No abstract available.
Low Back Pain* ; Pregnancy*

OBJECTIVE: To evaluate the feasibility of ultrasound guided atlanto-occipital joint injection. METHOD: Six atlanto-occipital joints of three cadavers were examined. Cadavers were placed in prone position with their head slightly rotated towards the contra-lateral side. The atlanto-occipital joint was initially identified with a longitudinal ultrasound scan at the midline between occipital protuberance and mastoid process. Contrast media 0.5cc was injected into the atlanto-occipital joint using an in-plane needle approach under ultrasound guide. The location of the needle tip and spreading pattern of the contrast was confirmed by fluoroscopic evaluation. RESULTS: After ultrasound guided atlanto-occipital joint injection, spreading of the contrast media into the joint was seen in all the injected joints in the anterior-posterior fluoroscopic view. CONCLUSION: The ultrasound guided atlanto-occipital injection is feasible. The ultrasound guided injection by Doppler examination can provide a safer approach to the atlanto-occipital joint.
Atlanto-Occipital Joint ; Cadaver ; Contrast Media ; Head ; Joints ; Mastoid ; Needles ; Prone Position

OBJECTIVE: This study evaluated the feasibility of ultrasound-guided lumbar nerve root block (LNRB) and S1 nerve root block by identifying spread patterns via fluoroscopy in cadavers.METHOD: A total of 48 ultrasound-guided injections were performed in 4 fresh cadavers from L1 to S1 roots. The target point of LNRB was the midpoint between the lower border of the transverse process and the facet joint at each level. The target point of S1 nerve root block was the S1 foramen, which can be visualized between the median sacral crest and the posterior superior iliac spine, below the L5-S1 facet joint. The injection was performed via an in-plane approach under real-time axial view ultrasound guidance. Fluoroscopic validation was performed after the injection of 2 cc of contrast agent.RESULTS: The needle placements were correct in all injections. Fluoroscopy confirmed an intra-foraminal contrast spreading pattern following 41 of the 48 injections (85.4%). The other 7 injections (14.6%) yielded typical neurograms, but also resulted in extra-foraminal patterns that occurred evenly in each nerve root, including S1.CONCLUSION: Ultrasound-guided injection may be an option for the delivery of injectate into the S1 nerve root, as well as lumbar nerve root area.
Cadaver ; Fluoroscopy ; Injections, Spinal ; Lumbosacral Region ; Methods ; Needles ; Spinal Nerve Roots ; Spine ; Ultrasonography ; Zygapophyseal Joint

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) has been reported rarely in systemic lupus erythematosus (SLE). We report a case of a 33 year-old woman who was diagnosed as SLE 2 years ago and presented with both feet and hands tingling sensation over 2 months. She also showed clinical features of areflexia, elevated CSF protein, and demyelination in the nerve conduction study. Her lower limb weakness and ataxic gait gradually progressed. Her symptoms which had shown minimal improvement to immunoglobulin therapy responded to immunosuppressant treatment.
Demyelinating Diseases ; Female ; Foot ; Gait ; Hand ; Humans ; Immunization, Passive ; Immunoglobulins ; Lower Extremity ; Lupus Erythematosus, Systemic ; Neural Conduction ; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating ; Sensation

OBJECTIVE: To determine optimal stimulation site for median motor conduction study, we compared fixed distance (7 cm proximal to the recording electrode) stimulation method and distal wrist crease stimulation method. METHOD: Nerve conduction studies were performed in 65 hands of 36 healthy adults without neurologic abnormality. Median motor responses were recorded from abductor pollicis brevis (APB) with the stimulations at the point 7 cm proximal to the recording electrode and at the distal wrist crease. The distal latencies and onset-to-peak amplitudes were measured and compared between two techniques. The distal latencies were also compared to that of ulnar compound muscle action potential (CMAP) obtained with fixed distance stimulation (7 cm proximal to the recording electrode). And we measured median nerve actual length from distal wrist crease to APB muscle motor point by anatomic dissection of 12 hands. RESULTS: The distal latencies of median CMAP to APB with 7 cm fixed distance stimulation and distal wrist crease stimulation were 2.91+/-0.37 ms and, 2.75+/-0.41 ms respectively. The differences were statistically significant. The distal latency of ulnar CMAP was 2.50+/-0.32 ms. Differences in distal latencies between ulnar CMAPs and not only 7 cm fixed distance median stimulation but also distal wrist crease median stimulation were also statistically significant. The mean length of median nerve from distal wrist crease to APB motor point was 5.91+/-0.77 cm. CONCLUSION: We suggest that the median motor nerve conduction study using distal wrist crease stimulation was an easier and more rapid procedure than fixed distance median motor nerve conduction study.
Action Potentials ; Adult ; Electrodes ; Hand ; Humans ; Median Nerve ; Muscles ; Neural Conduction ; Wrist

Neuropathic arthropathy is a chronic and progressive disease of bone and joints. One of the most common causes of neuropathic arthropathy is syringomyelia. Syringomyelia associated with Arnold-Chiari I malformation has been well documented in many reports. We report a case of 76 year-old woman presented with the right elbow joint pain and stiffness. Her symptom was caused by neuropathic arthropathy associated with Arnold-Chiari I malformation and syringomyelia. The purpose of this paper is to emphasize that neuropathic arthropathy requires the evaluation of central nervous system to assess for occult causal lesion.
Aged ; Central Nervous System ; Elbow Joint ; Female ; Humans ; Joints ; Syringomyelia*

