Is dry heat treatment (fluidotherapy) effective in improving hand function in patients with rheumatoid arthritis? A randomized controlled trial.

OBJECTIVE:: To evaluate the efficacy of dry heat treatment (fluidotherapy) in improving hand function in patients with rheumatoid arthritis. DESIGN:: Prospective randomized controlled trial. SETTING:: Departments of Physical Medicine and Rehabilitation and Rheumatology in a university hospital. SUBJECTS:: Patients with rheumatoid arthritis. INTERVENTIONS:: All patients were randomly divided into two groups. Group 1 underwent dry heat treatment (fluidotherapy) and Group 2 was a control group. Patients in both groups participated in a joint protection and exercise program. MAIN MEASURES:: Primary outcome measures were Health Assessment Questionnaire and Duruoz Hand Index. Secondary outcome measures were pain and stiffness, Grip Ability Test, Disease Activity Score-28, and grip strength. These assessments were performed at the hospital at baseline, week 3, and week 12. RESULTS:: A total of 93 participants were allocated to Group 1 ( n = 47) and Group 2 ( n = 46). The mean age of these groups was 54.19 ± 11.15 years and 53.00 ± 10.15 years, respectively ( P = 0.592). At baseline, there were no significant differences between the groups in any parameter except significantly poorer Health Assessment Questionnaire score in Group 1 ( P = 0.007). At week 3, there were no significant differences between the groups in any of the parameters ( P > 0.005). At week 12, Duruoz Hand Index scores were significantly better in Group 2 ( P = 0.039). CONCLUSION:: Dry heat treatment (fluidotherapy) was not effective in improving hand function in patients with rheumatoid arthritis. Moreover, no positive effect on any other clinical parameters was observed.

Ultrasonographic and clinical evaluation of additional contribution of kinesiotaping to tendon and nerve gliding exercises in the treatment of carpal tunnel syndrome

Background and aim: This study aims to ultrasonographically and clinically evaluate the additive contribution of kinesiotaping to tendon and nerve gliding exercises in the treatment of mild or moderate carpal tunnel syndrome (CTS). Materials and methods: Thirty-eight wrists of patients (n = 21) with CTS were randomized into two groups as the intervention group (n = 19) and the control group (n = 19). Tendon and nerve gliding exercises were given to both groups. In the intervention group, additional kinesiotaping was performed three times with 5-day intervals. Functional assessments were performed with the Boston Carpal Tunnel Syndrome Questionnaire and the Moberg pick-up test. Hand grip and pinch strength were evaluated. Cross-section area (CSA) of the median nerve was measured by ultrasonography. All assessments were performed at baseline and at 3 and 6 weeks after treatment. Results: In the intervention group, there was a significant improvement in all clinical assessments and in the CSA of the median nerve at the level of proximal carpal bones. In the control group, a significant improvement was detected in all clinical parameters except grip strength and ultrasonographic measurements. There was no significant difference in the clinical and ultrasonographic findings between the groups at 6 weeks. Conclusion: Kinesiotaping may provide a positive contribution to ultrasonographic and clinical outcomes in the treatment of mild or moderate CTS in the short term.

Is Continuous Passive Motion Effective in Patients with Lymphedema? A Randomized Controlled Trial.

BACKGROUND: In this randomized controlled study, we aimed to evaluate the effect of shoulder flexion exercise using continuous passive motion (CPM) on lymphedema during the treatment of breast cancer-related lymphedema (BCRL). METHODS: Thirty patients with BCRL were enrolled and completed the study. Fourteen patients were treated with complete decongestive therapy (CDT) and CPM in the intervention group, and 16 patients were treated with CDT alone (control group) for 15 sessions. The main outcome measures were included; the shoulder range of motion (ROM) assessed with a goniometer, limb volume difference measured using the water immersion method, function with the Disabilities of the Arm, Shoulder and Hand (DASH), and the quality of life using the Functional Assessment of Cancer Therapy for Breast Cancer (FACT-B4). Lymphedema volume measures were taken at baseline, on days 1, 2, 3, 4, 5, 10, and 15; and shoulder ROM, FACT-B4, and DASH were taken at baseline and on day 15. RESULTS: All subjects were similar at baseline. After treatment significant improvement was found in ROM, volumetric differences, DASH, and FACT-B4 scores in both groups. No significant differences were observed in the volumetric differences, ROM, and the DASH, and FACT-B4 scores between the groups, except for the FACT-B4 physical well-being subscores, which were better in intervention group. CONCLUSION: Our study results showed that CPM did not contribute to the reduction of BCRL.

