Pinar Akpinar

Reliability of the Spinal Cord Assessment Tool for Spastic Reflexes

OBJECTIVEnTo assess the reliability of the Spinal Cord Assessment Tool for Spastic Reflexes (SCATS).nnnDESIGNnObservational reliability study of the SCATS.nnnSETTINGnInpatient rehabilitation unit at an education and research hospital.nnnPARTICIPANTSnSubjects (N=47) between the ages of 18 and 88 years with spinal cord injury (SCI) and with American Spinal Injury Association Impairment Scale grades from A to D with spasticity, who were at least 6 months postinjury.nnnINTERVENTIONSnNot applicable.nnnMAIN OUTCOME MEASURESnInterrater and test-retest reliability of the SCATS.nnnRESULTSnThe SCATS had substantial to almost perfect interrater agreement (κ=.669-1.000) between the 2 physiatrists. Test-retest agreement of the SCATS was also substantial to almost perfect (κ=.614-1.000) as well. There was a significant correlation between the SCATS clonus scores and the Modified Ashworth scores of the hip, knee, and ankle. No correlation was found between SCATS extensor spasm scores and Modified Ashworth scores. The SCATS flexor spasm scores were only correlated significantly with the ankle plantar flexor Modified Ashworth scores (P<.05).nnnCONCLUSIONSnThe SCATS is a reliable tool for assessing spasm activity and spastic hypertonia in patients with SCI.

Kinesiotaping as an alternative treatment method for carpal tunnel syndrome

BACKGROUND/AIMnCarpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Conservative treatment choices are not always satisfactory. The aim of this study was to investigate the effect of kinesiotaping (KT) on pain level, grip strength, and functional status compared with that of placebo KT and orthotic device (OD) in patients with CTS.nnnMATERIALS AND METHODSnIn this randomized, placebo-controlled study, participants were allocated into one of three groups: an experimental KT group (Group 1), a placebo KT group (Group 2), and an OD group (Group 3). Visual analogue scale (VAS) and Douleur Neuropathique 4 (DN4) scores, dynamometric grip strength measures, and the Boston CTS questionnaire (BQ) were the outcome measures.nnnRESULTSnAll groups significantly improved in terms of VAS scores (P < 0.05), DN4 scores (P < 0.05), and BQ scores (P < 0.05). Grip strength improved in Group 3 (P = 0.001). There was a significant difference among the groups with respect to BQ scores (P < 0.05).nnnCONCLUSIONnKT application for the treatment of CTS should be an alternative treatment choice.

Irreversible Foot Drop as a Consequence of Neglected Knee Pain in an Adolescent with a Peroneal Intraneural Ganglion Cyst

BACKGROUNDnPeroneal intraneural ganglion cysts (IGCs) are nonneoplastic lesions. They are responsible for a small number of footdrop cases, which occur after additional nerve damage. The earliest patient symptom related to IGCs is knee pain.nnnCASE DESCRIPTIONnA 17-year-old boy developed pain in the left knee, which progressively worsened over 14 months. He did not seek any medical assistance during this time. The patient subsequently was involved in a bicycle accident, and 3 months later he was unable to raise his left foot and was referred to our clinic for footdrop. Surgery was performed, but the weakness persisted. We could not detect any functional reinnervation on electromyography 12 months after surgery.nnnCONCLUSIONSnThe most important factors in determining the prognosis of IGCs are the extent of the nerve trauma and the early diagnosis and treatment of the IGC. Detection of almost complete functional denervation on electromyography may indicate that it is too late for surgery.

Pregnancy-related osteoporotic vertebral compression fractures in two patients treated with low-molecular-weight heparin during pregnancy: case reports

Abstract Pregnancy-related osteoporosis (PRO) is an uncommon metabolic bone disease that can result in vertebral fragility fractures. Here we report two cases of young women who had been previously treated with LMWH-enoxaparin and were diagnosed with PRO with vertebral fragility fractures after delivery. In first case report, a 33-year-old primigravid woman who was treated with 40u2009mg/day of enoxaparin for eight months to prevent venous thromboembolism was presented. After delivery, Dual energy X ray absorptiometry (DEXA) revealed osteoporosis in lumbar and femoral neck region. In magnetic resonance imaging (MRI), T4–T7 thoracic vertebral height losses were detected. In second case report, a 28-year-old primigravid woman which was treated with 40u2009mg/day enoxparin from the second month to the birth was presented. Osteoporosis in lumbar region was detected by DEXA. MRI revealed T12–L1 and L5 vertebral height losses. In conclusion, PRO can cause severe low back pain and should be considered in differential diagnosis. A detailed medical history should be essential to detect relationship between LMWH and PRO.

