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Objective: The aim of this study was to compare the effects of steroid iontophoresis [SI] and electrotherapy [ET] on bicipital tendonitis. Methods: Forty-seven patients with bicipital tendonitis, diagnosed by ultrasonography, were all treated with hot packs [15 minutes], ultrasound [1.5 w/cm², five minutes], and a standard exercise program. They were also divided randomly into two experimental groups. One group received SI [0.5 percent hydrocortisone acetate given with the negative electrode, 3-4 mA galvanic current, 15 minutes]. The second group was treated with ET [interferential current, 0-100 Hz, 15 minutes]. All patients were evaluated at pre-treatment, post-treatment, and one month later with the following assessment tools: pain [pain at rest, with normal activities, and with strenuous activities] with a numeric scale [0 to 10], range of motion [ROM] with goniometry and with the ROM items of Constant's Shoulder Scale, patient satisfaction with a numeric scale [0 to 10], and disability by using the function section of the Pennsylvania Shoulder Scale. Results: All of the assessment parameters revealed statistically significant improvement at post-treatment and one month later [P < 0.05] in the SI group. The ET group experienced less dramatic improvement in the immediate post-treatment [P < 0.05] assessment and the durability of benefit was less than with SI. Conclusions: Application of SI to the conventional physical therapy for patients with biceps tendonitis seems to provide a better and more prolonged clinical and functional improvement. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the effects of cervical traction and exercise in addition to moist heat in thoracic outlet syndrome [TOS]. Methods: Forty patients [28 males, 12 females] with the diagnosis of TOS were randomly divided into two groups. While hot pack and a standard exercise program were applied to one group [the control group], cervical traction was added to that program in the other group [the study group] for 10 sessions. The provocative physical maneuvers were applied to all patients before treatment and after three weeks of the treatment. At follow-up, every patient was questioned with a Likert scale [no cure, little, moderate, much, very much]. Results: After a rehabilitation program, improvements in Adson, hyperabduction, and hyperextension maneuvers were statistically significant in both groups [P < 0.05]. While improvements in Roos, costoclavicular, Wright's maneuvers, and Erb tenderness were statistically significant in the study group [P < 0.05], they were not found significant in the control group [P > 0.05]. Improvement in pectoral tenderness was not statistically significant in either group [P > 0.05]. Improvement in pain was not statistically significant between the groups [90 percent versus 75 percent, P > 0.05]. Difference in numbness scores between the groups was statistically significant in favor of the study group [80 percent versus 20 percent, P < 0.001]. Conclusions: We suggest that hot pack and exercise together achieve some improvements in TOS. However, cervical traction in addition to exercise and hot pack obtains additional benefits in the conservative management of TOS. [ABSTRACT FROM AUTHOR]

PURPOSE: To assess the effectiveness of a hinged ankle-foot orthoses on gait impairments and energy expenditure in children with hemiplegic cerebral palsy (CP) whom orthoses were indicated to control equines. METHOD: Eleven children (seven males, four females) who had a diagnosis of hemiplegic cerebral palsy were included in the study. Each child underwent gait analysis and energy consumption studies with and without ankle-foot orthosis (AFO). The AFOs were all custom-made for the individual child and had plantarflexion stop at 0 degrees with no dorsoflexion stop. The Vicon 512 Motion analysis system was used for gait analysis. Walking energy expenditure measurements were done with breath by breath method using an open-circuit indirect calorimeter (Vmax 29c, Sensormedics, USA). All tests were carried out on the same day with enough resting period. RESULTS: AFO application, as compared with the barefoot condition improved walking speed, stride length and single support time. Double support time was decreased significantly with AFOs and no change in cadance. Ankle dorsiflexion at initial contact, midstance and midswing showed significiant increase. Knee flexion at initial contact was decreased and no significant change in maximum knee extension at stance and maximum knee flexion at swing was obtained. The oxygen consumption was significantly reduced during AFO walking. CONCLUSION: The hinged AFO is useful in controlling dynamic equinus deformity and reducing the energy expenditure of gait in children with hemiplegic spastic cerebral palsy. [ABSTRACT FROM AUTHOR]

