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1.
Clin Neurol Neurosurg ; 232: 107883, 2023 09.
Article in English | MEDLINE | ID: mdl-37467578

ABSTRACT

Application of botulinum toxin A (BoNT-A) into the muscles of the head and neck area has become a widespread and reliable treatment modality for chronic migraine. The mechanism of action for BoNT-A is the inhibition of acetylcholine and local nociceptive peptide release at the terminal nerve endings. Cranial sutures have the highest concentration of nociceptive structures; therefore BoNT-A injection into the suture lines - as opposed to head and neck muscles - has been proposed for the treatment of chronic migraine. Nerve endings in sutures rapidly absorb BoNT-A and transfer it across the afferent nerve fibers in dura mater via orthodromic and antidromic transmission. In this article, ultrasound-guided BoNT-A application around the cranial sutures will be illustrated. It is noteworthy that suture injections would be safer and more efficient when applied with such guidance.


Subject(s)
Botulinum Toxins, Type A , Migraine Disorders , Neuromuscular Agents , Humans , Neuromuscular Agents/therapeutic use , Botulinum Toxins, Type A/therapeutic use , Migraine Disorders/diagnostic imaging , Migraine Disorders/drug therapy , Muscles , Ultrasonography
2.
Am J Phys Med Rehabil ; 99(9): 847-852, 2020 09.
Article in English | MEDLINE | ID: mdl-32251112

ABSTRACT

The developments in technology have improved access to the use of musculoskeletal ultrasound (MSUS) in different clinical settings. Accordingly, MSUS has been applied to a wide range of musculoskeletal problems including inflammatory and degenerative diseases, sport injuries, and regional pain syndromes both for clinical practice and research. In this report, the authors aimed to globally examine the publications on MSUS among different specialties, countries, and topics. Sixteen reviewers under the umbrella of the European Musculoskeletal Ultrasonography Society Group and the Ultrasound Study Group of International Society of Physical and Rehabilitation Medicine have evaluated approximately 15,000 publications on MSUS. The authors believe that the results of this comparative analysis may provide a holistic snapshot with regard to the utility of MSUS, not only for clinicians/academicians but also for the industry. Accordingly, while aiming to further increase their awareness, this article would possibly guide future investments as well.


Subject(s)
Global Health/trends , Musculoskeletal System/diagnostic imaging , Periodicals as Topic/trends , Physical and Rehabilitation Medicine/trends , Ultrasonography/trends , Humans , Musculoskeletal Diseases/diagnostic imaging
3.
Acta Orthop Traumatol Turc ; 54(6): 651-654, 2020 Nov.
Article in English | MEDLINE | ID: mdl-33424001

ABSTRACT

Here, we report a case of a 30-year-old man with a diagnosis of complex shoulder instability, who was treated successfully by pectoralis major transfer following a series of failed instability correction surgeries. The patient was admitted to our outpatient clinic with an approximately 6-year history of chronic shoulder instability following several failed operations, including open Bankart repair, open capsular plication and Bankart repair, open capsule repair, arthroscopic Bankart repair, and Bristow-¬Latarjet procedure. Physical examination revealed persistent shoulder pain, weakness, and a limited range of motion. Imaging studies demonstrated complete subscapularis muscle atrophy with Goutallier grade 4 fatty infiltration. The decision for revision surgery was made owing to his shoulder findings and clinical symptoms. The intra-operative assessment revealed the subscapularis muscle to be fully atrophic and irreparable. The pectoralis major muscle was transferred from the intertubercular groove of the humerus to the lesser tuberosity. Postoperatively, the patient had 4 weeks of shoulder immobilization. Physical examination demonstrated an improved shoulder range of motion without evidence of recurrent shoulder instability. The authors encountered no sign of dislocation for 2.5 years of follow-up after the surgery. In conclusion, subscapularis muscle atrophy or insufficiency should be considered in the differential diagnosis of patients with failed shoulder instability surgeries. Pectoralis major tendon transfer may be successfully performed for the surgical treatment of such patients.


