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Objectives: Taking new developments in the management of rheumatoid arthritis (RA) and the economic conditions of our country into account, the Turkish League Against Rheumatism (TLAR) aimed to develop national treatment recommendations for the management of RA; thus, they consulted with national experts for their opinions. Materials and methods: Eight rheumatologists and 15 physiatrists experienced in the field contributed to the development of the TLAR recommendations for the management of RA. The expert committee planned to develope 'Recommendations for the Management of RA in Turkey' based on EULAR 2010 recommendations for the management of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) in light of expert opinions. Following the meeting, a systematic literature review was performed by searching the Medline and Cochrane, Embase, and Turkish Medical Index databases between 2009 and 2010 for pharmacological treatment recommendations and between 2007 and 2010 for non-pharmacological treatment recommendations. This was done in addition to the studies included in the EULAR 2010 recommendations. All articles were examined, their contents were summarized, their levels of evidence were determined, and the Delphi process was initiated. Results: Sixteen general recommendations were listed along with five main principles and one non-pharmacological treatment method. A consensus was reached for all recommendations, and their strength levels were voted upon. Conclusion: Recommendations were formed for the management of RA in Turkey. These national recommendations are intended to guide physical medicine and rehabilitation specialists (physiatrists), rheumatologists, and family physicians and should be regularly updated [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Physical Medicine & Rehabilitation / Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi is the property of Turkish Society of Physical Medicine & Rehabilitation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Physical Medicine & Rehabilitation / Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi is the property of Turkish Society of Physical Medicine & Rehabilitation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkish Journal of Rheumatology is the property of Turkish League Against Rheumatism / Turkiye Romatizma Arastirma ve Savas Dernegi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To evaluate the efficacy of intraarticular injection for the diagnosis and treatment of sacroiliac joint dysfunction [SID]. Methods: Three hundred and fifty patients with chronic low back pain [LBP] were evaluated for this study. After detailed examination, 37 patients [two patients had bilateral SID] who had four positive provocation tests, whose pain were thought to be purely due to SID, and who had visual anolog scale [VAS] values greater than 4 were assigned to sacroiliac joint injection under flouroscopic guidance to reach the diagnostic and therapeutic goal. The intensity of pain was scored using VAS and LBP was assessed with Oswestry Disability Index [ODI] just before the injection, after two hours, and after a one-month follow-up period. Results: The patients group consisted of 27 women and 10 men [mean age 31.63 ± 7.43 years]. Sixteen of 37 patients to whom diagnostic injection was performed gave positive responses [Group 1] and 21 did not [Group 2]. There was no significant difference between pre-injection VAS scores of the groups [P > 0.05]. Significant difference was observed between post-injection VAS scores of the groups [P < 0.001]. Significant decrease was found between preand post-injection VAS values of Group 2 [P < 0.001]. One month after injection, significant decrease [P < 0.001] was found in mean VAS score of Group 2 as compared to their pre-injection mean VAS value. Conclusion: Sacroiliac joint dysfunction is a syndrome of which the diagnosis and therapy is not clearly established. We consider intraarticular injection necessary for the diagnosis and treatment of SID. [ABSTRACT FROM AUTHOR]

Objective: Failed back surgery syndrome [FBSS] causes persistent low back problems in approximately 15 percent of patients who undergo spinal surgery for lumbar disc herniation. As reported by recent clinical data, gabapentin, an antiepileptic agent, is increasingly being used for chronic pain, with a favorable side effect profile. The aim of this study was to investigate the efficacy of gabapentin in patients with FBSS associated chronic back pain. Methods: Nine patients with chronic back pain diagnosed with FBSS according to clinical, lumbar spinal magnetic resonance imaging and electrodiagnostic findings were studied. Each patient received titrated dosage of gabapentin from 900 to 2400 mg/day. Pretreatment levels of pain and the degree of disability were measured using a visual analog scale and the Oswestry disability index. All nine patients were re-evaluated at six weeks and six months. Results: Eight of nine patients reported significant decrease in pain and disability scores at six weeks and six months after treatment.One patient who underwent spinal surgery five times did not report benefit from gabapentin. Gabapentin was well tolerated and there were no significant side effects. Conclusion: Our results indicate that gabapentin monotherapy may be an effective adjunct for the treatment of FBSS associated chronic low back pain. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to compare the effectiveness of radial extracorporeal shock wave therapy and local corticosteroid injection on pain, function, and nerve conduction studies in the treatment of idiopathic carpal tunnel syndrome., Design: A total of 72 patients who were diagnosed as having carpal tunnel syndrome were included in the study. The radial extracorporeal shock wave therapy group received radial extracorporeal shock wave therapy, the local corticosteroid injection group received local corticosteroid injection, and the control group only used a resting hand splint. The patients were evaluated using a Visual Analog Scale-pain, a Visual Analog Scale-numbness, the Boston Symptom Severity Scale, the Boston Functional Status Scale, and handgrip strength tests before treatment 1 and 12 wks after the treatment., Results: Both clinical and nerve conduction study parameters improved with all three groups, and this effect continued at the 12th-week follow-up of the patients. The Visual Analog Scale-pain, Visual Analog Scale-numbness, Boston Symptom Severity Scale, and Boston Functional Status Scale scores in the first week after the treatment, as well as Visual Analog Scale-pain and Boston Functional Status Scale scores in the 12th week after the treatment, were significantly lower in the local corticosteroid injection group compared with the other two groups., Conclusions: Our study revealed the success of radial extracorporeal shock wave therapy, splint, and local corticosteroid injection, but symptom relief was greater in the first week and 12th week with local corticosteroid injection., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

This study assessed the additional contribution of balneotherapy on physical therapy in subacute supraspinatus tendinopathy. Ninety patients with subacute supraspinatus tendinopathy were included. They were randomized into two equal groups. In group 1 (n = 45), transcutaneous electrical nerve stimulation (TENS), hot pack, ultrasound treatments, and Codman's and range of motion (ROM) exercises were performed. In group 2 (n = 45), balneotherapy was added to the treatment program. In both groups, shoulder active ROM and handgrip strength were measured. Pain was evaluated using a Visual Analogue Scale (VAS) (rest, sleep, movement); functional assessment and quality of life were measured respectively with the Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH), and the Short Form-36 health survey (SF 36) form. All measurements were repeated before and after 15 treatment sessions. There were statistically significant differences between the before and after assessment parameters in group 1 (all p < 0.05), but not for SF-36 General Health Perceptions, SF-36 Mental Health sub-parameters, and handgrip strengths. However, there were statistically significant differences between all the evaluation before and after the treatment in group 2 (all p < 0.05). When the two groups were compared in terms of alpha gains, statistically significant differences were observed in favor of group 2 in all measurements (all p < 0.05) except for SF-36 Emotional Role Difficulty and SF-36 Mental Health sub-parameters. This study shows that the addition of balneotherapy to physical therapy for subacute supraspinatus tendinopathy can make additional contributions to shoulder ROM, pain, handgrip strength, functional status, and quality of life.

