The frequency of superior cluneal nerve entrapment diagnosed with ultrasound-guided nerve block in patients with low back pain: A prospective, cross-sectional study.

INTRODUCTION: To determine the frequency of superior cluneal nerve entrapment (SCN-E) in patients who applied to our outpatient clinic with low back pain. METHODS: Two hundred patients with mechanical low back pain persisting more than 3 months were included in our study. All patients were evaluated with detailed clinical history and physical examination. Ultrasound-guided diagnostic injection was performed in patients who had tenderness on the posterior iliac crest and whose main complaint emerged by pressing on this point. Patients with 70% or greater pain relief 1 h after the injection were considered as SCN-E. The frequency and clinical features of SCN-E were determined and compared with other mechanical low back pain. RESULTS: The mean age of the patients included in our study was 48.56 ± 14.11 years, with 138 female and 62 male patients. The diagnostic injection was performed on 31 patients and considered positive in 24 of them. The frequency of SCN-E was determined as 12%. The Hip-Knee Flexion Test was determined to be more specific for SCN-E than other causes of low back pain, the sensitivity and specificity of the test were 41.67% and 88.64% (p = 0.001; p < 0.01). In addition, all demographic and clinical features in patients diagnosed with SCN-E were found to be similar to other mechanical low back pain cases. CONCLUSIONS: In patients with chronic low back pain, SCN-E is not a rare cause and is often overlooked. Increasing the awareness and experience of physicians on SCN-E will prevent patients from being exposed to unnecessary surgical or non-surgical treatments.

Ultrasonographic Evaluation of Nail Involvement in Patients With Axial Spondyloarthritis.

OBJECTIVES: This study aimed to evaluate the nail units of patients with axial spondyloarthritis (ax-SpA) using ultrasound and to identify any subclinical changes. We also aimed to examine the relationship between clinical enthesitis scores and nail involvement in patients with ax-SpA. METHODS: The study included 40 patients with ax-Spa, 40 patients with psoriatic arthritis (PsA), and 40 healthy controls. The thickness of the nail plates, morphological changes, the thickness of the proximal nail units, the thickness of the nail beds, and power Doppler signal intensities were evaluated and compared. Maastricht Ankylosing Spondylitis Enthesitis Score and Spondyloarthritis Research Consortium of Canada Enthesitis Index were also evaluated in patients with ax-SpA. RESULTS: There was no significant difference between the thickness of the nail plates of the three groups (P > .05). The first nail bed thickness of ax-SpA cases was significantly higher than the control group (P = .046), and the fourth and fifth nail proximal unit thicknesses of the control group were significantly lower than the ax-SpA and PsA groups (P = .023, P = .017). We also found that the Wortsman scores of the cases with PsA were significantly higher than the ax-SpA and control groups (P = .0001). CONCLUSION: The thickness of the proximal nail unit adjacent to the insertion of the digital extensor tendon, which is considered as the enthesis area, is similar to the patients with PsA in patients with ax-SpA, especially in the fourth and fifth fingers compared to the control group. On the other hand, almost no structural changes in nail plates were observed in patients with ax-SpA group.

Ultrasonographic evaluation of ulnar nerve morphology in patients with ulnar nerve instability.

INTRODUCTION/AIMS: Ulnar nerve instability (UNI) in the retroepicondylar groove is described as nerve subluxation or dislocation. In this study, considering that instability may cause chronic ulnar nerve damage by increasing the friction risk, we aimed to examine the effects of UNI on nerve morphology ultrasonographically. METHODS: Asymptomatic patients with clinical suspicion of UNI were referred for further clinical and ultrasonographic examination. Based on ulnar nerve mobility on ultrasound, the patients were first divided into two groups: stable and unstable. The unstable group was further divided into two subgroups: subluxation and dislocation. The cross-sectional area (CSA) of the nerve was measured in three regions relative to the medial epicondyle (ME). RESULTS: In the ultrasonographic evaluation, UNI was identified in 59.1% (52) of the 88 elbows. UNI was bilateral in 50% (22) of the 44 patients. Mean CSA was not significantly different between groups. A statistically significant difference in ulnar nerve mobility was found between the group with CSA of <10 versus ≥10 mm2 (p = .027). Nerve instability was found in 85.7% of elbows with an ulnar nerve CSA value of ≥10 mm2 at the ME level. DISCUSSION: The probability of developing neuropathy in patients with UNI may be higher than in those with normal nerve mobility. Further prospective studies are required to elucidate whether asymptomatic individuals with UNI and increased CSA may be at risk for developing symptomatic ulnar neuropathy at the elbow.

Ultrasound-Guided Treatment of Meralgia Paresthetica: With or Without Corticosteroid? A Double-Blinded, Randomized Controlled Study.

