Evaluation of the effectiveness of kinesio taping in myofascial pain syndrome of the trapezius muscle with quantitative ultrasound measurements

Miyofasiyal ağrı sendromu (MAS) sık görülen kas iskelet sistemi hastalıklarından biri olup çoğunlukla trapezius kasını etkilemektedir. MAS ağrı, anksiyete, depresyon, bozulmuş yaşam kalitesi ile ilişkilendirilmektedir. Farmakolojik olmayan tedavi yöntemlerinden biri olan kinezyolojik bantlama (KB) MAS tedavisinde kullanılan ve etkili olduğu bilinen seçeneklerdendir. Blob analizi, kantitatif ultrasonografik değerlendirme metodlarından biridir ve yapılan diğer çalışmalarda üst trapezius MAS hastalarında kullanılmıştır. Çalışmamızda; gerimli ve gerimsiz kinezyolojik bantlamanın üst trapezius MAS hastaları üzerindeki etkisinin blob analizi ile değerlendirilmesi ve karşılaştırılması amaçlanmıştır. Çalışmaya alınan üst trapezius kası MAS tanılı 52 kadın hasta gerimli (kas inhibisyon tekniği) KB (n= 26) ve gerimsiz KB (n= 26) gruplarına randomize edilmiştir. Hastalar iki hafta boyunca haftada iki kez KB değişimi sağlanacak şekilde takip edilmiştir. Tedavi öncesi, tedavi bitimi (2. hafta) ve 4. haftada vizüel ağrı skalası (VAS), boyun ağrı ve dizabilite skoru (BADS), hastane anksiyete depresyon ölçeği skoru (HAD), santral sensitizasyon anketi (SSA), kısa form-36 (SF-36) skorları, servikal eklem hareket açıklığı (EHA) ölçümü kayıt edilmiştir. Ayrıca B-mod ultrasonografi ile üst trapez kasınden elde edilen görüntüler blob analizi ile değerlendirilerek, blob sayısı ve ortalama blob boyutu verileri elde edilmiştir. Çalışmada yer alan 25 sağlıklı katılımcının HAD, SF-36 skorları ve blob analizi sonuçları istatistiksel analize dahil edilmiştir. İkinci ve 4. hafta sonuçları, tedavi öncesi ile karşılaştırıldığında; VAS, BADS, servikal EHA, SF-36, HAD-aksiyete, HAD-depresyon, SSA skorlarında her iki hasta grubunda da anlamlı iyileşme görülmüştür (p<0,05). Ayrıca gerimli KB grubunda, 2-4. haftalar arası HAD-anksiyete, HAD-depresyon skorlarındaki azalma, SF-36'nın fiziksel rol güçlüğü, emosyonel rol güçlüğü, ruhsal sağlık ve genel sağlık algısı alt skorlarındaki artış istatistiksel olarak anlamlı bulunmuştur (p<0,05). Her iki grupta da blob sayısında artış ve ortalama blob boyutunda azalma izlenmiş olup gruplar arası fark tespit edilmemiştir (p<0,05). MAS'ta kasın B-mod ultrasonografi görüntülerinin blob analizi objektif bir yöntem olarak tedavinin takibinde klinik pratikte kullanılabilir.Myofascial pain syndrome (MPS) is a common musculoskeletal disorder and mostly affects the trapezius muscle. MPS is associated with pain, anxiety, depression, and impaired quality of life. Kinesio taping (KT), which is one of the non-pharmacological treatment methods, is one of the options used in the treatment of MPS and known to be effective. Blob analysis is a quantitative ultrasonographic evaluation method and it has been used in patients with upper trapezius MPS in other studies. Our aim was to evaluate and compare the effect of kinesio taping with and without tension on upper trapezius MPS patients with blob analysis. Fifty-two female patients with a diagnosis of MPS of upper trapezius muscle included in the study were randomized to KT with tension (muscle inhibition technique) (n= 26) and KT without tension (n= 26) groups. The patients were followed for two weeks with changing the KT twice a week. Visual analogue scale (VAS), neck pain and disability score (NPDS), hospital anxiety and depression scale (HAD), central sensitization questionnaire (SSQ), short form-36 (SF-36) scores, range of motion (ROM) of cervical spine measurement were recorded at before treatment, second week and fouth week. In addition, the images obtained by B-mode ultrasonography in our clinic were evaluated with blob analysis, and data of the blob count and mean blob size were obtained. HAD and SF-36 scores and blob analysis results of 25 healthy participants in the study were included in the statistical analysis. When the results of the end of the treatment and the 4th week are compared with the pre-treatment, significant improvement was observed in VAS, NPDS, cervical ROM, SF-36, HAD-anxiety, HAD-depression, and SSQ scores in both groups (p<0.05). In addition, there is a significant difference in the sub-scores of SF-36, HAD-anxiety, HAD-depression in favor of the KT with tension group in the comparison of the changes between the groups between 2-4 weeks (p<0 .05). An increase in the blob count and a decrease in the mean blob size were observed in both groups. Blob analysis of B-mode ultrasonography images of the patients diagnosed with MPS can be used as an objective method in clinical practice in the follow-up of treatment

