Novel Orthobiologic Preparation and Regenerative Rehabilitation of a Complex Shoulder Injury in a Competitive Adolescent Female Athlete.

Background: Platelet-rich plasma (PRP) and prolotherapy have resulted in promising outcomes in patients with various types of shoulder injuries. However, there is a lack of preliminary evidence supporting preparation of PRP production, timely application of these therapies and regenerative rehabilitation protocols. The purpose of this case report is to describe the distinct method including orthobiologic preparation, tissue-specific treatment and regenerative rehabilitation of an athlete with a complex shoulder injury. Case Presentation: A 15y/o competitive female wrestler with a complex shoulder injury presented to the clinic after unsuccessful conservative rehabilitation. Unique methods were incorporated to optimize PRP production, specific tissue healing and regenerative rehabilitation. Multiple injuries required different orthobiologic interventions at different time frames, in order to promote optimal healing and stability of the shoulder. Outcomes: The described interventions resulted in successful outcomes including pain, disability, full return to sport, and regenerative tissue healing confirmed with diagnostic imaging. Level of Evidence: 5.

Cupping with neural glides for the management of peripheral neuropathic plantar foot pain: a case study.

Background/purpose: Plantar foot pain of neural origin is a challenging diagnosis to identify and treat. The purpose of this paper is to illustrate the novel way in which cupping was utilized in conjunction with neural glides to better diagnose and manage a patient who presented with symptoms of peripheral neuropathic plantar foot pain. Case description: A 65-year-old male presented to physical therapy with the diagnosis of plantar fasciitis by an orthopedic surgeon. The presentation included a diffuse area of pain toward the medial border of the foot with a peripheral neuropathic pain description. Cupping was used to identify pain in the saphenous nerve distribution and aided in resolving symptoms with the concomitant use of lower quarter neural glides. Outcome: At discharge and 1-year follow-up, the patient had a full resolution of symptoms and a return to prior level of function. Self-report outcomes included the numeric pain rating scale and the lower extremity functional scale. Discussion: This case is the first to describe the use of cupping combined with neural glides in the diagnosis and management of peripheral neuropathic pain from the saphenous nerve that was previously diagnosed as plantar fasciitis. The proposed mechanisms behind this treatment are also reviewed. Conclusion: In patients that present with symptoms of plantar fasciitis, testing neural glides combined with cupping may be warranted to confirm or refute the presence of a peripheral neuropathic pain source. Further studies are necessary to determine the mechanisms and further utility of the combined interventions in well controlled trials. Level of Evidence: Level IV.

The use of dry needling as a diagnostic tool and clinical treatment for cervicogenic dizziness: a narrative review & case series.

STUDY DESIGN: Narrative Review & Case Series. BACKGROUND: No "gold standard" test presently exists to confirm a diagnosis of cervicogenic dizziness, a condition whereby the neuromusculoskeletal tissues of the cervical spine are thought to contribute to imbalance and dizziness. Clusters of tests are presently recommended to provoke signs and symptoms of the condition. In this regard, dry needling may provide a valuable diagnostic tool. Targeting the musculoskeletal structures of the upper neck with dry needling may also provide a valuable treatment tool for patients that suffer from cervicogenic dizziness. While dry needling has been used to treat various musculoskeletal conditions, it has not been specifically reported in patients with cervicogenic dizziness. CASE DESCRIPTION: Three patients were screened for signs and symptoms related to cervicogenic dizziness in an outpatient physical therapy clinic. These patients presented with signs and symptoms often associated with (though not always) cervicogenic dizziness, including a positive flexion-rotation test, altered cervical range of motion, and tenderness with manual assessment of the upper cervical extensors. In addition, dry needling targeting the obliquus capitis inferior muscle was used diagnostically to reproduce symptoms as well as to treat the patients. OUTCOMES: Two of the patients reported full resolution of their dizziness and a significant improvement in their function per standardized outcome measures. While the third patient did not report full resolution of her cervicogenic dizziness, she noted significant improvement, and dry needling was helpful in guiding further treatment. Importantly, the effect of the treatment was maintained in all three patients for at least 6 months. DISCUSSION: This case series with narrative review covers various testing procedures for cervicogenic dizziness and explores the use of dry needling targeting the suboccipital muscles to evaluate and treat this patient population. The physiologic changes that occur in the periphery, the spine and the brain secondary to dry needling and their potential relevance to the mechanisms driving cervicogenic dizziness are discussed in detail.

Pathoanatomical characteristics of temporomandibular dysfunction: Where do we stand? (Narrative review part 1).

Temporomandibular dysfunction (TMD) is a complicated and multifactorial condition that affects the temporomandibular joint (TMJ) and muscles of mastication, resulting in pain and disability in 5-12% of the population. The condition involves genetic, anatomic and hormonal factors and is propagated, in part, by trauma, habitual activity, psychosocial components and occlusal variation. Yet, the exact etiology of TMD is still unknown and the most strategic conservative management of the condition is still a topic of debate. The purpose of this paper, the first of a two part series, is to provide greater insight into the pathoanatomical factors associated with TMD. Consistent with Scully (2008, 2013), degenerative changes seem to disrupt the relationship between the TMJ capsule, articular disc and muscles of mastication. The resulting position of the articular disc coincides with three primary classifications of TMD: Type 1 (muscle disorders), Type 2a/b (disc displacement with and without reduction), and Type 3 (any joint pain). Given the association of the lateral pterygoid with both the joint capsule and articular disc, the superior and inferior head seem to play a key role in TMD. Both heads undergo biological changes associated with the vicious cycle, pain adaptation and integrated pain adaptation, making the muscle a key pain generator associated with TMD. Clinicians must understand the pathoanatomic features associated with TMD so as to choose appropriate treatment strategies, leading to optimal short and long-term outcomes. While the former is discussed in part 1 of this narrative review, the latter will be considered in part 2.