Pain Management with Extracorporeal Shockwave Treatment in Multiple Level Clay-shoveler’s Fracture in a Novice Golfer: A Case Report

A 30-year-old male novice golfer was diagnosed with a clay-shoveler’s fracture. During golf practice, he experienced persistent posterior neck and upper back pain for a month. Cervical radiographs and computed tomography revealed a series of sequential spinous process fractures from C7 to T3. The patient was prescribed analgesic medication and fitted with a cervical brace alongside extracorporeal shockwave therapy (ESWT) directed explicitly toward the upper back region, subsequently leading to a notable reduction in pain. Therefore, ESWT could be considered an additional method for pain management in patients with clay-shoveler’s fractures.

Evaluation of Current Resources Available for Community-Based Cardiac Rehabilitation in Korea:A Nationwide Survey Study

Background@#In Korea, the actual distribution of cardiac rehabilitation (CR) to the clinical field is insufficient due to the many barriers for cardiovascular patients to participate in CR. Community-based CR is a useful alternative to overcome these obstacles. Through a nationwide survey, we investigated the possibility of regional medical and public health management institutes which can be in charge of community-based CR in Korea. @*Methods@#The questionnaires on recognition of CR and current available resources in health-related institutions were developed with reference to the CR evaluation tools of York University and the International Council of Cardiovascular Prevention and Rehabilitation.The questionnaires were sent to regional public and private medical institutions and public health management institutions. @*Results@#In total, 2,267 questionnaires were sent to 1,186 institutions. There were 241 and 242 responses from 173 and 179 regional private and public medical institutions, respectively. And a total of 244 responses were gathered from 180 public health management institutions. Although many institutions were equipped with the necessary facilities for exercise training, there were few patient-monitoring systems during exercise. Most institutions were aware of the need for CR, but were burdened with the cost of establishing personnel and facilities to operate CR. @*Conclusion@#Most regional medical, and public health management institutions in Korea are unprepared for the implementation of community-based CR programs. To encourage the utilization of such, there should be efforts to establish a national consensus.

Rapid Lymphedema Progression in Breast Cancer Patient with Previous Forearm Fracture

Fracture is uncommon cause of lymphedema. The mechanism of lymphedema progression is still unknown, but disruption of the lymphatic system during and after fracture might be involved. In contrast, breast cancer surgery is a common cause of lymphedema and is usually caused by the removal of axillary lymph nodes. Sentinel node biopsy (SNB) has been adopted in early breast cancer to reduce the risk of lymphedema. Thus, the incidence of lymphedema in SNB was lowered. However, less than 10% of SNB patients are still diagnosed with lymphedema, but it is known that it took years to diagnose. Recently, we encountered atypical lymphedema occurred after breast cancer surgery with SNB. Symptoms started earlier than usual and were more severe. Interestingly, she has a history of a proximal radial fracture on the same side of SNB. We thought there could be a relationship between the acceleration of breast cancer-related lymphedema and fracture

Rapid Lymphedema Progression in Breast Cancer Patient with Previous Forearm Fracture

Fracture is uncommon cause of lymphedema. The mechanism of lymphedema progression is still unknown, but disruption of the lymphatic system during and after fracture might be involved. In contrast, breast cancer surgery is a common cause of lymphedema and is usually caused by the removal of axillary lymph nodes. Sentinel node biopsy (SNB) has been adopted in early breast cancer to reduce the risk of lymphedema. Thus, the incidence of lymphedema in SNB was lowered. However, less than 10% of SNB patients are still diagnosed with lymphedema, but it is known that it took years to diagnose. Recently, we encountered atypical lymphedema occurred after breast cancer surgery with SNB. Symptoms started earlier than usual and were more severe. Interestingly, she has a history of a proximal radial fracture on the same side of SNB. We thought there could be a relationship between the acceleration of breast cancer-related lymphedema and fracture

Incidence and Characteristics of Immediate Substitutions of Injured Players in Korean Professional Football League Matches / 대한스포츠의학회지

