Pediatric cases of chronic osteomyelitis that remain asymptomatic for a prolonged period before becoming clinically evident are exceedingly rare. We report a rare case of pediatric chronic osteomyelitis of the left radius, which became clinically evident 1.5 years after an episode of left forearm cellulitis at the same anatomical site in a three-year-nine-month-old girl. The patient presented with fever, left wrist pain, and difficulty in flexing her left fingers. Plain radiography and magnetic resonance imaging (MRI) revealed osteolytic lesions spanning the distal radial metaphysis and epiphyseal nucleus across the epiphyseal line, consistent with a chronic disease course. She underwent emergency surgical debridement and lavage of the radius. Blood culture results revealed methicillin-susceptible Staphylococcus aureus, and antibiotic therapy was adjusted accordingly. Tuberculous osteomyelitis was excluded. The patient completed a six-week course of antibiotic therapy and remained recurrence-free, with no evidence of growth disturbance, during follow-up. The cellulitis resolved promptly with a one-week course of oral antibiotics, and the patient remained asymptomatic in the interim. This case underscores the importance of obtaining a careful history of prior skin infections at the same site when osteomyelitis is suspected, even when the infection appears to have resolved completely, and highlights the value of early MRI to facilitate prompt diagnosis given the potentially prolonged asymptomatic interval.

Isolated volar dislocation of the distal radioulnar joint (DRUJ) without associated fracture is a rare wrist injury that may be overlooked because clinical and radiographic findings can be subtle. We report the case of a 19-year-old male rodeo rider who presented with severe left wrist pain, swelling, and inability to rotate the forearm following a torsional injury. Radiographs demonstrated an isolated volar DRUJ dislocation without associated fracture. Initial closed reduction was unsuccessful. Under anesthesia, reduction was achieved but was unstable, requiring percutaneous radioulnar transfixation with Kirschner wires and immobilization. At the two-month follow-up, the patient was pain-free, had preserved pronation and supination, and demonstrated a clinically stable DRUJ. This case highlights the importance of early recognition, appropriate reduction, and stabilization when instability persists after reduction.

Objective Conduct a randomized controlled trial to investigate the safety, feasibility, and efficacy of wearable vibrotactile stimulation shirts and gloves for upper extremity stroke rehabilitation at the inpatient rehabilitation unit. The primary outcome measure was the Fugl-Meyer Assessment Upper Extremity (FMA-UE) motor score. The secondary outcome measures were the Modified Ashworth Scale (MAS) and statistics on device safety and feasibility. Exploratory outcome measures were the FMA-UE sensation, passive joint motion, and joint pain scores. Also, the MAS for the fingers, wrist, and elbow scores. Methods A total of 24 ischemic stroke patients were recruited for this study (45 to 85 years old) during their stay at the inpatient rehabilitation unit, which averaged 15.3 ± 4.5 days. Patients were randomly assigned to a treatment or control group, with 12 participants in each group. The control group received conventional therapy only, while the treatment group received both conventional therapy and vibrotactile stimulation. Participants in the treatment group wore the vibrotactile stimulation gloves and shirts for 1.5 hours per day, 5 days per week. Upper extremity impairment and spasticity were assessed with the FMA-UE and MAS at both admission and discharge from the rehabilitation unit. In addition, feedback from patients in the treatment group was collected through a questionnaire to evaluate comfort, usability, and satisfaction. The trial was prospectively registered at ClinicalTrials.gov (NCT06244719). Results The vibrotactile stimulation was safe and well-tolerated by stroke patients. No statistically significant differences were noted in FMA-UE motor scores and total MAS scores between the groups; however, exploratory analyses revealed a significant improvement in FMA-UE joint pain scores in the treatment group. A trend towards reduced wrist spasticity was observed in the treatment group, but this effect did not remain significant after correcting for multiple comparisons. Responder analyses showed a greater proportion of responders in the treatment group for both FMA-UE and MAS outcomes. Conclusions Our results show promise for a larger sample size study and follow-up work with longer durations of vibrotactile stimulation with gloves and shirts for upper extremity stroke rehabilitation. Although no significant improvements were observed in FMA-UE motor function or total MAS scores, vibrotactile stimulation was associated with reduced joint pain, potential benefits for distal spastic hypertonia, and increased responder rates.

