Explore the vast range of titles available.

Abstract Objective To evaluate the clinical effect of perineural platelet-rich plasma (PRP) injection for pain and numbness alleviation in diabetic peripheral neuropathy (DPN). Study Design A randomized prospective clinical trial. Setting Pain clinic and Rheumatology and Rehabilitation Departments, Assiut University Hospital. Methods Sixty adult patients with type II DM accompanied by DPN of at least six months’ duration were assessed by modified Toronto Clinical Neuropathy Score (mTCNS) and randomly allocated into two groups. Group I underwent ultrasound-guided perineural PRP injection and medical treatment, and Group II received medical treatment only. Patients were followed up at months 1, 3, and 6 with regard to pain and numbness visual analog scale (VAS) and mTCNS scores. Results Significant improvement was recorded in pain and numbness VAS scale scores in group I vs group II (P ≤ 0.001 during the whole study period for both parameters); at the same time, mTCNS improved in group I in comparison with group II with P = 0.01, 0.001, and <0.001 at months 1, 3, and 6, respectively. Conclusions Perineural PRP injection is an effective therapy for alleviation of diabetic neuropathy pain and numbness and enhancement of peripheral nerve function.

Objective This randomized controlled trial conducted a comparative analysis of postoperative outcomes between a modified anteromedial incision with saphenous nerve protection and the traditional medial parapatellar approach in total knee arthroplasty (TKA). We aimed to test the hypothesis that the nerve-sparing modified technique would significantly reduce postoperative anterior knee numbness and pain while maintaining surgical feasibility. Methods Sixty-eight TKA candidates (January 2022-June 2023) were prospectively randomized into two groups: Modified ( n  = 34) and Traditional ( n  = 34) approaches. The modified technique featured an anteromedial incision with infrapatellar branch visualization and preservation, whereas the control group received the traditional medial parapatellar exposure. Primary outcomes included numbness area and the Visual Analog Scale score; secondary outcomes encompassed surgical parameters (duration, blood loss) and functional recovery (Hospital for Special Surgery Knee score). Results Thirty one patients were randomized to the M group and 29 patients allocated to the T group. Compared to the T group, the M group demonstrated significantly lower VAS scores at 3 days, 7 days, and 2 weeks postoperatively, with statistical significance ( P  < 0.05). The M group showed a statistically significant reduction in the area of numbness compared to the T group at all postoperative follow-up intervals: 2 weeks, 1 month, 3 months, 6 months, and 1 year ( P  < 0.05 for all time points). However, postoperative HSS scores did not differ significantly between the M group and the T group at any follow-up interval ( P  > 0.05). Conclusion The nerve-preserving modified approach achieved superior patient-reported outcomes (PROs) in reducing anterior knee numbness and early postoperative pain without compromising prosthesis implantation accuracy or functional recovery trajectories, suggesting its potential as a standardized refinement in TKA surgical protocols. Trial registration Chinese Clinical Trial Registry, ChiCTR2500107220, 6 August 2025, retrospectively registered.

Purpose To investigate the effectiveness of a 13-week combined supervised and home-based exercise program in alleviating the symptoms of chemotherapy-induced peripheral neuropathy (CIPN) in patients with breast cancer (BC). Methods In this non-randomized controlled study, 77 patients with BC selected after applying the inclusion and exclusion criteria were allocated to the intervention ( n  = 37) or control ( n  = 40) group. Patients in the intervention group underwent a 13-week exercise program consisting of health education and hand and foot exercises combined with aerobic, resistance, and balance training, while those in the control group received usual care. The symptoms of CIPN were assessed at baseline (T0), post-intervention (T1), and 3 months post-intervention (T2). Physical fitness and finger flexibility were assessed at T0 and T1. A generalized estimating equation (GEE) model was used to analyze the repeated measures data. Results The results of GEE showed a significant group effect, indicating significant intergroup differences in the total CIPN score and the dimensions of occurrence, severity, disruption, and frequency (all P  < 0.05). Moreover, the two groups showed significant differences in finger flexibility and balance at T1 (all P  < 0.05). Conclusions The exercise program was effective in alleviating the symptoms of CIPN and improved balance and finger dexterity in comparison with the control group. Randomized controlled trials with larger sizes are required to validate these findings.

