Publications by authors named "Bayram Kaymak"

74 Publications

Diagnosing sarcopenia: Functional perspectives and a new algorithm from the ISarcoPRM.

J Rehabil Med 2021 Jun 21;53(6):jrm00209. Epub 2021 Jun 21.

Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey. E-mail:

Sarcopenia is an important public health problem, characterized by age-related loss of muscle mass and muscle function. It is a precursor of physical frailty, mobility limitation, and premature death. Muscle loss is mainly due to the loss of type II muscle fibres, and progressive loss of motor neurones is thought to be the primary underlying factor. Anterior thigh muscles undergo atrophy earlier, and the loss of anterior thigh muscle function may therefore be an antecedent finding. The aim of this review is to provide an in-depth (and holistic) neuromusculoskeletal approach to sarcopenia. In addition, under the umbrella of the International Society of Physical and Rehabilitation Medicine (ISPRM), a novel diagnostic algorithm is proposed, developed with the consensus of experts in the special interest group on sarcopenia (ISarcoPRM). The advantages of this algorithm over the others are: special caution concerning disorders related to the renin-angiotensin system at the case finding stage; emphasis on anterior thigh muscle mass and function loss; incorporation of ultrasound for the first time to measure the anterior thigh muscle; and addition of a chair stand test as a power/performance test to assess anterior thigh muscle function. Refining and testing the algorithm remains a priority for future research.
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http://dx.doi.org/10.2340/16501977-2851DOI Listing
June 2021

Reassessing Sarcopenia in Hypertension: STAR and ACE Inhibitors Excel.

Int J Clin Pract 2021 Mar 20;75(3):e13800. Epub 2020 Nov 20.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

Background: Hypertension and sarcopenia are commonly seen in older adults. The renin-angiotensin system and the therapeutic use of angiotensin-converting enzyme (ACE) inhibitors have been on the agenda of sarcopenia in different perspectives. Our aim was to explore the frequency of sarcopenia in patients with hypertension and to investigate the association between the use of ACE inhibitors and sarcopenia.

Methods: A total of 272 community-dwelling adults were recruited. Anterior thigh muscle thickness was measured by ultrasound. Handgrip strength, gait speed, and chair stand test were evaluated. Low muscle mass was diagnosed in the presence of low sonographic thigh adjustment ratio (STAR) values and sarcopenia was diagnosed if low STAR values were coupled with low functional tests.

Results: 136 subjects (50.0%) had no comorbid disease; 102 (37.5%) had one, 21 (7.7%) had two, nine (3.3%) had three and four (1.5%) had four comorbid diseases. Both low muscle mass (41.9% vs 13.2%) and sarcopenia (32.2% vs 7.8%) were more commonly seen in hypertensive when compared with normotensive older adults. Subgroup analysis of older adults with hypertension revealed that sarcopenia was less prevalent (P = .003) in patients using ACE inhibitors (8.7%) than those using angiotensin II receptor blockers (48.7%) and other antihypertensive drugs (46.4%). After binary logistic regression analyses; only the presence of hypertension seemed to independently predict the development of sarcopenia in older adults [OR = 6.5 (95% CI: 2.4-17.8, P < .001)].

Conclusions: Sarcopenia is highly prevalent in hypertensive older adults. Amongst many antihypertensive medications, ACE inhibitors seem to have favourable effects on both disorders.
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http://dx.doi.org/10.1111/ijcp.13800DOI Listing
March 2021

STAR-Sonographic Thigh Adjustment Ratio: A Golden Formula for the Diagnosis of Sarcopenia.

Am J Phys Med Rehabil 2020 10;99(10):902-908

From the Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (MK, BK, AB, LÖ) Department of Physical and Rehabilitation Medicine, Doctor Ayten Bozkaya Spastic Children Hospital and Rehabilitation Center, Bursa, Turkey (AMA); Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Ankara, Turkey (ÖÖ, ST); Geriatrics Unit, Yenimahalle Training and Research Hospital, Yıldırım Beyazıt University, Ankara, Turkey (ÖK); Department of Geriatrics, Hacettepe University Medical School, Ankara, Turkey (GŞA, MH); Department of Biostatistics, Hacettepe University Medical School, Ankara, Turkey (SK); Department of Biophysics, Hacettepe University Medical School, Ankara, Turkey (ARS); and Department of Public Health, Hacettepe University Medical School, Ankara, Turkey (BÇ).

Objective: The aim of the study was to explore an individualized sonographic muscle thickness ratio and its cutoff values in the diagnosis of sarcopenia.

