Despite widespread smartphone use, research on its impact on musculoskeletal health among lower-dependence European populations remains limited. This cross-sectional study explored smartphone-related hand symptoms among 585 Portuguese university students across 14 faculties. Participants completed an online survey including sociodemographic data, smartphone-use patterns, the Mobile Phone Dependence Test (TMD) and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Nearly 60% reported hand symptoms, mostly pain and tingling. Increased TMD scores and symptom frequency were significantly associated with greater functional disability (p < 0.001), although daily usage and device features were not. Women experienced higher disability (β = 3.64, 95% CI [1.81-5.49]), with twice the odds of symptoms compared with men (OR = 2.41, 95% CI [1.22-4.78]). One-handed device uses also markedly increased symptom risk. These findings highlight the prevalence and functional impact of smartphone-related hand symptoms and advocate for ergonomic interventions promoting early symptom recognition and two-handed use.

BackgroundThe improvement following arthroscopic rotator cuff repair (ARCR) is associated with biopsychosocial factors, including emotional well-being, health beliefs, and patient engagement.ObjectiveThis prospective study aimed to investigate the relationship between musculoskeletal health literacy (MHL) and physical and psychological outcomes in patients with ARCR.MethodsA total of 44 patients were divided into two groups: low (n = 24) and high (n = 20) MHL using the Turkish Health Literacy Scale-32. The patients received a standardized rehabilitation program composed of 30 treatment sessions (five days per week) lasting between 45 and 60 min. The primary outcomes included pain (Visual Analog Scale) and disability-function (Shoulder Pain and Disability Index and The Disabilities of the Arm, Shoulder and Hand Questionnaire). Secondary outcomes included pain catastrophizing (Pain Catastrophizing Scale-PCS), anxiety/depression (Hospital Anxiety and Depression Scale), kinesiophobia (Tampa-Scale of Kinesiophobia-TSK), and quality of life (12-Item Short-Form Health Survey). The outcomes were assessed pre- and post-treatment.ResultsBoth MHL groups showed significant improvements in pain, disability, and function over time (p < 0.001), with no group-by-time interaction for physical outcomes. However, higher MHL was associated with greater improvements in PCS (p = 0.029) and TSK scores (p = 0.041), indicating significant group-by-time interactions for psychological outcomes.ConclusionHigher MHL was associated with improved psychological outcomes, but not physical outcomes, after ARCR. The MHL may be more strongly related to psychological adaptation rather than physical recovery. Interventions targeting MHL may have the potential to influence rehabilitation outcomes. Further randomized trials are required to assess the clinical benefits of MHL-targeted educational interventions in terms of causality.

This study assessed responsiveness of the Lymphedema Life Impact Scale (LLIS), Upper Limb Functional Index (ULFI), and Shoulder Pain and Disability Index (SPADI) instruments in patients with upper limb lymphedema undergoing complete decongestive therapy (CDT). The prospective cohort study was conducted from March 2024 to May 2025. Participants were patients with unilateral upper limb lymphedema secondary to breast cancer. All patients completed the LLIS, ULFI, and SPADI at baseline and again after 10 sessions of physiotherapy delivered over a 20-day period. Additionally, a 7-point Global Rating of Change scale (GRC) was administered as an external anchor. Paired t-tests or Wilcoxon tests were utilized to examine differences between pre- and post-intervention scores. A total of 110 patients were enrolled. The ULFI, LLIS, and SPADI demonstrated acceptable responsiveness, as indicated by an area under the curve (AUC) exceeding 0.70. Furthermore, the change scores for all three instruments exhibited strong correlations with patients' GRC scales, with Spearman correlation coefficients greater than 0.60. The results support the use of the LLIS, ULFI, and SPADI as reliable tools to monitor treatment outcomes in patients with upper limb lymphedema due to breast cancer.

