Browsing by Author "Ozen, Selin"

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Bilateral Femoral Head Insufficiency Fractures and Multiple Vertebral Fractures: A Case Report on Rare Presentations of Pregnancy and Lactation-associated Osteoporosis and Their Outcomes
(2020) Ozen, Selin; Yemisci, Oya Umit; Sozay, Seyhan; 0000-0002-7290-8558; 0000-0002-0501-5127; ABC-1305-2020
Pregnancy and lactation-associated osteoporosis (PLO) is a rare condition seen in the last trimester of pregnancy and early puerperal period which can result in vertebral and femoral fractures. In this case report, two cases of fractures secondary to PLO, their management and clinical outcomes are presented. Case one describes a patient with vertebral fractures secondary to PLO who was treated with bisphosphonates. Case two describes a rare case of bilateral femoral head stress fractures secondary to PLO, treated with bed rest, a home exercise programme and calcium and vitamin D supplementations. Pharmacological treatment of PLO includes teriparatide and strontium ranelate and crossover treatments-all of which require the cessation of breastfeeding. The optimal PLO treatment remains to be determined. Further studies comparing the clinical and biological outcomes of these drugs are necessary so that clinicians can accurately advise women on the risks and benefits of each, for both themselves and their child and guide patients in making a suitably informed decision regarding treatment.
Bilateral peroneal nerve palsy secondary to prolonged sitting in an adolescent patient
(2020) Guzel, Sukran; Ozen, Selin; Cosar, Sacide Nur; 0000-0001-9852-0917; 0000-0002-7290-8558; 0000-0001-8306-463X; 33175582; AAG-3148-2021; ABC-1305-2020; AAF-1085-2021
Peroneal nerve palsy most commonly occurs due to focal compression of the peroneal nerve at the level of the fibular head and causes foot drop and variable sensory loss. Mononeuropathies infrequently occur in childhood, bilateral peroneal palsy is very rare. In this article, we report the case of a 14-year-old boy with bilateral peroneal nerve entrapment which developed secondary to a prolonged sitting posture. We discuss the clinical assessment, diagnosis, and treatment of this rare case of bilateral peroneal palsy following prolonged immobility in light of the current literature.
A CASE OF ISCHAEMIC STROKE FOLLOWING CERASTES CERASTES SNAKE BITE IN LIBYA
(2020) Ozen, Selin; Guzel, Sukran; 0000-0001-9852-0917; 0000-0002-7290-8558; AAG-3148-2021; ABC-1305-2020
Background: Cerastes cerastes is a venomous species of viper native to the deserts of northern Africa and parts of the Middle East. Reported cases of ischaemic stroke following a Cerastes cerastes bite are extremely few. Here we describe a case of ischaemic stroke occurring four days after envenomation by C.cerastes. Case presentation: A 26-year-old male was admitted to our rehabilitation unit with a history of ischaemic stroke and right sided hemiplegia. Four months previously he had been bitten by a C.cerastes viper in Libya. Four days after envenomation the patient developed sudden onset of aphasia and right sided weakness. Brain magnetic resonance imaging (MRI) revealed ischaemia in the territory of the left middle cerebral artery. On admission to our hospital, routine blood tests, coagulopathy and vasculitis screening was normal. Colour doppler ultrasound imaging of the carotid and vertebral arteries, MR angiography, transthoracic and transoesophageal echocardiography and Holter electrocardiogram were normal. A daily dose of aspirin 100 mg and physical therapy program was commenced. Conclusion: Only three cases of ischaemic stroke following C.cerastes bite have been reported in the literature. Hypotension, endothelial injury, hypercoagulability and vasculitis have been suggested as possible mechanisms for its occurrence. This probable case of stroke due to envenomation shows that stroke may occur as late as four days after the snake bit and highlights the importance of early administration of antivenom. Patient education on this subject maybe considered an important public health issue in areas of Africa and Asia in which viper bites occur.
