Özlem El

Treatment of Carpal Tunnel Syndrome with Nerve and Tendon Gliding Exercises

Akalin E, El Ö, Peker Ö, Şenocak Ö, Tamci Ş, Gülbahar S, Çakmur R, Öncel S: Treatment of carpal tunnel syndrome with nerve and tendon gliding exercises. Am J Phys Med Rehabil 2002;81:108–113. ObjectiveTo assess the effect of nerve and tendon gliding exercises in carpal tunnel syndrome. DesignThe study was a prospective, randomized, before-and-after treatment trial. A total of 28 patients with the diagnosis of carpal tunnel syndrome in 36 hands were randomly assigned to two groups. A custom made neutral volar wrist splint was given to group 1 and group 2. The patients were instructed to wear the splints all night and during the day as much as possible for 4 wk. The patients in group 2 were also instructed to perform series of nerve and tendon gliding exercises in addition to the splint treatment. Patients were evaluated with clinical parameters, a functional status scale, and a symptom severity scale. ResultsAt the end of treatment, statistically significant improvement was obtained in all parameters in both groups. The improvement in group 2 was slightly greater, but the difference between the groups was not significant, except for the lateral pinch strength value. Patient satisfaction was investigated during the follow-up period, ranging from 5 to 11 mo, with a mean of 8 mo. A total of 72% of the patients in group 1 and 93% of the patients in group 2 reported good or excellent results. The difference between the two groups was not statistically significant. ConclusionAlthough the results in group 2 were better than group 1, the difference was not statistically significant. Further investigations are required to establish the role of nerve and tendon gliding exercises in the treatment of carpal tunnel syndrome.

Interobserver reliability of the Turkish version of the expanded and revised gross motor function classification system

Purpose: Cerebral palsy (CP) is the most common disability in childhood. The gross motor function classification system (GMFCS) has become an important tool to assess motor function in CP patient. In 2007, the expanded and revised (E&R) version of GMFCS which includes age band for youth 12–18 years of age was developed. The aim of this study was to evaluate reliability of Turkish version of expanded and revised GMCS. Methods: We assessed interobserver reliability between two physical medicine and rehabilitation specialists in 136 children with CP and test-retest reliability within a subgroup of 48 patients. Percent agreement, intraclass correlation coefficient (ICC) and μ statistics were used to evaluate reliability. Result: The ICC between two physicians was 0.97 and the total agreement was 89%. This result indicates excellent agreement. The overall weighted μ was 0.86. High test-retest reliability was found (ICC: 0.94 95% confidence interval) and the total agreement was 75% for test-retest reliability. Conclusion: The Turkish version of the E&R GMFCS is shown to be reliable and valid for assessment of Turkish CP children. Implications for Rehabilitation Cerebral palsy (CP) is the major developmental disability affecting function in children. Assessment of functional status of children with CP is important for planning treatment. The gross motor function classification system (GMFCS) can be considered to be a diagnostic tool for predicting motor development in children with CP based on self-initiated movement, emphasising on sitting, transfers and mobility. The expanded GMFCS includes an age band for youth 12–18 years of age.

Clinical and functional outcomes and proprioception after a modified accelerated rehabilitation program following anterior cruciate ligament reconstruction with patellar tendon autograft

