Clinical effects of suprascapular nerve block in addition to intra-articular corticosteroid injection in the early stages of adhesive capsulitis: A singleblind, randomized controlled trial.

OBJECTIVE: The aim of this study was to evaluate the short and long-term effects of the combination of suprascapular nerve block (SSNB) and intra-articular corticosteroid injection (IAI) on pain, shoulder range of motion (ROM), disability, and quality of life in the management of patients with adhesive capsulitis (AC). METHODS: Forty patients (ages 30-70 years) who were diagnosed with AC stages 1 and 2 were randomlyassigned to one of two groups: Group-1 received IAI and SSNB combination, while group-2 only-IAI. Both groups started a three-week rehabilitation program after the intervention. The Shoulder Pain and Disability Index (SPADI), Numeric Rating Scale (NRS), active and passive shoulder ROMs, and the Short Form 36(SF-36) were assessed by a physiatrist who was blinded to the allocation at baseline and three weeks, three months, and twelve months. The NRS and shoulder ROMs were also examined in the first hour. RESULTS: Nineteen patients from each group with mean ages of 55.84±2.19 (15 females, 4 males) and51.79 ± 1.58 (14 females, 5 males) were included. Within the groups, SPADI and NRS scores were decreased, while active and passive ROMs and the physical function, physical role, and bodily pain domains of SF-36 were increased by time (P < 0.05). Between the groups, the change in NRS value and active flexion in the first hour was more remarkable in group 1 (P < 0.05). No significant difference between outcome measurements was found at the 3rd week, 3rd month, and 12th month (P > 0.05). CONCLUSIONS: SSNB as an adjunct to IAI in AC positively affected the immediate pain relief and functional improvement after the intervention; however, it did not yield any additional benefit in the short and long-terms. LEVEL OF EVIDENCE: Level I, Therapeutic Study.

The clinical effects of combining postural exercises with chest physiotherapy in cystic fibrosis: A single-blind, randomized-controlled trial.

OBJECTIVES: This study aims to investigate the effects of postural exercises as an adjunct to chest physiotherapy program on respiratory function, exercise tolerance, quality of life (QoL), and postural stability in patients with cystic fibrosis (CF). PATIENTS AND METHODS: In this single-blind, randomized-controlled trial, 19 pediatric CF patients (11 males, 8 females; mean age: 9.36 years; range, 6 to 14 years) were randomly allocated to chest physiotherapy and postural exercise program (Group 1, n=10) or chest physiotherapy program alone (Group 2, n=9) between March 2017 and October 2017. Respiratory functions were assessed with pulmonary function tests, whereas exercise tolerance with the Modified Shuttle Test (MST), quality of life with the Cystic Fibrosis Questionnaire-Revised Child Version (CFQR), and postural stability with the Limits of Stability Test (LOS). All tests were performed before treatment and six weeks, three months, and six months after treatment. RESULTS: Respiratory functions were improved in both groups; however, these changes were not statistically significant. The MST increased after treatment in both groups (p<0.001 and p=0.003 respectively), without a significant difference between the groups. Emotional function and treatment difficulties subdomains in CFQR were significantly increased only in the group with postural exercises (p<0.05). CONCLUSION: The postural exercise program in addition to chest physiotherapy in pediatric CF patients whose postural changes were not taken place did not cause significant changes in respiratory function, exercise tolerance, and postural stability; however, it affected the emotional state well and improved the compliance with the treatment.

Pain Symptoms in COVID-19.

OBJECTIVE: The clinical manifestations of COVID-19 range from mild symptoms to severe pneumonia and severe organ damage. When evaluated specifically for pain, the data so far have shown that myalgia, headache, and chest pain can be seen in patients at varying rates; myalgia and headache, especially, are among the initial symptoms. DESIGN: This retrospective chart review, followed by a descriptive survey design study, was carried out by examining patients afflicted with COVID-19. After discharge, patients were asked about the severity and the body region of their pain, their use of analgesics, their mood and mental health, and their overall quality of life. RESULTS: A total of 206 patients with a mean age of 56.24 ± 16.99 yrs were included in the study. Pain during COVID-19 was found to be higher compared with the preinfectious and postinfectious states. The most frequent painful areas were reported to be the neck and back before the infection, whereas the head and limbs during the infection. The most frequently used analgesic during infection was paracetamol. There was no relationship between the patients' pain and anxiety and depression; the quality of life was found to be worse in patients with persistent pain. CONCLUSIONS: This study showed that the head and limbs were the most common painful body regions during COVID-19. It was also found that pain can continue in the postinfection period.

