Acute Muscle Pain Research Articles

Lower limb acute onset muscle pain: what do we have to look for? A case of isolated rupture of the rectus femoris.

Acute muscle pain is muscle soreness that occurs during or within 24 hours of strenuous activity. Possible causes of acute muscle pain include localized muscle trauma, muscle tear, contusion with acute hemorrhage, or acute compartment syndrome. Isolated ruptures of the rectus femoris muscle are rare clinical conditions that result from excessive muscle strain following an abrupt contraction, incorrect movement, or sudden snap that exceeds the physiological limit of strain that the muscle can withstand. To date, there are few published reports evaluating the results of non-invasive treatment of such injuries. Herein, we report an unusual case of isolated distal rectus femoris tear in a 46-year-old female patient with no risk factors, who initially presented with extensor muscle weakness and pain and was treated conservatively with functional rest, physiotherapy, and cryotherapy.

Exercise-induced pain within endurance exercise settings: Definitions, measurement, mechanisms and potential interventions.

Pain can be defined as an unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage. Though consistent with this definition, different types of pain result in different behavioural and psychophysiological responses. For example, the transient, non-threatening, acute muscle pain element of exercise-induced pain (EIP) is entirely different from other pain types like delayed onset muscle soreness, muscular injury or chronic pain. However, studies often conflate the definitions or assume parity between distinct pain types. Consequently, the mechanisms through which pain might impact exercise behaviour across different pain subcategories may be incorrectly assumed, which could lead to interventions or recommendations that are inappropriate. Therefore, this review aims to distinguish EIP from other subcategories of pain according to their aetiologies and characteristics, thereby providing an updated conceptual and operational definition of EIP. Secondly, the review will discuss the experimental pain models currently used across several research domains and their relevance to EIP with a focus on the neuro-psychophysiological mechanisms of EIP and its effect on exercise behaviour and performance. Finally, the review will examine potential interventions to cope with the impact of EIP and support wider exercise benefits. HIGHLIGHTS: What is the topic of this review? Considerations for future research focusing on exercise-induced pain within endurance exercise settings. What advances does it highlight? An updated appraisal and guide of research concerning exercise-induced pain and its impact on endurance task behaviour, particularly with reference to the aetiology, measurement, and manipulation of exercise-induced pain.

Work bout handling of a search dog reduces handgrip strength and increases firefighters' risk of falls.

Firefighters work with dogs as support for their search activities for victims. Firefighters who handle dogs supposedly have higher acute muscle pain, more stumbling, and fatigue. This study aimed to verify the influence of a mantrailing dog on the firefighter's psychophysiological and muscular responses and the number of imbalances in a simulated activity of searching for people. The sample consisted of 10 canine operators characterized by mass (92.57 ± 9.66 kg), height (1.78 ± 0.06 m), age (37.8 ± 2.1 yr), and length of service (9.5 ± 4.6 yr), who performed a search activity under 2 experimental conditions (dog condition and control condition). The simulated search activity consisted of a predefined hike of 2.5 km between the beginning of a search and the place where the sham victim was hidden. Cardiometabolic variables, pain level, and muscular performance were measured pre and postactivity (time factor). The number of imbalances suffered during hiking was also quantified. ANOVA data indicated interactions (condition × time) related to handgrip strength (P < 0.05). Handgrip strength was reduced in the postsearch activity with the dog, and it increased the control when compared to the preactivity (-12.3% versus +9.2%). Also, the level of pain and discomfort in the neck, trunk, and hip regions was higher with dogs (P < 0.05). Under the dog and control conditions, there were 25 and 05 imbalances, respectively, during the hike. There were no significant differences between the experimental conditions for vertical jump performance and cardiovascular responses either with dog or control. The findings of this study highlight that a mantrailing dog with the firefighter increased the number of slips, trips, sudden changes in direction, and loss of body balance, accompanied by a reduction in handgrip strength, and increased acute pain in the neck, trunk, and hip. These findings may contribute to support strategies for mitigating injuries and optimizing the performance of canine operators in the fire department and other units cinotechnic.

Nanomaterials as catalysts for the sensitive and selective determination of diclofenac.

