• The Korean Journal of Pain
• /
• 제22권1호
• /
• pp.52-57
• /
• 2009

Background: Transforaminal epidural injection (TEI) may be useful to treat unilateral pain that has a dermatomal distribution. In this approach, the needle tip can be placed closer to the dorsal root ganglion and ventral aspect of the nerve root. However many studies have reported that serious complications following TEI occurred more frequently when it was conducted at the cervical level. One of the presumptive mechanisms of the complication is intravascular injection. Therefore this study was conducted to identify the incidence of complications in response to intravascular injections at cervical segments. Methods: This study included all patients, who visited our pain clinic and had radicular symptoms or herpes zoster associated pain. All procedures were conducted under fluoroscopic guidance with contrast enhancement by one of the authors. After the ideal needle position was confirmed by biplanar fluoroscopy, the blood aspiration through the needle hub was evaluated, and a 3 ml mixture of nonionic contrast (2 ml) with normal saline (1 ml) was injected at a rate of 0.3-0.5 ml/sec continuously under real time fluoroscopic visualization. We then classified the contrast spreading pattern as neural, simultaneous neural and vascular, or vascular. Results: A total 71 cervical TEIs were performed. In 26 cases (36.6%), the contrast only spread to the nerve sheath. However, 45 cases (63.4%) showed an intravascular spreading pattern, 37 (52.1%) of which showed a neural and vascular pattern and 8 (11.3%) of which showed only a vascular pattern. Conclusions: Approximately two thirds of the cases of cervical TEI were found to lead to intravascular spreading, which is much higher than the incidence reported in previous studies.

• 대한물리치료과학회지
• /
• 제24권2호
• /
• pp.61-70
• /
• 2017

Purpose : The purpose of this study was to examine the effect of therapeutic massage and Mckenzie exercise on pain and range of motion in chronic neck pain patient: a case study. Method : A Twenty-year old female subject with chronic neck pain was selected, she received therapeutic massage and Mckenzie exercise for 30 minutes a day, three days a week for five weeks. Pain was measured visual analog scale(VAS), neck disability index(NDI) and the Copenhagen neck functional disability scale (CNFDS). Range of motion was measured using a goniometer(shoulder joint) and the CROM Deluxe(cervical range of motion instrument). Result : VAS, NDI and CNFDS were decreased 3 score, 4 score and 6 score(respectively) than before the training. The range of motion was increased in shoulder joint and neck movement than before the training. Conclusion : The massage and Mckenzie exercise increased range of motion in shoulder joint and neck movement, and decreased neck pain in chronic neck pain patient. Additional research on therapeutic massage and Mckenzie exercise for improving pain and range of motion is need.

• 대한물리의학회지
• /
• 제1권1호
• /
• pp.93-108
• /
• 2006

Purpose : To evaluate effects of McKenzie exercise on the functional recovery and forward head posture of chronic neck pain patients. Methods : The subjects were consisted of fifteen patients who had abnormal neck posture, mild neck pain (28 males, 17 females; mean aged 21.9) from 19 to 33 years of age(mean age 21.9). All subjects were received McKenzie exercise for 35 minutes with clinical massage per day three times a week during 4 weeks period. Neck disability index was used to measure functional disability level. Visual analogue scale(VAS) was used to measure subjective pain level. craniovetebral angle(CVA), cranial rotation angle(CRA) was used to measure forward head posture with digital camera. All measurements of each patients were measured at pre-treatment and after 2 week, after 4 week, post-treatment on 2 week. Result : The VAS of McKenzie exercise was significantly reduced between pre-treatment and post-treatment (p<.05) and effects of pain reduce was continued follow 2 weeks. The Neck Disability Index of McKenzie exercise was significantly reduced between pre-treatment and post-treatment (p<.05) and effects of pain reduce was continued follow 2 weeks. The CVA of McKenzie exercise was significantly reduced between pre-treatment and post-treatment (p<.05) and effects of pain reduce was continued follow 2 weeks. The CRA of McKenzie exercise was not significantly reduced between pre-treatment and post-treatment (p<.05). Conclusion : McKenzie exercise improved pain and function of Chronic neck pain patients.

