The effect of physical therapy and exercise on pain and functional capacity according to the radiological grade of knee osteoarthritis.

BACKGROUND: Physical therapy and exercise programs are frequently used in the treatment of knee osteoarthritis (OA). However, it is not known at what stage of knee OA it is more effective. OBJECTIVE: The purpose of this work was to determine the relationship between the effectiveness of the physical therapy and exercise programs and the radiological findings presence/grade of knee OA. MATERIAL AND METHODS: Overall, 92 patients (65F, 27M) with knee OA were enrolled in the retrospective study. Standard knee radiographs were graded according to Kellgren-Lawrence. Pain and functional status were evaluated using a visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, at the end of the physical therapy program (first month), and at third-month control visits. The demographic characteristics and VAS/WOMAC scores of the subjects were obtained from patient files. RESULTS: We analyzed 131 knees of 92 patients with knee OA (65F, 27M, mean age 53.02 ± 11.13 years). The mean total VAS and WOMAC scores on the first and third months were significantly lower than the initial values (all p< 0.001). The mean VAS scores on the first and third months were significantly lower than the initial values in the group without radiological damage, but WOMAC scores were similar between the evaluations (p= 0.009, p 50 = 0.003, respectively). The mean VAS and WOMAC scores on the first and third months were significantly lower than the initial values in the grade 1 according to the Kellgren-Lawrence radiological grades (all p< 0.001). CONCLUSIONS: According to the results of our study, physical therapy and exercise was effective on pain in all patients with knee OA, but only effective on knee functional capacity in the group with radiological findings, and especially more effective in patients with Kellgren-Lawrence grade 1.

The relationship between femoral cartilage thickness and muscle strength in knee osteoarthritis.

To explore whether femoral cartilage thickness is related (and changes) with muscle strength in subjects with knee osteoarthritis (OA). Forty patients (27 F, 13 M) with knee OA-who were under quadriceps muscle strengthening program-were enrolled in the study. Isokinetic/isometric knee muscle strength measurements (at 30-60° angles and 60-180° velocity) were performed at baseline, end of the muscle strengthening program, and third month control visit using a biodex dynamometer. Femoral cartilage thicknesses (at medial/lateral condyle and intercondylar area) were measured using ultrasonography. Seventy-nine knees of 40 patients (27 F, 13 M) aged 52.03 ± 11.72 years (range, 26-71) were analyzed. Mean VAS scores on the first and third months were significantly lower than the initial values (p < 0.001, p = 0.049). Isometric peak torque and total work values at 180 °/s were significantly higher than the baseline measurements at first and third month controls (all p < 0.05). Cartilage thicknesses (at three sites) were significantly higher than the baseline measurements (all p < 0.05) on the third month but not on the first month (all p > 0.05). Femoral cartilage thicknesses were positively correlated with isometric strength values at baseline and third month. We propose that femoral cartilage thicknesses increase on the third month of strengthening therapy. Since this late-phase thickening parallels the earlier increase in muscle strength (starting, on the first month), we speculate that regeneration rather than edema might be the primary underlying cause.

Prevalence of metabolic syndrome in women with rheumatoid arthritis and effective factors.

PURPOSE: Metabolic syndrome (MS), which is framed by cardiovascular risk factors such as hypertension, obesity, glucose intolerance and dyslipidemia, is thought to be associated with the rheumatic diseases. The aim of this study is to examine the frequency of metabolic syndrome (MS) and insulin resistance in patients with rheumatoid arthritis (RA) and to examine the effect of the inflammation symptoms, disease activity and drugs used in treating RA on insulin resistance and presence MS. METHOD: One hundred women patients diagnosed with RA according to the American College of Rheumatology (ACR) diagnosis criteria and 100 healthy women were included in the study as controls. Insulin resistance were evaluated using the homeostasis model assessment for insulin resistance (HOMA-IR) method and MS was diagnosed according to two Metabolic Syndrome definitions (National Cholesterol Education Programme 2004, International Diabetes Federation). The disease activity of RA was evaluated by the disease activity score including 28 joints (DAS28). RESULTS: In total, 27% and 33% of the RA patients and 28% and 44% of the control group patients according to the diagnostic criteria used were also MS patients. There was no significant difference between the RA and control groups in MS frequency and insulin resistance according to two diagnostic criteria used. The DAS28, erythrocyte sedimentation speed (ESS) and serum uric acid levels in the RA patients with MS were significantly higher than those of the RA patients without MS. The prevalence of MS In patients with RA using methotrexate (MTX) was significantly lower than without RA. Other drugs used in treatment of RA had no effect on the prevalence of MS in patients with RA. CONCLUSION: Controlling inflammation and disease activity can reduce the MS frequency of RA patients and MTX treatment also may be a protective factor against MS.