Design: A total of 326 community-dwelling adults were included in this cross-sectional study. Total skeletal muscle mass was evaluated by bioelectrical impedance analysis, and nine-site muscle thickness measurements using ultrasound. Isometric handgrip and knee extension strengths were assessed. Physical performance was evaluated by usual Gait Speed, Chair Stand Test, and Timed Up and Go Test.

Results: Because the anterior thigh muscle thickness was the most significantly decreasing measurement with aging and the most significantly related value with body mass and height; sonographic thigh adjustment ratio was calculated by dividing it with body mass index. Using the two standard deviation values of our healthy young adults, sonographic thigh adjustment ratio cutoff values were found as 1.4 and 1.0 for male and female subjects, respectively. Sonographic thigh adjustment ratio values were negatively correlated with Chair Stand Test and Timed Up and Go Test in both sexes (all P < 0.05) and positively correlated with gait speed in female subjects and knee extension strength in male subjects (both P < 0.05).

Conclusions: Our results imply that regional (rather than total) muscle mass measurements should be taken into consideration for the diagnosis of sarcopenia.
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http://dx.doi.org/10.1097/PHM.0000000000001439DOI Listing
October 2020

Comment on Asian Working Group on Sarcopenia's Updated Consensus Recommendations: Emphasis on Anterior Thigh Muscle Mass.

J Am Med Dir Assoc 2020 08;21(8):1173-1174

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1016/j.jamda.2020.03.034DOI Listing
August 2020

Ultrasonography in Sarcopenic Obesity: "Good Looking" But Wrong Buttoning of the First Button.

JPEN J Parenter Enteral Nutr 2020 09 17;44(7):1171-1172. Epub 2020 Jul 17.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1002/jpen.1951DOI Listing
September 2020

"Zooming" in the Anterior Thigh Muscle for the Diagnosis of Sarcopenia.

J Am Geriatr Soc 2020 08 13;68(8):1878-1879. Epub 2020 Jun 13.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1111/jgs.16572DOI Listing
August 2020

The need for an integrative musculoskeletal approach in sarcopenia: the ISarcoPRM Kickstart.

Eur J Phys Rehabil Med 2020 Aug 15;56(4):535-536. Epub 2020 Apr 15.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.23736/S1973-9087.20.06255-3DOI Listing
August 2020

A "Neuromuscular Look" to sarcopenia: Is it a movement disorder?

J Rehabil Med 2020 04 14;52(4):jrm00042. Epub 2020 Apr 14.

Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

Objective: Impairment of physical function is the main determinant of morbidity/mortality in sarcopenia and frailty. Physical function tests are performed by the movement around the joints, and skeletal muscles are the main generators of the forces required to perform these functional tasks. However, the central nervous system, which initiates and coordinates muscle movements, controls the magnitude and temporal parameters of muscle forces.

Methods: Non-systematic literature review was performed about the effects of aging on neuromotor control.

Result: The ability of a muscle to produce force by aging is deteriorated not only by muscle structural changes, but also by neuromotor control dysfunction. With aging, changes in muscle structure and loss of volumes in brain structures related with movement and cognition have been shown. Age-related cognitive impairment can have considerable negative effects on the force generating capacity of skeletal muscles. In this sense, the relationship has been found between handgrip strength, gait speed, and cognition.

Conclusion: Treatments targeting muscle mass only would be insufficient unless we address the impairment of neurocognitive functions. It is essential that prescribing life-long exercise is important for healthy aging including the preservation of muscle mass/strength, physical and cognitive functioning, and independent living.
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http://dx.doi.org/10.2340/16501977-2672DOI Listing
April 2020

Ultrasonographic measurements of the skin, fat and muscle in vitamin D deficiency.

Int J Clin Pract 2020 Jun 9;74(6):e13494. Epub 2020 Mar 9.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

Background: Vitamin D is a steroid hormone and it is essential for the musculoskeletal system health. The relationship among vitamin D levels and adiposity was shown. However, there is only one study seems to have examined the relationship between skinfold thickness and vitamin D levels.

Methods: A total of 116 healthy subjects who had a recent vitamin D measurement were included. Skin, subcutaneous fat and muscle thicknesses were measured by ultrasound (US). Hand grip strength and usual gait speed were evaluated.

