bims-ricfun Biomed News
on Rehabilitation ICF
Issue of 2026–04–19
83 papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica
  1. Ultrasound Evaluation and Treatment of Posterior Medial Antebrachial Cutaneous Nerve Injury Following Cubital Tunnel Release.
  2. Rheological properties and clinical efficacy of a chemically modified hyaluronic acid for joint health enhancement.
  3. Comparing the Efficacy and Safety of Intra-articular Injection Treatments for Hip Osteoarthritis: A Systematic Review and Network Meta-analysis.
  4. The influence of early exercise (Proprioceptive Neuromuscular Facilitation-based muscle activation) on functional prognosis in patients with distal radius fracture: A retrospective observational study.
  5. The role of ulnar nerve hypermobility in the etiology of ulnar nerve neuropathy at the elbow - A retrospective cohort study.
  6. Lower Positive Body Pressure Walking Significantly Improves Pain And Function In Individuals With Knee Osteoarthritis: A Pilot Randomized Clinical Trial.
  7. Platelet-Rich Plasma vs. Placebo Injections in Achilles tendinopathy: A systematic Review and Meta-analysis of Randomized Controlled Trials.
  8. Safety and Efficacy of Intra-articular Cell-Free Fat Extract Injection in Patients With Symptomatic Knee Osteoarthritis.
  9. Bisphosphonate Pamidronate for Treatment of Complex Regional Pain Syndrome Type I: A Systematic Review and Meta-Analysis.
  10. LatinVisco: A Latin American Expert Consensus on Viscosupplementation for Knee Osteoarthritis.
  11. Maintaining the benefits of pulmonary rehabilitation in COPD: a SPACE to fill.
  12. Knee Injectables in Young Athletes: Evidence, Recommendations, and Clinical Application.
  13. The social dimensions of fibromyalgia scientific research: an international classification of functioning, disability, and health-based perspective.
  14. Where Pain Hides Deep: Ultrasound-Guided Management of a Rare Brachialis Myotendinous Cyst.
  15. Imaging in the diagnosis and characterization of tennis leg.
  16. Ultrasound of the distal tibiofibular syndesmosis.
  17. The effect of a topical curcumin formulation (VAS-101) on knee pain in adults with knee osteoarthritis: a randomised, double-blind, placebo-controlled study.
  18. Incidence of Carpal Tunnel Syndrome After the Diagnosis of Ulnar Neuropathy.
  19. Outcomes of Treating Myofascial Pain by Injecting Masseter and Temporalis Muscles with Botulinum Toxin.
  20. AAPM&R guidance statement on platelet rich plasma for knee osteoarthritis.
  21. Genicular Nerve Radiofrequency Ablation for Persistent Postsurgical Pain After Total Knee Arthroplasty: A Systematic Review of Clinical Effectiveness and Safety.
  22. Wrist Flexor Spasticity and Hemiplegic-Contralateral Median Nerve Latency Asymmetry After Stroke: A Bilateral Nerve Conduction and Ultrasound Study.
  23. Effect of scapular stabilization and mobilization-based rehabilitation on pain and shoulder function in subacromial impingement syndrome: a randomized controlled trial.
  24. Reliability of quadriceps and hamstring muscle stiffness measured by ultrasound shear wave elastography in patients with knee osteoarthritis.
  25. The Added Value and the Efficacy of Preoperative Physiotherapy on Degenerative Diseases of the Lumbar Spine: A Systematic Review.
  26. Reconstruction of Partial Achilles Tendon Rupture After Corticosteroid Injection Using the Midsubstance SpeedBridge Technique With Platelet-Rich Plasma: A Case Report.
  27. Ultrasound-guided injection strategies for lateral epicondylitis: a multicenter randomized comparison of corticosteroid, platelet-rich plasma, and ozone.
  28. Beyond joint damage: mechanistic insights into osteoarthritis pain.
  29. Efficacy of a Mobile Health-Supported Home-Based Resistance Exercise After Ultrasound-Guided Corticosteroid Injection in Chronic Subacromial Bursitis: A Randomized Controlled Trial.
  30. Carpal tunnel syndrome in systemic sclerosis: prevalence, clinical correlates, and diagnostic performance of ultrasound compared with nerve conduction studies.
  31. Loading rate during weight acceptance: Differential contributions of the knee and contralateral ankle with aging.
  32. Morphological-biomechanical dual-cornerstone framework: quantitative ultrasound for electrodiagnostically negative carpal tunnel syndrome.
  33. Retrospective analysis of platelet rich plasma injections for ankle osteoarthritis in athletic population.
  34. MRI abnormal patterns of lumbar paraspinal muscles in patients with amyotrophic lateral sclerosis and lumbosacral radiculopathy: a comparative study.
  35. Comparison of the Therapeutic Effects of Intra-Articular Injection of Ozone and Corticosteroid in Knee Osteoarthritis.
  36. Case report of a 54-year-old line specialist following surgical reconstruction of a complete chronic pectoralis major muscle tear.
  37. Severe Spaghetti Wrist Injury With Complete Laceration of Median Nerve, Radial and Ulnar Arteries, and Multiple Flexor Tendons: A Case Report and Literature Review.
  38. Effectiveness of exercise therapy versus passive conservative treatments for rotator cuff-related shoulder pain: a systematic review and meta-analysis of randomized controlled trials.
  39. Full-endoscopic rhizotomy for degenerative lumbar facet joint syndrome: a systematic review and meta-analysis.
  40. Response to the "Letter to the Editor" regarding "Efficacy and safety of a single intra-articular injection of mannitol-combined hyaluronan in patients with knee osteoarthritis - A double-blinded randomized clinical study".
  41. Time-dependent comparative efficacy of non-surgical treatments for pain relief in lateral epicondylitis: a systematic review and network meta-analysis.
  42. Predictors of Achieving the Patient Acceptable Symptom State at 5 Years After Primary Hip Arthroscopy in High-Level Adult Athletes.
  43. Ultrasound Assessment of the Anterolateral Ligament of the Knee: A Narrative Review of Current Evidence, Interpretative Limitations, and Clinical Context.
  44. Platelet-Rich Plasma in Anterior Cruciate Ligament Reconstruction: An Updated Systematic Review and Meta-Analysis of Clinical and Radiological Outcomes.
  45. Utility of Ultrasound-Based Dynamic Assessment in Physical Therapy for Far-Lateral Lumbar Disc Herniation: A Case Report.
  46. Descriptive analysis of platelet-rich plasma injection therapy in chronic musculoskeletal pain.
  47. Comparative effectiveness of water-based versus land-based rehabilitation in COPD: a systematic review and network meta-analysis of randomized controlled trials.
  48. Longitudinal Changes in Kinesiophobia, Psychological Readiness, and Knee Function Across Anterior Cruciate Ligament Reconstruction Rehabilitation Phases.
  49. Effects of ultrasound-guided nerve hydro-dissection on severe post stroke shoulder pain: a pilot study.
  50. Effects of an Exercise-Assisting Mobile App (Osteoarthritis-Rehabilitation Assistant [O-RA]) on Rehabilitation Outcomes in Older Adults: Randomized Controlled Parallel Clinical Trial.
  51. Physical rehabilitation interventions for hand function in people with systemic sclerosis.
  52. Establishing Normative Sonographic Muscle Ratios for the Rotator Cuff in a Military Beneficiary Population.
  53. Functional Outcome of Unstable Intertrochanteric Femur Fracture Treated Surgically With Long Proximal Femoral Nail.
  54. Preliminary observations on the effect of Kegel exercise and perihip muscle exercise training and combined training on transversus abdominis thickness in healthy young women.
  55. Percutaneous electrical nerve stimulation as alternative to nerve blocks for the diagnosis of facet joint syndrome in patients with non-specific chronic low back pain: a clinical trial protocol.
  56. Advocacy, Support, and Rehabilitation Programs Federal Programs.
  57. Surgical Timing and Rehabilitation (STaR) for Multiple Ligament Knee Injuries: Study Protocol for a Multicenter Integrated Clinical Trial.
  58. Huber Proprioceptive Training and Alpha-Lipoic Acid: A New Approach in Optimizing Nerve Function in Patients With Chronic Low Back Pain.
  59. Arthroscopic Microfracture for Focal Glenoid Osteochondral Lesions in Young Active-Duty Military Patients: A Minimum 10-Year Follow-Up.
  60. Secondary Carpal Tunnel Syndrome Due to Flexor Tenosynovitis in a Diabetic Patient.
  61. Muscle strength recovery after total hip arthroplasty and its impact on quality of life: findings from a Romanian cohort.
  62. Return to Golf After Shoulder Arthroplasty: An ASES Multicenter Study Predicting Performance after rTSA and aTSA.
  63. Combined mode-kinetic chain exercise with and without core stability exercises on patients with knee osteoarthritis.
  64. Osteopathy for Musculoskeletal Pain: A Systematic and Umbrella Review of Effectiveness and Safety.
  65. Carpal Tunnel Release Surgical Techniques.
  66. Incidental detection of congenital absence of the long head of the biceps tendon during shoulder arthroscopy: A case report.
  67. [Experience of using Relatox in the complex rehabilitation of patients with lower limb spasticity after focal brain damage of various etiologies].
  68. Assessing the Safety and Efficacy of a Noninvasive Device in the Management of Musculoskeletal Pain Using Low-Level Light Therapy: Double-Blinded, Randomized, Placebo-Controlled, Multicentric Study.
  69. Beyond muscle activation: the role of biomechanical properties of muscles in determining dynamic knee valgus in female volleyball players.
  70. Weight-bearing computed tomography reveals greater anterior tibial translation and femorotibial rotation than magnetic resonance imaging in chronic anterior cruciate ligament deficiency: A prospective observational study.
  71. Evaluation of the Relationship Between Radial Translation and Functional Outcomes in Nonsurgical and Surgically Treated Distal Radius Fractures.
  72. The sarcopenia-pain connection: why mechanisms matter for patient care?
  73. Medial compartment knee contact force during gait reflects symptom severity in advanced knee osteoarthritis.
  74. Restoring balance in the distal radioulnar joint: advancements in minimally invasive surgical approaches.
  75. Open reduction and internal fixation vs acute total hip arthroplasty for geriatric acetabular fractures: A multicenter matched cohort study.
  76. Patellofemoral Pain After Knee Trauma: Exploring Clinical, Biomechanical, and Muscle Strength Variables.
  77. Patellofemoral Pain is a Multifactorial Complex Condition; Are We Missing a Multidisciplinary Approach to its Management? Time for a Paradigm Shift.
  78. Psychological Factors, Central Sensitization, and Insomnia as Potential Prognostic Factors for Short-Term Pain and Disability in Patients With Frozen Shoulder: A Multicentric Prospective Single-Cohort Study.
  79. Comprehensive quantitative analysis of muscle cross-sectional area and intramuscular fat infiltration of hip using modified DIXON MRI based on chemical shift encoding technique.
  80. 3D functional balancing in hip arthroplasty: Why the future of total hip arthroplasty must move beyond 2D thinking.
  81. Comparing the Subvastus and Medial Parapatellar Approaches in Total Knee Arthroplasty.
  82. Acupuncture-Integrated Chinese-Western Medicine Accelerated Rehabilitation Protocol Following Acute Achilles Tendon Repair: A Prospective Cohort Study.
  83. Prediction of type 1 complex regional pain syndrome with the presence of diaschisis in hemiplegic supratentorial stroke patients.
  1. Diagnostics (Basel). 2026 Mar 24. pii: 960. [Epub ahead of print]16(7):
    Ultrasound Evaluation and Treatment of Posterior Medial Antebrachial Cutaneous Nerve Injury Following Cubital Tunnel Release.
    Wei-Ting Wu, Ke-Vin Chang, Levent Özçakar.
      This case highlights the diagnostic value of high-resolution ultrasonography in identifying postoperative injury of the posterior branch of the medial antebrachial cutaneous nerve (MABCN) following cubital tunnel surgery. A 45-year-old man developed localized pain, warmth, and paresthesia extending from the medial epicondyle to the proximal anterior forearm one month after ulnar nerve decompression and anterior transposition. Physical examination revealed focal allodynia and a positive Tinel sign. Because previous surgery may substantially alter the anatomical location of the surrounding nerves, electrodiagnostic localization can be technically challenging and less reliable. Ultrasonography therefore played a key diagnostic role. The images demonstrated the normal sonoanatomy of the MABCN and its anatomical relationship with the basilic vein and ulnar nerve, followed by pathologic findings of focal enlargement of the posterior branch adjacent to postoperative scar tissue. These imaging features, together with a positive sonographic Tinel sign, supported the diagnosis of localized nerve irritation. Ultrasound-guided hydrodissection using 5% dextrose and methylcobalamin resulted in marked clinical improvement, with the Visual Analog Scale pain score decreasing from 9 to 2. This case is particularly illustrative because postoperative injury of the MABCN may mimic recurrent cubital tunnel syndrome yet typically produces purely sensory symptoms confined to the medial elbow region. Targeted ultrasonographic evaluation can reveal subtle postoperative nerve pathology and guide effective ultrasound-guided intervention.
    Keywords:  entrapment; hydrodissection; injection; medial antebrachial cutaneous nerve; ultrasonography
    DOI:  https://doi.org/10.3390/diagnostics16070960
  2. Drugs Context. 2026 ;pii: 2025-10-4. [Epub ahead of print]15
    Rheological properties and clinical efficacy of a chemically modified hyaluronic acid for joint health enhancement.
    Francesco Benazzo, Andrea Bernetti.
      Osteoarthritis (OA) significantly impairs mobility and quality of life, with its prevalence rising due to ageing populations. Intra-articular hyaluronic acid (HA) injections, or viscosupplementation, restore synovial fluid viscosity, enhancing lubrication and joint function. Hymovis®/Hymovis ONE®, an advanced HA-based viscosupplement, incorporates hydrophobic modifications via MO.RE. technology, forming a reversible network that enhances viscoelasticity and lubrication. Hymovis exhibits self-healing properties, retaining elasticity and viscosity under mechanical stress, and demonstrates enhanced resistance to oxidative damage and enzymatic degradation. Evidence also supports its shock absorption and lubricating efficacy, which may exceed that of some cross-linked HA products. Clinical trials confirm its effectiveness in reducing OA-related pain and improving function in the knee, shoulder and hip. Additionally, Hymovis supports meniscal healing, as evidenced by MRI, highlighting its role in conservative meniscal tear management. In sports medicine, Hymovis alleviates joint overuse injuries, reducing pain, enhancing function, and potentially delaying OA progression. Hymovis ONE, specifically indicated for mild-to-moderate knee and hip OA, offers a single-injection solution with long-term benefits. Limitations of this narrative review include a predominance of observational studies and relatively small sample sizes in some clinical trials. Nonetheless, current evidence suggests that Hymovis/Hymovis ONE represent effective intra-articular viscosupplementation options, leveraging MO.RE. technology to improve HA properties. Their clinical efficacy and safety make them valuable for OA management, meniscal injury treatment and joint health maintenance in active individuals, ultimately contributing to improved quality of life.
    Keywords:  Hymovis; MO.RE. technology; athletes; hyaluronic acid; joint health; joint lubrication; meniscal tears; osteoarthritis; pain relief; viscosupplementation
    DOI:  https://doi.org/10.7573/dic.2025-10-4
  3. Orthop J Sports Med. 2026 Apr;14(4): 23259671261419519
    Comparing the Efficacy and Safety of Intra-articular Injection Treatments for Hip Osteoarthritis: A Systematic Review and Network Meta-analysis.
    Chunlin Liu, Jiawen Deng, Aazad Abbas, Darius Luke Lameire, Hassaan Abdel Khalik, Daniel Whelan, Tim Dwyer, Jaskarndip Chahal.
       Background: Hip osteoarthritis is a debilitating condition that leads to progressive joint pain and stiffness. While total hip arthroplasty provides definitive treatment, intra-articular injections offer a less invasive alternative for patients. Several injection options are available, including corticosteroids (CS), hyaluronic acid (HA), and platelet-rich plasma (PRP). Previous reviews and network meta-analyses have compared the short-term efficacy of these injections, but it remains unclear if a particular injection provides superior symptom relief for up to 12 months.
    Purpose: To provide an updated summary of the current hip intra-articular injection literature and compare the efficacy of all injection types at 3 months, 6 months, and 12 months.
    Study Design: Systematic review; Level of evidence, 1.
    Methods: Four databases were queried: Web of Science, Embase, MEDLINE, and Cochrane Central Register of Controlled Trials. The primary outcome measures were the Western Ontario and McMaster Universities Osteoarthritis Index Total Score (WOMAC-Total) and the visual analog scale (VAS) at 3, 6, and 12 months. The Cochrane risk-of-bias tool was used to assess study quality. Treatment effects were expressed as mean differences for the WOMAC-Total and standardized mean differences for the VAS.
    Results: A total of 14 studies were included in the final analysis with 1254 participants. Eight unique intra-articular injection types were identified: CS, HA of varying molecular weights (low, high, and ultra-high), PRP, CS + high molecular weight HA, PRP + HA, and standard of care/placebo (SOC/PBO) group. When compared with SOC/PBO, no statistically significant differences in WOMAC-Total and VAS outcomes were observed between any injections at 3, 6, or 12 months.
    Conclusion: There were no statistically significant differences in WOMAC-Total and VAS outcomes at any time point between all injection types to baseline. Future studies should compare the long-term efficacy of various intra-articular injections with a control and examine the efficacy of combined injections.
    Registration: CRD42024574937 (PROSPERO identifier).
    Keywords:  hip osteoarthritis; intra-articular injection; network meta-analysis
    DOI:  https://doi.org/10.1177/23259671261419519
  4. J Hand Ther. 2026 Apr 13. pii: S0894-1130(26)00014-1. [Epub ahead of print]
    The influence of early exercise (Proprioceptive Neuromuscular Facilitation-based muscle activation) on functional prognosis in patients with distal radius fracture: A retrospective observational study.
    Hong Tang, Pushan Yang, Xu Wang, Biao Zhao, Kun Ling.
       BACKGROUND: Early rehabilitation is important after distal radius fractures, but evidence for Proprioceptive Neuromuscular Facilitation remains limited.
    PURPOSE: This study aimed to evaluate the effect of a Proprioceptive Neuromuscular Facilitation-based early exercise program on functional prognosis after surgical fixation of distal radius fractures, compared with standard postoperative care.
    STUDY DESIGN: A retrospective observational study.
    METHODS: In this retrospective observational study, 114 surgically treated patients from January-December 2023 were allocated to a control group receiving standard postoperative care or an early exercise group receiving additional Proprioceptive Neuromuscular Facilitation-based exercise starting 3-4 weeks after surgery. Outcomes included wrist range of motion, grip strength, pain level, Disabilities of the Arm, Shoulder, and Hand (DASH) score, time to return to work, and radiographic healing at 12 weeks.
    RESULTS: At 6 weeks after surgery, the early exercise group showed greater wrist flexion (4.9°), extension (4.3°), pronation (5.4°), and supination (4.9°) than the control group. Grip strength was 3.1 kg higher (p = 0.002), Visual Analog Scale pain scores were 1.4 points lower (p = 0.001), and the mean DASH score was better (p = 0.015). Time to return to work was shorter (p = 0.002), and the healing rate at 12 weeks after surgery was higher (p = 0.002).
    CONCLUSIONS: Proprioceptive Neuromuscular Facilitation-based early exercise significantly enhanced wrist motion, grip strength, pain relief, and disability reduction, leading to faster return to work and improved fracture healing. These results support incorporating structured Proprioceptive Neuromuscular Facilitation-based rehabilitation into standard postoperative care for distal radius fractures.
    Keywords:  Distal radius fracture; Early exercise; Functional prognosis; Rehabilitation intervention
    DOI:  https://doi.org/10.1016/j.jht.2026.02.002
  5. Brain Spine. 2026 ;6 106024
    The role of ulnar nerve hypermobility in the etiology of ulnar nerve neuropathy at the elbow - A retrospective cohort study.
    Debora Garozzo, Eman Abusharbain, Fatma Alzahmi, Giovanni Cocco, Shahad Alhoot, Dana Gefe, Kenan Saleh, Muhammed Tayob, Ruzaina Sait, Khizer Rana.
       Introduction: Ulnar neuropathy at the elbow (UNE) is the second most frequent entrapment syndrome. Ulnar nerve hypermobility (UNH) has been considered an anatomical variant, but recent studies suggest it may predispose to neuropathy. We investigated the role of dynamic UNH in UNE.
    Research question: Does ulnar nerve hypermobility contribute to the development of ulnar neuropathy at the elbow, and can dynamic ultrasound classification of ulnar nerve instability improve diagnosis and management of UNE?
    Material and methods: A series of 220 adult patients with suspected UNE was retrospectively reviewed. All patients underwent clinical examination, bilateral dynamic ultrasound of the ulnar nerve, and nerve conduction studies and electromyography (EDX). An ultrasound-based grading of ulnar nerve hypermobility (Grade 0 = stable, Grade 1 = subluxation, Grade 2 = dislocation) was applied.
