Dirsek hemofilik artropatisinde hemartroz, fiziksel değerlendirmeler ve üst ekstremite fonksiyonelliği arasındaki ilişkiler
Öz
Amaç: Bu çalışmanın amacı, dirsek hemofilik artropatisinde, hemartroz ve üst ekstremitenin kas-iskelet sistemi ve işlevselliği arasındaki ilişkiyi incelemekti.
Yöntem: Bu kesitsel çalışma yaşları 12-30 arasında 17 adölesan ve genç erişkin içermektedir. Bu kapsamda 23 dirsek eklemi değerlendirildi. Hastalara dirsek eklemindeki kanama sayıları soruldu. Ağrı seviyesi Nümerik Ağrı Skalası (NAS) ile eklem hareket açıklığı evrensel gonyometre ile kas kuvveti dijital dinamometre ile değerlendirildi. Hemofili Eklem Sağlığı Skoru-Dirsek Puanı (HESS-DP), Hospital for Special Surgery Dirsek Skorlama Sistemi ve Kol, Omuz ve ve El Sorunları Hızlı Anketi (Q-DASH: Quick-Disability of Arm, Shoulder and Hand) dirsek ve üst ekstremitenin fiziksel durumunu ve fonksiyonelliğini değerlendirmek için kullanıldı.
Bulgular: HESS-DP ile ekstansiyon kaybı arasındaki (r=0,54, p=0,008) ve aktivite NAS ve pronasyon/supinasyon açıları arasındaki güçlü ilişkiler (sırasıyla, r=-0,55, p=0,007; r=-0,60; p=0,003) vardı. Ekstansiyon kaybı, triceps kas kuvveti gücü ile ters yönlü güçlü ilişki (r=-0,53, p=0,01) gösterdi. Q-DASH, triceps kas kuvveti ve pronasyon açısı ile ters yönlü güçlü ilişkiliydi (sırasıyla, r=-0,58, p=0,004; r=-0,74, p<0,001). Kanama sayısı ile aktivite NAS arasında pozitif yönlü güçlü ilişki vardı (r=0,56, p=0,005).
Sonuç: Ekstansiyon kaybı ve pronasyon açısının dirsek hemofilik artropatisinde fiziksel değerlendirmesinde önemli değişkenler olduğunu ve fonksiyonelliğin, pronasyon açısı ve triceps kas kuvvetinin iyileşmesiyle gelişebileceğini ayrıca aktivite ağrısı azaltılarak hemartroz sayısı düşürülebileceğini düşündük.
Anahtar Kelimeler
Kaynakça
- 1. Hemofili Tanı ve Tedavi Klavuzu. Turk Hematoloji Dernegi, 2011.
- 2. Konkle BA, Huston H, Fletcher SN. Hemophilia a. GeneReviews®[Internet]: University of Washington, Seattle; 2017.
- 3. Van Dijk K, Fischer K, Van der Bom J, et al. Variability in clinical phenotype of severe haemophilia: the role of the first joint bleed. Haemophilia. 2005;11:438-43.
- 4. Srivastava A, Brewer A, Mauser‐Bunschoten E, et al. Guidelines for the management of hemophilia. Haemophilia. 2013;19:1-47.
- 5. Mulder K, Llinás A. The target joint. Haemophilia. 2004;10:152-6.
- 6. Hilgartner MW, Pochedly C. Hemophilia in the Child and Adult. New York: Raven Press; 1989.
- 7. Heim M, Beeton K, Blamey G, et al. Management of the elbow joint. Haemophilia. 2012;18:101-4.
- 8. Cotta S, Jutras M, Mc Quarrie A. Physical Therapy in Haemophilia. The National Hemophilia Foundation and the Canadian Haemophilia Society, NewYork. 1986.
- 9. Sampath SC, Bredella MA. Magnetic resonance imaging of the elbow: a structured approach. Sports Health. 2013;5:34-49.