Chronic shoulder pain is a prevalent and disabling condition encompassing diverse pathologies such as adhesive capsulitis, tendinopathy, enthesopathy, and trapezius myalgia. These disorders share multifactorial mechanisms involving chronic inflammation, angiogenesis, and neurogenic sensitization, leading to persistent pain and functional limitation. Recent insights into the vascular basis of shoulder pain have highlighted pathological neovascularization as a potential therapeutic target. This narrative review explores the role of transarterial embolization (TAE) as a minimally invasive treatment option for chronic shoulder pain refractory to conservative management. Adhesive capsulitis, characterized by capsular fibrosis and restricted motion, demonstrates significant pain reduction and improved range of motion following TAE, with technical success rates approaching 100% and minimal adverse events. Similarly, rotator cuff tendinopathy and trapezius myalgia have shown marked improvement in pain and function, confirming the role of TAE in disrupting pathological neovascular and neurogenic pathways. Various embolic agents, including imipenem/cilastatin sodium, polyethylene glycol, and calibrated microspheres, have been used with favorable safety profiles, though concerns regarding antibiotic resistance warrant further evaluation. Overall, current evidence supports TAE as a safe, effective, and joint-preserving alternative to surgery for patients with chronic shoulder pain of vascular-inflammatory origin. While the literature demonstrates consistent improvements in pain scores and functional outcomes, large-scale randomized controlled trials remain necessary to validate these findings and establish standardized treatment protocols.

Anti-granulocyte macrophage colony stimulating factor (anti-GM-CSF) antibodies, classically associated with pulmonary alveolar proteinosis (PAP), are increasingly recognised as a cause of adult-onset immunodeficiency predisposing to opportunistic infections. Coinfections with multiple opportunistic pathogens in this context are uncommon. We describe a rare case of disseminated Nocardia paucivorans, pulmonary Cryptococcus gattii, pulmonary Mycobacterium chelonae, and subsequent PAP in a patient with high-level anti-GM-CSF antibodies. A 64-year-old man presented with subacute bilateral shoulder pain and was diagnosed with acromioclavicular septic arthritis. N. paucivorans was isolated, and subsequent evaluation demonstrated disseminated infection with numerous brain abscesses, left eye endophthalmitis and pulmonary involvement. Interval computed tomography of the chest revealed new right lower lobe consolidation, a biopsy of which identified C. gattii and M. chelonae. Immunological testing confirmed high-level anti-GM-CSF antibodies. The patient received prolonged combination antimicrobial therapy, including meropenem, ceftriaxone, linezolid, trimethoprim-sulfamethoxazole, moxifloxacin, fluconazole, tigecycline and clofazimine, with clinical and radiological improvement of infectious lesions. Despite microbiological clearance, progressive bilateral ground-glass opacities developed on serial chest imaging consistent with PAP, with no pathogens identified on bronchoscopic sampling. Given minimal respiratory symptoms, PAP-directed therapy was deferred. The patient remains clinically stable on trimethoprim-sulfamethoxazole prophylaxis with ongoing clinical and radiological surveillance. This case illustrates the expanding clinical spectrum of anti-GM-CSF antibody-associated disease and underscores the importance of considering this diagnosis in patients presenting with opportunistic infections, in particular, disseminated nocardiosis or C. gattii infection. It also highlights the need for vigilance in evaluating for coinfections, recognition of PAP as a noninfectious codiagnosis, and the importance of long-term follow-up in affected patients.

