Clinical and Ultrasonographic Effectiveness of Two Different Splints Used for the Treatment of Lateral Epicondylitis: A Prospective Randomized Controlled Study.

OBJECTIVE: This study compares the clinical and ultrasonographic efficacy of 2 splint types, the lateral epicondylitis band (LEB) and the wrist extensor splint (WES), for treatment of lateral epicondylitis (LE). DESIGN: Randomized controlled single-blind trial. SETTING: Outpatient clinic. PARTICIPANTS: 159 participants diagnosed with unilateral LE based on clinical and ultrasonographic findings, and 2-12 weeks from symptom onset, were included (N=159). INTERVENTIONS: One group received joint-protection education-only (wait-and-see), while the other 2 groups were fit with splints: one the LEB and the other the WES. Both splint groups received joint-protection education. MAIN OUTCOME MEASURES: The primary outcome measure was the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire. Secondary outcome measures were the Visual Analog Scale (VAS) for pain, hand grip strength by dynamometry, algometric measurements, patient satisfaction, and selected ultrasonographic parameters (maximum tendon thickness measurements (MTTM) in the capitellar-radiocapitellar region and total ultrasonography scale score [TUSS]). All outcomes were assessed at baseline, 3-weeks, and 6-weeks post intervention initiation. RESULTS: Participants' mean age was 46.85±8.63 years. Of the participants, 40.88% (n=65) were male and 59.12% (n=94) were female. The baseline median (1Q-3Q) values of PRTEE-total scores were 58.5 (51-68) for the LEB, 63.5 (56.25-70.25) for the WES and 57 (48-68) for the education-only groups. At 6-weeks, the PRTEE-total scores had decreased by 44 points for those randomized to the LEB, 46 points to the WES and 7 points in the education-only groups(P<.001). While the LEB and WES approaches were superior to the wait-and-see approach in algometric measurements, VAS, and PRTEE scores (P<.05), no significant changes were found in MTTM and TUSS values. The LEB group was superior to the WES group in hand grip strength and patient satisfaction (P<.05). CONCLUSION: Using either splint for 6 weeks can be considered effective for the relief of pain and increased functionality in persons with subacute LE, although the LEB had a more positive effect on grip strength and patient satisfaction than the WES.

The effect of arthroscopic coracoplasty on subscapularis strength in cases of subcoracoid impingement in the absence of subscapularis tear.

Subcoracoid impingement leads to anterior shoulder pain, and arthroscopic subcoracoid decompression (coracoplasty) is the preferred treatment in recalcitrant cases. The purpose of the present study was to evaluate the effect of coracoplasty on the severity of anterior shoulder pain and the strength of the subscapularis muscle and to correlate it with the preoperative and postoperative coracohumeral distance (CHD) (t:transverse, s:sagittal). Sixteen patients without any subscapularis tendon tears who underwent arthroscopic subcoracoid decompression and rotator cuff repair with 2 years follow-up were included. Preoperative and postoperative 2-year assessments of function and pain were performed using the modified Kennedy-Hawkins test, power grading of various subscapularis muscle tests, and ASES scores. Preoperative and postoperative coracohumeral distance (tCHD, sCHD) and coracoid overlap (CO) were measured using MRIs before and after surgery. The Mean Hawkins pain score and coracoid overlap were decreased. The strength scores for subscapularis strength testing, ASES score, maximum degree of internal rotation, and coracohumeral distance increased (P < .05). Changes in belly press strength were negatively correlated with postoperative tCHD (r = -0.6, P = .04) and postoperative sCHD (r = -0.7, P = .008). A significant increase in the internal rotation range of the shoulder, subscapularis strength, and relief of anterior shoulder pain was observed. However, this increase was inversely proportional to the postoperative CHD, indicating the mechanical effect of the coracoid on subscapularis strength.

Identification of Myofascial Trigger Point Using the Combination of Texture Analysis in B-Mode Ultrasound with Machine Learning Classifiers.

