Segmental zoster paresis is characterized by focal, asymmetric motor weakness in the myotome corresponding to the dermatome of the rash. A 73-year-old man, who presented with severe right shoulder pain and shoulder girdle muscle weakness, was diagnosed with segmental zoster paresis involvement of the C5 C6 motor roots as a complication of herpes zoster. Girdle muscles (supraspinatus, deltoid and infraspinatus) atrophy had developed in his right shoulder. An MRI showed rotator cuff tearing in his right shoulder; therefore, an arthroscopic rotator cuff repair was performed. Herein, this case is presented to emphasize the importance of considering post-herpetic segmental motor paresis in the differential diagnosis of acute painful motor weakness of the upper extremities.
Acute Pain ; Aged ; Atrophy ; Diagnosis, Differential ; Exanthema ; Herpes Zoster* ; Humans ; Magnetic Resonance Imaging ; Muscle Weakness ; Muscles ; Muscular Atrophy ; Paresis* ; Rotator Cuff* ; Shoulder ; Shoulder Pain ; Upper Extremity

Droopy shoulder syndrome (DSS) is a rare disease, characterized by drooping shoulders, which stretches the brachial plexus, and causes pain, but without any signs of neurological impairment. These patients suffer from pain in the neck, shoulders, arms and hands, which result in long, graceful, swan necks, low-set shoulders, and horizontal or down sloping clavicles. No abnormalities in the vascular, neurological or electrical findings have also been known. The T1 and/or T2 bodies can be seen in the lateral view in a radiological study of the cervical spine. In the majority of cases, conservative treatments, such as postural correction and shoulder girdle strengthening exercise, are commonly recommended. However, DSS may be misdiagnosed as severe thoracic outlet syndrome or herniated cervical disc disease, leading to unnecessary and hazardous invasive treatments. The presented case was consistent with DSS, and was treated with stellate ganglion block, trigger point injection, and shoulder girdle strengthening exercise.
Arm ; Brachial Plexus ; Clavicle ; Hand ; Humans ; Neck ; Rare Diseases ; Shoulder* ; Spine ; Stellate Ganglion ; Thoracic Outlet Syndrome ; Trigger Points

The diagnosis of chronic abdominal pain due to abdominal cutaneous nerve entrapment can be elusive. Tenderness in patients with abdominal pain is naturally assumed to be of either peritoneal or visceral origin. Studies have shown that some patients suffer from prolonged pain in the abdominal wall and are often misdiagnosed, even after unnecessary and expensive diagnostic tests, including potentially dangerous invasive procedures, and treated as having a visceral source for their complaints, even in the presence of negative X-ray findings and atypical symptoms. Abdominal cutaneous nerve entrapment syndrome is rarely diagnosed, which is possibly due to failure to recognize the condition rather than the lack of occurrence. The accepted treatment for abdominal cutaneous nerve entrapment syndrome is a local injection, with infiltration of anesthetic agents coupled with steroids. Careful history taking and physical examination, in conjunction with the use of trigger zone injections, can advocate the diagnosis of abdominal cutaneous nerve entrapment and preclude any unnecessary workup of these patients. Herein, 3 cases of abdominal cutaneous nerve entrapment syndrome, which were successfully treated with local anesthetics and steroid, are reported.
Abdominal Pain ; Abdominal Wall ; Anesthetics ; Anesthetics, Local ; Diagnosis ; Diagnostic Tests, Routine ; Humans ; Nerve Compression Syndromes* ; Physical Examination ; Steroids

Epidural analgesia using an epidural catheter is an effective method to relieve the pain during the rehabilitating procedure for postoperative orthopedic patients. Total spinal anesthesia is one of the possible complications of epidural catheterization which can lead to a life-threatening condition. Achondroplasia is the most common form of short-limbed dwarfism resulting from a failure of endochondral bone formation. In patients suffering with short stature syndrome like achondroplasia, the incidence and risk of total spinal anesthesia during epidural anesthesia may increase because of the technical difficulty and structural anomaly of the spine. We report here on a 35-year old female patient with a height of a 115 cm. She was diagnosed as achondroplasia and she had a previous Ilizarov operation; both tibial lengthening and correction of valgus were done. No specific event occurred during epidural catheterization. Immediately after the injection of a test dose via epidural catheter, the patient became hypotensive, drowsy and showed weakness of both her upper and lower extremities. The symptoms were disappeared after 40 minutes. The catheter was removed on the next day. We concluded that the total spinal anesthesia was caused by intrathecal injection of local anesthetics through the epidural catheter, and the anesthesia then migrated into the subarachonoid space.
Achondroplasia* ; Adult ; Analgesia, Epidural ; Anesthesia ; Anesthesia, Epidural ; Anesthesia, Spinal* ; Anesthetics, Local ; Catheterization ; Catheters ; Dwarfism ; Female ; Humans ; Incidence ; Injections, Spinal ; Lower Extremity ; Orthopedics ; Osteogenesis ; Spine

