Two-point discrimination assessment of the upper extremities of healthy young Turkish individuals.

Objectives: This study aims to measure the two-point discrimination (TPD) values of the upper extremities of healthy young Turkish individuals. Patients and methods: Between March 2016 and June 2016, a total of 60 healthy students (31 males, 29 females; mean age: 22.0±1.7 years; range, 19 to 27 years) were included. Eleven grand upper limb parts which take innervation from the brachial plexus were measured with an esthesiometer. Results: The values at the dominant sides were statistically significantly greater than the non-dominant sides at those areas: upper lateral arm (p=0.001), lower lateral arm (p=0.001), mid-posterior arm (p=0.001), mid-lateral forearm (p=0.001), mid-posterior forearm (p=0.012), skin over the first dorsal interossei muscle (p=0.031), and palmar surface of distal phalanx of the thumb (p=0.045). Both dominant and non-dominant lower lateral arm TPD measurement results increased in males compared to females, indicating a statistically significant difference (p=0.005 and p=0.011, respectively). Also, dominant and non-dominant mid-posterior arm measurement scores were found to statistically significantly increase in males compared to females (p=0.019 and p=0.040, respectively). Conclusion: Our study results show that laterality, with lower values on the non-dominant side, but not the sex, has an effect on TPD. The findings of this study may be useful in establishing the normative data for TPD in the upper extremity parts of healthy young Turkish individuals.

Investigation of asymptomatic intestinal inflammation in ankylosing spondylitis by fecal calprotectin.

BACKGROUND AND STUDY AIMS: This study aimed to investigate the prevalence of intestinal inflammation in patients with ankylosing spondylitis (AS) by assessing fecal calprotectin (FC) levels and comparing them with those in patients with rheumatoid arthritis (RA) and non-inflammatory rheumatic diseases. Our secondary aim was to correlate FC levels with antirheumatic treatment, nonsteroidal anti-inflammatory drug (NSAID) usage, and disease activity measures. PATIENTS AND METHODS: This cross-sectional study included 97 patients with AS fulfilling the modified New York criteria, 48 patients with RA fulfilling the American College of Rheumatology criteria, and 49 patients with non-inflammatory rheumatic diseases. All patients were questioned about intestinal complaints, and symptomatic patients were excluded. Disease activity was measured in the AS and RA patient groups. RESULTS: The AS group had a significantly higher FC test positivity rate than the RA group (p = 0.016). Furthermore, the AS group had FC levels that were negatively correlated with disease duration (p = 0.04). FC levels were not correlated with any disease activity index, erythrocyte sedimentation rate, C-reactive protein, uveitis, or peripheral arthritis. Patients with AS who used NSAIDs had significantly higher FC levels than nonusers (p = 0.001). CONCLUSIONS: This study revealed that 11% of patients with AS without intestinal complaints had elevated FC levels. FC levels were not correlated with disease activity in AS. Subclinical intestinal inflammation was higher in the early stages of AS. The AS group had a significantly higher FC test positivity than the RA group. In the AS group, NSAID users had significantly higher FC levels than nonusers; thus, no statistically significant difference was observed between biological agent users and nonusers.

Two-point discrimination assessment of the lower extremities of healthy young Turkish individuals.

OBJECTIVES: To investigate the normative two-point discrimination (TPD) values of the lower extremities of healthy young Turkish individuals. PATIENTS AND METHODS: Fifty-five healthy, young adults were recruited in this prospective study. Ten lower extremity parts were tested with esthesiometer: proximal thigh, midlateral thigh, midmedial thigh, midposterior thigh, proximal lateral leg, distal lateral leg, medial leg, the tip of great toe, skin over 1-2 metatarsal interspace, skin over 5th metatars at both dominant and non-dominant sides. RESULTS: There were 27 (49.1%) female and 28 (50.9%) male participants with a mean age of 22.06 ± 1.76 years. The reference values of the TPD of the lower extremities were between 42.4 ± 5.4 mm and 4.0 ± 1.3 mm by females and between 42.6 ± 6.4 mm and 4.4 ± 2.4 mm by males. Test values in the combined group of men and women were statistically greater at the dominant sides than the non-dominant sides at the following areas: proximal lateral leg (p = 0.01), distal lateral leg (p = 0.046), medial leg (p = 0.001), tip of great toe (p = 0.02), skin over 1-2 metatarsal interspace (p = 0.010), skin over 5th metatars (p = 0.002). There was no statistical difference in the test scores of men and women in any of the measured areas, with additional evaluation of both the dominant and the non-dominant sides (p > 0.05). CONCLUSION: The results of the present study demonstrated that TPD ability varied in different skin areas within the same individual. We found that laterality, though with lower scores on the non-dominant side in some lower extremity parts, but not the gender had an effect on TPD.