    Results: UNE was confirmed in 199 patients of 220 (90.4%), 21 (9.6%) had alternative diagnoses. Ulnar nerve hypermobility was frequent among UNE patients: 55 (25%) Grade 2 and 61 (28%) Grade 1 in at least one elbow. Dynamic ultrasound of 440 elbows identified Grade 1 hypermobility in 126 elbows (28.6%) and Grade 2 in 80 elbows (18.2%), with most hypermobile nerves corresponding to confirmed UNE, supporting a strong association between increasing nerve instability and neuropathy.
    Discussion and conclusion: Dynamic ultrasound grading of nerve mobility (Grades 0-2) provided potentially useful diagnostic information. Combining high-resolution ultrasound with EDX may offer a more comprehensive diagnostic approach, particularly in cases where electrodiagnostic findings are normal despite abnormal ultrasound features. However, because this study was retrospective and lacked an internal non-UNE control group, the findings and proposed score should be interpreted as exploratory and require prospective validation before routine clinical adoption.
    Keywords:  Cubital tunnel syndrome; Electrodiagnostic studies; Snapping ulnar nerve; Ulnar nerve entrapment at the elbow; Ulnar nerve hypermobility; Ultrasound
    DOI:  https://doi.org/10.1016/j.bas.2026.106024
  6. Am J Phys Med Rehabil. 2026 Apr 10.
    Lower Positive Body Pressure Walking Significantly Improves Pain And Function In Individuals With Knee Osteoarthritis: A Pilot Randomized Clinical Trial.
    Prakash Jayabalan, Yelyzaveta Merenzon, Audrey Lazar, Sanchita Sen, Vikram Darbhe, Elizabeth Gray, Thomas Schnitzer, Leah Welty.
       OBJECTIVES: Body weight-supported (BWS) walking therapies, lower body positive pressure (LBPP) treadmills or aquatic pool walking could provide a treatment to reduce pain in individuals with knee osteoarthritis (OA). Our objective was to examine the potential benefits of BWS for individuals with knee OA.
    DESIGN: Parallel group randomized clinical trial. Forty-nine (n=49) participants, aged>50 with knee OA, randomly assigned to one of three groups: (1)Control (n=16), (2)Aquatic (n=17), and (3)LBPP (n=16). Interventional groups had two 30-minute walking sessions for eight weeks. The control group received no active treatment. Primary outcome was change in Knee Injury and Osteoarthritis Outcome Score (KOOS)-Pain from baseline to 8 weeks. Secondary outcomes included other KOOS subscales, six-minute walk test (6-MWT), joint kinematics, and serum cytokine concentration.
    RESULTS: Forty-one participants completed the trial. Changes in KOOS-Pain from baseline to 8 weeks were statistically significant and clinically relevant in the LBPP group (15.3,95% CI 5.0,25.6). Changes in the other groups were not statistically significant (Aquatic 0.9(95% CI -7.8,9.6); and Control -3.3(95% CI -12.3,5.7). Post-hoc analyses indicated improvements were significantly larger with LBPP. This group improved in 6-MWT(58.9m, 95% CI 26.1,91.7) and most KOOS sub-scales. Improvements in KOOS-Pain at 8 weeks in the LBPP group were associated with increased knee flexion(P=0.02). Only the control group had significant increases in IL-1β(P=0.04) and IL-1RA(P=0.02) concentration at 8 weeks.
    CONCLUSIONS: This is the first randomized controlled trial of BWS for knee OA and showed benefits of LBPP treadmill walking. Future, larger studies should assess effect size, sustained benefits and cost-effectiveness.
    Keywords:  Exercise; Knee osteoarthritis; Rehabilitation
    DOI:  https://doi.org/10.1097/PHM.0000000000003007
  7. J Foot Ankle Surg. 2026 Apr 15. pii: S1067-2516(26)00101-8. [Epub ahead of print]
    Platelet-Rich Plasma vs. Placebo Injections in Achilles tendinopathy: A systematic Review and Meta-analysis of Randomized Controlled Trials.
    Ahmad Assi, Ali Hamyeh, Rami Mohanna, Marc Boutros, Wissam Boueri, Amer Sebaaly.
       BACKGROUND: Achilles tendinopathy (AT) is a prevalent overuse injury marked by pain, functional limitation, and structural tendon degeneration. Platelet-rich plasma (PRP) has emerged as a biological treatment alternative due to its regenerative potential. Nonetheless, its efficacy compared to placebo for AT remains unclear. This meta-analysis aimed to evaluate the effectiveness of PRP injections versus placebo in the treatment of AT.
    METHODS: A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, and Google Scholar (first 20 pages) through January 2025. Eligible studies were English-language randomized controlled trials that compared PRP with placebo in patients clinically diagnosed with Achilles tendinopathy. Outcomes included VISA-A (Victorian Institute of Sport Assessment-Achilles) scores, VAS (Visual Analog Scale) pain scores, and radiological findings. Data were extracted and analyzed using Review Manager 5.4. Heterogeneity was assessed using I² statistics.
    RESULTS: Four randomized controlled trials including 337 patients reported VISA-A scores at 3 and 6 months. No statistically significant differences were found between PRP and placebo at either timepoint. Similarly, VAS scores from three studies (n=283 at 3 months; n=270 at 6 months) showed no significant difference. Radiological outcomes from two studies revealed no significant changes in tendon thickness or vascularity between groups.
    CONCLUSION: This meta-analysis found no significant clinical or radiological benefit of PRP injections compared to placebo in the treatment of Achilles tendinopathy. Larger, high-quality trials are needed to confirm these findings and standardize treatment protocols.
    LEVEL OF EVIDENCE: I.
    Keywords:  Achilles tendinopathy; Meta-analysis; Placebo-controlled trial; Platelet-rich plasma
    DOI:  https://doi.org/10.1053/j.jfas.2026.04.005
  8. Orthop J Sports Med. 2026 Apr;14(4): 23259671261431840
    Safety and Efficacy of Intra-articular Cell-Free Fat Extract Injection in Patients With Symptomatic Knee Osteoarthritis.
    Kai Xie, Zhuoxuan Jia, Lin Sun, Jiangdong Wu, Xu Jiang, Liao Wang, Songtao Ai, Zhifeng Yu, Wenjie Zhang, Chenglei Liu, Zheyuan Yu, Mengning Yan.
       Background: Cell-free fat extract (CEFFE) has shown promising therapeutic effects on osteoarthritis (OA) in preclinical studies, but its clinical role remains unclear.
    Purpose: To evaluate the safety and efficacy of intra-articular autologous CEFFE injections for symptomatic early- and mid-stage knee OA.
    Study Design: Randomized controlled trial; Level of evidence, 2.
    Methods: A total of 24 participants were randomly allocated to 1 of 4 groups to receive 5 weekly injections of (1) hyaluronic acid (HA, active comparator), (2) low-dose CEFFE (containing 1 mL CEFFE), (3) medium-dose CEFFE (containing 1.5 mL CEFFE), or (4) high-dose CEFFE (containing 2 mL CEFFE). Autologous CEFFE was prepared by spin, emulsification, and filtration after abdominal liposuction, effectively removing lipid and cellular components. Information regarding adverse effects was collected. Routine blood tests, C-reactive protein levels, liver function tests, and kidney function tests were performed at baseline and at the 24-week follow-up to assess systemic toxic effects of CEFFE injection. The clinical effectiveness of CEFFE injections was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS) scores. Magnetic resonance imaging (MRI) was used to detect changes in bone marrow lesions (BMLs) and cartilage loss at baseline and at the final follow-up.
    Results: All patients received the corresponding injections and were followed up for 24 weeks without serious adverse events or clinically significant laboratory abnormalities. At the final follow-up, the mean WOMAC pain subscale score was 5 ± 1.3 in the HA group, compared with 1.5 ± 1.5, 1.7 ± 1, and 1.8 ± 1.7 in the low-, medium-, and high-dose CEFFE groups, respectively. All 3 CEFFE doses were more effective than an intra-articular HA injection for pain relief and recovery of knee function, as assessed by WOMAC and VAS scores. Semi-quantitative MRI analysis indicated greater improvements in BML in CEFFE-treated participants (57.1%) than in controls (16.7%). None of the research groups exhibited a significant improvement in cartilage loss compared with baseline.
    Conclusion: CEFFE is an alternative biosafety method for the biological treatment of knee OA, with symptom improvement and BML reduction, and has promising potential for clinical application.
    Keywords:  bone marrow lesions; cell-free fat extract; knee; osteoarthritis
    DOI:  https://doi.org/10.1177/23259671261431840
  9. J Pain Palliat Care Pharmacother. 2026 Apr 17. 1-13
    Bisphosphonate Pamidronate for Treatment of Complex Regional Pain Syndrome Type I: A Systematic Review and Meta-Analysis.
    Anas R Alashram.
      This review aims to evaluate the evidence regarding effectiveness of intravenous pamidronate in individuals with complex regional pain syndrome type I (CRPS I), focusing on pain reduction, functional outcomes, and dosing strategies. "PsycINFO, PubMed, EMBASE, SCOPUS, Web of Science, PEDro, and CINAHL" were searched until October 2025. The quality of the studies was evaluated using the Physiotherapy Evidence Database (PEDro) scale for randomized controlled trials (RCTs), the ROBINS-I tool for non-randomized controlled trials (non-RCTs), and the Newcastle-Ottawa Scale for observational studies. Seven studies met the eligibility criteria. Two studies were of high quality, two had a high risk of bias, and three had a moderate risk of bias. The meta-analysis of three studies showed a non-significant effect size of 0.722 (Cohen's d, p = 0.381) with high heterogeneity (Q = 17.203, p < 0.001; I2 = 88%) and a wide prediction interval (-19.257 to 20.701), highlighting high uncertainty and the need for cautious interpretation due to the limited studies. Intravenous pamidronate may offer symptom relief for individuals with CRPS I, particularly in reducing pain and edema and improving function. Given the heterogeneity of the studies and limited sample sizes, findings should be interpreted as preliminary and hypothesis-generating rather than definitive.
    Keywords:  Bisphosphonates; complex regional pain syndrome; neuropharmacology; pamidronate; therapy
    DOI:  https://doi.org/10.1080/15360288.2026.2659129
  10. Complement Ther Med. 2026 Apr 12. pii: S0965-2299(26)00068-3. [Epub ahead of print] 103385
    LatinVisco: A Latin American Expert Consensus on Viscosupplementation for Knee Osteoarthritis.
    Paulo Cesar Hamdan, Zartur José Barcelos Menegassi, Marcos Britto da Silva, Paulo Jose Llinas Hernandez, Rafael Fernando Serrano Sanchez, Juan José Scali, Guillermo Zivietcovich Cornejo, Allan Chew, Gustavo Antonio Gil Noriega, Gustavo Nasswetter, Antonio Ortega, Jesus Ignacio Cardona Medina, Osvaldo Andres Riveros, José Montes Ferrin, Ronny Saavedra Lara, Luiz Gomez, Douglas Francisco Toche Hermano, Luiz Diego Castro Sanchez, Carlos Bruno Reis Pinheiro, Carlos Adolfo Pasquel Correa, Fabio Ramos Costa.
       BACKGROUND: Osteoarthritis (OA) continues to rise worldwide, mainly driven by population aging, and represents one of the leading causes of pain and disability in older adults. Knee OA is the most prevalent form and constitutes a significant clinical and economic challenge. In response to this need, the LATINVISCO group brought together specialists from various Latin American countries to develop evidence-based recommendations on viscosupplementation (VS) and other intra-articular (IA) therapies.
    METHODS: Twenty-five experts in traumatology, orthopedics, rheumatology, and sports medicine participated. Fifteen questions were formulated using the PICO method, and a systematic search was performed in PubMed, Scopus, Cochrane, Scielo, and Elsevier, covering the last decade. Of the 396 studies identified, 57 highly relevant ones were selected. The GRADE scale was applied, and a modified Delphi method was used to reach consensus.
    RESULTS: Recent evidence confirms that intra-articular hyaluronic acid (HA) reduces pain, improves function, and has a favorable safety profile. VS is recommended in OA grades I-III and may be considered in grade IV. Platelet-rich plasma (PRP) showed superiority over VS in some parameters, while VS demonstrated additional usefulness in patellofemoral chondropathy and periarticular conditions. Likewise, VS showed good cost-effectiveness and safety in patients on anticoagulant or antiplatelet therapy.
    CONCLUSION: The LATINVISCO consensus provides updated recommendations adapted to the Latin American context, supporting VS as an effective, safe, and cost-effective intervention for knee OA. These guidelines facilitate therapeutic standardization and optimize clinical outcomes.
    Keywords:  Knee osteoarthritis; Latin America; hyaluronic acid; platelet-rich plasma; viscosupplementation
    DOI:  https://doi.org/10.1016/j.ctim.2026.103385
  11. Thorax. 2026 Apr 15. pii: thorax-2025-224633. [Epub ahead of print]
    Maintaining the benefits of pulmonary rehabilitation in COPD: a SPACE to fill.
    Arwel W Jones.
      
    Keywords:  Pulmonary Disease, Chronic Obstructive; Pulmonary Rehabilitation
    DOI:  https://doi.org/10.1136/thorax-2025-224633
  12. J Bone Joint Surg Am. 2026 Apr 16.
    Knee Injectables in Young Athletes: Evidence, Recommendations, and Clinical Application.
    Ashraf Hantouly, Asheesh Bedi, Moin Khan.
      Knee pain resulting from acute trauma and overuse injury is common among athletes and represents a major cause of reduced performance, time loss from sport, and long-term sequelae including osteoarthritis. Injectable therapies are frequently used as a nonoperative treatment modality to alleviate symptoms and facilitate early return to sport. This review evaluates the current evidence on commonly used knee injectables in the younger athletic population with pre-arthritic knee pain, including corticosteroids, hyaluronic acid, platelet-rich plasma (PRP), and other biologics. Relevant literature was identified without restriction on study design and with a focus on athlete-specific outcomes and clinical applicability. Overall, the available evidence on knee injectables for athletes remains limited, heterogeneous, and largely extrapolated from older, nonathletic cohorts. In the absence of available athlete-specific guidelines, most injectables carry weak and/or conditional recommendations, highlighting the need for individualized treatment and shared decision-making. High-quality, sport-specific clinical trials are required to establish clear guidelines and optimize outcomes in this population.
    DOI:  https://doi.org/10.2106/JBJS.26.00267
  13. Pain Rep. 2026 Jun;11(3): e1433
    The social dimensions of fibromyalgia scientific research: an international classification of functioning, disability, and health-based perspective.
    André Pontes-Silva.
      
    DOI:  https://doi.org/10.1097/PR9.0000000000001433
  14. Am J Phys Med Rehabil. 2026 Mar 26.
    Where Pain Hides Deep: Ultrasound-Guided Management of a Rare Brachialis Myotendinous Cyst.
    Berkay Yalçınkaya, Ahmet Furkan Çolak, Harun Kürşat Karademir, Murat Kara.
      
    DOI:  https://doi.org/10.1097/PHM.0000000000002997
  15. Skeletal Radiol. 2026 Apr 15.
    Imaging in the diagnosis and characterization of tennis leg.
    Ivan Rodrigues Barros Godoy, Tatiane Cantarelli Rodrigues, Maithaa Alharfi, Dyan V Flores.
      Tennis leg is a common cause of acute posteromedial calf pain and encompasses a spectrum of injuries involving the posterior calf. Although initially described as rupture of the plantaris tendon, clinical, surgical, and imaging evidence indicates that injury to the medial head of the gastrocnemius at the distal myotendinous junction is the most frequent cause. Less commonly, the lateral gastrocnemius, the soleus, or the plantaris may be affected. Clinical presentation is often nonspecific and overlaps with important alternative diagnoses, including Achilles tendon rupture, deep vein thrombosis, and ruptured Baker cyst, making imaging helpful for accurate diagnosis. Sonography (US) and magnetic resonance imaging (MRI) are the principal imaging modalities used in assessment. US is well suited for initial evaluation due to its wide availability, dynamic capability, and high spatial resolution for superficial tissues. It enables panoramic assessment of the posterior calf, allowing detection of muscle fiber disruption, myoaponeurotic injury, and intermuscular hematoma, while also facilitating exclusion of common mimics. MRI provides superior characterization of deep or subtle myoconnective tissue injuries and allows comprehensive assessment of injury extent and associated findings. In addition, MRI supports standardized grading using established muscle injury classification systems, which is valuable for prognosis and return-to-play decision-making. Emerging imaging techniques like quantitative MRI and artificial intelligence-based analysis may improve injury prognostication and individualized return-to-play assessment. This review summarizes the relevant anatomy, definitions, mechanisms of injury, and characteristic US and MRI features of tennis leg. Current classification systems are outlined, and key differential diagnoses and potential complications are also discussed.
    Keywords:  Achilles; MRI; Medial gastrocnemius; Plantaris; Soleus; Tennis leg; US
    DOI:  https://doi.org/10.1007/s00256-026-05212-4
  16. J Ultrason. 2026 Apr;26(104): 20260004
    Ultrasound of the distal tibiofibular syndesmosis.
    Abdullah Alkorbi, Ramy Mansour.
       Purpose: To review the anatomy, biomechanics, ultrasound technique, and imaging features of the distal tibiofibular syndesmosis, and to highlight the role of ultrasound relative to MRI in evaluating syndesmotic injuries.
    Methods: A literature-based narrative review was performed, focusing on normal and pathologic ultrasound findings of the syndesmotic ligaments and their MRI correlation.
    Results: The anterior inferior tibiofibular ligament is the most commonly visualized and injured structure. It is best seen in an oblique axial plane, extending from the tibial to the fibular tubercle. It appears as a thin, well-defined, fibrillar, echogenic band crossing the syndesmotic interval. The posterior inferior tibiofibular ligament is best seen posteriorly, slightly deeper and thicker, extending between the posterior tibia and fibula. Ultrasound examination of acute ligament injury shows ligament thickening, loss of normal fibrillar pattern, fiber discontinuity, or the presence of small, avulsed bone fragments. Ultrasound of chronic ligament injury shows thinning, irregularity, or heterogeneous scarring. Hypoechoic fibrotic changes or calcification at insertion sites can also be seen. Ultrasound provides high-resolution, real-time imaging capable of detecting ligament tears and assessing tibiofibular instability under stress. Dynamic ultrasound demonstrates good correlation with MRI for identifying acute syndesmotic disruptions, particularly in athletic or acute trauma settings.
    Conclusion: Ultrasound is a valuable and accessible modality for evaluating distal tibiofibular syndesmotic injuries. It complements MRI by providing immediate, functional assessment, aiding in timely diagnosis and management of high ankle sprains. Ultrasound should be considered in the imaging algorithm for suspected syndesmotic injuries, especially in sports and trauma settings.
    Keywords:  AiTFL; PiTFL; ankle syndesmosis; high ankle sprain; ultrasound
    DOI:  https://doi.org/10.15557/jou.2026.0004
  17. Front Pain Res (Lausanne). 2026 ;7 1789088
    The effect of a topical curcumin formulation (VAS-101) on knee pain in adults with knee osteoarthritis: a randomised, double-blind, placebo-controlled study.
    Adrian L Lopresti, Benny Antony, Stephen J Smith.
       Background: The oral delivery of curcumin has been shown in several studies to have beneficial pain-relieving effects for the treatment of knee osteoarthritis. However, there has been limited investigation into its efficacy and tolerability when delivered topically. The purpose of this two-arm, 28-day, parallel-group, randomised, double-blind, placebo-controlled trial was to determine the effects of a topical curcumin gel (VAS-101) on knee pain and symptoms in adults with knee osteoarthritis.
    Methods: Sixty adults aged 45-75 with knee osteoarthritis applied a curcumin or placebo gel to their knee, every second day for 28 days. Outcome measures comprised the Knee Injury and Osteoarthritis Outcome Score (KOOS), daily pain ratings, and several performance-based tests. Rescue oral medication intake was also monitored over time.
    Results: Compared to the placebo, VAS-101 was associated with greater improvements in the KOOS pain score (primary outcome measure) (β: 5.12; 95% CI: 0.47, 9.77; d = 0.62, p = 0.041), and mean daily pain ratings (F3, 225 = 4.42; d = 0.55, p = 0.005). In the VAS-101 group, 39.3% of participants reported feeling either much or very much improved, compared with 13.3% in the placebo group (p = 0.019). Moreover, 32.1% of participants in the VAS-101 group achieved a Minimal Clinically Important Difference, compared to 13.3% in the placebo group, although this group difference was not statistically significant (p = 0.086). There were no group differences in changes in other KOOS subscale scores or the performance-based tests. VAS-101 was well-tolerated, with no significant adverse reactions reported. However, skin staining was observed as expected with topical curcumin, which resolved 2-3 days after application ceased.
    Conclusions: Conservative dosing of a topically applied curcumin-containing gel (VAS-101), administered every two days for 28 days, is associated with moderate reductions in knee pain in adults with knee osteoarthritis. Further investigations utilising larger sample sizes, longer treatment durations, and alternative treatment regimens will be important to identify how these factors affect treatment adherence, tolerance, and efficacy.
