Limitation Of Shoulder Motion Research Articles

Charcot joint in a case of syringomyelia with spinal dysraphism

A 35-year-old man with a swelling over the right shoulder and right anterior chest wall was referred to our hospital. The swelling had been present for over 2 months and...

A COMPARATIVE PROSPECTIVE STUDY TO EVALUATE THE RESULTS OF PHYSICAL THERAPY V/S INTRAARTICULAR STEROID INJECTION IN PERIARTHRITIS OF SHOULDER

Background: Frozen shoulder or adhesive capsulitis is a condition where the patient experience stiffness and pain in joint of the shoulder. It is an enigma as till now its etiology is unknown. It affects both the genders of the middle and elderly age. A retrospective, comparative study was to evaluate the effects of physical therapy versus intra-articular steroid injection in periarthritis of shoulder. Methods: 30 patients each with frozen shoulder who were treated either using physical therapy (Group 1) and intra-articular steroid injection (Group 2). The data was collected at baseline and at different follow-up periods and analyzed. Results: There were 3 lost to follow-up in physiotherapy group and 4 in intra-articular injection group. Slight male preponderance (51.9% vs. 48.1%) was seen in physiotherapy group. Left side more affected in both the groups. Literacy (p=0.064), socioeconomic status (p=0.22), occupation (p=0.866), comorbidities (p=0.974), abnormal x-ray (p=0.34) were all comparable between the two groups. Mean duration of shoulder pain and restriction of shoulder motion were also comparable (p>0.05). Side effects– 46.2% were higher in intra-articular injection group. Response to treatment, disability score and SPADI index showed signicant reduction in both the groups, but signicantly more reduction in intra-articular injection was seen in comparison to the physiotherapy group. Conclusions: The overall treatment outcome in intra-articular injection group is much better in comparison to the physiotherapy group, but with higher side effects. Intra-articular injection of steroid will prove to be a boon after effective management of side effects.

A Comparative Study on the Association of Hypothyroidism with Adhesive Capsulitis of Shoulder

Objective: Adhesive capsulitis (AC) is a pathologic condition characterized by pain and limitation of shoulder movements. Thyroid dysfunction often accompanies musculoskeletal disorders, and undiagnosed hypothyroidism can delay response to treatment outcomes. Early diagnosis and treatment of hypothyroidism in patients with AC of shoulder could help to improve pain and disability. This study was done to assess the association of hypothyroidism with AC of shoulder and to find the correlation of severity of pain and disability in AC with hypothyroidism. MATERIALS AND METHODS: In this case–control study, patients who attended PMR OPD during a period of 2 years with pain and limitation of shoulder movements satisfying the inclusion and exclusion criteria were included as cases and patients without AC as controls. Fifty-seven patients were selected as cases and 114 patients as controls. Serum thyroid-stimulating hormone (TSH) level and free tetraiodothyronine level were estimated. Shoulder range of motion (ROM) measurement and radiographs were performed in cases, and the TSH values obtained were compared with the severity of ROM restriction, Visual Analog Scale score, and Shoulder Pain and Disability Index Scale (SPADI) score. Statistical analysis was done using IBM SPSS 20 (SPSS Inc., Chicago, IL, USA). RESULTS: Among cases, 8 (14%) patients had hypothyroidism and 16 (28.1%) had subclinical hypothyroidism, and among controls, 4 (3.5%) had hypothyroidism and 9 (7.9%) had subclinical hypothyroidism. Among the 24 patients with elevated TSH, 16 (66.6%) had mild-to-moderate pain and 8 (33.3%) had severe pain. Mean TSH was elevated in patients with severe pain compared with those with mild-to-moderate pain (5.43 ± 2.31 vs. 3.35 ± 2.48 µIU/mL, P = 0.031). TSH levels showed a positive correlation with SPADI pain score (r =0.335, P = 0.011) and SPADI disability score (r = 0.375, P = 0.004), respectively. There was significant restriction in ROM in patients with higher TSH levels (P < 0.001). CONCLUSION: Patients with AC have higher prevalence of hypothyroidism and subclinical hypothyroidism compared with those who did not. Patients with higher TSH levels had more severe pain, restriction of movement, and overall disability when compared with euthyroid patients. Proper management of hypothyroidism along with the standard measures of management may result in more speedy relief from symptoms and recovery of function in these patients.

