bims-ricfun 2025-09-14 papers

bims-ricfun

Biomed News

on Rehabilitation ICF

Issue of 2025–09–14
fifteen papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica

Development of the International Classification of Functioning, Disability and Health (ICF) core set for stroke survivors in community-based rehabilitation settings in Hong Kong.
Chinese Guideline for the Rehabilitation Treatment of Osteoporosis (2024 Edition).
An International Classification of Functioning, Disability, and Health (ICF) comprehensive core set for vertebral fragility fracture.
Locomotors disability assistive devices for frail persons: An update with focus on advancement in hybrid assistive devices.
Modified Epidural Adhesiolysis Protocol for the Treatment of Refractory Low Back Pain - A Case Series.
Review of Methods for Evaluating Changes in the Tension and Properties of the Gluteus Medius Muscle (GMED) and the Tensor Fascia Latae (TFL) as a Result of Hip Osteoarthritis (HOA) and After Total Hip Arthroplasty (THA)-Could MyotonPRO Assessment Be the New Standard?
Effect of inpatient rehabilitation on self-care and functional activities in acute ischemic stroke patients who underwent thrombectomy.
The Popliteofibular Ligament: A Narrative Review of Anatomical Variants and Their Surgical Relevance in Posterolateral Knee Reconstruction.
Effectiveness of Ultrasound-Guided Peritendinous Injection Treatment with Low Molecular Weight Hyaluronic Acid in Patients with Supraspinatus Tendinopathy.
Wearable technology in rehabilitation: assessing the impact of the Apple watch on physical activity and cardiovascular health: a scoping review.
Mobile health applications for the rehabilitation of people with spinal cord injury: a scoping review.
The new perspective of cardiac exercise rehabilitation: based on integrative physiology.
Older adults' perspectives on physical activity during hospitalization: a qualitative interview study.
Botulinum toxin injection of the piriformis muscle for refractory pudendal neuralgia after decompression surgery: case report.
Harnessing Artificial Intelligence for Shoulder Ultrasonography: A Narrative Review.

Disabil Rehabil. 2025 Sep 09. 1-15

Development of the International Classification of Functioning, Disability and Health (ICF) core set for stroke survivors in community-based rehabilitation settings in Hong Kong.

Chi Keung Yeung, Ping Kin Wong, Ka Man Cheng, Shui Sang Wong, Hon Yee Cheng, Wai Yee Cheung, Choi Wa Ling.

   PURPOSE: This study aimed to develop an ICF core set for assessing stroke survivors in community-based rehabilitation settings in Hong Kong.
MATERIAL AND METHODS: A three-round Delphi process which involved 39 multidisciplinary experts in community-based rehabilitation services was conducted to reach consensus on a preliminary version of ICF core set for stroke survivors. The initial questionnaire included 130 second-level ICF categories while the panel was invited to suggest additional categories. Experts rated the relevance of each category using a 5-point Likert-type scale. Consensus of ratings was assessed using Spearman's rho and inter-quartile range indices. Two experts were identified as outliers and excluded after the second and third rounds. The remaining 37 experts then then applied the preliminary core set to stroke survivors under their care. After 6 months of application, a fourth Delphi round using the same list of categories from the third round was conducted to refine the core set based on practical feedback.
RESULTS: After refinement through 30 out of 37 experts in the fourth Delphi round, the finalised core set was developed which included 41 categories.
CONCLUSION: The final core set reflects key dimensions of functioning relevant to stroke survivors receiving community-based rehabilitation services in Hong Kong.

Keywords:  Delphi method; Hong Kong; ICF; Stroke; community-based rehabilitation; core set

DOI:  https://doi.org/10.1080/09638288.2025.2557499
J Evid Based Med. 2025 Sep 13. e70056

Chinese Guideline for the Rehabilitation Treatment of Osteoporosis (2024 Edition).

Haiming Wang, Yi Li, Chengqi He.

