The purpose of this study was to determine the accuracy of detecting knee effusion with clinical examination and to evaluate whether the amount of effusion, patient obesity, and the clinicians' experience affect the clinicians' decisions in patients with knee osteoarthritis. Patients presenting with knee pain were examined by two residents with different levels of experience and underwent ultrasonographic examination, including measurement of effusion in the medial, mid, and lateral aspects of the suprapatellar bursa. One hundred seventy-two knees of 86 patients were examined. Of the knees investigated, 127 (73.8 %) had effusion. The consistency between ultrasonographic and resident examination were weak (κ = 0.193, p = 0.007 and κ = 0.349, p < 0.001), although the more experienced senior resident had a stronger agreement. The overall inter-rater agreement between the two residents was low (κ = 0.254). The senior resident had a significantly higher accuracy ratio (p = 0.036). In the knees without effusion, the two examiners had no agreement (κ = -0.028, p = 0.856); however, the ratios of the true decisions were similar (p = 1.0). The accuracy of the less experienced resident's decisions was affected by effusion depth (p = 0.005). Clinicians' decisions and their accuracy in detecting knee effusion during clinical examination were different, especially in the absence of effusion. The consistency between ultrasonography and residents was low. The accuracy of clinical examination was affected by effusion depth and experience, but not by patient obesity.

Objectives: This study aims to investigate the association of two common HTR2A gene polymorphisms, rs6313 (102 T/C) and rs6311 (1438 A/G), with chronic low back pain (CLBP) and the pain threshold, disability, and sex differences. Patients and methods: A total of 121 patients (40 males, 81 females; mean age 36.8±9.9 years; range 18 to 50 years) having CLBP and 91 healthy controls (26 males, 65 females; mean age 34.1±10.2 years; range 18 to 55 years) were included. Pressure pain thresholds (PPTs) of all participants were examined with manual algometer in certain sites of their body. Results:The PPTs were all decreased in CLBP patients (p<0.05). Although PPTs were lower in healthy female individuals, there was no sex difference regarding PPTs in CLBP patients (p>0.05). rs6311 polymorphism of HTR2A gene was associated with CLBP (p<0.05). In rs6313 polymorphism, at least one copy of T carriers and in rs6311 polymorphism, at least one copy of G carriers showed higher disability. Conclusion: The PPT decreases in CLBP patients similar to other chronic pain conditions without any sex difference. Although rs6311 single nucleotide polymorphism of HTR2A gene was associated with CLBP and rs6313 polymorphism was not, rs6311 might have a protective effect on disability of these patients.

These preliminary results revealed that cold exposure may cause acute nerve swelling. Further studies with larger samples will be necessary to confirm our findings, to correlate them with electrophysiological data, and to explore when/how the nerve edema resolves.

Flatfoot, shoe size, age and weight must be kept in mind as a clue for a thinner Achilles tendon morphometry which can be a risk factor in lower limb pathologies.

Objective: Radial shock wave therapy (RSWT) has increasingly been utilized in the treatment of spasticity recently. The purpose of the current study is to assess the effectiveness of RSWT in the treatment of ankle plantar flexor muscles spasticity of stroke patients by pedobarography and clinical evaluation. Materials and Methods: A total of 23 stroke patients were enrolled into the study. Patients received an initial sham treatment of RSWT, followed by three separate interventional sessions received one week apart. Treatment success was assessed using the Modified Ashworth Scale (MAS), ankle passive range of motion (pROM) measurement and pedobarography. Results and Discussion: No significant change was observed in clinical and pedobarographic values following sham RSWT. In the intervention group, however, MAS decreased from3.34±0.7 to 2.39±0.89 after a single RSWT session and to 2.04±0.92 first week and to 2.52±0.89 fourth week after three RSWT sessions. As a result of the study, heel peak pressure and total plantar contact area were improved. In particular, three RSWT sessions were more effective than single RSWT session. Conclusions: We observed a significant improvement in plantar flexor spasticity in stroke patients after both a single and three RSWT sessions and this improvement persisted during the four-week study period. Bangladesh Journal of Medical Science Vol.20(3) 2021 p.586-593

ÖZAmaç: Fiziksel tıp ve rehabilitasyon kliniklerinde inme, travmatik beyin, spinal kord yaralanması, multipl skleroz ve serebral palsi gibi hastalıklarda ortaya çıkan fokal spastisite tedavisinde botulinum toksin tip-A enjeksiyonu sıklıkla uygulanmaktadır. Botulinum toksin tip-A uygulamalarında manuel enjeksiyon, elektromiyografi-elektriksel stimülasyon ve ultrasonografi eşliğinde yapılan enjeksiyonlar sıklıkla kullanılan tekniklerdir. Bu çalışmadaki amacımız, fiziksel tıp ve rehabilitasyon kliniğinde çalışan asistan hekimlerin botulinum toksin tip-A enjeksiyonunda tercihlerini ve bunun nedenlerini değerlendirmektir. Yöntem: Bu tekniklerinden her birini hastalara en az 5 kez öğretim üyesi eşliğinde uygulayan 12 asistan hekime hazırladığımız formdaki sorular yöneltildi. Bulgular: Uygulama tekniği tercih edilirken en çok dikkat edilen konular etkinlik, uygulanacak kasın lokalizasyonu kısa sürede uygulayabilme, uygulanacak kasın ebatı ve tekniğin güvenilirli-ğiydi. Üst ekstremite uygulamalarında en sık tercih edilen ultrasonografiydi. Ultrasonografinin ilk tercih edilmesinde güvenilirlik ön plandaydı. Ancak alt ekstremite uygulamalarında asistan hekimlerin ilk tercihi manuel enjeksiyon iken, ultrasonografi ikinci sırada tercih edilmekteydi. Pediatrik hastalarda da ilk tercih ultrasonografiydi. Kasların lokalizasyonu ve ebatlarına bağlı olarak uygulanacak tekniğin seçimi değişmekteydi. Asistan hekimler gastro-soleus ve biseps için manuel enjeksiyonu, tibialis posterior ile önkol ve el kasları için ultrasonografiyi kullanmayı tercih etmekteydiler. Sonuç: Asistan hekimlerin tercihleri kasların lokalizasyonu ve ebatlarından, uygulama için gereken zamandan ve tekniğin güvenilirliğinden etkilenmektedir. Her ne kadar önkol ve el kasları ile bacağın zor lokalize edilen kasları için ultrasonografiyi tercih etmelerine rağmen, kolayca lokalize edilen bacak kasları için manuel enjeksiyonu tercih etmektedirler. Çünkü manuel enjeksiyonun pratik ve hızlı uygulanabilen bir yöntem olduğunu düşünmektedirler.Anahtar kelimeler: Botulinum, eğitim etkinlikleri, intramusküler enjeksiyonlar ABSTRACT Objective: Botulinum toxin type-A is frequently injected for focal treatment of spasticity which appears in post-stroke, traumatic brain, spinal cord injury, multiple sclerosis and cerebral palsy at the physical therapy and rehabilitation clinics. Manual injections , electromyographyelectrical stimulation and ultrasonography guided interventions are commonly used in botulinum toxin type A applications. In this study, we aimed to evaluate preferences and relevant reasons of the residents working in the clinics of physical therapy, and rehabilitation for botulinum toxin type A injection techniques. Methods: Twelve physical medicine and rehabilitation residents who had applied each of these techniques at least five times under the supervision of instructors completed survey questionnaires. Results: The application techniques were preferred mostly for their effectiveness, size, and location of the muscle to be injected, reliability, and rapidity o...