Purpose@#To identify the incidence and characteristics of immediate substitutions of injured players that occurred during Korean professional football league matches. @*Methods@#This study included injuries that resulted in immediate substitutions of injured players during Korean professional football league matches. The match broadcasting records were used to check the date of the match, home-away matches, the team to which players belong, the position on the field of play, and the time of injury.The match recording videos were used to evaluate the injury mechanism and the injured area. @*Results@#In 228 matches, 66 immediate substitutions of injured players occurred, with an incidence rate of 0.3 per match. Total number of substitutions due to injuries most frequently occurred in May, with 15 substitutions in 30 matches; however, after considering the number of substitutions per match in each month, November was the most severe month with 0.53 substitutions after injuries per match. Most frequently injured players were defenders (36.4%), followed by midfielders, forwards, and goalkeepers. Immediate substitutions of injured players took place 32 times in the first half and 34 times in the second half. 51.5% of all injuries were related to collisions, and injuries to the knee and thigh accounted for 45.5% of all injuries. @*Conclusion@#There were 66 immediate substitutions of injured players during a single season of the Korean professional football league, with 0.3 substitutions after injuries per match. To prevent and manage serious injuries that can occur during a football match, a thorough analysis of risk factors of injuries that lead to immediate substitution is required.

Changes in Grip Strength and Associations with Grip Strength in Breast Cancer Survivors Treated with Adjuvant Chemotherapy

Purpose@#The aim of this study was to identify the change in hand grip strength (HGS) for consecutive 6 months in breast cancer survivors (BCS) undergoing postoperative adjuvant chemotherapy (adjCTX) and to determine the factors relevant to HGS after chemotherapy completion @*Methods@#This study was a retrospective observational cohort study. BCS (N=38) who underwent breast cancer surgery and subsequent adjCTX were enrolled. The HGS of both sides was measured before adjCTX and 3 weeks, 2 months and 6 months after adjCTX. And we also collected body composition, anthropometric measurements, social demographics and clinical data. Then we analyzed the changes in HGS over time, and correlation of collected data with HGS at 6 months. @*Results@#A significant increase in HGS of the unaffected side was observed within the first 3 weeks of adjCTX and maintained up to 6 months. In correlation analysis, HGS of both sides was positively correlated with the ipsilateral HGS at 3 weeks, and contralateral HGS at 6 months. And skeletal muscle mass was also positively correlated with the HGS of the unaffected side. In addition, subjects treated with targeted therapy had lower HGS of the unaffected side. However, HGS of the affected side was significantly lower in subjects with breast reconstruction and treated without radiotherapy. @*Conclusions@#To maintain the early recovery of HGS, active and continuous exercise intervention for strengthening might be necessary.

Changes in Grip Strength and Associations with Grip Strength in Breast Cancer Survivors Treated with Adjuvant Chemotherapy

Purpose@#The aim of this study was to identify the change in hand grip strength (HGS) for consecutive 6 months in breast cancer survivors (BCS) undergoing postoperative adjuvant chemotherapy (adjCTX) and to determine the factors relevant to HGS after chemotherapy completion @*Methods@#This study was a retrospective observational cohort study. BCS (N=38) who underwent breast cancer surgery and subsequent adjCTX were enrolled. The HGS of both sides was measured before adjCTX and 3 weeks, 2 months and 6 months after adjCTX. And we also collected body composition, anthropometric measurements, social demographics and clinical data. Then we analyzed the changes in HGS over time, and correlation of collected data with HGS at 6 months. @*Results@#A significant increase in HGS of the unaffected side was observed within the first 3 weeks of adjCTX and maintained up to 6 months. In correlation analysis, HGS of both sides was positively correlated with the ipsilateral HGS at 3 weeks, and contralateral HGS at 6 months. And skeletal muscle mass was also positively correlated with the HGS of the unaffected side. In addition, subjects treated with targeted therapy had lower HGS of the unaffected side. However, HGS of the affected side was significantly lower in subjects with breast reconstruction and treated without radiotherapy. @*Conclusions@#To maintain the early recovery of HGS, active and continuous exercise intervention for strengthening might be necessary.

