Objective
To investigate the effect of steroid administration on the apoptosis and heat shock protein 70 (HSP70) expression after exercise in the animal model of Duchenne muscular dystrophy. Method: We measured Bcl-2, BAX and HSP70 expression by western blotting. 20 control and 20 mdx mice were divided into free-living (n=10) and exercise (n=10) groups. Free-living and exercise groups were further divided into steroid-treated and sham-treated groups to evaluate the effect of steroid administration. Results: Apoptosis was most prominent in the sham-treated exercise group, while apoptosis was significantly reduced in the steroid-treated exercise group. HSP70 expression was maximized in sham-treated exercise group, whereas steroid administration inhibited HSP70 expression after exercise in muscular dystrophy animal model. Exercise loading was found to cause severe apoptosis but steroid administration alleviated apoptotic damage in mdx mice. sConclusion: HSP70 expression was suppressed in the steroid-treated exercise group, which suggests steroid might have major preventive effect in exercise-induced apoptosis of muscular dystrophy animal model. (J Korean Acad Rehab Med 2009; 33: 1-4)

Objective
To investigate whether transcranial direct current stimulation (tDCS) could improve the motor function of hemiparetic upper limb in chronic stroke patients through randomized double-blinded, sham-controlled study. Method: Twenty chronic post-stroke hemiparetic patients participated in this study. They were randomly assigned into either tDCS or sham group. Anodal tDCS was delivered on lesional primary motor cortex for 20 minutes in tDCS group and 30 seconds in sham group. Just after stimulation, both groups performed the shaping exercise for 30 minutes. Total 10 stimulation sessions (5 session/week for 2 weeks) were administered. Fugl-Meyer motor assessment, box and block test, grasp strength and FIM were assessed before stimulation, after 1 week of stimulation, after 2 weeks of stimulation, and 2 weeks after stimulation. Results: The upper extremity score of Fugl-Meyer motor assessment and box and block test improved significantly in tDCS group compared to sham group (p＜0.05). Their improvement lasted significantly for 2 week after stimulation. However, FIM, lower extremity score of Fugl-Meyer motor assessment and grasp power did not improved significantly in tDCS group compared to sham group. Conclusion: tDCS can improve the motor function of hemiparetic upper limb in chronic post-stroke patients, and the effects lasted after stimulation. tDCS may be used as an additional tool for stroke rehabilitation. (J Korean Acad Rehab Med 2009; 33: 5-11)

Objective
To test the feasibility of newly developed 3- dimensional virtual reality (VR) program for assessing the post-stroke cognitive dysfunction. Method: Thirty five post-stroke patients and twenty normal healthy subjects were recruited in this study, and post-stroke patients were classified into three groups according to the severity of cognitive dysfunction. We developed three dimensional virtual reality program to assess the cognitive function with virtual subway environment from taking a subway to arriving at one's destination. The total score, number of success and cue were obtained during completing virtual tasks. We investigated the test-retest reliability, and the parameters of the 3-dimensional VR program were compared with Korean Mini-mental status examination. Results: All parameters of the VR program were significantly correlated with MMSE score (p＜0.01), and showed the significant difference between patient subgroups and control group (p＜0.05). The test-retest reliability of the VR program was significantly high (p＜0.01). Conclusion: Three dimensional virtual reality program may be helpful to assess the cognitive function in patients with stroke. (J Korean Acad Rehab Med 2009; 33: 12-20)

Objective
To investigate the change of respiratory function and relationship between pulmonary function and functional improvement following rehabilitation in acute hemiplegic stroke patients. Method: Thirteen stroke patients were enrolled in this study. To evaluate hemi-diaphragmatic paralysis, we checked chest radiographs in the inspiration and expiration position of all patients. When diaphragmatic paralysis was suspected, fluoroscopy of diaphragm was conducted. To evaluate respiratory function, pulmonary function test and peak cough flow (PCF) were performed before and 3 weeks after conventional rehabilitation period. To evaluate correlation of functional performance, motor and pulmonary function, Motricity index and modified Barthel index were checked also before and 3 weeks after the period. Results: Only one of 13 acute stroke patients was diagnosed as diaphragmatic paralysis. At initial evaluation of pulmonary function test, restrictive pattern was observed in 5 of 13 patients and female and patients with restrictive pattern generally showed lower pulmonary function scores. After rehabilitation, forced inspiratory vital capacity (FIVC), peak expiratory flow rate (PEF), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP) and PCF were significantly improved. Improvements of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV₁), MIP and FIVC were correlated with those of MBI. Conclusion: Decline in respiratory function could be occurred in acute hemiplegic stroke patients. Also, respiratory function could be improved with conventional rehabilitation and may be correlated with functional improvement. Therefore, the evaluation of respiratory function and active rehabilitation therapy should be conducted in acute stage to prevent pulmonary complications and promote functional recovery. (J Korean Acad Rehab Med 2009; 33: 21-28)

