Physio Plus UG

06/01/2026

🎊🌲Between Christmas and the beginning of the new year, we traditionally publish our ‘Best of’ series featuring the most influential posts of the year that is coming to an end.

📣 Today 🥇 # rank 9 in 2025

𝗕𝗲𝘆𝗼𝗻𝗱 𝗡𝗲𝗿𝘃𝗲 𝗘𝗻𝘁𝗿𝗮𝗽𝗺𝗲𝗻𝘁: 𝗔 𝗡𝗮𝗿𝗿𝗮𝘁𝗶𝘃𝗲 𝗥𝗲𝘃𝗶𝗲𝘄 𝗼𝗳 𝗠𝘂𝘀𝗰𝗹𝗲–𝗧𝗲𝗻𝗱𝗼𝗻 𝗣𝗮𝘁𝗵𝗼𝗹𝗼𝗴𝗶𝗲𝘀 𝗶𝗻 𝗗𝗲𝗲𝗽 𝗚𝗹𝘂𝘁𝗲𝗮𝗹 𝗦𝘆𝗻𝗱𝗿𝗼𝗺𝗲

▶️ Sciatica-like pain is frequently attributed to lumbar disc herniation or spinal stenosis, but in many patients, symptoms persist despite treatment of spinal causes, suggesting extraspinal etiologies (Guedes et al., 2020). Deep Gluteal Syndrome (DGS), first described by McCrory and Bell (1999) as sciatic nerve entrapment, has emerged as a significant source of nondiscogenic buttock and leg pain.

▶️ Prevalence estimates suggest that up to 17% of patients presenting with sciatica may have DGS (Kizaki et al., 2020). Traditionally viewed as a nerve entrapment disorder, more recent evidence highlights the contribution of muscular and tendinous pathologies—particularly enthesopathies of the deep external rotators and hamstring origin—as primary pain generators (Martin et al., 2015; De Lorenzis et al., 2023).
▶️ This evolving perspective necessitates a redefinition of DGS that integrates muscle–tendon pathology with neural mechanisms.

📘 In a brand-new narrative review Yoon et al. (2025, https://www.mdpi.com/2075-4418/15/19/2531 -diagnostics-15-02531) expand the conceptual framework of Deep Gluteal Syndrome beyond sciatic nerve entrapment, emphasizing muscle- and tendon-related pathologies as central contributors.

✅ Pathogenesis: In addition to sciatic nerve compression, pathologies such as ischiofemoral impingement, proximal hamstring tendinopathy, and enthesopathy of the deep external rotators can directly generate pain or secondarily irritate neural structures.

✅ Diagnosis: Clinical differentiation from lumbar radiculopathy is critical. Provocative maneuvers (FAIR, piriformis stretch, Pace’s test) and imaging (high-resolution MRI, MR neurography, dynamic ultrasonography) aid in distinguishing nerve-dominant from tendon-dominant subtypes. This differentiation might be a crucial factor in clinical reasoning.

✅ Treatment: A stepwise strategy is recommended—beginning with conservative care (load management, progressive tendon loading exercises , neural mobilization/desensitization), depending on tendon involvement or neural mechano-hypersensitive with refractory cases reserved for surgery. But, current evidence largely comprises case series and expert opinion underscoring the need for randomized controlled trials.

💡 Conclusion:

DGS should be reframed as a heterogeneous syndrome involving both neural entrapment and muscle–tendon pathology. Recognition of tendon-dominant and mixed subtypes allows for more precise diagnosis and tailored treatment strategies. Future work must focus on validating classification systems and establishing high-level evidence for emerging therapies.

📷 Illustration: Anatomy of the subgluteal space according to Koh (2021) https://pubmed.ncbi.nlm.nih.gov/33827758/

Diagram of the deep muscles of the subgluteal space, with the gluteus maximus muscle removed.

The sciatic nerve (1) typically emerges from beneath piriformis muscle (P), passing over the obturator internusegemellus tendon and muscle complex, quadratus femoris (QF) muscle and lateral to the hamstring origin (H).

Note that the gemellus muscles lie superior (SG) and inferior (IG) to the obturator internus tendon within the subgluteal space; the obturator internus muscle belly lies deep to the subgluteal space within the pelvis (not drawn).

Medial to the sciatic nerve lies the PCNT (2). The inferior gluteal nerve (3) and pudendal nerve (4) emerge from below piriformis further medially within the subgluteal space.

