Banu Dilek

Efficacy of Paraffin Bath Therapy in Hand Osteoarthritis: A Single-Blinded Randomized Controlled Trial

OBJECTIVE To evaluate the efficacy of paraffin bath therapy on pain, function, and muscle strength in patients with hand osteoarthritis. DESIGN Prospective single-blinded randomized controlled trial. SETTING Department of physical medicine and rehabilitation in a university hospital. PARTICIPANTS Patients with bilateral hand osteoarthritis (N=56). INTERVENTIONS Patients were randomized into 2 groups with a random number table by using block randomization with 4 patients in a block. Group 1 (n=29) had paraffin bath therapy (5 times per week, for 3-week duration) for both hands. Group 2 (n=27) was the control group. All patients were informed about joint-protection techniques, and paracetamol intake was recorded. MAIN OUTCOME MEASURES The primary outcome measures were pain (at last 48h) at rest and during activities of daily living (ADL), assessed with a visual analog scale (0-10cm) at 12 weeks. The secondary outcome measures were the Australian Canadian Osteoarthritis Hand Index (AUSCAN) and the Dreiser Functional Index (DFI), used for subjective functional evaluation, loss of range of motion (ROM), grip and pinch strength, painful and tender joint counts, and paracetamol intake. A researcher blind to group allocation recorded the measures for both hands at baseline, 3 weeks, and 12 weeks at the hospital setting. RESULTS At baseline, there were no significant differences between groups in any of the parameters (P>.05). After treatment, the paraffin group exhibited significant improvement in pain at rest and during ADL, ROM of the right hand, and pain and stiffness dimensions of the AUSCAN (P<.05). There was no significant improvement in functional dimension of the AUSCAN and the DFI (P>.05). The control group showed a significant deterioration in right hand grip and bilateral lateral pinch and right chuck pinch strength (P<.05), but there was no significant change in the other outcome measures. When the 2 groups were compared, pain at rest, both at 3 and 12 weeks, and the number of painful and tender joints at 12 weeks significantly decreased in the paraffin group (P<.05). Bilateral hand-grip strength and the left lateral and chuck pinch strength of the paraffin group were significantly higher than the control group at 12 weeks (P<.05). CONCLUSIONS Paraffin bath therapy seemed to be effective both in reducing pain and tenderness and maintaining muscle strength in hand osteoarthritis. It may be regarded as a beneficial short-term therapy option, which is effective for a 12-week period.

Efficacy of Pulsed and Continuous Therapeutic Ultrasound in Myofascial Pain Syndrome: A Randomized Controlled Study.

ObjectivesThis study aimed to compare continuous and pulsed ultrasound therapy with sham ultrasound in terms of pain, severity of muscle spasm, function, depression, and quality of life in patients with myofascial pain syndrome. DesignPatients were randomly divided into three groups, including the continuous ultrasound group (3 MHz, 1 W/cm2, n = 20), the pulsed ultrasound group (3 MHz, 1 W/cm2, 1:1 ratio, n = 20), and control group (sham, n = 20). The primary outcome measures were severity of pain at rest and during activity (visual analog scale, 0–10 cm). The secondary outcome measures were function (Neck Pain and Disability Scale), depressive mood (Beck Depression Scale), and quality of life (Nottingham Health Profile). All evaluations were performed at baseline, after treatment, and at the 6th and 12th wks. ResultsAll three groups had significant improvements in all of the pain scores, the severity of muscle spasms, function assessments, and certain subparameters of the quality of life scale (P < 0.05). The continuous ultrasound group had significantly greater improvements in pain at rest (P < 0.05). However, no statistically significant differences were observed in the other parameters (P > 0.05). ConclusionsContinuous ultrasound therapy is more efficient in reducing pain at rest for myofascial pain syndrome patients than is sham or pulsed ultrasound therapy.

Efficacy of Proprioceptive Exercises in Patients with Subacromial Impingement Syndrome: A Single-Blinded Randomized Controlled Study.

