BMC Musculoskeletal Disorders最新文献

Objectives: This study aimed to examine the impact of handwriting versus iPad writing on cervical alignment and pinch muscle strength among female university students at the Faculty of Physical Therapy, Cairo University.

Methods: Thirty female students were divided into two equal groups: Group A engaged in handwriting, and Group B used iPad writing. The mean body mass index of the participants was 25.12 kg/m². Each participant was instructed to write for 15 min. Cervical range of motion (ROM) devices were used to assess cervical flexion, lateral bending, and rotation, whereas key pinch strength was measured to evaluate the strength of the dominant pinch muscles.

Results: Analysis of variance (ANOVA) indicated no significant differences in the pinch strength outcome variables between the handwriting and iPad writing groups, F (1, 28) = 12.54, P = 0.25; η² = 0.05. The handwriting group exhibited lower mean values within their group compared to the iPad group. Furthermore, a repeated-measures ANOVA comparing the groups revealed no significant difference in the mean cervical range of motion (ROM) in flexion between the two groups (P = 0.67). However, the mean values for the handwriting group increased post-writing compared to those for the iPad group. The repeated-measures ANOVA between groups also demonstrated no significant difference in the mean cervical range of motion values for rotation to the right after writing for either group (P = 0.34) or for the cervical range of motion for rotation to the left (P = 0.49); however, an increase in the mean values of cervical rotation to the right was observed for the handwriting group.

Conclusions: Using an iPad increases the degree of lateral bending and rotation to the left and right. In addition, the degree of right rotation increased in the iPad group. However, key-pinch muscle strength was lower in the handwriting group than in the iPad writing group.

Background: Objective radiological predictors of sedation requirement during closed reduction of anterior shoulder dislocation have not been clearly established. This study aimed to evaluate the association between humeral head displacement parameters and computed tomography (CT)-based deltoid muscle morphology and attenuation with sedation requirement.

Methods: A total of 467 patients presenting with anterior shoulder dislocation between May 2020 and February 2026 were retrospectively screened, and 213 patients were included after applying exclusion criteria. Closed reduction was performed without sedation in 182 patients and under procedural sedation in 31 patients. Humeral head displacement length, humeral head area, and the displacement length-to-head area index (HNADI) were measured on anteroposterior radiographs. CT measurements included anterior, lateral, and posterior deltoid muscle thicknesses, total cross-sectional area, and deltoid muscle attenuation (Hounsfield Units, HU). Independent predictors of sedation requirement were analyzed using multivariate logistic regression.

Results: Patients requiring sedation were significantly older (p=0.022), and age remained an independent predictor in multivariate analysis (OR=1.052, p=0.003). Deltoid HU was significantly higher in the sedation group (p<0.001) and independently associated with sedation requirement (OR=1.133, p<0.001). Humeral head displacement length, humeral head area, HNADI, and deltoid muscle morphometric parameters were not independently associated with sedation requirement.

Conclusion: Sedation requirement during closed reduction of anterior shoulder dislocation is associated with advanced age and increased deltoid HU rather than bony displacement parameters. CT-based assessment of deltoid HU may have potential as an adjunctive parameter for pre-procedural sedation planning.

Background: Despite advances in medical treatment for ankylosing spondylitis (AS), total hip arthroplasty (THA) remains essential for managing advanced hip involvement. However, how the clinical characteristics and real-world treatment patterns of AS patients undergoing THA have evolved over the past two decades, and whether these trends differ according to age at disease onset, remains unclear.

Methods: We conducted a retrospective cohort study of AS patients who underwent THA between 2001 and 2023. Patients were stratified by age at symptom onset (juvenile-onset AS [JAS]: ≤16 years; adult-onset AS [AAS]: >16 years) and surgery period (2001-2011 and 2012-2023). Demographics, clinical characteristics, laboratory parameters, and treatment patterns were compared between groups.

Results: Among 1,032 patients included, 204 (19.8%) were classified as JAS and 828 (80.2%) as AAS. Comparing 2001-2011 with 2012-2023, median age at surgery increased (36.0 vs. 42.0 years, P < 0.001), employment rate improved (69.3% vs. 82.5%, P < 0.001), and biologic agent use increased (0% vs. 10.5%, P < 0.001). JAS patients showed earlier disease onset (13.0 vs. 22.0 years, P < 0.001), shorter diagnostic delays (4.0 vs. 9.0 years, P < 0.001), but higher inflammatory markers (CRP: 20.9 vs. 11.9 mg/L, P < 0.001) compared to AAS patients. An increasing proportion of unilateral procedures was observed in both groups (JAS: 22.1% to 41.5%; AAS: 33.5% to 52.0%).

