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A Case Report of Golf-Swing-Induced T2∼T3 Clay-Shoveler’s Fractures

Jae Sam SEO ; Young Sook PARK ; Hyun Jung CHANG ; Jin Gee PARK ; Eun Sol CHO ; Kyo Hoon KU

Clinical Pain.2020;19(2):138-141. doi:10.35827/cp.2020.19.2.138

Clay-shoveler’s fractures are rare stress-type avulsion fractures of the spinous processes especially in sports. There have been two case reports that discussed clay-shoveler’s fractures in golf. A 36-year-old beginner golfer presented with a pain in the back after practicing golf swing. No fractures were detected using cervical radiography; however, computed tomography (CT) and magnetic resonance imaging (MRI) revealed T2∼T3 spinous process fractures. The patient was treated conservatively and his pain subsided. The mechanism of injury is speculated to that of clay-shoveler’s fractures. Therefore, if a golfer suffers persistent pain in the cervicothoracic region, clay-shoveler’s fracture is one possibility to consider.

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Multimodal Treatment for Various Clinical Features in Bertolotti’s Syndrome

Dong-Ha KANG ; Da-Sol KIM ; Yu-Hui WON ; Sung-Hee PARK ; Myoung-Hwan KO ; Jeong-Hwan SEO ; Gi-Wook KIM

Clinical Pain.2020;19(2):133-137. doi:10.35827/cp.2020.19.2.133

Bertolotti's syndrome (BS) is a disease that should be differentiated from low back pain (LBP) in young patients. BS shows an anatomical abnormality in which elongated transverse processes of the last lumbar vertebra articulate or fuse with varying degrees to the sacrum or ilium according to radiologic findings, which is associated with the clinical feature of LBP or radiating pain. In this case report, we describe various clinical features such as a waddling gait with severe foot and triceps surae muscle pain, in addition to the typical symptom of BS such as LBP. We report the various clinical symptoms and treatment progress in this case and review the literature.

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Rapid Lymphedema Progression in Breast Cancer Patient with Previous Forearm Fracture

Sungwook SON ; Sangcheol LEE ; Chung Reen KIM

Clinical Pain.2020;19(2):129-132. doi:10.35827/cp.2020.19.2.129

Fracture is uncommon cause of lymphedema. The mechanism of lymphedema progression is still unknown, but disruption of the lymphatic system during and after fracture might be involved. In contrast, breast cancer surgery is a common cause of lymphedema and is usually caused by the removal of axillary lymph nodes. Sentinel node biopsy (SNB) has been adopted in early breast cancer to reduce the risk of lymphedema. Thus, the incidence of lymphedema in SNB was lowered. However, less than 10% of SNB patients are still diagnosed with lymphedema, but it is known that it took years to diagnose. Recently, we encountered atypical lymphedema occurred after breast cancer surgery with SNB. Symptoms started earlier than usual and were more severe. Interestingly, she has a history of a proximal radial fracture on the same side of SNB. We thought there could be a relationship between the acceleration of breast cancer-related lymphedema and fracture

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Pain and Weakness on Unilateral Upper Extremity Diagnosed as Brachial Plexopathy after Herpes Zoster Infection

Junmo CHO ; Si Hyun KANG ; Kyung Mook SEO ; Don-Kyu KIM ; Du Hwan KIM ; Hyun Iee SHIN

Clinical Pain.2020;19(2):124-128. doi:10.35827/cp.2020.19.2.124

Motor paralysis is a less common neurologic complication of herpes zoster. Until now, a few cases have been reported, and most of these cases showed brachial plexopathy involving one or two segments. We report a patient with pain and weakness on upper extremity diagnosed as brachial plexopathy after herpes zoster infection. An 88-year-old female patient complained not only tingling sense, pain, and swelling on right whole arm, but also weakness on this right upper extremity. On physical examination, weakness is seen in right shoulder abductionㆍshoulder flexionㆍelbow flexionㆍelbow extensionㆍ wrist extension (grade 4), finger flexionㆍfinger abductionㆍfinger extensionㆍfinger DIP flexion (grade 3). In electrodiagnostic study and magnetic resonance imaging study, she was diagnosed as the brachial plexopathy, whole branch involved. This is the only case of post-herpetic brachial plexopathy involving whole branch in domestic.

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Rapidly Destructive Arthrosis of Knee Following Treatment of Crizotinib in a Patient with Non-Small-Cell Lung Cancer

Jin Tae HWANG ; Jae-Hyeong CHOI ; Chul-Hyun PARK ; Kyung Jae YOON ; Yong-Taek LEE ; Jong Geol DO

Clinical Pain.2020;19(2):120-123. doi:10.35827/cp.2020.19.2.120

Rapidly destructive arthrosis is a rare syndrome characterized by narrowing of the joint space and rapid joint destruction within 6∼12 months. A 62-year-old woman with anaplastic lymphoma kinase rearranged non-small-cell lung cancer presented with both knee pain and varus deformity. She was treated with crizotinib 500 mg/day for more than 2 years, with partial tumor response. Initial plain radiography showed Kellgren and Lawrence (K-L) grade 1. After 10 months, varus deformity was worsened and plain radiography aggravated to K-L grade 4 despite conservative treatment including activity modification.Diffuse synovitis with massive joint effusion and destruction of anterior cruciate ligament, medial meniscus, medial collateral ligament, and lateral collateral ligament were shown in magnetic resonance imaging. The patient was diagnosed with rapidly destructive arthrosis of knee and underwent a both total knee arthroplasty.

