Search Results (417)

Background/Objectives: A subset of individuals develops persistent symptoms following SARS-CoV-2 infection, including musculoskeletal (MSK) manifestations, a condition known as long COVID (LC). Emerging hypotheses suggest that chronic low-grade inflammation in LC may impair bone metabolism and compromise joint health. However, empirical evidence is limited, and the impact of LC on MSK health, particularly bone and joint integrity, is poorly understood. To determine the influence of LC on MSK function, including bone health, body composition, and joint integrity. Methods: A 12-month longitudinal prospective cohort feasibility study was conducted involving 45 adults with LC and 40 well-recovered (WR) post-COVID-19 controls. Baseline and follow-up assessments included dual-energy X-ray absorptiometry (DXA) for bone mineral density (BMD) and total body composition (TBC), alongside ultrasound of the hand and knee joints to evaluate intra-articular changes. Results: The LC group had more fat in the gynoid, android, and leg regions at each assessment point compared to the controls (p < 0.01). LC showed a significantly lower knee synovial hypertrophy at the baseline, 13.3% compared to WR 45% (p = 0.001), and a marginal improvement in hand synovial hypertrophy, over 12 months, from a median of 2 (IQR 1;5) to 1 (IQR 0;3) (p = 0.012), as observed via MSK ultrasound. No notable differences were found between groups regarding BMD, either in the LC group compared to the control group or overtime. Conclusions: This cohort study of LC adults and controls found no evidence of rapid bone loss; however, adiposity and joint symptoms suggest the need for ongoing monitoring. Future research should focus on MSK markers, muscle function, advanced imaging, and improving MSK health. Full article

This work presents a standardized 360-degree, clock-face ultrasonographic protocol for comprehensive static and dynamic assessment of the glenoid labrum. The protocol translates the arthroscopic clock-face orientation into ultrasound scanning windows, providing reproducible steps for each labral quadrant (12 to 12 o’clock) including patient positioning, transducer orientation, and dynamic maneuvers. By leveraging linear transducers with trapezoidal imaging and an optional convex transducer to bypass acoustic shadowing from the acromion and coracoid, all labral segments can be consistently visualized, while dynamic testing reveals subtle clefts, irregular margins, and medial displacement patterns. Clinically, this approach is particularly valuable for patients who cannot undergo MRI or MR arthrography (e.g., due to metallic implants, contrast allergy, claustrophobia or renal dysfunction) and in settings where MR/MRA is unavailable or impractical (sports medicine, urgent care, postoperative follow-up). The pictorial atlas and step-by-step checklists aim to support adoption in routine practice and to facilitate communication with surgeons through shared clock-face terminology. This protocol is not intended to replace MR arthrography for surgical planning; rather, when MRI/MRA cannot be performed or access is limited, it provides actionable, dynamic information that complements clinical decision-making. Full article

Primary spinal osseous tumors are relatively rare, comprising ~5–10% of spinal bone neoplasms, whereas metastases account for the vast majority of spinal lesions. Patients commonly present with insidious back pain, sometimes with a focal mass, and constitutional symptoms are uncommon early in the disease course. As clinical features are often nonspecific and may overlap with degenerative, infectious, and metastatic disease, imaging plays an important role in lesion identification, characterization, and treatment planning. Computed tomography helps to define osseous architecture and matrix characteristics. Magnetic resonance imaging can assess marrow involvement, soft tissue extension, neural compression and intra-canal disease, and tumor vascularity. Together, advanced imaging modalities guide further workup, optimize biopsy planning, inform prognostic assessment and therapeutic decision-making, and anticipate mechanical instability or neural compromise. This narrative pictorial review synthesizes radiographic, CT, and MRI appearances of primary spinal tumors across major histologic lineages (e.g., osteogenic, chondrogenic, notochordal, vascular), illustrated with representative cases. We correlate imaging with clinical presentation to distinguish typical from atypical variants and highlight mimics and pitfalls with implications for diagnostic interpretation and management. Full article

