Background: Ozone therapy is used for its immunomodulatory, antioxidant, and analgesic properties in several fields. It can be useful in the rehabilitation of musculoskeletal disorders. Studies showed that O₂-O₃ therapy can reduce pain and improve functioning in patients affected by low back pain and knee osteoarthritis. Only a few studies have been published about the efficacy of this treatment in upper limb disease. Objective: The aim of this study is to investigate the use of ozone therapy in upper limb pathologies, evaluating its quantity, quality, and reported results in upper limb musculoskeletal disease, supraspinatus tendinopathy, shoulder impingement, adhesive capsulitis, chronic epicondylitis, and carpal tunnel syndrome. O₂-O₃ reduces inflammation by stimulating anti-inflammatory cytokines and inactivating pro-inflammatory molecules, relieves pain by interacting with pain receptors and improving blood circulation, promotes the regeneration of damaged tissues by stimulating growth factors and improving vascularization, and, finally, activates endogenous antioxidant defense systems by protecting cells from oxidative damage. Methods: A comprehensive search was conducted on PubMed and Scopus using the following MeSH terms: ozone therapy, infiltration joint, musculoskeletal disease, rehabilitation, upper limb, shoulder, wrist, hand, elbow, including English papers published in the last five years. Results: Five papers have been selected: four randomized controlled trials and one retrospective cohort study. The RCTs compared the effectiveness of intra-articular ozone injection with steroid injection alone or with other conservative treatments in shoulder diseases; one paper studied the effectiveness of ozone injection and orthoses in carpal tunnel syndrome compared to orthoses alone; one paper used ozone injections compared with steroid injection in patients with chronic lateral epicondylitis. A total of 218 patients were studied in these trials. Conclusions: Ozone treatment seemed to improve pain and function as well as other therapies in upper limb musculoskeletal disease. However, the trials’ protocols and the upper limb areas treated are different. Further studies are needed to define the effectiveness of ozone therapy in upper limb diseases in rehabilitation fields.

Background and Objectives: Postural instability is a key feature of Parkinson’s disease (PD), contributing to disability and increased risk of falls. Pharmacological treatments are important, but it is necessary to integrate them with rehabilitation programs that provide benefits for gait and balance. Focal muscle vibration (fMV) has been proposed as a proprioceptive-oriented intervention to enhance postural control, but evidence in PD remains heterogeneous. This observational, retrospective, and controlled pilot study aimed to evaluate whether the integration of fMV into a standardized rehabilitation program provides additional benefits for balance, gait, and fall risk compared to standardized exercise alone in patients with PD. Materials and Methods: Medical records of 35 outpatients with Parkinson’s disease (Hoehn & Yahr stage II–III) were reviewed. All practiced a standardized rehabilitation exercise group program. Of these, 18 patients agreed to undergo fMV before the exercise sessions (fMV group); 17 patients did not accept fMV due to personal organizational reasons (EG) and were considered a retrospective control group. In detail, (i) the fMV group receivdc focal muscle vibration during the first three weeks in addition to a standardized group rehabilitation exercise program, and (ii) the EG underwent a standardized rehabilitation program only. Both groups then completed an identical 16-week standardized rehabilitation program. Functional outcomes were assessed at baseline (T0) and after one month (T1). Results: Groups were homogeneous at baseline. The fMV group showed significant improvements in SPPB (from 8.16 ± 1.6 to 10.2 ± 1.6 p < 0.001) in the Tinetti total (from 18.38 ± 3.2 to 21.5 ± 2.9 p < 0.05). Stabilometric analysis revealed a significant improvement in the Romberg Quotient in the fMV group (p < 0.005). Conclusions: A short time-limited fMV intervention may act as a sensory primer, enhancing the effects of a subsequent standardized rehabilitation program in PD.

