The Effectiveness of Dry Needling and Exercise Therapy in Patients with Dizziness Caused By Cervical Myofascial Pain Syndrome; Prospective Randomized Clinical Study.

Objective: The aim of this study is to compare the effectiveness of dry needling therapy combined with exercise and exercise treatment alone for alleviating the dizziness caused by cervical myofascial pain syndrome. Design: This was a prospective randomized clinical study that included 61 women who had dizziness and myofascial trigger points on the neck muscles. The patients were randomized into a dry needling + exercise group (N = 31) and an exercise only group (N = 30). Results: The mean age of the patients (±SD) was 38.4 ± 8.3 years. The intragroup comparisons of the severity of neck pain, algometric measurement, number of dizziness attacks per week, severity of the dizziness, fall index, and the Dizziness Handicap Inventory were improved in both groups at the first and fourth months (P < 0.05). The intergroup comparisons of the severity of neck pain, algometric measurement, number of dizziness attacks per week, the severity of the dizziness, and the Dizziness Handicap Inventory were more improved in the dry needling + exercise group at the first or fourth month compared with their inital assessments (P < 0.05). There was no diffence in fall index scores between the groups (P > 0.05). Conclusions: Both dry needling + exercise therapy and exercise therapy alone were effective in treating dizziness caused by cervical myofascial pain syndrome. However, dry needling + exercise treatment was superior to exercise treatment alone.

Effects of whole body vibration training on isokinetic muscular performance, pain, function, and quality of life in female patients with patellofemoral pain: a randomized controlled trial.

OBJECTIVES: To investigate the effects of whole body vibration (WBV) training on isokinetic muscular performance, pain, function, and quality of life in patients with patellofemoral pain (PFP). METHODS: Forty women with PFP were included in this study and assigned to either a WBV group that received WBV training plus home exercise or a control group that performed home exercise only. A supervised WBV training was performed in 24 sessions on a synchronous vertical vibration platform three times a week for eight weeks. The home exercise program in the control group was identical to that in the WBV group. Isokinetic measurements were performed at baseline and post-treatment. In addition, patients were assessed after 6 months using a visual analog scale (VAS), Kujala Patellofemoral Score (KPS), and Short Form-36 (SF-36). RESULTS: Total work of knee extensors and VAS improved significantly post-treatment in the WBV group compared to the control group (P=0.041, P=0.003, respectively). However, there was no significant difference between groups at the 6-month follow-up (P>0.05). CONCLUSIONS: The present findings recommended that eight weeks of WBV training plus home exercise can more effectively reduce pain and improve the endurance of the knee extensors than that of home exercise of patient with PFP.

Therapeutic efficacy of three hyaluronic acid formulations in young and middle-aged patients with early-stage meniscal injuries.

[Purpose] To investigate and compare the efficacy of three hyaluronic acid formulations in patients with early-stage meniscal injuries. [Subjects and Methods] Male and female patients who were admitted to our clinic between January 2013 and December 2013, diagnosed with early-stage meniscus lesions of the knee, and given a hyaluronic acid treatment were included in this retrospective study. Patients were categorized into 3 groups according to their treatments: MONOVISC, OSTENIL PLUS, or ORTHOVISC. Scores from a Visual Analog Scale and the Western Ontario and McMaster Universities Arthritis Index were evaluated at baseline and one, three, and six months after baseline. [Results] A total of 55 patients were included in this study. Most of the patients were female (55%), and the mean age of the patients was 42.4 (± 8.1) years. Based on the pre- and post-injection data, there was significant reductions both in the Visual Analog Scale score and the Western Ontario and McMaster Universities Arthritis Index score after the injections for all groups. According to intergroup comparisons, no significant difference was observed in terms of efficacy. [Conclusion] Three hyaluronic acid formulations produced a similar efficacy in patients with meniscal injuries, and further studies are needed to evaluate long-term results.

Effect of platelet concentration on clinical improvement in treatment of early stage-knee osteoarthritis with platelet-rich plasma concentrations.

