Search Results (140)

Background: Multimodal analgesia, combining adductor canal block (ACB) and local infiltration analgesia (LIA), is commonly used for pain control after total knee arthroplasty (TKA). However, ACB alone may not fully cover the anteromedial knee, a region extensively disrupted by TKA. Recent studies suggest that blocking branches of the anterior femoral cutaneous nerve (AFCN) could enhance analgesia, but targeted AFCN blocks are technically challenging. We evaluated supra-sartorial subcutaneous infiltration (SSSI) at the femoral triangle apex as a simpler alternative to AFCN blocks. Methods: We retrospectively reviewed 19 patients undergoing TKA with a standardized multimodal analgesic protocol, including intraoperative LIA limited to posterior capsule (PC-LIA), postoperative SSSI, and delayed intermittent ACB via catheter. SSSI involved infiltrating 20 mL of 0.3% ropivacaine into the subcutaneous plane above the sartorius muscle at the level of femoral triangle apex. Pain was assessed using Numerical Rating Scale (NRS) scores at rest and during movement at 9:00 PM on postoperative day 0 (POD 0) and 9:00 AM on POD 1, with scheduled ACB doses administered at the time of NRS pain score assessments. Rescue ACB boluses were given for intolerable pain before the first scheduled dose. Results: Eleven patients (58%) required no rescue analgesia before the first scheduled ACB, maintaining NRS scores ≤ 4 at rest and with movement for a minimum of 575–785 min post-spinal anesthesia. Eight patients needed rescue ACB, with variable pain relief. Conclusions: SSSI, when combined with PC-LIA, provided clinically meaningful analgesia in 58% of our patient cohort following TKA, though the variability observed suggests limited consistency. As a practical alternative to targeted AFCN blocks, SSSI could potentially complement ACB in multimodal pain management, but its efficacy remains uncertain due to the retrospective, non-controlled study design without a comparator group. Further investigation through prospective randomized controlled trials is warranted to validate these preliminary findings. Full article

Background/Objectives: This study investigates whether systemic ovalbumin–aluminum sensitization followed by cutaneous challenge induces thermal hyperalgesia and spinal cord gliosis in mice. Methods: Adult female ICR-CD1 mice received ovalbumin–aluminum salt solution intraperitoneally on days 0, 7 and 14, and subcutaneously with daily skin application via brush during days 15–21, 28–35 and 42–49. Control animals received saline. Plantar thermal hyperalgesia was assessed on days 21, 35 and 49. On day 49, tissues (dorsal skin, spinal cord, footpads) were harvested after perfusion and processed histologically to detect mast cells, astrocytes, microglia, afferent fibers and intraepidermal nerve profiles. Results: Ovalbumin-treated mice displayed thermal hyperalgesia, increased astrogliosis, and reactive microglia in the spinal cord, and expanded CGRP- and IB4-immunoreactive fiber areas. In footpads, CGRP-positive intraepidermal nerve profile density was elevated, and dorsal skin showed increased mast cell density compared to controls. Conclusions: Combined systemic and cutaneous ovalbumin–aluminum sensitization induces skin inflammation, spinal gliosis, and nociceptive fiber sprouting in both central and peripheral sites, which likely contribute to the observed thermal hyperalgesia. Full article

