Role of Magnetic Resonance Imaging in Ascertaining the Success of Transforaminal Epidural Steroid Injection for Lumbar Radicular Pain.

Objective: To explore the outcome differences of lumbar transforaminal epidural steroid injection (TFESI) according to magnetic resonance imaging (MRI) findings in patients with lumbar radicular pain. Design: Retrospective study. Setting: Single university-based interventional pain management unit. Patients: Fifty-nine patients who had lumbar radicular pain with a recent lumbar MRI and three-month follow-up were included. Methods: MRI findings were reviewed for the following items: herniation type (bulging, protrusion, extrusion), herniation location (central, subarticular, foraminal, extraforaminal), high intensity zone (HIZ), and nerve root impingement (NRI). Pain severity was evaluated using a visual analogue scale (VAS) at time of before injection, then two weeks and three months after. Results: Pain scores improved significantly in each group ( P < 0.05) at all time points, but there were no statistically significant differences in improvements according to type or location of disc herniation. Pain scores were significantly lower in patients with HIZ at the second week and in patients with NRI at the third month ( P < 0.05). Conclusions: TFESI was an effective treatment method in patients with radicular pain, irrespective of the type or location of disc herniation. However, greater improvement in pain may be expected at the second week in patients with HIZ and at the third month in patients with NRI.

Is phonophoresis effective in the treatment of chronic low back pain? A single-blind randomized controlled trial.

The aim of this trial is to investigate and compare the effects of phonophoresis (PP) and ultrasound (US) therapy on pain, disability, trunk muscle strength, walking performance, spinal mobility, quality of life (QOL), and depression in the patients with chronic low back pain (CLBP). A total of 60 patients with definite CLBP were included in this study. The patients were randomized into three groups. Group 1 (n = 20) was accepted as the control group and was given only exercises. Group 2 (n = 20) received US treatment and exercises. Group 3 (n = 20) received PP and exercises. All of the programs were performed 3 days a week, for 6 weeks. The pain (visual analog scale, VAS), disability (Oswestry Disability Questionnaire, ODQ and pain disability index, PDI), walking performance (6 min walking test, 6MWT), depression (Beck Depression Inventory scores, BDI), and QOL (Short Form 36, SF-36) of all participants were evaluated. The trunk muscle strength was measured with a handheld dynamometer. All of the groups showed statistically significant improvements in pain, disability, muscle strength, endurance, 6MWT, mobility, QOL, and depression. The intergroup comparison showed significant differences in VAS pain, 6MWT, and EMS, among three groups. These differences were statistically significant in groups 2 and 3 compared with the group 1. The intergroup comparison showed significant difference in pain, physical function, and energy subgroups of SF-36. The differences were statistically in group 3 compared with group 1 and 2. We observed that US and PP treatments were effective in the treatment of patients with CLBP but PP was not found to be superior over ultrasound therapy.

Assessment of the impact of proprioceptive exercises on balance and proprioception in patients with advanced knee osteoarthritis.

Impaired proprioceptive perception and the balance function are known to associate with knee osteoarthritis. The previous publications have reported the beneficial effects of proprioceptive exercises on mild or moderate knee osteoarthritis. Scientific data in the literature regarding their effects in advanced stages of knee osteoarthritis are lacking. The objective of this study is to investigate the impact of the proprioceptive exercises on balance, proprioceptive perception and clinical findings in advanced-stage knee osteoarthritis. Fifty-four patients diagnosed as having knee osteoarthritis according to the American Collage of Rheumatology criteria with grade of 3 or higher according to the Kellgren-Lawrence scale were enrolled in the study. Patients were allocated randomly into two groups. The study group included 30 patients, and the control group included 24 patients. The proprioceptive perception was assessed by the ability to reproduce the knee position. The balance function was assessed by stabilometric evaluation in static and dynamic patterns. The clinical evaluation was made by using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Patients were reevaluated after the three-week proprioceptive rehabilitation program. The improvement in the scores of static balance was significant statistically. No significant improvement in the dynamic balance scores was obtained. Although the measurements of proprioceptive perception showed a tendency toward improvement, the difference was not significant statistically. The WOMAC scores showed better improvements in the study group. As conclusion, in further stages of knee osteoarthritis, proprioceptive exercises have beneficial effects on static balance and to some extent on proprioceptive accuracy. In the treatment for advanced knee osteoarthritis, adding exercises specifically targeting the proprioceptive and balance dysfunction might be useful.

