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.

The role of ultrasonography in follow-up of effectiveness of Complex Decongestive Therapy (CDT) in different subgroups of patients with breast cancer-related lymphoedema.

OBJECTIVE: To determine the role of ultrasonography in the follow-up of effectiveness of complex decongestive therapy (CDT) in different subgroups of patients with breast cancer-related lymphoedema (BCRL). METHODS: Forty-seven patients with unilateral upper BCRL were enrolled in the study. The patient group was divided into two subgroups according to body mass index (BMI) as obese and non-obese and three subgroups according to International Society of Lymphology staging. All patients underwent CDT, the circumference measurements and ultrasonographic soft tissue thicknesses evaluations were performed at two anatomic sites, and upper extremity limb volumes were calculated using the truncated cone formula before and after CDT. RESULTS: There were significant decreases in both circumferential measurements and ultrasonographic soft tissue thicknesses in non-obese patients and stage 2 lymphoedema patients after 15 sessions of CDT. The ultrasonographic soft tissue thickness values were correlated with the upper arm and forearm circumference values before (r = 0.491, p < .001, r = 0.841, p < .001, respectively) and after (r = 0.535, p < .001, r = 0.714, p < .001, respectively) CDT. CONCLUSIONS: Ultrasonography presents as a reliable method to measure the soft tissue thickness and treatment efficacy after CDT in only non-obese and stage 2 patients with BCRL.

Bone loss in the affected forearm in patients with breast cancer-related lymphedema: a controlled study.

PURPOSE: We aimed to investigate the association between lymphedema and bone mass density (BMD) of affected and unaffected forearms in patients with breast cancer-related lymphedema (BCRL). We also explored whether there was a relationship between any disability and BMD on the affected side. METHODS: We evaluated 111 patients (53.75 ± 9.07) with unilateral lymphedema (group 1) and 61 patients (50.90 ± 12.44) without lymphedema (group 2) after breast cancer surgery. BMD was performed by dual-energy x-ray absorptiometry (DXA) in lumbar spine, femoral neck, and distal forearm on both sides. Functional situation was assessed by the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. RESULTS: The total Z score (p = 0.018), T score (p = 0.005), and BMD value (p = 0.014) were lower in the affected forearm than the unaffected forearm in group 1. There was no difference between the affected or unaffected sides in the total Z score (p = 0.394), T score (p = 0.518), and BMD value (p = 0.629) in group 2. The DXA measurements in terms of the total forearm Z, T scores, and BMD value on the affected side were statistically significantly different between the groups. There was no difference between groups in the femur neck and lumbar total Z and T scores. There was also a positive correlation between the QuickDASH scores and lymphedema stage (r = 0.469, p = 0.001) and the duration without treatment of lymphedema (r = 0.298, p = 0.02) in group 1. CONCLUSION: We recommend early diagnosis and treatment of lymphedema for the protection of upper extremity disability and localized osteoporosis in patients with BCRL.

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.

The effects of coexisting fibromyalgia syndrome on pain intensity, disability, and treatment outcome in patients with chronic lateral epicondylitis.

OBJECTIVE: The objective of this study was to evaluate the effects of coexisting fibromyalgia syndrome (FS) on pain intensity, disability, and treatment outcome in patients with chronic lateral epicondylitis (LE). METHODS: Seventy-eight patients with chronic unilateral LE and 30 healthy subjects were included. Patients were classified into two groups: group 1 consisted of 46 LE alone patients, while group 2 consisted of 32 LE plus FS patients. A pain questionnaire was used to determine the subjective pain and disability. Pressure pain threshold (PPT) on the lateral epicondyles, isometric hand grip strength (IHGS), lateral pinch grip strength (LPGS), and tender point examinations of groups were performed. A mixture of methylprednisolone and prilocaine was injected 1 cm distal to the lateral epicondyle. All measurements were repeated 2 weeks and 3 months after injection. RESULTS: Compared with healthy subjects, both patient groups had significantly increased pain and disability scores and decreased IHGS, LPGS, and PPT values (P < 0.001). Compared with the LE alone group, pain and disability scores were significantly higher (P < 0.01), and PPT, IHGS, and LPGS values were significantly lower in LE plus FS group (P < 0.05). Pain questionnaire scores of the LE alone and LE plus FS patients showed statistically significant decrease, and IHGS, LPGS, and PPTs showed statistically significant increase at the second week (P < 0.01) and at the third month (P < 0.001) after injection. Improvements in the LE plus FS group were poorer than FS alone group at both second week and third month after injection. CONCLUSION: Coexisting FS may increase the pain intensity and disability, and negatively affect the treatment outcome in patients with chronic LE.

