Filiz CAN, Bülent ANTMEN, Ayşe Merve TAT, Necati Muhammed TAT, Hatice Ilgen ŞAŞMAZ

Dirsek hemofilik artropatisinde hemartroz, fiziksel değerlendirmeler ve üst ekstremite fonksiyonelliği arasındaki ilişkiler

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:

Artropati, Dirsek Eklemi, Hemofili, Eklem Hareket Açıklığı

Correlations between hemarthrosis, physical assessments and functionality of upper extremity in hemophilic arthropathy of the elbow

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.

Keywords:

Arthropathy, Elbow Joint, Hemophilia, Range of Motion,

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