Obturator Internus Myofascial Pain: A Cause of Undiagnosed Chronic Pelvic Pain Syndrome: Case reports

Chronic pelvic pain is difficult to diagnose and usually has a poor outcome. However, if it was identified early it might have a better prognosis. We treated three patients whose trigger points in obturator internus were diagnosed as origin of myofascial pain. The first patient complained of coccygodynia with pain that radiated up his left leg when walking. The second patient had coccygeal pain that radiated to the left thigh area. The last patient was troubled with coccygeal and pelvic pain at anytime. In all of the cases MRI studies of the lumbar spine and pelvis were unrevealing. Electrodiagnostic studies were normal. The impression was that the patients had the myofascial pain syndrome, therefore injections with local anesthetics and cortisone at the myofascial pain originated in obturator internus. Although each of the patients had different symptoms, they all had a good response to treatment.

Relation of Nerve Conduction Study and Physical Parametersin Diabetic Polyneuropathy

OBJECTIVE: To determine the relations of parameters of nerve conduction study (NCS) and total symptom score (TSS), neuropathy impairment score (NIS) in diabetic polyneuropathy patients. METHOD: Seventy three patients with diabetes mellitus were included in the study. The NIS, TSS was scored in each patient by a single examiner. NCS was performed on median, ulnar, tibial, peroneal and sural nerves. Distal latencies, amplitudes and conduction velocities of compound muscles and nerves were used as parameters of NCS. The transformed individual amplitudes and nerve conduction velocities were graded in relation to the mean values and standard deviations of our control group study. Then, composite score (CS) was calculated in each individual and was correlated to the NIS, TSS using correlation analysis. RESULTS: There was a significant linear relationship between CS and NIS-LL (neuropathy impairment score-lower limb) (r=0.718, p<0.01) CONCLUSION: This study showed significant correlations between composite score and NIS-LL. Thus, composite score appears to reliably represent the objective neurologic findings. In addition, NIS-LL would be useful in determining the progression of peripheral polyneuropathy in diabetic patients.

Spinal Subdural Hematoma Associated with Anticoagulant Treatment for Acute Cerebral Infarct: A case report

Spinal subdural hematoma (SDH) is a rare cause of acute spinal cord compression. In most cases, these lesions are observed in association with lumbar puncture or spinal anesthesia, coagulation defect, or an underlying vascular malformation. The use of anticoagulant drug is recommended in managing deep vein thrombosis, acute myocardiac infarct, or acute cerebral infarct. But the risk of bleeding in major organs still exists and is increased by the use of multiple anticoagulants and the intensity of anticoagulation. The risk of spinal hematoma is increased in anticoagulated patients who undergo lumbar puncture or spinal anesthesia. But to dates, there are extremely rare cases of spontaneous spinal SDH occurring in patients with anticoagulant therapy when spinal instrumentation is not also being used. With reviewing some of literatures, we present a case of acute spontaneous spinal SDH developed whilereceiving anticoagulant therapy for treating acute cerebral infarct.

Clinical Spectrum of Peripheral Neuropathy in Post-AcuteSpinal Cord Injured Patients

OBJECTIVE: To determine the incidence of peripheral neuropathy occurring in post-acute spinal cord injury patients. METHOD: We retrospectively reviewed the distribution of involved nerves in 94 spinal cord injury patients (men: 77, mean age: 45.2 years) who underwent electrodiagnostic studies at an early stage of rehabilitative therapy between March 1999 and June 2007 and looked for the existence of peripheral neuropathy according to the injured area (cervical/ thoracolumbar cord). RESULTS: The incidence of peripheral neuropathy observed on electrodiagnostic studies was 38.3% (36/94). Twenty-one (46.7%) of 45 patients with injured cervical cords exhibited peripheral neuropathy, and 15 (30.6%) of 49 thoracolumbar cord injury patients exhibited peripheral neuropathy; hence, tetraplegia had a higher incidence. The most commonly involved nerve was the peroneal nerve (24 cases), followed by the median nerve (9 cases) and the ulnar nerve (9 cases). CONCLUSION: The incidence of peripheral neuropathy observed in electrodiagnostic studies was high in spinal cord injury patients at the initiation of intensive rehabilitative therapy. The incidence of peripheral neuropathy in cervical cord injury patients was higher than that seen in thoracolumbar injury patients. Active education and training concerning appropriate bed positioning are necessary for spinal cord injury patients at an early stage after injury to prevent peripheral neuropathy.