Diclofenac (DCF) is a non-steroidal anti-inflammatory drug possessing analgesic and antipyretic properties. It is used for the treatment of rheumatoid arthritis pain, osteoarthritis, and acute muscle pain conditions and can be administrated orally, topically or intravenously. Because of its widespread use, hydrophilicity, stability and poor degradation (bioaccumulation in the food chain), DCF is an emerging chemical contaminant that can cause adverse effects in the ecosystems. Taking into account the consumption of DCF in pharmaceutical formulations and its negative impact on the environment, the development of new sensitive, selective, cheap, fast, and online capable analytical devices is needed for on-site applications. This brief review attempts to cover the recent developments related to the use of nanomaterials as catalysts for electrochemical determination of DCF in pharmaceutical formulations, biological fluids and environmental samples. The article aims to prove how electrochemical sensors represent reliable alternatives to conventional methods for DCF analysis. The manuscript highlights the progress in the development of electrochemical sensors for DCF detection. We have analyzed numerous recent papers (mainly since 2019) on sensors developed for the quantitative determination of DCF, indicating the limit of detection, linear range, stability, reproducibility, and analytical applications. Current challenges related to the sensor design and future perspectives are outlined.

Effects of experimental pain on elbow flexor muscles performance after eight weeks of strength training: a pilot study

INTRODUCTION: Strength training has been recommended in clinical rehabilitation, as well as in the physical conditioning of athletes. It is not uncommon, in both cases, the presence of pain during practice; however, to date, there is no consensual information about the effects of acute muscle pain on strength training adaptations. OBJECTIVE: The aim of this pilot study was to evaluate the effects of experimentally induced pain on muscle strength adaptation after an 8-week training period. METHOD: The study included five untrained, healthy male volunteers. Participants were submitted to a strength training protocol (3x/week for 8 weeks) for the elbow flexor muscles. Acute muscle pain was induced at the beginning of each training session through an intramuscular infusion of 2.5 ml of hypertonic saline (6%) into the biceps brachii muscle belly. Maximal dynamic strength (1RM) and maximal voluntary isometric contraction (MVIC) were measured at pre- and after four and eight weeks of training. RESULTS: Maximal dynamic strength increased, on average, 37.3% and 78.4% after four and eight weeks, respectively. However, little, if any, difference was found in MVIC (-1.7% and – 3.0% after four and eight weeks, respectively). CONCLUSION: After 24 strength training sessions, with acute muscle pain induced every session, healthy volunteers increased their ability to produce maximal dynamic strength by more than 75%; however, isometric strength presented only small negative changes.

Effects of anxiety, visual target predictability and pain on gaze behavior during a visuomotor task

BACKGROUND: Attention and cognitive effort during postural control can be influenced by under threatening situations, such as pain, particularly in anxious individuals when visually tracking a target. AIM: This study aimed to investigate the effects of anxiety, visual target type, and acute lumbar muscle pain on gaze behavior during a visual pursuit/postural control task. METHOD: Nine young adult participants underwent testing over three time periods: (1) pre-infusion, (2) intramuscular (multifidus muscles) infusion of hypertonic (acute pain)/isotonic (placebo) solution, and (3) post-infusion (after 40 minutes after pain is vanished). The two sessions were separated by one week, in a counterbalanced order. During each session, participants performed a postural control task with visual pursuit, focusing on three targets (fixed, stochastic, and deterministic - 3 trials per target) while wearing an eye-tracker. STAI/IDATE was used to assess the participants' level of state anxiety: n=4 high-anxious and n=5 low-anxious. Continuous time of gaze on target (CTGT) and pupil diameter variability (PDV) were grouped into blocks of 3 trials. RESULTS: High-anxious participants exhibited greater variability in PDV during the infusion period. The deterministic target required less visual attention (shorter CTGT) compared to the fixed and stochastic targets. Both injected solutions (hypertonic and isotonic) had similar effects on CTGT and PDV. CONCLUSION: During the postural control task with visual pursuit: (1) high-anxious participants exerted greater cognitive effort, (2) participants deflected visual attention on the deterministic target, (3) acute and placebo muscle pain did not affect visual attention and cognitive effort.

