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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-013
Os Trigonum Sendromlu Bir Olgu
Yasemin Turan, Ifl›l Karatafl Berkit, Fatih Kahvecio¤lu, Ömer Faruk fiendur
Adnan Menderes Üniversitesi T›p Fakültesi
Fiziksel T›p ve Rehabilitasyon Anabilim Dal›, Ayd›n
G‹R‹fi: Os trigonum sendromu, arka ayak a¤r›s›na sebep olan nadir nedenlerden biridir. Os
trigonum, talusun posteriorunda yer alan, 7 ile 13 yafllar› aras›nda ossifikasyon merkezi olarak
ortaya ç›kan ve genellikle bir y›l içinde talus ile birleflen bir aksesuar kemiktir. Toplumun
%7’sinde talus ile birleflmez ve bu yap›n›n semptomatik hale gelmesi os trigonum sendromu
olarak tan›mlan›r. Bizde tan›s› s›kl›kla atlanan nadir görülen os trigonum sendromlu olguyu
sunmay› amaçlad›k.
OLGU: Son iki ayd›r sol aya¤›nda a¤r› yak›nmas› olan 65 yafl›ndaki bayan hasta klini¤imize
baflvurdu. Özellikle aya¤›n arka bölümünde olan a¤r›s› yürümekle fliddetleniyordu. Is›, flifllik,
sabah tutuklu¤u tariflemeyen olgunun travma öyküsü yoktu. Yap›lan muayenesinde ayak bile¤inin
ve baflparma¤›n aktif ve pasif eklem hareket aç›kl›¤› tam ve plantar fleksiyonlar› a¤r›l›yd›.
A¤r›-VAS’› 8cm olarak de¤erlendirildi. Derin palpasyon ile talusun posteriorunda hassasiyet
saptand›. Ek olarak olgu parmak ucuna bast›¤›nda ayn› bölgede a¤r› hissediyordu. Laboratuar
incelemesinde ESH ve CRP düzeyi normal olarak bulundu. Sol ayak bile¤i lateral radyografisinde
os trigonum mevcutken MRG incelemesinde talus posterior kesiminde supur
formasyonu saptanmas› üzerine hastaya os trigonum sendromu tan›s›yla non-steroid antiinflamatuvar
ilaç, TENS, coldpack yan›s›ra ayak bile¤ine ve ayak baflparma¤›na EHA, güçlendirme
egzersizinden oluflan fizik tedavi program› uyguland›. Tedavi sonucunda baflparma¤›n dirençli
plantar fleksiyonunda oluflan a¤r› VAS’›nda 2cm’e gerileme görüldü ve hasta takibimize
al›nd›.
SONUÇ: Os trigonum sendromu, arka ayak a¤r›s›na sebep olan bir patolojidir. Olgumuzda oldu¤u
gibi arka ayak a¤r›s› ile baflvuran hastalarda di¤er s›k görülen sebeplerin yan›nda os trigonum
sendromuda ay›r›c› tan›da göz önünde bulundurulmal›d›r.
Anahtar Kelimeler: Os trigonum sendromu, ayak a¤r›s›
P-014
Adeziv Kapsülit ve Retinopatinin Efllik Etti¤i Diyabetik
Bir Hastada Osteopoikiloz
Ali Biçer 1, Koray Ço¤ul 1 , Müjdat Yaz›c› 2, Ayça Sar› 3, Kerem Sezer 4
1Mersin Üniversitesi T›p Fakültesi Fiziksel T›p ve Rehabilitasyon Anabilim Dal›, Mersin
2Mersin Üniversitesi T›p Fakültesi, Radyoloji Anabilim Dal›, Mersin
3Mersin Üniversitesi T›p Fakültesi Göz Hastal›klar› Anabilim Dal›, Mersin
4Mersin Üniversitesi T›p Fakültesi Endokrinoloji Bilim Dal›, Mersin
Osteopoikilosis etyolojisi belli olmayan, genellikle otozomal dominant yol ile geçifl gösteren,
nadir görülen bir sklerozan kemik displazisidir. Hastalar›n büyük bir ço¤unlu¤u asemptomatiktir
ve osteopoikiloz tan›s› s›kl›kla direk radyografik incelemeler s›ras›nda tesadüfen
konulur. Bu vaka takdiminde, klinik ve radyolojik bulgular› osteopoikilosis ile uyumlu bir erkek
hasta sunulmaktad›r. Hastada osteopoikilozla birlikte tip 2 diabetes mellitus ve buna efllik
eden retinopati ile sol omuz adeziv kapsuliti de bulunmaktad›r. Osteopoikiloz ile tip 2 diabetes
mellitus birlikteli¤i nadir görülen klinik bir durumdur.
