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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-058
Ayakta ‹ntramüsküler Hemanjiom: Olgu Sunumu
Mustafa Özflahin 1, Mustafa Uslu 2, Erkan ‹nanmaz 2,
Ramazan Büyükkaya 3, Havva Erdem 4
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 Radyoloji Anabilim Dal›, Düzce
4Düzce Üniversitesi T›p Fakültesi Patoloji Anabilim Dal›, Düzce
‹ntramüsküler hemanjiomlar ise tüm hemanjiomlar›n yaklafl›k %1’i kadar s›kl›kta gözlenir.
Genellikle alt ekstremitede ve özellikle de uyluk kaslar›nda gözlenmelerine ra¤men ayakta
intramüsküler hemanjiom varl›¤› oldukça nadirdir ve literatürde çok az rapor edilmifltir. Biz
burada ayakta fleksör digitorum birevis kas› içersinde intramüsküler hemanjiomu olan bir
olguyu sunduk. Sekiz yafl›nda k›z hasta sa¤ ayak medial plantar yüzde a¤r›l› flifllik yak›nmas›
ile poliklini¤imize baflvurdu. Yak›nmas› bir y›l önce travma olmaks›z›n bafllam›fl. Hastan›n
a¤r›s› ve fliflli¤i ayakta durmak, yürümek ve özellikle egzersizle art›yor yatak istirahat› ile geriliyormufl.
Birkaç de¤iflik uzman doktora baflvuran hastaya plantar fasiit, pes planus ve tendinit
tan›lar› ile NSA‹ ilaçlar, tabanl›k ve ayak bilekli¤i reçete edilmifl. Hastan›n bize geldi¤inde
ayak taban›nda ciltte belirgin renk de¤iflikli¤i ve ›s› art›fl› yapmayan palpasyonla hareketsiz,
yumuflak yaklafl›k 3cm çapl› a¤r›l› kitlesi vard›. Fizik muayenesinde ve mevcut ayak bile¤i ve
aya¤a yönelik çekilen direk grafilerinde ek patolojik de¤ifliklik yoktu. Hastaya öncelikli olarak
çekti¤imiz MR görüntülemede fleksör digitorum brevis kas› içersinde 4,1 cm – 1,7 cm – 1,1 cm
boyutlar›nda intramüsküler hemanjiomla uyumlu kitle gözlemlendi. Lezyon cerrahi olarak
komple ç›kar›ld›, lezyonun postoporatif histopatolojik de¤erlendirilmesi tan›m›z› do¤rulad›.
‹ntramüsküler hemanjiomlar özellikle 30 yafl alt› genç yetiflkinlerde görülür genellikle de a¤r›
ve/veya flifllik yak›nmas› ile kendini belli ederler. Direk grafide belirgin patolojik de¤iflikliklere
neden olmad›klar› için tan› genellikle flifllik oluflana kadar gecikmektedir. A¤r› ve fliflli¤in tipik
karakteri teflhiste yard›mc› olurken tan› genellikle klinik muayene ve MR ile konulmakta, postoperatif
histopatolojik de¤erlendirme ile do¤rulanmaktad›r. ‹ntramüsküler hemanjiomlar
ayakta oldukça nadir görülmesine ra¤men, ayakta özellikle egzersizle artan a¤r› ve flifllik
yak›nmas› ile gelen genç eriflkin hastalarada ay›r›c› tan›da hat›rlanmal›d›r.
Anahtar Kelimeler: Ayak a¤r›s›, a¤r›l› flifllik, intramüsküler hemanjiom
P-059
Infraspinatus Kas›nda Atrofiye Neden Olan ‹zole Atravmatik
Supraskapular Sinir Hasar›: Olgu Sunumu
Oya Ümit Yemiflci, Nur Coflar Saraçgil, Ufuk Dokur, Merve fiahin, Deniz Öke
Baflkent Üniversitesi T›p Fakültesi Fiziksel T›p ve Rehabilitasyon Anabilim Dal›, Ankara
Supraskapular sinir s›k›flmas› traksiyon, direkt travma, tekrarlayan mikrotravmalar, kitle lezyonu,
sinir iskemisine neden olan mikroemboli ve iyatrojenik sebepler sonras› görülebilir
Literatürde genellikle sporcularda ve gençlerde travma sonras› görülen olgular bildirilmifltir.
