Muscle architecture in patients with primary Sjögren syndrome.

Objectives: This study aims to investigate skeletal muscle architecture and strength in patients with primary Sjögren syndrome (pSS). Patients and methods: Between July 01, 2017 and November 30, 2017, 19 pSS patients (19 females; mean age: 54.1±6.6 years; range, 42 to 62 years) and 19 age-, body mass index-, and sex-matched healthy controls (19 females; mean age: 53.2±6.7 years; range 42 to 61 years) were included. Sjögren symptoms were assessed with the European Alliance of Associations for Rheumatology (EULAR) Sjögren's Syndrome Patient Reported Index (ESSPRI). Muscle thickness, pennation angle, and fascicle length were measured at quadriceps femoralis, gastrocnemius and soleus muscles. Isokinetic muscle strength tests were performed at 60 and 180°/sec for knee and at 30 and 120°/sec for ankle. Anxiety and depression evaluated with the Hospital Anxiety and Depression Scale (HADS), fatigue with Multidimensional Assessment of Fatigue scale (MAF), and functionality with Health Assessment Questionnaire (HAQ). Results: In the pSS group, the mean ESSPRI was 7.70±1.17. The mean scores of depression (10.05±3.09 vs. 4.47±2.29; p<0.0001), anxiety (8.26±4.28 vs. 3.79±2.42; p<0.0001), functionality (0.94±0.78 vs. 0.22±0.26; p<0.0001), and fatigue (37.69±5.47 vs. 17.69±5.26; p<0.0001) were significantly higher in patients with pSS. Only, the pennation angle of vastus medialis in dominant leg was significantly greater in healthy controls (p=0.049). Peak torques/body weight of knee and ankle muscles were found to be similar. Conclusion: Excluding a minor decrease of the pennation angle at vastus medialis, muscle structure of lower extremity of pSS patients were similar to healthy controls. In addition, isokinetic muscle strength did not significantly differ in patients with pSS compared to healthy controls. In patients with pSS, disease activity and fatigue level were negatively correlated with isokinetic muscle strength measurements.

The evaluation of muscle strength and architecture in type 1 diabetes mellitus: a cross-sectional study.

BACKGROUND: The aim of this study is to compare muscle strength and architecture between type 1 diabetes patients and healthy volunteers and to assess whether there is an ultrasonographic structural change in this population. METHODS: Thirty-two patients with T1D (23 female, 9 male) with an age average of 31.3 ± 8.7 years, matched in terms of age, gender, height, weight and physical activity were included in the study. In the T1D and control group, ultrasonographic measurements of quadriceps femoris muscle (RF, VI, VM, VL) and pennate angle (VI, VM, VL) were performed. Muscle strength values were measured using isokinetic dynamometer system at angular velocities of 60º/s and 180º/s in both groups. RESULTS: Initially, both groups were similar in demographic and clinical characteristics (p > 0.05). In the T1D group, there was a statistically significant difference in flexion/extension peak torque measurements at an angular velocity of 60º/s compared to the control group (p < 0.05). In support of these isokinetic measurements, RF, VI, VM, VL muscle thicknesses and VI, VM pennate angle measurements in T1Ds were significantly lower (p < 0.05). When the T1D group was subgrouped according to HbA1C and diabetes duration, there was no significant difference in ultrasonographic and isokinetic measurements between the two groups (p > 0.05). When the T1D group was subgrouped, in the group that used insulin pump RF, VI, VM muscle thickness measurements were significantly higher (p < 0.05) than the group using subcutaneous insulin. CONCLUSIONS: This study supports that muscle strength and architecture are adversely affected in the T1D patient group, insulin deficiency is a risk factor for sarcopenia and this can be shown through ultrasonography. It can also be said that insulin pump use has more positive effects in terms of diabetic myopathy than subcutaneous insulin, and diabetic myopathy develops independently of other diabetic complications. As a result, the muscle architecture of T1D people is adversely affected by insulin deprivation, so regular physical activity should be an integral part of diabetes treatment.

The Importance of Functional Hamstring/Quadriceps Ratios in Knee Osteoarthritis.

