• Journal of Korean Neurosurgical Society
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• v.49 no.4
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• pp.231-233
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• 2011

Chronic spinal epidural hematoma related to Kummell's disease is extremely rare. An 82-year-old woman who had been managed conservatively for seven weeks with the diagnosis of a multi-level osteoporotic compression fracture was transferred to our institute. Lumbar spine magnetic resonance images revealed vertebral body collapse with the formation of a cavitary lesion at L1, and a chronic spinal epidural hematoma extending from L1 to L3. Because of intractable back pain, a percutaneous vertebroplasty was performed. The pain improved dramatically and follow-up magnetic resonance imaging obtained three days after the procedure showed a nearly complete resolution of the hematoma. Here, we present the rare case of a chronic spinal epidural hematoma associated with Kummell's disease and discuss the possible mechanism.

• Journal of Korean Foot and Ankle Society
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• v.15 no.3
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• pp.179-182
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• 2011

Naviculocuneiform coalition is one of uncommon tarsal coalitions and especially symptomatic cases which need operative treatment are rare. Authors report 2 cases of pediatric naviculocuneiform patients who showed symptomatic condition as mainly pain. Plain radiographs, computed tomography or magnetic resolution imaging study showed bony bridge in naviculo-medial cuneiform joint. After over six months conservative treatment, excision of coalition and interposition $Tisseel^{(R)}$ was performed for motion preservation and relief of pain.

• Journal of the Korean Society of Radiology
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• v.16 no.1
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• pp.7-13
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• 2022

This study compared the aortic root image by using the ECG gating and non-ECG gating methods. We observed the presence or absence of progression of the aortic root image in the images examined by the high pitch (flash) chest pain protocol method and in the patients tested without ECG gating by the conventional method. The AAPM phantom was scanned by using high pitch (flash) chest pain protocol and general chest pain protocol. CTDI values were compared. By ECG gating, the blurring of ascending aorta was significantly reduced compared to the existing non-ECG gating test method, and the image quality of the aortic root was improved. Within the parametar range that did not show differences in noise, uniformity, and high contrast resolution, CTDI values were lower when tested with the high-pitch chest pain protocol. It was found that there is an advantage in dose reduction, and if it is applied and applied to diagnostic fields such as dissection using the dose reduction mode in the cardiac field, it is a very important test for patients who need rapid diagnosis and prompt treatment as well as a dramatic reduction in exposure dose. It is presumed to be a method.

• Clinics in Shoulder and Elbow
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• v.18 no.4
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• pp.229-236
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• 2015

Background: Twenty-six patients (12 male and 14 female) with symptomatic scapular winging caused by serratus anterior dysfunction were managed by split pectoralis major tendon transfer (sternal head) with autogenous hamstring tendon augmentation from 1998 to 2006. Methods: Twenty-five patients showed positive results upon long thoracic nerve palsy on electromyography. The mean duration of symptoms until surgery was 48 months (range, 12-120 months). Four patients had non-traumatic etiologies and 22 patients had traumatic etiologies. On follow-up assessment for functional improvement, a Constant-Murley score was used. Twenty-one patients were completely evaluated, while five patients who had less than 12 months of follow-up were excluded. Results: Pain relief was achieved in 19 of the 21 patients, with 20 patients showing functional improvement. The pain scores improved from 6.0 preoperatively to 1.8 postoperatively. The mean active forward elevation improved from $108^{\circ}$ (range, $20^{\circ}-165^{\circ}$) preoperatively to $151^{\circ}$ (range, $125^{\circ}-170^{\circ}$) postoperatively. The mean Constant-Murley score improved from 57.7 (range, 21-86) preoperatively to 86.9 (range, 42-98) postoperatively. A recurrence developed in one patient. Of the 21 patients, ten had excellent results, six had good results, four had fair results, and one had poor results. Conclusions: Most patients with severe symptomatic scapular winging showed functional improvement and pain relief with resolution of scapular winging.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2008.03a
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• pp.53-53
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• 2008

