The effects of scapular mobilization in patients with subacromial impingement syndrome: a randomized, double-blind, placebo-controlled clinical trial.

OBJECTIVE: To determine the effects of scapular mobilization on function, pain, range of motion, and satisfaction in patients with subacromial impingement syndrome (SAIS). DESIGN: Randomized, double-blind, placebo-controlled clinical trial. SETTING: University hospital clinics in Turkey. PARTICIPANTS: 66 participants (mean ± SD age 52.06 ± 3.71 y) with SAIS. INTERVENTIONS: Participants were randomized into 3 groups: scapular mobilization, sham scapular mobilization, and supervised exercise. Before the interventions transcutaneous electrical stimulation and hot pack were applied to all groups. Total intervention duration for all groups was 3 wk with a total of 9 treatment sessions. MAIN OUTCOME MEASURES: Shoulder function and pain intensity were primary outcome measures; range of motion and participant satisfaction were secondary outcome measures. Shoulder function was assessed with the short form of the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH). A visual analog scale was used to evaluate pain severity. Active range of motion was measured with a universal goniometer. A 7-point Likert scale was used to evaluate satisfaction. Outcome measurements were performed at baseline, before visits 5 and 10, 4 wk after visit 9, and 8 wk after visit 9. RESULTS: There was no group difference for DASH score (P = .75), pain at rest (P = .41), pain with activity (P = .45), pain at night (P = .74), and shoulder flexion (P = .65), external rotation (P = .63), and internal rotation (P = .19). There was a significant increase in shoulder motion and function and a significant decrease in pain across time when all groups were combined (P < .001). The level of satisfaction was not significantly different for any of the questions about participant satisfaction between all groups (P > .05). CONCLUSION: There was not a significant advantage of scapular mobilization for shoulder function, pain, range of motion, and satisfaction compared with sham or supervised-exercise groups in patients with SAIS.

Activity performance problems of patients with cardiac diseases and their impact on quality of life.

[Purpose] To describe the functional consequences of patients with cardiac diseases and analyze associations between activity limitations and quality of life. [Subjects and Methods] Seventy subjects (mean age: 60.1±12.0 years) were being treated by Physical Medicine and Rehabilitation and Cardiology Departments were included in the study. Activity limitations and participation restrictions as perceived by the individual were measured by the Canadian Occupational Performance Measure (COPM). The Nottingham Extended Activities of Daily Living (NEADL) Scale was used to describe limitations in daily living activities. To detect the impact of activity limitations on quality of life the Nottingham Health Profile (NHP) was used. [Results] The subjects described 46 different types of problematic activities. The five most identified problems were walking (45.7%), climbing up the stairs (41.4%), bathing (30%), dressing (28.6%) and outings (27.1%). The associations between COPM performance score with all subgroups of NEADL and NHP; total, energy, physical abilities subgroups, were statistically significant. [Conclusion] Our results showed that patients with cardiac diseases reported problems with a wide range of activities, and that also quality of life may be affected by activities of daily living. COPM can be provided as a patient-focused outcome measure, and it may be a useful tool for identifying those problems.

Ulnar nerve conduction abnormalities in carpal tunnel syndrome.

INTRODUCTION: The aim of this study was to verify the involvement of ulnar nerve fibers in cases of carpal tunnel syndrome (CTS) and investigate the correlation between ulnar nerve conduction parameters and extra-median spread of symptoms. METHODS: Electrophysiological studies were conducted in 93 CTS and 76 control hands. Patients were analyzed with regard to symptoms in the fifth finger. RESULTS: In the CTS cases, ulnar distal motor latency (DML) and distal sensory latency (DSL) were significantly longer, and amplitudes were lower than in controls. Increased median nerve DML correlated with increased ulnar nerve DSL and decreased sensory amplitudes and conduction velocities (SCVs). In cases with symptoms in the fifth finger, ulnar nerve SCVs and amplitudes were lower than in patients without symptoms. CONCLUSIONS: Pathological processes leading to median neuropathy in CTS may affect ulnar nerve motor and sensory fibers in the Guyon canal. This may explain the extra-median spread of sensory symptoms in CTS patients.