To investigate the effect of balneotherapy on body mass index, adipokine levels, sleep disturbances, and quality of life in women with morbid obesity. Fifty-four women with morbid obesity were included in the study. The body mass indexes (BMI) and waist/hip ratios (WHR) of the women were calculated. Subcutaneous fat thickness was measured using a *skinfold meter, and the percentage of adipose tissue was calculated. The *Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality, and the Nottingham Health Profile (NHP) was used to assess quality of life. In addition to routine biochemical tests, leptin, adipokine, visfatin from blood, and cortisol from saliva samples were studied. Participants were given 15 sessions of balneotherapy for 20 min each. After treatment, the laboratory and clinical parameters of the participants were *reevaluated. There was no statistically significant difference of BMI, WHR, and percentage of adipose tissue between before and after treatment measurements (p ˃ 0.05).There was a statistically significant improvement in PSQI and NSP scores (p ˂ 0.001). The levels of blood glucose, leptin, and visfatin were significantly decreased, and adiponectin was significantly increased after treatment (p = 0.047, p ˂ 0.001, p ˂ 0.001, and p ˂ 0.001, respectively).There was no statistically significant changes in salivary cortisol levels (p = 0.848). Patients with diabetes showed a statistically significant decrease in glucose levels after treatment (p = 0.017).There was a statistically significant decrease in low-density lipoprotein cholesterol levels in patients with dyslipidemia compared with pre-treatment (p = 0.018). Balneotherapy improves sleep and quality of life of women with morbid obesity. After balneotherapy, glucose, leptin, adiponectin, and visfatin levels may change positively.

Objectives: This study aims to evaluate whether there was a difference between oxidative stress index (OSI), total antioxidant status (TAS), and total oxidant status (TOS) values between patients with fibromyalgia syndrome (FMS) and healthy controls, and to show the effect of balneotherapy on clinical conditions such as pain, depression, and quality of life in patients with FMS and oxidative stress., Patients and Methods: Thirty-five females (mean age 39.9±5.8 years; range, 18 to 50 years) with fibromyalgia and 35 healthy females (mean age 37.9±6.6 years; range, 18 to 50 years) were included in the study. The TAS, TOS, and OSI of patients with FMS and healthy controls were measured. Disease severity was evaluated using the Fibromyalgia Impact Questionnaire, pain levels were evaluated using a visual analog scale (VAS), mood was evaluated using the Beck Depression Inventory (BDI), and quality of life was evaluated using the Short Form 36 (SF-36). Patients with FMS were given 15 sessions of balneotherapy. After treatment, the laboratory and clinical parameters of the patients were reevaluated., Results: Although the TAS levels of patients with FMS were not significantly different from those of the control group (p=0.114), the TOS and OSI levels were higher than those of the control group (p<0.001). The VAS, BDI, and SF-36 parameter scores of patients with FMS were significantly higher than those of the control group (p<0.001). A statistically significant decrease (p<0.001) in TOS and OSI levels of patients with FMS was detected after balneotherapy; however, the TAS levels of patients with FMS did not change significantly (p=0.538). All clinical parameters showed significant improvement with balneotherapy (p<0.001)., Conclusion: An oxidative disorder was detected in patients with FMS compared with the control group. Balneotherapy showed antioxidant activity and decreased oxidative stress while also improving clinical parameters and quality of life., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2020, Turkish League Against Rheumatism.)

Objective: The aim of the study was to compare the efficacy of steroid injection and kinesio taping (KT) in the treatment of lateral epicondylitis., Design: A total number of 84 patients were randomized into three groups. Group 1 was given steroid injection, group 2 received KT, and group 3 received both. Pain was measured using a visual analog scale, functional status was measured using a quick form of the Disabilities of Arm, Shoulder and Hand questionnaire, pain-free grip strength was measured using a dynamometer, and the pressure pain threshold was measured using an algometer. All evaluations were performed before treatment and at the third and twelfth weeks after the treatment., Results: Twenty-eight patients were included in each group. A statistically significant difference was found between the pretreatment and posttreatment evaluations of all groups in the third and twelfth weeks after treatment. When group 1 and group 2 were compared, there was a significant difference only in pain-free grip strength measured in the twelfth week. The results of treatment in group 3 patients were significantly better in almost all evaluation parameters compared with the other groups., Conclusion: In the treatment of lateral epicondylitis, KT alone was found to be as effective as steroid injection alone. However, co-administration of steroid injection and KT is more effective compared with each treatment alone.

Background: There is no Turkish version of the Postural Assessment Scale for Stroke patients (PASS). Objectives: To translate and make the cross-cultural adaptation of the PASS into the Turkish language and evaluate the reliability and validity of the Turkish version (PASS-Turk). Methods: Sixty patients with stroke who had survived the three-week acute period were included in the study. The first researcher applied the scale to the participants twice with 5-day intervals. The second researcher applied the scale once at the same time with the first researcher. The reliability of PASS-Turk and its subsections was evaluated using Cronbach's alpha coefficient. In addition, item-total correlation and test-retest reliability were calculated. The interobserver agreement was assessed using the intraclass correlation coefficient. The construct validity of PASS-Turk was assessed using Pearson's product-moment correlation and principal component analyses. The Berg Balance Scale (BBS) and motor subscale of the Functional Independence Measure (FIM) were used for validity. Results: The Cronbach's alpha coefficients of the PASS-Turk scale were 0.903 for the subsection of "maintaining posture," 0.940 for the subsection of "changing a posture," and 0.953 for the total PASS-Turk scale. The first and second researcher evaluations were perfectly consistent with each other in terms of PASS-Turk total scores (ICC = 0.999, 95% CI: 0.998-0.999, and p < .001). A strong positive correlation was found between PASS-Turk and BBS and the motor subscale of FIM. Conclusion: PASS-Turk is a valid and reliable scale for the evaluation of posture and balance of patients with stroke.

Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Purpose: In this study, we aimed to investigate effects of Ai Chi on balance, functional mobility, health-related quality of life, and motor impairment in patients with Parkinson's disease., Method: This study was conducted as an open-label randomized controlled trial (ISRCTN26292510) with repeated measures. Forty patients with Parkinson's disease stages 2 to 3 according to the Hoehn and Yahr Scale were randomly allocated to either an Ai Chi exercise group or a land-based exercise control group for 5 weeks. Balance was measured using the Biodex-3,1 and the Berg Balance Scale. Functional mobility was evaluated using the Timed Up and Go Test. Additionally, health-related quality of life and motor activity were assessed with the Parkinson's Disease Questionnaire-39 and the Unified Parkinson's Disease Rating Scale-III., Results: Although patients in both groups showed significant improvement in all outcome variables, improvement of dynamic balance was significantly greater in the Ai Chi group (p < 0.001), Berg Balance Scale (p < 0.001), Timed Up and Go Test (p = 0.002), Parkinson's Disease Questionnaire-39 (p < 0.001), Unified Parkinson's Disease Rating Scale-III (p < 0.001)., Conclusion: Our results suggest that an Ai Chi exercise program improves balance, mobility, motor ability, and quality of life. In addition, Ai Chi exercise was more effective as an intervention than land-based exercise in patients with mild to moderate Parkinson's disease. Implications for rehabilitation Ai Chi exercises (aquatic exercises) may help improve balance, functional mobility, health-related quality of life, and motor ability in patients with mild to moderate Parkinson's disease more efficiently than similar land-based exercises. Ai Chi exercises should be considered as a rehabilitation option for treatment of patients with mild or moderate Parkinson's disease.

Objectives: This study aims to determine the effects of obesity and obesity related anthropometric and body composition determiners on the severity of fibromyalgia syndrome (FS) and to compare obese, overweight and normoweight FS patients according to general health and psychological status., Patients and Methods: The study included 42 obese (mean age 48.8±11.6; range 24 to 65 years), 27 overweight (mean age 47.3±3.4; range 24 to 61 years) and 32 normoweight (mean age 47.1±7.8 years; range 31 to 60 years) female FS patients. Widespread pain scores and symptom severity scores were noted. Pain pressure thresholds of tender points and control points were measured and total myalgic score (TMS) was calculated. The anthropometric assessments and skinfold measurements of all participants were recorded. Quality of life was evaluated by Health Assessment Questionnaire while psychological status was evaluated using Beck Depression Inventory., Results: Control points, TMS values and hand grip strength values of obese FS patients were significantly lower, while disease duration, symptom severity, widespread pain scores, visual analog scale and Health Assessment Questionnaire scores were significantly higher than normoweight and overweight FS patients. Fat free mass, fat mass, body fat percentage and waist/hip ratio values were significantly higher in obese FS patients than overweight and normoweight FS patients (p<0.001 for all values). Stepwise linear regression analysis showed that increased body mass index, decreased fat free mass (R2=0.11) and increased disease duration (R2=0.13) were associated with lower TMS., Conclusion: We found that obesity had significant negative effects on pain, disease severity and quality of life in patients with FS., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Objective: Aim of the study was to evaluate the choroidal thickness (CT) in patients with RA and detect the relation with disease activity and joint damage in patients with rheumatoid arthritisBACKGROUND: Rheumatoid arthritis (RA) is a systemic inflammatory disease associated with various extra-articular organ manifestations including ocular manifestationsMATERIALS AND METHODS: We included 59 eyes of 59 patients with RA and 59 eyes of 59 controls without RA in the study. Subfoveal and perifoveal CT were measured using enhanced depth imaging optic coherence tomography. Disease activity score 28 (DAS 28) and Larsen score were calculated for each patient with RA and compared with measurements of CT., Results: CT was statistically thinner in patients with RA than controls, at subfoveal CT (p = 0.008), at 500 μm temporal to the fovea (p = 0.004), at 1000 μm temporal to the fovea (p = 0.010), at 1500 μm temporal to the fovea (p = 0.005), at 500 μm nasal to the fovea (p = 0.035). Additionally there was no correlation measurements of CT with disease activity and joint damage., Conclusions: Subfoveal and perifoveal CT was significantly thinner in patients with RA than in healthy controls but there was no correlation detected between CT measurements and DAS 28 or Larsen scores (Tab. 5, Ref. 33).

Objective: Lumbosacral transitional vertebra (LSTV) and spina bifida occulta (SBO) are widespread within the lumbosacral spine. Their connection to lumbar disc herniation (LDH) and/or lower back pain has been debated in the current literature; however, there is no consensus. The purpose of this study is to evaluate the relationship between the frequency of LSTV and SBO with that of LDH among young patients with chronic lower back pain., Study Design: Cross-sectional., Materials and Methods: A total of 1094 patients with lower back pain, aged between 20 and 40 years, with lower back pain history persisting for longer than 12 weeks were studied. All the patients in the study were evaluated with standard pelvic radiographs and lumbar vertebra magnetic resonance imaging. The severity of pain was measured using the visual analog scale, and the effect of lower back pain on daily life activities was measured using the Oswestry disability index. The patients were separated into two groups: Group 1 consisted of patients without LDH, and Group 2 consisted of patients with LDH. Additionally, these two groups were separated into three subgroups: Non-LSTV-SBO, LSTV, and SBO., Results: It was determined that LSTV frequency was significantly higher (p=0.004) in the lumbar disc herniation group 2. In addition, the existence of LSTV increased the risk of lower back pain (p<0.001, p<0.001) and disability (p<0.001, p<0.001) in young patients with and without LDH or not. However, the presence of SBO did not increase lower back pain (p=0.251, p=0.200) and disability (p=0.134, p=0.161) in both groups., Conclusion: A relationship was detected between the frequency of LDH and LSTV in young patients with chronic lower back pain between the ages of 20 and 40 years. Also, the presence of LSTV was found to increase the risk of lower back pain and disability., Competing Interests: The authors have no conflict of interest to declare.

