Figen Kocyigit

Functional magnetic resonance imaging of the effects of low-frequency transcutaneous electrical nerve stimulation on central pain modulation: a double-blind, placebo-controlled trial.

Objectives: Transcutaneous electrical nerve stimulation (TENS) is an analgesic current that is used in many acute and chronic painful states. The aim of this study was to investigate central pain modulation by low-frequency TENS. Methods: Twenty patients diagnosed with subacromial impingement syndrome of the shoulder were enrolled in the study. Patients were randomized into 2 groups: low-frequency TENS and sham TENS. Painful stimuli were delivered during which functional magnetic resonance imaging scans were performed, both before and after treatment. Ten central regions of interest that were reported to have a role in pain perception were chosen and analyzed bilaterally on functional magnetic resonance images. Perceived pain intensity during painful stimuli was evaluated using visual analog scale (VAS). Results: In the low-frequency TENS group, there was a statistically significant decrease in the perceived pain intensity and pain-specific activation of the contralateral primary sensory cortex, bilateral caudal anterior cingulate cortex, and of the ipsilateral supplementary motor area. There was a statistically significant correlation between the change of VAS value and the change of activity in the contralateral thalamus, prefrontal cortex, and the ipsilateral posterior parietal cortex. In the sham TENS group, there was no significant change in VAS value and activity of regions of interest. Discussion: We suggest that a 1-session low-frequency TENS may induce analgesic effect through modulation of discriminative, affective, and motor aspects of central pain perception.

Kinesio taping or sham taping in knee osteoarthritis? A randomized, double-blind, sham-controlled trial

PURPOSE To compare effects of kinesio taping with sham taping at the end of 3 consecutive taping periods in knee osteoarthritis. METHODS 41 patients diagnosed with knee osteoarthritis according to American College of Rheumatology were randomized to receive either KT or sham taping. Baseline evaluations included a visual analog scale (VAS) for activity and nocturnal pain, Lequesne index for functional assessment and Nottingham Health Profile (NHP) for the quality of life. Taping was applied every four days, three times, and all of the assessments were repeated at the end of the treatment period. RESULTS In both groups VAS for activity pain, VAS for nocturnal pain, Lequesne index score, NHP score decreased significantly. NHP energy scores were different significantly between the groups in favor of sham taping at the end of the 12-day period. CONCLUSION Our findings indicate inconclusive evidence of a beneficial effect of kinesio taping over sham taping in knee osteoarthritis.

Investigation of Biomechanical Characteristics of Intact Supraspinatus Tendons in Subacromial Impingement Syndrome: A Cross-sectional Study with Real-time Sonoelastography.

ObjectiveThe aim of this work was to evaluate the real-time sonoelastography (RTSE) in the assessment of the supraspinatus tendon in patients with subacromial impingement syndrome (SIS). MethodsTwenty-five patients with unilateral shoulder pain that was diagnosed as SIS according to magnetic resonance imaging findings were included in the study. Healthy shoulders of the patients comprised the control group. Bilateral shoulder RTSE examinations were performed by a radiologist who was blinded to the involved side of the participants. The RTSE images were recorded and assessed by 2 radiologists individually 1 month later. American Shoulder and Elbow Surgery shoulder index, Quick Disabilities of Arm Shoulder and Hand Questionnaire, and Constant scores were applied to evaluate the disability and functional status. The correlation between strain ratio and functional scores were investigated. ResultsOf the 25 participants, 9 (36%) were men and 16 (64%) were women. The RTSE findings were pathologic in tendons of 23 patients (92%) with SIS. The strain ratio was significantly higher in the affected shoulders (P < 0.001). The interobserver agreement was good for image analysis. There was no significant correlation between strain ratio and functional scores. ConclusionStructural changes in the supraspinatus tendon can be demonstrated with RTSE in patients with SIS.

The importance of patient compliance in nonunion of forearm fracture

INTRODUCTION Studies on radius ulna shaft fractures are very important. Surgical treatment is generally administered due to the unstability caused by the dynamic effect of forearm muscles. Surgical technique, implant, osteoporosis, patient compliance can affect the surgical treatment and healing. PRESENTATION OF CASE An 86-year-old female patient was admitted to emergency service with the complaint of protrusion of forearm implant from the skin. Physical examination revealed that 80° nonunion developed on the radial side. Therefore, protruded and exposed internal fixation materials were excised under axillary block. We used zoledronic acid as a treatment of osteoporosis with the value of −3.2 Dexa score. DISCUSSION Complication rate is reported to be 25% in patients treated with plate fixation. Patient compliance is very crucial in forearm fractures as in all surgical procedures. Presence of comorbidities and socioeconomical status of the patient are important factors in fracture healing. CONCLUSION This case emphasizes the importance of compliance of the patient to the follow-up after surgical treatment of forearm fracture.

Sonoelastography in Orthopaedics: Fact or Fashion?

