underscores the potential utility of combining these techniques in refractory cases. Ultrasound-guided hydrodissection, when combined with manual therapy and a structured home-based exercise program, may represent a minimally invasive and effective management option for chronic pronator teres syndrome that is unresponsive to conservative care.
    Keywords:  manual mobilization techniques; median nerve entrapment; peripheral nerve restrictions; rehabilitation exercises; upper extremity neuropathy
    DOI:  https://doi.org/10.7759/cureus.95978
  12. Cells. 2025 Dec 01. pii: 1899. [Epub ahead of print]14(23):
    Conservative Management of Focal Chondral Lesions of the Knee and Ankle: Current Concepts.
    Filippo Migliorini, Raju Vaishya, Julian Koettnitz, Madhan Jeyaraman, Luise Schäfer, Jörg Eschweiler, Francesco Simeone.
      Focal chondral defects of the knee and ankle remain a challenging clinical condition, particularly in young and active patients, as they often cause pain, mechanical symptoms, and functional limitation without necessarily progressing to osteoarthritis (OA). This narrative review summarises current evidence on non-operative strategies for managing focal chondral lesions in non-arthritic joints, emphasising the role of rehabilitation as the central component of care. A thematic literature search was conducted across major databases for studies published between 2000 and 2025, selecting articles based on clinical relevance. Structured rehabilitation programmes based on load optimisation, neuromuscular retraining, and progressive strengthening represent the foundation of conservative management. Pharmacological agents and intra-articular injectables may provide temporary relief, although the evidence supporting their efficacy remains heterogeneous and primarily short-term. Nutraceuticals and physical modalities show encouraging but inconsistent results, limited by methodological variability and undefined dosing. Overall, conservative treatment should be tailored to the individual patient's biomechanical and biological profile, integrating rehabilitation with selected adjuncts when appropriate. Future research should focus on developing standardised rehabilitation protocols, identifying predictors of recovery, and clarifying the biological mechanisms that sustain symptom improvement in focal cartilage pathology.
    Keywords:  ankle cartilage defect; focal cartilage injury; hyaluronic acid; joint preservation; non-operative treatment; platelet-rich plasma; rehabilitation
    DOI:  https://doi.org/10.3390/cells14231899
  13. Knee. 2025 Dec 11. pii: S0968-0160(25)00314-X. [Epub ahead of print]58 104292
    Efficacy and safety of a single intra-articular injection of mannitol-combined hyaluronan in patients with knee osteoarthritis - A double-blinded randomized clinical study.
    Chun-Yu Chen, Cheng-Chang Lu, I-Hsiu Liou, Ming-Hsuan Huang, Ruei-Sian Ding, Shu-Fen Sun.
       BACKGROUND: Treatments for knee osteoarthritis (OA) include injections such as hyaluronic acid (HA), which stabilizes joints but degrades quickly due to reactive oxygen species. The experimental product JETKNEE combines non-crosslinked HA (20 mg/ml) with 0.5 % mannitol, that may slow HA degradation and extend its effect, but with a limited clinical evidence base.
    OBJECTIVE: To evaluate the efficacy and safety of a single intra-articular injection of JETKNEE versus saline in patients with symptomatic knee OA.
    METHODS: In this double-blind randomized trial, 132 patients with Kellgren-Lawrence grade 2-3 OA received 2 ml of either JETKNEE or saline. The primary outcome was change in visual analog scale (VAS) pain score at 6 months. Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, ultrasound evaluation of cartilage thickness, quadriceps muscle thickness, OA cartilage grading, and adverse events.
    RESULTS: VAS pain improved significantly in both groups without between-group difference. JETKNEE showed significantly greater improvement in WOMAC pain, function, and total scores across all time points (P < 0.05). Lequesne index improved more rapidly at early visits. No significant differences were observed in ultrasound findings or patient satisfaction. Adverse events were more frequent in the JETKNEE group but were mostly mild.
    CONCLUSION: A single injection of JETKNEE did not show superiority to placebo in the primary outcome (VAS pain), but demonstrated improvements in secondary functional outcomes for 6 months in patients with knee OA.
    Keywords:  Hyaluronic acid; Intra-articular injection; Knee osteoarthritis; Mannitol; Viscosupplementation
    DOI:  https://doi.org/10.1016/j.knee.2025.11.018
  14. Cureus. 2025 Nov;17(11): e95996
    The "Nail File Sign": A Report of Three Cases With Varied Etiologies.
    Vasudeva G Iyer, Lisa B Shields, Yi Ping Zhang, Christopher B Shields.
      Similar to the Wartenberg, Froment, and Duchenne signs, the more recently described "nail file sign" is also considered a diagnostic feature of ulnar nerve neuropathy. The "nail file sign" indicates a patient's inability to maintain the distal interphalangeal (DIP) joints of the small and ring fingers in a flexed position for filing the nail. Localizing the site of an ulnar nerve lesion is based on the topography of muscle weakness. The presence of the "nail file sign" points to a location at or proximal to the branch of the flexor digitorum profundus (FDP) muscle. We describe three patients who exhibited the "nail file sign," each with a different etiology. One patient had an ulnar nerve neuropathy at the elbow from compression by a cyst, another had ulnar neuropathy from entrapment at the cubital tunnel, and the third had it from an injury to the FDP tendons attached to the small and ring fingers. Testing for weakness of flexion at the DIP joints of the ring and small fingers should be an essential part of the clinical evaluation of patients with ulnar neuropathy, as it provides an important clue for anatomic localization of the lesion. Ultrasound studies complement the electrodiagnostic evaluation, not only to confirm the location but also to determine the cause of the ulnar nerve neuropathy.
    Keywords:  cubital tunnel syndrome; electrodiagnostic studies; nail file sign; neurology; ulnar nerve; ulnar neuropathy; ultrasound studies
    DOI:  https://doi.org/10.7759/cureus.95996
  15. J Orthop Surg Res. 2025 Dec 10. 20(1): 1065
    Progress in the clinical use of bone marrow aspirate concentrate for knee osteoarthritis: an expert opinion.
    Filippo Migliorini, Marco Pilone, Francesco Simeone, Madhan Jeyaraman, Andreas Bell, Nicola Maffulli.
      Knee osteoarthritis (OA) is a common degenerative joint condition and a major cause of disability. Orthobiological therapies aim to regenerate articular cartilage and delay or stop the progression of the degenerative lesion. Intra-articular injections of biological derivatives have been increasingly used in the last decade, although the indications for using bone marrow aspirate concentrate (BMAC) are still unclear. The present expert opinion reviewed the current literature on BMAC in the management of knee OA, providing an update on the current indications for the selection of the ideal patient, as well as the preparations and efficacy of BMAC compared to other biological alternatives. Clinical studies that investigated BMAC in the management of knee OA were identified and discussed. BMAC is a valuable source of mesenchymal stem cells, offering potential benefits in attenuating the inflammatory pathway associated with knee OA. Intra-articular administration of BMAC has shown effectiveness in clinical trials, improving the functional outcomes of patients. However, the superiority of BMAC over other orthobiologic treatments cannot be assessed, given the conflicting results presently available.
    Keywords:  BMAC; Biological derivatives; Bone marrow aspirate concentrate; Knee osteoarthritis
    DOI:  https://doi.org/10.1186/s13018-025-06509-1
  16. Medicine (Baltimore). 2025 Dec 05. 104(49): e46035
    Anterior nerves of the knee (ANK) block: A novel motor sparing fascial plane block for analgesia of the knee: Observational cohort study.
    Onur Balaban, Ridvan Işik, Ali Eman, Keziban Karacan, Kemal Nas.
      Knee osteoarthritis is a widespread disorder that may contribute to severe chronic pain. Multiple nerve blocks are implemented for analgesia of the knee, which have some restrictions, including the need for multiple injections, making the procedure complicated. We aimed to introduce a novel ultrasound-guided nerve block technique for analgesia of the knee. The study presents a description of the anterior nerves of the knee block and its application to individuals with knee osteoarthritis. Local anesthetic was injected (20 mL of 0.25% bupivacaine) within the fascia between the rectus femoris and vastus muscles in 42 patients with severe knee pain. The pain charts of the patients were reviewed and numerical rating pain scores (NRS) before and 1st hour, 1st month after the block were evaluated. First-month Western Ontario and McMaster Universities Arthritis Index (WOMAC) was also reviewed. The block was also performed in a fresh embalmed cadaver with methylene blue to identify the distribution of the injected dye. The mean age of patients was 65.3 ± 7.8 years. The mean NRS before block performance was 8.0 ± 1.2. The NRS score at 1 hour and 1 month after the block, decreased to 1.5 ± 1 and 4.4 ± 1.2, respectively. The decrease was statistically and clinically significant (P = .000). Mean WOMAC score was 71.6 ± 14.5 before the block which decreased to 42.7 ± 14.9 one month after the block (P = .000). No muscle weakness, motor block, or block-related complications were observed. Methylene blue spread in the cadaver was between the rectus femoris and vastus muscles, covering the nerves that innervate the anterior region of the knee. The novel anterior nerves of the knee block provided sufficient analgesia at the first hour and first month, and improved 1-month WOMAC scores in patients with chronic pain at the anterior of knee.
    Keywords:  anterior knee pain; fascial plane block; knee osteoarthritis; nerve block
    DOI:  https://doi.org/10.1097/MD.0000000000046035
  17. Front Surg. 2025 ;12 1687970
    Combined flexor sheath and gastrocnemius aponeurosis flap for the treatment of chronic calcified Achilles tendon rupture: a case report.
    Shuangqiang Tu, Zhongshan Li, Mengying Xiao, Wensheng Zhu, Yi Shao.
       Introduction: The Achilles tendon is the largest tendon in the human body and is prone to rupture when subjected to excessive dorsiflexion trauma of the ankle joint. The primary goal of treatment is to restore limb function; however, there remains considerable debate regarding the optimal management strategy.
    Patient concerns: We report a patient presenting with chronic Achilles tendon rupture accompanied by calcification of the tendon, which caused persistent pain and functional limitation of the affected limb.
    Diagnosis: Chronic Achilles tendon rupture with associated tendon calcification, with a tendon defect measuring approximately 6 cm on preoperative imaging, confirmed by clinical examination and imaging evaluation.
    Interventions: The patient underwent surgical removal of the calcified lesion, followed by reconstruction of the tendon defect using a gastrocnemius aponeurosis flap combined with the Achilles tendon sheath.
    Outcomes: Postoperative recovery was favorable, and at the 6-month follow-up, the patient achieved satisfactory ankle function with an AOFAS score of 89, a VISA-A score of 91, and an ATRS score of 90. At the 12-month follow-up, functional outcomes remained stable, with an AOFAS score of 95, a VISA-A score of 96, and an ATRS score of 94, confirming sustained recovery and tendon integrity.
    Conclusion: This case highlights a feasible surgical strategy for chronic Achilles tendon rupture with calcification, which may provide an alternative approach for tendon reconstruction in patients with sheath proliferation and calcified lesions.
    Keywords:  Achilles tendon; calcification; case report; chronic rupture; suture anchor
    DOI:  https://doi.org/10.3389/fsurg.2025.1687970
  18. Sports Med Open. 2025 Dec 12. 11(1): 158
    Calf Strains in Athletes: A Narrative Review of Management, Injury Grading, and Return to Sport.
    Robert Pagan-Rosado, Wesley Troyer, Raul Rosario-Concepcion, Brandon Feaster, Sebastian Encalada, Brett Kindle, Carles Pedret.
       BACKGROUND: Calf strains are common in sports like football, rugby, and tennis, with high recurrence rates during competition. Despite their frequency, there are no universally accepted guidelines for managing these injuries based on grading systems or imaging modalities. This review aims to evaluate the role of imaging and injury grading in predicting return to sport following a calf strain.
    METHODS: A systematic search was conducted to assess the role of imaging and grading in predicting return to sport in athletes with calf strains. A search of Scopus and PubMed in June 2024 identified relevant studies using terms related to calf strains, imaging, and return to sport. Eligible studies involved human participants, used imaging for diagnosing or grading calf injuries, and assessed return to play outcomes. Studies were excluded if they involved animals, lacked imaging, or did not report relevant outcomes. The screening was done by a team of investigators based on predefined criteria.
    RESULTS: The review identified that imaging, particularly ultrasound and MRI, offers valuable information for grading calf strains and predicting recovery timelines. Different grading systems correlated with clinical outcomes, but no single modality or grading system was universally superior. Clinical assessments remained essential in return to play decisions.
    CONCLUSIONS: Imaging modalities, along with injury grading, provide useful insights into calf strain severity and recovery. However, these tools should complement clinical assessments, which are the gold standard for return to sport decisions. An integrative approach combining imaging and clinical evaluation is recommended to optimize return to sport protocols. Further standardization of grading systems and imaging protocols may improve prediction accuracy and treatment outcomes for calf strains.
    Keywords:  Calf strain; Grading; MRI; Rehabilitation; Return to sport; Ultrasound
    DOI:  https://doi.org/10.1186/s40798-025-00960-4
  19. World J Clin Cases. 2025 Dec 06. 13(34): 110925
    Acute massive rotator cuff tear and biceps tendon dislocation following posterior shoulder dislocation: A case report.
    Meng-Yu Liu, Chang-Hao Lin, Shih-Hao Chen, Yu-Sian Ding, Chen-Hao Chiang.
       BACKGROUND: Posterior shoulder dislocation is a rare injury. It accounts for only 1%-4% of all shoulder dislocation cases. However, this injury is often underdiagnosed. Massive rotator cuff tears associated with posterior shoulder dislocation are exceptionally rare. Early diagnosis and surgical management are crucial for restoring shoulder function and preventing long-term disability.
    CASE SUMMARY: A 60-year-old male with no previous shoulder injuries presented to our hospital with severe right shoulder pain and immobility after a motorcycle accident. He reported that he braced his fall with his right hand. Initial imaging examination revealed posterior shoulder dislocation with minimal glenoid bone loss. Six days after the injury, the patient exhibited pseudoparalysis and active forward flexion limited to 10°. Two weeks after the injury, magnetic resonance imaging revealed complete tears of the supraspinatus, infraspinatus, and subscapularis muscles as well as dislocation of the long head of the biceps tendon. Arthroscopic rotator cuff repair was performed 6 weeks after injury. The tendon quality was acceptable with minimal fatty infiltration. At the 12-month surgical follow-up, the patient had recovered full strength and complete range of motion.
    CONCLUSION: Early diagnosis and tailored repair of massive rotator cuff tears after dislocation are crucial for restoring shoulder function in older patients.
    Keywords:  Biceps tendon; Case report; Elderly; Rotator cuff injuries; Shoulder dislocation; Treatment outcome
    DOI:  https://doi.org/10.12998/wjcc.v13.i34.110925
  20. J Clin Med. 2025 Dec 04. pii: 8590. [Epub ahead of print]14(23):
    Rehabilitation in Amyotrophic Lateral Sclerosis: Recommendations for Clinical Practice and Further Research.
    Andreas Gratzer, Natalie Gdynia, Nadine Sasse, Rainer Beese, Cordula Winterholler, Yvonne Bauer, Carsten Schröter, Hans-Jürgen Gdynia.
      Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative condition characterized by the degeneration of upper and lower motor neurons. This degeneration leads to a gradual muscle weakness, dysarthria, dysphagia, respiratory insufficiency, and, in some patients, alterations in cognitive and behavioral performance. Regardless of advancements made in pharmacological and gene-targeted interventions, a definitive curative treatment remains elusive. Consequently, rehabilitation plays a pivotal role in preserving autonomy, participation, and overall quality of life. This review outlines the current evidence and clinical approaches related to multidisciplinary rehabilitation in ALS. It covers physical and occupational therapy, respiratory, speech and language, psychological, and palliative care domains. Evidence supports moderate tailored exercise programs, early respiratory therapy, and structured management of mobility deficits, spasticity, pain, dysphagia, and communication impairments as key elements of symptomatic treatment. Psychological and social support, which includes the involvement of caregivers and relatives, enhances emotional well-being and coping resilience. Even with progressive development of gene-targeted and disease-modifying therapies, rehabilitation will stay relevant for maintaining long-term motor function. This review highlights the need for standardized, evidence-based rehabilitation protocols and intensified neurorehabilitation research to strengthen clinical outcomes and quality of life as key therapeutic goals in ALS management.
    Keywords:  amyotrophic lateral sclerosis; motoneuron disease; neuromuscular disorders; neurorehabilitation; rehabilitation
    DOI:  https://doi.org/10.3390/jcm14238590
  21. Int J Surg. 2025 Dec 08.
    Letter to the editor: outcome comparison of arthroscopic latissimus dorsi tendon transfer and muscle advancement for irreparable rotator cuff tear: a systematic review.
    Jingmin Song, Yunxia Du.
      
    DOI:  https://doi.org/10.1097/JS9.0000000000004183
  22. Pain Ther. 2025 Dec 13.
    The Diagnosis and Management of Pudendal Neuralgia.
    Mohammed Ahmed, Periklis Zavridis, Despina Hadjiconstanti, Panagiotis Zis.
       INTRODUCTION: Pudendal neuralgia (PN) is a chronic neuropathic pain syndrome affecting the pudendal nerve, often presenting with perineal or pelvic pain exacerbated by sitting. The aim of this systematic review was to summarize the existing knowledge on the diagnosis and management of PN.
    METHODS: A PubMed database search identified 475 articles, of which 35 met the inclusion criteria. Nine studies focused on diagnostic strategies, and 26 on management.
    RESULTS: Diagnosis of PN is largely clinical, with the Nantes criteria providing a widely adopted framework. Imaging modalities such as MRI and MR neurography, along with neurophysiological tests including quantitative sensory testing, have been explored as adjuncts, though their roles remain limited. Pudendal nerve blocks are both diagnostic and therapeutic, with response rates up to 94%. Management follows a stepwise approach, beginning with conservative therapies and progressing to nerve blocks, and extending to neuromodulation or surgery when necessary. Pulsed radiofrequency and nerve stimulation techniques demonstrate promising results, with reported pain reduction in up to 95% of refractory cases, though long-term durability remains uncertain. Surgical decompression remains the most common operative option, with several techniques described.
    CONCLUSIONS: Despite the established recognition of PN, there is a paucity of high-quality comparative studies and randomized controlled trials assessing diagnostic accuracy and treatment efficacy. Current evidence suggests conservative measures and nerve blocks are sufficient for most patients, with stimulation techniques and decompression surgery reserved for refractory cases. Emerging modalities may offer future therapeutic options, but require validation in larger cohorts.
    Keywords:  Chronic pelvic pain; Nantes criteria; Nerve decompression; Nerve stimulation; Pudendal nerve block; Pudendal neuralgia
    DOI:  https://doi.org/10.1007/s40122-025-00803-w
  23. Pain Res Manag. 2025 ;2025 6649252
    Intra- and Postoperative Botulinum Toxin Injection in Postsurgical Pain Management: A Literature Review.
