THE EFFECT OF PHYSIOTHERAPY AND REHABILITATION PRACTICES IN MULTIPLE SCLEROSIS PATIENT WITH FEMUR HEAD AVASCULAR NECROSIS: A CASE REPORT Femur Başı Avasküler Nekrozu Olan Multiple Skleroz Hastasında Fizyoterapi ve Rehabilitasyon Uygulamalarının Etkisi: Olgu Sunumu

Yıl 2022, Cilt: 12 Sayı: 4, 120 - 124, 15.12.2022

Mine Argalı Deniz Burcu Özüberk Feray Cinevre Soyupek

Öz

ABSTRACT
The aim of this study was to investigate the contribution of physiotherapy to the improvement of joint range
of motion, pain and functional capacity in Avascular Necrosis (AVN). Our case diagnosed with Multiple
Sclerosis (MS) 22 years ago developed AVN due to Corticosteroid (CS) use for 1 year. Patient was evaluated
Visual Analog Skala (VAS), Katz Daily Life Activities Scale (Katz ADL), Harris Hip Score (HHS), International
Ataxia Rating Scale (IARS), Single Leg Stance Test (SLST), Four Square Stepping Test (FSS), Berg Balance Scale
(BBS), Timed Up-Go Test (TUG), Dynamic Gait Index (DGI), Fatigue Severity Scale (FSS). Our patient was
followed up with a physiotherapist in the clinic for 3 weeks with exercise and manual therapy and the next
3 weeks with a home exercise program. A 75% improvement in pain, a 5° increase in right hip flexion, abduction,
and internal rotation, 15° in left hip flexion, and 10° increase in left hip abduction and external rotation
were noted after treatment. 20° increase in lumbar flexion, 5° increase in lumbar extension, right/left lateral
flexion and right/left rotation were recorded. Katz ADL, HHS, IARS, BBS, DGI, FSS, SLST (right/left), FSS, TUG
improved by 1, 28, 2, 3, 3, 7 points, 1/5, 4 sec, 8 cm, respectively. The physical therapy applications applied
in our study were minimally effective in reducing pain and the course of the disease.
Keywords: Multiple Sclerosis; Avascular Necrosis; Corticosteroid; Physical Therapy
ÖZET
Bu çalışmanın amacı avasküler nekrozda görülen eklem hareket kısıtlılığı, ağrı ve fonksiyonel kapasitenin iyileşmesine,
fizyoterapinin katkısını araştırmaktır. 22 yıl önce Multiple Skleroz (MS) tanısı alan olgumuz 1 yıldır
Kortikosteroid (KS) kullanımına bağlı Avasküler Nekroz (AVN) gelişmiş. Hastaya Görsel Analog Skalası (GAS),
Katz Günlük Yaşam Aktiviteleri Ölçeği (Katz GYAÖ), Harris Kalça Skoru (HKS), Uluslararası Ataksi Derecelendirme
Ölçeği (UADÖ), Tek Bacak Duruş Testi (TBDT), Dört Kare Adım Testi (DKAT), Berg Denge Skalası (BDS),
Zamanlı Kalkma Testi (ZKT), Dinamik Yürüyüş İndeksi (DYİ), Yorgunluk Şiddet Ölçeği (YŞÖ) değerlendirmeleri
yapıldı. Hastamız fizyoterapist eşliğinde 3 hafta klinikte egzersiz ve manuel terapi ve sonraki 3 hafta ev egzersiz
programı şeklinde takip edildi. Tedavi sonrası ağrıda %75’lik iyileşme, sağ kalça fleksiyon, abdüksiyon, iç
rotasyonda 5°, sol kalça fleksiyonda 15°, sol kalça abdüksiyon ve dış rotasyonda 10° artış kaydedildi. Lomber
fleksiyonda 20°, lomber ekstansiyonda, sağ/sol lateral fleksiyon ve sağ/sol rotasyon 5° artış kaydedildi. Katz
GYAÖ, HKS, UADÖ, BDS, DYİ, YŞÖ, TBDT (sağ/sol), DKAT, ZKT sırasıyla 1, 28, 2, 3, 3, 7 puan, 1/5, 4 saniye, 8
cm iyileşti. Çalışmamızda uygulanan fizik tedavi uygulamaları ağrıyı ve hastalığın seyrini azaltma konusunda
minimal düzeyde etkili oldu.

Anahtar Kelimeler

THE EFFECT OF PHYSIOTHERAPY AND REHABILITATION PRACTICES IN MULTIPLE SCLEROSIS PATIENT WITH, FEMUR HEAD AVASCULAR NECROSIS: A CASE REPORT, Femur Başı Avasküler Nekrozu Olan Multiple Skleroz Hastasında Fizyoterapi ve Rehabilitasyon Uygulamalarının Etkisi: Olgu Sunumu

Kaynakça

• 1. Cree BAC, Hollenbach JA, Bove R, Kirkish G, Sacco G, Caversasi E. et al. Silent progression in disease activity-free relapsing multiple sclerosis. Ann Neurol. 2019;85(5):653-66.
• 2. Repovic P. Management of Multiple Sclerosis Relapses. Multiple Sclerosis and other CNS Inflammatory Diseases.2019;25(3):655-69.
• 3. Ömerhoca S, Yazıcı Akkaş S, Yıldırım Haşimoğlu Z, Erdoğan S, Kale N. The Adverse Effects of High-dose Corticosteroids with Early and Late Severe Morbidity in the Treatment of Patients with Multiple Sclerosis: Long-term Observation Results. Turk J Neurol. 2019;25:71-5.
• 4. Basyal B, Bhandari B, Derk CT. Avascular necrosis in systemic sclerosis patients: a case-based review of demographics, presentation, and management. Clinical Rheumatology. 2021;40:399–405.
• 5. Chang C, Greenspan A, Gershwin ME. The pathogenesis, diagnosis, and clinical manifestations of steroidinduced osteonecrosis. J Autoimmunity. 2020;110:102460.
• 6. Crim J, Oserowsky A, Layfield LJ, Schmidt RL. Comparison of radiograph and histopathologic analysis in the evaluation of hip arthritis AJR 2019; 213(4):895-902.
• 7. Westad K, Tjoestolvsen F, Hebron C. The effectiveness of Mulligan's mobilisation with movement (MWM) on peripheral joints in musculoskeletal (MSK) conditions: A systematic review. Musculoskelet Sci Pract. 2019; 39:157-63.
• 8. Konstantonis A. Physical therapy intervention in early-stage femoral head osteonecrosis. Journal of Research and Practice on the Musculoskeletal System. 2021;5(1):20-4.
• 9. Mart-Carvajal AJ, Sol I, Agreda-Prez LH. Treatment for avascular necrosis of bone in people with sickle cell disease. Cochrane Database of Syst Rev. 2019 Dec 5;12(12):CD004344.
• 10. Alphonsus KB, Su Y, D’Arcy C. The effect of exercise, yoga and physiotherapy on the quality of life of people with multiple sclerosis: Systematic review and meta-analysis. Complementary Therapies in Medicine. 2019;43:188–95.