Amaç: Bu çalýþmanýn amacý, kanser tanýlý hastalarda palyatif bakým hizmeti almanýn, semptom ve memnuniyet düzeyine etkisini deðerlendirmektir.
Gereç ve Yöntem: Bu araþtýrma, Palyatif Bakým Merkezi’nde (PBM) hizmet alan 60 ve kamu hastanesinde genel bakým hizmeti alan 59 kanser tanýlý hastayla gerçekleþtirildi. Ýki farklý hastanede sunulan hizmetlerin etkisini deðerlendirmede; Edmonton Semptom Tanýlama Ölçeði ve Avrupa Kanser Tedavisi ve Araþtýrmalarý Organizasyonu Bakým Memnuniyet Ölçeði (EORTC-IN-PATSAT32) kullanýldý. Veriler, SPSS ve Excel programlarý kullanýlarak; sayý ve yüzde daðýlýmlarý, iki eþ arasýndaki farkýn önemlilik testi ve tekrarlý ölçümlerde iki yönlü varyans analizi yöntemleriyle analiz edildi.
Bulgular: PBM’de hizmet alan hastalarýn semptom þiddetlerinin, daha yüksek olduðu belirlendi. Bir hafta ara ile gerçekleþtirilen semptom deðerlendirilmesinde, hastaneler arasýnda “yorgunluk, bulantý ve solunum güçlüðü” semptomlarý açýsýndan istatistiksel olarak anlamlý bir fark olduðu (p<0.05) ve genel bakým hizmeti alan hastalarýn bütün semptomlarýnda daha fazla iyileþme gerçekleþtiði belirlendi. Ancak, PBM’de hizmet alan hastalarýn ortalama memnuniyet düzeyinin daha yüksek seviyede olduðu ve hastaneler arasýndaki genel memnuniyet düzeyi farkýnýn istatistiksel olarak anlamlý olduðu bulundu (p<0.05).
Sonuç: Kanser hastalarý açýsýndan, PBM’de palyatif bakým alýnmasý, bir kamu hastanesinde genel bakým hizmeti almaya kýyasla, semptom seviyelerinin azaltýlmasýnda daha az etkilidir, ancak daha yüksek hasta memnuniyeti saðlamaktadýr.

Objectives: The aim of this study was to evaluate the effect of palliative care on the symptom level assessment and satisfaction of patients diagnosed with cancer.
Methods: The study was carried out with 60 cancer patients who received service at a palliative care center (PCC) and 59 cancer patients who received general care services at a public hospital. The effect of the services provided at the 2 hospitals was evaluated using the Edmonton Symptom Assessment System and the European Organisation for Research and Treatment of Cancer In-patient Satisfaction with Care Questionnaire. The data were analyzed to determine number and percentage distributions, the significance of differences between 2 peers, and 2-way analysis of variance in repetitive measurements.
Results: It was determined that the symptom severity of the PCC patients was greater. In a 1 week interval, greater improvement was observed in all of the symptoms of the patients who received general care, and the evaluation revealed a statistically significant difference between the hospitals in terms of fatigue, nausea, and dyspnea (p<0.05). However, the mean satisfaction of the patients who received services at the PCC was higher, and the difference in the general satisfaction level between hospitals was statistically significant (p<0.05).
Conclusion: The palliative care provided to cancer patients at the PCC was less effective in reducing symptom levels compared with the results from patients of general care at a public hospital, but provided greater patient satisfaction.

