Ultrasound-guided versus blind subacromial corticosteroid and local anesthetic injection in the treatment of subacromial impingement syndrome: A randomized study of efficacy.

OBJECTIVES: This study aims to compare the effects of ultrasound (US)-guided and blind subacromial corticosteroid and local anesthetic (LA) injection in the treatment of subacromial impingement syndrome (SIS) on shoulder pain, range of motion (ROM), and functionality. PATIENTS AND METHODS: The prospective study was conducted between 01 February 2017 and 31 May 2017. A total of 29 patients with clinical findings and magnetic resonance imaging (MRI) consistent with SIS were randomized into two groups: 14 patients received US-guided subacromial corticosteroid and LA injection and 15 patients received a blind subacromial corticosteroid and LA injection. Patients were evaluated before and one month after treatment. One patient was lost to follow up. The primary outcome measure was a visual analog scale (VAS) for shoulder pain. Secondary outcomes were active shoulder ROM in flexion and abduction, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the modified Constant-Murley Score (CMS). RESULTS: Twenty-eight patients (11 males, 17 females; mean age 39.5 in the US guided group and 42.5 in the blind group; range 20 to 64 years in both groups) completed the study. There was a significant improvement in VAS for shoulder pain, active ROM, DASH questionnaire score and modified CMS in both groups four weeks after treatment (p<0.05). There was no between-group difference in VAS, ROM or DASH questionnaire scores. Following treatment, the modified CMS in the US-guided injection group was higher than in the blind injection group (p=0.02). However, when the mean change in modified CMS in the US-guided injection group was compared to that of the blind injection group, the difference was insignificant (p=0.23). CONCLUSION: Both US-guided and blind subacromial steroid injection improve shoulder pain, ROM, and functionality in SIS; one treatment option was not found to be superior to the other. Therefore, blind injection can be performed in clinical settings where US is not available. Equally, blind injection can also be performed in patients who have a definite diagnosis of SIS based on clinical and MRI findings.

A Comparison of Physical Therapy Modalities Versus Acupuncture in the Treatment of Fibromyalgia Syndrome: A Pilot Study.

OBJECTIVES: Physical therapy (PT) modalities are used in the treatment of fibromyalgia syndrome (FMS). Acupuncture is a treatment option often sought after by FMS patients. The aim of this study was to compare the effects of PT modalities with those of acupuncture on pain, daily function, and quality of life in FMS patients. DESIGN: A comparative effectiveness study. SETTING AND SUBJECTS: Forty-four female patients between the ages of 18-70 years presenting to Baskent University Faculty of Medicine Department of Physical and Rehabilitation Medicine with a new diagnosis of FMS according to the American College of Rheumatology, with manifestations of chronic widespread musculoskeletal pain symptoms, normal routine blood tests, and a desire to receive PT or acupuncture were included in the study. Exclusion criteria included the presence of neurologic, inflammatory, endocrinologic, and other chronic diseases, psychiatric illness, use of antidepressants or analgesics, and contraindication to treatment with PT modalities. INTERVENTIONS: One group (n = 22) received 15 sessions of hotpack, transcutaneous electrical nerve stimulation (TENS), and ultrasound to the tender points of the cervical and upper back regions. The other group (n = 22) received 10 sessions of formulated acupuncture aimed at treating pain of the neck, upper, and lower back regions. OUTCOME MEASURES: Pain, functionality, and quality of life measured using the Short Form McGill Pain Questionnaire (SF-MPQ) and Fibromyalgia Impact Questionnaire (FIQ) before and after treatment. RESULTS: There was a reduction in all SF-MPQ domains and FIQ scores after treatment in both the PT and acupuncture groups. There was no difference in pre- and post-treatment scores between the two groups. CONCLUSIONS: PT modalities and acupuncture can be effectively used in the treatment of FMS. Even though one treatment option was not found to be more beneficial than the other, longer post-treatment follow-up may help determine the superior treatment option.

The effect of postural control and balance on femoral anteversion in children with spastic cerebral palsy.

