Suprascapular Nerve Pulsed Radiofrequency as an Effective Pain Relief Strategy in Supraspinatus Muscle Tendon Tears.

INTRODUCTION: The supraspinatus muscle tendon is the most frequently rotator cuff muscle torn. Reliable shoulder pain relief strategies are needed for patients with severe pain, refractory to conservative management, and without surgical indication. MATERIALS AND METHODS: We conducted a retrospective analysis in a Portuguese reference Rehabilitation Centre during the 1st of January 2020 and the 30th of June 2021, including all patients with partial or complete supraspinatus tendon tear, older than 50 years, who presented with severe pain and who were submitted to suprascapular nerve pulsed radiofrequency. RESULTS: We included 32 patients in our retrospective analysis, mainly female (53%) with a mean age of 66.50 years old. Most of the patients reported right shoulder pain (21 patients, 66%). The mean baseline pain, reported on the numeric rating scale, was 8.00 ± 0.88. Compared to baseline, mean pain reduced 4.00 ± 3.19 at three months (p<0.001), 3.59 ± 3.13 at six months (p<0.001) and 2.94 ± 2.78 at 12 months (p<0.001). From the 3rd to the 12th month there was an increase of 1.06 ± 2.77 in mean pain (p=0.038). There was no difference (p>0.05) in average pain at 0, 3, 6, or 12 months between patients who were simultaneously submitted to an intra-articular shoulder injection. DISCUSSION: Our analysis revealed 36% average shoulder pain reduction for, at least, 12 months following suprascapular nerve pulsed radiofrequency, with a peak pain reduction of 50% at three months. Slow fading of pain reduction in the following nine months was seen, however, compared to baseline, pain reduction was always statistically significant. Cortico-anaesthetic intra-articular shoulder injections seem not to add benefit in shoulder pain reduction when performed simultaneously with suprascapular nerve pulsed radiofrequency. CONCLUSION: Suprascapular nerve pulsed radiofrequency seems to be an effective strategy for shoulder pain reduction, in patients with severe pain, refractory to other management modalities. Nonetheless, larger prospective studies, analyzing shoulder functionality and quality of life lost scores, besides pain reduction, should be pursued.

Knowing Your Accessory Foot Ossicles and Avoiding Misdiagnoses: A Case Report of Painful Os Vesalianum Pedis.

Os vesalianum pedisis located proximal to the base of the fifth metatarsal. Rarely, this accessory ossicle can be the source of lateral foot pain. There are very few cases of symptomatic os vesalianum pedisdescribed in the literature, and most of them were surgically managed. We report a painful case of os vesalianum pedis managed conservatively. A 25-year-old professional soccer player presented with lateral left midfoot pain. There was no known acute sprain or trauma, and no history of injuries in the left lower limb. The athlete reported both mechanical and inflammatory pain findings and tenderness on the palpation of the fifth metatarsal base. We conducted a radiographic study of the left foot and found an image compatible with os vesalianum pedis​​​​​​​. A right foot X-ray was also performed, and similar findings were reported, although the athlete had no pain. The athlete was treated conservatively, and the return-to-play was seven days.  Due to the unspecific symptoms of our athlete, many diagnoses could be considered such as peroneus brevistendinopathy, lateral plantar fasciitis, ligamentum plantare longumsprain. However, the X-ray findings led us to other possible pathologies, mainly affecting the bone. Integrating clinical and radiological findings is mandatory to achieve a proper diagnosis and avoid mistakenly diagnosing a fracture such as a Jones fracture or pseudo-Jones fracture. Even though os vesalianum pedis​​​​​​​ is usually asymptomatic, this condition can lead to chronic pain. Well-designed conservative management should always be pursued to treat this condition as it might prevent the need for surgery.

Plantar Fascia Lateral Fascicle Rupture: How Severe Can It Be?

The plantar fascia is a thick and strong group of longitudinal and transverse bands of collagen-rich tissue, consisting of central, medial, and lateral fascicles. Biomechanically, the central fascicle assumes a special role in medial longitudinal foot arch preservation. However, there is scarce data on plantar fascia medial and lateral fascicles' anatomy and pathology in the literature. We report the case of a 27-year-old male professional soccer player who presented with sudden-onset, severe lateral right rearfoot pain that had started while doing linear sprinting practice. The athlete had no relevant medical history and no history of previous right foot injuries. The radiographic study of the right foot revealed no significant changes. MRI showed a high T2 signal partially interrupting the plantar fascia lateral fascicle low signal, consistent with a lateral fascicle rupture. The rehabilitation program was initiated and included pharmacological and non-pharmacological management. He experienced an extremely favorable evolution of his condition with the absence of pain and partial weight bearing in less than one week, with a full return to sports in approximately two weeks. During dynamic foot movement, the lateral fascicle seems to be less biomechanically recruited compared to the central one; however, the strain is not negligible and might be the reason for the pathology. Still, this slightly decreased strain might explain this injury's faster healing time compared to that associated with the central fascicle. Regarding the risk factors for plantar fascia ruptures, it should be kept in mind that a tear might occur even in their absence. We intend to raise awareness about the existence of plantar fascia lateral fascicle and the possibility of associated pathology, either acute or chronic. Hopefully, in the near future, plantar fascia ruptures will get significantly more attention in the literature, enabling the creation of proper management guidelines.