Bulent Hazneci

Clinical significance of congenital lumbosacral malformations in young male population with prolonged low back pain.

Study Design. A prospective clinical investigation. Objective. To determine the clinical significance of congenital lumbosacral malformations in young male patients with subacute or chronic low back pain and to investigate a possible worsening of the clinical picture with the concurrence of transitional vertebra (TV) or spina bifida occulta (SBO). Summary of Background Data. Although the causative roles of congenital malformations in low back pain and lumbar disc herniation have been investigated, there is no study that compares the incidence of congenital malformations in prolonged low back pain between radicular and nonradicular groups; nor is there a study that compares the pain intensity between the groups with and without congenital malformations. Methods. Lumbosacral plain radiographs of 881 young male patients with low back pain lasting for >4 weeks were evaluated. For all patients, we recorded the clinical signs and their pain intensities based on a 10-cm visual analog scale (VAS). Results. Congenital lumbosacral malformations were determined in 88 of 881 patients. Of these, 48 were TV, 38 were SBO, and 2 were a combined lesion of TV and SBO. The difference in positive clinical sign and VAS was statistically significant (P < 0.05) between the groups with and without congenital lumbosacral malformations. In contrast to SBO, there was a statistically significant difference of TV incidence between the sign positive and the sign negative groups (P < 0.05). The difference in VAS values was statistically significant for both TV and SBO (P < 0.001). Conclusions. The results of this study show that SBO and TV increase the severity of the clinical picture whether or not they have a causal relationship. Additionally, transitional vertebrae seem to increase nerve-root symptoms whereas spina bifida occulta does not.

Efficacy of isokinetic exercise on joint position sense and muscle strength in patellofemoral pain syndrome.

Hazneci B, Yildiz Y, Sekir U, Aydin T, Kalyon TA: Efficacy of isokinetic exercise on joint position sense and muscle strength in patellofemoral pain syndrome. Am J Phys Med Rehabil 2005;84:521–527. Objective:The objective of this study was to demonstrate the impairment of knee joint position sense in individuals with patellofemoral pain syndrome and investigate the effects of isokinetic exercise on knee joint position sense and muscle strength. Design:A total of 24 male patients complaining of anterior knee pain caused by overexertion and 24 male healthy individuals without symptoms were included for this investigation. Isokinetic exercise protocol was carried out at angular velocities of 60 degrees/sec and 180 degrees/sec. These sessions were repeated three times per week and lasted for 6 wks. At the beginning and after 6 wks of knee passive joint position sense, quadriceps and hamstring muscle strength and pain assessments were performed. Results:After the isokinetic exercise, flexion peak torque (P < 0.05), extension peak torque (P < 0.01), flexion total work (P < 0.001), extension total work (P < 0.001), passive reproduction of knee joint position sense for 40 degrees of flexion (P < 0.05) and 50 degrees of extension (P < 0.01), and pain score (P < 0.001) improved significantly in the patellofemoral pain syndrome group. Conclusion:Isokinetic exercises have positive effects on passive position sense of knee joints, increasing the muscular strength and work capacity. These findings show that using the present isokinetic exercise in rehabilitation protocols of patients with patellofemoral pain syndrome not only improves the knee joint stabilization but also the proprioceptive acuity.

Shoulder terminal range eccentric antagonist/concentric agonist strength ratios in overhead athletes

Objective: The agonist–antagonist strength relationship for shoulder external rotation and internal rotation was formerly described by the relatively more functional ratios of eccentric external rotator to concentric internal rotator moments, and eccentric internal rotator to concentric external rotator moments for the entire range of motion. The aim of this study was to provide descriptive data for terminal range eccentric antagonist/concentric agonist rotator cuff strength in overhead athletes.

Severe heterotopic ossification in the non-affected limbs of a hemiplegic patient with traumatic brain injury

Background/objective: Heterotopic ossification characterized by new bone formation in the periarticular regions of large joints in patients with neurologic injury most commonly occurs on the neurologically involved side. This study presents a very rare localization of heterotopic ossification that developed in the non-paretic limbs of a hemiplegic patient with traumatic brain injury (TBI). Case report: A 25-year-old left hemiplegic male with TBI due to a gunshot wound was admitted to the rehabilitation centre after a 2.5-month period of coma in the intensive care unit. He had limited range of motion accompanied by pain in the bilateral hip, bilateral elbow and right knee joints. Neurological examination revealed upper motor neuron lesions only on the left side in neurological exam. Plain radiographs of the involved joints revealed bilateral heterotopic ossification, which was more severe on the non-paretic side. Discussion: Clinicians should keep in mind that heterotopic ossification can occur in non-hemiplegic extremities as well as hemiplegic extremities in patients with TBI in whom the extent of neurologic damage cannot be definitely established.

Pellegrini-stieda disease in a patient with cauda equina syndrome.

A 30-yr-old man with cauda equina syndrome resulting from a compression fracture of the L1 vertebra was enrolled in a rehabilitation program at the authors’ hospital, and on completion, he was able to walk with the aid of an ankle-foot orthosis and cane. One year later, at his clinical follow-up visit, the patient complained of pain and swelling in his left knee. Despite the absence of a history of knee trauma, patellar subluxation was observed by physical examination. The patient then underwent several orthopedic surgeries to improve this condition. After this surgical process, a kneeankle foot orthosis was prescribed to prevent any exacerbation of the knee lesion secondary to walking. Nonetheless, he again developed patellar subluxation 6 mos after his last surgery. There was no swelling of the knee or restriction of motion. Valgus stress test results were positive, and the medial knee was sensitive to palpation. Plain radiography showed a characteristic bony formation and calcification in the soft tissue next to the medial femoral condyle (Fig. 1). Pellegrini-Stieda disease was considered based on the characteristic x-ray findings and clinical course. Radiographically, Pellegrini-Stieda disease seems as an ossification arising from the epicondylar portion of the medial femoral condyle. Humoral, neural, and local factors including tissue hypoxia, hypercalcemia, changes in sympathetic nerve activity, prolonged immobilization, and mobilization with frequent periods of exercise after prolonged immobilization may result in neurogenic ectopic bone formation. Although Pellegrini-Stieda disease has rarely been reported in patients with spinal cord injury, this report highlights the need for its consideration in the diagnosis of such patients if knee symptoms are present.