Background: Post-hamstring-injury residual pain may persist despite muscle-tissue healing and impairs athletes seeking early full recovery. Given their unclear cause, recent attention has focused on the role of fascial dysfunction and a method to restore fascial mobility, namely, hydrorelease (HR), involving the ultrasound (US)-guided injection of saline. We evaluated the clinical efficacy of HR for treating residual pain and ascertained the underlying pathological mechanisms. Methods: Seven patients (aged 17–49 years) with residual pain ≥8 weeks after hamstring injury were included. All exhibited localized tenderness and US findings of fascial thickening around the aponeurotic fascia (APF). HR with 6.0 mL saline–lidocaine solution (0.17% lidocaine) was performed and targeted the peri-APF loose connective tissues. Pain was evaluated using a numerical rating scale (NRS) before and after HR. Passive straight leg raise (SLR) was used to assess tightness. Results: Post-HR, the mean NRS score significantly decreased from 10 to 0.86 (p = 0.017). Four patients required a single HR session; three required two–four sessions. Post-HR, the tightness of all patients improved. Short-axis US of the posterior thigh revealed APF fascial thickening in the area of tenderness, including the posterior femoral cutaneous nerve (PFCN). No adverse events or recurrence occurred during the follow-up (mean: 6.6 months). Conclusions: HR targeting the peri-PFCN-APF effectively reduced residual pain following hamstring injury. These findings support the concept of “Perineural fascial pain”—a pathology wherein persistent pain originates not from direct nerve damage or classical myofascial pain syndrome but rather from the dysfunction of the surrounding fascia. Full article

Neurocutaneous syndromes, known as phakomatoses, encompass a diverse group of congenital conditions affecting the nervous system and skin, with neurofibromatosis type 1 (NF1) and neurofibromatosis type 2 (NF2) among the most clinically significant. Both disorders are inherited in an autosomal dominant manner. NF1 presents with café-au-lait macules; cutaneous, subcutaneous, and plexiform neurofibromas; skeletal abnormalities; learning disabilities; and optic pathway gliomas, while NF2 is characterised by bilateral vestibular schwannomas, multiple meningiomas, ependymomas, and peripheral nerve schwannomas. Although germline mutations in the NF1 and NF2 tumour suppressor genes are well established, they do not fully explain the broad clinical variability observed, even among individuals carrying identical mutations. As increasingly recognised in other genetic diseases, epigenetic mechanisms, including DNA methylation, histone modifications, chromatin remodelling, and non-coding RNA (ncRNA) regulation, play a critical role in modulating gene expression and influencing disease severity. Despite important findings, the research remains fragmented, and a unified model is lacking. This review organises the current knowledge, emphasising how epigenetic alterations impact disease behaviour and outlining their potential as prognostic biomarkers and therapeutic targets. A deeper understanding of these mechanisms could lead to improved personalised management and the development of targeted epigenetic therapies for individuals with NF1 and NF2. Full article

Background: Hip fractures represent a major clinical challenge, particularly in elderly and frail patients, where postoperative pain control must balance effective analgesia with motor preservation to facilitate early mobilization. Various regional anesthesia techniques are used in this setting, including the pericapsular nerve group (PENG) block, fascia iliaca compartment block (FICB), femoral nerve block (FNB), and quadratus lumborum block (QLB), yet optimal strategies remain debated. Objectives: To systematically review the efficacy, safety, and clinical applicability of major regional anesthesia techniques for pain management in hip fractures, including considerations of fracture type, surgical approach, and functional outcomes. Methods: A systematic literature search was conducted following PRISMA 2020 guidelines in PubMed, Scopus, Web of Science, and the virtual library of the Hospital Central de la Defensa “Gómez Ulla” up to March 2025. Inclusion criteria were RCTs, systematic reviews, and meta-analyses evaluating regional anesthesia for hip surgery in adults. Risk of bias in RCTs was assessed using RoB 2.0, and certainty of evidence was evaluated using the GRADE approach. Results: Twenty-nine studies were included, comprising RCTs, systematic reviews, and meta-analyses. PENG block demonstrated superior motor preservation and reduced opioid consumption compared to FICB and FNB, particularly in intracapsular fractures and anterior surgical approaches. FICB and combination strategies (PENG+LFCN or sciatic block) may provide broader analgesic coverage in extracapsular fractures or posterior approaches. The overall risk of bias across RCTs was predominantly low, and certainty of evidence ranged from moderate to high for key outcomes. No significant safety concerns were identified across techniques, although reporting of adverse events was inconsistent. Conclusions: PENG block appears to offer a favorable balance of analgesia and motor preservation in hip fracture surgery, particularly for intracapsular fractures. For extracapsular fractures or posterior approaches, combination strategies may enhance analgesic coverage. Selection of block technique should be tailored to fracture type, surgical approach, and patient-specific functional goals. Full article