Metabolic activation and cytotoxicity of metaxalone mediated by cytochrome P450 enzymes and sulfotransferases

Metaxalone (MTX) is a central nervous system (CNS) depressant used for the treatment of acute skeletal muscle pain. Several cases of fatal overdose deaths in the clinical use of MTX, along with the presence of ischemic hepatitis in deceased patients, have been documented. The present study aimed to investigate the metabolic activation of MTX and to define the possible correlation between the metabolic activation and cytotoxicity of MTX. An oxidative metabolite (M1) and a GSH conjugate (M2) were observed in S9 fraction incubations as well as in rat primary hepatocyte culture after exposure to MTX. M1 and M2 were also observed in bile of MTX-treated rats. CYP2A6 was found to dominate the oxidation of MTX. Both methoxsalen (MTS, a CYP2A6 inhibitor) and 2,6-dichloro-4-nitrophenol (DCNP, a sulfotransferase inhibitor) dramatically decreased the formation of M2. Pre-treatment of primary hepatocytes with DCNP or MTS significantly decreased the susceptibility to the cytotoxicity of MTX.

Molnupiravir and risk of post-acute sequelae of covid-19: cohort study

ObjectiveTo examine whether treatment with the antiviral agent molnupiravir during the first five days of SARS-CoV-2 infection is associated with reduced risk of post-acute adverse health outcomes.DesignCohort study.SettingUS Department of...

Association of Treatment With Nirmatrelvir and the Risk of Post–COVID-19 Condition

Post-COVID-19 condition (PCC), also known as long COVID, affects many individuals. Prevention of PCC is an urgent public health priority. To examine whether treatment with nirmatrelvir in the acute phase of COVID-19 is associated with reduced risk of PCC. This cohort study used the health care databases of the US Department of Veterans Affairs (VA) to identify patients who had a SARS-CoV-2 positive test result between January 3, 2022, and December 31, 2022, who were not hospitalized on the day of the positive test result, who had at least 1 risk factor for progression to severe COVID-19 illness, and who had survived the first 30 days after SARS-CoV-2 diagnosis. Those who were treated with oral nirmatrelvir within 5 days after the positive test (n = 35 717) and those who received no COVID-19 antiviral or antibody treatment during the acute phase of SARS-CoV-2 infection (control group, n = 246 076) were identified. Treatment with nirmatrelvir or receipt of no COVID-19 antiviral or antibody treatment based on prescription records. Inverse probability weighted survival models were used to estimate the association of nirmatrelvir (vs control) with post-acute death, post-acute hospitalization, and a prespecified panel of 13 post-acute COVID-19 sequelae (components of PCC) and reported in relative scale as relative risk (RR) or hazard ratio (HR) and in absolute scale as absolute risk reduction in percentage at 180 days (ARR). A total of 281 793 patients (mean [SD] age, 61.99 [14.96]; 242 383 [86.01%] male) who had a positive SARS-CoV-2 test result and had at least 1 risk factor for progression to severe COVID-19 illness were studied. Among them, 246 076 received no COVID-19 antiviral or antibody treatment during the acute phase of SARS-CoV-2 infection, and 35 717 received oral nirmatrelvir within 5 days after the positive SARS-CoV-2 test result. Compared with the control group, nirmatrelvir was associated with reduced risk of PCC (RR, 0.74; 95% CI, 0.72-0.77; ARR, 4.51%; 95% CI, 4.01-4.99), including reduced risk of 10 of 13 post-acute sequelae (components of PCC) in the cardiovascular system (dysrhythmia and ischemic heart disease), coagulation and hematologic disorders (pulmonary embolism and deep vein thrombosis), fatigue and malaise, acute kidney disease, muscle pain, neurologic system (neurocognitive impairment and dysautonomia), and shortness of breath. Nirmatrelvir was also associated with reduced risk of post-acute death (HR, 0.53; 95% CI, 0.46-0.61); ARR, 0.65%; 95% CI, 0.54-0.77), and post-acute hospitalization (HR, 0.76; 95% CI, 0.73-0.80; ARR, 1.72%; 95% CI, 1.42-2.01). Nirmatrelvir was associated with reduced risk of PCC in people who were unvaccinated, vaccinated, and boosted, and in people with primary SARS-CoV-2 infection and reinfection. This cohort study found that in people with SARS-CoV-2 infection who had at least 1 risk factor for progression to severe disease, treatment with nirmatrelvir within 5 days of a positive SARS-CoV-2 test result was associated with reduced risk of PCC across the risk spectrum in this cohort and regardless of vaccination status and history of prior infection; the totality of findings suggests that treatment with nirmatrelvir during the acute phase of COVID-19 may reduce the risk of post-acute adverse health outcomes.

