The relationship between sarcopenia-related measurements and osteoporosis: The SARCOP study.

As muscle and bone are closely-related, we have explored the association between sarcopenia-related measurements and bone mineral density (BMD) (and osteoporosis) in postmenopausal women. Grip strength, anterior thigh muscle thickness and chair stand test were found to be related with BMD. Additionally, grip strength < 22 kg increased the odds ratio of osteoporosis 1.6 times. INTRODUCTION: As muscle and bone are two closely related tissues, we aimed to investigate the association between sarcopenia-related measurements (i.e., sonographic anterior thigh muscle thickness, grip strength, chair stand test (CST), gait speed) and clinical factors, lumbar/femoral BMD, and the presence of osteoporosis (OP) in postmenopausal women. METHODS: Community dwelling postmenopausal women from two physical and rehabilitation medicine outpatient clinics were consecutively included in this cross-sectional study. Demographic data, age, weight, height, education/exercise status, smoking, and comorbidities were registered. BMD measurements were performed from lumbar vertebrae (L1-4) and femoral neck using dual energy X-ray absorptiometry (DXA). A T-score of ≤ -2.5 SD in the lumbar vertebrae (L1-L4) and/or femoral neck was accepted as OP. Anterior thigh muscle thickness (MT) at the midthigh level was measured sonographically using a linear probe. Grip strength was measured from the dominant side. Physical performance was assessed by CST and gait speed. RESULTS: Among 546 postmenopausal women, 222 (40.7%) had OP. Among sarcopenia-related parameters, grip strength and anterior thigh MT were positively associated with lumbar vertebral BMD. CST performance was positively associated with femoral neck BMD. After adjusting for confounding factors, low grip strength (< 22 kg) increased 1.6 times the risk of OP. CONCLUSION: Loss of muscle mass/function (i.e., sarcopenia) can coexist with loss of trabecular and cortical bone. To this end, grip strength and anterior thigh MT seem to be associated with the lumbar vertebral BMD, while CST is associated with the femoral neck BMD. Lastly, low grip strength might have an association with postmenopausal OP.

Ultrasonographic measurements of the skin, fat and muscle in vitamin D deficiency.

BACKGROUND: Vitamin D is a steroid hormone and it is essential for the musculoskeletal system health. The relationship among vitamin D levels and adiposity was shown. However, there is only one study seems to have examined the relationship between skinfold thickness and vitamin D levels. METHODS: A total of 116 healthy subjects who had a recent vitamin D measurement were included. Skin, subcutaneous fat and muscle thicknesses were measured by ultrasound (US). Hand grip strength and usual gait speed were evaluated. RESULTS: Subjects were classified into two groups according to 25-OH vitamin D levels. Skin thicknesses of anterior forearm in women and of anterior tibia in men, and trochanteric fat thicknesses of both genders were higher in lower 25-OH vitamin D group (both P < .05). There were no differences between the groups regarding muscle thicknesses, grip strength and gait speed (all P > .05). For identifying vitamin D deficiency (≤20 ng/mL); optimal skin thickness value was 1.25 mm in women (sensitivity: 91.3%, specificity: 54.7%), and optimal trochanteric fat thickness was 1.79 cm in men (sensitivity: 87.5%, specificity: 76.9). The specificity was increased to 79.2% if the cut-off value was taken as 1.35 mm for anterior forearm skin thickness in women. CONCLUSION: We imply that skin thicknesses (anterior forearm and tibia) and subcutaneous fat (trochanteric region) increase in subjects with low vitamin D levels. Having also ascertained the relevant cut-off values, we underscore the possible role of these measurements as regards the assessment of vitamin D status.

Monoclonal antibodies for chronic pain: a practical review of mechanisms and clinical applications.

