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Left-Sided Poland’s Syndrome without Limb Anomalies

Yeong-Il NA ; Seungbok LEE ; Seung-Min BAEK ; Jong Hoo LEE

Clinical Pain.2022;21(2):129-132. doi:10.35827/cp.2022.21.2.129

“Poland’s syndrome” is a rare congenital disease whereby defects can accompany the chest, nipple, chest wall, and extremities on one side of the body. We diagnosed a 19-year-old male patient who presented to another hospital for a routine physical exam before enlisting in the military and was suspected of having a left brachial plexus injury. His chief complaint was the flatness of the left anterior chest wall without any significant functional inconvenience. Aplasia of the pectoralis minor and costosternal portion of the pectoralis major was observed through physical examination and computed tomography (CT). The patient was diagnosed with left-sided Poland’s syndrome without any limb abnormalities. Poland Syndrome should be highly considered in patients presenting with bilateral chest wall imbalance in the absence of with a recent traumatic history.

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Comprehensive Rehabilitation in Patients with Acute Respiratory Distress Syndrome due to Coronavirus Disease 2019 (COVID-19)

Dong Wan JIN ; Seong Jun KIM ; Sang Chul LEE

Clinical Pain.2022;21(2):123-128. doi:10.35827/cp.2022.21.2.123

We described a case in which symptoms and function improved through rehabilitation in a patient with coronavirus disease 2019 (COVID-2019) accompanied by acute respiratory distress syndrome (ARDS), limb weakness, and peroneal neuropathy. A 71-year-old man was diagnosed with COVID-19 and ARDS. He needed extracorporeal membrane oxygenation (ECMO) treatment in an incentive care unit (ICU). After ICU treatment, both ankle dorsiflexor weakness and foot drop were present. Common peroneal neuropathy was diagnosed and it was presumed to be due to long-term ECMO application. Comprehensive rehabilitation was performed to improve respiratory function and functional level. In addition, electrical stimulation therapy was applied to strengthen the ankle dorsiflexor. Before rehabilitation, he could not maintain a sitting position independently and required oxygen supply through tracheostomy. After 6 months rehabilitation, he was able to walk independently without oxygen.However, the ankle dorsiflexor did not improve sufficiently, so ankle foot orthosis was applied for outdoor gait.

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A Malignant Tumor in the Calf Muscles Misdiagnosed as a Myofascial Trigger Point

Hyun Jeong LEE ; Hyun Sung LEE ; Jaewon BEOM

Clinical Pain.2022;21(2):119-122. doi:10.35827/cp.2022.21.2.119

Tumors are rare causes of calf pain and usually present insidiously. A 69-year-old woman developed sudden severe pain and a hard palpable mass in her left calf that persisted for 6 months without a history of trauma. Although a myofascial trigger point was initially suspected, subsequent ultrasonography revealed two well-defined heterogeneous masses in the calf muscle. Magnetic resonance imaging revealed a multi-lobulated mass involving the soleus, tibialis posterior muscle, and deep peroneal neurovascular bundle, suggesting a soft tissue sarcoma. Fluorine-18-fluorodeoxyglucose positron emission tomography revealed a heterogeneous hypermetabolic lesion in the left calf, suggesting malignancy. The patient received an incisional biopsy of her left calf lesion and was diagnosed with leiomyosarcoma. The patient underwent a wide excision with partial fibulectomy of the left calf and received chemotherapy for metastasis in the left upper lobe of the lung. Although rare, soft tissue sarcoma should be considered in the differential diagnosis if calf pain and a palpable mass persist despite conservative management, and imaging studies are essential for distinguishing tumors from other causes of calf pain.

