Kör omuz enjeksiyonu yapmaya devam etmeli miyiz?

Objectives: This study aims to investigate the accuracy and effectiveness of blind and fluoroscopic-guided intra-articular shoulder injections in patients with shoulder pain.Patients and methods: The study included 17 patients (6 males, 11 females; mean age 52.6±9.9 years; range 36 to 66 years) with shoulder pain more than three months. First intra-articular joint injections were performed with anterior approach blindly. Following the injection and after confirming that the needle tip was intra-articular with fluoroscopy and contrast distribution, the procedure was completed using 3 mL of local anesthetic (prilocaine and bupivacaine) and 1 mL of steroid (40 mg methylprednisolone). When the contrast distribution was observed to be extra-articular at the first administration, a second injection was continued under fluoroscopy guidance. All of the injections were intraarticular with the continuation of the procedure. Pain intensity was measured with visual analog scale (VAS).Results: According to the contrast distribution viewed with fluoroscopy, first blind injections were intra-articular in 11 of the 17 shoulders (64.7%). Mean of initial VAS score was 7.11. Improved pain was observed in the clinical follow-ups at the first hour (mean VAS: 2.35), third day (mean VAS: 2.64), and at the end of the first month (mean VAS: 2.23). The mean durations for blind and fluoroscopic-guided procedures excluding patients' preparation time were 0.8 minutes and 4.2 minutes, respectively.Conclusion: Although blind intra-articular shoulder injections are inexpensive and easily applicable, injections should be performed under fluoroscopy or another guide to ensure that the needle is intra-articular, not peri-articular.Amaç: Bu çalışmada omuz ağrısı olan hastalarda kör ve floroskopi rehberli eklem içi omuz enjeksiyonlarının doğruluğu ve etkinliği araştırıldı.Hastalar ve yöntemler: Çalışmaya üç aydan uzun süredir omuz ağrısı olan 17 hasta (6 erkek, 11 kadın; ort. yaş 52.6±9.9 yıl; dağılım 36-66 yıl) dahil edildi. İlk eklem içi enjeksiyonlar ön yaklaşım ile kör olarak uygulandı. Enjeksiyon sonrası iğne ucunun eklem içerisinde olduğu floroskopi ve kontrast dağılımı ile doğrulandıktan sonra işlem 3 mL lokal anestezik (prilokain ve bupivakain) ve 1 mL steroid (40 mg metilprednizolon) ile tamamlandı. İlk uygulamada kontrast dağılımının eklem dışı olduğu gözlendiğinde, ikinci enjeksiyona floroskopi eşliğinde devam edildi. İşlemin devam ettirilmesi ile tüm enjeksiyonlar eklem içi oldu. Ağrı yoğunluğu görsel analog ölçeği (GAÖ) ile ölçüldü.Bulgular: Floroskopi ile bakılan kontrast dağılımına göre, 17 omzun 11'inde (%64.7) birinci kör enjeksiyonlar eklem içi idi. Başlangıç GAÖ skoru ortalaması 7.11 idi. Klinik takiplerde birinci saatte (ortalama GAÖ: 2.35), üçüncü günde (ortalama GAÖ: 2.64) ve birinci ayın sonunda (ortalama GAÖ: 2.23) ağrıda iyileşme gözlendi. Kör ve floroskopi rehberli uygulama için hasta hazırlanma süresi dışındaki ortalama süre sırasıyla 0.8 dakika ve 4.2 dakika idi.Sonuç: Kör eklem içi omuz enjeksiyonları ucuz ve kolay uygulanabilir olsa da iğnenin eklem çevresinde değil eklem içinde olduğundan emin olmak için enjeksiyonlar floroskopi ya da başka bir rehber eşliğinde yapılmalıdır

