Effects of a Modified Hand Compression Bandage for Treatment of Post-Burn Hand Edemas

OBJECTIVE: To evaluate the effect of a modified hand compression bandage in patients with a post-burn hand edema. METHODS: Patients were recruited from burn centers. We classified the patients into two groups: the modified hand compression bandage group comprising of 22 patients who had a modified hand compression bandage and received conventional physical therapy and the conventionally treated group, comprising of 20 patients who received only conventional physical therapy during the 4-week period post-burn. Hand circumference, hand skin thickness, and hand function were evaluated by grip strength, active range of motion (ROM), Jebsen hand function test, and visual analogue scale (VAS). These assessments were used to evaluate treatment effectiveness prior to the first treatment, 2 weeks after the first treatment, 4 weeks after the first treatment, and 4 months after the first treatment. RESULTS: As a result of repeated-measures analysis of variance on hand circumference, skin thickness, VAS, and each metacarpophalangeal joint ROM, we found significant differences that corresponded to time effect (p0.05). CONCLUSION: The modified hand compression bandage will be clinically useful for the treatment of patients with post-burn hand edemas.

Outcomes of Ultrasound-Guided Extracorporeal Shock Wave Therapy for Painful Stump Neuroma

OBJECTIVE: To investigate the effect of extracorporeal shock wave therapy (ESWT) on painful stump neuroma. METHODS: Thirty patients with stump neuroma at the distal end of an amputation site were assigned randomly to the ESWT group (n=15) and the transcutaneous electrical nerve stimulation (TENS)+desensitization+pharmacological treatment group (n=15). For 3 weeks, the ESWT group received a weekly session involving 1,500 pulses at 0.10 mJ/mm2, while the control group was treated 10 times each, 40 minutes per day with TENS and desensitization treatment, and daily medication for 3 weeks. ESWT stimulation was given by focusing on the area at the neuroma site clearly identified by ultrasound. RESULTS: The changes in the McGill pain questionnaire were 38.8+/-9.0 prior to treatment and 11.8+/-3.1 following the treatment. The corresponding values for the control group were 37.2+/-7.7 and 28.5+/-10.3. The changes between groups were significantly different (p=0.035). The change in visual analog scale prior to and after treatment was 7.0+/-1.5 and 2.8+/-0.8 in the ESWT group, respectively, and 7.2+/-1.4 and 5.8+/-2.0 in the control group. These changes between the groups were also significantly different (p=0.010). The outcome in the pain rating scale also showed significant differences between groups (p0.05). CONCLUSION: The study findings imply that ESWT for stump neuroma is superior to conventional therapy.

Myoelectric Hand Rehabilitation in the Bilateral Upper Extremity Amputee of Burn Patients: Two Cases Report

Bilateral upper extremity amputee is rare and also complex, difficult process to apply the prosthesis to daily life. In Korea, there is no case report of bilateral myoelectric hand training, which is installed to bilateral upper extremity amputee due to electrical burn. We present usual 2 cases, who underwent bilateral transradial amputee, were fitted with a bilateral myoelectric prosthetic hand with an adaptive grip. It's not just long-term issues like the prosthesis prescription, but it is important functional problem whether or not to use actually. Especially the unique features of hand grasp function and writing can be the scale that measure recovery of the patient. The development of modern science and technology applications in clinical medicine cause the innovation of a prosthetic hand. In our two cases, good acceptance and functional improvement were noted. The information obtained in this case would be expected to be helpful in the bilateral amputee prosthetic prescription and training for their welfare.