Background/Objectives: Despite the increasing use of ultrasound (US) as a tool for assessing muscle mass and diagnosing sarcopenia, its application remains limited because few studies have validated cut-off points for specific populations. This study aimed to propose US cut-off points for diagnosing sarcopenia in Brazilian individuals aged 60 years and older. Methods: Patients schedule for elective abdominal computed tomography (CT) were also evaluated with musculoskeletal US of the thigh. CT images were obtained at the level of the third lumbar vertebra. US measurements included the thickness of the rectus femoris (RF) muscle and the rectus femoris combined with the vastus intermedius (RF + VI). Receiver Operating Characteristic (ROC) curves determine the sensitivity and specificity of the US cut-off points. The area under the curve (AUC) and 95% confidence intervals (CI) were calculated. Results: The study sample (n = 88) had a mean age of 71.8 ± 8.7 years, and 64% were women. The proposed cut-off points for diagnosing sarcopenia using US, based on the mean ± SD, were ≤19.1 mm and ≤15.9 mm for RF thickness and ≤31.9 mm and ≤29.2 mm for RF + VI thickness in men and women, respectively. These cut-off points demonstrated good accuracy and significant AUC values. Conclusions: This study proposes US-based cut-off points with good accuracy for suggesting sarcopenia diagnosis, particularly when assessing RF thickness. Full article

Background and Objectives: This systematic review synthesized somatic and psychosocial determinants of postpartum sexual dysfunction (PSD) during the first 12 months after childbirth. Methods: Following PRISMA 2020 guidelines, we searched PubMed, Web of Science, and Scopus from inception to 4 August 2025 without language limits for the indexed records. Eligible studies enrolled postpartum women (≤12 months) and reported validated sexual outcomes (FSFI/FSFI-6, PISQ-12), dyspareunia, or sexual activity, examining breastfeeding, partner support/body image, perineal trauma/instrumentation, or postpartum perineal/musculoskeletal pain. Two reviewers independently screened and extracted data; risk of bias was assessed with a modified Newcastle–Ottawa Scale. Results: Of 1127 records screened, 15 studies were included. Perineal morbidity and early pain consistently tracked with worse sexual outcomes; assisted vaginal birth increased 6-month dyspareunia odds (OR 2.5). Breastfeeding was often associated with lower early sexual function and higher dyspareunia (6-month dyspareunia OR 4.4), with attenuation by 12 months. Higher partner/family support and more positive body image correlated with better FSFI scores. Heterogeneity in timing, measures, and adjustment precluded meta-analysis; results were narratively synthesized. Conclusions: Perineal trauma and early pain are dominant risk signals; breastfeeding-related symptoms exert early and context-dependent effects; psychosocial resources are protective. Full article

Patellofemoral instability (PFI) is a multifactorial orthopedic condition affecting predominantly young and active individuals. Accurate diagnosis and personalized treatment planning remain challenging due to the complex interplay of anatomical and biomechanical factors. Recently, artificial intelligence (AI), particularly machine learning (ML) and deep learning (DL), has gained attention for its role in musculoskeletal imaging and orthopedics care. This review explores the current and potential applications of AI in diagnosis and management of PFI. A total of 11 relevant articles were identified and included in the review. Articles originated from six countries, with China having the most contributions (n = 4), followed by Finland (n = 3), and Korea, Japan, USA and Portugal with 1 each. In the results section, findings are grouped into three themes: (A) Diagnosis, (B) Outcomes and Complications and (C) Challenges, Limitations and Future Directions. The review also discussed advancements in automated image analysis, predictive modeling and outcome prediction. Overall, AI has the potential to improve consistency, efficiency, and personalization of care in patients with PFI, although still requiring technological developments for implementation in daily practice. Existing studies are limited by small datasets, methodological heterogeneity, and lack of external validation. Future research should focus on multicenter data integration, explainable AI frameworks, and clinical validation to enable translation into routine orthopedic practice. Full article

Background: Hallux limitus (HL) is a restriction of first metatarsophalangeal joint dorsiflexion, commonly linked to foot biomechanics-related disorders or trauma, increasing sports injury risk. It involves plantar fascia tension, compensations, and tendon adaptations. Rehabilitative ultrasound imaging (RUSI) accurately assesses musculoskeletal changes, supporting physiotherapy evaluation and the study of HL-related structural adaptations. Objectives: Comparing the thickness and cross-sectional area (CSA) of flexor hallucis brevis (FHB), flexor digitorum brevis (FDB), abductor hallucis (AbH), and quadratus plantae (QP) muscles, as well as the thickness of the plantar fascia (PF), Achilles tendon (AT), and plantar calcaneal fat pad (CFP), between participants with and without HL. Methods: Case–control study included 80 basketball players recruited from semi-professional teams by consecutive non-probabilistic sampling. Participants were divided into two groups: an HL group (n = 40) and a healthy group (n = 40). Musculotendinous parameters were assessed using RUSI. Results: The FDB, FHB, AB, and QP showed significant reductions in thickness and CSA at rest and at contraction in the HL group. PF thickness increased in participants with HL, while CFP thickness decreased significantly. Significance was established at (p < 0.05). Conclusions: HL participants exhibited reduced muscle size and CSA, increased PF, and lower CFP thicknesses, indicating adaptive tissue alterations. Full article

