bims-ricfun 2026-03-01 papers

bims-ricfun

Biomed News

on Rehabilitation ICF

Issue of 2026–03–01
83 papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica

Finger Joint Releases in the Setting of Complex Regional Pain Syndrome: Worthwhile or Risky?
Beyond Cross-Sectional Area: Expanding the Diagnostic and Procedural Framework for Ultrasound in Carpal Tunnel Syndrome.
Hybrid Assistive Limb Single Joint Type (HAL-SJ) Training for Knee Osteoarthritis: A Case Series.
Safety and Efficacy of Autologous Bone-Marrow-Derived Mesenchymal Stem Cells for Treating Partial Rotator Cuff Tears: Observational Study with 4-Year Follow-Up.
Effects of Exercise-Based Telerehabilitation for Knee Osteoarthritis: A Systematic Review and a Study Protocol.
Comparison of the efficacy of platelet-rich plasma versus corticosteroid in the treatment of adhesive capsulitis: a systematic review and meta-analysis based on randomized controlled trials.
From mild to severe carpal tunnel syndrome: The role of ultrasound-guided perineural 5% dextrose injection: A prospective study.
Advances in hyaluronic acid therapy for knee osteoarthritis: monotherapy and combination strategies: an evidenced based review.
Efficacy of different doses of platelet-rich plasma for moderate carpal tunnel syndrome: study protocol for a prospective, randomized, controlled trial in Guangzhou, China.
Comparing Regenerative Biologics and Standard Pharmacotherapy for Chronic Rotator Cuff Tendinopathy: A Study of PRP, Cell-Based, and Peptide Interventions.
Advancing Neurological Rehabilitation: The BRAIN Framework for Clinical Reasoning in Neurophysiotherapy.
Outcome Measure Frequency in Stroke Rehabilitation Lower Extremity Randomized Controlled Trials and its Correlation with Research and Clinical Practice Recommendations.
Ultrasound diagnosis of three different types of carpal tunnel syndrome associated with persistent median artery: A case report and literature review.
The efficacy of platelet-rich plasma compared to corticosteroids for partial-thickness rotator cuff tears: a randomized controlled trial.
Rotator Cuff Disorders: Practical Recommendations for Conservative Management Based on the Literature.
Evaluating the Impact of 6-Week Gamified Virtual Reality Rehabilitation Program on Pain, Function, and Balance in Knee Osteoarthritis: A Randomized Controlled Trial.
Degeneration of paraspinal and gluteus medius muscles in nonspecific chronic low back pain: a quantitative MRI study.
Ultrasound-Guided Percutaneous Needle Electrolysis Versus Surgery for Carpal Tunnel Syndrome: A Randomized Clinical Trial.
Comprehensive Sonographic Paradigm and Trend Pattern of Median Nerve Indices in Carpal Tunnel Syndrome from Wrist to Forearm: What We Need to Know.
[Research progress on the causes of pain in knee osteoarthritis].
Towards optimized rehabilitation with regenerative therapy: A systematic review and meta-analysis on the effects of cell-based injections for knee osteoarthritis.
MULTIple or ONE home strengthening exercise(s) for knee osteoarthritis: Protocol for the MULTI-ONE randomised controlled trial.
Novel technique of arthroscopic debridement for pisotriquetral joint arthrosis through standard radiocarpal portals of wrist arthroscopy.
Comparative Rehabilitation Benefits of Water-Based Versus Land-Based Exercise in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.
Association between pain, physical performance, and kinesiophobia in older women with low back pain: A cross-sectional study.
Content Analysis of ICF-Based Data in the Multidisciplinary Health Records of People With Spinal Cord Injury.
Which Training Is More Effective in Post-COVID-19 Geriatric Patients with COPD: Cycle Ergometer Interval Training or Continuous Training?
A scoping review of the impact of transverse carpal ligament sectioning on the thumb carpometacarpal joint: Does it increase the risk of ostearthritis?
Pilates-Based Training and Its Influence on Muscle Viscoelasticity and Health-Related Outcomes in Chronic Low Back Pain: A Comparative Study.
Impact of Early Versus Late Treatment with Botulinum Toxin A on Goal Attainment in Post-Stroke Spasticity: A Retrospective Cohort Study.
Relative Motion Extension Orthosis Versus Classic Immobilization in Extensor Tendon Repairs (Zones IV-VI of the Hand): A Randomized Controlled Trial.
Fatty change and muscle atrophy in patients with rotator cuff tears: a prospective study with a mean 6-year follow-up.
Conservative management of degenerative rotator cuff tears: A systematic review of long-term clinical outcomes and cost effectiveness.
Clinical Outcomes of Injectable Porcine Collagen in Diabetic Patients with Achilles Tendinopathy: A Retrospective Study.
Ultrasound Accuracy in Classifying Full-Thickness Supraspinatus Tear Patterns: An Arthroscopic Correlation Study.
Hip Arthroplasty in Supra-trochanteric Limb Length Discrepancy Patients.
Ultrasound-Guided Aspiration and Dextrose Prolotherapy for a Triangular Fibrocartilage Complex Ganglion Cyst in an Avid Golfer: A Case Report.
[Interpretation of the 2025 American Academy of Orthopaedic Surgeons (AAOS) on Management of Rotator Cuff Injuries Evidence-Based Clinical Practice Guideline].
Three intra-articular injections of allogeneic umbilical cord-derived mesenchymal stromal cells in knee osteoarthritis: a phase-I clinical trial.
Rehabilitation Strategies Following Isolated Meniscal Repair: A Systematic Review of Protocols and Outcomes.
Old Is Gold: The Continued Relevance of Functional Tests in Older Adults Amid Technological Advances in the Field of Exercise and Rehabilitation.
Long-term efficacy of intra-articular viscosupplementation in delaying hip osteoarthritis radiographic progression: a retrospective, non-controlled study from the ANTIAGE registry.
Injury characteristics, outcome, and return to play after ankle sprains and Achilles tendon ruptures in tennis.
Investigation of the effects of morphometric characteristics of the foot on Achilles tendon rupture.
Shoulder pain in wheelchair rugby athletes: Athlete characteristics, training behaviors, and rehabilitation implications.
Preoperative Cryogenic Neurolysis Trends Toward Reduced Severe Postoperative Pain in Patients Admitted to the Hospital After Total Knee Arthroplasty.
Effectiveness of Radiofrequency Ablation for Chronic Low Back Pain: A Systematic Review of Sham-Controlled Randomized Controlled Trials.
Efficacy and safety of a combination of platelet-rich plasma with non-crosslinked hyaluronic acid versus a crosslinked hyaluronic acid, in single-injection for knee osteoarthritis. Randomized, controlled, multicenter, non-inferiority trial.
YouTube as a digital health platform: A cross-sectional thematic and sentiment analysis of the 100 most-viewed knee osteoarthritis videos.
Exploratory Use of Proximal Cryoneurolysis and Distal Botulinum Toxin Type A for Upper-Limb Spasticity: A Case Report with Scoping Review.
Imaging and its role in predicting osteoarthritis progression.
Standing up to neurodegeneration: evaluating autonomic stress and safety in sit-to-stand using heart rate variability analysis.
Single-injection hyaluronic acid treatment demonstrates non-inferiority in the relief of symptomatic knee osteoarthritis: A randomized double-blind, multi-center controlled study.
How Intense Is Effective? Exploring Aerobic Exercise Intensity for Knee Osteoarthritis Through a Bayesian NetworkMeta-Analysis.
Ultrasound-Guided Radiofrequency Ablation of the Ilioinguinal Nerves to Treat Ilioinguinal Neuralgia: A Description of a Novel Approach.
Differences in Pressure Pain Threshold and Strain Elastography Between Women with and Without Fibromyalgia: A Cross-Sectional Study.
Effect of neuromuscular electrical stimulation associated with therapeutic exercise on pain, function, and strength of people with knee osteoarthritis: a systematic review with meta-analysis of randomized clinical trials with GRADE recommendations.
The effects of traditional Chinese mind-body exercise on pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.
Finite Element Modeling of the Scaphoid Shift Maneuver: Implications for Scapholunate Ligament injuries.
Responsiveness of central sensitization-related measures in older people with chronic low back pain.
Grey matter volume reduction in the cerebellum of hip osteoarthritis patients: insights from pre- and postoperative VBM analysis.
Muscle reorientation as a novel cause of motor weakness after spinal realignment surgery: a hypothesis based on psoas muscle overstretching.
Ankle Bracing as a Public Health Game Changer: A Narrative Review on the Prevention of Ankle Injuries in Basketball Players.
Effects of Focal Muscle Vibration on Static and Dynamic Balance in Patients with Parkinson's Disease: Preliminary Results of a Retrospective Study.
Let them move: Early range of motion and rehabilitation after fixation of medial epicondyle fractures in adolescent athletes.
Intra-articular hyaluronic acid (viscosupplementation) for osteoarthritis: is it effective?
Effects of yoga on pain, physical function, and biomechanical/impairment outcomes in knee osteoarthritis: A systematic review and three-level meta-analysis.
Integrated nerve and tendon transfer approach to restore functional balance of the hand in tetraplegia.
Imaging-derived neuromuscular ultrasound phenotypes are associated with functional status in amyotrophic lateral sclerosis.
Effect of Single Perineural Injection of Platelet Rich Plasma on Nerve Function in Hansen's Disease With Truncal Neuropathy: An Interventional Study.
Injection of Adipose-Derived Stromal Vascular Fraction Rapidly Relieves Pain in Patients with Knee Osteoarthritis.
Is melatonin's efficacy in diabetic neuropathic pain dependent on circadian timing of administration?
How is the rating of perceived effort reported in anterior cruciate ligament and knee osteoarthritis rehabilitation studies? A scoping review.
Intravenous Pamidronate in Persistent Complex Regional Pain Syndrome (CRPS): A Retrospective Observational Study on Effectiveness and Tolerability.
Management of infected flexor tendon injuries: A narrative review.
Minimal important change and minimal clinically important difference in pain and function with exercise in hip osteoarthritis.
The Silent Strain: Grip Strength, and Wrist/Hand Musculoskeletal Disorders among Meat Cutters.
Addition of platelet-rich plasma to physiotherapy reduces tear volume and іmproves functional outcomes in articular-sided partial supraspinatus tendon tears.
Artificial Intelligence-Based Exploration of the Relationship Between Running Motion Patterns and Achilles Tendon Stress in Inactive Adults Initiating a Running Program.
On "Depressive Symptoms and Physical Activity Mediate the Adverse Effect of Pain on Functional Dependence in Patients With Arthritis: Evidence from the Canadian Longitudinal Study on Aging." Goubran M, van Allen ZM, Bilodeau M, Boisgontier MP. Phys Ther. 2025;105(11):pzaf120. 10.1093/ptj/pzaf120.
Outcome Reporting in Distal Radius Fracture Research: A Systematic Review Across Treatment Modalities.
Adjuvant bladder thermal irrigation for ultrasound-guided botulinum toxin a injection in refractory bladder pain syndrome: a retrospective cohort study.
Pain After Brachial Plexus Injury Surgery: Variability in Reporting.

J Hand Surg Am. 2026 Feb 27. pii: S0363-5023(26)00049-3. [Epub ahead of print]

Finger Joint Releases in the Setting of Complex Regional Pain Syndrome: Worthwhile or Risky?

Francisco Del Piñal.

   PURPOSE: The literature remains pessimistic about surgery for finger stiffness in patients with complex regional pain syndrome (CRPS), citing the risks of exacerbation and limited motion gains. This study reports the outcomes of joint-release procedures and details the surgical technique.
METHODS: All patients with CRPS and contracted finger joints who presented with unyielding stiffness and consented to surgery were included. Patients underwent a minimally invasive release of the metacarpophalangeal and/or proximal interphalangeal (PIP) joints. By protocol, all patients also underwent carpal tunnel release of the median nerve. Splinting and physical therapy were added as required. Primary outcomes were improvement in total active motion and in the arc of motion of the affected joint. Secondary outcomes were pain, on a scale of 0-10, and function.
RESULTS: Between January 2018 and December 2024, 25 patients met the inclusion criteria. There were 22 females and 3 males, with a mean age of 54 years (range, 28-74). Ninety-nine finger joints were released in 74 fingers: 54 metacarpophalangeal extension, 42 PIP flexion, and 3 PIP extension contractures. Significant improvements were observed in total active motion (104° ± 43° to 220° ± 43°, mean gain 116° at 34 months), active metacarpophalangeal motion (mean gain 61° ± 38°), active PIP motion (mean gain 42° ± 28°), pain (8.1 ± 3 to 0.5 ± 1), and Disabilities of the Arm, Shoulder and Hand score (79 ± 18 to 15 ± 12) over the same period. No patient experienced CRPS exacerbation after surgery, despite no sympathetic-directed measures being used. One patient required further surgery for residual pain, and another required joint rerelease before achieving the final result.
CONCLUSIONS: Joint releases followed by splinting yield favorable outcomes in CRPS-associated joint contractures.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Keywords:  CRPS; Sudeck; finger contractures; finger stiffness; irritative carpal tunnel syndrome

DOI:  https://doi.org/10.1016/j.jhsa.2026.01.002
J Ultrasound Med. 2026 Feb 28.

Beyond Cross-Sectional Area: Expanding the Diagnostic and Procedural Framework for Ultrasound in Carpal Tunnel Syndrome.

Tian Ruan.

DOI: https://doi.org/10.1002/jum.70222
Cureus. 2026 Jan;18(1): e102019

Hybrid Assistive Limb Single Joint Type (HAL-SJ) Training for Knee Osteoarthritis: A Case Series.

Mao Tanaka, Yuichiro Soma, Yukiyo Shimizu, Naoya Kikuchi, Hideki Kadone, Masashi Yamazaki, Hajime Mishima, Yasushi Hada.

  Knee osteoarthritis (OA) is a common degenerative joint condition in older adults, and pain often limits engagement in conventional exercise therapy. We report three cases of patients with Kellgren-Lawrence (KL) grade 3 KO who underwent rehabilitation using the Hybrid Assistive Limb Single Joint Type (HAL-SJ), a wearable robotic device that supports voluntary knee movement based on bioelectrical signals from muscle activity. All patients completed 10 training sessions over five weeks with no serious adverse events. The intervention was well tolerated, and no clinically significant deterioration in symptoms was observed during the training period. Knee pain decreased in two cases and remained unchanged in one case. These cases suggest that HAL-assisted knee training is feasible and safe for patients with moderate knee OA and may offer potential clinical benefits.

Keywords:  conservative therapy; hybrid assistive limb (hal); knee osteoarthritis/ koa; rehabilitation protocol; robotic-assisted rehabilitation

DOI:  https://doi.org/10.7759/cureus.102019
Biomedicines. 2026 Feb 06. pii: 382. [Epub ahead of print]14(2):

Safety and Efficacy of Autologous Bone-Marrow-Derived Mesenchymal Stem Cells for Treating Partial Rotator Cuff Tears: Observational Study with 4-Year Follow-Up.

Nicholas Hooper, Ahmad Alhusen, Hinnah Siddiqui, John Pitts, Prathap Jayaram, Chirstopher J Williams.

  Background/Objectives: Rotator cuff tears (RCTs) are a leading cause of shoulder pain and disability. Management typically involves conservative measures, such as physical therapy and anti-inflammatory medications, or surgery for full-thickness or refractory tears. Regenerative medicine therapies, including platelet-rich plasma (PRP), platelet lysate (PL), and mesenchymal stem cells (MSCs), show promise as alternative treatment strategies, although long-term outcomes remain under investigation. Methods: This cohort included 30 patients with partial rotator cuff tears and were treated with culture-expanded MSC injections. There was no control group. Inclusion criteria included an imaging-confirmed diagnosis of partial-thickness rotator cuff tears. Outcomes were assessed at multiple time points up to 6 years. Pain and function were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH), a Numeric Rating Scale (NRS), and the modified Single Assessment Numeric Evaluation (SANE). Results: Thirty patients (37 shoulders) were included in the analysis. Significant improvements in the NRS and DASH scores were observed at 3, 6, 12, 18, and 24 months (p < 0.01). Twenty-four months post-treatment, the mean NRS and DASH decreased by 2.25 and 15.93 points, respectively, and SANE improved by 60%. At six years, among seven respondents, the mean SANE improvement was 75.54%. During this study, no significant adverse events were reported. Conclusions: This study provides the longest known follow-up of MSC therapy for partial-thickness RCTs, finding sustained pain and functional improvements. The findings support further research into MSC-based and combination regenerative therapies as a viable alternative treatment option for partial-thickness rotator cuff tears.

Keywords:  bone-marrow-derived stem cells; mesenchymal stem cells; regenerative medicine; rotator cuff tears

DOI:  https://doi.org/10.3390/biomedicines14020382
Bioengineering (Basel). 2026 Jan 24. pii: 136. [Epub ahead of print]13(2):

Effects of Exercise-Based Telerehabilitation for Knee Osteoarthritis: A Systematic Review and a Study Protocol.

Giacomo Farì, Francesco Quarta, Federica Bressi, Raffaele La Russa, Teresa Paolucci, Andrea Bernetti.

   BACKGROUND: Knee osteoarthritis causes considerable pain and disability. Telerehabilitation has emerged as a promising treatment option, especially after the Coronavirus Disease 2019 pandemic, but it still faces challenges regarding solid scientific evidence about its multiple benefits. This systematic review aimed to analyze the reported beneficial effects of telerehabilitation based on therapeutic exercise for the management of knee osteoarthritis. Methodsː PubMed, PEDro, Web of Science and Cochrane Library databases were used to identify eligible studies. This review followed the PRISMA guidelines and was registered at PROSPERO (n° CRD42024579836). The selected studies underwent a qualitative assessment using the Modified Jadad Score.
RESULTS: Ten studies, including a total of 1354 participants, were included. From the selected studies, a wide variety of outcome measures emerged to evaluate the efficacy of telerehabilitation in the relief of pain and its clinical consequences. Seven studies specifically assessed pain, with four showing significant improvements in pain reduction in the intervention group compared with the control group. Telerehabilitation was found to be more effective or non-inferior to traditional rehabilitation in relieving pain, as reported across various pain scales. Limitations include the heterogeneity of interventions, the exclusion of non-recent studies, and the exclusive focus on therapeutic exercise. Conclusionsː The results of this systematic review suggest that telerehabilitation provides pain relief, improves physical function, and enhances quality of life, while preliminary evidence indicates potential cost-related advantages. However, some studies did not find TR to be superior to control interventions, highlighting mixed evidence. Additional high-quality studies are required to better support this promising rehabilitation approach.

Keywords:  digital medicine; knee; osteoarthritis; rehabilitation; systematic review; telemedicine

DOI:  https://doi.org/10.3390/bioengineering13020136
Front Med (Lausanne). 2026 ;13 1766836

Comparison of the efficacy of platelet-rich plasma versus corticosteroid in the treatment of adhesive capsulitis: a systematic review and meta-analysis based on randomized controlled trials.

Chang Xu, Ziyue Wang, Junru Tan, Ningning Zhou, Qingling Zhong, Yajun Chen, Rilong Huang.

   Background: Adhesive capsulitis (AC) often impairs patients' quality of life due to shoulder pain and restricted joint mobility. Intra-articular shoulder injection is a profound conservative treatment modality. Existing randomized controlled trials (RCTs) have reported conflicting results regarding the efficacy of platelet-rich plasma (PRP) versus corticosteroid (CS) injections. Therefore, a meta-analysis of the relevant RCTs is warranted.
Methods: A systematic search was conducted across four databases (PubMed, Embase, the Cochrane Library, and Web of Science) for articles published from their inception to September 15, 2025. RCTs comparing the efficacy of PRP versus CS injections for the treatment of AC were included. The primary outcomes were the Visual Analog Scale (VAS) score and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcomes included range of motion (ROM): abduction, flexion, external rotation, and internal rotation.
Results: This meta-analysis included a total of 13 studies involving 1,056 patients with AC. Among them, 531 patients were allocated to the PRP group and 525 to the CS group. No statistically significant differences were observed between the two groups in the VAS and DASH scores at 1 month, VAS score at 3 months, or flexion ROM. However, compared with the CS group, the PRP group demonstrated significantly superior outcomes in the VAS score at 6 months, DASH scores at 3 and 6 months, as well as in abduction, external rotation, and internal rotation. Specifically, significant differences were observed in: the 6-month VAS score (MD: -1.84, 95% CI: -2.57 to -1.10, p < 0.00001), the 3-month DASH score (MD: -5.88, 95% CI: -9.72 to -2.03, p = 0.003), the 6-month DASH score (MD: -14.42, 95% CI: -16.35 to -12.49, p < 0.00001), abduction (MD: 11.90, 95% CI: 2.23 to 21.57, p = 0.02), external rotation (MD: 8.39, 95% CI: 1.39 to 15.40, p = 0.02), and internal rotation (MD: 10.04, 95% CI: 8.80 to 11.29, p < 0.00001).
Conclusion: Compared with CS, PRP for AC demonstrated significant advantages in pain relief, functional improvement, and range of motion recovery at the 6-month follow-up. However, the two treatments showed comparable efficacy in terms of pain relief at the 1- to 3-month follow-ups and functional improvement at the 1-month follow-up.
Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, CRD420251156731.

