Ilknur Aktas

Conservative treatment for late-diagnosed spinal accessory nerve injury.

Akgun K, Aktas I, Uluc K: Conservative treatment for late-diagnosed spinal accessory nerve injury. Am J Phys Med Rehabil 2008;87:1015–1021. Objective:Spinal accessory nerve (SAN) injuries cause considerable shoulder joint dysfunction and pain, but are often underdiagnosed or diagnosed late. The aim of this study was to present the clinical and electrophysiological features and response to conservative treatment of the patients with late-diagnosed SAN injury. Design:Nine patients diagnosed with SAN injury based on clinical and electrophysiological examinations were evaluated. All patients were treated with a standard physical therapy and rehabilitation program and then received home exercise program. Shoulder pain during rest and activity and pain causing sleep disturbances were evaluated using a visual analog scale. Constant scale investigated shoulder function. Shoulder disability questionnaire evaluated daily living activities. Results were assessed before treatment, after one month of treatment, and years after treatment. Results:According to the electrophysiological studies, seven patients had partial and two patients had total axonal SAN injuries. The delay from the time of injury to diagnosis ranged between 12 and 84 mo (median 14 mo). When compared with the baseline values, visual analog scale, Constant scale, and shoulder disability questionnaire scores were significantly improved in all of the patients. Conclusions:For patients with late-diagnosed SAN injury, conservative treatment seems to be an effective treatment option.

Risk of falls in patients with ankylosing spondylitis.

BackgroundRisk of vertebral fractures is increased in patients with ankylosing spondylitis (AS). The underlying mechanisms for the elevated fracture risk might be associated with bone and fall-related risks. The aims of this study were to evaluate the risk of falls and to determine the factors that increase the risk of falls in AS patients. MethodsEighty-nine women, 217 men, a total of 306 AS patients with a mean age of 40.1 ± 11.5 years from 9 different centers in Turkey were included in the study. Patients were questioned regarding history of falls within the last 1 year. Their demographics, disease characteristics including Bath AS Disease Activity Index, Bath AS Metrology Index (BASMI), Bath AS Functional Index (BASFI), and risk factors for falls were recorded. The Short Physical Performance Battery (SPPB) test was used for evaluation of static and dynamic balance. Erythrocyte sedimentation rate, C-reactive protein, and 25-hydroxyvitamin D levels were measured. ResultsForty of 306 patients reported at least 1 fall in the recent 1 year. The patients with history of falls had higher mean age and longer disease duration than did nonfallers (P = 0.001). In addition, these patients’ BASMI and BASFI values were higher than those of nonfallers (P = 0.002; P = 0.000, respectively). We found that the patients with history of falls had lower SPPB scores (P = 0.000). We also found that the number of falls increased with longer disease duration and older age (R = 0.117 [P = 0.041] and R = 0.160 [P = 0.005]). Our results show that decreased SPPB scores were associated with increased number of falls (R = 0.183, P = 0.006). Statistically significant correlations were found between number of falls and AS-related lost job (R = 0.140, P = 0.014), fear of falling (R = 0.316, P = 0.000), hip involvement (R = 0.112, P = 0.05), BASMI (R =0.234, P = 0.000), and BASFI (R = 0.244, P = 0.000). ConclusionsAssessment of pain, stiffness, fatigue, and lower-extremity involvement as well as asking for a history of falls will highlight those at high risk for further falls. In addition to the general exercise program adopted for all patients, we suggest that a balance rehabilitation program should be valuable for the patients with risk factors for fall. Exercise may improve fear of falling and BASFI and BASMI scores. However, further study is needed to investigate these hypotheses. We believe that clinicians should train and support the patients via reducing fear of falls and maintaining good posture and functional capacity.

