Citations
To compare diffusion tensor tractography (DTT) and motor evoked potentials (MEPs) for estimation of clinical status in patients in the subacute stage of stroke.
Patients with hemiplegia due to stroke who were evaluated using both DTT and MEPs between May 2012 and April 2015 were recruited. Clinical assessments investigated upper extremity motor and functional status. Motor status was evaluated using Medical Research Council grading and the Fugl-Meyer Assessment of upper limb and hand (FMA-U and FMA-H). Functional status was measured using the Modified Barthel Index (MBI). Patients were classified into subgroups according to DTT findings, MEP presence, fractional anisotropy (FA) value, FA ratio (rFA), and central motor conduction time (CMCT). Correlations of clinical assessments with DTT parameters and MEPs were estimated.
Fifty-five patients with hemiplegia were recruited. In motor assessments (FMA-U), MEPs had the highest sensitivity and negative predictive value (NPV) as well as the second highest specificity and positive predictive value (PPV). CMCT showed the highest specificity and PPV. Regarding functional status (MBI), FA showed the highest sensitivity and NPV, whereas CMCT had the highest specificity and PPV. Correlation analysis showed that the resting motor threshold (RMT) ratio was strongly associated with motor status of the upper limb, and MEP parameters were not associated with MBI.
DTT and MEPs could be suitable complementary modalities for analyzing the motor and functional status of patients in the subacute stage of stroke. The RMT ratio was strongly correlated with motor status.
Citations
To evaluate the clinical utility of the electrically calculated quantitative pain degree (QPD) and to correlate it with subjective assessments of pain degree including a visual analogue scale (VAS) and the McGill Pain Questionnaire (MPQ).
We recruited 25 patients with low back pain. Of them, 21 patients suffered from low back pain for more than 3 months. The QPD was calculated using the PainVision (PV, PS-2100; Nipro Co., Osaka, Japan). We applied electrodes to the medial forearm of the subjects and the electrical stimulus was amplified sequentially. Minimum perceived current (MPC) and pain equivalent current (PEC) were defined as minimum electrical stimulation that could be sensed by the subject and electrical stimulation that could trigger actual pain itself. To eliminate individual differences, we defined QPD as the following: QPD=PEC-MPC/MPC. We scored pre-treatment QPD three times at admission and post-treatment QPD once at discharge. The VAS, MPQ, and QPD were evaluated and correlations between the scales were analyzed.
Result showed significant test-retest reliability (ICC=0.967, p<0.001) and the correlation between QDP and MPQ was significant (at admission SRCC=0.619 and p=0.001; at discharge SRCC=0.628, p=0.001). However, the correlation between QPD and VAS was not significant (at admission SRCC=0.240, p=0.248; at discharge SRCC=0.289, p=0.161).
Numerical values measured with PV showed consistent results with repeated calculations. Electrically measured QPD showed an excellent correlation with MPQ but not with VAS. These results demonstrate that PV is a significantly reliable device for quantifying the intensity of low back pain.
Citations
To offer the basic data about the causes and distribution of hand tingling, symptoms and physical findings, and pressure pain threshold in desk workers.
Five physiatrists participated in the screening test composed of history and physical examination. A total of 876 desk workers were evaluated and of them 37 subjects with hand tingling were selected. For further analyzing, detailed history taking and meticulous physical examination were taken. Pressure pain threshold (PPT) at the infraspinatus, upper trapezius, flexor carpi radialis, rhomboideus, and flexor pollicis longus were examined. PPT measurements were repeated three times with two minute intervals by a pressure algometer. Electrodiagnostic study was done to detect potential neurologic abnormalities.
The causes of hand tingling in order of frequency were: myofascial pain syndrome, 68%; cervical radiculopathy, 27%; rotator cuff syndrome, 11%; tenosynovitis, 8%; and carpal tunnel syndrome, 5%. The location of trigger points in the myofascial pain syndrome, which were proven to evoke a tingling sensation to the hand in order of frequency were: infraspinatus, 65.4%; upper trapezius, 57.7%; flexor carpi radialis, 38.5%; rhomboideus 15.4%; and flexor pollicis longus 11.5%. The PPT of the affected side was significantly lower than that of the unaffected side in myofascial pain syndrome (p<0.05).
The most common cause of hand tingling in desk workers was myofascial pain syndrome rather than carpal tunnel syndrome. Common trigger points to evoke hand tingling were in the infraspinatus and upper trapezius.
