Scapular dyskinesis and loss of cervical lordosis in myofascial pain syndrome and its effects on pain and posture disorders.

Objectives: This study aimed to evaluate scapular dyskinesia and loss of cervical lordosis in myofascial pain syndrome and its effects on pain and posture disorders. Patients and methods: In this cross-sectional study, 101 individuals (74 females, 27 males; mean age: 44.3±8.8 years; range, 25 to 60 years) with chronic neck pain were recruited between January 2021 and February 2021. Demographic and clinical data of the patients were recorded. Visual Analog Scale (VAS), posture evaluation form, the scapular dyskinesia test, the lateral scapular shift test, and Cobb's methods for cervical angle measurements were used in the evaluation of the patients. Results: In the study population, 52.25% of patients had loss of cervical lordosis, and 44.5% of patients had scapular dyskinesia. It was observed that the VAS activity score was significantly higher in individuals with loss of cervical lordosis, all VAS scores and pain duration were significantly higher in individuals with scapular dyskinesia (p<0.05). Shoulder elevation, rounded shoulder, forward head posture, and kyphosis were significantly higher in patients with scapular dyskinesia, while thoracic kyphosis was significantly higher in patients with both scapular dyskinesia and loss of cervical lordosis (p<0.05). The presence of trigger points was found to be significantly higher in patients with scapular dyskinesia and in patients with both scapular dyskinesia and loss of cervical lordosis (p<0.05). Conclusion: In patients with chronic neck pain diagnosed with myofascial pain syndrome, the presence of loss of cervical lordosis and scapular dyskinesia have negative effects on pain and posture.

Ultrasound-guided versus palpation-guided platelet-rich plasma injection for the treatment of chronic lateral epicondylitis: A prospective, randomized study.

Objectives: This study aims to compare the effectiveness of palpation-guided and ultrasound (US)-guided platelet-rich plasma (PRP) injections in patients with chronic lateral epicondylitis (LE). Patients and methods: Between January 2021 and August 2021, a total of 60 patients (34 males, 26 females; mean age: 40.5±10.9 years; range, 22 to 64 years) diagnosed with chronic LE were included. The patients were randomly allocated to either the palpation-guided (n=30) or the US-guided injection group (n=30) before they received PRP injection. All patients were assessed using the Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) scale, and grip strength at baseline and at one, three, and six months after injection. Results: Baseline sociodemographic and clinical variables were statistically similar between two groups (p>0.05). The VAS and DASH scores improved significantly after the injection at each control, as well as grip strength in both groups (p<0.001). No statistically significant difference was found between the groups regarding VAS and DASH scores, and grip strength at one, three, and six months post-injection (p>0.05). No significant complication related to the injection was observed in any of the groups. Conclusion: This study demonstrates that both palpation-guided and US-guided PRP injection protocols can improve clinical symptoms and functional parameters of patients with chronic LE.

Ultrasonographic Measurement of Median Nerve Cross-Sectional Area in Evaluating Carpal Tunnel Release Outcomes.

PURPOSE: Earlier research has explored carpal tunnel release (CTR) surgery outcomes using electrodiagnostic tests (EDX). However, evaluation of the median nerve before and after CTR by ultrasound (US) is understudied. This study aimed to establish the outcomes of CTR by EDX and US, and examine the correlation between the clinical improvement and US after CTR. METHODS: The sample consisted of 172 wrists that underwent CTR. Pain was assessed using the visual analog scale (VAS). The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), including the symptom severity and function subscales, was applied before and 3 months after CTR. The proximal and distal cross-sectional areas (CSAs) of the median nerve were measured using US, and EDX was performed before and 3 months after CTR. RESULTS: Patients had mean preoperative and postoperative VAS scores of 7.7 ± 1.2 and 1.7 ± 1.2, respectively. The mean preoperative and postoperative proximal CSA measurements were 16.4 ± 4.5 mm2 and 12.1 ± 3.9 mm2, respectively. The mean preoperative and postoperative distal CSA measurements were 13.6 ± 3.7 mm2 and 11.0 ± 3.1 mm2, respectively. A significant improvement was observed in VAS, BCTQ, and EDX 3 months after CTR. A weak, positive correlation was observed between the improvement in the BCTQ symptom severity and function subscales and CSAs following CTR. CONCLUSIONS: The results of this study demonstrate that preoperative median nerve CSA values may be used in evaluating CTR outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Physical therapy versus radial extracorporeal shock wave therapy in the treatment of carpal tunnel syndrome: A randomized-controlled study.

