Bone Stress Injuries in Runners: a Review for Raising Interest in Stress Fractures in Korea

A bone stress injury (BSI) means that the bones cannot tolerate repeated mechanical loads, resulting in structural fatigue and local bone pain. A delay in BSI diagnosis can lead to more serious injuries, such as stress fractures that require longer treatment periods. Therefore, early detection of BSI is an essential part of management. Risk factors for BSI development include biological and biomechanical factors. Medical history and physical examination are the basics for a BSI diagnosis, and magnetic resonance imaging is helpful for confirming and grading. In this paper, the authors review the overall content of BSI and stress fractures which are common in runners. Through this review, we hope that interest in stress fractures will be raised in Korea and that active researches will be conducted.

Bone Stress Injuries in Runners: a Review for Raising Interest in Stress Fractures in Korea

A bone stress injury (BSI) means that the bones cannot tolerate repeated mechanical loads, resulting in structural fatigue and local bone pain. A delay in BSI diagnosis can lead to more serious injuries, such as stress fractures that require longer treatment periods. Therefore, early detection of BSI is an essential part of management. Risk factors for BSI development include biological and biomechanical factors. Medical history and physical examination are the basics for a BSI diagnosis, and magnetic resonance imaging is helpful for confirming and grading. In this paper, the authors review the overall content of BSI and stress fractures which are common in runners. Through this review, we hope that interest in stress fractures will be raised in Korea and that active researches will be conducted.

Bone Stress Injuries in Runners: a Review for Raising Interest in Stress Fractures in Korea

A bone stress injury (BSI) means that the bones cannot tolerate repeated mechanical loads, resulting in structural fatigue and local bone pain. A delay in BSI diagnosis can lead to more serious injuries, such as stress fractures that require longer treatment periods. Therefore, early detection of BSI is an essential part of management. Risk factors for BSI development include biological and biomechanical factors. Medical history and physical examination are the basics for a BSI diagnosis, and magnetic resonance imaging is helpful for confirming and grading. In this paper, the authors review the overall content of BSI and stress fractures which are common in runners. Through this review, we hope that interest in stress fractures will be raised in Korea and that active researches will be conducted.

Association of Post-extubation Dysphagia With Tongue Weakness and Somatosensory Disturbance in Non-neurologic Critically Ill Patients

OBJECTIVE: To prospectively assess the association between impoverished sensorimotor integration of the tongue and lips and post-extubation dysphagia (PED). METHODS: This cross-sectional study included non-neurologic critically ill adult patients who required endotracheal intubation and underwent videofluoroscopic swallowing study (VFSS) between October and December 2016. Participants underwent evaluation for tongue and lip performance, and oral somatosensory function. Demographic and clinical data were retrieved from medical records. RESULTS: Nineteen patients without a definite cause of dysphagia were divided into the non-dysphagia (n=6) and the PED (n=13) groups based on VFSS findings. Patients with PED exhibited greater mean duration of intubation (11.85±3.72 days) and length of stay in the intensive care unit (LOS-ICU; 13.69±3.40 days) than those without PED (6.83±5.12 days and 9.50±5.96 days; p=0.02 and p=0.04, respectively). The PED group exhibited greater incidence of pneumonia, higher videofluoroscopy swallow study dysphagia scale score, higher oral transit time, and lower tongue power and endurance and lip strength than the non-dysphagia groups. The differences in two-point discrimination and sensations of light touch and taste among the two groups were insignificant. Patients intubated for more than 7 days exhibited lower maximal tongue power and tongue endurance than those intubated for less than a week. CONCLUSION: Duration of endotracheal intubation, LOS-ICU, and oromotor degradation were associated with PED development. Oromotor degradation was associated with the severity of dysphagia. Bedside oral performance evaluation might help identify patients who might experience post-extubation swallowing difficulty.

