Search Results (10,158)

Background/Objectives: The aim of this study was to precisely characterize neurological deficits in patients with idiophatic scoliosis (IS) by comparing preoperative clinical and neurophysiological examination results in patients with Lenke 1 and 3 spinal curvatures. Bracing alone (NTP) is commonly applied preoperatively in subjects with IS, but incorporating the concept of prerehabilitation with additional physiotherapy (TP) may further slow the progression of scoliosis. Methods: An interview regarding the development and conservative treatment of IS, clinical neurological assessment, and bilateral neurophysiological tests involving electromyography (sEMG) of motor unit activity in the paraspinal and lower extremity muscles, electroneurography (ENG) of neural impulse transmission in the peroneal nerve motor fibers and entire efferent conduction involving recordings of motor evoked potentials (MEPs) induced with transcranial magnetic field stimulation (TMS) were performed in patients with Lenke 1 (N = 33) and Lenke 3 (N = 27) spine curvatures in two groups (N = 30 each) that were treated (TP) or not treated (NTP) with physiotherapy. Results: Back pain, assessed on the VAS by all Lenke 3 patients, was 3.3 on average. Limited spine mobility (p < 0.001) was not associated with better results following physiotherapeutic treatment in either Lenke patient group. Sensory perception studies within the L3–S1 dermatomes and vibration sensation tests were found to be slightly decreased in Lenke 3 patients (p < 0.001), predominantly on the concave IS side, but less so in the TP group. Achilles tendon and patellar reflexes were detected as pathological (p < 0.001) only in Lenke 3 patients, and less frequently in the TP group. Asymmetry on the concave side of scoliosis in manual muscle testing scores was found (p < 0.001) in Lenke 3 patients, showing moderate muscle weakness in the distal lower extremities, mainly in the NTP group. sEMG recordings from the paraspinal muscles revealed moderate neurogenic abnormality that was more intense on the concave side of scoliosis curvature, both main and second; the pattern of muscle motor unit activity in the proximal and distal muscles of the lower extremities was consistent with the muscle strength deficits observed in manual muscle testing, though less so in the TP group. Deficits in MEP amplitudes recorded from lower extremity muscles and the peroneal nerve were found to be more commonly expressed on the concave side of the main scoliosis curvature and on the concave side of the second scoliosis curvature, particularly in Lenke 3 patients, but the significance of changes was lower in the TP group (p = 0.03–0.009). ENG studies showed moderate abnormalities in peripheral neural conduction of peroneal nerve motor fibers originating at the L5 ventral root, especially in Lenke 3 patients from the NTP group. Conclusions: Neurological diagnostic tests, supported by selected clinical neurophysiological studies, reveal greater motor and sensory abnormalities in IS patients with Lenke 3 than with Lenke 1 curvatures. The study indicates that patients in both groups who received only bracing had poorer outcomes than those who received additional physiotherapy. In the context of prerehabilitation, a combined conservative treatment approach including physiotherapy can provide functional benefits for the IS patient before the necessary surgical treatment. In this study, differences were observed between the groups treated with physiotherapy and those not treated; however, a causal link cannot be established. The results are consistent with a possible benefit of the physiotherapy, but they require further prospective studies to be proven. Full article

Background/Objectives: Ultrasound-guided fascial hydrorelease (FHR) occasionally elicits a brief localized contraction (“local twitch”) at the moment the needle tip contacts a fascial layer; the anatomical basis of this reaction has not yet been systematically characterized. To examine local twitch occurrence relative to stacking fascia (yes/no) at the needle tip (primary outcome), as well as the anatomical distribution and per-video capture rate (secondary outcomes). Methods: We retrospectively analyzed 11,205 ultrasound videos from a single pain clinic (October 2015–March 2026). Twitches were identified by prospective clinical observation and computational screening (frame-difference-based Profile Match classifier; 417 candidates over 30 review rounds). The stacking fascia status was independently determined by two FHR-experienced clinicians, with discordant cases jointly adjudicated. Results: Inter-rater agreement was 86/90 (95.6%; 95% CI 89.0–98.8%); one case was reassessed, deemed to not be a twitch, and excluded. In the final cohort (n = 89), local twitches occurred at stacking fascia in 89/89 (100%; 95% CI 95.9–100%). Events were concentrated in gluteal/pelvic (51%) and lumbar paraspinal (29%) regions, with a per-video capture rate of 0.98% (110/11,205; 95% CI 0.81–1.18%). Conclusions: Local twitches during ultrasound-guided FHR essentially always coincide with the needle tip lying within stacking fascia, identifying this as the structural locus within this cohort. This figure represents inclusion-criterion-bound selectivity within the twitch-positive subset, not the positive predictive value of stacking fascia for twitch occurrence. Full article

