Background: Corticosteroid (CS) can be injected in a blind fashion (landmark-guided) or with ultrasound (US) guidance, and this may contribute to varying clinical results. We conducted this systematic review and meta-analysis to assess the effectiveness of US-guided versus landmark CS injections in the treatment of adult patients with shoulder pain. Methods: We searched MEDLINE (via PubMed), Scopus, Web of Science, EBSCO, and Cochrane Library for randomized controlled trials (RCTs) comparing US-guided versus landmark CS injection regarding visual analogue scale (VAS), functional scores, disability scores, abduction degree, and side effects. The data were pooled as mean difference (MD), standardized mean difference (SMD), or risk ratios (RRs), with 95% confidence intervals (CIs), using R software (meta package 4.9-0) for windows. Subgroup analysis and leave-one-out analysis were conducted. Results: Eighteen RCTs, with a total of 1010 patients, were included in this meta-analysis. The pooled estimate favored the US-guided over landmark CS injection in terms of the mean change of VAS between 6 weeks and baseline (SMD = − 0.48, 95% CI [− 0.79, − 0.17]), the shoulder functional scores (SMD = 0.35, 95% CI [0.05, 0.65]) and shoulder abduction degree (MD = 8.78, 95% CI [3.11, 14.46]). Whilst no significant difference was found between the compared group regarding the overall shoulder disability scores (SMD = − 0.51, 95% CI (− 1.25, 0.22]) and side effects (RR = 0.45, 95% CI [0.15, 1.34]). None of the eligible study analyzed the cost-effectiveness of the US-guided method compared with the landmark method for CS injection. Conclusion: Our analysis showed that US-guided CS injection was effective in the treatment of various shoulder diseases. Further research on the cost-effectiveness of US-guided CS methods is needed.

Objective: The aim of this study was to examine the effects of combining extracorporeal shock wave therapy or local corticosteroid injections with a conventional physical therapy (CPT) program for patients with shoulder impingement syndrome. Design: This was a prospective single-blinded, randomized controlled study. Methods: Sixty patients with unilateral shoulder impingement syndrome >3 mos were allocated to group A (a 4-wk program of CPT plus a single local corticosteroid injection of 40 mg triamcinolone acetonide mixed with 1% xylocaine, n = 20), group B (CPT only, n = 20), and group C (CPT plus extracorporeal shock wave therapy, 2000 impulses, 0.2–0.3 mJ/mm², one session per week for 3 wks, n = 20). Subacromial space, shoulder pain and disability index, and shoulder range of motion were assessed at baseline and 4 and 12 wks posttreatment. Results: There were no between-group differences at 4 wks. At the 12-wk follow-up, no significant differences were found between groups A and B. There was a significant difference in favor of group C compared with group A with the expectation of shoulder internal rotation and subacromial space. Group C was also superior to group B in all outcomes except for subacromial space. Conclusion: The addition of extracorporeal shock wave therapy to CPT induced more noticeable intermediate-term effects than CPT plus local corticosteroid injection or CPT alone.

Background and Study Aim. Cerebral palsy is a broad term for a variety of non-progressive, resulting in physical impairment, movement dysfunction, and poor posture. The purpose of the study was to compare the effectiveness in the Halliwick aquatic exercise versus conventional land-based therapy on gross motor function of children aged from 3 to 5 years with spastic cerebral palsy. Material and Methods. In this randomized controlled trial, (n=34) children diagnosed with spastic Cerebral palsy were randomly assigned into either the Halliwick concept group (n=17) or active control (conventional exercising group) (n=17). A physiotherapist performed the sessions with participants three times a week, 45 minutes duration over 12 weeks. An independent pediatric rehabilitation specialist assessed the children’s gross motor function using the gross motor function measures (sitting, crawling and kneeling, standing, walking, running, and jumping). Results. After the intervention, both Halliwick concept group and conventional exercising group significantly improved activities of sitting, crawling & kneeling, standing and walking, running and jumping. Besides, the estimate of the effect of the Halliwick exercises on sitting, standing and walking, running & jumping activities was more clinically significant than conventional exercises, with sitting; MD = -0.06 [95%, CI; -0.19 to 0.32], standing; MD = 0.14 [95%, CI; -0.15-0.31], and walking, running & jumping activities; MD = -0.09 [95%, CI; -0.11 to 0.20]. None of the between-group differences for any remaining outcomes was significant. Conclusion. Aquatic exercises based on the Halliwick concept are better than conventional exercises to improve sitting, standing and walking, running and jumping activities in children aged 3 to 5 years with spastic cerebral palsy.

