Koray Aydemir

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.

A Different Approach to the Management of Osteoarthritis in the Knee: Ultrasound Guided Genicular Nerve Block

Dear Editor, A 61-year-old female was referred to our tertiary physical medicine and rehabilitation outpatient clinic with a 7-year history of severe left knee pain. The patient was a nonsmoker and obese, with no comorbidities, and reported that the left knee pain worsened when walking and descending stairs and particularly when climbing stairs. Radiography of the left knee revealed Kellgren-Lawrence grade 3 osteoarthritis (OA) with multiple osteophytes and definite joint space narrowing. The pain and functional disability were nonresponsive to conservative treatment methods including weight loss, exercise, analgesics (paracetamol or diclofenac sodium once or twice a day), intra-articular steroid and hyaluronic acid injections, and physical therapy. The patient was finally offered knee replacement surgery by an orthopedic surgeon, but she did not accept surgery. The sensory and motor nerves supplying all the structures around the knee are the saphenous, tibial, and common peroneal nerves together with the subsartorial, peripatellar, and popliteal plexuses [1,2]. Vas et al. [2] targeted both the sensory and motor nerves supplying all the structures around the knee and succeeded in relieving the pain. Choi et al. [3] reported successful pain relief by ablation of the three branches of the genicular nerve [superior lateral (SL), superior medial (SM), and inferior medial (IM) genicular nerves]. These three nerves were selected because they pass the periosteal areas connecting the shaft of the femur to the bilateral epicondyles and the shaft of …

Efficacy of Ultrasound in the Diagnosis of Biceps Tendon Dislocation.

A 25-yr-old man presented with pain and weakness secondary to posttraumatic anterior shoulder dislocation from a traffic accident 3 mos earlier. The patient received 15 sessions of physical therapy but no improvement was observed. On physical examination, minimal swelling of the anterior aspect of the right shoulder and tenderness with palpation were detected. Speed and Yergason tests yielded positive results, and a 2-cm reduction in circumference was determined on the right arm. Muscle strength of right elbow flexion and forearm supination was 4/5. Shoulder internal rotation was restricted by 50%. All laboratory findings, including erythrocyte sedimentation rate, C-reactive protein, and X-ray examination were normal. Musculoskeletal ultrasound (US) revealed that the bicipital groove was empty and the long head of the biceps tendon (LHBT) had dislocated anteromedially with surrounding edema (Fig. 1). The supraspinatus tendon was observed to be intact and a full-thickness tear of the subscapularis tendon was seen (Fig. 2). Despite a trial of conservative treatment including physical therapy and nonsteroidal anti-inflammatory agents, the condition did not improve and the patient was referred to an orthopedic service for surgery. Dislocation of the LHBT out of the bicipital groove is usually linked with tears of the subscapularis tendon or massive rotator cuff tears. It has been stated that there is no specific clinical test correlated to the presence of medial dislocation of the LHBT. Thus, imaging methods such as US, magnetic resonance imaging, and magnetic resonance imaging arthrography are of paramount importance. Magnetic resonance imaging has long been the primary mode of evaluating shoulder pathologies, but US has rapidly assumed a similar role as an imaging modality in the past few years. When compared with other imaging tools, US imaging is practical, noninvasive, inexpensive, and portable. In addition, US has been found to have 100% specificity and 96% sensitivity for subluxation or dislocation. It is important to detect the position of the LHBT on US particularly after traumatic shoulder dislocation, because pathology of the LHBT may have a part in the development of shoulder pain and long-term dysfunction. FIGURE 1 Bicipital groove (BG) and long head of the biceps brachii tendon. The star indicates empty bicipital groove, and the arrow denotes biceps brachii tendon. l, lateral; m, medial.

A case of recurrent complex regional pain syndrome accompanying Raynaud's disease: a prospective coincidence?

Complex regional pain syndrome (CPRS) and Raynauds disease are disorders characterized by vasomotor disturbances associating with abnormal autonomic nervous system. We present a case of CRPS involving a history of recurrence and no initiating event. Raynauds disease accompanying CRPS was diagnosed clinically in the patient. We propose that a sympathetic dysfunction underlies the pathophysiologies of both disorders and may be responsible for the coexistence of these two distinct entities. Recurrence and unknown etiology of CRPS might account for temporary alterations in sympathetic function.

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.

