Extracorporeal Shock Wave Therapy and Quantitative Ultrasonographic Evaluation of the Rheologic Effect in the Patients with Post-stroke Upper Limb Spasticity: A Case Report

Post-stroke spasticity is a common complication that causes limitations of function, pain and decrement of the quality of life. Although botulinum toxin injection and anti-spastic medications are effective and widely used for the management of post-stroke spasticity, clinical applications are often limited in stroke patients because of their invasiveness and systemic side effects. Alternatively, we performed upper limb muscle-belly extracorporeal shock wave therapy (ESWT) to resolve problematic spasticity in two subacute stroke patients. Serial quantitative ultrasonographic measurements of spastic muscle were conducted to investigate the rheological changes in chronological order by echogenicity comparison. After 4 sessions of weekly ESWT, gradual decrements of clinical spasticity parameters and muscle echogenicity were observed and lasted for 1 week after the cessation of the therapy. ESWT may be a useful alternative management for treating post-stroke spasticity.

Results of the Flexor Tendon Repairs of the Hand in Children / 대한정형외과학회잡지

PURPOSE: When flexor tendons are injuried in children, the management is difficult. There are needs to determine the periods of postoperative immobilization. MATERIALS AND METHODS: From April 1994 to March 1998, 40 patients younger than 16 years who had sustained flexor tendon lacerations in zone I or zone II of 52 digits were available for critical evaluation. The average postoperative follow-up period was 24 (range, 3-48) months. RESULTS: All profundus repairs in zone I achieved excellent or good function. Isolated profundus and combined profundus and superficialis repairs in zone II achieved comparable results which managed with a passive motion program immediately after operation (TAM=82%) or motion following immobilization for 3 weeks (TAM =79%) or 4 weeks (TAM=78%) . Immobilization for longer than 4 weeks which resulted in an appreciable deterioration of funtion (5 weeks: TAM=64%, 6 weeks: TAM=61%) . Digital motion following flexor tendon injuries treated with less than 4 weeks of immobilization or early motion was not significantly different. CONCLUSION: We could find no benefits of early mobilization protocols in children. Howerver, it does appear that it is important that postoperative immobilization not be continued beyond 4 weeks.