bims-ricfun Biomed News
on Rehabilitation ICF
Issue of 2025–11–16
34 papers selected by
Gerardo Amilivia, Médica Uruguaya Corporación de Asistencia Médica
  1. Novel Sonoguided Digital Palpation and Hydrodissection for Sural Nerve Dysfunction Mimicking Achilles Tendinopathy in a Psoriasis Patient.
  2. Ultrasound Applications in Adaptive Sports Medicine.
  3. Elite runner with piriformis syndrome treated with botulinum toxin and gait retraining.
  4. Integrated diagnostic approaches for superficial radial neuropathy: The role of ultrasonography in enhancing morphological assessments.
  5. The Pronator Teres Muscle Revisited: Morphological Classification, Neurovascular Entrapment, and Surgical Implications.
  6. Ultrasound Imaging and Frozen Shoulder: Unlocking the Benefits, Navigating the Risks.
  7. Uses and technique of ultrasound-guided botulinum toxin infiltration.
  8. MRI Analysis of Paraspinal Muscle Morphology in Patients With Chronic Low Back Pain: A Case-Control Study.
  9. Diagnosis and treatment of the infrapatellar fat pad disorders: A systematic mapping review.
  10. MRI Features of Acute Muscle Injuries in Professional Soccer Players: A Systematic Review of Prognostic Associations With Return to Play.
  11. What Happened to Masticatory Muscles after Botulinum-Toxin-Type A Injection into Masseter: A Systematic Review.
  12. Diagnostic accuracy of ultrasonography for meniscal tears: a systematic review and meta-analysis.
  13. Sequential bilateral quadriceps tendon rupture in a young individual with chronic kidney disease.
  14. Anatomic Reinsertion of Isolated Proximal Semimembranosus Tendon Avulsion in Athletic Population: A Technical Note.
  15. Comment on "Rehabilitation of facial nerve palsy combining neuromuscular retraining and botulinum toxin a injection: a tertiary referral centre experience and a new working protocol proposal".
  16. Herniated intervertebral disc induced cauda equina syndrome during pregnancy: Case report and literature review.
  17. Comparing the effectiveness of two community-based multimodal exercise programs (CMEPs) on physical activity, performance, fall prevention, and quality of life in older adults: protocol for a multicenter, double-blind, randomized clinical trial.
  18. "Pain Prehabilitation" in Major Joint Surgery: The Way Forward to Improve Outcomes and Prevent Pain Chronicity.
  19. Evaluation of the relationship between tension-type headache and masseter muscle thickness in women with fibromyalgia syndrome: a cross-sectional ultrasonographic study.
  20. Infrapatellar Fat Pad in Knee Osteoarthritis: A Comprehensive Review of Pathophysiology and Targeted Therapeutic Strategies.
  21. Frailty detection tools in geriatric rehabilitation: a systematic review.
  22. Ultrasound-Guided Platelet-Rich Plasma (PRP) Injection for Deep Medial Collateral Ligament (MCL) Injuries of the Knee.
  23. Chair Yoga for Individuals With Osteoarthritis.
  24. Impact of meniscal root tears on knee osteoarthritis development: A systematic review of the literature.
  25. MRI has limited accuracy in diagnosing complex regional pain syndrome Type 1 - a systematic review of the literature.
  26. Platelet-Poor Plasma for Muscle Injuries: A Review of Mechanisms and Clinical Perspectives.
  27. Ultrasound-guided trapezius plane block for removal of superficial lesions in the upper thoracic paravertebral region.
  28. Update on Peripheral Regional Analgesic Techniques for Hip Surgery Patients.
  29. Return to Sport After Acromioclavicular Injury: A Systematic Review of Modifiable Factors.
  30. Pain mechanism and management strategy of rheumatoid arthritis.
  31. Muscle or Fascial System Lesion (Part II): The Medial Gastrocnemius and the "Tennis Leg" Paradigm.
  32. Point of Care Ultrasound as a Bedside Diagnostic Tool in Acute Dyspnea Patients in Emergency Department for timely management.
  33. Efficacy of Mediterranean diet in musculoskeletal disorders: A systematic review and meta-analysis for primary and tertiary prevention featured in the Italian National Guidelines "La Dieta Mediterranea".
  34. Association between walking gait biomechanical changes after anterior cruciate ligament injury or reconstruction and the development of osteoarthritis: A systematic review.
  1. Diagnostics (Basel). 2025 Oct 25. pii: 2706. [Epub ahead of print]15(21):
    Novel Sonoguided Digital Palpation and Hydrodissection for Sural Nerve Dysfunction Mimicking Achilles Tendinopathy in a Psoriasis Patient.
    Yonghyun Yoon, King Hei Stanley Lam, Howon Lee, Chanwool Park, Seungbeom Kim, Minjae Lee, Jaeyoung Lee, Jihyo Hwang, Hyemi Yu, Jonghyeok Lee, Daniel Chiung-Jui Su, Teinny Suryadi, Anwar Suhaimi, Kenneth Dean Reeves.
      Background and Clinical Significance: Psoriasis, a chronic immune-mediated inflammatory disease, can affect musculoskeletal structures, including the Achilles tendon. Achilles pain in psoriasis patients may arise from tendinitis or neuropathic pain due to peripheral nerve dysfunction, such as sural nerve (SN) involvement, a condition frequently misdiagnosed due to limitations in conventional diagnostics. Fascial tissues are critical in nerve compression syndromes. This case explores the application of a novel quantitative Sonoguide Digital Palpation (SDP) protocol and ultrasound (US)-guided hydrodissection (HD) for SN dysfunction mimicking Achilles tendinopathy in a psoriasis patient. Case Presentation: A 41-year-old male with psoriasis presented with acute onset of right heel stiffness and paresthesia. Physical examination, radiographs, and ultrasound were performed. SDP, employing a validated four-criterion diagnostic framework (including fascial mobility quantification and concordant pain provocation), identified crural fascia restriction affecting SN and reproduced patient's concordant Achilles pain. High-resolution ultrasonography provided key morphological evidence, revealing a 2.6-fold enlargement of the sural nerve's cross-sectional area (CSA) on the affected side (13 mm2) compared to the asymptomatic side (5 mm2). Notably, a positive Tinel's sign was elicited over the psoriatic plaque. US-guided HD was performed using 50 cc of 5% dextrose in water (D5W) without local anesthetic below the psoriatic lesion. Post-HD, the patient reported immediate and significant pain relief (Numeric Pain Rating Scale (NPRS) score reduction from 8 to 2), confirming the prompt correction of a clinically important fascial restriction, associated with improved SN mobility, objectively verified by a post-procedure SDP assessment. At 24-month follow-up, sustained symptom relief and complete functional recovery were reported. Conclusions: This case highlights SDP's ability to objectively visualize and confirm fascial restriction as a cause of nerve dysfunction by quantitatively reproducing concordant pain. The objective finding of nerve swelling provides sonographic substantiation for the functional diagnosis of nerve dysfunction. This integrated diagnostic approach, combining dynamic functional assessment with morphological confirmation, offers a novel paradigm for evaluating peripheral nerve disorders. US-guided HD of the SN with D5W without local anesthetic shows promise as both a diagnostic confirmatory tool and therapeutic intervention for neuropathic Achilles pain in psoriasis patients with SN involvement, aligning with its efficacy in other peripheral neuropathies. The significant nerve swelling (13 mm2) provides robust morphological corroboration of the functional impairment diagnosed by SDP, offering a more comprehensive diagnostic paradigm.
    Keywords:  5% dextrose in water; Achilles tendinopathy; Sonoguide Digital Palpation; crural fascia; fascial restriction; neuropathic foot pain; psoriasis; psoriasis-associated neuropathy; sural nerve dysfunction; ultrasound-guided hydrodissection
    DOI:  https://doi.org/10.3390/diagnostics15212706
  2. Phys Med Rehabil Clin N Am. 2026 Feb;pii: S1047-9651(25)00068-3. [Epub ahead of print]37(1): 87-98
    Ultrasound Applications in Adaptive Sports Medicine.
    Niran Vijayaraghavan, Donald Kasitinon, Casey Pierce, Berdale Colorado.
