Effect of Perineural Dextrose Injection on Ulnar Neuropathy at the Elbow: A Randomized, Controlled, Double-Blind Study.

OBJECTIVE: To compare perineural dextrose injection efficacy in the treatment of ulnar neuropathy at the elbow with a control group. DESIGN: Prospective double-blind randomized control study. SETTING: Training and research hospital. PARTICIPANTS: The study was completed with 40 patients with ulnar neuropathy at the elbow. INTERVENTION: Normal saline (0.9% sodium chloride) was injected in patients in the control group (n=20; mean age=38.1±10.7 years; median duration of symptoms=4.5 months), and 5% dextrose was injected in patients in the dextrose group (n=20; mean age=43.6±13.5 years; median duration of symptoms=5 months), perineurally under ultrasound guidance twice at 2-week intervals. Ultrasound-guided perineural injection of 1 cc each was administered into the ulnar nerve, 2 cm and 4 cm distal to the medial epicondyle, at the level of the medial epicondyle, and 2 cm and 4 cm proximal to the medial epicondyle. The amount of total fluid injected was 5 cc. MAIN OUTCOME MEASURE(S): At baseline and weeks 2, 4, and 12, the patients were evaluated with the Visual Analog Scale for pain and the Disabilities of the Arm Shoulder and Hand questionnaire for disability. Electrophysiological evaluation was performed with ulnar nerve conduction studies, and the ulnar nerve cross-sectional area was measured on ultrasonography. RESULTS: The improvements in pain, disability, ulnar motor nerve velocity, and ulnar nerve cross-sectional area in the dextrose group were superior to those in the control group, especially at weeks 4 and 12 (P<.001, using independent samples t tests). CONCLUSION: Perineural 5% dextrose may be an effective alternative therapy for those with ulnar neuropathy at the elbow for up to the 12th week.

Median nerve conduction studies in rabbits.

BACKGROUND: When planning nerve conduction studies using animal models, the sciatic nerve is often used and the upper extremity nerves are not preferred due to the size of laboratory animals. This study aimed to present the method and mean values of median nerve conduction studies in laboratory rabbits. Fifty-five six-month-old male New Zealand white rabbits weighing 2 to 2.5 kg were included in nerve conduction studies performed under anesthesia. The compound muscle action potential amplitude and distal latency values were recorded for the median motor nerve with the electrodes placed on the flexor digitorum superficialis muscle and tendon. RESULTS: A total of 110 median nerves were evaluated. The mean amplitude of the median nerve was 30.6 ± 6.8, mV the median nerve distal latency was 1.3 ± 0.2 ms, and the mean intensity of stimulation inducing a response was 2.5 ± 1 mA. CONCLUSIONS: The mean values obtained by the median motor nerve conduction method in this study can act as a guide for future nerve interventions undertaken in the upper extremities.

Comparison of the effectiveness of orthotic intervention, kinesiotaping, and paraffin treatments in patients with carpal tunnel syndrome: A single-blind and randomized controlled study.

PURPOSE: The aim of the study was to compare different conservative treatments in patients with carpal tunnel syndrome (CTS). STUDY DESIGN: A single-blind randomized controlled study. METHODS: Patients (n = 169) diagnosed with mild or moderate CTS were screened; 110 met study requirements. The patients were randomized into 3 groups. The control (CON) comparison provided to all patients was a fabricated night orthotic which held the wrist in a neutral position. The second group received adjunctive kinesiotaping (KIN) and the third group received paraffin (PARA). All patients were evaluated clinically, electrophysiologically, and ultrasonographically before treatment and at 3 weeks, 3 months, and 6 months. RESULTS: There were 36 patients in CON, 37 in KIN, and 37 in PARA. Pain reduction in KIN was better than the other groups at 3 weeks (mean difference [MD] in CON 2.4 ± 2.5, KIN 3.7 ± 2.0, PARA 2.7 ± 2.3; P < .01) and 6 months (MD in CON 3.4 ± 3.0, KIN 4.9 ± 3.1, PARA 3.7 ± 2.9; P < .05). KIN pain reduction was better than CON at 3 months (MD in CON 3.8 ± 2.8, KIN 5.0 ± 2.5; P < .05). Reduction of the cross-sectional area of median nerve at the level of radioulnar joint was greater for KIN than CON at 3 weeks (MD in CON 0.0 ± 0.5, KIN 0.3 ± 0.7; P < .01) than PARA at 3 months (MD in KIN 0.3 ± 0.8, PARA 0.0 ± 0.8; P < .05) and both groups at 6 months (MD in CON 0.1 ± 0.8, KIN 0.5 ± 0.9, PARA 0.0 ± 1.0 P < .05). CONCLUSION: Adding KIN to night use of an orthotic was more effective in achieving symptomatic and structural improvements than either the orthotic alone or adjunctive use of paraffin in patients with mild and moderate CTS.