Keywords:  adhesive capsulitis; corticosteroid; frozen shoulder; meta-analysis; platelet-rich plasma

DOI:  https://doi.org/10.3389/fmed.2026.1766836
J Back Musculoskelet Rehabil. 2026 Feb 25. 10538127261424304

From mild to severe carpal tunnel syndrome: The role of ultrasound-guided perineural 5% dextrose injection: A prospective study.

Gamze G Güleç, Emre Özmen, Serdar Kokar.

  BackgroundUltrasound-guided perineural injection of 5% dextrose in water (D5W) is considered a safe treatment option associated with clinical improvement in patients with mild-to-moderate carpal tunnel syndrome (CTS).ObjectiveThis study aimed to evaluate the efficacy of ultrasound-guided D5 W injection in patients with varying severities of CTS, including mild, moderate and severe cases.Methods36 patients with electrophysiologically confirmed CTS (mild, n = 11; moderate, n = 13; severe, n = 12) received a single ultrasound-guided perineural injection of 5 mL D5W. Patients with severe CTS were included only if surgical treatment was declined or not feasible. Pain, neuropathic pain, symptoms and functional outcomes were assessed using the Visual Analogue Scale (VAS), Douleur Neuropathique en 4 Questions (DN4), and Boston Carpal Tunnel Questionnaire (BCTQ: Symptom Severity Scale [SSS], Functional Status Scale [FSS]) at baseline and weeks 1, 4, 12, and 24.ResultsAll three groups demonstrated significant within-group improvements in VAS, DN4, SSS, and FSS scores from baseline, with improvements evident by week 1 and maintained throughout the 24-week follow-up period (p < 0.001). Between-group comparisons showed better outcomes in mild and moderate CTS, whereas the severe group achieved significant improvements but with higher outcome scores (p < 0.05). No major adverse events, including hematoma, nerve injury or tendon rupture were observed during follow-up; however, mild and transient injection-site pain was reported in most patients.ConclusionThis study suggests that ultrasound-guided perineural D5W injection is associated with clinically meaningful improvements in pain, symptoms and function in patients with CTS across different severity levels, with less favorable outcomes in severe cases. This treatment may be considered a nonsurgical option for selected patients in whom surgical management is declined or not feasible.

Keywords:  Carpal tunnel syndrome; hydrodissection; pain intensity; ultrasound-guided interventions

DOI:  https://doi.org/10.1177/10538127261424304
Orthop Rev (Pavia). 2026 ;18 155103

Advances in hyaluronic acid therapy for knee osteoarthritis: monotherapy and combination strategies: an evidenced based review.

Kim Xoa Cao, Ha Nam Anh Tang, Manh Hung Tran.

  Knee osteoarthritis (KOA) is a chronic degenerative joint disease that lead to cartilage loss, inflammation, and disability. Intra-articular hyaluronic acid (HA) is widely used for its viscoelastic, anti-inflammatory, and chondroprotective properties; however clinical outcomes remain inconsistent. Recent studies have explored combining HA with biologic or pharmacologic agents, such as platelet-rich plasma (PRP), corticosteroids (CS), fibrinogen, botulinum toxin A, polydeoxyribonucleotide (PDRN), and stem cells, to enhance efficacy through multimodal mechanisms. Despite this, the comparative benefits and safety profiles of these emerging strategies remain unclear. This review aims to evaluate the clinical efficacy of intra-articular HA, used either alone or in combination with adjunctive agents, for the management of KOA. A comprehensive literature search was conducted across PubMed, Embase, the Cochrane Library, and Web of Science, covering the period from January 2010 to April 2025. A total of 70 studies were included, comprising 50 randomized controlled trials (RCTs) and 20 meta-analyses. High-quality evidence supports the modest yet clinically significant efficacy of HA monotherapy, especially in the early to moderate stages of KOA. Outcomes appear to be affected by factors such as molecular weight, crosslinking, and injection protocols. Among combination strategies, the combination of HA and PRP demonstrates the most consistent synergistic benefits across various outcome domains. Short-term improvements are also observed with the combination of HA and CS. Emerging combinations involving fibrinogen, botulinum toxin A, peripheral blood stem cells and polydeoxyribonucleotide show early promise but remain under investigation.

Keywords:  Hyaluronic acid; combination therapy; corticosteroids; knee osteoarthritis; platelet-rich plasma; viscosupplementation

DOI:  https://doi.org/10.52965/001c.155103
Trials. 2026 Feb 25.

Efficacy of different doses of platelet-rich plasma for moderate carpal tunnel syndrome: study protocol for a prospective, randomized, controlled trial in Guangzhou, China.

Yuxi Li, Ying Lu, Zhenhai Wei, Zhipeng Li, Mengxia Guo, Guobin Xu, Lianjun Yin, Li Kuang, Jisheng Guo, Huiting Feng, Wenjie Hu, Li Jiang.

   BACKGROUND: Carpal tunnel syndrome (CTS) is the most prevalent peripheral nerve disorder, with a reported lifetime prevalence of approximately 8% in the general population, and higher rates observed in females than in males (approximately 10% vs. 5.8%), based on global epidemiological estimates. Recently, Platelet-rich plasma (PRP) injections have attracted increasing attention as an innovative treatment, proving more effective than corticosteroids and dextrose. However, the optimal PRP therapeutic dosage remains unclear. This study aims to determine if a 5 mL (vs. 3 mL) platelet-rich plasma injection around the median nerve more effectively relieves symptoms in moderate carpal tunnel syndrome patients.
METHODS: This prospective, double-blind, randomized, parallel-group, superiority-controlled trial will be conducted at the Third Affiliated Hospital of Southern Medical University (a tertiary academic hospital) in Guangzhou, China. Trained rehabilitation physicians in the outpatient department of Rehabilitation Medicine, will recruit 60 adults with moderate CTS and obtain informed consent. Participants will be randomly assigned (a 1:1 ratio) to receive either 3 mL or 5 mL PRP injection under ultrasound guidance at baseline and at 2 weeks. Eligible participants are adults aged 20-80 years with electromyography (EMG)-confirmed moderate CTS, a numbness score ≥ 40 mm on a 100-mm Visual Analogue Scale (VAS). Additionally, all injections will be performed by physicians who have completed advanced training in ultrasound-guided peripheral nerve injection procedures and all participants will receive standardized health education from licensed physiotherapists with at least three years of specialized experience. The primary outcome is the change in the VAS score of numbness from baseline to 6 months. Secondary outcomes include changes in ultrasound parameters (cross-sectional area (CSA), blood flow of median nerve (MNBF), and swollen rate of median nerve (MNSR)), Boston Carpal Tunnel Syndrome Questionnaire-Symptom Severity Scale (BCTQ-SSS), Boston Carpal Tunnel Syndrome Questionnaire-Functional Status Scale (BCTQ-FSS), electrophysiological measures (sensory nerve conduction velocity (SNCV), distal motor latency (DML)). Safety outcomes include all adverse events (AEs) and injection-related complications recorded throughout follow-up. Data will be analyzed by using intention-to-treat and per-protocol approaches. All analyses will be performed using IBM SPSS Statistics software.
DISCUSSION: The results of this study will evaluate the efficacy of different doses of PRP injection in the treatment of moderate CTS, thereby providing suggestions on the optimal dose for injection therapy and offering guidance for clinical application.
TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2400094746). Retrospectively registered on 26 December 2024. https://www.chictr.org.cn/showproj.html?proj=252770. The first participant was enrolled on 30 September 2024.

Keywords:  Carpal Tunnel Syndrome; Different doses; Platelet-Rich Plasma; Protocol; Randomized Controlled Trial

DOI:  https://doi.org/10.1186/s13063-026-09538-1
J Orthop Sports Med. 2026 ;8(1): 1-10

Comparing Regenerative Biologics and Standard Pharmacotherapy for Chronic Rotator Cuff Tendinopathy: A Study of PRP, Cell-Based, and Peptide Interventions.

Andre Aabedi, Devendra K Agrawal.

  Chronic rotator cuff tendinopathy is a degenerative condition characterized by persistent shoulder pain, weakness, and functional limitation. Conventional pharmacologic therapies-including nonsteroidal anti-inflammatory drugs and corticosteroid injections-are commonly used but provide only short-term symptom relief without addressing underlying tendon degeneration, and may negatively affect tendon integrity. These limitations have prompted increasing interest in regenerative therapies aimed at promoting tissue repair and durable clinical improvement. This literature review evaluates and compares the clinical outcomes, safety profiles, and practical considerations of regenerative therapies-specifically platelet-rich plasma, mesenchymal stem cell-based interventions, and peptide-based therapies-relative to traditional pharmacologic management for chronic rotator cuff tendinopathy. A comprehensive review of randomized controlled trials, systematic reviews, meta-analyses, and consensus guidelines was conducted to assess pain relief, functional outcomes, tendon structural integrity, safety, and clinical applicability of pharmacologic versus regenerative treatment strategies. Pharmacologic treatments, particularly NSAIDs and corticosteroid injections, demonstrate limited efficacy beyond short-term pain reduction and do not promote tendon healing; repeated corticosteroid use is associated with tendon weakening and inferior long-term outcomes. In contrast, PRP consistently provides superior intermediate- and long-term improvements in pain and function compared with corticosteroids, with favorable safety profiles. Mesenchymal stem cell therapies show promising regenerative potential, including structural tendon improvement and sustained symptom relief, though evidence is limited by heterogeneity, cost, and regulatory constraints. Peptide-based therapies represent an emerging modality with encouraging preclinical and early clinical data but remain insufficiently validated for routine use. Regenerative therapies-particularly platelet-rich plasma and mesenchymal stem cell-based interventions-offer safer and more durable alternatives to conventional pharmacologic management for select patients with chronic rotator cuff tendinopathy who have failed conservative care. However, widespread clinical adoption is limited by variability in protocols, regulatory barriers, and a lack of large-scale, high-quality randomized trials. Further research is required to standardize treatment approaches, refine patient selection, and establish long-term efficacy.

Keywords:  Cell-based therapy; Chronic Rotator Cuff Tendinopathy; Corticosteroids; Inflammation; Mesenchymal Stem Cells (MSCs); Orthobiologics; Peptide-based Therapies; Platelet-rich Plasma (PRP); Regenerative Medicine; Shoulder Pain Management; Tendon Healing; Tissue Engineering

DOI:  https://doi.org/10.26502/josm.511500247
Brain Sci. 2026 Feb 18. pii: 235. [Epub ahead of print]16(2):

Advancing Neurological Rehabilitation: The BRAIN Framework for Clinical Reasoning in Neurophysiotherapy.

Alfredo Lerín-Calvo, Raúl Ferrer-Peña, Sergio Lerma-Lara.

  Background/Objectives: Clinical reasoning is essential in neurological rehabilitation, in which patient management is complex and multifactorial. However, existing models lack operationalization for neurophysiotherapy practice. This paper proposes the Biopsychosocial Reasoning Approach In Neurophysiotherapy (BRAIN) framework, a unified clinical reasoning model that integrates the International Classification of Functioning, Disability, and Health (ICF) with neurophysiotherapy-specific domains of physical function. Methods: The BRAIN framework was developed by integrating previously validated models: the ICF, the American Physical Therapy Association (APTA) patient-management process, and Kisner and Colby's interrelated aspects of physical function, adapted for neurological populations. The model employs a biopsychosocial, patient-centered, and goal-oriented approach, thereby providing a structured workflow for examination, evaluation, diagnosis, prognosis, intervention, and outcomes assessment. Results: The BRAIN framework provides an operationalized mapping between ICF body functions and neurophysiotherapy-specific impairment domains, a clear separation between body functions and body structures, tiered assessment pathways addressing patient heterogeneity, and a unified language for interdisciplinary communication. The model incorporates shared decision-making and goal-oriented reasoning within the clinical workflow. Conclusions: The BRAIN framework offers a structured, teachable template for clinical reasoning in neurological physiotherapy. As a theoretical proposal, there is a need for empirical validation through expert consensus and clinical implementation studies.

Keywords:  BRAIN framework; ICF; biopsychosocial model; clinical reasoning; motor control; neurological rehabilitation; physiotherapy

DOI:  https://doi.org/10.3390/brainsci16020235
Arch Phys Med Rehabil. 2026 Feb 25. pii: S0003-9993(26)00087-0. [Epub ahead of print]

Outcome Measure Frequency in Stroke Rehabilitation Lower Extremity Randomized Controlled Trials and its Correlation with Research and Clinical Practice Recommendations.

Robert Teasell, Cecilia Flores-Sandoval, Sarvenaz Mehrabi, Jamie L Fleet, Michael W Payne, Ricardo Viana, Sue Peters, Andrew Bowman, Mohammad R Safaei-Qomi.

   OBJECTIVE: To (1) determine the frequency of outcome measures (OMs) used in randomized controlled trials (RCTs) of lower extremity (LE) rehabilitation post-stroke; (2) to categorize OMs based on the International Classification of Functioning, Disability, and Health (ICF) framework; and to (3) determine how use of OMs correlates with current research and clinical practice recommendations.
DATA SOURCES: Systematic searches were conducted in Embase, CINAHL, MEDLINE, and PsycINFO, up to December 2024, in line with PRISMA guidelines.
STUDY SELECTION: RCTs published in English were included if they evaluated a rehabilitation intervention for LE motor dysfunction in adults (≥18yr).
DATA EXTRACTION: Two independent reviewers screened titles and abstract and conducted full-text review against inclusion criteria. Covidence was used for article screening and data extraction.
DATA SYNTHESIS: 1,548 RCTs were included, with 339 unique OMs identified and classified according to the ICF: body structures and function (n=112), activities (n=161) and participation (n=66). The most frequently used OMs were the Berg Balance Scale (31.5%), Biomechanical Gait Measures (29.3%), 10-Metre Walk Test (28.2%), Timed-Up-and-Go Test (25.5%), Fugl-Meyer Assessment (23.1%), 6-Minute Walk Test (18.6%), Gait Speed (15.4%), Barthel Index (14.1%), Functional Ambulation Category (12.0%), and the Modified Ashworth Scale (11.5%). To a certain degree, OM utilization aligns with current recommendations given the Fugl-Meyer Assessment was recommended in 10 out of 12 guidelines, and the Berg Balance Scale in 8 out of 12 guidelines; in contrast, some OMs are included in guideline recommendations but are utilized in very few RCTs.
CONCLUSIONS: Despite recommendations to streamline OMs used in LE stroke rehabilitation studies, including those available in the last decade, OM utilization in RCTs shows significant heterogeneity which may limit meaningful comparisons of interventions.

Keywords:  Lower Extremity; Outcome Measures; Rehabilitation; Stroke

DOI:  https://doi.org/10.1016/j.apmr.2026.02.009
Medicine (Baltimore). 2026 Feb 27. 105(9): e47643

Ultrasound diagnosis of three different types of carpal tunnel syndrome associated with persistent median artery: A case report and literature review.

Wenjiao Xu, Xin Jin, Baomin Liu.

   RATIONALE: Carpal tunnel syndrome (CTS) is the most common neuropathy worldwide. Although multiple factors contribute to CTS, persistent median artery (PMA)-related CTS is relatively uncommon. To date, no literature has reported the ultrasonic features of different types of PMA-induced CTS.
PATIENT CONCERNS: We report the clinical manifestations and ultrasonographic features of 3 patients with different types of CTS associated with PMA and review relevant literature.
DIAGNOSES: All 3 cases were diagnosed with PMA combined with CTS, specifically categorized as CTS with PMA thrombosis, CTS with PMA and median nerve bifidity, and CTS with PMA and high bifurcation of the median nerve.
INTERVENTIONS: Different treatment measures were administered based on ultrasound diagnosis and clinical presentation, all with good prognoses.
LESSONS: Ultrasound enables precise and rapid identification of various PMA-related types of CTS, effectively guiding clinicians in making the most patient-friendly treatment decisions.

Keywords:  carpal tunnel syndrome; different types; persistent median artery; ultrasound diagnosis

DOI:  https://doi.org/10.1097/MD.0000000000047643
JSES Int. 2026 Mar;10(2): 101409

The efficacy of platelet-rich plasma compared to corticosteroids for partial-thickness rotator cuff tears: a randomized controlled trial.

Mohammad Reza Guity, Mahdi Sahebi, Mohammad Pourfarzaneh, Omid Salkhori, Mahdieh Ghiasi, Nima Bagheri.

   Background: Management of partial-thickness rotator cuff tears (PTRCTs) remains debated, especially when conservative treatments fail. Corticosteroid (CS) and platelet-rich plasma (PRP) injections are frequently used, but their comparative effectiveness remains unclear. This study compares PRP and CS injections in improving shoulder range of motion, pain, and patient-reported outcomes in an Iranian population.
Methods: A double-blind, randomized controlled trial was conducted with PTRCT patients receiving ultrasound-guided PRP or CS injections. Assessments included shoulder range of motion, visual analog scale for pain, Simple Shoulder Test, Constant-Murley Score, and Oxford Shoulder Score at baseline, 3 months, and 6 months postinjection.
Results: Out of 208 patients screened, 107 were analyzed (39 PRP, 68 CS). Baseline measures were similar except for external rotation, which was higher in the PRP group (P < .05). The CS group showed significantly lower visual analog scale scores at 3 and 6 months (P < .001). No significant differences were found in forward flexion, abduction, or internal rotation (P > .05). External rotation remained greater in the PRP group throughout (P < .001). Simple Shoulder Test and Constant-Murley Scores were significantly higher, and Oxford Shoulder Score significantly lower, in the CS group at both follow-ups (P < .001). Both groups showed significant improvement from baseline, except for internal rotation in the PRP group at 6 months (P = .248).
Conclusion: Both injections improve clinical outcomes in PTRCT, but CS injections provide superior short- and medium-term pain relief and patient-reported outcomes. CS is preferable for patients prioritizing rapid pain reduction. Further long-term studies are needed to assess sustained effects and safety.

Keywords:  Corticosteroid; Decision making; Functional outcomes; PRP; Pain; Rotator cuff tendinopathy

DOI:  https://doi.org/10.1016/j.jseint.2025.101409
Medicina (Kaunas). 2026 Jan 27. pii: 272. [Epub ahead of print]62(2):

Rotator Cuff Disorders: Practical Recommendations for Conservative Management Based on the Literature.

Adrien J-P Schwitzguébel.

  Conservative management of rotator cuff disorders remains challenging, with no comprehensive, evidence-based framework integrating diagnosis, prognosis, rehabilitation, and biological therapies. Existing recommendations usually address isolated components of care, leading to inconsistent treatment strategies. This article proposes a global, pragmatic protocol for the non-surgical management of rotator cuff lesions, from initial assessment to long-term follow-up. Drawing on clinical expertise supported by recent literature, we outline a stepwise approach that begins with a comprehensive diagnostic process that combines history, clinical examination, and targeted imaging. Based on lesion type, associated shoulder or neurogenic conditions, and patient profile, rotator cuff disorders are stratified into three prognostic categories under conservative care: good, borderline, and poor prognosis, highlighting factors that require treatment adaptation or early surgical consideration. Rehabilitation objectives are structured around four domains: (1) inflammation and pain control, (2) mobility and scapular kinematics, (3) strengthening and motor control with tendon-sparing strategies, and (4) preservation or restoration of anatomy. For each prognostic category, we define a monitoring plan integrating clinical reassessment, ultrasound follow-up, and functional milestones, including return-to-play criteria for athletes. This comprehensive narrative review demonstrates that precise diagnosis and individualized rehabilitation can optimize medical follow-up, active strengthening, and complementary or regenerative therapies. Aligning therapeutic decisions with prognostic and functional goals allows clinicians to optimize patient satisfaction and recovery, providing a clear, evidence-informed roadmap for conservative management of rotator cuff disorders.

Keywords:  classification; clinical follow-up; clinical protocol; conservative management; musculoskeletal medicine; non-surgical treatment; regenerative medicine; regenerative therapies; rehabilitation; return-to-play; rotator cuff; rotator cuff disorders; shoulder; sports medicine

DOI:  https://doi.org/10.3390/medicina62020272
Games Health J. 2026 Feb 25. 2161783X261421436

Evaluating the Impact of 6-Week Gamified Virtual Reality Rehabilitation Program on Pain, Function, and Balance in Knee Osteoarthritis: A Randomized Controlled Trial.

Moayad S Subahi, Mohamed S Alayat, Fahda M Alshaikh, Moiyad S Aljehani, Ammar Fadil, Mansour Abdullah Alshehri.

   OBJECTIVE: This study aimed to evaluate the effects of a gamified virtual reality (VR) rehabilitation program, using immersive VR combined with conventional conventional physical therapy (CPT), on pain, functional mobility, disability, and balance in individuals with knee osteoarthritis (OA).
METHODS: A randomized controlled trial was conducted on 90 volunteered participants diagnosed with knee OA, equally divided into VR and control groups. VR group received VR + CPT, while the control group received only CPT. Outcome measures included Visual Analog Scale (VAS) for pain, 6-minute walk test (6MWT) for function, Western Ontario and McMaster Universities Arthritis Index (WOMAC) for disability, and the Berg Balance Scale (BBS) for balance. Participants underwent three sessions per week for 6 weeks. Assessments were performed at baseline, after 3 weeks, and after 7 weeks (postintervention). The level of significance was set at P ≤ 0.05.
RESULTS: The VR group demonstrated greater improvements than the control group, including a 38.6% reduction in pain compared with 26.3% in the control group, and a 39.9% increase in 6MWT distance compared with 19.4% in the control group. WOMAC improved substantially in the VR group (57.9%) compared with the control group (25%). Pain reduction became significantly greater in the VR group in the third week. Significant between-group differences at postintervention (P < 0.001) were observed for VAS, 6MWT, and WOMAC. Both groups demonstrated significant within-group improvements in balance; however, no significant between-group difference was found for BBS (P = 0.090).
CONCLUSION: Integrating a gamified VR rehabilitation program alongside CPT significantly reduces pain and improves mobility and knee function in individuals with knee OA. The findings support using VR as an effective adjunct to traditional physiotherapy, improving engagement and clinical outcomes.