Background/Objectives: Pain behaviors observed during movement may complement self-reported and performance-based assessment in chronic nonspecific low back pain (NSLBP). The Pain Behaviour Scale (PaBS) quantifies clinician-observed pain behavior severity during functional tasks, but no Turkish version has been evaluated. This study translated and culturally adapted the PaBS into Turkish and examined its reliability, agreement, measurement error, and construct validity. Methods: This cross-cultural adaptation and psychometric validation study included 102 adults with chronic NSLBP. The PaBS was translated, back-translated, reviewed by an expert panel, and pilot tested. Participants completed clinical questionnaires and standardized physical performance tests. Two independent raters scored the PaBS at baseline; one rater repeated scoring after one week. Reliability was analyzed using ICCs. Measurement error, agreement, and construct validity were assessed using SEM, MDC95, percentage agreement, Cohen’s kappa, Bland–Altman analysis, and predefined correlation hypotheses. Results: Total-score interrater reliability was excellent (ICC = 0.95), and intrarater reliability was high (ICC = 0.96), although the latter should be interpreted cautiously because participant status changed between sessions. MDC95 values were 2.05 and 1.85. Individual behavior agreement ranged from 81.4% to 100.0%, but item-level findings should be supplementary. All construct-validity correlations were in the expected direction; however, most were stronger than predefined expectations, and only 1 of 13 hypotheses met both direction and magnitude. Conclusions: The Turkish PaBS appears reliable for assessing observed pain behavior severity during functional movement in adults with chronic NSLBP. Construct-validity findings should be considered preliminary because stronger-than-expected correlations may reflect construct overlap with disability, fear-avoidance, and physical performance. Full article

Background/Objectives: Adductor canal blocks (ACBs) are widely used for postoperative analgesia following total knee arthroplasty (TKA). However, the duration of analgesia with a single-shot ACB is limited. Pharmacological adjuncts may enhance and prolong the duration of single-injection blocks, but their efficacy in this setting remains unclear. The aim of this study was to assess the analgesic effectiveness of adjuncts added to local anaesthetic for single-shot ACBs following TKA. Methods: An extensive systematic literature review was performed on Medline, Embase, CINAHL, Cochrane CENTRAL, and Web of Science. Adult patients undergoing primary TKA who received a single-shot ACB with an adjunct added to LA were eligible, with a single-shot ACB with LA alone as the comparator. The primary outcome was postoperative analgesic efficacy, assessed by pain scores (VAS/NRS), time to first rescue analgesia, total postoperative opioid consumption, or sensory block duration. Secondary outcomes included functional recovery measures and adverse events. Risk of bias was evaluated using the Cochrane RoB 2 tool, and the certainty of evidence for each adjunct–outcome combination was assessed using GRADE. Due to clinical heterogeneity, a meta-analysis was not feasible and findings were synthesised narratively. Results: Nine randomised controlled trials (RCTs) assessing the analgesic efficacy of adjuncts added to local anaesthetic in ACB following TKA were included in this review. Adjuncts included dexmedetomidine, dexamethasone, butorphanol, buprenorphine, and magnesium sulphate. Three RCTs demonstrated improvements in early postoperative analgesia with dexmedetomidine at doses of 0.5 µg/kg, while lower doses (0.25 µg/kg) did not. Dexamethasone also decreased early postoperative pain across two RCTs and showed the most evidence for significant prolongation in sensory blockade, with a dose of 4 mg needed to produce significant effects. Butorphanol and buprenorphine demonstrated a significant reduction in postoperative opioid consumption and improved pain, but evidence was limited to single trials. Findings for magnesium were inconsistent. No adjunct was associated with any serious side effect or adverse event. Conclusions: Pharmacological adjuncts added to single-shot ACBs following TKA generally improved early postoperative pain and reduced opioid consumption compared with LA alone, with the most consistent benefits observed for dexmedetomidine (0.5 µg/kg) and dexamethasone (≥4 mg). However, these effects appeared dose-dependent, were largely confined to the first 24 h after surgery, and were supported by moderate-to-low certainty evidence with limited functional outcome data. Further high-quality, adequately powered RCTs with standardised functional endpoints and longer follow-up are required to define optimal dosing, clarify safety, and determine whether improved analgesia translates into meaningful gains in rehabilitation and recovery. Full article