Context: Monoclonal antibodies are being investigated for chronic pain to overcome the shortcomings of current treatment options. Objective: To provide a practical overview of monoclonal antibodies in clinical development for use in chronic pain conditions, with a focus on mechanisms of action and relevance to specific classes. Methods: Qualitative review using a systematic strategy to search for randomized controlled trials, systematic and nonsystematic (narrative) reviews, observational studies, nonclinical studies, and case reports for inclusion. Studies were identified via relevant search terms using an electronic search of MEDLINE via PubMed (1990 to June 2017) in addition to hand-searching reference lists of retrieved systematic and nonsystematic reviews. Results: Monoclonal antibodies targeting nerve growth factor, calcitonin gene-related peptide pathways, various ion channels, tumor necrosis factor-α, and epidermal growth factor receptor are in different stages of development. Mechanisms of action are dependent on specific signaling pathways, which commonly involve those related to peripheral neurogenic inflammation. In clinical studies, there has been a mixed response to different monoclonal antibodies in several chronic pain conditions, including migraine, neuropathic pain conditions (e.g., diabetic peripheral neuropathy), osteoarthritis, chronic back pain, ankylosing spondylitis, and cancer. Adverse events observed to date have generally been mild, although further studies are needed to ensure safety of monoclonal antibodies in early stages of development, especially where there is an overlap with non-pain-related pathways. High acquisition cost remains another treatment limitation. Conclusion: Monoclonal antibodies for chronic pain have the potential to overcome the limitations of current treatment options, but strategies to ensure their appropriate use need to be determined.

Correlations among enthesitis, clinical, radiographic and quality of life parameters in patients with ankylosing spondylitis.

OBJECTIVES: To investigate the relationship between enthesitis and disease activity, functional status, fatigue, joint mobility, radiological damage, laboratory parameter and quality of life in patients with ankylosing spondylitis (AS). METHODS: A total of 421 patients with AS (323 male and 98 female) who were included in the Turkish League Against Rheumatism Registry were enrolled in the study. The Bath AS Disease Activity Index (BASDAI), fatigue, the Bath AS Functional Index (BASFI), the Bath AS Metrology Index (BASMI), the Maastricht AS Enthesitis Score (MASES), AS quality of life (ASQoL), the Bath AS Radiology Index (BASRI) and erythrocyte sedimentation rate (ESR) were evaluated. RESULTS: Enthesitis was detected in 27.3% of patients. There were positive correlations between MASES and BASDAI, BASFI and fatigue (p < 0.05). MASES was not correlated with BASRI, BASMI, ASQoL and ESR. The mean MASES score was 1.1 ± 2.4. The most frequent regions of enthesopathies were right iliac crest, spinous process of L5 and proximal to the insertion of left achilles tendon, respectively. CONCLUSIONS: Enthesitis was found to be associated with higher disease activity, higher fatigue, worse functional status and lower disease duration. As enthesitis was correlated with BASDAI, we conclude that enthesitis can reflect the disease activity in patients with AS.

Ultrasonography in plantar fibromatosis: the conduit between heel pain and 'catwalk'.

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Frequency of fibromyalgianess in patients with rheumatoid arthritis and ankylosing spondylitis: A multicenter study of Turkish League Against Rheumatism (TLAR) network.

