Objective
To investigate the clinical usefulness of newly developed 3-dimensional virtual reality (VR) program to assess the unilateral neglect. Method: Sixteen unilateral neglect patients and forty healthy subjects were included in this study. Forty healthy subjects were classified into two groups (control group I, II) based on the previous computer experience. This VR program was composed of two sessions, the first session was to search the midpoint of the monitor and the second session was to scan the randomized target movement. Head- mounted display and 3-dimensional position sensor were used during VR program. The unilateral neglect patients performed the line bisection test and the letter cancellation test. The corre-lations of the clinical measurements and the parameters of the 3-dimensional VR program were analyzed. Results: All parameters of the VR program in patient group were significantly different with those in control group I, II (p＜0.05). Left directional parameters were significantly different with right directional parameters of the VR program in patient group (p＜0.05), but not in control group I, II. The parameters of the VR program were significantly correlated with clinical measurements (p＜0.05). Conclusion: The assessment of unilateral neglect using 3- dimensional virtual reality program may be clinically useful. (J Korean Acad Rehab Med 2005; 29: 1-8)

Objective
Comprehensive poststroke rehabilitation includes continuum of care after discharge from hospital. Day hospital is a milieu-oriented outpatient rehabilitation program that offers continuous rehabilitation service to promote psychosocial adaptation and quality of life. This study is to evaluate long-term effects of day hospital program in stroke patients. Method: Forty-eight stroke patients who received day hospital program for 2 or more months after inpatient rehabilitation program and 42 control stroke patients, who received only inpatient rehabilitation program, responded telephone interview for the study. Outcome measurement included the Korean Activities of Daily Living (K-ADL), the Korean Instrumental Activities of Daily Living (K-IADL) and the Medical Outcome Study 8-item Short Form Survey (SF-8). Results: There was no difference in many item scores of K-ADL between day hospital group and control group, but the item scores of dressing, washing face and hands were significantly higher in control group. Among the item scores of K-IADL, except managing money, most item scores of K-IADL were no significant difference between day hospital group and control group. All item scores of SF-8 were significantly higher in day hospital group than control group. Conclusion: Day hospital is an effective rehabilitation program to enhance health-related quality of life for stroke patients. (J Korean Acad Rehab Med 2005; 29: 9-14)

Objective
The aim of this study was to investigate the correlation between crossed cerebellar diaschisis (CCD) and motor evoked potentials (MEPs) and to study the relationship between CCD and the severity and prognosis of stroke. Method: 28 patients with first-ever unilateral stroke were recruited for this study. The central motor conduction times (CMCTs) were obtained from Abductor pollicis brevis (APB) and Abductor hallucis (AH) by recording MEPs. The existence of CCD was evaluated by single photon emission computed tomography (SPECT) of brain. The National Institutes of Health stroke scale (NIHSS), Motricity Index (MI), and functional outcome scales were measured. Results: The presence of CCD correlated significantly with "not evoked" MEPs in upper extremity (p＜0.01). The existence of CCD was not associated with the locations (p＞0.05) and volume of brain lesion (p＞0.05). There was a significant correlation between the presence of CCD and lower MI score of upper extremity (p＜0.05). Conclusion: The presence of CCD would indicate the damage on descending motor pathways and be associated with the severe motor impairment of upper extremity in stroke patients. (J Korean Acad Rehab Med 2005; 29: 15-22)

Objective
To investigate whether the dual route model is applicable to Korean word reading in acquired dyslexia after stroke. Method: Sixty-two year old patient with dyslexia after left inferior temporal and occipital lobe infarct was evaluated according to the lexical processing. After evaluation of general cognitive and language function, visual perception, semantic, and lexical stages were assessed. Results: Visual perception was appropriate, and semantic categorization and picture-word matching tasks were 80.6% and 78.6% correct, respectively. Lexical decision task showed no significant differences within word classes, exceptshorter reaction time in reading words of Korean origin than those of chinese origin (p＜0.05). The patient was able to read only 39.8% of tested words, and he could not read all the non-words. Reading of high frequency word was superior (65.4%) to that of low frequency words (10.9%) and semantic errors were not remarkable (p＜0.05). Conclusion: The patient showed characteristics of recovery from deep to phonologic dyslexia with impairment of grapheme to phoneme conversion (GPC) route. These findings support that dual route model is applicable to Korean word reading. (J Korean Acad Rehab Med 2005; 29: 23-31)

