Int Orthop. 2025 Mar 28. doi: 10.1007/s00264-025-06505-4. Online ahead of print.

NO ABSTRACT

PMID:40152988 | DOI:10.1007/s00264-025-06505-4

Int Orthop. 2025 Mar 28. doi: 10.1007/s00264-025-06506-3. Online ahead of print.

ABSTRACT

PURPOSE: Firearm-related injuries in children and adolescents have increased over the past decade. The standard of care for ballistic fractures in children is complex, resulting in a burden of healthcare follow-up that many families find challenging. Consistent follow-up is crucial, especially in orthopaedic trauma and firearm cases, to prevent complications. This study aims to identify demographic and clinical variables associated with loss to follow-up (LTFU) in paediatric patients with ballistic fractures.

METHODS: This is a retrospective registry study at a Level I trauma centre for patients aged zero to 21 who presented with a ballistic-induced fracture. Patients with isolated skull, facial, or rib fractures were excluded. Follow-up was dichotomized at the median number of follow-up days for analysis. Logistic regression analysis was used to identify predictors of LTFU.

RESULTS: The study included 144 patients with a median age of 18 years. The majority were male (89%) and White (72%). Most patients had government insurance (44%) or were uninsured (33%). The mechanism of injury was primarily assault (71%). Operative intervention occurred in 55% of cases. Key factors increasing follow-up adherence included male sex (p = 0.011), higher injury severity scores (p = 0.009), requiring operative intervention (p < 0.001), air transportation (p < 0.001), or injury at a private residence (p = 0.040). Uninsured status (p = 0.007), opioid use (p = 0.047), and greater distance from the hospital (p = 0.002) were associated with low follow-up.

CONCLUSIONS: This study identifies key factors influencing follow-up adherence in pediatric patients with ballistic fractures. Identifying these factors allows for tailoring future interventions to improve follow-up adherence for this vulnerable population.

PMID:40152987 | DOI:10.1007/s00264-025-06506-3

Int Orthop. 2025 Mar 26. doi: 10.1007/s00264-025-06512-5. Online ahead of print.

ABSTRACT

PURPOSE: The direct anterior approach (DAA) in total hip arthroplasty (THA) has a risk of lateral femoral cutaneous nerve (LFCN) injury. Long-term outcomes and therapeutic options for such injuries are poorly investigated. This study evaluates the impact of iatrogenic LFCN lesions on long-term outcomes and investigates treatments like ultrasound-guided nerve infiltration or neurolysis.

METHODS: Our institutional database of primary THAs (2014-2022) was searched for patients with iatrogenic LFCN lesions after DAA, confirmed via ultrasound or electroneurography. First, retrospective analysis of the effects of ultrasound-guided nerve infiltration and neurolysis. Second, clinical-radiological assessment of pain, function, incision, and affected skin area. Patient-reported outcomes (OHS, COMI Hip, UCLA) were compared to a matched non-LFCN injury control group.

RESULTS: Of 8136 patients, 29 (0.36%) met inclusion criteria, with 22 undergoing ultrasound diagnostics. Eighteen received nerve infiltration (improvement after one (n = 7), two (n = 3) or three (n = 1) infiltrations), and two had neurolysis. After a mean follow-up of 4.95 years, 13 patients were assessed. Common symptoms included hypesthaesia (11), dysesthesia (6), and tingling (3), with a mean affected area of 253cm2 ± 64.8. 24-months questionnaires for the LFCN group (OHS 39.2 ± 8.6, COMI Hip 2.4 ± 2.7, UCLA 6.5 ± 1.6) were worse than the control group (OHS 46.2 ± 2.3, COMI Hip 0.6 ± 0.8, UCLA 7.2 ± 1.5), though differences were not statistically significant.

CONCLUSION: Instrumentally proven LFCN lesions after DAA THA are rare but lead to worse long-term outcomes. Ultrasound-guided nerve infiltration shows favorable results for symptom management.

PMID:40140107 | DOI:10.1007/s00264-025-06512-5

Int Orthop. 2025 Mar 26. doi: 10.1007/s00264-025-06504-5. Online ahead of print.

NO ABSTRACT

PMID:40137944 | DOI:10.1007/s00264-025-06504-5

Int Orthop. 2025 Mar 22. doi: 10.1007/s00264-025-06500-9. Online ahead of print.