Results: Subjects were classified into two groups according to 25-OH vitamin D levels. Skin thicknesses of anterior forearm in women and of anterior tibia in men, and trochanteric fat thicknesses of both genders were higher in lower 25-OH vitamin D group (both P < .05). There were no differences between the groups regarding muscle thicknesses, grip strength and gait speed (all P > .05). For identifying vitamin D deficiency (≤20 ng/mL); optimal skin thickness value was 1.25 mm in women (sensitivity: 91.3%, specificity: 54.7%), and optimal trochanteric fat thickness was 1.79 cm in men (sensitivity: 87.5%, specificity: 76.9). The specificity was increased to 79.2% if the cut-off value was taken as 1.35 mm for anterior forearm skin thickness in women.

Conclusion: We imply that skin thicknesses (anterior forearm and tibia) and subcutaneous fat (trochanteric region) increase in subjects with low vitamin D levels. Having also ascertained the relevant cut-off values, we underscore the possible role of these measurements as regards the assessment of vitamin D status.
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http://dx.doi.org/10.1111/ijcp.13494DOI Listing
June 2020

Sarcopenia Is Not "Love": You Have to Look Where You Lost it!

Am J Phys Med Rehabil 2020 10;99(10):e119-e120

From the Doctor Ayten Bozkaya Spastic Children Hospital and Rehabilitation Center, Department of Physical and Rehabilitation Medicine, Bursa, Turkey (AMA); and Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey (MK, BK, LÖ).

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http://dx.doi.org/10.1097/PHM.0000000000001391DOI Listing
October 2020

Sonoanatomy of the spine: a comprehensive scanning protocol from cervical to sacral region.

Med Ultrason 2019 Nov;21(4):474-482

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

Ultrasound has been increasingly used in the musculoskeletal system, including the spine. In this protocol, the probe positionings, anatomical relationships, and ultrasound images of commonly scanned spinal structures are described. With an international consensus of several expert physiatrists i.e. USPRM; Ultrasound Study Group of ISPRM (International Society of Physical and Rehabilitation Medicine), this guide can provide a standardized approach for physicians who are interested in ultrasound diagnosis and guided pain interventions of the spine.
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http://dx.doi.org/10.11152/mu-2034DOI Listing
November 2019

Ultrasound Imaging and Rehabilitation of Muscle Disorders: Part 2: Nontraumatic Conditions.

Am J Phys Med Rehabil 2020 07;99(7):636-644

From the Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (MK, BK, LÖ); and Doctor Ayten Bozkaya Spastic Children Hospital and Rehabilitation Center, Bursa, Turkey (AMA).

Because of its several advantages, ultrasound imaging has started to take place in the diagnostic and therapeutic algorithms of a wide range of musculoskeletal disorders. After the first part on traumatic conditions, in this review, the authors aim to discuss the applicability of ultrasound imaging for nontraumatic muscle disorders in the daily clinical/academic practice. While trying to summarize the whole spectrum (e.g., myofascial pain syndrome, inflammatory diseases, neuromuscular disorders), special emphasis will be given to sarcopenia, which is, by far, the most challenging clinical condition in the era of "aging world." Of note, rehabilitation with regard to the exemplified problems will also be briefed throughout.
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http://dx.doi.org/10.1097/PHM.0000000000001352DOI Listing
July 2020

Botulinum toxin injections to cranial sutures for chronic migraine Rewinding the technique using ultrasound imaging.

Toxicon 2019 Oct 23;172:19-22. Epub 2019 Oct 23.

Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey.

The treatment of chronic migraine headache is quite challenging and new alternatives are still being explored for its management. Onabotulinum toxin A (BoNT-A) applied into extracranial muscles has been shown to inhibit the release of acetylcholine and local nociceptive peptides at the sensory nerve endings. As the highest concentration of extracranial pain fibers are located at/nearby the sutures, extracranial applications of BoTN-A are suggested to be performed to sutures rather than into the head and neck muscles in the treatment of chronic migraine. Moreover, in an animal study, BoTN-A is found to be more effective for decreasing the chemosensitivity of meningeal nociceptors when the total dose is injected along the sutures in comparison to being divided into sutures and cranial muscles. Of note, since BoNT-A injections performed with the blind/nontargeted technique have lower effectivity and several complications (muscle weakness, ptosis, facial paresis, etc.), the use of ultrasound guidance for targeting the cranial sutures is definitely expected to provide technical ease, better pain relief and toxin tolerance in chronic migraine.
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http://dx.doi.org/10.1016/j.toxicon.2019.10.239DOI Listing
October 2019

Scan, see and inject: no need to palpate, imagine or narrate.

