Histo-Anatomy and Sonographic Examination for the Retrocalcaneal Bursal Complex: EURO-MUSCULUS/USPRM Approach.

Insertional Achilles tendinopathy is an umbrella medical term referring to pain and swelling on the posterior aspect of the calcaneus. High-resolution ultrasound imaging is commonly used in daily practice to assess the pathological changes of the Achilles tendon, cortical bone of the calcaneus, and soft tissues located inside the retrocalcaneal space to optimize the management of relevant patients. To the best of our knowledge, a standardized ultrasound protocol to evaluate the retrocalcaneal bursal complex is lacking in the pertinent literature. In this sense, our step-by-step sonographic approach is intended to be an easy and ready-to-use guide for sonographers/physicians in daily practice to assess this anatomical complex in patients with Achilles tendinopathy. Needless to say, the peculiar histological features of this V-shaped synovial/fibrocartilaginous bursa surrounding the posteroinferior wedge of the Kager's fat pad and the retrocalcaneal space make the examination challenging.

Insights into the cardiovascular benefits of taurine: a systematic review and meta-analysis.

BACKGROUND: Cardiovascular disease (CVD) remains the foremost cause of mortality globally. Taurine, an amino acid, holds promise for cardiovascular health through mechanisms such as calcium regulation, blood pressure reduction, and antioxidant and anti-inflammatory effects. Despite these potential benefits, previous studies have yielded inconsistent results. This meta-analysis of randomized controlled trials (RCTs) aims to evaluate the existing evidence on the quantitative effects of taurine on hemodynamic parameters and cardiac function grading, which are indicative of overall cardiovascular health and performance. METHODS: We conducted an electronic search across multiple databases, including Embase, PubMed, Web of Science, Cochrane CENTRAL, and ClinicalTrials.gov, from their inception to January 2, 2024. Our analysis focused on key cardiovascular outcomes, such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), left ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) Functional Classification. Meta-regression was applied to explore dose-dependent relationships based on the total taurine dose administered during the treatment period. A subgroup analysis, stratified according to the baseline disease status of patients, was also conducted. RESULTS: The analysis included a pooled sample of 808 participants from 20 randomized controlled trials. Taurine demonstrated a significant reduction in HR (weighted mean difference [WMD] = -3.579 bpm, 95% confidence interval [CI] = -6.044 to -1.114, p = 0.004), SBP (WMD = -3.999 mm Hg, 95% CI = -7.293 to -0.706, p = 0.017), DBP (WMD: -1.435 mm Hg, 95% CI: -2.484 to -0.386, p = 0.007), NYHA (WMD: -0.403, 95% CI: -0.522 to -0.283, p < 0.001), and a significant increase in LVEF (WMD: 4.981%, 95% CI: 1.556 to 8.407, p = 0.004). Meta-regression indicated a dose-dependent reduction in HR (coefficient = -0.0150 per g, p = 0.333), SBP (coefficient = -0.0239 per g, p = 0.113), DBP (coefficient = -0.0089 per g, p = 0.110), and NYHA (coefficient = -0.0016 per g, p = 0.111), and a positive correlation with LVEF (coefficient = 0.0285 per g, p = 0.308). No significant adverse effects were observed compared to controls. In subgroup analysis, taurine significantly improved HR in heart failure patients and healthy individuals. Taurine significantly reduced SBP in healthy individuals, heart failure patients, and those with other diseases, while significantly lowered DBP in hypertensive patients It notably increased LVEF in heart failure patients and improved NYHA functional class in both heart failure patients and those with other diseases. CONCLUSIONS: Taurine showed noteworthy effects in preventing hypertension and enhancing cardiac function. Individuals prone to CVDs may find it advantageous to include taurine in their daily regimen.

Successful evaluation of a new image-based parameter for the diagnosis of carpal tunnel syndrome: ultrasound assessment of longitudinal median nerve gliding in patients, healthy volunteers, and cadavers.

