Irfan Koca

Evaluation of open and closed kinetic chain exercises in rehabilitation following anterior cruciate ligament reconstruction.

[Purpose] To compare outcomes of anterior cruciate ligament (ACL) reconstruction after open kinetic chain (OKC) exercises and closed kinetic chain (CKC) exercises. [Subjects and Methods] The subjects comprised 11 female and 47 male patients who are randomly divided into two groups: which performed a CKC exercise program Group I and Group II which performed an OKC exercise program. Pain intensity was evaluated using visual analogue scale (VAS). Knee flexion was evaluated using a universal goniometer, and thigh circumference measurements were taken with a tape measure at baseline and at 3 months and 6 months after the treatment. Lysholm scores were used to assess knee function. [Results] There were no significant differences between the two groups at baseline. Within each group, VAS values and knee flexion were improved after the surgery. These improvements were significantly higher in the CKC group than in the OKC group. There were increases in thigh circumference difference at the 3 and 6 month assessments post-surgery. A greater improvement in the Lysholm score was observed in the CKC group at 6 months. [Conclusion] The CKC exercise program was more effective than OKC in improving the knee functions of patients with ACL reconstruction.

The Relationship between Quadriceps Thickness, Radiological Staging, and Clinical Parameters in Knee Osteoarthritis.

[Purpose] The aim of this study was to investigate the relationship between clinical parameters, radiological staging and evaluated ultrasound results of quadriceps muscle thickness in knee osteoarthritis. [Subjects] The current study comprised 75 patients (51 female, 24 male) with a mean age of 57.9±5.2 years (range 40–65 years) and a diagnosis of osteoarthritis in both knees. [Methods] Knee radiographs were evaluated according to the Kellgren-Lawrence grading system. Clinical evaluation performed with the visual analog scale (VAS), Western Ontario and McMaster Osteoarthritis Index (WOMAC), the 50-meter walking test, and the 10-step stair test. The thickness of the muscle layer of the quadriceps femoris (M. vastus intermedius and M. rectus femoris) was measured with high-resolution real-time ultrasonography. [Results] The results of this study showed a significant negative correlation between quadriceps thickness and age, duration of disease, stage of knee OA, and VAS, WOMAC, 50-m walking test, and 10-step stair test scores. [Conclusion] The evaluation of quadriceps muscle thickness with ultrasound can be considered a practical and economical method in the diagnosis and follow-up of knee osteoarthritis.

Is There Any Relationship between Joint Destruction and Carotid Intima-media Thickness in Patients with Rheumatoid Arthritis?

[Purpose] The purpose of this study was to investigate the possible relationship between joint destruction and carotid intima-media thickness in patients with rheumatoid arthritis. [Subjects and Methods] Thirty-four RA patients and 31 healthy controls were enrolled in this study. The disease activity for 28 joints was recorded for each patient using the erythrocyte sedimentation rate (DAS28ESR), a visual analog scale (VAS0–10 cm), and a disability index, the health assessment questionnaire (HAQ). X-ray imagesof the patients were scored according to the modified Sharp/van der Heijde method, and the common carotid intimal medial thickness (CIMT) was automatically measured with software using high-resolution Doppler ultrasound. [Results] Contrary to our hypothesis, the modified total Sharp score (mTSS) and CIMT were not significantly associated. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels of the RA patients and the right CIMT, left CIMT, and mean CIMT scores were significantly elevated. Positive correlation was detected between the mean CIMT score and age, CRP levels, LDL concentration and triglycerides (TG) level. In the regression model, where the mean CIMT was the independent variable and age, CRP, LDL, and TG were dependent variables, age was found to be an independent predictor of CIMT. [Conclusions] Patients suffering from RA require close monitoring for cardiovascular risks, and the comorbidity of age-related cardiovascular disease should not be overlooked.

Effectiveness of a Home Exercise Program in Combination with Ultrasound Therapy for Temporomandibular Joint Disorders

[Purpose] This study compared the effectiveness of home exercise alone versus home exercise combined with ultrasound for patients with temporomandibular joint disorders. [Subjects and Methods] This study enrolled 23 female and 15 male patients who were divided randomly into two groups. The home exercise group performed a home exercise program consisting of an exercise program and patient education, and the home exercise combined with ultrasound group received ultrasound therapy in addition to the home exercise program. Pain intensity was evaluated using a visual analogue scale. Pain free maximum mouth opening was evaluated at baseline and 2 weeks after the treatment. [Results] There was no difference between the two groups in baseline values. After the treatment, the visual analogue scale decreased and pain free maximum mouth opening scores improved significantly in each group. Additionally, both values were higher in the home exercise combined with ultrasound group than in the home exercise group. [Conclusion] The combination of home exercise combined with ultrasound appears to be more effective at providing pain relief and increasing mouth opening than does home exercise alone for patients with temporomandibular joint disorders.

Changes in spastic muscle stiffness after botulinum toxin A injections as part of rehabilitation therapy in patients with spastic cerebral palsy

OBJECTIVE To investigate changes in stiffness in the gastrocnemius (GCM) muscle following rehabilitation therapy and botulinum toxin type A (BTX-A) injections in patients with spastic cerebral palsy (CP). METHODS The study included 16 children with spastic CP (Group 1) and 17 healthy children (Group 2). The children with CP received BTX-A injections and underwent rehabilitation therapy. The GCM and soleus muscles of the CP group were evaluated according to the modified Ashworth scale (MAS). The thicknesses of the muscles were measured, and the elasticity score (ELX 2/1) index was calculated. RESULTS The ELX 2/1 indices of the gastromedialis (GM) and gastrolateralis (GL) were significantly higher in Group 1 than in Group 2 (p < 0.05). The ELX 2/1 indices in the GM and GL muscles in the CP group were found to have decreased 4 weeks after the procedure (p < 0.05). Furthermore, the mean MAS score of the ankle decreased, from 3.4 to 2.6 (p < 0.05). GM ELX 2/1 in Group 1 (post-treatment) was significantly different from Group 2 (p < 0.05). CONCLUSIONS The combined use of clinical scales and sonoelastography can provide valuable information for determining structural changes in the GCM muscle following rehabilitation therapy and BTX-A injections.

