Association of real-time sonoelastography findings with clinical parameters in lateral epicondylitis.

The objective of this study was to investigate the role of real-time sonoelastography (RTSE) in patients with lateral epicondylitis (LE) and whether it is associated with clinical parameters. Seventeen patients with unilateral LE were enrolled in the study. The healthy elbows of the participants constituted the control group. Using B-mode ultrasound, color Doppler ultrasound, and RTSE, we prospectively examined 34 common extensor tendon elbows of 17 patients. Both color scales and strain ratio were used for evaluating RTSE images. Two radiologists evaluated the RTSE images separately. Elbow pain was scored on a 100-mm visual analog scale (VAS). Symptom duration and the presence of nocturnal pain were questioned. Quick disabilities of arm shoulder and hand (DASH) Questionnaire was applied to assess the pain, function, and disability. Nottingham health profile (NHP) was used to determine and quantify perceived health problems. Both color scales and strain ratios of the affected tendon portions were significantly different from that of healthy tendons (p < 0.001). There was no significant association between NHP, VAS, Quick DASH scores, and color scales and strain ratio. Strain ratio of the medial portion of the affected tendon was significantly correlated with symptom duration (rho = -0.61 p = 0.010) and nocturnal pain (rho = 0.522 p = 0.031). Interobserver agreement was substantial for color scales (κ = 0.74, p = 0.001) and strain ratio (ICC = 0.61, p = 0.031). RTSE may facilitate differentiation between healthy and affected elbows as a feasible and practical supplementary method with substantial interobserver agreement. RTSE was superior to B-mode ultrasound and color Doppler ultrasound in discriminating tendons with LE. Strain ratio of the medial portion of the tendon is associated moderately with nocturnal pain and symptom duration. No other associations were present between RTSE findings and clinical or functional parameters.

Investigation of Biomechanical Characteristics of Intact Supraspinatus Tendons in Subacromial Impingement Syndrome: A Cross-sectional Study with Real-time Sonoelastography.

OBJECTIVE: The aim of this work was to evaluate the real-time sonoelastography (RTSE) in the assessment of the supraspinatus tendon in patients with subacromial impingement syndrome (SIS). METHODS: Twenty-five patients with unilateral shoulder pain that was diagnosed as SIS according to magnetic resonance imaging findings were included in the study. Healthy shoulders of the patients comprised the control group. Bilateral shoulder RTSE examinations were performed by a radiologist who was blinded to the involved side of the participants. The RTSE images were recorded and assessed by 2 radiologists individually 1 month later. American Shoulder and Elbow Surgery shoulder index, Quick Disabilities of Arm Shoulder and Hand Questionnaire, and Constant scores were applied to evaluate the disability and functional status. The correlation between strain ratio and functional scores were investigated. RESULTS: Of the 25 participants, 9 (36%) were men and 16 (64%) were women. The RTSE findings were pathologic in tendons of 23 patients (92%) with SIS. The strain ratio was significantly higher in the affected shoulders (P < 0.001). The interobserver agreement was good for image analysis. There was no significant correlation between strain ratio and functional scores. CONCLUSION: Structural changes in the supraspinatus tendon can be demonstrated with RTSE in patients with SIS.

Kinesio taping or just taping in shoulder subacromial impingement syndrome? A randomized, double-blind, placebo-controlled trial.

OBJECTIVE: To verify effects of kinesio taping (KT) in shoulder subacromial impingement syndrome (SIS) when compared to sham taping applied in the same way with KT. PATIENTS AND METHODS: Patients were randomized as group 1 (n = 21) KT group and group 2 (n = 20) sham-taping group. Taping was applied every three days, three times during the study period. We assessed all the patients at baseline, at the end of the taping period (12th day), and at one-month post-intervention. We assessed pain on the 100 mm visual analog scale (VAS). Shoulder range of motion (ROM), Constant Scores, and Nottingham Health Profile (NHP) scores were evaluated. RESULTS: Of the 41 participants, 13 were males (32%) and 28 were females (68%). The mean age was 45 ± 15 years (range 20-65 years). We documented a significant decrease in VAS for nocturnal pain, and Constant Score in both groups. The KT group showed additional significant change in NHP pain and physical activity scores. CONCLUSION: KT and sham taping generated similar results regarding pain and Constant Scores.

The association of calcaneal spur length and clinical and functional parameters in plantar fasciitis.