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The Treatment of Calcific Tendinitis of the Gluteus Medius Muscle Using Ultrasound-Guided Barbotage Technique

Ji Hwan KIM ; Wonjea LEE ; Jong Hu JEON ; I Jun CHOI ; Seong JIN ; Hyokyum KIM

Clinical Pain.2022;21(2):114-118. doi:10.35827/cp.2022.21.2.114

We report the effective treatment of calcific tendinitis in the gluteus medius muscle with a single application of the barbotage technique. A 68-year-old man visited our hospital complaining of right hip pain with an intensity of 8 on a numeric rating scale. A simple radiograph of the right hip showed a calcific nodule at the insertion site of the gluteus medius tendon. The stage of the calcific lesion was inferred through the characteristics of the findings confirmed on radiographs. Ultrasonography was performed and the results were combined to determine the appropriate stage to apply the barbotage technique. He confirmed the pain relief effect after performing the intervention. After 1 month, it was confirmed that the calcific lesion was completely removed at follow-up.

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Intramedullary Spinal Cord Hemorrhage Associated with Monoparesis after Transforaminal Cervical Epidural Steroid Injection

Mi Rim SUH ; Yongbum PARK ; Seok Hyeon LEE ; Dong Yuk LEE ; Jaeki AHN

Clinical Pain.2022;21(2):109-113. doi:10.35827/cp.2022.21.2.109

Transforaminal cervical epidural steroid injection (TFCESI) is widely used as conservative treatment for cervical radiculopathy, but severe complications associated with this procedure have been reported. This report was the first case of intramedullary spinal cord hemorrhage following TFCESI. A 67-year-old woman presented with weakness and sensory disturbance in left upper extremity after TFCESI. Cervical magnetic resonance imaging revealed intramedullary spinal cord hemorrhage accompanied by myelopathy at the C2∼C5 level. The patient was administered intravenous methylprednisolone daily (1,000 mg/8 hours) for 5 days and was subsequently transferred to the Department of Rehabilitation Medicine for rehabilitation therapy. A month later, the patient’s neurological impairment partially improved. Although TFCESI is rarely associated with major complications, physicians should be cautious when performing the procedure, and remain mindful of the potentially serious complications.

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Shoulder Injury Related to Vaccine Administration (SIRVA) after COVID-19 Vaccinations:Clinical and Radiological Investigation in 8 Cases of Adhesive Capsulitis

Chae Woon PAEK ; Jong Geol DO

Clinical Pain.2022;21(2):100-108. doi:10.35827/cp.2022.21.2.100

Objective: Recently, there are clinical reports of Shoulder Injury Related to Vaccine Administration (SIRVA) after COVID-19 vaccinations. Yet, radiological description and treatment response has not been delineated. The purpose of this study is to report clinical aspects of eight cases of SIRVA after COVID-19 vaccinations and to describe MRI characteristics in five of these patients. Method: We retrospectively identified and investigated eight patients who presented with shoulder pain and global range of motion limitation following COVID-19 vaccination between January 1 st , 2022 and March 31 st , 2022. Results: The mean age of the eight patients (five women and three men) was 56. 0 ± 5.0 years (range, 48∼63 years). Symptoms of shoulder pain and stiffness began on the day of injection in four patients, within 24 hours in two patients, and more than three days in two patients. Initial shoulder range of motion was restricted in forward elevation, abduction, and internal rotation. Three patients who received glenohumeral intra-articular injection showed improvement of NRS scores and shoulder range of motion. Five patients’ MRI were featured with hyperintense axillary capsule, axillary capsular thickness thicker than 4 mm (6.1 ± 0.4 mm, range 5.7∼6.8 mm) and rotator interval fat obliteration. Conclusion Adhesive capsulitis after COVID-19 vaccine resembles idiopathic adhesive capsulitis both clinically and radiologically. Although the exact pathogenesis regarding adhesive capsulitis after COVID-19 vaccinations remains ambiguous, immune-mediated inflammatory reaction after vaccination can cause adhesive capsulitis. Appropriate anti-inflammatory treatment including intra-articular steroid injection is effective.Physicians should be mindful of this diagnosis so that such patients can be diagnosed promptly and treated properly.