ABSTRACT

PURPOSE: Cutibacterium species, formerly known as Propionibacterium, are gram-positive, anaerobic bacilli increasingly recognized as a cause of periprosthetic joint infection (PJI) following total hip arthroplasty (THA). This study aimed to compare the incidence of Cutibacterium-associated PJI among different surgical approaches for THA.

METHODS: A retrospective review was conducted on patients treated for Cutibacterium-associated PJI following THA between 2011 and 2021. Patients were categorized based on the surgical approach: direct anterior (DAA), lateral, or posterior. A total of 211 patients met inclusion criteria, comprising 153 men (72.5%) and 58 women (27.5%).

RESULTS: Among the 211 cases of Cutibacterium-associated PJI, 102 (48.3%) underwent THA via DAA, 63 (29.9%) via a lateral approach, and 46 (21.8%) via a posterior approach. There were no significant differences between groups in age, sex, laterality, BMI or fistula formation. The incidence of Cutibacterium PJI was significantly higher with DAA compared to the lateral (P < 0.001) and posterior approaches (P < 0.001), while no significant difference was observed between lateral and posterior approaches (P = 0.059). The rate of Cutibacterium-associated PJI has increased since 2016.

CONCLUSION: Nearly half of all Cutibacterium PJIs were associated with the DAA. Surgeons should be aware of this increased risk and implement appropriate preventive measures when performing THA via DAA.

PMID:40119900 | DOI:10.1007/s00264-025-06500-9

Int Orthop. 2025 Mar 21. doi: 10.1007/s00264-025-06495-3. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the efficacy of tibiotalocalcaneal arthrodesis using retrograde nailing (TTCAN) in post-traumatic conditions with high septic risk. We hypothesized that this minimally invasive technique would achieve bone union and satisfactory functional recovery without increasing septic risk.

METHODS: A prospective single-centre observational study included 20 patients who underwent TTCAN between January 2020 and December 2023. The primary outcome was the complete joint fusion rate at six months. Secondary outcomes included pain assessment, complications, functional evaluation using the modified AOFAS score, and quality of life assessment using the SF-12 questionnaire.

RESULTS: Complete tibiotalocalcaneal fusion was achieved in 55% of patients at six months. Diabetes was significantly associated with fusion failure (p = 0.026). For nonunion cases (n = 14), the consolidation rate reached 78.6% at six months and 92.9% at final follow-up. The mean modified AOFAS score was 48.4 ± 17.5 at six months, improving to 51.2 ± 19.3 at final follow-up (mean 15.6 months). Quality of life assessment showed greater impact on physical (PCS-12: 32.0 ± 6.9) than mental (MCS-12: 47.0 ± 12.7) components. Complications included delayed healing (25%) and one superficial infection.

CONCLUSION: TTCAN proves to be a reliable salvage solution for complex ankle and hindfoot trauma in high-risk septic contexts, enabling limb preservation with acceptable functional outcomes and minimal complications.

PMID:40116881 | DOI:10.1007/s00264-025-06495-3

Int Orthop. 2025 Mar 21. doi: 10.1007/s00264-025-06456-w. Online ahead of print.

ABSTRACT

PURPOSE: Early onset scoliosis (EOS) surgery with growth rods has complications. While casting is an alternative, special frames and training are often unavailable. Our study evaluates a simple, reproducible casting technique for EOS using universally available equipment without a special casting table.

METHODS: 27 children with EOS underwent serial casting with a simple technique using two standing stools, a Cervical Sayre traction kit, and a metal plate. Casts were changed every three to four months. Pre, post, and follow-up Cobb angles and complications were recorded. Patients were grouped into congenital (CS) and non-congenital (NCS) EOS and compared.

RESULTS: 27 children (mean age 4.15 years) with EOS underwent 116 casting procedures (mean 4.29 casts/patient). Significant curve correction (63.85° to 33.8°) was noted (p < 0.05). NCS had better correction than CS post-first cast (p < 0.05). Complications included three dermatitis and one mild respiratory distress.

CONCLUSION: The technique yielded results similar to those of traditional casting tables/frames and is ideal for resource-limited settings.

PMID:40116880 | DOI:10.1007/s00264-025-06456-w

Int Orthop. 2025 Mar 21. doi: 10.1007/s00264-025-06502-7. Online ahead of print.