Background: Postural disability develops in almost all patients with diabetic polyneuropathy (DPN). While transcutaneous electrical nerve stimulation (TENS) has proven effective in regressing sensory and motor impairments, its efficacy in improving postural control remains insufficiently studied. Purpose: To evaluate and compare the efficacy of direct peroneal and tibial high-frequency low-amplitude (HFLA) TENS and low-frequency high-amplitude (LFHA) TENS in correcting DPN-related postural disability, among European female patients without a documented history of falls, motor deficits, or pronounced electromyographic impairments, using computerized static posturography and the tandem walk test. Materials and methods: In this single-center, three-arm, randomized controlled trial (registration number: ISRCTN47534508, 3 December 2024), we conducted a longitudinal prospective analysis of European women with DPN-related postural disability. All enrolled patients were non-fallers with no motor deficits and baseline compound muscle action potential (CMAP) amplitudes of the peroneal and tibial nerves of at least 1.5 mV. The intervention groups received HFLA TENS (n = 24) or LFHA TENS (n = 25), while the control group underwent sham TENS (n = 24). Primary endpoints were assessed via static posturography and the tandem walk test (TWT); secondary endpoints were evaluated using hypoesthesia and pain evaluation, the Modified Clinical Test of Sensory Interaction in Balance (mCTSIB), and electromyography. Assessments were performed before treatment, immediately post-treatment, and at the conclusion of a 2-month follow-up period. Results: Comparative analysis incorporating the Bonferroni adjustment demonstrated that LFHA TENS is significantly superior to HFLA TENS. Post-treatment, LFHA TENS induced a reduction in envelope area by 20.7% under the eyes-open (EO) condition (p < α_adj; α_adj = 0.0028) and 32.9% under the eyes-closed (EC) condition (p < α_adj; α_adj = 0.0028), alongside a 16.6% decrease in the Romberg uotient (RQ) (p < α_adj; α_adj = 0.0056). Furthermore, LFHA TENS elicited a significant 39.0% reduction in velocity of CoP sway (VCS) under the EO condition (p < α_adj; α_adj = 0.0042), and decreased total CoP sway excursion by an average of 35.8% (EO) (p < α_adj; α_adj = 0.0042) and 43.8% (EC) (p < α_adj; α_adj = 0.0042) compared to baseline. In contrast, no statistically significant changes in these parameters were observed after HFLA TENS. Ultimately, LFHA TENS outperformed HFLA TENS in improving postural stability by 7.04% under the EO condition (p < α_adj; α_adj = 0.0042) and by 25.5% under the EC condition (p < α_adj; α_adj = 0.0042) in both the tandem walk test (TWT) and the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB). Notably, a statistically significant increase in the CMAP amplitude of the affected peroneal nerves by 22.2% was observed exclusively following LFHA TENS treatment (p < α_adj; α_adj = 0.0056). Conclusions: The clinical efficacy of direct peroneal and tibial TENS compared to sham stimulation in reducing postural disability during both static and dynamic conditions was established in European female patients with moderate-to-severe DPN and unremarkable EMG impairments. Comparative analysis reveals a clear therapeutic superiority of LFHA TENS over HFLA TENS, as evidenced by significantly greater improvements in both posturographic parameters (envelope area, total CoP excursion under EO and EC conditions, and VCS under the EO condition) and functional clinical tests (TWT and mCTSIB), demonstrating long-term stability for up to 2 months post-intervention. Full article

