Neurogenic bladder in patients with spinal cord injury can lead to a rapid deterioration of renal function by compromise of the upper urinary tracts. Algorithm of neurogenic bladder management in spinal cord injury has been discussed according to the types of neurogenic bladder and the hand function of patients. Although intermittent catheterization with a low intravesical pressure has been generally known as the best method of neurogenic bladder management in the patients with spinal cord injury, the most popular method of neurogenic bladder management for the patients with spinal cord injury in Korea has been reported as reflex voiding up to the present. It is necessary to identify the reasons for patients not to continue intermittent catheterization after discharge from inpatient rehabilitation care.

Objective: To evaluate the efficacy of direct current electrical fields and peripheral external electrical stimulation to promote regeneration of the transected rat sciatic nerve.

Method: Four groups were studied: three experimental groups and one control group. Cathod distal (CD) group; nerves were treated with 1.0 μA direct current with the cathode oriented distally to the lesion, anode distal (AD) group; nerves were treated with the anode oriented distally to the lesion, external stimulation (ES) group; nerves were treated with 3 mA, 60 Hz, galvanic current, using a ring electrode at ankle joint 3 times per day. No current was delivered in control group. Electrophysiologic and functional assessments were conducted at 3 weeks postoperatively.

Results: All experimental groups showed significantly higher electrophysiologic and functional improvement than the control group. However, there is no significant differece in improvement among experimental groups.

Conclusion: Both direct current electrical field and peripheral external electrical stimulation can effectively promote peripheral nerve regeneration.

Objective: The purpose of this study is to evaluate the balance training effects of balance system in hemiplegic stroke patients.

Method: The study consisted of 14 male and 6 female hemiplegic patients, aged 48 to 70 years, time postattack ranged from 6 to 17 months. Balance training was done by conventional method (control group) and using balance system (Chattanooga Group, Inc., training group) and the effect were evaluated by balance system.

Results: Body sway index and moving target accuracy rate were not significantly different between training group and control group before training, but were significantly different after training. Training group showed significantly decreased sway index and increased moving target accuracy rate at four weeks after training compared to the status before training.

Conclusion: The hemiplegic patients trained by balance system showed significantly improved static and dynamic postural balance control. Therefore, the balance system is considered to be a valuable training modalitiy for the hemiplegic patients.

Objective: The present study was prospectively designed to identify the incidence, risk factors and characteristics of falls in a patient with stroke.

Method: One hundred and three stroke patients admitted to the department of rehabilitation medicine between March 1, 1998 and June 30, 1998, were evaluated.

Results: Fifteen (14.6%) have falled at least one time, and most of the falls occurred in their own room while walking. Risks for falls were associated with multiple brain lesion involving both anterior and posterior circulation, the presence of the cognitive function disturbance, and presence of caregiver hired by the patient. Fifteen (78.9%) of total 19 incidents did not cause any problem, but 4 falls (21.1%) caused mild injury - pain, and simple contusion. Severe injury such as fracture or intracerebral hemorrhage were not caused by these falls.

Conclusion: The incidence of fall in a patient with stroke was 14.6%. And risks for falls were associated with multiple brain lesion, the presence of the cognitive function disturbance, and presence of caregiver hired by the patient.

Objective: To clarify the relationship of primitive reflexes and motor development during second six months of age.

Method: All infants were referred to Inha University Hospital Cerebral Palsy Clinic from January 1, 1996 to March 30, 1997. Identical evaluations were performed on 49 risk infants at eight months of age. Their primitive reflexes were graded on a 0∼2 scale; 0 being inability to elicit the reponses passively, 1 being intermediate degree, 2 being obligatory. The following primitive reflexes were studied; asymmetric tonic neck reflex (ATNR), tonic labyrinthine reflex on supine (TLS), Moro reflex (Moro). The presence of some voluntary activities (rolling prone to supine, rolling supine to prone, and sitting unsupported) were observed. The Mantal-Haenszel chi-square for trend test was used in order to study the association of primitive reflex and motor development in infants with delayed development.

Results: Inability of rolling prone to supine was most significantly associated with presence of ATNR and TLS but not with that of Moro reflex. Inability of rolling supine to prone was significantly associated with presence of TLS and then Moro reflex, ATNR. Inability to Sit independently without support was associated with the presence of TLS, but not with that of ATNR and Moro reflexes.

