Comparison of the Effect of Out-of-plane and In-plane Injection Approaches on Injection Pain and Functionality in Patients with Carpal Tunnel Syndrome Undergoing Ultrasound-guided Injection: A Patient- and Assessor-blinded Randomized Study.

OBJECTIVES: The aims were i) to compare the out-of-plane (OP) and in-plane (IP) approaches for carpal tunnel syndrome (CTS) in terms of pain during injection and post injection adverse effects, and ii) to investigate whether these approaches led to any difference in terms of pain/numbness, symptom severity, functionality, and median nerve cross-sectional area and to examine the relationship of these parameters with the pain during injection. DESIGN: Patient/assessor blinded randomized study SETTING: Hospital outpatient clinic. PARTICIPANTS: Fifty patients with mild to moderate CTS. INTERVENTIONS: The participants were randomized into OP and IP (both n = 25) ultrasound-guided injection groups. MAIN OUTCOME MEASURES: Each patient reported the pain felt during the injection at 1 h thereafter, and also any adverse effects at 4 weeks after injection. Before and 4 weeks after injection, patients used a visual analog scale to indicate pain/numbness; symptom severity and functionality were assessed using the Boston Carpal Tunnel Syndrome Questionnaire. The cross-sectional area of the median nerve was also obtained. RESULTS: The average pain during injection was 2.64±0.82 in the IP group and 1.96±0.86 in the OP group (p=0.017). Post-injection adverse effects were similar between the two groups (p<0.05). After injection, the percentage change in symptom severity was 49.8±11.8 in the IP group and 40.6±11.5 in the OP group (p=0.008). In the IP group, day pre-injection pain/numbness, night pain/numbness percentage change scores, and symptom severity percentage change scores were moderately correlated with the pain during injection (r=0.439, 0.469, and 0.429, respectively). CONCLUSIONS: IP injection caused greater pain during injection compared to OP injection and led to greater reduction in symptom severity at 1 month after injection. In that group, injection pain was associated with the baseline day pain score, change in night pain score, and change in symptom severity score.

Effects of Therapeutic Ultrasound Applied to the Lumbar Region on Renal Function: A Randomized Controlled Prospective Trial.

OBJECTIVES: Therapeutic ultrasound (TUS) is one of the most commonly used modalities in low back pain treatment. The objective of this study was to determine whether TUS applied to the low back region in patients with chronic low back pain had any effect on renal function. METHODS: Forty patients with chronic low back pain were randomized to 2 groups by a block randomization method. Thirty-seven patients completed the final evaluation. All patients were treated for 5 sessions per week for 3 weeks with the same physiotherapy modalities (superficial heating and transcutaneous electrical nerve stimulation) and exercise therapy; in addition to these treatments, the second group was treated with TUS for 10 minutes (frequency, 1 MHz; intensity, 1.5 W/cm2 ; and effective irradiation area of the transducer head, 5 cm2 ). The serum creatinine, serum cystatin C, 24-hour urine creatinine, creatinine clearance, 24-hour urine microalbumin and microprotein, urine volume, and glomerular filtration rate were measured. The patients were evaluated at baseline (day 0) and the end of the treatment (day 21). RESULTS: The serum cystatin C levels were increased in both groups, but this increase was not significant (P > .05). There was no difference between the groups in the percent change in all outcome measures (P > .05). CONCLUSIONS: This showed that TUS applied to the low back region does not affect renal function.

The effect of combining physiotherapy with dry needling in patients with cervical spondylosis: A randomized controlled trial.

BACKGROUND: There are no data on the additional contribution of dry needling (DN) for trigger points (TPs) accompanying patients with cervical spondylosis (CS). OBJECTIVE: To analyse the contribution of DN applied to concomitant active TPs in the upper trapezius muscle on the treatment outcomes of physiotherapy in CS. METHODS: In this prospective randomized controlled study, 70 patients with CS and active TPs in the upper trapezius muscle were included. The first group received physiotherapy for 5 days per week for 3 weeks. The second group received DN with the same program. All participants were evaluated before treatment (day 0) and at the end of treatment (day 21) in terms of pain, functional status, quality of life, anxiety/depression scores, and number of TPs. RESULTS: 33 patients in the first group and 32 patients in the second group completed the study. While the change over time was found significant in all variables, the change was not different between groups. The group-time interaction effect was not found to be statistically significant in any variable. Percentage changes of all variables were similar between the groups. CONCLUSION: DN treatment added to the physiotherapy did not contribute to recovery in patients with CS.