Daily Physical Activity in Children and Adolescents with Low Lumbar and Sacral Level Myelomeningocele.

PURPOSE: Children with low lumbar and sacral level myelomeningocele are expected to be community ambulators. However, they do not always meet the expected ambulation level by the time they reach adulthood. The purpose of this study is to investigate daily activity energy expenditure and physical activity levels of these patients in daily routine. MATERIALS AND METHODS: 20 patients and 20 healthy peers were included in this case-control study. Omnidirectional accelerometer monitor was used for assessing activity energy expenditure, and daily durations spent in sedentary, light activity, and moderate to vigorous physical activity levels (NCT04186338). RESULTS: Mean activity energy expenditure and moderate to vigorous physical activity duration were significantly lower in the patient group, while age was positively correlated with sedentary time and negatively correlated with light activity time. CONCLUSIONS: In patients with myelomeningocele, increasing daily activity energy expenditure and moderate to vigorous physical activity and, especially as age progresses, decreasing the sedentary behavior may assist in providing the expected ambulation level. These patients should be encouraged to partake in regular exercise programs.

Meralgia paresthetica caused by inguinal lymphadenopathy related to tinea pedis infection: A case report.

Mechanical compression at any point along the lateral femoral cutaneous nerve (LFCN) may result in meralgia paresthetica (MP). A 54-year-old male patient presented with pain and tingling on the anterolateral side of thigh. After excluding other causes of pain radiating to legs, he was diagnosed with MP. Inguinal lymphadenopathy which caused the compression of LFCN was found on ultrasonographic examination. Tinea pedis infection was also identified during the detailed investigation for lymphadenopathy. Associated MP symptoms partially resolved immediately after ultrasound-guided LFCN block and a complete recovery was achieved after the treatment of tinea pedis.

Effects of dynamic lycra orthosis as an adjunct to rehabilitation after botulinum toxin-A injection of the upper-limb in adults following stroke: A single-blinded randomized controlled pilot study.

BACKGROUND: Dynamic lycra splints are proposed to modify hypertonicity due to their characteristics - neutral warmth, circumferential pressure, and creating a low-intensity prolonged stretch on hypertonic muscles - to contribute to increased sensory awareness of the involved limb. OBJECTIVES: The aim of this study was to investigate the effects of dynamic lycra orthosis as an adjunct to botulinum toxin-A injection and rehabilitation of the upper-limb in adults following stroke. METHODS: Patients who had suffered a stroke more than three months previously were randomized into two groups: lycra sleeve plus rehabilitation (n = 10) and only-rehabilitation group (n = 10). After botulinum toxin injection, both groups underwent an upper-limb rehabilitation program. The intervention group wore a lycra sleeve for eight hours a day, five days a week for three weeks in addition to the rehabilitation program. Fugl Meyer upper-limb motor score, Motricity index, Modified Ashworth scale, Box and Block test, Stroke Impact Scale and change in touch-detection thresholds of the fingers measured via Semmes-Weinstein monofilaments were assessed by blinded investigators at before treatment, post-treatment (at 3 weeks) and three months post-treatment. This trial is registered with Clinicaltrials.gov, number NCT03546959. RESULTS: There were no differences between groups in terms of Fugl Meyer upper-limb motor score, Motricity Index, Modified Ashworth scale, Box and Block test, Stroke Impact Scale and change in light touch threshold at any follow-up time points. CONCLUSIONS: Using lycra splints as an adjunct to an upper-limb rehabilitation program after stroke did not provide additional benefit in spasticity, upper-limb motor function, light touch threshold of fingers or stroke-specific quality-of-life.

Postural Stability in Children with High Sacral Level Spina Bifida: Deviations from a Control Group.

Objective: To assess static and dynamic postural stability changes in children with high sacral level spina bifida.Methods: Thirty-five children with high sacral level spina bifida and 35 age-matched healthy controls were enrolled. Their lower extremity muscle strengths and static and dynamic postural stability parameters were measured with the use of a dynamometer and the NeuroCom Balance Master® device, respectively. Functional gait and balance were evaluated using the five times sit-to-stand test (5STS) and the 6-minute walk test (6MWT). Spinal, hip, and ankle deformities of the patient group were measured by radiologic evaluation.Results: In comparison with controls, patients were found to have lower ankle dorsiflexion and plantar-flexion strength, increased 5STS duration, and decreased 6MWT distance while both static and dynamic postural stability parameters were significantly different. Bilateral ankle muscle strengths were found to be negatively correlated with postural stability parameters. The presence of hydrocephalus or meningomyelocele in the patient group was found to have negative effects on static postural stability.Conclusion: Static and dynamic postural stability is affected even in children with high sacral level spina bifida who are expected to have best condition in this patient population. The ankle muscle strength is the main factor influencing these changes.