ABSTRACT

PURPOSE: Rotator cuff (RC) tears are common in older adults, often leading to muscle atrophy. Standard arthroscopic repair has high re-tear rates, prompting the use of biological patches for augmentation. This study assessed differences in range of motion, strength, and tendon healing using ultrasound in primary and revision RC repairs using acellular dermal allograft augmentation.

METHODS: Forty-eight patients undergoing arthroscopic RC repair with dermal allograft augmentation were assessed, with 42 completing a median follow-up of 32.4 months. Twenty patients had primary repairs and 22 had revision procedures. A control group of 26 patients, matched for age, sex, BMI, and RC injury type, underwent RC repair without patch augmentation. Active range of motion, Constant-Murley socre (CS), Simple Shoulder Test (SST), Subjective Shoulder value (SSV) and isometric strength were measured. Tendon healing was assessed via dynamic US.

RESULTS: Both primary and revision groups showed significant improvements in clinical scores and shoulder mobility. However, the primary group had significantly higher postoperative CS, SST and SSV scores. Strength tests indicated lower values in the revision group compared to primary and control groups. Ultrasound outcomes showed reduced tendon thickness in 23 patients, with similar repair integrity across groups. Five cases of RC re-tears were noted, with higher but not significantly different re-tear rates in the revision group.

CONCLUSION: Dermal allograft augmentation in RC repair leads to significant clinical improvement in both primary and revision cases, but strength recovery is less pronounced in revision repairs. Long-term follow-up is necessary to validate these findings and assess the durability of tendon healing.

LEVEL OF EVIDENCE: Level III, Retrospective cohort design, Treatment study.

PMID:40116879 | DOI:10.1007/s00264-025-06502-7

Int Orthop. 2025 Mar 20. doi: 10.1007/s00264-025-06498-0. Online ahead of print.

ABSTRACT

Nerve injury primarily leads to neuropathic pain but may also have overlapping elements of nociplastic pain or ongoing nociceptive pain. Electrical stimulation is particularly effective in the treatment of neuropathic pain and may be effective for nociplastic and nociceptive pain. While multiple mechanisms contribute to the analgesic effect of electrical stimulation, the most widely accepted theory for the predominant effect is that of Melzack and Wall's gate control theory. According to this theory, non-painful sensory input carried by low-threshold large-diameter Aβ fibres disrupt the transmission of pain signals in small pain fibers (Aδ and C fibres). This occurs through the activation of inhibitory interneurons in the dorsal horn, which ultimately blocks pain signal transmission.This theory has been employed for different forms of stimulation, including transcutaneous electrical nerve stimulation (TENS), percutaneous electrical nerve stimulation (PENS), and peripheral nerve stimulation (PNS). Each of these methods offers a different approach to localized stimulation and neuromodulation for the treatment of pain. TENS is a non-invasive technique, that delivers electrical currents via surface electrodes placed on the skin. PENS, in contrast, is a minimally invasive method that applies electrical currents through small needles inserted near a target muscle or neural structure. PNS involves the implantation of temporary or permanent electrodes to deliver electrical stimulation directly to peripheral nerves. These modalities are widely used to manage various pain conditions including non-malignant, chronic musculoskeletal and neuropathic pain, such as chronic low back pain, neck pain, neuropathic pain, myofascial pain, and post-operative pain. TENS is particularly notable as a non-invasive device that is affordable, over-the-counter, self-administered, and nonpharmacological option that does not pose the risk of toxicity or overdose. PENS stands out for its ability to integrate electrical stimulation therapy with electroacupuncture through a minimally invasive technique. PNS, on the other hand, is unique in its capacity to precisely target specific nerves and provide a range of stimulation options for extended treatment durations.This article provides a narrative overview of TENS, PENS and PNS with a particular focus on their application for neuropathic pain management and for athletes. We will review mechanisms of action, indications, diagnostic and treatment algorithms, as well as complications and limitations. The overview concludes with a complex case study demonstrating the use of various electrical stimulation therapies, ultimately to successful pain resolution for the patient.

PMID:40111452 | DOI:10.1007/s00264-025-06498-0

Int Orthop. 2025 Mar 20. doi: 10.1007/s00264-025-06496-2. Online ahead of print.

NO ABSTRACT

PMID:40111451 | DOI:10.1007/s00264-025-06496-2

Int Orthop. 2025 Mar 20. doi: 10.1007/s00264-025-06481-9. Online ahead of print.