Hundreds of drugs have been implicated as the causes of antibody-mediated thrombocytopenia. Naproxen is a commonly used nonsteroidal anti-inflammatory drug, and it is generally considered to be safe with few hematological side effects such as thrombocytopenia. In this case, severe thrombocytopenia associated with petechia and epistaxis appeared after initiation of naproxen therapy in the 59-year-old man. We report here on a case of severe thrombocytopenia that was recognized at 10 days after the use of naproxen, and the patient rapidly recovered to a normal platelet count without bleeding symptoms or any complications, although immunoglobulin or steroid was not used.
Epistaxis ; Hemorrhage ; Humans ; Immunoglobulins ; Middle Aged ; Naproxen ; Platelet Count ; Thrombocytopenia*

Percutaneous radiofrequency thermocoagulation has been applied in patients with various forms of chronic pain, such as facet joint pain, cancer pain and trigeminal neuralgia. A major portion of the hip joint is innervated by the articular branches of the femoral and obturator nerves. Radiofrequency thermocoagulation of the articular branches of the obturator and femoral nerves can be a good alternative treatment for patients with hip joint pain, especially in those where surgery is not applicable. A patient suffering hip joint pain due to metastatic cancer underwent multiple radiofrequency lesioning of the femoral and obturator nerves at 80degrees C for 120 seconds, using a Racz-Finch Kit. The patient experienced about a 50% reduction in the pain, without any numbness or other side effects.
Chronic Pain ; Electrocoagulation ; Femoral Nerve* ; Hip Joint* ; Hip* ; Humans ; Hypesthesia ; Obturator Nerve ; Trigeminal Neuralgia ; Zygapophyseal Joint

The diagnosis of pyomyositis in the pelvic region is difficult, as its incidence is relatively, with symptoms that mimic those of discogenic pain. Sciatica is a common presentation of a prolapsed lumbar disc. Less common causes, such as spinal stenosis, pelvic tumors or even primary nerve tumors can also cause these symptoms. Magnetic resonance imaging (MRI) is a useful diagnostic tool. Herein, the case of a patient with an acute pyogenic infection in the iliopsoas muscle, presenting with sciatica, is reported. This is a rare infective disease, which if promptly treated with intravenous antibiotics, can be completely resolved; otherwise, it can result in deep abscess formation, sepsis and death.
Abscess ; Anti-Bacterial Agents ; Diagnosis ; Humans ; Incidence ; Magnetic Resonance Imaging ; Pelvis ; Pyomyositis* ; Sciatica ; Sepsis ; Spinal Stenosis

A 58-year old male patient, with a history of gastrectomy, came to our department for recently aggravated glossodynia. A delicate physical examination revealed gait ataxia and a positive Rhomberg test. He was diagnosed as having vitamin B12 deficiency using a combination of the laboratory results, such as macrocytic anemia. It was thought that the tongue pain might have been a main clinical manifestation of vitamin B12 deficiency.
Anemia, Macrocytic ; Gait Ataxia ; Gastrectomy ; Glossalgia* ; Humans ; Male ; Middle Aged ; Physical Examination ; Tongue ; Vitamin B 12 Deficiency* ; Vitamin B 12* ; Vitamins*

Unstable angina is a critical phase of coronary heart disease, with widely variable symptoms and prognoses. Recently, despite the advances in surgical revascularization, catheter-based revascularization and medical treatment, an increasing number of patients with angina pectoris are refractory to medical therapy and; therefore, can not be considered as candidates for coronary artery bypass grafting or interventional angioplasty. These patients are often treated with narcotics for pain relief, and forced to severely reduce their levels of activity and productivity. It has become clear that alleviating the pain caused by myocardial ischemia may be possible by altering the sympathetic afferent nerve fibers. Sympathetic blockade can be produced using high thoracic epidural analgesia. Herein, the case of a patient with intractable angina and poor ventricular function, who received high thoracic epidural analgesia to relieve ischemic chest pain, is reported.
Analgesia, Epidural* ; Angina Pectoris ; Angina, Unstable* ; Angioplasty ; Chest Pain ; Coronary Artery Bypass ; Coronary Disease ; Efficiency ; Humans ; Myocardial Infarction ; Myocardial Ischemia ; Narcotics ; Nerve Fibers ; Prognosis ; Ventricular Function

A case of an epidural abscess, a rare but possibly devastating complication of epidural instrumentation and catheterization, which occurred in a cancer pain patient with an epidural port connected to the epidural catheter, is described. Although cases of a catheter related epidural abscess have been intermittently reported, those following epidural port implantation are very rare, with no case having been reported in Korea. Herein, the case of a 31-year-old man, who developed an epidural abscess 54 days after subcutaneous implantation of an epidural port connected to an epidural catheter, is reported. Methicillin-sensitive staphylococcus aureus was detected in a culture of the purulent discharge. Magnetic resonance imaging was essential, not only for the diagnosis of the epidural abscess, but also for determining the extent of spread. The patient refused further evaluation and treatment, and expired 22 days later.
Adult ; Catheterization ; Catheters ; Diagnosis ; Epidural Abscess* ; Humans ; Korea ; Magnetic Resonance Imaging ; Staphylococcus aureus