Twenty-six patients (12 male and 14 female) with symptomatic scapular winging caused by serratus anterior dysfunction were managed with split pectoralis major tendon transfer (sternal head) with autogenous hamstring tendon augmentation from 1998 to 2006. Twenty-five patients had positive results for long thoracic nerve palsy on electromyography. The mean duration of symptoms until surgery was 48 months (range 12~120 months). Four patients had non-traumatic etiologies and twenty-two patients had traumatic etiologies. At the final follow-up assessment for functional improvement, a Constant-Murley score was used. 21 patients were completely evaluated, while 5 patients who had less than 12 months follow-up were excluded. Pain relief was achieved in 19 of the 21 patients, with twenty patients showing functional improvement. The pain scores improved from 6.0 preoperatively to 1.8 postoperatively. The mean active forward elevation improved from $108^{\circ}$ (range $20^{\circ}\sim165^{\circ}$) preoperatively to $151^{\circ}$ (range $125^{\circ}\sim170^{\circ}$) postoperatively. The mean Constant-Murley score improved from 57.7 (range 21~86) preoperatively to 86.9 (range 42~98) postoperatively. A recurrence developed in one patient. Of the twenty-one patients, eight had excellent results, nine had good results, three had fair results, and one had poor results. Most patients with severe symptomatic scapular winging had functional improvement and pain relief with resolution of scapular winging.

• Journal of Korean Neurosurgical Society
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• v.48 no.4
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• pp.375-379
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• 2010

The Chiari 1.5 malformation is defined as a tonsillar hemiation within a Chiari I malformation with additional caudal descent of the brainstem through the foramen magnum. We describe a patient with Chiari I malformation who evolved to Chiari 1.5 malformation during longitudinal follow-up. A 15-year-old girl presented with neck pain during exercise for two years. She had been diagnosed with Chiari I malformation with mild hydrocephalus after minor cervical trauma at the age of six years. At that time, she was asymptomatic. After she complained of aggravated neck pain, neuroimaging (nine years after first imaging) revealed caudal descent of the brainstem and syringomyelia in addition to progression of tonsillar hemiation. Posterior fossa decompressive surgery resulted in complete resolution of neck pain. Based on neuroimaging and operative findings, she was diagnosed as Chiari 1.5 malformation. Neuroimaging performed seven months after surgery showed an increased anterior-posterior diameter of the medulla oblongata and markedly decreased syringomyelia. This case demonstrates progressive developmental process of the Chiari 1.5 malformation as an advanced form of the Chiari I malformation.

• Clinics in Shoulder and Elbow
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• v.22 no.4
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• pp.227-234
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• 2019

Lateral epicondylitis, also known as 'tennis elbow', is a degenerative rather than inflammatory tendinopathy, causing chronic recalcitrant pain in elbow joints. Although most patients with lateral epicondylitis resolve spontaneously or with standard conservative management, few refractory lateral epicondylitis are candidates for alternative non-operative and operative modalities. Other than standard conservative treatments including rest, analgesics, non-steroidal anti-inflammatory medications, orthosis and physical therapies, nonoperative treatments encompass interventional therapies include different types of injections, such as corticosteroid, lidocaine, autologous blood, platelet-rich plasma, and botulinum toxin, which are available for both short-term and long-term outcomes in pain resolution and functional improvement. In addition, newly emerging biologic enhancement products such as bone marrow aspirate concentrate and autologous tenocyte injectates are also under clinical use and investigations. Despite all non-operative therapeutic trials, persistent debilitating pain in patients with lateral epicondylitis for more than 6 months are candidates for surgical treatment, which include open, percutaneous, and arthroscopic approaches. This review addresses the current updates on emerging non-operative injection therapies as well as arthroscopic intervention in lateral epicondylitis.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.1 no.2
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• pp.117-121
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• 2008