The efficacy of mirror therapy in patients with adhesive capsulitis: A randomized, prospective, controlled study.

OBJECTIVE: To investigate the effect of mirror therapy (MT) in conjunction with a standard physical therapy program on shoulder range of motion (ROM), pain and quality of life in patients with adhesive capsulitis (AC). METHOD: This prospective, randomized, controlled, single blind study included 30 patients with AC who were scheduled to undergo 10 sessions of standard physical therapy. The participants were divided into two identical groups, namely, The MT group and the control group. After each session, the MT group underwent active ROM exercises with the reflective side of the mirror while the control group underwent active ROM exercises with the non-reflective side of the mirror. Pre-treatment and post-treatment shoulder pain (VAS), shoulder function (UCLA shoulder scale) and quality of life (SF-36) were assessed, and active and passive ROM were quantified with a goniometer. RESULTS: Both groups revealed a significant reduction of shoulder pain and significant improvement of shoulder function, active and passive ROM, and quality of life after the treatment. Post-treatment measurements showed that the MT group had a significantly lower amount of pain compared to the control group (p= 0.007). The UCLA scores were significantly higher in the MT group (p= 0.003). The MT group had significantly better post-treatment active flexion, active abduction, passive flexion, and passive abduction values (p= 0.001, p= 0.02, p= 0.002, and p= 0.02, respectively). The MT group had significant post-treatment improvement in physical function, physical role limitation and emotional role limitation, and pain parameters including SF-36 (p= 0.003, p= 0.01, p= 0.015, and p= 0.002, respectively). CONCLUSION: MT in conjunction with physical therapy appears to be an effective treatment modality that reduces shoulder pain and improves shoulder ROM, shoulder function, and quality of life among patients with AC.

The Effect of Associated Parkinsonism on Rehabilitation in Stroke Patients: A Case Series.

Stroke and Parkinson's disease are 2 major causes of movement impairment and a decreased ability to perform daily activities. The aim of this case series was to demonstrate the difficulty of rehabilitation in stroke patients with accompanying parkinsonism. Four stroke patients with parkinsonism who underwent rehabilitation at the Physical Medicine and Rehabilitation Clinic between March and May of 2016 were evaluated. The Standardized Mini-Mental State Examination (SMMSE), the Functional Independence Measure (FIM), the Barthel Index (BI), the Berg Balance Scale (BBS), and the Stroke Impact Scale version 3.0 (SIS) were used in the assessment. Of the 4 patients, 3 were female, and the mean age was 74.5±9.3 years. The mean hospital stay was 19±5.3 days. The initial test scores recorded were low, and they remained low at the time of discharge. After rehabilitation, the mean FIM score in the group was 42% of the maximum possible score, the mean SMMSE was 55%, the BI was 18%, the BBS was 0.08%, and the SIS was 25%. Three patients required a wheelchair, and 1 patient could ambulate with a walker at discharge. A stroke accompanied by parkinsonism negatively affects mobility and functional status, primarily through the deterioration of balance. In this study, cognitive function was reduced to half of the maximum, and the balance and function loss was more than 50%. Barthel index; berg balance scale; functional independence measure; mini-mental state examination; parkinsonism; stroke; stroke impact scale.

Evaluation of the internal oblique, external oblique, and transversus abdominalis muscles in patients with ankylosing spondylitis: an ultrasonographic study.

The objectives of the study are to compare abdominal muscle thickness in ankylosing spondylitis (AS) patients with healthy subjects and determine the factors affecting these muscle thickness. Thirty-five male patients with a previous diagnosis of AS according to the Modified New York criteria and a control group consisting of 35 healthy male individuals were included in this cross-sectional and case-control study. Thicknesses of the internal oblique (IO), external oblique (EO), and transversus abdominalis (TrA) muscles were measured with ultrasound (US). AS patients were classified according to the International Physical Activity Questionnaire (IPAQ). There were 35 AS patients with a mean age of 35.17 ± 8.05 years and 35 healthy subjects with a mean age 32.57 ± 7.05 years. No significant difference was observed between the groups in terms of abdominal muscle thicknesses (p > 0.005). When the AS patients were classified according to the IPAQ scores, thicknesses of the IO and TrA muscles were significantly lower in patients who had the low level of IPAQ scores (p < 0.05). In the light of our first and preliminary results, muscle thickness of the IO, EO, and TrA muscles were similar in AS patients to healthy subjects. However, AS patients who had lower level of physical activity have also reduced thickness of IO and TrA muscles.

Medial calcaneal neuropathy: A rare cause of prolonged heel pain.

