Ozgur Zeliha Karaahmet

Introduction: Neuromuscular diseases (NMDs) have a substantial burden on patients, their caregivers, and healthcare systems. The level of knowledge of Physical Medicine and Rehabilitation (PMR) specialists about NMD is of great importance for these patient groups. This study aimed to measure the level of knowledge and expectation of PMR specialists about NMD. Methods: We conducted a national, population-based, cross-sectional survey of PMR specialists caring for persons with NMD. An experience-based survey had three themes: clinician facing NMD, clinician’s NMD knowledge, and clinician’s expectations. Results: Of the 198 PMR specialists included in the study. Among the NMD subgroup diseases, Duchenne Muscular dystrophy was the most well-known disease (n=179, 90.4%), followed by Myasthenia Gravis (n=174, 87.9%) and Amyotrophic Lateral Sclerosis (ALS) (n=162, 81.8%). The subgroup with the least awareness was diabetic polyneuropathy (n=61, 30.8%). While most of the participants (n=192, 97%) thought that rehabilitation programs could be effective in NMD, almost half of them (n=83, 41.9%) thought that stretching and strengthening exercises were harmful. Conclusion: Despite the high potential and thousands of patients who might benefit, NMD rehabilitation awareness is inadequate among PMR specialists. Improving PMR specialists' knowledge of NMD may contribute to patient outcomes. We recommend future studies investigating patient outcomes based on increased PMR knowledge following educational interventions.

Background/aim: Shoulder pain is common and often evaluated with physical examination tests, yet their diagnostic accuracy remains controversial. The aim of this cross-sectional study was to determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) rates of clinical test results in patients with shoulder pain, based on ultrasonography (US) and magnetic resonance imaging (MRI) findings as reference diagnostic methods. Materials and methods: The study included 78 patients who had complaints of shoulder pain. All patients underwent physical examinations and specific clinical tests (such as Neer and Jobe tests) to reveal shoulder pathologies, and US and MRI evaluations were performed. Results: The sensitivity of clinical examination tests for subacromial impingement syndrome, biceps tendinitis and rupture, and infraspinatus tendinitis was higher than US. The specificity of tests for biceps rupture, rotator cuff rupture, infraspinatus and subscapularis tendinitis was higher compared with US. Subacromial impingement tests also showed higher sensitivity compared to MRI. The specificity of tests for acromioclavicular arthritis, biceps rupture, rotator cuff rupture, infraspinatus tendinitis was higher than MRI. Comparison of diagnostic performance with US was significant for subacromial impingement syndrome, acromioclavicular arthritis, biceps tendinitis and rupture, rotator cuff rupture and subscapularis tendinitis (p values; 0.003, 0.003, 0.000, 0.026, 0.000, 0.000, respectively). In contrast, comparison with MRI was significant only for subacromial impingement syndrome (p = 0.026). Conclusion: Clinical tests have an important place in practice when examining shoulder lesions with their high specificity and sensitivity. Although US reveals many shoulder lesions that cannot be detected by clinical tests or support our examination, MRI maintains its importance in shoulder imaging.

POSITIVE IMPACT OF RILUZOLE USE AND SWALLOWING REHABILITATION FOR DYSPHAGIA IN AMYOTROPHIC LATERAL SCLEROSIS: A CASE-BASED PERSPECTIVE

Aim: Breast cancer patients who get certain chemotherapeutic agents are more likely to experience early menopause and to suffer osteoporotic fractures at a younger age. This study investigated the impact of breast cancer history on bone mineral density (BMD) levels in postmenopausal osteoporosis (OP) treatment. Materials and Methods: This is a retrospective case-control study analyzed 65 female cases diagnosed with OP, including 32 patients with stable breast cancer who had undergone chemotherapy and/or radiotherapy but not within the last 5 years, and 33 matched controls. Demographic characteristics, total lumbar and femoral neck BMD levels and biochemical parameters were recorded for both groups. Results: Before treatment, femoral neck T-score and serum Ca levels were lower in the patient group than in the control group (p=0.038, p=0.007, respectively). There was no difference between groups for the first year (p>0.05), but when the change within a group was examined, only the patient group showed a significant increase in femoral neck T-score and serum Ca levels (p=0.027, p=0.001, respectively). Patients who received radiotherapy had lower femoral neck BMD levels before and after treatment than those who did not receive radiotherapy (p=0.021, p=0.024, respectively), and the post-treatment recovery was not different (p>0.05). Conclusion: This study demonstrated the success of osteoporosis treatment in patients with a previous diagnosis of breast cancer. Patients with breast cancer must be screened for osteoporosis and treated accordingly.