BACKGROUND: Reduced longitudinal median nerve gliding is a new promising diagnostic feature in carpal tunnel syndrome (CTS). However, the complexity of existing ultrasound analysis protocols undermines the application in routine clinical practice. AIM: To provide a simple method for assessing longitudinal gliding with ultrasound, without the need for post-hoc image analysis. DESIGN: 1) Retrospective cohort study, validation by external blinded reviewers; 2) proof of concept in body donors. SETTING: 1) Outpatient clinic; 2) anatomy department. POPULATION: The population included 48 patients with idiopathic CTS diagnosed by electrodiagnostic testing and ultrasound, as well as 15 healthy controls. Twelve, non-frozen, non-embalmed body donors were enrolled. METHODS: Longitudinal gliding of the median nerve in the carpal tunnel was visualized in all patients with idiopathic CTS and healthy controls. All ultrasound videos were pseudonymized, equipped with a scale, and randomized. Videos were analyzed by four independent radiologists, all blinded to clinical characteristics. The endpoint was gliding rated as millimeters. Validity of the technique was tested by using speckle tracking software, and in body donors, directly measuring nerve excursion in situ, simultaneously to ultrasound. RESULTS: Gliding differed significantly between controls and patients with CTS, decreasing with incremental CTS severity. A cut-off value of 3.5 mm to identify patients with CTS, yielded 93.8% sensitivity and 93.3% specificity. Intraclass correlation coefficient among senior author and raters was 0.798 (95% CI 0.513 to 0.900, P<0.001), indicating good reliability. Speckle tracking and especially direct validation in body donors correlated well with ultrasound findings. CONCLUSIONS: First, longitudinal median nerve gliding can reliably be assessed using this simple technique without the need for complicated procedures. Second, a decrease in gliding was found with progressive severity of CTS. Reproducibility for measured distances is good among raters. CLINICAL REHABILITATION IMPACT: An easy to apply sonography parameter would bolster the diagnostic ability of specialists in physical medicine and rehabilitation in daily routine.

The Effect of Lumbopelvic Manipulation for Pain Reduction in Patellofemoral Pain Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Patellofemoral pain syndrome (PFPS) is one of the most common etiologies of knee pain and might be relieved with lumbopelvic manipulation (LPM). This meta-analysis aimed to investigate the effects of LPM on pain reduction in patients with PFPS. Electronic databases were searched from inception to December 2023 for randomized controlled trials (RCTs) investigating the effects of LPM on PFPS. The primary outcome was the change in visual analog or numeric rating scale scores assessing pain. Ten studies comprising 346 participants were included. Significant pain reduction was noted in the LPM group (Hedges' g = -0.706, 95% confidence interval [CI] = -1.197 to -0.214, p = 0.005, I2 = 79.624%) compared with the control group. Moreover, pain relief was more pronounced when LPM was combined with other physical therapies (Hedges' g = -0.701, 95% CI = -1.386 to -0.017, p = 0.045, I2 = 73.537%). No adverse events were reported during the LPM. The LPM appears to be a safe and effective adjuvant therapy for pain reduction in patients with PFPS. Clinicians should consider adding LPM to other physical therapies (e.g., quadriceps muscle strengthening) during the management of these patients.

Ultrasound examination for injury of the wrist extensor retinaculum.

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Ultrasound imaging and guidance in the management of myofascial pain syndrome: a narrative review.

Myofascial pain syndrome (MPS) is a common musculoskeletal disorder characterized by muscle pain, tenderness, and trigger points. Ultrasonography has emerged as a key tool for diagnosing and treating MPS owing to its ability to provide precise, minimally invasive guidance. This review discusses the use of ultrasonography in various approaches to evaluate and manage MPS. Studies have shown that shear-wave sonoelastography can effectively assess muscle elasticity and offer insights into trapezius stiffness in patients with MPS. Ultrasound-guided interfascial hydrodissection, especially with visual feedback, has demonstrated effectiveness in treating trapezius MPS. Similarly, ultrasound-guided rhomboid interfascial plane blocks and perimysium dissection for posterior shoulder MPS have significantly reduced pain and improved quality of life. The combination of extracorporeal shockwave therapy with ultrasound-guided lidocaine injections has been particularly successful in reducing pain and stiffness in trapezius MPS. Research regarding various guided injections, including dry needling, interfascial plane blocks, and fascial hydrodissection, emphasizes the importance of ultrasonography for accuracy and safety. Additionally, ultrasound-guided delivery of local anesthetics and steroids to the quadratus lumborum muscle has shown lasting pain relief over a 6-month period. Overall, these findings highlight the pivotal role of ultrasonography in the assessment and treatment of MPS.

