International Orthopaedics最新文献

{"title":"Total knee arthroplasty and persistent pain: a neuropathic perspective on peroneal and saphenous nerve compression.","authors":"Benjamin Ferembach, Caio Pina, Omar Fata Nahhas, Vincent Martinel","doi":"10.1007/s00264-025-06466-8","DOIUrl":"10.1007/s00264-025-06466-8","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty (TKA) is a common surgical procedure aimed at relieving pain and restoring function in patients with advanced knee osteoarthritis. However, up to 25% of patients report persistent postoperative pain, which remains a major clinical challenge. While mechanical and biological causes are well-documented, neuropathic pain due to dynamic nerve compression is often overlooked, particularly involving the common peroneal and saphenous nerves.</p><p><strong>Objective: </strong>This study aims to highlight the role of dynamic nerve compressions in persistent post-TKA pain and propose an enhanced diagnostic approach by expanding Hagert's triad into a tetrad (pain, weakness, Scratch Collapse Test + , and orthogonal taping).</p><p><strong>Method: </strong>Dynamic nerve compression differs from static entrapment as it occurs intermittently, often escaping detection in standard electromyography (EMG) or imaging studies. The common peroneal nerve is commonly compressed in the peroneal tunnel, leading to lateral knee pain, ankle weakness, and gait instability. The saphenous nerve, entrapped in Hunter's canal, is associated with medial knee pain, fatigability in standing, and pain while climbing stairs. Incorporating orthogonal taping in the clinical assessment enhances diagnostic sensitivity by providing a reproducible mechanical relief test.</p><p><strong>Conclusion: </strong>Dynamic nerve compression should be systematically considered in cases of persistent post-TKA pain. A thorough clinical examination, including Hagert's tetrad, helps improve early detection. When conservative management fails, surgical nerve release offers a valuable solution, with significant potential for pain relief and functional recovery. Further studies are needed to optimize treatment protocols and validate long-term outcomes.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"835-844"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143501351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Hip Abduction Maneuver (HAM) to diagnose meralgia paraesthetica.","authors":"Caio Pina, Vincent Martinel, Omar Fata Nahhas, Benjamin Ferembach","doi":"10.1007/s00264-025-06467-7","DOIUrl":"10.1007/s00264-025-06467-7","url":null,"abstract":"<p><strong>Background: </strong>Meralgia paresthetica (MP) is a compressive neuropathy of the lateral femoral cutaneous nerve (LFCN), characterized by pain, paresthesia, and numbness in the anterolateral thigh. Despite its well-documented etiology, diagnosing MP remains challenging, as complementary tests such as electromyography (EMG) and ultrasound may yield normal results due to anatomical variations and the dynamic nature of nerve compression.</p><p><strong>Objective: </strong>This study introduces the Hip Abduction Maneuver (HAM) as a novel diagnostic tool for LFCN compression and investigates its utility in clinical and intraoperative assessments METHOD: The maneuver, inspired by Hagert's triad, evaluates hip abduction weakness as a functional indicator of LFCN entrapment. MP can result from mechanical, metabolic, iatrogenic, traumatic, or anatomical factors. Compression occurs under the inguinal ligament, where orthogonal taping (OKT) can serve as a mechanical relief test to support diagnosis. HAM exploits afferent inhibitory responses, assessing hip abduction strength before and after decompression maneuvers. The Scratch Collapse Test (SCT) further improves diagnostic accuracy. The Hip Abduction Maneuver (HAM) and Orthogonal KinesioTaping (OKT) enhance the clinical assessment of meralgia paresthetica, particularly in cases with inconclusive imaging.</p><p><strong>Conclusion: </strong>Their integration into preoperative evaluation and intraoperative validation may improve diagnostic precision and optimize surgical outcomes. Further studies are required to validate reproducibility and long-term efficacy.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"891-897"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Return to play and outcomes of surgically treated upper limb nerve entrapment in athletes: a systematic review.","authors":"Jad J Lawand, Diane Saab, Anna Luan, Catherine Curtin, Elisabet Hagert","doi":"10.1007/s00264-025-06473-9","DOIUrl":"10.1007/s00264-025-06473-9","url":null,"abstract":"<p><strong>Purpose: </strong>Athletes face a higher risk of upper limb nerve entrapment due to repetitive stress, trauma, and biomechanics. Diagnosis is challenging, and delayed treatment can impair performance. When conservative care fails, surgery may be needed to restore function and enable return to play (RTP).