Objectives: This study aimed to evaluate the frequency of fibromyalgianess, fibromyalgia syndrome (FS), and widespread pain in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and their relationship with clinical and demographic parameters. Patients and methods: This cross-sectional multicenter trial was performed in 14 centers across Türkiye between June 2018 and November 2019. Out of 685 patients recruited from the accessible population, 661 patients (342 RA, 319 AS; 264 males, 397 females; mean age: 48.1±12.9 years; range, 17 to 88 years) met the selection criteria. In these cohorts, those who did not meet the criteria for FS and had widespread pain (widespread pain index ≥7) were evaluated as a separate group. Clinical status and demographic parameters of patients in both cohorts were evaluated as well as the evaluations of RA and AS patients with widespread pain (widespread pain index ≥7) and RA and AS patients with FS groups. In addition, correlations between polysymptomatic distress scale (PSD) scores and Visual Analog Scale (VAS), Simplified Disease Activity Index (SDAI), Clinical Disease Activity Index (CDAI), and Disease Activity Score using 28 joint counts for RA patients and VAS, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Ankylosing Spondylitis Disease Activity Score (ASDAS) for AS patients were analyzed. Results: Frequencies of patients with FS and patients who had PSD scores ≥12 were 34.1% and 44.4% in all RA patients, respectively. Moreover, FS and PSD scores ≥12 were found in 29.2% and 36.9% of all AS patients, respectively. PSD scores of RA patients with FS were higher than all RA patients and RA patients with widespread pain. SDAI and CDAI scores of RA patients with FS were higher than all RA patients and RA patients with widespread pain. Similarly, PSD scores of AS patients with FS were higher than all AS patients and AS patients with widespread pain. ASDAS-erythrocyte sedimentation rate and BASDAI scores of AS patients with FS were found higher than all AS patients and AS patients with widespread pain. Conclusion: Disease activity scores, including pain in RA and AS, were higher in the presence of FS or fibromyalgianess. It may be related to clinical parameters, but cohort studies with long-term follow-up are needed to reveal causality. Additionally, to avoid overtreatment, coexistence of fibromyalgianess should be kept in mind in patients who have inflammatory diseases such as RA and AS, particularly with intractable widespread pain.

Ultrasonographic evaluation of the femoral cartilage thickness in patients with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a multisystem chronic inflammatory disease with a broad spectrum of clinical and serological manifestations. Although articular involvement is known in SLE, articular cartilage has not been studied before. Therefore, in this study, we have evaluated the femoral cartilage by using ultrasonography. Twenty-nine SLE patients (5 M, 24 F) with a mean age of 37.93 ± 10.66 years and mean disease duration of 3.69 ± 3.24 years and 29 age-, gender- and body mass index-matched healthy subjects were enrolled. Demographic and clinical characteristics of the patients were recorded. The thickness of the femoral articular cartilage was measured by using a 7- to 12-MHz linear probe. Three mid-point measurements were taken from each knee; from right lateral condyle, right intercondylar area (RIA), right medial condyle (RMC), left medial condyle, left intercondylar area (LIA) and left lateral condyle (LLC). Although SLE patients had thicker femoral cartilage values than those of the control group at all measurement sites, the differences were not statistically significant (all p > 0.05). Twenty-two patients (75.9 %) were using corticosteroids, and when those patients were compared with their healthy controls, the difference reached statistical significance at RIA (p = 0.022), LIA (p = 0.059) and LLC (p = 0.029). We found that SLE patients seem to have thicker femoral cartilage values and that this increase could be related with corticosteroid treatment. In addition to studies that have shown the favorable effects of corticosteroids on chondrogenesis, further studies are needed to clarify the scenario in SLE patients.

Evaluation of disease burden, patient journey, unmet diagnosis and treatment needs of patients with HIP and knee osteoarthritis in Turkey: A study through Delphi Methodology.

Objective: To get information-driven insights from expert physicians regarding multiple aspects of the patient journey in knee and hip OA and establish a consensus for future studies and decision tree models in Turkey. Design: 157 questions were asked in total during this three-round modified Delphi-method panel to 10 physical medicine and rehabilitation specialists (2 have rheumatology and 3 have algology subspeciality), one orthopaedic surgeon and one algology specialist from anaesthesia specialty background. A consensus was achieved when 80% of the panel members agreed with an item. Contradictions between different disciplines were accepted as a non-consensus factor. Results: Panellists agreed that American College of Rheumatology classification criteria is mostly sufficient to provide an OA diagnosis in clinical practice, OA patients with ≥5 Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain or physical function score can be defined as moderate-to-severe OA if they have an additional ≥2 Kellgren-Lawrence (KL) score, a minimum improvement of 30% from baseline in WOMAC pain or function subscales or in PGA score can be accepted as moderate treatment response where ≥50% improvement from baseline in those scores as substantial response. Panellists stated that arthroplasty procedures need to be delayed as long as possible, but this delay should not jeopardize a beneficial and successful operation. Conclusions: These findings show that there is a significant disease burden, unmet treatment needs for patients with moderate-to-severe OA in Turkey from experts' perspective. Therefore, an updated systematic approach and decision tree models are needed to be implemented.

