A 67-year-old unvaccinated male patient was analyzed. Clinical manifestations, laboratory and imaging findings, treatment, and disease progression were evaluated using hospital records. Eight days after facial trauma from a bicycle accident, the patient developed progressive trismus, dysphagia, neck stiffness, and respiratory discomfort. He was hospitalized on day 10 post-injury. Initial treatment included 500 IU of tetanus immunoglobulin. Two days later, his condition deteriorated with progression to generalized tetanus, requiring ICU admission. Additional 2000 IU of tetanus immunoglobulin, sedation, and oxygen therapy were administered. The course was complicated by pneumonia. Gradual improvement occurred, and he was discharged in stable condition on day 35. Cephalic tetanus is a rare but severe form that may progress to generalized disease. Early recognition and prompt administration of tetanus immunoglobulin are crucial for favorable outcomes.

Background and Objectives: Many patients suffer from chronic pain of the shoulder, neck, upper back, and/or arm. They may be diagnosed with fibromyalgia, complex regional pain syndrome, myofascial pain, thoracic outlet, subacromial pain, cervical radiculopathy, cervicogenic headaches, post-mastectomy pain, and/or occupational shoulder disorder. The pectoralis minor (PM) is the only muscle of the scapula controlled by the lower trunk of the brachial plexus. In the Human Disharmony Loop (HDL), this neurologic asymmetry produces persistent protraction of the scapula. Protraction deforms the scapula's connections, generating headaches and neck stiffness, upper back tightness, shoulder weakness, and hand numbness. We hypothesize patients with the above who meet HDL diagnostic criteria will benefit from PM tenotomy with brachial plexus neurolysis (PM+ICN). Materials and Methods: Patients diagnosed with the above disorders who also met HDL criteria of medial coracoid tenderness and scapula protraction on exam underwent PM+ICN, with secondary neurolysis after 3 months if needed. Clinical neuropathy was diagnosed via the scratch-collapse test. Outcomes included self-reported Visual Analogue Score pain scores, active shoulder abduction range of motion (ROM), prevalence of occipital headaches. Results: N = 318 patients were included. Average age was 51; 68.0% were female. Following treatment, average pain decreased from 7.3/10 to 2.1/10 (p < 0.001), average shoulder ROM increased from 96 to 170 degrees (p < 0.001), and occipital headaches decreased from 76.7% to 1.6% (p < 0.001). Scapular protraction normalized from 98.8% static to 92.5% none (p < 0.001). Overall, 17% required subsequent neurolysis, chiefly of the axillary, radial, and ulnar nerves. The pain reductions were statistically indistinguishable across all diagnoses (p = 0.709, I[2] = 0.02%). Average follow-up was 22 months. Conclusions: PM+ICN significantly reduced self-reported pain and headaches in select intractable patients. The PM pathologizing the scapula may constitute a shared anatomic mechanism that contributes to chronic pain across heterogenous disorders of the upper limb.

Background: Non-specific neck pain is associated with altered muscle mechanical properties, including increased stiffness. Radial extracorporeal shockwave therapy (rESWT) and orthopedic manual therapy (OMT) are commonly used interventions, although their combined effects on cervical muscle stiffness remain unclear. This study aimed to evaluate the short-term and within-session effects of adding rESWT to OMT on cervical muscle stiffness measured by means of shear wave elastography (SWE) in individuals with non-specific neck pain. Methods: A randomized controlled trial was conducted including 24 participants (mean age 34.36 years) allocated to an intervention group (IG, n = 12) or a control group (CG, n = 12). The IG received a combined protocol of rESWT (1500 impulses per point at 10 Hz, 2-4 bar) and OMT based on the Maitland concept, while the CG received OMT alone. Primary outcomes included cervical muscle stiffness assessed via SWE expressed in meters per second (m/s) and kilopascals (kPa). Secondary outcomes were pain intensity (VAS), pressure pain threshold (PPT), cervical range of motion (ROM), and shoulder elevation strength (SES). Treatment effects were estimated using ANCOVA adjusted for baseline values. Results: The combined intervention was associated with greater reductions in cervical muscle stiffness compared with the control group, with significant decreases in SWE values (m/s: β = -1.27, p < 0.001; kPa: β = -27.97, p < 0.001). Pain intensity was also reduced (β = -2.12, p = 0.012), while PPT increased (β = 18.84, p = 0.024). Improvements were observed in cervical extension ROM (β = 10.30, p = 0.014) and right SES (β = 3.85, p = 0.044). No significant differences were found for other ROM variables or left SES. Conclusions: The addition of rESWT to OMT was associated with greater short-term improvements in cervical muscle stiffness, pain intensity, and mechanical sensitivity compared with OMT alone in individuals with non-specific neck pain. However, these findings should be interpreted with caution due to the study limitations.

