Search Results (128)

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

Background: Scapular body fractures, when significantly displaced or malunited, can cause glenohumeral discomfort and functional disability. This study compares single- and dual-plating techniques in terms of pain, function, and active range of motion (aROM) in patients with scapular body fractures. Methods: Twenty-eight patients with scapular fractures were retrospectively analyzed, with sixteen undergoing single plating treatment and twelve dual plating treatment. The mean age was 44.9 years, and the mean follow-up was 14 months for single plating and 13.8 months for dual plating. Outcomes included Disabilities of the Arm, Shoulder and Hand (DASH) scores, the Visual Analog Scale (VAS) for pain, aROM measurements, and the time to return to work. Functional outcomes were assessed using two-way ANOVA with Šidák’s multiple comparisons test at 2 weeks, 4 weeks, 3 months, 6 months, and 1 year. The time to return to work was analyzed with survival analysis and a log-rank test. Results: The single plating group had higher DASH scores than the dual plating group at 2 weeks (44.88 ± 10.81 vs. 32.75 ± 6.05, p = 0.005), 4 weeks (28.50 ± 5.91 vs. 22.83 ± 4.24, p = 0.033), and 3 months (19.63 ± 2.45 vs. 16.00 ± 2.45, p = 0.004), indicating greater disability. VAS scores were also higher in the single plating group at 2 weeks (4.00 ± 1.21 vs. 2.33 ± 0.88, p = 0.002) and 4 weeks (2.50 ± 1.03 vs. 1.17 ± 0.94, p = 0.008), suggesting faster pain relief in the dual plating group. However, differences were no longer significant after 3 months. At 1 year, the dual plating group demonstrated better external rotation (73 ± 3° vs. 63 ± 5°, p = 0.032), with no significant differences in internal rotation, abduction, or forward flexion. Dual plating patients returned to work earlier (Hazard Ratio = 3.346, 95% CI: 1.208 to 9.269, p = 0.020). Conclusions: In the current cohort, dual plating for scapular fractures offers superior early pain relief and functional outcomes compared to single plating, along with better external rotation at 1 year and an earlier return to work. These findings suggest that dual plating may facilitate faster recovery and enhanced active range of motion in selected patients, a hypothesis that warrants further investigation through future randomized trials. Full article

Background and Objectives: Lymphedema is one of the most important morbid complications of modified radical mastectomy (MRM) surgery. It can cause limb movement restriction and psychosocial deformities in some patients. This study aimed to determine and compare the physiological and pathological changes that develop in the axillary venous structures in patients who underwent axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB). Materials and Methods: Patients diagnosed with breast cancer who underwent MRM and breast-conserving surgery (BCS) plus SLNB between 2017 and 2022 were retrospectively examined. The patients’ operation side and contralateral axillary vein diameter and the difference between them, axillary vein flow rate and the difference between them, axillary vein wall thickness and the difference between them, severity of lymphedema, extremity joint restriction examination, and the Nottingham Health Profile (NHP) data were recorded. The relationship of these parameters with the lymph node dissection width and radiotherapy was analyzed. Results: Fifty-eight patients in total were included in the study. In the distribution of lymphedema and lymphedema severity according to ALND groups, there is a statistically significant difference (p < 0.001). A statistically significant difference was determined in the distribution of the difference in the axillary vein blood flow rate and axillary vein diameter difference between the two arms according to the lymph node dissection groups. In the distribution of physical therapy and rehabilitation scales according to the lymph node dissection groups, a significant difference was found in the disabilities of the arm, shoulder, and hand (DASH), shoulder flexion restriction variables, and NHP sleep variables (all p < 0.001). Conclusions: This study demonstrated that ALND leads to more pronounced physiological and pathological changes in axillary venous structures—including increased vein wall thickness, altered flow rates, and diameter differences—compared to SLNB combined with breast-conserving surgery. These changes may be attributed to lymphovenous disruption and postoperative edema. Furthermore, radiotherapy appears to contribute to these changes, though to a lesser extent than ALND. Therefore, SLNB followed by radiotherapy may be preferable in eligible patients to reduce postoperative complications such as lymphedema, joint restriction, and sleep disturbances. Full article

