ÖZAmaç: Bu çalışmada omuz ağrısı olan hastalarda kör ve floroskopi rehberli eklem içi omuz enjeksiyonlarının doğruluğu ve etkinliği araştırıldı. Hastalar ve yöntemler: Çalışmaya üç aydan uzun süredir omuz ağrısı olan 17 hasta (6 erkek, 11 kadın; ort. yaş 52.6±9.9 yıl; dağılım 36-66 yıl) dahil edildi. İlk eklem içi enjeksiyonlar ön yaklaşım ile kör olarak uygulandı. Enjeksiyon sonrası iğne ucunun eklem içerisinde olduğu floroskopi ve kontrast dağılımı ile doğrulandıktan sonra işlem 3 mL lokal anestezik (prilokain ve bupivakain) ve 1 mL steroid (40 mg metilprednizolon) ile tamamlandı. İlk uygulamada kontrast dağılımının eklem dışı olduğu gözlendiğinde, ikinci enjeksiyona floroskopi eşliğinde devam edildi. İşlemin devam ettirilmesi ile tüm enjeksiyonlar eklem içi oldu. Ağrı yoğunluğu görsel analog ölçeği (GAÖ) ile ölçüldü. Bulgular: Floroskopi ile bakılan kontrast dağılımına göre, 17 omzun 11'inde (%64.7) birinci kör enjeksiyonlar eklem içi idi. Başlangıç GAÖ skoru ortalaması 7.11 idi. Klinik takiplerde birinci saatte (ortalama GAÖ: 2.35), üçüncü günde (ortalama GAÖ: 2.64) ve birinci ayın sonunda (ortalama GAÖ: 2.23) ağrıda iyileşme gözlendi. Kör ve floroskopi rehberli uygulama için hasta hazırlanma süresi dışındaki ortalama süre sırasıyla 0.8 dakika ve 4.2 dakika idi. Sonuç: Kör eklem içi omuz enjeksiyonları ucuz ve kolay uygulanabilir olsa da iğnenin eklem çevresinde değil eklem içinde olduğundan emin olmak için enjeksiyonlar floroskopi ya da başka bir rehber eşliğinde yapılmalıdır.Anahtar sözcükler: Enjeksiyon; eklem içi; ağrı; omuz. ABSTRACT Objectives:This study aims to investigate the accuracy and effectiveness of blind and fluoroscopic-guided intra-articular shoulder injections in patients with shoulder pain. Patients and methods: The study included 17 patients (6 males, 11 females; mean age 52.6±9.9 years; range 36 to 66 years) with shoulder pain more than three months. First intra-articular joint injections were performed with anterior approach blindly. Following the injection and after confirming that the needle tip was intra-articular with fluoroscopy and contrast distribution, the procedure was completed using 3 mL of local anesthetic (prilocaine and bupivacaine) and 1 mL of steroid (40 mg methylprednisolone). When the contrast distribution was observed to be extra-articular at the first administration, a second injection was continued under fluoroscopy guidance. All of the injections were intraarticular with the continuation of the procedure. Pain intensity was measured with visual analog scale (VAS). Results: According to the contrast distribution viewed with fluoroscopy, first blind injections were intra-articular in 11 of the 17 shoulders (64.7%). Mean of initial VAS score was 7.11. Improved pain was observed in the clinical follow-ups at the first hour (mean VAS: 2.35), third day (mean VAS: 2.64), and at the end of the first month (mean VAS: 2.23). The mean durations for blind and fluoroscopic-guided procedures excluding patients' preparation time were 0.8 minutes and 4.2 minutes, respectively. Con...

[Purpose] The aim of this study was to investigate the usefulness of ultrasonography for the diagnosis of polyneuropathy in diabetic patients by examination of the median and ulnar nerves. [Subjects and Methods] Sixty-three diabetic patients and fourteen controls were enrolled in the study. Nerve conduction studies were performed on both upper and lower limbs. Median and ulnar nerve cross-sectional areas were measured at the wrist and forearm levels in 140 hands by ultrasound. [Results] The median nerve cross-sectional area was increased at the hook of hamatum, pisiform bone, and radioulnar joint levels in patients with carpal tunnel syndrome. The ulnar nerve area at the medial epicondyle was significantly increased in the diabetic polyneuropathy (9.2 ± 1.6), diabetic polyneuropathy plus carpal tunnel syndrome (9.3 ± 1.4), and carpal tunnel syndrome (9.2 ± 1.9) groups compared with the control group (7.7 ± 1.1). In receiver operating characteristics analysis, the cutoff value of the ulnar nerve was 8.5 mm2 at ulnar epicondyle with 71.4% specificity and 70.4% sensitivity, corresponding to the highest diagnostic accuracy for diabetic polyneuropathy. [Conclusion] Ultrasonographic examination of the median and ulnar nerves can be an alternative or additional diagnostic modality for the evaluation of neuropathies in diabetic patients.

Fibromyalgia syndrome (FMS) is an important chronic condition seen in 2% to 5% of the general population, characterized by widespread pain and often accompanied by fatigue, cognitive problems, and sleep disturbances. 1 Although the etiology of FMS remains unclear, nociplastic pain has been reported as the most accepted mechanism in the pathophysiology of widespread pain experience and other symptoms related to FMS. 2,3 Different biologic factors may cause hyperexcitability of the central nervous system in patients with FMS. 4,5 In addition to such neurobiological factors, negative or maladaptive thoughts, emotions, cognitions, and catastrophizing and hypervigilance behaviors have been associated with FMS. 6

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Objectives: This study aimed to compare kinesiophobia, fatigue, physical activity, and quality of life (QoL) between the patients with rheumatoid arthritis (RA) in remission and a healthy population. Patients and methods: The prospective controlled study included 45 female patients (mean age: 54.22±8.2 year; range, 37 to 67 year) with a diagnosis of RA determined to be in remission according to the Disease Activity Score in 28 Joints (DAS28) being ≤2.6 between January 2022 and February 2022. As a control group, 45 female healthy volunteers (mean age: 52.2±8.2 year; range, 34 to 70 year) of similar age were evaluated. The QoL, disease activity, pain, kinesiophobia, fatigue severity, and physical activity were assessed using the Health Assessment Questionnaire, DAS28, Visual Analog Scale, Tampa Scale of Kinesiophobia, Fatigue Severity Scale, and International Physical Activity Questionnaire, respectively. Results: There was no significant difference between the groups in demographic data. A statistically significant difference was found between the groups in terms of pain, C-reactive protein level, fatigue, kinesiophobia, QoL, and total, high, and moderate physical activity scores (p<0.001). Among the RA patients in remission, there was a significant correlation between kinesiophobia and moderate physical activity and QoL, as well as between fatigue and high physical activity (p<0.05). Conclusion: Patient education and multidisciplinary approach strategies should be developed to increase the QoL and physical activity and reduce kinesiophobia in RA patients in remission since there may be a decrease in physical activity due to kinesiophobia, fatigue, and fear of movement in this patient group compared to the healthy population, impairing their QoL.