[Purpose] To compare two platelet-rich plasma kits with different platelet concentrations for treatment of knee osteoarthritis. [Subjects and Methods] Male and female patients with knee osteoarthritis who had confirmed diagnosis with X-ray and magnetic resonance imaging were included in this retrospective study. Eligible patients were divided into two groups: Group I, which received platelet-rich plasma kit I, and Group II, which received platelet-rich plasma kit II. Platelet concentrations of both kits were measured by manual counting. For each group, platelet-rich plasma kit was injected twice with a one-month interval between injections. The Western Ontario and McMaster Universities Osteoarthritis Index and the Visual Analog Scale were applied for clinical evaluation before the first injection and one, three and six months after the second injection. [Results] Kits I and II contained 1,000,000 and 3,000,000 platelets/µl respectively. In both groups, initial Western Ontario and McMaster Universities Osteoarthritis Index and Visual Analog Scale scores were significantly higher compared to the latter evaluations. However, no significant difference was observed between groups in terms of clinical evaluations. [Conclusion] Similar clinical results were found in groups receiving different platelet concentrations, therefore, a concentration of 1,000,000 platelet/µl is considered sufficient for pain relief and functional recovery.

Efficacy of single-dose hyaluronic acid products with two different structures in patients with early-stage knee osteoarthritis.

[Purpose] There are many types of hyaluronic acid preparations, but no clear data are available about which preparations is more effective. The aim of this trial was to investigate the effectiveness of different types of hyaluronic acid preparations on pain and function of inpatients with knee osteoarthritis. [Subjects and Methods] All patients were diagnosed by clinical examination and x-ray. Ostenil PLUS® was injected into 28 patients (group 1, 1.6 million daltons), and MONOVISC® (group 2, 2.5 million daltons) was injected into 46 patients. Demographic data and Western Ontario and McMaster Universities Osteoarthritis Index and Visual Analog Scale scores were used for clinical evaluation at 1, 3, and 6 months post injection. [Results] In both groups, baseline Ontario and McMaster Universities Osteoarthritis Index and Visual Analog Scale scores were higher compared with those in subsequent evaluations. Based on the pre- and post-injection data, a significant reduction in all scores was observed after the injections for in both groups. According to intergroup comparisons, there was no significant difference in any of the scores between the two groups. [Conclusion] There were no difference in Ontario and McMaster Universities Osteoarthritis Index and Visual Analog Scale scores in patients with knee osteoarthritis injected with two different hyaluronic acid structures in short-term preparations.

Evaluation of personality profile in patients with fibromyalgia syndrome and healthy controls.

OBJECTIVES: Fibromyalgia syndrome (FMS) is associated with widespread musculoskeletal pain disorder characterized by various symptoms. Our aim was to compare the personality profiles and psychological aspects between FMS patients and control subjects. Additionally, we evaluated the FMS symptoms, pain and functional status. A total of 72 female patients with FMS and 64 age- and sex-matched healthy controls were included. METHODS: Visual Analog Scale (VAS), to assess pain and sleep quality, and Fibromyalgia Impact Questionnaire (FIQ), to evaluate the functional status, were used in both groups. We assessed the psychological status with Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and the personality profiles were evaluated with Minnesota Multiphasic Personality Inventory (MMPI). RESULTS: Total BDI and BAI scores of FMS patients were higher than control subjects (p < 0.01, p < 0.01). In terms of psychopathology, hysteria parameters of MMPI were significantly higher in FMS. MMPI parameters except lie, infrequency, masculinity femininity and hypomania parameters (p > 0.05) were significantly higher in FMS group than the control group. CONCLUSIONS: The results of the present study suggest that there is a relationship between the psychological state and personality characteristics in FMS. Much more research is needed to better define the role of personality characteristics in the pathogenesis and symptoms of FMS.

Evaluation of the effectiveness of an aerobic exercise program and the personality characteristics of patients with fibromyalgia syndrome: a pilot study.

