Search Results (28)

The effectiveness of breathing interventions on postural alignment, pain reduction, and functional improvement in patients with forward head posture (FHP) and chronic neck pain remains uncertain. Previously conducted randomized controlled trials (RCTs) that involved breathing interventions were identified through searches of the PubMed, Cochrane Library, Web of Science, and Scopus databases. Studies were included if they applied diaphragmatic breathing, breathing muscle training, or feedback breathing exercises for at least 2 weeks to chronic neck pain (duration ≥ 3 months) and/or forward head posture. The craniovertebral angle (CVA), the visual analog scale (VAS), and the neck disability index (NDI) were the primary outcome measures. The results showed that breathing interventions had a moderate effect size in terms of improving the CVA. Limited effects were observed for pain reduction, and improvements in neck disability approached statistical significance. However, despite these positive findings, the overall evidence was rated as ‘very low certainty’ in the GRADE assessment, primarily due to high heterogeneity among studies, limited sample sizes, and the potential for unit-of-analysis errors in diagnosis-based subgroup analyses. Consequently, their overall effectiveness in chronic neck pain was limited. Future research is needed to explore a multidisciplinary approach to neck pain using standardized protocols and larger samples. Full article

Background/Objectives: Patient-reported outcome measures (PROMs) are widely used tools in orthopedic surgery for evaluating clinical outcomes, guiding research, and supporting value-based care. However, the optimal timing for collecting baseline PROMs, whether in clinic prior to surgery or on the day of surgery, remains uncertain. This study investigated whether the clinical setting (preoperative clinic vs. day of surgery) affects baseline PROMs in patients undergoing anterior cervical discectomy and fusion (ACDF). Methods: Patients undergoing elective, primary ACDF at a single institution between August 2019 and June 2021 were prospectively enrolled. Inclusion criteria included age over 18, English literacy, and eligibility for primary ACDF. Participants completed PROMIS domains, Neck Disability Index (NDI), Modified Japanese Orthopaedic Association (mJOA) score, and Visual Analog Scale (VAS) at two time points: during the preoperative clinic visit and again in the perioperative area on the day of surgery. A subgroup analysis was performed for patients with anxiety, defined as a PROMIS anxiety score ≥ 59.4. Results: A total of 63 patients were enrolled, with 48 completing both sets of surveys. The average time between the two assessments was 7.9 days (95% CI: 6.4–9.3). After Bonferroni correction (α = 0.005), no significant differences were observed in any PROMs across the two time points, including PROMIS physical function (p = 0.398), pain interference (p = 0.682), fatigue (p = 0.019), social satisfaction (p = 0.331), anxiety (p = 0.047), depression (p = 0.042), NDI (p = 0.072), mJOA (p = 0.566), VAS neck pain (p = 0.054), or VAS overall pain (p = 0.335). Subgroup analysis of anxious patients similarly revealed no statistically significant changes between settings. Conclusions: PROM scores were not meaningfully different between the preoperative clinic and the day of surgery in patients undergoing ACDF. These results are most applicable when baseline PROMs are collected within about one week of ACDF. These findings support flexibility in workflow design for PROM collection, as the timing and setting do not significantly impact baseline responses. Full article

Background/Objectives: Neck pain caused by myofascial pain syndrome (MPS) is a highly prevalent musculoskeletal condition. Repetitive peripheral magnetic stimulation (rPMS) is a promising treatment option; however, its therapeutic effect and optimal treatment frequency remain unclear. This study aimed to investigate the therapeutic effect and duration of effect of rPMS in patients with MPS of the neck. Methods: In this randomized, sham-controlled, crossover trial, 27 patients with neck MPS and baseline visual analog scale (VAS) scores ≥ 40 were enrolled. The mean age was 43.8 ± 9.1 years, and 63% were female. Participants were randomly assigned to receive either an initial rPMS treatment (a 10 min session delivering 3900 pulses at 5–10 Hz) or sham stimulation. After 7 days, groups crossed over. Pain intensity (VAS), disability (Neck Disability Index; NDI), and analgesic use were recorded daily for seven consecutive days. A linear mixed-effects model was used for analysis. Results: At baseline, the VAS and NDI scores were 61.8 ± 10.5 and 26.0 ± 6.3, respectively. rPMS produced a significantly greater reduction in both VAS and NDI scores, with the greatest differences observed on Day 4: the differences were −24.1 points in VAS and −8.5 points in NDI compared to the sham group. There was no significant difference in analgesic use between the two groups. Conclusions: A single rPMS session provides short-term improvement in pain and disability in neck MPS. Based on the observed therapeutic window, more frequent sessions (e.g., twice weekly) may provide sustained benefit and should be explored in future studies. Full article

