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Review Article
Normal Sonographic Peripheral Nerve Cross-Sectional Area Based on the Results of Meta-Analysis Studies
Genetic and electrodiagnostic testing have long been standard diagnostic testing methods for peripheral nerve lesions. Ultrasound examination can be considered as a complementary test and has the advantage of obtaining detailed morphological information about peripheral nerves. Morphological information such as peripheral nerve cross sectional area (CSA), which can be obtained using ultrasound, is useful in evaluating peripheral nerve lesions such as entrapment neuropathy and inflammatory polyneuropathy. In this paper, I would like to briefly introduce existing meta-analysis studies on the nor...
Clinical Pain 2024; 23(1): 1-5
Review Article
Suggestions for Effective Extracorporeal Shock Wave Treatment Methods for Lateral Epicondylitis
Extracorporeal shock wave therapy (ESWT) is a non-invasive treatment method that uses mechanical energy to help restore biological tissue. Recently, the treatment targets have expanded to include not only musculoskeletal injuries such as plantar fasciitis and lateral epicondylitis, which are typical treatment targets, but also peripheral nerve damage, diabetic foot ulcers, and osteoarthritis. However, the therapeutic effect of ESWT has not yet been proven even for lateral epicondylitis. The purpose of this article is to review recent literature on ESWT for lateral epicondylitis and to suggest ...
Clinical Pain 2024; 23(1): 6-11
Review Article
Ultrasound-Guided Nerve Hydrodissection in the Upper Extremity
To perform effective nerve hydrodissection on the upper extremities, it is essential to first select the target site through subjective and objective examinations based on basic anatomical knowledge of the nerve pathways and sites prone to entrapment. In ultrasound scanning, if the proximal diameter of the nerve increases compared to the distal one or the cross-sectional area of the nerve fascicle within the main nerve increases, it may be confirmed as a lesion site. If necessary, symptoms can be induced directly through stimulation using a nerve stimulator under ultrasound guidance for select...
Clinical Pain 2024; 23(1): 12-17
Review Article
Natural Course, Classification and Treatment Algorithms of Rotator Cuff Disease
When treating rotator cuff disease, it is crucial to understand the natural course and classification of the condition. It is necessary to distinguish whether the injury is acute, chronic, or an acute on chronic tear. From an anatomical perspective, it’s also essential to check for full thickness or partial thickness tears, and to identify any accompanying issues such as muscular atrophy or fat infiltration. Although the size of the rupture may increase over time, it is inappropriate to determine the treatment method solely based on the size or extent of the lesion, as the degree of damage a...
Clinical Pain 2024; 23(1): 18-21
Review Article
Ultrasound-Guided Injection in the Management of Shoulder Pain
Shoulder pain is one of the common symptoms that pain physicians frequently encounter in outpatient settings. Historically, the diagnosis of shoulder pain relied on clinical presentation and physical examination. However, with the advancement of ultrasound technology, physicians can now better diagnose and treat shoulder pain. When administering injection therapy for shoulder pain, the target may vary depending on the structure causing the pain. Furthermore, even when injecting the same structure, different approaches can be employed based on the practitioner’s preference, patient’s anatom...
Clinical Pain 2024; 23(1): 22-26
Original Article
Effects of Rehabilitation after Knee Arthroplasty by Home Care Pilot Program
Objective: The nationwide rehabilitation at-home care pilot program aims to provide medical services such as education, counseling, and remote management to patients who require continuous medical management after surgery. This study aims to retrospectively analyze the medical records of patients who participated in the project after knee arthroplasty to investigate the effectiveness of rehabilitation education in home-based care. Method: Data for analysis were collected from the evaluation form which is completed by the physician immediately after surgery and outpatient follow-up. The collect...
Clinical Pain 2024; 23(1): 27-32
Case Report
Three Diverse, Nearly Misdiagnosed Inflammatory, and Infectious Diseases at Atlantoaxial Joint
Severe neck pain, worsened by head rotation, may signal atlantoaxial joint involvement, prompting differentiation between inflammatory and mechanical causes. This study challenges conventions by presenting three cases where inflammatory diseases, typically associated with extremities, affect the atlantoaxial joint. Cases involve a 64-year-old woman with crowned dens syndrome (CDS) due to calcium pyrophosphate crystals, a 69-year-old male with septic arthritis at the C1-2 level and an 82-year-old female with rheumatoid arthritis (RA). Despite shared severe neck pain, patients with CDS and septi...
Clinical Pain 2024; 23(1): 33-38
Corrigendum
Correction: Safety and Effectiveness of Repeated Treatment of Dodium Polynucleotide in Knee Osteoarthritis
Clinical Pain 2024; 23(1): 39-39