Superficial retrocalcaneal bursae and nerves: From anatomy to ultrasound-guided procedures.

The pertinent literature widely describes ultrasound-guided procedures targeting the retrocalcaneal bursa and the tendon tissue to manage insertional Achilles tendinopathy. Synovial bursae and cutaneous nerves of the superficial retrocalcaneal pad are often overlooked pain generators and are poorly considered by clinicians and surgeons. A layer-by-layer dissection of the superficial soft tissues in the retrocalcaneal region of two fresh frozen cadavers was matched with historical anatomical tables of the textbook Traite d'Anatomie Topographique Avec Applications Médico-Chirurgicales (1909 by Testut and Jacob). An accurate and detailed description of the superficial retrocalcaneal pad with its synovial bursae and cutaneous nerves was provided. Cadaveric dissections confirmed the compartmentalized architecture of the superficial retrocalcaneal fat pad and its histological continuum with the superficial lamina of the crural fascia. Superficial synovial tissue islands have been demonstrated on the posterior aspect of the Achilles tendon in one cadaver and on the posterolateral surface of the tendon in the other one. Digitalization of the original anatomical tables of the textbook Traite d'Anatomie Topographique Avec Applications Médico-Chirurgicales (1909 by Testut and Jacob) showed five potential locations of the superficial calcaneal bursa and a superficial retrocalcaneal nerve plexus within the Achilles tendon-fat pad interface. In clinical practice, in addition to the previously described interventions regarding the retrocalcaneal bursa and the tendon tissue, ultrasound-guided procedures targeting the synovial and neural tissues of the superficial retrocalcaneal pad should be considered to optimize the management of insertional Achilles tendinopathy.

Taurine reduces the risk for metabolic syndrome: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Metabolic syndrome (MetS) is a cluster of interconnected risk factors that significantly increase the likelihood of cardiovascular disease and type 2 diabetes. Taurine has emerged as a potential therapeutic agent for MetS. This meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the effects of taurine supplementation on MetS-related parameters. METHODS: We conducted electronic searches through databases like Embase, PubMed, Web of Science, Cochrane CENTRAL, and ClinicalTrials.gov, encompassing publications up to December 1, 2023. Our analysis focused on established MetS diagnostic criteria, including systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), triglyceride (TG), and high-density lipoprotein cholesterol (HDL-C). Meta-regression explored potential dose-dependent relationships based on the total taurine dose administered during the treatment period. We also assessed secondary outcomes like body composition, lipid profile, and glycemic control. RESULTS: Our analysis included 1024 participants from 25 RCTs. The daily dosage of taurine in the studies ranged from 0.5 g/day to 6 g/day, with follow-up periods varying between 5 and 365 days. Compared to control groups, taurine supplementation demonstrated statistically significant reductions in SBP (weighted mean difference [WMD] = -3.999 mmHg, 95% confidence interval [CI] = -7.293 to -0.706, p = 0.017), DBP (WMD = -1.509 mmHg, 95% CI = -2.479 to -0.539, p = 0.002), FBG (WMD: -5.882 mg/dL, 95% CI: -10.747 to -1.018, p = 0.018), TG (WMD: -18.315 mg/dL, 95% CI: -25.628 to -11.002, p < 0.001), but not in HDL-C (WMD: 0.644 mg/dl, 95% CI: -0.244 to 1.532, p = 0.155). Meta-regression analysis revealed a dose-dependent reduction in DBP (coefficient = -0.0108 mmHg per g, p = 0.0297) and FBG (coefficient = -0.0445 mg/dL per g, p = 0.0273). No significant adverse effects were observed compared to the control group. CONCLUSION: Taurine supplementation exhibits positive effects on multiple MetS-related factors, making it a potential dietary addition for individuals at risk of or already experiencing MetS. Future research may explore dose-optimization strategies and potential long-term benefits of taurine for MetS management.

