bims-ricfun Biomed News
on Rehabilitation ICF
Issue of 2026–03–08
sixty-four papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica



  1. Acta Orthop Belg. 2025 Sep;91(3): 299-307
      The most common entrapment neuropathy is carpal tunnel syndrome (CTS). Treatment options include both surgical and conservative procedures. The purpose of this study is to compare surgical treatment, corticosteroid injection, and platelet-rich plasma (PRP) injection in mild and moderate CTS and assess their clinical, electrophysiological, and ultrasonographic superiority over each other. This research was carried out using a prospective, randomized, controlled design. The study included 92 wrists from 68 participants with mild to moderate carpal tunnel syndrome. Following patient randomization, the first group underwent surgical treatment, the second group received steroid injections guided by ultrasonography, and the third group received PRP injections guided by ultrasonography. Prior to treatment, as well as one, three, and six months later, patients had evaluations. The patients' functional status and the severity of their symptoms were assessed using the Boston Carpal Tunnel Questionnaire (BCTQ), while the visual analog scale (VAS) was used to determine the patients' pain levels. Patients also had electrodiagnostic examinations, and ultrasonography was used to measure the median nerve's cross-sectional area (CSA) and flattening ratio (FR). The VAS and BCTQ showed significant improvements in all groups; however, surgical treatment outperformed the other two treatment modalities. While there was no significant change in compound muscle action potential amplitude in either group, surgical treatment was found to be superior in other electrophysiological measures. Before treatment, there was a difference in the groups' CSA measurements, and following treatment, all three treatment groups showed significant improvements. FR remained unchanged across all groups. In patients with mild to moderate CTS, injection procedures are useful, but surgical treatment has been shown to be more effective in terms of both clinical outcomes and electrophysiological parameters.
    DOI:  https://doi.org/10.52628/91.3.14385
  2. Int J Sports Phys Ther. 2026 ;21(3): 337-341
      The wrist joint is a common site of pain and injury due to either overuse or acute trauma. Many instances of wrist pain occur on the ulnar side of the wrist. This side of the wrist is commonly referred to as the "black box" of the wrist due to its small size and complex anatomy. Housed within the ulnar side of the wrist is the triangular fibrocartilage complex (TFCC). The TFCC is a complex of soft tissues that serves as a shock absorber and stabilizer of the distal radioulnar joint (DRUJ). This entire complex around the DRUJ and TFCC is composed of a central articular disc, a dorsal/volar radioulnar ligament, ulnar collateral ligament, and the extensor carpi ulnaris sheath. Diagnostic musculoskeletal ultrasound (MSKUS) offers a portable, real-time, and cost-effective alternative that is gaining traction in rehabilitation and sports medicine settings. MSKUS has emerged as a valuable, non-invasive imaging modality for evaluating wrist ligaments, discs, and bone. MSKUS is excellent at detecting changes in ligament composition and continuity. This manuscript will review the utility of MSKUS in evaluating TFCC and DRUJ injuries, including anatomy, common injury patterns, sonographic techniques, and clinical implications for rehabilitation professionals. Due to the small size and variety of structures in a confined space, diagnosing acute injury by physical examination is often difficult. By integrating MSKUS into clinical practice, providers can improve diagnostic accuracy, enhance diagnostic confidence, monitor healing progression, and guide rehabilitation strategies to achieve optimal patient outcomes for patients with wrist injuries.
    Keywords:  dynamic imaging; musculoskeletal ultrasound; rehabilitation; triangular fibrocartilage complex; wrist
    DOI:  https://doi.org/10.26603/001c.157566
  3. Clin Case Rep. 2026 Mar;14(3): e72189
      Long head of biceps tendinopathy (LHBT) is a common source of anterior shoulder pain, often misdiagnosed due to overlapping symptoms with other shoulder disorders. This case report presents a 56-year-old female with chronic shoulder pain managed through a clinical reasoning-guided physiotherapy program. Assessment using clinical reasoning, including the International Classification of Functioning, Disability, and Health (ICF) framework, confirmed LHBT. The intervention included pain management, manual therapy, range of motion exercises, strengthening exercises, and patient education over 6 weeks. Outcomes showed marked improvements: pain decreased from 7/10 to 1/10, muscle strength improved from 4/5 to 5/5, and functional disability scores (SPADI, DASH) reduced by over 80%. These findings demonstrate that structured, reasoning-based physiotherapy can facilitate accurate diagnosis and effective recovery in LHBT. This approach provides a model for evidence-informed, individualized clinical reasoning-based rehabilitation in similar musculoskeletal conditions.
    Keywords:  biceps tendinopathy; case report; clinical reasoning; exercise; physiotherapy
    DOI:  https://doi.org/10.1002/ccr3.72189
  4. CJEM. 2026 Mar 02.
      
    Keywords:  Analgesia; Chronic pain; Complex regional pain syndrome; Emergency medicine; Neuropathic pain
    DOI:  https://doi.org/10.1007/s43678-026-01121-6
  5. Clin Rheumatol. 2026 Mar 06.
       OBJECTIVE: Extra-articular soft tissue pathologies are relatively understudied in osteoarthritis (OA). We aimed to explore the relationship between structural pathology, sites of knee pain and knee pain severity, as determined using real-time ultrasound (US).
    METHODS: Patients with painful knee OA received an US scan assessing a range of soft tissue structures at four quadrants (anterior, medial, lateral and posterior). US probe site tenderness (sono-palpation) was also assessed at each structure. Participants' reported outcome measures were recorded, including sites of knee pain using the Knee Pain Map (using the same quadrant locations as structural pathology) and average numeric rating scale (NRS) for pain severity in the past week.
    RESULTS: Fifty-four knees (26 men, BMI 31.5, mean NRS pain 5.4, 96% Kellgren-Lawrence 2/3) were included. Medial pain was the most frequently reported location. Semimembranosus tendon (SMT) hypoechogenicity, indicating tendinopathy, was the most frequent US finding (53%). However, there was no clear pattern between SMT pathology and knee pain location. Medial collateral ligament (MCL) and lateral collateral ligament (LCL) sono-palpation (reflecting clinical enthesitis) was more frequently observed in medial and lateral knee pain, respectively (43.2% and 52.9%). Higher NRS pain was significantly associated with MCL sono-palpation (1.41 NRS points; CI 0.47-2.36, p = 0.004) and Baker's cyst sono-palpation (1.78 NRS points; CI 0.35-3.20, p = 0.016). A trend toward greater NRS pain was associated with US-detected patellar tendon pathology (1.1 NRS points; CI - 0.14-2.35, p = 0.08).
    CONCLUSION: This exploratory study highlighted the potential importance of extra-articular knee pathologies, particularly the collateral ligaments, in understanding OA knee pain location and severity. Key Points • This study measured the potential role of extra-articular pathology in OA knee pain. • Sono-palpation has been used as a novel method of measuring enthesitis. • Medial and lateral collateral ligament enthesitis may contribute to respective joint pain locations in knee OA. • Enthesitis may be secondary to biomechanical stresses around the knee joint.
    Keywords:  Knee; Ligament; Osteoarthritis; Pain; Tendon; Ultrasound
    DOI:  https://doi.org/10.1007/s10067-026-08017-x
  6. Folia Morphol (Warsz). 2026 ;85 e01726016
       BACKGROUND: The quadriceps femoris muscle compartment comprises four muscles, including the bi-articular rectus femoris, which is particularly prone to strain in kicking athletes. Anatomical variations such as accessory heads occur frequently but are seldom identified clinically. This retrospective case series describes injuries involving a previously undescribed accessory rectus femoris head in professional footballers.
    MATERIALS AND METHODS: We retrospectively reviewed a series of cases in professional footballers from 2022-2024 with acute anterior thigh injuries. Inclusion criteria required MRI evidence of a supernumerary rectus femoris muscle belly injury. MRI scans were reviewed to characterize the injury, and return-to-play times were recorded. One cadaver was dissected to confirm the accessory muscle anatomy in the thigh.
    RESULTS: Seven footballers met the inclusion criteria. MRI revealed an accessory anterolateral rectus femoris muscle belly with distinct proximal and distal aponeuroses, separate from the main rectus femoris. All injuries occurred at the myotendinous junction of the accessory head. Median return-to-play was 8 weeks. Cadaveric dissection confirmed an accessory muscle head arising from the anterior inferior iliac region and merging with the quadriceps tendon, corroborating the MRI findings.
    CONCLUSIONS: Recognizing anatomical variants is clinically important, as their characterization may explain atypical injury patterns and influence prognosis and clinical management. Identification of an accessory rectus femoris head on imaging can improve diagnostic accuracy, prevent misdiagnosis of injury severity and inform targeted rehabilitation strategies, thereby improving return-to-play outcomes.
    Keywords:  accessory muscle; magnetic resonance imaging; muscle injury; rectus femoris; return to play
    DOI:  https://doi.org/10.5603/fm.109644
  7. Cureus. 2026 Jan;18(1): e102519
      The platelet-rich plasma in achilles tendon healing 2 (PATH-2) trial is the largest randomized study of platelet-rich plasma (PRP) in acute Achilles tendon rupture. While the original frequentist analysis showed no significant benefit, such methods cannot quantify the probability of clinically meaningful improvement. We conducted a Bayesian re-analysis of PATH-2 data (n = 177) with Achilles tendon total rupture score (ATRS) and patient-specific functional scale (PSFS) at 24 months as outcomes. Minimally clinically important differences (MCIDs) were defined as 8 ATRS points and 2.3 PSFS points. Across flat, neutral, optimistic, and pessimistic priors, posterior probabilities of PRP providing benefit ≥MCID were <0.001% for ATRS and ~5×10-13 for PSFS. Probabilities of any benefit were 39.6% and 47.0%, respectively, with posterior mean differences close to zero. Results were robust across priors. This analysis demonstrates that PRP is unlikely to yield clinically meaningful functional improvement after Achilles tendon rupture.
    Keywords:  acute achilles tendon rupture; ankle and foot; functional score; outcome analysis; platelet-rich plasma (prp)
    DOI:  https://doi.org/10.7759/cureus.102519
  8. Front Med (Lausanne). 2026 ;13 1737973
       Objectives: To compare knee range of motion and muscle strength between individuals with symptomatic knee osteoarthritis and healthy controls, and to assess how Kellgren-Lawrence grade and measurement protocols affect these outcomes.
    Methods: A systematic search of PubMed, Scopus, and Web of Science identified studies comparing knee flexion/extension range of motion or flexor/extensor strength between patients with knee osteoarthritis and controls. Risk of bias was assessed with Joanna Briggs Institute tools. Pooled mean and standardized mean differences with 95% confidence intervals were calculated using random-effects meta-analyses.
    Results: Thirty studies were included. Compared with healthy controls, individuals with knee osteoarthritis showed significantly reduced knee flexion [MD = 16.30°, 95%CI (11.40, 21.21)] and extension [MD = 4.25°, 95%CI (2.30, 6.19)], with greater flexion loss in advanced KL grades. Knee osteoarthritis participants also demonstrated significantly lower strength across all contraction types: isometric [extensors: SMD = 0.86, 95%CI (0.57, 1.14); flexors: SMD = 0.52, 95%CI (0.30, 0.74)], concentric [extensors: SMD = 1.07, 95%CI (0.65, 1.50); flexors: SMD = 0.77, 95%CI (0.43, 1.12)], and eccentric extensor strength. Strength deficits were consistent across Kellgren-Lawrence grades, knee joint angles, and angular velocities during testing.
    Conclusions: Individuals with symptomatic knee osteoarthritis present with marked reductions in knee range of motion and strength. While range of motion impairments worsen with disease severity, strength deficits are stable across Kellgren-Lawrence grades and measurement protocols. Given the very low to low certainty of evidence, results should be interpreted with caution.
    Keywords:  arthritis; knee; osteoarthritis; rehabilitation; risk factors
    DOI:  https://doi.org/10.3389/fmed.2026.1737973
  9. Cureus. 2026 Jan;18(1): e102587
       PURPOSE: Shear wave elastography (SWE) is a non-invasive technique for assessing median nerve (MN) stiffness in carpal tunnel syndrome (CTS). This study evaluated whether SWE measurements of the MN improve after corticosteroid injection (CSI) and correlate with symptom improvement in CTS.
