Duygu Geler Külcü

Differential diagnosis of intraspinal and extraspinal non-discogenic sciatica.

The aim of this study is to present a series of 11 patients with non-discogenic sciatica (NDS), and to review the diagnostic techniques of careful clinical and radiological examination. The cases include lumbar radicular herpes zoster, lumbar nerve root schwannoma, lumbar instability, facet hypertrophy, ankylosing spondylitis, sacroiliitis, sciatic neuritis, piriformis syndrome, intrapelvic mass and coxarthrosis. The pain pattern and accompanying symptoms were the major factors suggesting a non-discogenic etiology. Pelvic MRI and CT scans, and sciatic nerve magnetic resonance neurography were the main diagnostic tools for diagnosis of NDS. The treatment of choice depended on the primary diagnosis. Detailed physical examinations with special attention paid to the extraspinal causes of sciatica and to pain characteristics are the major components of differential diagnosis of NDS.

Immediate Effects of Silicone Insoles on Gait Pattern in Patients with Flexible Flatfoot

Background: Flatfoot in which a normal arch fails to develop is a common deformity in both children and adults. A frequently-used treatment is an over-the-counter insole to normalize foot mechanics and relieve pain. This study was designed to evaluate the effects of over-the-counter silicone insoles on the gait patterns of patients with flexible flatfoot. Methods: Thirty-four adults (24 women and nine men, average age 43.7 ± 9.7 years) with bilateral symptomatic flatfoot deformities were included in the study. Flatfoot was diagnosed by a lateral talometatarsal angle of more than 4 degrees and a talocalcaneal angle of more than 30 degrees. Three-dimensional gait analysis and video recordings were done at a single session. All patients walked at self-selected speeds over a 10-meter walkway with and without insoles. Time-distance parameters and kinematic and kinetic characteristics of gait in the sagittal plane were evaluated by a quantitative gait analysis system. Results: Mean lateral talometatarsal and talocalcaneal angles were 6.3 ± 2.5 degrees and 56.1 ± 8.6 degrees, respectively. There was no difference in gait parameters with or without the insoles. Conclusions: Over-the-counter insoles have no beneficial effect in normalizing forces acting on the foot and on the entire lower extremity in adults with flexible flatfoot.

Autonomic dysreflexia in a man with multiple sclerosis.

Abstract Background/Objective: To report manifestation of autonomic dysreflexia (AD) in a man with multiple sclerosis (MS). Design: Case report. Findings: A young man presented with a history of several admissions to the emergency department with complaints of hypertensive attacks, palpitations, difficulty in breathing, headaches, and flushing. The attacks were attributed to a previously diagnosed anxiety disorder. Onset of numbness of the left leg numbness prompted a more thorough study, which showed evidence of MS. AD was suspected as the cause of his recurrent attacks of hypertension. Bladder distension was identified as the cause of AD, and his hypertensive attacks were controlled by management of neurogenic bladder. Conclusions: This report emphasizes that AD can occur in MS. Somatic symptoms warrant thorough investigation before attributing them to psychosomatic causes.

Associated Factors with Pain and Disability in Patients With Knee Osteoarthritis

Özet Amaç: Diz osteoartriti (OA) olan hastalarda ağrı ve fonksiyonel düzeyle ilişkili etkenleri belirlemektir. Yöntem ve Gereçler: Diz OA tanısı alan 161 hasta çalışmaya alındı. Hastaların yaş ortalaması 62.4± 8.7 yıl olup ortalama semptom süresi 43.76± 26.6 aydı. Hastaların yaş, cinsiyet, vücut kütle indeksi, eğitim düzeyi, sigara ve düzenli egzersiz alışkanlığı ve semptom süreleri kaydedildi. Ön-arka ve lateral diz grafilerinde Kellgren-Lawrence skorları hesaplandı. Hastaların fonksiyonel düzeyi Western Ontario ve McMaster Üniversitesi Osteoartrit İndeksi (WOMAC) ile, ağrı şiddeti Görsel Ağrı Skalası (GAS) ile değerlendirildi. Bulgular: Vücut kütle indeksi ile WOMAC ağrı skoru (r=0.592, p=0.0001), WOMAC eklem sertliği skoru (r=0.634, p=0.0001) ve WOMAC günlük yaşam aktiviteleri skoru (r=0.749, p=0.0001) arasında ilişki saptandı. Eğitim düzeyi ile WOMAC ağrı skoru (r=-0.394, p=0.001), WOMAC eklem sertliği skoru (r=-0.345, p=0.004), ve WOMAC günlük yaşam aktiviteleri skoru (r=-0.352, p=0.003) arasında ters ilişki saptandı. Kellgren-Lawrence skoru (ön-arka ve yan grafi) ile GAS skoru ve her üç WOMAC skoru arasında ilişki saptanmadı (p>0.05). Kellgren-Lawrence ön-arka ve yan grafi skorları yaş ve semptom süresiyle ilişkili bulundu (sırasıyla r=0.263, p=0.001 ve r=0.339, p=0.016). GAS skoru ile herhangi bir parametre arasında ilişki saptanmadı. WOMAC alt grup skorları ve GAS skoru cinsiyete göre karşılaştırıldığında WOMAC ağrı skorunun bayanlarda daha yüksek olduğu saptandı (p= 0.024). Geri kalan faktörlerle WOMAC alt grup skorları arasında korelasyon saptanmadı. Sonuç: Vücut kütle indeksi, diz OA olan hastalarda fonksiyonel düzey ve ağrı şiddetiyle ilişkili en önemli faktördür. Hastalar, semptom ve hastalık şiddetini azaltmak açısından kilo vermeye teşvik edilmelidirler. (Turk J Rheumatol 2010; 25: 77-81) Anah tar sözcükler: Diz, osteoartrit, ağrı, özürlülük