Congenital forearm and wrist deformities, including Madelung's deformity, congenital radial head dislocation, and proximal radioulnar synostosis, present reconstructive challenges for upper extremity surgeons. While etiologically distinct, these developmental anomalies disrupt forearm rotation, elbow stability, and aesthetic appearance. This review examines the natural histories and management strategies necessary to restore form and function in pediatric patients. Madelung's deformity, characterized by distal radial physeal growth arrest and a tethering Vickers ligament, requires corrective osteotomies to address progressive pain and deformity. Congenital radial head dislocation necessitates radiographic evaluation to distinguish it from acquired trauma and is managed conservatively. Proximal radioulnar synostosis causes functional restrictions requiring derotational osteotomies in symptomatic patients. Precise anatomical understanding and individualized clinical judgment are essential to restore joint kinematics.

Fractures of the triquetrum are the second most common carpal fractures after scaphoid fractures and represent a frequent cause of post-traumatic ulnar-sided wrist pain. Dorsal shear fractures account for approximately 93% of all triquetral fractures and are therefore by far the most common fracture type. Two pathomechanisms have been proposed: avulsion by the dorsal ligamentous attachments to the triquetrum and impaction of the dorsal cortex by a prominent ulnar styloid. The dorsal shear/ avulsion fracture is commonly associate with a localized tenderness to palpation over the dorsal aspect of the triquetrum. The diagnosis is confirmed by a lateral wrist X-ray, and, if necessary, also by CT. Treatment is for purely osseous lesions as well as for osteoligamentous avulsion fractures conservative with immobilization in a short-arm cast for 3 weeks. Residual symptoms may persist for several months and are not uncommon. Fractures of the triquetral body are considerably much less frequent and may occur as part of more complex carpal injuries, such as perilunate fracture-dislocations. In these cases, CT is recommended in addition to standard radiographs to accurately define the fracture pattern. Palmar cortical fractures may represent an avulsion injury of the strong palmar portion of the lunotriquetral (LT) ligament. Consecutively, the diagnostic work-up should include magnetic resonance imaging (MRI) in addition to standard radiographs of the wrist. Wrist arthroscopy is the gold standard to confirm an associated LT ligament rupture, followed consecutively by a transfixation of the LT joint.

Congenital radial head dislocation (CRHD) is an uncommon orthopedic anomaly affecting the elbow joint and is frequently associated with other congenital deformities. This narrative review synthesizes evidence identified through targeted searches of PubMed and Web of Science, with emphasis on peer-reviewed studies addressing the epidemiology, developmental and genetic mechanisms, diagnostic evaluation, clinical differentiation, management strategies, and treatment outcomes of CRHD. CRHD may present as either unilateral or bilateral dislocation, with posterior dislocation being the most frequently reported subtype. Frequently overlooked during childhood, CRHD often becomes clinically apparent during adolescence or adulthood through symptoms such as elbow discomfort, cosmetic prominence, mechanical symptoms, and restricted joint mobility. Diagnosis remains challenging because of its variable clinical presentation and often requires careful integration of clinical history, physical examination, and imaging findings. The pathogenesis of CRHD is multifactorial and involves complex genetic, developmental, and structural abnormalities, particularly collagen type I defects, disturbances in endochondral ossification, and disproportionate growth between the ulna and radius. Management strategies range from conservative observation in asymptomatic or minimally symptomatic patients to surgical interventions, including radial head excision, ulnar osteotomy, open reduction, and annular ligament reconstruction in selected symptomatic cases. Although surgery may provide pain relief and improve forearm rotation, it carries potential complications, including wrist pain, recurrent deformity, and redislocation. Further research is needed to refine diagnostic criteria, optimize patient selection for surgery, and improve long-term functional outcomes in patients with CRHD.