Coexistence of fibromyalgia and metabolic syndrome in females: The effects on fatigue, clinical features, pain sensitivity, urinary cortisol and norepinephrine levels: A cross-sectional study.

OBJECTIVES: This study aims to evaluate the coexistence of metabolic syndrome (MetS) and fibromyalgia syndrome (FMS) and determine the effects of this coexistence on neuroendocrine levels and clinical features of FMS. PATIENTS AND METHODS: One-hundred female FMS patients (mean age 40.1±7.8 years; range, 24 to 58 years) and 38 healthy females (mean age 40.4±5.8 years; range, 30 to 55 years) were included in this cross-sectional study. MetS was identified by using the criteria from the Adult Treatment Panel III. Widespread pain index, symptom severity score and number of tender points were determined. Visual analog scale, Fibromyalgia Impact Questionnaire, Fatigue Severity Scale, Beck Depression Inventory, and pain pressure threshold were used as the outcome measures. The severity of FMS was assessed with total myalgic score (TMS) and control point score. RESULTS: Twenty-four (24%) of the 100 FMS patients and three (7.9%) of the 38 control patients fulfilled the MetS criteria (p=0.047). The coexistence of FMS and MetS was associated with higher symptom severity score (p=0.004), widespread pain index (p=0.001), number of tender points (p=0.039), and lower total myalgic score (p=0.029) values. There was a significant association between the occurrence of FMS and MetS (odds ratio=3.76; 95% confidence interval: 1.04-13.4; p=0.043). CONCLUSION: We found that patients with FMS had a nearly four times higher risk for MetS and the coexisting MetS may increase the severity of FMS. In clinical practice, when evaluating a patient with FMS, metabolic characteristics should also be evaluated.

Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): The revised guideline for the acute, subacute, and post-COVID-19 rehabilitation.

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psychological, and generalized systemic dysfunction. The severity of disease ranges from an asymptomatic infection or mild illness to mild or severe pneumonia with respiratory failure and/or death. COVID-19 dramatically affects the pulmonary system. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and has been developed in the light of the guidelines on the diagnosis and treatment of COVID-19 provided by the World Health Organization and Republic of Turkey, Ministry of Health, recently published scientific literature, and PR recommendations for COVID-19 regarding basic principles of PR. This national guideline provides suggestions regarding the PR methods during the clinical stages of COVID-19 and post-COVID-19 with its possible benefits, contraindications, and disadvantages.

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.

Neurodynamic evaluation and nerve conduction studies in patients with forward head posture.

Forward head posture (FHP) is one of the most frequently seen problems. The aim of this study was to evaluate the neurodynamic tests and peripheral nerve conductions of upper extremity in patients with FHP. The study population included 100 patients with upper extremity and neck problems and 34 healthy individuals as a control group. Craniovertebral angle measurement was used to determine forward head posture. Stretch tests for radial, ulnar and median nerves were performed. Nerve conductions of bilateral median, radial, ulnar and medial antebrachial cutaneous (MAC) nerves were examined in all patients included in the study. The most significant nerve conduction differences in moderate-to-severe FHP patients were a decrease in the sensory nerve action potential (SNAP) and compound muscle action potential (CMAP) 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. FHP makes patients more prone to peripheral entrapments.

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.

Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): A guideline for the acute and subacute rehabilitation.

Coronavirus disease 2019 (COVID-19) is a contagious infection disease, which may cause respiratory, physical, psychological, and generalized systemic dysfunction. The severity of disease ranges from an asymptomatic infection or mild illness to mild or severe pneumonia with respiratory failure and/or death. COVID-19 dramatically affects the pulmonary system. There is a lack of knowledge about the long-term outcomes of the disease and the possible sequelae and rehabilitation. This clinical practice guideline includes pulmonary rehabilitation (PR) recommendations for adult COVID-19 patients and has been developed in the light of the guidelines on the diagnosis and treatment of COVID-19 provided by the World Health Organization and Republic of Turkey, Ministry of Health, recently published scientific literature, and PR recommendations for COVID-19 regarding basic principles of PR. In this guideline, the contagiousness of COVID-19, recommendations on limited contact of patient with healthcare providers, and the evidence about possible benefits of PR were taken into consideration.

