The effectiveness of mobilization with movement on patients with mild and moderate carpal tunnel syndrome: A single-blinded, randomized controlled study.

STUDY DESIGN: Single-blinded, randomized controlled study. INTRODUCTION: Carpal Tunnel Syndrome (CTS) causes pain and loss of function in the affected hand. The mobilization with movement (MWM) technique is a manual therapy method applied to correct joint movement limitation and to relieve pain and functional disorders. PURPOSE OF THE STUDY: This study aimed to examine the effectiveness of MWM technique on pain, grip strength, range of motion, edema, hand reaction, nerve conduction, and functional status in patients with CTS. METHODS: A total of 45 patients enrolled in the study. The MWM group (n = 18) completed a 4-week combined conservative physiotherapy and MWM program, whereas the control group (n = 18) received only the 4 weeks of conservative physiotherapy. Pain severity according to the numerical rating scale was used as primary outcome. RESULTS: We found an improvement within the subjects in resting pain (MWMG:5.1 ± 3.6 vs 1.1 ± 2.4, Effect Size (ES)=1.3; CG:4.5 ± 3.3 vs 1.0 ± 2.2, ES=1.1), in activity pain (MWMG:6.5 ± 3.7 vs 1.1 ± 2.4, ES=1.5; CG:4.8 ± 3.4 vs 2.2 ± 2.3, ES=1) and in night pain (MWMG:5.9 ± 3.2 vs 1.8 ± 2.5, ES=1.2; CG:5.3 ± 4.2 vs ± 2.3 ± 3.5, ES=0.9). For between the groups, a statistical difference was found for the activity pain, Disabilities of the Arm Shoulder and Hand Questionnaire score (MWMG:52.2 ± 23.8 vs 27 ± 24.7, ES=1.3; CG:47.0 ± 24.8 vs 41.5 ± 22.1, ES=0.2), Michigan Hand Outcomes Questionnaire (MHQ-1), (MWMG:44.4 ± 23.7 vs 74.7 ± 24.5, ES=1.3; CG:44.8 ± 17.4 vs 57.4 ± 21.7, ES=0.9) and MHQ-5 (MWMG:68.8 ± 13.1 vs 82.5 ± 11.5, ES=0.9; CG:63.4 ± 26.7 vs 59.3 ± 25.8, ES=0.1) parameters in favour of MWM group. DISCUSSION: This study showed that MWM compared to conservative physiotherapy might be more effective in reducing perceived symptoms in mild and moderate CTS patients. CONCLUSIONS: MWM produced a small benefit to recovery of activity pain and upper extremity functionality level outcomes of patients with mild to moderate CTS when added to a traditional CTS physical therapy program.

The therapeutic efficacy of dexpanthenol on sciatic nerve injury in a rat model.

Objective: The aim of this study was to evaluate histopathological, functional and bone densitometry examinations of the beneficial effects of dexpanthenol (DEX) on nerve regeneration in a rat model of peripheral nerve crush injury.Methods: Thirty adult Sprague-Dawley rats were divided equally into three groups. A crush injury was simulated in all rats by clamping the right sciatic nerve for one minute. In group 1, one day before the surgical procedure, 500 mg/kg DEX administered via intraperitoneally (ip) was initiated and continued three times in a week during the experiment period as 28 days. In group 2, rats received a dose of 10 mg/kg DEX to investigate possible effects of DEX alone. Group 3 served as the control (sciatic nerve injury) and was not given any drugs.Results: Performance was significantly lower in group 3 compared to the drug treatment groups during the rotarod test (30 rpm and 40 rpm) (p < 0.05). After a while, the rats which were able to remain on the rod was significantly lower in group 3 during the acceleration test (p < 0.05). Hot plate latency test results in group 3 were significantly lower when compared to the other groups (p < 0.05).Conclusion: DEX appears to be useful as a supportive clinical agent for the treatment of pain and nerve damage.

The Effect of Sildenafil on Recuperation from Sciatic Nerve Injury in Rats.