[Purpose] The aim of the study was to investigate the relationships between femoral anteversion and functional balance and postural control in children with spastic cerebral palsy. [Subjects and Methods] Twenty children with spastic cerebral palsy (mean age=12.4 ± 4.5) with grosss motor functional classification system levels I, II, and III were recruited for this study. Functional balance was evaluated using the Pediatric Balance Scale, postural control was evaluated using the Trunk Control Measurement Scale, and femoral anteversion was assessed with a handheld goniometer using the great trochanter prominence method. [Results] The results indicated that there was significant correlation between femoral anteversion and Trunk Control Measurement Scale dynamic reaching score. There were no significant correlation between femoral anteversion and the Trunk Control Measurement Scale static sitting balance, Trunk Control Measurement Scale selective movement control, total Trunk Control Measurement Scale and Pediatric Balance Scale results. [Conclusion] Increased femoral anteversion has not correlation with functional balance, static sitting, and selective control of the trunk. Femoral anteversion is related to dynamic reaching activities of the trunk, and this may be the result of excessive internal pelvic rotation. It is important for the health professionals to understand that increased femoral anteversion needs to be corrected because in addition to leading to femoral internal rotation during walking, it also effects dynamic reaching activities of spastic children with cerebral palsy.

Diurnal variation in clinical and electrophysiologic parameters associated with carpal tunnel syndrome.

OBJECTIVE: Patients with carpal tunnel syndrome (CTS) often report aggravated symptoms in the early morning. In this study, we aimed to identify diurnal variations in clinical and electrophysiologic parameters of patients with CTS. DESIGN: A cross-sectional clinical and electrophysiologic study was designed. First, electrophysiologic examinations were performed at 2 p.m. to confirm the diagnosis of patients who had been clinically labeled with CTS. Patients who were electrophysiologically and clinically diagnosed with CTS were included in the study, and electrophysiologic examinations were repeated at 7 p.m. and 7 a.m. A total of 64 hands with CTS (27 bilateral, 10 unilateral) and 40 control hands were studied. Grip and pinch strength of all the patients included in the study were measured using a hand dynamometer. Finally, a CTS clinical symptom severity scale and functional status scale were used to measure the symptoms and functional impairment, respectively. RESULTS: The median motor nerve distal latency and median F-minimum latency were found to be prolonged in the CTS group in the morning, and the grip strength was also markedly reduced at this time. Similar results were obtained for the median palm mixed nerve conduction velocity and amplitude. CONCLUSIONS: This study demonstrated that the clinical and electrophysiologic parameters of CTS patients were clearly different in the morning hours, with the symptoms of CTS manifesting at that time.

Correlations of isokinetic measurements with tendon healing following open repair of rotator cuff tears.

The aim of this study was to investigate the correlation of tendon integrity following open cuff repairs with functional and isokinetic strength measurements. Twenty-six shoulders of 25 patients were included in this study. At the final follow-up, 14 repairs (53.8%) were intact and 12 repairs (46.2%) had failed on magnetic resonance imaging (MRI). Mean UCLA score at latest follow-up was 28.5 and mean Constant score was 80.3. Constant scores were found to be significantly low for the failed group. Age was found to be significantly related to failed repair. Fatty infiltration stage in the failed repair group was significantly high, and a strong positive correlation for both groups existed pre and postoperatively. When both groups were compared, the failed group was found to have significantly low measurements at extension and internal rotation. Despite high failure rates, functional results were satisfactory. Increased age and fatty infiltration stage decrease success.

Comparing hot pack, short-wave diathermy, ultrasound, and TENS on isokinetic strength, pain, and functional status of women with osteoarthritic knees: a single-blind, randomized, controlled trial.

OBJECTIVE: To investigate the therapeutic effects of physical agents administered before isokinetic exercise in women with knee osteoarthritis. DESIGN: One hundred patients with bilateral knee osteoarthritis were randomized into five groups of 20 patients each: group 1 received short-wave diathermy + hot packs and isokinetic exercise; group 2 received transcutaneous electrical nerve stimulation + hot packs and isokinetic exercise; group 3 received ultrasound + hot packs and isokinetic exercise; group 4 received hot packs and isokinetic exercise; and group 5 served as controls and received only isokinetic exercise. RESULTS: Pain and disability index scores were significantly reduced in each group. Patients in the study groups had significantly greater reductions in their visual analog scale scores and scores on the Lequesne index than did patients in the control group (group 5). They also showed greater increases than did controls in muscular strength at all angular velocities. In most parameters, improvements were greatest in groups 1 and 2 compared with groups 3 and 4. CONCLUSIONS: Using physical agents before isokinetic exercises in women with knee osteoarthritis leads to augmented exercise performance, reduced pain, and improved function. Hot pack with a transcutaneous electrical nerve stimulator or short-wave diathermy has the best outcome.

