Ebru Sahin

Regular Exercise Improves Outcome in Droopy Shoulder Syndrome: A Subgroup of Thoracic Outlet Syndrome

Objective: Droopy shoulder syndrome [DSS] is classified as a small subgroup of disputed neurogenic thoracic outlet syndrome and characterized by drooping of the shoulders which leads to traction on the brachial plexus. The effect of exercise seems controversial in DSS. The aim of this study is to evaluate the effect of exercise both on clinical and radiological outcome in DSS. Methods: Thirty-four patients referred to the physical medicine and rehabilitation outpatient clinic with DSS were included in this prospective follow-up study. Of these patients, five were lost to follow-up. All patients were given home exercises and followed up for 13.7 ± 5.0 months. The patients were divided into two groups with regard to their adherence to exercise programs as regular and irregular exercise groups. The clinical outcome was assessed on the basis of pain with visual analog scale, patients response to treatment, and radiographic changes. Results: At the end of the treatment when the two groups were compared, the patients doing regular exercise had a better improvement in pain scores [P = 0.002] and radiographic findings [P = 0.05] than the irregular exercisers. They also said they were much more satisfied with the treatment [P = 0.04]. Conclusion: Regular exercise improves outcome in DSS. Unlike previous reports, radiographic improvement can also be achieved if the objective evaluation is performed.

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.

Regional migratory osteoporosis: case report of a patient with neuropathic pain

Regional migratory osteoporosis (RMO) is an idiopathic disorder characterized by severe periarticular pain, transient and migratory arthralgia, and osteoporosis. Osteoporosis in this disease may appear in the form of local regional osteoporosis and bone marrow edema or generalized osteoporosis. It occurs most commonly in middle-aged men and late second or third trimester pregnant women. The laboratory findings of the disease are usually normal and do not demonstrate apparent anomalies. The presence of bone marrow edema on MRI is its characteristic finding. RMO can only be separated from transient osteoporosis of hip and avascular necrosis with migration to other joints. Clinically, RMO progresses in three stages: increasing pain and disability, radiological findings (osteopenia), maximalization of symptoms, and finally, the regression of the disease and radiological changes. In this case report, we present a 29-year-old woman whose symptoms had first appeared at the second trimester of pregnancy and migrated both to the other joints in the proximo-distal direction and to the adjacent bones within the same joint. She also had symptoms such as hyperalgesia, hyperesthesia and hypertrichosis along with neuropathic pain, which she described as a burning, biting, and prickling type of pain at the right leg. The neuropathic pain of the patient was resistant to medical treatment. We believe that this case was worth reporting because of the obstinate clinical course of the patient’s disease and her severe neuropathic pain that was resistant to treatment.

Shoulder proprioception in patients with subacromial impingement syndrome

BACKGROUND Recently, proprioception deficits of the rotator cuff and the deltoid muscles have been suggested to play a pivotal role in the subacromial impingement syndrome (SIS). To date, there are no study has been found where the kinesthesia and joint position senses have been evaluated together in SIS. OBJECTIVE To investigate the shoulder proprioception in patients with SIS. METHODS Sixty-one patients with SIS and 30 healthy controls, aging between 25 and 65 years, were included in the study. Main outcome measure was proprioception, assessed with an isokinetic dynamometer. Kinesthesia, active and passive joint repositioning senses were tested at 0° and 10° external rotation. All tests were repeated 4 times and the mean of angular errors were obtained. RESULTS The mean age was 49.14 ± 10.27 and 48.80 ± 11.09 years in patient group and in control group respectively. No significant difference was found between two groups in terms of age, gender and dominance. When involved and uninvolved shoulders of the patient group were compared, kinesthesia, active and passive joint position senses were significantly impaired in involved shoulders at all angles (P < 0.05). When involved shoulders of the patient group were compared to the control group, kinesthesia, active and passive joint position senses were significantly impaired in involved shoulders in patient group at all angles (P < 0.05) except active position sense at 0°. When uninvolved shoulders of the patient group were compared to the control group, kinesthesia at 10° was significantly impaired (P < 0.05). CONCLUSION This study showed that shoulder proprioception was impaired in patients with SIS. This proprioceptive impairment was found not only in involved shoulders but also in uninvolved shoulders in patients with SIS.

Neuralgic amyotrophy as the primary cause of shoulder pain in a patient with rotator cuff tear

A 66-year-old woman with no history of trauma presented with severe shoulder pain. Magnetic resonance imaging revealed rupture of the supraspinatus tendon, for which surgical treatment was considered. However, it was noted that shoulder pain was accompanied by weakness in the shoulder muscles, and the patient underwent electroneuromyographic examination, which revealed neuralgic amyotrophy. Following physical therapy and rehabilitation combined with appropriate medical therapy, her symptoms significantly improved. In cases with severe shoulder pain without a trauma history, characteristics of pain should be thoroughly analyzed and neuralgic amyotrophy considered in the differential diagnosis.