Objective: The goal was to compare the efficacies of botulinum toxin A (BTX) treatment and Johnstone pressure splint (JPS) treatment against hip adductor muscle spasticity among children with spastic diplegic cerebral palsy.Methods: For each patient in the BTX group, a total of 300 IU of BTX was injected into adductor and medial hamstring muscle groups. In the JPS group, long leg JPS were administered for 30 minutes 3 days per week. Bobath neurodevelopmental exercises were administered to both groups 3 days per week during the study period. All cases were assessed by using gross motor function measurements, passive hip abduction goniometric measurements, modified Ashworth Scale scores, and measurements of the distance between the knees as indicator variables.Results: We found that there was statistically significant improvement in all indicators for both groups. BTX treatment was found to be superior to JPS treatment in terms of the indicator variables of our study. [ABSTRACT FROM AUTHOR]

We aimed to investigate the diagnostic significance of high frequency ultrasonography (USG), comparing the findings in USG, bone scintigraphy and clinical stuation. Fifty-one patients who had early symptoms of inflammatory arthritis, but not fulfilling the ACR diagnostic criteria for rheumatoid arthritis (RA) were included in this study. They were referred to USG and bone scintigraphy for examination of the synovial joints. After following at least 2 years with visits at every 3 months, those who fulfilled the ACR criteria for the diagnosis of RA were defined as reference group. The concordance levels were assessed with Kappa statistic among them. The diagnosis of inflammatory arthritis that was made with USG in early time showed average agreement with the diagnosis according to ACR criteria. However, there was statistically discordance between the diagnosis of inflammatory arthritis that was made with bone scintigraphy in early time and the diagnosis according to ACR criteria.

A 21-year-old male patient with low back pain and marked forward bending was presented. The exaggerated lumbar flexion was preventing him to stand in erect posture but disappeared while lying. The symptoms had begun after he had lifted a heavy object. Straight-leg-raising test could not be performed properly because of the exaggerated pain. The light-touch sense was decreased on L5 and S1 dermatomes. There was no loss of muscle strength. The deep-tendon reflexes were normal. Plain graph showed mild narrowing in the L4-5 and L5-S1 intervertebral spaces. Lumbar magnetic resonance imaging revealed disc protrusions in L4-5 and L5-S1 levels. During his stay in the department, the patient was given tizanidine and tramadol, and physical therapy was performed. A paravertebral intramuscular injection with lidocaine was applied. Moreover, the patient was referred to psychiatrist for evaluation regarding his medical history of conversive seizures and possible efforts for secondary gain. No response was obtained from all the treatments. The final diagnosis was camptocormia triggered by lumbar-disc herniation. He was applied supportive psychotherapy, psychoeducation regarding secondary gain, strong suggestions to improve posture, positive reinforcement, and behavioral therapy. His postural abnormality resolved and disappeared completely with mild pain.

The objective of this study is to investigate the endothelial function in complex regional pain syndrome. A total of 21 patients with CRPS and 15 healthy controls were enrolled. The mean age of patients was 22 +/- 4.9 years and the mean duration of the disease was 5.9 +/- 2.5 months. Flow-mediated vasodilatation (FMD) technique was performed for evaluating the endothelial function. Parameters were the waveforms obtained and the increase in diameter and blood flow of the brachial artery, which were expressed as the percent change from baseline. The differences of the waveforms obtained in the affected limbs in comparison to non-affected limbs and to controls were statistically significant. We observed a trend of greater percent dilating responses in the affected limbs; however, the differences showed no statistical significance. In macrovascular evaluation, the endothelial function seems to be impaired in the earlier stage of the disease.

Osteoid osteoma is one of the unusual causes of musculosceletal pain. A case of a 21-year-old man who had low back and hip pain radiating to the posterior thigh for 3 years is presented. Pain was worse at night but reduced with the use of nonsteroidal anti-inflammatory drugs. Straight leg raising test was negative. Patrick-Fabere and sacroiliac compression tests were positive on the right. Neurological examination was normal. Lumbar spinal and pelvic radiographs were normal except for sclerosis at the inferior half of the iliac bone adjacent to the right sacroiliac joint. Sedimentation rate, C-reactive protein, and whole blood counts were normal. Bone scan showed nonspecific increased uptake. Computed tomography revealed the presence of diffuse sclerosis at inferior half of the right iliac bone extending to medial border of sacroiliac joint with subcortical osteolytic region and centrally hyperdense sclerotic nidus inside.