Background/Objectives: Temporomandibular disorders may influence the perception of odontogenic pain through shared trigeminal pathways and referred pain mechanisms. This study compared postoperative pain following root canal treatment (RCT) between patients with anterior disc displacement with reduction (ADDwR) and individuals without temporomandibular disorders. Methods: The study was registered at ClinicalTrials.gov (NCT07329413; 8 January 2026). Individuals with irreversible pulpitis and symptomatic apical periodontitis in a vital mandibular molar, with or without ADDwR according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), were included. After exclusions and losses to follow-up, 70 patients (35 per group) were analyzed. All RCTs were performed by one clinician using a standardized protocol. Postoperative pain was assessed using the Numeric Rating Scale at 6 and 12 h and on postoperative days 1, 2, 3, 5, and 7. Joint pain and maximum mouth opening were recorded preoperatively and on postoperative day 7, and their associations with postoperative pain were analyzed. Results: Patients with ADDwR reported significantly higher pain scores at 6 and 12 h compared with the comparison group (p < 0.05). Multivariable analyses showed that ADDwR, female gender, and age were independently associated with postoperative pain at specific time points (p < 0.05). Additionally, procedure duration was significantly longer in the ADDwR group than in the comparison group (p < 0.05). Conclusions: Patients with ADDwR reported higher levels of early postoperative pain following RCT than individuals without temporomandibular disorders. These findings suggest that temporomandibular conditions may influence postoperative pain perception and should be considered when evaluating postoperative pain complaints. Full article

Background: Costal cartilage is the preferred structural material for augmentation rhinoplasty when robust and durable tip support is required. However, conventional full-thickness harvest is associated with significant donor-site morbidity, and commonly employed rigid fixation strategies—such as the septal extension graft—substantially restrict postoperative nasal tip compliance. The present study introduces a novel two-component technique combining a half-harvest costal cartilage procurement method with a pyramidal-shaped columellar strut graft anchored on the floating-tip principle, with the objective of maintaining postoperative nasal tip flexibility while providing structural support following augmentation rhinoplasty. Methods: A retrospective review was performed of consecutive patients who underwent primary or revision augmentation rhinoplasty using the pyramidal costal cartilage columellar strut graft technique by a single surgeon between June 2018 and February 2026. The medial half of the conjoined costal cartilage at the seventh, eighth, or ninth rib was procured via a half-harvest approach, preserving the lateral cortex and perichondrium to minimize donor-site morbidity and potential cartilage regeneration was considered a theoretical benefit. The harvested cartilage was carved into a pyramidal columellar strut and secured to the anterior nasal spine using a floating fixation construct; the inferior base of the strut was rigidly fixed to the nasal septum and anterior nasal spine with a minimum of three PDS 5-0 sutures, while the superior portion remained free to preserve physiologic nasal tip mobility. Adjunctive cap and shield grafts, perichondrial wrapping, and dermal fat grafts were employed as indicated. Primary outcomes included nasal tip projection, postoperative tip mobility, donor-site morbidity, and surgical complication rates. Results: Favorable clinical observations of maintained tip projection were noted throughout follow-up. Manual postoperative examination suggested preservation of tip flexibility in most patients; however, no validated objective mobility assessment tool was available. The revision rate for clinically significant tip deviation was low. No major donor-site adverse events—including pneumothorax or rib fracture—were encountered. Postoperative chest wall pain was minimal and transient, with most patients resuming daily activities within one week of surgery. Conclusions: The pyramidal-shaped costal cartilage columellar strut graft with half-harvest technique is a novel, biomechanically informed, and technically reproducible approach to augmentation rhinoplasty that was developed to address donor-site morbidity and postoperative tip rigidity, two commonly recognized limitations of conventional costal cartilage rhinoplasty: donor-site morbidity and postoperative nasal tip rigidity. Preservation of the lateral cortex and perichondrium during procurement may contribute to reduced postoperative donor-site discomfort, accelerates functional recovery, and may promote endogenous cartilage regeneration over time. The anatomically derived pyramidal strut geometry, combined with floating fixation to the anterior nasal spine, was designed to approximate the native columellar architecture, enabling consistent preservation of physiologic nasal tip mobility. The present series demonstrated a favorable safety profile with a low overall complication rate and an absence of major donor-site adverse events. Prospective studies with validated objective outcome measures are required to confirm these findings, to delineate the optimal patient selection criteria, and to establish evidence-based long-term outcome benchmarks for this technique. Full article