OBJECTIVES The aim of this study was to evaluate the clinical and functional outcomes and proprioceptive function in patients who received a modified accelerated rehabilitation program after anterior cruciate ligament (ACL) reconstruction with a patellar tendon (PT) graft. METHODS The study included 38 patients (33 men, 5 women; mean age 27.6 ± 6.4 years; range 18 to 45 years) who underwent ACL reconstruction with a PT graft and participated in a modified accelerated rehabilitation program. Only six patients were athletes. Isokinetic strengths of concentric knee extension and flexion were measured with the Cybex isokinetic dynamometer, and static balance was tested with the Sport-KAT device. For proprioceptive assessment, active repositioning was measured at knee flexions of 40°, 20°, and 5° with an isokinetic dynamometer. Activity levels and subjective functional results were evaluated with the Tegner activity scale and Lysholm knee score, respectively. For objective functional testing, single leg hop, triple leg hop, and one-legged crossover hop tests were used. Knee stability was assessed with the Lachman test and anterior drawer test and knee range of motion was measured. The mean follow-up period was 16.2 ± 9.8 months. RESULTS There was no graft failure during the follow-up. Twenty patients (52.6%) had hypoesthesia at the donor site and 15 patients (39.5%) had anterior knee pain. Before surgery, all the patients had positive results in the Lachman and anterior drawer tests. After surgery, the Lachman test was negative in 32 patients (84.2%), while six patients (15.8%) had grade 1 laxity. The mean Lysholm knee score showed a significant increase postoperatively (p<0.001). The mean preoperative and postoperative Tegner activity scores were not significantly different (p>0.05). There were no significant differences in the range of motion between operated and uninjured extremities (p>0.05). The two extremities were similar in proprioception and balance (p>0.05). Isokinetic quadriceps muscle strength was significantly decreased in the operated extremity only in extension at 60°/sec angular velocity (p<0.05). Other muscle strength measurements were similar in both extremities. The ratios of flexion/extension muscle strength were significantly greater in the involved extremity at all angular velocities (p<0.05). The mean performance scores of three functional tests were more than 85% of the uninvolved extremity. All the patients returned to preinjury daily activities or sports activities in 6 to 12 months postoperatively. CONCLUSION We had satisfactory clinical, proprioceptive, and functional results in achieving dynamic and static stability of the knee with the modified accelerated rehabilitation program after ACL reconstruction with a PT graft.

Efficacy of Paraffin Bath Therapy in Hand Osteoarthritis: A Single-Blinded Randomized Controlled Trial

OBJECTIVE To evaluate the efficacy of paraffin bath therapy on pain, function, and muscle strength in patients with hand osteoarthritis. DESIGN Prospective single-blinded randomized controlled trial. SETTING Department of physical medicine and rehabilitation in a university hospital. PARTICIPANTS Patients with bilateral hand osteoarthritis (N=56). INTERVENTIONS Patients were randomized into 2 groups with a random number table by using block randomization with 4 patients in a block. Group 1 (n=29) had paraffin bath therapy (5 times per week, for 3-week duration) for both hands. Group 2 (n=27) was the control group. All patients were informed about joint-protection techniques, and paracetamol intake was recorded. MAIN OUTCOME MEASURES The primary outcome measures were pain (at last 48h) at rest and during activities of daily living (ADL), assessed with a visual analog scale (0-10cm) at 12 weeks. The secondary outcome measures were the Australian Canadian Osteoarthritis Hand Index (AUSCAN) and the Dreiser Functional Index (DFI), used for subjective functional evaluation, loss of range of motion (ROM), grip and pinch strength, painful and tender joint counts, and paracetamol intake. A researcher blind to group allocation recorded the measures for both hands at baseline, 3 weeks, and 12 weeks at the hospital setting. RESULTS At baseline, there were no significant differences between groups in any of the parameters (P>.05). After treatment, the paraffin group exhibited significant improvement in pain at rest and during ADL, ROM of the right hand, and pain and stiffness dimensions of the AUSCAN (P<.05). There was no significant improvement in functional dimension of the AUSCAN and the DFI (P>.05). The control group showed a significant deterioration in right hand grip and bilateral lateral pinch and right chuck pinch strength (P<.05), but there was no significant change in the other outcome measures. When the 2 groups were compared, pain at rest, both at 3 and 12 weeks, and the number of painful and tender joints at 12 weeks significantly decreased in the paraffin group (P<.05). Bilateral hand-grip strength and the left lateral and chuck pinch strength of the paraffin group were significantly higher than the control group at 12 weeks (P<.05). CONCLUSIONS Paraffin bath therapy seemed to be effective both in reducing pain and tenderness and maintaining muscle strength in hand osteoarthritis. It may be regarded as a beneficial short-term therapy option, which is effective for a 12-week period.