Objective: The aim of the study was to evaluate the effect of postural stabilization exercises, in addition to cervical stabilization (CS), on the craniovertebral angle (CVA), pain, neck disability index (NDI), and quality of life in people with chronic neck pain. Methods: This study was performed on 60 women with chronic neck pain, aged 20–60 years, who were randomly divided into two groups. Individuals in the first group underwent CS exercises, in addition to scapular and lumbopelvic stabilization (SLPS) exercises, three times a week for 6 weeks. The individuals in the second group underwent only CS exercises for the same period. Moreover, stretching exercises and a 20 min hot pack were applied to the muscles around the neck of all patients. The CVA was measured using photogrammetry. The visual analog scale (VAS) was used to assess pain. The disability level was measured using the NDI. The Turkish version of the 36-Item Short-Form Health Survey (SF-36) was used to assess quality of life. The assessments were conducted before treatment, after treatment, and at the 2-month follow-up. To assess changes over time and between groups, a two-way repeated measures analysis of variance (ANOVA) was conducted. Results: Post-treatment measurements revealed significant differences favoring the SLPS group. The VAS and NDI scores were markedly lower in the SLPS group than in the CS group, both post-treatment (p < 0.001) and at follow-up (p < 0.001). The CVA was significantly greater in the SLPS group at both the post-treatment (p < 0.001) and follow-up (p < 0.001) assessments. However, in all sub-parameters except the SF-36 general health subscale, the SLPS group reported higher scores than the CS group post-treatment and at follow-up. Effect sizes for between-group comparisons ranged from moderate to very large (Cohen’s d = 0.65 to 2.31), and partial eta-squared (η²) values indicated moderate to large effect magnitudes (η² = 0.09 to 0.48), supporting the clinical relevance of the findings. Conclusion: In individuals with neck pain, including SLPS exercises in the treatment program, rather than just exercises for the cervical region, provides more positive results in terms of reducing disability and pain and increasing functionality. Clinical Trial Registration Number: NCT06578481. Full article

Introduction: Intertrochanteric femoral fractures (IFFs) are the most common traumatic injuries in elderly people and significantly impact the patient’s health status. The current evidence indicates that short intramedullary nails may be a better choice than dynamic hip screws in IFF management, being less invasive and biomechanically superior, providing a buttress to limit fracture collapse. On the other hand, an unstable fracture may collapse even after adequate reduction and fixation. This paper aims to describe the surgical complexity of the nail-to-total hip arthroplasty (THA) conversion, focusing on the restoration of normal hip geometry. Material and Methods: Patients referred to our level I trauma center with failed cephalomedullary nailing following IFFs and managed with the nail-to-THA conversion were retrospectively recruited. The anteroposterior postoperative pelvis radiographs were analyzed to establish whether the normal biomechanics of the involved hip were restored. The following radiographic parameters were recorded and compared to the contralateral unaffected side: hip offset, cervical–diaphyseal angle, and limb length discrepancy. Clinical assessment was performed using the following scores: the Harris hip score (HHS) and the visual analog scale for pain (VAS). The independent samples t-test and the Pearson correlation test were performed. The tests were two-tailed; a p < 0.05 was considered significant. Results: A total of 31 patients met the inclusion and exclusion criteria (10 males and 21 females; mean age: 76.2 years; range: 66–90 years) and were included in this study. The modes of trochanteric nail failure included the following: cut-out in 22 cases (70.97%), non-union in 4 cases (12.9%), peri-implant fracture in 1 case (3.23%), cut-through in 2 cases (6.45%), and femoral head avascular necrosis (HAN) in 2 cases (6.45%). Long stems were used in 21 patients out of 31 (67.74%), while dual-mobility cups were implanted in 24 patients out of 31 (77.41%). A significant mean neck shaft angle (NSA) increase (p < 0.001) and a significant mean femoral offset reduction (FO, p 0.001) compared to the contralateral hip were recorded; a mean limb length discrepancy (LLD) of 8.35 mm was observed. A significant correlation between HHS and ∆NSA (p = 0.01) and ∆FO (p = 0.003) was recorded. Conclusions: Conversion from a cephalomedullary nail to THA is a complex procedure that should be considered a revision surgery, rather than a primary surgery. Surgeons must be aware that normal hip geometry may not be obtained during this surgical procedure; thus, a patient undergoing the nail-to-THA conversion for intertrochanteric fixation failure may have an increased risk of implant-related complications. Full article