[Purpose] The aim of this study was to assess the effectiveness of a 6-week aerobic exercise program on pain, physical function, and psychological status, and to evaluate the personality characteristics of fibromyalgia syndrome (FMS) patients. [Subjects and Methods] Fourteen women with FMS were enrolled. They were trained for a 6-week home-based aerobic exercise program. The Fibromyalgia Impact Questionnaire, the Beck Depression Inventory, the visual analog scale of pain and sleep quality were measured at baseline and at the end of week 6. The personality profiles were evaluated using the Minnesota Multiphasic Personality Inventory (MMPI). [Results] After the exercise program, significant improvements were determined in pain, sleep quality, physical function, depression and FMS symptoms compared to baseline. In addition, the hysteria item (71.21±8.84) of the MMPI was significantly higher in FMS. [Conclusion] Our findings indicate that home-based aerobic exercise may be a useful treatment in the management of FMS. Personality characteristics should be considered during the planning process of the treatment of FMS. Personality is a filter between life events and psychological responses. It is defined to be the integration of effective and behavioral patterns. Long-term studies involving larger clinical samples are needed to define the role of personality characteristics in FMS.

Comparison of patients with different pathologies in terms of shoulder protraction and scapular asymmetry.

[Purpose] The aim of this study was to compare cases with different shoulder and cervical pathologies in terms of shoulder protraction and scapular asymmetry. [Methods] A total of 216 patients, aged between 30-70 years, were included, 108 of which were in the patient group (subacromial impingement, rotator cuff problems, adhesive capsulitis, disc herniations) and 108 of which were in the control group. The control group consisted of cases with no prior neck and shoulder problems or pain. Pain was evaluated using the visual analogue scale (VAS); the asymmetry of scapula was evaluated using the Lateral Scapular Slide Test (LSST) with two additional positions; and the protraction of the scapula was evaluated using the shoulder protraction test. [Results] According to the data obtained, the affected side scapular asymmetry and protraction in the patient group were significantly greater than in the control group. When the patient groups were compared in terms of different pathologies, there were no differences between scapular asymmetry and shoulder protraction. [Conclusion] In conclusion, the pathologies of the neck and shoulder were found to cause scapular asymmetry and shoulder protraction. However, patients with different pathologies had similar scapular asymmetry and shoulder protraction.

Which high-intensity interval training program is more effective in patients with coronary artery disease?

The aim of the study is to examine high-intensity interval training (HIIT) programs and a moderate-intensity continuous training (MICT) program, which are frequently used in cardiac rehabilitation programs in terms of their effects on the functional capacity and quality of life of patients with coronary artery disease (CAD). The study included 20 patients with CAD (mean age, 60.95 ± 5.08 years) who had undergone revascularization surgery. The participants were randomized into HIIT-short, HIIT-long, and MICT groups. All the groups participated in a 24-session exercise-based cardiac rehabilitation program. The participants' exercise capacity was evaluated using the maximal exercise test and estimated VO2max values, functional capacity using the 6-min walk test (6MWT), and quality of life using the Short Form-36 survey and MacNew Heart Disease Health-related Quality of Life (MacNew) questionnaire. It was determined that the estimated VO2max values statistically significantly improved after treatment (P < 0.05), and both HIIT groups were superior to the MICT group (P < 0.05). Only the HIIT groups achieved the minimal clinically important difference in the 6MWT distance. After treatment, only the MICT group had a statistically significant improvement in quality of life. There was no statistically significant difference between the groups in relation to the improvement in the 6MWT distance and quality of life (P > 0.05). The results of our study showed that both HIIT programs were superior to MICT in improving the maximal exercise capacity of patients with CAD, and the three programs had a similar effect on quality of life.

Caudal epidural steroid injection for chronic low back pain: A prospective analysis of 107 patients.

