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Background: Objective measures from imaging studies have the potential to assist in timely diagnosis of atraumatic shoulder hypermobility to better guide management. The aim of this scoping review is to examine imaging modalities and techniques used to characterize atraumatic shoulder hypermobility., Methods: MEDLINE, EMBASE, SPORTDiscus, Cochrane Library, and Web of Science were searched up to May 2024 for any primary study investigating imaging findings seen in atraumatic shoulder hypermobility. Patients with unilateral instability were excluded given its frequent association with traumatic origin., Results: Eighteen observational studies met inclusion criteria. Results were divided into outcomes relating to capsular redundancy, glenohumeral anatomy, and muscle activation. Five studies using magnetic resonance arthrography (MRA) demonstrated statistically significant increases in capsular cross-sectional area (CSA), while a significant superior capsular elongation was reported by two studies in patients with multidirectional instability (MDI). Labrocapsular distance, glenocapsular ratio, and the presence of a combined sail and triangle sign on MRA were highly sensitive and specific parameters for identifying MDI. There were inconsistent findings for alterations of glenohumeral anatomy. Ultrasound assessments of acromiohumeral distance (AHD) were significantly increased in patients with MDI, but not in shoulders with hypermobility alone. Similarly, muscle activity measured by electromyography or glenohumeral translations differed significantly in patients with MDI, but not in those with hypermobility alone., Conclusion: Radiographic markers of capsular redundancy (e.g., CSA, labrocapsular distance, glenocapsular ratio), AHD, and muscular activity are useful in the diagnosis of MDI. However, there are no definitive imaging markers for diagnosing atraumatic shoulder hypermobility without MDI., (© 2024. The Author(s), under exclusive licence to International Skeletal Society (ISS).)

Background and Objective: Cryoneurolysis involves percutaneous insertion of a cryoprobe induced to extremely cold temperatures to disrupt peripheral nerve conduction. The primary objective of this scoping review is to summarize and critically appraise the current evidence for the benefits and safety of cryoneurolysis for non-cancer knee pain. The secondary objective is to describe the variations in cryoneurolysis techniques used., Methods: MEDLINE, EMBASE, PubMed, Cochrane Library, and Web of Science were searched from their inception to February 2023 for any primary literature investigating the use of cryoneurolysis for non-cancer-related knee pain. Data was extracted for study characteristics, intervention characteristics, and clinical outcomes., Results: Fourteen studies were identified, including three randomized controlled trials, four retrospective cohort studies, and seven case studies/series. Two studies included knee osteoarthritis patients, three studies included non-specific chronic knee pain patients; and nine studies included pre- or post-total knee arthroplasty patients. Ten studies targeted the infrapatellar branch of the saphenous nerve while the remaining four studies did not report the nerve targeted. Studies consistently demonstrated improvements in pain, function, quality of life, and opioid consumption. Most adverse events were mild and self-limiting. Considerable variations in technique parameters were observed., Conclusions: Cryoneurolysis is a promising intervention to improve outcomes in non-cancer knee pain populations, particularly in mild-to-moderate knee osteoarthritis and pre-total knee arthroplasty populations. However, cryoneurolysis for knee pain remains largely investigational as more high-quality randomized controlled trials are required to further elucidate efficacy as well as optimal nerve selection and technique., Competing Interests: The authors declare no conflicts of interest., (© 2023 The Authors.)

Background: Depression and anxiety disorders are considered to be among the greatest burdens of disease in children and adolescents. Recent literature has reported music therapy to be a safe and potentially effective intervention for the treatment of depression and anxiety. This systematic review examined the effectiveness of music therapy in reducing the symptom severity of depression and/or anxiety among children and adolescents., Methods: Randomized controlled trials (RCTs) were obtained from a systematic search of nine major English databases from inception to January 2021. Studies were categorized by outcome, music therapy technique and follow-up period., Results: Seven RCTs (n = 589) were included. Four RCTs had some concern of bias, while three had high risk of bias. Statistical pooling was not appropriate due to clinical heterogeneity. Four studies (n = 428) favoured music therapy for improvement of depressive symptoms at short- and intermediate-term follow-ups compared to control. One study (n = 106) favoured music therapy for improvement of anxiety symptoms at short-term follow-up compared to control. No studies favoured any control over music therapy for symptom improvement of depression and/or anxiety., Conclusion: Limited evidence suggests music therapy is an effective treatment for improving depression and/or anxiety symptom severity in children and adolescents. More high-quality RCTs are needed to address methodological flaws of current studies., (© 2021 Association for Child and Adolescent Mental Health.)

