Multiple stress fractures presented by groin pain in female athlete: A case report

Stres kırığı sporcularda ve askeri popülasyonda sık görülen kemiğin aşırı kullanım yaralanmasıdır. Sıklıkla tibiada ve metatarslarda görülür. Bu yazıda 25 yaşındaki kadın sporcuda konservatif olarak tedavi edilen sağ inferior pubik ramus, sağ asetabulum ve sol tibia metafiz kırığı multiple stres kırığı olgusu olarak sunulmuş ve multiple stres kırığı olan sporcularda predispozan faktörler, tanı, tedavi ve rehabilitasyon yaklaşımları literatür eşliğinde tartışılmıştır.Stress fracture is an overuse injury to the bone that is common in athletes and the military population. It is frequently see n in the tibia and metatarsals. In this article, a case of multiple stress fractures of the right inferior pubic ramus, right acetabulum and left tibia metap hysis, which were treated conservatively in a 25-year-old female athlete, was presented and predisposing factors, diagnosis, treatment and rehabilitation approaches in athletes with multiple stress fractures were discussed in the light of the literature

Gebe olmayan bir kadında kalçanın idiopatik geçici osteoporozu: vaka çalışması

Kalçanın geçici osteoporozu (KGO) öncelikle orta yaşlı erkekleri ve ge- beliğin üçüncü trimestrindeki dönemindeki kadınları etkileyen nadir bir hastalıktır. KGO kalça ağrısı ve radyolojik olarak eklem aralığında daralma veya destrüksiyon olmaksızın ortaya çıkan geçici osteopeni ile ilişkilidir. Kadınlar için tanımlanmış tek risk faktörü gebeliktir. Tipik olarak semp- tomların kendiliğinden rezolüsyonu ile benign bir seyir gösterir. Radyog- rafiler erken dönemde belirti vermeyebilir. Bu nedenle, geçici osteoporoz avasküler nekroz gibi çok sayıda diğer hastalıklarla karışabilir. Erken dö- nemlerde bu iki hastalığın birbirinden ayırt edilmesi uygun tedavi planı- nın seçilebilmesi için önemlidir. Bu yazıda, gebelik de dahil olmak üzere herhangi bir risk faktörü olmayan ve konserevatif tedavi ile yeterli iyileşme gösteren KGO’lu 35 yaşındaki kadın hasta sunulmuştur.Türk Fiz T›p Re­hab Derg 2013;59:157-60.Transient osteoporosis of the hip (TOH) is a rare disease affecting women in the third trimester of pregnancy as well as middle-aged men. TOH is associated with hip pain and temporary osteopenia apparent on radiology without joint space narrowing or destruction of the hip. Pregnancy is the only recognized risk factor for women. It typically runs a benign course with eventual resolution of symptoms. Radiographs may be unrevealing early in its course. Therefore, transient osteoporosis may be confused with many other conditions such as avascular necrosis. In early stages, it is important to distinguish between these two conditions to order to decide on an appropriate treatment plan. In this report, we present a 35-year-old woman who had TOH, without any risk factor including pregnancy, and showed sufficient improvement with conservative treatment. Turk J Phys Med Rehab 2013;59:157-60

Resorption mechanisms related with neo- vascularization for the lomber disc herniation

Lomber disk herniasyonu (LDH) bel ağrısı ve siyatiğin önemli bir nedenidir. LDH’nın magnetik rezonans görüntüleme (MRG) ile incelenmesi neo-vaskülarizasyonla ilişkili rezorbsiyon mekanizmasını ortaya çıkarmıştır. Aktive makrofajların disk dokusuyla etkileşimlerinin infamatuvar sitokinlerin üretimine yol açtığı gösterilmiştir. Buna ek olarak tümör nekrozis faktör-? (TNF -?) gibi infamatuvar sitokinler, vasküler endotelyal growt faktör (VEGF) gibi anjiogenezi uyaran faktörlerin indüksiyonu için gereklidir. VEGF endotel hücresine özgü bir mitojendir ve yeni kan damarlarının oluşumunda esaslı bir rolü vardır. Yeni oluşmuş kan damarları ve makrofaj infiltrasyonu LDH rezorbsiyonu sırasında önemli bir rol oynarlar. Bu derlemede LDH’da rezorbsiyon mekanizmaları hakkındaki güncel bilgiler özetlendi.Lomber disc herniation (LDH) is a major cause of low back pain and sciatica. MRI investigation of LDH has revealed a resorption mechanism related with neo -vascularization. It has shown that the interaction of activated macrophages with disc tissues leads to the generation of inflammatory cytokines. In addition, inflammatory cytokines such as tumor necrosi s factor-α (TNF -α) is required for the induction of angiogenesis stimulating factors such as vascular endothelial growth factor (VEGF). VEGF is an endothelial cell -specific mitogen, and it has an essential role in the formation of new blood vessels. The ne wly formed vessels and infiltrating macrophages play an important role during LDH resorption. In this review, recent knowledge on the resorbtion mechanisms of LDH is summerized

