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166 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-023 Dizde Lipoma Arboresan ve Baker kisti: Olgu Sunumu Zuhal Güldeste, Esin Baran, Nimet Atakul, Mehmet K›rnap Erciyes Üniversitesi T›p Fakültesi Fizik Tedavi ve Rehabilitasyon Anabilim Dal›, Kayseri Lipoma arboresan (LA) diz ekleminin özellikle suprapatellar bölgesinde sinovyumun villöz lipomatöz proliferasyonu ile karakterize nadir görülen intraartiküler lezyondur. Hastalarda genellikle tekrarlayan diz a¤r›s› ve fliflli¤i mevcuttur. Vakalar›n %20’sinde popliteal kist vard›r. Manyetik rezonans görüntüleme (MR) tan›da oldukça yararl›d›r, sinovyumdan köken alan yaprak benzeri görüntüler tipiktir. 35 yafl›nda bayan hastan›n 5 y›ld›r sol dizinde tekrarlayan flifllik ve a¤r› hikayesi mevcuttu. Dört kez mayi boflalt›c› ponksiyon yap›lan hastaya kronik idiopatik artrit tan›s›yla salazopyrin, steroid ve antienfalamatuar tedavi bafllanm›flt›. Sol dizde a¤r› ve flifllik vard›. Di¤er muayeneleri ve romatolojik sorgulama normaldi. ESH 29, CRP 3.41 ve Romatoid faktör, anti-CCP, antinukleer antikor (ANA), ANA profil, anti dsDNA, brusella, hepatit mark›rlar› negatifti. Kan biyokimya ve CBC de normaldi. Sol diz eklem aspirasyonu ile 315 cc berrak sar› s›v› elde edildi, kristal, hücre ve mikroorganizma negatifti. MR’da popliteal fossada 6x2 cm ölçüsünde popliteal kist, suprapatellar bursada s›v› miktar›nda artma ve lipoma arboresan ile uyumlu görünüm izlendi. Krioterapiden hiçbir fayda görmeyen ve ortopedi ile konsülte edilen hastaya cerrahi sinovyektomi önerildi. Bu vakada oldu¤u gibi tek eklemde tekrarlayan flifllik mevcut olan hastalarda lipoma arboresan aç›s›ndan MR ile de¤erlendirme yap›lmal›d›r. Anahtar Kelimeler: Baker kisti, lipoma arboresan, manyetik rezonans görüntüleme P-024 Çift tarafl› Do¤ufltan Yüksek Skapula (Sprengel Deformitesi): Olgu Sunumu Mustafa Özflahin 1, Mustafa Uslu2, Erkan ‹nanmaz2, Mesut Okur3 1Düzce Üniversitesi T›p Fakültesi Fiziksel T›p ve Rehabilitasyon Anabilim Dal›, Düzce 2Düzce Üniversitesi T›p Fakültesi Ortopedi ve Travmatoloji Anabilim Dal›, Düzce 3Düzce Üniversitesi T›p Fakültesi,Çocuk Sa¤l›¤› ve Hastal›klar› Anabilim Dal›, Düzce On yafl›nda erkek hasta gö¤sün sol taraf›nda olan flifllik nedeniyle hastanemiz Gö¤üs Cerrahisi poliklini¤ine baflvurmufl. Gö¤üs kafesi anterior duvar›nda deformite nedeniyle opere edilen hasta rehabilitasyon amac›yla poliklini¤imize yönlendirilmifl. Hastan›n yap›lan fizik muayenesinde ve X-ray grafisinde çift tarafl› do¤ufltan yüksek skapula (Sprengel deformitesi) mevcuttu. Torakal ve servikal vertebra grafilerinde belirgin yap›sal anomalisi yokken, sa¤ 2-3. kostalarda füzyon vard›. Hikayesi öz ve soy geçmiflinde belirgin bir özellik yoktu. Hastan›n her iki üst ekstremitesinde istirahat halinde a¤r› ve kuvvetsizlik yak›nmas› yokken kolun bafl üzerindeki aktiviteleri s›ras›nda zorlan›yor ve çok ender a¤r›s› oluyormufl. Hastan›n fizik muayenesinde, bafl-boyun ve omuz hareketlerinde k›s›tl›l›k haricinde belirgin özellik yoktu. Bafl-boyun hareketleri tüm yönlere minimal k›s›tl› ve her iki omuz aktif fleksiyonu 160 abdüksiyonu ise 140 dereceydi. Sprengel deformitesi intrauterin geliflim s›ras›nda boynun alt yar›m›nda oluflan skapulan›n normal yeri olan ikinci ile yedinci torakal omurlar aras›na kaudal iniflinde yetersizlik sonucu yüksekte kalmas›d›r. Deformiteye baflta kemik olmak üzere birçok yumuflak doku ve organ anomalisi de efllik edebilmektedir. Genellikle k›z çocuklar›nda görülür ve çok nadiren iki