Tarsal tünel sendromunun tanısında çeşitli elektrofizyolojik testlerin duyarlılığının araştırılması

TARSAL TÜNEL SENDROMUNUN TANISINDA ÇEŞİTLİ ELEKTROFİZYOLOJİK TESTLERİN DUYARLILIĞININ ARAŞTIRILMASI Bu çalışmada tarsal tünel sendromu (TTS) tanısında duyusal sinir iletim çalışmaları parametrelerinin değerlendirilmesi ve provokatif manevraların bu parametreler üzerindeki etkileri ile iğne EMG’de kantitatif motor ünit potansiyel (MÜP) analizinin tanıya katkısını araştırmak amaçlandı. TTS ön tanısı ile başvuran 20 hasta (35 ayak) ve 18 sağlıklı birey (36 ayak) çalışmaya alındı. Sural, medial ve lateral plantar sinirlerin duyusal; peroneal ve tibial sinirlerin motor iletim çalışmaları yapıldı. Ayak-ayak bileği 5 dk dorsifleksiyon-eversiyon pozisyonunda tutulduktan sonra medial ve lateral plantar sinirlerin duyusal incelemeleri yenilendi. Abduktor hallusis longus (AHL) ve ekstansör digitorum brevis (EDB) kaslarının kantitatif motor ünit potansiyeli (MÜP) incelemesi ile amplitüd, süre, alan ve polifazi oranları kayıtlandı. Medial plantar sinirde duyusal sinir aksiyon potansiyeli (DSAP) TTS ön tanılı çalışma grubunda 3 ekstremitede (%8,5), kontrol grubunda ise 1 ekstremitede (%2,7); lateral plantar sinir DSAP ise sırasıyla 12 ekstremitede (%34,2) ve 8 ekstremitede (%22) elde edilemedi. Çalışma grubunda manevra sonrası lateral plantar sinir duyusal latansında uzama, iletim hızında yavaşlama saptandı. Kontrol grubunda ise medial plantar sinir duyusal aksiyon potansiyel (DAP) amplitütünde azalma, iletim hızında yavaşlama; lateral plantar sinir DAP amplitütünde ise azalma tespit edildi. İğne EMG kantitatif MÜP analizinde ise AHL’de TTS grubunda belirgin polifazi artışı bulundu. Sonuç olarak, TTS ön tanılı hastalarda eğer lateral plantar sinir kaydı alınabilirse latansta uzama ve hızda yavaşlama; ayrıca iğne EMG AHL kantitatif MÜP analizinde ise polifazi sayısında artış tanıyı destekleyen elektrofizyolojik yöntemler olarak kullanılabilir. Anahtar sözcükler: Tarsal tünel sendromu, duyusal sinir iletim çalışmaları, provokasyon manevraları, motor ünit potansiyeli EVALUATION OF DIFFERENT ELEKTRODIAGNOSTİC METHODS IN DIAGNOSIS OF TARSAL TUNNEL SYNDROME The aims of our study were to evaluate the parameters of sensory conduction studies in the diagnosis of tarsal tunnel syndrome (TTS) and to find out how provocative maneuver affects these parameters, the contribution of the quantitative motor unit potential (MUP) analysis in diagnosis. Twenty patients (35 feet) that presented with the clinical diagnosis of TTS and 18 healthy volunteers (36 feet) were taken to the study. Nerve conduction studies of sural, medial and lateral plantar nerves; motor conduction studies of peroneal and tibial nerves were evaluated. Electrophysiologic studies of medial and lateral plantar nerves were repeated after holding of foot-ankle in dorsiflexion-eversion position for 5 minutes. Quantitative motor unit potential (MUP) analysis of the abductor hallucis longus (AHL) and extensor digitorum brevis (EDB) muscles was examined and MUP amplitude, duration, area under the curve and polyphasic MUP ratios were recorded. Sensory nerve action potential (SNAP) in medial plantar nerve could not be obtained in 3 extremities (8.5%) in the study group, 1 extremity in the control group (2.7%); SNAP of lateral plantar nerve could not be obtained in respectively 12 extremities (34,2%) and 8 extremities (22%). In the study group, delay in lateral plantar nerve latency and decrease in velocity were determined. In the control group, decreasing of medial plantar nerve amplitude and velocity; decreasing of lateral plantar nerve amplitude was determined. There was a significant increase in polyphasic MUP ratio in AHL in quantitative MUP analysis in the TTS group. As a result, if the lateral plantar nerve SNAP can be obtained in patients with TTS prediagnosis, delay in the latency and decrease in the conduction velocity; together with increased number of polyphasic MUPs in needle EMG of AHL can be used as the electrophysiologic methods that support the diagnosis of TTS. Key Words: Tarsal tunnel syndrome, sensory nerve conduction studies, provocation maneuvers, motor unit potential