Progressive bladder fibrosis and impaired detrusor function represent converging pathological endpoints across diverse bladder disorders, including bladder outlet obstruction (BOO) associated with benign prostatic hyperplasia, spinal cord injury (SCI)-induced neurogenic bladder, radiation cystitis, and interstitial cystitis/bladder pain syndrome. Conventional therapies primarily manage symptoms and rarely reverse established fibrosis or restore durable bladder homeostasis. Mesenchymal stem/stromal cells (MSCs) have attracted considerable interest as therapeutic agents owing to their antifibrotic, immunomodulatory, angiogenic, and trophic paracrine activities. This review synthesises six key studies from our group and places them within the broader international literature on bladder regenerative medicine: (i) feasibility of superparamagnetic iron oxide (SPIO)-based molecular MRI tracking of transplanted human MSCs (hMSCs) in the bladder; (ii) SPIO-hMSC therapy for BOO-associated fibrosis with concurrent MRI monitoring; (iii) hepatocyte growth factor (HGF)-overexpressing engineered hMSC (B10.HGF) therapy in BOO; (iv) hMSC transplantation into the SCI-injured bladder wall monitored by MRI; (v) systematic review and meta-analysis of stem cell therapy effects on urodynamic outcomes in SCI models; and (vi) HGF-overexpressing hMSC therapy for BOO-induced underactive bladder. These six key studies are contextualised within the broader literature addressing cell sources, biomaterial-assisted delivery platforms, mechanistic pathways, emerging clinical evidence, and the evolving regulatory landscape for cell-based advanced therapy medicinal products. Key translational challenges include product standardisation, long-term durability, and mechanism-linked potency assay development. Full article

Background and Objectives: Knee osteoarthritis (KOA) and other degenerative chondropathies are major causes of pain and disability. When core conservative treatments are insufficient, intra-articular hyaluronic acid (HA) and platelet-rich plasma (PRP) are commonly used as adjunctive options, although evidence remains difficult to interpret because of heterogeneity in patients, products, preparation protocols, and treatment schedules. This exploratory retrospective study described short-term clinical outcomes after two standardized intra-articular protocols, hybrid HA and autologous PRP, in a real-world outpatient physiatry setting. Materials and Methods: This monocentric retrospective study included 40 treated knees (19 HA, 21 PRP) from 31 unique patients at the Policlinico di Bari between October 2022 and November 2024. The HA group received two injections of a hybrid high-/low-molecular-weight HA formulation, whereas the PRP group received three injections of autologous PRP. Outcomes were pain intensity, assessed by the Numerical Rating Scale (NRS), and function, assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), from baseline to end-of-cycle follow-up. Results: Both groups showed short-term clinical improvement. Mean NRS scores decreased from 6.26 to 2.26 in the HA group and from 6.76 to 2.29 in the PRP group, with no significant between-group difference in change from baseline (p = 0.509). WOMAC improved by 25.42 ± 20.39 points in the HA group and 20.19 ± 16.18 points in the PRP group (p = 0.372). In the main regression analysis, treatment type was not a significant predictor of outcome; unadjusted and age-/sex-adjusted WOMAC sensitivity models suggested a possible HA advantage that was not retained after full adjustment. Conclusions: In this small exploratory cohort, both protocols were associated with short-term improvements, without definitive fully adjusted evidence of between-group superiority. These findings should not be interpreted as evidence of equivalence or definitive comparative efficacy. Full article

