Effects of Intra-Articular Injection and Subscapularis Motor Point Block on Painful Hemiplegic Shoulder

OBJECTIVE: To evaluate the effects of intra-articular injection of shoulder and subscapularis motor point block on painful hemiplegic shoulder. METHOD: Thirty painful hemiplegic shoulder of recent onset stroke were divided randomly into three groups, i.e. group I: range of motion (ROM) exercise only, group II: intra-articular injection with ROM exercise, group III: subscapularis motor point block with ROM exercise. The intra-articular injection of shoulder was done with 20 ml of normal saline, 5 ml of 1% lidocaine, and 40 mg of triamcinolone. The subscapularis motor point block was done with 5 ml of 5% phenol under electromyographic guide. The ROM in external rotation and simple X-ray of shoulder in full abduction were checked in three groups at pre-treatment and post-treatment 3 week, and the glenohumeral abduction and scapulohumeral rhythm were obtained from the shoulder X-ray. RESULTS: There were significant (p<0.05) improvements of glenohumeral abduction, external rotation, and scapulohumeral rhythm of shoulder in group II and III, but improvement of only glenohumeral abduction was significant in group I. Angular increment of glenohumeral abduction and external rotation was most significant in group III compared with other two groups. CONCLUSION: These results suggest that the intra-articular injection of shoulder and subscapularis motor point block are potentially useful techniques in the prevention and management of the painful hemiplegic shoulder.

Clinical Measurement of Distance from Skin to Epidural Space in L3-4 Interspace

The purpose of this study is to measure the skin epidural distance(SED) of L3-4 interspace and to correlate SED with the individual constitutional data of patients such as body-weight, height, abdominal circumference and body mass index(BMI; kg/m2). In this study we examined 120 patients (45 men and 75 women) who had no pathological abnormality in L3-4 interspace such as herniated disc, spondylolisthesis and spinal stenosis in MRI study, although majority of patients had pathology below this level. The SED was measured under fluoroscopic guide with loss of resistance technique, and we also measured individual constitutional data of patients. Pearson's correlation analysis of the data showed that there were no correlations of statistical significance between SED and the height, abdominal circumference of the patient (p>0.01). But there were statistically significant correlations between SED and body-weight as well as BMI (p<0.0001). Linear regression analysis of these data showed significant correlations between SED and body weight(male r(2)=0.49, p<0.0001, y=0.37x18.1; female r(2)=0.31, p<0.0001, y=0.18x30.8), BMI(male r(2)=0.52, p<0.0001, y=0.89x23.1; female r(2)=0.35, p<0.0001, y=0.41x31.6).

Recurrent Dermatomyositis during Pregnancy: A Case Report

Dermatomyositis(DM) is the classic example of an inflammatory disease that has both cutaneous and systemic manifestations. An association with pregnancy is very uncommon. Glickman described the first case of DM associated with pregnancy in 1958. Since then a few reports of DM cases associated with pregnancy were published. This is the report of a female patient who had a previously established diagnosis of DM, and then became pregnant during the remission stage of DM. The DM recurred in 33 week of gestation. Because a Pregnancy it involves alterations in the immune responses of the patients, it may lead to a recrudescence or aggrevation of DM. The pregnancy should be considered a high risk for a recrudescence and aggrevation of DM. Careful monitoring of DM patients and with pregnancy should be warranted.

Antispastic Effect of Transcutaneous Electrical Nerve Stimulation and Acupuncture in the Stroke Patients

Spasticity is common stroke in patients, and its management has been considered as one of the major problems in stroke rehabilitation. The goal of this study was to determine if transcutaneous electrical nerve stimulation(TENS) and acupuncture would reduce the muscle spasticity. To estimate the efficacy of electrical stimulation for the treatment of spasticity TENS(100 Hz, asymmetric bipolar pulse current) was applied to the skin over the extensor muscles of spastic limbs for 20 minutes, once a day in six stroke patients. In addition, acupuncture was also applied to the acupoints of extensor muscles of all extremities and face for 20 minutes twice a day to determine the efficacy of acupuncture for the treatment of spasticity in six stroke patients. As controls subjects, six stroke patients were examined without TENS or acupuncture treatment. In experimental groups, the efficacy of treatment was measured 1, 5, 10, 15 days and 20 days after treatment with either TENS or acupuncture using the spasticity measurement methods (modified Ashworth scale, ankle clonus score, and H/M ratio). Based on the results from the present study, we have concluded that the H/M ratios of affected spastic limbs were significantly higher than those of unaffected limbs (p<0.05). TENS and acupuncture therapies lessened the spasticity of affected limbs of stroke patients when measured with the modified Ashworth scale however not with the H/M ratios nor with the ankle clonus scores.