The Diagnostic Role of Adding the Hoffman Reflex for L5 Radiculopathy in the Electrodiagnostic Laboratory: A Cross-sectional Study.

OBJECTIVES: To investigate changes in the H-reflex in patients with monoradiculopathies involving L5 or S1 levels by stimulating the sciatic nerve and recording simultaneously from the tibialis anterior (TA), peroneus longus (PL), and soleus (S) muscles. METHODS: Patients with unilateral radicular back pain with L5 or S1 root compression on MRI, participated in this cross-sectional study. The H-reflex over the TA, PL, and S muscles was simultaneously recorded by sciatic nerve stimulation. The H-reflex latency was compared with that of the contralateral extremity. RESULTS: Fifty-eight patients (29 patients L5; 29 patients S1 radiculopathy) were included in the study. There were significant delays in the latency of the H-reflex over TA (30.95±2.31-29.21±1.4) and PL (31.05±2.85-29.02±1.99) muscles on the affected side in patients with L5 radiculopathy. However, the latency of the S H-reflex was similar on both sides. In contrast, in patients with S1 radiculopathy, there was a significant delay in the latency of soleus H reflex (32.76±3.45-29.9±3.19), while the significant delay was not detected in the TA and PL muscles. However, the cutoff values for the H-reflex latency of all muscles were not found to have clinical significance. CONCLUSIONS: The study presents that the H-reflex study, recorded from the TA, PL, and S muscles by sciatic nerve stimulation, is of interest but has minimal contribution to radiculopathy diagnosis in conventional electrodiagnostic tests.

Utility of shear wave elastography for diagnosing carpal tunnel syndrome with psoriatic arthritis.

BACKGROUND: Carpal tunnel syndrome (CTS) is a type of peripheral entrapment neuropathy and common for the patients with psoriatic arthritis (PsA). Shear wave elastography (SWE) is a new ultrasonography technique that can be used for diagnosing CTS, but not studied in PsA patients. AIMS: The aim of this study to measure the stiffness of median nerve and hand muscles by quantitative SWE to identify whether SWE can be used for diagnosing CTS in patients with PsA or not. METHODS: To diagnose CTS, all patients had electrodiagnostic study. The stiffness values of the median nerve, abductor pollicis brevis, and abductor digiti minimi were determined using SWE. Muscle stiffness ratio was also calculated. RESULTS: Consideration is given to 48 patients with PsA (93 wrists) and 29 healthy volunteers (57 wrists). Median nerve stiffness was found to be significantly higher, and abductor pollicis brevis' stiffness and muscle stiffness ratio were significantly lower in PsA patients' wrists compared to control group (p = 0.002, p < 0.001, p = 0.001, respectively) and in CTS wrists compared to others (p < 0.001, p < 0.001, p = 0.001, respectively). Receiver operating characteristic analysis identified 28.2 kPA as the median nerve stiffness cut-off point for differentiating CTS in PsA patients (p = 0.001). CONCLUSIONS: We found that SWE has a good diagnostic value for CTS with PsA patients; hence, we can conclude that SWE could diagnose CTS in PsA patients.

Carpal Tunnel Syndrome in Patients with Psoriatic Arthritis: Ultrasonography and Magnetic Resonance Imaging Findings.

Objective: The aim of the present study is to assess carpal tunnel syndrome's (CTS's) ultrasonography (US) and magnetic resonance imaging (MRI) findings in patients with psoriatic arthritis (PsA) and compare them with healthy controls. Methods: Thirty-nine PsA and twenty-eight healthy volunteers were examined in this study. Demographic and clinical features were recorded. CTS-6, a diagnostic algorithm, was used to estimate the probability of CTS. Electrodiagnostic study (EDS) was applied to all wrists included in the report, where the diagnosis of CTS was made by EDS. The cross-sectional area (CSA) of the median nerve was measured at pisiform bone level by US and MRI. Results: Regarding to the demographic characteristics, no statistically significant difference was found between the groups. Twelve of 39 (30.76%) PsA patients had CTS, whereas CTS was not detected in the control group (p=0.001). US and MRI showed increased median nerve CSA in PsA patients compared to healthy controls (p=0.005, p<0.001; respectively). Also, US and MRI showed increased median nerve CSA in CTS patients compared to others (p=0.002, p<0.001; respectively). The Pearson correlation coefficient between MRI and US measurements of the CSA was 0.85 (p<0.001). Conclusion: CTS frequency in PsA patients is found higher than healthy controls. The relationship between CTS diagnosed by EDS and CSA measured by both US and MRI was observed in PsA patients.

Evaluation of short-term and residual effects of Kinesio taping in chronic lateral epicondylitis: A randomized, double-blinded, controlled trial.

