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P-310
Genç Yafllarda Geliflen Nodal Osteoartrit: Bir Olgu Sunumu
Zeynep Saruhan 1, Huya Uzkeser 2, Kadir Yildirim 1
1Atatürk üniversitesi T›p Fakültesi Fiziksel T›p ve Rehabilitasyon Anabilim Dal›, Erzurum
2Numune Hastanesi Fiziksel T›p ve Rehabilitasyon Anabilim Dal›, Erzurum
Bu olgu sunumunda genç yafllarda geliflen, Heberden nodülleriyle karekterize osteoartrit olgusu
sunulmaktad›r. 29 yafl›ndaki kad›n hasta 4 y›l önce bafllayan el, ayak ve diz a¤r›lar›yla
klini¤imize bafl vurdu. Hastan›n anemnezinde 4 y›l önce el, ayak ve dizlerde a¤r›, yanma flikayetlerinin
bafllad›¤› ö¤renildi. Daha sonra el parmaklar›nda a¤r›l›, sert fliflliklerin olufltu¤u
ifade edildi. 5-10 dakika süren sabah tutuklu¤u oldu¤u ö¤renildi. Hastan›n muayenesinde ellerde
sa¤ 2. ve 3. DIF ve sol 3. DIF eklemlerinde Heberden nodülleri belirlendi. Bu eklemlerin
hareketleri de a¤r›l›yd›. Her iki diz hareketleri minimal a¤r›l›, eklem hareket aç›kl›klar› normaldi.
Laboratuvar analizde rutin tetkikler normal olarak bulundu. Hastan›n soy geçmiflinde
de annesinde benzer a¤r› ve fliflliklerin oldu¤u ö¤renildi. Hastam›za nodal osteoartrit tan›s›yla
parasetamol tedavisi baflland›. 1 ay sonraki kontrolde rahatlamas› oldu¤u ö¤renildi. Bu olgu
sunumunda nodal osteoartritin genç yafllarda da bulgu verebilece¤i vurgulanmaktad›r.
Anahtar Kelimeler: Osteoartrit, heberden nodülleri, nodal osteoartrit
P-311
‹leri Derece Diz Osteoartritli Hastalarda Artroplasti Korkusu
Erkan Özgüçlü
Haymana Devlet Hastanesi Fizik Tedavi ve Rehabilitasyon Klini¤i, Haymana, Ankara
AMAÇ: ‹leri derece diz osteoartriti olan hastalarda tedavi yaklafl›mlar›n›n de¤erlendirilmesi.
GEREÇ-YÖNTEM: Çal›flmaya Kallgren-Lawrence diz osteoartrit evrelemesine göre dördüncü
derece olan toplam 30 hasta al›nd›. Çal›flmada a¤r›n›n sorgulamas›nda 0-10 aras› puanland›r›lan
VAS kullan›ld›. Hastal›¤a spesifik sa¤l›k durum ölçütü olan WOMAC kullan›larak son 24
saatteki a¤r›, sertlik ve fiziksel aktiviteleri sorguland›. Tüm hastalara ileri derecede diz osteoartriti
olduklar›, konservatif ve cerrahi tedavi seçeneklerinin oldu¤u anlat›ld›. Hangi tedaviyi
neden seçtikleri veya reddeddikleri soruldu.
BULGULAR: Hastalar›n yafllar› 66-74 aras›ndad›r (ortalama yafllar› 68±4). Bu hastalar›n 18'i
kad›n, 12'si erkekti. VAS skorlar› ortalama 8.3'tü. Toplam WOMAC puanlar› ortalama
48,13±2,1'di. Tüm hastalar fizik tedavi, lokal ve/veya oral analjezik tedavilerini tercih ettiklerini
belirtti. Hiçbir hasta daha önce de kendilerine cerrahi tedavi önerildi¤i halde artroplasti olmak
istemedi¤ini belirtti. En s›k cerrahi tedavi red nedeni olarak %96 hastada ameliyat sonras›nda
daha kötü durumda olaca¤› korkusu ve hiç yürüyememe olarak tespit edildi.