Proposed Use of Thickener According to Fluid Intake on Videofluoroscopic Swallowing Studies: Preliminary Study in Normal Healthy Persons

OBJECTIVE: To examine the characteristics and changes in the pharyngeal phase of swallowing according to fluid viscosity in normal healthy persons, to help determine fluid intake methods in more detail than the use of standardized fluid. METHODS: This was a prospective observational study involving 10 normal healthy adults. While the participants sequentially took in fluids with 10 different viscosities changes in the pharyngeal phase of the swallowing process were monitored using videofluoroscopic swallowing studies (VFSS). Twenty parameters of the pharyngeal phase, including epiglottis contact, laryngeal elevation, pharyngeal constriction, and upper esophageal sphincter opening, were determined and compared. RESULTS: No significant viscosity-based changes in epiglottis contact, laryngeal elevation, or upper esophageal sphincter-opening duration of the pharyngeal phase were observed. However, pharyngeal transit time and time from the start of the pharyngeal phase to peak pharyngeal constriction were significantly delayed upon intake of fluid with viscosities of 150.0 centipoise (cP) and 200.0 cP. CONCLUSION: VFSS analysis of fluid intake may require the use of fluids of various concentrations to determine a suitable viscosity of thickener mixture for each subject.

Effects of Head Rotation and Head Tilt on Pharyngeal Pressure Events Using High Resolution Manometry

OBJECTIVE: To observe changes in pharyngeal pressure during the swallowing process according to postures in normal individuals using high-resolution manometry (HRM). METHODS: Ten healthy volunteers drank 5 mL of water twice while sitting in a neutral posture. Thereafter, they drank the same amount of water twice in the head rotation and head tilting postures. The pressure and time during the deglutition process for each posture were measured with HRM. The data obtained for these two postures were compared with those obtained from the neutral posture. RESULTS: The maximum pressure, area, rise time, and duration in velopharynx (VP) and tongue base (TB) were not affected by changes in posture. In comparison, the maximum pressure and the pre-upper esophageal sphincter (UES) maximum pressure of the lower pharynx in the counter-catheter head rotation posture were lower than those in the neutral posture. The lower pharynx pressure in the catheter head tilting posture was higher than that in the counter-catheter head tilting. The changes in the VP peak and epiglottis, VP and TB peaks, and the VP onset and post-UES time intervals were significant in head tilting and head rotation toward the catheter postures, as compared with neutral posture. CONCLUSION: The pharyngeal pressure and time parameter analysis using HRM determined the availability of head rotation as a compensatory technique for safe swallowing. Tilting the head smoothes the progress of food by increasing the pressure in the pharynx.

Median Nerve Injury Caused by Brachial Plexus Block for Carpal Tunnel Release Surgery

Carpal tunnel release is required to treat patients with severe carpal tunnel syndrome. The regional anesthesia of the upper limb by brachial plexus block (BPB) may be a good alternative to general anesthesia for carpal tunnel release surgery, because it results in less complications. However, the regional anesthesia still has various side effects, such as hematoma, infection, and peripheral neuropathy. We hereby report a rare case of median nerve injury caused by BPB for carpal tunnel release.

A Comparison of the Short-Term Effects of a Botulinum Toxin Type A and Triamcinolone Acetate Injection on Adhesive Capsulitis of the Shoulder

OBJECTIVE: To evaluate the short-term clinical effects of the intra-articular injection of botulinum toxin type A (BoNT-A) for the treatment of adhesive capsulitis. METHODS: A prospective, controlled trial compared the effects of intra-articular BoNT-A (Dysport; 200 IU, n=15) with the steroid triamcinolone acetate (TA; 20 mg, n=13) in patients suffering from adhesive capsulitis of the shoulder. All patients were evaluated using a Numeric Rating Scale (NRS) of the pain intensity and a measurement of the range of motion (ROM) at baseline (before treatment) and at 2, 4, and 8 weeks post-treatment. RESULTS: The NRS at 2 weeks (BoNT-A vs. TA; 5.0 vs. 5.2), 4 weeks (4.1 vs. 4.9) and 8 weeks (3.8 vs. 4.6) of both treatment groups were significantly lower than that measured at baseline (7.4 vs. 7.6). The ROM of patients' shoulders increased significantly from baseline in both treatment groups. There was no significant difference in the NRS of pain intensity or the ROM between the two groups. Reduction in the pain intensity score was maintained for 8 weeks post-injection in both groups. There were no significant adverse events in either treatment group. CONCLUSION: The results suggest that there are no significant short-term differences between the intra-articular injections of BoNT-A and TA. Although BoNT-A has a high cost, it may be used as a safe alternative of TA to avoid the steroid-induced side effects or as a second-line agent, for patients who have failed to respond to the current treatments.