Sonographic evaluation of sciatic nerves in patients with unilateral sciatica.

OBJECTIVES: To evaluate the sciatic nerves of patients with unilateral sciatica by using an ultrasound, and to determine whether ultrasonographic findings were related to clinical and electrophysiologic parameters. DESIGN: Cross-sectional study. SETTING: Physical medicine and rehabilitation departments of a university hospital and a rehabilitation hospital. PARTICIPANTS: Consecutive patients (N=30; 10 men, 20 women) with complaints of low back pain and unilateral sciatica of more than 1 month of duration were enrolled. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: All patients underwent a substantial clinical assessment, and they were also evaluated by electromyogram and magnetic resonance imaging. Pain was evaluated by a visual analog scale and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Scale. A linear array probe (7.5-12MHz) was used to scan sciatic nerves bilaterally in the prone position. Sciatic nerve diameters-thickness (short axis) and width (long axis)-and cross-sectional areas were measured bilaterally at the same levels, proximal to the bifurcation and midthigh. The values pertaining to the unaffected limbs were taken as controls. RESULTS: When compared with the unaffected sides, mean values for sciatic nerve measurements-long axis at bifurcation level (P=.017) and cross-sectional area at midthigh level (P=.005)-were significantly larger on the affected sides. Swelling ratios negatively correlated with symptom duration (r=-.394, P=.038) and LANSS scores (r=-.451, P=.016) at only midthigh level. CONCLUSIONS: Sciatic nerves seem to be enlarged on the side of sciatica in patients with low back pain. Our preliminary results may provide insight into better understanding the lower limb radiating pain in this group of patients.

Ultrasonographic Evaluation of the Metacarpal Cartilage Thicknesses in Weightlifters and Volleyball Players.

OBJECTIVE: The aim of the study was to evaluate the possible effects of impact and loading on the metacarpal cartilage and hand functions in young elite athletes. DESIGN: In this cross-sectional study athletes with at least 3 yrs of sport background and who have been under a scheduled training program were enrolled. The second to fifth fingers' metacarpal head cartilage thicknesses were measured bilaterally by using ultrasonography. Handgrip and pinch strengths were measured. Michigan Hand Outcomes Questionnaire was also completed for every participant. RESULTS: A total of 42 male athletes (19 weightlifters, 23 volleyball players) and 46 healthy control subjects were enrolled. Metacarpal cartilage thicknesses of the athletes were thicker than those of the healthy controls (all P < 0.001). There were no differences between the dominant and nondominant hands (all P > 0.05). In the weightlifting group, Michigan Hand Outcomes Questionnaire work performance and pain scores were worse than the other groups (both P < 0.001). CONCLUSIONS: The presence of increased cartilage thickness measurements in the athletes suggests that sports activities might affect the metacarpal articular cartilage. Highest pain scores and lowest work performance scores in the weightlifters with highest metacarpal cartilage thickness might suggest that impact and loading during their sports play could lead to cartilage edema.

Quality of life and related variables in patients with ankylosing spondylitis.