A randomized, single-blinded pilot study evaluating the effects of kinesiology taping and the tape application techniques in addition to therapeutic exercises in the treatment of congenital muscular torticollis.

OBJECTIVE: To investigate the effects of kinesiology taping and different types of application techniques of kinesiology taping in addition to therapeutic exercises in the treatment of congenital muscular torticollis. DESIGN: Prospective, single blind, randomized controlled trial. SETTING: An outpatient rehabilitation clinic in a tertiary university hospital. SUBJECTS: Infants with congenital muscular torticollis aged 3-12 months. INTERVENTIONS: Group 1 included 11 infants who only received exercises, Group 2 included 12 infants who received kinesiology taping applied on the affected side by using inhibition technique in addition to exercises. Group 3 included 10 infants who additionally received kinesiology taping applied on the unaffected side by using facilitation technique and on the affected side by using inhibition technique. MAIN MEASURES: Range of motion in lateral flexion and rotation of the neck, muscle function and degree of craniofacial changes were assessed at pretreatment, post treatment and, 1 month and 3 months' post treatment. RESULTS: Friedman analysis of within-group changes over time revealed significant differences for all of the outcome variables in all groups except cervical rotation in Group 3 ( P<0.05). No significant differences were found between groups at any of the follow-up time points for any of the outcome variables ( P>0.05). CONCLUSIONS: There is no any additive effect of kinesiology taping to exercises for the treatment of congenital muscular torticollis. Also different techniques of applying kinesiology taping resulted in similar clinical outcomes.

The effect of combined hydrolyzed type 2 collagen, methylsulfonylmethane, glucosamine sulfate and chondroitin sulfate supplementation on knee osteoarthritis symptoms.

Objectives: This study aimed to evaluate the effects of the combined hydrolyzed type 2 collagen, methylsulfonylmethane (MSM), glucosamine sulfate (GS), and chondroitin sulfate (CS) supplement on knee pain intensity in patients with knee osteoarthritis (OA). Patients and methods: This multicenter, observational, noninterventional study included 98 patients (78 females, 20 males; mean age: 52.8±6.5 years; range, 40 to 64 years) who had Grade 1-3 knee OA between May 2022 and November 2022. The patients were prescribed the combination of hydrolyzed type 2 collagen, MSM, GS, and CS as a supplement for knee OA. The sachet form of the combined supplement containing 1250 mg hydrolyzed type 2 collagen, 750 mg MSM, 750 mg GS, and 400 mg CS was used once daily for two consecutive months. Patients were evaluated according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS)-pain, and Health Assessment Questionnaire (HAQ). Patients were scheduled to visit for follow-up four weeks (Visit 2) and eight weeks (Visit 3) after Visit 1 (baseline; day 0 of the study). Results: For the VAS-pain, WOMAC, WOMAC-subscale, and HAQ scores, the differences in improvement between the three visits were significant (p<0.001 for all). The patient compliance with the supplement was a median of 96.77%, both for Visit 2 and Visit 3. Conclusion: The combination of hydrolyzed type 2 collagen, MSM, GS, and CS for eight weeks in knee OA was considered an effective and safe nutritional supplement.

Evaluation of the effect of pitavastatin on motor deficit and functional recovery in sciatic nerve injury: A CatWalk study.

