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Provocative Discography Following Focal Selective Coagulation in a Patient with Chronic Lumbar Discogenic Pain

Clinical Pain.2019;18(2):142-146. doi:10.35827/cp.2019.18.2.142

This is a case report of the provocative discographic findings before and after focal selective coagulation of the major annular fissure using intradiscal navigable catheter. A 46-year-old woman had a 30-month history of axial low back pain and magnetic resonance imaging findings suspicious for painful L4/5 disc. The provocative discography confirmed painful disc before coagulation. The final electrode tip position in the coagulation procedure was at the largest fissure within the outer annular margin identified through the discography. Six months after the successful coagulation therapy, inadvertently performed discography resulted in decreased pressure rise over time. Neither evoked pain nor change in the integrity of outer annulus as compared with the previous results was reported. Such an interventional method has not been reported previously, and the analytic results suggest that it may be possible to relocate the pressure of the entire nucleus pulposus only by focal selective coagulation of the fissure.
Catheters ; Electrodes ; Female ; Humans ; Low Back Pain ; Magnetic Resonance Imaging ; Methods ; Middle Aged

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Chronic Intractable Calcific Lateral Epicondylopathy Treated with Ultrasound-Guided Barbotage Combined with Extracorporeal Shock-Wave Therapy

Kun Woo KIM ; Kyung Jae YOON ; Jong Geol DO ; Jin Tae HWANG ; Yong Taek LEE

Clinical Pain.2019;18(2):138-141. doi:10.35827/cp.2019.18.2.138

Lateral epicondylopathy represents pain in the lateral (radial aspect) of the elbow caused by degeneration in the common extensor tendon. Calcium deposit frequently developes in lateral epicondylopathy, with the prevalence up to 46%. There are considerable debates on its treatment protocols for lateral epicondylopathy so far, likewise, the effective treatment method for calcific lateral epicondylopathy has not been established. We report here a case of chronic intractable calcific lateral epicondylopathy treated with ultrasound-guided barbotage and focused type extracorporeal shock wave therapy (ESWT). To our knowledge, this is the first report of calcific lateral epicondylopathy treated by ultrasound-guided barbotage combined with ESWT.
Calcium ; Clinical Protocols ; Elbow ; Methods ; Prevalence ; Shock ; Tendons ; Therapeutic Irrigation

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Contralateral Mirror Image Spreading in Post-Stroke Complex Regional Pain Syndrome

Ki Hyun BYUN ; Chang Ho HWANG

Clinical Pain.2019;18(2):133-137. doi:10.35827/cp.2019.18.2.133

The long-term prognosis of complex regional pain syndrome is difficult to predict because of its unclear pathophysiology. The syndrome can spontaneously spread to other regions in the body. We report a case in which a complex regional pain syndrome that occurred in a 75-year-old male patient after a stroke spread to the opposite side.
Aged ; Causalgia ; Humans ; Male ; Prognosis ; Reflex Sympathetic Dystrophy ; Stroke

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Late-Onset Spinal Subdural Hematoma after Acupuncture

Hyo Sik PARK ; Jong Keun KIM ; Jin Seok BAE ; Yong Sung JEONG ; Jong Youb LIM

Clinical Pain.2019;18(2):130-132. doi:10.35827/cp.2019.18.2.130

Acupuncture is generally regarded as a safe procedure and as a popular treatment for patients with musculoskeletal disorders. We report a case of a 47-year-old male patient with late-onset tetraplegia, developed after acupuncture. He had no trauma, medical, and social history relevant to tetraplegia. Right after the acupuncture, he felt discomfort in his right arm. After 6 days, all 4 extremity weakness developed. Whole-spine magnetic resonance imaging revealed the presence of spinal subdural hematoma extending from the C5 vertebra to the coccyx level. Hand coordination dysfunction, neurogenic bladder, and neuropathic pain were other symptoms. After the management, he recovered muscle strength, but incomplete bladder control and neuralgia were sustained. It is important to be aware of the possibilities of severe complications after acupuncture.
Acupuncture ; Arm ; Coccyx ; Extremities ; Hand ; Hematoma, Subdural, Spinal ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscle Strength ; Neuralgia ; Quadriplegia ; Spine ; Urinary Bladder ; Urinary Bladder, Neurogenic

