Alparslan Bayram Çarlı

The utility of musculoskeletal ultrasound in rehabilitation settings.

Aside from its prompt use in musculoskeletal injuries (sports lesions, degenerative/inflammatory joint disorders, and peripheral nerve pathologies), ultrasonographic imaging can be used quite conveniently in various types of rehabilitation conditions as well. If used in a rehabilitation setting, ultrasound can significantly contribute to the diagnostic/therapeutic algorithm of rehabilitation patients. Accordingly, in this article, the authors focus on the diagnostic/interventional utility of ultrasound particularly for shoulder problems, overuse injuries of wheelchair users, heterotopic ossification, amputee follow-up, peripheral nerve and botulinum toxin injections, and diaphragm imaging/electromyography.

Musculoskeletal Sonography in Physical and Rehabilitation Medicine: Results of the First Worldwide Survey Study

OBJECTIVES To explore the current status of musculoskeletal ultrasound (MSUS) in the realm of physical medicine and rehabilitation (PMR), and to determine the effects of a 1-day MSUS course on the awareness of physiatrists. DESIGN Survey. SETTING International Society of Physical and Rehabilitation Medicine Congress, 2009, Istanbul. PARTICIPANTS Physiatrists attending the congress (n=276) and the MSUS course (n=30). INTERVENTION Not applicable. MAIN OUTCOME MEASURES The survey contained 17 multiple-choice and open-ended questions concerning personal background, perceptions regarding MSUS, and current use of MSUS. Additionally, a group of physicians who attended the 1-day MSUS course before the congress were evaluated twice (before and after the course) to assess the change in their awareness. RESULTS Data from 306 physiatrists (with a mean experience of 10.5+/-8.1 y in the field of PMR) were evaluated. Among the participants, 57.8% were using MSUS in their diagnostic algorithms, 90.4% were thinking that physiatrists should perform sonography themselves, and 75.1% declared that they would perform sonography if they had a device. The ratio of subjects who rated MSUS to be essential for their clinical practice increased from 35.7% to 58.6% after the MSUS course (P>.05). CONCLUSIONS Physiatrists strongly believe that they should perform MSUS themselves, lack of education and lack of device seem to be important issues to be addressed, and even a 1-day course significantly changes awareness of MSUS.

Thoracic Outlet Syndrome in a Patient With Poland Syndrome

We report a 20-year-old man with Poland syndrome who suffered from weakness, pain, numbness, and discoloration in the left upper extremity. He was eventually diagnosed as also having thoracic outlet syndrome. The concomitance of these two disorders is discussed with a special emphasis on the underlying mechanisms.

Choosing the right imaging method in muscle hernias: musculoskeletal ultrasonography.

Abstract Muscle hernia (MH) is a focal protrusion of muscle into the overlying subcutaneous tissue through an acquired or congenital facial defect. Herniation in the thigh muscles is not common and there are limited reports evaluating this pathology using ultrasonography (US). A 28-year-old amateur football player presented with a palpable mass on the anterior aspect of his right thigh. Sonographic examination demonstrated a MH through a fascial defect, which is called mushroom appearance. Based on the clinical and sonographic findings, the diagnosis of a MH in the rectus femoris muscle was established. Today, there is no doubt anymore on the role of musculoskeletal US in the field of sports injuries. Therefore, with its various advantages (non-invasive, practical and convenient, inexpensive, etc.), US is the key imaging method in the diagnosis of MHs.

Hepatitis B virus reactivation in a Juvenile Rheumatoid arthritis patient under treatment and its successful management: a complicated case

Juvenile rheumatoid arthritis is a common chronic inflammatory disease in the childhood and it can differentiate rarely into spondiloarthropaties. It is one of the important causes of chronic pain and disability. Some of the drugs used for the treatment have immunosupressive activity. One of the serious side-effects of immunosupressive treatment is activation of opportunistic pathogens. Hepatitis B virus (HBV) is one of these pathogens, and the rate of carriers in the population is considerably high. It can cause liver damage and death if reactivated. Thus, the management of oppotunistic pathogens becomes a complex issue when treating rheumatic diseases with immunosupressive drugs. In this case report, we present a juvenile rheumatoid arthritis patient whose liver enzymes raised while he was under treatment and afterwards HBV reactivation was determined as the cause. When reactivation was detected, we started controlled antiviral therapy. We achieved successful clinical and laboratory results after adding biological agents to the treatment. Careful evaluation of the patients who have indication for immunosuppressive agents and regular follow-up in case of infection may be protective from severe morbidity and/or mortality.

Ultrasound imaging for neurofibromatosis: from the dermatologist's perspective.

