Search Results (293)

This study aimed to analyze the placebo effect associated with caffeine ingestion on cycling performance at the respiratory compensation point (RCP). Nineteen trained male cyclists (age: 28.1 ± 9.4 years; body mass: 71.0 ± 8.4 kg; VO₂max: 67.1 ± 6.7 mL·kg⁻¹·min⁻¹) completed two time-to-exhaustion (TTE) tests at the power output associated with RCP under two conditions: caffeine informed/placebo ingested (Expectancy) and non-ingested (Control), separated by 4–7 days. Total work (kJ) was recorded as the main performance variable and heart rate and rating of perceived exertion were measured. The side effects were evaluated through a questionnaire administered the day after the expectancy condition. TTE performance was similar (157.31 ± 63.45 kJ Expectancy vs. 154.83 ± 56.19 kJ Control, p = 0.68, trivial d = 0.09). Heart rate did not differ between trials (173.05 ± 9.65 bpm vs. 173.32 ± 9.74 bpm, p = 0.71 trivial d = −0.07), and RPE reached maximal values. Mild side effects—mainly increased activeness and muscular pain (31.3%)—were reported following placebo ingestion. In conclusion, this study did not detect an effect of a caffeine expectancy manipulation on time to exhaustion at the RCP in trained male cyclists. Heart rate was similar between conditions, and mild subjective symptoms were reported following the expectancy condition, although these cannot be causally attributed to expectancy. Full article

Background: Work-related musculoskeletal disorders impose substantial global burdens. Although Pilates is a recognized biopsychosocial intervention, a quantitative synthesis evaluating its occupational efficacy remains limited. Objective: To compute the pooled effect sizes of workplace Pilates interventions on musculoskeletal pain intensity, functional disability, muscular endurance, and health-related quality of life (QoL). Methods: Twelve randomized controlled trials (14 reports) involving diverse occupational cohorts were analyzed. Data dependency was resolved via outcome aggregation. Random-effects models calculated pooled effect sizes (Hedges’ g), 95% confidence intervals (CI), and 95% prediction intervals (PI). Risk of bias was assessed using RoB 2. Results: The meta-analysis demonstrated a moderate, statistically significant reduction in functional disability (g = −0.660, 95% CI [−1.091, −0.229], p = 0.011). Conversely, pooled estimates for pain intensity (g = −0.461, p = 0.360), muscular endurance (g = 1.354, p = 0.223), and QoL (g = −0.146, p = 0.815) were non-significant. Substantial heterogeneity was observed (I²: 32.02–98.25%), and all prediction intervals crossed the null, indicating high uncertainty regarding future effects. Conclusions: Workplace Pilates consistently mitigates functional disability, but current evidence does not support significant pooled improvements in absolute pain, endurance, or QoL. This divergence between functional recovery and pain reduction aligns with biopsychosocial frameworks, suggesting improved work capacity despite variable pain relief. Given the high heterogeneity and wide prediction intervals, findings must be interpreted cautiously, highlighting the need for rigorously standardized trials. Full article

Background/Objectives: Low back pain (LBP) is a major cause of disability worldwide. In Saudi Arabia, research has predominantly focused on its prevalence and associated risk factors, with comparatively limited evidence directly comparing balance, muscular strength, foot characteristics, and physical performance between young adults with and without LBP. This study therefore compared unilateral balance and handgrip strength between young adults with and without LBP, with foot arch status, walking performance, and lower limb functional capacity examined as secondary outcomes. Methods: This study employed a cross-sectional observational design and enrolled 55 young participants (25 with LBP and 30 healthy controls). The primary outcomes included unilateral balance, measured using the Single-Leg Stance Test (SLST) with eyes open and eyes closed, and handgrip strength. Secondary outcomes included foot arch status, assessed using the Sit-to-Stand Navicular Drop Test (SSNDT), walking performance using the 10-Metre Walk Test (10-MWT), and lower limb functional capacity using the 30-s Chair Stand Test (30s-CST). SLST duration was analysed using generalized estimating equations, whereas multivariable linear regression models were used for the remaining outcomes. All adjusted analyses accounted for age, body mass index, sex, smoking status, athletic status, and limb dominance where appropriate. Results: Participants with LBP demonstrated significantly poorer unilateral balance than healthy controls after adjustment, with significant main effects of group on both the right and left SLST. Significant group-by-visual condition interactions were observed for both limbs, indicating that between-group differences were greater under eyes-closed conditions. Handgrip strength was lower in participants with LBP in the unadjusted models; however, these between-group differences were no longer significant after adjustment. No significant adjusted between-group differences were observed for SSNDT scores, walking speed, or 30s-CST performance. Among the adjustment variables, male sex, right leg dominance, and athletic status were associated with better performance, whereas increasing age and smoking were associated with poorer performance. Conclusions: Young adults with LBP demonstrated poorer unilateral balance than healthy controls, with between-group differences being greater under eyes-closed conditions. In contrast, no significant adjusted between-group differences were observed for handgrip strength, foot arch status, walking performance, or lower limb functional capacity. These findings identify unilateral balance, particularly under reduced visual input, as a functional domain that differed between groups in this young adult sample. Full article