Citations
To evaluate the effect of extracorporeal shock wave therapy (ESWT) in myofascial pain syndrome of upper trapezius with visual analogue scale (VAS) and pressure threshold by digital algometer.
Twenty-two patients diagnosed with myofascial pain syndrome in upper trapezius were selected. They were assigned to treatment and standard care (control) groups balanced by age and sex, with eleven subjects in each group. The treated group had done four sessions of ESWT (0.056 mJ/mm2, 1,000 impulses, semiweekly) while the control group was treated by the same protocol but with different energy levels applied, 0.001 mJ/mm2. The VAS and pressure threshold were measured twice: before and after last therapy. We evaluated VAS of patients and measured the pressure threshold by using algometer.
There were two withdrawals and the remaining 20 patients were three men and 17 women. Age was distributed with 11 patients in their twenties and 9 over 30 years old. There was no significant difference of age, sex, pre-VAS and pre-pressure threshold between 2 groups (p>0.05) found. The VAS significantly decreased from 4.91±1.76 to 2.27±1.27 in the treated group (p<0.01). The control group did not show any significant changes of VAS score. The pressure threshold significantly increased from 40.4±9.94 N to 61.2±12.16 N in the treated group (p<0.05), but there was no significant change in the control group.
ESWT in myofascial pain syndrome of upper trapezius is effective to relieve pain after four times therapies in two weeks. But further study will be required with more patients, a broader age range and more males.
Citations
To investigate the effect of extracorporeal shock wave therapy (ESWT) on myofascial pain syndrome (MPS).
Thirty patients with MPS in trapezius muscle were randomly divided into two groups, ESWT group (n=15), and trigger point injections (TPI)+transcutaneous electrical nerve stimulation (TENS) group (n=15). For a total of 3 weeks, ESWT was undertaken with 1,500 pulse each time at one week interval totaling 4,500 pulse, TPI for once a week totaling three times and TENS for five times a week totaling three weeks.
The changes in pain threshold (lb/cm2) showed the values of 6.86±1.35 before first therapy, 11.43±0.27 after first therapy, and 12.57±0.72 after third therapy, while TPI+TENS group showed the values of 6.20±1.92 before first therapy, 8.80±0.48 after first therapy, and 9.60±2.19 after third therapy, and the changes between the groups were significantly different (p=0.045). The changes in visual analog scale were estimated to be 6.86±0.90 before first therapy, 2.86±0.90 after first therapy, and 1.86±0.69 after third therapy in case of ESWT group, whereas the figures were estimated to be 7.20±1.30 before first therapy, 4.60±0.55 after first therapy, and 2.80±0.84 after third therapy in case of TPI+TENS group, and the changes between the groups were significantly different (p=0.010). The changes in McGill pain questionnaire (p=0.816) and pain rating scale (p=0.644) between the groups were not significantly different. The changes in neck ROM were also not significantly different between the groups (p>0.05).
The ESWT in patients with MPS in trapezius muscle are as effective as TPI and TENS for the purpose of pain relief and improving cervical range of motion.
Citations
To assess the usefulness of a pressure algometer to measure pressure pain threshold (PPT) for diagnosis of myofascial pain syndrome (MPS) in the upper extremity and trunk muscles.
A group of 221 desk workers complaining of upper body pain participated in this study. Five physiatrists made the diagnosis of MPS using physical examination and PPT measurements. PPT measurements were determined for several muscles in the back and upper extremities. Mean PPT data for gender, side, and dominant hand groups were analyzed. Sensitivity and specificity of Fischer's standard method were evaluated. PPT cut-off values for each muscle group were determined using an ROC curve.
Cronbach's alpha for each muscle was very high. The PPT in men was higher than in females, and the PPT in the left side was higher than in the right side for all muscles tested (p<0.05). There was no significant difference in PPT for all muscles between dominant and non-dominant hand groups. Diagnosis of MPS based on Fischer's standard showed relatively high specificity and poor sensitivity.
The digital pressure algometer showed high reliability. PPT might be a useful parameter for assessing a treatment's effect, but not for use in diagnosis or even as a screening method.
Citations
Objective: To compare the degree of change of current perception threshold (CPT) results with the degree of nerve conduction study (NCS) change and evaluate the effectiveness of the CPT in following up patients who went through operation for carpal tunnel syndrome (CTS).
