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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).

Reasons for using swelling ratio in sonographic diagnosis of carpal tunnel syndrome and a reliable method for its calculation.

The aim of this study was to investigate factors affecting median nerve cross‐sectional area (CSA) and determine a dependable swelling ratio (SR) calculation method.

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.

Correlations among enthesitis, clinical, radiographic and quality of life parameters in patients with ankylosing spondylitis.

Abstract Objectives. To investigate the relationship between enthesitis and disease activity, functional status, fatigue, joint mobility, radiological damage, laboratory parameter and quality of life in patients with ankylosing spondylitis (AS). Methods. A total of 421 patients with AS (323 male and 98 female) who were included in the Turkish League Against Rheumatism Registry were enrolled in the study. The Bath AS Disease Activity Index (BASDAI), fatigue, the Bath AS Functional Index (BASFI), the Bath AS Metrology Index (BASMI), the Maastricht AS Enthesitis Score (MASES), AS quality of life (ASQoL), the Bath AS Radiology Index (BASRI) and erythrocyte sedimentation rate (ESR) were evaluated. Results. Enthesitis was detected in 27.3% of patients. There were positive correlations between MASES and BASDAI, BASFI and fatigue (p < 0.05). MASES was not correlated with BASRI, BASMI, ASQoL and ESR. The mean MASES score was 1.1 ± 2.4. The most frequent regions of enthesopathies were right iliac crest, spinous process of L5 and proximal to the insertion of left achilles tendon, respectively. Conclusions. Enthesitis was found to be associated with higher disease activity, higher fatigue, worse functional status and lower disease duration. As enthesitis was correlated with BASDAI, we conclude that enthesitis can reflect the disease activity in patients with AS.

[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.

The Effects of Coexisting Fibromyalgia Syndrome on Pain Intensity, Disability, and Treatment Outcome in Patients with Chronic Lateral Epicondylitis

OBJECTIVE The objective of this study was to evaluate the effects of coexisting fibromyalgia syndrome (FS) on pain intensity, disability, and treatment outcome in patients with chronic lateral epicondylitis (LE). METHODS Seventy-eight patients with chronic unilateral LE and 30 healthy subjects were included. Patients were classified into two groups: group 1 consisted of 46 LE alone patients, while group 2 consisted of 32 LE plus FS patients. A pain questionnaire was used to determine the subjective pain and disability. Pressure pain threshold (PPT) on the lateral epicondyles, isometric hand grip strength (IHGS), lateral pinch grip strength (LPGS), and tender point examinations of groups were performed. A mixture of methylprednisolone and prilocaine was injected 1 cm distal to the lateral epicondyle. All measurements were repeated 2 weeks and 3 months after injection. RESULTS Compared with healthy subjects, both patient groups had significantly increased pain and disability scores and decreased IHGS, LPGS, and PPT values (P < 0.001). Compared with the LE alone group, pain and disability scores were significantly higher (P < 0.01), and PPT, IHGS, and LPGS values were significantly lower in LE plus FS group (P < 0.05). Pain questionnaire scores of the LE alone and LE plus FS patients showed statistically significant decrease, and IHGS, LPGS, and PPTs showed statistically significant increase at the second week (P < 0.01) and at the third month (P < 0.001) after injection. Improvements in the LE plus FS group were poorer than FS alone group at both second week and third month after injection. CONCLUSION Coexisting FS may increase the pain intensity and disability, and negatively affect the treatment outcome in patients with chronic LE.

An alternative in the treatment of notalgia paresthetica: neural therapy

Jessica G. Labadie *, MD Aleksandra G. Florek , MD Alexandru Croitoru , RN Wenhua Liu , MD Aleksandar L. Krunic , MD, PhD Department of Internal Medicine, Presence St. Joseph Hospital, Chicago, IL, USA Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Department of Dermatology, University of Colorado Denver School of Medicine, Aurora, CO, USA Innovative Dermatology, Chicago, IL, USA Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA *E-mail: Jessica.gandy13@gmail.com

The Association Between Patellofemoral Pain Syndrome and Lower Extremity Biomechanics

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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.