Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Omuz Ağrısı Olan Spinal Kord Yaralanmalı Hastalarda Fizik Muayene ve Omuz Ultrasonografi Bulguları
Physical Examination and Shoulder Ultrasonography Findings in the Patients with Shoulder Pain After Spinal Cord Injury
Serdar KAYMAZa, Sanem ASLIHAN AYKANb, Tuğba İKİZ KAYMAZa, Sinem UYAR KÖYLÜa
aFiziksel Tıp ve Rehabilitasyon Kliniği, Ankara Fizik Tedavi Eğitim ve Araştırma Hastanesi, Ankara, TÜRKİYE
bFiziksel Tıp ve Rehabilitasyon Kliniği, Sultan Abdülhamid Han Eğitim ve Araştırma Hastanesi, İstanbul, TÜRKİYE
Turkiye Klinikleri J Health Sci. 2019;4(3):288-94
doi: 10.5336/healthsci.2019-64805
Article Language: TR
Full Text
ÖZET
 Amaç: Spinal kord yaralanması (SKY) sonrası parapleji tanısı almış, omuz ağrısı olan ve yardımcı cihaz ya da tekerlekli iskemle (Tİ) kullanan hastalarda, omuz lezyonlarının klinik ve ultrasonografik (US) olarak incelenmesi ve bunların nörolojik seviye, cinsiyet, SKY süresi ile ilişkisinin belirlenmesidir. Gereç ve Yöntemler: Çalışmaya alınan 66 hastanın yaş, cinsiyet, nörolojik seviye, SKY süresi, etiyoloji ve ambulasyon seviyesi belirlendi. Ağrı vizüel analog skalası (VAS) ile değerlendirildi. Nörolojik seviye belirlenirken en son 2011 yılında revize edilen 'American Spinal Injury Association (ASIA)' skalasından yararlanıldı. Omuz muayenesi için 'Omuz Fizik Muayenesi Değerlendirme Ölçeği (PESS)', ultrasonografik değerlendirme için 'Omuz Patolojilerinin Ultrasonografik Sınıflaması (USPRS)' kullanıldı. Bulgular:Hastaların 46 (%69,6)'sı erkek-20 (%30,4)'si kadın olup; yaş ortalamaları 36,00±13,00 yıl idi. Supraspinatus tendon/tüberkülüm majus hassasiyeti, biseps tendon/oluk hassasiyeti, ağrılı ark ile Hawkins-Kennedy dominant ve nondominant omuzda sırayla %60 ve %56 oranında pozitif bulundu. Bilateral supraspinatus tendiniti en sık saptanan ultrasonografi bulgusuydu. Dominant omuzun %4,5'inde supraspinatus tendinopati, %6'sında bisipital tendinopati, non-dominant omuzun %3'ünde supraspinatus tendinopatisi ve %1,5'inde bisipital tendinopatisi saptandı. PESS değeri sağ omuz için 6,24±4,11 sol omuz için ortalama 5,70±4,30 idi. USPRS değerleri ort 11,53±6,07 idi. PESS ile USPRS arasında istatistiksel olarak anlamlı bir ilişki saptandı (p<0,001, r=0,51). Bu skalaların nörolojik seviye, cinsiyet ve SKY süresi ile istatistiksel olarak anlamlı ilişkisi saptanmadı (p>0,05). Ancak, nörolojik seviye ile supraspinatus ve bisipital tendinopati arasında anlamlı ilişki belirlendi (p=0,036). Sonuç: Yardımcı cihaz ya da Tİ kullanan paraplejik hastalarda omuz patolojileri sıktır. Cinsiyet ve SKY süresi omuz patolojisi için risk faktörü değildir. Fakat nörolojik seviye yükseldikçe omuzda tendon patolojisi oluşma ihtimali artmaktadır.

Anahtar Kelimeler: Omuz eklemi; ultrasonografi; spinal kord yaralanması; vizüel analog skala
ABSTRACT
 Objective: Our aim is to evaluate the relationship between neurological level, sex, diagnosis duration and physical and ultrasonographic examination of shoulder in paraplegic spinal cord injury (SCI) patients with shoulder pain using assistive devices or wheelchair. Material and Methods: We included 66 cases in our study. Age, gender, neurological level, duration of SCIambulation level were noted. Pain was evaluated by using visual analog scale (VAS). Neurological level was determined by using 'American Spinal Injury Association (ASIA, 2011)'. The physical and ultrasonographic examination were evaluated with 'Physical Examination of the Shoulder Scale (PESS)' and 'Ultrasound Shoulder Pathology Rating Scale (USPRS)' respectively. Results: Forty-six (69.6%) men and 20 (30.4%) women were included in our study. The mean±standard deviation of age was 36.00±13.00 years. Bilateral supraspinatus tendinitis was the most common ultrasonographic (US) finding. The prevelance of the supraspinatus and bisipital tendinopathy in dominant shoulder were 4.5% and 6%, in non-dominant shoulder were 3% and 1.5% respectively. The mean±standard deviation of PESS was 6.24±4.11 for right and 5.70±4.30 for left shoulder. The mean±standard deviation of USPRS was 11,53±6,07 for shoulders. PESS was positively correlated with USPRS (p<0.001, r=0.51). There was no statistically significant relationship between neurological level, sex, duration of SCI and USPRS or PESS. We found statistically significant relationship between neurological level and supraspinatus-bisipital tendinopathy (p=0.036). Conclusion: Shoulder pathology was seen commonly in paraplegic patients using assistive devices or wheelchairs. Sex and duration of SCI are not risk factor for shoulder pathology. But higher neurological levels increases the risk of tendinopathy in shoulder.

Keywords: Shoulder; ultrasonography; spinal cord injury; visual analog scale
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