Background: Blockade of the lateral femoral cutaneous nerve (LFCN) with local anesthetic (LA) has therapeutic role as well as diagnostic value for meralgia paresthetica (MP). The aim of this study was to compare the effectiveness of ultrasound-guided LA and LA + CS injections in the treatment of MP. Methods: This was a prospective, double-blinded, randomized controlled study. Thirty-two patients were evaluated clinically, and electrophysiologically and diagnosed as MP by diagnostic block. They were randomly assigned to two groups and all patients completed the study. The first group (n = 17) received 2 mL of lidocaine 2%+1 mL of betamethasone, while the second group (n = 15) received 2 mL of lidocaine 2% + 1 mL saline solution. Results: No statistically significant difference was detected between the groups in numeric rating scale (NRS) values. In both groups, NRS values were significantly decreased after the injection that confirms the diagnosis of MP. The improvement continued on the following weeks in both groups. At the 4th week, the NRS value reached to 2.47 in the CS group and reached to 3.13 in the LA group. Conclusions: Both CS and LA injections for the treatment of MP were found to be clinically effective and both may be therapeutic options. In intractable cases, once the nerve block is applied with or without CS, well-being can be achieved by keeping the patient away from the triggering factors. To provide effective and isolated injection of LFCN, that may have frequent anatomical variations, ultrasonography guidance could be suggested.

Relationship between ultrasonographic hand muscle thickness measurements and muscle strength following median or ulnar nerve reconstruction.

INTRODUCTION: The aim of this study was to assess the relationship between ultrasonographic hand muscle thickness measurements and hand muscle strength in patients who underwent median or ulnar nerve reconstruction. METHODS: In this prospective, cross-sectional study, intrinsic hand muscle thicknesses were measured using ultrasound with a 4- to 13-MHz linear-array probe. Measurements of hand strength were performed using a dynamometer and a pinchmeter. RESULTS: In the median nerve group (n = 11), a moderate correlation (r = 0.694; P = .018) was observed between lateral pinch strength and transverse thenar thickness. In the ulnar nerve group (n = 11), longitudinal thenar thickness below the flexor pollicis longus tendon was moderate to highly correlated with pinch and handgrip strengths (r = 0.726-0.893; P < .05); whole transverse thenar thickness was moderate to highly correlated with pinch strengths (r = 0.724-0.836; P < .05). DISCUSSION: Sonographic measurements of intrinsic hand muscle thickness may be a useful tool for the assessment and follow-up of patients with median or ulnar nerve injury.

Dynamic ultrasound imaging for the assessment of extensor tendon adhesion after fifth metacarpal intraarticular head fracture: A case report.

STUDY DESIGN: Case report. INTRODUCTION: Development of extensor tendon adhesions is a common complication after intra-articular metacarpal head fracture. Whenever these adhesions cannot be mobilized by rehabilitation, tenolysis should be considered. However, the decision for tenolysis is often delayed. When the rehabilitation program comes to a plateau and clinical examination may not be sufficient to find out the cause, dynamic ultrasound (US) can show where the gliding mechanism is disrupted and help clinicians to give an accurate decision for determining the next steps. PURPOSE OF THE STUDY: To determine the role of dynamic US during hand rehabilitation. METHODS: A 22-year-old woman presented with a fifth metacarpal intra-articular head fracture. Ten days after the surgery (open reduction and internal fixation) the hand rehabilitation program was commenced. After the third week, the metacarpophalangeal (MP) joint range of motion (ROM) gradually diminished. Dynamic US near the level of fifth MP joint revealed diminished extensor tendon excursion and capsular thickening. RESULTS: Considering physical and sonographic findings, surgical tenolysis and capsular release was planned. After surgery, the DIP, PIP and MP joints reached full passive ROM. CONCLUSION(S): Ultrasound is a quick and practical way to diagnose tendon adhesions. With this report, the authors suggest that clinicians may use dynamic US, especially in times when the patient comes to plateau during hand rehabilitation. LEVEL OF EVIDENCE: IV.

Letter to the editor involving the article 'Piriformis muscle syndrome: A cross-sectional imaging study in 116 patients and evaluation of therapeutic outcome'.

KEY POINTS: • Lack of use of local injection test to confirm the diagnosis may lead to miss the diagnosis of PMS of myofascial origin. • Piriformis muscle syndrome should be diagnosed on the basis of clinical symptoms, specific physical examinations, and positive response to local injection. • Sciatic nerve entrapment is not a must in the diagnosis of PMS and PMS is mostly myofascial in origin.

Does a core stabilization exercise program have a role on shoulder rehabilitation? A comparative study in young females.

