The Effect of Extracorporeal Shock Wave Therapy in Plantar Fasciitis

OBJECTIVE: To evaluate the effect of extracorporeal shock wave therapy (ESWT) in plantar fasciitis with visual analog scale score and thickness of fascia by ultrasonography. METHOD: The subjects consisted of 32 feet (24 patients) with established diagnosis of chronic plantar fasciitis, including 17 feet in the ESWT group and 15 feet in the control group. In the ESWT group, three session of ESWT (0.24 mJ/mm2 FED, 1,200 impulse, weekly) were performed. The visual analog scale (VAS) score and thickness of the plantar fascia were measured by ultrasound before therapy and at the 6-week and 6-month follow-up. Patients in the control group were treated with medication, orthotics, physical therapy and exercise program. VAS and thickness of plantar fascia was evaluated at the same time as ESWT group. RESULTS: In the ESWT group, thickness of plantar fascia decreased significantly at 6-week follow-up (p 0.05). Visual analog scale score showed no significantly difference at 6-week follow-up (>0.05), but decreased at 6-month follow-up. On the other hand, in the control group, thickness of plantar fascia did not change significantly at 6-week follow-up (>0.05) and 6-month follow-up (>0.05). VAS score was not significant different at the 6-week follow-up (>0.05), but decreased at the 6-month follow-up (p <0.05). CONCLUSION: ESWT in plantar fasciitis is effective in relieving subjective pain and reducing thickness of plantar fascia at 6-month follow-up.

Computerized Analysis of Postural Instability in Parkinson's Disease

OBJECTIVE: To evaluate and quantify the postural instability in patients with Parkinson's disease (PD) using computerized posturography. METHOD: Twenty subjects with PD group (10 men, 10 women) and 20 control group (10 men, 10 women) were matched for age and sex. Average Hoehn-Yahr stage of PD group was 2.3+/-0.3. Sensory dysfunction, voluntary motor impairments and functional limitation were measured by determining the subject's response to reduced or altered sensory and voluntary motor control of balance. RESULTS: PD subjects demonstrated wider area of sway (degrees) under eye closed condition in modified sensory organization test and lower directional control (%) in right/left rhythmic weight shift (p<0.05). No significant difference was observed for sit to stand. Wider area of turn sway (degrees) and longer turn time (sec) during left step/quick turn were demonstrated in PD subjects (p<0.05). CONCLUSION: Computerized posturography shows that sensory dysfunction scores, voluntary motor impairment scores and functional limitation test scores were reduced in patients with PD.

The Effects of Growth Hormone on Quality of Life and Metabolism of Spinal Cord Injured Patients

OBJECTIVE: To evaluate the effects of growth hormone on metabolism and quality of life of spinal cord injured patients. METHOD: Thirteen chronic spinal cord injured patients without metabolic and psychologic disorders except growth hormone deficiency were included in the study. They were randomly divided into two groups. Seven patients received growth hormone and six patients received distilled water as control. Before and after 6 months' administration, we measured Adult Growth Hormone Deficiency Assessment (AGHDA) and Psychological General Well-Being Index (PGWBI) for assessing quality of life. Bone mineral density (BMD), osteocalcin, urine deoxypyridinoline, % lean body mass, % body fat, body mass index (BMI) and lipid profile were also examined for assessing metabolic states. RESULTS: The AGHDA score decreased significantly from 6.7+/-2.9 to 3.9+/-2.1 (p<0.05), and the PGWBI score increased significantly from 81.7+/-14.8 to 88.7+/-8.7 (p<0.05) in growth hormone treatment group. There were no significant differences in control group. Other values about metabolic states were not significantly different in all groups. CONCLUSION: Growth hormone was effective on improving quality of life in spinal cord injured patients, but there was no positive effect on metabolic values for short-term therapy.

The Prevalence of Anemia in Recreational Runner

OBJECTIVE: To evaluate the prevalence and characteristics of anemia in the long distance runners. METHOD: Subjects included 61 long distance runners and 40 control. The 61 subjects averaged 39.9+/-4.5 years of age. Long distance runners has been training for at least 6 months. Hemoglobin, iron, total iron binding capacity, reticulocyte count, peripheral blood smear, urine hemosiderin were evaluated. WHO criteria cut off value of hemoglobin for the diagnosis of anemia was used, 13 g/dl in men and 12 g/dl in women. Iron deficiency was defined as the percent transferrin saturation less than 15. The percent transferrin saturation was calculated by dividing the serum iron level by the total iron-binding capacity. RESULTS: Anemia occurred in only 2.0% and 9.0% of the male and female long distance runners respectively and other laboratory findings supported diagnosis of iron deficiency anemia. The percentage of iron deficiency anemia was lower than normal control. Iron deficiency was evident in 6.0% and 18.1% of the male and female long distance runners respectively. CONCLUSION: Recreational long distance runners were at no greater risk for developing a frank anemia than the non-exercising population.

