Marta Jokiel

Purpose Degeneration at the common extensor origin leads to lateral elbow pain and reduced quality of life. We conducted a double-blind, randomized, placebo-controlled trial involving 71 patients treated with leukocyte-poor PRP (LP-PRP), leukocyte-rich PRP (LR-PRP), or saline. Methods PRP content was analyzed using flow cytometry, confocal microscopy, and holotomography. Clinical outcomes (Visual Analogue Scale, Oxford Elbow Score) were assessed at baseline and at three, six, 12, 24, and 55 weeks. Results LR-PRP contained 3.8 × more leukocytes and 2.7 × fewer platelets than LP-PRP. Imaging revealed distinct platelet morphology and activation patterns between PRP types. The LP-PRP group showed significantly greater pain reduction at six weeks and improved elbow function from three to six weeks onward. Conclusion LP-PRP produced superior and longer-lasting clinical outcomes compared to LR-PRP and saline. ClinicalTrials.gov NCT06854666 (retrospectively registered on 2025–01-13).

Introduction Background: Marfan syndrome is a genetic connective tissue disorder. Organ involvement in the course of Marfan syndrome affects the entire body, influencing physical performance and quality of life. Aims The aim of this study was to assess symptoms and the role of physiotherapy...

Background Handball is a highly popular sport in Europe. The specific characteristics of the game significantly contribute to the incidence of injuries reported by players. Frequent physical contact with opponents, jumping and landing, the high pace of play, and rapid changes of direction are...

Background and Objectives: Biodex System^® is an advanced dynamometer used for testing various biomechanical parameters of muscles. Test outcomes allow for the identification of muscle pathology and consequently lead to a clinical diagnosis. Despite being widely used for the testing and rehabilitation of the human musculoskeletal system, no universal and acceptable protocol for wrist examination has been proposed for patients with wrist pathology. In this study, the authors aim to identify the most appropriate protocol for testing the biomechanical parameters of flexors and extensors of the wrist. Materials and Methods: A group of 20 patients with symptomatic tennis elbow and 26 healthy volunteers were examined using three different protocols: isokinetic, isometric and isotonic. Protocol order for each study participant was assigned at random with a minimum of a 24 h break between protocols. All protocol parameters were set according to data obtained from a literature review and an earlier pilot study. Following completion of each protocol, participants filled out a questionnaire-based protocol, assessing pain intensity during the exam, difficulty with exam performance and post-exam muscle fatigue. Results: The isotonic protocol showed the best patient tolerance and the highest questionnaire score. There was a significant difference (p < 0.05) between the three protocols in average pain intensity reported by study participants. All participants completed the isotonic protocol, but not all patients with symptomatic tennis elbow were able to complete the isometric and isokinetic protocols. The isotonic protocol was deemed “difficult but possible to complete” by study participants. Conclusions: The isotonic protocol is most suitable for testing the flexors and extensors of the wrist. It gives the most biomechanical data of all protocols, is well tolerated by patients and rarely causes pain during examination even in symptomatic participants.

A thorough theoretical and practical preparation is crucial in the education of medical professionals. Present-day knowledge recipients expect a broad range of multimedia and interactive resources in the consumed media. The article discusses examples of such implementations for the nationwide education of a pharmacy technician, massage technician, medical sterilization technician, and occupational therapy technician. These examples were created for the Integrated Education Platform of the Ministry of Education and Science in Poland, as part of an EU-funded project. This study delineates the characteristics of e-materials, such as instructional and educational videos, film sequences, scenario-based learning games, interactive documentation, 3D animations, simulators and virtual tours. We prepared a learner benefit analysis based on the e-materials discussed. We aimed to formulate recommendations and guidelines for designing and developing multimedia and interactive resources, paying special attention to educational values and content for the medical industry. Regardless of the type of multimedia, profession and content, materials should prioritize realism, interactivity and detailed presentation of the situations/cases. The same multimedia rarely achieve different learning objectives and learning outcomes. To design and produce high-quality multimedia, it is necessary to know their characteristics and to work with a team of subject matter experts experienced in e-learning development.

Background and Objectives: Severe carpal tunnel syndrome (CTS) is the most common compression neuropathy in the upper extremities treated conservatively; later, when advanced, CTS is treated mostly surgically. The most prevalent symptoms comprise numbness, as well as sensation loss in the thumb, index, and middle finger, and thenar muscle strength loss, resulting in impaired daily functioning for patients. Data on the results of CTS treatment in patients with delayed surgical intervention are scarce. The aim of this study was to determine the postoperative results of chronic carpal tunnel syndrome treatment in patients with symptoms lasting for at least 5 years. Materials and Methods: A total of 86 patients (69 females, 17 males) with a mean age of 58 years reporting symptoms of CTS for at least 5 years (mean: 8.5 years) were prospectively studied. The average follow-up time was 33 months. All patients underwent the surgical open decompression of the median nerve at the wrist. A preoperative observation was composed of an interview and a clinical examination. The subjects completed the DASH (the Disabilities of the Arm, Shoulder, and Hand), PRWE (Patient-Rated Wrist Evaluation), and self-report questionnaires. Global grip strength, sensory discrimination, characteristic symptoms of CTS, and thenar muscle atrophy were examined. Postoperatively, clinical and functional examinations were repeated, and patients expressed their opinions by completing a BCTQ (Boston Carpal Tunnel Syndrome Questionnaire). Results: We found improvements in daily activities and hand function postoperatively. Overall, 88% of patients were satisfied with the outcome of surgery. DASH scores decreased after surgery from 44.82 to 14.12 at p < 0.001. PRWE questionnaire scores decreased from 53.34 to 15.19 at p < 0.001. The mean score of the BCTQ on the scale regarding the severity of symptoms was 1.48 and 1.62 on the scale regarding function after surgery. No significant differences were found in the scores between the male and female groups or between age groups (p > 0.05). A significant increase in global grip strength from 16.61 kg to 21.91 kg was observed postoperatively at p < 0.001. No significant difference was detected in the measurement of sensory discrimination (6.02 vs. 5.44). In most of the examined patients, night numbness and wrist pain subsided after surgery at p < 0.001. Thenar muscle atrophy diminished after surgery at p < 0.001. Conclusions: Most patients were satisfied with the results of CTS surgery regarding the open decompression of the median nerve even after 5 years of ineffective conservative treatment. Significant improvement of the hand function was confirmed in the functional studies.

