Publications by authors named "Du Hwan Kim"

60 Publications

Amputation stump management: A narrative review.

World J Clin Cases 2022 May;10(13):3981-3988

Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu 705-717, South Korea.

In this review intended for medical staff involved in patient rehabilitation, we provided an overview of the basic methods for managing amputation stumps. After the amputation surgery, it is imperative to optimize the remaining physical abilities of the amputee through rehabilitation processes, including postoperative rehabilitation, desensitization, and continuous application of soft or rigid dressings for pain reduction and shaping of the stump. Depending on the situation, a prosthesis may be worn in the early stage of recovery or an immediate postoperative prosthesis may be applied to promote stump maturation. Subsequently, to maintain the range of motion of the stump and to prevent deformation, the remaining portion of the limb should be positioned to prevent contracture. Continuous exercises should also be performed to improve muscle strength to ensure that the amputee is able to perform activities of daily living, independently. Additionally, clean wound or edema management of the stump is necessary to prevent problems associated with wearing the prosthesis. Our review is expected to contribute to the establishment of basic protocols that will be useful for stump management from the time of completion of amputation surgery to the fitting of a prosthesis to optimize patient recovery.
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http://dx.doi.org/10.12998/wjcc.v10.i13.3981DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9131228PMC
May 2022

Comparative Efficacy of Rotator Interval Versus Posterior Capsule Approach Intraarticular Corticosteroid Injections for Primary Frozen Shoulder: A Single-blind, Randomized Trial.

Pain Physician 2022 05;25(3):313-321

Department of Rehabilitation Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea.

Background: Intraarticular (IA) corticosteroid injection is commonly performed in patients with primary frozen shoulder (PFS). However, the best administration site remains controversial.

Objectives: To compare the efficacy of rotator interval (RI) vs posterior capsule (PC) approach for ultrasound-guided corticosteroid injections into the glenohumeral joint of patients with PFS.

Study Design: A randomized, exploratory, prospective study.

Setting: A single fellowship training institution in Daegu, Republic of Korea.

Methods: This study was approved by the Institutional Review Board (2019-04-047-001).  Ninety patients with PFS were randomly assigned to either RI approach (RI group, n = 43) or PC approach (PC group, n = 45) for ultrasound-guided IA corticosteroid injection. Fluoroscopic images to assess the accuracy of the injection were obtained immediately after injection by a shoulder specialist. Visual Analog Scale for pain, the American Shoulder and Elbow Surgeons score, the subjective shoulder value, and range of motion (ROM) were used to assess clinical outcomes for all patients at the time of presentation, and at 3, 6, and 12 weeks after injection.

Results: The accuracy of injection was 76.7% (33/43) and 93.3% (42/45) in the RI and PC groups, respectively; the between-group difference was statistically significant (P = .028). Significant improvements were observed in both groups in terms of all clinical scores and ROMs throughout follow-up until 12 weeks after the injection (all P < .001). At 12 weeks, better improvements in forward flexion and abduction (P = .049 and .044) were observed in the RI group than in the PC group. No adverse effect related to injection was observed in either group.

Limitations: This study had no control group receiving placebo injections and limited follow-up time.

Conclusions: Both groups showed significant pain reduction and functional improvement until 12 weeks after injection. Although no significant differences were observed in pain and functional scores between the 2 groups, the RI group showed better improvement of ROM than the PC group. These results indicate that the RI and anterior structures are a major site in the pathogenesis and treatment target of PFS.
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May 2022

Lumbosacral plexopathy caused by the perineural spread of pelvic malignancies: clinical aspects and imaging patterns.

Acta Neurochir (Wien) 2022 06 21;164(6):1509-1519. Epub 2022 Apr 21.

Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.

Background: Perineural spread (PNS) of tumors from pelvic malignancies is a rare phenomenon but constitutes an important differential diagnosis of lumbosacral plexopathy (LSP). Herein, we describe the clinical and imaging features of patients with LSP due to PNS of pelvic malignancies along with a literature review.

Methods: We retrospectively reviewed 9 cases of LSP caused by PNS of pelvic malignancy between January 2006 and August 2021, and all clinical and imaging parameters were recorded in detail. Clinical symptoms and signs of patients were described and listed in the order in which they occurred. The results of imaging test were analyzed to describe specific findings in LSP caused by PNS.

Results: This study enrolled nine adult patients (mean age, 50.1 years). Two cases initially presented as LSP and were later diagnosed with pelvic malignancy. Pain in the perianal or inguinal area preceded pain at the extremities in six patients. Neurogenic bladder or bowel symptoms developed in five patients. On the magnetic resonance imaging (MRI), the S1-S2 spinal nerve was most commonly involved, and S1 myotome weakness was more prominent in six patients than the other myotomes. One patient had an intradural extension. F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) showed abnormal signal intensity in six patients. No abnormality in F-FDG PET/CT was detected in the nervous structures in one patient. Only four patients survived until the last follow-up visit.

Conclusions: Though rare, physicians should always keep in mind the possibility of LSP due to the PNS in patients with pelvic malignancy. Thorough physical examination and history taking could provide clues for diagnosis. Pelvic MRI and F-FDG-PET/CT should be considered for patients with LSP to rule out neoplastic LSP.
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http://dx.doi.org/10.1007/s00701-022-05194-xDOI Listing
June 2022

Regarding "A Multisite Injection Is More Effective Than a Single Glenohumeral Injection of Corticosteroid in the Treatment of Primary Frozen Shoulder: A Randomized Controlled Trial".

Arthroscopy 2022 04;38(4):1032-1033

Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea.

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http://dx.doi.org/10.1016/j.arthro.2022.01.034DOI Listing
April 2022

Serum Levels of TNF-α Are Increased in Patients with Rotator Cuff Tear and Sleep Disturbance.

Diagnostics (Basel) 2021 Nov 27;11(12). Epub 2021 Nov 27.

Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, Korea.

