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Ex) Article Title, Author, Keywords

  • Review Article 2023-12-31

    Abstract
    This review journal focuses on using ultrasound-guided root block in spondylotic radiculopathy, exploring its therapeutic potential, safety advantages, and validation challenges. C-arm guided transforaminal epidural steroid injection (C-TFESI) has constantly shown effective treatment outcomes for spondylotic radiculopathy. However, C-TFESI has been associated with rare significant adverse events, including cervical cord and brain infarction. Advancements in musculoskeletal ultrasonography have sparked efforts to apply this technique in spondylotic radiculopathy treatment. The distinct advantages of ultrasound, particularly in soft tissue discrimination and vascular visualization, have positioned it as a valuable tool in minimizing the risk of significant complications like spinal cord and brain infarction following cervical spinal injection procedures. Numerous studies have reported the potential and efficacy of ultrasound-guided cervical root block, establishing it as a safe and effective therapeutic approach. However, further validation is warranted to address the limitations and gaps in the current knowledge, particularly regarding the risk of vascular injection.
  • Review Article 2023-12-31

    Abstract
    The sacroiliac joint (SIJ) is known to account for 14.5∼30% of chronic low back pain patients with non-radicular symptoms. Diagnosing SIJ-related pain is challenging, as initial symptoms often resemble those of other causes of low back pain. Pain may radiate from below the fifth lumbar vertebra to the thigh, making it essential to differentiate from lumbar facet joint, hip joint, lumbar disc, and surrounding muscle problems. There are no single symptoms or physical exams that definitively diagnose SIJ pain. Clinically, if a patient shows positive findings in three or more different physical exams related to the SIJ and experiences more than 75% symptom improvement following a local anesthetic injection under fluoroscopic guided injection, SIJ pain can be suspected. This review aims to provide a comprehensive overview of the SIJ as a source of pain, covering its anatomy, functions, pathologic injury mechanisms, and diagnostic approaches.
  • Review Article 2023-12-31

    Clinically, evaluation and procedures using ultrasound are expanding in the field of neuromusculoskeletal disorders, and ultrasound is also actively used for hip and thigh pain. This review delineates the normal ultrasound findings of lateral and posterior aspects of the hip joint and thigh. Furthermore, it covers ultrasound findings of commonly occurring soft tissue diseases and nerve entrapment, along with ultrasound-guided injections.
  • Review Article 2023-12-31

    Abstract
    Patients with pelvic or sacral pain can be easily encountered in outpatient clinic settings. Since the cause of pain can be originated from the lumbar spinal region, or sometimes directly from the pelvis or sacral region, it is essential to differential diagnose where the pain is coming from. Caudal epidural steroid injection, sacroiliac joint injection, and piriformis injection are not only therapeutic, but are often used diagnostically, therefore they would be more useful in the outpatient clinic. Ultrasound-guided injections have similar clinical effects and the advantage of having shorter procedure times and no radiation exposure compared with fluoroscopic image-guided injection. Therefore, it is recommended to safely perform pelvic or sacral injections using ultrasound guidance.
  • Review Article 2023-12-31

    Abstract
    Carpal Tunnel Syndrome is the most common entrapment neuropathy. Treatment for carpal tunnel syndrome varies according to the severity of the disease, ranging from conservative treatment to surgical intervention. Conservative treatments such as steroid injection within carpal tunnel are helpful for most patients with mild to moderate carpal tunnel syndrome. However, in the case of the most commonly used steroid injection, the effect is short or limited within 6 months. In this paper, I will review ultrasound-guided nerve hydrodissection for carpal tunnel syndrome, which has recently attracted attention.
  • Review Article 2023-12-31

    Abstract
    Various injectable agents are used for nerve and musculoskeletal pain control. We want to review these injectable agents and several examples under ultrasonographic guidance. Ultrasound (US) can depict of various anatomical structures, such as muscles, tendons, ligaments, nerve roots, and vessels, all over the body. The use of US during injection is increasing due to its quick and easy application for guided injection with higher accuracy compared to the blind technique. The aim of this review article is to get accustomed to various injectables, and to get to know about several US-guided intervention technique.
  • Original Article 2023-12-31

    Donghwi Park1, Kwangohk Jun1, Seongho Woo1, Won Mo Koo1, Jong Min Kim1, Byung Joo Lee1, Sunyoung Joo2, Hyoshin Eo1

    Clinical Pain 2023; 22(2): 97-103

    https://doi.org/10.35827/cp.2023.22.2.97
    Abstract
    Objective: Flatfoot is a very common condition in pediatric rehabilitation that can cause various symptoms. Therefore, objective evaluation and effective management of flatfoot is important. The resting calcaneal stance position (RCSP) angle has been widely used as an indicator of flatfoot. This study followed up the RCSP angle in children with flatfoot who were prescribed biomechanical foot orthoses (BFOs), to determine whether BFOs significantly improved flatfoot. Methods: We included 77 children who were diagnosed with flatfoot and prescribed BFOs. We followed up and compared the RCSP angle using the paired t-test. In addition, the patients divided into two groups according to RCSP angle improvement to determine whether any significant indicators were present in the group with greater improvement. Results: The mean age of 77 children was 11.05 years, with 50 boys and 27 girls. The RCSP angle improved by 3.25 and 2.78 degrees on the right and left sides, respectively, with the paired t-test showing a significant improvement in the RCSP angle (p≤0.001). 40 and 37 exhibited an RCSP angle improvement of more and less than 4 degrees, respectively, with the paired t-test also confirming a significant improvement in the RCSP angle (p≤0.001). However, independent t-tests revealed no significant differences in all indicators between the two groups. Conclusion: This study confirmed that wearing BFO in children with flatfoot can improve the RCSP angle. Our findings showed that RCSP angles improved regardless of other factors. Further studies providing more data and including a control group are needed.
  • Original Article 2023-12-31