The Effect of Extracorporeal Shock Wave Therapy on Myofascial Pain Syndrome

OBJECTIVE: To investigate the effect of extracorporeal shock wave therapy (ESWT) on myofascial pain syndrome (MPS). METHOD: Thirty patients with MPS in trapezius muscle were randomly divided into two groups, ESWT group (n=15), and trigger point injections (TPI)+transcutaneous electrical nerve stimulation (TENS) group (n=15). For a total of 3 weeks, ESWT was undertaken with 1,500 pulse each time at one week interval totaling 4,500 pulse, TPI for once a week totaling three times and TENS for five times a week totaling three weeks. RESULTS: The changes in pain threshold (lb/cm2) showed the values of 6.86+/-1.35 before first therapy, 11.43+/-0.27 after first therapy, and 12.57+/-0.72 after third therapy, while TPI+TENS group showed the values of 6.20+/-1.92 before first therapy, 8.80+/-0.48 after first therapy, and 9.60+/-2.19 after third therapy, and the changes between the groups were significantly different (p=0.045). The changes in visual analog scale were estimated to be 6.86+/-0.90 before first therapy, 2.86+/-0.90 after first therapy, and 1.86+/-0.69 after third therapy in case of ESWT group, whereas the figures were estimated to be 7.20+/-1.30 before first therapy, 4.60+/-0.55 after first therapy, and 2.80+/-0.84 after third therapy in case of TPI+TENS group, and the changes between the groups were significantly different (p=0.010). The changes in McGill pain questionnaire (p=0.816) and pain rating scale (p=0.644) between the groups were not significantly different. The changes in neck ROM were also not significantly different between the groups (p>0.05). CONCLUSION: The ESWT in patients with MPS in trapezius muscle are as effective as TPI and TENS for the purpose of pain relief and improving cervical range of motion.

The Factors Associated with Contact Burns from Therapeutic Modalities

OBJECTIVE: To understand the injury pattern of contact burns from therapeutic physical modalities. METHOD: A retrospective study was done in 864 patients with contact burns who discharged from our hospital from January 2005 to December 2008. The following parameters were compared between patients with contact burns from therapeutic modalities and from other causes: general characteristics, burn extent, cause of burn injury, place of occurrence, burn injury site, treatment methods, prevalence of underlying disease, and length of hospital stay were compared between patients with contact burns. RESULTS: Of the 864 subjects, 94 patients were injured from therapeutic modalities. A hot pack (n=51) was the most common type of therapeutic modality causing contact burn followed by moxibustion (n=21), electric heating pad (n=16), and radiant heat (n=4). The lower leg (n=31) was the most common injury site followed by the foot & ankle (n=24), buttock & coccyx (n=9), knee (n=8), trunk (n=8), back (n=6), shoulder (n=4), and arm (n=4). Diabetes mellitus was associated with contact burns from therapeutic modalities; the odds ratio was 3.99. Injuries took place most commonly at home (n=56), followed by the hospital (n=33), and in other places (n=5). CONCLUSION: A hot pack was the most common cause of contact burns from therapeutic modalities, and the lower leg was the most common injury site. Injuries took place most commonly at home. The patients with contact burns from therapeutic modalities showed high correlation to presence of diabetes mellitus. These results would be helpful for the prevention of contact burns due to therapeutic modalities.

Intra-articular Injection of Hyaluronic Acid to Rehabilitate Post-burn Elbow Contracture

PURPOSE: Limitation of motion of the elbow joint causes upper extremity dysfunction and limitation in activities of daily living. Hyaluronic acid (HA) is a glycosaminoglycan (GAG), which is a substance that attaches to collagen and elastin to form cartilage. HA not only helps keep the cartilage that cushions joints strong and flexible, but also helps to increase supplies of joint-lubricating synovial fluid. We investigated the effect of intraarticularly applied HA on the post-burn contracture of the elbow. METHODS: Total 14 patients were randomized into HA and control groups. The treatment group who treated with HA intra-articular injection once a week for 3 times. A control group was not injected. The effect of HA injection was evaluated by range of motion (ROM) of elbow, grip strength, patient's visual analogue scale (VAS) of pain and functional independence measure (FIM) scale before the first injection as well as after 1 and 3 months. RESULTS: The change in elbow flexion ROM was 29.2+/-19 for HA vs 1.4+/-2.4 for control (P<0.05). The change in VAS pain was 2.9+/-1.3 for HA vs 1+/-1.3 for control (P<0.05). These beneficial effects of HA are sustained for 3 months. There was no significant difference in elbow extension, supination, pronation, grip strength and FIM score. CONCLUSION: As a result, intra-articular injection of hyaluronic acid is effective for the treatment of post-burn contracture of the elbow.