Fahr's Disease With Intracerebral Hemorrhage at the Uncommon Location: A Case Report

Fahr's disease (FD) is a rare neurologic disorder characterized by the symmetric and bilateral intracerebral calcification in a patient. We describe the case of a 65-year-old woman who presented with gait disturbance, abnormal mentality, and visual field defect. The result of a brain computerized tomography showed spontaneous intracranial hemorrhage in the right parieto-occipital area, and also showed the incidence of symmetric and bilateral intracerebral calcification. Moreover, laboratory studies indicated characteristic hypoparathyroidism. This brings us to understand that additionally, one of her sons also presented with similar intracerebral calcification, and was subsequently diagnosed with FD. Thus, her case was consistent with that of a patient experiencing FD. The patient had hypertension, which we now know might have caused the intracerebral hemorrhage. However, this patient's brain lesions were in uncommon locations for spontaneous intracerebral hemorrhage, and the lesions were noted as occurring away from the identified heavily calcified areas. Thus, it seemed that the massive calcification of cerebral vessels in the basal ganglia, the most common site of intracerebral hemorrhage, might have prevented a hypertensive intracerebral hemorrhage. Eventually, an intracerebral hemorrhage occurred in an uncommon location in the patient's brain.

The Effectiveness of Complex Decongestive Physical Therapy for Pain in Patients with Rheumatoid Lymphedema: Two Case Reports

Rheumatoid lymphedema (RL) is a rare complication of rheumatoid arthritis (RA). The pathophysiology of RL is not yet fully understood, and the management is also not standardized. As yet, there is low awareness regarding RL and complex decongestive physical therapy (CDPT) among physicians; hence, diagnosis and treatment are delayed. A few studies have reported the positive effects of tumor necrosis factor-α inhibitory drugs on RL. CDPT is still considered the gold standard for the treatment of cancer-related lymphedema, but there are few reports on the effects of CDPT on RL. Therefore, we report two cases of chronic International Society of Lymphology lymphedema stage II RL that exhibited good therapeutic outcomes after CDPT. One of the two patient had taken a tumor necrosis factor-α inhibitory drug, but RL still has progressed. However, CDPT with multilayer bandage showed significant reduction in the pain and edema of the lower extremities.

Effects of Cervical Kyphosis on Recovery From Dysphagia After Stroke

OBJECTIVE: To determine the effects of cervical kyphosis on the recovery of swallowing function in subacute stroke patients. METHODS: Baseline and 1-month follow-up videofluoroscopic swallowing studies (VFSSs) of 51 stroke patients were retrospectively analyzed. The patients were divided into the cervical kyphosis (Cobb's angle <20°, n=27) and control (n=24) groups. The penetration-aspiration scale (PAS), American Speech-Language-Hearing Association National Outcomes Measurement System swallowing scale (ASHA NOMS), and videofluoroscopic dysphagia scale (VDS) were used to determine the severity of dysphagia. Finally, the prevalence of abnormal VFSS findings was compared between the two groups. RESULTS: There were no significant differences in baseline PAS, ASHA NOMS, and VDS scores between the two groups. However, the follow-up VDS scores in the cervical kyphosis group were significantly higher than those in the control group (p=0.04), and a follow-up study showed a tendency towards worse ASHA NOMS scores (p=0.07) in the cervical kyphosis group. In addition, the cervical kyphosis group had a higher occurrence of pharyngeal wall coating in both baseline and follow-up studies, as well as increased aspiration in follow-up studies (p<0.05). CONCLUSION: This study showed that stroke patients who had cervical kyphosis at the time of stroke might have impaired recovery from dysphagia after stroke.

Effect of Chronic Obstructive Pulmonary Disease on Swallowing Function in Stroke Patients

OBJECTIVE: To investigate the prevalence of chronic obstructive pulmonary disease (COPD) in stroke patients, and to assess the difference in swallowing function between stroke patients with COPD (COPD group) and stroke patients without COPD (control group). METHODS: The subjects included 103 stroke patients. They underwent the pulmonary function test and were assigned to either the COPD group or the control group. Their penetration-aspiration scale (PAS) scores and functional dysphagia scale scores were compared by performing a videofluoroscopic swallowing study. The intergroup differences in lip closure, bolus formation, mastication, and the oral transit time, laryngeal elevation, cricopharyngeal dysfunction, oronasal regurgitation, residue in pyriform sinus and vallecula, pharyngeal transit time, aspiration, and esophageal relaxation were also compared. RESULTS: Thirty patients were diagnosed with COPD. The COPD group showed statistically higher PAS scores (4.67+/-2.15) compared to the control group (2.89+/-1.71). Moreover, aspiration occurred more frequently in the COPD group with statistical significance (p<0.05). The COPD group also showed higher occurrence of cricopharyngeal dysfunction, albeit without statistical significance. CONCLUSION: This study shows that a considerable number of stroke patients had COPD, and stroke patients with COPD had higher risk of aspiration than stroke patients without COPD.