The case of a previously healthy 16-year-old male who presented with an initial 15-day history of progressive headaches, fever, neck stiffness, and vomiting is discussed. A cerebrospinal fluid (CSF) analysis was suggestive of bacterial pyogenic meningitis. However, Gram staining, CSF bacterial and fungal culture, and CSF TB GeneXpert (Cepheid, Sunnyvale, CA) test results were negative. The patient developed vasculitis, which led to further complications, such as cerebral infarcts, subarachnoid hemorrhage, ruptured cerebral aneurysm, and hydrocephalus. The patient worsened despite being subjected to standard treatment protocols for bacterial meningitis, prompting a comprehensive diagnostic evaluation. 16S and 18S-internal transcribed spacer 2 (ITS2) polymerase chain reaction (PCR) test results for bacterial and fungal DNA were negative and positive, respectively. Capillary sequencing of the fungal ITS2 PCR product revealed a rare neuroinvasive fungal pathogen, Neoscytalidium dimidiatum, which was further confirmed using next-generation sequencing. This information enabled targeted antifungal therapy and surgical interventions, which led to significant clinical improvement. The present case underscores the importance of integrating molecular diagnostics and genomic testing into the diagnostic workflow for diagnosing challenging acute central nervous system infections.

Dual-energy computed tomography (DECT) enables improved volumetric bone mineral density (vBMD) assessment by accounting for marrow alterations associated with aging, disease, and injury. However, DECT reconstruction kernels and monochromatic energy pair combinations may influence vBMD measurements and finite element model (FEM)-estimated bone stiffness. This study investigated the effects of reconstruction kernel and DECT energy pair combinations on proximal humeral vBMD and FEM-estimated stiffness in cadaveric specimens. Fourteen cadaveric shoulders from seven specimens were scanned bilaterally using DECT with a K2HPO4 calibration phantom. Images were reconstructed using standard (STD) and bone-sharpening (BONE) kernels. Simulated monochromatic images at 40, 90, and 140 keV were combined into 40/90, 40/140, and 90/140 keV energy pairs. Volumetric BMD was extracted from the humeral shaft diaphysis and anatomic neck using custom Python scripts and 3D Slicer software. Image-based FEMs were generated to estimate bone stiffness. Results were analyzed using repeated-measures analysis of variance (RM-ANOVA). In the cortical-dense humeral diaphysis, energy pair combinations had the greatest variation. Mean diaphyseal vBMD increased from 332.08 ± 102.54 mgK2HPO4/cc (40/90 keV BONE) to 406.84 ± 130.15 mgK2HPO4/cc (90/140 keV BONE), while FEM stiffness increased from 180.30 ± 47.07 kN/mm to 223.30 ± 63.91 kN/mm. Significant differences were observed across reconstruction conditions and energy pair combinations. In contrast, trabecular-rich anatomic neck regions demonstrated minimal variation in vBMD and FEM stiffness across energy pairs and kernels. These findings indicate that DECT energy pairs and reconstruction kernel substantially influence cortical bone assessments, particularly when using the 90/140 keV energy pair, while trabecular-rich regions remain comparatively unaffected.

Pilots are susceptible to neck injury during carrier-based aircraft arrested landings due to excessive head flexion. This study used a validated multibody head-neck model to examine how tether stiffness and orientation affect the performance of tether-type head-neck restraint systems. Polyester (stiff) and nylon (soft) tethers were evaluated at four sagittal-plane orientations. Results showed that the presence of a tether significantly reduced peak neck muscle force. Stiff tethers generally provided better restraint, while soft tethers showed slightly lower upper-cervical injury indices. No significant cervical injury was predicted in any condition. These findings can inform future restraint-system design.