Effectiveness of Therapeutic protocol for Physiotherapy Management of Adhesive Capsulitis

Background: Adhesive Capsulitis idiopathic painful restriction of Shoulder movement results in globalrestriction of the glenohumeral joint. It is affecting 2% to 3% of the general population and affects manyfunctional activities like combing, lifting, pushing and pulling. Although Physiotherapy is often the firstline of management, there are various treatments has found its effectiveness but yet to date its protocolof treatment has not been established. So, it is necessary to find effectiveness of specific Physiotherapytreatment protocol for Adhesive Capsulitis. The aim of this study was to find effectiveness of TherapeuticProtocol for Physiotherapy management of Adhesive Capsulitis.Materials and Method: Experimental trial of 30 patients, diagnosed with primary Adhesive Capsulitisselected and divided into two groups. One group was given a Therapeutic Protocol based on review ofliterature and the other group was treated with Conventional Physiotherapy treatment for 4 Weeks. Preand post treatment measurement of ROM, and SPADI Index were taken and statistical analysis was done.The two treatment strategies were compared, Group A showed better improvement in Abduction, IRROM and Functional Score (SPADI) as compare to Group B which was treated with Conventional regularPhysiotherapy Treatment. Improvement in Flexion, Extension and ER ROM was relatively less.Conclusion: Therapeutic Protocol proved effective for management of Adhesive Capsulitis.

A descriptive study on prevalence of arm/shoulder problems and its impact on quality of life in breast cancer survivors.

Surgery for breast cancer and adjuvant radiotherapy are frequently associated with impairment of arm/shoulder function and development of lymphedema. However, most of the studies in Indian breast cancer survivors (BCSs) have focused on the development of lymphedema even though restriction of shoulder movement and pain are even more prevalent and adversely affect the quality of life (QOL). Hence, this study was conducted with the objectives to (1) study the prevalence of arm/shoulder problems (ASPs) including restricted shoulder mobility (ROM), lymphedema and arm/shoulder pain (2) assessment of the QOL in BCSs (3) to study the impact of ASPs on QOL. This descriptive study was conducted on BCSs at an academic center in Delhi These patients underwent a mastectomy and axillary lymph node dissection with adjuvant therapies and were within 6 months to 5 years of follow-up. Assessment of ASPs was done using Kwan's arm problem scale (KAPS), and survivors with scores of more than 21.5 were considered to have significant ASPs. Assessment of shoulder movements was done by using a goniometer, lymphedema by measuring arm circumference at multiple points and arm/shoulder pain by using a numerical pain rating scale (NPRS). QOL was assessed using short form (SF-36) questionnaire. A total of 212 BCSs were studied with a mean duration of follow-up of 2.7 years (range = 6 months - 60 months). The prevalence of ASPs was 49% on KAPS. Prevalence of ROM, lymphedema, and arm/shoulder pain was found to be 51%, 27%, and 12% respectively. Patients with ASPs had poorer QOL scores on SF-36, significantly affecting both physical and mental component summary score. Among ASPs, worst scores were reported for limb swelling. There is a high prevalence of ASPs in BCSs. Survivorship care plans should appropriately address these issues.