The superior gluteal nerve (5) is seen superiorly within the subgluteal space, passing superior to the piriformis muscle and adjacent to the SI joint.

📚 References

Battaglia, P.J., Mattox, R., Haun, D.W., Welk, A.B., & Kettner, N.W. (2016). Dynamic ultrasonography of the deep external rotator musculature of the hip: A descriptive study. PM&R, 8(7), 640–650. https://doi.org/10.1016/j.pmrj.2015.11.001

De Lorenzis, E., Natalello, G., Simon, D., Schett, G., & D’Agostino, M.A. (2023). Concepts of entheseal pain. Arthritis & Rheumatology, 75(3), 493–498. https://doi.org/10.1002/art.42299

Guedes, F., Brown, R.S., Lourenço Torrão-Júnior, F.J., Siquara-de-Sousa, A.C., & Pires Amorim, R.M. (2020). Nondiscogenic sciatica: What clinical examination and imaging can tell us? World Neurosurgery, 134, e1053–e1061. https://doi.org/10.1016/j.wneu.2019.11.083

Hauser, R.A., Lackner, J.B., Steilen-Matias, D., & Harris, D.K. (2016). A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders, 9, 139–159. https://doi.org/10.4137/CMAMD.S39160

Hernando, M.F., Cerezal, L., Pérez-Carro, L., Abascal, F., & Canga, A. (2015). Deep gluteal syndrome: Anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space. Skeletal Radiology, 44(7), 919–934. https://doi.org/10.1007/s00256-015-2112-6

Kizaki, K., Uchida, S., Shanmugaraj, A., Aquino, C.C., Duong, A., Simunovic, N., Martin, H.D., & Ayeni, O.R. (2020). Deep gluteal syndrome is defined as a non-discogenic sciatic nerve disorder with entrapment in the deep gluteal space: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 28(10), 3354–3364. https://doi.org/10.1007/s00167-020-05966-x

Martin, H.D., Reddy, M., & Gómez-Hoyos, J. (2015). Deep gluteal syndrome. Journal of Hip Preservation Surgery, 2(2), 99–107. https://doi.org/10.1093/jhps/hnv029

McCrory, P., & Bell, S. (1999). Nerve entrapment syndromes as a cause of pain in the hip, groin and buttock. Sports Medicine, 27(4), 261–274. https://doi.org/10.2165/00007256-199927040-00005

Yen, Y.S., Lin, C.H., Chiang, C.H., & Wu, C.Y. (2024). Ultrasound-guided sciatic nerve hydrodissection can improve the clinical outcomes of patients with deep gluteal syndrome: A case-series study. Diagnostics, 14(4), 757. https://doi.org/10.3390/diagnostics14040757

Yoon, Y.H., Hwang, J.H., Lee, H.W., Lee, M., Park, C., Lee, J., Kim, S., Lee, J., de Castro, J.C., Lam, K.H.S., et al. (2025). Beyond nerve entrapment: A narrative review of muscle–tendon pathologies in deep gluteal syndrome. Diagnostics, 15(19), 2531. https://doi.org/10.3390/diagnostics15192531

25/12/2025

🎊🌲Between Christmas and the beginning of the new year, we traditionally publish our ‘Best of’ series featuring the most influential posts of the year that is coming to an end.

📣 Today 🥇 # place 14 in 2025

𝗖𝗮𝗻 𝗯𝗮𝘀𝗲𝗹𝗶𝗻𝗲 𝗠𝗥𝗜 𝗳𝗶𝗻𝗱𝗶𝗻𝗴𝘀 𝗶𝗱𝗲𝗻𝘁𝗶𝗳𝘆 𝘄𝗵𝗼 𝗿𝗲𝘀𝗽𝗼𝗻𝗱𝘀 𝗯𝗲𝘁𝘁𝗲𝗿 𝘁𝗼 𝗲𝗮𝗿𝗹𝘆 𝘀𝘂𝗿𝗴𝗲𝗿𝘆 𝘃𝗲𝗿𝘀𝘂𝘀 𝗲𝘅𝗲𝗿𝗰𝗶𝘀𝗲 𝗮𝗻𝗱 𝗲𝗱𝘂𝗰𝗮𝘁𝗶𝗼𝗻 𝗶𝗻 𝘆𝗼𝘂𝗻𝗴 𝗽𝗮𝘁𝗶𝗲𝗻𝘁𝘀 𝘄𝗶𝘁𝗵 𝗺𝗲𝗻𝗶𝘀𝗰𝗮𝗹 𝘁𝗲𝗮𝗿𝘀 ?

