Search Results (900)

Objective: Inferior alveolar (IAN) and lingual nerve (LN) injuries are known complications of impacted mandibular third molar surgery and may result in persistent neurosensory deficits. This exploratory, non-randomized clinical study evaluated the clinical and electrophysiological effects of low-level laser therapy (LLLT) and transcutaneous electrical nerve stimulation (TENS) on neurosensory recovery following trigeminal nerve injury. Methods: Twenty-seven patients with postoperative IAN or LN injury received LLLT, TENS, or placebo therapy according to institutional clinical protocols. Clinical outcomes were assessed using Visual Analog Scale (VAS) scores, and electrophysiological evaluation was performed using electromyography by measuring cutaneous silent period (CSP) duration. Non-parametric statistical analyses were conducted using the Wilcoxon signed-rank and Mann–Whitney U tests. Results: LLLT was associated with statistically significant improvements in several neurosensory symptoms, including pain, burning sensation, speech difficulty, biting, and taste disturbance. In contrast, TENS and placebo treatment did not demonstrate a consistent or generalized improvement across neurosensory outcomes. CSP durations differed significantly between healthy and pathological sides both before and after treatment. Although CSP duration showed a tendency to increase following LLLT, these changes did not reach statistical significance. Subgroup analysis revealed greater clinical improvement in LN injuries compared with IAN injuries within the LLLT group. Conclusions: Within the limitations of this exploratory study, LLLT was associated with more pronounced clinical improvement than TENS or placebo in patients with third molar-related trigeminal nerve injury. CSP measurements provided supportive objective information, although electrophysiological recovery remained limited. Full article

Objectives: This study aimed to investigate the impact of scrotal pain on venous diameter and reflux duration in varicocele, and to assess the predictive value of ultrasonographic findings for varicocele grading. Methods: Fifty-two symptomatic patients with left-sided varicocele, presenting with infertility or scrotal pain, were prospectively evaluated. Grading was based on physical examination. Visual Analog Scale (VAS) scores, venous diameters, and reflux durations were measured using scrotal color Doppler ultrasonography (CDUS) both during active pain and after pain had markedly subsided or resolved. Results: After pain resolution, venous diameters significantly decreased in both resting and Valsalva states (p < 0.001). In grade-specific analysis, this reduction was significant only in grade II varicocele (rest: p = 0.004; Valsalva: p = 0.026). Reflux durations also significantly decreased after pain relief in all varicocele grades, both at rest and during Valsalva (p < 0.001 for all, except G3 Valsalva: p = 0.001). Ultrasonographic parameters during the pain-present state showed better discrimination for detecting grade I varicocele (AUC: 0.88), while the pain-free state provided better diagnostic accuracy for grade III varicocele (AUC: 0.69). Combining measurements from both conditions further improved predictive accuracy, especially for grade III varicocele (AUC: 0.77). Conclusions: Scrotal pain significantly influences scrotal CDUS findings in patients with varicocele, leading to measurable differences in venous diameter and reflux duration between pain-present and pain-free states. Therefore, consideration of symptom status when interpreting scrotal CDUS results may improve diagnostic accuracy and support more informed clinical decision-making. Full article

Background: Spasticity is a complex and multifactorial condition resulting from upper motor neuron injury. It manifests through muscle contractions, pain, limited range of motion, and clonus, which significantly impair daily activities and quality of life. High-frequency spinal cord stimulation (HF SCS) has shown optimal results in treating chronic neuropathic pain, but its potential role in spasticity remains underexplored. This study aimed to evaluate the efficacy of HF SCS in patients with spasticity. Methods: From April 2021 to July 2024, six patients with spasticity from various etiologies underwent SCS implantation at our institution. Clinical evaluations including the use of the Visual Analog Scale (VAS), Douleur Neuropathique 4 (DN4), and the Ashworth score, as well as ambulation ability and clonus episodes, were performed preoperatively and at a minimum of six months post-surgery. Subjective assessments of motor function, including coordination, movement efficiency, and postural transitions, were also recorded. Results: The mean age of patients was 50.12 ± 9.41 years, with follow-up averaging 24.32 ± 10.83 months. Statistically significant improvements were observed in VAS (p = 0.0412) and DN4 (p = 0.0422) scores, alongside a reduction in clonus episodes. All patients reported subjective improvements in coordination, movement efficiency, and postural transitions. Ambulation remained stable or improved in all cases. No perioperative complications or sensory/motor side effects were noted. Conclusions: HF SCS offers a promising approach to managing spasticity, with improvements in motor function, ambulation, and postural transitions. These findings support further investigation into HF SCS for spasticity, with multicenter trials needed to optimize treatment protocols and identify the most responsive patient populations. Full article