Background: Childhood obesity is a growing global concern associated with early-onset orthopedic complications that may persist into adulthood. Among the anthropometric indicators, abdominal adiposity plays a key role in assessing health risks during pediatric evaluations. However, the relationship between abdominal fat distribution and biomechanical alterations, such as changes in posture and foot support, remains poorly understood. Ultrasonography (US) is a validated, noninvasive imaging method capable of distinguishing preperitoneal and intraperitoneal fat in children. Despite its diagnostic advantages, no study to date has directly examined ultrasound-measured abdominal adiposity-predicted pronated foot posture in children. Objective: We aimed to verify the impact of abdominal adiposity on foot support and its association with obese, overweight, and eutrophic schoolchildren. Methods: This is a cross-sectional study. Sixty-five pupils (aged 6–9 years) from a public school in São Paulo, Brazil, were divided into three groups according to nutritional status: obese (n = 25), overweight (n = 20), and eutrophic (n = 20). Anthropometric measurements and foot posture, assessed using the Foot Posture Index (FPI), were collected during the initial evaluation. Abdominal adiposity was determined by ultrasonography, measuring subcutaneous, preperitoneal, and intraperitoneal fat thickness. Statistical Analysis: Analyses compared group differences and relations between abdominal fat and foot posture, with significance set at p < 0.05. Results: Obese and overweight schoolchildren showed pronated foot posture when compared to eutrophic children, on both sides of the feet. Abdominal adiposity was a good predictor of a more pronated footrest for the right and left feet, showing a high-to-moderate association. Conclusions: Ultrasound-measured abdominal adiposity was identified as a significant predictor of pronated foot posture in schoolchildren. These findings highlight the importance of monitoring abdominal fat accumulation during pediatric evaluations, as excessive adiposity may increase the risk of musculoskeletal dysfunctions and pain in the lower limbs. Early detection of these alterations may help prevent postural and musculoskeletal disorders in overweight and obese children. Full article

The anatomical structure of the foot can be assessed by examining the plantar footprint for orthopedic intervention. In fact, there is a relationship between a specific type of foot and multiple musculoskeletal disorders, which are among the main ailments affecting the lower extremities, where its accurate classification is essential for early diagnosis. This work aims to develop a method for accurately classifying the plantar footprint and hindfoot, specifically concerning the sagittal plane. A custom image dataset was created, comprising 603 RGB plantar images that were modified and augmented. Six state-of-the-art models have been trained and evaluated: swin_tiny_patch4_window7_224, convnextv2_tiny, deit3_base_patch16_224, xception41, inception-v4, and efficientnet_b0. Among them, the swin_tiny_patch4_window7_224 model achieved 98.013% accuracy, demonstrating its potential as a reliable and low-cost tool for clinical screening and diagnosis of foot-related conditions. Full article

Background: Sickle cell disease (SCD) affects more than 100,000 people in the United States and 8 million people worldwide, with high morbidity and mortality and musculoskeletal (MSK) complications that contribute to functional disability. However, MRI-based characterization of musculoskeletal manifestations remains limited in high-prevalence regions, including the Middle East. This study aimed to review MRI findings of MSK manifestations in SCD patients and assess associations with clinical characteristics. Methods: A retrospective study was conducted on 96 patients with SCD who underwent MSK MRI between 2012 and 2022 at King Abdulaziz University Hospital. Patient demographics, clinical characteristics, and imaging findings were reviewed. The prevalence and distribution of MSK complications were analyzed across age, gender, and BMI categories. Results: Of the 96 patients (47% males; 53% females; mean age 28.9 years), the hip was the most frequently scanned region (46%), followed by the leg, femur, shoulder, and knee. Bone infarction was the most common complication, observed in 57 patients (59.3%), and was more prevalent among older adults. Osteomyelitis was identified in 16 patients (16.7%), with higher rates in children and underweight individuals. Decreased bone marrow signal intensity was seen in 11 patients (11.4%), particularly in older age groups. Other findings and unremarkable scans each accounted for 6 cases (6.3%). Gender analysis showed broadly similar patterns, although decreased marrow signal intensity was more common in females. Conclusions: MRI is an effective imaging modality for detecting and differentiating MSK complications in SCD. Routine use of MRI in follow-up care is recommended to facilitate early diagnosis, guide management, and prevent long-term disability. Larger prospective studies are needed to validate these findings and establish MRI as a routine diagnostic tool for SCD. Full article