Effect of bone mineral density on lumbar discs in young adults: A case–control study

Abstract Bone mineral density (BMD) might be a risk factor for lumbar disc herniation (LDH) in young adults, but there is not enough data concerning this effect. Several studies have been performed on elderly and osteoporotic patients. Thus, we aimed to investigate the effect of BMD on the etiopathogenesis of LDH in young adults. One hundred patients (mean age: 38.45u200a±u200a8.92 years; 50 men and 50 women) were enrolled this case–control study and classified into 2 groups, as follows. The case group (G-I) included 50 patients with symptomatic LDH who were hospitalized in the Physical Medicine and Rehabilitation Clinic, and the control group (G-II) included 50 patients with lower back pain but no finding of LDH detected using magnetic resonance imaging. Patients in the G-II were recruited among those admitted to the outpatient clinic at the time of the study, and whose age and sex were matched to those of the study group. Women in menopause were excluded from the study. BMD analysis by dual energy x-ray absorptiometry was performed in both groups. The mean values of the femur neck and lumbar spine BMD were 1.02u200a±u200a0.13 and 1.19u200a±u200a0.14u200ag/cm2, respectively. There was no statistically significant relationship between BMD and LDH in this population. This result may mean that in a normal range, BMD does not exert a compressive load on the lumbar discs in young adults and therefore may not lead to LDH by this mechanism and the load.

Reliability and cross-cultural adaptation of the Turkish version of the Spinal Cord Injury Spasticity Evaluation Tool.

The Spinal Cord Injury Spasticity Evaluation Tool is a 7-day recall self-reported questionnaire that assesses the problematic and useful effects of spasticity on daily life in patients with spinal cord injury (SCI). We aimed to determine the reliability and cross-cultural validation of the Turkish translation of the Spinal Cord Injury Spasticity Evaluation Tool (SCI-SETT). After translation and back translation of the Spinal Cord Injury Spasticity Evaluation Tool, 66 patients between the ages of 18 and 88 years with SCI, American Spinal Injury Association impairment scale grades from A to D with spasticity, and at least 6 months after injury were assessed. Participants rated the SCI-SETT at the same time period of the day, 1 week apart, and test–retest agreement was investigated. Also, the Penn Spasm Frequency Scale, self-assessment of spasticity severity, self-assessment of spasticity impact, Functional Independence Measure motor subscale, and 36-Item Short Form Health Survey were assessed for the evaluation of the convergent validity. There were 45 participants with tetraplegia and 21 patients with paraplegia. The test–retest reliability for the SCI-SETT was good. The intraclass correlation coefficient was 0.80 at 95% confidence interval. There were no significant correlations between the SCI-SETT scores and Functional Independence Measure motor subscale and Penn Spasm Frequency Scale scores. There was a significant correlation between the SCI-SETT scores and vitality scores of the 36-Item Short Form Health Survey. The SCI-SETT showed statistically significant correlations with other measures including self-assessed spasticity severity and self-assessed spasticity impact (P<0.05). The SCI-SETT is a reliable self-rating tool for assessing spasticity in patients with SCI in the Turkish population.

SAT0595 Effectiveness of short wave diathermy treatment in patients with subacromial impingement syndrome and value of night pain on patient selection: a double-blind, randomized, placebo-controlled trial

Background Shoulder impingement syndrome (SIS) is a common causes of shoulder pain and the night pain is a frequent symptom of this condition (1,2). Short wave diathermy (SWD) is a deep diathermic agents used in the treatment of musculoskeletal system disorders. Local inflammation could be the major cause of night pain, and using a deep diathermic modality might be contradictory. Objectives Investigation of the effectiveness of short wave diathermy SWD treatment in patient with SIS and to emphasize the significance of night pain (NP) status on treatment response. Methods In this double-blind, randomized placebo controlled trial, 57 patients aged between 35 to 65 years, diagnosed as SIS were classified into two groups as night pain positive NP(+) (n=28) and night pain negative NP(-) (n=29). Both groups were randomly assigned to SWD treatment NP(+) n=14, NP(-) n=14 and sham NP(+) n=15, NP (-) n=14 subgroups. Exercise, cold pack application and a non-steroidal anti-inflammatory drug treatment were applied to all groups. 27.12 MHz continuous SWD (daily 20 min per session, 5 days per week, for 2 weeks, 10 sessions) was applied to the treatment groups while sham SWD was applied to the sham groups with the same protocol. Rest, activity and night visual analog scale (VAS), Constant (Murley) Score (CS) and Shoulder Disability Questionnaire (SDQ) were used for evaluation of patients at 2 weeks before the treatment, 1 month and 2 months after the treatment. Results There were no statistical differences between the SWD treatment and sham groups in all outcome parameters except for the Constant pain scores in NP (+) group. In NP(-) group, SWD treatment improved the parameters of pain, strength, total scores of CS, and SDQ compared to sham group at 1 month. SWD treatment was superior to sham for all parameters except for the Constant daily living activity scores at 2 months. Conclusions In conclusion, addition of 27.12 MHz continuous SWD treatment to conventional therapies provides long term benefits when compared to sham SWD in terms of rest and activity VAS scores, Constant-Murley scores, and SDQ scores in SIS patients without night pain. However, there was no convincing evidence that SWD treatment is of additional benefit in SIS patients with NP. Therefore; night pain as a symptom should be regarded in the selection of treatment modalities in order to use the deep heaters effectively in the management of SIS. References Van der Windt DA, Koes BW, de Jong BA, Bouter LM (1995) Shoulder disorders in general practice: incidence, patient characteristics, and management. Ann Rheum Dis 54(12), 959–964. Minns Lowe CJ, Moser J, Barker K (2014) Living with a symptomatic rotator cuff tear “bad days, bad nights”: a qualitative study. BMC Musculoskelet Disord 15:228. Disclosure of Interest None declared