[Purpose] To evaluate the short-term effects of kinesio tape on joint position sense, isokinetic measurements, kinesiophobia, symptoms, and functional limitations in patients with patellofemoral pain syndrome. [Subjects and Methods] A total of 90 patients (112 knees) with patellofemoral pain syndrome were randomized into a kinesio tape group (n=45) or placebo kinesio tape group (n=45). Baseline isokinetic quadriceps muscle tests and measurements of joint position sense were performed in both groups. Pain was measured with a Visual Analog Scale, kinesiophobia with the Tampa kinesiophobia scale, and symptoms and functional limitations with the Kujala pain scale. Measurements were repeated 2 days after kinesio tape application. [Results] No differences were found between baseline isokinetic muscle measurements and those taken 2 days after application. However, significant improvements were observed in the kinesio tape group, with regard to joint position sense, pain, kinesiophobia, symptoms, and functional limitations after treatment. Examination of the differences between pre- and post-treatment values in both groups revealed that the kinesio tape group demonstrated greater improvements compared to the placebo kinesio tape group. [Conclusion] Although short-term kinesio tape application did not increase hamstring muscle strength, it may have improved joint position sense, pain, kinesiophobia, symptoms, and daily limitations.

Objectives: This study aims to determine the effects of non-pharmacological therapies, namely balneotherapy, exercise, and the combined use of balneotherapy and exercise, on total myalgic score (TMS), sleep quality, health status, and signs of depression in patients with fibromyalgia syndrome, and to compare the efficacies of these treatment programs with respect to the above parameters., Patients and Methods: A total of 120 female subjects (mean age 37.21±12.45 years; range 18 to 63 years) diagnosed with fibromyalgia were enrolled. The patients were randomized into three groups with 40 patients in each (group 1: balneotherapy group, group 2: balneotherapy + exercise group, and group 3: exercise group). The patients underwent the treatment program for five days a week for a total of three weeks. Clinical parameters, Fibromyalgia Impact Questionnaire, Pittsburgh Sleep Quality Index, TMS, and Beck Depression Scale were evaluated at pre-treatment and post- treatment periods, and at the third-month control visit., Results: There were no differences between the groups with respect to Fibromyalgia Impact Questionnaire, Pittsburgh Sleep Quality Index, TMS and Beck Depression Scale scores on pre-treatment evaluation, while the combined use of balneotherapy + aerobic exercise was more effective on TMS (p<0.001), health status (p=0.009), and level of depression (p<0.001) in post-treatment evaluation. A better state of well-being with respect to sleep quality was achieved by balneotherapy and balneotherapy + exercise groups. The third-month comparisons, on the other hand, demonstrated that the balneotherapy + exercise group had a greater state of well-being with respect to TMS (p<0.001) and general health status (p<0.001). Balneotherapy + exercise and exercise therapy benefited signs of depression to a better degree (p<0.001). Balneotherapy and combined balneotherapy + exercise therapy produced more effective results in terms of sleep quality (p<0.001). TMS regressed to near baseline levels (p=0.397), while Fibromyalgia Impact Questionnaire levels rose to near baseline levels at the third-month control in the exercise therapy group (p=0.070)., Conclusion: The combined application of balneotherapy + exercise therapy, which are two of the recommended non-pharmacological treatments, may have superior and more sustained effects than administering either therapy alone., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Episacral lipoma is a small, tender subcutaneous nodule primarily occurring over the posterior iliac crest. Episacral lipoma is a significant and treatable cause of acute and chronic low back pain. Episacral lipoma occurs as a result of tears in the thoracodorsal fascia and subsequent herniation of a portion of the underlying dorsal fat pad through the tear. This clinical entity is common, and recognition is simple. The presence of a painful nodule with disappearance of pain after injection with anaesthetic, is diagnostic. Medication and physical therapy may not be effective. Local injection of the nodule with a solution of anaesthetic and steroid is effective in treating the episacral lipoma. Here we describe 2 patients with painful nodules over the posterior iliac crest. One patient complained of severe lower back pain radiating to the left lower extremity and this patient subsequently underwent disc operation. The other patient had been treated for greater trochanteric pain syndrome. In both patients, symptoms appeared to be relieved by local injection of anaesthetic and steroid. Episacral lipoma should be considered during diagnostic workup and in differential diagnosis of acute and chronic low back pain.

Objectives: This study aims to investigate the effect of acromioclavicular joint (ACJ) degeneration on orthopedic shoulder tests (OST) and to determine complementary role of ACJ injections in the treatment of subacromial shoulder impingements., Patients and Methods: At a secondary care center, 62 patients (56 females, 6 males; mean age 55.8±9.3 years; range 35 to 74 years) with the clinical and radiological diagnosis of shoulder impingement syndrome were enrolled to the study. Two injections were applied to ACJ and subacromial space. Patients were assessed through OSTs (Neer, Hawkins-Kennedy, empty can, full can, external rotation resistance, lift-off and cross-body adduction tests) at baseline and after injection to ACJ and subacromial space. Visual analog scale was used for overall pain., Results: Two injections and three sets of OSTs were performed on the patients. A significant difference was found in the all OSTs after ACJ injection (p<0.001). Visual analog scale scores improved significantly following both ACJ and subacromial injections (p<0.001)., Conclusion: Concomitant ACJ diseases should assessed carefully in the patients with rotator cuff lesions, as it may change the type of management approach.

Background and Aims: We undertook this study to evaluate upper extremity nerve conduction velocities (NCVs) in fibromyalgia syndrome (FS) and the relationship of the electrophysiological findings between carpal tunnel syndrome (CTS) and FS., Methods: Sixty three right-handed female patients diagnosed with FS and 52 right-handed age- and gender-matched healthy controls were enrolled in the study. Conduction studies of the median and ulnar nerves and median nerve F-wave latencies were assessed in both upper extremities using standard methods. CTS was diagnosed electrophysiologically if the median nerve sensory NCV was decreased and/or motor distal latency (DL) was prolonged., Results: CTS was detected electrophysiologically in 26 (20.63%) of 126 extremities of 63 patients and in three (2.82%) of 104 extremities of 52 individuals of the control group. Statistically significant differences were detected between groups with respect to rate of carpal tunnel syndrome (p <0.05). There were no differences between results of NCVs of patients in FS group and healthy controls except the prolongation of the right median nerve motor DL (p = 0.019), decrease of the sensory NCV (p = 0.003) in the right median nerve, in the left median nerve (p = 0.011) and in the left ulnar nerve (p = 0.015)., Conclusions: We determined an increased rate of CTS and decreased NCVs in the upper extremities in patients with FS. We should consider that complaints of paresthesia and pain in hands, increasing especially at nights, observed in FS may mask that CTS can be an associated illness., (Copyright © 2012 IMSS. Published by Elsevier Inc. All rights reserved.)