    Keywords:  clinical trial; curcumin; knee osteoarthritis; pain; topical; turmeric
    DOI:  https://doi.org/10.3389/fpain.2026.1789088
  18. J Hand Surg Glob Online. 2026 May;8(3): 100970
    Incidence of Carpal Tunnel Syndrome After the Diagnosis of Ulnar Neuropathy.
    Harrison S Fellheimer, Eric DiDomenico, Mahaa Ayub, Magnolia Livingston, William L Justice, Gabriel I Onor, Eric Tecce, Pedro K Beredjiklian.
       Purpose: The purpose of this study is to determine whether patients diagnosed with ulnar nerve lesions (UNLs) have an increased risk of developing carpal tunnel syndrome (CTS).
    Methods: A retrospective cohort study was conducted using the TriNetX database, which contains data of >100 million patients. We identified 360,021 patients with UNLs and matched them 1:1 with controls. The incidence of CTS was assessed at 1, 2, 3, 4, and 5 years following the diagnosis of UNL. Statistical analyses were used to evaluate the development of CTS in the UNL cohort compared with controls.
    Results: Patients with UNL demonstrated a significantly higher risk of developing CTS at all time points. At 1 year post-UNL diagnosis, the risk of CTS was 10.4% in the UNL group versus 3.1% in controls (P < .0001). This difference persisted throughout the 5-year period. Odds ratios similarly indicated a significantly greater likelihood of CTS development in patients with UNL.
    Conclusions: Patients with a history of UNLs are at a significantly increased risk of developing CTS, especially within the first 2 years. This supports the hypothesis that ulnar nerve pathology may precede and increase susceptibility to median nerve compression.
    Type of study/level of evidence: Prognostic III.
    Keywords:  Carpal tunnel syndrome; Incidence; Neuropathy progression; Peripheral nerve; Ulnar neuropathy
    DOI:  https://doi.org/10.1016/j.jhsg.2026.100970
  19. J Maxillofac Oral Surg. 2026 Apr;25(2): 501-508
    Outcomes of Treating Myofascial Pain by Injecting Masseter and Temporalis Muscles with Botulinum Toxin.
    Ahmed M Abdul Rahman, Zahraa M Al-Hawwaz, Sarah A Haji.
       Aims and Objectives: Botulinum toxin (BTX) injections have gained great attention for the management of myofascial pain involving the masticatory muscles as alternative or complementary to other treatments. The objective is to evaluate how effective the botulinum toxin injections in reducing myofascial pain of the masseter and temporalis muscles through assessing pain changes over time and factors influencing treatment outcomes.
    Methods: A prospective clinical study was conducted between January 2019 and November 2024 in Basrah, Iraq. The number of patients to be enrolled was the 320 patients who had myofascial pain and 200 patients had completed the follow-up. Pain intensity was measured on a pain scale at baseline and structural follow-ups on an interval of several follow-ups following botulinum toxin injection on masseter and temporalis muscle tender points.
    Results: The mean pain scores were lower at two years of follow up as compared to the baseline of 7.99 with a standard deviation of 0.79, which had reduced to 3.87 with a standard deviation of 1.53. The highest reduction of pain was experienced during the early follow up but it was sustained. At 8 weeks, younger patients (2635 years) had lower pain scores. There was a small difference in genders and more pain reduction was experienced by married patients. The increased income and education level was correlated with a low score of pain in the early follow-up. But the differences decreased by the two year assessment.
    Conclusion: The effects of Botulinum toxin injections are a large and long-lasting decrease in myofacial pains of the masseter and temporalis muscles. Early pain reaction may depend on demographic and socio-economic factors, but the long-term results seem to be similar.
    Keywords:  Botulinum toxin; Masseter muscle; Myofascial pain; Pain relief; Temporalis muscle
    DOI:  https://doi.org/10.1007/s12663-025-02895-5
  20. PM R. 2026 Apr 16.
    AAPM&R guidance statement on platelet rich plasma for knee osteoarthritis.
    Joanne Borg-Stein, Prathap Jayaram, Berdale S Colorado, Arthur Jason de Luigi, Michael Khadavi, Erek Latzka, William J Naber, Shounuck Patel, Walter I Sussman, Xiaoning Yuan, Kenneth Mautner.
       BACKGROUND: The current nonoperative standard-of-care therapies for knee osteoarthritis (OA) include weight reduction, physical therapy, analgesics, optimization of biomechanics, and intra-articular injection of corticosteroids. Platelet rich plasma (PRP) is an orthobiologic intervention that is increasingly used in patients with knee OA, primarily due to its many key mediators that can potentially reduce joint inflammation thereby improving pain and enhancing overall joint function. The American Academy of Physical Medicine and Rehabilitation (AAPM&R) convened a technical expert panel (TEP) to summarize and assess the evidence for use of PRP in patients with knee OA and synthesize current knowledge into a summary document that can serve as a resource for clinicians. We address many of the questions and decision points that practitioners need to consider for responsible use of PRP in knee OA.
    OBJECTIVE: To develop consensus-based practice recommendations to identify and address gaps in PRP applications in patients with knee OA.
    METHODS: The AAPM&R orthobiologic TEP initiated development of this consensus guidance statement in March 2023. The TEP was responsible for formulating search terms and research questions and synthesizing evidence obtained from a structured literature review that was initially completed in April 2023 and subsequently updated to reflect studies published between May 2023 and June 2025. The recommended actions and best practices in this guidance reflect consensus being achieved by the expert physiatrists and supported by best available evidence, where available. These actions and practices were conceptualized in response to common questions this expert panel frequently encounter in the use and administration of PRP. The TEP was asked to consider the strengths and limitations of available evidence and augment with expert opinion focused on closing knowledge gaps guiding the delivery of PRP in patients with knee OA.
    RESULTS: As a result of the structured literature review and use of a modified Delphi process to achieve consensus on clinical guidance for PRP use in patients with knee OA, the AAPM&R TEP on use of PRP in knee OA arrived at five evidence-based clinical recommendations for PRP management and 11 consensus-based best practices supported by expert opinion and limited evidence.
    CONCLUSION: This consensus guidance addresses common questions about the use of PRP in patients with knee OA and provides actionable recommendations and best practices based on expert opinion supported by best available evidence. Despite their growing availability as point-of-care interventions, orthobiologic therapies remain an evolving area of practice. Robust, dose-dependent randomized controlled trials are needed to more clearly establish the clinical effects of PRP on patient outcomes. Clinical judgment should be exercised and management options tailored to individual patient needs, preferences, and risk profiles.
    DOI:  https://doi.org/10.1002/pmrj.70144
  21. Biomed Res Int. 2026 ;2026(1): e4650605
    Genicular Nerve Radiofrequency Ablation for Persistent Postsurgical Pain After Total Knee Arthroplasty: A Systematic Review of Clinical Effectiveness and Safety.
    Yerdar Shaukhin, Talgat Anashev, Tamerlan Shokanov.
       INTRODUCTION: Total knee arthroplasty is an effective and established surgical treatment of knee osteoarthritis. However, patients report significant perioperative pain and persistent postsurgical pain, which in turn affect the recovery of the patients. Current treatment options include multimodal analgesia. Lately, RFA has been suggested as a procedure for post-TKA pain management. This systematic review is aimed at critically evaluating the current evidence on the effectiveness and safety of RFA of the genicular nerve as a persistent postoperative pain management in patients after TKA.
    METHODS: This systematic review focused on RCTs and cohort studies. The search of the literature was done on several databases.
    RESULTS: Ten studies, including one RCT and nine retrospective cohort studies with a total of 211 patients, were included. Studies included different RFA techniques and imaging modalities. All studies reported improvement in outcome measures after the procedure according to different scales. The bias assessment revealed moderate-to-high risk. The statistical analysis was not done due to heterogeneity of the results.
    CONCLUSION: GNRFA is a promising modality, which reports improvement in outcome measures and absence of adverse effects. It is promising for selected patients but requires RCTs for routine use.
    Keywords:  genicular nerve; knee; osteoarthritis; radiofrequency ablation
    DOI:  https://doi.org/10.1155/bmri/4650605
  22. Diagnostics (Basel). 2026 Apr 03. pii: 1088. [Epub ahead of print]16(7):
    Wrist Flexor Spasticity and Hemiplegic-Contralateral Median Nerve Latency Asymmetry After Stroke: A Bilateral Nerve Conduction and Ultrasound Study.
    Ki-Hyeok Ku, Seongmin Choi, Kyung Chul Noh, Eo Jin Park.
      Background/Objectives: The paretic wrist after stroke may exhibit median nerve conduction abnormalities, but factors underlying hemiplegic-contralateral asymmetry remain uncertain. We compared electrodiagnostic and ultrasonographic wrist measures between sides and assessed predictors of side-to-side differences in distal motor latency (ΔDML) and distal sensory latency (ΔDSL). Methods: We retrospectively analyzed 85 patients with stroke. Distal motor latency (DML), distal sensory latency (DSL), wrist-to-forearm ratio (WFR), and median nerve inlet cross-sectional area (CSA) were measured bilaterally. Paired t-tests evaluated hemiplegic-contralateral differences, and Wilcoxon signed-rank tests were performed as sensitivity analyses. Multivariable linear regression with robust (HC3) standard errors modeled ΔDML as the primary outcome and ΔDSL as the secondary outcome, with wrist flexor spasticity (Modified Ashworth Scale, MAS) specified a priori as the primary explanatory variable; extended models additionally included ΔWFR. Sensitivity analyses re-specified MAS as an ordered category, and complementary linear mixed-effects models using raw bilateral latency values were fitted to assess the robustness of Δ-based modeling. Results: The hemiplegic side showed higher DML (5.51 ± 0.79 vs. 4.81 ± 0.42 ms; mean difference 0.694; p < 0.001), DSL (4.51 ± 0.88 vs. 3.66 ± 0.45 ms; mean difference 0.852; p < 0.001), WFR (1.21 ± 0.30 vs. 1.07 ± 0.16; p = 0.008), and CSA (11.16 ± 3.67 vs. 9.69 ± 2.04 mm2; p = 0.032). MAS was associated with ΔDML (β = 0.336; p < 0.001) and ΔDSL (β = 0.238; p = 0.015). ΔWFR remained significant for ΔDML (β = 1.314; p < 0.001) and ΔDSL (β = 1.371; p = 0.001), improving adjusted R2 from 0.251 to 0.370 for ΔDML and from 0.142 to 0.253 for ΔDSL. Findings remained directionally consistent when MAS was modeled as an ordered category. Complementary mixed-effects models using raw bilateral latency values showed significant hemiplegic-side-by-MAS interactions for both DML (β = 0.425; 95% CI 0.275 to 0.575; p < 0.001) and DSL (β = 0.366; 95% CI 0.195 to 0.537; p < 0.001). Conclusions: In chronic stroke hemiplegia, median nerve latencies and wrist morphology may differ between sides. Wrist flexor spasticity and side-to-side increases in WFR may be independently associated with greater latency asymmetry. These interlimb latency differences should be interpreted as physiological markers of side-to-side median nerve involvement at the wrist rather than as stand-alone diagnostic criteria for carpal tunnel syndrome.
    Keywords:  hemiplegia; median nerve; nerve conduction study; spasticity; stroke; ultrasonography
    DOI:  https://doi.org/10.3390/diagnostics16071088
  23. BMC Musculoskelet Disord. 2026 Apr 13. pii: 330. [Epub ahead of print]27(1):
    Effect of scapular stabilization and mobilization-based rehabilitation on pain and shoulder function in subacromial impingement syndrome: a randomized controlled trial.
    Zeynep Karakuzu Güngör, Mehmet Salih Tan.
      
    Keywords:  Scapular Stabilization; Shoulder Exercise; Shoulder Rehabilitation; Subacromial Impingement Syndrome
    DOI:  https://doi.org/10.1186/s12891-026-09760-7
  24. BMC Musculoskelet Disord. 2026 Apr 15.
    Reliability of quadriceps and hamstring muscle stiffness measured by ultrasound shear wave elastography in patients with knee osteoarthritis.
    Ping Liu, Mohamad Shariff Bin Abdul Hamid, Yueyue Shi, Xiaohan Fan, Hengzhi Deng, Eliza Hafiz, Xuelin Zhang, Yaru Hao.
      
    Keywords:  Diagnostic Imaging; Elasticity Imaging Techniques; Hamstring Muscle; Knee Osteoarthritis; Muscle Stiffness; Quadriceps Muscle; Shear Wave Elastography
    DOI:  https://doi.org/10.1186/s12891-026-09705-0
  25. Physiother Res Int. 2026 Apr;31(2): e70214
    The Added Value and the Efficacy of Preoperative Physiotherapy on Degenerative Diseases of the Lumbar Spine: A Systematic Review.
    Manna Jacopo, Fanigliulo Ciro, Giardulli Benedetto, Testa Marco, Andreoletti Federico.
       BACKGROUND AND PURPOSE: Degenerative Diseases of the Lumbar Spine (DDLS) are typically managed with conservative treatments, while surgery is reserved for cases with severe motor and/or sensory deficits. Preoperative physiotherapy has been shown to improve postoperative outcomes in shoulder, hip, and knee surgeries. However, its effects on the lumbar spine have been poorly investigated. This systematic review aimed to evaluate the efficacy of preoperative physiotherapy on pain, disability, and hospitalisation in individuals with DDLS.
    METHODS: A literature search was conducted in MEDLINE, Cochrane CENTRAL, Scopus, PEDro and EMBASE. Two reviewers independently screened the studies, extracted the data, and assessed the risk of bias. We included randomised controlled trials (RCTs) in which preoperative interventions were delivered by physiotherapists and compared to usual care or other interventions. We conducted meta-analyses on primary outcomes.
    RESULTS: We screened 9.803 studies and included 6 with 5 different study populations. All studies were RCTs that evaluated the efficacy of preoperative physiotherapy compared with usual care in pain and disability. The preoperative interventions were heterogeneous, varying between therapeutic exercise, cognitive-behavioural therapies, and multimodal interventions. The meta-analyses showed no difference between interventions. All studies had a high risk of bias.
    CONCLUSION: The effects of preoperative physiotherapy, compared with usual care, on pain, disability, and hospitalisation among patients with DDLS, are minimal. However, the risk of bias of the included studies and the certainty of evidence, based on the GRADE approach, were very low. Future high-quality, low-bias trials are needed to clarify its effectiveness and identify patient subgroups that may benefit the most.
    Keywords:  degenerative diseases of the lumbar spine; lumbar surgery; physiotherapy; spine surgery; systematic review
    DOI:  https://doi.org/10.1002/pri.70214
  26. Cureus. 2026 Mar;18(3): e104965
    Reconstruction of Partial Achilles Tendon Rupture After Corticosteroid Injection Using the Midsubstance SpeedBridge Technique With Platelet-Rich Plasma: A Case Report.
    Kazuyoshi Minamino, Takahide Sasaki, Tomohiro Matsui, Yukihiro Nakagawa, Hiroshi Yamada.
      In cases of Achilles tendon rupture following local corticosteroid injection, simple end-to-end repair is often technically difficult because of tendon degeneration, and more invasive Achilles tendon reconstruction is commonly required. We report the case of a 56-year-old man with a partial Achilles tendon rupture after local corticosteroid injection who was treated using the Midsubstance SpeedBridge technique combined with platelet-rich plasma (PRP) injection and achieved a favorable clinical outcome. This case suggests that a minimally invasive strategy combining the Midsubstance SpeedBridge technique with biologic therapy may be a feasible therapeutic option for Achilles tendon rupture associated with prior local corticosteroid injection.
    Keywords:  achilles midsubstance speedbridge technique; achilles tendon rupture; corticosteroid injection; minimally invasive surgery; platelet rich plasma injection
    DOI:  https://doi.org/10.7759/cureus.104965
  27. Future Sci OA. 2026 Dec;12(1): 2644326
    Ultrasound-guided injection strategies for lateral epicondylitis: a multicenter randomized comparison of corticosteroid, platelet-rich plasma, and ozone.
    Seyed Ahmad Raeissadat, Davood Khavari Ardestani, Seyyede Elahe Mousavikhah, Masume Bayat, Marzieh Babaee, Mahfam PourAzin.
       OBJECTIVE: To compare the effectiveness of ultrasound-guided injections of corticosteroid, platelet-rich plasma (PRP), and ozone for treating chronic lateral epicondylitis.
    METHODS: This multi-center, three-arm, assessor-blinded, randomized controlled trial enrolled 90 patients with chronic lateral epicondylitis. Participants were randomized in a 1:1:1 ratio to receive a single ultrasound-guided injection of either methylprednisolone, low-leukocyte PRP, or medical ozone. The primary outcomes were pain on the visual analog scale (VAS), function via the Mayo Elbow Performance Index (MEPI), and the pressure pain threshold (PPT), assessed at baseline, 8 weeks, and 6 months.
    RESULTS: Eighty of the 90 randomized patients completed the study. All three treatment groups demonstrated statistically significant improvements from baseline across all primary outcome measures at both the 8-week and 6-month follow-ups (p < .05 for all). However, the primary comparative analysis revealed no statistically significant differences between the corticosteroid, PRP, and ozone groups for any outcome measure at any follow-up time point (p > .05 for all between-group comparisons).
    CONCLUSION: Ultrasound-guided injections of corticosteroid, low-leukocyte PRP, and ozone are all effective treatments for improving pain and function in patients with chronic lateral epicondylitis at 6 months. As no single agent proved statistically superior, the choice of therapy should be guided by a process of shared decision-making that considers factors such as patient preference, cost, and desired timeline for relief.
    Keywords:  Tennis elbow; blood platelets; injections; intra-articular; ozone/therapeutic use; regenerative medicine; treatment outcome
    DOI:  https://doi.org/10.1080/20565623.2026.2644326
  28. Pain Manag. 2026 Apr 14. 1-3
    Beyond joint damage: mechanistic insights into osteoarthritis pain.
    Giacomo Rossettini, Chad E Cook, Jorge Hugo Villafañe.
      
    Keywords:  Osteoarthritis; clinical decision-making; clinical reasoning; knee; pain; physical therapy modalities; rehabilitation; treatment outcome
    DOI:  https://doi.org/10.1080/17581869.2026.2659824
  29. J Clin Med. 2026 Mar 27. pii: 2567. [Epub ahead of print]15(7):
    Efficacy of a Mobile Health-Supported Home-Based Resistance Exercise After Ultrasound-Guided Corticosteroid Injection in Chronic Subacromial Bursitis: A Randomized Controlled Trial.
    Yuan-Chen Chang, Ming-Ta Yang, Yu-Hsuan Cheng, Chun-De Liao, Kwang-Hwa Chang, Pei-Chun Wong, Shih-Wei Huang.
      Background: Corticosteroid injections provide short-term relief for chronic subacromial bursitis but are associated with high recurrence rates. This study investigates the efficacy of a mobile health-supported home-based resistance exercise program compared with exercise education in patients with chronic recurrent subacromial bursitis after ultrasound-guided corticosteroid injections. Methods: Participants with chronic subacromial bursitis were assigned via computer-generated block randomization to either an intervention group receiving ultrasound-guided corticosteroid injections followed by a 12-week home-based exercise program (50 min strengthening and resistance/session, 5 days per week) supported via instant messaging applications, or a control group receiving the same injection followed by printed educational materials covering the same exercise protocol. Shoulder Pain and Disability Index (SPADI) scores, Visual Analog Scale (VAS) pain scores and active pain-free range of motion (ROM) were evaluated by a blinded assessor at weeks 4 and 12. Between-group comparisons were analyzed using two-way ANOVA after confirming normality and homoscedasticity. Results: Fifty-three patients (mean age: 55.6 ± 10.5 years; 47.2% female) were randomized to the intervention (n = 27) or control (n = 26) groups. Significant interaction effects were identified for SPADI (p = 0.040) and ROM (abduction: p = 0.036/ flexion: p = 0.032). Post hoc analysis revealed that the intervention group exhibited a significantly greater reduction in SPADI scores (p = 0.007, d = 0.72) and greater increase in abduction ROM (p = 0.004, d = 0.84) at 12 weeks; both gains surpassed the MCID. Conclusions: A mobile health-supported home-based resistance exercise program can significantly extend the benefits of corticosteroid injections in patients with chronic subacromial bursitis. Trial Registration: NCT06220643, registered 14 December 2023.
    Keywords:  corticosteroid injection; instant messaging; mHealth; subacromial bursitis; subacromial impingement syndrome; telerehabilitation
    DOI:  https://doi.org/10.3390/jcm15072567
  30. BMC Rheumatol. 2026 Apr 11.
    Carpal tunnel syndrome in systemic sclerosis: prevalence, clinical correlates, and diagnostic performance of ultrasound compared with nerve conduction studies.
    Daniela Nicoleta Popescu, Claudiu C Popescu, Oana Morari, Daniela Anghel, Alina Dima, Ioana Adriana Catanoiu, Alice Rakoczy, Magda Ileana Parvu, Mirela Alina Enache, Cătălin Codreanu, Luminita Enache.
      
    Keywords:  Carpal tunnel syndrome; Nerve conduction studies; Systemic sclerosis; Ultrasound
    DOI:  https://doi.org/10.1186/s41927-026-00645-9
  31. Gait Posture. 2026 Apr 07. pii: S0966-6362(26)00095-0. [Epub ahead of print]128 110185
    Loading rate during weight acceptance: Differential contributions of the knee and contralateral ankle with aging.
