Search Results (122)

Background: Adhesive capsulitis (AC) causes a global limitation of both active and passive range of motion (ROM) in the shoulder, with or without pain, and no specific radiographic findings. Its course is self-limiting and progresses through three or four stages. The diagnosis is primarily clinical, since imaging tests are nonspecific. Treatment options include physical therapy (PT), intra-articular corticosteroid injections, suprascapular nerve block (SSNB), and hydrodilatation (HD). The latter is useful for expanding and reducing inflammation of the joint capsule through the insufflation of saline solution, anesthetics, and corticosteroids. Objectives: To compare whether patients with AC, stratified by phase 1 and 2, who receive high-volume HD as treatment achieve better outcomes in terms of shoulder pain and function compared to patients who receive low-volume HD. To compare whether there are differences in PT times and to determine mean axillary recess (AR) values. Methods: A randomized, parallel-block, triple-blind clinical trial will be conducted in 64 patients with AC in phases 1 and 2, aged 30 to 70 years, with limited active and passive ROM in two planes, and shoulder pain lasting more than 3 months. HD will be administered with volumes of 20 mL or 40 mL, followed by a conventional rehabilitation program. Outcomes will be reviewed at the 1st, 3rd, and 6th months of HD. Variables collected will include Shoulder Pain and Disability Index (SPADI), Visual Analog Scale (VAS), Range of motion (ROM), Lattinen index (LI), AR size, and time to completion of PT. Results: HD has been gaining clinical relevance in interventional rehabilitation as a treatment for AC, although its medium- and long-term efficacy remains a matter of debate. The variability in the volumes used for capsular expansion, with studies ranging from 18 mL to 47 mL, is compounded by the fact that most of these studies do not differentiate between AC stages. This could influence treatment effectiveness. Furthermore, diagnosis remains a challenge since valid and specific diagnostic parameters are lacking. Conclusions: Understanding the differences between HD techniques, considering the influence of certain factors such as the volume used or the stages of AC, as well as improving diagnosis and the coordination of scientific work. This could facilitate the development of protocols for the use of HD in AC. Full article

Complex regional pain syndrome (CRPS) is a disabling pain condition, which is distinct from other pain syndromes by the presence of autonomic dysfunction and regional inflammatory changes. Objectives: To explore the impact of pharmacological treatment strategies, specifically scheduled, on-demand dosing regimens versus lack of medical treatment, on pain-related and functional outcomes in rehabilitation for individuals with CRPS. Methods: A total of 32 participants with CRPS were assigned to three treatment groups depending on analgesic treatment during the course of complex rehabilitation. Pre- and post-rehabilitation assessments were conducted using validated measures, including the Numerical Rating Scale (NRS) for pain, the Short-Form McGill Pain Questionnaire (SF-MPQ), PainDETECT, the Disabilities of the Arm, Shoulder, and Hand (DASH), and the Lower Extremity Functional Scale (LEFS). Results: Significant improvements in pain and upper limb function (DASH scores) were observed across all groups (p < 0.05). No statistically significant changes were found in lower limb function (LEFS). Between-group comparisons revealed significant differences in post-treatment pain scores (SFMPQ-B), particularly between groups with a constant treatment regimen and those without treatment. Conclusions: There were no statistically significant changes compared to different treatment regimen groups. The constant treatment group showed slightly better average improvements in pain and disability compared to other groups. Statistically significant improvements in all CRPS patients were observed in pain-related and functional measures. Full article

Upper extremity amputations significantly impact an individual’s physical capabilities, psychosocial well-being, and overall quality of life. The level at which an amputation is performed influences residual limb function, prosthetic compatibility, and long-term patient satisfaction. While surgical guidelines traditionally emphasize maximal limb preservation, prosthetists often advocate for amputation sites that optimize prosthetic fit and function, highlighting the need for a collaborative approach. This review examines the discrepancies between surgical and prosthetic recommendations for optimal amputation levels, from digit amputations to shoulder disarticulations, and explores their implications for prosthetic design, functionality, and patient outcomes. Various prosthetic options, including passive functional, body-powered, myoelectric, and hybrid devices, offer distinct advantages and limitations based on the level of amputation. Prosthetists emphasize the importance of residual limb length, not only for mechanical efficiency but also for achieving symmetry with the contralateral limb, minimizing discomfort, and enhancing control. Additionally, emerging technologies such as targeted muscle reinnervation (TMR) and advanced myoelectric prostheses are reshaping rehabilitation strategies, further underscoring the need for precise amputation planning. By integrating insights from both surgical and prosthetic perspectives, this review highlights the necessity of a multidisciplinary approach involving surgeons, prosthetists, rehabilitation specialists, and patients in the decision-making process. A greater emphasis on preoperative planning and interprofessional collaboration can improve prosthetic outcomes, reduce device rejection rates, and ultimately enhance the functional independence and well-being of individuals with upper extremity amputations. Full article

