Aynur Karagöz

Cycling progressive resistance training for people with multiple sclerosis: a randomized controlled study.

Çakıt BD, Nacir B, Genç H, Saraçoğlu M, Karagöz A, Erdem HR, Ergün U: Cycling progressive resistance training for people with multiple sclerosis: A randomized controlled study. Objective:To evaluate the effects of cycling progressive resistance training combined with balance exercises on walking speed, balance, fatigue, fear of falling, depression, and quality of life in patients with multiple sclerosis. Design:In this prospective randomized controlled trial, 45 patients were randomized into two exercise training (n = 30) groups and one control (n = 15) group. The patients in training group 1 (n = 15) underwent progressive resistance training on a bicycle ergometer and balance exercise, whereas group 2 (n = 15) patients received a home-based lower-limb strengthening and balance exercise. Outcome measures, including the duration of exercise, tolerated maximum workload, timed up and go test, Dynamic Gait Index, functional reach, Falls Efficacy scale, 10-m walk test, Fatigue Severity Scale, Beck Depression Inventory, and Short Form 36 scores, were assessed initially and at 8 wks. Results:After dropouts, the whole study group consisted of 20 women and 13 men (mean age, 37.9 ± 10.43 yrs). In training group 1, duration of exercise, tolerated maximum workload, timed up and go test, Dynamic Gait Index, functional reach, falls efficacy scale, 10-m walk test, Fatigue Severity scale, and Beck Depression Inventory scores, and in group 2, the mean duration of exercise, tolerated maximum workload, and Falls Efficacy scale scores were significantly improved after the training program (P < 0.05). There were no significant improvements in any of the outcome measurements in the control group (P > 0.05). In between-group comparisons, improvements in outcome measures of group 1 patients were significantly higher than those in other groups, except for 10-m walking test. Group 1 patients showed statistically significant improvement in physical functioning and role-physical functioning scales of the Short Form 36 (P < 0.01 and P < 0.05, respectively), and group 2 patients showed statistically significant improvement in only physical functioning scale of Short Form 36 (P < 0.05) after 8 wks. Conclusions:Specific exercise programs, including cycling progressive resistance training, may improve balance, fatigue, and depression and reduce fear of falling in patients with multiple sclerosis without worsening multiple sclerosis signs and symptoms.

Neuropathic arthropathy progressing with multiple joint involvement in the upper extremity due to syringomyelia and type I Arnold-Chiari malformation

Neuropathic arthropathy (NA), known as Charcot neuroarthropathy, is a chronic, degenerative arthropathy and is associated with decreased sensory innervation. Numerous causes of this arthropathy have been described. Neuropathic joint, although first described by Charcot in tabes dorsalis in 1868, has subsequently been observed in a variety of conditions including syringomyelia, diabetes mellitus and peripheral nerve disorders. Syringomyelia is characterized by slow progression. The shoulders and elbows are the most frequently involved joints in syringomyelia. Involvement of the hand is a quite rarely seen in the cases of NA caused by syringomyelia. In this article, we reported a case of NA secondary to syringomyelia. The characteristics of this presented case is the presence of Arnold-Chiari malformation accompanying with syringomyelia and involvement of the shoulder, elbow and hand (multiple joint involvement).

Evaluation of Upper Extremity Nerve Conduction Velocities and the Relationship Between Fibromyalgia and Carpal Tunnel Syndrome

BACKGROUND AND AIMS We undertook this study to evaluate upper extremity nerve conduction velocities (NCVs) in fibromyalgia syndrome (FS) and the relationship of the electrophysiological findings between carpal tunnel syndrome (CTS) and FS. METHODS Sixty three right-handed female patients diagnosed with FS and 52 right-handed age- and gender-matched healthy controls were enrolled in the study. Conduction studies of the median and ulnar nerves and median nerve F-wave latencies were assessed in both upper extremities using standard methods. CTS was diagnosed electrophysiologically if the median nerve sensory NCV was decreased and/or motor distal latency (DL) was prolonged. RESULTS CTS was detected electrophysiologically in 26 (20.63%) of 126 extremities of 63 patients and in three (2.82%) of 104 extremities of 52 individuals of the control group. Statistically significant differences were detected between groups with respect to rate of carpal tunnel syndrome (p <0.05). There were no differences between results of NCVs of patients in FS group and healthy controls except the prolongation of the right median nerve motor DL (p = 0.019), decrease of the sensory NCV (p = 0.003) in the right median nerve, in the left median nerve (p = 0.011) and in the left ulnar nerve (p = 0.015). CONCLUSIONS We determined an increased rate of CTS and decreased NCVs in the upper extremities in patients with FS. We should consider that complaints of paresthesia and pain in hands, increasing especially at nights, observed in FS may mask that CTS can be an associated illness.