The prediction and treatment of postpartum myofascial pelvic pain.

The clinical manifestations of myofascial pelvic pain (MFPP) are mainly acute or chronic muscle pain at one or more trigger points in the pelvic cavity or pelvic floor. This study aims to explore the predictive value of pelvic floor myoelectric parameters with respect to MFPP and the effect of its clinical treatment. Two hundred and one women followed up in the Wenzhou People's Hospital 6-12 weeks postpartum between July 2020 and July 2021. They were divided into an MFPP group (n= 90) and a non-MFPP group (n= 102), but 9 MFPP patients without a pelvic floor electromyography evaluation were not included. The general demographic data and pelvic floor electromyography evaluation parameters of the two groups were compared; the related factors of postpartum women suffering from MFPP were analyzed, and a nomogram model of the postpartum risk of suffering from MFPP was established. The 99 patients with postpartum MFPP were divided into a treatment group (n= 10) and a control group (n= 89). The difference in visual analog scale scores between the two groups initially and after three months of treatment was compared to evaluate the effective remission rate of postpartum MFPP after treatment. A significant difference was observed in the relaxation time at the rapid contraction stage (z= 4.369, p< 0.05) and the tension contraction stage (z= 135.645, p< 0.01) between the MFPP group and the non-MFPP group. The nomogram model for predicting postpartum MFPP was established with nine variables as potential predictors. The calibration chart and C index of 0.68 (95% CI: 0.65-0.71) proved that the model had a certain degree of discrimination. The clinical decision-making curve showed that the model could increase the net benefit rate of patients. The pain relief rate in the treatment group was significantly higher than that in the control group (p< 0.01). There is a significant correlation between postpartum MFPP and relaxation time at rapid contraction stage and tension contraction stage. The risk prediction nomogram model of postpartum MFPP established with nine potential predictors has a certain prediction capability, and clinical treatment can effectively relieve MFPP in postpartum patients.

HLA-A, HSPA5, IGFBP5 and PSMA2 Are Restriction Factors for Zika Virus Growth in Astrocytic Cells.

(1) Background: Zika virus (ZIKV), an arbo-flavivirus, is transmitted via Aeges aegyptii mosquitoes Following its major outbreaks in 2013, 2014 and 2016, WHO declared it a Public Health Emergency of International Concern. Symptoms of ZIKV infection include acute fever, conjunctivitis, headache, muscle & joint pain and malaise. Cases of its transmission also have been reported via perinatal, sexual and transfusion transmission. ZIKV pathologies include meningo-encephalitis and myelitis in the central nervous system (CNS) and Guillain-Barré syndrome and acute transient polyneuritis in the peripheral nervous system (PNS). Drugs like azithromycin have been tested as inhibitors of ZIKV infection but no vaccines or treatments are currently available. Astrocytes are the most abundant cells in the CNS and among the first cells in CNS infected by ZIKV; (2) Methods: We previously used SOMAScan proteomics to study ZIKV-infected astrocytic cells. Here, we use mass spectrometric analyses to further explain dysregulations in the cellular expression profile of glioblastoma astrocytoma U251 cells. We also knocked down (KD) some of the U251 cellular proteins using siRNAs and observed the impact on ZIKV replication and infectivity; (3) Results & Conclusions: The top ZIKV dysregulated cellular networks were antimicrobial response, cell death, and energy production while top dysregulated functions were antigen presentation, viral replication and cytopathic impact. Th1 and interferon signaling pathways were among the top dysregulated canonical pathways. siRNA-mediated KD of HLA-A, IGFBP5, PSMA2 and HSPA5 increased ZIKV titers and protein synthesis, indicating they are ZIKV restriction factors. ZIKV infection also restored HLA-A expression in HLA-A KD cells by 48 h post-infection, suggesting interactions between this gene product and ZIKV.

