Gluteal compartment syndrome is a rare disorder which often occurs in conjunction with prolonged immobility after an overdose of sedative. Signs of sciatic nerve compression frequently occur, and rhabdomyolysis may be associated with the syndrome. We recently encountered a patient with lumbosacral plexopathy, complicated by gluteal compartment syndrome. A 42-year-old man presented with weakness and swelling in the right lower extremity and gluteal area after an overdose of antipsychotic drug, accompanied by prolonged immobilization. Serum creatine phosphokinase and urinary myoglobin were markedly elevated, and a T2-weighted pelvis MRI showed hyperintensities and swelling in the gluteal muscles. An electrodiagnosis study showed incomplete lumbosacral plexopathy. The patient received medical treatment and rehabilitation. Six months later, his right lower limb weakness had improved and he could walk independently. Lumbosacral plexus injury with rhabdomyolysis is a rare but debilitating disorder. Therefore, early diagnosis and treatment are crucial for prevention of neurologic deterioration.
Adult ; Compartment Syndromes ; Creatine Kinase ; Early Diagnosis ; Electrodiagnosis ; Humans ; Immobilization ; Lower Extremity ; Lumbosacral Plexus ; Muscles ; Myoglobin ; Pelvis ; Rhabdomyolysis ; Sciatic Nerve

Saphenous mononeuropathy is an uncommon neuropathy in clinical condition, which may incur from various surgical procedures, direct trauma, or entrapment, and most frequently involves at the adductor canal, or Hunter's canal. A 17-year old female, who was majoring in ballet, visited our rehabilitation clinic for numbness in the medial aspect of the left lower leg for the previous 9 months, without weakness. The electrodiagnostic study revealed only a delayed small potential in the left saphenous nerve. MRI examination showed soft tissue swelling in the medial side of the left knee. Accordingly, we diagnosed the patient with saphenous mononeuropathy around the knee, without lumbar plexopathy or femoral neuropathy. We report a case of saphenous mononeuropathy which developed after repetitive compression on the medial side of the knee without any other iatrogenic injury, and include a review of the relevant literature.
Female ; Femoral Neuropathy ; Humans ; Hypesthesia ; Knee ; Leg ; Mononeuropathies

OBJECTIVE: To describe the current status of medical care for victims of industrial disaster in Korea, and especially for representative diseases requiring rehabilitation, such as ischemic, hemorrhagic stroke, intervertebral disc disease, and spinal fracture. METHOD: Data were extracted from the electronic data interchange database of the Korea Workers' Compensation and Welfare Service. Patients who had been approved as industrial disaster victims between January 1 and December 31, 2006 were included. This study covered 4 representative diagnoses: ischemic stroke, hemorrhagic stroke, intervertebral disc disease, and spinal fracture. We conducted an analysis of the length of in-patient and out-patient treatment, total length of treatment, medical cost according to types of disease, first admitted medical institute, age, sex, and the number of admissions from the approved time up to June 30, 2008. RESULTS: A total of 4,581 patients were included. There were 49, 373, 1,223, and 2,936 patients with ischemic stroke, hemorrhagic stroke, intervertebral disc disease, and spinal fracture, respectively. The total length of care tended to be longer in cases of neurologic disease. Positive correlations were observed between the total length of treatment and the type of first admitted medical institute in cases of ischemic stroke and spinal fracture. Medical cost showed an increasing trend in association with length of in-patient care. CONCLUSION: Differences were observed in the total length of care and medical cost, depending on the type of disease. The number of admissions showed a correlation with the length of inpatient treatment. The length of inpatient treatment was the most important factor determining medical cost.
Costs and Cost Analysis ; Disasters ; Electronics ; Electrons ; Humans ; Inpatients ; Intervertebral Disc ; Intervertebral Disc Degeneration ; Intervertebral Disc Displacement ; Korea ; Occupational Health ; Outpatients ; Spinal Fractures ; Stroke ; Workers' Compensation

OBJECTIVE: To determine the factors which influence the level of sexual adjustment. METHOD: A total of 96 subjects were enrolled in this study. The measuring instruments consisted of the dependent variables related to the perception of sexual adjustment and the independent variables that have an influence on sexual adjustment. The dependent variables were comprised of three sub-elements: satisfaction with sexual life, negative attitudes and prejudices, and sexual attractiveness. The independent variables were comprised of physical factors including sexual functioning; psychological factors including self-esteem, depression, the acceptance of disability, and ego-resilience; and domestic factors including feelings of intimacy with the partner, and support from family. RESULTS: The level of the sexual adjustment in men with spinal cord injury (SCI) was relatively high. When considering the correlation between the factors and sexual adjustment, the level of intimacy with the partner showed the highest correlation, followed by depression, ego-resilience, self-esteem, acceptance of disability, support from family, and sexual functioning, respectively. Finally, sexual adjustments were mainly influenced by psychological and domestic factors such as the intimacy with the partner and depression. CONCLUSION: Despite the disability of sexual function, men with SCI, recorded overall high levels of the sexual adjustment. The level of intimacy with the partner and depression were the variables that had effects on sexual adjustment.
Depression ; Humans ; Male ; Prejudice ; Spinal Cord ; Spinal Cord Injuries

