COVID-19 pandemisinin önceden var olan omuz problemlerine etkisi: Telerehabilitasyon fizik tedavi için yararlı bir araç mıdır?

To the Editor, On March 11, 2020, the world health organization announced coronavirus disease 2019 (COVID-19) outbreak as a pandemic.[1] During this global crisis, worldwide governments set up severe rules limiting individual freedom and keeping social distancing to avoid the deterioration of national health-care systems. Patients who had specific life-threatening conditions or suffering from severe COVID-19 needing high-intensity levels of care (e.g., intensive care units) were permitted to refer to hospitals. Furthermore, physical therapy and rehabilitation programs were postponed to provide better care for inpatients with severe COVID-19. In an Italian survey, during the pandemic, more than 50% of stroke patients have reported a reduction in seeking treatment in the hospital, possibly in fear of being infected or being denied seeing their families after hospitalization. [2] What can we say about the patients with painful musculoskeletal problems

Geriatrik popülasyonda omurga cerrahisinin en yaygın nedeni olan lomber stenozda ağrı ve nörojenik kladikasyo kontrolü

OBJECTIVES: The authors aim to present when to do physical therapy or surgery in geriatric patients with degenerative lumbar stenosis. METHODS: The authors retrospectively analyzed 250 patients who underwent physical therapy due to lumbar degenerative stenosis between December 2014 and April 2017. The patients were divided into two groups: Central canal stenosis and lateral recess/foraminal stenosis groups. Visual analogue scale and neurological claudication values of both patient groups were evaluated before and after physical therapy. The association between comorbid diseases and the frequency of surgery was also evaluated. RESULTS: 142 of the patients were female and 108 were male, and the mean age of these patients was 69 years. The mean onset of symptoms was 55 months. In the visual analog scale value of patients after physical therapy, the authors observed decreases of 4-6° in patients with central canal stenosis and 2-3° in patients with lateral recess/foraminal stenosis. In addition, the authors observed that patients with lateral recess/foraminal stenosis together with diabetes mellitus benefit less from physical therapy. CONCLUSION: Physical therapy and rehabilitation play an important role in the treatment of lumbar stenosis. Physical therapy is the primary treatment option for patients who do not have motor muscle strength losses and incontinence and who have pain control through medications. The authors can consider surgical interventions in patients with lateral recess/foraminal stenosis who do not benefit from physical therapy at a satisfactory level.Amaç: Çalışmada, dejeneratif lomber stenozu olan geriatrik hastalarda ne zaman fizik tedavi veya cerrahi yapılacağının araş-tırılması amaçlandı. Gereç ve Yöntem: Aralık 2014 ile Nisan 2017 tarihleri arasında lomber dejeneratif stenoz nedeniyle fizik tedavi gören 250 hasta retrospektif olarak analiz edildi. Hastalar santral kanal darlığı ve lateral reses/foraminal darlık olmak üzere iki gruba ayrıldı. Her iki hasta grubunun vizüel analog skala ve nörolojik kladikasyo değerleri fizik tedavi öncesi ve sonrası değerlendirildi. Komorbid hastalıklar ile ameliyat sıklığı arasındaki ilişki de değerlendirildi. Bulgular: Hastaların 142’si kadın 108’i erkek olup, yaş ortalaması 69’du. Semptomların ortalama başlangıcı 55 aydı. Fizik tedavi sonrası hastaların vizüel analog skala değerlerinde santral kanal darlığı olan hastalarda 4–6°, lateral reses/foraminal stenozu olan hastalarda 2–3° düşüşler gözlemlendi. Ayrıca, diabetes mellitus ile birlikte lateral reses/foraminal stenozu olan hastaların fizik tedaviden daha az fayda sağladığı tespit edildi. Sonuç: Fizik tedavi ve rehabilitasyon lomber darlığın tedavisinde önemli bir rol oynamaktadır. Motor kas gücü kayıpları ve inkontinansı olmayan ve ilaçlarla ağrı kontrolü olan hastalar için fizik tedavi birincil tedavi seçeneğidir. Fizik tedaviden tatmin edici düzeyde fayda görmeyen lateral reses/foraminal stenozlu hastalarda cerrahi girişim düşünebilir