Objective: The objective of this study was to evaluate the effects of coexisting fibromyalgia syndrome (FS) on pain intensity, disability, and treatment outcome in patients with chronic lateral epicondylitis (LE)., Methods: Seventy-eight patients with chronic unilateral LE and 30 healthy subjects were included. Patients were classified into two groups: group 1 consisted of 46 LE alone patients, while group 2 consisted of 32 LE plus FS patients. A pain questionnaire was used to determine the subjective pain and disability. Pressure pain threshold (PPT) on the lateral epicondyles, isometric hand grip strength (IHGS), lateral pinch grip strength (LPGS), and tender point examinations of groups were performed. A mixture of methylprednisolone and prilocaine was injected 1 cm distal to the lateral epicondyle. All measurements were repeated 2 weeks and 3 months after injection., Results: Compared with healthy subjects, both patient groups had significantly increased pain and disability scores and decreased IHGS, LPGS, and PPT values (P < 0.001). Compared with the LE alone group, pain and disability scores were significantly higher (P < 0.01), and PPT, IHGS, and LPGS values were significantly lower in LE plus FS group (P < 0.05). Pain questionnaire scores of the LE alone and LE plus FS patients showed statistically significant decrease, and IHGS, LPGS, and PPTs showed statistically significant increase at the second week (P < 0.01) and at the third month (P < 0.001) after injection. Improvements in the LE plus FS group were poorer than FS alone group at both second week and third month after injection., Conclusion: Coexisting FS may increase the pain intensity and disability, and negatively affect the treatment outcome in patients with chronic LE., (Wiley Periodicals, Inc.)

Background: The exact etiology of irritable bowel syndrome (IBS) remains unclear. Curative treatment is not available and current treatment modalities are mainly directed against the predominant symptoms. There are a few studies reporting the beneficial effects of transcutaneous electrical stimulation in patients with chronic constipation, gastroparesis, and functional dyspepsia., Aim: To investigate whether transcutaneous electrical stimulation is an effective procedure in IBS patients., Methods: IBS patients were randomly placed in vacuum interferential current (IFC) and placebo groups. Both treatments consisted of 12 sessions administered over 4 weeks. Symptoms due to IBS were documented via questionnaires, including the IBS Global Assessment of Improvement Scale, numeric rating scales, visual analogue scale, and IBS Quality of Life Scale at the beginning of, end of, and 1 month after the treatment., Results: Patients in the therapy (29 cases) and placebo (29 cases) groups were homogeneous with respect to demographic data and gastrointestinal system symptoms. When compared to the beginning scores, severity of abdominal discomfort, bloating, and abdominal distension and rumbling improved significantly in either interference or placebo groups at both the end of treatment and 1 month after treatment. In the IFC group, severity of symptoms continued to decrease significantly at 1 month after treatment when compared to scores at just the end of treatment, whereas in the placebo group severity of these symptoms did not change significantly on numeric severity scales. Also, the visual analogue scale of the first month after treatment continued to decrease significantly when compared to the level at the end of treatment in the IFC group. Total quality score increased significantly in the IFC group., Conclusions: Vacuum IFC therapy can significantly improve symptoms and quality of life in patients with IBS. It may represent a novel treatment modality for drug-refractory IBS patients., (Copyright © 2012 S. Karger AG, Basel.)

Osteopoikilosis (OPK) is a rare, autosomal dominant bone disorder, characterized by multiple, discrete round or ovoid radio densities scattered throughout the axial and appendicular skeleton. OPK is usually asymptomatic but rarely there may be slight articular pain and joint effusions. OPK is generally diagnosed incidentally on radiographic examinations and may mimic different bone pathologies, including bone metastases. Radionuclide bone scan has a critical role in distinguishing OPK from osteoblastic bone metastases. In this case report, we present a young man with right hip pain due to OPK, whose plain radiogram and computerized tomography findings thought cancer metastasis.

Neuropathic arthropathy (NA), known as Charcot neuroarthropathy, is a chronic, degenerative arthropathy and is associated with decreased sensory innervation. Numerous causes of this arthropathy have been described. Neuropathic joint, although first described by Charcot in tabes dorsalis in 1868, has subsequently been observed in a variety of conditions including syringomyelia, diabetes mellitus and peripheral nerve disorders. Syringomyelia is characterized by slow progression. The shoulders and elbows are the most frequently involved joints in syringomyelia. Involvement of the hand is a quite rarely seen in the cases of NA caused by syringomyelia. In this article, we reported a case of NA secondary to syringomyelia. The characteristics of this presented case is the presence of Arnold-Chiari malformation accompanying with syringomyelia and involvement of the shoulder, elbow and hand (multiple joint involvement).

The aims of this study are to determine the frequency of fibromyalgia syndrome (FMS) in patients with chronic cervical myofascial pain (CMP) and to investigate the FMS characteristics in CMP patients. Ninty-three patients with CMP and 30 age-matched healthy women were included in this study. Main outcome measures included visual analog scale (VAS), Beck Depression Inventory (BDI), and pain pressure thresholds. CMP patients were evaluated for the existence of FMS. The severity of FMS was assessed with total myalgic score (TMS) and control point score (CPS). Most common clinical characteristics of FMS were noted. Of the 93 CMP subjects, 22 (23.6%) patients fulfilled the classification criteria for FMS. Number of tender points were higher (p=0.0), while TMS (p=0.0) and CPS (p=0.0) values were lower in comorbid CMP and FMS patients than regional CMP group. There were statistically significant differences between regional CMP patients and comorbid CMP and FMS patients regarding presence of fatigue (p=0.0) and irritable bowel syndrome (p=0.022). There was no statistically significant difference between patient groups regarding VAS values (p>0.05). BDI values of the regional CMP were significantly lower than comorbid CMP and FMS patients (p=0.011). In conclusion, we found that nearly a quarter of CMP patients were comorbid with FMS, and psychological and comorbid symptoms were more prominent in comorbid patients. We thought that, these two syndromes might be overlapping conditions and as a peripheral pain generator or inducer of central sensitisation, MPS might lead to FMS or precipitate and worsen the FMS symptoms.