Objective
To investigate the effect of functional electrical stimulation (FES) on the motor function of lower limb in hemiplegic patients with stroke or brain injury. Method: Fifty subjects (age, 56.66±9.85 years old; prevalence duration, 113.49±79.94 days after stroke or brain injury) were assigned randomly to 1 of 2 groups; the experimental group (n=25) received conventional rehabilitation with FES and the control group (n=25) received conventional rehabilitation without FES. FES was applied 20 minutes concomitant with rehabilitation, 5 days per week for 4 weeks. Outcome measurements included muscle strength, modified Ashworth scale, Brunnstrom stage, motricity index, 10 meter walking test (10 MWT), and circumference ratios of lower extremity (including thigh and calf). Subjects were evaluated before treatment and at 4 weeks after treatment. Results: No significant differences were found in the baseline measurements. After 4 weeks of treatment, there was significant improvement in thigh circumference ratio and 10 MWT in the FES group, when compared with the control group (p＜0.05). Conclusion: Twenty sessions of FES, applied to postacute stroke or brain injured patients plus conventional rehabilitation, improved their motor and walking ability. (J Korean Acad Rehab Med 2009; 33: 29-35)

Objective
To investigate urodynamic findings and voiding symptoms according to the location of brain lesion after stroke. Method: Twenty-six patients with stroke (19 infarction, 7 hemorrhage) who had complained of voiding dysfunction were studied. Brain MRI was performed to identify the suprapontine lesion or pontine lesion. Intravesical pressure and voiding control function of the external urethral sphincters were evaluated by urodynamic study with electromyographic study of the external urethral sphincter. Also voiding symptoms were evaluated. We classified voiding dysfunction into three subgroups by urodynamic findings as follows: detrusor hyperactivity, detrusor hypoactivity, and normal. Functions of the external urethral sphincters were divided into normal, impairment of external urethral sphincter volitional control (IEUS), and detrusor-sphincter dyssynergia (DSD). The symptoms of voiding dysfunction were categorized into three types as a irritative, obstructive or mixed type. Results: In patients with suprapontine lesion (n=22), 11 (50%) showed hyperactive detrusor and 6 (27.3%) showed hypoactive detrusor. However, in the pontine lesion (n=4), one patient (25%) was normal and the others were hypoactive detrusor. Fourteen cases (64%) of the suprapontine lesion and 1 case (25%) of pontine lesion demonstrated normal external urethral volitional control. Seven of 11 patients with irritative symptoms showed detrusor overactivity. Five of 9 patients with obstructive symptoms showed hypoactive detrusor. Conclusion: We concluded that hyperactive detrusor in suprapontine lesion and hypoactive detrusor in pontine lesion were dominant. However, voiding symptoms in stroke patients were various according to the external urethral sphincter function as well as the detrusor activity. (J Korean Acad Rehab Med 2009; 33: 36-40)

Objective
To evaluate the effect of the biofeedback balance training using Interactive Balance System (IBS) in acute stroke patients. Method: We recruited 40 acute stroke patients who were able to stand independently. The patients were divided into two groups. One group received conventional balance training (control group) and the other group received biofeedback balance training using IBS (case group) for 2 weeks. After training, the effects were evaluated using 3 parameters: indices from IBS (stability score, weight distribution index, and distance form zero point to body's center of pressure (COP) in coordinate), balance assessments (Berg balance scale and postural assessment scale for stroke patients), and functional outcome (the Korean version of modified Barthel index). Results: There were no differences in age and time since onset between the two groups. All parameters were significantly improved in both groups after training. However, the distribution of COP of the case group was significantly closer to the zero point than that of the control group in coordinate after training (p=0.005). Conclusion: Biofeedback balance training using IBS has a better effect on the symmetry in static condition on evaluation using IBS than conventional balance training for acute stroke patients. (J Korean Acad Rehab Med 2009; 33: 41-47)

