Flexor Carpi Radialis Tendon Rupture due to Repetitive Golf Swing

Flexor carpi radialis (FCR) muscle is located in the forearm anteriorly that runs through a synovial fibro-osseous tunnel in the forearm. We described a case of FCR tendon rupture due to repetitive overuse injury. A 55-year-old man, right-hand dominant, presented with right forearm pain and swelling which started 3 days ago while playing amateur golf. Focal tenderness and bruising over volo-ulnar region of the right forearm were examined. Plain radiographs showed soft tissue edema around lesion area and no detectable fracture. Ultrasonography showed multiple hypoechoic lesions suspected as hematoma of the flexor muscle group. After done magnetic resonance imaging, he was diagnosed with rupture of FCR tendon at proximal origin and strain of flexor digitorum superficialis and palmaris longus muscle. He received compressive dressing and restriction of wrist range of motion for three weeks. Two months later, remaining traces of lesions were observed at the follow-up ultrasonography and the pain disappeared.

Therapeutic Effect of Microcurrent Therapy in Children With In-toeing Gait Caused by Increased Femoral Anteversion: A Pilot Study

OBJECTIVE: To investigate the efficacy of portable microcurrent therapy device (PMTD) of the hip internal rotators in the treatment of in-toeing gait caused by increased femoral anteversion in children over 8 years of age. METHODS: Eleven children (22 legs; 4 boys and 7 girls; mean age, 10.4±1.6 years) with in-toeing gait caused by increased femoral anteversion were included in the present study. All children received 60 minutes of PMTD (intensity, 25 µA; frequency, 8 Hz) applied to the hip internal rotators daily for 4 weeks. Hip internal rotation (IR) angle, external rotation (ER) angle, and midmalleolar-second toe angle (MSTA) measurement during stance phase at transverse plane and Family Satisfaction Questionnaire, frequency of tripping and fatigue like pains about the PMTD were performed before treatment and at 4 weeks after initial PMTD treatment. Paired t-test and Fisher exact test were used for statistical analysis. RESULTS: Hip IR/ER/MSTA was 70.3°±5.4°/20.1°±5.5°/–11.4°±2.7°, and 55.7°±7.8°/33.6°±8.2°/–2.6°±3.8° before treatment and at 4 weeks after initial PMTD treatment, respectively (p<0.01). Ten of 11 (91%) children's family stated that they were generally satisfied with the PMTD treatment. The frequency of tripping and fatigue like pains was significantly lower at 4 weeks after PMTD treatment (p<0.05). Excellent inter-rater and intra-rater reliability was observed for repeated MSTA measurements between the examiners (k=0.91–0.96 and k=0.93–0.99), respectively. CONCLUSION: PMTD of the hip internal rotators can be effective in improving the gait pattern of children with in-toeing gait caused by increased femoral anteversion.

Percutaneous Adhesiolysis Versus Transforaminal Epidural Steroid Injection for the Treatment of Chronic Radicular Pain Caused by Lumbar Foraminal Spinal Stenosis: A Retrospective Comparative Study

OBJECTIVE: To investigate the efficacy of percutaneous adhesiolysis (PA) compared to fluoroscopy (FL)-guided transforaminal epidural steroid injection (TFESI) in patients with radicular pain caused by lumbar foraminal spinal stenosis (LFSS) by assessing pain relief and functional improvement at 4 and 12 weeks post-procedure. METHODS: This retrospective study included 45 patients who underwent PA or FL-guided TFSEI for radicular pain caused by LFSS of at least 3 months' duration. Outcomes were assessed with the Oswestry Disability Index (ODI) and Verbal Numeric Pain Scale (VNS) before the procedure and at 4 and 12 weeks post-procedure. A successful outcome was defined by >50% improvement in the VNS score and >40% improvement in the ODI score. RESULTS: ODI and VNS scores improved 4 and 12 weeks post-procedure in both groups. Statistically significant differences between groups were observed in ODI and VNS at 12 weeks (p<0.05). The proportion of patients with successful outcomes was significantly different between the two groups only at the 12-week time point. CONCLUSION: Our study suggests that PA is effective for pain reduction and functional improvement in patients with chronic radicular pain caused by LFSS. Therefore, PA can be considered for patients with previous ineffective responses to conservative treatment. Although PA seems to be more effective than TFEFI according to the results of our study, in order to fully elucidate the difference in effectiveness, a prospective study with a larger sample size is necessary.