  Osteoporosis (OP) is one of the most serious health problems, causing a huge economic burden to patients, families, and society. OP rehabilitation treatment plays an important role in pain-relieving, reducing the risk of fracture, improving the ability of daily activities, and promoting the healing of OP fractures, and has been increasingly valued and recommended by domestic and foreign guidelines. This guideline was updated based on the Chinese Expert Consensus on Rehabilitation Intervention for Primary OP 2019 editions and was initiated by the Chinese Society of Physical Medicine and rehabilitation and the West China Hospital of Sichuan University. This guideline development was guided by domestic and international guideline development methods and principles and selected through clinical issue screening and deconstruction and two rounds of Delphi questionnaire consultation. The International Classification of Functioning, Disability and Health (ICF) was used as the theoretical framework, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used based on the best available evidence. The guideline was developed based on the best available evidence, used the GRADE method to grade the quality of evidence and recommendations, and reported according to the Reporting Items for Practice Guidelines in Healthcare. Taking into account patients' preferences and values and the needs of Chinese clinical practice, it puts forward 22 recommendations covering seven aspects (rehabilitation assessment, therapeutic modalities, occupational therapy, assistive devices, cognitive behavior and psychological therapy, traditional Chinese medicine therapy, and health education) to systematically standardize OP rehabilitation.

Keywords:  clinical practice guideline; evidence‐based medicine; osteoporosis; rehabilitation assessment; rehabilitation treatment

DOI:  https://doi.org/10.1111/jebm.70056
Disabil Rehabil. 2025 Sep 09. 1-14

An International Classification of Functioning, Disability, and Health (ICF) comprehensive core set for vertebral fragility fracture.

Matteo Ponzano, Nicholas Tibert, Sheila Brien, Larry Funnell, Jenna C Gibbs, Heather Keller, Judi Laprade, Suzanne N Morin, Alexandra Papaioannou, Zachary J Weston, Timothy H Wideman, Lora M Giangregorio.

   PURPOSE: To develop a comprehensive ICF Core Set (ICF-CS) for vertebral fragility fracture.
MATERIALS AND METHODS: The development of ICF-CSs involves three phases: i) systematic literature review and qualitative studies; ii) linking process to identify the ICF codes and categories; iii) international consensus process. i) We performed a literature search and qualitative studies with people with vertebral fragility fractures and healthcare professionals; ii) We linked the findings from the search and qualitative studies to the ICF categories, and drafted the proposed ICF-CS; iii) We performed an international consensus process involving experts with clinical or research experience in management of vertebral fragility fractures.
RESULTS: We identified 40 categories (second level categories, n = 28; third level categories, n = 11; and fourth level category, n = 1) from the international consensus process. Sixteen categories pertained to body functions and structures impairments, n = 12 to activity limitations, n = 4 to participations restrictions, and n = 7 to environmental factors.
CONCLUSIONS: The new ICF-CS for vertebral fragility fracture reports the consequences of vertebral fragility fractures in terms of body impairments, activity limitations, and participation restrictions, while taking into account personal and environmental factors that increase the negative impact of vertebral fragility fractures and hinders the access to care.

Keywords:  Osteoporosis; activity limitations; disability; mobility impairments; participation restrictions; spine

DOI:  https://doi.org/10.1080/09638288.2025.2550627
Expert Rev Med Devices. 2025 Sep 11.

Locomotors disability assistive devices for frail persons: An update with focus on advancement in hybrid assistive devices.

Rohit Kumar, Janakarajan Ramkumar, Mohan Gurjar, Siddharth Rai.

   INTRODUCTION: The World Health Organization (WHO) reported in 2023 that approximately 1.3 billion people, or 16% of the global population, are living with a disability. Among these, locomotor disabilities constitute a significant portion, underscoring the urgent need for devices that enhance mobility and support daily living. The growing demand for assistive devices highlights the critical importance of tools that foster independence and improve overall health and well-being for individuals with mobility impairments.
AREA COVERED: This review provides an update on the existing locomotor assistive devices (LADs), exploring their applications, benefits, limitations, and areas where further advancements are necessary. Special attention is given to hybrid assistive devices, a recent innovation that integrates mobility aids, transfer systems, and rehabilitation tools into a unified platform.
EXPERT OPINION: The LADs, particularly hybrid devices, not only promote user autonomy but also alleviate the caregiver demands. Additionally, this review also suggests areas for future research and development, focusing on improving the accessibility, usability, and affordability of LADs to enhance the quality of life for individuals with locomotor disabilities.