    METHODS: Ten patients (18 wrists) with CTS underwent SWE, grip strength testing, and completed questionnaires before and six weeks after ultrasound-guided CSI. SWE measurements included pressure and velocity in longitudinal/transverse planes at two locations: proximal to and at the carpal tunnel. Progression to carpal tunnel release (CTR) was recorded. Multivariate analyses assessed associations between SWE and symptom scores, controlling for confounders.
    RESULTS: Functional Status Scale (FSS) and Symptom Severity Scale (SSS) scores improved post-injection (p=0.007 and p<0.001, respectively). Significant changes occurred in SWE carpal tunnel pressure and velocity (p<0.05). No significant association between SWE and CTR progression. Post-injection proximal MN pressure (p=0.005) and velocity (p=0.006) measured longitudinally were associated with FSS scores.
    CONCLUSION: SWE measurements change with CSI but do not consistently predict symptom relief or surgery need. Questionnaires on daily function and symptoms may be more reliable for outcome tracking.
    Keywords:  carpal tunnel syndrome; corticosteroid injection; median nerve; shear wave elastography; ultrasound
    DOI:  https://doi.org/10.7759/cureus.102587
  10. Int J Sports Phys Ther. 2026 ;21(3): 272-280
       Background: Midportion Achilles tendinopathy is a common injury affecting individuals across various activity levels, characterized by pain, impaired performance, and pathological changes in tendon structure. Although the clinical examination is crucial for diagnosis and management, the relationship between pain measures and tendon pathology remains unclear, prompting further investigation into their diagnostic and prognostic value.
    Hypothesis/Purpose: This study aimed to (1) investigate the relationship between diverse clinical pain measures - pain on palpation, recall pain, pain pressure threshold (PPT), and pain during hopping - and pathological tendon structure in individuals with midportion Achilles tendinopathy, and (2) determine whether these pain measures represent overlapping or distinct features of the pain experience.
    Study Design: Cross-Sectional Study.
    Methods: One hundred and eighty-two participants with midportion Achilles tendinopathy completed clinical assessments for Achilles tendon pain (pain on palpation, recall pain, PPT, pain with hopping), and ultrasound imaging for Achilles tendon structure (thickness, degree of thickening, and cross-sectional area [CSA]) at a single visit. Spearman correlations were used to analyze the relationships between pain measures and Achilles tendon structure. Linear regression controlling for PPT was used to assess the relationship between pain on palpation and Achilles tendon structure.
    Results: All pain measures were significantly related (|r| = .19 - .51, all p<0.018). Pain on palpation was the only pain measure significantly related to Achilles tendon structure (thickness: r =.20, p=0.007; CSA: r =.21, p=0.005). Pain on palpation remained a significant predictor of tendon thickness (b=0.03, p=0.002), CSA (b=0.04, p=0.003), and degree of thickening (b=0.02, p=0.028) in linear regression models.
    Conclusion: Pain on palpation is a simple and important clinical measure that captures a unique aspect of the pain experience and relates to pathological Achilles tendon structural changes. This makes pain on palpation an important measure for the diagnosis and prognosis in those with midportion Achilles tendinopathy.
    Level of Evidence: 3.
    Keywords:  b-mode ultrasound; musculoskeletal assessment; musculoskeletal pain; pressure sensitivity; tendinitis; tendinosis
    DOI:  https://doi.org/10.26603/001c.156416
  11. PLoS One. 2026 ;21(3): e0344208
      Concurrent training (CT), defined as the integration of aerobic and strength exercise modalities, is increasingly implemented within cardiac rehabilitation (CR) to improve cardiovascular and musculoskeletal health. However, CT prescriptions vary markedly, and the characteristics and application of CT within CR have not been comprehensively mapped. This scoping review examined how CT has been designed and delivered in CR and summarised reported outcomes across International Classification of Functioning, Disability and Health (ICF) domains. A systematic search of databases and supplementary sources was conducted from October 2023 to December 2025. Clinical trials evaluating CT compared with usual care or aerobic training alone were eligible. Fourteen trials (n = 1,037; 13 randomised, 1 single-group) were included. CT programmes varied widely in setting (hospital, community, hybrid), CR phase (II-III), duration (5-32 weeks), and training structure. Aerobic training was delivered using continuous aerobic training (CAT), aerobic interval training (AIT), or high-intensity interval training (HIIT), with intensities prescribed using peak oxygen uptake (V̇O₂peak), maximum heart rate (HRmax), heart rate reserve (HRR), work rate, ventilatory threshold, or rating of perceived exertion (RPE). Modalities ranged from cycle ergometers and treadmills to multimodal or circuit-based formats. Strength-training prescriptions differed in targeted muscle groups, sets (2-8), repetitions (8-20), equipment (e.g., machines, free weights, TheraBand), and intensity anchors (% of one repetition maximum, RPE, % of maximum voluntary contraction). Application of progressive overload was inconsistent across studies. Exercise capacity (primarily V̇O₂peak) and muscle strength were the most consistently assessed outcomes. No CT-related adverse events were reported. CT has been applied using diverse delivery formats and exercise prescriptions within CR. Physiological outcomes were most consistently measured, whereas activity and participation-level outcomes showed greater variability and limited long-term evaluation. Future research should prioritise clearer reporting of training parameters, examine CT within community and hybrid CR models, incorporate behavioural and patient-reported outcomes, and investigate sex-specific responses and long-term effects to inform scalable and contextually adaptable CT approaches.
    DOI:  https://doi.org/10.1371/journal.pone.0344208
  12. JNMA J Nepal Med Assoc. 2025 Sep;63(289): 667-671
       Introduction: The diaphragm dysfunction is being increasingly recognized in chronic respiratory diseases. Ultrasonography offers a simple, non-invasive method for assessing diaphragmatic structure and function. This study aimed to evaluate and compare diaphragm thickness and excursion in patients with Chronic Obstructive Pulmonary Disease, Interstitial Lung Disease and healthy volunteers.
    Methods: A cross-sectional observational study was conducted among patients with Chronic Obstructive Pulmonary Disease, Interstitial Lung Disease and healthy controls. Diaphragm ultrasonography was performed to measure thickness at tidal expiration and tidal inspiration, maximal inspiration , thickening fraction, diaphragmatic excursion during quiet breathing, and maximal inspiration. Mean values were calculated and compared across groups. Correlations between mMRC score and FEV1 and FVC were also assessed.
    Results: A total of 75 participants were included: 25 Chronic Obstructive Pulmonary Disease patients, Interstitial Lung Disease patients and healthy volunteers each. All the parameters on both sides were comparable. Diaphragm thickness during tidal breathing were similar across groups. Diaphragm thickness during maximal inspiration and thickening fraction were lowest in Chronic Obstructive Pulmonary Disease, intermediate in Interstitial Lung Disease, and highest in healthy controls. Diaphragmatic excursion was reduced in Chronic Obstructive Pulmonary Disease compared with Interstitial Lung Disease and controls, with similar trends in maximal inspiration. Dyspnea severity negatively correlated with FEV1 and FVC in both Chronic Obstructive Pulmonary Disease and Interstitial Lung Disease patients.
    Conclusions: Chronic Obstructive Pulmonary Disease patients exhibited the greatest impairment in diaphragmatic contractility and excursion, followed by Interstitial Lung Disease, taking healthy volunteers as reference. Diaphragm ultrasonography provides useful physiological insights and may serve as an adjunctive tool in assessing respiratory muscle function in chronic lung disease.
    Keywords:  chronic obstructive pulmonary disease; diaphragm; interstitial lung disease; ultrasound; volunteers
    DOI:  https://doi.org/10.31729/jnma.9186
  13. Cureus. 2026 Jan;18(1): e102356
      Medial knee pain in knee osteoarthritis cannot always be explained solely by static structural abnormalities such as meniscal tears or osteophyte formation. Increasing attention has therefore been directed toward the dynamic behavior of peri-meniscal structures as potential contributors to symptom generation. This report describes two cases of knee osteoarthritis in which medial knee pain was localized near the tibial attachment of the medial meniscus (MM) despite minimal restriction of the knee range of motion and negative meniscal provocation tests. Dynamic ultrasonography revealed restricted MM displacement during tibial rotation in both cases, suggesting impaired adaptability of the meniscotibial ligament (MTL) and its underlying fat pad. Physical therapy focused on reducing tension in the MTL and facilitating physiological MM motion resulted in immediate and sustained pain reduction, accompanied by improvement in meniscal mobility on ultrasonographic assessment. These findings suggest that dynamic ultrasonographic evaluation combined with targeted physical therapy may represent a useful clinical approach for the assessment and management of medial knee pain in patients with knee osteoarthritis.
    Keywords:  fat pad; knee osteoarthritis; medial knee pain; medial meniscus; meniscotibial ligament; physical therapy; ultrasonography
    DOI:  https://doi.org/10.7759/cureus.102356
  14. Folia Morphol (Warsz). 2026 ;85 e01726006
       BACKGROUND: Ultrasound identification of genicular nerves to perform their blockade can be challenging due to high anatomical variability. Initial identification of the easier to visualize genicular artery could allow for further identification of the genicular nerve, permitting precise ultrasound-guided nerve blockades.
    MATERIALS AND METHODS: Three subsequent patients with the end-stage medial knee osteoarthritis (OA) with history of non-successful intraarticular treatment were included. The procedure assumed an ultrasound-guided blockade of the superior and inferior medial genicular nerves using 7 mL solution of lidocaine 8.33 mg/mL and betamethasone 1.17 mg/mL. Firstly, the superomedial genicular artery was visualized near the femoral medial metaphysis. Then, 3.5 mL of solution was injected in the plane between the deep fascia of the vastus medialis and the femur using 21G 50 mm needle. The same procedure was repeated at the distal part of the knee using the medial condyle of the tibia and inferomedial genicular artery as landmarks.
    RESULTS: In all cases, initial visualization of the genicular artery allowed for further identification of the genicular nerve adjacent to it. The procedure led to significant reduction of pain and improvement of the quality of life, with 50-80% of pain reduction at 6 weeks follow-up.
    CONCLUSIONS: Despite the high variability of the course of genicular nerves, the ultrasound guidance of perineural blockades facilitates a highly reliable and consistent measure to provide symptomatic relief in patients with knee OA. Genicular arteries are easier to visualize than adjacent genicular nerves, helping in effective identification of anatomical variations.
    Keywords:  genicular nerves; knee osteoarthritis; pain
    DOI:  https://doi.org/10.5603/fm.109680
  15. Front Neurol. 2026 ;17 1773636
       Introduction: Peripheral musculoskeletal structures may undergo secondary changes after stroke, but tendon-specific adaptations and their relationship with functional recovery are not well defined. This study examined lower extremity tendon thickness in patients with post-stroke hemiplegia before and after a four-week inpatient rehabilitation program and explored associations between tendon thickness and clinical improvement.
    Methods: In this prospective observational study, 45 patients with post-stroke hemiplegia completed a four-week rehabilitation program. Quadriceps, patellar, Achilles tendon and plantar fascia thicknesses were measured bilaterally at baseline and post-treatment using ultrasonography. Clinical assessments included the Berg Balance Scale (BBS), Functional Ambulation Classification (FAC), Barthel Index, Brunnstrom stages and Modified Ashworth Scale (MAS). Fifteen healthy volunteers served as controls (single assessment). Continuous variables are presented as mean ± SD when approximately normally distributed and as median (IQR) otherwise; p-values were adjusted for multiplicity in secondary analyses as specified.
    Results: Paretic-side quadriceps tendon thickness (primary outcome) increased from 5.94 ± 0.96 to 6.48 ± 0.95 mm (p < 0.001), with 21/45 (46.7%) exceeding minimal detectable change with a 95% confidence interval (MDC95). Baseline paretic-side quadriceps thickness was lower than controls (p_adj = 0.048) but did not differ post-treatment (p_adj > 0.99). Patellar and Achilles tendons and plantar fascia also showed consistent bilateral increases (all p < 0.001). Balance and functional outcomes improved over the period (BBS Δ: 6 [4-9]; FAC improved by ≥1 level in 27/45 [60.0%]; Barthel improved with median paired Δ: 0 [0-5]; all p < 0.001). Changes in quadriceps tendon thickness showed modest positive associations with changes in BBS (both sides) and Barthel (non-paretic side).