The purpose of this study was to determine serum levels of sleep-related cytokines in patients with rotator cuff tear (RCT) who were experiencing pain-related sleep disturbance. Peripheral blood samples before surgery were collected from 63 study participants and divided into three groups: RCT with sleep disturbance group; SD group ( = 21), RCT with normal sleep group; NS group ( = 21), and patients with chronic shoulder instability; control group ( = 21). Serum concentration levels of interleukin-1α (IL-1α), IL-1β, IL-2, IL-6, IL-8, IL-10, and tumor necrosis factor-α (TNF-α) were measured via ELISA. The associations between serum levels of sleep-related cytokines and clinical scores and the Pittsburgh Sleep Quality Index (PSQI) were analyzed. Serum concentration levels of TNF-α were significantly higher in the SD group compared with those of the NS and control groups ( = < 0.001 and 0.05). Serum levels of IL-8 and IL-10 were significantly higher in the SD group compared with those of control group ( = 0.01 and = 0.05), but did not differ significantly from that of the NS group. There were no associations between serum levels of sleep-related cytokines and all clinical scores. The current findings suggest that TNF-α may be associated with sleep disturbance in patients with RCT.
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http://dx.doi.org/10.3390/diagnostics11122215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8700194PMC
November 2021

Amyotrophic lateral sclerosis mimicking radiculopathy: a case series.

Nagoya J Med Sci 2021 Nov;83(4):877-881

Department of Physical Medicine and Rehabilitation, College of Medicine Yeungnam University, Daegu, Republic of Korea.

The clinical findings of early stage amyotrophic lateral sclerosis (ALS) are similar to those of cervical or lumbar radiculopathy. In the current study, we describe 3 cases of ALS that were misdiagnosed as cervical or lumbar radiculopathy. Three patients (a 48-, a 52-, and an 80-year-old) visited our clinic due to motor weakness on either the upper or lower extremities. At other clinics or hospitals, they were diagnosed with radiculopathy due to herniated lumbar disc or cervical foraminal stenosis. The motor weakness in these patients was ipsilateral or bilateral but dominant on one side. Sensory deficits or bulbar symptoms were not observed. Of the 3 patients, 2 had neuropathic pain, but it was not dermatome related. We conducted an electrodiagnostic test and observed a low amplitude of compound motor action potential on the affected nerve and positive sharp waves on muscles of involved segments, including thoracic paraspinalis. All the patients were diagnosed with probable laboratory-supported ALS or possible ALS based on the established diagnostic criteria (El Escorial Criteria). In the present study, we showed three cases of ALS that were misdiagnosed as radiculopathy. Our study would be helpful for early and accurate diagnosis of patients with ALS.
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http://dx.doi.org/10.18999/nagjms.83.4.877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8648534PMC
November 2021

Altered Differentiation of Tendon-Derived Stem Cells in Diabetic Conditions Mediated by Macrophage Migration Inhibitory Factor.

Int J Mol Sci 2021 Aug 20;22(16). Epub 2021 Aug 20.

Medical Research Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea.

The purpose of our study was to evaluate the role of macrophage migration inhibitory factor (MIF) in the differentiation of tendon-derived stem cells (TdSCs) under hyperglycemic conditions. In the in vivo experiment, rats were classified into diabetic (DM) and non-DM groups depending on the intraperitoneal streptozotocin (STZ) or saline injection. Twelve-week after STZ injection, the supraspinatus tendon was harvested and prepared for histological evaluation and real-time reverse transcription polymerase chain reaction for osteochondrogenic (aggrecan, BMP-2, and Sox9) and tenogenic (Egr1, Mkx, scleraxis, type 1 collagen, and Tnmd) markers. For the in vitro experiment, TdSCs were isolated from healthy rat Achilles tendons. Cultured TdSCs were treated with methylglyoxal and recombinant MIF or MIF gene knockdown to determine the effect of hyperglycemic conditions and MIF on the differentiation function of TdSCs. These conditions were classified into four groups: hyperglycemic-control group, hyperglycemic-recombinant-MIF group, hyperglycemic-knockdown-MIF group, and normal-control group. The mRNA expression of osteochondrogenic and tenogenic markers was compared among the groups. In the in vivo experiment, the mRNA expression of all osteochondrogenic and tenogenic differentiation markers in the DM group was significantly higher and lower than that in the non-DM group, respectively. Similarly, in the in vitro experiments, the expression of all osteochondrogenic and tenogenic differentiation markers was significantly upregulated and downregulated, respectively, in the hyperglycemic-control group compared to that in the normal-control group. The hyperglycemic-knockdown-MIF group demonstrated significantly decreased expression of all osteochondrogenic differentiation markers and increased expression of only some tenogenic differentiation markers compared with the hyperglycemic-control group. In contrast, the hyperglycemic-recombinant-MIF group showed significantly increased expression of all osteochondrogenic differentiation markers, but no significant difference in any tenogenic marker level, compared to the hyperglycemic-control group. These results suggest that tendon homeostasis could be affected by hyperglycemic conditions, and MIF appears to alter the differentiation of TdSCs via enhancement of the osteochondrogenic differentiation in hyperglycemic conditions. These are preliminary findings, and must be confirmed in a further study.
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http://dx.doi.org/10.3390/ijms22168983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396498PMC
August 2021

Strong association of type 2 diabetes with degenerative lumbar spine disorders.

Sci Rep 2021 08 13;11(1):16472. Epub 2021 Aug 13.

Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul, Korea.

