Assessment of the effectiveness of interferential current therapy and TENS in the management of carpal tunnel syndrome: a randomized controlled study.

We assessed the effectiveness of interferential current (IFC) and transcutaneous electrical nerve stimulation (TENS) therapies in the management of carpal tunnel syndrome (CTS) compared with splint therapy, a standard treatment modality for CTS. This was a prospective, single-blinded, single-center, randomized, three-group parallel intervention study of 3 weeks duration. Efficacy was examined in the third week after the end of treatments. Subjects were assigned randomly to one of three groups: group I patients received splint therapy, group II patients received TENS applied on the palmar surface of the hand and the carpal tunnel, and group III patients underwent IFC therapy applied on the palmar surface of the hand and the volar surface of the forearm. TENS and ICF treatments were applied five times weekly for a total of 15 sessions. Group 1 patients were stabilized with volar wrist splints for 3 weeks. The efficacy of the therapies was assessed before initiation of therapy and at 3 weeks after completion of therapy using a visual analog scale (VAS), a symptom severity scale, the functional capacity scale of the BCTQ, and measurement of median nerve motor distal latency (mMDL) and median sensory nerve conduction velocity (mSNCV). Groups were compared pairwise using the Mann-Whitney U test to identify the source of differences between groups. The Wilcoxon test was used to analyze changes in variables over time within a group. In the VAS, BCTQ, MDL, and mSNCV, no significant difference was observed between the groups (p > 0.05). In the VAS, BCTQ, and mSNCV, statistically significant improvements were detected in all groups (p < 0.05). There was no statistically significant difference between TENS and splint therapy with respect to improvement in clinical scores, whereas IFC therapy provided a significantly greater improvement in VAS, mMDL, and mSNCV values than splint therapy (VAS: 4.80 ± 1.18 and 6.37 ± 1.18; p = 0.001, mMDL: 3.89 ± 0.88 and 4.06 ± 0.61; p = 0.001, mSNCV: 41.80 ± 1.76 and 40.75 ± 1.48; p = 0.010). IFC therapy provided a significantly greater improvement in VAS, symptom severity, functional capacity, and mMDL and mSNCV values than TENS therapy (VAS: 4.80 ± 1.18 and 6.68 ± 1.42; p < 0.001, symptom severity: 2.70 ± 1.03 and 3.37 ± 1.21; p = 0.015, functional capacity: 1.90 ± 1.21 and 2.50 ± 0.78; p = 0.039, mMDL: 3.89 ± 0.88 and 4.06 ± 0.88; p = 0.003, and mSNCV: 41.80 ± 1.76 and 41.38 ± 1.78; p = 0.021). IFC may be considered a new and safe therapeutic option for the treatment of CTS.

Quality of life, depression, and sexual dysfunction in spouses of female patients with fibromyalgia.

The aim of this study was to investigate the effects of the quality of life and psychological condition of female patients with fibromyalgia and their spouses on sexual function. A total of 32 female patients diagnosed with fibromyalgia and their spouses were analyzed. Thirty married couples were included in the study as the control group. The demographic data of the fibromyalgia patients were recorded, a visual analog scale was used to evaluate the level of pain, and the Fibromyalgia Impact Questionnaire was used to evaluate the impact of the symptoms on the quality of life of the patients. The quality of life of both the patients and the control group were evaluated using the Short Form 36 (SF-36), and psychological variables were evaluated using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory. Sexual function was assessed using the Female Sexual Function Index for female participants and the International Index of Erectile Function (IIEF) for male participants. The IIEF erectile dysfunction scores were significantly lower in the spouses of female patients with fibromyalgia than in the control group (p < 0.05), and the BDI scores were significantly higher in the spouses of the female patients with fibromyalgia (p < 0.05). Among the SF-36 scores, the emotional and physical roles were significantly lower in the spouses of the female patients with fibromyalgia (p = 0.003 and p = 0.004, respectively). In all spouses of FMS patients and controls, there was a significantly negative correlation between erectile function, the BDI score, and to be married with FMS patient and positive correlations between erectile function and emotional role, social function, mental health, SF-36 pain score, and general health (p < 0.05 for all). In a linear regression model, BDI, to be married with FMS patient and general health were found to affect erectile function (beta regression coefficient = -0.572, SE = 0.082, p = 0.001; beta regression coefficient = -0.332, SE = 1.619, p = 0.007; beta regression coefficient = 0.445, SE = 0.065, p = 0.005, respectively). Being a spouse of a patient with fibromyalgia might significantly interfere with quality of life and lead to a high rate of sexual dysfunction. Spouses of patients with fibromyalgia might also be investigated for sexual dysfunction and quality of life. Treatment programs for this group should be considered.