      The use of ultrasound in adaptive sports has not been well studied. There is more literature for use in wheelchair athletes who suffer overuse upper extremity injuries, including shoulder and biceps tendon injuries, lateral epicondylosis, ulnar neuropathy at the elbow, and carpal tunnel syndrome. A few key lower extremity injury phenotypes have been studied with ultrasound in this population, including HO and skin complications. There are also unique applications of ultrasound, including boosting, respiratory muscle training, and evaluation of deep tissue injuries. Further ultrasound studies for adaptive athletes, particularly at the international level, would be advantageous.
    Keywords:  Adaptive athlete; Autonomic dysreflexia; Entrapment neuropathy; Heterotopic ossification; Tendinopathy; Ultrasound; Wheelchair user
    DOI:  https://doi.org/10.1016/j.pmr.2025.08.009
  3. PM R. 2025 Nov 11.
    Elite runner with piriformis syndrome treated with botulinum toxin and gait retraining.
    Katrina I Coogan, Tessa Taylor, Joanne Borg-Stein, Adam S Tenforde, Sydney C Karnovsky.
      
    DOI:  https://doi.org/10.1002/pmrj.70054
  4. PM R. 2025 Nov 10.
    Integrated diagnostic approaches for superficial radial neuropathy: The role of ultrasonography in enhancing morphological assessments.
    Hong Bum Park, Young Kwang Choi, Jong Chan Lim, Dong Hwee Kim.
       BACKGROUND: Ultrasonography is useful for evaluating cutaneous nerve lesions.
    OBJECTIVE: To investigate the clinical utility of ultrasonography in accurately localizing nerve abnormalities in distal superficial radial neuropathy, based on clinical symptoms and electrodiagnostic test results.
    DESIGN: Retrospective descriptive study.
    SETTING: Department of physical medicine and rehabilitation of a tertiary clinic center.
    PARTICIPANTS: Twenty-three patients (17 men and 6 women) with superficial radial neuropathy.
    INTERVENTIONS: Nerve conduction study and ultrasonography of superficial radial nerve.
    MAIN OUTCOME MEASURES: The patients were divided into three groups according to the location of the superficial radial nerve lesions based on the electrodiagnostic test results: lateral, medial, and both lesions. Ultrasonographic examination of the superficial radial nerve was performed on the affected and unaffected sides.
    RESULTS: According to the electrophysiological findings, patients with both lesions were the most common (10 patients), followed by those with medial (8 patients) and lateral (5 patients) lesions. Ultrasonographic examination revealed abnormal findings in 20 patients (87.0%), including nerve swelling in 19 patients and ganglion swelling in 1 patient. Cohen's kappa agreement coefficients for lesion locations between ultrasonographic and electrophysiological findings and between ultrasonographic and clinical findings were 0.741 and 0.736, respectively.
    CONCLUSION: Ultrasonography is useful for evaluating lesion location and structural abnormalities in superficial radial neuropathy and can be complementary to electrodiagnostic tests for diagnosing superficial radial neuropathy.
    DOI:  https://doi.org/10.1002/pmrj.70033
  5. J Clin Med. 2025 Oct 22. pii: 7474. [Epub ahead of print]14(21):
    The Pronator Teres Muscle Revisited: Morphological Classification, Neurovascular Entrapment, and Surgical Implications.
    Marta Podlasińska, Ingrid C Landfald, Zuzanna Adamczyk, Bartłomiej Szewczyk, Łukasz Olewnik.
      Background: The pronator teres (PT) muscle, although traditionally described as a constant two-headed forearm flexor, demonstrates considerable morphological variability. These variants play a crucial role in the pathogenesis of pronator syndrome, a rare but clinically significant entrapment of the median nerve in the proximal forearm. Despite growing interest, there is no widely adopted classification integrating anatomy, imaging, and surgical relevance. This review summarises and contextualises current classifications of the pronator teres in relation to median nerve entrapment, with emphasis on their anatomical, imaging, and surgical relevance. Methods: We performed a narrative review of the literature using PubMed, Scopus, and Web of Science (1960-2025). Studies were included if they reported cadaveric findings, imaging features, or clinical management of PT-related median nerve entrapment. Representative anatomical and clinical sources were analysed to synthesise a morphology-based framework. Results: We identified three morphological types of the PT: Type I (median nerve between humeral and ulnar heads, 74%), Type II (beneath both heads, 12%), and Type III (beneath the humeral head only, 14%). Each type demonstrates distinct entrapment mechanisms and imaging features. Dynamic ultrasound and advanced MRI sequences, particularly MR neurography, have been reported to improve diagnostic confidence but remain underutilised. Published reports describe differing management approaches by type, with variable outcomes. Tables and summary boxes compile previously published findings on entrapment potential, imaging pitfalls, and surgical approaches by type. Conclusions: This review summarises existing classifications linking PT variability to median nerve entrapment. Such integration may have potential clinical relevance but requires further empirical validation. Future studies should standardise imaging protocols, validate electrodiagnostic correlations, and explore functional classifications incorporating clinical, radiological, and anatomical data.
    Keywords:  forearm anatomy; magnetic resonance imaging; median nerve entrapment; pronator syndrome; pronator teres muscle; ultrasonography
    DOI:  https://doi.org/10.3390/jcm14217474
  6. J Clin Ultrasound. 2025 Nov 12.
    Ultrasound Imaging and Frozen Shoulder: Unlocking the Benefits, Navigating the Risks.
    Filip Struyf, Marc Schmitz, Fabrizio Brindisino, José Javier Pérez-Montilla, Dina Hamed-Hamed, Santiago Navarro-Ledesma.
      Frozen shoulder (FS), or adhesive capsulitis, remains a challenging clinical entity due to its insidious onset, variable presentation, and diagnostic overlap with other shoulder pathologies. While FS is traditionally diagnosed clinically, musculoskeletal ultrasound (MSKUS) is emerging as a valuable adjunct tool capable of identifying early-stage structural and vascular changes. This review synthesizes the current evidence on MSKUS's diagnostic utility, highlighting its capacity to visualize characteristic features such as capsular thickening, rotator interval (RI) hypervascularity, and effusion in the long head of the biceps tendon (LHBT) sheath-particularly prominent in early or intermediate disease stages. Although MSKUS is highly operator-dependent and demands substantial training, its integration into clinical assessment may enhance diagnostic precision, particularly when FS is suspected early. As the field advances, combining MSKUS findings with metabolic and inflammatory biomarkers may support a pathophysiological classification of FS, paving the way for more personalized, algorithm-based interventions. In summary, MSKUS provides a safe, accessible, and dynamic modality for detecting capsuloligamentous changes in FS. Its role in early diagnosis, differential screening, treatment monitoring, and future integration with systemic biomarkers supports its growing clinical relevance in both orthopedic and interdisciplinary settings.
    Keywords:  adhesive capsulitis; biceps brachii; diagnostic imaging; musculoskeletal ultrasonography; shoulder joint
    DOI:  https://doi.org/10.1002/jcu.70135
  7. Radiologia (Engl Ed). 2025 Nov-Dec;67(6):pii: S2173-5107(25)00135-1. [Epub ahead of print]67(6): 501695
    Uses and technique of ultrasound-guided botulinum toxin infiltration.
    J Llorente Peris, J Miranda Bautista, P Menéndez Fernández-Miranda.
      Botulinum toxin (BT) is a neurotoxin that causes flaccid paralysis by inhibiting the release of acetylcholine at the neuromuscular junction, and it may lead to long-term muscle atrophy. It is used to treat conditions associated with muscle hypertrophy or to enhance muscle flexibility, thereby facilitating surgical procedures. It has been shown that ultrasound-guided administration is superior to the anatomical landmarks technique as it reduces side effects and improves efficacy. Although some applications are not officially approved, evidence supports its efficacy and safety in the treatment of various conditions. Some of these more established conditions include anterior abdominal wall hernias, piriformis syndrome, thoracic outlet syndrome, bruxism, spasticity and cervical dystonia. The objective of this study is to review the uses of botulinum toxin in muscular and neuromuscular disorders, analysing its efficacy, safety and the importance of ultrasound guidance in its administration.
    Keywords:  Abdominal wall; Botulinum toxin; Bruxism; Bruxismo; Pared abdominal; Pectoralis minor syndrome; Piriformis syndrome; Síndrome opérculo torácico; Síndrome pectoral menor; Síndrome piriforme; Thoracic outlet syndrome; Toxina botulínica
    DOI:  https://doi.org/10.1016/j.rxeng.2025.501695
  8. Cureus. 2025 Oct;17(10): e94072
    MRI Analysis of Paraspinal Muscle Morphology in Patients With Chronic Low Back Pain: A Case-Control Study.