Spinal accessory nerve (SAN) injury is one of the most common causes of shoulder impairment after neck dissection for head and neck cancer. Dysfunction of trapezius muscle function is related to scapular biomechanics, and it results in pain, along with a reduction in range of motion, muscle weakness, and limitations in activities of daily living. Recently, exercise-based rehabilitation has been recognized as an important component of care. Evidence regarding the most effective rehabilitation strategies remains limited. The aim of this narrative review is to provide a comprehensive overview of SAN-related shoulder dysfunction following neck dissection for head and neck cancer, with particular emphasis on three main aspects: surgical strategies for preventing SAN injury, postoperative rehabilitation interventions for patients with established or suspected SAN-related dysfunction, and clinical and patient-reported outcome measures used to assess shoulder function and disability. A narrative review was conducted. Papers evaluating rehabilitation interventions for spinal accessory nerve injury after head and neck cancer surgery were included, and studies on rehabilitation interventions (manual therapy, strengthening, and supervised exercise) that are related to a reduction in pain and improvements in shoulder mobility, disability, and function were analyzed. Manual therapy enhanced cervical mobility and quality of life, strengthening improved short-term shoulder abduction, and supervised programs were more effective than home-based rehabilitation for pain and disability reduction. Targeted rehabilitation, including structured exercises and supervised physiotherapy, may improve shoulder mobility, reduce pain, and enhance functional recovery following spinal accessory nerve injury. Hospital-based supervised programs appear to offer greater short-term benefits. However, the limited evidence, small sample sizes, and heterogeneity in interventions prevent definitive recommendations. Further high-quality randomized trials with standardized protocols and long-term follow-up are needed.

Background/Objective: Breast cancer-related lymphedema (BCRL) is a frequent postoperative complication associated with shoulder functional impairment. Early diagnosis and comprehensive assessment are recommended, yet the literature shows heterogeneity regarding instrumental tools and the role of soft tissue ultrasound is not yet standardized. The aim of this retrospective observational study is to evaluate correlations between shoulder impairment and lymphedema in breast cancer patients. Methods: Medical records of 27 outpatient women after breast cancer surgery (mean age ± SD: 55.10 ± 9.58) were evaluated. Clinical variables included anamnestic data regarding surgery and oncology treatments, limb circumferences, passive shoulder range of motion (PROM), axillary web syndrome (AWS) and BMI. Assessment tools included DASH, ECOG, and VAS. Millimetric ultrasound measurements of the dermo-epidermal complex and subcutaneous tissue, at standardized sites, were performed to study limb lymphedema. Results: Lymphedema was found in 35.7% of patients. They showed higher rates of lymphadenectomy, AWS, higher BMI, limited shoulder flexion (p = 0.002) and abduction (p = 0.004), and higher DASH scores (31.99 ± 15.70 vs. 26.16 ± 17.8) compared with patients without lymphedema. There was a preliminary correspondence between circumferential and ultrasound measurement sites of patients’ lymphedema limbs. Conclusions: Ultrasound evaluation associated with functional assessment may support the early diagnosis of shoulder impairment and higher limb lymphedema risk to improve rehabilitation treatments in patients after breast cancer surgery.

Chronic pelvic pain (CPP) affects approximately 26% of women and significantly impacts quality of life. Common causes include dysmenorrhea and pelvic floor dysfunction. Transcutaneous electrical nerve stimulation (TENS) is widely used for pain relief to inhibit pain transmission and stimulate...

Temporomandibular disorders (TMDs) represent a heterogeneous group of conditions, including myogenous and arthrogenous, with a significant impact on quality of life. Botulinum toxin type A (BoNT-A) has been proposed as a therapeutic option, particularly for patients with refractory myogenous TMD and bruxism. This systematic review aimed to evaluate the clinical effectiveness of BoNT-A in the management of TMDs overall and bruxism, with particular focus on myogenous TMDs compared to placebo and non-surgical treatments. RCTs published between 2020 and 2025 were identified through PubMed, Scopus, and Google Scholar. Overall, 15 RCTs involving 797 participants were included. The available evidence suggests potential benefits of BoNT-A, particularly in patients with localized myofascial pain, myogenous TMD, or marked masticatory muscle hyperactivity. Interpretation of the findings is limited by substantial heterogeneity in treatment protocols, toxin dosage, diagnostic criteria, outcome measures, and follow-up duration. Current evidence does not support the routine use of BoNT-A as a first-line treatment for TMDs overall. Instead, BoNT-A may represent an adjunctive or second-line option for selected patients with myogenous TMD, localized myofascial pain, or marked masticatory muscle hyperactivity who do not adequately respond to conventional noninvasive treatment. Larger and methodologically rigorous RCTs are needed to establish appropriate indications, duration of treatment effects, and long-term safety across different TMD subtypes.