Can isokinetic testing lead to more precise monitoring of chondromalacia patella? Prospective, cross-sectional study

Objective: Chondromalacia patella, one of the most common musculoskeletal problems encountered in clinical practice. The isometric test using the isokinetic dynamometer can be used for a valid assessment and follow-up of knee strength during the rehabilitation of chondromalacia patella. Our study investigates the effectiveness of the isokinetic dynamometer as a monitoring tool for individuals with chondromalacia patella. Methods: Twenty-eight patients with chondromalacia patella (mean age 39 +/- 10.84 years, mean symptom duration 11.75 +/- 7.38 months) were included in the study. All patients had physical therapy and rehabilitation program that was applied for 15 sessions, 5 days a week during 3 weeks. Knee flexion and extension strengths were measured at 60 degrees/second and 180 degrees/second (5 sets) angular velocity with an isokinetic dynamometer system before and after physical therapy and rehabilitation program. Visual analog scale (VAS)-pain value was used for clinical assessment. Modifies magnetic resonance imaging (MRI) staging system was used in the staging of chondromalacia patella. The relationship between VAS pain value and isokinetic dynamometer parameters was analyzed, as well as correlation in radiological MRI staging, treatment effectiveness, symptom duration. A value of p<0.05 was considered significant. Results: Statistically significant improvement was observed in the knee flexion and extension muscle strengths at 60 degrees/second and the 180 degrees/the second angular velocity (PTE_60, PTF_60, PTE_180, PTF_180) after the physical therapy and rehabilitation program in affected knees (p=0.0001 for all). Analysis of correlation and interaction of chondromalacia patella MR stages, VAS pain value, body mass index, duration of symptoms, and treatment efficacy was also statistically significant (p<0.05). Conclusion: Our study results suggest that physical therapy and rehabilitation program improves the strength of both knee extensors and flexors, and isokinetic parameters have a significant effect on the treatment effectiveness. The isokinetic dynamometer may provide a precise monitoring to assess treatment efficacy of patients with chondromalacia patella. More studies are needed for further scientific evidence.Amaç: Kondromalazi patella, klinik pratikte en sık karşılaşılan kas-iskelet sistemi problemlerinden biridir. İzokinetik dinamometre kullanılarak yapılan izokinetik testleme, kondromalazi patellanın rehabilitasyonu sırasında diz kuvvetinin objektif değerlendirmesi ve takibi için kullanılabilir. Bu çalışma, kondromalazi patellalı bireylerde izleme aracı olarak izokinetik dinamometrenin etkinliğini araştırmayı amaçlamaktadır. Gereç ve Yöntem: Kondromalazi patellası olan yirmi sekiz hasta (ortalama yaş 39±10,84 yıl, ortalama semptom süresi 11,75±7,38 ay) çalışmaya dahil edildi. Tüm hastalara 3 hafta boyunca, haftada 5 gün, 15 seans fizik tedavi ve rehabilitasyon programı uygulandı. Program öncesi ve sonrası izokinetik dinamometre ile 60°/saniye ve 180°/saniye (5 set) açısal hızda diz fleksiyon ve ekstansiyon kas kuvvetleri ölçüldü. Klinik değerlendirme için VAS-ağrı skoru kullanıldı. Kondromalazi patella evrelemesinde Modifiye MRG Evreleme Sistemi kullanıldı. Vizüel analog skala (VAS)-ağrı skoru ile izokinetik dinamometre parametreleri arasındaki ilişkinin yanı sıra radyolojik manyetik rezonans görüntüleme (MRG) evreleme, tedavi etkinliği ve semptom süresindeki korelasyon analiz edildi. P<0,05 değeri, istatistiksel anlamlı kabul edildi. Bulgular: Etkilenen dizlerde fizik tedavi ve rehabilitasyon programı sonrası 60°/saniye ve 180°/saniye açısal hızlarda (PTE_60, PTF_60, PTE_180, PTF_180), diz fleksiyon ve ekstansiyon kas kuvvetlerinde istatistiksel olarak anlamlı iyileşme gözlendi (p=0,001). Kondromalazi patella MRG evreleri, VAS-ağrı skoru, vücut kitle indeksi, semptom süresi ve tedavi etkinliği arasındaki korelasyon ve etkileşim analizi de istatistiksel olarak anlamlı bulundu (p<0,05). Sonuç: Çalışma sonuçlarımız, fizik tedavi ve rehabilitasyon programının hem diz ekstansörlerinin hem de fleksörlerinin kuvvetini geliştirdiğini ve izokinetik parametrelerin tedavi etkinliği üzerinde önemli bir etkiye sahip olduğunu göstermektedir. İzokinetik dinamometre, kondromalazi patellalı hastaların tedavi etkinliğini değerlendirmek için, kesin bir izleme aracı olarak kullanılabilir. Daha ileri bilimsel kanıtlar için daha fazla çalışmaya ihtiyaç vardır