Eur J Phys Rehabil Med 2020 02 26;56(1):127-128. Epub 2019 Sep 26.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.23736/S1973-9087.19.06011-8DOI Listing
February 2020

The Impact of Cut-Off Values and Adjustments for Muscle Mass and Strength on Diagnosis of Sarcopenia.

J Am Med Dir Assoc 2019 12 9;20(12):1653. Epub 2019 Sep 9.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1016/j.jamda.2019.07.014DOI Listing
December 2019

Assessment of core and lower limb muscles for static/dynamic balance in the older people: An ultrasonographic study.

Age Ageing 2019 11;48(6):881-887

Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey.

Background: sufficient research has not been conducted to determine the role of core and lower limb muscles in providing balance in older people.

Objective: to investigate the relationships between the thickness of core/lower limb muscles and static/dynamic balance in older people.

Methods: the study included a total of 68 older people (≥ 65 years) and 68 gender-matched young subjects, aged 20-40 years. Balance, knee proprioception sense, regional and total muscle measurements and grip strength were assessed using a force platform system, isokinetic dynamometer, ultrasound imaging, bioelectrical impedance analysis and Jamar dynamometer, respectively.

Results: all the static (postural sway) parameters were higher and all the dynamic (limits of stability) parameters were lower in the older adults compared to the young adults (all P<0.05). The diaphragm was thicker and all the other muscles (except for multifidus and tibialis anterior) were thinner in the older group (all P<0.05). A higher error of knee proprioception sense was determined at 45 and 70 degrees in the older subjects (both P<0.001). According to the multivariate analyses, significant predictors for balance were age, gender, height, and rectus femoris, vastus intermedius and diaphragm muscle thicknesses in the older group, and age, gender, height, grip strength, and rectus abdominis, internal oblique, longissimus, tibialis anterior and soleus muscle thicknesses in the young group (all P<0.05).

Conclusions: the thickness of core/lower limb muscles are important determinants of balance in both older and young adults. These findings could provide a strong rationale for strengthening specific (abdominal and quadriceps) muscles to prevent falls and regional sarcopenia, and to improve posture/balance in the older population.

Clinical Trial Registration Number: NCT03791047.

Ethics Committee Approval: Hacettepe University Non-interventional Clinical Research Ethics Board. Decision number:GO 18/506-39.
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http://dx.doi.org/10.1093/ageing/afz079DOI Listing
November 2019

Is grip strength an actual/significant predictor of areal bone mineral density by itself? Potential confounders and/or effect modifiers.

J Bone Miner Metab 2020 01 18;38(1):135-136. Epub 2019 Jun 18.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1007/s00774-019-01019-7DOI Listing
January 2020

Muscle strength and function rather than muscle mass in sarcopenia.

Eur J Appl Physiol 2019 07 9;119(7):1671-1672. Epub 2019 May 9.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1007/s00421-019-04155-0DOI Listing
July 2019

Regional and total muscle mass, muscle strength and physical performance: The potential use of ultrasound imaging for sarcopenia.

Arch Gerontol Geriatr 2019 Jul - Aug;83:55-60. Epub 2019 Mar 19.

Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey.

Objective: To evaluate the relationship between the regional and total muscle mass, muscle strength and physical performance, and also to investigate the affected muscles, their strength and physical performance with aging.

Methods: A total of 145 healthy subjects were included for the cross-sectional descriptive study. Demographic data were obtained, and body composition was consecutively assessed by anthropometric methods, bioelectrical impedance analysis and ultrasound (muscle thickness, fascicule length and pennation angle). Functional status was assessed using hand grip strength and gait speed measurements.

Results: Abdominal and thigh muscles were thinner and triceps muscle was thicker in older subjects when compared with younger ones. Age and grip strength were significant predictors for physical performance. Gait speed, grip strength and regional muscle measurements decreased with age at higher rates (26-28%), skeletal muscle mass index was affected at a lower rate (15%).

Conclusions: Low muscle strength and regional muscle measurements should be used to confirm the diagnosis of sarcopenia.
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http://dx.doi.org/10.1016/j.archger.2019.03.014DOI Listing
March 2020

Short-term effectiveness of platelet-rich plasma in carpal tunnel syndrome: A controlled study.