  • Review Article 2024-06-30

    Normal Sonographic Peripheral Nerve Cross-Sectional Area Based on the Results of Meta-Analysis Studies

    Sang Chul Lee

    Clinical Pain 2024; 23(1): 1-5

    https://doi.org/10.35827/cp.2024.23.1.1
    Abstract
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    Genetic and electrodiagnostic testing have long been standard diagnostic testing methods for peripheral nerve lesions. Ultrasound examination can be considered as a complementary test and has the advantage of obtaining detailed morphological information about peripheral nerves. Morphological information such as peripheral nerve cross sectional area (CSA), which can be obtained using ultrasound, is useful in evaluating peripheral nerve lesions such as entrapment neuropathy and inflammatory polyneuropathy. In this paper, I would like to briefly introduce existing meta-analysis studies on the normal value of peripheral nerve CSA to provide information for standardization of nerve examination on ultrasound.

  • Review Article 2024-06-30

    Suggestions for Effective Extracorporeal Shock Wave Treatment Methods for Lateral Epicondylitis

    Sang Chul Lee

    Clinical Pain 2024; 23(1): 6-11

    https://doi.org/10.35827/cp.2024.23.1.6
    Abstract
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    Extracorporeal shock wave therapy (ESWT) is a non-invasive treatment method that uses mechanical energy to help restore biological tissue. Recently, the treatment targets have expanded to include not only musculoskeletal injuries such as plantar fasciitis and lateral epicondylitis, which are typical treatment targets, but also peripheral nerve damage, diabetic foot ulcers, and osteoarthritis. However, the therapeutic effect of ESWT has not yet been proven even for lateral epicondylitis. The purpose of this article is to review recent literature on ESWT for lateral epicondylitis and to suggest more effective treatment options.

  • Review Article 2024-06-30

    Ultrasound-Guided Nerve Hydrodissection in the Upper Extremity

    Gi-Wook Kim1,2

    Clinical Pain 2024; 23(1): 12-17

    https://doi.org/10.35827/cp.2024.23.1.12
    Abstract
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    To perform effective nerve hydrodissection on the upper extremities, it is essential to first select the target site through subjective and objective examinations based on basic anatomical knowledge of the nerve pathways and sites prone to entrapment. In ultrasound scanning, if the proximal diameter of the nerve increases compared to the distal one or the cross-sectional area of the nerve fascicle within the main nerve increases, it may be confirmed as a lesion site. If necessary, symptoms can be induced directly through stimulation using a nerve stimulator under ultrasound guidance for selection. When approaching the nearby nerve that triggers symptoms, it is important to confirm sufficient separation of surrounding structures that compress and irritate the main nerve through pressure after positioning the needle bevel with a tangential approach to target nerve.

  • Review Article 2024-06-30

    Natural Course, Classification and Treatment Algorithms of Rotator Cuff Disease

    Jong Hwa Lee

    Clinical Pain 2024; 23(1): 18-21

    https://doi.org/10.35827/cp.2024.23.1.18
    Abstract
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    When treating rotator cuff disease, it is crucial to understand the natural course and classification of the condition. It is necessary to distinguish whether the injury is acute, chronic, or an acute on chronic tear. From an anatomical perspective, it’s also essential to check for full thickness or partial thickness tears, and to identify any accompanying issues such as muscular atrophy or fat infiltration. Although the size of the rupture may increase over time, it is inappropriate to determine the treatment method solely based on the size or extent of the lesion, as the degree of damage and symptoms often do not align. Some studies have shown that the outcomes of surgical repairs can be similar to those of conservative treatments. Both surgical and conservative treatments can be effective depending on the case. Therefore, a careful analysis of patients and their specific lesions is required to achieve more effective treatment outcomes. What is important is to establish evidence and guidelines to determine which therapeutic approaches would be more effective for each patient.

  • Review Article 2024-06-30

    Ultrasound-Guided Injection in the Management of Shoulder Pain

    Yongbum Park, Jun Hyeong Song

    Clinical Pain 2024; 23(1): 22-26

    https://doi.org/10.35827/cp.2024.23.1.22
    Abstract
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    Shoulder pain is one of the common symptoms that pain physicians frequently encounter in outpatient settings. Historically, the diagnosis of shoulder pain relied on clinical presentation and physical examination. However, with the advancement of ultrasound technology, physicians can now better diagnose and treat shoulder pain. When administering injection therapy for shoulder pain, the target may vary depending on the structure causing the pain. Furthermore, even when injecting the same structure, different approaches can be employed based on the practitioner’s preference, patient’s anatomical variations, or capability of maintaining specific positions for intervention. This review describes various ultrasound-guided injection techniques used in the treatment of shoulder pain.

