BMC Musculoskeletal Disorders最新文献

Background: The thoracolumbar fascia (TLF) is a key connective tissue structure that is involved in biomechanics of the lumbar spine and nociceptive processing. Growing evidence indicates that body mass index (BMI) is associated with connective-tissue remodeling, that may influence pain sensitivity and may thus contribute to musculoskeletal pain. However, the extent to which BMI-related differences in fascia morphology predict pain responses under controlled experimental conditions remains insufficiently understood. This study investigated thoracolumbar fascia thickness and BMI as predictors of pain sensitivity using a single-blinded experimental hypertonic saline pain model.

Methods: Twenty healthy adult volunteers (mean age 23.6 ± 2.4 years) received injections of hypertonic saline (5.8% NaCl) into the TLF to evoke low back pain. Induced Pain intensity was assessed using numerical rating scales (0-100 NRS) and the TLF thickness was measured via ultrasound at injection and contralateral site by a person blinded to pain ratings.

Results: TLF thickness was a significant predictor of experimentally induced pain sensitivity, demonstrating a moderate positive correlation with the individual peak pain (Pearson's r = 0.606, P < 0.01), accounting for approximately 37% of the variance in pain response. Furthermore, BMI was positively associated with TLF thickness (r = 0.495, P < 0.05), indicating that higher body mass predicts increased fascial thickness. Notably, BMI was positively correlated with induced pain intensity (r = 0.565, R² = 0.320, P < 0.05), supports the notion that body composition may contribute to inter-individual variability in pain sensitivity. No significant side-to-side differences in TLF thickness were observed.

Conclusion: These findings identify both thoracolumbar fascia thickness and BMI as potential predictors of low back pain sensitivity and demonstrate significant associations between structural fascial characteristics, body composition, and nociceptive responses. The results are consistent with clinical observations linking higher BMI to increased musculoskeletal pain burden and suggest that fascial structural characteristics may be related to nociceptive sensitivity. Furthermore, ultrasound-based assessment of fascial thickness may represent a clinically accessible parameter associated with pain sensitivity and may be useful for characterizing musculoskeletal outcomes in the context of weight-related interventions.

Objective: To compare the biomechanical performance of different lengths of intramedullary nails combined with reconstruction plates for fixation of Seinsheimer type IV subtrochanteric femoral fractures using finite element analysis, with additional evaluation of osteoporotic bone conditions.

Methods: A three-dimensional finite element model of Seinsheimer type IV subtrochanteric femoral fracture was constructed from CT data of a 51-year-old male volunteer. Three PFNA intramedullary nail lengths combined with a reconstruction plate were modelled: long-nail (320 mm), medium-nail (240 mm), and short-nail (160 mm) combinations. Each construct was analysed under axial (2,100 N), bending (175 N), and torsional (15 N·m) loading conditions in both healthy and osteoporotic bone subgroups (elastic modulus reduced to 60% of normal). Overall displacement, femoral stress, implant stress, and load-sharing ratio were evaluated.

Results: Under axial loading, the medium-nail combination exhibited the smallest maximum femoral displacement (10.7 mm healthy; 13.3 mm osteoporosis), while the short-nail combination showed the largest (13.2 mm; 19.7 mm) and the greatest sensitivity to bone quality. The short-nail combination generated the highest femoral stress under axial loading (325.4 MPa, 32.1% above the long-nail combination) and the highest nail stress under bending (199.4 MPa); the medium-nail combination produced notably high nail stress under torsion (300.7 MPa). The short-nail combination also exhibited substantially higher reconstruction plate stress under axial loading (804.5 MPa) relative to the long-nail (654.9 MPa) and medium-nail (578.8 MPa) combinations. Load-sharing analysis showed that the intramedullary nail bore the largest load fraction across all constructs (~ 47%-63%), and the long-nail combination demonstrated the most substantial load redistribution under osteoporotic conditions.

Conclusion: The medium-nail combination may offer superior displacement control under axial loading, while the short-nail combination was associated with higher stress levels across multiple loading modes and greater biomechanical vulnerability in osteoporotic bone. Intramedullary nail length should be selected individually, accounting for fracture type, bone quality, and anticipated loading demands.