Conclusion: This study suggests that the presence of primitive reflexes at second half of age are negatively influenced on motor development of infants.

Objective: To evaluate the characteristics of speech-language development and to find out the relationship between them and radiological findings, and mental/motor developmental quotient in the children with cerebral palsy and other delayed development.

Method: Fifty-eight children with cerebral palsy or delayed development were evaluated with Bayley scales of infant development, brain magnetic resonance imaging (MRI), and single photon emission computerized tomography (SPECT). At the same time, the speech-language development using several evaluation batteries was assessed.

Results: Most of the children with cerebral palsy or delayed development showed delay in speech-language development. There was no relationship between speech-language development and presence of the lesion on brain MRI or SPECT, and mental/motor developmental quotient.

Conclusion: Speech-language development was delayed in most of the children with cerebral palsy or other delayed development. Therefore, early interventions for speech-language development and comprehensive speech therapy are required for improving functional outcome in these children.

Objective: To evaluate the relationship of the respiration patterns and the abdominal muscle activities during various speech productions in the adults with athetoid cerebral palsy (CP).

Method: Subjects were 7 athetoid CPs and 7 healthy controls. Respirography and abdominal muscle activities were recorded by use of the pneumobelt and the surface EMG during their performances of six kinds of non-speech and speech tasks.

Results: The followings were observed in the athetoid CP.

1) Respiratory phase was irregular and variable in the intensity and period of revolution. The frequency of the respiratory phase was not different from the control in usual respiration, but higher in deep breathing. The time to persist one vowel phonation was shorter.

2) Inappropriate and frequent inspirations were occurred during speech task and the number of syllables was fewer and irregular for one speech breath.

3) The abdominal muscle activities were abrupt, irregular, inconsistent with the respiratory phase during all kinds of non-speech and speech tasks.

Conclusion: These findings suggest that the abnormal respiration patterns and abdominal muscle activities contribute to the abnormal speech production of athetoid CP and their incoordination is similar to athetoid movement of the extremities. We should consider the athetoid speech production as well as the dysarthria in the athetoid CP.

Objective: To investigate the change of peak latency, interpeak latency and amplitude of auditory brainstem evoked potentials (AEPs) in normal preterm infants in accordance with the age, and to find out the correlation between reproducibility of AEPs and high risk of premature infants.

Method: AEP studies were performed on 266 premature infants (male 143, female 123) within a month of the birth. Acquired potentials were grouped by the reproducibility of waveforms, and latency, interpeak latency and amplitude were measured in each group of potentials to interpret age appropriate changes of AEPs.

Results: 1) Peak latency of peak I, III and V were shortened in accordance with the age, especially latency of peak V was significantly decreased from 7.42 msec to 6.84 msec. 2) There was no significant change in interpeak latency or amplitude of AEPs according to the postmenstrual age. 3) Reproducibility of AEPs was worse in premature infants with history of asphyxia.

Conclusion: Considering the results, the latency of peak V can be used as one of the useful parameter to investigate and follow up the premature infants. Significant negative correlation between low grade reproducibility and history of neonatal asphyxia was found.

Objective: To identify psychological disturbance occurring in Duchenne Muscular Dystrophy (DMD) children.

Method: Fifty one DMD children aged from 5 up to 14 years and 51 age matched healthy children were evaluated. Korean child behavioral cheak list (K-CBCL) was used to evaluate psychological problems in DMD and healthy control children. Korean Wechsler Intelligence Scale for children were performed in DMD children to evaluate cognitive function. To evaluate children's functional level, Brooke's scale for upper extremities and Vignos' scale for lower extremities were used. A correlational analysis was performed between age and total IQ score and K-CBCL subscales.

Results: K-CBCL profiles of the DMD children and control group revealed that DMD children obtained significantly lower scores on social, school, total social competence scales (P＜0.01) and significantly higher scores on withdrawn, somatic complaints, anxious/depressed, immaturity, attention problems, internalizing problem, total behavior problems and emotional ability (P＜0.01). Correlations of the age and functional level of the DMD group with each social scale of the CBCL resulted in significant negative relationship on social, school, and total social competence scales (P＜0.01) and significant positive relationship on withdrawn, somatic complaints, anxious/depressed, immaturity, internalizing problems and total behavior problems (P＜0.01). Correlational analysis of IQ score of the DMD group and each scale of the CBCL revealed no significant relationships except school (P＜0.05) and total behavioral problem (P＜0.05).