• The Korean Journal of Pain
• /
• 제12권1호
• /
• pp.144-147
• /
• 1999

A 72-year-old female patient was presented complaining of unbearable abdominal pain in the upper left quadrant at our hospital. Two weeks earlier she had developed a vesicular eruption on the right C3 dermatome and 1 week earlier she had experienced a vesicular eruption on the left T11 dermatome. Her medical history was unremarkable. She had suffered from severe abdominal pain in the upper left quadrant for 10 days and the mild pain in the right shoulder region for 20 days. The pain in the upper left quadrant had increased and was unresponsive to drugs prescribed by the local clinic. And we performed T11 root block with 0.5% lidocaine 5 ml and dexametasone 5 mg, and thoracic epidural blockade on 1st hospital day under diagnosis of herpes zoster infection. Her VAS were improved from 10 to 2 on 2nd hospital day. We performed thoracic epidural blockade with 0.5% lidocaine 6 ml. Her VAS were changed from 2 to 7 and so then we performed the thoracic epidural blockade with 0.5% lidocaine 5 ml and triamcinolone 40 mg on 3rd hospital day. On 4th hospital day, her VAS were from 7 to 1. After 4 month of our managements she was tolerable without any medications.

• The Korean Journal of Pain
• /
• 제12권1호
• /
• pp.114-118
• /
• 1999

Backgrouds: Cervical epidural blocks were used as part of a comprehensive multimodal treatment program for patients with chronic pain in the head, neck and upper extremities. The depth of the epidural space beneth the skin surface varies at different levels of the spinal column in the same patient. It also varies from patient to patient at the same vertebral level. We studied the distance the skin to the cervical epidural space in adults patients at different intervertebral spaces. Methods: Date were gathered from 628 patients having cervical epidural block for relief of cervical and upper extrimity pain. All blocks were performed using hanging drop method after loss of resistance with saline at C5-6, C6-7, C7-T1 intervertebral space. Results: Mean distances for skin to cervical epidural space (DSES) were 5.42 cm, 5.06 cm, 4.68 cm in male, 5.00 cm, 4.61 cm, 4.10 cm in female at C7-T1, C6-7, C5-6 intervertebral space. DSES correlated with body weight, neck circumference and body mass index significantly. Conclusion: In the cervical spine, DSES varies from space to space. The longest DSES were noted at C7-T1 level in male, and the shortest DSES were at C5-6 in female. DSES has significant relationships with weight, neck circumference and body mass index.

• 대한정형도수물리치료학회지
• /
• 제20권1호
• /
• pp.9-14
• /
• 2014

Background: Cervical radiculopathy is the result of cervical nerve root pathology that may lead to chronic pain and disability. Although manual therapy interventions including cervical traction and neural mobilization have been advocated to decrease pain and disability caused by cervical radiculopathy, their analgesic effect has been questioned due to the low quality of research evidence. The purpose of this paper is to present the effect of manual therapy on pain, ROM, disability in a patient experiencing cervical radiculopathy. Methods: In this study, 30 participants who met the diagnostic criteria for cervical radiculopathy were randomized into two groups: group I (nerve mobilization group) & group II (Mckenzie exercise group). The experimental group was performed manual cervical traction and neural mobilization technique. The control group was performed manual cervical traction and cervical retraction, extension exercise. Assessments were performed to 30 participants before and after 4 weeks therapy. The components of assessments were pain intensity (PI), cervical rotation ROM (CR) and neck disability index (NDI). Results: After 4 weeks therapy, PI, CR and NDI were significantly reduced in both groups (p<.01). The PI, CR and NDI were no significantly reduced between group I and group II (p>.01). Conclusions: Manual therapy could reduce the symptoms of cervical radiculotpathy.