Objective
Decrease of platelet density by degranulation of activated platelet is well correlated with decrease of mean platelet component (MPC) value. We intended to investigate the change of MPC, mean platelet volume, and platelet count according to the stroke stage and difference between ischemic and hemorrhagic infarction. Method: Thirty eight patients (ischemic stroke 28 men, hemorrhagic stroke 10 men) and twenty age-matched healthy persons were included in this study. They were divided into acute stage group and subacute stage group. Each of them were sampled by venously and investigated about mean platelet component, mean platelet volume, and platelet counts. Results: In ischemic stroke, there was statically (p＜0.05) meaningful decrease of MPC value in acute stage (27.5⁑1.7) compared to control group (28.8⁑0.9). And MPC value in subacute stage showed meaningful increase (28.1⁑1.3) compared to acute stage but still remained in statically lower value compared to control value. In hemorrhagic stroke, there was no meaningful difference of MPC value in acute stage group (28.6⁑2.0) and subacute stage group (27.9⁑1.1) compared to control group. Conclusion: In ischemic stroke patients, MPC value in acute stage decreased meaningfully and this change might be useful as a landmark in predicting the activity of infarction. (J Korean Acad Rehab Med 2005; 29: 32-37)

Objective
To evaluate the effect of hyperbaric air therapy (HAT) on activity of cerebral motor cortex Method: Eighteen right-handed subjects were recruited, who had no brain lesion and did not take any medication that can affect brain function. Experimental group (n=9) underwent motor evoked potential (MEP) study by transcranial magnetic stimulation before and after 1-hour HAT. Control group (n=9) also received motor evoked potential study twice with 1 hour interval. The cortical activity was evaluated with parameters such as resting motor threshold (rMT), amplitude of MEP, intracortical inhibition (ICI) and intracortical facilitation (ICF) and recruitment curve (RC). Results: There was no significant difference of rMT, MEP, ICI, ICF and RC between experimental group and control group. Conclusion: One -hour hyperbaric air therapy could not modulate any cortical motor activity in health human brain. (J Korean Acad Rehab Med 2005; 29: 38-42)

Objective
The functional dysphagia scale based on videofluoroscopic swallowing study (VFS scale) is a numeric scale that is directly converted from physiologic parameters of videofluoroscopic swallowing study. We intended to show the clinical validity of the VFS scale by comparing the scale with the American Speech-Language Hearing Association National Outcomes Measurements System Swallowing Scale (ASHA scale) which is a clinical outcome scale based on patient's feeding ability and independence level. Method: Total 101 patients underwent the videofluorosco-pic swallowing studies and the VFS scale and ASHA scale were measured. We compared the two scales by means of Spearman correlation.Results: In 101 patients, the correlation between the two scales was statistically significant (Spearman's correlation coefficient=⁣0.536, p=0.000001). Conclusion: There was close relationship between the physiologic parameters observed during videofluoroscopy and the level of feeding ability and independence. So the VFS scale which is based on the physiologic parameters is clinically valid. (J Korean Acad Rehab Med 2005; 29: 43-49)

Objective
To investigate the effect of distant muscle contraction on the sensory and motor nerve conduction and F-wave studies in stroke patients. Method: During isometric contraction of contralateral hand, sensory nerve action potential (SNAP), compound muscle action potential (CMAP) and F-wave of median nerve were recorded at submaximal and supramaximal stimulus intensity. The subject group consisted of 15 stroke patients and 10 control subjects. Results: At submaximal stimulation, the amplitude and area of SNAP were significantly increased during muscle contraction in both groups (p＜0.05). However there were no changes in parameters of SNAP and CMAP at supramaximal stimulation in both groups. The latency of F-wave was prolonged, and the amplitude was increased in the stroke group than those in the control group at resting state (p＜0.05). The shortening of F-wave latency and increment of F-wave amplitude were observed in the control group during distant muscle contraction, but not in the stroke group. Conclusion: The distant muscle contraction might facilitate the nerve conduction. In addition F-wave elicited during voluntary contraction can be used as a monitor of upper motor neuron disorders. (J Korean Acad Rehab Med 2005; 29: 50-57)