A comparison of the effectiveness of low-, moderate- and high-dose ultrasound therapy applied in the treatment of myofascial pain syndrome.

OBJECTIVE: This study aimed to compare and evaluate the effects of ultrasound (US) treatment applied at low-, medium- and high-power-pain threshold (HPPT) doses to trigger points in the treatment of myofascial pain syndrome (MPS). METHODS: The study comprised 61 (40 female and 21 male) patients diagnosed with MPS, aged between 18 and 60 years. The patients were randomly allocated to three groups for the US application at different dosages. Group I patients received treatment of medium-dose US (1.5 Watt/cm(2)), Group II received HPPT US, and Group III received low-dose US (0.5 W/cm(2)). The patients were evaluated pre-treatment and 3 weeks after treatment in respect of visual analogue scale (VAS) scores, number of trigger points (NTP), pressure pain threshold (PPT), Range of Tragus-Acromioclavicular joint (RT-AJ) and neck pain disability scores (NPDS). RESULTS: A significant improvement was determined after treatment in all scores except PPT in Group I, in all scores in Group II, and only in the VAS score in Group III. When the groups were compared post-treatment in respect of improvement in NTP, VAS, RT-AJ and NPDS scores, Group II showed significant superiority over Group I, and Group I was determined to have significant superiority over Group III in respect of VAS, RT-AJ and NPDS scores (p < 0.05). CONCLUSIONS: In the treatment of MPS, US therapy at HPPT dose can be considered as an alternative therapy method, which is more economical and more effective than low-dose and conventional US therapy.

An evaluation of oxidative stress and antioxidant capacity in patients with myofascial pain syndrome.

OBJECTIVE: To evaluate total antioxidant capacity (TAC) and total oxidative stress (TOS) values in patients with myofascial pain syndrome (MPS). METHOD: The study comprised 38 patients diagnosed with MPS and 30 healthy volunteers. The age, body mass index (BMI) and pain scores (evaluation by visual analogue scales) of all the participants were recorded. The TAC, TOS and oxidative stress index (OSI) levels were compared between the MPS and control groups. RESULTS: There was no significant difference between the MPS and control groups in respect of demographic characteristics. The TAC levels were determined to be significantly lower and TOS levels and OSI values, significantly higher in the MPS patients than in the control group. CONCLUSION: The results of this study determined that the oxidant/antioxidant balance was impaired in MPS patients and thus MPS can be considered to be related to an increase in oxidative stress.

The Relationships among Vitamin D Level, Balance, Muscle Strength, and Quality of Life in Postmenopausal Patients with Osteoporosis.

[Purpose] The aim of this study was to examine the relationships among vitamin D levels, balance, falls, muscular strength, and quality of life in patients with postmenopausal osteoporosis. [Subjects and Methods] Forty-six patients diagnosed with postmenopausal osteoporosis and forty-six healthy controls were included in the study. Bone mineral density was determined by DEXA, and functional balance was evaluated the Timed Up and Go (TUG) test, Chair Raising (CRT) test, Berg Balance Scale (BBS). The muscular strengths were evaluated manually. The lumbosacral region range of motion (ROM) was measured by goniometry. The QUALEFFO-41 questionnaire was used for evaluating the quality of life. [Results] No statistically significant differences in muscular strength, balance, and fall values were found between the two groups. Statistically significant differences were noted between the QUALEFFO C, E, F and G scores and the QUALEFFO total scores of the QUALEFFO-41. Dividing the patient group into two groups revealed that patients with 25(OH)D levels < 15 ng/ml had significantly higher TUG and CRT test scores compared with patients with levels ≥ 15 ng/ml. Also, binary logistic regression analysis revealed that QUALEFFO total scores were found to be the independent factors for osteoporosis. [Conclusion] In this study, we found that vitamin D is necessary to maintain back extensor muscle strength, lumbar ROM, and balance. Our results show that bone mineral density, vitamin D level, balance, lumbar ROM, and the specified muscular strengths are factors that affect the quality of life.