Keywords:  assistive device; assistive technology; critical illness; early ambulation; exercise therapy; frail elderly; locomotion; rehabilitation

DOI:  https://doi.org/10.1080/17434440.2025.2560660
Pain Med Case Rep. 2023 Nov;7(7): 315-318

Modified Epidural Adhesiolysis Protocol for the Treatment of Refractory Low Back Pain - A Case Series.

Brian R Connolly, Jacqueline Curbelo, Sanketh Kichena, Annmarie Jaghab, Allan Hays.

BACKGROUND: Scar tissue can form within the epidural space following surgical trauma, infection, annular tearing, hematoma formation, and disc herniation. When epidural fibrosis (EF) is present, it can render nerve roots more susceptible to entrapment, compression, and tension-each of which can potentially contribute to low back and radicular pain in the lower extremities. In the past, several different epidural adhesiolysis protocols have been described to treat such pain.
CASE REPORT: Three patients with chronic low back and radicular pain, and evidence of EF underwent a modified epidural adhesiolysis protocol over a single visit. All 3 patients reported greater than 50% pain relief for at least 3 months following treatment with the modified epidural adhesiolysis protocol.
CONCLUSION: These case results suggest that the proposed modified epidural adhesiolysis can provide significant relief of axial and radicular pain in a cost effective and accessible manner for this patient population.

Keywords: Back pain; adhesiolysis protocol; epidural fibrosis; failed back surgery syndrome; post laminectomy syndrome; vertebrogenic pain
J Clin Med. 2025 Aug 24. pii: 5982. [Epub ahead of print]14(17):

Review of Methods for Evaluating Changes in the Tension and Properties of the Gluteus Medius Muscle (GMED) and the Tensor Fascia Latae (TFL) as a Result of Hip Osteoarthritis (HOA) and After Total Hip Arthroplasty (THA)-Could MyotonPRO Assessment Be the New Standard?

Agnieszka Posturzyńska, Artur Łazorko, Bartosz Cukierman, Agnieszka Tomczyk-Warunek, Anna Winiarska, Tomasz Skrzypek, Magdalena Lis, Jaromir Jarecki.

  Background/Objectives: Osteoarthritis (OA) is a condition affecting many joints, including the hip. The treatment of advanced hip osteoarthritis (HOA) involves total hip arthroplasty (THA). Atrophy of abductor muscles is often diagnosed in patients with HOA. This review presents a number of studies evaluating changes that occur in the gluteus medius (GMED) and tensor fasciae latae (TFL) as a result of HOA and THA. MyotonPRO is a portable and non-invasive device that allows for the assessment of muscle quality. This review aimed to collect studies assessing changes in GMED and TFL following HOA and THA and to determine whether MyotonPRO can be used for this assessment. Methods: We conducted a comprehensive search of databases, including Google Scholar, Science Direct, and PubMed, for relevant articles published between 2012 and 2024. A total of 37 articles were included in our review. Qualified papers evaluated changes in the lower limb muscles, including TFL and GMED, as a result of HOA and THA using MyotonPRO and other methods. Results: In this article, we emphasize the influence of the tested muscles on HOA and the postoperative course after THA using MyotonPRO. We have shown that myotonPRO was used to assess muscle changes due to knee OA and GMED and TFL in other groups of patients. Conclusions: This is the first review of the literature to indicate a new direction of research using myotonPRO. The use of MyotonPRO will allow for the more detailed development of rehabilitation programs for patients with HOA and after THA.

Keywords:  MyotonPRO; gluteus medius muscle; hip osteoarthritis; osteoarthritis; tensor fasciae late; total hip arthroplasty

DOI:  https://doi.org/10.3390/jcm14175982
Neurol Res. 2025 Sep 09. 1-7

Effect of inpatient rehabilitation on self-care and functional activities in acute ischemic stroke patients who underwent thrombectomy.