Anxious personality is a risk factor for developing complex regional pain syndrome type I.

The aim of this study was to investigate the role of psychological factors in the development of complex regional pain syndrome (CRPS) type I following the fracture of the distal radius. Fifty patients (average age 57.70 ± 13.43 years) with a distal radius fracture were enrolled in the present study. All of the patients were treated by closed reduction and cast immobilization. The Toronto Alexithymia Scale-20, Anxiety Sensitivity Index, State-Trait Anxiety Inventory, and Beck Depression Inventory were used to determine the patients' psychological features 2 days after the fracture. The patients were followed for 2 months after cast immobilization was completed using the International Association for the Study of Pain criteria to diagnose CRPS type I. CRPS type I developed in 13 (26%) patients of the 32 (34.4%) female patients and 18 (11.1%) male patients. The risk of CRPS type I was significantly increased in patients with high trait anxiety scores (P = 0.038). The results show that, after fracturing the distal radius, patients who have an anxious personality have a higher risk of developing CRPS type I. Following these patients closely for the development of CRPS type I may be advantageous for early preventative and therapeutic interventions.

The efficacy of conservative treatment in patients with full-thickness rotator cuff tears.

Rotator cuff tears are a common cause of shoulder pain and disability. Although many studies have reported about the surgical results of full-thickness tears of the rotator cuff, there are few studies about the efficacy of conservative treatment. The aim of this study was to investigate the efficacy of conservative treatment in patients with full-thickness rotator cuff tears by using objective and subjective measurements. Twenty patients with full-thickness rotator cuff tears were included in the study. Outcome measures were range of motion, pain and function according to the shoulder index of the American Shoulder and Elbow Surgeons (ASES), Constant score, Short-Form 36 Health Survey (SF-36), isokinetic shoulder strength, and patient response. Patients were assessed at baseline and after 6 months. In addition, patients were contacted by telephone at 1 year and at 3 years for functional assessment according to ASES, and patient response. The treatment protocol included activity modification, oral nonsteroidal antiinflammatory medications, physical modalities, and a specific exercise program. Statistically significant improvements were obtained in range of motion, pain and function scores according to ASES, Constant score, SF-36 scores, and isokinetic strength (P < 0.05). At the 6-month evaluation, 11 patients (55%) reported that they were "much better", and 9 patients (45%) "better". Conservative treatment of full-thickness rotator cuff tears yields satisfactory results both subjectively and objectively.

The reliability and validity of the Turkish version of the Western Ontario Rotator Cuff Index.

To adapt the Western Ontario Rotator Cuff (WORC) index for use in Turkey and to investigate its reliability and validity; the Turkish version of the WORC was developed according to the guidelines in the literature. Seventy-two patients with rotator cuff disease were administered the questionnaire and were also evaluated by using the University of California Los Angeles (UCLA) shoulder rating scale, Constant score, and Short Form (SF)-36 to test validity. The WORC questionnaire was repeated in 35 patients after a mean interval of 2.9 days (range 2-7 days) to evaluate test-retest reliability. Cronbach's alpha was calculated as 0.92 for the total questionnaire. The intraclass correlation coefficients were very high and ranged between 0.96 and 0.98 for each section. There was a significant negative correlation between the Turkish version of WORC and UCLA (r = -0.598, P < 0.01), Constant score (r = -0.630, P < 0.01), and all subscales of SF-36 (P < 0.01). The Turkish version of the WORC index is a reliable and valid instrument for use in clinical trials in patients with rotator cuff disorders.

Discrimination of irradiated starch gels using FT-Raman spectroscopy and chemometrics.

The effects of gamma-irradiation on starch gels were characterized at the molecular level by Fourier transform (FT) Raman spectroscopy. Starches from five different sources were gelatinized and irradiated at 3, 5, and 10 kGy using a Co60 gamma-irradiator. Gamma-irradiation effects on starch gels were noted by the C-H stretch (2800-3000 cm(-1)) and O-H stretch (3000-3600 cm(-1)) and bend (1600-1800 cm(-1)) regions of the FT-Raman spectra. FT-Raman molecular fingerprints obtained through spectral analyses were used for discrimination of the gels based on the extent of irradiation by means of two different pattern-recognition techniques: canonical variate analysis (CVA) and soft modeling of class analogy (SIMCA). A complete discrimination of irradiated starches was attained using a hybrid partial least-squares (PLS) and CVA model, using the spectral variations in the C-H stretch and O-H stretch and bend regions of FT-Raman spectra. Using the same spectral regions, SIMCA predicted 84% of samples correctly.