Background: Temporomandibular disorders (TMD) comprise a heterogeneous group of musculoskeletal conditions that may manifest during childhood and adolescence. However, standardized information regarding TMD-related clinical findings in pediatric populations remains limited because of methodological heterogeneity and the inconsistent application of validated diagnostic protocols. Objective: The aim of this study was to characterize clinical findings related to temporomandibular disorders in schoolchildren and to explore their potential contribution to individualized assessment strategies within the framework of personalized pediatric oral healthcare. Methods: A multicenter cross-sectional study was conducted in 1052 schoolchildren recruited from participating educational institutions. All participants underwent a standardized clinical examination that included assessment of masticatory muscle tenderness, temporomandibular joint tenderness, joint sounds, pain intensity, and perceived stress using an adapted pediatric DC/TMD protocol. Categorical variables were summarized as frequencies, percentages, and 95% confidence intervals (95% CIs). Associations between categorical variables were evaluated using Pearson’s chi-square test, and multivariable logistic regression was performed to identify factors independently associated with pain. Results: Pain during clinical examination was identified in 111 participants (10.6%; 95% CI: 8.8–12.6%), whereas temporomandibular joint sounds and myofascial pain were detected in 1.4% and 0.3% of participants, respectively. Most pain was classified as mild, and the masseter muscle was the most frequently affected anatomical site. Increasing age and female sex were independently associated with pain. Compared with children aged 4–6 years, participants aged 10–12 years (adjusted OR = 9.61; 95% CI: 2.22–41.51) and 13–16 years (adjusted OR = 35.49; 95% CI: 8.59–146.61) showed significantly greater odds of pain. Female participants also demonstrated higher odds of pain than males (adjusted OR = 7.49; 95% CI: 3.68–15.21; all p < 0.05). Conclusions: Clinically detectable TMD-related findings were generally uncommon among schoolchildren aged 4–16 years and were predominantly mild and muscular. Increasing age and female sex were independently associated with pain, emphasizing the importance of demographic factors in the early clinical expression of TMD. Standardized pediatric clinical examination protocols may facilitate early identification of TMD-related findings and support preventive strategies during childhood and adolescence. These findings support the implementation of individualized clinical assessment strategies for early identification of children at risk of temporomandibular disorders, contributing to personalized preventive and therapeutic approaches in pediatric oral healthcare. Full article

Bruxism-related orofacial pain is a common clinical manifestation associated with muscular hyperactivity, psychoemotional factors, and altered pain sensitivity. Immersive virtual reality (iVR) has emerged as a non-pharmacological strategy for pain management; however, evidence in individuals with bruxism-related pain remains limited. This pilot study evaluated the feasibility, tolerability, and preliminary clinical responses associated with an iVR intervention in adults with bruxism-related orofacial pain. A longitudinal pilot study with repeated assessments (T0–T4) was conducted in 15 adults with self-reported bruxism-related orofacial pain. Participants completed two standardized relaxation-oriented iVR sessions using an Oculus Quest 3 head-mounted display. Feasibility, immersive experience, cybersickness symptoms, pain intensity, and pressure pain threshold (PPT) were evaluated. All participants completed the intervention protocol and follow-up assessments, resulting in 100% adherence. Cybersickness symptoms were mild, and immersive experience scores indicated high perceived presence. Pain intensity decreased progressively throughout follow-up, with the greatest reduction observed at T4. The pressure pain threshold demonstrated modest temporal increases, particularly in the splenius, upper trapezius, and temporalis regions. The intervention was feasible and well tolerated and was accompanied by exploratory reductions in pain-related outcomes over time. These findings support future controlled studies to clarify the clinical effects of immersive virtual reality in individuals with bruxism-related orofacial pain. Full article