    Wan-ho Kim1, Young-sun Song2, Ho-kwang Ryu3, Jong-hoon Park4, Kug-jin Kim5, Il-nam Son6

    Clinical Pain 2023; 22(2): 104-114

    https://doi.org/10.35827/cp.2023.22.2.104
    Abstract
    Objective: The objective of this study is to assess the efficacy and safety of repeated sodium polynucleotide (Conjuran) treatments in patients with knee osteoarthritis. Methods: The study was conducted by retrospectively examining 45 patients who repeated the treatment course of 5 injections of Conjuran twice within 6 months. For each course, pain reduction by the change of 100-mm Weight-Bearing-Pain Visual-Analog-Scale was compared with before administration until 6 months after administration. Improvement by Clinical Global Impression (CGI) and Patient Global Impression (PGI) were also investigated, as well as adverse reactions. Results: Pain analysis after administration of Conjuran confirmed that VAS decreased by 51.6% until 6 months (p<0.001), and after that the effect was lost and was repeat for the 2nd course. In the 2nd, VAS continued to decrease by 58.7% compared to before the 1st course (p<0.001). Analysis of CGI, 88.9% of patients improved after the 1st and 84.4% of patients improved after the 2nd. In the PGI results, symptoms improved in 86.7% of patients after the 1st and 82.2% after the 2nd. No significant adverse event was reported. Conclusion: The safety and efficacy results of patients receiving Conjuran for 2nd treatment courses were similar to those for 1st treatment course. In addition, the effect lasts for up to 6 months after administration, and the pain reduction effect is lost thereafter, so it is recommended to apply it at 6-month intervals if additional treatment is needed. Conjuran is an intra-articular injection that is effective in reducing knee pain and can be used repeatedly without adverse reactions.
  • Original Article 2023-12-31

    Changhun Lee, Kil-Byung Lim, Jiyong Kim, Yeorin Kim, Jeehyun Yoo

    Clinical Pain 2023; 22(2): 115-121

    https://doi.org/10.35827/cp.2023.22.2.115
    Abstract
    Objective: Shoulder pain is a common post-mastectomy complication. This research aims to evaluate the role of shoulder structure changes in developing shoulder pain in post-mastectomy patients and determine ultrasonographic findings. Methods: Medical records of post-mastectomy patients with ipsilateral shoulder pain were reviewed. Ultrasonographic findings, visual analogue scale (VAS), Shoulder Pain and Disability Index (SPADI), age, body mass index, time from mastectomy, operation type, lymph node dissection type, presence of lymphedema, and radiation therapy were checked. Results: Of 40 patients, rotator cuff tear, subacromial-subdeltoid bursitis, calcific tendinitis, biceps brachii tendon sheath fluid accumulation, and tendinopathy were seen in ultrasonography. Age was statistically higher in the rotator cuff tear group than non-rotator cuff tear group. Time from mastectomy, VAS, and SPADI were statistically correlated with biceps brachii sheath fluid accumulation. Shoulders with tendinopathy developed pain shortly after surgery. VAS and SPADI were statistically correlated with presence of subscapularis or supraspinatus tendinopathy. Nine of thirteen patients (69.2%) with subscapularis tendinopathy had post-mastectomy lymphedema. Only two of fifteen (18.2%) patients with supraspinatus tendinopathy had a history of radiation therapy. Conclusion: Shoulder pain and rotator cuff tendinopathy may occur soon after surgery; therefore, shoulder range of motion exercises and muscle strengthening exercises are necessary in the early days after surgery. Elderly patients have a risk of rotator cuff tear, which physicians should pay more attention to. Even though there is no history of lymphedema and radiation therapy, shoulder lesions may occur. Therefore, prevention of shoulder pain in all patients after breast cancer surgery is needed.
  • Case Report 2023-12-31

    Jin Sun Kang, Sung Hoon Lee, Ki Hong Won, Tae Ki Choi, Su Min Lee, Eun Young Kang, Hyun Kyung Lee, Youn Kyung Cho

    Clinical Pain 2023; 22(2): 122-126

    https://doi.org/10.35827/cp.2023.22.2.122
    Abstract
    Spinal manipulation therapy (SMT) is commonly used to treat various musculoskeletal pains; however, it is associated with several complications. Mild complications resolve quickly; however, on rare occasions, they may cause severe complications that persist indefinitely. Here, we present a case of cervical myelopathy caused by a spinal manipulation. A 52-year-old man with a history of cervical radiculopathy at C4–7 underwent manipulation, performed by an unlicensed practitioner. After the manipulation, he explained abrupt muscle weakness in all four extremities. He was diagnosed with cervical myelopathy and had to undergo emergency surgery. Through this case, we aim to emphasize the role of doctors, with regard to spinal manipulation. Physicians must supervise the pre-evaluation of patients, manipulation, and post-manipulation monitoring, and the complications of SMT should be immediately reported.
  • Case Report 2023-12-31

    Jae Yeon Kim, Young Sook Park, Hyun Jung Chang, Jin Gee Park, Eun Sol Cho, Da Hye Kim, Jeong Hwan Lee, Se Jin Kim

    Clinical Pain 2023; 22(2): 127-130

    https://doi.org/10.35827/cp.2023.22.2.127
    Abstract
    Kennedy’s disease (KD) or bulbospinal muscular atrophy is an uncommon x-linked recessive genetic disorder. Its diagnosis is challenging due to its wide array of clinical manifestations and difficulty distinguishing it from other motor neuron diseases. Thus, diagnosis is confirmed through DNA testing. 52-year-old male patient presented to the hospital with chronic low back pain (LBP) and muscle weakness. The patient had mild weakness in some proximal muscles, increased deep tendon reflex. Lumbar spine magnetic resonance imaging (MRI) showed degenerative changes. Motor nerve conduction test results showed close to the normal. Sensory nerve conduction test results showed decreased latency and amplitude in most nerves. Needle electromyography revealed fasciculation potentials, diffuse fibrillation potentials, and positive sharp waves were detected. Thus, molecular genetic testing was performed. Consequently, KD was diagnosed. These results suggest the importance of detailed history taking and neurological examination even for patients with chronic LBP to rule out severe diseases.
  • Case Report 2023-12-31

