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Thoracic outlet syndrome (TOS) refers to a group of disorders that result in the compression of the brachial plexus and subclavian axillary vessels in the area of the thoracic outlet. Patients with TOS can experience various symptoms, such as neuropathic pain, paresthesia, numbness, and weakness. There is no definite consensus on the appropriate treatment method for TOS, and the treatment usually varies depending on the type of TOS. For patients with venous or arterial TOS, thrombolysis or embolectomy is usually considered first; however, when they do not respond to these treatments, surgical treatments are indicated. Patients with neurogenic TOS are typically treated conservatively. Conservative treatment, including oral medications, injections, rehabilitation therapy, activity modification, and patient education, is used as the initial treatment. This narrative review provides a brief overview of the disease, possible treatments, and exercise protocols to help physicians treat TOS.

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Background: The currently available topical diclofenac products do not provide effective penetration of diclofenac across the layers of skin. Troikaa Pharmaceuticals Ltd, has developed Dynapar QPS Plus^Ⓡ, a novel, topical formulation of diclofenac and compared its skin penetration with Diclofenac Aerosol Spray.
Methods: In this randomized, two way crossover study, healthy human subjects (n = 8) received single dose of either 2 ml of Dynapar QPS Plus or approximately 4 gm of marketed Diclofenac Aerosol Spray. The blood samples were drawn at pre dose and up to 24 hours post dose. The plasma concentrations of Diclofenac was measured using validated LC-MS/MS bioanalytical method.
Results: The mean Cmax after administration of Dynapar QPS Plus and Diclofenac Aerosol Spray were 102.945 ± 66.0109 and 15.885 ± 14.7750 ng/ml, respectively. Median Tmax for Dynapar QPS Plus was earlier compared to Diclofenac Aerosol Spray (7 hrs vs. 19 hrs). The mean AUC_0-t after administration of Dynapar QPS Plus was significantly higher as compared to Diclofenac Aerosol Spray (AUC_0-t: 855.289 ± 494.0262 vs. 149.707 ± 116.6317). Both the products were well tolerated and no adverse event occurred during the study.
Conclusions: The results of this study showed that Dynapar QPS Plus is safe and provides faster and more than six times higher skin penetration of diclofenac in comparison to marketed Diclofenac Aerosol Spray. Due to faster and higher penetration of diclofenac, from Dynapar QPS Plus it is best suitable option to treat pain and inflammation related to acute as well chronic musculoskeletal disorders.

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Discogenic back pain is a disease involving degenerative changes in the intervertebral disc. These structural changes cause biomechanical instability and inflammation. In particular, various interventional treatment methods have been proposed for discogenic pain that does not improve with drugs, physical therapy, or rest. Steroid administration in the intervertebral disc is performed based on research results that promote stabilization of the vertebral segment through degeneration of the intervertebral disc. Steroid injections in the intervertebral disc have shown various treatment results. Various minimally invasive intradiscal procedures are also being introduced. Thermal annular procedures transfer heat to the damaged annulus, resulting in denervation and pain relief. Intradiscal electrothermal therapy, radiofrequency annuloplasty, and intradiscal biacuplasty have been tried. Percuataneous disc decompression is a treatment method that improves pain by relieving intra-disc pressure. Percutaneous disc decompression, percutaneous laser disc decompression, and automated percutaneous lumbar discectomy have been tried. These various procedures report various results due to differences in each procedure method, patient selection, etc., and a small number. Through a literature review, we intend to investigate a more effective and safe procedure.

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Osteoarthritis (OA) is a leading cause of chronic pain and disability worldwide. Animal models are required to improve our understanding of the underlying pain mechanisms associated with OA and to evaluate potential therapeutics. In this review, discuss the variety of animal models used in OA research, with a focus on their relevance to human OA and the pain behavioral methods. We discuss commonly used pain behavioral assays, the technical nuances, advantages, and limitations. Moreover, we discuss how these models and methods translate into the clinic by emphasizing any interventions or findings that have guided clinical trials or drug development. Although animal models provide invaluable insight, they still have challenges and controversies, particularly with respect to their true representation of human OA pain as well as ethical considerations. We highlight the need for refining and standardizing pain assessment techniques in animal models and address emerging technologies that promise greater translational significance. This review provides insight into the role of animal models in advancing our understanding of OA pain and paves the way for future research in this field.

