Traction therapy in lumbar disc hernias: A finite element analysis study.

OBJECTIVES: This study aims to evaluate the results of lumbar traction treatment at different traction angles and different traction forces using the finite element analysis (FEA). MATERIALS AND METHODS: Computed tomography (CT) images of a healthy 35-year-old male patient who had no history of trauma or fracture were modeled in three-dimensional (3D) with Mimics® software for the lumbosacral spine model. Ligaments and discs were created on the 3D spine model in the SolidWorks® program. The obtained model was sent to the ANSYS version 18 software, and analyses were done non-linearly. All analyses were performed at different angles and forces from the center of the sacral surface to simulate traction therapy. RESULTS: Traction forces applied in the 0° axial direction decreased the intradiscal pressures by creating a similar tensile stress in the annulus fibrosus regions (anterior, posterior, and lateral) without any significant change in lordotic angle. CONCLUSION: The method used in this study is promising to investigate the benefits of traction therapy. Moreover, individual traction force and direction can be determined to increase the effectiveness of the treatment by using magnetic resonance imaging or CT images in traction therapy.

3D volumetric evaluation of the diagnosis and severity of carpal tunnel syndrome using MRI.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common nerve compression syndrome. The usage of clinical tests and nerve conduction studies (NCS), as well as ultrasonography and magnetic resonance images (MRI), have recently become widespread to diagnose CTS. This study aims to determine the alteration of the carpal tunnel volume based on disease seriousness by MIMICS 19.0 which is a three-dimensional modeling software. MATERIALS AND METHOD: In this study, 80 wrists of 63 (47 female and 16 male) patients with MRI and NCS results among 1252 patients who applied to our hospital with wrist pain and neuropathic complaints between January 2019 and August 2020 were included in our study. The patients were classified into four groups according to their NCS results as normal, mild CTS, moderate CTS, and severe CTS. Carpal tunnel volumes of the groups were measured with MIMICS 19.0 program using MRI. Three-dimensional carpal tunnel volume averages were statistically compared between the groups. Then, all statistical analyzes were performed using SPSS (Statistical Package for Social Sciences, version 23) software. RESULTS: The results demonstrate the mean carpal tunnel volume values for normal, mild CTS, moderate CTS, and severe CTS are 5.51 cm3 ± 0.20, 5.27 cm3 ± 0.16, 4.86 cm3 ± 0.20, and 4.43 cm3 ± 0.24, respectively. Carpal tunnel volumes were found to be lower in all groups which have CTS compared to the normal group. As the groups with CTS were compared among themselves, a significant difference was found between the groups in terms of carpal tunnel volumes (p < 0.001). CONCLUSIONS: In this study, a significant relationship between 3-dimensional measurements of carpal tunnel volume and the severity of CTS was observed. Therefore, MRI is an applicable method to diagnose and determine the severity of CTS.

The relationship between vitamin D, vertebral deformity and quality of life in psoriatic arthritis.

OBJECTIVE: The aim of this study is to investigate the relation between vitamin D levels, vertebral deformities, functional status, quality of life, acute phase reactants and enthesopathy in patients with psoriatic arthritis (PsA). PATIENTS AND METHODS: Fifty-two patients with PsA and 52 controls were enrolled to the study. Routine blood tests and serums 25-(OH)D3 were measured. The thoracic and lumbar vertebrae deformities identified in the radiographies were evaluated by a radiologist. Psoriatic Arthritis Quality of Life (PSAQoL) was used for evaluating quality of life and disease activity parameters for PsA were assessed. In PsA patients, correlations was performed between the 25(OH)-D3 levels and PGE (patient global assessment), PHGE (Physician global assessment), tender JC (joint count), HAQ-S (Health Assessment Questionnaire for the Spondyloarthropathies), PSAQoL, MASES (Maastricht Ankylosing Spondylitis Enthesitis Score) and BASDAI(Bath Ankylosing Spondylitis Disease Activity Index) values. RESULTS: The results showed that 25(OH)-D3 levels was not correlated with these values. (p>0.05 for r = -0.171, r = -0.167, r=-0.069, r=-0.236, r=-0.062, r= -0.058 and r = -0.106 respectively). It was determined that the PSAQoL score had a positive and statistically significant correlation with the DGD, swollen JC, CRP, HGD, tender JC, VAS-pain, HAQ-S, MASES and BASDAI values in PsA patients. (p>0.05 for r=0.291, r=0.324, r=0.346, r=0.312; and p=0.001 for r=0.472, r=0.380, r=0.565, r=0.696, r=0.359, r=0.633, respectively) Statistical analyses demonstrated that PsA patients with vertebral deformities had higher numbers of tender joints, more prolonged periods of morning stiffness, higher DAS28-ESR (Disease Activity Score) scores, and higher levels of vitamin D (p<0.05, p<0.05, p=0.05 and p<0.05, respectively). The multiple logistic regression analysis indicated that the only factor which had an effect on the development of vertebral deformities was the use of steroids. CONCLUSIONS: This result has demonstrated that psoriatic arthritis has a considerable effect on patient quality of life. Most significant factors that affecting quality of life were physical pain and disability while vertebral deformities and 25-(OH)D3 had no significant effect.

Common extensor tendon thickness measurements at the radiocapitellar region in diagnosis of lateral elbow tendinopathy.

PURPOSE: The aim of this study was to determine the value of measuring common extensor tendon (CET) thickness at the radiocapitellar and capitellar regions with qualitative ultrasonographic findings in the diagnosis of lateral elbow tendinopathy. MATERIALS AND METHODS: The study included 164 lateral elbow tendinopathy patients (84 bilateral, 80 unilateral) matched by age, gender, and body mass index with 80 normal subjects. CET was examined using gray-scale and Doppler ultrasonography for tendinopathy, and tendon thickness was measured at two landmark locations: capitellar and radiocapitellar. RESULTS: In tendinopathy, tendon thickness including the dominant capitellar region, increased in every measured location. In the capitellar region of the dominant elbow, the cut-off thickness was 5.15 mm, and in the radiocapitellar region, this value was 4.05 mm. For the non-dominant elbow, the cut-off thickness was 4.61 mm, whereas in the radiocapitellar region, this value was 3.51 mm. The greatest risk of tendinopathy was at the radiocapitellar region on the dominant side. The overall sensitivity and specificity of gray-scale findings were 54% and 88%, respectively, and the addition of Doppler readings did not alter these values. When capitellar measurements were added, the values increased to 79% and 80% for sensitivity and specificity, respectively. These values further increased to 93% and 91%, respectively, when radiocapitellar measurements were included. CONCLUSION: A second tendon thickness measurement at the radiocapitellar region of CET in addition to the capitellar region is recommended on the grounds that combined qualitative and quantitative evaluation of CET increases the diagnostic per- formance of ultrasonography in lateral elbow tendinopathy.