Subject(s)
Arthroplasty/adverse effects , Arthroscopy/adverse effects , Joint Instability , Muscular Atrophy , Pectoralis Muscles/surgery , Reoperation/methods , Rotator Cuff , Shoulder Dislocation , Adult , Arthroplasty/methods , Arthroscopy/methods , Diagnosis, Differential , Humans , Joint Instability/etiology , Joint Instability/surgery , Male , Muscular Atrophy/diagnostic imaging , Muscular Atrophy/etiology , Muscular Atrophy/surgery , Range of Motion, Articular , Recovery of Function , Rotator Cuff/pathology , Rotator Cuff/surgery , Shoulder Dislocation/diagnostic imaging , Shoulder Dislocation/etiology , Shoulder Dislocation/surgery , Shoulder Pain/surgery , Tendon Transfer/methods
4.
Toxicon ; 172: 19-22, 2019 Oct 25.
Article in English | MEDLINE | ID: mdl-31654680

ABSTRACT

The treatment of chronic migraine headache is quite challenging and new alternatives are still being explored for its management. Onabotulinum toxin A (BoNT-A) applied into extracranial muscles has been shown to inhibit the release of acetylcholine and local nociceptive peptides at the sensory nerve endings. As the highest concentration of extracranial pain fibers are located at/nearby the sutures, extracranial applications of BoTN-A are suggested to be performed to sutures rather than into the head and neck muscles in the treatment of chronic migraine. Moreover, in an animal study, BoTN-A is found to be more effective for decreasing the chemosensitivity of meningeal nociceptors when the total dose is injected along the sutures in comparison to being divided into sutures and cranial muscles. Of note, since BoNT-A injections performed with the blind/nontargeted technique have lower effectivity and several complications (muscle weakness, ptosis, facial paresis, etc.), the use of ultrasound guidance for targeting the cranial sutures is definitely expected to provide technical ease, better pain relief and toxin tolerance in chronic migraine.


Subject(s)
Botulinum Toxins, Type A/administration & dosage , Cranial Sutures/diagnostic imaging , Migraine Disorders/drug therapy , Animals , Humans , Injections, Intramuscular , Neuromuscular Agents/administration & dosage , Ultrasonography, Interventional
6.
Top Stroke Rehabil ; 26(2): 136-141, 2019 03.
Article in English | MEDLINE | ID: mdl-30570391

ABSTRACT

BACKGROUND: Review of the literature clearly reveals that little is known about the association between functional and mental status, and Lower Urinary Tract Dysfunction (LUTD) in patients with stroke. OBJECTIVE: The aim of this study was to assess functional and mental status in stroke patients and to identify possible associations with the prevalence, severity and bother of LUTD. MATERIAL AND METHODS: This study was designed as a cross-sectional study and included 260 stroke patients enrolled from six different hospitals in Turkey. The patients were questioned using the Danish Prostatic Symptom Score (DAN-PSS) Questionnaire to evaluate LUTD, and evaluated using the Modified Barthel Index (MBI), Incontinence Quality of Life Questionnaire (I-QoL), and the Mini Mental State Examination (MMSE). RESULTS: At least one LUTD finding was reported in 243 (93.5%) patients; the most commonly encountered complaint in these patients was nocturia (75.8%). The mean MBI, MMSE, and I-QoL scores were found to be significantly lower in LUTD (+) patients compared to LUTD (-) patients (p = 0.000, p = 0.005, and p < 0.01, respectively). Similarly all parameters (MBI, MMSE, and I-QoL scores) assessed were found to be significantly lower for patients with urinary incontinence than those without incontinence (p = 0.000, p = 0.000, and p < 0.01, respectively). CONCLUSION: LUTD is a common problem in patients with stroke. LUTD is associated with poorer cognitive and functional status and the quality of life in these patients. We, therefore, suggest that bladder dysfunction should not be overlooked during rehabilitation of stroke patients.


Subject(s)
Lower Urinary Tract Symptoms/etiology , Lower Urinary Tract Symptoms/psychology , Stroke/complications , Stroke/psychology , Aged , Cross-Sectional Studies , Female , Humans , Male , Mental Status and Dementia Tests , Middle Aged , Prevalence , Quality of Life , Stroke Rehabilitation , Surveys and Questionnaires , Urinary Incontinence/psychology
9.
Turk J Phys Med Rehabil ; 64(3): 284-287, 2018 Sep.
Article in English | MEDLINE | ID: mdl-31453523

ABSTRACT

Drug addiction has become an important problem worldwide, and the number of heroin users has been rapidly increasing. There are serious complications related to intravenous drug use. Sharing injectors and using them multiple times cause septic and infective complications. Another important aspect of intravenous drug use is that it potentiates vascular damage. Contaminated injectors may induce pseudoaneurysms when applied directly into the vessel, endothelium, or surrounding tissues. Infected pseudoaneurysms may provoke necrosis, rupture, bleeding, and some dramatic results such as loss of extremity or death. Herein, we report a female case who had a history of long-term substance abuse in whom foot drop developed with a popliteal artery aneurysm.

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