Ancak kronik durumlarda ve yafll›larda genellikle travma öyküsü bulunmaz, hastalar s›kl›kla
omuz posteriorunda fliddetli a¤r›, omuz hareketlerinde k›s›tl›l›k ve kuvvet kayb› flikayetleri ile
hekime baflvurabilirler. Burada 59 yafl›nda, travma olmaks›z›n ortaya ç›kan ve 3 ayd›r artan
fliddete sa¤ omuz a¤r›s› ve kuvvet kayb› flikayeti ile klini¤imize baflvuran bir sedanter erkek
hasta sunulmaktad›r. Farkl› merkezlerde omuz periartriti olarak de¤erlendirilen ve fizik tedavi
modaliteleri ve steroid olmayan antiinflamatuvar ilaçlardan fayda görmeyen hastan›n fizik
muayenesinde sa¤ akromiyoklaviküler eklemde hasssiyet mevcut idi. Omuz eklem hareket
aç›kl›¤› tam olan hastan›n nörolojik defisiti yoktu ancak detayl› fizik muayene sonucunda sa¤
infraspinatus kas›nda minimal atrofi saptanmas› üzerine yap›lan üst ekstremite elektronöromiyografisinde,
sa¤ infraspinatus kas›ndan kay›tla uzam›fl Erb latans› ve infraspinatus
kas›nda denervasyon bulgular› saptand›; supraspinatus kas› korunmufltu. Manyetik rezonans
görüntüleme sonucunda inferior ve posterior labrumda flüpheli y›rt›k görünümü ve labrum
komflulu¤undan bafllay›p infraspinatus kas› ile skapula aras›ndan posteriora uzanan, paralabral
ve sinovyal kiste ait oldu¤u düflünülen lobüle konturlu kistik lezyon ve infraspinatus
kas›nda kistik lezyonun kas›n sinirine yapm›fl oldu¤u bas›ya ba¤l› ödem saptand›. Konservatif
tedavilerden fayda görmeyen hasta cerrahi tedavi için yönlendirildi ancak hasta cerrahi
tedaviyi kabul etmedi. Posterior omuz a¤r›s› olan hastalarda, servikal radikülopati ve omuz
a¤r›s›na neden olan kemik veya eklem çevresi yumuflak dokudan kaynaklanan hastal›klar›n
ay›r›c› tans› yap›lmal›d›r. ‹zole infraspinatus kas›nda atrofiye yol açan supraskapular sinir
hasar› tan›s›n› erken evrede koymak güç olabilir; özellikle de hastada belirgin bir travma
hikayesi yoksa. Ancak posterior omuz a¤r›s› olan hastalar›n ay›r›c› tan›s›nda, ender olarak
görülen supraskapular sinir s›k›flmas› da mutlaka ak›lda tutulmal›d›r.
Anahtar Kelimeler: Labral y›rt›k, omuz a¤r›s›, supraskapular sinir s›k›flmas›
P-058
Intramuscular Hemangioma in the Foot: A Case Report
Mustafa Özflahin1, Mustafa Uslu2, Erkan ‹nanmaz2, Ramazan Büyükkaya 3, Havva Erdem4 1Duzce University Medical School Department of Physical
Medicine and Rehabilitation, Duzce
2Duzce University Medical School Department of Orthopaedics and
Traumatology, Duzce
3Duzce University Medical School Department of Radiology, Duzce,
4Duzce University Medical School Department of Pathology, Duzce
Intramuscular hemangioma is observed in 1% of all hemangioma cases. While it is generally
observed at lower extremities and especially in the muscles of the thigh, hemangioma in the
footis very rare and there are very few reports on it in the literature. Here we report a case
with intramuscular hemangioma located in the flexor digitorum brevis muscle in the feet.