Objectives: The aims of the presented study were to investigate and compare the effectiveness of Low-Level Laser Therapy (LLLT) and therapeutic ultrasound (US) on pain, function, emotional status, and sleep disturbances in patients with rotator cuff tendinopathy (RCT). Method: A total of 84 patients with RCT were included in the study and randomly divided into the US group (n = 42) and the LLLT group (n = 42). Hot-pack, transcutaneous electrical nerve stimulation, and a home-based exercise program were also administered to patients in each group. The patients were evaluated at baseline, and at 1st, 4th, and 12th weeks after treatment by Visual Analog Scale (VAS), Shoulder Pain and Disability Index (SPADI), Constant Murley Score (CMS), Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), Hand Grip Strength (HGS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Pittsburgh Sleep Quality Index (PSQI), and Short Form-36 (SF-36). Results: Significant improvements in VAS, SPADI, CMS, DASH, BDI, BAI, PSQI, and SF-36 scores were observed over time in both groups (p < 0.05 for all). The improvements in HGS scores were significantly greater in the US group compared to the LLLT group (p < 0.05 for all). There were no statistically significant differences between the groups in VAS, SPADI, CMS, DASH, BDI, BAI, PSQI, and SF-36 scores at each time point (p > 0.05 for all). Conclusions: Both therapeutic US and LLLT are effective and safe in the treatment of patients with RCT. However, our findings indicate no superiority of one treatment over the other in terms of pain relief or improvements in function, emotional status, sleep disturbances, or quality of life. Full article

Distal radius fractures (DRFs) constitute one of the most prevalent injuries in adults. This study compares the clinical and radiological outcomes of intra- and extra-articular DRFs treated with percutaneous Kirschner wires (PKW) or volar locking plates (VLP). Materials and Methods: A retrospective analysis was conducted on 42 patients (aged 18 to 85) treated between 2017 and 2019 with a minimum follow-up of five years. Outcomes were assessed using radiographic parameters and validated clinical scoring systems such as Disabilities of the Arm, Shoulder, and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), and Mayo Wrist Score (MAYO). Results: Clinical outcomes were better in the VLP group but not statistically significant (p > 0.05). For extra-articular fractures, DASH were 1.5 (VLP) vs. 6.4 (PKW) (p = 0.5007), PRWE were 1.3 (VLP) vs. 2.9 (PKW) (p = 0.4049), and MAYO were 95 (VLP) vs. 86.1 (PKW) (p = 0.2406). For intra-articular fractures, DASH were 6.6 (VLP) vs. 19.7 (PKW) (p = 0.0981), PRWE 12.9 (VLP) vs. 21.1 (PKW) (p = 0.3661), and MAYO 78.9 (VLP) vs. 72.2 (PKW) (p = 0.4503). Conclusions: PKW and VLP showed satisfactory long-term outcomes. VLP fixation allowed better short-term recovery and anatomical restoration, but long-term functional outcomes were comparable. Full article

Background/Objectives: Distal radius fractures (DRFs) are among the most common fractures in the elderly, with increasing incidence due to population aging. Recent evidence questions the benefits of operative treatment, particularly in elderly patients. The present study aimed to assess post-traumatic osteoarthritis (OA) and patient-reported outcome measures (PROMs) after a minimum of two years of follow-up of the previously published VOLCON randomized controlled trial (RCT), which compared operative and non-operative treatments of unstable DRFs in patients aged ≥ 65 years. Methods: This study presents a minimum two-year follow-up of a single-center, assessor-blinded RCT. A total of 100 patients with unstable DRFs were randomized to either operative treatment with volar locking plating or non-operative treatment with cast immobilization. The primary outcome was post-traumatic OA, assessed using the Knirk and Jupiter classification. Secondary outcomes included PROMs (Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH)) and Patient-Rated Wrist/Hand Evaluation (PRWHE), complications, pain, grip strength, and range of motion (ROM). Statistical analyses were performed using two-way ANOVA. Results: After a median follow-up of 3.0 years, 60 patients (28 non-operative and 32 operative) were available for analysis. There was no significant difference in OA between the groups (p = 0.57). PROMs (Quick-DASH, PRWHE), pain, grip strength, and ROM were time-dependent (p < 0.001) but not treatment-dependent. Complications were more frequent in the operative group, including hardware-related issues requiring reoperation. Conclusions: At a minimum of two years of follow-up, no correlation was found between treatment choice and post-traumatic OA. Functional outcomes were similar between groups, suggesting that non-operative treatment remains a viable option for elderly patients with unstable DRFs. Full article