Factors affecting the femoral cartilage thickness after anterior cruciate ligament reconstruction

Background This study aimed to evaluate the changes in the distal femoral cartilage thickness in patients that underwent anterior cruciate ligament reconstruction (ACLR) and to analyze their association with concomitant meniscal surgery, knee muscle strength, kinesophobia, and physical activity level. Methods The demographic characteristics and surgical data of 47 male patients that underwent unilateral ACLR (mean, 27.55 +/- 5.63; range, 18-40 years) were evaluated. The patients were assessed in three groups depending on surgery: isolated ACLR (n = 15), ACLR + partial medial meniscus resection (ACLR&M) (n = 16), and ACLR + medial meniscus repair (ACLR&MR) (n = 16). The medial (MCCT), intercondylar (ICCT), and lateral (LCCT) femoral cartilage thicknesses on both limbs were measured using ultrasonography. The extensor and flexor muscles strength of the knees was assessed using an isokinetic dynamometer at 60 degrees/s. The physical activity level was evaluated by the International Physical Activity Questionnaire (IPAQ) short form and Tegner Activity Scale (TAS). The fear of movement was assessed by the Tampa Scale for Kinesiophobia Questionnaire (TSKQ). Results The postoperative mean follow-up duration was 32.24 +/- 9.17 months. MCCT and LCCT were significantly decreased in the ACLR&M group (p 0.05). Conclusion The results showed partial meniscectomy and meniscus repair at the time of ACLR as important risk factors for decreased chondral thickness

Servikal disk hernisi nedeniyle opere edilen hastaların operasyon öncesi servikojenik baş ağrısının sıklığı ve operasyon sonrası değişiminin değerlendirilmesi

Amaç: Servikojenik baş ağrısı (SBA) popülasyonun %2,5-4,1 kadar kısmını etkilemektedir. Tanı ve yönetimi zor olup etyopatogenezi henüz tam anlaşılmamıştır. Bu çalışmamızda servikal disk hernisi (SDH) nedeniyle opere ettiğimiz hastalarda SBA sıklığı ve ameliyat sonrası düzelme oranlarının araştırılması amaçlanmıştır. Metod: 2012-2019 yılları arasında SDH nedeniyle kliniğimizde ameliyat edilen 51 hasta retrospektif olarak tarandı. Hastalarda SBA Uluslararası Baş Ağrısı Derneği (ICHD-3) tanı kriterleri kullanılarak değerlendirildi. Operasyon öncesi ve sonrası nörolojik muayeneleri, ağrı skorları (vizüel analog skala [VAS] ile) değerlendirildi. Operasyon tekniği kaydedildi. Bulgular: 38 (%74,5) kadın ve 13 erkek (%25,5) olmak üzere toplam 51 hasta çalışmamıza dahil edildi. Ortalama yaş 45,76 ± 11,56 ve ortalama takip süresi 30,40 ± 32,31 aydı. Hastaların 41’inde (%80,4) tek seviye, 10’unda (%19,6) multipl seviyede SDH mevcuttu. Hastalarda %25,5 oranında SBA saptandı. Bu hastaların operasyon öncesi ve sonrası VAS puanlarındaki düşüş ortalama 5,54 ± 4,46’ydı (p<0.01). Sonuç: SBA etyopatogenezi henüz tam anlaşılmamış olup, ilk muayenede tanı ve tedavisi zordur. Çalışmamız SDH olan hastaların dörtte birinden fazlasında şiddetli SBA olduğu ve operasyon sonrası ağrı skorlarının belirgin olarak azaldığını göstermiştir.Objective:Cervicogenic headache (CH) affects between 2.5% to 4.1% of the whole population. As its diagnosis and management are difficult, its etiopathogenesis is not completely understood. In the current study, we aimed to investigate the prevalence and the postoperative improvement rate in our operated patients with cervical disc herniation (CDH). Methods: Medical records were retrospectively reviewed for 51 patients who underwent surgical treatment for CDH at our institute from 2012 to 2019. The patients were evaluated according to the diagnostic criteria of the international Headache Society (ICHD-3). Pre- and postoperative neurological examination and pain scores were recorded. Pre- and postoperative pain severity was assessed via (pain visual analog scale[VAS]).The surgical techniques were recorded. Results: A total of 51 patients, 38 (74.5%) females and 13 (25.5%) males, were included in our study. The mean age was 45.76 ± 11.56. The patients were followed-up with an average of 30.40 ± 32.31 months. 41 (80.4%) patients were operated for one CDH level, and the remaining 10 patients (10.6%) were operated for multiple CDH levels. CH was observed in 25.5% of our patients. The mean improvement regarding the differences between pre- and postoperative VAS scores 5.54 ± 4.46 (p <0.01). Conclusions: The diagnosis and examination of the CH at the first time is difficult. The etiopathogenesis of CH can be interpreted by discogenic, convergence and sensitization-desensitization theories. We observed that more than a quarter of our patients with CDH were involved with severe CH. Postoperative pain scores were significantly reduced

