BackgroundIn addition to pharmacological treatment, psychotherapeutic approaches are recommended for the treatment of fibromyalgia. There is a suggestion that eye movement desensitization and reprocessing (EMDR) therapy may be effective. This study aimed to investigate the impact of EMDR therapy on fibromyalgia symptoms, depression, sleep quality, and traumatic stress in fibromyalgia patients through a randomized controlled study (RCT).Materials and methodsThe sample for this study comprised 79 individuals diagnosed with fibromyalgia. Participants were randomly assigned to two groups: the “Treatment as Usual” (TAU) group and the TAU + EMDR group. Prior to the study and at six different time points (before starting the study, at the end of the 5th, 10th, and 15th sessions, 1 month later, and 3 months later), participants completed assessments, including the Fibromyalgia Impact Questionnaire (FIQ), Visual Analog Scale (VAS), Fibromyalgia ACR 2010 Diagnostic Criteria [Widespread Pain Index (WPI) and Symptom Severity Scale (SSS)], Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and Trauma Symptom Checklist-40 (TSC-40).ResultsThere were no differences in the sociodemographic variables between the study and experimental groups. Analysis of variance revealed a statistically significant group effect on VAS (p = 0.019), WPI (p = 0.018), BDI (p = 0.019), and TSC-40 (p = 0.21). After applying Bonferroni correction, EMDR was found to be effective for VAS, WPI, SSS, BDI, PSQI, and TSC-40 (p <0.05).ConclusionThe results of the current study suggest that EMDR therapy is a viable alternative treatment for fibromyalgia. We believe these findings offer robust evidence supporting the efficacy of EMDR therapy in treating fibromyalgia, particularly in the context of a randomized controlled trial (RCT). The application of EMDR therapy for the treatment of patients with fibromyalgia is likely to be beneficial.Clinical trial registrationClinicalTrials.gov, identifier NCT06265194.

Introduction: Although COVID-19 primarily affects the respiratory system, one of the most frequently effected areas is the musculoskeletal system. COVID-19 associated musculoskeletal problems can cause disability in patients ≥65 years. The aim of the study was to define the musculoskeletal problems after the COVID-19 infection and to examine the relationship with the accompanying comorbidities in geriatric population. Materials and Method: The study was conducted by the members of Geriatric Rehabilitation Study Group of Turkish Physical Medicine and Rehabilitation Society at 11 different hospitals from 7 provinces (Ankara, İstanbul, İzmir, Gaziantep, Adana, Bursa, and Kırıkkale) of Türkiye. Individuals aged 65 years and over who had a history of COVID-19 within the last 12 months and experienced persistent/continuous musculoskeletal complaints were included into the study. COVID-19 diagnoses were confirmed from electronic hospital records and the e-Nabız system. Data were collected by face-to-face interviews and after recruiting the first 50 patients from each center, patient recruitment was terminated. Results: A total of 457 cases in which all questions were answered completely (without any missing data) were included in this observational study. The cases were mainly 65-75 years old, married, and non-smoking women. The most common musculoskeletal involvement was widespread pain (81%), followed by myalgia (63.7%) and arthralgia (44.4%). Other rare involvements (osteonecrosis, myositis, steroid myopathy, arthritis) were significantly more frequent in patients older than 75 years, regardless of gender. Analysis showed that musculoskeletal pain immediately after infection is observed more in cases with comorbid diseases (p<0.001), hypertension (p<0.001), pulmonary involvement (p=0.002) and hospitalization due to COVID-19 (p<0.001). It was determined that the incidence of pain seen immediately after infection increased as the number of comorbidities increased (p<0.001). In conjunction with this, persistent pain after COVID-19 infection were more common in those with osteoarthritis (p=0.039). Conclusion: Elderly patients may develop musculoskeletal pain in multiple body sites after COVID-19, which is primarily related to presence and number of comorbidities, hospitalization and pulmonary involvement. The long-term consequences of COVID-19 on musculoskeletal health are still being studied, and further research is needed to fully understand the extent and duration of these effects. Keywords: Aged; COVID-19; Arthralgia; Musculoskeletal Pain.