Comparative Effectiveness of Different Exercises for Reducing Pain Intensity in Primary Dysmenorrhea: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Studies have demonstrated that exercise can mitigate the intensity of menstrual pain in primary dysmenorrhea, but the most effective type of exercise remains unclear. The objective of this systematic review and network meta-analysis was to evaluate the effectiveness of different exercise regimens in reducing pain associated with primary dysmenorrhoea. METHODS: Randomized controlled trials investigating the relationship between menstrual pain and exercise were selected from major electronic databases until February 2, 2024. The primary outcome was the effect of exercise on pain intensity measured by the mean difference on a 10-cm visual analogue scale at 4 and 8 weeks after intervention. The secondary outcome was the difference in risk of dropout at 8 weeks. The study protocol was registered as INPLASY202330050. RESULTS: This systematic review and network meta-analysis included 29 randomized controlled trials, which involved 1808 participants with primary dysmenorrhea. Exercise interventions included relaxation exercise, strength training, aerobic activity, yoga, mixed exercise, and the Kegel maneuver. Relaxation exercise was the most effective in reducing menstrual pain in 4 weeks (- 3.56; 95% confidence interval: - 5.03 to - 2.08). All exercise interventions were effective in reducing menstrual pain at 8 weeks, with reductions ranging from - 3.87 (95% CI - 5.51 to - 2.22) for relaxation exercise to - 2.75 (95% CI - 4.00 to - 1.51) for yoga, compared to the control group. Relaxation exercises were found to have a significantly lower dropout risk (- 0.11; 95% CI - 0.20 to 0.02), while none of the exercise types was associated with a higher dropout risk than the control group. CONCLUSION: All exercise interventions were effective in reducing menstrual pain in primary dysmenorrhea after 8 weeks of intervention. However, relaxation exercise was found to be the most effective intervention at 4 and 8 weeks and had the lowest risk of dropout.

This analysis aimed to see how effective different types of exercise are in reducing pain in women with primary dysmenorrhea. The researchers looked at 29 studies involving 1808 participants and evaluated six different types of exercise. The main outcome was the effect of pain reduction after 4 and 8 weeks of exercise. The researchers found that all types of exercise were effective in reducing menstrual pain after 8 weeks, with relaxation exercises being the most effective at both 4 and 8 weeks. None of the exercise types were associated with higher dropout risks than the control group, and relaxation exercise had a lower dropout risk than the other types of exercise.

Pictorial Essay on Ultrasound and Magnetic Resonance Imaging of Paraspinal Muscles for Myofascial Pain Syndrome.

The paraspinal muscles of the cervical, thoracic, and lumbar spine are important pain generators because muscle strains or myofascial pain syndrome caused by trigger points are common during clinical practice. Ultrasonography is the most convenient imaging tool for evaluating these muscles due to its advantages, such as providing good delineation of soft tissues, easy accessibility, and zero radiation. Additionally, ultrasound can serve as a useful guiding tool for paraspinal muscle intervention to prevent inadvertent injuries to vital axial neurovascular structures. This pictorial essay presents ultrasound scanning protocols for the paraspinal and other associated muscles as well as a discussion of their clinical relevance. Axial magnetic resonance imaging has also been used to elucidate reciprocal anatomy. In conclusion, ultrasound imaging proves to be a valuable tool that facilitates the differentiation of individual paraspinal muscles. This capability significantly enhances the precision of interventions designed to address myofascial pain syndrome.

Ultrasound imaging of the transversus nuchae muscle: a potential entrapment site for the lesser occipital nerve.