Background/Objectives: Rotator cuff tears (RCT) are one of the most common causes of shoulder pain and loss of function. The aim of this study was to evaluate shoulder morphometric and soft tissue parameters using magnetic resonance imaging (MRI) and to compare them between patients diagnosed with RCT and symptomatic controls without MRI-evident RCT. Methods: In this retrospective study, shoulder MRI images of 64 patients diagnosed with RCT and 63 control subjects without RCT aged 20–80 years were analyzed. The critical shoulder angle (CSA), lateral acromial angle (LAA), acromial index (AI), coracohumeral distance (CHD), acromiohumeral distance (AHD), coracoacromial ligament (CAL) thickness, and supraspinatus tendon (SST) thickness were measured. Binary logistic regression analysis was applied to identify independent factors associated with RCT. Results: CSA was significantly higher in the RCT group compared to the symptomatic control group without RCT (36.18 ± 4.0 vs. 32.61 ± 2.6, p < 0.001). In contrast, CHD (7.06 ± 1.13 vs. 8.05 ± 1.30 mm, p < 0.001), AHD (6.15 ± 1.27 vs. 7.23 ± 0.99 mm, p < 0.001), and SST thickness (5.17 ± 0.69 vs. 6.89 ± 0.64 mm, p < 0.001) were significantly lower in the RCT group. No significant differences were found between the groups in terms of LAA, AI, and CAL thickness (p > 0.05). In the logistic regression analysis, increasing age (OR = 1.159; p = 0.044) and CSA (OR = 1.808; p = 0.005) were identified as independent risk factors, while an increase in SST thickness was identified as inversely associated with RCT (OR = 0.35; p = 0.003). ROC analysis demonstrated that SST thickness had the highest discriminatory performance (AUC = 0.963), while the combined multivariable model achieved an AUC of 0.979. Conclusions: CSA, CHD, AHD, and SST thickness are important morphometric and soft tissue parameters associated with RCT. In particular, the assessment of CSA and SST thickness may provide a more robust and clinically meaningful approach to RCT-associated changes. The combined evaluation of CSA and SST thickness may contribute to the understanding of morphometric associations related to RCT. Full article

Background and Clinical Significance: Proximal hamstring tendinopathy can occur not only in athletes but also in nonathletes when daily activities impose repetitive tensile or compressive loading at the ischial tuberosity. Because symptoms often resemble piriformis syndrome or lumbar pathology, diagnosis may be delayed; Case Presentation: A woman in her twenties developed buttock pain during desk work. Lumbar MRI was normal, and piriformis blocks provided only temporary relief. Localized tenderness at the ischial tuberosity, pain provocation during sitting, and positive provocation tests suggested proximal hamstring tendinopathy. Ultrasound showed a mildly hypoechoic area at the tendon insertion without definite thickening or tear. Ultrasound-guided injection of levobupivacaine and dexamethasone produced immediate but temporary relief. She continued receiving injections every two weeks, combined with stretching, hip-lift strengthening, and reduced sitting. After 18 injections, her pain improved from a numerical rating scale score of 10 to 0–1; Conclusions: This case demonstrates that proximal hamstring tendinopathy can develop in nonathletes due to lifestyle-related mechanical loading. Characteristic clinical findings and ultrasound evaluation are essential for diagnosis, and ultrasound-guided injection combined with exercise and activity modification provided sustained symptom improvement. Full article