Conclusion: We concluded that DMD children suffer from wide spectrum of psychological disturbance such as somatic complaints, attention and emotional problems in addition to expected psychological problems due to chronic disease and its progression. Thus, for the successful rehabilitation, these various emotional disturbances need proper treatment.

Objective: The purpose of this study is to evaluate the effects of regular sports activity on psychosocial adaptation, natural killer cell activity (NKCA) as an immunologic measure and HDL-cholesterol level as an indirect index of heart disease in chronic spinal cord injured persons.

Method: We compared two groups. One is sports group (n=13) who has been doing regular sports activity more than three hours a week for at least one year. Another group who leads sedentary life matched age and body mass index served as a control group (n=13). For the evaluation of psychosocial adaptation, we assessed Rosenberg Self Esteem Scale as subjective measure, Craig Handicap Assessment and Reporting Technique (CHART) as objective measure and Symptom Checklist 90 Revision (SCL-90-R) as a psychologic evaluation. NKCA and serum HDL-cholesterol level were assessed.

Results: There was no significant difference in subjective measure and psychologic evaluation between two groups. CHART score and NKCA are significantly higher in the sports group than in the control group (p＜0.05). HDL cholesterol level was increased in the sports group compared with the control group.

Conclusion: Participating in regular sports activity improved the psychosocial adaptation and immune system in chronic spinal cord injured persons.

Objective: The purposes of this study were 1) to evaluate the effectiveness of follow-up urologic evaluation of neurogenic bladder in patients with spinal cord injury, 2) to define risk factors causing upper urinary tract complications, and 3) to evaluate changes of the vesicoureteral reflux grade on follow-up study.

Method: Urodynamic studys, ultrasonographys, and voiding cystourethrographys of 90 patients with spinal cord injury who admitted to the bladder clinic of National Rehabilitation Hostpital were evaluated. Of the 90 patients, twenty four patients (27%) had upper urinary tract complication (vesicoureteral reflux or hydronephrosis). The risk factors of upper urinary tract complication were compared. The patients who had vesicoureteral reflux were devided into two main groups: conservative medical treatment group (oxybutynin, atropine intravesical instillation and intermittent catheterization) and primary surgical treatment group, and then the changes of the vesicoureteral reflux grade on follow-up study were evlauated.

Results: 1) The incidence of upper urinary tract complication was 27% for all patients. After bladder clinic evaluation, the patients who were recommended the change of the voiding mothods were 24%, and 58% of the patients were need management to decrease maximal detrusor pressure.

2) Maximal bladder capacity by clinical voiding chart recording (≤250 ml), bladder wall deformity (≥trabeculation grade 2), leak point pressure (≥40 cmH₂0), and maximal detrusor pressure (≥90 cmH₂O) were significantly different between patients with upper urinary tract complication and patients without that. 3) In the eight vesicoureteral reflux patients, five of six patients were cured or improved with conservative treatment and two patients were cured with surgical treatment.

Conclusion: The periodic follow-up evaluation of neurogenic bladder of spinal cord injured patients was important to prevent upper urinary tract deterioration. The factors related upper urinary tract complication were clinical bladder capacity, leak point pressure, bladder wall deformity (trabeculation) and maximal detrusor pressure.

Objective: To delineate the role of antidiuretic hormone (ADH) in relation to nocturnal polyuria, and to identify the factors influencing on the diurnal antidiuretic hormone level.

Method: The ADH was measured by radioimmuoassay at daytime (2:00 PM) and at nighttime (2:00 AM) with nocturnal polyuria group (11) and without nocturnal polyuria group (8). Urine volume, serum osmolarity, urine osmolarity, and blood pressure were also measured at the same time.

Results: 1) The ADH at 2:00 AM did not increase in nocturnal polyuria group, although it increased in no-symptom group. 2) There was a statistically significant correlation between wheelchair ambulation time and daytime ADH level. 3) The difference of ADH level between daytime and nighttime showed decrease in orthostatic hypotension group.

Conclusion: There was relationship between nocturnal polyuria and diurnal variation of ADH level. The ADH concentration seems to be influenced by the postural factors and sympathetic factors.