Effects of Growth Hormone Replacement Therapy on Quality of Life in Patients with Somatopause

OBJECTIVE: There is increasing interest in growth hormone (GH) replacement therapy to improve quality of life (QoL) of elderly with age-related decline in GH level (somatopause). The aim of this study was to evaluate the effect of GH replacement on the QoL in patients with somatopause. METHOD: A prospective study of 56 adults with somatopause was conducted. They were replaced with a GH over a 6-month period. QoL was assessed by using three self-rating questionnaires: the Nottingham Health Profile (NHP), the Psychological General Well-Being Index (PGWBI) and theAssessment of Growth Hormone Deficiency in Adults (AGHDA). RESULTS: Significant impairment in QoL as measured by NHP, PGWBI and AGHDA were noted in patients with somatopause compared with age and sex matched normal population (p<0.05). There was significant improvement in QoL after 6-month of GH replacement (p<0.05). CONCLUSION: Six months GH replacement induced an improvement in the QoL of patients with somatopause.

Effects of Zoledronate on Thoracic Vertebral Fracture in an Ankylosing Spondylitis Patient: A case report

Patients with ankylosing spondylitis are more susceptible to spine fractures than healthy people. Because of their underlying back pain, vertebral fracture induced pain is not easily controlled by bed rest, physical therapy and medications. Thus, new treatment methods should be introduced. We report a 63 year-old man with ankylosing spondylitis who fell down 4 weeks ago and suffered a fracture of T6 spine. He complained of a mid thoracic pain. Although he was treated with bed rest, physical therapy, second-line bisphosphonate agents, the pain persisted. Therefore, intravenous zoledronate which was approved for palliative treatment of bone metastases in patients with breast cancer, 4 mg was administrated. The severity of pain was decreased by half within 2 days and sustained over 4 weeks.

The Effects of Human Adipose Tissue Derived Mesenchymal Stem Cells on Degenerative Change of Disc in Rabbit Model

OBJECTIVE: To determine whether transplanted human adipose tissue derived stem cells (hATSCs) can survive and increase the amount of proteoglycans in degenerated intervertebral disc. METHOD: Lumbar disc degeneration was induced in thirty New Zealand white rabbits by injection of chondroitinase ABC(R). After 2 weeks, hATSCs were transplanted in degenerated disc in hATSCs group. Control group received phosphate buffered saline. The histologic grading and height of disc were measured at 2, 4, and 8 weeks after transplantation. The viability of donor cells was identified by using beta-Actin gene polymerase chain reaction (PCR). RESULTS: 4 and 8 weeks after hATSCs transplantation, the histologic grading showed significantly high score in hATSCs group (p<0.05), but the amount of proteoglycans was not significantly different between the two groups. The change of disc height was not significantly increased in hATSCs group. In the beta-Actin gene PCR analysis, positive signal in the hATSCs group was observed. CONCLUSION: hATSCs transplantation may be useful in decelerating disc degeneration in experimental models and provide new hopes for treatment of degenerative disc disease in humans

Effects of Short Stretch Bandage and Electrical Stimulation Therapy for the Complex Regional Pain Syndrome in Hemiplegic Patients

OBJECTIVE: To evaluate effects of short stretch bandage and electrical stimulation therapy (EST) for the complex regional pain syndrome (CRPS) in hemiplegic patients METHOD: 10 hemiplegic CRPS patients after stroke or traumatic brain injury were included in the study. We established CRPS from clinical symptoms and triphasic bone scan. Short stretch bandage was applied on affected limb and changed every 24 hours for 2 weeks. EST was tried for 10 minutes twice per day. It was applied at finger and wrist flexor muscles. We measured hand volume of pre-and posttreatment using hand volumeter. Also compared pre-and posttreatment pain-free range of motion (ROM) of metacarpophalangeal (MCP) joint and third proximal interphalangeal (PIP) joint circumference. RESULTS: Mean difference of hand volume between the affected and the unaffected prior to treatment was 20.5+/-4.9 ml (7.9+/-2.3%). After treatment, mean volume change was 15.5+/-4.9 ml (5.5+/-1.8%) (p<0.05). Mean change of pain-free ROM was 8.0+/-4.8 degree (10.9+/-7.1%), mean change of PIP joint circumference was 3.1+/-1.4 mm (5.9+/-2.4%) (p<0.05). CONCLUSION: Short stretch bandage and EST complex therapy is effective for the reduction of paralyzed hand edema and pain in hemiplegic CRPS patients. However further control study is required.