ObjectiveThe objective of this study was to evaluate the effectiveness of proprioceptive exercises on shoulder proprioception, range of motion, pain, muscle strength, and function in patients with subacromial impingement syndrome. DesignSixty-one patients with subacromial impingement syndrome participated in this prospective, single-blind randomized controlled trial. All patients were randomly divided into two groups: control group (conventional physiotherapy, n = 30) and intervention group (proprioceptive exercise and conventional physiotherapy, n = 31). The primary outcome measures were sense of kinesthesia and active and passive repositioning for proprioception at 0 degrees and 10 degrees external rotation at 12 wks. The secondary outcome measures were pain at rest, at night, and during activities of daily living with the visual analog scale (0–10 cm), the Western Ontario Rotator Cuff index, the American Shoulder and Elbow Surgeons index, range of motion, and isometric muscle strength at both 6 and 12 wks. ResultsAfter treatment, significant improvement was found in range of motion, pain, isometric muscle strength, kinesthesia at 0 degrees external rotation, and functional tests in both groups. The intervention group showed a significant improvement in kinesthesia at 10 degrees external rotation and active and passive repositioning at 10 degrees external rotation. When groups were compared, there were no statistically significant differences in any of the parameters at 12 wks. ConclusionsAlthough proprioceptive exercises may provide better proprioceptive acuity, no additional positive effect on other clinical parameters was observed.

The impact of ankylosing spondylitis on female sexual functions.

The aim of this study was to explore the impact of ankylosing spondylitis (AS) and the disease-related variables, psychological status and the quality of life on the female patients’ sexual function measured according to the Female Sexual Function Index (FSFI). Thirty-seven sexually active female AS patients and 33 healthy controls were enroled in this study. Their demographic data were evaluated and the generalised pain in patients with AS was assessed according to the visual analogue scale (0–100 mm). Laboratory tests were conducted in order to measure the C-reactive protein (CRP) and erythrocyte sedimentation rates (ESR) of the patients. In comparison to the healthy control group, patients with AS had significantly lower scores in each of the five domains of the FSFI except for the pain domain (P<0.05). The disease activity, functional status, quality of life, radiological score and CRP levels were negatively correlated with the FSFI (P<0.05). No significant correlation was observed with the disease duration, smoking status, depression, anxiety, pain and ESR when the total scores and the scores from the domains of the FSFI were compared. The sexual function is impaired in female patients with AS. This impairment in the sexual function is especially related to the functional status and disease activity among the clinical and laboratory parameters.

Relationship between serum leptin level and disease activity in patients with systemic sclerosis

To determine the relationship between serum leptin levels and disease activity in systemic sclerosis (SSc). A total of 60 subjects (30 controls and 30 patients) were included. The inflammatory markers and leptin levels were evaluated and body mass index (BMI) was measured for both groups. The assessment of the skin involvement was performed based on the modified Rodnan skin score (mRSS). Disease activity was evaluated according to the Valentini scleroderma disease activity index. There was a significant difference between the patient and control groups in terms of BMI (p < 0.05); however there was no difference with regards to age and gender (p > 0.05). Valentini scores and mRSS were determined to be significantly higher in active patients (n = 14) than in inactive patients (n = 16) (p < 0.05). No significant difference was determined between groups in terms of leptin levels (p > 0.05). However, leptin levels were significantly lower in active patients than in inactive patients (p < 0.05). We found a significant positive correlation between serum leptin and BMI (p < 0.05), and leptin and serum C3 levels (p < 0.05); no relationship was detected between leptin and other parameters. Leptin can be used as an activity marker in SSc. Further studies, including larger series, should be carried out to clarify this relationship.