    Nishanth Varma, Harini Bopaiah, Anil K Sakalecha, Rishi Prajwal H L, Sneha D N.
       BACKGROUND: Chronic low back pain (CLBP) is a major contributor to musculoskeletal disability worldwide. The paraspinal muscles, particularly those along the thoracolumbar spine, are essential for spinal stability and extension. Morphological alterations in these muscles may have diagnostic and therapeutic implications. This study aimed to determine the cross-sectional area (CSA) of each paraspinal muscle at the level of the L4 superior endplate in patients with chronic back pain (CBP) compared to age-matched individuals without any history of low back pain. We hypothesized that patients with CLBP would demonstrate selective reductions in the CSA of the multifidus, while the psoas major (PS) would remain relatively preserved.
    METHODS: A cross-sectional observational study was conducted with 80 participants: 40 patients with CBP and 40 age-matched controls without low back pain. The PS, multifidus, erector spinae (ES), and quadratus lumborum (QL) muscles were assessed bilaterally using magnetic MRI. An independent t-test was used to assess the statistical significance between the two groups, with significance set at p < 0.05.
    RESULTS: The mean ages of the cases and controls were 50.54 and 49.94 years, respectively, with no statistically significant difference. Among the paraspinal muscles evaluated, statistically significant differences in the CSA were found in the multifidus, ES, and QL muscles, but not in the PS.
    CONCLUSION: Statistically significant reductions in the CSA were observed in most paraspinal muscles, except for the PS, in patients with CBP. These preliminary, hypothesis-generating findings highlight the potential value of paraspinal muscle assessment in CLBP and warrant confirmation in larger, multi-center studies before therapeutic implications can be considered.
    Keywords:  atrophy; chronic; degeneration; inflammation; muscle fat infiltration; muscles; pain; spine; vertebrae
    DOI:  https://doi.org/10.7759/cureus.94072
  9. PM R. 2025 Nov 14.
    Diagnosis and treatment of the infrapatellar fat pad disorders: A systematic mapping review.
    Joseph Verrier, Sabry Kenzaoui, Burak Telis, Arnaud Delafontaine, Sylvain Belot, Raphaël Campagna, Afarine Madani, Joachim Van Cant.
       OBJECTIVE: Infrapatellar fat pad (IFP) conditions represent a significant cause of anterior knee pain, yet evidence-based recommendations for their diagnosis and treatment remain fragmented and underexplored. Despite their clinical relevance, no comprehensive synthesis currently exists of the diagnostic and therapeutic approaches used in these conditions. This review aimed to synthesize existing data on clinical and imaging diagnostics, as well as conservative and surgical treatments for IFP conditions.
    LITERATURE SURVEY: A comprehensive literature search was conducted in PubMed, Physiotherapy Evidence Database (PEDro), ProQuest, Scopus, and SPORTDiscus databases from their inception to January 2024.
    METHODOLOGY: Peer-reviewed studies in English focusing on the diagnosis or treatment of IFP conditions in patients with anterior knee pain were identified and screened independently by two reviewers. Diagnostic and treatments methods for IFP conditions, including clinical manifestations and evidence levels, were synthesized. The occurrence rates of each diagnostic and treatment method were identified and their correlation illustrated with evidence levels using a bubble plot.
    SYNTHESIS: This systematic mapping review analyzed 137 studies from 1272 identified articles, aiming to clarify current diagnostic practices and treatment modalities. IFP conditions were most commonly associated with anterior knee pain (52%), typically aggravated by physical activity. Clinical assessments predominantly relied on evaluations of range of motion and pain (25.5% and 24.2%), and magnetic resonance imaging emerged as the diagnostic gold standard, reported in 40.6% of studies. Radiography, ultrasound, and histopathology also played a role in selected cases. The most frequently reported IFP conditions included masses (55.7%) and impingement syndromes (21.6%), followed by scars or postoperative changes (7.2%) and synovial abnormalities (3%). Conservative treatments were reported in approximately one-third of the studies, with medications used in 37% and active modalities in 33.3% of cases. However, surgical interventions, particularly mass resections, were the most frequently reported therapeutic option, reported in 38.4% of the literature.
    CONCLUSIONS: Diagnosing IFP conditions with magnetic resonance imaging is standard, supported by clinical exams. Conservative approaches are prioritized for mild cases, with surgery considered if needed. Limited metrological validation and lack of standardized protocols limit generalizability. Future research should focus on diagnostic accuracy and treatment optimization.
    DOI:  https://doi.org/10.1002/pmrj.70042
  10. AJR Am J Roentgenol. 2025 Nov 12.
    MRI Features of Acute Muscle Injuries in Professional Soccer Players: A Systematic Review of Prognostic Associations With Return to Play.
    Eliodoro Faiella, Matteo Pileri, Valerio D'Andrea, Adriano Redi, Stefania Lamja, Domiziana Santucci, Luigi Stellato, Francesco Formiconi, Bruno Beomonte Zobel, Rosario Francesco Grasso, Umile Giuseppe Longo, Georg Ahlbäumer, Christoph Schaeffeler.
      Background: In professional soccer players, muscle injuries are a primary cause of loss of time from competition and have high recurrence rates, thus posing management challenges. MRI is widely used for injury grading and prognosis, yet associations of MRI findings with return-to-play (RTP) timelines have been inconsistent. Objective: To evaluate prognostic associations with RTP duration of MRI features of acute muscle injuries in professional soccer players. Evidence Acquisition: A systematic review of the PubMed and Scopus databases was conducted from January 2024 to February 2025 for studies evaluating an MRI classification system for acute muscle injuries in professional soccer players and provided quantifiable RTP outcome. Extracted information was summarized through narrative synthesis, organized according to muscle group. Evidence Synthesis: The analysis included 12 studies, which evaluated a total of 961 acute muscle injuries in professional soccer players, all of whom were male. In eight studies of hamstring injuries, tendon involvement (particularly of the biceps femoris free tendon) and musculotendinous junction involvement were key findings for predicting prolonged RTP; edema had poor predictive utility. In addition, injury grades based on two different advanced MRI classification systems showed weak and moderate prognostic associations with MTP. In four studies of quadriceps injury, distal aponeurosis involvement and associated hematoma were key findings for predicting prolonged RTP beyond structural grades alone. In two studies of adductor injuries, intratendinous location, large muscle gap, and proximal injury site were key findings for predicting prolonged RTP. In one study of hip external rotator injuries, such injuries were generally mild, exhibiting a low structural grade on MRI and being associated with favorable prognosis (i.e., prompt RTP). In two studies of calf injuries, injury grade and extent of edema were key findings for predicting prolonged RTP. However, most reinjuries occurred within 2 months of RTP, commonly following low-grade injuries. Conclusion: The findings highlight the role of MRI in prognostic assessments across muscle groups in professional soccer athletes with acute muscle injury. Clinical Impact: MRI is an important, yet not standalone, component of the RTP decision-making process. Imaging, clinical, and functional criteria should be combined to inform RTP decisions.
    Keywords:  Injury; Magnetic Resonance Imaging (MRI); Muscle; Return to Play (RTP); Soccer
    DOI:  https://doi.org/10.2214/AJR.25.33710
  11. Aesthetic Plast Surg. 2025 Nov 10.
    What Happened to Masticatory Muscles after Botulinum-Toxin-Type A Injection into Masseter: A Systematic Review.
    Mengyue Yan, Minghao Zhao, Jinbao Liu, Yuna Luo, Yuzhi Qiu, Ziying Guo, Panxi Yu, Jianjian Lu.
       BACKGROUND: Botulinum toxin type A (BoNT-A) is commonly used in neuromuscular disorders and cosmetic fields, but the detailed histological and subcellular changes in masticatory muscles, mainly in masseter, remain underexplored.
    METHODS: The literature review was conducted using the PubMed and Cochrane databases between January 2000 and September 2024. Studies of BoNT-A injection in masseters with available full- text and extractable data were included and were grouped depending on injected species. The sample size, dose of injection, follow-up duration, and detailed muscle changes were concluded.