The Effect of Vitamin K2 in Addition to Risedronate on the Patients with Postmenopausal Osteoporosis

OBJECTIVE: To assess the effect of vitamin K2 in addition to risedronate on postmenopausal osteoporosis METHOD: We enrolled 21 postmenopausal osteoporosis women (age: 65.2+/-7.8 years). Ten subjects received risedronate (35 mg, weekly) and vitamin K2 (45 mg, daily) and eleven subjects only received risedronate. They all received calcium citrate 2,130 mg and vitamin D 600 IU daily. The duration of treatment was 7.7+/-1.4 months. Bone mineral density (BMD) of lumbar spine and both femurs, serum osteocalcin and urine deoxypyridinoline were examined at baseline and after treatment. RESULTS: After treatment, BMD, serum osteocalcin and urine deoxypyridinoline were improved in each group but there was no statistical difference between the groups. CONCLUSION: There was no evidence of the benefit of vitamin K2 in addition to risedronate in bone metabolism on postmenopausal osteoporosis.

The Risk Factors Associated with Lymphedema after Axillary Dissection for Breast Cancer

PURPOSE: We wanted to evaluate the risk factors for developing lymphedema following axillary lymph node dissection in breast cancer patients. METHODS: Ninety-six patients who underwent axillary dissection for breast cancer were followed-up for up to 1 year. Lymphedema was assessed using a serial circumferential measurement method. More than a 2 cm difference in circumference was considered as clinically significant lymphedema. The effects of age, the body mass index (BMI), the cancer stage, chemotherapy, radiotherapy, the location of cancer and creating a latissimus dorsi (LD) flap on the development of lymphedema were analyzed. RESULTS: The incidence of lymphedema was increased with the advancing cancer stage. Radiotherapy was found to increase the incidence of lymphedema. Patients who had received an LD flap showed a lower incidence of lymphedema. CONCLUSION: These results could be useful as a clinical guideline for creating a management plan for postoperative lymphedema. Because there are some differences in the results between all the relevant reports, including ours, further research is needed in the form of a large, multi-center, long-term study.

The Change of Serum and Synovial IGF-I Level in Patients with Knee Osteoarthritis

OBJECTIVE: The purpose of this study was to investigate the serum and synovial IGF-I levels in 30 patients with knee osteoarthritis (OA) and the relationships among the IGF-I level, pain intensity and severity of knee OA. METHOD: Thirty patients who met criteria of knee OA of American Rheumatology Association participated in this study. Samples of serum and synovial fluid were obtained from all patients. The levels of IGF-I were determined by radioimmunoassay (RIA). The intensity of pain was assessed by Pain Rating Score (PRS) and Visual Analogue Scale (VAS). The severity of knee OA was evaluated by Kellgren's grade of knee OA. RESULTS: The mean serum and synovial IGF-I level was 231.66+/-86.15 ng/ml and 122.42+/-37.79 ng/ml, respectively. There was no correlation between pain intensity and IGF-I levels. Neither was there statistically significant correlation between Kellgren's grade and IGF-I levels. CONCLUSION: The serum and synovial IGF-I levels were not related with pain intensity and severity of knee OA.

Comparison of Provocative Tests for the Diagnosis of Adult Growth Hormone Deficiency in Normal Adults

OBJECTIVE: To compare the Madopar(R) (Levodopa Benserazide) test with Insulin Tolerance Test (ITT) as a provocation test for growth hormone (GH). METHOD: One hundred eighty-seven subjects who had not organic disease such as hypothalamic-pituitary disease were studied. Seventy-one subjects underwent an ITT by injection of 0.1 U/kg of regular insulin and blood samples for GH assay were taken at 0, 30, 60 and 120 minutes. One hundred sixteen subjects underwent a Madopar(R) test by administration of Madopar(R) and blood samples for GH assay were taken at 0, 60, 120 and 180 minutes. RESULTS: The GH mean peak response in ITT was significantly higher than that of the Madopar(R) test. Below 50 years, 18 of ITT and 24 of Madopar(R) test showd a GH peak response of less than 5 ng/ml. Above 50 years, 14 of ITT and 53 of Madopar(R) test showd a GH peak response of less than 5 ng/ml. CONCLUSION: The results suggested that the GH response to the Madopar(R) test was much less than that of the ITT. The Madopar(R) test was limited in diagnosis of the adult GH deficiency in normal adults.

