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  • Original Articles 2019-12-31 2019-12-31 \ 0 \ 162 \ 19

    Feasibility of Ultrasound-Guided Lumbar and S1 Nerve Root Block: A Cadaver Study

    Jaewon Kim, M.D. , Hye Jung Park, M.D. , Won Ihl Lee, M.D., Ph.D. and Sun Jae Won, M.D., Ph.D.

    https://doi.org/10.35827/cp.2019.18.2.59

    Abstract
    Objective: This study evaluated the feasibility of ultrasound-guided lumbar nerve root block (LNRB) and S1 nerve root block by identifying spread patterns via fluoroscopy in cadavers. Method: A total of 48 ultrasound-guided injections were performed in 4 fresh cadavers from L1 to S1 roots. The target point of LNRB was the midpoint between the lower border of the transverse process and the facet joint at each level. The target point of S1 nerve root block was the S1 foramen, which can be visualized between the median sacral crest and the posterior superior iliac spine, below the L5-S1 facet joint. The injection was performed via an in-plane approach under real-time axial view ultrasound guidance. Fluoroscopic validation was performed after the injection of 2 cc of contrast agent. Results: The needle placements were correct in all injections. Fluoroscopy confirmed an intra-foraminal contrast spreading pattern following 41 of the 48 injections (85.4%). The other 7 injections (14.6%) yielded typical neurograms, but also resulted in extra-foraminal patterns that occurred evenly in each nerve root, including S1. Conclusion: Ultrasound-guided injection may be an option for the delivery of injectate into the S1 nerve root, as well as lumbar nerve root area.
  • Original Articles 2019-12-31 2019-12-31 \ 0 \ 81 \ 15

    Cumulative Therapeutic Effect of High-Voltage Microcurrent Therapy in Patients with Herniated Lumbar Disc

    Wang Hyeon Yun, M.D., Jinyoung Park, M.D., Doyoung Kim, M.D. and Jung Hyun Park, M.D., Ph.D.

    https://doi.org/10.35827/cp.2019.18.2.65

    Abstract
    Objective: This study aims to evaluate the efficacy of high-voltage microcurrent therapy in patients with herniated lumbar disc (HLD) presenting radicular or back pain. Method: This is a retrospective study with 33 patients who are complaining pain with HLD findings on magnetic resonance image. Microcurrent therapy was applied to leg or paralumbar area. Treatment was conducted for seven minutes with 250 ∼ 1000 uA intensity as high as the patients could tolerate via stimulating probe with roller type and the frequency was 60 Hz with a sine wave pulse. The visual analogue scale (VAS) was measured just before and after the treatment. Results:The degree of pain reduction ( △ VAS) was 1.6 points after treatment on average. The △ VAS according to the diagnosis, stenosis, dermatome area, medication, pain site and caudal epidural block was not statistically significant. However, the △ VAS according to the number of treatments ( < 3, ≥ 3 times) showed a statistically significant difference ( p =0.04). Conclusion: High-voltage microcurrent therapy may help reduce lumbar or lumbosacral radiating pain after the procedure. The effect was better when microcurrent was applied three times or more. This result suggests that the microcurrent would have cumulative effect on reducing radicular or back pain in patients with HLD.
  • Original Articles 2019-12-31 2019-12-31 \ 1 \ 324 \ 156

    Diagnostic Usefulness of Digital Infrared Thermal Image in Carpal Tunnel Syndrome

    Jihyun Park, M.D. , Jang Woo Lee, M.D. , Sang Eok Lee, M.D. , Byung Hee Kim, M.D. and Dougho Park, M.D.