The relationship between radiological severity and functional status in patients with knee osteoarthritis.

In this study, we aimed to explore the relationship between radiological findings and functional status in patients with knee osteoarthritis (OA). In this study, 117 female patients diagnosed with knee osteoarthritis according to the ACR criteria were included. Antero-posterior knee radiographs of the patients were graded according to Kellgren-Lawrence, and functional capacity was evaluated with WOMAC and Lequesne indexes. Quadriceps and hamstring muscle strengths were also concentrically measured using an isokinetic dynamometer, five repetitions at 90°/s and 20 repetitions at 180°/s. In this study, a significant relationship was determined between the age, weight, praying period, and pain period of the patients with the radiological findings. No significant relationship was determined between the functional capacity of knee and muscle strength and the radiological findings. However, left hamstring functioning capacity was found as lower in the group with the radiological findings. The radiological findings in knee OA are not associated with decrease in knee muscle strength and functional capacity. Clinical symptoms such as pain, decrease in range of motion, etc. in knee OA may be responsible for decrease in knee muscle strength and functional capacity.

Digital evaluation of the muscle functions of the lower extremities among inguinal hernia patients treated using three different surgical techniques: a prospective randomized study.

PURPOSE: An inguinal hernia is a common pathology that can be treated using several different surgical procedures. Although there have been many studies comparing the clinical results of these techniques, there has so far been no digital analysis of the alterations developing secondary to pain with regard to the muscle functions of the lower extremities. This prospective randomized trial was designed to compare this aspect for subjects treated using the laparoscopic techniques and those treated using the conventional method. METHODS: A total of 75 patients, 25 of whom who had undergone hernia repair using the total extraperitoneal technique, 25 of whom who had undergone repair using the transabdominal preperitoneal technique, and 25 who had undergone repair using the Prolene mesh graft technique, were evaluated preoperatively and on the third postoperative day by isometric and isokinetic measurements, the visual analog score (VAS), the necessity of postoperative analgesia, complications, and the time that had elapsed before returning to work, and these results were recorded. RESULTS: Hernia repair using the conventional method led to an average of 3 times more muscle function loss compared with the laparoscopic techniques, and this difference was shown to be statistically significant. The VAS, postoperative complications, and time elapsed before returning to work were lower for laparoscopic surgeries and also were compatible with the findings described in the previous literature. CONCLUSIONS: Use of a digital environment with numerical parameters and measurements recorded using a dynamometer demonstrated that in the early postoperative period and on the third postoperative day, open surgery causes more functional loss in the lower extremities than laparoscopic methods. Therefore, surgeons should use laparoscopic methods whenever possible to reduce both pain and loss of muscle function.

TRAIL death receptor-4, decoy receptor-1 and decoy receptor-2 expression on CD8+ T cells correlate with the disease severity in patients with rheumatoid arthritis.

BACKGROUND: Rheumatoid Arthritis (RA) is a chronic autoimmune inflammatory disorder. Although the pathogenesis of disease is unclear, it is well known that T cells play a major role in both development and perpetuation of RA through activating macrophages and B cells. Since the lack of TNF-Related Apoptosis Inducing Ligand (TRAIL) expression resulted in defective thymocyte apoptosis leading to an autoimmune disease, we explored evidence for alterations in TRAIL/TRAIL receptor expression on peripheral T lymphocytes in the molecular mechanism of RA development. METHODS: The expression of TRAIL/TRAIL receptors on T cells in 20 RA patients and 12 control individuals were analyzed using flow cytometry. The correlation of TRAIL and its receptor expression profile was compared with clinical RA parameters (RA activity scored as per DAS28) using Spearman Rho Analysis. RESULTS: While no change was detected in the ratio of CD4+ to CD8+ T cells between controls and RA patient groups, upregulation of TRAIL and its receptors (both death and decoy) was detected on both CD4+ and CD8+ T cells in RA patients compared to control individuals. Death Receptor-4 (DR4) and the decoy receptors DcR1 and DcR2 on CD8+ T cells, but not on CD4+ T cells, were positively correlated with patients' DAS scores. CONCLUSIONS: Our data suggest that TRAIL/TRAIL receptor expression profiles on T cells might be important in revelation of RA pathogenesis.