Objectives: This study aims to investigate the electrophysiological, scintigraphic, and histopathological effects of pitavastatin and its impact on functional status in rats with sciatic nerve injury. Materials and methods: A total of 30 Wistar albino rats were divided into three equal groups including 10 rats in each group: sham group (no injury), control group (nerve injury induced), and pitavastatin group (nerve injury induced and 2 mg/kg of pitavastatin administered orally once a day for 21 days). Before and at the end of intervention, quantitative gait analysis with the CatWalk system and sciatic nerve conduction studies were performed. After the intervention, the gastrocnemius muscle was scintigraphically evaluated, and the sciatic nerve was histopathologically examined. Results: There was no significant difference in the sciatic nerve conduction before the intervention and Day 21 among the groups (p>0.05). According to the quantitative gait analysis, there were significant differences in the control group in terms of the individual, static, dynamic, and coordination parameters (p<0.05). The histopathological examination revealed a significant difference in the total myelinated axon count and mean axon diameter among the groups (p<0.001). Conclusion: Pitavastatin is effective in nerve regeneration and motor function recovery in rats with sciatic nerve injury.

Unusual presentation of an unusual disease: A very delayed diagnosis of Grisel's syndrome.

Grisel's syndrome (GS) is a rare syndrome which refers only to non-traumatic atlantoaxial subluxation. This syndrome predominantly occurs in young children following an upper respiratory infection or otolaryngologic procedures. An eight-year-old girl with a delayed diagnosis of GS was admitted to our outpatient clinic with complaints of painful torticollis and neck stiffness. Three-dimensional computed tomography revealed rotatory atlantoaxial subluxation. After consulting with the neurosurgery department, the patient underwent surgery. The significance of this patient was that she was unable to be diagnosed early and atlantoaxial subluxation remained hidden for five years without any complications. In conclusion, this rare case highlights the importance of delayed diagnosis of GS and clinicians should be aware of this syndrome.

Comparison of the effects of using non-steroidal anti-inflammatory drugs with or without kinesio taping on the radial nerve in lateral epicondylitis: A randomized-single blind study.

BACKGROUND: There is no knowledge about the effects of kinesio taping (KT) on the radial nerve in lateral epicondylitis. OBJECTIVE: This study aimed to determine the effects of non-steroidal-anti-inflammatory drugs (NSAIDs) combined with KT on lateral epicondylitis using ultrasonographic findings. METHODS: NSAID therapy was administered to the control group for 10 days, and the KT group additionally received KT three times a week for two weeks. Clinical and ultrasonographic evaluations were performed before treatment and at post-treatment at second, sixth and fourteenth weeks. The radial nerve cross sectional area and common extensor tendon thicknesses were measured using ultrasonography. RESULTS: The study was completed with 40 patients in each group. Improvements in clinical parameters, common extensor tendon thickness, and cross sectional area values were significant in the KT group (p<0.01). CONCLUSIONS: NSAID plus kinesio taping decrease pain intensity while improving functionality and ultrasonographic parameters, including common extensor tendon thickness and radial nerve cross sectional area; therefore, it may be an option treatment in lateral epicondylitis.

Undifferentiated connective tissue disease presenting with optic neuritis and concomitant axial spondyloarthritis: A rare case report.

Undifferentiated connective tissue disease (UCTD) represents a group of diseases which do not fulfill the criteria of rheumatologic diseases or may be considered as an early stage of any of these diseases. Axial spondyloarthritis (axSpA) is a disease accompanied by symptoms of inflammatory low back pain and peripheral symptoms, with more spine and sacroiliac joint involvement. In this report, we, for the first time, present a case of UCTD presenting with axSpA in whom the initial finding was optic neuritis, which is rarely seen in UCTD.

Role of paraspinal mapping before transforaminal epidural injections for lumbar radiculopathy.

