Tüzün Fırat

Neurodynamic mobilization in the conservative treatment of cubital tunnel syndrome: long-term follow-up of 7 cases.

OBJECTIVE The aim of this case series is to describe the effect of nerve mobilization techniques in the standard conservative management of cubital tunnel syndrome (CTS). METHODS Seven patients with CTS participated in this study. Inclusion criteria were having grade 1 and grade 2 entrapment neuropathy according to the McGowan grading system and no other neuropathies. In the evaluation, gripping with grip dynamometer; palmar gripping with a pinchmeter; pain level and Tinel sign with visual analog scale; sensibility with Semmes-Weinstein monofilaments; and functional status of the patients with the Turkish version of the Disability of Arm, Shoulder, and Hand Index were performed before starting a rehabilitation program, at the end of the 8-week rehabilitation program, and at 12-month follow-up. The physiotherapy program consisted of cold application, pulsed ultrasound, nerve mobilization techniques, strengthening exercises, postural adaptations, patient education, and ergonomic modifications. RESULTS Pain; Tinel sign; and Disability of Arm, Shoulder, and Hand Index scores were decreased, whereas grip and pinch strength increased in the observation period for these 7 patients. CONCLUSION This case series demonstrated that conservative treatment of CTS may be beneficial for selected patients with mild to moderate symptoms. The treatment included neurodynamic mobilizations, including sliding techniques and tensioning techniques, which are thought to enhance ulnar nerve gliding and restore neural tissue mobility. Conservative treatment using neurodynamic mobilization with patient education and activity modification demonstrated some long-term positive results.

Quality of life in mothers of children with obstetrical brachial plexus palsy.

Background:  The aim of this study was to explore impairment in quality of life (QOL) of the mothers who were primarily responsible for taking care of children with obstetrical brachial plexus palsy (OBPP) and to state its association with the age, sex and functional status of the child with OBPP.

Impact of obstetrical brachial plexus injury on parents

The aim of this study was to describe the impact of obstetrical brachial plexus palsy (OBPP) on parents and to investigate the effect of the severity of OBPP and the age of the children on parents.

Is the long sarcomere length responsible for non-traumatic supraspinatus tendinopathy? Potential novel pathophysiology and implications for physiotherapy

Several theories have been proposed to explain the mechanism of non-traumatic supraspinatus tendinopathy, which causes rotator cuff tendinitis and rotator cuff ruptures. However, these theories have not addressed all potential causes of rotator cuff tendinopathy. We propose that the microanatomy of the supraspinatus muscle and its response to gravity is the mechanism that responsible for non-traumatic supraspinatus tendinopathy and rotator cuff tears. Gravity causes chronic traction to the supraspinatus muscle, which results in elongation in the sarcomere length. Elongated sarcomere length causes compression on the micro vessels in the muscle which compromises internal microcirculation of the muscle and tendon. Poor microcirculation triggers ischemia and ischemia triggers inflammation process in the muscle and the tendon. This results in a higher incidence of tendinopathy. We also propose a new physiotherapeutic approach that may provide improved healing for rotator cuff tendinopathy.

Recovery of upper extremity function following endoscopically assisted contralateral C7 transfer for obstetrical brachial plexus injury.

Transfer of the contralateral C7 nerve for reconstruction of the brachial plexus in infants with obstetrical brachial plexus injury has rarely been reported. We developed a new endoscopy-assisted technique via the prevertebral (retroesophageal) route for the transfer of the contralateral C7 nerve in reconstruction of the brachial plexus. The reconstruction was performed in 20 infants (14 boys and six girls). Motor recovery was assessed using the Gilbert and Raimondi scales. The Narakas Sensory Grading System was used to evaluate hand sensation. The mean follow-up period was 45 months (SD 18.2). Of the 20 children, nine had contralateral C7 transfer to lower nerve roots, two had transfer to upper nerve roots and nine had transfer to both upper and lower roots. The postoperative shoulder and elbow functions were good or satisfactory according to the Gilbert classification in all children whose preoperative scores were poor. All patients with lower roots reconstruction (9) had satisfactory hand function. A total of 15 children had a Narakas score of S3. Our technique enables safe contralateral C7 transfer to the avulsed roots in severe obstetrical brachial plexus injury infants with a satisfactory functional recovery. Level of evidence: Level IV