Tantalizing connections between type 2 diabetes and degenerative lumbar spine disorders have become increasingly evident. However, the association of type 2 diabetes with degenerative lumbar spine disorders remains unclear. We sought to clarify the association between type 2 diabetes and lumbar spine disorders using nationwide data in Korea. Furthermore, we explored the association of diabetes with the prevalence of spinal procedures. The data in this study was obtained from Korean health claim database. Between 2016 and 2019, totals of 479,680 diabetes and 479,680 age- and sex-matched control subjects were enrolled. Patients with diabetes had more likely to have degenerative lumbar spine disorders and spinal procedures than controls. Using multivariate-adjusted analysis, patients with diabetes were at increased risk of being concomitantly affected by lumbar disc disorder [adjusted odds ratio 1.11 (95% confidence interval 1.10-1.12)], lumbar spondylotic radiculopathy [1.12 (1.11-1.13)], spondylolisthesis [1.05 (1.02-1.08)] and spinal stenosis [1.16 (1.15-1.18)], compared to controls. Furthermore, diabetic patients had an increased risk of undergoing lumbar spinal injection [1.13 (1.12-1.14)], laminectomy [1.19 (1.15-1.23)], and fusion surgery [1.35 (1.29-1.42)]. We demonstrated that type 2 diabetes was significantly associated with lumbar spine disorders and frequent spinal procedures. Our results suggest diabetes as a predisposing factor for lumbar spine disorders.
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http://dx.doi.org/10.1038/s41598-021-95626-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8363740PMC
August 2021

Essentials of thoracic outlet syndrome: A narrative review.

World J Clin Cases 2021 Jul;9(21):5804-5811

Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, South Korea.

Thoracic outlet syndrome (TOS) is a group of diverse disorders involving compression of the nerves and/or blood vessels in the thoracic outlet region. TOS results in pain, numbness, paresthesia, and motor weakness in the affected upper limb. We reviewed the pathophysiology, clinical evaluation, differential diagnoses, and treatment of TOS. TOS is usually classified into three types, neurogenic, venous, and arterial, according to the primarily affected structure. Both true neurogenic and disputed TOS are considered neurogenic TOS. Since identifying the causative lesions is complex, detailed history taking and thorough clinical investigation are needed. Electrodiagnostic and imaging studies are helpful for excluding other possible disorders and confirming the diagnosis of true neurogenic TOS. The existence of a disputed TOS remains controversial. Neuromuscular physicians tend to be skeptical about the existence of disputed TOS, but thoracic surgeons argue that disputed TOS is under-diagnosed. Clinicians who encounter patients with TOS need to understand its key features to avoid misdiagnosis and provide appropriate treatment.
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http://dx.doi.org/10.12998/wjcc.v9.i21.5804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8316950PMC
July 2021

Clinical Practice Guideline for Postoperative Rehabilitation in Older Patients With Hip Fractures.

Ann Rehabil Med 2021 Jun 30;45(3):225-259. Epub 2021 Jun 30.

Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

Objective: The incidence of hip fractures is increasing worldwide with the aging population, causing a challenge to healthcare systems due to the associated morbidities and high risk of mortality. After hip fractures in frail geriatric patients, existing comorbidities worsen and new complications are prone to occur. Comprehensive rehabilitation is essential for promoting physical function recovery and minimizing complications, which can be achieved through a multidisciplinary approach. Recommendations are required to assist healthcare providers in making decisions on rehabilitation post-surgery. Clinical practice guidelines regarding rehabilitation (physical and occupational therapies) and management of comorbidities/complications in the postoperative phase of hip fractures have not been developed. This guideline aimed to provide evidence-based recommendations for various treatment items required for proper recovery after hip fracture surgeries.

Methods: Reflecting the complex perspectives associated with rehabilitation post-hip surgeries, 15 key questions (KQs) reflecting the complex perspectives associated with post-hip surgery rehabilitation were categorized into four areas: multidisciplinary, rehabilitation, community-care, and comorbidities/complications. Relevant literature from four databases (PubMed, EMBASE, Cochrane Library, and KoreaMed) was searched for articles published up to February 2020. The evidence level and recommended grade were determined according to the grade of recommendation assessment, development, and evaluation method.

Results: A multidisciplinary approach, progressive resistance exercises, and balance training are strongly recommended. Early ambulation, weigh-bearing exercises, activities of daily living training, community-level rehabilitation, management of comorbidities/complication prevention, and nutritional support were also suggested. This multidisciplinary approach reduced the total healthcare cost.

Conclusion: This guideline presents comprehensive recommendations for the rehabilitation of adult patients after hip fracture surgery.
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http://dx.doi.org/10.5535/arm.21110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8273721PMC
June 2021

A Simple Bedside Exercise Method to Enhance Lower Limb Muscle Strength in Moderate Alzheimer's Disease Patients with Sarcopenia.

Healthcare (Basel) 2021 Jun 4;9(6). Epub 2021 Jun 4.

Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 705-717, Korea.

Background: Alzheimer's disease (AD) is known to accelerate muscle loss in the elderly due to reduced physical performance, increasing the prevalence and severity of sarcopenia. This study was undertaken to determine whether simple bedside exercise training may facilitate muscle growth and strengthening in moderate-degree AD patients.

Methods: This study was conducted on 26 prospectively recruited women admitted to a nursing hospital, who had moderate AD and sarcopenia. They were randomly and evenly divided into the control and exercise groups. For five sessions per week, those in the exercise group underwent 30 min of therapist-supervised exercise by simply kicking a balloon connected to the ceiling by a piece of string while lying on a bed. Additional exercise was encouraged, and isometric maximal voluntary contraction (MVC) and skeletal muscle mass index (SMI) were measured and calculated after 12 weeks.

Results: Through simple exercise training for 12 weeks, MVCs for hip flexion and knee extension significantly increased in the exercise group. However, no significant differences in SMI were found between the two groups.

Conclusions: We believe that our simple exercise method can be applied to patients with AD for maintaining and enhancing the strength of the muscles of the lower extremities.
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http://dx.doi.org/10.3390/healthcare9060680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8227277PMC
June 2021

Intraneural ganglion cyst of the lumbosacral plexus mimicking L5 radiculopathy: A case report.

World J Clin Cases 2021 Jun;9(17):4433-4440

Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, South Korea.

Background: Intraneural ganglion cysts are benign gelatinous masses that form within the epineurium of a peripheral nerve. Only few cases of intraneural ganglion cyst arising from the hip joint have been reported.

