OBJECTIVES:The epidemiology of acute hand injuries that require surgery in children is poorly defined. The purpose of this study was to outline the epidemiological and injury characteristics of surgically treated acute traumatic hand injuries in children and offer preventive recommendations. METHODS:We performed a retrospective descriptive epidemiological study of surgically treated acute traumatic hand injuries observed between 2004 and 2024 in a tertiary university hospital. The analysis included patients under 18 years of age, and examined demographics, injury mechanisms, causes, injury characteristics, and severity using the Modified Hand Injury Severity Scale (MHISS). RESULTS:Two hundred ninety-five patients were enrolled in the study. Injuries were most common among males and adolescents. The most frequent mechanism of acute hand injury was laceration (78.6%). Accidental falls with glass cups in toddlers and preschool children, street glass shards in schoolchildren, and punching glass and chainsaw injuries in adolescents were the most common causes of lacerations. The Modified Hand Injury Severity Score (MHISS) indicated that most hand injuries were moderate (35.9%). Complex injuries accounted for 39.7% of all cases, and 10.8% of patients required additional surgeries. CONCLUSIONS:The main cause of acute traumatic hand injuries requiring surgery in children is laceration due to glass, motorized and non-motorized farming equipment, cutting machines, knives, and various sharp objects. Raising parental awareness and educating the community can help to reduce the incidence of these injuries.

BACKGROUND:Mole guns are handmade destructive tools used in the fight against harmful rodents in agricultural areas. Acciden-tal triggering of these tools at the wrong time can result in major hand injuries that impair hand functionality and cause permanent hand disability. This study aims to draw attention to the fact that mole gun injuries cause severe loss of hand functionality and that these tools should be considered within the scope of firearms.METHODS:Our study is a retrospective, observational cohort study. The demographic characteristics of the patients, the clinical features of the injury, and the surgical methods applied were recorded. The severity of the hand injury was assessed by the Modified Hand Injury Severity Score. The Disabilities of Arm, Shoulder, and Hand Questionnaire was used to evaluate the upper extremity-re-lated disability of the patient. The patients' hand grip strength and palmar and lateral pinch strengths, and functional disability scores were compared with healthy controls.RESULTS:Twenty-two patients with mole gun hand injuries were included in the study. The mean age of the patients was 63.0±16.9 (22-86), and all but one were male. Dominant hand injury was found in more than half of the patients (63.6%). More than half of the patients had major hand injuries (59.1%). The functional disability scores of the patients were significantly higher than the controls, and the grip strengths and palmar pinch strengths were significantly lower.CONCLUSION:Even after years from the injury, our patients had hand disabilities, and their hand strengths were lower than that of the controls. Public awareness should be raised on this issue, and mole guns should be prohibited and considered in the scope of firearms.

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.

Introduction: Custom-made orthoses are used to prevent contractures and reinjury of tissues such as tendon rupture after traumatic tendon repairs. Despite their wide usage in hand rehabilitation, orthosis adherence is usually an overlooked problem. Purpose of the Study: This study aims to evaluate the possible factors affecting the orthosis adherence in patients with acute traumatic tendon repairs. Study Design: This is a prospective cohort study. Methods: Two hundred twelve patients with acute traumatic hand tendon repair were included in this prospective cohort study. Patients were evaluated on the third day postoperatively and at three weeks. All patients were told to wear their orthosis 24 h a day for three weeks and allowed to take it off to wash the hand carefully once a day. Adherence was measured as fully adherent, partially adherent, and nonadherent. Factors that may affect orthosis adherence were evaluated according to the five dimensions of the multidimensional adherence model including socioeconomic, condition-related, treatment-related, patient-related, and health-care system-related factors. The Modified Hand Injury Severity Scale was used to assess the severity of the injury. Depression and anxiety symptoms were evaluated with the Beck Depression Inventory and Beck Anxiety Inventory. A multivariate logistic regression model was constructed for orthosis adherence. Results: One hundred thirty-three patients were analyzed. Forty-four (33.1%) patients were fully adherent with the prescribed orthosis, whereas 67 (50.4%) were partially adherent and 22 (16.5%) were nonadherent. Higher depression symptoms caused orthosis nonadherence [odds ratio = 1.2 (95% confidence interval = 1.1-1.3), P = .001] and partial adherence [odds ratio = 1.1 (95% confidence interval = 1.0-1.2), P = .01]. Conclusions: Among our patients with acute traumatic tendon repair, only one-third of the patients were fully adherent with the orthosis wear program. Depression in the very acute period of injury impaired orthosis adherence. (C) 2020 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved.