The Relationship between Quadriceps Thickness, Radiological Staging, and Clinical Parameters in Knee Osteoarthritis.

[Purpose] The aim of this study was to investigate the relationship between clinical parameters, radiological staging and evaluated ultrasound results of quadriceps muscle thickness in knee osteoarthritis. [Subjects] The current study comprised 75 patients (51 female, 24 male) with a mean age of 57.9±5.2 years (range 40-65 years) and a diagnosis of osteoarthritis in both knees. [Methods] Knee radiographs were evaluated according to the Kellgren-Lawrence grading system. Clinical evaluation performed with the visual analog scale (VAS), Western Ontario and McMaster Osteoarthritis Index (WOMAC), the 50-meter walking test, and the 10-step stair test. The thickness of the muscle layer of the quadriceps femoris (M. vastus intermedius and M. rectus femoris) was measured with high-resolution real-time ultrasonography. [Results] The results of this study showed a significant negative correlation between quadriceps thickness and age, duration of disease, stage of knee OA, and VAS, WOMAC, 50-m walking test, and 10-step stair test scores. [Conclusion] The evaluation of quadriceps muscle thickness with ultrasound can be considered a practical and economical method in the diagnosis and follow-up of knee osteoarthritis.

Is There Any Relationship between Joint Destruction and Carotid Intima-media Thickness in Patients with Rheumatoid Arthritis?

[Purpose] The purpose of this study was to investigate the possible relationship between joint destruction and carotid intima-media thickness in patients with rheumatoid arthritis. [Subjects and Methods] Thirty-four RA patients and 31 healthy controls were enrolled in this study. The disease activity for 28 joints was recorded for each patient using the erythrocyte sedimentation rate (DAS28ESR), a visual analog scale (VAS0-10 cm), and a disability index, the health assessment questionnaire (HAQ). X-ray imagesof the patients were scored according to the modified Sharp/van der Heijde method, and the common carotid intimal medial thickness (CIMT) was automatically measured with software using high-resolution Doppler ultrasound. [Results] Contrary to our hypothesis, the modified total Sharp score (mTSS) and CIMT were not significantly associated. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels of the RA patients and the right CIMT, left CIMT, and mean CIMT scores were significantly elevated. Positive correlation was detected between the mean CIMT score and age, CRP levels, LDL concentration and triglycerides (TG) level. In the regression model, where the mean CIMT was the independent variable and age, CRP, LDL, and TG were dependent variables, age was found to be an independent predictor of CIMT. [Conclusions] Patients suffering from RA require close monitoring for cardiovascular risks, and the comorbidity of age-related cardiovascular disease should not be overlooked.

Relationship among Ocular Diseases, Developmental Levels, and Clinical Characteristics of Children with Diplegic Cerebral Palsy.

[Purpose] The aim of this study was to evaluate the relationships among vision problems, developmental levels, upper extremity functions, and qualities of life of children with cerebral palsy (CP). [Subjects] The study included 32 children, aged 4-15 years, diagnosed with diplegic type CP. [Methods] Hand function was evaluated using the Manual Ability Classification System (MACS) and the Bimanual Fine Motor Function (BFMF) scale, and the severity of CP was assessed using the Gross Motor Function Classification System (GMFCS). The developmental and mental capabilities of the children were evaluated using the Ankara Developmental Screening Inventory (ADSI) or the WISC-R test. An oculomotor examination was conducted for all patients. [Results] Positive correlations were found between GMFCS and BFMF, GMFCS and MACS, and MACS and BFMF scores (r=0.636; r=0.553; r=0.718, respectively). Significant correlations were found between upper extremity function, the severity of CP, the quality of life, and the general developmental level. There was no significant correlation between ocular disorders and clinical characteristics. [Conclusion] GMFCS, MACS, and BFMF may be useful for defining the functional status of children with CP, as they are easy, practical, and simple classification scales that conform to each other.

Effectiveness of a home exercise program in combination with ultrasound therapy for temporomandibular joint disorders.

