Evaluation of the efficacy of low-level laser therapy in the treatment of ulnar neuropathy at the elbow in terms of symptoms and clinical and electrophysiological findings: a randomized, prospective, double-blind clinical trial.

Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy and presents with symptoms such as pain, paresthesia, and weakness in the elbow. Provocative tests and electrophysiological examinations are helpful in the diagnosis of UNE. Low-level laser therapy is one of the conservative treatments of UNE however, limited results were reported on the effectiveness of low-level laser therapy (LLLT) in the treatment of UNE. In our study, we aimed to the efficacy of LLLT in reducing symptoms and providing clinical and electrophysiological improvement in patients with UNE. This study with a randomized-sham controlled, and double-blind design included 68 patients aged 18-60 years who were diagnosed with UNE. LLLT was applied to the first group, and sham laser was applied to the second group. The VAS pain, paresthesia, and weakness scores, grip strength, and provocative test positivity were evaluated in clinical examination. The QuickDASH questionnaire was administered to assess functional status. Electrophysiologically, motor distal latency (MDL) differences, sensory distal latency (SDL), motor and sensory nerve conduction velocity (NCV) were examined. Evaluations were performed before treatment and on the 15th day and at the third month after treatment. The LLLT group showed improvement in symptoms, clinical findings, motor NCV, and MDL at both post-treatment evaluations and sensory NCV on the post-treatment 15th day (p < 0.05). The comparison of post-treatment changes between the two groups revealed that the LLLT group had greater improvement in VAS day and night pain scores at both post-treatment evaluation times, QuickDASH scores at the third month, and sensory NCV on the 15th day (p < 0.05) compared to the SL group. There were no significant differences between the groups in terms of the post-treatment changes in VAS weakness scores, grip strength and electrophysiological findings (p > 0.05). It was observed that splinting alone was effective in UNE, but the addition of LLLT, one of the conservative treatment methods, enhanced treatment outcomes.

Late-onset Hirayama disease presenting with ulnar neuropathy: A case report.

Hirayama disease (HD) was first reported by Hirayama et al. in 1959. The disease is considered as a type of benign focal motor neuron disease that primarily affects upper limbs of young males. In this case report, we present a man aged 40-years with rapidly progressive weakness and atrophy in his left hand. The findings of nerve conduction studies were consistent with left ulnar neuropathy at the elbow. Flexion magnetic resonance imaging (MRI) revealed minimal enlargement of the posterior epidural space and anterior displacement of the spinal cord. After exclusion of relevant diseases the patient was diagnosed as having Hirayama disease with ulnar neuropathy. Mild ulnar entrapment at the elbow may be considered as a clinical feature of HD. Therefore, it is recommended that young male patients with wasting in upper extremities with findings of ulnar entrapment should not be judged to have ulnar neuropathy before HD has been carefully excluded.

The utility of faces pain scale in a chronic musculoskeletal pain model.

OBJECTIVES: The main aim of this study was to investigate the clinical utility and sensitivity to change of faces pain scale (FPS) in patients with shoulder pain, chosen as a chronic pain model. The secondary aim was to determine the association of FPS with psychologic status and quality of life of these patients. METHODS: Thirty Turkish patients with chronic shoulder pain were included in the study. Pain intensity was evaluated by visual analog scale (VAS), which is a commonly used pain scale besides FPS. Depression and quality of life were screened by Beck Depression Inventory (BDI) and Short Form-36 (SF-36). All assessments were done before and after the physical therapy. RESULTS: There was a statistically significant decrease in pain severity after the treatment as indicated by FPS and VAS (P=0.000). The standardized response mean (SRM) value of FPS of 2.35 was accepted as a good responsiveness. The FPS showed a strong correlation with VAS (r=0.62 and 0.73) both before and after the treatment. Also, moderate to strong correlations were detected between the FPS and physical functioning (PF), physical role (PR), bodily pain (BP), emotional role (ER), general health (GH), mental health (MH) subscales of SF-36 (r=-0.58-0.80), and BDI scores (r=0.39) before the treatment. However, there were moderate and weak correlations with FPS and PR and social functioning (SF) subscales of SF-36 only after the treatment (r=-0.52 and r=-0.39). CONCLUSIONS: FPS is a satisfactory tool to assess pain in patients with chronic pain conditions and demonstrates sensitivity to detect changes after the treatment.

Assessment of the relatives or spouses cohabiting with the fibromyalgia patients: is there a link regarding fibromyalgia symptoms, quality of life, general health and psychologic status?