J Tissue Eng Regen Med 2019 05 8;13(5):709-714. Epub 2019 Apr 8.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

Platelet-rich plasma (PRP) treatment has a potential to become a part of nonsurgical approach in carpal tunnel syndrome (CTS) as a regenerative method. PRP therapies aim to enhance the self-healing ability of human body, by exposing the injured tissue to a high concentration of autologous growth factors. Nerve tissues also seem to benefit from the regenerative effects of PRP concentrates. The aim of this study is to investigate the possible beneficial effects of PRP injection in CTS. A total of 40 hands of 30 patients were included (20 hands per group) with mild to moderate idiopathic CTS. Patients with mild to moderate CTS were placed into either control or PRP groups. Activity modification and night-only wrist splints were suggested in both groups. Additionally, in PRP group, a single perineural PRP injection into the carpal tunnel was applied under ultrasound guidance. Sensibility tests, Boston carpal tunnel questionnaire (BCTQ), and electrophysiological and ultrasonographical findings were measured initially and after 4 weeks. Groups were similar regarding demographics. BCTQ scores and ultrasonographical values were improved in both groups. Delta analyses revealed that the difference of BCTQ scores improved better in PRP group. Electrophysiological values improved in PRP group. Our study demonstrated that a single, perineural PRP injection into carpal tunnel provided further improvements in CTS.
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http://dx.doi.org/10.1002/term.2815DOI Listing
May 2019

Dorsal Scapular Neuropathy as a Rare Cause 1 of Complex Regional Pain Syndrome: A Reappraisal on Ultrasound Imaging and Guidance for Recalcitrant Pain.

Am J Phys Med Rehabil 2019 06;98(6):e60-e62

Department of Physical Physical and Rehabilitation Medicine Pakistan Aeronautical Complex Hospital Kamra Cantt Punjab, Pakistan Department of Physical and Rehabilitation Medicine Hacettepe University Medical School Ankara, Turkey.

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http://dx.doi.org/10.1097/PHM.0000000000001071DOI Listing
June 2019

Comment on Ultrasound Guidance for Botulinum Neurotoxin Chemodenervation Procedures. 2017, , 18-Quintessential Use of Ultrasound Guidance for Botulinum Toxin Injections-Muscle Innervation Zone Targeting Revisited.

Toxins (Basel) 2018 09 28;10(10). Epub 2018 Sep 28.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey.

Recently, the importance of targeting structures during botulinum neurotoxin applications has been discussed in a variety of disorders, including spasticity and dystonia. In this respect, the advantages of ultrasound imaging to traditional techniques have been emphasized. We would like underscore the importance of ultrasound guidance, with targeting innervation zone(s) of the over-active muscles to achieve effective clinical outcomes. Additionally, we also clarify the difference between the terms-innervation zone (motor end plate) and motor point-which have been used by the authors as if they were the same. Further, we disagree with the authors about the intramuscular botulinum neurotoxin application techniques i.e., in-plane vs. out-of-plane whereby the former is, for sure, superior.
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http://dx.doi.org/10.3390/toxins10100396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6215312PMC
September 2018

Ultrasound-Guided Botulinum Toxin Injections in Cervical Dystonia Needs Prompt Muscle Selection, Appropriate Dosage, and Precise Guidance.

Am J Phys Med Rehabil 2019 03;98(3):e21

Department of Physical and Rehabilitation Medicine, Pakistan Aeronautical Complex Hospital, Kamra Cantt, Punjab, Pakistan Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey. Department of Neurology, Eskişehir Osmangazi University Medical School, Eskisehir, Turkey Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1097/PHM.0000000000001013DOI Listing
March 2019

Ultrasound imaging for sarcopenia, spasticity and painful muscle syndromes.

Curr Opin Support Palliat Care 2018 09;12(3):373-381

Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada.

Purpose Of Review: On the basis of its various advantages and the relevant awareness of physicians, ultrasound imaging has overwhelmingly taken its place in the scientific arena. This is true both from the side of daily clinical applications and also from the side of research. Yet, ultrasound provides real-time (diagnostic) imaging and (interventional) guidance for a wide spectrum of muscle disorders. In this regard, this review aims to discuss the potential/actual utility of ultrasound imaging in particular muscle disorders, that is, sarcopenia, spasticity and fibromyalgia/myofascial pain syndrome.

Recent Findings: Due to the aging population worldwide and the importance of functionality in the older population, mounting interest has been given to the diagnosis and management of sarcopenia in the recent literature. Likewise, several articles started to report that ultrasound imaging can be used conveniently and effectively in the early diagnosis and quantification of sarcopenia.For spasticity, aside from ultrasound-guided botulinum toxin injections, intriguing attention has been paid to sonographic evaluation of muscle architecture, echogenicity and elasticity in the follow-up of these chronic conditions.As regards painful muscle syndromes, quantitative ultrasound techniques have been shown to detect statistically significant differences between healthy controls and patients with myofascial pain syndrome.