Objective
To evaluate the relationship between depression and cognitive-behavioral characteristics of caregivers using social problem solving inventory (SPSI), social support or conflict scale (SSS or SCS) and somatic symptoms (SS). Method: Fifty five couples of brain-injured patients and caregivers participated in this study. We conducted a questionnaire survey of caregivers with Beck depression index (BDI), SPSI, SSS, SCS and SS for cognitive-behavioral characteristics. And also we studied demographic factors of patients and caregivers, clinical features of brain-injured patients, care- giving duration and time per day through interview and review of medical records. The statistical analyses were performed by independent t-test, one-way ANOVA, Pearson correlation test and linear regression analysis-stepwise method. Results: BDI of the caregivers showed a negative correlation with SPSI, SSS, patients' MMSE and caregivers' education level, also a positive correlation with SCS, SS and patients' GDS (p＜0.05). And married caregivers showed more depressive mood (p＜0.05). Of these factors, the most influencing factors on BDI were GDS and SCS through linear regression analysis (p＜0.01). Conclusion: MMSE, GDS and education level as cognitive- mental factors rather than physical and economic strain had a statistical correlation with depression of caregivers. Especially, SPSI, SSS and SCS as cognitive-behavioral characteristics should be considered on evaluation of depression of caregivers and will be helpful for successful rehabilitation for patients and caregivers. (J Korean Acad Rehab Med 2009; 33: 48-58)

Objective
To study the effects of a passive exercise in hemiplegic lower limb on the blood flow velocity in the femoral vein compared with functional electrical stimulation. Method: Twenty stroke patients (men 11, women 9) were enrolled. The patients lied down on a table for 15 minutes. Then the investigator performed passive exercise, flexion and extension of the hip, knee and ankle joint of the hemiplegic limb, for 5 minutes with frequency of 1 Hz. At least 24 hours later, functional electrical stimulation was performed to tibialis anterior and gastrocnemius muscles for 20 minutes. We collected the peak blood velocities of the femoral vein before and 0, 15, 30, 45, and 60 minutes after each procedure. Results: The peak blood flow velocities of the femoral vein before passive exercise were 10.3±1.34 cm/sec and 15.4± 2.22, 14.5±1.86, 13.0±1.58, 11.4±1.23, 10.4±1.17 cm/sec at 0, 15, 30, 45, 60 minutes after exercise. There were significant differences until 30 minutes after exercise (p＜0.01). The velocities of the femoral vein were 10.6±1.36, 18.2±2.34, 16.6±2.1, 14.6±1.7, 12.6±1.7, 11.5±1.5 cm/sec for before and 0, 15, 30, 45, 60 minutes after functional electrical stimulation. There were significant differences until 45 minutes after FES (p＜0.01). Conclusion: The passive exercise of hemiplegic lower limb for 5 minutes was effective for increase of femoral blood flow. It may be a good method for preventing a DVT after stroke. (J Korean Acad Rehab Med 2009; 33: 59-63)

Objective
To investigate the prevalence of gait abnormalities of each joint of lower legs in children with spastic cerebral palsy (CP) and to find out the influences of subtype of CP, age, previous surgery and motor function on the gait abnormalities. Method: The gait analysis and foot scan from 320 children with CP were reviewed. Types of gait abnormalities were classified into 5 types for hip joint, 4 types for knee joint and 8 types for foot and ankle joint. The prevalence of gait abnormalities was assessed and the influence of subtype of CP, age, previous surgery and GMFCS (gross motor function classification system) level were also investigated. Results: In foot and ankle joint, intoeing (63.8%) was the most common in all CP. In knee joint, jumping knee (32.8%) was the most common in diplegic and hemiplegic CP but crouch (47.6%) was the most common in quadriplegic CP. The likelihood of having planovalgus and crouch significantly increased with age and pes calcaneus increased after orthopaedic surgery. The children with lower functional level on GMFCS tended to show stiff and recurvatum knee pattern. Conclusion: Predominent gait abnormalities in each joint were assessed. Age, previous surgery, motor function and subtype of children with CP had a significant effect on the prevalence of gait abnormalities in each joint. (J Korean Acad Rehab Med 2009; 33: 64-71)