Objectives: This study aims to compare the efficacy of physical therapy (PT) and radial extracorporeal shock wave therapy (rESWT) in the treatment of carpal tunnel syndrome (CTS). Patients and methods: Between May 2020 and July 2020, a total of 125 wrists of 95 patients (22 males, 73 females; mean age: 54.3±11.3 years; range, 19 to 69 years) with mild-to-moderate CTS were allocated into three groups and evaluated. The control group (Group 1, n=42) was treated with splinting and an exercise program. Group 2 (n=42) was treated with a total of three sessions of rESWT, splinting and an exercise program. Group 3 (n=41) was treated with a total of 15 sessions of PT modalities, splinting, and an exercise program. Each patient was evaluated before, three weeks and 12 weeks after treatment using a Visual Analog Scale (VAS), the Boston Carpal Tunnel Questionnaire (BCTQ), the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale, and electrodiagnostic testing. Results: The reduction in VAS, BCTQ, LANSS, and improvement in sensory nerve conduction velocity were significantly greater at three and 12 weeks of follow-up in Groups 2 and 3, compared to Group 1 (p<0.001). A greater improvement was observed in all clinical parameters in Group 2, compared to Group 3 (p<0.001). Conclusion: This is the first study to compare the treatment outcomes of PT and rESWT in the treatment of CTS. The results of this study show that both PT and rESWT are effective in the treatment of CTS; however, rESWT yields superior treatment effects compared to conventional PT. The practicalities of administering rESWT and its efficacy in the treatment of CTS may make it the treatment of choice.

Assessment of psychiatric disorders and sleep quality in chronic lateral epicondylitis.

OBJECTIVES: Psychiatric disorders including somatization impact pain severity and chronicity. This study aimed to determine sleep quality and the presence of psychiatric disorders in patients with chronic lateral epicondylitis (LE) and to investigate the effect of these comorbidities on pain levels. METHODS: This study included 46 patients diagnosed with chronic LE and 46 healthy controls. Visual analog scale (VAS) was used for the assessment of pain intensity. The prevalence of depression and other psychological factors was examined using Beck Depression Inventory (BDI) and the Symptom Checklist-90-Revised test (SCL-90-R). Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality. RESULTS: The mean BDI (p<0.001), all subdivisions of SCL-90-R including somatization (p<0.001), and the mean global PSQI scores (p=0.002) were found to be significantly higher in patients with chronic LE than those in the control group. The presence of depression according to BDI was 41.3% in the patient group. About 60.8% of the patients had somatization and 71.7% had poor sleep quality. VAS scores were significantly higher in the patients with depression, somatization, and low sleep quality indicating a low positive linear relationship (r=0.357, r=0.360, and r=0.463, respectively, and all p<0.05). CONCLUSION: Psychiatric disorders and poor sleep quality are frequently observed in patients with chronic LE. These comorbidities negatively affect pain levels and may be linked to pain chronicity. Therefore, the potential coexistence of psychiatric disorders should be kept in mind when determining the treatment protocols for patients with chronic LE and adjunctive treatment should be given if necessary.

The prevalence of scapular dyskinesia in patients with back, neck, and shoulder pain and the effect of this combination on pain and muscle shortness.