BackgroundSmartphones have become essential tools in modern daily life, with usage intensifying in the post-pandemic era. Prolonged and addictive smartphone use has been increasingly associated with Musculoskeletal disorders (MSD) in the upper extremity. Beyond usage duration, device characteristics may also influence musculoskeletal strain.ObjectivesThis study examined the relationships between smartphone usage patterns, addiction levels, device dimensions, pain severity, and the 12-month prevalence of MSD in the upper extremityMaterials and MethodsA cross-sectional study was conducted among 262 adults aged 19-44 years with at least 12 months of smartphone use. Data were collected using a structured questionnaire incorporating demographic variables, smartphone usage habits, device specifications, the SNMQ, the SAS-SV and the NPRS.ResultsThe 12-month prevalence of neck, shoulder, elbow, and wrist/hand MSDs was 52.7%, 39.3%, 34%, and 51.1%, respectively. Smartphone addiction was present in 60.3% of participants and was significantly associated with shoulder, elbow, and wrist/hand MSDs. Gender showed a small but significant association with shoulder symptoms. Correlation analyses revealed small positive associations between smartphone width and neck pain, and between phone length/width and right wrist and right thumb pain. Logistic regression models identified that phone width predicted neck MSD, daily usage duration and overall body position contributed to shoulder MSD, age predicted elbow MSD, and both smartphone addiction and age predicted wrist/hand MSD.ConclusionSmartphone addiction, specific device dimensions, and behavioral factors contribute to MSD. These findings underscore the need for ergonomic device design and informed usage practices to reduce musculoskeletal strain among young adults.

BackgroundFocused shock wave therapy (FSWT) and radial pressure wave therapy (RPWT) are commonly used noninvasive modalities for managing musculoskeletal disorders (MSKDs), yet their distinct physical properties and inconsistent evidence make it unclear which modality provides better outcomes.ObjectiveTo compare the FSWT with the RPWT in terms of pain, function, strength, and range of motion (ROM) in patients with MSKDs.MethodsWe searched PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, Scopus, MEDLINE, the Physiotherapy Evidence Database, and Google Scholar from inception to October 5, 2025. The risk of bias was assessed via the RoB 2.0 tool, and meta-analyses were conducted via RevMan 5.4. Sensitivity analysis was used to examine the effect of excluding studies at high risk of bias. The certainty of evidence was evaluated via the GRADE approach.ResultsTwenty-one randomized controlled trials (RCTs) (16 RCTs and 5 pilot RCTs) were included (n = 1030). Meta-analyses revealed that neither modality for pain nor function was favored across short-, medium-, or long-term follow-ups. For short-term grip strength, low-certainty evidence favored the FSWT (MD = 3.09; 95% CI: 0.31-5.88), whereas the RPWT was superior for improving medium-term wrist extensor strength (MD = -2.39; 95% CI: -4.34-0.44) in patients with lateral epicondylitis. For shoulder ROM, no significant difference was observed in the short term (P > 0.05). Excluding studies with a high risk of bias in the sensitivity analysis did not change the pooled effect estimates.ConclusionVery low- to low-certainty evidence suggests no significant difference between FSWT and RPWT for pain, function, or ROM. Low-certainty evidence suggests a potential short-term advantage of FSWT for grip strength and a potential medium-term advantage of RPWT for wrist extensor strength in patients with lateral epicondylitis. However, these findings should be considered exploratory because they are based on a limited number of studies with small sample sizes and require confirmation in adequately powered, high-quality randomized controlled trials before informing clinical recommendations.

We report a rare case of capitate osteonecrosis in a 51-year-old woman with thalassemia presenting with persistent wrist pain. Imaging findings were consistent with osteonecrosis of the capitate, and the patient underwent surgical treatment with a vascularized bone graft from the second metacarpal and cancellous bone graft from the iliac crest. Histopathological examination confirmed ischemic osteonecrosis. At 15 months after surgery, clinical improvement was limited; however, magnetic resonance imaging demonstrated preservation of capitate morphology and reduced signal abnormalities. Capitate osteonecrosis in patients with thalassemia is extremely rare but should be considered in the differential diagnosis of wrist pain. Early recognition may facilitate timely intervention and help prevent disease progression.