    Haruki Toda.
       BACKGROUND: An increase in impact loading is associated with the risk of knee osteoarthritis (OA). Dynamic joint stiffness (DJS), defined as the slope of the joint moment-angle relationship during power absorption phase, reflects the joint's power absorption characteristics.
    RESEARCH QUESTION: Do the relationships between loading rate (LR) and knee DJS of loading limb, as well as ankle DJS of trailing limb, differ between younger and older adults?
    METHODS: The AIST Gait Database 2019 included 129 older adults and 107 younger adults walking at a self-selected speed. LR was defined as the first vertical ground reaction force peak divided by the time from initial contact. Knee and ankle DJS were computed in the sagittal plane during power absorption intervals. Group differences were tested, and within-group regressions predicted LR from DJS and joint angular excursions and joint moment impulses at both joints, with covariates.
    RESULTS: Older adults had significantly lower knee DJS and extension moment impulse and higher knee flexion excursion. The ankle dorsiflexion excursion and plantar flexion impulse was significantly smaller in older adults, while ankle DJS were similar between groups. In older adults, LR was negatively associated with knee DJS. In younger adults, LR was negatively associated with ankle DJS and plantar flexion excursion, and positively associated with knee DJS.
    SIGNIFICANCE: Age-related differences in shock absorption may reflect changes in the relative contributions of the knee and ankle, and these findings may help inform future prevention and rehabilitation strategies targeting both joints.
    Keywords:  Dynamic joint stiffness; Loading rate; Mechanical stress; Older adults; Walking
    DOI:  https://doi.org/10.1016/j.gaitpost.2026.110185
  32. Eur J Radiol. 2026 Apr 09. pii: S0720-048X(26)00203-2. [Epub ahead of print]200 112855
    Morphological-biomechanical dual-cornerstone framework: quantitative ultrasound for electrodiagnostically negative carpal tunnel syndrome.
    Wenjie Lu, Shaoqi Chen, Jinzhong Wang, Jianming He, Hanjie Zhu, Ningjie Zhang.
       BACKGROUND: The diagnosis of carpal tunnel syndrome (CTS) is frequently challenging when typical clinical presentations conflict with negative electrodiagnostic (EDX) findings. Quantitative ultrasound (QUS) can detect early neuropathophysiological changes that precede electrophysiological abnormalities; however, its clinical application is limited by the lack of a systematic diagnostic framework.
    OBJECTIVE: To construct and validate an integrative QUS diagnostic framework for patients with clinically suspected CTS but negative or inconclusive EDX results.
    METHODS: We conducted a comprehensive literature search in PubMed and Embase (January 2015-March 2025) for studies reporting diagnostic performance metrics of QUS parameters in CTS. Based on critical evidence synthesis and clinical practice experience, we developed a systematic diagnostic framework integrating key QUS parameters into a clinical decision-making pathway.
    RESULTS: A dual-cornerstone strategy integrating nerve morphology (CSA: AUC 0.75-0.95; sensitivity 75-92%; specificity 83-95%) and tissue biomechanics (SWE: AUC 0.76-0.97; sensitivity 70-95%; specificity 78-95%) provides superior diagnostic value compared with single parameters, with combined models achieving AUC >0.90. We present a practical clinical toolkit comprising diagnostic thresholds, a four-quadrant decision matrix, and a quantitative scoring system. Preliminary validation in 78 EDX-negative patients demonstrated that 92% (72/78) scoring ≥5 points achieved significant symptom improvement following standardized treatment.
    CONCLUSIONS: Through its "morphology + biomechanics" dual-cornerstone strategy, QUS effectively identifies electrophysiologically occult CTS and serves as an indispensable complement to EDX in specific diagnostic scenarios.
    Keywords:  Carpal tunnel syndrome; Cross-sectional area; Diagnostic framework; Electrodiagnostic negative; Quantitative ultrasound; Shear wave elastography
    DOI:  https://doi.org/10.1016/j.ejrad.2026.112855
  33. BMC Musculoskelet Disord. 2026 Apr 13.
    Retrospective analysis of platelet rich plasma injections for ankle osteoarthritis in athletic population.
    Simone Natali, Iacono Venanzio, Daniele Screpis, Gianluca Piovan, Laura Mazzucco, Claudio Zorzi.
      
    Keywords:  Ankle osteoarthritis; Intra-articular injection; Pain management; Platelet-rich plasma (PRP); Return to sport
    DOI:  https://doi.org/10.1186/s12891-026-09790-1
  34. Front Neurol. 2026 ;17 1751139
    MRI abnormal patterns of lumbar paraspinal muscles in patients with amyotrophic lateral sclerosis and lumbosacral radiculopathy: a comparative study.
    Yuting Ren, Xu Han, Kang Zhang, Songtao Niu, Bin Chen, Xingao Wang, Fan Jian, Hua Pan, Zaiqiang Zhang, Xin Chen.
       Background: Recent evidence highlights the potential predictive value of paraspinal muscle degeneration in amyotrophic lateral sclerosis (ALS). However, the magnetic resonance imaging (MRI) characteristics of degeneration in lumbar paraspinal muscles in ALS and lumbosacral radiculopathy (LR) remain unclear.
    Methods: Comparison of fatty infiltration (FI) and relative cross-sectional area (rCSA) of the paraspinal muscles was conducted between 38 ALS patients and 32 LR patients.
    Results: The mean rCSA of the multifidus (MF), erector spinae (ES), and psoas major (PM) muscles was lower on the symptomatic onset side compared to the contralateral side at the L3-L5 segments in patients with ALS. On the symptomatic onset side, the FI of the ES (L1-L4 segments), MF (L4 segment), and PM muscles (L1, L2, and L4 segments) was significantly higher in ALS patients who had pathological spontaneous activity (PSA) than in those without PSA. At the L3-L5 segments on the symptomatic onset side, the mean rCSA of the MF, ES, and PM muscles was significantly higher in LR patients compared to ALS patients (p < 0.01). Similar differences in the rCSA of the MF, ES, and PM muscles were observed between lower limb-onset ALS patients and LR patients (p < 0.05). In addition, mild associations were observed between declines in the ALS functional rating scale (ALSFRS)-lower score and decreases in the rCSA of MF and PM muscles, as well as increased FI of the MF and ES muscles.
    Conclusion: The decrease in the rCSA of the paraspinal muscles on the symptomatic onset side suggests progressive involvement of muscle fibers in ALS patients. The presence of PSA in the paraspinal muscles appears to be more valuable and sensitive for evaluating fatty substitution than muscle atrophy in ALS. MRI parameters of the paraspinal muscles may be useful for monitoring disease progression in ALS and distinguishing ALS, especially lower limb-onset cases, from pauci-symptomatic LR.
    Keywords:  amyotrophic lateral sclerosis; fatty infiltration; lumbosacral radiculopathy; magnetic resonance imaging; paraspinal muscles; relative cross-sectional area
    DOI:  https://doi.org/10.3389/fneur.2026.1751139
  35. Sisli Etfal Hastan Tip Bul. 2026 ;60(1): 30-35
    Comparison of the Therapeutic Effects of Intra-Articular Injection of Ozone and Corticosteroid in Knee Osteoarthritis.
    Aylin Ayyildiz, Selda Ciftci Inceoglu, Beril Dogu, Banu Kuran.
       Objectives: Knee osteoarthritis (KOA) is a chronic condition that gradually reduces functional capacity and limits daily activities. Treatment methods in the early stages of the disease are still under discussion. The efficacy of ozone therapy versus corticosteroid injection in treating KOA is examined in this study.
    Methods: This randomized clinical trial involved 60 patients aged 40-85 years who had been experiencing knee pain for at least 6 months and had received a clinical diagnosis of knee osteoarthritis through radiologic imaging. The patients were randomly assigned to two groups. One group received an intra-articular injection of 10 mL 15 µg/ml ozone for three sessions with a one-week interval, while the second group received a 1 mL intra-articular injection of betamethasone. All patients were evaluated before treatment, as well as 4 and 12 weeks after the first dose of treatment. The study evaluated treatment efficacy using the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC).
    Results: The study participants had a mean age of 62.2±10 years, and 90% of them were female. Upon comparing the VAS and WOMAC scores with their respective pretreatment scores, both groups showed significant decreases at week 4 and week 12. Notably, the ozone group exhibited a significantly greater improvement in VAS and WOMAC scores at week 4.
    Conclusion: Intra-articular ozone injections have a rapid effect and provide better short-term results for KOA. In later periods, it has a similar effect to corticosteroids.
    Keywords:  Intraarticular injection; knee; osteoarthritis; ozone; pain
    DOI:  https://doi.org/10.14744/SEMB.2025.52460
  36. J Hand Ther. 2026 Apr 16. pii: S0894-1130(26)00026-8. [Epub ahead of print]
    Case report of a 54-year-old line specialist following surgical reconstruction of a complete chronic pectoralis major muscle tear.
    Priya Bakshi, Grace I Aubry, Nardos H Gebreyohannes, Amy L Jassman, Grace A Willman, Caitlyn E Wyrick.
       BACKGROUND: Literature on management of pectoralis major muscle injuries mostly describe acute injuries in young athletic males. Rehabilitation guidelines vary in the limited studies following reconstruction of chronic pectoralis major muscle tears.
    PURPOSE: To add to the literature on postoperative rehabilitation guidelines, outcomes following chronic pectoralis major muscle tear reconstruction in an older individual.
    STUDY DESIGN: Single case report.
    METHODS: Consensus-based clinical case reporting guidelines were referenced.
    RESULTS: 54-year-old linesman with complete pectoralis major muscle tear had reconstruction with Achilles allograft 7months post injury. Allograft revascularization under no tension guided first 6 weeks of rehabilitation. This included continuous sling wear, no shoulder external rotation, abduction past neutral, passive flexion limited to 90°. Next 6 weeks focused on range of motion remediation and last 6 weeks on strengthening. Challenge of first 2 weeks was axillary skin breakdown from strict adduction in sling. Capsular tightness was not experienced after 6 weeks of immobilization. Full active range of motion was restored by 11 weeks, 5/5 strength by 18 weeks, with return to full duty at 19 weeks. Final QuickDASH score was 0%, and Single Assessment Numerical Evaluation 80%.
    CONCLUSIONS: This study highlights absence of capsular tightness, minimal complications with good outcomes in an older individual with moderate to heavy work demands.
    Keywords:  Achilles allograft; Case report; Chronic pectoralis major muscle tears; Pectoralis major muscle rehabilitation; Reconstruction of pectoralis major muscle
    DOI:  https://doi.org/10.1016/j.jht.2026.02.011
  37. Cureus. 2026 Mar;18(3): e105107
    Severe Spaghetti Wrist Injury With Complete Laceration of Median Nerve, Radial and Ulnar Arteries, and Multiple Flexor Tendons: A Case Report and Literature Review.
    Luis E Ocampo-Guzmán, Maria K Biviano-Andrade, Edgar E Esparza-Tapia.
      Spaghetti wrist injuries are complex distal forearm lacerations involving flexor tendons, nerves, and vessels, associated with significant functional morbidity. We present the case of a 64-year-old right-handed man with a deep cut wound to his left forearm and clinical signs of distal ischemia, complete loss of digital flexion, and palmar anesthesia. An urgent examination was performed, identifying sections of the radial and ulnar arteries, median nerve, and injuries to the palmaris longus, flexor carpi ulnaris, flexor carpi radialis, superficial and deep flexor tendons of the fingers, and flexor pollicis longus tendons. Surgical repair followed by rehabilitation was performed. At six months, the patient demonstrated palmar sensory recovery and total active motion (TAM) of 73% compared with the contralateral hand, with residual limitation in digital flexion. This report highlights a severe spaghetti wrist injury with dual-artery transection causing distal ischemia and complete median nerve laceration, managed with single-stage primary tendon, vascular, and nerve repair, and reviews reconstructive options, repair sequencing, and rehabilitation strategies based on recent literature.
    Keywords:  flexor tendon injury; median nerve injury; radial artery; spaghetti wrist; ulnar artery; zone v
    DOI:  https://doi.org/10.7759/cureus.105107
  38. Musculoskelet Sci Pract. 2026 Apr 14. pii: S2468-7812(26)00072-X. [Epub ahead of print]83 103556
    Effectiveness of exercise therapy versus passive conservative treatments for rotator cuff-related shoulder pain: a systematic review and meta-analysis of randomized controlled trials.
    Jinde Liu, Di Tang, Rui Hu, Zihan Dai, Yanhao Liu, Ruisi Ma, Kewen Wan, Xiaohan Rong, Jianbing Sun, Lin Wang, Bin Kong.
       BACKGROUND: Exercise therapy is commonly recommended as first-line treatment for rotator cuff-related shoulder pain (RCRSP), yet its effectiveness versus passive conservative treatments is uncertain.
    OBJECTIVES: To evaluate the effectiveness of exercise therapy versus passive conservative treatments in individuals with RCRSP.
    METHODS: Five databases were searched from inception to December 2025. Randomized controlled trials comparing exercise therapy with non-exercise-based conservative treatments were included. Random-effects meta-analyses were performed. Risk of bias and certainty of evidence were assessed using the RoB 2.0 tool and the GRADE approach.
    RESULTS: Of 10546 records identified, 19 studies (n = 1349) were included in the meta-analysis. No differences in pain (SMD, -0.14; 95% CI, -1.25 to 0.96) or disability (SMD, -0.06; 95% CI, -1.57 to 1.45) were observed between exercise therapy and passive physical therapy in the short term. Exercise therapy combined with passive physical therapy was not more effective for pain and disability than passive physical therapy (pain: SMD, 0.23; 95% CI, -0.88 to 1.33; disability: SMD, -0.44; 95% CI, -1.64 to 0.77) or injections alone (pain: SMD, 0.02; 95% CI, -1.12 to 1.17; disability: SMD, -0.36; 95% CI, -1.38 to 0.66) in the short term. Exercise therapy combined with education was not superior to education alone for disability in the short term (SMD, -0.36; 95% CI, -1.54 to 0.83). The certainty of evidence ranged from very low to low.
    CONCLUSION: Exercise therapy, alone or in combination with other conservative treatments, may not be more effective than passive conservative treatments for managing RCRSP at short-term follow-up.
    Keywords:  Conservative treatment; Exercise; Meta-analysis; Shoulder pain
    DOI:  https://doi.org/10.1016/j.msksp.2026.103556
  39. J Spine Surg. 2026 Mar 23. 12(3): 32
    Full-endoscopic rhizotomy for degenerative lumbar facet joint syndrome: a systematic review and meta-analysis.
    Wongthawat Liawrungrueang, Sompoom Sunpaweravong, Pakawat Chongsathidkiet, Watcharaporn Cholamjiak, Meng-Huang Wu, Don Young Park, Peem Sarasombath.
       Background: Degenerative changes, such as osteoarthritis, often lead to facet joint syndrome (FJS). Standard treatments include physical therapy, nerve blocks, and radiofrequency rhizotomy. Full-endoscopic lumbar rhizotomy enables direct visualization and precise ablation of the medial branch nerves. Recent studies have shown significant reductions in pain and disability. This study aimed to evaluate the efficacy and safety of full-endoscopic rhizotomy in patients with degenerative lumbar FJS, using pooled data from clinical studies reporting postoperative outcomes.
    Methods: A systematic literature search was conducted in PubMed and Scopus databases between January 2000 and March 2025, following PRISMA guidelines. Studies reporting preoperative and postoperative outcomes of full-endoscopic rhizotomy in adult patients (18 years of age or older) with lumbar FJS were included. Both randomized controlled trials (RCTs) and observational studies were considered. Risk of bias was assessed using the Cochrane RoB 2 tool for RCTs and Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) for non-randomized studies. Primary outcomes included changes in pain and disability scores measured by the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Meta-analyses were performed using pooled mean differences with 95% confidence intervals (CIs).
    Results: Fourteen studies involving a total of 1,467 patients were included. The pooled mean improvement in VAS was -4.36 (95% CI: -4.42 to -4.31), and the mean improvement in ODI was -32.32 (95% CI: -32.84 to -31.80), indicating significant pain and functional improvement after endoscopic rhizotomy. No study reported any severe or permanent complications. Minor complications included transient skin numbness, intraoperative discomfort, and failed sutures. Endoscopic techniques demonstrated lower complication rates (6.67% vs. 30%, P<0.05), although associated with a longer operative time than fluoroscopic-guided percutaneous rhizotomy.
    Conclusions: Full-endoscopic rhizotomy is a safe and effective treatment for degenerative lumbar FJS, offering significant and sustained improvements in pain and disability. While it requires a longer operative time than conventional techniques, its satisfactory clinical outcomes and low complication rates support its use as a minimally invasive alternative. Further high-quality comparative studies are recommended to validate long-term benefits.
    Keywords:  Endoscopic rhizotomy; facet joint syndrome (FJS); minimally invasive surgery; radiofrequency ablation (RFA); systematic review
    DOI:  https://doi.org/10.21037/jss-2025-aw-199
  40. Knee. 2026 Apr 11. pii: S0968-0160(26)00133-X. [Epub ahead of print] 104454
    Response to the "Letter to the Editor" regarding "Efficacy and safety of a single intra-articular injection of mannitol-combined hyaluronan in patients with knee osteoarthritis - A double-blinded randomized clinical study".
    Shu-Fen Sun.
      
    DOI:  https://doi.org/10.1016/j.knee.2026.104454
  41. Front Physiol. 2026 ;17 1782562
    Time-dependent comparative efficacy of non-surgical treatments for pain relief in lateral epicondylitis: a systematic review and network meta-analysis.
    Congying Ouyang, Qiuping You, Chengbo Yang, Dawei Yu.
       Background: Lateral epicondylitis (LE) is a common tendinopathy, but the relative pain-relieving efficacy of different non-surgical interventions across follow-up stages remains unclear. This study used a Bayesian network meta-analysis to compare the time-dependent effects of multiple non-surgical treatments for pain relief in LE.
    Methods: PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials were systematically searched from database inception to March 5, 2024, with an updated search conducted to February 2, 2026. Randomized controlled trials involving adults with LE who received non-surgical interventions were included. Pain intensity measured by the visual analog scale (VAS) was the primary outcome, and all VAS scores were standardized to a 0-10 scale, with lower scores indicating less pain. Post-treatment VAS scores were synthesized in three predefined time windows: short-term (1-4 weeks; the result closest to 4 weeks), intermediate-term (4-12 weeks; the result closest to 12 weeks), and long-term (>12 weeks; the longest follow-up beyond 12 weeks). A Bayesian random-effects network meta-analysis was performed. Treatment effects were expressed as mean differences (MDs) with 95% credible intervals (CrIs), and ranking probabilities were summarized using the surface under the cumulative ranking curve (SUCRA).
    Results: A total of 27 randomized controlled trials were included. In the short term, kinesio taping (KT), corticosteroid injection (CSI), brace, and laser therapy (LA) showed superior pain relief compared with placebo; the MDs (95%CrIs) for KT and CSI were -4.10 (-6.14 to -2.11) and -3.57 (-5.71 to -1.47), respectively. In the intermediate term, CSI, extracorporeal shock wave therapy (ESWT), glycosaminoglycan polysulfate (GAGPS), KT, physical therapy (PT), pulsed ultrasound (PU), and ultrasound (US) were superior to placebo; the MDs (95%CrIs) for KT and CSI were -2.58 (-3.92 to -1.32) and -1.60 (-2.77 to -0.44), respectively. In the long term, no intervention showed a statistically significant advantage over placebo. Although KT and CSI ranked relatively high in the short term, and GAGPS and KT ranked relatively high in the intermediate term, ranking results should be interpreted cautiously in light of interval width, direct evidence, and network consistency.
    Conclusion: The pain-relieving effects of non-surgical interventions for LE appear to be time-dependent. Some treatments may be more favorable for short- or intermediate-term pain relief, but evidence for long-term superiority remains insufficient. Clinical interpretation should not rely on treatment ranking alone, but should instead integrate the follow-up stage, effect estimates, and evidence certainty. More high-quality randomized controlled trials with long-term follow-up are needed to clarify the long-term value of different non-surgical treatment strategies.
    Keywords:  lateral epicondylitis; network meta-analysis; non-surgical treatment; pain relief; time-dependent efficacy
    DOI:  https://doi.org/10.3389/fphys.2026.1782562
  42. Am J Sports Med. 2026 Apr 16. 3635465261436058
    Predictors of Achieving the Patient Acceptable Symptom State at 5 Years After Primary Hip Arthroscopy in High-Level Adult Athletes.
    Jade S Owens, Michael S Lee, Andrew E Jimenez, W Taylor Harris, Benjamin G Domb.
       BACKGROUND: Variables predictive of achieving clinically meaningful outcomes in high-level adult athletes after primary hip arthroscopy at midterm follow-up remain incompletely defined.
    PURPOSE: To identify variables predictive of achieving the patient acceptable symptom state (PASS) for the Hip Outcome Score-Sports-Specific Subscale (HOS-SSS) at a minimum 5-year follow-up after primary hip arthroscopy in high-level adult athletes.
