Yasin Demir

Demographic and clinical characteristics of patients with traumatic cervical spinal cord injury: a Turkish hospital-based study.

Study design:Retrospective study.Objectives:To determine the demographic and clinical characteristics of patients with cervical spinal cord injury (CSCI) admitted to a single Center.Setting:Turkish Armed Forces Rehabilitation Center, Ankara, Turkey.Methods:The medical records of all patients with spinal cord injury admitted from January 2009 to December 2013 were screened. Variables of each patient with cervical injury (CSCI), such as age at the time of injury, gender, etiology, degree and level of neurological impairment, associated injuries, surgical stabilization and length of rehabilitation stay (LOS), were analyzed.Results:In all, there were 804 patients with traumatic spinal cord injury (SCI) during the 5-year study period, of which 562 (69.9%) were paraplegic and the remaining 242 (30.1%) had a CSCI (C1–C8) and were included in the study. Among the CSCI patients, 80.6% were male (male:female ratio is 4.15:1), mean age at the time of injury was 32.58±14.71 years (range: 4–79 years), the largest age group was 16–30 years (n=117, 48.3%), followed by 31–45 years (n=70, 28.9%). Motor vehicle accident (MVA) was the most common cause of injury (49.2%), followed by falls (21.5%) and diving accidents (18.2%). Low CSCI (C5–8; 61.2%) and incomplete injury (55%) occured more often than high CSCI (C1–4) and complete injury. In total, 202 (83.5%) patients underwent surgical stabilization. Thirty-seven (15.3%) had associated injuries.Conclusion:The present findings show that most of the CSCI patients were aged 16–30 years. In addition, based on the frequency of the causes of injuries we think that prevention efforts should mainly focus on MVA, falls and diving accidents.

Spinal cord injury in older population in Turkey.

Study design:Retrospective, comparative 4-year study.Objectives:To identify the clinical characteristics unique to older patients with spinal cord injury (SCI).Setting:Turkish Armed Forces Rehabilitation Center, Ankara, Turkey.Methods:The study included 870 consecutive patients with SCI that were divided into two groups according to age. Patients aged ⩾60 years at the time of injury constituted the study group, and randomly selected patients aged <60 years that were matched for gender, week of admission and time since injury constituted the control group. Patients’ demographic and clinical characteristics were recorded, compared and analyzed.Results:The study group included 73 SCI patients (mean age: 66.98±6.28 years) and the control group included 75 SCI patients (mean age: 33.93±10.67 years). Among the 148 patients, 98 (66.2%) were male. The vast majority of lesions were at the thoracic level (47.3%). In the older group, falls were the most frequent etiology (32.9%), simple falls predominated (62.5%). 49.3% of the study group vs 18.6% of the control group had a non-traumatic cause of SCI. Older patients were found to be less likely to have complete injury (27.4 vs 44%, P=0.035). The most common bladder management method was intermittent catheterization (69.6%) and the number of patients in each group treated with this method did not differ significantly (P>0.05). More patients in the study group had neuropathic pain (50.7 vs 34.7%, P=0.049) and abnormal urinary ultrasound findings (23.3 vs 9.3%, P=0.021).Conclusion:Results revealed that older patients with SCI may have different demographic and clinical features compared with younger patients.

A Different Approach to the Management of Osteoarthritis in the Knee: Ultrasound Guided Genicular Nerve Block