Rehabilitasyona Güncel Bakış

Amputasyonbir ya da daha fazla kemiğin veya kemiğin bir parçasının çıkarılmasını içerencerrahi işlemdir.&nbsp; Amputerehabilitasyonu&nbsp; amputasyon öncesidönemden başlayarak kişinin toplum hayatına geri dönmesi ve mesleğini yenidenyapabilmesini amaçlayan operasyon öncesi ve sonrası devam eden bir süreçtir.Kişinin fonksiyonelliğini yeniden kazanmasında ortopedik cerrahi yöntemleri,protez tedavisi, rehabilitasyon tedavisi yer almaktadır. Rehabilitasyon sürecicerrahi öncesi dönemde başlar, cerrahi sonrasında egzersiz programı ile devameder. Protez seçimi ve protez eğitimi hastanın amputasyon sonrasırehabilitasyon sürecinde önemli bir yer tutar.</p

dahili hastalarda özel beslenme ve diyet yöntemi

Osteoartritte beslenme hem&nbsp;hastalıktan korunmada hem de semptomları gidermede önemli bir yeresahiptir. Obezite, hiperlipidemi,diabetes mellitus gibi hastalıklar&nbsp; mekanik ve inflamatuar etki ile osteoartritgelişme riskini artırır. Beden kitle indeksinde düşüş osteoartritsemptomlarında azalmaya neden olur. Osteoartrit tanılı hastalarda önerilendiyet Akdeniz tipi beslenmedir. Haftada 1 yada 2 balık yağı tüketimi, zeytin vezeytinyağından zengin besleme antioksidan mekanizmalar üzerinden etki ederekeklem ve kemik yapıyı korur. Antioksidan vitaminler, özellikle D vitamininyeterli alımı&nbsp; osteoartrit riskiniazaltır. Osteoartitte beslenme tipi,&nbsp;hastanın yaşına, egzersiz kapasitesine, ek hastalıklarına, besintakviyesi alıp almadığına bakılarak kişiye özel planlanmalıdır.</p

Does remission in rheumatoid arthritis bring kinesiophobia, quality of life, fatigue, and physical activity closer to normal?

© 2022 Turkish League Against Rheumatism. All rights reserved.Objectives: This study aimed to compare kinesiophobia, fatigue, physical activity, and quality of life (QoL) between the patients with rheumatoid arthritis (RA) in remission and a healthy population. Patients and methods: The prospective controlled study included 45 female patients (mean age: 54.22±8.2 year; range, 37 to 67 year) with a diagnosis of RA determined to be in remission according to the Disease Activity Score in 28 Joints (DAS28) being ≤2.6 between January 2022 and February 2022. As a control group, 45 female healthy volunteers (mean age: 52.2±8.2 year; range, 34 to 70 year) of similar age were evaluated. The QoL, disease activity, pain, kinesiophobia, fatigue severity, and physical activity were assessed using the Health Assessment Questionnaire, DAS28, Visual Analog Scale, Tampa Scale of Kinesiophobia, Fatigue Severity Scale, and International Physical Activity Questionnaire, respectively. Results: There was no significant difference between the groups in demographic data. A statistically significant difference was found between the groups in terms of pain, C-reactive protein level, fatigue, kinesiophobia, QoL, and total, high, and moderate physical activity scores (p<0.001). Among the RA patients in remission, there was a significant correlation between kinesiophobia and moderate physical activity and QoL, as well as between fatigue and high physical activity (p<0.05). Conclusion: Patient education and multidisciplinary approach strategies should be developed to increase the QoL and physical activity and reduce kinesiophobia in RA patients in remission since there may be a decrease in physical activity due to kinesiophobia, fatigue, and fear of movement in this patient group compared to the healthy population, impairing their QoL

Anatomy and Assessment of the Autonomic Nervous System

Autonomic Nervous System (ANS) is responsible for the vegetative functions of the body. It is composed of many ganglions, plexi, cerebrospinal nuclei and nerves. ANS, which is also known as visceral or vegetative nervous system, helps to control many functions, such as blood pressure, gastrointestinal motility, glands, bladder functions, sweating and body temperature. ANS innervates all the smooth muscles and the heart, and keeps to stabilize body functions within certain limits. ANS is composed of 3 components: sympathetic system (thoracolomber-adrenergic), parasympathetic system (craniosacral- cholinergic) and enteric system (nonadrenergic- noncholinergic). Autonomic nerves are classified with regard to their origin from central nervous system, the distribution of peripheral ganglions, their various physiological effects on visceral organs, and response to pharmacological agents. It is essential to know the anatomy and the physiology of the ANS, in order to evaluate disorders, achieve the correct diagnosis and to plan accurate treatment

