Obturator nerve block has been commonly used for pain management to prevent involuntary reflex of the adductor thigh muscles. One of several options for this block is chemical neurolysis. Neurolysis is done with chemical agents. Chemical agents used in the neurolysis of the obturator nerve have been alcohol, phenol, and botulinum toxin. In the current case, a patient with spasticity of the adductor thigh muscle due to cervical cord injury had obturator nerve neurolysis done with botulinum toxin type B (BoNT-B). Most of the previous studies have used BoNT-A with only a few reports that have used BoNT-B. BoNT-B has several advantages and disadvantages over BoNT-A. Thus, we report herein a patient who successfully received obturator nerve neurolysis using BoNT-B to treat adductor thigh muscle spasm.
Botulinum Toxins ; Botulinum Toxins, Type A ; Humans ; Muscle Spasticity ; Muscles ; Nerve Block ; Obturator Nerve ; Pain Management ; Phenol ; Reflex ; Spasm ; Thigh

No abstract available.
Calcium Pyrophosphate* ; Calcium* ; Knee Joint* ; Knee*

Vertebral compression fractures result in vertebral height loss and alter sagittal spinal alignment, which in turn can lead to increased morbidity and mortality. Acute osteoporotic vertebral compression fractures are known to increase mobility and instability of the spine. There are limited published data correlating the degree of dynamic mobility and the efficacy of kyphoplasty on vertebral compression fractures. Here we report a 73-year-old female with a severe acute osteoporotic L2 compression fracture who obtained total vertebral height restoration following kyphoplasty, with resolution of back pain.
Aged ; Back Pain ; Female ; Fractures, Compression ; Humans ; Kyphoplasty ; Osteoporosis ; Spine

BACKGROUND: An independent medical examination (IME) is a critical process for awarding reparation for injury. However, conducting an IME in pain medicine is very difficult, not only because pain is a subjective symptom, but also because there are no proper objective methods to demonstrate it. This study was conducted to compare IME reports and the court decisions on the disability status of the patients. METHODS: We analyzed 79 IME reports and 25 corresponding court decisions on the disability status of patients. The diagnoses, causal relationships between the patients' status and the trauma, McBride's degree of disability, the American Medical Association's impairment ratings, the estimated annual cost for future treatment, and the necessity of care-giving were compared and analyzed. RESULTS: The diagnoses in the 79 cases were complex regional pain syndrome (CRPS) type I (58 cases), CRPS type II (7 cases), peripheral neuropathy (5 cases), myofascial pain syndrome (4 cases), herniated intervertebral disc (2 cases), and fibromyalgia (1 case). The types of accidents were road traffic accidents (50 cases), military injuries (14 cases), industrial accidents (11 cases), and others (4 cases). The IME reports and the court decisions stated considerably different McBride's degrees of disability (P = 0.014). However, there was no significant difference in the estimated cost for future treatment between the IME reports and the court decisions (P = 0.912). CONCLUSION: IME reports should be accurate, fair, and based on objective findings. Feedback on IMEs from the court decisions is helpful for reference use.
Accidents, Occupational ; Accidents, Traffic ; Awards and Prizes ; Causalgia ; Disability Evaluation ; Fibromyalgia ; Humans ; Intervertebral Disc ; Jurisprudence ; Military Personnel ; Myofascial Pain Syndromes ; Peripheral Nervous System Diseases

BACKGROUND: A skin temperature difference is one of the variables used in the diagnosis of complex regional pain syndrome. However, there have been no reports as to whether the real (DeltaT) or absolute value (|DeltaT|) of skin temperature differences should be used in the diagnosis of complex regional pain syndrome. This study was conducted to compare the diagnostic validity of DeltaT with |DeltaT| for complex regional pain syndrome using receiver operating characteristic curves (ROC). METHODS: Infrared thermographic images were obtained from the 144 patients who were suspected to have CRPS in a unilateral limb. After DeltaT and |DeltaT| calculation from the thermographic image, ROCs of DeltaT and |DeltaT| were developed, and the areas under the curve (AUC) for the ROC curves were compared. RESULTS: AUCs of DeltaT and |DeltaT| were 0.520 and 0.746 respectively, this difference was statistically significant (P < 0.001). CONCLUSIONS: Absolute skin temperature difference shows greater validity in the diagnosis of CRPS than DeltaT. Therefore, |DeltaT| is more useful when comparing the skin temperature of CRPS patients.
Area Under Curve ; Diagnostic Imaging ; Extremities ; Humans ; ROC Curve ; Skin ; Skin Temperature ; Thermography

Hyaluronidase is an enzyme that has temporary and reversible enzymatic effects on the matrix of connective tissue. When added to local anesthetics in pain treatments, it enhances their infiltration and dispersal into tissues. It is widely used in anesthesia for ocular, dental, and plastic surgery. Reports of drug hypersensitivity to hyaluronidase are rare and are usually confined to peribulbar or retrobulbar anesthesia during ophthalmic surgery. However, few reports exist on adverse drug reaction after epidural injection. We have observed two patients experiencing anaphylactic shock caused by hyaluronidase following epidural injection. Most of the patients with a hypersensitivity to hyaluronidase had one previous uneventful injection containing hyaluronidase, implying that sensitization had taken place. However, hypersensitivity occurring at the first administration is possible. A positive skin test can help establish the diagnosis. Although rare, the possibility of an allergic reaction to hyaluronidase should be considered even in patients with no known previous exposure.
Anaphylaxis ; Anesthesia ; Anesthetics, Local ; Connective Tissue ; Drug Hypersensitivity ; Drug Toxicity ; Humans ; Hyaluronoglucosaminidase ; Hypersensitivity ; Hypogonadism ; Injections, Epidural ; Mitochondrial Diseases ; Ophthalmoplegia ; Skin Tests ; Surgery, Plastic