[Episacral lipoma: a treatable cause of low back pain].

Episacral lipoma is a small, tender subcutaneous nodule primarily occurring over the posterior iliac crest. Episacral lipoma is a significant and treatable cause of acute and chronic low back pain. Episacral lipoma occurs as a result of tears in the thoracodorsal fascia and subsequent herniation of a portion of the underlying dorsal fat pad through the tear. This clinical entity is common, and recognition is simple. The presence of a painful nodule with disappearance of pain after injection with anaesthetic, is diagnostic. Medication and physical therapy may not be effective. Local injection of the nodule with a solution of anaesthetic and steroid is effective in treating the episacral lipoma. Here we describe 2 patients with painful nodules over the posterior iliac crest. One patient complained of severe lower back pain radiating to the left lower extremity and this patient subsequently underwent disc operation. The other patient had been treated for greater trochanteric pain syndrome. In both patients, symptoms appeared to be relieved by local injection of anaesthetic and steroid. Episacral lipoma should be considered during diagnostic workup and in differential diagnosis of acute and chronic low back pain.

THU0197 The Effects of Vitamin D Levels on Pain Intensity, Muscle Strength and Functional Status of the Elderly Patients with Knee Osteoarthritis

Background Vitamin D deficiency can be associated with muscle weakness and is common in elderly people. Objectives The aim of this study was to evaluate the effects of the vitamin D levels on pain intensity, muscle strength and functional status of the elderly patients with knee osteoarthritis (OA). Methods Eighty-one patients with knee OA aged between 65 and 71 years were included in the study. Gender, ages and Body Mass Indexes (BMI) were recorded. The radiographic degree of knee OA was graded as 1 to 3 according to Kellgren and Lawrence scale. Visual Analog Scale (VAS) was used to measure pain intensity and Turkish version of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to evaluation of functional status. Measurements of isokinetic muscular function of both flexor and extensor muscles and peak torque/body weight levels were performed at the angular velocities of 60°/sec and 180°/sec using a Biodex system pro4. Serum calcium, phosphate, alkaline phosphatase, albumin, intact parathyroid hormone (iPTH), complete blood count, liver and kidney function tests, thyroid function tests and 25(OH) vitamin D levels were studied. Patients were divided into 2 subgroups according to 25(OH) vitamin D levels: Group 1 consisted of 40 patients with serum 25(OH) vitamin D levels below 20 ng/ml while 41 patients with serum 25(OH) vitamin D levels equal to 20 ng/ml and above were included in Group 2. Results The whole study group consisted of 41 women and 40 men (81 patients). The mean age of the group 1 patients (20 women, 20 men) was 68,1±1,48 years, and the mean age of the group group 2 patients (21 women, 20 men) was 67,8±1,30 years (p>0.05). The mean vitamin D level were 10,98±4,68 ng/ml in group 1 and 42,99±17,13 ng/ml in group 2. The mean VAS values of group 1 at rest and motion were significantly higher than those of group 2 (p=0,014, p=0,018, respectively). The mean values of pain, function and total scores of the WOMAC were significantly higher in group 1 than group 2 patients (p=0,001, p=0,0001, p=0,0001, respectively). At the angular velocities of 60°/sec and 180°/sec, significantly lower values were observed in both flexor and extensor peak torque and peak torque/body weight in group 1 patients (p<0,05). Conclusions Vitamin D deficiency can be a contributor factor in pain, disability and muscle weakness in patients with knee osteoarthritis. Concomitant vitamin D deficiency should be considered in elderly patients with knee osteoarthritis. References Davies GJ. A Compendium of Isokinetics in Clinical Usage and Rehabilitation Techniques. 4th ed. Onalaska, WI: S&S Publishers; 1992: 35-50. Dretakis OE, Tsatsanis C, Fyrgadis A, et al. Correlation between Serum 25 Hydroxyvitamin D Levels and Quadriceps Muscle Strength in Elderly Cretans. J In Medical Research 2010; 38: 1824-1834. Tuzun EH, Eker L, Aytar A et al. Acceptibility, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis Cartilage 2005;13(1):28-33. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.4402