- 10. Poonnoose PM, Hilliard P, Doria AS, et al. Correlating clinical and radiological assessment of joints in haemophilia: results of a cross sectional study. Haemophilia. 2016;22:925-33.
- 11. Cuesta-Barriuso R, Gómez-Conesa A, López-Pina JA. Manual and educational therapy in the treatment of hemophilic arthropathy of the elbow: a randomized pilot study. Orphanet J Rare Dis. 2018;13:151.
- 12. Ernstbrunner L, Hingsammer A, Imam MA, et al. Long-term results of total elbow arthroplasty in patients with hemophilia. J Shoulder Elbow Surg. 2018;27:126-132.
- 13. De Moerloose P, Fischer K, Lambert T, et al. Recommendations for assessment, monitoring and follow‐up of patients with haemophilia. Haemophilia. 2012;18:319-25.
- 14. Fischer K, Poonnoose P, Dunn A, et al. Choosing outcome assessment tools in haemophilia care and research: a multidisciplinary perspective. Haemophilia. 2017;23:11-24.
- 15. Cuesta‐Barriuso RA, Gómez‐Conesa and López‐Pina JA. Effectiveness of two modalities of physiotherapy in the treatment of haemophilic arthropathy of the ankle: a randomized pilot study. Haemophilia. 2014:71-78.
- 16. Downie W, Leatham P, Rhind V, et al. Studies with pain rating scales.Ann Rheum Dis. 1978;37:378-81.
- 17. Otman S, Kose N. Tedavi Hareketlerinde Temel Değerlendirme Prensipleri. 4th ed. Ankara: Yücel Ofset; 2008.
- 18. Andrews AW, Thomas MW, Bohannon RW. Normative values for isometric muscle force measurements obtained with hand-held dynamometers. Phys Ther. 1996;76:248-59.
- 19. Escobar RG, Munoz KT, Dominguez A, et al. Maximal isometric muscle strength values obtained By hand‐held dynamometry in children between 6 and 15 years of age. Muscle Nerve. 2017;55:16-22.
- 20. Fischer K, De Kleijn P. Using the Haemophilia Joint Health Score for assessment of teenagers and young adults: exploring reliability and validity. Haemophilia. 2013;19:944-50.
- 21. Turchin DC, Beaton DE, Richards RR. Validity of observer-based aggregate scoring systems as descriptors of elbow pain, function, and disability. JBJS. 1998;80:154-62.
- 22. Figgie M, Inglis A, Mow C. Total elbow arthroplasty for complete ankylosis of the elbow. J Bone Joint Surg. 1989;7:513-20.
- 23. Düger T, Yakut E, Öksüz Ç, et al. Kol, omuz ve el sorunları (disabilities of the arm, shoulder and hand-DASH) anketi Türkçe uyarlamasının güvenirliği ve geçerliği. Fizyoterapi Rehabilitasyon. 2006;17:99-107.
- 24. Hoots WK. Arthropathy in inhibitor patients: differences in the joint status. Semin Hematol. 2008:45;42-9.,
- 25. Morfini M. Articular status of haemophilia patients with inhibitors. Haemophilia. 2008;14:20-2.
- 26. Atalar AC, Koc B, Birisik F, et al. Benefits of radial head excision in patients with haemophilia: mid-term functional results. Haemophilia. 2016;22:25-9.
- 27. Ernstbrunner L, Hingsammer A, Imam MA, et al. Long-term results of total elbow arthroplasty in patients with hemophilia. J Shoulder Elb Surg. 2018;27:126-32.
- 28. Kamineni S, Adams RA, O'Driscoll SW, et al. Hemophilic arthropathy of the elbow treated by total elbow replacement: a case series. JBJS. 2004;86:584-9.
- 29. Gomis M, Querol F, Gallach J, et al. Exercise and sport in the treatment of haemophilic patients: a systematic review. Haemophilia. 2009;15:43-54.