A Comparison of Physical Therapy Modalities Versus Acupuncture in the Treatment of Fibromyalgia Syndrome: A Pilot Study
(2019) Ozen, Selin; Cosar, Sacide Nur Saracgil; Cabioglu, Mehmet Tugrul; Cetin, Nuri; https://orcid.org/0000-0002-7290-8558; https://orcid.org/0000-0001-8306-463X; 30620209; ABC-1305-2020; AAF-1085-2021
Objectives: Physical therapy (PT) modalities are used in the treatment of fibromyalgia syndrome (FMS). Acupuncture is a treatment option often sought after by FMS patients. The aim of this study was to compare the effects of PT modalities with those of acupuncture on pain, daily function, and quality of life in FMS patients. Design: A comparative effectiveness study. Setting and Subjects: Forty-four female patients between the ages of 18-70 years presenting to Baskent University Faculty of Medicine Department of Physical and Rehabilitation Medicine with a new diagnosis of FMS according to the American College of Rheumatology, with manifestations of chronic widespread musculoskeletal pain symptoms, normal routine blood tests, and a desire to receive PT or acupuncture were included in the study. Exclusion criteria included the presence of neurologic, inflammatory, endocrinologic, and other chronic diseases, psychiatric illness, use of antidepressants or analgesics, and contraindication to treatment with PT modalities. Interventions: One group (n=22) received 15 sessions of hotpack, transcutaneous electrical nerve stimulation (TENS), and ultrasound to the tender points of the cervical and upper back regions. The other group (n=22) received 10 sessions of formulated acupuncture aimed at treating pain of the neck, upper, and lower back regions. Outcome measures: Pain, functionality, and quality of life measured using the Short Form McGill Pain Questionnaire (SF-MPQ) and Fibromyalgia Impact Questionnaire (FIQ) before and after treatment. Results: There was a reduction in all SF-MPQ domains and FIQ scores after treatment in both the PT and acupuncture groups. There was no difference in pre- and post-treatment scores between the two groups. Conclusions: PT modalities and acupuncture can be effectively used in the treatment of FMS. Even though one treatment option was not found to be more beneficial than the other, longer post-treatment follow-up may help determine the superior treatment option.
Compliance with Long-Term Use of Orthoses Following Spinal Cord Injury
(2022) Yemisci, Oya U.; Ozen, Selin; Cosar, Sacide N. Saracgil; Afsar, Sevgi, I; 35532629
Background: Prescription of orthoses and assistive devices that facilitate physical function is a major component of the rehabilitation process in spinal cord injury (SCI). Objective: To evaluate the long-term use of orthoses prescribed during inpatient rehabilitation in people with SCI and investigate the factors related to discarding the device. Materials and Methods: Medical records of 202 SCI patients who were included in an inpatient rehabilitation program of a tertiary research hospital were reviewed retrospectively. Patients' demographic data, neurological level of spinal cord injury functional state and use of assistive devices for ambulation (orthoses, walkers, etc.) at discharge were recorded. At follow-up, study participants were contacted by telephone and queried regarding the frequency and duration of use of orthoses; if the individual had discontinued using the orthoses, the reasons for discarding the device were sought. Results: The majority of the study participants (62.7%) had been prescribed a knee-ankle-foot orthosis during their inpatient stay. At follow-up, the regular use of orthoses was ongoing in 67.6% of the participants, and nonuse was determined in 32.4%. The most common cited reasons for discarding the device were difficulty in donning and doffing, functional improvement, and mechanical problems of the orthoses. Conclusions: A significant number of patients had discarded their orthoses at the long-term follow-up and the main reasons for discarding the devices were orthotic factors. Timely reevaluation of the patient and orthosis modification according to patients' needs is necessary to achieve long-term compliance.
