Intramedullary Spinal Cord Hemorrhage Associated with Monoparesis after Transforaminal Cervical Epidural Steroid Injection

Transforaminal cervical epidural steroid injection (TFCESI) is widely used as conservative treatment for cervical radiculopathy, but severe complications associated with this procedure have been reported. This report was the first case of intramedullary spinal cord hemorrhage following TFCESI. A 67-year-old woman presented with weakness and sensory disturbance in left upper extremity after TFCESI. Cervical magnetic resonance imaging revealed intramedullary spinal cord hemorrhage accompanied by myelopathy at the C2∼C5 level. The patient was administered intravenous methylprednisolone daily (1,000 mg/8 hours) for 5 days and was subsequently transferred to the Department of Rehabilitation Medicine for rehabilitation therapy. A month later, the patient’s neurological impairment partially improved. Although TFCESI is rarely associated with major complications, physicians should be cautious when performing the procedure, and remain mindful of the potentially serious complications.

Ultrasound-Guided Injection Therapy for Elbow, Wrist, and Hand Pain

Patients with pain, numbness, and weakness in their elbows, wrists, and hands often need proper rehabilitation treatments. Among them, musculoskeletal injection therapy should be performed after a full evaluation of the patient, taking into account history and physical examination leading to clinical diagnosis. General rules such as accurate diagnosis and injection materials selection are used to achieve maximum benefit with minimal side effects. During injection, patient location, aseptic care, penetration techniques, follow-up and follow-up care must be maintained. Specific techniques may vary depending on the type, lesion, and location of the injection therapy. For optimal effectiveness, physician should inject directly into the lesion and avoid the injection of surroundings as much as possible. Therefore, ultrasound-guided injections are needed to accurately inject. These conditions and other conditions of the hands, wrists, and elbows can be effectively diagnosed and treated with diagnostic ultrasound and ultrasound-guided injections.

Effects of Long-Distance Running on Cardiac Markers and Biomarkers in Exercise-Induced Hypertension Runners: An Observational Study

OBJECTIVE: To investigate changes of cardiac and muscle damage markers in exercise-induced hypertension (EIH) runners before running (pre-race), immediately after completing a 100-km ultramarathon race, and during the recovery period (24, 72, and 120 hours post-race). METHODS: In this observational study, volunteers were divided into EIH group (n=11) whose maximum systolic blood pressure was ≥210 mmHg in graded exercise testing and normal exercise blood pressure response (NEBPR) group (n=11). Their blood samples were collected at pre-race, immediately after race, and at 24, 72, and 120 hours post-race. RESULTS: Creatine kinase (CK) and cardiac troponin I (cTnI) levels were significantly higher in EIH group than those in the NEBPR group immediately after race and at 24 hours post-race (all p < 0.05). However, lactate dehydrogenase (LDH), creatine kinase-myocardial band (CKMB), or CKMB/CK levels did not show any significant differences between the two groups in each period. N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were significantly higher in EIH group than those in NEBPR group immediately after race and at 24 and 72 hours post-race (all p < 0.05). A high sensitivity C-reactive protein (hs-CRP) level was significantly higher in EIH group than that in NEBPR group at 24 hours post-race (p < 0.05). CONCLUSION: The phenomenon of higher inflammatory and cardiac marker levels in EIH group may exaggerate cardiac volume pressure and blood flow restrictions which in turn can result in cardiac muscle damage. Further prospective studies are needed to investigate the chronic effect of such phenomenon on the cardiovascular system in EIH runners.

Sonographic Appearance and Variations of Plantar Fibromatosis in the Korean

OBJECTIVE: To investigate the sonographic appearance of plantar fibromatosis in Korean adults, thus enabling sonographic diagnosis of the benign, focally invasive fibrous neoplasm. METHOD: The medical records, pathologic reports, and sonographic reports and image of 42 patient with plantar fibromatosis were reviewed retrospectively. RESULTS: US demonstrated plantar fibromatosis as a fusiform nodular thickening of the plantar fascia oriented according to its major axis. A total of 60 fibromatosis nodules in 42 patient were examined. Thirty-eight (63.33%) of the 60 were elongated. The remaing 22 were rounded or oval. Thirty-five (58.33%) were hypoechoic; fivty-one (85%) were 20 mm long or less. Eight of 9 lesions that had mixed echogenicity were longer than 20 mm. CONCLUSION: Our results suggest that the lesions of the plantar fibromatosis were characteristically located on the surface of the plantar fascia, longitudinally elongated, most often less than 20 mm long, fusiform and hypoechoic. Lesions longer than 10 mm often exhibited mixed echogenicity. Our sonographic finding was helpful in diagnosing planatar fibromatosis in the Korean.

Change to Type and Size of Rotator Cuff Tear Following Arthro-3D Sonography

OBJECTIVE: To compare to type and size of rotator cuff tear (RCT) in the transverse view before and after arthro-3D sonography. METHOD: Total 24 cases with rotator cuff tear were diagnosed according to ultrasonographic finding. All of patients were performed by a posterior-lateral approach for sono-guided intra-articular injection and underwent by both before and after arthro 3D sonogrpahy. We measured size (transverse, longitudinal, area) of RCT on the transverse scan in search of the largest lesion and the difference to type and size of RCT after arthrography. RESULTS: 3D ultrasonography detected full-thickness tear in 18 cases, partial-thickness tear in 6 cases before arthro-3D sonograhy. Change in the diagnosis of rotator cuff tear after arthro-3D sonogrphy; 3 partial-thickness tear were diagnosed as full-thickness tear. The size (transverse, longitudinal, area) of RCT was increased significantly after arthro-3D sonography compared with that before arthro 3D sonography. CONCLUSION: Arthro-3D sonography is useful for evaluation the configuration of RCT. Using this method, we can provide the objective and steric image of RCT.

Accuracy of Ultrasound Guided Hip Trochanteric Bursa Injection

OBJECTIVE: To evaluate the accuracy of ultrasound guided hip trochanteric bursa (subgluteus maximus bursa) injection by using pelvis computed tomography (CT) scan with contrast dye. METHOD: Nine patients (37~79 years old) with greater trochanteric pain syndrome (GTPS) were recruited for the study. In lateral decubitus position with pain side up, ultrasound guided injection was done into trochanteric bursa located between gluteus maximus and medius tendons with a mixture of 10 ml 0.5% lidocaine and 10 ml contrast dye (Omnipaque) in all study subjects. Accuracy of injection was assessed by pelvis CT scan within 1 hour after bursa injection. RESULTS: As results of pelvis CT scan, all subjects' contrast dyes were accurately injected within trochanteric bursa space from trochanter to proximal gluteus. CONCLUSION: We confirmed that ultrasound guided trochanteric bursa injection was accurate and easy to perform.