An eight-year-old girl was referred to our outpatient clinic with a palpable painful mass in the
medial plantar surface of her right foot. The pain had started a year ago and she had no history
of major trauma. The pain and swelling increased while standing for a long time and
walking and relieved by rest. She admitted to a couple of specialists who had suggested different
treatments such as NSAID, insoles, and ankle support with diagnosis such as plantar
fasciitis, pes planus and tendinitis. When the patient arrived in our clinic, soft mass which
caused the pain was observed on the base of the foot with a diameter of about 3 cm, with no
apparent color change or temperature increase. Physical examination and present direct graphy
examination of the foot and ankle showed no pathological change. The MR images
showed a mass with the dimensions of 4.1 cm – 1.7 cm – 1.1 cm in the flexor digitorum brevis
muscle, compatible with intramuscular hemangioma. The lesion was removed surgically and
postoperative histological examination of the lesion confirmed the diagnosis. Intramuscular
hemangiomas are particularly observed in young adults under the age of 30 and accompanied
by pain and/or swelling. Since they do not lead to apparent pathological changes in
direct graphy diagnosis is usually deferred until there is an apparent swelling. While pain and
swelling helps detection, the diagnosis can only be possible with clinical examination and MR,
and can be verified with postoperative histo-pathological evaluation. While hemangiomas are
very rarely observed on foot, it must be considered in the differential diagnosis of young
adult patients who complain pain and swelling in the feet, especially during exercise.
Keywords: Foot pain, pain swelling, intramuscular hemangioma
P-059
Atraumatic Suprascapular Neuropathy Limited to the Infraspinatus
Muscle: A Case Report
Oya Ümit Yemiflci, Nur Coflar Saraçgil, Ufuk Dokur, Merve fiahin, Deniz Öke
Department of Physical and Rehabilitation Medicine Faculty of
Medicine Baskent University, Ankara
Suprasacpular neuropathy is considered as a rare condition, however, especially with the
advent of magnetic resonance imaging (MRI) and its usage in the evaluation of shoulder
pathology, it has increasingly been found to be a cause of shoulder pain and dysfunction. It
may occur as a result of traction, direct trauma, repetitive overhead activities and extrinsic
compression. Cases have been reported in the literature usually seen in athletes and young
peopleafter trauma However in chronic cases or in elderly people, a history of trauma may
not always be necessary. Here we present clinical, electrophysiological and radiologic
features of a 59 year-old sedentary male with a 3-month history of posterior shoulder pain
and weakness. Initially he was misdiagnosed at several other clinics as periarthritis of the
shoulder and treated with nonsteroidal anti-inflammatories and physical therapy which failed
to improve his symptoms. On physical examination, right acromioclavicular joint was tender
with palpation, but there was no limitation in the range of motion of the shoulder. There was
no neurologic deficit, however detailed physical examination revealed atrophy of the
infraspinatus muscle. Electrophysiological studies of the right upper extremity showed normal
peripheral nerve conduction parameters except for prolonged Erb latency recorded from
the infraspinatus muscle. Electromyography revealed spontaneous activity and reduced
recruitment in the infraspinatus muscle, while supraspinatus muscle was normal. Magnetic
resonance imaging demonstrated superior labral tear and a paralabral synovial cyst
extending to the infraspinatus muscle and edema in the infraspinatus muscle consistent with
denervation. The patient did not accept surgical treatment and was treated conservatively.
Suprascapular neuropathy resulting in isolated weakness and atrophy of the infraspinatus
muscle could be challenging at its onset and must be differentiated from servical
radiculopathy, or bone and joint diseases of the shoulder, especially in the presence of pain
and atrophy. Suprascapular neuropathy should always be considered in the differential
diagnosis of posterior shoulder pain.
Keywords: Labral tear, shoulder pain, suprascapular neuropathy