    Abstract
    Myositis ossificans (MO) is a benign ossified mass that could develop after muscle injury. Typically, it is easily diagnosed based on a history, physical examination and imaging. However, atypical cases can pose challenges in diagnosis. A 31-year-old male presented with left scapula pain that started two weeks ago. Physical examination showed findings similar to cervical herniated intervertebral disc (C-HIVD), and ultrasound examination revealed MO in left anterior scalene muscle. With conservative treatment, a follow-up ultrasound two weeks later revealed mostly absorbed calcifications. MO can occur in atypical locations, such as the scalene muscle, and in such cases, it may present with clinical features similar to C-HIVD. Therefore, clinicians should consider this possibility in patients with suspected C-HIVD. Additionally, it can progress and resolve rapidly, contrary to what was previously known. The experience from this case may help in determining the diagnostic and treatment approach for atypical MO in future clinical settings.
  • Case Report 2023-12-31

    Jin Sun Kang, Sung Hoon Lee, Tae Ki Choi, Su Min Lee, Eun Ju Na, Eun Young Kang, Hyun Kyung Lee, Youn Kyung Cho

    Clinical Pain 2023; 22(2): 136-140

    https://doi.org/10.35827/cp.2023.22.2.136
    Abstract
    Iatrogenic spinal cord injury resulting from direct needle injection is an exceedingly uncommon occurrence, mainly owing to the spinal cord’s protection by surrounding bony structures, with only a few exceptions, and its location a few centimeters beneath the skin. This study presents a case of a 27-year-old female who experienced cervical spinal cord injury following acupuncture treatment around the C3–4 region. The patient reported tingling paresthesia and persistent pain in her left arm for 1 month postinjection, with magnetic resonance imaging (MRI) revealing a syringomyelia in the direction of the injection. As determined at the follow-up, after undergoing 3 months of conservative treatments, including cervical intervention, medication, and education, her pain was reduced by approximately half. Cervical injections should be administered by a knowledgeable specialist well versed in musculoskeletal anatomy and potential complications, aided by radiological examination.
  • Case Report 2023-12-31

    Seong Jun Kim, Dong Wan Jin, Kun Wook Lee, Sang Chul Lee

    Clinical Pain 2023; 22(2): 141-145

    https://doi.org/10.35827/cp.2023.22.2.141
    Abstract
    Patellofemoral pain syndrome, one of the most common knee problems, is diagnosed by excluding other diseases that can cause similar pain or symptoms. The authors have been wondered about why patellofemoral pain syndrome can cause severe pain even when there are no structural abnormalities in the knee. For these reasons, if there are no structural abnormalities in the knee itself, the authors have strongly suspected referred pain due to injury of the surround structures, especially quadriceps femoris. Therefore, the authors want to report the successful experience in reducing knee pain and improving symptoms by performing extra-corporeal shockwave treatment in a patient who is concurred with diagnosis of patellofemoral pain syndrome and is suspected of having myofascial pain syndrome or chronic muscle injury of quadriceps femoris.
  • Case Report 2023-12-31

    Abstract
    Leg amputation causes serious complications in walking and ultimately leads to functional impairment. Usually, the non-amputated side is considered as the dominant leg during prosthetic gait training. However, if the non-amputated side is affected by pathological conditions and has associated pain, it is necessary to determine whether it can be considered as the dominant leg. This case series presents four individuals who underwent leg amputations who also had pathologic conditions and pain in the non-amputated legs. A functional goal was established for each patient and individualized step-by step prosthetic gait training strategies were applied. Consequently, we found out that functional outcomes could be achieved even in cases with accompanying complications, such as fractures, nerve injuries, or pain, in the non-amputated leg.
  • Case Report 2023-12-31

    Abstract
    We present a case of compressive cervical myelopathy seemingly produced by an amyloid deposit in a patient who had been on long-term hemodialysis. A 69-year-old man who had been on hemodialysis for about 25 years presented with neuropathic pain in both upper and lower extremities and progressive gait disturbance. Magnetic resonance imaging (MRI) revealed compressive myelopathy at the C3-4 level presumably caused by amyloidosis resulting from long-term dialysis-related complications. He underwent laminoplasty from C1 to C4. After surgical intervention and intensive rehabilitation, the patient showed clinical improvement. If progressive or sudden neurological symptoms and weakness develop in patients on long-term hemodialysis, spinal cord compression due to amyloidosis, which can occur rarely, should be considered.
  • Review Article 2023-06-30

    Abstract
    Muscle pain can be caused by various causes and it deteriorates the patient’s function and quality of life. Intramuscular stimulation therapy, performed under the concept of myofascial pain syndrome, is an effective treatment for relieving somatic pain in skeletal muscles through muscle relaxation, improving the limited range of motion of joints, enhancing muscle strength, and improving accompanying autonomic nervous system symptoms. Dry needling, trigger point injection, and intramuscular electrical stimulation are typical methods of intramuscular stimulation, and they must be safely performed by experienced practitioners. The mechanism, clinical use, efficacy, and precautions of intramuscular stimulation therapy will be reviewed in this article. Although additional supplementation of the academic evidence of intramuscular stimulation is still needed through experimental research, it is expected that the clinical application area can be expanded.
  • Review Article 2023-06-30

