‹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 2011:56 Suppl; 1-334
P-009
Ultrasonografi Rehberli¤inde Efl Zamanl› Sinir Stimulasyonu ile
Supraskapular Sinir Blok Tekni¤i
Kutay Tezel, Mehmet Ali Taflkaynatan, Koray Köro¤lu Aydemir,
Özlem Omaç, Ahmet Özgül
Gülhane Askeri T›p Akademisi Fiziksel T›p ve Rehabilitasyon Anabilim Dal›,
TSK Rehabilitasyon Merkezi, Ankara
Çal›flman›n amac› omuz a¤r›l› hastalarda ultrasonografi (USG) rehberli¤inde efl zamanl› supraskapular
sinir stimulasyonu ile sa¤lanan supraskapular sinir blokaj› tekni¤i ve etkinli¤inin
araflt›r›lmas›. Geçirilmifl sa¤ hemipleji öyküsü olan 68 yafl›nda, kad›n hasta öncesinde son
4 ayd›r devam eden sa¤ omuz a¤r›s› flikayeti ile poliklini¤imize baflvurdu. Yap›lan fizik muayene
ve MRI görüntüleme yöntemi sonucunda sa¤ omuzda parsiyel supraspinatus kas
rüptürü tan›s› konuldu. Bu nedenle hastaya NSA‹‹ ilaç tedavisi, 15 seans TENS, US, hot pack
ve omuz EHA egzersizlerini kapsayan fizik tedavi program› uyguland›. Bu tedavilerden yan›t
al›namamas› üzerine poliklini¤imize tekrar baflvuran hastaya tan›sal USG görüntüleme
yap›ld› ve bu incelemenin sonucunda hastan›n sa¤ omzunda rotator manflon rüptürünün
devam etti¤i ayn› zamanda subdeltoid bursitinin oldu¤u tespit edildi. Hastaya ultrasonografi
rehberli¤inde ve nörostimulator eflli¤inde supraskapular sinir blo¤u yap›lmas›na karar
verildi. Yüzeyel cilt temizli¤inin 70% isopropanol ile sa¤lanmas›ndan sonra içi jel dolu steril
k›l›ftan geçirilmifl USG probu spina skapula üzerine yerlefltirildi ve supraskapular fossa
gözlendi. Supraskapular fossadaki supraskapular kas ve skapulaya ait kemik dokusu görüldükten
sonra prob transvers hatta laterale do¤ru ilerletilerek supraskapular çentikte transvers
ligamant›n alt›ndaki oval hiperekoik odak supraskapular sinir olarak nitelendirildi. Nörostimulaör
i¤nesi ile USG probunun lateralinden 45 50 derece aç›yla, uzun aks›na paralel
flekilde cilt geçildi. ‹¤nenin tam boyu görüntülenerek sinire yeteri kadar yak›n olundu¤una
karar verildi¤inde nörostimulatör cihaz› ile uyar› verildi (100 Hz 0,5 mA). Hastaya 2 ml prilokain
ve 1 ml betametazon kar›fl›m› enjekte edildi.
SONUÇ: Hastan›n a¤r›s›n› de¤erlendiren enjeksiyon öncesi VAS de¤eri 7 iken birinci ay sonunda
2 de¤erine gerileme; eklem hareket aç›kl›¤›nda da ilerleme sa¤land›. Fonksiyonel de¤iflimin
takibinde kullan›lan Constant skalas› skoru da 51’den 81’e yükseldi.
TARTIfiMA: Di¤er konservatif tedavilerden yan›t al›namayan omuz a¤r›l› hastalarda ultrasonografi
rehberli¤inde efl zamanl› nörostimulasyon tekni¤i ile yap›lan supraskapular sinir blo-
¤u etkin ve güvenilir bir giriflimsel tedavi yöntemi olabilir.