Myofascial pain syndrome is a chronic pain disorder characterized by myofascial trigger points (MTrPs). Quantitative ultrasound (US) techniques can be used to discriminate MTrPs from healthy muscle. In this study, 90 B-mode US images of upper trapezius muscles were collected from 63 participants (left and/or right side(s)). Four texture feature approaches (individually and a combination of them) were employed that focused on identifying spots, and edges were used to explore the discrimination between the three groups: active MTrPs (n = 30), latent MTrPs (n = 30), and healthy muscle (n = 30). Machine learning (ML) and one-way analysis of variance were used to investigate the discrimination ability of the different approaches. Statistically significant results were seen in almost all examined features for each texture feature approach, but, in contrast, ML techniques struggled to produce robust discrimination. The ML techniques showed that two texture features (i.e., correlation and mean) within the combination of texture features were most important in classifying the three groups. This discrepancy between traditional statistical analysis and ML techniques prompts the need for further investigation of texture-based approaches in US for the discrimination of MTrPs.

Myofascial Trigger Point Identification in B-Mode Ultrasound: Texture Analysis Versus a Convolutional Neural Network Approach.

OBJECTIVE: Myofascial pain syndrome (MPS) is one of the most common causes of chronic pain and affects a large portion of patients seen in specialty pain centers as well as primary care clinics. Diagnosis of MPS relies heavily on a clinician's ability to identify the presence of a myofascial trigger point (MTrP). Ultrasound can help, but requires the user to be experienced in ultrasound. Thus, this study investigates the use of texture features and deep learning strategies for the automatic identification of muscle with MTrPs (i.e., active and latent MTrPs) from normal (i.e., no MTrP) muscle. METHODS: Participants (n = 201) were recruited from Toronto Rehabilitation Institute, and ultrasound videos of their trapezius muscles were acquired. This new data set consists of 1344 images (248 active, 120 latent, 976 normal) collected from these videos. For texture analysis, several features were investigated with varying parameters (i.e., region of interest size, feature type and pixel pair relationships). Convolutional neural networks (CNN) were also applied to observe the performance of deep learning approaches. Performance was evaluated based on the classification accuracy, micro F1-score, sensitivity, specificity, positive predictive value and negative predictive value. RESULTS: The best CNN approach was able to differentiate between muscles with and without MTrPs better than the best texture feature approach, with F1-scores of 0.7299 and 0.7135, respectively. CONCLUSION: The results of this study reveal the challenges associated with MTrP identification and the potential and shortcomings of CNN and radiomics approaches in detail.

SARcopenia Assessment in Hypertension: The SARAH Study.

OBJECTIVES: The aims of the study were to investigate the relationship between sarcopenia and renin-angiotensin system-related disorders and to explore the effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on muscle mass/function and physical performance. DESIGN: This multicenter, cross-sectional study was performed using ISarcoPRM algorithm for the diagnosis of sarcopenia. RESULTS: Of the 2613 participants (mean age = 61.0 ± 9.5 yrs), 1775 (67.9%) were hypertensive. All sarcopenia-related parameters (except chair stand test in males) were worse in hypertensive group than in normotensive group (all P < 0.05). When clinical/potential confounders were adjusted, hypertension was found to be an independent predictor of sarcopenia in males (odds ratio = 2.403 [95% confidence interval = 1.514-3.813]) and females (odds ratio = 1.906 [95% confidence interval = 1.328-2.734], both P < 0.001). After adjusting for confounding factors, we found that all sarcopenia-related parameters (except grip strength and chair stand test in males) were independently/negatively related to hypertension (all P < 0.05). In females, angiotensin-converting enzyme inhibitors users had higher grip strength and chair stand test performance values but had lower anterior thigh muscle thickness and gait speed values, as compared with those using angiotensin II receptor blockers (all P < 0.05). CONCLUSIONS: Hypertension was associated with increased risk of sarcopenia at least 2 times. Among antihypertensives, while angiotensin-converting enzyme inhibitors had higher muscle function values, angiotensin II receptor blockers had higher muscle mass and physical performance values only in females.

Adherence to Compression Garment Wear and Associated Factors Among Patients with Breast Cancer-Related Lymphedema: A Pilot Study from a Turkish Tertiary Center.