Reliability of the Spinal Cord Assessment Tool for Spastic Reflexes

OBJECTIVE To assess the reliability of the Spinal Cord Assessment Tool for Spastic Reflexes (SCATS). DESIGN Observational reliability study of the SCATS. SETTING Inpatient rehabilitation unit at an education and research hospital. PARTICIPANTS Subjects (N=47) between the ages of 18 and 88 years with spinal cord injury (SCI) and with American Spinal Injury Association Impairment Scale grades from A to D with spasticity, who were at least 6 months postinjury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Interrater and test-retest reliability of the SCATS. RESULTS The SCATS had substantial to almost perfect interrater agreement (κ=.669-1.000) between the 2 physiatrists. Test-retest agreement of the SCATS was also substantial to almost perfect (κ=.614-1.000) as well. There was a significant correlation between the SCATS clonus scores and the Modified Ashworth scores of the hip, knee, and ankle. No correlation was found between SCATS extensor spasm scores and Modified Ashworth scores. The SCATS flexor spasm scores were only correlated significantly with the ankle plantar flexor Modified Ashworth scores (P<.05). CONCLUSIONS The SCATS is a reliable tool for assessing spasm activity and spastic hypertonia in patients with SCI.

Lateral Pectoral Nerve Injury Mimicking Cervical Radiculopathy.

Abstract:The lateral pectoral nerve (LPN) is commonly injured along with the brachial plexus, but its isolated lesions are rare. Here, we present a case of an isolated LPN lesion confused with cervical radiculopathy. A 41-year-old man was admitted to our clinic because of weakness in his right arm. Previous magnetic resonance imaging (MRI) examination revealed right posterolateral protrusion at the C6-7 level. At the initial assessment, atrophy of the right pectoralis major muscle was evident, and mild weakness of the right shoulder adductor, internal rotator, and flexor muscles was observed. Therefore, electrodiagnostic evaluation was performed, and a diagnosis of isolated LPN injury was made. Nerve injury was thought to have been caused by weightlifting exercises and traction injury. Lateral pectoral nerve injury can mimic cervical radiculopathy, and MRI examination alone may lead to misdiagnosis. Repeated physical examinations during the evaluation and treatment phase will identify the muscle atrophy that occurs 1 or more months after the injury.

A randomized, double-blind study to assess if vitamin D treatment affects the outcomes of rehabilitation and balance in hemiplegic patients

[Purpose] To investigate the effect of vitamin D supplementation on rehabilitation outcomes and balance in patients having hemiplegia due to ischemic stroke. [Subjects and Methods] Vitamin D levels of 132 patients hospitalized for hemiplegia rehabilitation due to ischemic stroke were tested. Consequently, 86/132 patients had low vitamin D levels, 72 of which met the inclusion criteria and were included in the study. Patients were divided into two groups: Group A (injected with 300,000 IU vitamin D), and Group B (injected intramuscularly with saline). Each patient was tested at the baseline and at the third month using the Brunnstrom recovery staging, functional ambulation scale, modified Barthel index, and Berg balance scale. The findings were compared between the groups. [Results] By the end of the third month, The Berg balance scale results and modified Barthel index scores significantly differed between the two groups, whereas Brunnstrom recovery staging and functional ambulation scale test results did not. [Conclusion] This study found that vitamin D administration increased the activity levels and accelerated balance recovery but did not significantly affect ambulation or motor recovery. These results warrant confirmation by longer follow-up studies with a larger number of participants.

Pregnancy-related osteoporotic vertebral compression fractures in two patients treated with low-molecular-weight heparin during pregnancy: case reports

Abstract Pregnancy-related osteoporosis (PRO) is an uncommon metabolic bone disease that can result in vertebral fragility fractures. Here we report two cases of young women who had been previously treated with LMWH-enoxaparin and were diagnosed with PRO with vertebral fragility fractures after delivery. In first case report, a 33-year-old primigravid woman who was treated with 40 mg/day of enoxaparin for eight months to prevent venous thromboembolism was presented. After delivery, Dual energy X ray absorptiometry (DEXA) revealed osteoporosis in lumbar and femoral neck region. In magnetic resonance imaging (MRI), T4–T7 thoracic vertebral height losses were detected. In second case report, a 28-year-old primigravid woman which was treated with 40 mg/day enoxparin from the second month to the birth was presented. Osteoporosis in lumbar region was detected by DEXA. MRI revealed T12–L1 and L5 vertebral height losses. In conclusion, PRO can cause severe low back pain and should be considered in differential diagnosis. A detailed medical history should be essential to detect relationship between LMWH and PRO.