    Discussion: Lower-extremity tendon morphology in post-stroke hemiplegia appeared dynamic over a 4-week inpatient rehabilitation period, with quadriceps tendon thickness broadly paralleling improvements in balance and functional independence. Larger, longer-term studies are needed to clarify clinical utility.
    Keywords:  hemiplegia; lower extremity; postural balance; stroke rehabilitation; tendons ultrasonography
    DOI:  https://doi.org/10.3389/fneur.2026.1773636
  16. Injury. 2026 Feb 28. pii: S0020-1383(26)00125-7. [Epub ahead of print]57(4): 113140
       STUDY TYPE: Retrospective cohort.
    PURPOSE: Complex regional pain syndrome (CRPS) is a rare but debilitating complication that may develop following distal radius fracture (DRF). Concomitant nerve-related injury may increase risk. The current study aimed to evaluate the incidence and odds of developing CRPS following DRF with or without need for open reduction and internal fixation (ORIF) and/or carpel tunnel release (CTR).
    METHODS: Unilateral DRF patients between 2010-2022 were abstracted from the PearlDiver M170 Ortho database. Cohorts were defined as: (1) DRF managed non-operatively, (2) DRF treated with ORIF without same-day CTR, and (3) DRF treated operatively with ORIF and same-day CTR. ICD-10 laterality coding was used to ensure side-specific matching of DRF and CRPS diagnoses. Management cohorts were matched 1:1:1 based on patient age, sex, and Elixhauser Comorbidity Index (ECI). Monthly incidence of CRPS diagnosis through 1-year post-injury was determined for each matched cohort. Multivariable regression was performed to identify factors independently associated with CRPS.
    RESULTS: After matching, there were 7656 patients in each management cohort. At 1 year, the incidence of CRPS was 24 (0.31 %) in the non-operative group, 44 (0.57 %) in the ORIF-only group, and 110 (1.44 %) in the ORIF+CTR group. Compared with non-operative management, ORIF-only was associated with an odds ratio for CRPS of 2.19 at 3 months and 1.84 at 1 year, while ORIF+CTR demonstrated an odds ratio for CRPS of 6.42 at 3 months and 4.60 at 1 year. A pre-existing diagnosis of fibromyalgia was independently associated with CRPS at 3-months (OR 2.42) and 1-year (OR 1.73).
    CONCLUSIONS: Patients undergoing ORIF with concomitant CTR demonstrated the highest odds of CRPS at both early and late timepoints, likely related to median nerve injury or irritation at the time of injury in cases requiring acute CTR.
    LEVEL OF EVIDENCE: III.
    Keywords:  CRPS; Carpal tunnel release; Distal radius fracture
    DOI:  https://doi.org/10.1016/j.injury.2026.113140
  17. J Pain Res. 2026 ;19 576439
       Background: Dorsal scapular nerve (DSN) entrapment is a common cause of chronic interscapular pain. Ultrasound-guided corticosteroid hydrodissection is an effective intervention, but no randomized controlled trial has directly compared the efficacy of the proximal (scalene) and distal (scapular) injection approaches.
    Methods: In this multicentre, prospective, randomized controlled study conducted across seven centers in Egypt, patients and outcome assessors were blinded; proceduralists could not be blinded due to inherent technical differences. Sixty patients with electrodiagnostically-confirmed DSN entrapment were randomly assigned to receive a single ultrasound-guided hydrodissection injection of triamcinolone acetonide (40 mg) and lidocaine in 10 mL saline. Group I (n=30) received the injection at the DSN within the middle scalene muscle, while Group II (n=30) received it below the levator scapulae muscle. The primary outcome was the Visual Analog Scale (VAS) for pain at rest. Secondary outcomes included VAS during movement, Fatigue Assessment Scale (FAS), patient satisfaction, and motor distal latency, assessed at baseline, 1, and 3 months.
    Results: The groups were well-matched at baseline. The scalene group demonstrated a significantly greater reduction in pain at rest at both 1 month (Z = 6.68, p < 0.001) and 3 months (Z = 6.68, p < 0.001). Similar significant differences favoring the scalene group were observed for pain during movement and fatigue scores at all follow-ups (p < 0.001). Patient satisfaction was significantly higher in the scalene group at all follow-ups (p < 0.001). No significant between-group difference was found in motor distal latency, and no major complications occurred.
    Conclusion: Ultrasound-guided corticosteroid hydrodissection administered at the middle scalene muscle resulted in significantly greater short-term improvement in pain, fatigue, and patient satisfaction over three months compared to the distal scapular approach. The scalene approach may be considered more effective for short-term management, though longer-term studies are needed to confirm durability.
    Keywords:  dorsal scapular neuropathy; hydrodissection; interventional; middle scalene muscle; nerve block; pain management; randomized controlled trial; ultrasonography
    DOI:  https://doi.org/10.2147/JPR.S576439
  18. BMJ Open. 2026 Mar 03. 16(3): e113185
       INTRODUCTION: Knee osteoarthritis (OA) causes pain, reduced function and disability and may require total knee replacement (TKR). Although TKR is effective, up to 20% of patients remain dissatisfied, partly due to poor preoperative function and unrealistic expectations. Long waiting times for surgery may worsen patients' function, yet preoperative physiotherapy is rarely offered. Prehabilitation-exercise and education before surgery-could improve postoperative recovery, but current evidence is limited. This trial investigates whether adding prehabilitation to standard care before TKR improves postoperative patient-reported joint awareness, enablement and knee function.
    METHODS AND ANALYSIS: This multicentre, randomised controlled parallel-group trial is planned to be conducted within two specialised orthopaedic outpatient rehabilitation units in the southeast healthcare region of Sweden. Eligible patients (40-85 years, awaiting unilateral TKR) are randomised 1:1, stratified by age (≤67, >67 years), to either 8 weeks of prehabilitation-comprising two times per week supervised exercise therapy (strength, range of motion and balance) and education-in addition to standard care, or to standard care alone. Standard care consists of self-care, a single standardised preoperative education session and standardised postoperative rehabilitation. Assessments are conducted at baseline, post-intervention, 1 week pre-surgery and 6, 12 and 52 weeks post-surgery. A total of 110 patients will be recruited to the trial. Primary outcomes are joint awareness (Forgotten Joint Score-12) and patient enablement (modified Patient Enablement Instrument-2). Secondary outcomes are patient satisfaction (5-category Likert scale), the Knee injury and Osteoarthritis Outcome Score, the EuroQol 5 Dimension 3 Level questionnaire, the International Physical Activity Questionnaire-short form, objective function and accelerometer-based physical activity. Analyses will follow intention-to-treat and per-protocol principles. Between-group and within-group differences will be tested using t-tests or non-parametric equivalents, and linear mixed models or generalised linear models. Multiple linear regression and logistic regression will be used to analyse predictor variables for the primary outcomes. Sensitivity analyses will be performed to quantify the magnitude of missing data from patients lost to follow-up.
    ETHICS AND DISSEMINATION: The trial has received ethical approval from the Swedish Ethical Review Authority (reg. no.2023-05120-01) and complies with the Declaration of Helsinki. Signed informed consent is collected for all patients before entering the trial. Results will be submitted for publication in a peer-reviewed journal and presented at international/national conferences. The findings may improve future clinical guidelines and care pathways for patients undergoing TKR.
    TRIAL REGISTRATION NUMBER: NCT06290336.
    Keywords:  Exercise; Health Education; Orthopedics; Physical Therapy Modalities
    DOI:  https://doi.org/10.1136/bmjopen-2025-113185
  19. Pain Med Case Rep. 2026 Feb;10(1): 77-80
       BACKGROUND: Iliotibial band syndrome (ITBS) is typically associated with and commonly presents as distal knee pain, particularly in athletes. Proximal ITBS is a rare and underrecognized condition, especially in nonobese, nonathletic individuals.
    CASE REPORT: We report the case of a 42-year-old woman with complaints of 6 months of progressive lateral hip and thigh pain. Clinical signs included tenderness over the iliac tubercle, and positive flexion, abduction, and external rotation and Ober's tests. Musculoskeletal ultrasound and magnetic resonance imaging confirmed proximal ITB inflammation and associated greater trochanteric bursitis. Conservative measures offered partial relief; however, the patient was treated with an ultrasound-guided steroid injection and provided complete resolution.
    CONCLUSIONS: Proximal ITBS, though rare, should be considered in cases of lateral hip/thigh pain, even in nonathletes. Early imaging and interventional management can significantly improve outcomes and prevent chronicity.
    Keywords:  Proximal ITBS; lateral thigh pain; steroid injection
  20. Pain Med Case Rep. 2026 Feb;10(1): 47-53
       BACKGROUND: Complex regional pain syndrome (CRPS) is a very challenging condition to treat. We present a case resistant to conservative management that was treated by peripheral nerve stimulation (PNS).
    CASE REPORT: Our case study highlights the efficacy of PNS in the management of chronic pain syndromes, specifically CRPS, following major trauma and surgical intervention. Our case report involves a patient experiencing debilitating postoperative pain who underwent PNS treatment targeting the right infrapatellar branch of the saphenous nerve and posterior tibial nerve. Remarkably, the patient demonstrated a significant improvement in subjective pain levels with a reduction of approximately 75%, as well as enhanced functional capacity, compared to before the intervention.
    CONCLUSIONS: Our case underscores the potential of PNS as a viable therapeutic option for individuals suffering from CRPS and other postsurgical chronic pain syndromes.
    Keywords:  Peripheral nerve stimulation; chronic pain syndrome; complex regional pain syndrome; posterior tibial nerve; postsurgical pain; tibial nerve; trauma
  21. Eurasian J Med. 2026 Feb 02. 58 1-6
       BACKGROUND: Adhesive capsulitis involves capsular fibrosis and restricted shoulder movements, particularly external rotation and abduction. Magnetic resonance imaging (MRI) enables assessment of capsular and ligamentous thickening. The relationship between capsular thickness, range of motion (ROM), and rotator cuff and biceps tendon pathologies remains unclear. This study aimed to investigate the relationship between the coracohumeral ligament and inferior glenohumeral capsule thickness, shoulder range of motion, and MRI-detected edema patterns in patients with adhesive capsulitis.
    METHODS: This prospective study included 100 adhesive capsulitis patients who underwent shoulder MRI between July 2024 and July 2025. Coracohumeral ligament (CHL) and inferior glenohumeral capsule (IGHC) thicknesses were measured, and rotator cuff and biceps tendon pathologies graded. Shoulder ROM in external rotation (ER) and abduction was measured using a goniometer. Analyses included correlation tests, multiple linear regression, and Kruskal-Wallis tests.
    RESULTS: The mean patient age was 57.7 ± 11.9 years, with 66% women. CHL thickness strongly negatively correlated with ER ROM (r = -0.82, P < .001), while IGHC thickness strongly negatively correlated with abduction ROM (r = -0.79, P < .001). Regression analysis showed that CHL thickness independently predicted ER limitation, and IGHC thickness predicted abduction limitation. Rotator cuff and biceps tendon pathologies were common but not independently associated with ROM.
    CONCLUSION: Coracohumeral ligament and IGHC thickening are key determinants of restricted shoulder mobility in adhesive capsulitis. Magnetic resonance imaging assessment of these structures provides reliable diagnostic markers and can guide treatment, while concomitant rotator cuff and biceps pathologies have a limited impact on ROM restriction. Cite this article as: Soğukpınar Karaağaç S, Yeşilmen N. Quantitative MRI evaluation of coracohumeral ligament and inferior glenohumeral capsule thickening in adhesive capsulitis: correlation with range of motion and edema patterns. Eurasian J Med. 2026; 58(1): 1185. doi: 10.5152/eurasianjmed.2026.251185.
    DOI:  https://doi.org/10.5152/eurasianjmed.2026.251185
  22. Zh Nevrol Psikhiatr Im S S Korsakova. 2026 ;126(2): 77-82
       OBJECTIVE: To evaluate the efficacy of abobotulinumtoxinA in stump preparation for prosthetic fitting in patients with limb amputations.