    https://doi.org/10.35827/cp.2019.18.2.70

    Abstract
    Objective: The purpose of this study is to evaluate the usefulness of infrared thermography in patients with carpal tunnel syndrome by comparing with electrodiagnostic and ultrasonographic findings. Method: From January 2014 to October 2017, electrodiagnosis, ultrasound, and digital infrared thermal image (DITI) of unilateral carpal tunnel syndrome diagnosed in a single hospital were retrospectively analyzed. The subjects with bilateral symptoms of carpal tunnel syndrome, peripheral vas- cular disease, diabetes, thyroid disease, fibromyalgia, rheumatic disease, systemic infection, inflammation, malignant tumor, and other musculoskeletal disorders such as finger osteoarthritis, peripheral neuropathy, cervical radiculopathy, and the previous history of surgery were excluded. Results: Of 53 patients diagnosed with carpal tunnel syndrome, 11 were male and 42 were female. The visual analogue scale was 4.9 ± 1.9, and the duration of symptom was 11.8 ± 12.5 months. There was no statistically significant difference in the body surface temperature between the unaffected and affected sides. The severity of symptoms, electrodiagnostic findings, and cross-sectional area of the median nerve significantly correlates to each other. The temperature difference between the second fingers of the affected and unaffected sides showed a weak correlation with the amplitude of sensory nerve action potential and onset latency of compound muscle action potential, when there was no significant correlation with the other parameters. Conclusion: The difference in temperature on the surface of the body, which can be confirmed by DITI, is little diagnostic value when DITI is performed in unilateral carpal tunnel syndrome patients, especially when compared with ultrasonography.
  • Original Articles 2019-12-31 2019-12-31 \ 0 \ 90 \ 23

    Changes in Range of Motion after Intra-Articular Corticosteroid Injection in Frozen Shoulder: A Retrospective 3-Month Follow-Up Study

    Hyoung Jun Cho, M.D., Seung-Hyun Yoon, M.D., Ph.D., Minchul Kim, M.D. and Dae Hwan Kim, M.D.

    https://doi.org/10.35827/cp.2019.18.2.76

    Abstract
    Objective: To examine (1) the degree of reduction of passive range of motion (PROM) on the affected side compared to that on the unaffected side and (2) the degree of increase in PROM following intra-articular corticosteroid injection (IACI) in patients with frozen shoulder. Method: The medical records of 120 patients with frozen shoulder were retrospectively reviewed. PROM of the unaffected and affected shoulder (flexion, extension, abduction, internal rotation, external rotation) was compared, and changes in PROM of the affected shoulder after a single IACI (triamcinolone 20 mg) were evaluated after 12 weeks. Results: At the time of diagnosis, PROM of the affected shoulder was most limited in external rotation, followed by internal rotation, abduction, extension, and flexion, compared to that of the unaffected shoulder. Compared to before IACI, PROM of external rotation demonstrated the greatest increase compared to all the other movements after IACI. Conclusion: Limitation in PROM of the frozen shoulder at the time of diagnosis was greatest for external rotation. Moreover, external rotation experi- enced the greatest improvement after IACI. Our findings should help to further clarify the clinical characteristics of frozen shoulder, aid in its diagnosis, and allow the prediction of the effects of IACI.
  • Original Articles 2019-12-31 2019-12-31 \ 0 \ 64 \ 85

    Korean Pain Descriptors in Patients with Neuromusculoskeletal Pain

    Gi-Young Park, M.D., Ph.D., Dong Rak Kwon, M.D., Ph.D. and In Ho Woo, M.D.