OBJECTIVE: To present the clinical characteristics of abnormal posture of the head and neck (APHN) caused by unilateral superior oblique palsy (USOP) for differential diagnosis of childhood APHN. METHOD: The medical charts of children who came to Department of Physical Medicine and Rehabilitation, Ajou University Medical Center from 2003 to 2008 for APHN were reviewed with special reference to ocular causes of APHN. Children who showed a positive Bielschowsky's head tilt test were strongly suspected to have USOP. In-depth ophthalmic evaluations were done after 6 months of age to identify USOP for those children. The clinical characteristics of children with USOP were compared with those of children with congenital muscular torticollis. RESULTS: Sixteen children were diagnosed with APHN related to ocular causes. Seven children out of 16 (43.8%) had APHN secondary to USOP, which was the most common ocular cause of APHN. The initial clinical presentation of 7 children with USOP was contralateral laterocollis toward the shoulder on the non-USOP side at a mean age of 15.57+/-12.55 months; USOP was diagnosed at a mean age of 19.07+/-11.29 months. APHN was aggravated by staring at objects, and craniofacial asymmetry was not evident at this age compared to children with congenital muscular torticollis. CONCLUSION: The clinical characteristics of USOP were presented, which showed laterocollis toward the shoulder of non-USOP. Differential diagnosis of APHN is critical for proper management for APHN and high index of suspicion for USOP by non-ophthalmologic physicians could make earlier diagnosis of USOP possible.
Academic Medical Centers ; Child ; Diagnosis, Differential ; Head ; Humans ; Neck ; Paralysis ; Physical and Rehabilitation Medicine ; Porphyrins ; Posture ; Shoulder ; Strabismus ; Torticollis

OBJECTIVE: To evaluate the prevalence of dysphagia in neonates who showed abnormal findings on videofluoroscopic swallowing studies (VFSSs), and to compare the accuracy of the clinical evaluation with the VFSS results. METHOD: A clinical investigation of 142 neonates admitted to a neonatal intensive care unit was carried out to evaluate the presence of low O2 saturation (<80%), symptoms of cyanosis, coughing and/or vomiting, nasal regurgitation, drooling saliva, voice change and crying during feeding. VFSSs were performed on the neonates who had at least one of these clinical abnormalities. RESULTS: Of the 142 patients, 37 (26.1%) had at least one of the clinical symptoms of dysphagia. Twenty two of 37 (59.5%) showed abnormal findings on the VFSS. The patients exhibiting cyanosis and coughing during feeding had a higher incidence of aspiration (11 of 11, 100%) on the VFSSs than did the patients with other symptoms: cyanosis (3 of 13, 30.8%), cyanosis with vomiting (0 of 2, 0.0%), coughing without cyanosis (2 of 5, 40.0%), voice change (2 of 2, 100%) and nasal regurgitation (1 of 3, 33.3%). CONCLUSION: The prevalence of laryngeal penetration or subglottic aspiration among those neonates who were clinically suspected of dysphagia was 59.5%. Coughing with cyanosis during feeding was the best predictor of both these abnormalities.
Cough ; Crying ; Cyanosis ; Deglutition ; Deglutition Disorders ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Prevalence ; Saliva ; Sialorrhea ; Voice ; Vomiting

OBJECTIVE: To investigate the effect of the body shape molded inner system on attenuation of spinal curvature and pelvic obliquity in cerebral palsy (CP) with scoliosis. METHOD: Fifteen patients with CP who had fixed or non-fixed scoliosis were recruited. By radiographic studies, Cobb's angle and pelvic obliquity were measured with or without sitting in the body shape molded inner system. RESULTS: Spinal curvature assessed by Cobb's angle was significantly reduced when CP patients were seated in the body shape molded inner system rather than in conventional seats. Although pelvic obliquity was not improved in patients with fixed scoliosis, it was significantly ameliorated in patients with non-fixed scoliosis when seated in the body shape molded inner system. CONCLUSION: The body shape molded inner system attenuated spinal curvature and pelvic obliquity in CP patients with non-fixed scoliosis which had a flexible spinal curve.
Cerebral Palsy ; Fungi ; Humans ; Scoliosis ; Spinal Curvatures