Method: Twenty hands with CTS were examined with CPT and NCS, before, 2 weeks after and 2 months after operation. In the CPT, the threshold of the median nerve was measured, in the NCS, amplitude and latency of the median nerve was measured. Subjects were divided into 3 groups according to the severity by NCS results and into 2 groups according to the subjective perception of improvement.
Results: The subjects mean age was 51.4. Changes of NCS results in amplitude and latency showed no statistical relevance. CPT study result changes demonstrated to be statistically significant. Improvement of CPT results seen in the period of 2 weeks and 2 months and the initial first 2 weeks showed no difference. Change of CPT results showed correlation not in accordance with the severity of the NCS study, but with the symptomatic improvement of the patients.
Conclusion: CPT can be an effective tool in evaluating the improvement of symptoms and may be used as a follow up tool in patients with CTS. (J Korean Acad Rehab Med 2002; 26: 414-419)
Objective: We measured current perception threshold (CPT) with transcutaneous electrical nerve stimulation (TENS) to prove the selective increment of the threshold of C sensory fiber and to determine onset time and duration of effect for application of TENS.
Method: TENS were applied to fifteen control volunteers for 20 minutes on hand three times per week for 2 weeks duration. The CPT was tested at the distal interphalangeal joint of the second finger with 5 Hz, 250 Hz, and 2,000 Hz in frequency, respectively. The test was repeated immediately and 30 minutes after cessation of TENS. These tests were performed on the first, eighth, and fifteenth day on application of TENS.
Results: The baseline CPT of C fiber was 32.7⁑6.4 102 mA, Aδ fiber 23.2⁑9.4 102 mA, and Aβ fiber 83.9⁑18.1 102 mA. At 30 minutes after cessation of TENS in the fifteenth day, the CPT of C fiber increased markedly and that of Aδ fiber increased a little. The CPT of Aβ fiber didn't increase for 2 weeks.
Conclusion: With application of TENS, the threshold of C and Aδ fibers selectively increased, especially 30 minutes after removal of TENS application. This effect was outstanding after 2 weeks' application. (J Korean Acad Rehab Med 2002; 26: 161-166)
Objective: To evaluate the clinical usefulness of current perception threshold (CPT) test in diagnosing the diabetic neuropathy.
Method: We have recorded the neuropathic symptom score (NSS), CPT and the parameters of nerve conduction study (NCS) in 45 patients with diabetes. NSS was calculated according to the clinical symptom and signs, and the score more than 3 was regarded as abnormal (neuropathic). CPT was measured at the 2nd finger and 1st toe delivering the three different frequencies (2000, 250 and 5 Hz) of current and conventional NCS were performed at the median, peroneal motor and sural nerves. All the patients were assigned to three groups according to the result of NSS and NCS; group A, abnormal NSS and NCS; group B, abnormal NSS only; group C, normal NSS and NCS. CPT was compared between groups, and we investigated the correlation between CPT and NSS, and parameters of NCS. Also the sensitivity and specificity of CPT test were calculated.
Results: The mean CPT was significantly increased in the entire diabetic groups as compared with control group (p＜0.05). CPTs measured by 2000 Hz stimulation at the finger and toe were positively correlated with the most parameters of NCS (p＜0.05), and CPT was more highly correlated with NCS (p＜0.05) than NSS. The sensitivity and specificity of the CPT were 94.1% and 10.7%, respectively.
Conclusion: The CPT test may have added value in diagnosing the diabetic neuropathy as a screening.
Objective: To evaluate usefulness of the current withdrawal threshold (CWT) on evaluation of the neuropathic pain in animal model.
Method: Surgical neuropathy was induced in 40 Sprague-Dawley rats. Fourteen days after the surgery, neuropathic rats were evaluated by von Frey hair. The CWT was determined by various stimulus intensities which induce the tail-withdrawal response or vocalization of rats. The experimental group was compared with the control group by CWT. Then the experimental group was subdevided to two groups. The experimental group 1 was injected with beta-methasone 0.1 mg/kg, intra-peritoneally and experimental group 2 was injected with normal saline with the same amount as steroid. The CWT of two experimental subgroups were measured before and 30 minutes after injections.
Results: The experimental group showed significant decrease of the CWT compared with the control group after the neuropathic pain was induced. The CWT of experimental group 1 was increased after steroid administration (p＜0.01).
Conclusion: This preliminary study suggests that the measurement of CWT would be an useful tool to study the neuropathic pain in experimental animal model.
