EURO-MUSCULUS/USPRM. Basic Scanning Protocols for Ankle and foot.

In this protocol, the patient/probe positionings, anatomical drawings and ultrasound images of commonly scanned ankle/foot structures are described. This practical guide is prepared (with an international consensus of several expert physiatrists) to serve as a uniform/standard approach especially for beginner sonographers.

EURO-MUSCULUS/USPRM. Basic scanning protocols for knee.

In this protocol, the patient/probe positionings, anatomical drawings and ultrasound images of commonly scanned knee structures are described. This practical guide is prepared (with an international consensus of several expert physiatrists) to serve as a uniform/standard approach especially for beginner sonographers.

EURO-MUSCULUS/USPRM. Basic scanning protocols for hip.

In this protocol, the patient/probe positionings, anatomical drawings and ultrasound images of commonly scanned hip structures are described. This practical guide is prepared (with an international consensus of several expert physiatrists) to serve as a uniform/standard approach especially for beginner sonographers.

EURO-MUSCULUS/USPRM Basic Scanning Protocols for shoulder.

In this protocol, the patient/probe positionings, anatomical drawings and ultrasound images of commonly scanned shoulder structures are described. This practical guide is prepared (with an international consensus of several expert physiatrists) to serve as a uniform/standard approach especially for beginner sonographers.

EURO-MUSCULUS/USPRM Basic Scanning Protocols for elbow.

In this protocol, the patient/probe positionings, anatomical drawings and ultrasound images of commonly scanned elbow structures are described. This practical guide is prepared (with an international consensus of several expert physiatrists) to serve as a uniform/standard approach especially for beginner sonographers.

EURO-MUSCULUS/USPRM Basic Scanning Protocols for wrist and hand.

In this protocol, the patient/probe positionings, anatomical drawings and ultrasound images of commonly scanned wrist/hand structures are described. This practical guide is prepared (with an international consensus of several expert physiatrists) to serve as a uniform/standard approach especially for beginner sonographers.

Impact of exercises administered to stroke patients with balance trainer on rehabilitation results: a randomized controlled study.

OBJECTIVE: The objective of this study was to determine the efficacy of the exercises administered to stroke patients with the balance trainer (BALANCE-trainer, art.nr. 07001-001(TM)) on balance, level of independence and ambulation parameters. MATERIAL AND METHOD: Fifty patients with hemiplegia were randomized into either study group or control group. Patients in the control group received 30 sessions of conventional rehabilitation program and patients in the study group were trained with balance trainer in addition to conventional rehabilitation program. Balance level and postural control were evaluated with Berg Balance Scale (BBS) and Timed-Up and Go Test (TUG). Their functional statuses were evaluated using Functional Independence Measure (FIM). Evaluations were repeated following the six-week rehabilitation program. RESULTS: Of the 50 participants, 19 were women (38%) and 31 were men (62%). The mean age was 57.1 ± 9.2 years. The time that elapsed after stroke was 87.3 ± 26.3 days. Statistically significant improvements were noted in BBS, TUG and FIM in intra-group evaluations for both groups. Statistically significant improvements were documented in BBS and TUG levels for inter-group evaluation (respectively p =0.038, p =0.025), while the difference in FIM levels was not statistically significant (p >0.05). CONCLUSION: Positive impact of balance trainer on balance and postural control was demonstrated in stroke patients in the current study. Hippokratia 2015; 19 (2):125-130.

Can long-term bisphosphonate use causes low-energy fractures? A case report.

Bisphosphonates are inorganic pyrophosphate analog which accumulate on the bone surface, cause osteoclast apoptosis, and inhibit bone resorption. The nitrogen-containing bisphosphonates continue to be the drug of choice for the treatment of osteoporosis in both men and women. Although histomorphometric studies including bone biopsies have not shown any evidence of microcracks, recent studies have revealed that potent bisphosphonates are responsible for the oversuppression of bone turnover leading to microdamages, reduced bone strength, and increased fracture risk. There are individual cases reporting atypical femoral fractures and severely suppressed bone turnover along with long-term (≥ 5 years) use of biphosphonates. In this study, we report on a 74-year-old woman with a history of continuous alendronate use for nearly 16 years who presented to the emergency department with right proximal humerus and left femur fracture.

Elbow problems in paraplegic spinal cord injured patients: frequency and related risk factors--a preliminary controlled study.

STUDY DESIGN: Cross-sectional controlled study. OBJECTIVES: To evaluate the elbow joint with ultrasound in paraplegic patients, determine the related factors and compare it with healthy controls. SETTING: A training and research rehabilitation hospital in Istanbul. METHODS: A total of 30 paraplegic patients and 20 healthy controls were included in the study. Patients demographic data, pain in the elbow joint, level and duration of injury, ambulation status, type of wheelchair used, daily duration of wheelchair and other ambulation equipment usage, transfers being dependent or independent, daily number of push-ups were recorded. Elbow joints were evaluated with ultrasound for presence of fluid and thickness of the triceps tendon. RESULTS: Mean triceps tendon thickness values of the right side were larger in spinal cord injury (SCI) patients when compared with those of healthy controls'. Joint effusion on the right elbow joint was also found to be more common in SCI patients than in normal subjects. Triceps tendon thickness measurements were not found to be correlated with demographic and clinical factors. Seven paraplegic patients (23%) reported that they have pain in the elbow. CONCLUSION: In this preliminary study, our results showed that right elbow effusion was more frequent and right triceps tendon was thicker in SCI patients when compared with healthy subjects.

