Search Results (91)

Background/Objectives: Iatrogenic abductor muscle injury following intramedullary nailing for proximal hip fractures can negatively impact postoperative rehabilitation and clinical outcomes. To quantify iatrogenic abductor muscle injury after intramedullary nailing and detect the degree of degenerative change in muscle around the entry point of trochanteric fractures. Methods: This cross-sectional study used data from a single center database from May to December 2023. This study utilized ultrasound examinations performed by a single expert orthopedic surgeon. This study included 61 patients who underwent intramedullary nailing surgery for adult hip fractures. All surgeries were performed by a single experienced hip surgeon. Patients who declined sonographic evaluation or did not undergo ultrasound during their admission were excluded. For more accurate comparison, sonography was also conducted on the healthy, non-operative limb. Descriptive statistics were used to summarize patient and ultrasound findings. A subgroup analysis using Fisher’s exact test was performed to assess the association between implant type and the incidence of iatrogenic gluteus medius tendon injury. Results: Of the 61 patients, tendon tears were identified in 35 cases (57%) on the affected side, with 20 cases (33%) involving gluteus medius tendon tears without fractures on the ipsilateral facet. Gluteus minimus tendon tears were observed in 13 cases (21%), while gluteus medius tendon tears were noted in 31 cases (51%). In the unaffected limbs, tendon degeneration was detected in the form of tendinosis and calcification. Overall, 39 patients (64%) exhibited abductor tendon tendinosis, and 30 patients (49%) were diagnosed with calcification. Conclusions: Gluteus medius and Gluteus minimus are important abductors for hip disease rehabilitation. Iatrogenic gluteus medius tendon injury during the intramedullary nailing showed 33%. Abductor degeneration also showed 92% of the unaffected limbs. This study suggests that abductor degeneration can be a risk factor of falling among the elderly population and an iatrogenic abductor injury can be an obstacle for the early recovery of ambulation in the hip fracture patients. Prevention of abductor degeneration and iatrogenic abductor injury might be important for the hip fracture prevention and rehabilitation. Full article

Background: The incidence of anterior cruciate ligament ruptures in football has experienced a marked increase in recent years, affecting both professional and amateur players. This injury is characterised by being highly disabling, causing the player to withdraw from the field of play for prolonged periods and there is no clear consensus on how to carry out the different phases of rehabilitation, which poses a major challenge for health professionals. Case presentation: This study followed a semi-professional player who suffered an anterior cruciate ligament tear following two forced valgus actions without direct contact in the same match. Outcome and follow-up: The patient underwent surgery using an autologous hamstring graft. He followed a progressive rehabilitation programme consisting of one preoperative phase and six phases after the operation. After a 12-month follow-up, with exercises aimed at perfecting step-by-step basic and specific physical skills, the player showed a complete functional recovery, achieving the desired parameters. Conclusions: This case highlights the importance of structured rehabilitation adapted to the specific needs of the football player through an approach with coherent progressions, which considers the muscle chains that determine the movements performed on the football pitch. Full article

Background: The muscles and their tendons exhibit considerable morphological variations. While the anterior leg compartment may seem uniform, several well-documented variants of the tibialis anterior, extensor hallucis longus (EHL) and extensor digitorum longus (EDL) exist. In contrast, little is known about the fibularis tertius muscle (FT). This literature review aims to compile existing data on the FT and its variations and assess this structure’s clinical significance. Material and Methods: This comprehensive literature review is based on scientific articles obtained from PubMed. All relevant papers were included, and citation tracking was conducted to ensure a thorough examination of the topic. Results: This detailed literature review synthesizes the latest scientific findings regarding the FT, exploring its variable morphology, functional anatomy, evolutionary significance and clinical relevance. A high morphological variability of the FT is described including its origin, insertion and accessory form. Nevertheless, the FT has been described in cadaveric studies between adults and fetuses, while few classification systems have been proposed. Conclusions: The FT is an intriguing structure that has garnered interest from researchers across various fields, including medicine, clinical practice and biological sciences. There are few clinical implications of the muscle such as FT syndrome or tendon tear. Adequate knowledge of its anatomy is of paramount importance for clinicians. Full article