    MATERIAL AND METHODS: This prospective open-label study included 88 male patients over 18 years old with lower limb amputations due to mine-blast trauma and phantom limb pain syndrome (PLP) with pain intensity of at least 5 points on the visual analogue scale (VAS), absence of significant effect from pharmacological therapy, stump tenderness, and preserved active movements in the transected muscles. AbobotulinumtoxinA at doses of 500-800 U was used to reduce PLP severity. Examination of all patients included collection of complaints and medical history, neurological examination (including manual muscle testing and muscle tone assessment), pain assessment by VAS, psycho-emotional status assessment using the Hospital Anxiety and Depression Scale (HADS), neuropathic pain assessment using the DN4 questionnaire, and stump ultrasound to assess muscle functional status (presence or absence of movements). The total observation period was 21 days. Seven patients with preserved muscles were additionally examined 3 months after botulinum toxin injection.
    RESULTS: Baseline VAS pain score was 5.8±0.4 points. Clinically significant anxiety according to HADS was present in 86 patients. The mean anxiety score before botulinum toxin injection in the group was 9.1±1.2 points. Depression scores on the HADS were subclinical in all patients, with a mean of 5.3±1.6 points. The mean DN4 neuropathic pain score was 5.9±0.5 points. Pain intensity decreased in all patients, reaching a mean of 3.7±0.5 points on VAS by day 7 after botulinum toxin therapy (p<0.05). By day 14, pain syndrome was completely resolved in all patients. The mean DN4 score was 5.1±0.4 points on day 7 and 2.6±0.9 points on day 14 after injection (p<0.05).
    CONCLUSIONS: Early botulinum toxin therapy enables rapid stump preparation for prosthesis fitting, resolves pain syndrome and accelerates patient rehabilitation.
    Keywords:  AbobotulinumtoxinA; amputation; botulinum toxin therapy; hypertrophic scars bionic prosthesis; phantom pain syndrome
    DOI:  https://doi.org/10.17116/jnevro202612602177
  23. Cureus. 2026 Jan;18(1): e102509
      Lumbar degenerative disease is mostly managed non-operatively, but lumbar spinal fusion has been used for almost a century. It has shown clinical efficacy in decreasing pain and disability scores and allowing patients to return to work. However, spinal fusion may not be clinically effective and may place a financial burden on patients. The alternative to spinal fusion is physical therapy and rehabilitation for lumbar degenerative diseases. This study aims to compare the functional outcomes of intensive rehabilitation and lumbar spine fusion surgery among patients with chronic low back pain from lumbar spine degenerative disease. We conducted a systematic search of clinical trials on the topic, followed by a meta-analysis using a random-effects model. The functional outcomes compared included the Oswestry Disability Index (ODI) score, improvement in low back pain and leg pain, as well as overall patient outcome. Five randomized controlled trials were included in the meta-analysis. There was a 7.25-point improvement in the change in the ODI (95% CI: 1.22-13.17; p = 0.02; I² = 98%), favoring fusion surgery. All studies showed improvement in low back pain, with a VAS score change of 11.49, favoring fusion surgery (95% CI: 4.48-18.50; p = 0.001; I² = 96%). There was a Visual Analog Scale (VAS) score change of 7.2 in leg pain improvement (95% CI: -8.58 to 22.97; p = 0.37; I² = 98%); however, the effect was not significant. There was no significant difference in terms of overall patient outcome (95% CI: 0.23-1.08; p = 0.08; I² = 78%). Among patients with chronic low back pain, lumbar spine fusion surgery showed improvement in functional outcomes related to changes in disability and low back pain when compared with intensive rehabilitation. However, the two treatment options showed no differences with respect to improvement in leg pain and overall patient outcome.
    Keywords:  fusion surgery; low back pain; lumbar spine; rehabilitation; spondylolisthesis
    DOI:  https://doi.org/10.7759/cureus.102509
  24. Bone Joint J. 2026 Mar 01. 108-B(3): 369-380
       Aims: This review provides a comprehensive overview of mid-substance Achilles tendinopathy (MAT), covering its aetiology, pathophysiology, diagnosis, and management strategies, both nonoperative and operative.
    Methods: A detailed literature analysis was conducted, focusing on MAT's epidemiology, clinical presentation, imaging methods, and treatment options. Key studies and meta-analyses were reviewed. This review synthesizes the current evidence on the assessment and management of MAT. It details the pathophysiology, epidemiology, and diagnostic process, including clinical evaluation, specific provocation tests, and the role of imaging. A comprehensive analysis of both conservative and surgical treatment options is presented, evaluating their efficacy based on the available literature.
    Results: MAT presents bimodally, with a male predominance. Diagnosis is primarily clinical, supported by ultrasound and tools such as the Victorian Institute of Sport Assessment-Achilles score. Nonoperative management is the cornerstone, with eccentric exercise rehabilitation standing as the most evidence-based and effective intervention. For recalcitrant cases, high-volume image-guided injection (HVIGI) is a promising second-line option with a favourable safety profile. Extracorporeal shockwave therapy (ESWT) may be considered as an adjunct. Evidence for other adjuncts such as platelet-rich plasma and corticosteroids is weak, and their use is not recommended. Surgical intervention is reserved for the approximately 20% to 29% of patients who fail conservative treatment. Options include gastrocnemius recession, plantaris excision, and open or minimally invasive/endoscopic debridement, with tendon transfer indicated for large defects. While most techniques report high success rates, a lack of high-level comparative evidence precludes a definitive surgical algorithm.
    Conclusion: The management of MAT is fundamentally staged, beginning with a prolonged trial of eccentric exercises. HVIGI and ESWT are valuable next-step options. Surgery is considered for refractory cases, with a trend towards minimally invasive techniques owing to their lower complication profile. However, there is a paucity of randomized controlled trials, making surgeon preference and expertise a significant factor in choice of procedure. An evidence-based treatment algorithm is proposed to guide clinical decision-making.
    DOI:  https://doi.org/10.1302/0301-620X.108B3.BJJ-2025-0431.R2
  25. J Orthop Sports Phys Ther. 2026 Mar;56(3): 158-175
      OBJECTIVE: To compare the effects of supervised physical therapy to home exercise programs on functional outcomes in patients after distal radius fractures. DESIGN: Intervention systematic review with meta-analysis of randomized clinical trials (RCTs). LITERATURE SEARCH: We searched MEDLINE, EMBASE, Web of Science, Scopus, CENTRAL, Epistemonikos, Cumulative Index of Nursing and Allied Health Literature, SPORTDiscus, Physiotherapy Evidence Database, and LILACS databases from inception to April 2025. STUDY SELECTION CRITERIA: We included RCTs comparing supervised physical therapy with a home exercise program on functional outcomes in patients with distal radius fracture. DATA SYNTHESIS: We used a random-effects meta-analysis for clinically homogeneous RCTs. We assessed risk of bias using the Cochrane Risk of Bias 2.0 and applied the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to judge the certainty of evidence. RESULTS: Thirteen RCTs were included. At 6 weeks, there were significant differences for Patient-Rated Wrist Evaluation (mean difference [MD] = -11.64 points, P < .001) with moderate certainty of evidence, for grip strength relative to the unaffected side (MD = 12.85%, P = .03) with low certainty of evidence, and for wrist extension range of motion (MD = 8.99°, P = .03) with moderate certainty of evidence. All results were in favor of the supervised physical therapy group. There were significant differences in favor of supervised physical therapy for wrist function and extension range of motion in patients over 65 years (P < .05). A greater number and frequency of supervised physical therapy sessions were associated with greater pain relief and improved wrist range of motion (P < .05). CONCLUSION: Supervised physical therapy had statistically significant short-term benefits in wrist function, grip strength, and wrist extension range of motion. J Orthop Sports Phys Ther 2026;56(3):158-175. Epub 4 February 2026. doi:10.2519/jospt.2026.13561.
    Keywords:  distal radius fracture; exercise therapy; functional outcomes; home exercise program; meta-analysis; supervised physical therapy
    DOI:  https://doi.org/10.2519/jospt.2026.13561
  26. Arch Phys Med Rehabil. 2026 Feb 26. pii: S0003-9993(26)00089-4. [Epub ahead of print]
       OBJECTIVE: To compare the effects of combined glenohumeral joint (GHJ) and subacromial-subdeltoid (SASD) bursa injections using platelet-rich plasma (PRP), corticosteroids (CSs), or normal saline (NS), in conjunction with physical therapy (PT), for the treatment of frozen shoulder.
    DESIGN: Prospective, single-blinded, randomized controlled trial.
    SETTING: Rehabilitation clinic in a medical center.
    PARTICIPANTS: Ninety patients with primary frozen shoulder.
    INTERVENTIONS: Participants were randomly assigned to one of the 3 intervention groups: PRP injection + PT (n = 30), CS injection + PT (n = 30), and NS injection + PT (n = 30). Each participant received 2 ultrasound-guided injections targeting both the GHJ and SASD bursa.
    MAIN OUTCOME MEASURES: The primary outcome was the Shoulder Pain and Disability Index (SPADI). Secondary outcomes included the Shoulder Disability Questionnaire (SDQ), pain visual analog scale (VAS), active and passive range of motion, the 36-Item Short Form Health Survey (SF-36), and patient self-assessment. Assessments were performed at baseline and at 1, 2, 4, and 6 months following treatment initiation.
    RESULTS: The CS group exhibited significantly greater improvement in SPADI (P < .001), SDQ (P < .001), pain VAS during activity (P = .005), active abduction (P = .022), active internal rotation (P = .036), passive abduction (P = .012), passive internal rotation (P = .029), self-assessment (P < .001), and selective SF-36 domains. The therapeutic effect of CS was evident at 1 month and persisted through the 6-month follow-up.
    CONCLUSION: Corticosteroid injections yielded superior outcomes compared with PRP, particularly during the freezing stage of frozen shoulder. Nonetheless, all 3 treatment groups exhibited significant postintervention improvement.
    Keywords:  PRP; adhesive capsulitis; corticosteroid; frozen shoulder; platelet-rich plasma
    DOI:  https://doi.org/10.1016/j.apmr.2026.01.031
  27. Cureus. 2026 Jan;18(1): e102370
      Deep gluteal syndrome (DGS) is a challenging cause of buttock pain and sciatic-like symptoms, often mimicking lumbar radiculopathy and remaining difficult to diagnose when conventional imaging is inconclusive. Structural abnormalities within the deep gluteal space, particularly at muscle-tendon insertions, may contribute to mechanically mediated sciatic nerve irritation but are frequently overlooked. We report a case of DGS in a 45-year-old man, caused by piriformis enthesopathy with a cortically based bony spur at the greater trochanter, identified using computed tomography (CT) and functionally assessed with dynamic ultrasonography. CT allowed precise detection of the bony abnormality, while dynamic USG demonstrated reproducible motion-related changes at the piriformis enthesis during hip rotation, which may provide further information to a patient with DGS. Targeted ultrasound-guided dextrose prolotherapy using a hyperosmolar dextrose solution was performed at the enthesopathic site (six sessions at two-week intervals), resulting in substantial and sustained symptom improvement at three-month follow-up. This case showed that the abnormal MRI findings may not be the cause of the patient's condition, and it highlights the diagnostic value of a multimodal imaging approach combining CT and dynamic ultrasound in this patient. Furthermore, it suggests that ultrasound-guided dextrose prolotherapy could be an effective, minimally invasive treatment option for selected patients with chronic, function-limiting DGS with symptomatic enthesopathy.
    Keywords:  deep gluteal syndrome; dextrose prolotherapy; dynamic examination; enthesopathy; piriformis; sciatic nerve; ultrasound
    DOI:  https://doi.org/10.7759/cureus.102370
  28. Clin Exp Rheumatol. 2026 Mar 04.
       OBJECTIVES: A randomised controlled trial (RCT) demonstrated that a single 6 mL intra-articular (IA) injection of polyacrylamide hydrogel (iPAAG) provided comparable efficacy and safety to hyaluronic acid over one year in patients with moderate-to-severe knee osteoarthritis (OA). This study reports the longer-term outcomes of iPAAG.
