Iltekin Duman

Reflex sympathetic dystrophy: a retrospective epidemiological study of 168 patients

This is a retrospective epidemiological study. The objective is to determine the epidemiological characteristics including the patient demographics, etiological factors, duration of symptoms, treatment modalities applied and clinical outcome of the treatment in reflex sympathetic dystrophy (RSD). Medical records of the 168 patients managed in two tertiary hospitals with the diagnosis of RSD that was made according to both IASP criteria and three-phase bone scan were reviewed. The upper limb was affected 1.5 times as commonly as the lower limb. Of the 168 cases, 10.7% were non-traumatic. In 89.3% of the patients, RSD developed after a traumatic inciting event with a predominance of fracture. In 75.6% of the patients, RSD developed due to job-related injuries. The percentage of successful clinical outcome was 72%. The percentage of the patients that did not respond to therapy was 28%. The management period is long and this causes higher therapeutic costs in addition to loss of productive effort. However, response to therapy is good. On the other hand, in approximately one third of the patients, RSD does not improve despite all therapeutic interventions. In addition to compensation costs, this potentially debilitating feature causes RSD to appear as a socioeconomic problem.

Neuralgic amyotrophy, diagnosed with magnetic resonance neurography in acute stage: a case report and review of the literature.

Objective:We present a case of neuralgic amyotrophy (NA) diagnosed with magnetic resonance neurography (MRN) in the acute stage. Methods:NA is an uncommon neurologic syndrome that affects mainly the brachial plexus. MRN is considered to be more sensitive than magnetic resonance imaging (MRI) for peripheral nervous system disorders. A case of acute NA with the sudden onset of shoulder pain and weakness in the shoulder girdle is presented. Results:Electrodiagnostic testing revealed an upper trunk lesion. Plexitis that could not be demonstrated with conventional MRI was revealed with MRN. The left brachial plexus was thickened and hyperintense with MRN, consistent with plexitis. Conclusions:MRN should be the preferred imaging modality for the diagnosis of acute NA. This might not only help early diagnosis and guide treatment but also prevent unnecessary testing.

Assessment of the impact of proprioceptive exercises on balance and proprioception in patients with advanced knee osteoarthritis

Impaired proprioceptive perception and the balance function are known to associate with knee osteoarthritis. The previous publications have reported the beneficial effects of proprioceptive exercises on mild or moderate knee osteoarthritis. Scientific data in the literature regarding their effects in advanced stages of knee osteoarthritis are lacking. The objective of this study is to investigate the impact of the proprioceptive exercises on balance, proprioceptive perception and clinical findings in advanced-stage knee osteoarthritis. Fifty-four patients diagnosed as having knee osteoarthritis according to the American Collage of Rheumatology criteria with grade of 3 or higher according to the Kellgren–Lawrence scale were enrolled in the study. Patients were allocated randomly into two groups. The study group included 30 patients, and the control group included 24 patients. The proprioceptive perception was assessed by the ability to reproduce the knee position. The balance function was assessed by stabilometric evaluation in static and dynamic patterns. The clinical evaluation was made by using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Patients were reevaluated after the three-week proprioceptive rehabilitation program. The improvement in the scores of static balance was significant statistically. No significant improvement in the dynamic balance scores was obtained. Although the measurements of proprioceptive perception showed a tendency toward improvement, the difference was not significant statistically. The WOMAC scores showed better improvements in the study group. As conclusion, in further stages of knee osteoarthritis, proprioceptive exercises have beneficial effects on static balance and to some extent on proprioceptive accuracy. In the treatment for advanced knee osteoarthritis, adding exercises specifically targeting the proprioceptive and balance dysfunction might be useful.

Familial mediterranean fever unusually coexisted in an ankylosing spondylitis patient. MEFV mutation has any role