Proprioception After Elbow Injury, Surgery, and Rehabilitation

Upper extremities do fine motor activities on a daily basis with high precision. In daily life, many activities such as writing, using computer, eating and dressing are being done repetitively. In order to do these activities function of elbow joint leads to change in hand position with flexion, extension, pronation and supination movements. To achieve this much preciseness in movement, proprioception is the key element. Even though elbow proprioception is not investigated comprehensively, it is a crucial element in rehabilitation of the whole arm.

How do physical capacity, fatigue and performance differ in children with duchenne muscular dystrophy compared with their healthy peers?

OBJECTIVE To compare the fatigue levels and energy expenditure of children with Duchenne Muscular Dystrophy (DMD) at different functional levels with healthy children. METHODS The cross-sectional study was carried out in the Unit of Pediatric Neuromuscular Diseases in the Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Hacettepe University between March 2015 and January 2016. Fifty two children diagnosed with DMD in Level I-III according to the Brooke Functional Classification Scale and 17 healthy children were included in the study. The Six Minute Walk Test (6MWT), Northstar Ambulatory Assessment Scale (NSAA), Physiological Cost Index (PCI), and Timed performance tests were used to assess the children. RESULTS Comparison in terms of PCI indicated a difference between Levels 2 and 3, and Levels 1 and 3 (p<0.0083). A difference was found in ascending and descending 4 stairs after 6MWT when fatigue after activity was evaluated. CONCLUSION The walking distances, fatigue levels and energy expenditure of DMD patients were higher than the healthy peers. This difference was more prominent with decreasing functional level.

Magnetic Resonance Imaging (MRI) of Snapping Scapula in a 10-Year-Old Boy

Summary Background Snapping scapula syndrome, also known as scapulothoracic crepitus or bursitis, is a manifestation of a mechanical abnormality of the scapulothoracic joint. In addition to characteristic findings on physical examination, magnetic resonance imaging (MRI) exquisitely reveals soft tissue changes such as muscle edema and scapulothoracic bursitis. Case Report We present a case of a 10-year-old boy who had snapping scapula syndrome of the right scapula that was associated with edema of the serratus anterior muscle at the scapulothoracic interface and with scapulothoracic, specifically supraserratus, bursitis on MRI. Conclusions MRI in snapping scapula syndrome, which is a clinical diagnosis, exquisitely reveals soft tissue changes such as muscle edema and scapulothoracic bursitis. Such soft tissue findings of snapping scapula syndrome need to be kept in mind while evaluating routine shoulder and/or scapular region MRI, especially in the absence of relevant clinical information at the time of the imaging study.

Restoration of function on bilateral absence of extensor pollicis longus and brevis: A case report

Gelis tarihi: 13.08.2012 Kabul tarihi: 23.09.2012 Gazi University Faculty of Health Sciences Department of Physiotherapy and Rehabilitation, PT, Assoc Prof*; Hacettepe University Faculty of Health Sciences Department of Physiotherapy and Rehabilitation, PT PhD**; PT, Prof ***; Gazi University Faculty of Health Sciences Department of Physiotherapy and Rehabilitation, PT, PhD****; PT, MSc***** OlGu sunuMu

Chronic Elbow Instabilities: Medial and Lateral Instability

Elbow stability relies on a complex interaction between the bony articulations of the elbow joint, the capsuloligamentous structures, and dynamic muscle restraints. Elbow instability presents a spectrum from minor subluxation to dislocation. This review discusses the anatomy of the elbow joint, the mechanism and classification of elbow instability, and outlines treatment options available for acute and chronic elbow instability.