Background and Objectives: Musculoskeletal disorders (MD) affect over 1.7 billion people worldwide, with neck and low back pain being prevalent and debilitating conditions. Current treatments include various interventions, but novel approaches are needed to improve functionality and reduce disability. To evaluate the effects of a postural hammock on pain and functionality in people with chronic neck and low back pain. Materials and Methods: A randomized controlled trial was conducted with participants experiencing chronic neck and/or low back pain. They were assigned to either an experimental group using a postural hammock or a control group lying on a mat. Participants underwent five sessions of 10 min each over five consecutive days. Results: Forty-three subjects completed the study. While both groups showed improvements, the experimental group exhibited significant increases in hamstring flexibility and pain tolerance, measured through the Visual Analog Scale (VAS) and pressure pain thresholds (PPT). Postural hammock use demonstrated potential benefits in pain management and flexibility compared to conventional methods. Conclusions: Using a postural hammock may offer benefits for individuals with chronic back pain. Future research should explore combining hammock therapy with other interventions to enhance outcomes and improve the quality of life for patients with back pain. Full article

Phlai (Zingiber montanum) has long been valued for its anti-inflammatory and analgesic properties in traditional medicine. This study aimed to develop and assess the physical stability, chemical composition, and clinical efficacy of a novel Phlai spray cool formula (PSCF) compared to a diclofenac spray (DS) in patients with chronic myofascial pain syndrome. The chemical analysis revealed curcumin (28.73 ± 5.73 mg/100 g), β-sitosterol (50.92 ± 1.27 mg/100 g), and lauric acid (38.86 ± 1.72 g/100 g) as key active compounds. PSCF demonstrated stable physicochemical properties, including pH and peroxide value across storage conditions. In a randomized controlled trial involving 66 participants, PSCF and DS groups exhibited comparable reductions in pain intensity, as measured by the Visual Analog Scale (VAS), from baseline to week 2. Both groups also showed significant improvements in neck disability index (NDI), pressure pain threshold (PPT), and cervical range of motion (CROM). By week 2, the increase in CROM for flexion and extension reached 23.54 ± 4.09° and 19.43 ± 3.20°, respectively, with no significant intergroup differences. The SF-36 health survey indicated notable improvements in overall health status and quality of life, particularly in physical and emotional domains. The analgesic effects of PSCF are attributed to the combined action of menthol, β-sitosterol, and curcumin. The study demonstrated that PSCF offers a therapeutic effect comparable to diclofenac spray without adverse reactions, highlighting its potential as an alternative topical analgesic for chronic myofascial pain management. Full article

Background: Cycling involves specific body positions that, when maintained for prolonged periods, may affect spinal curvature and increase the risk of pain-related issues. This study aimed to evaluate sagittal spinal curvatures, the prevalence of pain in spinal segments, and their interrelation among amateur road cyclists. Methoods: The research included 30 male participants aged 18–48 years. Pain severity was assessed using the Visual Analog Scale (VAS) and Laitinen scale, while spinal curvature was evaluated with an electronic inclinometer. Results: Results showed no statistically significant differences in spinal curvature angles between cyclists with and without pain complaints (p = 0.056). However, tendencies were noted, such as higher mean VAS scores for lower back pain (4.90) compared to neck pain (3.38), and variations in parameters like Beta, LL, and KGP. Conclusions: While the findings did not confirm clear distinctions, they suggest trends indicating potential links between spinal curvatures and pain occurrence. These results underscore the importance of further studies involving larger cohorts to verify these observations and explore the biomechanical adaptations associated with amateur cycling. Insights from such research could inform strategies for preventing and managing spinal pain among cyclists. Full article

