Background and Objectives: Hemiplegic shoulder pain (HSP) is a common and disabling complication in stroke patients, yet its pathogenesis remains unclear. This longitudinal study aimed to investigate the clinical and ultrasound characteristics of HSP emerging within the first 72 h (T0) post-stroke, with follow-ups at one month (T1) and three months (T2). Materials and Methods: A total of 28 stroke patients with hemiparesis were assessed for HSP. Evaluations included pain severity during passive shoulder mobilization, passive and active range of motion, muscle strength, spasticity, and functional disability. Ultrasound examinations were conducted to assess tendon disorders, bursitis, effusion, glenohumeral subluxation, and adhesive capsulitis. Results: HSP prevalence increased over time, affecting 11% of patients at T0, 32% at T1, and 57% at T2. Higher baseline scores on the National Institutes of Health Stroke Scale (NIHSS), an established marker of stroke severity, were significantly associated with HSP (p < 0.05). At T2, patients with HSP exhibited greater impairment, including restricted passive and active range of movement, pronounced muscle weakness, and increased spasticity (p < 0.05). Ultrasound findings at T2 revealed that adhesive capsulitis and glenohumeral subluxation were significantly more frequent in HSP patients (p < 0.05). Adhesive capsulitis showed a significant increase from 0% at T0 to 21% at T2 (p = 0.031), while glenohumeral subluxation exhibited a non-significant rise from 4% to 21% (p = 0.063). Patients with these conditions experienced significantly greater pain progression (p < 0.001). Conclusions: These findings suggest that capsular pathology plays a key role in the development of HSP within the first three months after stroke. The results highlight the need for targeted interventions addressing glenohumeral subluxation and adhesive capsulitis to alleviate pain and improve rehabilitation outcomes.

Stroke is a leading cause of long-term disability worldwide, often resulting in spasticity. Botulinum toxin injections have emerged as a cornerstone in the management of post-stroke spasticity. However, despite their clinical efficacy, maintaining long-term adherence to botulinum toxin therapy remains a significant challenge. This retrospective observational study analyzed 106 patients undergoing botulinum toxin therapy for post-stroke spasticity to identify the key factors influencing treatment continuation. The mean age of the cohort at the time of stroke was 57.7 years, with ischemic strokes accounting for 61.3% of cases and hemorrhagic strokes for 38.7%. A total of 61.3% of patients continued therapy, while 38.7% discontinued therapy due to a variety of reasons. The most common reasons included logistical barriers (43.9%) and comorbidities (36.6%), followed by perceived lack of benefit (24.4%) and clinical resolution (12.2%). Among those citing a lack of benefit, muscular fibrosis was a notable contributor. In the multivariable Cox regression analysis, logistical challenges, such as access to healthcare facilities and administrative difficulties, were associated with discontinuation (HR = 13.95, 95% CI: 5.57–34.94, p < 0.001). Comorbidities also significantly increased the likelihood of discontinuation (HR = 3.51, 95% CI: 1.56–7.87, p = 0.002), as did the lack of benefit (HR = 14.34, 95% CI: 5.65–36.38, p < 0.001) and condition resolution (HR = 19.20, 95% CI: 5.58–66.02, p < 0.001). In contrast, demographic and clinical factors, including age at the time of stroke, gender, stroke type, affected side, and baseline spasticity severity, did not significantly influence treatment continuation. These findings underscore the importance of addressing logistical barriers and mitigating the burden of comorbidities to enhance treatment adherence. A shift toward patient-centered approaches that integrate robust rehabilitation services and streamline healthcare accessibility is critical for optimizing outcomes.