Background and Aims: Bleeding and post-procedural pain are common adverse events after endoscopic mucosal resection (EMR) of large colorectal lesions. Epinephrine is frequently added to submucosal injectates, although its benefit for delayed bleeding is inconsistent and associated with post-procedural pain. Tranexamic acid (TXA), an antifibrinolytic agent used to prevent bleeding in several medical conditions, has not been evaluated during colorectal EMR. We compared TXA with epinephrine for bleeding outcomes, safety, and post-procedural pain. Methods: In this prospective, double-blind, randomized controlled pilot trial, adults undergoing EMR for colorectal lesions ≥20 mm were randomized 1:1 to receive a TXA-containing or epinephrine-containing submucosal injectate. Primary outcomes were intraprocedural bleeding severity and delayed bleeding. Secondary outcomes included post-procedural pain, post-polypectomy syndrome, and thromboembolic events. Results: The study included 121 patients (TXA, n = 60; epinephrine, n = 61). Intraprocedural bleeding rates and severity were similar between groups, and hemostasis was achieved endoscopically in all cases. Delayed bleeding occurred in 8.3% of patients in the TXA group and 11.5% in the epinephrine group (p = 0.762); clinically significant delayed bleeding occurred in 6.7% and 6.6%, respectively. Lesion size was the only independent predictor of delayed bleeding. Post-procedural pain was significantly less frequent with TXA (5.0% vs. 39.3%; p < 0.001), and no TXA-treated patients required opioid analgesia compared with 18% in the epinephrine group (p < 0.001). No major adverse events were observed in the TXA group. Conclusions: In this pilot study, TXA achieved bleeding outcomes comparable to epinephrine while significantly reducing post-procedural pain in large colorectal EMR procedures, warranting further evaluation in larger trials. Full article

Background/Objectives: Cervical radiculopathy is a frequent cause of pain, often leading to disability, reduced quality of life, and significant healthcare utilization. Cervical epidural steroid injections are widely used, though safety concerns have been reported. Ultrasound-guided cervical retrolaminar block (RLCB) is a potential alternative. The purpose of this study was to evaluate the long-term clinical trajectory after ultrasound-guided cervical retrolaminar block, including pain outcomes, patient-reported improvement, and the rate of subsequent cervical spine surgery. Methods: This is a retrospective cohort analysis that was conducted at the Pain and Spine Surgery units in a single center. : We included 121 patients with cervical radiculopathy treated between January 2020 and September 2022 (mean age 49.4 ± 11.1 years; 51.2% male). All patients underwent RLCB. s: Primary outcome measures were subsequent cervical decompressive surgery and composite pain response (≥2-point absolute and ≥50% relative NRS reduction). Secondary outcome measures included recurrence, analgesic use, global rating of change (GRC), satisfaction, willingness to repeat, and safety. Baseline data was extracted from records; structured follow-up interviews were conducted at two years. Results: At two years, 9.1% required surgery, and 57.9% achieved composite pain response; 74.4% reported ≥2-point NRS reduction. GRC scores showed improvement (mean 5.0 ± 3.4), with 37% reporting “very much better.” Satisfaction was high, with 70.2% willing to repeat. Pain recurred in 71.1% but persisted in 28.9%. No major complications occurred; minor events were reported in 6.6%. Outcomes were less favorable in patients with pre-injection pain duration ≥1 year. p. Conclusions: In this retrospective cohort, cervical RLCB was associated with sustained patient-reported improvement, high satisfaction, and a 9.1% observed subsequent surgery rate at two years. These findings are hypothesis-generating and require confirmation in prospective controlled studies. Full article