BACKGROUND: Severe functional and anatomical defects can be detected after the peripheral nerve injury. Pharmacological approaches are preferred rather than surgical treatment in the treatment of nerve injuries. AIMS: The aim of this study is to perform histopathological, functional and bone densitometry examinations of the effects of sildenafil on nerve regeneration in a rat model of peripheral nerve crush injury. STUDY DESIGN: Animal experiment. METHODS: The study included a total of thirty adult Sprague-Dawley rats that were divided into three groups of ten rats each. In all rats, a crush injury was created by clamping the right sciatic nerve for one minute. One day before the procedure, rats in group 1 were started on a 28-day treatment consisting of a daily dose of 20 mg/kg body weight sildenafil citrate given orally via a nasogastric tube, while the rats in group 2 were started on an every-other-day dose of 10 mg/kg body weight sildenafil citrate. Rats from group 3 were not administered any drugs. Forty-two days after the nerve damage was created, functional and histopathological examination of both sciatic nerves and bone densitometric evaluation of the extremities were conducted. RESULTS: During the rotarod test, rats from group 3 spent the least amount of time on the rod compared to the drug treatment groups at speeds of 20 rpm, 30 rpm and 40 rpm. In addition, the duration for which each animal could stay on the rod throughout the accelerod test significantly reduced in rats from group 3 compared to rats from groups 1 and 2 in the 4-min test. For the hot-plate latency time, there were no differences among the groups in either the basal level or after sciatic nerve injury. Moreover, there was no significant difference between the groups in terms of the static sciatic index (SSI) on the 42(nd) day (p=0.147). The amplitude was better evaluated in group 1 compared to the other two groups (p<0.05). Under microscopic evaluation, we observed the greatest amount of nerve regeneration in group 1 and the lowest in group 3. However, this difference was not statistically significant. Moreover, there was no significant difference in the bone mineral density (BMD) levels among the groups. CONCLUSION: We believe that a daily single dose of sildenafil plays an important role in the treatment of sciatic nerve damage and bone healing and thus can be used as supportive clinical treatment.

Results of treatment of chronic osteomyelitis by "gutter procedure and muscle flap transposition operation".

INTRODUCTION: The aim of this study was to evaluate the outcomes of creation of a gutter and muscle flap transposition method for the treatment of long-bone chronic osteomyelitis. PATIENTS AND METHODS: A total of thirty chronic osteomyelitis patients (thirty-one extremities), who had undergone the gutter creation and muscle flap transposition procedure between 2005 and 2009, were included in the study (19 male, 11 female; mean age 24.4 years; age range 2-75 years). Osteomyelitis of the long bones involved the femur in 13 patients, the tibia in 13, the humerus in 2, the fibula in 2 and the ulna in 1 patients, respectively. All the patients received post-operative antibiotic therapy of at least 6 weeks. The mean follow-up period was 28.7 months (6-53 months). At the end of this follow-up period, the patients were evaluated using clinical, laboratory and screening methods. RESULTS: Complete pain relief, disappearance of toxic symptoms, improvement in radiological findings, fistula closure and return of the blood parameters to normal ranges were accepted as successful treatment when all the afore-mentioned had been fulfilled. According to these criteria, 29 of the 30 patients had been cured. DISCUSSION: The gutter creation and muscle flap transposition method in the treatment of long-bone chronic osteomyelitis may be a successful mode of therapy when performed correctly and supported by long-term antibiotherapy.

Removal of metallic foreign bodies embedded in soft tissues by stereotaxic approach.

BACKGROUND: A trial fibrillation (AF) is the most common cardiac arrhythmia and increases the risk of stroke and death. Patients with hypertensive have an increased risk of developing atrial fibrillation. RDW (Red blood cell distribution width) levels are elevated in cardiovascular disorders including heart failure, stable coronary disease, acute coronary syndrome, slow coronary flow and stroke. OBJECTIVE: To investigate the relation between RDW and AF in patients with hypertensive. METHOD: We retrospectively examined 126 consecutive hypertensive patients (63 hypertensive patients with AF and 63 hypertensive patients without AF matched with age and sex. RESULTS: The mean age of the study population was 71,09± 8,50 (af group) and 70,97±8,24 (non-af group) years. RDW level was different among patients with atrial fibrillation and without atrial fibrillation.(15,13±1,58 and 14,05±1,15 p<001). Logistic regression analysis showed that RDW and left atrial dimension were only independently risk factory associated with atrial fibrillation. (Rdw odds ratio:1,846 CI; 1,221-2,793 p<0,05). Roc curve analyses were applied to determine the cut-off point. Cut-off point was at 14,195 and Sensitive, specificity was %71,4, %56 respectively. CONCLUSION: RDW levels were higher in hypertensive patients with atrial fibrillation. An increased RDW level in the patient with hypertension may alert physician on developing or presence of atrial fibrillation.