It was aimed to investigate the existence of the symptoms related to fibromyalgia in the first-degree relatives or spouses of the patients and to assess the psychologic and general health status of these individuals and the correlation of these with the patients' status. Thirty-seven patients with FS, 32 first-degree relatives or spouses of the patients and 30 healthy subjects as a control group were included. Symptoms related to FS were recorded in all subjects. Fibromyalgia Impact Questionnaire and Nottingham Health Profile were used to assess the components of functional status and quality of life. General health status was evaluated by General Health Questionnaire. Beck Depression Inventory and Beck Anxiety Inventory were used to assess the psychologic status. There were significant differences in the frequency of the symptoms between three groups (P < 0.05). Symptoms and signs related to of relatives/spouses of the patients and healthy controls were found to be significantly lower than those of the patients. GHQ, BAI and BDI scores of patients were found to be significantly higher than relative/spouses and control groups (P < 0.05). There were statistically significant differences between three groups in energy level, pain, sleep and physical abilities subscores of NHP (P < 0.05). No significant differences were detected in NHP subscores between relative/spouses of the patients and controls (P > 0.05). No fibromyalgia symptoms or signs were detected in the relatives/spouses. The general health status, psychologic status and quality of life were found to be not impaired in relatives/spouses of the patients with FS.

Comparison the efficacy of phonophoresis and ultrasound therapy in myofascial pain syndrome.

The aim of this study is to compare the effect of phonophoresis, ultrasound and placebo ultrasound therapies in the treatment of myofascial pain syndrome (MPS). This is a randomized, double-blind placebo controlled study. Sixty patients (48 women, 12 men, mean age 37.9 ± 12.2 years) with MPS were included in this study. Patients were allocated into three groups. Group 1(n = 20) was received diclofenac phonophoresis, group 2(n = 20) was received ultrasound and group 3(n = 20) was received placebo ultrasound therapies over trigger points, 10 min a day for 15 session during 3 weeks (1 MHz-1,5 watt/cm²). Additionally, all patients were given neck exercise program including isotonic, isometric and stretching. Patients were assessed by means of pain, range of motion (ROM) of neck, number of trigger points (NTP), algometric measurement and disability. Pain severity was measured by visual analog scale (VAS) and Likert scale. The neck pain disability index (NPDI) was used for assessing disability. Measurements were taken before and after treatment. After treatment, there were statistically significant improvements in pain severity, NTP, pressure pain threshold (PPT), ROM and NPDI scores both in phonophoresis and in ultrasound therapy groups (P < 0.05). Statistically significant increase in cervical lateral flexion and rotation was observed in the placebo US group. While there was no statistically significant improvement in the cervical flexion-extension joint movement, pain levels, number of trigger points and NPDI score, pressure pain threshold (P > 0.05), also there were no significant differences in all parameters between group 1 and 2 (P = 0.05). Both diclofenac phonophoresis and ultrasound therapy were effective in the treatment of patients with MPS. Phonophoresis was not found to be superior over ultrasound therapy.

Comparison of efficacy of different treatment methods in the treatment of idiopathic tinnitus.

OBJECTIVES: This study aims to detect whether any differences were present between betahistine dihydrochloride, transcutaneal electrical nerve stimulation and pure tone masking-tinnitus retraining therapy (TRT) methods in the effects on quality of life and treatment of the symptoms of the patients. PATIENTS AND METHODS: A total of 91 patients (42 females, 49 males; mean age 49.3±8.3 years; range 30 to 70 years) who admitted to the Otorhinolaryngology Clinic of the Ufuk University between June 2009 and June 2010 with a complaint of subjective tinnitus and who had no hearing loss were included in the study. In this study, the effects of these three treatment methods on healing and quality of life in patients suffering from bilateral subjective tinnitus were comparatively evaluated using Tinnitus Handicap Inventory Score (THIS), visual analog scale (VAS) and audiological parameters. The evaluations were made immediately before the treatment, immediately after the treatment and three weeks after the treatment. Kolmogorov-Smirnov analysis was used to test the normal distribution of the data and Wilcoxon signed rank test was used to show the differences between the different treatment methods before the treatment, immediately after the treatment and three weeks after the treatment. Mann-Whitney U and Kruskal-Wallis H tests were used to show the inter-group differences. RESULTS: In the inter-group analyzes, success rate of the pure tone masking-TRT was much higher when compared to the other treatment methods. In the evaluations performed at the end of the three-month period, it was seen that the efficacy of the treatment was continuing. CONCLUSION: According to these results, pure tone masking-TRT was found to be the best treatment method when compared to other methods and it was concluded that this treatment may be considered as the first choice in patients with idiopathic tinnitus.

Effects of lumbar lordosis increment on gait deteriorations in ambulant boys with Duchenne Muscular Dystrophy: A cross-sectional study.