ABSTRACT

PURPOSE: Tendon lengthening is a common lower limb surgical procedure in paediatric orthopaedics and deformity correction. Healing of a lengthened tendon is typically supported by casting and unloading of the operated limb. Although tendon rupture or overcorrection may adversely affect surgical outcomes, few studies have examined surgical means of improving post-operative stability of the tendon. We aim to evaluate a novel method for augmenting Z-Plasty tendon lengthening as a first step to clinical translation.

METHODS: In this experimental ex vivo study, we employed a bovine flexor tendon model (n = 18) to examine a novel mechanical augmentation method after tendon lengthening by Z-plasty. Conventional surgical suturing of the imposed Z-plasty (n = 6) and an experimental group (n = 6), in which additional augmentation was performed by interlocking fibres of a biomaterial scaffold to the underlying tendon using a novel micro-needling technique, were compared to native tendons (n = 6).

RESULTS: The needle interlocked scaffold successfully augmented the suture repair, showing more than doubled ultimate failure force compared to controls (482 ± 107 N vs. 206 ± 37 N, p < 0.01), and more than 1.5-fold repair stiffness (41 ± 7 N/mm vs. 26 ± 9 N/mm, p < 0.01).

CONCLUSION: We conclude that the use of an interpenetrating biomaterial scaffold represents a promising new approach for improving biomechanical tendon properties, which may have an implication on the stability of tendon suture, lengthening and tendon transfer procedures as well as on post-operative management and earlier mobilization.

PMID:40111450 | DOI:10.1007/s00264-025-06481-9

Int Orthop. 2025 Mar 19. doi: 10.1007/s00264-025-06501-8. Online ahead of print.

ABSTRACT

PURPOSE: This study seeks to explore whether intra-wound vancomycin powder (IVP) is a cost-effective adjunct to standard of care (SOC) in patients undergoing total joint arthroplasty (TJA) from a US payor perspective.

METHODS: A decision-analytic model in the form of a decision tree was developed to compare the cost and outcomes of IVP with those of SOC in preventing periprosthetic joint infections (PJI) in TJA patients. The base case analysis assumes a hypothetical practice with an equal volume (50/50) of THA and TKA procedures in both the IVP + SOC and the SOC arm. Cost and clinical effectiveness data were obtained from published literature. Sensitivity and threshold analyses were used to estimate how changing inputs would impact the cost-effectiveness of IVP.

RESULTS: Deterministic results found that in the base case model, IVP as an adjunct to SOC generates a cost saving of $260.38/patient. In scenario analysis, where THA and TKA procedures were separated, the estimated cost saving was $241.50/patient and $279.27/patient, respectively. Break-even analysis showed that the cost of IVP per patient would need to be $244.82-$282.59, or the PJI relative risk (RR) be approximately 0.99. Probabilistic analysis found IVP + SOC was cost-saving in 99.26% of the 10,000 iterations in the base case model.

CONCLUSION: Applying local vancomycin as an adjunct to SOC in primary TJA is not just cost effective, but cost-saving in reducing PJIs, saving an average of $260.38/patient. Depending on individual institution/practice infection rates and revision surgery costs, local vancomycin administration for primary TJA should be considered.

PMID:40107989 | DOI:10.1007/s00264-025-06501-8

Int Orthop. 2025 Mar 18. doi: 10.1007/s00264-025-06488-2. Online ahead of print.

ABSTRACT

PURPOSE: International Medical Graduates (IMGs) have lower match rates than their United States (U.S.)-trained Doctor of Allopathic Medicine (MD) and Doctor of Osteopathic Medicine (DO) peers. This study aims to more completely elucidate the research accomplishments required for IMGs to match into orthopaedic residency and to compare their academic productivity during residency to that of U.S. MD and DO graduates.

METHODS: Data from orthopaedic-related journals and ACGME-accredited residency programs were extracted in July of 2024 using Python. Variables included: residency year, publications, first-author publications, citations, journals, h-index, medical school type, and the medical school and residency program locations.