Dear editor, Ankylosing spondylitis (AS) and familial mediterranean fever (FMF) are two clinical conditions aVecting people of almost same age group. In AS, sacroiliitis is the hallmark, but peripheral joints can also be aVected. On the other hand, articular involvement is the second most common manifestation of FMF. In FMF, although peripheral joints are aVected mostly, sacroiliac joints can be involved and it can be accompanied by seronegative spondyloarthropathy (SNSA). The shared feature of AS and FMF is sacroiliitis. The higher rate of coincidence of sacroiliitis with FMF in comparison with the healthy population was found to be statistically signiWcant [1]. This Wnding has led the sacroiliitis to be accepted as one of joint involvements of FMF [1–3]. Although sacroiliitis can occur in course of both conditions, it is not known yet exactly if there is any pathogenic relation between FMF and AS. Almost all of the FMF-related SNSA are HLAB27 negative [1–4]. There were only Wve patients who had both FMF and HLAB27 positive AS in the literature. These patients were considered as being more severe form of FMF-related SNSA because of the presence of HLAB27. It was also proposed that the presence of HLAB27 could predispose the occurring of AS in these FMF-related SNSA patients [1, 4, 5]. In review of literature, we perceived that, in all of these HLAB27 positive patients, AS was diagnosed after a period of time from the onset of FMF or simultaneously in one. In our opinion, this might have led the authors to put forward this consideration. Herein we represent an unusual case of HLAB27 positive AS that was accompanied with FMF 8 years after the diagnosis of AS, having M680I mutation in MEFV gene. A 27-year-old man with low back pain for 10 years that was accompanied with abdominal pain, fever, polyarthralgia recurring periodically for last 2 years was presented. He had been feeling stiVness and pain in his low back and occasionally left hip at morning that was relieving with motion and daily activities slowly within about 2 h. His Wrst episode of abdominal pain, accompanying with polyarthralgia (especially low back, left hip and knee) had occurred 2 years ago and he had been hospitalized with the possible diagnosis of appendicitis but resolved spontaneously in 12 h and had been discharged. After two additional episodes occurred with intervals of approximately 3 months, he was diagnosed with FMF and began to receive colchicine. Regular colchicine treatment reduced not only the frequency but also intensities of complaints during episodes. Physical examination revealed restricted lumbar motions (Schober: 3 cm), Patrick–Fabere and sacroiliac compression tests were positive bilaterally. There was swelling in left ankle, pain in both of the wrists, both of the knees and left shoulder. Laboratory investigations revealed that HLAB27 was positive. Erythrocyte sedimentation rate was 14 mm/h. Whole blood counts were normal. The urine contained no protein. Radiographs of painful peripheral joints were normal. Sacroiliac plain radiography revealed marginal irregularities, increased in density and sclerosis at especially iliac sides of sacroiliac joints. Bone scan showed increased I. Duman (&) · B. Balaban · I. Tugcu · K. Dincer Department of Physical Medicine and Rehabilitation, Gulhane Military Medical Academy, 06018 Etlik-Ankara, Turkey e-mail: iltekinduman@yahoo.com

Unusual case of camptocormia triggered by lumbar-disc herniation

A 21-year-old male patient with low back pain and marked forward bending was presented. The exaggerated lumbar flexion was preventing him to stand in erect posture but disappeared while lying. The symptoms had begun after he had lifted a heavy object. Straight-leg-raising test could not be performed properly because of the exaggerated pain. The light-touch sense was decreased on L5 and S1 dermatomes. There was no loss of muscle strength. The deep-tendon reflexes were normal. Plain graph showed mild narrowing in the L4–5 and L5–S1 intervertebral spaces. Lumbar magnetic resonance imaging revealed disc protrusions in L4–5 and L5–S1 levels. During his stay in the department, the patient was given tizanidine and tramadol, and physical therapy was performed. A paravertebral intramuscular injection with lidocaine was applied. Moreover, the patient was referred to psychiatrist for evaluation regarding his medical history of conversive seizures and possible efforts for secondary gain. No response was obtained from all the treatments. The final diagnosis was camptocormia triggered by lumbar-disc herniation. He was applied supportive psychotherapy, psychoeducation regarding secondary gain, strong suggestions to improve posture, positive reinforcement, and behavioral therapy. His postural abnormality resolved and disappeared completely with mild pain.

Low-level laser therapy versus ultrasound therapy in the treatment of subacromial impingement syndrome: A randomized clinical trial