BACKGROUND: Increment of lumbar lordosis, a frequent spinal finding in Duchenne Muscular Dystrophy (DMD), is a compensatory mechanism secondary to muscle weakness. However, excessive lumbar lordosis may change the position of the center of mass, and lead to balance and walking difficulties. OBJECTIVE: To study the relationship between factors that may influence ambulatory function in boys with DMD and to investigate the effects of lumbar lordosis increment on gait and balance perturbations. METHODS: Twenty-one ambulant patients with DMD and 10 healthy boys were included. Lumbar lordosis and thoracic kyphosis angles, dynamic and static balance tests, ambulatory function, muscle strength, and disease severity were assessed. Usage of steroids and orthotic devices were recorded. Scoliosis was assessed on radiographs. Receiver operator characteristic curves were formed and area under curve (AUC) measurements were performed to assess the ability of the tests to discriminate ambulatory status and optimal cut-off values were established according to the Youden index. RESULTS: The amount of lumbar lordosis correlated strongly and negatively with quality of ambulation (r = -0.710) and moderately with performance on balance tests. The strength of both upper limbs and lower limbs muscles were not associated with any of the variables. According to the AUC analysis, patients with a lumbar lordosis higher than 36° had worse scores on gait and dynamic balance tests. CONCLUSION: Ambulation and dynamic balance are negatively affected by the increment of lumbar lordosis with a cut-off point of 36°in boys with DMD.

The effectiveness of transcutaneous electrical nerve stimulation in the management of patients with complex regional pain syndrome: A randomized, double-blinded, placebo-controlled prospective study.

OBJECTIVE: To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on clinical recovery in the management of patients with complex regional pain syndrome Type I (CRPS Type I). MATERIAL AND METHOD: The study included 30 patients with stage 1 and 2 CRPS Type I in the upper extremities. The patients were randomly assigned into 2 groups, group 1 (n= 15) received conventional TENS therapy for 20 minutes, and group 2 (n= 15) received sham TENS therapy. The standard physical therapy program, which included contrast bath for 20 minutes; whirlpool bath for 15 minutes; assisted active and passive range of motion, and static stretching exercises up to the pain threshold, was also conducted in both groups. Therapy was scheduled for 15 sessions. A visual analogue scale (VAS) was used to assess spontaneous pain. The Leeds Assessment of Neuropathic Signs and Symptoms (LANSS) scale and the Douleur Neuropathique en 4 Questions (DN-4) were used to assess neuropathic pain. In addition, range of motion (ROM) was measured using a goniometer and volumetric measurements were taken to assess edema. Functional capacity was assessed using a hand dynamometer and the Duruöz Hand Index (DHI). All measurements were performed at baseline and after therapy. RESULTS: Significant improvements were achieved in spontaneous and neuropathic pain scores, edema, ROM, and functional capacity in both groups (p< 0.05). However, improvement was found to be significantly greater in group 1 regarding pain intensity, neuropathic pain assessed using LANNS, edema, and in the 2nd-3rd finger ROM measurements (p< 0.05). No significant difference was detected between groups regarding improvements in 4th-5th finger and wrist ROM measurements, grip strength, and DN4 and DHI scores (p> 0.05). CONCLUSION: The addition of TENS to the physical therapy program was seen to make a significant contribution to clinical recovery in CRPS Type 1.

Comparison of efficacy of kinesiological taping and subacromial injection therapy in subacromial impingement syndrome.

The aim of the study was to compare the efficacy of kinesiological taping and subacromial injection therapy in patients with subacromial impingement syndrome (SIS). Seventy patients diagnosed with SIS were randomly assigned to group 1 (n = 35, injection group) or group 2 (n = 35, kinesiological taping group). Betamethasone plus prilocaine was injected to subacromial space in the patients in group 1. In group 2, tape was applied three times for a period of five consecutive days with a 2-day recovery interval. A 3-month exercise program was prescribed for both groups including stretching and strengthening exercises. All patients were assessed at baseline and at 1 and 3 months post-intervention. Assessments were made by visual analog scale (VAS) for pain, range of motion (ROM) measurements, specific tests, and Shoulder Pain and Disability Index (SPADI). Significant differences were detected in VAS and SPADI scores as well as ROM measurements in both groups when compared to baseline (p > 0.05). No significant differences were detected between the groups except for active flexion degree in favor of group 1 (p = 0.004). Both kinesiological taping and steroid injection in conjunction with an exercise program were found to be effective in the treatment of SIS. Kinesio taping may be an alternative treatment option in the rehabilitation of SIS especially when a non-invasive technique is needed.

