OBJECTIVE: To compare the efficacy of epidural injection in accordance the distribution of dye in the epidural space for low back pain patient. METHOD: Twenty nine patients with herniated nucleus pulposus or spinal stenosis confirmed by the radiologic studies were treated with epidural injection of steroid. The patients were divided into two groups: 1) patients whose distribution of dye was in the posterior part of epidural space and 2) patients whose distribution of dye was in the anterior and posterior parts of epidural space. RESULTS: The efficacy of epidural injection was assessed using the visual analog scale (VAS) and straight leg raising test (SLR) on pre-treatment and post-treatment. The VAS and SLR change of pre-treatment and post-treatment in the first group was from 7.81 +/- 1.54 and 50.00 +/- 18.97 degrees to 4.45 +/- 2.16 and 75.00 +/- 17.61 degrees (p<0.05), respectively. The VAS and SLR change of pre- and post-treatment in the second group was from 7.72 +/- 1.56 and 43.33 +/- 15.28 degrees to 3.72 +/- 1.64 and 60.00 +/- 10.00 degrees (p<0.05), respectively. The VAS and SLR change between groups has no statistically significant difference (p>0.05). CONCLUSION: The different distribution of dye in epidural space had no significant difference in treating patients with low back pain.
Epidural Space* ; Humans ; Injections, Epidural* ; Leg ; Low Back Pain ; Spinal Stenosis ; Visual Analog Scale

OBJECTIVE: This study was designed to observe the general characteristic of patients with shoulder pain, interrelation between the ultrasonographic findings, physical examination and radiological findings, and the effect of treatment of shoulder pain classified by ultrasonographic findings. METHOD: We examined 334 patients (165 male and 169 female) with shoulder pain who had been consulted to us. We examined degenerative changes such as subacromial spur, greater tuberosity sclerosis using radiological method. We classified patients into three categories -capsular, noncapsular and mixed - in accordance to physical examination and ultrasonographic findings. In order to estimate the effect of treatment, VAS change one week after injection, treatment duration, and frequency of injection were checked. RESULTS: The mean age of patients was 54.4 (range: 22~77) years. The average VAS change, duration of treatment, and frequency of injection were 4.68+/-2.93, 6.14 +/- 4.83 weeks, 3.59 +/- 2.70 times. There was meaningful correlation between diagnosis done with physical examination and ultrasonography in cases showing capsular and noncapsular patterns. Although there was meaningful difference of treatment effect classified by ultrasonographic findings, no meaningful difference in treatment effect was ween in patients classified by physical examination. CONCLUSION: Ultrasonography is an useful tool supporting diagnosis based on physical examination. The ultrasonography of shoulder could predict progress and prognosis of patients with shoulder pain.
Diagnosis ; Humans ; Male ; Physical Examination ; Prognosis ; Sclerosis ; Shoulder Pain* ; Shoulder* ; Ultrasonography*

OBJECTIVE: To identify the range of the precise locations of the motor points of triceps surae muscles in relation to bony landmarks. METHOD: Eight limbs of four male cadavers were dissected. The number and location of the motor points from the tibial nerve to each head of the triceps surae muscle were identified related to the bony landmarks. Bony landmarks were medial and lateral epicondyles of the femur, and medial and lateral malleolli of the tibia. The length of the lower leg was defined as the distance from the intercondylar line of the femur to the intermalleolar line of the tibia. The locations of the motor points were expressed as the vertical distance from the intercondylar line, which was normalized to the length of the lower leg. RESULTS: The most proximal motor points of the medial gastrocnemius, lateral gastrocnemius, and soleus were located in 9.6+/-3.5%, 12.0+/-3.4% and 20.5+/-3.9% of the lower leg below the intercondylar line of the femur. The most distal points were in 37.5+/-5.5%, 37.9+/-2.3% and 46.7+/-3.6%. CONCLUSION: The identification of the locations of motor points related to the bony landmarks would increase the ease and accuracy of the motor point blocks to the triceps surae muscles.
Cadaver ; Extremities ; Femur ; Head ; Humans ; Leg ; Male ; Muscles* ; Tibia ; Tibial Nerve