Background/Objectives: Long COVID (LC) causes persistent symptoms, including fatigue, musculoskeletal (MSK) pain, and a lower quality of life. It is hypothesised that chronic low-grade inflammation in LC could impact bone, joints, and muscle microcirculation, but evidence is limited. Our aim is to assess health-related quality of life (HRQoL) and circulating inflammation, bone turnover markers (BTM), and vitamin D in LC individuals to explore their potential association with MSK function. Methods: Prospective longitudinal cohort; LC n = 45, well-recovered (WR) n = 40; 12 ± 2 months follow-up. Baseline and follow-up assessments included evaluations of HRQoL and pain-rating questionnaires, and blood analysis of inflammatory and bone turnover markers (BTM). Results: More females were in the LC group. LC reported significantly lower HRQoL compared to WR, with no change over 12 months. LC had higher vitamin D levels at baseline, median 29.46 ng/mL (23.75; 35.06) compared to WR 20.36 ng/mL (15.995; 27.65) (p = 0.0021). Both groups experienced significant increases in vitamin D after 12 months: WR median from 21.4 ng/mL (16.34; 27.89) to 29.58 ng/mL (25.33; 41.74), (p =< 0.001) and LC median from 32.695 ng/mL (23.665; 35.1) to 35.89 ng/mL (30.1; 41.2), (p = 0.0023). Pain rating showed LC also experienced more hand pain at baseline median 1 (0; 5), (p = 0.003). There were no differences between groups in BTM or cytokines over time. Conclusions: This feasibility cohort showed that LC is associated with a reduction in HRQoL and joint symptoms; however, no significant changes were observed in the inflammatory markers, indicating the need for ongoing monitoring. Future studies should explore MSK, muscle function via imaging, and ways to enhance musculoskeletal health and well-being. Full article

Background/Objectives: Sarcopenia and muscle composition have emerged as significant indicators in the fields of musculoskeletal and metabolic research. The objective of this study was to develop and validate a fully automated, deep learning-based method for segmenting thigh muscles into three functional groups (extensor, flexor, and adductor) using non-contrast computed tomography (CT) images and to quantitatively evaluate the thigh muscles. Methods: In order to ascertain the most efficacious architecture for automated thigh muscle segmentation, three deep learning models (Dense U-Net, MANet, and SegFormer) were implemented and subsequently compared. Each model was trained using 136 manually labeled non-contrast thigh CT scans and externally validated with 40 scans from another institution. The performance of the segmentation was evaluated using the Dice similarity coefficient (DSC), sensitivity, specificity, and accuracy. Quantitative indices, including total muscle volume, lean muscle volume, and intra-/intermuscular fat volumes, were automatically calculated and compared with manual measurements. Results: All three models exhibited high segmentation accuracy, with the mean DSC exceeding 96%. The MANet model demonstrated optimal performance in internal validation, while the SegFormer model exhibited superior volumetric agreement in external validation, as indicated by an intraclass correlation coefficient (ICC) of at least 0.995 and a p-value less than 0.01. Conclusions: A CT-based deep learning framework enables accurate and reproducible segmentation of functional thigh muscle groups. A comparative evaluation of convolutional attention- and transformer-based architectures supports the feasibility of CT-based quantitative muscle assessment for sarcopenia and musculoskeletal research. Full article