INTRODUCTION: Plantar fasciitis (PF)is the most common cause of plantar heel pain. Despite many treatment alternatives for heel spur, the association of calcaneal spur size with clinical and functional parameters is inconclusive. The objective of this study to investigate the correlation of calcaneal spur length with clinical findings and functional status documented with Foot Function Index in patients with plantar fasciitis. METHODS: We performed power analysis for the sample size estimation. 87 patients with PF were scrutinized to reach the estimated patient number 75. Computer-aided linear measurements were done for spur length from tip to base in milimeters. Perceived pain intensity was evaluated by visual analog scale (VAS). Patients were asked to rate the pain experienced on a 10-cm VAS. Foot function index was applied to the patients to evaluate pain, disability and activity limitation of the patients. RESULTS: Of the 75 participants, 24 were males (32%) and 51 were females (68%). The mean age was 47 ± 10 years (range 30-65 years). The mean calcaneal spur length was 3.86 ± 3.36 mm (range between 0 and 12.2). Calcaneal spur length was significantly correlated with age (p = 0.003), BMI (p = 0.029), symptom duration, (p = 0.001) VAS (p = 0.003), and FFI total score (p < 0.001). DISCUSSION: Our study demonstrated that length of the calcaneal spur is significantly correlated with age, BMI, symptom duration, perceived pain, FFI pain and disability subscores, and FFI total scores. CONCLUSION: The size of the calcaneal spur is an important parameter correlated with pain and functional scores in PF.

Monoarticular hip involvement in pseudogout.

Pseudogout is the acutest form of arthritis in the elderly. Although clinical manifestations vary widely, polyarticular involvement is typical mimicking osteoarthritis or rheumatoid arthritis. Monoarticular involvement is relatively rare and is generally provoked by another medical condition. There are reported cases of hip involvement by pseudogout in monoarticular form. However, all of the cases were presented as septic arthritis. In this report, we present a case of monoarticular hip involvement mimicking soft tissue abscess. We confirmed the pseudogout diagnosis after ultrasonographic evaluation of the involved hip joint and pathological and biochemical analysis of synovial fluid analysis. Diagnosis is important to avoid unnecessary medical and surgical treatment in cases of the bizarre involvement of hip in pseudogout.

Is cold therapy really efficient after knee arthroplasty?

INTRODUCTION: Knee arthroplasty is a frequently used surgery. The purpose of this study is to evaluate the effects of cold therapy after knee arthroplasty. METHODS: 60 patients who were operated in our clinic between the years 2013 and 2014 were evaluated prospectively, and the patients were randomized into two groups. The cold therapy by Cryo/Cuff application was started 2 h before the surgery in Group-2 patients; it was repeated in a postoperative 6th hour and continued for postoperative four days. We analyzed the visual analog scales (VAS) for pain, Knee Society Scores (KSS), hemoglobin, and bleeding parameters. RESULTS: The data of the group that did not receive the Cryo/Cuff application (Group-1) are as follows; the number of the patients was 33; the mean age value was 68,4 (53-78). Group-2 data was as follows; the number of the patients was 27; the mean age value was 67.2 years (range 57-78). The mean KSS scores of the patients increased from 79.6 (75-83) and to 90.5 (88-92) postoperatively (p < 0.05). DISCUSSION: In our study, the pain and functional knee scores of the patients who received Cryo/Cuff application were significantly different and as expected, the use of analgesics was much lower. Cryotherapy did not affect the amount of bleeding during the surgery (p > 0.05), which was not reported previously in the literature. CONCLUSION: After knee arthroplasty, the preoperative and postoperative use of cryotherapy is effective in terms of the pain control and functional knee scores without a significant change in surgical blood loss.

Kinesio taping or sham taping in knee osteoarthritis? A randomized, double-blind, sham-controlled trial.

PURPOSE: To compare effects of kinesio taping with sham taping at the end of 3 consecutive taping periods in knee osteoarthritis. METHODS: 41 patients diagnosed with knee osteoarthritis according to American College of Rheumatology were randomized to receive either KT or sham taping. Baseline evaluations included a visual analog scale (VAS) for activity and nocturnal pain, Lequesne index for functional assessment and Nottingham Health Profile (NHP) for the quality of life. Taping was applied every four days, three times, and all of the assessments were repeated at the end of the treatment period. RESULTS: In both groups VAS for activity pain, VAS for nocturnal pain, Lequesne index score, NHP score decreased significantly. NHP energy scores were different significantly between the groups in favor of sham taping at the end of the 12-day period. CONCLUSION: Our findings indicate inconclusive evidence of a beneficial effect of kinesio taping over sham taping in knee osteoarthritis.