Myelopathy Caused by Spinal Dural Arterio-Venous Fistula after First Lumbar Vertebral Body Fracture: A Case Report

Spinal dural arteriovenous fistula is a rare vascular lesion of the spinal cord associated with progressive myelopathy. Symptoms include progressive gait dysfunction, weakness, sensory loss, and bowel and bladder dysfunction. Because these symptoms overlap with other common causes of myelopathy and the disease is rare, spinal dural arteriovenous fistula is often not suspected and the time to diagnosis is long. We report the case of a 60-year-old woman who presented with progressive lower limb weakness and gait disturbance diagnosed as spinal dural arteriovenous fistula involving a fractured L1 vertebral body.

Deep Vein Thrombosis Associated with May-Thurner Syndrome in an Amyotrophic Lateral Sclerosis Patient: A Case Report

There have been a few reports on deep vein thrombosis (DVT) associated with compression of the left common iliac vein by the right common iliac artery, referred to as May-Thurner syndrome (MTS). However, there have been no reports on DVT associated with MTS in amyotrophic lateral sclerosis (ALS) patients exhibiting similar clinical features to paraplegic spinal cord injury patients. We hereby report a case of DVT associated with MTS in an ALS patient, who was treated successfully.

The Intra-articular Shoulder Injection of Botulinum Toxin A on Stroke Patients with Complex Regional Pain Syndrome

OBJECTIVE: To evaluate the short-term clinical effects of intra-articular shoulder injection with botulinum toxin type A (BoNT-A) in acute hemiplegic stroke patients with complex regional pain syndrome type I (CRPS I). METHOD: Fifty patients were assigned at random to receive intra-articular shoulder injection. The treatment groups were divided into two groups: BoNT-A group, 200 IU of BoNT-A and 2 ml of normal saline; triamcinolone acetonide (TA) group, 20 mg of triamcinolone and 2 ml of 2% lidocaine. Uptake ratio of quantitative three phase bone scintigraphy (QTPBS) was calculated by dividing the radioactivity count on the affected side by that on the unaffected side. Shoulder pain was assessed by visual analogue scale (VAS) and neuropathic pain scale (NPS). Range of motion (ROM) of shoulder joint and functional independence measurement (FIM) of upper limb were evaluated. All of them were measured before injection, and 4 weeks after injection. RESULTS: After 4 weeks, the uptake ratio of blood pool phase was significantly decreased in hands of BoNT-A group than TA group. VAS, ROM and upper extremity FIM was similarly improved in both groups. Pain intensity and cold pain of NPS were similarly decreased in both groups. Hot pain and dull pain of NPS decreased more significantly in BoNT-A group than TA group. CONCLUSION: In the short-term, intra-articular BoNT-A shoulder injection maybe has the therapeutic effect on acute CRPS I related stroke. And the uptake ratio of blood pool phase of the hand of QTPBS may be useful to assess the therapeutic effect of CRPS after acute stroke.

Septated de Quervain's Disease with MRI Images: A case report

De Quervain's disease is the most common form of tenosynovitis, which causes disability in daily living and occupational activity. Anatomical variations in the first extensor compartment including separate comparment influenced the effects of treatment. A 45-year-old woman had severe pain on wrist and suffered in activity of daily living after motor vehicle accident. She had swelling and tenderness upon the radial styloid process, and more aggravated pain by Finkelstein's maneuver test. The magnetic resonance imaging (MRI) scans showed severe peritendinous edema within the synovial sheath, increased signal intensity within the tendons. Also, the images revealed a thickened septum between abductor pollicis longus and extensor pollicis brevis. Corticosteroid was injected on both sides of the septum. We report a case of definite septum of de Quervain's disease via MRI scans.

