The evaluation of the effect of vitamin D replacement on the symptoms of carpal tunnel syndrome in patients with low vitamin D levels

Aim: To evaluate the effect of vitamin D replacement on carpal tunnel syndrome (CTS) symptoms and signs in CTS patients with low vitamin D levels. Methods: This study was designed prospective observably. The patient population was admitted to the EMG (electromyography) laboratory in a tertiary hospital’s Physical Medicine and Rehabilitation Department between 1 January and 31 July 2018.  Initially, 55 patients were included in the study. The patients were categorized into two groups as group 1 (<10 ng / ml) and group 2 (10-20 ng / ml) according to the vitamin D levels. A total of 39 patients and 63 wrists, 17 patients in group 1 (28 wrists) and 22 patients in group 2 (35 wrists), were included in the analysis. Results: There was a statistically significant decrease in visual analogue scale and quick arm-shoulder-hand disability score in two groups when compared before treatment. In two groups, there was a significant improvement in grip and pinch strength after treatment.  At the same time, after treatment we showed that there was a statistically significant increase in median nerve sensory amplitude in two groups. The increase in median nerve sensory velocity was significant in group 2 whereas it was not statistically significant between group 1 vs group 2. Conclusions: Vitamin D replacement can improve symptoms, functional status and electrophysiological findings in CTS patients with low vitamin D levels

Acute Calcium Pyrophosphate Arthritis after Parathyroidectomy

Hypocalcemia after parathyroidectomy is a well-known metabolic sequela, but rare conditions such as acute calcium pyrophosphate (CPP) arthritis can be observed. In this study, we presented a case of acute CPP arthritis in both knees after parathyroidectomy. A 48-year-old man presented with pain and swelling in his right knee that started 1 day ago. There was no feature in his background and family history other than parathyroidectomy surgery performed for parathyroid adenomy a week ago. The diagnosis of acute CPP arthritis was made on the basis of blood, imaging and synovial fluid analysis. Evaluation was made after 3 days and acute arthritis in left knee was detected. Similar findings were also observed in the synovial fluid examination. After cold application and colchicine 1 mg/day started, improvement in arthritis and acute phase markers was detected. Acute CPP arthritis after parathyroidectomy is a rare condition and there are various theories in this regard. According to the most widely accepted theory; as a result of the decrease in the calcium level, the solubility of the CPP crystals decreases, and the CPP crystals previously deposited in the articular cartilage are poured into the synovial fluid. As a result; CPP arthritis should also be considered in differential diagnosis in patients with arthritis after parathyroidectomy and synovial fluid analysis should be performed

Assessment of Sexual Dysfunction in Patients with Fibromyalgia Syndrome

Objectives: The aim of our study is to determine the presence, quality of sexual dysfunction in patients with fibromyalgia syndrome and to compare with normal population. Material and Methods: A total of 55 sexually active women who were admitted to Department of Physical Therapy and Rehabilitation of Antalya Research and Training Hospital and diagnosed with fibromyalgia syndrome according to 1990 and 2010 American College of Rheumatology (ACR) criteria. A control group composed of 50 sexually active women who were admitted to our clinic with various musculoskeletal system complaints were also included in the study in order to compare the parameters used for clinical assessment of patients and to determine whether the patients differ from normal population. Patients and controls who met inclusion criteria were applied Female Sexual Function Index (FSFI) for assessment of sexual function. This test was developed by Rosen and colleagues in 2000, it is composed of 19 questions and inquires six different dimensions including desire, arousal, lubrication, orgasm, sexual satisfaction and pain. Turkish validation test was done by Turkish Society Of Andrology in 2003, answers are multiplied with a coefficient and each section is evaluated on six scores. Minimum score is 2.4 and maximum is 36 and standardly used for assessment of female sexual dysfunction in Turkey. Results: Subscale and total score of Female Sexual Function Index of Fibromyalgia syndrome patients were found statistically significantly lower than those of control group (p<0.05). Conclusion: Disorders of sexual function or its quality are one of the problems seen in fibromyalgia syndrome patients. It should be noticed that sexual function assessment must be a part of treatment of fibromyalgia syndrome. It is quite difficult to determine the mechanism between sexual dysfunction and fibromyalgia syndrome and new and larger studies are needed to determine this mechanism. (Turkish Journal of Osteoporosis 2013;19: 65-8

