Musculoskeletal sonography use in physiatry: a single-center one-year analysis.

OBJECTIVE: To document the musculoskeletal ultrasonography experience in a physiatry clinic for 1 yr and to find out whether its use decreased time, cost, and radiation exposure with regard to musculoskeletal imaging. DESIGN: All patients who underwent musculoskeletal ultrasonography examination (n = 309) in our physiatry department during the whole year of 2007 were enrolled. The same physiatrist, experienced in musculoskeletal ultrasonography, performed all of the evaluations by using 5-10 MHz and 8-16 MHz linear probes (Diasus Dynamic Imaging Ltd., Scotland, UK). At the end of the year, each patient was retrospectively considered on an individual basis, and the answers to the following three questions were recorded in case he/she had not been evaluated by musculoskeletal ultrasonography: (1) How long would the patient have waited (i.e., for further radiologic appointments)? (2) What would the extra cost have been? (3) What would the radiation exposure have been? Cumulative numbers were calculated for the whole year concerning time, cost, and radiation dose. RESULTS: According to the calculations, the total waiting period was estimated as 7620 days if musculoskeletal ultrasonography had not been used for imaging. Similarly, the total cost and the radiation dose were estimated to be euro8128 ($16,256 US) and 20 Sievert (2000 cGy), respectively. CONCLUSIONS: Musculoskeletal ultrasonography provides a significant amount of gain regarding time and cost in physiatry clinics. We call the attention of physiatrists to this issue and advocate that a standardized international approach to musculoskeletal ultrasonography training and assessment is definitely awaited.

A comparison of the benefits of sonography and electrophysiologic measurements as predictors of symptom severity and functional status in patients with carpal tunnel syndrome.

OBJECTIVES: To clarify whether sonography or electrophysiologic testing is a better predictor of symptom severity and functional status in carpal tunnel syndrome (CTS) and to assess the diagnostic value of sonography in patients with idiopathic CTS. DESIGN: Cross-sectional. SETTING: University hospital physical medicine and rehabilitation clinic. PARTICIPANTS: Thirty-four hands with CTS and 38 normative hands were evaluated. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Boston Carpal Tunnel Questionnaire, which comprised symptom severity and functional status scale, was applied to CTS patients. Bilateral upper-extremity nerve conduction studies of median and ulnar nerves and sonographic imaging of the median nerve were performed in all participants. Sonographic evaluation was performed by a physician blinded to the physical and electrophysiologic findings of the subjects. RESULTS: Cross-sectional areas (CSAs) of the median nerve at the carpal tunnel entrance and proximal carpal tunnel were 12.5+/-2.6 and 10.6+/-2.6 versus 15.6+/-4.2 and 11.5+/-3.2 in CTS patients versus controls, respectively. Increased CSA of the median nerve at the carpal tunnel entrance (P<.002) and at the proximal carpal tunnel (P<.000) were detected in the hands with CTS. Flattening ratios did not differ in a statistically significant manner between the groups (P>.05). The best predictor of symptom severity was median nerve sensory distal latency and that of functional status was median nerve motor distal latency. The optimum cutoff value for median nerve CSA was 11.2mm(2) at the carpal tunnel entrance and 11.9mm(2) at the proximal carpal tunnel. Sensitivity, specificity, and positive and negative predictive values at the proximal carpal tunnel (88%, 66%, 71%, 80%, respectively) were higher than those at the carpal tunnel entrance (68%, 62%, 65%, 66%, respectively). CONCLUSIONS: The best predictors of symptom severity and functional status in idiopathic CTS seem to be the electrophysiologic assessments rather than sonographic measurements. On the other hand, sonography may be helpful in the diagnosis of idiopathic CTS.

The effects of menstrual cycle on the knee joint position sense: preliminary study.