Can isokinetic test be a supportive tool for unilateral knee arthroplasty decision?

Objectives: This study analyzed whether the isokinetic muscle strength of bilateral knee osteoarthritis patients undergoing unilateral total knee arthroplasty (TKA) is a predictor for prior surgery side. Patients and methods: In the prospective study conducted between April 2021 and December 2021, 58 knees of 29 unilateral TKA candidates (6 males, 23 females; mean age: 66.7±7.4 years; range, 53 to 81 years) were enrolled. The patients were divided into surgical (n=29)and nonsurgical (n=29) groups. The knees of patients with bilateral knee osteoarthritis (Stage III or IV) according to the Kellgren-Lawrence (KL) scale were scheduled for unilateral TKA. An isokinetic testing system was used to assess knee flexor and extensor muscle strength (peak torque) at angular velocities of 60°/sec and 180°/sec (five cycles per velocity). The radiological (X-ray-based KL scale and magnetic resonance imaging-based quadriceps angle) and clinical findings (isokinetic test and Visual Analog Scale pain scores) in both groups were compared. Results: The mean symptom duration was 10±5.4 years. The KL score and quadriceps angle showed no significant differences (p=0.056 and p=0.663, respectively). Isokinetic test results were in accordance with the clinical results of the surgery group. In the isokinetic evaluation, both the 60°/sec concentric extension (35.00 vs. 46.00, p=0.002) and flexion peak torque (18.00 vs. 26.00, p=0.001) values were significantly lower in the surgical group than in the nonsurgical group. Conclusion: Isokinetic testing can be a supportive tool for assessing the prior side of TKA in patients with bilateral knee osteoarthritis. Further studies are required to support these findings

CD4(+) T cells of myasthenia gravis patients are characterized by ıncreased IL-21, IL-4, and IL-17A productions and higher presence of PD-1 and ICOS

Myasthenia gravis (MG) is an autoimmune disease mediated by autoantibodies predominantly against the acetylcholine receptor (AChR). Specific T cell subsets are required for long-term antibody responses, and cytokines secreted mainly from CD4(+) T cells regulate B cell antibody production. The aim of this study was to assess the differences in the cytokine expressions of CD4(+) T cells in MG patients with AChR antibodies (AChR-MG) and the effect of immunosuppressive (IS) therapy on cytokine activity and to test these findings also in MG patients without detectable antibodies (SN-MG). Clinically diagnosed AChR-MG and SN-MG patients were included. The AChR-MG patients were grouped as IS-positive and -negative and compared with age- and sex-matched healthy controls. Peripheral blood mononuclear cells were used for ex vivo intracellular cytokine production, and subsets of CD4(+) T cells and circulating follicular helper T (cTfh) cells were detected phenotypically by the expression of the chemokine and the costimulatory receptors. Thymocytes obtained from patients who had thymectomy were also analyzed. IL-21, IL-4, IL-10, and IL-17A productions in CD4(+) T cells were increased in AChR-MG compared to those in healthy controls. IS treatment enhanced IL-10 and reduced IFN-gamma production in AChR-MG patients compared to those in IS-negative patients. Increased IL-21 and IL-4 productions were also demonstrated in SN-MG patients. Among CD4(+) T cells, Th17 cells were increased in both disease subgroups. Treatment induced higher proportions of Th2 cells in AChR-MG patients. Both CXCR5(+) and CXCR5(-) CD4(+) T cells expressed higher programmed cell death protein 1 (PD-1) and inducible costimulatory (ICOS) in AChR-MG and SN-MG groups, mostly irrespective of the treatment. Based on chemokine receptors on CXCR5(+)PD-1(+) in CD4(+) T (cTfh) cells, in AChR-MG patients without treatment, the proportions of Tfh17 cells were higher than those in the treated group, whereas the Tfh1 cells were decreased compared with those in the controls. The relevance of CXCR5 and PD-1 in the pathogenesis of AChR-MG was also suggested by the increased presence of these molecules on mature CD4 single-positive thymocytes from the thymic samples. The study provides further evidence for the importance of IL-21, IL-17A, IL-4, and IL-10 in AChR-MG. Disease-related CD4(+)T cells are identified mainly as PD-1(+) or ICOS+ with or without CXCR5, resembling cTfh cells in the circulation or probably in the thymus. AChR-MG and SN-MG seem to have some similar characteristics. IS treatment has distinctive effects on cytokine expression.Istanbul Universit