Anahtar Kelimeler: Ultrason rehberli¤i, sinir stimulasyonu, supraskapular blok, omuz a¤r›s›
P-010
Kronik Bel A¤r›l› Hastalarda Episakral Lipoma S›kl›¤› ve Lokal
Enjeksiyon Uygulamalar›n›n Etkinli¤i
Hatice Rana Erdem, Seçil Atasoy, Burcu Duyur Çak›t, Hakan Genç
Sa¤l›k Bakanl›¤› Ankara E¤itim ve Araflt›rma Hastanesi,
2. Fizik Tedavi ve Rehabilitasyon Klini¤i, Ankara
AMAÇ: Çeflitli çal›flmalar ile episakral lipoman›n (Kopeman nodülü) akut ve kronik bel a¤r›s›n›n
önemli nedenlerinden biri oldu¤u gösterilmifltir. Bununla birlikte episakral lipoma bel a¤r›s›n›n
ay›r›c› tan›s›nda s›kl›kla gözden kaçan bir durumdur. Bu çal›flman›n amac› kronik bel a¤r›l›
hastalarda episakral lipoman›n görülme s›kl›¤›n› belirlemek ve episakral lipoman›n tedavisinde
lokal enjeksiyon uygulamalar›n›n etkinli¤ini de¤erlendirmektir.
GEREÇ-YÖNTEM: Çal›flmaya kronik bel a¤r›s› olan 90 hasta (76 kad›n, 14 erkek) dahil edildi.
Hastalar›n sakral bölgesi dikkatlice palpe edilerek episakral lipoma varl›¤› araflt›r›ld›. Hastalar›n
bel a¤r›s› VAS ile fonksiyonel durumlar› Roland-Morris disabilite anketiyle de¤erlendirildi.
A¤r›l› episakral lipoma tespit edilen hastalardan enjeksiyon tedavisini kabul eden hastalara
nodül içine 2 cc prilokain + 20 mg metilprednizolon uyguland›.
BULGULAR: 76 kad›n hastan›n 18’ inde (%23,7) palpasyonla a¤r›l› ve refere a¤r›ya yol açan
episakral lipoma mevcut iken erkek hastalarda episakral lipoma tespit edilmedi. Episakral lipoma
mevcut olan ve olmayan hastalar›n Roland Morris disabilite anket sonuçlar› ortalamalar›nda
istatistiksel anlamda farkl›l›k yoktu. Enjeksiyon uygulamas›n› kabul eden 13 hastaya intranodüler
enjeksiyon uyguland›. Enjeksiyon uygulanan 13 hastan›n enjeksiyon öncesi ve enjeksiyon
sonras› 1. saat VAS skorlar› karfl›laflt›r›ld›¤›nda VAS skorlar›nda anlaml› azalma tespit
edildi (p=0,001). Birinci ay sonunda yap›lan de¤erlendirmede VAS skorlar›ndaki anlaml› azalman›n
devam etmekte oldu¤u gözlendi (p=0,002). Enjeksiyon tedavisinin Roland Morris disabilite
anket sonuçlar›na etkisi tespit edilmedi.
SONUÇ: Episakral lipomalar kronik bel a¤r›l› hastalar›n az›msanmayacak bir bölümünde a¤r›dan
sorumlu yap›lard›r ve lokal enjeksiyon uygulamalar› ile a¤r›da önemli ölçüde azalma sa¤lan›r.
Bu flekilde a¤r›n›n kontrol edilebilmesi hastan›n egzersiz tedavisine uyum sa¤lamas›n›
kolaylaflt›racakt›r.