tarafl›d›r. Bilateral anomali kozmetik olarak daha kabul edilebilir olmas›na ra¤men fonksiyonel bozukluk daha belirgindir. Deformitenin tedavisindeki amaç kozmetik görünüm ve fonksiyonu olabildi¤ince düzeltmektir. Cerrahi giriflim için en uygun yafl tart›flmal›d›r; fakat birçok yazar 8 yafl›ndan sonra dokular›n esnekli¤inin ve pozisyonel de¤iflikliklere adaptasyonunun azalmas› nedeniyle cerrahi tedavi önermemektedir. Bizde olgumuzu Ortopedi klini¤ini ile konsülte ettik. Operasyon düflünülmeyen hasta ve yak›nlar› bilgilendirilerek hastaya omuz EHA, germe ve kuvvetlendirme ev egzersiz program› verildi. Sonuç olarak, sprengel deformitesi s›k rastlanan bir deformite olmamakla birlikte omuzun en yayg›n do¤umsal anomalisidir. Ancak ileri derecede deformitesi olanlar do¤umda fark edilebilir. Çift tarafl› ve düflük dereceli deformiteye sahip olgularda ek anomalide yoksa kozmetik olarak daha kabul edilebilir oldu¤u için bizim olgumuzdaki gibi tan› ve tedavide gecikmeler olabilmektedir. Sekiz yafl›ndan sonra ameliyat›n uygulanabilirli¤inin azalmas› erken tan›n›n önemini artt›rmaktad›r. Anahtar Kelimeler: Do¤umsal anomali, do¤ufltan yüksek skapula, sprengel deformitesi P-023 Lipoma Arborescens and Baker cyst of the Knee: Case Report Zuhal Güldeste, Esin Baran, Nimet Atakul, Mehmet K›rnap Erciyes University Faculty of Medicine Department of Physical Medicine and Rehabilitation, Kayseri Lipoma arborecens (LA) is a rare intraarticular lesion characterized by villous lipomatous proliferation of the synovium, usually involving the suprapateller area of the knee joint. Its etiology is unknown. Patients usually present with recurrent knee pain and swelling. Popliteal cyst exists in 20% of the cases. Magnetic Resonance Imaging (MRI) is highly benefical in diagnose where leaflike displays originated from synovium are typical. A 35-year-old female patient presented with history of recurrent left knee swelling and pain for 5 years. Fluid discharging punctions were performed for four times for the patient, the treatment of salazopyrin, steroid and antiinflammatory medications had been started with the diagnosis of chronically idiopathic arthritis. In the examination pain and effusion were found on the left knee. Other exams and rheumatologic questioning was completely normal. Sedimentation rate was 29, C reactive protein was 3.41 and Rheumatoid factor, anti-CCP, antinuclear anticor (ANA), ANA Profile, anti DsDNA, brucella, hepatitis markers were all negative. Blood biochemistry and CBC were also normal. Aspiration of the left knee yielded 315 cc of clear yellow of fluid, which was negative for crystals, cells and microorganisms. The MRI showed a large amount of fluid within the suprapatellar bursa, images consistent of lipoma arborecens and the popliteal cyst of 6x2 cm in diameter in the popliteal fossa. A surgical synovyectomy was suggested the patient who did not get any benefit from cryotherapy and consulted at Orthopedic. As in this case patients presented with recurrent swelling of a single joint should be evaluated by MR for lipoma arborecens. Keywords: Baker Cyst, lipoma arboresens, magnetic resonance imaging P-024 Bilateral Congenital Undescended Scapula (Sprengel’s Deformity): A Case Report Mustafa Özflahin 1, Mustafa Uslu 2, Erkan ‹nanmaz 2, Mesut Okur 3 1 Duzce University Medical School Department of Physical Medicine and Rehabilitation, Duzce 2 Duzce University Medical School of Department of Orthopaedics and Traumatology, Duzce 3 Duzce University Medical School Department of