Cigdem Bircan

Hypermobility syndrome increases the risk for low bone mass

Few studies on the benign joint hypermobility syndrome suggest a tendency toward osteopenia, but there are conflicting results. We assessed bone mineral density in pre-menopausal women with hypermobility. Twenty-five consecutive Caucasian women diagnosed with benign hypermobility syndrome by Beighton score and 23 age- and sex-matched controls were included in the study. Age, menarch age, number of pregnancies, duration of lactation, physical activity and calcium intake were questioned according to European Vertebral Osteoporosis Study Group (EVOS) form. All subjects were pre-menopausal and none of them were on treatment with any drugs effecting bone metabolism or had any other systemic disease. No statistically significant difference was found for body mass index, menarch age, number of pregnancies, duration of lactation, calcium intake, calcium score and physical activity score between the two groups. Total femoral and trochanteric bone mineral density and t and z scores were significantly lower in hypermobile patients compared to the control group. Ward’s triangle and femoral neck z scores were also found to be significantly low in hypermobile patients (p<0.05). Significant negative correlations were found between the Beighton scores and trochanteric BMD, t and z scores (r=−0.29, r=−0.30, and r=−0.32) in hypermobility patients. Low bone mass was more frequently found among subjects with hypermobility (p=0.03). Hypermobility was found to increase the risk for low bone mass by 1.8 times (95% confidence interval 1.01–3.38). Our study suggests that pre-menopausal women with joint hypermobility have lower bone mineral density when compared to the controls and hypermobility increases the risk for low bone mass.

Ef” cacy of two forms of electrical stimulation in increasing quadriceps strength: a randomized controlled trial

Objective: To investigate whether electrical stimulation is effective in improving quadriceps strength in healthy subjects and to compare interferential and low-frequency current in terms of the effects on quadriceps strength and perceived discomfort. Design: Randomized, controlled study. Setting: Physical Medicine and Rehabilitation Department in a university hospital. Subjects: Thirty medical faculty students, divided into three groups, participated in the study. Interventions: Group A received electrical stimulation with bipolar interferential current while group B received electrical stimulation with lowfrequency current (symmetrical biphasic). Group C served as the control group. Electrical stimulation was given for 15 minutes, ”ve days a week for three weeks, at a maximally tolerated intensity with the knee fully extended in the sitting position. Main outcome measures: Before and after the study, quadriceps strength was measured with a Cybex dynamometer isokinetically at the angular velocities of 60°/s and 120°/s. The perceived discomfort experienced with each type of electrical stimulation was quantified by the use of a visual analogue scale (VAS). Results: Statistically significant increase in isokinetic strength was observed after training in group A and group B. Increase in strength did not differ between the stimulation groups. No significant change in strength occurred in group C. Perceived discomfort by the stimulation groups was not significantly different. Conclusion: Both interferential and low-frequency currents can be used in strength training with the parameters used in this study.

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.

Impaired quality of life and functional status in patients with benign joint hypermobility syndrome

Abstract Objective: To evaluate the function and health-related quality of life [QoL], and to determine the relationship between pain, function and QoL in patients with benign joint hypermobility syndrome [BJHS]. Material and method: A total of 36 patients and 31 healthy controls were enrolled. Demographic characteristics were recorded and the patients were evaluated according to the Beighton score and Brighton criteria for BJHS. The assessment of pain was performed based on the visual analogue scale [VAS 0–10 cm]. Function and QoL were assessed using the Stanford Health Assessment Questionnaire [HAQ] and Nottingham Health Profile [NHP], respectively. Results: The mean age was 29.94 ± 6.04 years in the patient group and 30.16 ± 5.64 years in the control group. When the two groups were compared, there were significant differences in the HAQ scores. QoL was also significantly worse in the patient group in all dimensions of the NHP except for social isolation. There was a positive correlation between the Beighton score and the NHP-emotional reaction score. We have also observed a positive correlation between the HAQ scores and the pain [VAS], NHP-pain and NHP-Physical Mobility scores in the patient group. No correlation was observed among the other parameters. Conclusion: This study has demonstrated that function and QoL are significantly impaired in the patients with BJHS compared to healthy controls. Function and QoL as well as the pain should be assessed in the patients with BJHS. Also, the disease may not be benign as it is widely regarded.

442 COMPLEX REGIONAL PAIN SYNDROME: A PAINLESS CASE REPORT

Complex regional pain syndrome (CRPS) is characterized by diffuse pain, swelling, vasomotor instability, trophic changes and severe functional impairment of the affected extremity. About 75% of the patients with CRPS have spontaneous pain with hyperalgesia or allodynia. In this report we present a case having CRPS type-I but without any pain and hyperalgesia or allodynia. The subject was a 57 years old female patient who had a distal radius fracture after a fall. Her wrist was immobilized in a cast for six weeks and afterwards she was referred to our department for physical therapy. She had complaints such as; swelling, hyperhidrosis, restriction of finger and wrist movements and tremor in her injured hand but she had no pain. Our examination confirmed restriction of wrist and finger movements, hyperhidrosis, and tremor and also her hand was warm and swollen. But there was no allodynia and hyperalgesia. The patient did not report any pain at the follow-up controls, assessed by visual analog scale. Zyluk scoring system was used for diagnosis and clinical severity of CRPS type-I. Patient was treated with successfully with physical therapy and she did not develop pain during follow-up. Some patients with CRPS type-1 may have no pain in spite of severe sudomotor, vasomotor and motor signs and symptoms. In the literature there are few articles reporting CRPS with no pain and all of them were in lower extremities. It should be noted that CRPS type-I with no pain can also occur in upper extremities.

388 THE RELIABILITY AND VALIDITY OF THE TURKISH VERSION OF THE WESTERN ONTARIO ROTATOR CUFF INDEX

Background and Aims: To adapt the Western Ontario Rotator Cuff Index (WORC) index for use in Turkey and to investigate its reliability and validity. Methods: The Turkish version of the WORC was developed according to the guidelines in the literature. Seventy-two patients with rotator cuff disease were administered the questionnaire and they were also evaluated by using the UCLA shoulder rating scale, Constant score and SF-36 to test validity. The WORC questionnaire was repeated in 35 patients after a mean interval of 2.9 days (range 2 to 7 days) to evaluate test-retest reliability. Results: Cronbach’s a was calculated as 0.92 for the total questionnaire. The intraclass correlation coefficients were very high and ranged between 0.96–0.98 for each section. There was a significant negative correlation between the Turkish version of WORC and UCLA (r = −0.598, p< 0.01), Constant score (r = −0.630, p< 0.01) and all subscales of SF-36 (p< 0.01). Conclusion: The Turkish version of the WORC index is a reliable and valid instrument for use in clinical trials in patients with rotator cuff disorders.

439 DISTAL RADIUS FRACTURES AND COMPLEX REGIONAL PAIN SYNDROME TYPE I

A. Beerthuizen1 °, A. van ’t Spijker2, F.J.P.M. Huygen3, J. Klein4, J. Passchier2, D.L. Stronks1, R. de Wit5,6. 1Pain Expertise Center, Erasmus MC, Rotterdam; 2Department of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam; 3Pain Treatment Center, Erasmus MC, Rotterdam; 4Department of Anesthesiology, Erasmus MC, Rotterdam; 5Department of Nursing Research, Faculty of Health Sciences, University of Maastricht; 6University Hospital Maastricht, The Netherlands