Botulinum Toxin A Injection for Spasticity in Diplegic-Type Cerebral Palsy

Botulinum toxin type A can be both safe and effective in relieving spasticity in pediatric patients with cerebral palsy. In our prospective study, we evaluated the functional effect of botulinum toxin A in spastic diplegic-type cerebral palsy. Patients were examined on enrollment and at 1, 3, and 6 months after injection. Passive dorsiflexion of the ankle joint was measured using a goniometer as an angle of possible maximal dorsiflexion with the knee extended and flexed. Spasticity was graded using the Modified Ashworth Scale. Selective motor control at the ankle was assessed, and observational gait analysis was done. The functional status of the patients was determined by using the gross motor classification system. Botulinum toxin A was injected into the gastrocnemius muscle in all patients, and in four patients with concomitant jump knee gait, a hamstring muscle injection was added. Fourteen patients were included in the study. The mean age was 58.81 6 15.34 months. Following injection, spasticity was clinically decreased and statistically significant improvement was noticed in all clinical parameters after 1, 3, and 6 months of injection. The improvement in the clinical parameters decreased after 6 months but not to the baseline. One patient was Level II, four patients were Level III, and six patients were Level IV according to the Gross Motor Function Classification System at baseline. Improvement in the gross motor classification system is continued after 6 months in 12 children. The main goal of spasticity treatment in cerebral palsy is functional improvement. In our study, most of our patients had functional improvement according to the gross motor function classification system and did not change at 6 months.

Impaired quality of life and functional status in patients with benign joint hypermobility syndrome

Abstract Objective: To evaluate the function and health-related quality of life [QoL], and to determine the relationship between pain, function and QoL in patients with benign joint hypermobility syndrome [BJHS]. Material and method: A total of 36 patients and 31 healthy controls were enrolled. Demographic characteristics were recorded and the patients were evaluated according to the Beighton score and Brighton criteria for BJHS. The assessment of pain was performed based on the visual analogue scale [VAS 0–10 cm]. Function and QoL were assessed using the Stanford Health Assessment Questionnaire [HAQ] and Nottingham Health Profile [NHP], respectively. Results: The mean age was 29.94 ± 6.04 years in the patient group and 30.16 ± 5.64 years in the control group. When the two groups were compared, there were significant differences in the HAQ scores. QoL was also significantly worse in the patient group in all dimensions of the NHP except for social isolation. There was a positive correlation between the Beighton score and the NHP-emotional reaction score. We have also observed a positive correlation between the HAQ scores and the pain [VAS], NHP-pain and NHP-Physical Mobility scores in the patient group. No correlation was observed among the other parameters. Conclusion: This study has demonstrated that function and QoL are significantly impaired in the patients with BJHS compared to healthy controls. Function and QoL as well as the pain should be assessed in the patients with BJHS. Also, the disease may not be benign as it is widely regarded.

Calcaneal stress fracture, a case report

Gastrik volvulus hayati tehdit edebilen ve nadir gorulen bir durum olmakla birlikte; tani konulmasi zor bir hastaliktir. Bu hastalik spesifik olmayan abdominal semptomlarla ilerleyebileceginden tanisi gecikebilir veya atlanabilir. Distansiyonun eslik ettigi, epigastriumda agri, ogurme, kusma ve kilo kaybi sikâyetleriyle basvuran hastalarda gastrik volvulus ayirici tanida akilda tutulmalidir. Radyolojik goruntuleme yontemlerinden akciger grafisi ve torakoabdominal bilgisayarli tomografi taniya yardimci olabilir. Paraozefageal fitiga ikincil olarak gastrik volvulus icin halen kabul edilen tedavi yontemi minimal invaziv tekniklerdir. Bu yazimizda cok nadir bir tip olan mikst tip gastrik volvuluslu 65 yasindaki erkek hastayi sunmayi amacladik.