    Sogol Alikarami, Saereh Hosseindoost, Ahmad Reza Dehpour, Zahra Rezaei, Hossein Majedi.
      Postoperative pain remains a significant challenge in surgical services, which necessitates improving analgesic strategies to enhance patient outcomes. Botulinum neurotoxin (BoNT), which was primarily approved for the treatment of strabismus and blepharospasm, has demonstrated a promising impact on pain reduction through mechanisms such as neurotransmitter inhibition, receptor modulation, glial activity suppression, and interactions with opioidergic and GABAergic systems. A number of studies have investigated BoNT's impact on postsurgical pain. However, there is a lack of evaluation of its efficacy, safety, and optimal administration protocols across different surgical settings. This study aims to provide a comprehensive overview of the existing literature on the efficacy and complications of intra- and postoperative BoNT injections in managing postsurgical pain across various surgical procedures, including orthopedic and head and neck surgeries, mastectomy, hemorrhoidectomy, and fissurectomy.
    Keywords:  analgesics; botulinum neurotoxin; pain; postoperative pain
    DOI:  https://doi.org/10.1155/prm/6649252
  24. Vopr Kurortol Fizioter Lech Fiz Kult. 2025 ;102(5. Vyp. 2): 50-56
    [Role of training in biofeedback - an associated system of 3D video analysis of movements in comprehensive rehabilitation programs for patients after total knee arthroplasty].
    S M Konev, D G Tagabilev, N N Tolstykh, E N Zhumanova, T B Khaptagaev, A S Mochalova, K V Lyadov, E S Koneva.
      The priority goals of medical rehabilitation in the early postoperative period after total knee arthroplasty (TKR) are to eliminate abnormal movement patterns and improve patients' quality of life. This is directly related to effective early patient activation, which is only possible with low pain severity. Modern technologies that enable graduated patient activation with training of complex, coordinated dynamic patterns in a biofeedback (BFB) system in a virtual space simulation enable ergonomic control of motor intensity, preventing increased pain in patients in the early postoperative period. Combining motor rehabilitation with physiotherapy methods promotes more effective pain relief, which complicates patient activation.
    OBJECTIVE: Evaluation of the effectiveness of comprehensive early postoperative rehabilitation programs using a rehabilitation complex with biofeedback and 3D modeling of motor video analysis on the D-Wall rehabilitation system (DIH S.r.l., Florence, Italy), including in combination with local cryotherapy or electro-magnetic therapy in patients in the early recovery period of rehabilitation after total knee arthroplasty (TKR).
    MATERIAL AND METHODS: The study involved 105 patients, aged 58 to 75 years, receiving early comprehensive postoperative rehabilitation programs after TKR surgery. All patients were divided into three equal groups: patients of group 1 (n=35) underwent a comprehensive rehabilitation program, including therapeutic exercises in the form of individual sessions, massage of the area of the operated limb in an electrostatic field, local magnetic therapy on the knee joint area. Patients of group 2 (n=35), in addition to the specified program, received procedures of complex-coordinated training in the D-Wall system and local cryotherapy on the knee joint. Patients of group 3 (n=35), in combination with the standard rehabilitation program and training on the.
    D-Wall, received procedures of high-intensity electro-magnetic stimulation on the EMW MED device (Russia). Evaluation of the effectiveness of the rehabilitation programs was carried out before the course and after its completion (on the 14th day) using the VAS (visual analogue scale of pain), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), goniometry, 6-minute walk test, flexion and extension angles in the knee joint, analysis of complaints. All methods are interpreted from the standpoint of the International Classification of Functioning, Disability and Health (ICF).
    RESULTS: Statistically significant improvement in indicators was noted in all groups (p<0.05). The largest improvements were recorded in Groups 2 and 3: pain reduction according to the VAS was 58 and 62%, respectively (versus 44% in Group 1), function improvement according to the WOMAC was 52 and 56% (versus 41%), range of motion increased to 108° and 110° in flexion (versus 102°), and 6-minute walk distance improved by 38 and 41% (versus 30%).
    CONCLUSION: Incorporating training on the D-Wall rehabilitation system into comprehensive early postoperative rehabilitation programs for patients undergoing TKA promotes faster recovery of motor function. The addition of local cryotherapy or high-intensity magnetic stimulation enhances the effect, particularly in terms of pain relief and swelling reduction.
    Keywords:  3D video reconstruction; D-Wall; biofeedback; complex-coordinated training; cryotherapy; early rehabilitation; electro-magnetic stimulation; functioning; total knee arthroplasty
    DOI:  https://doi.org/10.17116/kurort202510205250
  25. Radiol Res Pract. 2025 ;2025 6270476
    Comparative Diagnostic Accuracy of MRI and Ultrasound in Meniscal Tear Detection: Evaluating Reliability and Limitations Against Arthroscopic Outcomes.
    Yasser Noorelahi.
       Objective: Accurate meniscal tear diagnosis is essential for proper knee injury management. While MRI is the gold standard, ultrasound (US) offers a cost-effective alternative. However, its accuracy compared to arthroscopy remains uncertain. This study evaluates the diagnostic performance of US versus MRI, using arthroscopic outcomes as the benchmark for meniscal tear detection.
    Methods: A prospective cohort study was conducted on 208 patients aged 18-60 years with suspected meniscal injuries. Each patient underwent both US and MRI, with findings compared to arthroscopy, the gold standard for confirmation. Clinical, imaging and arthroscopic data were systematically recorded and analysed for sensitivity, specificity and diagnostic agreement. The McNemar test was used to assess differences in sensitivity and specificity between US and MRI, while the κ coefficient evaluated the agreement between US, MRI and arthroscopy.
    Results: MRI demonstrated higher diagnostic accuracy (91.83%) compared to US (84.62%) in detecting meniscal tears, using arthroscopy as the gold standard. MRI showed superior sensitivity (96.19% vs. 86.67%), specificity (87.38% vs. 82.52%) and agreement (κ = 0.836 vs. 0.692), with a significant difference compared to arthroscopy (p=0.049).
    Conclusion: Overall, MRI demonstrated superior diagnostic accuracy, sensitivity and specificity compared to US, suggesting that it is a more reliable imaging modality for detecting meniscal tears when arthroscopy is not feasible. In addition, US limitations in detecting complex tear patterns highlight the need for further refinement of US techniques.
    Keywords:  arthroscopy; diagnosis; magnetic resonance imaging; meniscal tears; ultrasound
    DOI:  https://doi.org/10.1155/rrp/6270476
  26. J Clin Med. 2025 Nov 28. pii: 8467. [Epub ahead of print]14(23):
    Musculoskeletal Digital Therapeutics and Digital Health Rehabilitation: A Global Paradigm Shift in Orthopedic Care.
    Youn Kyu Lee, Eun-Ji Yoon, Tae Hyung Kim, Jong-Ick Kim, Jong-Ho Kim.
      Musculoskeletal disorders (MSDs) affect over 1.7 billion people globally and represent the leading cause of disability worldwide. Conventional rehabilitation strategies face challenges including limited accessibility, suboptimal adherence, and lack of personalization. Digital therapeutics (DTx)-evidence-based, software-driven interventions regulated as medical devices-have emerged as transformative solutions in chronic disease management. This review provides a narrative synthesis of representative studies in the field, drawing on a broad survey of literature from medical and engineering sources to capture current trends and clinically relevant developments. Seventy-five publications were examined, including clinical trials and validation studies, many of which reported outcomes comparable or superior to traditional rehabilitation approaches, with adherence gains of 15-40% and cost reductions of approximately 30-40%. We summarize the major technological foundations of musculoskeletal DTx and digital rehabilitation across orthopedic subspecialties, describing core-enabling technologies including artificial intelligence-driven motion analysis, wearable sensors, tele-rehabilitation platforms, and cloud-based ecosystems. Clinical applications spanning spine, upper and lower extremities, sports injuries, and trauma were analyzed alongside global regulatory frameworks, economic considerations, and implementation challenges. Early clinical evidence demonstrates improvements in functional outcomes, adherence, and cost-effectiveness. Future directions include digital twin-based precision rehabilitation, predictive analytics, and scalable integration into value-based orthopedic care. By establishing a comprehensive framework for musculoskeletal DTx implementation, this review highlights their potential to improve outcomes, reduce healthcare costs, and address global rehabilitation access gaps. However, evidence on long-term effectiveness, sustained cost benefits, and large-scale clinical integration remains limited and warrants further investigation.
    Keywords:  artificial intelligence; digital therapeutics; musculoskeletal rehabilitation; orthopedic surgery; precision orthopedics; tele-rehabilitation; wearable sensors
    DOI:  https://doi.org/10.3390/jcm14238467
  27. J Int Med Res. 2025 Dec;53(12): 3000605251404782
    All-arthroscopic repair of talar-sided anterior talofibular ligament insertion tears using knotless anchors: A retrospective case series.
    Feng Liu, Hao Pan, Ruo-Kun Huang.
      ObjectiveTo describe the surgical technique and evaluate the clinical efficacy of all-arthroscopic knotless anchor repair for talar-sided anterior talofibular ligament tears in the treatment of chronic lateral ankle instability.MethodsThis retrospective case series included 11 patients treated between February 2020 and October 2022. All patients presented with persistent lateral ankle pain and instability following an ankle sprain that did not respond to at least 6 months of conventional conservative management. Preoperative assessment included physical examination (positive anterior drawer and varus stress tests) and magnetic resonance imaging, which verified talar-sided anterior talofibular ligament insertion tears. The procedure was performed under complete arthroscopic visualization. Initially, the ankle joint was debrided to remove hyperplastic synovium and loose bodies. Then, the anterior talofibular ligament was tensioned using a suture tape passed through a two-wire loop sleeve. Finally, the ligament was secured with an absorbable knotless anchor implanted at the anatomical talar insertion site of the anterior talofibular ligament.ResultsAll 11 patients were followed up for a mean duration of 13.27 ± 2.41 months. At the final follow-up, significant clinical improvements were observed compared with the preoperative status: the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score increased from 42.62 ± 2.2 to 95.73 ± 1.43 (p < 0.001), and the pain score on a visual analog scale decreased from 6.47 ± 1.25 to 1.73 ± 1.26 (p < 0.001). No postoperative complications occurred, including wound infection, cutaneous nerve injury, or recurrent ankle instability. All patients reported improved ankle stability and returned to daily activities without significant limitation.ConclusionFor patients with chronic lateral ankle instability caused by talar-sided anterior talofibular ligament insertion tears, all-arthroscopic knotless anchor repair results in minimal surgical trauma, enables safe and reliable anatomical restoration of the ligament, and yields satisfactory short-term functional outcomes and pain relief. However, given the limitations of the retrospective case series design, including a small sample size and lack of a control group, further prospective studies with larger cohorts are needed to validate its long-term efficacy.
    Keywords:  Ankle instability; anterior talofibular ligament; arthroscopy; knotless suture anchor; ligament repair
    DOI:  https://doi.org/10.1177/03000605251404782
  28. J Pak Med Assoc. 2025 Sep;75(9): 1468-1469
    Glucodynia.
    Sanjay Kalra, Navneet Agrawal, Nitin Kapoor.
      Pain in patients with diabetes can be unpleasant, but at times protective as well. We propose the term 'glucodynia' i.e., an unpleasant sensory and emotional experience, associated with or without any organ-system dysfunction, in people living with diabetes. Glucodynia may be due to microvascular, musculoskeletal, metabolic, mood-related, miasmatic, mitogenic, visceral myogenic, malnutritionrelated or medicine-related (iatrogenic) causes. In this manuscript we explain the different mechanisms of pain in patients living with diabetes. Furthermore, the therapeutic modalities that can be used to reduce pain sensation are described.
    Keywords:  Diabetic neuropathy, glucodynia, pain, paresthesia, person centered
    DOI:  https://doi.org/10.47391/JPMA.25-69
  29. Front Rehabil Sci. 2025 ;6 1729389
    Editorial: Insights in rehabilitation for musculoskeletal conditions 2023/2024.
    Maciej Płaszewski, Josette Bettany-Saltikov.
      
    Keywords:  functioning; lived experiences; measurement; musculoskeletal; physical activity; rehabilitation; terminology
    DOI:  https://doi.org/10.3389/fresc.2025.1729389
  30. Diagnostics (Basel). 2025 Nov 24. pii: 2985. [Epub ahead of print]15(23):
    Complementary Role of Ultrasound and Clinical Features in Assessing Carpal Tunnel Syndrome Severity: A Cross-Sectional Study.
    Daniela Nicoleta Popescu, Claudiu Costinel Popescu, Oana Morari, Natalia Blidaru, Alina Dima, Ioana Adriana Catanoiu, Alice Rakoczy, Ioana Otobic, Magda Ileana Parvu, Catalin Codreanu, Luminita Enache.
      Background/Objectives: The goal of this study was to assess the correlation between ultrasound measurements and nerve conduction study (NCS)-defined carpal tunnel syndrome (CTS) severity and to explore clinical and demographic factors associated with CTS severity in a sample of Romanian patients. Methods: We prospectively evaluated consecutive patients with clinically diagnosed CTS. All patients underwent standardized clinical assessment, ultrasonographic examination of the median nerve, and NCS. CTS severity was graded electrophysiologically (three-level scale), and associations with demographic, clinical, and ultrasound parameters were examined using univariate analyses and multivariable generalized estimating equation (GEE) models to account for within-patient clustering. Results: Among 193 CTS hands (100 patients, mean age 58 years, 93% female), electrophysiological severity correlated significantly with several ultrasound and clinical parameters. In multivariable GEE models, the presence of nocturnal symptoms, sensory loss, thenar weakness/atrophy, male sex, larger maximal median nerve cross-sectional area (mCSA), and impaired median nerve mobility were independent predictors of higher NCS-defined severity. Pseudo-R2 increased from 0.04 in the core clinical model to 0.25 when ultrasound parameters were included, indicating improved model performance. Conclusions: Ultrasound parameters, particularly mCSA and median nerve mobility, together with clinical features, such as nocturnal symptoms, sensory loss, and thenar weakness, are independently associated with NCS-defined CTS severity. These findings support the complementary role of ultrasound alongside NCS in severity grading and highlight its potential to guide timely diagnosis and management.
    Keywords:  carpal tunnel syndrome; nerve conduction study; ultrasound
    DOI:  https://doi.org/10.3390/diagnostics15232985
  31. J Orthop Res. 2026 Jan;44(1): e70107
    Load Management After Gluteal Tendon Repair: A Controlled Laboratory Study.
    Alexander Derksen, Celina Wicke, Eike Jakubowitz, Stefan Budde, Christof Hurschler, Henning Windhagen, Michael Schwarze.
      Tendon lesions of the gluteus medius muscle require surgical repair if conservative treatment fails. Postoperatively, the success of the therapy is influenced by the loading conditions during follow-up treatment. Excessive loading of the hip joint during walking after surgery - and consequently, potential overload of the repaired gluteal tendon - could jeopardize the success of the therapy. In this controlled laboratory study, six subjects performed an instrumented 3D gait analysis using optoelectronic motion capture under three different loading conditions: full weight-bearing, partial weight-bearing, and full unloading with crutches. Gait data were used in silico in an inverse dynamics multi-body simulation to calculate tendon loading. Peak loads occurred on the gluteal tendons and the hip joint during the stance phase. The force on the gluteus medius tendon during full weight-bearing amounted to Fme = 12.0 ( ± 1.5) N/kg BW, while the force on the gluteus minimus tendon was Fmi = 5.0 ( ± 1.6) N/kg BW. Partial weight-bearing reduced these loads by ≈ 68%, whereas full unloading led to a ≈ 88% reduction compared to full weight-bearing. In the hip joint, the average maximum load during full weight-bearing reached FH = 39.8 ( ± 6.7) N/kg BW. To prevent muscle atrophy after gluteal tendon repair, the highest possible load should be applied without compromising suture integrity. Full unloading should be implemented if the tendon and/or bone integrity is compromised and suture stability is reduced. However, if stability is sufficient, partial weight-bearing is recommended.
    Keywords:  GTPS; gait analysis; gluteal tendon repair; gluteus force; gluteus medius; rehabilitation after gluteal tendon repair
    DOI:  https://doi.org/10.1002/jor.70107
  32. Cureus. 2025 Nov;17(11): e96300
    Inveterate Section of Deep Flexor in Pediatric Hand, Periosteum Clues.
    David Mayorga-Naranjo, María Ángeles Blasco-Molla, Carmen Garcia-Espert.
      Diagnostic delay in flexor tendon injuries is common in pediatric patients, and age influences both recovery and postoperative management. We report the case of a three-year-old girl who presented with the inability to flex the distal interphalangeal joint of the left third finger, two months after the digit became entrapped in a chair. Ultrasonography revealed cortical ossification of the middle phalanx compressing the flexor tendon, without clear evidence of discontinuity. Surgical exploration was undertaken due to a strong clinical suspicion of flexor digitorum profundus rupture, revealing an old laceration with fibrotic changes. The proximal tendon stump was reattached to the distal phalanx using a pull-out suture; the bone lesion was left untreated. At six weeks, radiographs demonstrated ossification consolidation, consistent with periosteal injury secondary to a middle phalanx fracture. This case highlights the importance of examination under sedation for pediatric hand injuries. Periosteal injury can result in callus formation, and after tendon repair, postoperative immobilization may need to be prolonged compared with adult patients.
    Keywords:  chronic rupture; pediatric hand; periosteum injury; tendon ruputre; ultrasound
    DOI:  https://doi.org/10.7759/cureus.96300
  33. J Biomech. 2025 Dec 03. pii: S0021-9290(25)00616-5. [Epub ahead of print]195 113104
    Biceps brachii regional shear modulus following elbow flexion exercises at different muscle lengths.
    Amanda de Oliveira Silva, Maria Clara Albuquerque Brandão, Thiago Torres da Matta, Liliam Fernandes de Oliveira.
      The biceps brachii (BB) muscle, due to its biarticular nature, undergoes substantial length changes during exercise. Muscle elongation, particularly when the shoulder is extended, increases passive tension and may impair force production due to passive insufficiency. The distal BB appears vulnerable to mechanical strain and injury during eccentric contractions. This study investigated regional changes in BB shear modulus (μ) through shear wave elastography before and after elbow flexion exercises performed in three shoulder positions: flexion (45°), neutral (0°), and extension (-45°). Eighteen resistance-trained males performed 3 sets of 10 repetitions at 80 % of their one-repetition maximum in each condition. The μ was measured in the proximal and distal regions of the long and short heads of the BB, pre and post-exercise. A three-way repeated-measures MANOVA revealed significant effects of joint position on muscle length (p < 0.05) and pre-exercise μ, with values increasing from flexion to extension. K-means clustering revealed heterogeneous individual responses, with emphasis on the distal region of the long head of the BB, showing μ reductions in 78.6 % of subjects. Post-exercise reductions in μ in well-trained men suggest region-specific mechanical responses potentially linked to muscle damage, particularly in the distal long head of the BB during shoulder extension. Shear wave elastography proved effective in detecting changes in BB stiffness, supporting its application in training and rehabilitation studies. Heavy exercises at long muscle lengths should be prescribed with caution in untrained individuals due to elevated mechanical stress.