    Abstract
    Ultrasound imaging of the musculoskeletal system is widely used for diagnosis and treatment. Pathologies occurring in the knee joint and the distal femur are among the challenging areas for ultrasound diagnosis due to their complex structural nature. However, advancements in ultrasound technology have made it possible to assess and diagnose superficial structures using ultrasound. Moreover, ultrasound-guided procedures have gained significant popularity due to their advantages in terms of efficacy and safety. This paper aims to explore the ultrasound findings of commonly occurring conditions in the knee joint and proximal femur and discuss ultrasound-guided interventions that can be performed in these areas for treatment.
  • Review Article 2023-06-30

    Abstract
    The facet joints are a common source of chronic spinal pain. Blocks of the nerves supplying the facet joints are validated tools in the diagnosis and treatment for facet joint pain. These interventions are typically performed with fluoroscopic guidance. However, the target, which is the nerve, is radiolucent and cannot be identified with fluoroscopy. Recently, several ultrasound guided techniques in the domain of spinal pain have been emerging because ultrasound is useful in visualization of the inner structures, is portable, and is not associated with the radiation exposure. This paper reviews a variety of techniques for ultrasound guided interventions for the medial branch block which has been reported in treating axial pain originating from the facet joint.
  • Review Article 2023-06-30

    Abstract
    Carpal tunnel syndrome is a very common and important disease caused by entrapment of the median nerve in the carpal tunnel. With the widespread use of high-resolution ultrasound, ultrasound is being used usefully in the diagnosis of carpal tunnel syndrome. Compared to electrodiagnostic study, ultrasound examinations are easier and, above all, non-invasive. In addition, ultrasound-guided injection can be performed alone or in combination with ultrasound examination. In the case of nerve hydrodissection, which has recently been spotlighted as a treatment for carpal tunnel syndrome, it is the procedure that could not be attempted before without ultrasound equipment. In this paper, through a comprehensive review of meta-analysis literatures, we look back at the value of ultrasound as a diagnostic tool for carpal tunnel syndrome and the effect of ultrasound-guided injection to get an objective perspective and gain new insights. The usefulness of ultrasound will be largely divided into applications of ultrasound-guided injection, diagnosis, and sonoelastography.
  • Original Article 2023-12-31

    Wan-ho Kim1, Young-sun Song2, Ho-kwang Ryu3, Jong-hoon Park4, Kug-jin Kim5, Il-nam Son6

    Clinical Pain 2023; 22(2): 104-114

    https://doi.org/10.35827/cp.2023.22.2.104
    Abstract
    Objective: The objective of this study is to assess the efficacy and safety of repeated sodium polynucleotide (Conjuran) treatments in patients with knee osteoarthritis. Methods: The study was conducted by retrospectively examining 45 patients who repeated the treatment course of 5 injections of Conjuran twice within 6 months. For each course, pain reduction by the change of 100-mm Weight-Bearing-Pain Visual-Analog-Scale was compared with before administration until 6 months after administration. Improvement by Clinical Global Impression (CGI) and Patient Global Impression (PGI) were also investigated, as well as adverse reactions. Results: Pain analysis after administration of Conjuran confirmed that VAS decreased by 51.6% until 6 months (p<0.001), and after that the effect was lost and was repeat for the 2nd course. In the 2nd, VAS continued to decrease by 58.7% compared to before the 1st course (p<0.001). Analysis of CGI, 88.9% of patients improved after the 1st and 84.4% of patients improved after the 2nd. In the PGI results, symptoms improved in 86.7% of patients after the 1st and 82.2% after the 2nd. No significant adverse event was reported. Conclusion: The safety and efficacy results of patients receiving Conjuran for 2nd treatment courses were similar to those for 1st treatment course. In addition, the effect lasts for up to 6 months after administration, and the pain reduction effect is lost thereafter, so it is recommended to apply it at 6-month intervals if additional treatment is needed. Conjuran is an intra-articular injection that is effective in reducing knee pain and can be used repeatedly without adverse reactions.
  • Case Report 2023-12-31

    Seong Jun Kim, Dong Wan Jin, Kun Wook Lee, Sang Chul Lee

    Clinical Pain 2023; 22(2): 141-145

    https://doi.org/10.35827/cp.2023.22.2.141
    Abstract
    Patellofemoral pain syndrome, one of the most common knee problems, is diagnosed by excluding other diseases that can cause similar pain or symptoms. The authors have been wondered about why patellofemoral pain syndrome can cause severe pain even when there are no structural abnormalities in the knee. For these reasons, if there are no structural abnormalities in the knee itself, the authors have strongly suspected referred pain due to injury of the surround structures, especially quadriceps femoris. Therefore, the authors want to report the successful experience in reducing knee pain and improving symptoms by performing extra-corporeal shockwave treatment in a patient who is concurred with diagnosis of patellofemoral pain syndrome and is suspected of having myofascial pain syndrome or chronic muscle injury of quadriceps femoris.
  • Review Article 2023-12-31

    Abstract
    This review journal focuses on using ultrasound-guided root block in spondylotic radiculopathy, exploring its therapeutic potential, safety advantages, and validation challenges. C-arm guided transforaminal epidural steroid injection (C-TFESI) has constantly shown effective treatment outcomes for spondylotic radiculopathy. However, C-TFESI has been associated with rare significant adverse events, including cervical cord and brain infarction. Advancements in musculoskeletal ultrasonography have sparked efforts to apply this technique in spondylotic radiculopathy treatment. The distinct advantages of ultrasound, particularly in soft tissue discrimination and vascular visualization, have positioned it as a valuable tool in minimizing the risk of significant complications like spinal cord and brain infarction following cervical spinal injection procedures. Numerous studies have reported the potential and efficacy of ultrasound-guided cervical root block, establishing it as a safe and effective therapeutic approach. However, further validation is warranted to address the limitations and gaps in the current knowledge, particularly regarding the risk of vascular injection.
  • Case Report 2023-12-31

    Jin Sun Kang, Sung Hoon Lee, Tae Ki Choi, Su Min Lee, Eun Ju Na, Eun Young Kang, Hyun Kyung Lee, Youn Kyung Cho