Syed A Gillani, Mohammad Maan Al-Salihi, Moeez Ahmed, Ibrahim A Bhatti, Rami Fakih, Martin Ngo, Sarah Reid, Brandi R French, Camilo R Gomez, Adnan I Qureshi.

   BACKGROUND: The benefits of rehabilitation in acute ischemic stroke patients following thrombectomy remain underexplored. We assessed which activities of daily living (ADLs) show the greatest improvement after goal-directed therapy in an inpatient rehabilitation setting.
METHODS: We retrospectively analyzed pre- and post-rehabilitation functional assessments in 40 acute ischemic stroke patients treated with mechanical thrombectomy. All patients received goal-directed therapy at a rehabilitation facility. Activities were grouped into two domains: (1) self-care (eating, oral hygiene, toileting hygiene, showering/bathing, dressing) and (2) functional mobility (footwear management, rolling, sit-to-lying, lying-to-sitting, sit-to-stand). Mean percent changes were calculated for each activity.
RESULTS: Patients had a mean rehabilitation stay of 18 ± 9 days. In the self-care domain, the greatest relative improvements were observed in showering/bathing (44% ± 17%), upper body dressing (39% ± 19%), and toileting hygiene (39% ± 29%). In the mobility domain, the sit-to-lying activity showed the highest improvement (44% ± 20%). All measured activities demonstrated functional gains post-rehabilitation.
CONCLUSIONS: Goal-directed inpatient rehabilitation was associated with substantial improvements in both self-care and functional mobility following thrombectomy. The most notable gains were in showering/bathing and sit-to-lying transitions. These findings demonstrate that structured inpatient rehabilitation is associated with measurable improvements in functional recovery in stroke patients post-thrombectomy.

Keywords:  Acute ischemic stroke; activities of daily living; functional recovery; inpatient rehabilitation; mechanical thrombectomy

DOI:  https://doi.org/10.1080/01616412.2025.2556252
J Clin Med. 2025 Sep 07. pii: 6322. [Epub ahead of print]14(17):

The Popliteofibular Ligament: A Narrative Review of Anatomical Variants and Their Surgical Relevance in Posterolateral Knee Reconstruction.

Łukasz Olewnik, Ingrid C Landfald, Bartosz Gonera, Kacper Ruzik, Robert F LaPrade.

  Purpose: This review aims to synthesize current knowledge of anatomical variations of the popliteofibular ligament (PFL) and evaluate the clinical relevance of the classification system proposed by Olewnik et al. in the context of the diagnosis, surgical treatment, and rehabilitation of posterolateral corner (PLC) injuries. Methods: A comprehensive analysis of anatomical, surgical, and radiological studies concerning the PFL was conducted. The implications of PFL morphological variants were examined across clinical applications, with an emphasis on reconstructive strategies, imaging interpretation, and rehabilitation planning. Emerging research directions, including AI-supported imaging and personalized algorithms, were also explored. Results: Olewnik's classification identifies three distinct types of PFL, each with unique structural and biomechanical properties. Recognizing these variants enhances intraoperative orientation, facilitates tailored surgical techniques, and supports individualized rehabilitation protocols. Variant-specific biomechanics, identified via cadaveric studies and imaging, are essential for optimizing functional outcomes and minimizing postoperative instability. Furthermore, the classification offers a platform for developing future diagnostic and decision-support tools using artificial intelligence. Conclusions: The Olewnik et al. classification system should be adopted as a modern anatomical standard for the PFL. Its integration into clinical practice has the potential to improve surgical precision, reduce complication rates, and enhance patient-specific treatment planning. This framework also supports future advancements in orthopedic imaging, education, and AI-driven diagnostics. Beyond descriptive anatomy, we provide a pragmatic surgical algorithm for PLC repair/reconstruction that accounts for scar- and fibrosis-dominated fields and the limited bone stock of the fibular head.