OBJECTIVE: The purpose of this study was to evaluate the effect of interferential current therapy (IFT) of swing pattern frequency alteration on the RIII nociceptive reflex. METHOD: Ten healthy volunteers received IFT of both constant (100 Hz) and swing (20~100 Hz) pattern frequency. Before and after the IFT application RIII nociceptive reflex was evoked by stimulation of sural nerve and recording at biceps femoris muscle. Twenty nine patients with low back pain were treated with IFT of constant or swing pattern frequency and degrees of pain relief were evaluated by Visual Analogue Scale (VAS) and Present Pain Intensity (PPI). RESULTS: The threshold of RIII reflex was increased immediately after both constant and swing frequency, but the increased threshold was lasted for 15 minutes only after swing pattern frequency alteration. Pain relieving effect of IFT evaluated by PPI was also lasted for 15 minutes only after swing frequency alteration. CONCLUSION: These results suggest that IFT of swing pattern frequency alteration had longer lasting effect on the inhibition of RIII nociceptive reflex and the relief of pain than that of constant frequency.
Electric Stimulation Therapy ; Healthy Volunteers ; Humans ; Low Back Pain ; Reflex* ; Sural Nerve

OBJECTIVE: To compare the patients of chronic low back pain with and without emotional depression in terms of psychosomatic aspect and clinical outcome by cross-sectional and prospective study. METHOD: We evaluated 100 patients who were admitted due to chronic low back pain. The patients were classified into three groups (moderately depressed, mild depressed, non-depressed) by the score of Beck Depression Inventory (BDI). And three groups were compared by Pain Disability Index (PDI), Visual Analogue Scale (VAS), Pain Rating Score (PRS) and special diagnostic studies such as MRI and EMG. All subjects took the same conservative treatments for 4 weeks and then, they were re-evaluated by PDI, VAS and PRS. RESULTS: BDI score was positively correlated with VAS and PRS significantly. All groups were not different with respect to functional limitation (measured by PDI) and organic lesion (measured by MRI and EMG study). But, subjective pain (measured by VAS, PRS) were severe in depressed group. All groups showed improvement in PDI, VAS and PRS after 4 weeks of treatment. But, the amount of improvement was greater in non-depressed group. CONCLUSION: The clinician treating chronic low back pain should be familiar with depression and prepare for screening on that.
Depression* ; Humans ; Low Back Pain* ; Magnetic Resonance Imaging ; Mass Screening ; Prospective Studies

OBJECTIVE: To evaluate the pain patterns of patients with osteoarthritis (OA) of the knee. METHOD: Forty-four patients (mean age 56.1 years) with pain around the knee who met the Simons' criteria for myofascial pain syndrome (MPS). Patients drew in their pain areas on a pain drawing diagram. The pain areas were input into the Pain Chart System (PCS) software program for analysis. Physical examination, trigger point injection, and exercises for knee muscles were performed. Oral analgesics were not prescribed. RESULTS: MPS was clinically diagnosed in all 44 patients. Radiologic examination revealed degenerative changes in 49 knees. Pain patterns detected by the PCS revealed pain patterns compatible with myofascial trigger point in the vastus medialis in 37 cases, rectus femoris in 32 cases, adductor longus in 5 cases, sartorius in 2 cases, vastus lateralis in 1 case, and the popliteus in 1 case. Following treatment, 36 of the 44 patients experienced pain relief. CONCLUSION: Degenerative changes of the joint seem not to be cause of the knee joint pain. Instead, pain relief following MPS treatment indicates the cause of knee pain as MPS. We recommend that the first step in the treatment for knee pain include recognition and treatment of MPS before applying invasive treatment.
Analgesics ; Exercise ; Humans ; Joints ; Knee Joint ; Knee* ; Muscles ; Myofascial Pain Syndromes* ; Osteoarthritis* ; Physical Examination ; Quadriceps Muscle ; Trigger Points

OBJECTIVE: This study was designed to investigate the effect of steroid injection on the blood sugar level in shoulder pain patients with diabetes mellitus. METHOD: Fifteen patients with shoulder pain and diagnosed diabetes mellitus were included. The blood sugar, insulin, cortisol and HbA1c level were measured before and twice (at 24 hours and 1 week) following a intraarticular, intratendinous or intrabursal injection containing triamcinolone. Statistical significance was determined by the paired t-test. RESULTS: The blood sugar, insulin and HbA1c levels had no significant difference between before and after steoid injection (p>0.05). But, the cortisol level significantly fell at 24 hours after steroid injection compared with preinjection level and returned to preinjection level by 1 week after steroid injection (p<0.05). CONCLUSION: One time triamcinolone injection resulted in significant suppression of cortisol level, but it returned to preinjection level after a week. The blood level of sugar, insulin and HbA1c showed no significant change after one time steroid injection.
Blood Glucose* ; Diabetes Mellitus* ; Humans ; Hydrocortisone ; Insulin ; Shoulder Pain* ; Shoulder* ; Triamcinolone