Anahtar Kelimeler: Kronik bel a¤r›s›, episakral lipoma, lokal enjeksiyon tedavisi
P-009
Ultrasound Guided and Synchronous Nerve-Stimulation Technique
for Suprascapular Nerve Block
Kutay Tezel, Mehmet Ali Taflkaynatan, Koray Köro¤lu Aydemir,
Özlem Omaç, Ahmet Özgül
Turkish Armed Forces Rehabilitation and Care Centre,
Gulhane Military Medical Academy, Ankara
68 years old woman with hemiplegia suffering from right shoulder pain for the last 4 months
referred to our outpatient clinic. After physical examination and magnetic resonance imaging
she was diagnosed as right supraspinatus partial muscle rupture. She was treated with
NSAID’s and 15 sessions of rehabilitation program that included ultrasound, hot pack, TENS,
shoulder range of motion exercises. Since she could not obtain sufficient pain relief she
admitted at our outpatient clinic again. On examination with diagnostic ultrasonography the
diagnosis of rotator cuff rupture and subdeltoid bursitis was made. Then ultrasound guided
and synchronous suprascapular nerve blockage procedure are decided to perform for her.
After cleaning the skin with 70% isopropanol, the ultrasound transducer was inserted into a
sterile sheath containing ultrasound gel placed on spina scapula then suprascapular fossa
visualized. After visualiziation of suprascapular muscle and bony fossa underneath, ultrasound
transducer moved to the lateral plane until suprascapular notch was identified and the
oval hyperechoic structure under the transverse ligament was labeled as suprascapular
nerve. Then neurostimulator needle advanced through the skin with an angle of 45-50
degree to ultrasound transducer, parallel to its long axis. The needle was visualized with its
full length. After operator decided that the needle was close enough to the suprascapular
nerve, the nerve was stimulated with the nerve stimulator (100 Hz 0.5 mA). A 2 ml of prilocaine
and 1 ml betamethasone mixture were administered.
Visual Analog Scale, assessing the patient's pain intensity was 7 before blockage and
decreased to 2 at the end of the second month, also improvement in range of motion was
observed. Constant scale score utilizing in functional improvement, was 51 and increased to
81. Ultrasound guided suprascapular nerve block with synchronous nerve-stimulation may be
an effective and reliable treatment method for shoulder pain that is unresponsive to other
conservative treatments.
Keywords: Ultrasound guided, nerve-stimulation, suprascapular nerve block, shoulder pain
P-010
The Frequency of Episacral Lipoma in Patients with Low Back Pain and the
Efficacy of Local Injection Therapy
Hatice Rana Erdem, Seçil Atasoy, Burcu Duyur Çak›t, Hakan Genç
Ministry of Health Ankara Training and Research Hospital 2nd Department of Physical
Medicine and Rehabilitation, Ankara
OBJECTIVE: It has been shown in several studies that episacral lipoma (Copeman's nodule)
is one of the significant causes of acute and chronic low back pain. However, episacral
lipoma has been usually overlooked in differential diagnosis of low back pain (LBP). The aim
of this study is to determine the frequency of episacral lipoma in patients with LBP and to
evaluate the efficacy of local injection therapy.
MATERIALS-METHODS: Nineteen patients with chronic LBP (76 females and 14 males) were
included in the study. Episacral lipomas were evaluated with careful palpation of episacral
region of the patients. The severity of low back pain was evaluated using Visual Anolog Scale
(VAS) and the functional status of the patients was assessed using Roland_Morris Disability
Questionnaire (RMDQ). The mixture of 2cc prilocaine 2% and 20mg methylprednisolone
were injected into lipoma in patients who accepted the injection therapy.
RESULTS: 18 of 76 female patients (23.7%) had episacral lipomas, painful with palpation and
cause referred pain while none of the male patients had lipomas. Statistically significant
difference was not found between the mean scores of RMDQ in chronic LBP patients with or
without lipoma. ‹ntranodular injection was applied to the 13 patients who accepted the
therapy. Statistically significant improvement was observed in the mean VAS scores of 13
patients treated with injection therapy 1 hour after the injection (p=0.001). Significant
improvement continued 1 month after the injection (p=0.002). Statistically significant effects
of injection therapy on RMDQ were not detected. CONCLUSION: Episacral lipomas are the
structures responsible for pain in a substantial part of patients with chronic low back pain.
Significant decrease of pain was provided with local injection therapy. Pain control by this way
facilitates the compliance of the patients to exercise treatment.
Keywords: Chronic low back pain, episacral lipoma, local injection therapy