Conclusion: This two-decade analysis described temporal changes in the clinical characteristics and management patterns of patients with ankylosing spondylitis (AS) undergoing total hip arthroplasty (THA), including increased use of biologic therapy. Within this THA-based surgical cohort, juvenile-onset AS (JAS) patients showed distinct clinical features compared with adult-onset AS (AAS) patients, including earlier disease onset and higher inflammatory burden. An increasing proportion of unilateral procedures was observed over time; however, the reasons for this trend cannot be determined from the present retrospective descriptive design and require further study.

Objective: Recurrent deformity following surgical correction remains a complex and technically demanding condition. This study aimed to evaluate the clinical and radiographic outcomes of minimally invasive surgery (MIS) in patients undergoing revision procedures for recurrent hallux valgus (HV).

Methods: This retrospective case series included 33 feet that underwent minimally invasive revision surgery using either the third generation Minimally Invasive Chevron-Akin (MICA) or the fourth-generation Metaphyseal Extra-Articular Transverse and Akin osteotomies (META), following failure of a previous hallux valgus correction performed by open or minimally invasive techniques. Clinical outcomes were assessed using the Manchester-Oxford Foot Questionnaire (MOXFQ), the Visual Analogue Scale (VAS) for pain, and patient satisfaction. Radiographic parameters and complications were recorded and statistically analysed using R software.

Results: Both techniques proved effective in angular correction, with significant reductions in the hallux valgus angle (HVA) and intermetatarsal angle (IMA) (p < 0.001), as well as in bone and soft-tissue forefoot width (p < 0.05). Significant improvements were also observed in all three MOXFQ domains (p < 0.001) and in VAS scores (p < 0.001). Subgroup analysis revealed no statistically significant differences between MICA and META in either radiographic or clinical outcomes related to pain and function (p > 0.05).

Conclusion: Third- and fourth-generation minimally invasive surgical techniques have proven effective in correcting radiographic parameters and improving pain and functional scores in patients undergoing revision for recurrent hallux valgus, with a low rate of complications.

Level of evidence: Level IV, retrospective case series.

The posterior horns of the medial menisci are more commonly injured during exercise. Cushioning insoles are one of the most widely used conservative interventions for preventing knee joint injuries. However, the effect of the cushion property of insoles on the knee joints with meniscal tears remain unknown. We investigated the effects of insoles with different cushioning properties on the knee joint following a radial tear of the posterior horn of the medial meniscus. Full extension landing with a heel-first strike pattern was performed by 12 participants randomly wearing ethylene vinyl acetate (EVA) and artificial cartilage foam (ACF) insoles, and the peak plantar pressures (pPP) were measured. The right knee of the participant whose pPP was closest to the median was loaded to a finite element model with radial tear. The pPP of EVA insoles (2386.42 ± 298.29 N) was higher than that of ACF (2174.16 ± 270.63 N) (t = 7.84, P < 0.001). The finite element analysis revealed that the peak von Mises Stress (pVMS) values of the medial and lateral menisci were 12.32 MPa and 7.90 MPa for injured joint with EVA, and 9.02 MPa and 6.84 MPa for injured joint with ACF. Hence, insoles with higher cushioning can decrease the vertical impact force and stress concentration of the knee joint after radial tear of the posterior horn of the medial meniscus.

Objective: A recent study demonstrated that subcutaneous fat tissue thickness (SFTT) at the L1-L2 level is predicting paraspinal muscle fatty infiltration. Given that fat distribution patterns differ between males and females, we calibrated the SFTT index to obtain a standardized subcutaneous fat index (SSFI).

Methods: A total of 175 patients admitted between January 2023 and July 2024 were included in this study. Based on lumbar CT attenuation values, patients were classified into an osteoporosis group (HU ≤ 110) and a normal bone density group (HU > 110). Demographic characteristics and clinical variables, including age, BMI, sex, medical history, and the standardized subcutaneous fat index (SSFI), were compared between the two groups. Pearson correlation analysis was subsequently performed to evaluate the associations between SSFI1 and other variables. Multiple linear regression analyses were conducted to further assess the relationships between SSFI1 and multifidus fatty infiltration, erector spinae fatty infiltration, frailty index, and vertebral bone quality (VBQ). Finally, receiver operating characteristic (ROC) curve analysis was performed to evaluate the ability of SSFI1 to discriminate osteoporosis.