Transient Osteoporosis in a Young Man: Case report – Case Report

Although osteoporosis is defined as being a painless and progressive condition, one special subtype of osteoporosis is reversible and painful. Because it isn’t permanent and is obvious in the hip joint, this condition is called transient osteoporosis of the hip. Typically, the paitents are women in the third trimester of pregnancy and middle-aged men who are seen initially with acute progressive pain, antalgic gait, and severe functional disability involving the affected extremity. Its aetiology remains a matter of speculation, and the same remains true for its treatment. Many researchers have proposed different surgical and non-surgical treatment strategies; but the conservative approach, which takes the form of analgesics, intermittent traction, range of motion exercises, abductor strengthening exercises and restricted weight bearing, is preferred. In this paper we report a 22 years old man with transient osteoporosis of the hip who showed excellent recovery following a conservative approach. (From the World of Osteoporosis 2008;14:35-9

Diagnostic performance of clinical tests in patients with shoulder pain

Amaç: Çalışmamızın amacı, fzik tedavi polikliniğine başvuran omuz ağrılı hastalarda manyetik rezonans görüntüleme (MRG) bulguları esas alınarak klinik testlerin tanısal performans düzeylerini araştırmaktır. Ayrıca MRG bulguları ile ağrı ve omzun fonksiyonel durumu arasındaki ilişki de incelenmiştir. Gereç ve Yöntemler: Çalışmaya omuz ağrısı nedeniyle polikliniğimize başvuran 76 hasta alındı. Tüm hastaların fzik muayeneleri ve farklı omuz patolojilerine yönelik özel klinik testleri yapıldı. Hastaların ağrı düzeyleri ‘Vizüel Analog Skala’ (VAS) ile değerlendirildi. Omzun fonksiyonel değerlendirilmesi ‘Omuz Özürlülük Sorgulaması’ (OÖS) formu kullanılarak yapıldı. Tüm hastalar MRG ile değerlendirildi. Manyetik rezonans görüntüleme bulguları esas alınarak, uygulanan klinik testlerin seçiciliği, duyarlılığı, pozitif ve negatif ve tahmini değerleri ile doğruluğu Ki-kare tablosu kullanılarak hesaplandı. Bulgular: İmpingement ve rotator kaf patolojilerini değerlendiren testlerin genel olarak duyarlılıkları yüksekken, seçicilikleri düşük bulundu. Supraspinatusta rüptürleri değerlendirmede Drop Arm; subakromial- subdeltoid efüzyonu saptamada Yocum testi, infraspinatus patolojilerini saptamada Patte ve dış rotasyon yetmezlik belirtisi, biseps patolojilerini saptamada Speed testi, akromiyoklaviküler eklem patolojilerini saptamada horizontal addüksiyon testi ile ağrılı ark testinin tanısal performansı istatistiksel olarak anlamlı bulundu. Ağrı şiddeti ile omuz patolojileri arasında anlamlı ilişki bulunamadı. Fonksiyonel durum açısından sadece bisipital tendiniti olan grupta fonksiyonel skorların anlamlı olarak yüksek olduğu saptandı. Sonuç: Omuz ağrılı hastaların büyük çoğunluğunda MRG’de çoklu patolojik lezyon olması ve klinik testlerin çoğunun patolojiyi saptamada düşük seçicilik oranlarına rağmen yüksek duyarlılık oranlarına sahip olması, tedaviyi planlama ve eşlik eden patolojileri belirleme açısından klinik testlerin önemli bir role sahip olduğunu göstermektedir.Objective: This study aimed to investigate the diagnostic performance of clinical tests applied to patients with shoulder pain at a physical therapy outpatient clinic. Magnetic resonance imaging (MRI) fndings were the major determinants to evaluate the accuracy of the clinical tests. Also, the relationship between the MRI fndings and the pain and functional status of the shoulder were evaluated. Material and Methods: Seventy-six patients, referred to a physical therapy outpatient clinic with shoulder pain, were included in the study. Physical examination of all patients and specifc clinical tests were performed for different shoulder pathologies. Pain levels of patients were evaluated with the visual analog scale and functional status of the shoulder with the Shoulder Disability Questionnaire. All patients were evaluated with MRI. Sensitivity, specifcity, and positive and negative predictive values of the clinical tests were evaluated on the basis of the MRI fndings. Results: The sensitivity of the tests evaluating impingement and rotator cuff pathologies was found to be high, but specifcity was low. Diagnostic performance of the drop arm test to determine the supraspinatus ruptures; Yocum test to determine the subacromial and subdeltoid effusion; Patte test and external rotation lag sign to determine infraspinatus tendon pathologies; speed test to determine biceps pathologies; and horizontal adduction test and painful arc test to determine acromioclavicular joint pathologies were found to be statistically signifcant. In this study, the severity of pain and shoulder pathologies showed no statistically signifcant correlation. In terms of functional status, high scores were achieved only in the bicipital tendinitis group. Conclusion: MRI fndings show that patients with shoulder pain may have multiple pathological lesions. Despite the coexistence of multiple pathologies and low specifcity of clinical tests, clinical tests evaluating shoulder pathologies have great importance in directing the clinicians to diagnose and plan treatments because of high sensitivity