Effects of Modified Dynamic Metacarpophalangeal Joint Flexion Orthoses after Hand Burn

OBJECTIVE: To assess the effectiveness of modified dynamic metacarpophalangeal joint flexion orthoses for treatment of post-burn hand contractures. METHOD: We enrolled 42 hand burn patients with limited range of motion at the metacarpophalangeal joints in this study. The patients were randomly assigned into either a control or an orthotic group. Both groups received the standard rehabilitation therapy focused on hand therapy; 21 subjects in the orthotic group wore a splint for 3 hours per day for 8 weeks. Hand function was measured by active range of motion, grip strength and other assessment tools. All parameters were estimated using the Mann-Whitney U test at the beginning and the end of the treatment after 8 weeks. RESULTS: The 21 subjects that had an orthotic intervention showed significant improvement in the range of motion at 2nd, 3rd, 4th and 5th metacarpophalangeal joints (p0.05). There was a significant difference in the hand function scales between the 2 groups (p<0.05). CONCLUSION: The modified dynamic metacarpophalangeal joint flexion orthoses provide continuous flexion to metacarpophalangeal joint that is needed for the restoration of range of motion in post-burn hand contractures. For the clinical application of hand orthoses in patients with hand disorders, additional research into its affects are required.

Triamcinolone and 5-Fluorouracil to Manage the Burn Hypertrophic Scar

PURPOSE: The purpose of this research is to evaluate the efficacy and side effect of 5-Fluorouracil (5-FU) and Triamcinolone (TA) as a therapeutic agent in the treatment of burn hypertrophic scars. METHODS: This is a prospective and randomized design. Twenty patients with burn hypertrophic scars of varying size and more than 3 months duration were included in this study. All the patients were given intralesional 5FU and TA in different scars at weekly intervals for 4 weeks. Improvement was assessed by the thickness, melanosis, erythema, pliability, and the side effects experienced were noted at each scar. RESULTS: The thickness score was significantly improved in both TA and 5FU injection, more improvement in 5FU than TA. The melanosis score, erythema score, and pliability score were all reported insignificantly different outcome. The side effects were not encountered in TA group, but melanosis in 40%, slough in 20% were observed in the 5-FU group. CONCLUSION: The efficacy of 5-FU is comparable to TA as a treatment option for burn hypertrophic scar. Its effect on lightening of the lesion was promising with the exception of the incidence of adverse effects of melanosis and slough.

Effect of Intradermal Injection of Placenta Hydrolysate to Postburn Hyperpigmented Skin

PURPOSE: The skin hyperpigmentation or hypermelanosis caused by burns results in social withdrawal due to cosmetic problem and depression as a psychiatric aspect. The treatment of the skin hyperpigmentation includes sunscreen, whitening material, skin massage, laser therapy and plastic surgery. Placenta extract can be used to reduce and inactivate the synthesis of the important enzyme (tyrosinase) that compose melanin. This study was performed to estimate the effect of intradermal injection of placenta extract (placenta hydrolysate) for the postburn hyperpigmentation. METHODS: Total 10 subjects who have postburn hyperpigmentation were selected. Two sites of skin area from each subject were randomly selected as possible as symmetrical body area, the one site was to be 'treated site' with placenta extract, the other site was untreated 'control site'. The injection was performed weekly for about 4 weeks only to the 'treated site', not to the control site. The both site were measured by pigment index using Mexameter. The index was also converted to the percentage that indicate a change of after-injection to before-injection. RESULTS: The pigment index of 'treated site' was 399.5+/-63.9 before treatment, and then it had decreased to 333.6+/-59.5 after 4 weeks of injection. The change after injection compared to before injection was significant statistically (p0.05). CONCLUSION: As a result, in the posttburn hyperpigmentation scar, the intradermal injection of placenta extract may be helpful in the management of hyperpigmentation or rehabilitation process of the hypertrophic scar.

