Sedat Tolga Aydoğ

Evaluation of dynamic postural balance using the Biodex Stability System in rheumatoid arthritis patients

The aim of this study was to investigate dynamic postural balance in patients with rheumatoid arthritis (RA) in relation to the disease characteristics. Seventy-four patients with RA and 42 controls of the same age group were tested using the Biodex Stability System (Biodex Medical Systems, Shirley, NY, USA). Anterior/posterior (AP), medial/lateral (ML), and overall (OA) indices were obtained with bilateral stance at platform stabilities of 2 and 8. Subjects were tested with “eyes open” at all times. At the same time, Disease Activity Score, functional disability [Health Assessment Questionnaire, (HAQ)], and Steinbrocker Functional Class (SFC) were assessed. Both the AP and OA indices in the RA group were significantly higher than in the control group for level 8. For OA index, the results were 2.7±0.9 in RA and 2.2±0.7 in the control group (p=0.006), and for AP index, the results were 2.1±0.7 in RA and 1.7±0.6 in the control group (p=0.002). Eleven patients (15.9%) and three controls (7.1%) could not complete the test at level 2. When the patients and controls who completed the test were compared, a significant difference was found only in the ML index. The results were 4.6±2.4 in RA and 3.8±1.6 in the control group (p=0.047). A positive correlation between HAQ and postural balance for all three stability indices at level 8 was detected. A positive correlation between SFC and postural balance for OA and ML at level 8 was also found. Multiple linear regression analyses revealed age and body mass index (BMI) to be the most important factors influencing postural dynamic balance at both levels in the RA group and in healthy controls. RA has a negative effect on dynamic postural stability. The functional status affects dynamic balance more than disease activity. Age and BMI were the most important factors influencing postural dynamic balance in the RA group and in healthy controls. Level 2 does not appear to be an appropriate level for evaluating postural stability in RA.

Reliability of isokinetic ankle inversion- and eversion-strength measurement in neutral foot position, using the Biodex dynamometer

This study was designed to investigate the intratester and intertester reliability of isokinetic ankle inversion and eversion-strength measurement in neutral foot position in healthy adults using the Biodex dynamometer. Twenty-five men and women performed five maximal concentric contractions at 60 and 180°/s angular velocities. Two physicians tested each subject. The first physician applied the test four times, and the second physician three times. Reliability of peak torque was assessed by calculating the intraclass correlation coefficient (ICC). At both angular velocities, inversion strength was greater than eversion, and when the angular velocity was increased, inversion and eversion strength were decreased, as tested by both physicians. The first measurements of inversion and eversion strength of the first physician were significantly lower than the other measurements (p<0.01). The intratester ICCs for ankle inversion in healthy young adults were highly reliable (ICC 0.92–0.96), and for the eversion values ranged from 0.87 to 0.94. Intertester ICCs for ankle inversion and eversion peak torque values demonstrated a value of 0.95. Isokinetic tests of ankle inversion and eversion strength at 60 and 180°/s angular velocities in neutral foot position for healthy adults are highly reliable with the Biodex dynamometer.

Differences in sole arch indices in various sports

Background: There are controversial data about the relation between foot morphology and athletic injuries of the lower extremity. Studies in soldiers have shown some relationship, whereas those involving athletes have not shown any significant relationship. The reason for these differences is not clear. Objective: To determine the effect of various sports on sole arch indices (AIs). Method: A total of 116 elite male athletes (24 soccer players, 23 wrestlers, 19 weightlifters, 30 handball players, and 20 gymnasts) and 30 non-athletic men were included in this cross sectional study. Images of both soles were taken in a podoscope and transferred to a computer using a digital still camera. AIs were calculated from the stored images. Results: The AI of the right sole of the gymnasts was significantly lower than that of the soccer players, wrestlers, and non-athletic controls (p<0.01). The AI of the right sole of the wrestlers was significantly higher than that of the soccer players, handball players, weightlifters, gymnasts, and non-athletic controls (p<0.03). The AI of the left sole of the gymnasts was significantly lower than that of the wrestlers and non-athletic controls (p<0.001). The AI of the left sole of the wrestlers was significantly higher than that of the soccer players, handball players, and gymnasts (p<0.007). The AI of both soles in handball players was significantly lower than those of the non-athletic subjects (p  =  0.049). The correlation between the AI of the left and right foot was poor in the soccer players, handball players, and wrestlers (r  =  0.31, 0.69, and 0.56 respectively), but was high in the gymnasts, weightlifters, and non-athletic controls (r  =  0.96, 0.88, and 0.80 respectively). Conclusion: The AIs of the gymnasts and wrestlers were significantly different from those of other sportsmen studied, and those of the gymnasts and handball players were significantly different from those of non-athletic controls.