BACKGROUND: Low back pain affects 80% of people worldwide at least once in a lifetime and reduces the quality of life and causes absence from work. OBJECTIVE: To evaluate the pain and functional status of patients with lumbar disc disease who received blind caudal epidural injections (CEI) for pain relief. METHODS: The records of 107 patients who had been given CEI between September 2017 and January 2018 were retrospectively analyzed. The inclusion criteria were age > 18 years, > 3-month history of low back pain, and diagnosis of lumbar disc disease by magnetic resonance imaging. The epidural injection solution consisted of 2 mL of betamethasone sodium and 8 mL saline. Follow-up examinations were conducted 3 and 6 months post-injection and the patients were evaluated using a visual analog scale (VAS) and the Oswestry Disability Index (ODI). RESULTS: The most common disc pathology was at the L4-L5 level. The VAS and ODI scores indicated significantly reduced pain at 3 and 6 months compared with the pre-injection baseline. Two patients experienced total anesthesia and paresis of the lower limbs, but recovered fully after 2 weeks. Blood was aspirated during the injection in two patients, but second-attempt injections were successful in both cases. No other complications were observed. CONCLUSION: Our results suggest that the blind method is safe for administering CEI to patients with chronic low back pain in the absence of radiological screening and results in significant pain relief with improved functional capacity.

Turkish version of health care providers' pain and impairment relationship scale: Reliability and validity.

PURPOSE: To develop the Turkish version of the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS-TR) by conducting the linguistic and cultural adaptation and to examine the psychometric properties and reliability of the adapted version. METHODS: A double back-translation procedure was used to translate the questionnaire. Participants received an online survey package with the HC-PAIRS-TR, the Turkish version of Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT-TR), and Turkish Version of the Tampa Scale for Kinesiophobia (TSK-TR). Cronbach's alpha coefficient and item analysis were used to evaluate internal consistency. Intraclass correlation coefficient (ICC) was used to determine the test-retest reliability. Confirmatory factor analysis (CFA) and Rasch Analysis were performed. RESULTS: The study was conducted with 153 physiotherapists practicing in Turkey. Cronbach's alpha was 0.81. Test-retest reliability was high (ICC = 0.85, p < 0.001), the standard error of measurement was 4.96 (0.94% of mean), and minimal detectable change was 13.75 (26.06% of mean). HC-PAIRS-TR scores correlated significantly with scores for the biomedical factor of the PABS-PT-TR (r = 0.52, p = 0.00), biopsychosocial factor of PABS-PT-TR (r = 0.32, p = 0.00), and TSK-TR (r = 0.52, p = 0.00). According to CFA and Rasch Analysis, the 12 items version of HC-PAIRS-TR fits the one-factor model excellently. CONCLUSION: The HC-PAIRS-TR appears to be a reliable and valid questionnaire to measure Turkish physiotherapists' beliefs and attitudes about the relationship between low back pain and impairment. Future studies might be planned to validate this questionnaire for other health care providers.

Comparison of the effectiveness of radial extracorporeal shock wave therapy and supervised exercises with neuromuscular inhibition technique in lateral epicondylitis: A randomized-controlled trial.

OBJECTIVES: The aim of this study was to evaluate and compare the effects of radial extracorporeal shock wave therapy (rESWT) and supervised exercises with neuromuscular inhibition (NMI) technique in improving pain, function, and grip strength in the treatment of patients with lateral epicondylitis (LE). PATIENTS AND METHODS: A total of 50 patients with LE (11 males, 30 females; median age: 46 years; range, 23 to 57 years) whose symptoms persisted for at least three months between February 2015 and August 2015 were included in the prospective, randomized-controlled, clinical study. The patients were divided into two groups as the rESWT group (n=25) receiving a total of three rESWT sessions (once per week with 1.8 bar pneumatic pressure, 10 Hz frequency, and with 2,000 pulses) and the exercise group (n=25) receiving supervised exercises with NMI (three times per week for three weeks). Pain and function were evaluated using Visual Analog Scale, the total Patient-Rated Tennis Elbow Evaluation, the Roles and Maudsley score, while the grip strength was evaluated using a hand dynamometer at one and three months after treatment compared to baseline. RESULTS: A significant improvement was observed in all outcome criteria at one and three months after treatment, compared to baseline, in both the rESWT and exercise groups (p<0.05). There was no significant difference in terms of the changes in the outcome criteria between the groups (p>0.05). CONCLUSION: The rESWT seems to provide no significantly superior benefit than supervised exercises with NMI at least until the three months in the treatment of LE.

