The reliability and validity of The Turkish version of Multidimensional Fatigue Inventory-20 for the evaluation of different dimensions of fatigue in patients with fibromyalgia.

OBJECTIVES: In this study, we aimed to evaluate the validity and reliability of the Multidimensional Fatigue Inventory-20 (MFI-20) for Turkish patients with fibromyalgia (FM). PATIENTS AND METHODS: Between February 2011 and September 2011, a total of 120 female patients (mean age 45±9.1 years; range, 20 to 60 years) admitted to our outpatient clinic with extensive pain and fatigue and diagnosed with FM according to 1990 and 2010 American College of Rheumatology criteria were included in this study. The MFI-20 was translated according to forward-backward translation procedure. For the test-retest reliability, the patients re-filled out the scale 48 hours after the first application. Structural validity was evaluated with confirmatory factor analysis (CFA). Reliability was assessed by internal consistency with Cronbach alpha and test-retest reliability was assessed by intra-class correlation coefficient (ICC). For convergent validity, Spearman rho correlation coefficient was used for relevance analysis with the Fatigue Impact Scale (FIS), visual analog scale (VAS)-pain, VAS-fatigue, and Short Form-36 (SF-36) questionnaires. RESULTS: The total Cronbach alpha coefficient was found to be 0.92 (range, 0.78 to 0.93). The CFA showed good structural validity and revealed five dimensions. The ICC coefficient was found to be 0.934. All correlation coefficients between the MFI and FIS were calculated as above 0.80, indicating a strong relationship. CONCLUSION: The results of this study show that the Turkish version of the MFI-20 has a high internal consistency and reasonable construct validity. It is a valid and reliable measurement of the assessment of fatigue in patients with FM multidimensionality.

Use of Shear Wave Elastography for Quantitative Assessment of Muscle Stiffness After Botulinum Toxin Injection in Children With Cerebral Palsy.

OBJECTIVES: This study aimed to investigate the stiffness of the gastrocnemius (GC) muscle with acoustic radiation force impulse (ARFI) elastography after botulinum toxin-A (BTX-A) injection in children with spastic cerebral palsy (CP) and to examine the relationship between elastographic and clinical parameters. METHODS: This prospective randomized single-blind controlled clinical study included 49 lower extremities of 33 children with spastic CP. They were randomized into 2 groups: group 1 (n = 25 extremities in 17 children) received BTX-A injection and a home-based exercise program; group 2 (n = 24 extremities in 16 children) received only a home-based exercise program. Patients were evaluated in pretreatment and posttreatment periods in the first and third months with ARFI elastography, the Modified Ashworth Scale, Modified Tardieu Scale, Pediatric Functional Independence Measure, Gross Motor Function Classification System, and goniometric range of motion measurement of the ankle. RESULTS: A statistically significant difference was found in elastography of the GC muscle in group 1 only at the first month after treatment (P < .05). No statistical difference was found in elastography of the GC after treatment in group 2. According to the Modified Ashworth Scale, Modified Tardieu Scale, and ankle passive range of motion, group 1 showed significant improvements after treatment (P < .05). Also, there was a significant correlation between these clinical parameters and elastographic measurements (P < .05). CONCLUSIONS: According to the results of this study, the measurements from ARFI elastography combined with clinical parameters might be useful for evaluation of spasticity after BTX-A treatment in children with CP. Also, they might be useful in distinguishing patients who will benefit clinically, especially in the early stages of treatment.

[Dermatomyositis presenting with low back pain]. / Bel agrisi ile basvuran dermatomiyozit olgusu.

Dermatomyositis (DM) is a rare connective tissue disease characterized by skin lesions and inflammatory changes observed in muscle biopsy findings. A definitive diagnosis of DM requires a characteristic rash in addition to proximal muscle weakness and muscle enzyme level elevation. DM is twice as common in women as men, with an age of onset of approximately 50 years. This case report describes a 29-year-old patient with low back pain and proximal muscle weakness in the legs diagnosed as lumbar disc herniation who was then referred by the neurosurgery department to our clinic. A physical examination revealed the characteristic skin lesions for dermatomyositis. Needle electromyography and a skin biopsy were performed, and corticosteroid treatment was initiated. In misdiagnosed patients, fatty infiltration in the muscles may cause irreversible weakness and gait disturbance. Early suppression of inflammation is important and can yield a dramatic response to treatment.