Referred pain/sensation provoked by trigger points suits the nociplastic pain criteria. There is a debate over whether trigger points are related to a peripheral phenomenon or central sensitization (CS) processes. Referred pain is considered a possible sign of CS, which occurs probably mainly due to the abnormal activity of the immune and autonomic nervous systems. To confirm abnormal autonomic reactivity within the referred pain zone of active trigger points, a new diagnostic tool, the Skorupska Protocol® (the SP test®), was applied. The test uses noxious stimulation (10 minutes of dry needling under infrared camera control) as a diagnostic tool to confirm abnormal autonomic nervous system activity. A response to the SP test® of healthy subjects with referred pain sensations provoked by latent trigger points (LTrPs) stimulation was not explored before. The study aims at examining if LTrPs can develop an autonomic response. Methods. Two groups of healthy subjects, (i) gluteus minimus LTrPs with referred pain (n = 20) and (ii) control (n = 27), were examined using the SP test®. Results. Abnormal autonomic activity within the referred pain zone was confirmed for all analyzed LTrPs subjects. 70% of control subjects had no feature of vasodilatation and others presented minor vasomotor fluctuations. The size of vasomotor reactivity within the referred pain zone was LTrPs 11.1 + 10.96% vs. control 0.8 + 0.6% p < 0.05 . Conclusions. Noxious stimulation of latent TrPs induces abnormal autonomic nervous system activity within the referred pain zone. The observed phenomenon supports the concept of central nervous system involvement in the referred pain patomechanizm.

The Skorupska Protocol (SP) test is a new validated tool used to confirm nociplastic pain related to muscles based on a pathological autonomic nervous system (ANS) activity due to muscle nociceptive noxious stimulation analyzed automatically. Two types of amplified vasomotor response are defined as possible: vasodilatation and vasoconstriction. Until now, amplified vasodilatation among low back leg pain and/or sciatica subjects in response to the SP test was confirmed. This case report presents an unusual vasomotor response to the SP test within the pain zone of a sciatica-like case. Conducted twice, the SP test confirmed amplified vasoconstriction within the daily complaint due to noxiously stimulated muscle-referred pain for the first time. Additionally, a new type of the SP test analysis using MATLAB was presented. The SP test supported by MATLAB seems to be an interesting solution to confirm nociplastic pain related to muscles based on the pathological autonomic reactivity within the lower leg back pain zone. Further studies using the SP test supported by MATLAB are necessary to compare the SP test results with the clinical state and other types of nociplastic pain examination.

Gluteal syndrome (GS) mimicking sciatica is a new disease that has been recently recognized and included in the International Classification of Diseases, 11th Revision. The present study examines nociplastic pain involvement in GS and sciatica patients using a new Skorupska protocol (SP) test that provokes amplified vasodilatation in the area of expected muscle-referred pain. A positive test is confirmed if there is (i) a development of autonomic referred pain (AURP) and (ii) an increase in the delta of average temperature (Δ₸°) > 0.3 °C at the end of the stimulation and during the observation SP phases. Chronic GS (n = 20) and sciatica (n = 30) patients were examined. The SP test confirmed muscle-referred pain for (i) all GS patients with 90.6% positive thermograms (Δ₸° 0.6 ± 0.8 °C; maximum AURP 8.9 ± 13.6% (both p < 0.05)) and (ii) those sciatica (n = 8) patients who reported pain sensation during the test with 20.6% positive thermograms (Δ₸° 0.7 ± 0.7 °C; maximum AURP 15.1 ± 17.8% (both p < 0.05)). The remaining sciatica (n = 22) patients did not report pain during the test and presented a Δ₸° decrease and the AURP size below 1%. Conclusion: Amplified vasodilatation suggesting nociplastic pain involvement was confirmed for all GS and sciatica patients who reported painful sensations in the zone typical for gluteus minimus referred pain during the test.

The trigger points (TrPs) related to chronic low back pain that mimic sciatica have been lately recognized and included in the International Classification of Diseases, 11th Revision. This study examined the MATLAB software utility for the objective stratification of low back pain patients using the Minimally Invasive Procedure (MIP). The two diagnostic MIP parameters were: average temperature (ΔTavr) and autonomic referred pain (AURP). Chronic sciatica patients with TrPs (n = 20) and without TrPs (n = 20) were examined using the MIP. A significant increase in both parameters was confirmed for the thigh ROI of the TrP-positive patients, with ΔTavr being the leading parameter (p = 0.016, Exp(β) = 2.603). A continued significance of both parameters was confirmed from 6′00″ to 15′30″ (p < 0.05). The maximum AURP value was confirmed at 13′30″ (p < 0.05) (TrPs(+) 20.4 ± 19.9% vs. TrPs(-) 3.77 ± 9.14%; p = 0.000; CI (0.347,0.348)).