Dear Editor, A 61-year-old female was referred to our tertiary physical medicine and rehabilitation outpatient clinic with a 7-year history of severe left knee pain. The patient was a nonsmoker and obese, with no comorbidities, and reported that the left knee pain worsened when walking and descending stairs and particularly when climbing stairs. Radiography of the left knee revealed Kellgren-Lawrence grade 3 osteoarthritis (OA) with multiple osteophytes and definite joint space narrowing. The pain and functional disability were nonresponsive to conservative treatment methods including weight loss, exercise, analgesics (paracetamol or diclofenac sodium once or twice a day), intra-articular steroid and hyaluronic acid injections, and physical therapy. The patient was finally offered knee replacement surgery by an orthopedic surgeon, but she did not accept surgery. The sensory and motor nerves supplying all the structures around the knee are the saphenous, tibial, and common peroneal nerves together with the subsartorial, peripatellar, and popliteal plexuses [1,2]. Vas et al. [2] targeted both the sensory and motor nerves supplying all the structures around the knee and succeeded in relieving the pain. Choi et al. [3] reported successful pain relief by ablation of the three branches of the genicular nerve [superior lateral (SL), superior medial (SM), and inferior medial (IM) genicular nerves]. These three nerves were selected because they pass the periosteal areas connecting the shaft of the femur to the bilateral epicondyles and the shaft of …

Knee pain relief with genicular nerve blockage in two brain injured patients with heterotopic ossification.

Abstract Background: Heterotopic ossification (HO) is the ectopic bone formation in non-osseous tissues. This study aimed to present two patients with traumatic brain injury (TBI) who had HO in knee joint and pain relief after genicular nerve blockage. Case 1: A 14-year-old patient with TBI was admitted with bilateral knee pain and limited range of motion. Physical examination and x-ray graphics revealed calcification which was diagnosed as HO. Ultrasonography (US) guided genicular nerve blockage was performed to both knees with 2 ml lidocaine and 1 ml betamethasone. VAS of pain was decreased to 30 mm from 80 mm. At 6-month follow-up, VAS of pain was still 30 mm. Case 2: A 29-year-old patient with TBI was admitted for rehabilitation. He had right knee pain and his pain was 80 mm according to VAS. Investigation revealed HO. US guided genicular nerve blockage was performed to the right knee and pain was decreased to 20 mm. Discussion: US guided genicular nerve blockage can provide pain relief in HO and this technique may be effective and alternative for pain relief in patients with neurogenic knee HO to increase patient’s compliance.

Spinal cord injury resulting from gunshot wounds: a comparative study with non-gunshot causes

Study design:Retrospective, comparative 7-year study.Objectives:To identify the clinical characteristics of patients with spinal cord injury (SCI) resulting from gunshot wound (GSW).Setting:Turkish Armed Forces Rehabilitation Center, Ankara, Turkey.Methods:The study included 1043 consecutive patients with SCI who were divided into two groups according to etiology: patients with gunshot-induced spinal cord injury (GSWSCI) constituted the study group, and randomly selected patients with non-gunshot-induced spinal cord injury (NGSWSCI) who were matched for gender and for week of admission constituted the control group. The demographic and clinical characteristics of the patients were recorded, compared and analyzed.Results:The study group included 102 patients (mean age: 26.93±9.11 years). The vast majority of the patients were aged 16–30 years (68.6%) and 90.2% were male. The majority of the lesions were at the thoracic level (58.8%) and a complete injury (60.8%). Surgical stabilization of the spine was performed in 50 patients (49%). The most prevalent associated injury was intra-abdominal injury followed by chest injury. Compared with the NGSWSCI group, the GSWSCI patients were more likely to have a complete lesion (60.8% vs 45.1%, P=0.025), had a lower rate of surgical stabilization (49 vs 88.2%, P=0.0001) and had a higher rate of associated injuries (54.9% vs 25.5%, P=0.0001). Compared with the civilian GSWSCI group, the military GSWSCI patients had a higher rate of surgical stabilization and associated injuries (60% vs 40%, P=0.049, 68.9% vs 43.9%, P=0.012, respectively).Conclusion:The results revealed that GSWSCI and military GSWSCI patients may have different demographic and clinical features compared with NGSWSCI and civilian GSWSCI patients, respectively.

The effect of knee joint loading and immobilization on the femoral cartilage thickness in paraplegics.