Sex Specific Role of RNA-binding Protein, AUF1, in the Evolution of Acute to Chronic Pain after Repetitive Ischemia with Reperfusion Injury

Myalgia is experienced worldwide more than any other type of pain. Prevention and treatment strategies are limited in the ability to prevent acute muscle pain from developing into chronic pain. One source of disease-based myalgia is repetitive ischemia with reperfusion (IR) injury. IR occurs in many disorders such as fibromyalgia or complex regional pain syndrome, which is reported significantly more in females compared to males. Our previous preclinical work suggested sex specific peripheral mechanisms of IR-related hypersensitivity after repetitive IR injury. One factor possibly underlying this phenomenon is a female specific expression pattern of phosphorylated AU-rich element RNA binding protein 1 (AUF1) in the dorsal root ganglion (DRG) which can differentially alter pain-related gene expression. To test if AUF1 regulated sex specific ischemic myalgia development, we performed a brachial artery occlusion followed by reperfusion on both sexes at p21-p28, followed by a second IR 7 days later to develop prolonged pain-like behaviors. We assessed spontaneous paw guarding and mechanical hypersensitivity to muscle squeezing in male and female mice with nerve-specific siRNA-mediated knockdown or AAV-mediated overexpression of AUF1 and compared them to controls. Affected muscles and/or DRGs were taken for immunohistochemistry, PCR or western blot analysis. We found that knockdown of AUF1 inhibited spontaneous paw guarding only in female mice. This corresponded with a specific inhibition of female related gene expression in the DRGs but did not alter male gene expression patterns. AAV-mediated overexpression of AUF1 in males however was found to produce prolonged paw guarding responses after repeated IR similar to that observed in females with dual IR. This study indicates that there are distinct receptor differences in relation to the development of acute to chronic pain between sexes. Results could provide evidence for development of sex specific treatment strategies for patients with IR-related pain. Grant support from R01NS113965 and R01NS105715.

Efficacy and safety/tolerability of pridinol: a meta-analysis of double-blind, randomized, placebo-controlled trials in adult patients with muscle pain

Objective To evaluate analgesic efficacy and safety/tolerability of the nonbenzodiazepine antispasmodic pridinol (PRI) in patients with muscle-related pain. Methods Systematic review and meta-analysis of randomized placebo-controlled trials (RCTs) according to PRISMA guidelines and Cochrane recommendations. Data sources included Google Scholar, Embase, PubMed, ClinicalTrials.gov, EU Clinical Trials Registry, Chinese Clinical Trial Registry, UMIN Clinical Trials Registry, and product manufacturer archives from inception to January 31st, 2022. Eligibility criteria for study selection was randomized, placebo-controlled trials with PRI in adults (≥18 years) with muscle-related pain. Data extraction, synthesis, and analysis carried out by two reviewers independently identified studies, extracted data, and assessed the risk of bias using the Cochrane risk of bias tool. Categorial global response rates (number of patients) based on clinical judgement of study physicians (as primary efficacy endpoint), and response on pain at rest, pain at movement, stiffness, tenderness, and movement restriction (as secondary efficacy endpoints), as well as the number of patients with drug-related adverse events were meta-analytically evaluated using the Review Manager Software 5.4.1. Results In total, 38 records were identified, but only two placebo-controlled studies [with 342 patients with mild to moderate acute muscle pain (55.3% female, age 50.6 ± 16.6 years), of whom 173 received pridinol and 169 placebo, each as monotherapy] proved to be suitable for quantitative and qualitative analysis. Treatment with pridinol was (irrespective of its mode of administration as oral tablet or intramuscular injection) associated with a significantly higher global response rate compared to placebo (74.0 vs. 49.7%; OR 2.86, 95%-CI: 1.82-4.51; p < 0.00001; Cohen´s h: 0.506, NNT: 4.1; Chi 2 for heterogeneity 1.41 [p = 0.24], I2=29%), and significantly higher response rates were also found for all secondary efficacy endpoints. The safety of pridinol was comparable to that of placebo: DRAEs were only seen in one of the two studies and reported for 13 vs. 10 patients (OR: 0.76 95%-CI: 0.32-18.1; p = 0.54, NNH: 62.6), and related discontinuations were reported for four vs. one patient (2.3 vs. 0.6%; p = 0.231). Conclusion The results from this meta-analysis as based on two placebo-controlled studies in adult patients with mild to moderate acute muscle pain demonstrate that a 3-week monotherapy with pridinol showed a comparable safety profile, but significantly better analgesic effects and improvements of related impairments such as stiffness, tenderness and movement restrictions compared with placebo – irrespective of its mode of administration.