Keywords:  balance; functional disability; functional mobility; knee osteoarthritis; pain management; randomized controlled trial; virtual reality rehabilitation

DOI:  https://doi.org/10.1177/2161783X261421436
Eur Spine J. 2026 Feb 26.

Degeneration of paraspinal and gluteus medius muscles in nonspecific chronic low back pain: a quantitative MRI study.

Jianping Wang, Dan Luo, Yaqin Qi, Zhenhua Zhao, Dingbo Shu.



Keywords:  Gluteus medius; Magnetic resonance imaging (MRI); Nonspecific chronic low back pain (NCLBP); Paraspinal muscle; q-Dixon

DOI:  https://doi.org/10.1007/s00586-026-09843-y
Healthcare (Basel). 2026 Feb 16. pii: 507. [Epub ahead of print]14(4):

Ultrasound-Guided Percutaneous Needle Electrolysis Versus Surgery for Carpal Tunnel Syndrome: A Randomized Clinical Trial.

Fermín Valera-Garrido, Jesús Segura-León, Paula García-Bermejo, Francesc Medina-Mirapeix.

  Background/Objectives: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. The aim of this study was to analyze the safety and effectiveness of ultrasound-guided percutaneous needle electrolysis (PNE) and open carpal tunnel release (OCTR) in patients with moderate-to-severe CTS. Methods: A total of 185 patients with idiopathic CTS were assigned to either the electrolysis group (75 patients) or the surgery group (73 patients); 112 patients completed the final follow-up assessment 12 months after randomization. The surgical procedure consisted of OCTR. The electrolysis group received four sessions of US-guided PNE applied every seven days. Main outcomes were nights waking up due, pain, paresthesia, Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS), Functional Status Scale (BCTQ FSS) and adverse events. These variables were evaluated in the short (6 weeks), medium (3 months), and long term (6 and 12 months). Results: In the short term (6 weeks), both interventions did not show significant differences in the severity of symptoms; however, the electrolysis group had less adverse events than the surgery group (2 vs. 100). In the medium (3 months) and long term (6 and 12 months), surgery was slightly more effective regarding nocturnal awakenings, paresthesia and BCTQ-SSS (p < 0.002). Conclusions: US-guided PNE may be a safe and effective technique for patients with moderate-to-severe CTS with a sustained long-term pattern of improvement. Although both treatments were effective, OCTR showed superior long-term symptom reduction. Therefore, PNE may serve as a first-line or bridging treatment in selected clinical scenarios.

Keywords:  Boston Carpal Tunnel Questionnaire; carpal tunnel syndrome; median nerve; open carpal tunnel release; percutaneous needle electrolysis; surgery

DOI:  https://doi.org/10.3390/healthcare14040507
Diagnostics (Basel). 2026 Feb 23. pii: 641. [Epub ahead of print]16(4):

Comprehensive Sonographic Paradigm and Trend Pattern of Median Nerve Indices in Carpal Tunnel Syndrome from Wrist to Forearm: What We Need to Know.

Adeena Khan, Fawaz T Salamah, Syed S Habib, Waleed Fawzy, Fawzia AlRouq, Huthayfah T Alkhliwi, Mamoona Sultan, Ahmed O Alsabih.

  Objective: The study aim was panoramic sonographic inspection of the median nerve (MN) from the wrist to the forearm in cases and controls. Additionally, integration of comparisons at various levels may aid in identifying principal ultrasound parameters of carpal tunnel syndrome (CTS). Methods: Dynamic, static, and panoramic sonographies of 65 healthy and 83 CTS hands were performed. Multileveled qualitative (MN and flexor retinaculum morphology) and quantitative (cross-sectional area CSA, differences, and ratios) MN variables for CTS, followed by comparative statistical analysis to predict values and patterns of MN, were derived. Results: Subjectively, hypoechoic, vascular, compressed, hypomobile MN and bowed thickened flexor retinaculum were significantly more prevalent in cases (28.9-66.3%) than in controls (0-7.7%). Objectively, the proximal to inlet (pi) and the forearm at 12 cm (12) were the most representative sites. The area under curve (AUC) values for the MN dimensions, in decreasing order, were 0.9, 0.89, 0.86, and ≤0.80 for the CSA difference 'pi' and '12' (Cpi-C12), the CSA proximal to inlet (Cpi), the ratio of CSA at pi and 12 (Cpi/C12), and the CSA at inlet (Ci), respectively. Their cut-off values were 3.7, 9.1, 1.8, and 7.2 mm2, respectively. Differences and ratios between 'Cpi' and 'Ci' were less reliable (AUC ≤ 0.74, sensitivity ≤ 61.4%). Flexor retinaculum bowing, thickening, and MN flattening ratios were unreliable. Conclusions: Sensitivity, specificity, and precision of MN sonographic parameters in CTS increase by utilizing differences and ratios between wrist and forearm rather than isolated values. The recommended site in wrist is proximal to the inlet, and in the forearm, the best site to determine ratios and differences is at 12 cm from the distal wrist crease.

Keywords:  carpal tunnel syndrome; cross-sectional area; forearm; inlet; median nerve; proximal to inlet; ultrasound

DOI:  https://doi.org/10.3390/diagnostics16040641
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2026 Feb 15. 40(2): 315-320

[Research progress on the causes of pain in knee osteoarthritis].

Ning Wei, Zhanle Zheng.

   Objective: To review the research progress related to pain in knee osteoarthritis (KOA).
Methods: A systematic review of relevant research literature at home and abroad in recent years was conducted to analyze the roles played by multi-dimensional factors such as demographics, imaging, serology, bone metabolism, biomechanics, neurological factors, and macrophages in the occurrence and development of KOA pain. The mechanisms of pain induction were expounded and the research directions were prospectively proposed.
Results: The occurrence of KOA pain is a complex process interwoven with multiple factors. Demographic factors such as gender, age, and body weight are closely related to its occurrence and pain degree. Structural changes shown by imaging examinations (such as MRI, ultrasound, and X-ray films) can be used to assess the level of pain. A variety of inflammatory factors released by intra-articular inflammation directly participate in the initiation of pain. Bone metabolic factors can also induce pain by influencing changes in bone density. Biomechanical factors are involved in the pain process by altering the concentrated distribution of joint stress. The various mediators released by the local inflammatory response of the joint trigger hyperalgesia and peripheral nerve sensitization through damage receptors, promoting the conduction and amplification of pain signals. The bidirectional interaction between nerves and joints further intensifies the pain. In addition, the expression of certain ion channels, the mediation and release of pain signals by macrophages and osteoclasts, provide a theoretical direction for in-depth exploration of the microscopic mechanism of KOA pain.
Conclusion: Future research needs to integrate multiple regulatory mechanisms such as biomechanics, inflammation and neural regulation, systematically explore key intervention targets, in order to deepen the understanding of the pain mechanism of KOA and promote the formation of more comprehensive and precise pain diagnosis and treatment plans.

Keywords:  Knee osteoarthritis; biomechanics; cause of illness; inflammation; neural regulation; pain

DOI:  https://doi.org/10.7507/1002-1892.202508009
Knee Surg Sports Traumatol Arthrosc. 2026 Feb 24.

Towards optimized rehabilitation with regenerative therapy: A systematic review and meta-analysis on the effects of cell-based injections for knee osteoarthritis.

Daniel Frank Cottmeyer, Melissa Chiu, Kevin Maltusch, Liang-Ching Tsai.

   PURPOSE: This meta-analysis aimed to determine the effects of intra-articular mesenchymal stem cell (MSC)-based injections on both subjective and objective measures of pain and function in patients with knee osteoarthritis (OA). The secondary purpose was to investigate how injection procedures, patient characteristics and post-injection rehabilitation influence outcomes.
METHODS: Studies published up to February 2025 were identified using PubMed, Cochrane Library, EBSCOhost, Embase, Web of Science and OpenGrey. Studies that investigated the effects of intra-articular MSC-based injections on improving outcomes for patients with knee OA compared to control conditions were included in this analysis. Two independent reviewers performed data extraction, and disagreements were settled through a third author.
RESULTS: Thirty-three studies qualified for analysis. Multi-level meta-analysis revealed that MSC-based injections were more effective than controls for improving subjective pain (effect size [ES] = 1.03, p < 0.001) and function (ES = 0.79, p < 0.001). These effects increased with time post-injection (both p < 0.001). Few objective measures of knee function were reported. Meta-analysis revealed no significant effect of MSC-based injections for improving knee flexion range of motion (ES = 0.76, p = 0.166). Follow-up exploratory analyses of moderator variables suggest that non-weightbearing (p = 0.022) and exercise (p = 0.001) may increase the effects of MSC-based injections for improving subjective pain and function, respectively, and that patients who are male (p = 0.049), have a greater BMI (p = 0.047), and have less severe OA (p = 0.029) may demonstrate greater improvements in subjective pain following MSC-based injections.
CONCLUSIONS: Intra-articular MSC-based injections may improve subjective pain and symptoms for patients with knee OA. However, the subjective improvements may not translate to improved objective knee function. Future studies should investigate the effects of MSC-based injections on objective knee function and how post-injection rehabilitation and patient characteristics augment the effects of MSC-based injections.
LEVEL OF EVIDENCE: Level II.

Keywords:  knee; mesenchymal stem cells; osteoarthritis; physical and rehabilitation medicine; regenerative medicine; rehabilitation

DOI:  https://doi.org/10.1002/ksa.70338
Osteoarthr Cartil Open. 2026 Mar;8(1): 100754

MULTIple or ONE home strengthening exercise(s) for knee osteoarthritis: Protocol for the MULTI-ONE randomised controlled trial.

Rana S Hinman, Belinda J Lawford, Penny K Campbell, Fiona McManus, Ben R Metcalf, Karen E Lamb, Monica R Maly, Kim L Bennell.

   Objective: To determine the effectiveness of a prescribed home exercise program comprised of a single strengthening exercise compared to i) a program with multiple (five) strengthening exercises and ii) control (usual care) for reducing walking pain in people with knee osteoarthritis (OA).
Design: A multi-centre superiority randomised controlled trial will be conducted, involving 144 people with chronic knee pain consistent with OA. Participants will be randomised to receive i) control (usual care); ii) a prescribed home program with one strengthening exercise or; iii) a prescribed home program with multiple (five) strengthening exercises. Participants in the exercise groups will have three consultations over 3 months with a physiotherapist for prescription, monitoring and progression of their exercise program, which will be performed independently at home. The primary outcome measure will be change in walking pain measured on a numerical rating scale. Secondary outcomes will include WOMAC pain and function subscales, quality-of-life; arthritis and exercise self-efficacy; fear of movement; global rating of change; muscle strength/power; and willingness for joint replacement. Primary time-point for re-assessment will be 3 months, with a secondary time-point of 9 months, after randomisation.
Ethics and dissemination: This trial is approved by the University of Melbourne Human Research Ethics Committee (#29890). Dissemination will occur via lay summaries, infographics, conference abstracts, oral presentations and journal papers.
Clinical trial registration: Australian New Zealand Clinical Trials Registry ACTRN12624001226594. Prospectively registered on 9/10/2024.
Conclusions: Findings will guide clinicians in choosing how many home strengthening exercises to prescribe for people with knee OA.

Keywords:  Clinical trial; Exercise; Knee; Osteoarthritis; Pain; Physiotherapy; Rehabilitation

DOI:  https://doi.org/10.1016/j.ocarto.2026.100754
Medicine (Baltimore). 2026 Feb 20. 105(8): e47772

Novel technique of arthroscopic debridement for pisotriquetral joint arthrosis through standard radiocarpal portals of wrist arthroscopy.

Young-Keun Lee, Jeffrey Ecker, Ji Woong Ho.

  Pisotriquetral (PT) arthrosis is one of the common cause of ulnar side wrist pain. Conservative treatment of PT arthrosis is recommended initially. Various surgical treatments have been introduced including pisiformectomy. However, there have been few reports using wrist arthroscopy for PT joint pathologies. This study aimed to introduce the novel technique of arthroscopic synovectomy, debridement, and thermal shrinkage for PT arthrosis using a standard radiocarpal wrist arthroscopic portal. We report surgical technique and clinical outcomes. The medical records of 12 patients with PT joint arthrosis treated with diagnostic wrist arthroscopy and arthroscopic debridement between December 2019 and September 2022 were retrospectively reviewed. Any intra-articular pathologies of the wrist diagnosed by wrist arthroscopy were treated simultaneously with arthroscopic synovectomy, debridement, and thermal shrinkage for PT arthrosis. Functional outcomes were evaluated by comparing quick disabilities of the arm, shoulder, and hand and visual analog scale scores for PT joint pain, measured preoperatively and at the final follow-up visit. Triangular fibrocartilage complex injuries were identified in 8 patients. Scapholunate and lunotriquetral joint instability in the midcarpal joint were observed in 2 patients. Lunate and triquetral cartilage defects were observed in 1 patient. The average follow-up period was 25 months (range: 12-41 months). At the final follow-up, the average visual analog scale score (5.3 → 0.3) and the average quick disabilities of the arm, shoulder, and hand score (36.7 → 8.5) improved significantly. Arthroscopic debridement and thermal shrinkage using standard wrist arthroscopic portals can be reliable treatment methods for patients with PT arthrosis who are unresponsive to conservative treatment before considering pisiformectomy. This treatment method is advantageous because it can lead to a more precise diagnosis of ulnar side wrist pain while simultaneously providing comprehensive treatment of accompanying injuries.

Keywords:  arthrosis; pisotriquetral joint; surgical treatment; wrist arthroscopy

DOI:  https://doi.org/10.1097/MD.0000000000047772
Life (Basel). 2026 Jan 27. pii: 207. [Epub ahead of print]16(2):

Comparative Rehabilitation Benefits of Water-Based Versus Land-Based Exercise in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

Weiping Du, Jianhua Zhou, Aiping Chi.

  Patients with chronic obstructive pulmonary disease (COPD) commonly experience impaired lung function, reduced exercise tolerance, and respiratory muscle weakness. Owing to the unique properties of the aquatic environment, water-based exercise may provide rehabilitation benefits that differ from those of traditional land-based exercise. Objective: This systematic review and meta-analysis aimed to compare the effects of water-based versus land-based exercise on lung function, exercise capacity, and respiratory muscle function in patients with COPD, thereby providing evidence to inform the optimization of pulmonary rehabilitation exercise modalities. Methods: PubMed, Web of Science, CNKI, and other databases were systematically searched to identify randomized controlled trials comparing water-based and land-based exercise interventions in adults with COPD. Primary outcomes included lung function (FEV1% predicted and FEV1/FVC), exercise capacity (six-minute walk distance, 6MWD), respiratory muscle strength (maximal inspiratory pressure (MIP]) and maximal expiratory pressure (MEP). Meta-analyses were performed using Stata 17.0. Results: A total of 14 RCTs were included. Meta-analysis showed that, compared with land-based exercise, water-based exercise significantly improved FEV1% predicted (WMD = 3.33, 95% CI: 0.02-6.64) and FEV1/FVC (WMD = 4.00, 95% CI: 1.27-6.73). Regarding exercise capacity, water-based exercise significantly increased 6MWD (WMD = 47.81 m, 95% CI: 20.19-75.44), with more pronounced improvements observed in short-term interventions (≤8 weeks). Respiratory muscle function analyses demonstrated significant improvements in MIP (WMD = 14.22 cmH2O, 95% CI: 7.75-20.69) and MEP (WMD = 14.40 cmH2O, 95% CI: 4.92-23.89). Conclusions: Compared with land-based exercise, water-based exercise demonstrates consistent advantages in improving exercise capacity and respiratory muscle function in patients with COPD and shows additional benefits for lung function indices. Therefore, water-based exercise may serve as a valuable adjunct to land-based training within pulmonary rehabilitation programs.

Keywords:  chronic obstructive pulmonary disease; land-based exercise; meta-analysis; pulmonary rehabilitation; water-based exercise

DOI:  https://doi.org/10.3390/life16020207
PLoS One. 2026 ;21(2): e0337553

Association between pain, physical performance, and kinesiophobia in older women with low back pain: A cross-sectional study.

Farzaneh Saki, Farzaneh Ramezani, Raziyeh Taheri.

BACKGROUND: Kinesiophobia is a psychological element that may contribute to persistent pain and functional decline in older women with chronic low back pain. Clarifying its role could inform more effective rehabilitation strategies.
OBJECTIVES: To examine associations between kinesiophobia, pain intensity, and physical performance in older women with chronic low back pain.
METHODS: A cross-sectional study was conducted in 2024 with 119 women aged ≥ 60 years reporting nonspecific low back pain. Kinesiophobia was assessed using the Tampa Scale for Kinesiophobia (TSK-17), and pain with the Visual Analog Scale (VAS). The Timed Up and Go test and the 30-second sit-to-stand test were performed to evaluate balance and lower limb strength, respectively (physical performance). Correlation, regression, and mediation analyses were used to explore relationships among variables.
RESULTS: Higher pain intensity was strongly associated with higher kinesiophobia (β = 0.74, p = 0.001), while lower limb strength showed a negative association (β = -0.17, p = 0.005). No significant relationship emerged between kinesiophobia and balance (p > 0.05). Regression indicated that pain was the strongest predictor of kinesiophobia. Mediation analyses suggested that kinesiophobia fully explained the relationship between pain and reduced lower limb strength, while strength itself partially mediated the link between pain and kinesiophobia, highlighting both direct and indirect effects.
CONCLUSIONS: In older women with chronic low back pain, kinesiophobia is positively related to pain severity and negatively related to lower limb strength, but not balance. Findings suggest fear of movement may mediate the impact of pain on physical performance, underscoring the importance of addressing psychological as well as physical factors in rehabilitation. Given the cross-sectional design, causal inferences should be drawn cautiously.

DOI: https://doi.org/10.1371/journal.pone.0337553
Top Spinal Cord Inj Rehabil. 2026 ;32(1): 96-109

Content Analysis of ICF-Based Data in the Multidisciplinary Health Records of People With Spinal Cord Injury.

Linda Nieminen, Jaana Leivo, Tiina Luukkaala, Markku Kankaanpää.

   Background: The International Classification of Functioning, Disability and Health (ICF) was developed by the World Health Organization as a standard language to describe biopsychosocial aspects of functioning, health, and health-related states. Different health professionals document functioning data from their professional perspective.
Objectives: The primary objective of this study was to utilize multidisciplinary electronic health records to identify the factors considered significant by different healthcare professional groups in documenting the functioning, disability, and health of individuals with spinal cord injury (SCI).
Methods: A random sample of 10 patients was selected from a larger cohort (n = 49) for analysis. Free text from electronic health records regarding subacute inpatient rehabilitation and an outpatient visit at the chronic stage was collected. Two researchers annotated the data to ICF codes. The study was a descriptive, longitudinal study using quantitative content analysis. Contextual analysis was used to compare the data between different health professionals and at different time points.
Results: In the 10-patient random sample, 447 health records were retrieved. The functioning data consisted of all ICF domains, with 9349 findings. Environmental factors were documented the most. Health professional groups had different patterns in the frequency of documented ICF categories in their documents, reflecting professionals' expertise in the multidisciplinary team. For example, occupational therapists highlighted activities and participation whereas psychologists emphasized body functions.
Conclusion: The findings of this study may facilitate the development of rehabilitation for persons with SCI and highlight the importance of multidisciplinary rehabilitation in complex medical conditions.

Keywords:  document analysis; electronic health record; international classification of functioning, disability and health; rehabilitation; spinal cord injuries

DOI:  https://doi.org/10.46292/sci25-00018
Life (Basel). 2026 Feb 14. pii: 334. [Epub ahead of print]16(2):

Which Training Is More Effective in Post-COVID-19 Geriatric Patients with COPD: Cycle Ergometer Interval Training or Continuous Training?

Katarzyna Bogacz, Jacek Łuniewski, Anna Szczegielniak, Danuta Lietz-Kijak, Jan Szczegielniak.

   INTRODUCTION: Respiratory rehabilitation programs for geriatric patients with chronic obstructive pulmonary disease (COPD) after COVID-19 require a precise assessment of needs and an individualized approach. However, there is a lack of specific recommendations for aerobic training in this patient group.
OBJECTIVE: The study aimed to compare two types of aerobic training-continuous and interval-and to determine which one is more effective and should be included in the respiratory rehabilitation program for geriatric patients with COPD after COVID-19.
METHODS: Of the 480 patients examined, 80 were included in the study. All patients underwent exercise tolerance tests (6-Minute Walk Test-6MWT) and functional performance tests (get-up-and-go test-TUG) before and after a 3-week intensive respiratory rehabilitation program.
RESULTS: Both types of training-interval and continuous-contributed to improved exercise tolerance and functional fitness in patients. However, analysis of the differences between the groups showed that continuous training with increasing exercise intensity resulted in significantly greater improvements in distance covered during the 6MWT, energy expenditure (METs), and TUG test time (p < 0.05).
CONCLUSIONS: Continuous training on a cycle ergometer is more effective in the rehabilitation of geriatric patients with COPD after COVID-19 and should be included in therapeutic programs.