Pediatrics, Duzce A 10-year-old male presented to the thoracic surgery outpatient clinic complaining of swelling of the left chest. He had undergone a surgical repair of a chest deformity, and was subsequently advised to undergo physical rehabilitation. The physical examination and chest x-ray showed Sprengel’s deformity. The cervical and thoracal spine was normal on x-rays; except the fusion of the second and third ribs. There was no family history of congenital anomalies. The physical and neurological examinations of his upper limbs were normal, except for the shoulder and neck range of motion, which revealed mild limitation of the neck movement in all directions and shoulder active flexion were up to 160° and abduction up to140° bilaterally. In Sprengel’s deformity, the scapula on one or both sides is underdeveloped and abnormally high due to failure of the scapula to descend from its position in the neck to its normal position in the posterior thorax during embryonic development. It is also frequently associated with bone and soft tissue abnormalities. It is more common in girls and may rarely be bilateral. Bilateral deformity is acceptable as cosmetically but functional failure is more obvious. The aim of the treatment is to improve the function and cosmesis. The optimal age for operative intervention is controversial; however, most authors recommend performing surgery when the patients are younger than 8 years, as there is a risk of loss of adaptation due to overextension of the surrounding tissues. Our patient consulted by orthopedic surgeons, who did not recommend an operative intervention. Therefore, we prescribed a home-based exercise regimen to maintain the range of motion and to strengthen the periscapular muscles. Although rare, Sprengel’s deformity is the most common congenital deformity of the shoulder. It is diagnosed at birth only in severe cases. Diagnosis and treatment can be delayed because patients have no additional abnormalities, and a mild deformity or bilateral involvement are more acceptable cosmetically, as in our case. The difficulty with surgery after 8 years of age increases the importance of an early diagnosis. Keywords: Congenital anomalies, congenital undescended scapula, sprengel's deformity
167 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-025 Pelvik Kosta; Olgu Saadet Deniz Demiral 1, Özer Gündüz 1, Ferda Karcebafl 1, Bahri Gümüfl 2 1Suat Seren Gö¤üs Hastal›klar› ve Cerrahisi E¤itim ve Araflt›rma Hastanesi Fizik Tedavi ve Rehabilitasyon Bölümü, ‹zmir 2Suat Seren Gö¤üs Hastal›klar› ve Cerrahisi E¤itim ve Araflt›rma Hastanesi Radyoloji Bölümü, ‹zmir Pelvik kosta veya pelvik dijit, kemi¤in nadir, benign geliflimsel anomalisidir. Bu tan›mlama ilk kez 1974 y›l›nda Sullivan ve Cornwell taraf›ndan yap›lm›flt›r. Embriyolojik geliflim s›ras›nda komflu yumuflak doku içinde geliflen kemik yap›d›r. T›bbi literatürde yer alan olgu say›s› azd›r. Ço¤unlukla tek tarafl›d›r ve asemptomatiktir, nadiren kalça a¤r›s› ve fonksiyonel yetmezli¤e yol açabilir. Genellikle, uygun pozisyonda al›nan direkt radyografiler tan›da yeterli olmakla birlikte, Bilgisayarl› Tomografi (BT) incelemesi ile yalanc› eklem yüzeyi daha iyi gösterilebilir. Posttravmatik myozitis ossifikans, heterotopik ossifikasyonlar, ekzostozlar ay›r›c› tan›da göz önünde bulundurulmal›d›r. Medikal tedaviye dirençli olgular d›fl›nda, ço¤unlukla cerrahi gerektirmez. Olgumuz 45 yafl›nda, erkek hasta sol kalçada lokalize, özellikle oturma, çorap giyme gibi durumlarda artan, yay›l›m göstermeyen