To investigate the effect of extracorporeal shock wave therapy (ESWT) on painful stump neuroma.
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.
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 (p<0.001). Changes in neuroma size and pain pressure threshold (lb/cm2) were not significantly different between groups (p>0.05).
The study findings imply that ESWT for stump neuroma is superior to conventional therapy.
Citations
To evaluate the effect of extracorporeal shock wave therapy (ESWT) in myofascial pain syndrome of upper trapezius with visual analogue scale (VAS) and pressure threshold by digital algometer.
Twenty-two patients diagnosed with myofascial pain syndrome in upper trapezius were selected. They were assigned to treatment and standard care (control) groups balanced by age and sex, with eleven subjects in each group. The treated group had done four sessions of ESWT (0.056 mJ/mm2, 1,000 impulses, semiweekly) while the control group was treated by the same protocol but with different energy levels applied, 0.001 mJ/mm2. The VAS and pressure threshold were measured twice: before and after last therapy. We evaluated VAS of patients and measured the pressure threshold by using algometer.
There were two withdrawals and the remaining 20 patients were three men and 17 women. Age was distributed with 11 patients in their twenties and 9 over 30 years old. There was no significant difference of age, sex, pre-VAS and pre-pressure threshold between 2 groups (p>0.05) found. The VAS significantly decreased from 4.91±1.76 to 2.27±1.27 in the treated group (p<0.01). The control group did not show any significant changes of VAS score. The pressure threshold significantly increased from 40.4±9.94 N to 61.2±12.16 N in the treated group (p<0.05), but there was no significant change in the control group.
ESWT in myofascial pain syndrome of upper trapezius is effective to relieve pain after four times therapies in two weeks. But further study will be required with more patients, a broader age range and more males.
Citations
Objective: To evaluate the effects of a new periarticular injection in the patients with knee osteoarthritis.
Method: Twenty seven patients, who had knee pain, were met criteria of knee osteoarthritis of American Rheumatology Association. Two injection sites were used: one to infrapatellar fat pad and the other to near the insertion area of popliteus. At first, 1 cc of 0.5% lidocaine was injected to both sites. If pain was not releaved above 50%, a mixture of 1 cc of 0.5% lidocaine and 10 mg of triamcinolone acetonide was injected to twenty seven patients, 46 knees. All patients were evaluated visual analogue scale (VAS), time for 10 meter walking, time for stair up and down, isometric knee strength before and after
treatment. Paired student t test was done to investigate statistical significance of change of pain and function.
Results: Before treatment VAS, time for 10 meter walking, time for stair up and down and isometric knee strength were 6.1⁑2.1, 10.4⁑3.6, 10.8⁑7.1 and 34.0⁑11.4 respectively. After last treatment VAS, time for 10 meter walking, time for stair up and down and isometric knee strength were 3.5⁑2.5, 8.3⁑1.7, 8.2⁑3.6 and 38.8⁑12.9 respectively. The difference was stastistically significant between before and after treatment (p＜0.05).
Conclusion: The new periarticular injection is useful in treatment of patients with knee osteoarthritis. (J Korean Acad Rehab Med 2002; 26: 198-202)
Objective: The purpose of this study is to evaluate the effect of visible light therapy for the management of somatic pain.
Method: Subjects consisted of 42 patients with pain and were divided into two groups; control (n=22) and experimental (n=20) groups. Control group received conventional physical therapy only, while experimental group received additional light therapy with blue light (light intensity 4080 lux, wave length 581 nm, distance from lamp 5 cm). Intensity of pain was assessed by visual analogue scale (VAS) and McGill pain questionnaire. Sympathetic skin response was measured to assess the status of autonomic nervous system. VAS and McGill pain questionnaire were administered before treatment and at 1 day, 2 days, 3 days, 1 week, and 2 weeks after treatment. Sympathetic skin response were performed before and 2 weeks after treatment.
Results: 1) In both experimental and control groups, VAS became significantly lower at two weeks after treatment compared to pretreatment scale (p＜0.05). 2) McGill pain questionnaire showed significantly lower scores two weeks after treatment compared to pretreatment score, only in experimental group (p＜0.05). 3) Experimental group showed significantly lower McGill pain questionnaire score than control group at two weeks after treatment (p＜0.05). 4) Latency and amplitude of sympathetic skin response showed no significant difference between experimental and control groups.
Conclusion: Visible light therapy can be used as an effective therapeutic modality for the management of symptomatic pain in combination with conventional physical therapy. (J Korean Acad Rehab Med 2002; 26: 81-85)
Objective: The purpose of this study was to determine the usefulness of manual medicine therapy in adhesive capsulitis of shoulder.
Method: Twelve patients with adhesive capsulitis of shoulder were treated with the muscle energy technique of Greenman in manual medicine therapy. The muscle energy technique of Greenman was repeated 6 times for each subject. The therapeutic effect of manual medicine therapy was assessed by the shoulder range of motion (ROM) and visual analogue scale (VAS) before and after the treatment. Two patients took the fluoroscopic examination before and after the treatment.