Keywords:  6MWT; COPD; COVID-19; continuous training; interval training; physical exercise

DOI:  https://doi.org/10.3390/life16020334
JPRAS Open. 2026 Mar;48 980-987

A scoping review of the impact of transverse carpal ligament sectioning on the thumb carpometacarpal joint: Does it increase the risk of ostearthritis?

Quinn Steiner, Robert George, Armin Edalatpour, Pradeep K Attaluri, Brett F Michelotti.

   Purpose: We aimed to review the effects of carpal tunnel ligament sectioning on the thumb carpometacarpal (CMC) joint with the hypothesis that carpal tunnel release (CTR) may result in biomechanical changes at the thumb CMC joint predisposing an individual to pain and or accelerated articular wear.
Methods: This review was performed using the Pubmed and Medline databases from January 1, 1970 to January 7, 2023. Articles that examine the thumb CMC joint after CTR were categorized as cadaveric, clinical, or computational studies. The anatomy, pathophysiology, and treatment of both CMC arthritis and carpal tunnel syndrome (CTS) were included to provide context for our results. These studies were synthesized to describe the effects of CTR on the thumb CMC joint.
Results: The search resulted in 1093 articles for possible inclusion. After screening abstracts and removing duplicates, 48 articles were included in this review. Common themes from this review include: widening and differences in configuration of the carpal arch following CTR, and changes in the positioning and movement of the carpal bones-leading to differences in the forces and contact stressors across articulations. We also review how these changes may lead to thumb CMC pain and could contribute to articular wear.
Conclusion: There are morphologic and biomechanical changes that occur across the carpal arch after CTR. These changes may be associated with differences in intrinsic hand muscle function, increased ligamentous stress, and accelerated ligamentous laxity - leading to alterations in the distribution of force around the trapezium and to its articular cartilage.

Keywords:  Carpal tunnel release; Carpometacarpal joint; Osteoarthritis; Transverse carpal ligament

DOI:  https://doi.org/10.1016/j.jpra.2026.01.029
Healthcare (Basel). 2026 Feb 11. pii: 448. [Epub ahead of print]14(4):

Pilates-Based Training and Its Influence on Muscle Viscoelasticity and Health-Related Outcomes in Chronic Low Back Pain: A Comparative Study.

Onur Aydoğdu, Osman Çoban, Yağmur Tetik Aydoğdu, Azime Yıldız, Zübeyir Sarı.

   BACKGROUND: The viscoelastic properties of muscle tissue are important factors affecting muscle performance; they play a significant role in maintaining spinal stability, as well as muscle contraction and function. Changes in these properties can result in pain, restricted movement, or poor posture. However, there is limited information in the literature regarding the viscoelastic properties of the paraspinal muscles, such as tone and stiffness, in individuals with chronic low back pain, which is one of the most common musculoskeletal disorders. The main aim of our study was to investigate the effects of reformer Pilates exercises on muscle viscoelastic properties in individuals with chronic low back pain for 4 weeks. In addition, our secondary aim was to examine the effects of Pilates-based exercises on body anthropometric values, pain intensity, functionality and kinesiophobia levels, sleep, and quality of life in individuals with chronic low back pain and to compare these parameters with a healthy group without low back pain.
METHODS: The study was carried out in a private clinic center and involved a total of 52 participants: 24 healthy subjects (control group) and 28 subjects with chronic low back pain (CLBP group). Pilates-based exercises were applied 2 days a week for 8 sessions for a total of 4 weeks. Muscle viscoelastic properties, body anthropometric values, pain intensity, functional status, kinesiophobia, sleep quality, and quality of life of all cases were evaluated. Muscle viscoelastic values were measured with a portable myotonometer, MyotonPro.
RESULTS: After 4 weeks of Pilates-based training, no significant improvements were observed in the parameters of muscle tone and stiffness in both groups (p > 0.05). It was found that pain intensity (p = 0.001), sleep quality (p = 0.004), quality of life (p = 0.019), and disability level (p = 0.003) improved after 4 weeks of Pilates-based training in subjects with chronic low back pain. In addition, there were significant differences in the parameters of the chest, waist, hip, and thigh circumferences after 4 weeks of Pilates-based training, except for the abdomen, in both groups (p < 0.05).
CONCLUSIONS: A period of four weeks of Pilates exercises did not lead to significant changes in the muscle viscoelastic properties of the lumbar and abdominal muscles, although performing these exercises did result in regional thinning. The efficacy of Pilates exercises in reducing pain, disability, and kinesiophobia and in improving sleep and quality of life has been demonstrated in individuals suffering from chronic low back pain.

Keywords:  Pilates-based exercises; low back pain; viscoelastic properties

DOI:  https://doi.org/10.3390/healthcare14040448
Toxins (Basel). 2026 Jan 27. pii: 68. [Epub ahead of print]18(2):

Impact of Early Versus Late Treatment with Botulinum Toxin A on Goal Attainment in Post-Stroke Spasticity: A Retrospective Cohort Study.

Atul Patel, Jinming Zhang, Simon Page, Sarah Harding, Mathieu Beneteau, Colin Navickas, Alberto Esquenazi.

  This study evaluated the effect of time of botulinum toxin A (BoNT-A) treatment on clinical outcomes in adults with post-stroke spasticity (PSS). Individual data were pooled from five studies. Eligible patients received ≥1 BoNT-A injection(s) for PSS and had goal attainment scaling (GAS) scores measured at baseline and 12 weeks. Patients were grouped according to time of treatment post-stroke: early (<1 year) or late (≥1 year). The primary endpoint was the total GAS (GAS-T) score change from baseline to 12 weeks. Secondary outcomes included the proportion of patients with a GAS-T score ≥ 50. Overall, 968 patients were included (166 early and 802 late). Median time post-stroke to BoNT-A treatment was 0.5 (early) versus 5.4 (late) years. Mean (standard deviation [SD]) baseline GAS scores were similar between cohorts (early: 36.9 [3.5]; late: 36.9 [3.6]). The mean (SD) change in the GAS-T score from baseline to 12 weeks was greater in the early versus late cohort (15.7 [8.9] vs. 13.1 [8.9]; p < 0.001). More patients in the early versus late cohort had a GAS-T score ≥ 50 (63.9% vs. 47.4%; p < 0.001) at 12 weeks. No new safety concerns were reported. Early treatment of PSS with BoNT-A has a positive impact on patients' ability to achieve treatment goals. Plain Language Summary: After a stroke, people can experience muscle stiffness in their limbs, called post-stroke spasticity (PSS), which can lead to pain and make movement difficult. Treatment can include botulinum toxin A (BoNT-A) injections given directly into affected muscles. The aim of our study was to assess whether giving BoNT-A within a year after experiencing a stroke was more effective in treating PSS than delaying treatment. We combined data from 968 patients across five different studies. Most people (802 patients) received BoNT-A treatment 1 year or more after their stroke (late treatment group), while 166 people received treatment within a year of their stroke (early treatment group). In the studies, patients set treatment goals with their physician, for example being able to hold an object or walk a certain distance. After treatment, the extent to which each goal was achieved was assessed and scored based on whether the result was less than expected, as expected, or better than expected by the patient and physician. The scores from the two treatment groups were compared. People in the early treatment group did better in achieving their treatment goals compared with those in the late treatment group. We also looked at any side effects patients experienced. No unexpected side effects were reported. BoNT-A treatment of PSS can help patients achieve their treatment goals, and patients treated early (within 1 year after stroke) may do better than those treated later. This information may help in rehabilitation planning for stroke patients.

Keywords:  botulinum toxins; muscle spasticity; stroke rehabilitation; treatment outcome; type A

DOI:  https://doi.org/10.3390/toxins18020068
Hand (N Y). 2026 Feb 27. 15589447261422483

Relative Motion Extension Orthosis Versus Classic Immobilization in Extensor Tendon Repairs (Zones IV-VI of the Hand): A Randomized Controlled Trial.

Miguel Cela-López, Cristina Méndez-Pérez, Diego M Domínguez-Prado, Alejandro García-Reza, Lucia Álvarez-Álvarez, Elena Pérez-Alfonso, Manuel Castro-Menéndez.

   BACKGROUND: Traditional treatment for extensor tendon injuries typically involves tenorrhaphy followed by a 4- to 6-week period of immobilization in a plaster orthosis. This study compares the efficacy of relative motion extension (RME) orthoses versus classic immobilization (CI) in promoting recovery after such injuries.
METHODS: We conducted a randomized, controlled, blind clinical trial approved by the Galicia ethics committee. Participants were individuals with single tendon injuries in the long fingers. They were randomly assigned to either the RME or the CI treatment group. Outcome measures, including range of motion, grip strength, pain (Visual Analog Scale), comfort level, and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, were assessed at 4 and 6 weeks post-treatment. The RME group used a daytime RME orthosis and a static nocturnal orthosis.
RESULTS: The study included 30 participants, 15 in each group. There were no significant differences in demographics or baseline characteristics between groups. Significant improvements were seen in the RME group in terms of grip strength, metacarpophalangeal and interphalangeal joint flexion, and QuickDASH scores (P < .05). Furthermore, 87% of the RME group reported high comfort levels with their orthoses, compared with 43% in the CI group.
CONCLUSIONS: Our findings suggest that RME orthoses are more effective than CI in improving initial functional outcomes post-extensor tendon tenorrhaphy. Patients in the RME group experienced better grip strength, increased flexion, reduced pain, and greater overall comfort during recovery. These advantages point to RME orthoses as a preferable method for managing extensor tendon injuries.This clinical trial was registered with ClinicalTrials.gov, registration number NCT06950268, URL: https://clinicaltrials.gov/study/NCT06950268.

Keywords:  classic immobilization; extensor tendon injury; functional recovery; immediate controlled active motion splinting; tenorrhaphy

DOI:  https://doi.org/10.1177/15589447261422483
JSES Int. 2026 Mar;10(2): 101624

Fatty change and muscle atrophy in patients with rotator cuff tears: a prospective study with a mean 6-year follow-up.

Atsushi Arino, Nobuyuki Yamamoto, Jun Kawakami, Rei Kimura, Hideaki Nagamoto, Hirotaka Sano, Toshimi Aizawa, Eiji Itoi.

   Background: Understanding how fatty change and muscle atrophy progress-and how they are interrelated-is important for determining appropriate treatment strategies in patients with rotator cuff tears. To prospectively evaluate the relationship between supraspinatus muscle atrophy and fatty change in patients with symptomatic rotator cuff tears treated nonoperatively, using magnetic resonance imaging.
Methods: Among 225 patients with symptomatic rotator cuff tears treated nonoperatively between 2006 and 2015, 58 patients (59 shoulders) who underwent at least two magnetic resonance imaging evaluations and were followed for ≥30 months were included. The occupation ratio (cross-sectional area of supraspinatus/supraspinatus fossa) was calculated to assess muscle atrophy, and fatty change was graded using the Goutallier classification. Tear dimensions (length and width) were also measured.
Results: Muscle atrophy progressed in 40 shoulders (68%), and fatty change progressed in 7 shoulders (12%) during an average duration of 53 months. Fatty change progression was significantly associated with larger initial tear length (25.9 mm vs. 11.0 mm; P < .001). The occupation ratio decreased progressively with higher Goutallier grades (P = .020).
Conclusion: Fatty change progressed in 7 shoulders (12%) during an average duration of 53 months. It was strongly associated with larger baseline tear size, tear enlargement, and muscle atrophy progression, highlighting the importance of early identification.

Keywords:  Fatty change; Magnetic resonance imaging; Muscle atrophy; Occupation ratio; Rotator cuff tear; Supraspinatus

DOI:  https://doi.org/10.1016/j.jseint.2026.101624
J Orthop. 2026 May;75 232-241

Conservative management of degenerative rotator cuff tears: A systematic review of long-term clinical outcomes and cost effectiveness.

Nikolaos Trygonis, Theodoros Loupasis, Wolf E Hautz, Aristomenis K Exadaktylos.

   Background: Degenerative rotator cuff tears are a prevalent cause of shoulder dysfunction in adults. The choice between conservative management and surgical repair remains controversial, particularly in older patients and those with partial-thickness tears. This systematic review evaluates the long-term outcomes and cost-effectiveness of conservative treatment strategies compared with surgical repair.
Methods: A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, and Scopus databases, covering publications from 2010 to 2025. Only randomized controlled trials (RCTs) and cohort studies comparing conservative and surgical interventions for degenerative rotator cuff tears were included. Methodological quality was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool and the ROBINS-I tool for cohort studies. Due to heterogeneity in study design and outcome measures, a meta-analysis was not feasible; instead, a structured narrative synthesis was performed to highlight consistent trends. This review integrates recent evidence, reflecting the increasing prevalence of degenerative tears in aging populations and evaluating novel conservative options such as PRP and ESWT.
Results: 16 high quality peer reviewed studies involving a total of 893 patients were included. Conservative treatment, primarily physiotherapy-based, demonstrated comparable outcomes to surgery in partial-thickness tears or low-demand individuals. For full-thickness tears, surgical repair yielded superior long-term improvements in Constant-Murley Score (CMS), Visual Analogue Scale (VAS) pain scores, American Shoulder and Elbow Surgeons (ASES) scores, and patient satisfaction. Although surgical groups demonstrated structural re-tears, these did not consistently correlate with deterioration in clinical function, suggesting that anatomical failure may not always equate to functional decline. Across multiple studies, conservative management was consistently associated with lower direct and indirect healthcare costs. Novel adjunctive therapies such as extracorporeal shockwave therapy (ESWT) and platelet-rich plasma (PRP) also showed promising results in selected populations.
Conclusion: Conservative management appears as a clinically effective and cost-efficient first-line approach for degenerative rotator cuff tears, particularly for partial tears and elderly patients. However, surgical is associated with superior long-term functional outcomes in full-thickness tears. Emerging nonoperative technologies further strengthen the role of conservative care. Treatment should be individualized based on tear severity, patient activity level, and therapeutic goals.

Keywords:  Conservative treatment; Cost-effectiveness; Long-term outcomes; Rotator cuff tear

DOI:  https://doi.org/10.1016/j.jor.2026.02.040
J Clin Med. 2026 Feb 10. pii: 1381. [Epub ahead of print]15(4):

Clinical Outcomes of Injectable Porcine Collagen in Diabetic Patients with Achilles Tendinopathy: A Retrospective Study.

Giacomo Placella, Niccolò Biavardi, Mattia Alessio Mazzola, Vincenzo Salini.

  Background/Objective: Achilles tendinopathy (AT) is a disabling condition, and treatment options are limited in patients in whom corticosteroid injections are discouraged or contraindicated, including individuals with diabetes. Porcine collagen injections have been proposed as a conservative option; however, clinical evidence in diabetic populations remains limited. This study aims to describe pain and functional outcomes after peritendinous collagen injections in diabetic patients with chronic Achilles tendinopathy. Methods: Twenty-two diabetic patients with ultrasound-confirmed degenerative Achilles tendinopathy refractory to conservative management were retrospectively included and split into two groups according to AT type: insertional (IAT) and non-insertional/midportion (NIAT). All patients received five weekly ultrasound-guided peritendinous collagen injections. Outcomes included VAS assessed at baseline, after the second injection, at 1 month, and at 6 months; VISA-A at baseline and 6 months; return-to-work (RTW) time; and adverse events. Baseline variables included BMI, HbA1c, symptom duration, and previous treatments. Analyses were based on descriptive statistics and within-group comparisons over time. Results: All patients completed the treatment protocol, and no adverse events were recorded. Pain significantly improved over follow-up in both subgroups. Mean VAS decreased from baseline to 6 months (mean ΔVAS: 5.1 in IAT and 4.4 in NIAT; p = 0.001 for within-group change). VISA-A also improved at 6 months (mean ΔVISA-A: 32.78 in IAT and 38.97 in NIAT; p < 0.0001). Median RTW was 37 days in IAT and 35 days in NIAT (p > 0.05). No significant between-group differences were observed for VAS or VISA-A changes (p > 0.05). Conclusions: In this uncontrolled retrospective case series, peritendinous collagen injections were feasible and well-tolerated in diabetic patients with Achilles tendinopathy and were associated with clinically relevant improvements in pain and functional outcomes at 6 months. These findings are hypothesis-generating and warrant confirmation in prospective controlled studies.

Keywords:  Achilles tendinopathy; BMI; VAS; VISA-A; diabetic patients; pain; porcine collagen injection; return to work

DOI:  https://doi.org/10.3390/jcm15041381
Br J Radiol. 2026 Feb 27. pii: tqag041. [Epub ahead of print]

Ultrasound Accuracy in Classifying Full-Thickness Supraspinatus Tear Patterns: An Arthroscopic Correlation Study.

Shengqiao Wang, Kuanli Tang, Juan Chen, Jun Jiang, Yi Dong.

   OBJECTIVE: To evaluate ultrasound's diagnostic value for full-thickness supraspinatus tendon (SST) tears and correlate it with arthroscopy findings.
METHODS: In this retrospective study, patients with a clinical diagnosis of rotator cuff tears were included. The inclusion criteria were patients with shoulder joint pain and limited shoulder mobility. The exclusion criteria comprised patients who had undergone any previous shoulder surgery or those with shoulder fractures or dislocations. Ultrasound imaging features were observed and recorded, including measurements of the length and width of tears to reveal tear patterns. The chi-square test was used to compare the clinical characteristics of categorical variables, and the Wilcoxon test was used to assess the correlation between ultrasound and arthroscopy.
RESULTS: From January 2023 to November 2023, 105 patients diagnosed with rotator cuff tears were included (50 males, 55 females, mean age 67.9 ± 14.2 years). Arthroscopy confirmed full-thickness SST tears in 82 patients (78.1%). Ultrasound demonstrated differential diagnostic performance across tear patterns: sensitivity/specificity 90.0%/95.8%(crescent), 93.1%/94.3% (U-shaped), 83.8%/98.0% (L-shaped), and 100%/98.6% (giant), with corresponding area under the ROC curves (AU-ROCs) of 0.789-0.882. Significant correlations were observed between ultrasound and arthroscopic measurements, particularly for crescent-type tear width (r = 0.949, p < 0.001).
CONCLUSION: Ultrasound effectively distinguishes SST tear types, with high concordance to arthroscopy, supporting its use as a primary imaging tool for surgical planning in rotator cuff pathology.
ADVANCES IN KNOWLEDGE: Ultrasound has significant application value in the diagnosis of full-thickness of SST tears. Ultrasound shows high consistency with arthroscopic findings and can effectively differentiate various tear patterns.

Keywords:  Supraspinatus tendon (SST); arthroscopy; correlation; diagnosis; ultrasound

DOI:  https://doi.org/10.1093/bjr/tqag041
Ortop Traumatol Rehabil. 2025 Jul 31. 27(4): 157-165

Hip Arthroplasty in Supra-trochanteric Limb Length Discrepancy Patients.

Mohamed Samir Gobba, Khaled Abdel-Kader, Mahmoud Awad, Fouad Zamel Sadek.

   BACKGROUND: Limb length discrepancy (LLD) with hip arthritis can lead to disability including impaired gait, low back pain, pelvic obliquity, and the need to use shoe lifts for correction. Total hip arthroplasty (THA) remains the most often performed procedure for patients with hip osteoarthritis. Elimination of LLD is an important goal of any THA procedure as it affects the functional outcome.
MATERIALS AND METHODS: Prospective clinical case series. Over 4 years we enrolled 23 cases in our study. All patients had hip arthritis with clinical true LLD of 2 cm or more. Primary total hip arthroplasty and additional soft tissue releases were performed. LLD, range of motion (ROM), pelvic obliquity and Harris hip score (HHS) were compared preoperatively and postoperatively with follow-up for at least one year.
RESULTS: The mean Harris hip score improved from 41 (preoperatively) to 88.4 (one year postoperatively). Mean preoperative LLD was -3.1 0.9 cm, while mean postoperative LLD was -0.10.8 cm. Before the operation, 11 patients had pelvic obliquity compared to only one after the operation. No postoperative nerve palsy was reported.
CONCLUSION: Patients with hip arthritis and associated supratrochanteric LLD can be successfully treated with primary THA and additional soft tissue releases.

Keywords:  THA; hip joint; limb length discrepancy

DOI:  https://doi.org/10.5604/01.3001.0055.6435
Cureus. 2026 Jan;18(1): e101874

Ultrasound-Guided Aspiration and Dextrose Prolotherapy for a Triangular Fibrocartilage Complex Ganglion Cyst in an Avid Golfer: A Case Report.

Yonghyun Yoon, Stephen Cavallino, Teinny Suryadi, Anwar Suhaimi, Jonghyeok Lee, King Hei Stanley Lam.