Risedronate-induced arthritis.

In most cases bisphosphonates are the first choice therapy for osteoporosis. We present a case of acute arthritis associated with once-weekly risedronate in a 58-year-old woman with osteoporosis. She developed arthritis 48 hours after the second dose of oral risedronate with elevated serum acute-phase reactants. There was no evidence of rheumatoid arthritis or seronegative arthritis. Her symptoms resolved rapidly with rest, however, recurred after the patient was rechallenged with the same drug 1 week later. Although the mechanism of this potential side effect remains speculative, it is thought to be as a result of the proinflammatory properties of aminobisphosphonates. With the increasing use of bisphosphonates in the treatment and prevention of osteoporosis, physicians should be well aware of this possible side effect of these drugs.

Influence of synthetic mesh on ilioinguinal nerve motor conduction and chronic groin pain after inguinal herniorrhaphy: a prospective randomized clinical study.

Chronic postherniorrhaphy pain is a significant complication that can ruin a patient's quality of life. Our study aimed to assess the mesh-nerve interactions and the possible effects of this interaction on nerve morphology and function. Ilioinguinal nerve motor transmission studies using electromyelogram (EMG) were performed before the herniorrhaphy procedure, and Lichtenstein (n=50) or Shouldice (n=50) herniorrhaphies were used for repair. At the end of the first year after surgery, we found no significant differences on ilioinguinal nerve motor conduction studies between the mesh and Shouldice groups. We found a significant correlation between EMG results and inguinal pain. Our results indicates that nerve graft contact does not influence nerve motor conduction. The etiology of postherniorrhaphy chronic pain may be caused by nerve injury resulting in dissection or compression of the nerves.

Intraoperative monitoring of a patient with craniovertebral junction meningioma.

Intraoperative monitoring is considered as a useful tool to prevent neurological damage during different neurosurgical procedures. Somatosensory evoked potentials (SEP) allow simultaneous assessment of several cortical and sub cortical centers. In this case presentation, we report intraoperative monitoring of an elderly patient with craniovertebral junction meningioma. Tibial SEP responses were elicited by stimulation of the tibial nerve; the recordings were visually analyzed for the presence of the main peaks P40-N50, peak to peak amplitudes, peak latencies and compared to baseline recordings throughout the procedure. During decompression from the medial aspect of the medulla SEP responses were lost for a brief period of time. Surgeons achieved total tumor removal and the patient left the operating room without any neurological deficit.

Unrecognized peripheral nerve lesions in a traumatic brain injury patient.

Patients with traumatic brain injury constitute a diagnostic challenge since peripheral nerve injuries may be overlooked due to cognitive dysfunction and priority given to life-sustaining measures. Electromyography may be helpful in the differential diagnosis of weakness and atrophy. Problems specific for the traumatic brain injury patients, namely heterotopic ossification, hypertrophic callus formation and myositis ossificans should be considered by the physician. We report a 15-year-old patient involved in a pedestrian motor vehicle accident with traumatic brain injury. He had weakness and atrophy of the left upper extremity. Electromyographic examination revealed axillary nerve injury and carpal tunnel syndrome. Differential diagnosis of atrophy and weakness in traumatic brain injury patients is discussed.

A Comparison of Magnetic Resonance Imaging and Electroneuromyography for Denervated Muscle Diagnosis.

