Radial collateral ligament (RCL) injuries of the thumb metacarpophalangeal (MCP) joint are relatively rare compared to ulnar collateral ligament lesions. These injuries typically occur due to forced and sudden adduction of the thumb and can significantly impair MCP joint functionality. In chronic cases, direct ligament repair is often unfeasible, necessitating various reconstruction techniques, including the use of the abductor pollicis brevis (APB) tendon. This manuscript aims to review the literature on APB-based reconstruction techniques and to present two cases of chronic RCL tears treated with a modified reconstruction technique using a dorsal half-slip of the APB tendon, along with their functional outcomes.

INTRODUCTION:Core stability is essential for maintaining postural alignment and preventing injuries during athletic activities. A growing body of literature suggests that structured core stability programs can reduce the risk of both upper and lower limb injuries across various sports. However, the evidence remains scattered and inconsistent, particularly regarding specific populations and sports contexts. EVIDENCE ACQUISITION:This scoping review was conducted following the Joanna Briggs Institute (JBI) methodology and reported according to the PRISMA-ScR guidelines. A comprehensive literature search was carried out across MEDLINE (via PubMed), Cochrane Library, PEDro, Scopus, and grey literature databases. Studies were included if they investigated the impact of core stability training on injury prevention in athletic populations, using the PCC (Population, Concept, Context) framework. Data extraction focused on participant characteristics, interventions, outcomes, and conclusions. EVIDENCE SYNTHESIS:Five randomized controlled trials (RCTs) met the inclusion criteria. The studies involved athletes aged 8 to 58 years across six sports disciplines (soccer, Gaelic football, basketball, volleyball, gymnastics, and swimming). All included interventions demonstrated positive outcomes in reducing injury incidence, improving neuromuscular control, and enhancing dynamic stability. However, variability in training protocols and methodological quality limited cross-study comparability. Most interventions were low-cost, equipment-free, and feasible in both team and individual settings. CONCLUSIONS:Core stability training shows strong potential as a preventive strategy in sports injury management. Despite the variability among existing studies, the consistent positive effects suggest the need for broader integration into routine athletic training. Future research should aim to standardize protocols and explore long-term efficacy across diverse athletic populations.

PURPOSE:Schwannomas originating from the deep motor branch of the ulnar nerve (DMBUN) are exceptionally rare, presenting with variable and often heterogeneous clinical manifestations depending on their precise anatomical location. While these tumors have been described in the literature, reports specifically involving the DMBUN are exceedingly limited, rendering postoperative prognostication challenging. This study aims to systematically review the existing literature and present a novel case, with the objective of delineating anatomical characteristics and clarifying potential postoperative outcomes. METHODS:A systematic literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the MEDLINE and Scopus databases. Data regarding patient demographics, clinical presentation, anatomical localization, and surgical outcomes were extracted and analyzed. RESULTS:Seven articles met the inclusion criteria. A total of nine tumors were initially identified as schwannomas of the DMBUN over a 73-year period; however, only five cases - including the newly reported one - were confirmed. The median patient age was 59.6 years; complete recovery was achieved in three cases, with time to functional improvement ranging from 4 to 6 months. CONCLUSION:In this limited series, available data suggest that accurate preoperative imaging and careful intraoperative microsurgical dissection may lead to favorable outcomes, with complete recovery achievable in schwannomas of the DMBUN. No clear association was observed between postoperative nerve function and tumor size, patient age, or time since symptom onset.

Background: Carpal tunnel syndrome (CTS) is one of the most common entrapment neuropathies. While surgical decompression is widely considered the definitive treatment, conservative options remain clinically relevant, particularly for symptom relief and functional recovery in the short term. Objectives: To update the evidence comparing surgical versus non-surgical interventions for CTS, assessing pain, function, and clinical recovery. Design: Systematic review of randomised controlled trials (RCTs). Data Sources and Methods: Six databases (CENTRAL, MEDLINE, Embase, Cochrane Neuromuscular Register, ClinicalTrials.gov, and WHO ICTRP) were searched for RCTs published between November 2022 and January 2025. Risk of bias was assessed with RoB 2.0 and certainty of evidence with GRADE. Due to clinical heterogeneity, a narrative synthesis was performed. Results: Four RCTs (n = 1158) were included. Corticosteroid injection and percutaneous electrical nerve stimulation (PENS) appeared to provide faster symptom relief than surgery at short-term follow-up. However, surgery was associated with a higher probability of sustained recovery at 12–18 months (RR 1.36; 95% CI 1.19–1.56). Evidence for PENS was limited to one female-only trial, which restricts generalisability. Certainty of evidence was moderate for long-term outcomes and low for short-term results and safety. Conclusions: The available evidence suggests that surgery may offer more durable long-term recovery, whereas corticosteroids and PENS may be useful for short-term symptom relief. These findings should be interpreted with caution given the limited number of trials and the risk of bias in most included studies. Treatment choice should align with patient goals and recovery timelines. Registration: PROSPERO (CRD420250650789).