</p><p><strong>Methods: </strong>This systematic review adhered to PRISMA guidelines and evaluated surgical outcomes, RTP rates, and complications in athletes with upper limb nerve entrapment. A comprehensive search was conducted using MeSH terms and keywords for surgical interventions, nerve entrapment syndromes, and sports. Eligible studies included case series, cohort studies, and comparative studies that reported postoperative outcomes in athletes. Data extraction included nerve involvement, surgical techniques, clinical outcomes, and RTP rates.</p><p><strong>Results: </strong>Thirty-one studies, comprising 1,297 athletes across 23 sports, were included. The most common nerve entrapments involved the ulnar nerve (50.1%), brachial plexus (39.2%), and suprascapular nerve (9.5%). Surgical interventions included ulnar nerve decompression/transposition, first rib resection with scalenectomy for thoracic outlet syndrome (TOS), and suprascapular nerve decompression. RTP rates ranged from 62 to 100%, with an average of 87%. Suprascapular nerve decompression had the highest RTP success (100%), while TOS demonstrated greater variability (62.5-97%). Functional improvements included pain reduction, increased grip strength, and enhanced patient-reported outcomes. The overall complication rate was low, but TOS procedures had the highest reoperation rates (3.8-27%).</p><p><strong>Conclusion: </strong>Surgical treatment of upper limb nerve entrapment in athletes yields high RTP rates and functional recovery. Ulnar and suprascapular nerve decompressions show consistent success, while TOS surgery outcomes vary.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"871-880"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in orthopaedic data collection in Gaza Strip: observational findings and bibliometric analysis.","authors":"Abdullah Ghali, Harris Hafeez, Abdulwhhab Abu Alamrain, Zina Smadi, Tahir Qasim, Bilal Irfan, Mark Perlmutter, Ali Elaydi","doi":"10.1007/s00264-025-06511-6","DOIUrl":"https://doi.org/10.1007/s00264-025-06511-6","url":null,"abstract":"<p><strong>Purpose: </strong>The aim is to showcase the urgent need for improved data infrastructure and international collaboration by highlighting the barriers to comprehensive orthopaedic documentation and quantifying the scope and nature of scholarly research on Gaza's healthcare crisis.</p><p><strong>Methods: </strong>Data was collected through integration of observational field notes, informal interviews, patient record reviews and a bibliometric analysis of peer-reviewed articles on the 2023-2025 armed escalations in Gaza.</p><p><strong>Results: </strong>The review of patient documentation during surgical missions in Gaza revealed significant gaps in critical clinical information, including surgical history, microbiology data, and postoperative instructions, which hindered patient care. Frequent damage to records due to resource shortages and bombardments, along with issues in retrieving imaging data, further exacerbated these challenges. Bibliometric analysis showed that most studies were retrospective, focusing on trauma care and limb salvage, reflecting the difficulty of conducting prospective research in a conflict zone. Of the 114 publications reviewed, only three (2.6%) met inclusion criteria, with two of them involving Gaza-based Palestinian authors, despite barriers like power outages, limited journal access, and resource constraints.These findings highlight the resilience of Gaza's healthcare workers and the need for improved infrastructure, standardized documentation, and international partnership to enhance patient outcomes and strengthen global orthopaedic research.</p><p><strong>Conclusion: </strong>Orthopaedic documentation in Gaza is hampered by the compound impacts of recurrent conflict, infrastructural decay, and constrained academic output. Observational findings reveal the fragility of paper-based systems, while a bibliometric survey underscores the paucity of locally driven, empirical research. International efforts are needed to overcome these barriers for improved data infrastructure.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State-of-the-art review: The advantage and use of Wide Awake Local Anaesthesia No Tourniquet (WALANT) for nerve decompression surgery.","authors":"Amir Adham Ahmad, Donald H Lalonde","doi":"10.1007/s00264-025-06432-4","DOIUrl":"10.1007/s00264-025-06432-4","url":null,"abstract":"<p><strong>Purpose: </strong>Wide Awake Local Anesthesia No Tourniquet (WALANT) has gained significant attention since its introduction in 2005. Over 343 publications since 2013 highlight its increasing use in nerve decompression surgeries. WALANT is known for its safety benefits, cost-effectivenes and improved patient experience compared to traditional sedation and tourniquet-based methods. This review examines the advantages of WALANT in nerve decompression surgery, emphasizing its growing adoption and benefits.