Case Summary: A previously healthy 65-year-old woman who had been experiencing left buttock pain radiating to the dorsum of the foot for 2 years visited our clinic. Prior to visiting the clinic, she underwent lumbar spine magnetic resonance imaging and received physiotherapy, pain killers, and epidural injections based on a presumptive diagnosis of spinal stenosis for 2 years in other hospitals. Repeat magnetic resonance imaging revealed joint connection of the articular branch of the hip joint and rostral extension of the cyst along the L5 spinal nerve near the L5-S1 neural foramen. The patient was diagnosed with intraneural ganglion cyst arising from the articular branch of the hip joint based on high-resolution magnetic resonance neurography. Using the arthroscopic approach, a cystic opening within the intra-articular space was detected, and cyst decompression was then performed. The pain in the left leg was significantly relieved during the 6-mo follow-up.

Conclusion: Although intraneural ganglion cysts arising from the hip joint are rare, they can cause typical radicular pain and mimic common L5 radiculopathy. Typical cyst ascent phenomenon starting from the termination of the articular branch on magnetic resonance imaging is a crucial finding indicative of intraneural ganglion cysts arising from the hip joint.
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http://dx.doi.org/10.12998/wjcc.v9.i17.4433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173415PMC
June 2021

Dynamic Ultrasonographic Measurement of Inferior Joint Capsule Thickness in Patients with Unilateral Frozen Shoulder.

Diagnostics (Basel) 2021 May 18;11(5). Epub 2021 May 18.

Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, Korea.

The diagnostic value of ultrasonography (US) for frozen shoulder (FS) is not well established. This study aimed to assess the diagnostic value of US measurement of inferior joint capsule (IJC) thickness and evaluate changes in the thickness of the IJC by US depending on arm position. A total of 71 patients with clinically diagnosed unilateral FS who underwent bilateral US measurement of the IJC were enrolled in this study. The US measurement of the IJC was performed with a linear transducer positioned around the anterior axillary line with the shoulder 40° abducted and with neutral rotation of the glenohumeral joint (neutral position). We also measured the IJC thickness in the externally rotated and internally rotated positions with the shoulder 40° abducted. In the neutral position, as well as in the internally rotated and externally rotated positions, the thickness of the IJC on US was significantly higher in the affected shoulder than that in the unaffected shoulder (all < 0.001). On both the affected and unaffected sides, the US thickness of the IJC in the neutral position was significantly higher than that in the externally rotated position ( < 0.001), but lower than that in the internally rotated position ( < 0.001). Regarding IJC thickness in the neutral position, a 3.2-mm cutoff value yielded the highest diagnostic accuracy for FS, with a sensitivity and specificity of 73.2% and 77.5%, respectively. The area under the curve for IJC thickness was 0.824 (95% confidence interval, 0.76-0.89). US measurement of the IJC in the neutral position yielded good diagnostic accuracy for FS. Because IJC thickness is affected by arm rotation, it is important to measure the IJC thickness in a standardized posture to ensure diagnostic value.
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http://dx.doi.org/10.3390/diagnostics11050898DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8158117PMC
May 2021

The Diagnostic Significance of Ultrasonographic Measurement of the Achilles Tendon Thickness for the Insertional Achilles Tendinopathy in Patients with Heel Pain.

J Clin Med 2021 May 17;10(10). Epub 2021 May 17.

Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea.

No consensus exists concerning the diagnostic role or cutoff value of the Achilles tendon thickness on ultrasonography (US) for the diagnosis of insertional Achilles tendinopathy. This study sought to assess the diagnostic utility of US measurement of the thickness and echogenicity of the Achilles tendon for the insertional Achilles tendinopathy in patients with heel pain, and to compare the results with those of the plantar fascia for the plantar fasciitis. We conducted US examinations in consecutive patients who presented with unilateral or bilateral heel pain at the foot clinic of a single tertiary hospital from February 2016 to December 2020. Each US evaluation assessed the thickness and echogenicity of the insertion area of the Achilles tendon and plantar fascia. We retrospectively compared these parameters between patients with insertional Achilles tendinopathy or plantar fasciitis and normal controls and analyzed the diagnostic utility of these parameters. Based on clinical diagnosis, 44 feet were diagnosed with insertional Achilles tendinopathy, 109 feet were diagnosed with plantar fasciitis, and 32 feet were classified as normal. There was a significant difference in the thickness of the plantar fascia between the plantar fasciitis and normal control groups ( = 0.032). There was also a significant difference in the echogenicity of the plantar fascia between the plantar fasciitis and normal groups ( < 0.001). However, there was no significant difference in the thickness of the insertional area of the Achilles tendon between the insertional Achilles tendinopathy and normal groups ( = 0.132). There was a significant difference in the echogenicity of the insertional area of the Achilles tendon between the insertional Achilles tendinopathy and normal groups ( < 0.001). US measurement of the thickness of the insertional area of the Achilles tendon might not reflect the clinical status of insertional Achilles tendinopathy, unlike that of plantar fasciitis.
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http://dx.doi.org/10.3390/jcm10102165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157148PMC
May 2021

Comparison of Shoulder Ultrasonographic Assessments between Polymyalgia Rheumatica and Frozen Shoulder in Patients with Bilateral Shoulder Pain: A Comparative Retrospective Study.

J Pers Med 2021 May 3;11(5). Epub 2021 May 3.

Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea.