Objectives:The aim of this study was to investigate the caregiver burden (CB) of informal caregivers for stroke survivors with and without dysphagia and to assess the relationship between the CB levels of informal caregivers for stroke survivors with dysphagia, patients' swallowing-related quality of life (QoL), and patients' stroke-specific QoL.Patients and methods:This multi-center, prospective, cross-sectional study included a total of 120 stroke patients (76 males, 44 females; mean age: 61.1±12.3 years; range, 19 to 86 years) between October 2019 and 2020. Of the patients, 57 had dysphagia and 63 had no dysphagia. The Functional Oral Intake Scale (FOIS) was used to classify the degree of functional dietary limitation caused by each patient's swallowing impairment. Patients and caregivers completed the Eating Assessment Tool (EAT-10), Swallowing Quality of Life (SWQoL) questionnaire, Stroke Impact Scale (SIS), and the Zarit Caregiver Burden Interview (ZBI).Results:The CB levels were higher in those caring for stroke patients with dysphagia than in those caring for stroke patients without dysphagia. Caregiver burden was found to be associated with patients' swallowing-related QoL and stroke-related QoL. Significant predictors of high CB scores (F=2.55, R2=0.59; p=0.007) were being an employed caregiver (B=17.48, p=0.003), being a caregiver with high school (B=-19.6, p=0.03), and secondary school (B=-16.28, p=0.02) educational status, being son, daughter (B=30.63, p=0.007) or other relative of the patient (B=20.06, p=0.01), lower FOIS stage (B=-3.14, p=0.011), lower SWQoL (B=0.52, p=0.009) and lower SIS (B=-0.37, p=0.04) scores.Conclusion:Caregivers of stroke patients with dysphagia suffer from a higher CB than those without dysphagia. In stroke patients with dysphagia, swallowing-related QoL is associated with the QoL levels of stroke patients and the CB levels of their caregivers. Employment status, educational status of caregiver, caregiver's relativity to the patient, FOIS stage, swallowing and stroke related QoL of the patients are factors related to burden levels of caregivers of stroke patients with dysphagia. These results may help health professionals to understand dysphagia as an essential source of CB and consider it, while planning treatments.

Objectives: This study aims to assess the stroke rehabilitation facilities provided by university hospitals (UHs) and training and research hospitals (TRHs) and to evaluate the geographical disparities in stroke rehabilitation. Patients and methods: Between April 2013 and April 2014 a total of 1,529 stroke patients (817 males, 712 females; mean age: 61.7±14.0 years; range, 12 to 91 years) who were admitted to the physical medicine and rehabilitation clinics in 20 tertiary care centers were retrospectively analyzed. Demographic, regional and clinical characteristics, details of rehabilitation period, functional status, and complications were collected. Results: The median duration of stroke was five (range, 1 to 360) months. The ratio of the patients treated in the TRH in the Marmara region was 77%, but only 25% of the patients were living in the Marmara region. Duration of hospitalization was longer in the TRHs with a median of 28 days compared to those of UHs (median: 22 days) (p<0.0001). More than half of the patients (55%) were rehabilitated in the Marmara region. Time after stroke was the highest in the Southeast region with a median of 12 (range, 1 to 230) months and the lowest in the Aegean region with a median of four (range, 1 to 84) months. Conclusion: This study provides an insight into the situation of stroke rehabilitation settings and characteristics of stroke patients in Turkey. A standard method of patient evaluation and a registry system may provide data about the efficacy of stroke rehabilitation and may help to focus on the problems that hinder a better outcome.