Tenosynovitis of the flexor foot tendons secondary to pes cavus: value of sonography

A 21-year-old man was referred with a 2-week history of pain and swelling in his right ankle and foot, accentuated by weight-bearing and weight-limiting activities. There was no history of trauma and rheumatic disease. Physical examination revealed tenderness and edema in medial aspect of ankle and foot dorsum, pain on foot Xexion and inversion, and high longitudinal arch on the right foot. Plain radiographs of foot displayed an increased calcaneal plantar angle on lateral view and ruled out any bony pathology. Laboratory data were unremarkable. Sonography assessment showed tenosynovitis of tibialis posterior, Xexor digitorum, and Xexor hallucis tendons. Paedobarography conWrmed pes cavus of the right foot, which was considered to be responsible for the spontaneous onset of foot tenosynovitis. The tendon injury was treated with rest, cold, and elevation. Proper insole for high arch foot was prescribed in Fig. 1.

The Anterior Cervical Triangle: An Unusual Site for Iatrogenic Accessory Nerve Palsy – A Case Report

Background Injury to the spinal accessory nerve [SAN] results in a debilitating shoulder dysfunction. Iatrogenic injury is common during radical neck dissection, cervical lymph node biopsy, and other surgical procedures; thus the superficial course of the nerve in posterior cervical triangle [PCT] makes it susceptible. The anterior cervical triangle [ACT] is an unusual location for iatrogenic SAN injury. Findings We present a case that outlines the risk of SAN injury following a surgical operation in the ACT. Conclusions Prevention of inadvertent injury to the SAN is also critical in the ACT, as well as in the PCT section.

Ultrasound Findings of Young and Traumatic Amputees With Lower Extremity Residual Limb Pain in Turkey.

Objective The current study was designed to document clinical and ultrasound (US) findings of patients with residual limb pain (RLP) after amputation and to investigate the relationship between these findings. Materials and Methods A chart review was performed to identify demographic and clinical data including the age (current and at the time of injury), time since amputation, gender, reason for amputation, affected limb number, side and level of limb loss, and ultrasonographic findings of young and traumatic amputees with RLP. Results The study included a total of 147 patients. Inflammation and neuroma were the leading pathologies in 20–29 years and 30–39 years age groups, respectively. Inflammation/edema were detected significantly more in patients with <1 year since amputation (P = 0.001). Neuroma was found at a significantly high rate in patients at 1–5 years (P = 0.029) and infection/abscess was more common in patients at >5 years since amputation (P = 0.051). The percentage of neuromas in below-the-knee amputees was significantly higher than in non–below-the-knee amputees (45.8% vs. 28.6%). Neuroma formation was detected in 50% of the patients with land mine–related amputation and at 27% in patients with amputation secondary to other traumatic reasons. Regression analysis showed below-the-knee-level amputation to be an associated factor for US abnormality. Conclusion The leading US findings were inflammation/edema, neuroma, and infection/abscess in traumatic amputees with RLP. The US findings might be different in patients according to the time since amputation. Patient with land mine–related amputations may have different US findings.

Poster 373-B Demographic and Clinical Features of Children and Adolescents with Spinal Cord Injury: A Turkish Hospital-Based Study

Setting: Musculoskeletal Clinic. Results: Initial work up included electrodiagnostic studies, x-ray of the hip, and targeted ultrasound of the lateral left hip. US demonstrated a mildly heterogeneously solid soft tissue mass that extends from the superficial subcutaneous soft tissues very close to/abutting the skin to the region of the deep fascia overlying the musculature. MRI was obtained for clarification and showed a 10 cm x 7.1 cm x 10 cm encapsulated intramuscular lesion in the left tensor fascia. Subsequently the patient improved in physical therapy with a focus on myofascial release techniques, assisted stretching including ART and PNF techniques, and core and hip girdle stabilization exercises. Discussion: Intramuscular lipomas are rare, deep seated lipomas that originate within the muscle. MRI can identify and localize these tumors and differentiate lipomas from lipo-sarcomas. Clinically, dysfunction of the engaged muscle due to extensive infiltration has been reported. In our case, the large size of the mass led to mechanical dysfunction that likely lead to his hip pain. Further developments will be discussed. Conclusions: This is the first reported case, to our knowledge, of an intramuscular lipoma within the tensor fascia lata, leading to muscle dysfunction and subsequent hip pain. Level of Evidence: Level V