Teoman Aydin

Bone loss in the contralateral asymptomatic hand in patients with complex regional pain syndrome type 1

Regional osteoporosis was seen radiographically in clinically affected areas in patients with complex regional pain syndrome type 1 (CRPS1). The aim of the this study was to investigate whether bone loss developed in the contralateral hand in patients with unilateral CRPS1 of the hand. Thirty-two patients with CRPS1 of the hand were included in this study. Bone mineral density was measured in the left proximal femur and both ultradistal radiuses, using dual-energy X-ray absorptiometry. The subjects were classified as grades 1 to 3 according to the T-score of both ultradistal radiuses (densitometric grades): grade 1, both radiuses were normal; grade 2, bone loss was determined only in the affected radius; and grade 3, there was bone loss in both radiuses. Twenty (62.5%) patients had bone loss in the affected hand; 11 patients (34.4%) had bone loss only on the affected side and 9 patients (28.1%) had bone loss on both sides. The mean duration of the period between the diagnosis of the injury and the measurement of bone density was 1.9 ± 0.6 months in patients with grade 1, 3.1 ± 1.0 months in patients with grade 2, and 5.5 ± 2.2 months in patients with grade 3. The Spearman test showed a significant correlation between the period of injury and the densitometric grade (R = 0.774; P = 0.0001). In conclusion, the current study of patients with CRPS1, showed that the bone loss in the asymptomatic contralateral hand developed at a later stage than that in the affected hand. This bone loss was less frequent and of a lower degree in the asymptomatic contralateral hand than in the affected hand. The bone loss in the asymptomatic contralateral hand could be explained by the loss of sympathetic tone in CRPS1 and contralateral sympathetic innervation.

Bone loss in males with ankylosing spondylitis: its relation to sex hormone levels

Objective  Osteoporosis is a common complication of ankylosing spondylitis (AS). The aim of the present study was to assess the association of sex hormone levels with bone loss in males with AS.

Bone mineral density evaluation of patients with type 2 diabetes mellitus.

[Purpose] Diabetes mellitus is a metabolic disorder resulting from a defect in insulin secretion, insulin action, or both. A consequence of this is chronic hyperglycemia with disturbances in carbohydrate, fat and protein metabolism. We investigated whether there is any difference among DM patients and a control group in terms of lumbar and femur BMD (bone mineral density), and standard deviation scores (Z score and T score). [Subjects and Methods] This randomized, prospective, controlled, single-blind study was conducted in the Physical Medicine and Rehabilitation Department Faculty of Medicine, Bezm-i Alem Vakıf University. Patients with type 2 diabetes mellitus were included in the patient groups. Healthy individuals were included in the control group. [Results] A total of 126 patients completed the study (63 in the study group, 63 in the control group). There was no significant difference in the results of the laboratory examinations of the cases. The bone mineral densities of the cases were found to be significantly low in terms of the lumbar (L1–4) T scores in the type 2 diabetes group. [Conclusion] Although osteoporosis is one of the potential complications of type 1 diabetes, its effect on bone mineral density in type 2 DM is controversial. In different studies, the bone mineral density values have increased, decreased or remained normal. With the exception of the lumbar (L1–4) T score, similar results were obtained in this study.

Upper Extremity Problems in Doner Kebab Masters

[Purpose] Doner kebab is a food specific to Turkey; it is a cone-shaped meat placed vertically on a high stand. The doner kebab chefs stand against the meat and cut it by using both of their upper extremities. This work style may lead to recurrent trauma and correspondingly the upper extremity problems. The aim of this study was to investigate the upper extremity disorders of doner chefs. [Subjects and Methods] Doner kebab chefs were selected as the study group, and volunteers who were not doner kebab chefs and didn’t exert intense effort with upper extremities their business lives were selected as the control group. A survey form was prepared to obtain data about the participants’ ages, working experience (years), daily work hours, work at a second job, diseases, drug usage, and any musculoskeletal (lasting at least 1 week) complaint in last 6 months. [Results] A total of 164 individuals participated in the study, 82 doner chefs and 82 volunteers. In 20.6% of the study group and 15.6% of the control group, an upper extremity musculoskeletal system disorder was detected. Lateral epicondylitis was more frequently statistically significant in the work group. [Conclusion] Hand pain and lateral epicondylitis are more frequent in doner chefs than in other forms of business.