    RESULTS: Fourteen articles were eligible for reviewing, among which 2 were conducted on humans, and 12 were conducted on animals including rats (n=5), mice (n=2), rabbits (n=3) and pigs (n=2). Morphological analysis showed muscle atrophy with variable recovery. Histological findings included decreased fiber diameter, disrupted arrangements, and shifts in myosin-heavy-chain fiber types. Immunohistochemistry indicated increased cell proliferation and nuclear centralization. Electrophysiological assessments demonstrated reduced EMG amplitudes and shorter signal durations, correlating with muscle size and bite force. Ion analysis revealed increased sodium, chloride and sulfur, and decreased potassium and phosphorus.
    CONCLUSION: BoNT-A injection causes dose-dependent denervation and dysfunction in masticatory muscles, with incomplete recovery over time. However, due to very limited human data, these findings should be interpreted cautiously, and strong clinical extrapolations are not justified. These findings provide valuable insights into the long-term effects of BoNT-A on muscle structure and function, highlighting the need for further research into the mechanisms underlying these changes and their clinical implications for both therapeutic and aesthetic applications.
    LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
    Keywords:  Botulinum toxin type A; Histology; Level of Evidence III; Masseter; Masticatory muscle; Ultrastructure
    DOI:  https://doi.org/10.1007/s00266-025-05410-w
  12. Skeletal Radiol. 2025 Nov 14.
    Diagnostic accuracy of ultrasonography for meniscal tears: a systematic review and meta-analysis.
    Rifat Hassan, Daryl Poku, Otto Chan, Nicola Maffulli.
       OBJECTIVE: To assess the diagnostic accuracy of ultrasonography for meniscal injuries using arthroscopy as the reference standard.
    MATERIALS AND METHODS: PubMed, Web of Science, and Cochrane Library databases were systematically explored for studies published since inception to July 2025. Studies using arthroscopy as the reference standard to assess the diagnostic accuracy of ultrasonography for meniscal tears met the inclusion criteria. Diagnostic accuracy, sensitivity, specificity, negative predictive value, and positive predictive value were extracted. Mean differences with 95% CI were calculated and the Inverse Variance fixed-effects model was used for meta-analysis.
    RESULTS: Eleven studies comprising 866 knees were included. Ultrasound demonstrated a high median diagnostic accuracy for both lateral (97%) and medial (94.2%) meniscal tears, with a pooled median accuracy of 95.3%. The greatest median sensitivity was for medial tears (93.1%), while lateral tears showed the highest specificity (95.6%). Radiologist-performed ultrasound showed superior diagnostic performance compared to surgeons, with a higher median sensitivity (90.9% vs. 85%) and specificity (93.9% vs. 85%). Meta-analysis of five studies comparing ultrasound and MRI revealed no significant difference in sensitivity or specificity for diagnosing medial (P = 0.81-0.92) or lateral (P = 0.86-0.91) meniscal tears. Heterogeneity was low-to-moderate for medial tears (I2 = 0-52%; P = 0.08-0.82) and low for lateral tears (I2 = 0%; P = 0.39-0.66).
    CONCLUSION: When performed by experienced operators, ultrasound demonstrates high sensitivity and specificity for meniscal tears. However, these findings should be interpreted with caution due to limited information on tear location, morphology, and variability in study quality.
    Keywords:  Arthroscopy; Diagnostic accuracy; MRI; Meniscal tears; Ultrasound
    DOI:  https://doi.org/10.1007/s00256-025-05076-0
  13. BMJ Case Rep. 2025 Nov 12. pii: e267533. [Epub ahead of print]18(11):
    Sequential bilateral quadriceps tendon rupture in a young individual with chronic kidney disease.
    Jsrg Saran, P Rahul, R Sandeep, Sartaj Wasal.
      Quadriceps tendon rupture (QTR) is a rare but debilitating condition that impairs knee extension, crucial for gait. It typically affects the elderly but may occur in younger individuals with systemic comorbidities such as chronic kidney disease (CKD). We report a case of sequential bilateral QTRs in a young male with CKD. The patient initially presented with left knee pain, swelling and extension lag. Imaging confirmed a full-thickness quadriceps tendon tear, which was surgically repaired using two double-loaded titanium suture anchors, followed by an uneventful recovery. Seven months later, he sustained a similar injury to the right knee. MRI confirmed a full-thickness avulsion tear and the same surgical technique was applied. At a 14-month follow-up, the patient achieved full, pain-free range of motion and improved functional outcomes in both knees. This case highlights the rarity of bilateral sequential ruptures and demonstrates successful management using suture anchor fixation and a structured rehabilitation programme.
    Keywords:  Chronic renal failure; Orthopaedic and trauma surgery; Tendon rupture
    DOI:  https://doi.org/10.1136/bcr-2025-267533
  14. Arthrosc Tech. 2025 Oct;14(10): 103844
    Anatomic Reinsertion of Isolated Proximal Semimembranosus Tendon Avulsion in Athletic Population: A Technical Note.
    Nicolas Lefèvre, Ali Alayane, Mohamad K Moussa, Yoann Bohu, Alain Meyer, Alexandre Hardy.
      Acute hamstring tears are common athletic injuries. Most of these injuries involve muscle belly strain or affect the myotendinous junction. These lesions can often be managed nonoperatively, resulting in a satisfactory functional outcome after an appropriate rehabilitation program. However, acute proximal hamstring avulsion injury occurs less commonly, and early surgical reinsertion is recommended to avoid long-term functional disabilities and to allow a successful return to sport. In this article, we describe a step-by-step surgical technique for reinsertion of proximal isolated semimembranosus tendon avulsion in the athletic population, highlighting the significance of the preoperative radiologic cobra-sign diagnosis and its intraoperative manifestation in this rare injury.
    DOI:  https://doi.org/10.1016/j.eats.2025.103844
  15. Eur Arch Otorhinolaryngol. 2025 Nov 08.
    Comment on "Rehabilitation of facial nerve palsy combining neuromuscular retraining and botulinum toxin a injection: a tertiary referral centre experience and a new working protocol proposal".
    Yuxuan Zhang, Lihua Xuan.
      
    DOI:  https://doi.org/10.1007/s00405-025-09731-z
  16. Taiwan J Obstet Gynecol. 2025 Nov;pii: S1028-4559(25)00254-2. [Epub ahead of print]64(6): 1061-1064
    Herniated intervertebral disc induced cauda equina syndrome during pregnancy: Case report and literature review.
    Yi-Min Chen, Yueh-Han Ku, Tsung-Ho Ying, Su-Ju Tsai.
       OBJECTIVE: Herniated intervertebral disc (HIVD) has long been a common cause of lower back pain. When complicated with cauda equina syndrome and neurological symptoms, HIVD remains a surgical indication to release compressive stress. However, for pregnant female patients, it poses a huge dilemma regarding preterm delivery, as the increasing fetal body weight may burden the mother's spinal condition.
    CASE REPORT: We present a case of a 27-year-old female diagnosed with HIVD complicated with cauda equina syndrome while pregnant in the second trimester. She underwent spinal decompression surgery during pregnancy and was under following rehabilitation and intensive prenatal examinations. Cesarean section delivery was performed under the situation of preterm labor at 35 weeks of pregnancy.
    CONCLUSION: Surgical decompression is necessary for pregnant patients with a combination of HIVD and cauda equina syndrome, followed by intensive monitoring of the fetal growth and delivery via cesarean section.
    Keywords:  Cauda equina; Intervertebral disc herniation; Pregnancy
    DOI:  https://doi.org/10.1016/j.tjog.2024.08.017
  17. Trials. 2025 Nov 14. 26(1): 505
    Comparing the effectiveness of two community-based multimodal exercise programs (CMEPs) on physical activity, performance, fall prevention, and quality of life in older adults: protocol for a multicenter, double-blind, randomized clinical trial.
    Kazi Md Azman Hossain, K M Amran Hossain, Suvro Nill Sarker, Md Feroz Kabir, Md Zahid Hossain, Sharmila Jahan, Ehsanur Rahman, Suraiya Yesmin Sharna, Jannatul Ferdous Rikti.