Objective: We present a case of neuralgic amyotrophy (NA) diagnosed with magnetic resonance neurography (MRN) in the acute stage., Methods: NA is an uncommon neurologic syndrome that affects mainly the brachial plexus. MRN is considered to be more sensitive than magnetic resonance imaging (MRI) for peripheral nervous system disorders. A case of acute NA with the sudden onset of shoulder pain and weakness in the shoulder girdle is presented., Results: Electrodiagnostic testing revealed an upper trunk lesion. Plexitis that could not be demonstrated with conventional MRI was revealed with MRN. The left brachial plexus was thickened and hyperintense with MRN, consistent with plexitis., Conclusions: MRN should be the preferred imaging modality for the diagnosis of acute NA. This might not only help early diagnosis and guide treatment but also prevent unnecessary testing.

The objective of this paper is to investigate the effect of gabapentin in the earlier stage of reflex sympathetic dystrophy syndrome (RSD). Twenty-two patients diagnosed with RSD were enrolled. Initial gabapentin dosage was 600 mg/day. This dosage is increased gradually until a satisfactory pain level was reached. After this level, this dosage was maintained throughout the study. An exercise program was also applied to the patients. Provoked and static pain scores of the patients were obtained initially, at 3-day intervals for maintenance dosage determining, and at 6 weeks after the discharge. Functional improvement parameters were volumetric measurement; dynamometric measurement and third finger pulp-distal palmar crease distance measurement for hands; and metric circumferential measurement and range of motion for elbow, knee, and foot initially, at baseline, on the tenth day, upon discharge, and 6 weeks after the discharge. The mean maintenance dose of gabapentin was 1,145.46+/-377.6 mg/day (range, 900-1,800 mg/day). Improvements in spontaneous and provoked pain intensities were statistically significant. No statistically significant difference was obtained in functional improvement parameters. Dizziness in three patients, headache in two patients, and mild burning feeling in the tongue in one patient were the reported side effects. These symptoms resolved spontaneously in few days. Gabapentin cannot be recommended as the drug of choice, but it may be considered as one of the therapeutic alternatives in the management of pain due to RSD. We suggest that it is effective only for the pain and not for other symptoms of RSD. Serious side effects that will cause the patient to stop using the drug are rare.

The aim of this study was to investigate the triggering micro-organisms and the clinical as well as laboratory differences between Chlamydial and non-chlamydial reactive arthritis (ReA) in a prospective study on 98 patients with acute/subacute arthritis. An inciting organism was found in 42 patients. Eighteen of these were chlamydial. Fifty-seven percent of all ReA patients were carriers for HLA-B27, which increased to 67% in the chlamydial group. Chlamydial ReA patients had more urethritis (P<0.05) with a longer period between arthritis and inciting infection, significantly lower CRP levels, and involved joint counts (P<0.05). Additionally, sacroiliitis was more frequent besides extra-articular manifestations in chlamydial ReA group. This study shows that chlamydial ReA differs in some points from non-chlamydial ReA, which in turn may affect the evaluation of an arthritic patient. ReA due to chlamydia more frequently encompasses a monoarticular or oligoarticular clinical picture with predominant distal extremity involvement. Non-chlamydial ReA presents higher joint counts and may involve upper extremity joints.

Objective: The agonist-antagonist strength relationship for shoulder external rotation and internal rotation was formerly described by the relatively more functional ratios of eccentric external rotator to concentric internal rotator moments, and eccentric internal rotator to concentric external rotator moments for the entire range of motion. The aim of this study was to provide descriptive data for terminal range eccentric antagonist/concentric agonist rotator cuff strength in overhead athletes., Method: The dominant and non-dominant shoulders of 40 asymptomatic military overhead athletes were tested through a range of 20 degrees of external rotation to 90 degrees of internal rotation using the Cybex NORM isokinetic dynamometer at a speed of 90 degrees /s. Differences between the dominant and non-dominant shoulders were assessed using the paired samples t-test., Results: The terminal range ratios during external rotation (20 degrees of internal rotation - 10 degrees of external rotation) were found to be 2.09 and 1.58 for the dominant and non-dominant shoulders, respectively, whereas the terminal range ratios during internal rotation (60-90 degrees of internal rotation) were 1.03 and 1.19 for the dominant and non-dominant shoulders, respectively. These ratio differences between the dominant and non-dominant shoulders were significant (P<0.01 for external and internal rotation)., Conclusion: The muscle torque ratios of eccentric antagonist/concentric agonist are different between dominant and non-dominant shoulders of skilled overhead athletes at terminal ranges. This functional assessment of strength testing that reflects dynamic shoulder joint stability during the throwing activity at these specific ranges may provide valuable information either during preventive exercise programs or in the evaluation of the injured shoulder of the overhead athlete. We recommended functional exercises that improve eccentric external rotation strength on the dominant shoulder during the rehabilitation and prevention programs in overhead athletes.