The patient was a 45-year-female who presented with pain at right shoulder and right upper arm. The patient suffered from right shoulder and arm pain for 3 years and had pain management which was performed using medication and conservative management after she had been diagnosed with calcific tendinitis. However, substantial pain relief was not consistently achieved, and recurrence of pain was reported. Therefore, we performed right axillary nerve and suprascapular nerve block through pulsed radiofrequency. Two months after the procedure, the shoulder pain gradually subsided with the size reduction of the calcified nodule and she needed no more pain management.
Arm ; Calcinosis ; Humans ; Nerve Block ; Pain Management ; Recurrence ; Rotator Cuff ; Shoulder ; Shoulder Pain ; Tendinopathy

BACKGROUND: The aims of this study were to analyze the anatomic variations of supraorbital foramina/notches in Koreans and to compare the results with those of previous studies examining other races. We evaluated the three-dimensional computed tomography (3D-CT) images of human faces using multidetector computed tomography (MDCT). METHODS: A total of 395 adults (232 men and 163 women) were enrolled and the 3D-CT images of their faces were reviewed in this study. In this study, the data from the images included the presence, shape, width and distance from the nasion to the supraorbital foramina/notches. ANOVA was used to assess the main effects of gender and side (right or left foramen/notch), and comparisons of the means were done by paired t-test. RESULTS: The most common shapes in Koreans were a single notch (39.5%) on the right hand side and a single foramen (42.3%) on the left hand side. The incidence of a single foramen in Koreans was high compared to other races. The mean foramen diameter was 2.34 +/- 0.78 mm, and the mean distance from the nasion was 27.19 +/- 4.03 mm. The mean notch diameter was 3.37 +/- 1.71 mm, and the mean distance from the nasion was 23.42 +/- 2.45 mm. CONCLUSIONS: This is the first study on the variations of supraorbital foramina/notches in Koreans using 3D-CT images of faces. The anatomic characteristics of the supraorbital foramina/notch will help in performing nerve blocks and maxillofacial surgery.
Adult ; Asian Continental Ancestry Group ; Continental Population Groups ; Hand ; Humans ; Incidence ; Male ; Multidetector Computed Tomography ; Nerve Block ; Surgery, Oral

BACKGROUND: Caudal block is a common technique in children for reducing postoperative pain, and there have been several reports on the variations of the sacral canal in children. However, previous studies have mainly focused on the needle trajectory for caudal block, and there is limited information on the structural variations of the sacrum in children. The purpose of this study was to analyze the anatomic variations of sacral canals in children. METHODS: Three-dimensional computed tomographic images were analyzed. The data from the images included fusion of the sacral vertebral laminae and the sacral intervertebral space existence of the sacral cornua and the types of sacral hiatus. The types of sacral hiatus were classified into 3 groups: group I (fusion of S3 or S4 vertebral laminae), group II (unfused vertebral arch with the distance of the S3 and S4 vertebral laminae < 50% of the distance between the cornua), and group III (unfused vertebral arch with the distance of the S3 or S4 vertebral laminae > or = 50% of the distance between the cornua). RESULTS: A total of 143 children were included in this study. All of the sacral vertebral arches were not fused in 22 children (15.4%). Cornua were not identified bilaterally in 5 (3.5%) and unilaterally in 6 (4.2%) children. In the sacral hiatus, group II and group III were identified in 22 (15.4%) and 31 (21.7%) children, respectively. CONCLUSIONS: The sacral canal has various anatomical variations in children. Careful attention must be paid to identify the correct anatomic landmark.
Anatomic Landmarks ; Anatomic Variation ; Anesthesia, Caudal ; Child* ; Humans ; Imaging, Three-Dimensional ; Needles ; Pain, Postoperative ; Sacrum

Background: Among various diseases that accompany pain, complex regional pain syndrome (CRPS) is one of the most frustrating for patients and physicians. Recently, many studies have shown functional and anatomical abnormalities in the brains of patients with CRPS. The calcium-related signaling pathway is important in various physiologic processes via calmodulin (CaM) and calcium-calmodulin kinase 2 (CaMK2). To investigate the cerebral mechanism of CRPS, we measured changes in CaM and CaMK2 expression in the cerebrum in CRPS animal models. Methods: The chronic post-ischemia pain model was employed for CRPS model generation. After generation of the animal models, the animals were categorized into three groups based on changes in the withdrawal threshold for the affected limb: CRPS-positive (P), CRPS-negative (N), and control (C) groups. Western blot analysis was performed to measure CaM and CaMK2 expression in the rat cerebrum. Results: Animals with a decreased withdrawal threshold (group P) showed a significant increment in cerebral CaM and CaMK2 expression (P = 0.013 and P = 0.021, respectively). However, groups N and C showed no difference in CaM and CaMK2 expression. Conclusions The calcium-mediated cerebral process occurs after peripheral injury in CRPS, and there can be a relationship between the cerebrum and the pathogenesis of CRPS.