Severe Adverse Effect after Intra-articular Injection of Hyaluronate in Osteoarthritis: A case report

Osteoarthritis of the knee is a common cause of disability in the aging population. Traditional nonoperative treatment options include exercise, physical therapy, weight reduction, nonsteroidal antiinflammatory drugs, analgesics and corticosteroid injection. In recent years, intra-articular injection of hyaluronate-derived products has gained popularity as a palliative modality for the treatment of osteoarthritis of the knee. The common adverse reaction are mild pain or swelling at the site of injection that may occur up to 20% of patients. Severe local inflammation, warmth and joint effusion are rare and no systemic complication have been reported, to our knowledge. We presented one case in which synovial inflammation was observed following intra-articular injection of the knee.

Characteristics of the Patients with Pain in Rehabilitation Medicine Outpatient Practice

OBJECTIVE: The purposes of this study are to find out the characteristics of patients with pain in outpatient practice of rehabilitation medicine and to provide basic data for outpatient management. METHOD: We surveyed a hundred one outpatient practices with questionnaire including the distribution of diagnosis, pain site, disease related with pain, pain treatment method, etc. RESULTS: 1) Distribution of diagnosis was traumatic brain injury (TBI) 10.5%, stroke 14.8%, spinal cord injury (SCI) 10.8%, musculoskeletal disorder (MSD) 55.8% and others 8.1% in training hospital, and TBI 6.7%, stroke 10.6%, SCI 14.0%, MSD 58.7% and others 10.0% in non-training general hospital, and TBI 2.6%, stroke 4.9%, SCI 2.9%, MSD 78.3% and others 11.3% in private clinic. 2) The most common site of pain was low back area. 3) The most common disease related with pain was myofascial pain syndrome. 4) Trigger point injection and physical therapy were performed for pain treatment in most of outpatient practice, whereas local injection and nerve block were less used. CONCLUSION: We believe that this study's results will provide helpful basic-data for management of outpatient with pain.

Essential Osteolysis: A case report

Essential osteolysis is very rare, slowly progressive disease. Its etiology and pathophysiology is still unknown. Only one case has been reported in Korea. We experienced one case of essential osteolysis associated with renal insufficiency involving bilateral carpal, metacarpal, tarsal, metatarsal bones, elbow, ankle. We report a case of 24-year-old female who had manifestations of essential osteolysis with renal insufficiency with brief review of literatures.

Use of Alternative Therapies by Rehabilitation Outpatients with the Musculoskeletal Pain

OBJECTIVE: The purpose of this study is to document the prevalence and patterns of use of alternative therapies and effectiveness in a rehabilitation medicine outpatient practice. METHOD: This study was performed that a random sample of 200 patients of rehabilitation outpatient were given a questionnaire addressing their use of alternative therapies. RESULTS: One or more alternative therapies had been used by 51.3% of subjects for their presenting problem. The most common therapies were acupuncture, oriental medicine, chiropractic and massage. Musculoskeletal pain syndrome involving the low back and shoulder were the most common problems of use of alternative therapies. Of the patients who used alternative treatments, 40.2% reported some degree of efficacy. CONCLUSION: A significant proportion of rehabilitation outpatients use alternative therapies and frequently perceived a benefit from them. Incorporating alternative therapies into physiatric practice is a desirable future direction for the speciality.

The Effect of Spinal Manipulation for Patients with Acute Low Back Pain

OBJECTIVE: To assess the efficacy of spinal manipulation for the patients with acute low back pain. METHOD: Twenty patients with acute low back pain have been received spinal manipulation 3 times per week. The 10-point scale and the distance of the fingertips from the floor on maximum forward flexion (fingertip-flexion test) were checked pretreatment, immediately posttreatment, 2 days posttreatment, 1 week posttreatment, and 2 weeks posttreatment. RESULTS: The results were as follows: 1) The 10-point scale at pretreatment, immediately posttreatment, 2 days posttreatment, 1 week posttreatment, and 2 weeks post-treatment were 10.0+/-0.0, 5.8+/-1.4, 2.2+/-1.0, 1.1+/-0.2, and 1.0+/-0.0, respectively (P<0.01). 2) The fingertip-flexion test at pretreatment, immediately posttreatment, 2 days posttreatment, 1 week posttreatment, 2 weeks posttreatment were 35.4+/-8.4 cm, 22.4+/-7.0 cm, 14.1+/-4.9 cm, 7.4+/-3.6 cm, and 5.4+/-4.6 cm, respectively (P<0.01). CONCLUSION: In our study, the spinal manipulation for the patients with acute low back pain offered significant efficacy and appeared to be a reasonable therapeutic option. But the effectiveness of this method leaves a critical aspect that should be dealt with in future studies.

The Effect of Caudal Epidural Injection for the Pseudoclaudication of Spinal Stenosis

OBJECTIVE: The goal of this study was to determine the efficacy of caudal epidural injection in relieving pseudoclaudication of patients with lumbar spinal stenosis. METHOD: Fifteen patients with a spinal stenosis which was confirmed by the magnetic resonance imaging(MRI) studies, received a caudal epidural steroid injection of triamcinolone acetate 120 mg, in a solution mixed with 2 ml of 1% lidocaine, and 15 ml of normal saline. RESULTS: The visual analogue scales checked at 1 hour prior to injection, 1 hour postinjection, and 1 month postinjection were 8.1+/-0.8, 3.7+/-1.7, and 6.4+/-1.9, respectively. The exercise tolerance on the treadmill with 0o ramp inclination and 1.8 km/h speed was measured at 1 hour prior to injection, 1 hour postinjection, and 1 month postinjection. The time intervals to the first symptom of the pseudoclaudication were 2.3+/-0.8 minutes, 6.5+/-0.7 minutes, and 4.6+/-1.9 minutes, respectively. CONCLUSION: In our study, the caudal epidural injection offered a significant short-term relief for the pseudoclaudication. Also it appeared to be a reasonable therapeutic option among patients with lumbar spinal stenosis after 1 month postinjection.

The Efficacy of Erectile Perineal Ultrasonography in Stress Urinary Incontinence / 대한비뇨기과학회지

To know the diagnostic efficacy of erectile perineal ultrasonography in stress urinary incontinence, We compared erectile perineal ultrasonography with chain cystourethrography in 16 women (mean age: 54 years old) with genuine stress urinary incontinence. We measured the posterior urethrovesical angle (PUVA) at rest and during straining in both tests. The average value of PUVA at rest state was 143.4 in chain cystourethrography and 150.9 in perineal ultrasonography (p<0.001). During straining state, PUVA was 172.4 in chain cystourethrography and 177.2 in perineal ultrasonography (p<0.001). The difference between PUVAs at rest and during straining were 29.0 in chain cystourethrography and 26.3 in perineal ultrasonography U)<0.05). In conclusion, erectile perineal ultrasonography is non-invasive, simple, comfortable and useful diagnostic method in stress urinary incontinence. So we think that erectile perineal ultrasonography can replace the chain cystourethrography to diagnose the stress urinary incontinence.