Objectives: Previous studies have suggested the potential for semitendinosus (ST) tendon regeneration following harvesting for anterior cruciate ligament (ACL) reconstruction. This retrospective cross-sectional (observational) study aims to evaluate ST tendon regeneration using high-resolution ultrasound (US), with special reference to morphological and structural changes in the muscle–tendon unit. Methods: Twenty-four patients who had undergone ST tendon harvesting at least 24 months prior were evaluated. Ultrasound assessment included neotendon (NT) detection, thickness, echotexture, insertion site, dynamic gliding, myotendinous junction (MTJ) shifting, and muscle cross-sectional area (CSA), compared with the healthy contralateral side. Results: ST tendon regeneration was detected in 19/24 patients (79%). In regenerated tendons, NT thickness was significantly greater than the native tendon (3.40 ± 1.38 mm vs. 2.40 ± 0.27 mm; mean difference 0.98 mm; p = 0.005. Subgroup analysis revealed that fibrillar-like NTs were associated with a smaller MTJ shift (3.91 ± 1.14 cm vs. 7.75 ± 2.43 cm; p = 0.001) and higher muscle CSA preservation (0.85 ± 0.10 vs. 0.55 ± 0.09; p < 0.001). A strong inverse correlation was found between MTJ displacement and muscle CSA (ρ = −0.96; p < 0.001). Patients without NT regeneration (n = 5) exhibited more pronounced MTJ retraction (11.0 ± 1.0 cm) and muscle hypotrophy (CSA ratio 0.41 ± 0.07), although these results were descriptive. Conclusions: High-resolution US is an effective, non-invasive method for assessing ST tendon regeneration from a qualitative and quantitative perspective. Our findings indicate possible changes in the architecture and position of the regenerated tendon, the MTJ, and the muscle belly, which may reflect structural remodeling of the muscle–tendon unit.

Background: Autoimmune encephalitis (AE) is a rare inflammatory disorder characterized by important psychiatric and neurologic symptoms. The literature documents high rates of neuropsychological dysfunction in N-methyl D-aspartate-receptor (NMDAr) encephalitis but papers don’t consider specifically calculation disturbances between the long-term deficits, although deficits in executive control and episodic memory were less likely to resolve. Case report: Here we present a severe case of NMDAr encephalitis in a young patient without a relevant past medical history. Upon first examination he presented psycho-motor slowdown, speech disorders, severe cognitive deficits in all areas: concentration, attention, memory, language, dual task functions, increased latency in responses, severe dyscalculia. Upon first evaluation, the young patient underwent a battery of neuropsychological tests and he showed a dysexecutive syndrome with performances significantly low for age and education. Our patient hence underwent 1 month of intensive cognitive rehabilitation. After the rehabilitation treatment, he presented an amelioration in all domains except calculations. Conclusions: In our patient the calculation disorder has proved to be the most relevant problem and the most difficult to treat. Clinicians should consider a careful approach to determine the prognosis of this syndrome because of the wide range of deficits, the need of prolonged treatment and the rate of long-term sequelae.

Purpose: To characterize longitudinal changes in axillary-pouch capsular thickness and clinical outcomes after ultrasound-guided hydrodilation with corticosteroid injection in patients with post-stroke adhesive capsulitis, and to examine associations between structural and clinical changes. Methods: In this longitudinal observational study, 20 patients underwent clinical and ultrasonographic assessment before the first procedure (T0) and at follow-up (T1), separated by a median of 5.7 months. All participants also received conventional neurorehabilitation. Paired changes in pain measured using the Numeric Rating Scale (NRS), range of motion (ROM), strength, muscle tone, disability, quality of life, and capsular thickness were assessed using Wilcoxon signed-rank or exact McNemar tests. Associations between within-participant changes were explored using Spearman correlations. Results: Median movement-evoked pain decreased by 4 NRS points during flexion and abduction and by 5 points during external rotation (all p < 0.001). Active and passive ROM improved across all assessed movements (all p ≤ 0.001). Median affected-side capsular thickness decreased from 3.7 to 2.45 mm, with a median within-participant reduction of 1.4 mm ( p < 0.001). The proportion meeting the ultrasonographic criteria for adhesive capsulitis decreased from 20/20 at T0 to 4/20 at T1. Capsular-thickness changes were not significantly associated with changes in any clinical outcome (all |ρ|≤ 0.35; all p ≥ 0.13). Conclusion: In this uncontrolled cohort, hydrodilation with corticosteroid injection, delivered alongside neurorehabilitation, was followed by reduced movement-evoked pain, improved shoulder mobility, and axillary-pouch capsular thinning. Capsular thickness should be interpreted as a complementary structural marker rather than a surrogate for clinical recovery.