PURPOSE: The aim of this study was to evaluate the diagnostic value of magnetic resonance imaging (MRI) for muscle denervation due to focal lesions of the median nerve and to compare electrophysiological findings with MRI findings. METHODS: Twenty-six patients with electrophysiological studies diagnosed for focal lesions of the median nerve were included in this study. Electrophysiological studies and MRI were conducted on 34 patients' hands. Patients' hands were divided into two groups based on edema findings revealed by the MRI: group 1 (edema-negative group; n = 24) and group 2 (edema-positive group; n = 10). RESULTS: Positive correlations were found between the existence of edema in MRI and fibrillation, positive sharp waves, denervation, and the level of reduced recruitment pattern. In median nerve conduction studies, amplitude of compound muscle action potential and palm-to-wrist segment mixed-nerve action potentials were significantly lower, and also the third-digit wrist sensory nerve conduction velocity and mixed-nerve palm-wrist conduction velocity were significantly slower in group 2. CONCLUSIONS: For muscle denervation resulting from median nerve lesions, MRI findings correlated with electrophysiological findings; further study is required for the use of MRI.

Validity and reliability of a Turkish Brief Pain Inventory Short Form when used to evaluate musculoskeletal pain.

BACKGROUND: The Brief Pain Inventory (BPI) is both a questionnaire and an outcome measure that is used widely in clinical trials to assess pain associated with many conditions. The BPI Short Form has been extensively translated into foreign languages. The aim of this study was to assess the validity and reliability of a Turkish Brief Pain Inventory Short Form (BPI-TR) to evaluate musculoskeletal pain. METHODS: In total, 297 patients with musculoskeletal pain participated in the study. Demographic characteristics and brief medical histories were recorded. Pain intensity was assessed using a visual analogue scale (VAS) and quality-of-life was assessed using the Short Form 36 (SF-36). Pain was evaluated using the BPI-TR in all patients. Internal consistency and test-retest analysis were used to assess reliability. The internal consistency of the scale items was assessed by calculating Cronbach's α value, which was expected to be > 0.7. The criterion validity of the BPI-TR was assessed by correlation with VAS scores. RESULTS: Pain intensity, pain interference, and other components of the Turkish version were consistent with validity thereof. Cronbach's α was 0.84 for pain intensity and 0.89 for pain interference. The extent of BPI-TR and VAS correlation was statistically significant. CONCLUSIONS: The BPI-TR may be used for assessment of musculoskeletal pain.

Effectiveness of Client-Centered Occupational Therapy in Patients With Rheumatoid Arthritis: Exploratory Randomized Controlled Trial.

OBJECTIVES: This study aims to examine the effectiveness of client-centered occupational therapy in patients with rheumatoid arthritis (RA). PATIENTS AND METHODS: The study included 40 patients (2 males, 38 females; range 39 to 60 years) with RA. Patients were divided into two groups as intervention group (n=20) and control group (n=20) by random sampling method. Each group was given 10 sessions of physical therapy program. In addition, the intervention group received client-centered occupational therapy. Patients were evaluated with Turkish versions of Short-Form McGill Pain Questionnaire, Health Assessment Questionnaire, The Arthritis Impact Measurement Scales 2, RA Quality of Life Questionnaire, and Canadian Occupational Performance Measurement. RESULTS: Pain, activity limitation, and participation restriction scores decreased significantly more in the intervention group compared to the control group. Also, quality of life increased significantly in the intervention group (p<0.05). CONCLUSION: Our findings suggest that occupational therapy intervention reduces activity limitation and participation restrictions in patients with RA. Therefore, such interventions may be generalized for this patient group.

Association Between Gender, Body Mass Index, and Ulnar Nerve Entrapment at the Elbow: A Retrospective Study.

INTRODUCTION: Entrapment of the ulnar nerve is the second most common compression neuropathy in the upper extremity, but the etiology is multifactorial and still not clearly understood. The authors aimed to determine whether gender and body mass index (BMI) are risk factors for ulnar nerve entrapment (UNE) at the elbow. METHODS: Results of electrodiagnostic studies performed on patients with UNE between January 2008 and February 2013 were examined retrospectively. Patients with BMI ≤22 were considered slender, those with a BMI between 22 and 29, normal, and those with a BMI >29, overweight. The authors compared the data for patients with and without UNE. RESULTS: A total of 622 subjects were studied; 295 were UNE cases (154 men, 141 women) and 327 were controls (110 men, 217 women). There was no difference between control and UNE groups in terms of BMI. In univariate analysis, age and gender are independent risk factors for UNE, but when included in a stepwise Cox regression model, only gender was a significant factor. Male gender was found to be a risk factor for UNE. CONCLUSIONS: Male gender is a risk factor for developing UNE, but age and BMI are not significant risk factors. Further studies which examine BMI and gender differences with data about occupational risk factors are required.