    METHODS: In this long-term extension of the RCT (ClinicalTrials.gov Identifier: NCT04045431), participants treated with IA 2.5% iPAAG were followed for changes from the RCT baseline in WOMAC pain, stiffness, and physical function subscales (0-100), as well as patient global assessment (PGA) of OA impact. Safety was monitored throughout the extension study.
    RESULTS: Of 119 participants initially treated with iPAAG, 91 (47 men) entered the extension, and 58 completed 5 years of follow-up. At year 5, WOMAC pain improved by a mean of -16.2 points (95% CI: -20.0 to -12.4; p<0.0001). Similar improvements were observed across other WOMAC domains and PGA. Between years 1 and 5, 79 adverse events (AEs) were reported in 47 participants (51.6%), none considered related to iPAAG.
    CONCLUSIONS: A single IA injection of iPAAG was associated with sustained improvements in pain and function, with a favourable safety profile maintained through 5 years. These observational data support iPAAG as a promising long-acting, non-surgical treatment option for knee OA.
    DOI:  https://doi.org/10.55563/clinexprheumatol/bsper8
  29. JBJS Case Connect. 2026 Jan 01. 16(1):
       CASE: A 45-year-old woman presented with right knee pain and low back pain 23 years after hip arthrodesis. Conversion total hip arthroplasty (THA) relieved her low back pain and improved limb alignment, but medial knee pain persisted. A closed-wedge high tibial osteotomy (HTO) was performed. Varus deformity was corrected, and bone union was achieved. Her hip and knee function improved, and pain was reduced.
    CONCLUSIONS: Staged treatment comprising THA followed by HTO is a novel joint-preserving strategy for young, active patients with ipsilateral knee osteoarthritis after hip arthrodesis that may result in favorable clinical and radiographic outcomes.
    Keywords:  high tibial osteotomy; hip arthrodesis; ipsilateral knee osteoarthritis; staged treatment; total hip arthroplasty
    DOI:  https://doi.org/e25.00603
  30. Int J Sports Phys Ther. 2026 ;21(3): 312-323
      Haglund's Syndrome is characterized by posterior superior calcaneal prominence with associated retrocalcaneal bursitis and insertional Achilles tendinopathy (IAT). Conservative management with physical therapy demonstrates strong evidence for efficacy and takes time. It is typically trialed for over a year, and if pain and dysfunction persist, surgical intervention is considered. Post-operative rehabilitation protocols described in the literature vary widely, with many restricting weightbearing for extended periods of time. This protocol emphasizes an expedited yet safe return to weightbearing for the patient to quickly normalize gait and return to evidence-based loading strategies. By aligning rehabilitation milestones with physiological healing timelines and objective criteria, this rehabilitation approach aims to optimize efficiency in recovery and facilitate a safe return to sport. The purpose of this clinical commentary is to review current literature and propose a criterion-based protocol recommending early weight bearing when significant repair of the tendon is not necessary. # Level of Evidence 5.
    Keywords:  Achilles; Ankle; Foot; Haglund; Insertional; Physical Therapy; Rehab; athlete; criterion-based
    DOI:  https://doi.org/10.26603/001c.156435
  31. Pain Med Case Rep. 2026 Feb;10(1): 17-20
       BACKGROUND: Bertolotti's syndrome is a congenital spinal disorder marked by back pain due to a lumbosacral transitional vertebra, often presenting with sacroiliac joint, groin, and hip pain. This condition results from the articulation of the lumbar 5 vertebra transverse processes with the sacrum, causing both radicular and pseudoradicular pain.
    CASE REPORT: This is a case report of a patient with bilateral axial low back pain related to bilateral Bertolotti joints who received sustained pain relief after a radiofrequency ablation (RFA) targeting the bilateral L4 medial branch, L5 dorsal ramus, and S1 lateral branch.
    CONCLUSIONS: Our case report demonstrates the complete resolution of chronic low back pain in a patient with bilateral Bertolotti's syndrome after an RFA targeting the L4 medial branch, L5 dorsal ramus, and S1 lateral branch.
    Keywords:  Bertolotti Joint; Bertolotti Syndrome; RFA; Radiofrequency Ablation
  32. Spinal Cord Ser Cases. 2026 Mar 04. pii: 3. [Epub ahead of print]12(1):
       STUDY DESIGN: Prospective interventional sham-controlled pilot study.
    OBJECTIVES: To investigate the effect of motor-tract paired-associative stimulation consisting of high-intensity transcranial magnetic stimulation and high-frequency electric stimulation of peripheral nerves (high-PAS) on moderate-to-severe upper limb neuropathic pain in patients with incomplete spinal cord injury compared with sham treatment in the same patients.
    SETTING: BioMag Laboratory, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
    METHODS: High-PAS was applied for 4 weeks to 5 patients with incomplete, non-traumatic SCI and chronic neuropathic pain in upper limb(s). Median, ulnar, and radial nerves of the more painful hand were stimulated. The same patients also received sham stimulation for 4 weeks. Pain was measured with Verbal Rating Scale weekly and with Brief Pain Inventory before and after both stimulation periods and after follow-up of 8 weeks.
    RESULTS: Clinically significant relief in pain was not achieved with high-PAS or sham treatment.
    CONCLUSIONS: In this pilot study, clinically significant pain relief was not observed with high-PAS compared with sham treatment. Larger studies are needed to confirm these findings. Nevertheless, pain is not a contraindication for high-PAS in rehabilitation. The previously reported positive effect on milder neuropathic pain may be due to improved muscle activity, different pain types, or placebo effect. High-PAS targeting sensory tracts instead of motor tracts merits further investigation for pain treatment.
    TRIAL REGISTRATION: clinicaltrials.gov, ID NCT05362422.
    DOI:  https://doi.org/10.1038/s41394-026-00729-1
  33. JMIR Rehabil Assist Technol. 2026 Mar 04. 13 e80400
       BACKGROUND: Lateral epicondylitis (LE) is a condition that impairs daily activities due to pain exacerbated by wrist and hand movements. The ArmLock sleeve is a novel, nonsurgical intervention to stretch the wrist extensor muscles by maintaining the elbow in extension, forearm in pronation, and wrist and fingers in flexion.
    OBJECTIVE: This study aimed to assess the effectiveness of sustained tension provided by the ArmLock sleeve on pain and functional outcomes in adults with LE. This novel device supports the forearm by aligning the elbow in extension, the forearm in pronation, and the wrist in flexion, while keeping the metacarpophalangeal and proximal interphalangeal joints of fingers II-V flexed.
    METHODS: A within-subjects repeated-measures design was used to assess outcomes at baseline, week 6, and week 12. Nineteen participants wore the device at home for 30 minutes daily for 12 weeks. Outcome measures were administered by research assistants and included pain intensity, pain-free grip strength, pressure pain threshold, pain during resisted wrist extension, and composite extensibility of wrist and finger extensors. Repeated-measures 1-way ANOVA and Friedman tests were conducted (α=.05), followed by post hoc comparisons (α=.017, Bonferroni correction).
    RESULTS: Significant improvements were observed in 6 of 7 (85.7%) outcome variables, including increased muscle extensibility, enhanced grip strength, and reduced pain intensity. Participants reported decreased pain and functional disability in a self-reported questionnaire.
    CONCLUSIONS: Wearing the device daily for 12 weeks led to significant improvements in extensibility, grip strength, and pain reduction. Participants also reported decreased pain and disability. These results suggest that the ArmLock sleeve may support symptom relief and functional gains in individuals with LE. Larger, controlled studies are needed to confirm its effectiveness.
    TRIAL REGISTRATION: ISRCTN Registry ISRCTN13309889; https://www.isrctn.com/ISRCTN13309889.
    Keywords:  lateral epicondylitis; musculoskeletal; orthopedic device; rehabilitation; tennis elbow; upper extremity
    DOI:  https://doi.org/10.2196/80400
  34. Cureus. 2026 Jan;18(1): e102376
      Isolated instability of the long head of the biceps tendon is uncommon and is usually associated with rotator cuff or bicipital pulley injuries. Isolated extra-articular medial dislocation in the absence of associated lesions is particularly rare in the adolescent population. We report the case of a 15-year-old male who presented with anterior shoulder pain after a recreational sports activity. Physical examination revealed localized anterior and anterolateral tenderness, with preserved active and passive range of motion and no clinical signs of instability. Magnetic resonance imaging using MR arthrography demonstrated an isolated extra-articular medial dislocation of the long head of the biceps tendon, characterized by an empty bicipital groove and preserved integrity of the rotator cuff, rotator interval, and labro-bicipital complex. Conservative management with physical therapy focused on pain control and shoulder stabilization was initiated, along with activity modification and injury prevention counseling. The patient showed a favorable clinical course during conservative management. This report highlights the importance of systematic evaluation of the bicipital groove and the entire course of the long head of the biceps tendon on MRI in young patients with anterior shoulder pain, even when classically associated injuries are not identified.
    Keywords:  adolescent shoulder pain; biceps tendon instability; long head of the biceps tendon; mr arthrography; shoulder mri
    DOI:  https://doi.org/10.7759/cureus.102376
  35. Cureus. 2026 Jan;18(1): e102712
      Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition associated with significant morbidity and functional impairment. Osteopathic manipulative treatment (OMT) has been proposed as an adjunctive therapy to address musculoskeletal and respiratory mechanics in patients suffering from COPD. However, the clinical evidence remains limited. Therefore, the objective of this study is to systematically review available clinical evidence evaluating the utility of osteopathic manipulative treatment in patients with chronic obstructive pulmonary disease. A systematic review of the MEDLINE/PUBMED, Google Scholar, Cochrane, and clinicaltrials.gov databases was conducted to identify clinical trials evaluating osteopathic manipulative treatment in adult patients with COPD. Eligible studies were screened and synthesized narratively due to heterogeneity in study design and outcome measures. Ultimately, five clinical studies met the inclusion criteria. Reported outcomes included pulmonary function measures, functional capacity, and patient-reported outcomes. Findings were mixed, with some studies demonstrating improvements in functional and subjective measures, while other studies showed no reported benefit following OMT. Overall, evidence regarding osteopathic manipulative treatments in chronic obstructive pulmonary disease remains limited and mixed. While some studies suggest potential benefit, most notably a statistically significant improvement in the six-minute walk test (6MWT), other studies show no improvement compared with standard care, and larger high-quality trials are needed to clarify OMT's role as an adjunctive therapy in COPD management.
    Keywords:  "spirometry"; copd: chronic obstructive pulmonary disease; osteopathic manipulative treatment (omt); osteopathy treatment; six-minute walk test
    DOI:  https://doi.org/10.7759/cureus.102712
  36. JB JS Open Access. 2026 Jan-Mar;11(1):pii: e25.00247. [Epub ahead of print]11(1):
       Background: Entrapment of the lateral cutaneous nerve of the forearm (LCNF), the terminal sensory branch of the musculocutaneous nerve, is rare and often overlooked in the differential diagnosis of lateral forearm paresthesia and anterior elbow pain. This study describes a cohort of competitive weightlifting athletes with LCNF neuropathy due to biceps tendon compression, who underwent surgical decompression after failed conservative treatment.
    Methods: We reviewed cases treated between 2009 and 2019 at a single orthopaedic center. Inclusion criteria were a clinical diagnosis of LCNF neuropathy (based on a positive Tinel sign lateral to the biceps tendon and paresthesia in the lateral forearm), a magnetic resonance imaging scan excluding other conditions, participation in competitive weightlifting, and failure of conservative treatment lasting ≥3 months. Outcome measures included symptom resolution, Tinel sign status, return to sport, and complications.
    Results: There were 5 male athletes (mean age, 28 years; range, 23-34) with LCNF entrapment lateral to the biceps tendon at the antecubital fossa. The mean interval from symptom onset to surgery was 12.8 months (range, 8-18). Mean follow-up was 74 months (range, 50-100). Within a month of the operation, all patients had complete symptom resolution and a negative Tinel sign and resumed competitions at their preinjury level. No complications occurred.
    Conclusions: LCNF entrapment should be considered in athletes performing repetitive elbow extension and pronation who present with unexplained lateral forearm paresthesia. When conservative measures fail, surgical decompression is safe, reproducible and has excellent long-term outcomes.
    Level of Evidence: Level IV, Case Series, Prognostic study. See Instructions for Authors for a complete description of levels of evidence.