Value of the D-dimer test in diagnosing deep vein thrombosis in rehabilitation inpatients.

OBJECTIVE: To assess the utility of the D-dimer test-a widely available, less costly, and less time-consuming test than others used to diagnose or exclude deep vein thrombosis (DVT) and pulmonary embolism. DESIGN: Blind comparison. SETTING: An inpatient rehabilitation facility in Turkey. PARTICIPANTS: Sixty-eight consecutive inpatients being rehabilitated after stroke, spinal cord injury, hip arthroplasty, or traumatic brain injury. INTERVENTIONS: A latex D-dimer assay was performed on each patient at admission and then weekly throughout the hospital stay. Color Doppler ultrasonography of the lower limbs was also done for each patient at admission and was repeated when indicated by clinical signs and symptoms of DVT or by elevated D-dimer levels. Main outcome measures Patients' clinical findings, D-dimer test results, and ultrasonography results were recorded. Sensitivity, specificity, and positive and negative predictive values were calculated for the D-dimer test, each clinical finding, and combinations of D-dimer results and clinical findings in relation to DVT diagnosis. RESULTS: The sensitivity and negative predictive value of the D-dimer test were high, at 95.2% and 96.2%, respectively. The specificity and positive predictive value were low, at 55.3% and 48.7%, respectively. No single clinical finding was reliably diagnostic for DVT. CONCLUSIONS: The D-dimer assay is a reliable method for ruling out DVT. In the rehabilitation setting, it can be used as a routine screening test or to assess cases of suspected DVT. D-dimer testing may reduce the need for sophisticated, time-consuming, and expensive diagnostic workup of rehabilitation inpatients, a group that is at increased risk for DVT.

Trunk muscle strength in relation to balance and functional disability in unihemispheric stroke patients.

OBJECTIVE: To evaluate trunk muscle strength in unihemispheric stroke patients and to assess how it relates to body balance and functional disability in this patient group. DESIGN: This prospective case-comparison study investigated isometric and isokinetic reciprocal trunk flexion and extension strength at angular velocities in 38 unihemispheric stroke patients and 40 healthy volunteers. The Berg balance scale was used to assess balance and stability, and the FIM instrument was used to evaluate functional disability in the patient group. Patients were evaluated as soon as they were able to stand long enough for testing. RESULTS: Peak torque values for trunk flexion and extension were lower in the stroke patients than in the controls. The differences were significant for trunk flexion and for trunk extension. In both groups, peak torque values for trunk flexors were greater than peak torque values for trunk extensors. There was a significant positive correlation between trunk muscle strength and Berg balance scale score at discharge. Trunk muscle strength was not correlated with FIM total score or FIM motor score, but the locomotion-transfers FIM subscore at discharge was positively correlated with trunk muscle torque values, except for isometric extension. CONCLUSION: The findings indicate trunk flexion and extension muscle weakness in unihemispheric stroke patients, which can interfere with balance, stability, and functional disability.

Hemorrhagic transformation in stroke patients.

OBJECTIVE: To identify the predictors of hemorrhagic transformation in stroke patients and to evaluate the impact of hemorrhagic transformation on rehabilitation outcome. DESIGN: The records of 203 hemiplegic patients hospitalized for rehabilitation after the acute phase of stroke were retrospectively analyzed. In 121 cases, the first computed tomographic scan and a repeat scan were compared to determine whether hemorrhagic transformation occurred. Correlations between the occurrence of hemorrhagic transformation and use of anticoagulants, antiaggregants, and antiedema drugs were evaluated. Admission and discharge FIM trade mark and Adapted Patient Evaluation Conference System scores were noted, and functional gain was calculated from these. These data were also analyzed for associations with hemorrhagic transformation. RESULTS: Hemorrhagic transformation was detected in 39 of the 121 cases. There was no significant difference in functional outcome between patients who did and did not show hemorrhagic transformation. Although not statistically significant, the use of antiedema drugs was found to increase the risk of hemorrhagic transformation, whereas the use of anticoagulants and antiaggregants had no influence. CONCLUSIONS: Hemorrhagic transformation of an ischemic lesion does not affect rehabilitation outcome in stroke survivors. The study results favor the use of anticoagulants and antiaggregants in the acute phase unless these drugs are contraindicated by the patient's condition. Still, prospective trials are needed to make definite conclusions.