The aim of this study was to determine the emotional and sociodemographic characteristics of patients with ankylosing spondylitis (AS) and to investigate the impact of the disease on their social life and quality of life (QOL). This study included 101 patients with the diagnosis of AS. All patients filled in a questionnaire comprising their sociodemographic and emotional status and their self-rating on the disease and completed the 36-item Short Form Health Survey (SF-36). The impact of the disease on work status, sexuality, and family relations was measured on a Likert scale. The impact of the disease on employment, family and sexual relations, work life as well as SF-36 was investigated. Therefore, the effect of educational level, employment, social security, and sexual relations with spouse, etc. on QOL were assessed. More than half of the patients had no knowledge about the disease and half of them were not under a physician's control. Thirty-two percent of the previously working patients quit their jobs because of the disease. Quitting a job due to the disease was more frequent in the first 10 years of the disease. The most affected domains of the SF-36 were physical role power, general health, and pain. Patients unemployed due to the disease had lower SF-36 scores compared with employed ones. Unemployed patients without social insurance had lower values on SF-36 subscales (p<0.05). A higher education level had positive influences on disease impact. The level of anxiety was high and was associated with sexual relations (p<0.05). Our results show that the disease affects patients' work and social life. Work disability affects QOL. Educating the patients about the disease may play an important role in improving his/her life quality and coping with the disease. Thus, the socioeconomic burden of the disease on the person and on society can be diminished.

Familial Mediterranean fever (FMF) is a multisystemic autosomal recessive disease, occasionally accompanied by sacroiliitis. Transient and non-erosive arthritis of the large joints is the most frequent articular involvement. Amyloidosis is also the most significant complication of FMF, leading to end stage renal disease. Here we present three cases of FMF with sacroiliitis and review the literature for spinal arthritic involvement of FMF. All cases were referred to our clinic with a diagnosis of seronegative spondyloarthropathy and with low back pain sourced by sacroiliitis. They also had homozygous M694V gene mutations and negative HLA B27 antigens. Molecular analysis of the gene mutation is recommended during the evaluation of uncertain cases in order to clarify diagnostic discrimination. We suggest that FMF with sacroiliitis, which is rare in rheumatological practice, should be considered in the differential diagnosis of seronegative spondyloarthropathy or other rheumatologic diseases causing spinal involvement.

Reflex sympathetic dystrophy (RSD) may be a misdiagnosis or at least not descriptive enough in patients with atypical hand posture and atypical edema. Seven patients with the previous diagnosis of RSD were investigated further because of inconsistent clinical picture with the underlying pathology and bizarre course of the disease. Four patients had clenched fist and three had factitious edema. These seven patients underwent psychological examination, and MMPI was applied to all. In two of these no psychological disorder was obtained according to DSM-IV. One patient could not adapt to MMPI. In two anxiety disorders, in one depression, and in one patient conversion disorder was diagnosed. We suggest that these patients are not motivated enough to improve their conditions and expectations of such patients may show some differences depending on the environment.

We report two human leukocyte antigen (HLA) B27-positive cases of urogenital tuberculosis (TB) with asymmetric polyarthritis. Stained smears with Ehrlich Ziehl-Neelsen and polymerase chain reaction (PCR) tests for Mycobacterium tuberculosis complex (MTC) of the ejaculate were positive in both cases, despite negative cultures. Stained smear, culture and PCR results of the synovial fluid for mycobacteria were negative. The patients were diagnosed with Poncet's disease. Polyarthritis was resolved rapidly with anti-tuberculosis treatment. We suggest that in cases with unexplained arthritis and non-articular TB, Poncet's disease should be considered. PCR can be used in the routine diagnostic algorithm when conventional methods fail to identify MTC.