    Clinical Pain 2023; 22(2): 136-140

    https://doi.org/10.35827/cp.2023.22.2.136
    Abstract
    Iatrogenic spinal cord injury resulting from direct needle injection is an exceedingly uncommon occurrence, mainly owing to the spinal cord’s protection by surrounding bony structures, with only a few exceptions, and its location a few centimeters beneath the skin. This study presents a case of a 27-year-old female who experienced cervical spinal cord injury following acupuncture treatment around the C3–4 region. The patient reported tingling paresthesia and persistent pain in her left arm for 1 month postinjection, with magnetic resonance imaging (MRI) revealing a syringomyelia in the direction of the injection. As determined at the follow-up, after undergoing 3 months of conservative treatments, including cervical intervention, medication, and education, her pain was reduced by approximately half. Cervical injections should be administered by a knowledgeable specialist well versed in musculoskeletal anatomy and potential complications, aided by radiological examination.
  • Original Article 2023-12-31

    Changhun Lee, Kil-Byung Lim, Jiyong Kim, Yeorin Kim, Jeehyun Yoo

    Clinical Pain 2023; 22(2): 115-121

    https://doi.org/10.35827/cp.2023.22.2.115
    Abstract
    Objective: Shoulder pain is a common post-mastectomy complication. This research aims to evaluate the role of shoulder structure changes in developing shoulder pain in post-mastectomy patients and determine ultrasonographic findings. Methods: Medical records of post-mastectomy patients with ipsilateral shoulder pain were reviewed. Ultrasonographic findings, visual analogue scale (VAS), Shoulder Pain and Disability Index (SPADI), age, body mass index, time from mastectomy, operation type, lymph node dissection type, presence of lymphedema, and radiation therapy were checked. Results: Of 40 patients, rotator cuff tear, subacromial-subdeltoid bursitis, calcific tendinitis, biceps brachii tendon sheath fluid accumulation, and tendinopathy were seen in ultrasonography. Age was statistically higher in the rotator cuff tear group than non-rotator cuff tear group. Time from mastectomy, VAS, and SPADI were statistically correlated with biceps brachii sheath fluid accumulation. Shoulders with tendinopathy developed pain shortly after surgery. VAS and SPADI were statistically correlated with presence of subscapularis or supraspinatus tendinopathy. Nine of thirteen patients (69.2%) with subscapularis tendinopathy had post-mastectomy lymphedema. Only two of fifteen (18.2%) patients with supraspinatus tendinopathy had a history of radiation therapy. Conclusion: Shoulder pain and rotator cuff tendinopathy may occur soon after surgery; therefore, shoulder range of motion exercises and muscle strengthening exercises are necessary in the early days after surgery. Elderly patients have a risk of rotator cuff tear, which physicians should pay more attention to. Even though there is no history of lymphedema and radiation therapy, shoulder lesions may occur. Therefore, prevention of shoulder pain in all patients after breast cancer surgery is needed.
  • Review Article 2023-12-31

    Clinically, evaluation and procedures using ultrasound are expanding in the field of neuromusculoskeletal disorders, and ultrasound is also actively used for hip and thigh pain. This review delineates the normal ultrasound findings of lateral and posterior aspects of the hip joint and thigh. Furthermore, it covers ultrasound findings of commonly occurring soft tissue diseases and nerve entrapment, along with ultrasound-guided injections.
  • Review Article 2023-06-30

    Abstract
    Most muscle and tendon injuries in thigh occur in sports activities with high energy, for example kicking and running, related with deceleration phase, which require eccentric contraction of quadriceps and hamstring. Most common injury is hamstring strain injury (HSI) and also common injuries of anterior thigh is quadriceps strain injury. Strain injuries occur at myo-tendinous junction and surrounding muscle fibers and in most strains except complete rupture first choice of treatment is conservative treatment including RICE in acute phase and subsequent rehabilitation programs. In competitive sports activities such as football quadriceps contusion injury is common after heavy collision. Prognosis is dependent on the extension of muscle fiber damage and hematoma formation. Hematoma formation can develop to myositis ossificans or Morel-Lavellee lesion, which can induce pain and disability. Hamstring and quadriceps strain and tendon tear can occur in middle-aged or elderly people in community circumstances after slip down or falling, which lead to sudden lengthening and eccentric contraction of hamstring or quadriceps. Tendon tear including avulsion tear in greater tuberosity has higher proportion than strain, that is opposite in sports injuries, because middle aged or elderly people have higher possibility of tendon degeneration and tendinosis with higher risk of tendon tear. Therefore rapid and accurate diagnosis and proper treatment including rehabilitation program for hamstring and quadriceps injury is necessary in middle aged or elderly people.
  • Review Article 2023-12-31

    Abstract
    Patients with pelvic or sacral pain can be easily encountered in outpatient clinic settings. Since the cause of pain can be originated from the lumbar spinal region, or sometimes directly from the pelvis or sacral region, it is essential to differential diagnose where the pain is coming from. Caudal epidural steroid injection, sacroiliac joint injection, and piriformis injection are not only therapeutic, but are often used diagnostically, therefore they would be more useful in the outpatient clinic. Ultrasound-guided injections have similar clinical effects and the advantage of having shorter procedure times and no radiation exposure compared with fluoroscopic image-guided injection. Therefore, it is recommended to safely perform pelvic or sacral injections using ultrasound guidance.
  • Case Report 2023-12-31

    Abstract
    Myositis ossificans (MO) is a benign ossified mass that could develop after muscle injury. Typically, it is easily diagnosed based on a history, physical examination and imaging. However, atypical cases can pose challenges in diagnosis. A 31-year-old male presented with left scapula pain that started two weeks ago. Physical examination showed findings similar to cervical herniated intervertebral disc (C-HIVD), and ultrasound examination revealed MO in left anterior scalene muscle. With conservative treatment, a follow-up ultrasound two weeks later revealed mostly absorbed calcifications. MO can occur in atypical locations, such as the scalene muscle, and in such cases, it may present with clinical features similar to C-HIVD. Therefore, clinicians should consider this possibility in patients with suspected C-HIVD. Additionally, it can progress and resolve rapidly, contrary to what was previously known. The experience from this case may help in determining the diagnostic and treatment approach for atypical MO in future clinical settings.
  • Review Article 2023-12-31