Knee arthroscopy for meniscal injuries remains among the most frequently performed orthopedic procedures (https://pmc.ncbi.nlm.nih.gov/articles/PMC6584718/, https://pubmed.ncbi.nlm.nih.gov/21531866/, https://pubmed.ncbi.nlm.nih.gov/37434234/). Recent randomized controlled trials (RCTs) in young adults with meniscal tears found that early arthroscopic surgery did not provide superior patient-reported outcomes at 12 or 24 months compared to a strategy of exercise and education, with subsequent surgery if needed https://pubmed.ncbi.nlm.nih.gov/37879858/, https://pubmed.ncbi.nlm.nih.gov/38319181/, https://pubmed.ncbi.nlm.nih.gov/35676079/).

👉 details of the exercise prograhttps://www.bodyworkmovementtherapies.com/cms/10.1016/j.jbmt.2017.07.010/attachment/31656b55-b97c-4b6a-ac12-7ad51c95a933/mmc1.pdf

👉 However, certain patient subgroups may respond better to one treatment approach over the other (https://pubmed.ncbi.nlm.nih.gov/36878666/). Identifying these subgroups based on clinical characteristics that modify treatment effects (https://pubmed.ncbi.nlm.nih.gov/36244961/) could enhance patient counselling and support more personalized treatment decisions.

📘 A brand-new study by Clausen et al. (2025, https://www.jospt.org/doi/10.2519/jospt.2025.12994), a secondary subgroup analysis of the DREAM trial, investigated whether specific baseline MRI findings could predict which young patients with meniscal tears would benefit more from early surgery compared to exercise and education.

✅ Objectives of the Study

The study focused on three predefined MRI characteristics as potential effect modifiers:

1️⃣ Type of meniscal tear – categorized as simple (radial/longitudinal) or complex (bucket-handle, displaced, or complex tears, s. illustration, https://pubmed.ncbi.nlm.nih.gov/26724644/).

2️⃣ Meniscus affected – whether the tear was located in the medial or lateral meniscus.

3️⃣ Presence of knee effusion/synovitis – present in any knee recess versus no effusion/synovitis

✅ Methods

The study utilized data from the DREAM trial, a randomized controlled trial (RCT) comparing early meniscal surgery to a structured exercise program with patient education. The study population consisted of 121 patients aged 18–40 years with MRI-confirmed meniscal tears, with 60 in the surgical group and 61 in the exercise group. Patients were followed for 12 months, and outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS4).

A linear mixed model was used to analyse treatment effects, and an adjusted effect difference of ≥10 points on KOOS4 was considered clinically relevant.

✅ Key Findings

🔑 Knee Effusion/Synovitis as a Potential Modifier: Patients with knee effusion/synovitis showed a greater improvement in KOOS4 after early surgery compared to exercise therapy.

▶️ The mean improvement was 11.1 points in favour of early surgery (p=0.07), which was considered clinically significant.

▶️ This suggests that signs of persistent inflammation (inflammatory phenotype) of the knee may predict better outcomes with surgery.

🔑 No Effect Modification by Tear Type: Contrary to expectations, patients with complex tears did not benefit more from early surgery than those with simple tears.

▶️ The difference between complex and simple tears was minimal (4.5 vs. 4.8 points on KOOS4, p=0.95), suggesting that both groups responded similarly to treatment.

🔑 No Effect Modification by Meniscus Location: The study hypothesized that medial meniscus tears would respond better to surgery due to biomechanical forces acting more on the medial compartment.

▶️ However, the results showed the opposite trend, with lateral tears showing a greater response to surgery (9.6 points) than medial tears (4.6 points, p=0.47).

▶️ This unexpected finding challenges previous assumptions about meniscus biomechanics.

💡 Discussion and Clinical Implications

▶️ Knee effusion/synovitis may be an MRI-defined effect modifier on patient-reported outcomes in favour of early meniscal surgery. These findings reinforce the importance of personalized treatment planning, considering MRI findings alongside patient symptoms (mechanical symptoms may be better improved by early surgery, https://pubmed.ncbi.nlm.nih.gov/36878666/) and patient preferences.

▶️ The lack of effect modification by tear type and location suggests that meniscal tear morphology alone should not determine treatment strategy.

▶️ The findings challenge the traditional assumption that medial meniscus tears are more problematic than lateral tears.

▶️ Exercise therapy remains a viable first-line treatment for most young adults with meniscal tears, given that complex tears did not significantly favour surgery.