Background/Objectives: Pressure pain thresholds (PPTs) are widely used to quantify hyperalgesia in tension-type headache (TTH). However, previous diagnostic accuracy research has mainly focused on muscular or segmental sites, while the discriminative performance of PPTs measured over peripheral nerves remains largely unexplored. This study primarily aimed to compare PPTs measured across nerve-related and muscular anatomical sites between women with frequent episodic TTH and headache-free controls. As a secondary exploratory objective, site-specific ROC analyses were performed to examine within-sample discrimination and derive sample-specific exploratory cut-offs. Methods: A cross-sectional exploratory study with a case–control sampling design evaluated 31 women with frequent episodic TTH (mean age: 19.6 ± 4.3 years) and 32 headache-free women (mean age: 22.1 ± 4.9 years). The groups differed significantly in age (p = 0.039). PPTs were recorded over peripheral nerves (greater occipital, median, ulnar, radial, tibial, common fibular), muscles (temporalis, tibialis anterior), 2nd–3rd interdigital hand space and the C5/C6 zygapophyseal joints. Results: Women with TTH showed lower PPTs than controls across all evaluated locations. However, after adjustment for age and Holm correction across the 20 anatomical sites, only the right greater occipital nerve remained statistically significant (p = 0.043). The right greater occipital nerve also yielded the highest area under the curve (AUC = 0.706; 95% CI 0.576–0.836) and was the only location whose AUC remained significantly different from 0.50 after correction for multiple testing (p = 0.040). Its sample-derived exploratory cut-off of 1.75 kg/cm² showed low sensitivity (0.419; 95% CI 0.245–0.609) but high specificity (0.969; 95% CI 0.838–0.999). Although the corresponding LR+ was 13.419, its confidence interval was extremely wide (95% CI 1.866–96.525), indicating substantial imprecision. The LR− was 0.599 (95% CI 0.442–0.814). Overall, the operating characteristics varied considerably across locations and should be interpreted as exploratory. Conclusions: Women with frequent episodic TTH showed generally lower PPTs across nerve and muscle locations. However, after adjustment for age and multiple testing, the between-group difference was statistically supported only at the right greater occipital nerve. Although this location showed the highest AUC and high specificity at the sample-derived cut-off, its low sensitivity and the considerable imprecision of the LR+ estimate limit its interpretation. These findings reflect discrimination between selected participants with established TTH and headache-free controls, and should not be interpreted as evidence of clinical differential-diagnostic accuracy. 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/Objectives: We report a case of severe dermatomyositis demonstrating characteristic widespread extraosseous uptake on ^99mTc-methylene diphosphonate (^99mTc-MDP) bone scintigraphy. This study highlights the diagnostic value of this modality in detecting active inflammatory myopathy when conventional muscle biopsy is inconclusive and introduces its novel use for intraoperative gamma-probe-guided biopsy to precisely target metabolically active muscle. This approach may help target metabolically active muscle in heterogeneous idiopathic inflammatory myopathies (IIMs). Case Presentation: A 49-year-old man developed progressive proximal muscle weakness (Medical Research Council grade 2/5 proximally, 5/5 distally) beginning in June 2025 following influenza infection, accompanied by dysphagia, classic dermatomyositis cutaneous manifestations, back pain, and difficulty standing. Laboratory evaluation revealed elevated inflammatory markers (ESR 55 mm/hr, CRP 20 mg/L), leukocytosis (16.58 × 10⁹/L), markedly raised creatine kinase (19,937 IU/L), and troponin T levels. An initial quadriceps muscle biopsy performed on 29 July 2025 was non-diagnostic. Three-phase ^99mTc-MDP scintigraphy (~1110 MBq) demonstrated intense, diffuse extraosseous uptake involving bilateral deltoids (symmetric), biceps and triceps (patchy), paraspinal muscles (longitudinal), gluteal muscles, thighs (quadriceps and hamstrings), and gastrocnemius muscles, with relative suppression of appendicular skeletal uptake on delayed images due to soft-tissue tracer dominance—findings consistent with severe inflammatory myopathy. Following reinjection (~1100 MBq), intraoperative gamma-probe-guided biopsy targeted areas of highest uptake (left quadriceps femoris and distal triceps brachii; intraoperative counts 1300–1400 versus background ~500). Histopathology revealed histiocyte-predominant inflammation with myofibre necrosis and regeneration, sparse CD4⁺ T-cell infiltrates, and absence of fibrosis, consistent with necrotising myopathy. Positive antinuclear antibodies and strong anti-Mi-2 antibodies confirmed the diagnosis of dermatomyositis. Treatment included pulse methylprednisolone followed by oral prednisone taper, methotrexate, azathioprine, intravenous immunoglobulin, and planned rituximab therapy. Discussion: Whole-body ^99mTc-MDP scintigraphy provided a complementary whole-body functional assessment of disease extent, revealing widespread muscular involvement. The novel application of intraoperative gamma-probe-guided biopsy enabled real-time targeting of metabolically active muscle, facilitating targeted sampling after an initial non-diagnostic biopsy and yielding supportive histopathological findings. This dual diagnostic and interventional role demonstrates the technical feasibility of gamma-probe guidance in a diagnostically challenging case of dermatomyositis. Conclusions: In our case, the integration of ^99mTc-MDP scintigraphy with gamma-probe-guided biopsy enabled precise targeting of metabolically active muscle following an initial non-diagnostic biopsy. This multimodal approach may be useful in selected diagnostically challenging cases of severe inflammatory myopathy. Larger studies are needed to evaluate its reproducibility and added value. Full article