OBJECTIVES: This study aims to investigate whether electromyography (EMG) including paraspinal mapping (PM) and specific clinical findings before the injection have a predictive role on the results in patients undergoing unilateral transforaminal epidural steroid injection (TFESI). PATIENTS AND METHODS: In this prospective study, a total of 46 patients (19 males, 17 females; mean age: 44.0±10.8 years; range, 23 to 60 years) with unilateral L5 root compression confirmed by physical examination, EMG and lumbar MRI between March 2013 and January 2014 were included. The patients underwent L5 TFESI. After the injection, they were examined at 1 h, three weeks, and three months. RESULTS: The clinical findings and presence of acute involvement on EMG were not predictive for TFESI results; however, the patients with lower scores for the L5 segment in PM benefited more from the injection, compared to patients with higher scores for the L5 segment in PM. CONCLUSION: In patients with very clearly defined L5 radiculopathy, PM EMG can give us an idea about the effectiveness of L5 TFESI.

A preliminary study of the child abuse and central sensitization in adolescent patients with chronic non-organic chest pain and an overlooked condition: juvenile fibromyalgia syndrome.

BACKGROUND: Only a small percentage of pediatric chest pain is of cardiac origin and the most common detected cause is musculoskeletal. Among musculoskeletal causes, acute chest pain is better described, with the causes of chronic pain not being adequately investigated in the literature. The aim of studuy is to evaluate the musculoskeletal causes of non-cardiac chest pain and investigate the relationship of chest pain with child abuse and central sensitization. METHODS: Patients aged 12 to 18 years presenting with chest pain for at least 3 months were evaluated by a pediatric cardiologist and those without an organic pathology were referred to the physical medicine and rehabilitation clinic. In addition to detailed history and physical examination, juvenile fibromyalgia was questioned according to the 2016 revised diagnostic criteria of the American College of Rheumatology. The visual analog scale (to measure intensity of chest pain), the Central Sensitization Inventory (to evaluate the presence of central sensitization), the Hospital Anxiety Depression Scale (to determine depression and anxiety), the Childhood Trauma Questionnaire (to assess the presence of child abuse) were administered. RESULTS: The study was completed with 64 patients. Twenty-six percent of patient (n = 17) were diagnosed with juvenile fibromyalgia, and central sensitization was detected in 34.4% (n = 22). Pain intensity, anxiety, depression and abuse scores were higher in patients with juvenile fibromyalgia than those without juvenile fibromyalgia and in patients with central sensitization compared to those without central sensitization (p < 0.001 for both). Higher scores of pain were related with child abuse [beta = 0.763, p < 0.001, (%95 CI, 4.397; 8.841)] and central sensitization of pain [beta = 0.382, p = 0.008 (95% CI: (0.986;6.231)] in regression analyses. CONCLUSION: In this study, juvenile fibromyalgia was detected as a cause of non-cardiac chest pain. Juvenile fibromyalgia or central sensitization may also indicate childhood abuse.

Effect of Dextrose Prolotherapy on Pain Intensity, Disability, and Plantar Fascia Thickness in Unilateral Plantar Fasciitis: A Randomized, Controlled, Double-Blind Study.

OBJECTIVE: The aim of the study was to evaluate the efficacy of dextrose prolotherapy in the treatment of chronic resistant plantar fasciitis through comparison with a control group. DESIGN: In this double-blind, randomized, controlled study, the patients were divided into two groups. The prolotherapy group (n = 30) was administered 5 ml of 30% dextrose, 4 ml of saline, and 1 ml of 2% lidocaine mixture (15% dextrose solution) and the control group was given 9 ml of saline and 1 ml of 2% lidocaine mixture twice at a 3-wk interval. During the 15-wk follow-up period, pain intensity was measured using the visual analog scale during activity and at rest. The foot function index was used to measure pain and disability. The plantar fascia thickness was measured by ultrasonography. The measurements were undertaken before treatment and at posttreatment weeks 7 and 15. RESULTS: Improvements in visual analog scale during activity, at rest, foot function index (all subgroups), and plantar fascia thickness measured at the 7th and 15th weeks were significantly higher in the prolotherapy group compared with the control group (P < 0.001). CONCLUSIONS: Dextrose prolotherapy has efficacy up to 15 wks and can be used as an alternative method in the treatment of chronic resistant plantar fasciitis.