    Keywords:  Muscle Stiffness; Passive tension; Shear wave elastography; Ultrasound
    DOI:  https://doi.org/10.1016/j.jbiomech.2025.113104
  34. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2025 Nov 01. 46(3): 73-82
    Radial Extracorporeal Shock Wave Therapy Decreases Hand Spasticity After Stroke.
    Cvetanka Gjerakaroska Savevska, Erieta Nikolikj Dimitrova, Valentina Koevska, Biljana Mitrevska, Marija Gocevska, Biljana Kalcovska, Maja Manoleva, Daniela Gecevska.
      Introduction: Hand spasticity after a stroke reduces residual hand functions and decreases independence in everyday activities. It is a cause of pain, discomfort and one of the biggest obstacles encountered during the rehabilitation of patients with stroke consequences. Radial extracorporeal shock wave therapy (RESWT) is an enticing non-invasive treatment option for this medical problem. Objectives: The main goal of this clinical study was to evaluate the effects of RESWT in the treatment of hand spasticity after a stroke. Material and methods: This prospective controlled clinical study included 90 patients with post-stroke hand spasticity. At the beginning of the study, patients who met the inclusion criteria were divided into two groups: an examined group (EG) that received RESWT and a standard rehabilitation and a control group (CG) that received only a standard rehabilitation. In order to evaluate the efficiency of the treatment, the following clinical scales were used: Modified Ashworth Scale (MAS) and Disability Assessment Scale (DAS). Clinical findings were evaluated at the same time points in both groups of patients: before the start of the rehabilitation, immediately at the end of the 2nd, 6th and 14th week after the start of the rehabilitation (i.e., for the EG before the application of RESWT, immediately after the completion of RESWT, and at one and three months after the completion of RESWT). Results: The results indicated a significantly lower MAS score in the EG.DAS results from the analysis of all domains (hygiene, dressing, hand position, pain) indicated a significant decrease in disability in the EG compared to the CG by more than one average score in all control time measurement points. Conclusions: RESWT significantly reduced hand and fingers spasticity at the 2nd, 6th and 14th week following the start of the rehabilitation for more than one average MAS score (p<0.05). RESWT contributed to a significant decrease in disability of hygiene maintenance, dressing, hand position, and pain after the 2nd, 6th and 14th week of the start of the rehabilitation of post-stroke hand spasticity (p<0.05). No side effects were observed during and after application of RESWT. It is a safe, non-invasive therapeutic modality for hand spasticity after stroke.
    Keywords:  radial extracorporeal shock wave therapy; rehabilitation; spasticity; stroke
    DOI:  https://doi.org/10.2478/prilozi-2025-0024
  35. Ann Med. 2025 Dec;57(1): 2601406
    Assessment properties of the Visual Analogue scale, Numeric Rating Scale, Face Pain Scale, and Pain Intensity Subscale of the Brief Pain Inventory in Albanian population with low back pain.
    Jasemin Todri, Enkeleda Gjini, Orges Lena.
       BACKGROUND: Pain intensity is the primary variable assessed in clinical trials for low back pain. A precise assessment of pain intensity is vital for the informed selection of medical and rehabilitation treatments; it represents a notable challenge in clinical settings.
    METHODS: The four pain intensity scales - Visual Analogue Scale (VAS), Numeric Rating Scale (NRS), Faces Pain Scale (FPS), and Brief Pain Inventory (BPI-IS) - were administered to 200 Albanian participants with low back pain at a regional healthcare center in Albania with a mean age of 69.77 and a standard deviation (SD) of 6.34. The mean of pain duration was 3.51 with a SD of 0.72. Participants were subsequently asked to assess four domains of pain intensity - worst pain, average pain, least pain over the past week, and current pain. The data collection occurred during the patients' initial visits for low back complaints. To assess the convergent validity of the scales - specifically, the relationship between each scale and a composite score of all measures, a principal components analysis was performed.
    RESULTS: There were significant correlations among the four scales across all domains of pain intensity in the 200 participants. The screen test from the principal component analyses indicated that the four scales captured a single overarching domain for each of the four pain intensity areas, with the first eigenvalue ranging from 2.33 to 3.63 and the second from 0.16 to 0.43. Moreover, all the scales showed a strong loading on the single component that emerged. The four scales had the highest loading on 'current pain' component (>0.9).
    CONCLUSION: The VAS, NRS, FPS and BPI-IS are valid and can be used for the clinical and research implication in the Albanian population.
    TRIAL REGISTRATION: The study was registered at clinical trial.gov before the data collection with ID. NCT04131998.
    Keywords:  Albanian population; Measurement; pain intensity; validity
    DOI:  https://doi.org/10.1080/07853890.2025.2601406
  36. Einstein (Sao Paulo). 2025 ;pii: S1679-45082025000100285. [Epub ahead of print]23 eAO1192
    Effect of simplified exercise program on quality of life, biomarkers, pain and muscle strength of individuals with knee osteoarthritis.
    Rosana Ravagnani Campedelli, Mariana Rosada de Souza Jardim, Eliane Antonioli, Felipe Bruno Dias de Oliveira, Sudha Agarwal, Mario Ferretti.
       OBJECTIVE: To evaluate a simplified exercise program for patients with knee osteoarthritis in terms of pain, functionality, muscle strength, and quality of life. The correlation of serum levels of molecules and cytokines was evaluated after the exercise program.
    METHODS: Overall, 47 patients with knee osteoarthritis participated in this single-arm interventional study. Outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index, Quality of Life, Visual Analog Scale, Timed Up and Go functional test, and muscle strength assessment. Serum levels of molecules and cytokines were analyzed using enzyme-linked immunosorbent assays.
    RESULTS: The program resulted in improvements in pain and physical function (0.21 points; 95%CI=-0.26; -0.17), Visual Analog Scale (1.50; 95%CI=-1.90; -1.10), EuroQol-5 Dimension 3-Level (0.16; 95%CI=0.100; 0.227), and Timed Up and Go test (0.40; 95%CI=-0.57; -0.23). Significant differences were noted in the isokinetic knee flexion peak torque (0.16; 95%CI=0.10; 0.22), isometric knee extension (0.31; 95%CI=0.20; 0.43), and flexion (0.18; 95%CI=0.12; 0.23) peak torques for osteoarthritis. However, there was no significant difference in serum biomarker levels after the program, and there was no correlation between serum biomarker levels and clinical improvement outcomes.
    CONCLUSION: The simplified exercise program for patients with knee osteoarthritis patients effectively improved pain, functionality, muscle strength, and quality of life. However, biomarkers do not provide evidence of clinical improvement.
    CLINICALTRIALS.GOV IDENTIFIER: NCT02964624.
    DOI:  https://doi.org/10.31744/einstein_journal/2025AO1192
  37. J Hand Surg Glob Online. 2025 Nov;7(6): 100826
    Differences in the Outcomes of Early Active Mobilization Following Flexor Tendon Repair Between Zone 1 and Distal Zone 2 Injuries.
    Koji Moriya, Yutaka Maki, Hisao Koda, Masahiro Odagiri, Shota Matsuzawa, Naoto Tsubokawa.
       Purpose: Complete release of the A4 pulley is recommended for flexor tendon repair to allow smooth tendon excursion, provided the proximal sheath is mostly intact. However, it is unclear whether the active range of motion of finger joints differs when the flexor digitorum profundus tendon is repaired at different levels with A4 pulley release. We evaluated differences in the outcomes of flexor tendon repair of zone 1 and zone 2A injuries using a six-strand suture (the Yoshizu #1 technique) and complete release of the A4 pulley, followed by an early active mobilization protocol.
    Methods: This retrospective case series analyzed 27 fingers from 22 patients: 12 index, 5 middle, 4 ring, and 6 little fingers. There were 13 zone 1 injuries in 12 patients and 14 zone 2A injuries in 10 patients. All tendons were repaired using the same technique, followed by a controlled active mobilization regimen initiated within the first three postoperative weeks. The follow-up period averaged 7 months (range: 3-13 months).
    Results: No tendon bowstringing was evident in any finger. Rupture of one flexor tendon repair occurred 8 weeks after primary surgery in one patient with a zone 1 injury. Excluding this case, no significant differences were observed in the active range of motion of the two finger joints between patients with zone 1 and 2A injuries. However, active motion of the distal interphalangeal joint of zone 1 was significantly reduced compared with that of zone 2A, given the increase in the total extension deficit.
    Conclusions: In this series, although complete release of the A4 pulley and postoperative treatment were performed in the same way, zone 1 injuries demonstrated greater total extension deficits and failed to achieve distal interphalangeal joint motion outcomes comparable with those observed in zone 2A injuries.
    Type of study/level of evidence: Therapeutic IV.
    Keywords:  A4 pulley; Flexor tendon repair; Venting; Zone 1; Zone 2A
    DOI:  https://doi.org/10.1016/j.jhsg.2025.100826
  38. Video J Sports Med. 2025 Nov-Dec;5(6):5(6): 26350254251368929
    Patellar Tendon Reconstruction With Achilles Allograft: A Technical Note.
    Ahab G Alnemri, Amar S Vadhera, Rahul Kumar, Hasani Swindell, Safa Gursoy, Nikhil N Verma, Jorge Chahla.
       Background: Patellar tendon ruptures are relatively common injuries, often caused by high tensile forces on a weakened tendon. In younger patients, they typically result from eccentric loading on the extensor mechanism, whereas in older patients, trauma is the more common cause. These injuries can be functionally limiting and challenging to treat when chronic due to tendon atrophy, scarring, and proximal retraction.
    Indications: Reconstruction is indicated for patients with chronic, symptomatic patellar tendon ruptures confirmed by clinical and radiographic evaluation.
    Technique Description: A longitudinal midline incision was made, and dissection proceeded through the subcutaneous tissue to identify the ruptured tendon. Fibrotic tissue was debrided, and the tendon length was adjusted to restore patellar height. Three 3.5-mm drill holes were created at the inferior pole of the patella for 5.5-mm bio-composite anchors. Sutures were placed in a Krackow interlocking fashion, with limbs tied in full extension. An Achilles tendon allograft with a bone block was prepared. A 10 × 20 mm tunnel was drilled distal to the tibial tubercle, and the graft was secured with a metal interference screw. The graft was looped proximally and secured to the native tendon with suture tape in a double-layer Krakow configuration. Additional anchors were placed at the tibial tubercle to secure the distal graft.
    Results: This technique demonstrated excellent functional outcomes, with radiographic evidence of a healed, well-fixed graft and restored patellar height. The patient achieved 120° of knee flexion, full extension, and independent ambulation at the 6-month follow-up.
    Discussion/Conclusion: Achilles allograft augmentation offers a reliable solution for chronic patellar tendon ruptures, especially in cases with tendon atrophy or retraction, eliminating donor site morbidity and enabling strong fixation and early rehabilitation.
    Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
    Keywords:  Achilles tendon allograft; allograft surgery; patellar tendon; patellar tendon reconstruction; patellar tendon rupture
    DOI:  https://doi.org/10.1177/26350254251368929
  39. Physiother Res Int. 2026 Jan;31(1): e70140
    Balance Exercise Parameters for Rehabilitation of Adult Chronic Ankle Instability: A Systematic Review of Randomised Controlled Trials.
    Lew Teck Yew Milton, Jewel Wee Jing Yi, Daniel S Harvie.
       BACKGROUND AND PURPOSE: The optimal ingredients underpinning effective rehabilitation of Chronic Ankle Instability are not well established. This systematic review aimed to consolidate the exercise parameters associated with effective balance rehabilitation in individuals with CAI and contrast variables distinguishing effective and ineffective balance training programmes.
    METHODS: This review was registered with PROSPERO (ID: CRD42024593743). A systematic electronic search was performed until September 2024 in Medline, Embase, CINAHL and Web of Science. Randomised controlled trials (RCTs) that compared the effectiveness of balance exercise against non-balance exercise interventions with respect to pain, function and/or perceived instability, among individuals with CAI were included. Studies that used non-exercise or balance control groups or were not published in English were excluded. Risk of bias was assessed using the Physiotherapy Evidence Database (PEDro) scale. Exercise parameters were extracted and presented in tables according to their effectiveness to elucidate commonalities and differences between protocols with and without statistically significant benefit.
    RESULTS: Nine RCTs were included, inclusive of 342 participants. The average PEDro score across studies was 6.8, suggesting 'good' quality and a low-to-moderate risk of bias overall. Six studies included protocols demonstrating statistically significant improvements in pain, self-reported function, and/or perceived instability. Overall, effective programs had a greater cumulative duration and a greater range of balance exercises.
    DISCUSSION: There is fair-to-good quality evidence supporting balance exercise programs for chronic ankle instability that incorporate higher training volumes and greater task variety. Effective programs typically span at least 4 weeks, with sessions three times per week, 30 min each, and include five or more exercises across multiple balance types. Progression should be based on the patient's ability to perform tasks with good control.
    Keywords:  balance; chronic ankle instability; parameters; rehabilitation
    DOI:  https://doi.org/10.1002/pri.70140
  40. J Pain Res. 2025 ;18 6397-6407
    Therapeutic Exercise Progression in Patients with Nonspecific Low Back Pain: A Systematic Review.
    Agnese Tuninetti, Valerio Barbari, Lorenzo Storari, Mattia Bisconti, Leonardo Piano, James Dunning, Firas Mourad, Filippo Maselli.
       Objective: This systematic review aimed to identify and synthesize the objective and subjective criteria currently used to guide the progression of therapeutic exercise during the rehabilitation of adults with nonspecific low back pain (NSLBP). A secondary objective was to determine whether the use of those progression criteria enhances the effectiveness of exercise interventions compared to protocols without specific criteria.
    Methods: A comprehensive search was performed across three electronic databases and supplemented by a manual reference screening. Eligible studies were randomized controlled trials (RCTs) including adults (>18 years) with NSLBP where at least one group received therapeutic exercise with defined progression criteria. Study selection and full-text screening were followed by risk of bias assessment using the Cochrane Risk of Bias 2 tool.
    Results: A total of 47 RCTs met the inclusion criteria. Due to the heterogeneity of included studies, a qualitative synthesis was conducted. Progression criteria were found to be both subjective and objective. Overall, intervention groups using predefined progression criteria showed greater short- and medium-term improvements than controls. However, only a subset of low-risk-of-bias studies confirmed these effects, and long-term benefits were rarely reported.
    Conclusion: Exercise progression based on specific criteria appears to offer promising benefits, particularly in the short-term reduction of pain and improvement in function. However, limitations persist regarding the direct applicability of these findings to clinical practice. Future research should aim to further standardize methodologies and establish measurable, clearly defined progression criteria for exercise-based interventions in patients with NSLBP.
    Keywords:  clinical outcomes; non-specific low back pain; progression criteria; rehabilitation; systematic review; therapeutic exercise
    DOI:  https://doi.org/10.2147/JPR.S539160
  41. Ann Med Surg (Lond). 2025 Dec;87(12): 9039-9043
    Osteitis condensans ilii masquerading as sacroiliitis: a case report of an underdiagnosed condition.
    Rishi Ram Banjade, Prabin Khatri, Aabishkar Subedi, Sagar Pokhrel, Shubham Gupta, Nabin Sapkota, Ranjana Rokaya.
       Introduction and Importance: Osteitis condensans ilii (OCI) is a benign, non-inflammatory condition characterized by triangular sclerosis of the iliac bone adjacent to the sacroiliac joint, typically with preserved joint space and normal inflammatory markers. It can mimic inflammatory sacroiliac disorders, leading to misdiagnosis.
    Case Presentation: We report the case of a 38-year-old multiparous woman with chronic low back pain that began during pregnancy and persisted for 2.5 years. The pain was mild, intermittent, and aggravated by activity. She had initially been treated for spondyloarthritis without improvement. Examination revealed normal spinal mobility and localized tenderness over the sacroiliac region. Laboratory tests, including inflammatory and autoimmune markers, were normal. The radiographs demonstrated bilateral triangular iliac sclerosis without erosions. MRI confirmed sclerosis with preserved sacroiliac joint space, consistent with OCI.
    Clinical Discussion: OCI is often underrecognized and may be mistaken for axial spondyloarthritis. Mechanical stress, particularly during pregnancy, is implicated; however, cases in men and nulliparous women suggest a multifactorial etiology. Imaging is crucial for diagnosis, as plain radiographs may be insufficient.
    Conclusion: OCI should be considered in patients with chronic low back pain to prevent unnecessary immunosuppressive therapy. Conservative management with physiotherapy, non-steroidal anti-inflammatory drugs (NSAIDs), and short-term muscle relaxants can provide significant symptomatic improvement, though complete resolution may require longer follow-up and adherence to rehabilitation measures. The overall prognosis is favorable.
    Keywords:  chronic low back pain; iliac bone sclerosis; osteitis condensans ilii; sacroilitis
    DOI:  https://doi.org/10.1097/MS9.0000000000004275
  42. Front Endocrinol (Lausanne). 2025 ;16 1651505
    Fatty infiltration and cross-sectional area as indicators of muscle mass in osteoporosis: a meta-regression study.
    Genwen Sun, Yuee Dai, Liu Liu, Yu Du, Ping Jiang, Xiangkui Li, Chao Li, Tao Lin.
       Background: Paraspinal muscle morphology, including cross-sectional area (CSA) and fatty infiltration (FI), has been increasingly recognized as a potential imaging-based indicator of osteoporosis. However, the extent to which these muscle parameters differ across osteoporosis, osteopenia, and healthy populations remains unclear.
    Methods: A systematic meta-analysis was conducted based on 14 studies published from inception to January 25, 2025, comprising 125 effect size estimates related to CSA and FI across key paraspinal muscles. Pooled standardized mean differences (SMDs) were calculated using a random-effects model. Subgroup analyses were stratified by muscle group and diagnostic comparison. Three-level meta-regression models were implemented to examine the influence of study-level moderators, including age, sex, measurement level and comparison category.
    Results: A significant decrease in CSA was observed only in osteoporotic patients compared with controls, and multiple muscle groups were evaluated. In contrast, CSA differences in osteopenia were less consistent and appeared to vary by muscle type. FI demonstrated greater sensitivity across diagnostic comparisons, with significant increases observed in both osteopenia and osteo- porotic groups relative to controls, especially in the multifidus and erector spinae. Meta-regression identified age as a significant moderator, indicating that morphological differences diminish with increasing age. Both CSA and FI are associated with musculoskeletal deterioration in osteoporosis, with FI suggested to be relatively more sensitive and potentially capable of detecting early pathological changes during the osteopenia stage. However, when examined across specific measurement approaches for CSA and FI, the apparent advantage of FI was attenuated, and no clear difference in sensitivity was identified. The psoas major showed inconsistent findings across studies, likely due to its lower baseline fat content and lower responsiveness to aging.