Interhemispheric Inhibition Between Primary Sensory Cortices is not Influenced by Acute Muscle Pain

Bilateral deficits in sensorimotor function have been observed in unilateral musculoskeletal pain conditions. Altered interhemispheric inhibition (IHI) between primary sensory cortices (S1s) is one mechanism that could explain this phenomenon. However, IHI between S1s in response to acute muscle pain, and the relationship between IHI and pressure pain sensitivity in the unaffected limb have not been examined. In 21 healthy individuals, IHI was assessed using somatosensory evoked potentials in response to paired median nerve electrical stimulation at: 1) baseline; 2) immediately following pain resolution; and 3) at 30-minutes follow-up. Acute muscle pain was induced by injection of hypertonic saline into the right abductor pollicis brevis (APB) muscle. Pressure pain thresholds were assessed at the right and left APB muscles before and 30-minutes after pain resolution. Compared to baseline, IHI from the affected to unaffected S1 was unaltered in response to acute muscle pain immediately following pain resolution, or at 30-minutes follow-up. Pressure pain thresholds were reduced over the right (P = .001) and left (P = .001) APB muscles at 30-minutes follow-up. These findings suggest IHI between S1s is unaffected by acute, short-lasting muscle pain, despite the development of increased sensitivity to pressure in the unaffected APB muscle. PerspectiveIHI from the affected S1 (contralateral to the side of pain) to unaffected S1 is unaltered following the resolution of acute muscle pain. This finding suggests that IHI between S1s may not be relevant in the development of bilateral sensorimotor symptoms in unilateral pain conditions.

Encounter patterns and worker absenteeism/presenteeism among healthcare providers in Thailand

• We examined number of encounters made by healthcare providers in inpatient wards. • Wards were stratified by risk of respiratory virus transmission. • A median encounter duration was two minutes. Difference in encounter patterns by ward type was observed. • About one in five work shifts were staffed by HCPs with acute muscle pain and/or respiratory symptoms who continued to work while ill. • The encounter episodes were highest among physicians working working during the 8-hour evening shift in high-risk wards. We examined the characteristics of healthcare providers’ (HCPs) encounters, and the frequency of worker absenteeism/presenteeism, among HCPs in inpatient wards at a tertiary-level public hospital in Bangkok, Thailand. The wards were stratified by risk of respiratory virus transmission: low-risk (Surgery, Rehabilitation, Orthopedic, and Obstetrics and Gynecology) and high-risk (Medicine, Pediatric, Emergency, and Ear, Nose, and Throat) . Observers followed HCPs throughout one self-selected 8-hour work shift to record their interaction with others. An encounter was defined as a 2-way conversation with ≥3 words in the physical presence of ≥1 person at <3 feet distance; or a physical skin-to-skin touch. We administered structured questionnaires to document demographics, health and work history, past practice while ill, and recent and current acute muscle pain and/or respiratory symptoms. We collected data from time and attendance records of participants reporting illness within the past seven days. From July to August 2019, 240 HCPs were enrolled and observed during 395 work shifts; 15,878 total encounters were made with a median duration of two minutes (interquartile range, 1–3). Number of contacts ranged from 25 to 49 encounters/8 h in the low-risk wards and 40 to 66 encounters/8 h in the high-risk wards. Physicians working during the 8-hour evening shift in high-risk wards had the highest estimated number of contacts (66 encounters; 95% confidence interval [CI], 43–89) while nurses working during the 8-hour night shift in the low-risk wards had the lowest number of contacts (25 encounters; 95% CI, 22–28). Forty-two (11%) shifts were staffed by HCPs with acute muscle pain and/or respiratory symptom(s) at the time of interview, and 89 (23%) by HCPs who reported symptom(s) during the past seven days, for which none were absent from work. We observed difference in encounter patterns by ward type. About one in five work shifts were staffed by HCPs with acute muscle pain and/or respiratory symptoms who continued to work while ill. These findings have implications for preventing infectious disease transmission and the policy around sick leave in healthcare settings.