Objectives:The aim of this study was to assess the effects of spasticity on glucose metabolism and percentage of fat-free mass (FFM%) in patients with spinal cord injury (SCI).Patients and methods:A total of 33 patients (22 males, 11 females; mean age: 38.6±12.5 years; range, 20 to 64 years) with SCI defined by the American Spinal Injury Association Impairment Scale Grades A to D were included between September 2014 and May 2018. We assessed spasticity with the Modified Ashworth Scale (MAS) and evaluated spasms with the Penn Spasm Frequency Scale (PSFS). We assessed the glucose metabolism by calculating the Matsuda and HOMA-IR index, and measured FFM% by dual-energy X-ray absorptiometry.Results:Fourteen patients had motor complete, and 19 had motor incomplete SCI. The neurological injury levels of the patients were C4-T12. There was a positive correlation between hip adductor muscle MAS and trunk, android, and gynoid FFM% and between hip extensor muscle MAS and android FFM% in patients with motor complete SCI. Hip extensor and knee flexor muscle MAS showed a negative correlation with the HOMA-IR. Hip adductor and extensor muscle MAS, as well as knee flexor and extensor muscle MAS, had a positive correlation with the Matsuda index in these patients. There was a positive correlation between knee extensor muscle MAS and gynoid FFM% and between PSFS and arms, trunk, gynoid, and total FFM% in patients with motor incomplete SCI. There was a negative correlation between hip adductor and extensor muscle MAS, PSFS, and level of fasting glucose in these patients.Conclusion:This study supports the notion that spasticity has positive effects on the FFM% and glucose metabolism in patients with motor complete and incomplete SCI.

Background Dysphagia is a geriatric syndrome. Changes in the whole body that occur with aging also affect swallowing functions and cause presbyphagia. This condition may progress to oropharyngeal and/or esophageal dysphagia in the presence of secondary causes that increase in incidence with aging. However, no study has been published that provides recommendations for use in clinical practice that addresses in detail all aspects of the management of dysphagia in geriatric individuals. This study aimed to answer almost all potential questions and problems in the management of geriatric dysphagia in clinical practice. Methods A multidisciplinary team created this recommendation guide using the seven-step and three-round modified Delphi method via e-mail. The study included 39 experts from 29 centers in 14 cities. Results Based on the 5W and 1H method, we developed 216 detailed recommendations for older adults from the perspective of different disciplines dealing with older people. Conclusion This consensus-based recommendation is a useful guide to address practical clinical questions in the diagnosis, rehabilitation, and follow-up for the management of geriatric dysphagia and also contains detailed commentary on these issues.

Objectives This study aims to identify the relationship between treatment modalities and the patients’ preferences in osteoarthritis (OA) treatment and identify the related factors. Patients and methods This multi-center, cross-sectional study included a total of 305 patients with OA (66 males, 239 females; mean age: 66.4±9.7 years; range, 38 to 90 years) between July 2019 and January 2020. Data including demographic and clinical characteristics of the patients were recorded using a structured questionnaire. Results The mostly common involvement sites were knee joints, lumbar, and cervical regions, respectively. Prior to the study, the treatment modalities which were prescribed to patients were oral drugs (79.7%), topical drugs (73.8%), home-based exercise program (62.6%), and physical therapy (outpatient) (61.3%). Of the recommended remedy, 89.2% were prescribed by physiatrists, 24.6% by orthopedists, 5.6% by family practitioners, 2.6% by neurosurgeons, and 1.6% by algologists. The most beneficial treatments (to whom) were inpatient physical therapy program (47%), oral drugs (41%), home-based exercise programs (24.9%) according to patients’ perspective. According to patient preferences, nearly half of the patients preferred outpatient physical therapy program (45.9%), oral drugs (33.1%), inpatient physical therapy (20%), and home-based exercises (18%). The most common reasons for their preferences were previous benefits from treatment (54.4%), long-term effects (38%), easy access to treatment (33.1%) and concerns about side effects (28.9%). The mostly common reasons for their preferences were previous benefits from the treatment (54.4%), long-term positive effects of physical therapy (38%), easy access to the treatment (33.1%) and concerns about side effects of drugs (28.9%). Conclusion Besides medical regimen, the results of this study showed that the patients preferred outpatient and inpatient physical therapy modalities, and home-based exercises programs. In the light of these findings, initiation of a new prescription (e.g., drugs or physical therapy modalities) in OA patients, previous treatment modalities, and approaches are suggested to be carefully reviewed by the clinician to anticipate and improve the adherence behavior to the new treatment.