To present a reproducible ultrasound-guided approach for the identification and injection of the long thoracic nerve (LTN) in patients with burning axillary pain. High-resolution ultrasound was used to visualize the LTN along its superficial course, from its emergence through the middle scalene muscle to its trajectory over the serratus anterior muscle. It is used a high-frequency linear transducer (10–18 MHz) with patients positioned supine or lateral decubitus with arm abduction. Under sterile conditions, it is performed perineural injections both proximal to the cervical spine and distally to the axilla, using the in-plane technique. The LTN was identified at both the supraclavicular and lateral thoracic levels. Ultrasound guidance allowed for accurate needle placement and perineural distribution of the injectate. The procedure has proven feasible, safe, and reproducible in the clinical setting. Ultrasound-guided injection of the long thoracic nerve is a precise and minimally invasive technique that combines precise diagnostic confirmation with lasting therapeutic benefit. It represents a valuable option in the management of long thoracic nerve neuropathy and may reduce the need for systemic medications. Further studies are needed to verify its long-term efficacy and define standardized protocols.

PURPOSE:Pudendal neuropathy is a debilitating condition often underdiagnosed due to its complex clinical presentation and overlapping symptoms with other pelvic disorders. This review aims to provide an updated synthesis of anatomical, clinical, and technical aspects of ultrasound-guided pudendal nerve infiltration, highlighting its diagnostic and therapeutic relevance in neuropathic pelvic pain. METHODS:A narrative analysis was conducted of the pudendal nerve's anatomy, etiologies of neuropathy, clinical manifestations, diagnostic tools, and image-guided intervention strategies. Particular attention was dedicated to high-resolution ultrasound (HRUS) for anatomical visualization and to the technical considerations underlying perineural injection procedures. RESULTS:Perineural infiltration of the pudendal nerve provides immediate, partial pain relief after anesthetic administration, with the addition of corticosteroids contributing to sustained relief. Ultrasound guidance minimizes complications and has proven superior to traditional landmark-based approaches. The technique demonstrates feasibility, safety, and reproducibility in clinical practice, for both diagnostic and therapeutic purposes. However, clinical results have varied, and repeated sessions or integration with multimodal strategies, including physical therapy, drug therapy, and lifestyle modifications, have often been required. CONCLUSION:Ultrasound-guided pudendal nerve infiltration is a minimally invasive, safe, and effective technique for both diagnosis and treatment of pudendal neuropathy. While offering rapid pain relief and confirming nerve involvement, infiltrations should be considered as part of a broader multimodal management strategy. Future directions include standardization of protocols, refinement of imaging guidance, and exploration of novel injectates or regenerative therapies to optimize long-term outcomes.

Background: Proximal phalanx fractures of the hand are common and can significantly impact hand function. Conservative treatments, including splinting and dynamic mobilization, are often used, but their efficacy compared to surgical interventions needs thorough evaluation. Methods: A scoping review was conducted by analyzing studies focused on conservative treatments for proximal phalanx fractures in adults. Inclusion criteria encompassed studies with adult populations, conservative management methods, and clearly reported outcomes. Data from eight selected studies were synthesized to evaluate treatment efficacy, patient outcomes, and complication rates. Results: The review found that conservative treatments, including splinting, buddy taping, and dynamic mobilization, were highly effective for stable, extra-articular proximal phalanx fractures. These methods promoted early functional recovery and had high patient satisfaction rates. Studies comparing conservative and surgical treatments indicated excellent outcomes for both, with fewer complications observed in the surgical groups for unstable fractures. Dynamic and traction splints facilitated significant improvements in total active motion (TAM) and grip strength. Younger patients with transverse fractures showed better outcomes with conservative treatments. Conclusions: Conservative management strategies are effective for stable proximal phalanx fractures, promoting satisfactory functional recovery and minimizing complications. Surgical intervention is recommended for unstable or complex fractures to achieve better functional outcomes. Standardized treatment protocols and long-term follow-up are essential to validate these findings and optimize patient care. Further research with larger sample sizes and standardized outcome measures is needed to establish clear guidelines for the conservative management of proximal phalanx fractures in adults.