    STUDY DESIGN: Case-control study; Level of evidence, 3.
    METHODS: Data were prospectively collected and retrospectively reviewed for adult (≥18 years old) athletes who underwent primary hip arthroscopy for femoroacetabular impingement syndrome between February 2010 and August 2016. Inclusion criteria consisted of participation in high school, collegiate, or professional sports within 1 year before surgery as well as the availability of preoperative and minimum 5-year patient-reported outcome scores for the modified Harris Hip Score, Nonarthritic Hip Score, HOS-SSS, and visual analog scale for pain. Exclusion criteria were age <18 or >50 years, workers' compensation status, previous ipsilateral hip surgery/conditions, Tönnis grade >1 osteoarthritis, or unwillingness to participate. Patients were stratified based on achievement of the PASS for the HOS-SSS at 5-year follow-up. Univariate and multivariate logistic regression analyses were performed to identify predictors of achieving the PASS. Receiver operating characteristic analysis was utilized to determine clinically relevant threshold values.
    RESULTS: A total of 105 athletes were included, of whom 84 achieved the PASS at a minimum 5-year follow-up and 21 did not. Patient characteristics, preoperative radiographic measurements, intraoperative findings, and intraoperative procedures were similar between groups (P > .05). Multivariate logistic regression identified postoperative alpha angle (odds ratio, 0.89; P = .021) and postoperative anterior center-edge angle (ACEA) (odds ratio, 1.20; P < .001) as independent predictors of achieving the PASS. Receiver operating characteristic analysis demonstrated excellent discrimination (area under the curve = 0.814), with thresholds <47° for the alpha angle and >26° for the ACEA associated with significantly higher rates of achieving the PASS (P < .05).
    CONCLUSION: Postoperative alpha angle and ACEA were significant predictors of achieving the PASS for the HOS-SSS at a minimum 5-year follow-up in high-level adult athletes undergoing primary hip arthroscopy. These findings emphasize the importance of precise bony correction to optimize long-term patient-acceptable outcomes.
    Keywords:  athletes; hip arthroscopy; outcomes; patient acceptable symptom state
    DOI:  https://doi.org/10.1177/03635465261436058
  43. Diagnostics (Basel). 2026 Apr 03. pii: 1084. [Epub ahead of print]16(7):
    Ultrasound Assessment of the Anterolateral Ligament of the Knee: A Narrative Review of Current Evidence, Interpretative Limitations, and Clinical Context.
    Paweł Niewiadomy, Katarzyna Szuścik-Niewiadomy.
      Rotational knee instability remains a relevant clinical problem, particularly in patients with anterior cruciate ligament injury, and has renewed interest in the anterolateral ligament (ALL) as a contributing structure. This narrative review critically synthesizes current anatomical, biomechanical, and ultrasonographic evidence regarding the ALL, with emphasis on the interpretative capabilities and limitations of musculoskeletal ultrasound. Available data indicate that ultrasound allows anatomical identification of the ALL, primarily in asymptomatic populations, but does not support its use as a standalone diagnostic tool for ALL injury. Dynamic ultrasound approaches remain observational, non-standardized, and lack clinical validation. Ultrasound may be considered only as a complementary modality within a clearly defined clinical context.
    Keywords:  anterior cruciate ligament; anterolateral ligament; diagnostic limitations; musculoskeletal ultrasound; rotational instability
    DOI:  https://doi.org/10.3390/diagnostics16071084
  44. J Clin Med. 2026 Mar 26. pii: 2526. [Epub ahead of print]15(7):
    Platelet-Rich Plasma in Anterior Cruciate Ligament Reconstruction: An Updated Systematic Review and Meta-Analysis of Clinical and Radiological Outcomes.
    Amer Abdallah, Georges Assaf, Caroline Chahine, Ghadi Abou Orm, Sadek Jaber, Anthony Chalfoun, Julien Bou Chaaya, Hadi Soukarieh, Charbel Chaiban, Maher Ghandour, Ali Ghosn.
      Background/Objectives: To evaluate the efficacy of platelet-rich plasma (PRP) as an adjunctive treatment in anterior cruciate ligament reconstruction (ACLR) and its impact on key clinical outcomes. Methods: A systematic search was conducted across five databases until 11 November 2024, including 33 randomized controlled trials (RCTs) that investigated PRP in ACLR. Outcomes analyzed included ligamentization (MRI hypointensity grades), pain VAS scores, functional scores (IKDC, Lysholm, Tegner), knee stability (KT-1000 arthrometer), and tunnel characteristics. Subgroup analyses were performed based on PRP application site, graft type, risk of bias, and follow-up duration. Results: PRP significantly enhanced ligamentization, particularly at 12 months, with marked reductions in MRI hypointensity grades. Patellar tendon grafts demonstrated the most substantial benefits. PRP also significantly reduced postoperative pain, with effects most pronounced in the early recovery period (1-9 months). However, the analgesic benefits diminished over time. Improvements in IKDC scores were observed only in studies with a high risk of bias, while Lysholm and Tegner scores showed no consistent differences between PRP and controls. Knee stability improved significantly with PRP, but this effect was limited to early follow-up periods (3 months). The heterogeneity in PRP preparation methods, application protocols, and patient populations limited the generalizability of the findings. Conclusions: PRP enhances ligamentization and provides short-term pain relief and stability benefits in ACLR. However, its impact on long-term functional recovery and other clinical outcomes remains limited and inconsistent. Standardization of PRP protocols and further high-quality research are necessary to refine its application and therapeutic potential.
    Keywords:  anterior cruciate ligament reconstruction; functional outcomes; knee stability; ligamentization; platelet-rich plasma
    DOI:  https://doi.org/10.3390/jcm15072526
  45. Cureus. 2026 Mar;18(3): e105249
    Utility of Ultrasound-Based Dynamic Assessment in Physical Therapy for Far-Lateral Lumbar Disc Herniation: A Case Report.
    Hiromichi Mizuno, Masashi Kawabata, Ryosuke Furuta, Hiroki Nakagawa, Kenichiro Tanaka.
      Far-lateral lumbar disc herniation is a relatively uncommon condition for which conservative treatment is generally prioritized; however, patients often present with severe radicular pain or motor deficits. This report describes the case of a woman in her 50s with a left L4/5 far-lateral disc herniation, who presented with persistent anterior thigh pain. Although magnetic resonance imaging (MRI) clearly demonstrated the herniated fragment, dynamic ultrasonography revealed reduced flexibility and impaired gliding among the herniated fragment, the psoas major muscle, and the L4 spinal nerve. Based on these findings, manual and targeted therapeutic exercises were performed on the affected regions. Following these interventions, the patient's anterior thigh pain during walking resolved, and neurological findings associated with L4 radiculopathy, including muscle weakness, sensory disturbance, and abnormal deep tendon reflexes, improved. A follow-up MRI at six months showed no reduction in the size of the herniation; however, no symptom recurrence was observed for up to one year. This case suggests that clinical improvement may occur even without morphological changes in the herniated disc, potentially through functional restoration of the nerve and surrounding tissues. Dynamic ultrasonography appears useful for identifying functional impairments and guiding treatment.
    Keywords:  conservative treatment; dynamic ultrasound; far-lateral lumbar disc herniation; neural gliding; psoas major muscle; spinal nerve
    DOI:  https://doi.org/10.7759/cureus.105249
  46. Hong Kong Med J. 2026 Apr 15.
    Descriptive analysis of platelet-rich plasma injection therapy in chronic musculoskeletal pain.
    M H M Chu, W S Chan, A C Y Li, H M K Wong, H L Wong, K M Ho.
       INTRODUCTION: Platelet-rich plasma (PRP) injections have been used to manage various chronic pain conditions. However, evidence remains limited due to poor standardisation across practices. In this descriptive study, we aimed to characterise current PRP practice patterns at a university-affiliated private pain clinic in Hong Kong, focusing on case mix and treatment outcomes in patients with chronic musculoskeletal pain.
    METHODS: This retrospective descriptive study included patients with diverse chronic musculoskeletal pain conditions aged 18 years or older who attended the Peter Hung Pain Specialist Clinic and received PRP injection therapy between January 2023 and December 2024. Improvements in pain and changes in oral analgesic use were recorded.
    RESULTS: In total, 248 patients were included. Prior to PRP treatment, over 70% required multiple oral analgesics for pain control, including 55.6% taking antidepressants, 41.5% gabapentin or pregabalin, and 25.8% oral opioids. At first follow-up (median: 4 weeks, range: 1-20), more than 60% reported 'moderate' or 'much' improvement in pain symptoms. By 12 months post-treatment, fewer than 10% of patients in each category continued to require oral opioids, antidepressants, gabapentin, or pregabalin. Of the 26 patients (10.5%) who required a second PRP session, only one reported no improvement.
    CONCLUSION: These results highlight the potential utility of PRP in managing chronic musculoskeletal pain and underscore the need for randomised controlled trials to confirm its long-term impact on quality of life of patients.
    Keywords:  Analgesia; Chronic pain; Inflammation
    DOI:  https://doi.org/10.12809/hkmj2514061
  47. NPJ Prim Care Respir Med. 2026 Apr 11.
    Comparative effectiveness of water-based versus land-based rehabilitation in COPD: a systematic review and network meta-analysis of randomized controlled trials.
    Eleuterio A Sánchez Romero, Ada Jacqueline Zubercová, Amélie Gran, Raphael Martins de Abreu, Francisco Xavier de Araujo, Pierluigi Sinatti, Juan Nicolás Cuenca-Zaldívar, Rob Sillevis, Camilo Corbellini.
      Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Pulmonary rehabilitation (PR) is central to COPD management; however, individuals with musculoskeletal limitations, obesity, or reduced tolerance to land-based rehabilitation (LBR) may benefit from water-based rehabilitation (WBR). To evaluate the comparative effectiveness of WBR, LBR, and control interventions on exercise capacity (EC) and health-related quality of life (HRQoL) in adults with COPD using a systematic review and network meta-analysis (NMA). Randomized controlled trials (RCTs) involving adults with COPD were searched in PubMed, Cochrane Library, PEDro, and Bibliothèque nationale du Luxembourg from inception to July 13, 2025. The primary outcomes were EC, measured using the 6-Minute Walk Test (6MWT), Incremental Shuttle Walk Test (ISWT), and Endurance Shuttle Walk Test (ESWT), and HRQoL, assessed using the Chronic Respiratory Disease Questionnaire (CRDQ) and St. George's Respiratory Questionnaire (SGRQ). The Risk of bias was assessed using the Risk of Bias 2.0 tool (RoB 2.0). A frequentist NMA was used to estimate the comparative effects and intervention rankings. The certainty of the evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluations approach (GRADE). Nine RCTs (n = 323) were included in the analysis. WBR was associated with clinically meaningful improvements in EC, particularly in endurance performance (ESWT) and shuttle walking (ISWT), with several effects exceeding the established minimal clinically important difference (MCID) thresholds. HRQoL outcomes were heterogeneous: WBR improved selected CRDQ and SGRQ domains, whereas LBR ranked highest for overall HRQoL. The NMA ranking suggested that WBR had the highest probability of being the most effective intervention for EC and combined EC+HRQoL outcomes, whereas LBR ranked highest for HRQoL alone. Heterogeneity was low for EC, moderate for HRQoL, and high for the combined outcomes. The certainty of evidence ranged from moderate (EC) to low (combined outcomes). WBR is a viable alternative to LBR for improving EC in individuals with COPD and may be particularly beneficial for those with reduced mobility or limited tolerance to land-based training. However, given the limited number of trials and variability across studies, these findings should be interpreted with caution. High-quality and adequately powered RCTs are required to confirm the long-term effects and real-world applicability of these findings.
    DOI:  https://doi.org/10.1038/s41533-026-00503-8
  48. Healthcare (Basel). 2026 Mar 29. pii: 879. [Epub ahead of print]14(7):
    Longitudinal Changes in Kinesiophobia, Psychological Readiness, and Knee Function Across Anterior Cruciate Ligament Reconstruction Rehabilitation Phases.
    Abdullah H AlMuhaya, Mai Aldera, Dalia M Alimam.
      Background/Objectives: Anterior cruciate ligament reconstruction (ACLR) is a common orthopedic procedure; however, successful return to sport (RTS) remains a major challenge influenced by both physical and psychological factors. Kinesiophobia and psychological readiness are crucial yet inadequately studied components of rehabilitation that may change across distinct phases. This study aimed to examine longitudinal, phase-specific changes in kinesiophobia, psychological readiness, and patient-reported knee function across standardized ACLR rehabilitation phases. Methods: A retrospective longitudinal cohort design was employed. Data were extracted from 45 patients who completed ACLR rehabilitation at a specialized musculoskeletal center in Riyadh, Saudi Arabia. Participants were assessed across four rehabilitation phases: Phase One (0-1 month), Phase Two (>1-3 months), Phase Three (>3-6 months), and Phase Four (>6 months post-ACLR). Outcomes included the Tampa Scale of Kinesiophobia (TSK-17), the ACL-Return to Sport after Injury scale (ACL-RSI), and the International Knee Documentation Committee subjective knee form (IKDC), administered using validated Arabic versions. Linear mixed-effects models with Bonferroni-adjusted pairwise comparisons were used to evaluate phase-related changes. Results: Significant fixed effects of rehabilitation phase were observed for all outcomes (p < 0.001). Kinesiophobia declined substantially from Phase One (mean 51.5) to Phase Three (34.7), with the greatest reduction between Phases Two and Three, followed by stabilization in Phase Four. Psychological readiness increased progressively across all phases (ACL-RSI: 37.1 to 61.8). Knee function demonstrated the greatest improvement during late rehabilitation (IKDC: 37.6 to 75.8). Conclusions: Psychological and functional recovery following ACLR follow distinct temporal trajectories rather than improving synchronously. Kinesiophobia declines most markedly during mid-rehabilitation, while functional gains peak in late rehabilitation. These findings support integrating structured psychological screening into phase-specific ACLR rehabilitation protocols.
    Keywords:  anterior cruciate ligament reconstruction; kinesiophobia; longitudinal study; psychological readiness; rehabilitation; return to sport
    DOI:  https://doi.org/10.3390/healthcare14070879
  49. Front Rehabil Sci. 2026 ;7 1749973
    Effects of ultrasound-guided nerve hydro-dissection on severe post stroke shoulder pain: a pilot study.
    Yuge Zhang, Yi Guo, Xiaoli Wu.
       Background: Shoulder pain is a major complication following stroke that substantially compromises patients' quality of life, despite the availability of various therapeutic options.
    Objective: This pilot study investigates the efficacy of ultrasound-guided nerve hydrodissection in treating severe post-stroke shoulder pain.
    Methods: Twelve eligible subjects were randomly assigned to the nerve hydro-dissection group (n = 6) and the control group (n = 6). All participants were given standardized shoulder rehabilitation, and the intervention group underwent additional ultrasound-guided brachial plexus hydrodissection. Visual analog scale (VAS), Fugl-Meyer Assessment (FMA) motor subscores of upper extremity and Shoulder Constant-Murley score were assessed at the baseline, and day1, week1, week2, week4 after the treatment.
    Results: The VAS scores in both groups had shown a decreasing trend at the four time points and there was a significant difference between the groups (p = 0.015, 0.015, 0.004 at the later three time points). The changes in Constant-Murley scores of both groups had shown an increasing trend and there was a significant difference between the groups (p = 0.026, 0.002, 0.041 at the later three time points).
    Conclusions: Ultrasound-guided nerve hydrodissection shows promising preliminary efficacy for post-stroke shoulder pain in this pilot study, warranting further investigation in larger, sham-controlled trials with longer follow-up.
    Keywords:  post stroke shoulder pain; post-stroke neuropathic pain; severe shoulder pain; shoulder rehabilitation; ultrasound-guided nerve hydrodissection
    DOI:  https://doi.org/10.3389/fresc.2026.1749973
  50. JMIR Rehabil Assist Technol. 2026 Apr 15. 13 e80971
    Effects of an Exercise-Assisting Mobile App (Osteoarthritis-Rehabilitation Assistant [O-RA]) on Rehabilitation Outcomes in Older Adults: Randomized Controlled Parallel Clinical Trial.
    Pajaree Sornmayura, Sintip Pattanakuhar, Napaschol Intapan, Krittipat Tragoolpua, Kaewkla Sroykabkaew, Rungkan Wangboon, Krittipong Wachirangkul, Sartita Wannarat, Jakkrit Klaphajone.
       Background: Mobile apps and biofeedback using motion analysis have both been used separately to increase compliance with exercise programs. We developed a mobile app, Osteoarthritis-Rehabilitation Assistant (O-RA), that uses motion analysis technology in the mobile app to assist older adults with performing a knee exercise program.
    Objective: This study aimed to evaluate the effects of the O-RA app on the compliance and correctness of the exercise program by older adults.
    Methods: We conducted an assessor-blind, parallel-design, randomized controlled trial with 40 older adults (aged 60 years or older) who had no symptoms and no diagnosis of knee osteoarthritis. Participants were divided into 2 groups: O-RA app (intervention) group and standard treatment (control) group. Both groups were taught 4 types of exercise programs by a physical therapist for 15 minutes and were instructed to do exercises at home every day for 1 week. The number of exercises, the percentage between observed and prescribed exercises, the correctness of exercises, and overall pain during the program were assessed in both groups.
    Results: The control group had significantly higher compliance with the exercise program than the intervention group (t38=3.5044, P=.001). There was no statistically significant difference in the correctness of the exercise program between the intervention and control groups. The difficulty of use and satisfaction were 47 and 59, respectively, out of the full score of 100. The main problems were the instability and the difficulty using the app.
    Conclusions: In older adults without knee osteoarthritis symptoms or diagnosis, the O-RA app was not a facilitator but a barrier to the lower extremity exercise program. An updated version, aiming to increase the stability and make it more user-friendly, should be developed; however, more comprehensive data, including qualitative user feedback and standardized usability metrics, will be needed to effectively guide its design.
    Keywords:  compliance; knee; mobile app; motion analysis; osteoarthritis; rehabilitation
    DOI:  https://doi.org/10.2196/80971
  51. Best Pract Res Clin Rheumatol. 2026 Apr 15. pii: S1521-6942(26)00007-0. [Epub ahead of print] 102122
    Physical rehabilitation interventions for hand function in people with systemic sclerosis.
    Michael Denton, Amanda Steiman, Sindhu R Johnson.
      Systemic sclerosis (SSc) is a complex systemic autoimmune rheumatic disease with marked clinical heterogeneity. Cutaneous manifestations affecting the hands and wrists include vascular insufficiency, early edema (puffy fingers), followed by progressive skin fibrosis and atrophy (sclerodactyly). This progressive skin tightening results in joint stiffness, deformity, functional impairment and reduced quality of life. Beyond skin changes, hand involvement may also include inflammatory arthritis, joint contractures, tendon friction rubs, Raynaud phenomenon, digital ulcers, acro-osteolysis, and calcinosis, all of which can further impair hand function, significantly affecting individuals' ability to perform routine occupational and daily tasks requiring grasping, gripping, and fine motor dexterity. In this article, we synthesize the evidence evaluating manual therapy, prescribed hand exercises, self-administered hand exercise protocols, telerehabilitation, paraffin wax, therapeutic ultrasound, manual lymphatic drainage, and dynamic splinting to improve hand function in people with SSc.
    Keywords:  Exercise; Hand therapy; Manual lymphatic drainage; Occupational therapy; Paraffin wax; Physical therapy; Rehabilitation; Scleroderma; Telerehabilitation
    DOI:  https://doi.org/10.1016/j.berh.2026.102122
  52. Mil Med. 2026 Apr 14. pii: usag162. [Epub ahead of print]
    Establishing Normative Sonographic Muscle Ratios for the Rotator Cuff in a Military Beneficiary Population.
    Jordan E Powell, Megan R Loftsgaarden, Marin S Smith, Alexis Southwell, Cristina Abboud Chalhoub, Kathryn Roberts, Riley R Boeth, Sean R Wise, Xiaoning Yuan.
       INTRODUCTION: Rotator cuff (RTC) muscle size is predictive of shoulder function and potential pathology following injuries. Ultrasound (US) offers a non-invasive method to differentiate normative from pathologic RTC musculature, which can guide the diagnosis and treatment of shoulder pathology for efficient, patient-centered care. This study's objective was to establish normative sonographic measurements and ratios for RTC muscles within a military population.
    METHODS: In this IRB-approved cross-sectional observational study (WRNMMC-2020-0288) at 3 military treatment facilities, military beneficiaries underwent a standardized US scanning protocol to measure the dimensions of the upper trapezius (UT), supraspinatus (SS), infraspinatus (IS), and teres minor (TM) muscles. Ratios were calculated by comparing to adjacent muscle measurements. Statistical analyses included measures of distribution to produce normative ranges, Z-scores to compare subgroups and evaluate specific subgroup differences, and Pearson's correlations to evaluate the strength of relationships between measures.