Objective
The purpose of this study was to evaluate the relationship between the visual acuity and visual evoked potentials of the amblyopia patients and normal persons for the demonstration of the visual disability. Method: We performed visual evoked potential study, in 49 eyes of the 43 amblyopia patients and in 76 eyes of 38 normal young adults. Our study was carried out to evaluate the relationship of the visual acuity with N₁, P₁, N₂, P₂ latency, P₁-N₂ amplitude and to compare the latency of N₁, P₁, N₂, P₂, and P₁-N₂ amplitude in amblyopia patients and normal young adults. Results: The mean values of N₁, P₁, N₂, P₂ latency wereprolonged in amblyopia patients compared to normal young adults (p＜0.05). There was no correlation between the visual acuity and P₁ latency (p＞0.05), but significant correlation was noted between the visual acuity and P₁-N₂ amplitude (p＜0.05). Conclusion: These results showed prolonged latency of N₁, P₁, N₂, P₂ in amblyopia group as well as significant correlation between visual acuity and P₁-N₂ amplitude in both groups. So, P₁ latency and P₁-N₂ amplitude are good parameters in evaluating the visual disability. (J Korean Acad Rehab Med 2005; 29: 58-62)

Objective
The purpose of this study was to investigate the prevalence and risk factors of ulnar neuropathy at the elbow (UNE) in a rural district in Korea. Method: Among the 578 residents in a rural district who participated in the health examination, 450 (116 male, 334 female) adults were randomly selected. A symptom questionnaire and electrodiagnostic studies were used to diagnose UNE. General characteristics, female-related factors, work-related factors and anthropometric measurements were compared between normal and UNE group to identify the risk factors of UNE. Results: Subjects with UNE were 29 (6.4%), symptom without electrodiagnosis findings 23 (5.1%), asymptomatic subjects were 379 (84.2%). Diabetes mellitus, repetitive heavy lifting were risk factors of UNE. Conclusion: The prevalence of UNE was 6.4% in a rural district and these data suggest that medical conditions like diabetes mellitus and physical factors like repetitive heavy lifting are risk factors of UNE. (J Korean Acad Rehab Med 2005; 29: 63-69)

Objective
To compare the surgical outcomes of carpal tunnel release in diabetic and non-diabetic patients. Method: Among the patients who underwent carpal tunnel release for carpal tunnel syndrome, 44 subjects (77 hands) were recruited and classified into two patient groups: group 1 composed of 20 subject (36 hands) with diabetes mellitus and group 2 with 24 subjects (41 hands) without diabetes mellitus. Electrodiagnostic parameters were included onset latency, peak latency, and amplitude of median motor and sensory nerves pre- and postoperatively. Also symptom (visual analogue scale) and complication were assessed.Results: Postoperative evaluation was done at 42.8 months and 84.5 months in patients groups 1 and 2, respectively. All the electrodiagnostic parameters and symptoms showed improvement postoperatively in both groups of patients (p＜0.05), but showed no significant difference between the two groups (p＞0.05). Conclusion: To relieve the carpal tunnel syndrome in diabetic patients, as in non diabetic patients, surgical release of carpal tunnel would be considered positively. (J Korean Acad Rehab Med 2005; 29: 70-75)

Objective
To investigate the evidence of improvement of spinal mobility and the radiologic change of ankylosing spondylitis with comprehensive rehabilitative management. Method: We retrospectively studied spinal mobility index and radiologic changes of the twenty eight patients who had met the modified New York criteria of ankylosing spondylitis. Results: Patients comprised 25 men and 3 women with age ranged from 22 to 63 (mean 44.9) years. With spinal mobility index, including Schöber index, lumbar lateral bending, chest expansion, occiput to wall, and finger to floor, all indices showed improvement after comprehensive rehabilitative management. When we evaluated the correlation between spinal mobility index and radiologic change scored by Bath ankylosing spondylitis radiology index (BASRI), patients with mild radiologic change (BASRI grade 0-2) showed improvement in spinal mobility. Radiologic change from initial visit to after one year showed no statistical difference. Conclusion: We found that intensive rehabilitative management increases spinal mobility of the patients with ankylosing spondylitis. (J Korean Acad Rehab Med 2005; 29: 76-80)