Keywords:  Olewnik; anatomical classification; knee instability; personalized orthopedics; popliteofibular ligament; posterolateral corner; reconstruction

DOI:  https://doi.org/10.3390/jcm14176322
J Clin Med. 2025 Sep 05. pii: 6291. [Epub ahead of print]14(17):

Effectiveness of Ultrasound-Guided Peritendinous Injection Treatment with Low Molecular Weight Hyaluronic Acid in Patients with Supraspinatus Tendinopathy.

Francesco Agostini, Alessandro de Sire, Alessio Savina, Giovanni Iudicelli, Andrea Fisicaro, Giacomo Camponogara, Marco Narciso, Alessio Fricano, Marco Conti, Umile Giuseppe Longo, Valter Santilli, Antonio Ammendolia, Massimiliano Mangone, Marco Paoloni.

  Background/Objectives: Tendinopathies represent a prevalent musculoskeletal condition characterized by load-dependent pain, stiffness, weakness, and impaired functionality. Current treatment includes therapeutic exercise, physical modalities and injective therapy. Hyaluronic acid (HA) is a fundamental component of the extracellular matrix and plays a crucial role in tissue hydration, elasticity, and lubrication. This study aims to evaluate the effectiveness of ultrasound-guided injections of HA in improving pain symptoms and functionality in patients with supraspinatus tendinopathy. Methods: Patients with a confirmed diagnosis of supraspinatus tendinopathy, verified through ultrasound imaging, were included in the study. Patients underwent 3 ultrasound guidance injections (1/week) of Sodium Hyaluronate (Hyalotend, 20 mg/2 mL). Patients were evaluated at the baseline, 1 month (T1), 3 months (T2), 6 months (T3), and 1 year (T4) after the first injection through the VAS, the QuickDASH and the SF-12. Results: Twenty-four patients were enrolled. As regards the VAS there was a statistically significant reduction (p < 0.01) of averages of values over time. The scores collected through the QuickDASH questionnaire have a statistically significant variation over time (p < 0.001). The values collected through the SF-12 Mental Component Summary (MCS) questionnaire show a highly statistically significant variation over time (p < 0.005). The values collected through the SF-12 Physical Component Summary (PCS) questionnaire show a statistically highly significant change over time (p < 0.001). Conclusions: Our results suggest that HA (Hyalotend) injections could represent a viable therapeutic option for patients with supraspinatus tendinopathy in the short, medium, and long term. Further studies with larger patient samples and a control group are needed to better investigate the effects and the modalities of administration of HA in tendinopathies.

Keywords:  hyaluronic acids; rehabilitation; supraspinatus tendon; tendinopathy; ultrasound-guided peritendinous injection

DOI:  https://doi.org/10.3390/jcm14176291
J Sports Med Phys Fitness. 2025 Sep 12.

Wearable technology in rehabilitation: assessing the impact of the Apple watch on physical activity and cardiovascular health: a scoping review.

Roberto Tedeschi, Federica Giorgi, Vincenzo Ricci, Fabio Vita, Danilo Donati.

INTRODUCTION: The Apple Watch is increasingly used in rehabilitation to monitor physical activity, cardiovascular health, and other physiological parameters. This review evaluates its effectiveness and accuracy in various rehabilitation settings, examining its potential to enhance patient adherence and clinical outcomes.
EVIDENCE ACQUISITION: A comprehensive search was conducted across databases including MEDLINE, Cochrane Central, Scopus, PEDro, and Web of Science, alongside grey literature. Studies were included based on the PCC criteria (Population, Concept, Context), focusing on the use of the Apple Watch in rehabilitation programs. Bias risk was assessed using RoB 2 for RCTs and ROBINS-I for non-randomized studies.
EVIDENCE SYNTHESIS: Five studies were reviewed. The Apple Watch showed potential in improving physical activity levels and functional outcomes, particularly when combined with behavioral interventions. It demonstrated effectiveness in detecting atrial fibrillation in large-scale screening but presented variability in heart rate and energy expenditure accuracy, especially during high-intensity activities. The studies highlighted that integrating cognitive support with the device enhances adherence and health outcomes. However, limitations in measurement accuracy and the need for hybrid monitoring approaches were noted.
CONCLUSIONS: The Apple Watch is a valuable tool in rehabilitation when used alongside behavioral support and validated clinical methods. Its effectiveness is enhanced when integrated into a multidisciplinary approach, but its limitations in accuracy necessitate further calibration and hybrid use with traditional tools. Future research should focus on long-term impacts and algorithm improvements to optimize its clinical utility in diverse rehabilitation contexts.