Background: The aim of this study was to evaluate clinical and treatment-related factors associated with advanced-stage femoral head avascular necrosis (AVN) (Ficat stage III-IV) in patients who developed osteonecrosis following COVID-19 infection, based on long-term follow-up data.

Methods: This single-center retrospective cohort study included patients diagnosed with femoral head AVN after confirmed COVID-19 infection who had at least five years of clinical and radiological follow-up. Demographic characteristics, comorbidities, clinical severity of COVID-19, duration of hospitalization, intensive care unit (ICU) requirement, type and duration of systemic corticosteroid therapy, and duration of antiviral treatment were recorded. AVN was staged according to the Ficat and Arlet classification. Patients were divided into early-stage (stage I-II) and advanced-stage (stage III-IV) groups. Independent predictors of advanced-stage AVN were evaluated using logistic regression analysis. Receiver operating characteristic (ROC) analysis was performed to determine the discriminatory ability of antiviral treatment duration for advanced-stage disease. Time to osteonecrosis was defined as the interval between confirmed RT-PCR diagnosis of COVID-19 and first MRI confirmation of femoral head AVN.

Results: A total of 40 patients were included. Advanced-stage AVN was significantly associated with longer hospitalization duration, prolonged corticosteroid use, extended antiviral treatment, and the presence of hypertension. Multivariable logistic regression analysis identified hypertension, hospitalization duration, steroid treatment duration, and antiviral treatment duration as independent risk factors for advanced-stage AVN. ROC analysis demonstrated that an antiviral treatment duration ≥ 9.5 days showed excellent discriminatory performance for advanced-stage AVN (AUC = 0.950). These results reflect associations within a selected cohort of patients with post-COVID AVN and do not imply a direct causal relationship. However, this finding should be interpreted with caution due to the limited sample size and should be considered exploratory rather than definitive.

Conclusions: In patients who develop femoral head AVN following COVID-19 infection, disease progression appears closely related to the clinical severity of COVID-19 and overall treatment burden. Patients with severe COVID-19 requiring prolonged hospitalization and extended treatment exposure should be carefully monitored for progression to advanced-stage AVN. The identified cut-off value should be considered hypothesis-generating rather than definitive.

Objectives: The objective of this study is to evaluate the relationship between posterior labroligamentous morphological variants and abnormal position of the humeral head in the glenoid cavity using MR arthrography (MRA). Additionally, the study seeks to investigate whether these variations act as biomechanical risk factors for subclinical instability.

Methods: The study's sample population comprised 190 patients who did not exhibit posterior labral tears or clinical instability. The posterior labrum morphology and capsulolabral insertion types were assessed using MRA, and the posterior subluxation index (PSI) of the humeral head in the glenoid cavity was quantitatively measured. A statistical analysis was conducted to examine the associations between capsulolabral variations and posterior humeral head positioning.

Results: The prevalence of labral hypoplasia was observed to be 29% among the patient population, while aplasia was identified in 2% of cases. Sublabral clefts were identified in 52% of cases. A statistically significant increase in posterior displacement of the humeral head was observed in cases of labral hypoplasia and sublabral clefts, particularly in cases of deep clefts (p < 0.001). Posterior capsular insertion type was also identified as an independent predictor of the posterior subluxation index (PSI).

Conclusions: Posterior labral variations, specifically hypoplasia and deep sublabral clefts, have been observed to be associated with increased posterior humeral head translation, even in the absence of clinical instability. These structures may serve as biomechanical risk factors contributing to subclinical posterior shoulder instability.

Level of evidence: Level IV; Case Series Using Large Database.

Clinical trial number: Protocol code: E-10840098-202.3.02-2631, date of approval: 21/04/2025.

Background: Healthcare employees are frequently exposed to several risk factors for musculoskeletal pain at work, including high physical demands, psychological stressors, and high levels of occupational physical activity. We aimed to describe self-perceived work demands and device-measured physical activity at work among hospital employees across different occupations and clinical settings experiencing no pain, short-term pain, or long-lasting pain.

