‹nmeli Hastalarda Yaflflam Kalitesini Etkileyen ... - FTR Dergisi

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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-074
Servikal Vertebran›n Radyolojik Bulgular› ile A¤r›, Özürlülük ve Yaflam
Kalitesi Aras›ndaki ‹liflki
Murat Ad›m1, Ali Biçer2, Altan Y›ld›z3 1Toros Devlet Hastanesi Fiziksel T›p ve Rehabilitasyon Klini¤i, Mersin
2Mersin Üniversitesi T›p Fakültesi Fiziksel T›p ve Rehabilitasyon Anabilim Dal›, Mersin
3Mersin Üniversitesi T›p Fakültesi Radyoloji Anabilim Dal›, Mersin
AMAÇ: Boyun a¤r›s› kas iskelet sistemi flikayetleri aras›nda s›k görülen klinik bir bulgudur. Çal›flmam›z›n
amac› a¤r›, özürlülük, yaflam kalitesi ile servikal vertebran›n radyografik incelemelerinden
elde edilen radyolojik bulgular aras›ndaki iliflkiyi de¤erlendirmekti.
GEREÇ-YÖNTEM: Çal›flmaya boyun a¤r›s› olan toplam 94 hasta (18 erkek, 76 kad›n) dahil edildi.
A¤r› de¤erlendirmesi için Vizüel Analog Skalas› (VAS) uyguland›. Özürlülük, Boyun A¤r› ve
Dizabilite Skalas› (BADS) ile de¤erlendirildi. Yaflam kalitesi ölçümü için K›sa Form–36 ölçe¤i
kullan›ld›. Radyolojik de¤erlendirmeler direkt servikal radyografi ve servikal Manyetik Rezonans
Görüntüleme (MRG) kullan›larak yap›ld›. Servikal direkt radyografi ve MRG skorlar› ile
a¤r›, özürlülük ve yaflam kalitesi skorlar› aras›ndaki iliflki araflt›r›ld›.
BULGULAR: Hastalar›n VAS ve BADS skorlar›n›n ortalama ve standart sapmalar› s›ras›yla
70,63±19,36 ve 49,16±16.00 olarak bulundu. Direk radyografi ile saptanan servikal dejenerasyonun
fliddeti ile VAS (p=0.203) ve BADS skorlar› (p=0.190) aras›nda anlaml› bir iliflki bulunmad›.
VAS (p=0.960) ve BADS (p=0.973) skorlar› ile servikal MRG skorlar› aras›ndaki iliflki istatistiksel
olarak anlaml› de¤ildi. K›sa Form–36 alt ölçek skorlar› ile servikal dejenerasyonun
fliddeti ve MRG skorlar› aras›nda anlaml› bir iliflki bulunmad›.
SONUÇ: Çal›flmam›z, boyun a¤r›s› olan hastalarda a¤r›, özürlülük ve yaflam kalitesi ile servikal
dejenerasyonun fliddeti ve MRG bulgular› aras›nda anlaml› bir iliflki olmad›¤›n› ortaya koymaktad›r.
Boyun hastal›klar›nda, servikal dejenerasyon d›fl›nda farkl› di¤er faktörlerin a¤r›,
özürlülük ve yaflam kalitesi üzerine etkileri oldu¤u düflünülmektedir.
Anahtar Kelimeler: Boyun a¤r›s›, özürlülük, servikal dejenerasyon, yaflam kalitesi
P-075
Eozinofilik Fasiit Tan›l› Bir Olgu
Yasemin Turan1, Canan Y›ld›r›m 1, Elif Ayd›n1, Canten Tataro¤lu 2,
Ömer Faruk fiendur1, Emre Çullu3 1Adnan Menderes Üniversitesi T›p Fakültesi Anabilim Dal› Anabilim Dal›, Ayd›n
2Adnan Menderes Üniversitesi T›p Fakültesi T›bbi Patoloji Anabilim Dal›, Ayd›n
3Adnan Menderes Üniversitesi T›p Fakültesi Ortopedi ve Travmatoloji Anabilim Dal›, Ayd›n
Eozinofilik fasiit, etiyolojisi tam olarak bilinmeyen primer olarak fasyay› etkileyen, enflamasyon
ve kal›nlaflmayla karakterize nadir görülen bir hastal›kt›r. Biz de nadir görülen eozinofilik
fasiit tan›l› bir olguyu sunmay› amaçlad›k.
65 yafl›ndaki bayan olgu sol ön kolda a¤r› yak›nmas› ile poliklini¤imize baflvurdu. 2 sene önce
sol ön kolunda a¤r›s›z flifllik ve sertlik bafllayan olgunun zamanla bu yak›nmalar› belirginleflmifl
ve 2 ay önce a¤r› da eklenmifl. Olgunun fizik muayenesinde sol dirsekten, el bile¤ine kadar
olan bölgede gode b›rakmayan, ›s› art›fl› olmayan flifllik ve sertlik mevcuttu. Kaslar aras›nda
oluklaflma (groove belirtisi) vard›. Sol el ve el bilek dorsifleksiyon ve palmar fleksiyonu minimal
k›s›tl› ve a¤r›l›yd›. A¤r›-VAS=9 cm olarak de¤erlendirildi. Laboratuvar incelemede; ESH; 31
mm/h, CRP; 5,23 mg/L, RF(-), ANA(-) ve IgE düzeyi s›n›rda yüksekti. Sol ön kolundan yap›lan
kas-fasya biopsisinin patoloji sonucunda, subkutan ya¤ dokusunda perilobüler mononükleer
hücre infiltrasyonu vard›. Fasya materyalinde aselüler kollajen demetlerde art›fl, damarlarda
endotelde fliflme ve perivasküler mononükleer hücre infiltrasyonu, çevre ya¤ dokuda ise
lenfositik hücre infiltrasyonu mevcuttu. Olgumuza mevcut klinik ve histopatolojik bulgular›yla
eozinofilik fasiit tan›s› konuldu. Hastal›¤› hakk›nda bilgilendirildi ve 40 mg/gün oral fluocortolone
ve 20mg/hafta metotreksat tedavisi baflland›. Sol el bile¤ine TENS (30 dk), so¤uk
paket (10 dk), eklem hareket aç›kl›¤› ve germe egzersizlerinden oluflan 10 seans fizik tedavi
program› uyguland›. Bir ay sonraki de¤erlendirmede a¤r›-VAS’› 1 cm olarak ölçüldü. Ön kolda
flifllik ve sertlik bulgusu azalm›flt›.