    RESULTS: One hundred twenty-eight participants (52 female, 88.2% active duty, 32.9 ± 7.5 years; 231 shoulders) were enrolled, excluding shoulders with a history of significant injury or surgery. Mean and standard deviation (SD) for UT and SS thickness (mm) were 8.8 ± 2.2 and 22.2 ± 4.1, respectively. Mean and SD for SS, IS, and TM cross-sectional area (CSA; cm2) were 6.48 ± 1.82, 8.65 ± 2.79, and 4.19 ± 1.45, respectively. Ratios (mean ± SD) for UT: SS thickness, SS: IS CSA, and IS: TM CSA were as follows: 0.41 ± 0.13, 0.77 ± 0.19, and 2.17 ± 0.73. Although dominant-sided RTC muscle measurements were significantly larger in biological males than females (P < .01), corresponding ratios were not significantly different.
    CONCLUSIONS: This study established a robust reference for normative sonographic measurements and ratios for RTC muscles in an active, healthy, military population that accounts for sex-based differences in absolute muscle size. US offers a cost-effective, efficient, and validated alternative to magnetic resonance imaging for assessing RTC muscle size. The introduction of sonographic muscle ratios as a diagnostic tool has the potential to enhance personalized shoulder health assessment, enabling timely, accurate diagnoses and patient-centered treatment plans that can optimize warfighter readiness. Future research should determine if RTC muscle ratios are more predictive of shoulder pathology in symptomatic personnel than absolute measurements.
    DOI:  https://doi.org/10.1093/milmed/usag162
  53. J Orthop Case Rep. 2026 Apr;16(4): 359-365
    Functional Outcome of Unstable Intertrochanteric Femur Fracture Treated Surgically With Long Proximal Femoral Nail.
    R R Rajkumar, Soundararajan Karuppanan, V Sudhir, Muthukannan Hari Sivanandan, S Balaji.
       Introduction: As the world's population ages, hip fractures become more common. The global incidence of hip fractures will rise to a million per year by 2040. Intertrochanteric femoral fractures are common fracture in older people, typically caused by low-energy falls. These fractures are also classified based on their stability, with unstable fracture patterns posing more challenges for surgical therapy and potentially resulting in worse functional recovery. Surgical fixation is the most effective treatment for these fractures since it restores motion while reducing complications. Intertrochanteric fractures occur between the lesser and greater trochanters of the femur. Unstable intertrochanteric fractures exhibit medial cortical comminution, fracture planes with reverse obliquity, and subtrochanteric extension. These characteristics contribute to the difficulty of achieving and maintaining reduction, as well as the likelihood of malunion, non-union, and eventual functional limitation.
    Aims and Objectives: To evaluate the functional outcomes of patients with unstable intertrochanteric femur fractures who undergo surgical treatment using a long proximal femoral nail (PFN) and to assess complication rates, radiographic evaluation, return to daily activities, and patient satisfaction.
    Materials and Methods: This prospective cross-sectional study was conducted in the Department of Orthopaedics, Vinayaka Mission's Kirupananda Variyar Medical College, from November 2022 to September 2025. Thirty patients aged above 18 years presenting with unstable intertrochanteric femur fractures (Boyd and Griffin types I-IV) were included and treated surgically with a long PFN.
    Results: The mean Harris Hip score (HHS) at the 3rd and 6th months after surgery was 75 ± 7.5 (72-77) and 87 ± 6.6 (84-89), respectively, with a statistically significant (P < 0.001) improvement. A significant (P < 0.05) increase in proportion from 3% in 3 months to 40% in 6 months in an excellent HHS. The mean hip disability and osteoarthritis outcome score (HOOS)-12 pain, function, quality of life (QoL), and summary of the study participants at the pre-operative stage were 29.2 ± 3.9, 34.6 ± 5.8, 26.3 ± 7, and 30 ± 5.4, respectively. In the 3rd and 6th months, there were significant improvements in all domains of the HOOS-12 score.
    Conclusion: The HHS was significantly increased at 6 months compared to HHS at 3 months. All the domains (pain, function, QoL, and summary) of the HOOS-12 and Visual Analog Scale pain scores increased significantly at the 3rd and 6th months from pre-operative.
    Keywords:  Harris Hip Score; Unstable intertrochanteric femur fracture; Visual Analog Scale pain score; functional outcome; hip disability and osteoarthritis outcome score-12; hip fracture; long proximal femoral nail; surgical fixation
    DOI:  https://doi.org/10.13107/jocr.2026.v16.i04.7150
  54. Medicine (Baltimore). 2026 Apr 17. 105(16): e48388
    Preliminary observations on the effect of Kegel exercise and perihip muscle exercise training and combined training on transversus abdominis thickness in healthy young women.
    Yufei Gao, Lili Yu, Cong Chen, Desheng Li, Miao Ye.
       BACKGROUND: The objective of our study was to compare the immediate effects of Kegel exercise alone and 2 types of hip muscle group exercise training with different degrees of contraction as well as combined training on thickness of the transversus abdominis (TrA), and to explore the optimal training method for its activation.
    METHODS: Twenty-eight healthy young women were selected as research participants, all of whom underwent Kegel exercises, mild-to-moderate hip adductor muscle training, and mild-to-moderate hip external rotation muscle training. Musculoskeletal ultrasound was used to measure resting TrA and immediate TrA thickness after each training session and to compare the changes in thickness after different training methods and times.
    RESULTS: There was a significant difference in the thickness of the TrA after only 1 training session compared to that at rest (P < .01), and after 5 training sessions compared to that at rest and after only 1 training session (P < .01). Comparing the immediate thickness of the TrA in the 5 different training methods, moderate contraction training of the hip external rotation muscle resulted in higher thickness than mild and moderate contraction of the hip adductor muscle and mild contraction of the hip external rotation muscle did (P < .01).
    CONCLUSION: Choosing any of the 5 training methods for 1 session can instantly activate the TrA, and a combination of the 5 training methods is more effective than training using solely one method. Among the different training methods, moderate contraction training of the hip external rotation muscle group had the best immediate activation effect on the TrA.
    Keywords:  Kegel exercise; activation of transversus abdominis; hip muscle group; instant effect; joint training
    DOI:  https://doi.org/10.1097/MD.0000000000048388
  55. Pain Manag. 2026 Apr 15. 1-7
    Percutaneous electrical nerve stimulation as alternative to nerve blocks for the diagnosis of facet joint syndrome in patients with non-specific chronic low back pain: a clinical trial protocol.
    Juan Antonio Valera-Calero, Sandra Sánchez-Jorge, Davinia Vicente-Campos, Dariusz Kosson, Marcin Kołacz, Magdalena Kocot-Kępska, Piotr Mieszczański, José López-Chicharro, Umut Varol, Grzegorz Górniewski, Mónica López-Redondo, Mateusz D Kobylarz.
      The diagnosis of chronic low back pain is frequently complicated by the absence of identifiable pathoanatomical causes on imaging. Consequently, clinical guidelines often advocate for interventional diagnostic procedures, such as medial branch nerve blocks, for suspected facet joint syndrome. Despite their utility, these interventions involve significant resource costs and potential risks associated with needle gauges and pharmacological agents. This study describes a protocol to evaluate percutaneous electrical nerve stimulation (PENS) as a safer, drug-free, and more cost-effective alternative. A parallel and multicenter study with an experimental design through a randomized clinical trial will be conducted. Adults with chronic low back pain and facet-mediated pain confirmed by two positive comparative medial branch diagnostic blocks will be randomized into four parallel groups: PENS, diagnostic medial branch nerve block (with local anesthetic), PENS + nerve block, and PENS + placebo block (full block ritual without active perineural anesthetic). The primary outcomes will be analgesic response. Secondary outcomes include pressure pain threshold, disability, health-related quality of life, rescue analgesic consumption, and the incidence/severity of local and systemic adverse events.Clinical Trial Registration: The www.clinicaltrials.gov identifier is NCT07273006.
    Keywords:  Anesthesiology; nerve blocks; nonspecific pain; pain medicine; percutaneous electrical nerve stimulation; rehabilitation
    DOI:  https://doi.org/10.1080/17581869.2026.2660325
  56. Am Ann Deaf. 2025 ;170(2): 101-137
    Advocacy, Support, and Rehabilitation Programs Federal Programs.
      
    DOI:  https://doi.org/10.1353/aad.2025.a987339
  57. JB JS Open Access. 2026 Apr-Jun;11(2):pii: e25.00052. [Epub ahead of print]11(2):
    Surgical Timing and Rehabilitation (STaR) for Multiple Ligament Knee Injuries: Study Protocol for a Multicenter Integrated Clinical Trial.
    STaR Trial for Multiple Ligament Knee Injuries Network
      Multiple ligament knee injuries (MLKIs) often result in persistent pain, residual disability including post-traumatic osteoarthritis, and high healthcare costs. Although nonrandomized and retrospective research supports operative management, evidence informing the optimal timing of MLKI surgery and subsequent rehabilitation is lacking. In addition, return to preinjury military duty, work, and sports after MLKI is poorly understood. The Surgical Timing and Rehabilitation (STaR) Trial for MLKIs was designed to address these gaps in evidence for surgery and postoperative rehabilitation for military personnel and civilians that have a MLKI. The purpose of this protocol paper is to describe the rationale and methodology for the first randomized trials to investigate the impact of timing of surgery and rehabilitation for individuals with a MLKI on time to return to preinjury levels of military duty, work, and sports. The outcomes of the STaR Trial for MLKIs are of paramount importance from the personal and societal perspective of the impact of MLKIs. The optimal time for surgery and timing of postoperative rehabilitation may also reduce residual knee impairments and complication rates that contribute to the development of long-term disability after MLKI.
    DOI:  https://doi.org/10.2106/JBJS.OA.25.00052
  58. Cureus. 2026 Mar;18(3): e105235
    Huber Proprioceptive Training and Alpha-Lipoic Acid: A New Approach in Optimizing Nerve Function in Patients With Chronic Low Back Pain.
    Aldijana Kadrić, Emina Rovčanin, Damir Čelik, Dževad Vrabac, Đemil Omerović, Ena Gogić, Amir Merdović, Selma Šabanagić-Hajrić, Edina Tanović.
      Background While there is evidence supporting the potential of alpha-lipoic acid (ALA) to improve nerve conduction parameters in certain neurological conditions, particularly diabetic neuropathy, its specific effects on nerve conduction in chronic low back pain (CLBP) patients have not been directly addressed in the current context. There is a connection between proprioceptive system deficits and movement control dysfunction in patients with chronic lower back pain, but the exact mechanism of this link is unknown. Aim To analyze the effectiveness of the proprioceptive rehabilitation method using the Huber system of exercises and to evaluate nerve conduction study findings in a patient with CLBP treated with ALA. Methods This prospective quasi-experimental clinical pilot study with a pre-test/post-test repeated-measures design included 15 patients treated at the Clinic for Physical Medicine and Rehabilitation, Clinical Center of the University of Sarajevo, during a three-week follow-up period. The study was conducted between January 1, 2025, and April 30, 2025. The patients were treated with 600 mg of ALA supplementation per day and participated in Huber proprioception training five days per week. Patients were followed for the next three weeks, with two study visits: one at baseline and one at the end of the study. The study visits included electromyography (EMG) and nerve conduction studies. A p-value of <0.05 was considered significant. Results Out of the total patients (n=15), 11 (73.3%) were male. The most commonly affected levels were L4/L5 (13, 87%), followed by L3/L4 (1, 6.5%) and L5/S1 (1, 6.5%). There was a statistically significant median increase after three weeks in both proximal (z=-3.298, p<0.001) and distal peroneal M wave amplitude (z=-3.415, p<0.001). A statistically significant median increase was also observed in proximal (z=-3.408, p<0.001) and distal tibial M wave amplitude (z=-3.409, p<0.001). Conclusion Future research with a larger sample size and longer follow-up periods is needed to evaluate the long-term effects of the sensoriomotor training program combined with ALA supplementation in patients with chronic low back pain.
    Keywords:  alpha-lipoic acid; chronic low back pain; electromyoneurographic activity; proprioceptive system; sensorimotor training
    DOI:  https://doi.org/10.7759/cureus.105235
  59. Orthop J Sports Med. 2026 Apr;14(4): 23259671261419510
    Arthroscopic Microfracture for Focal Glenoid Osteochondral Lesions in Young Active-Duty Military Patients: A Minimum 10-Year Follow-Up.
    Erel Ben-Ari, Clare K Green, John P Scanaliato, Alexis B Sandler, Ron Gilat, John R Tyler, Nata Parnes.
       Background: Glenoid osteochondral defects (OCDs), while uncommon, are a recognized source of shoulder pain and dysfunction, particularly in young, active individuals. Arthroscopic microfracture (MFx) is a commonly used surgical option. However, long-term outcomes remain poorly defined.
    Purpose: To evaluate long-term clinical and functional outcomes after arthroscopic MFx for focal glenoid OCD in active-duty military patients.
    Study Design: Case series; Level of evidence, 4.
    Methods: A retrospective review was conducted of 31 active-duty military patients (<54 years) who underwent arthroscopic MFx for focal, full-thickness (Outerbridge grade 4) glenoid OCD with concomitant biceps tendinitis, subacromial bursitis, and partial rotator cuff (RC) tears, performed by a single surgeon between January 2010 and June 2015. Descriptive data, trauma history, time from symptom onset to surgical intervention, and magnetic resonance imaging (MRI) findings were recorded. Pre- and postoperative clinical assessments included shoulder range of motion (ROM), visual analog scale (VAS) for pain, Single Assessment Numeric Evaluation (SANE), and American Shoulder and Elbow Surgeons (ASES) scores. Since minimal clinically important differences for glenoid MFx are not defined, validated thresholds from shoulder arthroplasty literature were used for context. Rates of return to sports, military duty, and revision procedures were assessed at final follow-up.
    Results: The mean follow-up was 138 ±14.85 months (range, 120-182 months). The mean age was 36 years (range, 22-54 months), and 94% (29/31) were men. A history of traumatic injury was recorded in 61% (19/31) of patients. The mean time from symptom onset to surgery was 31 ± 46.6 months. No significant differences in ROM were found postoperatively (P > .05). However, all patient-reported outcomes demonstrated statistically significant improvements: VAS (6.84 ± 1.92 to 2.52 ± 2.41), SANE (46.8 ± 20.1 to 81.1 ± 18), and ASES (51.1 ± 14.1 to 82.7 ±17) (P < .0001 for all). At final follow-up, 68% (21/31) returned to sports and 78% (24/31) resumed unrestricted active military duty. Revision procedures were required in 4 patients (13%): 2 underwent total shoulder arthroplasty, and 2 underwent revision MFx with debridement. MRI detected OCD lesions in only 29% (9/31) of cases.
    Conclusion: Arthroscopic MFx offers durable pain relief and functional improvement for focal glenoid OCD with concomitant biceps tendinitis, subacromial bursitis, or partial RC tears in high-demand military patients. At a minimum 10-year follow-up, outcomes demonstrated sustained clinical benefits, high return to duty, moderate return to sports (RTS), and low revision rates. Limited MRI sensitivity and prolonged time to surgical treatment highlight the importance of early clinical suspicion and timely surgical intervention in this challenging population.
    Keywords:  glenoid osteochondral lesion; long-term outcomes; microfracture; military personnel; return to sports
    DOI:  https://doi.org/10.1177/23259671261419510
  60. Ann Afr Med. 2026 Apr 16.
    Secondary Carpal Tunnel Syndrome Due to Flexor Tenosynovitis in a Diabetic Patient.
    Pankaj Sharma, Amit Kale, Dheerajkumar Jadhav.
       ABSTRACT: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper limb. Although many cases are idiopathic, structural or inflammatory pathology of the flexor tendon sheath can result in secondary median nerve compression. Diabetes mellitus predisposes to such changes due to chronic connective tissue alterations, but secondary CTS arising solely from noninfective flexor tenosynovitis remains uncommon. A 49-year-old woman with recently diagnosed type 2 diabetes presented with a 2-month history of progressive right-wrist pain, paresthesia, and volar swelling. Magnetic resonance imaging revealed marked tenosynovitis of the finger flexors with palmar bowing of the flexor retinaculum and associated median nerve edema, whereas nerve conduction studies confirmed compressive neuropathy. Conservative therapy failed, and open carpal tunnel release was performed, yielding immediate symptom relief and improved hand function at 6-week follow-up. Secondary CTS due to chronic flexor tenosynovitis should be suspected in diabetic patients with refractory symptoms. Early multimodal evaluation and timely decompression may prevent irreversible neuropathy.
    Keywords:  Carpal tunnel syndrome; Syndrome du canal carpien; compression du nerf médian; diabetes mellitus; diabète sucré; décompression chirurgicale; electrophysiology; flexor tenosynovitis; imagerie par résonance magnétique; magnetic resonance imaging; median nerve compression; surgical decompression; ténosynovite des fléchisseurs; électrophysiologie
    DOI:  https://doi.org/10.4103/aam.aam_796_25
  61. Front Rehabil Sci. 2026 ;7 1760961
    Muscle strength recovery after total hip arthroplasty and its impact on quality of life: findings from a Romanian cohort.
    Marjan Mihajlov, Alexandru Lisias Dimitriu, Monica Georgiana Roman, Elisa Georgiana Popescu, Eduard Cătălin Georgescu, Răzvan Ene, Dragoș Ene.
       Background: Musculoskeletal disorders represent a substantial global health burden, often leading to pain, functional impairment, and reduced quality of life. Total hip arthroplasty (THA) remains a key intervention for advanced hip pathology, yet postoperative recovery depends heavily on targeted rehabilitation. This study examined muscle strength progression and quality-of-life outcomes following a structured rehabilitation program after THA.
    Methods: Patients who underwent primary THA were enrolled in a structured postoperative physiotherapy protocol. Muscle strength (abduction, extension, and flexion peak force) was quantified using a validated digital dynamometer (ActivForce 2). Quality of life was evaluated using the Hip Disability and Osteoarthritis Outcome Score (HOOS), including the Quality-of-Life subscale (HOOS_QL). Assessments occurred at discharge (T1), six weeks post-discharge (T2), and twelve weeks postoperatively (T3).
    Results: Statistically significant longitudinal improvements in muscle strength were observed across all movement planes between T1-T2 and T2-T3 (p < 0.001). HOOS_QL scores showed a parallel increase over the same intervals. In regression analysis, hip extension peak force at T3 emerged as the only significant individual predictor of quality-of-life outcomes (p = 0.025).
    Conclusion: Participation in a structured postoperative rehabilitation program was associated with measurable improvements in muscle strength and patient-reported quality of life following THA. Hip extension strength was identified as an individual predictor of quality-of-life outcomes; however, the overall regression model demonstrated modest explanatory capacity, suggesting that this association warrants confirmation in larger controlled studies.
    Keywords:  hip abduction; muscle strength; peak force; quality of life; rehabilitation; total hip arthroplasty
    DOI:  https://doi.org/10.3389/fresc.2026.1760961
  62. J Shoulder Elbow Surg. 2026 Apr 10. pii: S1058-2746(26)00163-1. [Epub ahead of print]
    Return to Golf After Shoulder Arthroplasty: An ASES Multicenter Study Predicting Performance after rTSA and aTSA.
    ASES Multicenter Research Group
       INTRODUCTION: Return to sport (RTS), particularly golf, and athletic performance following reverse (rTSA) and anatomic (aTSA) shoulder arthroplasty remain largely understudied. Moreover, limited data exist on characteristics that predict successful RTS. This study aimed to evaluate return to golf after shoulder arthroplasty, as well as identify patient factors associated with optimal return to play.
    MATERIALS AND METHODS: A multicenter analysis utilizing RTS questionnaires was distributed to patients undergoing rTSA or aTSA at 17 institutions. We assessed preoperative golf participation, return to golf postoperatively, golf performance relative to preoperative level, and frequency of golf participation. Overall subjective satisfaction with their operative shoulder during golf activities was assessed numerically (0-10). Two separate age and sex matched propensity score analyses were performed; first to compare rTSA and aTSA performed for osteoarthritis with an intact rotator cuff (GHOA), and second to compare rTSA performed for GHOA and rotator cuff arthropathy (RCA). Golf-specific outcomes included change of self-reported handicap and driving distance before and after surgery, as well as whether hand dominance influenced outcomes.
    RESULTS: 208 patients reported golf participation, with a mean follow-up of 24.3 ± 5.7 months. The cohort was 77.9% male, with a mean age of 69.0 ± 7.9 years and BMI of 29.0 ± 5.5. Postoperatively, 88.9% (n=185) returned to golf, and 79.3% (n=165) reported that their performance improved/remained unchanged. Most patients (46.8%) returned within 3-6 months, and another 31.7% between 7-12 months. After propensity score matching, 91 rTSA and 48 aTSA patients were analyzed. Return-to-golf rates were similar (rTSA 95.6% vs. aTSA 90.0%, P=0.313), as were rates of maintained/improved performance (84.6% vs. 81.3%, P=0.313). No significant differences were found in pre- or postoperative handicap, driving distance, or outcomes based on surgery on the dominant vs. nondominant side.
    DISCUSSION: Patients demonstrate a high rate of returning to golf following both rTSA and aTSA. Among golfers the ability to return to play and performance level was comparable between arthroplasty types. No significant differences were observed between rTSA and aTSA in terms of postoperative handicap, driving distance, or side of surgery relative to hand dominance. However, despite these similarities, revision arthroplasty was independently associated with worse postoperative patient perceived golf performance. As the number of active patients undergoing shoulder arthroplasty continues to rise, the ability to provide sport-specific counseling is essential for setting realistic expectations and supporting recovery.