Background/Aim: Loss of gait is the key problem after stroke. Robotic rehabilitation devices, which constitute the new treatment alternatives for stroke, can be divided into two groups on the basis of their design, the exoskeletons and end-effectors. This study aims to investigate the effects of gait training with two different types of robot on rehabilitation outcomes in patients with stroke. Methods: Twenty-four patients treated for stroke between December 2015 and December 2018 were included in the study. They were randomly divided into two groups for rehabilitation with either the exoskeleton or the end-effector. They attended the robotic rehabilitation programme for five days a week for six weeks, with each session lasting for 40 minutes. They were evaluated in terms of motor stage, ambulation, walking speed and walking capacity at the start and end of the programme. Results: According to baseline evaluations, there were higher scores in the endpoint evaluations for motor stage, ambulation, 6-minute walking test and lower scores in the endpoint evaluations for 10-meter walking test (P 0.05 for all). Conclusion: In patients with stroke, improvements were observed following robot-assisted gait training. No superiority was observed between the end-effector device with the exoskeleton device.

Pantothenate kinase-associated neurodegeneration is an inherited neurodegenerative disease consisting of brain iron accumu- lation in basal ganglia. Extrapyramidal symptoms are common. Gait and posture disorders are also observed, but characteristics of these disorders have not been identified in the literature. We shared our experiences about gait disorders in a patient with pantothenate kinase-associated neu rodegeneration and the effectiveness of rehabilitation by using three-dimensional gait analysis. A better posture and walking stability are observed in this patient as a consequence of rehabilitation. Three-dimensional gait analysis is an objective tool to obtain quantitative gait data which helps to determine main requirements to improve the patient's gait and posture before planning rehabilitation.

BACKGROUND:Injections are a good alternative to conventional treatment-resistant cases with rotator cuff (RC) lesions before operation. Currently, different injection methods are used in RC lesions.OBJECTIVE:To evaluate the efficacy of different injection methods (platelet-rich plasma [PRP], corticosteroid [COR] and prolotherapy [PRO]) in RC tendon lesions.METHODS:One hundred and twenty-nine patients were divided into 4 groups as PRP, COR, PRO and the lidocaine group. Subacromial injection was applied to all groups. They were evaluated using the Visual Analogue Scale (VAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Western Ontario Rotator Cuff Index (WORC) at 3, 12 and 24 weeks post-injection.RESULTS:In the COR group in the 3rd week, VAS and WORC scores were significantly lower than the other groups (p< 0.01 and p< 0.05 respectively). In the PRP group in the 24th week, VAS and WORC scores were found to be significantly lower than the COR group (p< 0.01 and p< 0.05 respectively). In the COR group in the 3rd week the ASES score was found to be significantly higher than the PRP and PRO group (p< 0.01).CONCLUSION:In patients with RC lesions, corticosteroid injection provides short-term relief for pain, function, and quality of life, while PRP injection works for long-term wellbeing. For all types of applied injections, improvement in pain, function and quality of life were observed.

Purpose This randomized, placebo-controlled study examined the effect of vitamin D replacement therapy on neuropathic symptoms and balance in patients with diabetic neuropathic pain and low vitamin D levels. Patients and Methods Among the 258 patients, the results in a total of 57 volunteers (32 in the treatment and 25 in the control arm) meeting the inclusion criteria are reported. Symptoms of neuropathic pain were assessed using Douleur Neuropathique 4 (DN4) questionnaire, and presence of polyneuropathy (PNP) was determined by performing electromyography (EMG). Balance was assessed using Berg balance test (BBT). After undergoing these examinations, the patients in the treatment group were intramuscularly (IM) injected with 300,000 IU vitamin D in a liquid formulation and those in the placebo group were IM injected with physiological saline. The DN4 and BBT were repeated after 12 weeks, and the results were compared. Results The patients in the treatment group showed a significant decrease in total DN4 scores from baseline to the study endpoint compared with the patients in the placebo group (p=0.008). The patients in the treatment group also showed a significant increase in BBT scores from baseline to the study endpoint compared with the patients in the placebo group (p=0.001). Furthermore, in subgroup analysis, these patients showed a significant decrease in electric shock and burning sensation scores from baseline to the study endpoint compared with the patients in the placebo group (p=0.006, p=0.001, respectively). Conclusion In patients with diabetic neuropathic pain, vitamin D levels should be measured and vitamin D replacement therapy should be administered as required to resolve neuropathic symptoms and to improve balance.