• 대한인간공학회지
• /
• 제29권6호
• /
• pp.889-895
• /
• 2010

This study compared the effects of craniocervical flexion exercise with conservative cervical flexion exercise in workers with chronic neck pain. Subjects were randomly allocated to two groups: control (n=20) and experimental group (n=20), respectively. The conservative exercise for the control group consisted of cervical flexion exercise, whereas the experimental group performed a craniocervical flexion exercise. To compare the two groups, the visual analogue scale (VAS) for a pain, neck disability index (NDI) for a neck disability scale, and cross sectional area (CSA) of longus colli muscle using ultrasound image were assessed on pre-intervention, post-intervention, and 2 weeks follow-up. 2-way repeated ANOVA was used with Bonferroni post-hoc test. (1) There were significant main effects (within and between groups) (p<0.05) and interaction effect (p<0.05) in VAS. Post-hoc test revealed that there were significant differences in all pair-wise comparisons. (2) There were significant main effects (within and between groups) (p<0.05) and interaction effect (p<0.05) in NDI. Post-hoc test revealed that there were significant differences between pre-intervention and post-intervention, pre-intervention and 2 weeks follow-up. (3) There were significant main effects (within and between groups) (p<0.05) and interaction effect (p<0.05) in CSA of longus colli muscle. Post-hoc test revealed that there were significant differences in all pair-wise comparisons. The findings indicate that craniocervical flexion exercise are more effective for improving pain, neck disability, and CSA of longus colli muscle than cervical flexion exercise in workers with chronic neck pain.

• The Korean Journal of Pain
• /
• 제20권1호
• /
• pp.46-49
• /
• 2007

Background: Cervical epidural injection, performed via the interlaminar approach, represents a useful interventional pain management procedure indicated in patients with a cervical herniated disk. Due to thedecreased epidural space in the cervical region, cervical epidural injections may result in potentially serious complications, especially during a large volume injection. Methods: Thirty-four patients with neck pain due to a cervical herniated disk that were referred to the pain clinic for cervical epidural steroid injection were randomized into two groups. One group received a cervical epidural injection of 4 ml drug and the other group received 2 ml drug. The injected mixture included triamcinolon, ropivacaine and omnipaque. Spread levels of the drug after injection were estimated with the use of C-arm fluoroscopy. Results: Spread levels to the cephalad for patients in the two groups were $4.88{\pm}0.78segments$ and $4.53{\pm}0.49segments$, respectively. Spread levels to the caudad for patients in the two groups were $4.59{\pm}0.93segments$ and $4.47{\pm}0.51segments$, respectively. The results showed no significant difference in the spread level between the two groups. Conclusions: Use of a small volume of drug (2 ml) can provide a sufficient spread level of the injected drug that is desirable for patients with a cervical herniated disk.

• 한국임상수의학회지
• /
• 제31권6호
• /
• pp.511-514
• /
• 2014

7년령 암컷 비글이 심한 경부 통증과 보행 이상으로 내원하였다. 신경계 검사를 통해 경추 6번에서 흉추 2번사이 척수로 병변을 국소화하였다. 또한 경흉추 부위 자기 공명 영상으로 경추 7번과 흉추 1번 사이 추간강에 척수를 심하게 압박하는 추간판 탈출이 있는 것을 확인하였다. 이 부위의 치료를 위해 편측추궁절제술이 실시되었다. 수술은 효과적이었으며 환자의 상태가 현저히 개선된 것을 확인할 수 있었다. 이 결과를 통해 편측추궁절제술이 개의 경흉연접부에 발생한 추간판 탈출증을 치료하는데 효과적인 방법임을 확인할 수 있었다.

• 한국융합학회논문지
• /
• 제9권12호
• /
• pp.123-128
• /
• 2018

본 연구는 머리전방자세와 둥근어깨자세에 대한 일반 운동과 동작관찰, 시각적 되먹임의 효과를 알아보고자 한다. 머리전방자세와 둥근어깨자세를 가진 24명으로 하였으며, 일반 운동군(8명), 동작관찰군(8명), 시각적 되먹임군(8명)으로 무작위 배분하였다. 모든 운동군은 주 3회, 총 4주간 운동하였다. 운동 전 후 머리척추각(CVA), 둥근어깨자세(RSP), 시각적 상사척도(VAS), 경부장애지수(NDI)를 평가하였다. 연구결과 CVA는 일반 운동군과 동작관찰군에서 유의한 변화를 보였으며, RSP, VAS, NDI의 경우 모든 운동군에서 유의한 변화를 보였다. 운동군 간 변화량 비교에서는 VAS에서 동작관찰군이 일반 운동군과 시각적 되먹임군보다 큰 변화량을 보였다. 본 연구결과 동작관찰이 머리전방자세와 둥근어깨자세의 개선에 효과가 있을 것이라고 사료된다.