Citations

Background: Chemotherapy-induced peripheral neuropathy (CIPN) and cancer-related myelopathy often cause pain, numbness, and mobility impairment. While treatments such as medications typically target positive sensory symptoms (eg, burning or tingling), negative symptoms such as numbness and proprioceptive loss remain difficult to manage and significantly affect balance and gait. This study evaluated the feasibility of using textured insoles as a noninvasive approach to improve these symptoms. Methods: A prospective feasibility study was conducted with adult patients with cancer experiencing negative sensory symptoms due to CIPN or myelopathy. Participants were provided with textured insoles designed to enhance plantar sensory input and instructed to wear them during daily activities for 1 month. Outcomes were measured pre- and postintervention using the 4-Stage Balance Test, Timed Up and Go test, and patient-reported assessments of balance and mobility. Results: Twenty participants were enrolled: 70% reported numbness, 45% gait impairment, 40% balance impairment, and 35% pain. Objective improvements in balance and gait were observed with the use of insoles, with significant Timed Up and Go gains at both initial ( P < .001) and follow-up ( P = .01) visits, adjusting for additional therapy. Sixteen participants reported improved stability and confidence after 1 month. Adherence was high, and no adverse events occurred. Conclusion: Textured insoles are a feasible, well-tolerated supportive intervention for patients with negative sensory symptoms from CIPN or cancer-related myelopathy. By enhancing sensory feedback, insoles may improve balance, mobility, and quality of life. Larger controlled trials are warranted to confirm efficacy and long-term outcomes.

We aimed to describe outcomes, including shoulder motion, deltoid strength and Disabilities of Arm, Shoulder and Hand scores, in 19 patients with terrible triad shoulder injuries (anterior shoulder dislocation, rotator cuff tear or greater tuberosity fracture, and axillary nerve injury) who required axillary nerve reconstruction. The type of nerve surgery (grafting vs. nerve transfer), demographic factors and injury characteristics were not significantly associated with outcomes. The mean postoperative abduction and Disabilities of Arm, Shoulder and Hand score were 95° and 28, respectively. Patients with rotator cuff tears had a higher Disabilities of Arm, Shoulder and Hand score (more disability) than those with isolated greater tuberosity fractures. We conclude that spontaneous recovery of the axillary nerve may not occur in patients with a terrible triad injury. Functional outcomes after axillary nerve repair are poor with respect to motion, strength and patient-reported outcomes compared with reported results for axillary nerve reconstruction in the absence of rotator cuff injury. Level of evidence: IV

AbstractNonsteroidal anti‐inflammatory drugs (NSAIDs) are a valuable class of medications for orthopedic surgeons and often play a pivotal role in pain control. However, there are many common stipulations resulting in avoidance of its use in the treatment of musculoskeletal disease. This review summarizes the mechanism of action of NSAIDs as well as provides an overview of commonly used NSAIDs and the differences between them. It provides a concise summary on the osseous effects of NSAIDs with regard to bone healing and heterotopic ossification. Most of all, it serves as a guide or reference for orthopedic providers when counseling patients on the risks and benefits of NSAID use, as it addresses the common stipulations encountered: “It irritates my stomach,” “I have a history of bariatric surgery,” “I'm already on a blood thinner,” “I've had a heart attack,” and “I've got kidney problems” and synthesizes both current research and society recommendations regarding safe use and avoidance of NSAIDs.