Upper limb spasticity after stroke or spinal cord injury can lead to fixed wrist flexion contractures that limit hygiene, splinting, and functional positioning. Cryoneurolysis can effectively reduce wrist flexor spastic tone; however, when longstanding contracture is present, residual mechanical restriction often persists. Percutaneous needle tenotomy (PNT) offers a minimally invasive method to release structurally shortened musculotendinous units and restore passive mobility. In this retrospective case series, we describe the outcomes of wrist flexor PNT performed after prior cryoneurolysis in patients with refractory upper limb spasticity. Four adults with chronic upper limb spasticity secondary to stroke or spinal cord injury underwent wrist flexor cryoneurolysis followed by PNT for persistent contracture limiting passive range of motion (ROM). Passive wrist extension ROM and muscle tone were graded before and after intervention. Clinical rationale for transitioning from cryoneurolysis to PNT was qualitatively documented. Across all 4 cases, cryoneurolysis produced meaningful tone reduction; however, passive wrist extension remained limited due to fixed end-range contracture. After PNT, the patients demonstrated immediate and sustained gains in passive wrist extension ROM. Modified Ashworth Scale scores remained stable or demonstrated mild improvement posttenotomy, consistent with tone reduction achieved by preceding cryoneurolysis. No major adverse events were reported. Sequential use of cryoneurolysis followed by PNT may be effective for managing refractory wrist flexion contracture, where tone reduction alone is insufficient.

This study compared the immediate effects of a single 30-second stretching bout on local (stretched) and non-local (non-stretched) range of motion (ROM), pain sensitivity/onset, strength, and endurance. Fourteen participants were involved with this within-subjects, repeated-measures study, consisting of four conditions: 30-seconds of static (SS), proprioceptive neuromuscular facilitation (PNF), dynamic (DS) stretching, and a no-stretch control condition. Passive hip flexion and shoulder extension ROM, pain pressure thresholds (PPT), knee flexors and right shoulder extension maximum voluntary isometric contraction force (MVIC), 30-s MVIC fatigue index and muscle activation (electromyography: EMG) were measured pre- and post-intervention. The primary findings were that 30-seconds of SS elicited greater moderate magnitude ROM improvements in the stretched limb (p < 0.001, 8.1%) compared to control. Non- significant (p = 0.08) SS-induced ROM gains were observed with the contralateral leg inferring the possibility of crossover effects in some individuals. There were no significant effects on the shoulder with any intervention. All conditions including control experienced MVIC force decreases with the stretched limb (p = 0.007). However, there were no significant PPT interactions. Women demonstrated greater ROM whereas men exhibited greater force, EMG activity, and fatigue indices. In conclusion, while passive ROM improved across all conditions, these gains can be accompanied by declines in MVIC force. Overall, 30-seconds elicited significant increases in ROM of the stretched leg respectively; however, it failed to produce any significant effects on the contralateral leg and shoulder.

To evaluate the effectiveness of low-level laser therapy (LLLT) as an adjunct to rehabilitation in reducing pain and improving knee function in adults with MRI-confirmed meniscus injuries. In this randomized, double-blind, placebo-controlled trial, 40 adults with unilateral meniscus injuries were assigned to either an LLLT group or a placebo group. All participants received a standardized rehabilitation program over six weeks. The primary outcome was pain intensity measured using a visual analogue scale (VAS). Secondary outcomes included knee function (Lysholm score), range of motion (ROM), and physical performance tests. Both groups showed significant improvements; however, the LLLT group demonstrated greater reductions in pain and improvements in function, mobility, and ROM compared with the control group (p < 0.01 for all outcomes). The magnitude of improvement exceeded clinically meaningful thresholds, particularly for pain reduction and functional gains. Adjunctive LLLT was associated with greater improvements in pain and functional outcomes compared with rehabilitation alone. LLLT appears to be a safe and potentially effective complementary modality in the conservative management of meniscal injuries.

Chronic arthropathy is the most common complication of moderate to severe hemophilia. Chemical synovectomy with Rifampicin offers a cost-effective alternative to radioactive synovectomy, especially in resource-limited settings like Syria. A retrospective study was conducted at the Syrian Hemophilia Society (2020-2024), involving 50 patients (69 target joints) with hemophilic synovitis. Outcomes were assessed using the Hemophilia Joint Health Score visual analogue scale (VAS) for pain, range of motion (ROM), Arnold-Hilgartner classification, and annual bleeding rate,pre- and post-intervention. Participants were predominantly young (mean age 18.99 ± 6.51 years), with hemophilia A (80%). A significant delay was noted between target joint onset and intervention (mean 40.30 months). The knees were most affected (72%), with moderate joint involvement (Arnold-Hilgartner Class II-III). Regional disparities emerged: Damascus patients showed better outcomes (HJHS: 2.33 vs 7.04; VAS: 1.11 vs 3.27, P < .001). Most patients improved significantly (P < .05), except those with mild phenotypes (no HJHS/VAS improvement), ankle involvement (no ROM improvement), and Arnold score 0 (no ROM improvement). Findings underscored inequities in care access across regions. Rifampicin-based chemical synovectomy is a viable, accessible treatment for hemophilic synovitis in low-resource settings. It led to significant improvements in pain, bleeding episodes, joint health, and mobility. However, regional healthcare disparities and delayed interventions remain key challenges affecting outcomes.