This study aimed to assess and compare the ultrasonographic (US) pathologic findings in patients with polymyalgia rheumatica (PMR) and bilateral frozen shoulder (FS). We included 19 patients with clinically diagnosed PMR and 19 patients with stage II bilateral FS. The US evaluation included the assessment of subacromial-subdeltoid (SASD) bursitis, long head of biceps (LHB) tenosynovitis, and posterior and inferior glenohumeral (GH) synovitis. Unilateral SASD bursitis was noted significantly more frequently in PMR patients than in bilateral FS patients ( = 0.001). There were no significant differences in the incidence of unilateral LHB tenosynovitis and posterior GH synovitis between PMR and bilateral FS patients ( = 0.108 and = 0.304, respectively). Unilateral inferior GH synovitis was more common among bilateral FS patients than among PMR patients ( < 0.001). Bilateral SASD bursitis and LHB tenosynovitis were noted significantly more frequently in PMR patients than in bilateral FS patients ( < 0.001 and 0.049, respectively). Significant differences were not observed in the incidence of bilateral posterior GH synovitis between PMR and bilateral FS patients ( = 0.426). Bilateral inferior GH synovitis was more common among bilateral FS patients than among PMR patients ( = 0.044). The US evidence for bilateral inferior GH synovitis without bilateral SASD showed high specificity (94.7%) with sensitivity (78.9%) for the diagnosis of bilateral FS. SASD bursitis, representing periarticular synovial inflammation, was more common among the patients with PMR than among the patients with bilateral FS. Inferior GH synovitis without SASD bursitis suggests FS rather than PMR in patients with bilateral shoulder pain.
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http://dx.doi.org/10.3390/jpm11050372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8147595PMC
May 2021

Understanding the physical examination of the shoulder: a narrative review.

Ann Palliat Med 2021 Feb 2;10(2):2293-2303. Epub 2021 Feb 2.

Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea.

The shoulder joint is a ball and socket joint which provides an extensive range of motion. Shoulder pain and weakness are common complaints among patients, which can lead to disability and affect a person's ability to perform daily activities. Shoulder pain and weakness may be associated with shoulder conditions such as rotator cuff disorders adhesive capsulitis, superior labrum anterior to posterior lesions, lesions in the biceps, acromioclavicular joint disease, or instability. Often, a thorough understanding of the network of bony, ligamentous, muscular, and neurovascular anatomy is required to properly identify and diagnose shoulder pathology. Identifying a specific shoulder pathology may be challenging, considering the numerous structures involved in shoulder function. Appropriate physical examination of the shoulder is important for making an accurate diagnosis and distinguishing certain pathologies of the shoulder. Evaluation of shoulder problem may be reliant upon physical examination, which involves inspection, palpation, assessment of range of motion, strength, and neurovascular integrity. In addition, specific tests are used to reproduce symptoms and signs that would help physicians identify the pathology of the shoulder problem. The aim of this study was to review the shoulder anatomy and describe the specific tests used to evaluate common shoulder conditions to facilitate accurate diagnosis and guide proper treatment of these conditions.
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http://dx.doi.org/10.21037/apm-20-1808DOI Listing
February 2021

A prospective double-blind randomized trial on ultrasound-guided versus blind intra-articular corticosteroid injections for primary frozen shoulder.

Bone Joint J 2021 Feb;103-B(2):353-359

Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea.

Aims: Ultrasound (US)-guided injections are widely used in patients with conditions of the shoulder in order to improve their accuracy. However, the clinical efficacy of US-guided injections compared with blind injections remains controversial. The aim of this study was to compare the accuracy and efficacy of US-guided compared with blind corticosteroid injections into the glenohumeral joint in patients with primary frozen shoulder (FS).

Methods: Intra-articular corticosteroid injections were administered to 90 patients primary FS, who were randomly assigned to either an US-guided (n = 45) or a blind technique (n = 45), by a shoulder specialist. Immediately after injection, fluoroscopic images were obtained to assess the accuracy of the injection. The outcome was assessed using a visual analogue scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, the subjective shoulder value (SSV) and range of movement (ROM) for all patients at the time of presentation and at three, six, and 12 weeks after injection.

Results: The accuracy of injection in the US and blind groups was 100% (45/45) and 71.1% (32/45), respectively; this difference was significant (p < 0.001). Both groups had significant improvements in VAS pain score, ASES score, SSV, forward flexion, abduction, external rotation, and internal rotation throughout follow-up until 12 weeks after injection (all p < 0.001). There were no significant differences between the VAS pain scores, the ASES score, the SSV and all ROMs between the two groups at the time points assessed (all p > 0.05). No injection-related adverse effects were noted in either group.

Conclusion: We found no significant differences in pain and functional outcomes between the two groups, although an US-guided injection was associated with greater accuracy. Considering that it is both costly and time-consuming, an US-guided intra-articular injection of corticosteroid seems not always to be necessary in the treatment of FS as it gives similar outcomes as a blind injection. Cite this article: 2021;103-B(2):353-359.
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http://dx.doi.org/10.1302/0301-620X.103B2.BJJ-2020-0755.R1DOI Listing
February 2021

Focal vasculitic myositis as a primary manifestation of Behçet's disease: a case series of 10 Korean patients in a locomotive medicine clinic.

Rheumatology (Oxford) 2021 10;60(10):4609-4615

Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.

Objectives: Muscle involvement in Behçet's disease (BD) is rare, and several cases have been reported in the literature. Therefore, this study aimed to describe the clinical, laboratory and imaging findings in adult patients presenting with BD-associated myositis before the diagnosis of BD.

Methods: We retrospectively screened patients who visited a locomotive medicine clinic presenting with myalgia, local swelling, or tenderness of extremities without an established diagnosis of BD. We enrolled patients whose pain in the extremities was proven to be suggestive of focal vasculitic myositis and who were eventually diagnosed as having BD at the initial visit or during follow-up. We thoroughly reviewed the clinical, histological and imaging findings and treatment outcomes in patients who presented with focal vasculitic myositis as the primary manifestation of BD.

Results: Ten adult patients with focal vasculitic myositis as the primary manifestation of BD were enrolled. The lower and upper extremities were affected in eight and two patients, respectively. The affected lower extremities were the calf (n = 6) and thigh muscles (n = 2). The common findings of MRI included high signal intensity of the affected muscles and intermuscular fascia on fat-suppressed images, suggestive of myofascitis and oedematous changes in the subcutaneous layer. The results of skin or muscle biopsy were suggestive of vasculitis. All the patients were pain-free at the short-term follow-up (1-3 weeks) after oral steroid therapy.