CONTEXT: Osteoarthritis (OA) is the most common chronic joint condition. Muscle dysfunction plays a critical role in the pathogenesis of knee OA. OBJECTIVE: It has been suggested that the agonist-antagonist strength relationship for the knee may be better described by a functional hamstring/quadriceps (H/Q) ratio (Hconcentric/Qeccentric: the representative of knee flexion and Qeccentric/Hconcentric: the representative of knee extension). Therefore, in this study, the authors aimed to investigate this ratio and its importance for knee OA. DESIGN: Cross-sectional study. SETTING: Research clinic. Patients or Other Participant(s): Twenty healthy women and 20 women with grade 2 or grade 3 primer knee OA between the age of 50 and 80 years were included in this study. INTERVENTION(S): Concentric and eccentric peak torque of quadriceps and hamstring muscles were evaluated for all individuals in patient and control groups with a Cybex isokinetic device. Functional H/Q ratio is calculated manually. MAIN OUTCOME MEASURE(S): Functional H/Q torque ratios were analyzed between the patients with OA and healthy individuals by using the isokinetic system. RESULTS: The values of peak torque of hamstring concentric and eccentric and quadriceps concentric for the patient group were significantly lower than the control group (P < .05). No statistically important difference was found for quadriceps eccentric peak torque between 2 groups (P > .05). H/Q ratio for extension in the patient group was significantly higher than the control group (P < .05), whereas the H/Q ratio for flexion in the patient group was significantly lower than the control group (P < .05). CONCLUSION: This study showed the weakness of both quadriceps and hamstring muscles in patients with knee OA. The combination of functional H/Q ratio with hamstring and quadriceps muscles concentric and eccentric strength values can help to analyze the knee functions and develop preventive-therapeutic approaches for knee OA.

Cross-Cultural Adaptation, Validity, and Reliability Study of the Turkish Version of Back Performance Scale.

STUDY DESIGN: Validation of a performance scale. OBJECTIVE: The purpose of this study is to investigate adaptation, validity, and reliability of the Turkish version of the Back Performance Scale (BPS). SUMMARY OF BACKGROUND DATA: Low back pain affects people of all ages and causes pain, disability, and psychosocial problems. BPS is a condition-specific performance measure of activity limitation in patients with low back pain. The purpose of this study is to investigate the cross-cultural adaptation, validity, and reliability of the Turkish version of the BPS. METHODS: The study included 180 patients with low back pain. For the reliability assessment of the scale, test-retest, and internal consistency analyses were performed. The results of the test-retest analysis were analyzed by Intraclass Correlation Coefficient (ICC) method. For the internal consistency, Cronbach Alpha value was calculated and to construct validity, total points of the BPS were compared with the total points of Roland Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI) using Pearson correlation coefficient analysis. RESULTS: BPS was found to have high internal consistency (Cronbach alpha value 0.827). Test-retest results were found highly correlated (range from 0.723 to 0.899). Factor analysis indicated that the scale had one factor. BPS is well correlated with RMDQ and ODI (Pearson correlation coefficient with RMDQ 0.576 and with ODI 0.603). CONCLUSION: The Turkish version of BPS is valid and reliable. LEVEL OF EVIDENCE: 3.

Effects of isokinetic, isometric, and aerobic exercises on clinical variables and knee cartilage volume using magnetic resonance imaging in patients with osteoarthritis.

OBJECTIVES: This study aims to evaluate the effect of isokinetic, isometric, and aerobic exercise protocols on pain, disability, physical function, and articular cartilage in osteoarthritis. PATIENTS AND METHODS: A total of 45 women (mean age 52.1 years; range 45 to 65 years) who were admitted to the Physical Medicine and Rehabilitation outpatient clinic and were diagnosed with primary bilateral knee osteoarthritis between May 2008 and January 2010 were included. The patients were randomly divided into three groups as isokinetic (n=15), aerobic (n=15), and isometric exercise groups (n=15). Exercise protocols were applied five days a week for four weeks. Pain was evaluated using a 10 cm Visual Analog Scale for Pain (VAS-pain), pain, joint stiffness and physical function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and disability was assessed using the Lequesne Index before and after the interventions. Isokinetic knee muscle strength measurements were also obtained. Patellar and femoral cartilage volumes were analyzed using magnetic resonance imaging. RESULTS: The VAS-pain, WOMAC, and Lequesne scores and peak torque values of knee extension improved in all groups with the highest improvement in the isokinetic group. For the knee flexion peak torque values, improvements were significant only in the isokinetic group at both velocities. There was no significant change in the femoral cartilage volume in any group after the interventions. However, patellar cartilage volume significantly increased in the isometric group (p=0.036). CONCLUSION: A four-week isokinetic, aerobic, and isometric exercise programs improved pain and functional capacity in patients with knee osteoarthritis. Isokinetic exercise also increased the muscle strength with improved maintenance of the quadriceps/hamstring ratio. Only isometric exercise increased the patellar cartilage volume.