Tracheobronchopathia osteochondroplastica and cervical spine involvement in rheumatoid arthritis

A 62-year-old man presented to our outpatient clinic with a neck pain that began 4-month ago. The pain was increasing in severity without any neurological symptom or radiating to arms. The patient had a history of cerebrovascular accident without sequelae (1 year ago), 40 pack-year smoking, and diagnosis of rheumatoid arthritis (RA) 10 years ago. He had received an irregular treatment with prednisolone, methotrexate, and rituximab (discontinued 2 years ago)

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

Postpartum stress fracture of bilateral tibia: A case report

Stress fractures are overuse injuries of the bone characterized by a magnetic resonance imaging (MRI) finding of the fracture line with bone marrow edema. Clinical findings are tenderness and persistent pain. It is usually related to repetitive stresses. A 25-year-old woman was admitted with bilateral severe knee pain. She was in the postpartum period and the complaints started three days after the beginning of 2-h daily walk. The initial plain radiograph showed no abnormality, while MRI demonstrated bilateral incomplete fracture line at the proximal tibia. The patient had accompanying vitamin D deficiency and osteopenia, diagnosed with pregnancy-related osteopenia and stress fracture of bilateral proximal tibia. We advised cessation of weight bearing, resting, and supplementation of calcium and vitamin D. This report highlights that, in the postpartum period, persistent pain may indicate bone lesions such as stress fractures, particularly developing shortly after a vigorous physical activity. Detailed physical examination and further investigations are necessary to detect these fractures and risk factors

Peroneal nöropatisi olan hastalarda etiyolojik faktörlerin ve elektrofizyolojik bulguların değerlendirilmesi