    Conclusion: Both CSA and FI are associated with musculoskeletal deterioration in osteoporosis, with FI emerging as a more sensitive marker, potentially capable of detecting early pathological changes during the osteopenia stage. These findings highlight the value of paraspinal muscle assessments in osteoporosis research and clinical evaluation. Further studies are warranted to standardize measurement protocols and evaluate the integration of muscle morphology into imaging-based risk prediction models.
    Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251026322, identifier CRD420251026322.
    Keywords:  erector spinae; iliopsoas; multifidus; paraspinal muscles; psoas major; psoas muscle; quadratus lumborum; skeletal muscle
    DOI:  https://doi.org/10.3389/fendo.2025.1651505
  43. Sports Med Arthrosc Rev. 2025 Sep 16.
    When Does a Rotator Cuff Tear Hurt? A Critical Review of the Literature.
    Niraj V Lawande, John P Scanaliato, Grant E Garrigues.
      With increasing age, rotator cuff tears are common in symptomatic and asymptomatic patients. Yet, there remains a limited understanding of the etiology of pain associated with rotator cuff pathology. Recent research has associated patient perception, resilience, repair integrity, tear size, biomechanics of the humeral head, and muscle kinematics with pain levels. However, the evidence remains largely inconclusive in answering the fundamental question regarding why some patients experience symptoms severe enough to warrant surgery and others remain completely asymptomatic. A deeper understanding of the causes of pain with a rotator cuff tear can guide treatments to optimize pain relief in symptomatic individuals seeking treatment.
    Keywords:  asymptomatic rotator cuff injuries; narrative review; rotator cuff tear; shoulder pain
    DOI:  https://doi.org/10.1097/JSA.0000000000000440
  44. Mol Pain. 2025 Dec 12. 17448069251410747
    EXPRESS: Evaluation of Stress Biomarkers in individuals with Migraine or Tension-Type headached before and after Botulinum Toxin Injection.
    Afrah Abdulsahib Abbas, Fawaz Aswad, Taghreed Zaidan.
      Migraine is a very common and incapacitating condition. We chose to assess the therapeutic effect of Botulinum toxin injection on migraine and tension-type headache patients in an effort to measure salivary alpha amylase for these groups before and after treatment with Botulinum toxin injection because stress appears to be a significant provoking factor of this disorder.There were twenty patients with chronic tension-type headaches and twenty-five patients with chronic migraines among the forty-five individuals. Enzyme-linked immunosorbent assay (ELISA) kits were used to test the salivary biomarker (salivary cortisol and salivary alpha amylase). The PREEMPT (Onabotulinum toxinS AntIpOde for chronic migraiNe) treatment protocol, a systematic procedure for treating chronic migraines, was administered to the patients. Biomarkers measured during the study were analyzed as surrogate measures of stress to shed light on potential physiological action of the intervention. Context In patients with chronic migraine and tension-type headaches, the effect of Nabota (Botulinum toxin type A) on specific stress-related indicators was evaluated.The results demonstrated a statistically significant (p<0.05) rise in salivary cortisol and a statistically significant (p<0.05) decrease in salivary alpha amylase following Botulinum toxin intervention for both research groups (chronic migraine, chronic tension headaches).
    Keywords:  Migraine Headache; cortisol; salivary alpha amylase; tension-type headache
    DOI:  https://doi.org/10.1177/17448069251410747
  45. Med Sci Monit. 2025 Dec 11. 31 e950383
    Does Concomitant Biceps Tenotomy Affect Shoulder Proprioception and Strength? A Prospective Intra‑Individual Comparison After Arthroscopic Rotator Cuff Repair.
    Can Özcan, Necip Güven, Sehmuz Kaya.
      BACKGROUND Pathology of the long head of the biceps tendon (LHBT) frequently accompanies rotator cuff tears. Whether concurrent LHBT tenotomy during arthroscopic rotator cuff repair (RCR) adversely affects postoperative shoulder proprioception or upper-limb strength remains uncertain; intra-individual evidence is limited. MATERIAL AND METHODS A prospective intra-individual comparison was conducted at a single center between May 2018 and December 2021. Consecutive adults who underwent arthroscopic RCR with LHBT tenotomy were evaluated at a postoperative visit. Standardized assessments were performed by a single team. Primary outcomes included shoulder joint-position sense, measured by active position reproduction at predefined targets, and maximum isometric strength, measured with a handheld dynamometer. Statistical analysis included normality testing, paired tests, effect sizes, and 95% confidence intervals (CIs) with Holm adjustment. RESULTS Seventy-seven patients were analyzed (mean age 58.1 years; 73% women; 69% right side). Side-to-side differences were small. Representative metrics included elbow flexion Δ=-0.56 (95% CI, -1.05 to -0.06; P=0.028) and shoulder flexion Δ=-0.87 (95% CI, -1.41 to -0.33; P=0.002). Absolute proprioception error at 30° rotation was modestly lower on the operated side (Δ=-2.00°; 95% CI, -3.68° to -0.32°; P=0.020). Other targets showed no clinically meaningful differences. Effect sizes were small. CONCLUSIONS In patients with clinical indications for tenotomy, concurrent LHBT tenotomy during arthroscopic RCR was unrelated to measurable deficits in shoulder proprioception or upper-limb strength. These findings support clinical acceptability of tenotomy when indicated. Comparative studies are warranted to refine patient selection.
    DOI:  https://doi.org/10.12659/MSM.950383
  46. BMC Neurol. 2025 Dec 08.
    Evaluating the efficacy and tolerability of the oral combination of alpha lipoic acid and vitamin B complex preparation in carpal tunnel syndrome: a single center, randomized, double-blind, placebo-controlled trial.
    Nur Alya Zainal, Anna Misya'il Abdul Rashid, Adnan Lutfi A Rauf, Abdul Hanif Khan Yusof Khan, Wan Aliaa Wan Sulaiman, Hamidon Basri.
      
    Keywords:  Alpha lipoic acid; Carpal tunnel syndrome; Electrodiagnosis; Outcome assessment; Pain measurement; Quality of life; Vitamin b complex
    DOI:  https://doi.org/10.1186/s12883-025-04430-y
  47. Adv Rheumatol. 2025 Dec 10.
    Exercises plus intra-articular injection for knee osteoarthritis: a systematic review with meta-analysis.
    Christine Brumini, Jamil Natour, Sandra Mara Meireles Adolph, Rita Nely Vilar Furtado, Anamaria Jones.
       OBJECTIVE: To evaluate whether the combination of exercise and intra-articular injection (IAI) effectively improves pain, function, and quality of life in patients with knee osteoarthritis (OA) compared to any control group in the short, medium, and long term through a systematic review.
    METHODS: A comprehensive search strategy was applied in the databases Embase, PubMed, MEDLINE, CENTRAL, CINAHL, and PEDro. Inclusion criteria focused on randomized controlled trials examining the effects of exercise combined with IAI in patients with knee OA, with outcomes assessed at short-, medium-, and long-term follow-ups. The primary outcomes were pain and function. The quality of the evidence was evaluated using the GRADE system.
    RESULTS: Eleven studies, comprising 802 participants, were included. All studies investigated the combination of IAI and exercise. A statistically significant difference in pain was observed: in the short and medium term, the Botulinum toxin IAI group demonstrated superior pain reduction compared to the Hyaluronic acid IAI group (MD -1.32, 95% CI -2.20 to -0.44 and MD -9.09, 95% CI -13.16 to -5.01, respectively). In the medium term, Saline IAI was more effective than Corticosteroid IAI (MD 1.99, 95% CI 0.49 to 1.90). Regarding function, Saline IAI outperformed IAI with any medication in the short term (MD 0.50, 95% CI 0.20 to 0.79). In terms of quality of life, the Corticosteroid IAI group demonstrated superior physical function and mental health outcomes compared to the Saline IAI group in the medium term (MD -0.43, 95% CI -0.77 to -0.08 and MD -0.38, 95% CI -0.76 to -0.01, respectively). In the long term, physical function improved more with IAI combined with exercise compared to exercise alone.
    CONCLUSION: Given the very low quality of the evidence, it is not possible to definitively conclude that the combination of IAI and exercise is more effective than IAI or exercise alone in patients with knee OA. Further high-quality studies are needed to establish more definitive conclusions.
    REGISTRATION: The International Prospective Register of Systematic Reviews (PROSPERO): CRD42021277729.
    CLINICAL TRIAL NUMBER: Not applicable.
    Keywords:  Aged; Arthralgia; Exercise therapy; Injections, Intra-articular; Osteoarthritis, knee
    DOI:  https://doi.org/10.1186/s42358-025-00458-3
  48. Eur J Med Res. 2025 Dec 07.
    Associations between muscle stiffness, muscle co-activation, and balance in older individuals with knee osteoarthritis: a cross-sectional study.
    Ping Liu, Mohamad Shariff Bin A Hamid, Yueyue Shi, Xiaohan Fan, Hengzhi Deng, Eliza Hafiz, Xuelin Zhang.
       BACKGROUND: Increased muscle stiffness and co-activation are common in knee osteoarthritis (KOA) and may contribute to balance impairments. To our knowledge, no study has examined whether these associations vary across specific movement phases in KOA. This study aimed to examine phase-specific associations among stiffness, co-activation, and balance in KOA and compare them with healthy controls.
    METHODS: Sixty-four older adults with KOA (69 ± 4 years) and 25 controls participated. Quadriceps and hamstring stiffness were measured using shear-wave elastography, and co-activation was assessed via surface electromyography during squat-down (SD), stand-up (SU), and transition (SUSD). Balance was evaluated using the Y-Balance Test (YBT) and Balance Error Scoring System (BESS). Pearson correlations examined relationships between stiffness, co-activation, and balance in the KOA group.
    RESULTS: Compared with controls, KOA participants showed higher quadriceps stiffness, greater co-activation during SD and SU, and poorer dynamic balance (all p < 0.001). In SD, co-activation was negatively correlated with balance (YBT r = - 0.45 to - 0.39; BESS r = 0.40) and stiffness (quadriceps r = -0.25; hamstrings r = - 0.33; all p < 0.05). In contrast, during SU and SUSD, co-activation was positively correlated with balance (YBT r = 0.61 to 0.67; BESS r = - 0.37 to - 0.35) and stiffness (quadriceps r = 0.56 to 0.58; hamstrings r = 0.71 to 0.73; all p < 0.05).
    CONCLUSION: Co-activation in KOA shows phase-specific associations with stiffness and balance. Rehabilitation should incorporate phase-specific neuromuscular strategies, particularly reducing maladaptive eccentric responses to improve balance and reduce fall risk.
    Keywords:  Balance; Knee osteoarthritis; Muscle co-activation; Muscle stiffness
    DOI:  https://doi.org/10.1186/s40001-025-03571-7
  49. Cureus. 2025 Nov;17(11): e96100
    Arthroscopic Subacromial Decompression vs. Physical Therapy for Stage II Shoulder Impingement Syndrome: A Comparative Review of Functional and Social Impact.
    Garrett J Rutt, Chloe Esch, Marcia Ballantyne.
      Shoulder impingement syndrome is a highly frequent shoulder pathology that accounts for a large majority of visits in the primary care and orthopedic setting. Stage II impingement syndrome, defined as a progression of stage I impingement that occurs once the rotator cuff tendons have undergone fibrosis and tendonitis, is a critical phase in shoulder joint pathology that requires intervention. Although various treatments exist, including arthroscopic subacromial decompression (ASD) and physical therapy (PT), comparative data on their effectiveness, specifically for stage II impingement syndrome, remains limited. This review evaluates and compares the long-term outcomes of ASD and structured PT in specifically managing stage II shoulder impingement syndrome, focusing on pain relief, functional recovery, and return to daily activities with improvement in overall quality of life. Uniquely, this review also analyzes the social determinants of improved functional outcomes and the role that shared decision-making (SDM) plays in patient functionality and satisfaction. A comprehensive literature search was conducted using PubMed and Google Scholar, including only English-language, full-length clinical trials and randomized controlled trials that specifically addressed stage II shoulder impingement syndrome. Studies were screened using predefined inclusion and exclusion criteria, resulting in a final set of six articles for analysis. Outcomes were synthesized in a comparative table across both interventions. After analyzing multiple studies, ASD demonstrated no statistically significant benefit over PT in pain reduction, disability, work capability, muscle integrity, or patient-reported functional outcomes over two- to five-year follow-ups. Current evidence does not support the routine use of arthroscopic subacromial decompression over structured physical therapy for the management of stage II shoulder impingement syndrome, as both approaches yield comparable outcomes in pain reduction, functional improvement, and return to daily activities. Literature also supports improved outcomes with greater SDM preoperatively. These findings highlight the importance of adopting a personalized, patient-centered treatment strategy. In developing an optimal care plan, it is important to consider a range of individual factors, including the patient's age, occupation, access to emotional and physical support, financial circumstances, and long-term recovery goals.
    Keywords:  arthroscopic shoulder surgery; arthroscopic subacromial decompression; neer's classification; patient centered care; shared decision making (sdm); shoulder impingement syndrome; social determinants of health (sdoh); subacromial decompression
    DOI:  https://doi.org/10.7759/cureus.96100
  50. Thorax. 2025 Dec 12. pii: thorax-2025-223967. [Epub ahead of print]
    Measurement properties of the sit-to-stand test in community-dwelling people with chronic obstructive pulmonary disease: a COSMIN systematic review.
    Christopher Farley, Anastasia N L Newman, Stuart M Phillips, Jenna Smith-Turchyn, Dina Brooks.
       BACKGROUND: The sit-to-stand (STS) test can assess physical function in people with chronic obstructive pulmonary disease (COPD); however, there are multiple versions. No study has used current guidelines to assess the measurement properties of the STS tests in people with COPD.
    METHODS: We conducted a systematic review using current COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Full text peer-reviewed publications were included if they assessed the measurement properties (validity, reliability and/or responsiveness) of at least one STS test among community-dwelling people with COPD. We searched six databases and imported results into Covidence where title/abstract screening and full text selection was completed independently and in duplicate. Extraction was conducted independently and in duplicate using the COSMIN extraction file. We assessed study risk of bias (very good, adequate, doubtful or inadequate), measurement property quality (sufficient, indeterminate or insufficient) and overall certainty of evidence (high, moderate, low or very low) using the COSMIN recommended tools.
    RESULTS: We assessed 2577 titles/abstracts and 102 full texts for inclusion; 30 publications met eligibility. Seven unique STS tests were located with the most common being the 1 min STS test (n=14, 39%), 5-repetition STS test (n=10, 28%) and the 30 s STS test (n=8, 22%). Where assessed, reliability was sufficient for the 1 min, the 5-repetition and the 30 s STS tests. Only the 1 min STS test had high-quality evidence of sufficient construct validity, while the 30 s STS test was the sole test with at least moderate quality evidence of sufficient responsiveness.
    CONCLUSIONS: The 1 min STS test has the most robust measurement properties for cross-sectional assessments while the 30 s STS test is more robust to assess change.
    Keywords:  Exercise; Pulmonary Disease, Chronic Obstructive; Pulmonary Rehabilitation
    DOI:  https://doi.org/10.1136/thorax-2025-223967
  51. J Biomech. 2025 Dec 10. pii: S0021-9290(25)00630-X. [Epub ahead of print]195 113118
    Achilles' tendon stretch during walking in hinged controlled ankle motion boots.
    Mason L Stolycia, David E Lunn, Richard A Wilkins, Josh Walker.
      Hinged controlled ankle motion boots are used to incrementally increase ankle joint range of movement during rehabilitation following Achilles' tendon rupture. This increased movement should induce mechanical stress on the tendon via cycles of stretching and shortening. However, research has yet to determine how this permitted range of movement influences tendon length change. Eight healthy individuals (age: 23 ± 2 y; stature = 1.70 ± 0.09 m; body mass = 67.7 ± 13.7 kg) walked at a self-selected speed on an instrumented, motorised treadmill in a hinged controlled ankle motion boot with three pre-established ankle ranges of movement: 0, 15, and 30°, which were all compared with walking in normal footwear. Kinematic and kinetic measurements were obtained using motion capture and the treadmill. Triceps surae mechanical characteristics, including Achilles' tendon stretch, were obtained with B-mode ultrasonography. Achilles' tendon stretch significantly (p < 0.001) increased as boot range of movement increased and was strongly correlated with measured ankle joint range of movement when the boot was set to a 15 or 30° range of movement (r ≥ 0.84, p ≤ 0.009). Increasing controlled ankle motion boot range of movement also increased ankle joint mechanical work done and total mechanical work done by the boot-wearing limb, which led to an increase in self-selected walking speed (all p < 0.001). These findings provide preliminary evidence that hinged controlled ankle motion boots have the capacity to provide a controlled mechanical stimulus to the Achilles' tendon when range of movement is increased. This has possible clinical application for the early management of Achilles' tendon rupture, potentially improving healing and functional outcomes if it can be translated into a patient population.
    Keywords:  Conservative management; Foot orthosis; Muscle-tendon unit; Rehabilitation; Rupture; Triceps surae
    DOI:  https://doi.org/10.1016/j.jbiomech.2025.113118
  52. J Man Manip Ther. 2025 Dec 11. 1-10
    Effect of taping on pain and function in athletes with Patellofemoral pain syndrome: a systematic review and meta-analysis.
    Aatir Uddin Khan, Suraj Kumar, Chhavi Arora Sehgal, Kulsum Akhtar.
       BACKGROUND: Patellofemoral Pain Syndrome is a common musculoskeletal condition characterized by anterior knee pain, especially among athletes and active individuals. Taping techniques such as Kinesio taping and rigid taping are widely used as conservative interventions. However, the effectiveness of taping on pain reduction and functional improvement remains debated.
    OBJECTIVE: To systematically review and synthesize the evidence on the effect of taping on pain and function in athletes with patellofemoral pain syndrome. Methods A comprehensive literature search was conducted across databases, including PubMed, Scopus, PEDro, and Web of Science. Randomized trials evaluating the effect of taping on pain with or without function in athletes with PFPS were included. Methodological quality was assessed by PEDro. Risk of bias was assessed by Cochrane's Risk of Bias Tool Version 2. Meta-analysis was conducted using Review Manager (RevMan 5.4).
    RESULTS: Out of 39 records retrieved, 20 full-text articles were assessed, and 7 studies met the inclusion criteria. Qualitative and quantitative analysis (pain: Z = 1.94, p = 0.05, SMD = -1.71, 95% CI = -3.44 and function: Z = 2.0, p = 0.05, SMD = 1.06, 95% CI = 0.02) showed a significant reduction in pain and improvement in function with taping, especially when combined with exercise therapy. Rigid taping showed more significant results than Kinesio taping.