Background/Objectives: Following lumbar fusion procedures, adjacent segment degeneration (ASD) at cranial levels presents as a well-documented long-term complication, manifesting through recurrent pain, neurological deficits, and progressive functional decline. The prone single-position technique for lateral lumbar interbody fusion (PSP-LLIF) streamlines surgical workflow by eliminating the need for intraoperative patient repositioning; however, comprehensive evidence supporting its clinical and radiological effectiveness in managing cranial ASD remains insufficient. Material and Methods: This retrospective cohort study examined 30 consecutive patients presenting with symptomatic cranial adjacent segment disease who were treated with PSP-LLIF at a single institution. Patient-reported outcome measures included visual analog scale (VAS) assessments for axial and radicular pain, alongside the Oswestry Disability Index (ODI) for functional status evaluation. Radiological parameters included overall and segmental lumbar lordotic measurements, anterior and posterior disk height, fusion status, and instrumentation-related complications. Results: At 12-month postoperative evaluation, substantial clinical improvements were demonstrated. Mean VAS reductions measured 4.7 points for axial pain and 6.5 points for radicular pain, while ODI decreased by 28.5 points (p < 0.05). Radiological assessment demonstrated mean increases of 6.3° in lumbar lordosis and 5.1° in segmental lordosis, along with significant gains in both anterior and posterior disk height (p < 0.05). Solid fusion was radiographically confirmed at all instrumented levels. Temporary postoperative neurological symptoms developed in several patients but resolved spontaneously without requiring revision surgery. Conclusions: PSP-LLIF yields substantial clinical benefit and reliable radiological correction in patients with symptomatic cranial ASD. Optimal outcomes necessitate rigorous adherence to position-specific technical modifications, particularly maintenance of perpendicular fluoroscopic trajectories and implementation of continuous neural monitoring to account for prone-induced anatomical shifts. This approach represents a viable treatment strategy for patients with symptomatic cranial ASD. Full article

Objectives: Frozen shoulder (FS) leads to pain, reduced shoulder function, and deficits in postural stability and sensorimotor control during upper-limb weight-bearing and activities of daily living tasks. This study investigated how an eight-week Dynamic Neuromuscular Stabilization (DNS) program affected Center of Pressure (COP) control and pain in midlife women with FS. Methods: Twenty-two midlife women with FS were randomly assigned to a DNS group (DNSG, n = 11) or a control group (CG, n = 11). The DNSG performed DNS exercises twice weekly for eight weeks, while the CG performed a dynamic stretching–based active control program. COP variables (distance, velocity, and root mean square (RMS) in the anterior–posterior (AP) and medial–lateral (ML) directions) were measured using a force platform under affected-side single-hand support with visual input and bilateral hand support with and without visual input. Pain was assessed using the Visual Analog Scale (VAS). All variables were analyzed using a two-way mixed ANOVA. Results: Under the affected-side single-hand support condition, a significant group × time interaction was observed for the prespecified primary outcome, ML-RMS (p < 0.05). Other COP variables under this condition were not significant after Holm–Bonferroni correction. Under bilateral hand-support conditions, ML-RMS remained significant after multiplicity adjustment in both visual conditions (p < 0.05). Pain (VAS) decreased over time in both groups, with no significant group × time interaction observed. Conclusions: The DNS intervention was associated with positive changes in COP-based postural control during upper-limb weight-bearing tasks in midlife women with FS. Pain decreased over time in both groups, with no significant group-by-time interaction. These findings suggest that DNS may be a potentially useful intervention for improving postural stability during upper-limb support tasks in patients with FS. Full article