A Study to Compare the Effectiveness of Capsular Stretching Versus Scapulothoracic Exercise in Patients with Adhesive Capsulitis of Shoulder

Background Adhesive capsulitis also known as frozen shoulder is characterized by progressive global restriction of shoulder movements and is associated with pain and functional disability.Objective The present study compared the effect of stretching of shoulder capsule and scapulothoracic exercises in frozen shoulder management.Methods An experimental study design was conducted in which thirty subjects were conveniently assigned into two groups namely Group A n15 amp Group B n15 and were given capsular stretching amp scapulothoracic exercises respectively. The subjects in both the groups were commonly treated with Phonoporesis and glenohumeral exercises. The pre-test and post-test values were noted before and after treatment. The outcome measures used were Goniometer to measure ROM while pain and disability were assessed using SPADI.Results In order to compare groups A and B differences between the pre-intervention and post intervention for each variable were analyzed. This difference indicated the actual gain or response from the patients and was easy for comparison. On performing the independent samples t-test it was observed that there was a statistical significant difference plt0.05 between group A and B with respect to flexion abduction rotation and SPADI score group A 14.7 group B 24.9. Also it was noticed that Group B performed better with greater mean.Conclusion Scapulothoracic exercises produced better results than capsular stretching exercises for frozen shoulder.

CASE SERIES: INSTANT EFFECT OF MARMA THERAPY IN THE PAIN MANAGEMENT WSR: TO SHOULDER PAIN

Science of Marma known as Marma Vigyanam is a dynamic part, specially described in Sushrut samhita and other Ayurvedic classics. According to Sushrut Mamsa, Sira, Snayu, Asthi, and Sandhi, these five elements collectively present at Marma point. This is the peculiarity of Marma.1 Marmas are the vital points on the body having importance regarding surgical procedure and traumatic effect. It is also known as Ayurvedic Accupressure. In this paper, three similar cases of pain and stiffness in shoulder joints are presented, who has attended OPD of District Hospital Shivaji Nagar, Bhopal. In during the clinical examination partially restriction of shoulder movement is also recorded. The case was initially treated with Marma therapy mainly the stimulation of bilateral Bahu Marma along withAmsa Marma for instant pain management. After the treatment of about ten minutes the patient got relief in pain and stiffness and felt lightness in surrounding area of painful place. Amsa Marma manipulation can be used to give instant relief from Shoulder pain effectively.

Prevelance of upper extremity lymphedema and risk factors in patients with mastectomy: Single-center, observational, cross-sectional study.

Objective:Upper extremity complaints are frequently encountered in breast cancer. It was aimed to investigate the pain, extremity pain, and limitation of motion, lymphedema prevalence, severity, risk factors and quality of life in patients with breast cancer followed by mastectomy in our center.Materials and Methods:The study included 67 patients with mastectomy. The presence of lymphedema, lymphedema duration, and grade of lymphedema were recorded. Grip strength was measured on both hands using a dynamometer; arm, shoulder and hand problems were evaluated using the disabilities of the arm, shoulder, and hand. Quality of life was assessed using the World Health Organization Quality of Life scale-short form.Results:The presence of lymphedema was 23.9%; the most common was international society of lymphology grade 1 (76.1%); the median lymphedema duration was 12 (range, 3-72) months. Radical/modified radical mastectomy (58.2%) was the most common type of surgery. Median pain score in the affected extremity according to the visual analogue scale was 2 (minimum: 0/maximum: 7); the presence of shoulder pain was 40.3%; shoulder movement limitation was 7.5%.Conclusion:It was found that lymphedema had a negative effect on quality of life by affecting shoulder, arm, and hand functions even in the early stages. The recognition of risk factors and signs of upper extremity complications in breast cancer survivors will contribute to rehabilitation success.