The Efficiency of Manual Therapy and Sacroiliac and Lumbar Exercises in Patients with Sacroiliac Joint Dysfunction Syndrome.

BACKGROUND: Manual therapy, exercise therapy, and the combination of these 2 are common treatments for sacroiliac joint dysfunction syndrome. The effects of these treatments have been discussed in several studies; the superiority of one over the other for patients with sacroiliac joint dysfunction syndrome is still the subject of discussion. OBJECTIVE: This study aims to assess the effects of manual therapy for sacroiliac joints, sacroiliac joints home-based exercises, and home-based lumbar exercises. STUDY DESIGN: A comparative, prospective, single-blind, randomized, controlled trial. SETTING: This trial was conducted at a single center at the Istanbul University, Istanbul Medical Faculty, Department of Physical Medicine and Rehabilitation. METHODS: Within the scope of this study, 69 women diagnosed with sacroiliac joint dysfunction syndrome through specific sacroiliac joints clinical diagnostic tests were randomized into 3 groups. The first group was assigned manual therapy and a sacroiliac joints home-based exercise program (n = 23), the second group was assigned sacroiliac joints manual therapy and a home-based lumbar exercise program (n = 23), and the third group was assigned a home-based lumbar exercise program (n = 23). All patients who participated in the study were evaluated at the beginning of the study and on the twenty-eighth and ninetieth day. RESULTS: All 3 groups showed a significant decrease in the sacroiliac joints -related pain parameter, which is checked with the visual analogue scale (P < 0.05) after the treatment. The Gillet test, Vorlauf test, Posterior Shear test, Compression test, and irritation Point tests after the treatment yielded a significant (P < 0.05) negative trend in all groups. Short Form-36 health survey for screening form, Modified Oswestry Pain Questionnaire, and Douleur Neuropathique 4 questions patient interview questionnaire for the assessment of neuropathic pain forms revealed a significant (P < 0.05) improvement in patients' complaints after the treatment in all 3 groups. Significant improvement in patients with sacroiliac joint dysfunction syndrome in all 3 groups was identified after the treatment. LIMITATION: The absence of a healthy control group is one of the important limitations of the study. CONCLUSIONS: Manual therapy is effective in the long term in sacroiliac joint dysfunction syndrome. Adding specific exercises for sacroiliac joints to the sacroiliac joints manipulation treatment further increases this effectiveness.

Does pain neuroscience education improve pain knowledge, beliefs and attitudes in undergraduate physiotherapy students?

BACKGROUND: To evaluate the effect of a brief pain neuroscience education (PNE) session on physiotherapy students' knowledge of pain and their beliefs and attitudes about the treatment of patients with chronic low back pain. METHODS: This study was a single-center, cross-sectional study including 205 physiotherapy undergraduate students. The participants completed the Neurophysiology of Pain Questionnaire (NPQ) and Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). They then received a 70-min neuroscience education session covering the mechanisms and biopsychosocial aspects of chronic low back pain. The questionnaires were readministered immediately after the educational session and at 6 months posteducation. RESULTS: Our analysis included data from 156 participants (mean age: 20.9 ± 2.51, 69.8% women) who completed the questionnaires pre-, post-, and 6 months after the educational session. To assess the effect of the education on the scores of the questionnaires, a repeated-measures ANOVA was conducted. There was a significant interaction observed for NPQ over time (p = 0.00; η 2  = 0.654), for PABS-PT factor 1(p < 0.001; η2 = 0.50) and for PABS-PT factor 2 over time (p = 0.02; η 2  = 0.04) CONCLUSION: This study showed that a 70-min session of PNE improves the level of pain knowledge in undergraduate physiotherapy students and influences their beliefs and attitudes concerning chronic low back pain. These findings suggest that adding PNE to the curricula of physiotherapy and rehabilitation programs may be beneficial.