A Case of Lateral Medullary Infraction Presenting with Thoracic Sensory Level

Loss of pain and temperature sensation due to lateral medullary infarction are well known and classically involve the ipsilateral side of the face and the lower part of the body on the controlateral side. This pattern of sensory loss below a certain level on the trunk, usually a sign of spinal cord disease, may also appear following a lesion in the lateral medullar, due to damage to the spinothalamic tract. A 72-year-old hypertensive man developed sudden dizziness, headache, and gait ataxia. On neurologic examination, he had left limb and gait ataxia. Five days later he noted loss of pain and temperature sensation on the right leg and trunk with a sensory level at T4 with preservation of touch, vibration, and joint position sense in all limbs. Brain MRI showed a small infarct in the left lower lateral medulla. Brain MR angiography showed stenosis of the right proximal carotid artery, left distal vertebral artery, and mid-basilar artery. We report a case of sensory defects with a sensory level on the trunk that occured as the result of lesion of the lower lateral medulla.

Electrophysiological Abnormalities in a Patient with Acute Methyl Bromide Poisoning

No abstract available.

The Effects of Gait Training with Partial Weight Bearing Harness on Treadmill in Early Stroke Patients

OBJECTIVE: To assess the effects of partial weight bearing (PWB) harness with comparison of traditional exercise program by gait analysis in non-ambulatory acute stroke patients. METHOD: Nine patients participated with PWB harness on the treadmill, and nine patients with traditional exercise. In harness group, the gait training with 30% weight reduction was offered on treadmill, they were treated daily and gait training was done for 20 minutes. In no-harness group, traditional gait training was done by physical therapists. Variables were gait parameters assessed by VICON 370 Gait Analyzer, other function tested by Motricity Index and Functional Ambulatory Category. RESULTS: In linear parameter, the harness group had faster gait speed, longer stride length, and more decreased double support time compared to the no-harness group. In kinematic parameters, the maximal flexion of knee was significantly increased in harness group, but no significant differences was in hip and ankle motion. In kinetic parameters, hip flexion moment of normal side was increased in harness group at heel strike phase, knee flexion moment of normal side was decreased in harness group at heel strike phase. CONCLUSION: The gait training with partial weight bearing harness was more effective in acute stroke patients than traditional therapy, and was influenced in gait pattern, functional ability.

Scapular Mestastasis of Hepatocellular Carcinoma with Total Supraspinatus Tendon Rupture: A case report

Hepatocellular carcinoma is one of the most prevalent cancers in the world, particularly in Asia and part of Africa. Hepatocellular carcinoma usually spreads o the lung and regional lymph nodes and its clinical presentation with bone metastasis to scapulae is very rare. We experienced a patient who was a 60-year-old female, visited for unilateral shoulder pain with previous hepatocellular carcinoma history. The physical examination suggested supraspinatus tear and joint problem, but pain nature was atypical. In further MRI imaging, scapular metastasis with full thickness tear of supraspinatus was detected. So we confirmed scapular metastatic lesion by hepatocellular carcinoma and transferred to gastrointestinal department for intensive care, but she discharged to home her own way. She expired with dyspnea and heart arrest 1 month later. We report the scapular metastasis of hepatocellular carcinoma with total supraspinatus tendon rupture.

Changes of Plasma Lipids in Stroke Patients

OBJECTIVE: To investigate plasma lipid changes in pre- and poststroke patients and to evaluate the difference of these changes between hemorrhagic and ischemic strokes. METHOD: Two hundred thirty five stroke patients who underwent blood tests for health check-up before stroke were included in this study. Lipids profile among blood tests included total cholesterol, triglyceride, low density lipoprotein cholesterol, and high density lipoprotein cholesterol. These tests were taken again within 48 hours, at 1 week, and 3 months after stroke. Prestroke lipid profile was compared with the control group, which was composed of two hundred forty seven healthy men. RESULTS: The difference between lipid profile of prestroke and within 48 hours after stroke was not statistically significant. Total cholesterol at 1 week after stroke was significantly lower, but its concentration increased at 3 months after. There's no significant changes in triglyceride, low density lipoprotein cholesterol, or high density lipoprotein cholesterol according to time. There was no significant difference in lipid profile between the ischemic and hemorrhagic strokes and no significant changes between the subtypes of ischemic stroke were noted. CONCLUSION: Our results suggest that the lipid profile after stroke is changed, so the lipid profile taken after stroke are not reflect clearly the state of prestroke lipid concentration.

