Hasan Dursun

Sacroiliac Joint Injections Performed With Sonographic Guidance

Objective. To investigate the feasibility and effectiveness of sonographic guidance for therapeutic intra‐articular sacroiliac joint injections in patients with sacroiliitis. Methods. Thirty‐four consecutive patients with sacroiliitis were enrolled in this study. The synovial portions of 60 sacroiliac joints received injections under sonographic guidance. For treatment, a mixture of a corticosteroid and a local anesthetic was injected intra‐articularly. Fluoroscopic spot images were obtained to assess the accuracy of the sonographically guided technique. Results. Of the 60 sonographically guided injections, 46 (76.7%) were successful (i.e., intra‐articular), and 14 (23.3%) were missed. The successful intra‐articular injection rate was 60% in the first 30 injections, and it gradually improved, reaching 93.5% in the last 30 injections. The mean procedure time was 9 minutes. Conclusions. Our initial experience suggests that sonographically guided therapeutic injections to sacroiliac joints could be valuable alternatives to other guidance modalities in patients with sacroiliitis. In the hands of experienced radiologists, this technique is safe, rapid, and reproducible.

Clinical significance of congenital lumbosacral malformations in young male population with prolonged low back pain.

Study Design. A prospective clinical investigation. Objective. To determine the clinical significance of congenital lumbosacral malformations in young male patients with subacute or chronic low back pain and to investigate a possible worsening of the clinical picture with the concurrence of transitional vertebra (TV) or spina bifida occulta (SBO). Summary of Background Data. Although the causative roles of congenital malformations in low back pain and lumbar disc herniation have been investigated, there is no study that compares the incidence of congenital malformations in prolonged low back pain between radicular and nonradicular groups; nor is there a study that compares the pain intensity between the groups with and without congenital malformations. Methods. Lumbosacral plain radiographs of 881 young male patients with low back pain lasting for >4 weeks were evaluated. For all patients, we recorded the clinical signs and their pain intensities based on a 10-cm visual analog scale (VAS). Results. Congenital lumbosacral malformations were determined in 88 of 881 patients. Of these, 48 were TV, 38 were SBO, and 2 were a combined lesion of TV and SBO. The difference in positive clinical sign and VAS was statistically significant (P < 0.05) between the groups with and without congenital lumbosacral malformations. In contrast to SBO, there was a statistically significant difference of TV incidence between the sign positive and the sign negative groups (P < 0.05). The difference in VAS values was statistically significant for both TV and SBO (P < 0.001). Conclusions. The results of this study show that SBO and TV increase the severity of the clinical picture whether or not they have a causal relationship. Additionally, transitional vertebrae seem to increase nerve-root symptoms whereas spina bifida occulta does not.

Sexual problems in male ankylosing spondylitis patients: relationship with functionality, disease activity, quality of life, and emotional status

This study has focused on sexual problems of male ankylosing spondylitis (AS) patients. Initially, patients’ perceptions about the effects of disease on sexual intercourse were assessed. Secondly, we investigated the factors that relate to the disease and affect sexual intercourse negatively. Thirdly, we compared data from the patients whose sexual intercourse were affected negatively with of those whose sexual intercourse were unaffected. This is a cross-sectional and double-centered study. A total of 53 married or sexually active male patients, who were certainly diagnosed with AS according to modified New York criteria, were assessed. Twenty seven patients (50.94%) expressed that their sexual life was affected negatively by the AS in general (affected patients), and 26 patients (49.06%) expressed no negative effect (unaffected patients). Both affected and unaffected patients were compared with each other with regard to educational level, joint involvement, functionality, disease activity, quality of life, and depression status. Mean BASFI, BASDAI scores were worse in the affected group, and the difference was statistically significant (p = 0.012, p = 0.039, respectively). There were statistically significant differences between the groups with regard to lumbar column and hip involvement (p = 0.035, p = 0.021; respectively). The physical functioning, role limitations due to physical problems, vitality/energy/fatigue, general mental health, and general health perception subscale scores of SF-36 were worse in the affected group, and the differences were statistically significant (p = 0.027, p = 0.023, p = 0,013, p = 0.005, p = 0.045, respectively). Affected patients’ Beck Depression Inventory scores were worse than those of unaffected patients, and the difference between the groups was statistically significant (p = 0.039). Sexual problems are common in AS patients and might usually be associated with joint involvement, decreased functionality, increased disease activity, decreased health quality, and depression. Therefore, while examining AS patients and managing their treatments, special attention must be given to all domains of life instead of only physical problems.