OBJECTIVES: To evaluate quality of life (QoL) and related variables in patients with ankylosing spondylitis (AS), a chronic inflammatory disease of the spine. METHODS: Nine-hundred and sixty-two patients with AS from the Turkish League Against Rheumatism AS Registry, who fulfilled the modified New York criteria, were enrolled. The patients were evaluated using the Assessment of SpondyloArthritis International Society core outcome domains including Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), fatigue (BASDAI-question 1), pain (last week/spine/due to AS), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Radiology Index (BASRI), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and two QoL questionnaires (the disease-specific ASQoL and generic the Short Form-36 [SF-36]). RESULTS: The mean ASQoL score was 7.1 ± 5.7. SF-36 subscales of general health, physical role and bodily pain had the poorest scores. ASQoL was strongly correlated with disease duration, BASDAI, fatigue, BASFI, BASMI, BASRI, MASES, pain and SF-36 subscales (P < 0.001). SF-36 subscales were also strongly correlated with BASDAI and BASFI. Advanced educational status and regular exercise habits positively affected QoL, while smoking negatively affected QoL. CONCLUSIONS: In patients with AS, the most significant variables associated with QoL were BASDAI, BASFI, fatigue and pain. ASQoL was noted to be a short, rapid and simple patient-reported outcome (PRO) instrument and strongly correlated with SF-36 subscales.

Quantification of the effects of transcutaneous electrical nerve stimulation with functional magnetic resonance imaging: a double-blind randomized placebo-controlled study.

OBJECTIVE: To evaluate the effects of transcutaneous electric nerve stimulation (TENS) by using functional magnetic resonance imaging (fMRI) in patients with carpal tunnel syndrome (CTS). DESIGN: Randomized controlled trial. SETTINGS: University medical center and an outpatient imaging center. PARTICIPANTS: Female patients with CTS (n=20) were randomized into 2 groups receiving either TENS (n=10) or sham TENS (n=10). In both groups, an initial baseline fMRI session was performed via stimulating digits 2, 5, and 3 in turn, 1 scan run for each. TENS versus sham TENS treatment was given, and a repeat imaging was performed starting 20 minutes after the treatment as follows: second finger on the 20th minute, fifth finger on the 25th minute (ulnar nerve innervated control finger), and third finger on the 30th min. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Differences in fMRI activation between the 2 groups were evaluated. RESULTS: Our results demonstrated that 20 to 25 minutes after TENS treatment-but not in the sham TENS group-a significant fMRI signal decrease for digit 2 (post-TENS vs baseline) was observed in the secondary somatosensory regions, ipsilateral primary motor cortex (M1), contralateral supplementary motor cortex (SMA), contralateral parahippocampal gyrus, contralateral lingual gyrus, and bilateral superior temporal gyrus. Measurements on the 25th to 30th minutes for digit 5 were similar between the groups, with presence of activities in areas other than generally activated regions because of painful stimuli. Thirty to 35 minutes after TENS treatment, a significant fMRI signal decrease for digit 3 was detected in the contralateral M1 and contralateral SMA only in the TENS group. CONCLUSIONS: Our findings showed that TENS treatment significantly decreased the pain-related cortical activations caused by stimulation of the median nerve-innervated fingers up to 35 minutes after treatment.

Short-term effectiveness of platelet-rich plasma in carpal tunnel syndrome: A controlled study.

Platelet-rich plasma (PRP) treatment has a potential to become a part of nonsurgical approach in carpal tunnel syndrome (CTS) as a regenerative method. PRP therapies aim to enhance the self-healing ability of human body, by exposing the injured tissue to a high concentration of autologous growth factors. Nerve tissues also seem to benefit from the regenerative effects of PRP concentrates. The aim of this study is to investigate the possible beneficial effects of PRP injection in CTS. A total of 40 hands of 30 patients were included (20 hands per group) with mild to moderate idiopathic CTS. Patients with mild to moderate CTS were placed into either control or PRP groups. Activity modification and night-only wrist splints were suggested in both groups. Additionally, in PRP group, a single perineural PRP injection into the carpal tunnel was applied under ultrasound guidance. Sensibility tests, Boston carpal tunnel questionnaire (BCTQ), and electrophysiological and ultrasonographical findings were measured initially and after 4 weeks. Groups were similar regarding demographics. BCTQ scores and ultrasonographical values were improved in both groups. Delta analyses revealed that the difference of BCTQ scores improved better in PRP group. Electrophysiological values improved in PRP group. Our study demonstrated that a single, perineural PRP injection into carpal tunnel provided further improvements in CTS.