Objective
To investigate the relationship between spondyloarthropathy and peripheral neuropathy in spinal pain patient undergoing hemodialysis due to chronic renal failure. Method: Subjects were 60 patients complaining posterior neck or back pain, undergoing regular hemodialysis for chronic renal failure. They were divided into two groups according to the radiologic findings: spondyloarthropathy group (SAG, n=28) and no-spondyloarthropathy group (NSAG, n=32). Nerve conduction studies of extremities, simple spinal radiologic examination and bone mineral density at the lumbar spine were taken. Results: Electrodiagnostic study revealed 26 patients (43%) had carpal tunnel syndrome, 32 (53%) had ulnar neuropathy, and 32 (53%) had peripheral polyneuropathy. Carpal tunnel syndrome was more frequent in SAG, but other neuropathic fingings, bone mineral density and duration of hemodialysis were not different between two groups. Conclusion: Nerve conduction study could be useful to screen the peripheral neuropathy in patients undergoing hemodialysis due to chronic renal failure. If they complained spinal pain, and diagnosed as spondyloarthropathy by radiologic examination, we might need to do electrodiagnostic study for early detection and treatment of carpal tunnel syndrome. (J Korean Acad Rehab Med 2009; 33: 72-76)

Objective
To evaluate the effect of extracorporeal shock wave therapy (ESWT) and the improvement of ultrasonographic findings in refractory chronic epicondylitis of the elbow. Method: Twenty seven patients (7 men, 20 women, mean age 47) with minimum 1 year history of chronic epicondylitis of the elbow that was unresponsive to conventional therapy were included. Each patient was treated with 3∼4 sessions of low-energy (0.06∼0.12 mJ/mm², 2000 impulses) ESWT. A 100-point scoring system, Nirschl score and Roles and Maudsley score were evaluated before treatment and at the 3- and 6-month follow-up. Ultrasonography was performed before treatment and at the 3-month follow-up. Results: Total score of a 100-point scoring system and Nirschl score were significantly improved at the 3- and 6-month follow-up compared to before treatment (p＜0.05). Follow up ultrasonography was performed in twenty one patients. Eighteen of 21 patients (85.7%) showed improvement of tendinosis and 4 of 6 patients (66.7%) showed improvement of tear and 3 of 10 patients (30.0%) showed improvement of calcification on ultrasonography. Conclusion: ESWT is safe and effective modality in the treatment of refractory chronic epicondylitis of the elbow. And ultrasonography can be a useful method to evaluate the therapeutic effect of ESWT. (J Korean Acad Rehab Med 2009; 33: 77-83)

Objective
To estimate association between laboratory findings such as serum lipid panel, urine pH, alkaline phosphatase, lactic acid and chronic low back pain patients. Method: A sample (n=112) of blue color employees in an engineering company were divided into three groups, degenerative herniated disc patients, degenerative spondylosis patients and radiculopathy patients. Each group was examined for the correlation between several factors and chronic low back pain. Several factors including laboratory findings with serum total cholesterol, HDL-cholesterol, LDL-cholesterol, triglyceride, urine PH, alkaline phosphatase, lactic acid and smoking were analysed. Results: There was no association between the baseline total cholesterol, HDL-cholesterol, LDL-cholesterol, alkaline phosphatase, urine pH, lactic acid and chronic low back pain. However, the triglyceride levels were significantly higher in degenerative herniated disc patients, degenerative spondylosis patients and smokers. Conclusion: High serum triglyceride predicted incident degenerative chronic low back pain. (J Korean Acad Rehab Med 2009; 33: 84-88)

Objective
To evaluate the outcomes of intensive conservative treatment on extraforaminal lumbar disc herniations. Method: Twenty five patients with extraforaminal lumbar disc herniations with symptomatic radicular pain were included. Under fluoroscopic guidance, 40 mg of triamcinolone was infused around the nerve root after provocation of patient's usual radicular pain. Lumbosacral dynamic stabilization exercise, thermal and electrical therapy, and education of posture correction were added. The clinical outcomes were measured by visual analogue scale (VAS) and Oswestry disability index (ODI) before treatment, one, three, six, and twelve months after the treatment. After twelve months, patients' satisfaction was classified to four categories: excellent, good, fair, or poor. Four patients were dropped out. Results: Follow-up VAS and ODI significantly decreased since post-treatment one month (p＜0.0001). The average score of VAS for lower extremity and back pain reduced significantly from 6.6, 4.5 at pretreatment to 1.5, 1.9 at 12 months post-treatment, respectively (p＜0.0001). The averages of ODI reduced significantly from 65.4% at pretreatment to 25.4% at post-treatment 12 months (p＜0.0001). In patients' satisfaction, seventeen patients (81.0%) were recorded as excellent or good after post-treatment 12 months. Conclusion: Intensive conservative treatment was effective on patients who underwent extraforaminal lumbar disc herniation. Pain relief and functional improvement sustained for 12 months. (J Korean Acad Rehab Med 2009; 33: 89-93)