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Effects of Combined Treatment with Thermotherapy and Electrical Stimulation on Musculoskeletal Pain Disorders: A Systematic Review

Kyeong Eun UHM ; Bo Mi KWON ; Min Woo WOO ; Hyo Eun KWON ; Jongmin LEE

Clinical Pain.2022;21(2):95-99. doi:10.35827/cp.2022.21.2.95

Objective: This review aimed to investigate the effects of combined treatment with thermotherapy and electrical stimulation simultaneously in musculoskeletal pain disorders. Method: A systematic review was performed using electronic databases including PubMed and Embase. Following search terms were used: (simultaneous OR synchronous OR combined) AND (thermotherapy OR “thermal therapy” OR heat OR “hot pack” OR ultrasound OR microwave OR shortwave OR cold OR cryotherapy) AND (“electrical stimulation” OR electrotherapy OR TENS OR “interferential current”). Studies on the simultaneous application of thermotherapy and electrical stimulation, comparing with single physical modalities or massage were included. Results: After title and abstract exclusion, four articles were selected, according to the eligibility criteria. Combined treatment did not reveal a differential effect on pain reduction when compared to a single physical modality. However, combined treatment showed superior effects on functional aspects such as range of motion (ROM) and timed up-and-go score. Conclusion This review suggests that combined treatment with thermotherapy and electrical stimulation simultaneously seems to have a superior effect on ROM, balance, and gait ability, but not pain reduction, in musculoskeletal pain disorders. However, the number of included studies in this review was small and study designs were heterogeneous. Therefore, further research is needed to confirm these findings.

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Diagnosis and Treatment of Rheumatoid Shoulder

Gi-Young PARK

Clinical Pain.2022;21(2):88-94. doi:10.35827/cp.2022.21.2.88

Shoulder joint involvement is common in patients with rheumatoid arthritis (RA), and the clinical manifestations are nonspecific.Shoulder joint destruction in the patients with RA gradually occurs, resulting in decreased function. In rheumatoid shoulder, loss of cartilage and soft tissue degeneration coexists with pain and reduced range of motion. To avoid the joint destruction, early detection of inflammation in the shoulder joints is necessary. Therefore, shoulder involvement should be checked routinely and detected early. Radiograph of the rheumatoid shoulder provides essential guidance for treatment decisions. The development of glenohumeral joint space narrowing on radiograph is a turning point that indicates a risk of rapid joint destruction. Ultrasound and magnetic resonance imaging are useful for assessing the lesions and guiding the treatment strategy. The goals of treatment in rheumatoid shoulder are to relieve pain and to restore function. This is accomplished by early detection, proper medication, intervention, rehabilitation, and operation.

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Diagnosis and Treatment of Post-Traumatic Headache

Nam-Gyu JO ; Gi-Wook KIM

Clinical Pain.2022;21(2):80-87. doi:10.35827/cp.2022.21.2.80

Headache after trauma, such as a traffic accident are the most commonly reported as post-traumatic headache (PTH), a secondary headache disorder following traumatic brain injury or whiplash injury. Post-traumatic headache has various clinical features in terms of intensity, frequency, and duration of pain. The characteristics of PTH are often similar to primary headaches such as migraines or tension-type headaches, and may be accompanied by or sequentially present, other symptoms including fatigue, difficulty concentrating, dizziness, visual and auditory symptoms, emotional disturbances, anxiety, depression, and general irritability. Therefore, the diagnosis and therapeutic approach may vary depending on the patient’s condition, so careful consideration by the clinicians is required in the medical process. We believe that this review can be valuable in the classification, diagnosis, and therapeutic approaches for headache after traffic accident.

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Digital Therapeutics for the Musculoskeletal Disorders

Jinyoung PARK ; Jung Hyun PARK

Clinical Pain.2022;21(2):74-79. doi:10.35827/cp.2022.21.2.74

Digital therapeutics (DTx) is emerging in the field of digital healthcare thanks to the development of ICT (information and communications technology), sensors, and AI (artificial intelligence) technology. A clinical trial-based design and manufacturing process is required for DTx before it can be prescribed in the medical field. The risks, and effectiveness and intended use of DTx must then be approved by regulatory authorities. The digital healthcare apps for musculoskeletal disorders, which had previously concentrated on monitoring and feedback on aerobic exercise, have lately begun to be applied to rehabilitative exercises utilizing AI technologies using convolutional neural networks. The development of DTx focusing on therapeutic rehabilitative exercise is expected in the future.

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