When is needle examination of thenar muscle necessary in the evaluation of mild and moderate carpal tunnel syndrome?

Objectives: This study aims to evaluate the predictors of standard nerve conduction study (NCS) parameters in determining the presence of axonal loss by means of spontaneous activity in patients with mild and moderate carpal tunnel syndrome (CTS). Patients and methods: Between May 2015 and April 2018, a total of 118 patients (11 males, 107 females; mean age: 52.3±10.6 years; range, 27 to 79 years) who underwent electrophysiological studies and were diagnosed with CTS were included. Demographic data of the patients including age, sex, and symptom duration were recorded. Electrodiagnostic studies were performed in all patients. All the needle electromyography (EMG) findings were recorded, but only the presence or absence of spontaneous EMG activities was used as the indicator of axonal injury. Results: In 37 (31.4%) of the patients, spontaneous activity was detected at the thenar muscle needle EMG. No spontaneous activity was observed in any of 43 (36.4%) patients with normal distal motor latency (DML). There were significant differences in DMLs, compound muscle action potential (CMAP) amplitudes, sensory nerve action potentials amplitudes, and sensory nerve conduction velocities between the groups with and without spontaneous activity (p<0.05). The multiple logistic regression analysis revealed that DML was a significant independent risk variable in determining presence of spontaneous activity. The most optimal cut-off value for median DML was calculated as 4.9 ms. If the median DML was >4.9 ms, the relative risk of finding spontaneous activity on thenar muscle needle EMG was 13.5 (95% CI: 3.6-51.2). Conclusion: Distal motor latency is the main parameter for predicting the presence of spontaneous activity in mild and moderate CTS patients with normal CMAP. Performing needle EMG of the thenar muscle in CTS patients with a DML of >4.9 ms may be beneficial to detect axonal degeneration in early stages.

Ultrasonographic evaluation of femoral cartilage thickness in patients with familial Mediterranean fever

Objectives: This study aims to determine femoral cartilage thickness using ultrasonography in familial Mediterranean fever (FMF). Patients and methods: A total of 45 patients (16 males, 29 females; mean age: 38.5±9.1 years; range, 24 to 49 years) with the diagnosis of FMF and 31 healthy individuals (6 males, 25 females; mean age: 37.0±8.7 years; range, 25 to 47 years) between January 2016 and July 2016 were included in this study. Clinical data and demographic characteristics of the patients were recorded. All FMF cases in the study were in remission with colchicine treatment. The thickness of femoral cartilage in both knees were evaluated using ultrasonography. Three measurements (mid-point) were taken from both knees (at the medial/lateral femoral condyles and intercondylar area). Results: Ultrasonographical measurements revealed that cartilage measurements of FMF patients were significantly thinner at both the medial/lateral femoral condyles and intercondylar area on the right knee and at the medial/lateral femoral condyles on the left knee (p<0.001). The cartilage measurements in FMF patients were significantly thinner at the intercondylar area on left knee, compared to those in controls (p=0.023). Conclusion: Our study showed decreased femoral cartilage thickness in FMF patients. These findings indicate that even if these patients do not have an attack, they may have subacute and chronic arthritis in their joints, and their femoral cartilage thickness can be affected.

Evaluation of balance, fall risk, and related factors in patients with fibromyalgia syndrome

Objectives: In this study, we aimed to evaluate whether fibromyalgia patients had a higher fall risk compared to healthy individuals and to identify its relationship, if there was an increase, with clinical features. Patients and methods: Between March 2018 and September 2018, a total of 50 consecutive female patients with fibromyalgia (median age: 35 years; interquantile range [IQR], 27 to 40 years) and 50 healthy female volunteers (median age: 30 years; IQR, 23 to 40 years) were included in the study. Pain was evaluated with the Visual Analog Scale (VAS), life quality with the Nottingham Health Profile (NHP), balance functions with the Berg Balance Test (BBT), and the risk of falls with a posturography device. Disease activity of fibromyalgia patients was evaluated with the Fibromyalgia Impact Questionnaire (FIQ). Results: The mean fall risk index of the fibromyalgia patients was 45%. The fall risk index was significantly higher (p=0.010) and the BBT scores were significantly lower in the patient group (p<0.001). There was a significant difference in terms of fall risk between the control group and drug-free fibromyalgia patients; however, no significant difference was found between the balance scores of the two groups. In the fibromyalgia group, a weak positive relationship was determined between the fall risk index and the social isolation subscale of the NHP. Conclusion: Our study results showed an increased risk of loss of balance and falls in fibromyalgia patients, compared to healthy individuals. This fall risk increase was also detected in fibromyalgia patients who did not use drugs. These findings suggest a possible relationship between social isolation and an increased risk of falls.