Postoperative spondylodiscitis in a patient with ankylosing spondylitis diaphragmatic rupture

Bu olguda ankilozan spondilit tanısı olan, koksartroz nedeniyle sağ total kalça protezi cerrahisi geçirdikten sonra spondilodiskit gelişen hasta sunulmuştur. Cerrahi sonrası bacaklarda kuvvetsizlik, hareketle artan şiddetli bel ağrısı oluşan hastada parapleji gelişmesi sonucu çekilen manyetik rezonans görüntülemede torakal 11-12 vertebralar seviyesinde korda bası yapan spondilodiskit tespit edilmiş olup, hastaya T11 total laminektomi+kostatransversektomi uygulanıp, rehabilitasyon amaçlı servisimize yatırılmıştır. Etiyolojik bir neden bulunamamıştır. Tedavi sonrası alt ekstremite kas kuvvetleri düzelen hasta çift kanedyenle mobilize bir şekilde taburcu edilmiştir. Bu olguyu, cerrahi sonrası şiddetli bel ağrısı ve kas gücü kaybında tanı olarak spondilodiskiti de düşünmemiz ve ankilozan spondilitli hastalarda spondilodiskit komplikasyonunu hatırlatmak için hazırladık.In this case we present a patient with ankylosing spondylitis for 35 years who had spondylodiscitis after right total hip replacement operation. After right total hip replacement operation, patient had a progressive paraparesis of lower extremity, advanced to paraplegia, so we performed a thoracic magnetic resonance imaging which had spondylodiscitis with spinal cord compression at thoracic 11-12 vertebra levels. The patient is hospitalised for rehabilitation after T11 total laminectomy+- costotransversectomy. We couldn’t find any etiologic factor after our examination. Patient was discharged with better muscle strength with double crutches. We presented this case to remind spondylodiscitis after surgery and spondylodiscitis as a complication of ankylosing spondylitis

Postoperative spondylodiscitis in a patient with ankylosing spondylitis diaphragmatic rupture

Bu olguda ankilozan spondilit tanısı olan, koksartroz nedeniyle sağ total kalça protezi cerrahisi geçirdikten sonra spondilodiskit gelişen hasta sunulmuştur. Cerrahi sonrası bacaklarda kuvvetsizlik, hareketle artan şiddetli bel ağrısı oluşan hastada parapleji gelişmesi sonucu çekilen manyetik rezonans görüntülemede torakal 11-12 vertebralar seviyesinde korda bası yapan spondilodiskit tespit edilmiş olup, hastaya T11 total laminektomi+kostatransversektomi uygulanıp, rehabilitasyon amaçlı servisimize yatırılmıştır. Etiyolojik bir neden bulunamamıştır. Tedavi sonrası alt ekstremite kas kuvvetleri düzelen hasta çift kanedyenle mobilize bir şekilde taburcu edilmiştir. Bu olguyu, cerrahi sonrası şiddetli bel ağrısı ve kas gücü kaybında tanı olarak spondilodiskiti de düşünmemiz ve ankilozan spondilitli hastalarda spondilodiskit komplikasyonunu hatırlatmak için hazırladık.In this case we present a patient with ankylosing spondylitis for 35 years who had spondylodiscitis after right total hip replacement operation. After right total hip replacement operation, patient had a progressive paraparesis of lower extremity, advanced to paraplegia, so we performed a thoracic magnetic resonance imaging which had spondylodiscitis with spinal cord compression at thoracic 11-12 vertebra levels. The patient is hospitalised for rehabilitation after T11 total laminectomy+- costotransversectomy. We couldn’t find any etiologic factor after our examination. Patient was discharged with better muscle strength with double crutches. We presented this case to remind spondylodiscitis after surgery and spondylodiscitis as a complication of ankylosing spondylitis