Sciatic neuropathy is most commonly attributed to spinal or muscular causes, whereas vascular-related compression remains underrecognized. We report a case of sciatic nerve entrapment caused by an anomalous inferior gluteal artery in the deep gluteal region, who presented with persistent right gluteal and posterior thigh pain for more than two years, refractory to multiple conservative treatments. Physical examination demonstrated marked allodynia and a well-defined Tinel-like sign, with radiating symptoms extending to the lower limb, suggesting a peripheral etiology. High-resolution ultrasonography identified an aberrant inferior gluteal artery, which crossed over and compressed the sciatic nerve, forming an accompanying artery of the sciatic nerve. Doppler imaging confirmed the vascular nature of the structure, while long-axis views demonstrated focal nerve compression with segmental swelling. Magnetic resonance imaging further corroborated the diagnosis. Ultrasound-guided hydrodissection using 5% dextrose and lidocaine was performed, resulting in significant symptom relief. Pain scores improved from 7 to 3 after treatment, with resolution of symptoms at two-month follow-up. This case highlights a rare neurovascular cause of sciatic nerve entrapment and underscores the importance of ultrasonography in identifying anatomical variations. Recognition of vascular contributions to deep gluteal syndrome may improve diagnostic accuracy and guide targeted interventions. Full article

Background/Objectives: Duchenne muscular dystrophy (DMD) is a rare progressive neuromuscular disorder associated with increasing care demands. Despite the critical role of caregivers, their physical activity (PA) levels and health-related quality of life (HRQoL) have not been sufficiently investigated. This study aimed to compare PA levels and HRQoL between caregivers of children with DMD and caregivers of typically developing children. Methods: This cross-sectional observational study included 44 individuals: caregivers of children with DMD (n = 22) and caregivers of typically developing children (n = 22). The 36-Item Short-Form Health Survey (SF-36) was used for assessing HRQoL and the International Physical Activity Questionnaire—Short Form (IPAQ-SF) for determining PA levels. Results: IPAQ-SF-derived metabolic equivalent of task (MET) values and PA levels were similar between the groups (DMD caregivers: 1744.63 ± 1163.22, controls: 1945.09 ± 1042.12; p > 0.05). Caregivers of children with DMD demonstrated significantly poorer scores in several SF-36 domains, including vitality, social functioning, role limitations due to physical problems, bodily pain, and mental health (p < 0.05), with the largest difference observed in role limitations due to emotional problems (DMD caregivers: 45.27 ± 28.33, controls: 84.83 ± 24.63; p < 0.05). Physical functioning and general health perception scores were comparable (p > 0.05). Conclusions: Caregivers of children with DMD experience substantial impairments in multiple HRQoL domains, particularly those related to psychosocial well-being and pain, despite comparable PA levels and physical functioning. These findings suggest that reduced HRQoL is not directly explained by PA alone and highlight the need for multidisciplinary interventions targeting psychological health, pain management, and social well-being. Full article