Manual lymphatic drainage in management of edema in a case with CRPS: why the(y) wait?

Complex regional pain syndrome (CRPS) is a disorder characterized by pain, edema, skin color changes and autonomic abnormalities. Its treatment is quite difficult and in most of the patients effective results cannot be reached. Manual lymphatic drainage is a very rare method for managing limb edema in CRPS. In this case report, the dramatic response of an excessive edema to lymphatic drainage was discussed in a CRPS patient.

The effects of electrical stimulation combined with continuous passive motion versus isometric exercise on symptoms, functional capacity, quality of life and balance in knee osteoarthritis: randomized clinical trial.

The aim of this study was to evaluate effects of electrical stimulation combined with continuous passive motion (CPM-ES) versus isometric exercise on symptoms, functional capacity, quality of life, muscle strength, knee and thigh circle measurements, and balance in knee osteoarthritis (OA). This is a randomized clinical trial. The study was done in Gulhane Military Medical Academy (GMMA) Rehabilitation Center. Forty patients with knee OA were included in this study. Participants were randomly assigned to two groups: 20 patients placed in Group 1 were treated with conventional physical therapy and CPM-ES combination; 20 patients in Group 2 were treated with conventional physical therapy and isometric exercise. Therapies were applied 3 weeks, 5 days per week. The following main outcome measures were done: values of pain (VAS was used), WOMAC, SF-36, knee and thigh circle measurements, isokinetic tests, dynamic and static balance tests were determined at baseline and after the treatment. There were no statistically significant differences in the tested variables between the groups for post-treatment values. Dynamic and static balance test improved statistically strongly significantly in both groups. The findings of this study demonstrate that knee OA patients could improve their balance function in both static and dynamic conditions after CPM-ES combination or isometric exercise therapy. The improvement might prevent knee OA patients from falling down and increase their sense of security during physical activities.

Estimating the most accurate sonographic measurement in the diagnosis of carpal tunnel syndrome: Which is the best?

OBJECTIVES: This study aims to identify the most accurate method or ultrasonographic measurement for the diagnosis of carpal tunnel syndrome (CTS). PATIENTS AND METHODS: Between October 2010 and April 2011, a total of 160 hands of 87 patients (4 males, 83 females; mean age 54.5 years; range, 26 to 84 years) with clinically and electrodiagnostically proven CTS and 80 hands of 40 controls (3 males, 37 females; mean age 53.7 years; range, 32 to 77 years) were evaluated by sonographic examination. The diameters and cross-sectional areas (CSA) of the median nerve and longitudinal diameters of the median nerve were measured at the inlet, proximal carpal tunnel, and outlet of the carpal tunnel. Volar bulging and thickness of the retinaculum were also measured. RESULTS: The most optimal combination for the diagnosis of CTS was proximal CSA, volar bulging, and the proximal transverse diameter. The combination of proximal CSA with volar bulging increased the sensitivity and specificity of sonographic measurements. CONCLUSION: Based on our study results, ultrasonography can be used as a practical modality to distinguish CTS patients from asymptomatic controls.

Can Epidural Contrast Dispersal Pattern Help to Predict the Outcome of Transforaminal Epidural Steroid Injections in Patients with Lumbar Radicular Pain.

OBJECTIVE: To investigate the relationship between epidurographic contrast dispersal patterns and both immediate and short-term clinical effectiveness of lumbar transforaminal epidural steroid injections (TFESIs) in patients with radicular back pain. METHODS: A digital database of 64 patients who underwent single-level lumbar TFESI for unilateral lumbar radicular pain was scanned. The type of contrast pattern was analyzed by 1 physiatrist and defined as follows: type 1 (tubular appearance), type 2 (nerve root visible as a filling defect), or type 3 (cloud-like appearance). Pain was evaluated with a visual analog scale (VAS) and recorded before injection and 2 days, 2 weeks, and 3 months after injection. RESULTS: The mean age was 45.9 ± 13.5 years (range, 22-80 years), and the mean duration of symptoms was 5.7 ± 4.2 months. Contrast distribution patterns were as follows: type 1 in 33 patients (51.6%), type 2 in 18 patients (28.1%), and type 3 in 13 patients (20.3%). Mean decrease in VAS scores at all time points was statistically significant in 3 types of contrast dispersal patterns (P < 0.05). Differences in improvements of VAS scores obtained at any assessment period and success rates were not statistically significant between groups. However, the ratio of patients who achieved 50% or greater reduction in pain scores was higher in type 1 and type 2 than type 3 at each follow-up point. CONCLUSIONS: TFSEIs have a beneficial effect in managing lumbar radicular pain regardless of contrast pattern type. Success rates were higher in type 1 and type 2 than type 3.