Fear of Falling in Patients with Cervical Myofascial Pain Syndrome

Objective To detect whether cervical myofascial pain syndrome [MPS] leads to fear of falling (FOF) and to determine factors associated with FOF in patients with chronic cervical myofascial pain. Methods Ninety-eight women with chronic cervical MPS and 50 age-matched healthy women were included in this study. FOF was evaluated using Falls Efficacy Scale [FES]. Main outcome measures included number of trigger points [NTrP], visual analog scale [VAS], functional reach [FR], Berg Balance Test [BBT], Beck Depression Inventory, and Dizziness Handicap Inventory [DHI]. Results Ninety eight patients with cervical MPS and 50 demographically-matched healthy women were included in this study The FES scores of the patient group were significantly higher [P < 0.001], and functional reach and BBT values were significantly lower than the control group [P < 0.001]. The mean Beck Depression Inventory and Dizziness Handicap Inventory scores of patients were significantly higher than controls [P < 0.001]. Regression analysis showed that increased NTrP [R2 = 0.60], increased visual analog scale [R2 = 0.06], and decreased BBT scores [R2 = 0.01] were associated with higher FES scores. Conclusion Patients with cervical MPS suffer from FOF probably due to balance problems and dizziness.

Femoral Neuropathy in a Patient with Rheumatoid Arthritis

Femoral mononeuropathy (FMN) as an extraarticular finding of rheumatoid arthritis (RA) is a phenomenon which has not been reported previously. We report a 53-year-old female patient with RA, presenting FMN findings during the course of the disease. On examination, right quadriceps and iliopsoas muscles showed grade 3 weakness on the Medical Research Council (MRC) scale. Sensory examination revealed sensory loss in the right medial leg and thigh. Patellar tendon reflex was absent in the right side. A diagnosis of a partial right femoral neuropathy was confirmed using nerve conduction study and electromyography. The probable mechanism of FMN was thought to be vasculitis.

The Association Between Patellofemoral Pain Syndrome and Lower Extremity Biomechanics

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The Association of Skinfold Anthropometric Measures, Body Composition and Disease Severity in Obese and Non-obese Fibromyalgia Patients: A Cross-sectional Study

Objectives This study aims to determine the effects of obesity and obesity related anthropometric and body composition determiners on the severity of fibromyalgia syndrome (FS) and to compare obese, overweight and normoweight FS patients according to general health and psychological status. Patients and methods The study included 42 obese (mean age 48.8±11.6; range 24 to 65 years), 27 overweight (mean age 47.3±3.4; range 24 to 61 years) and 32 normoweight (mean age 47.1±7.8 years; range 31 to 60 years) female FS patients. Widespread pain scores and symptom severity scores were noted. Pain pressure thresholds of tender points and control points were measured and total myalgic score (TMS) was calculated. The anthropometric assessments and skinfold measurements of all participants were recorded. Quality of life was evaluated by Health Assessment Questionnaire while psychological status was evaluated using Beck Depression Inventory. Results Control points, TMS values and hand grip strength values of obese FS patients were significantly lower, while disease duration, symptom severity, widespread pain scores, visual analog scale and Health Assessment Questionnaire scores were significantly higher than normoweight and overweight FS patients. Fat free mass, fat mass, body fat percentage and waist/hip ratio values were significantly higher in obese FS patients than overweight and normoweight FS patients (p<0.001 for all values). Stepwise linear regression analysis showed that increased body mass index, decreased fat free mass (R2=0.11) and increased disease duration (R2=0.13) were associated with lower TMS. Conclusion We found that obesity had significant negative effects on pain, disease severity and quality of life in patients with FS.

Neurodynamic evaluation and nerve conduction studies in patients with forward head posture

Forward head posture (FHP) is one of the most frequently seen problems. The aim of this study was to evaluate the neurodynamic tests and peripheral nerve conductions of upper extremity in patients with FHP. The study population included 100 patients with upper extremity and neck problems and 34 healthy individuals as a control group. Craniovertebral angle measurement was used to determine forward head posture. Stretch tests for radial, ulnar and median nerves were performed. Nerve conductions of bilateral median, radial, ulnar and medial antebrachial cutaneous (MAC) nerves were examined in all patients included in the study. The most significant nerve conduction differences in moderate-to-severe FHP patients were a decrease in the sensory nerve action potential (SNAP) and compound muscle action potential (CMAP) amplitudes of median nerves, a decrease in the SNAP amplitude of ulnar nerves, a delay in the F response latency of ulnar nerves and prolongation in the SNAP latency of the MAC nerve. FHP makes patients more prone to peripheral entrapments.