The effects of head posture on nerve conduction studies in patients with ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic inflammatory disease which effects cervical posture of patients. The aim of this study was to evaluate AS patients according to the degree of cervical disorder and was evaluate them electrophysiologically, functionality, and disease parameters. Our study comprised 64 AS patients and 30 healthy controls. The head posture of patients was evaluated by craniovertebral angle (CVA) measurement. Nerve conduction of bilateral median, radial, ulnar, and medial antebrachial cutaneous (MAC) nerves were studied in all patients. The most important nerve conduction differences in AS patients who have severe forward head posture (FHP) were decrease in sensory nerve action potential (SNAP) amplitude and compound muscle action potential amplitudes of median nerves, a decrease in the SNAP amplitude of ulnar nerves, a delay in the F response latency of ulnar nerves, and prolongation in the SNAP latency of the MAC nerve. The FHP disorder that develops in AS patients may have electro physiological effects, similar to those of thoracic outlet syndrome In addition, the functional status of these patients is worsened as severity of FHP increases.

Isokinetic evaluation of the trunk muscle strength in housewives with fibromyalgia: a cross-sectional study.

BACKGROUND: It is known that physical activity and muscular performance are reduced in fibromyalgia (FM) syndrome. This study aims to compare the performance of trunk muscles in women with FM and healthy controls and evaluate the correlation between trunk muscle strength and FM severity. METHODS: Forty-six patients with FM and 42 age- and body mass index-matched healthy housewives without FM were included in the FM and control groups, respectively. The Fibromyalgia Impact Questionnaire (FIQ) was used for the assessment of FM severity. The pain intensity was evaluated using the visual analogical scale (VAS). An isokinetic dynamometer was used to measure the isokinetic trunk muscle strength. The peak torque (PT) values were recorded. The psychological status of the patients was evaluated using the Beck Depression Inventory. RESULTS: There was no statistically significant difference in terms of age, BMI, and BDI scores in two groups (p > 0.05, for all). The isokinetic trunk extensor PT values were significantly lower in the FM group (p = 0.002 for 60°/s, and p < 0.001 for 90°/s and 120°/s) than control group. There was a statistically significant negative correlation between FIQ score and isokinetic extensor muscle parameters. CONCLUSION: The results indicate that trunk extensor muscles were significantly weaker in FM patients. Trunk extensor muscle strength decreased as FM severity increased in FM patients.

Is Radial Deviation of Wrist Related With Median Nerve Swelling in Patients With Rheumatoid Arthritis? A Radiographic, Ultrasonographic, and Electroneuromyographic Study.

OBJECTIVES: This study aims to investigate whether or not radial deviation developing after wrist involvement of rheumatoid arthritis (RA) is a cause of median nerve swelling. PATIENTS AND METHODS: The study included 51 RA patients (12 males, 39 females; mean age 50.9±8.9 years; range, 18 to 65 years) without carpal tunnel syndrome (CTS) detected by electroneuromyography. Duruöz hand index, visual analog scale, and painDETECT questionnaire were performed in clinical assessment. Radiographic measurements including radial inclination (RI) angle were performed. Using ultrasonography, the median nerve cross-sectional areas (CSAs) were measured from the four levels of the distal one third of the forearm, radioulnar joint, pisiform bone, and hook of hamate, while the ulnar nerve CSAs were measured from the pisiform bone. RESULTS: The study was completed with 102 hands of 51 patients. A negative correlation was found between the RI and the median CSAs measured from the radioulnar joint (R=-0.49; p=0.00), the pisiform bone (R= -0.45; p=0.00), and hook of hamate (R= -0.60, p=0.00). When the hands were divided into three groups according to the ranges of RI specified in the literature, the median nerve CSA was found to be significantly higher in the group with low RI at these levels (p<0.001). CONCLUSION: In patients with RA without CTS, the increase in the median nerve CSAs may be associated with radiographic measures such as radial deviation.

Is Complex Decongestive Physical Therapy Safe for Median Nerve at the Level of Carpal Tunnel in Breast Cancer Related Lymphedema?