The purpose of this study was to determine the effects of menstrual cycle on proprioception by using the active knee joint position sense test (JPST). The 19 healthy women (ages between 20 years and 27 years) who have normal regular menstrual cycle were included in the study. We applied JPSTs at two different directions throughout the three different phases of the menstrual cycle, i.e. menstrual, follicular, and early luteal in dominant knees. When we started from flexion (90 degrees ), target angles were 70 degrees , 50 degrees , and 30 degrees and we started from extension (0 degrees ), target angles were 20 degrees , 40 degrees and 60 degrees . The absolute reposition errors from the target angles have been evaluated. Results have shown that reposition errors from the target angle at 40 degrees , 50 degrees and 70 degrees of knee angles were higher in the menstrual phase than that of the follicular phase (P<0.05). In addition, higher value of reposition error from the target angle at 40 degrees was found in the menstrual phase compared to luteal phase (P<0.05). In conclusion, we have demonstrated that active JPST was significantly reduced in the menstruation period.

The sole arch indices of adolescent basketball players.

OBJECTIVE: The aim of this study was to find out the difference between sole arch indices of adolescent basketball players and an age matched non-athletic group. METHODS: This study was carried out in the Sports Education, Health and Research Center, Ankara, Turkey, between November 1998 and December 1998. In junior (16-18 years) categories 48 male basketball players and 45 age matched controls were included in the study. Body mass index and podoscopic sole images of subjects were recorded, and the arch index was calculated for each group. RESULTS: The sole arch index has no difference between basketball players and controls. The right foot arch index of the control group was 59.62 +/- 23.26 and 56.74 +/- 17.21 in players (p=0.497). The left foot arch index was 54.54 +/- 23.72 in control groups and 55.13 +/- 17.33 in players (p=0.890). There was a significant negative correlation between sole arch index and training age in basketball players (r=-0.3312 for right sole arch index, p value is less than 0.05; r=-0.3056 for left sole arch index, p less than 0.05). CONCLUSION: These results have shown that basketball might result in specific adaptation on sole arches of adolescent players.

Exercise-induced apoptosis of rat skeletal muscle and the effect of meloxicam.

The aim of this study was to evaluate the effect of exercise on apoptosis in rat gastrocnemius and soleus muscle tissue and to determine the effect of meloxicam, a novel non-steroidal anti-inflammatory drug (NSAID), on the ratio of exercise-induced apoptosis. Forty male Wistar rats were used in the experiments. Spontaneous wheel-running was used as an exercise protocol. Rats were divided randomly into four groups. Group A (n = 10) was the control group, in which rats did not perform any exercise. In group B (n = 10), gastrocnemius and soleus muscles were biopsied immediately after exercise. The rats in group C (n = 10) were placed back in their cages after exercise and allowed to rest for 48 h, after which the gastrocnemius and soleus muscles were biopsied. In group D (n = 10), rats were given 11 mg meloxicam (Mobic, Boehringer Ingelheim) per kilogram body weight per day p.o. for 2 days, after which gastrocnemius and soleus muscles were biopsied 48 h after exercise. The terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate (dUTP)-biotin nick end labelling (TUNEL) technique was used to detect DNA fragmentation in situ. TUNEL-positive nuclei were identified and counted. The apoptosis ratio in gastrocnemius muscle was 0.50x10(-3)+/-0.96x10(-3) in group A, 5.42x10(-3)+/-3.58x10(-3) in group B, 3.55x10(-3)+/-3.23x10(-3) in Group C and 3.52x10(-3)+/-1.00 in Group D; the ratios in soleus muscle were 0.98x10(-3)+/-1.83x10(-3), 3.03x10(-3)+/-2.78x10(-3), 4.48x10(-3)+/-3.32x10(-3) and 2.91x10(-3) 1.98x10(-3), respectively. The differences between the apoptosis ratios in group A and B, Group A and C, and Group A and D were statistically significant (P < 0.05). There was no statistically significant difference between group C and D. In conclusion, exercise increased apoptosis in gastrocnemius and soleus muscle tissue, and the apoptosis ratios were not affected by meloxicam.