Background: Compression garments are the basis of the maintenance phase of the breast cancer-related lymphedema (BCRL) treatment. The aim of this study is to investigate the adherence to compression garment wear and the associated factors among patients with BCRL. Methods and Results: Patients who received standard therapy and training on compression garment wear from a single center were asked to fill out a 28-item questionnaire on compression garment wear. Adherence to compression garment wear and the associated factors were examined. These factors were compared between patients who were wearing and who were not wearing compression garments as recommended. The study was completed with 60 patients. Twenty-five percent of the patients used custom-made compression garment. The rate of patients wearing compression garments as per recommendation was 51.7% (n = 31). The most common reasons for not wearing/discontinuation included functional difficulties in daily life (33%) and discomfort (28.8%). Compared according to the factors with potential impact on wearing, the rate of garment wear as per recommendation was statistically significantly higher in patients who had modified radical mastectomy than in those who had breast-conserving surgery (p = 0.038). Conclusion: Although standard information was provided to the patients, the adherence to compression garments was nonoptimal. The economic status of the patients is one of the main factors affecting the choice of compression garments and thus their adherence. To improve the adherence to this method, which is the basis of maintenance treatment of lymphedema, training programs to reduce patient beliefs and anxiety that are tailored to individual needs can be useful. Clinical trial registration number: NCT04832386.

A multi-center, double-blind, randomized parallel-group Phase IV study comparing the efficacy and safety of thiocolchicoside ointment versus placebo in patients with chronic mechanical low back pain and an acute muscle spasm.

Objectives: This study aims to evaluate the efficacy and safety of thiocolchicoside (TCC) ointment treatment compared to placebo in patients with chronic mechanical low back pain (LBP) accompanied by acute muscle spasms. Patients and methods: A total of 292 adult patients (106 males, 186 females; mean age: 38.5±11.2 years; range, 18 to 64 years) were randomized to TCC group (n=147) and placebo group (n=145) in 12 centers between March 2020 and March 2021. Eight patients from each group were excluded from the analysis. The primary endpoint was pressure pain threshold (PPT) on Day 3, which was measured using a pressure algometer. Secondary endpoints were PPT on Day 7, patient, and physician Visual Analog Scales-pain (VAS-pain) on Days 3 and 7, and safety. Results: The PPT values on Day 3 was not significantly different between the treatment groups (p=0.701). Similarly, TCC and placebo group had similar VAS-pain scores over trial period (p=0.577 or higher for comparisons). Significantly higher PPT values and lower VAS-pain scores on Days 3 and 7 were observed in both groups (p<0.001 for all). In patients with a PPT value of ≥3.87, TCC arm had higher PPT on Day 3 compared to placebo (p=0.029). Three patients (two in the TCC arm and one in the placebo arm) discontinued the trial due to an adverse event. Conclusion: Topical TCC can be an appropriate option in a subset of patients with mild chronic LBP accompanied by muscle spasms. In a subset of patients with milder pain intensity, topical TCC may improve pain earlier. The results of this trial are compatible with the treatment approaches used in daily practice.

Effectiveness of training about kinesiotaping in myofascial pain syndrome: A prospective, single-blind, randomized-controlled study.

OBJECTIVES: In this study, we aimed to investigate whether there was any difference in kinesiotaping (KT) application on the upper trapezius muscle between a trained and untrained physiatrist in the management of patients with myofascial pain syndrome (MPS). PATIENTS AND METHODS: Between April 2013 and July 2015, a total of 45 patients (44 females, 1 males; mean age 31.9±8.0 years; range, 18 to 55 years) with MPS were included in this prospective, single-blind, randomized-controlled study. The patients were randomly divided into two groups. The first group (intervention group, n=24) was administered KT band with the muscle in a tense condition according to the muscle technique performed by a trained physiatrist, from the muscle origo toward its insertion point. The second group (control group, n=21) received no technique and KT was applied to the painful area by an untrained physiatrist using a randomly selected method. Primary outcome measures were pain at rest, during activity (0-10 cm visual analog scale), and threshold measurement with algometry (kg/cm2). Secondary outcome measures were function (Neck Pain and Disability Scale), degree of palpable muscle spasm, and quality of life (Nottingham Health Profile). All evaluations were performed at baseline, at three and six weeks after the treatment. RESULTS: There were significant improvements in all parameters in both groups. There were no significant differences in any parameters at six weeks. We demonstrated that KT, which was applied on active trigger points on the upper trapezius muscle by trained and untrained physiatrists, improved pain, palpable muscle spasm, neck function, quality of life, and patient satisfaction degree in patients with MPS. CONCLUSION: Our study results show that KT, which is applied by trained and untrained physiatrists, improves pain, palpable muscle spasm, neck function, quality of life in patients with MPS.

