Search Results (58)

Pain arising from the ischial region is commonly attributed to proximal hamstring injury or ischial bursitis, whereas injury to the ischiocondylar portion of the adductor magnus remains less commonly considered because of its deep location and complex anatomy. We report a 63-year-old woman who developed persistent proximal posterior thigh pain after sprinting, followed by progressive sitting pain despite conservative treatment. High-resolution musculoskeletal ultrasonography revealed focal structural abnormalities of the ischiocondylar portion of the adductor magnus at the tendon insertion and musculotendinous junction that were consistent with a partial tear, accompanied by surrounding inflammatory changes and ischial bursal fluid. The lesion was identified beginning with the short-axis view of the ischial tuberosity, followed by an oblique long-axis view of the ischiocondylar tendon. Conservative rehabilitation, activity modification, and low-level laser therapy resulted in complete symptom resolution without recurrence. This report emphasizes that injury of the ischiocondylar portion of the adductor magnus represents an uncommon differential consideration in patients presenting with proximal posterior thigh or ischial pain. A systematic ultrasound examination with appropriate transducer orientation facilitates accurate diagnosis and appropriate management. Full article

Superior cluneal nerve (SCN) entrapment is an underrecognized cause of chronic low back pain, and musculoskeletal ultrasound has recently gained attention as a potential diagnostic tool. In a recent pilot study, an indirect ultrasonographic triad consisting of thoracolumbar fascia thickening, iliac crest enthesophytes, and Copeman nodules was proposed as a potential diagnostic indicator of SCN entrapment. In this comment, we discuss several anatomical and methodological considerations regarding the ultrasonographic evaluation of SCN entrapment. Based on previous anatomical studies and our own ultrasonographic experience, we emphasize that the principal role of ultrasonography in SCN entrapment is to facilitate accurate ultrasound-guided diagnostic nerve blocks by identifying the target anatomy. Although direct visualization of the SCN may provide supportive anatomical information, the diagnosis should remain based on the clinical presentation and, when indicated, confirmation by an ultrasound-guided diagnostic nerve block. Further multicenter prospective studies are needed to establish standardized ultrasonographic diagnostic criteria for SCN entrapment. Full article

Background/Objectives: Knee injuries and overuse-related disorders are common among athletes participating in jumping sports such as handball and basketball. Musculoskeletal ultrasonography is increasingly used for the assessment of knee pathology; however, evidence regarding the prevalence and clinical relevance of ultrasonographic abnormalities in young athletes remains limited. The aim of this study was to investigate the prevalence of ultrasonographic knee abnormalities in young male handball and basketball athletes and to examine their association with pain intensity. Methods: A cross-sectional observational study was conducted between June 2025 and June 2026 and included 69 competitive male athletes (35 handball players and 34 basketball players). All participants underwent bilateral knee ultrasonographic examination using a standardized assessment protocol and completed a questionnaire regarding demographic and training characteristics. Knee pain intensity was evaluated using the Visual Analogue Scale (VAS). Comparisons between sports were performed using χ² and t-tests, while associations between participant-level ultrasonographic findings and pain were evaluated using independent-samples t-tests (or Mann–Whitney U tests, as appropriate), with Cohen’s d effect sizes and exploratory multivariable linear regression. Sensitivity analyses stratified by sport were additionally performed. Results: Patellar tendinopathy was the most prevalent ultrasonographic abnormality (21.0%), followed by medial meniscal abnormality (15.9%) and infrapatellar bursitis (13.0%). Athletes with patellar tendinopathy, medial meniscal abnormality, or infrapatellar bursitis had significantly higher VAS pain scores than athletes without the corresponding ultrasonographic abnormality. Patellar tendinopathy demonstrated the strongest association with participant-reported pain (VAS: 4.1 ± 1.3; Cohen’s d = 1.24; p < 0.001). Handball athletes exhibited a significantly higher prevalence of patellar tendinopathy than basketball athletes (34.3% vs. 11.8%; OR = 3.90, 95% CI: 1.09–13.95; p = 0.027). In multivariable regression analysis adjusted for age, BMI, sport type, previous knee injury, and weekly training volume, patellar tendinopathy (β = 1.34, p < 0.001), medial meniscal abnormality (β = 0.70, p = 0.017), and infrapatellar bursitis (β = 0.54, p = 0.046) remained independently associated with higher pain scores. The regression model explained 39% of the variance in VAS pain scores (R² = 0.39). Conclusions: Ultrasonographic knee abnormalities are common among young male handball and basketball athletes and are significantly associated with pain intensity. Because ultrasonography has limited ability to characterize intra-articular pathology, particularly the menisci, the ultrasonographic abnormalities identified in this study should not be interpreted as definitive diagnoses, and MRI remains the reference imaging modality when comprehensive evaluation of intra-articular pathology is clinically indicated. Patellar tendinopathy was the most prevalent ultrasonographic abnormality and was most strongly associated with pain intensity. These findings support the use of musculoskeletal ultrasonography as a complementary imaging modality alongside clinical assessment in the evaluation of symptomatic athletes. However, prospective longitudinal studies are required to determine whether these ultrasonographic abnormalities have prognostic value for future pain, functional limitation, or time-loss injury. Full article