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Sudden sensorineural hearing loss (SSNHL) is a common otolaryngologic emergency. In natural history of SSNHL, spontaneous resolutions have been reported in 32-65% in previous studies. However, hearing loss as a sequelae may remain for some patients, which is devastating. Therefore, when first-line therapy fails to SSNHL patients, necessity of salvage therapy could be emphasized. 36-year-old woman presented to our clinic. The patient has not responded to oral and intratympanic steroid therapy. Her initial audiogram revealed the patient is experiencing sensorineural hearing loss. We performed stellate ganglion block (SGB) under ultrasound. After two sessions of SGB, the patient experienced subjective recovery of SSNHL and recovery of audiogram. SGB could be attempted to the refractory SSNHL patients who failed to recover spontaneously or responded by primary therapy such as intratympanic or systemic steroids.

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Background: The purpose of this experimental study was to confirm whether the overall disease severity of Parkinson’s disease (PD), gait function, balance, and pain could be improved through the application of the lumbar muscle myofascial release technique (LMTT).
Methods: LMTT treatments were administered to 12 patients with PD and chronic pain and evaluated pre-and post-intervention. The LMTT device was designed to provide acupressure to the operational portion, to which the bogie method was applied. To increase the therapeutic effect, aluminum, with high thermal conductivity, was used to apply heat up to 70°C and acupressure simultaneously. A heating wire was also attached. The Timed Up and Go (TUG), 10 m gait speed, 6-min walk test, Berg Balance Scale (BBS), Functional Ambulatory Category (FAC), Visual Analog Scale (VAS), fear of falling, Oswestry Disability Index, and Geriatric Depression Scale Short-Form (GDSSS) were evaluated.
Results: The VAS score showed a significant decrease immediately after five treatments (4.46 points) and 10 treatments (3.00 points) compared to the pre-intervention evaluation (6.54 points). We found that this decrease was maintained after a 2 week follow-up (P < .001). Significant improvements were also confirmed in the TUG (P < .001), 10 m gait speed (P = .001), 6 min walk test (P = .001), and BBS (P = .001).
Conclusions: By applying LMTT, a significant reduction in pain was confirmed in patients with PD who experience chronic back pain.

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Carpal tunnel syndrome (CTS) is a common neurological disorder of the upper extremities that causes pain and numbness in the wrist or fingers. The primary treatment for CTS is conservative and includes the use of splints, injections, and ultrasound therapy. Surgical intervention is required if conservative treatment is ineffective and pain persists. When CTS occurs, the most basic treatment method is to reduce the frequency of wrist use in order to reduce the pressure on the carpal tunnel. Orthoses can be a useful therapeutic option for reducing pressure in the carpal tunnel. This study reviewed the effectiveness of orthoses in the management of CTS.

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Spontaneous intracranial hypotension (SIH) is caused by cerebrospinal fluid leakage and subsequent hypovolemia in the spinal subarachnoid membrane or, rarely, the intracranial space. Subdural fluid collection is a rare complication of SIH caused by the persistence of negative pressure. This report describes a case of SIH with subdural fluid collection in a patient who underwent surgical hematoma evacuation before an epidural blood patch (EBP). A 60-year-old man and 43-year-old man were initially diagnosed with SIH secondary to an orthostatic headache that became exacerbated. Brain computed tomography revealed subdural hemorrhage (SDH). Because their condition deteriorated gradually, they underwent burrhole trephination to evacuate the SDH. An epidural blood patch was applied to treat the remaining symptoms of SIH after evacuation. During the next 3 days, headache completely resolved with satisfactory results. We report this case of SIH with SDH resulting in surgical hematoma evacuation before EBP that successfully resolved.

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Bertolotti's syndrome (BS) is a condition that causes lower back pain due to the presence of a lumbosacral transitional vertebra (LSTV). A spectrum of therapeutic modalities, ranging from conservative management to surgical intervention, has been endeavored in its management. It has been reported that LSTV may subsequently lead to conditions such as scoliosis, facet joint arthritis, strains of the quadratus lumborum and iliopsoas muscles, and herniated discs. Moreover, BS commonly manifests with lower back pain; however, it is rarely associated with radiation-induced leg pain. In this case report, we aimed to investigate the effectiveness of pulsed radiofrequency treatment in patients who underwent diagnostic nerve blocks for radicular pain suspected to be induced by BS and demonstrated temporary pain relief.