OBJECTIVES: This study aims to evaluate the effect of core stabilization exercises and to explore the immediate effect of core muscles-activated posture on shoulder maximal voluntary isometric contraction (MVIC) strength. PATIENTS AND METHODS: Between November 2016 and January 2015, a total of 75 healthy female volunteers (mean age 25.36 years; range, 18 to 30 years) were included. Of these, 42 consecutive volunteers were assigned as the study group, while the remaining 33 volunteers were assigned as the control group. The study group completed a six-week core stabilization home-based exercise program. Two measurements were performed with six-week interval. A set of three repetitions for each shoulder side was performed by an electronic dynamometer under two conditions: core muscles relaxed and activated. Measurements were monitored real-time with a connected computer and recorded in Newton. RESULTS: The activation of core muscles during the measurement significantly decreased the MVIC values in both groups (p<0.05). The MVIC values significantly increased after home-based exercise program in both conditions (p<0.05). CONCLUSION: Our study showed that six-week core stabilization exercise program had a significant positive effect on the shoulder MVIC strength. This result may support the use of core stabilization exercises in the early periods of shoulder rehabilitation when the shoulder muscle strengthening exercises are painful.

Reliability of sonographic muscle thickness measurements of the thenar and hypothenar muscles.

Introduction This study was undertaken to assess the intra- and interrater reliability of sonographic thickness measurements of the thenar and hypothenar muscles. METHODS: The thickness of the thenar and hypothenar muscles of both hands of 15 volunteers (7 male, 8 female) were evaluated with a 4-13-MHz linear probe by 2 examiners who were blinded to each other's measurements. Interrater reliability was then evaluated. To assess intrarater reliability, the first examiner also performed a second measurement after an interval of at least 1 day. RESULTS: Mean age of the subjects was 31.1 ± 9.0 years. Test-retest reliability showed excellent intrarater reliability (intraclass correlation coefficient range: 0.889-0.963) and substantial to excellent results for interrater reliability (intraclass correlation coefficient range: 0.692-0.937). DISCUSSION: We found that ultrasound is a reliable method for thickness measurements of the thenar and hypothenar muscles. Muscle Nerve 57: E14-E17, 2018.

Regression of a symptomatic thoracic disc herniation with a calcified intervertebral disc component.

There were only a few cases describing spontaneous regression of calcified thoracic disc herniation in the literature. We present a 38-year-old male office worker who had left paramedian-foraminal extruded disc at T7-T8 with calcifications of the T7-T8 and T8-T9 intervertebral discs. This case was unique in that the non-calcified extruded disc material regressed almost completely in 5 months while the calcified intervertebral discs remained the same during the process of regression. This report stresses that regression of the herniated material of the thoracic discs with subsidence of the symptoms is still possible even if the disc material is calcified.

Validation of Duruöz Hand Index in patients with tetraplegia.

STUDY DESIGN: Cross-sectional, clinical measurement. PURPOSE: To investigate the validity of the Duruöz Hand Index (DHI) in the assessment of hand function in patients with tetraplegia. METHODS: A total of 40 patients with tetraplegia participated. Patients' upper extremities were assessed on the level of 'body function and structure' [The American Spinal Cord Injury Association (ASIA) Impairment Scale (AIS) 2000 revised criteria, upper extremity motor score (UEMS), neurologic level of injury and visual analogue scale of hand function (VAS-HF)], 'activity' [DHI and Quadriplegia index of function-short form (QIF-SF)] and 'body function and structure, activity and participation' [Health Survey Short Form-36 (SF-36)] according to International Classification of Function. RESULTS: The DHI showed significant correlations with UEMS, AIS, QIF-SF, VAS-HF, physical functioning and physical compound summary scores of SF-36. CONCLUSIONS: The DHI was found a valid method in the assessment of hand functions in patients with tetraplegia. LEVEL OF EVIDENCE: Diagnostic III.

Recovery features in ulnar neuropathy at the elbow.

[Purpose] This study evaluated the effect of age, sex, and entrapment localization on recovery time in patients treated conservatively for ulnar neuropathy at the elbow. [Subjects] Thirty-five patients (16 women and 15 men) who were diagnosed with ulnar neuropathy at the elbow using short segment conduction studies were evaluated retrospectively. [Methods] Definition of recovey was made based on patient satisfaction. The absence of symptoms was considered as the marker of recovery. Patients who recovered within 0-4 weeks were in Group 1, and patients who recovered within 4 weeks to 6 months were in Group 2. The differences between Group 1 and Group 2 in terms of age, sex and entrapment localization were investigated. [Results] Entrapment was most frequent in the retroepicondylar groove (54.3%). No significant difference was found in terms of age and entrapment localizations between Groups 1 and 2. There was a statistically significant difference between the groups for the male sex. [Conclusion] In ulnar neuropathy at the elbow, age and entrapment localization do not affect recovery time. However, male sex appears to be associated with longer recovery time.