    Abstract
    The sacroiliac joint (SIJ) is known to account for 14.5∼30% of chronic low back pain patients with non-radicular symptoms. Diagnosing SIJ-related pain is challenging, as initial symptoms often resemble those of other causes of low back pain. Pain may radiate from below the fifth lumbar vertebra to the thigh, making it essential to differentiate from lumbar facet joint, hip joint, lumbar disc, and surrounding muscle problems. There are no single symptoms or physical exams that definitively diagnose SIJ pain. Clinically, if a patient shows positive findings in three or more different physical exams related to the SIJ and experiences more than 75% symptom improvement following a local anesthetic injection under fluoroscopic guided injection, SIJ pain can be suspected. This review aims to provide a comprehensive overview of the SIJ as a source of pain, covering its anatomy, functions, pathologic injury mechanisms, and diagnostic approaches.
  • Original Article 2023-12-31

    Donghwi Park1, Kwangohk Jun1, Seongho Woo1, Won Mo Koo1, Jong Min Kim1, Byung Joo Lee1, Sunyoung Joo2, Hyoshin Eo1

    Clinical Pain 2023; 22(2): 97-103

    https://doi.org/10.35827/cp.2023.22.2.97
    Abstract
    Objective: Flatfoot is a very common condition in pediatric rehabilitation that can cause various symptoms. Therefore, objective evaluation and effective management of flatfoot is important. The resting calcaneal stance position (RCSP) angle has been widely used as an indicator of flatfoot. This study followed up the RCSP angle in children with flatfoot who were prescribed biomechanical foot orthoses (BFOs), to determine whether BFOs significantly improved flatfoot. Methods: We included 77 children who were diagnosed with flatfoot and prescribed BFOs. We followed up and compared the RCSP angle using the paired t-test. In addition, the patients divided into two groups according to RCSP angle improvement to determine whether any significant indicators were present in the group with greater improvement. Results: The mean age of 77 children was 11.05 years, with 50 boys and 27 girls. The RCSP angle improved by 3.25 and 2.78 degrees on the right and left sides, respectively, with the paired t-test showing a significant improvement in the RCSP angle (p≤0.001). 40 and 37 exhibited an RCSP angle improvement of more and less than 4 degrees, respectively, with the paired t-test also confirming a significant improvement in the RCSP angle (p≤0.001). However, independent t-tests revealed no significant differences in all indicators between the two groups. Conclusion: This study confirmed that wearing BFO in children with flatfoot can improve the RCSP angle. Our findings showed that RCSP angles improved regardless of other factors. Further studies providing more data and including a control group are needed.
  • Case Report 2023-12-31

    Jin Sun Kang, Sung Hoon Lee, Ki Hong Won, Tae Ki Choi, Su Min Lee, Eun Young Kang, Hyun Kyung Lee, Youn Kyung Cho

    Clinical Pain 2023; 22(2): 122-126

    https://doi.org/10.35827/cp.2023.22.2.122
    Abstract
    Spinal manipulation therapy (SMT) is commonly used to treat various musculoskeletal pains; however, it is associated with several complications. Mild complications resolve quickly; however, on rare occasions, they may cause severe complications that persist indefinitely. Here, we present a case of cervical myelopathy caused by a spinal manipulation. A 52-year-old man with a history of cervical radiculopathy at C4–7 underwent manipulation, performed by an unlicensed practitioner. After the manipulation, he explained abrupt muscle weakness in all four extremities. He was diagnosed with cervical myelopathy and had to undergo emergency surgery. Through this case, we aim to emphasize the role of doctors, with regard to spinal manipulation. Physicians must supervise the pre-evaluation of patients, manipulation, and post-manipulation monitoring, and the complications of SMT should be immediately reported.
  • Review Article 2023-12-31

    Abstract
    Carpal Tunnel Syndrome is the most common entrapment neuropathy. Treatment for carpal tunnel syndrome varies according to the severity of the disease, ranging from conservative treatment to surgical intervention. Conservative treatments such as steroid injection within carpal tunnel are helpful for most patients with mild to moderate carpal tunnel syndrome. However, in the case of the most commonly used steroid injection, the effect is short or limited within 6 months. In this paper, I will review ultrasound-guided nerve hydrodissection for carpal tunnel syndrome, which has recently attracted attention.
  • Original Article 2023-06-30

    Abstract
    Objective: Chronic low back pain (LBP) is a huge social burden, and optimal exercise therapies for chronic LBP patients are continuously being studied. To evaluate the effects of digital intervention on pain and disability in patients with chronic LBP, we performed a prospective cohort study. Method: From February 2020 to January 2021, 25 patients with chronic LBP were recruited. Digital intervention contains education contents and video demonstration for individually prescribed exercise. The exercise prescription was renewed every 4 weeks according to subjects’ condition and accomplishment of exercise. This intervention was performed for more than 30 weeks. The pain intensity was assessed using a numeric rating scale (NRS) while their degree of disability was assessed using the Roland-Morris Disability Questionnaire (RMDQ). The pain intensity and disability was evaluated at short term (8∼20 weeks) and long term (30 weeks). Results: As a result, pain intensity (NRS) decreased significantly over the short term and long term (p<0.05). However, pain related disability (RMDQ score) did not change significantly over the follow-up period (p=0.554). Conclusion: Our findings indicate that online-based digital intervention reduced the intensity of chronic LBP. Further research is needed to identify methods to cost-effectively and consistently manage chronic LBP.
  • Case Report 2023-12-31

