[Efficiency of TENS treatment in hemiplegic shoulder pain: a placebo controlled study]. / Hemiplejik omuz agrisinda TENS tedavisinin etkileri: plasebo kontrollü bir çalisma.

OBJECTIVE: To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) therapy on shoulder pain and upper extremity functions in hemiplegic patients. MATERIAL-METHODS: Total of 19 hemiplegic patients with shoulder pain were as consecutive randomly assigned into two groups. TENS was applied in group 1 (n = 10) for 20 minutes and group 2 (n = 9) received placebo stimulation. Conventional rehabilitation program were applied total 15 sessions during a period of 3 week in both groups.The visual analog scale (VAS) to evaluate shoulder pain, Barthel Index (BI) for daily-life activities (DLA) were used. The shoulder passive range of motions (PROMs) and Brunnstrom stage of motor recovery were measured. RESULTS: Clinical parameters were similar at baseline. In both groups, significant improvements were observed in VAS and BI (group 1: p<0.001; group 2: p<0.05). In VAS (p<0.001), and BI (p<0.05) were showed significant improvements in favor of group 1, when compared with the groups. In PROMs of abduction and external rotation of shoulder significant improvements were observed in only group 1 (p<0.001, p<0.001 respectively). There was not any significant improvement on Brunnstrom stage of motor recovery in both groups (p>0.05). CONCLUSION: In conclusion that TENS therapy together with conventional rehabilitation could be used as a good alternative therapy in patients with hemiplegic shoulder pain.

Effect of low level laser therapy in rheumatoid arthritis patients with carpal tunnel syndrome.

OBJECTIVE: the aim of the present study was to evaluate the efficacy of low level laser therapy (LLLT) in patients with rheumatoid arthritis (RA) with carpal tunnel syndrome (CTS). MATERIAL AND METHODS: a total of 19 patients with the diagnosis of CTS in 19 hands were included and randomly assigned to two treatment groups; LLLT (Group 1) (10 hands) with dosage 1.5 J/ per point and placebo laser therapy group (Group 2) (9 hands). A Galium-Aluminum-Arsenide diode laser device was used as a source of low power laser with a power output of 50 mW and wavelength of 780 nm. All treatments were applied once a day on week days for a total period of 10 days. Clinical assessments were performed at baseline, at the end of the treatment and at month 3. Tinel and Phalen signs were tested in all patients. Patients were evaluated for such clinical parameters as functional status scale (FSS), visual analogue scale (VAS), symptom severity scale (SSS) and grip-strength. However, electrophysiological examination was performed on all hands. Results were given with descriptive statistics and confidence intervals between group means at 3 months adjusted for outcome at baseline and for the difference between unadjusted group proportions. RESULTS: clinical and electrophysiological parameters were similar at baseline in both groups. Improvements were significantly more pronounced in the LLLT group than placebo group. A comparison between groups showed significant improvements in pain score and functional status scale score. Group mean differences at 3 months adjusted at baseline were found to be statistically significant for pain score and functional status scale score. The 95% significant confidence intervals were [-15 - (-5)] and [-5 - (-2)] respectively. There were no statistically significant differences in other clinical and electrophysiological parameters between groups at 3 months. CONCLUSIONS: our study results indicate that LLLT and placebo laser therapy seems to be effective for pain and hand function in CTS. We, therefore, suggest that LLLT may be used as a good alternative treatment method in CTS patients with RA.

Ankylosing spondylitis in a patient with Turner syndrome: a case report.

Turner's syndrome (TS) is a chromosomal disorder where phenotypic females have either a missing chromosome (45 X0) or a structural aberration of one of the chromosomes. It is possible for TS to accompany such autoimmune diseases as thyroid diseases, inflammatory intestinal diseases, diabetes mellitus, psoriatic arthritis and juvenile rheumatoid arthritis. Herein, we present an unusual case with Ankylosing spondylitis (AS) and autoimmune thyroiditis associated with TS. We suggest that the possibility that TS patients may also develop such other diseases as AS apart from the already known accompanying autoimmune diseases should not be ruled out when monitoring TS patients.

The treatment of osteoporosis in patients with rheumatoid arthritis receiving glucocorticoids: a comparison of alendronate and intranasal salmon calcitonin.