Periodontal disease and associated factors in patients with rheumatoid arthritis

Introduction: Periodontitis (PD) and rheumatoid arthritis (RA) are chronic inflammatory diseases that share complex multi-factorial pathologic processes, including genetics, environmental and inflammatory factors. This study aims to evaluate the periodontal status and its association with sociodemographic and clinical factors in patients with RA.Methods: This study included 51 patients with RA; the mean age was 49.75±9.79 years old and 10.59±6.37 years of disease duration. Sociodemographic data and the rheumatologic assessment included detailed profiling of the disease and serol-ogy were noted. A full mouth periodontal examination, including the Gingival index, Plaque index, Pocket probing depth and clinical attachment level, was carried out by a periodontist. The periodontal status was classified according to the Cen-ters for Disease Control-American Academy of Periodontology clinical case definitions.Results: Forty-five patients (88.2%) were female. 37.3% of patients had DAS28>3.2. All patients had PD, in mild (54.9%) to moderate (45.1%) severity. Aging, impaired oral hygiene, smoking, secondary Sjögren’s syndrome and high disease activity were associated with moderate PD.Discussion and Conclusion: This study results identified a serious need to pay particular attention to oral health in patients with RA and refer these patients for periodontal evaluation and treatment. Future studies are needed to better investigate whether if efforts to prevent periodontal disease may also help prevent RA

The relationship between gluteus medius latent trigger point and muscle strength in healthy subjects

Introduction: We hypothesized that latent MTrPs might decrease gluteus medius muscle strength in healthy individuals. This study aimed to investigate the relationship between latent MTrPs and gluteus medius muscle strength in a group of healthy adults. Methods: Forty-eight healthy men were included in the study. Trigger point examination for the gluteus medius was performed bilaterally. Subjects with one or more trigger points on the dominant side and those without any trigger point were assigned to two groups. Muscle strength for the gluteus medius was assessed with a manual muscle tester using the “break test” technique on both sides. For statistical analysis, the independent sample t-test was used to compare the intergroup differences. Results: The latent MTrP group demonstrated lower abduction muscle strength in the dominant gluteus medius. Moreover, the latent MTrP group showed higher abduction muscle strength in the non-dominant gluteus medius (p < 0.05). Intergroup comparison revealed that gluteus medius abduction muscle strength on the dominant side was higher in the non-latent MTrP group (p < 0.05). Conclusion: Latent MTrP may cause joint movement limitation, overload by affecting motor activation patterns and reciprocal inhibition mechanisms. Outcomes of the current study revealed that gluteus medius abduction strength values below 9.7 kg could be associated with latent MTrP with high sensitivity and low specificity. It is imperative to note that the latent MTrP of gluteus medius muscle, which has a critical role in the lumbopelvic junction, should not be ignored in clinical practice, and treatment should be applied when detected

