Objectives: This study aims to compare the superiority of different suprascapular nerve block (SSNB) application methods on hemiplegic shoulder pain (HSP), in a blinded and stimulator guided manner. Patients and methods:Twenty-six stroke patients (19 males, 7 females; mean age 61.0±9.4 years; range 53 to 76 years) meeting the enrollment criteria, were included in this study between September 2014 and November 2014. Patients were randomly divided into two equal groups. Patients in group A received blinded SSNB and patients in group B received stimulator guided SSNB. Range of motion (ROM) (by goniometer) and pain levels (by visual analog scale-VAS) were assessed. Evaluations were made before, one hour after and one week after SSNBs. Results:In each group, VAS pain scores significantly decreased over time (p<0.0001) and a significant increase in terms of flexion and abduction ROM angles (group A: p=0.002 and p=0.010; group B: p=0.004 and p=0.012, respectively) was observed. In addition, internal rotation ROM angles were found to have increased in group B (p=0.036). There were no significant differences in ROM and VAS one hour and one-week change scores between the two groups (p>0.05). Conclusion:Both blinded or stimulator guided suprascapular nerve block techniques were safe and effective for pain relief in hemiplegic shoulder pain management. None of the injection techniques was superior to the other.Keywords: Blinded; hemiplegic shoulder pain; stimulator guided; suprascapular nerve block.Hemiplejik omuz ağrısında kör ve stimülatör kılavuzluğunda supraskapular sinir blokajının karşılaştırılması: Pilot çalışma ÖZ Amaç: Bu çalışmada hemiplejik omuz ağrısında (HOA) kör ve stimülatör kılavuzluğunda, farklı supraskapular sinir blokajı (SSSB) uygulama yöntemlerinin birbirlerine üstünlüğü araştırıldı. Hastalar ve yöntemler:Eylül 2014 -Kasım 2014 tarihleri arasında yapılan bu çalışmaya katılma kriterlerini karşılayan 26 inme hastası (19 erkek, 7 kadın; ort. yaş 61.0±9.4 yıl; dağılım 53-76 yıl) dahil edildi. Hastalar randomize olarak iki eşit gruba ayrıldı. Grup A'daki hastalara kör SSSB, grup B'deki hastalara ise stimülatör kılavuzluğunda SSSB verildi. Eklem hareket açıklığı (EHA) (gonyometre ile) ve ağrı düzeyleri (görsel analog ölçeği-GAÖ ile) değerlendirildi. Ölçümler SSSB öncesinde, bir saat sonrasında ve bir hafta sonrasında yapıldı. Bulgular:Her iki grupta GAÖ ağrı skorlarında zamanla anlamlı olarak azalma (p<0.0001); fleksiyon ve abdüksiyon EHA açılarında (sırasıyla grup A: p=0.002 ve p=0.010; grup B: p=0.004 ve p=0.012) ise anlamlı artış gözlendi. Ek olarak grup B internal rotasyon EHA açılarında artış saptandı (p=0.036). Gruplar arasında, GAÖ ve EHA açıları bir saatlik ve bir haftalık değişim skorlarında anlamlı bir farklılık yoktu (p>0.05).Sonuç: Kör ya da stimülatör kılavuzluğunda yapılan supraskapular sinir blokajı tekniklerinin her ikisi de güvenli ve hemiplejik omuz ağrısı tedavisinde ağrının giderilmesinde etkilidir. Hiçbir enjeksiyon tekniği diğerinden üstün değildir.Anahtar sözcükler: Kör; hemiple...

Sacral stress fracture and sacroiliitis are two conditions that present with pain. Sacral stress fractures are a rare cause of lumbar and hip pain. Sacral insufficiency fractures are a type of sacral stress fractures. Sacroiliitis represents inflammation of the sacroiliac joints. Coexistence of sacroiliitis and sacral insufficiency fracture (SIF) has not been reported before. Case 1: A 39-year-old woman reporting inflammatory back pain. Imaging revealed bilateral chronic sacroiliitis and bilateral SIF. Case 2: A 31-year-old woman presenting with left hip and inguinal pain. Imaging revealed left sacroiliitis and ipsilateral SIF. Calcium and vitamin D supplementation together with nonsteroidal anti-inflammatory drug (NSAID) treatment were given. Sulfasalazine was added to the treatment of the second patient who developed peripheral arthritis during follow-ups. Early diagnosis is best made with magnetic resonance imaging (MRI) since roentgenograms may be negative initially. Furthermore, MRI findings of both entities share common features leading to a diagnostic dilemma. Interpretation of radiological findings assisted by detailed history and clinical findings is crucial for diagnosis and treatment.

