ABSTRACT
Herpes zoster is the consequence of reactivation of latent varicella zoster virus from dorsal root ganglia. Postherpetic neuralgia (PHN) may be diagnosed when pain persists in a dermatomal pattern long after the vesicular erruption has healed. PHN is a kind of neuropathic pain. The pathophysiology of PHN is uncertain, but neuropathic pain due to denervation supersensitivity may be important to understand the pathophysiology of PHN. Numerous treatment have been introduced for the management of PHN, but no methods that results in complete remission. Gunn's intramuscular stimulation (IMS) is one of the best treatment of chronic pain, especially neuropathic pain. We tried Gunn's IMS for treatment of PHN patients affecting thoracic dermatomes. As a result, the visual analogue scale (VAS) was decreased from 7-8 to 2-3 and the result were satisfactory. The purpose of this case report is to introduce the Gunn's IMS and review our experience for the treatment of PHN.
Subject(s)
Humans , Chronic Pain , Denervation , Ganglia, Spinal , Herpes Zoster , Herpesvirus 3, Human , Neuralgia , Neuralgia, PostherpeticABSTRACT
Frozen shoulder is characterized by pain in the shoulder and limitation of glenohumeral movement. The underlying pathologic changes in frozen shoulder are synovial inflammation with subsequent reactive capsular fibrosis. Capsular fibrosis is the ultimate course of frozen shoulder suffering from various causes irrespectively. Therefore, adhesions that are affecting the joint movement must be released. Most important diagnostic method is thoughtful history taking and physical examination, and ultrasonography is very valuable device of diagnosis and treatment. Interventional microadhesiolysis and nerve stimulation (IMNS) is effective to manage frozen shoulder patients. IMNS for frozen shoulder is composed of three release approaches. These are (1) subacromial, (2) posterior inferior capsular, and (3) subdeltoidal & subcoracoidal release and round needle can be used for each release. We report this experiences and recommand this technique for the treatment of frozen shoulder patients.
Subject(s)
Humans , Bursitis , Fibrosis , Inflammation , Joints , Needles , Physical Examination , Shoulder , Stress, PsychologicalABSTRACT
A 71-year-old man who had a laceration on his right fifth finger underwent an emergency explorative operation under brachial plexus block that was performed by using transaxillary artery technique.During axillary block, no elicitation of paresthesia was presented.Postoperatively he complained numbness on his right arm along the dermatome of 7th cervical nerve distribution.Two weeks later the evidence of nerve injury was found on EMG and NCV carried by the department of neurology. Observing closely for another two weeks, the symptoms and signs were gradually improved.On 42nd postoperative day, the patient complained no neurologic problems and the findings of EMG and NCV returned to normal.Considering the method of anesthesia, operation time, tourniquet time and patient position, we conclude that the direct needle injury and intraneural injection during axillary block are the highly suggestive causes of nerve injury.
Subject(s)
Aged , Humans , Anesthesia , Arm , Arteries , Brachial Plexus , Emergencies , Fingers , Hypesthesia , Lacerations , Needles , Neurology , Paresthesia , TourniquetsABSTRACT
A 71-year-old man who had a laceration on his right fifth finger underwent an emergency explorative operation under brachial plexus block that was performed by using transaxillary artery technique.During axillary block, no elicitation of paresthesia was presented.Postoperatively he complained numbness on his right arm along the dermatome of 7th cervical nerve distribution.Two weeks later the evidence of nerve injury was found on EMG and NCV carried by the department of neurology. Observing closely for another two weeks, the symptoms and signs were gradually improved.On 42nd postoperative day, the patient complained no neurologic problems and the findings of EMG and NCV returned to normal.Considering the method of anesthesia, operation time, tourniquet time and patient position, we conclude that the direct needle injury and intraneural injection during axillary block are the highly suggestive causes of nerve injury.
Subject(s)
Aged , Humans , Anesthesia , Arm , Arteries , Brachial Plexus , Emergencies , Fingers , Hypesthesia , Lacerations , Needles , Neurology , Paresthesia , TourniquetsABSTRACT
Epidural anesthesia for cesarean section allows the mother to be awake, minimizes or completely avoids the problem of maternal aspiration and neonatal drug depression from general anesthetics. But epidural anesthesia has the potential to produce local anesthetic systemic toxicity or inadvertent high spinal block which is due to unintentional administration of drug into an epidural vessel or subarachnoid space. There are several ways to avoid these complications. These include careful aspiration of epidural catheter, fractionation of the epidural dose, and the use of epinephrine containing epidural test dose before injection of epidural dose. We report a case of a pregnant woman who had developed a seizure after an injection of the epidural anesthetic. This occurred despite using the techniques of aspiration and epinephrine containing epidural test dose injection. So we thought that the seizure occurred probably by the migration of epidural catheter while changing positions and it should be considered in all cases of epidural anesthesia.
Subject(s)
Female , Humans , Pregnancy , Anesthesia, Epidural , Anesthetics, General , Catheters , Cesarean Section , Depression , Epinephrine , Mothers , Pregnant Women , Seizures , Subarachnoid SpaceABSTRACT
Cervicogenic headache (CGH) is not universally accepted as terminology used to discuss headaches associated with disorders of the cervical spine. Sjaastad was the first to describe CGH that its definition and diagnosis relied entirely on clinical features. Pain is often triggered by irritation of nociceptors from structures in the cervical spine, and so diagnostic criteria of CGH have been established with agreement that these headaches start in the neck or occipital region and are associated with tenderness of cervical paraspinal tissues. Past history and clinical features are important to detect and diagnose the disease because the significance of radiological findings and advanced diagnostic testing is unclear. Gunn's intramuscular stimulation (IMS) is a treatment modality of CGH upon radiculopathic model. We tried IMS for treatment of 3 patients with CGH. After IMS, the patients were well respond the therapy and the results were satisfactory. Therefore we recommend the IMS for the treatment of CGH.