This pictorial essay clarifies the complex anatomical and ultrasonographic features of the Achilles tendon. Utilizing high-frequency ultrasound probes (12–18 MHz), the study visualizes the tripartite segmentation of the tendon as it relates to anatomical fascicles. Notably, there is variability in the ultrasound visibility of fascicles and this partition influences biomechanical properties and susceptibility to injury. This essay not only enhances the understanding of Achilles tendon anatomy but also underscores the importance of anatomical knowledge for comprehending associated pathologies. The findings suggest potential areas for further research into tendon pathology, facilitating the development of targeted rehabilitation strategies.

Digital stiffness, defined as reduced articular mobility due to impaired tissue plane gliding, contrasts with rigidity and mechanical resistance to deformation. Viscoelastic tissue properties, primarily determined by collagen and elastin, govern the response to force, while edema exacerbates stiffness by increasing interstitial fluid resistance. Accurate assessment is critical for treatment selection. Subjective end-feel evaluation is limited, while objective tools such as torque range of motion (TROM) and torque-angle curve (TAC) analysis provide reliable, quantitative insights into tissue mechanics. Understanding viscoelastic and edema-related contributions enables the development of tailored interventions, thereby improving rehabilitation outcomes. Future research should integrate advanced technologies for real-time monitoring. This report aimed to explore the biomechanical principles underlying digital stiffness, differentiate it from rigidity, and highlight the role of viscoelastic properties and edema in movement restriction. By discussing both subjective and objective assessment methods, this report highlights the importance of quantitative tools, such as TROM and TAC analysis, in enhancing diagnostic accuracy and rehabilitation outcomes.

Background: Posterior cruciate ligament (PCL) injuries are relatively rare, with limited consensus on the optimal treatment for isolated acute cases. Conservative management and surgical reconstruction each offer potential benefits, but their comparative efficacy remains unclear. Methods: A scoping review was conducted following the Joanna Briggs Institute (JBI) framework and PRISMA-ScR guidelines. A systematic search of MEDLINE, Cochrane CENTRAL, Scopus, PEDro, and Web of Science was completed on 23 December 2024. Studies comparing conservative treatment and surgical reconstruction for isolated acute PCL injuries were included. Outcomes such as functional recovery, stability, and long-term complications were extracted and synthesized qualitatively. Results: Six studies were included, comprising case series, prospective, retrospective, and review designs. Conservative treatment demonstrated significant improvements in functional recovery (IKDC scores: 67–90.3/100) but showed limited improvement in stability (STSD reduction: 0–3 mm). Surgical reconstruction yielded superior stability (STSD reduction: 8.2 to 2.7 mm) and lower rates of degenerative changes but was associated with a higher risk of complications. Functional outcomes were comparable between approaches in some studies, although surgical patients showed slightly better long-term stability. Conclusions: Both conservative and surgical treatments achieve satisfactory outcomes for isolated acute PCL injuries. Treatment selection should be tailored to patient-specific factors, considering functional demands and injury severity.

OBJECTIVE:To propose the usefulness of ultrasound (US) examination in diagnosing isolated lumbar transverse process fractures (ILTPF) in minor trauma as a first-line imaging and decision-making process. METHODS:We report six cases of patients, who suffered from vertebral fractures after blunt trauma or sports injuries and were diagnosed with ILTPF. Data were collected from personal records and images were obtained by different doctors using the US. The results were confirmed by X-ray or magnetic resonance imaging. RESULTS:In two cases, US-examination was able to detect ITPF after a conventional X-ray was apparently normal. In the other four cases, US-examination allowed to discover of the fractures and subsequently, they were confirmed by MRI or X-ray. CONCLUSION:Our cases demonstrated the usefulness of the ultrasound technique, as a first-line imaging, for spine trauma in diagnosing ITPF, in the context of minor trauma. In two cases ultrasound showed superiority to X-ray in finding the fractures.