Effectiveness of local tenoxicam versus corticosteroid injection for plantar fasciitis treatment.

Plantar fasciitis is one of the most common causes of foot pain in adults. In this prospective study, the outcomes of local tenoxicam injection and corticosteroid therapy for the treatment of plantar fasciitis were compared. Patients were randomly assigned to either the tenoxicam or corticosteroid group. The tenoxicam group (n=31) was treated using a local injection of 1 mL of tenoxicam (20 mg/2 mL) and 1 mL of 2% lidocaine, whereas the steroid group (n=30) was treated with a local 1-mL injection containing 40 mg of methylprednisolone acetate and 1 mL of 2% lidocaine. Clinical evaluations, which were performed before the injection and 6 and 12 months after the injection, consisted of patient-assessed pain using a visual analog scale. In addition, patient satisfaction was measured using the Roles and Maudsley score. Comparison of pre- and posttreatment visual analog scale scores demonstrated a statistically significant difference in both groups (P<.05). Furthermore, no significant difference was found between the steroid and tenoxicam groups in terms of visual analog scale scores measured 12 months after injection (P>.05). The tenoxicam injection was not significantly more effective than the corticosteroid injection. However, both methods were effective and successful in treating patients with plantar fasciitis. Tenoxicam therapy appears to provide pain relief, but its effectiveness in the long term should be explored in additional studies.

Are consanguineous marriage and swaddling the risk factors of developmental dysplasia of the hip?

The purpose of this study was to investigate prospectively the effects of swaddling and consanguineous marriage on developmental dysplasia of the hip and associated risk factors. We screened by ultrasound 265 infants using the Graf method. The Pediatrics Department referred all newborn infants with suspected instability or a recognized risk factor to the orthopedic clinic. Risk factors of developmental dysplasia of the hip were searched and noted in these patients. Swaddling and consanguineous marriage were also determined and noted. We observed 164 of 265 infants (61.9 %) who had been swaddled and that 64 of 265 infants' parents were in a consanguineous marriage (24.2 %). In the statistical analysis that was conducted for swaddling and consanguineous marriage, highly significant differences were found. Our study showed that the rate of developmental dysplasia of the hip is very high, 11.7 %, in our region, eastern Turkey. Also, we commonly see improper swaddling and consanguineous marriage in our region, which affects many infants.

Review of Van earthquakes form an orthopaedic perspective: a multicentre retrospective study.

PURPOSE: This is a descriptive analysis, of victims of Turkey's October 23, 2011 and November 21, 2011 Van earthquakes. The goal of this study is investigated the injury profile of the both earthquakes in relation to musculoskeletal trauma. METHODS: We retrospectively reviewed medical records of 3,965 patients admitted to in seven hospitals. A large share of these injuries were soft tissue injuries, followed by fractures, crush injuries, crush syndromes, nerve injuries, vascular injuries, compartment syndrome and joint dislocations. A total of 73 crush injuries were diagnosed and 31 of them were developed compartment syndrome. RESULTS: The patients with closed undisplaced fractures were treated with casting braces. For closed unstable fractures with good skin and soft-tissue conditions, open reduction and internal fixation was performed. All patients with open fracture had an external fixator applied after adequate debridement. Thirty one of 40 patients with compartment syndrome were treated by fasciotomy. For twelve of them, amputation was necessary. The most common procedure performed was debridement, followed by open reduction and internal fixation and closed reduction-casting, respectively. CONCLUSIONS: The results of this study may provide the basis for future development of strategy to optimise attempts at rescue and plan treatment of survivors with musculoskeletal injuries after earthquakes.

[A clinical analysis of patients undergoing fasciotomy who experienced the 2011 Van earthquake]. / 2011 Van depremini yasayan fasyotomi yapilan hastalarin klinik analizi.