    DOI:  https://doi.org/10.2106/JBJS.OA.25.00247
  37. Physiother Res Int. 2026 Apr;31(2): e70183
       BACKGROUND AND PURPOSE: Robot-assisted total knee arthroplasty (rTKA) has been introduced to improve surgical accuracy, but its effects on periarticular soft tissues in the early postoperative period remain insufficiently described. Ultrasound imaging allows non-invasive assessment of muscle and nerve morphology after surgery. The primary objective of this exploratory case series was to demonstrate the feasibility of early postoperative ultrasound assessment and to describe quadriceps muscle and femoral nerve morphological findings, thereby providing a methodological framework for future longitudinal studies.
    METHODS: This prospective exploratory ultrasound case series included 11 patients undergoing conventional TKA (n = 5) or rTKA (n = 6). Quadriceps muscle thickness (rectus femoris, vastus intermedius, vastus medialis, and vastus lateralis) and femoral nerve morphological parameters were assessed preoperatively and within the first 24 h after surgery. Analyses focused on descriptive within-group pre-post variations, with effect sizes and percentage changes reported to characterize the magnitude and direction of observed changes. The study was not designed or powered for inferential or inter-group comparisons.
    RESULTS: Postoperative variations in quadriceps muscle thickness were observed in both surgical groups, most consistently in the rectus femoris and vastus intermedius, while changes in the vastus medialis and vastus lateralis were smaller and less consistent. In contrast, femoral nerve morphological measures demonstrated minimal variation, representing a relatively stable pattern across individuals. Overall, the observed changes were small in magnitude and showed inter-individual variability.
    DISCUSSION: At this early postoperative time point, the observed ultrasound findings primarily reflect initial postoperative tissue behavior rather than structural adaptation. The relative stability of femoral nerve morphology represents a reassuring descriptive observation, while the small and variable quadriceps changes highlight the need for cautious interpretation at this stage.
    CONCLUSIONS: This exploratory case series demonstrates the feasibility of early postoperative ultrasound assessment of quadriceps muscle and femoral nerve morphology following conventional and robot-assisted TKA. These descriptive findings provide preliminary data and a methodological basis for future longitudinal studies integrating functional and clinical outcomes.
    DOI:  https://doi.org/10.1002/pri.70183
  38. JNMA J Nepal Med Assoc. 2025 Nov;63(291): 797-802
       Introduction: Lateral epicondylitis is a common cause of lateral elbow pain that impairs grip strength and daily activities. While corticosteroid injection offers rapid symptom relief, dry needling is a newer, minimally invasive technique that may enhance tendon healing and provide longer-lasting benefits. This study compared the short- and long-term efficacy of corticosteroid injection and dry needling in improving pain and function in patients with lateral epicondylitis.
    Methods: This prospective comparative observational study was conducted in the Department of Orthopedics, Shree Birendra Hospital, Kathmandu, from June 2022 to July 2023 after obtaining ethical approval from the Institutional Review Committee (Registration number: 492). Sixty-two patients aged I860 years with clinically diagnosed lateral epicondylitis were consecutively assigned to receive either corticosteroid injection (n = 31) or dry needling (n = 31). Pain and function were assessed using the Patient-Rated Tennis Elbow Evaluation questionnaire at baseline, 3 weeks, and 3 months. Intergroup comparisons were made using t-tests or Mann-Whitney U tests, and intragroup differences were analyzed with paired t-tests or Wilcoxon signed-rank tests.
    Results: Baseline characteristics were comparable. Corticosteroid injection produced greater short-term improvement at 3 weeks (pain 28.23 ± 10.27 vs 41.71 ± 8.93, p < 0.001), while dry needling showed superior outcomes at 3 months (Patient-Rated Tennis Elbow Evaluation 42.97 ± 16.32 vs 50.45 ± 15.33, p = 0.04). Both interventions achieved significant within-group improvement (p < 0.001).
    Conclusions: Corticosteroid injection offers faster initial pain relief, but dry needling yields better long-term functional recovery. Both are effective modalities, with dry needling preferred for sustained management of lateral epicondylitis.
    Keywords:  corticosteroid injection; dry needling; elbow pain; lateral epicondylitis; patient-rated tennis elbow evaluation
    DOI:  https://doi.org/10.31729/jnma.v63i2091.9241
  39. Altern Ther Health Med. 2026 Mar 05. pii: AR11782. [Epub ahead of print]
       Introduction: Postoperative hand tendon injuries often lead to complications, such as stiffness, limited hand mobility, and impaired function, warranting effective rehabilitation. Matrix Rhythm Therapy (MaRhyThe®) is a novel physiotherapy method used in treating various soft tissue disorders.
    Objective: This pilot randomized controlled trial comparatively evaluated the impact of MaRhyThe® and conventional physiotherapy on hand mobility and function in individuals recovering from postoperative hand tendon injuries.
    Materials and Methods: Twenty Participants underwent a 2-week intervention program with 4 clinic-based sessions per group. Sessions were conducted every third day, with 2-day home exercise intervals between sessions. Group A (n = 10) received 60 min of MaRhyThe® while Group B (n = 10) received 5 min of conventional physiotherapy (therapeutic ultrasound). The range of motion (ROM) of the wrist and fingers, hand function measured by the Action Research Arm Test (ARAT), and pain levels using the Numerical Pain Rating Scale (NPRS) were assessed: pre-intervention (before session 1) and immediately post-intervention (after session 4).
    Results: Both MaRhyThe® and therapeutic ultrasound significantly improved hand mobility, function, and pain. Group A showed greater mean improvements and larger effect sizes across most outcomes compared to Group B. Wrist flexion improved by 19.5° (d = 1.23) in Group A versus 7° (d = 1.11) in Group B. ARAT total scores increased by 15.2 points (d = 1.04) in Group A and 12.9 points (d = 0.88) in Group B. Pain (NPRS) decreased by 3.1 points in Group A (d = 2.59) and 3.0 points in Group B (d = 3.18). Between-group comparisons favoured MaRhyThe® with significant gains in wrist and finger ROM and lower post-treatment pain scores.
    Conclusion: MaRhyThe® demonstrated superior post-treatment outcomes across most ROM parameters, with greater pain relief. These pilot findings support further investigation of MaRhyThe® in hand tendon rehabilitation protocols.
    Keywords: Physical Therapy Modalities, Hand Injuries, Tendon Injuries, Rehabilitation, Postoperative Care, Matrix Rhythm Therapy.
  40. Interv Pain Med. 2026 Mar;5(1): 100744
       Background: Glossopharyngeal nerve block provides long-term pain relief in glossopharyngeal neuralgia patients; the nerve block can be performed using landmarks or ultrasound guidance. The present study has evaluated the efficacy of ultrasound-guided glossopharyngeal nerve block utilizing the small-sized hockey stick probe.
    Methods: The present study was a prospective, observational study; twenty-five adult patients diagnosed with primary glossopharyngeal neuralgia not responding to medical management were included in this clinical trial. Glossopharyngeal nerve block was done under ultrasound guidance using hockey stick probe; patients having more than 50% reduction in numeric rating scale (NRS) score, for at least 2 h following nerve block, were enrolled in the study and followed for 6 months. The primary outcome measure was the severity of pain, measured by NRS score. Secondary outcome measures were percentage pain relief, reduction of analgesic usage, and PHQ-9 score for psychological assessment. All these assessments were done prior to the procedure and at 2 weeks, 1, 3 and 6 months after the procedure.
    Results: We observed significant reduction in the NRS scores at 2 weeks (1.7 ± 1.6), 1 (1.9 ± 1.3), 3 (1.8 ± 1.3) and 6 months (2.1 ± 1.5) after Glossopharyngeal nerve block as compared to the baseline (6.1 ± 1.3; P value < 0.05); we also observed a significant pain relief (76%) and significantly reduced analgesic consumption (68%) and PHQ-9 scores (2.3 ± 1.7) compared to the baseline values (P value < 0.05).
    Conclusion: Ultrasound-guided glossopharyngeal nerve block with a linear array hockey stick probe provided significant pain relief in 75% of study participants with glossopharyngeal neuralgia over a six-month follow-up period.
    Keywords:  Glossopharyngeal neuralgia; Image guided; Neck pain; Nerve block; Sternocleidomastoid muscle; Ultrasound guided
    DOI:  https://doi.org/10.1016/j.inpm.2026.100744
  41. Acta Orthop Belg. 2025 Sep;91(3): 257-264
       Objective: The aim of this study was to evaluate the effectiveness of Intra-articular abdominal adipose-derived mesenchymal stem cell (AD-MSC) therapy in patients diagnosed with knee osteoarthritis and to compare its effectiveness in patients with grade 2 and grade 3 osteoarthritis.
    Material and Method: The study group comprised 48 patients over the age of 18 that were diagnosed with Grade II or Grade III (Kellgren-Lawrence) primary knee osteoarthritis. Two-way comparative knee radiography was performed for all patients before the procedure. Intra-articular abdominal adipose-derived mesenchymal stem cell (AD-MSC) therapy was applied to all patients. The patients were evaluated with the VAS and WOMAC index before the treatment and 3 months and 6 months after the treatment.
    Results: A statistically significant decrease was found in the six-month follow-up WOMAC and VAS scores compared to the pre-treatment scores regardless of the grade of their osteoarthritis (p <0.001).
    Conclusion: In conclusion, it was observed that the intra-articular injection of the AD-MSCs provided satisfactory functional recovery and pain relief for patients with knee osteoarthritis at six-month follow-up. No procedure-related adverse events were observed during the follow-up period.
    DOI:  https://doi.org/10.52628/91.3.10897
  42. J Musculoskelet Neuronal Interact. 2026 Mar 01. 26(1): 1-12
       OBJECTIVES: To determine the force-length relationship, muscle thickness (MT), pennation angle (PA) and echo-intensity (EI) of the medial gastrocnemius (MG) in HSD/hEDS compared to healthy controls.
    METHODS: The maximal MG force-length relationship was determined throughout ankle passive ROM in 11 individuals with HSD/hEDS and 11 healthy age- and sex-matched controls. MG fascicle length (FL), MT, PA and EI were measured using ultrasonography. MG force was calculated from plantarflexion moments and MG FL. Sarcomere lengths (SL) were estimated from changes in FL and assuming an optimal SL of 2.64 μm at optimal fascicle length.
    RESULTS: HSD/hEDS were 36% weaker across the ankle ROM (p = 0.047). Optimal FL was significantly shorter in HSD/hEDS (34.8±8.1 mm) compared to controls (43.6±6.9 mm; p = 0.013). A shallower descending limb of the force-length relationship was seen in HSD/hEDS (p <0.001). MT, PA, and EI were similar between groups (p > 0.05).
    CONCLUSION: HSD/hEDS were weaker at all measured fascicle lengths, despite similar muscle architecture (MT, PA) and quality (EI) suggesting that reduced neuromuscular activation may contribute to muscle weakness in this population. Rehabilitation interventions should consider addressing joint-angle specific strength deficits in HSD/hEDS.
    Keywords:  Ehlers-Danlos Syndrome; Joint Instability; Muscle Strength; Muscle Weakness
  43. Regen Ther. 2026 Mar;31 101078
       Introduction: Osteoarthritis is an increasingly prevalent condition with limited conservative treatments. Platelet-rich plasma (PRP) therapy has gained attention, but its efficacy may depend on the type used. In particular, leukocyte-rich (LR-PRP) and leukocyte-poor (LP-PRP) formulations may influence outcomes, yet direct comparisons are limited.
    Methodology: a systematic literature search and analysis of clinical trials, through PubMed database, were conducted to evaluate the effect of leukocyte - rich and leukocyte - poor platelet rich plasma in the treatment of osteoarthritis.
    Results: 11 articles were analyzed individually, including both in vivo and in vitro studies, to examine the effect of leukocytes in PRP.
    Conclusion: This review highlights that current evidence is insufficient to determine whether adding leukocytes to PRP provides a clinical benefit in the treatment of osteoarthritis. Overall, results generally show no significant differences between LR-PRP and LP-PRP, suggesting that both may be effective. Although leukocytes were initially thought to induce inflammation, there is no conclusive evidence that local reactions are directly caused by them. Given the limitations of existing studies, further research is required to clarify the role of leukocytes in PRP therapy.
