This review examines the comparative effects of high-frequency pulse (HFP) versus low-frequency pulse (LFP) translingual neurostimulation (TLNS), combined with physiotherapy, on balance and gait outcomes in patients with traumatic brain injury (TBI). This analysis included five studies from two independent trials, totaling 166 patients with TBI. The studies have a low risk of bias on RoB2, and the Certainty of Evidence was moderate on GRADE. The meta-analysis of the Sensory Organization Test (SOT) revealed significant improvements (SMD = 0.40, 95
Radiation fibrosis syndrome (RFS) can cause progressive neuromuscular, musculoskeletal, and functional impairments years after radiation therapy. This review examines the manifestations of RFS most relevant to exercise and proposes a practical framework for personalized treatment and exercise prescription based on each person’s impairments and level of disability. Although exercise is broadly recommended in cancer survivorship, limited evidence addresses its adaptation for the heterogeneous weakness, fibrosis, contracture, sensory loss, balance dysfunction, pain, fatigue, lymphedema, and cardiopulmonary or vascular late effects associated with RFS. Available evidence supports tailoring aerobic, resistance, balance, and mobility exercise to individual impairments, functional capacity, goals, and response to training. Exercise prescription for RFS should emphasize safe whole-body activity, individualized modifications, and appropriate clinical referral rather than diagnosis alone. Resistance exercise may be particularly important given the prominence of weakness, atrophy, postural decline, and functional loss. Future research should evaluate personalized interventions, impairment-based screening and referral, and coordination among oncology, primary care, rehabilitation, and community exercise professionals.
Radicular pain is one of the most common neuromuscular complaints in patients with a history of cancer. However, there are many causes of radiculopathy unique to the oncologic setting that clinicians may be less familiar with. This review provides an overview of common etiologies and suggested evaluation. While the most common cause of radiculopathy in patients regardless of cancer-status is degenerative spondylosis, the differential for cancer survivors should remain broad and includes primary and secondary tumors, vascular complications, infection, fracture, paraprotein disorders, and paraneoplastic syndromes. Depending on treatment history, providers should also consider chemotherapy and immunotherapy-induced peripheral neuropathies and radiation fibrosis syndrome. Certain patient factors and the presence or absence of systemic symptoms can help providers narrow their differential and perform a structured evaluation. While the majority of radiculopathy in cancer patients is due to non-malignant causes, such as degenerative disc disease, there are many etiologies unique to cancer that warrant special consideration and comprehensive evaluation.
To synthesize the available literature for evidence-based management of femoroacetabular impingement syndrome (FAIS) among athletes and provide a conceptual framework to help guide clinical decision-making when managing in-season and out-of-season athletes with FAIS. Physical therapy remains the foundation of treatment for FAIS. Corticosteroid, nonsteroidal anti-inflammatory, and hyaluronic acid injections can provide moderate short term pain relief in FAIS. Current literature shows high rates of return to sport with arthroscopic surgical treatment in refractory cases. Despite FAIS being a common condition encountered by athletes, an optimal treatment algorithm remains undetermined. Anatomy predisposing to FAIS may be present in athletes but may not be symptomatic until sequalae such as chondral loss and labral tearing present. Factors such as timeline of athletic season, recovery time post-intervention, treatment efficacy, and cost should be considered when determining management. There are multiple non-operative treatment options available for those patients with FAIS but surgery may be required for refractory cases or in cases where early intervention may benefit joint preservation, such as in the setting of substantial cam morphology. The treatment framework outlined in this review is based on a comprehensive review of the current evidence.
Ulnar collateral ligament injuries are a cause of significant time lost for baseball players of all levels. These injuries and time lost have resulted in the pursuit of ways to treat this injury but also prevent the injury entirely. This manuscript aims to delve into decreasing the incidence of UCL injuries. The UCL acts as a static stabilizer to the medial elbow and is aided by the dynamic stabilizers, the flexor-pronator muscle mass. Recent research has delved into the flexor-pronator mass and its correlation with UCL injuries. The flexor carpi ulnaris and flexor digitorum superficialis have been tied to predisposition to UCL injuries. Grip and pinch strength have demonstrated a correlation with decreased medial gapping with valgus stress. Correlation has especially been noted when evaluating the FCU and FDS, along with associated weakening with increased innings pitched. This review demonstrates the need for further research on flexor pronator mass and the incidence of UCL injuries.