Background: Musculoskeletal injuries are frequent in handball players due to the high-impact nature of the sport. Accurate diagnosis and tailored treatment are essential for recovery. Magnetic resonance imaging (MRI) has become the gold standard for evaluating complex sports-related injuries. This case report aims to assess the role of MRI in diagnosing trauma in professional handball players and the effectiveness of individualized treatment approaches. Methods: Four male members of the “Politehnica” Timișoara first team who sustained match- or training-related injuries between January 2023 and December 2024 underwent an 1.5 T MRI. Individualized conservative protocols included rest, NSAIDs, physiotherapy, and graded kinesitherapy. Results: The first case involved a right back with a knee hematoma and a vastus lateralis tear. Conservative treatment led to recovery. The second case was a left back with peripheral neuropathy caused by hamstring avulsion at the ischial tuberosity. Conservative therapy alleviated symptoms. The third case involved a left winger with adductor muscle tears, which recovered with conservative management. The fourth case, a goalkeeper, had a type III navicular fracture misdiagnosed on radiography, correctly identified via MRI and treated conservatively. Conclusions: MRI is invaluable in diagnosing handball-related injuries, enabling accurate assessments and effective individualized treatment, resulting in early recovery. Full article

Hamstring muscle tears are among the most prevalent sports injuries. The occurrence of muscle injuries has been demonstrated to result in alterations to the movement control system, thus prompting the implementation of compensatory strategies. The potential for in-depth study of these adaptive or compensatory strategies for injuries is made possible by the use of electrophysiological biomarkers. The aim of this study was to evaluate the current evidence concerning the analysis of electrophysiological biomarkers in research conducted on subjects with a history of hamstring injury (HSI) on sprinting tasks. A comprehensive literature review was conducted, and five articles were selected based on a rigorous set of selection criteria. The heterogeneity of the results precludes the establishment of broad generalisations regarding hamstring muscle activity during running or sprinting. Notwithstanding these discrepancies, individuals with a history of hamstring injury have been shown to consistently exhibit altered EMG patterns. In order to enhance our comprehension of the neural strategies underpinning movement, it is imperative to employ methodologies that transcend the limitations of EMG amplitude measures. Full article

Injuries to the soleus muscle are often unrecognized, which increases the risk of complete tearing. Consequently, it results in the need for a long break in sports. This is mainly because the soleus muscle is complex, and the clinical signs of injury are difficult to capture, which can mimic Achilles tendinopathy and tennis player’s calves. This muscle has a complex connective tissue structure with three intramuscular tendons, which makes it challenging to interpret pathological muscle conditions. Injuries to the soleus muscle can be acute or chronic and are usually considered to be a minor discomfort by both the patient and the sports medicine physician, leading to a relatively quick return to sports activity with a high risk of re-injury. This narrative literature review aims to explore the diagnostic challenges and treatment failures associated with soleus muscle injuries, highlighting the critical lack of standardized protocols and a comprehensive understanding of the nuances of these injuries, which requires the collection of qualitative data from clinical case studies, quantitative data from imaging studies and rehabilitation outcomes, and expert opinion to formulate evidence-based guidelines to improve patient management. Calf muscle pain symptoms should not be ignored because the injury may become chronic, and the lack of treatment adequate to the actual cause of the pain increases the risk of the injury deepening, including complete rupture. High-resolution ultrasonography and magnetic resonance imaging are recommended methods for differentially diagnosing soleus muscle injury in conjunction with physical examination to make a precise and reliable diagnosis. A soleus muscle injury case report and a comprehensive proposal for conservative treatment supplement our literature review. Full article