Comparison of the efficacy of different concentrations of diclofenac sodium phonophoresis (1.16% vs 2.32%) in patients with knee osteoarthritis: A randomized double -blind controlled trial

PURPOSE OF THE STUDY The objective of the present study is to compare the efficacy of two different concentrations of diclofenac sodium phonophoresis (DSPH) (1.16% vs 2.32%) in patients with knee osteoarthritis (OA). MATERIAL AND METHODS A randomized, double-blind, controlled design was applied. Ninety patients (mean age SD, 59.98 8.89 years) who had Kellgren-Lawrence (K-L) grades II to III knee OA were randomly allocated into three groups; 1.16% DSPH, 2.32% DSPH, TUS (30 in each group). Each patient was treated five sessions per week for two weeks. A 100-mm visual analogue scale (VAS) for usual pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were evaluated before and after treatment in all groups. RESULTS The VAS pain and WOMAC scores were significantly improved after treatment in all groups (p < 0.05). The 2.32% DSPH showed more significant effects than the 1.16% DSPH, both in improving WOMAC- pain and physical function scores (p = 0.020, p = 0.008) and reducing the VAS pain measure, although it did not reach the level of significance (p = 0.077). The 2.32% DSPH was superior to the TUS, both in reducing the VAS pain measure (p < 0.001) and in improving WOMAC-pain, stiffness, physical function and total scores (p = 0.022, p = 0.016, p < 0.001, p < 0.001 respectively). 1.16% DSPH significantly reduced stiffness and physical function scores compared with TUS (p = 0.042, p = 0.047). CONCLUSIONS DSPH and TUS are effective treatments for knee OA. Our results indicated that 2.32% DSPH produces additional benefits to functional improvement and pain reduction compared with 1.16% DSPH in K-L grades II to III knee OA

Amiloidoz Gelişen Bir Juvenil Artrit ve Ailevi Akdeniz Ateşi Olgusu: Olgu Sunumu

Erçalık, Cem (Arel Author)AA amiloidoz, kronik inflamatuar hastalıklardaki amiloidoz türüdür. Günümüzde en sık nedeni romatizmal hastalıklardır. Amiloidoz, Romatoid artritte (RA) % 3-6, Ailevi Akdeniz Ateşinde (AAA) % 11- 3, İnflamatuar Barsak Hastalığında %1-3 oranında saptanmıştır. Burada AAA ve Juvenil İdiopatik Artrit (JİA) olan amiloidozlu bir olgunun tedavisi güncel literatür eşliğinde tartışılmıştır

Minör Tükürük Bezi Biyopsisi Yaptığımız Hastaların Özellikleri: Olgu Serisi

Erçalık, Cem (Arel Author)Sjögren Sendromu (SS) ayırıcı tanısında minör tükürük bezi biyopsisi (MTBB) Kulak Burun Boğaz Kliniklerinde sık yapılan bir işlem olmasına rağmen, Romatoloji Polikliniklerinde de uygulanmaya başlanan minör invaziv bir yöntemdir. Çalışmamızın amacı MTBB’nin Romatoloji pratiğinde SS tanısındaki yeri ve gerekliliğinin değerlendirilmesidir. Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi Romatoloji Polikliniğine ağız ve/veya göz kuruluğu, eklem şikayetleri ile başvuran daha ziyade otoantikor negatif hastalara yapılan MTBB sonuçlarının değerlendirilmesi sonucunda SS tanısı konuldu. MTBB invaziv bir girişim olmasına rağmen SS ayırıcı tanısında kullanılan değerli bir tanı aracıdır