Abstract: Fibromyalgia (FM) is a complex chronic pain condition. Its symptoms are nonspecific, and to date, no objective test exists to confirm FM diagnosis. Potential objective measures include the circulating levels of blood biomarkers. This systematic review and meta-analysis aim to review studies assessing blood biomarkers' levels in patients with FM compared with healthy controls. We systematically searched the PubMed, MEDLINE, EMBASE, and PsycINFO databases. Fifty-four studies reporting the levels of biomarkers in blood in patients with FM were included. Data were extracted, and the methodological quality was assessed independently by 2 authors. The methodological quality of 9 studies (17%) was low. The results of most studies were not directly comparable given differences in methods and investigated target immune mediators. Thus, data from 40 studies only were meta-analyzed using a random-effects model. The meta-analysis showed that patients with FM had significantly lower levels of interleukin-1 β and higher levels of IL-6, IL-8, tumor necrosis factor-alpha, interferon gamma, C-reactive protein, and brain-derived neurotrophic factor compared with healthy controls. Nevertheless, this systematic literature review and meta-analysis could not support the notion that these blood biomarkers are specific biomarkers of FM. Our literature review, however, revealed that these same individual biomarkers may have the potential role of identifying underlying pathologies or other conditions that often coexist with FM. Future research is needed to evaluate the potential clinical value for these biomarkers while controlling for the various confounding variables., (Copyright © 2021 International Association for the Study of Pain.)

Objective: To determine whether the proportion of sport-related concussion (SRC) cases among student athletes that resulted in a relapse of their symptoms due to premature return to play (RTP) or premature return to learn (RTL) has changed compared with a prior (2006 to 2011) study., Design: Retrospective cohort study of electronic medical record charts from a 5-year period (2011 to 2016) compared with previous data., Setting: A sport and exercise medicine physician's office-based practice in Ontario., Participants: Two-hundred forty-one students who had 258 distinct cases of SRC diagnosed., Main Outcome Measures: Premature RTP and RTL were defined as chart records documenting the relapse, recurrence, or worsening of concussion symptoms that accompanied the patient's RTP or RTL., Results: Between 2011 and 2016, premature RTP and RTL resulted in a relapse of symptoms in 26.7% and 42.6% of cases, respectively. When compared with data from the 2006 to 2011 chart review, the incidence of premature RTP decreased by 38.6%. However, the rate of the relapse of symptoms associated with premature RTL decreased by only 4.7%. There was a relapse of symptoms in 43.4% of the cases involving female students and 29.7% of the cases involving male students, indicating that female patients are more likely to experience a relapse of symptoms. Cases involving female athletes also resulted in much later RTP clearance compared with those involving male athletes, with a median duration that was almost double that of male athletes' cases (49 days vs 25 days)., Conclusion: An important decrease in the relapse of symptoms in the context of premature RTP occurred over the 2006 to 2016 period. However, this decrease was minimal for RTL. This may reflect the fact that efforts to implement structured RTP strategies arose earlier than those to implement RTL strategies. Efforts are needed to find the best method of implementing a coordinated plan for the postconcussion athlete who is returning to school., (Copyright© 2022 the College of Family Physicians of Canada.)

Objective: To identify barriers to and facilitators of return to learning (RTL) for female secondary school students following a sport-related concussion (SRC), and to identify critical junctures on the injury-to-recovery continuum that can be targeted to enhance the RTL process., Design: A grounded theory approach using in-depth qualitative interviews., Setting: Secondary schools within the York Region District School Board in Ontario., Participants: Ten female secondary school students who presented to a sports medicine physician with an SRC in 2015 or 2016. Five of the students received a Green Folder intervention containing an RTL strategy, while 5 students received no RTL intervention following their SRC., Methods: In-depth interviews were conducted in person or by telephone. All interviews were audiorecorded and transcribed. The transcriptions were analyzed, coded, and examined for common themes by 2 independent reviewers., Main Findings: Barriers to RTL included a lack of a graduated RTL process, students' own internal stress, poor communication of expectations, lack of concussion education, and inadequate support from teachers. Facilitators of RTL included academic accommodations and having a primary contact person within the school system. Owing to inconsistent implementation, the impact of the Green Folder intervention as a facilitator of RTL remains unknown., Conclusion: Results of this study support existing findings in the realm of concussion research. A novel finding includes the importance of a primary contact person as a facilitator of RTL. This person could help to overcome some of the identified barriers to RTL and improve outcomes by assisting with academic accommodations, providing reassurance regarding these accommodations, improving education among teachers and students, and enhancing communication between stakeholders., (Copyright© 2022 the College of Family Physicians of Canada.)