Computer Game Assisted Task Specific Exercises in the Treatment of Motor and Cognitive Function and Quality of Life in Stroke: A Randomized Control Study
(2021) Ozen, Selin; Senlikci, Huma Boluk; Guzel, Sukran; Yemisci, Oya Umit; 0000-0001-6771-3265; 0000-0002-7290-8558; 0000-0001-9852-0917; 34293643; AAX-8965-2021; ABC-1305-2020; AAG-3148-2021
Objectives: Computer game assisted task specific exercises (CGATSE) are rehabilitation gaming systems (RGS) used in stroke rehabilitation to facilitate patient performance of high intensity, task based, repetitive exercises aiming to enhance neuroplasticity. CGATSE maybe an appealing option in home based rehabilitation of stroke patients, especially during the COVID-19 pandemic. This study aimed to determine the effects of CGATSE on hemiplegic arm-hand function, cognitive function and quality of life in stroke. Materials and methods: Thirty stroke patients were randomized into two groups. All participants received twenty sessions of physical therapy. In addition, the therapy group undertook thirty minutes of CGATSE using the Rejoyce gaming system; while the control group undertook thirty minutes of occupational therapy (OT). Motor function was evaluated before and after treatment using the Fugl Meyer upper extremity (FMUE), Brunnstrom stages of stroke recovery (BSSR) arm and hand. The CGATSE group also completed the Rejoyce arm hand function test (RAHFT). Cognitive function was evaluated using the mini mental state examination, Montreal Cognitive Assessment (MoCA) and Stroke Specific Quality of Life (SS-QOL) scale. Results: The FMUE, BSSR arm and SSQOL improved in both groups (p < 0.05). BSSR of the hand improved only in the CGATSE group (p = 0.024). RAHFT scores improved in the CGATSE group (p = 0.008). MoCA scores significantly improved in the control group (p = 0.008). Conclusions: CGATSE may be beneficial in providing continuation of care after stroke, especially during the Covid-19 pandemic when home based rehabilitation options are becoming increasingly important. Benefits of CGATSE in improving cognitive function is less clear. RGS aimed at improving motor function may be compared to gaming systems designed to target cognitive development and more detailed higher cortical function deficit tests can be used as outcome measures.
Does the presence of ideomotor apraxia in stroke patients adversely affect rehabilitation outcomes? A prospective study
(2020) Cosar, Sacide Nur Saracgil; Ozen, Selin; Selcuk, Selin Taflan; Yemisci, Oya Umit; 0000-0001-8306-463X; AAF-1085-2021
Background and Objectives: Ideomotor apraxia is an inability to perform a gesture following a verbal command despite having intact knowledge of the task. The presence of ideomotor apraxia may negatively affect functional outcome of stroke patients. The aim of this study was to evaluate the effect of ideomotor apraxia on rehabilitation outcomes following first ever stroke. Methods: A cross sectional observational study of 35 stroke patients admitted to a rehabilitation unit for treatment. Patients were evaluated for ideomotor apraxia using the ideomotor apraxia test. Function was assessed before and after treatment using the Functional Independence Measure, motricity index and functional ambulation scale. Cognitive function was evaluated using the Functional Independence Measure and mini mental state examination. Results: Ideomotor apraxia was present in 31.4% of patients. Mean Functional Independence Measure motor and cognitive scores of apraxic patients on admission and at discharge were lower than those of non-apraxic patients, (p<0.05). The cognitive and total Functional Independence Measure scores and motricity scores in the ideomotor apraxia group on discharge had not reached the admission values of the non-ideomotor apraxia group. Conclusion: The presence of ideomotor apraxia following stroke has a negative impact on overall function, both before and after rehabilitation, when compared to stroke patients without ideomotor apraxia. Stroke patients must be assessed for ideomotor apraxia prior to commencement of a rehabilitation program in order to guide treatment and determine realistic treatment goals.
Effectiveness of continuous versus pulsed short-wave diathermy in the management of knee osteoarthritis: A randomized pilot study
(2019) Ozen, Selin; Doganci, Ekin B.; Ozyuvali, Ayla; Yalcin, Ayse Peyman; 31814942
Background: Short-wave diathermy (SWD) is an electrotherapeutic modality used in the conservative treatment of knee osteoarthritis (KOA). Electromagnetic radiation delivered in continuous (cSWD) or pulse (pSWD) mode provides a deep heating effect on tissues. There is no consensus on outcomes of treatment with cSWD versus pSWD in KOA. The aim of this study was to compare the effects of cSWD versus pSWD on pain, functionality and walking distance in KOA. Methods: 34 female patients aged 49-65 with KOA were randomized into two groups. A total of 27 patients completed the study. One group (n=11) was treated with cSWD, the other (n=16) with pSWD for three weeks. Patients were assessed before, after and at one month post therapy. Outcome measures included visual analogue scale (VAS) for knee pain, Western Ontario and Mcmaster University Osteoarthritis Index (WOMAC) and a six-minute walking test (6MWT). Results: Based on the minimal clinically important improvement (MCII), there was a reduction in VAS and WOMAC scores in both cSWD and pSWD groups post treatment (-37.3mm, 31.2mm respectively for VAS and 26%, 23% respectively for WOMAC) and at one month post treatment. There was no difference in pre and post treatment VAS for pain, WOMAC or 6MWT scores between the two groups. There was a small post treatment effect size on between- group 6MWT scores (Cohen's d: 0.238). Conclusion: Both treatment options appear to be efficacious in reducing pain and improving functionality in KOA. There was no between-group difference. A larger study must be conducted to consolidate these findings.