    Keywords:  Leukocytes; Osteoarthritis; platelet rich plasma
    DOI:  https://doi.org/10.1016/j.reth.2026.101078
  44. J Exp Orthop. 2026 Jan;13(1): e70673
      The global increase in total knee arthroplasty has led to greater examination of postoperative recovery, particularly the effectiveness and purpose of rehabilitation. Although surgery reliably reduces pain and improves patient-reported assessments of function, objectively measured physical activity commonly declines after surgery and often remains below preoperative levels for prolonged periods. This mismatch exposes shortcomings in traditional outcome measures and challenges longstanding assumptions about predictable, linear recovery. Emerging evidence from recent trials questions the clinical impact of conventional preoperative and postoperative rehabilitation programmes. At the same time, national registry data show that inadequate restoration of daily activity carries significant long-term socioeconomic consequences. These findings collectively indicate a need to move beyond protocol-driven models of rehabilitation towards a deeper understanding of the biological, behavioural and contextual factors that shape recovery. It proposes a conceptual shift towards personalised, dynamically reassessed recovery pathways informed by objective activity measurement, patient-centred outcomes and mechanistic understandings of postoperative physiology. The central question is not whether rehabilitation is required, but how to identify which individuals need targeted therapy, at what point in their recovery, and through which interventions. Reframing rehabilitation in this way is essential to closing the gap between symptomatic improvement and meaningful functional recovery after knee replacement surgery. Level of Evidence N/A, narrative commentary.
    Keywords:  physical therapy; prehabilitation; recovery of function; rehabilitation; total knee arthroplasty
    DOI:  https://doi.org/10.1002/jeo2.70673
  45. Sports Med Open. 2026 Mar 02. pii: 20. [Epub ahead of print]12(1):
       BACKGROUND: Despite the proposed link between psoas major (PM) muscle dysfunction and low back pain (LBP), the relationship remains unclear. This study aimed to investigate the association between PM muscle properties, particularly stiffness, and chronic LBP in elite athletes.
    METHODS: Ninety-nine elite athletes (age: 10 to 32 years) from gymnastics and wushu (kung fu) teams were recruited. Fifty-three had chronic LBP. PM muscle stiffness (measured by ultrasound shear wave elastography), strength, and flexibility were measured on both sides. LBP severity was assessed with the Numeric Pain Rating Scale and Oslo Sports Trauma Research Center Questionnaire on Health Problems. ANCOVA and partial correlation were conducted to analyze the association between included outcome measures and LBP, with regression analysis identifying confounding factors. Statistical significance was set at P ≤ 0.05.
    RESULTS: Increased PM stiffness of the affected side was significantly associated with LBP, especially when the pain was on the dominant side (17.2% increase; mean difference [MD] = 3.21 kPa; P < 0.001) and to a lesser extent on the non-dominant side (8.7% increase; MD = 1.65 kPa; P = 0.009). Higher PM stiffness correlated with greater LBP-related dysfunction (r = 0.349, P = 0.020). No associations were found between PM strength or flexibility and LBP (all P > 0.05).
    CONCLUSION: PM muscle stiffness, but not strength or flexibility, is associated with chronic LBP and related dysfunctions. These findings highlight a potential link between PM stiffness and LBP in high-risk sports. Further longitudinal research is warranted to clarify the temporal and causal relationships.
    Keywords:  Elite athletes; Low back pain; Muscle stiffness; Psoas muscle; Shear wave modulus
    DOI:  https://doi.org/10.1186/s40798-026-00983-5
  46. J Hand Surg Am. 2026 Mar 04. pii: S0363-5023(26)00126-7. [Epub ahead of print]
       PURPOSE: Arthroscopic transosseous foveal repair is a widely accepted technique for restoring distal radioulnar (DRU) joint stability in patients with triangular fibrocartilage complex (TFCC) foveal tears. The optimal method of final fixation remains controversial. This study compared postoperative outcomes between two fixation methods in transosseous suture repair: the conventional manual tie technique and the knotless suture anchor technique.
    METHODS: We retrospectively reviewed 70 patients who underwent arthroscopic TFCC foveal repair procedures between April 2015 and August 2024. Thirty-three procedures were performed using the manual tie technique, and 37 procedures were performed using the knotless suture anchor technique. Clinical evaluations included grip strength; wrist range of motion; Quick Disabilities of the Arm, Shoulder and Hand score; visual analog scale for pain; and Modified Mayo Wrist Score (MMWS). Multivariate logistic regression analysis was used to identify independent predictors of favorable outcomes, defined as a postoperative MMWS ≥ 80.
    RESULTS: Both techniques yielded significant postoperative improvements in grip strength, wrist motion, pain, and functional scores. Compared with the manual tie technique, the knotless anchor technique resulted in greater postoperative-wrist flexion and a larger flexion-extension arc. Although no significant differences were detected between groups in Quick Disabilities of the Arm, Shoulder and Hand score, visual analog scale score, or MMWS on univariate analysis, multivariate logistic regression identified the knotless anchor technique as an independent predictor of favorable outcomes, together with preoperative-grip strength and preoperative MMWS.
    CONCLUSIONS: The manual tie technique and knotless suture anchor technique were effective for arthroscopic transosseous foveal repair of TFCC tears; however, the knotless anchor method was independently associated with better functional outcomes. These findings suggested that knotless anchor fixation may provide clinical advantages over the conventional manual tie technique.
    TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
    Keywords:  Arthroscopy; knotless suture anchor; transosseous foveal repair; triangular fibrocartilage complex
    DOI:  https://doi.org/10.1016/j.jhsa.2026.01.021
  47. J Hand Surg Eur Vol. 2026 Mar 01. 17531934261415827
       INTRODUCTION: This systematic review evaluates the efficacy and safety of prosthetic arthroplasty of the ulnar head and distal radioulnar joint (DRUJ).
    METHODS: A comprehensive literature search identified studies reporting functional and safety outcomes of DRUJ prosthetic arthroplasty for 10 or more cases. Primary outcomes included function, pain, and implant survival. Secondary outcomes were satisfaction, grip strength, range of pronation-supination, complications and reoperations.
    RESULTS: Forty-three case series were included; of those, 25 reported outcomes of semi-constrained bipolar DRUJ arthroplasty with the APTIS prosthesis (n = 706 cases) and 18 of unconstrained ulnar head replacement (DRUJ hemiarthroplasty; n = 819 cases). Both the APTIS prosthesis and the participating ulnar head prostheses resulted in functional improvements which were statistically significant and clinically meaningful in most studies in all included functional scales. For pain, mean postoperative improvement ranged from 1.2 to 8.0 (weighted mean 4.3 points) in APTIS and from 1.7 to 5 points (weighted mean 2.5 points) in ulnar head prostheses. Weighted mean long-term survival (>7 years) was 89% with the APTIS and 87% with ulnar head prostheses. Reoperations were required in a weighted mean of 25% of cases in the APTIS group and 23% in the ulnar head arthroplasty group.
    CONCLUSIONS: Both APTIS DRUJ arthroplasty and ulnar head replacement yield substantial functional improvements and good long-term survivorship. However, complication and incidence of reoperation remain high. These findings highlight the need for improved implant design and material innovation to enhance long-term safety and outcomes.
    Keywords:  Aptis; DRUJ instability; Herbert; Scheker; distal radioulnar joint; distal ulna; prosthetic arthroplasty; ulnar head
    DOI:  https://doi.org/10.1177/17531934261415827
  48. Oral Surg Oral Med Oral Pathol Oral Radiol. 2026 Mar 03. pii: S2212-4403(26)00021-0. [Epub ahead of print]
       OBJECTIVE: This study investigates the effects of botulinum toxin type A (BoNT-A) injections on mandibular bone morphology in bruxism patients through the use of panoramic radiography.
    STUDY DESIGN: Sixty patients were assessed and categorized into three groups: bruxism with BoNT-A injection, bruxism without BoNT-A injection, and healthy controls. Morphological classifications (G0-G3), mandibular angle depth (AMD), antegonial notch depth (AND), and cortical thickness (CT) were evaluated at baseline and after a six-month period.
    RESULTS: The BoNT-A group demonstrated substantial decreases in G2 and G3 categories and enhancements in cortical thickness relative to noninjected and control groups (P < .05). However, no significant alterations were detected in AND values.
    CONCLUSION: The data indicate that BoNT-A diminishes problematic mandibular bone apposition and facilitates cortical remodeling by decrease excessive occlusal stresses. Panoramic radiographs can function as an effective instrument for both diagnosing bruxism and assessing treatment results.
    DOI:  https://doi.org/10.1016/j.oooo.2026.01.011
  49. J Back Musculoskelet Rehabil. 2026 Mar 03. 10538127261424311
      Background and purposeOsteoarthritis is a public health issue in an aging society with no radical cure. Complementary therapies such as Tai Chi might be beneficial for patients with osteoarthritis.MethodsThe present meta-analysis summarized current evidence on the effectiveness of Tai Chi in patients with osteoarthritis. PubMed, Embase, and Cochrane Library databases were systematically searched for RCTs published from inception up to March 2020. The primary outcome was the pain score on the Western Ontario and McMaster Universities Arthritis Index (WOMAC). For pooled outcomes, standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated.ResultsWe identified 13 trials with data from 817 patients. The results indicated that patients who practiced Tai Chi exercise showed more significant improvements in pain (SMD, -1.40; 95% CI, -2.17 to -0.63; P < 0.001), physical function (SMD, -1.54; 95% CI, -2.28 to -0.81; P < 0.001), and stiffness (SMD, -1.19; 95% CI, -1.94 to -0.44; P < 0.001) than the control group. Subgroup analysis data were consistent with the overall findings. Meta-regression showed that Tai Chi sessions, publication year, sample size, and Jadad score did not affect the therapeutic effects of Tai Chi. Tai Chi had a significant impact on the physiological and psychological health of patients with knee osteoarthritis.ConclusionsThis meta-analysis provides moderate-to-high quality evidence that Tai Chi has a clinically significant beneficial impact on knee osteoarthritis, with effect sizes exceeding minimal clinically important differences for pain and function.
    Keywords:  Tai Chi; knee osteoarthritis; meta-analysis; randomized controlled trial
    DOI:  https://doi.org/10.1177/10538127261424311
  50. BMJ Case Rep. 2026 Mar 05. pii: e270977. [Epub ahead of print]19(3):
      Anterior cutaneous nerve entrapment syndrome (ACNES) is an under-recognised cause of chronic abdominal or chest wall pain in the era of increased reliance on diagnostic imaging and laboratory studies. We present the case of a man in his mid-60s who was hospitalised eight times over a 2-year period for unexplained abdominal pain despite extensive non-diagnostic workups. Careful re-examination, focusing on physical examination, demonstrated a positive Carnett's sign, leading to the diagnosis of ACNES. Ultrasound-guided trigger point injection with corticosteroid and local anaesthetic led to immediate symptom relief, confirming the diagnosis. This case highlights the diagnostic value of the physical exam and the need to consider ACNES in patients with persistent abdominal pain and normal imaging and laboratory studies, as early diagnosis can reduce symptom burden, prevent unnecessary testing and improve patient outcomes.
    Keywords:  Gastroenterology; General practice / family medicine; Pain
    DOI:  https://doi.org/10.1136/bcr-2025-270977
  51. Joint Bone Spine. 2026 Mar 03. pii: S1297-319X(26)00017-5. [Epub ahead of print] 106048
      Knee osteoarthritis is increasingly recognized as a whole-organ disease in which synovial inflammation and neurovascular alterations contribute substantially to pain and functional impairment. In recent years, genicular artery embolization (GAE) has emerged as a minimally invasive, image-guided intervention targeting pathological synovial hypervascularization in patients with symptomatic knee osteoarthritis refractory to conservative treatment. This narrative review summarizes the pathophysiological rationale underlying GAE, focusing on the role of synovitis, angiogenesis, and neurovascular coupling in osteoarthritic pain. We provide an overview of the anatomical and technical principles of the procedure and critically appraise the available clinical evidence, including observational studies and randomized sham-controlled trials. While early observational studies have consistently reported clinically meaningful pain reduction, randomized evidence remains heterogeneous and highlights a substantial placebo response. Current data suggest that GAE may benefit selected patients with mild-to-moderate disease and inflammatory phenotypes, whereas its role in advanced osteoarthritis remains limited. Finally, we discuss unresolved issues, including patient selection, choice of embolic agents, and long-term safety, and outline future research directions required to define the place of GAE in the therapeutic algorithm of knee osteoarthritis.