Pregnancy and lactation-associated osteoporosis (PLO) is a rare condition. Its pathogenesis and etiology are unknown. It is frequently observed in the last trimester of pregnancy and during lactation period in primigravida. The symptoms may begin with back and hip pain. In addition, it could be complicated by osteoporotic fractures and disability. Here, we report a long-term (7 years) follow-up of a 29-year-old patient who underwent two pregnancies and was diagnosed with PLO both the times. The first time this patient was admitted to our outpatient clinic with a complaint of severe back pain, she was in the lactation period of her first pregnancy. Laboratory findings, X-ray imaging and densitometry revealed osteomalacia (25-OH Vit D = 6.8 ng/dL), multiple vertebral fractures (T6-T9-T11-T12-L1), and osteoporosis (L1-L4 T-score: -4.6). After the treatment for vitamin D deficiency, she was treated with risedronate and Ca-vitamin D supplementation. At the end of the 2-year follow-up, she terminated the use of risedronate [by her own decision] and continued with the Ca-vitamin D supplementation. Six years after the first pregnancy, she became pregnant again. In the postpartum period, she complained about gait difficulty, and severe hip and back pain. With the help of laboratory results, imaging, and densitometry (L1-L4 T-score: -3.9), she was diagnosed with PLO second time, and was treated with zoledronic acid, in addition to Ca-vitamin D supplementation. Once back pain occurs in the postpartum period, PLO should be considered in differential diagnosis even if the patient is taking Ca-vitamin D supplementation.Gebelik ve laktasyon ile ilişkili osteoporoz (GLO) patogenezi ve etyolojisi bilinmeyen nadir bir durumdur. Sıklıkla ilk gebeliğin son üç ayında ve laktasyon periyodunda görülür. Semptomlar bel ve kalça ağrısı ile başlayabilir, osteoporotik kırıklar ve disabilite eşlik edebilir. Bu vaka takdiminde her iki gebeliğinde de GLO teşhis edilen 29 yaşında bir hastanın uzun dönem (7 yıl) takiplerini sunduk. Hasta polikliniğimize şiddetli sırt ağrısı şikayetiyle başvurduğunda ilk gebeliğinin laktasyon periyodundaydı. Laboratuar bulguları, X-ray görüntüleme ve dansitometri sonucunda osteomalazi (25-OH Vit D= 6.8 ng/dL), multiple vertebra kırıkları (T6-T9-T11-T12-L1) ve osteoporoz (L1-L4 T-score: -4.6) tespit edildi. Tedavisine, D vitamini replasmanı sonrası risedronat ve Ca-D vitamin ile devam edildi. İki yıllık takibin sonunda hasta (kendi isteğiyle) risedronat kullanımını keserek Ca-D vitamini kullanmayı sürdürdü. Ilk gebeliğinden altı yıl sonra tekrar gebe kaldı. Postpartum periyodda yürüme güçlüğü, şiddetli sırt ve kalça ağrısı yakınmaları olan hastaya laboratuar, görüntüleme ve dansitometri (L1-L4 T-score: -3.9) bulgularının sonucunda ikinci defa GLO tanısı konuldu. Hastaya Ca-D vitamini takviyesine ek olarak zoledronik asit tedavisi uygulandı. Postpartum periyodda sırt ağrısı ile başvuran hastalarda; hasta Ca-D vitamini takviyesi kullansa bile ayırıcı tanıda GLO akla gelmelidir.