Evaluation of Online Education Provided to Students During the COVID-19 Pandemic: A University Experience.

AIM: In this study, it was aimed to evaluate the online education provided to students during the COVID-19 pandemic. METHOD: The research was carried out with 841 students studying for undergraduate and associate degrees in a health sciences university. The research was designed with qualitative and quantitative features using a mixed method. In the quantitative phase, an online questionnaire consisting of eight questions covering socio-demographic data and experiences in the COVID-19 process was used. In the qualitative phase, in-depth interviews were conducted online using a semi-structured interview form. The qualitative design was carried out and reported in accordance with the criteria of "COnsolidated criteria for REporting Qualitative research (COREQ)." RESULTS: Of the students who responded, 75.5% (n = 635) stated that they attended 76-100% of the total number of courses, and 56.1% of them stated that the efficiency of their lessons was over 50%. The analysis of the data was done manually according to Heidegger philosophy, in accordance with the steps of the data analysis method of Colaizzi (1978). As a result of the content analysis, three main themes and 21 categories were determined. The following themes were achieved: "Better than nothing!" for positive aspects of students' experiences, "Face-to-face education is better!" for negative aspects, and "It could have been better!" for their suggestions. CONCLUSION: It has been determined that the contents of distance education in health sciences for theoretical and applied courses should be further developed with a technological approach.

A spontaneous cervical spinal epidural hematoma in a male patient receiving treatment for acute coronary syndrome: A case report.

Although spontaneous spinal epidural hematoma is a rare entity with an unknown origin, it may occur secondary to the use of anticoagulant and/or antiplatelet agents, which are particularly used for the treatment of cardiovascular and cerebrovascular diseases. Since it occurs rarely and its initial symptoms are usually non-specific, early and accurate diagnosis can be challenging which affects survival rate and the quality of life. Herein, we present a 65-year-old male case who developed acute severe neck pain and headache on the third day of acute coronary syndrome treatment, followed by neurological deficits in bilateral upper and lower extremities.

A study on the validity and reliability of the Turkish version of the Clinical Chronic Obstructive Pulmonary Disease Questionnaire.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressive disease negatively affecting health-related quality of life. The related scales in Turkish are limited in number and generalizability. OBJECTIVE: To perform validity and reliability studies of the Turkish version of the Clinical Chronic Obstructive Pulmonary Disease Questionnaire (CCQ). METHODS: This study was conducted at the Department of Chest Diseases, with 100 volunteer COPD patients with a mean age of 67.72 ± 9.78 years. After obtaining the necessary permission, translation procedures were applied for Turkish cultural adaptation. Finally, a single Turkish translation was created, and this questionnaire was evaluated by linguists. Incomprehensible items were corrected in a pilot study. Baseline and test-retest measurements after two weeks were performed. Internal consistency analysis was made for validity, and correlations were calculated with the 36-Item Short Form Health Survey (SF-36), the modified Medical Research Council (mMRC) Dyspnea Scale and Respiratory Function Tests (RFTs). RESULTS: Cronbach's alpha value was found to be 0.90 for the first obtained data and 0.91 for the second obtained data. There was similarity at the rate of 0.97 between the first and second measurements in terms of total scores of the CCQ. The questionnaire significantly correlated with the SF-36, mMRC and RFTs (-0.85 ⩽r⩽ 0.69, p< 0.05). CONCLUSIONS: As a result of this study, the Turkish version of CCQ was determined to be reliable and valid. The CCQ is an easy-to-use questionnaire in terms of application-calculation and can be safely used for the clinical assessment and monitoring of patients.

The immediate effect of neurodynamic techniques on jumping performance: A randomised double-blind study.