</p><p><strong>Methods: </strong>A comprehensive review of the WALANT technique is provided, focusing on injection strategies, including buffered lidocaine with epinephrine, proper needle placement and generous volume of tumescent anesthesia. Specific injection protocols and surgical approaches are discussed for various nerve decompression procedures such as carpal tunnel, lacertus, cubital tunnel, radial tunnel and lateral intermuscular septum releases.</p><p><strong>Results: </strong>WALANT eliminates sedation-related risks such as nausea, aspiration pneumonia and thromboembolism, making it suitable for high-risk patients (ASA 4). It reduces healthcare costs by decreasing the need for post-anesthesia care units and operating in minor procedure rooms. The technique fosters greater surgeon-patient interaction, reduces hospital stays and avoids preoperative fasting and testing. WALANT has demonstrated positive outcomes across multiple nerve decompression procedures.</p><p><strong>Conclusion: </strong>WALANT provides a transformative approach in nerve decompression surgery, offering enhanced safety, cost-effectiveness and improved patient-centered care. It significantly contributes to positive surgical outcomes, making it a valuable technique for both patients and healthcare providers.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"959-963"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"After great pain: a journey to understanding pain and nerve compression syndromes, with a focus on athletes.","authors":"Elisabet Hagert, Catherine Curtin","doi":"10.1007/s00264-025-06496-2","DOIUrl":"10.1007/s00264-025-06496-2","url":null,"abstract":"","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"795-798"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmaceutical considerations in treating neuropathic pain in athletes.","authors":"Sina Ramtin, Asif Ilyas","doi":"10.1007/s00264-025-06440-4","DOIUrl":"10.1007/s00264-025-06440-4","url":null,"abstract":"<p><p>Neuropathic pain is a complex and challenging condition that arises from abnormal processing of somatosensory information, often following nerve injury or dysfunction. Its diagnosis involves a detailed clinical history, sensory examination, and diagnostic tests such as electromyography, nerve conduction studies, and MRI to identify nerve damage or structural causes. In athletes, neuropathic pain can result from nerve entrapment syndromes, post-surgical complications, or peripheral nerve injuries, with unique challenges in pain assessment due to psychological factors and exercise-induced changes. Pharmacological management primarily includes anticonvulsants (e.g., gabapentin, pregabalin) and antidepressants (e.g., tricyclics, SNRIs), tailored to minimize side effects that could impair athletic performance. Effective treatment requires a careful balance to manage pain while maintaining physical capabilities. When treating athletes for neuropathic pain, healthcare providers must ensure prescribed medications comply with World Anti-Doping Agency (WADA) regulations. Narcotics (opioids) and cannabinoids are prohibited in-competition. Glucocorticoids are also banned in-competition if administered via injection, orally, or rectally, and elevated levels in urine may lead to sanctions.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"951-958"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuropathic causes of groin pain in athletes: understanding nerve involvement.","authors":"Zarko Vuckovic, Milos Bojovic","doi":"10.1007/s00264-025-06461-z","DOIUrl":"10.1007/s00264-025-06461-z","url":null,"abstract":"<p><strong>Purpose: </strong>Groin pain in athletes, particularly inguinal-related groin pain, remains a diagnostic and therapeutic challenge despite recent consensus on terminology. This study aims to explore nerve disorders as a key contributor to groin pain in athletes, focusing on the anatomy, aetiology, diagnosis, and management options.</p><p><strong>Methods: </strong>A comprehensive review of the literature was conducted, focusing on the anatomical variability of the ilioinguinal, iliohypogastric, and genital branch of the genitofemoral nerves, clinical presentations, diagnostic methods, and conservative and surgical treatments for nerve-related inguinal pain. Key studies on nerve entrapment, neuropathic and nociceptive pain mechanisms, and surgical outcomes were analyzed.</p><p><strong>Results: </strong>Variability in nerve pathways and sensory overlap complicate diagnosis and management. Neuropathic pain often presents with burning or electric sensations due to nerve compression or entrapment, while nociceptive pain manifests as dull or stabbing pain. Conservative treatment, including exercise-based rehabilitation and nerve blocks, offers relief in many cases. For refractory cases, surgical treatment can provide significant pain resolution, with nerve identification and potential neurectomy improving outcomes.