Cihan Aksoy

Effectiveness of dry needling for the treatment of temporomandibular myofascial pain: A double-blind, randomized, placebo controlled study

BACKGROUND AND OBJECTIVES To test the hypothesis that dry needling is more effective than sham dry needling in relieving myofascial pain of the temporomandibular muscles. MATERIAL AND METHOD Fifty-two subjects with established myofascial trigger points were randomized into two groups; study group (N: 26) and placebo group (N: 26). Dry needling was applied using acupuncture needles. Sham dry needling was applied to the placebo group. Pain pressure threshold was measured with pressure algometry, pain intensity was rated using a 10-cm visual analog scale (VAS) and the unassisted jaw opening without pain measurement was performed. Evaluations were done by a physician blinded to the data. RESULTS Of 52 patients assigned, 50 completed the study. Mean algometric values were significantly higher in the study group when compared to the placebo group (p values being less than 0.05). There were no differences between the two groups in terms of VAS and unassisted jaw-opening without pain values. CONCLUSION Dry needling appears to be an effective treatment method in relieving the pain and tenderness of myofascial trigger points.

Evaluation of Needle Positioning During Blind Intra-Articular Hip Injections for Osteoarthritis: Fluoroscopy Versus Arthrography

UNLABELLED Diraçoğlu D, Alptekin K, Dikici F, Balci HI, Ozçakar L, Aksoy C. Evaluation of needle positioning during blind intra-articular hip injections for osteoarthritis: fluoroscopy versus arthrography. OBJECTIVE To evaluate needle positioning during blind/anatomically referenced hip joint injections for osteoarthritis (OA). DESIGN Experimental clinical study. SETTING Operating theater of a university hospital. PARTICIPANTS Patients (N=16) (10 women, 6 men), who were diagnosed as having OA according to the American College of Rheumatology criteria and whose radiologic grades were II or III according to Kellgren-Lawrence. INTERVENTIONS Three bilateral and 13 unilateral hip injections were performed (3 times at 1-week intervals). After it was presumed blindly that the needle was within the joint, the location of the needle was checked with backflow technique and fluoroscopy. Entrance to the joint cavity was also ensured by reconfirmation with contrast medium, and the procedure was then terminated with hyaluronic acid injection. MAIN OUTCOME MEASURES Assessment of blind needle placement into the hip joint by using backflow technique, fluoroscopic images, and contrast enhancement. RESULTS The location of the needle was fluoroscopically confirmed to be at the proper position in 38 (66.7%) of the 57 blind interventions. Furthermore, in 29 (76.3%) of those 38 interventions, localization of the intra-articular needle could be confirmed by intra-articular contrast uptake. Overall, 29 of 57 (50.9%) blind interventions exhibited intra-articular contrast enhancement. Backflow was not observed in 23 (79.3%) of these 29 interventions. Five (17.9%) of 28 interventions with no contrast uptake showed backflow. CONCLUSIONS In light of our results, we suggest that blind injection of the osteoarthritic hip joint can be inaccurate even with careful technique. Further, the backflow method does not appear to be reliable, and guidance during the injection seems to be necessary.

The role of systemic hypermobility and condylar hypermobility in temporomandibular joint dysfunction syndrome

Objective: To evaluate the risk of temporomandibular joint dysfunction (TMD), when both systemic joint hypermobility (SJH) and localized condylar hypermobility (LCH) exist. Materials and methods: Sixty-four consecutive outpatients with temporomandibular joint clicking or pain, and 77 sex- and age-matched control subjects, were recruited in the study. LCH was diagnosed when condylar subluxation was present, and SJL was diagnosed by using Beighton’s method. The frequency of symptoms, mean mouth opening, and the frequency of subjects with SJL and LCH were the main outcome measures. Results: Out of the 64 patients, 16 patients were suffering from pain, 20 patients from joint-clicking and 28 patients from both. Both SJH and LCH were more frequently observed in those patients with TMD than in control subjects. The risk of TMD was higher if LCH and SJH existed jointly. Conclusion: Both systemic and localized hypermobility may have a role in the etiology of TMD.

The effect of viscosupplementation on neuromuscular control of the knee in patients with osteoarthritis.

OBJECTIVE The aim of this study was to investigate the short-term effects of intra-articular injection of hyaluronan (Hylan G-F 20) on proprioception, isokinetic muscle force, self reported pain, and functional condition in patients with knee osteoarthritis (OA). METHODS 63 patients with stage II-III bilateral knee OA were included in this randomized, placebo controlled, and prospective study. Subjects were randomized with 42 of them into the treatment group and 21 of them into the placebo group. Hyaluronan was intraarticularly injected into both knees of the subjects which were in the treatment group, whereas physiological saline was intraarticularly injected to the subjects which were in the placebo group. Proprioception and the isokinetic muscle force measurement were performed. Visual analogue scale (VAS) and WOMAC scale were used to evaluate pain and physical function. RESULTS Statistical analysis was performed on 120 knees of 60 patients completing the trial. The average absolute angular error (AAAE) value showing the proprioceptive error level in the treatment group was detected to be statistically significantly lower compared to placebo at the measurements performed after the 3rd injection (p = 0.02) and after one week (p = 0.01). While there was no inter-group difference in isokinetic measurements performed at 180 and 240 degrees/sec, a significant difference was detected at the measurement performed at 60 degrees/sec in favor of the treatment group (p = 0.02). Activity and resting VAS-pain values, WOMAC parameters (except the WOMAC stiffness) were detected to be significantly lower in the treatment group. Local adverse events were not reported in any patient. CONCLUSION In this study, it was demonstrated that intraarticular injection of hyaluronan in patients with knee OA led to a short-term increase in proprioception and isokinetic muscle force, and also significant improvements in the functional conditions of patients. Long-term studies are needed.