Objective: Peroneal neuropathy is the most common entrapment mononeuropathy in the lower extremity. The common site of injury is around the fibular head where the nerve becomes superficial. Compressive pathologies are the most frequently seen etiologies. The treatment plan is designed according to the etiology. Electrophysiologic investigations are accepted as the gold standard for the diagnosis of peroneal neuropathy. In this study, we aimed to evaluate the etiologic factors and electrodiagnostic findings in peroneal neuropathy. Method: We retrospectively analyzed the etiological and electrodiagnostic test findings of patients with clinical features compatible with peroneal neuropathy, who presented to the Electromyography Laboratory of İstanbul Medipol University Hospital between January 2016 and December 2019. Patients with polyneuropathy or a disease that may cause polyneuropathy such as diabetes mellitus, those with lumbosacral radiculopathy or plexopathy, and those with neurodegenerative diseases were excluded. Results: A total of 30 patients with clinical features compatible with peroneal neuropathy (19 males, 11 females, median age 30 years; range 21 to 66) were enrolled in the study. Four (13.3%) patients had a comorbid disease. The median duration (minimum-maximum) of the symptoms was 20.5 (2-140) weeks. The affected side of the peroneal nerve was 43.3% right, 43.3% left, and 13.3% bilateral. The common cause of peroneal nerve injuries was due to compression (40%). Potential causes of compression in five out of 12 cases were iatrogenic. Weight loss was found in 10% of patients and one patient (3.3%) had a history of a recurrent ganglion cyst. Approximately 23% of lesions were due to traction injury and 23% of cases were idiopathic. According to electrophysiologic investigations, 16 cases were predominantly demyelinating without axonal injury. The axonal injury was detected in the remaining 14 cases (%46.6) and half of the cases with axonal injury were accompanied by demyelinating injury. Six cases had mild, 3 cases had severe, and 5 cases had a total axonal injury. Conclusion: Compression is the most commonly seen etiological factor in peroneal neuropathy. Electrophysiologic investigations play a significant role in the differential diagnosis, prognosis, management plan, and follow-up of recovery. Further detailed studies are needed to clarify the relationship between electrophysiologic findings and prognosis to form an algorithm for the treatment and follow-up.Amaç: Peroneal nöropati, alt ekstremitede en sık görülen tuzak mononöropatidir. Yaygın yaralanma bölgesi, sinirin yüzeysel olduğu fibula başındadır. En sık görülen etiyolojiler kompresif patolojilerdir. Tedavi planı etiyolojiye göre tasarlanır. Elektrofizyolojik incelemeler peroneal nöropati tanısında altın standart olarak kabul edilmektedir. Bu çalışmada peroneal nöropatide etiyolojik faktörleri ve elektrodiagnostik bulguları değerlendirmeyi amaçladık. Yöntem: İstanbul Medipol Üniversite Hastanesi Elektromiyografi Laboratuvarı’na Ocak 2016-Aralık 2019 tarihleri arasında başvuran peroneal nöropati ile uyumlu klinik özellikleri olan hastaların etiyolojik ve elektrodiagnostik test bulgularını retrospektif olarak inceledik. Polinöropatili veya diabetes mellitus gibi polinöropatiye neden olabilecek bir hastalığı olan hastalar, lumbosakral radikülopati veya pleksopatisi olanlar ve nörodejeneratif hastalığı olanlar çalışma dışı bırakıldı. Bulgular: Çalışmaya peroneal nöropati ile uyumlu klinik özelliklere sahip 30 hasta (19 erkek, 11 kadın, medyan yaş 30 yıl, 21-66 aralıkta) alındı. Dört (%13,3) hastada ek hastalık vardı. Medyan (minimum-maksimum) semptom süresi 20,5 (2-140) haftaydı. Peroneal sinirin etkilenen tarafı %43,3 sağ, %43,3 sol ve %13,3 bilateral idi. Peroneal sinir yaralanmalarının en sık nedeni kompresyona bağlıydı (%40). On iki olgudan beşinin olası kompresyon nedenleri iyatrojenikti. Hastaların %10’unda kilo kaybı saptandı ve bir hastada (%3,3) tekrarlayan ganglion kisti öyküsü vardı. Lezyonların yaklaşık %23’ü traksiyon yaralanmasına bağlıydı ve olguların %23’ü idiyopatikti. Elektrofizyolojik incelemelere göre, 16 olgu ağırlıklı olarak aksonal yaralanma olmaksızın demiyelinizan idi. Kalan 14 olguda (%46,6) aksonal yaralanma saptandı ve aksonal yaralanmalı olguların yarısına demiyelinizan yaralanma eşlik etti. Altı olguda hafif, 3 olguda ağır ve 5 olguda total aksonal yaralanma vardı. Sonuç: Kompresyon, peroneal nöropatide en sık görülen etiyolojik faktördür. Elektrofizyolojik araştırmalar ayırıcı tanıda, prognoz, tedavi planı ve iyileşmenin takibinde anahtar rol oynar. Tedavi ve takip için bir algoritma oluşturmak için elektrofizyolojik bulgular ile prognoz arasındaki ilişkiyi netleştiren daha detaylı çalışmalara ihtiyaç vardır

