Delayed Postoperative Paravertebral Abscess in a Patient with Cervical Spinal Cord Injury Accompanied by Ankylosing Spondylitis

이건재,이장우 대한임상통증학회 2021 Clinical Pain Vol.20 No.2

Ankylosing spondylitis (AS) is a chronic inflammatory disease presenting progressive spinal stiffness and sacroiliitis. Cervical spine fracture combined with AS should be treated with operation, but it is closely related with increased rates of surgical site infection, which are associated with an elevated erythrocyte sedimentation rate and elevated C-reactive protein. We report a case of delayed postoperative infection appeared in cervical paravertebral space, which was masked by laboratory findings and clinical characteristics represented in this rheumatic disease. A 53-year-old man who had medical history of AS got operation after cervical spine fracture. During hospitalization, he experienced aching pain originating from left posterior neck to shoulder, which was revealed out to be delayed postoperative infection, diagnostically obscured by elevated values of inflammatory markers. This case emphasizes detailed evaluation considering symptoms and comorbidity of the patient should be performed to apply proper management.

하퇴, 발목 및 발 손상에 관한 근골격 초음파

김성현,Park Donghwi 대한임상통증학회 2022 Clinical Pain Vol.21 No.2

In actual clinical practice, injuries of the lower extremities are frequently encountered. Some diseases are diagnosed through a physical examination, but when non-specific symptoms are complained, it may be difficult to diagnose only with a physical examination. Therefore, the ultrasound examination can be used as an appropriate diagnostic tool by using the inherent advantages of the device. This review article aims to describe in detail the main features of ultrasound imaging for common injuries of the distal lower extremity, ankle, and foot.

요통환자에서 디지털 요통 치료의 효과

김재원,김재민 대한임상통증학회 2022 Clinical Pain Vol.21 No.2

Low back pain (LBP) is a common musculoskeletal disorder such that 70∼85% of people experience LBP at least once in their lifetime. With advances in Internet and mobile technology, digital intervention for LBP has emerged as a new treatment method that allows patients to actively participate in treatment at home using digital devices. Several studies on digital interventions have reported improvements in pain by up to 68%, on disability scales by up to 55%, and also in other significant areas such as quality of life and psychological well-being. In particular, mobile application-based treatment was effective, and treatment including exercise therapy had a distinct effect. Also, studies have shown that interactions between healthcare provider and patient, and immediate audiovisual feedback following analysis of the patients’ motions can enhance the therapeutic effect. Evidence-based digital care for patients with LBP is an effective method of treatment and is expected to advance further in the future.

류마티스 어깨의 진단과 치료

박기영 대한임상통증학회 2022 Clinical Pain Vol.21 No.2

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.

사지 변형이 동반되지 않은 좌측 편위의 폴란드 증후군

나영일,Seungbok Lee,Baek Seung-Min,이정후 대한임상통증학회 2022 Clinical Pain Vol.21 No.2

“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.

유방암 수술 후 동일측 유착관절낭염에 대한 관절강내 주사 치료의 안전성 및 효과

조미경,김동민,김영모,양태웅,윤진아,이병주 대한임상통증학회 2021 Clinical Pain Vol.20 No.2

Objective: To confirm the safety of Intra-articular (IA) injection on the ipsilateral adhesive capsulitis (AC) after breast cancer surgery. Methods: Between January 2017 and May 2020, we retrospectively studied 29 patients after breast cancer surgery who underwent IA injection in the glenohumeral joint for AC in aseptic procedure. Results: There were no side effects or complications such as lymphedema or cellulitis in the patients. There was a significant improvement in pain score and range of motion (ROM) at the 1st, 3rd, and 6th months visits compared to the baseline (p<0.05). The presence or absence of axillary lymph node dissection and radiation therapy had no significant difference in improvement of ROM. But, in rotator cuff syndrome (RCS) group, there was a significant difference in improvement of shoulder IR in patients without RCS. Conclusion: IA Injection on the ipsilateral AC after breast cancer surgery was safe and even effective to improve pain and shoulder ROM. Ipsilateral IA injection can be a good treatment for breast cancer surgery patients suffering from AC.

손목관절과 수부의 신경근골격초음파

Sun Jae Won 대한임상통증학회 2022 Clinical Pain Vol.21 No.2

Neuromuscular ultrasound has been used increasingly for the diagnosis and guided-intervention of various neuromuscular structures. Using neuromuscular ultrasound, clinicians can reliably evaluate various structures in wrist and hand such as the nerves, joints, tendons or ligaments. In this article, a practical guide to the basis of neuromuscular ultrasound and the diagnostic criteria are reviewed for the diseases in wrist and hand; specifically median nerve, ulnar nerve, superficial radial nerve, wrist joint, ligaments, and stenosing tenosynovitis. Neuromuscular ultrasound can improve the accuracy of the diagnosis and the quality of patient care and is becoming a standard element in clinical practice. The development of quantitative measures also appears promising in its ability to improve patient care.

유방암 환자의 복합 상지병증에서 체외충격파치료의 유용성

하민철,신지철,정유상,임상희 대한임상통증학회 2021 Clinical Pain Vol.20 No.1

Upper limb morbidity including shoulder pain, lymphedema, adhesive capsulitis, myofascial pain syndrome, and limited range of motions (LROMs) occurs frequently in breast cancer patients. Especially restricted upper limb motion aggravated by chronic lymphedema results in functional limitation and impaired activities of daily living (ADL). However, conventional rehabilitation therapy including complex decongestive therapy and stretching exercise is insufficient for managing advanced breast cancer patients with complex upper limb morbidity. Here, we report a case of breast cancer-related chronic lymphedema in a 62-years old female with severe LROM in all joints of the affected upper extremity that caused severe disability in ADL. Significant improvements in range of motion and upper extremity function were observed after serial extracorporeal shock wave therapy (ESWT), combined with conventional rehabilitation therapy. Therefore, ESWT might be recommended for managing the extensive limited joint motion which causes functional decline in a patient of chronic lymphedema with trophic skin change.

근육내자극치료

Park Jinyoung 대한임상통증학회 2023 Clinical Pain Vol.22 No.1

Muscle pain can be caused by various causes and it deteriorates the patient’s function and quality of life. Intramuscular stimulation therapy, performed under the concept of myofascial pain syndrome, is an effective treatment for relieving somatic pain in skeletal muscles through muscle relaxation, improving the limited range of motion of joints, enhancing muscle strength, and improving accompanying autonomic nervous system symptoms. Dry needling, trigger point injection, and intramuscular electrical stimulation are typical methods of intramuscular stimulation, and they must be safely performed by experienced practitioners. The mechanism, clinical use, efficacy, and precautions of intramuscular stimulation therapy will be reviewed in this article. Although additional supplementation of the academic evidence of intramuscular stimulation is still needed through experimental research, it is expected that the clinical application area can be expanded.

4∼5번 요추 골극에 의해 유발된 비전형적 메이-터너 증후군

남경호,황지혜 대한임상통증학회 2023 Clinical Pain Vol.22 No.1

May–Thurner syndrome (MTS) is a condition in which the left common iliac vein is irritated by chronic pulsatile compression between the right common iliac artery and the upper iliac or lumbar spine. It mainly causes swelling and pain in the left lower extremity, venous thrombosis, and repeated deep venous thrombosis. In patients with sudden swelling and pain in the left lower extremity and suspected lower extremity thrombosis, when no other obvious cause can be found, the possibility of MTS should be considered. We experienced a rare case of an older patient with atypical MTS caused by bone spur of the 4th and 5th lumbar vertebrae, which has been reported here along with a review of the literature.