Kronik dönemdeki iskemik inmeye bağlı hemplejik hastalarda repetitif transkranial manyetik stimülasyonun beyindeki reorganizasyon sürecine ve elektrofizyolojik parametrelere etkisi

ÖZETKronik dönemdeki iskemik inmeye bağlı hemiplejik hastalarda repetitif transkranial manyetik stimülasyonun beyindeki reorganizasyon sürecine ve elektrofizyolojik parametrelere etkisiEngin ÇAKARBu çalışmada, kronik hemiplejik hastalarda transkraniyal manyetik stimülasyon (TMS) ile elde edilen motor uyandırılmış potansiyel (MUP) yanıtları ile klinik parametreler arasındaki ilişkiler ve repetitif TMS (rTMS) uygulamasının beyindeki reorganizasyonel sürece, klinik ve elektrofizyolojik parametrelere etkileri ile elektrofizyolojik parametrelerin prognostik değerleri incelenmiştir. Değerlendirilen 148 hastadan uygun bulunan 23 hasta ile başlanmış ve 20 hasta ile çalışma tamamlanmıştır. Klinik değerlendirme Barthel indeksi, Brunnstrom evrelemesi, Ashworth skalası, Motricity indeksi, parmak vurum sayımı ve motor aktivite izlemi-28 ile, elektrofizyolojik değerlendirme MUP latansı, MUP amplitüdü, istirahat motor eşiği (iME) ve santral motor iletim zamanı (SMİZ) ile yapılmıştır. Tüm hastalar beyin fonksiyonel manyetik rezonans görüntüleme ile değerlendirilmiştir. Hastalar gerçek ve taklit rTMS uygulanmak üzere randomize olarak iki gruba ayrılmıştır. Gerçek rTMS grubunda sağlam hemisfere parabolik koil ile 1 Hz frekansla, %90 iME şiddette 20 dakika (1200 atım) süre ile 5 gün rTMS uygulanmıştır. Başlangıç değerlendirmesinde motor ve fonksiyonel durum ile MUP latansı, iME, SMİZ arasında negatif, MUP amplitüdü arasında pozitif ilişki saptanırken spatisite ile MUP amplitüdü arasında negatif ilişkili bulunmuştur. Gerçek rTMS grubunda klinik ve elektrofizyolojik olarak daha belirgin gelişme olmuş ve bu gelişme kontrol grubuna kıyasla Brunnstrom üst ekstremite motor gelişiminde istatistiksel olarak anlamlı düzeye erişmiştir. Yine bu grupta spastistede anlamlı gerileme olmuştur. Prognostik açıdan spastisite için iME, motor gelişim için SMİZ değerli sonuçlar vermiştir. Sonuç olarak, TMS ile elde edilen elektrofizyolojik parametreler ile klinik durum ve gelişim arasında anlamlı ilişki saptanmıştır ve bu parametreler kronik dönemde prognoz tayini ve izlemde umut verici bulunmuştur. Ayrıca, rTMS uygulamalarının inme rehabilitasyonunda giderek önem kazanacağı düşünülmektedir.Anahtar Kelimeler: İnme, motor uyandırılmış potansiyel, transkraniyal manyetik stimülasyon, nörorehabilitasyonSUMMARYThe effect of repetitive transcranial magnetic stimulation on brain reorganization and electrophysiological parameters in chronic strokeEngin ÇAKARThe objective of this study was to investigate the relationships between motor evoked potential (MEP) responses which were evoked by transcranial magnetic stimuation (TMS) and clinical parameters, and to investigate the effects of repetitive TMS (rTMS) on reorganization and on clinical and electrophysiological parameters, and to analyze prognostic value of electrophysiological parameters. 148 patients were assessed, 23 were recruited and 20 finished the trial. Brunnstrom motor staging, Ashworth scale, Motricity index, finger tapping, motor activity log-28, MEP latency, amplitude, resting motor threshold (rMT), central motor conduction time (CMCT) and functional magnetic resonans imaging were used for assessment and follow-up. The patients were randomized to two groups (real rTMS, sham rTMS) and rTMS was applied for five consecutive days (1 Hz, %90 rMT, 20 minute). Motor and functional status were negatively correlated with MEP latency, rMT, CMCT, and were positively correlated with MEP amplitude, and spasticity was negatively correlated with MEP amplitude at baseline evaluation. There were better clinical and electrophysiological improvements in rTMS group and it was statistically better than sham group in regard to Brunnstrom upper extremity stage. There was significant decrease in spasticity in real rTMS group. rMT for spasticity and CMCT for motor improvement were found as hopeful parameters for prognosis determination. In conclusion, TMS evoked electrophysiological parameters had significant correlation with clinical status and improvement, and they were suggestive parameters for prognosis determination and follow-up. Additionally, it was considered that rTMS applications will continue to attract the attentions as a novel therapeutic approach for stroke rehabilitation.Keywords: stroke, motor evoked potential, transcranial magnetic stimulation, neurorehabilitatio