  • Original Article 2024-06-30

    Effects of Rehabilitation after Knee Arthroplasty by Home Care Pilot Program

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

    Clinical Pain 2024; 23(1): 27-32

    https://doi.org/10.35827/cp.2024.23.1.27
    Abstract
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    Objective: The nationwide rehabilitation at-home care pilot program aims to provide medical services such as education, counseling, and remote management to patients who require continuous medical management after surgery. This study aims to retrospectively analyze the medical records of patients who participated in the project after knee arthroplasty to investigate the effectiveness of rehabilitation education in home-based care. Method: Data for analysis were collected from the evaluation form which is completed by the physician immediately after surgery and outpatient follow-up. The collected data included the patient’s sex, age, pre-operative functional level, surgical site, and scores on the berg balance scale (BBS) and visual analogue scale (VAS) for evaluating pain. If patients were re-admitted to other medical institutions for rehabilitation, data on the duration of their stay were collected for further analysis. Results: A total of 234 patients were selected and their data were analyzed. The average change in the BBS (ΔBBS) between immediately after surgery and outpatient follow-up was 43.34 ± 5.51, while the average change in the VAS (ΔVAS) was −0.77 ± 2.27. A significant positive correlation (p=0.001) was found between pre-operative functional level and ΔBBS or ΔVAS. However, no significant correlation (p=0.554) was observed between the duration of stay in other medical institutions and ΔBBS or ΔVAS. Conclusion: The home care pilot program is effective in promoting functional recovery and pain relief after knee arthroplasty. It is expected that appropriate rehabilitation education, remote management, and follow-up observation for up to 6 months will sufficiently replace long-term inpatient treatment after knee arthroplasty.

  • Case Report 2024-06-30

    Three Diverse, Nearly Misdiagnosed Inflammatory, and Infectious Diseases at Atlantoaxial Joint

    Jihong Choi1, Sungwon Kim1, Duk Hyun Sung1, Yoonju Na2

    Clinical Pain 2024; 23(1): 33-38

    https://doi.org/10.35827/cp.2024.23.1.33
    Abstract
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    Severe neck pain, worsened by head rotation, may signal atlantoaxial joint involvement, prompting differentiation between inflammatory and mechanical causes. This study challenges conventions by presenting three cases where inflammatory diseases, typically associated with extremities, affect the atlantoaxial joint. Cases involve a 64-year-old woman with crowned dens syndrome (CDS) due to calcium pyrophosphate crystals, a 69-year-old male with septic arthritis at the C1-2 level and an 82-year-old female with rheumatoid arthritis (RA). Despite shared severe neck pain, patients with CDS and septic arthritis show notable neck rotation limitations, while the RA patient experiences joint pain without such constraints. Diagnostic methods include cervical computed tomography (CT) for CDS, and various imaging and blood tests for septic arthritis, and American College of Rheumatology/European League Against Rheumatism criteria (ACR/EULAR) for RA. These cases highlight atypical inflammatory manifestations at the atlantoaxial joint, urging consideration in severe neck pain scenarios.

  • Corrigendum 2024-06-30

    Correction: Safety and Effectiveness of Repeated Treatment of Dodium Polynucleotide in Knee Osteoarthritis

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

    Clinical Pain 2024; 23(1): 39-39

    https://doi.org/10.35827/cp.2023.22.2.104.e
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  • Original Article 2023-12-31

    Safety and Effectiveness of Repeated Treatment of Dodium Polynucleotide in Knee Osteoarthritis

    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
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    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.

  • Review Article 2023-06-30

    Intramuscular Stimulation Therapy

    Jinyoung Park

    Clinical Pain 2023; 22(1): 1-8

    https://doi.org/10.35827/cp.2023.22.1.1
    Abstract
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    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

    Ultrasound Guided Therapeutic Medial Branch Block for the Facet Joint Pain

    Yongbum Park, Jun Hyeong Song

    Clinical Pain 2023; 22(1): 33-37

    https://doi.org/10.35827/cp.2023.22.1.33
    Abstract
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    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 2023-12-31

    Various Injectable Agents for Neuromusculoskeletal Pain and Ultrasound-Guided Injection

    Yong-Soon Yoon1,2, Kwang Jae Lee1,2

    Clinical Pain 2023; 22(2): 88-96

    https://doi.org/10.35827/cp.2023.22.2.88
    Abstract
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    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.