Fibrodysplasia ossificans progressiva: lessons learned from a rare disease.

PURPOSE OF REVIEW: Fibrodysplasia ossificans progressiva (FOP) is an extremely rare and severely disabling autosomal dominant disease that is yet to be clearly understood. The purpose of this review is to present recent literature on pathophysiology, clinical features, diagnosis and treatment of FOP. RECENT FINDINGS: FOP is characterized by congenital great toe deformity and progressive heterotopic ossifications in connective tissue. Heterotopic ossifications occur after painful flare-ups that can arise spontaneously or can be triggered by minor trauma. Each flare-up ultimately causes restriction of related-joint, and along with the others eventually leads to immobility. Death is usually caused by pulmonary complications because of chest wall involvement. The causative gene of FOP is activin A receptor type 1 (ACVR1), a bone morphogenetic protein-signalling component, which normally acts to inhibit osteoblastogenesis. The treatment of FOP is still preventive and supportive. SUMMARY: Although there are still gaps in the underlying mechanism of FOP, effective treatment options, such as potential pharmacologic targets and cell-based therapies are promising for the future. Some of these were tested without a clinical trial setting, and are currently in the process of evidence-based research.

Muscle belly in the tunnel: an unusual cause of carpal tunnel syndrome in a patient with spinal cord injury.

Introduction: Carpal tunnel syndrome, entrapment of median nerve at the wrist, is one of the most commonly encountered peripheral neuropathies in the upper extremity. It is also common in individuals with spinal cord injury due to repetitive movements during wheelchair use. Although it is well known that prevalence of carpal tunnel syndrome is high in individuals with spinal cord injury, no previous study identified aberrant muscle as the cause. Case presentation: A 43-year-old man with T10 incomplete, ASIA Impairment Scale (AIS) C, patient with paraplegia who is a wheelchair basketball player presented to our electrodiagnostic laboratory with complaints of bilateral hand numbness after intensive training for a local veteran wheelchair basketball tournament. Nerve conduction studies showed carpal tunnel syndrome. Ultrasonographic assessment of carpal tunnel revealed the presence of abnormal muscle in the carpal tunnel encroaching the median nerve dynamically. Discussion: It is important to identify the underlying cause of carpal tunnel syndrome, which is a common cause of upper extremity impairment in individuals with spinal cord injury because individuals with spinal cord injury who use wheelchair depend on their arms for mobility, transfers, and most activities of daily life.

Outcome measurement in patients with low back pain undergoing epidural steroid injection.

OBJECTIVES: This study aims to evaluate the outcomes of epidural steroid injection (ESI) in patients with low back pain. PATIENTS AND METHODS: This prospective study included a total of 82 patients (51 females; 31 males; mean age 50.8±14.2 years; range, 17 to 86 years) who underwent ESI due to lumbar disc hernia-induced radiculopathy between September 2014 and May 2015. The Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), Istanbul Low Back Pain Disability Index (ILBPDI), and the Short Form-36 (SF-36) were administered to all patients before and three weeks and three months after ESI. RESULTS: The mean scores of all scales were significantly lower at three weeks and three months following ESI compared to the baseline scores. There were no significant differences between the mean scores at three weeks and three months. The NRS yielded the highest post-ESI change from baseline. CONCLUSION: Our study results showed that all scales used in this study were effective tools for the evaluation of outcomes of EPI in patients with low back pain. Although the NRS yielded the highest sensitivity for detecting change, evaluating functional state and quality of life is essential for multivariate analyses.

Caregiver burden in children with cystic fibrosis and primary ciliary dyskinesia.