Functional Evaluation of Fracture Shaft of Humerus Treated By Antegrade Closed Interlocking Nail

Introduction: Management of fractures shaft of humerus is always a challenging problem to deal with as they are very frequently associated with complex multiple injuries. Interlocking nails have gained popularity now a days for stabilization of humeral shaft fractures due to load sharing nature of implant, preservation of fracture hematoma, minimal exposures and rigid fixation with early mobilization.
 Objective: The objective of the study was to assess the outcome of the fracture shaft of humerus stabilized with interlocking nail.
 Methodology: A Prospective clinical study was done on fifty patients of fractures shaft of humerus stabilized using antegrade interlocking nail.
 Results: The most common causes of fractures shaft of humerus was road traffic accident (66%). The average union time was 12.7± 1.3 weeks. About 8% had delayed union and 10% had non-union which were treated with bone graft. There was no deep infection but two (4%)had superficial infection in open Gustilo grade II fracture. Four cases (8%) had radial nerve injury, mostly neuropraxias, which recovered in three months. There were 12 cases of significant restriction of shoulder movements which was resolved in six weeks after guarded physiotherapy.
 Conclusion: Closed interlocking nailing is a least invasive surgical option available to manage complex humeral shaft fractures.

Quilting suture versus conventional closure in prevention of seroma after total mastectomy and axillary dissection in breast cancer patients.

Total mastectomy and axillary dissection is a common procedure for breast cancer patients in our institution. Seroma is common. This study aimed to compare the quilting suture and conventional closure in prevention of seroma after total mastectomy and axillary dissection. This randomized comparative study was carried out from January 2018 to June 2019 in Yangon General Hospital. One hundred and forty patients (70 conventional and 70 quilting) were included. For quilting group, customized strategically placed interrupted alternate sutures were placed 2-3 cm apart with 3/0 vicryl sutures between skin flap and pectoral muscle. Age, body mass index and tumour diameter were comparable between the groups. The mean duration of operation was 111.44 ± 7.045 min in conventional and 124.5 ± 6.39 min in quilting (P = 0.0001). The mean drain output for conventional group was not significantly different from quilting group. In quilting, some area developed dimpling which resolved within a week. A total of 21 (30%) patients in the conventional group and 10 patients (14.3%) in the quilting group developed seroma (P = 0.041). The mean frequency and amount of seroma aspiration were significantly lower in the quilting group. Shoulder movement limitation and analgesia use showed no significant difference. Although total amount of drain output, duration of drain, hospital stay and post-operative complications were not different, the incidence of seroma was significantly lower in quilting group. Seroma is treated with more ease in the quilting group as the frequency and amount of aspiration were lower and less frequent follow-up visits were required. Quilting can reduce the seroma incidence in total mastectomy and axillary dissection for breast cancer patients.

Treatment of rotator cuff tear in global stiff shoulder by arthroscopic 360° capsular release with concomitant rotator cuff repair

To evaluate the clinical effect of arthroscopic 360° capsular release with concomitant rotator cuff repair for patients with rotator cuff tears in global stiff shoulder. From December 2016 to December 2018, 247 patients full-thickness rotator cuff tear were treated with arthroscopic rotator cuff repair. Among them, 42 patients (17%) with global limitation of shoulder movement were treated with arthroscopic 360° capsular release operation at the same time of rotator cuff repair. The function of shoulder was evaluated by Constant-Murley score and visual analogue scales (VAS), flexion, abduction and external rotation on body side before and after operation. Sugaya classification was used to evaluatethe healing of rotator cuff. The number of shoulder dislocations during follow-up was recorded. Thirty nine of the 42 patients were followed up for 12 to 36 (22±6) months. The patients were 43 to 73 (57±7) years old at the time of operation. The Constant- Murley score increased from (43.6±6.3) before operation to (87.5±2.8) at final follow-up (P<0.001). VAS score decreased from (7.2±1.5) before operation to (1.0±0.9) at final follow-up (P<0.001). The flexion of shoulder increased from (46±14)° before operation to (148±11)° after operation (P<0.001), the abduction from (36±6)° before operation to (121±10)° after operation (P<0.001), and the external rotation on body side from (5±10)° before operation to (42±8)° after operation(P<0.001). One year after the operation, MRI showed thatⅠ-Ⅲ of Sugaya classification was clinical healing, 38 cases in total. Arthroscopic 360° capsular release with concomitant rotator cuff repair was used to treat rotator cuff tear in global stiff shoulder. Themain observation indexes were improved after operation, and the clinical effect was definite.