Ekstrude lomber disk hernisinin rezorpsiyonu: Fizik tedavi yöntemlerinin etkisi

We would like to share our experience withextruded lumbar disc herniation which was treatedwith non-surgical spinal decompression and physicaltherapy.A 29-year-old man presented with a six-monthhistory of lower back and right leg pain. He could notrecall experiencing any trauma or initiating factorbefore the pain began, and the pain had increasedover the last month. His pain increased when he wasmoving and he experienced numbness in his rightfoot. Medication had not been beneficial, and as aresult surgery for a herniated disc was proposed. Uponexamination, he had right L4 and L5 dermatomalhypoesthesia. The strength of the L5 muscle was 4/5on the right side, and the right Achilles tendon reflexwas hypoactive. Magnetic resonance imaging (MRI)performed six months prior to this exam showedL4-L5 extruded disc herniation and right L5 rootcompression (Figure 1)

Plantar fasiiti olan hastalarda kinesiotaping uygulamasının ağrı, denge ve düşme riski üzerine etkisi

INTRODUCTION: Investigation of the effect of kinesiotaping on pain, balance, risk of falls and functional status in patients with plantar fasciitis syndrome. MATERIAL AND METHODS: Thrity patients with plantar fasciitis were divided into two groups randomly. Exercise and ice application were suggested to both groups. Kinesiotaping was applied to intervention group and placebo taping was applied to the other group. Patients were evaluated before intervention and one week after the intervention. We used visual analog scale (VAS) for pain evaluation. Foot Function Index (FFI), Nottingham Health Profile were filled and measurements were taken with the Biodex Balance system to assess balance-and-falls risk. RESULTS: There was a decrease in VAS values in both groups but there was no statistically significant difference between the groups. A statistically significant difference was found in treatment group in FFI-Disability score in functional comparison. DISCUSSION AND CONCLUSION: It was found that kinesiotaping for plantar fasciitis syndrome had a significant effect on pain, but this effect did not make a statistical difference compared to placebo.GİRİŞ ve AMAÇ: Plantar fasiit sendromu olan hastalarda kinesiotaping uygulamasının ağrı, denge, düşme riski ve fonksiyonel duruma olan etkisinin araştırılması YÖNTEM ve GEREÇLER: Çalışmaya dahil edilen 30 hasta randomize olarak eşit iki gruba ayrıldı. Her iki gruba egzersiz ve soğuk uygulama yapması önerildi. Tedavi grubuna ayaktopuk bölgesine kinesiotaping bantlama, kontrol grubuna ise aynı bölgeye yalancı bantlama yapıldı. Hastalar müdahale öncesi ve 1 hafta sonrasında değerlendirildi. Çalışmamızda hastaların ağrıları vizüel analog skala (VAS) ile değerlendirildi. Ayak Fonksiyon İndeksi (AFİ), Nottingham Sağlık Profili dolduruldu ve denge-düşme riski değerlendirmesi için Biodex Balance sistemi ile ölçümleri yapıldı. BULGULAR: Her iki grupta da VAS değerlerinde azalma oldu ancak gruplar arası istatistiksel olarak anlamlı fark bulunmadı. Fonksiyonel karşılaştırmada AFİ-Yetersizlik skorunda gerçek bantlama lehine istatiksel olarak anlamlı fark saptandı. TARTIŞMA ve SONUÇ: Plantar fasiit sendromu için uygulanan kinesiotaping uygulamasının ağrı üzerine anlamlı etkisinin olduğu, ancak bu etkinin plaseboya göre istatistiksel bir fark oluşturmadığı görülmüştür