Hypermobility syndrome increases the risk for low bone mass.

Few studies on the benign joint hypermobility syndrome suggest a tendency toward osteopenia, but there are conflicting results. We assessed bone mineral density in pre-menopausal women with hypermobility. Twenty-five consecutive Caucasian women diagnosed with benign hypermobility syndrome by Beighton score and 23 age- and sex-matched controls were included in the study. Age, menarch age, number of pregnancies, duration of lactation, physical activity and calcium intake were questioned according to European Vertebral Osteoporosis Study Group (EVOS) form. All subjects were pre-menopausal and none of them were on treatment with any drugs effecting bone metabolism or had any other systemic disease. No statistically significant difference was found for body mass index, menarch age, number of pregnancies, duration of lactation, calcium intake, calcium score and physical activity score between the two groups. Total femoral and trochanteric bone mineral density and t and z scores were significantly lower in hypermobile patients compared to the control group. Ward's triangle and femoral neck z scores were also found to be significantly low in hypermobile patients (p<0.05). Significant negative correlations were found between the Beighton scores and trochanteric BMD, t and z scores (r=-0.29, r=-0.30, and r=-0.32) in hypermobility patients. Low bone mass was more frequently found among subjects with hypermobility (p=0.03). Hypermobility was found to increase the risk for low bone mass by 1.8 times (95% confidence interval 1.01-3.38). Our study suggests that pre-menopausal women with joint hypermobility have lower bone mineral density when compared to the controls and hypermobility increases the risk for low bone mass.

[Rehabilitation of shoulder instability following surgery]. / Omuz instabilitelerinde cerrahi sonrasi rehabilitasyon.

The basic principals of rehabilitation for shoulder stabilization are the restoration of glenohumeral compression stability, scapulohumeral motion synchrony, and the proprioceptive mechanism. The principals of rehabilitation applied following surgical treatment of patients with shoulder instability do not differ from those applied for non-operative patients. Recent advances in surgical techniques and suture materials have improved the quality of healing tissues and allowed early institution and acceleration of rehabilitation programs. There are many different rehabilitation protocols constructed according to the type of instability and surgical procedures, but when a postoperative rehabilitation program is outlined, the patient's age, previous activity level, expectations, and compliance with and response to treatment should also be taken into consideration.

Functional outcome in patients with zone V flexor tendon injuries.

INTRODUCTION: Zone V flexor tendon injuries may involve major nerves and arteries as well as the wrist and finger flexors. Although these injuries are not infrequent, few studies have reported functional outcomes. The purpose of this study was to evaluate the functional outcome in patients with flexor tendon repairs in zone V. MATERIALS AND METHODS: Eighteen patients with repaired zone V flexor tendon injuries were followed up for an average of 20 months. The postoperative rehabilitation program consisted of a combined regime of modified Kleinert and modified Duran techniques. Outcome parameters were hand function according to the Buck-Gramcko assessment system, grip and key pinch strength values, and return to work status. RESULTS: Functional results were excellent in 92.8% of the digits, good in 1.4%, and poor in 5.8%. Grip strength recovered to an average of 77% and pinch strength to 74% of the uninjured hand. Two tendon ruptures occurred in a patient, and tenolysis was required in 3 patients. Of 15 patients who were employed at the time of injury, 13 returned to their original occupations. CONCLUSION: Satisfactory functional results can be obtained when proper surgical technique is coupled with careful postoperative management in patients with zone V flexor tendon injuries.

Characterization of irradiated starches by using FT-Raman and FTIR spectroscopy.

Fourier transform infrared (FTIR) and Fourier transform Raman (FT-Raman) methods were used for rapid characterization and classification of selected irradiated starch samples. Biochemical changes due to irradiation were detected using the two vibrational spectroscopic techniques, and canonical variate analysis (CVA) was applied to the spectral data for discriminating starch samples based on the extent of irradiation. The O-H (3000-3600 cm(-1)) stretch, C-H (2800-3000 cm(-1)) stretch, the skeletal mode vibration of the glycosidic linkage (900-950 cm(-1)) in both Raman and infrared spectra, and the infrared band of water adsorbed in the amorphous parts of starches (1550-1750 cm(-1)) were employed in classification analysis of irradiated starches. Spectral data related to water adsorbed in the noncrystalline regions of starches provided a better classification of irradiated starches with 5 partial least-squares (PLS) factors in the multivariate model.