Abstract | Full Text PDF

Amaç: Çalýþmamýzda kalça cerrahisi geçiren geriatrik dönem hastalarýnda yaþ faktörünün ve anestezi yöntemlerinin morbidite ve mortalite üzerine olan etkilerini deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: Kalça cerrahisi geçiren, ASA I-IV grubuna giren, 65 yaþ ve üstü hastalar çalýþmaya dâhil edildi. Hastalar, yaþlý grup (≥65 yaþ) Grup YG ve çok yaþlý (≥75 yaþ) Grup ÇYG olarak sýnýflandýrýldý. Hastane elektronik kayýt sisteminden hastalarýn yaþý, cinsiyeti, ASA skoru, anestezi yöntemleri, intraoperatif ve postoperatif kan transfüzyonu gereksinimi, solunum ve kardiyovasküler komplikasyonlar, postoperatif yoðun bakým ihtiyacý, hastanede kalýþ süreleri, postoperatif dönemde komplikasyonlarýn geliþme süresi, rejyonal ve genel anesteziye göre morbidite ve mortalite oranlarý yaþ gruplarýna göre deðerlendirildi.
Bulgular: Kalça cerrahisi geçiren ASA I-IV grubuna giren 65 ile 95 yaþ arasýnda toplam 258 hasta çalýþmaya dâhil edildi. 75 yaþýn üzerindeki Grup ÇYG, ASA III ve IV hastalarýn postoperatif dönemde morbidite ve mortalite oranlarý yüksek bulundu. Ayrýca Grup ÇYG hastalarýnda rejyonal anestezi yöntemlerinin daha çok tercih edilirken, anestezi yöntemleri arasýnda postoperatif morbidite ve mortalite açýsýndan farklýlýk olmamak ile birlikte intraoperatif dönemde geliþen kardiyovasküler komplikasyonlar genel anestezi uygulanan hastalarda daha yüksek bulundu.
Sonuç: Kalça cerrahisi uygulanan hastalarýn yaþ gruplarý ve anestezi yöntemlerine göre karþýlaþtýrýldýðý bu çalýþmada uygulanan anestezi yöntemleri ile morbidite ve mortalite iliþkilendirilememek ile birlikte, mortalite için ileri yaþ (≥75 yaþ) ve yüksek ASA skoru en önemli risk faktörleridir.

Objectives: Hip surgeries performed in elderly patients are important in terms of both the physiological features of geriatric patients and the risks of surgery. The aim of this study was to evaluate the effects of age and the anesthesia method used on morbidity and mortality in geriatric patients who had hip surgery.
Methods: Patients who were aged 65 and older who also had hip surgery and had American Society of Anesthesiologists (ASA) Physical Status Scale scores were included in the study. The patients were classified as aged (Group AG) for those ≥65 years of age, and very aged (Group VAG) for those ≥75 years of age. Details obtained from the hospital electronic records system of the patients’ age, sex, ASA score, anesthesia method used, intraoperative and postoperative blood transfusion requirements, respiratory and cardiovascular complications, postoperative intensive care requirements, duration of hospital treatment, period of development of any postoperative complications, morbidity, and mortality were evaluated by age group.
Results: A total of 258 patients between the ages of 65 and 95 who had hip surgery and available ASA scores were included in the study. In Group VAG, the rate of morbidity and mortality of ASA III and IV patients was high in the postoperative period. Regional anesthesia methods were used more often in Group VAG patients, and there were more cardiovascular complications developing in the intraoperative period in the general anesthesia patients, although there was no difference between anesthesia methods in terms of postoperative morbidity and mortality.
Conclusion: In this study of elderly patients who had hip surgery, there was no correlation between the anesthesia method used and morbidity and mortality. Advanced age (≥75 years) and a high ASA score were the most important risk factors for mortality.

Abstract | Full Text PDF

Amaç: Palyatif bakým çalýþanlarý acý, ýzdýrap, ölüm, keder, yas gibi yükü aðýr kavramlarla sürekli temas halindedir. Palyatif çalýþanlarýnda bakým süreçlerine eþlik etmeleri nedeniyle tükenmiþlik sendromunun görülmesi daha sýktýr.
Gereç ve Yöntem: Çalýþmaya palyatif bakým çalýþanlarý ile dahiliye ve nöroloji servisi çalýþanlarý olarak toplam 47 kiþi katýldý. Katýlýmcýlar palyatif bakým çalýþanlarý (Grup P) ve dahiliye ve nöroloji servisinde çalýþanlar (Grup A) kabul edildi. Çalýþmaya katýlanlara Maslach tükenmiþlik ölçeði, BECK anksiyete depresyon ölçeði ve Stres Belirtiler Ölçeði kullanýldý.
Bulgular: Kýrk yedi saðlýk çalýþaný ölçekleri doldurmayý kabul etti. Her iki grupta da duygusal tükenme ve duyarsýzlaþma puaný yüksek, kiþisel baþarý puaný ise düþük olarak bulundu. BECK anksiyete depresyon ölçeðine göre orta düzeyde anksiyete bulgusu mevcuttu. Ancak biliþsel-duyusal, fizyolojik ve aðrý yakýnmalarý ile stres belirtileri Grup A’da daha yüksekti.
Sonuç: Tükenmiþlik, saðlýk çalýþanlarýnýn karþý karþýya olduðu önemli bir sorundur. Özellikle palyatif bakým biriminde çalýþan saðlýk personelinde stres belirtileri ile biliþsel-duyusal, fizyolojik ve aðrý yakýnmasý daha fazladýr. Tükenmiþlik nedenlerinin düzeltilmesine yönelik yapýsal düzenlemeler yapýlmasý çalýþan saðlýðýný olumlu etkileyecektir.