The relationship between knee osteoarthritis and osteoporosis.

OBJECTIVE: The aim of this study was to investigate the association between knee osteoarthritis (OA) and bone mineral density (BMD) in the femur and lumbar vertebrae. MATERIALS AND METHODS: A total of 74 female patients (mean age 61.9 ±9.1 years, mean body mass index 27.09±4.24) diagnosed with knee OA were included in this study. To assess knee OA, bilateral weight-bearing antero-posterior knee radiographs were taken and graded from 0 to 4 according to Kellgren-Lawrence criteria. The BMD of the subjects was measured using dual-energy X-ray absorptiometry (DEXA). BMD measurements of those with OA were compared with those without OA. RESULTS: While there was no correlation between BMD and the grade of knee OA, a significant negative correlation was found between age and femur BMD. Body mass index was positively correlated with OA and negatively correlated with OP. CONCLUSION: Further investigations are needed to demonstrate the association between knee OA and BMD.

Evaluation of eNOS gene polymorphisms in relation to BMD in postmenopausal women.

OBJECTIVE: The aim of the present study was to evaluate the relations between T(-786)C and Glu298Asp polymorphisms of the endothelial nitric oxide synthase (eNOS) gene and BMD in postmenopausal Turkish women. METHODS: The T(-786)C and Glu298Asp polymorphisms were genotyped by PCR-RFLP method in 311 postmenopausal osteoporotic women (OP) and in 305 age-matched postmenopausal females (CG) with normal BMD. RESULTS: None of the SNPs of the eNOS gene was significantly associated with BMD at the lumbar spine, femoral neck, Ward's triangle and femoral trochanter in the combined group. Mean BMD values were therefore found to be similar across the genotypes in postmenopausal Turkish women. However, there was a significant association between the T(-786)C polymorphism and BMD values at the lumbar spine in the normal control group (P=0.005), and at the femoral trochanter in the osteoporotic patients (P=0.046). The mean value of the lumbar spine BMD in the normal controls was significantly higher in women with the TC genotype of the T(-786)C polymorphism than in women with the TT genotype (P=0.0012). Women with the CC genotype of the T(-786)C polymorphism in the osteoporotic patients had significantly higher BMD value at the femoral trochanter than those with the TC (P=0.018) and TT genotypes (P=0.024). Frequencies of the TC heterozygotes for T(-786)C polymorphism were significantly higher among osteoporotic subjects than normal controls. Also, the CC and TT genotype frequencies of control group were significantly higher than those of the osteoporotic group at the femoral neck. CONCLUSIONS: We conclude that, although the biological role of the nitric oxide synthases is well established, our study does not suggest that eNOS gene polymorphisms, T(-786)C and Glu298Asp, are major contributors to adult bone mineral density in the postmenopausal Turkish women.

No association between bone mineral density and transforming growth factor beta gene T(861-20)-C polymorphism in Turkish postmenopausal women.

The aim of the study was to examine whether the TGF-beta1 T(861-20)-C gene polymorphism might be useful in identifying individuals with increased susceptibility to postmenopausal bone loss within the Turkish women population. T(861-20)-C polymorphism was genotyped in 616 postmenopausal women selected from the Turkish population: 311 postmenopausal osteoporotic women (OP) aged 45-65 years (mean age 58 years) and a control group (CG) of 305 postmenopausal women in the same age range (mean age 53 years) with normal bone mineral density. We have not found any significant differences in the frequency of the individual genotypes between the osteoporotic and control groups. The distribution of the T(861-20)-C genotypes was for Lumbar spine, CC, 74.0% in OP, 75.1% in CG; TC, 24.1% in OP, 23.9% in CG; TT, 1.9% in OP, 1.0% in CG; and for femoral neck, CC, 76.8% in OP, 72.8% in CG; TC, 22.1% in OP, 25.5% in CG; TT 1.1% in OP, 1.7% in CG. T(861-20)-C polymorphism was not found to be associated with bone mineral density in postmenopausal Turkish women. It was argued that this will be a pioneering study for the future research and therapies.

Acromegalic arthropathy of the hip: a case report.

Acromegaly is a chronic and slowly developing endocrinopathy caused by hypersecretion of growth hormone and consequently of insulin like growth factor-1. The arthropathy in acromegaly can affect both axial and peripheral joints and it may present as the earliest clinical symptom of the disease. Patients with acromegaly may have high prevalence of joint related comorbidity and a reduced self perceived quality of life. An early diagnosis is crucial to obtaining the optimal treatment due to the potential reversibility of the lesions in an early stage. The aim of this case report is to draw attention to the possible articular involvement of acromegaly.