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Bilateral Stress Fracture of Femur Neck, Fatigue Type of Non-Athlete Young Adult

Yeo Joon YUN ; Yong Jae NA ; Ji Won JUNG ; Kyu Hoon LEE

Clinical Pain.2019;18(2):126-129. doi:10.35827/cp.2019.18.2.126

Bilateral femoral neck stress fractures have been rarely reported. When diagnosed, they are usually limited to athletes or military personnel. A 35-year-old man, previously healthy, visited the emergency department for right inguinal pain. On physical examination, no external wound, tenderness or limitation of motion were found in either lower extremity. Plain radiography showed normal findings but an magnetic resonance image showed a linear fracture in the femoral neck. In this case, bilateral femoral neck stress fractures were found in a young non-athlete adult with no prior medical history of related injuries. Surgery is generally not performed for stress fractures but considering the patient's early mobilization and the need for quick reintegration into society, surgery was done in this case.
Adult ; Athletes ; Early Ambulation ; Emergency Service, Hospital ; Fatigue ; Femur Neck ; Femur ; Fractures, Stress ; Humans ; Lower Extremity ; Military Personnel ; Physical Examination ; Radiography ; Wounds and Injuries ; Young Adult

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Rapid Functional Enhancement of Ankylosing Spondylitis with Severe Hip Joint Arthritis and Muscle Strain

Sangwon HWANG ; Sang Hee IM ; Ji Cheol SHIN ; Jinyoung PARK

Clinical Pain.2019;18(2):121-125. doi:10.35827/cp.2019.18.2.121

Arthritis of hip joints deteriorates the quality of life in ankylosing spondylitis (AS) patients. Secondary to the articular inflammatory process, the shortened hip-girdle muscles contribute to the decreased joint mobility which may lead to the functional impairment. As the limitation of range of motion (ROM) usually progress slowly, clinicians regard it as a chronic condition and prescribe long-term therapy. However, by short-term intensive multimodal treatment, a 20-year-old man diagnosed as AS with severely limited hip joint ROM who relied on crutches doubled the joint angle and could walk independently only within 2 weeks. The combination included intra-articular steroid injection, electrical twitch obtaining intramuscular stimulation, extracorporeal shock wave therapy, heat, manual therapy, and stretching exercises. The management focused on the relaxation of hip-girdle muscles as well as the direct control of intra-articular inflammation. Hereby, we emphasize the effectiveness of intensive multimodal treatment in improving the function even within a short period.
Arthritis ; Combined Modality Therapy ; Crutches ; Exercise ; Hip Joint ; Hip ; Hot Temperature ; Humans ; Inflammation ; Joints ; Muscle Relaxation ; Muscles ; Musculoskeletal Manipulations ; Quality of Life ; Range of Motion, Articular ; Relaxation ; Shock ; Spondylitis, Ankylosing ; Young Adult

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Successive Acute Calcific Tendinitis at Different Sites

Young Je KIM ; Seung Wook NO ; Hyo Joon JIN ; Du Hwan KIM

Clinical Pain.2019;18(2):115-120. doi:10.35827/cp.2019.18.2.115

Acute calcific tendinitis (ACT) is a benign painful inflammatory disorder characterized by resorptive process of calcific deposits following the formation of calcium hydroxyapatite crystals in the tendons. It can occur at various sites, especially in the shoulder or hip joint. ACT involving the lateral epicondyle of the humerus and the cervical spine is very rare. Few reports have demonstrated successive ACT at different sites. We report three cases of successive ACT in women, occurring at the subscapularis followed by the lateral epicondyle, flexor carpi ulnaris followed by the supraspinatus, and longus colli followed by the iliopsoas, respectively.
Durapatite ; Female ; Hip Joint ; Humans ; Humerus ; Shoulder ; Spine ; Tendinopathy ; Tendons

