Intramuscular Hemangioma Mimicking Myofascial Pain Syndrome: A Case Report

Intramuscular hemangioma, an infrequent but important cause of musculoskeletal pain, is often difficult to establish the diagnosis clinically. This report describes a case of a 32-yr-old woman who presented with severe left calf pain for 10 yr. Initial conservative treatments consisting of intramuscular electrical stimulation, herb medication, acupuncture, and intramuscular lidocaine injection under the diagnosis of myofascial pain syndrome in other facilities, failed to alleviate the symptoms. On physical examination, there was no motor weakness or sensory change. Conventional radiography of the leg revealed a soft tissue phlebolith. Conventional angiography study showed hemangioma. Intramuscular hemangioma within the soleus muscle was confirmed by magnetic resonance imaging. Following surgical excision of the hemangioma, the patient's symptom resolved completely. Intramuscular hemangioma is a rare cause of calf pain and should be considered in the differential diagnosis if a patient with muscle pain, particularly if associated with a soft tissue mass, fails to respond to conservative treatment.

The Influence of the Median Nerve Length on the Diagnosis of Carpal Tunnel Syndrome

OBJECTIVE: To evaluate the influence of the length of the median nerve in the diagnosis of carpal tunnel syndrome (CTS). METHOD: Inching test of median sensory nerve using Ten Electrodes was performed in 114 hands of 68 CTS patients and 68 hands of 34 controls. The abnormal cut-off values of 1-cm, 2-cm, 3-cm, 4-cm, 5-cm, 6-cm, and 7-cm segment studies were calculated as the maximal conduction delay per centimeter (maximal CD/cm)+SD x 2 for each segment in controls. Based on such values, the sensitivity of each segment study in the CTS group and the specificity in controls were obtained. RESULTS: In controls, mean CD/cm was 0.20+/-0.08 ms, and maximal CD/cm was 0.26+/-0.08 ms in the segment between 2 and 3 cm distal to distal wrist crease. With the abnormal cut-off value set at 0.26 ms, the sensitivity of the 1-cm segment study was 98.5% in CTS. The sensitivities of the 2-cm through 7-cm segment studies were 93.9%, 93.9%, 92.4%, 92.4%, 92.4%, and 90.9%, respectively. CONCLUSION: These suggest that studies of longer nerve segments tend to lower the sensitivity of the test because the inclusion of the unaffected segments in calculation attenuates the effect of conduction delay at the site of the lesion.

The Reliability of Patient Pain Drawings Using 3D Virtual Human Body System

OBJECTIVE: The purpose of this study was to evaluate the reliability of patient pain drawings using a 3-dimensional (3D) virtual human body system. METHOD: Pain drawings were collected from thirty-four patients with various types of musculoskeletal pain. On the first clinic visit, patients were instructed to draw in their pain areas on a diagram depicting the body (P1). The examining physiatrist, blinded to the patients drawing, also drew in the pain areas on a separate diagram based on thorough history taking (D). After 2 to 9 days without treatment, patients repeated their pain drawings (P2). A second physiatrist input each of the pain drawings into thePain Chart System (PCS), for comparison of pain distribution sites and areas among the three drawings. The weighted-sum of comparison algorithms was calculated for similarity determinations between drawings. RESULTS: The similarity values between P1 and P2, and P1 and D were 0.63+/-0.18 (mean+/-S.D.) and 0.62+/-0.18 (mean+/-S.D.), respectively, reflecting a high reliability of pain drawings. CONCLUSION: High test-retest and inter-individual reliability of successive pain drawings suggest that pain drawings may be a useful tool to describe the painful sites.

Tenelectrodes: a New Stimulator for Inching Technique in the Diagnosis of Carpal Tunnel Syndrome

This study was designed to evaluate the usefulness of a new multielectrode stimulator, TenElectrodes, in the diagnosis and localization of the compression site in the wrists of carpal tunnel syndrome (CTS) patients. Antidromic inching technique (IT) of the median nerve at the wrist was performed with the TenElectrodes, on 46 controls and 21 CTS patients. In controls, mean conduction delay per centimeter (CD/cm) was 0.21 milliseconds (ms), and maximal CD/cm was 0.27 ms in the segment 3 to 4 centimeters distal to the distal wrist crease. The abnormal cut-off value, calculated as the maximal CD/cm + 2SD, was 0.45 ms. In the CTS group, the maximal CD/cm was 0.56 ms in the segment 2 to 3 centimeters distal to the distal wrist crease, and the CD/cm values in all segments between the distal wrist crease and 4 cm distal to the distal wrist crease were greater than 0.45 ms. Antidromic IT using TenElectrodes may be an easy, fast and accurate method as the electrodes of the stimulator are aligned at 1-cm intervals and are adjustable to the wrist contour by springs.