Background/Objectives: This study aimed to identify the risk factors for retears after arthroscopic rotator cuff repair (ARCR) and to establish a hierarchy of their importance using machine learning. Methods: This study analyzed 788 primary ARCR cases performed by a single senior surgeon from January 2016 to December 2022. The condition of the repaired supraspinatus was assessed via magnetic resonance imaging (MRI) or sonography within 2 years after surgery. In total, 27 preoperative demographic, objective, and subjective clinical variables were analyzed using five well-established models: Extreme Gradient Boosting (XGBoost), Random Forest (RF), Support Vector Machine (SVM), Neural Network (NN), and logistic regression (LR). The models were trained on an 8:2 split training and test set, with three-fold validation. The primary metric for evaluating model performance was the area under the receiver operating characteristic curve (AUC). The top five influential features were extracted from the best-performing models. Univariate and multivariate LRs were performed independently as a reference. Results: The overall retear rate was 11.9%. The two best-performing prediction models were RF (validation AUC = 0.9790) and XGBoost (validation AUC = 0.9785). Both models consistently identified the tear size in the medial–lateral (ML) and anterior–posterior (AP) dimensions, full-thickness tears, and BMI among the top five risk factors. XGBoost uniquely included female sex, while RF highlighted the visual analogue scale (VAS) pain score. While conventional univariate regression indicated multiple significant factors associated with retears (age, full-thickness tear, AP and ML tear size, biceps conditions, fatty infiltration of three rotator cuff muscles, and atrophy of supraspinatus), multivariate analysis demonstrated that only age and the ML tear size are significant factors. Conclusions: Machine learning models demonstrated enhanced predictive accuracy compared to traditional LR in predicting retears, and the importance of risk factors was derived. Tear size, full-thickness tears, BMI, female sex, and VAS pain score emerged as the most influential risk factors. Full article

Background/Objectives: Secure large-bore cannula insertion is critical for effective extracorporeal membrane oxygenation (ECMO), as inadequate fixation can lead to complications such as infection, dislodgment, and life-threatening events. With inconsistent guidelines for ECMO line management, this study compares the effectiveness of traditional suture fixation to an adhesive securement method in the prevention of ECMO cannula dislodgment using an in vitro model. Methods: Porcine skin and muscle tissue sections were prepared and mounted in a custom holder. A 21F venous ECMO cannula was inserted using a modified Seldinger technique. Three fixation methods were randomly compared: (1) three silk sutures, and (2a) one silk suture with a CathGrip adhesive anchoring device. In addition, a sub-analysis was performed using (2b) the Hollister adhesive anchoring device. A uniaxial testing machine simulated 50 mm cannula dislodgment, measuring tensile forces at 12.5, 25, and 50 mm dislodgment points. Results: A total of 26 ECMO cannula fixations using sutures, 26 with adhesive CathGrip, six with a Hollister device, and three controls were tested across six porcine samples. Sutures demonstrated greater variability in force at maximum dislocation, with 27% rupturing at 50 mm. In contrast, CathGrip provided greater flexibility without tearing. The adhesive exhibited higher stiffness (2.38 N/mm vs. 2.09 N/mm, p < 0.001) and dislodgment energy (0.034 J vs. 0.032 J, p = 0.002) in the 0–5 mm range, while sutures showed greater stiffness in the 5–50 mm range (1.42 N/mm vs. 1.18 N/mm, p < 0.001). At larger displacements (25 mm and 50 mm) and in total energy absorption, no statistically significant differences were observed (p = 0.57). In a sub-analysis, the six fixations using the Hollister device exhibited higher variability and significantly lower dislodgment forces at 25 mm (p = 0.033) and 50 mm (p = 0.004) compared to the CathGrip device. Conclusions: This study suggests that adhesive anchoring methods, such as CathGrip, may provide comparable or potentially superior fixation strength to sutures for ECMO cannula stabilization under controlled conditions. However, further research, including clinical trials, is necessary to confirm these findings, evaluate long-term performance, and explore the implications for dislodgment risk and infection prevention in clinical practice. Full article