Objective: Carpal tunnel syndrome (CTS), a common entrapment neuropathy of the median nerve at the wrist, can be diagnosed clinically and electrophysiologically and treated successfully. The purpose of this study was to determine an association between clinical findings and the electrodiagnostic severity of this syndrome.

Method: Medical records of 313 patients with CTS which was confirmed based on clinical and electrophysiological findings were reviewed. Clinical symptoms and signs (thenar atrophy, sensory change, positive Tinel sign and Phalen test) and electrodiagnostic values were recorded. CTS severity was determined according to the modified Stevens' criteria. The relationship between electrodiagnostic severity and clinical findings was investigated and statistically analyzed using the ANOVA and chi square tests.

Results: The median motor and sensory latencies became prolonged and amplitudes decreased with worsening electrophysiological severity of CTS, and the differences between severity groups were statistically significant. The frequency of symptoms and signs obtained was significantly greater in the more severe CTS groups.

Conclusion: A positive correlation exists between the frequency of clinical findings and electrophysiological severity of CTS.

Objective: There is a room for considerable error in the measurement of across-elbow conduction velocity due to the different possible positions of the elbow and the difficulty in measuring distance accurately. We propose a technique for the measurement of conduction velocity through the elbow segment in a fully flexed elbow position with the arm abducted at 90^o.

Method: We assumed 'ideal' across-elbow segmental conduction velocity is the mean of the forearm and arm segmental conduction velocities, and established an optimal deflection point at the elbow, which best reflects the ideal conduction velocity in normal healthy subjects. Five deflection points were examined at the elbow. Segmental conduction velocities of across-elbow segments were calculated at each of these points, using the sum of the linear distances from each point to the proximal above-elbow cathode stimulation site and to the distal below-elbow cathode stimulation site.

Results: The optimal deflection point was the midpoint between the epicondyle and the olecranon in an arm abducted 90^o and elbow fully flexed position.

Conclusion: Our data suggests that an across-elbow segment velocity lower than 54.2 m/sec, or a difference of more than 11.6 m/sec between the across-elbow and forearm segments is to be considered abnormal. The lower limit values expressed as mean - 2 S.D. for absolute across-elbow segmental conduction velocity and relative velocity difference between the across- elbow segment and forearm segments at other possible deflection points of the elbow were also calculated.

Objective: To assess the possibility of phrenic neuropathy in diabetic patients, and to define the factors that influence phrenic neuropathy in those patients.

Method: Seventeen diabetic patients and sixteen controls participated in this study. The fasting and postprandial 2 hours blood sugar levels, HbA1c study, motor and sensory nerve conduction study, pulmonary function test, and phrenic nerve conduction study were examined in all subjects. The neuropathic disability score (NDS) was measured for clinical assessment in diabetic patients.

Results: 1) The mean duration of diabetes was 12.3⁑7.7 years, and the mean NDS score was 3.2⁑3.8. 2) In pulmonary function test, FEV₁ and FVC of diabetic patients were lower than controls (p＜0.05). 3) The prolonged latency and decreased amplitude of phrenic nerve were shown in diabetic patients compared with controls (p＜0.05). The FEV₁ and FVC in the diabetics with phrenic neuropathy were lower than ones without phrenic neuropathy (p＜0.05). 4) The duration of diabetes, NDS are related to prolonged phrenic latency.

Conclusion: The diabetic patients with decreased pulmonary function with might be related phrenic neuropathy. The prolonged latencies of phrenic nerve were related with longer duration of diabetes and higher NDS score.

Objective: To investigate the effects of Jendrassik maneuver on latency and amplitude of the T-reflex and H-reflex of the soleus muscle in normal adults.

Method: The T-reflex and H-reflex tests were performed on sixty normal adults with standardized technique using the soleus muscle. The shortest latency and the largest peak-to-peak amplitude were chosen for representative values.

Results: The results were as follows: 1) There was a significant difference in latency of the T-reflex between with and without Jendrassik maneuver. 2) The increment ratio of the amplitude with Jendrassik maneuver was 88% in the T-reflex and 18% in the H-reflex. There were a significant difference in the amplitude of both reflexes between with and without Jendrassik maneuver. 3) A high correlation was present between the latency of H- & T-reflex and the length.

Conclusion: According to these results, we suggest that Jendrassik maneuver primarily increases the sensitivity of muscle spindles and decreases the presynaptic inhibition of the Ia terminals at cortical, subcortical and spinal levels. Jendrassik maneuver can be a useful tool in cases of clinically decreased or absent deep tendon reflex.

