The purposes of this study were to verify the effect of selective nerve root injection for sciatica caused by lumbosacral radiculopathy and to compare the difference of the therapeutic effects with the various clinical parameters and the morphologic types of herniated intervertebral disc on MRI finding. Forty-two patients, 14 males and 28 females, with an average age of 51 years (range, 26~71) and an average duration of symptoms of 17.8 months (range, 1~120) presenting with sciatica thought to be due to lumbosacral nerve root compromise were admitted to the study. All of the patients underwent clinical examination and lumbosacral MRI. Epiradicular infiltration of corticosteroids and local anesthetics by the transforaminal route under the image intensifier was done as a treatment. All the patients were followed up at 2 weeks and 3 months after the injection. A high proportion of patients made a satisfactory relief of sciatica with a selective nerve root injection at 2 weeks (85.7%) and 3 months (76.2%) follow-up. Among the patients who showed a significant symptom relief at 3 months, 12 patients were followed up and the relieved symptoms lasted for 6 months to 1 year in majority of those patients. In a few patients with clinical improvements at 2 weeks after the injection, the symptoms recurred at 3 months (9/36, 25%) and between 6 months to 1 year (3/12, 25%). There were no differences of the therapeutic effects according to the duration of the disease, neurologic findings on physical examination and the MRI findings of herniated intervertebral discs. The selective nerve root injection can be an effective therapeutic modality for the treatment of sciatica in lumbosacral radiculopathy.
Adrenal Cortex Hormones ; Anesthetics, Local ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc ; Magnetic Resonance Imaging ; Male ; Neurologic Manifestations ; Physical Examination ; Radiculopathy* ; Sciatica*

OBJECTIVE: The purposes of this study were to obtain the reference values of latency and amplitude of the medial plantar sensory nerve action potential(SNAP) in normal controls and to evaluate the diagnostic sensitivity of medial plantar sensory nerve conduction study(NCS) in diabetic neuropathy. METHOD: Thirty healthy controls(mean age, 48.7 years; range, 38~59 years) and 33 diabetic patients(mean age, 50.8 years; range, 37~64 years) were included in this study. The inclusion criteria for diabetic patients were subjects with the normal peroneal and tibial compound muscle action potentials, obtainable sural SNAPs and intact pressure-perception to Semmes-Weinstein monofilament 5.07. RESULTS: The medial plantar sensory nerve action potentials were obtainable in all control subjects and the reference values of onset latency and peak to peak amplitude were 4.29+/-0.49 msec and 3.1+/-1.34 V, respectively. All 33 diabetic patients showed the normal latency and 3 of them showed the low amplitude in sural SNAPs. The medial plantar SNAPs were obtainable in 24 diabetic patients. Among 9 patients with unobtainable medial plantar SNAPs, 6 showed the normal sural SNAPs and 3 showed the low sural SNAPs. The sensitivities of medial plantar SNAPs to sural nerve and sural SNAPs to medial plantar sensory nerve were 100%(3/3) and 27.3%(3/11) respectively. CONCLUSION: We concluded that medial plantar sensory NCS was more valuable in the early diagnosis of diabetic neuropathy than the sural NCS and Semmes-Weinstein monofilament (North Coast Medical Inc, USA).
Action Potentials ; Diabetic Neuropathies ; Early Diagnosis ; Humans ; Neural Conduction* ; Reference Values ; Sural Nerve ; Tibial Nerve

OBJECTIVE: To verify the effectiveness of nerve block to the femoral nerve (motor branch of rectus femoris) for stiff-legged gait in spastic patients and to identify factors which influence its effect. METHOD: EMG-guided femoral nerve (motor branch of rectus femoris) block by 2% lidocaine and/or 5% phenol was performed on 33 patients with stiff-legged gait: 22 were spastic hemiplegia after stroke; 10 were spastic paraparesis; 1 was spastic diplegia. Subjective improvement in gait performance was evaluated. Pre- and post-block comparisons were made by objective parameters, including gait speed and sagittal knee kinematics. RESULTS: Twenty five of all subjects showed subjective improvement in gait performance and significant differences of pre- and postblock gait data after nerve block by 2% lidocaine. Eighteen of 19 patients who had activity of rectus femoris alone at swing phase showed subjective improvement in gait performance and significant differences of pre- and postblock gait data after this procedure. Twenty two of 25 patients with sufficient strength of hip flexor showed the same result as the above. There were no significant differences between the subgroups depending on the degree of the quadriceps spasticity. 5% phenol block for more long-term effect also showed significant increase in knee flexion at swing phase in these 25 patients. CONCLUSION: Femoral nerve (motor branch of rectus femoris) block can be a effective treatment modality for stiff-legged gait. Sufficient strength of hip flexor muscle, rectus femoris activity without activities of vastus muscles at swing phase on dynamic EMG are the factors which predict the favorable outcome in this procedure. But, diagnostic block with lidocaine is a mandatory to predict its effect in clinical practice.
Biomechanical Phenomena ; Cerebral Palsy ; Femoral Nerve* ; Gait* ; Hemiplegia ; Hip ; Humans ; Knee ; Lidocaine ; Muscle Spasticity* ; Muscles ; Nerve Block ; Paraparesis, Spastic ; Phenol ; Quadriceps Muscle ; Stroke

