Özlen Peker

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.

Hypermobility syndrome increases the risk for low bone mass

Few studies on the benign joint hypermobility syndrome suggest a tendency toward osteopenia, but there are conflicting results. We assessed bone mineral density in pre-menopausal women with hypermobility. Twenty-five consecutive Caucasian women diagnosed with benign hypermobility syndrome by Beighton score and 23 age- and sex-matched controls were included in the study. Age, menarch age, number of pregnancies, duration of lactation, physical activity and calcium intake were questioned according to European Vertebral Osteoporosis Study Group (EVOS) form. All subjects were pre-menopausal and none of them were on treatment with any drugs effecting bone metabolism or had any other systemic disease. No statistically significant difference was found for body mass index, menarch age, number of pregnancies, duration of lactation, calcium intake, calcium score and physical activity score between the two groups. Total femoral and trochanteric bone mineral density and t and z scores were significantly lower in hypermobile patients compared to the control group. Ward’s triangle and femoral neck z scores were also found to be significantly low in hypermobile patients (p<0.05). Significant negative correlations were found between the Beighton scores and trochanteric BMD, t and z scores (r=−0.29, r=−0.30, and r=−0.32) in hypermobility patients. Low bone mass was more frequently found among subjects with hypermobility (p=0.03). Hypermobility was found to increase the risk for low bone mass by 1.8 times (95% confidence interval 1.01–3.38). Our study suggests that pre-menopausal women with joint hypermobility have lower bone mineral density when compared to the controls and hypermobility increases the risk for low bone mass.

Ef” cacy of two forms of electrical stimulation in increasing quadriceps strength: a randomized controlled trial

Objective: To investigate whether electrical stimulation is effective in improving quadriceps strength in healthy subjects and to compare interferential and low-frequency current in terms of the effects on quadriceps strength and perceived discomfort. Design: Randomized, controlled study. Setting: Physical Medicine and Rehabilitation Department in a university hospital. Subjects: Thirty medical faculty students, divided into three groups, participated in the study. Interventions: Group A received electrical stimulation with bipolar interferential current while group B received electrical stimulation with lowfrequency current (symmetrical biphasic). Group C served as the control group. Electrical stimulation was given for 15 minutes, ”ve days a week for three weeks, at a maximally tolerated intensity with the knee fully extended in the sitting position. Main outcome measures: Before and after the study, quadriceps strength was measured with a Cybex dynamometer isokinetically at the angular velocities of 60°/s and 120°/s. The perceived discomfort experienced with each type of electrical stimulation was quantified by the use of a visual analogue scale (VAS). Results: Statistically significant increase in isokinetic strength was observed after training in group A and group B. Increase in strength did not differ between the stimulation groups. No significant change in strength occurred in group C. Perceived discomfort by the stimulation groups was not significantly different. Conclusion: Both interferential and low-frequency currents can be used in strength training with the parameters used in this study.

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.

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.

A comparison of inverted spinal traction and conventional traction in the treatment of lumbar disc herniations

The purpose of this investigation of lumbar disc herniation patients was to compare the effi cacy of the inversion spinal traction and the conventional mechanical spinal traction on several clinical parameters and computed tomography. This investigation consisted of 29 patients with low back pain and sciatica due to lumbar disc herniation. Patients were randomly assigned into two groups: an inversion spinal traction that was applied to 15 patients, and a conventional traction that was applied to 14 patients for ten sessions. The efficacy of the treatments was evaluated based upon clinical parameters before, immediately after, and three months after the treatment. Computed tomographic (CT) investigation was done before and immediately after the treatment. Both methods of traction were found to be clinically effective. Although there was no statistically significant difference between the two groups based upon the clinical parameters, CT fi ndings of the conventional traction group tended to show more improved parameters than the inverted spinal traction group. Reasons for better results of the conventional traction are discussed and the necessity for further investigations on this topic is emphasized.

Technetium-99m human immunoglobulin scintigraphy in patients with adhesive capsulitis : A correlative study with bone scintigraphy

Adhesive capsulitis (AC) is a disorder that is characterized by shoulder pain and progressive limitation of both active and passive shoulder motion. Although the underlying pathological mechanisms of the disease are not well understood, the inflammatory reactions depending on the stage have been demonstrated histologically. The purpose of the study is to investigate the inflammatory changes that can be demonstrated with Tc-99m HIG in AC, and to determine the presence of correlations between scintigraphic findings and the clinical assessment. Twenty-one patients (12 females and 9 males) with a mean age of 50.57±8.49 were included in the study. AC was diagnosed according to recognized criteria. The planar X-ray images of the affected shoulders of all patients were normal. The patients were evaluated with the Constant Scoring System, and the functional and pain assessment parts of the American Shoulder and Elbow Surgeons’ Form (ASES). Three phase bone scans and Tc-99m HIG scintigraphy were performed at least two days apart. Bone scan and Tc-99m HIG scintigraphy were evaluated visually and HIG uptake was evaluated in comparison with the contralateral normal shoulder. Bone scan demonstrated hypervascularity in 9 of the 21 patients (43%), whereas increased osteoblastic activity was detected in 19 (90%) in the affected shoulder. Tc-99m HIG uptake was positive in 12 (57%), and negative in 9 (43%) patiens. All patients with increased Tc-99m HIG accumulation in the affected shoulder, also had increased osteoblastic activity on Tc-99m bone scintigraphy. A significant correlation was found between HIG uptake and constant, functional and pain scores. The difference between these scores was also statistically significant in patients with HIG positive and negative uptake. This study indicates that there is a good correlation between Tc-99m HIG scan findings and clinical scores. Tc-99m HIG accumulation in the affected shoulder may be related to continuing inflammatory reaction to AC. Tc-99m HIG scan may be a noninvasive, complementary method for demonstrating continuing inflammatory changes and may help in staging the disease.

The droopy shoulder syndrome.

Abstract Droopy shoulder syndrome (DSS) is characterized by a depression of the shoulders that stretches the brachial plexus, thus causing pain without any signs of neurological impairment. We describe ten patients with DSS; all had been treated for different diagnoses before. Contrary to previous reports, three patients had unilateral involvement, and five had accompanying disease of the cervical-shoulder region. All patients responded well to conservative treatment in 2–10 weeks. DSS must be kept in mind in the differential diagnosis of pain in the cervical-shoulder region, to prevent unnecessary medication.

An atypical psoriatic spondylitis case, successfully treated with methotrexate

SummaryWe present a 45 - year-old male patient who was hospitalized with lumbar disc herniation and whose control magnetic resonance imaging (MRI) findings initially suggested brucella spondylitis. Definitive diagnosis, however, indicated psoriatic spondylitis and the patient was succesfully treated with methotrexate. A diagnosis of lumbar disc herniation was made in May 1991, during his psoriasis vulgaris treatment. He was hospitalized in August 1994 with a complaint of low-back pain persisting over the last six months despite treatment with analgesics. He was evaluated by clinical, radiological, laboratory and scintigraphic methods, following control MRI findings suggesting infection of vertebral bodies, particularly pointing to brucellosis in addition to disc herniation. A diagnosis of psoriatic spondylitis was finally established and 7.5 mg methotrexate weekly was administered. Significant improvement was obtained of psoriatic skin lesions, low-back pain and MRI findings through a six-month treatment period.

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.