The effect of gabapentin in earlier stage of reflex sympathetic dystrophy.

The objective of this paper is to investigate the effect of gabapentin in the earlier stage of reflex sympathetic dystrophy syndrome (RSD). Twenty-two patients diagnosed with RSD were enrolled. Initial gabapentin dosage was 600 mg/day. This dosage is increased gradually until a satisfactory pain level was reached. After this level, this dosage was maintained throughout the study. An exercise program was also applied to the patients. Provoked and static pain scores of the patients were obtained initially, at 3-day intervals for maintenance dosage determining, and at 6 weeks after the discharge. Functional improvement parameters were volumetric measurement; dynamometric measurement and third finger pulp-distal palmar crease distance measurement for hands; and metric circumferential measurement and range of motion for elbow, knee, and foot initially, at baseline, on the tenth day, upon discharge, and 6 weeks after the discharge. The mean maintenance dose of gabapentin was 1,145.46+/-377.6 mg/day (range, 900-1,800 mg/day). Improvements in spontaneous and provoked pain intensities were statistically significant. No statistically significant difference was obtained in functional improvement parameters. Dizziness in three patients, headache in two patients, and mild burning feeling in the tongue in one patient were the reported side effects. These symptoms resolved spontaneously in few days. Gabapentin cannot be recommended as the drug of choice, but it may be considered as one of the therapeutic alternatives in the management of pain due to RSD. We suggest that it is effective only for the pain and not for other symptoms of RSD. Serious side effects that will cause the patient to stop using the drug are rare.

Reflex sympathetic dystrophy: a retrospective epidemiological study of 168 patients.

This is a retrospective epidemiological study. The objective is to determine the epidemiological characteristics including the patient demographics, etiological factors, duration of symptoms, treatment modalities applied and clinical outcome of the treatment in reflex sympathetic dystrophy (RSD). Medical records of the 168 patients managed in two tertiary hospitals with the diagnosis of RSD that was made according to both IASP criteria and three-phase bone scan were reviewed. The upper limb was affected 1.5 times as commonly as the lower limb. Of the 168 cases, 10.7% were non-traumatic. In 89.3% of the patients, RSD developed after a traumatic inciting event with a predominance of fracture. In 75.6% of the patients, RSD developed due to job-related injuries. The percentage of successful clinical outcome was 72%. The percentage of the patients that did not respond to therapy was 28%. The management period is long and this causes higher therapeutic costs in addition to loss of productive effort. However, response to therapy is good. On the other hand, in approximately one third of the patients, RSD does not improve despite all therapeutic interventions. In addition to compensation costs, this potentially debilitating feature causes RSD to appear as a socioeconomic problem.

Sexual problems in male ankylosing spondylitis patients: relationship with functionality, disease activity, quality of life, and emotional status.

This study has focused on sexual problems of male ankylosing spondylitis (AS) patients. Initially, patients' perceptions about the effects of disease on sexual intercourse were assessed. Secondly, we investigated the factors that relate to the disease and affect sexual intercourse negatively. Thirdly, we compared data from the patients whose sexual intercourse were affected negatively with of those whose sexual intercourse were unaffected. This is a cross-sectional and double-centered study. A total of 53 married or sexually active male patients, who were certainly diagnosed with AS according to modified New York criteria, were assessed. Twenty seven patients (50.94%) expressed that their sexual life was affected negatively by the AS in general (affected patients), and 26 patients (49.06%) expressed no negative effect (unaffected patients). Both affected and unaffected patients were compared with each other with regard to educational level, joint involvement, functionality, disease activity, quality of life, and depression status. Mean BASFI, BASDAI scores were worse in the affected group, and the difference was statistically significant (p = 0.012, p = 0.039, respectively). There were statistically significant differences between the groups with regard to lumbar column and hip involvement (p = 0.035, p = 0.021; respectively). The physical functioning, role limitations due to physical problems, vitality/energy/fatigue, general mental health, and general health perception subscale scores of SF-36 were worse in the affected group, and the differences were statistically significant (p = 0.027, p = 0.023, p = 0,013, p = 0.005, p = 0.045, respectively). Affected patients' Beck Depression Inventory scores were worse than those of unaffected patients, and the difference between the groups was statistically significant (p = 0.039). Sexual problems are common in AS patients and might usually be associated with joint involvement, decreased functionality, increased disease activity, decreased health quality, and depression. Therefore, while examining AS patients and managing their treatments, special attention must be given to all domains of life instead of only physical problems.

