Ayca Uran

The relationship between prosthesis use, phantom pain and psychiatric symptoms in male traumatic limb amputees

OBJECTIVES The purpose of this study was to identify psychiatric symptoms by comparing male patients with traumatic leg amputations (LAs) with healthy controls and to determine the association between these psychiatric symptoms and phantom pain and prosthesis use characteristics. METHODS One hundred four volunteers, 51 LA patients (group 1) and 53 healthy controls (group 2) were included. Demographic data including age, height, weight, time since amputation, duration of prosthesis use, and Satisfaction with Prosthesis Questionnaire scores were recorded. Phantom pain was measured a visual analog scale (VAS). Psychiatric symptoms were measured using the Symptom Checklist-90-R, Beck Depression Inventory, Pittsburgh Sleep Quality Index, Rosenberg Self-Esteem Scale, and State-Trait Anxiety Inventory. Correlations were determined between time since amputation, duration of prosthesis use and satisfaction with prosthesis questionnaire scores and psychiatric scale scores. RESULTS Amputee patients had higher phobic anxiety, state anxiety, trait anxiety and sleep disturbance scores (p<0.05) than the controls. No difference was determined in terms of psychiatric symptoms between the phantom pain and no phantom pain groups (p>0.05). There were significant negative correlations between time since amputation, duration of prosthesis use, duration of daily prosthesis use, and satisfaction with prosthesis questionnaire scores and psychiatric symptoms. CONCLUSIONS Apart from anxiety (state, trait or phobic) and disturbed sleep, other psychiatric symptoms in amputee patients undergoing lengthy prosthetic rehabilitation may not differ from those of healthy controls. The presence and severity of phantom pain appear to be unrelated to general psychiatric symptomatology. Length of time since amputation, length of prosthesis use, daily length of prosthesis use and prosthesis satisfaction are negatively correlated with general psychiatric symptoms. These characteristics must be borne in mind in psychiatric and prosthetic rehabilitation.

Knee pain relief with genicular nerve blockage in two brain injured patients with heterotopic ossification.

Abstract Background: Heterotopic ossification (HO) is the ectopic bone formation in non-osseous tissues. This study aimed to present two patients with traumatic brain injury (TBI) who had HO in knee joint and pain relief after genicular nerve blockage. Case 1: A 14-year-old patient with TBI was admitted with bilateral knee pain and limited range of motion. Physical examination and x-ray graphics revealed calcification which was diagnosed as HO. Ultrasonography (US) guided genicular nerve blockage was performed to both knees with 2 ml lidocaine and 1 ml betamethasone. VAS of pain was decreased to 30 mm from 80 mm. At 6-month follow-up, VAS of pain was still 30 mm. Case 2: A 29-year-old patient with TBI was admitted for rehabilitation. He had right knee pain and his pain was 80 mm according to VAS. Investigation revealed HO. US guided genicular nerve blockage was performed to the right knee and pain was decreased to 20 mm. Discussion: US guided genicular nerve blockage can provide pain relief in HO and this technique may be effective and alternative for pain relief in patients with neurogenic knee HO to increase patient’s compliance.

Poster 326 Synovial Chondromatosis of the Knee: A Case Report

Disclosures: W. Sussman: I Have No Relevant Financial Relationships To Disclose. Design: Case Report Case Description: The patient sustained a concussion during a helmet-to-helmet hit. At three-weeks after the concussion, the patient continued to be symptomatic. The patient had an Immediate PostConcussion Assessment and Cognitive Testing (ImPACT) symptom score of 15. By week-six, the ImPACT symptom score had decreased to 2, however, the patient continued to have daily headaches. After failing acetaminophen, the patient was started on topiramate 50mg twice daily for symptomatic management. Setting: Sports medicine clinic. Results or Clinical Course: At twelve-weeks, the patient continued to have headaches interfering with school and preventing a full return to sport. The decision was made to treat the patient with an intranasal SPG block. After the SPG block, the patient was symptom free and able to return to school and football. At the 6-month follow-up, the patient remained symptom free. Discussion: Post-traumatic headaches (PTHs) are headaches that develop within 7 days of a head injury, and in cases that persists for more than 3 months the headache is classified as chronic. Therapeutic options for PTHs are often the same as for their non-traumatic counterparts. In cases refractory to standard treatment, the SPG has been described as a therapeutic target in various headache disorders, including cluster headaches, migraine headaches, and tension-type headaches. Here we present the first report of successful treatment of PTHs after a sport-related concussion. Conclusion: Intranasal SPG block is a safe and effective treatment for refractory chronic PTHs after a sport-related concussion.