The relationship between scoliosis and upper extremity functions in patients with Duchenne muscular dystrophy.

OBJECTIVES: The aim of this study was to investigate the relationship between scoliosis and upper extremity functions in patients with Duchenne muscular dystrophy (DMD). PATIENTS AND METHODS: Between January 2018 and July 2018, a total of 55 patients (54 males, 1 female; mean age: 9.9±2.9 years; range, 6 to 15 years) who were diagnosed with DMD based on the clinical, laboratory, muscle biopsy and molecular analysis results were included in this cross-sectional study. Scoliosis was evaluated and Cobb angles were measured. Functional Ambulation Scale and Brooke and Vignos scale scores were recorded. The ABILHAND-Kids questionnaire and Nine-Hole Peg Test (9-HPT) were used to assess the upper extremity functions. Hand grip strengths were also evaluated. RESULTS: The median ABILHAND-Kids scores and the hand grip strength values of the patients without scoliosis were significantly higher compared to those with scoliosis (p=0.002 and p=0.004 for right hand and p=0.012 for left hand, respectively). There was no statistically significant difference in the 9-HPT scores between the patients with and without scoliosis (p>0.05). We found a negative, significant correlation between the Cobb angle and ABILHAND-Kids scores in patients with scoliosis (r=-0.503; p=0.017). CONCLUSION: Our study results show a moderate relationship between scoliosis and upper extremity functions. Scoliosis may adversely affect upper extremity functions in patients with DMD.

Diagnostic Contribution of Ultrasonography in Breast Cancer-Related Lymphedema.

Background: Many assessments have been reported and used in evaluating lymphedema. The aim of this study was to investigate the diagnostic contribution of ultrasonography in unilateral breast cancer-related lymphedema. Methods and Results: Upper extremity circumferences were measured with a measuring tape from ulnar styloid at the wrist to the axilla at 4 cm intervals. The point with the highest difference between the upper extremities and the control point with no difference between the lower extremities were marked. Skin and subcutaneous thicknesses were measured from four quadrants (volar medial-lateral and dorsal medial-lateral) at the marked points and also subcutaneous tissue changes were graded according to the subcutaneous echogenicity grade (SEG) scale ultrasonographically. The correlations between circumferential and ultrasonographic measurements were investigated. Receiver operating characteristic curve analysis was made to estimate the diagnostic accuracy of the difference in ultrasonographic subcutaneous thickness measurements between the two arms. The study was completed with 34 female patients. Circumferential and subcutaneous tissue thickness measurements were moderately positively correlated in the volar quadrants and strongly positively correlated in the dorsal quadrants of the affected extremity. In the unaffected extremity, a strong positive correlation was identified in all quadrants. The clinical stages of lymphedema and SEG were weakly positively correlated in the volar medial quadrant. The difference between the two upper extremities was found to have a high (0.83%) sensitivity, and an acceptable (0.75%) specificity in the differentiation of Grade II and Grade III lymphedema. Conclusion: A correlation was established between circumferential measurements and ultrasonographic measurements. Ultrasonography can be used complementary to circumferential measurements in diagnosing lymphedema. Clinical trial registration number: NCT04213001.

Reliability and Validity of the Turkish Version of the ABILHAND-Kids Survey in Children with Cerebral Palsy.