An unexpected event after deep vein thrombosis in spinal cord injury: Ruptured Baker's cyst.

Context: Deep vein thrombosis (DVT) is a well-known complication of spinal cord injury (SCI). Low-molecular-weight heparin (LMWH) may be used in SCI patients who develop DVT, but can lead to subcutaneous bleeding. If subcutaneous bleeding occurs, then lymphedema, cellulitis, muscle or tendon tearing, or baker's cyst rupture should be considered in the differential diagnosis.Findings: Herein, we present a 61-year-old female patient who was hospitalized for rehabilitation due to paraplegia, and used LMWH due to DVT development. The patient suddenly developed pain, swelling, and discoloration of the left lower extremity. Although subcutaneous hemorrhage was considered initially, ultrasound and MRI revealed a ruptured Baker's cyst. In addition to supportive therapy, ultrasound-guided aspiration was performed.Conclusion/Clinical Relevance: In this report, we present a case of clinically severe Baker's cyst rupture, which occurred in the lower extremity of a SCI patient using LMWH due to DVT in the same extremity. To our knowledge, no similar cases have been reported.

Nocturnal pain in patients with rotator cuff related shoulder pain: A prospective study.

INTRODUCTION: Nocturnal pain is a common complaint in rotator cuff related shoulder pain (RCRSP), and there is no study in literature that has evaluated the relationship between nocturnal pain severity and other evaluation parameters in RCRSP. The objective of the study was to investigate the relationship between the severity of nighttime pain and demographic and clinical data including physical examination findings, magnetic resonance imaging (MRI) findings, disability, kinesiophobia, and quality of life scores in patients diagnosed with RCRSP. MATERIALS AND METHODS: We assessed 61 patients (52.4% female) using the Visual Analog Scale (VAS) for nighttime and daytime, Shoulder Pain and Disability Questionnaire (SPADI), Tampa Scale of Kinesiophobia (TSK), and Short Form-36 (SF-36). Demographic and clinical data were recorded and rotator cuff specific examinations were performed and documented. RCRSP lesions were evaluated in terms of tendonitis and rupture by MRI. RESULTS: The nighttime VAS score was positively correlated with SPADI disability and total scores, and daytime VAS score, and negatively correlated with SF-36 physical function subscale. The nighttime VAS score was associated with presence of calcific tendonitis in supraspinatus, infraspinatus tendinosis, and subscapularis tendinosis. On multivariate analysis with a linear regression model, presence of subscapularis tendinosis was an independent predictor of nighttime VAS score. In shoulder clinical tests, the nighttime VAS score correlated with only Neer test positivity. CONCLUSIONS: Our results suggest that there is a relationship between nocturnal pain severity and disability. Presence of subscapularis tendinosis appears to be a predictor of nocturnal pain severity. Additionally, patients with positive Neer test may experience more nocturnal pain.

The effect of mirror therapy on lower extremity motor function and ambulation in post-stroke patients: A prospective, randomized-controlled study.