Objective
To investigate the rates and mean duration of symptom recurrence after repeated radiofrequency thermocoagulations of the lumbar medial branch nerves for facet joint syndrome. Method: Medical records of 284 patients who had consecutive radiofrequency thermocoagulations for facet joint syndrome were reviewed. Responses of repeated radiofrequency thermocoagulations were compared with the initial radiofrequency thermocoagulation for mean duration of symptom recurrence and visual analogue scale (VAS). Results: Forty-one (14.4%) among the patients who had radiofrequency thermocoagulation for facet joint syndrome were treated with additional radiofrequency thermocoagulation because of symptom recurrence. Thirty-seven patients were treated twice and four patients were treated three times. The mean duration of symptom recurrence of these patients was 7.3 months (2.3∼12.3 months). Reduction of the VAS pain scores were significantly lower after repeated radiofrequency thermocoagulations compared with initial radiofrequency thermocoagulation (p＜0.05). Conclusion: With well-defined diagnostic criteria for facet joint syndrome and a meticulous technique of radiofrequency thermocoagulation, radiofrequency thermocoagulation would be a useful treatment modality for patients with facet joint syndrome. (J Korean Acad Rehab Med 2009; 33: 94-97)

Objective
To analyze the bifurcating points of medial plantar proper digital (MPPD) nerve by using anatomical landmarks on plane coordinates and thus determine the ideal stimulation site for MPPD sensory nerve conduction studies. Method: We dissected 10 feet from five adult cadavers and identified the bifurcation points of the MPPD nerve. Two reference lines in relation to anatomical landmarks were defined. A vertical line connecting the mid-point of heel (H) and tip of great toe (G) was defined as the HG line. A transverse line connecting the navicular tuberosity (N) and tuberosity of 5th metatarsal bone (M) was defined as the NM line. The bifurcation points of the 10 MPPD nerves were expressed in X, Y coordinates in relation to these two axis. Results: The bifurcation points were located at approximately 40% (40.0±2.4; mean±SD) of the HG line from the mid-point of heel (H) and at approximately 37% (36.5±3.6) of the NM line from the navicular tuberosity (N). The majority of these points were found to be clustered close to the HG line. Conclusion: The data on the MPPD nerve bifurcation points may be useful to localize the appropriate stimulation site that could be used in MPPD nerve conduction studies. (J Korean Acad Rehab Med 2009; 33: 98-102)

Objective
To determine the effects of the antiresorptive agent bisphosphonate in hemiplegic patients with CRPS and to compare its effects to standard steroid pulse therapy. Method: Thirteen randomly selected hemiplegic patients diagnosed with CRPS received bisphosphonate therapy which consisted of intravenous pamidronate injection of a total cumulative dose of 180 mg in one week. Eleven hemiplegic patients with CRPS received the standard 2-week steroid pulse therapy. Clinical assessments were made for temperature, pain score, volumetry and circumference of both the third digit and wrist. All assessments were carried out twice; before the initiation of therapy and two weeks after pamidronate or steroid therapy. Results: The steroid group showed statistical improvement in pain (p=0.039), total hand volume(p=0.006) wrist (p= 0.007) and 3rd digit (p=0.003) circumference. The pamidronate group showed statistical improvement in pain (p=0.011), wrist (p=0.043) and 3rd digit (p=0.021) circumference; however no statistical improvement was observed in total hand volume (p=0.767). Neither group showed any statistical significance in temperature change. Conclusion: Pamidronate therapy may be an alternative method in managing CRPS in hemiplegic patients with multiple medical comorbidities who are not eligible to receive the conventional steroid therapy. (J Korean Acad Rehab Med 2009; 33: 103-107)

Objective
To determine sensory levels of injury using dermatomal somatosensory evoked potentials (SEPs) and compare with the neurological level of injury determined by ASIA standard in patients with thoracic spinal cord injury. Method: By stimulating segmental thoracic dermatomes, cortical SEPs were studied in nine spinal cord injured patients from T2 to T12 (9 men, mean age 41.8) and 20 normal adult men (mean age, 28.3). The SEP studies were performed bilaterally. Results: In eight cases (44%) of the paraplegics tested, the neurological level of injury by dermatomal SEPs was same compared to the level of injury assessed by ASIA standard. In 15 cases (83%), there were no or one level difference of the level of injury between the levels by SEPs and ASIA standard. Conclusion: This study suggests that dermatomal SEP can be a useful tool in determination of the neurological level of injury in patients with thoracic spinal cord injury. (J Korean Acad Rehab Med 2009; 33: 108-111)