    https://doi.org/10.35827/cp.2019.18.2.82

    Abstract
    Objective: To evaluate which Korean pain descriptors are frequently used in the patients with neuromusculoskeletal diseases and compare the frequency of Korean pain descriptor according to age, gender, pain pattern and intensity, and clinical diagnosis. Method: Two hundreds sixty nine patients with neuromusculoskeletal diseases were enrolled in this study. The patients were asked to fill out a pain questionnaire using Korean. The Korean pain descriptors were collected and classified according to neurophysiological mechanism. The frequency of Korean pain descriptor was analyzed by age, gender, pain pattern and intensity, and clinical diagnosis. They were divided into axial spine and peripheral joint pain group depending on the location of causal disease and shoulder pain descriptors were divided into intra-articular and bursa group. Results: Among 24 Korean pain descriptors, ‘arida’ was the most common pain descriptor, followed by ‘ssusida’ and ‘jjireunda’. When the pain descriptors were classified according to neurophysiological mechanism, superficial somatic pain was the most common, followed by deep somatic pain. There was a significant difference in the frequency of the pain descriptor between axial spine and peripheral joint pain group (p =0.007). The pain descriptor ‘danggida’ was used significantly more in the patients with axial spine pain than peripheral joint pain (p =0.024). However, there was no significant difference in other factors. Conclusion: The patients with neuromusculoskeletal diseases expressed their pain using various Korean pain descriptors with stabbing nature and super- ficial somatic pain. Our results may be helpful to assess and develop a new Korean pain quality measure in the patients with neuromusculoskeletal diseases.
  • Original Articles 2019-12-31 2019-12-31 \ 0 \ 76 \ 26

    A Man Presenting with Sudden Weakness and Pain of the Right Hand, by Non-Small Cell Lung Cancer with Brain Metastases

    Won Jin Sung, M.D., Bo Young Hong, M.D., Ph.D., Joon Sung Kim, M.D., Ph.D., Jae Wan Yoo, M.D. and Seong Hoon Lim, M.D., Ph.D.

    https://doi.org/10.35827/cp.2019.18.2.88

    Abstract
    Unexplained pain and weakness, i.e., without obvious predisposing factors, are often encountered by physiatrists and efforts should be made to determine the cause. A 63-year-old male presented with radiating pain in his right arm and mild weakness of the right hand. An electrodiagnostic examination revealed distal symmetric sensory polyneuropathy in the upper and lower extremities, and denervation potentials in the forearm muscles, which were inconsistent with the cervical spine MRI images and symptoms. A predisposing undiscovered disease was revealed, i.e., squamous cell carcinoma in the lung; brain metastasis affecting the left primary motor cortex was also detected. Therefore, we concluded that the pain and weakness were related to paraneoplastic syndrome and brain metastases of the hand knob. The observed denervation potentials were characterized as trans-synaptic changes in the brain metastasis. This case highlights the importance of unexplainable focal pain and weakness in the increasing prevalence of cancer.
  • Case Report 2019-12-31 2019-12-31 \ 0 \ 122 \ 128

    Torticollis and Atlantoaxial Rotatory Subluxation after Chiropractic Therapy

    Doyoung Kim, M.D., Wang Hyeon Yun, M.D., Jinyoung Park, M.D. and Jung Hyun Park, M.D., Ph.D.

    https://doi.org/10.35827/cp.2019.18.2.92

    Abstract
    Torticollis is an abnormal, asymmetric head or neck position which usually caused by imbalance of paracervical muscles. The traumatic torticollis can be caused by following events; atlantoaxial rotatory subluxation, atlantoaxial dislocation, cervical vertebral fractures, and injury to the cervical musculature. Especially, acute traumatic atlantoaxial rotatory subluxation usually presents limitation of cervical range of motion without pain or neurologic deficit. We report a case of a 58 year-old man who developed the acute atlantoaxial rotatory subluxation right after the chiropractic therapy, which induced the limitation of cervical range of motion to 52.5% of normal range. The magnetic resonance image revealed the facture of the odontoid process and the partial injury in transverse ligaments of the atlas. He underwent intramuscular botulinum toxin injection and 10 days of continuous cervical traction 15 hours a day using a 5 kg weight. The range of the cervical motion restored up to 90.2% of normal range.
  • Original Articles 2019-12-31 2019-12-31 \ 0 \ 114 \ 18

    Tardy Ulnar Nerve Palsy by Neurofibroma

    Sang Chul Lee, M.D., Sung Hoon Koh, M.D. and Chul Kim, M.D., Ph.D.