OBJECTIVE: The purpose of this study was to assess the effects of alendronate and intranasal salmon calcitonin (sCT) treatments on bone mineral density and bone turnover in postmenopausal osteoporotic women with rheumatoid arthritis (RA) receiving low-dose glucocorticoids. METHODS: Fifty osteoporotic postmenopausal women with RA, who had been treated with low-dose corticosteroids for at least 6 months, were randomized to receive alendronate 10 mg/day or sCT 200 IU/day for a period of 24 months. All patients received calcium supplementation 1,000 mg and vitamin D 400 IU daily. Bone mineral density (BMD) of the lumbar spine, femoral neck, and trochanter was measured annually using dual-energy X-ray absorptiometry. Bone metabolism measurements included urinary deoxypyridinoline (DPD), serum bone alkaline phosphatase (BAP), and serum osteocalcin (OC). RESULTS: Over 2 years, the lumbar spine (4.34%, P < 0.001), femoral neck (2.52%, P < 0.05), and trochanteric (1.29%, P < 0.05) BMD in the alendronate group increased significantly. The sCT treatment increased lumbar spine BMD (1.75%, P < 0.05), whereas a significant bone loss occurred at the femoral neck at month 24 (-3.76%, P < 0.01). A nonsignificant decrease in the trochanteric region was observed in the sCT group (-0.81%). The difference between the groups with respect to the femoral neck and trochanteric BMD was statistically significant ( P < 0.001 and P < 0.05, respectively). The decreases in urinary DPD (-21.87%, P < 0.001), serum BAP (-10.60%, P < 0.01), and OC (-19.59%, P < 0.05) values were statistically significant in the alendronate group, whereas nonsignificant decreases were observed in the sCT group (-5.77%, -1.96%, and -4.31%, respectively). A significant difference was found in the DPD and BAP levels between the two treatment groups in favor of the alendronate group at all time points ( P = 0.001 and P < 0.05, respectively). CONCLUSION: The results of this study demonstrated that alendronate treatment produced significantly greater increases in the femoral neck BMD and greater decreases in bone turnover than intranasal sCT in RA patients receiving low dose glucocorticoids.

Low power laser treatment in patients with knee osteoarthritis.

The aim of this study was to investigate the analgesic efficacy of low power laser therapy in patients with knee osteoarthritis (OA). The study design was randomised, placebo-controlled and single blinded. Sixty patients with knee OA according to the American College of Rheumatology criteria were included and randomly assigned to three treatment groups: active laser with dosage of 3 J/per painful point, active laser with a dosage of 1.5/J per painful point and placebo laser treatment groups. A Gal-Al-As diode laser device was used as a source of low power laser with a power output of 50 mW and a wavelength of 830 nm. The patients were treated 5 times weekly with 10 treatments in all. The clinical assessments included Western Ontario and McMaster Universities osteoarthritis index (WOMAC) pain, stiffness and physical function subscales. In addition, the intensity of pain at rest and on activation was evaluated on a visual analogue scale. Compared to baseline, at week 3 and at month 6, no significant improvement was observed within the groups. Similarly, no significant differences were found among the treatment groups at any time. With the chosen laser type and dose regimen the results that we obtained in this study, suggest that low-level laser therapy has no effect on pain in patients with knee OA.

Electromyographic biofeedback in the treatment of the hemiplegic hand: a placebo-controlled study.

OBJECTIVE: To evaluate the efficacy of electromyographic (EMG) biofeedback treatment in the functional recovery of the hemiplegic hand. DESIGN: A total of 27 patients were randomly assigned to EMG biofeedback or placebo EMG biofeedback groups. Both treatments were applied five times a week for a period of 20 days. In addition, the patients in both groups received an exercise program according to the Brunnstrom's neurophysiologic approach. Goniometric measurements for wrist extension, scale for judging the performance of drinking from a glass, Brunnstrom's stages of recovery for hand, and surface EMG potentials were used for the clinical assessments. All patients were assessed before treatment and after 20 treatment sessions. RESULTS: The results showed that there were statistically significant improvements in all variables in both groups, but the improvements in active range of motion and surface EMG potentials were significantly greater in the EMG biofeedback group at the end of the treatment. CONCLUSION: Our study demonstrates the potential benefits of EMG biofeedback in conjunction with neurophysiologic rehabilitation technique to maximize the hand function in hemiplegic patients.