Objective: Knowing which of the special clinical tests used in subacromial impingement syndrome is more successful in making the diagnosis is important for patient evaluation, determining if further examination is necessary, and arranging treatment. Utilizing sonographic impingement as a reference diagnostic technique, the study sought to evaluate how well clinical test results performed in diagnosing patients with subacromial impingement syndrome. Material and method: The study involved 42 patients with shoulder pain and at least one positive subacromial impingement test, including Neer, Hawkins, or Yocum tests. Dynamic sonographic compression of the tendon in the coracoacromial area was examined by abducting the shoulder. Dynamic sonographic compression findings were compared with clinical examination tests. Results: In 40.5% of the patients, the ultrasonographic impingement test was positive. Hawkins test was positive in 81% of patients, Neer test was positive in 69% of patients, and Yocum test was positive in 78.6% of patients. A significant relationship was found between the ultrasonographically evaluated subacromial impingement test and the Neer test, but no significant relationship was found with other special tests (Hawkins and Yocum test) (p = 0.02, p = 0.4, p = 0.12, respectively). Conclusion: We have demonstrated a significant relationship between the ultrasonographic finding of dynamic subacromial impingement and the Neer test, which is a non-invasive and device-independent physical examination test.

Summary Objective Rotator cuff calcific tendinitis (RCCT) is a benign but incapacitating condition and in some patients it is the cause of chronic debilitating pain and functional disability. We aimed to reveal the short-term effects of low-level laser therapy (LLLT) on clinical and sonographic parameters in patients with symptomatic RCCT. Method This prospective randomized controlled study analyzed 76 painful shoulders of 68 patients aged 18–75 years, with over 3 months of shoulder pain and where RCCT was confirmed sonographically. Patients in the LLLT group (received 5 LLLT sessions per week and home exercises for 5 days/week for 3 weeks) and the control group (received home exercises, 5 days/week for 3 weeks) were assessed clinically and sonographically just before and after treatment, recording pain intensity, range of motion (ROM), shoulder functional status, location (supraspinatus/infraspinatus, subscapularis), number and degree of calcification. Degree of calcification was determined with ultrasound and classified by the Bianchi-Martinoli classification. The LLLT was applied to the calcified areas marked under ultrasound guidance. Results Both groups showed statistically significant improvements in ROM, pain intensity, shoulder pain and disability index (SPADI) pain/disability/total, and degree of calcification after treatment. No significant change was achieved for calcification in the control group. Considering the change values, improvements in abduction, extension, pain intensity, SPADI pain/disability/total, calcification number, and calcification degree parameters were found to be statistically significantly better in the LLLT group than in the control group. Conclusion Adding LLLT to the home program in treatment of symptomatic RCCT outperformed the home program alone, reducing the number and severity of calcifications, improving pain and disability.

Background & Objective: Although different kinesiotaping (KT) techniques can be applied in the treatment of carpal tunnel syndrome (CTS), to our knowledge, there is no study in the literature showing the superiority of these techniques over each other. The aim of this study is to compare the effectiveness of KT techniques applied to the dorsal surface and palmar surface of the forearm in patients with CTS. Methods: Forty six patients (70 wrists) diagnosed with CTS were randomized into 3 groups. Fabricated night splint was applied to the first group, KT was applied to the palmar surface of the wrist to the second group, and KT was applied to the dorsal surface of the wrist to the third group. Clinical, electrophysiological and ultrasonographic evaluations before treatment and at the end of 3-week treatment were compared. Results: In the comparison pre- and post-treatment, the changes in pain evaluated with Visual Analog Scale, and median motor nerve distal latency were significant in all groups, the change in median nerve sensory conduction velocity was significant in Groups 1 and 2, the change in median motor nerve conduction velocity was significant in only Group 2, the change in The Boston Carpal Tunnel Questionnaire (BCTQ)-Symptom Severity Status was significant in Group 1 and Group 3, the change in BCTQ-Functional Severity Scale and median nerve cross-sectional area was significant in only group 1. When the changes in treatment between the groups were compared, no statistically significant difference was found in any of the parameters. Conclusion: While splinting and different KT methods provided various benefits in CTS patients, they were not statistically superior to each other.