Background: Breast reconstruction post-mastectomy has increasingly emphasized the importance of sensory restoration. This study aimed to evaluate the comparative efficacy of anterior versus lateral cutaneous intercostal nerve branches in neurotization during abdominal-based autologous breast reconstruction. Methods: Through a systematic literature search and meta-analysis, we reviewed studies published between January 2003 and August 2023. Our methods involved categorizing studies based on the nerve branch used, extracting relevant data, and conducting a quality assessment. To determine the difference in the magnitude of sensory recovery, a meta-analysis was conducted to pool the effect sizes (mean differences) from individual studies. Given the potential for heterogeneity across studies, a random-effects model was employed using the DerSimonian and Laird method. Subgroup analysis was then performed to separately evaluate the effect sizes for the anterior and lateral groups. Results: We identified five studies for the anterior group and five studies for the lateral group. The anterior group included a total of 225 non-neurotized and 240 neurotized breasts, while the lateral group consisted of 62 non-neurotized and 51 neurotized breasts. The anterior group exhibited superior sensory recovery compared to the lateral group (p = 0.08 for the common effect model). The result was borderline significant, suggesting a trend towards a difference between the two groups. In terms of patient-reported outcomes, the anterior group provided data, while the lateral group lacked such data, underscoring a potential research gap. Conclusions: Results indicated a trend favoring the anterior cutaneous branch, with studies showing improved sensory outcomes and patient satisfaction. However, the choice between the two should be individualized, considering the patient’s unique needs and the surgeon’s expertise. Full article

Introduction: Acute Myeloid Leukemia (AML) is a hematologic malignancy characterized by the clonal expansion of myeloid progenitors. While it primarily affects the bone marrow, extramedullary relapse occurs in 3–5% of cases, and it is linked to poor prognosis. Central nervous system (CNS) involvement presents diagnostic challenges due to nonspecific symptoms. CNS manifestations include leptomeningeal dissemination, nerve infiltration, parenchymal lesions, and myeloid sarcoma, occurring at any disease stage and frequently asymptomatic. Methods: A 62-year-old man with a recent history of AML in remission presented with diplopia and aching paresthesias in the left periorbital region spreading to the left frontal area. The diagnostic workup included neurological and hematological evaluation, lumbar puncture, brain CT, brain magnetic resonance imaging (MRI) with contrast, and dermatological evaluation with skin biopsy due to the appearance of nodular skin lesions on the abdomen and thorax. Results: Neurological evaluation showed hypoesthesia in the left mandibular region, consistent with left trigeminal nerve involvement, extending to the periorbital and frontal areas, and impaired adduction of the left eye with divergent strabismus in the primary position due to left oculomotor nerve palsy. Brain MRI showed an equivocal thickening of the left oculomotor nerve without enhancement. Cerebrospinal fluid (CSF) analysis initially showed elevated protein (47 mg/dL) with negative cytology; a repeat lumbar puncture one week later detected leukemic cells. Skin biopsy revealed cutaneous AML localization. A diagnosis of AML relapse with CNS and cutaneous localization was made. Salvage therapy with FLAG-IDA-VEN (fludarabine, cytarabine, idarubicin, venetoclax) and intrathecal methotrexate, cytarabine, and dexamethasone was started. Subsequent lumbar punctures were negative for leukemic cells. Due to high-risk status and extramedullary disease, the patient underwent allogeneic hematopoietic stem cell transplantation. Post-transplant aplasia was complicated by septic shock; the patient succumbed to an invasive fungal infection. Conclusions: This case illustrates the diagnostic complexity and poor prognosis of extramedullary AML relapse involving the CNS. Early recognition of neurological signs, including cranial nerve dysfunction, is crucial for timely diagnosis and management. Although initial investigations were negative, further analyses—including repeated CSF examinations and skin biopsy—led to the identification of leukemic involvement. Although neuroleukemiosis cannot be confirmed without nerve biopsy, the combination of clinical presentation, neuroimaging, and CSF data strongly supports the diagnosis of extramedullary relapse of AML. Multidisciplinary evaluation remains essential for detecting extramedullary relapse. Despite treatment achieving CSF clearance, the prognosis remains unfavorable, underscoring the need for vigilant clinical suspicion in hematologic patients presenting with neurological symptoms. Full article