Radiologic Measurement of Pes Cavus

OBJECTIVE: To determine valuable radiologic criteria in diagnosis of pes cavus. METHOD: Thirty eight healthy subjects and twenty seven pes cavus cases were evaluated by radiologic measurements. We evaluated the criteria for longitudinal arch curve by measuring the calcaneal pitch, talocalcaneal angle, talometatarsal angle, metatarsal angle and navicular height I and II. RESULTS: By comparing the pes cavus with the control group, no significant differences in the talocalcaneal angle, metatarsal angle and navicular height I and II were found. Whereas we found a significant difference between the talometatarsal angle and calcaneal pitch. Talometatarsal angle is more sensitive and specific compared to the calcaneal pitch. CONCLUSION: In diagnosis of idiopathic pes cavus, talometa tarsal angle is more reliable in the diagnosis of pes cavus. The ultimate diagnostic value of talometatarsal angle in pes cavus is 6degrees.

Effect of Lateral Heel and Sole Wedges in Patients with Osteoarthritis of Knees

OBJECTIVE: The purpose of this study was to evaluate the effect of lateral heel and sole wedges on osteoarthritis of knees. METHOD: Sixty patients with knee osteoarthritis were enrolled and divided into the control (n=30) and wedge (n=30) groups. The control group received only conventional therapy for 5 weeks, while the wedge group took lateral wedges with 4 mm height in additional to the same conventional therapy. Intensity of pain and funtional activity were assessed by Western Ontario and Mac-Master Universities Osteoarthritis index (WOMAC index) and Lequesne s index. Scanogram was measured to assess femorotibial anglechange. WOMAC index, Lequesne's index and scanogram were measured before and 6 months after the therapy. RESULTS: For the wedge group, WOMAC index and Lequesne's index were significantly lower at the six month follow up compared to the initial indices (p<0.05). The femorotibial angle showed no significant change in both groups. CONCLUSION: Lateral heel and sole wedges can be used as an effective therapeutic modality for long term management of knee osteoarthritis in combination with conventional therapy.

Clinical Utility of the Bedside Swallowing Evaluations for Dysphagia

OBJECTIVE: To assess the sensitivity and specificity of bedside swallowing evaluation for detecting tracheal aspiration. METHOD: Thirty patients who complained of swallowing difficulty or had potential for dysphagia were evaluated using videofluoroscopy and bedside swallowing evaluation for dysphagia. The bedside swallowing evaluations included gag reflex, laryngeal elevation, water swallowing test and swallowing provocation test. We compared bedside swallowing evaluations with videofluoroscopy to determine the sensitivity and specificity in detecting tracheal aspiration. RESULTS: The comparison of the all combination of bedside swallowing evaluation and videofluoroscopic results suggested that the sensitivity and specificity in the detection of tracheal aspiration was 84.6%, 47.0% respectively. CONCLUSION: Bedside swallowing evaluations are limited for screening test of tracheal aspiration, so videofluoroscopic swallowing studies would be necessary to evaluate swallowing difficulty.

Ultrasonographic Findings in Plantar Fasciitis

OBJECTIVE: To know the clinically meaningful findings of ultrasonography in plantar fasciitis. METHOD: Thirty one feet of 24 patients who had clinical diagnosis of plantar fasciitis and 70 feet of 35 healthy volunteers were evaluated with ultrasound. Sagittal sonograms were obtained in the prone position, and the plantar fascia thickness (PFT) was measured at proximal end near its insertion into the calcaneus. Hypoechogenecity, perifascial fluid collection, tendon rupture, calcaneal spur and calcification were also evaluated. RESULTS: The plantar fascia thickness (PFT) of the symptomatic heels (SH) of patients group (4.83+/-0.86 mm) was significantly greater than that of their asymtomatic heels (ASH) (2.95+/-0.57 mm)(p3.8 mm), difference of thickness between SH and ASH (>1.0 mm) and hypoecho genecity of plantar fascia were clinically meaningful ultrasonographic findings of plantar fasciitis, and ultrasonogrphy can be used as the inital imaging modality for the diagnosis.