Background Pain Science Education (PSE) aims to improve patients' understanding of pain based on modern pain science, empowering informed care choices and supporting better health outcomes and has demonstrated effectiveness in chronic musculoskeletal conditions. The Knowledge and Attitudes of Pain (KNAP) questionnaire was developed to assess the knowledge and attitudes about pain science in physical therapy students undergoing PSE. In 2022, a Japanese-language version was created that is comprehensible to university students without specialized knowledge of pain. The KNAP is expected to assess changes in patients' knowledge of pain science and attitudes toward pain among those receiving PSE, but its measurement error in patient populations remains unclear. This study aimed to determine the smallest detectable change (SDC) of the Japanese KNAP among female teleworkers with chronic neck/shoulder stiffness, a population with high levels of presenteeism. Methodology This test-retest reliability study was conducted alongside a randomized controlled trial involving female teleworkers with presenteeism related to neck/shoulder stiffness. Participants who completed the final one-year follow-up and who still had neck/shoulder stiffness were invited. The KNAP was administered via a web-based survey twice, with a one-week interval. The SDC was calculated using the intraclass correlation coefficient. Results A total of 101 participants completed two surveys. The mean KNAP total score was 75.6 (standard deviation (SD) 3.7). The SDC was 6.5.  Conclusion The KNAP demonstrated a smallest detectable change of 6.5 points in female teleworkers with chronic neck/shoulder stiffness, indicating the threshold for changes beyond measurement error at the individual level. This finding contributes to the interpretability of the KNAP and may assist in evaluating changes over time, although the clinical importance of such changes remains to be established.

Rectal prolapse is a pelvic floor disorder characterized by pathological descent of the rectum resulting from impaired pelvic support. Understanding the rectum's in vivo biomechanical behavior is essential for improving diagnosis and treatment planning. This study aimed to estimate the in vivo mechanical properties of the rectum using inverse finite element analysis (FEA) driven by magnetic resonance imaging (MRI) data. MRI scans from six women (three with rectal prolapse and three asymptomatic controls) were analyzed to quantify supero-inferior (SI) and antero-posterior (AP) rectal displacements, as well as puborectalis muscle thickness. A previously validated three-dimensional pelvic model was adapted to simulate the Valsalva maneuver under an intra-abdominal pressure (IAP) of 4 kPa. Rectal tissue was modeled using a Yeoh hyperelastic formulation, with material parameters optimized through inverse FEA by minimizing the discrepancy between experimental and simulated displacements. The prolapse group exhibited a marked increase in SI displacement (26.22 mm) compared to controls (3.44 mm), together with reduced puborectalis muscle thickness. The optimized model indicated a 28% reduction in rectal stiffness in women with prolapse. Numerical simulations further showed increased SI displacement of the bladder neck in the prolapse group (9.73 mm) compared to asymptomatic controls (6.40 mm), indicating that biomechanical impairment extends beyond the rectum to the anterior pelvic compartment. This difference corresponds to approximately 34% of the SI bladder neck displacement observed in the prolapse group. Inverse FEA based on in vivo MRI enables non-invasive characterization of rectal tissue mechanics, with potential applications in patient-specific diagnosis, surgical planning, and outcome prediction.

Enteroviral encephalitis in children is rare but can lead to severe neurological complications. This study describes the clinical, neuroimaging, and laboratory features of pediatric enteroviral encephalitis at Burjeel Hospital, Abu Dhabi, and explores, in an exploratory and hypothesis-generating manner, associations between clinical findings, laboratory results, neuroimaging, and patient outcomes. This is a small descriptive case series (n = 9), and all findings should be interpreted accordingly. A retrospective study included nine pediatric patients with enteroviral encephalitis confirmed by CSF PCR; other etiologies were excluded per predefined inclusion and exclusion criteria. The median age was five years, with a male predominance (n = 7; 77.8%). Symptoms included fever (9/9; 100%), vomiting (8/9; 88.9%), headache (7/9; 77.8%), and neck stiffness (7/9; 77.8%). Seizures occurred in one patient (1/9; 11.1%). Total hospital stays ranged from 2 to 15 days (median three days); PICU stays ranged from 1 to 12 days (median one day). As an exploratory observation, neuroimaging abnormalities showed an association with prolonged PICU stays (rs = 0.694, p = 0.038) and adverse outcomes, while CRP levels did not (rs =- 0.548, p = 0.127); these are hypothesis-generating findings only and not confirmatory. One patient (1/9; 11.1%) with ALERD on MRI had the most severe outcome, including long-term neurological sequelae. Eight of nine patients (8/9; 88.9%) achieved full neurological recovery with supportive care alone. This exploratory case series suggests a potential role for early neuroimaging in clinical decision-making and contributes region-specific data from the UAE. Prospective multicenter studies are required to validate these observations.