  • Review Article 2023-06-30

    Ultrasound Findings and Procedures for Knee and Distal Femur Pathologies

    Seok Kang

    Clinical Pain 2023; 22(1): 14-21

    https://doi.org/10.35827/cp.2023.22.1.14
    Abstract
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    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.

  • Case Report 2023-12-31

    Iatrogenic Cervical Spinal Cord Injury Associated with Acupuncture

    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
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    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.

  • Review Article 2023-12-31

    Ultrasound-Guided Selective Cervical Root Block in Spondylotic Radiculopathy: Advantages and Safety

    Dong Gyu Lee

    Clinical Pain 2023; 22(2): 61-65

    https://doi.org/10.35827/cp.2023.22.2.61
    Abstract
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    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 2023-06-30

    Painful Chronic Expanding Hematoma of the Transtibial Amputation Stump

    Son Mi Lee, Donghyun Shin, Jongkyu Kim

    Clinical Pain 2023; 22(1): 48-51

    https://doi.org/10.35827/cp.2023.22.1.48
    Abstract
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    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.

  • Review Article 2023-06-30

    Usefulness of Ultrasound for Carpal Tunnel Syndrome Proven in Meta-Analysis Studies

    Sang Chul Lee

    Clinical Pain 2023; 22(1): 9-13

    https://doi.org/10.35827/cp.2023.22.1.9
    Abstract
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    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.

  • Case Report 2023-12-31

    Effect of Extra-Corporeal Shockwave Treatment in a Patient with Patellofemoral Pain Syndrome

    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
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    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 2023-06-30

    Muscle and Tendon Injury in Thigh

    Ho Jun Lee

    Clinical Pain 2023; 22(1): 22-28

    https://doi.org/10.35827/cp.2023.22.1.22
    Abstract
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    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.

  • Case Report 2023-12-31

    Cervical Myelopathy after Neck Manipulation

    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
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    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.

  • Original Article 2023-12-31

    Ultrasonographic Findings in Breast Cancer Patient with Shoulder Pain after Mastectomy

    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
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    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

    Clinical Assessment and Diagnosing Sacroiliac Joint Pain

    Myung Chul Yoo

    Clinical Pain 2023; 22(2): 66-71

    https://doi.org/10.35827/cp.2023.22.2.66
    Abstract
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    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

    Ultrasound-Guided Nerve Hydrodissection for Carpal Tunnel Syndrome

    Sang Chul Lee

    Clinical Pain 2023; 22(2): 82-87

    https://doi.org/10.35827/cp.2023.22.2.82
    Abstract
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    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

    Ultrasonography of the Lateral, Posterior Aspect of Hip Joint and Thigh

    Choong-Hee Roh1, Gi-Wook Kim1,2

    Clinical Pain 2023; 22(2): 72-77

    https://doi.org/10.35827/cp.2023.22.2.72
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    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.

  • Original Article 2023-06-30

    The Effects of Online-Based Interventions for Chronic Low Back Pain Patients: A Clinical Trial

    Dong Jin Heo, Jaewon Kim, Jae Min Kim

    Clinical Pain 2023; 22(1): 38-47

    https://doi.org/10.35827/cp.2023.22.1.38
    Abstract
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    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.

  • Review Article 2023-12-31

    Injections for Pelvic or Sacral Pain

    Seung Yeol Lee

    Clinical Pain 2023; 22(2): 78-81

    https://doi.org/10.35827/cp.2023.22.2.78
    Abstract
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    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

    Myositis Ossificans in Scalene Muscle Clinically Mimicking Cervical Herniated Intervertebral Disc

    Garam Hong, Won Kim

    Clinical Pain 2023; 22(2): 131-135

    https://doi.org/10.35827/cp.2023.22.2.131
    Abstract
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    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

    Kennedy’s Disease with Chronic Low Back Pain and Muscle Weakness

    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
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    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.

  • Original Article 2023-12-31

    Effects of Biomechanical Foot Orthoses on the Resting Calcaneal Stance Position Angle in Flatfoot Patients

    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
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    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 2023-06-30

    Clinical Effect of Selective Neuroablative Technique Using Radiofrequency on Spasticity in a Patient with Stroke

    Hyo Jeong Lee1, Yeon-Jae Seong2, Yoon Ghil Park3

    Clinical Pain 2023; 22(1): 52-56

    https://doi.org/10.35827/cp.2023.22.1.52
    Abstract
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    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

    Exercise-Induced Pain Reduction and Its Central Mechanism in Patients with Chronic Pain

    Suk Hoon Ohn

    Clinical Pain 2023; 22(1): 29-32

    https://doi.org/10.35827/cp.2023.22.1.29
    Abstract
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    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