Background: Myogenous temporomandibular disorders (TMDs) are a common subtype of orofacial pain. Evidence regarding treatment with botulinum toxin type A (BoNT-A) remains heterogeneous, and its use is generally limited to refractory cases. This study evaluated 12-month clinical outcomes following an incobotulinumtoxinA protocol (the Ângelo Botulinum Toxin Protocol^®) in adults with DC/TMD-confirmed myogenous TMD unresponsive to conservative therapy. Methods: This retrospective observational study reviewed records from 98 adults treated with incobotulinumtoxinA following the predefined injection protocol. All patients had failed ≥ 3 months of conservative management and completed ≥ 12 months of follow-up. Outcomes included myalgia severity (0–3), patient-reported orofacial pain intensity (VAS 0–10), and maximum mouth opening (MMO). Favorable outcome criteria required myalgia 0–1 or VAS ≤ 2 and MMO ≥ 35 mm. Results: Myalgia significantly decreased at 12 months (2.69 ± 0.64 to 0.43 ± 0.85; p < 0.001). Patient-reported orofacial pain intensity also improved (2.44 ± 2.54 to 0.37 ± 1.33; p < 0.001). MMO remained stable, indicating preserved mandibular mobility. Overall, 79.6% of patients met the predefined favorable outcome criteria. Reintervention was required in 12 patients; 7 received additional incobotulinumtoxinA injections, and 5 underwent TMJ arthrocentesis. No complications were observed. Conclusion: This protocol was associated with improvements in muscular pain and orofacial discomfort while preserving mandibular mobility. However, given the retrospective design and absence of a control group, these findings should be interpreted as hypothesis generating. Full article

Background/Objectives: The Individualized Neuromuscular Quality-of-Life Questionnaire (INQoL) is a widely used measure of quality of life in patients with various neuromuscular diseases. This study aimed to adapt and test the validity and reliability of this measure in Hungarian patients with neuromuscular disease. Methods: According to the widely accepted method of validation, we first translated the original INQoL version into Hungarian, and then a native English speaker translated it back into English to test its validity. Following a pretest procedure, the INQoL was administered to 80 patients with various muscular diseases and 30 age-matched controls. The internal consistency and test–retest reliability were assessed. Concurrent validity was measured using the 36-item Short Form Survey (SF-36) questionnaire. Results: For all INQoL subscales, Cronbach’s alpha was above 0.7, demonstrating the reliability of the subscales. The highest Cronbach alpha value was for the Weakness subscale (0.983) and the lowest for the Treatment subscale (0.794). The intraclass correlation coefficient test values ranged from 0.810 (Treatment) to 0.988 (Pain), indicating excellent test–retest reliability. There was a strong correlation between the SF-36 Physical Function and multiple INQoL subscales, including Weakness (r = 0.754, p < 0.001), Fatigue (r = 0.704, p < 0.001), Activities (r = 0.744) p < 0.001, Independence (r = 0.791 p < 0.001), Body Image (r = 0.714 p < 0.001), and overall Quality of Life (r = 0.742 p < 0.001). Conclusions: Our findings indicate that the Hungarian-language adaptation of the questionnaire possesses adequate reliability and construct validity for assessing the quality of life in patients with muscular disorders. Full article

Background: The etiology and diagnosis of heel pain are complex and multifactorial, and it has been reported that Baxter’s entrapment is responsible for up to 20% of foot disorders. The most conservative treatment of Baxter’s entrapment has been the use of custom insoles. Electromyography was considered an effective test to assess muscle activity. The aim of this study was to test the use of insoles of different hardness on muscle activity of the abductor hallucis muscle in subjects with entrapment of the lateral branch of the external plantar nerve. Methods: 18 subjects (7 women and 11 men) diagnosed with nerve entrapment of the first branch of the lateral plantar nerve were recruited. Muscle activity of the adductor hallucis muscle was analyzed with insoles of different hardness in static and dynamic situations using electromyographic evaluation. Results: The statistical analysis did not show statistically significant differences in the muscle activity of the abductor hallucis muscle in the static position, with and without plantar orthoses (p>0.05), in contrast, in dynamic situations statistically significant differences were found between groups (p<0.01). Conclusions: The use of a hard insole decreases the maximum peak muscular activity of the abductor hallucis muscle in subjects with Baxter’s nerve entrapment in walking conditions. Full article