Objective: To explore the clinical value of postoperative follow-up examination of F-wave and H-reflex in patients with lumbosacral radiculopathy and to clarify optimal timing of follow-up examination.

Method: The subjects were 17 patients with unilateral lumbosacral radiculopathy caused by disc herniation. In patients with the L5 radiculopathy, F-waves were obtained from extensor digitorum brevis and six parameters including minimal latency per height were used. In patients with the S1 radiculopathy, H-reflexes were obtained from gastrocnemius and amplitude and minimal latency were used as parameters. These parameters were evaluated preoperatively and postoperatively at week 1, 3, 6. These changes of the parameters and clinical findings were related.

Results: The parameters of peroneal F-wave and tibial H-reflex showed significant improvement at 3 weeks and 6 weeks after surgery. The improvements of these parameters were not related with clinical improvement at 1 week after operation, but these were significantly related with improvement of pain and muscle weakness at 3 weeks after operation.

Conclusion: These findings suggested that follow-up examination of F-wave and H-reflex were valuable for objective assessment of lumbosacral radiculopathy after operation and the optimal timing for follow-up study was 3 weeks after operation.

Objective: This study was designed to observe how the mento-blink reflex (MBR) study is valuable in evaluating the inferior alveolar nerve injury.

Method: Eleven patients, suffering from the sensory discomfort after extraction of the third molar, and a control group consisting of 20 healthy individuals participated in the clinical neurosensory test (CNST) and the MBR study. The score of CNST was from 0 (normal) to 5 (worst) according to sensory deficit, and the results of MBR were divided into 3 groups: normal; prolongation of R₂ latency; no response.

Results: In the control group, R₂ latencies of right and left were 31.9⁑6.1 msec and 31.5⁑5.9 msec, respectively with the difference of 1.3⁑0.9 msec. The abnormality in the MBR study in patients was correlated with the subjective sensory symptoms (p=0.017) and the abnormality of MBR response was proportional to the score of the CNST.

Conclusion: We concluded that the MBR study is a useful diagnostic tool in reflecting the inferior alveolar nerve lesion.

Object: The isolated posterior femoral cutaneous nerve (PFCN) neuropathy has rarely been described in the literature and documented electrophysiologically, based on the paucity of published report. The purpose of this study was to assess the reference value of somatosensory evoked potentials (SSEP) in posterior femoral cutaneous nerve.

Method: Both legs of twenty healthy adults were tested. Somatosensory evoked potentials were obtained with the active recording electrode placed at Cz', 2 cm posterior to C_Z, and the reference electrode at F_Z (international 10∼20 system). The posterior femoral cutaneous nerve was excited 14 cm proximal to the midpopliteal fossa between the long head of the biceps femoris and the semitendinosus muscles.

Results: The mean latency of right P1 were 35.35⁑3.17 msec, N1 were 45.28⁑2.71 msec and mean peak amplitudes were 1.42⁑0.98 μV. In the left side, mean latency of P1 were 34.54⁑2.89 msec, N1 were 43.87⁑2.44 msec and mean peak amplitudes were 1.20⁑0.53 μV.

Conclusion: Based on the result of this study, the reference values could be used to differentiate and detect the lesion in the case of isolated dysfunction of the posterior femoral cutaneous nerve.

Objective: To evaluate the effect of aerobic exercise training on the cardiovascular system in the early stroke patients by bicycle ergometer exercise test.

Method: 16 stroke patients without cardiac disease were randomly assigned to exercise training group (8 patients) and control group (8 patients). The time interval between the onset of stroke and exercise training was within 90 days. Exercise tests by bicycle ergometer using Astrand-Ryhming protocol were performed twice before and after training. Exercise training was consisted with the intensity of 60∼70% of maximal heart rate, 30 minutes per day, 3 times per week for 6 weeks using bicycle ergometer. Modified Barthel Index (MBI) score and blood lipid profile were recorded before and during training. Blood pressure and heart rate were checked before and during exercise test.

Results: In a training group, maximal systolic blood pressure and rate pressure product were decreased immediately after exercise test after 6-weeks exercise training (p＜0.05). The MBI score and lipid profile were not changed after training.

Conclusion: Early exercise training in the stroke patients for 6 weeks have beneficial effects on the cardiovascular system.