Objectives: Palliative care workers have continuous exposure to the emotionally draining effects of pain, suffering, death, grief, and mourning. Burnout syndrome is common among these individuals who accompany patients on the way to death. This study evaluated burnout, stress, anxiety, and depression among care givers.
Methods: A total of 47 individuals working in palliative care units or internal disease and neurology clinics participated in the study. The participants were divided into 2 groups: palliative care workers (Group P) and workers in internal disease and neurology clinics (Group A). All of the participants completed the Maslach Burnout Inventory, the Beck anxiety and depression scales, and the Stress Appraisal Measure.
Results: A total of 47 healthcare workers agreed to complete the scales. Emotional burnout and desensitization scores were found to be elevated, and personal success scores were low in both groups. The Beck Anxiety Inventory revealed findings of moderate anxiety in both groups, while cognitive-sensorial, physiological, and pain complaints, as well as signs of stress, were more pronounced in Group A.
Conclusion: Burnout is a significant problem among healthcare workers and signs of stress and cognitive-sensorial, physiological, and pain complaints are particularly common among those working in palliative care units. Structural arrangements aimed at addressing the causes of burnout could positively affect the well-being of healthcare workers.

Abstract | Full Text PDF

Amaç: Dolu bardak testinin (DBT) aðrýlý diyabetik periferal nöropati (ADPN)’de kullanýmýný ve geçerliliðini test etmek.
Gereç ve Yöntem: Bu kesitsel ve prospektif çalýþmaya ADPN olan olgular alýndý. Çalýþma popülasyonunda periferal nöropati yapacak diðer nedenler ve kognitif yetmezlik dýþlandý. Periferik nöropati tanýsý muayene ve Douleur Neuropathique 4 (DN4) anketi kullanýlarak gösterildi. Aðrý þiddeti tedavi öncesi ve sonrasýnda DBT ve Vizüel Analog Skala (VAS) ile deðerlendirildi. Geçerlilik için DBT’nin VAS ile korelasyonuna bakýldý.
Bulgular: Çalýþmaya 43 (33 kadýn, 10 erkek) olgu alýndý. Ortalama yaþ 61.9±8.25, ortalama hastalýk süresi 13.02±7.6 yýldý. Tip I DM 2 (%4.7) olguda, Tip II DM 41 (%95.3) olguda mevcuttu. HbA1c düzeyi ortalama 8.9±1.9 mmol/mol’du. Aðrý þiddetinin deðerlendirilmesinde kullanýlan VAS ve DBT tedavi öncesi ve sonrasý karþýlaþtýrýldýðýnda ortalama skorlar tedavi öncesinde 6.7±2.05, 66.35±23.2, tedavi sonrasýnda ise 4.6±2.2, 41.36±23.5 bulundu. Sonuçlar istatistiksel olarak anlamlýydý (p<0.001, p<0.001). Olgularda ortalama kontrol süresi 23.4 (minimum–maksimum: 15–30) gün oldu. Aðrý þiddet ölçeði DBT, tedavi öncesi ve sonrasýnda VAS ile yüksek korele bulundu (rs=0.86, p<0.001; rs=0.843, p<0.001).
Sonuç: Dolu bardak testi ADPN’de aðrý þiddetini belirlemede kullanýþlý olabilir.