OBJECTIVE:The aim of this study is to investigate the differences between hemorrhagic and ischemic stroke patients in terms of clinical and functional features.METHODS:Medical records of the patients with stroke were analyzed retrospectively. The patients’ demographic characteristics, stroke etiology, time interval after the event, comorbid illness and functional status were recorded.RESULTS:The stroke etiology was ischemia for 60 (36 male/24 female) (75%) patients, and haemorrhage for 20 (10 male/10 female) (25%) patients. Patients with ischemic stroke were classified as Group 1, and patients with hemorrhagic stroke were classified as Group 2. The mean age for Group 1 was 62.2±13.2, and 55.8±17.1 years for Group 2 (p=0.592). In Group 1, 33 (55%) patients, and in Group 2, 11 (55%) patients were primary school graduates (p=0.984). Localization of the lesion was in the right side for 33 (55%) patients in Group 1, and for 15 (75%) patients in Group 2 (p=0.372). The mean time interval after event for Group 1 was 7 months (0-211 days), and for Group 2 it was 14.5 (1-420 days) months (p=0.592). FIM score for Group 1 was 71.9±28.0, and 68.1±21.0 for Group 2 (p=0.575). The mean Brunnstrom score for upper extremity was 3.5 for Group 1, 3 for Group 2, (p=0.866), and for lower extremity, it was 3.5 for Group 1, and 3 for Group 2 (p=0.143). Spasticity was present in 45 (75%) patients in Group 1, and in 12 (60%) patients in Group 2 (p=0.311). In Group 1 51 (85%) of the patients and 18 (95%) patients had a history of comorbid disease (p=0.554).CONCLUSION:Etiology of stroke is thought to be not effective on the patient’s clinical and functional status.

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Amaç: Piriformis sendromu (PS) olan hastalarda ultrason (US) eşliğinde steroid ve lokal anestezik (LA) enjeksiyonunun kısa dönem etkinliğini değerlendirmektir. Yöntem ve Gereçler: Piriformis sendromlu 17 hasta (14/3:kadın/erkek; yaş ortalaması 56.2±10.2 yıl) çalışmaya dahil edildi. PS tanısı klinik anamnez, piriformis kası üzerinde hassasiyet, Freiberg test, Pace bulgusu ve fleksiyon-adduksiyon-internal rotasyon (FAIR) test sonuçları ile konuldu. US eşliğinde enjeksiyon öncesi ve enjeksiyondan 1 hafta sonra tedavinin etkinliği; uzun süreli oturma sonrası vizüel ağrı skalası (VAS: 0-10), piriformis kası üzerinde derin palpasyonla hassasiyet (var/ yok), Freiberg testi (pozitif/negatif), Pace bulgusu (pozitif/negatif) ve FAIR testi (pozitif/negatif) ile değerlendirildi. İstatistiksel analizlerde McNemar test ve Wilcoxon test kullanıldı.

Aim: Pain is the most significant symptom in musculoskeletal disorders. General hypersensitivity to pain is often associated with conditions of chronic pain. In this study we compared pain degrees of different musculoskeletal disease groups by pain pressure threshold and visual analog scale. Materials and Method:Patients diagnosed with ankylosing spondylitis (n=34), fibromyalgia (n=30), myofascial pain syndrome (n=33), osteoporosis (n=34), generalized osteoarthritis (n=34) and rheumatoid arthritis (n=34) and healthy subjects (n=30) were included in the study. Beck depression inventory was used for psychological evaluation. Visual analog scale (VAS) was used to quantify clinical pain. PPT measurements made from the areas that generally not showing involvement of disease: at middle deltoid, middle ulna, hypothenar eminence, thumb, mid-tibia, and quadriceps femoris.Results: VAS score for clinical pain ranged from 4.76±3.15 in ankylosing spondylitis to 7.44±2.42 in fibromyalgia. Fibromyalgia consistently had the lowest PPT across all sites of measurements indicating increased pain sensitivity. Myofascial pain syndrome and ankylosing spondylitis were the only diseases that did not show greater sensitivity to pain compared to healthy controls. Osteoporosis patients also reported an average clinical pain of 6.09±3.23 on VAS, and showed general tenderness regardless of presence of verified fractures. Overall, female gender, advanced age, depression and NSAID use correlated with lower PPT. Conclusions:The level of pain sensitivity may provide a clue regarding the mechanism and treatment options of musculoskeletal disorders.

Heterotopik Ossifikasyon (HO), anormal bir anatomik bölgede, genellikle yumuşak dokuda kemik oluşumu olarak tanımlanır. Nörolojik hastalıklar (travmatik beyin yaralanması, spinal kord yaralanması gibi) veya travma sonrasında gelişebilir. Erken HO'da tipik olarak ısı artışı, şişlik, eritem ve azalmış eklem hareketi görülür. Enfeksiyon, derin ven trombozu ile karışabilir. Diyagnostik radyografi bulguları semptom başlangıcından yaklaşık 1 ay sonra ortaya çıkabilir. Ultrasonografi (USG)'nin ise HO erken tanısında ve takibinde yararlı olduğu bildirilmiştir. Burada olguda travma sonrası gelişen HO erken tanısında USG'nin önemi belirtilmiştir.