Aim: Apart from the complications of spinal cord injury, some comorbidities in patients with this injury should be considered in the long term. In this study, we aimed to identify the comorbidities in patients with chronic spinal cord injury and the relationship of these comorbidities with the patients’ level of independence.Methods: This retrospective cohort study involved 40 patients who had spinal cord injury and were admitted to an inpatient rehabilitation program at our hospital between March 2014 and January 2016. The participants were evaluated in terms of age, height, weight, body mass index, place of residence, and marital status. Their type, level, and duration of injury were also assessed. ASIA Impairment Scale (AIS), Functional Independence Scale (FIM), Functional Ambulation Scale (FAS), Spinal Cord Independence Scale (SCIM), and Cumulative Illness Rating Scale (CIRS) were used to evaluate the patients.Results: The mean age of the 40 patients with chronic spinal cord injury was 41.83 (16.87) years. Their most common comorbidities were genitourinary (62.5%), lower gastrointestinal (50%), and ophthalmological–otolaryngologic problems (42.5%). No correlation was found between the CIRS scores and the SCIM Personal Care, Respiratory and Sphincter Management, Mobility, and the total SCIM scores of the participants. (P=0.949, P=0.469, P=0.452, P=0.521, respectively). By contrast, the FIM scores were correlated with the SCIM scores of the cases (P=0.014).Conclusion: The most common long-term comorbidities in patients with spinal cord injury were genitourinary, lower gastrointestinal, and ophthalmological–otolaryngologic problems. However, these comorbidities were not directly related to the patients’ ambulation and independence levels.

Aim: To determine the effect of quality of life and sociodemographic characteristics of patients admitted to the outpatient clinic of a Physical Therapy and Rehabilitation Hospital on Health Service Perceptions. Methods: This cross-sectional study was conducted on a total of 367 patients (236 female, 131 male) who met the criteria of participation in the study and applied to the policlinic at a Physical Therapy and Rehabilitation Hospital between June 15 and September 15, 2019. Data were collected using a structured form measuring the socio-demographic characteristics and satisfaction levels of the patient and Nottingham Health Profile Scale (NHP) to measure the general perceived quality of life of the patient. Results: A statistically significant correlation was found between age values and total satisfaction mean scores (r = 0.215 p = 0.0001). Total satisfaction average scores of the literate group were found to be significantly higher than the other groups (p = 0.032, p = 0.005).The total satisfaction mean scores of the Hospital Advise (+) group were found to be statistically higher than the Hospital Advise (-) group (p = 0.0001). There was a statistically significant correlation between NHP Pain average scores and total satisfaction mean scores (p = 0.001). Conclusion: Health service perception may be affected by many different factors in patient-hospital communication. Age, education, hospital referral status and presence of pain are important parameters that we defined in our study. In the development of the health service provided, it will be guided to examine and define all factors in detail.

Objective: The aim of this study is to evaluate patients with fibromyalgia in terms of mentalizing abilities and to identify the relationships between mentalization skills, attachment styles, anxiety, and depressive symptoms in these patients. Method: The sample consisted of 30 patients diagnosed with fibromyalgia and 30 healthy volunteers. Patients with fibromyalgia and the control group were both administered the following battery of tests: Reading the Mind in the Eyes Test (RMET), Experiences in Close Relationships Questionnaire-Revised (ECR-R), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI). Results: Fibromyalgia group and healthy controls differed significantly in terms of total scores of the RMET. The fibromyalgia group had significantly lower scores in terms of mentalization skills compared to healthy controls. The mean anxiety and depression scores of the fibromyalgia group were higher than in the healthy controls. The mean scores of anxiety and avoidance dimensions in the fibromyalgia group were not different from healthy controls. Conclusion: Fibromyalgia patients were found to have significantly lower mentalizing abilities compared to healthy controls. This study may provide data for clinical applications using mentalization as a tool to understand and treat the patients diagnosed with fibromyalgia more efficiently.