       BACKGROUND: Aging leads to physiological decline, increasing the risk of frailty, sarcopenia, and falls, which impact older adults' physical activity, performance, and quality of life. Exercise is recommended for mitigating these effects, yet the optimal approach remains unclear. This trial will compare two community-based multimodal exercise programs-sensorimotor and strengthening exercise-to evaluate their effectiveness in enhancing physical activity, performance, fall prevention, and quality of life. The findings will guide evidence-based recommendations for promoting functional independence and healthy aging among community-dwelling older adults.
    METHODS: This trial will be a multicenter, double-blind, parallel, randomized clinical trial in which 140 older adults will be enrolled from July 2025 to May 2026 in Bangladesh. Eligible participants will be allocated into two groups for community-based multimodal exercise programs (CMEPs) at a 1:1 ratio: CMEP-I: sensorimotor exercise group; CMEP-II: strengthening exercise group. The exercise programs will last for 24 sessions/8-week, with a 24-week follow-up. The major outcome measurements will include physical activity, performance, fall prevention, and quality of life using a Physical Activity Scale for the Elderly (PASE), Short Physical Performance Battery (SPPB), Modified Falls Efficacy Scale (MFES), and 36-item Short Form Survey (SF-36). All outcomes will be assessed at pretest, posttest after 8 weeks, and follow-up after 32 weeks.
    DISCUSSION: This randomized clinical trial will investigate the comparative effectiveness of sensorimotor and strengthening exercise programs as community-based multimodal interventions for older adults. These findings will provide evidence on nonpharmacological strategies for improving physical activity, performance, fall prevention, and quality of life, particularly in resource-limited settings. The trial's robust design strengthens validity, although generalizability may be constrained. Long-term follow-up will provide insights into sustained benefits, potentially informing rehabilitation guidelines and policy recommendations to promote accessible, cost-effective exercise interventions for aging populations.
    TRIAL REGISTRATION: This trial is registered prospectively in the Clinical Trial Registry India CTRI/2025/03/083260. Registered on 24/03/2025.
    Keywords:  Fall prevention; Multimodal exercise; Older adults; Physical activity performance; Quality of life
    DOI:  https://doi.org/10.1186/s13063-025-09245-3
  18. J Clin Med. 2025 Oct 28. pii: 7659. [Epub ahead of print]14(21):
    "Pain Prehabilitation" in Major Joint Surgery: The Way Forward to Improve Outcomes and Prevent Pain Chronicity.
    Flaminia Coluzzi, Alberto Di Martino.
      Osteoarthritis (OA) is one of the most frequent orthopedic disorders and a common cause of chronic pain, which is one of the most important factors in recommending total joint arthroplasty (TJA). Due to a greater need for pain relief and improved mobility in the OA population, TJA procedures are in high demand, and most patients with OA experience long waiting times. Waiting for TJA places a significant burden on patients as a result of worsening pain and functional deterioration. Therefore, optimizing pre-operative circumstances in these patients is essential to target analgesic interventions, preserve post-operative quality of life, and minimize post-operative outcomes such as chronic post-surgical pain. Achieving optimal pain control before surgery remains an unmet need, and it is difficult to devise a one-size-fits-all analgesic regimen. Pain is a challenge for orthopedic healthcare professionals (OHCPs), and orthopedic patients are notably less satisfied than patients undergoing other surgeries in terms of pain management. We reviewed the latest clinical evidence on pain management in patients with OA wait-listed for TJA to help OHCPs effectively manage their pain. Here, we provide actionable suggestions to strengthen orthopedic surgeons' competency in pain assessment and therapy selection. By integrating the perspectives of an orthopedic surgeon and a pain therapist, we also introduce the concept of "pain prehabilitation" and propose integrating it into standard care protocols during the TJA wait-list period to optimize TJA outcomes and prevent the development of chronic post-surgical pain.
    Keywords:  arthroplasty; chronic post-surgical pain; hip; knee; osteoarthritis; peri-operative pain; post-operative pain; prehabilitation
    DOI:  https://doi.org/10.3390/jcm14217659
  19. Ir J Med Sci. 2025 Nov 12.
    Evaluation of the relationship between tension-type headache and masseter muscle thickness in women with fibromyalgia syndrome: a cross-sectional ultrasonographic study.
    Handan Elif Nur Bayraktar, Ender Erden, Ayla Çağlıyan Türk, Serdar Aykaç.
       BACKGROUND: Tension-type headache is the most common headache type in fibromyalgia syndrome (FMS). The association between FMS and tension-type headache has been explained by central sensitization disorder. However, the neuromuscular mechanisms involved in this condition remain unclear.
    AIM: This study aimed to assess the relationship between masseter muscle thickness and tension-type headache in women with FMS.
    METHODS: This cross-sectional study included 30 FMS patients with tension-type headache (Group 1), 33 FMS patients without headache (Group 2), and 31 healthy controls (Group 3). FMS diagnosis followed the 2016 ACR criteria. Masseter muscle thickness was measured bilaterally using ultrasonography. Pain intensity was assessed using the Visual Analog Scale (VAS), quality of life using the Short Form-36 (SF-36), the impact of headache using the Headache Impact Test-6 (HIT-6), and disease severity using the Fibromyalgia Impact Questionnaire (FIQ).
    RESULTS: Masseter muscle thickness significantly differed among groups (p < 0.001). Group 1 (11.6 ± 2.6 mm) had greater thickness than Group 2 (9.4 ± 1.5 mm) and Group 3 (8.5 ± 1.0 mm) (p < 0.001). In Group 1, masseter thickness correlated with HIT-6 scores (r = 0.377, p = 0.040). The optimal cut-off value of masseter muscle thickness for predicting tension-type headache in FMS was ≥ 9.74 mm (AUC = 0.748, p = 0.001; 76.6% sensitivity, 66.6% specificity).
    CONCLUSION: This study showed that masseter muscle thickness is associated with tension-type headache in FMS. However, further studies are needed to elucidate the neuromuscular mechanisms involved.
    Keywords:  Central sensitization; Fibromyalgia syndrome; Masseter muscle; Tension-type headache
    DOI:  https://doi.org/10.1007/s11845-025-04164-3
  20. Int J Mol Sci. 2025 Oct 26. pii: 10408. [Epub ahead of print]26(21):
    Infrapatellar Fat Pad in Knee Osteoarthritis: A Comprehensive Review of Pathophysiology and Targeted Therapeutic Strategies.
    Ilenia Mallia, Antonella Fioravanti, Serena Guiducci.
      Osteoarthritis (OA) is the most common joint disorder globally, affecting approximately 595 million individuals and representing the first cause of chronic pain and disability. Recently, the infrapatellar fat pad (IFP), an intracapsular adipose tissue in the human knee joint, was recognized as an active and metabolically significant contributor to the pathophysiology of OA through the release of pro-inflammatory cytokines, adipokines, and growth factors that sustain inflammatory response, fibrotic remodeling, and neurogenic pain. The present review provides an overview of the pathophysiological significance of the IFP in OA and current and promising therapeutic strategies targeting this adipose structure. We summarize the available preclinical and translational evidence on conservative therapies, minimally invasive interventions, and surgical options as well as IFP-derived mesenchymal stromal cells as a potential cell source for cartilage repair. Overall, preclinical research indicates that the modulation of IFP inflammation and fibrosis could alleviate pain and delay the progression of the disease. The superficial location and its central role in the pathogenesis of OA make the IFP a promising therapeutic target in knee OA (KOA).
    Keywords:  adipokines; adipose tissue; infrapatellar fat pad; osteoarthritis; pathophysiology; treatment
    DOI:  https://doi.org/10.3390/ijms262110408
  21. Eur Geriatr Med. 2025 Nov 12.
    Frailty detection tools in geriatric rehabilitation: a systematic review.
    Diana Maia Alcaide, Francesco Cilla, Emilie Kort, Patrizia D'Amelio.
       PURPOSE: Frailty is common among older adults admitted to geriatric rehabilitation and influences outcomes such as recovery, length of stay, and discharge destination. Identifying reliable tools to assess frailty in this setting is essential for clinical decision-making. This review aims to identify the tools used to detect frailty in geriatric rehabilitation settings, analyze the associations between frailty and rehabilitation outcomes, and assess their ability to predict short- and long-term clinical outcomes in patients admitted to post-acute geriatric inpatient rehabilitation.
