Diagnostic value of ultrasonography in the evaluation of the temporomandibular joint anterior disc displacement.

The aim of the study was to evaluate the extent of agreement between the findings of ultrasonography (US) and magnetic resonance imaging (MRI) in the assessment of anterior disc displacement (ADD), with or without reduction, and to assess the sensitivity, specificity and the accuracy of the US examination in establishing diagnosis. Fifty-two temporomandibular joints (TMJ) in 52 patients with chronic TMJ pain were examined by US and MRI with respect to ADD, with, and without reduction of the TMJ. The level of agreement between US and MRI findings was evaluated. The sensitivity, specificity, and the accuracy of US were found to be respectively 91%, 16% and 82% in the assessment of ADD; 70%, 38% and 57% in ADD with reduction; 50%, 89% and 76% in ADD without reduction. The findings of both methods were in agreement with each other. US method is fairly sensitive especially in detecting ADD, and it is very reliable in determining the absence of ADD without reduction. However, it was not found to be as quite effective in demonstrating ADD whether it was with or without reduction.

Poststroke shoulder pain in Turkish stroke patients: relationship with clinical factors and functional outcomes.

The objective of this study was to assess the possible causes of hemiplegic shoulder pain (HSP) in Turkish patients with stroke, to identify the correlation between HSP and clinical factors, and to review the effects of HSP on functional outcomes. A total of 187 consecutive patients with stroke were evaluated for the presence of HSP and for the possible causes. Each patient was evaluated by clinical, radiographic, and ultrasonographic examination. Daily living activities were assessed using the Functional Independence Measure at admission and at discharge. Patients were divided into two groups, one comprising patients with shoulder pain and the other comprising patients without shoulder pain. They were then compared with respect to clinical characteristics, radiologic findings, and Functional Independence Measure scores. Shoulder pain was present in 114 (61%) patients. Of the 114 patients with pain, 71 patients showed various grades of glenohumeral joint subluxation, 70 patients had complex regional pain syndrome-type I, 70 patients had impingement syndrome, 68 patients had spasticity, 49 patients had adhesive capsulitis, and 10 patients had thalamic pain. No correlation was found between shoulder pain and clinical factors (sex, hemiplegic side, hand dominance, etiologic cause, comorbidities). The relationship between shoulder pain and adhesive capsulitis was significant (P=0.01) and also complex regional pain syndrome-type I was statistically significant (P=0.001). The group without HSP showed significantly more improvement than the group with HSP in functional outcomes (P=0.01) and the hospitalization period was significantly shorter (P=0.03). Shoulder pain is a frequent problem in patients with stroke. It is, however, often difficult to isolate a specific cause and it causes a prolonged hospitalization period and can have a negative effect on functional outcomes.