OBJECTIVES: The aim of the present study is to develop a Turkish version of the ABILHAND-Kids Survey, which evaluates upper extremity function in children with cerebral palsy (CP), and to carry out a validity and reliability study of the survey for Turkish CP patients. MATERIALS AND METHODS: Between November 2016 and March 2017, a total of 109 pediatric CP patients (62 males, 47 females; mean age 9.3±2.9 years; range, 6 to 15 years) followed in our outpatient clinic were included. The demographic characteristics and type of CP of the patients were recorded. A functional evaluation was made using the ABILHAND-Kids and Manual Ability Classification System (MACS) surveys. The reliability of the surveys was tested based on internal consistency (Cronbach's α) and test-retest (intraclass correlation coefficient [ICC]) methods. The validity of the approach was evaluated using converted scores from an ABILHAND-Kids Rasch analysis and a correlation of the MACS levels. RESULTS: The ICC value for the test/retest reliability was 0.98 and internal consistency was 0.94. A strong negative correlation was found between the Turkish version of the ABILHAND-Kids and MACS surveys (r=-0.849; p<0.001). A Rasch analysis indicated good item fit, unidimensionality, and model fit. CONCLUSION: The Turkish version of the ABILHAND-Kids survey is a reliable and valid scale for the assessment of manual ability in Turkish children with CP.

Addiction of smartphones and related finger deformities: A case report.

Widespread and excessive use of smartphones is very common, and its overuse is associated with several health-related conditions. A 58-year-old man presented with a spontaneous swan-neck deformity of the third digit. On his physical examination, full passive range of motion of the finger was achieved, while active range of motion was limited due to pain. Laboratory test results were normal. Ultrasonographic imaging demonstrated digital extensor tenosynovitis of the second, third, fourth, and fifth digits. Plain radiographs of bilateral hands were normal. Magnetic resonance imaging of the affected hand revealed no mass lesion. He attended to the hand rehabilitation program. At the end of the program, his pain decreased, and he was easily able to do the finger range of motion exercises. In conclusion, smartphone addiction has an adverse influence on hand function and pinch strength. Youngsters should be aware of the harmful effects which may result from smartphone overuse.

The effectiveness of pulsed ultrasound treatment on pain, function, synovial sac thickness and femoral cartilage thickness in patients with knee osteoarthritis: a randomized, double-blind clinical, controlled study.

OBJECTIVE: This study aims to investigate the efficacy of therapeutic pulsed ultrasound on pain, function, synovial sac and femoral cartilage in knee osteoarthritis. DESIGN: Randomized, double-blind, controlled study. SETTING: Dokuz Eylul University, Department of Physical Medicine and Rehabilitation. SUBJECTS: A total of 96 patients with knee osteoarthritis. INTERVENTIONS: Participants were randomized into two groups; Group I (n = 48, pulsed ultrasound) and Group II (n = 48, sham ultrasound). The sessions were held three times a week for 8 weeks. The study continued for 12 weeks (with 4 weeks follow-up). All participants performed exercises at home for 12 weeks. MAIN MEASURES: Knee pain (at rest and ADLs) was assessed using the visual analog scale (VAS). Functionality was assessed using the Timed Up and Go test and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaire. Femoral cartilage and synovial sac thickness was measured using ultrasonography. All evaluations were performed at the baseline, at the 8 and 12 weeks after baseline. RESULTS: The study was completed with a total of 75 patients (n = 39 in group I and n = 36 in group II). The mean (SD) pain at ADLs score at baseline and week 12 was 7.2 (2.1), with 3.6 (2.9) in the group I, and 6.7 (2.0) and 4.3 (2.2) in the group II, respectively. Both groups presented significant improvements in terms of pain and function (P < 0.001). There was no difference between groups for any parameters. CONCLUSION: Treatment of pulsed ultrasound has no positive effect on knee pain, function, femoral cartilage and synovial sac thickness in knee osteoarthritis.

The Effects of Multifaceted Ergonomic Interventions on Musculoskeletal Complaints in Intensive Care Units.