Effects of Bihemispheric Transcranial Direct Current Stimulation on Upper Extremity Function in Stroke Patients: A randomized Double-Blind Sham-Controlled Study
(2020) Alisar, Dilek Cetinkaya; Ozen, Selin; Sozay, Seyhan; 0000-0002-8460-7699; 0000-0002-7290-8558; 0000-0002-9610-2153; 31699572; AAJ-2936-2021; ABC-1305-2020
Background and Purpose: Transcranial direct current stimulation (tDCS) is a treatment used in the rehabilitation of stroke patients aiming to improve functionality of the plegic upper extremity. Currently, tDCS is not routinely used in post stroke rehabilitation. The aim of this study was to establish the effects of bihemspheric tDCS combined with physical therapy (PT) and occupational therapy (OT) on upper extremity motor function. Methods: Thirty-two stroke inpatients were randomised into 2 groups. All patients received 15 sessions of conventional upper extremity PT and OT over 3 weeks. The tDCS group (n = 16) also received 30 minutes of bihemispheric tDCS and the sham group (n = 16) 30 minutes of sham bihemispheric tDCS simultaneously to OT. Patients were evaluated before and after treatment using the Fug1 Meyer upper extremity (FMUE), functional independence measure (FIM), and Brunnstrom stages of stroke recovery (BSSR) by a physiatrist blind to the treatment group Results: The improvement in FIM was higher in the tDCS group compared to the sham group (P = .001). There was a significant within group improvement in FMUE, FIM and BSSR in those receiving tDCS (P = .001). There was a significant improvement in FIM in the chronic (> 6months) stroke sufferers who received tDCS when compared to those who received sham tDCS and when compared to subacute stroke (3-6 months) sufferers who received tDCS/sham. Conclusions: Upper extremity motor function in hemiplegic stroke patients improves when bihemispheric tDCS is used alongside conventional PT and OT. The improvement in functionality is greater in chronic stroke patients.
Efficacy of Ultrasound Versus Short Wave Diathermy in the Treatment of Chronic Low Back Pain in Patients with Lumbar Disk Herniation: A Prospective Randomized Control Study
(2023) Ozen, Selin; Guzel, Sukran; Senlikci, Huma Boluk; Cosar, Sacide Nur Saracgil; Selcuk, Ebru Selin; 0000-0002-7290-8558; 0000-0001-8306-463X; 37986090; ABC-1305-2020; AAF-1085-2021
Background Lumbar disk herniation (LDH) is a cause of chronic low back pain (CLBP) treated using physical therapy (PT), including exercise and physical modalities such as ultrasound (US) and short wave diathermy (SWD). Despite the use of US and SWD, there is inconclusive evidence on their efficacy. The aim of this study was to investigate the efficacy of US and SWD in the treatment of CLBP in patients with LDH.Method A prospective randomized control clinical study. Individuals with radicular CLBP and LDH on magnetic resonance imaging, presenting to the Physical and Rehabilitation Medicine Department were randomized into 3 treatment groups. All participants received 10 sessions of hotpack, transcutaneous nerve stimulation (TENS) and therapeutic exercises. In addition, Group 1 received 10 sessions of therapeutic US (1 MHz, 1.5W/cm2, 10 min), Group 2 SWD (27.12 MHz, wavelength 11.06 m, induction technique, 20 min) to the lower back. Group 3 (control group) received hotpack, TENS and therapeutic exercises alone. Visual analogue scale (VAS) for LBP, Modified Oswestry Disability Index (MODI) and Short Form 36 (SF-36) were evaluated pre and post treatment and at one and three months follow up.Results In all groups, VAS for LBP and MODI improved with treatment and at the one and three month follow up (p < 0.001). In Groups 1 and 2, MODI scores continued to reduce at 1 and 3 months (p < 0.001 and p = 0.012 respectively). SF-36 physical, social function and pain parameters reduced in all groups (p < 0.05). Role limitation due to physical and emotional problems, emotional well-being, vitality and mental health improved in Groups 1 and 2 (p < 0.05).Conclusions Deep heating agents can be used as part of the physical therapy for CLBP in those with LDH with positive mid-term effects.Trial registrationNCT03835182, 02/04/2019.