Complex Decongestive Therapy in Breast Cancer-Related Lymphedema: Does Obesity Affect the Outcome Negatively?

BACKGROUND: The aim of this prospective clinical study was to compare the long-term efficacy of complex decongestive therapy (CDT) in obese and nonobese patients with breast cancer-related lymphedema (BCRL). MATERIALS AND METHODS: A total of 59 patients (29 obese patients group 1, 30 normoweight overweight patients group 2) with unilateral BCRL were enrolled. All patients underwent CDT that included manual lymphatic drainage, intermittent pneumatic compression pump, multilayer compression bandaging, lymphedema exercises, and skin care. The CDT was performed for 1 hour a day, 5 days a week for 3 weeks. Patients were assessed according to limb volume difference before CDT, after CDT, and after 1 year. RESULTS: The initial lymphedema volume of group 1 was 866.34 ± 389.34 mL and that of group 2 was 661.84 ± 470.6 mL (p = 0.031). The lymphedema severity percentage of excess volume (PEV) of group 1 was 33.37 ± 15.71 and that of group 2 was 31.86 ± 19.63, which was moderate lymphedema. After 15 sessions of CDT program, in group 1, lymphedema volume decreased to 771.46 ± 389.14 mL (post-CDT p = 0.013) and in group 2, lymphedema volume decreased to 468.38 ± 417.36 mL (post-CDT p < 0.0001), and in group 1, PEV decreased to 28.54 ± 16.84 (post-CDT p = 0.002) and that in group 2 decreased to 22.1 ± 16.87 (post-CDT p < 0.0001). After 1 year, group 1 reached the baseline values of the extremity volumes, but in group 2, the volumes of extremities could maintain their post-CDT values. CONCLUSION: Obesity is a factor that deteriorates the CDT efficacy. Early treatment, before developing fat accumulation and fibrosis, must be primary goal in the treatment of BCRL.

The effects of sulfasalazine treatment on enthesal abnormalities of inflammatory rheumatic diseases.

The aim of this study was to evaluate the effects of a 1-year course of sulfasalazine monotherapy on enthesal abnormalities of inflammatory rheumatic diseases (IRDs) using ultrasonography. Thirty-six patients with IRD including 20 patients with rheumatoid arthritis (RA) and 16 patients with ankylosing spondylitis (AS) (22 women, 14 men, mean ages 43.3 +/- 8.8 years), and 18 healthy controls (10 women, 8 men, mean ages 42.5 +/- 9.9 years) matched by age and body mass index were enrolled in this study. For the evaluation of enthesal structures, all patients and controls underwent ultrasonographic (USG) examinations of five enthesal sites of both lower limbs using high-resolution and Doppler USG. An ultrasonographic score of lower limb enthesitis was calculated using Glasgow ultrasound enthesitis scoring system (GUESS). Clinical and laboratory activities of IRD patients were also evaluated. Patient group was made to undergo 2 g/day sulfasalazine monotherapy for 1 year. All evaluations were made at the beginning of the treatment and repeated after 1 year follow-up. Results showed that the frequency of enthesal abnormalities of the IRD group was significantly higher than controls. On USG examination, 301/1,296 (23.2%) enthesal structures were abnormal in IRD patients, and 19/648 (2.93%) structures were abnormal in controls. Mean GUESS score of the IRD group (6.40 +/- 2.41) was also significantly higher than controls (1.79 +/- 1.60) (p < 0.001). Although there was a significant improvement in clinical and laboratory activity parameters of the IRD patients, significant decrease was not observed in enthesal abnormalities (295/1,296 enthesal structures-22.7%) and mean GUESS score (6.20 +/- 2.38) after 1 year sulfasalazine trial. Additionally, there was no significant improvement in enthesal abnormalities and mean GUESS scores of AS and RA subgroups separately. Sulfasalazine treatment was not found effective on enthesal abnormalities of IRD patients. Further studies with larger groups including other IRDs are required to validate our results.