</p><p><strong>Conclusion: </strong>Nerve disorders play a critical role in inguinal-related groin pain in athletes. Accurate diagnosis relies on detailed clinical examination and targeted imaging. Conservative treatments are first line, but surgical interventions addressing nerve entrapment or compression are effective for persistent cases. Future research should focus on the role of collagen deficiencies, nerve histopathology, and long-term outcomes of different treatment modalities.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"845-852"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic ultrasonography of upper extremity dynamic compressive neuropathies in athletes: A narrative review.","authors":"Chantal Nguyen, Raymond Chou","doi":"10.1007/s00264-025-06417-3","DOIUrl":"10.1007/s00264-025-06417-3","url":null,"abstract":"<p><strong>Purpose: </strong>This narrative review identifies and summarizes current evidence for diagnostic ultrasonographic evaluation of upper extremity dynamic compressive neuropathies affecting athletes.</p><p><strong>Methods: </strong>Relevant literature was identified using the PubMed database and then summarized.</p><p><strong>Results: </strong>The compressive neuropathies affecting athletes we identified included: neurogenic thoracic outlet syndrome, pectoralis minor syndrome, quadrilateral space syndrome, suprascapular nerve entrapment, proximal median nerve entrapment or bicipital aponeurosis/lacertus fibrosus (lacertus syndrome), radial tunnel syndrome, and cubital tunnel syndrome. Symptoms may develop only during specific sport activity, after specific sport-related trauma, or in setting of overuse during sport. Diagnostic ultrasound strategies assessing compressive neuropathies focus on static evaluation of nerves and surrounding structures, as well as dynamic evaluation of these structures in certain degrees of shoulder abduction, elbow flexion, or forearm pronation.</p><p><strong>Conclusion: </strong>Ultrasonography can be used as a diagnostic tool in assessing upper extremity dynamic compressive neuropathies. Ultrasound allows for dynamic evaluation of these rare conditions, especially for athletes who primarily develop symptoms during movement or participation in sport.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"925-933"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overview of nerve entrapment syndromes in the foot and ankle.","authors":"Milos Bojovic, Sanja Dimitrijevic, Bruno C R Olory, Cristiano Eirale, Omar AlSeyrafi, Abdulrahman Abdulla AlBaker, Branislav Krivokapic, Danilo Jeremic, Pieter DHooghe","doi":"10.1007/s00264-025-06469-5","DOIUrl":"10.1007/s00264-025-06469-5","url":null,"abstract":"<p><strong>Purpose: </strong>Tunnel syndromes around the foot and ankle are underrecognized and frequently misdiagnosed nerve entrapments that can significantly impact patients' quality of life. This review aims to provide a comprehensive overview of the etiology, clinical presentation, diagnostic challenges, and management strategies for these syndromes, focusing on the sural nerve, deep peroneal nerve, tibial nerve, medial plantar nerve, and inferior calcaneal nerve.</p><p><strong>Methods: </strong>A thorough literature review was conducted, examining studies and case reports on nerve entrapments in the foot and ankle. The review covers the clinical assessment, differential diagnosis, and treatment options, including conservative and surgical interventions.</p><p><strong>Results: </strong>Tunnel syndromes of the foot and ankle can arise from various causes, including trauma, anatomical variations, repetitive strain, and systemic conditions. Clinical manifestations often include burning pain, tingling, and motor weakness, depending on the affected nerve. Accurate diagnosis relies on a detailed patient history, physical examination, and adjunctive tests such as electrodiagnostic and imaging. Conservative treatments, such as physical therapy, orthotics, and corticosteroid injections, are often effective, while surgical decompression is reserved for refractory cases.</p><p><strong>Conclusions: </strong>Recognizing and diagnosing tunnel syndromes in the foot and ankle is essential for effective management and preventing permanent nerve damage. A systematic approach that integrates clinical evaluation and appropriate imaging can improve patient outcomes. Timely intervention, whether conservative or surgical, is crucial for alleviating symptoms and restoring function.</p>","PeriodicalId":14450,"journal":{"name":"International Orthopaedics","volume":" ","pages":"853-862"},"PeriodicalIF":2.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}