Arthrocentesis versus nonsurgical methods in the treatment of temporomandibular disc displacement without reduction

OBJECTIVE The aim was to compare the short- and medium-term results of arthrocentesis and conventional treatment (splint, heat, and exercise) in patients with early temporomandibular joint (TMJ) disc displacement without reduction (DDw/oR). STUDY DESIGN One hundred twenty consecutive patients (104 female, 16 male), who had been followed by a multidisciplinary TMJ unit with the diagnosis of DDw/oR were enrolled in this single-blind prospective study. Patients either underwent arthrocentesis or they were given a combination of splint, hot pack, and home exercise program. Visual analog scale (VAS) was used for pain assessment. Maximal mouth opening (MMO), lateral movement, and protrusion were measured. Repeat measurements were performed on the first, third, and sixth months following treatments. RESULTS Arthrocentesis group consisted of 54 individuals (51 female, 3 male), and the conventional treatment group consisted of 56 individuals (49 female, 7 male). The mean age values of the groups were 33.4 years (range 15-63 years) and 34.8 years (range 17-61 years), respectively. Baseline VAS and MMO values of the arthrocentesis and conventional treatment groups were similar (P > .05). Regarding VAS and MMO, lateral movement, and protrusion, the intragroup analyses showed a statistically significant reduction in both groups compared with baseline values (all P < .01). Regarding VAS values, the difference values between each evaluation and the baseline measurement were significantly higher in the arthrocentesis group, except for the first-month difference. Regarding MMO, lateral movements, and protrusion, the differences between the baseline values and each evaluation thereafter were statistically similar between the 2 groups (P > .05). CONCLUSION We conclude that early treatment either with conservative methods or with arthrocentesis is beneficial in DDw/oR. However, arthrocentesis seems to be superior regarding pain management. Therefore, arthrocentesis may be indicated in patients where painful complaints overwhelm despite other conservative treatments.

Relationship between maximal bite force and tooth wear in bruxist and non-bruxist individuals

OBJECTIVE (i) To compare individuals with self-reported bruxism and non-bruxist individuals in terms of maximal bite force (MBF) and temporomandibular joint (TMJ) primary assessment parameters and (ii) to examine the relationship between MBF and tooth wear in these subjects. MATERIALS AND METHODS Twenty-nine bruxist subjects and 29 healthy controls were enrolled. MBF measurements were carried out by the use of bite force recorder. Tooth wear indices, maximal mouth opening, maximal lateral excursions and maximal protrusions were measured for every subject. RESULTS MBF and tooth wear index scores were significantly higher in bruxists (p values <0.05) compared to non-bruxists. MBF and tooth wear index scores were found to be significantly correlated in the bruxist group (r=0.79, p=0.00). Less significant correlation was observed in the non-bruxist group (r=0.38, p=0.04). No differences in masticatory clinical examination parameters were identified between the groups. CONCLUSION This study is the first to show that MBF can increase in bruxist individuals and that the increase in MBF are correlated with tooth wear in bruxist subjects. Further studies regarding the possible role of MBF in bruxism are to be done.

Evaluation of the Effectiveness of an Aerobic Exercise Program and the Personality Characteristics of Patients with Fibromyalgia Syndrome: A Pilot Study

[Purpose] The aim of this study was to assess the effectiveness of a 6-week aerobic exercise program on pain, physical function, and psychological status, and to evaluate the personality characteristics of fibromyalgia syndrome (FMS) patients. [Subjects and Methods] Fourteen women with FMS were enrolled. They were trained for a 6-week home-based aerobic exercise program. The Fibromyalgia Impact Questionnaire, the Beck Depression Inventory, the visual analog scale of pain and sleep quality were measured at baseline and at the end of week 6. The personality profiles were evaluated using the Minnesota Multiphasic Personality Inventory (MMPI). [Results] After the exercise program, significant improvements were determined in pain, sleep quality, physical function, depression and FMS symptoms compared to baseline. In addition, the hysteria item (71.21±8.84) of the MMPI was significantly higher in FMS. [Conclusion] Our findings indicate that home-based aerobic exercise may be a useful treatment in the management of FMS. Personality characteristics should be considered during the planning process of the treatment of FMS. Personality is a filter between life events and psychological responses. It is defined to be the integration of effective and behavioral patterns. Long-term studies involving larger clinical samples are needed to define the role of personality characteristics in FMS.