The Turkish League Against Rheumatism Recommendations for the Management of Hand Osteoarthritis Under Guidance of the Current Literature and 2018 European League Against Rheumatism Recommendations.

OBJECTIVES: This study aims to explore the accordance to the 2018 European League Against Rheumatism (EULAR) recommendations for the management of hand osteoarthritis (OA) among the Turkish League Against Rheumatism (TLAR) expert panel and composition of TLAR recommendations for the management of hand OA under guidance of the current literature. MATERIALS AND METHODS: The TLAR convener designated an expert panel of 10 physicians experienced in hand OA for this process. The 2018 EULAR recommendations for the management of hand OA and the systematic review of the literature were sent to the expert panel via e-mails. The e-mail process which included Delphi round surveys was completed. The EULAR standard operational procedure Appraisal of Guidelines for Research and Evaluation II was followed. The level of agreement was calculated for each item and presented as mean, standard deviations, minimum and maximum and comparisons of 2018 EULAR recommendations were performed. RESULTS: Five overarching principles and 10 recommendations were discussed. Revisions were held for the sixth, seventh, and ninth recommendations with lowest level of agreements. These recommendations were revised in accordance with suggestions from the experts and re-voted. The revised forms were approved despite the lack of statistically significant difference between these forms (p=0.400, p=0.451, p=0.496, respectively). Except for the ninth recommendation about surgery (p=0.008), no significant difference in level of agreements was observed between the EULAR and TLAR hand OA recommendations. The 11th recommendation about paraffin bath was added. CONCLUSION: The optimal treatment of hand OA consists of personalized non-pharmacological (self-management, exercise, splint), pharmacological (topical non-steroidal anti-inflammatory drugs as the first choice), and interventional procedures (only for refractory cases) based on shared decision between the patient and physician. TLAR hand OA recommendations were created mainly based on the most recent literature and the last EULAR hand OA management recommendations, which are widely approved among the TLAR experts.

[A rare cause of forearm pain: Schwannoma of the posterior interosseous nerve]. / Nadir görülen bir önkol agrisi nedeni: Posterior interosseöz sinir Schwannomu.

A schwannoma, also known as a neurilemoma, is composed of Schwann cells, and is the most common benign tumor of the peripheral nerves. It commonly appears as a solitary lesion in the head and neck region. The diagnosis is based on ultrasonography, magnetic resonance imaging, and histopathological examination. This encapsulated tumor has a good prognosis with a low recurrence rate after surgical removal. This case report is a description of a forearm schwannoma that initially appeared to be a ganglion cyst.

A rare cause of thigh pain: Morel-lavallée lesion.

Morel-Lavallée lesion is an unusual clinical entity which was first described by the French surgeon Maurice Morel-Lavallée in 1853. These lesions result from peeling off the surfaces between the fat tissue and the muscular fascia. During this decomposition, the rupture of small vessels may cause an effusion full of necrotic blood, lymph and fat cells. In prolonged cases, these lesions may become increasingly painful, leading to be confused with other diagnosis such as sciatalgia, piriformis syndrome, trochanteric bursitis or soft tissue tumor. Herein, we present a-65-year-old female case who had pain in the right thigh for one year and was referred to our clinic with radicular pain.

Medial calcaneal neuropathy: A rare cause of prolonged heel pain.

Pain heel constitutes 15% of foot pain. Pain may be caused by plantar fasciitis, calcaneal fractures, calcaneal apophysitis, heel pad atrophy, inflammatory diseases or related with nerve involvement. Tibial, plantar and/or medial nerve entrapment are the neural causes of pain. Most of the heel soft tissue sensation is provided by medial calcaneal nerve. Diagnosis of heel pain due to neural causes depends on history and a careful examination. Surgery should not be undertaken before excluding other causes of heel pain. Diagnosis should be reconsidered following conservative therapy.

Common Mistakes in the Dual-Energy X-ray Absorptiometry (DXA) in Turkey. A Retrospective Descriptive Multicenter Study.