Objective: To compare current perception threshold with nerve conduction study, we measured current perception threshold (CPT) in healthy control and patients with carpal tunnel syndrome (CTS).
Method: Twenty control subjects and twenty patients with CTS were included. Latency and amplitude of median and ulnar motor and sensory nerves were measured. The sensory current perception threshold was measured at the distal interphalangeal joint of third and fifth fingers and the palm with electrical current of 5 Hz, 250 Hz, and 2,000 Hz in frequency. We compared the results of the nerve conduction study with the data of the CPT.
Results: We found that measuring of the sensory threshold might detect carpal tunnel syndrome, especially with 2,000 Hz and 250 Hz stimulation and that CPT data correlated to sensory latency and amplitude of the median nerve.
Conclusion: The sensory threshold test might be useful for diagnosis and follow up test in carpal tunnel syndrome.
Objective: The aim of the present study was to investigate the pain intensity, quality, and pattern in experimental muscle pain.
Method: Eleven healthy adults and eleven myofascial pain syndrome (MPS) patients participated in this study. Hypertonic saline (5%) was injected into upper trapezius, infraspinatus and tibialis anterior muscles of 11 healthy adults. A continuous recording of ongoing pain intensities of the local pain and referred pain was measured. After pain had subsided, the subjects completed a Korean version of the McGill Pain Questionnaire (MPQ). This study included 11 patients who have trigger point on upper trapezius muscle. Pain pressure thresholds (PPTs) and pain intensity ratings of different pressure stimuli in upper trapezius muscles were compared with experimental group.
Results: In experimental group, local pain became maximal after one minute and referred pain after one and a half minutes. At that time, Visual analogue scale (VAS) score was 3.8 and 1.9 each other. The referred pain of upper trapezius muscle primarily radiated to the posterolateral side of neck. The one of infraspinatus muscle radiated to the shoulder joint and anterolateral side of upper arm area and the one of tibialis anterior muscle radiated to the shin and dorsum of ankle joint. The PPTs were found to be significantly lower in upper trapezius muscle of patients with myofascial pain syndrome (MPS) than in those of experimental group. The slope of VAS to different stimuli showed the linear relationship at both group, and in that of patient groups was found to be significantly steeper than in that of experimental group. The experimental muscle pain group had no difference in pain quality compared with MPS patients except affective subscale.
Conclusion: The present results suggest that intramuscular injection of hypertonic saline can be used a experimental pain model of MPS, and PPTs and pain intensity ratings of different pressure stimulus are valuable tools for quantitative description of chronic and experimental muscle pain.
Objective: This study was conducted to compare the effects of low frequency needle transcutaneous electrical nerve stimulation (TENS) and high frequency needle TENS on experimental pain threshold.
Method: Twenty two healthy adult subjects were assigned randomly to a low-TENS group or to a high-TENS group. Experimental pain threshold at forearm was determined with pain threshold of electrical simulation using surface electrode and needle electrode.
Results: Low-TENS group showed that pain relief was developed after 10 minutes and persisted 3 hours after treatment cessation. Low-TENS group showed a significant increase in experimental pain threshold opposing to high TENS group.
Conclusion: This results suggest that effect of low frequency needle TENS therapy is better and longer than high frequency needle TENS therapy.
Objective: The purpose of this study is to evaluate the effects of cold air application on the pressure threshold of myofascial trigger points.
Method: The 60 patients with myofascial trigger points in unilateral infraspinatus muscle were divided into 3 groups with equal number and cold air was applied using CRAis (Kyung-won Century, Korea) for 1, 3 and 5 minutes. We examined the changes of pressure threshold in myofascial trigger points before, immediately after and 30 minutes after cold air application. Also we examined the changes of pressure threshold of contralateral infraspinatus muscles.
Results: 1) The pressure threshold of trigger point in infraspinatus muscle were increased immediately and 30 minutes after the cold air application as assessed by the pressure algometer (p＜0.05).
2) There was no significant correlations in the changes of pressure threshold among 3 groups after the cold air application (p＞0.05).
3) There was no significant correlations among the age, the body mass index and the changes of pressure threshold in myofascial trigger points (p＞0.05).
Conclusion: We conclude that the cold air application is a effective method for treatment of myofascial trigger points.
Objective: The purpose of this study is to evaluate the effects of the cold air application on the subjective pain threshold of knee joint pain.