Functional outcome of manipulation under anaesthesia for the treatment of frozen shoulder

Background: Frozen shoulder is defined as painful progressive loss of shoulder movements with unknown etiology. It is a self-limiting disease with the natural history of 18-30 months but with residual pain and restriction of shoulder movement. Its incidence is 2-5%. Various treatment modalities include benign neglect, physical therapy, non-steroidal anti-inflammatory medications, oral glucocorticoids, distention arthrography, intra articular steroid injections, closed manipulation under anaesthesia (MUA) and arthroscopic release of joint capsule. MUA regarding pain control and range of motion is safe, yields immediate results and is very cost effective. The purpose of this study was to ascertain the functional outcome of manipulation under anaesthesia and physiotherapy for the treatment of frozen shoulder in term of safety, cost effectiveness and immediate results.&#x0D; Patients and Methods: In the 6 months study period, 50 patients with adhesive capsulitis were included by non-probability purposive sampling. Manipulation of shoulders was done under general anaesthesia and after the MUA intra articular injection of a mixture of corticosteroid and local anaesthetic was injected. Postoperatively, all patients underwent physiotherapy. Functional outcome was measured using Shoulder Pain and Disability Index (SPADI) preoperatively and postoperatively at 1st, 2nd and 3rd week follow up.&#x0D; Results: Out of 50 patients, 32 (64%) were females and 18 (36%) were males having female to male ratio of 1.8:1. Average age was 51 years and average duration of symptoms preceding to MUA was 4 months and 27 days. The average pain score decreased from 92.52% to 18.08% and the average disability score reduced from 95% to 17.10%, both at 3rd week postoperative follow up. There were no procedure-related complications.&#x0D; Conclusion: Manipulation under anaesthesia along with physiotherapy diminishes pain and disability, improves range of motion and expedites early recovery of function in patients having frozen shoulder.

Evaluation of axillary reverse mapping (ARM) in clinically axillary node negative breast cancer patients - Randomised controlled trial.

Axillary lymph node dissection (ALND) is an important procedure for control of axillary nodal metastasis in breast cancer patients. Lymphedema, restriction of shoulder movement and axillary nodal recurrence are the most disabling complications of the procedure. Axillary reverse mapping (ARM) procedure for arm lymph node identification emerged as a step for their preservation during ALND. Here we are testing the effect of ARM on lymphedema development and whether it compromises oncological safety in early breast cancer patients. 98 clinically node free breast cancer female patients undergoing completion ALND after positive sentinel lymph node biopsy were recruited in the study. They were put into group A (49 patients with ARM+ve preservation ALND) and group B (49 patients in the conventional ALND group). ARM procedure was performed in both groups, ARM positive nodes were preserved in group A, marked and taken out with other axillary LN in group B. The outcome was histopathology of ARM+ve LN, development of arm lymphedema, and restriction of shoulder movement on follow-up. ARM was positive in 46 patients (93.8%) in group A and 43 patients (87.8%) in group B, ARM+ve LN revealed positive metastasis only in 1 patient (2.3%) in group B. Lymphedema developed in 3 (6.5% patients in group A and 9 patients (20.9%) in group B. Restriction of shoulder movement showed a non-significant difference between the two groups. Axillary reverse mapping and preservation of arm lymphatics helped to decrease the lymphedema rate without compromising oncological safety in early breast cancer.