Shear wave elastography (SWE) is an increasingly investigated ultrasound-based technique in musculoskeletal imaging that provides quantitative information on tissue stiffness and biomechanical properties. This narrative review aims to summarize the basic principles, technical considerations, current clinical applications, limitations, and future perspectives of SWE in musculoskeletal imaging. Unlike conventional grayscale and Doppler ultrasonography, which mainly assess morphology and vascularity, SWE may provide additional functional information in major musculoskeletal tissues, including tendons and ligaments, skeletal muscles, peripheral nerves, fibrocartilaginous structures, plantar fascia, and selected soft tissue lesions. Current evidence suggests potential roles for SWE in detecting early biomechanical alterations, assessing disease severity, differentiating symptomatic from asymptomatic tissues, and monitoring response to treatment or rehabilitation. However, musculoskeletal tissues are anisotropic, viscoelastic, and position-dependent; as a result, SWE measurements are influenced by acquisition-related factors, tissue biomechanics, positioning and loading conditions, region of interest (ROI) placement, tissue depth, and device-related variability. For this reason, SWE findings should not be interpreted as standalone diagnostic criteria but should be considered together with clinical findings, conventional ultrasonography, MRI, electrophysiology, histopathology, and patient-centered outcomes when appropriate. This review highlights the need for tissue-specific measurement protocols, standardized reporting, normative reference data, inter-vendor harmonization, and longitudinal validation against clinically meaningful outcomes before SWE can be more reliably integrated into routine musculoskeletal imaging and rehabilitation practice. Full article

When assessing hip pain in athletes, it is important to focus on the extra-articular soft tissues that may clinically mimic joint pathology. One such extra-articular structure is the synovial bursa. Bursitis can clinically be misdiagnosed as joint-, tendon- or muscle-related pain. These pathological processes are a result of inflammation that is often secondary to acute trauma, overuse injuries, arthritis, or infection. Traumatic and overuse hip bursitis occur frequently in amateur and professional athletes and clinical presentation is often nonspecific. After clinical assessment, imaging plays an important role in diagnosis and in work-up of these lesions. Ultrasonography (US) is being increasingly used in the assessment of the hip because of the wide availability of US machines, the lower cost, and the unique real-time imaging capability which allows both static and dynamic evaluation as well as guidance of interventional procedures such as fluid aspiration and steroid injection. In order to obtain a correct diagnosis, an efficient US examination requires a thorough understanding of hip anatomy. In this setting, a structured approach based on identification of important US landmarks and compartmentalization of hip anatomy can significantly simplify the task. Sports physicians must be aware about the diagnostic and therapeutic possibilities offered by US in order to expedite rapid referral to a musculoskeletal specialist who can perform a point-of-care US examination of the hip by using a structured diagnostic approach. The purpose of this narrative review is to illustrate both the normal and pathological features of anterior and lateral hip compartments bursae using schematic diagrams and corresponding US images. We will concentrate on sport-related bursitis, of which we will discuss the etiology, clinic and principles of care management. Our aim is to promote the acquisition of these concepts in sports medicine in order to improve patient outcomes. Full article

