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

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: To assess the accuracy and confidence of the glenohumeral joint injection using an anterior approach in cadavers. METHOD: Eight shoulders from six cadavers were placed supine with arm abduction and external rotation. A single physiatrist performed all the ultrasonography guided injection using an anterior approach. A twenty-one gauge needle was placed into shoulder and intraarticular position was verified by small injection of blue dye. And then the anatomic dissection was done. RESULTS: Seven out of eight (87.5%) were judged to be accurately placed by the anatomic section. In one case, the needle tip was placed in supraglenoid space. In one of the seven accurate cases, the needle traversed the long head tendon of biceps muscle. Confidence of the injections was 87.5%. CONCLUSION: Ultrasonography guided glenohumeral injection using an anterior approach was efficient and safe.
Arm ; Cadaver ; Head ; Injections, Intra-Articular ; Muscles ; Needles ; Shoulder ; Shoulder Joint ; Tendons

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

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

OBJECTIVE: To investigate and quantify functional deficit in ischemic stroke rat. METHOD: Male Sprague-Dawley rats were divided into sham group and stroke group. Permanent cerebral ischemia was inflicted on the stroke group by occluding the middle cerebral artery (MCAO). The proportion of hind limb weight bearing pressure was also measured. The withdrawal threshold values in the hindpaws were measured by using von-Frey hair for seven days from the day before ischemia. RESULTS: The proportion of paretic hind limb pressure to whole hind limb pressure in stroke group was significantly reduced than sham group (p<0.05). The withdrawal threshold values of the paretic hindpaw in stroke group were not different from those in the sham group during whole experimental session (p>0.05). Garcia motor score of stroke group was reduced significantly than sham group in whole experimental session after MCAO (p<0.05). The proportions of right hind limb pressure showed no correlation with Garcia motor score after MCAO (p>0.05). CONCLUSION: Ischemic stroke in rats can lead to the reduction of pressure at paretic hind limb. The motor test for pressure weight borne on the paretic leg may provide functional information in the future studies with ischemic stroke rat.
Animals ; Brain Ischemia ; Extremities ; Hair ; Humans ; Infarction, Middle Cerebral Artery ; Leg ; Male ; Middle Cerebral Artery ; Rats ; Rats, Sprague-Dawley ; Salicylamides ; Stroke ; Weight-Bearing

OBJECTIVE: To evaluate the effect of tear after passive ROM exercise during distension arthrography in patients with frozen shoulder. METHOD: Fifteen patients (male: 7, female: 8, mean 57.5 years old) who had complained of shoulder pain with decreased ROM at least 3 months prior were enrolled. Distension arthrogrphy of 35 ml of fluid which contained 10 ml of 1% lidocaine, 1 ml of depomedrol (40 mg), 19 ml of normal saline, and 5 ml of radiocontrast material was injected by a single physician. Then if there was no capsular tear, passive ROM exercise was performed for two minutes. RESULTS: In seven of the thirteen patients, the occurrence of capsular tear was observed after only distension arthrography. In five of the six patients without capsular rupture, the occurrence of capsular tear was observed by passive ROM exercise after distension arthrography. Two patients were interrupted because of severe pain. Clinical outcomes of occurrence of capsular tear by conventional distension arthrography and by passive ROM exercise after distension arthrography were similar. CONCLUSION: Passive ROM exercise after distension arthrography could serve as an effective method of capsular tear in patients with frozen shoulder.
Arthrography ; Bursitis ; Humans ; Injections, Intra-Articular ; Lidocaine ; Rupture ; Shoulder Pain

BACKGROUND/AIMS: The treatment efficacy for advanced hepatocellular carcinoma is poor. This study examined the efficacy and toxicity of 3-dimensional conformal radiotherapy (3D-CRT) in combination with transarterial chemolipiodolization (TACL) for a huge hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). METHODS: From March 2001 to November 2004, 49 patients with advanced HCC with PVTT (size>8 cm, modified UICC stage IVa) were enrolled in this retrospective study. Twenty two patients underwent more than 2 cycles of TACL (adriamycin 50 mg/m2, cisplatin 60 mg/m2, 5-fluorouracil 200 mg/m2 every 4-6 weeks) without 3D-CRT, while 27 patients underwent consecutive TACL with 3D-CRT (40-45 Gy for 4-5 weeks) that was started one week after the 1st TACL. The response was assessed by a computed tomography (CT) and the serum alpha-fetoprotein (AFP) level at 1-2 month intervals. RESULTS: The objective response rates in the TACL group and TACL with 3D-CRT group were 18% and 48% at 3 months (P=0.051), and 10.5% and 42% at 6 months (P=0.024) respectively. The median survival time was 13 months and 13.5 months in TACL and TACL with 3D-CRT groups, respectively (P=0.502). The treatment response was better in the TACL with 3D-CRT group but there was no significant difference in survival between the two groups. Most toxicities in the two groups were mild, not exceeding grade 1 according to the WHO criteria. CONCLUSIONS: For patients with a huge HCC with PVTT, TACL with 3D-CRT achieved some meaningful clinical benefit. Prospective controlled trials will be needed to confirm the real benefit of TACL combined with 3D-CRT.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular/complications/radiotherapy/*therapy ; Chemoembolization, Therapeutic/*methods ; Combined Modality Therapy ; Data Interpretation, Statistical ; Female ; Humans ; Liver Neoplasms/complications/radiotherapy/*therapy ; Male ; Middle Aged ; *Portal Vein ; Radiotherapy, Conformal/adverse effects/*methods ; Severity of Illness Index ; Survival Analysis ; Venous Thrombosis/etiology/radiotherapy/*therapy