Results: Patients with osteoporosis were older than the control group, while no significant differences were observed in smoking, alcohol consumption, diabetes, or hypertension between the two groups. Compared with controls, patients with osteoporosis showed lower SSFI1 values, greater paraspinal muscle fatty infiltration, and higher frailty index and VBQ scores. Moreover, SSFI was lower in both male and female patients with osteoporosis. Pearson correlation analysis further demonstrated that SSFI1 was significantly associated with paraspinal muscle fatty infiltration, lumbar bone mineral density, femoral bone mineral density, frailty index, and VBQ. Multiple linear regression analysis revealed that SSFI1 was associated with VBQ. ROC curve analysis indicated that SSFI1 had potential value in distinguishing osteoporosis from non-osteoporotic individuals. When the cutoff value of SSFI1 was < 0.29, the area under the curve (AUC) was 0.642, with a sensitivity of 0.696 and a specificity of 0.921, suggesting that SSFI1 may serve as a potential imaging marker for osteoporosis.

Conclusion: SSFI1 was significantly reduced in patients with osteoporosis and was closely associated with paraspinal muscle fatty infiltration, bone mineral density, frailty index, and VBQ. In addition, SSFI1 demonstrated potential value in distinguishing osteoporosis from non-osteoporotic individuals. These findings suggest that SSFI1 may serve as a simple and accessible imaging biomarker for evaluating bone quality and may provide a novel approach for the early identification and risk stratification of osteoporosis.

Background: This study aimed to compare the clinical efficacy and minimal invasiveness of percutaneous endoscopic lumbar discectomy (PELD) and unilateral biportal endoscopic (UBE) in the treatment of calcified lumbar disc herniation (CLDH), to provide evidence for spinal surgeons to select the most appropriate surgical method for individual patients.

Methods: A retrospective analysis was conducted on the data of 49 CLDH patients who underwent PELD or UBE in our hospital from January 2016 to August 2024, including 20 who underwent PELD and 29 who underwent UBE. The demographic, clinical, and perioperative data of the two groups of patients were collected and analyzed.

Results: All surgeries were completed successfully, with significant improvement in clinical symptoms observed in both groups postoperatively. The mean fluoroscopy frequency was 5.52 times higher in the PELD group than in the UBE group. The average operative time in the PELD group was 9.21 min shorter than in the UBE group. The mean preoperative-to-postoperative difference in hemoglobin level was 3.65 g/L lower in the PELD group than in the UBE group. The mean preservation rate of the lumbar facet joints was 9.10% higher in the PELD group than in the UBE group. These differences were statistically significant (P < 0.05). The excellent-to-good rate was 90.00% in the PELD group and 93.10% in the UBE group. Additionally, two patients in the PELD group experienced complications, and two patients had recurrence at 12 months postoperatively, with no severe outcomes. No complications or postoperative recurrences were observed in the UBE group.

Conclusions: PELD and UBE are both effective minimally invasive procedures for the treatment of CLDH. The short-term clinical efficacy of the two methods is similar; PELD is characterized by shorter operative time, less intraoperative blood loss, and less damage to facet joints. The advantages of UBE are more sufficient surgical field exposure and more flexible operation, though it may require a wider range of facet joint resection. Clinical decision-making should be based on the patient's clinical symptoms, imaging features, and the surgeon's procedural expertise to formulate an individualized surgical plan.

Background: Reverse total shoulder arthroplasty (RTSA) is increasingly performed among older adults, and postoperative functional recovery is closely associated with patients' engagement in rehabilitation. However, participation in home-based rehabilitation varies widely, posing ongoing challenges for nurses involved in discharge education and post-discharge support. This study applied the Health Belief Model (HBM) to explore patients' lived experiences and self-management behaviors during home-based rehabilitation.

Methods: A qualitative descriptive study was conducted at a tertiary hospital in southwest China. Purposive sampling with maximum variation was used to recruit patients within six months after primary unilateral RTSA. Data were collected through face-to-face semi-structured interviews and analyzed using directed content analysis guided by the HBM.

Results: Five themes were identified: perceived threats to recovery, anticipated benefits of rehabilitation, perceived barriers to home-based rehabilitation, cues to action, and dynamic changes in self-efficacy. Patients interpreted health threats holistically, encompassing physical, functional, and psychosocial concerns. Perceived benefits were primarily related to regaining independence and resuming valued daily activities. Barriers operated across individual, familial, and healthcare system contexts. Cues to action were embedded in ongoing interpersonal interactions. Self-efficacy evolved over time, increasing as patients accumulated successful rehabilitation experiences.

Conclusion: Patients' engagement in home-based rehabilitation after RTSA is influenced by dynamic and context-specific health beliefs, and applying a HBM-informed perspective may inform the development of individualized nursing strategies to support sustained rehabilitation engagement.