Background and Objectives: Coracoid process (CP) fractures combined with acromioclavicular (AC) joint dislocation are extremely rare, and evidence guiding optimal surgical management remains limited. This retrospective, single-center case series study evaluated clinical and radiologic outcomes after simultaneous fixation of both lesions using a clavicular hook plate and a coracoid screw. Materials and Methods: We retrospectively reviewed 15 consecutive patients with Ogawa type I CP fractures combined with AC joint dislocation who underwent clavicular hook plate and coracoid screw fixation between March 2019 and May 2024. Clinical outcomes at final follow-up included shoulder range of motion (ROM), visual analog scale (VAS) for pain, and the Constant score. Radiologic outcomes included CP union confirmed by computed tomography (CT) and residual AC joint subluxation. Results: The cohort comprised 13 men and 2 women with a mean age of 55.2 years, and the mean final follow-up was 40.2 months. At final follow-up, mean ROM was 168° for forward elevation, 161° for abduction, and 69° for external rotation at the side, with internal rotation to L1. The mean VAS score was 0.4 and the mean Constant score was 97. CT-confirmed union of the CP fracture was achieved in all patients, and no residual AC joint subluxation was observed. All patients returned to sports and activities of daily living. Conclusions: In this series, simultaneous fixation using a clavicular hook plate and a coracoid screw provided reliable stabilization for CP fractures with AC joint dislocation, achieving consistent CP union, restoration of AC joint alignment, and favorable clinical outcomes. However, given the retrospective, non-comparative study design, these findings should be interpreted with caution, and further comparative studies are warranted. Full article

Background and Objectives: Long COVID-19 (LC) is a multifaceted condition characterized by persistent fatigue and impaired health-related quality of life (HRQoL). Exercise intolerance and post-exertional symptom exacerbation (PESE) pose challenges for rehabilitation. This study aimed to evaluate the effects of a 12-week core-focused plank exercise program on fatigue and HRQoL in women with LC, using validated patient-reported measures. Materials and Methods: A pilot quasi-experimental design was implemented, with non-randomized group allocation. Thirty-nine women with LC were recruited from the Madrid Long COVID Association. Participants were assigned to either an intervention group (n = 20), which completed a supervised plank-based motor control program, or a control group (n = 19), which maintained usual activity. Fatigue was assessed using the Modified Fatigue Impact Scale (MFIS), and HRQoL was measured using the EQ-5D-5L and EQ Visual Analog Scale (EQ-VAS). Body composition was evaluated via bioelectrical impedance analysis. Results: The intervention group showed significant reductions after intervention in the MFIS total scores compared to the control group, particularly in the physical (21.26 ± 6.76 vs. 25.21 ± 6.06; p < 0.001) and psychosocial domains (4.51 ± 0.41 vs. 5.21 ± 0.38; p < 0.001), without triggering PESE. EQ-VAS scores improved significantly (63.94 ± 15.33 vs. 46.31 ± 14.74; p = 0.034). No significant changes were found in body composition parameters, suggesting that benefits were driven by neuromuscular adaptations rather than morphological changes. Conclusions: A core-focused, non-aerobic exercise program effectively reduced fatigue and improved perceived health status in women with LC. These findings support the use of motor control-based interventions as a safe and feasible strategy for LC rehabilitation, particularly in populations vulnerable to PESE, suggesting clinical applicability for the rehabilitation of women with LC. Further randomized trials are warranted to confirm these results and explore long-term outcomes. Full article

Background: Gamification is a promising approach to support rehabilitation, but implementing new devices after hand surgery (HS) faces challenges, especially in patient motivation and compliance. Technology-based, personalized solutions may encourage patients to perform gamified exercises consistently. This study investigated the impact of a tablet-based gamified hand-mobilization system on functional outcomes after HS compared to standard finger-expander training. Methods: Forty inpatients at BG Klinikum Duisburg were randomly assigned to a gamified or control group. Both groups underwent four weeks of stationary rehabilitation. Outcomes were assessed using the Disabilities of Arm, Shoulder, and Hand questionnaire (DASH), SF-36 health-related quality of life, and a visual analog scale (VAS) at pre- (T0) and post-training (T1). Tablet use frequency and duration were recorded. Results: DASH scores improved significantly over time (F(1.55, 58.85) = 16.36, p < 0.001, partial η² = 0.137) with no Group or Time × Group effects (p > 0.40), exceeding the MCID in both groups. SF-36 MCS, PCS, and VAS pain also improved over time (all p < 0.05) with no between-group differences (p > 0.40). Exercise duration differed (p = 0.007), but training frequency did not. Conclusions: Both gamified and conventional rehabilitation programs led to clinically meaningful improvements in hand function after hand surgery. No significant differences were observed between groups, indicating that the tablet-based system was feasible and well-accepted but not superior to standard training. Full article