    Jae Yeon Kim, Young Sook Park, Hyun Jung Chang, Jin Gee Park, Eun Sol Cho, Da Hye Kim, Jeong Hwan Lee, Se Jin Kim

    Clinical Pain 2023; 22(2): 127-130

    https://doi.org/10.35827/cp.2023.22.2.127
    Abstract
    Kennedy’s disease (KD) or bulbospinal muscular atrophy is an uncommon x-linked recessive genetic disorder. Its diagnosis is challenging due to its wide array of clinical manifestations and difficulty distinguishing it from other motor neuron diseases. Thus, diagnosis is confirmed through DNA testing. 52-year-old male patient presented to the hospital with chronic low back pain (LBP) and muscle weakness. The patient had mild weakness in some proximal muscles, increased deep tendon reflex. Lumbar spine magnetic resonance imaging (MRI) showed degenerative changes. Motor nerve conduction test results showed close to the normal. Sensory nerve conduction test results showed decreased latency and amplitude in most nerves. Needle electromyography revealed fasciculation potentials, diffuse fibrillation potentials, and positive sharp waves were detected. Thus, molecular genetic testing was performed. Consequently, KD was diagnosed. These results suggest the importance of detailed history taking and neurological examination even for patients with chronic LBP to rule out severe diseases.
  • Review Article 2023-12-31

    Abstract
    Various injectable agents are used for nerve and musculoskeletal pain control. We want to review these injectable agents and several examples under ultrasonographic guidance. Ultrasound (US) can depict of various anatomical structures, such as muscles, tendons, ligaments, nerve roots, and vessels, all over the body. The use of US during injection is increasing due to its quick and easy application for guided injection with higher accuracy compared to the blind technique. The aim of this review article is to get accustomed to various injectables, and to get to know about several US-guided intervention technique.
  • Case Report 2023-06-30

    Abstract
    Radiofrequency energy, such as that used in neuroablation, has been applied in various medical and surgical fields. However, no consensus exists regarding neuroablation protocols using radiofrequency. This study aimed to report the effect of a radio-frequency neuroablative technique on spastic foot management in a patient with stroke and present its safety and persistence. A 59-year-old man with hemiplegic gait by the intracerebral hemorrhage had radiofrequency ablation of the motor nerve branch supplying the medial gastrocnemius. The patient’s subjective and objective measurements of the spastic limb improved after the intervention. The effect lasted for 3 months. Radiofrequency neuroablative technique may be beneficial for treating spastic gait in patients with stroke. The above technique must be used to verify patients with spasticity, and research should be investigated to determine appropriated parameters.
  • Review Article 2023-06-30

    Abstract
    For the effective rehabilitation of chronic pain, it is necessary to know the changes in the pain networks of patients with chronic pain. There is a need for attention to changes in emotional pain networks and cognitive pain networks. In patients with chronic pain, post-exercise pain reduction is less pronounced than in those without chronic pain. In order to achieve the exercise effect, emotional problems must be considered in addition to the patient's physical changes. In addition, a detailed prior explanation is needed to raise the expectations for exercise effect, moreover, in order to continue exercising for a safe and long period, exercise suitable for patients should be selected and low-intensity exercise protocols should be provided.
  • Case Report 2023-12-31

    Abstract
    Leg amputation causes serious complications in walking and ultimately leads to functional impairment. Usually, the non-amputated side is considered as the dominant leg during prosthetic gait training. However, if the non-amputated side is affected by pathological conditions and has associated pain, it is necessary to determine whether it can be considered as the dominant leg. This case series presents four individuals who underwent leg amputations who also had pathologic conditions and pain in the non-amputated legs. A functional goal was established for each patient and individualized step-by step prosthetic gait training strategies were applied. Consequently, we found out that functional outcomes could be achieved even in cases with accompanying complications, such as fractures, nerve injuries, or pain, in the non-amputated leg.
  • Case Report 2023-12-31

    Abstract
    We present a case of compressive cervical myelopathy seemingly produced by an amyloid deposit in a patient who had been on long-term hemodialysis. A 69-year-old man who had been on hemodialysis for about 25 years presented with neuropathic pain in both upper and lower extremities and progressive gait disturbance. Magnetic resonance imaging (MRI) revealed compressive myelopathy at the C3-4 level presumably caused by amyloidosis resulting from long-term dialysis-related complications. He underwent laminoplasty from C1 to C4. After surgical intervention and intensive rehabilitation, the patient showed clinical improvement. If progressive or sudden neurological symptoms and weakness develop in patients on long-term hemodialysis, spinal cord compression due to amyloidosis, which can occur rarely, should be considered.
  • Case Report 2023-06-30

    Abstract
    Chronic expanding hematoma (CEH) is a hematoma that increases in size, usually occurring after trauma or surgery, more than a month after initial bleeding. Thighs and upper limbs are the most common sites of CEH. Only a few cases of CEH have been reported in the amputation stump site since CEH itself is a rare disease.We experienced a case of a 59-year-old man who underwent transtibial amputation and suffered from recurrent non-infectious hematoma. For the treatment of CEH, the patient underwent an open bursectomy, followed by bony spur removal surgery. However, CEH recurred, and the pain was only managed by intermittent aspiration and compression. We report a long journey of managing painful CEH of the transtibial amputation stump.
  • Case Report 2023-06-30

    Abstract
    May–Thurner syndrome (MTS) is a condition in which the left common iliac vein is irritated by chronic pulsatile compression between the right common iliac artery and the upper iliac or lumbar spine. It mainly causes swelling and pain in the left lower extremity, venous thrombosis, and repeated deep venous thrombosis. In patients with sudden swelling and pain in the left lower extremity and suspected lower extremity thrombosis, when no other obvious cause can be found, the possibility of MTS should be considered. We experienced a rare case of an older patient with atypical MTS caused by bone spur of the 4th and 5th lumbar vertebrae, which has been reported here along with a review of the literature.
  • Review Article 2022-12-31

    Abstract
    Neuromuscular ultrasound has been used increasingly for the diagnosis and guided-intervention of various neuromuscular structures. Using neuromuscular ultrasound, clinicians can reliably evaluate various structures in wrist and hand such as the nerves, joints, tendons or ligaments. In this article, a practical guide to the basis of neuromuscular ultrasound and the diagnostic criteria are reviewed for the diseases in wrist and hand; specifically median nerve, ulnar nerve, superficial radial nerve, wrist joint, ligaments, and stenosing tenosynovitis. Neuromuscular ultrasound can improve the accuracy of the diagnosis and the quality of patient care and is becoming a standard element in clinical practice. The development of quantitative measures also appears promising in its ability to improve patient care.
  • Case Report 2022-12-31

    Yeong-Il Na, M.D., Seungbok Lee et al.