Anahtar Kelimeler: Adeziv kapsülit, diabetes mellitus, osteopoikiloz, retinopati, sklerozan
kemik displazisi
P-013
Os Trigonum Syndrome: A Case Report
Yasemin Turan, Ifl›l Karatafl Berkit, Fatih Kahvecio¤lu, Ömer Faruk fiendur
Adnan Menderes University Medical School of Department of
Physical Therapy and Rehabilitation, Aydin
INTRODUCTION: Os trigonum syndrome is one of the rare causes of posterior foot pain. Os
trigonum, which is placed at the posterior of talus, appears as an ossification center between
ages 7-13 years, and generally joins with talus in one year-time, is an accessory bone. In 7%
of the population, it does not join with talus, and it is defined as os trigonum syndrome, when
this structure becomes symptomatic. We aim to present our case, which is a rare disease and
is generally missed out.
CASE: 65-year old female patient with the complaint of left foot pain for the last 2 months,
was admitted to our clinics. The severity of the pain on the posterior of her foot was increasing
especially during a walk. The patient reported no redness, swelling or morning stiffness
and there was no history of trauma. The physical examination revealed that active and
passive motion ranges of ankle and toe were complete, whereas plantar flexion was painful.
Pain VAS was 8 cm. There was sensitivity at the posterior of talus during deep palpation.
ESR and CRP levels were all within normal limits. While there was os trigonum on left ankle
lateral radiography, spur formation was detected on posterior talus in MRI examination,
and the patient was diagnosed as os trigonum. Treatment included non-steroidal
anti-inflammatory drugs, TENS, cold pack as well as a physiotherapy program with
ROM strengthening exercises for ankle and toe. After the treatment, pain VAS due to forced
plantar flexion of the toe decreased to 2 cm, and then the patient was followed up.
CONCLUSION: Os trigonum syndrome is a pathology leading to posterior foot pain. As in
our case, os trigonum syndrome should also be remembered in the differential diagnosis
of patients complaining of posterior foot pain, apart from other frequently encountered
causes.
Keywords: Os trigonum syndrome, foot pain
P-014
Osteopoikilosis in a Diabetic Patient Associated with Adhesive
Capsulitis and Retinopathy
Ali Biçer 1, Koray Ço¤ul 1, Müjdat Yaz›c› 2, Ayça Sar› 3, Kerem Sezer 4
1 Mersin University School of Medicine Department of Phsical Medicine and Rehabilitation, Mersin
2 Mersin University School of Medicine Department of Radiology, Mersin
3 Mersin University School of Medicine Department of Ophthalmology, Mersin
4 Mersin University School of Medicine Department of Endocrinology, Mersin
Osteopoikilosis is a rare osteosclerotic bone dysplasia with unknown etiology which usually
has an autosomal-dominant inheritance pattern. The majority of the patients are asymptomatic
and the diagnosis of osteopoikilosis is often made incidentally on the radiographic
examination. In this case report, a male patient whose clinical and radiological findings consisted
with osteopoikilosis was presented. The patient had also type 2 diabetes mellitus associated
with retinopathy and adhesive capsulitis of the left shoulder coexisting with osteopoikilosis.
Coexistence of osteopoikilosis and type 2 diabetes mellitus is a rare clinical condition.
Keywords: Adhesive Capsulitis, diabetes mellitus, osteopoikilosis, retinopathy, sclerotic bone
dysplasia