Effect of Self-treatment During Rehabilitation Maintenance Phase on Affected Limb Lymphedema in Patients After Breast Cancer Surgery

Objective: This article aims to discuss the effect of self-treatment during rehabilitation maintenance phase on affected limb lymphedema after surgery for breast cancer. Methods: Therapists for lymphedema gave one course of complex decongestion therapy (CDT) to affected limb lymphedema of 42 patients after operation for breast cancer. After CDT, patients took self-treatment during rehabilitation maintenance phase. At the 1st, 3rd, 6th, and 12th month after self-treatment, follow-up was conducted for the patients to measure the circumference of the limb, and condition of some lymphedema-related symptoms (such as limitation of shoulder movement, sense of tension, heaviness, needling and numbness). Results: After self-treatment, the circumference of the limb reduced and the lymphedema-induced symptoms improved significantly at the 1st, 3rd, 6th, and 12th month (P<0.05). Besides, 12 months after self-treatment, the lymphedema was maintained at stable phase and lymphedema-related symptoms were improved. The incidence of limitation of shoulder movement, sense of numbness, needling, tension, and heaviness reduced significantly compared with that before self-treatment (P<0.05). Conclusions: Adherence to self-treatment for lymphedema-related symptoms during rehabilitation maintenance phase can reduce the recurrence rate of lymphedema and thus is an effective method for consolidation treatment.

Physical and functional complications after surgical treatment for breast cancer

Introduction: The ideal treatment for breast cancer should be carried out by a multidisciplinary team, aiming at the global approach of the patient. It is usually a prolonged process and can cause relevant changes in the lives of patients, such as limited shoulder movement, pain, lymphedema, adherence scarring, sensitive changes, phlebitis, among others. Physical therapy intervention plays an essential role and can prevent and minimize complications, besides enabling functional recovery. It is extremely important that the physical therapy service is aware of the prevalence of the main physical and functional complications and the impact of its intervention. Objective: To assess the main physical and functional complications in the post-surgical treatment of breast cancer. Methods: This is a cross-sectional study in which we analyzed the medical records of patients treated in the Physical Therapy Ambulatory from 2011 to 2016. We obtained data about the surgery, prevalence of pain, changes in perimeter, movement amplitude, evaluation of scapulohumeral rhythm and presence of axillary cording. Results: We assessed the data of 703 patients, whose mean age was 56 years; 50.1% were married, and body mass index pointed to overweight (mean: 26.8kg/m²). Sedentary lifestyle was prevalent (73.7%). The main surgery performed was quadrantectomy, followed by mastectomy. Pain was present, however, in extremely low levels (mean of pain in the Visual Analog Scale on the seventh postoperative day was 2.55); movement amplitude restrictions were higher in the beginning, and functionally reversed during follow-up; scapular dysfunction is also little prevalent (9.9%), with high percentage of long term resolution. The incidence of axillary cording was high (87.9%), which requires special attention. Conclusion: The study allowed to observe the main physical and functional complications after breast cancer treatment, and show the importance and necessity of early physical therapy.

PSY36 THE CORRELATION STUDY BETWEEN HIGH-FREQUENCY ULTRASONOGRAPHY OF KNEE JOINT`S LESIONS IN RHEUMATOID AND VARIETY OF SERUM MARKERS INPATIENTS WITH EARLY AND NON-EARLY

The serum levels of CRP,ESR,RF,anti-CCP and the knee joint high-frequency color Doppler ultrasonography were detected in patients of ERA and NERA,respectively.The correlation between ultrasonographic (US) knee abnormalities in patients with rheumatoid arthritis (RA) and levels of CRP,ESR were investigated. 60 RA patients were divided into two groups, 24 cases in ERA group and 36 cases in NERA group were enrolled in this study. Demographical and Clinical data were recorded, including aging、sex、duration、positive signs of limited shoulder movement、DAS28、serum markers,such as RF、anti-CCP、CRP and ESR. 1. The level of CRP and ESR were significantly higher in NERA group than that in ERA group（P=0.002，0.001）Positive rate of RF was significantly higher in NERA group（0.028）,Positive rate of anti-CCP was not significantly different between NERA and ERA group;2. In the ERA patients, the proportion of suprapatellar bursa effusion was higher than the NERA group,while that of synovitis in NERA was higher than ERA group; 3. Synovitis and synovial blood flow score in NERA group were significantly correlated with DAS28,CRP and ESR.None of the ultrasonography in ERA group was significantly correlated with DAS 28,CRP and ESR. High-frequency color Doppler ultrasonography detected accurately the abnormalities of knee joint,it was valuable in the diagnosis of knee in RA patients.