BACKGROUND: Lateral epicondylitis is degenerative tendinosis of the extensor carpi radialis brevis muscle and is the most common work/sports-related chronic musculoskeletal problem affecting the elbow. PURPOSE: This study aimed to evaluate the short term and residual effectiveness of the Kinesio taping method on pain, grip force, quality of life, and functionality. STUDY DESIGN: Randomized, double-blinded, controlled study. METHODS: Subjects were 50 patients diagnosed with chronic unilateral lateral epicondylitis with a symptom duration of at least 12 weeks. During the first four weeks, the study group received a true inhibitor Kinesio taping while the control group received sham taping. In both groups, progressive stretching and strengthening exercises were given as a home program for six weeks. The primary outcome measure was the Numerical Rating Scale (NRS) for self-report of pain intensity; secondary outcome measures were Cyriax resistive muscle test evaluation, maximal grip strength, Patient- Rated Tennis Elbow Evaluation (PRTEE), and Short Form-36 (SF-36). After the treatment, patients were evaluated by the first assessor who was blinded to taping types. RESULTS: There was a significant decrease in NRS scores overtime during the first four weeks in both groups (P < .001,) and effect sizes were large. There was no significant difference in Cyriax muscle resistance test maximal grip strength between groups (P > .05). However, there was a significant improvement in muscle strength of elbow extension and pronation in the study group detected in the intragroup analysis. Intragroup comparisons also showed a significant improvement in all subunits of the PRTEE and SF-36 except energy/vitality, social functioning, and pain in both groups (P < .05) with moderate to high effect sizes. PRTEE pain scores were significantly decreased in the study group compared to the placebo group (P < .05, d = 0.48). CONCLUSION: The effects of Kinesio taping on muscle strength, quality of life, and function in chronic lateral epicondylitis are not superior to placebo. However, NRS scores showed that in the two weeks after Kinesio taping treatment, pain reduction persisted as a residual effect which may improve the exercise adherence and functionality.

Validity and reliability of the fatigue impact scale in stroke.

BACKGROUND: Fatigue is one of the significant problems of post-stroke patients as it causes a decreased quality of life. Although the fatigue impact scale (FIS) is used in stroke, it lacks validation studies. OBJECTIVE: This study evaluates the psychometric properties of the FIS in patients with stroke. SUBJECTS AND METHODS: A total of 41 subjects with stroke and 41 control subjects admitted to Physical Medicine and Rehabilitation Department were included. Convergent validity was assessed using the SF-36 vitality (SF-36 v) scale and the fatigue severity scale (FSS). Divergent validity was assessed using the Hospital Anxiety and Depression Scale (HADS). RESULTS: All subscores of the FIS were significantly higher in the stroke group than in the control group (p < .05). FIS showed excellent internal consistency in stroke patients (Cronbach's alpha = 0.946). There was a negative correlation among FIS and SF-36 v (r = -0.506, p = .001), and a positive correlation between the HADS anxiety score (r = 0.356, p = .026) and the HADS depression score (r = 0.293, p = .071). FIS total scores were weakly correlated with the FSS (r = 0.323, p = 0.039). The test-retest reliability of FIS was good in terms of its cognitive, physical, and psychosocial subscales and total scores, with ICC values of 0.78, 0.73, 0.80, and 0.83, respectively. CONCLUSION: FIS is a valid and reliable multidimensional scale that sensitively discriminated fatigue in the stroke patients from that in the control subjects.

Musculoskeletal symptoms and relationship with laboratory findings in patients with COVID-19.

AIM: To investigate the frequency of fatigue and musculoskeletal symptoms and their correlation with laboratory data in patients with COVID-19. METHODS: This study included 80 patients hospitalised and treated for COVID-19 in the infectious diseases clinic between March 2020 and May 2020. Data analysis was performed retrospectively from the hospital medical charts. Demographic data, clinical symptoms, and laboratory findings were noted. Clinical symptoms and correlations with laboratory results were assessed. Besides, an analysis of patients with and without chronic disease was performed for clinical symptoms and laboratory findings. RESULTS: The frequencies of myalgia and fatigue were 46.1% and 50%, respectively. In the laboratory data, there was a significant increase in creatinine kinase (CK) level and lymphocyte count in the patients with myalgia symptoms (P < .05). There were no other significant results in the laboratory data. Of the patients with chronic disease, it has been shown that hemoglobin levels were significantly decreased (P < .05), while D-dimer was markedly increased (P < .05). CONCLUSION: The laboratory findings of COVID-19-related myalgia suggested that patients might have a risk of progressive muscle injury. Therefore, these patients should also be followed up in terms of the myopathic process.

The Importance of Functional Hamstring/Quadriceps Ratios in Knee Osteoarthritis.