[Purpose] This study compared the effectiveness of home exercise alone versus home exercise combined with ultrasound for patients with temporomandibular joint disorders. [Subjects and Methods] This study enrolled 23 female and 15 male patients who were divided randomly into two groups. The home exercise group performed a home exercise program consisting of an exercise program and patient education, and the home exercise combined with ultrasound group received ultrasound therapy in addition to the home exercise program. Pain intensity was evaluated using a visual analogue scale. Pain free maximum mouth opening was evaluated at baseline and 2 weeks after the treatment. [Results] There was no difference between the two groups in baseline values. After the treatment, the visual analogue scale decreased and pain free maximum mouth opening scores improved significantly in each group. Additionally, both values were higher in the home exercise combined with ultrasound group than in the home exercise group. [Conclusion] The combination of home exercise combined with ultrasound appears to be more effective at providing pain relief and increasing mouth opening than does home exercise alone for patients with temporomandibular joint disorders.

Evaluation of oxidative stress parameters and urinary deoxypyridinoline levels in geriatric patients with osteoporosis.

[Purpose] To evaluate the oxidative stress parameters and urinary deoxypyridinoline levels in geriatric patients with osteoporosis. [Subjects and Methods] Eighty geriatric patients aged over 65 years were recruited. Patients were divided into two groups: Group 1 (n=40) consisted of patients with osteoporosis, and Group 2 (n=40) consisted of patients without osteoporosis. Bone mineral density measurements were performed for all patients using DEXA. Oxidative stress parameters were analyzed in blood samples, and deoxypyridinoline levels were analyzed in 24-hour urinary samples. [Results] Compared to Group 2, the total antioxidant status and oxidative stress index levels of Group 1 were not significantly different; however, total oxidant status and 24-hour urinary deoxypyridinoline levels were significantly higher. Pearson correlation coefficients indicated that OSI and urinary deoxypyridinoline levels were not correlated with any biochemical parameters. ROC-curve analysis revealed that urinary deoxypyridinoline levels over 30.80 mg/ml predicted osteoporosis with 67% sensitivity and 68% specificity (area under the curve = 0.734; %95 CI: 0.624-0.844). [Conclusion] Our results indicate that oxidative stress would play a role in the pathogenesis of osteoporosis, and that urinary deoxypyridinoline levels may be a useful screening test for osteoporosis.

Health-related quality of life in Turkish patients with ankylosing spondylitis: impact of peripheral involvement on quality of life in terms of disease activity, functional status, severity of pain, and social and emotional functioning.

Ankylosing spondylitis (AS) affects sacroiliac joints at early stages and may involve the axial skeleton at later stages of disease. Peripheral involvement usually occurs in lower extremities. When it develops early in the disease course, it is a predictor of more aggressive disease. The aim of this study is to evaluate health-related quality of life (HRQoL) in AS and to assess the impact of peripheral involvement on HRQoL domains in terms of disease activity, functional status, pain, and social and emotional functioning. Seventy-four AS patients were included. Peripheral involvement was present in 51.35 % of the patients. In 65.79 % of these cases the hips, in 31.58 % the knees, in 18.42 % the shoulders and in 13.16 % the ankles were affected. Patients were evaluated by Ankylosing Spondylitis Quality of Life (ASQoL), Short Form-36 (SF-36), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Functional Index (BASFI). ASQoL was strongly correlated with ASDAS, BASDAI, BASFI, and Bath Ankylosing Spondylitis Metrology Index (BASMI), severity of total pain, night pain, fatigue, morning stiffness and ESR. ASDAS and BASDAI showed the strongest correlation with ASQoL. Severity of total pain, functional status and severity of night pain followed it, respectively. Patients with peripheral involvement scored significantly lower in all subgroups of SF36 and significantly higher in ASDAS, BASDAI, BASFI, BASMI and ASQoL scores and levels of pain, night pain, fatigue and morning stiffness. Peripheral involvement is associated with more active disease and functional disability and has a negative influence on HRQoL including physical, social and emotional functioning.

Comparison of the efficacy of ketoprofen phonophoresis, ultrasound, and short-wave diathermy in knee osteoarthritis.