Methods: We used cross-sectional data on 1,413 hospital employees who participated in the first wave of the STUNTH (The Study of New Technology and Health among Hospital employees) cohort study. Physical activity was captured by two Axivity AX3 triaxial accelerometers placed on the thigh and lower back during up to seven consecutive days. Self-perceived work demands at the most demanding shift during the same period were assessed by NASA-Task Load Index (overall score and physical and mental demands subscales), ranging from 0 "Very low demands" to 100 "Very high demands". Musculoskeletal pain was measured by the Norwegian Pain Society Minimum Questionnaire, categorized by pain duration: no pain, short-term (during the last 7 days), or long-lasting (> 3 months). Quantile median regression models adjusted for age and sex were used to estimate work demands and physical activity according to different characteristics of musculoskeletal pain.

Results: The overall prevalence of musculoskeletal pain was 75.7%, where 31.6% reported short-term pain during the previous seven days, and 44.1% reported having pain lasting > 3 months. Both perceived overall work demands and perceived physical work demands were higher for those reporting long-lasting musculoskeletal pain compared to those without pain, with a median difference of 5.8 (95% CI: 3.35 to 8.21) and 10.3 (95% CI: 1.51 to 19.02), respectively. There were no clear differences in mental demands or in device-measured physical activity between employees with or without musculoskeletal pain.

Conclusion: Employees with long-lasting musculoskeletal pain reported higher perceived overall work demands and perceived physical demands, but no significant differences in proportion of time spent in device-measured physical activity types compared to employees without musculoskeletal pain.

Background: To evaluate the validity and reliability of the Turkish version of the General Rehabilitation Adherence Scale (GRAS) in individuals with osteoarthritis receiving physiotherapy.

Methods: Eighty-eight individuals diagnosed with osteoarthritis and undergoing physiotherapy participated in the study. The scale was translated using a forward-backward translation procedure and assessed for content validity. Construct validity was examined using exploratory factor analysis and confirmatory factor analysis to evaluate model fit. Internal consistency was evaluated using Cronbach's alpha coefficients. Test-retest reliability was assessed using intraclass correlation coefficients (ICC).

Results: Content validity indices indicated adequate item relevance. Factor analyses supported a two-factor structure with acceptable model fit indices. Internal consistency was acceptable for the overall scale and subscales. Test-retest reliability demonstrated good to excellent stability over time (ICC > 0.80). The findings indicate that the Turkish GRAS is a psychometrically sound instrument for assessing rehabilitation adherence in individuals with osteoarthritis.

Conclusion: The Turkish version of the GRAS is a valid and reliable tool for evaluating adherence behaviors in individuals with osteoarthritis receiving physiotherapy. Its use may assist clinicians in identifying patients at risk of poor rehabilitation engagement and may support individualized intervention planning to optimize functional outcomes.

Clinical trials registry: ClinicalTrials.gov Identifier: NCT07107412. Registry date: 30/07/2025. Registry link: https://clinicaltrials.gov/study/NCT07107412.

Background: Studies comparing arthroscopic surgery with open reduction internal fixation (ORIF) for posterior cruciate ligament (PCL) tibial avulsion fracture have exploded in recent years; however, the results are not consistent. This meta-analysis aimed to summarize the efficacy and safety profile of arthroscopic surgery and ORIF in patients with PCL tibial avulsion fracture.

Methods: Relevant studies were searched across the Web of Science, PubMed, EMBASE, Wan Fang, CNKI, and VIP databases. The standardized mean difference (SMD) or odds ratio (OR) with 95% confidence interval (CI) was pooled for analyses.