Proprioceptive comparison of allograft and autograft anterior cruciate ligament reconstructions.

The aim of this study is to search if there is any proprioceptive difference between auto and allograft anterior cruciate ligament (ACL) reconstructions, and also to determine if there is any relationship between instrumented anterior knee laxity and proprioception after an ACL reconstruction. The following four groups were constituted for this purpose: group I, control group; group II, autograft reconstructions; group III, allograft reconstructions and group IV, people with injured ACLs. Each group consisted of 20 patients/volunteers. Two subgroups were constituted according to the findings of KT-1,000 laxity testing in group II and III; patients/volunteers found to have a laxity of 3 mm or less were enrolled in the normal subgroup and those with a laxity of more than 3 mm were enrolled in the lax subgroup. Two proprioceptive tests were used: threshold to detect passive motion (TDPM) and joint position sense (JPS) by using Cybex Norm dynamometer. Patients underwent ten tests and the discrepancy in degrees was averaged for ten trials. Comparisons were made to evaluate the proprioceptive differences between groups/subgroups; ANOVA and t test was used for comparisons where appropriate, and the significance was set at P < 0.05. There was a significant difference in degrees between patients with injured ACLs and the other three groups in TDPM evaluations (injured: 1.93 degrees vs. control: 1.03 degrees , autograft: 1.01 degrees , allograft: 0.96 degrees ; P < 0.001). Auto and allograft reconstructions were not different from each other and controls. Allo and autograft ACL reconstructions are not different from each other according to proprioceptive measurements. Also, proprioception is not correlated to postoperative anterior knee laxity; many variables involve joint proprioception and mostly the anterior knee laxity may not be the sole determining element, and a lax ACL still may fulfill some of its afferent arc functions as long as it bridges the femur and tibia.

Legg-Perthes disease-like joint involvement and diagnosis delay in Scheie syndrome: a case report.

Mucopolysaccharidosis (MPS) type I is an inherited disease caused by the absence or malfunctioning of lysosomal enzymes. Three subtypes, based on severity of symptoms, were described, and Scheie syndrome (also called MPS I S) is the mildest form. Although there may be some typical extra-articular manifestations, musculoskeletal involvement may be the only presenting sign in the absence of other symptoms in the patients with less severe forms. The patients with MPS I S, especially in attenuated phenotypes, may be sometimes difficult to recognize for physicians not familiar with the disease. With this case presentation, it is aimed to draw attention to this disease, which could be delayed for the correct diagnosis. An increased awareness of the disease may contribute to more accurate diagnosis, and patients may benefit from early intervention.

Acute effect of exercise on plasma leptin level and insulin resistance in obese women with stable caloric intake.

UNLABELLED: Obese individuals are frequently hyperleptinemic and insulin resistant. Chronic exercise is associated with improvements in plasma leptin level and insulin sensitivity; however, little is known about the acute effect of exercise on these parameters. The aim of this study was to evaluate the acute effect of aerobic exercise on plasma leptin and insulin sensitivity in obese women with stable caloric intake. PATIENTS AND METHODS: Twenty-three obese women (age 41.2 +/- 10.3 years, body mass index 40.7 +/- 6.7 kg/m2) were included to the study. All subjects were admitted to an exercise program (45-minute walking sessions at 60-80% of maximum heart rate) every day except weekends for four weeks (total 20 exercise sessions). Insulin resistance was evaluated by HOMA model. Plasma glucose, insulin and leptin levels were determined at baseline and at the end of the first, seventh, and twentieth exercise session. RESULTS: Baseline and at the end of the first, seventh, and twentieth exercise session plasma leptin levels were 59.1 +/- 20.1, 58.5 +/- 21.0, 53.4 +/- 21.9, and 51.2 +/- 20.5 ng/ml and HOMA-r were 2.75 +/- 1.47, 1.77 +/- 0.71, 1.73 +/- 0.89, 1.62 +/- 0. 70, respectively. Compared to baseline, at the end of the seventh (p = 0.021) and twentieth exercise session (p = 0.003), plasma leptin levels were significantly low. Plasma leptin level did not change significantly at the end of the first exercise session (p > 0.05). At the end of the first exercise session (p = 0.005), end of the seventh (p = 0.003) and twentieth exercise session (p = 0.007) HOMA-r was lower than baseline. There was no correlation between weight loss during exercise period and the change of leptin, and HOMA-r. Fasting plasma glucose, insulin and leptin levels were determined at baseline and at the end of the first, seventh, and twentieth exercise session. CONCLUSION: Our study suggests that acute exercise decreases insulin resistance at the first exercise session with no effect on leptin levels. Significant leptin decrement was evident at the first week and lasted during the entire four weeks exercise session.