Objectives: The aim of this study was to test the utility and validity of the full cup test (FCT) to assess the severity of pain in subjects with painful diabetic peripheral neuropathy (PDPN).
Methods: Subjects with diabetic PDPN were enrolled for this prospective, cross-sectional study. Other causes of PDPN and subjects with cognitive impairment were excluded. The diagnosis of neuropathic pain was made using the results of a physical examination and the Douleur Neuropathique 4 questionnaire. Pain severity was assessed with a FCT and a visual analog scale (VAS) administered before and after treatment. The correlation of FCT with VAS was evaluated to examine validity.
Results: A total of 43 (33 female, 10 male) subjects were included. The mean age was 61.9±8.25 years and the mean disease duration was 13.02±7.6 years. Type I diabetes mellitus (DM) was present in 2 (4.7%) subjects and Type II DM in 41 (95.3%) subjects. The mean glycated hemoglobin level was 8.9±1.9 mmol/mol. When the mean VAS and FCT scores were analyzed, the results were 6.7±2.05 and 66.35±23.2, respectively, pretreatment and 4.6±2.2 and 41.36±23.5 posttreatment, which were both statistically significant (p<0.001, p<0.001). The mean control period was 23.4 days (min–max: 15-30 days). The VAS and FCT scores in pretreatment and posttreatment demonstrated a high positive correlation (rs=0.86, p<0.001; rs=0.843, p<0.001).
Conclusion: The FCT can be useful to detect pain severity in PDPN.

Abstract | Full Text PDF

Amaç: Jinekolojik malignite nedeniyle ameliyat edilen hastalarda epidural veya intravenöz hasta kontrollü analjezinin akut ve kronik postoperatif aðrý üzerine etkisini karþýlaþtýrmak.
Gereç ve Yöntem: Postoperatif hasta kontrollü analjezi Grup 1 için epidural yol ve Grup 2 için intravenöz yoldan uygulandý. Aðrý, akut fazda postoperatif 24. saat ve kronik fazda 6. ayda Vizüel Analog Skoru (VAS) kullanýlarak deðerlendirildi.
Bulgular: 24. saatte VAS skoru Grup 1’de Grup 2’ye göre daha düþük bulundu (3.29 ve 3.93; p<0.05). Altýncý aydaki VAS skorlarý istatistiksel anlamlý farklýlýk göstermeyecek þekilde Grup 1’de 2.03 ve Grup 2’de 2.53 idi. Altýcý aydaki LANSS skorlarýnda da anlamlý farklýlýk yoktu (p>0.05).
Sonuç: Bizim sonuçlarýmýz, akut dönemde epidural analjezi ile daha iyi sonuçlar elde edilebilmesine raðmen epidural ve intravenöz analjezinin aðrýnýn kronikliði için benzer etkilere sahip olduðunu gösterdi.

Objectives: This study compared the effects of patient-controlled epidural and intravenous analgesia on acute and chronic postoperative pain in patients who were operated on for gynecological malignancy.
Methods: Postoperatively, patient-controlled analgesia was administered via epidural route to Group 1 and the intravenous route to Group 2. Pain was evaluated using the Visual Analog Scale (VAS) in the acute phase at postoperative 24 hours and at 6 months in the chronic phase.
Results: The VAS scores at 24 hours were lower in Group 1 than in Group 2 (3.29 vs 3.93; p<0.05). The VAS scores at 6 months were 2.03 in Group 1 and 2.53 in Group 2, indicating no statistically significant difference (p>0.05). There was no significant difference in the Leeds Assessment of Neuropathic Symptoms and Signs pain scale scores at 6 months (p>0.05).
Conclusion: The results showed that epidural and intravenous analgesia had a similar effect regarding the chronicity of pain but better outcomes were achieved with epidural analgesia in the acute stage.

Abstract | Full Text PDF

Dermatomiyozit (DM), nadir görülen bað doku hastalýklarýndan olup cilt lezyonlarý ve kas biyopsisindeki enflamatuvar deðiþiklikler ile karakterizedir. DM tanýsý için karakteristik raþlara ilaveten proksimal kas güçsüzlüðü ve kas enzim düzeylerinin artýþý gibi kriterlere gerek duyulmaktadýr. Kadýnlarda 2 kat fazla görülmekle birlikte, hastalýðýn ortaya çýkýþ yaþý ortalama 50 yaþtýr. Biz bu olgu sunumunda bel aðrýsý ve bacaklarda güçsüzlük þikayeti olan kliniðimize lomber disk hernisi ön tanýsý ile gönderilen bir olguyu sunmayý amaçladýk. Bu yazýda, kliniðimize proksimal kas güçsüzlüðü ve bel aðrýsý ile baþvuran 29 yaþýndaki bir olgu sunduk. Olgu nöroþirurji kliniðinden lomber disk hernisi tanýsý ile kliniðimize refere edildi. Fizik muayenede dermatomiyozit için karakteristik cilt lezyonlarý saptandý. Ýðne elektromiyografi ve cilt biyopsisi sonrasýnda kortikosteroid tedavisi baþlandý. Geç taný konan hastalarda kaslarda yaðlý deðiþiklik geliþmesi geri dönüþsüz kas kuvvetsizliðine ve yürüme bozukluðuna yol açabilir. Enflamasyonun erken dönemde baskýlanmasý tedaviye dramatik yanýt almada önemlidir.