Dynamic Elbow Flexion Orthosis for Elbow Flexion Limit in Upper Extremity Burn

PURPOSE: Patients who have a elbow flexion limitation from burn often contend with a severe functional problem in activity of daily living. Positional splint or serial casting have been invented to prevent from elbow contracture, which splint could not improved the range of motion more than 90 flexion. The purpose of this article is to present a dynamic forced elbow flexion orthosis with limited motion joint to overcome the problem of less effective function of correctability of conventional splints. METHODS: The cases were 3rd degree burned patients of upper extremities who had a elbow joint flexion limitation from the post burn skin or joint contracture. This dynamic elbow flexion brace device was fabricated with the dynamic force of the elbow joint, which was induced by a rubber band or spring device into the orthotic joint. The orthosis kept a lower grade constant corrective force with coustom made design and strong strap fixation with comfortable material. RESULTS: This dynamic elbow flexion brace device was fabricated for two burn patients who had 24% and 37% TBSA in a flame burn with extensive involvement of the upper extremities. They developed hypertrophic scar and skin contracture around both elbow joint. Both patients had moderate to severe elbow joint limitation of motion. Patients with elbow limitation had improved the range of motion more than 90 flexion by this dynamic elbow flexion brace. CONCLUSION: The dynamic forced elbow flexion orthosis with limited motion joint had improved the range of motion more than 90 flexion, however those has some problems which ought to be improved to more effective and comfortable function.

Burn Injury in Stroke Patients

PURPOSE: To provide epidemiologic data of the burn injuries in stroke patients and to determine the most effective prevention and education methods. METHODS: We retrospectively reviewed the medical records of patients who had been admitted to the burn center at the Hangang Sacred Heart Hospital between January 2002 and June 2008. Burn cause, size, depth, duration of hospital stay, rate of operation performed, outcomes and time from stroke onset to burn were reviewed and compared. RESULTS: We reviewed the charts of total 87 patients (57 men and 30 women with a mean age of 61.95+/-14.48 years). Places of burn were divided into two groups (at home: n=52, outside: n=25) and patients injured at home were more than twice than who were outside. According to etiology of infarction, patients group was divided into ischemic (n=49) and hemorrhagic (n=38) group. Most of the patients were injured from flame burn. The rate of operation for ischemic group was significantly higher than hemorrhagic group. The etiology of infarction and cause of burn were not significant to prognosis. Chronic group (defined as burn occurred 6 months after the onset of stroke) had the higher incidence of burn injuries. But, there was no significant relationship between the time from stroke onset to burn and burn cause, prognosis, rate of operation, total body surface area burned. Non-survivor group had a higher operation rate than survivor group, although there was no difference in total burn surface area. CONCLUSION: Functional recovery of stroke was not associated with burn injury in our study. Flame burn took the highest percentage of burn causes. We believe that studies pooling different center's results are need to improve significance of conclusion drawn from these data.

Comparison of Peak Torque according to Size of the Rotator Cuff Tear Patients

OBJECTIVE: To investigate the peak torque of shoulder according to the size of the rotator cuff tear. METHOD: With 26 patients of unilateral rotator cuff tear, we measured the concentric isokinetic peak torque of shoulder, using Con-Trex isokinetic dynamometer (CMV AG, Deubendorf, Switzerland). We measured flexion, extension, abduction, adduction, external rotation, and internal rotation torques and calculated the peak toque ratio of flexion/ extension, abduction/adduction and external rotation/internal rotation. Before the test, we injected 1% lidocaine to the subacromial bursa to minimize the error that can be caused by pain. The difference of peak torque according to the size of tear was compared. RESULTS: Comparing the peak torque between affected and sound side, significant difference in flexion, extension, abduction, adduction, internal rotation, and external rotation were shown, but there were no difference in peak torque's ratio in flexion/extension, abduction/adduction, and internal rotation/external rotation. When we compared the peak torque according to the tear size, it didn't show significant difference and also there were no difference of peak torque's ratio in flexion/extension, abduction/adduction, internal rotation/external rotation. CONCLUSION: When we measured the shoulder's strength of rotator cuff tear, peak torque decreased in all motion. But the peak torque's loss and peak torque's ratio is not related with size of tear.