Functional limitations due to foot involvement in spondyloarthritis.

[Purpose] Spondyloarthritis is a major inflammatory disease followed-up in the rheumatology clinics, foot involvement in spodyloarthritis is common. The functional states of patients with spondyloarthritis are usually evaluated globally. The aim of this study was to assess the foot involvement-related functional limitations in patients with spondyloarthritis. [Subjects and Methods] Patients with ankylosing spondylitis and psoriatic arthritis with foot pain more than 4 weeks who underwent anteroposterior and lateral feet radiography were enrolled into the study. A “clinical findings score” was calculated by assigning 1 point for every finding of swelling, redness, and tenderness. C-reactive protein and erythrocyte sedimentation rate were used as serum markers for disease activity. Foot radiograms were evaluated using the spondyloarthropathy tarsal radiographic index and the foot-related functional state of patients was determined by the Turkish version of the Foot and Ankle Outcome Score. [Results] There were no relationships between Foot and Ankle Outcome Score subscales and clinical findings score, serum markers, or radiologic score. Pain and symptoms subscale scores were result positively correlated with activity of daily living, sport and recreation, and quality of life subscale scores. [Conclusion] Pain and symptoms are the main determinants of foot-related functional limitations in spondyloarthritis.

Somatosensory Evoked Potential Findings in Ankylosing Spondylitis

OBJECTIVE Somatosensory evoked potential (SSEP) abnormalities were reported in patients with ankylosing spondylitis (AS). This study aimed to investigate SSEP abnormalities and its relation with clinical findings in AS patients. MATERIALS AND METHODS The study included 26 patients with AS and 17 age-matched health volunteers (Control for SSEP). Median nerve SSEP findings were normal in all AS cases. RESULTS However, delayed latency and/or very low amplitude of tibial nerve SSEP was found in 20 (76.9%) AS patients. There were significant correlations between tibial SSEP latency and disease duration (R=0.433 to 0.635). There was also an inverse correlation between tibial SSEP amplitude and disease duration (R=-0.429, p=0.047). Serum estradiol level, hip total bone mineral density, The Bath Ankylosing Spondylitis Functional Index (BASFI) score and Beck depression score were significantly lower in AS patients with SSEP abnormalities (37.3±10.8 pg/mL, 0.916±0.123 g/cm(2), 35.0±27.9, 12.8±8.4, respectively) than in AS patients without SSEP abnormalities (53.7±12.3 pg/mL, 1.103±0.197 g/cm(2), 64.8±15.5, 24.8±10.1, respectively). CONCLUSION Significant inverse correlations between SSEP latencies and dehydroepiandrosterone sulphate (DHEAS) levels were found (R=-0.400 to -0.713). There were also significant inverse correlation between SSEP latencies and DHEAS/oestrogen index (R=-0.596 to -0.868), and between SSEP latencies and DHEAS/Progesterone index (R=-0.467 to -0.685). As a conclusion, this study indicates that tibial nerve SSEP abnormalities are common in patients with AS and there are significant correlations between clinical findings of AS and SSEP abnormalities.

Alteration of Facet Joint Orientation and Asymmetry With Time in Lumbar Disc Herniation

In the previous studies, the facet tropism and its relation to the development of lumbar disc herniation (LDH) were investigated. However, these studies have shown inconsistent conclusions. The aim of this study was to investigate the alteration of facet joint angle and (a)symmetry in LDH. Fifty-four patients with LDH were included. In the first and second computed tomography images, all facet angles were measured from the similar axial slice by the same observer who was blinded with regard to the date of computed tomography scan. Total reproducibility of the variability was found to be ±1.85 degrees. Thirty-one patients had a change in the orientation of at least 1 facet joint. The mean rate of the change in the facet orientation varied from 2.69 to 3.63 degree/y. The most common observed change in the orientation was sagittalization. Females, taller patients, cases with median herniation, and patients with longer course of LDH had a higher risk of this change (P=0.011). The facet asymmetry was found to develop in 7 patients and to recover in 7 patients (P=0.002). The facet orientation could change and the facet asymmetry could develop or recover in the same patient with time in LDH. These results could explain contradictory results in the literature.