EVALUATION OF FUNCTIONALITY, DEPRESSION AND QUALITY OF LIFE IN HEMIPLEGIC PATIENTS DURING COVID-19 PANDEMIC

OBJECTIVE: The aim of this study was to investigate the changes of the functionality, mood and life quality of patients diagnosed with hemiplegia due to an ischemic or hemorrhagic stroke during the COVID-19 pandemic. MATERIAL AND METHODS: A total of 83 patients (mean age, 62.0±6.43 years) diagnosed with hemiplegia due to stroke, who received 30 sessions of rehabilitation therapy, before the COVID-19 pandemic, were included in this study. Data regarding the participants’ age, gender, body mass index (BMI), duration of stroke, stroke type, affected side, and education level were recorded. All the assessments were undertaken before the COVID-19 pandemic and repeated at the first year after the beginning of the pandemic. The functional status of the patients was evaluated with the Functional Independence Measure (FIM). The depression levels of the participants were evaluated using the Beck Depression Inventory (BDI). The life quality of the participants was evaluated using the Stroke-Specific Quality of Life Scale (SS-QOL). RESULTS: There were significant differences in the FIM total scores of the patients evaluated before and during COVID-19 (91.32±15.94 and 87.15±15.60, respectively, p&lt;0.001).When the FIM domain scores were evaluated before COVID-19 and at the first-year control during COVID-19, the FIM self-care scores were 27.45±6.62 and 25.27±7.08, respectively, the FIM sphincter control scores were 10.10±2.56 and 9.39±2.87, respectively, the FIM transfers scores were 14.67±3.36 and 13.61±3.54, respectively, the FIM social cognition scores were 18.40±1.86 and 17.67±1.93 respectively (p&lt;0.001). The BDI score was 10.06±3.18 before the pandemic and 13.66±3.04 at the first year of the pandemic, the SS-QOL scores was 136.48±29.63 before the pandemic and 133.63±29.63 at the first year evaluation (p&lt;0.001). CONCLUSIONS: The COVID-19 pandemic has caused delays in both follow-up and rehabilitation therapy in patients with chronic hemiplegia. The functionality, life quality and mood of the patients have been affected due to the lack of therapy and social isolation

EFFECTS OF CARDIAC REHABILITATION ON FUNCTIONAL EXERCISE CAPACITY, QUALITY OF LIFE AND DEPRESSION

OBJECTIVE: Cardiac Rehabilitation Program (CRP) is a comprehensive program developed specifically for the patients aims to improve functional exercise capacity, quality of life, and psychosocial status. This study aims to investigate the effect of CRP in retrospectively on patients who went through percutaneous coronary interference (PCI) with coronary artery disease (CAD) diagnosis and coronary artery bypass graft (CABG) history.MATERIAL AND METHODS: 38 patients with CAD diagnosis and 12 patients with CABG history who underwent through PCI were assessed retrospectively. CRP consists of 5 minutes of warm-up, 10 minutes of joint range of motion, a 15 minute-tone-up exercise for the greater muscle groups, 30 minutes of aerobic exercise through constant heart rate training program by using bicycle ergometer exercise and 5 minutes of cool-down exercise. A total of 30 sessions were applied. The demographic data of the patients were recorded. 6-minute-walk-test (6-MWT), Short Form- 36 (SF-36), and Beck depression inventory were used respectively to assess the functional exercise capacity, quality of life, and the level of depression of the patients for their before and after the rehabilitation process.RESULTS: Physical function (p&lt;0.001), physical role (p=0.001), emotional role (p=0.01), pain (p=0.03), overall health (p=0.04) of life quality parameters, 6-MWT (p&lt;0.001) and value of Beck depression inventory (p&lt;0.001) showed significant improvement after the rehabilitation process of patients with CAD diagnosis. Furthermore, significant improvement was found in physical role difficulty and emotional role (p=0.001), which are from the quality of life parameters, and 6 MWT (p&lt;0.001) and BDI (p&lt;0.001) after rehabilitation in patients with CABG.CONCLUSIONS: The cardiopulmonary aerobic exercise program that is applied together with cycle ergometer exercise improves the functional exercise capacity and the life quality of the patients with CAD diagnosis and CABG history and helps bring down the depression level of the patients.</p