Umberto De Rosa, Alessio Cairoli, Edoardo Conti, Michela Marcucci, Francesca Baroni, Christian Lunghi
Chronic low back pain is a pervasive condition that challenges healthcare systems and can compromise healthy ageing. This case report describes a person-centred osteopathic approach in a 60-year-old woman. A 60-year-old woman presented with a 10-year history of chronic low back pain (working diagnosis) radiating to the coccyx, accompanied by shoulder pain and recurrent cervicogenic headaches. Her clinical picture was complicated by diabetes, depression, and a history of trauma, illustrating a complex case of multimorbidity. Prior physical therapy had been only partly undertaken and prescribed glucocorticoid injections were declined, with limited relief and progressive functional decline. A structured conventional examination preceded a personalized osteopathic assessment informed by reasoning based on the Cynefin Framework—a complexity-science approach to making sense of her presentation—with the complete framework mapping assembled retrospectively for this report. The multimodal osteopathic care plan, delivered by a single practitioner, comprised osteopathic manipulative treatment (including myofascial release and balanced ligamentous tension), patient active-participatory graded movement (such as functional neuromyofascial activity), prescribed home activity, shared decision-making, and reassurance addressing kinesiophobia. Progress was monitored with the RAND-36 Health Survey (scored at baseline and the third session, with unchanged scores confirmed at the two subsequent encounters, through ∼10.6 months) and the Visual Analogue Scale (VAS, current pain, recorded at every encounter). The VAS decreased from 7 to 2, and substantial numerical improvements were recorded across multiple RAND-36 domains, temporally associated with the course of osteopathic care. In this single, uncontrolled case, clinical improvement occurred but cannot be attributed to the intervention alone, as regression to the mean, natural symptom fluctuation, expectancy effects, and the therapeutic alliance cannot be excluded. The case suggests a potential role for a holistic, biopsychosocial approach grounded in complexity-informed, person-centred reasoning and shared decision-making, and may inform wider discussions of non-pharmacological care within universal health coverage and healthy-ageing strategies, including tertiary-prevention objectives that minimize morbidity and maximize functional and psychosocial recovery in long-term conditions. These broader implications are, however, hypothesis-generating and not established by a single case. Controlled prospective research is required to evaluate efficacy and clarify the underlying mechanisms.
Although percutaneous vertebroplasty (PVP) is a minimally invasive treatment for osteoporotic vertebral compression fractures, bone cement leakage remains a serious complication. Management becomes particularly challenging in elderly patients with multiple comorbidities. An 84-year-old woman with severe osteoporosis underwent PVP for a T10 vertebral fracture. Postoperatively, she developed progressive low back pain, bilateral lower limb weakness, and urinary dysfunction. She had multiple comorbidities, including pulmonary embolism, coronary artery disease, grade 3 hypertension, and deep vein thrombosis, which significantly increased perioperative risk. Primary diagnosis: Intraspinal space-occupying lesion secondary to bone cement leakage after PVP, with thoracic spinal cord injury and incomplete paraplegia. Direct complication: Intraspinal cement leakage at T10 with spinal cord compression. Relevant comorbidities included pulmonary embolism, postherpetic neuralgia, pulmonary hypertension, lumbar stenosis, and multiple systemic conditions. After multidisciplinary team consultation, the patient underwent posterior thoracic laminectomy, removal of leaked cement, pedicle screw fixation with bone cement augmentation at adjacent levels, and bone grafting. Perioperative management included anticoagulation adjustment, electrolyte correction, inferior vena cava filter placement, and anti-osteoporotic therapy. The patient showed significant pain relief and neurological improvement postoperatively. No surgical complications occurred. Follow-up imaging confirmed stable fixation without re-leakage. At six months, she demonstrated continued clinical improvement and better quality of life. Comprehensive preoperative evaluation, timely surgical intervention, and multidisciplinary management are essential for favorable outcomes in elderly patients with cement leakage after PVP.