A pictorial view to tarsal coalition: The presentation of two children with foot pain

Two male patients aged 9 and 16 years were admitted with complaints of ankle pain and intoeing. There was no history of trauma and arthritis. In the first case, radiography examination revealed a “C sign” (a cortical continuity from the medial portion of the talus to the sustentaculum tali), a narrowing in the middle subtalar joint space, and convexity in the lower margin of the sustentaculum tali (Figure 1). Magnetic resonance imaging (MRI) showed triple coalition in the anterior subtalar joint (talocalcaneonavicular joint) in the first case (Figures 2 and 3) and fibrocartilaginous coalition at the posterior subtalar joint in the second case (Figure 4). Narrowing in the joint spaces, findings of early degeneration, and medullary edema in the adjacent bone were observed at the sites of coalition (Figures 3 and 4). Nonoperative treatment, such as physical therapy, exercises, and analgesic medication were applied

Karpal tünel sendromu hastalarında el bileği kas gücünün izokinetik değerlendirilmesi

Objectives: This study aims to investigate the isokinetic characteristics of wrist strength in flexion, extension, supination, pronation, radial, and ulnar deviation in patients with moderate or severe carpal tunnel syndrome (CTS).Patients and methods: Thirteen patients (23 hands) (2 males, 11 females; mean age 45 years; range 29 to 60 years) with moderate or severe CTS were compared to six healthy control subjects (12 hands) (2 males, 4 females; mean age 41 years; range 27 to 63 years) in this study, which was conducted between January 2016 and April 2016. Wrist flexion, extension, supination, pronation, radial, and ulnar deviation muscle strengths were measured at 30&ordm;/second (5 sets) angular velocity with isokinetic dynamometer. Grip strength was measured with hand dynamometer (kilograms). Boston Questionnaire was used for clinical assessment.Results: Grip strength (p=0.003); wrist flexion 30&ordm;/second (p=0.014); extension 30&ordm;/second (p=0.016); and ulnar deviation 30&ordm;/second (p=0.017) muscle strengths were lower in CTS patients compared with the control group. An evaluation according to symptom duration did not reveal any significant relationship in any of the isokinetic tests with the exception of pronation 30&ordm;/second (p=0.039, r= -0.432) and ulnar deviation 30&ordm;/second (p=0.034, r=0.443) in CTS patients. No significant relationship was found between Boston Questionnaire, grip strength, and isokinetic test results.Conclusion: Quantitative wrist strength measurements with isokinetic dynamometers are beneficial in conservative exercise treatments and motor assessments of CTS patients.Amaç: Bu çalışmada orta veya ağır karpal tünel sendromu (KTS) hastalarında el bileğinin fleksiyon, ekstansiyon, supinasyon, pronasyon, radial ve ulnar deviyasyon kas gücünün izokinetik özellikleri araştırıldı.Hastalar ve yöntemler: Ocak 2016-Nisan 2016 tarihleri arasında yapılan bu çalışmada orta veya ağır KTS olan 13 hasta (23 el) (2 erkek, 11 kadın; ort. yaş 45 yıl; dağılım 29-60 yıl) ile altı sağlıklı kontrol deneği (12 el) (2 erkek, 4 kadın; ort. yaş 41 yıl; dağılım 27-63 yıl) karşılaştırıldı. El bileği fleksiyon, ekstansiyon, supinasyon, pronasyon, radial ve ulnar deviasyon kas gücü izokinetik dinamometre ile 30º/saniye (5 set) açısal hızda ölçüldü. Kavrama gücü el dinamometresi ile (kilogram) ölçüldü. Klinik değerlendirme için Boston Anketi kullanıldı.Bulgular: Karpal tünel sendromu hastalarında kavrama gücü (p=0.003); el bileği fleksiyonu 30º/saniye (p=0.014); ekstansiyonu 30º/saniye (p=0.016) ve ulnar deviasyonu 30º/saniye (p=0.017) kas güçleri kontrol grubuna göre daha düşük idi. Semptom süresine göre yapılan değerlendirme, izokinetik testlerde pronasyon 30º/saniye (p=0.039, r= -0.432) ve ulnar deviasyon 30º/saniye (p=0.034, r=0.443) dışında KTS hastalarında anlamlı ilişki göstermedi. Boston Anketi, kavrama gücü ve izokinetik test sonuçları arasında anlamlı ilişki saptanmadı.Sonuç: El bileği kas gücünün izokinetik dinamometreler ile sayısal olarak ölçülmesi KTS hastalarının konservatif egzersiz tedavileri ve motor değerlendirmelerinde faydalıdır