Background/Objectives: Pressure pain thresholds (PPTs) are commonly used to quantify mechanical hyperalgesia in migraine and tension-type headache (TTH), but the discriminatory performance of PPTs across neural and muscular sites remains unclear. This study compared nerve- and muscle-related PPTs between migraine and frequent episodic TTH and explored site-specific ROC-derived cut-off values as complementary classification markers. Methods: In this cross-sectional case-group discrimination study, participants with migraine (n = 33) and frequent episodic TTH (n = 31) underwent bilateral PPT assessment (electronic algometry) over the temporalis and tibialis anterior muscles, C5/C6 zygapophyseal joints, peripheral nerves (greater occipital, median, ulnar, radial, posterior tibial, common peroneal), and the second metacarpal region. Results: PPTs were generally lower in the migraine group than in the TTH group. After adjustment for sex and age, the most consistent between-group differences remained at the temporalis muscles bilaterally (left: adjusted mean difference 0.49 kg/cm², 95% CI 0.10 to 0.89, p = 0.015; right: 0.53 kg/cm², 95% CI 0.13 to 0.93, p = 0.011) and at the left tibialis anterior muscle (0.90 kg/cm², 95% CI 0.03 to 1.78, p = 0.044). In the main ROC analysis, the temporalis muscles showed the strongest discriminatory performance (left AUC = 0.733; right AUC = 0.707), whereas tibialis anterior and left posterior tibial nerve sites showed modest, below-threshold discrimination (AUCs < 0.70 despite statistical significance in some cases). Women-only ROC analyses showed a broadly similar pattern, with slightly improved metrics at some sites, particularly the temporalis muscles. Across most sites, likelihood ratios indicated only small-to-moderate shifts in post-test probability. Conclusions: Participants with migraine showed lower PPTs than those with frequent episodic TTH across most assessed sites, with the clearest differences at the temporalis muscles. ROC and PR analyses suggest that PPTs (especially at temporalis sites) may provide complementary, hypothesis-generating discriminatory information, but their overall stand-alone discriminative utility is modest. PPT assessment should therefore be interpreted as an adjunct to clinical evaluation rather than a replacement diagnostic test. Full article

Background/Objectives: Temporomandibular disorders (TMDs) are a group of multifactorial conditions affecting the temporomandibular joints (TMJs), masticatory muscles, and associated structures. TMDs are identified as the main cause of non-dental orofacial pain in children and adolescents. This scoping review aims to explore recent evidence on prevalence, clinical presentation, associated factors, and treatment approaches of TMDs in children and adolescents. Methods: A systematic search was conducted across PubMed, Scopus and Embase for studies published between 2015 and 2025, following PRISMA-ScR guidelines. Results: Thirty-eight studies were included. TMD prevalence in children and adolescents ranged from 16.9% to 40% through clinical examination, with painful TMD rates ranging from 16.2% to 25.5%, while symptom-based surveys reported prevalences of 9–35.3%. The most frequent diagnoses were myofascial pain, myalgia, arthralgia and disc displacement with reduction. Female sex and increasing age were consistent risk factors. Psychosocial variables, such as anxiety and depression, showed strong associations with pain-related TMDs. Structural and systemic conditions such as musculoskeletal alterations, joint hypermobility, respiratory conditions and headaches/migraines were also frequently reported. Evidence on treatment appears to be limited. In juvenile idiopathic arthritis (JIA), TMJ involvement is prevalent (32.6–64%), particularly in the persistent oligoarticular subtype. Conclusions: TMDs in children and adolescents are prevalent and multifactorial conditions, mainly of muscular origin, presenting more frequently in adolescents and females. Psychosocial factors, functional habits, clenching, mouth breathing and systemic conditions may be associated with TMD presence or severity. Substantial heterogeneity persists in diagnostic criteria, assessment tools and outcome measures. Research on therapeutic interventions is scarce and often limited to small samples. Standardized diagnostic protocols, improvements in research consistency, longitudinal cohorts and RCTs are needed to clarify etiological pathways, validate diagnostic criteria and establish effective, evidence-based strategies for the management of TMDs in children and adolescents. Full article