Effect of supervision on ultrasonographic measurements. A blinded randomized cross-over study.

BACKGROUND: Musculoskeletal ultrasound is becoming an increasingly popular clinical tool in the hands of physiatrists. Herewith, although the role of direct supervision (by an expert) is universally recognized as the core element for appropriate ultrasound training, to our best notice, its impact on ultrasonographic measurements has not been studied quantitatively in the hitherto literature. AIM: To quantify the effect of supervision in the early period of musculoskeletal ultrasound training by using three different tissues (muscle-cartilage-tendon) as models. DESIGN: A blinded randomized cross-over study. SETTING: Physical Medicine and Rehabilitation Department of a University Hospital. POPULATION: A total of 9 sonographers (8 novice and 1 expert) were involved whereby the novice sonographers were randomly divided into two groups; Group A (N.=4) and Group B (N.=4). METHODS: All sonographers performed three thickness measurements; medial head of the gastrocnemius muscle, patellar tendon and femoral cartilage on the left lower limb of the same subject. The expert supervised Group A in the first half of the study (9 days), and Group B in the second half (9 days). Throughout the study period, all the participants were blinded to the data. Relative effectiveness, expert effect, order effect, treatment-period effect were studied for cross-over variance analysis. RESULTS: For all the three sites, measurements under the supervision of the expert were significantly different than those without him -p values pertaining to relative effectiveness, expert effect were 0.014, 0.013 for femoral cartilage; <0.001, <0.001 for gastrocnemius and <0.001, <0.001 for patellar tendon, respectively). For gastrocnemius muscle measurements, studying with the expert in the second half of the study (vs in the first half) was better concerning the precision of the measurements (order effect P<0.001). CONCLUSION: Supervision during measurements of novice sonographers is crucial and their data should otherwise be interpreted attentively.

Using diffusion weighted MR imaging in a lipomatous chest wall lesion.

Hibemoma is a rare benign soft tissue tumor derived from brown fat.The tumor is also known as "fetal lipoma, lipoma of embryogenic fat and lipoma of immature adipose tissue. Hibemomas are slow-growing, painless soft tissue tumors which do not recur after surgical resection. Preferred locations are brown fat containing sites as thigh, interscapular region, shoulder, axilla, and mediastinum.The tumor occurs most commonly in adults, with a mean age of 38 years (age range, 2-75 years). We present a rare case of hibernoma with radiological and pathological findings.

The ankle-foot orthosis improves balance and reduces fall risk of chronic spastic hemiparetic patients.

BACKGROUND: Ankle foot orthoses (AFO) are commonly used orthotic device in order to restore the ankle foot function and to improve the balance and gait in post-stroke hemiparetic patients. However, there remain some discussions about their effectiveness on long term hemiparetic patients who had mild to moderate spasticity. AIM: To investigate the relative effect of prefabricated thermoplastic posterior leaf spring AFO (PLS-AFO) on balance and fall risk. DESIGN: A cross-over interventional study SETTING: The Department of PMR of a tertiary hospital. POPULATION: Twenty-five chronic post-stroke long duration hemiparetic patients who had Ashworth grade 1-2 spasticity at affected calf muscles and lower limb Brunnstrom stage 2-3 and also able to walk independently without an assistive device. METHODS: Berg Balance Scale (BERG), and the postural stability test (PST) and the fall risk test (FRT) of Biodex balance systems were used for the assessments. All of the patients were assessed with AFO and without AFO. All assessments were made with footwear. RESULTS: The mean post-stroke duration was 20,32±7,46 months. The BERG scores were 42,12±9,05 without AFO and 47,52±7,77 with AFO; the overall stability scores of FRT were 3,35±1,97 without AFO and 2,69±1,65 with AFO (P<0,001). CONCLUSION: It was found that the prefabricated thermoplastic PLS-AFO improve balance and provide fall risk reduction in chronic post-stroke ambulatory hemiparetic patients who had mild to moderate spasticity on their affected lower limb. CLINICAL REHABILITATION IMPACT: These results encourage the usage of AFO on long duration hemiparetic patients in order to provide better balance and lesser fall risk.

Coccyx fractures in patients with spinal cord injury.

AIM: The aim of this study was to report whether coccyx fractures are present in spinal cord injury (SCI) patients, who suffered from painful symptoms in the low back, gluteal, hip and thigh regions; and to determine the pain characteristics of coccydynia in these patients. METHODS: Twenty males and six females with traumatic SCI (mean age: 31.57+/-12.23 years) who described painful symptoms in the low back, hip, gluteal or thigh regions were included in the study. Pain assessment was done by using visual analogue scale (VAS) and the short form of McGill pain questionnaire. Radiological assessment comprised two-sided lumbar vertebrae, hip and coccyx X-ray graphics. RESULTS: Mean duration of SCI was 19.54+/-30.08 months. Nine patients (34.62%) had coccyx fractures. Sensory Pain Index and total McGill scores were found to be significantly higher in patients with coccyx fractures. Correlation analyses revealed significant correlations between VAS, SPI, affective pain index, present pain intensity and McGill total scores (all P<0.05). Duration of SCI was correlated with SPI (P=0.03) and total McGill scores (P=0.05). CONCLUSION: Coccyx fractures have been detected in patients with SCI and the presence of such fractures seems to affect the pain scenario unfavorably. Involved patients will be treated promptly and their rehabilitation process will be enhanced when these fractures are recognized early.