BACKGROUND. Groin injury syndromes estimated to be 10-18% per year in soccer players. Chronic Osteitis Pubis and its treatment are extremely complex in the groin injury syndromes. Dextrose prolotherapy (DPT) is an alternative treatment for management of chronic osteitis pubis. Our objective was to investigate the efficacy of dextrose prolotherapy (DPT) for the management of chronic osteitis pubis (OP) in athletes. METHODS. Nineteen elite professional soccer players with chronic recalcitrant OP were included the study. Retrospective data analysis of patients with chronic OP was conducted. DPT was applied once a week, three times in total by the same sports medicine physician to symphysis pubis, suprapubic abdominal insertions and the thigh adductors. Visual analog scale (VAS) was used for pain evaluation and the Nirschl Pain Phase Scale (NPPS) used for the evaluation of functional impairment due to pain. RESULTS. All VAS and NPPS scores were significantly better after each injection compared with baseline (P < 0.05). The VAS score reduced from 51.7 +/- 1.82 to 2.83 +/- 1.29. In addition, NPPS score was reduced from 4.44 +/- 0.92 to 2.01 +/- 0.84. CONCLUSIONS. This study showed that DPT can be an effective method for reducing pain and functional improvement of patients with OP.

INTRODUCTION[|]Compliance is a major problem in the treatment of many diseases in the elderly. Problems related to compliance of calcium+vitaminD treatment with low bone mineral densitometry values appear to be come with doctors. This study was planned to investigate about the frequency and reason of compliance problems.[¤]METHODS[|] 296 elderly volunteers were included in the study between January 2013 and December 2015. A face-to-face interview was conducted with participants to assess their socio-demographic characteristics and treatment compliance. [¤]RESULTS[|]Only 41.2% of the participants regularly take Ca + vitD treatment prescribed by the physician. The reasons for not taking the treatment are stated as considering that they take adequate calcium diet with 39,08%, 20,11% do not like the taste of the medicine and 16,09% think that it is harm to the heart health, respectively. [¤]DISCUSSION AND CONCLUSION[|]Motivation, side effects and fear of possible side effects are important factors that determine compliance in the use of Ca + vitD in elderly patients. After elaborating on whether or not contraindicated in a geriatric patient with a low BMI, it is necessary to carefully explain the importance of prescribed Ca + vitD treatment, possible side effects, and the risks that arise in case of not using it. [¤]

[Purpose] To investigate the effect of vitamin D supplementation on rehabilitation outcomes and balance in patients having hemiplegia due to ischemic stroke. [Subjects and Methods] Vitamin D levels of 132 patients hospitalized for hemiplegia rehabilitation due to ischemic stroke were tested. Consequently, 86/132 patients had low vitamin D levels, 72 of which met the inclusion criteria and were included in the study. Patients were divided into two groups: Group A (injected with 300,000 IU vitamin D), and Group B (injected intramuscularly with saline). Each patient was tested at the baseline and at the third month using the Brunnstrom recovery staging, functional ambulation scale, modified Barthel index, and Berg balance scale. The findings were compared between the groups. [Results] By the end of the third month, The Berg balance scale results and modified Barthel index scores significantly differed between the two groups, whereas Brunnstrom recovery staging and functional ambulation scale test results did not. [Conclusion] This study found that vitamin D administration increased the activity levels and accelerated balance recovery but did not significantly affect ambulation or motor recovery. These results warrant confirmation by longer follow-up studies with a larger number of participants.