⭕ Limitations

▶️ The study was not powered to detect small subgroup differences, meaning that some trends may not have reached statistical significance due to the sample size.

▶️ MRI scans were conducted at multiple centers, which could introduce variability in image interpretation.

▶️ Long-term effects beyond 12 months were not analyzed, leaving uncertainty about the durability of the observed benefits.

Illustration: https://doi.org/10.1016/j.ejrad.2015.10.022

10/11/2025

🤟Das „vergessene“ laterale Patellofemoralband

Im Gegensatz zum bekannten und umfassend untersuchten medialen Patellofemoralband (MPFL, mediales patellofemorales Ligament ) ist das laterale Patellofemoralband (LPFL, lalterales patellofemorales Ligament) (siehe Abbildung), ein primärer medialer Stabilisator der Patella in Streckung und früher Flexion.

Es ist jedoch nach wie vor nur wenig erforscht und verstanden.

Den ganzen Artikel mit Quellen jetzt auf physiomeets.science lesen! 🥳💪

03/11/2025

🔥Viszerale Schmerzen

Ausstrahlende Schmerzen sind Schmerzen, die in einer Region wahrgenommen werden, die von anderen Nerven innerviert wird als denen, die die Schmerzquelle innervieren.

Viszerale ausstrahlende Schmerzen beziehen sich ausdrücklich auf die viszerale Nozizeption und Schmerzen, die an andere Körperstellen ausstrahlen.

Viszerale Schmerzen werden nicht lokal wahrgenommen. Die Eingeweide sind diffus innerviert (weniger als 10 % der gesamten afferenten Eingänge des Rückenmarks stammen aus den viszeralen Afferenzen), und die zentralen Bahnen der viszeralen Schmerzen sind somatotopisch (= räumlich geordnete Zuordnung von Körperregionen im Nervensystem) schlecht organisiert.

👉Jetzt den Artikel (mit Quellen) auf physiomeets.science lesen! 🥳💪

20/10/2025

14/10/2025

Hot off the press 🔥

𝗕𝗲𝘆𝗼𝗻𝗱 𝗡𝗲𝗿𝘃𝗲 𝗘𝗻𝘁𝗿𝗮𝗽𝗺𝗲𝗻𝘁: 𝗔 𝗡𝗮𝗿𝗿𝗮𝘁𝗶𝘃𝗲 𝗥𝗲𝘃𝗶𝗲𝘄 𝗼𝗳 𝗠𝘂𝘀𝗰𝗹𝗲–𝗧𝗲𝗻𝗱𝗼𝗻 𝗣𝗮𝘁𝗵𝗼𝗹𝗼𝗴𝗶𝗲𝘀 𝗶𝗻 𝗗𝗲𝗲𝗽 𝗚𝗹𝘂𝘁𝗲𝗮𝗹 𝗦𝘆𝗻𝗱𝗿𝗼𝗺

▶️ Sciatica-like pain is frequently attributed to lumbar disc herniation or spinal stenosis, but in many patients, symptoms persist despite treatment of spinal causes, suggesting extraspinal etiologies (Guedes e
t al., 2020). Deep Gluteal Syndrome (DGS), first described by McCrory and Bell (1999) as sciatic nerve entrapment, has emerged as a significant source of nondiscogenic buttock and leg pain.

▶️ Prevalence estimates suggest that up to 17% of patients presenting with sciatica may have DGS (Kizaki et al., 2020). Traditionally viewed as a nerve entrapment disorder, more recent evidence highlights the contribution of muscular and tendinous pathologies—particularly enthesopathies of the deep external rotators and hamstring origin—as primary pain generators (Martin et al., 2015; De Lorenzis et al., 2023).

▶️ This evolving perspective necessitates a redefinition of DGS that integrates muscle–tendon pathology with neural mechanisms.

📘 In a brand-new narrative review Yoon et al. (2025, https://www.mdpi.com/2075-4418/15/19/2531 -diagnostics-15-02531) expand the conceptual framework of Deep Gluteal Syndrome beyond sciatic nerve entrapment, emphasizing muscle- and tendon-related pathologies as central contributors.

✅ Pathogenesis: In addition to sciatic nerve compression, pathologies such as ischiofemoral impingement, proximal hamstring tendinopathy, and enthesopathy of the deep external rotators can directly generate pain or secondarily irritate neural structures.