Objective: To evaluate cardiopulmonary function and maximal exercise capacity in patients with ankylosing spondylitis using exercise stress test, the possible causes of reduced maximal exercise capacity and the correlation between dynamic pulmonary function and static pulmonary funtion

Method: Twenty patients with ankylosing spondylitis were evaluated with incremental exercise stress test, static pulmonary function test and the mobility of thoracic cage and spine.

Results: 1) Nineteen patients (95%) showed reduced maximal exercise capacities. 2) Deconditioning was the most frequent cause of reduced maximal exercise capacities (13 patients, 68%). 3) There was no significant correlation between exercise stress test and static pulmonary function test, and between exercise stress test and the mobility of the spine and thoracic cage.

Conclusion: Maximal exercise capacities were reduced in patients with ankylosing spondylitis, and the most frequent cause of them was deconditioning. To improve exercise capacity, conditioning exercise should be emphasized in patients with ankylosing spondylitis.

Objective: This study was designed to evaluate the relation of leg length discrepancy on ankle muscle strength.

Method: Twenty four adult women were tested (12 leg length equality and 12 leg length discrepancy). Leg length was measured by tape ruler from anterior superior iliac spine to medial malleolus, three times by three different trained examiners. The muscle strength (bilateral ankle dorsiflexors and plantarflexors) was measured by using Cybex 340 dynamometer at 30 degree/sec and 120 degree/sec.

Results: The mean value of leg length discrepancy was 0.89⁑0.24 cm. In leg length discrepancy group, the peak torque of ankle plantarflexor were 44.50⁑20.94 Nm in long leg and 51.83⁑12.75 Nm in short leg at 30 degree/sec angular velocity (p＜0.05).

Conclusion: We concluded that there were significant increase in plantar flexor peak torques of short leg than those of long legs at 30 degree/sec (P＜0.05). Perhaps the difference of the muscle strength might be due to compensatory mechanism of short leg in propulsion during gait.

Objective: To evaluate the clinical features of lower extremity amputees and the process of prosthetic fitting and its use at follow up and to know the effects of prosthetic rehabilitation on adaptation to prosthesis and its long-term use.

Method: One hundred and twenty four patients who underwent amputation surgery in 3 major hospitals in Korea from 1990 to 1997 were enrolled.

They were evaluated by reviewing of medical records for anthropometry, level of amputation, causes of amputation, other coincidental medical problems, general physical states and followed up by telephone and mail questionnaire with respect to general outcome, prosthetic fitting, satisfaction of prosthesis, state of prosthetic use, functional state of prosthetic ambulation.

Results: The most common cause of amputation was trauma. The mean time to fit the prosthesis was 4.1 months and only 38 patients was supervised by rehabilitation programs. The patients who were supervised by rehabilitation program were fitted and able to ambulate significantly earlier than those who were not. They wore and used prosthesis significantly more often than those who were not supervised. The patients with above knee amputation who were supervised were significantly independent with walking aids.

Conclusion: Rehabilitation training program enables amtupees to be fitted and walk earlier with prosthesis. Also, this program lowered the dependency on walking aids in above knee amputees.

Enterovirus 71 (E-71) infection was first described in 1974 after isolation studies of specimens from a series of patients who had severe neurological disease. One important feature of E-71 is its ability to cause paralytic disease. In the summer of 1997, we identified 4 children with E-71 infection. The striking feature of this outbreak is the occurrence of all cases with polio-like paralytic disease. Other disease associated with E-71 infection included aseptic meningitis, meningoencephalitis, respiratory disease, gastroenteritis, and hand-foot-mouth disease. The spectrum of illness observed in our cases was compared to that seen in other outbreaks. It is suggested that the significance of E-71 infection lies in its neuropathogenic potential. There is no specific, therapeutic modality of E-71 infection but its prognosis is good except some cases.

Diabetic muscle infarction (DMI) is an unusual neuromuscular complication of diabetes mellitus. It tends to occur in young, poorly controlled, insulin dependent diabetic patient with end-organ complication. We report a 24-year-old woman with diabetic muscle infarction in both lower extremities. DMI began with an abrupt onset of pain, tenderness, swelling and formation of a firm mass. MRI revealed an increase in the signal intensity on T2 weighted image and SPECT showed an increased uptake of Tc-99m-pyrophosphate (PYP) in affected muscles. We report this case with review of the literature.