Results: After the manual medicine therapy, active range of shoulder motion were increased by 30.0o in forward flexion, by 21.2o in abduction, by 11.2o in external rotation, and by 18.7o in internal rotation, respectively. The visual analogue scale was decreased after treatment. None of the subjects complained pain during treatment. The mobility of shoulder joint was improved and the rhythm of scapulohumeral joint was restored.
Conclusion: The manual medicine therapy is an effective, tolerable and noninvasive treatment method for the painful adhesive capsulitis of shoulder.
Objective: The aim of this study is to know the usefulness of ultrasonographic evaluation of hemiplegic shoulder pain.
Method: For 20 hemiplegic patients with shoulder pain, the shoulder was evaluated by simple radiographic findings, physical examinations, visual analogue scale (VAS), manual muscle test (MMT), and finally the ultrasonographic examination to define shoulder pain nature. The ultrasonographic results were compared to the simple radiography, physical examination, VAS, and MMT.
Results: The ultrasonographic findings were variable. The positive ultrasonographic findings were 10 joint fluid collections, 3 tendinous thickenings, 4 high echogenic findings, 4 tendon surface defects, 2 tendinous gracilings, and 1 joint surface irregularity. The ultrasonographic interpretative conclusion included 6 tendon (or muscle) tears, 2 degenerative changes, 5 nonspecific simple joint fluid collections, and 7 normal shoulder joints. In comparison of ultrasonographic findings and subluxation, VAS, and fluid collection, VAS showed relatively higher correlation.
Conclusion: The ultrasonography is very useful as a non-invasive, inexpensive, painless, and rapid screening diagnostic method for the evaluation of painful hemiplegic shoulder.
Objective: The purpose of this study is to evaluate the effects of the cold air application on the subjective pain threshold of knee joint pain.
Method: We recorded the changes of the pain threshold in 60 patients before and after cold air application who complaint of knee joint pain. Patients were divided into 3 groups randomly with each 20 patients and each group received cold air application for 30 seconds, 1 minute, 3 minutes. Cold air of CRAis (Kyung-won Century, Korea) was applied to the anterior portion of the knee with a temperature of 30oC. The changes of the pain threshold was estimated by visual analogue scale.
Results: In 30 seconds treating group, VAS score was lowered 2.25±1.16 and 2.26±1.13 immediately after, and 30 minutes after cold air application, respectively (P＜0.05). In 1 minutes treating group, VAS score was lowered 1.65±2.58 and 2.41±2.59 immediately after and 30 minutes after cold air application, respectively (P＜0.05). In 3 minutes treating group, VAS score was lowered 1.94±1.80 and 2.10±2.3 immediately after and 30 minutes after cold air application, respectively (P＜0.05). The VAS score was lowered significantly after cold air application in all groups, but there's no significant correlation between change of VAS score and cold air application time. In group with initial VAS score greater than 5, the VAS score was more decreased after cold air application.
Conclusion: Cold air application for 30 seconds using CRAis machine is useful treatment method for knee joint pain.
Objective: The purpose of this study is to evaluate the effects of a self-stretching exercise on the pressure threshold of myofascial trigger point.
Method: We examined the changes of pressure threshold in 66 patients with myofascial trigger points before and after a self-stretching exercise of shoulder girdle and also tested the visual analogue scale (VAS) of the subjective pain intensity. The self-stretching exercise of shoulder girdle includes a stretching exercise of four muscles in shoulder girdle simultaneously, including upper trapezius, levator scapulae, infraspinatus, rhomboideus major and minor, which is followed by 1) a sitting position, relaxed, 2) lateral bending of neck to contralateral side, 3) forward and downward stretching of ipsilateral arm with protrusion of scapula and internal rotation of arm maximally to the contralateral foot. Each stretching motion is maintained for 30 seconds.
Results: The results of the patients experiencing unilateral or bilateral myofascial neck and shoulder pain showed that the pressure threshold of trigger point increased in response to the self-stretching exercise as assessed by a pressure algometer. Also visual analogue scale (VAS) decreased in response to the self-stretching exercise.
Conclusion: We conclude that the self-stretching exercise of shoulder girdle is an effective method for the simultaneous stretching of upper trapezius, levator scapulae, infraspinatus, rhomboideus major and minor.
Objective: The purposes of this study were to measure the effect of Stellate ganglion block(SGB) objectively and quantitatively by the use of sympathetic skin response(SSR), and to evaluate the cumulative effects and complications of repetitive SGB and to find out optimal numbers of injection per one cycle in the patients with reflex sympathetic dystrophy(RSD).
Method: Six patients with RSD were evaluated with a SSR test before and after the injection of 1% lidocaine 4 ml by SGB method.
Results: There was a significant prolongation of latencies in SSR of the lesion side of sixty mixed cases by the SGB methods and SSR tests. There were no significant changes in the latency and amplitude of SSR from the lesion side between pre- and post injection states. There was a significant decrease of amplitude in the sound side after the injection. The differences of the amplitudes between pre- and post injections were significantly higher in the lesion side than the sound side. The degree of pain of the patients with RSD was evaluated by visual analogue scale(VAS), which scored on pre and post injection state decreased from 10 to 6.5 by 5 times injections, but did not decrease by more injections.
Conclusion: We concluded that SGB is more effective in the RSD lesion side than the sound side and the SSR is a useful test for evaluating the effect of SGB.
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