The present study aimed to compare the efficacy of three different deep heating modalities: phonophoresis (PH), short-wave diathermy (SWD), and ultrasound (US), in knee osteoarthritis. Patients who consented to participate in the study were randomly divided into the following three groups. Group 1 (n = 33) received PH, Group 2 (n = 33) received US, and Group 3 (n = 35) received SWD. These deep heating therapies were applied by the same therapist. Each therapy began with 20-min hot pack application. Each of the three physical therapy modalities was applied 5 days a week for 2 weeks (a total of 10 sessions). The patients were evaluated using visual analogue scale (VAS) at rest, 15-m walking time, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) both before and after the treatment. Moreover, at the end of the treatment, both the physician and the patient made an overall evaluation, by rating the treatment efficacy. The results of the study showed that VAS, 15-m walking time, and WOMAC parameters were improved with all three deep heating modalities, and all the three modalities were effective. However, there was no significant difference between the three modalities in terms of efficacy. There was also no significant difference between the three groups in terms of post-treatment general evaluation of the physician and the patient. The present study is the first to suggest that choosing one of PH/US/SWD therapy options would provide effective results and none of them are superior to the others, and we believe that these findings will be a basis for further studies.

Validity and reliability of the Turkish version of the Health Assessment Questionnaire for the Spondyloarthropathies.

The Health Assessment Questionnaire for Spondyloarthropathies (HAQ-S) was built by adding five new questions related with cervical and lumbar spine functions to HAQ by Daltroy et al. (in J Rheumatol 17(7):946-945, 1990). The aim of this study was to adapt the added five items into Turkish and then to test its reliability and validity. New questions were adapted to Turkish according to 'translation-back translation' method. Seventy-nine patients with ankylosing spondylitis were asked with the Turkish version of HAQ-S (HAQ-S TV). To assess, construct validity patients were evaluated by HAQ, Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), Bath AS Metrology Index (BASMI), Maastricht AS Enthesitis Score (MASES), Ankylosing Spondylitis Quality of Life (ASQoL), and laboratory variables (erythrocyte sedimentation rate, C-reactive protein). Construct validity was investigated with Spearmann's rank correlation coefficient. Reliability of HAQ-S TV was assessed by internal consistency. Inter- and intra-observer reliability were tested with Cronbach's alpha score. HAQ-S TV met set criteria of reliability and validity. Reliability of adapted version was found good with high internal consistency value. (Cronbach's alpha = 0.89). In addition to this intra-observer and inter-observer reliability were found adequate for total score of HAQ-S (Cronbach's alphas: 0.999 and 0.998 in order) and also for each added five questions (Cronbach's alphas >0.7). Positive correlations were found between HAQ-S TV and HAQ, BASFI, BASDAI, BASMI, MASES, ASQoL, ESR, and CRP (P < 0.05). The results of this study showed that HAQ-S TV was reliable and valid in patients with AS.

Platelet and Erythrocyte Indexes in Complex Regional Pain Syndrome Type I.

OBJECTIVES: This study aims to compare the levels of platelet and erythrocyte indexes including mean platelet volume, platelet distribution width (PDW), and red blood cell distribution (RDW) values between complex regional pain syndrome (CRPS) type I patients and healthy controls to establish a marker of neuroinflammation that might be a potential factor involved in CRPS etiopathogenesis. PATIENTS AND METHODS: A total of 21 patients (14 males, 7 females; mean age 35.0±15.4 years; range 15 to 69 years) with a diagnosis of CRPS type I and 44 age- and sex-similar healthy controls (29 males, 15 females; mean age 35.8±8.5 years; range 16 to 53 years) were included in this study. Mean platelet volume, PDW, RDW, white blood count, hemoglobin, erythrocyte sedimentation rate, and C-reactive protein levels, and neutrophil to lymphocyte ratio and thrombocyte to lymphocyte ratio were compared between the patient and control groups. RESULTS: No differences were noted between patient and control groups in terms of erythrocyte sedimentation rate and C-reactive protein levels, white blood cell, neutrophil, lymphocyte and thrombocyte counts, and neutrophil to lymphocyte and thrombocyte to lymphocyte ratios (all p>0.05). When compared with controls, patients had significantly higher mean corpuscular volume (p=0.019) and RDW (p=0.002) values, and a lower PDW level (p=0.006). CONCLUSION: Differences in PDW, RDW, and mean corpuscular volume values between patients and controls might support the potential role of neuroinflammation in the etiopathogenesis of CRPS type I. Prospective studies with larger sample sizes are warranted in the early detection and differential diagnosis of CRPS type I.