    METHOD: A systematic review was conducted using Medline/PubMed and CINAHL databases. Studies were eligible if they focused on geriatric rehabilitation and analyzed associations between frailty and rehabilitation-sensitive outcomes.
    RESULTS: Twenty-five studies were included, covering a range of frailty instruments. Across studies, frailty consistently predicted mortality, institutionalization, functional recovery, and patient-reported outcomes. The Clinical Frailty Scale (CFS) and Frailty Index (FI) were the most frequently used and showed the most consistent associations with these outcomes, with reported AUC values typically between 0.60 and 0.73, and up to 0.82 for short-term mortality. Performance-based tools such as gait speed and the Frailty Phenotype were particularly predictive of functional outcomes.
    CONCLUSION: The CFS and FI currently represent the most validated and feasible approaches for frailty assessment in geriatric rehabilitation, while direct head-to-head comparisons between tools remain limited. Detecting frailty at admission can help anticipate rehabilitation trajectories and guide individualized care strategies.
    Keywords:  Frail older adults; Frailty; Frailty screening; Rehabilitation; Screening tool
    DOI:  https://doi.org/10.1007/s41999-025-01352-3
  22. Video J Sports Med. 2025 Nov-Dec;5(6):5(6): 26350254251342814
    Ultrasound-Guided Platelet-Rich Plasma (PRP) Injection for Deep Medial Collateral Ligament (MCL) Injuries of the Knee.
    Jhulia Kawachi Cruz, Jade Chee, Mok Ying Ren, Yee Han Dave Lee, MingChang Wang.
       Background: Deep medial collateral ligament (dMCL) injuries are a known cause of medial knee pain, which can result from either trauma or degenerative conditions. While conservative management, including bracing and physical therapy, remains the first-line treatment, persistent symptoms may necessitate additional interventions. Platelet-rich plasma (PRP) therapy has emerged as a promising treatment modality due to its ability to enhance ligament healing by promoting collagen synthesis and tissue regeneration. Recent studies highlight PRP's potential to improve pain and function in patients with medial collateral ligament injuries, particularly when guided by ultrasound for precise delivery.
    Indications/Technique Description: This study presents 2 cases of dMCL injury with different causes. The first case involves a 25-year-old male athlete with a traumatic valgus injury, while the second case is a 63-year-old man with nontraumatic medial knee pain and underlying degenerative changes. Both patients underwent ultrasound-guided PRP injections after not responding to conservative management. The PRP preparation involved centrifugation of autologous blood to obtain leukocyte-rich PRP, which was then injected into the meniscotibial ligament (MTL) under ultrasound guidance. The injection was performed using a high-frequency linear transducer to visualize the dMCL and guide the needle precisely into the injured area of the MTL. The in-plane approach ensured optimal placement, minimizing the risk of inadvertent tissue damage.
    Results: Both patients demonstrated significant pain reduction and functional improvement within 4 weeks postinjection. The athlete successfully returned to football, and the older patient resumed brisk walking without discomfort. Follow-up showed no recurrence of symptoms. Key considerations for PRP therapy include careful patient selection, individualization of PRP therapy, familiarity with the different PRP preparation systems, and proper patient education for managing expectations regarding treatment outcomes. Technical proficiency in ultrasound-guided injections is essential for accurate PRP delivery, minimizing procedural errors, and maximizing therapeutic benefits.
    Discussion/Conclusion: dMCL injuries can cause persistent medial knee pain that is unresponsive to conservative treatment. PRP therapy presents a promising option for promoting ligament healing, with ultrasound guidance improving precision and potentially optimizing outcomes. However, further research is needed to establish standardized protocols for PRP formulation, dosing, and long-term efficacy.
    Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
    Keywords:  chronic medial knee pain; deep MCL tear; leukocyte-rich PRP; medial collateral ligament; meniscotibial ligament; platelet-rich plasma therapy; ultrasound-guided PRP injection
    DOI:  https://doi.org/10.1177/26350254251342814
  23. Arch Phys Med Rehabil. 2025 Nov 11. pii: S0003-9993(25)00972-4. [Epub ahead of print]
    Chair Yoga for Individuals With Osteoarthritis.
    Shubham Tawade, Mamta Shetty.
      
    Keywords:  Chair yoga; Joint mobility; Osteoarthritis; Physical activity; Rehabilitation
    DOI:  https://doi.org/10.1016/j.apmr.2025.09.033
  24. Knee. 2025 Nov 07. pii: S0968-0160(25)00264-9. [Epub ahead of print]
    Impact of meniscal root tears on knee osteoarthritis development: A systematic review of the literature.
    Gianluca Canton, Andrea Marchetti, Belinda Trobec, Michelangelo Scordo, Alessandra Mazzon, Chiara Ratti, Manuela Deodato, Alex Buoite Stella, Luigi Murena.
       BACKGROUND: Meniscal root tears (MRTs) are a significant cause of knee pain and dysfunction. An MRT can alter the biomechanics of the knee joint, leading to cartilage damage and osteoarthritis. This systematic review aims to evaluate the impact of MRTs on the progression of knee osteoarthritis in patients undergoing non-operative treatment.
    METHODS: A systematic review was performed based on the PRISMA guidelines in PubMed, Scopus, and ScienceDirect databases ("meniscal root injuries" OR "meniscal root tears") AND ("osteoarthritis" OR "joint degeneration").
    RESULTS: Eight studies, including 1160 patients with MRTs, met the inclusion criteria. MRTs were associated with more severe cartilage damage on the medial femoral condyle (Noyes score, 4.95; P < 0.001) and on the medial tibial plateau (Noyes score, 3.9; P < 0.005) compared with other meniscus tear patterns. Eighty per cent of medial meniscus posterior root tears had an ICRS grade ≥2 chondral lesions at the medial femoral condyle, and those chondral lesions had a more progressive and faster nature compared with medial meniscus posterior horn tears. MRTs and meniscal extrusion were predominant factors associated with accelerated osteoarthritis progression (odds ratio 4.64; 95 % confidence interval, 1.61-13.34; P = 0.004).
    CONCLUSIONS: MRTs have a crucial role both in the initiation and the progression of knee osteoarthritis, leading to severe cartilage damage and dramatic consequences on quality of life. Early diagnosis and appropriate management could preserve knee function and delay osteoarthritic changes.
    Keywords:  Cartilage degeneration; Knee; Meniscal root tears; Osteoarthritis
    DOI:  https://doi.org/10.1016/j.knee.2025.10.012
  25. Eur J Radiol. 2025 Nov 07. pii: S0720-048X(25)00597-2. [Epub ahead of print]194 112511
    MRI has limited accuracy in diagnosing complex regional pain syndrome Type 1 - a systematic review of the literature.
    Anna Henzi, Stephanie Schneider, Reto Sutter, Maria Monika Wertli, Florian Brunner.
       OBJECTIVES: To review the current body of research on the diagnostic accuracy of magnetic resonance imaging (MRI) in Complex Regional Pain Syndrome (CRPS) Type 1.
    MATERIAL AND METHODS: A systematic search was conducted across MEDLINE, Embase, Cochrane, Scopus, and Web of Science from their inception to September 2023, following PRISMA guidelines. Risk of bias was assessed for all included studies, sensitivity and specificity values were extracted from studies with comparative data.
    RESULTS: Fifteen studies published between 1991 and 2022, involving 562 patients (353 with CRPS Type 1 and 209 controls), were included in the qualitative synthesis. Four comparative studies provided sufficient data to calculate diagnostic performance. Reported sensitivity ranged from 6 % to 91 %, and specificity from 50 % to 100 %, demonstrating substantial heterogeneity. Bone marrow edema was the most frequently reported MRI feature, particularly in early disease stages. Most studies had a high risk of bias due to inconsistent diagnostic criteria, non-standardized imaging protocols, and incomplete clinical and demographic reporting. Comparative studies showed inconsistent diagnostic performance, while non-comparative studies revealed variable MRI findings across different CRPS Type 1 presentations.
    CONCLUSION: MRI is not accurate in diagnosing CRPS Type 1, with a lack of consistent findings across studies. While it may assist in differential diagnosis, its utility as a standalone diagnostic tool is very limited.
    CLINICAL RELEVANCE STATEMENT: MRI can be used as an adjunct to clinical assessment for CRPS Type 1 to exclude alternative diagnoses and guide management but lacks the diagnostic accuracy to diagnose CRPS Type 1.