An unusual late complication in traumatic brain injury: Persistent dysphagia due to tracheoesophageal fistula.

Traumatic brain injury (TBI), which leads to cognitive, physical, emotional and behavioral deficits according to the severity of trauma, is a disability with high morbidity and mortality. In addition to primary effects of TBI, direct trauma to the face, neck, and chest also contributes to increased morbidity. Recovery in swallowing functions in TBI patients is often parallel with recovery in functional daily activities. Herein, contrary to that expectation, we present a TBI case with persistent dysphagia symptoms lasting for even 1.5 years after trauma, despite the fact that she gained independence in dailylife activities under supervision.

Inter-rater agreement of the Turkish version of the Neurobehavioral Rating Scale-Revised form.

OBJECTIVES: This study aims to adapt the Neurobehavioral Rating Scale-revised form (NBRS-R) for Turkish traumatic brain injury (TBI) patients and to investigate the inter-rater agreement of the Turkish revised scale. PATIENTS AND METHODS: A total of 45 patients (36 males, 9 females; mean age 31.1±13.0 years; range 18 to 60 years) with TBI were included in this study between September 2013 and August 2014. A semi-structured interview was set up for Turkish patients using a multidisciplinary approach (physiatrist, psychiatrist, neurologist and psychologist) with the participation of four rehabilitation centers. Questions were prepared for each of the 29 items, based on the recommendations of the original NBRS-R form. Four different interviewers from the four centers applied this form to a total of 45 TBI patients. RESULTS: The items evaluated by intra-class correlation coefficient showed satisfactory stability and the reliability of the items ranged from moderate to very good. CONCLUSION: The NBRS-R form can be suggested to provide a reliable and easily reproducible evaluation method of neurobehavioral deficits in TBI patients who speak Turkish.

Reliability, Validity, and Cross-Cultural Adaptation of the Turkish Version of the Bournemouth Questionnaire.

STUDY DESIGN: Validation of a self-report questionnaire. OBJECTIVE: The purpose of this study was to investigate adaptation, validity, and reliability of the Turkish version of the Bournemouth Questionnaire. SUMMARY OF BACKGROUND DATA: Low back pain is one of the most frequent disorders leading to activity limitation. This pain affects most of people in their lives. The most important point to evaluate patient's functional abilities and to decide a successful therapy procedure is to manage the assessment questionnaires precisely. METHODS: One hundred ten patients with chronic low back pain were included in present study. To assess reliability, test-retest and internal consistency analyses were applied. The results of test-retest analysis were assessed by using Intraclass Correlation Coefficient method (95% confidence interval). For internal consistency, Cronbach alpha value was calculated. Validity of the questionnaire was assessed in terms of construct validity. For construct validity, factor analysis and convergent validity were tested. For convergent validity, total points of the Bournemouth Questionnaire were assessed with the total points of Quebec Back Pain Disability Scale and Roland Morris Disability Questionnaire by using Pearson correlation coefficient analysis. RESULTS: Cronbach alpha value was found 0.914, showing that this questionnaire has high internal consistency. The results of test-retest analysis were varying between 0.851 and 0.927, which shows that test-retest results are highly correlated. Factor analysis test indicated that this questionnaire had one factor. Pearson correlation coefficient of the Bournemouth Questionnaire with Roland Morris Disability Questionnaire was calculated 0.703 and it was found with Quebec Back Pain Disability Scale is 0.659. These results showed that the Bournemouth Questionnaire is very good correlated with Roland Morris Disability Questionnaire and Quebec Back Pain Disability Scale. CONCLUSION: The Turkish version of the Bournemouth Questionnaire is valid and reliable. LEVEL OF EVIDENCE: 3.

Is there a relationship between Eagle Syndrome and cervicofacial painful soft tissue rheumatisms?

