Ramazan Kizil

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.

Regular Exercise Improves Outcome in Droopy Shoulder Syndrome: A Subgroup of Thoracic Outlet Syndrome

Objective: Droopy shoulder syndrome [DSS] is classified as a small subgroup of disputed neurogenic thoracic outlet syndrome and characterized by drooping of the shoulders which leads to traction on the brachial plexus. The effect of exercise seems controversial in DSS. The aim of this study is to evaluate the effect of exercise both on clinical and radiological outcome in DSS. Methods: Thirty-four patients referred to the physical medicine and rehabilitation outpatient clinic with DSS were included in this prospective follow-up study. Of these patients, five were lost to follow-up. All patients were given home exercises and followed up for 13.7 ± 5.0 months. The patients were divided into two groups with regard to their adherence to exercise programs as regular and irregular exercise groups. The clinical outcome was assessed on the basis of pain with visual analog scale, patients response to treatment, and radiographic changes. Results: At the end of the treatment when the two groups were compared, the patients doing regular exercise had a better improvement in pain scores [P = 0.002] and radiographic findings [P = 0.05] than the irregular exercisers. They also said they were much more satisfied with the treatment [P = 0.04]. Conclusion: Regular exercise improves outcome in DSS. Unlike previous reports, radiographic improvement can also be achieved if the objective evaluation is performed.

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.

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.

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.

439 DISTAL RADIUS FRACTURES AND COMPLEX REGIONAL PAIN SYNDROME TYPE I

A. Beerthuizen1 °, A. van ’t Spijker2, F.J.P.M. Huygen3, J. Klein4, J. Passchier2, D.L. Stronks1, R. de Wit5,6. 1Pain Expertise Center, Erasmus MC, Rotterdam; 2Department of Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam; 3Pain Treatment Center, Erasmus MC, Rotterdam; 4Department of Anesthesiology, Erasmus MC, Rotterdam; 5Department of Nursing Research, Faculty of Health Sciences, University of Maastricht; 6University Hospital Maastricht, The Netherlands