    Keywords:  Anatomic Total Shoulder Arthroplasty (aTSA); Glenohumeral Osteoarthritis (GHOA); Patient-Reported Outcomes; Propensity Score Analysis; Return to Sport (RTS); Reverse Total Shoulder Arthroplasty (rTSA); Rotator Cuff Arthropathy (RCA)
    DOI:  https://doi.org/10.1016/j.jse.2026.03.021
  63. BMC Musculoskelet Disord. 2026 Apr 15.
    Combined mode-kinetic chain exercise with and without core stability exercises on patients with knee osteoarthritis.
    Maryam Maqsood, Jannat Sohail, Syeda Aiman Batool.
      
    Keywords:  Core Stability; Exercise Therapy; Knee; Osteoarthritis; Pain; Quality of Life; Range of Motion
    DOI:  https://doi.org/10.1186/s12891-026-09531-4
  64. Healthcare (Basel). 2026 Apr 02. pii: 928. [Epub ahead of print]14(7):
    Osteopathy for Musculoskeletal Pain: A Systematic and Umbrella Review of Effectiveness and Safety.
    Lucia Gassner, Viktoria Hofer, Ingrid Zechmeister-Koss, Inanna Reinsperger.
      Background: Musculoskeletal pain affects an estimated 1.7 billion people worldwide and ranks among the leading causes of global disability. This review evaluates the effectiveness and safety of osteopathy in treating musculoskeletal pain across multiple body regions and conditions. Methods: A systematic literature review following PRISMA guidelines was conducted across five databases (Embase, Medline via Ovid, The Cochrane Library, PEDro, and INAHTA), yielding 964 citations. Eligible studies were RCTs published in English or German up to May 2022; conference abstracts were excluded. A hybrid design was employed: a systematic review of RCTs for neck, shoulder, knee, foot, osteoporosis, and fibromyalgia was combined with a pre-specified umbrella review component for chronic non-specific low back pain (registered in PROSPERO) to avoid duplication of an existing high-confidence evidence synthesis. From 35 critically appraised articles, the best available evidence (n = 15) was selected per body region based on a risk of bias (RoB) assessment (Cochrane Collaboration tool, version 1); the existing review was appraised with AMSTAR 2. An updated search (2022-July 2025) was performed without a RoB assessment. Data were synthesised qualitatively and reported narratively. Results: Fifteen RCTs and one systematic review were included, covering eight body regions and conditions (2408 participants). Pain improved immediately post-treatment in most regions; statistically significant between-group differences were less consistent at mid- and long-term follow-ups. Key findings: neck pain (n = four RCTs)-improvement in three of four studies immediately post-treatment; shoulder pain (n = two RCTs)-improvements across all follow-up points in one study; low back pain (n = one systematic review, 10 RCTs, 1160 participants)-pain reduced immediately and at mid-term follow-up; knee pain (n = two RCTs)-significant reduction in one study; foot pain (n = two RCTs)-improvement in both studies post-treatment and at mid-term follow-up; osteoporosis (n = one RCT)-no improvement immediately post-treatment; fibromyalgia (n = two RCTs)-significant between-group differences in one study post-treatment and at mid-term follow-up. Functional outcomes were heterogeneous across regions. Adverse events were minor and transient; no serious side effects were reported across any included study. The updated search (2022-July 2025) identified 12 additional RCTs across five regions, with findings broadly consistent with the primary analysis, though results for the neck region were marginally less favourable. Discussion: Based on current evidence, osteopathy can improve neck and low back pain for up to three months and may reduce shoulder and foot pain; evidence for other body regions remains inconclusive. RoB was unclear to high across studies, largely due to the inherent inability to blind patients and practitioners in manual therapy trials. Substantial heterogeneity in interventions, outcome measures, and study designs limits comparability. Overall certainty of evidence was low to moderate, warranting cautious interpretation. The consistent absence of serious adverse events across all included studies supports osteopathy as a safe therapeutic option. High-quality research with standardised interventions, rigorous designs, long-term follow-ups, and a focus on technique, dosage, and safety is needed to inform clinical practice and healthcare policy. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector.
    Keywords:  musculoskeletal pain; osteopathy; systematic review
    DOI:  https://doi.org/10.3390/healthcare14070928
  65. J Hand Surg Am. 2026 Apr 16. pii: S0363-5023(26)00227-3. [Epub ahead of print]
    Carpal Tunnel Release Surgical Techniques.
    Rayan El Bachaoui, Brandon E Earp, Philip E Blazar, Dafang Zhang.
      Carpal tunnel syndrome is the most common upper-extremity compressive neuropathy, resulting from increased pressure within the carpal tunnel leading to symptomatic median nerve dysfunction. While conservative measures may offer temporary relief, surgical decompression remains the definitive treatment for persistent or progressive disease. Multiple surgical techniques for carpal tunnel release (CTR) have been described, each with distinct advantages and limitations. This review provides an updated synthesis of the evidence surrounding CTR, beginning with an overview of the conventional open and the mini-open approaches. This is followed by an examination of endoscopic CTR techniques, including both single- and dual-portal methods. We further discuss the emergence of ultrasound-guided CTR with both standard and thread-based methods. Comparative analyses are presented regarding surgical outcomes, complication profiles, recovery trajectories, and other key considerations such as cost-effectiveness, anatomical variability, and procedural sustainability. The review concludes with a discussion of current controversies, future directions in surgical innovation, and representative clinical images to illustrate technique nuances.
    Keywords:  Carpal tunnel; endoscopic release; nerve; open release; ultrasound
    DOI:  https://doi.org/10.1016/j.jhsa.2026.03.004
  66. Ulus Travma Acil Cerrahi Derg. 2026 Apr;32(4): 504-507
    Incidental detection of congenital absence of the long head of the biceps tendon during shoulder arthroscopy: A case report.
    Mustafa Kınas, Burak Kuşcu.
      Although congenital variations of the biceps brachii are relatively common, agenesis of the long head is exceedingly rare. Due to the absence of clinical symptoms and notable physical examination findings, its diagnosis is challenging. The absence of the long head repre-sents one such variant, although it has only rarely been reported in arthroscopic and imaging studies. As this anomaly does not result in functional impairment, congenital biceps agenesis is often incidentally detected on shoulder magnetic resonance imaging performed for other reasons. In this case report, we present a 42-year-old industrial worker with a two-year history of persistent pain who under-went rotator cuff repair, during which an absent long head of the biceps tendon was incidentally identified. Current evidence suggests that the absence of the long head of the biceps tendon is not a risk factor for rotator cuff rupture or labral pathology. Additionally, when evaluating patients with an absent long head of the biceps tendon, it is essential to consider any previous surgical interventions. If the long head cannot be identified, the distal portion of the tendon should be carefully assessed, as the most common cause of its ab-sence near the shoulder is not a congenital condition but rather a complete tear causing the tendon to retract downward. This condi-tion represents an incidental anatomical variation and does not contribute to the functional impairment observed in these conditions.
    DOI:  https://doi.org/10.14744/tjtes.2025.88661
  67. Zh Nevrol Psikhiatr Im S S Korsakova. 2026 ;126(3): 126-135
    [Experience of using Relatox in the complex rehabilitation of patients with lower limb spasticity after focal brain damage of various etiologies].
    S E Khatkova, J S Krainova.
       OBJECTIVE: Evaluating the safety and efficacy of Relatox, a Russian botulinum neuroprotein type A preparation, in the comprehensive rehabilitation of patients with focal and multipattern lower limb spasticity due to focal brain damage of various etiologies (stroke, traumatic brain injury, neurosurgical interventions).
    MATERIAL AND METHODS: The prospective study included 15 patients with spasticity scores ≥2 on the modified Ashworth Spinal Scale. Under dual navigation guidance (ultrasound and electromyography), Relatox injections were administered to the lower limb muscles at doses of up to 400 U. Five patients with multipattern spasticity also received injections to the upper limb muscles at a maximum dose of up to 800 U. Efficacy assessments were conducted at weeks 4 and 12.
    RESULTS: Results showed a decrease in muscle tone, a significant increase in walking speed, and improvement in walking parameters. The safety profile of the drug was favorable: four adverse events were recorded (one case of generalized weakness at a dose of 800 U and three localized hematomas), and no serious adverse events were observed.
    CONCLUSION: The authors conclude that Relatox has proven efficacy and safety for the treatment of lower limb spasticity, including the use of high doses in multipattern lesions. The drug reduces muscle tone, increases range of motion, and improves functional gait, justifying its inclusion in standard rehabilitation programs. Further studies with a larger number of patients are needed to optimize treatment protocols, determine optimal doses, and determine long-term effects.
    Keywords:  botulinum toxin Relatox; gait; lower extremity; rehabilitation; spasticity; spasticity patten; stroke
    DOI:  https://doi.org/10.17116/jnevro2026126031126
  68. JMIR Biomed Eng. 2026 Apr 16. 11 e87566
    Assessing the Safety and Efficacy of a Noninvasive Device in the Management of Musculoskeletal Pain Using Low-Level Light Therapy: Double-Blinded, Randomized, Placebo-Controlled, Multicentric Study.
    Surya Prakash Maguluri, Vinod Kumar Penubakala, Sai Laxman Anne, Shankar A Navaladi, Chandrashekar P, Antony Leo Aseer, Ashok Kumar B K, Mohamed Sameer M, Radhika Soanker, Vikas Sharma.
       Background: Musculoskeletal pain significantly impacts quality of life and daily functioning. Light-based therapies, including those using red and infrared wavelengths, have shown potential in pain management due to their anti-inflammatory and tissue healing properties. CURAPOD, a pain management device developed by Litemed, uses a combination of visible red and infrared light for noninvasive pain relief.
    Objective: This study aimed to assess the safety and efficacy of Litemed's pain management device (CURAPOD) in managing acute and chronic musculoskeletal pain at various pain sites, in comparison with a placebo, and to evaluate its efficacy across different skin types.
    Methods: In a double-blinded, randomized, placebo-controlled, multicentric study, 240 participants (aged 18-60 years) with acute or chronic musculoskeletal pain were enrolled and treated with either the test or control device for 30 minutes. The test device contains 7 LEDs designed to emit a combination of visible red and infrared radiation, while the control device emits visible light of the red spectrum. Pain intensity was subjectively measured at baseline, at 30 minutes after treatment, and at time windows of 8 to 12 hours and 21 to 24 hours after treatment.
    Results: A greater number of participants reported a reduction in pain (of up to 60%) in the treatment group than in the placebo group. Repeated measures ANOVA revealed significant effects of time (F3,684=282.37; P<.001) and treatment group (F1,228=662.12; P<.001), indicating that the relief experienced may be more sustained in the treatment group. No significant effects of pain site (F5,228=0.169; P=.97) or skin type (F5,228=0.8; P=.55) were observed, suggesting consistent action across anatomical locations and skin types. No significant adverse events were reported.
    Conclusions: The device appears to be safe and viable as a nonpharmacological adjunct for managing acute and chronic musculoskeletal pain. Treatment with the device showed short-term pain reduction, with reports of up to 60% pain reduction within 30 minutes of use and sustained self-reported relief in pain for up to 20 hours after treatment. No significant effects of pain sites or skin type on reduction in visual analog scale scores were observed, suggesting broad applicability. However, these results must be interpreted with caution while considering the limitations inherent to the study methodology and short-term follow-up. These findings should be interpreted as evidence of short-term analgesic response rather than definitive clinical effectiveness. Further investigation through rigorously designed randomized controlled trials and longitudinal studies is necessary to definitively establish the efficacy of the device, the durability of its action, and the potential integration of CURAPOD into pain management strategies.
    Keywords:  infrared therapy; low-level light therapy; pain; pain management device; photobiomodulation
    DOI:  https://doi.org/10.2196/87566
  69. BMC Sports Sci Med Rehabil. 2026 Apr 16.
    Beyond muscle activation: the role of biomechanical properties of muscles in determining dynamic knee valgus in female volleyball players.
    Nizami Chalabiyev, Sibel Basaran, Volkan Deniz, Ümit Adaş, Aylin Sariyildiz.
      
    Keywords:  Dynamic knee valgus; Electromyography; Muscle activity; Volleyball
    DOI:  https://doi.org/10.1186/s13102-026-01681-1
  70. Knee Surg Sports Traumatol Arthrosc. 2026 Apr 14.
    Weight-bearing computed tomography reveals greater anterior tibial translation and femorotibial rotation than magnetic resonance imaging in chronic anterior cruciate ligament deficiency: A prospective observational study.
    Renata Vidal Leão, Andre Giardino Moreira da Silva, Sandro Ricardo Benites Zelada, Catherina Zadeh, Carlos Felipe Teixeira Lobo, Riccardo Gomes Gobbi, Alexandre Leme Godoy-Santos, Paulo Victor Partezani Helito, Camilo Partezani Helito.
       PURPOSE: To compare anterior tibial translation and femorotibial rotation measurements obtained from conventional supine, non-weight-bearing magnetic resonance imaging (MRI) and weight-bearing computed tomography (WBCT) in patients with chronic anterior cruciate ligament (ACL) tears.
    METHODS: WBCT of the knee acquired in full extension and at 30° of flexion was prospectively compared with conventional supine, non-weight-bearing MRI in patients with chronic ACL tears. Medial and lateral anterior tibial translation and femorotibial rotation were measured across imaging modalities and knee positions. Associated intra-articular and peripheral lesions were assessed on MRI. Statistical comparisons were performed using Friedman's test with Sidak post hoc analysis, and effect sizes were calculated using Cohen's d.
    RESULTS: Twenty-three patients with chronic ACL tears (8-24 months) were included. Mean lateral anterior tibial translation was significantly greater on WBCT at 30° of flexion compared with MRI (8.6 ± 3.4 mm vs. 4.0 ± 3.6 mm; p < 0.001), demonstrating a large effect size, with no difference in extension (3.1 ± 3.4 mm; p = 0.705). Medial anterior tibial translation was higher on WBCT in extension than on MRI (6.0 ± 3.0 mm vs. 3.1 ± 2.4 mm; p = 0.003), with no difference at 30° of flexion. Femorotibial rotation was greater on WBCT at 30° of flexion (12.0 ± 5.6° vs. 7.3 ± 5.5°; p < 0.001) and lower in extension (3.6 ± 4.7° vs. 7.3 ± 5.5°; p = 0.002), both with large effect sizes.
    CONCLUSION: Anterior tibial translation and femorotibial rotation measurements differed between MRI and WBCT, with load-bearing imaging revealing greater, position-dependent measured values under weight-bearing conditions. These findings suggest that WBCT may provide clinically relevant information on functional instability that complements MRI and may assist in preoperative assessment and surgical planning in patients with chronic ACL deficiency.
    LEVEL OF EVIDENCE: Level III.
    Keywords:  anterior cruciate ligament tear; joint instability; knee; magnetic resonance imaging; weight‐bearing computed tomography
    DOI:  https://doi.org/10.1002/ksa.70402
  71. J Hand Surg Am. 2026 Apr 15. pii: S0363-5023(26)00224-8. [Epub ahead of print]
    Evaluation of the Relationship Between Radial Translation and Functional Outcomes in Nonsurgical and Surgically Treated Distal Radius Fractures.
    Yusuf Yahşi, Yusuf Sülek, Süleyman Çakırtürk, Rodi Ertoğrul, Hacı Mustafa Özdemir.
       PURPOSE: This study aimed to evaluate the prognostic importance of radial translation on functional outcomes in patients treated nonoperatively or surgically for distal radial fractures. It was hypothesized that increased radial translation would be associated with worse functional scores, regardless of treatment modality.
    METHODS: This retrospective comparative study included 130 adult patients (aged 18-70 years) with unilateral AO/OTA 2R3A2 distal radius fractures, treated between January 2020 and December 2024. Group 1 (n = 60) underwent closed reduction and plaster casting, whereas group 2 (n = 70) underwent open reduction and volar locking plating performed by a consultant hand surgeon. Disabilities of the Arm, Shoulder, and Hand (DASH) scores and standard wrist radiographs were analyzed in patients with at least 12 months of clinical follow-up. Radiographic parameters, including radial inclination, radial length, volar tilt, ulnar variance, and radial translation, were assessed. Outcomes were assessed using the DASH score, visual analog scale pain scores, and the goniometric wrist range of motion. Correlation and multivariable regression analyses were performed to identify independent predictors of the DASH scores.
    RESULTS: A total of 130 patients were included. Across the entire cohort, radial translation demonstrated the strongest association with patient-reported disability, showing a substantial positive correlation with DASH scores (R2 = 0.763). Other radiographic parameters, including radial length, ulnar variance, volar tilt, and radial inclination, showed only weak or minimal correlations with functional outcomes. Pain scores and wrist range of motion measurements did not display meaningful radiographic associations. In multivariable analysis, radial translation remained the most important independent variable related to DASH scores, whereas the contributions of other radiographic and demographic factors were limited.
    CONCLUSIONS: Radial translation is a strong and independent predictor of functional outcomes in distal radius fractures. Intraoperative assessment and correction of coronal alignment, including radial translation, should be emphasized along with sagittal parameters. Routine radiographic assessment of this parameter may improve the functional prognosis.
    TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.
    Keywords:  DASH score; distal radius fracture; functional outcome; radial translation; radiographic alignment
    DOI:  https://doi.org/10.1016/j.jhsa.2026.02.037
  72. Front Pain Res (Lausanne). 2026 ;7 1759943
    The sarcopenia-pain connection: why mechanisms matter for patient care?
    Giovanni Iolascon, Antimo Moretti.
      Sarcopenia and pain are two highly prevalent conditions in aging populations, each exerting profound effects on mobility, independence, and quality of life. Emerging evidence demonstrates that these conditions are not merely coincidental but are closely interconnected through shared biological, mechanical, and neurophysiological pathways. Pain reduces physical activity, accelerates muscle wasting, and fosters functional decline, while sarcopenia increases vulnerability to painful syndromes such as osteoarthritis, fragility fractures, and low back pain. This bidirectional relationship is further amplified by chronic low-grade inflammation ("inflammaging"), mitochondrial dysfunction, and central sensitization, creating a vicious cycle of musculoskeletal fragility and disability. Despite robust epidemiological data, current diagnostic frameworks for sarcopenia fail to integrate pain dimensions, risking misclassification and underestimation of disease burden. Novel screening approaches that combine anthropometric measures with validated pain assessments may improve case finding and clinical management. This narrative review synthesizes epidemiological insights, mechanistic links, and diagnostic challenges, and advocates for integrated strategies that simultaneously target muscle health and pain management. Recognizing pain as both a determinant and consequence of sarcopenia is essential to advancing prevention, rehabilitation, and multidisciplinary care in older adults.
    Keywords:  aging; exercise; nutrition; pain; rehabilitation; sarcopenia
    DOI:  https://doi.org/10.3389/fpain.2026.1759943
  73. Acta Bioeng Biomech. 2025 Dec 01. 27(4): 27-34
    Medial compartment knee contact force during gait reflects symptom severity in advanced knee osteoarthritis.
    Takaya Watabe, Ryota Muramatsu, Yuta Taniguchi.
      Purpose: Patients with moderate-to-severe knee osteoarthritis commonly adopt altered gait patterns. A better understanding of how the medial compartment knee contact force during specific phases of gait reflects symptom burden and functional limitations may clarify the biomechanical mechanisms underlying disease progression. This study aimed to investigate the correlation between medial compartment knee contact force during gait and physical function, patient-reported outcome measures, and imaging findings in patients with knee osteoarthritis. Methods: Thirteen patients with advanced knee osteoarthritis (Kellgren-Lawrence grade ≥3) walked a 5-m path at a self-selected speed. Physical function was assessed using passive knee range of motion, muscle strength, pain scores, and walking speed. Self-reported outcomes and imaging data, including medial meniscal extrusion and quadriceps measurements were obtained. Gait kinematic data were collected using markerless motion capture, and the knee contact forces were estimated using a musculoskeletal modeling system. Results: The medial compartment knee contact forces during early and late stance were 1340.45 N and 984.54 N, respectively. Late stance force showed significant negative correlations with knee flexion range of motion and symptom scores (r < -0.737 and r < -0.604, respectively; P < 0.05). No correlations were observed in the early stance force. Conclusions: Greater medial knee contact force during the late stance phase was correlated with reduced mobility and greater symptom severity. Late-stance mechanics may be a valuable target for knee osteoarthritis management.
    Keywords:  gait; knee contact force; knee osteoarthritis; musculoskeletal model
    DOI:  https://doi.org/10.37190/abb/214382
  74. J Hand Surg Eur Vol. 2026 Apr 14. 17531934261417561
    Restoring balance in the distal radioulnar joint: advancements in minimally invasive surgical approaches.
    Gerald A Kraan, Rohit Arora, Pak Cheong Ho, Niels Wl Schep.