Tissues are exposed to various forces. They change in shape and deform as a result of these forces. The tendency of the tissue to deform when opposing forces are applied is defined as elastic modulus. Different tissues have different elastic modulus. Elastic modulus also changes in time because of changes in tissue components in response to inflammation, injury and degeneration. Evaluation of elasticity of tissues by ultrasonography has started in the 1990s and gained popularity in time. 83 patients (51 female,32 male) with different muscıuloskeletal diseases (34 lateral epicondylitis, 20 plantar fasciitis, 25 shoulder impingement syndrome, four gastrocnemius sprain) were evaluated by sonoelastography (Logiq E9; GE Healthcare, Milwaukee, WI, USA) both for diagnosis and treatment follow-up. Sonoelastographic evaluations were performed by the same radiologist (AK) who was experienced in ultrasonography. Color scaling and strain ratio were used for analysis of sonoelastography images. Three orthopedists (YK, ME, EK) evaluated the patients. Appropriate conservative treatment was recommended for management in all of the patients. The sonoelastographic findings of the involved extremity were significantly different from the health side in all patients. Sonoelastography can evaluate dynamic properties of tissues. Orthopedics is interested in different tissues like cartilage, muscle, and bone. Therefore, the use of sonoelastography in orthopaedic science seems to increase. Availability, repeatability, and low financial cost are the other important advantages of sonoelastography in clinical practice. Figure-1 Thickness of right (a) and left plantar fascia (b) (arrow). Despite left plantar fascia being thicker, both of them are in the standard range.(USG) Figure-2 (Sonoelastography revealed mostly blue and green pattern on the right plantar enthesis (arrow) with low strain index (0.1) (a).Sonoelastography revealed green, yellow, and red pattern on the left plantar enthesis (arrow) with high strain index (0.4) (b).

The effect of ultrasonography guided intra-articular corticosteroid injections in advanced knee osteoarthritis

Gönderilme tarihi: 23.02.2015 Kabul tarihi: 16.03.2015 Abstract Purpose: The aim of the study is to evaluate the effect of ultrasonography-guided intra-articular corticosteroid injection on pain, functional status and quality of life in patients with advanced knee osteoarthrit. Materials and methods: 50 knees of 26 patients who were diagnosed as grade 4 knee osteoarthritis according to Kellgren Lawrence classification system were treated with ultrasonography-guided intra-articular injection of 40 mg triamcinolone acetonide. Perceived pain, weekly analgesic consumption, findings of physical examination, knee pain threshold, functional status and quality of life were evaluated before and four weeks after the injection. Western Ontario and McMaster Universities’ (WOMAC) osteoarthritis index was used to assess functional status, and Nottingham Health Profile (NHP) was used to evaluate the quality of life. Results: Mean age of the patients in the study was 65±7.5 years and mean symptom duration was 74.7± 32.5 months. Visual analog scale for pain decreased from 85.3.±14.1 mm to 59, 6±21.1 mm (p=0.003) and mean analgesic consumption decreased from 8±3 to 3±2 (p=0.000). Total WOMAC score (p=0.000) and scores of 4 NHP subdivisions (pain (p=0.000); physical mobility (p=0.003), social isolation (p=0.012); emotional reactions (p=0.016) decreased significantly 4 weeks after the injection. Conclusion: Injection under ultrasonography guidance may improve the beneficial effects of corticosteroids in advanced knee osteoarthritis.

Monoarticular Hip Involvement in Pseudogout

Pseudogout is the acutest form of arthritis in the elderly. Although clinical manifestations vary widely, polyarticular involvement is typical mimicking osteoarthritis or rheumatoid arthritis. Monoarticular involvement is relatively rare and is generally provoked by another medical condition. There are reported cases of hip involvement by pseudogout in monoarticular form. However, all of the cases were presented as septic arthritis. In this report, we present a case of monoarticular hip involvement mimicking soft tissue abscess. We confirmed the pseudogout diagnosis after ultrasonographic evaluation of the involved hip joint and pathological and biochemical analysis of synovial fluid analysis. Diagnosis is important to avoid unnecessary medical and surgical treatment in cases of the bizarre involvement of hip in pseudogout.

An unusual cause of knee pain in a young patient; hydatid disease of femur

INTRODUCTION Osseous hydatid disease is a rare pathology and its differential diagnosis can be difficult. PRESENTATION OF CASE This article presents clinical and radiological findings of a femoral primary hydatid disease in a 23 year-old patient admitted with knee pain. DISCUSSION Osseous hydatid in femur is a rare entity. Curettage is one of the surgical options with high risk of anaphylaxis and implantation. Radical resection of involved segment is the preferred treatment method in the current literature. However, patient preference can be different. CONCLUSION Although late stages of this disease need be treated with amputation or disarticulation, in the early stages it can be treated with curettage and bone cementing. Our case with early diagnosis of hydatid disease of distal femur was treated successfully with curettage and bone cementing.