    Keywords:  Genicular artery embolization; Knee osteoarhrtitis; pain
    DOI:  https://doi.org/10.1016/j.jbspin.2026.106048
  52. EFORT Open Rev. 2026 Mar 02. 11(3): 175-182
      Femoral head fractures are complex and severe injuries, usually associated with hip dislocation. They typically result from high-energy trauma. Therefore, a low index of suspicion is required for diagnosis in these contexts. Initial presentation can vary depending on coexisting injuries but is typically an emergency and requires immediate reduction of the joint. Delays result in worse outcomes for patients. Pelvic radiographs are recommended before and after joint reduction, with Judet, inlet and outlet views to identify any associated acetabular fracture and pelvic ring injury. Computed tomography helps determine the fracture configuration and classification, commonly using the Pipkin classification. Definitive fracture management depends on patient demographics, fracture pattern and associated injuries. Pipkin type I and II fractures with minimal displacement and an anatomically congruent hip joint may be treated conservatively. Otherwise, surgical open reduction internal fixation via the anterior approach is recommended. Young patients with Pipkin type III injuries usually require open reduction internal fixation via the anterior or posterior approach, while elderly patients may need total hip arthroplasty. Pipkin type IV fractures may require a combination of open reduction internal fixation approaches with or without trochanteric flip osteotomy. Femoral head fractures often have poor outcomes, with type III and IV fractures having worse outcomes than types I and II. Early complications include infection and sciatic nerve palsy. Late complications include avascular necrosis, heterotopic ossification and post-traumatic arthritis. This article considers the anatomy, diagnosis and evidence-based management strategies for femoral head fractures.
    Keywords:  Pipkin; anatomy; diagnosis; femoral head; fracture; hip dislocation; management; surgical approach
    DOI:  https://doi.org/10.1530/EOR-2025-0026
  53. Pain Med Case Rep. 2026 Feb;10(1): 1-6
       BACKGROUND: Chronic pain in patients with multiple overlapping pain syndromes is often refractory to conventional treatments. Peripheral nerve stimulation (PNS) has emerged as a promising neuromodulation therapy, especially when spinal cord stimulation (SCS) is contraindicated or ineffective.
    CASE REPORT: We present the case of a 68-year-old man with severe chronic pain in the left hand and wrist following carpal tunnel release surgery, superimposed on a background of cervical and lumbar radiculopathies, degenerative cervical spondylosis, sacroiliitis, and failed back surgery syndrome. Conservative therapies (including transcutaneous nerve stimulation, physical therapy, injections, and opioids) as well as an intrathecal pump and a thoracolumbar SCS trial were moderately successful in relieving chronic back pain but had failed to relieve his hand pain. The patient was not a candidate for a cervical SCS due to extensive cervical spondylosis and stenosis. The patient underwent a 10-day trial of an externally powered PNS system targeting the left median nerve at the wrist, achieving > 50% pain reduction. This was followed by permanent implantation of the PNS device. The intervention produced an immediate pain score reduction from 9/10 to 4/10, and at 12 months postimplant, the patient reported complete pain relief (0/10) with restored hand function, improved sleep, and quality of life. No device-related complications occurred, and no reprogramming was required.
    CONCLUSIONS: In this complex pain patient, the externally powered Freedom® Peripheral Nerve Stimulator System provided effective, focal analgesia where other therapies (including SCS) were not effective or viable, highlighting the potential of PNS as a safe and efficacious treatment for postsurgical neuropathic pain of the upper extremity.
    Keywords:  Peripheral nerve stimulation; carpal tunnel syndrome; chronic pain; median nerve; upper extremity; wrist pain
  54. Medicine (Baltimore). 2026 Mar 06. 105(10): e47755
      Open reduction and tension band internal fixation is the standard treatment for patellar fractures. Although this surgery aids early weight-bearing and joint movement, full recovery of knee function - particularly the ability to perform straight leg raising (SLR) - often still requires a longer period, which can affect the patients' daily activities, such as getting out of bed and dressing. To enhance its recovery, we implemented an early high knee walking (HKW) protocol from June 2023. This retrospective analysis was conducted on 48 patients from June 2023 to April 2025, with 42 eligible patients included in the analysis. Among them, 22 patients initiated HKW training (intervention group) on postoperative day 7, while 20 patients received assisted straight leg raise training (assisted straight leg raising; control group). Self-reported measures assessed at postoperative days 7, 14, 28, and 100 included visual analogue scale score, SLR and seated knee extension (SKE) ability, and thigh circumference difference. The results showed no differences between the 2 groups on postoperative day 7. At 14, 28, and 100 days postoperatively, both groups demonstrated significant improvements compared to baseline (day 7) in all indexes (P < .05 or P < .01). Additionally, compared to the control group, the intervention group demonstrated quicker pain relief (Day 14, 28, 100; P < .05) and swelling reduction (Day 14; P < .05), superior SKE (day 28; P < .05) and SLR function (day 100; P < .05), and less muscle atrophy (day 100; P < .01). The results of this study suggest that HKW exercise for the postoperative patients with patellar fractures facilitates pain relief, SLR and SKE recovery, and reduces thigh swelling and muscle atrophy.
    Keywords:  exercise; high knee walking; patellar fracture; postoperative
    DOI:  https://doi.org/10.1097/MD.0000000000047755
  55. Rom J Morphol Embryol. 2025 Oct-Dec;66(4):66(4): 719-726
      Patients with lung cancer commonly report a broad spectrum of symptoms driven by both side effects of treatment and aggressive progression of disease. As a result, growing evidence indicates that pulmonary rehabilitation (PR) can meaningfully improve exercise performance, health-related quality of life (QoL), fatigue, and dyspnea. The core objective of any PR program is to improve the patient's overall functional profile. In this study conducted at the Marius Nasta Institute of Pneumophthisiology, Bucharest, Romania, we assessed the functional profile of patients with non-small cell lung cancer (NSCLC) - specifically lung adenocarcinoma (LUAD) and squamous cell carcinoma (SCC) - and explored its relationship with key biomarkers: programmed death-ligand 1 (PD-L1), anaplastic lymphoma kinase (ALK), and epidermal growth factor receptor (EGFR). Functional status was evaluated using the International Classification of Functioning, Disability, and Health-Rehabilitation Core Set (ICF-RCS). Exercise capacity was measured with the 6-Minute Walk Distance (6MWD) test, health-related QoL was evaluated using the validated European Organization for the Research and Treatment of Cancer Core Quality of Life 30-item Questionnaire (EORTC QLQ-C30) questionnaire and anxiety levels were assessed with the Generalized Anxiety Disorder 7-item (GAD-7) instrument. The study identified a correlation between the patients' functional profiles and specific biomarker patterns. Based on these findings, we believe that incorporating biomarker information into functional evaluation could help build a clearer and more clinically relevant understanding of patient needs during PR, ultimately contributing to more personalized comprehensive care. We propose that future research should examine whether the relationship between biomarker status and functional, psychological, and QoL outcomes remains consistent following a structured rehabilitation program, and whether these biological markers can predict which patients are most likely to experience functional and emotional improvements. Such insight could prove valuable in guiding individualized rehabilitation strategies for patients with NSCLC.
    Keywords:  biomarkers; non-small cell lung cancer; pulmonary rehabilitation
    DOI:  https://doi.org/10.47162/RJME.66.4.10
  56. Cureus. 2026 Jan;18(1): e102616
      Eagle syndrome is a form of glossopharyngeal neuralgia, usually seen in older adults and characterized by pain in the throat, side of the face, and neck due to an elongated styloid process or calcified stylohyoid ligament. This condition can be managed with multimodal analgesia by multidisciplinary teams and may require surgical intervention for definitive relief. A 65-year-old female presented to the pain management clinic with chronic recurrent left-sided submandibular and neck pain. The pain was moderate in intensity (numeric rating scale (NRS) 5/10), episodic, sharp, burning, and electric shock-like in nature, and was associated with coughing and swallowing. She obtained only temporary and partial relief from medications. Her symptoms were successfully managed with repeated office-based ultrasound-guided glossopharyngeal nerve blocks using 3 ml of 0.25% ropivacaine and 4 mg dexamethasone. Significant improvement was maintained for approximately three months after the procedure.
    Keywords:  eagle syndrome; glossopharyngeal neuralgia; pain management; peripheral nerves; ultrasound guided intervention
    DOI:  https://doi.org/10.7759/cureus.102616
  57. Front Med (Lausanne). 2026 ;13 1790566
       Background: Knee osteoarthritis (OA) is a major cause of global disability, necessitating cost-effective interventions. While balneotherapy and acquatic exercise (AE) are established conservative treatments, evidence regarding their combined efficacy remains limited. This study evaluated the clinical impact of a combined program that include balneotherapy and AE in natural mineral waters - compared to balneotherapy alone in patients with mild-to-moderate knee OA in Health Resorts. Primary outcomes included pain intensity, joint range of motion (AROM/PROM), and functional indices [Western Ontario and McMaster Universities (WOMAC), Lequesne's Algofunctional Index for Knee (LAI-knee)]. Secondary outcomes encompassed quality of life (Short Form-12) and psychological well-being (Pittsburgh Sleep Quality Index and Psychological General Well-Being Index).
    Methods: 66 patients were allocated to either an experimental group (EG), receiving a combined two-week protocol of balneotherapy and AE in salt-bromine-iodine thermal water, or a control group (CG), receiving balneotherapy alone.
    Results: Both groups demonstrated significant short-term improvements in all the assessments included in study. However, the EG exhibited a superior reduction in pain intensity (31% vs. 13% in CG) and more consistent gains in bilateral active range of motion (AROM). Linear mixed-effects models confirmed significant time effects for WOMAC, LAI, and SF-12 Physical Component scores for both groups. Regression analysis revealed that higher BMI and age negatively correlated with mobility gains.
    Conclusion: A combined intervention significantly enhances the analgesic and functional benefits of standard balneotherapy. By leveraging physical properties of mineral water, the combined protocol addresses both the mechanical and biological components of knee OA. These findings support the integration of water exercise with balneotherapy in Health Resorts for degenerative joint diseases and the personalization of treatment based on patients age and BMI.
    Keywords:  balneotherapy; health resort; hydrokinesitherapy; knee OA; knee osteoarthritis; pain; quality of life; treatment efficacy
    DOI:  https://doi.org/10.3389/fmed.2026.1790566
  58. Pain Res Manag. 2026 ;2026 7008601
       Objectives: To explore existing evidence and identify whether dry needling (DN) intervention has effects on sleep disturbance in patients with musculoskeletal pain.
    Methods: The Arksey and O'Malley framework guided the scoping review methodology. Seven databases were searched for clinical trials investigating DN in musculoskeletal pain disorders. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Data extraction included study year, location, study design, musculoskeletal pain disorder, needling intervention type, and sleep outcome measure utilized.
    Results: After duplicates were removed, 2292 articles were identified, and 33 studies were included in the review after independent screening. Two supplemental searches (May 2023 and January 2024) in addition to a hand search yielded an additional 146 articles. A total of 21 of those studies were also included, increasing the total to 54 studies. A total of 46 (84%) articles were RCTs and 8 (16%) were single-group, pretest-posttest clinical trials. A total of 9 studies were of optimal quality (PEDro score ≥ 8), and 11 were of moderate-to-high quality (PEDro score = 7).
    Discussion: Due to significant variability in intervention, sleep outcome measurement, patient population, and study methodology quality, the evidence is mixed and inconclusive to support or refute the effects of DN on sleep deficits in individuals with musculoskeletal pain. However, future studies investigating the effects of needling interventions on musculoskeletal pain conditions should include valid sleep outcome measurements if considered.
    Keywords:  dry needling; musculoskeletal; outcome measures; pain; sleep disturbance
    DOI:  https://doi.org/10.1155/prm/7008601