Objective: Shoulder pain, which is common in hemiplegic stroke patients, decreases quality of life and interferes with rehabilitation. Although many local injection therapies have been reported for shoulder pain in hemiplegic stroke patients, that to the coracohumeral ligament has not been reported. In a stroke paraplegic patient with shoulder pain, we evaluated the effect of local steroid injection therapy on pain, sleep and range of movement.Methods: Among stroke hemiplegia patients with shoulder pain admitted to our rehabilitation department, 14 shoulders with inadequate pain control by joint range of motion training, anatomical restoration, and analgesic medication were included in this study. Local steroid injections were performed on the coracohumeral ligament under ultrasound guidance. The evaluation items were pain during movement, nocturnal pain, sleep disturbance, and changes in shoulder joint range of motion (flexion, abduction, and external rotation in the pronated position). The Athens Insomnia Scale score was used to assess sleep disturbance. Each item was evaluated before injection, 2 weeks after injection, and 4 weeks after injection.Results: Pain during movement 4 weeks after injection, nocturnal pain and Athens Insomnia Scale score 2 and 4 weeks after injection improved significantly. The range of motion of the shoulder joint was also significantly improved in flexion 2 weeks after injection and in external rotation after 4 weeks of injection.Conclusion: Local steroid injections into the coracohumeral ligament may be one treatment option to reduce shoulder pain in stroke hemiplegic patients, as it significantly reduced pain during movement and nighttime pain and sleep disturbances.

Objective: Shoulder pain, which is common in hemiplegic stroke patients, decreases quality of life and interferes with rehabilitation. Although many local injection therapies have been reported for shoulder pain in hemiplegic stroke patients, that to the coracohumeral ligament has not been reported. In a stroke paraplegic patient with shoulder pain, we evaluated the effect of local steroid injection therapy on pain, sleep and range of movement.Methods: Among stroke hemiplegia patients with shoulder pain admitted to our rehabilitation department, 14 shoulders with inadequate pain control by joint range of motion training, anatomical restoration, and analgesic medication were included in this study. Local steroid injections were performed on the coracohumeral ligament under ultrasound guidance. The evaluation items were pain during movement, nocturnal pain, sleep disturbance, and changes in shoulder joint range of motion (flexion, abduction, and external rotation in the pronated position). The Athens Insomnia Scale score was used to assess sleep disturbance. Each item was evaluated before injection, 2 weeks after injection, and 4 weeks after injection.Results: Pain during movement 4 weeks after injection, nocturnal pain and Athens Insomnia Scale score 2 and 4 weeks after injection improved significantly. The range of motion of the shoulder joint was also significantly improved in flexion 2 weeks after injection and in external rotation after 4 weeks of injection.Conclusion: Local steroid injections into the coracohumeral ligament may be one treatment option to reduce shoulder pain in stroke hemiplegic patients, as it significantly reduced pain during movement and nighttime pain and sleep disturbances.

Introduction：Respiratory failures are categorized into types I and II. To our knowledge, we report the first case of pulmonary rehabilitation in a patient with systemic sclerosis/polymyositis overlap syndrome who developed type II respiratory failure.Methods：The patient was a 77-year-old woman who had received treatment for systemic sclerosis and polymyositis at another hospital. When she visited our hospital to obtain a second opinion, she suddenly lost consciousness and underwent trachea intubation because of typeⅡrespiratory failure. She received physical therapy on the third day of hospitalization and underwent a tracheotomy on the 16th day. As her thoracic movement was markedly restricted, we started physical training. After she was weaned off from the ventilator on the 43rd day, we performed muscular strength training and aerobic exercise. No exacerbation of CO2 storage was observed even if chest motion training was performed. She was discharged on the 72nd day and advised to wear retina®．Administration of therapeutic drugs such as steroids was maintained at the same dose.Conclusion：Physical therapy, such as chest mobilization, was effective for marked restriction of chest movement in a patient who had both polymyositis and systemic sclerosis.

Introduction：Respiratory failures are categorized into types I and II. To our knowledge, we report the first case of pulmonary rehabilitation in a patient with systemic sclerosis/polymyositis overlap syndrome who developed type II respiratory failure.Methods：The patient was a 77-year-old woman who had received treatment for systemic sclerosis and polymyositis at another hospital. When she visited our hospital to obtain a second opinion, she suddenly lost consciousness and underwent trachea intubation because of typeⅡrespiratory failure. She received physical therapy on the third day of hospitalization and underwent a tracheotomy on the 16th day. As her thoracic movement was markedly restricted, we started physical training. After she was weaned off from the ventilator on the 43rd day, we performed muscular strength training and aerobic exercise. No exacerbation of CO2 storage was observed even if chest motion training was performed. She was discharged on the 72nd day and advised to wear retina®．Administration of therapeutic drugs such as steroids was maintained at the same dose.Conclusion：Physical therapy, such as chest mobilization, was effective for marked restriction of chest movement in a patient who had both polymyositis and systemic sclerosis.