Objective: Patellofemoral pain syndrome (PFPS) is one of the most common causes of anterior knee pain and is associated with biomechanical, muscular, and functional impairments affecting the extensor mechanism of the knee. Quadriceps muscle dysfunction, altered tendon morphology, and impaired lower extremity biomechanics have been suggested to contribute to patellofemoral joint instability and pain development. The aim of this study was to evaluate the muscle and tendon thicknesses of the extensor mechanism using ultrasonography in individuals with PFPS and to investigate the relationship of these measurements with knee pain, knee function, and physical performance, with particular emphasis on the combined assessment of muscle morphology, tendon morphology, and functional performance parameters. Methods: This cross-sectional study was conducted between 5 November 2019 and 15 December 2019, including 80 individuals aged 18–45 years who presented with anterior knee pain and were clinically diagnosed with patellofemoral pain syndrome (PFPS). Demographic characteristics of the participants were collected. Pain severity was assessed using the Visual Analog Scale (VAS), and functional status was evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Physical performance was assessed using the 6 m walk test and the five-repetition sit-to-stand test. Ultrasonographic examination was used to measure rectus femoris muscle thickness, vastus intermedius muscle thickness, quadriceps tendon thickness, and patellar tendon thickness using a high-frequency linear probe in a standardized supine position with the knee relaxed and the lower extremity muscles at rest. Results: The mean age of the participants was 32.11 ± 7.08 years, and the mean body mass index (BMI) was 25.05 ± 4.11 kg/m². Of the participants, 42 (52.5%) were male and 38 (47.5%) were female; 46 (57.5%) were smokers and 34 (42.5%) were non-smokers. Ultrasonographic measurements showed that rectus femoris muscle thickness was 1.98 ± 0.45 cm, vastus intermedius muscle thickness was 1.75 ± 0.53 cm, quadriceps tendon thickness was 0.54 ± 0.12 cm, and patellar tendon thickness was 0.35 ± 0.08 cm. Rectus femoris, vastus intermedius, and quadriceps tendon thicknesses were significantly higher in males compared to females (p = 0.001). Individuals with BMI > 25 had greater rectus femoris (p = 0.023) and vastus intermedius (p = 0.001) muscle thicknesses. A negative correlation was found between rectus femoris muscle thickness and WOMAC total (r = −0.227, p = 0.042) and WOMAC pain scores (r = −0.233, p = 0.028). Additionally, a significant relationship was observed between quadriceps tendon thickness and the five-repetition sit-to-stand test (r = −0.247, p = 0.044). Conclusions: In patients with PFPS, quadriceps muscle and tendon thicknesses were found to be associated with certain demographic and clinical parameters. Ultrasonographic evaluation of muscle and tendon structures may be a useful, non-invasive, dynamic, and radiation-free method for better understanding the clinical characteristics of PFPS and its relationship with physical performance. Ultrasonographic assessment may also provide complementary information for rehabilitation planning and functional evaluation in individuals with PFPS, although these findings should be interpreted cautiously because of the cross-sectional design and weak correlations observed. Full article

Background: Cervicogenic headache (CEH) is a secondary headache disorder originating from dysfunction in the cervical spine. In addition to pain, individuals with CEH frequently experience disturbances in postural control and sensorimotor integration, which may compromise functional capacity and quality of life. Conventional clinical assessments typically focus on pain intensity and cervical range of motion; however, these measures often fail to capture the multifactorial mechanisms underlying balance impairments in this population. Machine learning (ML) methods offer the ability to integrate multidimensional clinical data and may provide a more comprehensive approach for identifying patterns of postural stability and the factors influencing balance regulation in CEH. Methods: A secondary analysis was conducted using baseline data pooled from three registered randomized controlled trials, comprising 68 independent participants diagnosed by a neurologist according to the International Classification of Headache Disorders, 3rd edition (ICHD-3). Postural Stability Class served as the primary outcome and was derived from quantitative stability scores categorized as High, Moderate, or Low. Predictor variables included demographic characteristics (age, gender), clinical measures (pain intensity, headache frequency, symptom duration, cervical range of motion), and sensorimotor parameters (center-of-pressure sway and gaze accuracy). Five machine learning algorithms—Random Forest, XGBoost, Support Vector Machine, Logistic Regression, and Gradient Boosting—were trained and evaluated using 10-fold cross-validation with procedures implemented to reduce overfitting. Results: The Gradient Boosting classifier demonstrated the best performance, achieving an accuracy of 0.857 and an F1 score of 0.857, with a cross-validated accuracy of 0.802 ± 0.063. Random Forest and XGBoost achieved accuracies of 0.786. Feature importance analysis identified center-of-pressure sway and pain intensity as the most influential predictors of stability classification, followed by cervical flexion range of motion and gaze accuracy. Demographic variables showed minimal contribution to model performance. Conclusions: Machine learning models were able to distinguish different levels of postural stability in individuals with CEH. The findings highlight the central role of pain and sensorimotor control in balance regulation and suggest that predictive analytics may support precision physiotherapy by enabling rehabilitation strategies tailored to individual sensorimotor profiles. Full article