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Enhancing Overhead Throwing Ball Velocity after Core Muscle Training in Athletes: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the influence of core muscle training (CMT) on throwing ball velocity among overhead throwing athletes. DESIGN: A literature search was performed from inception to July 2023 for randomized controlled trials (RCTs) investigating the effects of CMT on overhead throwing ball velocity. The primary outcome was the change in standing throwing ball velocity. The secondary outcome focused on the enhancement of step/jump throwing ball velocity. RESULTS: Seven RCTs were included, revealing a significant improvement in standing throwing ball-velocity in the group undergoing CMT (Hedges' g = 0.701, 95% confidence interval [CI] = 0.339 to 1.063, p < 0.001). Longer treatment duration and a higher frequency of CMT sessions per week contributed to improved standing throwing ball velocity. However, CMT did not show significant benefits for step (Hedge's g = 0.463, 95% CI = -0.058 to 0.985, p = 0.082) and jump throwing ball-velocity (Hedges' g = 0.550, 95% CI = -0.051 to 1.152, p = 0.073). CONCLUSION: CMT significantly enhanced standing ball throwing velocity. However, its effect on step/jump-throwing ball velocity was less certain. Further research is needed to explore the impact of CMT (especially its long-term effects) on throwing ball velocity.

Effectiveness of Lumbar Segmental Stabilization Exercises in Managing Disability and Pain Intensity Among Patients with Lumbar Spondylolysis and Spondylolisthesis: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: This study aims to assess the effectiveness of lumbar segmental stabilization exercises (LSSE) in managing spondylolysis and spondylolisthesis. SUMMARY OF BACKGROUND DATA: Spondylolysis and spondylolisthesis are spinal disorders associated with lumbar segmental instability. LSSE have shown positive effects in treating these conditions; however, systematic reviews and meta-analyses are lacking. METHODS: A systematic search adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including studies from the inception of the databases used up to January 2024, was conducted. Disability improvement and pain intensity change were the primary and secondary outcomes, respectively, standardized using Hedges' g. Eligible articles underwent independent scrutiny by two authors, who also performed data extraction and quality assessment. Data pooling was accomplished using a random-effects model. RESULTS: In total, five randomized controlled trials comprising 198 participants were included, revealing a trend effect toward disability improvement in the LSSE group (Hedges' g=-0.598, 95% CI=-1.211 to 0.016, P=0.056, I2=75.447%). When the LSSE was administered as a single treatment, disability improvement became significant (Hedges' g=-1.325, 95% CI=-2.598 to -0.053, P=0.041, I2=80.020%). No significant effect of LSSE on pain reduction was observed (Hedges' g=-0.496, 95% CI=-1.082 to 0.090, P=0.097, I2=73.935%). CONCLUSION: In summary, our meta-analysis suggests that LSSE can potentially improve disability, especially when used as a single treatment. LSSE appears more beneficial in reducing disability than alleviating pain. Future research on different patient groups is needed to understand comprehensively LSSE's effects on other musculoskeletal disorders.

Ultrasound imaging of the posterior lateral corner of the knee: a pictorial review of anatomy and pathologies.

Assessment of the posterior lateral knee pain poses diagnostic challenges, requiring accurate evaluation of various structures in light of the medical history and physical examination. Despite substantial progress in the ultrasonographic diagnosis of musculoskeletal disorders, the current protocol (EURO-MUSCULUS/USPRM. Basic scanning protocols for knee) fails to conduct a comprehensive investigation into the intricate, tendons, and ligaments of the posterior lateral knee. This pictorial review aims to bridge this gap by offering a systematic approach to utilize ultrasound examination of the less-discussed structures in this specific region. Providing cadaveric and magnetic resonance images, this essay demonstrates the efficacy of ultrasound in diagnosing posterior lateral knee pain. Notably, pathologies such as ligamentous sprains and tears are clearly discernible. Moreover, the integration of ultrasound guidance plays a vital role in reducing the risk of inadvertent neurovascular injury during injection, such as the common peroneal nerve and lateral genicular artery. This comprehensive approach will enhance clinicians' understanding and equip them with effective management strategies for posterior lateral knee pain.Critical relevance statement In this visual exposition, we delve into the intricacies of the posterior lateral corner of the knee. Offering a methodical approach to employ ultrasound for visualization of the less-explored structures within this region, the authors aim to enhance the diagnosis in posterior lateral knee pain.Key points1. Ultrasound excels at revealing intricate structures in the posterior lateral knee.2. Due to proximity of vital structures, extreme caution is crucial during injections.3. Employing dynamic scan and understanding ligaments enables a comprehensive exploration of pathologies.