Botulinum toxin injections to cranial sutures for chronic migraine Rewinding the technique using ultrasound imaging.

The treatment of chronic migraine headache is quite challenging and new alternatives are still being explored for its management. Onabotulinum toxin A (BoNT-A) applied into extracranial muscles has been shown to inhibit the release of acetylcholine and local nociceptive peptides at the sensory nerve endings. As the highest concentration of extracranial pain fibers are located at/nearby the sutures, extracranial applications of BoTN-A are suggested to be performed to sutures rather than into the head and neck muscles in the treatment of chronic migraine. Moreover, in an animal study, BoTN-A is found to be more effective for decreasing the chemosensitivity of meningeal nociceptors when the total dose is injected along the sutures in comparison to being divided into sutures and cranial muscles. Of note, since BoNT-A injections performed with the blind/nontargeted technique have lower effectivity and several complications (muscle weakness, ptosis, facial paresis, etc.), the use of ultrasound guidance for targeting the cranial sutures is definitely expected to provide technical ease, better pain relief and toxin tolerance in chronic migraine.

Regional and total muscle mass, muscle strength and physical performance: The potential use of ultrasound imaging for sarcopenia.

OBJECTIVE: To evaluate the relationship between the regional and total muscle mass, muscle strength and physical performance, and also to investigate the affected muscles, their strength and physical performance with aging. METHODS: A total of 145 healthy subjects were included for the cross-sectional descriptive study. Demographic data were obtained, and body composition was consecutively assessed by anthropometric methods, bioelectrical impedance analysis and ultrasound (muscle thickness, fascicule length and pennation angle). Functional status was assessed using hand grip strength and gait speed measurements. RESULTS: Abdominal and thigh muscles were thinner and triceps muscle was thicker in older subjects when compared with younger ones. Age and grip strength were significant predictors for physical performance. Gait speed, grip strength and regional muscle measurements decreased with age at higher rates (26-28%), skeletal muscle mass index was affected at a lower rate (15%). CONCLUSIONS: Low muscle strength and regional muscle measurements should be used to confirm the diagnosis of sarcopenia.

Ultrasonographic Evaluation of the Femoral Cartilage, Achilles Tendon, and Plantar Fascia in Young Women Wearing High-Heeled Shoes.

BACKGROUND: Specific attention on the musculoskeletal impact of wearing high-heeled shoes (HHS) has mainly focused on knee osteoarthritis and the literature is limited to biomechanical changes. The distal femoral cartilage has not been morphologically studied. Additionally, although heel elevation is coupled with a shear stress at the heel and overloaded calf muscles, Achilles tendon (AT) and plantar fascia (PF) thicknesses have not been assessed either. OBJECTIVE: To investigate whether the distal femoral cartilage, AT, and PF were different in women wearing HHS and flat-heeled shoes (FHS) and specifically, different in terms of AT/PF and distal femoral cartilage thicknesses. DESIGN: Cross-sectional observational study. SETTING: Tertiary care center. PARTICIPANTS: There were 34 women (mean age; 31.1 ± 6.4, body mass index [BMI]; 21.6 ± 2.4 kg/m2 ) in the HHS group and 54 women (mean age; 29.5 ± 7.2 years, BMI 22.5 ± 2.9 kg/m2 ) in the FHS group (P = .271, P = .102, respectively). Women wearing shoes with a heel height of >5 cm were enrolled in the HHS group, and those wearing shoes with a heel height of <1.4 cm were included in the FHS group. MAIN OUTCOME MEASUREMENTS: Distal femoral cartilage from the lateral condyle, intercondylar area and medial condyle (MFC), AT and PF thicknesses, and any abnormalities were evaluated bilaterally by ultrasound. RESULTS: Within-group comparisons yielded thicker right MFC (P = .022) and left AT (P = .028) only in the HHS group. Between-group comparisons yielded thicker left AT in the HHS group (P = .040). PF thicknesses were similar both within and between group comparisons (all P > .05). Right AT thickness was positively correlated with right (r = .469, P = .005) and left (r = .402, P = .018) PF thicknesses only within the HHS group. Only calcaneal irregularity/spur was found to be common in the HHS group (P = .038). CONCLUSIONS: We found thickening of the right MFC and left AT in those wearing HHS, whereas PF thickness was not significantly different between those wearing HHS and those wearing FHS. LEVEL OF EVIDENCE: III.