Heterotopic ossification related to toxic epidermal necrolysis in a patient with Behçet's disease.

We describe a 44-year-old woman with an 18-year-history of Behçet's disease (BD) in whom heterotopic ossification (HO) developed as a complication of toxic epidermal necrolysis (TEN). The patient presented with high fever, a progressive erythematous rash including target-like lesions, flaccid blister formations, and severe detachment. The patient was diagnosed with TEN, and methylprednisolone therapy was started. In the 2nd month of her hospital course, painful limitation developed in both her elbow and shoulder joints. Laboratory and radiographic findings confirmed HO of these areas. BD associated with TEN and HO is a previously unreported entity. In such a condition, determination of underlying genetic abnormality is important. Additionally, HO should be considered as a potential cause of the symptoms related to the joints.

Effects of exercise on gallbladder volume and motility in obese women.

PURPOSE: Comparatively few prospective studies have investigated the relationship between physical activity and gallbladder motility, and the results are controversial. Exercise may affect gallbladder motility via neural or hormonal mechanisms. The purpose of this study was to evaluate the possible effects of aerobic exercise on gallbladder motility in a group of obese women without gallstones. PATIENTS AND METHODS: Twenty-three obese women (age 41.2+/-10.3 years, body mass index 40.7+/-6.7 kg/m(2)) were included in the study. Following an overnight fast, fasting and postprandial (15, 30, 45, 60, 75, 90, 120, and 150 minute) volumes and ejection fractions were evaluated with real-time ultrasonography before exercise. For all subjects, the exercise regimen consisted of daily 45-minute walking sessions at 60-80% of maximum heart rate for 4 weeks except weekends. Gallbladder volume and ejection fraction were again evaluated after exercise. RESULTS: Fasting and postprandial (15, 30, 45, 60, 75, 90, 120, and 150 minute) volumes were 38.6+/- 10.9, 32.8+/- 8.8, 27.6/- 8.1, 22.7+/- 8.5, 21.4+/- 7.2, 20.8+/- 7.0, 22.8+/- 7.3, 29.6 +/- 7.0, and 36.8+/- 6.2 cm(3) before the exercise period, respectively, and 40.8+/- 18.9, 29.9+/-11.2, 25.3+/- 9.2, 22.4+/-8.5, 19.6+/-7.8, 17.7+/- 6.8, 17.8+/- 7.3, 23.1+/-10.8, and 29.0+/-14.4 cm(3) after the exercise period, respectively. Postprandial (15, 30, 45, 60, 75, 90, 120, and 150 minute) ejection fractions were 13.5+/-15.9, 27.4+/-15.4, 39.5+/-20.0, 43.2+/-16.7, 44.3+/-17.3, 37.5 +/- 23.5, 23.5 +/-25.1, and 5.5+/- 21.6% before the exercise period, respectively, and 22.6+/- 20.1, 34.6+/-14.5, 42.0+/-13.6, 49.2+/-12.6, 53.1+/-14.1, 52.6+/-16.1, 43.6+/-17.0, and 29.2+/- 26.5% after exercise, respectively. After the exercise period, the 75, 90, 120, and 150 minute volumes were lower (p< 0.05, p< 0.05, p< 0.05, p< 0.01) and the 90, 120, and 150 minute ejection fractions were higher than before exercise (p< 0.05, p < 0.05, p< 0.01). CONCLUSIONS: Our study showed that exercise decreased late-phase postprandial gallbladder volume and increased late-phase postprandial gallbladder motility in these obese women.

Results of zone II flexor tendon repair in children younger than age 6 years: botulinum toxin type A administration eased cooperation during the rehabilitation and improved outcome.