INTRODUCTION: Caregiver burden impacts both the social and economic framework of society. Cystic fibrosis (CF) causes significant caregiver burden, but the current data is scarce. In the case of primary ciliary dyskinesia (PCD), even less is known. This study aims to compare the caregiver burden of the parents of patients with CF and PCD. METHODS: Patients with CF and PCD between the ages of 6 to 13 and their parents were included. Patients' clinical information and parents' demographics were recorded. Caregiver burden was measured with Zarit Caregiver Burden Scale (ZCB), while the quality of life (QOL) was measured with CFQOL-revised (CFQOL-R) and PCD QOL questionnaire as the patients' age and diagnosis indicated. RESULTS: A total of 63 patients, 44 with CF (69%) and 85 caregivers (35 mothers, 6 fathers, and 22 mother-father dyads) participated in the study. Caregiver burden was significantly higher in mothers of the CF group with a mean ZCB of 30.5 ± 10.7 when compared to the PCD group with a mean ZCB of 21.93 ± 8.26 (P = .006). This was similar in fathers with mean ZCB of 27.5 ± 9.21 in the CF group and 20.36 ± 7.43 in the PCD group (P = .03). In correlation analyses, mothers' caregiver burden moderately and inversely correlated with CFQOL-R subscales in the CF population. CONCLUSION: Caregiver burden is significantly higher in the CF population when compared to PCD. It is correlated with pulmonary functions and QOL in patients with CF.

Challenges in the treatment of fibrodysplasia ossificans progressiva.

Fibrodysplasia ossificans progressiva (FOP), is a rare autosomal dominant connective tissue disease with a prevalence of 1 in 2 million. It is characterized by congenital foot deformities and multiple heterotopic ossifications in fibrous tissue. It usually starts with painful soft tissue swellings occurring with attacks at the ages of three or four. The attacks develop spontaneously or after minor trauma, and gradually turn into heterotopic ossifications that cause joint limitations, growth defects, skeletal deformities and chronic pain. The average life expectancy is forthy, and most of the patients are lost due to pulmonary complications. FOP is often misdiagnosed as fibromatosis, desmoid tumour or cancer, bunion, myositis, arthritis and rheumatic diseases. After clinical suspicion, confirmatory genetic analysis should be used for the diagnosis. The treatment of FOP is currently supportive. An effective, proven method has not yet been established. Herein, we present an 18-year-old female patient with FOP who underwent different treatment modalities in a 5-year period. This case-based review reveals all available treatment approaches with at least 6-month follow-up for FOP in the literature.

The evaluation of the static and dynamic balance disorders in patients with psoriatic arthritis.

To evaluate the static and dynamic balances in psoriatic arthritis (PsA) and to investigate their relationship with clinical and functional parameters. Patients diagnosed with PsA and healthy controls were recruited consecutively into the study. The demographic variables such as age, sex, body mass index of the subjects were noted. Radiographic images were examined for the detection of foot deformities. 'Foot and Ankle Outcome Score' (FAOS) was used to assess foot function. The dynamic and static balance of the patients was evaluated by 'Berg Balance Scale' (BBS) and 'Neurocom Balance Master' device. The fatigue (Multidimensional Assessment of Fatigue: MAF), depression (Beck Depression Inventory: BDI) and sleep disorders (Pittsburgh Sleep Quality Index: PSQI) of all patients were evaluated. This study included 50 PsA patients and 50 healthy controls with mean ages of 45.02 (SD 12.81) and 45.12 (SD 10.56), respectively. Demographic data of both groups were similar. Concerning the balance tests, there were significant differences (p < 0.05) between patient and control groups about the all tests of sway velocity (except on foam surface eyes closed test), end sway of tandem walk test, movement time of bilateral step up over test and lift up index of left step up over test. There was no significant correlation between static and dynamic balance parameters with MAF, BDI, PSQI, foot deformities and FAOS. The static and dynamic balance impairments are seen in PsA. As the balance parameters had no significant correlation with functional and clinical data, they are acceptable as independent parameters during the course of the disease.

Is fluoroscopy-guided percutaneous rupture of facet cyst an alternative to surgery? A case report.

Lumbar intraspinal synovial cysts (LISCs) are rare cause of the lumbosacral radicular syndrome. Fluoroscopy-guided percutaneous cyst rupture (PCR) is an option in the treatment. This report introduces long-term symptom relief after fluoroscopy-guided PCR of LISC. A 73-year-old patient presented with low back pain radiating to right leg. L5 radiculopathy was suspected by physical examination; however, an intraspinal cystic mass was visualized through imaging studies. The patient reported immediate pain relief after fluoroscopy-guided PCR, which sustained for one year. In conclusion, fluoroscopy-guided PCR appears to be a safe and effective treatment option and should be considered before surgery in patients with LISCs.