    https://doi.org/10.35827/cp.2019.18.2.97

    Abstract
    Tardy ulnar nerve palsy is ulnar neuropathy at or around elbow and commonly evaluated in the electromyography laboratory. However, ulnar neuropathy at the elbow due to neurofibroma is rare. Neurofibromas are tumors that arise within nerve fasciculi and anywhere along a nerve from dorsal root ganglion to the terminal nerve branch. We report one case of ulnar neuropathy at the elbow due to neurofibroma. Patient had paresthesia on the left 5th finger and there had been left hypothenar atrophy since 2 months ago. Tinel’s sign was positive at left elbow. As a result of electromyography, there were suggestive of right ulnar neuropathy at or around elbow, referred to as tardy ulnar nerve palsy. Ultrasonography showed a diffuse tortuous thicken- ing with multiple neurofibromas arising from individual fascicles of the ulnar nerve in cubital tunnel area. Surgery was then performed to release cubital tunnel of left elbow, then the patient’s symptoms improved.
  • Case Report 2019-12-31 2019-12-31 \ 0 \ 95 \ 19

    Calcaneal Osteomyelitis Presenting as a Paradoxical Reaction during Treatment of Multidrug-Resistant Tuberculosis

    Yong Hyun Han, M.D. , Chang Hwa Lee, M.D. , Min Joon Bae, M.D. and Kihun Hwang, M.D.

    https://doi.org/10.35827/cp.2019.18.2.102

    Abstract
    Tuberculosis in the foot progresses gradually; thus, diagnosis is usually delayed, and early treatment is rarely provided. If osteomyelitis occurs due to delayed diagnosis and treatment, surgical treatment should be considered. We report the case of a 46-year-old man with osteomyelitis of the calcaneus who was diagnosed with multidrug-resistant pulmonary tuberculosis and he was treated with anti-tuberculosis drugs. Bilateral adrenal masses, abscess of both testes and a small wound in the left plantar heel were observed. Both adrenal masses and abscess were regarded as paradoxical reaction of anti-tuberculosis treatment. After 1 month, he developed a pain in the left plantar heel that was compatible with calcaneal osteomyelitis in radiological features. He underwent right orchiectomy for right scrotal abscess aggravation and surgical treatment for left calca- neal osteomyelitis. Mycobacterium tuberculosis was confirmed by polymerase chain reaction. The patient was immobilized by cast for 8 weeks and the heel pain gradually improved.
  • Original Articles 2019-12-31 2019-12-31 \ 0 \ 131 \ 52

    Flexor Carpi Radialis Tendon Rupture due to Repetitive Golf Swing

    Sang Chul Lee, M.D., Sung Hoon Koh, M.D., Jin Hyuk Jang, M.D. and Jae Ki Ahn, M.D., Ph.D.

    https://doi.org/10.35827/cp.2019.18.2.107

    Abstract
    Flexor carpi radialis (FCR) muscle is located in the forearm anteriorly that runs through a synovial fibro-osseous tunnel in the forearm. We described a case of FCR tendon rupture due to repetitive overuse injury. A 55-year-old man, right-hand dominant, presented with right forearm pain and swelling which started 3 days ago while playing amateur golf. Focal tenderness and bruising over volo-ulnar region of the right forearm were examined. Plain radiographs showed soft tissue edema around lesion area and no detectable fracture. Ultrasonography showed multiple hypoechoic lesions suspected as hematoma of the flexor muscle group. After done magnetic resonance imaging, he was diagnosed with rupture of FCR tendon at proximal origin and strain of flexor digitorum superficialis and palmaris longus muscle. He received compressive dressing and restriction of wrist range of motion for three weeks. Two months later, remaining traces of lesions were observed at the follow-up ultra- sonography and the pain disappeared.
Korean Association of Pain Medicine

Vol.23 No.2
2019-12-31

eISSN: 2765-5156

Frequency: Semi Annual

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