LYMPHEDEMA TREATMENT CERTIFIED PHYSICAL THERAPISTS' AWARENESS OF AND PRACTICE PATTERNS FOR SIDE EFFECT RISK REDUCTION AFTER BREAST CANCER TREATMENTS

Background: Lymphedema and other side effects (SEs) of breast cancer (BC) treatments are a clinical condition; hence, input based on clinical experience is highly relevant for deciding on intervention.Purpose: To evaluate lymphedema treatment certified physical therapists' (CLT) awareness of SEs after BC treatments and their recommendations for risk-reduction.Methods: In a mixed model qualitative study, a convenience sample of 20 CLTs with at least 5-years' experience were interviewed by phone call. Topics discussed were SEs after BC treatments and recommendations for risk reduction.The authors analyzed the data separately and then discussed the interpretation of similarities and differences.Results: The most frequently mentioned SEs were arm lymphedema, breast swelling, pain, and shoulder movement limitation. General SEs, such as stress and anxiety, were also mentioned. There was consensus on the need for education about lymphedema, infection prevention, and physical activity, but not on the optimal timing to provide instruction, orfor a preliminarysession with a CLT.Conclusions: The participants wereaware of and knowledgeable about common SEs after BC surgery and preventive interventions, in keeping with best practice recommendations. However, remaining controversies raise the need for a practical guideline for SEs risk reduction after BC surgery.

PREVALENCE OF CORACOCLAVICULAR JOINT IN PATIENTS VISITING RADIO-DIAGNOSIS DEPARTMENT AT COLLEGE OF MEDICAL SCIENCES, CHITWAN

Background: Coracoclavicular joint (CCJ) is a true synovial joint between superior surface of coracoid process of scapula and conoid tubercle of clavicle. The radiological prevalence of CCJ in various population ranges 0.55% to 21%. The CCJ are mostly discovered incidentally and is rarely associated with any symptom. Sometimes it may present with shoulder pain, limitation of shoulder movement, upper limb paresthesia and osteoarthritis of itself or adjacent acromioclavicular joint. Hence, this study is aiming to determine the prevalence of anomalous CCJ in patient visiting department of Radio-diagnosis in College of Medical Sciences, Bharatpur, Chitwan, Nepal and to observe association of CCJ with laterality, sides and gender.&#x0D; Methods: A total of 1936 digital chest x-rays films were observed for the presence of CCJ, out of which 1097 images were of male and 839 of females. Age of study population ranged from 3 to 90 years. The data obtained were analyzed using Stastical Package for Social Science version (SPSS) 16.0. The prevalence of CCJ was calculated. The cases with CCJ were further analyzed to evaluate the association of CCJ with laterality, sidedness and gender using Chi-square for one-dimensional "goodness of fit" test. Chi-square of Independence was employed to compare the various parameters (laterality and side) with genders.&#x0D; Results: The prevalence of CCJ was 4.6%. CCJ was more frequently observed in male (67.42%) than female (32.57%). Unilateral occurrence of CCJ (55.06%) was slightly more than bilateral (44.94%). Gender difference was not significantly associated with laterality and sidedness of joint (p&lt;0.05). The incidence of CCJ was more in group C (between 20 to 29 years of age) in both male and female.&#x0D; Conclusions: CCJ is not rare, hence, knowledge of presence of CCJ as an etiology of shoulder pain is essential for rational therapy and will prevent misdiagnosis.