a¤r› flikayeti ile poliklini¤imize baflvurdu. Efllik eden bel a¤r›s›, uyuflma yak›nmas› yoktu. Muayenede sol kalça fleksiyon ve eksternal rotasyonu a¤r›l› bulundu. Rutin laboratuar testleri, lomber ve sakroiliak muayene bulgular› normal olarak de¤erlendirildi. Hastan›n çekilen kalça radyografisinde spina iliaka anterior inferiordan, trochanter majore uzanan kemik kitle izlendi. BT ile de¤erlendirmede pelvisle yalanc› eklem oluflturan pelvik kosta anomalisi rapor edildi. Olgumuzda 10 günlük NSAII ve myorelaksan tedavi ile semptomlarda iyileflme elde edildi. Anahtar Kelimeler: Dijit, kosta, pelvik P-026 Kronik Plantar Fasiit Tan›l› Hastalarda Ekstrakorporeal fiok Dalga Tedavisi (ESWT)'nin Etkinli¤i Osman Tüfekci Özel Konya Farabi Hastanesi Fiziksel T›p ve Rehabilitasyon Servisi, Konya AMAÇ: Plantar fasiit tedavisinde ekstrakorporeal flok dalga tedavisi (ESWT)'nin etkinli¤inin araflt›r›lmas› GEREÇ-YÖNTEM: Bu çal›flmada kronik plantar fasiitli hastalarda ESWT'nin etkinli¤inin araflt›r›lm›flt›r. Bu çal›flmaya en az 6 ayd›r topuk a¤r›s› olan ve di¤er fizik tedavi yöntemlerine cevap vermeyen 39 (27K, 12E) hasta al›nd›. Kad›n hastalar›n yafl ortalamas› 50,1 erkek hastalar›n ortalama yafl› 48,7 idi. Tüm hastalar›n ortalama yafl› ise 48,89 idi. Tüm hastalara ayn› uygulay›c› taraf›ndan ESWT yap›ld›. Tedavi sonras› hastalar ortalama 6,3 ay takip edildi. Hastalara rutin olarak 1000 flok dalga impulsu (s›kl›¤› 2 saniyede bir kez), enerji yo¤unlu¤u ise 0.35 mJ/mm 2 olarak her seansta uyguland›. Tüm hastalara haftada bir kez tedavi yap›ld›. Tüm hastalara tedaviden hemen sonra ve tedavi sonras› 2.hafta, 1.ay, 3. ay ve 6. ay telefon ile ulafl›larak tedavini etkinli¤i sorguland›. Hastalarda tedavini etkinli¤i VAS, Roles and Maudsley skorlar›, American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score ile de¤erlendirildi. Tedavini etkinli¤i VAS de¤erinde %30'luk azalma olarak kabul edildi. BULGULAR: Dört seansl›k ESWT uygulamas› sonucunda %67'lik bir baflar›, tedavi sonras› ikinci haftada %70, 6. ay sonunda ise %81'lik bir baflar› elde edildi. SONUÇ: Plantar fasiit topuk a¤r›s›n›n en s›k nedenidir ve toplumda yaklafl›k %10 s›kl›¤›nda görülmektedir. Hastal›¤a travma, ayaktaki biyomekanik anormallikler, uygunsuz dar ayakkab›, fliflmanl›k, sürekli ayakta durmay› gerektiren ifllerin neden olabilece¤i bildirilmifltir. Radyolojik olarak kemiksel ç›k›nt› görülebilir. Bir çok tedavi seçene¤i vard›r. Bu hastalar›n büyük ço¤unlu¤u germe egzersizi, enjeksiyon, ayakkab› modifikasyonlar› gibi konservatif tedavi yöntemleri ile iyileflir. Plantar fasiitin klinik tan›s› genellikle kolayd›r ve Plantar fasiitin genel tedavi yaklafl›m› konservatiftir. Bu hastalar›n yaklafl›k %10'unda konservatif tedavi yetersiz kalmakta ve bazen cerrahi tedavi yöntemleri kullan›lmas›n› gerektirebilmektedir. Elde edilen bu sonuçlar ESWT' nin plantar fasiitin tedavisinde etkili bir yöntem oldu¤unu göstermektedir. Anahtar Kelimeler: Kalkeneal spur, ekstrakorporeal flok dalga tedavisi (ESWT), plantar fasiit P-025 Pelvic Rib; Case Report Saadet Deniz Demiral 1, Özer Gündüz 1, Ferda Karcebafl 1, Bahri Gümüfl 2 1 Suat Seren Chest Diseases Training and Research Hospital Department of Physical Therapy and Rehabilitation, Izmir 2 Suat Seren Chest Diseases Training and Research Hospital, Department of Radiology, Izmir Pelvic rib or digit is uncommon and benign congenital anomaly. It has been defined as a bone tissue developed in soft tissue near the pelvis. It was first reported by Sullivan -Cornwell in 1974. It’s