Arthrographic Findings of Frozen Shoulder and Therapeutic Effect of Distension Arthrography

OBJECTIVE: To define arthrographic findings in patients with frozen shoulder and to evaluate the therapeutic effect of arthrographic capsular distension and rupture. METHOD: Thirty patients who were clinically diagnosed as frozen shoulder were enrolled. During a trial of intra-articular injection of 35 mL of fluid which contained 8 mL of 1% lidocaine, 2 mL of prednisolone (80 mg) and 25 mL of radiocontrast material, arthrographic findings and the occurrence of iatrogenic capsular tear were observed. Passive range of shoulder motion (percent of normal, %) at flexion, abduction, internal rotation, and external rotation was measured at pre- and 1 week post-injection. The therapeutic effect of the procedure was statistically analyzed by paired Student's t-test. RESULTS: Mean age of the subjects was 57-years-old (range: 40~76 years) and mean duration of the symptom was 6 months (2~42 months). A decreased joint volume of less than 10 mL (100%), poor or absent filling of the axillary recess or subscapular bursa (75.9%), nonfill of the biceps tendon sheath (37.9%), and irregularity of capsular insertion (31.0%) were typical abnormal arthrographic findings. In one week after arthrographic distension and rupture, the passive range of shoulder motion was significantly (p<0.05) increased at flexion, abduction and external rotation, of which the range of external rotation was the most remarkably increased (mean, 23.9%). CONCLUSION: Distension arthrography was useful for increasing shoulder motion in frozen shoulder, especially at flexion, abduction and external rotation.

Clinical Significance of the Corpus Callosum in Cerebral Palsy

PURPOSE: To evaluate, using magnetic resonance (MR) imaging, the clinal significance of the corpus callosum by measuring the size of various portions of the corpus callosum in children with cerebral palsy, and in paired controls. MATERIALS AND METHODS: Fifty-two children [30 boys and 22 girls aged between six and 96 (median, 19) months in whom cerebal palsy was clinically diagnosed underwent MR imaging. There were 23 term patients and 29 preterm, and the control group was selected by age and sex matching. Clinal subtypes of cerebal palsy were classified as hemiplegia(n =14), spastic diplegia(n=22), or spastic quadriplegia(n=16), and according to the severity of motor palsy, the condition was also classified as mild(n=26), moderate(n=13), or severe(n=13). In addition to the length and height of the corpus callosum, the thickness of its genu, body, transitional zone and splenium, as seen on midsagittal T1-weighted MR images, were also measured. Differences in the measured values of the two groups were statistically analysed and differences in the size of the corpus callosum according to the clinical severity and subtypes of cerebral palsy, and gestational age, were also assessed. RESULTS: Except for height, the measured values of the corpus callosum in patients with cerebral palsy were significantly less than those of the control group (p < 0.05). Its size decreased according to the severity of motor palsy. Compared with term patients, the corpus callosum in preterm patients was considerably smaller (p< 0.05). CONCLUSION: There was statistically significant correlation between the severity of motor palsy and the size of the corpus callosum. Quantitative evaluation of the corpus callosum might be a good indicator of neurologic prognosis, and a sensitive marker for assessing the extent of brain injury.

Pressure Pain Threshold of Shoulder Muscles in VDT Workers / 대한산업의학회지

This study was carried out for evaluating the usefullness of pressure pain threshold as an objective test on shoulder muscles in VDT workers. Subjective symptoms, frequency and intensity of pain complaint were investigated by questionnaire method and objective tests, trigger point and pressure pain threshold of 14 shoulder muscles of dominant and nondominant side each, were performed by physical examination and using pressure algometer on 44 VDT workers (more than 2hrs a day) and 20 controls. And work status including work duration, daily work hours and continuous work hours per one time was also surveyed by questionnaire method. The relations among these items were analysed. Results were as follows; 1. The prevalences of shoulder pain in VDT workers and controls were 72.7% and 50.0%. The mean of pain frequency category scale was not significantly different between 2 groups, while the mean of pain intensity category! scale in VDT workers was higher than that in controls. The trigger point in VDT workers showed the highest frequency in the upper trapezius muscle which followed by the levator scapular muscle. And pressure pain thresholds of VDT workers were significantly lower than those of controls in all 14 shoulder muscles. 2. In VDT workers, the category scales of pain frequency and intensity during last one week in shoulder pain complaint group at the time of investigation were significantly higher than those in non complaint group. And the pressure pain thresholds of nondominant levator scapular, bilateral lower trapezius, nondominant posterior deltoid and nondominant pectoralis major muscles were significantly lower in complaint group. 3. The pressure pain thresholds of bilateral upper trapezius, levator scapular and lower trapezius muscles in VDT workers with trigger point at shoulder muscles were significantly lower than those in VDT workers without trigger point. 4. In terms of work duration, the pain frequency category scale during last one week of '5 years and more' group was significantly higher than that of 'less than 5 years' group, while pain intensity category scale. and pressure pain threshold were showed no significant difference. 5. In terms of daily work hour, pressure pain thresholds of bilateral upper trapezius, nondoininant levator scapular, dominant anterior deltoid, dominant posterior deltoid, dominant supraspinatus, and nondominant pectoralis major of 4 hours and more' group were significantly lower than those of 'less than 4 hours group, while category scales of pain frequency and intensity during last one week were showed no significant difference. 6. In terms of continuous work hour, the frequency and intensity category scale was significantly higher and pressure pain thresholds of dominant upper trapezius, bilateral levator scapular and dominant lower trapezius muscles were significantly lower in 2 hours and more' group than 'less than 2 hours' group. In conclusion, in order to evaluate more objectively the musGuloskeletal. impairment by VDT work it is recommended that objective tests such as trigger point and pressure pain threshold are performed in addition to survey of subjective symptoms. And also more consideration on daily work hour and continuous work hour than total work duration is required.