Regional migratory osteoporosis: case report of a patient with neuropathic pain

Regional migratory osteoporosis (RMO) is an idiopathic disorder characterized by severe periarticular pain, transient and migratory arthralgia, and osteoporosis. Osteoporosis in this disease may appear in the form of local regional osteoporosis and bone marrow edema or generalized osteoporosis. It occurs most commonly in middle-aged men and late second or third trimester pregnant women. The laboratory findings of the disease are usually normal and do not demonstrate apparent anomalies. The presence of bone marrow edema on MRI is its characteristic finding. RMO can only be separated from transient osteoporosis of hip and avascular necrosis with migration to other joints. Clinically, RMO progresses in three stages: increasing pain and disability, radiological findings (osteopenia), maximalization of symptoms, and finally, the regression of the disease and radiological changes. In this case report, we present a 29-year-old woman whose symptoms had first appeared at the second trimester of pregnancy and migrated both to the other joints in the proximo-distal direction and to the adjacent bones within the same joint. She also had symptoms such as hyperalgesia, hyperesthesia and hypertrichosis along with neuropathic pain, which she described as a burning, biting, and prickling type of pain at the right leg. The neuropathic pain of the patient was resistant to medical treatment. We believe that this case was worth reporting because of the obstinate clinical course of the patient’s disease and her severe neuropathic pain that was resistant to treatment.

Shoulder proprioception in patients with subacromial impingement syndrome

BACKGROUND Recently, proprioception deficits of the rotator cuff and the deltoid muscles have been suggested to play a pivotal role in the subacromial impingement syndrome (SIS). To date, there are no study has been found where the kinesthesia and joint position senses have been evaluated together in SIS. OBJECTIVE To investigate the shoulder proprioception in patients with SIS. METHODS Sixty-one patients with SIS and 30 healthy controls, aging between 25 and 65 years, were included in the study. Main outcome measure was proprioception, assessed with an isokinetic dynamometer. Kinesthesia, active and passive joint repositioning senses were tested at 0° and 10° external rotation. All tests were repeated 4 times and the mean of angular errors were obtained. RESULTS The mean age was 49.14 ± 10.27 and 48.80 ± 11.09 years in patient group and in control group respectively. No significant difference was found between two groups in terms of age, gender and dominance. When involved and uninvolved shoulders of the patient group were compared, kinesthesia, active and passive joint position senses were significantly impaired in involved shoulders at all angles (P < 0.05). When involved shoulders of the patient group were compared to the control group, kinesthesia, active and passive joint position senses were significantly impaired in involved shoulders in patient group at all angles (P < 0.05) except active position sense at 0°. When uninvolved shoulders of the patient group were compared to the control group, kinesthesia at 10° was significantly impaired (P < 0.05). CONCLUSION This study showed that shoulder proprioception was impaired in patients with SIS. This proprioceptive impairment was found not only in involved shoulders but also in uninvolved shoulders in patients with SIS.

Efficacy of Thumb Arthroplasty in Carpometacarpal Joint Osteoarthritis: A LongTerm Follow-up

Introduction: The purpose of the present study is to evaluate long term functional results and satisfaction following arthroplasty of thumb carpometacarpal joint (CMC) osteoarthritis and compare with controls, who had CMC osteoarthritis ( Eaton stages II-III). Materials and Methods: Ten patients with arthroplasty of thumb CMC joint osteoarthritis (arthroplasty group) and ten patients with the same side thumb CMC joint osteoartrhritis without arthroplasty (control group) were enrolled in the study. All patients were evaluated according to Eaton radiologic classification. Outcome measures were included visual analog scale (VAS 0-10 cm) scores for pain, Disabilities of Arm, Shoulder and Hand (DASH) scores for function, abduction of thumb, thumb total active range of motion (TAROM), grip and pinch strength. We also evaluated patients’ satisfaction scores with numeric scale (0-10) in arthroplasty group. Results: Mean age of the arthroplasty group was 66.50 ± 6.90, control group was 66.70 ± 9.22. The average duration of after operation was 49.20 ± 24.94 months and patients’ satisfaction score was 8.10 ± 1.44 in arthroplasty group. When the groups were compared, DASH scores, pain at activity of daily living and at rest were found significantly in arthroplasty group (p 0.05). Discussion: Arthroplasty in CMC osteoarthritis can be effective in terms of improvement of pain, mobility and function. Long term successful results can be achieved in treatment with use the arthroplasty in patient who suffer from moderate or severe CMC osteoarthritis.