Recently, musculoskeletal ultrasound (US) has received increased attention in the field of dermatology [1]. While ultrasound can be used to image the skin (epidermis, dermis, subcutaneous fat), nail and the nearby soft tissues/joints [2, 3], it can be particularly useful in patients with leprosy and neurofibromatosis (NF) to demonstrate the extent of peripheral nervous system involvement [4, 5]. We have previously shown the role of ultrasound in the diagnosis and follow-up of several complications in leprosy (submitted data); and similarly in this short report describing two military, we underscore the convenient role of ultrasound for imaging the peripheral nerves in NF. Neurofibromatosis, described by Friedrich Daniel von Recklinghausen in 1882, is a neuroectodermal abnormality Clinical letter comprised of a set of clinical symptoms that compromise the skin, nervous system, bones, eyes and other sites [6]. It is believed that at least one million individuals worldwide are living with neurofibromatosis [7]. It is inherited in an autosomal-dominant pattern and considered one of the most common disorders in humans inherited in this manner [6, 7]. Neurofibromas are the hallmark tumors of NF and predominantly involve the peripheral nerves [8]. They can be of different types such as localized (90 %), diffuse and plexiform [9]. The localized form presents as an ovoid or a fusiform mass through which the nerve trunk passes. The diffuse form grows in an infiltrative pattern and entraps adjacent normal structures. The plexiform neurofibroma has a serpentine-like appearance and characteristically involves a long segment of the nerve with its branches. This form is pathognomonic for NF type 1 and can potentially be malignant [4, 5]. For peripheral nerve problems, a thorough physical examination combined with nerve conduction studies usually suffices for the diagnosis. However, imaging may be needed to identify the underlying cause of nerve dysfunction or to assess the extent for more widespread disease. Ultrasound using a linear array high frequency probe, 7–12 MHz offers numerous advantages (patient and physician friendly, costeffective, no ionizing radiation, dynamic imaging) has become the method of choice for peripheral nerve imaging – not only for diagnosis but also for guiding possible surgery or

Sonographic diagnosis of recurrent peroneal tendon subluxation.

SummaryA case of recurrent peroneal tendon subluxation is reported. Dynamic ultrasonography is the best imaging modality in the diagnosis of peroneal tendon subluxation.ZusammenfassungEs wird über einen Fall rezidivierender Subluxation der Peronealsehnen berichtet. Dynamischer Ultraschall ist das beste bildgebende Verfahren zur Diagnose von rezidivierender Subluxation der Peronäus Sehne.

A rare cause of anterior knee pain: Bipartite patella

Joint Bone Spine - In Press.Proof corrected by the author Available online since lundi 20 juin 2016

Effects of Balneotherapy and Physical Therapy on Sleep Quality in Patients with Osteoarthritis Aged 50 to 85 Years

Objectives This study aims to investigate the effect of balneotherapy (BT) and physical therapy (PT) on sleep quality in patients with knee osteoarthritis (OA) aged 50 to 85 years. Patients and methods A total of 199 patients (76 males, 123 females; mean age 67.8±7.3 years; range 50 to 85 years) suffering from knee OA (Kellgren-Lawrence grade 2-3) for more than six months were enrolled. Sleep and functional status were assessed at baseline and after 19 sessions of BT and 15 sessions of PT by using Pittsburgh Sleep Quality Index and Western Ontario and McMaster Universities Osteoarthritis Index, respectively. Results A high prevalence of abnormal sleep quality in patients with knee OA was observed. The most common abnormality was sleep fragmentation (71%), with an increased sleep disturbance score. Patients reported significantly improved sleep, pain, stiffness, and functional status after BT and PT. Conclusion Balneotherapy and PT improved self-reported sleep and functional status in patients with OA aged 50 to 85 years. We may conclude that BT and PT, which are used in the treatment of OA, not only reduce nocturnal pain, but also improve sleep quality.

Letter to the Editor: Folliculitis Associated with Intermittant Pneumatic Compression

To the Editor, We read with a great interest the article by Won, et al.1 in which the authors presented a patient with extensive bullous complication associated with intermittent pneumatic compression (IPC). They stated that no skin complication has been reported after the use of IPC so far.1 Therefore, we would like to share our experience of a patient with folliculitis complication associated with IPC, thus being the second report in the literature. A 23-year-old man was seen due to his complaint of mild global swelling in the lower extremities. On detailed questioning he told that he was diagnosed with bilateral lower extremity lymphedema and suffering from it for the past 2 years. He was using compression stockings for the treatment of lymphedema, but no drugs. He had no history of skin allergy. The medical and family histories were otherwise non-contributory. He underwent IPC treatment (Daesung Maref Co. Ltd., Gyeonggi-do, Korea) for 30 minutes once a day. On the fifth day of the treatment, he complained of skin lesions on both legs (Fig. 1). The patient was consulted at the Dermatology Department and a diagnosis of folliculitis was made. IPC treatment was terminated and after receiving antibiotherapy for 7 days his skin lesions disappeared completely. Fig. 1 (A) The skin lesions of the patient on both legs. (B) Focused image of the skin lesions. There are two types of lymphedema: primary lymphedema without etiological factors, and secondary lymphedema resulting from lymph node dissection for malignant disorders.2 Peripheral lymph transportation is interrupted because of the lymph vessel hypo-function, leading to lymphedema.2 Although there is no recently developed advanced effective treatment technique, IPC is recommended by the International Society of Lymphology3 for the treatment of lymphedema and it is one of the commonly used physical modalities in daily practice. On the other hand, as the lymph vessel function is damaged, bacterial infection may become more troublesome because of increased capillary permeability due to inflammation in the affected limbs.2 To prevent infection of affected limb, it is important to clean the skin and the cuff of the device. Furthermore, considering the risk of lymph vessel injury, strong compression for a long duration should be avoided.2 Therefore, when IPC device is applied to patients with lymphedema, as stated by Won, et al.,1 skin condition of the limbs should frequently be checked during the application.