Treatment Effects of Ultrasound Guide Selective Nerve Root Block for Lower Cervical Radicular Pain: A Retrospective Study of 1-Year Follow-up

OBJECTIVE: To compare the long-term effects and advantages of ultrasound (US)-guided selective cervical nerve root block with fluoroscopy (FL)-guided transforaminal block. METHODS: From March 2009 to November 2012, 162 patients received steroid injections for lower cervical radicular pain. A total of 114 patients fulfilled the inclusion criteria. All procedures were performed by using US or FL. We compared the intravascular injections during the procedure with the effects and functional scales at 3, 6, and 12 months after the procedure between the two groups. Successful treatments occurred when patients obtained significant pain reliefs (as measured by >50% improvements in the verbal numerical scale [VNS] score and >40% improvements in the neck disability index [NDI] score) and reported a patient satisfaction score of 3 or 4 points at 12 months after the injection. Image analysis of intravascular injection and chart review were performed. Logistic regression was performed to reveal the correlations between successful treatments and variables (patient's age, gender, duration of the disease, cause, injection method, and radiologic finding). RESULTS: The VNS and NDI improved 3 months after the injection and continued to improve until 12 months for both groups. But there were no statistical differences in changes of VNS, NDI, and effectiveness between these two groups. The proportion of patients with successful treatment is illustrated as 62.5% in US-guided group and 58% in FL-guided group at 12 months. There were no significant differences between the groups or during follow-up periods. Three cases of the intravascular injections were done in FL-guided group. CONCLUSION: The US-guided selective cervical nerve root blocks are facilitated by identifying critical vessels at unexpected locations relative to the foramen and to protect injury to such vessels, which is the leading cause of reported complications from FL-guided transforaminal blocks. On treatment effect, significant long-term improvements in functions and pain reliefs were observed in both groups after the intervention. However, significant differences were not observed between the groups. Therefore, the US-guided selective cervical nerve root block was shown to be as effective as the FL-guided transforaminal block in pain reliefs and functional improvements, in addition to the absence of radiation and protection vessel injury at real-time imaging.

Sonographically Guided Musculocutaneous Nerve Phenol Block for Elbow Flexor Spasticity: Case report

Seven hemiplegic stroke patients suffering elbow flexor spasticity were selected for musculocutaneous nerve (MN) blocks. The MN was identified at the proximal 1/3 area on anteromedial surface of upper arm at supine position. An injectable monopolar EMG needle electrode was inserted into MN under real time ultrasonography. The 7% phenol solution was injected 0.2 ml at a time into MN until biceps brachii and brachialis muscle contractions were completely blocked at a maximum of 5 mA electrical stimulation. The total dose of injected phenol solution was 1.2~2.2 ml. We examined modified Ashworth scale (MAS) of elbow flexor and elbow angle at the standing position. In all the subjects, MAS was decreased and elbow angle was increased after nerve block. Ultrasonography guidance makes it exact to identify MN and to inject neurolytic solution to target. It can lead minimal complications by using the least dosage of neurolytic drug.

Effectiveness of the Cardiac Rehabilitation on Exercise Capacity and Risk Factor in Coronary Artery Obstructive Disease

OBJECTIVE: To evaluate the effectiveness of cardiac rehabilitation (CR) program on the exercise capacity and secondary prevention in coronary artery obstructive disease (CAOD). METHOD: CR group of 48 CAOD patients had underwent regularly supervised exercise training for 6~8 weeks as well as home exercise continued for 1 year. CR group was advised to control their risk factors by nutrition counsel, abstaining from smoking and reducing their weight. Control group of 16 CAOD patients did not participate in the CR program. Two groups were evaluated for their exercise capacity and risk factors at baseline and after 1 year. RESULTS: CR group showed significantly higher maximal oxygen consumption, maximal rate pressure product and ratings of perceived exertion at stage 3 compared with control group (p<0.05). The number of risk factors per person after 1 year in both groups was significantly lower than baseline (p<0.05), but there was no significant difference between the two groups. CONCLUSION: CR program can improve the exercise capacity and level of risk factor in CAOD patients. Therefore, CR program is recommended for helping CAOD patients improve their functional capacity and reduce the possibility of recurrence.