Etanercept-induced Crohn's disease in ankylosing spondylitis: A case report and review of the literature

WOS: 000448513400023PubMed ID: 30293157Tumor necrosis factor (TNF)- is a cytokine that plays a well-established, key role as a central mediator of inflammation and immune regulation. TNF- and its receptors are suggested to play a critical role in a number of chronic inflammatory diseases, including rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis (AS), juvenile chronic arthritis, and inflammatory bowel disease (IBD). TNF- inhibitors are currently used in the treatment of these diseases. We report a 29-year-old male with AS who developed Crohn's disease while taking etanercept. Etanercept treatment was interrupted and a switch to a monoclonal antibody-based anti-TNF treatment using adalimumab was started, which induced a prompt improvement of the gastrointestinal symptoms. We indicate the immunodysregulatory and proinflammatory effects of etanercept and discuss the potential pathogenic mechanisms of the paradoxical effect of TNF- inhibitors. We also review the related literature on new-onset IBD following anti-TNF treatment for AS

Postural stability and the relationship with enthesitis in ankylosing spondylitis: A cross-sectional study

This study aims to investigate the static and dynamic postural stability in ankylosing spondylitis (AS), and to evaluate their relationships with clinical parameters, postural measurements, and enthesitis. Sixty-four patients with AS (37 males, 27 females; mean age 41.06±8.89 years) and 42 healthy individuals (23 males, 19 females; mean age 38.45±8.46 years) were involved in the study. The static and dynamic postural stability of all participants were assessed using the Biodex Balance System. Patients’ posture was evaluated using chest expansion, tragus-wall distance, and the modified Schober’s test. The disease activity (Bath Ankylosing Spondylitis Disease Activity Index: BASDAI), functional status (Bath Ankylosing Spondylitis Functional Index: BASFI), spinal mobility (Bath Ankylosing Spondylitis Metrology Index: BASMI), enthesitis score (Maastricht Ankylosing Spondylitis Enthesitis Score: MASES), pain (Visual Analogue Scale: VAS), quality of life (Ankylosing Spondylitis Quality of Life: ASQoL) and depression (Beck Depression Inventory: BDI) of all patients were evaluated. Similar demographic data were found in both groups. Significant differences were acquired between the patient and control groups regarding all postural stability tests (p<0.05). The BASDAI, BASMI, BASFI, MASES, VAS pain, modified Schober’s test, ASQoL, and BDI were associated with sway velocity on a firm surface with eyes closed. There was a significant correlation between MASES and all tests of sway velocity. Dynamic postural stability in the sagittal plane and whole tests (except on foam surface eyes closed test) of sway velocity were affected negatively in patients with Achilles enthesitis. Static and dynamic postural stability impairments are seen in AS. Enthesitis significantly impaired static postural stability and increased postural sway

Flexion-Induced Cervical Cord Compression: Hirayama Disease

WOS: 000467416800008PubMed ID: 30819416A 15-year-old man was presented with progressive weakness and amyotrophy of the right distal arm and hand muscles, which had been present for the last 3 months. The patient had no comorbid diseases and a history of cervical trauma. His family members had no neuromuscular disorders. A clinical examination showed weakness of the right interosseous muscles (grade 3/5 on the Medical Research Council scale), abduction of the right thumb, and extension of the right wrist and fingers II-V (Medical Research Council 4/5). On inspection, there was marked atrophy of the right first dorsal interosseous muscle and mild atrophy of the other intrinsic hand and flexion and extension muscles of the wrist. There was no fasciculation, sensory deficit, and pain, but tremulous movement of his fingers was observed