Study Design: A prospective clinical investigation., Objective: To determine the clinical significance of congenital lumbosacral malformations in young male patients with subacute or chronic low back pain and to investigate a possible worsening of the clinical picture with the concurrence of transitional vertebra (TV) or spina bifida occulta (SBO)., Summary of Background Data: Although the causative roles of congenital malformations in low back pain and lumbar disc herniation have been investigated, there is no study that compares the incidence of congenital malformations in prolonged low back pain between radicular and nonradicular groups; nor is there a study that compares the pain intensity between the groups with and without congenital malformations., Methods: Lumbosacral plain radiographs of 881 young male patients with low back pain lasting for >4 weeks were evaluated. For all patients, we recorded the clinical signs and their pain intensities based on a 10-cm visual analog scale (VAS)., Results: Congenital lumbosacral malformations were determined in 88 of 881 patients. Of these, 48 were TV, 38 were SBO, and 2 were a combined lesion of TV and SBO. The difference in positive clinical sign and VAS was statistically significant (P < 0.05) between the groups with and without congenital lumbosacral malformations. In contrast to SBO, there was a statistically significant difference of TV incidence between the sign positive and the sign negative groups (P < 0.05). The difference in VAS values was statistically significant for both TV and SBO (P < 0.001)., Conclusions: The results of this study show that SBO and TV increase the severity of the clinical picture whether or not they have a causal relationship. Additionally, transitional vertebrae seem to increase nerve-root symptoms whereas spina bifida occulta does not.

Shoulder pain is a common complaint in elder population and may cause an important functional disability. The aim of this study was to compare the effects of suprascapular nerve block with those of steroid injection in patients with non-specific shoulder pain. A total of 60 patients with shoulder pain lasting for more than four weeks were included in this study. After 1:1 randomization, patients were included in the steroid group (n=30) or the suprascapular nerve block group (n=30). Single injection was performed in both groups. All patients were evaluated before treatment, within one week after treatment, and one month later, in terms of pain, range of motion (ROM) (flexion, abduction, internal and external rotations, and total constant shoulder ROM score), satisfaction, and disability (Pennsylvania shoulder scale function score). Steroid injection was applied at two points in order of lateral and anterior routes. Suprascapular nerve block with lidocaine was applied at the suprascapular notch. No difference was noted in the indicated parameters before the treatment between the groups (p >0.05). The difference in all follow-up parameters was statistically significant in the assessment periods in both groups (p <0.05). No method was found to be superior to each other (p >0.05). No complications occurred in suprascapular nerve block in contrary to steroid injection. We suggest that suprascapular nerve block can be considered the preferred treatment for non-specific shoulder pain because of being as effective as steroid injection with rare side effects.

Background and Objective: To investigate the effect of intravenous regional anesthesia (Bier block) with methylprednisolone and lidocaine in complex regional pain syndrome (CRPS) type I in a randomized, double-blinded, and placebo-controlled study., Methods: Twenty-two patients with the diagnosis of CRPS of their upper limb were divided randomly into 2 groups. The mean age was 22.3 +/-1.6 years. Average pain duration was 3.1 +/- 1.4 months. In the placebo group (10 patients), patients received only 100 mL of saline. In the study group (12 patients), 40 mg of methylprednisolone and 10 mL of 2% lidocaine were added to the saline. Treatments were applied once a week. Unless significant adverse effects occurred, 3 sessions of blockade were completed. Pain severity, range of motion (ROM), and volumetric edema measurements were obtained before treatment. Pain severity and satisfaction (resolved, better, no change, or worse) were recorded after each session. The final assessment was performed 1.5 months later. ROM and volumetric measurements were repeated the day after the block and at the final assessment., Results: Differences in pretreatment features of the patients were not statistically significant ( P >.05). In all assessment periods during the study, improvement in pain severity was statistically significant ( P <.05) in both groups. This statistically significant difference disappeared at the final assessment ( P >.05). No statistically significant difference was obtained in ROM and volumetric measures in any assessment period before and after the block. Satisfaction scores between the groups were also not different in any assessment period., Conclusions: Bier block with methylprednisolone and lidocaine in CRPS type I does not provide long-term benefit in CRPS, and its short-term benefit is not superior to placebo.