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Neuropathic Pain in Guillain-Barre Syndrome Associated with Scrub Typhus

Saerom KANG ; Sook Jung LEE ; Eunseok CHOI

Clinical Pain.2019;18(2):111-114. doi:10.35827/cp.2019.18.2.111

Guillain-Barre syndrome (GBS) is usually characterized by acute areflexic ascending paralysis with minimal sensory involvement. Only a few cases of GBS associated with scrub typhus have been reported. Previous case reports focused on the laboratory findings, pathogenesis, and clinical manifestation. Unlike the previous case, neuropathic pain was a prominent symptom of GBS in our case. We report scrub-typhus-related GBS with a detailed description of the clinical manifestations, especially neuropathic pain, along with results of serial follow-up electrodiagnostic studies.
Follow-Up Studies ; Guillain-Barre Syndrome ; Neuralgia ; Paralysis ; Scrub Typhus

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Flexor Carpi Radialis Tendon Rupture due to Repetitive Golf Swing

Sang Chul LEE ; Sung Hoon KOH ; Jin Hyuk JANG ; Jae Ki AHN

Clinical Pain.2019;18(2):107-110. doi:10.35827/cp.2019.18.2.107

Flexor carpi radialis (FCR) muscle is located in the forearm anteriorly that runs through a synovial fibro-osseous tunnel in the forearm. We described a case of FCR tendon rupture due to repetitive overuse injury. A 55-year-old man, right-hand dominant, presented with right forearm pain and swelling which started 3 days ago while playing amateur golf. Focal tenderness and bruising over volo-ulnar region of the right forearm were examined. Plain radiographs showed soft tissue edema around lesion area and no detectable fracture. Ultrasonography showed multiple hypoechoic lesions suspected as hematoma of the flexor muscle group. After done magnetic resonance imaging, he was diagnosed with rupture of FCR tendon at proximal origin and strain of flexor digitorum superficialis and palmaris longus muscle. He received compressive dressing and restriction of wrist range of motion for three weeks. Two months later, remaining traces of lesions were observed at the follow-up ultrasonography and the pain disappeared.
Bandages ; Cumulative Trauma Disorders ; Edema ; Follow-Up Studies ; Forearm ; Golf ; Hematoma ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Range of Motion, Articular ; Rupture ; Tendon Injuries ; Tendons ; Ultrasonography ; Wrist

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Calcaneal Osteomyelitis Presenting as a Paradoxical Reaction during Treatment of Multidrug-Resistant Tuberculosis

Yong Hyun HAN ; Chang Hwa LEE ; Min Joon BAE ; Kihun HWANG

Clinical Pain.2019;18(2):102-106. doi:10.35827/cp.2019.18.2.102

Tuberculosis in the foot progresses gradually; thus, diagnosis is usually delayed, and early treatment is rarely provided. If osteomyelitis occurs due to delayed diagnosis and treatment, surgical treatment should be considered. We report the case of a 46-year-old man with osteomyelitis of the calcaneus who was diagnosed with multidrug-resistant pulmonary tuberculosis and he was treated with anti-tuberculosis drugs. Bilateral adrenal masses, abscess of both testes and a small wound in the left plantar heel were observed. Both adrenal masses and abscess were regarded as paradoxical reaction of anti-tuberculosis treatment. After 1 month, he developed a pain in the left plantar heel that was compatible with calcaneal osteomyelitis in radiological features. He underwent right orchiectomy for right scrotal abscess aggravation and surgical treatment for left calcaneal osteomyelitis. Mycobacterium tuberculosis was confirmed by polymerase chain reaction. The patient was immobilized by cast for 8 weeks and the heel pain gradually improved.
Abscess ; Calcaneus ; Delayed Diagnosis ; Diagnosis ; Foot ; Heel ; Humans ; Middle Aged ; Mycobacterium tuberculosis ; Orchiectomy ; Osteomyelitis ; Polymerase Chain Reaction ; Testis ; Tuberculosis ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary ; Wounds and Injuries

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