OBJECTIVES: This study aims to investigate the clinical profile and prognosis of the patients with fasciotomy who were admitted to Van Training and Research Hospital following the 2011 Van earthquake. PATIENTS AND METHODS: Twenty-one patients (11 males, 10 females; mean age 38.3 years; range 18 to 60 years) who had urgent fasciotomy in our clinic following the earthquake were included. Medical records including demographic data, clinical characteristics and prognostic data of the patients were retrospectively analyzed. RESULTS: Seven of 21 patients with fasciotomies underwent amputation. Fasciotomy incisions were closed with skingrafting in nine patients and with primary closure in three patients. Eight patients had full range of motion of the joint, while four patients had restricted range of motion of the joint and needed rehabilitation. Two patients had sensory loss. CONCLUSION: Compartment syndrome is one of the serious problems after the Van earthquake. The infection ratio was low, while the amputation ratio was high. The use of anticoagulants following compartment syndrome worsens the clinical presentation, increasing the intracompartmental pressure.

Biepicondylar fracture presenting with elbow dislocation: a case report.

INTRODUCTION: Biepicondylar fracture of the elbow is very rare, and to date there have only been three reports of this injury and its treatment in the English scientific literature. This case report evaluates the surgical internal fixation of a biepicondylar fracture of the elbow with an associated dislocation. CASE PRESENTATION: We report the case of a 15-year-old Turkish girl with a biepicondylar fracture dislocation of the left elbow. Open reduction and an internal fixation operation were applied. There were no complications. CONCLUSION: In these injuries, open reduction and internal fixation appear to be a good method to restore elbow stability and function.

The clinical profile of musculoskeletal injuries associated with the 2011 Van earthquake in Turkey.

OBJECTIVES: In this study, we aimed to evaluate the clinical profile of the patients with musculoskeletal injuries associated with the 2011 Van earthquake and treatment modalities applied. PATIENTS AND METHODS: Between 23.10.2012 and 28.10.2012, a total of 285 patients (151 males, 134 females; mean age 38.6 years; range 1 to 84 years) with musculoskeletal injuries associated with the earthquake who were admitted to Emergency Department of Van Training and Research Hospital were retrospectively analyzed. Medical records including the profile of injury, injury type, site of injury, treatment modalities applied and prognosis were evaluated. RESULTS: Ninety-five of 285 patients had soft tissue damage, while 144 had fractures. Of these fractures, 81 required surgical treatment. Forty-six patients had crush injury, while 28 had compartment syndrome. Open and multiple fractures and fragmented fractures were common. The majority of the fractures involved limbs, indicating higher incidence of lower limb involvement rather than upper limb involvement. The incidence of infection was lower in the patients who experienced the earthquake. CONCLUSION: Orthopedic surgery is of utmost importance for the patients with musculoskeletal injuries associated with the earthquake. Appropriate triage should be performed and then the patients with open fractures and compartment syndrome should be given priority for surgery. In such cases, debridement, open reduction and internal fixation are the most common surgical treatments.

A randomized controlled trial of electrostimulation effects on effussion, swelling and pain recovery after anterior cruciate ligament reconstruction: a pilot study.

OBJECTIVE: To evaluate rehabilitation results of electrostimulation especially on joint effusion, swelling and pain recovery after anterior cruciate ligament reconstruction. DESIGN: A randomized controlled trial; the assessor was not blinded to the group allocation. SETTING: Orthopaedics-traumatology and physical medicine-rehabilitation departments. SUBJECTS: Twenty-nine consecutive patients underwent anterior cruciate ligament reconstruction. INTERVENTIONS: Both groups began the voluntary exercise protocol one day post-surgery. The intervention group (n = 15) also received 30 sessions electrostimulation treatment protocol started four days after the operation. MAIN MEASURES: Numerical bulge-dancing patella signs for effusion assessment; differences in circumferences of the mid-centre of the patella between operated and non-operated knees for swelling assessment. A self-report of average daily resting pain assessed by visual analogue scale; Intenational Knee Documentation Committee scoring system and Tegner Activity Scale for subjective response assessment. RESULTS: Twenty-six subjects including 13 patients from the intervention group completed the study. Significantly less effusion and swelling were determined in the intervention group after seven days (1.8 ± 1.3 versus 2.4 ± 1.7 for effusion and 1.7 ± 1.2 versus 3.4 ± 1.5 for swelling) to 12 weeks (0.2 ± 0.7 versus 0.6 ± 0.8 for effusion and 0.2 ± 0.8 versus 0.8 ± 0.9 for swelling) postoperative (P < 0.05). Patients treated with electrostimulation had significantly lower pain scores from seven days up to 12 weeks after the operation (P < 0.05). CONCLUSION: Electrostimulation along with exercise therapy appears superior to exercise alone regarding knee effusion, swelling and pain recovery after anterior cruciate ligament reconstruction. Still, there is need for further clinical studies using a radiologic method to demonstrate this effect of electrostimulation.