The purposes of the study was to measure the normal value of peak torque of lumbar extensors at various degrees of lumbar flexion and to compare this with the chronic low back pain patient. 100 normal subjects, 70 men(age, 49.0+/-.3) and 30 women(age, 48.1+/-.4), completed isometric lumbar extension strength test. 26 low back pain subjects, 9 men(age, 35.3+/-4.7) and 17 women(age, 42.6+/-0.1), completed isometric lumbar extension strength test. Normal male peak torques of lumbar extensors were 125+/-8 Ft-1bs at 0 degree, 164+/-3 at 12 degree, 200+/-3 at 24 degree, 221+/-6 at 35 degree, 241+/-0 at 48 degree, 257+/-0 at 60 degree, and 262+/-1 at 72 degree of lumbar flexion. Normal female peak torques of lumbar extensors were 78+/-4 at 0 degree, 105+/-7 at 12 degree, 120+/-38 at 24 degree, 135+/-5 at 36 degree, 142+/-7 at 48 degree, 151+/-0 at 60 degree, and 157+/-1 at 72 degree of lumbar flexion. Normal peak torques of lumbar extensors increase as degrees of lumbar flexion increase. Body weight in more correlated with peak torque than body mass index. Male peak torques of lumbar extensors with low back pain were 91+/-7 ft-1bs at 0 degree. 129+/-6 at 12 degree, 156+/-7 at 24 degree, 178+/-1 at 36 degree, 197+/-4 at 48 degree, 217+/-1 at 60 degree, and 218+/-2 at 72 degree of lumbar fiexion. Female peak torques of lumbar extensors with low back pain were 45+/-4 at 0 degree, 73+/-8 at 12 degree, 98+/-2 at 24 degree, 117+/-4 at 35 degree, 130+/-0 at 48 degree, 138+/-1 at 60 degree, and 148+/-6 at 72 degree of lumbar fiexion. Peak torques of lumbar extensors with 1cw back pain increase as degrees of lumbar flexion increase. Comparison of the normal male peak torque of lumbar extensors with low back pain group revealed statistical differences at 48 and 72 degree of lumbar extensors. And the female group revealed statistical difference at 0, 12, and 24 degree of lumbar flexion.
Back Pain ; Body Mass Index ; Body Weight ; Female ; Humans ; Low Back Pain* ; Male ; Reference Values ; Torque

OBJECTIVE: To evaluate the frequency of forearm anastomosis in healthy Korean subjects. METHOD: Healthy Korean adult subjects (70 males, 30 females) were included. Median and ulnar nerves were stimulated at wrist and elbow and recorded with the surface electrodes over abductor pollicis brevis (APB), first dorsal interossei (FDI) and abductor digiti quinti (ADQ). RESULTS: Martin-Gruber anastomosis (MGA) was found in 18 males and 8 females (26/100, 26%). MGA was found in 37 arms (18.5%). But, Marinacci anastomosis was not observed. For each type of MGA, type II was found in 36 arms (97.3%) whereas type I was found in 11 arms (29.7%), and type III was found in 1 arm (2.7%). Anastomosis was comprised 67.6% of type II, 2.7% of type III, and 29.7% of coexistence of type II and type I. Average innervation ratio of crossing fibers was the highest in FDI (16.2%). CONCLUSION: Compound muscle action potential (CMAP) comparison method using modified incremental technique is a simple and sufficient method for evaluating forearm anastomosis without stimulus spread to adjacent nerve. In evaluating MGA, the FDI is a very important muscle because of high frequency and innervation ratio.
Action Potentials ; Adult ; Arm ; Elbow ; Electrodes ; Electromyography ; Female ; Forearm ; Humans ; Male ; Muscles ; Ulnar Nerve ; Wrist

Spinal cord infarction, especially anterior spinal artery syndrome, is a relatively rare disease. We report a case of spinal cord infarction caused by thoracoabdominal aortic aneurysm with intraluminal thrombus. A 52-year-old man presented with sudden onset paraplegia. At first, he was diagnosed with cervical myelopathy due to a C6-7 herniated intervertebral disc, and had an operation for C6-7 discetomy and anterior interbody fusion. Approximately 1 month after the operation, he was transferred to the department of rehabilitation in our hospital. Thoracoabdominal aortic aneurysm with intraluminal thrombus was found incidentally on an enhanced computed tomography scan, and high signal intensities were detected at the anterior horns of gray matter from the T8 to cauda equina level on T2-weighted magnetic resonance imaging. There was no evidence of aortic rupture, dissection, or complete occlusion of the aorta. We diagnosed his case as a spinal cord infarction caused by thoracoabdominal aortic aneurysm with intraluminal thrombus.
Animals ; Anterior Spinal Artery Syndrome ; Aorta ; Aortic Aneurysm ; Aortic Aneurysm, Thoracic ; Aortic Rupture ; Cauda Equina ; Horns ; Humans ; Infarction ; Intervertebral Disc ; Magnetic Resonance Imaging ; Middle Aged ; Paraplegia ; Rare Diseases ; Spinal Cord ; Spinal Cord Diseases ; Thrombosis