OBJECTIVE: To access the clinical features of peripheral arterial disease (PAD) combined with lumbar spinal stenosis (LSS) in patients, and the effects of peripheral arterial disease rehabilitation after peripheral vascular intervention. METHOD: We studied 21 patients who were diagnosed with PAD combined with LSS. We investigated the past histories symptoms, diagnoses and treatment of the 21 patients to determine if there were atypical features that could be attributed to PAD. Thirteen patients who were diagnosed with PAD combined with LSS received peripheral arterial disease rehabilitation after peripheral vascular intervention. A control group (n=11) was instructed to practice self-exercise training in the community exercise program after peripheral vascular intervention. Initial claudication distance (ICD), absolute claudication distance (ACD), peak oxygen uptake, and ankle-brachial index (ABI) were measured at baseline, 3 months, and 6 months after peripheral arterial disease rehabilitation. RESULTS: Thirteen of 16 patients were satisfied with the cardiac rehabilitation program and experienced symptom relief, however, there was a recurrence of symptoms and peripheral arterial restenosis in 2 patients. After peripheral arterial disease rehabilitation, PAD and LSS groups showed significant changes in ABI, ICD, ACD, and peak oxygen uptake. The control group also showed significant improvements of ABI, ICD, ACD, and peak oxygen uptake. There were significant differences between the two groups in ICD, ACD, and peak oxygen uptake after 6 months. CONCLUSION: Attention should be paid to patients complaining of back pain, lower limb radiating pain, and claudication, because they were diagnosed with neurogenic intermittent claudication by simple spinal stenosis and it would overlook the PAD. We recommend also considering the possibility of PAD. Compared with angioplasty alone, angioplasty in combination with subsequent training is a superior treatment modality for patients with intermittent claudication.
Angioplasty ; Ankle Brachial Index ; Extremities ; Humans ; Intermittent Claudication ; Low Back Pain ; Oxygen ; Peripheral Arterial Disease ; Recurrence ; Spinal Stenosis

OBJECTIVE: To delineate the clinical manifestation of myofascial pain syndrome (MPS) around the face, neck and shoulders in patients with cervical vertigo (CV) and to determine whether treatment of MPS can improve CV. METHOD: We evaluated 72 patients who were diagnosed with CV and 72 patients as controls who had MPS in the neck and shoulder without vertigo symptoms. Clinical evaluations for MPS were performed on all subjects, and vestibular function tests were also performed in patients with vertigo symptoms. Most patients and controls received treatments including trigger point injection, physical therapy or medication, and were then followed up. RESULTS: Seventy CV patients (97%) had MPS in the face, neck and shoulders. The distribution of trigger points in CV patients differed from that in controls, especially in the lateral neck muscles (odds ratio=0.361, p=0.019). The gender, age, symptom duration and number of trigger points were not different between CV patients and controls. 57 CV patients and 56 controls that had received treatments were followed up. Vertigo symptoms improved in 40 CV patients (70%) after treatment of MPS and pain symptoms improved in 77% of CV patients and 75% of controls after treatment. CONCLUSION: Most CV patients had myofascial pain syndrome and the distribution of trigger points differed from that in controls. Treatment for myofascial pain syndrome could improve vertigo symptoms in CV patients, but further study is required to delineate the relationship between MPS and CV.
Humans ; Myofascial Pain Syndromes ; Neck ; Neck Muscles ; Shoulder ; Trigger Points ; Vertigo ; Vestibular Function Tests

OBJECTIVE: To establish reference data for dermatomal somatosensory evoked potentials (DSEP) using a stimulation intensity lower than what is conventionally utilized. METHOD: Fifty subjects (25 older adults>48 years old; 25 younger adults<32 years old) without history of neck pain or cervical spine surgery were enrolled. The DSEP study was performed with stimulation intensities of 1.0, 1.5, and 2.5 times sensory threshold (ST) on right arms for C5, C6, C7, and C8 dermatomes. RESULTS: The mean latencies of DSEP stimulating C5, C6, C7, and C8 dermatomes with 1.5 times ST intensity were 17.6+/-1.7 ms, 22.2+/-2.1 ms, 22.8+/-1.4 ms, and 22.6+/-1.8 ms, respectively. The mean amplitude (N1P1) of DSEP stimulating C5, C6, C7, and C8 dermatomes with 1.5 times ST intensity were 0.9+/-0.4 microV, 0.9+/-0.5 microV, 1.0+/-0.6 microV, and 1.1+/-0.8 microV, respectively. The C5, C6, C7, and C8 DSEP were evoked in 84%, 98%, 100%, and 96% of cases with 2.5 times ST compared to 64%, 56%, 60%, and 62% with 1.5 times ST, respectively. When one DSEP was not evoked, the DSEP of the opposite side was evoked only in 2 subjects. CONCLUSION: This study provides the reference data of DSEP with lower stimulation intensities than are conventionally utilized. Additionally, two cases of clinical significance were reported.
Arm ; Evoked Potentials, Somatosensory ; Neck Pain ; Radiculopathy ; Sensory Thresholds ; Spine