Effects of Dynamic Ankle-Foot Orthosis on Postural Balance Control in Hemiparetic Patients

OBJECTIVE: To determine the effects of dynamic ankle foot orthosis (AFO) on balance control by comparing it with conventional plastic AFO and barefoot conditions in hemiparetic patients. METHOD: Fifteen hemiparetic patients with brain lesions were recruited for this study. All subjects were capable of standing up independently and had a modified Ashworth score of less than two. The postural control capabilities of the subjects were assessed using the timed up and go (TUG) test, and Tetrax(R) tetra-ataxiametric posturography. The stability index, weight distribution index, and synchronization index were measured at six different head positions with dynamic AFO, conventional AFO and under barefoot conditions. RESULTS: There were nine males and six females, whose average age was 45.1 years. There was a significantly even weight distribution for the dynamic AFO and conventional AFO conditions relative to the barefoot condition in neutral, right-sided head, and left-sided head with eyes closed (p<0.05). And there was significantly increased stability in left sided-head, neck flexed positions with eyes closed for dynamic AFO and conventional AFO (p<0.05). However, there was no significant difference in weight distribution or stability between dynamic and conventional AFO conditions, except the stability in right-sided head position with eyes closed. CONCLUSION: In this study, the balance control of hemiparetic patients with dynamic AFO was better than in the barefoot condition, and was similar to conventional AFO. Therefore, we suggest that dynamic AFO may be a useful orthosis for hemiparetic patients with mild to moderate spasticity with poor balance control and foot drop.

Stroke in Colorectal Cancer Patients

OBJECTIVE: To find the characteristics of stroke in colorectal cancer patients. METHOD: We retrospectively analyzed 32 patients of stroke in colorectal cancer who were operated from January 2001 to December 2002 by reviewing their charts and brain CTs or MRIs. The type, risk factor, localization and origin of stroke and the stage of colorectal cancer were analyzed. RESULTS: The mean age was 69.2 years. TNM stage II (41%) was the most common. Twenty-three cases were ischemic stroke, four were hemorrhagic stroke and the others were unidentified. Diabetes (63%), hypertension (53%), cardiac disease (19%), and family history of stroke (9%) were observed in patients. The main cause of ischemic stroke was arterial thrombosis, and lacunar and middle cerebral infarction were more common in ischemic stroke. CONCLUSION: Several common risk factors between colorectal cancer and stroke were observed, and these risk factors are associated with the atherosclerosis of cerebral vascular system. To reduce the incidence of cerebrovascular disease and colorectal cancer, we may need to control those risk factors.

Assessments of Balance Control Using Tetra-ataxiametric Posturography

OBJECTIVE: To assess and to compare the balance control between healthy old and young adults using clinical tests and tetra-ataxiametric posturography. METHOD: Eighteen healthy elderly adults over 60 years old and twenty one young individuals under 60 years old were recruited. All subjects had no neurological, cognitive and musculoskeletal problems, and were capable of standing and walking independently. The postural control capabilities of the subjects were assessed using the timed up and go test, Berg balance scale and a Tetrax(R) tetra-ataxiametric posturography (Tetrax, Ramat Gan, and Sunlight Medical, Tel-Aviv, Israel), which utilized two paired force plates measuring vertical pressure fluctuations over both heels and forefeet. Stability index, weight distribution index, synchronization index, and Fourier index were measured at six different head positions and at two positions with standing on pillows, and analyzed by independent t-test. RESULTS: The stability index was higher in the elderly subjects (p<0.05) than in young subjects, which indicated that the ability of balance control in the elderly subjects was poor. The abnormality of peripheral vestibular system, central nervous system and musculoskeletal system all affected the balance control in the elderly subjects, when standing on pillows or turning head to the up, down, right and left sides. However, the weight distribution index and synchronization of both heels and forefeet were not significantly different between the elderly and young subjects. CONCLUSION: These findings suggest that elderly adults have more deficits in postural control than young subjects. Therefore changing environment around elderly adults and educating for prevention of falls were needed.