Background:Femoral cartilage thickness has been used as an indicator for immobilization and unloading in patients with spinal cord injury (SCI). However, conflicting results have been reported on this subject.Objectives:(i) To determine femoral cartilage thickness alterations after prolonged immobilization, (ii) to demonstrate the effect of the daily standing or ambulation time on the cartilage and (iii) to analyze the predictors of the femoral cartilage in patients with SCI.Methods:A total of 50 patients with SCI and 50 healthy age and sex-matched volunteers were enrolled in the study. A physician scanned both knees of all participants and measurements were taken at three locations: trochlear notch, midpoints of the medial and lateral condyle.Results:The trochlear notch, medial and lateral condyle femoral cartilage thickness of both sides were significantly thicker in the control group (P<0.05). Patients with <1 h daily standing/walking time had higher thickness measurements in all sub parameters than patients with >1 h daily standing/walking time (P<0.05). Daily standing/walking time and the Walking index for SCI score were statistically significant predictors for cartilage thickness.Conclusion:SCI patients had thinner knee cartilage compared with healthy individuals in ultrasonographic assessment. More than 1 h daily standing/walking time may have a negative effect on the femoral cartilage thickness. Thus, ultrasonographic evaluation of the femoral cartilage should be considered in clinical practice to detect early cartilage thinning in patients with SCI.

Ultrasound findings of the urinary tract in patients with spinal cord injury: a study of 1005 cases

Study design:Retrospective chart review.Objectives:To document urinary tract abnormalities (UTAs) in patients with spinal cord injury (SCI) and to assess demographic and clinical features associated with UTA detected via ultrasound (US).Setting:Turkish Armed Forces Rehabilitation Center, Ankara, Turkey.Methods:The medical and radiological records of all patients with SCI were screened. Variables in each patient with SCI, including age at the time of the US examination, gender, etiology, level and severity of SCI, time since injury, bladder management methods and findings of urinary tract US, were reviewed and analyzed.Results:Data were obtained from 1005 patients during the 6-year study period (2008–2013). The mean age was 35.67±14.79 years and the male–female ratio was 2.84:1. Trabeculated bladder (TB) was observed in 35.1% of the patients, bladder calculi in 6%, renal calculi in 6%, hydronephrosis in 5.5% and renal atrophy in 1.2%. Bladder calculi, renal calculi and renal atrophy were observed in patients with TB at higher rates than in those without TB (P=0.001, 0.036 and 0.004, respectively). The association of TB with hydronephrosis was very close to significance level (P=0.052).Conclusion:A large number of SCI patients had UTAs including TB, renal and bladder calculi, hydronephrosis and renal atrophy. The time since injury, level and severity of SCI and bladder management method may influence development of UTA. In addition, TB may be a helpful parameter for predicting UTA in SCI patients.

Re: Quadriceps Fat Pad Impingement and Synovial Hypertrophy with Mild to Moderate Lipoma Arborescens.

A 40-yr-old male patient presented with pain and swelling in the left knee. He reported sudden onset of the knee pain 2 days previously, and the next day, swelling was noticed. There was no history of trauma or any rheumatologic disease. The patient recorded a pain score of 70 mm on a 100-mm visual analog pain scale. On physical examination, there was significant swelling predominantly on the lateral aspect of the left knee, mild heat, tenderness with palpation, and restricted range of motion. The whole blood count values and erythrocyte sedimentation rate were within the reference ranges. The C-reactive protein level was 21 mg/dL (reference range, 0Y6 mg/dL). Plain x-ray examination yielded normal results. Ultrasound scanning revealed fluid in the suprapatellar region and a 1721-mm hyperechoic mass beneath the quadriceps tendon and next to the upper margin of the patella (Fig. 1). Magnetic resonance imaging was then applied, which revealed suprapatellar effusion and a mild hyperintense lesion located posterior to the quadriceps tendon and projecting into the joint space (Fig. 2). The patient was diagnosed as having lipoma arborescens. The patient refused arthroscopic surgery and was managed conservatively with rest, cold packs, and nonsteroidal anti-inflammatory drugs. Lipoma arborescens is a rare benign condition defined as lipomatous proliferation of the synovium, characterized by villous proliferation of the fat cells. Although the etiology has not been fully defined, trauma, inflammation, and degenerative osteoarthritis have been reported as etiologic factors but there have also been case presentations without any causative factor. Most cases of lipoma arborescens are

Efficacy of Ultrasound in the Diagnosis of Biceps Tendon Dislocation.