OBJECTIVE: To evaluate the potential feasibility of application of the extended International Classification of Functioning, Disability and Health (ICF) Core Set for stroke. METHODS: We retrospectively reviewed the medical records of 40 stroke outpatients (>6 months after onset) admitted to the Department of Rehabilitation Medicine for comprehensive rehabilitation. Clinical information of the patients were respectively evaluated to link to the 166 second-level categories of the extended ICF Core Set for stroke. RESULTS: Clinical information could be linked to 111 different ICF categories, 58 categories of the body functions component, eight categories of the body structures component, 38 categories of the activities and participation component, and seven categories of the environmental factors component. CONCLUSION: The body functions component might be feasible for application of the extended ICF Core Set for stroke to clinical settings. The activities and participation component and environmental factors component may not be directly applied to clinical settings without additional evaluation tools including interview and questionnaire.
Humans ; International Classification of Functioning, Disability and Health ; Medical Records ; Outpatients ; Rehabilitation* ; Retrospective Studies ; Stroke* ; Surveys and Questionnaires

OBJECTIVE: To determine the age-related changes in cardiac rehabilitation (CR) outcomes, which includes hemodynamic and metabolic factors, in patients with myocardial infarction (MI). METHODS: CR was administered for 8 weeks to 32 men (mean age, 54.0±8.8 years) who underwent percutaneous coronary intervention for acute MI between July 2012 and January 2016. The exercise tolerance tests were performed before and after the CR. The results were stratified based on a cut-off age of 55 years. RESULTS: In the whole patient group, the hemodynamic variables such as the resting heart rate (HRrest), systolic blood pressure (SBPrest), submaximal HR (HRsubmax), SBP (SBPsubmax), and rate pressure product (RPPsubmax) significantly decreased and the maximal HR (HRmax) and RPP (RPPmax) significantly increased. All metabolic variables displayed significant improvement, to include maximal oxygen consumption (VO2max) and ventilation (VEmax), anaerobic threshold (AT), and the maximal oxygen pulse (O2pulsemax). However, upon stratification by age, those who were younger than 55 years of age exhibited significant changes only in the HRrest and RPPsubmax and those aged 55 years old or greater displayed significant changes in all hemodynamic variables except diastolic BP. Both groups displayed significant increases in the VO2max, VEmax, and AT; the older group also exhibited a significant increase in O2pulsemax. The magnitude of the changes in the hemodynamic and metabolic variables before and after CR, based on age, did not differ between the groups; although, it tended to be greater among the older participants of this study's sample. CONCLUSION: Because the older participants tended to show greater hemodynamic and metabolic changes due to CR, a more aggressive CR program must be administered to elderly patients with MI.
Aged ; Anaerobic Threshold ; Blood Pressure ; Exercise Test ; Exercise Tolerance ; Heart Rate ; Hemodynamics ; Humans ; Male ; Myocardial Infarction* ; Oxygen ; Oxygen Consumption ; Percutaneous Coronary Intervention ; Rehabilitation* ; Ventilation

We report a case of a 44-year-old patient with paralysis of the left leg who had a thoracic epidural catheterization after general anesthesia for abdominal surgery. Sensory losses below T10 and motor weakness of the left leg occurred after the surgery. Magnetic resonance image study demonstrated a well-defined intramedullary linear high signal intensity lesion on T2-weighted image and low-signal intensity on T1-weighted image in the spinal cord between T9 and L1 vertebral level, and enhancements of the spinal cord below T8 vertebra and in the cauda equina. Electrodiagnostic examination revealed lumbosacral polyradiculopathy affecting nerve roots below L4 level on left side. We suggest that the intrinsic spinal cord lesion and nerve root lesion can be caused by an epidural catheterization with subsequent local anesthetic injection.
Analgesia, Epidural ; Anesthesia, General ; Catheterization ; Catheters ; Cauda Equina ; Humans ; Leg ; Magnetic Resonance Spectroscopy ; Paralysis ; Polyradiculopathy ; Spinal Cord ; Spinal Cord Injuries ; Spine

Thyrotoxic periodic paralysis (TPP) is rare in white Caucasian but a few in Asian. A 36-year-old man presented with suddenly developed paraparesis was brought by ambulance. He got some medications and injection for the upper respiratory infection in the morning of admission day. On admission he revealed bilateral proximal muscle weakness without pain. He didn't have any specific medical history of himself and his family. The laboratory results on admission revealed severe hypokalemia (2.1 mM/l). Potassium replacement was immediately started and his symptom was gone. We found TSH was extremely decreased (<0.005 microIU/ml) but T3 and T4 were within normal level. We guess TPP was induced by some drugs to the patient with sub-clinical hyperthyroidism. Hyperthyroidism is not always clinically apparent and then may be easily missed. However just a single medication or injection that is usually prescribed can induce critical progressive hypokalemia.
Adult ; Ambulances ; Asian Continental Ancestry Group ; Humans ; Hyperthyroidism* ; Hypokalemia ; Muscle Weakness ; Paralysis ; Paraparesis ; Potassium