Prolotherapy can be defined as the injection of growth factors or growth factor production stimulants to grow normal cells or tissue. Even though it has been a controversal procedure for decades, it is currently gaining in popularity among many physicians. The term prolotherapy was coined by Hacket in the 1950s to imply proliferation of normal tissue at ligamentous and tendinous entheses. The procedure has been described by other terms, such as sclerotherapy, regenerative injection therapy, and stimulated ligament repair. Incomplete healing from sprains or strains is common and can lead to chronic pain, joint instability and laxity, and is a risk factor for the development of osteoarthritis. Prolotherapy is commonly used for these musculoskeletal conditions which are refractory to usual care therapies. The proliferant solution and technique varies according to physicial training and preferance. Commonly reported proliferants include 10% to 25% dextrose, P2G and sodium morrhuate. High resolution ultrasound imaging of musculoskeletal tissue is increasing in popularity because of patient tolerability, low cost, ability to visualize tissue in real time motion and superior resolution of highly organized tissue such as a tendon. This procedure can be introduced by ultrasound imaging and tissue growth and repair after this procedure in a tendon or a ligament can be documented with ultrasound.

• Journal of Korean Neurosurgical Society
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• v.41 no.6
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• pp.359-366
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• 2007

Trigeminal neuralgia is a condition associated with severe episodic lancinating facial pain subject to remissions and relapses. Trigeminal neuralgia is often associated with blood vessel cross compression of the root entry zone or more rarely with demyelinating diseases and occasionally with direct compression by neoplasms of the posterior fossa. If initial medical management fails to control pain or is associated with unacceptable side effects, a variety of surgical procedures offer the hope for long-lasting pain relief or even cure. For patients who are healthy without significant medical co-morbidities, direct microsurgical vascular decompression [MVD] offers treatment that is often definitive. Other surgical options are effective for elderly patients not suitable for MVD. Percutaneous retrogasserian glycerol rhizotomy is a minimally invasive technique that is based on anatomic definition of the trigeminal cistern followed by injection of anhydrous glycerol to produce a weak neurolytic effect on the post-ganglionic fibers. Other percutaneous management strategies include radiofrequency rhizotomy and balloon compression. More recently, stereotactic radiosurgery has been used as a truly minimally invasive strategy. It also is anatomically based using high resolution MRI to define the retrogasserian target. Radiosurgery provides effective symptomatic relief in the vast majority of patients, especially those who have never had prior surgical procedures. For younger patients, we recommend microvascular decompression. For patients with severe exacerbations of their pain and who need rapid response to treatment, we suggest glycerol rhizotomy. For other patients, gamma knife radiosurgery represents an effective management strategy with excellent preservation of existing facial sensation.

• Journal of Oral Medicine and Pain
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• v.40 no.2
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• pp.55-62
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• 2015

Purpose: The aims of this study were to evaluate the differences in subjective symptoms, clinical characteristics, distribution according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) subgroup, psychological profile of TMD patients, and to identify the prevalence and trend according to age. Methods: A total of 1,052 patients (261 men and 791 women; mean age, $34.40{\pm}15.73$ years) who visited the Orofacial Pain Clinic of the Department of Oral Medicine, Seoul National University Dental Hospital complaining of TMD symptoms of were evaluated. All patients were questioned for medical history, clinical symptoms and contributing factors. Clinical examination and patient grouping based on RDC/TMD was conducted. Radiographies were taken. The Korean version of RDC/TMD axis II and Symptom Checklist-90-Revision (SCL-90-R) were administered to evaluate pain-related disability level and psychological status of the patients. Results: Prevalence peaked in the 20-year-old age group. There were more women than men in all groups. The highest T-score among SCL-90-R dimensions was somatization in each group, except for teenagers who showed the highest T-score in interpersonal sensitivity. The 30-year-old age group showed the highest distribution of high disability based on the graded chronic pain scale. Age was positively associated with pain intensity (r=0.100), number of positive muscles on palpation (r=0.137) and negatively associated with maximum mouth opening (r=-0.168). Conclusions: Subjective symptoms and clinical characteristics of TMD patients show distinct tendencies according to different age groups. Treatment should be customized and personalized according to age for efficient symptom resolution and patient satisfaction.