A comparison of the benefits of sonography and electrophysiologic measurements as predictors of symptom severity and functional status in patients with carpal tunnel syndrome.

OBJECTIVES: To clarify whether sonography or electrophysiologic testing is a better predictor of symptom severity and functional status in carpal tunnel syndrome (CTS) and to assess the diagnostic value of sonography in patients with idiopathic CTS. DESIGN: Cross-sectional. SETTING: University hospital physical medicine and rehabilitation clinic. PARTICIPANTS: Thirty-four hands with CTS and 38 normative hands were evaluated. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Boston Carpal Tunnel Questionnaire, which comprised symptom severity and functional status scale, was applied to CTS patients. Bilateral upper-extremity nerve conduction studies of median and ulnar nerves and sonographic imaging of the median nerve were performed in all participants. Sonographic evaluation was performed by a physician blinded to the physical and electrophysiologic findings of the subjects. RESULTS: Cross-sectional areas (CSAs) of the median nerve at the carpal tunnel entrance and proximal carpal tunnel were 12.5+/-2.6 and 10.6+/-2.6 versus 15.6+/-4.2 and 11.5+/-3.2 in CTS patients versus controls, respectively. Increased CSA of the median nerve at the carpal tunnel entrance (P<.002) and at the proximal carpal tunnel (P<.000) were detected in the hands with CTS. Flattening ratios did not differ in a statistically significant manner between the groups (P>.05). The best predictor of symptom severity was median nerve sensory distal latency and that of functional status was median nerve motor distal latency. The optimum cutoff value for median nerve CSA was 11.2mm(2) at the carpal tunnel entrance and 11.9mm(2) at the proximal carpal tunnel. Sensitivity, specificity, and positive and negative predictive values at the proximal carpal tunnel (88%, 66%, 71%, 80%, respectively) were higher than those at the carpal tunnel entrance (68%, 62%, 65%, 66%, respectively). CONCLUSIONS: The best predictors of symptom severity and functional status in idiopathic CTS seem to be the electrophysiologic assessments rather than sonographic measurements. On the other hand, sonography may be helpful in the diagnosis of idiopathic CTS.

Evaluation of the patient positioning during DXA measurements in daily clinical practice.

For prompt diagnosis of osteoporosis, properly instructed dual-energy X-ray absorptiometry (DXA) measurements are required. To get correct DXA results in addition to quality control procedures, proper positioning of specific body regions such as hip and spine should also be achieved. The aim of this study was to assess the accurateness of the patient positioning for hip and spine regions in daily clinical practice. Hip and spine scan images of 113 DXA reports were evaluated for whether or not the patient was positioned correctly. Out of 113 hip and spine DXA reports, 61 hips and 94 spines were found to have scan images with improper positions. The spine was not straight in 48.7% of the images. The 38.9% of the spinal images did not comprise both iliac crests, and 40.7% did not include T12 and L5 vertebrae. In hip DXA reports, 40.7% of the femoral shaft was deviated to one side. We found the ratio of invalid positions surprisingly very high. Although this may stem from local technical problems and may not reflect the overall quality of scans in other centers, such misinterpretations would definitely affect clinicians' decisions in an inappropriate way. We suggest that relevant inconveniences should be kept in mind both by the clinicians and the technical staff for better production and prompt estimation of DXA measurements.