Citations
To evaluate the effect of a modified hand compression bandage in patients with a post-burn hand edema.
Patients were recruited from burn centers. We classified the patients into two groups: the modified hand compression bandage group comprising of 22 patients who had a modified hand compression bandage and received conventional physical therapy and the conventionally treated group, comprising of 20 patients who received only conventional physical therapy during the 4-week period post-burn. Hand circumference, hand skin thickness, and hand function were evaluated by grip strength, active range of motion (ROM), Jebsen hand function test, and visual analogue scale (VAS). These assessments were used to evaluate treatment effectiveness prior to the first treatment, 2 weeks after the first treatment, 4 weeks after the first treatment, and 4 months after the first treatment.
As a result of repeated-measures analysis of variance on hand circumference, skin thickness, VAS, and each metacarpophalangeal joint ROM, we found significant differences that corresponded to time effect (p<0.05) and time×group (reciprocal action) effect (p<0.05). The results of grasp power, Jebsen hand function test, and each proximal interphalangeal joint ROM, show significant differences in accordance with the time effect (p<0.05), however, there was no reciprocal action effect (p>0.05).
The modified hand compression bandage will be clinically useful for the treatment of patients with post-burn hand edemas.
Citations
Type 2 superior labral anterior to posterior (SLAP) lesion is a common cause of shoulder pain requiring surgical operation. SLAP tears are often associated with paralabral cysts, but they rarely cause nerve compression. However, we experienced two cases of type 2 SLAP-related paralabral cysts at the spinoglenoid notch which were confirmed as isolated nerve entrapment of the infraspinatus branch of the suprascapular nerve by electrodiagnostic assessment and magnetic resonance imaging. In these pathological conditions, comprehensive electrodiagnostic evaluation is warranted for confirmation of neuropathy, while surgical decompression of the paralabral cyst combined with SLAP repair is recommended.
Citations
To determine clinical and radiological factors that predict the successful outcome of percutaneous disc decompression (PDD) in patients with lumbar herniated nucleus pulposus (HNP).
We retrospectively reviewed the clinical and radiological features of patients who underwent lumbar PDD from April 2009 to March 2013. Sixty-nine patients with lumbar HNP were studied. Clinical outcome was assessed by the visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Multivariate logistic regression analysis was performed to assess relationship among clinical and radiological factors and the successful outcome of the PDD.
The VAS and the ODI decreased significantly at 1 year follow-up (p<0.01). One year after PDD, the reduction of the VAS (ΔVAS) was significantly greater in the patients with pain for <6 months (p=0.03) and subarticular HNP (p=0.015). The reduction of the ODI (ΔODI) was significantly greater in the patients with high intensity zone (p=0.04). Multivariate logistic regression analysis revealed the following 5 factors that were associated with the successful outcome after PDD: pain duration for <6 months (odds ratio [OR]=14.036; p=0.006), positive straight leg raising test (OR=8.425, p=0.014), the extruded HNP (OR=0.106, p=0.04), the sequestrated HNP (OR=0.037, p=0.026), and the subarticular HNP (OR=10.876, p=0.012).
PDD provided significant improvement of pain and disability of patients. The results of the analysis indicated that the duration of pain <6 months, positive straight leg raising test, the subarticular HNP, and the protruded HNP were predicting factors associated with the successful response of PDD in patients with lumbar HNP.
Citations
Immunoglobulin G4 (IgG4)-related sclerosing disease is a systemic disease, characterized by mass forming inflammatory lesions which respond well to steroid therapy. Pancreas is the most common site of involvement, and other organ involvements are also common. However, there are only a few reports about central nervous system involvement. We report a case of IgG4-related sclerosing disease which involves spinal cord causing paraplegia. A middle-aged female presented with sudden lower limb weakness. Magnetic resonance imaging showed a soft tissue mass which was diffusely compressing spinal cord along the C7 to T5 levels. Intravenous steroid pulse therapy and emergent operation was performed. The immunopathologic findings revealed IgG4-related sclerosing pachymeningitis postoperatively. There was no evidence of other organ involvement. Her neurologic deficit remained unchanged after two months of comprehensive rehabilitation therapy.