Background: This retrospective study evaluated the association between the number of intra-articular ozone injection sessions and clinical outcomes in patients with hip osteoarthritis (OA). Methods: Data from 54 patients (65 hips) with Tönnis grade 1–2 hip OA treated at a tertiary algology clinic between 2022 and 2024 were analyzed. Patients were categorized into three groups based on the number of ozone sessions received (1, 2, or 3). Pain and functional status were assessed using the Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index at baseline and at 4, 12, and 24 weeks post-procedure.Results: All groups demonstrated significant improvements in VAS and WOMAC scores compared to baseline (p < 0.001). Although the three-session group showed more pronounced numerical improvements in both early and late follow-ups, intergroup differences did not consistently reach statistical significance across all time points.Conclusions: Intra-articular ozone application is associated with favorable clinical trends in pain reduction and functional recovery. Our findings suggest that a three-session regimen may provide more pronounced clinical improvement compared to fewer sessions. These findings warrant validation through rigorous, randomized controlled trials. Full article

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disorder. Revodiol Calming Cream^® (RCC) is a novel dermocosmetic product containing cannabidiol (CBD) and Annona cherimola fruit extract, designed for the management of atopic-prone and sensitive skin. Objective: Clinically assess the efficacy and safety of RCC in the management of atopic-prone and/or sensitive skin. Materials and methods: A prospective study included 20 adults and 22 children with mild-to-moderate atopic-prone skin. RCC was applied daily, for 56 days. Clinical evaluation included the SCORAD index, pruritus and dryness scales; and a Visual Analog Scale (VAS). Biometric assessments (Mexameter^®, Tewameter^®, Visioscan^®, Corneofix^®) were performed. Subjective satisfaction and quality of life (DLQI) were also recorded. Results: RCC was well tolerated, with no significant adverse events. After 56 days, SCORAD scores decreased by 55% in adults and 60% in children. Pruritus and dryness were significantly reduced, and VAS scores indicated a 65% decrease in discomfort. Biometric assessments demonstrated improvements in erythema, skin barrier function, topography, and desquamation. Subjective satisfaction reached 75% in both populations, and DLQI improved by 23%. Conclusions: The synergistic combination of CBD, Annona cherimola extract, and natural humectants offers a safe and effective daily dermocosmetic care for both adults and children. Full article

