BMC Musculoskeletal Disorders最新文献

Background: Shoulder pain is a very common symptom. A number of studies have demonstrated that botulinum toxin type A is effective in relieving shoulder pain. Therefore, this systematic review and meta-analysis aimed to synthesize scientific evidence and quantify the combined effects of ultrasound-guided botulinum toxin type A on shoulder pain.

Methods: A comprehensive literature search was conducted in databases such as PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Information Database (CNKI), Wanfang database, and VIP database (VIP) using the keywords "ultrasound", "Botulinum toxin type A", and "shoulder pain". Two reviewers independently reviewed the studies, extracted data from eligible studies, and assessed the risk of bias. A random-effects model was used to calculate the standardized mean difference (SMD) and 95% confidence interval (CI) for Visual Analog Scale (VAS), Upper Extremity Fugl-Meyer Assessment (UEFMA), Range of Motion (ROM), Modified Barthel Index (MBI). Funnel plots and sensitivity analyses were also employed to evaluate the four outcome indicators above.

Results: Out of retrieved 854 records, ten studies (involving 533 patients) were finally included. Pooled analysis showed that ultrasound-guided botulinum toxin type A was associated with large improvements in shoulder pain (SMD = -1.1; 95% CI -1.47 to -0.73; P < 0.001), UEFMA score (SMD = 1.43; 95% CI 0.49 to 2.37; P = 0.003), ROM of shoulder flexion (SMD = 1.28; 95% CI 0.63 to 1.93; P < 0.001) and external rotation (SMD = 1.66; 95%CI, 0.83 to 2.48; P < 0.001). Mild improvements were observed in ROM of shoulder abduction (SMD = 0.8; 95%CI 0.18 to 1.43; P = 0.01) and MBI score (SMD = 1.33; 95% CI 0.22 to 2.43; P = 0.02).

Conclusions: Our meta-analysis has shown ultrasound-guided BoNT-A injections have potential benefits for reducing shoulder pain and improving upper limb function, range of motion, and quality of life. However, these findings should be interpreted cautiously due to small sample size, measured differences, substantial heterogeneity and possible publication bias. More high-quality studies with large sample size are needed to assess long-term efficacy, strengthening the evidence that ultrasound-guided BoNT-A facilitates the reduction of shoulder pain.

Background: Posterior cruciate ligament (PCL) injury is common in sports, with anatomical factors like posterior tibial slope (PTS) and femoral intercondylar notch morphology potentially influencing risk. However, evidence remains limited and inconsistent. In addition to the PTS and femoral intercondylar angle, this study also investigated the potential roles of the lateral proximal tibial angle and lateral distal femoral angle in posterior cruciate ligament injuries.

Methods: A retrospective study was conducted including 169 participants: 80 with isolated PCL injuries and 89 controls. Anatomical parameters (PTS, femoral intercondylar angle, etc.) were measured from imaging. Univariate and multivariate analyses were used to evaluate associations with PCL injury.

Results: No significant differences in demographic variables. The PTS was significantly lower in the PCL group (7.81° ± 3.59°) than controls (11.06° ± 4.07°, P < 0.001). The femoral intercondylar angle was also smaller in cases (P < 0.05). Other parameters showed no significant differences. ROC analysis indicated that lower PTS and narrower intercondylar angle were associated with higher PCL injury risk.

Conclusion: PTS ≤ 6.5° and an intercondylar angle ≤ 49.5° were associated with a significantly increased risk of PCL injury.

Background: Pediatric septic arthritis requires immediate recognition, as delayed diagnosis can cause severe joint damage and long-term dysfunction. In the absence of guideline-based cut-off values for laboratory markers, surgical decisions are often made on a case-by-case basis. Due to the scarcity of evidence specific to the pediatric population, treatment strategies are often based on adult data, highlighting the need for targeted research in this population. To address this gap, we developed a diagnostic algorithm that incorporated reliable predictive factors.

Methods: Of 443 joint aspirations performed in our clinic (2014-2024), 132 (29.8%) were for suspected septic arthritis. After applying exclusion criteria, 80 cases were included. Clinical (fever, pain with movement, comorbidities), laboratory parameters at the time of joint aspiration (serum CRP, synovial white blood cell count [syWBC], serum white blood cell count [seWBC], synovial neutrophil perventage [syN%] and radiological data (radiographs, CT and MRI if available) were collected. Septic arthritis was defined by detection of pathogens in joint aspirate via culture or PCR.

Results: A pathogen was identified in 25% (20/80) of cases, with Kingella kingae (30%) being the most frequently detected organism, followed by Staphylococcus aureus (25%). Regression analysis revealed CRP (p < 0.01), syWBC (p = 0.04), but not syN% (p = 0.51) as predictors. ROC analysis yielded optimal cutoff values for CRP (69 mg/L; AUC = 0.82; 95% CI 0.71-0.93) and syWBC (65,000 cells/µL; AUC = 0.79; 95% CI 0.66-0.92). A diagnostic algorithm using CRP > 69 mg/L alone, or CRP < 69 mg/L combined with syWBC > 110,000 cells/µL, predicted septic arthritis with a sensitivity of 85% (95% CI 0.62-0.97; p < 0.01) and a specificity of 90% (95% CI 0.79-0.96; p < 0.01).

Conclusion: CRP was slightly more accurate than syWBC in predicting septic arthritis. When combined in an recursive partitioning model, these parameters demonstrated strong diagnostic performance. In cases where CRP measurements may be unreliable, an elevated syWBC count represents a CRP-independent alternative, although with reduced specificity.

Level of evidence: Level III: a retrospective case-control study.

Background: Low back pain (LBP) is a leading cause of disability worldwide. Impaired lumbopelvic control contributes to chronic and recurrent LBP, often presenting as aberrant movement patterns. This study aimed to investigate whether inertial measurement units (IMUs) can classify individuals with no LBP (NoLBP), chronic LBP (CLBP), and a history of LBP (HxLBP) based on lumbopelvic kinematics.

Methods: A total of 141 participants (47 per group) performed ten standardized lumbopelvic movement control tests while wearing IMU sensors. Kinematic parameters, including mean velocity (MV), peak-to-peak amplitude (P2P), and area under the curve (AUC) of acceleration, were extracted. One-way ANOVA was used to compare kinematic differences across groups, and binary logistic regression models were developed to identify predictors for classification. Robustness analyses using 10-fold cross-validation with the least absolute shrinkage and selection operator (LASSO) were also performed.

Results: Significant group differences were found in MV, P2P, and AUC across multiple movement tests (P < 0.05). The most pronounced differences were observed between NoLBP and CLBP: individuals with CLBP were characterized by slower trunk flexion (odds ratio [OR] = 0.94, 95% CI: 0.90-0.98), greater AUC during prone hip rotation (OR = 2.78, 95% CI: 1.45-5.34), and greater P2P during trunk rotation (OR = 1.32, 95% CI: 1.12-1.55). Robustness analyses confirmed the robustness and stability of the classification models.

Conclusion: IMU-derived kinematic parameters provide objective measures of impaired movement control and may support clinical identification of individuals at risk for chronic or recurrent LBP.