Background: Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive surgical technique for the treatment of lumbar disc herniation. Despite its growing popularity, limited research has explored the influence of patient characteristics and the choice of technique on post-operative outcomes and patient satisfaction. Objective: To investigate the impact of patient characteristics and surgical technique (interlaminar vs. transforaminal) on the surgical outcomes and patient satisfaction following PELD. Methods: A retrospective analysis was conducted on 177 patients who underwent PELD (53.1% males, age = 46.11 ± 14.2 years), including 147 patients with the interlaminar approach and 30 with the transforaminal approach. Demographic data, pre-operative clinical features, surgical technique, intra-operative and post-operative complications and complaints, patient-reported outcomes (disability, quality of life, satisfaction), and revision surgery rates were documented and analyzed. The mean follow-up duration was 5.55 years ± 2.73 years. Results: No significant differences were observed in demographics, pre-operative status, or post-operative complaints and complication rates between two surgical techniques, except that transforaminal technique showed a higher incidence for dural tear and persistent muscle weakness (p = 0.028 and p = 0.046, respectively). Both techniques led to excellent patient-reported outcomes with no significant differences. Total patient satisfaction with PELD was 93.8%, which correlated positively with the absence of complications and complaints and negatively with persistent back pain, recurrent herniation and revision surgery. Conclusions: Interlaminar and transforaminal PELD are both effective and safe minimally invasive surgical techniques for the treatment of lumbar disc herniation with a high patient satisfaction rate. Further prospective studies are warranted to confirm these findings. Full article

Introduction: Meniscus injuries are common among endurance athletes, requiring structured rehabilitation to restore function and facilitate a safe return to sport. Traditional in-person rehabilitation may not always be accessible or feasible for high-performance athletes. Telerehabilitation, incorporating virtual reality, motion tracking, and telemonitoring, offers an innovative approach to guided recovery. However, evidence supporting its effectiveness in elite athletes remains limited. Case presentation: This case report explores the application of an innovative telerehabilitation program for a 49-year-old triathlete recovering from partial meniscectomy following a medial meniscus tear. The program was structured into three progressive phases over 12 weeks, focusing on restoring range of motion (ROM), muscle strength, and functional stability while gradually reintroducing sports-specific activities. Results: By the end of the rehabilitation, the patient achieved full ROM and muscle strength (scoring 5/5 on the Medical Research Council scale for the vastus medialis), along with a pain-free state in both static and dynamic conditions. The integration of telemonitoring devices facilitated detailed monitoring and feedback, enabling personalized adjustments to the rehabilitation protocol. Key milestones included a return to swimming and cycling in Phase 2, reintroduction of running in Phase 3, and a full resumption of triathlon training by week 12. Conclusions: Despite the positive results, the study highlights the need for further research to validate these findings across larger cohorts and establish standardized telerehabilitation protocols for athletes. This case underscores the potential of digital health technologies in enhancing recovery trajectories for high-demand athletes post-meniscus surgery, paving the way for supervised, accelerated, and effective sports reintegration. Full article

Background: With the rapid increase in the aging population, the number of patients complaining of shoulder pain is also increasing. Among shoulder ailments, rotator cuff tears (RCTs) are most frequently observed in middle-aged and elderly individuals. Sarcopenia refers to the decline in muscle mass (lean body mass) and the subsequent decrease in muscle function that is linked to the natural aging process. To the best of our knowledge, there is currently limited information available regarding the association between RCTs and sarcopenia. Methods: The study included only individuals who had undergone dual-energy X-ray absorptiometry and body composition assessments. After applying the exclusion criteria, the participants were divided into sarcopenia and non-sarcopenia groups by the body composition tests. Next, those diagnosed with RCTs were assigned to the experimental group, and those without RCTs were assigned to the control group. The matching was performed using propensity score matching. Sarcopenia was defined as a skeletal muscle index lower than 7.0 kg/m² in males and 5.4 kg/m² in females. Multivariable logistic regression with backward elimination was performed. Results: After propensity score matching, there were no significant differences in age, sex, and bone mineral density between the RCT and control groups. In the univariate analysis, it was observed that most of the baseline data and demographic factors did not exhibit significant differences, except for calcium levels and the presence of chronic kidney injury. According to the multivariable logistic regression analysis of factors related to RCTs, sarcopenia was unrelated to RCTs, but chronic kidney injury and Ca levels were significantly associated. Also, there was also no significant association between sarcopenia and RCT size and severity. Conclusions: In conclusion, we cannot find a significant relationship between sarcopenia and RCTs. Full article