OBJECTIVES/HYPOTHESIS: To investigate the incidence of locomotor system pathologies such as myofacial pain syndrome (MPS), fibromyalgia syndrome (FMS), and temporomandibular dysfunction in patients with Eagle Syndrome. STUDY DESIGN: Prospective study. PATIENTS AND METHODS: Fourteen patients with Eagle Syndrome, who were treated surgically, were enrolled in the study. Etiologic factors for cervicofacial pain were assessed, pain status was compared preoperatively and postoperatively using visual analogue scale. Palpation of tonsillar fossa, neck and shoulder examination, neurologic examination, evaluation of occlusion status, trigger points, and painful zones were done. Plain anteroposterior and lateral radiographs of the cervical spine were obtained and the lengths of the transverse processes of the seventh cervical vertebrae were measured bilaterally. RESULTS: MPS, FMS, and temporomandibular dysfunction were diagnosed in 9 (64.3%), 3 (21.4%), and 2 (14.3%) patients, respectively. Visual analogue scale scores decreased significantly after the surgical excision of elongated styloid processes (from 6.7 +/- 2.3 to 2.1 +/- 1.8), and all the complaints except for headache had diminished (P < .05). Lengths of transverse processes of seventh cervical vertebra were found to be correlated with the length of styloid process (right; r = 0.644, P = .024, left; r = 0.616, P = .033). CONCLUSIONS: Cervicofacial pain is a common complaint in patients with Eagle Syndrome. It frequently coexists with rheumatic disorders resulting in chronic pain such as MPS and FMS. Even though Eagle Syndrome is a rare condition, it should be kept in mind in patients suffering from chronic cervicofacial pain that is refractory to treatment. Clinicians should be alert to diagnose and treat coexisting locomotor system disorders.

What leads to unfavourable Cybex test results for quadriceps power after modified tension band osteosynthesis of patellar fractures?

This study recruited 20 patients who had undergone modified tension band wiring for patellar fracture, with a mean follow up of 30 months. Subjects were grouped according to results of Cybex isokinetic testing at 60 degrees /s angular velocity. Subjects with <30% deficit as compared with the contralateral knee constituted group I, and those with >30% similar deficit formed group II. Plain radiography and HSS scoring were also performed. According to patient satisfaction, HSS scoring and Cybex testing, results were good in 80%, 90% and 55% of cases, respectively. Statistical analysis revealed that there were no significant differences between the two groups in terms of age, gender, duration of follow up, fracture type (two-part or comminuted), dominancy, time interval between trauma and surgery, or duration of immobilisation. The number of patients with >1 mm articular incongruity postoperatively was significantly higher in group II, which also had significantly higher incidences of >1 cm thigh atrophy and pain and thus increased deficits. We suggest that articular incongruity should be limited strictly to 1mm in surgery for patellar fractures.

Proximal humeral fractures with minimal displacement treated conservatively.

We reviewed 27 patients with a minimally displaced proximal humeral fracture treated conservatively after a mean follow-up of 25 (12-34) months. All fractures had united. Patients were evaluated using the Constant-Murley scoring system, and isokinetic muscle strength was tested using a Cybex dynamometer. Finally, all shoulders were examined ultrasonographically. The mean Constant score for all patients were 81 (54-100). Twenty-three patients had no or only mild pain, while three had moderate and one severe pain necessitating regular use of oral analgesics. Twenty patients were able to perform all activities of daily living, but seven had mild trouble in overhead activities and weight carrying. Only in one patient, the abduction peak torque equalled the one of the opposite shoulder. In all other patients, the peak torque was lower than, and in 14 patients below, 50%. In nine patients, rotator cuff tears were seen at ultrasonography.

Autonomic nervous system involvement in Behçet's disease.

In this study, R-R interval variation (RRIV) and sympathetic skin response (SSR) were used to evaluate autonomic nervous system (ANS) involvement in 25 patients with Behçet's disease. Normative values of RRIV and SSR were determined in a group of 25 healthy volunteers. R-R interval variation at rest (R%) and during deep breathing (D%), the difference between D% and R% (D-R), and the ratio of D% to R% (D/R) were determined. R-R interval variations did not show a significant difference between patients and the control group. There was a negative correlation with age for R%, D%, and D-R in the control group, but none was found in the patient group. The SSR latencies were two standard deviations above the normal mean values in three patients who described symptoms of autonomic dysfunction. In conclusion, symptoms of autonomic disturbance must be evaluated carefully for a possible involvement of ANS that might occur in Behçet's disease.