  The triangular fibrocartilage complex (TFCC) is a key stabilizer of the ulnar side of the wrist, and ganglion cysts arising primarily from the TFCC are uncommon, with no clear consensus on optimal management. We report the case of a 63-year-old right-handed male businessman and avid golfer, whose work required regular business golf rounds, presenting with several months of persistent left ulnar-sided wrist pain that worsened during golf swings when not using a brace. Physical examination revealed a positive ulnar fovea sign and pain with grip strength testing. Radiographs demonstrated neutral ulnar variance, and computed tomography showed no evidence of fracture or significant arthritic changes. Ultrasonography identified a multiseptated ganglion cyst adjacent to the TFCC. Under ultrasound guidance, the cyst was aspirated, followed by prolotherapy using 10% dextrose injected into the TFCC enthesis. The patient subsequently underwent a structured rehabilitation program including physical therapy and isometric exercises. After five sessions of prolotherapy at two-week intervals, his pain resolved completely, and he was able to maintain his work-related golf schedule without discomfort. This case suggests that ganglion cysts may occur secondary to TFCC pathology and underscores the value of ultrasound not only for diagnosis but also for guiding minimally invasive interventions. Ultrasound-guided aspiration combined with prolotherapy may represent an effective, joint-preserving treatment option for TFCC-associated ganglion cysts, potentially avoiding the need for more invasive surgical procedures in selected patients.

Keywords:  ganglion cyst; prolotherapy; tfcc; triangular fibrocartilage complex; ultrasound-guided intervention; wrist pain

DOI:  https://doi.org/10.7759/cureus.101874
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2026 Feb 15. 40(2): 197-203

[Interpretation of the 2025 American Academy of Orthopaedic Surgeons (AAOS) on Management of Rotator Cuff Injuries Evidence-Based Clinical Practice Guideline].

Yi Ye, Bing Lu, Jiahong Li, Kun Zhang.

  The American Academy of Orthopaedic Surgeons (AAOS) released the updated Evidence-Based Clinical Practice Guideline for the Management of Rotator Cuff Injuries in August 2025. The guideline provides 25 recommendations and 4 consensus statements across diagnosis, treatment decision-making, biologic interventions, and postoperative rehabilitation, with the strength of each recommendation graded according to the quality of supporting evidence. The updated guideline highlights several key advances, including establishing CT as an important adjunctive imaging modality, providing specific recommendations on repair strategies for high-grade partial-thickness rotator cuff tears, and clearly restricting the use of platelet-rich plasma and marrow stimulation in rotator cuff repair, as well as limiting the application of prolotherapy in the treatment of full-thickness rotator cuff tears. In addition, the guideline emphasizes the potential benefits of early mobilization in patients with small to medium-sized tears.

Keywords:  American Academy of Orthopaedic Surgeons; Rotator cuff injury; clinical practice guideline; guideline interpretation

DOI:  https://doi.org/10.7507/1002-1892.202511084
Regen Med. 2026 Feb 27. 1-13

Three intra-articular injections of allogeneic umbilical cord-derived mesenchymal stromal cells in knee osteoarthritis: a phase-I clinical trial.

Elaheh Khodadoust, Morteza Zarrabi, Elahe Afzal, Fatemeh Zamani, Masoumeh Nouri, Safdar Masoumi, Seyedeh Malihe Mahmoodi, Faeze Sharafi, Maedeh Alizadeh, Mohsen Emadedin, Massoud Vosough.

   PURPOSE: This phase I clinical trial evaluated the safety and preliminary efficacy of three intra-articular injections of 20 × 106 allogeneic Umbilical Cord-derived Mesenchymal Stromal Cells (UC-MSCs) in patients with Knee Osteoarthritis (OA) at a two-month interval.
METHODS: Six participants aged 40-70 years with Kellgren and Lawrence grade II-III were enrolled. They received three bilateral intra-articular injections of allogeneic UC-MSCs at two-month intervals. They were assessed for possible Adverse Events, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Scale (VAS), Short Form Health Survey, and Magnetic Resonance Imaging (MRI) over 12 months.
RESULTS: No serious adverse events occurred. Four participants (66%) reported at least one adverse event, most commonly transient injection-site pain or swelling. Exploratory analyses showed improvement in WOMAC scores from a median of 58.33 (IQR: 25-69.53) at baseline to 21.85 (IQR: 11.97-61.44) at 12 months, with pain and function improving in five patients (83%). VAS scores decreased by a median of 55% (IQR: -62.5 to -12.5). MRI showed no consistent structural changes, although mild tibial cartilage improvement was observed in two participants.
CONCLUSION: Three intra-articular injections of allogeneic UC-MSCs appear to be safe and may provide functional benefits in patients with knee OA, supporting further investigation in larger, controlled trials.
CLINICAL TRIAL REGISTRATION: https://irct.behdasht.gov.ir identifier is IRCT20211102052944N1.

Keywords:  Knee osteoarthritis; Regenerative Medicine; allogeneic umbilical cord-derived mesenchymal stromal cell; cell-based therapy; phase 1 clinical trial

DOI:  https://doi.org/10.1080/17460751.2026.2636683
J Clin Med. 2026 Feb 19. pii: 1616. [Epub ahead of print]15(4):

Rehabilitation Strategies Following Isolated Meniscal Repair: A Systematic Review of Protocols and Outcomes.

Waleed Albishi, Ibraheem Al Yami, Abdullah Alyami, Omar A Aldosari, Sarah AlJasser.

  Background: Meniscal injuries are common athletic injuries, and isolated meniscal repair is a critical procedure for restoring knee function. However, rehabilitation protocols after meniscal repair remain controversial. This systematic review aimed to evaluate rehabilitation protocols to determine the best strategies for enhancing recovery following isolated meniscal repair. Objectives: Analyze current rehabilitation protocols following isolated meniscal repair, focusing on the efficacy of approaches in improving functional outcomes and reducing recovery time. This study also aims to identify gaps in the existing literature and provide recommendations for future studies. Data sources: Search was conducted using PubMed, Scopus, and Web of Science databases, covering studies published between May 2015 and May 2024. Inclusion criteria: Studies reporting on isolated meniscal repair with defined postoperative rehabilitation protocols and quantifiable outcome measures. Data extraction: Focused on patient demographics, meniscal tear types, repair techniques, and rehabilitation outcomes. The methodological quality of the included studies was assessed, and narrative synthesis was conducted. Results: The review included 13 studies with significant variability in rehabilitation protocols and outcomes. Early weight-bearing and range of motion exercises have been associated with improved recovery in some studies for stable meniscal tears. However, conservative approaches have better outcomes in patients with complex tears. The use of adjunctive therapies such as blood flow restriction training has demonstrated potential in enhancing muscle preservation and overall recovery. Conclusions: Rehabilitation protocols after meniscal repair surgery should be individualized. Although innovative protocols show promise, further research is needed to standardize rehabilitation approaches and optimize long-term outcomes.

Keywords:  early weight-bearing; functional outcomes; knee injury; meniscal repair; physical therapy; range of motion; rehabilitation protocols; systematic review

DOI:  https://doi.org/10.3390/jcm15041616
J Aging Phys Act. 2026 Feb 19. 1-3

Old Is Gold: The Continued Relevance of Functional Tests in Older Adults Amid Technological Advances in the Field of Exercise and Rehabilitation.

Emerson Sebastião, Lindsay S Nagamatsu.

DOI: https://doi.org/10.1123/japa.2025-0420
Reumatismo. 2026 Feb 25.

Long-term efficacy of intra-articular viscosupplementation in delaying hip osteoarthritis radiographic progression: a retrospective, non-controlled study from the ANTIAGE registry.

Alberto Migliore, Nazzareno Iannarelli, Antonio Devito, Raffaele Saporito, Luca Saccone, Irene Beriotto, Michele Grassi, Eugenio Cunego, Annamaria Paglionico, Sandro Tormenta.

OBJECTIVE: Viscosupplementation is a recognized treatment for improving pain and joint function in the long term. The study aimed to analyze the radiological changes after 2 years of treatment with HyalOne® (Hyalubrix® 60 Italian brand name) in patients with symptomatic hip osteoarthritis (OA). The primary objective was to evaluate the ability of delaying hip OA progression, measured by the percentage of patients showing no radiological Kellgren-Lawrence (K-L) grade change ≥ 1 at 2 years. Secondary objectives included variations in pain at rest, Lequesne index, and non-steroidal anti-inflammatory drug (NSAID) intake after 2 years of treatment.
METHODS: Data of patients suffering from symptomatic hip OA treated with HyalOne®/Hyalubrix® 60 were selected from the ANTIAGE national registry. The analysis included 78 patients aged 50-to 80 years with radiological and clinical OA (K-L grade 1-3), body mass index ≤35, and at least 2 years of radiological follow-up. Patients with significant comorbidities or who received previous treatment within two years after HyalOne®/Hyalubrix® 60 were excluded.
RESULTS: This retrospective observational non-controlled study showed that intra-articular injections with HyalOne®/Hyalubrix® 60 were well tolerated and may help maintain clinical and radiographic stability in patients with hip OA. At 2-year follow-up, the K-L grade remained stable in 72 hips (92.31%). Symptom reduction was also observed, supporting lower NSAID consumption and the avoidance of the related adverse events.
CONCLUSIONS: These results are clinically meaningful and support the treatment with HyalOne® as a valuable background therapy for maintaining clinical and radiographic stability in patients with hip OA.

DOI: https://doi.org/10.4081/reumatismo.2026.1917
S Afr J Sports Med. 2026 ;38(1): v38i1a22949

Injury characteristics, outcome, and return to play after ankle sprains and Achilles tendon ruptures in tennis.

P Kaiser, B Petry, K Genelin, S Singh, T Ellenbecker, T Kastenberger, R A Lindtner, A Keiler.

   Background: Ankle sprains and acute Achilles tendon ruptures are common injuries among recreational tennis players.
Objectives: This study investigated the specific cause, return to play, and ability to play tennis after an ankle sprain and Achilles tendon rupture.
Methods: Patients who sustained an ankle sprain (n=39) or an Achilles tendon rupture (n=7) while playing tennis were retrospectively evaluated, with a mean follow-up of 6.0 and 5.2 years, and follow-up rates of 80% and 78%, respectively.
Results: Ankle sprain patients were younger (39 years), smaller and lighter (BMI males 24.3, females 22.5) than Achilles tendon rupture patients (49 years, BMI males 26.8). Ankle sprains occurred more often on clay (56% [CI 40-72%]) and Achilles tendon ruptures on carpet courts (57% [CI 18-90%]). The return-to-play rate for tennis was 90% in patients with ankle sprains after a mean of 3.6 months and 29% in patients with Achilles tendon ruptures (two patients), with returns occurring at 5 and 36 months. The return to any sport was 97% and 100%, respectively. Twenty-nine players (74%) with an ankle sprain reported no complaints while playing tennis, and 6 (15%) had some instability or slight pain. Twenty-one per cent of all ankle sprain patients experienced subsequent events (1-3), with a 10% recurrence rate after a first-time event and a 33% rate in patients with recurrent instability episodes.
Conclusion: The return-to-play rate for tennis was high after an ankle sprain and low after an Achilles tendon rupture. The reason for not returning in recreational players was either fear of re-injury or preference for other sports, not because of injury-related disabling factors. Patients after Achilles tendon rupture who returned to play tennis did not have any functional problems, and patients after ankle sprain rarely experienced minor instability or pain.

Keywords:  Achilles; ankle; foot; return to sports; sprain; tennis

DOI:  https://doi.org/10.17159/2078-516X/2026/v38i1a22949
BMC Musculoskelet Disord. 2026 Feb 24.

Investigation of the effects of morphometric characteristics of the foot on Achilles tendon rupture.

Osman Hanbeyoğlu, Mustafa Canbolat, Veysel Burulday.



Keywords:  Achilles tendon rupture; Foot biomechanics; Radiographic measurement

DOI:  https://doi.org/10.1186/s12891-026-09658-4
Assist Technol. 2026 Feb 24. 1-9

Shoulder pain in wheelchair rugby athletes: Athlete characteristics, training behaviors, and rehabilitation implications.

John V Rider, Ryan E Linford, Wei Ju Lin.

  Shoulder pain is a common concern among wheelchair users and may be influenced by adaptive sports. Although participation in adaptive sports is increasing, limited research has examined shoulder pain in this population. This cross-sectional survey investigated the prevalence and severity of shoulder pain and explored associations with demographic factors, activity patterns, and management strategies among 61 wheelchair rugby athletes in the United States. The Wheelchair User's Shoulder Pain Index (WUSPI) measured pain, with an average score of 56.08 (performance-corrected score (PC-WUSPI) = 58.13), reflecting high levels of shoulder pain. Significant negative correlations (ps < 0.001) were found between PC-WUSPI scores and years of wheelchair use (r = -0.48), adaptive sports participation (r = -0.47), warm-up frequency (r = -0.53), and shoulder strength training (r = -0.34). A positive correlation was observed with power wheelchair use (r = 0.51, p < 0.001). Most participants managed shoulder pain with medication (67.2%) or exercise (57.4%), with medication rated as more effective. The most common medical services utilized for pain management were physical therapy (54.1%), occupational therapy (44.3%), and primary care physicians (41%). Findings highlight the need for targeted prevention and rehabilitation strategies to address shoulder pain in wheelchair rugby athletes, emphasizing proactive conditioning and multidisciplinary approaches.

Keywords:  Adaptive sports; injury prevention; rehabilitation, shoulder pain, wheelchair rugby

DOI:  https://doi.org/10.1080/10400435.2026.2630939
Cureus. 2026 Jan;18(1): e101918

Preoperative Cryogenic Neurolysis Trends Toward Reduced Severe Postoperative Pain in Patients Admitted to the Hospital After Total Knee Arthroplasty.

Jorge Perera, Robert Wood, Jacqueline Krumrey.

  Introduction Cryogenic neurolysis is an emerging conservative intervention for knee pain. It involves the percutaneous application of low temperatures to peripheral nerves to produce a long-lasting nerve blockade. Although commonly used conservative treatments for knee osteoarthritis provide temporary relief and carry risks, cryogenic neurolysis may offer longer-term pain control with minimal complications. This study examined the trends of preoperative cryogenic neurolysis and its role in reducing postoperative pain and opioid consumption in patients undergoing total knee arthroplasty (TKA). Methods We conducted a retrospective observational study of all primary TKA patients treated by a single surgeon between February 21, 2023, and February 21, 2024. Patients were grouped based on whether they received cryogenic neurolysis within two weeks preoperatively. Outcomes included maximum visual analog scale (VAS) pain scores, morphine milligram equivalents (MME) administered on postoperative days zero and one, and opioid refills within six weeks. Statistical analyses included chi-square tests with effect sizes, two-sample t-tests, and Wilcoxon rank-sum tests. Results A total of 168 patients were included (92 cryogenic neurolysis; 76 controls). On postoperative day zero, 24 of 92 patients (26.1%) in the cryogenic neurolysis group and 24 of 76 patients (31.6%) in the control group reported severe pain (VAS ≥7), a non-significant difference (χ²(1, N = 168) = 0.62, p = 0.43, Cramer's V = 0.06). Among the subset of 128 overnight patients, 10 of 54 (18.5%) in the cryogenic neurolysis group and 19 of 74 (25.7%) in the control group reported severe pain on postoperative day one, also non-significant (χ²(1, N = 128) = 0.91, p = 0.34, Cramer's V = 0.08). No significant differences were found in inpatient MME consumption. Opioid refills were similar between groups, with 49 of 92 patients (53.3%) in the cryogenic neurolysis group and 43 of 76 patients (56.6%) in the control group receiving at least one refill (χ²(1, N = 168) = 0.18, p = 0.67, Cramer's V = 0.03). Conclusions Preoperative cryogenic neurolysis was not associated with statistically significant reductions in postoperative pain scores, inpatient MME usage, or opioid refills. However, a lower percentage of patients who received cryogenic neurolysis reported severe postoperative day zero and one pain, suggesting a possible early clinical benefit. Although trends favored the cryogenic neurolysis group, larger prospective studies are needed to better evaluate its role in multimodal pain management for TKA patients.

Keywords:  multimodal pain control; post operative pain control; total joint arthroplasty; total knee replacement (tkr); total knee replacement postoperative recovery

DOI:  https://doi.org/10.7759/cureus.101918
J Pain Res. 2026 ;19 571566

Effectiveness of Radiofrequency Ablation for Chronic Low Back Pain: A Systematic Review of Sham-Controlled Randomized Controlled Trials.

Tamerlan Shokanov, Talgat Anashev, Kazybek Baktybergen, Yerdar Shaukhin.

   Background: Radiofrequency ablation (RFA) is widely used as an interventional treatment for chronic low back pain; however, its clinical effectiveness across different pain generators remains uncertain, particularly when evaluated in rigorously controlled trials.
Objective: To systematically review randomized controlled trials assessing the effectiveness of RFA for chronic low back pain, stratified by pain generator and radiofrequency technique.
Methods: A systematic search of PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov was conducted to identify randomized controlled trials evaluating RFA for chronic low back pain. Trials employing sham or active comparator interventions were included. Study selection, data extraction, and risk of bias assessment were performed independently by two reviewers.
Results: Six randomized controlled trials involving different pain generators were included. For discogenic low back pain, RFA of the ramus communicans did not demonstrate superiority over sham treatment, with pain reduction observed over time in both groups. Similarly, for facet joint pain, medial branch RFA was not superior to sham procedures within the studied follow-up period. For sacroiliac joint pain, results were heterogeneous. Sham-controlled trials evaluating conventional lateral branch RFA did not demonstrate a specific treatment effect, whereas studies employing alternative techniques, including strip-lesion, capsular, or cooled RFA, were associated with greater and more sustained pain reduction, with statistically significant between-group differences reported at up to 12 months in selected trials.
Conclusion: Based on a limited number of randomized controlled trials, RFA does not consistently demonstrate superiority over sham treatment for discogenic or facet joint-related chronic low back pain. For sacroiliac joint pain, selected RFA techniques may offer benefit in appropriately selected patients; however, conclusions remain constrained by heterogeneity and small sample sizes. Further high-quality, sham-controlled trials are required before definitive clinical recommendations can be made.

Keywords:  chronic low back pain; facet joint; radiofrequency ablation; randomized controlled trials; sacroiliac joint; sham-controlled trials

DOI:  https://doi.org/10.2147/JPR.S571566
BMC Musculoskelet Disord. 2026 Feb 25.

Efficacy and safety of a combination of platelet-rich plasma with non-crosslinked hyaluronic acid versus a crosslinked hyaluronic acid, in single-injection for knee osteoarthritis. Randomized, controlled, multicenter, non-inferiority trial.

Louis Riglet, Thomas Delgado, Rosanna Ferreira Lopez, Yves-Marie Pers, Catherine Cyteval, Philippe Adam, Paul Ornetti.



Keywords:  Hyaluronic acid; Knee osteoarthritis; Non-inferiority trial; Platelet-rich plasma; Randomized controlled trial

DOI:  https://doi.org/10.1186/s12891-026-09625-z
Medicine (Baltimore). 2026 Feb 27. 105(9): e47925

YouTube as a digital health platform: A cross-sectional thematic and sentiment analysis of the 100 most-viewed knee osteoarthritis videos.

Nurmuhammet Taş, Yakup Erden, Mustafa Hüseyin Temel, Fatih Bağcier.

  Knee osteoarthritis (OA) is a prevalent source of pain and disability. As YouTube becomes increasingly used for health information, the nature and impact of OA-related content warrant systematic evaluation. Using the YouTube Data Application Programming Interface, 327 videos were initially retrieved with the terms "knee osteoarthritis," "gonarthrosis," and "degenerative joint disease." After applying exclusion criteria, the 100 most-viewed English-language videos were selected. Metadata and 60,888 user comments were extracted. Videos were thematically categorized into 6 domains: treatment, disease education, symptoms, diagnosis, patient experience, and uncategorized. Sentiment analysis was performed using the TextBlob library, and statistical trends were assessed via Statistical Package for the Social Sciences (SPSS) 29.0. Treatment was the dominant theme (38%), with nonsurgical options like exercise and rehabilitation comprising over half of these videos (55.3%). Educational (24%) and symptom-related content (12%) were also frequent. Viewer engagement peaked in 2022, with the highest number of views and comments. Over time, video uploads and comment activity increased, best modeled by quadratic trends. Seasonal variation in engagement was not significant. Commonly used words included "exercise," "knee," "thank," and "pain." Sentiment analysis revealed a decline in positive comments and a rise in neutral sentiment, while negative sentiment remained stable. YouTube serves as a growing platform for knee OA information, emphasizing conservative treatments. Although engagement and content volume have increased, sentiment has shifted toward neutrality. Given the variability in content quality, healthcare providers should guide patients toward credible, evidence-based resources to optimize digital health literacy.

Keywords:  YouTube health information; digital health platforms; knee osteoarthritis videos; sentiment analysis YouTube; social media in healthcare

DOI:  https://doi.org/10.1097/MD.0000000000047925
Toxins (Basel). 2026 Jan 27. pii: 66. [Epub ahead of print]18(2):

Exploratory Use of Proximal Cryoneurolysis and Distal Botulinum Toxin Type A for Upper-Limb Spasticity: A Case Report with Scoping Review.

Di Lorenzo Luigi, De Meo Bruno, Forte Alfonso Maria, Forte Francesco, Palmieri Vincenzo, Pirraglia Nicola, D'Avanzo Carmine.