Sexuality and sexual dysfunction in spinal cord-injured men in Turkey.

BACKGROUND/AIM: To provide a comprehensive evaluation of sexual function and dysfunction in spinal cord-injured men based on self-reports of patients. MATERIALS AND METHODS: Forty-seven spinal cord-injured men who completed the spinal shock and rehabilitation period were included. Patients were asked to complete a questionnaire developed to assess social status, sexual activities, abilities, and sexuality education after injury. Neurologic levels of patients were classified according to American Spinal Cord Injury Association protocol. Erectile function was evaluated by International Index of Erectile Function-5 (IIEF-5) questionnaire. RESULTS: Patients were aged between 20 and 62 years (mean: 35.2). Twenty-eight patients had T10 and above, 15 between T11 and L2, and 4 cauda conus injury. While 61.7% of the patients declared sexual activity, 93.6% declared some degree of erection. Mean IIEF-5 score was 5.3 and 87.3% of the patients had moderate to severe erectile dysfunction. CONCLUSION: Continuation of sexual activity after injury is very important and has a great impact on quality of life and interpersonal relationships for spinal cord-injured men. More attention must be given to sexuality after spinal cord injury. A very high rate of sexual dysfunction in spinal cord-injured patients was found and the importance of sexual education was emphasized in this study.

Isolated posterior malleolus fracture: a rare injury mechanism.

Sprain of the ankle is undoubtedly a common injury during athletic activity, and the sprain can be also associated with fracture of the ankle. Isolated posterior malleolus fracture is a very rare condition, which is usually missed. Here, we are presenting a 37 years old female patient, who suffered injury secondary pressing on brake pedal during collision in a traffic accident. Clinical evaluation is based on Ottawa Ankle Rules and a fracture is diagnosed; patient is started on daily activities at postoperative Week 8. This study aims to emphasize that Ottawa Ankle Rules are usually efficient for evaluating fractures of ankle, but clinicians should always make a detailed physical examination.

The Upper Extremity Functional Index (UEFI): cross-cultural adaptation, reliability, and validity of the Turkish version.

BACKGROUND: Turkish version of the Upper Extremity Functional Index (UEFI) may help to assess shoulder function in patients with shoulder impingement syndrome (SAIS). OBJECTIVE: To translate and cross-culturally adapted UEFI into Turkish and to assess its acceptability, reliability, validity in patients with SAIS. METHODS: This study conducted with 93 SAIS participants. UEFI, the short version of the Disability of the Arm, Shoulder and Hand scale (Quick DASH), the Shoulder Pain and Disability Index, and the Short Form-36 Health Survey (SF-36) were administered. Acceptability was assessed in terms of refusal rate, rates of missing responses, and administration time. Test-retest reliability was assessed with intra class correlation coefficient (ICC), internal consistency was assessed with Cronbach's alpha coefficient. Validity was assessed by floor and ceiling effects, skew of distributions and Pearson's correlation coefficients. RESULTS: Cronbach's alpha coefficients for the UEFI at Time 1 and Time 2 were as follows: α = 0.89 and α = 0.89. Average measure ICC was 0.80. The UEFI score demonstrated strong negative correlations with SPADI total score and Quick DASH score. There was not a significant correlation between the UEFI and mental health subscale score derived from SF-36. CONCLUSIONS: The Turkish version of UEFI is acceptable, valid, and reliable.

Prolonged P300 latency in thyroid failure: a paradox. P300 latency recovers later in mild hypothyroidism than in severe hypothyroidism.