Working at intensive care units (ICUs) is considered a risk factor for developing musculoskeletal complaints (MSC). This study was conducted between January 2017 and June 2019 in two ICUs of a university hospital. It was designed as a pre- and post-assessment of the intervention group (IG) (N = 27) compared with a control group (CG) (N = 23) to determine the effects of a multifaceted ergonomics intervention program in reducing MSC. The IG (N: 35) received a multifaceted ergonomic intervention program, which was implemented by an ERGO team over an 18 month period. Four ergonomic interventions were planned as follows: individual level interventions such as training; stretching exercises and motivation meetings; administrative intervention such as a daily 10 min stretching exercises break; engineering interventions such as lifting and usage of auxiliary devices. The CG (N:29) did not receive any intervention. Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) was used to assess MSC in both groups. At the start of the intervention, both groups were similar concerning the number of visits to doctors due to MSC, the number of sick leave days, and total CMDQ scores (p > 0.05 for all). Two factor repeated ANOVA measures were performed for between-groups and within-group analyses. The mean of the initial CMSDQ total scores in both groups increased significantly in the 18th month (p < 0.001). However, the interaction effect of group and time (between and within factors) was not significant (p = 0.992). Work-related MSC is a common occupational health problem among nurses. This study showed that individual-level interventions are not likely to succeed in eliminating manual patient lifting by nurses. Our results suggested that interventions without administrative measures might have limited success.

Efficiency of pulsed electromagnetic fields on pain, disability, anxiety, depression, and quality of life in patients with cervical disc herniation: a randomized controlled study

Background/aim: In this study, it was aimed to investigate the effects ofpulsed electromagnetic field(PEMF) therapy on pain, disability, psychological state, and quality of life in cervical disc herniation. Materials and methods: Patients were randomly divided into two groups, including Group 1, which received a therapy consisting of transcutaneous electrical nerve stimulation (TENS), hot pack (HP), and PEMF, and Group 2, which received a magnetic field (sham magnetic field) without current flow in addition to TENS and HP therapy. Pain was assessed by a visual analog scale (VAS, 0­10 cm). The other outcome measures were function (Neck Pain and Disability Scale), anxiety-depressive mood (Hospital Anxiety and Depression Scale), and quality of life (Nottingham Health Profile). All evaluations were performed at baseline, in the 3rd week, and in the 12th week after treatment. Results: A significant improvement was found in the neck pain, disability, depression, anxiety, and quality of life scores of both groups after treatment when compared to those before treatment. However, in the comparison between changes within groups, significant improvements were determined only in the VAS and Nottingham Health Profile sleep subparameter in the 12th week after treatment compared to those before treatment. Conclusion: PEMF therapy in cervical disc herniation can be used safely in routine treatment in addition to conventional physical therapy modalities.

An investigation into the effects of kinesiotaping for posture correction on kyphosis angle, pain, and balance in patients with postmenopausal osteoporosis-associated thoracic kyphosis.

Although positive effect of kinesiotaping in reducing back pain in addition to exercise was observed in 6-week follow-up, no additional contribution to exercise was demonstrated in kyphosis angle and balance assessment. Instantaneous positive effect of taping was observed in kyphosis angle and static balance measurement using a SportKAT device measurements 30 min after taping. OBJECTIVE: The present study aims to investigate whether kinesiotaping for posture correction in patients with osteoporosis-related increased kyphosis provides additional benefits to routine osteoporosis and balance exercises in reducing dorsal kyphosis angle, pain, and balance. METHOD: A single-center, parallel-group randomized controlled trial with unblinded assessments at baseline, week 3, and week 6 and additional measures 30 min immediately after taping in intervention group only. Forty-two female osteoporotic patients with hyperkyphosis were enrolled and randomized into 2 groups. The intervention group received an exercise program plus 3 sessions of kinesiotaping over the upper back; the control group received only an exercise program. The primary outcome measure was dorsal kyphosis angle, measured using a digital inclinometer. Secondary outcome measures were pain assessed on a visual analog scale (VAS 0-10 cm) and balance assessed with the Berg Balance Scale and SportKAT device. RESULTS: The study was conducted on 22 patients with an average age of 64 ± 7.08 in the control group and 20 patients with an average age of 63.1 ± 8.8 in the treatment group. There was not a significant difference when dorsal kyphosis angle of the two groups was compared in terms of the change between the baseline and week 6. The mean change in the control group was 0.86 ± 2 while it was 0.70 ± 1.75 in the intervention group. No significant difference was detected between the groups in terms of balance measurements. Significant differences were seen in favor of the intervention group when the VAS pain scores of the two groups were compared in terms of the change between the baseline and week 3 (p < 0.001) and the baseline and week 6 (p < 0.001), while no such difference was identified when the changes between weeks 3 and 6 were compared between the two groups. A significant effect on dorsal kyphosis angle and balance was also shown in the treatment group 30 min after taping. CONCLUSION: Application of kinesiotaping may have short-term positive effects on pain, but is unlikely to have significant effects on kyphosis angle or balance for women with osteoporosis. Positive changes seen in kyphosis angle and balance 30 min after taping are short-lived.

