Ebru Şahin

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.

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.

Functional restriction and satisfaction with prosthesis in lower limb amputee patients

Amac: Bu calismanin amaci; alt ekstremite ampute hastalarda fonksiyonel kisitliligi ve protez memnuniyetini degerlendirmek ve iliskili faktorleri ortaya koymaktir. Gerec ve Yontem: Calismaya alt ekstremite amputasyonu gecirmis olan 43 hasta alindi. Hastalarin demografik ve klinik ozellikleri kaydedildi. Hastalarin fonksiyonel kisitliligini degerlendirmek amaciyla Groningen Aktivite Kisitlilik Skalasi (GARS) kullanildi. Hasta memnuniyetini belirlemek icin ise Protez Memnuniyet Anketi uygulandi. Bulgular : Hastalarin yas ortalamasi 43,2 ± 12,4 idi. 28 hastanin diz alti, 12 hastanin diz ustu, 3 hastanin ise diz dezartikulasyon seviyesinde amputasyonu vardi. 21(%48) hastanin fonksiyonel seviyesi K4, 19 (%44) hastanin fonksiyonel seviyesi K3’tu. Toplam 28 hastaya aktif vakumlu, 10 hastaya mikroislemcili, 5 hastaya hidrolik protez recete edilmisti. Hastalarin baslangic GARS medyan puani 21 (18 – 64). Hastalarin kontrol GARS medyan puani 19 (18 – 60) dur. Hastalarin Protez Memnuniyet Anketi’ne gore degerlendirilen memnuniyet ortalamasi ise %82,9 (minimum: 37, maksimum: 100) dur. Hastalarin memnuniyetleri veya fonksiyonel duzeyleri ile yas ve amputasyon seviyesi arasinda anlamli iliski saptanmadi. Daha once moduler protez kullanmakta olup yeni moduler protez recete edilen 28 hastanin fonksiyonelliginde istatistiksel olarak anlamli duzelme saptandi. Sonuc: Alt ekstremite amputasyonlarinda protez uygulamalari fonksiyonel kisitliligi azaltan ve hasta memnuniyetinin yuksek oldugu uygulamalardir.

The Association Between Knee Pain, Symptoms, Function and Quality af Life After Anterior Cruciate Ligament Reconstruction at Short-Term Follow-Up: A Preliminary Study

Objectives: To investigate the associations between pain, symptoms, function and knee-related quality of life (QOL) after ACL reconstruction at short-term follow-up Methods: Twenty patients who had undergone ACL reconstruction were included in the study. Knee Injury and Osteoarthritis Outcome Score-Turkish (KOOS-T) was used to evaluate knee pain, other symptoms (symptoms), activities of daily living and sport and recreation (Sport/Rec). Quality of life was assessed with Short Form (SF)-36. Lysholm knee scoring scale was used for clinical evaluation. Results: The mean age of patients was 28. 2 ± 5.5 and the mean time passed after surgery was 38.22 ± 24.7 weeks. A significant correlation (p<0, 05) was found between KOOS-T pain, activities of daily living subscales and all SF-36 subscale scores and both physical component and mental component summary scores. KOOS symptoms and Sports/Rec subscales were correlated with physical and social functioning subscale scores and mental component summary scores of SF-36. Symptoms subscale was also correlated with vitality subscale of SF-36. There was no correlation between SF-36 scores and age and time passed after surgery. Lysholm score was also correlated with most of the subscales of SF-36 but especially with physical component summary score. Conclusion: The QOL of patients who had undergone ACL reconstruction was significantly correlated with pain and activities of daily living. The mental health subscales of SF-36 also correlated with pain, symptoms, ADL and Sports/Rec suggesting that apart from the physical impairment, mental health is also an important clinical issue in patients who had undergone ACL reconstruction.