Objective: To determine the effects of glucocorticoids in enhancing athletic performance., Design: At least 2 independent reviewers conducted study selection and extracted demographic and outcome data. Relevant outcomes were stratified by administration time frame and the specific type of drug used. Study quality was assessed using the Cochrane Risk-of-Bias tool and the Cochrane Grading of Recommendations Assessment Development and Education scale. Where appropriate, meta-analyses were performed. Data sources: Embase, MEDLINE, and SPORTDiscus were searched from their beginning to April 2020., Participants: Participants of any sex and training status aged 18 to 65 years were included., Interventions and Main Outcome Measures: Any type of published randomized controlled trial (RCT) that examined any enhancement in sport as well as aerobic, anaerobic, or body compositional parameters for glucocorticoids compared with placebo., Results: There is low-to-moderate evidence suggesting that the administration of glucocorticoids may be more beneficial than placebo in enhancing athletic performance. short-term administration of glucocorticoids significantly improved time to exhaustion, maximal force, and total distance travelled. By contrast, acute administration of glucocorticoids predominantly yielded no changes to athletic performance, except for reductions in total work and maximal power output., Conclusions: Although there is evidence suggesting glucocorticoids have ergogenic effects, these improvements may differ depending on the specific type of drug, dose, and the administration time frame and are also limited by small sample sizes. Therefore, there is a need for large, high-quality RCTs as this may influence future doping policy and athlete care., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Translingual neurostimulation (TLNS) with adjunct physical rehabilitation is used to treat balance and gait deficits in several chronic neurological conditions. The purpose of this review is to summarize and appraise the evidence currently available on the portable TLNS device and to assess its potential clinical application., Materials and Methods: In this narrative review, MEDLINE, EMBASE, Web of Science, and Google Scholar were searched for primary research investigating the use of portable TLNS devices on any neurologic condition. Data were extracted, reviewed, and appraised with respect to study design, conduct, and reporting., Results: Five randomized controlled trials (RCTs), three quasi-experimental trials, and seven case reports/series were found. Most studies demonstrated improvements in balance and gait deficits secondary to traumatic brain injury and multiple sclerosis, but evidence is also present to a lesser degree for stroke and balance disorder patients. In these studies, the feasibility and safety of TLNS have been convincingly demonstrated. Functional magnetic resonance studies have also suggested a plausible neuroplastic therapeutic mechanism. However, the efficacy of TLNS remains unclear due to bias and confounding within studies, and heterogeneity of results between studies., Conclusions: TLNS is a promising treatment modality for various chronic neurological conditions that are often refractory to conventional therapy. However, TLNS technology remains largely investigational as high-quality RCTs are still required to elucidate efficacy, optimal dosages, necessary treatment durations, and treatment durability. Further research to develop an appropriate control group is needed for scientifically valid comparisons of TLNS., (© 2020 International Neuromodulation Society.)

Objective: To assess the extent and trends in registration of Orthopaedic randomized clinical trials (RCTs) between 2015 and 2020., Design: Epidemiological study. Primary publications of RCTs published in top Orthopaedic journals (ISI Journal Citation Reports 2019 rankings) between 2015 and 2020 were included in this meta-epidemiological study with no restrictions on patient population, intervention/control groups or outcome type. Independent reviewers in pairs were involved in RCT selection and data extraction. The proportion of RCTs published that were registered (prospectively or retrospectively) or not registered were reported using counts and percentages stratified by years for each journal., Results: A total of 474 primary RCTs were considered eligible. We identified 157 out of 474 RCTs (33% of RCTs across journals) that were reported to have been registered prospectively.The proportion of prospective RCT registrations had increased by 40% (10%-50%) between 2015 and 2020. On the other hand, the proportion of RCTs with no registrations were reduced by 29% (50%-21%) between 2015 and 2020., Conclusion: Prospective RCT registration in the past 5 years in the field of orthopaedic has increased, but 2/3 of published RCTs still failed to report prospective registration., Competing Interests: Authors state no competing of interests., (© 2021 The Authors.)