Background: The role of autonomic nervous system (ANS) modulation in chronic neck pain remains elusive. Transcutaneous vagus nerve stimulation (t-VNS) provides a novel, non-invasive means of potentially mitigating chronic neck pain. This study aimed to assess the effects of ANS modulation on heart rate variability (HRV), pain perception, and neck disability. Methods: In this double-blind randomized clinical trial, 102 participants with chronic neck pain were randomly allocated to one of three groups: t-VNS plus standard-care physiotherapy (SC-PT), heart rate variability biofeedback (HRV-BF) with SC-PT, or SC-PT alone. Interventions were administered three times weekly for 6 weeks. The following outcome measures were assessed at baseline and after 6 weeks: HRV, the visual analog scale (VAS), the pressure pain threshold (PPT), and the neck disability index (NDI). Results: The t-VNS group exhibited significant improvements compared to the HRV-BF and SC-PT groups. Specifically, t-VNS increased the RR interval (mean difference [MD] = 35.0 ms; p = 0.037) and decreased the average heart rate (MD = −5.4 bpm; p = 0.039). Additionally, t-VNS reduced the VAS scores (versus HRV-BF: MD = −0.8 cm, p = 0.044; SC-PT: MD = −0.9 cm, p = 0.018), increased the PPT (versus HRV-BF: MD = 94.4 kPa, p < 0.001; SC-PT (MD = 56.2 kPa, p = 0.001)), and lowered the NDI scores (versus HRV-BF: MD = −4.0, p = 0.015; SC-PT: MD = −5.9, p < 0.001). Conclusions: t-VNS demonstrated superior effectiveness compared to HRV-BF and SC-PT in regulating HRV, alleviating pain, and enhancing functional capabilities in individuals with chronic neck pain. Full article

Background/Objectives: Posterior neck, trapezius, and interscapular pain, exacerbated by poor posture such as forward head and rounded shoulders, is common. In this study, we aimed to assess the clinical outcomes of isotonic saline injections at nerve entrapment points (NEPs) within the sternocleidomastoid (SCM) and scalenus medius (SM) muscles for alleviating spinal accessory nerve (SAN) and dorsal scapular nerve (DSN) compression in patients suffering from posterior neck, trapezius, and interscapular pain. Methods: In this retrospective study, 68 patients were included, with 34 receiving isotonic saline injections and 34 undergoing Extracorporeal Shock Wave Therapy (ESWT) as a control. The clinical outcomes were evaluated using the Visual Analog Scale (VAS) and Percent Pain Intensity Difference (PPID) before and after therapy. The effectiveness of isotonic saline injections targeting NEPs in the SCM and SM muscles in relieving pain associated with SAN and DSN entrapment was assessed. Results: Both treatments significantly reduced VAS and PPID scores, with injection therapy showing a larger treatment effect size (Cohen’s d: 3.521 for VAS and 3.521 for PPID) compared to ESWT (Cohen’s d: 1.379 for VAS and 1.710 for PPID). The mean clinically important difference observed for VAS was 4.2, exceeding the expected value of 2.6, indicating a substantial improvement in pain and patient quality of life. Conclusions: Isotonic saline injections at the NEPs of SAN and DSN within the SCM and SM muscles might potentially reduce posterior neck, trapezius, and interscapular pain associated with possible nerve entrapment, without causing complications. Further research is needed to validate these findings in larger, controlled trials. Full article