The Effect of Intra-articular Hyaluronic Acid and Steroid Injection in Osteoarthritis of the Knee

OBJECTIVE: To evaluate the efficacy of intra-articular hyaluronic acid and steroid injection in osteoarthritis of the knee. METHOD: Among 653 patients with osteoarthritis, 531 patients were participated in this study. They were divided to three groups; A, treated with hyaluronic acid 2.5 ml intra-articular injection once a week for 5 times; B, hyaluronic acid 2.5 ml once a week for 5 times with triamcinolone 20 mg once at the first time; C, only triamcinolone 20 mg at the first time. Before injection, X-ray with standing view were checked and divided according to Kellgren's grade of osteoarthritis. The amount of pain relief was assessed by pain rating score (PRS) and visual analogue scale (VAS) 1 week before and 1 month after the treatment. RESULTS: The degree of pain relief by PRS and VAS were all improved at 1 month after injection compared with pre-injection status (p<0.001). Intra-articular hyaluronic acid injection was more effective in Kellgren's grade I, II than in III, IV in pain relief and hyaluronic acid with steroid injection was more effective in III, IV. CONCLUSION: The results suggest that intra-articular hyaluronic acid injection would be effective for the treatment of patients with osteoarthritis.

Radiologic Measurement of Flatfoot

OBJECTIVE: This study was aimed to demonstrate definite diagnostic radiologic criteria between normal and flatfoot. METHOD: Sixty healthy subjects and fifty two flatfoot cases were evaluated by radiologic measurements. We evaluated criteria for longitudinal arch curve by measuring of calcaneal pitch, talocalcaneal angle, talometatarsal angle, metatarsal angle and navicular height I and II. RESULTS: Over 10 years old, there was significant correlation between normal group and flatfoot in calcaneal pitch, talocacaneal angle, difference angle, metatarsal angle, navicular height I and II. But below 10 years old, there was difference in only talometatarsal angle and metatarsal angle. Therefore talometatarsal angle and metartarsal angle are valuable in diagnosis of flatfoot in all age group. CONCLUSION: In diagnosis of flatfoot, variable radiologic measurement are clinically significant.

Ultrasonography in the Shoulder Impingement Syndrome

OBJECTIVE: The purpose of this study was to evaluate the ultrasonographic (US) findings in the shoulder impingement syndrome and to correlate them with the Hawkins and Kennedy's clinical stages. METHOD: 41 patients with suspected shoulder impingement syndrome were evaluated. All patients were divided into 3 clinical groups according to Hawkins and Kennedy and US examination was done in each group. RESULTS: US findings were as follows. In stage I, there were 3 normal findings, 5 tendinitis of the rotator cuff (RC), 2 partial thickness tear of RC, and 0 full thickness tear of RC. In stage II, 6 normal findings, 13 tendinitis of RC, 3 partial thickness tear of RC and 2 full thickness tear of RC. In stage III, 0 normal findings, 1 tendinitids of RC, 1 partial thickness tear of RC, and 5 full thickness tear of RC. The most common findings in the tendinits of RC were tendon thickness, focal hypoechogenicity and calcification. In partial thickness tear of RC, focal hypoechogenicity and impingement in abduction were most common findings. In full thickness tear of RC, the irregular humeral head surface and the biceps tendon effusion were most common findings CONCLUSION: The ultrasonography is a valuable means of evaluating the shoulder impingement syndrome and its findings have good correlation with clinical stages

Effects of Low and High Frequency Needle Transcutaneous Electrical Nerve Stimulation on Pain Threshold in Normal Adults

OBJECTIVE: This study was conducted to compare the effects of low frequency needle transcutaneous electrical nerve stimulation (TENS) and high frequency needle TENS on experimental pain threshold. METHOD: Twenty two healthy adult subjects were assigned randomly to a low-TENS group or to a high-TENS group. Experimental pain threshold at forearm was determined with pain threshold of electrical simulation using surface electrode and needle electrode. RESULTS: Low-TENS group showed that pain relief was developed after 10 minutes and persisted 3 hours after treatment cessation. Low-TENS group showed a significant increase in experimental pain threshold opposing to high TENS group. CONCLUSION: This results suggest that effect of low frequency needle TENS therapy is better and longer than high frequency needle TENS therapy.