The aim of this study was to evaluate the efficacy of manual therapy based on neurodynamic techniques and electrophysical modalities in the conservative treatment of cubital tunnel syndrome (CuTS). A total of 128 upper limbs affected by CuTS were initially enrolled in this study, with 82 completing the full treatment protocol. The participants were divided into the following two intervention arms: the first arm (MT) (42 arms) received therapy based on sliding and tensioning neurodynamic techniques, while the second arm (EM) (40 arms) underwent physiotherapy based on electrophysical modalities, specifically low-level laser therapy (LLLT) and ultrasound therapy (US). Chi² and Student’s t-test were used to compare the intervention arms, and no statistically significant differences were found. The evaluated outcomes included nerve conduction testing, ultrasound assessments (measuring cross-sectional area and shear modulus), pain levels, two-point discrimination, thresholds for cutaneous sensory perception, symptom severity, functional ability in specific tasks, and overall post-treatment improvement. Baseline comparisons indicated no statistically significant differences in any measured variables between the intervention groups (p > 0.05). Following treatment, each group exhibited significant improvements in their respective parameters (p < 0.01). Comparisons between groups post-intervention revealed statistically significant differences in nerve conduction results, ultrasound measurements (cross-sectional area and shear modulus), two-point discrimination, and sensory perception thresholds. These parameters improved more in the MT intervention arm. The use of neurodynamic techniques, ultrasound, and low-level laser therapy in the conservative treatment of mild to moderate forms of CuTS has a beneficial therapeutic effect. Full article

Background: We aimed to determine the utility of different electrodiagnostic (EDx) methods in diagnosing meralgia paresthetica (MP). Methods: Twenty-nine MP patients and 26 controls were included. Sensory nerve action potential (SNAP) and somatosensory evoked potential (SEP) of the lateral femoral cutaneous nerve (LFCN) and tibial SEPs were measured bilaterally. Results: At least one LFCN SNAP was unobtainable in 18 patients (62%) and two controls (8%). In all remaining 11 patients, SNAPs were abnormal at least unilaterally. By contrast, LFCN SEPs were recorded bilaterally in all subjects and were abnormal in 16 patients (sensitivity 48%). Patients’ tibial SEP latency was significantly larger than that of controls (p < 0.001). Conclusions: LFCN NCSs are superior to SEP in the evaluation of MP. However, SEP studies may be useful in old (>60 years) and obese subjects with unobtainable LFCN SNAP. Longer tibial SEP points to subclinical neuropathy in MP patients predisposed to LFCN entrapment. Full article