Traumatic shoulder fracture-dislocation in a 7-year-old child: a case report

IntroductionIn contrast to adults, traumatic glenohumeral dislocation is a rarely observed condition among children. In some cases, success in durable reduction with conservative methods, and achieving lasting treatment, may not be possible.Case presentationIn this study, the case of a 7-year-old Turkish girl with a Salter–Harris type II fracture and glenohumeral dislocation of the proximal humerus due to a fall from a height of 1.5 meters who underwent open reduction surgery is presented along with a review of the literature.ConclusionOrthopedic surgeons should consider glenohumeral dislocation which is an extremely rare condition when they encounter proximal humerus fractures in pediatric trauma.

An evaluation of oxidative stress and antioxidant capacity in patients with myofascial pain syndrome.

Abstract Objective. To evaluate total antioxidant capacity (TAC) and total oxidative stress (TOS) values in patients with myofascial pain syndrome (MPS). Method. The study comprised 38 patients diagnosed with MPS and 30 healthy volunteers. The age, body mass index (BMI) and pain scores (evaluation by visual analogue scales) of all the participants were recorded. The TAC, TOS and oxidative stress index (OSI) levels were compared between the MPS and control groups. Results. There was no significant difference between the MPS and control groups in respect of demographic characteristics. The TAC levels were determined to be significantly lower and TOS levels and OSI values, significantly higher in the MPS patients than in the control group. Conclusion. The results of this study determined that the oxidant/antioxidant balance was impaired in MPS patients and thus MPS can be considered to be related to an increase in oxidative stress.

A comparison of the effectiveness of low-, moderate- and high-dose ultrasound therapy applied in the treatment of myofascial pain syndrome

Abstract Objective. This study aimed to compare and evaluate the effects of ultrasound (US) treatment applied at low-, medium- and high-power-pain threshold (HPPT) doses to trigger points in the treatment of myofascial pain syndrome (MPS). Methods. The study comprised 61 (40 female and 21 male) patients diagnosed with MPS, aged between 18 and 60 years. The patients were randomly allocated to three groups for the US application at different dosages. Group I patients received treatment of medium-dose US (1.5 Watt/cm2), Group II received HPPT US, and Group III received low-dose US (0.5 W/cm2). The patients were evaluated pre-treatment and 3 weeks after treatment in respect of visual analogue scale (VAS) scores, number of trigger points (NTP), pressure pain threshold (PPT), Range of Tragus-Acromioclavicular joint (RT-AJ) and neck pain disability scores (NPDS). Results. A significant improvement was determined after treatment in all scores except PPT in Group I, in all scores in Group II, and only in the VAS score in Group III. When the groups were compared post-treatment in respect of improvement in NTP, VAS, RT-AJ and NPDS scores, Group II showed significant superiority over Group I, and Group I was determined to have significant superiority over Group III in respect of VAS, RT-AJ and NPDS scores (p < 0.05). Conclusions. In the treatment of MPS, US therapy at HPPT dose can be considered as an alternative therapy method, which is more economical and more effective than low-dose and conventional US therapy.

The horses are the first thought but one must not forget the zebras even if they are rare: Stiff person syndrome associated with malignant mesothelioma

Stiff person syndrome (SPS) is a rare condition that causes rigidity in the muscles of the body and extremities, difficulty in walking, episodic spasms and progressive disability. SPS is generally seen together with autoimmune disorders such as diabetes mellitus, thyroiditis, vitiligo and pernicious anaemia. Rarely, it may develop as a paraneoplastic condition. SPS cases associated with breast cancer, small cell lung carcinoma, thymoma, Hodgkins lymphoma and colorectal cancer have been reported in the literature. We present a case of a 58-year-old female patient who had malignant mesothelioma-associated SPS. Patients who have muscle spasms and difficulty in movement of joints should be evaluated for SPS before diagnosis of Parkinsons or other neurological disorders, and possible underlying malignancies should be excluded.

Comparison of the Efficacy of Ultrasound and Extracorporeal Shock Wave Therapies in Patients with Myofascial Pain Syndrome: A Randomized Controlled Study

Abstract Objective: Evaluation and comparison of the efficacy of ultrasound [US] and extracorporeal shock wave therapy [ESWT] in the treatment of myofascial pain syndrome. Methods: Sixty-six patients with active myofascial trigger points in the trapezius muscle were randomized into treatment groups with US and three sessions of ESWT. Efficacy of the therapies were evaluated prior to therapy at 3 weeks and at 3 months of therapy using the Patient Global Assessment and Physician’s Global Assessment scales, Neck Pain and Disability Scale, Nottingham Health Profile, and Hamilton Anxiety Scale. Results: No severe complications were encountered with US and ESWT, and patients tolerated the therapies well overall. Statistically significant improvement was determined in the number of trigger points, pain, quality of life, and anxiety scores in post-therapy evaluations [p < 0.01]. Efficacy of therapies in inter-group comparison was evaluated in terms of improvement in the same scores, and the ESWT group had greater improvement when the anxiety scores were excluded [p < 0.05]. Conclusion: Our results indicated that both US and ESWT were effective and safe treatment modalities in myofascial pain syndrome. Three sessions of low dosage ESWT was more effective compared to US therapy that could be used as an effective and safe modality in the treatment protocols of myofascial pain syndrome.