Background and Objectives: Multilevel cervical spondylotic myelopathy (MCSM) presents complex challenges for surgical management, particularly in patients with kyphosis or significant anterior pathology. This study aimed to assess the long-term efficacy of modified expansive open-door laminoplasty (MEOLP) combined with short-level anterior cervical fusion (ACF) in providing decompression, preserving alignment, and maintaining range of motion (ROM) over a nine-year follow-up. Materials and Methods: A retrospective analysis was conducted on 124 MCSM patients treated with MEOLP combined with ACF between 2011 and 2015. MEOLP, a muscle-sparing posterior approach, was combined with ACF to correct sagittal misalignment and address anterior compression. Key outcome measures included the Pavlov ratio, C2–C7 angle, Japanese Orthopedic Association (JOA) score, and Visual Analog Scale (VAS) for neck pain. Patients were monitored for adjacent segment degeneration (ASD) and other postoperative changes over the long-term follow-up. Results: At nine years post-surgery, patients demonstrated significant improvements in decompression and cervical alignment. The mean C2–C7 angle increased, reflecting enhanced lordotic curvature, while the Pavlov ratio showed maintained canal expansion. JOA scores improved significantly, indicating reduced myelopathy symptoms, and VAS scores for neck pain decreased, reflecting symptom relief. Despite these positive outcomes, ASD was noted, especially in patients with reduced preoperative disk height, highlighting the need for strategies to mitigate degeneration at adjacent segments. Conclusions: MEOLP combined with short-level ACF is a viable and durable option for managing complex MCSM cases, offering effective decompression, alignment correction, and ROM preservation. The limitations of this study, including its retrospective, single-center design and the lack of quality-of-life assessments, underscore the need for future multi-center studies with broader outcome measures. These findings support MEOLP with ACF as an alternative approach in cases where traditional laminoplasty may be insufficient. Full article

Background and Objectives: Posterior cervical foraminotomy (PCF) aims to resolve cervical radiculopathy while preserving range of motion (ROM). However, its effectiveness in maintaining ROM is uncertain. This study investigates the changes in ROM after PCF and identifies preoperative factors that influence ROM reduction post surgery. Materials and Methods: This retrospective cohort study included patients treated at our hospital from August 2016 to September 2021. Clinical outcomes were assessed using the visual analog scale (VAS) for neck and arm pain and the neck disability index (NDI). Radiological outcomes included the segmental angle (SA), cervical angle (CA), C2–C7 SVA, Pfirrmann grade, extent of facetectomy, foraminal stenosis, and ROM. Patients were categorized into two groups based on segmental ROM changes: decreased (Group D) and maintained (Group M). Radiological and clinical outcomes were compared between the groups. Univariate and multivariate regression analyses were performed to identify risk factors for ROM loss after PCF. Results: 76 patients were included: 34 in Group D and 42 in Group M, with no demographic differences. Preoperatively, Group D had significantly larger flexion segmental and cervical angles than Group M (segmental, p < 0.001; cervical, p = 0.001). Group D also had a higher Pfirrmann grade (p = 0.014) and more bony bridge formations (p = 0.004). While no significant differences were observed in arm pain VAS and NDI scores, Group D exhibited worse neck pain VAS at the last follow-up (p = 0.03). Univariate linear regression indicated that preoperative segmental ROM (p < 0.001, B = 0.82) and bony bridge formation (p = 0.046, B = 5.33) were significant predictors of ROM loss post PCF. Conclusions: Patients with higher preoperative flexion angles and Pfirrmann grades at the operative level are at an increased risk for ROM loss and neck pain and often exhibit bony bridge formation. Accounting for these factors can improve surgical planning and patient outcomes. Full article

Background/Objectives: Vibration therapy approaches are an effective and safe treatment option for musculoskeletal disorders. This study examines the effects of vibration therapy using a percussion massage gun (PMG) on joint position sense, range of motion, pain, functionality, and kinesiophobia in individuals with cervical disc herniation (CDH). Methods: This single-blind randomized controlled trial involved 44 CDH patients divided into a Vibration Group (VG) and a Conventional Group (CG). The CG underwent a standard physiotherapy treatment heat application, Transcutaneous Electrical Nerve Stimulation (TENS), and exercises for range of motion and strengthening. VG received conventional therapy augmented with vibration therapy (VT) via a PMG. Joint position sense (JPS) using the Laser Pointer Assisted Angle Repetition Test; pain intensity with the Visual Analog Scale, kinesiophobia with the Tampa Scale for Kinesiophobia, and cervical dysfunction with the Neck Disability Index were assessed. Results: Both groups showed statistically significant improvements in pain, kinesiophobia, disability, and proprioception after treatment (p < 0.05). When comparing the difference values between groups, the VG was found to be more effective than the CG in the parameters of VAS activity (p = 0.013). The CG had more improvement in JPS neck left rotation than the VG (p = 0.000). Conclusions: VT, when combined with conventional physiotherapy, is effective in improving pain, proprioception, and functionality in individuals with CDH. These findings support the inclusion of VT as a beneficial adjunct therapy. Further research with larger sample sizes and longer follow-ups is recommended to validate these results and explore the long-term effects of VT on CDH. Full article