An evaluation of sleep quality and the prevalence of restless leg syndrome in vitamin D deficiency.

Vitamin D is known to increase levels of dopamine and its metabolites in the brain and also protects dopaminergic neurons against dopaminergic toxins. The aims of the study were to assess the frequency and symptom severity of restless leg syndrome (RLS) and sleep quality in vitamin D deficiency. A total of 102 patients were enrolled in this cross-sectional study, comprising 57 vitamin D deficient patients as Group 1 and 45 patients with normal levels of vitamin D as Group 2. RLS was diagnosed according to the International RLS Study Group (IRLSSG) diagnostic criteria. Symptom severity was assessed using the IRLSSG rating scale and sleep quality was measured with the Pittsburgh sleep quality index (PSQI). RLS incidence was higher in Group 1 (p = 0.034). The PSQI scores were higher in Group 1 and the difference between the groups was determined as statistically significant (p < 0.05). No statistically significant difference was determined in respect of the clinical evaluation and the IRLSSG Symptom Severity Scale between the patients in Group 1 diagnosed with RLS and the patients in Group 2 diagnosed with RLS (p > 0.05). The findings of this study support the hypothesis that RLS is more frequent and more severe in vitamin D deficiency and indicate a negative effect of vitamin deficiency on sleep parameters.

Does Behcet's disease associate with neuropathic pain syndrome and impaired well-being?

Previously peripheral neuropathy signs have been reported in inflammatory chronic diseases but the presence of neuropathic pain syndrome (NPS) in Behcet's disease (BD) is unclear. The aim of this study was to investigate the association of BD with NPS and impaired quality of life and sleep quality. A total of 111 patients diagnosed as BD and 52 healthy controls were included. Pain severity was assessed by visual analogue scale (VAS) in rest and during activity. The NPS was diagnosed according to the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) index. The well-being and sleep disturbances of the groups were evaluated with Psychological General Well-Being (PGWB) Scale and Pittsburg Sleep Quality Index (PSQI). Although there were no one with NPS in healthy controls, the proportion of NPS in patients with BD was 19.8 % (p = 0.001). The VAS scores both in activity and at rest were higher in BD (p < 0.001). There was statistically significant decrease in total PGWB score in BD patients compared to healthy controls (p < 0.001). And significant increase in LANSS score was observed in patients with BD compared to healthy controls (p = 0.000). The total LANSS scores showed significant positive correlation with PSQI scores (r = 0.322) and negative correlation with total PGWB scores (r = -0.672) in patients with BD. We observed a positive correlation between LANSS and VAS (rest and activity) scores (r = 0.44, r = 0.42 respectively). The NPS seems to be associated with BD which should be taken into consideration in patients with neuropathic signs. The quality of life (QoL) and quality of sleep of the patients with BD were found to be impaired and this may be due to the presence of NPS.

Is low-level laser therapy effective in acute or chronic low back pain?

The purpose of this study was to compare the effectiveness of low-level laser therapy (LLLT) on pain and functional capacity in patients with acute and chronic low back pain caused by lumbar disk herniation (LDH). LLLT has been used to treat acute and chronic pain of musculoskeletal system disorders. This study is a randomized, double-blind, placebo-controlled study. Forty patients with acute (26 females/14 males) and 40 patients with chronic (20 females/20 males) low back pain caused by LDH were included in the study. Patients were randomly allocated into four groups. Group 1 (acute LDH, n = 20) received hot-pack + laser therapy; group 2 (chronic LDH, n = 20) received hot-pack + laser therapy; group 3 (acute LDH, n = 20) received hot-pack + placebo laser therapy, and group 4 (chronic LDH, n = 20) received hot-pack + placebo laser therapy, for 15 sessions during 3 weeks. Assessment parameters included pain, patients' global assessment, physician's global assessment, and functional capacity. Pain was evaluated by visual analog scale (VAS). [corrected] Patients' and physician's global assessment were also measured with VAS. Modified Schober test and flexion and lateral flexion measures were used in the evaluation of range of motion (ROM) of lumbar spine. Roland Disability Questionnaire (RDQ) and Modified Oswestry Disability Questionnaire (MODQ) were used in the functional evaluation. Measurements were done before and after 3 weeks of treatment. After the treatment, there were statistically significant improvements in pain severity, patients' and physician's global assessment, ROM, RDQ scores, and MODQ scores in all groups (p < 0.05). However, no significant differences were detected between four treatment groups with respect to all outcome parameters (p > 0.05). There were no differences between laser and placebo laser treatments on pain severity and functional capacity in patients with acute and chronic low back pain caused by LDH.

