Investigation of the effectiveness of neck stabilization exercises in patients with chronic neck pain: A randomized, single-blind clinical, controlled study.

Objectives: This study aims to compare the efficacy of neck stabilization exercises versus a conventional exercise program on pain, range of motion, disability, and depression in patients with chronic neck pain. Patients and methods: This prospective, single-blind, randomized controlled study included 60 patients with chronic neck pain, 58 (21 males, 37 females; mean age: 36.7±8.5 years; range, 18 to 55 years) of whom completed the study. The patients were randomized into two groups. Patients in one group were given neck stabilization exercises, while the patients in the other group were given conventional neck exercises. Neck pain due to activities of daily living (Visual Analog Scale), neck range of motion in sagittal, transverse, and frontal planes, disability (Neck Disability Index), and depression (Beck Depression Inventory) were evaluated at the beginning, at the end of the treatment, and at the first and third months after the end of treatment. Results: Significant improvement was achieved in both groups in terms of Visual Analog Scale, Neck Disability Index, neck range of motion in the sagittal, transverse, and frontal planes, and Beck Depression Inventory compared to the beginning of treatment (p<0.05). In the stabilization exercise group, statistically significant improvement was found in the range of motion of the neck in the transverse plane (p<0.05). Conclusion: Stabilization exercise programs, which show their effect by maintaining segmental stabilization, postural control, and balance between the superficial and deep muscles of the neck region, contribute to reduced pain in daily activities and improved function similar to conventional exercise programs.

The effectiveness of pulsed ultrasound treatment on pain, function, synovial sac thickness and femoral cartilage thickness in patients with knee osteoarthritis: a randomized, double-blind clinical, controlled study.

OBJECTIVE: This study aims to investigate the efficacy of therapeutic pulsed ultrasound on pain, function, synovial sac and femoral cartilage in knee osteoarthritis. DESIGN: Randomized, double-blind, controlled study. SETTING: Dokuz Eylul University, Department of Physical Medicine and Rehabilitation. SUBJECTS: A total of 96 patients with knee osteoarthritis. INTERVENTIONS: Participants were randomized into two groups; Group I (n = 48, pulsed ultrasound) and Group II (n = 48, sham ultrasound). The sessions were held three times a week for 8 weeks. The study continued for 12 weeks (with 4 weeks follow-up). All participants performed exercises at home for 12 weeks. MAIN MEASURES: Knee pain (at rest and ADLs) was assessed using the visual analog scale (VAS). Functionality was assessed using the Timed Up and Go test and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaire. Femoral cartilage and synovial sac thickness was measured using ultrasonography. All evaluations were performed at the baseline, at the 8 and 12 weeks after baseline. RESULTS: The study was completed with a total of 75 patients (n = 39 in group I and n = 36 in group II). The mean (SD) pain at ADLs score at baseline and week 12 was 7.2 (2.1), with 3.6 (2.9) in the group I, and 6.7 (2.0) and 4.3 (2.2) in the group II, respectively. Both groups presented significant improvements in terms of pain and function (P < 0.001). There was no difference between groups for any parameters. CONCLUSION: Treatment of pulsed ultrasound has no positive effect on knee pain, function, femoral cartilage and synovial sac thickness in knee osteoarthritis.

Tc-99m HIG Scintigraphy in Detection of Active Inflammation in Ankylosing Spondylitis.