RESULTS: Prior to residency, the 56 matched IMGs had a mean of 32.8 publications, 9.8 first-author publications, and 517.1 citations. Matched U.S. MDs had an average of 3.7 publications, 1.1 first-author publications, and 61.0 citations while DO matched applicants had an average of 3.7 publications, 1.0 first-author publications, and 5.6 citations. During residency, IMG orthopaedic residents averaged 5.2 publications per year and 16.6 citations per year. U.S. MD residents averaged 1.3 publications per year and 3.6 citations per year, while DO residents averaged 0.55 publications per year and 1.1 citations per year. The h-index averaged 9.8 for IMGs, 2.2 for U.S. MDs and 0.7 for DOs. All comparisons for IMGs vs. U.S. MDs and IMGs vs. DOs yielded P < 0.0001.

CONCLUSION: These findings highlight the significant differences in research output between IMGs and their U.S.-trained counterparts in orthopaedic surgery, and show that these differences continue throughout residency.

PMID:40100391 | DOI:10.1007/s00264-025-06488-2

Int Orthop. 2025 Mar 18. doi: 10.1007/s00264-025-06497-1. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of this scoping review is to analyze the application of artificial intelligence (AI) in ultrasound (US) imaging for diagnosing carpal tunnel syndrome (CTS), with an aim to explore the potential of AI in enhancing diagnostic accuracy, efficiency, and patient outcomes by automating tasks, providing objective measurements, and facilitating earlier detection of CTS.

METHODS: We systematically searched multiple electronic databases, including Embase, PubMed, IEEE Xplore, and Scopus, to identify relevant studies published up to January 1, 2025. Studies were included if they focused on the application of AI in US imaging for CTS diagnosis. Editorials, expert opinions, conference papers, dataset publications, and studies that did not have a clear clinical application of the AI algorithm were excluded.

RESULTS: 345 articles were identified, following abstract and full-text review by two independent reviewers, 18 manuscripts were included. Of these, thirteen studies were experimental studies, three were comparative studies, and one was a feasibility study. All eighteen studies shared the common objective of improving CTS diagnosis and/or initial assessment using AI, with shared aims ranging from median nerve segmentation (n = 12) to automated diagnosis (n = 9) and severity classification (n = 2). The majority of studies utilized deep learning approaches, particularly CNNs (n = 15), and some focused on radiomics features (n = 5) and traditional machine learning techniques.

CONCLUSION: The integration of AI in US imaging for CTS diagnosis holds significant promise for transforming clinical practice. AI has the potential to improve diagnostic accuracy, streamline the diagnostic process, reduce variability, and ultimately lead to better patient outcomes. Further research is needed to address challenges related to dataset limitations, variability in US imaging, and ethical considerations.

PMID:40100390 | DOI:10.1007/s00264-025-06497-1

Int Orthop. 2025 Mar 17. doi: 10.1007/s00264-025-06492-6. Online ahead of print.

NO ABSTRACT

PMID:40095073 | DOI:10.1007/s00264-025-06492-6

Int Orthop. 2025 Mar 17. doi: 10.1007/s00264-025-06499-z. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to evaluate the clinical efficacy of endoscopic plantar fascia release through the modified dual medial deep fascia approach for the treatment of refractory plantar fasciitis.

METHODS: A retrospective study was conducted involving 34 patients with refractory plantar fasciitis treated by endoscopic plantar fascia release through the modified dual medial deep fascia approach. Among them, 25 patients had concurrent calcaneal spurs. All patients were followed for a minimum of 12 months. Functional outcomes were assessed using the Visual Analogue Scale (VAS) and the American Orthopaedic Foot and Ankle Society (AOFAS) score, while structural evaluations included the Medial Longitudinal Arch Angle (MLAA), navicular tuberosity height-to-foot length ratio (NH/FL), and the Arch Index (AI). Differences between patients with and without calcaneal spurs were also analyzed.

RESULTS: All patients completed at least 12 months of follow-up, with primary wound healing in all cases. Two patients experienced transient plantar skin numbness and small toe abduction difficulty, which resolved within three months. The VAS score decreased significantly from 6.53 ± 1.19 preoperatively to 1.18 ± 0.76 postoperatively, and the AOFAS score improved from 52.41 ± 5.23 to 93.29 ± 3.91 (both P < 0.05), indicating statistical significance. However, changes in the MLAA, NH/FL and AI were not statistically significant. Apart from age differences (49.04 ± 4.41 vs. 34.56 ± 3.13), no significant differences in other scores were observed between the calcaneal spur group and the non-calcaneal spur group at the final follow-up. Moreover, compared to the methods reported in other studies, our study demonstrated a shorter operative time and superior pain and functional outcomes.