Effect and Safety of Cardiac Rehabilitation Program in Heart Failure

OBJECTIVE: This study was performed to investigate the effect and safety of cardiac rehabilitation program in heart failure. METHOD: 36 patients who suffered from heart failure with decreased left ventricular ejection fraction less than 50% by echocardiogram were recruited for study subject. They took graded exercise test before and after cardiac rehabilitation program. Cardiac rehabilitation program was consisted of 6~8 weeks monitoring exercise according to the result of exercise test. We reviewed the all courses of the program to see the safety and compared the several results to know the effect of the program. RESULTS: During totally 696 exercise-hours with ECG monitoring, 12 abnormal hemodynamic responses were happened, but those were minor in severity. All of them were managed successfully and could complete their exercise program as their schedules. Even in heart failure patients, cardiac rehabilitation program could improve exercise capacity in terms of increased maximal oxygen consumption, maximal exercise time, and maximal myocardial oxygen demand. Submaximal myocardial oxygen demand and rate of perceived exertion were significantly decreased after cardiac rehabilitation program. CONCLUSION: In case of prudent monitoring and proper management, cardiac rehabilitation program is safe and effective to improve exercise capacity in heart failure patient.

Immediate and Long-term Effect of Exercise on Heart Rate Variability in Coronary Artery Disease

OBJECTIVE: To evaluate the dynamics of autonomic nervous activity at rest and immediately after maximum exercise using heart rate variability (HRV) in coronary artery disease (CAD) and to assess the long-term effect of exercise. METHOD: Time and frequency domain of HRV was measured in 18 normal subjects, 37 CAD patients with percutaneous transluminal angioplasty and 10 CAD patients with coronary artery bypass graft at rest and 1 hour after peak graded treadmill exercise. Nineteen CAD patients were exercised with moderate intensity during 4 month and HRV was measured. RESULTS: At rest, the standard deviation of the NN interval (SDNN) and low frequency was significantly lower in both CAD groups than in normal subjects. At recovery stage after maximum exercise, low frequency and low frequency/high frequency ratio was significantly lower in both CAD groups than in normal subjects. SDNN at recovery stage in normal subjects remained significantly below the baseline. There was no significant change in HRV after long-term exercise even though maximum oxygen uptake had improved. CONCLUSION: This study demonstrated the reduced control of autonomic nervous activity in CAD patients at rest and immediately after peak exercise. There was no change in HRV after long-term exercise.

Influence of Beta Blocker on Cardiac Rehabilitation Program

OBJECTIVE: The purpose of this study was to evaluate the beta blocker effect on excercise ability and hemodynamics after cardiac rehabilitation program (CRP). METHOD: Thirty-two patients with coronary artery disease were divided into two groups: 16 patients in the beta blocker group and 16 patients in the control group. CRP with aerobic exercise was done for 6 weeks. Before and after CRP, a symptom limited graded exercise test was done. RESULTS: The maximal exercise time and the maximal oxygen uptake were significantly higher, and the percentage of maximal oxygen uptake and the rating of perceived exertion were significantly lower after CRP as compared to those parameters before CRP in both groups (p 0.05). The submaximal heart rate and submaximal rate pressure product (RPP) were significantly lower after CRP as compared to those before CRP in both groups (p<0.05). After CRP, the maximal heart rate and the submaximal RPP were significantly lower in the beta blocker group than in control (p<0.05). CONCLUSION: A beta blocker can be widely used in CRP without having a negative effect on exercise capacity in the patients with coronary artery disease.

Atypical Sturge-Weber Syndrome: A case report

Sturge-Weber syndrome is a congenital neurocutaneous disorder of the vessels of the face, the leptomeninges and the brain. Clinically SWS consists of symptoms and signs including a facial nevus (port-wine stain), seizure, hemiparesis, mental retardation. But only a few reports related to atypical Sturge-Weber syndrome without facial nevus have been published. We report a patient with atypical Sturge-Weber syndrome without any clinical feature except hemiparesis. In neuroimaging studies using brain CT scan and MRI, leptomeningeal angiomatosis was demonstated that is the characteristic feature of Sturge- Weber syndrome. In atypical Sturge-Weber syndrome, there may be late- developed complications such as hemiparesis. In conclusion, neuroimaging study is recommended to confirm diagnosis in suspicious atypical SWS patient.