The aim of this study is to detect whether cervical myofascial pain leads to disability and to determine factors associated with disability in patients with chronic cervical myofascial pain. One hundred-three female patients with chronic cervical myofascial pain and 30 age-matched healthy females participated. Main outcome measurements are visual analog scale, Neck Pain and Disability scale, Beck Depression Inventory and pain pressure threshold measurements from the most usual trigger-point locations of trapezius, levator scapula, multifidus, and splenius capitis muscles. The Neck Pain and Disability scale and Beck Depression Inventory scores of the patient group were higher than controls. In the patient group, the total Neck Pain and Disability scale scores were significantly correlated with the pain pressure threshold values of the trapezius and levator scapula muscles and Beck Depression Inventory scores. Regression analyses showed that increased disease duration (R (2) = 0.37), decreased pain pressure threshold values of trapezius muscle (R (2) = 0.04), unilateral disease (R (2) = 0.02) and increased Beck Depression Inventory scores (R (2) = 0.02) were associated with higher disability. Cervical myofascial pain is a reason for disability in chronic neck pain population. Disease duration was found as the strongest predictor of disability.

Femoral mononeuropathy (FMN) as an extraarticular finding of rheumatoid arthritis (RA) is a phenomenon which has not been reported previously. We report a 53-year-old female patient with RA, presenting FMN findings during the course of the disease. On examination, right quadriceps and iliopsoas muscles showed grade 3 weakness on the Medical Research Council (MRC) scale. Sensory examination revealed sensory loss in the right medial leg and thigh. Patellar tendon reflex was absent in the right side. A diagnosis of a partial right femoral neuropathy was confirmed using nerve conduction study and electromyography. The probable mechanism of FMN was thought to be vasculitis.

Objective: To detect the effectiveness of incremental speed-dependent treadmill training on postural instability, dynamic balance and fear of falling in patients with idiopathic Parkinson's disease., Design: Randomized controlled trial., Setting: Ankara Education and Research Hospital, 2nd PM&R Clinic, Cardiopulmonary Rehabilitation Unit., Subjects: Fifty-four patients with idiopathic Parkinson's disease in stage 2 or 3 of the Hoehn Yahr staging entered, and 31 patients (21 training, 10 control) had outcome data., Interventions: Postural instability of patients with Parkinson's disease was assessed using the motor component of the Unified Parkinson's Disease Rating Scale (UPDRS), Berg Balance Test, Dynamic Gait Index and Falls Efficacy Scale. Twenty-one patients with Parkinson's disease participated in an eight-week exercise programme using incremental speed-dependent treadmill training. Before and after the training programme, balance, gait, fear of falling and walking distance and speed on treadmill were assessed in both Parkinson's disease groups., Main Measures: Walking distance and speed on treadmill, UPDRS, Berg Balance Test, Dynamic Gait Index and Falls Efficacy Scale., Results: Initial total walking distance of the training group on treadmill was 266.45 +/- 82.14 m and this was progressively increased to 726.36 +/- 93.1 m after 16 training session (P < 0.001). Tolerated maximum speed of the training group on treadmill at baseline was 1.9 +/- 0.75 km/h and improved to 2.61 +/- 0.77 km/h (P < 0.001). Berg Balance Test, Dynamic Gait Index and Falls Efficacy Scale scores of the training group were improved significantly after the training programme (P < 0.01). There was no significant improvement in any of the outcome measurements in the control group (P > 0.05)., Conclusions: Specific exercise programmes using incremental speed-dependent treadmill training may improve mobility, reduce postural instability and fear of falling in patients with Parkinson's disease.

The aim of this study was to evaluate the effects of a 1-year course of sulfasalazine monotherapy on enthesal abnormalities of inflammatory rheumatic diseases (IRDs) using ultrasonography. Thirty-six patients with IRD including 20 patients with rheumatoid arthritis (RA) and 16 patients with ankylosing spondylitis (AS) (22 women, 14 men, mean ages 43.3 +/- 8.8 years), and 18 healthy controls (10 women, 8 men, mean ages 42.5 +/- 9.9 years) matched by age and body mass index were enrolled in this study. For the evaluation of enthesal structures, all patients and controls underwent ultrasonographic (USG) examinations of five enthesal sites of both lower limbs using high-resolution and Doppler USG. An ultrasonographic score of lower limb enthesitis was calculated using Glasgow ultrasound enthesitis scoring system (GUESS). Clinical and laboratory activities of IRD patients were also evaluated. Patient group was made to undergo 2 g/day sulfasalazine monotherapy for 1 year. All evaluations were made at the beginning of the treatment and repeated after 1 year follow-up. Results showed that the frequency of enthesal abnormalities of the IRD group was significantly higher than controls. On USG examination, 301/1,296 (23.2%) enthesal structures were abnormal in IRD patients, and 19/648 (2.93%) structures were abnormal in controls. Mean GUESS score of the IRD group (6.40 +/- 2.41) was also significantly higher than controls (1.79 +/- 1.60) (p < 0.001). Although there was a significant improvement in clinical and laboratory activity parameters of the IRD patients, significant decrease was not observed in enthesal abnormalities (295/1,296 enthesal structures-22.7%) and mean GUESS score (6.20 +/- 2.38) after 1 year sulfasalazine trial. Additionally, there was no significant improvement in enthesal abnormalities and mean GUESS scores of AS and RA subgroups separately. Sulfasalazine treatment was not found effective on enthesal abnormalities of IRD patients. Further studies with larger groups including other IRDs are required to validate our results.

Complex regional pain syndrome type I (CRPS-I) is a complex disorder characterised by pain, autonomic dysfunction, and decreased range of motion. The syndrome was believed as a well-recognized disorder in adults but, less commonly recognized in children. CRPS-I after vaccination has been rarely reported. We reported an 11-year-old young girl with CRPS-I due to rubella vaccine.