Myofascial pain syndrome (MPS) is characterized by the presence of clinically detected myofascial trigger points (MTrPs). Diagnostic ultrasound (US) has been proposed as a method to strengthen the reliability of MTrP localization, thus potentially improving the efficacy and safety profile of interventional procedures. The objective is to evaluate the benefit and safety profile of any US-guided interventional procedure for MPS. Medline, Embase, PubMed, the Allied and Complementary Medicine Database (AMED), and Web of Science were systematically searched from their inception to May 2020 for any randomized controlled trial that evaluated treatment benefit and safety of any US-guided interventional procedure for MPS. The primary outcome of interest was pain severity. Additional outcomes of interest were function and adverse effects. The risk of bias was assessed using the Risk of Bias V.2.0 tool. eleven studies met all inclusion and exclusion criteria. Two studies (n=174) with a high risk of bias revealed some evidence supporting US guidance over blinded interventions for improvement in pain and function. Eight studies (n=483) with varying risks of bias were of head-to-head comparisons of different US modalities. These studies revealed that US-guided local anesthetic injections were inferior to US-guided pulse radiofrequency and US-guided dry needling (DN). US-guided DN was also found to be superior to US-guided platelet-rich-plasma injections but inferior to US-guided miniscalpel. Meanwhile, one study (n=21) with some concerns of bias found that US-guided local anesthetic injections were superior to non-steroidal anti-inflammatory drugs for pain outcomes and fewer adverse events. All US-guided procedures resulted in zero or minimal self-limited adverse events. Issues with clinical relevance, limited sample sizes, and small point estimates warrant more high-quality research to better characterize the possible value of US-guided injections., Competing Interests: Competing interests: None declared., (© American Society of Regional Anesthesia & Pain Medicine 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: There is a paucity of long-term treatment benefit and safety data of botulinum toxin A (BTX-A) for cervical dystonia (CD) and myofascial neck pain syndrome (MPS). Additionally, the prevalence of adjunct modality uses during this period is unknown despite evolving practices., Objective: To assess and compare treatment benefit, safety, and adjunct modality prevalences of long-term BTX-A injections between CD and MPS patients., Design: Retrospective cohort study., Setting: Private practice tertiary care clinics in Toronto., Patients: Convenience sample of 37 (52.9%) CD and 33 (47.1%) MPS patients treated for a mean±SD duration of 7.2±4.3 and 8.3±4.7 years, respectively., Interventions: BTX-A injections administered at least once yearly, for a duration longer than 1 year., Main Outcome Measures: Toronto Western Spasmodic Torticollis Rating Scales (TWSTRS) for disability and pain, Patient Global Impression of Change (PGIC) score, time to peak effect, duration of total response, adverse effects, and prevalence of adjunct modalities., Results: CD patients experienced improvements in TWSTRS disability (17.57±6.79 to 9.81±4.35, p<0.001) and pain (14.61±3.08 to 9.05±3.49, p<0.001) scores as well as PGIC score (52.00%±23.60% to 64.80%±23.60%, p=0.007). MPS patients experienced improvements in TWSTRS disability (15.86±7.70 to 10.07±7.01, p=0.01) and pain (15.25±4.09 to 10.85±4.49, p=0.01) scores. In both cohorts, there were no changes in time to peak effect and duration of total response. Adverse effects were minimal and self-limiting. Prevalences of adjunct modalities used by CD versus MPS patients were 28.13% versus 50.00% for anesthetic procedures, 23.08% versus 15.38% for image-guidance, 65.71% versus 56.25% for pectoralis minor injections, and 47.06% versus 53.13% for cannabis-use., Conclusion: There were demonstrated and comparable treatment benefit, safety, and adjunct modality prevalences. Our study is the first to demonstrate that long-term BTX-A injections for MPS, although commonly used off-label, can be effective and safe., Competing Interests: Dr. Gordon Ko has received speaker’s and advisory board honoraria in the past from Allergan, Ipsen and Merz. The authors declare no other conflicts of interest in this work., (© 2020 Diep et al.)