Atypical spindle cell/pleomorphic lipomatous tumor (ASPLT) is a rare, benign adipocytic neoplasm characterized by a highly indolent biological behavior and a lack of distant metastatic potential. We present a 44-year-old male with a continuously enlarging, mildly tender right back mass. Magnetic resonance imaging showed a large subcutaneous tumor, subsequently treated with extended surgical excision. Histopathology revealed atypical spindle cells, adipocytes, lipoblasts, and floret-like multinucleated giant cells. Immunohistochemistry demonstrated a notable loss of retinoblastoma protein (RB1) expression. Crucially, fluorescence in situ hybridization (FISH) confirmed the absence of murine double minute 2 (MDM2) gene amplification, establishing the definitive diagnosis. The patient experienced no recurrence or metastasis during an 18-month follow-up. The key lesson for physicians is the critical need to integrate histomorphology, immunohistochemistry, and molecular genetic testing-specifically FISH-to accurately differentiate this benign entity from well-differentiated liposarcoma, thereby preventing unnecessarily aggressive treatments.
George J. Beneck, Mohini Rawat, Stacie Akins, Alycia Markowski, Beshoy Ghaly, Ryan Boggs, Stephen Ramsey, Simon Hayward, Ruth M. Maher, Jennifer Wiley, Maureen K. Watkins, Murray E. Maitland
Access to the clinical use of ultrasound imaging by physical therapists (e.g., costs, portability, and educational resources) has improved significantly over the last 5–10 years, while the clinical applications for ultrasound imaging continue to expand. Along with this rapid growth, substantial evidence has been developed regarding the clinical utility and diagnostic value of ultrasound imaging in physical therapy practice, particularly in orthopedic, cardiovascular, lung, pediatric, and pelvic health physical therapy. This narrative review aims to demonstrate how ultrasound imaging can be applied as a practical, evidence-supported clinical tool in physical therapy practice, by presenting a sample of the type and strength of evidence for its applications in evaluating injuries or pathologies of bone, ligament, tendon, muscle, nerve, heart, vascular, lung, diaphragm, and pelvic structures. When integrated with the physical therapist's clinical examination, ultrasound imaging will provide objective information that enhances clinical reasoning, supports decision-making, and directly informs patient management, leading to improved care delivery, efficiency, and outcomes. To promote the effective and responsible use of ultrasound imaging across practice areas, appropriate education and training are required. Educational models, strategies, curricular recommendations, and documented outcomes in professional programs are discussed to support the translation of ultrasound imaging into routine physical therapy clinical practice.
Periprosthetic tibial fractures (PTFs) after total knee arthroplasty are uncommon and technically demanding injuries, and available evidence is largely derived from heterogeneous retrospective studies. This study aimed to describe the surgical strategy and clinical and radiographic outcomes of dual locking-plate fixation for selected Felix type 2A and 3A fractures with a well-fixed tibial component. This retrospective case series included 13 patients treated between June 2022 and December 2024. Seven fractures were classified as Felix type 2A and six as type 3A. The primary outcomes were fracture union and retention of the original tibial component. Secondary outcomes included knee range of motion (ROM), Knee Society Score (KSS), Hospital for Special Surgery knee score (HSS), radiographic alignment, reduction quality, and surgery-related complications. Longitudinal changes in ROM, KSS, and HSS were evaluated for the overall cohort. No inferential comparison between Felix subtypes was performed. All 13 fractures achieved radiographic union, first documented at a mean of 16.4 ± 1.0 weeks. At a mean final follow-up of 20.5 ± 1.6 months, the mean ROM was 122.9 ± 2.2°, the mean KSS was 89.9 ± 3.0, and the mean HSS knee score was 86.7 ± 2.5. All three clinical outcomes differed across the three assessment time points (all P < 0.001). Reduction was graded as good in eight patients and acceptable in five. The original tibial component was retained in all patients. No delayed union, nonunion, fixation failure, reoperation, or revision arthroplasty was recorded. In this small retrospective case series, dual locking-plate fixation was followed by fracture union, retention of the original tibial component, maintained alignment, and longitudinal functional improvement in selected Felix type 2A and 3A fractures with a well-fixed component. These findings support the technical feasibility of this approach but do not establish its effectiveness or superiority over alternative treatments.