The effects of ankle-foot orthoses with plantar flexion stop and plantar flexion resistance using rocker-sole shoes on stroke gait: A randomized-controlled trial

Objectives: This study aims to evaluate the effect of two ankle-foot orthoses (AFOs), AFO with plantar flexion stop (AFO-PlfS), and AFO with plantar flexion resistance (AFO-PlfR), while wearing standard shoes and rocker-sole shoes. Patients and methods: Between November 2017 and July 2018, in this randomized-controlled study, a total of 20 stroke patients (8 males, 12 females; mean age: 48.1 years; range, 33 to 65 years) in chronic phase were randomized to AFO groups (AFO-PlfS group, n=10 and AFO-PlfR group, n=10). Each group received the allocated AFO along with two kinds of shoes (standard shoe and rocker shoe) for a two-week adaptation. Two effects were separately evaluated: The orthotic effect and rocker shoe effect were defined as the evaluation of using an AFO wearing standard shoe compared to only standard shoe, and evaluation of using an AFO wearing rocker shoe compared to an AFO wearing standard shoe, respectively. The gait of each group was measured by three-dimensional motion analysis. Results: A significant orthotic effect was found in both AFO groups in spatiotemporal parameters and maximum ankle dorsiflexion in the single-support phase. Additionally, the AFO-PlfR group showed a significant improvement in the parameters related to the first rocker of gait, but not for AFO-PlfS group concerning the orthotic effect. The rocker shoe effect was found in significant reduction of peak ankle plantar flexor moment and power ankle generation during preswing for both AFO groups. Conclusion: According to the orthotic effect, an AFO-PlfR can create better function in the improvement of parameters related to the first rocker. Although a rocker shoe can facilitate rollover for weight progression in the third rocker of gait, it cannot make a strong push-off function in stroke survivors.

Vascular pectoralis minor syndrome as an overlooked condition: A case report

Thoracic outlet syndrome is characterized by pain, paresthesia, muscle weakness, and arterial/venous symptoms caused by compression of the neurovascular structures. Compression mainly occurs at three distinct areas in the thoracic outlet: the retropectoralis minor space, the costoclavicular space, and the interscalene triangle. As the symptoms of these three compression sites are very similar, it is difficult to pinpoint the location of the compression and the treatment methods are quite different. Ultrasound-guided diagnostic injections play an important role in the differential diagnosis. Herein, we report a 49-year-old female patient who was previously diagnosed with thoracic outlet syndrome and scheduled for decompression of cervical ribs, but cured by conservative methods after being diagnosed with pectoralis minor syndrome.

Validity and reliability of the Turkish version of the lymphedema symptom intensity and distress survey

Objectives: This study aims to adapt the Lymphedema Symptom Intensity and Distress Survey- Arm (LSIDS-Arm) into Turkish and to test its validity and reliability. Patients and methods: Between September 2017 and July 2018, this descriptive, methodological study included a total of 186 women (mean age: 55.4±10.2 years; range, 20 to 80 years) who were diagnosed with breast cancer-related lymphedema (BCRL) and followed in the lymphedema outpatient clinic. Data were collected using sociodemographic and clinical features form, LSIDS-Arm, and Functional Assessment of Cancer Treatment-Breast Cancer Scale+4 (FACT-B+4). After the linguistic and content validity of the scale was achieved, confirmatory factor analysis and known-groups validation were utilized to test the construct validity. Reliability of the survey was tested using the Cronbach alpha and Spearman Brown coefficient, item analysis, and parallel forms reliability. Results: All patients completed the questionnaire. After achievement of linguistic and content validity, confirmatory factor analysis results were found to be higher than the accepted value. Known-groups validation revealed a significant difference in the mean scores for the intensity and distress scales between the patients with and without lymphedema. Cronbach alpha for the subscales ranged from 0.61 to 0.86. Parallel forms reliability showed a moderate, significant correlation between subscales of the intensity and distress scales of the survey and the subscales of FACT-B+4. Conclusion: The Turkish version of the survey is valid and reliable and can be used to evaluate symptoms, severity of symptoms, and distress caused by BCRL symptoms in the Turkish women.