OBJECTIVE: The diagnosis of active inflammation in ankylosing spondylitis (AS) is crucial for treatment to delay possible persistent deformities. There are no specific laboratory tests and imaging methods to clarify the active disease. We evaluated the value of Tc-99m human immunoglobulin (HIG) scintigraphy in detection of active inflammation. MATERIAL AND METHODS: Twenty-nine patients were included. Tc-99m methylenediphosphonate bone (MDP) and HIG scintigraphies were performed within 2-5 day intervals. Two control groups were constituted both for MDP and HIG scintigraphies. Active inflammation was determined clinically and by serologic tests. Both scintigraphies were evaluated visually. Sacroiliac joint index values (SII) were calculated. RESULTS: Active inflammation was considered in five (sacroiliitis in 2, sacroiliitis-spinal inflammation in 1, achilles tendinitis in 1, arthritis of coxafemoral joints in 1) patients. HIG scintigraphy demonstrated active disease in all 3 patients with active sacroiliitis. But, it was negative in the rest. The other 2 active cases were HIG negative. Right and left SII obtained from HIG scintigraphy was higher (p<0.05) in clinically active patients than inactive patients. There was not any significant difference between patients with inactive sacroiliitis and normal controls. Right and left SII obtained from bone scintigraphy was higher (p<0.05) in patient group than in control group. CONCLUSION: Clinically inactive AS patients, behave no differently than normal controls with quantitative sacroiliac joint evaluation on HIG scintigraphy. HIG scintigraphy may be valuable for evaluation of sacroiliac joints in patients with unc RESULTS: ertain laboratory and clinical findings. CONFLICT OF INTEREST: None declared.

Efficacy of EMG-biofeedback in knee osteoarthritis.

This study was designed to investigate the additive effect of EMG-biofeedback in rehabilitation of knee osteoarthritis. Forty patients, aged 45-70, with the diagnosis of knee osteoarthritis according to American College of Rheumatology (ACR) criteria were taken into the study. The patients were randomly assigned in two groups. One group (n = 20) received strengthening exercise program with EMG-biofeedback while the other group (n = 20) had the same exercise program without biofeedback for 3 weeks. The clinical outcome was assessed on the basis of pain with visual analog scale (VAS), function with Western Ontario McMaster Osteoarthritis Index (WOMAC) and quality of life with Nottingham Health Profile (NHP). Quadriceps strength was measured with Cybex isokinetic dynamometer, isokinetically at the angular velocities of 60 and 180 degrees /s and isometric strength at 65 degrees of knee flexion. Pain, WOMAC scores and muscle strength improved in both groups but there was no statistically significant differences between two groups (p > 0.05). In both groups physical mobility, pain scores of NHP improved significantly (p < 0.001) while in EMG-biofeedback group energy and sleep scores also improved after treatment (p < 0.05). As reported in the literature, in our study, strengthening exercises improved pain, function, muscle strength and quality of life in patients with knee osteoarthritis. But it seems that there is no significant additive effect of EMG-biofeedback to regular strengthening exercise program in these patients.

Motor conduction time along the cauda equina in patients with lumbar spinal stenosis.

STUDY DESIGN: Magnetic lumbar stimulation was used to detect spinal nerve degeneration in patients with lumbar spinal stenosis (LSS). OBJECTIVE: To evaluate delays in the motor conduction time in the cauda equina of patients with LSS. SUMMARY OF BACKGROUND DATA: Previous studies suggested a bilateral slowing of motor conduction in the cauda equina in LSS. Among several methods, only magnetic stimulation is sufficiently sensitive for detecting potential degeneration in LSS. A recent study demonstrated the direct calculation of the cauda equina motor conduction time using magnetic stimulation at proximal and distal sites of the cauda equina. We used this technique to determine potential degeneration in patients with LSS. METHODS: Twenty adult subjects and 15 patients with LSS were investigated. Lumbosacral roots were stimulated at intervertebral levels L1-L2 and L5-S1 by magnetic coil stimulation. The muscle responses to stimulation were recorded from the gastrocnemius-soleus, and anterior tibialis muscles on both sides with bipolar surface electrodes. The response latency from stimulations at the L5 spine level were subtracted from those at the L1 level on the same side. This value represented the conduction time from the proximal to distal ends of the cauda equina. RESULTS: The mean conduction time along the cauda equina was significantly prolonged in patients with LSS compared with controls. The mean cauda equina motor conduction time was 1.97 +/- 0.67 milliseconds in controls and 3.57 +/- 2.22 milliseconds in patients with LSS (P = 0.00). CONCLUSION: Determining the motor conduction time along the cauda equina using L1 and L5 magnetic stimulation provides an effective alternative method for evaluating the lumbar motor roots in patients with LSS.