The effectiveness of transforaminal epidural steroid injection in patients with radicular low back pain: Combination of pain provocation with effectiveness results.

OBJECTIVES: This study aims to investigate the efficacy of transforaminal epidural steroid injection (TFESI) on low back pain relief and functional impairments and whether pain provocation during injection has an effect on pain relief in mid-term. PATIENTS AND METHODS: The study, which was conducted between September 2012 and September 2013, included 62 patients with low back pain (38 males, 24 females; median age 45 years; min 22 - max 88 years). All injections were applied under C-arm fluoroscopy guidance, using a mix of betamethasone and lidocaine. A 100 mm Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), and Short Form-36 were administered before the injection, and at post-injection second and 12th weeks. Presence of any pain provocation was questioned during injection. RESULTS: The most frequent level of intervention was L5 level. Median initial VAS score was 80.0 (50.0;100.0) mm, which was measured as 45.0 (0.0;90.0) mm and 30.0 (0.0;100.0) mm at the post-injection second and 12th weeks, respectively. Median initial ODI score was 25.0 (9.0;43.0) points, which was measured as 17.0 (3.0;38.0) and 12.5 (1.0;38.0) points at the post-injection second and 12th weeks, respectively. All subgroup scores of SF-36 improved significantly during the follow-up period. We detected statistically significant improvements in the outcome measurements at the post-injection second and 12th weeks (p<0.05). There were significant differences between patients with positive and moderate pain provocation in terms of VAS (p=0.004) and ODI (p=0.006) scores. CONCLUSION: In this follow-up study, transforaminal epidural steroid injection was found to be effective in both the early period and in the mid-term. Pain provocation was not clinically predictive for better outcome according to the results.

Comparison of lumbosacral transforaminal epidural steroid injection techniques in terms of radiation safety.

AIM: To investigate the difference in radiation exposure to the patients between oblique and posteroanterior view, initial approach techniques in fluoroscopy-guided lumbosacral transforaminal epidural steroid injections. PATIENTS & METHODS: Total amount of Kerma area product, elapsed time of the procedure and fluoroscopy time were obtained from medical records retrospectively. RESULTS: 28 patients were included in each group. Fluoroscopy time was significantly lower in group 1, but there was no statistically significant difference in terms of procedure time and Kerma area product. CONCLUSION: Radiation risk does not change between these approaches.

Peripheral nerve injuries: Long term follow-up results of rehabilitation.

BACKGROUND: Peripheral nerve injury (PNI) is a common problem in the world resulting with severe disability. Etiological data is different in studies because of the study period, patient population, economic status, and workplace safety policies of the different countries. OBJECTIVE: To define epidemiological and etiological data of our patients with peripheral nerve injury and to identify factors influencing efficacy of rehabilitation methods and recovery. METHODS: Patients were compared by means of electromyography and muscle strength changes. Influence of orthotics use, disease interval and type of physical therapy (electrical stimulation or EMG biofeedback) was assessed. RESULTS: There was no significant difference between groups. But we found weak correlation between EMG and motor changes. There was no difference in EMG and motor score changes in terms of orthotics use and type of physical therapy. When the patients were grouped according to EMG changes, we found significant difference by disease interval. Disease interval was longest in patients with no change in EMG. When the patients were grouped according to motor score changes, there was no significant difference by disease interval. CONCLUSION: Etiology of the patients didn't affect long term results in peripheral nerve injury. The results of this study might help rehabilitation teams to guide their follow-up.

Factitious disorders encountered in patients with the diagnosis of reflex sympathetic dystrophy.

Reflex sympathetic dystrophy (RSD) may be a misdiagnosis or at least not descriptive enough in patients with atypical hand posture and atypical edema. Seven patients with the previous diagnosis of RSD were investigated further because of inconsistent clinical picture with the underlying pathology and bizarre course of the disease. Four patients had clenched fist and three had factitious edema. These seven patients underwent psychological examination, and MMPI was applied to all. In two of these no psychological disorder was obtained according to DSM-IV. One patient could not adapt to MMPI. In two anxiety disorders, in one depression, and in one patient conversion disorder was diagnosed. We suggest that these patients are not motivated enough to improve their conditions and expectations of such patients may show some differences depending on the environment.