BACKGROUND: Osteoporosis is a widespread metabolic bone disease representing a global public health problem currently affecting more than two hundred million people worldwide. The World Health Organization states that dual-energy X-ray absorptiometry (DXA) is the best densitometric technique for assessing bone mineral density (BMD). DXA provides an accurate diagnosis of osteoporosis, a good estimation of fracture risk, and is a useful tool for monitoring patients undergoing treatment. Common mistakes in BMD testing can be divided into four principal categories: 1) indication errors, 2) lack of quality control and calibration, 3) analysis and interpretation errors, and 4) inappropriate acquisition techniques. The aim of this retrospective multicenter descriptive study is to identify the common errors in the application of the DXA technique in Turkey. METHODS: All DXA scans performed during the observation period were included in the study if the measurements of both, the lumbar spine and proximal femur were recorded. Forearm measurement, total body measurements, and measurements performed on children were excluded. Each examination was surveyed by 30 consultants from 20 different centers each informed and trained in the principles of and the standards for DXA scanning before the study. RESULTS: A total of 3,212 DXA scan results from 20 different centers in 15 different Turkish cities were collected. The percentage of the discovered erroneous measurements varied from 10.5% to 65.5% in the lumbar spine and from 21.3% to 74.2% in the proximal femur. The overall error rate was found to be 31.8% (n = 1021) for the lumbar spine and 49.0% (n = 1576) for the proximal femur. CONCLUSION: In Turkey, DXA measurements of BMD have been in use for over 20 years, and examination processes continue to improve. There is no educational standard for operator training, and a lack of knowledge can lead to significant errors in the acquisition, analysis, and interpretation.

Do new diagnostic criteria for fibromyalgia provide treatment opportunity to those previously untreated?

BACKGROUND AND OBJECTIVES: It has been known that tender points detected by ACR 1990 criteria alone might not describe the essence of fibromyalgia, so preliminary diagnostic ACR 2010 criteria was developed. Since there has been no clear evidence exist examining the concordance rates and sensitivity to treatment of these two criteria comparatively, we aimed to shed light on this ambiguity. MATERIAL AND METHODS: [corrected] One hundred patients with widespread pain were studied. Fulfillment of both criteria was determined at baseline, at 3th and 12th months. Sensitivity and specificity values were identified. The relationship between Fibromyalgia Impact Questionnaire and components of two criteria was detected by pearson correlation. And the concordance rate was evaluated by kappa coefficient. RESULTS: At the 1st visit (baseline), two criteria were concordant in 48.5% (n=49) of cases (κ=0.43[95%CI.0.22,0.58]). However, the concordance was present in only 25(25%) of the subjects (κ=0.29[95%CI:0.12,0.36]) at the end of the study. After 1 year of follow-up, the sensitivity of ACR 2010 was higher than that of ACR 1990 (0.88; 0.56 respectively) (p< 0.05). CONCLUSION: ACR 2010 criteria is more sensitive than ACR 1990 both at first diagnosis and after 1 year of follow-up. So; it enables to diagnose and may give oppurtunity to treat more underdiagnosed FM patients.

A comparison of impact of fatigue on cognitive, physical, and psychosocial status in patients with fibromyalgia and rheumatoid arthritis.

This study was performed to compare the impact of fatigue on different aspects of quality of life in patients with rheumatoid arthritis (RA) and fibromyalgia syndrome (FM). This study involved subjects with FM (n = 45) and RA (n = 44). Impact of fatigue on physical, cognitive, and psychosocial status was measured with Fatigue Impact Scale (FIS) and health-related quality of life (HRQoL) with the Medical Outcome Study Short Form 36 (SF-36). Multiple regression analyses were used to evaluate impact of fatigue on quality of life by taking into account clinical symptoms and disease activity scores in these two patient groups. Although the severity of fatigue assessed by FSS was the same in FM and RA; according to Fatigue Impact Scale, fatigue has higher impact on cognitive function in FM (mean ± SD; 28.8 ± 19.9), and on the other hand, it has higher impact on mainly physical component (mean ± SD; 26.3 ± 4.9) in RA. Regarding all the clinical symptoms and disease activity scores, multiple regression models showed that fatigue together with pain affected the HRQoL (SF-36) in both patient groups. Fatigue has different impacts on QoL in FM and RA, respectively. Together with pain, fatigue lead FM patients to see disease as having worse health in terms of mental function, whereas it leads to poor health in terms of physical function in RA.

[Characteristics of pediatric hand injuries followed up in a hand rehabilitation unit]. / El rehabilitasyon ünitesinde izlenen el yaralanmali pediyatrik hastalarin özellikleri.