Conclusion: Focal vasculitic myositis can be a primary manifestation of BD warranting medical attention. BD-associated myositis responds well to oral steroid therapy.
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http://dx.doi.org/10.1093/rheumatology/keab053DOI Listing
October 2021

Development of Neuromonitoring Pedicle Screw - Results of Electrical Resistance and Neurophysiologic Test in Pig Model.

Neurospine 2021 Mar 18;18(1):117-125. Epub 2020 Nov 18.

Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea.

Objective: To analyze the electrical resistance of a newly developed neuromonitoring pedicle screw (Neuro-PS) and to verify the electrophysiologic properties of the Neuro-PS in a pig model.

Methods: We developed 2 types of the Neuro-PS in which a gold lead was located internally (type I) and externally (type II). We measured the electrical resistance of the Neuro-PS and the conventional screw and analyzed the electrical thresholds of triggered EMG (t-EMG) of each screw by intentionally penetrating the medial pedicle wall and contacting the exiting nerve root in a pig model.

Results: The electrical resistances of the Neuro-PS were remarkably lower than that of the conventional screw. In electrophysiologic testing, only the type II Neuro-PS under the leadnerve contact condition showed a significantly lower stimulation threshold as compared to the conventional screw.

Conclusion: The Neuro-PS demonstrated lower electrical resistances than the conventional screw. The type II Neuro-PS under the lead-nerve contact condition showed a significantly lower stimulation threshold compared to that of the other screws in the t-EMG test.
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http://dx.doi.org/10.14245/ns.2040424.212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021819PMC
March 2021

Distribution of Peripheral Nerve Injuries in Patients with a History of Shoulder Trauma Referred to a Tertiary Care Electrodiagnostic Laboratory.

Diagnostics (Basel) 2020 Oct 30;10(11). Epub 2020 Oct 30.

Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, Korea.

Peripheral nerve injury after shoulder trauma is an underestimated complication. The distribution of the affected nerves has been reported to be heterogeneous in previous studies. This study aimed to describe the distribution of peripheral nerve injuries in patients with a history of shoulder trauma who were referred to a tertiary care electrodiagnostic laboratory. A retrospective chart review was performed for all cases referred to a tertiary care electrodiagnostic laboratory between March 2012 and February 2020. The inclusion criteria were a history of shoulder trauma and electrodiagnostic evidence of nerve injury. Data on patient demographics, mechanism of injury, degree of weakness, clinical outcomes at the final follow-up, and electrodiagnostic results were retrieved from medical records. Fifty-six patients had peripheral nerve injuries after shoulder trauma. Overall, isolated axillary nerve injury was the most common. A brachial plexus lesion affecting the supraclavicular branches (pan-brachial plexus and upper trunk brachial plexus lesions) was the second most common injury. In cases of shoulder dislocation and proximal humerus fracture, isolated axillary nerve injury was the most common. Among acromioclavicular joint injuries and clavicular fractures, lower trunk brachial plexus injuries and ulnar neuropathy were more common than axillary nerve or upper trunk brachial plexus injuries. Patients with isolated axillary nerve lesions showed a relatively good recovery; those with pan-brachial plexus injuries showed a poor recovery. Our study demonstrated the distribution of peripheral nerve injuries remote from displaced bony structures. Mechanisms other than direct compression by displaced bony structures might be involved in nerve injuries associated with shoulder trauma. Electrodiagnostic tests are useful for determining the extent of nerve damage after shoulder trauma.
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http://dx.doi.org/10.3390/diagnostics10110887DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693958PMC
October 2020

The Electrophysiologic and Ultrasonographic Change after Carpal Tunnel Release in a Patient with Hereditary Neuropathy with Liability to Pressure Palsy.

Neurol India 2020 Sep-Oct;68(5):1232-1234

Department of Physical Medicine and Rehabilitation, Chung Ang University, College of Medicine, Seoul, Korea.

Hereditary neuropathy with liability to pressure palsy (HNPP) often manifests via peripheral nerve entrapment including median nerve compression at the carpal tunnel. However, there are few reports on surgical interventions for focal compression of the median nerve at the wrist in patients with HNPP. We report a case of a patient with HNPP who improved clinically, electrophysiologically, and ultrasonographically after carpal tunnel release (CTR). A 56-year-old woman presented with an 18-month history of pain in both thumbs. Nerve conduction study (NCS) revealed bilateral median neuropathy at the wrist. Ultrasonography demonstrated a markedly increased cross-sectional area (CSA) of both median nerves. Gene analysis revealed a deletion of the PMP22 gene. She received bilateral CTR. Follow-up NCS at one year demonstrated the improvement of motor and sensory conduction; follow-up ultrasonography revealed significantly reduced CSA. Our case suggests that surgical decompression can be applicable to well-selected patients with HNPP.
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http://dx.doi.org/10.4103/0028-3886.299164DOI Listing
June 2021

The Frequency of Axial Deposition in Korean Patients With Gout at a Tertiary Spine Center.

Front Med (Lausanne) 2020 5;7:339. Epub 2020 Aug 5.

Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul, South Korea.

This study aimed to describe the frequency of axial deposition (axial gout) and determine the associated factors in patients with gout who presented to a spine clinic in Korea. We enrolled 95 Korean patients who visited our spine center from March 2012 to February 2016 and who had been previously diagnosed with gout and had available computed tomography (CT) images of the vertebral columns. Axial gout was defined as the presence of erosions or tophi in the vertebral endplate or facet joint. The clinical and laboratory data of these patients were retrieved from medical records. Out of 95 patients, 15 [15.8%; 95% confidence interval (CI), 9.4-25.0%] had a conventional CT evidence suggestive of axial gout. In these 15 patients, 12 (80%) had lumbar spine involvement (95% CI, 51.4-94.7%). Fifteen patients had erosions of the vertebral column, and two presented with tophi that exhibited erosive changes of the facet joints. The presence of axial gout was not associated with the patients' age, duration of gout, laboratory findings, inflammatory back pain symptoms, identification of monosodium urate crystals in the peripheral joints, current use of urate-lowering drugs, hypertension, and end-stage renal disease; however, there was a significant association with the presence of diabetes ( = 0.008). The frequency of axial deposition in Korean patients with gout and spinal symptoms was 15.8%, with the lumbar region being the most commonly involved section of the spine. In addition, diabetes was associated with evidence of axial gout on imaging.
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http://dx.doi.org/10.3389/fmed.2020.00339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419467PMC
August 2020

Deep vein thrombosis of the common iliac vein caused by neurogenic heterotopic ossification in the anterior lower lumbar spine of a patient with complete paraplegia due to radiation-induced myelopathy.