CONTEXT: Osteoarthritis (OA) is the most common chronic joint condition. Muscle dysfunction plays a critical role in the pathogenesis of knee OA. OBJECTIVE: It has been suggested that the agonist-antagonist strength relationship for the knee may be better described by a functional hamstring/quadriceps (H/Q) ratio (Hconcentric/Qeccentric: the representative of knee flexion and Qeccentric/Hconcentric: the representative of knee extension). Therefore, in this study, the authors aimed to investigate this ratio and its importance for knee OA. DESIGN: Cross-sectional study. SETTING: Research clinic. Patients or Other Participant(s): Twenty healthy women and 20 women with grade 2 or grade 3 primer knee OA between the age of 50 and 80 years were included in this study. INTERVENTION(S): Concentric and eccentric peak torque of quadriceps and hamstring muscles were evaluated for all individuals in patient and control groups with a Cybex isokinetic device. Functional H/Q ratio is calculated manually. MAIN OUTCOME MEASURE(S): Functional H/Q torque ratios were analyzed between the patients with OA and healthy individuals by using the isokinetic system. RESULTS: The values of peak torque of hamstring concentric and eccentric and quadriceps concentric for the patient group were significantly lower than the control group (P < .05). No statistically important difference was found for quadriceps eccentric peak torque between 2 groups (P > .05). H/Q ratio for extension in the patient group was significantly higher than the control group (P < .05), whereas the H/Q ratio for flexion in the patient group was significantly lower than the control group (P < .05). CONCLUSION: This study showed the weakness of both quadriceps and hamstring muscles in patients with knee OA. The combination of functional H/Q ratio with hamstring and quadriceps muscles concentric and eccentric strength values can help to analyze the knee functions and develop preventive-therapeutic approaches for knee OA.

Validity and reliability of fatigue severity scale in stroke.

BACKGROUND: Fatigue is a frequent complaint after stroke and may be associated with dependence in activities of daily living, decreased quality of life, increased institutionalization and mortality. Although fatigue severity scale (FSS) is the most frequently used scale in stroke, validation studies are scarce. OBJECTIVES: This study aimed to examine the psychometric properties of FSS in subjects with stroke. METHODS: A total of 46 subjects with stroke who were admitted for rehabilitation and 52 control subjects who were admitted for local musculoskeletal problems were included. A comprehensive assessment including functional independence measure, Folstein Mini-Mental State Examination, Hospital Anxiety and Depression Scale (HADS), visual analog scale for fatigue (VAS), FSS, and vitality subscale of 36-item Medical Outcomes Study Short-Form Health Survey (SF-36v) was conducted. FSS, VAS and SF-36v were repeated 7 days later. RESULTS: FSS demonstrated excellent internal consistency in subjects with stroke (Cronbach's alpha: 0.928). There was a moderate correlation between FSS and SF-36v (r = -0.498, p < 0.001). FSS was weakly correlated with HADS anxiety (r = 0.310, p = 0.041) and HADS depression (r = 0.334, p = 0.027). Test-retest reliability of SF-36v (ICC: 0. 746, CI: 0.518-0.866), VAS (ICC: 0.829, CI: 0.671-0.911) and FSS (ICC: 0.742, CI: 0.512-0.863, p < 0.001) was good. ICC values for individual items of FSS were good except for item 6. CONCLUSIONS: FSS is a valid and reliable scale to measure fatigue in stroke. FSS is not sensitive to differentiate fatigue in stroke from the control subjects with orthopedic problems with similar age and gender.

Effectiveness of Wii-based rehabilitation in stroke: A randomized controlled study.

OBJECTIVE: To investigate the efficacy of Nintendo Wii Fit®-based balance rehabilitation as an adjunc-tive therapy to conventional rehabilitation in stroke patients. METHODS: During the study period, 70 stroke patients were evaluated. Of these, 23 who met the study criteria were randomly assigned to either the experimental group (n = 12) or the control group (n = 11) by block randomization. Primary outcome measures were Berg Balance Scale, Functional Reach Test, Postural Assessment Scale for Stroke Patients, Timed Up and Go Test and Static Balance Index. Secondary outcome measures were postural sway, as assessed with Emed-X, Functional Independence Measure Transfer and Ambulation Scores. An evaluator who was blinded to the groups made assessments immediately before (baseline), immediately after (post-treatment), and 4 weeks after completion of the study (follow-up). RESULTS: Group-time interaction was significant in the Berg Balance Scale, Functional Reach Test, anteroposterior and mediolateral centre of pressure displacement with eyes open, anteroposterior centre of pressure displacement with eyes closed, centre of pressure displacement during weight shifting to affected side, to unaffected side and total centre of pressure displacement during weight shifting. Demonstrating significant group-time interaction in those parameters suggests that, while both groups exhibited significant improvement, the experimental group showed greater improvement than the control group. CONCLUSION: Virtual reality exercises with the Nintendo Wii system could represent a useful adjunctive therapy to traditional treatment to improve static and dynamic balance in stroke patients.

Do postural changes affect balance in patients with ankylosing spondylitis?

OBJECTIVE: To investigate the effect on balance control of postural changes related to ankylosing spondylitis. DESIGN: Thirty-four subjects with ankylosing spondylitis and 34 healthy individuals were enrolled. Examination of postural alignment was conducted using lumbar Schober, hand to ground distance, tragus to wall distance and occiput to wall distance measurements, and Bath Ankylosing Spondylitis Metrology Index. Balance was evaluated by Berg Balance Scale, Functional Reach Test, Lateral Reach Test, and Static Balance Index. Postural sway during quiet standing was assessed by centre of pressure displacement in 2 conditions: eyes open and eyes closed. RESULTS: Functional reach test and right-side lateral reach tests were significantly lower in subjects with ankylosing spondylitis. Eyes closed anteroposterior centre of pressure sway was significantly higher in the subject group. CONCLUSION: Ankylosing spondylitis can lead to balance deterioration due to postural changes.