Accurate range of motion (ROM) assessment is essential for evaluating musculoskeletal function and guiding rehabilitation, particularly in pediatric populations. Traditional methods, such as optical motion capture and handheld goniometry, are often limited by cost, accessibility, and inter-rater variability. This study evaluated the feasibility and accuracy of the Microsoft Azure Kinect-powered Monitored Augmented Rehabilitation System (MARS) compared to Kinovea. Sixty-five pediatric participants (ages 5–18) performed standardized shoulder and elbow movements in the frontal and sagittal planes. ROM data were recorded using MARS and compared to Kinovea. Measurement reliability was evaluated using intraclass correlation coefficients (ICC3k), and accuracy was evaluated using root mean squared error (RMSE) analysis. MARS demonstrated excellent reliability with an average ICC3k of 0.993 and met the predefined accuracy threshold (RMSE ≤ 8°) for most movements, with the exception of sagittal elbow flexion. These findings suggest that MARS is a reliable, accurate, and cost-effective alternative for clinical ROM assessment, offering a markerless solution that enhances measurement precision and accessibility in pediatric rehabilitation. Future studies should enhance accuracy in sagittal plane movements and further validate MARS against gold-standard systems. Full article

Background: Frozen shoulder (FS) is a common musculoskeletal condition with significant socioeconomic impact. Despite its prevalence, the condition lacks a definitive understanding and universally effective treatment approach. Objective: To evaluate the effects of an intervention combining manual therapy, conventional exercises, and strategies to improve sleep quality and circadian rhythm on recovery and biomarkers in patients with FS. Methods: A single-blind, randomized, controlled trial was conducted with 34 participants divided into control and experimental groups (n = 17 each). Both groups received manual therapy and conventional exercises, while the experimental group (EG) also received sleep and circadian rhythm optimization instructions. Biomarkers (fasting glucose, insulin, Homeostasis Model Assessment of Insulin Resistance (HOMA) index, leptin, triglycerides, total cholesterol, HDL cholesterol, uric acid, CRP, IL-1β, IL-6, IL-17, IL-10, IL-33, HMGB1, and TNF-α) and functional outcomes (SPADI, ROM, and PSQI) were assessed pre- and post-intervention. Results: After six weeks, the EG showed significant improvements in IL-10 levels (mean change: 2.5 pg/mL vs. 0.5 pg/mL in the control group (CG), p = 0.03), IL-6 reduction (−1.8 pg/mL vs. −0.4 pg/mL, p = 0.02), and HOMA index (−0.8 vs. −0.2, p = 0.04). ROM improved by 20 degrees in the EG versus 10 degrees in the CG (p = 0.01), SPADI scores decreased by 25 points versus 15 points (p = 0.03), and PSQI improved by 4 points compared to 2 points (p = 0.05). Conclusion: The integration of sleep quality and circadian rhythm optimization into conventional rehabilitation significantly enhances recovery, particularly IL-10 modulation, but these did not translate into superior clinical improvements within the study period. Further long-term studies are needed to confirm whether early biological effects lead to sustained functional recovery in FS patients. Full article

Rotator cuff tears are common in individuals over 40, and physical therapy is often prescribed post-surgery. However, access can be limited by cost, convenience, and insurance coverage. CuffLink is a telehealth rehabilitation system that integrates the Strengthening and Stabilization System mechanical exerciser with the interACTION mobile health platform. The system includes a triple-axis accelerometer (LSM6DSOX + LIS3MDL FeatherWing), a rotary encoder, a VL530X time-of-flight sensor, and two wearable BioMech Health IMUs to capture upper-limb motion. CuffLink is designed to facilitate controlled, home-based exercise while enabling clinicians to remotely monitor joint function. Concurrent validity and test–retest reliability were used to assess device accuracy and repeatability. The results showed moderate to good validity for shoulder rotation (ICC = 0.81), device rotation (ICC = 0.94), and linear tracking (from zero: ICC = 0.75 and RMSE = 2.41; from start: ICC = 0.88 and RMSE = 2.02) and good reliability (e.g., RMSEs as low as 1.66 cm), with greater consistency in linear tracking compared to angular measures. Shoulder rotation and abduction exhibited higher variability in both validity and reliability measures. Future improvements will focus on manufacturability, signal stability, and force sensing. CuffLink supports accessible, data-driven rehabilitation and holds promise for advancing digital health in orthopedic recovery. Full article