    Keywords:  Complex regional pain syndrome; Diagnostic imaging; Magnetic resonance imaging
    DOI:  https://doi.org/10.1016/j.ejrad.2025.112511
  26. Orthop J Sports Med. 2025 Nov;13(11): 23259671251356628
    Platelet-Poor Plasma for Muscle Injuries: A Review of Mechanisms and Clinical Perspectives.
    Guilherme C A M Fernandes, Scott A Rodeo.
       Background: Muscle injuries are a frequent challenge in professional sports, with hamstring injuries being particularly prevalent. Despite advances in rehabilitation protocols, recurrence rates remain high, and recovery timelines vary depending on injury location and severity.
    Purpose: To examine the roles of platelet-rich plasma (PRP) and platelet-poor plasma (PPP) in muscle injury treatment, highlighting their biological differences and potential clinical applications.
    Study Design: Narrative review.
    Methods: A comprehensive literature search was conducted, focusing on the biological properties of PRP and PPP, their effects on muscle regeneration, and clinical outcomes related to their use in muscle injury management.
    Results: PRP contains high concentrations of growth factors, including transforming growth factor-beta, myostatin, vascular endothelial growth factor, and platelet-derived growth factor, which promote cell proliferation and angiogenesis. However, its leukocyte content and associated pro-inflammatory cytokines may exacerbate inflammation, potentially increasing pain, delaying recovery, and raising the risk of heterotopic ossification. Conversely, PPP is rich in insulin-like growth factor-1 and hepatocyte growth factor, which modulate inflammation and fibrosis, promoting muscle regeneration. Basic science studies have demonstrated that PPP induces myoblast differentiation, whereas PRP primarily promotes myoblast proliferation, potentially favoring scar formation over true muscle tissue regeneration. Clinically, PPP has been explored as a treatment for muscle injuries, with some reports suggesting it may facilitate recovery and reduce reinjury risk. However, the limited availability of high-quality clinical trials prevents definitive conclusions about its efficacy compared with PRP.
    Conclusion: While both PRP and PPP offer biological advantages, PPP may present a favorable profile for muscle regeneration due to its ability to enhance differentiation while modulating inflammation. However, current clinical evidence remains limited, and further research is needed to establish definitive treatment guidelines.
    Keywords:  hamstring muscle; muscle injury; platelet-poor plasma (PPP); platelet-rich plasma (PRP); regenerative medicine; sports rehabilitation
    DOI:  https://doi.org/10.1177/23259671251356628
  27. Anaesth Crit Care Pain Med. 2025 Nov 12. pii: S2352-5568(25)00217-6. [Epub ahead of print] 101685
    Ultrasound-guided trapezius plane block for removal of superficial lesions in the upper thoracic paravertebral region.
    Wen-Yi Gong, Chen-Guang Li, Kang-Ming Che, Kun Fan.
      
    Keywords:  nerve block; spinal nerve; trapezius muscle; ultrasound
    DOI:  https://doi.org/10.1016/j.accpm.2025.101685
  28. Anesthesiol Clin. 2025 Dec;pii: S1932-2275(25)00065-5. [Epub ahead of print]43(4): 673-686
    Update on Peripheral Regional Analgesic Techniques for Hip Surgery Patients.
    Dario Bugada, Greta Gandolfi, Luca F Lorini, Edward R Mariano.
      A wide range of selective nerve blocks is available for analgesia after hip surgery due to the multiple different nerves that originate from lumbar and sacral plexus and innervate the hip joint. The ideal regional block technique (or combination of techniques) is yet far to be defined. A number of nerve and plexus blocks have demonstrated utility for patients undergoing hip surgery and are supported by evidence. The ideal block for analgesia for each patient who has hip surgery may depend on the specifics of each surgical scenario, patient characteristics and preferences, and outcomes of interest.
    Keywords:  Fascia iliaca block; Femoral nerve block; Hip fracture; Lumbar plexus block local infiltration analgesia; Post-operative analgesia; Surgical outcome; Total hip replacement
    DOI:  https://doi.org/10.1016/j.anclin.2025.07.008
  29. J Clin Med. 2025 Oct 28. pii: 7656. [Epub ahead of print]14(21):
    Return to Sport After Acromioclavicular Injury: A Systematic Review of Modifiable Factors.
    William Chad Elliott, Benjamin Olivo, Alexander Abraham, Evan J Hernandez, Tammam Hanna.
      Background: Acromioclavicular joint (ACJ) injuries are common in athletes, particularly in contact and collision sports, and frequently cause time lost from play. Although functional outcomes are well described, return to sport (RTS) is inconsistently reported, and the influence of treatment modality, surgical technique, and rehabilitation strategy on RTS outcomes remains uncertain. Methods: A systematic review was conducted following PRISMA guidelines registered in PROSPERO (ID 1155609). PubMed, Embase, Scopus, Web of Science, and Cochrane were searched for studies from 2015-2025 reporting at least one RTS metric (time, rate, or return to pre-injury level) after ACJ injury. Data on injury classification, surgical technique, rehabilitation protocols, and RTS outcomes were extracted. Results: Twenty-five studies (1077 patients) were included. The pooled RTS rate was 90.8% (95% CI, 88.6-93.0), with 87.7% (95% CI, 84.5-90.9) returning to their pre-injury level. The overall mean RTS time was 125.0 ± 63.05 days (4.5 months). Non-operative treatment was associated with faster RTS (52 days [95% CI, 47-58]) compared with operative management (127 days [95% CI, 114-140]). Among surgical techniques, allograft reconstruction demonstrated slightly higher rates of RTS at pre-injury level (84.2%) versus non-allograft approaches (78.9%). Rehabilitation timing was also influential: protocols initiating strengthening within 6 weeks were associated with faster RTS (93 vs. 132 days) and higher pre-injury RTS rates (86.8% vs. 72.7%). Conclusions: Most athletes return to sport after ACJ injury, with high RTS rates across treatment approaches. Earlier surgery, allograft reconstruction, and early strengthening show associative trends toward faster and more complete RTS, though these findings should be interpreted cautiously due to heterogeneity and confounding with existing data. Standardized RTS definitions, consistent rehabilitation reporting, and prospective comparative studies are needed to clarify which modifiable factors most influence recovery and return to play.
    Keywords:  acromioclavicular joint; allograft; reconstruction; rehabilitation; return to sport; shoulder injury
    DOI:  https://doi.org/10.3390/jcm14217656
  30. Front Pain Res (Lausanne). 2025 ;6 1693399
    Pain mechanism and management strategy of rheumatoid arthritis.
    Dijun Wang, Ting Li, Weiqi Wang, Yonglan Ruan, Jiali Cai, Xiaojing Yan.
      Rheumatoid arthritis (RA) pain is one of the most common forms of chronic pain in clinic. A large number of RA-related literature has been reported. At present, although some analgesic measures are used in clinic, pain management after drug treatment remains suboptimal in real-world settings, and clinically meaningful pain after treatment is still reported. RA pain is a complex pathological process that involves inflammatory response, neuroimmune interaction, peripheral and central nerve sensitization, autoantibodies, structural damage, and other dimensions. Although inflammatory reaction is the most common cause of RA-induced pain, neuroimmune interaction is the key and core of RA pain, and autoantibodies are one of the significant characteristics of RA, which can directly or indirectly lead to pain. In addition, joint structural damage is the final pathological stage and a serious consequence in the late stage of RA. This article aims to summarize the mechanisms of RA pain, which is helpful to further clarify the diagnosis and provide targeted treatment.
    Keywords:  RA; inflammation; neuroimmune interaction; pain; therapy
    DOI:  https://doi.org/10.3389/fpain.2025.1693399
  31. Cureus. 2025 Oct;17(10): e93994
    Muscle or Fascial System Lesion (Part II): The Medial Gastrocnemius and the "Tennis Leg" Paradigm.
    Saverio Colonna, Fabio Casacci, Paolo Minafra, Nicola Basile.