DOI: https://doi.org/10.23736/S0022-4707.25.16874-6
Disabil Rehabil Assist Technol. 2025 Sep 11. 1-16

Mobile health applications for the rehabilitation of people with spinal cord injury: a scoping review.

Afonso Mota, Marta Campos Ferreira, Carla Sílvia Fernandes.

   BACKGROUND: Individuals with spinal cord injury (SCI) face complex and ongoing rehabilitation needs. In this context, mobile health applications have emerged as promising tools to support self-management and rehabilitation.
OBJECTIVE: To map and characterize mobile applications specifically developed to support rehabilitation of individuals with SCI.
METHODS: A scoping review was conducted in accordance with PRISMA-ScR guidelines. A systematic search was performed across five electronic databases (PubMed, Scopus, Web of Science, and CINAHL). Studies published between 2015 and 2024 describing the use of mobile applications in the rehabilitation of adults with SCI were included.
RESULTS: A total of 24 studies were included. We synthesized the identified applications descriptively into four domains: self-management and health education; gamification and motivation for physical rehabilitation; monitoring and prevention of secondary complications; and assistive technology and advanced rehabilitation. A consistent adoption of user-centered design principles was observed. Despite high levels of reported usability, challenges remain regarding long-term engagement, technological complexity, and sustained adherence.
CONCLUSION: Mobile applications represent a promising complementary resource to support rehabilitation and health management in individuals with SCI. However, more robust longitudinal studies with larger sample sizes are required to assess the clinical impact and long-term feasibility of these interventions.

Keywords:  Health app; assistive technology; mobile health; rehabilitation apps; spinal cord injury

DOI:  https://doi.org/10.1080/17483107.2025.2559190
Front Physiol. 2025 ;16 1651589

The new perspective of cardiac exercise rehabilitation: based on integrative physiology.

Guopeng You, Jinwen Xie, Wei Tong, Shaocong Zhao.

  Cardiovascular diseases (CVDs) are the world's leading cause of death, but there's a gap between scientific research and real-world treatment. Exercise is a safe and effective way to prevent and manage CVDs, yet putting it into practice faces many challenges. This review shows how exercise protects the heart by improving metabolism, reducing inflammation and cell damage, and strengthening connections between heart cells and blood vessels. Exercise establishes a multi-organ defense network involving remote organs including the brain, skeletal muscle, adipose tissue, liver, and kidneys. To bridge the gap between research and clinical use, future efforts should focus on developing exercise-like drugs, personalized workout plans, and remote rehabilitation programs.

Keywords:  aerobic exercise; cardiac rehabilitation; cardiovascular; exercise rehabilitation; integrative physiology

DOI:  https://doi.org/10.3389/fphys.2025.1651589
BMC Geriatr. 2025 Sep 08. 25(1): 688

Older adults' perspectives on physical activity during hospitalization: a qualitative interview study.

Kristina Dalin Eriksson, Anna-Karin Welmer, Linda Sandberg, Anne-Marie Boström.

   BACKGROUND: The benefits of physical activity for frail older acutely hospitalized adults are becoming increasingly clear. To enhance opportunities for physical activity on geriatric wards, it is essential to understand the older adult's perspective.
AIM: The aim of the study was to explore the experiences and perceptions of physical activity among older adults during hospital stays on a geriatric ward.
METHOD: This was a qualitative interview study with an exploratory interview design, where data were collected through semi-structured individual face-to-face interviews with 20 hospitalized older adults aged 75 years and older. The interviews were transcribed verbatim, and the material was analyzed inductively using qualitative content analysis.
RESULTS: An overarching theme Barriers and enablers related to the environment, personal adaptation, and emotional dilemmas influencing changes in physical activity and three main categories and seven subcategories were identified. The main categories are Perceiving how context influences physical activity, Adapting physical activity to aging and health condition, and Balancing emotional dilemmas about engaging in physical activity.
CONCLUSIONS: The results emphasize the need for enhanced communication and personalized care to better support frail older adults in engaging in physical activity during hospitalization. Customized advice and tailored physical activities are key to supporting them in staying active and healthy. Effective strategies, teamwork, and resource allocation are needed to meet these older adults' needs and develop interventions that ensure proper care and support.
TRIAL REGISTRATION: This study did not involve any healthcare interventions on human participants. Data were collected through interviews, and focused solely on exploring experiences and perceptions, with ethical approval obtained for the study.