OBJECTIVES: The aim of the study was to evaluate the prevalence of scapular dyskinesia in patients with neck, back, and shoul-der pain and examine the variations in clinical parameters cause by this combination. METHODS: A total of 121 patients with neck, back, or shoulder pain were included in this prospective cross-sectional study. De-mographic and clinical data of the patients were recorded. It was evaluated the intensity of pain with the visual analog scale (VAS), the presence of muscle shortness with muscle shortness tests, and scapular dyskinesia with the Lateral Scapular Slide Test. RESULTS: The prevalence of scapular dyskinesia was 41.9% in the study population. Patients were divided into groups, with or without scapular dyskinesia for evaluation, and compared. The presence of scapular dyskinesia was significantly higher in pa-tients with back and shoulder pain (p<0.05). When the distribution of scapular dyskinesia pathological types was evaluated, it was found that Type 1 was the most common in the study population. No significant difference was observed in pain intensity at rest and during activity between the groups (p>0.05), but the VAS score at night was significantly higher in patients with scapular dyskinesia (p<0.05). The pectoral, latissimus dorsi, and rhomboids muscle shortness were significantly higher in the group with scapular dyskinesia (p<0.05). CONCLUSION: The evaluation of the presence of scapular dyskinesia in a physical examination in patients with neck, back, and/or shoulder pain will be a guide for the diagnosis and treatment of pain-related problems.

An investigation of coronaphobia and physical activity among patients with rheumatoid arthritis.

Objectives: This study aims to investigate coronaphobia and physical activity levels in patients with rheumatoid arthritis (RA). Patients and methods: Between December 2021 and February 2022, a total of 68 RA patients (11 males, 57 females; mean age: 48.3±10.1 years; range, 29 to 78 years) and 64 age- and sex-matched healthy individuals (4 males, 60 females; mean age: 47.9±10.2 years; range, 23 to 70 years) were included in this cross-sectional study. Demographic, physical, lifestyle, and medical characteristics of all participants were recorded. The COVID-19 Phobia Scale (C19PS) and the International Physical Activity Questionnaire-Short Form (IPAQ-SF) were administered to all participants. The RA patients were divided into two groups as: patients treated with biological and non-biological agents. The Disease Activity Score-28 (DAS28) and Clinical Disease Activity Index (CDAI) were used to measure disease activity. Results: The total and subgroup scores of the C19P-S were found to be statistically significantly higher in both the biological and non-biological RA groups than in the control group (p=0.001). However, there was no statistically significant difference between the RA groups in terms of total and subgroup C19P-S scores. The mean IPAQ score was significantly lower in the RA group using biological drugs than in the control group (p=0.002). A significant correlation was found between DAS28 and total C19P-S scores (r:0.63, p<0.05), and CDAI and total C19P-S scores (r:0.79, p<0.05). Conclusion: Patients with RA have an increased risk of coronaphobia and disease activity is correlated with coronaphobia. Patients treated with biological agents seem to have lower activity levels compared to other RA patients and healthy controls. These results should be considered in the management of RA during COVID-19 pandemic and preventive intervention strategies should be formulated to cope with coronaphobia.

Efficacy of extracorporeal shock wave therapy for pillar pain after open carpal tunnel release: a double-blind, randomized, sham-controlled study.

BACKGROUND: Pillar pain may develop after carpal tunnel release surgery (CTRS). This prospective double-blinded randomized trial investigated the effectiveness of extracorporeal shock wave therapy (ESWT) in pillar pain relief and hand function improvement. METHODS: The sample consisted of 60 patients with post-CTRS pillar pain, randomized into two groups. The ESWT group (experimental) received three sessions of ESWT, while the control group received three sessions of sham ESWT, one session per week. Participants were evaluated before treatment, and three weeks, three months, and six months after treatment. The pain was assessed using the visual analogue scale (VAS). Hand functions were assessed using the Michigan hand outcomes questionnaire (MHQ). RESULTS: The ESWT group showed significant improvement in VAS and MHQ scores after treatment at all time points compared to the control group (P < 0.001). Before treatment, the ESWT and control groups had a VAS score of 6.8 ± 1.3 and 6.7 ± 1.0, respectively. Three weeks after treatment, they had a VAS score of 2.8 ± 1.1 and 6.1 ± 1.0, respectively. Six months after treatment, the VAS score was reduced to 1.9 ± 0.9 and 5.1 ± 1.0, respectively. The ESWT group had a MHQ score of 54.4 ± 7.7 before treatment and 73.3 ± 6.8 six months after. The control group had a MHQ score of 54.2 ± 7.1 before treatment and 57.8 ± 4.4 six months after. CONCLUSIONS: ESWT is an effective and a safe non-invasive treatment option for pain management and hand functionality in pillar pain.