   BACKGROUND: Upper-limb spasticity involving the shoulder girdle and elbow flexors often impairs functional hand use, and although Botulinum toxin type A (BoNT-A) is a first-line therapy, severe proximal synergies may persist while higher doses risk distal weakness.
METHODS: We report a case of a 47-year-old woman with neurodegenerative tetraparesis and marked shoulder and elbow flexor spasticity treated with bilateral percutaneous cryoneurolysis of the lateral pectoral, thoracodorsal, and musculocutaneous nerves, followed by distal BoNT-A injections, and we conducted a scoping review following Arksey and O'Malley, Levac, and PRISMA-ScR methods to contextualize the current evidence.
RESULTS: At one-month follow-up, the patient showed a reduction in MAS from 4 to 1-2, complete resolution of pain, improved passive shoulder abduction and elevation, preserved distal dexterity, and high satisfaction with no adverse events. The scoping review identified consistent MAS and range-of-motion improvements across multiple case reports and small series involving similar proximal nerve targets.
CONCLUSIONS: The combined proximal cryoneurolysis-distal BoNT-A approach appears to be a feasible dual-modulation strategy for complex upper-limb spasticity when the preservation of hand function is essential, and the emerging literature supports its further investigation.

Keywords:  botulinum toxin type A; cryoneurolysis; neurorehabilitation; shoulder girdle; upper-limb spasticity

DOI:  https://doi.org/10.3390/toxins18020066
J Bone Miner Res. 2026 Feb 25. pii: zjag041. [Epub ahead of print]

Imaging and its role in predicting osteoarthritis progression.

Polly Taylor, Benjamin G Faber.



Keywords:  hip pain; osteoarthritis; total hip replacement

DOI:  https://doi.org/10.1093/jbmr/zjag041
Biomed Tech (Berl). 2026 Feb 24.

Standing up to neurodegeneration: evaluating autonomic stress and safety in sit-to-stand using heart rate variability analysis.

Sorfina Ilham Rozman, Nur Azah Hamzaid, Einly Lim, Norhamizan Hamzah, Jade P Guan, Sakinah Sabirin, Nazirah Hasnan, Nortina Shahrizaila.

   OBJECTIVES: Sit-to-stand (STS) exercises are commonly incorporated in functional rehabilitation due to their simplicity, relevance to daily mobility and more recently, cardiac fitness. While generally considered safe for most clinical populations, its effect on autonomic stability remains underexplored - particularly in those with autonomic vulnerability such as individuals with amyotrophic lateral sclerosis (ALS). This study investigates the suitability of STS exercises for individuals with ALS, with specific focus on establishing baseline heart rate variability (HRV) data during rest and transient STS movement.
METHODS: Heart rate (HR) and HRV (RMSSD and HF) were assessed across three cohorts; healthy young adults (n=29), individuals living with ALS (n=8), and their age-matched controls (n=9), under resting condition and two STS protocols: Timed up and go (TUG) and five times sit-to-stand test (FTSST).
RESULTS: All groups exhibited significant increase in mean HR during STS compared to rest (p<0.05), whereas no statistically significant differences were observed in RMSSD and HF. These results indicate that STS exercises elicit measurable cardiovascular exertion without triggering acute autonomic dysfunction in ALS individuals, supporting its role in safe rehabilitation for early-mid stages ALS.
CONCLUSIONS: HRV serves as a potential tool for non-invasive monitoring and assessment of autonomic function during physical therapy.

Keywords:  autonomic dysfunction; cardiac autonomic response; heart rate variability; motor neuron disease; sit-to-stand; therapeutic exercise

DOI:  https://doi.org/10.1515/bmt-2025-0338
Osteoarthr Cartil Open. 2026 Jun;8(2): 100752

Single-injection hyaluronic acid treatment demonstrates non-inferiority in the relief of symptomatic knee osteoarthritis: A randomized double-blind, multi-center controlled study.

C Ruosi, U G Longo, N Giordan, L Saracino, M A Minetto, C Busso, N Migliaccio, C Melchior, A Guardoli, E Vaienti, G Scita, F Atzori, G Chitoni, N Orabona, F Benazzo.

   Objective: To compare two sodium hyaluronate formulations (HYMOVIS® ONE and MONOVISC®) for single intra-articular (IA) injection in patients with knee osteoarthritis pain.
Methods: This randomized, controlled study included 347 subjects allocated to two treatment arms: HYMOVIS® ONE (n = 175) and MONOVISC® (n = 172). The primary endpoint assessed non-inferiority of HYMOVIS® ONE versus MONOVISC® based on change from baseline in the WOMAC LK3.1 A1 Pain subscale. Secondary outcomes evaluated patient response using OMERACT-OARSI criteria, changes in WOMAC stiffness and function scores, health-related quality of life (SF-12), global assessments by patients and clinicians, and rescue medication use.
Results: The mean WOMAC LK3.1 A1 walking pain subscale score decreased significantly from baseline at week 12 in both groups, with reductions of 65 % for HYMOVIS® ONE and 66 % for MONOVISC®. At week 26, reductions were 73 % for HYMOVIS® ONE and 69 % for MONOVISC®. The non-inferiority test yielded a p-value of 0.0003. Clinically significant change from baseline was observed for all secondary endpoints. For the WOMAC LK3.1 Function subscale, the comparison between groups at week 26 showed a statistically significant difference (p = 0.0367) favoring HYMOVIS® ONE. Both treatments were well tolerated.
Conclusions: A single injection of HYMOVIS® ONE was well tolerated and non-inferior to MONOVISC®, with improvements across all study endpoints maintained through 26 weeks, indicating sustained symptomatic relief of knee OA.
Trial registration number: NCT06528600 (www.clinicaltrials.gov).

Keywords:  Hyaluronic acid; Knee; Osteoarthritis

DOI:  https://doi.org/10.1016/j.ocarto.2026.100752
Healthcare (Basel). 2026 Feb 11. pii: 451. [Epub ahead of print]14(4):

How Intense Is Effective? Exploring Aerobic Exercise Intensity for Knee Osteoarthritis Through a Bayesian NetworkMeta-Analysis.

Luis Cabrera-Durán, Javier Palomares-Fernández, Ignacio Canitrot-González, Paride Crisafulli, Carlos Donato Cabrera-López, José Fierro-Marrero.

   INTRODUCTION: Knee osteoarthritis (KOA) is characterized by pain, stiffness, and functional limitation. Aerobic exercise (AE) is a key treatment with proven benefits.
AIMS: To determine the most effective AE intensity for KOA.
METHODS: Searches were performed in seven databases, including randomized controlled trials with AE-only groups. Outcomes assessed were pain, walking and sit-to-stand performance, stiffness, and disability. Methodological quality and bias were evaluated. Bayesian random-effects network meta-analyses compared AE intensities, reporting standardized mean differences (Hedges' g) with 95% credible intervals. Certainty of evidence was rated using GRADE.
RESULTS: Fifteen studies were included (mean PEDro score: 5.93), showing "some concerns" or "high risk" of bias. Two meta-analyses (pain and walking performance) were conducted. Comparisons between AE intensities showed non-significant, imprecise results with very low certainty of evidence.
CONCLUSIONS: Evidence is insufficient to identify the optimal AE intensity for KOA. Limitations include high risk of bias, wide credible intervals, and reliance on indirect comparisons. In this context, clinicians should apply a structured, patient-centered approach to AE prescription, considering gradual progression and monitoring of tolerance, and combine AE with other recommended interventions. High-quality trials with direct comparisons of AE intensity should be conducted for this inconclusive gap.

Keywords:  aerobic exercise; exercise intensity; knee osteoarthritis; knee pain; network meta-analysis

DOI:  https://doi.org/10.3390/healthcare14040451
Pain Ther. 2026 Feb 21.

Ultrasound-Guided Radiofrequency Ablation of the Ilioinguinal Nerves to Treat Ilioinguinal Neuralgia: A Description of a Novel Approach.

Alaa A Abd-Elsayed, Madelyn J Reilly, Rishika Joshi.

   INTRODUCTION: Ilioinguinal neuralgia is a commonly underdiagnosed and often refractory cause of chronic groin and lower abdominal pain. This technical report outlines an ultrasound-guided radiofrequency ablation (RFA) technique for ilioinguinal nerve (IIN) pain, summarizing key anatomical considerations to enhance procedural accuracy.
TECHNIQUE: Anatomical studies show that the IIN most commonly arises from L1 and traverses between the internal oblique and transversus abdominis muscles within 1-2 cm of the anterior superior iliac spine (ASIS). Under ultrasound guidance, an 18-22-gauge radiofrequency cannula is advanced into the interfascial plane to target the IIN. Sensory stimulation is used to elicit the patient's typical symptoms, while motor testing confirms the absence of distal muscle activation. A diagnostic block is performed before lesioning. Continuous RFA is then applied at 80 °C for 60-90 s with additional lesions placed as needed based on anatomical variation.
DISCUSSION: Previous published data demonstrate significant pain reduction and sustained benefits following ilioinguinal RFA, with improved function and minimal complications. Ultrasound-guided probe placement and stimulation testing enhance the reproducibility, accuracy, and safety of the procedure.
CONCLUSIONS: Ultrasound-guided RFA of the IIN offers a minimally invasive treatment option for patients with refractory ilioinguinal neuralgia. Recognizing anatomical variability and utilizing stimulation testing, along with real-time imaging, can help clinicians improve the consistency of outcomes and reduce complications.

Keywords:  Chronic pain management; Ilioinguinal nerve; Ilioinguinal neuralgia; Long-term pain relief; Minimally invasive procedure; Radiofrequency ablation; Ultrasound guidance

DOI:  https://doi.org/10.1007/s40122-026-00819-w
Diagnostics (Basel). 2026 Feb 13. pii: 559. [Epub ahead of print]16(4):

Differences in Pressure Pain Threshold and Strain Elastography Between Women with and Without Fibromyalgia: A Cross-Sectional Study.

María Aguilar-García, María Encarnación Aguilar-Ferrándiz, Ana González-Muñoz, Santiago Navarro-Ledesma.

  Background: Fibromyalgia (FM) is a chronic pain condition primarily linked to central sensitization, although peripheral tissue-related factors have also been suggested. Ultrasound strain elastography (SEL) provides a semi-quantitative, operator-dependent estimate of tissue deformation under standardized compression, yet evidence comparing SEL findings and pressure pain sensitivity between FM and healthy controls at standardized tender-point sites remains limited. Objective: To compare pressure pain threshold (PPT) and SEL-derived tissue deformation between women with FM and healthy controls across standardized FM tender-point sites. Methods: In this cross-sectional study, 84 women (42 with FM; 42 healthy controls) were recruited from a private rehabilitation center in Málaga (Spain). PPT and SEL were assessed bilaterally at 13 standardized tender-point sites. Between-group differences were examined using Student's t-test or the Mann-Whitney U test according to distribution. Results: Women with FM exhibited lower PPT across all assessed sites (p < 0.01) and lower SEL-derived deformation scores at most sites, whereas no between-group SEL differences were observed at the dominant and non-dominant forearm, non-dominant lower cervical region, dominant paraspinal region, and bilateral lateral pectoral region. Conclusions: Compared with controls, women with FM showed reduced pressure pain thresholds and site-dependent differences in SEL-derived tissue deformation at standardized tender-point sites. Given the cross-sectional and exploratory design, SEL findings should be interpreted cautiously and considered non-diagnostic; heterogeneity across anatomical sites should be considered in future confirmatory and longitudinal studies.

Keywords:  elasticity imaging techniques; fibromyalgia; pain threshold; soft tissue

DOI:  https://doi.org/10.3390/diagnostics16040559
Disabil Rehabil. 2026 Feb 26. 1-17

Effect of neuromuscular electrical stimulation associated with therapeutic exercise on pain, function, and strength of people with knee osteoarthritis: a systematic review with meta-analysis of randomized clinical trials with GRADE recommendations.

Andressa Costa da Silva, Geovanna Cândido Rafael, Rayane Quintão Castro, Priscila Monteiro Veras, Cyntia Pace Schmitz Corrêa, Jennifer Granja Peixoto, Fabiana Roberta Nunes Carnaúba, Marco Antonio Cavalcanti Garcia, Carla Malaguti, Diogo Carvalho Felício, Diogo Simões Fonseca.

   OBJECTIVE: To determine whether NMES combined with therapeutic exercise improves pain, function, and muscle strength compared to exercise alone in adults with KOA.
METHODS: We searched nine databases (PubMed, MEDLINE-Ovid, EMBASE, Cochrane Library, Web of Science, Scopus, SPORTDiscus, LILACS, SciELO) up to 5 April 2025. Randomized controlled trials comparing NMES + exercise with exercise alone were eligible. Two reviewers independently screened records, extracted data, and assessed methodological quality and risk of bias using the PEDro scale and the RoB 2. Random-effects meta-analyses generated mean differences (MD) or standardized mean differences (SMD). Certainty of the evidence was assessed with GRADE (PROSPERO CRD42023393616).
RESULTS: Eight trials (354 participants; mean age ≈59 years; 71% women) were included. Immediately post-intervention, NMES + exercise did not reduce pain versus exercise alone (SMD -0.90, 95% CI -1.84 to 0.03; I2 = 84%). At 8-12 weeks, small benefits were observed for pain (SMD -1.30, 95% CI -1.87 to -0.73; I2 = 0%) and TUG (SMD -0.67, 95% CI -0.98 to -0.35). No differences were found for WOMAC total or quadriceps strength. Certainty was very low.
CONCLUSIONS: NMES + exercise may modestly improve long-term pain and mobility in KOA, though evidence certainty is very low.

Keywords:  Knee osteoarthritis; function; muscle strength; neuromuscular electrical stimulation; pain; physical performance

DOI:  https://doi.org/10.1080/09638288.2026.2633271
Front Med (Lausanne). 2026 ;13 1740693

The effects of traditional Chinese mind-body exercise on pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.

Yuqiong Xiang, Jiangbo Liu, Zhen Zhu, Xingyu Hu, Wei Li.

   Background: Chronic obstructive pulmonary disease (COPD) remains the leading cause of illness and death. Traditional Chinese mind-body exercises (TCMBEs), such as Tai Chi, Baduanjin, Liuzijue, and Yijin Jing, have emerged as additional treatment options for pulmonary rehabilitation (PR). This meta-analysis sought to find out the extent to which TCMBEs affect lung function, exercise capacity, and health-related quality of life (HRQoL) in patients with COPD.
Methods: Five international databases (PubMed, Embase, Web of Science, Cochrane Library, and Scopus) were examined until October 2025. Twenty-two randomized controlled trials (RCTs) with 1,871 individuals fulfilled the qualifying criteria. Outcomes included forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), the FEV1/FVC ratio, percent predicted FEV1 (FEV1 % predicted), six-min walk distance (6MWD), and patient-reported measures such as the St. George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), and the modified Medical Research Council (mMRC) dyspnea scale. Data were synthesized using a random-effects model, with subgroup analyses conducted according to exercise type. The risk of bias was evaluated using the Cochrane Risk of Bias 2.0 tool.
Results: Compared with usual care or conventional PR, TCMBEs significantly improved FEV1 (MD = 0.20 L; 95% CI 0.09-0.30), FVC (MD = 0.22 L; 95% CI 0.06-0.38), FEV1/FVC (MD = 3.42 %; 95% CI 2.54-4.29), FEV1 % predicted (MD = 4.98 %; 95% CI 2.53-7.42), and 6MWD (MD = 42.05 m; 95% CI 29.06-55.05; p < 0.01). Quality-of-life scores improved significantly, as reflected by reductions in SGRQ (-13.76 points), CAT (-2.62 points), and mMRC (-0.50 points). Subgroup analyses revealed that Liuzijue and Yijinjing produced the greatest gains in pulmonary function, while Tai Chi yielded the most pronounced improvement in functional endurance. No serious adverse events were reported across the included studies.
Conclusions: TCMBEs are effective and safe adjuncts for COPD rehabilitation. By focusing on controlled breathing, gentle movement, and mindful awareness, these practices can enhance lung function, improve exercise capacity, and support psychological well being. Incorporating approaches such as Liuzijue, Tai Chi, and Yijinjing into structured PR programs may provide a sustainable and cost-effective way to promote functional recovery and improve overall quality of life in people with COPD.

Keywords:  baduanjin; chronic obstructive pulmonary disease; liuzijue; pulmonary rehabilitation; tai chi; traditional Chinese mind-body exercises; yijinjing

DOI:  https://doi.org/10.3389/fmed.2026.1740693
bioRxiv. 2026 Feb 18. pii: 2026.02.17.705556. [Epub ahead of print]

Finite Element Modeling of the Scaphoid Shift Maneuver: Implications for Scapholunate Ligament injuries.

Thor E Andreassen, Taylor P Trentadue, Andrew R Thoreson, Parunyu Vilai, Kai-Nan An, Sanjeev Kakar, Kristin D Zhao.

Background: Computational modeling is a tool being deployed for orthopaedic solutions but its use in the hand and wrist remains limited. This work used a model to simulate a clinically relevant provocative scaphoid shift maneuver (SSM) with different levels of scapholunate interosseous ligament (SLIL) injuries to observe the effect on different metrics.
Methods: A personalized model simulated the full SSM motion cycle from ulnar deviation with extension to radial deviation with flexion informed by the participant's motion obtained from dynamic computed tomography. Models repeated the SSM under different levels of SLIL injury and reported changes in joint kinematics, contact mechanics, and ligament forces.
Results: The fully injured model increased scaphoid dorsal translation, flexion, and radial deviation compared to the intact condition and caused a subluxation of the scaphoid. Radioscaphoid contact areas were approximately 200% greater in the fully injured model compared with all others and the fully injured model was the only condition where contact force decreased across the motion cycle. Ligament forces in the intact condition were on average 33.0 N and 54.2 N for the volar and dorsal SLIL, respectively. Lastly, the long radiolunate, an extrinsic stabilizer, had forces that increased following SLIL injury.
Conclusions: Computational models can successfully recreate clinically observed behaviors of an SSM, including scaphoid subluxation, while providing new insights via quantification of contact mechanics and ligament forces. Contact mechanics metrics may be important for understanding the long-term progression of untreated SLIL injuries to osteoarthritis. Additionally, ligament force metrics may explain the progression of SLIL injuries from volar SLIL to dorsal SLIL and highlight the importance of repairing extrinsic stabilizers of the joint, due to increased force sharing following SLIL injury. This work provides a pathway to future studies investigating the effects of SLIL injury and repair, both acutely and chronically.

DOI: https://doi.org/10.64898/2026.02.17.705556
Musculoskelet Sci Pract. 2026 Feb 17. pii: S2468-7812(26)00034-2. [Epub ahead of print]82 103519

Responsiveness of central sensitization-related measures in older people with chronic low back pain.

Larissa Bragança Falcão Marques, Leandro Alberto Calazans Nogueira, Robert Resende Nascimento, Maria Carolina Viana Lemuchi, Eleonora Esposito, Jackson Linke, Marcia Rodrigues Franco, Ana Paula Coelho Figueira Freire, Rafael Zambelli Pinto.

   OBJECTIVES: To determine the responsiveness of central sensitization measures, Conditioned Pain Modulation (CPM) and Central Sensitization Inventory (CSI), in older adults undergoing an exercise program and to compare their responsiveness with outcomes measures of pain and disability.
DESIGN: This is a prospective registered (RBR-2qyc425) responsiveness study with a pre-post interventional study design.
METHODS: People aged 60 years and over with chronic non-specific low back pain were recruited. Demographic and clinical data were collected before and after an 8-week group exercise program. The CSI, CPM test, pain intensity and disability were collected at baseline and post-intervention. The Global Perceived Effect scale was collected post-intervention. Responsiveness was determined by calculating effect sizes, standardized response mean (SRM) and the area under the receiver operator curve (AUC). We also conducted subgroup analyses to investigate the responsiveness of these measures in participants classified as: recovered versus not recovered, CPM-efficient versus CPM-inefficient and as having high versus low CSI scores.
RESULTS: 118 participants completed the study. Pain and disability were the most responsive measures (effect sizes and SRM >0.7), followed by CSI (effect size and SRM >0.3). The CPM measures were not responsive. Pain and disability were also more responsive in identifying those participants who recovered after treatment (AUC >0.70) compared to CSI and CPM measures (AUC< 0.70). In addition, CSI showed a moderate to good correlation (0.52) with disability and little or no correlation (0.24) with pain. The CPM measures showed little or no correlation with pain and disability. Our subgroup analyses showed that CSI and CPM may be more responsive in patients with higher baseline CSI scores and those classified as CPM-inefficient, respectively.
CONCLUSIONS: Current measures of central sensitization are not as responsive as clinical outcomes of disability and pain. Central sensitization measures should not be used to monitor improvement with exercise intervention in older adults with non-specific low back pain. Future studies investigating the responsiveness of these measures in more precisely defined subgroups and using contemporary operational definitions are warranted.

Keywords:  Central sensitization; Central sensitization inventory; Chronic pain; Low back pain

DOI:  https://doi.org/10.1016/j.msksp.2026.103519
Radiol Med. 2026 Feb 25.

Grey matter volume reduction in the cerebellum of hip osteoarthritis patients: insights from pre- and postoperative VBM analysis.

Francesca Caramia, Valentina Calistri, Maddalena Boccia, Alice Teghil, Costanza Giannì, Stefano Gumina, Marco Fiorelli, Alessandro Calistri.

