Involvement of temporomandibular joint (TMJ) in rheumatoid arthritis (RA) patients is described, but the incidence varies greatly. In this study our aim was to determine the frequency and character of TMJ involvement in RA patients asymptomatic for this joint, to investigate the relationship with disease activity, and to evaluate the early diagnostic value of imaging techniques. Twenty patients were included in this study, ten were evaluated with computed tomography (CT) and ten with magnetic resonance imaging (MRI). Among the 20 patients 45% had TMJ involvement detected by imaging techniques. The most frequent pathological signs were osteophyte formation, erosion of the mandibular condyle and decreased joint space (40%). Age, duration of disease, number of swollen joints. CRP and RF levels were found to be correlated with TMJ involvement. It is concluded that TMJ involvement may be detected even in asymptomatic patients with RA and there is a positive correlation between the severity of disease and involvement of TMJ.

a relatively common surgical approach for closed procedures in infants and children with congenital cardiac malformations. This approach results in division of the latissimus dorsi and serratus anterior muscles. Division of these muscles can result in significant postoperative pain, diminished pulmonary function, and marked impairment of motion.The thoracotomy incision may also result in longterm physical impairment and deformity. Scoliosis has been reported to develop with an incidence of 22% several years after left posterolateral thoracotomy for correction of aortic coarctation in infancy and childhood. 1 The long-term musculoskeletal consequences of thoracotomy for surgical treatment of congenital cardiac disease, however, have seldom been evaluated. [2][3][4][5][6] With this in mind, we sought to determine whether a posterolateral thoracotomy performed in children with congenital cardiac disease influences the postoperative anatomy and function of the musculoskeletal system. Materials and methodsWe evaluated 49 children, 28 boys and 21 girls, undergoing surgery through a posterolateral thoracotomy in the forth-intercostal space for treatment of congenital cardiac disease at Hacettepe University Hospital. An additional median sternotomy was needed in 9 (18%) of the patients.By means of a general clinical examination and radiological studies, we evaluated thoracic symmetry, Cardiol Young 2003; 13: 264-267 Abstract The standard surgical approach for closed heart procedures in small infants and children is to use a posterolateral thoracotomy incision, which results in the division of the latissimus dorsi and serratus anterior muscles. The aim of our study was to determine the frequency and type of musculoskeletal deformities in children undergoing surgery with this approach for congenital cardiac disease.We included 49 children, 28 boys and 21 girls, in the study. Their mean age was 10.2 Ϯ 4.8 years, the mean age at the time of surgery was 3.8 Ϯ 4.0 years, and they were evaluated at an average of 6 years after the thoracotomy. Of the patients, 94% had various musculoskeletal deformities. Scoliosis was observed in 15 patients (31%) but only in two patients did the curves exceed 25 degrees. Of these patients, three-fifths had aortic coarctation. Elevation of the shoulder was seen in 61%, winged scapula in 77%; while 14% had asymmetry of the thoracic wall due to the atrophy of the serratus anterior muscle. Deformity of the thoracic cage was observed in 18%; and 63% had asymmetry of the nipples.Thus, we found that musculoskeletal deformities are frequent after thoracotomies in children with congenital cardiac disease. Patients who have undergone such procedures for cardiac or noncardiac surgery should be followed until their skeletal maturation is complete. Techniques sparing the serratus anterior and latissimus dorsi muscles should be preferred. These adverse effects of thoracotomy may be another reason for using interventional procedures in these cases.

Both splinting combined with the use of a nonsteroidal antiinflammatory drug and steroid injection into the carpal tunnel resulted in significant improvement in carpal tunnel syndrome.

Assessment of pain, stiffness, fatigue, and lower-extremity involvement as well as asking for a history of falls will highlight those at high risk for further falls. In addition to the general exercise program adopted for all patients, we suggest that a balance rehabilitation program should be valuable for the patients with risk factors for fall. Exercise may improve fear of falling and BASFI and BASMI scores. However, further study is needed to investigate these hypotheses. We believe that clinicians should train and support the patients via reducing fear of falls and maintaining good posture and functional capacity.

No abstract