Burden of chronic low back pain in the Turkish population

Amaç: Kronik bel ağrısının özellikle kayıp iş günleri ve dizabilite anlamında toplum üzerine maliyeti çok büyüktür ve giderek arttığı görülmektedir. Türkiye’de kronik bel ağrısının maliyeti tam olarak bilinmemektedir. Bu çalışmada kronik bel ağrılı hastalarda sağlık kaynaklarının kullanımı, iş gücü-üretim kaybı ve hastalığın toplam ekonomik yükünün araştırılması planlanmıştır. Gereç ve Yöntemler: Çalışma, Türkiye’nin 8 ayrı bölgesindeki fziksel tıp ve rehabilitasyon kliniklerine başvuran hastaların çok merkezli kesitsel araştırılması olarak planlanmıştır. Çalışmaya kronik bel ağrılı 18 yaş üstü 662 hasta dahil edilmiştir. Olguların sosyo-demografk verileri, son 6 ay içindeki sağlık kaynaklarının kullanımı, son 3 ay içindeki çalışabilme durumlarını içeren bir anket, fonksiyonel durumu için Roland-Morris Disabilite anketi, depresyon durumu için de Beck Depresyon Ölçeği dolduruldu. Kişinin kendisi, işvereni ve sağlık sistemi tarafından yapılan harcamalar hesaplandı. Doğrudan harcamaları poliklinik viziti, tanısal testler, medikal tedaviler, hastane bakımı, ortopedik yardımcı cihazlar, fzik tedaviler; dolaylı harcamaları ise üretim gücündeki azalma, raporlu günler, iş gücü kaybı ile ilgili veriler oluşturdu. Bulgular: Bel ağrısı için hasta başı yıllık doğrudan harcama 1080 TL, dolaylı harcama ise 5511 TL idi. Doğrudan maliyet hastalık şiddeti, süresi ve yaş ile korele bulundu. Dolaylı maliyet kadınlarda yüksekti. Sonuç: Özellikle iş günü ve iş gücü kaybına bağlı dolaylı harcamalar doğrudan harcamalardan çok daha fazla maliyetlidir.Objective: Chronic low back pain (CLBP) is a great economic burden to the society mainly in terms of the large number of the lost work days and disability, and it appears to be growing. The economic burden of LBP in Turkey is not known. This study aims to analyze the health care resource use, work and productivity loss, and health-related economics of CLBP in Turkey. Material and Methods: The study was designed as a multi-centered cross-sectional survey of patients in physical therapy and rehabilitation clinics from eight different regions of Turkey and 662 patients with CLBP over 18 years of age were included. Data on patient sociodemographics, disease-related healthcare resource use during the previous 6 months, inability to work during the last 3 months, Roland Morris Disability Index for the functional status, and psychological health with Beck Depression Scale were collected. Direct costs included medical visits, investigations, medications, hospitalizations, orthopedic aids, and physical therapy. İndirect costs were evaluated mostly with productivity loss. Results: The total annual direct costs for CLBP per patient were estimated at 1080 TL. The indirect costs were estimated at 5511 TL per patient. Direct cost was correlated with disease severity, duration, and age. Indirect cost was higher in women. Conclusion: The indirect costs for CLBP were signifcantly higher than the direct costs

Effects of Robotic Rehabilitation on Motor Functions in Children with Cerebral Palsy