Elastofibroma dorsi: A case report on an unobserved cause of back pain
(2020) Guzel, Sukran; Ozen, Selin; Sozay, Seyhan; Kilic, Mehmet Dalokay; 0000-0002-8460-7699; 0000-0002-7290-8558; 0000-0001-9852-0917; 32962604; AAJ-2936-2021; ABC-1305-2020; AAG-3148-2021
Elastofibroma dorsi (ED) is a rare, benign soft tissue tumor which often occurs in the subscapular region of elderly individuals and shows a female predominance. While many patients remain asymptomatic, ED can cause pain in the periscapular region. The clinical signs of ED are non-specific and variable which can result in misdiagnoses; it is often confused with rotator cuff and cervical spine pathologies. In this article, we present the case of a 78-year-old female patient with persistent back and shoulder pain. The patient was admitted to various clinics over a number of years for diagnostic investigations and treatment. However, the true etiology of back pain was never established and treatments were applied without any positive effect. Finally, when the patient presented to our clinic, a mass was detected in the right subcapular region. Thoracic computed tomography imaging was consistent with a diagnosis of ED. Due to the patient's persistent back pain, surgical excision of the tumor was performed. The pathology report confirmed the diagnosis. This case emphasizes the importance of a thorough examination in patients who may initially only have very subtle signs of the underlying pathology. This case also highlights the importance of re-visiting initial evaluations and differential diagnoses when faced with a difficult case of persistent back and shoulder pain so to avoid misdiagnoses and unnecessary treatments.
Exercise, Manipulative Therapy, and Physical Modalities in the Treatment of Notalgia Paresthetica: A Case Report
(2021) Ozen, Selin; Cosar, Sacide NurSaracgil; Sozay, Seyhan; 35496723
Objective: The purpose of this case report is to describe the care of a patient with notalgia paresthetica (NP).& nbsp;Clinical Features: A 61-year-old man presented with a 7-year history of upper back pain, concentrated in the right periscapular region. Physical examination revealed a hyperpigmented area in the right dorsal paravertebral and infrascapular region with local paraesthesia. After investigations, a diagnosis of NP was made.& nbsp;Intervention and Outcome: An exercise program including back and shoulder stretching and shoulder strengthening exercises, and transcutaneous electrical nerve stimulation resulting in a reduction of symptoms.& nbsp;Conclusion: In the case described here, the patient's symptoms regressed when treated conservatively with exercise and physical therapy modalities.& nbsp;
Isolated brachial artery aneurysm successfully treated with a covered stent in a patient with Behcet's disease
(2019) Yigit, Gorkem; Ozen, Selin; Ozen, Anil; Iscan, Zafer; 32082926
Behcet's disease is a vasculitic pathology characterized by skin lesions, genital ulcers, aphthous stomatitis, and uveitis. Arterial aneurysms are rare in this disease. Herein, we report a rare case of an isolated brachial artery aneurysm with a history of Behcet's disease treated with endovascular covered stenting of the brachial artery.
Multiple Dissecting Intracranial and Extracranial Aneurysms in Rheumatoid Arthritis: A Rare Case
(2023) Ozen, Selin; Guzel, Sukran; https://orcid.org/0000-0002-7290-8558; https://orcid.org/0000-0001-9852-0917; 35389771; ABC-1305-2020; AAG-3148-2021
A 52 year old female with a history of rheumatoid arthritis (RA) and persistently raised levels of serum rheumatoid factor and cyclic citrunillated peptide, presented with dissecting aneurysms at the right internal carotid artery, and intact aneurysms at the supraclinoid segment and opening of the right opthalmic artery. Coil embolization was performed. The patient developed an ischaemic stroke two days later. Intra and extra-cranial large vessel aneurysms in RA have rarely been reported in the literature. RA patients with persistent systemic inflammation are at increased risk of developing vascular complications and ischaemic stroke. Here, high levels of tissue-deposited immune complexes may have resulted in cerebral artery vasculopathy. Risk stratification for the development of vascular complications, including cranial aneurysms and ischaemic stroke, in RA patients with poorly controlled systemic inflammation, is important; especially when we consider the neurological sequelae associated with dissecting cerebral aneurysms, cerebral infarction and surgical intervention.