Functional independence measure scores of patients with hemiplegia followed up at home and in university hospitals

[Purpose] Our purpose was to create awareness among of social rehabilitation at the university and in local governments, to identify gaps in social rehabilitation, and to increase the effectiveness of social rehabilitation. [Subjects and Methods] This study included stroke patients undergoing physical rehabilitation from the stroke outpatient clinic (43 patients) and the Istanbul Metropolitan Municipality Home Care Service (101 patients); face-to-face interviews were conducted to collect patient information regarding nutritional status. In addition, baseline functional independence measure (FIM) scores at baseline and during three months of follow-up were also compared. [Results] The average FIM motor scores at three months did not differ significantly between the home and hospital treatment groups. However, there were significant differences in baseline FIM motor and cognitive scores and three-month follow-up scores as well as average FIM total baseline scores between groups. In addition, month-to-month analysis of changes in FIM values between the two groups also revealed significant differences. [Conclusion] The results of our study were concordant with those of previous studies of stroke patients receiving rehabilitation, in demonstrating improved patient functional and cognitive capacity.

Evaluation of the effectiveness of home based or hospital based calisthenic exercises in patients with ankylosing spondylitis

OBJECTIVE The aim of this study is to evaluate the effects of calisthenic exercises on functionality, mobility, disaese activity, quality of life, and psychological status in patients with Ankylosing spondylitis (AS). METHODS Prospective analysis of forty patients diagnosed with AS were randomized into two exercise groups. AS patients having diagnosis based on 1984-modified New York criteria were involved. Patients were given 8 weeks calisthenic exercise program. Outcome measures including the Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI), Bath AS Metrology Index (BASMI), AS Quality of Life Questionnaire (ASQoL), Bath AS Patient Global Score (BAS-G) Hospital Anxiety Depression Score (HADS), erythrocyte sedimentation rate (ESR) and the serum C-reactive protein (CRP) levels were assessed at the baseline and at 8 weeks. RESULTS Thirty-seven participants completed the exercise programme. After the 8-week exercise programme, the home-based exercise group showed significant improvement in ESR levels and hospital-based exercise group showed significant improvements in terms of the BASMI and HADS-A scores. CONCLUSION Calisthenic exercises can be easily performed both at home and in hospital setting. In patients with AS, calisthenic exercises performed at the hospital may improve the mobility, and psychological status (anxiety).

Concomitance of fibromyalgia syndrome and cervical disc herniation

[Purpose] Fibromyalgia syndrome (FMS) and cervical disc herniation (CDH) are a common diseases commonly encountered in physical therapy clinics. There are also patients who have both of these diseases. In this study we aim to investigated whether FMS is a risk factor for cervical disc herniation and the frequency of their coincident occurrence. [Subjects and Methods] Thirty-five patients having a primary FMS diagnosis according to the American Rheumatism Association criteria are taken into consideration and a control group were the subjects of this study. The two groups were compared with respect to cervical disc hernia using cervical region MRI. [Results] The distribution of disc hernia of 6 fibromyalgia patients who had cervical discopathy was: 16.6% C2–3, 16.6% C5–6, 16.6% C6–7, 33.3% C4–5, C5–6 (two levels in two patients) and 16.6% C4–5, C5–6, C7–1 (three levels in one patient) . The herniation directions were given as: central in 5 levels, right paramedian in 1 level, and left paramedian disc hernia in 1 level. There were 4 cervical disk hernia in the control group. The herniation direction were central in two, right paramedian in one, and left paramedian in one patient. [Conclusion] In this study, the existence of cervical disc herniation in fibromyalgia patients was found to be not different from the normal population.