Background: Postoperative length of stay (LOS) carries a high burden of healthcare costs. In resource-intense specialties such as neurosurgery, it is imperative to identify factors that influence LOS to improve care. The current study investigates the potential for variables that affect clinical presentation, tumor characteristics, treatment modalities, and postoperative complications to impact overall LOS in pediatric brain tumor patients., Methods: A retrospective cohort study design was used with patients enrolled in the McMaster Pediatric Brain Tumor Study Group database. All patients up to 18 years of age, presenting with a newly diagnosed brain tumor admitted to and discharged from neurosurgery, were included. Patients were sorted into three cohorts: short LOS (≤3 days), extended LOS (≥20 days), and control LOS (4-19 days)., Results: Of the 124 patients included, 20 (65% male; median age: 9.1 years; range, 0.8-17.4 years) were considered short LOS, 28 (61% male; median age: 4.7 years; range, 0.4-14.7 years) were considered extended LOS, and 76 (57% male; median age: 8.5 years; range, 0.3-17.9 years) were considered control LOS. Variables that prolonged LOS were emesis at presentation (P < 0.001), developmental delay (P = 0.02), multiple surgeries (P = 0.004), tumor location (P < 0.05), subtotal resection (P = 0.02), feeding tube (P < 0.001), adjuvant chemoradiotherapy (P < 0.001), and posterior fossa syndrome (P = 0.004)., Conclusions: This study identifies variables related to clinical presentation, tumor characteristics, treatment modalities, and postoperative complications associated with extended LOS. These findings uncover novel predictors of LOS that can be used to guide future research and improve health resource management., (© 2019 Wiley Periodicals, Inc.)

Objective: A Cochrane Systematic Review published by Linde et al. in 2016 found moderate evidence suggesting that acupuncture is "at least non-inferior" to conventional prophylactic drug treatments (flunarizine, metoprolol, and valproic acid) for episodic migraine prophylaxis. The evidence for the efficacy of these conventional treatments must be verified to strengthen and validate the original comparison made in Linde et al.'s 2016 review. The aim of the current authors' systematic review was to verify the efficacy of the conventional treatments used in Linde et al.'s 2016 comparison with acupuncture. Materials and Methods: Search strategies were applied to find studies that could verify the efficacy of conventional treatments for treating episodic migraines. Relevant outcomes and dosages were extracted from the retrieved studies. Each study's quality was assessed, using the Cochrane's collaboration tool for assessing risk of bias and the Cochrane GRADE [Grading of Recommendations Assessment, Development, and Evaluation] scale. Results: There is high-quality evidence suggesting that prophylactic drug treatment, at the treatment dosage ranges used in Linde et al.'s 2016 review, reduced headache frequency at a 3-month follow-up, compared to placebo. Headache frequency at a 6-month follow-up, and responses (at least 50% reduction of headache frequency) at 3-month and 6-month follow-ups could not be assessed. Conclusions: These findings strengthened Linde et al.'s 2016 comparison of conventional treatments and acupuncture for reducing headache frequency at a 3-month follow-up. For episodic migraine prophylaxis, moderate evidence suggests that acupuncture is "at least non-inferior," to now- proven , conventional treatments. This raises significant questions in the debate concerning claims that acupuncture is a placebo-based treatment and the prescriptions of proven conventional treatments that have similar effects as acupuncture., Competing Interests: No competing financial interests exist.

Objective: To determine the effects of marijuana on athletic performance., Design: We searched MEDLINE, EMBASE, CINAHL, PsycINFO, AMED, and SPORTDiscus from their beginning to September 2016. Study quality was assessed using the Cochrane collaboration tool for assessing risk of bias and the Cochrane GRADE scale. No meta-analyses were performed for this review., Setting: Subjects in a track, gym, or recreational ward., Participants: Any primary study which included male and female adults of any athletic background between ages 18 and 65, with no other comorbid conditions., Interventions: Any primary study which used marijuana cigarettes and included a control group., Main Outcome Measures: Vital signs, pulmonary measures, physical work capacity, grip strength, and exercise duration were determined to be relevant outcomes., Results: Three trials examined marijuana and its effects on athletic performance. Two trials had a high risk of bias and 1 trial had an unclear risk of bias. The effect of marijuana on outcomes including heart rate, blood pressure, and exercise duration remains unclear. Low quality evidence suggests that treatment, sham, and inactive control groups do not have a significant difference for grip strength. Low quality evidence suggests that there is an ergogenic effect of treatment demonstrated by increased bronchodilation and FEV1 compared with inactive control and that there is an ergolytic effect of treatment demonstrated by decreased physical work capacity compared with sham and inactive control groups., Conclusion: Because the number and quality of studies was low, the effects of marijuana on athletic performance remain unclear.