Background: Hypermobile Ehlers–Danlos syndrome (hEDS), the most common EDS subtype, is characterized by chronic pain and joint laxity, yet no definitive causative genes or imaging-based diagnostic criteria have been established. This study investigated the genetic basis of hEDS using whole-exome sequencing (WES) and objectively evaluated ankle instability. Methods: We conducted an observational cohort study with a case–control comparison, including 22 patients and a three-generation Korean family (six individuals, four affected) diagnosed with hEDS by the 2017 criteria. WES was performed; ankle laxity was assessed by the anterior drawer test (ADT), stress ultrasonography, and stress radiography. Healthy young adults (n = 24, Beighton score < 5) from our previous study served as controls. Results: The hEDS cohort had a mean Beighton score of 8.5, with all participants reporting a family history of hypermobility and musculoskeletal complications. Family-based WES identified variants in CD44 (c.1516 + 1G > A), ITIH2 (c.783C > G), and ADAM21 (c.397C > T) in all affected individuals. In 22 unrelated patients, 114 variants in 103 candidate genes were identified; 17 patients harbored variants in genes from the same pathways as the family-derived causative genes. Compared with controls, the hEDS group showed significantly greater manual ADT grade, anterior talofibular ligament (ATFL) length at rest and under stress, dynamic ATFL change, anterior talar translation, and talar tilt. Conclusions: These findings provide molecular evidence that hEDS is a multifactorial disorder involving interconnected biological pathways, and confirm ankle instability as a clinically meaningful diagnostic feature. These complementary approaches may improve diagnostic accuracy and provide insights into the prognosis and therapeutic strategies for hEDS. Full article

Background/Objectives: Shoulder involvement is common in rheumatoid arthritis (RA), yet periarticular pathology may remain subclinical. Musculoskeletal ultrasonography enables detection of early inflammatory and structural changes; however, data on asymptomatic shoulder involvement in RA are limited. This study aimed to evaluate ultrasonographic shoulder findings in asymptomatic RA patients, compare them with healthy controls, and assess their association with disease activity. Methods: This prospective case–control study included 31 patients with RA without shoulder pain and 33 asymptomatic healthy controls. Bilateral shoulder examinations were performed using standardized ultrasonographic protocols. Periarticular findings were assessed using the Ultrasound Shoulder Pathology Rating Scale (USPRS), and acromiohumeral distance (AHD) was measured. Disease activity was evaluated using the Disease Activity Score in 28 joints (DAS28). Group comparisons, correlation analyses, receiver operating characteristic (ROC) analysis, and multivariate logistic regression were performed. Results: There were no significant differences in demographic characteristics or comorbidities between groups. Biceps tendinopathy scores were significantly higher in RA patients than in healthy controls (1.0 ± 0.79 vs. 0.5 ± 0.56, p = 0.01), whereas other ultrasonographic parameters, including supraspinatus tendinopathy, dynamic impingement findings, AHD, and total USPRS score, did not differ significantly. DAS28 showed significant positive correlations with biceps tendinosis (r = 0.37, p < 0.05) and supraspinatus tendinosis (r = 0.36, p < 0.05). Total USPRS demonstrated acceptable discrimination for identifying moderate–high disease activity (AUC = 0.73). In multivariate analysis, DAS28 was independently associated with biceps tendinopathy (OR = 1.62, 95% CI: 1.05–2.49). Conclusions: Asymptomatic patients with RA exhibit a higher burden of biceps tendon involvement compared with healthy individuals, and subclinical shoulder ultrasonographic findings are associated with disease activity. Asymptomatic patients with RA demonstrated a significantly higher biceps tendinopathy score compared with healthy controls, whereas most other ultrasonographic parameters, including total USPRS score and AHD, did not differ significantly. These findings suggest that the long head of the biceps tendon may represent a relatively more sensitive site of subclinical periarticular involvement in RA; however, the overall ultrasonographic differences were limited and should be interpreted cautiously. Full article

Background and Clinical Significance: Post-traumatic finger stiffness is frequently attributed to soft tissue adhesions; however, mechanical obstruction from occult osseous structures remains a rare but critical differential diagnosis in adults. Case Presentation: This report describes a 56-year-old female presenting with severe, refractory stiffness of the little finger eight months after a proximal phalanx fracture. Despite extensive conservative therapy, active and passive flexion at the proximal and distal interphalangeal joints remained locked in extension. While conventional radiographs demonstrated bony union, musculoskeletal ultrasonography (MSUS) revealed an occult protruding malunited fragment incarcerating the flexor tendons. Dynamic MSUS provided real-time evidence of mechanical impingement by demonstrating proximal muscle contraction without distal tendon excursion. Intraoperatively, initial soft tissue tenolysis failed to restore motion; further exploration guided by MSUS evidence successfully identified a sharp bone spike. Subsequent ostectomy resulted in immediate restoration of functional range of motion. This case underscores the limitations of static imaging in evaluating the dynamic gliding mechanism and highlights the valuable role of MSUS in identifying mechanical functional obstructions. Conclusions: Early sonographic evaluation should be considered for refractory post-traumatic stiffness to prevent prolonged, ineffective conservative care and to guide definitive surgical management. Full article