- 30. da Silva GS, de Almeida Lourenço M, de Assis MR. Hand strength in patients with RA correlates strongly with function but not with activity of disease. Adv Rheumatol. 2018;58:20.
- 31. Izawa K, Kasahara Y, Hiraki K, et al. Relation between the Disability of the Arm, Shoulder and Hand Score and muscle strength in post-cardiac surgery patients. Diseases. 2017;5:31.
Correlations between hemarthrosis, physical assessments and functionality of upper extremity in hemophilic arthropathy of the elbow
Öz
Purpose: The aim of this study was to examine the correlations between hemarthrosis, physical assessments, and functionality of upper extremity in hemophilic arthropathy (HA) of the elbow.
Methods: This cross-sectional study includes 17 adolescents and young adults with HA of elbow aged between 12 and 30 years. In this scope 23 elbow joints were evaluated. Number of hemarthrosis in elbow was asked to the patients. Pain level was assessed with the Numerical Pain Scale (NPS), range of motion with universal goniometer, muscle strength with digital dynamometer. Hemophilia Joint Health Score-Elbow Point (HJHS-EP), Hospital for Special Surgery Elbow Scoring System and Quick-Disability of Arm, Shoulder and Hand (Q-DASH) were also used for assessing physical status and functionality of elbow and upper extremity.
Results: There were correlations between HJHS-EP and loss of extension (r=0.54, p=0.008) and between activity NPS and pronation/supination angles (r=-0.55, p=0.007 and r=-0.60, p=0.003; respectively). Loss of extension was showed moderate negative correlation with triceps muscle strength (r=-0.53, p=0.01). The Q-DASH was strongly negative correlated with triceps muscle strength and pronation angle (r=-0.58, p=0.004 and r=-0.74, p<0.001; respectively). There was strong positive correlation between number of hemarthrosis and NPS (r=0.56, p=0.005).
Conclusion: We thought that extension loss and pronation angle were important variables in the physical examination of the elbow in hemophilic arthropathy and functionality may be increased with improvement of pronation angle and triceps muscle strength also the number of hemarthrosis can be decreased by reducing activity pain.
Anahtar Kelimeler
Kaynakça
- 1. Hemofili Tanı ve Tedavi Klavuzu. Turk Hematoloji Dernegi, 2011.
- 2. Konkle BA, Huston H, Fletcher SN. Hemophilia a. GeneReviews®[Internet]: University of Washington, Seattle; 2017.
- 3. Van Dijk K, Fischer K, Van der Bom J, et al. Variability in clinical phenotype of severe haemophilia: the role of the first joint bleed. Haemophilia. 2005;11:438-43.
- 4. Srivastava A, Brewer A, Mauser‐Bunschoten E, et al. Guidelines for the management of hemophilia. Haemophilia. 2013;19:1-47.
- 5. Mulder K, Llinás A. The target joint. Haemophilia. 2004;10:152-6.
- 6. Hilgartner MW, Pochedly C. Hemophilia in the Child and Adult. New York: Raven Press; 1989.
- 7. Heim M, Beeton K, Blamey G, et al. Management of the elbow joint. Haemophilia. 2012;18:101-4.
- 8. Cotta S, Jutras M, Mc Quarrie A. Physical Therapy in Haemophilia. The National Hemophilia Foundation and the Canadian Haemophilia Society, NewYork. 1986.
- 9. Sampath SC, Bredella MA. Magnetic resonance imaging of the elbow: a structured approach. Sports Health. 2013;5:34-49.
- 10. Poonnoose PM, Hilliard P, Doria AS, et al. Correlating clinical and radiological assessment of joints in haemophilia: results of a cross sectional study. Haemophilia. 2016;22:925-33.
- 11. Cuesta-Barriuso R, Gómez-Conesa A, López-Pina JA. Manual and educational therapy in the treatment of hemophilic arthropathy of the elbow: a randomized pilot study. Orphanet J Rare Dis. 2018;13:151.