The effectiveness of transforaminal epidural steroid injection in patients with radicular low back pain due to lumbar disc herniation two years after treatment.

BACKGROUND AND AIM: The aim of this retrospective study was to investigate the therapeutic effect of transforaminal epidural steroid injection in patients with chronic low back pain and radicular leg pain due to lumbar disc herniation. MATERIALS AND METHODS: This study included 80 patients (32 female and 48 male; mean age: 45.8 years [range: 25-65 years]) that received fluoroscopically guided transforaminal epidural steroid injections for chronic radicular low back pain due to lumbar disc herniation. All of the patients had diagnostic MRI findings and did not respond to conservative treatment. All injections were performed by the same physician at the interventional pain unit of a tertiary hospital. The effectiveness of transforaminal epidural steroid injections was assessed via a standardized telephone questionnaire administered 2 years after the first injection. RESULTS: Mean duration of radicular low back pain was 24.50 ± 18.25 months. Most of the epidural injections were administered at the L5 and S1 levels. The most effective post-injection period was the first 5.11 ± 3.07 months. Mean duration of injection effect was 12.46 ± 7.24 months. The response rate to the epidural steroid injections was 72%. CONCLUSIONS: There was negative correlation between the duration of treatment effect and the duration of pre-treatment symptoms. Additionally, clinical improvement of radicular low back pain increased significantly as the duration of pre-treatment symptoms decreased. Based on the present findings, we think that transforaminal epidural steroid injections can be used as an alternative treatment for managing chronic radicular low back pain.

Bier block with methylprednisolone and lidocaine in CRPS type I: a randomized, double-blinded, placebo-controlled study.

BACKGROUND AND OBJECTIVE: To investigate the effect of intravenous regional anesthesia (Bier block) with methylprednisolone and lidocaine in complex regional pain syndrome (CRPS) type I in a randomized, double-blinded, and placebo-controlled study. METHODS: Twenty-two patients with the diagnosis of CRPS of their upper limb were divided randomly into 2 groups. The mean age was 22.3 +/-1.6 years. Average pain duration was 3.1 +/- 1.4 months. In the placebo group (10 patients), patients received only 100 mL of saline. In the study group (12 patients), 40 mg of methylprednisolone and 10 mL of 2% lidocaine were added to the saline. Treatments were applied once a week. Unless significant adverse effects occurred, 3 sessions of blockade were completed. Pain severity, range of motion (ROM), and volumetric edema measurements were obtained before treatment. Pain severity and satisfaction (resolved, better, no change, or worse) were recorded after each session. The final assessment was performed 1.5 months later. ROM and volumetric measurements were repeated the day after the block and at the final assessment. RESULTS: Differences in pretreatment features of the patients were not statistically significant ( P >.05). In all assessment periods during the study, improvement in pain severity was statistically significant ( P <.05) in both groups. This statistically significant difference disappeared at the final assessment ( P >.05). No statistically significant difference was obtained in ROM and volumetric measures in any assessment period before and after the block. Satisfaction scores between the groups were also not different in any assessment period. CONCLUSIONS: Bier block with methylprednisolone and lidocaine in CRPS type I does not provide long-term benefit in CRPS, and its short-term benefit is not superior to placebo.

Management of lower back pain in young Turkish recruits.

The aims of this study were to determine the appropriate management strategy for lower back pain in the young male population of the Turkish Army and to analyze the results of surgical treatment of such a common health problem versus medical treatment. Participants in the study included 865 recruits who underwent basic military training between June 2001 and June 2002. All were admitted to our department with the complaint of lower back pain and were evaluated by neurological and radiological examinations. We operated on 23 of them and followed-up by 3 months. We compared the data of surgically and nonsurgically treated patients. In our opinion, the indications for surgery for lower back pain must be strict, and careful selection of patients is needed for a satisfactory outcome.

Low-level laser therapy versus ultrasound therapy in the treatment of subacromial impingement syndrome: a randomized clinical trial.