✅ Diagnosis: Clinical differentiation from lumbar radiculopathy is critical. Provocative maneuvers (FAIR, piriformis stretch, Pace’s test) and imaging (high-resolution MRI, MR neurography, dynamic ultrasonography) aid in distinguishing nerve-dominant from tendon-dominant subtypes. This differentiation might be a crucial factor in clinical reasoning.

✅ Treatment: A stepwise strategy is recommended—beginning with conservative care (load management, progressive tendon loading exercises , neural mobilization/desensitization), depending on tendon involvement or neural mechano-hypersensitive with refractory cases reserved for surgery. But, current evidence largely comprises case series and expert opinion underscoring the need for randomized controlled trials.

💡 Conclusion:

DGS should be reframed as a heterogeneous syndrome involving both neural entrapment and muscle–tendon pathology. Recognition of tendon-dominant and mixed subtypes allows for more precise diagnosis and tailored treatment strategies. Future work must focus on validating classification systems and establishing high-level evidence for emerging therapies.

📚 References

Battaglia, P.J., Mattox, R., Haun, D.W., Welk, A.B., & Kettner, N.W. (2016). Dynamic ultrasonography of the deep external rotator musculature of the hip: A descriptive study. PM&R, 8(7), 640–650. https://doi.org/10.1016/j.pmrj.2015.11.001

De Lorenzis, E., Natalello, G., Simon, D., Schett, G., & D’Agostino, M.A. (2023). Concepts of entheseal pain. Arthritis & Rheumatology, 75(3), 493–498. https://doi.org/10.1002/art.42299

Guedes, F., Brown, R.S., Lourenço Torrão-Júnior, F.J., Siquara-de-Sousa, A.C., & Pires Amorim, R.M. (2020). Nondiscogenic sciatica: What clinical examination and imaging can tell us? World Neurosurgery, 134, e1053–e1061. https://doi.org/10.1016/j.wneu.2019.11.083

Hauser, R.A., Lackner, J.B., Steilen-Matias, D., & Harris, D.K. (2016). A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders, 9, 139–159. https://doi.org/10.4137/CMAMD.S39160

Hernando, M.F., Cerezal, L., Pérez-Carro, L., Abascal, F., & Canga, A. (2015). Deep gluteal syndrome: Anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space. Skeletal Radiology, 44(7), 919–934. https://doi.org/10.1007/s00256-015-2112-6

Kizaki, K., Uchida, S., Shanmugaraj, A., Aquino, C.C., Duong, A., Simunovic, N., Martin, H.D., & Ayeni, O.R. (2020). Deep gluteal syndrome is defined as a non-discogenic sciatic nerve disorder with entrapment in the deep gluteal space: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 28(10), 3354–3364. https://doi.org/10.1007/s00167-020-05966-x

Martin, H.D., Reddy, M., & Gómez-Hoyos, J. (2015). Deep gluteal syndrome. Journal of Hip Preservation Surgery, 2(2), 99–107. https://doi.org/10.1093/jhps/hnv029

McCrory, P., & Bell, S. (1999). Nerve entrapment syndromes as a cause of pain in the hip, groin and buttock. Sports Medicine, 27(4), 261–274. https://doi.org/10.2165/00007256-199927040-00005

Yen, Y.S., Lin, C.H., Chiang, C.H., & Wu, C.Y. (2024). Ultrasound-guided sciatic nerve hydrodissection can improve the clinical outcomes of patients with deep gluteal syndrome: A case-series study. Diagnostics, 14(4), 757. https://doi.org/10.3390/diagnostics14040757

Yoon, Y.H., Hwang, J.H., Lee, H.W., Lee, M., Park, C., Lee, J., Kim, S., Lee, J., de Castro, J.C., Lam, K.H.S., et al. (2025). Beyond nerve entrapment: A narrative review of muscle–tendon pathologies in deep gluteal syndrome. Diagnostics, 15(19), 2531. https://doi.org/10.3390/diagnostics15192531

📷 Figure: Anatomy of the deep gluteal space. Muscles and ligaments are indicated in black, and nerves are indicated in yellow boxes. The area with red stars is where enthesopathy occurs. Ligaments are indicated by black circles, nerves by yellow boxes, and tendons by red boxes, https://www.mdpi.com/diagnostics/diagnostics-15-02531/article_deploy/html/images/diagnostics-15-02531-g002.png

13/10/2025

Ever heard of Peroneus Quartus ❓

🦶 The peroneus quartus (PQ) muscle, also called fibularis quartus, is a supernumerary anatomical variant located in the lateral compartment of the leg, typically originating from the peroneus brevis and inserting on the calcaneus, cuboid or the lateral tubercle. Paul Hecker proposed that its presence in humans but absence in other primates represents an adaptive response to bipedal gait, contributing to lateral foot elevation and stabilization of the subtalar joint during pronation and supination (https://onlinelibrary.wiley.com/doi/10.1002/ar.1090260110).