Relationship of Depression and Risk Factors in Osteoporotic Men

Although osteoporosis mainly affects women, it could also be seen in men. The aims of the this study were to evaluate the risk factors for osteoporosis in men and to determine their relationships with each other. 49 men with osteoporosis were enrolled in the study. The participants completed a questionnaire covering education, work, alcohol intake, smoking, milk consumption, physical activity and oral glucocorticoid therapy. Additionally, Beck Depression and Visual Analogue Scales were used to assess depression and back pain level. Bone mineral density measurements of the lumbar spine (L2-L4), neck of femur and Ward’s triangle zone were performed by means of dual energy x-ray absorptiometer (DEXA). Dorsal, lumbar x-ray images were taken. According to WHO criteria, patients having Tscores of BMD ≥ -2.5 SD were included. In all patients, positive correlation between the length of education and exercise (r=0.305, p=0.03) and a negative correlation with milk consumption (r= -0.428, p=0.002) were found. Beck Deepression Scale scores were lower in working patients (r=0.457, p=0.001). There was positive corelation between Beck Depression and Visual Analogue Scales values (r=0.376, p=0.01). In men, life style and habits of the individual could be risk factors for osteoporosis and these issues should be taken into consideration before the planning of the treatment

Repetitive Transcranial Magnetic Stimulation in Patients with Hereditary Spastic Paraplegia

Hereditary spastic paraplegia (HSPP) is a heterogeneous genetic disease characterized by progressive spasticity of lower extremities. Spasticity is a major cause of long-term disability in HSPP and significantly affects the functional life of patients. Repetitive transcranial magnetic stimulation (rTMS) is widely used in diagnosis and treatment of many neurological and psychiatric diseases. Although the positive impacts of rTMS for spasticity have been reported, no study has been found on HSPP. We present two HSPP patients treated with low frequency rTMS (20 minutes at a frequency of 1 Hz (1200 pulses), for a period of 10 treatment sessions)

The Effects of Vitamin D Treatment on the Pain and the Quality of Life in Elderly Women - Original Investigation

Aim: Vitamin D synthesis in the body is reduced by older ages. It is known that in this age group with occurrence of vitamin D deficiency there is an increase in the number of muscle weakness, musculoskeletal system pain, balance impairment and falling. Quality of life is also negatively affected because of these problems. The aim of the present is to evaluate the effects of vitamin D treatment on pain and quality of life. Material and Methods: Fifty six patients over 65 years old with established vitamin D deficiency (<50 nmol/l) were enrolled in the study. 23 patients were given alphacalcidol 1 mg and elementary calcium 500 mg a day and the control group received elementary calcium 500 mg a day. All the patients were evaluated by visual analog scala (VAS), beck depression scale (BDS) and Short Form-36 (SF-36) at the starting of the treatment and at the end of 3rd and 6th months. Results: Pain relief started at 3rd month and continued till 6th month with vitamin D treatment (p0.05). Conclusion: It is observed that with alphacalcidol treatment the pain is reduced and thus the adaptation of the patients to social life is increased. (From the World of Osteoporosis 2010;16:9-12

The Effects of Risedronate Treatment on the Pain and the Quality of Life - Original Investigation

Aim: Osteoporosis is a skeletal system disease characterised by pain, physical disability and increased fracture risk which negatively effect quality of life. The aim of this study is to investigate the effects of risedronate treatment on pain and the quality of life at 6th and 12th months. Material and Methods: Eighty patients with osteoporosis were included the study and randomized into two groups. Thirty seven patients in the first group were given 35 mg weekly Risedronate and 600 mg elemantary calcium and 400IU vitamin D daily, 34 patients in the second group were given 600 mg elemantary calcium and 400IU vitamin D daily. Visual analogue scale, Beck depression scale and Notthingham health profile were completed to patients at the beginning of the treatment and at the end of the first year. Results: There was significant pain relief in both groups at 6 and 12 months. However, this was more prominent in the treatment group. It was defined that the significant decrease in the Beck depression scores was occured at the 6th month and continued at the end of the first year. In the assesment quality of life test, there was no difference before and after the treatment in the control group but we obtained significant difference in the treatment group. Conclusion: Improving the quality of life and decrease in the pain levels of the osteoporosis patients can be provided by risedronate treatment. (From the World of Osteoporosis 2009;15:34-7