Pain heel constitutes 15% of foot pain. Pain may be caused by plantar fasciitis, calcaneal fractures, calcaneal apophysitis, heel pad atrophy, inflammatory diseases or related with nerve involvement. Tibial, plantar and/or medial nerve entrapment are the neural causes of pain. Most of the heel soft tissue sensation is provided by medial calcaneal nerve. Diagnosis of heel pain due to neural causes depends on history and a careful examination. Surgery should not be undertaken before excluding other causes of heel pain. Diagnosis should be reconsidered following conservative therapy.

Psychometric characteristics of Duruoz Hand Index in patients with traumatic hand flexor tendon injuries.

INTRODUCTION: The aim of the study was to assess reliability, validity and responsiveness of Duruoz Hand Index (DHI), which has been developed for evaluation of activity limitation in rheumatoid arthritis in patients with traumatic hand flexor tendon injuries. MATERIAL AND METHOD: Sixty-five patients older than 16 years who underwent surgical intervention after flexor tendon injuries were enrolled. Reliability was assessed by internal consistency (with Cronbach's-α) and test-retest intraclass correlation coefficient (ICC). Construct validity was estimated correlating the scale with the DASH and VAS-hd. Also responsiveness was estimated using standardised response mean (SRM) and effect size (ES). RESULT: Mean age of the patients was 30.25 ±â€Š11.07 years and totally 140 fingers were evaluated. Cronbach's-α and ICC values of DHI were found to be 0.87 and 0.99, respectively. In validation study, highly significant correlation was detected between DHI with DASH and VAS-hd (r = 0.86, r = 0.54, p < 0.0001, respectively). SRM values and ES values (excepting workplaces subgroup score) were higher than 0.80 for total and all subgroup scores. CONCLUSION: DHI is a reliable, valid questionnaire to assess hand-related activity limitation in patients with traumatic hand flexor tendon injuries. Also, due to its high level responsiveness DHI can be used for assessing the clinical course of the traumatic hand flexor tendon injured patient.

[Characteristics of pediatric hand injuries followed up in a hand rehabilitation unit]. / El rehabilitasyon ünitesinde izlenen el yaralanmali pediyatrik hastalarin özellikleri.

BACKGROUND: To establish the characteristics of patients in pediatric age who have been referred to hand rehabilitation center since 1998. METHODS: The patients were screened retrospectively and those within 0-16 age range were included into the study (178 patients; 126 males [70.8%], 52 females [29.2]; mean age 10.33+/-4.45; range 0 to 16 years). Demographic data, causes and locations of injury and follow-up period (week) were recorded. RESULTS: Mean duration of application for rehabilitation was 5.4+/-0.7 weeks. Only 99 (55.6%) patients could be followed-up for a period more than 4 weeks (20.8+/-22.2 weeks). Types of injuries were categorized as accidental (n=133; 74.7%), intentional (n=29; 16.3%) and congenital (n=15; 8.4%). Accidents were related to domestic (n=109; 61.2%) and environmental causes (n=53; 29.8%). The most frequent domestic accident was glass injury and fall accident. The regions in order of decreasing frequency were wrists, metacarpal bones, proximal phalanges, forearms, elbows, plexus, mid-phalanges, total hands, shoulders, total arm and bilateral hands. Fourth digit was the most frequently injured digit. The most common types of injuries were as followings: flexor tendon cut (44.5%), nerve cut and arterial injuries, fractures and burn contractures. CONCLUSION: Hand injuries occurred mostly in male children, the most frequent type injury was accidental domestic injury of the wrist flexor tendon caused by broken glass fragments and the most frequently injured digit was the 4th and adherence of the patients to the follow-up protocol was unsatisfactory since majority of referrals were out-of-towners.

Quality of life assessments with SF 36 in different musculoskeletal diseases.

The aim of this study is to evaluate comparatively the life quality of patients with knee osteoarthritis (KO), shoulder impingement syndrome(SIS), fibromialgia(FM), or osteoporosis(OP) using SF 36 and establish the impact of these diseases on quality of life (QoL). A total of 193 patients with one of the above-mentioned different diagnoses completed SF 36 scale. The diseases were compared to each other with SF 36 subgroups scores. There were significant differences among patients with KO and SIS, SIS and FM with respect to all SF 36 subgroups scores. According to these assessments, QoL of KO and FM patients was worst than that of SIS. The QoL scores of KO patients were worse than those of FM patients considering the physical function, while QoL scores of FM patients were lower than those of KO patients with respect to their general well-being. Scores of physical function and pain in KO patients were lower than those of OP patients. In domains of social functioning, emotional role, energy, pain, and general health condition QoL of FM patients was worse than that of OP patients. Quality of life of SIS patients was less affected than the patients of the other disease groups. In spite of their young age, FM patients appear to be the group with the worst quality of life scores.