BackgroundHamstring strain injuries (HSIs) are among the most common injuries in football, causing significant time-loss and impacting player performance. Despite various preventive strategies, the incidence of HSIs remains high, necessitating evidence-based approaches to reduce injury rates.ObjectiveThis scoping review aims to evaluate the effectiveness of the Nordic Hamstring Exercise (NHE) in reducing the incidence and recurrence of HSIs in football players and to provide practical recommendations for its implementation.MethodsA comprehensive literature search was conducted in PubMed, Scopus, Web of Science, PEDro, and the Cochrane Library. Randomized controlled trials (RCTs) focusing on NHE interventions for football players were included. The primary outcomes were injury incidence, recurrence, and compliance with NHE programs.ResultsThe review found that NHE significantly reduces the incidence of new hamstring injuries by up to 60% and recurrent injuries by up to 85%. Players performing NHE demonstrated a 35% increase in eccentric hamstring strength. Compliance with NHE programs was a critical factor in achieving these outcomes, with higher adherence rates leading to better preventive effects.ConclusionsThe Nordic Hamstring Exercise is an effective, evidence-based intervention for preventing hamstring injuries in football. Its integration into regular training programs, combined with education to improve compliance, can significantly reduce injury rates and enhance player performance. Future research should focus on standardizing protocols and exploring long-term outcomes.

PURPOSE:To describe a reproducible ultrasound-guided technique for infiltrating the posterior femoral cutaneous nerve (PFCN) in patients with neuropathic pain involving the posterior thigh and gluteal region. METHODS:High-resolution ultrasound was used to identify the PFCN along its superficial course over the long head of the biceps femoris muscle. Under sterile conditions, a perineural injection was performed using an in-plane approach. Hydrodissection with saline was employed to confirm needle placement. A local anaesthetic, with or without corticosteroids, was administered. RESULTS:The PFCN was reliably visualised in all procedures, and the targeted infiltration was successfully performed in each case. Patients experienced immediate partial pain relief, and no adverse events were reported. The technique proved feasible, safe, and reproducible in clinical practice. CONCLUSION:Ultrasound-guided infiltration of the PFCN is a precise and minimally invasive approach for managing neuropathic pain in the posterior thigh. It enables accurate nerve targeting and provides both diagnostic confirmation and therapeutic benefit. This technique may reduce reliance on systemic medications and guide further management in complex pain syndromes. Additional studies are needed to evaluate long-term outcomes and confirm clinical efficacy.

This case report presents an innovative, minimally invasive treatment for a Grade II medial collateral ligament (MCL) tear, utilizing ultrasound-guided injections of low molecular weight peptides (LWPs) and hydrolyzed collagen with vitamin C supplementation. The approach adds to the surgical literature by demonstrating the feasibility of a minimally invasive, image-guided therapy aimed at enhancing ligament healing, an important consideration for individuals seeking faster recovery and return to physical activities. A 50-year-old male amateur athlete presented with acute medial knee pain following a soccer game, diagnosed as a Grade II MCL tear. Key concerns included pain management and rapid recovery to resume sports activities. The patient was treated with two rounds of ultrasound-guided injections directly into the MCL, containing a novel solution of LWPs, hydrolyzed collagen, and vitamin C. This treatment was complemented by a physiotherapy regimen. Clinical outcomes showed significant improvements in pain, knee functionality, and stability, allowing a return to sports within three months. The patient achieved significant improvement as assessed by patient-reported outcome measures (PROMs), including a reduction in Visual Analogue Scale (VAS) pain scores from 7 to 1 and an increase in the Lysholm Knee Scoring Scale from 25 to 85. The case highlights the potential benefits of using targeted, biologically active compounds in non-surgical treatment of ligament injuries. It underscores the importance of innovative treatments that can significantly reduce recovery time and improve functional outcomes for athletes, suggesting a promising area for further research and application in sports medicine and orthopedics.

Background and Objectives: Arthrogenic muscle inhibition (AMI) is a key neurophysiological barrier to effective rehabilitation in individuals with chronic ankle instability (CAI). The primary objective of this narrative review is to explore the role of arthrogenic muscle inhibition (AMI) in chronic ankle instability (CAI) and to critically appraise neurophysiological and rehabilitative strategies targeting its resolution. Although peripheral strengthening remains a cornerstone of treatment, the roles of spinal and cortical modulation are increasingly recognised. Materials and Methods: A narrative review was conducted to examine recent clinical trials targeting AMI in CAI populations. A structured search of MEDLINE, Web of Science, Scopus, Cochrane Central, and PEDro was performed. Five studies were included, encompassing peripheral, spinal, and cortical interventions. The outcomes were grouped and analysed according to neurophysiological and functional domains. Results: Manual therapy combined with exercise improved pain, strength, and functional mobility. Fibular reposition taping transiently enhanced spinal reflex excitability, while transcranial direct current stimulation (tDCS) over the primary motor cortex significantly modulated corticospinal excitability and voluntary muscle activation. Improvements in subjective stability, dynamic balance, and neuromuscular responsiveness were observed in the majority of the five included studies, although methodological heterogeneity and short-term follow-ups limit generalisability. Conclusions: Multimodal interventions targeting different levels of the neuromotor system appear to be more effective than isolated approaches. Integrating manual therapy, sensorimotor training, and neuromodulation may optimise outcomes in CAI rehabilitation. Future trials should focus on standardised outcome measures and long-term efficacy.