Purpose Supporters of minimally invasive approaches for transforaminal lumbar interbody fusion (TLIF) have reported short-term advantages associated with a reduced soft tissue trauma. Nevertheless, mid- and long-term outcomes and specifically those involving physical activities have not been adequately studied. The aim of this study was to compare the clinical outcomes of mini-open versus classic open surgery for one-level TLIF, with an individualized evaluation of the variables used for the clinical assessment. Methods A prospective cohort study was conducted of 41 individuals with degenerative disc disease who underwent a one-level TLIF from January 2007 to June 2008. Patients were randomized into two groups depending on the type of surgery performed: classic open (CL-TLIF) group and mini-open approach (MO-TLIF) group. The visual analog scale (VAS), North American Spine Society (NASS) Low Back Pain Outcome instrument, Oswestry Disability Index (ODI) and the Short Form 36 Health Survey (SF-36) were used for clinical assessment in a minimum 3-year follow-up (36–54 months). Results Patients of the MO-TLIF group presented lower rates of lumbar ( p  = 0.194) and sciatic pain ( p  = 0.427) and performed better in daily life activities, especially in those requiring mild efforts: lifting slight weights ( p  = 0.081), standing ( p  = 0.097), carrying groceries ( p  = 0.033), walking ( p  = 0.069) and dressing ( p  = 0.074). Nevertheless, the global scores of the clinical questionnaires showed no statistical differences between the CL-TLIF and the MO-TLIF groups. Conclusions Despite an improved functional status of MO-TLIF patients in the short term, the clinical outcomes of mini-open TLIF at the 3- to 4-year follow-up showed no clinically relevant differences to those obtained with open TLIF.

Background Rubber band ligation (RBL) is a widely accepted intervention for the treatment of haemorrhoids. However, post procedure pain is a common complaint. The aim of this study was to determine whether the addition of local anaesthetic (LA) to the haemorrhoid pedicle base, post RBL, aids in reducing early post-procedure pain. Additionally, to compare perceived perianal numbness, oral analgesia usage and total consumption, and adverse events. Methods This study was a prospective, single-blinded randomised controlled trial. Patients were recruited from colorectal clinics in two Australian hospitals between 2018–2019. Patients randomised to the intervention (LA) group received 2mls bupivacaine 0.5% with adrenaline 1:200,000 to each haemorrhoid base. Patients in the control group were not administered LA. Pain scores were recorded over 48 h using visual analogue scales. Analgesia consumption was documented and other secondary objectives were recorded dichotomously (yes/no). Results At 1 h post-procedure, patient reported pain scores were significantly lower in the LA group compared to the control group ( p  = 0.04). There were no significant differences in pain scores between the groups at 4, 24 or 48 h. Additionally, there were no significant differences between groups with respect to oral analgesia usage, perianal numbness or adverse events. Conclusions LA to the haemorrhoid pedicle post RBL may significantly reduce early post procedure pain without any increased risk of adverse effects.

BACKGROUND:Sectioning of the C2 nerve root allows for direct visualization of the C1-2 joint and may facilitate arthrodesis. OBJECTIVE:To determine the clinical and functional consequences of C2 nerve root sectioning during placement of C1 lateral mass screws. METHODS:All patients undergoing C1 lateral mass screw fixation were included in this prospective study. A standard questionnaire was used to determine the severity of occipital numbness/pain and its effect on quality of life (QOL). Domains of the neck disability index were used to assess the disability related to C2 symptoms. RESULTS:A total of 28 patients were included (C2 transection, 8; C2 preservation, 20). A trend of decreased blood loss and length of surgery was observed in the C2 transection cohort. Occipital numbness was reported by 4 (50.0%) patients after C2 transection. Occipital neuralgia was reported by 7 (35.0%) patients with C2 preservation. None of the patients with numbness after C2 transection reported being “bothered” by it. All patients with occipital neuralgia after C2 sparing reported being “bothered” by it, and 57.1% reported a moderate to severe effect on QOL. The use of medication was reported by 5 (71.4%) patients with neuralgia vs none with numbness. Mean disability was significantly higher with neuralgia vs numbness (P = .016). CONCLUSION:C2 nerve root transection is associated with increased occipital numbness but this has no effect on patient-reported outcomes and QOL. C2 nerve root preservation can be associated with occipital neuralgia, which has a negative impact on patient disability and QOL. C2 nerve root transection has no negative consequences during C1-2 stabilization. ABBREVIATIONS:NDI, neck disability indexQOL, quality of life

Background Of children with hemiplegic cerebral palsy, 75% have impaired somatosensory function, which contributes to learned non-use of the affected upper limb. Currently, motor learning approaches are used to improve upper-limb motor skills in these children, but few studies have examined the effect of any intervention to ameliorate somatosensory impairments. Recently, Sense© training was piloted with a paediatric sample, seven children with hemiplegic cerebral palsy, demonstrating statistically and clinically significant change in limb position sense, goal performance and bimanual hand-use. This paper describes a protocol for a Randomised Controlled Trial of S ense© for Kids training, hypothesising that its receipt will improve somatosensory discrimination ability more than placebo (dose-matched Goal Directed Therapy via Home Program). Secondary hypotheses include that it will alter brain activation in somatosensory processing regions, white-matter characteristics of the thalamocortical tracts and improve bimanual function, activity and participation more than Goal Directed Training via Home Program. Methods and design This is a single blind, randomised matched-pair, placebo-controlled trial. Participants will be aged 6–15 years with a confirmed description of hemiplegic cerebral palsy and somatosensory discrimination impairment, as measured by the sense©_assess Kids . Participants will be randomly allocated to receive 3h a week for 6 weeks of either S ense© for Kids or Goal Directed Therapy via Home Program. Children will be matched on age and severity of somatosensory discrimination impairment. The primary outcome will be somatosensory discrimination ability, measured by sense©_assess Kids score. Secondary outcomes will include degree of brain activation in response to a somatosensory task measured by functional MRI, changes in the white matter of the thalamocortical tract measured by diffusion MRI, bimanual motor function, activity and participation. Discussion This study will assess the efficacy of an intervention to increase somatosensory discrimination ability in children with cerebral palsy. It will explore clinically important questions about the efficacy of intervening in somatosensation impairment to improve bimanual motor function, compared with focusing on motor impairment directly, and whether focusing on motor impairment alone can affect somatosensory ability. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry, registration number: ACTRN12618000348257. World Health Organisation universal trial number: U1111–1210-1726.

