Twohey, Eric E.

Objective: Percutaneous needle tenotomy (PNT) and ultrasonic debridement (UD) are minimally invasive interventions for the management of chronic tendinopathy. Despite their increasing use, no standardized, evidence-based rehabilitation guidelines currently exist to direct clinicians in post-procedural management. This systematic review aimed to characterize and synthesize reported rehabilitation protocols following PNT and UD for patellar, proximal hamstring, and gluteal tendinopathies. Design: Systematic Review Results: Twenty-seven studies met inclusion criteria, with patellar tendon procedures (n=13) being the most common, followed by gluteal (n=6), proximal hamstring (n=3), and multi-tendon protocols (n=5). Of the included studies, 21 (78%) utilized percutaneous needle tenotomy (PNT) and six (22%) used ultrasound debridement or Tenex. Exercise restrictions were mandated in 19 studies (70%), while 12 (44%) provided a detailed, structured rehabilitation program, frequently emphasizing eccentric loading for patellar and hamstring tendons. Weight-bearing limitations were uncommon, appearing in only three studies (11%). Fifteen studies (56%) combined the procedure with platelet-rich plasma (PRP). Pharmacological protocols also showed high variance, with NSAID restrictions ranging from 1 to 28 days and corticosteroid avoidance lasting between 10 days and one year. Overall, substantial variability remains regarding recommended activity progression, exercise initiation, and mechanical loading strategies across current research. Conclusion: PNT and UD appear effective for managing refractory tendinopathy, yet post-procedure rehabilitation guidelines remain inconsistent and supported by limited high-quality evidence. Future research should aim to identify key variables that guide individualized rehabilitation progressions, optimizing recovery timelines, and facilitating safe and efficient return to activity following PNT and UD procedures.

Abstract Jagim, AR, Horswill, CA, Dobbs, WC, Twohey, EE, Tinsley, GM, Fields, JB, and Jones, MT. Minimum wrestling weight for high school girls wrestling: Time to revisit minimal body fat percent. J Strength Cond Res 39(3): 332–339, 2025—The purpose of this study was to determine whether an alternative body fat percentage (BF%) could be established as a safer margin for minimal wrestling weight (MWW) determination by evaluating the distribution of BF% and MWW values naturally occurring for high school girls wrestling. Data from the 2022–2023 high school season were retrospectively analyzed. In total, 33,321 female wrestlers completed skinfold (SKF) assessments or bioelectrical impedance analysis (BIA) in accordance with sport governing body mandates for weight certification. Frequency statistics and descriptive analysis were performed to compute normative MWW and BF% profiles. Body fat percentage thresholds of 12% (12MWW) and the BF% value defining the lowest fifth percentile were used to determine the resulting MWW and minimum weight class for each method. The median ± interquartile range for BF% was 28.3 ± 9.2%. There was a difference ( p < 0.001) in BF% values between BIA (28.4 ± 6.8%) and SKF (29.4 ± 7.6%), but a trivial effect size (ES = 0.14). The fifth percentile for BF% was 19%, which was used for alternative MWW determination (19MWW). 12MWW and 19MWW were 11.2 ± 6.4 kg ( p < 0.001; ES = 1.8) and 8.6 ± 7.7 kg ( p < 0.001; ES = 1.1) lower than the body mass of the wrestlers at the time of weight certification. Nearly all BF% values were above the 12% threshold currently used to determine MWW. Current body weights were more than 9.1 kg above MWW values for both 12MWW and 19MWW. Increasing the minimum BF% threshold from 12 to 19% would affect a small percentage of wrestlers and improve the margin of safety for those intent on achieving a lower weight class.

AbstractObjectiveTo analyze the association between preoperative electrodiagnostic (EDX) studies and postoperative pain and functional outcomes following ulnar nerve decompression and/or transposition for ulnar neuropathy at the elbow (UNE).Literature SurveyProtocol was submitted and database search was conducted by an experienced librarian of all available studies in the English language from 1990 to June 8, 2022. Databases included Ovid MEDLINE(R) and Epub Ahead of Print, In‐Process & Other Non‐Indexed Citations and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, and Scopus.MethodologyInclusion criteria consisted of randomized controlled trials, prospective and retrospective longitudinal studies, and studies involving adults ≥18 years of age who underwent ulnar nerve decompression and/or transposition for UNE. Study quality and risk of bias were assessed using the National Heart, Lung, and Blood Institute (NHLBI) Study Quality of Assessment Tool. Certainty in evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. A meta‐analysis was not performed.SynthesisA total of 289 studies were screened, and 8 retrospective cohort studies met inclusion criteria comprising 762 patients. A decreased or absent preoperative sensory nerve action potential amplitude (SNAP) showed significance with worse postoperative outcomes. The presence of preoperative conduction block showed significance in higher quality studies. There was limited evidence for slow preoperative motor conduction velocities or preoperative electromyography (EMG) abnormalities and postoperative outcomes. Overall quality assessment demonstrated that two studies had “good,” four “fair,” and two “poor” quality of evidence. Certainty in evidence was “low” due to risk of bias.ConclusionsA decreased or absent preoperative ulnar SNAP may predict worse postoperative outcomes. Per higher quality studies, preoperative conduction block at the elbow may also predict worse postoperative outcomes. Careful interpretation is required with a full understanding of the limited evidence, risk of bias, and low certainty in evidence to support the use of preoperative EDX to predict postoperative outcomes in UNE.