A 25-yr-old man presented with pain and weakness secondary to posttraumatic anterior shoulder dislocation from a traffic accident 3 mos earlier. The patient received 15 sessions of physical therapy but no improvement was observed. On physical examination, minimal swelling of the anterior aspect of the right shoulder and tenderness with palpation were detected. Speed and Yergason tests yielded positive results, and a 2-cm reduction in circumference was determined on the right arm. Muscle strength of right elbow flexion and forearm supination was 4/5. Shoulder internal rotation was restricted by 50%. All laboratory findings, including erythrocyte sedimentation rate, C-reactive protein, and X-ray examination were normal. Musculoskeletal ultrasound (US) revealed that the bicipital groove was empty and the long head of the biceps tendon (LHBT) had dislocated anteromedially with surrounding edema (Fig. 1). The supraspinatus tendon was observed to be intact and a full-thickness tear of the subscapularis tendon was seen (Fig. 2). Despite a trial of conservative treatment including physical therapy and nonsteroidal anti-inflammatory agents, the condition did not improve and the patient was referred to an orthopedic service for surgery. Dislocation of the LHBT out of the bicipital groove is usually linked with tears of the subscapularis tendon or massive rotator cuff tears. It has been stated that there is no specific clinical test correlated to the presence of medial dislocation of the LHBT. Thus, imaging methods such as US, magnetic resonance imaging, and magnetic resonance imaging arthrography are of paramount importance. Magnetic resonance imaging has long been the primary mode of evaluating shoulder pathologies, but US has rapidly assumed a similar role as an imaging modality in the past few years. When compared with other imaging tools, US imaging is practical, noninvasive, inexpensive, and portable. In addition, US has been found to have 100% specificity and 96% sensitivity for subluxation or dislocation. It is important to detect the position of the LHBT on US particularly after traumatic shoulder dislocation, because pathology of the LHBT may have a part in the development of shoulder pain and long-term dysfunction. FIGURE 1 Bicipital groove (BG) and long head of the biceps brachii tendon. The star indicates empty bicipital groove, and the arrow denotes biceps brachii tendon. l, lateral; m, medial.

The short-term effect of ultrasound and peripheral nerve stimulator-guided femoral nerve block with phenol on the outcomes of patients with traumatic spinal cord injury

Study designA pre–post descriptive study.ObjectivesTo examine the immediate effects of ultrasound-guided femoral nerve block with phenol (UGFNBwP) in managing the lower limb spasticity of individuals with traumatic spinal cord injury (SCI).SettingAnkara, Turkey.MethodsNineteen patients with traumatic SCI presenting with lower extremity spasticity were treated with UGFNBwP. Modified Ashworth Scale of hip flexion and knee extension, functional independence measure motor subscale, difficulty of catheterization, hygiene score, spasm frequency, sleep quality, and patient satisfaction (PS) were measured in all patients prior to treatment, in the first week and second month.ResultsThere was a statistically significant decrease in the Modified Ashworth Scale scores in the first week and second month compared to baseline (p < 0.017). Significant improvements were detected in functional independence measure motor subscale, DoC, HS, SF and PS at follow-up examinations compared to baseline (p < 0.017). No statistically significant difference in the SQ score was found. Patients reported no complications during the intervention and follow-up period.ConclusionsUltrasound-guided femoral nerve block with phenol is an option worth considering to reduce spasticity and improve function in people with SCI.