Physical therapy versus radial extracorporeal shock wave therapy in the treatment of carpal tunnel syndrome: A randomized-controlled study
(2022) Saglam, Gonca; Alisar, Dilek Cetinkaya; Ozen, Selin; 35949973
Objectives: This study aims to compare the efficacy of physical therapy (PT) and radial extracorporeal shock wave therapy (rESWT) in the treatment of carpal tunnel syndrome (CTS). Patients and methods: Between May 2020 and July 2020, a total of 125 wrists of 95 patients (22 males, 73 females; mean age: 54.3 +/- 11.3 years; range, 19 to 69 years) with mild-to-moderate CTS were allocated into three groups. The control group (Group 1, n=42) was treated with splinting and an exercise program. Group 2 (n=42) was treated with a total of three sessions of rESWT, splinting and an exercise program. Group 3 (n=41) was treated with a total of 15 sessions of PT modalities, splinting, and an exercise program. Each patient was evaluated before, three weeks and 12 weeks after treatment using a Visual Analog Scale (VAS), the Boston Carpal Tunnel Questionnaire (BCTQ), the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale, and electrodiagnostic testing. Results: The reduction in VAS, BCTQ, LANSS, and improvement in sensory nerve conduction velocity were significantly greater at three and 12 weeks of follow-up in Groups 2 and 3, compared to Group 1 (p<0.001). A greater improvement was observed in all clinical parameters in Group 2, compared to Group 3 (p<0.001). Conclusion: This is the first study to compare the treatment outcomes of PT and rESWT in the treatment of CTS. The results of this study show that both PT and rESWT are effective in the treatment of CTS; however, rESWT yields superior treatment effects compared to conventional PT. The practicalities of administering rESWT and its efficacy in the treatment of CTS may make it the treatment of choice.
Platelet-rich plasma injection in a patient with adhesive capsulitis due to chronic kidney disease
(2020) Boluk Senlikci, Huma; Ikbali Afsar, Sevgi; Ozen, Selin; 0000-0002-4003-3646; 0000-0002-7290-8558; 32297967; E-2103-2019; ABC-1305-2020
Post-stroke bilateral heterotopic ossification: An acute problem with long-lasting consequences
(2020) Ozen, Selin; Senlikci, Huma Boluk; Yemisci, Oya Umit; 0000-0002-7290-8558; 0000-0002-0501-5127; 32584742; ABC-1305-2020; AAJ-8820-2021
Heterotopic ossification (HO) is a complication of injury to the central nervous system in which production of lamellar bone within the soft tissues occurs resulting in pain, reduced range of motion ( ROM) and loss of functional capacity. Heterotopic ossification is rarely seen in stroke patients and mostly affects the paretic side. In this article, we present a case of established bilateral HO of the hips soon after stroke onset. A 77-year-old female patient with a five-month history of stroke presented to our rehabilitation clinic. Physical examination revealed sensorimotor aphasia, right-sided hemiplegia, bilateral painful limited ROM of the hips and left knee contracture. An anteroposterior X-ray of the pelvis revealed previously undiagnosed bilateral HO of the hips. The patient and her relatives declined operative interventions. The patient was discussed in the departmental meeting and it was agreed that she would not be able to partake in an active inpatient rehabilitation program. She was discharged with a home exercise plan. This case highlights the importance of HO, of both the paretic and non-paretic side, being included in the differential diagnosis of post-stroke patients presenting with joint pain and reduced ROM, both acutely and in the long-term. This may aid the timely diagnosis and management of HO, a pathology which has detrimental effects on functionality.