    CONCLUSION: This review concludes that rigid taping provides short-term benefits in reducing pain and improving function in patients with PFPS, especially when integrated with exercise-based rehabilitation.
    Keywords:  Patellofemoral pain syndrome; function; kinesio taping; knee pain; rigid taping; taping
    DOI:  https://doi.org/10.1080/10669817.2025.2601586
  53. Pol J Radiol. 2025 ;90 e561-e570
    The role of ultrasonography of the brachial plexus in differentiating between Parsonage-Turner syndrome and neuroborreliosis. A pictorial review.
    Paweł Stanisław Walkowiak, Grzegorz Mikołaj Kozera.
      Parsonage-Turner syndrome (PTS), also known as neuralgic amyotrophy (NA), is an idiopathic inflammatory neuropathy of the brachial plexus presenting with neuropathic pain and motor deficits of the shoulder girdle. Routinely, PTS must be differentiated from infectious variants of brachial plexitis, especially early manifestations of neuroborreliosis. Both conditions can quickly lead to significant disability, so early, targeted therapy based on a correct diagnosis is essential for a favourable clinical outcome. High-resolution ultrasound (HRUS) can quickly and non-invasively differentiate PTS from infectious forms of brachial plexitis by detecting nerve twisting and swelling with the so-called "hourglass-like" constriction sign. The following article presents the authors' proposal for an HRUS protocol for the brachial plexus and shows typical ultrasound findings in PTS and brachial plexitis with Banwarth's syndrome due to Borrelia infection.
    Keywords:  Banwarth syndrome; Parsonage-Turner syndrome; brachial plexitis; high-resolution ultrasound; hourglass-like constriction; neuroborreliosis
    DOI:  https://doi.org/10.5114/pjr/213569
  54. Clin Radiol. 2025 Nov 08. pii: S0009-9260(25)00369-1. [Epub ahead of print]92 107164
    The diagnostic value of a subcoracoid effusion in ultrasound assessment of rotator cuff tears.
    M Charnock, N Kotnis.
       AIM: The aim of this study was to assess the prevalence of a subcoracoid effusion and its association with rotator cuff tears at shoulder ultrasound.
    MATERIALS AND METHODS: This was a prospective study involving 3,405 patients who underwent shoulder ultrasound referred from both primary and secondary care between January 2019 and January 2025. Demographic details, sonographic diagnosis including the size of a rotator cuff tear, and subcoracoid bursal distension was recorded. Details of further imaging studies and surgical outcomes were also documented.
    RESULTS: Of the 3405 patients examined, ultrasound revealed a subcoracoid effusion in 132 patients. Four patients had a subcoracoid effusion and no rotator cuff tear on ultrasound, and six patients reported a subcoracoid effusion and a partial thickness tear on ultrasound. A total of 122 (4%) patients had a subcoracoid effusion and a full-thickness tear on ultrasound, with 64 patients having surgical correlation (Fisher's exact test P<0.001).
    CONCLUSION: While subcoracoid effusions are not common, this study confirms a strong association between subcoracoid effusions and full-thickness rotator cuff tears. Careful assessment of the rotator cuff is essential when subcoracoid effusions are identified on ultrasound.
    DOI:  https://doi.org/10.1016/j.crad.2025.107164
  55. Sensors (Basel). 2025 Dec 02. pii: 7334. [Epub ahead of print]25(23):
    A Wearable System for Knee Osteoarthritis: Based on Multimodal Physiological Signal Assessment and Intelligent Rehabilitation.
    Jingyi Hu, Shuyi Wang, Yichun Shen, Xinrong Miao.
      Knee osteoarthritis (KOA), a common degenerative joint disease, affects a large patient population and poses significant challenges in early diagnosis and rehabilitation. Achieving precise assessment of knee function and efficient home-based intelligent rehabilitation is crucial for alleviating pain, slowing disease progression, and improving patients' quality of life. This study proposes a smart wearable knee function assessment based on multimodal physiological signals and a rehabilitation system. The system integrates surface electromyography (sEMG), pressure sensors, and an inertial measurement unit (IMU) to synchronously capture gait, posture, and muscle activity. It quantifies knee function by extracting gait and EMG features. Additionally, a wearable massage device driven by airbags was designed and implemented to simulate the traditional Chinese medicine "seated knee-adjustment method" and deliver precise intelligent rehabilitation interventions. Experimental results validated the system's accuracy in functional assessment and reliability in rehabilitation assistance. The average relative error in gait feature extraction was below 8%, while the massage head displacement error remained within clinically acceptable ranges. By integrating multimodal sensing technology with intelligent rehabilitation devices, this system offers KOA patients a convenient, efficient, and sustainable home-based rehabilitation solution with strong clinical application potential and promotional value.
    Keywords:  gait analysis; intelligent rehabilitation; knee osteoarthritis (KOA); surface electromyography (sEMG); wearable system
    DOI:  https://doi.org/10.3390/s25237334
  56. Clin Orthop Surg. 2025 Dec;17(6): 1046-1053
    Effect of Postoperative Immobilization Method on Outcomes Following Triangular Fibrocartilage Complex Transosseous Foveal Repair: Long-Arm Cast Versus Muenster Brace.
    Hyun-Cheol Oh, Hyoung Bok Kim, Hyun Tak Kang, Youngwoo Lee, Jun-Ku Lee.
       Backgroud: The optimal postoperative immobilization method following triangular fibrocartilage complex (TFCC) foveal repair remains debated. While long-arm casting effectively restricts wrist rotation, it also limits elbow movement and may cause discomfort. The Muenster brace, which allows partial elbow flexion while restricting wrist rotation, has been proposed as an alternative. This study compared clinical outcomes, patient satisfaction, and complication rates between long-arm cast (LAC) and Muenster brace immobilization.
    Methods: A retrospective comparative study was conducted on 40 cases from 37 patients who underwent TFCC transosseous foveal repair between March 2021 and February 2024. Patients were categorized into 2 groups: the LAC group (n = 19) and the Muenster brace group (n = 21). Demographics, radiologic assessments, operative details, and pre- and postoperative functional outcomes were analyzed. Pain and function were assessed using a visual analog scale (VAS) and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Patient satisfaction and complications were recorded.
    Results: The mean patient age was 29 years, with an average follow-up of 282 days. Preoperative VAS scores (6.3 ± 1.9) improved to 1.2 ± 1.4, and DASH scores improved from 52.6 ± 16.0 to 10.4 ± 12.4. No significant differences were found between groups in demographics, tear classification, operative time, or preoperative functional scores. Postoperative pain relief, functional improvement, grip strength, and satisfaction were comparable. Minor complications included 1 case of transient cubital tunnel syndrome and 1 case of persistent pain requiring revision in the LAC group. In the Muenster group, 1 patient sustained a traumatic re-injury, and another developed distal radioulnar joint instability. No infections, tendon ruptures, or severe stiffness occurred.
    Conclusions: Both immobilization methods yielded comparable outcomes and satisfaction. While the Muenster brace improves elbow mobility, its effectiveness in preventing retears was similar to that of LAC.
    Keywords:  Foveal repair; Long-arm cast; Muenster brace; Postoperative immobilization; Triangular fibrocartilage complex
    DOI:  https://doi.org/10.4055/cios25084
  57. Occup Ther Health Care. 2025 Dec 09. 1-19
    Functional Profiles and Baseline Correlates of Hand Function Change in Youth with Unilateral Cerebral Palsy Following Constraint-Induced Movement Therapy.
    Angela Shierk, Ashlie Frederiksen, Fabiola Reyes, Sydney Chapa, Nancy Clegg, Lillian Cates, Heather Roberts.
      This study aimed to describe the functional profiles of children with unilateral cerebral palsy who participated in constraint-induced movement therapy and correlate change in hand function after the intervention with factors across the International Classification of Functioning, Disability, and Health (ICF). Twenty-three children aged 5.0 to 13.5 years (SD = 3.08) with unilateral cerebral palsy participated in a two-week (60-h) group-based constraint induced movement therapy program as part of a blinded randomized controlled trial comparing a constraint induced movement therapy camp to constraint induced movement therapy plus virtual reality. The International Classification of Functioning, Disability, and Health Brief Core Set for Cerebral Palsy (ICF CP Core Set) was administered at baseline. Changes in hand function were measured using the Assisting Hand Assessment at baseline and after intervention. Descriptive statistics were used to summarize the ICF CP Core Set results, providing functional profiles of children with unilateral cerebral palsy who participated in constraint induced movement therapy across ICF domains. Assisting Hand Assessment change scores were correlated with the ICF CP Core Set using Spearman's rank analysis to identify characteristics associated with favorable responses to intervention. Positive correlates to change in hand function only included the following ICF CP Core Set environmental supports: Health services, systems, and policies [p = 0.03]; Education and training services, systems, and policies [p = 0.01]; and the Environmental sum score [p ≤ 0.01]. While the clinical presentation of this population necessitates a heavy focus on motor deficits, these findings highlight that environmental factors also play an important role in functional improvement and, ultimately independence in this population.
    Keywords:  Cerebral palsy; constraint-induced movement therapy; disability and health (ICF); environment; international classification of functioning; virtual reality
    DOI:  https://doi.org/10.1080/07380577.2025.2595969
  58. J Clin Med. 2025 Nov 24. pii: 8339. [Epub ahead of print]14(23):
    Patient-Centred and Daily Life-Oriented Botulinum Toxin Treatment for Stroke Survivors with Upper Extremity Spasticity-Effects and Practical Aspects.
    Sybille Roschka, David Punt, Thomas Platz.
      Background/Objectives: To investigate the impact of a routine botulinum toxin type A (BoNT-A) injection in combination with outpatient therapy on the daily activities of stroke survivors with upper extremity spasticity and to facilitate patient-centred assessment focusing on individual needs during daily life. Methods: Design: Observational study across one treatment cycle (3 months).
    SETTING: Spasticity outpatient clinic of a neurorehabilitation hospital in Germany.
    PARTICIPANTS: Adult stroke survivors (n = 27) with upper extremity spasticity receiving routine BoNT-A treatment.
    INTERVENTIONS: Participants received one BoNT-A injection and outpatient therapies as part of their routine management. Augmented assessment was conducted directly before the injection (T0), and at 4 to 6 weeks (Tmax1) and 12 to 14 weeks (T2) following the injection.
    MAIN OUTCOME MEASURES: The Canadian Occupational Performance Measure (COPM), Goal Attainment Scaling (GAS), and Arm Activity Measure (ArmA).
    SECONDARY OUTCOME MEASURES: The Resistance to Passive Movement Scale (REPAS), Motricity Index (MI), SF-12v2 Health Survey (SF-12v2), Global Clinical Impression (GCI), and importance of and satisfaction with the BoNT-A treatment. Results: Performance of individually selected daily activities and satisfaction with their performance (COPM), passive care tasks (ArmA, part A), and resistance to passive movement (REPAS) significantly improved from T0 to Tmax1. Improvements largely remained at T2. Individual goals were all set at the activities and participation levels of the International Classification of Functioning, Disability and Health. These improved for 75% of participants and were fully attained by 33.3% at Tmax1. Responder analysis indicated that COPM and ArmA improvements were clinically significant for up to 50% of participants. Active upper extremity use (ArmA, part B), health-related quality of life (SF-12v2), and upper extremity strength (MI) remained unchanged. Conclusions: Our results indicate that BoNT-A in combination with routine outpatient therapy positively influenced the individually valued daily activities of stroke survivors. COPM, GAS, and ArmA are suitable for facilitating a patient-centred and daily life-oriented spasticity management post-stroke.
    Keywords:  activities of daily living; botulinum toxin; patient reported outcome measures; patient-centred; spasticity; stroke; upper extremity
    DOI:  https://doi.org/10.3390/jcm14238339
  59. Quintessence Int. 2025 Dec 09. 0(0): 0
    Botulinum toxin A for chronic neurovascular and myofascial facial pain: a comprehensive case report.
    Anna Novikov, Yair Sharav, Yaron Haviv.
      We present a female patient with chronic orofacial pain, followed up for 12 years. She described her pain as throbbing with intermittent pain attacks, and frequently accompanied by symptoms such as photophobia, phonophobia, and nausea. This was associated with myofascial pain of masticatory muscles, which were very painful on palpation. The patient was diagnosed with a complex pain profile that included chronic facial migraine, chronic masticatory myofascial pain, nonspecific neuropathic components, and generalized facial hypersensitivity. Despite the diversity of pharmacological treatments, clinical benefit was limited and transient, with many medications discontinued due to adverse effects or lack of efficacy. We present the successful use of botulinum toxin type A (BoNT-A; Dysport®) in treating this patient. Planned administration of BoTN-A into anatomically and symptomatically defined trigger zones, produced significant and sustained relief of migraine symptoms, followed up for two years. However, mild residual myofascial discomfort persisted. BoTN-A administration has the advantage of providing periodic rather than daily prophylactic treatment, the latter utilized by the present conventional method.
    Keywords:  BoNT-A; botulinum toxin; migraine; neuropathic pain; orofacial pain; temporomandibular disorder
    DOI:  https://doi.org/10.3290/j.qi.b6739961
  60. Neurocirugia (Engl Ed). 2025 Dec 05. pii: S2529-8496(25)00086-3. [Epub ahead of print] 500737
    Failed Back Syndrome or Extra-Spinal Sciatica? Ischiofemoral Syndrome as a Cause of Persistent Radicular Pain After 4 Lumbar Spine Surgeries.
    Andrés Barriga Martín, Orlando Paredes Muñóz, Miguel Peral Alarma, Luis Romero Muñóz, Joint Halley Guimbard Pérez.
      Most cases of sciatica are caused by compression of lumbar nerve roots, although some originate from extraradicular structures, such as in ischiofemoral impingement syndrome. We present the case of a 64-year-old man with a 10-year history of right-sided sciatic pain occurring only while seated. He underwent several lumbar surgeries for spinal stenosis (L4-L5, then L3-L4, and later L5-S1 with fusion to S1), as well as multiple infiltrations and pulsed radiofrequency, without improvement. Neurophysiological and imaging studies showed no significant compression, except for edema at the ischial insertion of the quadratus femoris muscle. A diagnostic local anesthetic infiltration temporarily resolved the pain, confirming ischiofemoral impingement syndrome. He was treated with osteotomy of the lesser trochanter, achieving complete pain resolution and functional recovery. This case highlights the importance of considering extraradicular causes in patients with persistent sciatic pain after spinal surgery.
    Keywords:  ciática; dolor lumbar; ischiofemoral syndrome; low back pain; sciatica; síndrome isquiofemoral
    DOI:  https://doi.org/10.1016/j.neucie.2025.500737
  61. J Clin Med. 2025 Nov 29. pii: 8488. [Epub ahead of print]14(23):
    Hybrid Tightrope-PEEK Dual Fixation for Distal Biceps Tendon Reinsertion in High-Performance Athletes: A Prospective Case Series.
    Roland Fazakas, Gloria Alexandra Tolan, Brigitte Osser, Csongor Toth, Iosif Ilia, Florin Mihai Marcu, Nicoleta Anamaria Pascalau, Ramona Nicoleta Suciu, Liviu Gavrila-Ardelean, Laura Ioana Bondar.
      Background/Objectives: Distal biceps tendon rupture is a disabling injury that compromises elbow flexion and forearm supination strength, particularly in high-performance athletes. Although several fixation techniques have been proposed, no single method has proven optimal in combining mechanical stability, anatomical restoration, and early functional recovery. This study aimed to evaluate the efficacy, safety, and reproducibility of a hybrid dual-fixation technique combining a Tightrope® cortical button (Arthrex, Naples, FL, USA) with a PEEK interference screw for anatomic reinsertion of the distal biceps tendon in athletic individuals. Methods: A prospective observational study was conducted on 13 high-performance athletes who underwent distal biceps tendon repair using the hybrid Tightrope-PEEK construct between March 2024 and September 2025. Functional recovery, muscle strength, esthetic contour, and patient satisfaction were evaluated using the Visual Analog Scale (VAS), Mayo Elbow Performance Score (MEPS), Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), and a 5-point Likert scale over a 12-month follow-up. Descriptive statistical analysis was performed using IBM SPSS Statistics, version 29.0. Results: All patients achieved secure fixation with no intraoperative or postoperative complications, loss of reduction, or hardware failure. Early controlled mobilization began within the first postoperative week. At 6 months, flexion and supination strength were fully restored, and at 12 months, all patients achieved full range of motion and optimal functional scores (mean MEPS 100; QuickDASH 0). No "Popeye" deformities or contour irregularities were observed, and mean patient satisfaction was 5/5. Conclusions: The hybrid Tightrope-PEEK dual-fixation technique provides excellent mechanical stability, allowing early mobilization and rapid functional recovery with minimal complications. Its reproducibility and cosmetic advantages suggest that it represents a safe and effective option for distal biceps tendon reinsertion in high-demand athletes.
    Keywords:  biceps brachii; biomechanical phenomena; elbow injuries; orthopedic procedures; postoperative rehabilitation; suture anchors; tendon injuries; tendon reattachment
    DOI:  https://doi.org/10.3390/jcm14238488
  62. Eur J Med Res. 2025 Dec 06.
    Analysis of the association between lumbar paraspinal muscle atrophy, facet joint degeneration, and degenerative lumbar scoliosis.
    Jiangkai Yu, Cong Zhang, Yan Zhou, Chengming Li.
       OBJECTIVE: To analyze the correlation between paraspinal muscle atrophy, facet joint degeneration, and degenerative scoliosis (DS).
    METHODS: A retrospective study included 231 chronic low back pain patients from Zhongda Hospital Affiliated to Southeast University (January 2023-January 2024). Radiographic diagnosis assigned 150 patients to DS group (subclassified into mild [n = 72], moderate [n = 56], severe [n = 22]) and 81 to non-DS control group. Using T2-weighted MRI at L3-S1 levels, ImageJ software measured multifidus (MF) and erector spinae (ES) cross-sectional area (CSA) and functional muscle ratio (LCSA/GCSA). Surgimap software quantified facet joint angle (FJA), facet overhang (FO) length, and facet joint space width (FJSW). Logistic regression analyzed risk factors with ROC curves determining diagnostic thresholds.