Keywords:  Exercise; Frailty; Geriatric patients; Hospitalization; Older adults; Older patients; Physical activity; Qualitative; Sedentary behavior

DOI:  https://doi.org/10.1186/s12877-025-06292-y
Pain Manag. 2025 Sep 09. 1-6

Botulinum toxin injection of the piriformis muscle for refractory pudendal neuralgia after decompression surgery: case report.

Tomás Caroço, Renaud Bollens, Diogo Portugal.

  Pudendal neuropathy is a cause of pelvic pain, specifically pudendal neuralgia. The pudendal nerve is related to sensory, motor, and autonomic functions. We present the case of a 41-year-old man who suffered from chronic pelvic pain. In detail, the patient described stinging burning pain in the glans penis, proctalgia, lower urinary tract symptoms, sensation of "muscle tension" and squeezing pain. He was diagnosed with prostatitis and, following, pudendal neuralgia. Our patient was treated with antibiotics and analgesics, without improvement of symptoms. He was then submitted to decompression surgery of the pudendal nerve, with partial improvement. The patient started a rehabilitation program and was treated with OnabotulinumtoxinA (BoNT-A) injections into the piriformis muscle with benefit. BoNT-A positive effects on pain relief may corroborate piriformis muscle compression of the pudendal nerve. BoNT-A may also reduce the release of neurotransmitters from the pain pathways. Early identification of pudendal neuralgia could have prevented the progression to chronic pain. There is still not an established role for BoNT-A in post-operative pudendal nerve decompression patients. Our case corroborates that more studies should be performed to explore BoNT-A administration in these patients.

Keywords:  Botulinum toxin; case report; neuropathy; onabotulinumtoxinA; pelvic pain; piriformis muscle; pudendal neuralgia; ultrasound

DOI:  https://doi.org/10.1080/17581869.2025.2555162
J Imaging Inform Med. 2025 Sep 12.

Harnessing Artificial Intelligence for Shoulder Ultrasonography: A Narrative Review.

Wei-Ting Wu, Yi-Chung Shu, Che-Yu Lin, Consuelo B Gonzalez-Suarez, Levent Özçakar, Ke-Vin Chang.

  Shoulder pain is a common musculoskeletal complaint requiring accurate imaging for diagnosis and management. Ultrasound is favored for its accessibility, dynamic imaging, and high-resolution soft tissue visualization. However, its operator dependency and variability in interpretation present challenges. Recent advancements in artificial intelligence (AI), particularly deep learning algorithms like convolutional neural networks, offer promising applications in musculoskeletal imaging, enhancing diagnostic accuracy and efficiency. This narrative review explores AI integration in shoulder ultrasound, emphasizing automated pathology detection, image segmentation, and outcome prediction. Deep learning models have demonstrated high accuracy in grading bicipital peritendinous effusion and discriminating rotator cuff tendon tears, while machine learning techniques have shown efficacy in predicting the success of ultrasound-guided percutaneous irrigation for rotator cuff calcification. AI-powered segmentation models have improved anatomical delineation; however, despite these advancements, challenges remain, including the need for large, well-annotated datasets, model generalizability across diverse populations, and clinical validation. Future research should optimize AI algorithms for real-time applications, integrate multimodal imaging, and enhance clinician-AI collaboration.

Keywords:  Deep learning; Machine learning; Neural networks; Rotator cuff; Ultrasound

DOI:  https://doi.org/10.1007/s10278-025-01661-w