Prevalence of Coracoclavicular Joint in Patients Visiting Radio-Diagnosis Department at College of Medical Sciences, Chitwan

Introduction: Coracoclavicular joint (CCJ) is a true synovial joint between su­perior surface of coracoid process of scapula and conoid tubercle of clavicle. The radiological prevalence of CCJ in various population ranges 0.55% to 21%. The CCJ are mostly discovered incidentally and is rarely associated with any symptom. Sometimes it may present with shoulder pain, limitation of shoulder movement, upper limb paresthesia and osteoarthritis of itself or adjacent ac­romioclavicular joint. Hence, this study is aiming to determine the prevalence of anomalous CCJ in patient visiting department of Radio-diagnosis in College of Medical Sciences, Bharatpur, Chitwan, Nepal and to observe association of CCJ with laterality, sides and gender.&#x0D; Methods: A total of 1936 digital chest x-rays films were observed for the pres­ence of CCJ, out of which 1097 images were of male and 839 of females. Age of study population ranged from 3 to 90 years. The data obtained were analyzed using Stastical Package for Social Science version (SPSS) 16.0. The prevalence of CCJ was calculated. The cases with CCJ were further analyzed to evaluate the association of CCJ with laterality, sidedness and gender using Chi-square for one-dimensional “goodness of fit” test. Chi-square of Independence was em­ployed to compare the various parameters (laterality and side) with genders.&#x0D; Results: The prevalence of CCJ was 4.6%. CCJ was more frequently observed in male (67.42%) than female (32.57%). Unilateral occurrence of CCJ (55.06%) was slightly more than bilateral (44.94%). Gender difference was not signifi­cantly associated with laterality and sidedness of joint (p&lt;0.05). The incidence of CCJ was more in second decade of life in both male and female.&#x0D; Conclusion: CCJ is not rare, hence, knowledge of presence of CCJ as an etiol­ogy of shoulder pain is essential for rational therapy and will prevent misdiag­nosis.

Meme kanserli kadınların cerrahi girişim sonrası yaşadıkları üst ekstremite sorunlarının yaşam kalitesine etkisi

Amaç: Araştırmada, meme kanseri cerrahisi uygulanan kadınların yaşadığı üst ekstremite sorunlarını ve bu sorunların yaşam kalitesine etkisini belirlemek amaçlandı. Yöntem: Tanımlayıcı tipteki bu araştırmanın örneklemini, tek taraflı meme kanseri cerrahisi sonrası üzerinden en az bir, en fazla 24 ay geçmiş olan 81 kadın oluşturdu. Veriler, Kasım 2015- Ağustos 2016 tarihleri arasında toplandı. Araştırmada, “Omuz Ağrı ve Özürlülük İndeksi (OAÖİ)”, “Avrupa Kanser Araştırma ve Tedavi Teşkilatı Yaşam Kalitesi Ölçeği (EORTC QLQ-C30)” ve “Meme Kanserine Özgü Yaşam Kalitesi Ölçeği (EORTC QLQ- BR23)” kullanıldı. Omuz hareket açıklığı ölçüldü ve lenfödem değerlendirildi. Bulgular: Araştırmaya katılan kadınların %37’sinde omuz eklem hareket kısıtlılığı; %19.8’inde lenfödem vardı. Omuz eklem hareket kısıtlılığı olan kadınların olmayanlara göre OAÖİ puanlarında anlamlı fark saptandı. Omuz eklem hareket kısıtlılığı olan kadınların, EORTC QLQ-C30 ölçeğinin fiziksel işlev, ağrı; EORTC QLQ-BR23 ölçeğinin meme ve kola bağlı semptom puanlarında anlamlı fark bulundu. OAÖİ ile EORTC QLQ-C30 ve EORTC QLQ-BR23 yaşam kalitesi ölçekleri arasında anlamlı ilişki vardı. Lenfödem ile OAÖİ ve yaşam kalitesi ölçekleri arasında ise anlamlı ilişki bulunmadı. Sonuç: Araştırma bulguları, kadınların meme kanseri cerrahisi sonrası yaşam kalitesini azaltan üstekstremite sorunları yaşadığını ve bu sorunların ağrı, yorgunluk, dispne, uykusuzluk gibi semptomların görülme sıklığını artırdığını ortaya koydu.