The objective of this study was to determine tendon involvements and enthesal abnormalities in patients with rheumatoid arthritis (RA) using high-resolution ultrasonographic images and to compare the findings with those seen in patients with ankylosing spondylitis (AS) and healthy controls. A total of 24 patients with RA, 18 with AS, and 20 healthy controls matched by age and body mass index (BMI) were included in the study. All of the patients and controls underwent clinical and ultrasonographic examinations of both lower limbs at five enthesal sites (superior and inferior pole of the patella, tibial tuberosity, Achilles tendon, and plantar aponeurosis) and both upper limbs at two tendon sites (tendons of m. biceps brachii and supraspinatus at the shoulder). High-resolution ultrasonographic examinations were performed to detect bursitis, structure thickness, bony erosion, and enthesophyte. An ultrasonographic score of lower limb enthesitis was calculated using the Glasgow Ultrasound Enthesitis Scoring System (GUESS) in all patients. Tendon involvements and enthesal abnormalities were found significantly more often in the RA group than in controls (p<0.05 to <0.001), but were not found to be different from the AS group (p>0.05). On clinical examination 67 of 336 (19.9%) tendon and enthesal sites were abnormal and on ultrasonographic examination 130 of 336 (38.2%) sites were abnormal in RA patients. The most frequently affected enthesal sites in the lower limbs were suprapatellar, infrapatellar, and Achilles tendon in both the RA and AS groups. The tibial tuberosity was less affected in both groups, and involvement of the plantar aponeurosis was not different from the controls. A statistically significant correlation was found between the Ritchie articular index and GUESS (r=0.578, p=0.008). Tendon involvements and enthesal abnormalities in RA patients were found more often than had been estimated. Further studies are required to validate our results.

The aim of this study was to evaluate the relationship between high-resolution computed tomography (HRCT) findings and the Stoke index (SI) in patients with rheumatoid arthritis (RA). Forty RA patients (31 women, 9 men) were evaluated. All patients fulfilled the criteria proposed by the American College of Rheumatology. Clinical evaluation, haematological data, chest radiography, pulmonary function tests (PFTs) and HRCT were obtained in all patients. The SI was used to assess disease activity. In 17 (42.5%) patients, there were no signs of pulmonary involvement on HRCT; 23 (57.5%) of 40 patients had abnormal HRCT findings. Of 23 patients with HRCT abnormalities, six (two male, four female) had respiratory symptoms, four (one male, three female) had abnormalities on chest radiography and five (all female) had abnormalities on PFTs. There was no relationship between pulmonary changes observed on HRCT, clinical and laboratory disease activity parameters, chest X-ray and PFTs. There was no difference in the mean SI between patients included in the HRCT (+) and those included in the HRCT (-) groups. No significant correlations between the HRCT and the SI were seen. The main findings of this study are that HRCT can give useful information on RA-associated lung changes and that there was no relationship between the SI and the HRCT findings of patients with RA.

Objective: To evaluate the long-term efficacy of steroid injection for plantar fasciitis using clinical parameters and high-resolution ultrasonography., Material and Methods: Thirty patients (27 female and three male) with plantar fasciitis and 30 healthy controls matched by age, gender and body mass index (BMI), were enrolled in this study. Seventeen of the patients had bilateral and 13 had unilateral (six right, seven left) plantar fasciitis. Palpation-guided steroid injection was applied to the 47 heels of 30 plantar fasciitis patients. Ultrasound examination and pain intensity with visual analog scale (VAS) were assessed three times in each plantar fasciitis patients; before injection and at 1 and 6 months after steroid injection. Ultrasonography was performed to the controls at initial assessment., Results: The plantar fascia was remarkably thicker in the plantar fasciitis group than in controls (P < 0.001). The thickness of the plantar fascia and mean VAS values in the plantar fasciitis group decreased significantly 1 month after steroid injection (P < 0.001, P < 0.001, respectively) and a further decrease was noted 6 months postinjection (P < 0.001, P < 0.001, respectively). Strong correlation was found between the changes of plantar fascia thickness and VAS values 1 month after (P < 0.001, r: 0.61) and 6 months after (P < 0.001, r: 0.49) steroid injection. The incidence of hypoechoic fascia was 73% in the plantar fasciitis group before steroid injection. It decreased significantly at 1 and 6 months postinjection (33% and 7%, respectively, P < 0.001). Gross fascia disruption or other side effects were not observed after steroid injection., Conclusion: Steroid injection could be used in plantar fasciitis treatment for its positive long-term effects.

Fibromyalgia Syndrome (FS) is a common disease characterized by diffuse, widespread pain and multiple tender points. The syndrome has been subclassified as primary (PFS) and secondary (SFS) fibromyalgia. The aim of this study was to evaluate the role of common tendinitis (rotator cuff tendinitis, bicipital tendinitis, lateral epicondylitis, De-Quervain's tendinitis and pes anserinus tendinitis) in FS. Twenty female patients with PFS, 20 with SFS and 20 female controls, matched by age and body mass index, participated in the study. Existence of common tendinitis was evaluated with specific examination methods. Right and left rotator cuff tendinitis, pes anserinus tendinitis and left lateral epicondylitis were significantly more common in patients with PFS and SFS than in control subjects. As a result, considering the central hyperexcitability present in the fibromyalgia patients, concomitant pathologies such as tendinitis which lead to shoulder, arm, and leg pain must be evaluated. Follow up and therapy for the disease must be planned according to these factors which are not only probable symptoms of FS, but also leading causes for the occurrence and continuity of the pain in this disease.

Objective: Hallux valgus is a very common foot deformity in modern societies. Muscle imbalance in abductor and adductor muscles was cited as a major factor in the production of hallux valgus. Our aim in this study was to evaluate the role of certain muscles in this deformity., Design: Twenty hallux valgus patients and 20 healthy volunteers participated in the study. After thorough physical, neurologic, and radiographic investigations, we performed an electromyographic study to observe the relationship of hallux valgus deformity with the muscles coordinating first metatarsophalangeal joint movements. Voluntary extension, flexion, abduction, and adduction at the hallux with maximum resistance were performed. Firing rates and amplitudes of motor unit potentials of four muscles: musculus abductor hallucis, musculus adductor hallucis, musculus extensor hallucis longus, and musculus flexor hallucis brevis were recorded. Statistical analysis, including Spearman's correlation analysis and Mann-Whitney U tests were performed with SPSS 8.0 for Windows., Results: We observed that in the hallux valgus group, abduction activity of musculus abductor hallucis was markedly decreased when compared with adduction of musculus adductor hallucis. Motor unit potential amplitude of abductor activity recorded from musculus abductor hallucis was slightly more than half of the activity in flexion., Conclusion: Muscle imbalance in abductor and adductor muscles is apparent in hallux valgus deformity, and this imbalance may be the reason or the result of joint deformity.

Familial Mediterranean fever (FMF) is characterized by an autosomal inheritance pattern, Mediterranean ancestry, and history of recurrent fever. We present a 30-year-old Turkish man with FMF and accompanying seronegative spondyloarthropathy. His diagnose depended on the clinical course of his disease: recurrent fever accompanied by abdominal pain attacks together with a positive family history and his ethnic origin and sacroiliitis. We review the common manifestations of FMF and remind physicians that sacroiliac joint involvement must be kept in mind in presence of articular symptoms in a FMF patient.