Prognostic Value of Magnetic Resonance Imaging in the Evaluation of Physical Therapy Outcomes in Patients with Adhesive Capsulitis
(2021) Cosar, Sacide Nur Saracgil; Ozen, Selin; Coskun, Mehmet; Yemisci, Oya Umit; Kurtcebe, Ali Niyazi; 0000-0001-8306-463X; 0000-0002-7290-8558; 0000-0002-0501-5127; 34396065; AAF-1085-2021; ABC-1305-2020; AAJ-8820-2021
Objectives: This study aims to investigate whether the treatment outcomes of patients with a clinical diagnosis of adhesive capsulitis (AC) and magnetic resonance imaging (MRI) findings consistent with AC undergoing physical therapy (PT) differs to those with AC in the absence of these MRI findings. Patients and methods: Between January 2012 and October 2012, a total of 30 patients (8 males, 22 females; mean age 55.6 +/- 12.1 years; range, 35 to 85 years) with a clinical diagnosis of AC underwent MRI of the index shoulder. The MRI scans were evaluated for findings associated with AC: intensity of the inferior glenohumeral ligament (IGHL) and rotator interval (RI). All patients received a total of 15 sessions of PT: hot pack, transcutaneous electrical nerve stimulation, ultrasound, and shoulder exercises. The patients were assessed for shoulder range of motion (ROM) using the Visual Analog Scale ( VAS) for shoulder pain, Quick Disabilities of the Arm Shoulder and Hand (Q-DASH), and Health Assessment Questionnaire (HAQ) prior to and following completion of PT. Results: Of the patients, 21 had no MRI findings consistent with AC (Group 1), nine patients had changes in the IGHL and/or RI characteristic of AC (Group 2). In both groups, there was a significant improvement in active and passive shoulder ROM and VAS scores for shoulder pain at rest (Group 1: p<0.001, Group 2: p=0.017) with movement (Group 1: p<0.001, Group 2: p=0.007) and at night (Group 1: p<0.001, Group 2: p=0.012) following PT. However, there was no significant inter-group difference in scores. Similar findings were recorded for Q-DASH and HAQ. Conclusion: Based on these study findings, the presence of characteristic MRI findings of AC with a clinical diagnosis do not predict clinical response to physical therapy.
A Rare Benign Tumor With Diagnostic Difficulties: Synovial Chondromatosis
(2020) Yemisci, Oya Umit; Ozen, Selin; Koseoglu, Hamide Kart; 0000-0002-7290-8558; 0000-0002-0501-5127; 32851378; ABC-1305-2020; AAJ-8820-2021
In this article, we present a case of a 47-year-old male patient presenting with an insidious onset of hip pain and loss of range of motion. The patient was initially treated conservatively to no avail. Detailed investigations included magnetic resonance imaging of the left hip which revealed a synovitis. Blood results were unremarkable apart from moderately raised inflammatory markers. Differential diagnoses of both intra-and extra-articular hip pain were ruled out and the patient treated for a preliminary diagnosis of psoriatic arthritis for a total of six months. Persistent pain resulted in a re-visit of the diagnosis and further clinical evaluation. This time, an X-ray of the hip revealed calcification at the joint. A computed tomography followed and revealed synovial thickening and intra-articular calcification. A biopsy was consistent with primary synovial chondromatosis (SC). Open synovectomy was performed approximately one year after the onset of symptoms. This case emphasizes the importance of re-visiting initial evaluations and diagnoses when faced with a difficult case of persistent hip pain so to avoid misdiagnosis and unnecessary pharmacological treatment. In view of its rarity and diagnostic challenges, future work on SC should concentrate on gathering data which can be used to produce a diagnostic algorithm.
Sacroiliac Joint Dysfunction Treated Using Neural Therapy to the Temporomandibular Joint: A Case Report
(2021) Senlikci, Huma Boluk; Ozen, Selin; https://orcid.org/0000-0001-6771-3265; https://orcid.org/0000-0002-7290-8558; 33429385; AAX-8965-2021; ABC-1305-2020
Temporomandibular joint disorders (TMJD) include temporomandibular joint dysfunction and bruxism. Sacroiliac joint dysfunction (SJD) is a frequent cause of non-discogenic low back pain. Studies suggest a relationship between TMJD and SJD; however, the link remains unclear. Neural therapy (NT) utilises local anaesthetic injections to treat pain by normalising a dysfunctional autonomic nervous system held responsible for initiating or propagating chronic pain. A 31-year-old female presented with a 1-year history of mechanical left-sided low back pain and sleep bruxism. Examination revealed crepitation of the left TMJ and a trigger point in the masseter muscle. Range of motion of the spine and hip joints were normal, Patrick and Geanslen tests were positive on the left side. Spine and standing flexion tests were also positive. Magnetic resonance imaging of the lumbar spine and sacroiliac joints were normal. A diagnosis of SJD was made, and the patient was treated using NT. Injections of lidocaine 0.5% to the left TMJ, the masseter muscle and intradermal segmental injections at the level of C-4 were administered. The patient's back pain and TMJ tenderness reduced and continued so throughout the 3-month follow-up period. SJD may be related to TMJD, and NT may be used in its treatment. (c) 2021 S. Karger AG, Basel