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Spinal Cord Infarction after C7 Transforaminal Epidural Steroid Injection Using Dexamethasone

Jong Hwa LEE ; Young Sam KIM ; Sang Beom KIM ; Kyeong Woo LEE ; Young Hwan KIM

Clinical Pain.2020;19(2):116-119. doi:10.35827/cp.2020.19.2.116

Cervical transforaminal epidural steroid injection (TFESI) is commonly performed to provide relief of pain caused by radiculopathy. Intra-arterial injection of particulate steroid or direct needle injury can lead to spinal artery embolism or thrombosis.Also there is a possibility of vascular spasm. To our knowledge, this is the first reported case of spinal cord infarction that occurred after TFESI with non-particulate steroid in Korea. A 47-year-old female patient underwent C7 TFESI at local pain clinic. Injected materials were dexamethasone and mepivacaine. Right after the intervention, she felt muscle weakness and decreased sensation. On physical examination, she had decreased sensation from C4 to T2 dermatome in light touch and pin-prick test. Proprioception and vibration were intact. The motor grades of upper extremities were grade 1. Cervical and thoracic spine MRI was checked. Diffusion-weighted image and apparent diffusion coefficient image showed long extension of spinal cord infarction from C2 to T1 level.

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Insufficiency Fracture of Proximal Tibia in a Young Male Patient with Osteoporosis

Min-Ji AN ; Nam-Gyu IM ; Seo-Ra YOON ; Su-Ra RYU

Clinical Pain.2020;19(2):111-115. doi:10.35827/cp.2020.19.2.111

We report a case of a healthy 38-year-old man presenting with insufficiency fracture of proximal tibia associated with unrecognized osteoporosis. Radiologic bone DEXA (Dual Energy X-ray Absorptiometry) assessment revealed osteoporosis, but the patient displayed no apparent risk factors for insufficiency fractures and osteoporosis except for a history of smoking. Following right proximal tibial open reduction and internal fixation, the patient commenced smoking cessation and began taking alendronate.The patient was treated for gait rehabilitation, which included quadriceps strengthening exercises and his condition improved with independent walking. This report highlights an unusual site of proximal tibial insufficiency fractures and the potential effect of smoking on low bone mineral density in a young male patient.

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Radiation Recall Myositis during Gemcitabine Chemotherapy

Jin Ho PARK ; Yoon KIM ; Seung Mi YEO ; Ji Hye HWANG

Clinical Pain.2020;19(2):106-110. doi:10.35827/cp.2020.19.2.106

Radiation recall is an uncommon phenomenon in which administration of a chemotherapy or another systemic agent induces an acute inflammatory reaction in previously irradiated tissues, often weeks to years after completion of radiotherapy.Gemcitabine can induce an inflammatory reaction within an area of prior radiation. Radiation recall is known to medical oncologists, however only few cases have been reported in Korean journals, therefore physiatrist who diagnose and treat the treatment-related physical impairments of cancer patients must know about it. We emphasize the importance of knowledge of this phenomenon when considering the differential diagnosis of painful limb edema in a patient who has received cancer treatment.

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Diagnosis of Benign Monomelic Amyotrophy

Justin BYUN ; Meyong Hwan BANG ; Jung Hyun PARK

Clinical Pain.2020;19(2):101-105. doi:10.35827/cp.2020.19.2.101

Benign monomelic amyotrophy (BMA) is a benign motor neuron disease in which amyotrophic change is confined to either the upper or the lower extremities. Numerous cases of BMA have been reported from Japan and India. However, only a few cases have been reported from other regions, including South Korea. Here we report a rare case of late-onset BMA in Korean male using conventional diagnostic approach with magnetic resonance imaging and electromyography. The patient received ten sessions of manual therapy, which focused on strengthening of the left ankle. At two-month follow up, weakness was still isolated to the patient’s left ankle. There were no signs of disease progression.

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Diagnosis of Ulnar Neuropathy Caused by Intraneural Ganglion at Elbow with Ultrasound

Inhyun KANG ; Minjoon BAE ; Yangrok HUR ; Kihun HWANG

Clinical Pain.2020;19(2):97-100. doi:10.35827/cp.2020.19.2.97

An intraneural ganglion in the peripheral nerve and the resulting ulnar neuropathy at the elbow are uncommon and may show various symptoms ranging from local pain to motor and sensory impairment. We report a case of a 76-year-old man who was diagnosed with ulnar neuropathy caused by an intraneural ganglion derived from the elbow. We also discuss the pathophysiology, treatment, prognosis, and diagnostic value of ultrasonography in neuropathy caused by a ganglion.

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