Rheumatic patients experience persistent and disabling pain. We aimed to investigate the pain pressure threshold (PPT) values in ankylosing spondylitis (AS) patients compared to rheumatoid arthritis (RA) patients and healthy subjects. The relationship between lumbar and thoracal Schober, chin-to-chest distance, occiput-to-wall distance, finger-to-floor distance, chest expansion, and pain scores were also evaluated in an AS group. Our study group consisted of 17 AS patients, 20 RA patients, and 21 healthy volunteers. Eighteen tender points accepted by the American College of Rheumatism (ACR) for fibromyalgia syndrome evaluation in 1990 and three control points were evaluated with Fischer's tissue compliance meter, which can also be used as an algometer. Fourteen paravertebral points were evaluated, and mean values of paravertebral myalgic scores were recorded in the AS group. Our data indicate that AS patients do not have lower PPT with respect to healthy individuals, whereas RA patients have significantly lower PPT. A significant correlation was obtained between finger-to-floor distance and paravertebral myalgic score for AS. We conclude that AS does not have a widespread pain nature as RA.

Hallux valgus (HV) is a static subluxation of the first metatarsophalangeal joint with lateral deviation of the great toe and medial deviation of the first metatarsal. Our aim was to evaluate the interference of HV deformity with changes in lumbar lordosis and some foot deformities. Twenty HV patients and 20 healthy subjects were selected for the study. Hallux valgus angle, metatarsus primus varus (MPV), metatarsus omnis varus (MOV), first intermetatarsal (1.IMT), second metatarsal (2. MT) and hallux interphalangeal (HIP) angles were estimated from the anteroposterior foot X-rays. Lumbosacral (LSA) and sacrohorizontal angles (SHA) were measured from lateral lumbar x-rays and pes planus was detected from lateral and anteroposterior ankle and foot radiographs. There was a significant difference between HV angle mean values of two groups. MPV, MOV, 1.IMT, 2. MT and HIP angles did not show significant difference between groups. HV angle was found to be correlated with MPV. HIP angle was found to be correlated with LSA and SHA, indicating a relation with lordosis. HV and pes planus were correlated with each other. HV also showed weak correlation with hyperlordosis. Transmission of variations in body mechanics through pelvis and lower extremity plays an important role for certain foot deformities. Some factors affecting HV development are correctable; early diagnosis and treatment of MPV and pes planus, suggesting healthy rather than fashionable footwear and preventing obesity may lower HV incidence.

The Martin-Gruber Anastomosis (MGA) is probably the most well known of the anastomotic anomalies that occur at various levels between the median and ulnar nerves. It is formed by motor axons from the median nerve or its branch anterior interosseous nerve that cross in the upper forearm to join the ulnar nerve. The purpose of this study was to establish the frequency of MGA in healthy subjects and to draw the attention of clinicians working in the neurophysiological laboratory to the presence of this anastomosis, and thus to avoid possible misinterpretations of data from needle electromyography (EMG) and nerve conduction studies. 100 volunteers (60 women and 40 men) were selected for the study. Surface recording electrodes were placed on the right hand thenar, hypothenar and on the first dorsal interosseous (FDI) muscles. The median and ulnar nerves were stimulated supramaximally at the wrist and at the elbow and compound muscle action potentials (CMAPs) were recorded and their amplitudes evaluated. MGA was found in 27 of the 100 subjects. The type of anastomosis most frequently seen was type II, which was observed in 21 subjects. Type I anastomosis was observed in three, type I + type II in two and type III anastomosis in one subject. It can thus be concluded that MGA is frequently encountered and it should be borne in mind that abnormal innervation models may influence the electrophysiological findings and thus give rise to faulty interpretations, especially in the case of median and ulnar nerve lesions.

Aim of the Study: Reliable and valid evaluation of hand strength is important for determining the effectivity of treatment strategies and it is accepted that grip and pinch strength provide an objective index for the functional integrity of upper extremity. This study was designed to evaluate the grip and pinch strength differences between sides for the right and left handed population., Methods: The study included 128 right and 21 left hand dominant volunteers. Grip strength of the participants were measured by using a Jamar dynamometer. Pulp pinch strength measurements were performed by manual pinchmeter., Results: When the study group was totally evaluated, a statistically significant difference was found between the grip and pinch strengths of dominant and nondominant hands in favour of the dominant hand. For further information we grouped 149 participants as right and left handed and investigated the number of subjects with stronger nondominant hand for each group. The percentage of stronger nondominant hand grip was 10.93% and 33.33% for right and left handed groups respectively. The results were less significant for pinch strength with 28.12% and 28.57% for right and left handed subjects respectively., Conclusion: We concluded that the dominant hand is significantly stronger in right handed subjects but no such significant difference between sides could be documented for left handed people.

The aim of this study was to evaluate the effects of local steroid injection on both the clinical symptoms and motor and sensory conduction of the median nerve in carpal tunnel syndrome (CTS). Using a standard evaluation and treatment protocol, we prospectively studied steroid injection in 32 hands in 24 patients (mean age: 50.7 +/- 10 years; 23 women and 1 man). To determine the normal median nerve values, 42 normal controls (mean age: 39.1 +/- 10.5 years; 21 women and 21 men) were also studied. At follow-up, clinical symptom scores and signs of CTS, as well as electrophysiological variables of the median nerve, showed a significant trend towards improvement with respect to baseline values (p < 0.01). By the end of the one-year follow-up period, the symptoms had remitted completely or partially in 27 hands (84.4%). In addition to the relief of the symptoms, motor nerve conduction abnormalities had improved in 62.6% of hands, and anti-dromic sensory nerve conduction abnormalities in 62.5%. In cases where a sensory nerve action potential (SNAP) could be obtained, the efficacy of this treatment was found to be relatively higher than in cases in which SNAP was absent (p < 0.01).

Brucellosis is a zoonotic disease and still a major health problem in many geographical areas. In this paper a forty year-old woman with spinal brucellosis associated with epidural abscess formation and mimicking lumbar disc herniation is presented. Compression of spinal nerve root(s) by epidural masses due to brucella disc infection is a rare condition and should be kept in mind in differential diagnosis of lumbar disc herniation. The crucial role of magnetic resonance imaging in differential diagnosis is also emphasised.