The effectiveness of conservative treatments of carpal tunnel syndrome: splinting, ultrasound, and low-level laser therapies.

OBJECTIVE The objective of this study was to investigate the effectiveness of splinting, ultrasound (US), and low-level laser (LLL) in the management of carpal tunnel syndrome (CTS). BACKGROUND DATA CTS is the entrapment mononeuropathy most frequently seen in clinical practice, caused by compression of the median nerve at the wrist. Although several treatment modalities are routinely in use, there is no consensus about the best way to manage CTS. MATERIALS AND METHODS In our study, patients were randomly allocated to three groups that received the following treatment protocols: splinting only, splinting plus US, and splinting plus LLL therapy. Patients were assessed with the Boston Questionnaire, patient satisfaction inquiry, visual analogue scale for pain, and electroneuromyography. RESULTS AND CONCLUSION The study was completed with a total of 100 hands of 50 women patients with bilateral CTS at 3 mo after treatment. At the end of the follow-up period, each of the groups had improvements to varying degrees. It appeared that the combinations of US or LLL therapy with splinting were more effective than splinting alone in treating CTS. However, LLL therapy plus splinting was more advantageous than US therapy plus splinting, especially for the outcomes of lessening of symptom severity, pain alleviation, and increased patient satisfaction.

Aortic elasticity in patients with ankylosing spondylitis.

Objective — Ankylosing spondylitis (AS) is a chronic inflammatory disease which may show cardiac involvement. The effect of AS on aortic elasticity has not been previously defined. The aim of this study was to determine whether there was any change in aortic elasticity in AS. Methods and results — Thirty-five AS patients without cardiovascular involvement and 30 healthy subjects were enrolled into the study. Aortic strain, distensibility index and stiffness index beta were calculated from aortic diameters measured by echocardiography and blood pressures simultaneously measured by sphygmomanometry.The mean aortic strain and distensibility indexes in the AS group were lower than those in the control group.The mean aortic stiffness index in the AS group was higher than that in the control group (p < 0.05). No correlation between the means and the duration was observed in the AS group. Conclusion — We found that in AS patients without cardiac involvement, aortic elasticity was decreased and this decrease was not correlated with the duration of AS.

Comparison of low intensity laser therapy and trigger point injection in the management of myofascial pain syndrome

AbstractMyofascial Pain Syndrome (MPS) is quite a common clinical manifestation characterised by the presence of trigger points (TrP), muscle spasm, tenderness, motion restriction, weakness and autonomic dysfunction. The ideal therapy should be fast, cheap and long-term effective. Local anesthetic injection and low-intensity laser therapy are two types of such treatments. Aim: The main purpose of this study was to compare the effectiveness of TrP injection and low intensity laser therapy in patients with MPS. Method: 43 patients (14 men, 29 women) diagnosed as MPS were included in this study. In the first group (23 cases), laser therapy was applied for 3 min to each TrP within 12 sessions. In the second group (20 cases), 1 ml prilocaine 2% was injected to the TrP once a week for four consecutive weeks. The evaluation was made before the treatment (BT), after the treatment (AT) and sixth months after the treatment (SMT). Effectiveness of treatment was evaluated by a visual analog scale (VAS), a pressure al...

A Novel Treatment Modality for Myofascial Pain Syndrome: Hyperbaric Oxygen Therapy

The aim of the present study was to evaluate the effects of hyperbaric oxygen (HBO) therapy on myofascial pain syndrome (MPS). Thirty patients with the diagnosis of MPS were divided into HBO (n=20) and control groups (n=10). Patients in the HBO group received a total of 10 HBO treatments in 2 weeks. Patients in the control group received placebo treatment in a hyperbaric chamber. Pain threshold and visual analogue scale (VAS) measurements were performed immediately before and after HBO therapy and 3 months thereafter. Additionally, Pain Disability Index (PDI) and Short Form 12 Health Survey (SF-12) evaluations were done before HBO and after 3 months. HBO therapy was well tolerated with no complications. In the HBO group, pain threshold significantly increased and VAS scores significantly decreased immediately after and 3 months after HBO therapy. PDI, Mental and Physical Health SF-12 scores improved significantly with HBO therapy after 3 months compared with pretreatment values. In the control group, pain thresholds, VAS score, and Mental Health SF-12 scores did not change with placebo treatment; however, significant improvement was observed in the Physical Health SF-12 test. We concluded that HBO therapy may be a valuable alternative to other methods in the management of MPS. Our results warrant further randomized, double-blinded and placebo-controlled studies to evaluate the possible role of HBO in the management of MPS.