SONUÇ: ‹leri derece osteoartrit sebebiyle fliddetli a¤r›, sertlik ve fonksiyon k›s›tl›l›¤› olan hastalar
endifle ve korkular› nedeniyle cerrahi tedaviye s›cak bakmamaktad›r. Hastalar›n hayat
kalitelerinin ve fonksiyonelliklerinin korunmas› ad›na hastalar tedavi yöntemleri hakk›nda objektif
ve hasta örnekli yaklafl›mlarla bilgilendirilmelidir.
Anahtar Kelimeler: Analjezikler, artroplasti, diz osteoartrit, fizik tedavi
307
23. Ulusal Fiziksel T›p ve Rehabilitasyon Kongresi / 23 rd National Physical Medicine & Rehabilitation Congress
Türk Fiz Rehab Derg 2011:57Özel Say›; 1-334 /Turk J Phys Med Rehab 2011:57Suppl; 1-334
P-310
Development of Nodal Osteoarthritis At Young Age: A Case Report
Zeynep Saruhan 1, Huya Uzkeser 1, Kadir Yildirim 1
1 Ataturk University Medical Faculty Department of Physical Medicine and Rehabilitation, Erzurum
2 Numune Hospital Department of Physical Medicine and Rehabilitation, Erzurum
A young case of osteoarthritis characterized by Heberden nodules is presented in this report.
A twenty nine years old woman was admitted to our clinic with the complaint of pain in the
hands, knees and feet. From the medical history, we learned that pain and burning sensation
complaints had started four years ago in her hands, knees and feet. Following these
complaints, painful and palpable nodules appeared in her fingers. Morning stiffness had
been lasting for 5-10 minutes. In her examination Heberden nodules were determined on the
second and third DIF in right and also third DIF in the left hand. Arthralgia with movement
was obvious in these joints. Examination of the knees revealed full range of motion but with
minimal pain. Laboratory analysises were normal. Similar nodules and pain on her mother’s
hand was reported in her family history. Paracetamol treatment was started to the patient
with the diagnosis of nodal osteoarthritis. Improvements were reported one month later. In
this case we emphasize that nodal osteoarthritis may also occur at a young age.
Keywords: Osteoarthritis, heberden nodule, nodal osteoarthritis
P-311
Fear of Arthroplasty in High Grade Knee Osteoarthritis Patients
Erkan Özgüçlü
Haymana State Hospital Department of Physical Medicine and Rehabilitation Haymana, Ankara
OBJECTIVE: The aim of this study is to evaluate the treatment approaches of high grade
knee osteoarthritis patients.
MATERIALS-METHODS: 30 patients diagnosed with knee osteoarthritis grade 4 according to
Kallgren-Lawrence osteoarthritis index were included in our study. Visual analogue scale
(VAS) with 0-10 points was applied to the patients for pain questioning. Disease specified
health status instrument WOMAC (Western Ontario and McMaster Universities) index was
applied to assess pain, stiffness and physical activity in the last 24 hours. All patients were informed
about their disease that they have high grade knee osteoarthritis, and conservative
and surgical treatment options existed. Patients’ opinion on refusing or accepting the
treatment option was questioned.
RESULTS: 18 female and 12 male patients, aged between 66 and 74 years (mean age 68±4)
are included in our study. Mean VAS score was 8.3. Mean total WOMAC score was 48.13±2.1.
All of the patients preferred physical therapy, local and/or oral analgesic treatments and
none of them preferred surgical treatment despite previous surgical treatment suggestion.
The most frequent reason for surgery rejection was the fear of being in a worse condition
and unable to walk after the operation.
CONCLUSION: High grade knee osteoarthritis patients with severe pain, stiffness and
functional limitation refuse surgery because of the fear and anxiety. Patients should be
informed about treatment modalities objectively and with patient samples to improve their
quality of life and functionality.
Keywords: Analgesics, arthroplasty, knee osteoarthritis, physical therapy