Purpose: This study aimed to investigate the impacts of breast cancer-related lymphedema (BCRL) severity on shoulder function including range of motion, strength, muscle activation patterns, and patient-reported disability. Methods: A cross-sectional, observational study design was utilized. Seventy-five women with unilateral BCRL were recruited and categorized into mild, moderate, and severe groups based on limb swelling severity. Outcomes included shoulder range of motion, isometric strength, Disabilities of Arm Shoulder and Hand (DASH) scores for disability, and surface electromyography (EMG) of shoulder muscles. Data were analyzed using parametric and nonparametric tests. Results: Increasing lymphedema severity was associated with progressive declines in shoulder mobility, strength, and function. Severe cases showed markedly reduced shoulder flexion, abduction, rotation, and extension range of motion along with decreased isometric flexor and abductor strength versus mild cases ( p < 0.001). Higher pain levels ( p < 0.001) and DASH disability scores ( p < 0.001) were noted in severe BCRL. Surface EMG revealed impaired activation patterns including reduced amplitudes ( p < 0.001) and delayed onsets ( p < 0.001) in the deltoids, rotator cuff, and scapular muscles with greater impairment. Conclusions: Advancing BCRL severity was associated with substantial declines in shoulder mobility, strength, neuromuscular activation, pain threshold, and upper limb functionality. These quantitative results demonstrate impaired shoulder joint control underlying disability in arm elevation and daily tasks. The progressive nature of these deficits highlights the relationship between lymphedema severity and shoulder dysfunction in breast cancer survivors.

Objective: Transcutaneous electrical neuromuscular stimulation (TENS) is a noninvasive, nonpharmacological, and least expensive technique to improve sensitivity and reduce pain in patients with neuropathy. Evidence reported on the effectiveness of TENS on neuropathy was inconclusive. This study was aimed at providing recent evidence on the effectiveness of TENS for neuropathic pain, using data from randomized controlled trials and nonrandomized studies. Methods: We conducted a comprehensive search across Scopus, CINAHL, Web of Science, Medline, Embase, Cochrane Central Register of Control Trials (CENTRAL), Physiotherapy Evidence Database (Pedro), and Google Scholar from January 1, 1999, to May 5, 2024. Eligible studies included randomized controlled trials and nonrandomized studies on TENS for neuropathic pain, without restrictions based on language or country. Key inclusion criteria were studies on TENS for neuropathic pain, while exclusion criteria included studies on neuropathic pain due to cancer, HIV infection, or stroke. Two independent reviewers selected studies, extracted data, and assessed quality using the GRADE tool. Results: Thirty articles met the eligibility criteria, and 25 were included in the meta‐analysis. Overall, TENS slightly reduced neuropathic pain compared to placebo, but this was not clinically significant (SMD = −0.35; 95% CI: −0.90 to 0.10, p = 0.13). For patients with diabetic neuropathic pain, TENS was similar to placebo and other electrotherapies. However, it was better than placebo and other interventions for reducing neuropathic pain in spinal cord injury patients (SMD = −1.14; 95% CI: −2.22 to −0.06, p = 0.04). Conclusions: TENS generally seems to provide a small reduction in neuropathic pain compared with a placebo, other electrotherapies, or other interventions.