Objective
The purpose of this study was to investigate physical and ultrasonographic (US) imaging findings in pain-free shoulders of high school baseball players. Method: Physical examination including range of motion (ROM) and several pain provocative tests and US examination on both shoulders in forty-one high school baseball players were performed. The findings of these examinations were classified according to the dominance of shoulders and position of the players and described. Results: Neer, Jobe, Hawkins test, and acromioclavicular tenderness were positive in 33.3%, 4.8%, 28.6%, and 38.3% respectively. Dominant shoulders had larger ROM of exter-nal rotation and internal rotation than non-dominant shoulders (p＜0.05). Dominant shoulders of pitchers group had larger ROM of external rotation and smaller ROM of internal rotation than those of non-pitchers group (p＜0.05). Dominant supraspinatus tendons of pitchers group were thicker than those of non-pitchers group (p＜0.05). Conclusion: About one third of pain-free shoulders of baseball players showed positive in pain provocative tests. There were several differences in shoulder ROM and ultrasonographic thickness of supraspinatus tendon according to the dominance of shoulders and position of players. (J Korean Acad Rehab Med 2005; 29: 81-86)

Objective
The purpose of this study was to investigate the serum and synovial IGF-I levels in 30 patients with knee osteoarthritis (OA) and the relationships among the IGF-I level, pain intensity and severity of knee OA. Method: Thirty patients who met criteria of knee OA of American Rheumatology Association participated in this study. Samples of serum and synovial fluid were obtained from all patients. The levels of IGF-I were determined by radioimmunoassay (RIA). The intensity of pain was assessed by Pain Rating Score (PRS) and Visual Analogue Scale (VAS). The severity of knee OA was evaluated by Kellgren's grade of knee OA. Results: The mean serum and synovial IGF-I level was 231.66±86.15 ng/ml and 122.42±37.79 ng/ml, respectively. There was no correlation between pain intensity and IGF-I levels. Neither was there statistically significant correlation between Kellgren's grade and IGF-I levels. Conclusion: The serum and synovial IGF-I levels were not related with pain intensity and severity of knee OA. (J Korean Acad Rehab Med 2005; 29: 87-91)

Objective
This study was performed to investigate the effect and safety of cardiac rehabilitation program in heart failure. Method: 36 patients who suffered from heart failure with decreased left ventricular ejection fraction less than 50% by echocardiogram were recruited for study subject. They took graded exercise test before and after cardiac rehabilitation program. Cardiac rehabilitation program was consisted of 6∼8 weeks monitoring exercise according to the result of exercise test. We reviewed the all courses of the program to see the safety and compared the several results to know the effect of the program. Results: During totally 696 exercise-hours with ECG monitoring, 12 abnormal hemodynamic responses were happened,but those were minor in severity. All of them were managed successfully and could complete their exercise program as their schedules. Even in heart failure patients, cardiac rehabilitation program could improve exercise capacity in terms of increased maximal oxygen consumption, maximal exercise time, and maximal myocardial oxygen demand. Submaximal myocardial oxygen demand and rate of perceived exertion were significantly decreased after cardiac rehabilitation program. Conclusion: In case of prudent monitoring and proper management, cardiac rehabilitation program is safe and effective to improve exercise capacity in heart failure patient. (J Korean Acad Rehab Med 2005; 29: 92-97)

Objective
To investigate whether early postmastectomy rehabilitation program could improve shoulder function and upper limb edema. Method: 40 patients who underwent either a breast conserving procedure or a modified radical mastectomy were included. Among 40 patients, 20 patients recieved early postmastectomy rehabilitation program and 20 patients were recieved only instruction for exercise. The patinets were assessed on the three days after surgery and one month after surgery. The range of motion (ROM) of shoulder, pain onmobility of shoulder and arm circumference were evaluated. Results: One month after surgery, both groups showed improvements in shoulder motion range, pain and edema. But there were significantly better in early rehabilitation group than control group (p＜0.05). Conclusion: We concluded that early postmastectomy rehabilitation program was beneficial in regaining the shoulder motion and in reduction of pain and edema. (J Korean Acad Rehab Med 2005; 29: 98-101)