Effect of bone mineral density on lumbar discs in young adults: A case–control study

Abstract Bone mineral density (BMD) might be a risk factor for lumbar disc herniation (LDH) in young adults, but there is not enough data concerning this effect. Several studies have been performed on elderly and osteoporotic patients. Thus, we aimed to investigate the effect of BMD on the etiopathogenesis of LDH in young adults. One hundred patients (mean age: 38.45 ± 8.92 years; 50 men and 50 women) were enrolled this case–control study and classified into 2 groups, as follows. The case group (G-I) included 50 patients with symptomatic LDH who were hospitalized in the Physical Medicine and Rehabilitation Clinic, and the control group (G-II) included 50 patients with lower back pain but no finding of LDH detected using magnetic resonance imaging. Patients in the G-II were recruited among those admitted to the outpatient clinic at the time of the study, and whose age and sex were matched to those of the study group. Women in menopause were excluded from the study. BMD analysis by dual energy x-ray absorptiometry was performed in both groups. The mean values of the femur neck and lumbar spine BMD were 1.02 ± 0.13 and 1.19 ± 0.14 g/cm2, respectively. There was no statistically significant relationship between BMD and LDH in this population. This result may mean that in a normal range, BMD does not exert a compressive load on the lumbar discs in young adults and therefore may not lead to LDH by this mechanism and the load.

Mild form of Poland syndrome: A case report and review of the literature

Received: 29.12.2016 Accepted: 07.02.2017 1University of Health Sciences, Fatih Sultan Mehmet Research and Training Hospital, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey 2University of Health Sciences, Fatih Sultan Mehmet Research and Training Hospital, Department of Pediatric Surgery, Istanbul, Turkey Yazışma adresi: Özge Gülsüm İlleez, University of Health Sciences, Fatih Sultan Mehmet Research and Training Hospital, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey e-mail: ozgeilleez@hotmail.com Gİrİş

A rare case of ankylosing spondylitis with severe temporomandibular joint and dental involvement

Ankilozan spondilit (AS) primer olarak aksiyel iskeleti tutan ve fonksiyonel bozukluga yol acan kronik enflamatuvar bir hastaliktir. Temporomandibular eklem (TME) ankilozu, eklem bilesenlerinin kemik veya fibroz adezyonu ile karakterize olup, agiz acikliginda kisitlanma ile sonuclanmaktadir. Hastaligin yuksek prevelansina ragmen AS’e bagli TME ve dis ankilozu oldukca nadir bir durumdur. Bu olgu sunumu ile TME agrisi ve agiz acikliginda kisitlilik ile poliklinigimize basvuran ve TME ve dis ankilozu tanisi alan bir AS olgusu sunmayi amacladik. Hastanin agiz acikliginda kisitlilik ve zorlu bir dis cekimi oykusu mevcuttu. Kotu dental hikayesi olan ve agiz acmakta zorlugu olan AS hastalarinda, TME ve dis ankilozu mutlaka dusunulmelidir. Şupheli olgularda cene ve dis anormalliklerini tespit etmek icin panoramik agiz grafisi ile hasta degerlendirilmelidir.

Bilateral Idiopathic Carpal Tunnel Syndrome in a 4-Year-Old Girl.

Carpal tunnel syndrome (CTS), the most common entrapment neuropathy in adulthood, is rare in childhood. The symptoms may differ to those in adults, or may be misinterpreted owing to children’s difficulties in expressing themselves. Cases of idiopathic, bilateral CTS under the age of 5 are rare. A 4-year-old girl presented with pain in both hands and difficulty opening them in the morning. Bilateral severe CTS was determined at electroneuromyography (ENMG). Bilateral wrist splints were advised for both hands. Improvement in ENMG was seen at 2 weeks following conservative treatment.