   PURPOSE: This exploratory study aimed to investigate grey matter (GM) volume changes in patients with hip osteoarthritis undergoing hip joint arthroplasty using voxel-based morphometry (VBM), assessing pre- and postoperative differences and comparing findings with healthy controls (HC).
MATERIAL AND METHODS: Twenty-one patients with unilateral hip osteoarthritis before and after hip prosthesis insertion (PT group) and 16 HC were studied. All participants were right-handed and free from neurological or psychiatric conditions. Structural T1-weighted MRI scans were acquired at 3 T before and after surgery in the PT group, with an average interval of 112 days, and in the HC group. VBM analyses were conducted using the Computational Anatomy Toolbox (CAT12). Preoperative GM volume differences between PT and HC groups, as well as changes in PT before and after surgery, were analysed using statistical parametric mapping with family-wise error (FWE) correction.
RESULTS: Preoperative comparisons revealed a significant reduction in grey matter volume in the ipsilateral cerebellar Crus II in the PT group compared with HC (pFWE = 0.004). No significant GM volume differences were found between pre- and postoperative assessments in the PT group. Although all patients demonstrated marked clinical improvement at 1-month follow-up, MRI-clinical correlations could not be performed because clinical assessments and postoperative MRI were not acquired at the same time.
CONCLUSION: The findings provide preliminary evidence of cerebellar GM changes in patients requiring hip prostheses, suggesting central nervous system involvement in chronic hip pathology. Interpretation is constrained by the modest sample size and by variability in postoperative imaging intervals. The absence of significant postoperative changes highlights the need for further research to explore the timeline and extent of neuroplastic recovery. These results underscore the importance of considering central adaptations in the management of peripheral joint disorders.

Keywords:  Arthroplasty, replacement, Hip; Gray matter; Magnetic resonance imaging; Neuroplasticity; Osteoarthritis, Hip; Voxel-based morphometry

DOI:  https://doi.org/10.1007/s11547-026-02184-2
J Neurosurg Spine. 2026 Feb 27. 1-9

Muscle reorientation as a novel cause of motor weakness after spinal realignment surgery: a hypothesis based on psoas muscle overstretching.

Moon-Soo Han, Jong-Hwan Hong, Ji-Ho Jung, Jung-Kil Lee.

   OBJECTIVE: The aim of this study was to investigate whether postoperative reorientation of the psoas muscle is associated with hip flexion weakness in patients who underwent posterior-only spinal realignment surgery (SRS). It was hypothesized that changes in spinal alignment might indirectly contribute to hip flexion weakness by altering the anatomical orientation and function of the psoas muscle.
METHODS: A total of 101 patients who underwent posterior-only SRS between 2012 and 2022 were retrospectively reviewed. Patients without evidence of intraoperative nerve injury, as confirmed by intraoperative neurophysiological monitoring, and without postoperative nerve injury, as confirmed by electromyography or nerve conduction velocity studies were included. Radiographic parameters were measured to assess psoas muscle orientation using two novel reference lines: the vertical line (VL) and the diagonal line (DL). Cross-sectional areas (CSAs) of the psoas muscle were evaluated on axial MRI at the L4-5 disc level. Group comparisons were conducted to assess differences in radiological parameters and CSAs between patients with and without hip flexion weakness.
RESULTS: Hip flexion weakness was observed in 14 patients (13.9%) and recovered in all cases with a median recovery time of 55.2 days. Postoperatively, VL and DL measurements increased significantly, and the psoas muscle CSAs decreased. Changes in VL, DL, and CSAs were significantly greater in the group with hip flexion weakness. Correlation analysis revealed significant negative associations between VL/DL changes and CSA reduction. In multivariate regression, only VL changes remained an independent predictor of postoperative CSA reduction.
CONCLUSIONS: This study demonstrates that postoperative hip flexion weakness can occur after SRS, even without direct nerve or muscle injury. The findings suggest that spinal alignment changes alone might mechanically rearrange the psoas muscle, contributing to transient hip flexion weakness.

Keywords:  adult spinal deformity; anatomy; degenerative; hip flexion weakness; motor weakness; muscle reorientation; psoas muscle; spinal realignment surgery

DOI:  https://doi.org/10.3171/2025.10.SPINE25877
Medicina (Kaunas). 2026 Jan 31. pii: 287. [Epub ahead of print]62(2):

Ankle Bracing as a Public Health Game Changer: A Narrative Review on the Prevention of Ankle Injuries in Basketball Players.

Goran Slivšek, Marin Marinović, Sandra Mijač, Ivan Dolanc, Silvija Petković, Renato Mautner, Josip Kranjčić, Iva Sorta-Bilajac Turina, Karmen Lončarek, Ksenija Vitale, Miran Čoklo.

  Ankle injuries are among the most common sports injuries in basketball and represent a substantial public health and economic burden. This narrative review synthesises evidence on ankle bracing as external protective support and shows that ankle braces reduce the risk of both first-time injuries and ankle re-injuries in basketball players without significantly affecting sport-specific performance, such as sprinting, jumping, or changing direction. Similarly, despite earlier theoretical concerns, current evidence shows no increased risk of knee injury associated with the use of ankle bracing. Mechanistic studies indicate that protection is provided by limiting excessive frontal-plane motion, enhancing proprioceptive feedback, and increasing perceived joint stability. Economic analyses show that a single ankle injury generates considerable direct and indirect costs, whereas seasonal team-wide ankle bracing programmes are low cost per athlete and likely cost-effective at scale. As a public health measure, ankle bracing is practical and easily scalable in community and sports settings. Overall, routine ankle bracing is shown to be a feasible, low-cost strategy for primary and secondary prevention of ankle injuries in basketball without compromising performance, and may support broader participation goals aligned with Sport for All principles.

Keywords:  ankle; ankle injuries; athlete; basketball; braces; physical activity; prevention; public health; social inclusion; sports injuries

DOI:  https://doi.org/10.3390/medicina62020287
Medicina (Kaunas). 2026 Feb 02. pii: 300. [Epub ahead of print]62(2):

Effects of Focal Muscle Vibration on Static and Dynamic Balance in Patients with Parkinson's Disease: Preliminary Results of a Retrospective Study.

Paola Emilia Ferrara, Emiddio Della Casa, Rossella Calciano, Diego Ricciardi, Ludovica Tassi, Alberto Cutaia, Elisabetta Lama, Claudia Lombardo, Augusto Fusco, Giorgio Ferriero, Gianpaolo Ronconi.

  Background and Objectives: Postural instability is a key feature of Parkinson's disease (PD), contributing to disability and increased risk of falls. Pharmacological treatments are important, but it is necessary to integrate them with rehabilitation programs that provide benefits for gait and balance. Focal muscle vibration (fMV) has been proposed as a proprioceptive-oriented intervention to enhance postural control, but evidence in PD remains heterogeneous. This observational, retrospective, and controlled pilot study aimed to evaluate whether the integration of fMV into a standardized rehabilitation program provides additional benefits for balance, gait, and fall risk compared to standardized exercise alone in patients with PD. Materials and Methods: Medical records of 35 outpatients with Parkinson's disease (Hoehn & Yahr stage II-III) were reviewed. All practiced a standardized rehabilitation exercise group program. Of these, 18 patients agreed to undergo fMV before the exercise sessions (fMV group); 17 patients did not accept fMV due to personal organizational reasons (EG) and were considered a retrospective control group. In detail, (i) the fMV group receivdc focal muscle vibration during the first three weeks in addition to a standardized group rehabilitation exercise program, and (ii) the EG underwent a standardized rehabilitation program only. Both groups then completed an identical 16-week standardized rehabilitation program. Functional outcomes were assessed at baseline (T0) and after one month (T1). Results: Groups were homogeneous at baseline. The fMV group showed significant improvements in SPPB (from 8.16 ± 1.6 to 10.2 ± 1.6 p < 0.001) in the Tinetti total (from 18.38 ± 3.2 to 21.5 ± 2.9 p < 0.05). Stabilometric analysis revealed a significant improvement in the Romberg Quotient in the fMV group (p < 0.005). Conclusions: A short time-limited fMV intervention may act as a sensory primer, enhancing the effects of a subsequent standardized rehabilitation program in PD.

Keywords:  Parkinson’s disease; falls; focal muscle vibration; gait; postural balance; rehabilitation

DOI:  https://doi.org/10.3390/medicina62020300
J Child Orthop. 2026 Feb 19. 18632521261423069

Let them move: Early range of motion and rehabilitation after fixation of medial epicondyle fractures in adolescent athletes.

Brian Le, Taylor Troutman, Andre Perez-Chaumont, Felix H Savoie, Timothy Skalak.

   Background: Medial epicondyle fractures account for 11%-20% of pediatric elbow fractures. While nonoperative treatment is effective, surgery is often recommended for overhead athletes to enhance union rates, valgus stability, and expedited return to sporting activities. Postoperative recovery protocols vary, with traditionally up to 2 weeks of strict immobilization and rehabilitation lasting 6-12 months. This study evaluates the early range of motion (ROM) and accelerated rehabilitation in high-performing youth athletes undergoing surgical fixation.
Methods: A retrospective review included patients aged 12-17 who underwent medial epicondyle fracture fixation (2015-2023). Those with concomitant injuries were excluded. Recovery was assessed by unrestricted Return to Sports (RTS).
Results: 18 patients (mean age 14) were included. Postoperatively, all wore a hinged elbow orthosis locked at 90° flexion. At 1 week, extension was allowed to -30°, with flexion as tolerated. Physical therapy was initiated, focusing on gentle stretching to full ROM out of the brace. Patients remained in a hinged elbow brace for an average of 4.47 weeks before transitioning to a hinged sleeve or discontinuing brace use. After 4-6 weeks, physical therapy increased with emphasis on strengthening and terminal extension. For the 16 baseball players included, progressive return to throw and hit programs began at an average of 8.6 weeks. All patients returned to sports without restriction at an average of 13.4 weeks.
Conclusion: Early mobilization and accelerated rehabilitation following medial epicondyle fracture fixation facilitate a faster RTS in high-demand youth athletes.
Levels of Evidence IV: Case series.

Keywords:  Medial epicondyle; ORIF; avulsion; return to sports

DOI:  https://doi.org/10.1177/18632521261423069
Aust Prescr. 2026 Feb;49(1): 16-21

Intra-articular hyaluronic acid (viscosupplementation) for osteoarthritis: is it effective?

Huai Leng Pisaniello, Shyan Goh, Rachelle Buchbinder.

  Viscosupplementation with intra-articular hyaluronic acid derivatives and cross-linked polymers of hyaluronic acid is increasingly used to treat symptomatic osteoarthritis in the knee, hip and other joints. Most guidelines conditionally recommend against its use to treat knee osteoarthritis, and strongly or conditionally recommend against its use for other joints, indicating a large evidence-to-practice gap. Conclusive evidence from randomised placebo-controlled trials indicates that intra-articular hyaluronic acid provides no important benefits for people with knee (and other joints) osteoarthritis, and may have potentially serious harms including septic arthritis and severe inflammatory joint and cutaneous reactions. Use of computed tomography scans to guide hyaluronic acid injection exposes the patient to unnecessary radiation and has an unwarranted financial and environmental cost. When the topic arises in clinical practice, prescribers should use a shared decision-making approach that includes an explanation as to why hyaluronic acid injection is not recommended care for osteoarthritis and offer alternatives, taking into consideration the patient's values and preferences.

Keywords:  hyaluronic acid; intra-articular injections; osteoarthritis; viscosupplementation

DOI:  https://doi.org/10.18773/austprescr.2026.005
J Back Musculoskelet Rehabil. 2026 Feb 27. 10538127261421867

Effects of yoga on pain, physical function, and biomechanical/impairment outcomes in knee osteoarthritis: A systematic review and three-level meta-analysis.

Jilan Zhou, Mohd Nidzam Jawis, Shiming Li.

  BackgroundThe effects of yoga on pain, functional limitations, and biomechanical/impairment deficits in knee osteoarthritis (KOA) remain inconclusive.ObjectiveTo conduct a three-level meta-analysis that retains all eligible effect sizes to evaluate the effects of yoga on KOA and examine potential moderators.MethodsFive Chinese- and English-language databases were searched from inception to 28 August 2025. Risk of bias was assessed with RoB 2, and certainty of evidence with GRADEpro. Pooled effects were estimated using R (metafor). Influence diagnostics, sensitivity analyses, moderator analyses, and publication-bias tests (Egger's test, funnel plots) were performed.ResultsFourteen studies (n = 1183) were included. Low-certainty evidence showed that yoga improved pain (g = -0.79, 95% CI -1.24 to -0.35) and physical function (g = -0.39, 95% CI -0.57 to -0.21). Very-low-certainty evidence indicated benefits for biomechanical/impairment outcomes (g = -0.56, 95% CI -0.85 to -0.26). Weekly session frequency moderated pain outcomes, with 4-7 sessions/week producing the largest effects (g = -1.53). Programs lasting ≥8 weeks were required for consistent analgesic benefit.ConclusionsYoga may provide beneficial effects on pain, physical function, and biomechanical/impairment outcomes in individuals with KOA. Evidence suggests that programs delivered on most days of the week (≥4 sessions/week) and lasting at least 8 weeks are associated with greater pain reduction. Yoga may serve as a feasible and acceptable adjunct to pharmacologic care and established exercise therapies; however, these conclusions should be interpreted cautiously in light of study quality and heterogeneity.

Keywords:  Yoga; knee osteoarthritis; pain; physical functional performance; systematic reviews

DOI:  https://doi.org/10.1177/10538127261421867
J Hand Surg Eur Vol. 2026 Feb 25. 17531934261415775

Integrated nerve and tendon transfer approach to restore functional balance of the hand in tetraplegia.

Jan Fridén, Natasha van Zyl.

   INTRODUCTION: The primary goal for many individuals with tetraplegia is restoration of hand and arm function. Recent advancements in surgical techniques for upper extremity reconstruction have significantly progressed motor control and postural stability to restore functional balance of the hand and upper limb. The integration of nerve and tendon transfers has enabled improvements in essential activities of daily living.Key considerations:It is crucial to ensure that surgical interventions are tailored to the unique functional needs and wishes of each patient, related to self-care, mobility, vocational aspirations and social engagement. Comprehensive evaluation of preoperative hand use for specific tasks is an essential component of surgical planning. Also, patients should be thoroughly informed about both preoperative and postoperative rehabilitation protocols, critical to optimizing functional outcomes. Preoperative preparation may involve strengthening existing key functions, enhancing donor muscle strength, preserving or improving passive joint range of motion, utilizing surface electrical stimulation where indicated and addressing spasticity when necessary. Postoperative rehabilitation should focus on structured, supervised motor retraining to facilitate effective restoration of motor balance and functionality.Reconstructive options:There are pros and cons for nerve vs. tendon transfers, although these can be combined for optimal results, to reconstruct either different functions or the same function. Tendon transfers can be used secondarily; in the same way, reanimated muscles through nerve transfer can also be transferred at a later stage. Strong consideration should be given to a nerve transfer reconstruction when surgery is performed early. Secondary surgery may be required to further adjust the hand position to optimize balance and maximize function if it is suboptimal after primary surgery.

Keywords:  Electrodiagnostics; functional balance; kinetic chain; nerve transfer; patient-tailored treatment goals; tendon transfer; tetraplegia; upper extremity surgery

DOI:  https://doi.org/10.1177/17531934261415775
J Neurol. 2026 Feb 21. pii: 158. [Epub ahead of print]273(2):

Imaging-derived neuromuscular ultrasound phenotypes are associated with functional status in amyotrophic lateral sclerosis.

Ying Wang, Hao Zhang, Tianhua Yang, Jialei Luo, Ting Lin, Xinyi Yan, Junlin Ding, Yuxuan Qiu, Min Zhao, Gaoyi Yang.

   BACKGROUND: Amyotrophic lateral sclerosis (ALS) presents with marked clinical heterogeneity, complicating diagnosis and management. Neuromuscular ultrasound (NMUS) provides a non-invasive means to visualize peripheral nerve and muscle integrity, but its potential to delineate ALS subtypes has not been systematically explored.
OBJECTIVE: To identify clinically meaningful ALS subgroups through unsupervised clustering of NMUS features integrated with clinical and electrophysiological data.
METHODS: A total of 454 ALS patients (August 2024-December 2025) underwent standardized NMUS assessment, including muscle thickness, echogenicity, and nerve cross-sectional area, alongside ALSFRS-R, manual muscle testing (MMT), and compound muscle action potentials (CMAPs). K-means clustering was applied to standardized NMUS variables, with cluster stability assessed using silhouette coefficients, sensitivity analyses (k = 2-5), and resampling-based adjusted Rand indices. Multivariable regression examined associations between cluster membership and ALSFRS-R.
RESULTS: Two reproducible NMUS-based subgroups were identified: a Mild cluster (n = 288, 63.4%) and a Severe cluster (n = 166, 36.6%). The Severe cluster showed reduced muscle thickness and higher echogenicity across multiple sites, together with lower ALSFRS-R scores (adjusted β = - 3.84, 95% CI - 5.41 to - 2.27, P < 0.001). Cluster membership correlated negatively with MMT and CMAP amplitudes, supporting functional and electrophysiologic validity. Stability metrics confirmed robustness of the two-cluster solution.
CONCLUSION: Integrating NMUS with clinical data enables objective, imaging-derived stratification of ALS patients into biologically and functionally distinct subgroups. This approach offers a pragmatic framework for phenotypic characterization and may inform personalized monitoring and trial design in ALS.

Keywords:  ALSFRS-R; Amyotrophic lateral sclerosis; Neuromuscular ultrasound; Phenotypic heterogeneity; Unsupervised clustering

DOI:  https://doi.org/10.1007/s00415-026-13705-4
Cureus. 2026 Jan;18(1): e102127

Effect of Single Perineural Injection of Platelet Rich Plasma on Nerve Function in Hansen's Disease With Truncal Neuropathy: An Interventional Study.

Anyesha Saha, Shashank Y Kothari, Swapnil Sonune, Nirendra K Rai, Reni Benny, Anuradha D Shenoy, Prasenjit Bhadra.

  Background A large number of people with leprosy suffer from neuropathy and its associated complications. Platelet-rich plasma (PRP) is a simple therapy by which concentrations of natural growth factors are obtained that accelerate axonal recovery. With the intent to find an effective option for the improvement of neuropathy in Hansen's disease, perineural injection of autologous PRP was used in this study. This study aims to investigate the potential therapeutic efficacy of perineural injection of PRP in alleviating the effects of neuropathy associated with Hansen's disease. Methodology A cohort of 30 patients with Hansen's disease experiencing ulnar or common peroneal neuropathy were administered a single perineural injection of autologous PRP (1 ml). Evaluations were conducted by a group of three investigators at baseline, six, and twelve weeks, encompassing two-point sensory discrimination, total sensory impairment area, nerve conduction study (NCS) parameters, Screening Activity Limitation and Safety Awareness Scale (SALSA) score, hand function, and extrinsic foot muscle power. Adverse effects were meticulously recorded. Results Significant improvements were observed in two-point discrimination, sensory loss area, hand dynamometry scores, and foot muscle power (p<0.05). The SALSA score exhibited a significant enhancement at the 12-week mark. Motor NCS demonstrated a substantial increase in amplitude, while sensory NCS revealed a noteworthy decrease in latency and an increase in conduction velocity at the 12-week assessment. No adverse effects were documented, aside from transient pain at the injection site for one or two days. As the follow-up period in this study was 12 weeks, the long-term effects of peri-neural injection of PRP on Hansen's neuropathy could not be assessed. COVID-19 also had an impact on the follow-up visits of the participants, resulting in three patients being lost to follow-up. Conclusion This study suggests that perineural injection of autologous PRP could be a safe and promising therapeutic option for Hansen's neuropathy. However, further research and long-term follow-up studies are imperative to establish its sustained efficacy.

Keywords:  leprosy; nerve conduction study; peroneal neuropathy; platelet rich plasma; ulnar neuropathy

DOI:  https://doi.org/10.7759/cureus.102127
Medicina (Kaunas). 2026 Feb 20. pii: 409. [Epub ahead of print]62(2):

Injection of Adipose-Derived Stromal Vascular Fraction Rapidly Relieves Pain in Patients with Knee Osteoarthritis.

Yong Sang Kim, Dong Suk Suh, Yoo Beom Kwon, Jai Hyun Chung, Yong Gon Koh.

  Background and Objectives: Intra-articular injection of adipose-derived stromal vascular fraction (SVF) has emerged as a promising regenerative treatment for knee osteoarthritis (OA) because of its heterogeneous cellular composition and potent anti-inflammatory paracrine effects. Although SVF therapy has demonstrated clinical efficacy, the timing of pain relief and the influence of SVF cell dose on early clinical outcomes remain incompletely defined. Materials and Methods: This retrospective study included 146 patients (217 knees) with Kellgren-Lawrence (K-L) grade II-IV knee OA who underwent intra-articular injection of autologous adipose-derived SVF and completed a minimum follow-up of 1 year. Pain was assessed using the visual analog scale (VAS), and patients reported the time to perceived pain improvement after treatment. Radiographic severity was evaluated using the K-L grading system. Correlation analyses were performed to assess associations between pain-related outcomes, SVF cell number, and radiographic severity. Results: VAS scores improved significantly from baseline to the final follow-up (p < 0.01). Patients reported perceived pain improvement at a mean of 18.9 ± 14.5 days after SVF injection. The mean injected dose was 7.4 × 107 total SVF cells per knee, including approximately 7.0 × 106 stromal cells. Higher SVF cell numbers were significantly associated with greater pain improvement and lower VAS scores at final follow-up (p < 0.001 for both). Radiographic severity was not significantly correlated with pain at final follow-up, the magnitude of pain improvement, or the time to symptom relief. No clinically relevant adverse events were observed. Conclusions: Intra-articular injection of high-dose autologous SVF was associated with rapid and clinically meaningful pain relief, with symptom improvement occurring within approximately 3 weeks after treatment. The dose-dependent association and the lack of correlation with radiographic severity suggest that early pain relief is primarily mediated by the anti-inflammatory and paracrine effects of SVF rather than immediate structural cartilage regeneration.