[Neuralgic amyotrophy as the primary cause of shoulder pain in a patient with rotator cuff tear]. / Rotator manset yirtigi olan bir olguda omuz agrisinin ana nedeni: Nöraljik amiyotrofi.

A 66-year-old woman with no history of trauma presented with severe shoulder pain. Magnetic resonance imaging revealed rupture of the supraspinatus tendon, for which surgical treatment was considered. However, it was noted that shoulder pain was accompanied by weakness in the shoulder muscles, and the patient underwent electroneuromyographic examination, which revealed neuralgic amyotrophy. Following physical therapy and rehabilitation combined with appropriate medical therapy, her symptoms significantly improved. In cases with severe shoulder pain without a trauma history, characteristics of pain should be thoroughly analyzed and neuralgic amyotrophy considered in the differential diagnosis.

A placebo-controlled, multicenter, randomized, double-blind, flexible-dose, two-way crossover study to evaluate the efficacy and safety of sildenafil in men with traumatic spinal cord injury and erectile dysfunction.

BACKGROUND/OBJECTIVE: To show the efficacy, safety, and tolerability of sildenafil in men with erectile dysfunction (ED) associated with complete or incomplete spinal cord injury (SCI) and to assess its effects on quality of life (QoL) using the Life-Satisfaction Check List. METHODS: This was a placebo-controlled, multicenter, randomized, double-blind, flexible-dose, 2-way crossover study with a 2-week washout period between each phase. Patients with ED attributable to SCI (Sexual Health Inventory-Male score < or =21) received 50 to 100 mg sildenafil (n = 24) or placebo (n = 26). RESULTS: Compared with placebo, sildenafil produced higher levels of successful sexual stimulation, intercourse success, satisfaction with sexual life and sexual relationship, erectile function, overall sexual satisfaction, and an improved Erectile Dysfunction Inventory of Treatment Satisfaction score, with no clinically relevant effects on vital signs. Sildenafil seemed more effective in patients with incomplete SCI than in those with complete SCI, producing significant improvements, compared with placebo, in a number of measures only in patients with incomplete SCI. All patients who expressed a preference selected sildenafil over placebo, although the drug had no effect on patient QoL. Sildenafil was well tolerated, with a profile comparable to that of placebo. CONCLUSIONS: Compared with placebo, treatment with oral sildenafil safely and effectively improved erectile function in patients with ED attributable to SCI, especially in those with incomplete injury, and was the agent of choice in those who expressed a preference.

[The relationship between objective and subjective evaluation criteria in lumbar spinal stenosis]. / Lomber spinal stenozda objektif ve subjektif degerlendirme ölçütleri arasindaki iliski.

OBJECTIVES: We evaluated the relationship between functional objective and patient-based subjective assessments and quality of life in patients with lumbar spinal stenosis (LSS). METHODS: Thirty patients (25 females, 5 males; mean age 62+/-9 years; range 41-78 years) were prospectively studied. All were diagnosed as having LSS by clinical and radiological evaluations. Pain was assessed by a visual analog scale. The patients were evaluated by the two-staged treadmill exercise tolerance (TET) test, SF-36 health status survey, and Oswestry Disability Index (ODI). The relationships between the TET test, which is an objective functional assessment, and patient-based assessments (SF-36 and ODI), pain and age were investigated. RESULTS: There were significant differences between the functional grades of the patients at the speed of 1.9 km/hour with respect to ODI scores, the physical component scale of SF-36, age, and the preferred speed of the patients (p<0.05). These differences emerged from the fourth functional stage (p<0.01). Oswestry disability scores and the physical component scores of SF-36 worsened in parallel with the stages of the TET test. The preferred speed of the patients at the TET test was positively correlated with the physical component scores of SF-36 and negatively correlated with Oswestry disability scores (p<0.05). There was a negative correlation between the physical component scores of SF-36 and Oswestry disability scores (p<0.05). CONCLUSION: The TET test used to determine the functional capacity seems to be correlated well with subjective patient-based assessments. This objective tool, when combined with subjective assessments, may be helpful in the evaluation and treatment of patients with LSS.