This study was performed to analyze quantitatively the cognitive functions of patients with mild and severe hypothyroidism by measuring P300 event-related evoked potentials before and after euthyroidism was established. Patients diagnosed as having Hashimato's thyroiditis with thyroid stimulating hormone (TSH) levels between 5 and 10 mU/L (mild thyroid failure; n = 24) and those with severe hypothyroidism (n = 13) were enrolled randomly to the study protocol. P300-event related potentials were recorded during thyroid insufficiency, and in the first and sixth month of euthyroidism. P300 latencies were prolonged in both the mild and severe hypothyroid patients compared to controls (p = 0.042, p < 0.001, respectively). The overt hypothyroid patients showed significant decrease in their P300 latencies after the first month of euthyroidism (p = 0.001). These P300 latency values did not differ in the subsequent 6-month period. The mild hypothyroid group, however, displayed no improvement of P300 latency in the first month but normalized at the sixth month of euthyroidism. In conclusion, both the overt and the mild hypothyroid patients revealed prolonged P300 latencies. Unexpectedly, P300 latencies in the patients with mild thyroid failure required more time to recover compared to the overt hypothyroid patients. This finding indicates different clinical outcomes of various thyroid insufficiency states on the brain.

Evaluation of restless legs syndrome in fibromyalgia syndrome: an analysis of quality of sleep and life.

BACKGROUND AND OBJECTIVE: The aim of this study is to find prevalence and severity of restless legs syndrome (RLS) in patients with fibromyalgia syndrome (FMS) and detect effect of FMS and RLS coexistance on quality of sleep and life. METHODS: In this study, presence and severity of RLS were detected in patients with FMS and Pitsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Fibromyalgia Impact Questionnaire (FIQ) scores of all patients were measured. RESULTS: One hundred and fifteen female patients with median age 49 (39.0-57.0)[median (25-75{\%} interquartile range)] were included in the study. In 42.6% of patients RLS coexisting with FMS was found. RLS was classified as moderate in 42.9% of patients and as severe in 49.0% of patients. In patients with FMS ans RLS sleep quality, daytime sleepiness and quality of life were more severely impaired (PSQI scores were 9.0 ± 4.4 vs 7.8 ± 4.3, p=0.003; ESS scores were 5.0(3.0-7.5) vs 3.0(1.0-4.3), p=0.036 and FIQ scores were 68.1 ± 9.8 vs 59.4 ± 16.9, p=0.027) compared to patients with only FMS. Prevalence of RLS was found higher in FMS than normal population and quality of sleep and quality of life were worse in patients with RLS. CONCLUSIONS: Presence of RLS should be investigated in every patient with FMS and treatment plans should also cover RLS in case of coexistance with FMS. Prospective cohort studies are needed for better explanation of FMS and RLS coexistance.

[The relationship between scapular dyskinesia, pain, range of motion, and flexibility in patients with neck and shoulder problems]. / Boyun ve omuz agrili olgularda skapular diskinezi, agri, eklem hareket açikligi ve esneklik arasindaki iliski.

OBJECTIVES: To investigate the relationship between scapular dyskinesia, pain, and flexibility in patients with neck, shoulder, or both injuries. METHODS: A total of 160 patients who came to Baskent University Hospital, Department of Physical Medicine and Rehabilitation with pathology and pain in the neck and shoulder regions were included to our study. Patients were divided into three groups; Neck group, shoulder group and neck+shoulder group. Visual Analog Scale (VAS) for pain intensity, goniometer for range of motion, and tape measurement for evaluation of flexibility was used. Lateral Scapular Slide Test (LSST) and Scapular Retraction Test (SRT) vs Skapular Assisstance Test (SAT) were used for evaluation of scapular dyskinesia. RESULTS: SRT (r=0.617, p=0.000) and SAT (r=0.565, p=0.000) positivity was found to be correlated with dominant and non-dominant sides in patients with neck pathology. Pain at night and during rest were found to correlate with pain during activity in patients with neck+shoulder pathology (r=0.572, p=0.002). No significant correlation was found between pain intensity and scapular dyskinesia in all groups. LSST values were found under 1.5 cm and therefore, scapular mobilization was considered as normal (LSST1=0.76±0.74; LSST2=0.68±0.81; LSST3=0.75±0.75). CONCLUSION: In addition to joint limitations and flexibility, scapular dyskinesia should also be evaluated in order to solve problems related to pain in patients with neck, shoulder and neck+shoulder pathology. In future studies, the classification of groups according to pathology may help to understand the impact of scapular dyskinesia on the pathology of shoulder and neck pain.