Objective
To determine the effects on the lumbar stability caused by various thoracic exercise programs, the extent of spinal posture correction and the increase in thoracic mobility to the extension direction. Method: Exercise programs, which can increase the thoracic mobility to the extension direction, were applied to the exercise group. The control subjects were trained for the correct posture according to ergonomic principles by exercise at home and at the clinic. Both groups had three sessions of exercise program per week for 8 weeks. Results: A comparison of the various parameters in the exercise group before and after exercise showed that the VAS, thoracic kyphosis and lumbar mobility decreasedsignificantly (p＜0.05), and the thoracic mobility in the extension direction, chest expansion, maximal elevation of the arms and spinal length increased significantly (p＜0.05). In addition, the thoracic kyphosis and lumbar mobility increased significantly (p＜0.05), and thoracic mobility in the extension direction, chest expansion, maximum elevation of the arms and the spinal length decreased significantly (p＜0.05), but the VAS did not show a significant difference. Conclusion: A thoracic exercise program, which can correct the posture, improve the functional restrictions of the thoracic spine and reduce the lumbar mobility, is very important. (J Korean Acad Rehab Med 2005; 29: 102-108)

Objective
To investigate the effect and the correlation of characteristics of joint motion of lower extremity according to aging on balance in elderly. Method: There were thirty nine healthy elderly subjects aged 60 and older. The subjects were divided into 3 groups by their age. Each group was measured with joint motion of bilateral lower extremities by goniometer. The subjects were evaluated with clinical balance tests [(Berg balance scale (BBS), Functional reach test (FRT), Tinetti's performance oriented mobility assessment (POMA), and one leg standing (OLS)]. Results: The flexibilities of lower extremities were decreased according to the increase in age. The balanceability was also decreased according to the increase in age by tested clinical balance scores. The flexibility of the ankle joints showed the strongest correlation with clinical balance scores (BBS, FRT, POMA and OLS) according to the increase in age, and the flexibility of hip joints also correlated with clinical balance scores (POMA and OLS). Conclusion: Among clinically validated balance tests, the decline of balance performance related with aging. Correlation exists between ankle ROM and balance in healthy elderly people. Additional research is needed to add the ankle ROM to reflect the excise for balance tests and balance ability. (J Korean Acad Rehab Med 2005; 29: 109-118)

Objective
The purpose of this study was to analysis the medial longitudinal arch of the foot with simple radiography Method: We reviewed 387 feet of 219 patients with no deformity who took weight-bearing foot simple radiography. Foot length, length from talonavicular joint to posterior heel (TN), length from cuneonavicular joint to posterior heel (CN), length from cuneiform-metatarsal joint to posterior heel (CM) were measured with the digital imaging and communication in medicine (DICOM) files of the picture archiving communication system (PACS) (PiViewSTAR^Ⱂ, INFINITT, Korea).Results: There was significant correlation of foot length and relative location of joints of medial longitudinal arch. In males, relative value to foot length of TN, CN, CM was 39.86⁑0.97%, 45.97⁑1.20%, and 57.12⁑1.15% respectively. In females, relative value to foot length of TN, CN, CM was 39.41⁑1.19%, 47.12⁑1.44%, and 56.51⁑1.37% respectively. There were significant differences between men and women for location of joints of medial longitudinal arch. Conclusion: Location of joints of the medial longitudinal arch of the foot can be given a numerical value. (J Korean Acad Rehab Med 2005; 29: 119-121)

Objective
To investigate the characteristics, predictors, and consequences of pressure ulcers and to provide prospective epidemiologic data. Method: The prospective data of 100 patients with pressure ulcers were collected who were admitted to the department of rehabilitation medicine of 4 hospitals from 2002 June to 2003 September. We have collected the informations on clinical features of pressure ulcer prospectively. Results: Quadriplegia/Tetraplegia was the most commonly involved type of injury, followed by hemiplegia, paraplegia. Most patients developed pressure ulcer before they were transferred to the rehabilitation unit. The average Braden scale scores was 13.06⁑3.46 and were 16 point or below in 80% of patients, and this point was considered as the cut-off score of the patients with high risk. Sacrum was the most common site of the ulcers and most ulcers were 2nd and 3rd stage. The ulcers were treated with conservative (82%) or surgical management (18%). The more severe and larger ulcers required the surgical management. Conclusion: The results of this prospective study on clinical features would be helpful for the understandings, prevention and management of pressure ulcers. (J Korean Acad Rehab Med 2005; 29: 122-127)