Efekti samomasaže penastim valjkom (Foam-roller) na fleksibilnost i druge motoričke sposobnosti - pregled najnovijih istraživanja

During the past decade, self-massage of the muscular fascia using a foam roller (FR) has become an increasingly common way of supplementing traditional methods of soft tissue treatment, while both professional and recreational athletes use it as a tool for warm-up and/or post-training relaxation. Considering the relevance of this topic among researchers, coaches, and physiotherapists, the aim of this this paper is to present a narrative review with the systematization of the latest research on the effects of foam rolling on motor skills. Publication search was conducted using the following databases: Google Scholar, PubMed, and ScienceDirect. The following keywords were used in the search: foam rolling, self-myofascial release, fascia, and muscle soreness. The selection of papers was based on the following criteria: 1) publications written in English and published in the period 2019-2022, and 2) original scientific papers focused on examining the effects of soft tissue massage using FR on the range of motion (ROM), motor abilities (strength, power, speed, balance and others), acute muscle pain, and delayed muscle soreness. Recent research results confirm earlier findings that FR can have short-term, positive effects on flexibility and ROM, while findings regarding the effects on muscle strength, explosive power, and balance are equivocal. In addition, it has been noted that this type of treatment can delay the onset of fatigue, and alleviate the painful sensitivity of muscles after intensive work-out. Although foam rollers have been in use for a long time both in sports and in rehabilitation, due to the heterogeneity of methods applied in related studies, there is still no official recommendation on the optimal way of applying these tools (treatment duration, pressure and cadence, i.e. the frequency of vibration if such a roller is used)

Ectopic parathyroid adenoma with acute pancreatitis in a pediatric patient

Abstract Introduction: Hypercalcemia due to primary hyperparathyroidism (PHPT) is uncommon in children with an incidence of 2 to 5 in 100,000 children and adolescents. Primary hyperparathyroidism in children has a bimodal distribution that reflects different etiologies in very young and older children. PHPT is typically caused by a single parathyroid adenoma. Ectopic parathyroid adenomas account for 20% to 22% of primary hyperparathyroidism cases and are rare in children but should be considered in cases that present with hypercalcemia. Patient concerns: We report the case of a 13-year-old girl with PHPT who presented with an unusual presentation of acute pancreatitis and persistent hypercalcemia. Diagnosis: Tc-99m-sestamibi scanning and chest computed tomography scan with contrast showed an anterior mediastinal lesion at the midline embedded into the thymus and was diagnosed as an ectopic anterior mediastinal parathyroid adenoma. Interventions: The genetic test results of whole-exome sequencing were negative. After thoracoscopic and thymus excision, the patient's serum calcium level immediately normalized. Outcomes: Intact parathyroid hormone, serum calcium, and alkaline phosphatase levels returned to normal within two months. Conclusion: PHPT may present with acute pancreatitis, generalized fatigue, and muscle pain as presented in this patient and need a high index of suspicion for early diagnosis. Delayed diagnosis of PHPT can cause end-organ damage; timely diagnosis is especially critical to preserving bone and renal function.