Alcoholic Neuropathy with Superimposed Focal Entrapment Neuropathies

We reported here a case of alcoholic polyneuropathy with superimposed focal entrapment neuropathies. A 55-year-old male patient was admitted to the electrophysiology unit with the diagnosis of left ulnar neuropathy. He had a previous history of chronic alcoholism. Nerve conduction studies revealed bilateral carpal tunnel syndrome, bilateral ulnar neuropathy at the elbow, left peroneal neuropathy at the fibular head, prolonged distal motor latencies and moderately reduced motor conduction velocities in multiple motor nerves, slowed conduction velocities in multiple sensory nerves and multiple prolonged F-waves. Gene analysis did not reveal deletion on chromosome 17p11.2-12. We wanted to share our findings with other clinicians to get their opinion regarding possible diagnosis of the case

Pseudothrombophlebitis syndrome in a rheumatoid arthritis patient with swollen calf and persistent itching: a case report

Abstract Background Baker’s cyst is a benign lesion that results from degenerative or inflammatory diseases of the knee joint. When Baker’s cyst ruptures, it may simulate deep vein thrombosis known as Pseudothrombophlebitis syndrome with calf pain, swelling and redness. Pseudothrombophlebitis syndrome without thrombus in popliteal veins has distinct treatment choice than deep vein thrombus. Case presentation In this report, we presented a 47 year-old male rheumatoid arthritis patient with complaints of redness, pain and swelling on his right calf. Pseudothrombophlebitis syndrome was diagnosed due to ruptured Baker’s cyst. Conclusions We used musculoskeletal ultrasound for both differential diagnosis and treatment of pseudothrombophlebitis syndrome. Ultrasonography revealed massive fluid collection within muscle layers. 280 cc inflammatory fluid was aspirated simultaneously. We also emphasized the importance of ultrasonography in diagnosis and treatment of Pseudothrombophlebitis syndrome with this report