Background: Total hip arthroplasty (THA) improves the quality of life by alleviating pain and restoring function. The optimal pain control with minimal muscle weakness is paramount for early rehabilitation and for reducing complications. Although PROSPECT and ICAROS guidelines recommend the Fascia Iliaca Compartment Block (FICB), it is associated with insufficient pain relief and a prolonged quadriceps motor block. The association of the PENG (Pericapsular Nerve Group) with LFCN (lateral femoral cutaneous nerve) blocks may address these limitations, provide improved motor-sparing pain control, and offer a more tailored approach that enhances both an early postoperative recovery and patient satisfaction. Methods: A randomized controlled trial (November 2023–July 2024) compared the PENG + LFCN to the FICB in patients undergoing elective THAs under spinal anesthesia. The primary outcome was quadriceps weakness at 6 h post-block. Secondary outcomes included the degree of hip flexion and pain scores at 6, 24, and 48 h post-block, opioid consumption, and time to ambulation. Results: Fifty-eight patients were randomized (twenty-nine per group). The PENG + LFCN group achieved a significantly greater muscle strength (MRC: 4 [4; 4] vs. 3 [3; 4], p < 0.0001) and better hip flexion at all measured moments (6 h: 45° [37; 60] vs. 30° [25; 43], 24h: 59° [49; 66] vs. 47° [36; 50], 48 h: 62° [55; 70] vs. 50° [40; 55], all p < 0.0001). Resting pain was lower in the PENG + LFCN group (0 [0; 1], 0 [0; 2], and 0 [0; 1] vs. 2 [0; 3], 1 [0; 3], 1 [0; 3]), as was the dynamic pain during movement (1 [0; 2], 2 [2; 4], and 2 [1; 2] vs. 3 [2; 5], 3 [2; 4], and 3 [1; 3]; all p < 0.001), along with a lower total opioid consumption (0 [0; 0] vs. 7.5 [7.5; 22.5] MME, p < 0.001). Conclusions: The PENG + LFCN block outperformed the FICB in muscle strength, hip flexion, pain control, and opioid use, suggesting it may be a more effective option for THAs. Full article

The skin is the body’s largest organ. It serves various functions, including protection and metabolism. Due to its structure and location, it is more vulnerable to external physical and chemical damage than internal organs. Additionally, certain endogenous diseases can cause pathological changes to appear on the skin and nerves. When skin tissue breaks down or sustains severe trauma, the cells, blood vessels, and nerves across all layers can suffer varying degrees of damage. This often results in pain, itching, sensory disturbances, and other discomforts, causing significant distress to patients. Stem-cell-derived exosome therapy has emerged as a promising treatment for skin injuries due to its safety, non-toxicity, and precision medicine benefits. Research has shown that stem-cell-derived exosomes regulate nerve cells by mediating MicroRNA (miRNA) transport and expression between cells, promoting axon growth. This exosome-driven miRNA exchange serves as a vital mode of intercellular communication, playing a crucial role in nervous system repair. Nerves play a critical role in skin wound healing and tissue regeneration, with sensory and autonomic nerves influencing key skin functions such as inflammation, immune defense, apoptosis, proliferation, and wound repair. Exosomes may aid in treating cutaneous nerve injuries by directly or indirectly promoting axon regeneration, nerve cell proliferation, and the release of protective neurofactors. Full article

Recessive dystrophic epidermolysis bullosa (RDEB) is a severe genetic disease caused by COL7A1 mutations. It leads to skin fragility, chronic inflammation, and impaired wound healing. The condition often results in fibrotic scarring, pseudosyndactyly, and cutaneous squamous cell carcinoma (SCC). However, current animal models fail to fully replicate chronic RDEB wounds. In this study, we used Collagen VII-hypomorphic mice (Col7a1^flNeo/flNeo) and created full-thickness wounds on their paw skin, an area prone to fibrosis due to mechanical stress. We analyzed the healing process using histology, immunofluorescence, and electron microscopy. The RDEB mice showed delayed wound closure, increased inflammation, and poor granulation tissue formation. At 30 days post-injury, we observed persistent fibrosis, with elevated levels of Collagen I, α-SMA+ myofibroblasts, and tenascin-C. These mice also had fewer intraepidermal nerve fibers, which may help explain the neuropathic pain associated with RDEB. Our model reproduces the main features of chronic RDEB wounds. It offers a useful tool for evaluating therapies aimed at reducing inflammation, fibrosis, and tumor risk in these patients. Full article