Summary: Ultrasound imaging seems to be a promising tool that indisputably deserves further research in the management of a wide range of muscle disorders. VIDEO ABSTRACT: http://links.lww.com/COSPC/A17.
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http://dx.doi.org/10.1097/SPC.0000000000000354DOI Listing
September 2018

Selective peripheral neurolysis using high frequency ultrasound imaging: a novel approach in the treatment of spasticity.

Eur J Phys Rehabil Med 2019 Aug 11;55(4):522-525. Epub 2018 Jun 11.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

Background: Chemoneurolysis is used to treat focal spasticity in patients with upper motor neuron syndrome.

Case Report: Neurolytic substances (phenol/alcohol) injected nearby/in the main trunk of peripheral nerves can cause not only motor but also cutaneous nerves destruction. The latter is thought to be responsible for considerable side effects such as dysesthesia and paresthesia. During injections, targeting the primary motor branches originating from the main trunk while sparing cutaneous nerves will result in decrease/elimination of these side effects and better clinical improvement.

Clinical Rehabilitation Impact: We suggest that high frequency ultrasound enabling the physician to scan peripheral nerves and their primary branches can be useful to perform this selective peripheral neurolysis in the treatment of spasticity.
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http://dx.doi.org/10.23736/S1973-9087.18.05295-4DOI Listing
August 2019

Sonographic quantification of the forearm muscles in relation with handgrip strength.

Clin Physiol Funct Imaging 2018 Jun 11. Epub 2018 Jun 11.

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1111/cpf.12531DOI Listing
June 2018

Ultrasound Imaging for Muscle Variations: Digastric Flexor Carpi Ulnaris, Gastrocnemius Tertius, and Supernumerary Fibularis Longus in an Asymptomatic Family.

Am J Phys Med Rehabil 2018 11;97(11):e107-e109

From the Department of Physical Medicine and Rehabilitation, Viranşehir State Hospital, Şanliurfa, Turkey (AMA); Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey (MK, BK, LÖ); Department of Physical and Rehabilitation Medicine, Yildirim Beyazit University Medical School, Ankara, Turkey (GA); and Gaziler Physical and Rehabilitation Medicine Training and Research Hospital, Ankara, Turkey (EG).

Anatomical variations of the muscles are seen with different frequencies. Although most of them are asymptomatic; in certain cases, their existence requires attention with regard to entrapment syndromes, mass lesions, botulinum toxin injections, and tendon transfers. Herein, as ultrasound imaging is a convenient method for muscle imaging, it can easily be used in daily practice for prompt understanding of such muscular variations. In this report, we demonstrated and discussed a similar scenario in an asymptomatic individual (and his close family members) using ultrasound imaging for scanning the digastric flexor carpi ulnaris, gastrocnemius tertius, and supernumerary fibularis longus muscles.
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http://dx.doi.org/10.1097/PHM.0000000000000945DOI Listing
November 2018

Sonographic Guide for Botulinum Toxin Injections of the Neck Muscles in Cervical Dystonia.

Phys Med Rehabil Clin N Am 2018 02;29(1):105-123

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey. Electronic address:

Intramuscular botulinum toxin (BoTX) injection is the first-line treatment of cervical dystonia. Poor treatment outcomes and some side effects, however, have been reported after BoTX applications. One of the most important reasons is incorrect localization of the needle during toxin injections. Without imaging, it is impossible to verify precise needle positioning in the proper muscle. Ultrasound has been recommended because of its high capability in illustrating most of the neck muscles. This review article discusses how ultrasound imaging can be used to scan/access neck muscles, mainly from the perspective of BoTX injections.
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http://dx.doi.org/10.1016/j.pmr.2017.08.009DOI Listing
February 2018

Ultrasound imaging and guidance in the management of cervical dystonia: A caveat on the compartmentalization of sternocleidomastoid muscle.

Parkinsonism Relat Disord 2017 10 24;43:127-128. Epub 2017 Aug 24.

Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine, Ankara, Turkey.

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http://dx.doi.org/10.1016/j.parkreldis.2017.08.022DOI Listing
October 2017

One Step Further in "Sono-Palpation" During Ultrasound Imaging: "Self-Palpation".

Pain Med 2018 02;19(2):411

Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.

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http://dx.doi.org/10.1093/pm/pnx117DOI Listing
February 2018
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