Objective
To determine the relations of parameters of nerve conduction study (NCS) and total symptom score (TSS), neuropathy impairment score (NIS) in diabetic polyneuropathy patients. Method: Seventy three patients with diabetes mellitus were included in the study. The NIS, TSS was scored in each patient by a single examiner. NCS was performed on median, ulnar, tibial, peroneal and sural nerves. Distal latencies, amplitudes and conduction velocities of compound muscles and nerves were used as parameters of NCS. The transformed individual amplitudes and nerve conduction velocities were graded in relation to the mean values and standard deviations of our control group study. Then, composite score (CS) was calculated in each individual and was correlated to the NIS, TSS using correlation analysis. Results: There was a significant linear relationship between CS and NIS-LL (neuropathy impairment score-lower limb) (r=0.718, p＜0.01) Conclusion: This study showed significant correlations between composite score and NIS-LL. Thus, composite score appears to reliably represent the objective neurologic findings. In addition, NIS-LL would be useful in determining the progression of peripheral polyneuropathy in diabetic patients. (J Korean Acad Rehab Med 2009; 33: 112-117)

Mitochondrial cytopathies represent a heterogeneous group of multisystem disorder that preferentially affects the muscle and nervous systems. Mitochondrial respiratory chain enzyme complexes (MRC) defect can be the cause of many unexplained neurological disorders including epilepsy, cerebral palsy, delayed development and hypotonia. We retrospectively reviewed clinical and laboratory features of 16 patients who showed defects in MRC activity, confirmed by biochemical assay from spectrophotometry in muscles to characterize clinical and laboratory features for MRC defects and provide more precise diagnosis and effective treatments. In the patients with uncontrolled seizure activity, developmental regression, characteristic features of bilateral symmetric high signal intensity at deep nucleus and/or white matter in T2WI, the mitochondrial cytopathies should be added to the list of differential diagnoses. And lactate elevation in magnetic resonance spectroscopy (MRS) can be useful in the diagnosis of mitochondrial cytopathies. (J Korean Acad Rehab Med 2009; 33: 118-122)

Idiopathic retroperitoneal fibrosis (IRF) is a rare condition in which a mass of fibrous tissue encompasses the abdominal aorta and the common iliac arteries. Although the histologic findings of IRF are mostly benign, its diagnosis is often delayed, leading to significant physiologic deteriorations, namely renal insufficiency, and poor treatment prognosis. Back pain, which is a common presenting symptom, may lead to confusion in determining the diagnosis of IRF. This report presents a patient with retroperitoneal fibrosis whose diagnosis was delayed due to the concomitant presence of myofascial pain syndrome and lumbar intervertebral disc herniation. (J Korean Acad Rehab Med 2009; 33: 123-126)

We report an elderly woman suffering from bilateral sciatic neuropathy associated with rhabdomyolysis, identified with electrodiagnosis and hip MRI. She was found sitting in the same position following benzodiazepine intoxication for several hours. She complained of thigh pain, asymmetric hypoesthesia and weakness of both lower extremities. The electrodiagnostic study showed profound abnormal spontaneous activities on muscles innervated by sciatic nerve and no action potentials in nerve conduction study indicating bilateral sciatic neuropathy, more severely involved in the right than in the left, between gluteal region and mid thigh level. The hip MRI revealed rhabdomyolysis and inflammatory lesion around sciatic nerve between the ischial spine and 5 cm below ischial tuberosity. The possibilities of focal inflammatory neuropathy triggered by immobilization in chronic illness or vulnerable conditions were reviewed. (J Korean Acad Rehab Med 2009; 33: 127-130)

Chronic pelvic pain is difficult to diagnose and usually has a poor outcome. However, if it was identified early it might have a better prognosis. We treated three patients whose trigger points in obturator internus were diagnosed as origin of myofascial pain. The first patient complained of coccygodynia with pain that radiated up his left leg when walking. The second patient had coccygeal pain that radiated to the left thigh area. The last patient was troubled with coccygeal and pelvic pain at anytime. In all of the cases MRI studies of the lumbar spine and pelvis were unrevealing. Electrodiagnostic studies were normal. The impression was that the patients had the myofascial pain syndrome, therefore injections with local anesthetics and cortisone at the myofascial pain originated in obturator internus. Although each of the patients had different symptoms, they all had a good response to treatment. (J Korean Acad Rehab Med 2009; 33: 131-134)