Background: Plantar fasciitis is a prevalent musculoskeletal disease characterized by heel pain and functional impairment. Both high-intensity laser therapy (HILT) and extracorporeal shockwave therapy (ESWT) have demonstrated efficacy in managing plantar fasciitis; however, their relative effectiveness remains unclear. Purpose: This systematic review and meta-analysis aimed to compare the effects of HILT and ESWT for treating plantar fasciitis. Methods: A comprehensive literature search of PubMed, the Cochrane Library, EMBASE, and Scopus was conducted from inception to 13 July 2025 to identify randomized controlled trials (RCTs) investigating both interventions. Two reviewers independently extracted data and assessed the methodological quality of the trials using the Physiotherapy Evidence Database (PEDro) scale. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The primary outcomes of this study were pain intensity and foot function. The visual analog scale (VAS) was used for pain assessment. Foot function was evaluated by the total scores of the Foot Function Index (FFI) and American Orthopedic Foot & Ankle Society Scale (AOFAS) and the activities of daily living (ADL) subscale scores of the Foot and Ankle Ability Measure (FAAM). Outcomes were assessed at the end of treatment and during short-, medium-, and long-term follow-ups. The meta-analysis utilized standardized mean differences (SMDs), assessed heterogeneity using the I² test, applied the inverse variance method for pooling continuous variables, and employed a random-effects model because of the variable study methods used across the included articles. Results with p < 0.05 were considered statistically significant. The I² test was used to objectively measure statistical heterogeneity, with I² ≥ 50% indicating significant heterogeneity. Results: Five RCTs met the inclusion criteria, with methodological quality scores ranging from 6 to 7 on the 10-point PEDro scale. In total, 120 participants received HILT and 116 received ESWT. Regarding pain intensity (VAS), no statistically significant differences were detected between HILT and ESWT at any time point, including short-term morning pain (SMD = −0.11, 95% CI −0.42 to 0.19, p = 0.40), resting pain (SMD = 0.01, 95% CI −0.48 to 0.49, p = 0.05), and activity pain (SMD = −0.08, 95% CI −0.41 to 0.26, p = 0.89), as well as medium-term morning, resting, and activity pain (all p > 0.05). For foot function (FFI), the pooled analysis of all studies showed no significant short-term difference (SMD = 0.37, 95% CI −0.22 to 0.95, p = 0.01; I² = 73%); however, a subsequent sensitivity analysis, which excluded one studyreduced heterogeneity to 0% and revealed a significant short-term advantage of ESWT (SMD = 0.64, 95% CI 0.32 to 0.95, p < 0.01). Medium-term FFI also favored ESWT (SMD = 0.53, 95% CI 0.14 to 0.92, p < 0.01). Overall, the certainty of evidence ranged from moderate to low, mainly due to risk of bias and heterogeneity, as assessed by the GRADE approach. Conclusions: While the pooled results suggested a trend toward greater functional improvement with ESWT than with HILT in the short- and medium-term, the effect sizes were small. No significant between-group differences were observed in pain-related outcomes. Given the limited number of available trials and variability in treatment protocols, current evidence remains insufficient to draw definitive conclusions about the comparative efficacy of ESWT and HILT. Further high-quality, large-scale randomized controlled trials with standardized methodologies are needed to better inform clinical decision-making. Full article

Background: Patients with dental phobia frequently require intravenous sedation (IVS) to undergo dental treatment; however, some can gradually discontinue IVS through repeated clinical experiences. The physiological and psychological factors influencing successful IVS withdrawal remain unclear. This study aimed to compare physiological (sAA, HR) and subjective (VAS) measures between patients who discontinued IVS and those who remained dependent on IVS. Methods: This prospective cohort study included 51 patients with dental phobia treated under IVS. Participants were classified into a Non-Sedation Group (NSG; n = 25) and a Sedation-Dependent Group (SDG; n = 26) based on their ability to discontinue IVS during the course of treatment. Salivary alpha-amylase (sAA), heart rate (HR), and visual analog scale (VAS) scores for fear, tension, and anxiety were assessed at predefined time points from the waiting room to venous cannulation. Treatment satisfaction and expectations for future treatment were also evaluated. Results: sAA activity was significantly higher in the SDG than in the NSG at T0 and T1 (p < 0.05), indicating higher levels of selected physiological measures during anticipatory phases; however, the difference at T2 was not significant. HR differed significantly only in the waiting room, whereas no between-group differences were observed in self-reported VAS scores for fear, tension, or anxiety at any time point, indicating a dissociation between physiological and subjective stress measures. Treatment satisfaction and expectations for future treatment were significantly higher in the SDG. Conclusions: Patients who remained dependent on IVS showed higher levels in selected physiological measures at the group level during anticipatory stages, whereas no corresponding differences were observed in self-reported subjective measures. These findings are exploratory and descriptive in nature and do not imply predictive or causal relationships. Full article