Dermatomyositis (DM) is a rare connective tissue disease characterized by skin lesions and inflammatory changes observed in muscle biopsy findings. A definitive diagnosis of DM requires a characteristic rash in addition to proximal muscle weakness and muscle enzyme level elevation. DM is twice as common in women as men, with an age of onset of approximately 50 years. This case report describes a 29-year-old patient with low back pain and proximal muscle weakness in the legs diagnosed as lumbar disc herniation who was then referred by the neurosurgery department to our clinic. A physical examination revealed the characteristic skin lesions for dermatomyositis. Needle electromyography and a skin biopsy were performed, and corticosteroid treatment was initiated. In misdiagnosed patients, fatty infiltration in the muscles may cause irreversible weakness and gait disturbance. Early suppression of inflammation is important and can yield a dramatic response to treatment.

Abstract | Full Text PDF

Pregabalin ve gabapentin, analjezik, antikonvülsan ve anksiyolitik özelliklere sahip benzer bileþiklerdendir. Bu tür farmakolojik özellikler nedeniyle, nöropatik aðrý tedavisinde ve anksiyete bozukluklarýnda genel olarak dünyada yaygýn olarak kullanýlmaktadýrlar. Santral sinir sisteminde baþ dönmesi ve uyuþukluk gibi hafif ila orta þiddette yan etkiler pregabalinin kullanýmýný sonlandýrmada önemli faktörlerdir. Ayný zamanda, bazý çalýþmalarda, doza baðlý pregabalin kullanýmý, hastalarda periferik ödem ve kilo vermeye neden olmuþtur. Bu olguda, önceden pregabalin kullanan hastanýn ilaç dozunda bir artýþ yapýldýktan sonra oluþan iþitme kaybýný sunmak istedik.

Pregabalin and gabapentin are similar compounds with analgesic, anticonvulsant, and anxiolytic characteristics. Due to these pharmacological features, they are commonly used throughout the world in neuropathic pain treatment and anxiety disorders. Mild to moderate side effects of the central nervous system, such as dizziness and somnolence, are important factors in deciding to terminate the use of pregabalin. Studies have also reported that the use of dose-dependent pregabalin resulted in peripheral edema and weight gain. Described in this case report is hearing loss occurring after an increase in the drug dose of a patient using pregabalin.In this case, we wanted to present the occuring hearing-loss after an increase in the drug dose of the patient already using pregabalin.

Abstract | Full Text PDF

Elli dokuz yaþýndaki erkek hastanýn kulak operasyonu için yüzeyel servikal pleksus bloðu uygulanmasý ile ilgili tecrübemizi paylaþmayý hedefledik. Yüzeyel servikal pleksus anterolateral boyun, kulak ve omuzun yüzeysel yapýlarýnýn duyusal innervasyonunu saðlar. Ultrason kýlavuzluðunda yapýlan servikal pleksus bloðu kulak cerrahisinde hem anestezi hem de analjezi amacý ile uygulanabilecek alternatif bir yöntem olabilir.

The aim of this study was to share our experience with the application of a superficial cervical plexus block in the ear operation of a 59-year-old male patient. The superficial cervical plexus provides sensory innervation of the superficial structures of the anterolateral neck, ear, and shoulder. Ultrasound-guided cervical plexus block may be an alternative method for both anesthesia and analgesia in ear surgery.

