Citations

Objectives Ultrasound‐guided percutaneous needle fenestration (UPNF) and percutaneous needle tenotomy (UPNT) are minimally invasive procedures commonly used to treat chronic tendinopathies. However, these techniques can be painful, potentially limiting patient tolerance, satisfaction, and procedural feasibility. Although local anesthetics (LAs) provide analgesia, their potential inhibitory effects on tenocyte activity and the efficacy of orthobiologics raise concerns regarding their impact on tendon healing. The objectives of this study is to propose a practical, anatomy‐based approach for the use of ultrasound‐guided peripheral nerve blocks (USG‐PNBs) as a strategy to reduce pain and improve patient comfort during UPNF and UPNT, with or without orthobiologic adjuncts. Methods We reviewed commonly affected anatomical sites in chronic tendinopathies and identified corresponding peripheral nerve targets that can be reliably and safely blocked under ultrasound guidance. For each condition, we outline appropriate nerve block techniques, anatomical landmarks, and recommended patient positioning to optimize procedural analgesia. Results A set of targeted USG‐PNBs was defined for commonly treated tendinopathies, including supraspinatus tendinopathy, lateral and medial epicondylitis, gluteus medius and/or minimus tendinopathy, patellar tendinopathy, Achilles tendinopathy, and plantar fasciopathy. Conclusion Ultrasound‐guided peripheral nerve blocks represent a practical and effective approach to manage pain during percutaneous procedures for chronic tendinopathies. By reducing procedural discomfort and avoiding the potential drawbacks of peritendinous LAs, these techniques may enhance patient tolerance, procedural success, and overall clinical outcomes.

Latissimus dorsi (LD) and teres major (TMA) injuries are increasingly recognized as significant sources of pain in overhead athletes, particularly pitchers. These injuries are challenging to diagnose clinically, and conventional MRI often lacks sufficient detail to fully evaluate them. Musculoskeletal ultrasound (US) offers dynamic, high‐resolution evaluation and may better characterize these injuries. This pictorial review illustrates the sonographic appearance of common LD and TMA injuries, aiming to enhance diagnostic accuracy, increase clinician familiarity with this region, and support future research in injury classification using ultrasound.

Ultrasound imaging is vital for musculoskeletal assessment due to its real‐time, high‐resolution capabilities and safety. While protocols exist for rotator cuff evaluation, comprehensive guidelines for imaging the latissimus dorsi and teres major muscles are lacking. This article fills this gap by presenting a detailed ultrasound protocol for these muscles, essential for shoulder stability and movement in overhead athletes. We review their anatomy, propose a standardized examination approach, and discuss clinical indications, aiming to improve diagnostic accuracy and management of these injuries.

Abstract Background: Lumbar facet joint arthropathy (LFJA) is a major cause of low back pain (LBP), with current treatments offering limited long-term benefits. Bone marrow–derived mesenchymal stem cells (BM-MSCs) show promise due to their immunomodulatory and trophic effects, potentially addressing underlying degenerative processes in LFJA. Objectives: This initial report describes the outcomes of the first treated patient in an ongoing mutidisciplinary phase 1 clinical trial evaluating the safety and feasibility of intra-articular allogeneic BM-MSCs for painful LFJA. Methods: Following enrollment in our IRB-approved protocol, symptomatic LFJA was confirmed through double blocks on L4 and L5 medial branches. Two 1-mL syringes, each containing 10 million BM-MSCs, were prepared in the cGMP facility and administered bilaterally to the patient’s L4-L5 lumbar facet joints. The patient underwent standardized follow-ups, including clinical examinations and functional and imaging assessments for 2 years, utilizing patient-reported outcomes measurement information system—computer adaptive tests (PROMIS CATs), visual analogue scale, Oswestry disability index, work functional status and opioid pain medication use, and MR imaging Fenton–Czervionke score. Results: The patient tolerated the procedure well, with no drug-related adverse events during the study period. Pain, spine function, and work functional status improved at multiple follow-ups. This patient also reported improvements in mental and social health, along with a notable improvement in the grade of facet synovitis observed at the one-year follow-up MRI evaluation. Conclusions: This case report suggests the safety and feasibility of administering intra-articular allogeneic BM-MSCs, offering therapeutic benefits for pain management and functional activities.