🦶 Its presence, although often asymptomatic, has been implicated in mechanical crowding within the peroneal tunnel and in predisposing to peroneal tendon pathologies (https://onlinelibrary.wiley.com/doi/10.1002/ar.1090260110), https://pubmed.ncbi.nlm.nih.gov/2265813/, https://pubmed.ncbi.nlm.nih.gov/8976937/). MRI-based studies have improved detection of this muscle, yet its true prevalence and clinical significance remain controversial. The present study by Yuksel, Ergun, and Kose (2025, https://pubmed.ncbi.nlm.nih.gov/41008701/]) investigated the prevalence of the PQ on MRI in a large cohort and examined its associations with peroneal tendon (PT) pathologies.

🩻 A retrospective MRI review was conducted on 1160 ankle scans from 1073 patients (mean age = 42.7 ± 14.5 years; 643 females, 430 males) obtained between June 2021 and October 2023. Exclusion criteria included poor image quality, postsurgical or traumatic alterations, infections, and congenital deformities. The PQ was defined as an accessory muscle–tendon unit posterior or medial to the peroneus brevis and longus, typically inserting on the calcaneus.

📊 Results

👫 The PQ muscle was identified in 123 of 1160 ankles (10.6 %), more frequently in males (12.7 %) than females (9.2 %) (p = 0.018). No significant side predilection was found. Among 87 patients with bilateral imaging, PQ was bilateral in 5.7 %, unilateral in 13.8 %, and absent in 80.5 %.

▶️ PQ presence showed significant associations with:

▶️ PBT tendinitis: OR = 3.06 (95 % CI 1.73–5.41, p = 0.001)

▶️ PBT tear: OR = 3.64 (95 % CI 1.64–8.10, p = 0.003)

▶️ PLT tendinitis: OR = 2.43 (95 % CI 1.56–3.79, p = 0.001)

▶️ No significant relationship was found with tenosynovitis (p = 0.396) or PLT tear (p = 0.638).

Discussion💡

This large MRI-based study—one of the most extensive to date—demonstrated a PQ prevalence of 10.6 %. Male predominance has been inconsistently reported in prior works but was statistically significant here, supporting possible sex-linked anatomical differences (https://pubmed.ncbi.nlm.nih.gov/24740146/).

The PQ was significantly correlated with PBT tendinitis and tears, indicating localized mechanical stress or friction due to reduced retromalleolar space. These findings reinforce prior smaller imaging and surgical studies linking PQ with peroneal tendon pathology (https://pubmed.ncbi.nlm.nih.gov/14752761/, https://pubmed.ncbi.nlm.nih.gov/35606277/, https://pubmed.ncbi.nlm.nih.gov/15168186/). Conversely, the absence of an association with PLT tears or tenosynovitis suggests that PQ’s pathogenic influence is more pronounced on the peroneus brevis due to anatomical adjacency and shared sheath.

❎ Strengths, Limitations, and Future Directions

Key strengths include large sample size, standardized MRI evaluation, and expert consensus review. Limitations involve its retrospective design and absence of symptom correlation Future prospective studies should correlate PQ morphology with clinical presentation and biomechanical data to clarify causal mechanisms and therapeutic relevance.

26/09/2025

18/09/2025

15/09/2025

📌Mid-sagittal view on T2-weighted images of the whole spine MRI with Pfirrmann classification.

The grade is described according to Pfirrmann classification. Grades 4 and 5 were considered degenerated. The signal intensity for grade 4 was intermediate to hypointense to the cerebrospinal fluid (dark gray), while the structure is inhomogeneous. Meanwhile, for grade 5, the signal intensity is hypointense to the cerebrospinal fluid (black), and the structure is also inhomogeneous. Additionally, the disc space is collapsed.

24/08/2025

Anatomic location & functional / structural muscle injuries in sport👇🏼

Top👉🏾normal muscle
a👉🏾Overexertion-related muscle disorders
b👉🏾Neuromuscular muscle disorders
c👉🏾Partial and (sub)total muscle tears



https://bjsm.bmj.com/content/47/6/342