Relation between foot arch index and ankle strength in elite gymnasts: a preliminary study.

Background: Gymnasts usually start intensive training from early childhood. The impact of such strenuous training on the musculoskeletal system is not clear. Objectives: To evaluate the relation between muscle strength of the ankle joint and foot structure in gymnasts. Methods: The study population comprised 20 high level male gymnasts and 17 non-athletic healthy male controls. Arch indices were measured using a podoscope. Ankle plantar/dorsiflexion and eversion/inversion strengths were measured using a Biodex 3 dynamometer within the protocol of concentric/concentric five repetitions at 30°/s velocity. Results: The mean arch index of the right and left foot of the gymnasts and the controls were respectively: 31.4 (29.1), 34.01 (34.65); 60.01 (30.3), 63.75 (32.27). Both the arch indices and the ankle dorsiflexion strengths were lower in the gymnasts. Although no correlation was found between strength and arch index in the control group, a significant correlation was observed between eversion strengths and arch indices of the gymnasts (r  =  0.41, p  =  0.02). Conclusions: Whether or not the findings indicate sport specific adaptation or less training of the ankle dorsiflexors, prospective data are required to elucidate the tendency for pes cavus in gymnasts, for whom stabilisation of the foot is a priority.

Paget-Schroetter Syndrome Forerunning the Diagnoses of Thoracic Outlet Syndrome and Thrombophilia:

Reported here is a 22-year-old professional wrestler who was diagnosed to have Paget-Schroetter syndrome after Greco-Roman wrestling. On substantial neuromuscular examination and laboratory testing, he was found to have also thoracic outlet syndrome and heterozygous mutations for factor V Leiden and methyltetrahydrofolate reductase genes. To the best knowledge of the authors, the concomitance of these pathologies is discussed for the first time in the literature.

Rectus muscle strain akin to a mass lesion of the thigh: sonography distinguishes the nuance.

A 16-yr-old boy was seen for a palpable mass in his left thigh for the previous 2–3 wks. He denied having any concomitant pain, and the medical history was otherwise unremarkable. During physical examination, the lower limbs were found to be symmetric. The mass could not be visualized when he was standing or sitting in a relaxed position; but as he contracted the left quadriceps muscle, a 3-cm 3-cm bulging mass could easily be observed. Results of the neurological examination of the lower limbs were normal. Radiographs of the thigh were noncontributory. Muscle sonography was performed, and it was consistent with a partial tear of the rectus femoris muscle during dynamic examination (Fig. 1). A home-based regimen, including stretching and isometric strengthening exercises for rectus femoris muscle, was prescribed. A mass lesion found during the musculoskeletal examination of an adolescent patient always poses challenges to the clinician because soft tissue sarcomas or some other malignant disorders need to be excluded. Moreover, the wide spectrum of differential diagnoses also comprises some benign diseases, including infection, hematoma, lipoma, fibroma, hygroma, and some vascular tumors. However, muscle strain is another benign pathology that can easily be misdiagnosed, unless physicians are familiar with it. There are several reports in the literature that mention patients who were seen by oncologists and who had even undergone muscle biopsies before their correct diagnoses of simple strains were made. It is important to get a detailed medical history so that the subset of patients in whom a specific episode of trauma is absent are not overlooked. The authors, by means of this report, emphasize the role of muscle sonography which, in the hands of experienced clinicians, can provide dynamic imaging and comparison with the normal side.