Ultrasonographic and clinical evaluation of additional contribution of kinesiotaping to tendon and nerve gliding exercises in the treatment of carpal tunnel syndrome

Background and aim: This study aims to ultrasonographically and clinically evaluate the additive contribution of kinesiotaping to tendon and nerve gliding exercises in the treatment of mild or moderate carpal tunnel syndrome (CTS). Materials and methods: Thirty-eight wrists of patients (n = 21) with CTS were randomized into two groups as the intervention group (n = 19) and the control group (n = 19). Tendon and nerve gliding exercises were given to both groups. In the intervention group, additional kinesiotaping was performed three times with 5-day intervals. Functional assessments were performed with the Boston Carpal Tunnel Syndrome Questionnaire and the Moberg pick-up test. Hand grip and pinch strength were evaluated. Cross-section area (CSA) of the median nerve was measured by ultrasonography. All assessments were performed at baseline and at 3 and 6 weeks after treatment. Results: In the intervention group, there was a significant improvement in all clinical assessments and in the CSA of the median nerve at the level of proximal carpal bones. In the control group, a significant improvement was detected in all clinical parameters except grip strength and ultrasonographic measurements. There was no significant difference in the clinical and ultrasonographic findings between the groups at 6 weeks. Conclusion: Kinesiotaping may provide a positive contribution to ultrasonographic and clinical outcomes in the treatment of mild or moderate CTS in the short term.

Is Continuous Passive Motion Effective in Patients with Lymphedema? A Randomized Controlled Trial.

BACKGROUND: In this randomized controlled study, we aimed to evaluate the effect of shoulder flexion exercise using continuous passive motion (CPM) on lymphedema during the treatment of breast cancer-related lymphedema (BCRL). METHODS: Thirty patients with BCRL were enrolled and completed the study. Fourteen patients were treated with complete decongestive therapy (CDT) and CPM in the intervention group, and 16 patients were treated with CDT alone (control group) for 15 sessions. The main outcome measures were included; the shoulder range of motion (ROM) assessed with a goniometer, limb volume difference measured using the water immersion method, function with the Disabilities of the Arm, Shoulder and Hand (DASH), and the quality of life using the Functional Assessment of Cancer Therapy for Breast Cancer (FACT-B4). Lymphedema volume measures were taken at baseline, on days 1, 2, 3, 4, 5, 10, and 15; and shoulder ROM, FACT-B4, and DASH were taken at baseline and on day 15. RESULTS: All subjects were similar at baseline. After treatment significant improvement was found in ROM, volumetric differences, DASH, and FACT-B4 scores in both groups. No significant differences were observed in the volumetric differences, ROM, and the DASH, and FACT-B4 scores between the groups, except for the FACT-B4 physical well-being subscores, which were better in intervention group. CONCLUSION: Our study results showed that CPM did not contribute to the reduction of BCRL.

Skydiving and the risk of cervical disc herniation.

The skydiving/parachuting sport which has recently gained popularity is also known for its accidents and injuries. However, there are a few studies related to its occupational ergonomic risks and occupational musculoskeletal diseases. It has been reported that the sudden hyperextension of the neck during the parachute opening, so called opening shock results in neck pain. It has been found that the jumpers are subjected to an average deceleration of 3-5 times the earth's gravitational acceleration (3-5 G) during parachute opening shock. It is considered that the spinal cord is destabilized by the impact of this force. This study presents the occupational cervical disc herniation occurring in the case of a subject who has been working as a skydiving/parachuting instructor for 25 years, and the ergonomic risks specific to the sports of skydiving. There is a requirement for systematic and representative studies related to the administrative measures to be taken in order to prevent the occupational diseases that may occur in the case of skydivers, the personal protective equipment to be used, and the employee. Int J Occup Med Environ Health 2018;31(2):243-249.