Vitamin D Levels and Related Factors in Patients with Chronic Nonspecific Low Back Pain

Abstract Objectives: To evaluate the 25-hydroxy vitamin D3 [25OHD3] levels and the associated factors in patients with chronic nonspecific low back pain [LBP] in our region. Methods: Sixty patients diagnosed with chronic nonspecific LBP and a control group of 30 healthy subjects were enrolled. The demographic characteristics were recorded and the serum 25OHD3 level was measured. The severity of the LBP was measured with a visual analog scale. Milk and dairy product consumption, fish consumption, dressing style, exposure to the sunlight, and physical activity levels of the individuals in each group were recorded. The quality of life was evaluated with the Short Form 36. Depression status was evaluated through the Beck Depression Inventory. The Oswestry Disability Scale was used for the functional assessment of the patient group. Results: The mean age of the patients was 30.58 ± 7.78 years and control group was 30.97 ± 6.70 years. The sun exposure and fish consumption were significantly higher in the control group. The scores from all the dimensions of the Short Form 36 [except for the mental health parameter] and Beck Depression Inventory were significantly lower in the patient group. The 25OHD3 level was also significantly lower in the patient group. According to the Oswestry Disability Scale, the daily life of the patients was observed to be limited due to LBP. Conclusions: In the patients with chronic LBP [CLBP], 25OHD3 level is lower than the healthy controls. In CLBP, increasing incidence of depression, deterioration in the quality of life, and serious functional impairment are observed. Vitamin D levels should be evaluated and any deficiency should be treated in patients with CLBP.

Serebral palsili çocukların annelerinde depresyon ve yaşam kalitesinin değerlendirilmesi

Amac: Serebral palsili (SP) cocuklarin annelerinde depresyon varliginin arastirilmasi ve yasam kalitesinin degerlendirilmesi, cocugu saglikli annelerden olusan kontrollerle karsilastirilmasidir. Hastalar ve Yontem: Calismaya 49 SP’li cocuk ve annesi ile saglikli cocugu olan 30 anne alindi. SP tipi belirlenen cocuklarin; Kaba Motor Fonksiyon Siniflama Sistemi (KMFSS) ile fonksiyonel duzeyi belirlendi. Annelerin depresyon durumu Beck Depresyon Olcegi (BDO) ile, yasam kalitesi Nottingham Saglik Profili (NSP) ile degerlendirildi. Bulgular: SP’li cocuklarin yas ortalamasi 66.20 ± 43.73 aydi. Cocuklarin 28’ i diplejik, 1’i hemiplejik, 20’si kuadriplejik tipteydi. KMFSS’e gore; cocuklarin cogu, duzey 2 (n=20) ve duzey 3 (n=17)’ tu. SP grubunun annelerinin yas ortalamasi 35.75 ± 7.44, kontrol grubunun ise 33.80 ± 7.21 bulundu. SP’li cocugu olan anne grubunda akraba evliligi, annenin ev hanimi olma orani, gelir duzeyi dusuklugu, NSP ve BDO puanlari anlamli olarak yuksek bulundu (p<0.05). KMFSS duzeyi ve SP tipi ile annelerin BDO ve NSP puanlari arasinda anlamli korelasyon saptanmadi (p < 0.05). Sonuc: SP’li cocuklarin annelerinde yasam kalitesinde bozulmanin ve depresyona egilimin daha fazla oldugu saptanmistir. Bu surec cocugun fonksiyonel durumundan ve serebral palsi tipinden etkilenmemektedir.