Effects of lower back pain on postural equilibrium and fall risk during the third trimester of pregnancy

Abstract Objective: To evaluate the effects of lower back pain (LBP) on postural equilibrium and fall risk during the third trimester pregnancy period by comparing postural stability between pregnant with LBP and pregnant without LBP control women. Methods: The study population comprised 68 women of 24–35 years in the third trimester of pregnancy. They were divided into Groups 1 (n = 30) and 2 (n = 38) according to the presence or absence of LBP, respectively. Postural stability were evaluated between groups using Tetrax Interactive Balance System posturography (Tetrax, Sunlight Medical Ltd, Tel Aviv, Israel) with eight sensory conditions. Results: For eight different positions, pregnant patients with LBP showed significantly higher values of general stability index, Fourier transformation index (F1, F2–F4, F5–F6 and F7–F8) and fall index than controls. Conclusion: LBP has a negative effect on postural stability. Postural equilibrium decreases and fall risk increases in pregnant patients with LBP.

Diagnostic Significance of Ultrasonographic Measurements and Median-Ulnar Ratio in Carpal Tunnel Syndrome: Correlation with Nerve Conduction Studies

Background and Purpose We determined the reliability of ultrasonography (US) measurements for diagnosing carpal tunnel syndrome (CTS) and their correlation with symptom duration and electrophysiology findings. We determined whether the ratio of the median-to-ulnar cross-sectional areas (CSAs) can support CTS diagnoses. Methods The pisiform CSA (CSApisiform), swelling ratio (SR), palmar bowing, and CSApisiform/ulnar CSA (CSAulnar) measurements made in two subgroups of CTS patients (having sensory affection alone or having both sensory and motor affection) were compared with controls. CSAulnar was measured in Guyons canal at the level of most-protuberant portion of the pisiform bone. Results The values of all of the measured US parameters were higher in patients with CTS (n=50) than in controls (n=62). CSApisiform could be used to diagnose CTS of mild severity. All of the parameters were positively correlated with the distal latency of the compound muscle action potential, and all of them except for SR were negatively correlated with the sensory nerve conduction velocity. A CSApisiform/CSAulnar ratio of ≥1.79 had a sensitivity of 70% and a specificity of 76% for diagnosing CTS. Conclusions Only CSApisiform measurements were reliable for diagnosing early stages of CTS, and CSApisiform/CSAulnar had a lower diagnostic value for diagnosing CTS.

Efficacy of kinesio tape application on pain and muscle strength in patients with myofascial pain syndrome: a placebo-controlled trial

[Purpose] The purpose of this study was to determine the short- and mid-term effects of Kinesio taping on the trapezius muscle in individuals with myofascial pain syndrome. [Subjects and Methods] Thirty-seven patients with active upper trapezius myofascial trigger points were randomly divided to 2 groups: group 1 received Kinesio taping for the upper trapezius muscle, and group 2 received a sham Kinesio taping application. Neck pain (Visual Analog Scale and pressure algometry) and trapezius muscle strength data were collected at baseline, immediately after Kinesio taping application, and at one month follow-up. [Results] The mean changes in Visual Analog Scale scores were significantly different between groups at T2 and T1, with less pain in group 1. The mean changes in algometry scores were significantly different between groups at T3 compared with T2 in favor of group 1. The mean changes in trapezius muscle strength were significantly different between the groups at T2 compared with T1 in favor of group 1. [Conclusion] Patients with myofascial pain syndrome receiving an application of Kinesio taping exhibited statistically significant improvements in pain and upper trapezius muscle strength.