CONCLUSION: The dual medial deep fascia approach for endoscopic plantar fascia release is a safe, quick, effective, and minimally invasive technique that yields favourable clinical outcomes. It has certain advantages compared to other techniques. The presence of calcaneal spurs does not impact postoperative outcomes.

PMID:40095072 | DOI:10.1007/s00264-025-06499-z

Int Orthop. 2025 Mar 17. doi: 10.1007/s00264-025-06472-w. Online ahead of print.

ABSTRACT

PURPOSE: Study of the sagittal accuracy of the 'Robotic Surgical Assistant' (ROSA®), compared to conventional surgery, regarding the application of the tibial slope (TS). Study of the impact of TS on the range of motion (ROM) and patient-reported outcome measures (PROMS).

METHODS: Inclusion of patients who underwent primary Total Knee Arthroplasty (TKA) between 1/1/2021 and 15/4/2024. Divided into robotic-assisted TKA (RA-TKA) and manual TKA (M-TKA). Measurement of pre- and post-operative TS, using the posterior tibial cortex, on profile knee X-rays. 3° TS applied arbitrarily for both groups. ROM was measured pre-operatively and at three, six and 12 months post-operatively. Patient satisfaction assessed via Knee Injury and Osteoarthritis Outcome Score (KOOS) and Oxford Knee Score (OKS).

RESULTS: 266 patients were included in the study. The M-TKA (110) had a post-operative TS of 3.11° (± 2.12°). 81.21% were within 2° of the target and 92.87% within 3°. The RA-TKA (82) had a post-operative TS of -0.11° ± (1.93°). 36.83% were within 2° of the target and 56.63% within 3°. RA-TKA had a KOOS of 64.43 ± 12.87 and OKS of 33.05 ± 6.01. M-TKA had a KOOS of 64.18 ± 13.11 and OKS of 32.31 ± 5.97. Maximum flexion at 12 months was 118.74° ± 8.19° for M-TKA and 121.88° ± 7.43° for RA-TKA (p = 0.002).

CONCLUSION: The application of TS using ROSA® was less precise than the conventional method in achieving post-operative TS values as measured on X-rays. However, there were no clinical differences in ROM or PROMS.

PMID:40095071 | DOI:10.1007/s00264-025-06472-w

Int Orthop. 2025 Mar 17. doi: 10.1007/s00264-025-06494-4. Online ahead of print.

ABSTRACT

BACKGROUND: understanding the concept of multiple compression neuropathy syndrome has recently evolved, leading to better clinical assessment and evaluation. However, decompression of the involved nerves might require multiple incisions. Concomitant compression neuropathy, such as Lacertus Syndrome (LS) and cubital tunnel syndrome, is not uncommon. The traditional approach for releasing both nerves encompasses two separate surgical incisions. Minimazing surgical incisions is essential for postoperative scar management and nerve gliding. In this paper we describe a single surgical incision for releasing both compressions.

SURGICAL TECHNIQUE: To release the Lacertus Fibrosis using the classical surgical incision for cubital tunnel syndrome, an incision is made between the medial epicondyle and olecranon. After reaching the brachial fascia, the skin and subcutaneous tissue are raised as a one flap off the fascia. The lacertus fibrosis, identified as a thick rectangular or trapezoid stracture attached to the brachial fascia, is then incised to expose the median nerve beneath it.

CONCLUSION: As we advance towards the concept of multiple compression neuropathy, it is crucial to minimize surgical incisions to reduce pain, wound breakdown, scar formation, traction neuropathy, neuroma formation, and unsatisfactory aesthetic outcomes.

PMID:40095070 | DOI:10.1007/s00264-025-06494-4

Int Orthop. 2025 Mar 14. doi: 10.1007/s00264-025-06465-9. Online ahead of print.