Citations
The postoperative infectious spondylitis has been reported to occur among every 1% to 12%. It is difficult to early diagnose in some cases. If the diagnosis is delayed, it can be a life-threatening condition. We report a 32-year-old male patient with postoperative infectious spondylitis. He had surgical treatments for traumatic intervertebral disc herniations in L3-4 and L4-5. Three weeks after surgery, he complained for fever and paraplegia. Cervicothoracic magnetic resonance imaging showed the collapsed T2 and T3 vertebral body with changes of bone marrow signal intensity. Moreover, it showed anterior and posterior epidural masses causing spinal cord compressions which suggested infectious spondylitis. After the use of antibiotics and surgical decompressions T2-T3, his general conditions were improved and muscle power of lower extremities began to be gradually restored. However, we could not identify the exact organisms that may be the cause of infectious spondylitis. It could be important that the infectious spondylitis, which is presented away from the primary operative level, should be observed in patients with fevers of unknown origin and paraplegia.
Citations
Baker cyst is an enlargement of the gastrocnemius-semimembranosus bursa. Neuropathy can occur due to either direct compression from the cyst itself or indirectly after cyst rupture. We report a unique case of a 49-year-old man with left sole pain and paresthesia who was diagnosed with posterior tibial neuropathy at the lower calf area, which was found to be caused by a ruptured Baker cyst. The patient's symptoms resembled those of lumbosacral radiculopathy and tarsal tunnel syndrome. Posterior tibial neuropathy from direct pressure of ruptured Baker cyst at the calf level has not been previously reported. Ruptured Baker cyst with resultant compression of the posterior tibial nerve at the lower leg should be included in the differential diagnosis of patients who complain of calf and sole pain. Electrodiagnostic examination and imaging studies such as ultrasonography or magnetic resonance imaging should be considered in the differential diagnosis of isolated paresthesia of the lower leg.
Citations
To investigate the effects of trigger point injection with or without ischemic compression in treatment of myofascial trigger points in the upper trapezius muscle.
Sixty patients with active myofascial trigger points in upper trapezius muscle were randomly divided into three groups: group 1 (n=20) received only trigger point injections, group 2 (n=20) received trigger point injections with 30 seconds of ischemic compression, and group 3 (n=20) received trigger point injections with 60 seconds of ischemic compression. The visual analogue scale, pressure pain threshold, and range of motion of the neck were assessed before treatment, immediately after treatment, and 1 week after treatment. Korean Neck Disability Indexes were assessed before treatment and 1 week after treatment.
We found a significant improvement in all assessment parameters (p<0.05) in all groups. But, receiving trigger point injections with ischemic compression group showed significant improvement as compared with the receiving only trigger point injections group. And no significant differences between receiving 30 seconds of ischemic compression group and 60 seconds of ischemic compression group.
This study demonstrated the effectiveness of ischemic compression for myofascial trigger point. Trigger point injections combined with ischemic compression shows better effects on treatment of myofascial trigger points in the upper trapezius muscle than the only trigger point injections therapy. But the duration of ischemic compression did not affect treatment of myofascial trigger point.
Citations
To evaluate the outcomes of medial branch block in facet joint pain for osteoporotic compression fracture and utilize multiple regression, the relationship between their impact on treatment outcome and other factor, such as the radiologic finding, clinical parameters was analyze.
Fifty-three patients with axial back pain from osteoporotic compression fracture were enrolled. The clinical outcomes were measured by Verbal Numeric Rating Scale (VNS) and Oswestry Disability Index (ODI) before treatment, 2 weeks, 3 months, and 12 months after the medial branch block. Radiographic analysis included measurement of overall sagittal alignment, collapsed vertebral height, and vertebral kyphotic angle. After 12 months, patients' satisfaction was classified to five categories: excellent, good, fair, poor or fail. Statistical analysis of both radiographic and clinical parameters along with treatment outcome was performed to determine any significant correlations between the two.