Background: Regular exercise is essential in the treatment of Ankylosing Spondylitis (AS), as the main goals of the treatment are to reduce pain, restore function, avoid disability and structural deterioration, and improve quality of life (QoL). The purpose of this study is to ascertain whether patients adhere to exercise recommendations and to evaluate the effects of consistent exercise on patients' pain, function, disease activity, mood, and quality of life. Many studies emphasize the need for exercise in treatment of AS, but none reveal whether patients follow prescribed practices and the results of doing so. Results: Exercising group had significantly decreased pain, erythrocyte sedimentation rate and Bath ankylosing spondylitis functional index and Bath ankylosing spondylitis disease activity index (BASDAI) scores (p < 0.05). There was no significant difference between the two groups in morning stiffness, mood, spinal mobility, and QoL parameters (p > 0.05). Regular exercise was positively correlated with physiotherapy history. Regression analysis revealed that with an increase of 1 unit in visual analog scale and BASDAI, regular exercise decreased by 0.087 and 0.116 units, respectively. Conclusion: Our study revealed how much the patients considers and follows the recommended exercises and concluded that regular exercise habits should be developed since they offer promising effects in treatment of AS, hence, patients should be educated in this area, and particular exercise routines should be developed to encourage them to exercise.

Introduction. The coronavirus disease (COVID-19) pandemic has the potential to impact disease activity and psychological well-being in people with rheumatic diseases. This study aimed to compare ankylosing spondylitis (AS) patients with and without COVID-19 history in terms of treatment, disease control, quality of life and psychological status by providing a cross-sectional look at treatment, disease control, quality of life and psychological status in patients with AS during the COVID-19 pandemic. Methods. The study included 74 AS patients, in two groups based on COVID-19 history. Demographic data and clinical characteristics were recorded. Treatment, disease control, functional status, and quality of life were evaluated using Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index (BASFI), and impact of COVID-19 on quality-of-life scales. Psychological status was assessed using the Beck Depression Inventory, Beck Hopelessness Scale, and COVID-19 anxiety scale. Results. Of the 74 patients diagnosed with AS, 44 were female and 34 were male. The mean age was 47.3 years. In total, 35 patients (47.3%) had COVID-19. We found that the group without COVID-19 had significantly higher levels of hypothyroidism than the other group (p = 0.008). The BASFI value was significantly higher in the COVID-19 group (p = 0.031). The group with COVID-19 had a substantially higher rate of continuing non-anti-rheumatic drug use than the other group (p = 0.02). Conclusion. During COVID-19 pandemic period, the majority of patients continued their medication, so treatment and disease control were not negatively affected. Having COVID-19 did not cause a significant difference psychologically.

Summary Objective To present a patient with complex regional pain syndrome type 1 (CRPS-I) and improvement of contracture of hand muscles and grip strength after successful treatment with botulinum neurotoxin‑A (BoNT-A). Case A 53-year-old woman with CRPS‑I experienced severe allodynia, swelling and autonomic changes in the left hand after a distal radius fracture. Over the succeeding months, she developed contracture of the left hand muscles which was treated with injection of BoNT‑A into the hand muscles (10 points). Results In the patient treatment with BoNT‑A an improvement was seen in the hand range of motion (ROM) and grip strength. Conclusion Successful results can be obtained with BoNT‑A injection in treatment-resistant CRPS‑I cases which may develop joint contracture.