Radial extracorporeal shockwave therapy (rESWT) is used in the rehabilitation of patients with shoulder periarthritis (SP) to promote tendon regeneration. This quasi-experimental non-randomized comparative study included 36 cases of SP, divided into two groups, and aimed to comparatively investigate the analgesic and functional effects of two different rESWT protocols. In Group One, the protocol involved an energy level of 210 J/session, a frequency of 10 Hz, and 2500 impulses per session. In Group Two, the protocol used an energy level of 190 J/session, a frequency of 10–15 Hz, and 2000 impulses per session. Treatments were administered over three sessions in Group One and five sessions in Group Two, with one-week intervals between sessions. Both rESWT protocols were combined with a physical therapy program consisting of ten daily sessions of analgesic physiotherapy and kinesiotherapy. Before and after the rehabilitation program, patients were assessed for pain intensity using the visual analog scale (VAS) and shoulder function using range of motion (ROM) measurements (via goniometry) and the Shoulder Pain and Disability Index (SPADI). Significantly better outcomes were observed in Group One (p < 0.001), particularly in terms of pain reduction and improvements in shoulder functionality, especially external rotation. These results support the effectiveness of the rESWT protocol used in Group One, which combined lower energy and frequency levels with a higher number of impulses over fewer sessions. Full article

Trapeziometacarpal osteoarthritis is the second most frequent degenerative hand disease, and it presents in 66% of women over the age of 55. Post-surgery immobilization results in functional losses that could be attenuated by motor imagery training. Objectives: The aim of this study is to evaluate the efficacy of motor imagery training during the post-surgical immobilization period in women who underwent surgery for trapeziometacarpal osteoarthritis. Methods: A randomized controlled trial was performed. A total of 40 patients satisfied the eligibility criteria, agreed to participate, and were randomized into an experimental group (n = 20) or control group (n = 20). Motor imagery was applied to the experimental group during the 3 weeks of post-surgical immobilization and to the control group with the conventional protocol. Measurement outcomes were assessed four times throughout the study using the Disabilities of the Arm, Shoulder, and Hand questionnaire, the Cochin Hand Function Scale questionnaire, the Visual Analogue Scale, goniometry, a baseline pinch gauge, circumferential measurement, and the modified Kapandji Index. Results: There were significant improvements in the motor imagery group compared with the control group in post-motor imagery, pre- and post-rehabilitation measurements, functional pain (p < 0.001), rest pain (p < 0.01), hand mobility (p < 0.001), range of motion (p < 0.05), and wrist edema (p < 0.04); there were also improvements in pre- and post-rehabilitation measurements, quality of life in relation to upper limb function problems (p < 0.04), the post-rehabilitation measurement of hand functionality (p = 0.02), and post-motor imaging in finger-to-finger pinch strength. There were no statistically significant differences in the rest of the variables. Conclusions: Early intervention with motor imagery could be effective for resting and functional pain, quality of life in relation to upper limb problems, functional capacity, mobility, range of motion, strength, and edema. Full article

Background and Objectives: Although virtual reality (VR) has been shown to be effective in rehabilitation through motor learning principles, its impact on upper extremity function, particularly in the context of console use, remains unclear. Materials and Methods: This study aimed to investigate the effects of VR-based task-oriented movement on the upper extremity of healthy individuals. A total of 26 healthy individuals performed task-oriented movements in both real and virtual environments in a randomized order. All participants completed a single session of task-oriented movements using a VR Goggle system in a virtual setting. Physiotherapists designed immersive VR-based experiences and 3D screen-based exergames for this study. Upper extremity function was assessed using several measures: joint position sense (JPS) of the wrist and shoulder was evaluated using a universal goniometer, reaction time was measured via a mobile application, and gross manual dexterity was assessed using the box-and-block test (BBT). Evaluations were conducted before and after the interventions. Results: The results showed that JPS remained similar between conditions, while BBT performance improved in both groups. However, the reaction time increased significantly only after VR intervention (p < 0.05). No significant period or carryover effects were observed across the parameters. These findings suggest that VR-based task-oriented training positively influences reaction time and supports hand function. Moreover, VR systems that simulate joint position sense similar to real-world conditions may be beneficial for individuals with musculoskeletal motor deficits. Conclusions: These results highlight the potential for integrating VR technology into rehabilitation programs for patients with neurological or orthopedic impairments, providing a novel tool for enhancing upper extremity function and injury prevention strategies. Full article