BACKGROUND: Multilayer bandaging used in complex decongestive therapy (CDT) may increase tissue pressure resulting in nerve entrapments. The aim of this study was to discover if median nerve damage is a consequence of CDT in patients with breast cancer-related lymphedema (BCRL). METHODS AND RESULTS: Eighty-two arms of 41 patients with BCRL were included. Mean age was 56.05 (8.16) years and all stages of lymphedema were equally included. Fifteen sessions of CDT was applied to all patients. The calculated volume of extremities, the quality of life (cancer adaptation of Ferrans-Powell), neuropathic pain (NP; Douleur Neuropathique 4), and disability (quick disabilities of arm, shoulder, and hand [Q-DASH]) tests were recorded before and after therapy. Skin and subcutaneous tissue thicknesses of volar and dorsal sides and median nerve cross-sectional area (CSA) at the level of carpal tunnel were measured using ultrasonography (US), before and after therapy. Carpal tunnel syndrome (CTS; 41.37%) and polyneuropathy (10.34%) were common findings confirmed by electromyography. Neuropathic pain profile was also found in 34.14% of patients. The arm volume of affected side, quality of life, and skin and subcutaneous tissue thicknesses were improved after therapy (p < 0.05). However, median nerve CSA, the NP, and Q-DASH scores were not changed after therapy. CONCLUSIONS: Although lymphedema is a painless condition, NP and CTS should not be ignored in patients with BCRL. US is an alternative, precise, and high technological method for evaluating treatment response. CDT is an effective and safe treatment according to volumetric calculations, US measurements of tissue thicknesses, and median nerve size.

Are extramedian symptoms associated with peripheral causes in patient with carpal tunnel syndrome? Electrodiagnostic and ultrasonographic study.

OBJECTIVE: To evaluate the relationship between extramedian spreading of sensorial symptoms and median and ulnar nerve cross-sectional area (CSA) and to compare the ultrasonographic and electrophysiological findings in patients with carpal tunnel syndrome (CTS) with or without extramedian sensory symptoms. DESIGN: Cross-sectional study. MATERIALS AND METHODS: Patients with CTS were divided into two groups as with or without extramedian symptoms and were assessed clinically, electrophysiologically and ultrasonographically by three blind investigators. In electrophysiological tests, median and ulnar nerve conduction studies were performed. Nerve cross-sectional areas were measured at hook of hamate, psiform bone, radio-ulnar joint, one-third distal part of forearm, and medial epicondyle by ultrasonography. FINDINGS: The study was completed with 61 patients (108 hands). Extramedian symptoms were present in 31 patients (54 hands). Finger grip strength was lower, pain values evaluated with visual analogue scale were higher in patients with extramedian symptoms (p<0.05). There was no statistically significant difference in electrophysiological and ultrasonographic parameters. CONCLUSION: According to our results, extramedian symptoms are not related to nerve conduction studies or nerve ultrasonography, these symptoms may be explained with central sensitization in patient with CTS.

Does electrodiagnostic evidence correlate with mood and function in patients with a pre-diagnosis of carpal tunnel syndrome?

OBJECTIVES: This study aims to investigate if function and mood involvement correlate in female patients who have a pre-diagnosis of carpal tunnel syndrome (CTS) and its correlation with physical examination and electrodiagnostic findings. PATIENTS AND METHODS: A total of 170 patients between the ages of 18-65 who applied to Physical Medicine and Rehabilitation outpatient clinics with CTS symptoms between May 2014 and December 2015 were enrolled. The mean age of patients was 44.6±11 years. Before electrophysiological testing (electromyography; EMG), Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), Beck Depression Inventory, Tinnel, Phalen and Durkan tests, grip and pinch strength measurement by JAMAR hand dynamometer were performed. The patients also used a Visual Analog Scale (VAS) to determine the severity of their symptoms during the day and at night. RESULTS: In 98 patients (57.6%) the diagnosis of CTS was confirmed by EMG, while 72 patients (42.4%) had normal electrodiagnostic findings. In patients who had normal EMG, Beck Depression Inventory and QuickDASH scores were not significantly different from the patients who had an electrodiagnosis of CTS. Pain experienced in the night was significantly higher in patients who had an electrodiagnosis of CTS, and these patients had significantly higher Beck Depression Inventory and QuickDASH scores. CONCLUSION: The lack of electrodiagnostic evidence in patients who have CTS symptoms does not show that function and mood are not affected in these patients. However, mood is significantly affected in patients with severe CTS.