Objective
To evaluate the effect of Vacuum-Assisted Closure (V.A.C.) therapy in stage 3 or 4 pressure ulcers refractory to traditional saline wet gauze dressing. Method: Ten patients who had stage 3 or 4 pressure ulcers which were failed to heal with saline wet gauze dressing over 4 weeks were investigated. We treated these subjects with V.A.C. therapy. The length, width and depth of pressure ulcers were evaluated every week for 3 weeks. Soft tissue biopsy from pressure ulcer was taken before starting V.A.C. therapy and after the scheduled therapy was done. Results: The sizes of length, width and depth in pressure ulcer were significantly decreased after one week of V.A.C. application. And then healthy granulation tissue was formed. The length, width and depth of the pressure ulcer were decreased of 40.2%, 42.7% and 79.8% of their original size. Soft tissue biopsy in pressure ulcers was taken in 4 cases, the number and size of capillaries were more increased and inflammatory cells were decreased.Conclusion: V.A.C. therapy promoted wound healing and revealed favorable histological changes in pressure ulcers refractory to traditional dressing. We suggest that V.A.C. therapy can be used for the effective management of pressure ulcer. (J Korean Acad Rehab Med 2005; 29: 128- 134)

Objective
To identify the factors which can delay home discharges or transfers to other hospitals of rehabilitation inpatients in a tertiary hospital and the change of discharge destination during past 6 years. Method: This was a retrospective study of patients with a diagnosis of stroke, traumatic brain injury or spinal cord injury who were admitted to our hospital in 1996, 1999, 2001 and 2003. Demographic data, length of stay, discharge destination and functional status by the FIM^TM instrument were studied by a medical record review. Result: Patients who were transferred to other hospitals ordischarged with delay showed significantly lower admission and discharge FIM scores, lower FIM efficiencies, longer length of stays and longer intervals between the onset and admission to a rehabilitation ward. Conclusion: Lower functional outcome was associated with a longer length of stay and discharge to another hospital. It would be necessary to establish the long term rehabilitation care facilities with extended rehabilitation program for the patients with lower functional gains in a rehabilitation unit of the tertiary hospitals. (J Korean Acad Rehab Med 2005; 29: 135-140)

We reported three types of newly designed arm slings (the "V" strap pouch arm sling, the Modified hemisling, the Tripod arm sling). The three slings and the conventional hemisling were all tested by a single stroke patient for the correction of shoulder subluxation. Sling effectiveness was evaluated by simple shoulder AP X-rays, quantitative electromyography (root mean square; RMS), strap tension, and preference of the patient. Of the four types, the "V" strap pouch arm sling reduced the vertical displacement the most. RMS values of the supraspinatus muscle tended decrease and strap tension was also lower after using the "V" strap pouch arm sling compared with others. The patient also preferred the "V" strap pouch arm sling to the other slings. We suggested that "V" strap pouch arm sling was the most effective among four types of arm slings (including conventional hemisling) for the correction of shoulder subluxation, and patient's preference. (J Korean Acad Rehab Med 2005; 29: 141-144)

Syringomyelia may present with confusing, unilateral patterns of segmental muscle involvement and dissociated sensory loss. The objective of this study was to report a patient with syringomyelia and Chiari malformation type 1 (CM 1) who had an unusual presentation suggesting lower cervical radiculopathy. A 50-year-old woman presented with clinical evidence of left lower cervical radiculopathy. Nerve conduction studies revealed normal in both motor and sensorynerves of the left upper extremity. Electromyography showed abnormal spontaneous activities in the paracervical muscles at C7-T1 levels and in some examined muscles of the left upper extremity such as abductor pollicis brevis and abductor digiti minimi muscles. Magnetic resonance imaging of cervical spine demonstrated syringomyelia at C4- T4 levels. Syringomyelia may clinically mimic lower cervical radiculopathy. (J Korean Acad Rehab Med 2005; 29: 145-148)

Pancoast tumor is a specific lung carcinoma that has symptoms according to the location. It often involves the extrathoracic structure more than parenchyme of lung, that cause shoulder pain. A 61-years old man had been complaining of shoulder pain and limitation of range of motions of shoulder joint. Conservative management of the shoulder pain was not effective with physical therapy and injection therapy and the symptom of right upper extremity radiating pain had been aggravated. We had examination of the eletro-diagnostic test in 17 months after shoulder pain was developed. The findngs of the electrodiagnostic test was suspected as the injury of lower trunk of brachial plexus, so we had checked MRI on brachial view. The pancoast tumor was found in the extrathoracic region that invaded the lower trunk of the brachial plexus. The shoulder pain related with tumor was rare and could cause brachial plexopathy. (J Korean Acad Rehab Med 2005; 29: 149-153)