Interobserver reliability of articular examination in juvenile idiopathic arthritis.

Diagnosis, treatment and follow-up of children with juvenile idiopathic arthritis are based upon the articular examination. The objective of the current study was to assess the interobserver agreement in grading the joint with arthritis and limited range of motion, and to detect the sources of disagreement. Twenty children with juvenile idiopathic arthritis were included. Assessment parameters were a) Physician Global Assessment, b) number of joints with active arthritis, and c) number of joints with limited range of motion. A total number of 1,320 joints were examined by both observers, blinded to each other. Each observer marked the involved joints as active arthritis, as limited range of motion, or as both. Interobserver agreement was determined by using Kappa statistics and Wilcoxon signed rank test. The statistical analysis was performed by SPSS 10.0. There was no statistical difference in the comparison of Physician Global Assessment of the two observers. There was substantial agreement in both arthritis and limited range of motion scores. Chance corrected agreement for the interobserver reliability was also performed for frequently involved joint such as neck, wrist, hip and knee. A substantial agreement was found. The close agreement between the observers could be attributed to standardization of examination techniques and to using objective variables.

Bone mineral density reference values in the normal female and male population of Izmir, Turkey.

In this study we aimed to establish the dual-energy X-ray absorptiometry (DXA) bone mineral density (BMD) reference values of healthy Turkish women and men residing in Izmir, western Turkey. We examined 347 women and 119 men (age range 20-80 years) who did not have any known risk factor that might affect bone mass. The BMD measurements were performed by Hologic QDR 4500 W Elite DXA instrument from the lumbar spine (L1-L4) and non-dominant hip. In women the mean BMD (g/cm(2))+/-standard deviation (SD) of the normal reference group between 20 and 39 years of age was 0.963+/-0.121 g/cm(2) in the lumbar spine and 0.891+/-0.119 g/cm(2) in total femoral region. The percentages of annual and total BMD losses in women between 30 and 80 years of age were 0.74 and 29% at spinal level and 0.65 and 26% in femoral region, respectively. The average BMD of the normal men's group between 20 and 39 years of age was 0.996+/-0.111 g/cm(2) in the lumbar spine and 1.025+/-0.110 g/cm(2) in femoral region. The percentages of annual and total BMD losses were 0.33 and 13% at spinal level and 0.50 and 20% in femoral region, respectively. In conclusion, like the values reported from mid-Anatolian region of Turkey, the BMD values of Turkish women and men residing in Izmir, western Anatolia, are also lower than in most European countries with regard to US and preinstalled Hologic values.

Lung parenchyma changes in ankylosing spondylitis: demonstration with high resolution CT and correlation with disease duration.

OBJECTIVE: To analyze the spectrum of the lung parenchyma changes in ankylosing spondylitis (AS) with high resolution computed tomography (HRCT) and correlate the findings with disease duration. MATERIAL AND METHODS: Twenty patients (18 male, 2 female) with the diagnosis of AS according to New York criteria were included in the study. None of the patients had history of tuberculosis, prolonged inorganic dust exposure and hospitalization for pneumonia. Seven of the patients were smokers, three patients were ex-smokers, and 10 patients were nonsmokers. The patients were assigned to three groups depending on disease duration. Group 1: patients with disease duration or=6 years but or=11 years (N: 12 patients). HRCT and pulmonary function tests (PFT) were performed in all patients. RESULTS: HRCT demonstrated pathology in 17 patients (85%). Two patients in group 1, 4 patients in group 2 and 11 patients in group 3 had pulmonary parenchyma changes. Emphysema (9/20), septal thickening (9/20) and pleural thickening (9/20) were the most common changes followed by nodule (8/20) and subpleural band formation (7/20). Three patients had apical fibrosis (AF). Septal and pleural thickening (both 4/10) were the most common changes when only nonsmokers were considered. Among nine patients with emphysema three were nonsmokers. CONCLUSION: There is a wide spectrum in pulmonary parenchyma changes in AS. These changes begin in early stages of the disease and increase with disease duration. Although smoking complicates the spectrum of changes in pulmonary parenchyma, they are predominately in the form of interstitial inflammation.