    RESULTS: The non-DS group demonstrated a significantly higher proportion of males (P = 0.023) and greater bone mineral density (P = 0.043) compared to the DS group. Regarding paraspinal muscle parameters, the non-DS group exhibited significantly larger MF CSA, MF + ES CSA, and LCSA/GCSA at the L3/4, L4/5, and L5/S1 levels, as well as a larger ES CSA at the L3/4 level (all P < 0.05). Conversely, the ES CSA at the L5/S1 level was significantly smaller in the non-DS group. For facet joint parameters, the non-DS group showed significantly smaller FJA, FO Length at the L3/4, L4/5, and L5/S1 levels, and smaller FJSW at the L3/4 and L4/5 levels (all P < 0.05). Within the DS group, significant differences were observed between the convex and concave sides at all L3-S1 levels for LCSA/GCSA, MF CSA, ES CSA, FJA, FO Length, and FJSW (all P < 0.05). With increasing severity of DS, there was a progressive decrease in LCSA/GCSA, MF CSA, and ES CSA, and a progressive increase in FJA and FO Length across the L3-S1 levels (all P < 0.01). Post-hoc analysis revealed significant differences in the majority of muscle parameters between severe DS and mild/moderate DS (P < 0.05). Correlation analysis indicated that, except for FJSW at L5-S1 (P = 0.526), the Cobb angle was negatively correlated with MF CSA, ES CSA, LCSA/GCSA, and FJSW, and positively correlated with FJA and FO Length (all P < 0.001). In both the DS and non-DS groups, most LCSA/GCSA and other CSA measurements demonstrated no significant correlations with FJA, FO length, and FJSW. Among the few statistically significant correlations observed, all were weak (rho < 0.30). Multivariate logistic regression analysis identified the following risk-associated factors for DS: lower BMD (OR = 0.802, P = 0.032), reduced LCSA/GCSA (OR = 0.005, P = 0.003), smaller MF CSA (OR = 0.969, P = 0.027), smaller ES CSA (OR = 0.973, P = 0.014), larger FJA (OR = 1.075, P = 0.016), and greater FO length (OR = 1.067, P = 0.001). ROC analysis yielded AUCs/cut-offs: BMD (0.581/- 0.900 T-score), LCSA/GCSA (0.712/0.805), MF CSA (0.608/635 mm2), ES CSA (0.463/832 mm2), FJA (0.627/57°), FO length (0.651/6.550 mm).
    CONCLUSION: DS patients demonstrate progressive paraspinal muscle atrophy, sagittal-oriented facet joints, and advanced facet degeneration correlating with scoliosis severity. Diagnostic thresholds indicating DS probability are BMD < - 0.900 T-score, LCSA/GCSA < 0.805, MF CSA < 635 mm2, ES CSA < 832 mm2, FJA > 57°, and FO length > 6.550 mm.
    Keywords:  Degenerative changes; Lumbar facet joints; Paraspinal muscles; Risk factors; Scoliosis
    DOI:  https://doi.org/10.1186/s40001-025-03609-w
  63. J ISAKOS. 2025 Dec 06. pii: S2059-7754(25)00665-0. [Epub ahead of print] 101047
    Infratuberositary Derotational Tibial Osteotomy for Anterior Knee Pain in Patients with Pathological External Tibial Torsion: A Novel Technique.
    Vicente Sanchis-Alfonso, Erik Montesinos-Berry, Fermín Ordoño-Dominguez.
      Pathological external tibial torsion is recognized as a cause of anterior knee pain. Derotational tibial osteotomy is a promising surgical intervention for anterior knee pain in patients with excessive external tibial torsion. It is indicated in disabling anterior knee pain recalcitrant to an appropriate conservative treatment with external tibial torsion > 35°. However, there is currently no strong evidence supporting specific torsion angles as a standalone indication for surgery. It is contraindicated in patients with pathological external tibial torsion without clinical symptoms or for cosmetic reasons. This technical note describes our surgical technique of derotational osteotomy to correct pathological external tibial torsion in patients with a normally positioned tibial tuberosity. When there is an excess of external tibial torsion and the foot is placed in a forward direction during gait, the knee joint is pointed inward, and this increases the Q angle and thereby the lateral quadriceps vector. When we internally rotate the distal tibial fragment of the osteotomy to the pre-planned correction, the knee faces forward when the foot points forward during gait, thereby correcting the excessive lateral quadriceps vector by reducing the Q-angle. Good clinical outcomes and few complications have been reported with this surgical technique.
    Keywords:  Anterior Knee Pain; Derotational Tibial Osteotomy; External Tibial Torsion; Tibial Maltorsion
    DOI:  https://doi.org/10.1016/j.jisako.2025.101047
  64. J Clin Med. 2025 Nov 22. pii: 8299. [Epub ahead of print]14(23):
    Anatomical Considerations in the Twin Block Technique for the Treatment of Masticatory Myofascial Pain: An Anatomical Review.
    Camila Venegas-Ocampo, Veronica Iturriaga, Nicolás E Ottone, Carlos Torres-Villar, Franco Marinelli, Ramón Gelabert, Ramón Fuentes.
      Myofascial pain (MFP) is one of the most frequent temporomandibular disorders (TMDs), primarily affecting the masseter and temporalis muscles. Various treatment strategies have been developed, including trigger point injections (TrP) and nerve blocks. Among these, the twin block technique has recently emerged as a promising, minimally invasive approach for simultaneously anesthetizing the masseteric and anterior deep temporal nerves through a single extraoral injection. This review presents the anatomical considerations essential for the application of the twin block technique. The course, branching patterns, and relationships of the masseteric and deep temporal nerves with adjacent vascular structures are described based on the current anatomical literature. A comparison is also made of isolated nerve blocks and the twin block, highlighting procedural protocols, clinical advantages, and safety profiles. The anatomical proximity between the masseteric and deep temporal nerves supports the rationale for a single-puncture approach, which can effectively reduce muscle tone, inhibit nociceptive input, and silence multiple trigger points simultaneously. In addition to its therapeutic benefits, the twin block can serve as a diagnostic tool to differentiate muscular from joint or odontogenic pain. In conclusion, the twin block technique offers a precise and efficient method for managing masticatory myofascial pain, provided that detailed anatomical knowledge is applied to ensure procedural accuracy, a low incidence of adverse effects, and patient safety.
    Keywords:  deep temporal nerve; masseteric nerve; myofascial pain; temporomandibular disorders; twin block technique
    DOI:  https://doi.org/10.3390/jcm14238299
  65. Ann Med. 2025 Dec;57(1): 2586334
    Towards the strategies of return to sport after lateral ankle Sprain: a systematic review.
    Hanhui Jiang, Qichang Mei, Yuan Wang, Xiaoyi Yang, Bernard Xw Liew, Justin Fernandez, Yaodong Gu.
       BACKGROUND: Returning to sport (RTS) from lateral ankle sprain (LAS) is multifaceted and interdisciplinary. This systematic review aimed to investigate the factors involved in RTS and further establish a standard paradigm of RTS to treat and rehabilitate the LAS.
    METHODS: Four electronic databases, including PubMed (MEDLINE), Web of Science, Science Direct, and Scopus, were searched until March 1, 2024. The literature was identified, screened, evaluated, managed and data was extracted by developing inclusion criteria based on the PICO model for systematic reviews. The quality of the studies was assessed using the Downs and Black checklist and the measurement parameters were summarised.
    RESULTS: This systematic review included 20 papers with a mean quality score of 75.36±10.40%. Participant's information, research content, purpose, methods, and interventions were extracted and summarized. The included articles were divided into four categories for further discussion, including (1) rehabilitation measures for LAS, (2) criteria for RTS of LAS, (3) performance assessment after RTS of LAS, and (4) the relationship between criteria and time of RTS for LAS.
    CONCLUSION: RTS for LAS is a continuous process, which is influenced by complex factors, such as the injury extent, injury causation, treatment protocols, and recovery criteria. The standard paradigms of RTS rehabilitation for LAS is still lacking in the literature. Current study identified the procedure and timeline of RTS for LAS. Findings may provide theoretical basis, clinical implications, and decision-making guidance for the RTS of LAS patients.
    Keywords:  Ankle Sprain; Foot and ankle; clinical treatment; return to play; sport rehabilitation
    DOI:  https://doi.org/10.1080/07853890.2025.2586334
  66. J Clin Med. 2025 Dec 01. pii: 8538. [Epub ahead of print]14(23):
    Additional Benefits of Creatine Supplementation with Physical Therapy and Resistance Exercise in Knee Osteoarthritis: A Randomized Controlled Trial.
    Muhammad Osama, Sabah Afridi, Bruno Bonnechère.
      Background: Knee osteoarthritis (KOA) is a progressive joint disorder that leads to pain, functional limitations, and reduced quality of life. While physical therapy (PT) and resistance exercise are effective in managing KOA, creatine supplementation (CS) may provide additional benefits. Aims/Objectives: To determine the additive effects of creatine supplementation alongside physical therapy (PT) and resistance exercise training in individuals with KOA. Methods: A parallel-design, double-blind, randomized controlled trial was conducted on 40 patients with KOA (≤grade III on Kellgren classification), aged 40-70 years. Participants were randomly allocated to either a placebo control group, which received placebo supplementation (maltodextrin) along with PT, including heat therapy, electrotherapy, manual therapy, and resistance exercises, for four weeks, or an experimental group, which received CS instead of maltodextrin in addition to the same treatment. Outcome measures included the visual analog scale (VAS), fall risk, Knee Injury and Osteoarthritis Outcome Score (KOOS), isometric muscle strength (IMS), five-repetition sit-to-stand test (5xSST), knee range of motion (ROM), and body composition analysis. Results: No significant differences were observed between the two groups at baseline. After four weeks of treatment, a significant interaction effect (treatment group x time) was observed for VAS (p = 0.001), fall risk score (p < 0.001), KOOS overall score (p < 0.001), IMS (p < 0.001), and body composition parameters (p < 0.05) in favor of the CS group. However, no significant interaction effect was observed for knee ROM and KOOS QOL subscale. Conclusions: CS, when combined with PT and resistance exercise, may provide additional benefits in terms of pain, function, muscle strength, and body composition parameters in individuals with KOA. However, no supplementary benefits of CS are observed in terms of quality of life and ROM.
    Keywords:  creatine; knee osteoarthritis; physical therapy; physiotherapy; resistance exercise; strength training
    DOI:  https://doi.org/10.3390/jcm14238538
  67. Orthop Traumatol Surg Res. 2025 Dec 06. pii: S1877-0568(25)00415-3. [Epub ahead of print] 104566
    Does tendon healing after isolated supraspinatus tendon repair influence clinical outcomes?
    Charles Thery, Maxime Antoni, Florent Baldairon, Thomas Mereb, Philippe Clavert.
       INTRODUCTION: Many factors intrinsic and extrinsic are known to influence the clinical result after rotator cuff repair. Achieving tendon healing is one of the objectives in surgical repair of the rotator cuff, and many factors could influence this healing. After one-year post-op, assessment of tendon healing can guide management if clinical examination reveals persistent pain or unsatisfactory mobility. Despite non-healing being known to be associated with poorer outcome in massive tear, it has not been clearly established that tendon healing has influence on the clinical outcome in the case of isolated distal ruptures. Therefore we performed a retrospective study aiming to determine whether if there is difference in clinical outcomes between healed and non-healed patients at one year follow up after isolated supraspinatus distal repair?
    HYPOTHESIS: We hypothesized that tendon healing status at one year has no impact on clinical outcomes.
    MATERIALS AND METHODS: A retrospective comparative study was conducted in 203 patients who undergo repair of isolated distal supraspinatus tendon tear. Healing was assessed at 1 year on MRI using the Sugaya classification. Stages I, II and III counting as "healed". Two groups were compared between 186 "healed" (107 females, 79 males) and 17 "non-healed" patients (9 females, 8 males). We analyzed evolution of Constant score and its subscores (pain, activities of daily living, motion and strength components), anterior elevation and lateral rotation at 6 weeks, 3 months, 6 months and results at one year follow up.
    RESULTS: There were no significant between the two groups in demographic data and surgical procedures. We found no significative differences during evolution at one year of follow up in global Constant score (healed, 73.7 ± 17.6; non-healed, 72.4 ± 15.6 (p = 0.72)) or its components: pain (11.3 vs 10.9 (p = 0.78)), activities of daily living (8.2 vs 8.3 (p = 0.85)), motion (35.4 vs 32.2 (p = 0.09)), strength (10.8 vs 10.1 (p = 0.59)), and anterior elevation (165.6 ° vs 163.2 ° (p = 0.65)) or lateral rotation (58.6 ° vs 58.7 ° (p = 0.98)).
    DISCUSSION: Healing showed no clinical impact in isolated distal supraspinatus tendon repair at one year follow up in Constant score analysis and in pain, activities of daily living, strength or motion. Factors which could influence healing, and the absence of result are not clear. Even so, tendon healing is a prime objective, as it has been shown to prevent lesion extension and long-term clinical deterioration. Many studies have sought to improve intra- or post-operative healing, by improve surgical technique of repair and biological supplements. Further studies are needed to improve these results.
    LEVEL OF EVIDENCE: IV; retrospective study.
    Keywords:  Arthroscopic rotator cuff repair; Cuff healing; Cuff tear; Rotator cuff tendon
    DOI:  https://doi.org/10.1016/j.otsr.2025.104566
  68. J Clin Med. 2025 Nov 21. pii: 8284. [Epub ahead of print]14(23):
    Impact of Physical Rehabilitation on Endometriosis and Adenomyosis-Related Symptoms: A Systematic Review and Meta-Analysis.
    Ángel Rodríguez-Ruiz, Beatriz Sierra-Artal, Mario Lozano-Lozano, Francisco Artacho-Cordón.
      Objectives: The aim of this study is to summarize recent evidence of the effectiveness of rehabilitation interventions in managing symptoms related to endometriosis and adenomyosis. Methods: The review protocol was registered previously (CRD42022236516). A systematic search was conducted in the Medline, Web of Science, and Scopus databases for studies published up to 23 July 2025 that reported the effects of any rehabilitation intervention in women diagnosed with endometriosis or adenomyosis. Risk of bias was assessed, and meta-analyses were performed. Results: A total of 970 studies were identified, of which 19 reports from 17 trials met the inclusion criteria. Approximately one-third of the trials focused on electrophysical agents, another third on exercise programs, and the remaining studies included manual therapy-based interventions-such as pelvic floor physiotherapy (PFP), or Swedish massage-as well as other modalities. Most trials assessed changes in pain, quality of life (QoL), and mental health, showing consistent improvements following intervention. Additional outcomes evaluated included lumbopelvic impairments, sexual function, and bone mineral density. Meta-analyses of eleven studies on pain and five on QoL revealed significant effects, favoring the intervention groups. Conclusions: This review highlights promising benefits of physical rehabilitation, particularly in patients with endometriosis. A range of approaches-including therapeutic exercise, electrophysical agents, and PFP-may contribute to improvements in endometriosis-related clinical outcomes, especially pain and QoL.
    Keywords:  adenomyosis; electrotherapy; endometriosis; exercise; pain; physical rehabilitation; quality of life
    DOI:  https://doi.org/10.3390/jcm14238284
  69. J Clin Neurosci. 2025 Dec 09. pii: S0967-5868(25)00777-5. [Epub ahead of print]144 111804
    The role of collagen pathologies and ligamentous laxity in lumbar disc herniation and its recurrence: a systematic review and meta-analysis.
    Richard Parkinson, Ralph J Mobbs, Alison Ma.
       BACKGROUND: Lumbar disc herniation is a leading cause of low back pain and radiculopathy, with substantial healthcare and socioeconomic impacts. While age-related degeneration and biomechanical stress are established contributors, emerging evidence implicates systemic connective tissue abnormalities, particularly collagen disorders and ligamentous laxity, in both the development and recurrence of lumbar disc herniation. Understanding these associations may inform preventive and therapeutic strategies.
    METHODS: A systematic review and meta-analysis were conducted using PubMed, combining the terms "lumbar disc herniation," "collagen," and "ligamentous laxity." Following screening of 218 records, 57 full-text articles were assessed, with 22 meeting inclusion criteria and 10 providing quantitative data for meta-analysis. Extracted data included sample characteristics, collagen gene involvement, presence of ligamentous laxity, and outcomes such as risk ratios (RRs) or odds ratios (ORs) for primary and recurrent LDH. Pooled RRs with 95% confidence intervals were calculated using a random-effects model.
    RESULTS: Patients with collagen anomalies or clinical ligamentous laxity demonstrated a significant increased risk of LDH with a pooled RR of 2.12 (95% CI 1.58-2.84). Mutations in COL1A1, COL1A2, COL9A3, and COL11A1 were associated with higher incidence of disc degeneration and symptomatic herniation. Ligamentous laxity and degenerative changes in the ligamentum flavum contributed mechanically to disc instability. Histological studies showed persistent matrix fragmentation and impaired collagen remodelling in recurrent LDH, indicating that connective tissue integrity influences both initial herniation and post-surgical recurrence.
    CONCLUSIONS: Collagen disorders and ligamentous laxity are associated with an increased risk of primary and recurrent LDH through combined molecular and mechanical mechanisms. These findings highlight the potential importance of connective tissue vulnerability in affected patients. While tailored interventions, including annular reinforcement, dynamic stabilization, and modified rehabilitation, may mitigate risk and improve outcomes, further research is required before routine genetic or biomechanical assessments can be incorporated into clinical evaluation or surgical planning.
    Keywords:  Collagen diseases; Disc degeneration; Intervertebral disc displacement
    DOI:  https://doi.org/10.1016/j.jocn.2025.111804
  70. J Hand Surg Glob Online. 2026 Jan;8(1): 100882
    Frequency and Outcomes of Distal Radioulnar Joint Dislocation Associated With Distal Radius Fractures in the Elderly.
    Manami Ishimatsu, Takashi Oda, Yuka Yamanaka, Katsunori Takahashi, Shuto Hamada, Takuro Wada.
       Purpose: Although dislocation or subluxation of the distal radioulnar joint (DRUJ) rarely coexists with distal radius fractures, the necessity for complementary repair of the triangular fibrocartilage complex (TFCC) in the elderly is debated. We investigated the frequency and surgical outcomes of TFCC reattachment for DRUJ dislocations with distal radius fractures in elderly patients.
    Methods: We retrospectively reviewed consecutive patients aged 65 years or older who underwent internal fixation of distal radius fractures. The fracture type and dislocation or subluxation of the DRUJ at the time of injury were evaluated. Pain, range of motion, grip strength, Modified Mayo Wrist Score, and Disability of the Arm, Shoulder, and Hand (DASH) scores were retrieved from medical records after 6 months. All cases were divided into three groups to compare the clinical outcomes: dislocation, subluxation, and nondislocation.
    Results: A total of 173 wrists (77.8 years old; 12 men and 159 women) were included. Two (1.2%) and 3 (1.7%) wrists showed dislocation and subluxation of the DRUJ, respectively, and all five wrists had Arbeitsgemeinschaft für Osteosynthesefragen (AO) type A3 distal radius fractures. Both cases of dislocation that demonstrated recurrent volar dislocation of the ulnar head after internal fixation of the radius involved repair of the TFCC using a bone anchor. Wrist extension and grip strength were worse; however, pain and DASH scores were better in the dislocation group than those in the subluxation and nondislocation groups.
    Conclusions: The incidence of DRUJ dislocation/subluxation associated with radius fractures is low in elderly patients. If the DRUJ remains unstable after internal fixation of the radius, good outcomes can be expected with one-stage reattachment of the TFCC, even in elderly patients.
    Type of study/level of evidence: Therapeutic IV.