      Distal radioulnar joint (DRUJ) balance is essential for forearm rotation, load transmission, and overall wrist function. Traumatic injuries - including foveal triangular fibrocartilage complex (TFCC) tears, distal radius malunions and disruption of the distal oblique bundle - represent the most common causes of symptomatic DRUJ instability. Accurate differentiation between physiological laxity and clinically relevant instability remains challenging owing to limited reliability of physical examination and the subtle nature of soft-tissue pathology. Comprehensive assessment requires detailed anatomical understanding, structured clinical evaluation, multimodal imaging and, when indicated, diagnostic arthroscopy. Advances in minimally invasive surgical techniques have transformed the management of DRUJ instability. Arthroscopic interventions allow precise identification and treatment of TFCC lesions, enabling foveal repairs, capsular reinforcement, and tendon-graft reconstructions while minimizing soft-tissue disruption. Open yet minimally invasive procedures - including suture-button suspension constructs and distal oblique bundle reinforcement - offer additional options for restoring stability, particularly in chronic or complex cases. Treatment selection depends on underlying pathoanatomy, patient age, severity of instability and associated osseous deformities such as distal radius malunion or ulnar-positive variance. Postoperative recovery requires careful monitoring of stability, range of motion and functional progression, with growing evidence supporting shorter immobilization and early supervised mobilization in stable repairs. A stepwise algorithm integrating anatomical, clinical, radiographic and arthroscopic findings can guide decision-making and optimize outcomes. As diagnostic imaging and arthroscopic techniques continue to evolve, minimally invasive approaches will play an increasingly central role in restoring DRUJ balance, improving function and preventing long-term degenerative change.Level Evidence: V.
    Keywords:  Arthroscopy; DRUJ instability; TFCC repair; distal radioulnar joint; distal radius malunion; foveal reconstruction; wrist surgery
    DOI:  https://doi.org/10.1177/17531934261417561
  75. Injury. 2026 Apr 09. pii: S0020-1383(26)00250-0. [Epub ahead of print]57(6): 113265
    Open reduction and internal fixation vs acute total hip arthroplasty for geriatric acetabular fractures: A multicenter matched cohort study.
    Alireza Mirahmadi, Christopher R Leland, Ishaq O Ibrahim, Edward K Rodriguez.
       BACKGROUND: Optimal management of acetabular fractures remains controversial. Open reduction and internal fixation (ORIF) may be followed by post-traumatic degeneration and late conversion arthroplasty, whereas acute total hip arthroplasty (THA) may introduce implant-related risks. We compared short- and long-term outcomes after ORIF versus acute THA in a large, multicenter electronic health record cohort.
    METHODS: We performed a retrospective cohort study using the TriNetX Network. Adults with isolated, closed, acute acetabular fractures treated with either ORIF or acute primary THA were identified. Patients were propensity score-matched (PSM) 1:1 on demographics and comorbidities. Outcomes were assessed at 90 days and at 1, 2, 5, and 10 years, including mortality, complications, health care utilization, and procedure-specific failures (for ORIF: nonunion, post-traumatic osteoarthritis, and conversion to THA; for THA: periprosthetic fracture, prosthetic joint infection [PJI], instability/dislocation, and mechanical complications).
    RESULTS: After PSM, 3700 matched pairs comprised the early follow-up cohorts. At 90 days, ORIF was associated with higher mortality (5.2% vs 3.5%; OR 1.5; p < 0.0001) and higher rates of stroke, respiratory failure, venous thromboembolism, and ICU admission, whereas acute THA had higher emergency department visits (9.1% vs 5.3%; p < 0.0001) and hip pain (23.2% vs 13.2%; p < 0.0001). Over long-term follow-up, acute THA demonstrated higher implant-related complications at 2 years, including periprosthetic/implant fracture (3.0% vs 0.8%), PJI (6.8% vs 3.8%), instability (7.7% vs 3.0%), and mechanical complications (6.3% vs 3.5%) (all p < 0.0001), while overall reoperation rates were similar at 2 years (11.8% vs 11.2%; p = 0.53) and remained comparable through 10 years. In the ORIF cohort, nonunion reached 11.3%; conversion to THA increased from 4.3% at 2 years to 5.8% at 10 years; and post-traumatic osteoarthritis (PTOA) increased from 21.2% at 2 years to 27.2% at 10 years. Pre-index hip disease was markedly more common among acute THA patients (OA 51% vs 10%; AVN 14% vs 1%).
    CONCLUSIONS: In this study, ORIF was associated with higher early mortality and systemic complications, whereas acute THA was associated with higher implant-related complications. Despite these differing complication profiles, cumulative reoperation rates were similar through long-term follow-up. Progressive PTOA and conversion to THA remain important sequelae after ORIF.
    Keywords:  Acetabular Fracture; Geriatric; Open Reduction and Internal Fixation; Post-Traumatic Osteoarthritis, Conversion; Propensity Score Matching; Total Hip Arthroplasty
    DOI:  https://doi.org/10.1016/j.injury.2026.113265
  76. Scand J Med Sci Sports. 2026 Apr;36(4): e70274
    Patellofemoral Pain After Knee Trauma: Exploring Clinical, Biomechanical, and Muscle Strength Variables.
    Helder Dos Santos Lopes, Marina Cabral Waiteman, Fabio Viadanna Serrão, Joachim Van Cant, Bradley Neal, Ronaldo Valdir Briani, Fábio Mícolis de Azevedo.
      It remains unclear whether people with traumatic-onset patellofemoral pain (PFP_T) present with the same physical and non-physical changes as people with gradual-onset patellofemoral pain (PFP_A). In this cross-sectional study, we aimed to compare clinical, biomechanical and muscle strength outcomes between people with PFP_T, people with PFP_A, pain-free controls with a history of knee trauma (CTRL_T), and pain-free controls without a history of knee trauma (CTRL_A). Clinical variables included pain-related characteristics, time since knee trauma, kinesiophobia, and functional capacity (e.g., self-reported, objective). We captured kinematics and kinetics during a single-leg landing task, and maximal isometric torque of the knee extensors and flexors, and the hip abductors using an isokinetic dynamometer. We performed between-group comparisons using generalized linear models and independent t-tests. The PFP_T group reported higher pain, greater kinesiophobia, and lower self-reported function compared with the PFP_A group. The PFP_T group also demonstrated greater peak trunk flexion, greater peak hip flexion, and a lower knee contribution to the total support moment (TSM) compared with the PFP_A group. Both the PFP_T and PFP_A groups demonstrated reduced isometric peak torque of the knee extensors compared with the CTRL_T group. The CTRL_T group demonstrated higher peak hip flexion, lower knee contribution to TSM, and greater patellofemoral joint stress compared with CTRL_A. People with PFP_T demonstrated a worse clinical profile and a more hip-dominant landing strategy compared with those with PFP_A. Most impairments (e.g., landing biomechanics and muscle strength) were evident only in comparison with CTRL_T, who also differed clinically and mechanically from CTRL_A.
    Keywords:  kinematics; kinetics; knee injuries; musculoskeletal; patellofemoral pain syndrome
    DOI:  https://doi.org/10.1111/sms.70274
  77. Open Access J Sports Med. 2025 ;16 517971
    Patellofemoral Pain is a Multifactorial Complex Condition; Are We Missing a Multidisciplinary Approach to its Management? Time for a Paradigm Shift.
    Bruno C Gragnani, Harvi F Hart, Adrienne Forsyth, Christian J Barton, Danilo De Oliveira Silva.
       Background: Patellofemoral pain is a prevalent musculoskeletal condition characterized by persistent anterior knee pain, often exacerbated by activities that increase patellofemoral joint stress. The aetiology of patellofemoral pain is multifactorial, involving biomechanical, muscular, and psychological factors. Altered movement patterns and muscle weaknesses, particularly in the hip and knee regions, are commonly observed in people with patellofemoral pain. These impairments can either contribute to or result from the condition. Psychological factors, such as kinesiophobia and pain catastrophizing, also play a significant role in the persistence and severity of patellofemoral pain, highlighting the need for a comprehensive treatment approach.
    The Problem: Patellofemoral pain imposes a considerable burden on those who leave with the condition, leading to high pain levels, impaired physical function, and reduced quality of life. The condition's persistent nature and potential progression to patellofemoral osteoarthritis underscore the critical need for effective management strategies. Current best practices include exercise therapy and adjunct treatments, but adherence and long-term effectiveness remain challenges.
    Take-Home Message: Emerging evidence suggests that addressing obesity and incorporating patient education and self-management strategies could enhance outcomes. Additionally, integrating dietary interventions targeting systemic inflammation presents a promising avenue for reducing pain and improving function. A multidisciplinary approach, involving various health professionals, is advocated to provide holistic and patient-centered care for those affected by patellofemoral pain.
    Keywords:  fear of movement; knee joint; obesity; osteoarthritis; patellofemoral pain syndrome; rehabilitation
    DOI:  https://doi.org/10.2147/OAJSM.S517971
  78. Pain Res Manag. 2026 ;2026(1): e6298409
    Psychological Factors, Central Sensitization, and Insomnia as Potential Prognostic Factors for Short-Term Pain and Disability in Patients With Frozen Shoulder: A Multicentric Prospective Single-Cohort Study.
    Fabrizio Brindisino, Elena Silvestri, Alessio Fioretti, Fabrizio Pulina, Jacopo Conteduca, Santiago Navarro Ledesma, Germanna Medeiros Barbosa, Filip Struyf.
       BACKGROUND: Identifying modifiable prognostic factors is essential for personalizing conservative interventions. Several psychological and systemic variables remain underexplored in the frozen shoulder (FS) population, particularly regarding their prognostic relevance for short-term changes in pain and disability.
    AIM: To estimate the prognostic value of psychological factors, central sensitization, and sleep disturbances in predicting clinical outcomes after 3 months of standardized conservative treatment.
    METHOD: This multicenter, prospective cohort study was reported following the REMARK statement. Individuals were recruited between July and September 2025. Baseline demographic and clinical variables such as pain catastrophizing, state and trait anxiety, fear-avoidance beliefs (for Work and Physical Activity), central sensitization signs and symptoms, and insomnia were collected at baseline as potential prognostic factors. Shoulder pain and disability (measured with the SPADI subscores) served as outcome variables. Patients underwent a standardized multimodal conservative management for 3 months. Univariable and multivariable linear regression analyses were performed to examine associations between potential prognostic factors and SPADI pain and disability scores at 3-month follow-up.
    RESULTS: Eighty participants were included. Trait anxiety emerged as the sole significant prognostic factor for shoulder pain (exp (β) = 1.21, 95% CI 1.06-1.38), while state anxiety significantly predicted disability (exp (β) = 0.83, 95% CI 0.73-0.95). The removal of outliers during sensitivity analysis eliminated the statistical significance of all potential prognostic factors when SPADI pain was the outcome. Regarding disability, however, state anxiety remained a significant prognostic factor (exp(β) = 0.86; 95% CI: 0.74-0.99).
    DISCUSSION AND CONCLUSION: Baseline trait and state anxiety showed prognostic relevance for short-term pain and disability outcomes in patients with FS receiving conservative care. Pain catastrophizing, fear-avoidance behavior, central sensitization, and insomnia did not show significant associations in this cohort. These findings underscore the importance of incorporating psychological profiling, particularly anxiety assessment, into the clinical evaluation and prognostic reasoning for patients with FS.
    Keywords:  anxiety; avoidance; behavior; biopsychosocial; catastrophization; sleep-wake disorders
    DOI:  https://doi.org/10.1155/prm/6298409
  79. Front Aging. 2026 ;7 1726714
    Comprehensive quantitative analysis of muscle cross-sectional area and intramuscular fat infiltration of hip using modified DIXON MRI based on chemical shift encoding technique.
    Dezhao Jia, Ming Wang, Hong Yu, Yongzhi Zhang, Yi Wang, Yiming Sun, Mengfei Wu.
       Purpose: Noninvasive quantitative assessment of hip musculature is critically needed, as the structural integrity of hip muscles and the degree of intramuscular fat infiltration are essential determinants of hip stability and function. This study employed a modified DIXON of magnetic resonance imaging (MRI) technique to evaluate the cross sectional area (CSA) and intramuscular fat fraction (IMFF) of hip muscles. We analyzed factors influencing changes in hip muscle structure and intramuscular fat infiltration with the aim of establishing a comprehensive map of hip muscle characteristics.
    Methods: This cross-sectional study enrolled participants from the health examination center of our research institution. All participants underwent 3.0T MRI with mDIXON Quant sequence. The CSA and IMFF of 10 muscles of hip were semi-automatically delineated and measured at four predefined anatomical levels. the effects of sex, age, and laterality on hip muscle CSA and IMFF were investigated. Multivariate analysis was also performed to identify factors influencing IMFF in the hip.
    Results: A total of 177 participants (100 males, 77 females; age range: 18-80 years) were included. The mean age was 52.70 ± 14.36 years for males and 51.58 ± 14.85 years for females. Compared with females, males exhibited significantly smaller subcutaneous fat area (SFA)/subcutaneous fat thickness (SFT) (p < 0.001) and a larger proximal femoral area (PFA) in the hip (p < 0.001). Additionally, males demonstrated larger CSA in all muscles (p < 0.001) and lower IMFF in most muscles (p ≤ 0.001) of hip. With advancing age, the CSA of all 10 hip muscles progressively decreased, while IMFF increased. Laterality had minimal influence on hip muscle CSA and IMFF. Multivariate analyses showed that age as the predominant factor influencing IMFF.
    Conclusion: The mDIXON QUANT sequence enables noninvasive quantification of CSA and IMFF of hip muscles, with age identified as a significant influencing factor. This technique holds promise for establishing normative reference data on hip muscle CSA and IMFF in healthy populations, thereby enhancing the understanding of degenerative changes and aiding in clinical decision-making for surgical planning and postoperative rehabilitation guidance.
    Keywords:  chemical shift encoding; cross sectional area; hip muscles; intramuscular fat infiltration; modified DIXON sequence
    DOI:  https://doi.org/10.3389/fragi.2026.1726714
  80. J Clin Orthop Trauma. 2026 Apr;75 103382
    3D functional balancing in hip arthroplasty: Why the future of total hip arthroplasty must move beyond 2D thinking.
    Kunal Aneja, Supreet Bajwa.
      
    DOI:  https://doi.org/10.1016/j.jcot.2026.103382
  81. J Orthop Case Rep. 2026 Apr;16(4): 346-350
    Comparing the Subvastus and Medial Parapatellar Approaches in Total Knee Arthroplasty.
    Parin Shah, Ravindra Singh, Pawan Kumar Shanwal, Deependra Kumar Yadav, Rishabh Jain.
       Introduction: Knee osteoarthritis (OA) is a common cause of pain and disability in the elderly, for which total knee arthroplasty (TKA) is an effective treatment. The medial parapatellar approach is widely used but may impair patellar blood supply and delay quadriceps recovery. The subvastus (SV) approach has been introduced to preserve the extensor mechanism and potentially allow faster post-operative rehabilitation. This study compares the SV and medial parapatellar approaches in primary TKA, focusing on early recovery of quadriceps function.
    Objective: This study aims to evaluate and compare the SV and medial parapatellar approaches for total knee replacement (TKR) in patients with OA at a tertiary care center, focusing on the time required for post-operative recovery of quadriceps function.
    Materials and Methods: We conducted a retrospective review of medical records from 200 patients with OA who underwent TKR at a tertiary care hospital between January 2024 and December 2025. Patients were categorized into two groups: Group A underwent TKR using the SV approach, while Group B received TKR through the medial parapatellar approach. Pre-operative data, including quadriceps strength, body mass index, and baseline demographic characteristics, were collected from initial workup notes. Demographic data of all the patients were described in Table. Starting from the 1st post-operative day, the time to the first unassisted straight leg raise was recorded as the primary measure of quadriceps function. The collected data were then analyzed to assess post-operative quadriceps recovery.
    Results: The SV approach was associated with faster recovery of quadriceps function compared to the medial parapatellar approach. Patients in their sixties experienced the most significant improvement. In addition, pre-operative quadriceps strength was found to play a key role in post-operative muscle recovery.
    Conclusion: The SV approach in TKA promotes faster early recovery, including quicker quadriceps function, less pain, earlier range of motion, and shorter hospital stays compared to the medial parapatellar approach. Long-term functional outcomes are similar between the two techniques. Although technically more demanding, the SV approach is a safe and effective option that enhances early rehabilitation.
    Keywords:  Total knee arthroplasty; medial parapatellar approach; post-operative rehabilitation; quadriceps recovery; subvastus approach
    DOI:  https://doi.org/10.13107/jocr.2026.v16.i04.7146
  82. Orthop Surg. 2026 Apr 12.
    Acupuncture-Integrated Chinese-Western Medicine Accelerated Rehabilitation Protocol Following Acute Achilles Tendon Repair: A Prospective Cohort Study.
    Gao Si, Chi Zhang, Xiuzhi Li, Yuan Cao, Zengzhen Cui, Jingying Li, Letian Wang, Yang Lv, Dong Li.
       OBJECTIVE: Postoperative pain and swelling often impede early rehabilitation after Achilles tendon repair. This study aimed to evaluate the clinical efficacy of an acupuncture-integrated Chinese-Western medicine accelerated rehabilitation protocol following acute Achilles tendon rupture repair.
    METHODS: We prospectively analyzed 193 patients with acute Achilles tendon rupture treated between May 2022 and November 2023. Participants were stratified into three postoperative rehabilitation groups: accelerated rehabilitation (AR, n = 69), traditional rehabilitation (TR, n = 61), and sham acupuncture (SA, n = 63). All patients underwent identical surgical procedures, with postoperative complications documented. Pain was assessed using the Visual Analog Scale (VAS) at postoperative days 1 and 4, and weeks 1, 2, and 4. Limb swelling was quantified by measuring calf and midfoot circumference differences between affected and unaffected limbs. Functional outcomes were evaluated at 12 weeks using objective measures (one-leg heel-rise height [OHRH] and time [OHRT]) and validated scales (Achilles tendon Total Rupture Score [ATRS], AOFAS ankle-hindfoot score, and Holden Walking Ability Classification [HWAC]). Functional outcomes were evaluated at 12 weeks. Statistical analyses were performed using one-way ANOVA, Kruskal-Wallis H test, χ2 test, or Fisher's exact test as appropriate, with Bonferroni correction for multiple comparisons.
    RESULTS: Compared with the TR group and the SA group, the AR group had lower VAS scores on the 4th day (p < 0.001) and 1 week (p < 0.001) postoperatively, and more obvious reduction of limb swelling on the 4th day (p < 0.001) and 1 week (p < 0.001) postoperatively. At 12 weeks postoperatively, the AR group showed higher OHRH (p < 0.001) and longer OHRT (p < 0.001). There was no statistically significant difference in ATRS scores, AOFAS ankle-hindfoot scores, and HWAC among the three groups at 12 weeks postoperatively.
    CONCLUSION: The early adoption of the acupuncture-integrated accelerated rehabilitation strategy after acute Achilles tendon rupture repair can effectively reduce pain and accelerate the resolution of swelling within 1 week after surgery, which facilitates early functional mobilization for patients.
    TRIAL REGISTRATION: NCT05957614 (https://www.
    CLINICALTRIALS: gov/, registered 15 July 2023).
    Keywords:  acupuncture therapy; acute Achilles tendon rupture; early rehabilitation; integrative medicine of Chinese and Western medicine
    DOI:  https://doi.org/10.1111/os.70309
  83. Top Stroke Rehabil. 2026 Apr 17. 1-8
    Prediction of type 1 complex regional pain syndrome with the presence of diaschisis in hemiplegic supratentorial stroke patients.
    Seong Bok Choi, Myoung Hyoun Kim, Jong Joon Lee, Ji Hee Kim.
       BACKGROUND: Hemiplegic shoulder pain (HSP) and complex regional pain syndrome type 1 (CRPS) are common post-stroke complications. Crossed cerebellar diaschisis (CCD) has been associated with poor motor outcomes, but its relationship with CRPS is unclear.
    OBJECTIVES: To investigate whether CCD on brain perfusion SPECT is associated with CRPS type 1 in subacute unilateral supratentorial stroke.
    METHODS: We retrospectively analyzed 148 patients who underwent brain SPECT. CCD was defined as a cerebellar asymmetry index (AI) ≥10%. CRPS was diagnosed using the Budapest criteria and confirmed by three-phase bone scintigraphy. Multivariable logistic regression analyses were performed with pre-specified covariates.
    RESULTS: CCD was present in 65 patients (43.9%), and CRPS occurred in 40 (27.0%). CRPS incidence was higher in patients with CCD (46.2% vs. 12.0%; relative risk 3.83, 95% CI 2.02-7.25). In adjusted analyses, higher AI (OR 1.11, 95% CI 1.04-1.18) and CCD (OR 3.76, 95% CI 1.50-9.41) were associated with increased CRPS risk, while higher proximal MMT was protective (OR 0.27, 95% CI 0.15-0.48).
    CONCLUSIONS: CCD is associated with increased CRPS risk in subacute stroke. Early identification on SPECT may aid monitoring and intervention.
    Keywords:  Crossed cerebellar diaschisis; brain SPECT; complex regional pain syndrome; hemiplegic shoulder pain; post-stroke pain; stroke rehabilitation
    DOI:  https://doi.org/10.1080/10749357.2026.2659066
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