Adolesan skolyoz dört haftada ne kadar iyileştirilebilir?

Scoliosis is a condition that leads to severe disability and an impaired cosmetic appearance in adolescence. This article presents x-ray images of a patient with adolescent idiopathic scoliosis (AIS) in whom the pain and posture improved dramatically over four weeks, emphasizing the importance of physical therapy. A 13-year-old male was admitted because of posture deformity and mild back and lower back pain. He was being followed with the diagnosis of scoliosis for two years and specific exercises were proposed for scoliosis. On physical examination, we observed paravertebral muscle spasm and significant asymmetry of the thoracolumbar region. Neurological examination and laboratory tests were normal. X-ray showed arcuate thoracolumbar scoliosis (cobb angle: 24&deg;) with a leftward convexity. Electrical stimulation was applied to the convex and concave sides for 30 minutes, five times a week for four weeks and an exercise program was performed under the supervision of a therapist. The stimulation amplitude was the maximum stimulation intensity with which the patient was comfortable. Analgesic and myorelaxant drugs were not required, and no brace was used. After the treatment, significant improvements were observed in the patient's posture and radiography (cobb angle: 10&deg;). This work demonstrates that well-planned physical therapy is a rapid and effective option for treating AIS.Skolyoz, adolesan dönemde ağır özürlülüğe ve kozmetik bozukluğa neden olabilen bir durumdur. Bu yazıda fizik tedavi uygulamalarının önemini vurgulamak için, adolesan idiyopatik skolyozu olan ve dört haftada belirgin iyileşme gösteren bir olgu grafileri ile birlikte sunulmuştur. On üç yaşındaki erkek hastamızın duruş bozukluğu ve hafif bel ağrısı şikayeti bulunmaktaydı. Hastamız iki yıldır skolyoz tanısıyla takip edilmekteydi ve hastaya skolyoza özel egzersizler önerilmişti. Fizik muayenede paravertebral kas spazmı ve belirgin torakolomber asimetrisi vardı. Nörolojik muayene ve laboratuvar testleri normaldi. X-ray grafisinde konveksitesi sola bakan torakolomber skolyozu (cobb açısı: 24°) tespit edildi. Hastaya haftada beş gün, dört hafta boyunca elektrik stimülasyonu (konveks ve konkav tarafa eş zamanlı olarak 30 dakika süre ile) ve terapist eşliğinde egzersiz programı uygulandı. Stimülasyonun amplitüdü hastanın rahatsızlık duymayacağı maksimum uyarı şiddetindeydi. Analjezik ve miyorelaksan ilaç ihtiyacı olmadı ve breys kullanılmadı. Tedavi sonunda yapılan değerlendirmede hastanın postüründe ve radyografisinde belirgin düzelme elde edildi (cobb açısı: 10°). Sonuç olarak, bu olgu iyi planlanmış fizik tedavi programının adolesan idiyopatik skolyoz tedavisinde hızlı ve etkin bir seçenek olduğunu göstermektedir.Anahtar­ Sözcükler:­ Elektrik stimülasyonu, egzersiz tedavisi, skolyoz