OBJECTIVE: To know the correlation between the grading of facial neuropathy by facial nerve conduction study (FNCS) and dysphagia severity by videofluoroscopic swallowing study (VFSS) in patients with acute peripheral facial palsy (PFP). METHOD: Twenty patients with acute PFP were recruited for this study. The causes of acute PFP were limited to idiopathic Bell's palsy and Ramsay-Hunt syndrome. The time interval from the onset of PFP to study of FNCS and VFSS was 10 to 14 days. The severity of PFP was graded according to House-Brackmann facial nerve grade (H-B FNG). Percent degeneration grade (PDG) was determined by FNCS. Baseline-to-peak amplitude of compound muscle action potentials in orbicularis oris muscle was used as an evaluation parameter. Oral transit time (OTT), pharyngeal transit time (PTT), pharyngeal delay time (PDT) and dysphagia limit were obtained by VFSS. RESULTS: There was a significant correlation between PDG and H-B FNG. The severity of oropharyngeal dysfunction was increased as the severity of the PDG increases. Delayed OTT, delayed PDT, and/or reduced dysphagia limit were revealed as a presentation of oropharyngeal dysfunction in acute PFP. CONCLUSION: The severity of PFP and oropharyngeal dysfunction were significantly correlated. And so we think that precise evaluation and adequate management of oropharyngeal dysfunction will be needed in acute PFP patients.
Action Potentials ; Bell Palsy ; Deglutition ; Deglutition Disorders ; Facial Nerve ; Facial Nerve Diseases* ; Facial Paralysis ; Humans

OBJECTIVE: To evaluate the effectiveness and electrophysiological changes after alcohol neurolysis of the tibial nerve motor branches to gastrocnemius muscles on the treatment of ankle spasticity in stroke patients. METHOD: Fourteen poststroke hemiplegic patients who had an abnormal gait pattern due to the ankle spasticity participated. They were evaluated by modified Ashworth scale (MAS) score, passive range of motion (PROM) of ankle, and ankle clonus, and were studied using electrophysiological measurements such as amplitude and latency of H-reflex and M response, and H/M ratio. 50% alcohol was injected into the tibial nerve motor branches to the both gastrocnemius muscles with electromyography guidance. Follow-up evaluations were performed immediately, and then, at the one-week, one-month, and three-months following the neurolysis. RESULTS: The MAS scores significantly decreased and the PROM of the ankle significantly increased. The M response and H-reflex amplitude of gastrocnemius muscles significantly decreased after the neurolysis and they had a tendency to increase at the 3-months follow-up. Also, H/M ratio significantly decreased. There were no serious postinjection complications. CONCLUSION: Alcohol neurolysis of the tibial nerve motor branches was an effective and safe method for the treatment of the ankle spasticity in poststroke hemiplegic patients.
Ankle ; Electromyography ; Follow-Up Studies ; Gait ; H-Reflex ; Humans ; Muscle Spasticity ; Muscles* ; Range of Motion, Articular ; Stroke ; Tibial Nerve*

OBJECTIVE: To evaluate the effect of vascular abnormality on diabetic neuropathy with the use of pedal vascular pulsation and electrodiagnostic study. METHOD: One hundred-eight non-insulin dependent diabetes mellitus patients were studied. All patients underwent nerve conduction studies. Evaluation of vascular status was done using pedal pulse palpation. Four groups were formed. Electrophysiologically normal group was subdivided into non-vascular abnormality group (A1) and vascular abnormality group (A2). Neuropathy group was subdivided into non-vascular abnormality group (B1) and vascular abnormality group (B2). The frequency of diabetic neuropathy among whole groups and the difference of amplitude, conduction velocity, and F-wave latency within A groups and B groups were investigated, respectively. RESULTS: Diabetic neuropathy was significantly correlated with vascular abnormality (p<0.05). There was no definite difference of electrophysiologic parameters between A1 and A2 groups. B1 group showed significantly reduced amplitude of SNAPs in sural and median sensory nerves compared with B2 group (p<0.05). CONCLUSION: The results of the study support the influence of vascular abnormality on diabetic neuropathy and suggest that vascular abnormality in patients with diabetic neuropathy results in axonal injury rather than demyelination injury.
Axons ; Demyelinating Diseases ; Diabetes Mellitus ; Diabetic Neuropathies* ; Humans ; Ischemia ; Neural Conduction ; Palpation ; Peripheral Nervous System Diseases ; Vascular Diseases