Abstract | Full Text PDF

Pancoast tümörü ya da superiyor sulkus tümörü, nadir görülen bronkojenik karsinomlardandýr. Erken dönemde omuz aðrýsý en sýk semptomdur. Bizim hastamýzda omuz ve kol aðrýsý þikayetiyle gelmesi nedeniyle diðer baþvurduðu polikliniklerde öncelikle muskuloskeletal nedenler ve radikülopati açýsýndan tetkik edilmiþ ve yüzündeki Horner sendromu dikkat çekmemiþti. Ayný zamanda hastanýn aðrýsý ön planda olmasý nedeniyle, bu durumdan þikayetçi deðildi. Anhidrozisin yüzü ve boyun bölgesini kapsamasý nedeniyle preganglionik Horner sendromu düþünülen hastadan ileri görüntüleme istenildi. Pancoast tümörü olan hastalarýn %50’sinden azý ilk tanýda rezektabl lezyonlara sahip olurlar. Akciðere yönelik þikayetleri daha az ve geri planda olan bu hastalarda muskuloskeletal hastalýklar öncelikle düþünülür ve taný koyulmasý gecikir ya da yanlýþ taný alýrlar. Bu nedenle kol ve omuz aðrýsý ile gelen hastalarda ayrýntýlý muayene ve anamnezin önemi büyüktür.

A Pancoast or superior sulcus tumor is a rare, bronchogenic carcinoma. In the early period, shoulder pain is the most common symptom. In this case, the patient had presented with complaints of shoulder and arm pain at other outpatient clinics and was examined primarily for musculoskeletal causes and radiculopathy. The patient had no complaints of facial symptoms and Horner’s syndrome signs, such as anhidrosis of the face and neck region, were not noticed. Advanced imaging of a patient with preganglionic Horner’s syndrome is important. Fewer than 50% of patients with a Pancoast tumor have a resectable lesion at the first diagnosis. Diagnosis is often delayed or there may be a misdiagnosis because musculoskeletal disorders are the focus and there are few lung-related complaints. A detailed examination and anamnesis is very important in patients with arm and shoulder pain.

Abstract | Full Text PDF

Adheziv kapsülit kronik böbrek hastalýðý olan hastalarda sýk rastlanan bir problemdir. Hastalar eklem tutukluðu ve aðrýlý hareketlerden þikayetçidir. Non-steroid antiinflamatuar ilaçlar, intraartiküler enjeksiyonlar ve fizik tedavi konvansiyonel yaklaþýmlar arasýndadýr. Trombosit zengin plazma enjeksiyonu (TZP) gibi yeni yaklaþýmlar uygulanabilir ancak adheziz kapsülitli hastalarda yeterli kanýta sahip deðildir.
70 yaþýnda diyaliz tedavisi alan kadýn hasta polikliniðimize omuzda hareket kýsýtlýlýðý ve aðrý þikayetleri ile baþvurdu. Manyetik Rezonans görüntüleme (MRG) ile adheziv kapsülit tanýsý aldý. TZP enjeksiyonu planlandýðý þekilde 3 seans ve her seans arasý 15 gün olacak þekilde uygulanmaya baþlandý. Vizüel analog skala (VAS), kol, omuz ve el anketi (DASH) ve eklem hareket açýklýðý (ROM) prosedür öncesi deðerlendirildi. ROM,DASH ve VAS 2 haftada 1 enjeksiyon sonrasý deðerlendirildi.Son deðerlendirmede hastanýn fleksor, abduktor ve internal rotator ROMlarýnda artýþ olduðu görüldü.Ancak deðerlendirmede hastanýn aðrý ve fonksiyonel durumunda DASH ve VAS’a göre herhangi bir düzelme saptanmadý.

Adhesive capsulitis is a common problem in patients with chronic kidney disease. Patients suffer from joint stiffness and painful joint movement.Conservative treatments consist non-steroid antiinflamatory drugs, intraarticular injections and physical therapy. Newer approches such as platelet-rich plasma injections (PRP) also can be applied but there is little evidence for the effectiveness of PRP in patients with adhesive capsulitis.
A 70 year-old woman, receives dialysis treatment admitted to our out-patient clinic with stiffness and pain in her right shoulder. Her diagnosis was confirmed with MRI as adhesive capsulitis., PRP injectionn began to be applied as planned; 3 times, 15 days between each injection. Visual analog scale (VAS), disabilities of the arm, shoulder and hand questionnare (DASH) and range of motion (ROM) of her right shoulder were evaluated before the procedure process. ROM, DASH and VAS were assessed every 2 weeks after each injection. At the last assesment average ROM increased on flexor, abductor and internal rotator sides. It was evaluated 90° for flexion, 90° for abduction and 30° for internal rotation. However, she didn’t report any improvement for function and pain based on DASH and VAS.

Abstract | Full Text PDF