The evaluation in terms of sarcopenia of patients with fibromyalgia syndrome.

BACKGROUND: Fibromyalgia syndrome (FMS) is an extra-articular rheumatic illness, characterized by widespread body pain and decreased muscle function. Generalized loss of muscle mass and strength is named as sarcopenia. The objective of this study was to evaluate patients with FMS regarding sarcopenia. METHODS: This was a cross sectional, case-controlled, single-blinded, and single-centered study. The FMS patients were assessed by Fibromyalgia Impact Questionnaire (FIQ), visual analog scale (VAS), Beck Depression Index (BDI), and Pittsburg Sleep Quality Scale (PSQI). All the participants were evaluated for sarcopenia by bioimpedance analysis (BIA), anthropometric measurements, handgrip strength, and the parameters of walking speed. RESULTS: In this study, 82 patients with FMS and 38 healthy control female subjects were included. VAS, BDI, and PSQI scores were statistically higher in the FMS group than the control group (p < 0.001). Handgrip strength (HS) and walking speed (WS) scores in the group with FMS were statistically lower than the control group (p = 0.023, p < 0.001 respectively). VAS score of FMS patients was significantly correlated with BIA, body mass index, waist circumference, HS, and WS scores (r = 0.284, p = 0.012; r = 0.228, p = 0.045; r = 0.249, p = 0.028; r = - 0.361, p = 0.001; and r = - 0.230, p = 0.043 respectively). Also FIQ in patients was significantly correlated with BIA, waist circumference, HS, WS, and body mass index (r = 0.267, p = 0.018; r = 0.291, p = 0.010; r = - 0.319, p = 0.004; r = - 0.360, p = 0.001; and r = 0.304, p = 0.007 respectively). CONCLUSION: Evaluation of female patients with primary FMS by the sarcopenia parameters could contribute a more objective evaluation during the patients' follow-up.

Comparison of the Efficacy of Dry Needling and High-Power Pain Threshold Ultrasound Therapy with Clinical Status and Sonoelastography in Myofascial Pain Syndrome.

OBJECTIVE: The aim of this study was to compare the therapeutic efficacy of high-power pain threshold (HPPT) ultrasound therapy applied to the trigger points and dry needling (DN) in myofascial pain syndrome. DESIGN: Sixty-one patients were randomly assigned to an HPPT (n = 30) and dry needling (n = 31) groups. The primary outcome measures were the Visual Analog Scale (VAS) and Neck Pain and Disability Scale (NPDS), both at 1 week and 4 weeks after treatment. The secondary outcome measures were the number of painful trigger points, range of the tragus-acromioclavicular joint, the Short Form-36, the Beck Depression Inventory, the Beck Anxiety Inventory, and sonoelastographic tests after a 1-week treatment. RESULTS: More improvement was seen in anxiety in the HPPT group (P < 0.05). However, no significant differences were found between the groups with regard to other parameters (P > 0.05). A decrease in tissue stiffness was only seen in the HPPT group (P < 0.05). Significant posttreatment improvements were seen on all clinical scales in both groups (P < 0.05). After a treatment period of 4 weeks, a significant improvement was also observed on the visual analog scale and NPDS (P < 0.05). CONCLUSIONS: Our study favors the efficacy of both treatment methods in myofascial pain syndrome. Although a significant decrease was shown in tissue stiffness with HPPT, neither of these treatments had an apparent superiority.

Short-term effectiveness of short-wave diathermy treatment on pain, clinical symptoms, and hand function in patients with mild or moderate idiopathic carpal tunnel syndrome.