Cardiovascular Complications during Cardiac Exercise Program

OBJECTIVE: To investigate the safety of exercise program under medical supervision for cardiac patients in their early phase from cardiac events, and the types and the frequency of possible cardiovascular complications during or after exercise. METHOD: 197 cardiac patients who participated in phase 2 cardiac rehabilitation were selected and they performed aerobic exercise program by individualized exercise prescription under ECG monitoring 3 times a week for 6 weeks. Throughout total 2,429 sessions of exercise, abnormal symptoms, hemodynamic responses and ECG abnormalities were analyzed. RESULTS: Cardiovascular complications ocurred in 25 patients (12.7%). ECG abnormalities in 14 sessions (0.58%) of 13 patients, chest pain during exercise in 17 sessions (0.67%) of 13 patients, abnormal hemodynamic responses in 8 sessions (0.33%) of 8 patients were observed. Cardiac arrest and myocardial infarct didn't happened. 18 patients (72%) experienced these complications during warming-up period, 6 patients (24%) during cool-down period and one patient (4%) during resting period. CONCLUSION: During exercise, there was some possibility of abnormal ECG changes, chest pain, hemodynamic responses but these potentially dangerous situations could be prevented from advancing on real emergency by intense attention and monitoring. Even cardiac patients of acute stage can tolerate adequate amount of exercise load safely under careful clinical supervision.

The Reasons That Cardiac Patients Did Not Participate in and Drop out from the Cardiac Rehabilitation Program

OBJECTIVE: To survey the cause of the cardiacs' low participation rate and poor compliance in cardiac rehabilitation. METHOD: Among those who admitted in the department of cardiology and chest surgery for acute care and then discharged, group 1 included 104 patients who never participated in cardiac rehabilitation, and group 2 included 47 patients who once joined in but discontinued before 7 sessions, and group 3 included 25 patients who continued it more than 18 sessions with good compliance. Questions related to the low participation rate and discontinuity and personality, psychological status, education level were asked. By SPSS, basic discriptive data were calculated. To compare the data among groups, independent t-test and Chi-square test were done. RESULTS: In group 1, the main causes of low participation rate was lack of recognition about it (78 patients, 75%), doubt on effect (48 patients, 46.2%), poor physical condition (38 patients, 36.5%). In group 2, the main cause of discontinuity was lack of time (12 patients, 25.5%), thought of being able to perform at home (11 patients, 23.4%), poor physical condition (7 patients, 14.9%). CONCLUSION: To raise the participation rate and compliance in cardiac rehabilitation, it is very important to make a pitch for cardiac rehabilitation and improve program service for patient's convinience.

The Change of Visual Evoked Potential in Patients with Myopia in Correction of Refraction

OBJECTIVE: Multiple factors including age, sex, habituation, refraction, cooperation and technical variables are associated with P100 latency of Visual evoked potential (VEP). So we tried to evaluate the P100 latency of visual evoked potential according to refraction. METHOD: We studied 28 patients (12 males, 16 females) with myopia. Subjects were divided into 3 groups (mild, moderate, severe myopia) according to refraction and we evaluated the results of VEP studies. RESULTS: Mean values of refraction and latency (P100) of naked eyes were -4.27 D, 103.95 msec. and those of corrected eyes (in glasses) were -0.25 D, 100.59 msec. Respectively, in mild, moderate and severe myopia, the each P100 latency of naked eyes were 101.27 msec, 102.59 msec, 107.99 msec and those of corrected eyes were 98.33 msec, 100.58 msec, 102.19 msec respectively (p<0.05). There was significant negative correlation between refraction and P100 latency in myopia. CONCLUSION: Our results suggested that there were significant changes in VEP (P100 latency) according to refraction. In performing the VEP study, we should consider the refraction and visual acuity.

The Effect of Epidural Injection for Spinal Stenosis

OBJECTIVE: To evaluate the efficacy of epidural injection for spinal stenosis with symptoms of low back pain, pseudoclaudication, or radiating pain. METHOD: Thirteen patients with spinal stenosis which were confirmed by the computed tomography (CT) studies were treated with epidural injections of steroids and local anesthetics for three times with 1 week interval. The efficacy of epidural injection was assessed by visual analogue scale (VAS), pain rating score (PRS), treadmill test, and jump test. RESULTS: 1) The VAS, PRS, pain free walking distances, and jump heights were checked right before injection, and at 1 week and 3 months after injection. The VAS and PRS were significantly decreased after epidural injection. The pain free walking distances and the jump heights were significantly increased after epidural injecton. CONCLUSION: Epidural injections of steroid and local anesthetics are effective in the short term period, but also in the long term period for patients with spinal stenosis.