The inability of young children with a zone II flexor tendon repair to cooperate in postoperative care and rehabilitation may represent a high risk for medical and surgical complications. To forestall that risk, botulinum toxin type A (2.5 U/kg, 7 U/kg) injection was used during surgery to induce forearm flexor muscle relaxation in seven children under 6 years old with zone 2 flexor tendon repairs. Patients received a controlled passive motion regimen after surgery. Results were evaluated on the basis of the acquisition of muscle tone and active finger movements, total range of motion of affected joints, postoperative grip strength, muscle atrophy, and phalangeal length. In this prospective clinical study, the mean follow-up was 18 months. All the children had good and excellent results based on the Strickland criteria. As for postoperative complications, one patient had bowstring and another had poor finger sensibility and first web space contracture that required Z-plasty. The selective use of botulinum toxin type A to weaken the targeted muscles generated a sufficient reduction in spontaneous activity of the fingers, permitting an improved rehabilitation program. Botulinum toxin type A administration could be an effective form of therapy, serving as an alternative or adjunct to conventional rehabilitation modalities in these children.

Factors affecting one year mortality and functional outcome after first ever ischemic stroke in the region of Antalya, Turkey (a hospital-based study).

In order to establish good health politics for stroke survivors, regional differences in factors affecting the outcome of patients have to be known. For this purpose we investigated factors affecting 1 year mortality and functional outcome in patients with first-ever-in a lifetime stroke in the region of Antalya, Turkey. One-hundred and forty-seven patients with a first ever stroke were included and followed up for at least one year. The modified Rankin Scale was used for evaluation of handicap. Several factors known to affect prognosis such as demographic features, socioeconomic status, stroke subtype, neurological findings and stroke risk factors were compared between patients who died during follow-up and survivors. Of the 147 patients 35 (23.8%) died during the course of the study. Multivariate logistic regression analysis showed that only illiteracy, being single or widowed and presence of urinary incontinence were significant predictors of being dead at the end of 1 year. In the survivors factors independently affecting dependence at the end of one year were age, presence of coma on admission and urinary incontinence. Our results suggest that not only stroke severity but also socioeconomic variables are important in determining the prognosis of stroke patients.

Musculoskeletal manifestations in patients with thyroid disease.

OBJECTIVE: Thyroid dysfunction may cause musculoskeletal symptoms. We have evaluated the prevalence of adhesive capsulitis, Dupuytren's contracture, trigger finger, limited joint mobility and carpal tunnel syndrome in a series of patients with various thyroid diseases and differing levels of function. DESIGN AND PATIENTS: Patients with euthyroid (diffuse and/or nodular) goitre, Hashimoto's thyroiditis, Graves' disease, toxic nodular goitre, toxic diffuse goitre and patients with goitre who had partial thyroidectomy were included in the study (n = 137). Neurological and musculoskeletal examinations were performed after a standardized symptom questionnaire. The prevalence of musculoskeletal problems was analysed with respect to thyroid function and thyroid autoantibody status. MEASUREMENTS: Serum concentrations of free T3, free T4, TSH and thyroglobulin and thyroperoxidase antibodies were determined. Serum levels of creatine kinase, lactate dehydrogenase, calcium and phosphate along with erythrocyte sedimentation rate were measured to exclude other causes of musculoskeletal complaints. RESULTS: When the study group (n = 137) was divided according to thyroid status, 30.6% (n = 42) were thyrotoxic, 16.8% (n = 23) had subclinical thyrotoxicosis, 28.5% (n = 39) were euthyroid, 7.3% (n = 10) had subclinical hypothyroidism and 16.8% (n = 23) were hypothyroid. Overall, adhesive capsulitis was found in 10.9% (n = 15), Dupuytren's contracture in 8.8% (n = 12), limited joint mobility in 4.4% (n = 6), trigger finger in 2.9% (n = 4) and carpal tunnel syndrome in 9.5% (n = 13) of the patients. The prevalence of adhesive capsulitis was highest in patients with subclinical thyrotoxicosis (17.4%); Dupuytren's contracture, limited joint mobility and carpal tunnel syndrome were commonest in hypothyroid patients (21.7%, 8.7% and 30.4%, respectively). Trigger finger occurred in 10% of patients with subclinical hypothyroidism. When these prevalences were analysed with respect to thyroid status, carpal tunnel syndrome was significantly more prevalent in the hypothyroid group (P = 0.004). When thyroperoxidase antibody-positive and -negative patients were compared, adhesive capsulitis negatively (P = 0.03, r =-0.18) and trigger finger positively correlated with (P = 0.03, r = 0.21) thyroperoxidase antibody existence. CONCLUSIONS: These results demonstrate that musculoskeletal disorders often accompany thyroid dysfunction. In addition to the well-known observation that these disorders are common in patients with hypothyroidism, they are also observed in patients with thyrotoxicosis. Patients with thyroid dysfunction should be questioned for musculoskeletal complaints and referred to a specialist if necessary.