OBJECTIVE: We determined the effects of short-wave diathermy (SWD) treatment on mild and moderate idiopathic carpal tunnel syndrome (CTS). METHODS: This was a prospective, randomized, controlled, double-blind clinical trial. The study involved 58 wrists in 31 patients diagnosed clinically and electrophysiologically with mild and moderate CTS. They were assigned randomly to one of two groups. Group 1 received a hot pack, SWD, and nerve and tendon gliding exercises and Group 2 received a hot pack, placebo SWD, and nerve and tendon gliding exercises. The treatment was applied five times weekly for a total of 15 sessions. Patients were evaluated using the Tinel test, Phalen test, carpal compression test, reverse Phalen test, carpal tunnel compression test, Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS), Functional Status Scale (FSS), and a visual analog scale (VAS). Clinical tests and scales were evaluated at the beginning and end of therapy. RESULTS: In the SWD group, in the Tinel test, Phalen test, reverse Phalen test, carpal compression test, VAS, BCTQ-FSS, and BCTQ-SSS, statistically significant improvements were detected (p < 0.001). In the placebo group, although improvements were seen in all parameters, the results were not statistically significantly different (p > 0.05) from baseline. All parameters improved significantly in the SWD group versus the controls (p < 0.05). CONCLUSION: SWD provided short-term improvements in pain, clinical symptoms, and hand function in patients with mild and moderate CTS.

Assessment of lower extremity arterial blood flow in females with knee osteoarthritis.

To investigate whether blood flow in the lower extremity arteries changes in patients with osteoarthritis (OA) using color Doppler ultrasonography. The study comprised 39 female patients with osteoarthritis and 30 healthy female controls. The patients were evaluated using visual analogue scale (VAS) at rest and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Color Doppler imaging was used to measure mid-diastolic velocity (MD), pulsatility index (PI), peak systolic velocity (PS), end-diastolic velocity (ED), vascular diameter, and flow volume in the external iliac (EIA), common femoral (CFA), superficial femoral (SFA), deep femoral (DFA), popliteal (PA), anterior tibial (ATA), posterior tibial (PTA), and distal superficial femoral arteries (DSFA). The femoral artery intima-media thickness (FIMT) was also measured. OA patients' PS and flow volume in the EIA and SFA were greater than those of controls, as were PI and ED in the EIA, ED in the PA, MD in the DFA, and the diameter of the PA, ATA, and PTA (p < 0.05). There were no statistically significant differences in FIMT between patients with knee OA and controls (p > 0.05). The flow volume of the main arteries feeding the knee joint is significantly greater than normal in patients with symptomatic knee OA. No evidence was identified relating this difference to ischemic processes.

The relationship between disease activity and depression and sleep quality in Behçet's disease patients.

Like many chronic illnesses, Behçet's disease (BD) has been reported to negatively affect the quality of life and mental health of the individuals diagnosed with this disease. This study aims to investigate the relationship between disease activity and depression and sleep quality in BD. Forty patients with BD and 30 healthy subjects (controls), aged 18-65, were included in this study, and all of the subjects enrolled in this study were assessed in terms of depression and sleep quality using the Beck depression index (BDI) and Pittsburg sleep quality index (PSQI). Additionally, the subjects with BD were also assessed using the Behçet's disease current activity form (BDCAF). It was determined that the depression and sleep quality scores were significantly higher in the BD group compared to those in the control group (p = 0.012 and p = 0.020, respectively), and in the BD group, significant positive correlations were determined between the BDCAF and depression and sleep quality scores (r = 0.559, p < 0.001 and r = 0.462, p = 0.003, respectively). We believe that the assessment of BD patients for depressive symptoms and sleep quality, and providing medical support to those who need it, will contribute to the treatment and follow-up processes of BD.

[Complex regional pain syndrome type 1 after fracture of distal phalanx: case report]. / Distal falanks kirigi sonrasi kompleks bölgesel agri sendromu tip 1 gelisimi: olgu sunumu.

Complex Regional Pain Syndrome (CRPS) is a disease characterized especially by pain, swelling, limited range of motion, vasomotor instability and patchy bone demineralization in the extremities. In this case, we report a 46-year-old woman diagnosed with CRPS type 1, whose complaints, such as swelling in the left hand, pain, and limitation of movement, started 2 months after a fracture of the distal phalanx in the left 4th finger. Her complaints were reduced with treatment of calcitonin, gabapentin, calcium and vitamin D3, retrograde edema massage, contrast baths, conventional TENS, pulsed ultrasound, desensitization and exercise with range of joint motion. CRPS type 1 should be considered in the differential diagnosis of upper limb pains which start after a fracture of the distal phalanx.