      Muscle injuries have traditionally been interpreted as disruptions of contractile fibers. Increasing evidence, however, highlights the central role of the intramuscular connective tissue system - including endomysium, perimysium, epimysium, aponeuroses, and extracellular matrix - in force transmission, injury susceptibility, and recurrence risk. Medial gastrocnemius strain, or "tennis leg," exemplifies how myoconnective architecture dictates injury mechanics. The biomechanical interplay between the medial gastrocnemius (MG) and lateral gastrocnemius (LG) and between the MG and soleus (Sol) may represent key determinants of tissue failure through aponeurotic shear and displacement mismatches. Biological healing times, including the expected phases of inflammation, proliferation, and remodeling, provide a framework for safe return-to-play and help tailor rehabilitation timing according to lesion severity and location. Ultrasound imaging is a valuable tool to precisely localize the lesion, distinguish contractile from connective tissue involvement, and guide clinical decision-making, allowing monitoring of tissue continuity, early scar formation, and readiness for progressive loading. This etiopathogenetic framework has direct therapeutic implications. Rehabilitation should include a progressive therapeutic exercise program - from isometric to concentric, eccentric, and plyometric loading - complemented by neuromuscular coordination drills. Such programs must be calibrated by joint angle and mechanical demand to improve viscoelastic properties and optimize connective tissue adaptation, thereby enhancing fascial resilience and neuromuscular efficiency. Complementary manual therapy, aimed at restoring fascial continuity, correcting articular restrictions (particularly at the subtalar joint), and optimizing posterior myofascial chain function, represents an essential component of treatment. When integrated with ultrasound-guided monitoring and aligned with biological healing timelines, these approaches might support safer functional recovery, contribute to lowering recurrence risk, and offer a preventive framework for athletes at high risk of re-injury.
    Keywords:  achilles tendon; medial gastrocnemius strain; muscle strain injury; myoaponeurotic injury; myofascial junction; myotendinous junction; neuromuscular coordination; return-to-play; tennis leg; ultrasound evaluation
    DOI:  https://doi.org/10.7759/cureus.93994
  32. Respir Med. 2025 Nov 12. pii: S0954-6111(25)00563-3. [Epub ahead of print] 108500
    Point of Care Ultrasound as a Bedside Diagnostic Tool in Acute Dyspnea Patients in Emergency Department for timely management.
    Mohamed Saied Hamza Yousef, Hatem Mohamed Al Azizi, Marwa Mohammed Fouad.
       BACKGROUND: Acute dyspnea is a common symptom in the Emergency Department. Chest-X-ray is the first investigation performed for dyspneic patients. Point of care ultrasound (POCUS) is the first quick method that can reliably distinguish between different causes of acute dyspnea. This study aimed to determine the accuracy of the ultrasound diagnosis among patients presenting with acute dyspnea compared to the radiological imaging for timely management.
    METHODS: We conducted a cross-sectional analytical study that included 79 patients presenting with acute dyspnea to the emergency Department and performed POCUS then radiography.
    RESULTS: POCUS demonstrated 100% sensitivity, specificity, and diagnostic accuracy in diagnosing interstitial lung disease and pleural effusion. For pneumonia, POCUS achieved 96.3% sensitivity, 90.4% specificity, and 92.4% diagnostic accuracy. In cases of chronic obstructive pulmonary disease (COPD) or asthma exacerbation, it showed 91.3% sensitivity, 96.4% specificity, and 94.9% diagnostic accuracy. POCUS had slightly lower sensitivity in pneumothorax and pulmonary edema but maintained high specificity (98.6% and 100%, respectively) and diagnostic accuracy (97% and 91%). Radiological findings were consistent with POCUS in 97.7% of patients. The mean time to diagnosis was significantly shorter with POCUS (16 ± 6.7 minutes; range = 5-30 minutes) compared to radiography (83.6 ± 39.4 minutes; range = 35-200 minutes).
    CONCLUSIONS: POCUS has a high sensitivity, specificity and diagnostic accuracy in identification of underlying causes of dyspnea in emergency and reduction of the time needed till final diagnosis compared to radiographies, and for the first definitive management.
    Keywords:  Dyspnea; Lung Diseases; Point-of-Care Systems; Radiography; Ultrasonography
    DOI:  https://doi.org/10.1016/j.rmed.2025.108500
  33. Nutrition. 2025 Sep 08. pii: S0899-9007(25)00268-0. [Epub ahead of print]142 112950
    Efficacy of Mediterranean diet in musculoskeletal disorders: A systematic review and meta-analysis for primary and tertiary prevention featured in the Italian National Guidelines "La Dieta Mediterranea".
    Mediterranean Diet Guideline Group
       OBJECTIVES: Musculoskeletal disorders (MSDs) represent a leading cause of disability. Given its anti-inflammatory and antioxidant properties, the Mediterranean diet (MD), may be a low-cost strategy for the prevention of MSDs. The aim of this systematic review and meta-analysis is to summarize the evidence and evaluate the association between adherence to the MD and prevention of MSDs.
    METHODS: This review was conducted in accordance with PRISMA 2020 and MOOSE guidelines. A comprehensive search of several databases was performed up to February 28, 2024. Study quality was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence was evaluated using the NUTRIGRADE approach. Pooled effect sizes were computed using a random-effects model and expressed as risk ratios (RR), hazard ratios (HR), or odds ratios (OR), as appropriate.
    RESULTS: A total of 16 studies were included. Higher adherence to the MD was associated with a possible risk reduction in the prevalence of osteoporosis in adults (OR = 0.77; 95% confidence interval [CI]: 0.60-1.00; low degree of certainty). A one-point increase in MD adherence was associated with a slight reduction in the risk of incidence of fractures (RR = 0.97, 95% CI: 0.94-0.99) and in the risk of pain in patients with knee OA (HR = 0.98, 95% CI: 0.97-0.998), with a moderate degree of certainty.
    CONCLUSIONS: Adherence to the MD may exert some beneficial effects in the risk of incidence of fractures in the general population and in the risk of pain among patients with knee OA. However, more high-quality studies are needed.
    Keywords:  Fractures; Mediterranean diet; Meta-analysis; Musculoskeletal conditions; Osteoarthritis; Osteoporosis; Pain; Sarcopenia; Systematic review
    DOI:  https://doi.org/10.1016/j.nut.2025.112950
  34. Knee Surg Sports Traumatol Arthrosc. 2025 Nov 14.
    Association between walking gait biomechanical changes after anterior cruciate ligament injury or reconstruction and the development of osteoarthritis: A systematic review.
    Jérôme Riera, Mattéo Campion, Thomas Néri, Alexandre J M Rambaud, Noémie C Duclos.
       PURPOSE: Anterior cruciate ligament (ACL) injury and reconstruction significantly increase the risk of knee osteoarthritis (OA). Biomechanical alterations during walking are frequently suggested contributors to OA development. This systematic review aims to determine the association between walking gait biomechanical changes following ACL injury or reconstruction and the early development of knee OA.
    METHODS: Studies were identified from MEDLINE, Web of Science, CINAHL and SPORTDiscus databases searched up to January 2024. Eligible studies included adults (≥15 years) with ACL injury or reconstruction, assessing knee biomechanics during walking compared to healthy controls or the contralateral limb. Outcomes included cartilage changes assessed through imaging techniques or biological markers. Methodological quality was evaluated using the modified Downs and Black checklist.
    RESULTS: Of the 1221 records identified, four cross-sectional studies (total: 199 participants; mean [SD]: 26.3 [6.4] years old) met the inclusion criteria. Three of the four included studies were conducted on participants who had undergone ACL reconstruction surgery. Two studies were of high methodological quality, one was of moderate quality and one was of low quality. The analysis showed that knee unloading (i.e., reduced knee adduction moment (KAM) and vertical ground reaction forces) was associated with an increase in cartilage MRI T1ρ and T2 relaxation times, suggesting a deterioration in cartilage composition. Reduced gait variability and kinematic alterations (reduced knee excursion, altered knee flexion angles and tibial rotations) correlated with early cartilage biochemical changes detectable through MRI T1ρ, T2 relaxation time. Meta-analysis was not feasible due to heterogeneity in outcomes among studies.
    CONCLUSION: The included studies demonstrated significant associations between altered gait biomechanics and cartilage degradation. Biomechanical factors such as reduced KAM or reduced knee flexion angle during gait could serve as early indicators for OA risk and inform targeted rehabilitation interventions.
    LEVEL OF EVIDENCE: Level III.
    Keywords:  gait; imaging; knee injury; knee surgery; osteoarthritis
    DOI:  https://doi.org/10.1002/ksa.70183
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