Background/Objectives: Childhood-onset Sjögren disease (cSjD) is a rare autoimmune disorder with heterogeneous manifestations and ongoing diagnostic challenges, as there are no validated paediatric criteria. Our study aims to characterise the clinical, laboratory, and imaging features of children diagnosed with cSjD at a single Romanian paediatric rheumatology centre between 2015 and 2025 and contextualise these findings within the most recent literature. Methods: A retrospective review of 15 consecutive cSjD patients was conducted, including clinical features, autoantibodies, imaging, biopsy findings, treatment, and outcomes. Results: Our cohort showed a significant female predominance (80%) and a broad age range at disease onset (3–15 years). Extraglandular manifestations were more common at presentation than glandular phenotypes (53.3% vs. 40%). Lupus-like extraglandular presentations frequently led to initial misdiagnosis as childhood-onset systemic lupus erythematosus (SLE) in our cohort. Sicca symptoms were present at diagnosis in only 3 of 15 patients (20%) and developed later during follow-up in an additional 4 patients (26.7%). Notably, the cohort included novel findings, such as an unprecedented presentation with acute exudative pericarditis complicated by cardiac tamponade. Anti-SSA antibodies and salivary gland ultrasound abnormalities were highly prevalent (86.7% and 100%, respectively). Anti-SSB antibodies were detected in seven patients (46.7%), with titres showing more variability than those of anti-SSA, ranging from just above the positivity threshold to mildly elevated levels. The association with macro-creatine kinase type I was another distinctive feature of this series. Chronic musculoskeletal pain and dryness were our patients’ most frequently reported symptoms at the last assessment, affecting up to 5/15 (33.3%) in each domain. One patient showed irreversible ocular damage during our study. Conclusions: Extraglandular presentations of cSjD are highly heterogeneous and diagnostically challenging, often occurring without glandular symptoms. Lupus-like systemic features—including facial vasculitic purpura, with or without arthralgia, and occasional pericarditis, as observed in our cohort—may contribute to frequent initial diagnostic misattribution to SLE. Early salivary gland ultrasonography, targeted autoantibody testing, and selective biopsy are essential for timely diagnosis, underscoring the urgent need for paediatric-specific validated classification criteria. Full article

Background: Tendinopathy remains a prevalent musculoskeletal disorder with limited disease-modifying pharmacotherapy. This study aimed to identify a reparative agent from the traditional medicinal herb Eucommiae Cortex and elucidate its mechanism of action. Methods: A bioactive fraction was first identified through a bioactivity-guided strategy using tenocyte cytoprotection and migration assays, then characterized by UHPLC-HRMS/MS. Its major constituent, aucubin (AU), which mirrors the fraction’s key pharmacological activities, was evaluated both in vitro and in vivo. In H₂O₂-injured tenocytes, AU’s effects on viability, apoptosis, oxidative stress (ROS, MDA, SOD) and inflammation (IL-1β, TNF-α) were assessed, with specific focus on estrogen receptor (ER) pathway involvement using pharmacological tools (17β-estradiol and (R, R)-THC). In a collagenase-induced Achilles tendinopathy model using male SD rats, AU’s therapeutic efficacy was evaluated via multimodal assessment: ultrasonography, histopathology (H&E, Masson’s trichrome, Sirius red), TEM, immunohistochemistry, and biochemical analysis of tissue markers. Results: AU effectively attenuated H₂O₂-induced tenocyte injury by enhancing viability, reducing apoptosis, and mitigating oxidative/inflammatory stress. These effects were mimicked by 17β-estradiol and reversed by the selective ERβ antagonist (R, R)-THC, indicating ERβ dependence. In vivo, AU treatment promoted structural and functional recovery, improved collagen maturity (increased Col I/Col III ratio and fibril diameter), suppressed matrix degradation (MMP-3, MMP-13) and apoptosis, and reduced oxidative stress and inflammation in tendon tissue. Conclusions: This study identifies aucubin as a novel phytoestrogenic compound from Eucommiae Cortex that promotes tendon repair through an ERβ-mediated mechanism. These findings position ERβ activation as a promising therapeutic strategy for tendinopathy and highlight AU as a promising lead compound for further development. Full article