Medical anomaly detection is challenged by limited labeled data and domain shifts, which reduce the performance and generalization of deep learning (DL) models. Hybrid convolutional neural network–Vision Transformer (CNN–ViT) architectures have shown promise, but they often rely on large datasets. Multistage transfer learning (MTL) provides a practical strategy to address this limitation. In this study, we evaluated parallel hybrids, where convolutional neural network (CNN) and Vision Transformer (ViT) features are fused after independent extraction, and sequential hybrids, where CNN features are passed through the ViT for integrated processing. Models were pretrained on non-wrist musculoskeletal radiographs (MURA), fine-tuned on the MURA wrist subset, and evaluated for cross-domain generalization on an external wrist X-ray dataset from the Al-Huda Digital X-ray Laboratory. Parallel hybrids (Xception–DeiT, a data-efficient image transformer) achieved the strongest internal performance (accuracy 88%), while sequential DenseNet–ViT generalized best in zero-shot transfer. After light fine-tuning, parallel hybrids achieved near-perfect accuracy (98%) and recall (1.00). Statistical analyses showed no significant difference between the parallel and sequential models (McNemar’s test), while backbone selection played a key role in performance. The Wilcoxon test found no significant difference in recall and F1-score between image and patient-level evaluations, suggesting balanced performance across both levels. Sequential hybrids achieved up to 7× faster inference than parallel models on the MURA test set while maintaining similar GPU memory usage (3.7 GB). Both fusion strategies produced clinically meaningful saliency maps that highlighted relevant wrist regions. These findings present the first systematic comparison of CNN–ViT fusion strategies for wrist anomaly detection, clarifying trade-offs between accuracy, generalization, interpretability, and efficiency in clinical AI. Full article

Primary bone tumors encompass a heterogeneous spectrum ranging from benign entities to highly aggressive sarcomas. This review aims to summarize the current role and future perspectives of nuclear medicine in the diagnosis, staging, and management of primary bone tumors. Accurate diagnosis and staging are critical yet challenging due to histologic heterogeneity and overlapping imaging features. While radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) remain essential, nuclear medicine provides a complementary functional perspective by assessing bone turnover, vascularity, and glucose metabolism. Bone scintigraphy is highly sensitive for skeletal lesions and useful for detecting skip lesions or multifocal disease, although its specificity is limited. Hybrid single-photon emission computed tomography (SPECT)/CT enhances diagnostic confidence through precise anatomic localization and quantitation. [¹⁸F]fluorodeoxyglucose ([¹⁸F]FDG) positron emission tomography (PET)/CT, by directly visualizing tumor metabolism, has become a cornerstone in osteosarcoma and Ewing sarcoma management, demonstrating superiority over bone scintigraphy for detecting skeletal metastases. In chondrosarcoma, [¹⁸F]FDG uptake correlates with histologic grade, although overlap with benign cartilage tumors complicates interpretation. Future directions include the integration of quantitative SPECT, artificial intelligence, and novel tracers such as [¹⁸F]sodium fluoride and [⁶⁸Ga]Ga-fibroblast activation protein inhibitor (FAPI). Collectively, nuclear medicine imaging is becoming a key element in musculoskeletal oncology, offering unique biological insights that complement anatomic imaging and contribute to improved patient management. Full article

Background: Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread musculoskeletal pain, fatigue, unrefreshed sleep, and cognitive disturbances. Despite extensive research, its pathophysiology remains incompletely understood, and there are no validated biomarkers for diagnosis. Videocapillaroscopy is a non-invasive imaging technique that enables detailed visualization of microvascular structures and may provide insights into microcirculatory alterations associated with FM. Methods: Thirty patients with FM and 30 healthy controls underwent oral videocapillaroscopy at four sites: right and left buccal mucosa and upper and lower labial mucosa. Quantitative parameters, including capillary caliber, density, and length, were extracted using a validated neural-network-based software, while qualitative parameters, including visibility, orientation, and the presence of microhemorrhages, were assessed by the operator. Results: Capillary length was significantly reduced in fibromyalgia patients (297.49 ± 26.82 µm) compared to healthy controls (324.43 ± 37.59 µm; p = 0.002), and capillary orientation differed significantly between groups (p < 0.05). Capillary caliber, density, and visibility did not show statistically significant differences. Conclusions: These findings indicate subtle microvascular alterations in the oral mucosa of patients with fibromyalgia. Although the observed changes are not sufficient for diagnostic purposes or early detection, they provide preliminary evidence that videocapillaroscopy can detect microvascular features associated with FM in the oral mucosa. Further studies with larger cohorts and longitudinal designs are warranted to clarify the clinical relevance of these observations and to explore their potential association with symptom severity or disease progression. Full article