    Keywords:  Dislocation; Distal radioulnar joint; Distal radius fracture; Triangular fibrocartilage complex
    DOI:  https://doi.org/10.1016/j.jhsg.2025.100882
  71. PLoS One. 2025 ;20(12): e0333961
    3D-MRI evaluation of cartilage thickness changes and their location in the patellofemoral joint after open wedge high tibial osteotomy for knee osteoarthritis: A retrospective cohort study.
    Yusuke Fuchioka, Nobutake Ozeki, Hideyuki Koga, Tomomasa Nakamura, Yusuke Nakagawa, Masaki Amemiya, Asuka Asami, Hisako Katano, Ichiro Sekiya.
       BACKGROUND: Open wedge high tibial osteotomy (OWHTO) has been widely established as a safe surgical procedure for medial compartmental knee osteoarthritis. However, concerns remain regarding the progression of patellofemoral (PF) osteoarthritis following surgery. Recent advances in 3D-MRI analysis have enabled quantitative cartilage thickness measurement. We hypothesized that OWHTO would result in measurable decreases in the PF joint cartilage thickness, predominantly medially and detectable using quantitative 3D-MRI. This study evaluated the clinical utility of quantitative 3D-MRI for assessing PF joint cartilage changes before and after OWHTO.
    METHODS: Patients were included if they had undergone OWHTO without lateral retinacular release for medial osteoarthritis and had both the preoperative and post-hardware-removal 3D-MRI datasets required for this analysis. Radiographic evaluations were performed before and after OWHTO. Trochlear and patellar cartilage thicknesses were measured from 3D-MRI images at both time points. Changes exceeding 0.1 mm (the validated measurement precision threshold) were considered significant. To assess cartilage loss location, each 3D image was divided into medial, central, and lateral thirds. Superimposed images were observed to determine spatial correspondence of the cartilage defects.
    RESULTS: In total, 13 knees from 13 patients (median age 55 [32-74] years) were evaluated. Postoperatively, patellar height and lateral tilt significantly decreased (p < 0.001 for both). Of these 13 cases, 7 (54%) showed thickness reductions exceeding 0.1 mm in the trochlear cartilage, and 7 cases showed reductions in the patellar cartilage, with 4 cases showing reductions in both. All cases demonstrated predominantly medial thickness decreases (p = 0.008). Of the 3 cases with patellar cartilage defects, 2 cases showed spatial correspondence with trochlear defects.
    CONCLUSIONS: Quantitative 3D-MRI analysis revealed significant cartilage thickness decreases after OWHTO, predominantly in the medial aspect of the PF joint. This method proved useful for evaluating postoperative PF joint changes and detecting cartilage defect locations.
    DOI:  https://doi.org/10.1371/journal.pone.0333961
  72. Rheumatol Int. 2025 12 08. 46(1): 8
    Methotrexate osteopathy in rheumatoid arthritis.
    Olga Dorota Lotkowska, Sabine Adler, Armin Zgraggen.
      Methotrexate (MTX) is one of the most commonly used therapeutic agents for rheumatologic inflammatory diseases and is generally considered a safe medication. Its negative effects on bone mineral density and the occurrence of fractures were first described as side effects of high-dose MTX in pediatric cancer patients. MTX-associated osteopathy in adults receiving moderate or low doses of MTX (up to 25 mg/week) for rheumatic musculoskeletal disorders remains a controversial topic. The pathogenesis and clinical significance of MTX-associated osteopathy are still incompletely understood. Clinically, it presents as atraumatic stress fractures of the distal or proximal tibia and the calcaneus, most often in elderly women with longstanding rheumatic musculoskeletal diseases, particularly rheumatoid arthritis (RA) and reduced bone mineral density. Its characteristic hallmark remains the imaging finding of band- or meander-shaped fractures along the growth plate, which are commonly multiple. The diagnosis is challenging and requires the exclusion of other causes of lower limb pain. Moreover, overlapping risk factors for insufficiency fractures are common and should be carefully investigated. The diagnosis must be made with caution, as the clinical consequences are discontinuation of MTX. In this paper, we describe four female patients with RA who presented with stress, meander-shaped fractures of the calcaneus and tibia (two with multiple fractures), showing rapid clinical improvement after MTX discontinuation, which can be attributed to MTX-associated osteopathy. Additionally, we performed a systematic review of this condition, focusing on its most common clinical and radiological features, as well as the effects of MTX on bone mineral density and fracture risk.
    Keywords:  Arthritis; Insufficiency fractures; MTX osteopathy; Methotrexate; Osteoporosis; Stress fractures
    DOI:  https://doi.org/10.1007/s00296-025-06045-5
  73. Healthcare (Basel). 2025 Nov 26. pii: 3079. [Epub ahead of print]13(23):
    Effects of Resistance Training on Motor and Cognitive Function in Older Adults with Alzheimer's Disease: A Systematic Review.
    Maria Fernanda Serna-Orozco, Stefania Pitto-Bedoya, Jhoan Sebastián Salazar-Goyes, Sebastián Figueroa-Zúñiga, Luisa María Martínez-Muñoz, Jennifer Jaramillo-Losada.
      Background/Objectives: This systematic review aimed to determine the effects of resistance training on cognitive and motor function in older adults diagnosed with Alzheimer's disease (AD). Methods: The review followed PRISMA guidelines. A comprehensive search strategy was applied across MEDLINE (OVID), SCOPUS, Web of Science, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL). The included studies were experimental, quasi-experimental, cohort, case-control, and cross-sectional designs. Exclusion criteria included studies in animals, pediatric populations, individuals with other types of dementia, Down syndrome, or other neurodegenerative diseases. Conclusions: Resistance training appears to exert beneficial effects on both motor and cognitive functions in older adults with AD. However, the development of standardized, individualized exercise protocols is essential to optimize therapeutic outcomes.
    Keywords:  Alzheimer’s disease; cognitive function; motor function; muscle strength; physical exercise
    DOI:  https://doi.org/10.3390/healthcare13233079
  74. Rev Assoc Med Bras (1992). 2025 ;pii: S0104-42302025001100608. [Epub ahead of print]71(11): e20250806
    The effectiveness of dry heat treatment (fluidotherapy) in patients with distal radius fracture followed conservatively: a single-blinded, randomized controlled clinical study.
    Basak Cigdem-Karacay, Levent Horoz, Ismail Ceylan, Halil Alkan.
       OBJECTIVE: The effectiveness of fluidotherapy has not been investigated in patients with distal radius fracturedistal radius fracture.
    AIMS: The aim of this study was to investigate the effectiveness of fluidotherapy added to conventional rehabilitation programs on pain, edema, muscle strength, and functionality in conservatively followed distal radius fracture patients.
    METHODS: The present randomized controlled, single-blinded study was conducted with 40 distal radius fracture patients who were followed conservatively with a cast. The patients were divided into two groups: the fluidotherapy and conventional rehabilitation groups. In addition to the conventional rehabilitation programs, the patients in the fluidotherapy group received 30 sessions of fluidotherapy for 6 weeks. Rest and activity pain were measured with the Numeric Rating Scale, edema with the Figure 8 method, joint range of motion with goniometry, handgrip strength with a dynamometer, and functionality with the patient-rated wrist evaluation questionnaire. Outcome measures were assessed at baseline, at week 2, and at week 6.
    RESULTS: Statistically significant changes were found in the intragroup measurements for all parameters in both groups (p<0.05). In the measurements between the groups, there was a statistical difference in the Numeric Rating Scale rest and range of motion flexion values in the conventional rehabilitation group and in the range of motion pronation parameters in the fluidotherapy group (p<0.05). No difference was found between the groups in the other parameters (p>0.05).
    CONCLUSION: Adding fluidotherapy to distal radius fracture rehabilitation had no effect on activity pain, edema, muscle strength, or functionality. Improvement in resting pain among distal radius fracture patients was less with the addition of fluidotherapy. Fluidotherapy was effective only on wrist pronation.
    DOI:  https://doi.org/10.1590/1806-9282.20250806
  75. Curr Probl Pediatr Adolesc Health Care. 2025 Nov;pii: S1538-5442(25)00151-8. [Epub ahead of print]55(11): 101877
    Congenital muscular torticollis: Diagnosis, management, and prognosis in the pediatric population.
    Leslie Phillips, Kelly Walsh, Justin Burton.
      Congenital muscular torticollis (CMT) typically is due to unilateral shortening of fibrosis of sternocleidomastoid muscle. Timely diagnosis and management are essential for improving outcomes in children. Within CMT, there are several classifications with variable prognosis: postural, muscular, and sternomastoid tumor group. The diagnosis of CMT involves comprehensive physical assessment. Treatment of CMT typically involves conservative treatment that includes physical therapy, but can involve pharmacologic treatment with botulinum toxin injections, and at worst case, surgical treatment. Caregiver education is the key to successful treatment.
    DOI:  https://doi.org/10.1016/j.cppeds.2025.101877
  76. J Exp Orthop. 2025 Oct;12(4): e70565
    Severe knee osteoarthritis is associated with histological and ultrastructural changes in the semitendinosus tendon.
    Dlshad Qadir, Khaled Meknas, Sonja Eriksson Steigen, Randi Olsen, Ninni Sernert, Jüri-Toomas Kartus, Ioannis Karikis.
       Purpose: This study aimed to assess degenerative changes in the semitendinosus tendon in patients with knee osteoarthritis (OA). The hypothesis was that individuals with severe OA would demonstrate more pronounced histological and ultrastructural tendon degeneration than those with mild-to-moderate OA.
    Methods: Tendon samples were obtained from 45 patients with knee OA. Twenty patients (median age: 53 [30-63] years) with mild-to-moderate OA underwent high tibial osteotomy (HTO), while 25 patients (median age: 71 [51-88] years) with severe OA underwent total knee arthroplasty (TKA). Semitendinosus tendon biopsies were collected at the time of surgery and examined histologically and ultrastructurally using light and electron microscopy.
    Results: The severe OA group exhibited a significantly larger mean fibril diameter than did the mild-to-moderate OA group. Histological analysis revealed significant differences across all components of the semiquantitative scoring system, except in cellularity, which remained similar between groups. The overall degenerative score was significantly higher in the severe OA group.
    Conclusions: Advanced knee OA is associated with significant histological and ultrastructural degeneration of the semitendinosus tendon, which could be interpreted as an adaptive response to chronic joint degeneration and biomechanical stress.
    Level of Evidence: Level III.
    Keywords:  knee; osteoarthritis; semitendinosus; tendinosis; tendon degeneration
    DOI:  https://doi.org/10.1002/jeo2.70565
  77. Pain Manag. 2025 Dec 08. 1-5
    Peripheral nerve stimulation of the trochanteric branch of the femoral nerve to treat greater trochanteric pain syndrome.
    Hesham Elsharkawy, Nicolas Mario Mas D Alessandro, Marianne Tanios, Andrew Olsen.
      Greater trochanteric pain syndrome (GTPS), a common cause of hip pain, is typically managed with conservative treatments such as physical therapy and corticosteroid injections. However, some cases do not respond to these conservative treatments, so alternative therapeutic options become necessary. Peripheral nerve stimulation (PNS) is a promising modality for chronic pain management and may be effective for GTPS. A 71-year-old female with a BMI of 30 kg/m2 and chronic left hip pain for over a year, unresponsive to conservative treatments, underwent temporary PNS lead placement targeting the trochanteric branch of the femoral nerve. Within one week, she reported a 90% reduction in pain, improving to 95% at two months. She regained independent mobility and improved quality of life. Leads were removed at two months, with benefits sustained at 24 months. This is the first reported case of successful PNS (SPRINT PNS System, SPR Therapeutics, Cleveland, Ohio, US) targeting the trochanteric branch of the femoral nerve for treating GTPS.
    Keywords:  Chronic pain; femoral nerve; femur; hip; treatment outcome
    DOI:  https://doi.org/10.1080/17581869.2025.2591595
  78. Sports Health. 2025 Dec 12. 19417381251387609
    Prevalence of Ulnar Nerve Dislocation Among Division I Collegiate Baseball Players.
    Tomas F Vega, Matthew P Ithurburn, Alex F Yates, Brody Westbrooks, Sydney Carlson, Ricardo E Colberg.
       BACKGROUND: Ulnar nerve dislocation is an under-reported cause of medial elbow mechanical symptoms in baseball players. It is often accompanied by a "pop" during the throwing motion. This mechanical symptom is often confused with ulnar collateral ligament (UCL) injury. This study evaluated associations of asymptomatic ulnar nerve subluxation with UCL laxity in collegiate baseball players.
    HYPOTHESIS: Asymptomatic ulnar nerve dislocation is prevalent among collegiate baseball players, and associated with years of playing baseball, playing as a pitcher, and having medial UCL laxity.
    STUDY DESIGN: Cross-sectional study.
    LEVEL OF EVIDENCE: Level 4.
    METHODS: Healthy, asymptomatic, National Collegiate Athletic Association Division I, male, collegiate baseball athletes were evaluated with dynamic stress ultrasound imaging for ulnar nerve dislocation and UCL laxity, and associations with demographic and athletic variables were evaluated.
    RESULTS: A total of 50 male athletes were evaluated (mean age, 20.5 years; 40% pitchers; mean playing experience, 15.7 years). Ulnar nerve dislocation was found in 16% of players (8 of 50 players) and in 11% of elbows evaluated (11 of 100 elbows; bilateral dislocations were identified in 3 players). None of the players reported ulnar nerve symptoms. No demographic or athletic variables, including years of playing or position, were associated with dislocation (P > 0.05). Players with ulnar nerve dislocation demonstrated higher values for all sonographic UCL laxity measurements than those who did not dislocate, including 0.6 mm greater valgus stress ulnohumeral joint space and 0.4 mm greater joint space gap. However, these group differences did not reach statistical significance (P > 0.05).
    CONCLUSION: Ulnar nerve dislocation can be an asymptomatic finding in baseball athletes. Ulnar nerves may be more prone to dislocate in the presence of medial elbow valgus laxity.
    CLINICAL RELEVANCE: Ulnar nerve dislocation should be considered a cause of medial elbow mechanical symptoms, even if the athlete is asymptomatic.
    Keywords:  UCL; baseball; ulnar collateral ligament; ulnar nerve instability; ultrasound
    DOI:  https://doi.org/10.1177/19417381251387609
  79. J Bone Joint Surg Am. 2025 Dec 10.
    Thigh Muscle Changes in the ACL-Deficient Knee: A 4-Year Longitudinal MRI Study of 1,207 Patients.
    Osama Alzobi, Bahram Mohajer, Jean Fleuriscar, Shadpour Demehri, Bashir A Zikria.
       BACKGROUND: Anterior cruciate ligament (ACL) injuries may lead to long-term neuromuscular and structural adaptations in thigh muscles. Although quadriceps dysfunction is well reported, chronic changes in other muscle groups, especially in nonoperatively managed ACL-deficient individuals, remain poorly understood.
    METHODS: The present cohort study utilized Osteoarthritis Initiative data to assess longitudinal thigh muscle changes in individuals with ACL tears confirmed on magnetic resonance imaging (MRI) and no history of reconstruction. A validated deep-learning model segmented muscle cross-sectional area and quantified intra-muscular adipose tissue and contractile percentage. Quantitative MRI data were obtained at baseline and at 4-year follow-up. Propensity score matching (1:2 to 1:3) controlled for baseline covariates. Strength was assessed with use of standardized Osteoarthritis Initiative protocols. Linear mixed-effects models compared longitudinal changes between ACL-deficient and ACL-intact thighs.
    RESULTS: A total of 1,207 thighs were analyzed, including 92 with ACL tears and 1,115 controls, with a mean patient age of 61 ± 9 years. Over 4 years, ACL-deficient thighs exhibited progressive hamstring atrophy (-28.18 mm2/year; 95% confidence interval, -42.43 to -13.92; p < 0.001) and sartorius atrophy (-3.02 mm2/year; 95% confidence interval, -5.15 to -0.89; p = 0.006). No significant differences were observed in quadriceps or adductor cross-sectional area. Hamstring force decreased significantly (-3.49 N/year; 95% confidence interval, -6.62 to -0.36; p = 0.029), whereas quadriceps force and specific force showed no significant changes. Intra-muscular adipose tissue and contractile percentage did not significantly differ between groups. Findings had been similar in unmatched patients.
    CONCLUSIONS: The present findings highlight selective muscle deterioration in the posterior thigh muscles following ACL injury, with minimal changes in quadriceps morphology, over time. These results underscore the importance of long-term, targeted rehabilitation strategies focusing on hamstring preservation. This study represents the first longitudinal matched-cohort analysis of muscle morphology and fat infiltration in unreconstructed ACL-deficient knees.
    LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
    DOI:  https://doi.org/10.2106/JBJS.25.00641
  80. Pediatr Neurosurg. 2025 Dec 12. 1-16
    Tailoring the surgical approach to Chiari I malformation with Intraoperative Ultrasounds: Advantages, limitations, and controversies.
    Fabio Zeoli, Paolo Frassanito, Rosa Linda Rinaldi, Ivane Tsiskaridze, Gianpiero Tamburrini.
      Introduction Decompression of posterior cranial fossa remains the mainstay of surgical treatment of Chiari Malformation type I (CMI), though several surgical manoeuvres have been differently combined to bony decompression aiming to increase the efficacy of surgery. In this context, Intraoperative Ultrasounds (IOUS) claims to offer a real-time feedback of adequacy of surgical decompression, thus accordingly tailoring the aggressiveness of surgery. The present review aims to highlighting benefits, limitations, and areas in need of further investigation. Materials and Methods A comprehensive literature search of PubMed, Scopus, and Google Scholar was performed for studies published in English in the last 30 years. The following keywords - including MeSH terms - were used to retrieve eligible papers: "Chiari Malformation Type I", "posterior fossa decompression", "ultrasonography". Results A total of 3189 results was collected. Duplicate records were then removed (n=1591). A total of 1598 papers were screened, and 1531 records were excluded through title and abstract screening; 65 studies were considered relevant to our research question and were assessed for eligibility. Finally 23 articles were included in the review. Conclusions IOUS has been frequently used to evaluate the adequacy of surgical decompression, though this qualitative assessment remains subjective with obvious inter-operator variability. On the other side, a quantitative assessment has been more rarely used through the literature, as this approach is difficult to reproduce. Despite the obvious advantages of IOUS, further investigation is required to standardize this approach.
    DOI:  https://doi.org/10.1159/000550058
  81. Sports Health. 2025 Dec 12. 19417381251388438
    The Burden of Shoulder and Elbow Injuries in Wrestling: A Systematic Review of Incidence, Injury Types, and Competition-Level Comparisons.
    Daniel J Maunder, Bradley C Nelson, Anand M Murthi, Ryan A Hoffman.
       CONTEXT: Wrestling is a physically demanding sport that places athletes at a high risk of musculoskeletal injuries, particularly to shoulder and elbow joints.