Comparison of platelet-rich plasma and extracorporeal shock wave therapy in patients with chronic lateral epicondylitis: A prospective, randomized-controlled study

Objectives: In this study, we aimed to investigate the effectiveness or comparative therapeutic superiority of exercise, extracorporeal shock wave therapy (ESWT), and platelet-rich plasma (PRP) on pain, grip strength and functional activities in chronic lateral epicondylitis (LE). Patients and methods: Between January 2016 and February 2017, a total of 74 patients (14 males, 60 females; mean age; 49.7±7.6 years, range, 26 to 60 years) with chronic LE were included in this prospective, randomized-controlled study. All patients received stretching and eccentric strengthening exercises for three months. The patients were divided into three groups. The first group (Exercises group, n=24) was given home exercises. The second group (ESWT+Exercises group, n=25) received one session of ESWT added once a week for three weeks. The third group (PRP+Exercises group, n=25) received one session of PRP in addition to the exercise program. All patients were evaluated for pain by Visual Analog Scale (VAS), for functionality by Disabilities of Arm, Shoulder and Hand (DASH) questionnaire and Patient-Rated Tennis Elbow Evaluation (PRTEE), handgrip strength by a dynamometer, and extensor tendon thickness by ultrasonography (USG) at baseline and at one, two, three, and six months. Results: A significant improvement was found in the VAS, DASH, PRTEE, handgrip strength values at six months compared to between in all groups (p<0.001). Extensor tendon thickness as assessed by USG indicated no significant difference (p>0.05). Regarding the VAS activity levels, there was a significant difference in the PRP+Exercises group compared to the Exercises group at six months of follow-up (p<0.001). The decrease in the DASH scores during six-month follow-up was significantly higher in the PRP+Exercises group compared to the Exercises group (p=0.004). For the PRTEE scores at six months, the PRP+Exercises group showed a statistically significant improvement than both Exercises (p<0.001) and ESWT+Exercises (p=0.007) groups. Conclusion: In the treatment of chronic LE, PRP combined with exercise seems to be superior to exercise or ESWT in terms of pain and functionality in chronic LE patients.

Assessment of the frequency of tarsal tunnel syndrome in rheumatoid arthritis

Objectives: In this study, we aimed to determine the frequency of tarsal tunnel syndrome (TTS) in rheumatoid arthritis (RA) patients. Patients and methods: Thirty RA patients (1 male, 29 females; mean age: 41.9±10.1 years; range, 26 to 65 years) who met the American College Rheumatology (ACR) classification criteria and 20 healthy volunteers (1 male, 19 females; mean age: 39.3±10.8 years; range, 26 to 60 years) without any complaints between August 2006 and October 2007 were included in the study. Demographic characteristics of the study group were assessed and neurological examinations were performed. The Tinel’s sign was checked to provoke the TTS symptoms. Disease severity was measured using Visual Analog Scale (VAS), Disease Activity Score-28 (DAS28), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The health-related quality of life and disability status were determined using the Health Assessment Questionnaire (HAQ), Short Form 36 (SF-36), Foot Function Index (FFI), and VAS (0-100 mm). The positional relationship of the foot pain was questioned with VAS. The 100-m walking distance of the patient and control groups were calculated. Results: Bilateral TTS was detected in 10 of the patients (33.3%) with rheumatoid arthritis. No relationship with the TTS disease duration, seropositivity, rheumatoid nodule, joint deformities, corticosteroid use, and DAS28 score were found. In correlation with TTS, foot and ankle joint were the first involved joints at the beginning of RA disease (p<0.005). The Tinel’s sign was found to be 45% positive in patients with TTS. The 100-m walking time was significantly longer in RA patients compared to the control group (p<0.0001). Conclusion: Tarsal tunnel syndrome is commonly seen in RA and its incidence increases in patients with primary foot involvement. Therefore, caution should be taken against the entrapment neuropathies in these patients, and they should be supported by electrophysiological practices, when the diagnosis is necessary.