Several months after left radical mastectomy without irradiation therapy for breast cancer, a 74-year-old woman developed severe edema on the homolateral arm extending to the axilla. Ten years later, purplish to brownish blotch and nodules accompanied with heating sensation and pain appeared and increased in size gradually on the left forearm. The patient was treated by irradiation therapy under the clinical and histopathologic diagnosis of Stewart-Treves syndrome and almost all of the skin lesions and symptoms disappeared after irradiation of 6450 rads.
Aged ; Arm ; Breast Neoplasms/*surgery ; Female ; Hemangiosarcoma/*etiology/pathology/radiotherapy ; Humans ; Lymphedema/*complications ; Mastectomy, Radical/*adverse effects ; Skin Neoplasms/*etiology/pathology/radiotherapy

OBJECTIVE: To determine the prevalence of denervation potentials from the foot intrinsic and the lumbosacral paraspinal muscles in asymptomatic persons in Korea. METHOD: Nerve conduction studies were performed in 80 asymptomatic persons at sural, peroneal and tibial nerves. We excluded 15 persons with abnormal values of nerve conduction studies. In our study, 36 males and 29 females participated and the mean age of subjects was 52.9 years. We checked denervation potentials from unilateral lumbosacral paraspinal (L4-S1) and foot intrinsic muscles (abductor hallucis and extensor digitorum brevis muscle) by needle EMG. RESULTS: The prevalence of denervation potentials from foot intrinsic muscles was 3% (2 cases out of 65 asymptomatic subjects). Denervation potentials consisting of a positive sharp wave were seen from the abductor hallucis muscle. No subjects showed any denervation potentials from the lumbosacral paraspinal muscles in our study. Abnormal X-ray findings were seen in subjects who had denervation potentials from the foot intrinsic muscles. CONCLUSION: The prevalence of denervation potentials from the foot intrinsic and the lumbosacral paraspinal muscles in asymptomatic person was not as high as previously reported
Denervation ; Female ; Foot ; Humans ; Korea ; Male ; Muscles ; Needles ; Neural Conduction ; Organic Chemicals ; Prevalence ; Tibial Nerve

OBJECTIVE: To identify the optimal site for piriformis muscle injection, using easily detectable sacroiliac joint as a landmark, under fluoroscopic guidance. METHOD: We examined the anatomic relationships of the sciatic nerve, piriformis muscle and sacroiliac joint in 18 buttocks from 9 cadavers. The distance from the inferior margin of the sacroiliac joint to the piriformis muscle at the crossing point with the sciatic nerve, and the width of the sciatic nerve at that point were measured. We assessed the depth of the piriformis muscle and the sciatic nerve using ultrasonography in asymptomatic controls. RESULTS: The mean distance from the inferior margin of the sacroiliac joint to the piriformis muscle at the crossing point with the sciatic nerve was 15.7+/-3.4 (12~22) mm laterally and 16.5+/-4.1 (10~25) mm caudally. The mean width of the sciatic nerve at that point was 15.4+/-3.7 (12~22) mm. Ultrasonographic findings revealed the mean distance as 4.48+/-0.49 cm from the skin to the surface of the piriformis muscle and as 5.68+/-0.62 from the skin to the surface of the sciatic nerve. CONCLUSION: The most optimal injection site for piriformis syndrome was located 15.6+/-3.4 (12~22) mm laterally and 16.5+/-4.1 (10~25) mm caudally from the inferior margin of the sacroiliac joint.
Buttocks ; Cadaver ; Muscles ; Piriformis Muscle Syndrome ; Sacroiliac Joint ; Sciatic Nerve ; Skin

Isotonic exercise occurs when the tension or torque generated by a muscle is constant throughout the movement. In practice it is very difficult to maintain the tension constant. Evaluation of isotonic exercise should include the works of concentric and eccentric contraction and the changes in tension and torque during joint motion. However, optimal evaluation tools for isotonic exercise has yet to be developed. We authors, used virtual reality motion analysis system(VRMAS) which was codeveloped by us and EMG system(Cardwell Excel). Healthy male adult subjects(n=10) were recruited from hospital personnel. After dominant upper arm and trunk of each subject was fixed with velcro, he was instructed to repeat flexion and extension of his dominant elbow grasping dumbell (9 kg) in hand with maximal velocity as possible as can until the point of exhaustion. We measured the elbow angle, the angular velocity, torque, power, total work and the work of concentric and eccentric contraction during exercise. The results were as follows: there were four distinct elbow flexor muscle contractions during flexion and extension of the elbow with the first and the second contractions during concentric contraction and the third and the fourth contractions during eccentric contraction. Between the peaks of contraction, motion was maintained due to the momentum that was generated. Of the ten subjects, seven had higher concentric work than eccentric work with the eccentric work being higher in the remaining three. But there was no statistic significance between the works of concentric contraction and eccentric contraction(p>0.05). The biggest work was observed in the fourth contraction, while the third contraction showed the least work(p<.05). In conclusion, there were four distinct muscle contractions during elbow isotonic exercise and the works of each muscle contraction were different. This result is contrary to the definition of isotonic exercise. This study also shows that the VRMAS could be a very useful evaluation tool for several types of isotonic exercise.
Adult ; Arm ; Elbow ; Hand ; Hand Strength ; Humans ; Joints ; Male ; Muscle Contraction ; Personnel, Hospital ; Torque