J Spinal Cord Med 2022 03 18;45(2):316-319. Epub 2020 Aug 18.

Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea.

: Deep vein thrombosis (DVT), a frequent complication of spinal cord injury, is occasionally caused by neurogenic heterotopic ossification (NHO). In most cases of NHO, the hip joint is affected. Herein, we present a case of paraplegia following radiation-induced myelopathy that presented with left leg swelling due to DVT in the common iliac vein (CIV) caused by venous compression by NHO on the anterior lower lumbar spine.: A 28-year-old man with complete paraplegia due to radiation-induced myelopathy presented with left lower extremity swelling 6 years after the onset of paraplegia. DVT in the left CIV was observed on computed tomography venography. The left CIV was significantly compressed between the NHO at the anterior longitudinal ligament of the lumbar spine and the right common iliac artery, suggestive of May-Thurner syndrome. Slightly distal to that compressed area, the left CIV was significantly compressed by the large NHO at the anterior longitudinal ligament of the lumbar spine.: We believe that such compression of the left CIV would have contributed to the development of DVT. This case shows that DVT might be caused by NHO at the anterior aspect of the lumbar vertebral body, and this may help clinicians identify the main cause of DVT in the leg.
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http://dx.doi.org/10.1080/10790268.2020.1807767DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8986183PMC
March 2022

Incidental Severe Fatty Degeneration of the Erector Spinae in a Patient with L5-S1 Disc Extrusion Diagnosed with Limb-Girdle Muscular Dystrophy R2 Dysferin-Related.

Diagnostics (Basel) 2020 Jul 29;10(8). Epub 2020 Jul 29.

Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.

Limb-girdle muscular dystrophy type R2 dysferin-related (LGMD R2 dysferin-related), a phenotype of dysferlinopathy, usually begins with pelvic girdle weakness. A 35-year-old male presented with right leg pain for 2 weeks without a previous history of limb weakness. Magnetic resonance imaging of the lumbar spine showed disc extrusion at L5-S1 and incidental severe fatty degeneration of the lumbar erector spinae. Physical examination demonstrated no definite limb weakness. Serum creatine kinase levels were elevated. Genetic testing using a targeted gene-sequencing panel identified compound heterozygous variants NM_003494.3() c.[1284+2T>C]; [5303G>A]. Computed tomography revealed fatty degeneration of lower-limb muscles, which was mild in the adductor muscles and severe in the gluteus minimus. Immunohistochemistry staining of the vastus lateralis showed under-expression of dysferlin. This patient was diagnosed with LGMD R2 dysferin-related. Thus, unusual fatty degeneration of the lumbar paraspinalis can be a manifestation of dysferlinopathy.
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http://dx.doi.org/10.3390/diagnostics10080530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7459781PMC
July 2020

Pudendal nerve entrapment syndrome caused by ganglion cysts along the pudendal nerve.

Yeungnam Univ J Med 2021 Apr 21;38(2):148-151. Epub 2020 Jul 21.

Department of Physical Medicine and Rehabilitation, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.

Pudendal nerve entrapment (PNE) syndrome refers to the condition in which the pudendal nerve is entrapped or compressed. Reported cases of PNE associated with ganglion cysts are rare. Deep gluteal syndrome (DGS) is defined as compression of the sciatic or pudendal nerve due to a non-discogenic pelvic lesion. We report a case of PNE caused by compression from ganglion cysts and treated with steroid injection; we discuss this case in the context of DGS. A 77-year-old woman presented with a 3-month history of tingling and burning sensations in the left buttock and perineal area. Ultrasonography showed ganglion cystic lesions at the subgluteal space. Magnetic resonance imaging revealed cystic lesions along the pudendal nerve from below the piriformis to the Alcock's canal and a full-thickness tear of the proximal hamstring tendon. Aspiration of the cysts did not yield any material. We then injected steroid into the cysts, which resolved her symptoms. Steroid injection into a ganglion cyst should be considered as a treatment option for PNE caused by ganglion cysts.
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http://dx.doi.org/10.12701/yujm.2020.00437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016628PMC
April 2021

Comparison of Clinical Outcomes between Idiopathic Frozen Shoulder and Diabetic Frozen Shoulder After a Single Ultrasound-Guided Intra-Articular Corticosteroid Injection.

Diagnostics (Basel) 2020 Jun 4;10(6). Epub 2020 Jun 4.

Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, Korea.

There is no consensus on the use of intra-articular corticosteroid injections in diabetic frozen shoulder (FS). Thus, we aimed to compare clinical outcomes after intra-articular corticosteroid injections in patients with diabetic FS and idiopathic FS. Data collected from 142 FS patients who received glenohumeral joint intra-articular corticosteroid injections were retrospectively reviewed. Thirty-two patients were diagnosed with diabetic FS and 110 patients with idiopathic FS. Data including visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, subjective shoulder value (SSV), and passive range of motion (ROM) were compared before the injection and at 3, 6, and 12 weeks after the injection. There were significant improvements in all outcomes ( < 0.001 for all parameters) through 12 weeks in both groups. There were no significant differences in all outcomes, except for ASES scores, between both groups at 3 weeks. However, there were significant differences in VAS score, SSVs, ASES scores, and passive ROMs, except for angle of abduction, between the two groups at 6 weeks and 12 weeks after injection. A single intra-articular steroid injection can be used as a conservative treatment for diabetic FS, but less effective than for idiopathic FS.
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http://dx.doi.org/10.3390/diagnostics10060370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344419PMC
June 2020

Diagnosis of Hourglass-Like Constriction Neuropathy of the Radial Nerve Using High-Resolution Magnetic Resonance Neurography: A Report of Two Cases.