Scar Quality and Hand Function after Moist Exposed Burn Ointment and Skin Graft Treatment in Full Thickness Hand Burn

OBJECTIVE: To compare the scar formation and hand function between moist exposed burn ointment (MEBO) treatment and conventional skin graft in full thickness hand burns. METHOD: Prospective comparative study was done between MEBO treatment group and conventional skin graft group. Full thickness burn wound scars on dorsal hand were compared. Scars were assessed with the Vancouver scar scale and other objective measurement tools such as pigmentation, erythema, pliability, transepideramal water loss, thickness and perfusion. Hand function was evaluated by the Jebsen hand function test and Michigan Hand Function Questionnaire. RESULTS: Vancouver Scar scale showed significantly better scores in the MEBO group than in the conventional skin graft group. Scar thickness and transepidermal water loss were greater in the MEBO treatment group whereas pigmentation value was greater in the conventional skin graft group. There was no significant difference in the hand function between the two groups. CONCLUSION: MEBO application could be an alternative treatment to conventional skin graft treatment in full thickness hand burn wounds. In the future, more studies are yet to come how MEBO treatment may affect the skin condition of the burn injuries.

The Types of Impairments in Burn Patients

OBJECTIVE: The aim of this study was to investigate the types of impairments in burn patients. METHOD: The retrospective data of 143 patients with burn injury was collected who were admitted to the burn rehabilitation department in Hangang Sacred Heart Hospital from Jan 2000 to Jul 2004. We have collected the informations on impairment of burn injury. RESULTS: Limitation of joint motion (78.6%) was the most common disability, followed by hypertrophic scar (53%), peripheral neuropathy (32.9%), and amputation (20.3%) in burn injured patients in rehabilitation management. The common sites of joint limitation were finger joint (38.1%), shoulder (35.7%), elbow (30.8%) and knee (28.0%) joint. Neuropathy by the order of frequency were median (29.7%), ulnar (22.6%) and peroneal (20.2%) nerve lesion. The most common site of amputation was transradial amputation (8.4%). CONCLUSION: Above analytic data will provide the useful information about disability of burn patients to know where we should focus on to reduce complication rate or to restore body functional level in burn patient rehabilitation.

Running Injuries

Running is becoming one of the most popular leisure sports. Part of the growing popularity of running is its easy accessibility and health benefits. The incidence of running injuries rates ranges from 37% to 56%, which incidence rate is still 2 to 6 times lower than in all other sports. Most running injuries are musculoskeletal overuse syndrome of the lower extremity. The risk factors of running injuries can be training errors, improper running surface, worn shoes, body flexibility, prior injury. The knee is the most common site of injury and accouts for 25% to 33% of all, and pa-tellofemoral stress syndrome is the most common known as runner's knee. Iliotibial band syndrome, medial tibial stress syndrome, plantar fascitis, Achilles tendinitis, stress fracture are common injuries in runners. The physical examination includes a biomechanical screening to identify related imbalances. Additionally, each runner is observed walking and running. This comprehensive, running specific approach to diagnosis can be helpful in developing optimum rehabilitation program.

Rehabilitation of Running Injuries

Running is becoming one of the most popular leisure sports. The growing popularity of running is due in part to its easy accessibility and health benefits. The incidence of running injuries ranges from 37% to 56%, which is still 2 to 6 times lower than in other sports. Most running injuries are musculoskeletal overuse syndrome of the lower extremities. The risk factors of running injuries include training errors, improper running surface, worn shoes, body flexibility, and prior injury. The knee is the most common site of injury and accounts for 25% to 33% of all, and patellofemoral stress syndrome is most commonly known as 'runner's knee'. Iliotibial band syndrome, medial tibial stress syndrome, plantar fascitis, Achilles tendinitis, and stress fracture are all common injuries among runners. The process of rehabilitation is to be divided into four stages according to the athlete's level of function; the initial stage, intermediate stage, advanced stage, and final stage.

Evaluation of Nerve Block after Phenol and Ethanol Injection

OBJECTIVE :To evaluate the axonal degeneration after nerve block with phenol and ethanol injection into tibial nerve. METHOD: Tibial nerves of thirty Sprague-Dawley rats were exposed. For the developement of neuropathic pain, the method of intraneural injection was performed. Five percent phenol, 90% ethanol or normal saline were injected into the epineurial sheath of tibial nerve at each group. The mechanical and thermal allodynia were evaluated in post- injection 1, 2, 3, and 4 weeks. The mechanical allodynia was evaluated by withdrawal response to 10 stimulations with von Frey hair. Thermal allodynia was tested by withdrawal response to 5 stimulations with acetone. Motor nerve conduction study was performed in post-injection 1, 2, and 4 weeks. RESULTS: In behavioral test, the experimental group exhibited increased withdrawal response to mechanical and cold stim ulation, but there was no significant difference between two groups, phenol and ethanol groups. In motor nerve conduc tion study, compound motor action potential amplitude loss were observed in experimental group, but there was no significant difference between two groups, phenol and ethanol groups. CONCLUSION: These results suggest that axonal degeneration of ethanol is roughly similar to those of phenol block.