    Prosthetic Gait Training in Individuals with Pathologic Conditions and Associated Pain on the Non-Amputated Side

    Seongeun Park, Su Ji Lee, Ji Cheol Shin

    Clinical Pain 2023; 22(2): 146-151

    https://doi.org/10.35827/cp.2023.22.2.146
    Abstract
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    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

    Compressive Cervical Myelopathy Related with Hemodialysis-Associated Amyloidoma

    Ji Woong Park, Junwon Park

    Clinical Pain 2023; 22(2): 152-155

    https://doi.org/10.35827/cp.2023.22.2.152
    Abstract
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    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 2024-06-30

    Ultrasound-Guided Nerve Hydrodissection in the Upper Extremity

    Gi-Wook Kim1,2

    Clinical Pain 2024; 23(1): 12-17

    https://doi.org/10.35827/cp.2024.23.1.12
    Abstract
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    To perform effective nerve hydrodissection on the upper extremities, it is essential to first select the target site through subjective and objective examinations based on basic anatomical knowledge of the nerve pathways and sites prone to entrapment. In ultrasound scanning, if the proximal diameter of the nerve increases compared to the distal one or the cross-sectional area of the nerve fascicle within the main nerve increases, it may be confirmed as a lesion site. If necessary, symptoms can be induced directly through stimulation using a nerve stimulator under ultrasound guidance for selection. When approaching the nearby nerve that triggers symptoms, it is important to confirm sufficient separation of surrounding structures that compress and irritate the main nerve through pressure after positioning the needle bevel with a tangential approach to target nerve.

  • Case Report 2023-06-30

    Atypical May-Thurner Syndrome Caused by Bone Spur of the L4∼5 Lumbar Vertebrae

    Gyoung Ho Nam, Ji Hye Hwang

    Clinical Pain 2023; 22(1): 57-60

    https://doi.org/10.35827/cp.2023.22.1.57
    Abstract
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    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 2024-06-30

    Normal Sonographic Peripheral Nerve Cross-Sectional Area Based on the Results of Meta-Analysis Studies

    Sang Chul Lee

    Clinical Pain 2024; 23(1): 1-5

    https://doi.org/10.35827/cp.2024.23.1.1
    Abstract
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    Genetic and electrodiagnostic testing have long been standard diagnostic testing methods for peripheral nerve lesions. Ultrasound examination can be considered as a complementary test and has the advantage of obtaining detailed morphological information about peripheral nerves. Morphological information such as peripheral nerve cross sectional area (CSA), which can be obtained using ultrasound, is useful in evaluating peripheral nerve lesions such as entrapment neuropathy and inflammatory polyneuropathy. In this paper, I would like to briefly introduce existing meta-analysis studies on the normal value of peripheral nerve CSA to provide information for standardization of nerve examination on ultrasound.

  • Review Article 2024-06-30

    Ultrasound-Guided Injection in the Management of Shoulder Pain

    Yongbum Park, Jun Hyeong Song

    Clinical Pain 2024; 23(1): 22-26

    https://doi.org/10.35827/cp.2024.23.1.22
    Abstract
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    Shoulder pain is one of the common symptoms that pain physicians frequently encounter in outpatient settings. Historically, the diagnosis of shoulder pain relied on clinical presentation and physical examination. However, with the advancement of ultrasound technology, physicians can now better diagnose and treat shoulder pain. When administering injection therapy for shoulder pain, the target may vary depending on the structure causing the pain. Furthermore, even when injecting the same structure, different approaches can be employed based on the practitioner’s preference, patient’s anatomical variations, or capability of maintaining specific positions for intervention. This review describes various ultrasound-guided injection techniques used in the treatment of shoulder pain.

  • Review Article 2024-06-30

    Suggestions for Effective Extracorporeal Shock Wave Treatment Methods for Lateral Epicondylitis

    Sang Chul Lee

    Clinical Pain 2024; 23(1): 6-11

    https://doi.org/10.35827/cp.2024.23.1.6
    Abstract
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    Extracorporeal shock wave therapy (ESWT) is a non-invasive treatment method that uses mechanical energy to help restore biological tissue. Recently, the treatment targets have expanded to include not only musculoskeletal injuries such as plantar fasciitis and lateral epicondylitis, which are typical treatment targets, but also peripheral nerve damage, diabetic foot ulcers, and osteoarthritis. However, the therapeutic effect of ESWT has not yet been proven even for lateral epicondylitis. The purpose of this article is to review recent literature on ESWT for lateral epicondylitis and to suggest more effective treatment options.
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Korean Association of Pain Medicine

Vol.23 No.1
June 2024

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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