BACKGROUND AND OBJECTIVES: Neurodynamic techniques are used to restore neural functions. However, there are few studies about the effects on performance. The aim of this study was to investigate the immediate effects on vertical jumping (VJ) and horizontal jumping (HJ) of 2 different tension loading techniques applied to young adults. MATERIAL AND METHOD: In this randomised double-blind study, a total of 68 participants with a mean age of 21.31 ± 1.21 years were separated into 2 groups using the closed envelope system: the femoral nerve mobilization (FNM) group and the sciatic nerve mobilization (SNM) group. The FNM and SNM techniques were applied as 2 seconds stretching with 2 seconds resting for 10 repetitions. The VJ and HJ performance of the participants was evaluated before and after the interventions by a researcher blinded to the groups. RESULTS: The mean VJ performance before and after interventions was measured as 34.56 ± 7.80 cm and 35.89 ± 8.15 cm in the FNM group (p< 0.05) and 31.74 ± 8.31 cm and 32.76 ± 8.45 cm in the SNM group (p< 0.05). The effects of the techniques on HJ performance were not statistically significant (p> 0.05). There was no superiority between the techniques (p> 0.05). CONCLUSION: The neurodynamic techniques were found to provide an immediate increase in VJ performance. Neurodynamic techniques are generally used in patient populations to improve treatment outcomes. According to these study results, neurodynamic techniques can be safely used to provide an immediate increase in performances of individuals with no lower extremity problems.

Evaluation of needle positioning during blind intra-articular hip injections for osteoarthritis: fluoroscopy versus arthrography.

UNLABELLED: Diraçoglu D, Alptekin K, Dikici F, Balci HI, Ozçakar L, Aksoy C. Evaluation of needle positioning during blind intra-articular hip injections for osteoarthritis: fluoroscopy versus arthrography. OBJECTIVE: To evaluate needle positioning during blind/anatomically referenced hip joint injections for osteoarthritis (OA). DESIGN: Experimental clinical study. SETTING: Operating theater of a university hospital. PARTICIPANTS: Patients (N=16) (10 women, 6 men), who were diagnosed as having OA according to the American College of Rheumatology criteria and whose radiologic grades were II or III according to Kellgren-Lawrence. INTERVENTIONS: Three bilateral and 13 unilateral hip injections were performed (3 times at 1-week intervals). After it was presumed blindly that the needle was within the joint, the location of the needle was checked with backflow technique and fluoroscopy. Entrance to the joint cavity was also ensured by reconfirmation with contrast medium, and the procedure was then terminated with hyaluronic acid injection. MAIN OUTCOME MEASURES: Assessment of blind needle placement into the hip joint by using backflow technique, fluoroscopic images, and contrast enhancement. RESULTS: The location of the needle was fluoroscopically confirmed to be at the proper position in 38 (66.7%) of the 57 blind interventions. Furthermore, in 29 (76.3%) of those 38 interventions, localization of the intra-articular needle could be confirmed by intra-articular contrast uptake. Overall, 29 of 57 (50.9%) blind interventions exhibited intra-articular contrast enhancement. Backflow was not observed in 23 (79.3%) of these 29 interventions. Five (17.9%) of 28 interventions with no contrast uptake showed backflow. CONCLUSIONS: In light of our results, we suggest that blind injection of the osteoarthritic hip joint can be inaccurate even with careful technique. Further, the backflow method does not appear to be reliable, and guidance during the injection seems to be necessary.

Effect of aerobic exercise training on oxygen uptake and kinetics in patients with fibromyalgia.

The aim of this study is to investigate relation between cardiopulmonary performance and muscular microcirculation in patients with fibromyalgia syndrome (FMS). Twenty-one female sedentary patients who were diagnosed as FMS, and 15 sedentary females were enrolled in to the study. All participants underwent a modified Bruce multistage maximal treadmill protocol with metabolic measurements and Near-Infrared Spectroscopy measurements. Exercise sessions were performed 3 times a week for 8 weeks. The results of the study suggest that cardiopulmonary system in charge of delivering oxygen to whole body and muscular microcirculation may have dysfunction in patients with FMS.