Diagnostics (Basel) 2020 Apr 17;10(4). Epub 2020 Apr 17.

Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Taegu 705-717, Korea.

Hourglass-like constriction neuropathy is a neurological condition caused by fascicular constriction of one or more peripheral nerves, unrelated to intrinsic or extrinsic compression. It is often neglected in clinical practice, and its diagnosis is challenging. Here, we report two cases of hourglass-like constriction neuropathy in the radial nerve diagnosed using high-resolution magnetic resonance neurography (MRN). Two men, aged 47 and 19 years, developed sudden weakness in the left wrist and finger extensors. They were diagnosed with radial neuropathy between the left mid-humerus level and the elbow joint, using the electrodiagnostic test. To evaluate the cause of the nerve lesion and the lesion location, high-resolution MRN was performed. Patient 1 showed an hourglass-like constriction of the left posterior interosseous nerve within the epineurium of the left radial nerve, 8.9 cm proximal to the lateral epicondyle. Patient 2 showed two focal constrictions of the left radial nerve, 8.0 and 6.9 cm proximal to the lateral epicondyle, respectively, and distal to the radial groove. Additionally, bull's eye signs were observed juxta-proximal to constrictions of the left radial nerve. The findings were indicative of hourglass-like constriction neuropathy. Both of the patients underwent surgery. However, at the 6-month follow-up, their motor weakness showed no improvement. MRN can be beneficial for diagnosing hourglass-like constriction neuropathy and locating the lesion.
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http://dx.doi.org/10.3390/diagnostics10040232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235890PMC
April 2020

"Nature Abhors a Vaccuum": Invagination of the Small Intestine into the Lumbar Disc Space After a Spinal Fusion Operation.

Diagnostics (Basel) 2020 Mar 27;10(4). Epub 2020 Mar 27.

Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, Korea.

A 77-year-old woman having back pain due to an L2 vertebral body compression fracture took a lumbar spine magnetic resonance imaging (MRI). In MRI, in addition to the L2 vertebral body fracture, invagination of the small intestine into the intervertebral disc space at L5-S1 was found by chance. On a lateral lumbar spinal X-ray, the lordotic angle was markedly increased at the L5-S1 level. Additionally, the L5-S1 disc space had widened. These X-ray findings indicate the segmental instability at L5-S1. The spinal fusion operation on L3-4-5 seems to have resulted in overt mechanical loading on the inferior spinal segment (L5-S1). We think the instability damaged the anterior longitudinal ligament and caused a tear in the anterior portion of the annulus fibrosus. The defect in the L5-S1 intervertebral disc after the tear would have caused the vacuum, which is presumed to have pulled the patient's small intestine into the empty space within the L5-S1 intervertebral disc. Although intervertebral invagination of intra-abdominal structures is not common, clinicians should be aware of the possibility of this complication in patients who have spinal segmental instability.
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http://dx.doi.org/10.3390/diagnostics10040185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235918PMC
March 2020

Definition, Diagnosis, Treatment, and Prognosis of Frozen Shoulder: A Consensus Survey of Shoulder Specialists.

Clin Orthop Surg 2020 Mar 13;12(1):60-67. Epub 2020 Feb 13.

Department of Orthopedic Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

Background: The objective of this study was to identify a consensus on definition, diagnosis, treatment, and prognosis of frozen shoulder (FS) among shoulder specialists.

Methods: A questionnaire composed of 18 questions about FS-definition, classification, utilization of diagnostic modalities, the propriety of treatment at each stage, and prognosis-was sent to 95 shoulder specialists in Korea. Most questions (15 questions) required an answer on a 5-point analog scale (1, strongly disagree; 5, strongly agree); three questions about the propriety of treatment were binary.

Results: We received 71 responses (74.7%). Of the 71 respondents, 84.5% agreed with the proposed definition of FS, and 88.8% agreed that FS should be divided into primary and secondary types according to the proposed definition. Only 43.7% of the respondents agreed that FS in patients with systemic disease should be classified as secondary FS. For the diagnosis of FS, 71.9% agreed that plain radiography should be used and 64.8% agreed ultrasonography should be used. There was a high consensus on proper treatment of FS: 97.2% agreed on education, 94.4%, on the use of nonsteroidal anti-inflammatory drugs; 76.1%, on intra-articular steroid injections; and 97.2%, on stretching exercise. Among all respondents, 22.5% answered that more than 10% of the patients with FS do not respond to conservative treatment.

Conclusions: The survey revealed a general consensus among shoulder specialists on the definition and treatment of FS. However, classification of FS was found controversial.
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http://dx.doi.org/10.4055/cios.2020.12.1.60DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031440PMC
March 2020

Significance of Sufficient Neck Flexion During Magnetic Resonance Imaging in the Diagnosis of Hirayama Disease: Report of Two Cases.

Ann Rehabil Med 2019 Oct 31;43(5):615-620. Epub 2019 Oct 31.

Department of Rehabilitation Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

It is difficult to distinguish Hirayama disease (HD) from other mimicking disorders in adolescent patients with distal upper limb weakness. The prevailing theory of HD postulates that the lower cervical cord is susceptible to compression during neck flexion because of insufficient growth of the dura relative to the spinal column. Confirmation of a dynamic change in the dorsal epidural space on magnetic resonance imaging (MRI) during neck flexion is essential for diagnosing HD. However, neck flexion MRI has not been routinely performed in juvenile patients with distal upper limb weakness in the absence of suspected HD. We report two cases of HD that were initially confused with other diseases because of insufficient or absent cervical flexion during MRI. Full-flexion MRI showed typical findings of HD in both cases. Our cases suggest that dynamic cervical MRI in the fully flexed position is necessary for evaluating suspected HD.
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http://dx.doi.org/10.5535/arm.2019.43.5.615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6835133PMC
October 2019
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