Dirsek düzeyinde ulnar sinir tuzak nöropatisi tanısında sinir iletim çalışması sırasındaki dirsek fleksiyon açısının elektrofizyolojik inceleme sonuçlarına etkisi

TÜRKÇE Amaç: Dirsekte ulnar nöropatinin (DUN) tanısı semptomlar, fizik muayene bulguları ve elektrodiagnostik incelemelere dayanır. DUN’un elektrofizyolojik incelemesinde literatürde önerilen dirsek pozisyonu 70-90 derece fleksiyondur. Çalışmamızın amacı sinir iletim çalışması sırasındaki dirsek fleksiyon açısının DUN’un elektrofizyolojik inceleme sonuçlarına etkisinin araştırılması ve optimal dirsek fleksiyon açısının belirlenmesidir. Gereç ve Yöntem: Fatih Sultan Mehmet Eğitim ve Araştırma Hastanesi Fiziksel Tıp ve Rehabilitasyon Polikliniğine 4. ve 5. parmakta duyusal yakınma, ağrı ve güçsüzlük şikayetiyle başvuran hastalardan izole DUN olduğu düşünülen 46 hasta ve 44 sağlıklı kontrol çalışmaya alındı. Dört kişide bilateral DUN saptanması üzerine etkilenen her ekstremite ayrı olarak ele alındı ve toplam 50 DUN olgusu değerlendirildi. Bütün olgulara median ve ulnar sinir duyu ve motor iletim çalışmaları ile ulnar sinir kısa segment iletim çalışması yapıldı. Ulnar sinir motor iletim ve kısa segment iletim çalışmaları abdüktör digiti minimi kasından kayıtla dirsek 90̊ fleksiyonda ve 70̊ fleksiyonda olmak üzere ikişer kez yapıldı. Doksan ve 70̊’de her kısa segment için latans farkının normal değerleri belirlendi. DUN grubunun verileri kendi içinde ve kontrol grubu ile karşılaştırıldı. Bulgular: 90̊ ulnar motor iletim çalışmasının duyarlılığı %50, 70̊ ulnar motor iletim çalışmasının duyarlılığı %80, 90̊ kısa segment iletim çalışmasının duyarlılığı %86, 70̊ kısa segment iletim çalışmasının duyarlılığı %94 olarak bulundu. Sonuç: DUN’un tanı ve değerlendirmesinde kısa segment iletim çalışmaları konvansiyonel yöntemlerden daha duyarlıdır. Çalışmamızda 70̊’de yapılan ulnar motor ve kısa segment iletim çalışmaları 90̊’de yapılan çalışmalara kıyasla daha duyarlı bulunmuştur. DUN tanısı için en duyarlı test olan 70̊ dirsek fleksiyonunda kısa segment iletim çalışması yapılmasını öneriyoruz. Anahtar kelimeler: Dirsek düzeyinde ulnar nöropati, kısa segment iletim, dirsek fleksiyon açısı SUMMARY The effect of elbow flexion angle during nerve conduction studies on the results of electrodiagnostic studies of ulnar nerve entrapment at the elbow. Aim: Moderate elbow flexion 70̊ to 90̊ is recommended in the literature for the electrodiagnostic investigation of UNE. Aim in this study is to investigate the effect of elbow position on electrodiagnostic studies in UNE and to define the optimal elbow position. Material and Method: Patients referring to the outpatient clinic with the complaint of paresthesia on 4th and 5th fingers, pain and weakness were evaluated, 46 of them having pure UNE were enrolled in the study. 44 healthy volunteers constituted the control group. Bilateral UNE was detected in 4 patients so totally 50 extremities with were evaluated. Median, ulnar sensory motor and ulnar short segment conduction studies were performed. Abductor digiti minimi was recorded for the ulnar motor and short segment conduction studies (SSCS) which were performed twice with the elbow in 90 ̊̊ and 70̊ flexion. Normal values for latency change in each short segment was determined. The results of UNE group were compared with each other and with the control group. Results: Sensitivity of ulnar motor conduction study with 90̊ elbow flexion was 50%, with 70̊ elbow flexion was 80%, sensitivity of 90̊ SSCS was 86% and of 70̊ SSCS was 94%. Conclusion: SSCS have higher sensitivity in the diagnosis of UNE in comparison with the conventional methods. Ulnar motor and SSCS performed with 70̊ elbow flexion found to have a higher sensitivity than the studies in 90̊ flexion. We recommend the SSCS with the elbow 70̊ flexed for the diagnosis of UNE as the most sensitive diagnostic test. Key words: ulnar neuropathy at the elbow, short segment conduction, elbow flexion angl

A rare case of ankylosing spondylitis with severe temporomandibular joint and dental involvement

Ankylosing spondylitis (AS) is a chronic inflammatory disease that primarily affects the axial skeleton, resulting in functional deterioration. Temporomandibular joint (TMJ) ankylosis is characterized by bony or fibrous adhesion of the anatomic joint components, which results in limited mouth opening. Despite the high prevalence of the disease, ankylosis of the TMJ and tooth secondary to AS are rare conditions. Here, a patient with AS admitted to the outpatient clinic with a chief complaint of TMJ pain and restricted mouth opening was diagnosed with TMJ and dental sclerosis. The patient’s dental history included fracture of a wisdom tooth during an attempted extraction and difficulty in mouth opening. TMJ and dental ankylosis should be considered in patients with AS with a poor dental history and difficulty in mouth opening. For such suspected cases, a panoramic radiograph of the jaws and teeth should be obtained to detect abnormalities

Subacromial tenoxicam injection in the treatment of impingement syndrome

Objectives: As subacromial bursa injection is widely used for pain relief and functional improvements in patients with periarticular shoulder disorder, we aimed to present our results of subacromial tenoxicam injection in the treatment of impingement syndrome

The Effect of Glucocorticoids on Bone Mass in Patients with Asthma and Chronic obstructive Pulmonary Disease

Inhaled corticosteroids and bronchodilators have become a key element in the maintenance treatment of bronchial asthma and chronic obstructive pulmanory disease (COPD). It is well known that long-term systemic steroid use causes osteoporosis, whereas inhaled corticosteroids and bronchodilators have been discussed to be cause of such side-affect. The aim of this study was to detect the effect of long term inhaled/oral steroids and bronchodilators on bone mineral density (BMD) with asthma and COPD. Fifty-three patients with bronchial asthma (n=44) and COPD (n=9) were enrolled in this study. BMD were measured and risk factors for osteoporosis were detected. BMD measurements of lumbar area of the spine (L2-4), neck of femur and femoral ward’s triangle zone were performed by the dual energy x-ray absorptiometer (LUNAR). 53 patients evaluated in three groups according to treatment type; 26 patients were using inhaled corticosteroids and bronchodilators (group 1), 18 patients were using only bronchodilators (group 2) and 9 patients were using (group 3) oral corticosteroids and bronchodilators. There were significant differences between group 3 and other two groups in terms of BMD, T and Z scores of the lumbar and femoral neck (p0.05). As a result, we suggest that systemic corticosteroids negatively affect bone mineral density more than inhaled corticosteroids in patients with COPD