Background/Objectives: Sarcopenia, an underdiagnosed musculoskeletal disorder, is a serious cause of disability, poor quality of life, and healthcare costs in an increasingly elderly population. This study aimed to examine an ultrasound (US)-based, inexpensive, simple, and reproducible alternative to magnetic resonance imaging (MRI) for assessing muscle quality. A study compared Dixon MR fat fraction with US attenuation imaging (ATI) and echo intensity (EI) in the rectus femoris (RF) and biceps brachii (BB). Methods: The US images were acquired from 34 participants who had previously received a whole-body MRI. The ATI measurements were carried out using a linear array on a Canon Aplio i800 scanner. The measurements of EI were assessed by manually tracing the cross-sectional border of the right RF and BB muscles. Corresponding T1-weighted Dixon VIBE-based fat and water images were required for the MRI fat fraction percentage (MR %FF) measurements. Results: Using Pearsons correlation coefficient, a good correlation was found between MR %FF and EI measurements. The results between operators’ measurements showed a strong correlation and were highly repeatable. Attenuation imaging revealed no correlation with MR %FF or EI. Conclusions: Echo intensity offers a low-cost, non-invasive, and widely accessible US-based imaging modality for screening patients at risk for sarcopenia. No correlation was found between the ATI and MR %FF or between the ATI and EI. Further adapted protocols and software adjustments are needed so that ATI has the potential to prove itself as an additional US-based method for assessing fat infiltration in muscles. Full article

This work presents a standardized 360-degree, clock-face ultrasonographic protocol for comprehensive static and dynamic assessment of the glenoid labrum. The protocol translates the arthroscopic clock-face orientation into ultrasound scanning windows, providing reproducible steps for each labral quadrant (12 to 12 o’clock) including patient positioning, transducer orientation, and dynamic maneuvers. By leveraging linear transducers with trapezoidal imaging and an optional convex transducer to bypass acoustic shadowing from the acromion and coracoid, all labral segments can be consistently visualized, while dynamic testing reveals subtle clefts, irregular margins, and medial displacement patterns. Clinically, this approach is particularly valuable for patients who cannot undergo MRI or MR arthrography (e.g., due to metallic implants, contrast allergy, claustrophobia or renal dysfunction) and in settings where MR/MRA is unavailable or impractical (sports medicine, urgent care, postoperative follow-up). The pictorial atlas and step-by-step checklists aim to support adoption in routine practice and to facilitate communication with surgeons through shared clock-face terminology. This protocol is not intended to replace MR arthrography for surgical planning; rather, when MRI/MRA cannot be performed or access is limited, it provides actionable, dynamic information that complements clinical decision-making. Full article

Background and Objectives: Subacromial pain syndrome (SAPS) is one of the most common musculoskeletal problems affecting the shoulder joint. In this study, we aimed to investigate the effectiveness of a rehabilitation program targeting humeral head depressor muscles on symptoms in individuals with SAPS. Materials and Methods: Participants were sequentially assigned to study and control groups in a quasi-randomized design. While the control group received standard physical therapy and rehabilitation, the study group underwent a combined progressive exercise program, including humeral head depressor strengthening, peri-articular muscle exercises, scapular stabilization, and proprioceptive training. Acromio–humeral distance (AHD) and tendon thickness measurements were evaluated via ultrasonography (USG), while pain intensity, upper-extremity disability, and kinesiophobia were measured using the VAS and McGill Pain Questionnaire, DASH-T, and the Fear Avoidance Beliefs Questionnaire, respectively. Results: Both the study and control groups showed statistically significant increments in AHD compared to the baseline. The first and final measurements changed from 7.92 mm to 10.54 mm and from 7.72 mm to 8.41 mm, respectively. However, the increase in AHD was greater in the study group relative to the control group, and the value was statistically significant. The study group showed significant improvements in pain and disability. Kinesiophobia levels, on the other hand, decreased in both groups, but a greater decrease was observed in the study group. Conclusions: In this study, both the study and control groups showed an increase in AHD, but the combined exercise program targeting humeral head depressor muscles resulted in a greater improvement. Reduced tendon thickness indicated the eased motion of the rotator cuff, supporting the improvements in pain and disability. The program had a positive impact on psychosocial parameters, including pain-related kinesiophobia. Given the limited literature on the effects of such exercises on AHD and tendon thickness, this study provides an original contribution. Clinical Trial Registration: ClinicalTrials.gov identifier: NCT07228455. Full article