ABSTRACT

BACKGROUND: The suprascapular and axillary nerves can be subject to entrapment due to both their anatomical courses and their anatomical relationships with surrounding anatomical structures around shoulder. These entrapments were previously considered as a diagnosis of exclusion. However, today these pathologies can be diagnosed as primary. The most common complaints of patients are pain and sometimes weakness. The clinician's suspicion is very important in making diagnosis. The patient's history, duration of symptoms, and information such as the movements in which the complaints increase should be questioned carefully and in detail. In physical examination, symmetrical evaluation of both shoulders can provide important information. In addition, cervical and brachial plexus pathologies should be kept in mind. According to the suprascapular and axillary nerve innervations, muscle atrophy should be evaluated during inspection. Range of motion and neurological examination around shoulder should be performed. Since these entrapments can be seen together with rotator cuff tears and labrum pathologies etc., these additional pathologies should also be targeted during evaluation. The evaluation should be expanded with imaging methods such as plain radiographs, ultrasonography, computed tomography, magnetic resonance imaging, electrodiagnostic studies and local anaesthetic injections to the entrapment area. There is no definitive method to diagnose these pathologies. As a result of all these evaluations, a diagnosis can be made. There is no consensus on treatment. In isolated entrapment cases where there are no additional surgical pathologies such as space-occupying lesions, non-operative treatment is primarily recommended. It is generally recommended to try non-operative treatment for at least six months. Surgical treatment is recommended in cases where non-operative treatment fails or in cases where there are additional pathologies requiring surgery or in cases where there is extrinsic compression such as sapce-occupying lesions. In the decision and choice of surgical treatment, it is very important to determine the aetiology precisely. Surgical treatment can be performed open and arthroscopically. Various additional arthroscopic portals and techniques have been described. However, there is no clear consensus on the superiority of these treatments over each other. Although physical therapy is recommended after surgical treatment, there is no consensus on this issue in the literature.

AIM: This review aims to summarize the diagnosis and management of suprascapular and axillary nerve entrapments in athletes, focusing on clinical presentation, diagnostic methods, treatment options, and current controversies.

PMID:40082300 | DOI:10.1007/s00264-025-06465-9

Int Orthop. 2025 Mar 14. doi: 10.1007/s00264-025-06493-5. Online ahead of print.

ABSTRACT

BACKGROUND: The role of lacertus fibrosis as the primary perpetrator behind the illusive pronator teres syndrome is becoming increasingly recognized in recent literature. The aim of this systematic review is to explore the outcomes of lacertus fibrosis release in patients complaining of proximal median nerve entrapment signs and symptoms.

METHODOLOGY: In this systematic review, Pubmed, Cochrane Library, Scopus, Ovid databases were reviewed. Studies in which structures, other than the lacertus fibrosus, in the proximal forearm had been concomitantly released were deemed illegible. Various outcome assessment tools were utilized; those were pain, numbness, and satisfaction visual analog scales, return of function and muscle strength, quick DASH, work DASH, and activity DASH scores. Adherence to PRISMA guidelines was maintained.

RESULTS: A total of seven studies, three interventional and 4 retrospective observational studies, were included in this review out of 118 articles. These included 446 participants who underwent lacertus fibrosis release with a mean age of 45 years old across a mean duration of postoperative follow-up of 16.1 months. A significant proportion of the patients had a history of unsuccessful conservative or surgical management (prior carpal tunnel release in 10.5%). Minimal access surgery under WALANT was performed in 95%, US-guided release under WALANT in 3.3%, and open exploration was done in 1.5%. A horizontal incision hidden in the elbow flexion creese was done in 74.2%, oblique incision 2 cm distal and 2 cm radial to the medial epicondyle in 20.8%, and open exploration through a Z-shaped incision over the antecubital fossa in 1.5%. Immediate pain relief and return of function and strength was reported in 99.6%. A significant improvement was reported in postoperative quick DASH (mean = 24 points), work DASH (mean = 28.8 points), and activity DASH (mean = 44.8 points). Further, a significantly lower VAS score was obtained on pain, numbness, and paraesthesia scales. There were two complications, a case of postoperative haematoma and another case of surgical site infection. Seven patients complained of residual symptoms by the end of the follow up duration; carpal tunnel release was done in three and release of superficialis arcade was necessitated in four other cases.

CONCLUSION: Lacertus syndrome can be optimally managed by surgically releasing the lacertus fibrosus. This can be done as a minimally invasive procedure under WALANT. A high index of suspicion is required when encountering patients with signs and symptoms of median nerve entrapment, specifically those who were treated unsuccessfully with the presumption of carpal tunnel syndrome.

PMID:40082299 | DOI:10.1007/s00264-025-06493-5