Background: Groin pain is a complex and multifactorial condition commonly observed in athletes, often impairing performance and quality of life. While conservative treatments are the first-line approach, the variability in intervention protocols and inconsistent evidence necessitate a comprehensive synthesis of current knowledge. Methods: This narrative review analyzed the available literature on conservative management of groin pain in athletes. A systematic search was conducted across the MEDLINE, Cochrane CENTRAL, Scopus, PEDro, and Web of Science databases. Studies focusing on pain reduction, functional recovery, return-to-sport outcomes, and prevention strategies were included. Findings were synthesized to evaluate the efficacy of conservative interventions and identify gaps in the evidence. Results: Conservative treatments, particularly active rehabilitation and multimodal therapy, demonstrated significant efficacy in reducing pain (50–80%) and improving function, as measured by tools such as the HAGOS score. Return-to-sport rates ranged from 70% to 90%, depending on intervention type and adherence. Screening tools, including the adductor squeeze test, were effective in predicting and preventing groin injuries. However, variability in methodologies, small sample sizes, and a lack of long-term follow-up limited the generalizability of the findings. Conclusions: Conservative management remains a cornerstone for treating groin pain in athletes, offering effective outcomes for pain reduction, functional recovery, and injury prevention. However, standardized protocols and high-quality research are needed to enhance clinical guidance and optimize patient outcomes.

BackgroundLymphedema, particularly in cancer survivors, is a chronic, debilitating condition that lacks a definitive cure. Current management strategies are complex and focus on symptom control. Health coaching (HC) has emerged as a promising intervention to enhance patient self-management and quality of life in chronic diseases, but its specific role in lymphedema care remains underexplored.MethodsThis review synthesized findings from existing literature reviews and systematic reviews examining HC's effectiveness in improving health outcomes in chronic conditions, including lymphedema. Databases searched included MEDLINE, Cochrane Central, Scopus, PEDro, and Web of Science, with no date limitations. Five relevant studies were identified, each evaluating HC's impact on quality of life, mental health, physical activity, self-management, and decision-making.ResultsThe reviewed studies consistently indicated that HC enhances quality of life, reduces mental distress, and supports self-management in chronic conditions. Improvements were also noted in patient engagement in physical activity and informed decision-making. However, outcomes varied in sustainability and were influenced by HC delivery method and duration.ConclusionsThe findings suggest that HC, delivered within multidisciplinary teams, could be a valuable addition to lymphedema management by empowering patients, improving adherence to care routines, and enhancing psychological resilience. Future research should standardize HC protocols and assess their long-term benefits specifically for lymphedema. This review highlights HC's potential in chronic disease care and the need for tailored interventions in lymphedema.

Background: Handheld dynamometry (HHD) is widely utilized for assessing muscle strength, particularly in the wrist. However, variability in measurement reliability due to differences in testing protocols poses a challenge for clinical and research applications. Methods: The design of this study includes a scoping review of the literature, conducted following the PRISMA-ScR checklist methodology developed by the Joanna Briggs Institute. The databases most commonly cited in review articles were consulted: EBSCO, PEDro, PubMed, Scopus, and Cochrane Library. The following MeSH terms were used: “Handheld Dynamometer”, “Wrist”, “Forearm”, “Muscle”, and “Strength”. The search strings were built using combinations of these terms. Article screening was performed by three reviewers independently, blinded to each other’s selections. Results: The review indicates that HHD can provide reliable measurements when standardized protocols are used. Most studies reported high intra-examiner reliability with Intraclass Correlation Coefficients (ICCs) between 0.71 and 0.90. However, inter-examiner reliability showed more variability, particularly when more than two examiners were involved. The review also highlights the importance of precise dynamometer placement and consistent patient positioning in order to reduce measurement variability. Conclusions: While HHD is a valuable tool for wrist strength assessment, the effectiveness of its measurements largely depends on the testing procedure’s standardization. Implementing validated standardized protocols is essential in enhancing measurement reliability and ensuring their consistent application across clinical settings. Further research is needed to firmly implement these protocols and expand their application in clinical practice.