The importance of patient compliance in nonunion of forearm fracture.

INTRODUCTION: Studies on radius ulna shaft fractures are very important. Surgical treatment is generally administered due to the unstability caused by the dynamic effect of forearm muscles. Surgical technique, implant, osteoporosis, patient compliance can affect the surgical treatment and healing. PRESENTATION OF CASE: An 86-year-old female patient was admitted to emergency service with the complaint of protrusion of forearm implant from the skin. Physical examination revealed that 80° nonunion developed on the radial side. Therefore, protruded and exposed internal fixation materials were excised under axillary block. We used zoledronic acid as a treatment of osteoporosis with the value of -3.2 Dexa score. DISCUSSION: Complication rate is reported to be 25% in patients treated with plate fixation. Patient compliance is very crucial in forearm fractures as in all surgical procedures. Presence of comorbidities and socioeconomical status of the patient are important factors in fracture healing. CONCLUSION: This case emphasizes the importance of compliance of the patient to the follow-up after surgical treatment of forearm fracture.

Relation of age and sex with carotid intima media thickness in healthy children.

BACKGROUND/AIM: To investigate the age- and sex-associated carotid intima media thickness (clMT) changes in healthy children to determine the age- and sex-specific normal range of values for childhood. MATERIALS AND METHODS: This study examined 91 healthy school-age children aged 7-15 years prospectively. Standardized sonographic cIMT measurements and analyses were performed. Body mass index and blood pressure were obtained, and atherosclerotic risk factors were investigated. Age- and sex-specific cIMT measurements for different age groups were calculated and the relation with sex was investigated. RESULTS: Regarding the total study group, mean cIMT measurements for age groups 7-9, 10-12, and 13-15 years were 4.1 + 0.5 mm, 4.4 ± 0.6 mm, and 4.6 ± 0.4 mm, respectively. cIMT did not differ between boys and girls in the same age group. Age related analyses showed significant variations among the age groups with positive correlation between cIMT and age. CONCLUSION: Our results suggest that age-related physiologic thickening of the carotid artery intima-media occurs not only in adults but also in children and that sex is not a factor for cIMT differences in childhood.

An unusual cause of knee pain in a young patient; hydatid disease of femur.

INTRODUCTION: Osseous hydatid disease is a rare pathology and its differential diagnosis can be difficult. PRESENTATION OF CASE: This article presents clinical and radiological findings of a femoral primary hydatid disease in a 23 year-old patient admitted with knee pain. DISCUSSION: Osseous hydatid in femur is a rare entity. Curettage is one of the surgical options with high risk of anaphylaxis and implantation. Radical resection of involved segment is the preferred treatment method in the current literature. However, patient preference can be different. CONCLUSION: Although late stages of this disease need be treated with amputation or disarticulation, in the early stages it can be treated with curettage and bone cementing. Our case with early diagnosis of hydatid disease of distal femur was treated successfully with curettage and bone cementing.

Functional magnetic resonance imaging of the effects of low-frequency transcutaneous electrical nerve stimulation on central pain modulation: a double-blind, placebo-controlled trial.

OBJECTIVES: Transcutaneous electrical nerve stimulation (TENS) is an analgesic current that is used in many acute and chronic painful states. The aim of this study was to investigate central pain modulation by low-frequency TENS. METHODS: Twenty patients diagnosed with subacromial impingement syndrome of the shoulder were enrolled in the study. Patients were randomized into 2 groups: low-frequency TENS and sham TENS. Painful stimuli were delivered during which functional magnetic resonance imaging scans were performed, both before and after treatment. Ten central regions of interest that were reported to have a role in pain perception were chosen and analyzed bilaterally on functional magnetic resonance images. Perceived pain intensity during painful stimuli was evaluated using visual analog scale (VAS). RESULTS: In the low-frequency TENS group, there was a statistically significant decrease in the perceived pain intensity and pain-specific activation of the contralateral primary sensory cortex, bilateral caudal anterior cingulate cortex, and of the ipsilateral supplementary motor area. There was a statistically significant correlation between the change of VAS value and the change of activity in the contralateral thalamus, prefrontal cortex, and the ipsilateral posterior parietal cortex. In the sham TENS group, there was no significant change in VAS value and activity of regions of interest. DISCUSSION: We suggest that a 1-session low-frequency TENS may induce analgesic effect through modulation of discriminative, affective, and motor aspects of central pain perception.