Background: Cartilaginous exostoses of the scapula are rare and can cause symptoms such as pain and mechanical crepitus due to scapulothoracic bursitis. While open surgical resection remains the standard approach, it is associated with significant tissue disruption and longer rehabilitation. This technical note presents a minimally invasive arthroscopic technique for excising scapular exostoses. Methods: We report the case of a 22-year-old female patient with a symptomatic ventral scapular exostosis. After confirmation of a benign lesion, the exostosis was excised en bloc under continuous arthroscopic guidance. The surgical procedure, including patient positioning, portal placement, instrumentation, and specimen removal, is described in detail. Results: The lesion was successfully excised as a single piece for histopathological analysis. The patient experienced no intra- or postoperative complications. Postoperative rehabilitation included early passive motion, and full recovery was achieved within six weeks. At 24-month follow-up, the patient remained pain-free with complete restoration of shoulder function and no evidence of recurrence. Conclusions: Arthroscopic excision of scapular exostoses offers a viable alternative to open surgery. The technique minimizes soft tissue trauma, supports faster recovery, and may be safely performed in experienced hands with appropriate preoperative planning and imaging. Full article

Background: Ozone therapy is used for its immunomodulatory, antioxidant, and analgesic properties in several fields. It can be useful in the rehabilitation of musculoskeletal disorders. Studies showed that O₂-O₃ therapy can reduce pain and improve functioning in patients affected by low back pain and knee osteoarthritis. Only a few studies have been published about the efficacy of this treatment in upper limb disease. Objective: The aim of this study is to investigate the use of ozone therapy in upper limb pathologies, evaluating its quantity, quality, and reported results in upper limb musculoskeletal disease, supraspinatus tendinopathy, shoulder impingement, adhesive capsulitis, chronic epicondylitis, and carpal tunnel syndrome. O₂-O₃ reduces inflammation by stimulating anti-inflammatory cytokines and inactivating pro-inflammatory molecules, relieves pain by interacting with pain receptors and improving blood circulation, promotes the regeneration of damaged tissues by stimulating growth factors and improving vascularization, and, finally, activates endogenous antioxidant defense systems by protecting cells from oxidative damage. Methods: A comprehensive search was conducted on PubMed and Scopus using the following MeSH terms: ozone therapy, infiltration joint, musculoskeletal disease, rehabilitation, upper limb, shoulder, wrist, hand, elbow, including English papers published in the last five years. Results: Five papers have been selected: four randomized controlled trials and one retrospective cohort study. The RCTs compared the effectiveness of intra-articular ozone injection with steroid injection alone or with other conservative treatments in shoulder diseases; one paper studied the effectiveness of ozone injection and orthoses in carpal tunnel syndrome compared to orthoses alone; one paper used ozone injections compared with steroid injection in patients with chronic lateral epicondylitis. A total of 218 patients were studied in these trials. Conclusions: Ozone treatment seemed to improve pain and function as well as other therapies in upper limb musculoskeletal disease. However, the trials’ protocols and the upper limb areas treated are different. Further studies are needed to define the effectiveness of ozone therapy in upper limb diseases in rehabilitation fields. Full article

Background and Objectives: Hemiplegic shoulder pain (HSP) is a common and disabling complication in stroke patients, yet its pathogenesis remains unclear. This longitudinal study aimed to investigate the clinical and ultrasound characteristics of HSP emerging within the first 72 h (T0) post-stroke, with follow-ups at one month (T1) and three months (T2). Materials and Methods: A total of 28 stroke patients with hemiparesis were assessed for HSP. Evaluations included pain severity during passive shoulder mobilization, passive and active range of motion, muscle strength, spasticity, and functional disability. Ultrasound examinations were conducted to assess tendon disorders, bursitis, effusion, glenohumeral subluxation, and adhesive capsulitis. Results: HSP prevalence increased over time, affecting 11% of patients at T0, 32% at T1, and 57% at T2. Higher baseline scores on the National Institutes of Health Stroke Scale (NIHSS), an established marker of stroke severity, were significantly associated with HSP (p < 0.05). At T2, patients with HSP exhibited greater impairment, including restricted passive and active range of movement, pronounced muscle weakness, and increased spasticity (p < 0.05). Ultrasound findings at T2 revealed that adhesive capsulitis and glenohumeral subluxation were significantly more frequent in HSP patients (p < 0.05). Adhesive capsulitis showed a significant increase from 0% at T0 to 21% at T2 (p = 0.031), while glenohumeral subluxation exhibited a non-significant rise from 4% to 21% (p = 0.063). Patients with these conditions experienced significantly greater pain progression (p < 0.001). Conclusions: These findings suggest that capsular pathology plays a key role in the development of HSP within the first three months after stroke. The results highlight the need for targeted interventions addressing glenohumeral subluxation and adhesive capsulitis to alleviate pain and improve rehabilitation outcomes. Full article