Background and Objectives: Cervical radiculopathy (CR) manifests as pain and sensorimotor disturbances in the upper extremities, often resulting from nerve root compression due to intervertebral disc herniation, degenerative changes, or trauma. While conservative treatments are initially preferred, persistent or severe cases may require surgical intervention. Ultrasound-guided selective nerve root block (SNRB) has emerged as a promising intervention for alleviating symptoms and potentially obviating the need for surgery. This study evaluates the therapeutic efficacy of ultrasound-guided SNRB in managing chronic CR, aiming to determine its potential in symptom relief and delaying or avoiding surgical procedures. Materials and Methods: A retrospective analysis was conducted on 720 outpatients treated for CR between October 2019 and March 2022. After excluding patients with traumatic CR, previous surgeries, malignancies, progressive neurological symptoms requiring immediate surgery, or inadequate conservative treatment, 92 patients who had experienced cervical radicular pain for more than three months and had failed to improve after more than six weeks of conservative treatment with VAS scores ≥ 5 were included. The patients underwent single or multiple ultrasound-guided SNRB procedures, involving the injection of dexamethasone and lidocaine under real-time ultrasound guidance. Symptom severity was assessed at the baseline, and at 4, 8, and 12 weeks post-procedure using the Visual Analog Scale (VAS). The data collected included age, sex, presence of neck and/or radicular pain, physical examination findings, recurrence of symptoms, improvement in symptoms, and whether surgical intervention was ultimately required. Statistical analyses were performed to identify the factors associated with symptom improvement or recurrence. Results: Significant symptom improvement was observed in 69 (75.0%) participants post-SNRB, with 55 (79.7%) showing improvement at 4 weeks, 11 (15.9%) at 8 weeks, and 3 (4.4%) at 12 weeks. Symptom recurrence, defined by an increase in VAS score accompanied by a pain flare lasting at least 24 h after a pain-free interval of at least one month, was noted in 48 (52.2%) patients. The presence of combined neck and radicular pain was a significant predictor of recurrence (p = 0.008). No significant associations were found between symptom relief and factors such as age, gender, initial pain severity, or MRI findings. Conclusions: Ultrasound-guided SNRB effectively manages chronic CR, providing substantial symptom relief and potentially reducing the need for surgical intervention. This technique offers a promising conservative treatment option, especially given its real-time visualization advantages and minimal radiation exposure. Full article

(1) Background: The goal of this study is to evaluate psychological tolerance and health-related quality of life (QOL) in head and neck (HN) cancer patients treated with definitive accelerated radiotherapy (DART). (2) Methods: 76 recurrence-free patients eligible for the study, who were treated with DART in the CAIR-2 phase III clinical study (median of follow-up = 47 months), completed EORTC QLQ-C30 with the H&N35 module, Hospital Anxiety and Depression Scale (HADS) and Visual–Analog Scales (VAS) of pain in HN and the neck/arm areas. (3) Results: The most dominant symptoms measured with QLQ-C30 were as follows: fatigue (44/100), sleeplessness (39/100), financial problems (38/100) and pain (32/100). Within the H&N35, the highest scores were reported on the subscales of sticky saliva (60/100), mouth dryness (65/100) and increased intake of painkillers (50/100). Pain (VAS) was reported by 87% (HN area) and 78% (shoulder area) of the patients, with a mean score of 3/10. One-third of the patients reported depressive moods (HADS ≥ 15 points) with an average score of 12.5/42 p. The depressed group, who smoked more as compared to the non-depressed group before DART (96% vs. 78%) and required steroids treatment (85% vs. 58%) during DART, also scored significantly worse on 23 of the 35 subscales of QLQ-C30 and H&N35 and experienced more intense pain (VAS). Women and less-advanced patients scored better in several aspects of quality of life. (4) Conclusions: Patients treated with DART struggle with low quality of life and persistent treatment-related symptoms including constant pain. HNC survivors, especially those who are depressed, may require additional psychosocial, rehabilitation and medical intervention programmes. Full article