Suprascapular nerve block for pain relief in adhesive capsulitis: comparison of 2 different techniques.

OBJECTIVE: To evaluate the clinical effectiveness of 2 suprascapular nerve block techniques in adhesive capsulitis. DESIGN: A single-blinded, randomized, comparative clinical trial. SETTING: Physical medicine and rehabilitation department of a university hospital in Turkey. PARTICIPANTS: Forty-one patients with adhesive capsulitis. INTERVENTIONS: Suprascapular nerve block with patients randomly divided into 2 groups: group A, needle tip guided by superficial bony landmarks, or group B, near-nerve electromyographically guided technique. MAIN OUTCOME MEASURES: Visual analog scale (VAS) score for pain severity and range of motion (ROM) were assessed before the injection and at 10 and 60 minutes after it. RESULTS: Active and passive ROM changes and VAS score changes from baseline were statistically significant for each group (P<.05). Passive ROM changes within time after the injection were statistically significant between the 2 groups in all planes except glenohumeral abduction. Achieved VAS score changes in the groups within time were significantly different from each other (P=.001). The VAS score difference after the suprascapular nerve block was more prominent in the near-nerve electromyography group. CONCLUSION: The near-nerve electromyography technique for suprascapular nerve block was more successful in providing and maintaining pain relief for up to 60 minutes.

Reliability of isokinetic trunk muscle strength measurement.

OBJECTIVE: To determine the intrarater and interrater reliability of reciprocal concentric trunk flexion and extension peak torque values at different angular velocities using the Cybex NORM isokinetic dynamometer. DESIGN: Trunk flexor and extensor muscles of 15 healthy subjects were assessed at 60 degrees/sec and 90 degrees/sec angular velocities. Each subject was tested by two physicians three times, with at least 48 hr between test sessions. Intraclass correlation coefficients were used to determine the intrarater and interrater reliability of the reciprocal concentric trunk flexion and extension peak torques at 60 degrees/sec and 90 degrees/sec angular velocities. RESULTS: For intrarater reliability intraclass correlation coefficients for trunk flexion, peak torque values ranged from 0.89 to 0.95; for the extensors, values ranged from 0.80 to 0.92. The intraclass correlation coefficient values for interrater reliability were also found to be highly reliable, and peak torque values demonstrated intraclass correlation coefficients values that ranged from 0.95 to 0.98. CONCLUSIONS: Reciprocal concentric trunk flexion and extension peak torque measurements at 60 degrees/sec and 90 degrees/sec angular velocities had a high intrarater and interrater reliability with the Cybex NORM isokinetic dynamometer in healthy subjects.

[Evaluation of functional results following surgical treatment of supracondylar femoral fractures]. / Cerrahi olarak tedavi edilen suprakondiler femur kirikli hastalarda fonksiyonel sonuçlarin degerlendirilmesi.

OBJECTIVES: We evaluated functional results of patients who underwent surgical treatment for supracondylar femoral fractures. METHODS: Functional results of surgical treatment for supracondylar femoral fractures were evaluated in 23 patients (14 males, 9 females; mean age 34 years; range 14 to 64 years) with the use of the Neer and HSS (The Hospital for Special Surgery) scoring systems. The strength of the quadriceps muscle was measured using Cybex isokinetic testing. The mean follow-up was 52 months (range 13 to 160 months). RESULTS: The average HSS score was 93.8 (range 68 to 100) and the average Neer score was 90.1 (range 55 to 100). The average losses of extension strength at 60 degrees /s and 180 degrees /s were 27.30% and 22.13%, respectively. Statistically significant correlations were found between the losses of extension strength and the Neer and HSS scores (p<0.01). The results showed that the patient's age and sex, the length of time between trauma occurrence and surgery, immobilization period, and the presence of subjective pain complaints had no significant influence on the HSS and Neer scores and on Cybex isokinetic test results (p>0.05). CONCLUSION: Evaluation of the quadriceps muscle strength with the use of objective tests proved helpful in the determination of functional results of surgery following supracondylar femoral fractures.