Results: Twenty-seven studies were included in this meta-analysis. Compared with those in the ORIF group, the incision length (SMD: -4.701, 95%CI: -5.717~-3.686), perioperative bleeding (SMD: -3.304, 95%CI: -3.834~-2.774), postoperative drainage volume (SMD: -1.071, 95%CI: -1.870~-0.273), time to first ambulation (SMD: -2.294, 95%CI: -4.127~-0.460), and hospital stays (SMD: -1.918, 95%CI: -2.594~-1.242) were lower, but the operation duration (SMD: 1.998, 95%CI: 0.595 ~ 3.401) was greater in the arthroscopy group. After treatment, the Lysholm score (SMD: 1.424, 95%CI: 0.858 ~ 2.837), International Knee Documentation Committee score (SMD: 1.848, 95%CI: 0.858 ~ 2.837), range of motion (SMD: 0.527, 95%CI: 0.001 ~ 1.053) were greater in the arthroscopy group than in the ORIF group, but no statistically significant difference was observed in the pain score (SMD: -0.250, 95%CI: -0.664 ~ 0.165), and posterior drawer test negative rate (OR: 1.040, 95%CI: 0.460 ~ 2.351). Moreover, the incidence of postoperative complications (OR: 0.458, 95%CI: 0.149 ~ 1.411) was not significantly different between the arthroscopy group and the ORIF group.

Conclusion: Arthroscopic surgery appears to provide better functional outcomes and a comparable risk of complications than ORIF does to some extent, although longer operative time and study heterogeneity warrant caution, for PCL tibial avulsion fracture.

Background: To report a rare case of cervical Tarlov cyst successfully treated using a percutaneous uniaxial endoscopic fenestration.

Methods: This was a single case report describing the surgical technique, clinical assessment, radiological verification, and long-term follow-up outcomes of percutaneous uniaxial endoscopic surgery for symptomatic cervical Tarlov cyst.

Clinical presentation: A 43-year-old male patient presented with intermittent pain and numbness in his right forearm for 2 years, with exacerbation over the past month. The symptoms were aggravated by fatigue and upon waking in the morning, and conservative treatment yielded no effect. MRI revealed a C8 Tarlov cyst. The patient underwent cervical percutaneous endoscopic laminar decompression and Tarlov cyst resection. Cervical MRI performed on the 2nd postoperative day confirmed complete cyst resection. Postoperatively, the patient's radicular pain almost completely resolved without symptoms of cerebrospinal fluid leakage, and no recurrence of pain was reported during a 2-year follow-up.

Conclusion: This case report describes the safe and successful application of percutaneous uniaxial endoscopic fenestration combined with cervical Tarlov cyst resection.

Objective: Multisite musculoskeletal pain is highly prevalent and negatively impacts physical function through several potential mechanisms. However, it remains unclear how the number of affected pain regions relates to function. This study explored associations between different aspects of pain (global pain intensity, catastrophizing, kinesiophobia, pain interference) and physical function in individuals with multisite pain.

Methods: This cross-sectional analysis included 101 participants aged 18-85 years. Multisite pain was assessed across eight anatomic regions, using binary questions, with scores based on total affected sites. A composite function score was derived via principal component analysis from self-reported physical function, objective gait speed, and clinician-assessed dynamic balance. Hierarchical multivariable linear regression models examined the associations between number of pain regions and composite function, adjusting for age, sex and BMI, with sequential addition of global pain intensity, catastrophizing, kinesiophobia, and pain interference.

Results: Participants (aged 40 ± 17.6; 69% women) reported a median of 2 (IQR 1-3) pain regions. After adjusting for demographics, a greater number of reported pain regions correlated with worse composite physical function (ß: -0.16; 95% CI (-0.31 to -0.01); R² = 0.520, ΔR² = 0.205). Global pain intensity explained additional variance in physical function (ß: -0.20; 95% CI -0.30 to -0.10);R² = 0.589, ΔR² = 0.069), whereas catastrophizing, kinesiophobia, and pain interference contributed minimally.

Conclusions: Greater number of pain regions was associated with worse composite function, and global pain intensity explained additional variance in this relationship. The independent contributions of catastrophizing, kinesiophobia, and pain interference to composite function were minimal when examined alongside this cumulative pain burden, though findings should be interpreted with caution and replicated in larger samples, with longitudinal designs to clarify the directionality of these relationships. Results are consistent with biopsychosocial understandings of multisite pain in which cumulative pain burden, psychological factors, and functional outcomes are interconnected through overlapping pathways.