Objective:The aim of this study was to investigate the effects of robotic rehabilitation (RR) on spasticity and motor functions of children with varying types and functional levels of cerebral palsy (CP).Materials and Methods:A total of 28 children were evaluated aged 6-16 years, with level 2-4 CP according to the Gross Motor Function Classification System (GMFCS) who were planned to undergo 30 sessions of RR. Motor functions were evaluated before and after RR using the Gross Motor Function scale-66 (GMFS-66) B, C, D and E dimensions, gastrosoleus spasticity with the Modified Ashworth scale (MAS) and a target was defined for each patient with a Goal Attainment scale (GAS). Following the RR treatment, the efficacy was evaluated by grouping the patients according to the GMFCS level and the type of CP.Results:11% of the patients were at level 2, 36% were at level 3, and 54% were at level 4.61% of them were identified as bilateral spastic, 21% unilateral spastic and 14% mixed type. The patients comprised 50% male and 50% female children with a mean age of 10.8±2.7 years. Mean participation in the RR program was 23±9.6 sessions. A statistically significant improvement was determined in the D dimension of the GMFS in the children at level 2 and 3 of GMFCS (p<0.05), and there were no differences in respect of the MAS and GAS (p>0.05). No differences were determined between the type of CP groups in respect of GMFS, MAS and GAS. Conclusion:It was concluded that the application of RR was of benefit for the children with CP at the level 2 and 3 of GMFCS in respect of the development of standing activities

Burden of chronic low back pain in the Turkish population

Amaç: Kronik bel ağrısının özellikle kayıp iş günleri ve dizabilite anlamında toplum üzerine maliyeti çok büyüktür ve giderek arttığı görülmektedir. Türkiye’de kronik bel ağrısının maliyeti tam olarak bilinmemektedir. Bu çalışmada kronik bel ağrılı hastalarda sağlık kaynaklarının kullanımı, iş gücü-üretim kaybı ve hastalığın toplam ekonomik yükünün araştırılması planlanmıştır. Gereç ve Yöntemler: Çalışma, Türkiye’nin 8 ayrı bölgesindeki fziksel tıp ve rehabilitasyon kliniklerine başvuran hastaların çok merkezli kesitsel araştırılması olarak planlanmıştır. Çalışmaya kronik bel ağrılı 18 yaş üstü 662 hasta dahil edilmiştir. Olguların sosyo-demografk verileri, son 6 ay içindeki sağlık kaynaklarının kullanımı, son 3 ay içindeki çalışabilme durumlarını içeren bir anket, fonksiyonel durumu için Roland-Morris Disabilite anketi, depresyon durumu için de Beck Depresyon Ölçeği dolduruldu. Kişinin kendisi, işvereni ve sağlık sistemi tarafından yapılan harcamalar hesaplandı. Doğrudan harcamaları poliklinik viziti, tanısal testler, medikal tedaviler, hastane bakımı, ortopedik yardımcı cihazlar, fzik tedaviler; dolaylı harcamaları ise üretim gücündeki azalma, raporlu günler, iş gücü kaybı ile ilgili veriler oluşturdu. Bulgular: Bel ağrısı için hasta başı yıllık doğrudan harcama 1080 TL, dolaylı harcama ise 5511 TL idi. Doğrudan maliyet hastalık şiddeti, süresi ve yaş ile korele bulundu. Dolaylı maliyet kadınlarda yüksekti. Sonuç: Özellikle iş günü ve iş gücü kaybına bağlı dolaylı harcamalar doğrudan harcamalardan çok daha fazla maliyetlidir.Objective: Chronic low back pain (CLBP) is a great economic burden to the society mainly in terms of the large number of the lost work days and disability, and it appears to be growing. The economic burden of LBP in Turkey is not known. This study aims to analyze the health care resource use, work and productivity loss, and health-related economics of CLBP in Turkey. Material and Methods: The study was designed as a multi-centered cross-sectional survey of patients in physical therapy and rehabilitation clinics from eight different regions of Turkey and 662 patients with CLBP over 18 years of age were included. Data on patient sociodemographics, disease-related healthcare resource use during the previous 6 months, inability to work during the last 3 months, Roland Morris Disability Index for the functional status, and psychological health with Beck Depression Scale were collected. Direct costs included medical visits, investigations, medications, hospitalizations, orthopedic aids, and physical therapy. İndirect costs were evaluated mostly with productivity loss. Results: The total annual direct costs for CLBP per patient were estimated at 1080 TL. The indirect costs were estimated at 5511 TL per patient. Direct cost was correlated with disease severity, duration, and age. Indirect cost was higher in women. Conclusion: The indirect costs for CLBP were signifcantly higher than the direct costs