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Is Complex Decongestive Physical Therapy Safe for Median Nerve at the Level of Carpal Tunnel in Breast Cancer Related Lymphedema

BACKGROUND Multilayer bandaging used in complex decongestive therapy (CDT) may increase tissue pressure resulting in nerve entrapments. The aim of this study was to discover if median nerve damage is a consequence of CDT in patients with breast cancer-related lymphedema (BCRL). METHODS AND RESULTS Eighty-two arms of 41 patients with BCRL were included. Mean age was 56.05 (8.16) years and all stages of lymphedema were equally included. Fifteen sessions of CDT was applied to all patients. The calculated volume of extremities, the quality of life (cancer adaptation of Ferrans-Powell), neuropathic pain (NP; Douleur Neuropathique 4), and disability (quick disabilities of arm, shoulder, and hand [Q-DASH]) tests were recorded before and after therapy. Skin and subcutaneous tissue thicknesses of volar and dorsal sides and median nerve cross-sectional area (CSA) at the level of carpal tunnel were measured using ultrasonography (US), before and after therapy. Carpal tunnel syndrome (CTS; 41.37%) and polyneuropathy (10.34%) were common findings confirmed by electromyography. Neuropathic pain profile was also found in 34.14% of patients. The arm volume of affected side, quality of life, and skin and subcutaneous tissue thicknesses were improved after therapy (p < 0.05). However, median nerve CSA, the NP, and Q-DASH scores were not changed after therapy. CONCLUSIONS Although lymphedema is a painless condition, NP and CTS should not be ignored in patients with BCRL. US is an alternative, precise, and high technological method for evaluating treatment response. CDT is an effective and safe treatment according to volumetric calculations, US measurements of tissue thicknesses, and median nerve size.

The Association of Skinfold Anthropometric Measures, Body Composition and Disease Severity in Obese and Non-obese Fibromyalgia Patients: A Cross-sectional Study

Objectives This study aims to determine the effects of obesity and obesity related anthropometric and body composition determiners on the severity of fibromyalgia syndrome (FS) and to compare obese, overweight and normoweight FS patients according to general health and psychological status. Patients and methods The study included 42 obese (mean age 48.8±11.6; range 24 to 65 years), 27 overweight (mean age 47.3±3.4; range 24 to 61 years) and 32 normoweight (mean age 47.1±7.8 years; range 31 to 60 years) female FS patients. Widespread pain scores and symptom severity scores were noted. Pain pressure thresholds of tender points and control points were measured and total myalgic score (TMS) was calculated. The anthropometric assessments and skinfold measurements of all participants were recorded. Quality of life was evaluated by Health Assessment Questionnaire while psychological status was evaluated using Beck Depression Inventory. Results Control points, TMS values and hand grip strength values of obese FS patients were significantly lower, while disease duration, symptom severity, widespread pain scores, visual analog scale and Health Assessment Questionnaire scores were significantly higher than normoweight and overweight FS patients. Fat free mass, fat mass, body fat percentage and waist/hip ratio values were significantly higher in obese FS patients than overweight and normoweight FS patients (p<0.001 for all values). Stepwise linear regression analysis showed that increased body mass index, decreased fat free mass (R2=0.11) and increased disease duration (R2=0.13) were associated with lower TMS. Conclusion We found that obesity had significant negative effects on pain, disease severity and quality of life in patients with FS.

Neurodynamic evaluation and nerve conduction studies in patients with forward head posture

Forward head posture (FHP) is one of the most frequently seen problems. The aim of this study was to evaluate the neurodynamic tests and peripheral nerve conductions of upper extremity in patients with FHP. The study population included 100 patients with upper extremity and neck problems and 34 healthy individuals as a control group. Craniovertebral angle measurement was used to determine forward head posture. Stretch tests for radial, ulnar and median nerves were performed. Nerve conductions of bilateral median, radial, ulnar and medial antebrachial cutaneous (MAC) nerves were examined in all patients included in the study. The most significant nerve conduction differences in moderate-to-severe FHP patients were a decrease in the sensory nerve action potential (SNAP) and compound muscle action potential (CMAP) amplitudes of median nerves, a decrease in the SNAP amplitude of ulnar nerves, a delay in the F response latency of ulnar nerves and prolongation in the SNAP latency of the MAC nerve. FHP makes patients more prone to peripheral entrapments.

A Rare Coexistence of Seronegative Enthesopathy and Arthropathy Syndrome with Familial Mediterranean Fever

Several studies showed an increase in the frequency of MEFV mutations among children with vasculitic and rheumatic diseases. Association between seronegative enthesopathy and arthropathy syndrome, and familial mediterranean fever has not been reported previously. The present case report may therefore be of interest.