Background: Childhood obesity is a growing global concern associated with early-onset orthopedic complications that may persist into adulthood. Among the anthropometric indicators, abdominal adiposity plays a key role in assessing health risks during pediatric evaluations. However, the relationship between abdominal fat distribution and biomechanical alterations, such as changes in posture and foot support, remains poorly understood. Ultrasonography (US) is a validated, noninvasive imaging method capable of distinguishing preperitoneal and intraperitoneal fat in children. Despite its diagnostic advantages, no study to date has directly examined ultrasound-measured abdominal adiposity-predicted pronated foot posture in children. Objective: We aimed to verify the impact of abdominal adiposity on foot support and its association with obese, overweight, and eutrophic schoolchildren. Methods: This is a cross-sectional study. Sixty-five pupils (aged 6–9 years) from a public school in São Paulo, Brazil, were divided into three groups according to nutritional status: obese (n = 25), overweight (n = 20), and eutrophic (n = 20). Anthropometric measurements and foot posture, assessed using the Foot Posture Index (FPI), were collected during the initial evaluation. Abdominal adiposity was determined by ultrasonography, measuring subcutaneous, preperitoneal, and intraperitoneal fat thickness. Statistical Analysis: Analyses compared group differences and relations between abdominal fat and foot posture, with significance set at p < 0.05. Results: Obese and overweight schoolchildren showed pronated foot posture when compared to eutrophic children, on both sides of the feet. Abdominal adiposity was a good predictor of a more pronated footrest for the right and left feet, showing a high-to-moderate association. Conclusions: Ultrasound-measured abdominal adiposity was identified as a significant predictor of pronated foot posture in schoolchildren. These findings highlight the importance of monitoring abdominal fat accumulation during pediatric evaluations, as excessive adiposity may increase the risk of musculoskeletal dysfunctions and pain in the lower limbs. Early detection of these alterations may help prevent postural and musculoskeletal disorders in overweight and obese children. Full article

Background and Clinical Significance: Psoriasis, a chronic immune-mediated inflammatory disease, can affect musculoskeletal structures, including the Achilles tendon. Achilles pain in psoriasis patients may arise from tendinitis or neuropathic pain due to peripheral nerve dysfunction, such as sural nerve (SN) involvement, a condition frequently misdiagnosed due to limitations in conventional diagnostics. Fascial tissues are critical in nerve compression syndromes. This case explores the application of a novel quantitative Sonoguide Digital Palpation (SDP) protocol and ultrasound (US)-guided hydrodissection (HD) for SN dysfunction mimicking Achilles tendinopathy in a psoriasis patient. Case Presentation: A 41-year-old male with psoriasis presented with acute onset of right heel stiffness and paresthesia. Physical examination, radiographs, and ultrasound were performed. SDP, employing a validated four-criterion diagnostic framework (including fascial mobility quantification and concordant pain provocation), identified crural fascia restriction affecting SN and reproduced patient’s concordant Achilles pain. High-resolution ultrasonography provided key morphological evidence, revealing a 2.6-fold enlargement of the sural nerve’s cross-sectional area (CSA) on the affected side (13 mm²) compared to the asymptomatic side (5 mm²). Notably, a positive Tinel’s sign was elicited over the psoriatic plaque. US-guided HD was performed using 50 cc of 5% dextrose in water (D5W) without local anesthetic below the psoriatic lesion. Post-HD, the patient reported immediate and significant pain relief (Numeric Pain Rating Scale (NPRS) score reduction from 8 to 2), confirming the prompt correction of a clinically important fascial restriction, associated with improved SN mobility, objectively verified by a post-procedure SDP assessment. At 24-month follow-up, sustained symptom relief and complete functional recovery were reported. Conclusions: This case highlights SDP’s ability to objectively visualize and confirm fascial restriction as a cause of nerve dysfunction by quantitatively reproducing concordant pain. The objective finding of nerve swelling provides sonographic substantiation for the functional diagnosis of nerve dysfunction. This integrated diagnostic approach, combining dynamic functional assessment with morphological confirmation, offers a novel paradigm for evaluating peripheral nerve disorders. US-guided HD of the SN with D5W without local anesthetic shows promise as both a diagnostic confirmatory tool and therapeutic intervention for neuropathic Achilles pain in psoriasis patients with SN involvement, aligning with its efficacy in other peripheral neuropathies. The significant nerve swelling (13 mm²) provides robust morphological corroboration of the functional impairment diagnosed by SDP, offering a more comprehensive diagnostic paradigm. Full article