The Phrenic Nerve Conduction Study in Diabetic Patients

OBJECTIVE: To assess the possibility of phrenic neuropathy in diabetic patients, and to define the factors that influence phrenic neuropathy in those patients. METHOD: Seventeen diabetic patients and sixteen controls participated in this study. The fasting and postprandial 2 hours blood sugar levels, HbA1c study, motor and sensory nerve conduction study, pulmonary function test, and phrenic nerve conduction study were examined in all subjects. The neuropathic disability score (NDS) was measured for clinical assessment in diabetic patients. RESULTS: 1) The mean duration of diabetes was 12.3+/-7.7 years, and the mean NDS score was 3.2+/-3.8. 2) In pulmonary function test, FEV1 and FVC of diabetic patients were lower than controls (p<0.05). 3) The prolonged latency and decreased amplitude of phrenic nerve were shown in diabetic patients compared with controls (p<0.05). The FEV1 and FVC in the diabetics with phrenic neuropathy were lower than ones without phrenic neuropathy (p<0.05). 4) The duration of diabetes, NDS are related to prolonged phrenic latency. CONCLUSION: The diabetic patients with decreased pulmonary function with might be related phrenic neuropathy. The prolonged latencies of phrenic nerve were related with longer duration of diabetes and higher NDS score.

The Initial Computerized Tomography Findings of the Brain and the Functional Outcome in Traumatic Brain Injured Patients

OBJECTIVES: To investigate the correlation of the initial Computerized Tomography(CT) findings of the brain and the functional outcome, and to suggest the initial CT findings as a functional outcome predictor in the traumatic brain injured(TBI) patients. METHODS: Thirty-nine TBI patients were included in this study. Subjects were divided into groups of non-focal or focal TBI, and with or without a depressed skull fracture according to their initial brain CT findings. RESULTS: The non-focal TBI patients were not significantly different from focal TBI patients in the days from onset to rehabilitation, rehabilitation stay, and initial FIM score. However their outcome in FIM gain and FIM efficiency significantly worse than focal TBI patients. The TBI patients with a depressed skull fracture were not significantly different from the patients without a depressed skull fracture in the days from onset to rehabilitation, rehabilitation stay, and intial FIM score. However their outcomes were significantly worse than patients without a depressed skull fractrue in FIM efficiency. CONCLUSION: The initial brain CT findings were generally useful for the prediction of functional outcomes in TBI patients.

Diurnal Variation of Plasma Anti-Diuretic Hormone and Relationship to Nocturnal Polyuria after Spinal Cord Injured Patients

OBJECTS: To investigate the effect of anti-diuretic hormone (ADH) on nocturnal polyuria in spinal cord injured patients. METHODS: Eleven quadriplegics, seven paraplegics, and nine normal person participated in this study. Quadriplegics and paraplegics ranged from A to C grades according to the ASIA classification. All participants were independent in activities of daily living on wheelchair level. Their intake and output were measured at every 6 hours for 24 hours. The level of ADH was measured by the radioimmunoassay method. RESULTS: 1) Urine output from midnight to 6:00 A.M. was increased in quadriplegics, but not in paraplegics. 2) ADH at 6:00 A.M. and midnight was decreased in quadriplegics than in controls. No significant change of ADH level was noted in paraplegics. 3) Serum osmolality was higher in quadriplegics than in controls at 6:00 A.M. and midnight. CONCLUSION: This study indicates that the nocturnal polynuria in spinal cord injured patient is partly due to a decreased ADH.