    Clinical Pain 2022; 21(2): 129-132

    https://doi.org/10.35827/cp.2022.21.2.129
    Abstract
    “Poland’s syndrome” is a rare congenital disease whereby defects can accompany the chest, nipple, chest wall, and extremities on one side of the body. We diagnosed a 19-year-old male patient who presented to another hospital for a routine physical exam before enlisting in the military and was suspected of having a left brachial plexus injury. His chief complaint was the flatness of the left anterior chest wall without any significant functional inconvenience. Aplasia of the pectoralis minor and costosternal portion of the pectoralis major was observed through physical examination and computed tomography (CT). The patient was diagnosed with left-sided Poland’s syndrome without any limb abnormalities. Poland Syndrome should be highly considered in patients presenting with bilateral chest wall imbalance in the absence of with a recent traumatic history.
  • Review Article 2022-12-31

    Abstract
    In actual clinical practice, injuries of the lower extremities are frequently encountered. Some diseases are diagnosed through a physical examination, but when non-specific symptoms are complained, it may be difficult to diagnose only with a physical examination. Therefore, the ultrasound examination can be used as an appropriate diagnostic tool by using the inherent advantages of the device. This review article aims to describe in detail the main features of ultrasound imaging for common injuries of the distal lower extremity, ankle, and foot.
  • Original Articles 2022-12-31

    Jinyoung Park, M.D. and Jung Hyun Park, M.D. et al.

    Clinical Pain 2022; 21(2): 74-79

    https://doi.org/10.35827/cp.2022.21.2.74
    Abstract
    Digital therapeutics (DTx) is emerging in the field of digital healthcare thanks to the development of ICT (information and communications technology), sensors, and AI (artificial intelligence) technology. A clinical trial-based design and manufacturing process is required for DTx before it can be prescribed in the medical field. The risks, and effectiveness and intended use of DTx must then be approved by regulatory authorities. The digital healthcare apps for musculoskeletal disorders, which had previously concentrated on monitoring and feedback on aerobic exercise, have lately begun to be applied to rehabilitative exercises utilizing AI technologies using convolutional neural networks. The development of DTx focusing on therapeutic rehabilitative exercise is expected in the future.
  • Case Report 2021-12-31

    Abstract
    Digital therapeutics (DTx) is emerging in the field of digital healthcare thanks to the development of ICT (information and communications technology), sensors, and AI (artificial intelligence) technology. A clinical trial-based design and manufacturing process is required for DTx before it can be prescribed in the medical field. The risks, and effectiveness and intended use of DTx must then be approved by regulatory authorities. The digital healthcare apps for musculoskeletal disorders, which had previously concentrated on monitoring and feedback on aerobic exercise, have lately begun to be applied to rehabilitative exercises utilizing AI technologies using convolutional neural networks. The development of DTx focusing on therapeutic rehabilitative exercise is expected in the future.
  • Original Articles 2019-12-31

    Jihyun Park, M.D., Jang Woo Lee et al.

    Clinical Pain 2019; 18(2): 70-75

    https://doi.org/10.35827/cp.2019.18.2.70
    Abstract
    Digital therapeutics (DTx) is emerging in the field of digital healthcare thanks to the development of ICT (information and communications technology), sensors, and AI (artificial intelligence) technology. A clinical trial-based design and manufacturing process is required for DTx before it can be prescribed in the medical field. The risks, and effectiveness and intended use of DTx must then be approved by regulatory authorities. The digital healthcare apps for musculoskeletal disorders, which had previously concentrated on monitoring and feedback on aerobic exercise, have lately begun to be applied to rehabilitative exercises utilizing AI technologies using convolutional neural networks. The development of DTx focusing on therapeutic rehabilitative exercise is expected in the future.
  • Case Report 2019-12-31

    Abstract
    Digital therapeutics (DTx) is emerging in the field of digital healthcare thanks to the development of ICT (information and communications technology), sensors, and AI (artificial intelligence) technology. A clinical trial-based design and manufacturing process is required for DTx before it can be prescribed in the medical field. The risks, and effectiveness and intended use of DTx must then be approved by regulatory authorities. The digital healthcare apps for musculoskeletal disorders, which had previously concentrated on monitoring and feedback on aerobic exercise, have lately begun to be applied to rehabilitative exercises utilizing AI technologies using convolutional neural networks. The development of DTx focusing on therapeutic rehabilitative exercise is expected in the future.
Korean Association of Pain Medicine

Vol.22 No.2
December 2023

eISSN: 2765-5156

Frequency: Semi Annual

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Aims and Scope

Clinical Pain is the official journal of the Korean Association of Pain Medicine(KAPM) and Korean Association of Neuromusculoskeletal Ultrasound Society (KANMS), which publishes scientific articles regarding the characteristics, the mechanism of development, valuable diagnostic procedure, management of pain and the clinical research & education of neuromusculoskeletal ultrasonography for muscles, ligaments, joints and peripheral nerves.
This is a peer-reviewed open access journal that is published twice a year on the last day of June and December.

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