usually unilateral and asymptomatic, but rarely causes hip pain and functional deficiency. Although direct radiography usually is sufficient for diagnosis, Computerized tomography (CT) would be better to show pseudo-articulations. In the differential diagnosis, post-traumatic myositis ossificans, heterotrophic ossifications and exostoses are important. Therapy is medical, but it rarely needs surgery. Our 45 year old patient had pain in his left hip increasing by sitting and wearing socks and etc. He didn’t suffer from back pain and numbness. On clinical examination, left hip flexion and external rotation were painful. Lumber and sacroilac examinations and routine blood tests were normal. Radiographic examination showed bone formation, prolonged from spina ilaca ant inf to thoracanter major. Pelvic rib was reported in CT which had pseudo- articulations. The symptoms of the patient were improved with NSAI and myorelaxating drugs in 10 days. Keywords: Digit, pelvic, rib P-026 Efficiency of Extracorporeal Shock Wave Therapy (ESWT) for Patients Diagnosed with Chronic Plantar Fasciitis Osman Tüfekci Private Konya Farabi Hospital Physical Therapy and Rehabilitation Service, Konya OBJECTIVE: Research on efficiency of Extracorporeal Shock Wave Therapy (ESWT) in treatment of Plantar fasciitis MATERIALS-METHODS: This study deals with efficiency of ESWT in patients with chronic plantar fasciitis. 39 patients (27M, 12F) with heel pain of 6 months or longer duration and replied to no other physical treatment methods were included in the study. Average age of female patients was 50.1, it was 48.7 for male patients. Average age of all patients was 48.89. ESWT was performed for all the patients by the same practitioner. After the treatment, patients were followed up for 6,3 months on average. One thousand shock wave impulses (once in two seconds as a frequency) were applied to the patients in routine, while energy density of 0.35 mJ/mm 2 for each seance. All patients were treated once a week. All patients were questioned about the efficiency of treatment following the treatment and 2nd week, 1st month, 3rd month and 6th month after treatment on the phone. Treatment efficiency was evaluated with VAS, Roles and Maudsley scores, American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score for the patients. Having a decrease of 30% in VAS value was accepted as the efficiency of the treatment. RESULTS: 67% success for ESWT application for four seances, 70,6% success for the second week after treatment and 81% success for end of the month were obtained. CONCLUSIONS: Plantar fasciitis is the most common reason of heel pain and seen approximately with a frequency of 10% in population. It has been explained that trauma, biomechanical abnormalities of the foot, inappropriate narrow shoes, obesity, and tasks always requiring standing cause the disease. Osteophyte can be seen in radiology. There are lots of treatment options. Most patients recover with conservative treatment methods such as stretching exercises, injection, shoe modifications. Clinic diagnosis of plantar fasciitis is generally easy and usual treatment approach of plantar fasciitis is conservative. Conservative treatment is ineffective in 10% of the patients, and sometimes requires surgical treatment. Results demonstrate that ESWT is an effective method for treatment of plantar fasciitis. Keywords: Calcaneal spur, extracorporeal shock wave therapy (ESWT), plantar fasciitis
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