Background: Isolated greater tuberosity (GT) fractures account for approximately 20% of proximal humeral fractures and are frequently associated with glenohumeral dislocation and rotator cuff injuries. Displacement exceeding 5 mm is recommended for surgery to prevent subacromial impingement and functional impairment. Current fixation methods, such as cannulated screws, suture anchors, and locking plates, each have limitations, including inadequate stability for comminuted fractures, risk of impingement, and suboptimal anatomical adaptation. This underscores the necessity of a hybrid technique that integrates the benefits of both soft tissue and rigid fixation.

Methods: This retrospective study analyzed 12 patients with comminuted split-type or avulsion-type greater tuberosity fractures treated with a hybrid surgical technique from January 2023 to June 2025. A deltopectoral approach was utilized to achieve fracture reduction, which was temporarily stabilized via K-wires. Two anchors were placed at the greater tuberosity, and a double-row suture technique was employed, with the sutures secured through an external row anchor arranged in a parachute configuration. A low-profile anatomic locking plate was subsequently applied to provide buttress support, resulting in a composite construct referred to as a "suture plate." The outcomes measured included operative time, blood loss, Constant-Murley and ASES scores, VAS pain scores, and radiographic healing status.

Results: All patients were followed up for a mean duration of 11.3 ± 5.0 months. The mean operative time was 82.5 ± 15.8 min, and the mean blood loss volume was 170.8 ± 52.6 ml. All fractures achieved clinical union at a mean of 11.0 ± 1.5 weeks, with no instances of anchor pullout, suture cutout, or implant failure. The Constant-Murley scores improved from 30.5 ± 4.8 preoperatively to 90.3 ± 3.7, the ASES scores improved from 32.1 ± 5.8 to 89.4 ± 3.6, and the VAS scores decreased from 6.8 ± 2.1 to 1.0 ± 0.6. Excellent or good outcomes were observed in 91.7% (11/12) of the patients.

Conclusion: The combination of the double-row parachute suture technique and a low-profile anatomic locking plate provides a hybrid fixation system that integrates flexible and rigid stabilization. This construct can provide reliable fixation, supporting early rehabilitation, and yielding satisfactory short-term functional outcomes for comminuted split-type or avulsion-type greater tuberosity fractures, representing a potentially feasible alternative to conventional methods, although further high-level studies are required to confirm its long-term efficacy and safety.

Background: Effective postoperative analgesia after lumbar transpedicular fixation (TPF) surgery remains challenging because of extensive tissue trauma and high nociceptive burden. Ultrasound-guided fascial plane blocks have emerged as important components of multimodal analgesia in spinal surgery. This study aimed to compare the analgesic efficacy, opioid consumption, technical performance, and quality of recovery associated with the modified thoracolumbar interfascial plane (mTLIP) block versus the anterior quadratus lumborum block (QLB) in patients undergoing two- or three-level lumbar TPF surgery.

Methods: In this prospective, randomized, single-center trial, 100 patients (ASA I-II) scheduled for two- or three-level lumbar TPF surgery were randomly assigned to receive bilateral ultrasound-guided mTLIP (n = 50) or anterior QLB (n = 50) in addition to standardized general anesthesia and multimodal postoperative analgesia. The primary outcome was cumulative fentanyl consumption during the first 24 postoperative hours. Secondary outcomes included interval opioid consumption, postoperative pain scores, time to first analgesic request, block performance characteristics, opioid-related adverse effects, and quality of recovery assessed using the QoR-15 questionnaire.

Results: Baseline demographic and surgical characteristics were comparable between groups. Fentanyl consumption during the first 4 postoperative hours was significantly lower in the mTLIP group compared with the QLB group (75 [50-125] µg vs. 125 [75-175] µg; p = 0.017). Opioid consumption during the 4-8 h and 8-24 h intervals, as well as total 24-hour fentanyl consumption, did not differ significantly between groups. Postoperative pain scores at rest and during movement, time to first analgesic request, additional analgesic requirements, QoR-15 scores, and opioid-related adverse effects were similar. The mTLIP block demonstrated significantly shorter performance time and superior needle visualization compared with QLB (p < 0.001).

Conclusions: In patients undergoing multi-level lumbar TPF surgery, the mTLIP block provided superior opioid-sparing analgesia in the early postoperative period compared with anterior QLB, while overall analgesic efficacy and quality of recovery were comparable thereafter. Improved technical performance and procedural efficiency may favor mTLIP as a practical regional analgesia option in extensive lumbar spinal surgery.