Background: Age-related changes to the orbicularis oculi muscle include impaired eyelid function, such as lagophthalmos, alterations in tear film dynamics, and aesthetic changes like wrinkles, festoons, and the descent of soft tissue. To date, the structural and functional changes that would comprehensively increase our understanding of orbicularis aging have not been analyzed. This study aims to investigate functional outcomes using surface electromyography and correlate them with ultrastructural changes in orbicularis during aging. Methods: This study enrolled 26 patients aged 37 to 78 years with a clinical diagnosis of dermatochalasis. Patients were divided into two age groups (<60 years; ≥60 years). Ultrastructural and electromyographical examinations were performed, and the electromyographical signals were correlated with the ultrastructural damage in the orbicularis. Results: This study revealed significantly lower values of average voluntary contraction and RMS of the surface electromyography signals in the older age group compared to the younger age group (p = 0.029 and p = 0.045, respectively). There was no statistically significant association between age and muscle damage (χ²(2) = 2.86, p > 0.05). There was no correlation between average voluntary contraction and the degree of ultrastructural damage in both groups (Spearman’s coefficient equaled 0.06923 and 0.64366, respectively). Conclusions: sEMG measurements are valuable for monitoring age-related functional changes in the orbicularis. Aging diminishes the functional capacity of the orbicularis, as evidenced by reduced contraction strength. This study, the first to compare ultrastructural and electromyographical changes in the orbicularis among dermatochalasis patients of different ages, finds that ultrastructural damage to muscle fibers is not directly responsible for the contraction strength decline. Full article

Objective: With the remarkable advances in diagnostic ultrasound equipment, there is a growing need for ultrasound diagnosis of muscle and soft tissue injuries in sports injuries. Among these, hamstring strains are often difficult to treat and require early and accurate diagnosis. Injuries to the proximal part of the hamstring often take a long time to heal. For this reason, the diagnosis of proximal hamstring injuries is extremely important. The structure of the origin tendon is characteristic, and it is a complex in which the semitendinosus muscle (ST) of the medial hamstring and the long head of the biceps femoris muscle (BFLH) of the lateral hamstring share a conjoint tendon (CT). On the other hand, the semimembranosus muscle (SM) attaches to the ischial tuberosity independently. In this study, we created a classification of injury sites focusing on the origin tendon, and investigated the distribution of injury location, relationship to the player’s position, and the detection rate of ultrasound diagnosis. Material and Methods: We used ultrasound and MRI to diagnose 52 university men’s rugby players who had suffered a hamstring strain for the first time and investigated the distribution of the injured areas. We performed an ultrasound scan as the initial diagnosis and used MRI as a final diagnostic tool. A classification focusing on the origin of the muscle was created. First of all, it was divided into two types: the BFLH-ST complex type, which originates in the CT, and the SM type, which originates in the SM tendon. We also classified BFLH-ST complex damage, including CT damage, as Type I, a BFLH injury without CT injury as Type II, and a ST injury without CT injury as Type III. We then investigated the distribution of the injury location. The degree of ultrasound detection in each injury type was evaluated in three grades. The frequency of BFLH complex and SM injuries was investigated in players who played the forward (FW) and back (BK) positions. Results: The distribution was 40 limbs (77%) for BFLH-ST complex injury type and 12 limbs (23%) for SM injury type. In the BFLH complex type,19 limbs which met the Type I classification criteria for CT tear, 19 limbs met the Type II, and 2 limbs met the Type III. FWs had a higher incidence of SM injuries and BKs had a higher incidence of BFLH-ST complex injuries. With regard to the detection of muscle injuries via ultrasound, a high rate of detection was possible, except for a slight injury to the myofascial junction of the BFLH. Discussion: In terms of the distribution, the BFLH-ST complex, which shares the same origin tendon (i.e. CT), had a higher frequency of muscle tears than the SM. In addition, CT junction injuries occurred frequently in Type II as well as Type I (=CT injury). One possible cause is that the CT is subject to concentrated traction stress from both the medial and lateral hamstrings. With ultrasound, the detection rate of muscle damage around the BFLH-ST complex and SM originating tendon was high, suggesting that it is useful as an initial diagnosis. From this, it can be said that ultrasound is also useful for primary evaluation of “proximal hamstring injury”, which is prone to severe and should be given a final diagnosis using MRI. Conclusions: We created a classification system focusing on the originating tendons and clarified their incidence rates. In this study, ultrasound was found to be useful in the detection of originating tendon injuries. We also identified the characteristic sonographic findings of each type. Full article

