Erkan Kaya

Effects of Balneotherapy and Physical Therapy on Sleep Quality in Patients with Osteoarthritis Aged 50 to 85 Years

Objectives This study aims to investigate the effect of balneotherapy (BT) and physical therapy (PT) on sleep quality in patients with knee osteoarthritis (OA) aged 50 to 85 years. Patients and methods A total of 199 patients (76 males, 123 females; mean age 67.8±7.3 years; range 50 to 85 years) suffering from knee OA (Kellgren-Lawrence grade 2-3) for more than six months were enrolled. Sleep and functional status were assessed at baseline and after 19 sessions of BT and 15 sessions of PT by using Pittsburgh Sleep Quality Index and Western Ontario and McMaster Universities Osteoarthritis Index, respectively. Results A high prevalence of abnormal sleep quality in patients with knee OA was observed. The most common abnormality was sleep fragmentation (71%), with an increased sleep disturbance score. Patients reported significantly improved sleep, pain, stiffness, and functional status after BT and PT. Conclusion Balneotherapy and PT improved self-reported sleep and functional status in patients with OA aged 50 to 85 years. We may conclude that BT and PT, which are used in the treatment of OA, not only reduce nocturnal pain, but also improve sleep quality.

Letter to the Editor: Folliculitis Associated with Intermittant Pneumatic Compression

To the Editor, We read with a great interest the article by Won, et al.1 in which the authors presented a patient with extensive bullous complication associated with intermittent pneumatic compression (IPC). They stated that no skin complication has been reported after the use of IPC so far.1 Therefore, we would like to share our experience of a patient with folliculitis complication associated with IPC, thus being the second report in the literature. A 23-year-old man was seen due to his complaint of mild global swelling in the lower extremities. On detailed questioning he told that he was diagnosed with bilateral lower extremity lymphedema and suffering from it for the past 2 years. He was using compression stockings for the treatment of lymphedema, but no drugs. He had no history of skin allergy. The medical and family histories were otherwise non-contributory. He underwent IPC treatment (Daesung Maref Co. Ltd., Gyeonggi-do, Korea) for 30 minutes once a day. On the fifth day of the treatment, he complained of skin lesions on both legs (Fig. 1). The patient was consulted at the Dermatology Department and a diagnosis of folliculitis was made. IPC treatment was terminated and after receiving antibiotherapy for 7 days his skin lesions disappeared completely. Fig. 1 (A) The skin lesions of the patient on both legs. (B) Focused image of the skin lesions. There are two types of lymphedema: primary lymphedema without etiological factors, and secondary lymphedema resulting from lymph node dissection for malignant disorders.2 Peripheral lymph transportation is interrupted because of the lymph vessel hypo-function, leading to lymphedema.2 Although there is no recently developed advanced effective treatment technique, IPC is recommended by the International Society of Lymphology3 for the treatment of lymphedema and it is one of the commonly used physical modalities in daily practice. On the other hand, as the lymph vessel function is damaged, bacterial infection may become more troublesome because of increased capillary permeability due to inflammation in the affected limbs.2 To prevent infection of affected limb, it is important to clean the skin and the cuff of the device. Furthermore, considering the risk of lymph vessel injury, strong compression for a long duration should be avoided.2 Therefore, when IPC device is applied to patients with lymphedema, as stated by Won, et al.,1 skin condition of the limbs should frequently be checked during the application.

Sesamoid ossicle of the nuchal ligament

A 43-year-old woman was seen due to chronic neck pain over the last two years. There was no history of cervical trauma. On physical examination, there was no limitation on cervical range of motion, but there was mild pain on cervical extension. Lateral view X-ray imaging of the cervical spine showed an ossicle within the nuchal ligament at the level of C5 vertebral spinous process (Figure). The ossicle had smooth borders in the upper part, whereas the lower part had irregular borders. These small bodies are mostly seen in the sixth decade and are always found at the posterior margin of the shadow of the nuchal ligament, most frequently at C5–C6 level where the mobility is greatest (80% of cases) [1]. The postulated cause is mechanical pressure of the nuchal ligament against the apex of the spinous processes during forward flexion of the neck [2]. They are usually painless [2]. In this case, the patient’s pain resolved with physical therapy and non-steroidal antiinflammatory drugs.