The relation between tooth loss and bone mass in postmenopausal osteoporotic women in Turkey: a multicenter study.

The purpose of this study was to investigate the associations of tooth loss with skeletal bone mass, years since menopause, educational level, current smoking status, dietary calcium intake, and number of pregnancies in postmenopausal osteoporotic women in Turkey. The study population consisted of 1171 postmenopausal women aged 40-86 years (mean age, 61.19 +/- 7.28 years). A detailed history was obtained from all women, including relevant lifestyle parameters, risk factors, and measurements of weight and height. Women were separated into three groups according to the number of teeth remaining as group 1 (edentulous, 457 women), group 2 (10 or fewer teeth, 232 women), and group 3 (more than 10 teeth remaining, 482 women). There was no significant difference among the three groups in mean age and menopausal age ( P < 0.05). Body mass index of group 1 was significantly higher than that of group 2 ( P< 0.01). Educational level was significantly different between three groups: groups 1 and 2 ( P< 0.001), groups 1 and 3 ( P< 0.0001), and groups 2 and 3 ( P< 0.001). Educational level was lowest in group 1 and highest in group 3. Despite a low ratio of cigarette smoking in general, a smoking habit was most prevalent in group 3 and least in group 2. The ratio of women receiving adequate calcium was significantly lower in group 1 than in other groups ( P< 0.001); mean calcium intake was similar in all groups. The number of pregnancies was significantly higher in group 1 than in other groups ( P< 0.001). Lumbar bone mineral density (BMD) of group 1 was significantly lower than that of groups 2 and 3 ( P< 0.001). Although no significant difference was found between groups 1 and 3, femoral neck BMD of group 2 was less than in others, and differences between groups 1 and 2 and between groups 2 and 3 ( P< 0.001) were significant. Lumbar bone mineral content (BMC) of group 1 was significantly lower than that of groups 2 and 3 ( P< 0.001), and lumbar BMC in group 2 was significantly higher than in group 3 ( P< 0.05). Femoral neck BMC in group 1 was significantly higher than in groups 2 and 3 ( P< 0.001). In conclusion, lumbar BMD and BMC in the edentulous group were significantly lower, whereas femoral neck BMD and BMC were significantly higher in edentulous group compared with the others. Our findings indicated that improvement in lifestyle factors and nutritional strategies for the treatment and prevention of osteoporosis may have additional benefit in reducing tooth loss.

Technetium-99m human immunoglobulin scintigraphy in patients with adhesive capsulitis: a correlative study with bone scintigraphy.