Background and Objectives: The primary objective of this study was to assess the impact of pelvic floor muscle (PFM) strengthening on the pelvic floor function in women who have experienced OASIS two years after delivery, and the secondary objective was to educate women about PFM strengthening and instruct them on the correct way to exercise. Methods and Materials: A prospective case-control study was conducted. The participants were divided into two groups: the case group (women who experienced OASIS) and the control group (women who did not experience perineal tears but had similar obstetric-related data to the case). Women were invited for a gynecological exam, PFM assessment, and consultation on PFM training. Women in the case group had three consultations, and women in the control group had two. Women were presented with four sets of questions about pre-pregnancy condition and questions related to UI and FI after delivery. Results were considered significant when p < 0.05. Results: OASIS were detected in 13 (0.4%) women in 2021. Risk factors for OASIS were found to be fetal macrosomia (p = 0.012), fetal occiput posterior position (p = 0.001), and epidural analgesia (p = 0.003). After one year of performing PFM strengthening exercises, some women in the study group exhibited stronger PFM contractions (p = 0.076), while others held the contracted PFM for a longer time (p = 0.133). UI affected women in the control group more often (p = 0.019). Two years after delivery, gas incontinence was mentioned significantly more frequently in the case group (p = 0.019). One year after initial consultation, gas incontinence was also more significantly common in the case group (p = 0.037). Conclusions: This study found that PFM strengthening exercises significantly improved pelvic floor function in women who experienced OASIS two years after delivery. Participants exhibited stronger PFM contractions and an increased ability to maintain these contractions. Women reported a better understanding of PFM exercises and proper techniques. Full article

Shoulder and elbow injuries are prevalent among baseball players, particularly pitchers, who experience repetitive eccentric loading of the shoulder, leading to muscle damage and increased injury risk. Nearly 40% of shoulder injuries in baseball occur in pitchers, with many facing low rates of return to sport. The rotator cuff (RC) muscles—supraspinatus (SSP), infraspinatus (ISP), subscapularis (SSC), and teres minor (TMin)—are crucial for shoulder stability, movement, and force generation, particularly in overhead sports. Each RC muscle comprises subregions with distinct biomechanical properties, such as strength, moment arm behavior, and activation patterns. These differences allow for a finely tuned balance between joint stability and mobility. For example, the superior subregion of the ISP significantly contributes to external rotation, a function critical in sports like baseball that require precision and power. During pitching, the SSP, ISP, and SSC stabilize the glenohumeral joint through high activation during explosive phases, such as stride, arm cocking, and arm acceleration. Understanding these functional subregional differences is vital for diagnosing and managing shoulder pathologies like RC tears. Despite advancements, clinicians face challenges in predicting re-injury risks and determining return-to-play readiness for athletes with shoulder injuries. Integrating insights into subregional biomechanics with patient care could enhance outcomes. Tailored interventions—whether surgical or rehabilitative—targeting specific subregions could improve recovery times, reduce re-injury risks, and enable more personalized treatment plans. Such approaches are especially beneficial for athletes, older individuals, and those prone to RC injuries, promoting better long-term shoulder health and performance. The present work aims to highlight some of the research on these subregions and their differences, providing insights to enhance treatment approaches for shoulder injuries. Full article