Diabetic Myonecrosis: A Case Study

Abstract Background: Diabetic myonecrosis is a rare complication of diabetes mellitus with less than 200 cases reported in the literature since initial description in 19651. Diabetic myonecrosis most commonly affects the thigh and usually presents with acute muscle pain, edema, and erythema in the absence of trauma or fever1. The pathogenesis has yet to be elucidated—atherosclerosis, microangiopathy, vasculitis, and ischemia-reperfusion injury have been theorized. Laboratory findings are relatively nonspecific—of the findings reported in a systematic review, CRP was elevated in 90%, ESR elevated in 83.3%, WBC elevated in 42.5%, and CK elevated in 31.6%1. Definitive diagnosis can be made by muscle biopsy which demonstrates muscle necrosis and edema; however, it is not routinely recommended due to procedural complications. MRI is the diagnostic modality of choice for diabetic myonecrosis which is both sensitive and specific for the diagnosis2. Clinical Case: 76-year-old male with T2DM presented to regional hospital with severe right lower leg pain in the absence of fever, tachycardia, hypotension, or recent trauma. Physical exam demonstrated discrete erythema of distal 2/3 of posterior right lower leg extending to the ankle distally. Labs demonstrated normal CK, elevated ESR, HgbA1c 8.2%, and negative blood cultures. MRI of the right lower extremity demonstrated abnormal prolongation of T2 relaxation time involving posterior muscle compartment including soleus and gastrocnemius with associated perifacial and subcutaneous edema. These findings were consistent with diabetic myonecrosis without evidence of osteomyelitis or abscess. Rest, optimal glycemic control, and aspirin were recommended and patient improved gradually with complete clinical resolution on outpatient follow-up. Conclusions: Diabetic myonecrosis is a rare complication of diabetes and should be considered in patients presenting with acute muscle pain. Among cases described in literature, 5.7% have affected the soleus and 5% have affected the gastrocnemius respectively1. The diagnostic modality of choice is contrast enhanced MRI with typical findings including hyperintense signal on T2 weighted images with associated muscular, perifascial, and/or subcutaneous edema3. The optimal treatment is yet unknown, but reasonable strategies based on case series include rest, glycemic control, and NSAID therapy1.

High Incidence of Dengue Fever in Karachi and the Benefits of Ultrasound for Diagnosis of Complications

Background: Dengue fever presentations are from asymptomatic fever to most serious complications. Acute high-grade fever, muscle and joint pain, myalgia, skin rashes, hemorrhage and circulatory shock are the common symptoms. There has been reported increase in number of dengue fever and last few years. Urgent diagnosis is critical to avoid complications like liver injury, cardiomyopathy, pneumonia, orchitis, oophoritis, seizures and encephalopathies. This study aimed to determine the complication caused by dengue fever after the diagnosis by clinical and laboratory investigation by performing ultrasound abdomen and thorax. Methods: In this study one hundred and twenty one (121) patients diagnosed with dengue fever and laboratory investigations done from Jinnah Medical Hospital (JMH) and Pathological &amp; Molecular Laboratories from August to November 2019. Ultrasound of abdomen and thorax was performed for diagnosing complications such as ascites, pleural and pericardial effusion through Xario-100 sonography machine. Results: Out of one hundred and twenty one (121) patients diagnosed with dengue fever forty-three (43) were found to have developed the complications such as ascites, pleural and pericardial effusion by performing ultrasound abdomen and chest. Conclusion: We found 35 % patients with dengue fever complications by ultrasound, which is most convenient diagnostic tool. Therefore, by performing early ultrasound scan of abdomen and thorax in these patients can reduce the risk of morbidity and mortality.

Fear of movement is associated with corticomotor depression in response to acute experimental muscle pain.

Acute musculoskeletal pain is associated with reductions in corticomotor output that persists even after pain resolves. Factors that contribute to corticomotor depression following acute pain are unknown. This study examined whether psychological factors, including pain catastrophising, kinesiophobia, and implicit theories of pain, were associated with corticomotor depression following acute experimental muscle pain. Forty-two healthy individuals participated. Participants completed three questionnaires: Pain Catastrophising Scale, Tampa Scale of Kinesiophobia, and Implicit Theories of Pain Scale. Acute pain was induced into the right extensor carpi radialis brevis (ECRB) muscle by injection of hypertonic saline. Corticomotor depression was assessed as a reduction in motor-evoked potentials measured from ECRB muscle in response to transcranial magnetic stimulation before, immediately after, and at 10, 20, and 30min following pain resolution. Corticomotor depression was present at each time point relative to baseline (p < 0.001). Higher levels of kinesiophobia were associated with less corticomotor depression 10-min post pain resolution (r = 0.32, p = 0.03), but not at any other time point (p > 0.11). When corticomotor depression was compared between individuals with 'high' and 'low' kinesiophobia, a similar relationship was observed: Individuals with high compared to low kinesiophobia displayed less corticomotor depression immediately after (p = 0.02) and 10min post pain (p = 0.02), but not at 20 or 30min (p = 0.05 for both). No relationship was observed with any other psychological variable (p > 0.15). These data provide preliminary support for a relationship between pain-related fear of movement and corticomotor depression in response to acute pain. These findings may have implications for clinical musculoskeletal pain disorders.