The effectiveness of low laser therapy in subacromial impingement syndrome: a randomized placebo controlled double-blind prospective study.

OBJECTIVES: Conflicting results were reported about the effectiveness of Low level laser therapy on musculoskeletal disorders. The aim of this study was to investigate the effectiveness of 850-nm gallium arsenide aluminum (Ga-As-Al) laser therapy on pain, range of motion and disability in subacromial impingement syndrome. METHODS: A total of 52 patients (33 females and 19 males with a mean age of 53.59 ± 11.34 years) with subacromial impingement syndrome were included. The patients were randomly assigned into two groups. Group I (n = 30, laser group) received laser therapy (5 joule/cm² at each point over maximum 5-6 painful points for 1 minute). Group II (n = 22, placebo laser group) received placebo laser therapy. Initially cold pack (10 minutes) was applied to all of the patients. Also patients were given an exercise program including range of motion, stretching and progressive resistive exercises. The therapy program was applied 5 times a week for 14 sessions. Pain severity was assessed by using visual analogue scale. Range of motion was measured by goniometer. Disability was evaluated by using Shoulder Pain and Disability Index. RESULTS: In group I, statistically significant improvements in pain severity, range of motion except internal and external rotation and SPADI scores were observed compared to baseline scores after the therapy (p < 0.05). In Group II, all parameters except range of motion of external rotation were improved (p < 0.05). However, no significant differences were recorded between the groups (p > 0.05). CONCLUSIONS: The Low level laser therapy seems to have no superiority over placebo laser therapy in reducing pain severity, range of motion and functional disability.

The utility of the Faces Pain Scale in the assessment of shoulder pain in Turkish stroke patients: its relation with quality of life and psychologic status.

This study was planned to investigate the utility of the vertical Faces Pain Scale (FPS) in the assessment of pain in stroke patients using the shoulder pain model and to assess its utility in the Turkish patient population. The secondary aim was to analyze the association of FPS with the quality of life and depression in the study population.Thirty stroke patients (group I) and 30 controls (group II),all suffering from shoulder pain were included in the study.The patients with subacute shoulder pain and with no other known diseases and impairments were recruited as a control group. Shoulder pain was evaluated by the commonly used pain scales including the Visual Analogue Scale, Likert Pain Scale and 0­10 Numerical Rating Scale besides FPS. Depression was screened using Beck Depression Inventory (BDI) and quality of life was evaluated using Short Form-36 (SF-36). FPS showed good correlations with the other pain scales in both the groups(r= 0.950­0.972 and 0.674­0.926, respectively). In group I,there were significant correlations between FPS and physical functioning, pain and emotional role subscales of SF-36 (r= ­ 0.432, 0.707 and ­ 0.461, respectively).Although there was a low correlation between the FPS and BDI scores, it was not statistically significant. In group II,FPS showed significant correlations with the BDI scores and all subscales of SF-36 except social functioning and vitality (r= ­ 0.679 to 0.848). FPS had a high degree of convergent validity and can be used in the assessment of shoulder pain in stroke patients. It may be a good alternative for pain assessment especially in patients with speech disorders and illiterate patients.

The effectiveness of low laser therapy in subacromial impingement syndrome: a randomized placebo controlled double-blind prospective study

OBJECTIVES: Conflicting results were reported about the effectiveness of Low level laser therapy on musculoskeletal disorders. The aim of this study was to investigate the effectiveness of 850-nm gallium arsenide aluminum (Ga-As-Al) laser therapy on pain, range of motion and disability in subacromial impingement syndrome. METHODS: A total of 52 patients (33 females and 19 males with a mean age of 53.59±11.34 years) with subacromial impingement syndrome were included. The patients were randomly assigned into two groups. Group I (n = 30, laser group) received laser therapy (5 joule/cm² at each point over maximum 5-6 painful points for 1 minute). Group II (n = 22, placebo laser group) received placebo laser therapy. Initially cold pack (10 minutes) was applied to all of the patients. Also patients were given an exercise program including range of motion, stretching and progressive resistive exercises. The therapy program was applied 5 times a week for 14 sessions. Pain severity was assessed by using visual analogue scale. Range of motion was measured by goniometer. Disability was evaluated by using Shoulder Pain and Disability Index. RESULTS: In group I, statistically significant improvements in pain severity, range of motion except internal and external rotation and SPADI scores were observed compared to baseline scores after the therapy (p<0.05). In Group II, all parameters except range of motion of external rotation were improved (p<0.05). However, no significant differences were recorded between the groups (p>0.05). CONCLUSIONS: The Low level laser therapy seems to have no superiority over placebo laser therapy in reducing pain severity, range of motion and functional disability.