The Classification of Lumbar Interspinous Ligament in Relation to Herniated Intervertebral Disc and Spinal Degeneration of Korean

OBJECTIVE: To classify the findings of magnetic resonance imaging of the lumbar interspinous ligaments in relation to the lumbar disc herniation, disc degeneration, and lordosis. METHOD: The subjects were 45 herniated intervertebral disc(HIVD) patients and 35 normal subjects on MRI finding. The magnetic resonance features of the interspinous ligament were classified into five categories according to their signal intensities: type 1A (low intensity on T1- and T2- weighted images without hypertrophy of spinal process); type 1B (same signal pattern as in type 1A with hypertrophy of spinal process); type 2 (low intensity on T1- and high intensity on T2-weighted images); type 3 (high intensity on T1-weighted images); type 4 (others). RESULTS: The most common type in both HIVD patients and normal subjects was type 3. The mean age and disc degeneration grade of the type 1B ligaments were significantly higher. Lordosis of type 1B of L5-S1 interspinous ligament was increased with significant difference. CONCLUSION: The classification of the MRI findings of interspinous types didn't show statistical difference between HIVD patients and normal subjects, but was helpful in assessing the degree of the degeneration of the intervertebral disc and age.

The Proximal and Distal Interphalangeal Flexion Dysfunction, Opposition Palm Ratio and Thumb Index Ratio in the Korean Adults

OBJECTIVE: The purpose of this study was to evaluate the incidence of inability to flex proximal interphalangeal (PIP) and distal interphalangeal (DIP) joint in normal Koreans. The opposition palm ratio and thumb index ratio was also of interest. METHOD: Randomly selected eighty nine normal Korean adults of 48 men and 41 women, with ages 20 to 79 years. The finger flexion was measured using the standard flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) screening tests. Thumb index ratio and opposition palm ratio was also assessed additionally. RESULTS: In the sample population, 2 subjects (2.2%) were unable to bilaterally flex their fifth PIP joints independently. Four subjects (4.4%) were unable to flex one or both of their fourth or fifth DIP joints. These results show far less incidence of FDS dysfunction comparing with 52% of FDS dysfunction rate in Americans. The opposition palm ratio in men were 63.6% and in women 69.9%, indicating lower ratio in men. The thumb index ratio was not different statistically between the men and women. CONCLUSION: These data suggest that the different incidences of FDS and FDP dysfunction should be considered in interpretation. The opposition palm ratio and thumb index ratio might be useful in the hand rehabilitation.

The Prevalence and Ergonomic Analysis of Cumulative Trauma Disorders in the Paper Reviewing Workers

OBJECTIVE: To survey the prevalence of cumulative trauma disorders (CTDs) and to analyze the ergonomic factors in the paper reviewing workers. METHOD: Five hundreds and twenty subjects of paper reviewers were collected from 'National Medical Insurance Association' who had been exposed to risky working environment regarding CTDs. The subjects were first screened by occupational medicine specialists and confirmed by physiatrist. The subjects were also examined by serologic test, radiologic imaging, and electro diagnostic study. Ergonomists analyzed the job element to identify the risk factors by baseline checklist of CTDs. RESULTS: Among the workers, 51 (9.8%) of 520 were confirmed to CTDs, the prevalance of myofascial pain syndrome was 22 (43.1%), that of medial epicondylitis was 13 (25.5)%, lateral epicondylitis 8 (15.7%) and others. Pain scale of National Industrial Occupational Safety Health Institute symtoms criteria was highest in the shoulder girdle and the next was in the neck, in the wirst and fingers. The ergonomic risk score was highest 2.56 in the 'verifying' job, and the next 2.20 in 'the 2nd examination' job and 'the 1st examination' job, 1.72 in 'correcting' job. CONCLUSION: The result would be helpful for the prevention and management of CTDs in the paper reviewing workers.