Background and Objectives: Lateral epicondylitis, commonly known as tennis elbow, is a prevalent condition characterized by pain and tenderness over the lateral epicondyle. Various treatment options, including corticosteroids, platelet-rich plasma (PRP), and saline injections, are utilized, yet their comparative efficacy remains unclear. Hypothesis: This study hypothesizes that PRP injections result in superior functional and clinical outcomes compared to corticosteroid and saline treatments, as assessed by clinical scoring systems and radiological findings. Materials and Methods: The study enrolled patients aged 18 years and older with pain and tenderness over the lateral epicondyle persisting for at least three months and no prior treatment. Patients with comorbidities affecting the upper extremity were excluded. Fifty-five elbows from 50 patients were randomized into three groups (glucocorticoid, PRP, and saline). Functional outcomes were assessed using the Visual Analog Scale (VAS), Patient-Rated Tennis Elbow Evaluation (PRTEE), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Radiological evaluations included vascularity and superb microvascular imaging (SMI) indices via ultrasonography before injection and three months post-injection. Results: Fourteen patients were lost to follow-up, leaving 36 patients (36 elbows, 16 males and 20 females; mean age 42.4 ± 6.15 years) for analysis. The glucocorticoid group included 13 elbows, PRP group 14 elbows, and saline group 14 elbows. Baseline functional and radiological scores were similar across groups. At three months, PRP and glucocorticoid groups showed no significant differences in VAS scores (p = 0.7), but PRP outperformed both of the other groups in DASH and PRTEE scores, with the saline group performing the worst (p < 0.001). PRP consistently achieved the best outcomes at both three and six months. Radiological assessments revealed no significant group differences in vascularity or SMI indices (p = 0.3 and p = 0.2, respectively). Conclusions: PRP treatment demonstrated superior functional outcomes in early and mid-term evaluations compared to glucocorticoid and saline. However, ultrasonographic measures of vascularity and SMI did not correlate with functional outcomes. Clinical Relevance: PRP offers a promising treatment option for lateral epicondylitis, with superior functional improvements over other commonly used injections. Radiological assessments of vascularity and SMI may not reliably predict clinical outcomes. Full article

Background: Syndactyly, the congenital fusion of digits, compromises hand function and esthetics. Although surgical separation is the standard treatment, the optimal timing of the intervention remains controversial. Methods: We prospectively analyzed 20 pediatric patients (86 operated fingers) undergoing syndactyly repair, comparing early (≤24 months) versus delayed (>24 months) surgery. Outcome measures included range of motion (ROM) at the metacarpophalangeal (MP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints; complications (synostosis, nail deformities, finger length disparity, webbing); and patient-reported outcomes assessed by the Disabilities of the Arm, Shoulder, and Hand (DASH) and overall esthetic satisfaction scores. Results: The median age at surgery was 31 months (IQR25/75: 24.75–36.5), with a median follow-up of 72 months (IQR25/75: 42.0–86.25). Notably, digits III (28.24%) and IV (29.41%) were predominantly affected. Delayed surgery resulted in significantly improved MP ROM (90.98° ± 8.44° vs. 73.13° ± 22.37°, p = 0.004) and DIP ROM (76.28° ± 22.24° vs. 67.19° ± 22.78°, p = 0.028), with a non-significant trend toward better PIP ROM (93.00° ± 25.18° vs. 77.37° ± 30.29°, p = 0.075). Furthermore, the incidence of synostosis was markedly reduced in the delayed surgery group (6.0% vs. 38.9%, p = 0.001). Despite superior joint function associated with delayed intervention, early surgery patients reported higher satisfaction with cosmetic results (3.00 vs. 2.80, p = 0.028), while the DASH scores remained comparably low between groups (0.00 vs. 0.24, p = 0.141). Finger length disparities and webbing were minimal. Conclusions: Our study challenges the conventional advocacy for early syndactyly repair, by demonstrating that delaying surgery beyond 24 months significantly enhances joint mobility and reduces the synostosis rate. However, the higher satisfaction observed as a result of early intervention suggests that surgical timing should be individualized for affected fingers, joints, and severities to balance the functional and cosmetic outcomes. Further studies are needed to define the optimal surgical timing and techniques for pediatric syndactyly. Full article