The development of giant lipoma on the BCG vaccine caused scar.

Lipoma is the most common mesenchymal tumors that accounts for about 6% of all soft-tissue tumors in children. The lesion size is usually around 1-2 cm that rarely reaches the bigger diameter. A 14-month-old baby girl was brought to our clinic for a progressively growing lesion on the left shoulder. The lesion started 4 months ago, and then was rapidly growing that caused pain and movement restriction. On the same site, there was a scar of BCG vaccination. The clinical and histopathological findings of the lesion were consistent with lipoma. The lesion was totally resected with no recurrence within 12 months. There are several complications related to BCG vaccination. However, the occurrence of lipoma on BCG vaccine caused scar has not been reported in literature. We reported this case because of its rarity and to emphasize that lipoma can present as a giant lesion in child.

The prevalence and risk factors of decreased bone mineral density in firstly diagnosed ulcerative colitis patients in the eastern region of Turkey.

The prevalance of osteoporosis or osteopenia in Turkish population with ulcerative colitis (UC) at the diagnosis time has not been evaluated so far. Therefore we aimed to determine the prevelance and risk factors of decreased bone mineral density (BMD) in UC patients at the diagnosis time in Turkey. We retrospectively evaluated dexa results, demographic and clinical characteristics, and some biochemical markers of bone turnover of the UC patients at the diagnosis time between June 2005 and February 2010 from the gastroenterology clinic records of the university hospital. The study population consisted of firstly diagnosed 63 UC patients (male: female = 27: 36; mean age 41.8 years). 38.1% at lumbar spine and 44.4% at femoral neck of the Turkish UC patients patients had low BMD at the diagnosis time. The occurrence of osteoporosis among Turkish UC patients at the diagnosis time were 8% at lumbar spine and 11% at femoral neck. 30.1% at lumbar spine and 33.3% at femoral neck of the patients had osteopenia at the diagnosis time. Pearson's coefficient of correlation showed significant correlations between low BMD and pancolitis (p<0.01), age, menopause, and symptom duration before the diagnosis (p<0.05).In conclusion, the prevelance of low bone density at the diagnosis time in Turkish UC patients is in accordance with Western and Eastern societies. Pancolitis, age, duration of symptoms, and menopause are predictive factors for low bone density in these patients.

Relationship between anti-CCP antibodies and oxidant and anti-oxidant activity in patients with rheumatoid arthritis.

OBJECTIVE/AIM: A new group of autoantibodies in Rheumatoid Arthritis (RA), the anti-cyclic citrullinated peptide (anti-CCP) antibodies directed to citrulline-containing proteins, which are of value for the severity of RA. Up to date, the relationship between anti-CCP antibodies and oxidant, anti-oxidant activity in patients with RA has not been elucidated in the previous studies. In this study we aimed to investigate the effect of anti-CCP antibodies in the circulation on whole blood, serum and synovial fluid oxidant and anti-oxidant activity in patients with RA. MATERIALS AND METHODS: RA patients with anti-CCP (+) (n=25) and anti-CCP (-) (n=24) were recruited into the study. All patients had a positive rheumatoid factor (RF). The patients who were under treatment with only non-steroidal antiinflammatory drugs (NSAID) at the study time included in the study. Catalase (CAT), Glutathione peroxidase (GSHPx), Myeloperoxidase (MPO) activities and the levels of Malondialdehyde (MDA) were measured in whole blood, serum and synovial fluid in both groups. RESULTS: There were no significant differences in terms of the mean whole blood and serum antioxidative activity (CAT, GSHpx) and the mean blood and serum MDA and MPO values (oxidative activity), between the patients with anti-CCP(+) and those with anti-CCP(-). There was increased synovial oxidant activity (MDA and MPO levels) (p<0.05) in anti-CCP(+) RA patients with or without ESR negativity when compared with anti-CCP(-) RA patients. There was positive correlation between anti-CCP antibody levels and synovial MDA and MPO levels (r=0.435, p<0.05, r=0.563, p<0.05 respectively) in anti-CCP (+) group. CONCLUSIONS: In conclusion, anti-CCP antibody positivity seems to be associated with increased synovial fluid oxidant activity (increased MDA and MPO levels) in patients with RA. These conclusions need to be validated in a larger controlled study population.