Ultrasonographic Diagnosis of Finger Flexor Tendon Hypoplasia in a Child with Phalangeal Agenesis.

Agenesis and hypoplasia affecting multiple flexor tendons within the same hand represent an exceedingly uncommon occurrence, with no previous studies addressing this condition. This report details a 4-year-old girl with agenesis of the right third and fourth fingers, who sought consultation due to the inability to flex her seemingly unaffected second and fifth fingers. Ultrasound examination revealed substantial thinning of the flexor tendons in the second to fifth digits, with a notable absence of attachment to the middle phalanx. In addition to flexor tendon hypoplasia, hypoplasia of the third and fourth middle phalanges was observed. Hand deformities featuring both finger agenesis and flexor tendon hypoplasia across multiple fingers were exceptionally rare. In such instances, ultrasound, in conjunction with radiography, emerges as the recommended initial imaging tool for comprehensive evaluation of both the phalangeal bones and flexor tendons.

A systematic review on sonoelastography for rotator-cuff post-repair assessment.

Surgical repair of rotator cuff tears is performed routinely; however, the risks of re-tears and the associated consequences are significant. Sonoelastography, an imaging modality that evaluates the mechanical properties of tissues, can examine the dynamic transitions in rotator cuff stiffness following retear and investigate the relationship between these changes and the occurrences of retears. This systematic review aimed to summarize the role of perioperative sonoelastography in repaired rotator cuffs. A comprehensive search of the PubMed, Embase, and Cochrane databases was conducted, covering studies published until June 19, 2023. The Newcastle-Ottawa scale was used for quality assessment. The key information extracted from each study included the injury/surgery type, follow-up duration, sonoelastography mode, and main sonoelastographic findings. Eleven eligible studies comprising 355 patients were included. All studies focused on supraspinatus muscles and tendons with previous arthroscopic repairs. During the postoperative 1st - 6th months, muscle stiffness increased in the supraspinatus and decreased in the ipsilateral deltoid. Failure to recover supraspinatus muscle elasticity might be indicative of potential tendon re-tear; however, it is imperative to first establish correlations with other imaging modalities. Conflicting findings have been observed regarding stiffening or softening of the supraspinatus tendon after surgical repair. The preoperative stiffness of the supraspinatus tendon did not correlate with postoperative tendon integrity or function.

Ultrasound Imaging of the Articularis Genus Muscle: Implications for Ultrasound-Guided Suprapatellar Recess Injection.

Elucidating its dynamic interaction within the knee joint, this exploration delves into the awareness regarding the articularis genus muscle for ultrasound-guided suprapatellar recess injections. While injections into the infrapatellar recess may proceed without ultrasound guidance, we highlight concerns regarding the potential cartilage injury. In contrast, especially with ultrasound guidance, suprapatellar recess injections significantly mitigate this risk, especially in the case of collapsed recess. Originating from the distal femur and vastus intermedius, the articularis genus muscle influences the tension of the suprapatellar recess during knee motion. Sonographically identifying this muscle involves visualizing the slender linear structure of the suprapatellar recess, with guidance on differentiation from the vastus intermedius. We provide a succinct approach to ultrasound-guided suprapatellar recess injections, emphasizing needle insertion techniques and strategies to prevent fluid accumulation. In conclusion, this study serves as a concise clinician's guide, underscoring the significance of the articularis genus muscle's sonoanatomy in ultrasound-guided suprapatellar recess injections. Ultimately, procedural precision and patient safety can be advanced in this aspect.