VNS and ODI was improved 2 weeks after the injection and continued to improve until 12 months. Significant improvement with significant pain relief (>40%), functional improvement (>20%), and the patients rated their satisfaction level as "excellent" or "good" at 12 months after the first injection were observed in 78.9%. The radiographic and clinical parameters were not significantly correlated with treatment outcome.
Our retrospective study demonstrated that the medial branch block provided significant pain relief and functional recovery to the patients with osteoporotic spinal compression fractures complaining of continuous facet joint pain after vertebroplasty or conservative treatment. A placebo-controlled prospective randomized double-blind study should be conducted in the future to evaluate the treatment effects.
Citations
Thyroid carcinoma is the commonest endocrinological malignancy. After papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC) is the second most common histological subtype. Common presentations of FTC include a solitary thyroid nodule and cervical lymphadenopathy. The incidence of individuals diagnosed with thyroid cancer showing initially distant metastatic disease ranges from 1 to 9%. Also, the incidence of solitary bone metastasis from thyroid is only 2 to 3%. We report a case of a patient with FTC whose initial presentation was low back pain and right buttock pain due to vertebral metastasis rather than the usual neck lumps or symptoms of thyroid disease.
Citations
Methods: Thirty nine patients who underwent cervical decompression and fusion for cervical myelopathy were studied. Preoperatively, gait disturbance was present in all patients. The patients were evaluated with Nurick classification, Functional Independence measure (FIM) score and gait analysis using three dimensional motion analyzer before surgery, 1 week and 3 months after surgery.
Results: In the Nurick classification there was statistically significant change but no significant change in FIM score after surgery. In the gait analysis there were statistically significant improvements in all the linear parameters, kinetic (ankle plantarflexion moment) and kinematic (knee range of motion in swing phase) parameters (p＜0.05).
Conclusion: This study suggests that gait analysis can be used as a quantitative tools of postoperative gait improvement in patient with cervical myelopathy. (J Korean Acad Rehab Med 2003; 27: 58-62)
Objective: To assess the median nerve compression with ultrasonography before and after the carpal tunnel release and to assess the correlation between electrophysiologic findings and ultrasonographic findings of the median nerve.
Method: We studied 50 hands of 29 patients diagnosed as carpal tunnel syndrome electrophysiologically and 20 hands of 19 asymptomatic controls. We evaluated the flattening ratio and compression ratio through the short axis and long axis of the median nerve by ultrasonography before carpal tunnel release, 2 weeks and 3 months after release. The correlation of the
improvement between the eletrophysiologic findings and compression ratio was analyzed.
Results: The compression ratio of the median nerve was decreased significantly after carpal tunnel release, compared with that before release. The decrease of the compression ratio correlated with the improvement of the electrophysiologic findings significantly.
Conclusion: The ultrasonography is useful to follow up the median nerve after carpal tunnel release. (J Korean Acad Rehab Med 2002; 26: 172-176)
Aspergillosis of the spine has been reported infrequently. It has usually been attributed to hematogenous infection, spread from an adjacent pulmonary infection. Acute paraplegia developed in a 68 year old man with aspergillus infection. Histopathologic findings showed aspergillus hyphae and magnetic resonance imaging study revealed mid thoracic cord compression. Direct extension of aspergillus infection caused an epidural abscess, vertebral destruction, thoracic spinal cord compression, and paraplegia.
Objective: To evaluate the usefulness of the diagnostic ultrasound (US) to diagnose carpal tunnel syndrome (CTS) and the correlation between electrodiagnosis and US findings.
Method: Forty hands of 30 patients diagnosed with CTS by electrodiagnosis and 28 hands of 19 controls were examined with US. The 7.5 MHz probe of the US was used to view the median nerve in the carpal tunnel. The short and the long axis and the area at the two points, 2 cm proximal and 1 cm distal to the distal wrist crease were measured. The flattening and compression ratio and the ratio of the area in both groups were analysed. The correlation between the eletrodiagnostic severity and compression ratio were analyzed.