Adhesive capsulitis (AC) is a disorder that is characterized by shoulder pain and progressive limitation of both active and passive shoulder motion. Although the underlying pathological mechanisms of the disease are not well understood, the inflammatory reactions depending on the stage have been demonstrated histologically. The purpose of the study is to investigate the inflammatory changes that can be demonstrated with Tc-99m HIG in AC, and to determine the presence of correlations between scintigraphic findings and the clinical assessment. Twenty-one patients (12 females and 9 males) with a mean age of 50.57+/-8.49 were included in the study. AC was diagnosed according to recognized criteria. The planar X-ray images of the affected shoulders of all patients were normal. The patients were evaluated with the Constant Scoring System, and the functional and pain assessment parts of the American Shoulder and Elbow Surgeons' Form (ASES). Three phase bone scans and Tc-99m HIG scintigraphy were performed at least two days apart. Bone scan and Tc-99m HIG scintigraphy were evaluated visually and HIG uptake was evaluated in comparison with the contralateral normal shoulder. Bone scan demonstrated hypervascularity in 9 of the 21 patients (43%), whereas increased osteoblastic activity was detected in 19 (90%) in the affected shoulder. Tc-99m HIG uptake was positive in 12 (57%), and negative in 9 (43%) patients. All patients with increased Tc-99m HIG accumulation in the affected shoulder, also had increased osteoblastic activity on Tc-99m bone scintigraphy. A significant correlation was found between HIG uptake and constant, functional and pain scores. The difference between these scores was also statistically significant in patients with HIG positive and negative uptake. This study indicates that there is a good correlation between Tc-99m HIG scan findings and clinical scores. Tc-99m HIG accumulation in the affected shoulder may be related to continuing inflammatory reaction to AC. Tc-99m HIG scan may be a noninvasive, complementary method for demonstrating continuing inflammatory changes and may help in staging the disease.

Efficacy of two forms of electrical stimulation in increasing quadriceps strength: a randomized controlled trial.

OBJECTIVE: To investigate whether electrical stimulation is effective in improving quadriceps strength in healthy subjects and to compare interferential and low-frequency current in terms of the effects on quadriceps strength and perceived discomfort. DESIGN: Randomized, controlled study. SETTING: Physical Medicine and Rehabilitation Department in a university hospital. SUBJECTS: Thirty medical faculty students, divided into three groups, participated in the study. INTERVENTIONS: Group A received electrical stimulation with bipolar interferential current while group B received electrical stimulation with low-frequency current (symmetrical biphasic). Group C served as the control group. Electrical stimulation was given for 15 minutes, five days a week for three weeks, at a maximally tolerated intensity with the knee fully extended in the sitting position. MAIN OUTCOME MEASURES: Before and after the study, quadriceps strength was measured with a Cybex dynamometer isokinetically at the angular velocities of 60 degrees/s and 120 degrees/s. The perceived discomfort experienced with each type of electrical stimulation was quantified by the use of a visual analogue scale (VAS). RESULTS: Statistically significant increase in isokinetic strength was observed after training in group A and group B. Increase in strength did not differ between the stimulation groups. No significant change in strength occurred in group C. Perceived discomfort by the stimulation groups was not significantly different. CONCLUSION: Both interferential and low-frequency currents can be used in strength training with the parameters used in this study.

Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises.

OBJECTIVE: To assess the effect of nerve and tendon gliding exercises in carpal tunnel syndrome. DESIGN: The study was a prospective, randomized, before-and-after treatment trial. A total of 28 patients with the diagnosis of carpal tunnel syndrome in 36 hands were randomly assigned to two groups. A custom made neutral volar wrist splint was given to group 1 and group 2. The patients were instructed to wear the splints all night and during the day as much as possible for 4 wk. The patients in group 2 were also instructed to perform series of nerve and tendon gliding exercises in addition to the splint treatment. Patients were evaluated with clinical parameters, a functional status scale, and a symptom severity scale. RESULTS: At the end of treatment, statistically significant improvement was obtained in all parameters in both groups. The improvement in group 2 was slightly greater, but the difference between the groups was not significant, except for the lateral pinch strength value. Patient satisfaction was investigated during the follow-up period, ranging from 5 to 11 mo, with a mean of 8 mo. A total of 72% of the patients in group 1 and 93% of the patients in group 2 reported good or excellent results. The difference between the two groups was not statistically significant. CONCLUSION: Although the results in group 2 were better than group 1, the difference was not statistically significant. Further investigations are required to establish the role of nerve and tendon gliding exercises in the treatment of carpal tunnel syndrome.