Mehmet Ali Taskaynatan

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.

Bier block with methylprednisolone and lidocaine in CRPS type I: A randomized, double-blinded, placebo-controlled study

Background and objective To investigate the effect of intravenous regional anesthesia (Bier block) with methylprednisolone and lidocaine in complex regional pain syndrome (CRPS) type I in a randomized, double-blinded, and placebo-controlled study. Methods Twenty-two patients with the diagnosis of CRPS of their upper limb were divided randomly into 2 groups. The mean age was 22.3 ±1.6 years. Average pain duration was 3.1 ± 1.4 months. In the placebo group (10 patients), patients received only 100 mL of saline. In the study group (12 patients), 40 mg of methylprednisolone and 10 mL of 2% lidocaine were added to the saline. Treatments were applied once a week. Unless significant adverse effects occurred, 3 sessions of blockade were completed. Pain severity, range of motion (ROM), and volumetric edema measurements were obtained before treatment. Pain severity and satisfaction (resolved, better, no change, or worse) were recorded after each session. The final assessment was performed 1.5 months later. ROM and volumetric measurements were repeated the day after the block and at the final assessment. Results Differences in pretreatment features of the patients were not statistically significant (P > .05). In all assessment periods during the study, improvement in pain severity was statistically significant (P < .05) in both groups. This statistically significant difference disappeared at the final assessment (P > .05). No statistically significant difference was obtained in ROM and volumetric measures in any assessment period before and after the block. Satisfaction scores between the groups were also not different in any assessment period. Conclusions Bier block with methylprednisolone and lidocaine in CRPS type I does not provide long-term benefit in CRPS, and its short-term benefit is not superior to placebo.

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.

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.

Effect of playing football (soccer) on balance, strength, and quality of life in unilateral below-knee amputees

Yazicioglu K, Taskaynatan MA, Guzelkucuk U, Tugcu I: Effect of playing football (soccer) on balance, strength, and quality of life in unilateral below-knee amputees. Am J Phys Med Rehabil 2007;86:800–805. Objective:To investigate the effect of playing football (soccer) on balance, muscle strength, locomotor capabilities, and health-related quality of life in subjects with unilateral below-knee amputation. Design:Cross-sectional controlled study. Results:Difference in KAT dynamic balance scores obtained 3 days after was statistically significant in the study group (P < 0.05) but not in the control group (P > 0.05). Differences in static balance test scores was statistically significant between the groups (P < 0.05) in favor of the study group. In isokinetic evaluation, differences in flexion and extension peak torque measures of the lower extremities were not statistically significant between the groups (P > 0.05). Differences in Houghton and Berg balance scales were not found statistically significant between the groups (P > 0.05). Differences in Locomotor Capabilities Index and in the SF-36 in physical functioning, physical role, pain, and emotional role between the groups were statistically significant (P < 0.05) in favor of the study group. Conclusions:Our results show that playing football may have positive effects on balance and health-related quality of life in unilateral below-knee amputees.

Ochronotic spondyloarthropathy: spinal involvement resembling ankylosing spondylitis

Ochronotic spondyloarthropathy is a rare metabolic disease with the musculoskeletal manifestations of alkaptonuria. Ochronotic arthropathy patients may have spinal abnormalities similar to ankylosing spondylitis (AS). The proof of sacroiliac involvement or bamboo spine appearance is not sufficient either for diagnosis of ankylosing spondilitis or exclusion of ochronosis. In this report, the case of a 54-year-old woman having ochronosis, with clinically more recognizable axial arthropathy resembling AS, is presented, and the history, clinical presentation, diagnostic techniques, and distinctive diagnosis are reviewed.

Factitious disorders encountered in patients with the diagnosis of reflex sympathetic dystrophy

Reflex sympathetic dystrophy (RSD) may be a misdiagnosis or at least not descriptive enough in patients with atypical hand posture and atypical edema. Seven patients with the previous diagnosis of RSD were investigated further because of inconsistent clinical picture with the underlying pathology and bizarre course of the disease. Four patients had clenched fist and three had factitious edema. These seven patients underwent psychological examination, and MMPI was applied to all. In two of these no psychological disorder was obtained according to DSM-IV. One patient could not adapt to MMPI. In two anxiety disorders, in one depression, and in one patient conversion disorder was diagnosed. We suggest that these patients are not motivated enough to improve their conditions and expectations of such patients may show some differences depending on the environment.

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.

Clinical presentations of chlamydial and non-chlamydial reactive arthritis

The aim of this study was to investigate the triggering micro-organisms and the clinical as well as laboratory differences between Chlamydial and non-chlamydial reactive arthritis (ReA) in a prospective study on 98 patients with acute/subacute arthritis. An inciting organism was found in 42 patients. Eighteen of these were chlamydial. Fifty-seven percent of all ReA patients were carriers for HLA-B27, which increased to 67% in the chlamydial group. Chlamydial ReA patients had more urethritis (P<0.05) with a longer period between arthritis and inciting infection, significantly lower CRP levels, and involved joint counts (P<0.05). Additionally, sacroiliitis was more frequent besides extra-articular manifestations in chlamydial ReA group. This study shows that chlamydial ReA differs in some points from non-chlamydial ReA, which in turn may affect the evaluation of an arthritic patient. ReA due to chlamydia more frequently encompasses a monoarticular or oligoarticular clinical picture with predominant distal extremity involvement. Non-chlamydial ReA presents higher joint counts and may involve upper extremity joints.

Effects of Steroid Iontophoresis and Electrotherapy on Bicipital Tendonitis

Objective: The aim of this study was to compare the effects of steroid iontophoresis [SI] and electrotherapy [ET] on bicipital tendonitis. Methods: Forty-seven patients with bicipital tendonitis, diagnosed by ultrasonography, were all treated with hot packs [15 minutes], ultrasound [1.5 w/cm2, five minutes], and a standard exercise program. They were also divided randomly into two experimental groups. One group received SI [0.5 percent hydrocortisone acetate given with the negative electrode, 3–4 mA galvanic current, 15 minutes]. The second group was treated with ET [interferential current, 0–100 Hz, 15 minutes]. All patients were evaluated at pre-treatment, post-treatment, and one month later with the following assessment tools: pain [pain at rest, with normal activities, and with strenuous activities] with a numeric scale [0 to 10], range of motion [ROM] with goniometry and with the ROM items of Constants Shoulder Scale, patient satisfaction with a numeric scale [0 to 10], and disability by using the function section of the Pennsylvania Shoulder Scale. Results: All of the assessment parameters revealed statistically significant improvement at post-treatment and one month later [P < 0.05] in the SI group. The ET group experienced less dramatic improvement in the immediate post-treatment [P < 0.05] assessment and the durability of benefit was less than with SI. Conclusions: Application of SI to the conventional physical therapy for patients with biceps tendonitis seems to provide a better and more prolonged clinical and functional improvement.