The Effects of Fibromyalgia Syndrome on Physical Function and Psychological Status of Pregnant Females.

OBJECTIVES: This study aims to investigate the frequency and most common symptoms of fibromyalgia syndrome (FS) among pregnant females and determine the impacts of FS on physical functioning and psychological status. PATIENTS AND METHODS: A total of 360 pregnant females (mean age 26.5 years, range 19 to 42 years) were included. The subjects were divided into two groups in terms of having (FS group; n=136; mean age 27 years; range 19 to 41 years) or not having FS (control group; n=224; mean age 26.5 years; range 20 to 42 years). The impact of FS on physical functions was evaluated using Fibromyalgia Impact Questionnaire. Psychological statuses of the subjects were evaluated using State-Trait Anxiety Inventory, Wijma Delivery Expectancy/Experience Questionnaire, and Beck Depression Inventory. RESULTS: Low back pain was the most common complaint while fatigue was the most common symptom in FS group. FS group had higher levels of pain and physical disability (p<0.001) and also higher values of anxiety, fear of childbirth, and depression (p<0.001, for all values) compared to control group. Symptom severity and physical function scores were significantly correlated with increased levels of pain, depression, anxiety, and fear of childbirth (p<0.001, for all values). CONCLUSION: Fibromyalgia syndrome is common among pregnant females. The existence of FS in pregnancy is a severe factor contributing to maternal stress, anxiety, and depression. Therapeutic measures for fibromyalgia syndrome should be well-established to support healthy pregnancy and good child health outcome.

Evaluation of upper extremity nerve conduction velocities and the relationship between fibromyalgia and carpal tunnel syndrome.

BACKGROUND AND AIMS: We undertook this study to evaluate upper extremity nerve conduction velocities (NCVs) in fibromyalgia syndrome (FS) and the relationship of the electrophysiological findings between carpal tunnel syndrome (CTS) and FS. METHODS: Sixty three right-handed female patients diagnosed with FS and 52 right-handed age- and gender-matched healthy controls were enrolled in the study. Conduction studies of the median and ulnar nerves and median nerve F-wave latencies were assessed in both upper extremities using standard methods. CTS was diagnosed electrophysiologically if the median nerve sensory NCV was decreased and/or motor distal latency (DL) was prolonged. RESULTS: CTS was detected electrophysiologically in 26 (20.63%) of 126 extremities of 63 patients and in three (2.82%) of 104 extremities of 52 individuals of the control group. Statistically significant differences were detected between groups with respect to rate of carpal tunnel syndrome (p <0.05). There were no differences between results of NCVs of patients in FS group and healthy controls except the prolongation of the right median nerve motor DL (p = 0.019), decrease of the sensory NCV (p = 0.003) in the right median nerve, in the left median nerve (p = 0.011) and in the left ulnar nerve (p = 0.015). CONCLUSIONS: We determined an increased rate of CTS and decreased NCVs in the upper extremities in patients with FS. We should consider that complaints of paresthesia and pain in hands, increasing especially at nights, observed in FS may mask that CTS can be an associated illness.

Disability and related factors in patients with chronic cervical myofascial pain.

The aim of this study is to detect whether cervical myofascial pain leads to disability and to determine factors associated with disability in patients with chronic cervical myofascial pain. One hundred-three female patients with chronic cervical myofascial pain and 30 age-matched healthy females participated. Main outcome measurements are visual analog scale, Neck Pain and Disability scale, Beck Depression Inventory and pain pressure threshold measurements from the most usual trigger-point locations of trapezius, levator scapula, multifidus, and splenius capitis muscles. The Neck Pain and Disability scale and Beck Depression Inventory scores of the patient group were higher than controls. In the patient group, the total Neck Pain and Disability scale scores were significantly correlated with the pain pressure threshold values of the trapezius and levator scapula muscles and Beck Depression Inventory scores. Regression analyses showed that increased disease duration (R (2) = 0.37), decreased pain pressure threshold values of trapezius muscle (R (2) = 0.04), unilateral disease (R (2) = 0.02) and increased Beck Depression Inventory scores (R (2) = 0.02) were associated with higher disability. Cervical myofascial pain is a reason for disability in chronic neck pain population. Disease duration was found as the strongest predictor of disability.