Results: The compression ratio of CTS was significantly increased comparing with that of control group. The compression ratio of severe CTS was significantly increased comparing with that of mild and moderate CTS.
Conclusion: These results suggest that US is useful in diagnosis of CTS.
Objective: To evaluate the effects of facet joint injection in the conservative management of osteoporotic spinal compression fractures
Method: Among 27 patients with osteoporotic spinal compression fractures which were confirmed by plain radiography and bone densitometry (dual energy x-ray absorptiometry), 9 patients were control group and 18 patients received facet joint injection treatment. Facet joint injection of thoracolumbar spine was done under fluoroscopic guide with 1% lidocaine 1 ml and triamcinolone 10 mg at each joint above and below the level of compression fracture at both side. Main outcome measures were visual analog scale (VAS), spinal movement (modified Schober's and lateral bending test), and physical activity from bed-ridden state (grade I) to outdoor activity without pain (grade V). The treatment outcomes were assessed before injection, 2 weeks and 4 weeks after injection.
Results: There were significant decrease in VAS at 2 weeks and 4 weeks after injection in the study group (p＜0.05). Physical activity was significantly improved at post injection 2 weeks and 4 weeks (p＜0.05). There were no significant differences between the two groups in spinal movement.
Conclusion: These results suggest that facet joint injection of thoracolumbar spine is useful method in the conservative management of painful osteoporotic compression fractures.
Parkinson's disease(PD) is characterized clinically by bradykinesia, rigidity, tremor, and disturbance of posture and equilibrium. A higher incidence of fractures in PD patient has been reported, however the studies of musculoskeletal complications in PD have been negligible.
The purposes of this study were to investigate the incidence of osteoporosis and spinal compression fracture in PD patients and to evaluate whether the incidence were affected by the severity of PD.
Bone mineral density(BMD) in 21 patients(5 males and 16 females) with idiopathic PD was measured by dual energy X-ray absorptiometry(DXA) and compared with an age adjusted control group(32 females). The patients were divided into two groups according to the Hoehn and Yahr(H-Y) stage as mild or severe and the BMD was compared. Simple x-ray studies of thoracolumbar spine were performed to find out the presence of spinal compression fractures.
The results showed that the BMD of PD patients was significantly lower than control subjects. The PD patients with high H-Y stage(severe group) had lower BMD scores with no statistical significance. The spinal compression fractures were noted mainly at mid-thoracic area and thoraco-lumbar junction. Spinal t-score in patients with a compression fracture was significantly reduced. No significant correlation exists between back pain and a compression fracture.
The peripheral nerves can restore their impaired function after injuries from trauma or surgery. The known factors affecting the recovery of damaged peripheral nerves include the severity of damage, nerve growth factor(NGF) from the damaged area and the concentrations of fibrinogen and thrombin. One of polypeptides, transforming growth factors beta(TGF-β) has been known to be related to inflammation and healing process of various wound. The TGF-β has to three subtypes, TGF-β1, TGF-β2 and TGF-β3. This study was performed to explore the effects of TGF-β subtypes on the recovery phase of damaged nerve. Sciatic nerves of rat were compressed 200 dyne/mm2. The latencies were measured by stimulation of proximal and distal portion of compression injury site and expression of TGF-β isoforms was studied in proximal and distal nerve of compression site and spinal cord by using avidin-biotin complex immunoperoxidase technique.
The latencies were increased at one week after nerve injury and then recovered progressively following 4 weeks. The latencies were restored to almost normal values at 4 weeks after nerve injury. TGF-β1 and TGF-β3 were expressed weakly at the cytoplasm of Schwann cell in the distal portion after 12 hours of injury. The values of TGF-β1 and TGF-β3 were increased at 3rd day after injury and lasted till the 4th week which was the end point of nerve regeneration. The changes of proximal portion were different from those of distal portion. TGF-β1 and TGF-β3 of proximal portion showed stronger positive reaction than that of distal portion and the reaction was peaked at 3rd day after injury. TGF-β subtypes were rarely present at neuronal cells and astrocytes in spinal cord from 12th hour to 3rd day after injury. The TGF-β subtypes were weakly appeared at the 1st week after injury and successively increased to 4th week at which the latencies were restored to almost normal value. The patterns of revelation of TGF-β subtypes showed that TGF-β1 was predominant at neuronal cell and TGF-β2 was at glial cells.