A 46-year-old female patient presented with restricted joint movements, swelling in arms and legs, skin stiffness, and whole-body inflexibility. Her complaints had started five years ago and increased since then. She did not have any vascular condition or symptoms indicative of Raynaud’s phenomenon (evident skin conditions on her face, coldness in her hands, or cyanosis). There were no prominent skin pigment changes, telangiectases, or any distinctive finger appearance with sclerodactyly or ulceration. Upon inspection, significant bilateral skin thickness and edema were found in her lower extremities. Her skin surface was shiny and irregular. Her range of motion (ROM) was limited for the bilateral shoulder, elbow, wrist, hip, knee, and ankle joints (Figure 1). Laboratory analyses showed normal results for hemogram, routine biochemical tests, erythrocyte sedimentation rate and normal extractable nuclear antibody profile. She had normal levels for muscle enzymes, protein, C-reactive protein, anti-nuclear antibody, rheumatoid factor, anti-scleroderma-70, and anti-centromere antibody. Furthermore, radiographs were normal. Doppler ultrasound of the extremities revealed no abnormal findings, except thickness reaching to the subcutaneous tissues. On skin biopsy of the extremities, thickened and enlarged bundles of collagen were found in the dermis. We also found evidences of atrophy in the epidermis, adipocyte entrapment, and non-inflammatory enlargement in the fascia with normal muscle appearance beneath it. Slight accumulations of mucopolysaccharide were identified using the Alcian-blue stain. The patient was identified as having widespread stiff skin syndrome (SSS) as a result of the above- mentioned clinical and pathological findings. Stiff skin syndrome is a rare kind of scleroderma that is characterized by contracture- like limited joint ROM and thickened stiff skin.(1,2) It is divided into two categories: widespread SSS and segmental SSS.(3) Widespread SSS is more severe, more common, has more limited joint ROM, and an earlier onset than segmental SSS. Both widespread SSS and segmental SSS are reported to have early onset within the first six years of life. The patient discussed herein is a rare case because she was diagnosed as an adult. Segmental SSS is predominant in females, whereas widespread SSS does not seem to feature any sex preinclination. Segmental SSS has segmental distribution with unilateral predominance. Compared with widespread SSS, limited joint ROM occurs less than half of patients in segmental SSS.(3) Both categories of SSS may be genetically inherited (~20%). In many cases, chest expansion is decreased due to the decreased elasticity and increased thickening of the skin in the thoracic region, causing restrictive changes in the lungs.(1-7) It is not a progressive disorder;(1-8) however, two cases reportedly progressed from segmental SSS to widespread SSS.(7,9) Therapeutic exercises and rehabilitation programs are suggested for preventing joint contractures. Corticosteroids and other immunosuppressants have proven ineffective.(1-9) Only mycophenolate mofetil resolved skin lesions and improved joint ROM in two cases.(10) Our patient underwent active rehabilitation with regularly performing ROM exercises and stretching exercises for alleviating contracture. Wet cold compresses and local corticosteroids were applied to rubescent extremities; oral antihistaminic treatment was administered. Consequently, SSS is rare and can have different clinical presentations. Overall, further knowledge and experience of this syndrome are required for a better treatment approach.

OBJECTIVE:The aim of this study was to evaluate the coexistence of C5 and/or C6 root compression with rotator cuff pathologies and its effect on pain and disability.METHODS:A total of 65 patients with pain radiating from neck to shoulder were retrospectively evaluated on the basis of demographic data, duration of symptoms, overhead activities, and physical examination. The visual numerical scale (VNS), Quick DASH (Disabilities of the Arm, Shoulder, and Hand), and Shoulder Pain and Disability Index (SPADI) were also used. Cervical magnetic resonance imaging (MRI) was used to evaluate C5-C6 root compression, which was separated into two groups as patients with or without upper trunk root compression (UTRC). These groups were compared according to the MRI findings of patients with rotator cuff pathologies.RESULTS:According to our results, C5 root compression (12.3%), C6 root compression (41.5%), UTRC (44.6%) were detected. There was no difference between the groups regarding the Hawkins and Neer tests. The Yergason and Jobe tests were statistically higher in patients without UTRC. In the shoulder MRIs, the rate of subscapular muscle tear was significantly higher in patients with UTRC. Other shoulder MRI findings were not different between the groups. VNS-neck and SPADI-pain scores were significantly higher in patients without UTRC. There was no difference between the groups in the scores of VNS-shoulder, Quick DASH, SPADI-disability, and SPADI-total.CONCLUSION:Radiating pain from neck to shoulder that is caused by C5-C6 root compression does not create a predisposition for clinical, radiologic, and functional pathologies in shoulder joint. It seems difficult to diagnose the exact origin of pain in patients who present with neck pain radiating to shoulder based on the findings of cervical or shoulder MRI alone.

Synovial osteochondromatosis is a benign metaplasia involving the synovial membrane, bursas, and tendon sheaths. In the literature, involvement of the hand joints is not common. Pain, swelling, and limitation of movement in the affected joints can be seen, as well as joint locking in the advanced stages of the disease. Diagnosis is usually made using imaging methods. Accurate diagnosis and follow-up of such cases are important due to the risk of malignant degeneration.