Chronic groin pain is common in soccer players because of the biomechanics of kicking causing recurrent stress to the abdominal muscles, groin flexors, and adductor muscles. Myositis ossificans in adductor muscles is a rare cause of chronic groin pain in soccer players. Only two cases have been reported and the iliopsoas muscle was involved in both. This case report emphasises the importance of direct radiography for diagnosis in chronic groin pain and is a reminder that the development of myositis ossificans in the adductor muscles may be a cause.

The aim of this study was to evaluate the alterations in eccentric evertor/concentric invertor strength ratio and their importance in the chronically unstable ankle. Eight patients with chronic ankle instability (CAI) and nine healthy individuals participated in this study. Isokinetic concentric and eccentric invertor and evertor muscle strength measurement was carried out at an angular velocity of 120°·sec(-1) by measuring maximal force moments (torque) during isokinetic ankle inversion and eversion movements. Functionally, evertor/invertor muscle strength ratios (E/I strength ratio) were calculated separately based on peak moment and angle-specific moments obtained at 0°, 5°, 10°, 15°, 20° ankle joint angles. Peak and angle-specific eccentric evertor strength values at 0°, 5°, 10°, 15°, 20° were significantly lower in the chronic ankle instability (CAI) group. In spite of this, no differences were obtained for peak and angle-specific concentric invertor torque values. Eccentric evertor/concentric invertor strength (Eecc/Icon) ratios were also significantly lower in the CAI group, but only at 15° and 20°. Eccentric evertor muscle torque and end range (15°-20°) Eecc/Icon strength ratio for the chronically unstable ankle were significantly different from those for the healthy ankle. For this reason, measurements of end range eccentric/concentric strength ratios are more valuable in monitoring chronic ankle injuries and rehabilitation should include not only concentric muscle strengthening but also eccentric muscle strengthening, particularly for the evertor muscles.

A case of anterior inferior iliac spine (AIIS) apophyseal avulsion fracture caused while playing football is reported. A 16-year-old amateur football player felt severe pain in his left groin while kicking the ball during training. There was point tenderness over the anterior inferior iliac spine (AIIS). Avulsion fracture of AIIS was considered clinically. Radiographs confirmed the diagnosis. He was treated with a conservative rehabilitation program. He is still an active football player. Avulsion fractures follow violent or explosive muscular contractions against a fixed resistance, sudden deceleration, or stretching of the involved muscle or as a result of a direct trauma. This injury usually occurs with an extension moment to the hip joint, with the knee flexed, and it is commonly seen in sports that involve kicking. AIIS avulsion fractures should be a diagnostic consideration in patients with pain in the groin who are involved in activities requiring high-level forces of flexion of the hip.

Proprioceptive mechanisms appear to play a role in stabilizing the joints and may serve as a means for interplay between static stabilizers and dynamic muscular restraints. The purpose of our study was to investigate whether or not gymnastic training has any effect on the balance and on proprioception in an ankle, as seen in gymnasts and in nongymnasts. We evaluated the proprioceptive ability of the ankle using four different tests (a one-leg-standing test, a single-limb-hopping test, an active angle-reproduction test, and a passive angle-reproduction test). Proprioception of the ankle was measured in 40 subjects who were assigned to two experimental groups. Group 1 (n: 20) were healthy control subjects, and group 2 (n: 20) were teenaged female gymnasts. The sense of position of a joint was actively measured using a Cybex NORMTM isokinetic dynamometer and measured passively with a proprioception-testing device. A Mann-Whitney U test was used to compare mean values of the gymnasts to the controls. Results revealed statistically significant differences (p<0.05) between two groups. We found no statistically significant differences between the dominant and nondominant ankle in volunteers or in gymnasts, in all tests. The results of this study suggest that gymnastic training has a positive influence on sense of position of the ankle joint and on balance, in addition to increasing muscle tone.