Background/Objectives: Non-traumatic (degenerative) rotator cuff tendinopathy with partial supraspinatus tear (NT-RCTT) is a common source of shoulder pain and disability. Comparative evidence between radial extracorporeal shock wave therapy (rESWT) and multimodal physical therapy modalities (PTMs) remains scarce. Methods: In this single-center randomized controlled trial, 60 adults with MRI-confirmed NT-RCTT were assigned (1:1) to rESWT (one session weekly for six weeks; 2000 impulses per session, 2 bar air pressure, positive energy flux density 0.08 mJ/mm²; 8 impulses per second) or a multimodal PTM program (interferential current, shortwave diathermy and magnetothermal therapy; five sessions weekly for six weeks). All participants performed standardized home exercises. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) total score; secondary outcomes included pain (visual analog scale, VAS), satisfaction, range of motion (ROM), supraspinatus tendon (ST) thickness and acromiohumeral distance (AHD). Assessments were conducted at baseline, and at week 6 (W6) and week 12 (W12) post-baseline. Results: Both interventions significantly improved all outcomes, but rESWT produced greater and faster effects. Mean ASES total scores increased by 31 ± 5 points with rESWT versus 26 ± 6 with PTMs (p < 0.05). VAS pain decreased from 5.2 ± 0.7 to 1.0 ± 0.7 with rESWT and from 5.2 ± 0.8 to 1.7 ± 0.8 with PTMs (p < 0.01). rESWT achieved higher satisfaction and larger gains in abduction, flexion and external rotation. Ultrasound showed reduced ST thickness and increased AHD after rESWT but not after PTMs. No serious adverse events occurred. Conclusions: rESWT yielded superior pain relief, functional recovery and tendon remodeling compared with a multimodal PTM program, with markedly lower treatment time and excellent tolerability. Full article

Background/Objectives: In patients requiring unilateral total knee arthroplasty who have relatively mild but symptomatic degenerative osteoarthritis in the contralateral knee, there is ongoing debate regarding whether active intervention, such as arthroscopic surgery, should be performed concurrently or whether conservative management is more appropriate. This study compares patients who underwent simultaneous arthroscopic surgery on the contralateral knee with those who received only conservative treatment, and evaluates the effectiveness of performing arthroscopic surgery concurrently with total knee arthroplasty. Methods: From 2007 to 2013, 44 patients underwent unilateral total knee arthroplasty with simultaneous contralateral arthroscopic meniscectomy (Group 1), while 70 patients underwent unilateral total knee arthroplasty and received conservative treatment for degenerative osteoarthritis of the contralateral knee (Group 2). All patients were followed for a minimum of two years. Clinical outcomes were evaluated and compared using the Visual Analog Scale (VAS); Knee Society Score (KSS); and Lysholm score at preoperative, 1-month, 3-month, 1-year, and 2-year postoperative intervals. Results: At 1 and 3 months postoperatively, all outcome measures showed improvement compared to preoperative values, with Group 1 demonstrating significantly better results. At 1 and 2 years postoperatively, all three scores remained improved compared to preoperative levels but showed a declining trend relative to the early postoperative period, and no significant differences were observed between the two groups. Conclusions: In patients with degenerative osteoarthritis of the knee, simultaneous arthroscopic meniscectomy of the contralateral knee during unilateral total knee arthroplasty was associated with better early outcomes; however, no clinical or statistical differences were observed at 12 months. Full article

Background/Objectives: Periprosthetic humeral fractures (PF) after reverse total shoulder arthroplasty (RSA) are expected to increase. This study investigated PF after RSA with short stems and reported outcomes. Methods: A total of 165 patients underwent short-stem RSAs between 2014 and 2023. Among them, patients who developed postoperative PFs were identified and classified by fracture location and stem loosening. Operative data, complications, and bone union time were analyzed. Clinical outcomes before injury and at final follow-up were evaluated. Results: PF occurred in 5/165 patients (3.0%). Based on our classification, four had type B1 fractures and one had a type B3 fracture. All underwent revision RSA (Re-RSA) with conversion to long-stem implants. Bone union was achieved in four patients, while one patient experienced infection without union. Among the four patients without complications, mean shoulder flexion declined from 138° pre-injury to 103°, abduction from 118° to 95°, external rotation from 37° to 31°, the American Shoulder and Elbow Surgeons (ASES) score from 82.0 to 68.7, Constant Score from 67 to 43, while the Visual Analog Scale (VAS) pain score increased from 1.7 to 2.6. Conclusions: All five cases of PF following short-stem RSA were stem-level (type B) fractures. All patients underwent Re-RSA using long-stem conversion. Four patients had bone union. Clinical outcomes at one year postoperatively had deteriorated mildly compared to pre-fracture. However, this change was not statistically significant. One patient had a postoperative infection, and bone union was not observed. This study indicates the need for caution regarding postoperative infections after RSA. Full article