OBJECTIVE The aim of this study was to compare the effectiveness of low-level laser therapy and ultrasound therapy in the treatment of subacromial impingement syndrome. MATERIALS AND METHODS Thirty one patients with subacromial impingement syndrome were randomly assigned to low-level laser therapy group (n=16) and ultrasound therapy group (n=15). Study participants received 10 treatment sessions of low-level laser therapy or ultrasound therapy over a period of two-consecutive weeks (five days per week). Outcome measures (visual analogue pain scale, Shoulder Pain and Disability Index -SPADI-, patients satisfactory level and sleep interference score) were assessed before treatment and at the 1st and 3rd months after treatment. All patients were analyzed by the intent-to-treat principle. RESULTS Mean reduction in VAS pain, SPADI disability and sleep interference scores from baseline to after 1 month, and 3 months of treatment was statistically significant in both groups (P< 0.05). However, there was no significant difference in the mean change in VAS pain, SPADI disability and sleep interference scores between the two groups (P > 0.05). The mean level of patient satisfaction in group 1 at the first and third months after treatment was 72.45 ± 23.45 mm and 71.50 ± 16.54 mm, respectively. The mean level of patient satisfaction in group 2 at the first and third months after treatment was 70.38 ± 21.52 mm and 72.09 ± 13.42 mm, respectively. There was no significant difference in the mean level of patient satisfaction between the two groups (p > 0.05). CONCLUSIONS The results suggest that efficacy of both treatments were comparable to each other in regarding reducing pain severity and functional disability in patients with subacromial impingement syndrome. Based on our findings, we conclude that low-level laser therapy may be considered as an effective alternative to ultrasound based therapy in patients with subacromial impingement syndrome especially ultrasound based therapy is contraindicated.

Assessment of the Efficacy of Gabapentin in Carpal Tunnel Syndrome

arpal tunnel syndrome (CTS) is the most common en-trapment neuropathy characterized by pain and numb-ness of first 3 digits. Pain in forearm, elbow, or even shoulderis not unusual as well.In mild or moderate entrapments of the median nerve,conservative measures such as splints, nonsteroidal anti-inflammatory drugs, physical therapy, ergonomic modifica-tions and steroid injections are preferred. Although conserva-tive treatment modalities successfully reduce the symptoms inmost patients, they can fail in some cases. Ongoing symptomsdespite the conservative measures are considered to be anindication for surgery.Gabapentin is an antiepileptic drug, but has also beenreported to have pain-relieving effect on various neuropathicpain conditions like diabetic neuropathy, postherpetic neural-gia, plexopathies, radiculopathies, and various conditions inneurologic and rheumatological practice.

Piriformis Syndrome Presenting with Foot Drop Diagnosed with Magnetic Resonance Imaging: A Case Report

ABSTRACT Background: In piriformis syndrome, the main symptom is pain. Foot drop is not typical and radiological evaluations are usually normal. Findings: A 35-year-old woman was presented with intense pain in the lower limb. She had foot drop and Laseques sign was positive at 30 degrees. Pelvic magnetic resonance imaging showed hypertrophy of the piriformis muscle and perineural edema of the sciatic nerve on T2-weighted images. Fluoroscopy guided local corticosteroid injection to the piriformis muscle and around the nerve provided complete pain relief and motor recovery. Conclusions: Piriformis syndrome can cause foot drop. Magnetic resonace imaging can help earlier diagnosis and treatment.

Multiple Sclerosis Presenting with Parsonage–Turner Syndrome: A Case Report

Abstract Background: A case of Parsonage–Turner syndrome [PTS] with typical sudden onset of shoulder pain and weakness in shoulder girdle was presented. Findings: Electrodiagnostic testing revealed an upper trunk lesion. Further diagnostic steps were pursued because of medical history and additional clinical findings. Hyperintense plaques typical of multiple sclerosis [MS] were revealed by cranial magnetic resonance imaging. Diagnosis of clinically definite MS was establised according to the McDonald criteria. Conclusions: A variety of peripheral nervous system pathologies might coexist with MS with unknown binding pathogenesis. This is an unusual case of PTS coexisting with MS as the presenting symptom.

Post-laminectomy rotokyphoscoliosis causing paraplegia in long term: case report.

Abstract Context Childhood laminectomy can lead to spinal deformity. This is a report of a case of paraplegia caused by rotokyphoscoliosis, a late complication of laminectomy. Findings A 55-year-old woman developed paraplegia due to post-laminectomy kyphoscoliosis. She had surgery for a spinal tumor at age 13 years. She developed kyphosis 2 years after the laminectomy, which has been gradually progressing over the years. She experienced weakness of lower limbs that progressed to paraplegia. There was no evidence for tumor recurrence. To our knowledge, this is the first reported case of post-laminectomy kyphoscoliosis causing late-onset paraplegia. Conclusions/clinical relevance This case highlights a possible long-term complication of laminectomy without stabilization or untreated kyphoscoliosis. Children should be followed closely after laminectomy because development of spinal deformity is very common. Without intervention, the kyphosis might progress and in the long term, serious neurological complications may result, including paraplegia.