We suggest that TGF-β subtypes might be related to the regeneration process of nerve injuery.
This retrospective study reviewed clinical and electromyographic (EMG) findings in 106 patients with cervical pain syndrome.
The purpose of this study was to test the validity of clinical tests (neck compression test, manual muscle test, sensory test, deep tendon reflex) in the diagnosis of cervical radiculopathy. Electromyographic studies were interpretated as positive finding with the presence of abnormal spontaneous activities of limb and paravertebral muscles and the clinical tests were interpretated by the presence or absence of abnormalities. The results showed that the neck compression and manual muscle tests correlated well with the EMG findings but the sensory test and deep tendon reflex were not.
It is suggested that the neck compression and manual muscle tests may be helpful in the diagnosis of radiculopathy.
The children with Down's syndrome are predisposed to atlantoaxial instability due to ligamentous laxity of the atlantoaxial joint. That can lead to cervical spinal cord compression. A careful neurologic examination and periodic screening for atlantoaxial instability would be very important for early detection and prompt management. We report a child with Down's syndrome who was diagnosed as atlantoaxial dislocation, long times after he showed progressive symptoms of cervical cord compression including respiratory distress.
Osteoporosis is the most common generalized skeleta l disease, which lays a significant socioeconomic burden to Korea. The early diagnosis and treatment of osteoporosis are of the great interest to minimize the economic consequence. We have studied vertebral BMD and bone scan of 30 patients with osteoporotic compression fractures. The purpose of this study was to in vestigate the effect of osteoporotic compression fracture on bone mineral density(BMD). We have measured the vertebral heights, vertebral bone mineral density, and bone scan counts of vertebral bodies on osteoporotic patients. Vertebral BMD was measured from T12 to L4 using dual photon absorptiometry. Anterior(Ha), middle(Hm), and posterior(Hp) height of vertebrae were measured from T12 to L4, and the spinal deformity indices(Ha/Hp, Hm/Hp, and Hp/Hi ratios) were calculated. The bone scan counts were measured from T12 to L4, and bone scan ratios were calculated. The BMD of fractured vertebrae was significantly higher than that of non-fractured vertebrae. The spinal deformity indices were not correlated to the BMD of fractured vertebrae. The bone scan ratio was correlated to the BMD of fractured vertebrae. This study suggests that the increased BMD observed in fractured vertebrae is related to metabolic effect of compression fractures rather than mechanical effect.
We tried to assess the effect of sequential intermittent pneumatic compression therapy in patients with lymphedema and analyze the potential prognostic factors in response to the therapy. Ninety lymphedema patients were included in the analysis. Among them, thirty-six subjects who were in clinical stage 2 or 3, infection-free and free of documented metastasis in the involved extremity were treated with the Lympha-Press. All patients were admitted for 3 days clinical trial. Comparison of circumferential limb measurements before and after a 3-day treatment period was performed. As a result of sequential intermittent pneumatic compression therapy, the volume reductions of arm and leg were 37.95±12.27% and 35.21%±24.42%, respectively. The calf, wrist and lower forearm levels showed the greatest reduction. In contrast with this, the proximal levels of arm and leg showed comparatively poor reduction than distal levels. Almost 90% of arm patients and 76% of leg patients experienced significant reduction (>25%) after therapy. The previous history of secondary infection was significantly associated with the extent of initial leg edema. But the duration and the previous history of radiotherapy or secondary infection were not a negative prognostic factor for response of pneumatic compression therapy.
This study clearly indicates that sequential intermittent pneumatic compression therapy is an effective treatment for lymphedema regardless of the duration of edema and previous history of radiotherapy or secondary infection.
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