    OBJECTIVE: This study summarizes published data on shoulder and elbow injuries in wrestling, determines their burden, and reports weighted average injury rates (wIRs).
    DATA SOURCES: Databases searched included PubMed, Embase, Medline, Cochrane Library, and SPORTDiscus.
    STUDY SELECTION: Full-text studies in English evaluating shoulder or elbow injuries in competitive wrestlers with reported injury data specific to wrestlers, as well as to the shoulder or elbow were included. Exclusions were case reports, reviews, and studies not reporting orthopaedic injury data.
    STUDY DESIGN: Systematic review.
    LEVEL OF EVIDENCE: Level 4.
    DATA EXTRACTION: Extracted data included the first author, publication year, journal, country of the corresponding author, level of competition, method of data collection, duration of data collection, incidence of injury (injury rate [IR]) per athlete-exposure (AE), number of shoulder or elbow injuries, total number of injuries, total AEs, specific injury types, mechanism of injury, and time lost due to injury.
    RESULTS: Shoulder and elbow injuries together accounted for 21.2% of all wrestling injuries, with a wIR of 14.1 per 10,000 AEs. Shoulder injuries accounted for 14.1% of all injuries (wIR = 6.2 per 10,000 AEs), while elbow injuries accounted for 7.2% (wIR = 4.1 per 10,000 AEs). The most frequent injuries were shoulder strains/sprains (wIR = 4.2), including rotator cuff (wIR = 3.4) and acromioclavicular joint injuries (wIR = 1.5), shoulder instability (wIR = 2.5), and elbow instability, including ulnar collateral ligament injury (wIR = 1.8).
    CONCLUSION: Shoulder and elbow injuries are common in wrestling, with shoulder injuries being more prevalent due to the joint's mobility and relative instability. This review identifies the most common injuries and serves as a valuable resource for physicians managing the care of wrestlers.
    Keywords:  AC joint; elbow; rotator cuff; shoulder; shoulder instability; wrestling
    DOI:  https://doi.org/10.1177/19417381251388438
  82. Neuroepidemiology. 2025 Dec 11. 1-19
    Botulinum toxin underuse in older stroke survivors with spasticity: a nationwide population-based cohort study.
    Etienne Ojardias, Jonathan Levy, Lorène Zerah, Pierre Karam, Anne Forestier, Jean-Yves Loze, Djamel Bensmail, Rebecca Haddad.
       INTRODUCTION: While botulinum toxin type A (BoNT-A) is effective for poststroke spasticity, its accessibility in older adults remains unclear. We aimed to examine the association between BoNT-A use and age among stroke survivors.
    METHODS: This nationwide, population-based, retrospective cohort study analyzed data from the French National Hospital Discharge Database. Stroke survivors admitted between 2014 and 2016 were followed until 2020. BoNT-A use was assessed across different age groups (18-64, 65-74, 75-84, ≥85 years). Multivariable logistic regression was performed to examine the association between BoNT-A use and age, adjusting for potential confounders, including sex, comorbidities, stroke unit hospitalization, and rehabilitation.
    RESULTS: BoNT-A use was reported in 1,757 (2.88%), 862 (0.99%), and 183 (0.22%) of 60,928, 86,917, and 82,725 stroke survivors aged 65-74, 75-84, and ≥85 years, respectively. These rates were significantly lower than BoNT-A use in those aged <65 years (5.13%) (p<0.001). After adjustment, the inverse relationship between age and BoNT-A use was maintained, demonstrating an age-dependent association in the 65-74, 75-84, and ≥85 age groups versus 18-64 years. Odds ratios (ORs) (95% confidence intervals [CIs]) were 0.49 (0.47-0.53), 0.18 (0.17-0.19), and 0.05 (0.04-0.06), respectively. Stroke unit stays (OR, 1.33; 95% CI, 1.26-1.41) and neurological rehabilitation unit stays (OR, 16.69; 95% CI, 15.59-17.87) were significantly associated with a higher probability of receiving BoNT-A.
    CONCLUSIONS: BoNT-A use is notably low in older stroke survivors, highlighting the need to enhance equitable access to BoNT-A injections for this population.
    DOI:  https://doi.org/10.1159/000548679
  83. Physiother Res Int. 2026 Jan;31(1): e70147
    Structural Preservation Without Functional Recovery: Physiotherapy Reflections on Early Neuromuscular Electrical Stimulation and Passive In-Bed Cycling.
    Tigran Petrosyan, Nune Ter-Margaryan.
      Early physiotherapy interventions in critically ill patients aim to mitigate muscle wasting and functional decline. Lorenzoni et al. examined the effects of early neuromuscular electrical stimulation (NMES) combined with passive in-bed cycling on quadriceps morphology. While ultrasound measurements suggested structural preservation, functional outcomes remained unchanged. From a physiotherapy perspective, preserved thickness does not necessarily indicate preserved function, especially when interventions lack voluntary activation. This Commentary discusses the physiological and methodological limitations of interpreting passive interventions as exercise and emphasizes the need for integrated approaches combining NMES with active participation and multimodal assessment to better align structural preservation with meaningful functional recovery.
    DOI:  https://doi.org/10.1002/pri.70147
  84. Sci Rep. 2025 Dec 09.
    Rumination catastrophism and pain in injured athletes.
    Verónica Gómez-Espejo, Aurelio Olmedilla, Alejandro García-Mas, Enrique Ortega-Toro, Iván Sánchez-Iglesias, Victor J Rubio.
      Pain associated to injuries is a complex experience that combine both objective and-subjective elements and which strongly affects rehabilitation outcomes of sport injuries. It may affect directly (e.g., reducing range and strength of the movements involved in the physical therapy), or indirectly (e.g., decreasing adherence, reducing psychological readiness). Cognitive factors such as rumination and catastrophic thinking may affect the perception of pain and play a role in athletes management of pain during this journey. This study is aimed at longitudinally examine the predictive role of ruminative and catastrophism thinking in the perception of pain among injured athletes. A total of 22 injured male soccer players were recruited (Mean age = 20.3 years old; SD = .991). The assessment instruments used were ad hoc questionnaire of personal and sports-related variables; a questionnaire of current injury and sports injury history; the Pain Catastrophism Scale (PCS); the Ruminative Response Scale (RRS); and the Visual Analogue Scale (VAS) of Pain. The results showed a significant relationship between catastrophism, ruminative responses, and the perception of pain in injured athletes. Athletes with higher levels of catastrophism and rumination consistently reported a greater perception of pain. These results highlight the importance of targeted and tailored personalized psychological interventions for pain management to improve the rehabilitation process outcomes. Addressing individual coping strategies could improve recovery outcomes and support a more effective return -to-sport process.
    Keywords:  Catastrophism; Pain; Rumination responses; Sports injury
    DOI:  https://doi.org/10.1038/s41598-025-29247-0
  85. Eur J Pharm Sci. 2025 Dec 08. pii: S0928-0987(25)00400-2. [Epub ahead of print]217 107403
    Update on clinical trials of intra-articular disease-modifying osteoarthritis drugs inducing cartilage regeneration.
    Luca Morici, Ines Nikolic.
      Osteoarthritis is the most common degenerative joint disease affecting millions of people in the world and leading to disability. Currently, the only available treatments on the market are symptomatic therapies for pain and inflammation. There are no intra-articular drugs that can restore the cartilage matrix, also known as disease-modifying osteoarthritis drugs (DMOADs). This review focuses on all clinical trials of pro-anabolic DMOADs, which stimulate the regeneration of the cartilage matrix by inducing the differentiation of mesenchymal progenitors into chondrocytes, a process known as chondrogenesis. This review also discussed some pathways of chondrocytes, which boost the transcription of genes involved in the production of extracellular matrix components. Finally, the review also covers some implants in the commercial and clinical phases for cartilage repair.
    Keywords:  Cartilage; DMOADs; Intra-articular; Lorecivivint; Osteoarthritis
    DOI:  https://doi.org/10.1016/j.ejps.2025.107403
  86. J Clin Med. 2025 Nov 25. pii: 8358. [Epub ahead of print]14(23):
    Clinical Outcomes of Repeated Sodium Polynucleotide Injections in Knee Osteoarthritis: Large-Scale, Retrospective Cohort Study.
    Jiyon Bok, Bongseong Kim, Kyungdo Han, Dongwook Shin, Hasuk Bae.
      Background/Objectives: Sodium polynucleotide (PN) injection has recently been considered as a potential intra-articular therapy for knee osteoarthritis (OA); however, there is limited evidence regarding the long-term consistency of repeated PN cycles. To evaluate the clinical effectiveness of repeated intra-articular PN injections after the initial 6 months of therapy in patients with knee OA, using nationwide claims data. Methods: We conducted a retrospective cohort study using data from the Korea Health Insurance Review and Assessment Service collected between 2020 and 2023. Patients who received PN injections for knee OA were classified into two groups based on the treatment cycle: Group 1 (single cycle) and Group 2 (re-administration). Surgical outcomes and symptomatic indicators, including pain-related hospital visits, arthrocentesis, nonsteroidal anti-inflammatory drug prescriptions, and antidepressant prescriptions, were analyzed. Results: A total of 142,322 patients were included in this study. Readministration of PN was associated with significantly lower rates of total knee arthroplasty (2.31% vs. 4.92%, p < 0.0001) and delayed time to surgery (252.0 vs. 176.6 days, p < 0.0001). Similar trends were observed for hemiarthroplasty, with a lower incidence (0.28% vs. 0.55%, p < 0.0001) and longer time to surgery (240.7 vs. 162.2 days, p < 0.0001) in the readministration group. All groups showed a timewise reduction in pain-related hospital visits and instances of arthrocentesis. Safety outcomes were not assessed in this claim-based dataset. Conclusions: Repeated cycles of PN injections provide sustained clinical benefits and may effectively delay the need for surgical intervention in patients with knee OA, supporting their possible role as a long-term conservative treatment option. Radiographic severity and safety outcomes were unavailable in this claims dataset, limiting the adjustment for baseline OA severity and restricting causal interpretation.
    Keywords:  intra-articular injection; knee osteoarthritis; real-world evidence; repeated treatment; retrospective cohort study; sodium polynucleotide; surgery delay; viscosupplementation
    DOI:  https://doi.org/10.3390/jcm14238358
  87. J Inflamm Res. 2025 ;18 16843-16855
    Immune Mechanisms and Pain in Intervertebral Disc Degeneration.
    Haozhe Cheng, Lice Wang, Chuang Huang, Zechuan Yang, Hua Wu, Zhong Fang.
      Intervertebral disc degeneration (IVDD) is a major cause of low back pain and radicular pain, posing significant socio-economic challenges. The intervertebral disc is traditionally viewed as immune-privileged. This privilege is maintained by physical barriers and molecular factors such as Fas ligand. However, when these barriers are compromised, the nucleus pulposus (NP) can be exposed to the immune system. Recent evidence underscores a critical role for immune cells, particularly macrophages, in IVDD progression. This exposure can trigger an autoimmune response, leading to inflammation that aggravates dorsal root ganglion injury and results in hyperalgesia and pain. This review aims to autoimmunity, adaptive immunity, and the origins of pain in IVDD. We conclude that understanding these immune mechanisms is crucial, as they reveal promising avenues for future targeted immunotherapies.
    Keywords:  T-lymphocytes; immunity; inflammation; intervertebral disc degeneration; macrophages; pain
    DOI:  https://doi.org/10.2147/JIR.S565510
  88. Cureus. 2025 Nov;17(11): e96419
    Outcomes Following Stem Cell-Based Therapies for Hip Osteoarthritis: A Scoping Review.
    Guilherme E Reali, Daniel Araujo Fernandes, Eduardo Campos Martins.
      Hip osteoarthritis (OA) is a prevalent and debilitating condition for which current treatment options remain limited, especially in early to moderate stages. Stem cell-based therapies, particularly those using mesenchymal stem cells (MSCs), have gained attention due to their potential regenerative and anti-inflammatory properties. This scoping review aimed to map and summarize current clinical evidence on the efficacy and safety of intra-articular stem cell therapies for hip OA. This review followed the PRISMA-ScR guidelines and was registered on the Open Science Framework (DOI: 10.17605/OSF.IO/G8V9S). A systematic search of PubMed, Embase, Cochrane Library, Web of Science, and Scopus was conducted from December 2024 to January 2025. Inclusion criteria comprised clinical studies evaluating intra-articular stem cell-based therapies in adults with hip OA. Excluded were non-clinical studies, reviews, and studies involving joints other than the hip or non-stem cell interventions. Two reviewers independently selected studies and extracted data, resolving disagreements through discussion with a third reviewer. Out of 286 records identified, 9 studies met the inclusion criteria. These included five cohort studies and four case series, assessing various MSC sources: bone marrow-derived MSCs (BM-MSCs), adipose-derived MSCs (AD-MSCs), stromal vascular fraction (SVF), and amniotic-derived preparations. Pain reduction was consistently observed, with average visual analog scale (VAS) score reductions of 30-50%. Functional improvement was reported via metrics like the Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiologic evidence of cartilage repair was limited and inconsistent. Adverse events were rare and mild, including transient joint discomfort and local swelling, with no major complications reported. Stem cell-based therapies show promising short- to mid-term outcomes in pain relief and functional improvement for hip OA, with favorable safety profiles. However, heterogeneity in study designs and limited long-term structural outcomes highlight the need for standardized protocols and robust randomized trials to confirm regenerative efficacy.
    Keywords:  hip; osteoarthritis; pain; regenerative medicine; stem cells
    DOI:  https://doi.org/10.7759/cureus.96419
  89. Arch Physiother. 2025 Jan-Dec;15:15 297-313
    Is resistance training with external loads superior to unloaded exercise in the management of chronic low back pain? A systematic review and meta-analysis.
    Marco Ranzani, Andrea Pozzi, Daniele Fornasari, Diego Ristori, Marco Testa.
       Introduction: Chronic non-specific low back pain is a leading cause of disability worldwide. While resistance training using external loads is common in rehabilitation, its added value over unloaded exercise remains uncertain, particularly across physical and psychological variables.
    Method: This systematic review and meta-analysis, registered on PROSPERO (CRD42022366975), included randomized controlled trials comparing externally loaded resistance training to unloaded exercise in adults with chronic non-specific low back pain. Primary outcomes were pain intensity and disability. Secondary outcomes included back muscle endurance, maximal strength, fear-avoidance beliefs, and pain catastrophizing. Random-effects meta-analyses were conducted, stratified by follow-up duration.
    Results: Thirteen randomized trials (778 participants) were included. At follow-up periods beyond seven weeks, externally loaded resistance training showed a small but statistically significant reduction in pain compared to unloaded exercise (mean difference = -0.52 on a 0-10 scale; 95% confidence interval [-0.92, -0.08]). No significant differences were found at short-term or post-washout follow-ups. Effects on disability were inconsistent and highly variable. Resistance training was associated with improvements in back muscle endurance and suggested a possible effect on long-term maximal strength, although wide prediction intervals prevent definitive conclusions. No meaningful differences were found for psychological variables, and pain catastrophizing was assessed in only one trial, limiting conclusions.
    Conclusion: Externally loaded resistance training is safe and feasible for chronic non-specific low back pain, but its effects on pain, disability and psychosocial outcomes are comparable to unloaded exercise. In line with the multifactorial nature of chronic pain, improvements appear driven more by exposure, adherence and therapeutic context than by load intensity alone. Exercise prescription should therefore remain individualized and embedded within a biopsychosocial framework.
    Keywords:  Chronic; Exercise therapy; Load; Low back pain; Resistance training; Weight training
    DOI:  https://doi.org/10.33393/aop.2025.3533
  90. Proc Inst Mech Eng H. 2025 Dec 10. 9544119251397581
    Sex differences in fall circumstances and injury biomechanics among older adults: A narrative review.
    Fatemeh Khorami, Numaira Obaid, Carolyn J Sparrey.
      Falls are a leading cause of injury and disability among older adults, yet sex-specific differences in fall biomechanics and injury mechanisms remain underexplored. This narrative review synthesizes current evidence on how fall circumstances, intrinsic risk factors, and biomechanical responses differ between older males and females. A comprehensive literature search was conducted using PubMed, ScienceDirect, and Google Scholar, with search terms including "fall biomechanics,""sex differences,""older adults," and "injury risk." We screened peer-reviewed studies and included English-language, human-based research that examined sex-specific fall patterns, injury outcomes, and biomechanical factors. Our findings reveal that while males are more likely to fall from seated positions, females more commonly fall while walking and are prone to sideways and backward falls-patterns associated with increased hip and head injuries. In addition, biological differences such as lower injury thresholds, reduced muscle strength, and distinct soft tissue composition further elevate injury risk in females. Despite these differences, most injury models and prevention guidelines remain male-centric or do not consider sex differences. Our findings underscore the need to integrate sex-specific anatomical and functional characteristics into fall prevention strategies and injury prediction models to improve outcomes for both sexes.
    Keywords:  fall biomechanics; fall prevention; fall-related injuries; injury thresholds; older adults; sex differences; soft tissue
    DOI:  https://doi.org/10.1177/09544119251397581
  91. Addict Biol. 2025 Dec;30(12): e70098
    A Review of Exercise Interventions for Rehabilitation in Drug-Dependent Individuals.
    Qinghua He, Li Zhu, Zhaosong Wang, Hao Wang, Yiyi Jiang, Xin Wang, Fuxuan Luo, Chaoyi Zhu, Changlong Zhan.
      This study systematically investigates the multidimensional rehabilitative effects and neurobiological mechanisms of exercise interventions in individuals with substance use disorders (SUDs). By synthesizing and critically analysing current evidence, the aim is to establish a theoretical framework for exercise-based rehabilitation and provide empirical support for optimizing intervention strategies. A comprehensive literature review was conducted, encompassing 39 core studies on exercise interventions in drug rehabilitation. Evidence-based medicine principles were applied to integrate mechanistic findings and evaluate effect sizes. The review focused on examining the physiological, psychological and neurobiological effects of various exercise modalities in individuals with SUD. Findings consistently demonstrate that exercise interventions are effective in reducing drug craving and withdrawal symptoms, improving overall quality of life and potentially lowering relapse rates. For individuals undergoing rehabilitation, exercise promotes improvements in physical health, psychological well-being and social functioning, while concurrently attenuating relapse vulnerability. As a nonpharmacological, multitarget intervention, exercise therapy exhibits significant potential in promoting neuroplasticity and facilitating psychological recovery in individuals with SUD. Standardized exercise prescriptions should be integrated into existing rehabilitation frameworks. Future research should emphasize comparative effectiveness across exercise modalities, explore the benefits of multimodal interventions, and further elucidate the interplay between biological, clinical and psychosocial mechanisms to enhance long-term rehabilitation outcomes.
    Keywords:  benefit mechanisms; drug addiction; exercise intervention; exercise‐based drug rehabilitation
    DOI:  https://doi.org/10.1111/adb.70098
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