Two Different Types of Extension Arm Sling to Compare the Reduction of Shoulder Subluxation in Hemiplegic Patients

OBJECTIVE: The purpose of this study was to compare the reduction of shoulder subluxation radiologically using two types of extension arm sling. METHOD: Fifteen patients with a hemiplegic shoulder subluxation were studied. Two types of extension sling (forearm cuff type and humeral cuff type) were applied for the shoulder subluxation. On the shoulder X-ray, three parameters were measured: vertical distance (VD), horizontal distance (HD), and joint distance (JD). RESULTS: The mean values of the VD, HD, and JD of hemiplegic shoulder without a sling were 2.00+/-0.69 cm, 2.69+/-0.45 cm, and 1.53+/-0.56 cm, respectively, which were reduced to 1.00+/-0.43 cm, 2.61+/-0.46 cm, and 0.80+/-0.37cm by a forearm cuff type and to 1.80+/-0.83 cm, 2.60+/-0.45 cm, and 1.33+/-0.66 cm by a humeral cuff type. A forearm cuff type showed corrective effect in VD and JD, but a humeral cuff type did not in any of three parameters. When compared with nonhemiplegic side, there was no significant difference in VD and JD with a forearm cuff. But a humeral cuff showed significant difference in all parameters. So a forearm cuff type showed corrective effect this time. CONCLUSION: A forearm cuff type extension arm sling was a more effective orthosis for the reduction of the hemiplegic shoulder subluxation than a humeral cuff type extension arm sling.

Comparison of Skin Temperature between Supine and Prone Position during Application of Hot Packs on the Back

OBJECTIVE: To compare the skin temperature change between supine and prone position during application of hot pack on the back. METHOD: 15 healthy adults were recruited as subjects. We applied two hot packs to the lumbar region for two consecutive days. On the first day, the body part was on the top of hot pack and on the second day, the hot pack was placed over the body part. We measured peak skin temperature, skin temperature elevation, time required to peak skin temperature, skin temperature after 20 minutes and visual analogue scale(VAS) of subjective feeling of heat (hot). RESULTS: In the peak skin temperature, the means were 44.4+/-0.70degrees C and 42.7+/-0.99degrees C in the supine and prone position, respectively. In the skin temperature elevation, the means were 11.2+/-1.1degrees C and 9.5+/-1.6degrees C, respectively. In the time required to peak skin temperature elevation, the means were 6'49"+/-15" and 10'33"+/-15", respectively. In the skin temperature after 20 minutes, the means were 42.4+/-0.7degrees C and 41.6+/-0.8degrees C, respectively. In the VAS of subjective feeling of heat (hot), the means were 8.66+/-1.11 and 5.72+/-1.48, respectively. CONCLUSION: The patient's position is one of the important factors in determining temperature elevation. Therefore, it should be considered during application of the hot pack.

The Estimation of the Probable Cause and the Time of Cerebral Insult in Cerebral Palsy

OBJECTIVE: To estimate the probable cause and the time of cerebral insult in cerebral palsy (CP) based on MRI findings and risk factors. METHOD: The subjects comprised all sixty-seven patients with CP showing abnormal MRI findings between March 1999 and September 2001 at the Catholic University of Korea, St. Mary's Hospital. A detailed medical history was available for all patients including those not born in our hospital. They ranged in age from two months to five years. We analyzed the brain magnetic resonance (MR) findings of patients with CP to correlate the probable cause and the time of cerebral insult through the consideration of medical histories including prenatal, perinatal and postnatal histories. RESULTS: Of the 67 MRIs, abnormalities were the followings; periventricular leukomalacias (PVLs) in 49 cases, cortical or subcortical infarction in 4 cases, brain atrophy in 7 cases, neuronal migration disorder in 4 cases, and delayed myelination in 3 cases. Among the patients with PVL, perinatal risk factors were responsible for cerebral insult in preterm, but pre- and perinatal contribution were similar in patients born at full term. Among the patients with cerebral infarction, only one case with meningitis at 11 months was suspected for cerebral insult. These patients had no risk factor as a peri- or post-natal etiology. Four patients with neuronal migration disorder had no risk factor for peri- or postnatal etiology except for the one who was a twin. CONCLUSION: Review of brain MRI findings such as PVL, infarct, neuronal migration disorder and a detailed medical history including prenatal and perinatal etiology would be a useful method to estimate the probable cause and the time of cerebral insult in CP.

MRI Findings of Adhesive Capsulitis of Shoulder

OBJECTIVE: MRI findings of adhesive capsulitis (AC) have been rarely documented even though the disease is a rather common disorder. To find reliable MRI parameters, we studied MRI findings of the patients with arthrographically-proven AC. METHOD: Eighteen patients with AC (patient group) and eight subjects without AC (control group) were enrolled. Mean age of the former was 55.1 years and that of the latter was 41.4 years. Mean duration of the diseases in patient group was 5.9 months. Oblique coronal and axial MRI images of the shoulder were measured for the thickness of capsule and synovium around the axillary fold (TAF), volume of axillary recess (VAR), and volume of biceps tendon sheath (VBTS), which were compared in both groups using unpaired t-test. RESULTS: TAF was significantly increased in patient group (p<0.0001), and the thickened axillary fold greater than 5.1 mm was a useful MRI criterion for the diagnosis of AC with sensitivity of 93% and with specificity of 100%. VBTS was also significantly diminished in patient group (p<0.05), whereas there was no significant difference in VAR between two groups. CONCLUSION: TAF, especially greater than 5.1 mm, and decreased VBTS are useful MRI parameters for the diagnosis of AC of shoulder.