STUDY DESIGN:Prospective cohort study. INTRODUCTION:Identification of risk factors for CRPS development in patients with surgically treated traumatic injuries attending hand therapy allows to watch at-risk patients more closely for early diagnosis and to take precautionary measures as required. PURPOSE OF THE STUDY:The aim of this study was to evaluate the risk factors for the development of complex regional pain syndrome (CRPS) after surgical treatment of traumatic hand injuries. METHODS:In this prospective cohort, 291 patients with traumatic hand injuries were evaluated 3 days after surgery and monitored for 3 months for the development of CRPS. The factors assessed for the development of CRPS were age, sex, manual work, postoperative pain within 3 days measured on a Pain Numerical Rating Scale (0-10), and injury type (crush injury, blunt trauma, and cut laceration injury). RESULTS:CRPS was diagnosed in 68 patients (26.2 %) with a duration of 40.10 ± 17.01 days between the surgery and CRPS diagnosis. The mean postoperative pain score was greater in patients with CRPS than in those without CRPS (P < .001). Patients with pain scores ≥ 5 had a high risk of developing CRPS compared with patients with pain scores <5 (odds ratio: 3.61, confidence interval = 1.94-6.70). Patients with crush injuries were more likely to develop CRPS (odds ratio: 4.74, confidence interval = 2.29-9.80). CONCLUSIONS:The patients with a pain score of ≥5 in the first 3 days after surgery and the patients with crush injury were at high risk for CRPS development after surgical treatment of traumatic hand injuries. LEVEL OF EVIDENCE:II b.

Objectives This study aims to estimate the prevalence of rheumatoid arthritis (RA) and spondyloarthritis (SpA) in Turkey using the same telephone questionnaire developed for screening RA and SpA in France and used in Serbia and Lithuania. Material and methods The study was performed in two steps. In step I, the French questionnaire was translated into Turkish and validated through a group of 200 patients (80 males, 120 females; mean age 44.0±13.1 years; range 19 to 75 years) followed up at the rheumatology departments of University Hospitals in Antalya and Ankara. In step II, the validated Turkish questionnaire was administered face-to-face to randomly selected 4,012 subjects (1,670 males, 2,342 females; mean age 41.5±16.8 years; range 16 to 97 years) by trained general practitioners across the country, in 25 prov- inces for case detection. The subjects who were suspected of having RA or SpA in accordance with the questionnaire were invited to the nearest university hospital for rheumatologic examination in order to confirm the diagnosis. Results In step II, a total of 25 subjects (2 males, 23 females) were diagnosed as RA. The standardized RA prevalence for the general population of Turkey was calculated as 0.56% (95% confidence interval [CI]; 0.33-0.79), 0.10% (95% CI; -0.05-0.25) for males and 0.89% (95% CI; 0.51-1.27) for females. A total of 18 subjects (3 males, 15 females) were diagnosed as SpA. The standardized SpA prevalence for the general population of Turkey was 0.46% (95% CI; 0.25-0.67), 0.17% (95% CI; -0.03-0.37) for males and 0.65% (95% CI; 0.32-0.98) for females. The prevalence of RA was highest in the Northern region (2.00%) and the prevalence of SpA was highest in the Central region (1.49%). Conclusion The prevalences of RA and SpA in Turkey are close to each other and there are significant inter-regional variations in prevalences of both RA and SpA.

IntroductionIn this study we investigated the flexor pollicis longus (FPL) tendon and median nerve in smartphone users by ultrasonography to assess the effects of smartphone addiction on the clinical and functional status of the hands. Methods: One hundred two students were divided into 3 groups: non-users, and high or low smartphone users. Smartphone Addiction Scale (SAS) scores and grip and pinch strengths were recorded. Pain in thumb movement and rest and hand function were evaluated on the visual analog scale (VAS) and the Duruoz Hand Index (DHI), respectively. The cross-sectional areas (CSAs) of the median nerve and the FPL tendon were calculated bilaterally using ultrasonography. Results: Significantly higher median nerve CSAs were observed in the dominant hands of the high smartphone users than in the non-dominant hands (P<0.001). SAS scores correlated with VAS pain for movement and rest, DHI scores, and pinch strength (P<0.05; r=0.345, 0.272, 0.245, and 0.281, respectively). Conclusions: Smartphone overuse enlarges the median nerve, causes pain in the thumb, and decreases pinch strength and hand functions. Muscle Nerve, 2015 Muscle Nerve52: 183-188, 2015

Renal cell carcinoma (RCC) is the most common primary malignancy of the kidney. Here, we reported a 75-year-old female patient who was admitted to the hospital with chronic low back pain radiating to both legs with numbness. After lumbar magnetic resonance imaging reported findings such as left paracentral disc protrusion at the level of L1-2, left paracentral foraminal disc protrusion at the level of L45, and diffuse annular bulging at the levels of L3-4 and L5-S1 with bilateral narrowing of the neural foramina, we started physical therapy with a diagnosis of lumbar radiculopathy. During her follow up, renal ultrasonography (US) was performed because of slightly high persisting creatinine levels. Renal US reported a renal mass that includes necrotic regions. Finally, she was diagnosed with non-metastatic RCC. Her pain substantially disappeared after she underwent radical nephrectomy.