Background: Optimal treatment for high-grade acromioclavicular (AC) joint dislocations is still not unanimous. Improving horizontal AC stability has been emphasized in recent years. Biomechanical studies and computer simulations have demonstrated that adequate horizontal stability could be restored with an additional AC fixation. We aim to prospectively investigate if AC augmentation leads to better clinical and radiological results. Methods: A total of 70 patients with a mean (± SD) age of 42 ± 11 years with acute AC joint dislocation Rockwood type IIIb and V were prospectively randomized into two equal groups. All patients underwent arthroscopically assisted stabilization using a double coracoclavicular (CC) suspensory system. Group N (No-augmentation group) had no additional fixation across the AC joint, while group T (tape-augmentation group) had additional fixation with tape. Patients were evaluated at 3, 6, and 12 months postoperatively. Primary clinical outcome measures included the Constant–Murley score and the Specific AC Score (SACS). Secondary outcome measures included the Subjective Shoulder Value (SSV), the Simple Shoulder Test (SST), the Disabilities of the Arm, Shoulder, and Hand (DASH) outcome measure, and the AC Joint Instability (ACJI) Score. Horizontal stability was radiologically measured with overlapping length (OL) and overlapping area (OA). Vertical alignment was measured with the CC distance. All radiological measurements were compared to the uninjured side and expressed in percentages as relative values. Results: There were no significant differences found between groups regarding the Constant score (p = 0.664), SACS (p = 0.518), or any other outcome measure at the one-year follow-up. Pain level (p = 0.635) and strength (p = 0.217) at the one-year mark also showed no significant differences. Clinical drawer testing for residual horizontal instability was non-significant (p = 0.061), but showed a tendency for a more stable AC joint in group T. The CC distance was smaller in group T at 6 and 12 months (p = 0.047 and p = 0.046, respectively). A two-way mixed factorial ANOVA test showed significantly lower CC differences for group T (p = 0.032); however, the gradual increase in CC distance was similar for both groups over time (p = 0.869). No significant differences were found in OL (p = 0.619) or OA (p = 0.236). Conclusions: The results of our study show that both CC stabilization with the double suspensory system alone and with additional AC fixation are effective surgical treatment options for acute AC joint dislocations, without any important clinical differences. CC distance similarly increased over one year in both groups but was better retained in the AC-augmented group, which showed a tendency toward a more stable fixation. Full article