Background: The anatomic pathways of the lateral femoral cutaneous nerve (LFCN) have primarily been reported in adult in vitro populations with limited branching patterns. Children with hip disorders may require surgical treatment with an anterior approach, and the LFCN is a structure at risk. The aim of our study was to photographically verify the initial six-centimeter pathway of the LFCN in children measured from its appearance at the anterior superior iliac spine (ASIS). Method: A total of 31 children underwent pelvic osteotomy, including three bilateral. The nerve was identified and isolated in the subcutaneous layer. Standardized photographs were obtained. Our outcome parameters were type of pelvic exit, branching pattern, distance from the pelvic exit to the ASIS, and nerve thickness and appearance, categorized as straight or curved. Results: 91.3% of nerves passed medially to the ASIS. A total of 74% of the nerves showed a splitting branching pattern, and 9% had a branching pattern of more than four. The mean distance from pelvic exit to the ASIS was 17 mm, and the mean nerve thickness was 2.7 mm. Conclusions: In contrast to adult anatomy, our study shows that the LFCN has two or more branches in 74% of patients. Thus, based on our observations, surgeons should carefully dissect the subcutaneous tissue around the LCFN due to the numerous anatomical variations to avoid iatrogenic damage to the nerve. Full article

Background and Clinical Significance: The current study aims to show the diagnostic challenge of mandibular exposed necrotic bone in a patient with locally aggressive cutaneous squamous cell carcinoma of the lower lip and carrying risk factors for osteoradionecrosis and medication-related osteonecrosis of the jaws. Case Presentation: In March 2023, an 80-year-old ex-farmer male patient complaining of feeding difficulty showed a 3 cm area of exposed bone in the left region of the mandible. In July 2020, the patient underwent an incisional biopsy of a lower labial cutaneous keratinizing squamous cell carcinoma, which developed within actinic cheilitis. The cancer was unresectable due to the extent of the local invasion; thus, the patient underwent radiotherapy. In February 2022, the cancer reached the left mandibular canal by completely infiltrating the homolateral canal of the mental nerve. Therefore, the oncologist prescribed cemiplimab and denosumab as palliative immunotherapy. The differential diagnosis included osteoradionecrosis, stage-III medication-related osteonecrosis of the jaws, and intraoral localization of the cutaneous squamous cell carcinoma. The oral surgeon performed a sequestrectomy under local anesthesia and antibiotic prophylaxis; a histological examination confirmed the hypothesis of medication-related osteonecrosis. The patient currently undergoes follow-up visits monthly; the combination of photobiomodulation therapy and cycles of antibiotics keeps the necrotic lesion steady, and the oncological therapy prevents the growth of the cutaneous squamous cell cancer. Conclusions: The current case supports the need for histological examination to resolve the diagnostic challenge of mandibular exposed necrotic bone and to differentiate among osteoradionecrosis, stage-III medication-related osteonecrosis of the jaws, and intraoral localization of cutaneous squamous cell carcinoma. Full article

Cerebrovascular accident (CVA) or stroke is a devastating neurological condition with dismal prognosis associated with recurrent episodes that further damage the neuronal networks, thus disabling neuronal plasticity. Vagus nerve stimulation (VNS) has been used in clinical practice to treat epilepsy for several decades and is well accepted as a safe procedure devoid of serious adverse events. Bailey and Bremer demonstrated that VNS has the capabilities to stimulate neuronal pathways that enhance the recovery of damaged cerebral function. Further studies have strengthened these observations, while technology has improved the tolerability of implants, resulting in VNS applications for epilepsy. Several animal models on neural plasticity have improved our understanding of VNS and its ability to provide neuromodulation to improve recovery in stroke patients. The closed-loop stimulation of the vagus nerve with individualized stimulation parameters combined with physical therapy appears to be an attractive option today. VNS is also being tested as a noninvasive trans-cutaneous modality to further improve patient acceptance and tolerability. However, the implantation of VNS is yielding desirable outcomes and appears to be a more reliable treatment for stroke rehabilitation in clinical trials. Full article