Kas sertli¤i ve a¤r›s› olan hastalarda eozinofilik fasiit tan›s› göz önünde bulundurulmal›d›r.
Erken tan› ve tedavi ile hastal›¤›n di¤er kas ve fasyalara ilerlemesinin önlenece¤i bilinmelidir.
Anahtar Kelimeler: Eozinofilik fasiit, erken tedavi
P-074
Relationship Between Pain, Disability and Quality ff Life with
Radiological Findings of the Cervical Vertebra
Murat Ad›m 1, Ali Biçer 2, Altan Y›ld›z 3
1 Toros State Hospital Department of Physical Medicine and Rehabilitation, Mersin
2 Mersin University School of Medicine Department of
Physical Medicine and Rehabilitation, Mersin
3 Mersin University School of Medicine Department of Radiology, Mersin
OBJECTIVE: Neck pain is a common clinical finding among the musculoskeletal complaints.
The objective of our study was to assess the relationship between pain, disability and
quality of life with radiological findings obtained from radiographic examinations of the
cervical vertebra.
MATERIALS-METHODS: Total of 96 patients (18 male, 78 female) having cervical pain were
enrolled in the study. Visual Analogue Scale (VAS) was administered for pain assessment.
Disability was assessed by Neck Pain and Disability Scale (NPDS). Short Form-36 (SF-36)
questionnaire was used for quality of life measurement. Radiologic evaluations were
performed by using plain cervical radiographs and cervical Magnetic Resonance Imaging
(MRI). The relationship between cervical plain radiography and MRI scores with pain,
disability and quality of life scores were investigated.
RESULTS: The means and standard deviations of the VAS and NPDS scores were found to be
70.63±19.36 and 49.16±16.00, respectively. No significant relationship was found between the
scores of VAS (p=0.203) and NPDS (p=0.190) with the levels of the cervical degeneration,
determined in plain radiographs. Relationship between the scores of VAS (p=0.960)
and NPDS (p=0.973) scores with MRI scores was not statistically significant. No significant
relationship was found between the sub-scores of SF-36 with the level of cervical
degeneration and MRI scores.
CONCLUSION: Our study reveals that there is no significant relationship between pain, disability
and quality of life with the level of cervical degeneration and MRI findings in patients
with neck pain. Different factors other than the cervical degeneration are thought to have
effects on pain, disability and quality of life in cervical disorders.
Keywords: Cervical degeneration, disability, neck pain, quality of life
P-075
A Case With Eosinophilic Fasciitis
Yasemin Turan 1, Canan Y›ld›r›m 1, Elif Ayd›n 1, Canten Tataro¤lu 2,
Ömer Faruk fiendur 1, Emre Çullu 3
1 Adnan Menderes University Medical School Department of Physical Therapy and
Rehabilitation, Aydin
2 Adnan Menderes University Medical School Department of Medical Pathology, Aydin
3 Adnan Menderes University Medical School Department of Orthopedics and
Traumatology, Aydin
Eosinophilic fasciitis is a rare disease with unknown etiology affecting primarily fascia, which
is characterized by inflammation and thickening. We aimed to present a case diagnosed with
eosinophilic fasciitis. 65-year old female applied to our clinics with the complaint of pain in
the left forearm. Her complaint of painless swelling and rigidity in left forearm appeared 2
years ago, the symptoms became prominent in time, and pain was added to her complaints
2 months ago. The physical examination revealed swelling and rigidity with non-pitting
edema and normal temperature in the region from the left elbow to the wrist. Groove sign
was present between the muscles. Dorsiflexion and palmar flexion of left hand and wrist were
limited minimally and painful. Pain VAS was 9 cm. ESR: 31 mm/h, CRP=5.23 mg/L, RF (-), ANA
(-), and IgE level was slightly high. Muscle/fascia biopsy of left forearm revealed perilobular
mononuclear cell infiltration in subcutaneous adipose tissue. ‹ncrease of the acellular collagen
bundles, swelling of endothelium and perivascular mononuclear cell infiltration in vessels,
and lymphocytic cell infiltration in the surrounding adipose tissue were observed in the
fascial material. Our case was diagnosed with eosinophilic fasciitis with the present clinical
and histopathological signs. The diagnosis was explained to the patient, and 40 mg/day oral
fluocortolone and 20 mg/week methotrexate treatment was initiated. TENS (30 minutes),
cold pack (10 minutes) and a 10-session physiotherapy program including joint movement
range and stretching exercises to the left wrist were performed. After a month, pain VAS was
1 cm, and swelling and rigidity on the forearm were decreased.
Eosinophilic fasciitis should be retained in patients with muscle rigidity and pain. It should be
also recognized that early diagnosis and treatment can prevent the disease spread to other
muscles and fascia.
Keywords: Eosinophilic faciitis, early treatment