Selmin Gulbahar

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.

The efficacy of conservative treatment in patients with full-thickness rotator cuff tears

Rotator cuff tears are a common cause of shoulder pain and disability. Although many studies have reported about the surgical results of full-thickness tears of the rotator cuff, there are few studies about the efficacy of conservative treatment. The aim of this study was to investigate the efficacy of conservative treatment in patients with full-thickness rotator cuff tears by using objective and subjective measurements. Twenty patients with full-thickness rotator cuff tears were included in the study. Outcome measures were range of motion, pain and function according to the shoulder index of the American Shoulder and Elbow Surgeons (ASES), Constant score, Short-Form 36 Health Survey (SF-36), isokinetic shoulder strength, and patient response. Patients were assessed at baseline and after 6xa0months. In addition, patients were contacted by telephone at 1xa0year and at 3xa0years for functional assessment according to ASES, and patient response. The treatment protocol included activity modification, oral nonsteroidal antiinflammatory medications, physical modalities, and a specific exercise program. Statistically significant improvements were obtained in range of motion, pain and function scores according to ASES, Constant score, SF-36 scores, and isokinetic strength (Pxa0<xa00.05). At the 6-month evaluation, 11 patients (55%) reported that they were “much better”, and 9 patients (45%) “better”. Conservative treatment of full-thickness rotator cuff tears yields satisfactory results both subjectively and objectively.

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.

Efficacy of EMG-biofeedback in knee osteoarthritis

This study was designed to investigate the additive effect of EMG-biofeedback in rehabilitation of knee osteoarthritis. Forty patients, aged 45–70, with the diagnosis of knee osteoarthritis according to American College of Rheumatology (ACR) criteria were taken into the study. The patients were randomly assigned in two groups. One group (nxa0=xa020) received strengthening exercise program with EMG-biofeedback while the other group (nxa0=xa020) had the same exercise program without biofeedback for 3xa0weeks. The clinical outcome was assessed on the basis of pain with visual analog scale (VAS), function with Western Ontario McMaster Osteoarthritis Index (WOMAC) and quality of life with Nottingham Health Profile (NHP). Quadriceps strength was measured with Cybex isokinetic dynamometer, isokinetically at the angular velocities of 60 and 180°/s and isometric strength at 65° of knee flexion. Pain, WOMAC scores and muscle strength improved in both groups but there was no statistically significant differences between two groups (pxa0>xa00.05). In both groups physical mobility, pain scores of NHP improved significantly (pxa0<xa00.001) while in EMG-biofeedback group energy and sleep scores also improved after treatment (pxa0<xa00.05). As reported in the literature, in our study, strengthening exercises improved pain, function, muscle strength and quality of life in patients with knee osteoarthritis. But it seems that there is no significant additive effect of EMG-biofeedback to regular strengthening exercise program in these patients.

The reliability and validity of the Turkish version of the Western Ontario Rotator Cuff Index.

To adapt the Western Ontario Rotator Cuff (WORC) index for use in Turkey and to investigate its reliability and validity; 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 were also evaluated by using the University of California Los Angeles (UCLA) shoulder rating scale, Constant score, and Short Form (SF)-36 to test validity. The WORC questionnaire was repeated in 35 patients after a mean interval of 2.9 days (range 2–7 days) to evaluate test–retest reliability. Cronbach’s alpha was calculated as 0.92 for the total questionnaire. The intraclass correlation coefficients were very high and ranged between 0.96 and 0.98 for each section. There was a significant negative correlation between the Turkish version of WORC and UCLA (rxa0=xa0−0.598, Pxa0<xa00.01), Constant score (rxa0=xa0−0.630, Pxa0<xa00.01), and all subscales of SF-36 (Pxa0<xa00.01). The Turkish version of the WORC index is a reliable and valid instrument for use in clinical trials in patients with rotator cuff disorders.

Anxious personality is a risk factor for developing complex regional pain syndrome type I

The aim of this study was to investigate the role of psychological factors in the development of complex regional pain syndrome (CRPS) type I following the fracture of the distal radius. Fifty patients (average age 57.70xa0±xa013.43xa0years) with a distal radius fracture were enrolled in the present study. All of the patients were treated by closed reduction and cast immobilization. The Toronto Alexithymia Scale-20, Anxiety Sensitivity Index, State-Trait Anxiety Inventory, and Beck Depression Inventory were used to determine the patients’ psychological features 2xa0days after the fracture. The patients were followed for 2xa0months after cast immobilization was completed using the International Association for the Study of Pain criteria to diagnose CRPS type I. CRPS type I developed in 13 (26%) patients of the 32 (34.4%) female patients and 18 (11.1%) male patients. The risk of CRPS type I was significantly increased in patients with high trait anxiety scores (Pxa0=xa00.038). The results show that, after fracturing the distal radius, patients who have an anxious personality have a higher risk of developing CRPS type I. Following these patients closely for the development of CRPS type I may be advantageous for early preventative and therapeutic interventions.

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.

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

OBJECTIVESnThe 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.nnnMETHODSnThe 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.nnnRESULTSnThere 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.nnnCONCLUSIONnWe 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

OBJECTIVEnTo evaluate the efficacy of paraffin bath therapy on pain, function, and muscle strength in patients with hand osteoarthritis.nnnDESIGNnProspective single-blinded randomized controlled trial.nnnSETTINGnDepartment of physical medicine and rehabilitation in a university hospital.nnnPARTICIPANTSnPatients with bilateral hand osteoarthritis (N=56).nnnINTERVENTIONSnPatients 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.nnnMAIN OUTCOME MEASURESnThe 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.nnnRESULTSnAt 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).nnnCONCLUSIONSnParaffin 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.

Functional outcome in patients with zone V flexor tendon injuries

IntroductionZone V flexor tendon injuries may involve major nerves and arteries as well as the wrist and finger flexors. Although these injuries are not infrequent, few studies have reported functional outcomes. The purpose of this study was to evaluate the functional outcome in patients with flexor tendon repairs in zone V.Materials and methodsEighteen patients with repaired zone V flexor tendon injuries were followed up for an average of 20xa0months. The postoperative rehabilitation program consisted of a combined regime of modified Kleinert and modified Duran techniques. Outcome parameters were hand function according to the Buck-Gramcko assessment system, grip and key pinch strength values, and return to work status.ResultsFunctional results were excellent in 92.8% of the digits, good in 1.4%, and poor in 5.8%. Grip strength recovered to an average of 77% and pinch strength to 74% of the uninjured hand. Two tendon ruptures occurred in a patient, and tenolysis was required in 3 patients. Of 15 patients who were employed at the time of injury, 13 returned to their original occupations.ConclusionSatisfactory functional results can be obtained when proper surgical technique is coupled with careful postoperative management in patients with zone V flexor tendon injuries.