- 12. Ernstbrunner L, Hingsammer A, Imam MA, et al. Long-term results of total elbow arthroplasty in patients with hemophilia. J Shoulder Elbow Surg. 2018;27:126-132.
- 13. De Moerloose P, Fischer K, Lambert T, et al. Recommendations for assessment, monitoring and follow‐up of patients with haemophilia. Haemophilia. 2012;18:319-25.
- 14. Fischer K, Poonnoose P, Dunn A, et al. Choosing outcome assessment tools in haemophilia care and research: a multidisciplinary perspective. Haemophilia. 2017;23:11-24.
- 15. Cuesta‐Barriuso RA, Gómez‐Conesa and López‐Pina JA. Effectiveness of two modalities of physiotherapy in the treatment of haemophilic arthropathy of the ankle: a randomized pilot study. Haemophilia. 2014:71-78.
- 16. Downie W, Leatham P, Rhind V, et al. Studies with pain rating scales.Ann Rheum Dis. 1978;37:378-81.
- 17. Otman S, Kose N. Tedavi Hareketlerinde Temel Değerlendirme Prensipleri. 4th ed. Ankara: Yücel Ofset; 2008.
- 18. Andrews AW, Thomas MW, Bohannon RW. Normative values for isometric muscle force measurements obtained with hand-held dynamometers. Phys Ther. 1996;76:248-59.
- 19. Escobar RG, Munoz KT, Dominguez A, et al. Maximal isometric muscle strength values obtained By hand‐held dynamometry in children between 6 and 15 years of age. Muscle Nerve. 2017;55:16-22.
- 20. Fischer K, De Kleijn P. Using the Haemophilia Joint Health Score for assessment of teenagers and young adults: exploring reliability and validity. Haemophilia. 2013;19:944-50.
- 21. Turchin DC, Beaton DE, Richards RR. Validity of observer-based aggregate scoring systems as descriptors of elbow pain, function, and disability. JBJS. 1998;80:154-62.
- 22. Figgie M, Inglis A, Mow C. Total elbow arthroplasty for complete ankylosis of the elbow. J Bone Joint Surg. 1989;7:513-20.
- 23. Düger T, Yakut E, Öksüz Ç, et al. Kol, omuz ve el sorunları (disabilities of the arm, shoulder and hand-DASH) anketi Türkçe uyarlamasının güvenirliği ve geçerliği. Fizyoterapi Rehabilitasyon. 2006;17:99-107.
- 24. Hoots WK. Arthropathy in inhibitor patients: differences in the joint status. Semin Hematol. 2008:45;42-9.,
- 25. Morfini M. Articular status of haemophilia patients with inhibitors. Haemophilia. 2008;14:20-2.
- 26. Atalar AC, Koc B, Birisik F, et al. Benefits of radial head excision in patients with haemophilia: mid-term functional results. Haemophilia. 2016;22:25-9.
- 27. Ernstbrunner L, Hingsammer A, Imam MA, et al. Long-term results of total elbow arthroplasty in patients with hemophilia. J Shoulder Elb Surg. 2018;27:126-32.
- 28. Kamineni S, Adams RA, O'Driscoll SW, et al. Hemophilic arthropathy of the elbow treated by total elbow replacement: a case series. JBJS. 2004;86:584-9.
- 29. Gomis M, Querol F, Gallach J, et al. Exercise and sport in the treatment of haemophilic patients: a systematic review. Haemophilia. 2009;15:43-54.
- 30. da Silva GS, de Almeida Lourenço M, de Assis MR. Hand strength in patients with RA correlates strongly with function but not with activity of disease. Adv Rheumatol. 2018;58:20.
- 31. Izawa K, Kasahara Y, Hiraki K, et al. Relation between the Disability of the Arm, Shoulder and Hand Score and muscle strength in post-cardiac surgery patients. Diseases. 2017;5:31.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 6 Ocak 2021 |
| Gönderilme Tarihi | 24 Eylül 2019 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 7 Sayı: 3 |