Objectives: Metal anchors (MA), commonly used in the early stages of rotator cuff surgical treatment development, are associated with a high risk of complications, especially in osteoporotic bone. As an alternative to rigid anchors, all-suture anchors (ASA) have been introduced for the medial row, offering promising clinical outcomes and favorable biomechanical studies. We aimed to compare the clinical outcomes of MAs and ASAs in either single-row or in medial-row suture bridge techniques in arthroscopic rotator cuff repair. Our hypothesis was that in cases where ASA was used for at least 12 months of follow-up, more favorable results would be obtained as compared to rigid anchors, and intraoperative complications such as anchor pullout would be encountered less. Methods: In this retrospective cohort analysis, we reviewed patients who underwent arthroscopic rotator cuff repair between January 2020 and December 2022. Surgeries were performed by two senior surgeons in a single tertiary center. Patients who had undergone revision surgery, had a history of previous shoulder surgeries, had massive rotator cuff tears, and partial-thickness tears; or had concomitant subscapularis tears were excluded. Preoperative and postoperative scores, including Constant–Murley (CM), Disabilities of the Arm, Shoulder, and Hand (DASH), and visual analog scale (VAS), were compared. The minimum follow-up period was 12 months. Clinical assessment of shoulder range of motion included forward flexion, abduction, internal rotation, and external rotation. Intraoperative anchor-related complications were compared. All patients underwent the same surgical technique and postoperative rehabilitation protocol. Results: A total of 142 patients (89 females, 53 males; mean age: 57.4 years) were included in the study, with 67 patients in the ASA group and 75 in the MA group. The sex distribution and mean age were similar between groups. The ASA group had 15 traumatic tears, while the MA group had 13 (p < 0.05). The mean follow-up period was 21.6 months (range 12–40 months). Preoperative CM scores were statistically better in the ASA group, but this difference was not clinically relevant (p < 0.046). The mean CM score was 75.64, the mean DASH score was 8.57, and the mean VAS was 1.38 at the postoperative period in the MA group. The mean CM score was 78.40, the mean DASH score was 9.75, and VAS was 1.59 at the postoperative period in the ASA group. Seven cases experienced anchor pullout in the MA group, and thread breakage occurred in one patient of each group (p = 0.014). The mean age of the patients with anchor pullout was significantly higher (p = 0.002). This finding was not hypothesized in the initial study design but emerged during post-hoc analysis and highlights the importance of considering bone quality in elderly patients. Conclusions: The clinical outcomes of rotator cuff repairs using all-suture anchors or metal anchors are comparable. However, ASA use may offer an advantage in elderly patients by reducing the risk of anchor pullout. Further studies assessing tendon integrity and bone quality and incorporating long-term follow-up periods are recommended to support and validate the present findings. Full article

Trapeziometacarpal joint osteoarthritis (TMJ OA) is a progressive condition, particularly affecting postmenopausal women. Various surgical techniques have been proposed, but the optimal approach remains debated. This clinical study compares the clinical, functional, and radiological outcomes of two surgical treatments: suspension tenoplasty using the flexor carpi radialis tendon (Altissimi technique, AST) and a dual-mobility prosthesis. The main complications associated with these procedures include postoperative pain, De Quervain’s syndrome, radial nerve injuries, and prosthetic component mobilization. In prosthetic arthroplasty, the most common complication is component mobilization (8%), while in tenoplasty, postoperative pain is the most frequent (15%). A total of 36 patients were randomized into two groups: 18 patients underwent AST (Group A), and 18 received trapeziometacarpal joint arthroplasty (Group B). Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH), Visual Analogue Score (VAS), and Michigan Hand Outcomes Questionnaire (MHQ) at 3, 6, 12, and 24 months. Range of motion (ROM), Kapandji score, pulp pinch strength, hand grip strength (Jamar dynamometer), and radiological maintenance of the trapezial space (step-off measurement) were also evaluated. Both procedures resulted in significant pain reduction (VAS, p < 0.05) and functional improvement (DASH, MHQ, p < 0.05). ROM increased significantly in both groups. The Kapandji scores improved from 4.0 ± 1.1 to 9.2 ± 1.2 (Group A) and 4.3 ± 0.8 to 7.8 ± 1.4 (Group B) (p < 0.05). Group B grip strength results showed a greater increase in hand grip strength than Group A (p = 0.23). The radiographic step-off showed slight proximal migration of the first metacarpal in Group A, whereas Group B maintained joint height. No implant loosening or major complications were reported in either group. Both suspension tenoplasty and dual-mobility arthroplasty are effective in TMJ OA. AST ensures joint stability with minimal radiographic changes, whereas TJA provides superior grip strength and ROM recovery. The absence of major complications suggests that TJA is a safe alternative to AST, but its higher cost and potential for implant-related complications must be considered. Full article