Alcoholic Neuropathy with Superimposed Focal Entrapment Neuropathies

Bu yazıda fokal tuzaklanma nöropatileri ile birlikte olan alkolik nöropatili bir hasta sunulmuştur. Elli beş yaşında erkek hasta sol ulnar nöropati tanısı ile kliniğimiz elektrofizyoloji ünitesine kabul edildi. Hasta anamnezde önceye ait kronik alkol alışkanlığı öyküsü veriyordu. Sinir iletim çalışmaları hastada bilateral karpal tünel sendromu, dirsekte bilateral ulnar nöropati, solda fibula başı bölgesinde peroneal nöropati, distal motor latanslarda uzama ve orta derecede azalmış motor iletim hızları, çok sayıda duyusal sinir ileti hızlarında yavaşlama ve çok sayıda uzamış F yanıtı latansı varlığını ortaya koydu. Genetik analizlerde 17p11.2-12 kromozomda delesyon saptanmadı. Bulgularımızı hastanın muhtemel tanısı hakkındaki görüşlerini almak için diğer klinisyenlerle paylaşmak istedik.We reported here a case of alcoholic polyneuropathy with superimposed focal entrapment neuropathies. A 55-year-old male patient was admitted to the electrophysiology unit with the diagnosis of left ulnar neuropathy. He had a previous history of chronic alcoholism. Nerve conduction studies revealed bilateral carpal tunnel syndrome, bilateral ulnar neuropathy at the elbow, left peroneal neuropathy at the fibular head, prolonged distal motor latencies and moderately reduced motor conduction velocities in multiple motor nerves, slowed conduction velocities in multiple sensory nerves and multiple prolonged F-waves. Gene analysis did not reveal deletion on chromosome 17p11.2-12. We wanted to share our findings with other clinicians to get their opinion regarding possible diagnosis of the case

The Role of Mediterranean Fever Mutation in the Clinical Course and Pathogenesis of Ankylosing Spondylitis

Objectives: This study aims to investigate the role of Mediterranean fever (MEFV) gene mutations in the pathogenesis and clinical progression of disease in ankylosing spondylitis patients. Patients and methods: The study included 88 patients (60 males, 28 females; mean age 38.7±8.7 years; range 19 to 56 years) diagnosed with ankylosing spondylitis according to modified New York criteria. The patients were evaluated for peripheral joint and hip joint involvement and treatment characteristics. Using multiplex/polymerase chain reaction reverse hybridization method, the presence of 12 different MEFV mutations was investigated. Results: Of 29 patients, heterozygote mutation was detected in 24 (83%), mutations in both alleles were detected in three (10%), and combined heterozygote mutations were detected in two patients (7%). Three most common mutations were M694V (11.3%), E148Q (8%), and V726A (4.5%). In the group with mutations, symptoms had started earlier than in the other group, and the number of peripheral joints involved was higher. When both characteristics were compared with the characteristics of the group that did not have any gene mutations, the differences were statistically significant (p<0.001 and p=0.044, respectively). The highest correlation with the number of peripheral joints involved was determined for M694V mutation (p=0.034), while onset of symptoms at younger age was correlated with E148Q mutation (p=0.010). Conclusion: Based on the findings of this study and our clinical experience, it can be said that the clinical progression of ankylosing spondylitis patients with MEFV gene mutations is more severe, and this suggests that MEFV gene mutations may be contributive to ankylosing spondylitis pathogenesis.Objectives: This study aims to investigate the role of Mediterranean fever (MEFV) gene mutations in the pathogenesis and clinical progression of disease in ankylosing spondylitis patients. Patients and methods: The study included 88 patients (60 males, 28 females; mean age 38.7±8.7 years; range 19 to 56 years) diagnosed with ankylosing spondylitis according to modified New York criteria. The patients were evaluated for peripheral joint and hip joint involvement and treatment characteristics. Using multiplex/polymerase chain reaction reverse hybridization method, the presence of 12 different MEFV mutations was investigated. Results: Of 29 patients, heterozygote mutation was detected in 24 (83%), mutations in both alleles were detected in three (10%), and combined heterozygote mutations were detected in two patients (7%). Three most common mutations were M694V (11.3%), E148Q (8%), and V726A (4.5%). In the group with mutations, symptoms had started earlier than in the other group, and the number of peripheral joints involved was higher. When both characteristics were compared with the characteristics of the group that did not have any gene mutations, the differences were statistically significant (p<0.001 and p=0.044, respectively). The highest correlation with the number of peripheral joints involved was determined for M694V mutation (p=0.034), while onset of symptoms at younger age was correlated with E148Q mutation (p=0.010). Conclusion: Based on the findings of this study and our clinical experience, it can be said that the clinical progression of ankylosing spondylitis patients with MEFV gene mutations is more severe, and this suggests that MEFV gene mutations may be contributive to ankylosing spondylitis pathogenesis