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: Osteochondral lesions of the lateral talar shoulder (OLT) represent a significant therapeutic challenge, particularly when associated with chronic lateral ankle instability (CAI). While bone marrow stimulation is well established for talar lesions, clinical evidence on the minced cartilage technique (AutoCart™, Arthrex, Naples, FL, USA) in this specific localization remains limited. This study aimed to evaluate the short-term clinical and functional outcomes following combined treatment of lateral OLT and CAI using autologous minced cartilage and open ligament repair. Methods: Nine patients (mean age: 39.8 years) with symptomatic lateral OLT and concomitant CAI were treated using the minced cartilage technique in conjunction with lateral ligament reconstruction. The mean defect size was 64.8 ± 30.2 mm2. Clinical and functional outcomes were assessed at a mean follow-up of 15.8 months using the Foot Function Index (FFI), Visual Analog Scale (VAS) for pain, return-to-sport status, and a motor-cognitive test (Skillcourt system). Postoperative complications and patient satisfaction were recorded. Results: No postoperative complications occurred. All patients reported satisfaction with surgical outcomes. The mean postoperative FFI was 14.92 ± 12.74, indicating minimal functional limitations in daily life. Skillcourt testing revealed no significant side-to-side differences in most tests, except for the Single Leg Stability Test, which showed a significant deficit on the operated side (p = 0.027; Cohen's d = 0.9). Reduced dorsiflexion limited test performance of four patients. The average postoperative VAS during functional testing was 1.42 ± 1.62. Conclusions: Combined treatment of lateral OLT and CAI using the minced cartilage technique and open ligament stabilization yields favorable short-term clinical and functional outcomes. Despite minor limitations in dorsiflexion, patients achieved high satisfaction rates and functional recovery. These preliminary findings support the technical feasibility and short-term clinical applicability of combining biological cartilage repair with mechanical stabilization for lateral talar lesions < 100 mm2. However, larger prospective studies with longer follow-ups are warranted to validate these findings.

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.

Background: Rotator cuff tears, a prevalent pathology with significant functional impact, primarily find their therapeutic approach in arthroscopic repair. The long-term success of this intervention is modulated by various factors, among which shoulder morphology stands out. In this context, the critical shoulder angle (CSA) has gained relevance as a potential predictor of postoperative prognosis. Objectives: To determine if the CSA influences the need for reoperation after retears and functional outcomes following the arthroscopic repair of chronic rotator cuff tears. Methods: A retrospective cohort study has been conducted, which includes 74 patients (between 47 and 86 years old, mean age of 58.85 ± 2.21 years) who underwent arthroscopic shoulder surgery for the repair of chronic rotator cuff tears by the traumatology service of a tertiary level hospital in the period between 2009 and 2022, to study variables such as the appearance of complications, reoperation, and functional outcomes. Results: Patients with a CSA greater than 40° represent 56.75% (n = 42). Functional improvement was achieved in 59.52%, in contrast to 40.48% of patients who did not obtain significant functional improvement (OR = 1.470; 95% CI = 1.009-2.141). The reoperation rate in this group was 21.4% (n = 9) (OR = 1.562; 95% CI = 1.085-2.249). Conclusions: This study provides statistically significant evidence that a high CSA (>40°) behaves as a risk factor for the reoperation rate and poorer functional outcomes after the arthroscopic repair of chronic rotator cuff tears.

Pathology of the long head of the biceps tendon (LHBT) is a common source of anterior shoulder pain and is frequently encountered during arthroscopic shoulder surgery. Although biceps tenodesis is widely performed, many existing techniques rely on implants that increase cost and may be associated with bone- or fixation-related complications. This paper describes a novel arthroscopic intracapsular soft-tissue biceps tenodesis technique emphasizing efficiency, reproducibility, and implant minimization. The LHBT is pierced percutaneously using a spinal needle approximately 1 cm proximal and lateral to the anterior portal with the patient in the lateral decubitus position. A simple 1.8-mm non-absorbable suture is passed through the needle and retrieved arthroscopically through the anterior portal. The suture limb that was advanced through the needle is then retrieved from the subacromial space through the anterior portal with a probe thus leaving both limbs of the suture exiting through the anterior portal. A sliding arthroscopic knot is then tied in a blind fashion through the incision of the anterior portal thereby securing the biceps to the capsule in the rotator interval above the superior border of the subscapularis. This technique provides stable fixation while preserving the native length-tension relationship of the biceps and avoids interference screws or humeral drilling. This technique may represent an efficient, cost-effective option for arthroscopic biceps tenodesis, particularly when performed in conjunction with other shoulder procedures. Further comparative studies with larger cohorts and longer follow-up are warranted.