The Reliability and Validity of the Turkish Version of the Fibrofatigue Scale

ABSTRACT Objective: To validate translated Turkish version of the Fibrofatigue Scale [FFS]. Methods: The Turkish version of FFS was administered to a consecutive sample of 82 patients with fibromyalgia syndrome [FMS; 78 women]; mean age was 37 years and mean symptom duration was 2.3 years. The Turkish version of the Fibromyalgia Impact Questionnaire, the Beck Depression Inventory [BDI], and the Medical Outcome Survey Short Form-36 [SF-36] were documented. Reliability was tested by the test-to-test reliability [intraclass correlation coefficient] and internal consistency [Cronbachs alpha coefficients]. Construct validity was assessed by association with BDI and SF-36 [Spearmans correlation coefficient]. Paired t-test was used to determine the statistical significance of change score [responsiveness]. Results: The test–retest reliability and internal consistency of the FFS were excellent with intraclass correlation coefficient of 0.98 [0.97–0.99] and Cronbachs alpha of 0.74. The correlations between the FFS and the Fibromyalgia Impact Questionnaire items [rho = 0.56], BDI [rho = 0.52], and subscales of SF-36 [rho value ranging from −0.333 to −0.553] were adequate. The FFS score improved significantly after a four-week physical therapy program [P < 0.001]. Conclusions: The Turkish FFS is a reliable and valid instrument for detecting and measuring functional disability and symptom severity in Turkish patients with FMS.

Reliability of the Spinal Cord Assessment Tool for Spastic Reflexes

OBJECTIVE To assess the reliability of the Spinal Cord Assessment Tool for Spastic Reflexes (SCATS). DESIGN Observational reliability study of the SCATS. SETTING Inpatient rehabilitation unit at an education and research hospital. PARTICIPANTS Subjects (N=47) between the ages of 18 and 88 years with spinal cord injury (SCI) and with American Spinal Injury Association Impairment Scale grades from A to D with spasticity, who were at least 6 months postinjury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Interrater and test-retest reliability of the SCATS. RESULTS The SCATS had substantial to almost perfect interrater agreement (κ=.669-1.000) between the 2 physiatrists. Test-retest agreement of the SCATS was also substantial to almost perfect (κ=.614-1.000) as well. There was a significant correlation between the SCATS clonus scores and the Modified Ashworth scores of the hip, knee, and ankle. No correlation was found between SCATS extensor spasm scores and Modified Ashworth scores. The SCATS flexor spasm scores were only correlated significantly with the ankle plantar flexor Modified Ashworth scores (P<.05). CONCLUSIONS The SCATS is a reliable tool for assessing spasm activity and spastic hypertonia in patients with SCI.

Comparison of ultrasound and extracorporeal shock wave therapy in lateral epicondylosis

Objective The aim of this study was to compare the efficacy of extracorporeal shock wave therapy (ESWT) and therapeutic ultrasound (US) in the treatment of lateral epicondylosis (LE). Methods Our study enrolled 50 patients with LE. Patients were randomized into two groups. Group 1 underwent therapeutic US (n = 24; 5 males and 15 females; mean age: 43.75 ± 4.52) Group 2 underwent ESWT (n = 20; 8 males and 16 females; mean age: 46.04 ± 9.24). Patients were evaluated at baseline, after treatment,and 1 month following treatment. The outcome measures were the visual analog scale (VAS), algometer, grip dynamometer, quick-disability of the arm,shoulder,and hand (QDASH), patient-rated tennis elbow evaluation (PRTEE), and Short Form-36 (SF-36) health survey questionnairre. Results Both groups showed significant improvements in terms of VAS (all p values < 0.0001), dynamometer (p = 0.001 vs p = 0.015), algometer (all p values < 0.0001), PRTEE (all p values < 0.0001), QDASH (all p values < 0.0001), and SF-36 scores (p = 0.001 vs p = 0.005) within time. There was no significant difference between the two groups, except algometer scores in favor of ESWT (p = 0.029). Conclusion ESWT and therapeutic US are equally effective in treating LE. ESWT is an alternative therapeutic intervention and as effective as US. Level of evidence Level III, Therapeutic study.