To evaluate whether corticosteroid dose affects pain and functional outcomes in shoulder impingement syndrome (SIS) treated with subacromial injection. Systematic review and meta-analysis. Six databases (CINAHL, EMBASE, Ovid MEDLINE, Ovid HealthSTAR, PubMed, Web of Science) were searched from inception to July 2025. Outcomes were pooled using random-effects meta-analysis with meta-regression to assess association between dose and treatment effect. Twenty-three studies comprising 739 patients were included. Seven studies used triamcinolone-equivalent doses below 40 mg, while 16 used doses of 40 mg or more. The pooled improvement in pain was 3.00 points on the VAS (95% CI: 2.60-3.40). No significant association was found between corticosteroid dose and pain improvement (=0.003, P=0.814), with pooled VAS improvements of 2.85 (95% CI: 2.50-3.20) and 3.06 (95% CI: 2.54-3.58) for the low and high dose groups, respectively. For functional outcomes, the overall pooled SMD was 1.876 (95% CI: 1.370-2.383), with no dose-response relationship (=0.008, P=0.609). Subacromial corticosteroid injection produced clinically meaningful reductions in pain and improvement in function across the doses studied. These findings suggest a therapeutic ceiling effect, where lower doses may achieve comparable benefit; head-to-head trials are needed to confirm equivalence and establish optimal dosing guidelines.

Pharmaceutical supply chain disruptions from pandemics, natural disasters, and geopolitical conflicts increasingly threaten medications central to rehabilitation practice. Rehabilitation pharmacotherapy is especially exposed because many core agents have narrow therapeutic windows, require cold-chain logistics, lack ready substitutes, or carry life-threatening consequences when abruptly interrupted. This analysis examines vulnerabilities across three rehabilitation medication categories: spasticity-targeted therapies, pain and musculoskeletal therapeutics, and neurorehabilitation agents. We describe the clinical consequences of medication interruption across rehabilitation populations, then define and apply an expert-derived, literature-informed stockout risk matrix that classifies events along two dimensions. These dimensions comprise likelihood of stockout (manufacturer concentration, logistics chain integrity, lead time, and price volatility) and severity of clinical consequence (withdrawal-related morbidity, substitutability, and size of the affected patient population). The 2026 Strait of Hormuz crisis, during which Gulf Cooperation Council countries faced potential threats to the availability of medications across multiple logistics corridors, serves as a contemporary case illustration. A contingency framework that includes strategic reserves, protocol switching, telerehabilitation-based monitoring, and cross-border mutual aid is then outlined. Preparedness for pharmaceutical supply disruption appears to be an underdeveloped competency in Physical and Rehabilitation Medicine and merits attention in service delivery wherever import dependence or disruption risk applies.

We implemented an educational intervention centered on resident-led, board review-focused didactics to improve Self-Assessment Exam for Residents (SAE-R) scores at our institution, carried out over two academic years (2024-2025 and 2025-2026). As a result, mean percentile scores increased from 48.4±25.6 (2024) to 77.4±26.9 (2025) and 82.3±24.0 (2026), reflecting significantly higher percentile scores in both 2025 and 2026 compared with 2024. There were also significantly greater proportions of residents exceeding the 50th percentile in 2025 (86.4%, 95% CI 66.7%-95.3%) and 2026 (83.3%, 95% CI 64.1%-93.3%) compared with 2024 (31.8%, 95% CI 16.4%-52.7%). Similar trend was observed for proportions of residents exceeding the 90th percentile (2024: 4.5%, 95% CI 0.8%-21.8%; 2025: 45.5%, 95% CI 26.9%-65.3%; 2026: 58.3%, 95% CI 38.8%-75.5%). There were no significant differences in mean percentile scores and proportions of residents exceeding the 50th and 90th percentiles between 2025 and 2026. Our educational intervention was associated with improved resident SAE-R performance over a two-year follow-up period, supporting its effectiveness and sustainability.

Repetitive use injuries are commonly seen by musculoskeletal providers, usually in the form of tendinopathies. However, focal peripheral nerve entrapment can mimic or coexist with tendon pathology, particularly when weakness, sensory symptoms, or imaging findings are subtle or nonspecific. This review provides a practical, symptom-first framework to help clinicians distinguish tendon-dominant, nerve-dominant, and mixed presentations in clinical practice. Five clinically relevant tendon-nerve mimic pairs are emphasized: (1) rotator cuff tendinopathy versus suprascapular neuropathy; (2) lateral epicondylitis versus radial tunnel syndrome; (3) iliotibial band syndrome versus common peroneal neuropathy; and (4) peroneal tendinopathy versus superficial or deep peroneal nerve entrapment; (5) plantar fasciitis versus tarsal tunnel syndrome or Baxter nerve entrapment. Across these conditions, diagnosis is most strongly informed by symptom pattern, pain distribution, and focal neurologic deficits, with imaging and adjunctive testing used selectively when they are likely to clarify the diagnosis or change management. Therefore, a symptom-first approach may reduce diagnostic anchoring, improve recognition of atypical or refractory presentations, and support more targeted rehabilitation strategies.