Vibration and its effects on the body.

Objectives: To assess the effects of machine-induced vibration on workers and to determine effective precautions for vibration-induced trauma. Subjects and Methods: The study group consisted of 114 workers who were randomly selected: 50 rock drill workers and 64 truck heavy vehicle operators. Fifty-four office workers were designed as controls. The study and control groups were age-matched. All subjects were interviewed to determine subjective symptoms using a 38-item questionnaire designed by the Medical Committee of Vibration Disease, Japanese Association of Industrial Health. Results: The complaints of pain in the fingers, sensitivity to cold, numbness and pain of fingers at night, weakness of static position, wrist-elbow pain, difficulty in bending and stretching elbow, pain in shoulder when holding up arms, lower back pain, sleeping disturbance and hearing difficulty were significantly higher in rock drillers than heavy vehicle operators and office workers (p < 0.05–0.01). Conclusion: Permanent vibration exposures cause negative physical effects that may lead to occupational diseases. In order to be protected against whole-body and hand-arm vibrations, technical and medical measures must be taken into account.

Exercise capacity and oxygen recovery half times of skeletal muscle in patients with fibromyalgia

It is known that increased muscle fatigability and exercise intolerance is a major symptom of fibromyalgia (FM) [1]. Although many models have been proposed, the patho-physiology of exercise intolerance in FM remains unclear. Up to now, muscle fatigue and exercise tolerance can be explained by numerous central and peripheral mechanisms [1]; however, the exact patho-physiological role of the microvascular involvement in FM is still unclear. As a peripheral mechanism, there are few reports on abnormalities of the microcirculation in patients with fibromyalgia. Continuous wave near-infrared spectroscopy (NIRS) technology is based on the fact that light in the wavelength range 650–950 nm is weakly absorbed by tissues and signal intensity changed mainly due to hemoglobin. Since light passing through the large vessels is mostly absorbed, light that reaches the detector comes mainly from small blood vessels (arterioles, capillaries and venules) [2]. Thus, it gives dynamic balance information between oxygen supply and consumption of skeletal muscles. The objective of the present study was to evaluate association with exercise intolerance and oxygen recovery half times of skeletal muscle in patients with FM. Thirty-three female subjects (18 consecutive female patients with FM), aged between 21 and 36 years, were investigated. All subjects were fully informed of any risks and discomforts associated with the experiments before giving their informed written consent to participate with ethical approved. All have taken examination by near-infrared spectroscopy and cardiopulmonary exercise testing. In the experiment protocol, brachial ischemia was used for detecting muscular oxygen kinetics by NIRS method before cardiopulmonary exercise testing. A continuous wave NIRS device was used (Niroxcope 201, Biophotonics Lab) and the probe containing multiple source-detectors was placed on the subjects’ lower half of left forearm and arterial blood flow is restricted by placing a tourniquet on the upper arm at a pressure of 250 mmHg after a 5 min baseline measurement, and then post-ischemic measurement was taken. In both rest and post-ischemic traces, change of difference of oxyhemoglobin and deoxyhemoglobin concentrations between minimum point and maximum point was taken as the full range and time to reach half of the 95% of the full range was calculated as half-time value (t1/2) [2]. Then, all participants underwent a standard Bruce multistage maximal treadmill protocol with metabolic measurements. All exercise testings were discontinued due to fatigue. Peak oxygen conM. Dinler AE C. Aksoy AE A. Oncel AE E. Berker Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

Temporomandibular dysfunction and risk factors for anxiety and depression

BACKGROUND Anxiety and depression may cause temporomandibular joint (TMJ) complaints or TMJ disorders may trigger some of psychiatric problems. OBJECTIVE The aim of this study was to determine the risk factors and the interactive role of anxiety and depression in patients with TMJ dysfunction. METHOD A total of 273 patients who presented to the multidisciplinary outpatient clinic of TMJ diseases that were followed up for temporomandibular dysfunction (TMD), were included in this trial. Patients were classified in three sub-groups: patients with myofacial pain alone (group-1), patients with TMJ disorder alone (group-2), and patients with TMJ disorder and also myofacial pain (group-3). All patients were examined using the standard TMJ examination and were evaluated with the Hospital Anxiety Depression (HAD) scale in order to determine anxiety and depression. RESULTS According to the univariate analysis, risk factors for patients with confirmed anxiety and/or depression were being female (p= 0.005), existence of myofacial pain (p= 0.01), effects of stress on complaints (p= 0.005) and insufficient social support (p< 0.001). According to regression analysis, presence of psychopathology was increased 3.7 times in those being female, 3.5 times with insufficient social support, and 1.2 times with myofacial pain. CONCLUSIONS Among the patients with TMD, the groups who were considered to have anxiety and depression were female patients, patients with deficient social support system, and patients with myofacial pain alone or patients with myofacial pain accompanying an existing TMJ disorder. The existence of anxiety and depression should be considered in addition to musculoskeletal pathologies during the treatment plan of patients with TMJ who have these risk factors.