Background: The ability to measure the stretch-shortening cycle of isolated muscle groups has been limited. The purpose of this study was to measure the stretch-shortening cycle of the internal rotator muscle group., Methods: Sixty-eight volunteer subjects, 35 men and 33 women, participated in one test session; eight men and eight women also participated in a retest session; to examine the reliability of the test. A concentric contraction of the dominant internal rotator was measured for peak torque, standardized peak torque, power, standardized power and acceleration time on a Cybex Norm isokinetic dynamometer under three conditions: 1) concentric contraction only, 2) isometric preload before a concentric contraction, and 3) eccentric preload before a concentric contraction., Results: Condition 3 showed a significant increase in peak torque production compared to condition 1 (p=0.001). Conditions 2 and 3 showed a significant increase in power production compared to condition 1 (p=0.0001, p=0.003). A significant difference was found in all three conditions between the men and women, with the men producing greatest peak torques and powers., Conclusions: The testing protocol was found to have high reliability. This testing protocol could be used to further study the stretch-shortening cycle in the internal rotator muscle group.

Proprioceptive mechanisms appear to play a role in stabilizing the glenohumeral joint and may serve as a means for interplay between the static stabilizers and the dynamic muscle restraints. The aim of this study was to investigate proprioception of the joint in healthy and surgically repaired shoulders. Shoulder proprioception was measured in 44 subjects who were assigned to two experimental groups: group 1, healthy subjects (n = 24); and group 2, patients who have undergone surgical reconstruction (n = 20). Joint position sense was measured with a Cybex NORM isokinetic dynamometer. The results revealed no significant differences in proprioception between the dominant and nondominant shoulders in group 1. No significant mean differences were revealed between the surgical and contralateral shoulder in group 2 under any test condition. These results imply that arm dominance in healthy individuals does not influence the proprioceptive sensibility and that reconstructive surgery appears to restore some of these proprioception characteristics.

In this study, we examined scalp recorded dermatomal somatosensory evoked potentials (DSEPs) to electrical stimulation of L4, L5 and S1 dermatomes in 55 patients with proven lumbosacral radiculopathy and in 22 healthy subjects. We did not observe any significant ipsilateral intertrial variations and arithmetic mean side-to-side differences in normal subjects. As for segmental latencies, the dermatomal P40 latencies were directly correlated with height. The regression equations for L4, L5 and S1 dermatomes were as follows: (L4) y = 5.8 + 21.3 (height), (L5) y = -2.09 + 28.04 (height), (S1) y = -13.9 + 36.4 (height). Maximum side-to-side latency differences and maximum P 40 latencies were obtained by adding 2 standard deviations to the arithmetic means. The abnormal latencies for L4, L5 and S1 dermatomes were 48 msec., 52 msec., and 55 msec., respectively. The abnormal side-to-side latency difference were 3 msec. for all dermatomes. DSEPs accurately predicted the lesion only in four patients (7.2%). In 20 patients (36.3%), DSEPs correctly identified the lesion but also gave misleading information on the other levels. DSEP abnormality were on the correct level but opposite side in 5 patients (9%). The findings were normal in 11 patients (20%), and misleading in 15 patients (27.2%). We conclude that the ultimate diagnostic utility of DSEPs in lumbosacral radiculopathies is doubtful and controversial needs further investigations.

Although back pain is very common, the differential diagnosis may sometimes be very difficult. Both inflammation and infections of spinal or sacroiliac joints are examples of such causes. We report three cases of brucella sacroiliitis resembling acute low back pain or lumbar disc herniation. All patients had had a recent infection and were referred complaining of acute back pain with a suspicion of lumbar disc herniation. The complaints of all patients reduced dramatically after proper medication. Radiographs of all patients and bone scans of two patients revealed sacroiliitis. One of the patients was positive for HLA-B27; in the other two patients HLA-B27 could not be determined.

In this study an attempt was made to treat spinal cord injured patients with severe spasticity by peripheral nerve blocks. Thirty-six patients (5 female, 31 male) ranging in age from 20 to 71 years (mean: 29 +/- 8.2) were treated by phenol injections. A specially designed electrostimulation needle was used for the injections. The results showed that peripheral nerve blocks with phenol solution could be a remedy on a temporary basis, but are not as effective as has been described previously.