Hyperthyroidism is a pathologic condition in which the body is exposed to excessive amounts of circulating thyroid hormones. Skeletal muscle is one of the major target organs of thyroid hormones. We evaluated hand grip strength and function in patients with overt hyperthyroidism. Fifty-one patients newly diagnosed with hyperthyroidism and 44 healthy controls participated in this study. Age, height, weight, and dominant hand of all participants were recorded. The diagnosis of hyperthyroidism was confirmed by clinical examination and laboratory tests. Hand grip strength was tested at the dominant hand with a Jamar hand dynamometer. The grooved pegboard test (PGT) was used to evaluate hand dexterity. The Duruöz Hand Index (DHI) was used to assess hand function. No significant differences were found in terms of clinical and demographic findings between the patients with hyperthyroidism and healthy controls (p > 0.05). Significant differences were found between the patients with hyperthyroidism and healthy controls regarding PGT and DHI scores (p < 0.05). Hyperthyroidism seemed to affect hand dexterity and function more than hand grip strength and seemed to be associated with reduced physical function more than muscle strength. This may also indicate that patients with hyperthyroidism should be evaluated by multidisplinary modalities.

BACKGROUND:We aimed to determine the sympatholytic and clinical effects of low dose high frequency ultrasound (US) applied on stellate ganglion in Complex Regional Pain Syndrome (CRPS) type I patients. MATERIAL AND METHOD:Fourty-five patients with CRPS type I were randomly allocated into three groups. Pharmacological treatment, transcutaneous electrical nerve stimulation (TENS), contrast bath and exercise were applied to all groups for 20 sessions. In addition to this treatment protocol, low dose high frequency US was applied on stellate ganglion as 0.5 watts/cm(2) in group I; 3 watts/cm(2) in group II and as placebo in group III. Forty age and sex matched healthy controls were served as controls. Sympathetic skin response (SSR) was used for determining the sympatholytic effects of US. Pain was assessed with visual analog scale (VAS), limitation of total finger flexion was assessed with finger pulp-distal crease distance, muscle strength was assessed with measuring the grip strength, upper extremity disability was assessed with Disability of the Arm, Shoulder and Hand (DASH) scale before and after the treatment. RESULTS:All groups evalueted in terms of VAS score, finger pulp-distal crease distance, grip strength and DASH score after the treatment. The improvements in those parameters were not statistically significant between the groups (P > 0.05). SSR latency was significantly shorter in CRPS patients than controls (P < 0.05). Pre- and post-treatment SSR amplitude and latency values were not different within patient groups (P > 0.05). The differences in pre- and post-treatment SSR amplitude and latency values were not statistically different between patient groups (P > 0.05). CONCLUSION:Low dose high frequency US applied on stellate ganglion did not make a sympathetic blockade and was not of further benefit for pain, range of motion, grip strength and upper extremity disability in CRPS type I patients.

Transverse myelitis (TM) has rarely been reported in association with tetanus toxoid-containing vaccines. Here, we report a 46-year-old man presented with progressive paresthesias and weakness in his arms and legs following an intramuscular injection of adult-type diphtheria and tetanus toxoids (Td). This is the sixth reported case of TM following Td vaccination. Physicians must be aware of this rare but serious side effect when prescribing Td vaccine and postvaccinial TM must be kept in mind when making a differential diagnosis of TM.

© Tur kish Jo ur nal of Physi cal Me di ci ne and Re ha bi li ta ti on, Pub lis hed by Ga le nos Pub lis hing./ © Tür ki ye Fi zik sel Tıp ve Re ha bi li tas yon Der gi si, Ga le nos Ya yı ne vi ta ra fın dan ba sıl mış tır.