Complex decongestive therapy and taping for patients with postmastectomy lymphedema: a randomized controlled study.

PURPOSE: The purpose of our study was to investigate the effects of Kinesio Taping(®) Application with Complex Decongestive Therapy (CDT) in patients with lymphedema. MATERIALS AND METHODS: 45 patients were randomly divided into 3 groups (CDT including Bandage, CDT including Bandage + Kinesio Tape(®), CDT including Kinesio Tape(®) without bandage). Assessments included the severity of the symptoms such as pain, discomfort, heaviness, tension, stiffness and weakness. Bilateral circumference measurements were done for evaluation of the edema. RESULTS: Symptoms were decreased in all three groups (p < 0.05). CDT was found effective only during treatment in arm volume (p < 0.05). Kinesio Taping(®) applied with CDT had effect of decreasing edema after 10 days of treatment period (p < 0.05) and for control period (p < 0.05). Only the application of Kinesio Taping(®) group also had significant decrease at edema (p < 0.05). CONCLUSION: Kinesio Taping(®) Application along with CDT may have a better effect on decreasing lymphedema which can stimulate the reduction of edema for long term effects.

Atypical presentation of cauda equina syndrome secondary to lumbar disc herniation.

The article describes the case of 35 year old female who was admitted to the department with saddle type hypoesthesia, anal incontinence without muscle weakness of lower extremities and sciatica. Central lumbar disc herniation (LDH) was determined on level L5-S1 level and the patient was operated thereafter. In the postoperative period, the patient did not have any muscle weakness of leg but had residual saddle type sensory loss and sphincter dysfunction. This article discusses atypical presentation of cauda equina syndrome (CES) secondary to LDH. Early diagnosis and surgery are important factors for a better prognosis in CES.

Is there a relationship between core stability, balance and strength in amputee soccer players? A pilot study.

BACKGROUND: The body is a kinetic chain and all the systems and muscle groups play important roles in this chain. Core stability, strength and balance are important components of performance within many sports, and in particular soccer. However, the relationship between these components is not fully understood. OBJECTIVES: To investigate the relationship between core stability, balance and strength in amputee soccer players. STUDY DESIGN: Clinical pilot trial. METHODS: Eleven amputee soccer players (mean age = 24.63 ± 6.48 years) participated in our study. A Kinesthetic Ability Trainer device was used to assess balance. Trunk strength was evaluated by isokinetic dynamometer. Gillet test was used to evaluate the sacroiliac joint movement. Modified plank test was used to determined dynamic core stability. Disability was evaluated using the Oswestry Disability Index. RESULTS: The results showed that there was a correlation between flexor isokinetic trunk muscle strength at the velocity of 60°/sec and modified plank test (r = 0.630, p = 0.038). There was a negative correlation between flexor isokinetic trunk muscle strength at the velocity of 180°/sec and Oswestry Disability Index score (r = -0.649, p = 0.031). CONCLUSIONS: Amputee soccer is a sport which is generally performed with one limb balance with crutches. It is therefore perceived that a relationship between balance and sacroiliac mobility, and should be considered for evaluation process and performance analysis in amputee soccer. However, in future studies, we recommend that such evaluations on amputee soccer players should be carried out with increased numbers.