BACKGROUND: To establish the characteristics of patients in pediatric age who have been referred to hand rehabilitation center since 1998. METHODS: The patients were screened retrospectively and those within 0-16 age range were included into the study (178 patients; 126 males [70.8%], 52 females [29.2]; mean age 10.33+/-4.45; range 0 to 16 years). Demographic data, causes and locations of injury and follow-up period (week) were recorded. RESULTS: Mean duration of application for rehabilitation was 5.4+/-0.7 weeks. Only 99 (55.6%) patients could be followed-up for a period more than 4 weeks (20.8+/-22.2 weeks). Types of injuries were categorized as accidental (n=133; 74.7%), intentional (n=29; 16.3%) and congenital (n=15; 8.4%). Accidents were related to domestic (n=109; 61.2%) and environmental causes (n=53; 29.8%). The most frequent domestic accident was glass injury and fall accident. The regions in order of decreasing frequency were wrists, metacarpal bones, proximal phalanges, forearms, elbows, plexus, mid-phalanges, total hands, shoulders, total arm and bilateral hands. Fourth digit was the most frequently injured digit. The most common types of injuries were as followings: flexor tendon cut (44.5%), nerve cut and arterial injuries, fractures and burn contractures. CONCLUSION: Hand injuries occurred mostly in male children, the most frequent type injury was accidental domestic injury of the wrist flexor tendon caused by broken glass fragments and the most frequently injured digit was the 4th and adherence of the patients to the follow-up protocol was unsatisfactory since majority of referrals were out-of-towners.

Quality of life assessments with SF 36 in different musculoskeletal diseases.

The aim of this study is to evaluate comparatively the life quality of patients with knee osteoarthritis (KO), shoulder impingement syndrome(SIS), fibromialgia(FM), or osteoporosis(OP) using SF 36 and establish the impact of these diseases on quality of life (QoL). A total of 193 patients with one of the above-mentioned different diagnoses completed SF 36 scale. The diseases were compared to each other with SF 36 subgroups scores. There were significant differences among patients with KO and SIS, SIS and FM with respect to all SF 36 subgroups scores. According to these assessments, QoL of KO and FM patients was worst than that of SIS. The QoL scores of KO patients were worse than those of FM patients considering the physical function, while QoL scores of FM patients were lower than those of KO patients with respect to their general well-being. Scores of physical function and pain in KO patients were lower than those of OP patients. In domains of social functioning, emotional role, energy, pain, and general health condition QoL of FM patients was worse than that of OP patients. Quality of life of SIS patients was less affected than the patients of the other disease groups. In spite of their young age, FM patients appear to be the group with the worst quality of life scores.

[Demographic features and difficulties in rehabilitation in patients referred to hand rehabilitation unit for phalangeal fractures]. / El rehabilitasyonu için basvuran falanks kirikli hastalarin özellikleri ve rehabilitasyon sorunlari.

OBJECTIVES: We evaluated demographic and occupational features of patients with phalangeal fractures of the hand, etiologies and types of injuries, and the results of rehabilitation. METHODS: The study included 91 fingers of 62 patients (54 males, 8 females; mean age 28+/-13 years; range 4 to 59 years) who were referred to our hand rehabilitation unit for phalangeal fractures. Demographic features, the cause and localization of injury, the type of surgery, time from surgery to rehabilitation, and the follow-up period were determined. At the end of rehabilitation, range of motion (ROM) of the phalangeal joint and total ROM of the injured fingers were assessed using the Strickland-Glogovac rating system. RESULTS: A great majority of injuries were caused by work accidents, followed by sport injuries and falls occurring in students. Sixty patients (96.8%) were right-handed. The fractures occurred in the dominant hand in 29 patients (46.8%). The majority of patients (n=45) were primary school graduates. The most common mechanism of injury was accidents related to heavy work machinery (n=18). The most commonly injured finger and the phalanx were the third finger (n=25, 27.5%) and the proximal phalanx (n=59, 56.7%), respectively. Only 27 patients (43.6%) had a sufficient follow-up with a mean of 79.7+/-46.6 days (range 30 to 254 days). Following rehabilitation, the mean ROM and the total ROM were 45.0+/-22.9 degrees and 63.3+/-16.1 degrees for the injured joint and the thumb, and 31.3+/-22.5 degrees and 122+/-60.3 degrees for the injured joint and the other fingers, respectively. CONCLUSION: Our data provide important insight into appropriate treatment and rehabilitation of phalangeal fractures, in particular, shortcomings in the treatment and follow-up.