OBJECTIVES: This study aims to evaluate the effects of mirror therapy (MT) on lower extremity motor function and ambulation in post-stroke patients. PATIENTS AND METHODS: A total of 42 post-stroke patients (25 males, 17 females; mean age 58 years; range, 32 to 71 years) were included. All patients were randomly divided into two groups as the control group (n=21) receiving a conventional rehabilitation program for four weeks (60 to 120 min/day for five days a week) and as the MT group (n=21) receiving MT for 30 min in each session in addition to the conventional rehabilitation program. The Brunnstrom stages of stroke recovery, Functional Independence Measure (FIM), Berg Balance Scale (BBS) and Motricity Index (MI) scores, six-minute walking test (6MWT), Functional Ambulation Category (FAC), and the degree of ankle plantar flexion spasticity using the Modified Ashworth Scale (MAS) were evaluated at baseline (Day 0), at post-treatment (Week 4), and eight weeks after the end of treatment (Week 12). RESULTS: There were significant differences in all parameters between the groups, except for the degree of ankle plantar flexion spasticity, and in all time points between Week 0 and 4 and between Week 0 and 12 (p<0.05). CONCLUSION: These results suggest that MT in addition to conventional rehabilitation program yields a greater improvement in the lower extremity motor function and ambulation, which sustains for a short period of time after the treatment.

Comparison of effectiveness of different kinesiological taping techniques in patients with chronic low back pain: A double-blind, randomized-controlled study.

OBJECTIVES: This study aims to investigate the effects of kinesiological taping (KT) method combined with physiotherapy modalities and exercise therapy on the severity of pain, range of lumbar motion, and degree of disability. PATIENTS AND METHODS: Between November 2015 and November 2016, a total of 125 patients (63 males, 62 females; mean age 45 years; range, 20 to 65 years) who were diagnosed with chronic non-specific low back pain were included in this double-blind, randomized, placebo-controlled study. The patients were randomly assigned to four groups. All groups received the same physiotherapy modalities and exercise therapy. Group 1 received physiotherapy modalities and exercise therapy alone; Group 2 received additional sham KT; Group 3 received additional KT with a space correction technique; and Group 4 received additional KT with a fascia correction technique. Kinesiological taping was applied for three weeks with five-day intervals and four times in total. The patients were evaluated at baseline (Day 0), at the end of the treatment (Day 21), and on Day 51. Pain severity using the Visual Analog Scale (VAS), ranges of lumbar motion using the fingertip-to-floor distances and modified lumbar Schober test, and the degree of disability using the Oswestry Disability Index (ODI) and Roland Morris Disability Questionnaire (RMDQ) were evaluated. RESULTS: We found a significant difference among the groups in terms of VAS motion T0-51 changes (p<0.05). There was also a significant difference among the groups in terms of T0-21 and T0-51 changes in the ODI and RMDQ (p<0.05). CONCLUSION: Our study results suggest that KT ensures reduction in pain and disability, irrespective of the technique of taping, with sustainable short-term effects following the end of the treatment.

Recurrent uveitis under golimumab treatment in a patient diagnosed with axial spondyloarthritis: Is it a paradoxical effect?

Anti-tumor necrosis factor drugs are highly effective in the treatment of spondyloarthropathies. In recent years, there have been reports of paradoxical effects with the use of these drugs. Herein, we report the first case of axial spondyloarthropathy in whom recurrent attacks of panuveitis paradoxically developed under golimumab treatment in the light of literature data.

Unexpected foreign body in the bladder of a spinal cord injured patient: A case report.

Context: Bladder dysfunction is common in patients with spinal cord injuries. Clean intermittent catheterization is a preferred method of neurogenic bladder management among spinal cord injured patients. Some complications may occur due to the use of clean intermittent catheterization.Findings: In this report, we presented a case with an unexpected foreign body detected in the bladder of a patient who used to perform clean intermittent catheterization for her neurogenic bladder management, to our knowledge, which has not been reported in the literature so far.Conclusion/Clinical Relevance: In this case report, we want to emphasis the importance of different kind of foreign bodies remaining in the bladder during clean intermittent catheterization.

Familial Mediterranean fever with recurrent erysipelas-like erythema and myalgia: A case report.

Familial Mediterranean fever (FMF) is a disease progressing with recurrent serositis episodes and usually accompanied by fever. Symptoms, such as myalgia and skin lesion, are less common in the clinical presentation of FMF. Herein, we present a 23-year-old female patient who was admitted to our outpatient clinic with myalgia. She had no findings of typical episodes for FMF. However, on physical examination, she had an unrecognized skin lesion. In conclusion, FMF should be kept in mind in patients with recurrent erysipelas-like lesions.