Background/Objectives: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and various surgical techniques are used for its treatment. Extended open carpal tunnel release (EOCTR) has been proposed for improved nerve decompression. This study compares the clinical and functional outcomes of open carpal tunnel release (OCTR) and EOCTR in severe CTS, hypothesizing superior functional outcomes and lower pain levels with EOCTR. Methods: This retrospective study included 53 patients (45 females, 8 males) with severe CTS confirmed by electromyography. Patients underwent either OCTR (n = 28) or EOCTR (n = 25) between January 2020 and February 2023. The EOCTR techinque involved additional neurolysis of the recurrent motor branch and palmar cutaneous branch of the median nerve. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), the Visual Analog Scale (VAS) for pain, and hand strength measurements. Complications and recovery parameters were also analyzed. Results: EOCTR resulted in significantly lower postoperative VAS scores (3.31 vs. 3.78, p < 0.001), DASH scores (16.54 vs. 20.68, p < 0.001), and BCTQ symptom scores (1.87 vs. 2.01, p < 0.001). No significant differences were found in grip strength (p = 0.52) or pinch strength (tip-to-tip: p = 0.54, lateral: p = 0.061, 3-point: p = 0.17). No major complications occurred, and pillar pain was similar in both groups (p = 0.82), resolving with conservative treatment. Conclusions: EOCTR with additional palmar cutaneous branch of the median nerve neurolysis may provide better short-term functional outcomes and lower pain levels compared to OCTR in severe CTS. Further prospective studies are needed to validate the long-term benefits and safety of this surgical approach. Full article

Background/Objectives: Various surgical methods have been proposed for the treatment of comminuted Mason III/IV radial head fractures. In particular, the advantages and disadvantages between prosthesis implantation (RHA) or radial head resection (RHR) are not sufficiently quantified in the current literature. Methods: A systematic literature search was conducted using PubMed Web of Science, Cochrane Library, and Embase in February 2024. Studies conducted on patients with Mason type III or IV radial head fractures and studies relating to surgical methods, including radial head resection or Radial head prosthesis implantation, were included. The two methods were evaluated in terms of clinical and functional results through the DASH score (Disability of the arm, shoulder, and hand), Mayo Elbow Performance Index (MEPI), and flexion-extension range of motion. The onset of osteoarthritis and complications were also assessed. Risk of bias and quality of evidence were assessed using Cochrane guidelines. Results: A total of 345 articles were evaluated and, of these, 21 were included in the study for a total of 552 patients. The results of the meta-analysis showed no significant differences in favor of RHA or RHR in terms of Mayo Elbow Performance (p = 0.58), degrees of flexion (p = 0.689), degrees of extension deficit (p = 0.697), and overall incidence of complications (p = 0.389), while it highlighted a statistically significant difference in terms of DASH score (19.2 vs. 16.2, respectively; p = 0.008) and subjects who developed osteoarthritis (13.4% vs. 47.3%, respectively; p = 0.046). Conclusions: The results of this meta-analysis confirm that both surgical methods provide good functional outcomes, with no significant differences in MEPI, DASH, and range of motion. However, a higher incidence of post-traumatic osteoarthritis was observed in patients undergoing RHR. Additionally, RHR patients exhibited slightly worse functional outcomes in the DASH score; however, this difference is not substantial enough to be considered clinically significant. These findings suggest that while both techniques are viable, RHA may be preferable in patients at higher risk of joint degeneration and instability, and the choice of treatment should be tailored to individual patient characteristics. Full article

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

Background/Objectives: Many patients with neck pain have upper limb disorders, and prolonged use of computers at work commonly induces neck/shoulder pain. The purpose of this study was to investigate the psychometric properties of the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) in patients with neck pain. Methods: A total of 189 patients with neck pain were included in acceptability, reliability, validity, and responsiveness studies. The floor and ceiling effects were used for assessing acceptability. The internal reliability and test–retest reliability were used for assessing reliabilities. The construct validities (convergent/divergent validity and exploratory/confirmatory factor analyses) were used for assessing validity. The effect size (ES) and standardized response mean (SRM) were used for assessing responsiveness. Results: The QuickDASH had a slight floor effect (16.4%). For reliability, the internal consistency (Cα= 0.945) and test–retest reliability (ICC = 0.98; SEM = 3.17, and MDC = 8.79) were excellent. For validity, the convergent and divergent validities were satisfactory. Exploratory factor analysis revealed two factors of the QuickDASH (function factor and symptom factor), and confirmatory factor analysis confirmed the two-factor model. Responsiveness was supported by the high ES (0.85) and SRM (0.82). Conclusions: The QuickDASH is a reliable, valid, and responsive instrument for assessing upper limb disorders in patients with neck pain. Full article