Keywords:  dose–response relationship; intra-articular injection; knee osteoarthritis; pain relief; stromal vascular fraction

DOI:  https://doi.org/10.3390/medicina62020409
J Formos Med Assoc. 2026 Feb 24. pii: S0929-6646(26)00146-4. [Epub ahead of print]

Is melatonin's efficacy in diabetic neuropathic pain dependent on circadian timing of administration?

Wei-Jia Meng, Ya-Qi Chen, Ting Wang.

DOI: https://doi.org/10.1016/j.jfma.2026.02.025
Disabil Rehabil. 2026 Feb 26. 1-16

How is the rating of perceived effort reported in anterior cruciate ligament and knee osteoarthritis rehabilitation studies? A scoping review.

Daniel Germano Maciel, José Diego Sales do Nascimento, Ingrid Martins França, Alef Cavalcanti Matias de Barros, Sávio Douglas Ferreira Santana, Mikhail Santos Cerqueira, Wouber Hérickson de Brito Vieira.

   PURPOSE: To map the methodological aspects of rating of perceived effort (RPE) in resistance exercises during anterior cruciate ligament rehabilitation (ACLR) and knee osteoarthritis (KOA).
MATERIALS AND METHODS: A scoping review was conducted by performing systematic search in PubMed, EMBASE, CINAHL, SPORTDiscus, PEDro and CENTRAL databases. Inclusion criteria were longitudinal intervention studies (i.e., randomized clinical trials, quasi-experimental, or case studies) that used RPE to prescribe and monitor the load of resistance exercises targeting the lower limbs in individuals over 18 years with knee osteoarthritis or post-ACL reconstruction. Methodological aspects related to RPE were categorized as yes or no. Then, the percentage of studies reporting each aspect was calculated.
RESULTS: Forty-seven studies were included. The methodological aspects "type of scale", "terms used", and "exercise intensity", were frequently reported (37 to 40 studies). However, "familiarization", "anchoring", "instructions", "local vs. whole-body RPE", and "moment of RPE recording" were less reported (1 to 11 studies).
CONCLUSION: "Familiarization", "anchoring", "instructions", "local vs. whole-body RPE", and "moment of RPE recording" were not consistently reported in studies, limiting the validity of the method and study replication and making it difficult for clinicians to interpret and apply the method.

Keywords:  Physical exertion; exercise tolerance; intensity; knee; resistance training

DOI:  https://doi.org/10.1080/09638288.2026.2633261
J Pain Res. 2026 ;19 573167

Intravenous Pamidronate in Persistent Complex Regional Pain Syndrome (CRPS): A Retrospective Observational Study on Effectiveness and Tolerability.

Daniël P C van der Spek, Frank J P M Huygen, Sanne E Hoeks, Paul L A van Daele, Maaike Dirckx.

   Purpose: Pamidronate is a nitrogen-containing bisphosphonate with immunomodulatory and anti-osteoclastic properties that has shown benefit in early-onset complex regional pain syndrome (CRPS), yet evidence in persistent CRPS remains limited. Given that chronicity may attenuate therapeutic response, this study evaluates the effectiveness and tolerability of intravenous pamidronate in CRPS patients managed in routine clinical practice.
Patients and Methods: We conducted a single-center retrospective observational study, including all adult CRPS patients treated with pamidronate between 2014 and 2024 at our tertiary referral center. Data were collected from medical records at baseline, during treatment and at routine follow-up at approximately 1-, 3-, 6-, and 12-months post-treatment. The primary outcome was the pain trajectory, analyzed using a linear mixed-effects model. Responders were defined by a ≥2-point NRS reduction or subjective benefit when NRS data were unavailable.
Results: Of 110 eligible patients, 97 were included with a median age of 45 (IQR 32-54), and a median disease duration of 31 months (IQR 9-97). Baseline mean NRS was 7.95 (95% CI: 7.66 to 8.25), declining by 1.10 points (95% CI: -1.49 to -0.70; p<0.001) at 1 month and by 0.66 points (95% CI: -1.13 to -0.20; p<0.01) at 3 months. Responder rates were 34% and 22%, respectively. Treatment-related adverse events occurred in 91% of patients but led to discontinuation in only 6%.
Conclusion: In patients with predominantly persistent CRPS, intravenous pamidronate was well tolerated and associated with a modest, short-term pain relief up to 3 months. No sustained analgesic benefit was evident at later timepoints.

Keywords:  chronic pain; complex regional pain syndrome; drug-related side effects and adverse reactions; interventional pain management; pamidronate; treatment outcome

DOI:  https://doi.org/10.2147/JPR.S573167
J Hand Microsurg. 2026 May;18(3): 100441

Management of infected flexor tendon injuries: A narrative review.

Lamisah Seedat, Papa Kyei, Tatolo Sefeane, Mohamed Bhamjee, Grant Biddulph.

Purpose: Flexor tendon injuries are a common result of trauma to the hand. The mechanisms of injury often result in open wounds with contamination and infection. The complications associated with infected wounds pose challenges to flexor tendon repair. Management entails adequate eradication of infection and tissue healing prior to tendon repair. Whilst guidelines exist for the management of flexor tendon injuries of the hand, the literature puts little emphasis on the management of these cases with the presence of concomitant infection. Creating clear outlines to adequately manage such cases would aid future management for optimal outcomes.
Methods: A comprehensive search of literature was conducted. Articles published in English within the last 20 years were used.
Results: Wounds with macroscopic wound contamination should receive empiric antibiotics. There is little evidence supporting prophylactic antibiotics. Pyogenic flexor tenosynovitis should be immediately taken to theatre. If possible, primary tendon repair is the ideal method of repair, however this is often limited by infection. The choice of secondary reconstruction depends on timing and extent of injury. If there is loss of nerve function, a tendon transfer is required. Tendon grafts are used in cases of loss of tendon length. A damaged tendon sheath requires two-stage tendon reconstruction.
Conclusion: Infected wounds are a common complicating presenting factor in flexor tendon injuries. Empiric antibiotics in complex and contaminated wounds is essential. Primary tendon repairs have the best outcomes, however repair should be withheld until granulation tissue develops. Secondary repair options should be looked at on a case-specific basis.

DOI: https://doi.org/10.1016/j.jham.2026.100441
Arthritis Care Res (Hoboken). 2026 Feb 24.

Minimal important change and minimal clinically important difference in pain and function with exercise in hip osteoarthritis.

Yareni Guerrero, Fiona Dobson, Venkatesha Venkatesha, Kim Allison, Gabrielle Knox, Libby Spiers, Travis Haber, David J Hunter, Michelle Hall.

OBJECTIVE: The objective of this study was to estimate the minimal important change (MIC) and minimal clinically important difference (MCID) for pain and physical function in individuals with hip osteoarthritis (OA) following a physiotherapist-guided exercise intervention.
METHODS: Secondary analysis from a randomised controlled trial of 196 adults with hip OA allocated one of two 9-month exercise programs. Patient reported outcomes measures for hip pain severity (Numeric Rating Scale [NRS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] pain subscale) and physical function (WOMAC physical function subscale, patient-specific functional scale [PSFS]) were collected at baseline, 3 and 9 months. Global ratings of change in pain and physical function at 3 and 9 months served as anchors.
RESULTS: MIC estimates were 2.1-points and 2.4-points for NRS pain at 3 and 9 months, respectively; 2.8-points and 3.0-points for WOMAC pain at 3 and 9 months, respectively; 8.7-points and 8.3-points for WOMAC physical function at 3 and 9 months, respectively; and -2.1-points and -2.0-points for PSFS at 3 and 9 months respectively. The MCID estimates were 2.0-points and 2.4-points for NRS pain at 3 and 9 months, respectively; 2.8-points and 3.0-points for WOMAC pain at 3 and 9-months, respectively; 9.2-points and 8.3-points for WOMAC physical function at 3 and 9 months, respectively; and -3.5-points and -0.7-points for PSFS at 3 and 9 months, respectively.
CONCLUSION: This study provides robust, context-specific MIC and MCID estimates for outcomes in hip OA following exercise. These values can inform the interpretation and design of exercise-based clinical trials for hip OA.

DOI: https://doi.org/10.1002/acr.80029
Med Lav. 2026 Feb 24. 117(1): 17299

The Silent Strain: Grip Strength, and Wrist/Hand Musculoskeletal Disorders among Meat Cutters.

Hamid Jahangiri, Fatemeh Ghasemi, Mojgan Zoaktafi, Hamid Salmani Nodooshan, Mohebat Vali, Hadi Daneshmandi.

BACKGROUND: Meat cutters are a working group engaged in awkward posture, repetitive motion, and forceful exertion in wrists/hands. This study was conducted a) to examine the prevalence of musculoskeletal symptoms among Iranian meat cutters, b) to assess the wrist musculoskeletal disorders risk assessment and hand grip strength.
METHODS: Ninety-five male meat cutters in Iran (≥ 1 year tenure) completed a demographic/occupational questionnaire, the Nordic Musculoskeletal Questionnaire (NMQ), and the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Ergonomic risk was assessed via the ACGIH-TLV hand activity method, and maximum hand-grip force was measured.
RESULTS: With 69.5% reporting point prevalence and 70.5% reporting period prevalence of wrist/hand musculoskeletal symptoms, the study indicated that meat cutters had a significant prevalence of these symptoms. Most participants demonstrated mild to moderate severity in self-reported wrist symptoms while retaining asymptomatic functional status. The ACGIH-HAL assessment indicated most participants operated at or above the action level (AL), suggesting potential ergonomic risks. Moreover, The ACGIH-HAL ratio had a weak negative association with hand grip strength (β = - 0.0071, p = 0.12).
CONCLUSIONS: These findings highlight the ergonomic challenges associated with meat-cutting tasks.

DOI: https://doi.org/10.23749/mdl.2026.17299
Knee Surg Sports Traumatol Arthrosc. 2026 Feb 27.

Addition of platelet-rich plasma to physiotherapy reduces tear volume and іmproves functional outcomes in articular-sided partial supraspinatus tendon tears.

Muhammet Furkan Demiral, Bahar Yılmaz Çankaya, Ahmet Emre Paksoy, Ebubekir Safa Budak, Ahmet Yalçın, Hülya Uzkeser, Barış Kocaoğlu.

   PURPOSE: The aim of this study was to compare the therapeutic efficacy of physiotherapy alone versus physiotherapy combined with platelet-rich plasma (PRP) in patients with articular-sided partial-thickness supraspinatus tendon tears.
METHODS: In this single-centre prospective randomized controlled trial, 63 patients (n = 32 in the PRP group and n = 31 in the control group) aged between 25 and 65 years with isolated articular-sided partial supraspinatus tendon tears on magnetic resonance arthrography (MRA) were included. Patients were randomized in a 1:1 ratio using a computer-generated sequence, and allocation concealment was ensured with sequentially numbered, opaque, sealed envelopes. The control group received only physical therapy, while the treatment group received two doses of PRP with ultrasound guidance in addition to physical therapy. The primary outcome was the change in tear volume measured by MRA. Clinical evaluation using the Visual Analogue Scale (VAS) and Constant-Murley Score (CMS) was performed before and after treatment.
RESULTS: A significantly greater reduction in tendon tear volume was observed in the PRP group compared to the control group. In the clinical evaluation of the patients, significant improvements were observed in VAS and CMS scores in both groups. In the evaluation of CMS scores, a significantly greater improvement was observed in the PRP group compared to the control group (p < 0.01).
CONCLUSION: The combination of PRP and physical therapy was shown to be more effective in radiological and clinical improvement than physical therapy alone in the treatment of articular-sided partial-thickness supraspinatus tear.
LEVEL OF EVIDENCE: Level II, randomized controlled trial.

Keywords:  arthrography; conservative treatment; partial‐thickness rotator cuff tear; platelet‐rich plasma; supraspinatus

DOI:  https://doi.org/10.1002/ksa.70370
Scand J Med Sci Sports. 2026 Mar;36(3): e70229

Artificial Intelligence-Based Exploration of the Relationship Between Running Motion Patterns and Achilles Tendon Stress in Inactive Adults Initiating a Running Program.

Zeyi Zhang, Ting Fan, Jin Wu, Youping Sun.

  Inactive adults face a measurable risk of chronic Achilles tendon injury when starting to run, yet the mechanisms remain unclear. We leverage machine learning and Shapley Additive Explanations (SHAP)-core methodologies in artificial intelligence-to identify running motion patterns that elevate Achilles tendon stress in this population. Our findings aim to inform safer running practices, ultimately helping inactive adults integrate into the running community more healthily. A total of 189 inactive adults were recruited, and their running biomechanics were comprehensively assessed. Achilles tendon stress was estimated using OpenSim musculoskeletal modeling combined with ultrasound imaging. The relationship between running biomechanics and Achilles tendon stress was examined using three machine-learning models-Extreme Gradient Boosting (XGBoost), Random Forest (RF), and Support Vector Regression (SVR)-integrated with the SHAP framework. Modeling results demonstrated that the XGBoost model outperformed both RF and SVR in prediction accuracy. SHAP analysis revealed that Achilles tendon stress increased significantly when the ankle dorsiflexion angle was less than 10.5°, the ankle plantarflexion moment exceeded 1.5 N·m/kg, the ankle eversion moment exceeded 0.1 N·m/kg, the hip internal rotation angle exceeded 8.2°, the ankle external rotation angle was less than 25.3°, or the knee flexion angle was less than 23.3°. Based on this analysis, for inactive adults, reducing ankle plantarflexor activation, moderately increasing ankle dorsiflexion and external rotation, and optimizing proximal joint movement patterns may be crucial for decreasing Achilles tendon stress. These findings may also inform future studies on Achilles tendon injury prevention.

Keywords:  biomechanics; chronic Achilles tendon injury; inactive adults; machine learning; running mechanics

DOI:  https://doi.org/10.1111/sms.70229
Phys Ther. 2026 Feb 28. pii: pzag023. [Epub ahead of print]

On "Depressive Symptoms and Physical Activity Mediate the Adverse Effect of Pain on Functional Dependence in Patients With Arthritis: Evidence from the Canadian Longitudinal Study on Aging." Goubran M, van Allen ZM, Bilodeau M, Boisgontier MP. Phys Ther. 2025;105(11):pzaf120. 10.1093/ptj/pzaf120.

Anas Anas.



Keywords:  Arthritis; Functional Dependence; Geriatric Rehabilitation; Pain; Physical Activity

DOI:  https://doi.org/10.1093/ptj/pzag023
Hand (N Y). 2026 Feb 23. 15589447261422493

Outcome Reporting in Distal Radius Fracture Research: A Systematic Review Across Treatment Modalities.

Ethan Blum, Julia M Perugini, Mitch S Mologne, Christopher J Dy.

  Distal radius fractures (DRFs) are among the most common adult fractures, yet outcome reporting across studies remains inconsistent. Variability in assessed domains, measurement tools, and follow-up timing limits evidence synthesis and hinders standardized, patient-centered care. We systematically reviewed 179 English-language clinical studies evaluating DRF management across 5 treatment categories: casting, surgical intervention, physical therapy, pharmacotherapy, and operative versus nonoperative comparison. Data were extracted on study characteristics, outcome domains, measurement tools, and timing, and risk of bias was assessed using RoB 2.0 for randomized trials and MINORS (Methodological Index for Non-Randomized Studies) for nonrandomized studies. Patient-reported outcome measures were most frequent, with Disabilities of the Arm, Shoulder, and Hand (DASH/QuickDASH; n = 110) and Patient-Rated Wrist Evaluation (PRWE; n = 71) most common. Functional outcomes such as grip strength (n = 124) and range of motion (n = 140) were widely reported, particularly in therapy studies, while radiographic outcomes predominated in surgical and casting studies. Sixty percent of studies reported outcomes at 12 months or longer, and most exhibited low risk of bias. This review highlights heterogeneity in outcome reporting for DRF management, supporting development of a core outcome set and integration of longitudinal, real-world monitoring approaches such as digital phenotyping. This review demonstrates that outcome reporting in DRF studies remains fragmented, with variability in domains, instruments, and follow-up timing. Such heterogeneity prevents meaningful comparison across studies, reduces the feasibility of meta-analysis, and hampers the development of best-practice guidelines. A standardized core outcome set would address these limitations by ensuring consistent minimum reporting, while emerging methods such as digital phenotyping could complement traditional measures and provide continuous, patient-centered monitoring in future research.

Keywords:  anatomy; diagnosis; distal radius; forearm; fracture/dislocation; hand therapy; outcomes; rehabilitation; research and health outcomes; specialty; surgery

DOI:  https://doi.org/10.1177/15589447261422493
Int Urol Nephrol. 2026 Feb 28.

Adjuvant bladder thermal irrigation for ultrasound-guided botulinum toxin a injection in refractory bladder pain syndrome: a retrospective cohort study.

Chenhao Tang, Junhua Li, Longfei Yang, Chen Song, Jingyu Zhu, Huixian Pan.

   PURPOSE: This retrospective preliminary study aimed to evaluate whether adjuvant bladder thermal irrigation (TI) enhances the efficacy of ultrasound-guided botulinum toxin type A (BoNT-A) injection in patients with refractory bladder pain syndrome (BPS).
METHODS: We analyzed patients with refractory BPS who received an initial ultrasound-guided injection of 100 U BoNT-A into the bladder trigone between February 2019 and January 2025. Patients were divided into two groups based on irrigation temperature: the Thermal Irrigation Group (TI Group, n = 38) received warm saline irrigation at 43 °C ± 2 °C, and the Room-Temperature Irrigation Group (CON Group, n = 38) received irrigation at 22-25 °C. Propensity score matching (PSM) was used to balance baseline characteristics. The primary endpoint was median duration of efficacy. Secondary endpoints included changes in Visual Analogue Scale (VAS) pain scores and O'Leary-Sant Symptom Score (OSS) at 1, 3, and 6 months, and the Global Response Assessment (GRA) at 6 months.
RESULTS: After PSM, 32 matched pairs (n = 64) were included. The median duration of efficacy was significantly longer in the TI group than in the CON group (34.5 weeks vs. 24.0 weeks, log-rank test P = 0.012; HR = 0.52, 95% CI 0.31-0.88). At 3 months, the TI group demonstrated significantly greater pain reduction (adjusted mean VAS difference: -1.00, 95% CI -2.05 to 0.05, P = 0.008). At 6 months, the overall treatment success rate (GRA ≥ 2) was 71.9% in the TI group versus 50.0% in the CON group (OR = 2.57, 95% CI: 1.02-6.49, P = 0.043).
CONCLUSION: Adjuvant bladder thermal irrigation was associated with a longer duration of efficacy and greater symptom improvement in refractory BPS patients receiving BoNT-A injection, with a favorable safety profile. These findings support the need for prospective randomized trials to confirm the role of thermal irrigation as an efficacy enhancer for intravesical BoNT-A therapy.

Keywords:  Bladder pain syndrome; Botulinum toxin type A; Combination therapy; Drug delivery; Interstitial cystitis; Thermotherapy; Ultrasound guidance

DOI:  https://doi.org/10.1007/s11255-026-05066-8
Cureus. 2026 Jan;18(1): e102144

Pain After Brachial Plexus Injury Surgery: Variability in Reporting.

Anna Zakusylo, Aryan Borole, Evan Lobato, Andrew G Baddoo, Diana Vitkovska, Daniel Devine, Jomar N Aryee, Ajul Shah, Brian M Katt.

  Pain is a major contributor to morbidity following brachial plexus injury (BPI), yet pain-related outcomes are inconsistently reported. The extent of postoperative pain improvement after surgical reconstruction remains unclear due to variable measurement techniques and nonstandardized reporting intervals. A systematic review was conducted in accordance with the PRISMA guidelines. Studies involving adults undergoing operative treatment for traumatic BPI that reported pain using the Visual Analog Scale (VAS) were included. Data extraction focused on the timing and methods of postoperative pain assessment. Nine studies met the inclusion criteria. Pain reporting demonstrated substantial heterogeneity, with more than 15 different postoperative timepoints reported across studies. Only a small minority of studies reported pain at comparable intervals, precluding pooled analysis. Pain was consistently prevalent after BPI, particularly in cases involving root avulsion, and several surgical techniques were associated with qualitative pain improvement. Overall, pain reporting after BPI surgery lacks standardization, limiting meaningful comparison of outcomes. Standardized measurement intervals and reporting methods are needed to guide clinical expectations and strengthen future research.

Keywords:  brachial plexopathy; brachial plexus injury; brachial plexus trauma; nerve graft; nerve transfer; traumatic brachial plexus injury; visual analog scale

DOI:  https://doi.org/10.7759/cureus.102144