Functional restriction and satisfaction with prosthesis in lower limb amputee patients

Amac: Bu calismanin amaci; alt ekstremite ampute hastalarda fonksiyonel kisitliligi ve protez memnuniyetini degerlendirmek ve iliskili faktorleri ortaya koymaktir. Gerec ve Yontem: Calismaya alt ekstremite amputasyonu gecirmis olan 43 hasta alindi. Hastalarin demografik ve klinik ozellikleri kaydedildi. Hastalarin fonksiyonel kisitliligini degerlendirmek amaciyla Groningen Aktivite Kisitlilik Skalasi (GARS) kullanildi. Hasta memnuniyetini belirlemek icin ise Protez Memnuniyet Anketi uygulandi. Bulgular : Hastalarin yas ortalamasi 43,2 ± 12,4 idi. 28 hastanin diz alti, 12 hastanin diz ustu, 3 hastanin ise diz dezartikulasyon seviyesinde amputasyonu vardi. 21(%48) hastanin fonksiyonel seviyesi K4, 19 (%44) hastanin fonksiyonel seviyesi K3’tu. Toplam 28 hastaya aktif vakumlu, 10 hastaya mikroislemcili, 5 hastaya hidrolik protez recete edilmisti. Hastalarin baslangic GARS medyan puani 21 (18 – 64). Hastalarin kontrol GARS medyan puani 19 (18 – 60) dur. Hastalarin Protez Memnuniyet Anketi’ne gore degerlendirilen memnuniyet ortalamasi ise %82,9 (minimum: 37, maksimum: 100) dur. Hastalarin memnuniyetleri veya fonksiyonel duzeyleri ile yas ve amputasyon seviyesi arasinda anlamli iliski saptanmadi. Daha once moduler protez kullanmakta olup yeni moduler protez recete edilen 28 hastanin fonksiyonelliginde istatistiksel olarak anlamli duzelme saptandi. Sonuc: Alt ekstremite amputasyonlarinda protez uygulamalari fonksiyonel kisitliligi azaltan ve hasta memnuniyetinin yuksek oldugu uygulamalardir.

442 COMPLEX REGIONAL PAIN SYNDROME: A PAINLESS CASE REPORT

Complex regional pain syndrome (CRPS) is characterized by diffuse pain, swelling, vasomotor instability, trophic changes and severe functional impairment of the affected extremity. About 75% of the patients with CRPS have spontaneous pain with hyperalgesia or allodynia. In this report we present a case having CRPS type-I but without any pain and hyperalgesia or allodynia. The subject was a 57 years old female patient who had a distal radius fracture after a fall. Her wrist was immobilized in a cast for six weeks and afterwards she was referred to our department for physical therapy. She had complaints such as; swelling, hyperhidrosis, restriction of finger and wrist movements and tremor in her injured hand but she had no pain. Our examination confirmed restriction of wrist and finger movements, hyperhidrosis, and tremor and also her hand was warm and swollen. But there was no allodynia and hyperalgesia. The patient did not report any pain at the follow-up controls, assessed by visual analog scale. Zyluk scoring system was used for diagnosis and clinical severity of CRPS type-I. Patient was treated with successfully with physical therapy and she did not develop pain during follow-up. Some patients with CRPS type-1 may have no pain in spite of severe sudomotor, vasomotor and motor signs and symptoms. In the literature there are few articles reporting CRPS with no pain and all of them were in lower extremities. It should be noted that CRPS type-I with no pain can also occur in upper extremities.

388 THE RELIABILITY AND VALIDITY OF THE TURKISH VERSION OF THE WESTERN ONTARIO ROTATOR CUFF INDEX

Background and Aims: To adapt the Western Ontario Rotator Cuff Index (WORC) index for use in Turkey and to investigate its reliability and validity. Methods: The Turkish version of the WORC was developed according to the guidelines in the literature. Seventy-two patients with rotator cuff disease were administered the questionnaire and they were also evaluated by using the UCLA shoulder rating scale, Constant score and SF-36 to test validity. The WORC questionnaire was repeated in 35 patients after a mean interval of 2.9 days (range 2 to 7 days) to evaluate test-retest reliability. Results: Cronbach’s a was calculated as 0.92 for the total questionnaire. The intraclass correlation coefficients were very high and ranged between 0.96–0.98 for each section. There was a significant negative correlation between the Turkish version of WORC and UCLA (r = −0.598, p< 0.01), Constant score (r = −0.630, p< 0.01) and all subscales of SF-36 (p< 0.01). Conclusion: The Turkish version of the WORC index is a reliable and valid instrument for use in clinical trials in patients with rotator cuff disorders.