AbstractPersistent chest pain (PCP) following acute COVID‐19 infection is a commonly reported symptom with an unclear etiology, making its management challenging. This scoping review aims to address the knowledge gap surrounding the characteristics of PCP following COVID‐19, its causes, and potential treatments. This is a scoping review of 64 studies, including observational (prospective, retrospective, cross‐sectional, case series, and case–control) and one quasi‐experimental study, from databases including Embase, PubMed/MEDLINE, Cochrane CENTRAL, Google Scholar, Cochrane Database of Systematic Reviews, and Scopus. Studies on patients with PCP following mild, moderate, and severe COVID‐19 infection were included. Studies with patients of any age, with chest pain that persisted following acute COVID‐19 disease, irrespective of etiology or duration were included. A total of 35 studies reported PCP symptoms following COVID‐19 (0.24%–76.6%) at an average follow‐up of 3 months or longer, 12 studies at 1–3 months and 17 studies at less than 1‐month follow‐up or not specified. PCP was common following mild—severe COVID‐19 infection, and etiology was mostly not reported. Fourteen studies proposed potential etiologies including endothelial dysfunction, cardiac ischemia, vasospasm, myocarditis, cardiac arrhythmia, pneumonia, pulmonary embolism, postural tachycardia syndrome, or noted cardiac MRI (cMRI) changes. Evaluation methods included common cardiopulmonary tests, as well as less common tests such as flow‐mediated dilatation, cMRI, single‐photon emission computed tomography myocardial perfusion imaging, and cardiopulmonary exercise testing. Only one study reported a specific treatment (sulodexide). PCP is a prevalent symptom following COVID‐19 infection, with various proposed etiologies. Further research is needed to establish a better understanding of the causes and to develop targeted treatments for PCP following COVID‐19.

Brachial plexus avulsion injuries result in permanent motor and sensory deficits, leading to debilitating symptoms. We report the case of a 25-year-old man with chronic pain following right-sided C5-T1 nerve root avulsion without evidence of peripheral nerve injury. His pain was recalcitrant to medical and neurosurgical interventions. However, he experienced substantial (>70%) pain relief with peripheral nerve stimulation targeting the median nerve. These results agree with data suggesting collateral sprouting of sensory nerves occurs following a brachial plexus injury. Further study is needed if we are to understand the mechanisms of the peripheral nerve stimulator as a treatment option.

This case series aims to highlight the efficacy of peripheral nerve stimulation (PNS) in the treatment of phantom limb pain, as well as provide an alternative method for the treatment of this pain syndrome. In this report, we describe three amputee patients with severe phantom limb pain who obtained substantial analgesia and improvement in physical functionality after implantation of a temporary PNS device. Future studies should assess predictors of successful response or poor response to PNS therapy, such as mental health, environmental stressors, coping skills, and procedural factors. These factors may facilitate an individualized approach for each patient to ensure appropriate candidacy for PNS and better prognosis. Considering that patients in our cohort did not achieve long-lasting benefit after removal of temporary PNS, future research should assess if patients with phantom limb pain would benefit from permanent PNS, rather than temporary PNS.

Back pain with radicular symptoms is associated with detrimental physical and emotional functioning and economic burden. Conservative treatments including physical, pharmacologic and injection therapy may not provide clinically significant or long-standing relief. Regenerative medicine research including Platelet rich plasma (PRP), Platelet lysate (PL) or Plasma rich in growth factors (PRGF) continues to develop, however evidence appraisal for treatment of radicular pain remains lacking. Thus, we performed a systematic review to evaluate the effectiveness of epidural steroid injections containing PRP or related products to treat radicular pain. Embase, PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases were queried. Twelve studies were included in qualitative analysis, consisting of three randomized controlled trials and nine observational studies. The primary outcome was pain intensity, and secondary outcomes included functional improvement, anatomical changes on advanced imaging, and adverse events. All studies identified improved pain intensity and functional outcomes after epidural injection of PRP, PRGF and/or PL. Similar or longer lasting pain relief was noted in the PRP cohort compared to the cohort receiving epidural steroid injections with effects lasting up to 12–24 months. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) analysis revealed a very-low certainty of evidence due to risk of bias, indirectness, and imprecision.

Abstract Diversity, equity, and inclusion have been recognized as important drivers of excellence and innovation in the physician workforce. Given the historical underrepresentation of women in medicine, gender diversity is of interest. In this cross-sectional study, we sought to quantify leadership representation of female physicians in primary care sports medicine settings, including primary care sports medicine fellowship programs, select sports medicine societies, and select sports medicine-related scientific journals. Data were collected by querying the corresponding web site for each fellowship program, society, and journal and analyzed in a descriptive manner. Results showed that fewer female physicians hold primary care sports medicine leadership roles than men do. This work establishes a baseline for female representation in primary care sports medicine leadership; efforts should continue to increase the presence of women in leadership positions.