OBJECTIVE: The aim of this study was to compare the effectiveness of low-level laser therapy and ultrasound therapy in the treatment of subacromial impingement syndrome. MATERIALS AND METHODS: Thirty one patients with subacromial impingement syndrome were randomly assigned to low-level laser therapy group (n=16) and ultrasound therapy group (n=15). Study participants received 10 treatment sessions of low-level laser therapy or ultrasound therapy over a period of two-consecutive weeks (five days per week). Outcome measures (visual analogue pain scale, Shoulder Pain and Disability Index -SPADI-, patient's satisfactory level and sleep interference score) were assessed before treatment and at the 1st and 3rd months after treatment. All patients were analyzed by the intent-to-treat principle. RESULTS: Mean reduction in VAS pain, SPADI disability and sleep interference scores from baseline to after 1 month, and 3 months of treatment was statistically significant in both groups (P< 0.05). However, there was no significant difference in the mean change in VAS pain, SPADI disability and sleep interference scores between the two groups (P > 0.05). The mean level of patient satisfaction in group 1 at the first and third months after treatment was 72.45 ± 23.45 mm and 71.50 ± 16.54 mm, respectively. The mean level of patient satisfaction in group 2 at the first and third months after treatment was 70.38 ± 21.52 mm and 72.09 ± 13.42 mm, respectively. There was no significant difference in the mean level of patient satisfaction between the two groups (p > 0.05). CONCLUSIONS: The results suggest that efficacy of both treatments were comparable to each other in regarding reducing pain severity and functional disability in patients with subacromial impingement syndrome. Based on our findings, we conclude that low-level laser therapy may be considered as an effective alternative to ultrasound based therapy in patients with subacromial impingement syndrome especially ultrasound based therapy is contraindicated.

Femoral cartilage thickness measurements in healthy individuals: learning, practicing and publishing with TURK-MUSCULUS.

BACKGROUND AND OBJECTIVES: Measurement of the femoral cartilage thickness by using in-vivo musculoskeletal ultrasonography (MSUS) has been previously shown to be a valid and reliable method in previous studies; however, to our best notice, normative data has not been provided before in the healthy population.The aim of our study was to provide normative data regarding femoral cartilage thicknesses of healthy individuals with collaborative use of MSUS. METHODS: This is across-sectional study run at Physical and Rehabilitation Medicine Departments of 18 Secondary and Tertiary Centers in Turkey. 1544 healthy volunteers (aged between 25-40 years) were recruited within the collaboration of TURK-MUSCULUS (Turkish Musculoskeletal Ultrasonography Study Group). Subjects who had a body mass index value of less than 30 and who did not have signs and symptoms of any degenerative/inflammatory arthritis or other rheumatic diseases, history of knee trauma and previous knee surgery were enrolled. Ultrasonographic measurements were performed axially from the suprapatellar window by using linear probes while subjects' knees were in maximum flexion. Three (mid-point) measurements were taken from both knees (lateral condyle, intercondylar area, medial condyle). RESULTS: A total of 2876 knees (of 817 M, 621 F subjects) were taken into analysis after exclusion of inappropriate images. Mean cartilage thicknesses were significantly lower in females than males (all p< 0.001). Thickness values negatively correlated with age; negatively (females) and positively (males) correlated with smoking. Men who regularly exercised had thicker cartilage than who did not exercise (all p < 0.05). Increased age (in both sexes) and absence of exercise (males) were found to be risk factors for decreased cartilage thicknesses. CONCLUSION: Further data pertaining to other countries would be interesting to uncover whether ethnic differences also affect cartilage thickness. Collaborative use of MSUS seems to be promising in this regard.

Neoplastic brachial plexopathy detected by ultrasonography in a patient with chronic cervicobrachialgia.

OBJECTIVE: We report here a case of neoplastic brachial plexopathy detected by musculoskeletal ultrasonography in a patient with chronic cervicobrachialgia. METHODS/RESULTS: A 71-year-old man presented at Gülhane Military Medical Academy, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey with a one-year history of cervicobrachial pain radiating to the left arm and numbness in the medial aspect of the left arm and hand. He could not tolerate magnetic resonance imaging because his pain was exacerbated by cervical extension. Radiographs of his chest and cervical spine were normal. Ultrasound examination of the left brachial plexus revealed segmental fusiform swelling, suggestive for a compressing lesion. Magnetic resonance imaging of the brachial plexus performed under general anaesthesia revealed a left apical lung tumour (Pancoast) infiltrating the brachial plexus. CONCLUSION: Clinicians should consider neoplastic brachial plexopathy, which is an uncommon diagnosis, when evaluating patients with unrelenting and severe cervicobrachialgia. Musculoskeletal ultrasonography can be beneficial for examining brachial plexus lesions.