Background Irritation of inguinal nerves with laparoscopic hernia repair may cause chronic neuralgia and hypoesthesia. Hypoesthesia in particular is generally not assessed objectively. We objectively investigated hypoesthesia and chronic pain after transabdominal preperitoneal inguinal hernia repair (TAPP) with titanium spiral tacks (STs) compared with tissue adhesive (TA) for mesh fixation. Methods Mesh fixation in 80 TAPP procedures was randomized to fixation with ST ( n  = 40) or TA ( n  = 40). The outcome parameters included hypoesthesia assessed with von Frey monofilaments, early postoperative and chronic pain with the visual analog scale (VAS), morbidity (surgical-site infection, hematoma/seroma, relapse of hernia, trocar hernia), and recovery time to normal activity. Results Median (range) follow-up was 38 (13–56) months. Demographic and baseline parameters were similar in the two groups. Prevalence of hypoesthesia was significantly higher at all postoperative times in the ST group (6 weeks: 32 vs. 6%; 6 months: 38 vs. 14%; 12 months: 34 vs. 13%; 13–56 months: 32 vs. 4%). Mean hypoesthesia scores over all time points were significantly higher in the ST group. The percentages of regions with hypoesthesia (abdominal, inguinal, or genitofemoral) following all procedures were higher in the ST group after 6 weeks (14 vs. 2%), 6 months (15 vs. 5%), and 13–56 months (22 vs. 4%). The intensity of pain decreased significantly in both groups over time. Conclusions Postoperative hypoesthesia depends on the method of mesh fixation during TAPP and is significantly reduced with TA compared with stapling.

Background Following Lichtenstein hernia repair, up to 25% of patients experience prolonged postoperative and chronic pain as well as discomfort in the groin. One of the underlying causes of these complaints are the compression or irritation of nerves by the sutures used to fixate the mesh. We compared the level and rate of chronic pain in patients operated with the classical Lichtenstein technique fixated by sutures to patients with sutureless mesh fixation technique. Methods A two-armed randomized trial with 264 male patients was performed. After consent, patients were randomized preoperatively. For the fixation of the mesh we used either sutures with slow-absorbing material (PDS 2.0) (group I, n  = 133) or tissue glue (Histoacryl) (group II, n  = 131). Follow-up examinations were performed after 3, 12 months and after 5 years. Results Patient characteristics in the two groups were similar. No cross-over between groups was observed. After 5 years, long-term follow-up could be completed for 59% of subjects. After 5 years, 10/85 (11.7%) patients in group I and 3/70 (4.2%) in group II suffered from chronic pain in the groin region ( P  = 0.108). The operation time was significantly shorter in group II (79 min vs 73 min, P  = 0.01). One early recurrence occurred in group II (3 months). The recurrence rate was 0 and 0% after 12 months and 5.9% (5/85) and 10% (7/70) after 5 years in group I and group II, respectively ( P  = 0.379). Conclusion After 5 years, the two techniques of mesh fixation resulted in similar rates of chronic pain. Whereas recurrence rates were comparable, fixation of the mesh with tissue glue decreased operating room time significantly. Hence, suture less mesh fixation with Histoacryl is a sensible alternative to suture fixation and should be especially considered for patients prone to pain.

Carpal tunnel syndrome is one of the most common compression neuropathies in the upper limbs and requires surgery if conservative treatment fails. This article compares the result of regular open incision, mid-palmar mini incision and endoscopic technique in carpal tunnel release. This is a clinical trial study on 105 patients (10 males, 95 females) within one year, who were surgical candidates. The surgery was done with regular open incision or with mid-palmar small incision. The clinical outcomes were evaluated one week, 4 weeks and 4 months post-surgery. Relief and satisfaction were better in the first month in the endoscopic and mid-palmar mini incision group. All 3 techniques had similar outcomes after 4 months. In the 4-month follow-up, night pain relief, followed by parasthesia relief had the best improvement. Weakness was the symptom with the least improvement. Longer incision cases were associated with more delay to return to work. Carpal tunnel release with endoscopic and mini incision techniques have better early satisfaction rates compared to regular open incision, but no difference is seen between the two groups after four months.