Effectiveness of Aerobic Exercise in Cardiac Patients

OBJECTIVE: The purpose of this study is to evaluate the effectiveness and safety of aerobic exercise program in cardiac patients. METHOD: Twenty patients participated in 6 weeks of aerobic exercise with telemetry monitoring as an outpatient rehabilitation program. For the comparison of physiologic changes, we used graded exercise test (GXT) by means of modified Bruce protocol before and in 6 weeks after aerobic exercise training. Exercise prescription for cardiac rehabilitation was composed of intensity, mode, frequency and duration. By use of EKG telemetry and monitoring of blood pressure and Borg RPE (ratings of perceived exertion) scale, we were monitored patients status during exercise. RESULTS: In six weeks after aerobic exercise training, the hemodynamic and metabolic responses were improved and statistically significant parameters were as follows: exercise time, maximal METs, resting heart rate, maximal heart rate, submaximal rate pressure product, maximal expired volume, maximal oxygen consumption rate and anaerobic threshold. CONCLUSION: We concluded that six week cardiac rehabilitation program is useful and safe to improve the aerobic capacity for cardiac patients.

The Effects of Rehabilitative Training in the Treatment of Patellofemoral Pain Syndrome

OBJECTIVE: Inappropriate neural control of the quadriceps femoris muscle group has been implicated in patellofemoral pain syndrome (PFPS) and the methods of biomechanical assessment of PFPS has been developed recently. The aims of the present investigation were to evaluate the effects of therapeutic exercise in the alleviation of PFPS and to develope objective clinical test for PFPS. METHOD: We investigated the onset time of the isometric contraction of vastus medialis oblique muscle (VMO) and the vastus lateralis muscle (VL) under four different conditions: knee flexion and extension in weight bearing (standing) and non-weight bearing (sitting on chair) situations. For each condition, onset times of EMG activities and onset times for VMO and VL were determined from five trials of isometric contraction. In addition, we compared knee flexor and extensor torques in control group and subjects with PFPS. To evaluate the effects of the exercise we compared the onset time difference (onset time of VL-onset time of VM) and quadriceps muscle torque at pre- and post- exercise in PFPS groups. RESULTS: In PFPS group, onset time of VMO during knee extension was significantly longer than the onset time of VL and the knee extensor torque was considerably weaker in comparison with normal group. Although onset time difference was not changed after exercise program, there were significant increase in knee extensor torque in subjects with PFPS. CONCLUSION: The role of exercise in the rehabilitation of quadriceps functions is to reduce the pain, to strengthen the knee extensor, and further accurate diagnostic tools and methods for the result of therapeutic exercise in PFPS are needed.

Effect of Functional Electrical Stimulation on Clearance of Broncheal Secretion in Patients with High Spinal Cord Injury

OBJECTIVE: To determine the effects of abdominal functional electrical stimulation(FES) on the ability to clear the broncheal secretion in high spinal cord injury(SCI) patients. METHOD: Eleven cervical SCI male patients were assessed for the pulmonary function using a routine pulmonary function test. Maximal expiratory pressure(MEP) and peak expiratory flow rate(PEFR) measurements were recorded during (1) spontaneous cough attempts and (2) cough attempts with FES applied to the abdominal wall. Each measurement was recorded in supine and sitting positions. The portable FES unit was set at 24 Hz, with a pulse width of 150 microsecond( s), an asymmetrical biphasic waveform and a maximal intensity to 90 mA. RESULTS: All subjects had a decreased vital capacity, peak expiratory flow and increased ratio of forced expiratory volume at one second(FEV1) to the forced vital capacity(FVC) in a routine pulmonary function test. These cervical SCI patients were greatly reduced the MEP and the PEFR when they coughed spontaneously. FES-assisted coughing increased the MEP and PEFR in all patients in a supine and sitting positions with statistical significance(p<0.05). CONCLUSION: By increasing the MEP and PEFR, abdominal FES could enhance the coughs in high SCI patients. Abdominal FES can be a useful physical therapy for the prevention and treatment of pulmonary complications in high SCI patients at the bed side as well as at homes.