Objective: It still remains unclear if lumbar supports are effective in the treatment of chronic low back pain. The objective of the present study was to assess and compare the short-term effect of extension-controlled lumbar support and elastic lumbar support on low back pain, lumbar flexibility and back-specific disability in chronic low back pain patients. We also investigated the factors affecting the lumbar support compliance. Materials and Methods: One hundred and eighteen chronic low back pain patients were randomly allocated into three groups. Group 1 (n=39) was prescribed traditional, extension-controlled lumbar support; group 2 (n=40) was prescribed elastic lumbar support; both for six hours a day for three weeks. Lumbar support was not prescribed for group 3 (n=39). All patients used 1000 mg/day naproxen sodium. Pain severity was evaluated with numeric rating scale (NRS), back flexibility was evaluated with the Schober test and back-specific disability was evaluated with the Roland-Morris Disability Questionnaire (RMDQ). A 30% improvement was considered as threshold for identifying clinically meaningful improvement on NRS and RMDQ. Results: Clinically meaningful improvement was detected on NRS (45%) and RMDQ (35%) in group 1; on NRS (37%) in group 2. No meaningful clinical improvement was detected in group 3 on NRS and RMDQ. Lumbar support compliance was 52.1% in groups 1 and 2. Compliancewas positively correlated with patients' pre-treatment positive beliefs about the lumbar support and negatively side effects of lumbar support. Conclusion: In chronic low back pain patients, extension-controlled lumbar support or elastic lumbar support usage in addition to classical medical treatment is better than classical medical treatment alone in terms of pain intensity in short term. Extension-controlled lumbar support improves back-specific disability. Compliance with the lumbar support was increased with the patients' pre-treatment positive beliefs about lumbar support and decreased with the side effects of lumbar support.

Objectives: This study aims to identify the frequency of clinical risk factors associated with osteoporosis in postmenopausal women.Patients and methods: In this cross-sectional, observational, multicenter study, a total of 730 postmenopausal women were assessed for risk factors associated with osteoporosis. The assessment included a standardized questionnaire which recorded the following clinical risk factors: family and personal histories of fractures, prolonged immobilization, sun exposure, lifelong sedentary lifestyle, smoking history, low calcium intake in childhood and adulthood, excessive caffeine intake, high sodium intake, inadequate protein intake, number of pregnancies, age at menopause, the presence of premature menopause, primary and secondary amenorrhea, medical conditions, and chronic use of prescription drugs.Results: The most frequent clinical risk factors for osteoporosis were inadequate sun exposure (53.3%), current sedentary lifestyle (52.9%), low calcium intake in adulthood (45.1%) and childhood (41.9%), and sedentary lifestyle in adolescence (27.9%). A total of 707 patients (96.5%) described more than one risk factor, while 74.3% of the patients reported one clinical risk factor at least for secondary osteoporosis.Conclusion: Adequate sun exposure and proper intake of dietary calcium beginning in childhood combined with lifelong daily physical activity may play a role in preventing osteoporosis in postmenopausal women. In addition, physicians should be aware of the high probability of secondary osteoporosis in this patient group.

Aging is an inevitable process. Increased physical activity and regular exercise in the elderly reduces the rate and the magnitude of this physiological deterioration and the subsequent functional decline. Regular exercise in the older adults improves aerobic capacity, muscle strength, flexibility and balance which is needed for functional independence and also improves blood pressure, diabetes, lipid profile, osteoarthritis, osteoporosis and neurocognitive function. The exercise prescription for the elderly should consist of three components: aerobic exercise, strength training, and flexibility and balance. Physicians must inform their older patients about the benefits of exercise; encourage them to maintain an active lifestyle and to do regular exercises; to remove the barriers to exercise; prescribe exercises according to the patient's individual health needs and increase long-term exercise compliance.

Osteonecrosis is a pathological process which results in death of bone and bone marrow elements and can be associated with a variety of medical conditions. Involvement of the knee is believed to account for approximately 10% of all cases. The most frequent type of knee osteonecrosis is idiopathic osteonecrosis (spontaneous), and commonly involves the medial femoral condyl. Spontaneous osteonecrosis is more common in patients older than 60 years. In this case report, a 31-year-old female patient diagnosed as having spontaneous osteonecrosis of the knee after a sudden pain was presented. Turk J Phys Med Rehab 2010;56:40-2.

Purpose. To find out if the quality of life (QOL) and self-concept of the children with cerebral palsy (CP) was different from that of children without disability, to investigate predictive variables that could affect self-concept and QOL.Methods. A total of 40 children with CP and 46 age-matched peers were included. The baseline characteristics including sex, type of CP, the level of disability according to Gross Motor Function Classification System (GMFCS) were recorded. Education levels of both children and parents, demographic features of parents, features of living area, usage of devices and associated impairments were filled out. Self-concept was measured using Piers-Harris Self-concept (PH) Scale. Quality of life was measured by Pediatric Quality of Life Inventory 4.0 (PedsQL). The physical and psychosocial health subscale scores of PedsQL (P-PedsQL and PS-PedsQL) were recorded.Results. Significant differences in mean scores favouring the control group were found for PH scale, PedsQL scale (p < 0.001). P-PedsQL and PS-PedsQL of the CP group were lower than the control group (p < 0.001). PS-PedsQL report was significant predictor of self-concept. The presence of incontinence and GMFCS level were significant predictors of PedsQL and PPedsQL, respectively.Conclusion. Self-concept and QOL of the CP children were lower than the children without CP. Presence of incontinence, self-concept rating and GMFCS level were important to predict domains of QOL.