Background: In the cardio-respiratory rehabilitation field, thermal medicine represents an interesting complementary therapy approach. It can aid in complex medical contexts characterized by cardio-respiratory deficiency, functional limitation, and pain determined by the invasiveness of pharmacological and surgical treatments in combination with limited post-surgical physical activity. Methods: We investigated the evolution of cardio-respiratory and functional performances following the application of the Integrated Thermal Care (ITC) protocol in 11 mastectomized/quadrantectomized women (mean age of 54 years). The ITC protocol consisted of hydroponic treatments, steam inhalations treatment, hydrokinesitherapy, and manual treatments. Patients were assessed before and after a cycle of 1 h long treatment sessions, which were performed 5 days a week for 4 weeks. The outcomes were measured through the following scales and tests: Piper Fatigue Scale (PIPER), 6-Minute Walking Test (6MWT), Five Times Sit-to-Stand (5STS), Range of Arm Motion (ROM), Disability of the Arm–Shoulder–Hand Scale (DASH), and Numeric Pain Rating Scale (NPRS). Results: We found appreciable improvements in cardio-respiratory efficiency and in pain perception exemplified by a reduction of PIPER, 5STS, DASH, and NPRS values together with an increase in 6MWT and ROM values. Conclusions: We conclude that ITC is a promising rehabilitative tool to enhance cardio-respiratory and functional performance and reduce pain after mastectomy/quadrantectomy. Full article

Inertial Measurement Units (IMUs) are widely utilized in shoulder rehabilitation due to their portability and cost-effectiveness, but their reliance on spatial motion data restricts their use in comprehensive musculoskeletal analyses. To overcome this limitation, we propose SWCTNet (Sliding Window CNN + Channel-Time Attention Transformer Network), an advanced neural network specifically tailored for multichannel temporal tasks. SWCTNet integrates IMU and surface electromyography (sEMG) data through sliding window convolution and channel-time attention mechanisms, enabling the efficient extraction of temporal features. This model enables the prediction of muscle activation patterns and kinematics using exclusively IMU data. The experimental results demonstrate that the SWCTNet model achieves recognition accuracies ranging from 87.93% to 91.03% on public temporal datasets and an impressive 98% on self-collected datasets. Additionally, SWCTNet exhibits remarkable precision and stability in generative tasks: the normalized DTW distance was 0.12 for the normal group and 0.25 for the patient group when using the self-collected dataset. This study positions SWCTNet as an advanced tool for extracting musculoskeletal features from IMU data, paving the way for innovative applications in real-time monitoring and personalized rehabilitation at home. This approach demonstrates significant potential for long-term musculoskeletal function monitoring in non-clinical or home settings, advancing the capabilities of IMU-based wearable devices. Full article

Background: This systematic review examines the clinical presentations and prevalence of scapulohumeral periarthritis (SP) by synthesizing the relevant literature from open-access articles from international databases (Medline, Pedro, and EBSCO). Methods: Keywords guiding the review included ‘scapulohumeral periarthritis’, ‘clinical forms’, ‘incidence’, ‘impingement syndrome, ‘calcifying tendinitis’, ‘bicipital tendonitis’, ‘shoulder bursitis’, ‘adhesive capsulitis or frozen shoulder’, ‘rotator cuff tears’, ‘functional assessment’, and ‘clinical trials’. Eligible studies included randomized controlled trials, nonrandomized controlled trials, cross-sectional studies, and review articles published between 1972 and 2024. Results: Our screening identified 2481 initial articles, of which 621 were further reviewed for eligibility resulting in 107 articles that met the relevance criteria. The findings highlight six distinct clinical forms of SP, such as partial rotator cuff tears and calcific tendinitis, each characterized by specific pathological features and prevalence patterns. Key factors contributing to SP include injuries, scapular instability, acromion deformities, and degenerative rotator cuff changes. Functional assessments, including the Neer, Hawkins, Pain Arc, and Yocum tests, demonstrated diagnostic value in distinguishing SP from other shoulder conditions. Conclusions: By comprehensively analyzing the clinical forms, functional assessment methods, and prevalent lesions of SP, functional testing can improve early diagnosis and guide personalized physiotherapy protocols for optimal rehabilitation in the physiotherapist’s practice. Full article