Method: We recorded the changes of the pain threshold in 60 patients before and after cold air application who complaint of knee joint pain. Patients were divided into 3 groups randomly with each 20 patients and each group received cold air application for 30 seconds, 1 minute, 3 minutes. Cold air of CRAis (Kyung-won Century, Korea) was applied to the anterior portion of the knee with a temperature of 30oC. The changes of the pain threshold was estimated by visual analogue scale.
Results: In 30 seconds treating group, VAS score was lowered 2.25±1.16 and 2.26±1.13 immediately after, and 30 minutes after cold air application, respectively (P＜0.05). In 1 minutes treating group, VAS score was lowered 1.65±2.58 and 2.41±2.59 immediately after and 30 minutes after cold air application, respectively (P＜0.05). In 3 minutes treating group, VAS score was lowered 1.94±1.80 and 2.10±2.3 immediately after and 30 minutes after cold air application, respectively (P＜0.05). The VAS score was lowered significantly after cold air application in all groups, but there's no significant correlation between change of VAS score and cold air application time. In group with initial VAS score greater than 5, the VAS score was more decreased after cold air application.
Conclusion: Cold air application for 30 seconds using CRAis machine is useful treatment method for knee joint pain.
Objective: The purpose of this study is to evaluate the effects of a self-stretching exercise on the pressure threshold of myofascial trigger point.
Method: We examined the changes of pressure threshold in 66 patients with myofascial trigger points before and after a self-stretching exercise of shoulder girdle and also tested the visual analogue scale (VAS) of the subjective pain intensity. The self-stretching exercise of shoulder girdle includes a stretching exercise of four muscles in shoulder girdle simultaneously, including upper trapezius, levator scapulae, infraspinatus, rhomboideus major and minor, which is followed by 1) a sitting position, relaxed, 2) lateral bending of neck to contralateral side, 3) forward and downward stretching of ipsilateral arm with protrusion of scapula and internal rotation of arm maximally to the contralateral foot. Each stretching motion is maintained for 30 seconds.
Results: The results of the patients experiencing unilateral or bilateral myofascial neck and shoulder pain showed that the pressure threshold of trigger point increased in response to the self-stretching exercise as assessed by a pressure algometer. Also visual analogue scale (VAS) decreased in response to the self-stretching exercise.
Conclusion: We conclude that the self-stretching exercise of shoulder girdle is an effective method for the simultaneous stretching of upper trapezius, levator scapulae, infraspinatus, rhomboideus major and minor.
Thirty-eight patients with a musculoskeletal chest wall syndrome were evaluated for the musculoskeletal findings of chest wall. All patients had the chest wall tenderness and the typical chest pain could be reproduced by the palpation. There was no significant difference in the diagnostic features of the pain for the onset, location, characteristics, duration, radiation, and area of references for chest pain among the different groups of the patients. However, a reproduction of pain by palpation and the pressure threshold difference between the lesion and control points by using pressure algometry was a reliable and specific diagnostic tool. Pressure threshold difference was correlated with numerical rating scale by the correlation coefficient 0.96. The common causes of the chest wall syndrome were the myofascial pain syndrome, chostochondritis, sternalis syndrome, rib-tip syndrome, xiphodynia in order. Six patients had chest wall disorders in conjunction with other associated intrathoracic condition. Thirty-two patients had an isolated chest wall syndrome. Chest wall syndrome should be considered in all patients with the chest pain, as its recognition could help the patient management.
The purpose of this study was to estimate mean pressure thresholds over several skeletal muscles, grip and pinch strengths in female telephone operators.
Pressure thresholds on muscles of neck and shoulder were measured with a pressure algometer, and grip and pinch strength were measured with a Jamar dynamometer and a Jamar pinch gauge in 904 female telephone operators.
The pressure threshold was highest in the supraspinatus and lowest in the cervical paraspinals. There was no statistically significant difference between right and left corresponding muscles. The mean grip strength was 22.29 kg in the right hand, 21.97 kg in the left hand. The mean tip pinch strength was 0.56 kg in the right, 0.51 kg in the left. The mean lateral pinch strength was 2.21 kg in the right, 2.12 kg in the left. The mean palmar pinch strength was 1.82 kg in the right, 1.66 kg in the left.
There was no significant correlation between grip, pinch strength and age(p＞0.05). There were positive correlations between height, weight and grip strength. There were positive correlations between exposure duration to visual display terminal and pinch strength.
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