A Comparison of the Effectiveness of Ultrasound-Guided Versus Landmark-Guided Suprascapular Nerve Block in Chronic Shoulder Pain: A Prospective Randomized Study.

BACKGROUND: Suprascapular nerve block (SSNB) is an effective therapeutic approach for shoulder pain and has been increasingly used by professionals in clinical practice. In the landmark-guided nerve block technique, it could be difficult to determine the exact localization of the suprascapular nerve. OBJECTIVES: To evaluate and compare the clinical and functional outcomes of ultrasound (US)-guided versus landmark-guided SSNB for the treatment of chronic shoulder pain. STUDY DESIGN: Randomized, prospective analysis. SETTING: Outpatient physical therapy and rehabilitation clinic. METHODS: Seventy-two patients with chronic shoulder pain were enrolled into this study. The patients were randomly allocated to 2 groups. Thirty-six patients received US-guided SSNB and 36 underwent landmark-guided SSNB. Initial examinations before injection and for the first week and first and third months postinjection were recorded. Visual Analog Scale (VAS) pain intensity levels, shoulder functions based on the Shoulder Pain and Disability Index (SPADI), and quality of life levels based on the Health Assessment Questionnaire (HAQ) were evaluated at each control. RESULTS: Statistically significant recovery was observed in terms of VAS pain levels, SPADI, and HAQ from the first week after injection in both groups, but no significant difference was observed between the groups. LIMITATIONS: The absence of a control group. CONCLUSIONS: Our results indicate that US-guided SSNB does not potentially offer a significantly greater clinical improvement over landmark-guided SSNB in patients with chronic shoulder pain. Further research is required to establish whether this hypothesis is consistently supported in practice.

Presence of Fibromyalgia Syndrome and Its Relationship with Clinical Parameters in Patients with Axial Spondyloarthritis.

BACKGROUND: Fibromyalgia syndrome (FMS) is a disorder with a population prevalence of 1% to 5%. There are insufficient data in the literature on the incidence of FMS in patients with axial spondyloarthritis (SpA), with only a limited number of studies conducted. OBJECTIVES: The aim of this study was to determine the presence of FMS in patients diagnosed with axial SpA and to investigate the effect of this coexistence on clinical and laboratory assessments in patients with ankylosing spondylitis. STUDY DESIGN: This research involved a retrospective analysis of prospectively collected data. SETTING: The research took place in an outpatient rheumatology clinic. METHODS: This study included 125 patients diagnosed with axial SpA according to the Assessment of Spondyloarthritis International Society criteria. The presence of FMS was investigated according to the 2010 American College of Rheumatology criteria. Pain during activity, resting, and at night was examined using the Visual Analog Scale. Ankylosing Spondylitis Disease Activity Scores were used for assessment of disease activity, Ankylosing Spondylitis Quality of Life Scale was used for quality of life, Bath Ankylosing Spondylitis Functional Index was used for functionality, and Pittsburgh Sleep Quality Index was used for sleep quality. RESULTS: Incidence of FMS was 29.6% in the study population, which consisted of patients who were all diagnosed with axial SpA. Comparison of patient groups with and without FMS revealed no statistically significant differences in age, weight, body mass index, marital status, family history, and smoking history (P > .05), with a higher rate of female patients in the group with FMS at 55% (P < .05). Ankylosing Spondylitis Disease Activity Score-C-Reaktif Protein, Ankylosing Spondylitis Disease Activity Score-Erythyrocyte Sedimentation Rate, Ankylosing Spondylitis Quality of Life Scale, Bath Ankylosing Spondylitis Functional Index, Pittsburgh Sleep Quality Index, and Visual Analog Scale pain scores were significantly higher in the group with FMS (P < .05). LIMITATION: The study involved a limited number of patients. CONCLUSIONS: FMS is observed in one-third of patients with axial SpA. The presence of FMS negatively affects quality of life, functional status, sleep quality, disease activity, and pain level of patients with ankylosing spondylitis. The possibility for coexistence of FMS should be kept in mind when determining the treatment protocols for patients with axial spondyloarthritis, and adjunctive treatment should be given if necessary. KEY WORDS: Disease activity, fibromyalgia, quality of life, spondyloarthritis, sleep quality.