Distal humeral nonunion associated with extensive bone loss remains one of the most challenging reconstructive conditions in upper-extremity surgery. We present a technically demanding case treated using a patient-specific 3D-printed implant and discuss its potential advantages compared with alternative reconstructive strategies. This case report describes the management of a 59-year-old woman presenting with a hypertrophic distal humeral shaft nonunion three years after intramedullary nailing. Preoperative evaluation included bilateral Computed Tomography (CT) using a dedicated low-artifact acquisition protocol to enable contralateral humeral mirroring, three-dimensional virtual planning, and the design of a patient-specific implant. A custom-made Ti6Al4V implant featuring a cemented proximal stem, a porous metaphyseal interface, and a dual-flange distal fixation platform was manufactured based on the preoperative planning. Reconstruction was performed through a posterior approach with olecranon osteotomy using patient-specific cutting guides. Clinical and radiographic outcomes were prospectively assessed at 1, 3, 6, and 12 months postoperatively. Progressive improvements were observed in elbow motion, MEPS, TCI, and sleep quality (PSQI). By 12 months, the patient achieved near-complete ROM and excellent clinical scores, with radiographs showing full union and stable alignment. At 1 year, however, a fall resulted in proximal stem mobilization, while the distal fixation and porous interface remained stable. This case demonstrates that patient-specific reconstruction can achieve accurate anatomical restoration, stable fixation, and excellent functional recovery in selected patients with complex distal humeral nonunion and bone loss. It also highlights the potential advantages of customized implants, while emphasizing the importance of meticulous preoperative planning, complete implant fixation, and appropriate postoperative protection to minimize the risk of late mechanical failure. Although the present findings are encouraging, further clinical studies are required to establish the long-term effectiveness and broader applicability of this reconstructive strategy.

BackgroundKnee osteoarthritis (KOA) is a leading cause of pain and impaired quality of life. Although multimodal rehabilitation is recommended, additional benefit of eccentric strengthening within such programs remains unclear.ObjectiveTo evaluate whether adding eccentric exercise to multimodal intervention improves pain, physical function, and psychological outcome in KOA.MethodsThis trial included 120 KOA participants, randomly allocated to experimental group (eccentric exercise plus multimodal intervention; n = 60) or control group (multimodal intervention alone; n = 60). Both groups received supervised treatment for 6 weeks. Outcomes were assessed at baseline, post-intervention (week-6), and follow-up (week-30). Domains included pain (Numeric Pain Rating Scale [NPRS] and pressure pain threshold [PPT]), physical function (muscle strength, Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], range of motion [ROM], and Six-Minute Walk Test [6MWT]), and psychological status (Patient Health Questionnaire-9 [PHQ-9]).ResultsBoth groups improved over time, with greater improvements in the experimental group. At week 6, between-group differences favored the experimental group for NPRS (MD -0.570, 95% CI -1.003 to -0.136), PPT (0.225 kg/cm[2], 0.131 to 0.319), WOMAC pain (-1.145, -1.929 to -0.361), function (-2.646, -4.708 to -0.584), 6MWT (19.347 m, 14.743 to 23.951), and PHQ-9 (-1.136, -1.877 to -0.394). At week 30, these benefits were sustained or increased, with additional improvement in knee-flexion ROM (3.139°, 1.128 to 5.150); although knee-extension ROM did not differ. No serious adverse events occurred.ConclusionIntegrating eccentric strengthening into multimodal rehabilitation yields superior, sustained improvements in pain, physical function, and psychological outcome in KOA.

Interest in fasting-based diets to improve metabolic health is growing. Caloric restriction (CR) with one meal per day includes an extended fasting component that contributes to its metabolic and longevity benefits, yet the role of fasting within CR remains unclear. Here, we compare CR with a fasting-refeeding-fasting (FRF) regimen while controlling food intake and fasting duration. Changes in plasma insulin and free fatty acids, hepatic mTOR signaling and ketogenesis, metabolic rhythms, and food digestion kinetics suggest that gastric emptying serves as a primary metabolic trigger in acute fasting. In contrast, CR fasting responses are regulated, suggesting anticipatory mechanisms. CR enhances circadian rhythmicity and metabolic gene coordination, whereas FRF disrupts it. CR improves glucose and fatty acid metabolism, while fasting leads to glucose intolerance and liver fat accumulation. These findings reveal that CR engages clock-aligned, anticipatory metabolic control, while fasting-refeeding cycles rely on direct nutrient cues.