• Journal of Oral Medicine and Pain
• /
• v.33 no.4
• /
• pp.339-352
• /
• 2008

Aims: The aims of this study were to identify the association between cervical muscle pain and TMD by pressure pain response, and to find cervical muscles showing moderate to severe pressure pain that are correlated with masticatory muscle pain. Methods: Patients(n=129, female 65.9%, mean age 28.8 years) answered a TMD questionnaire asking about headache, neck pain, emotional stress, sleep disturbance, parafunction habits, and pain intensity. A clinical examination of the masticatory system was performed. Of the neck muscles, (1) the upper sternocleidomastoid, (2) the middle sternocleidomastoid, (3) the upper trapezius, (4) the splenius capitis, (5) the semispinalis capitis, (6) the scalene medius, and (7) the levator scapulae muscles were examined by palpation. Pressure pain or tenderness of all palpation sites was scored from 0 to 3 according to the pain response. The variables of sum of pressure pain scores were calculated from pressure pain scores and were used for statistical analyses. Results: Eighty patients(62.0%) answered that they suffer from neck pain in the TMD questionnaire. More than 40% of sternocleidomastoid and upper trapezius examination sites showed moderate to severe tenderness in the cervical muscles, and 36% of middle masseter in the masticatory muscles. For the 129 patients, the sum of cervical muscle pain scores(mean=12.88, SD=8.06) and the sum of TMD pain scores(mean=5.36, SD=5.10) were moderately correlated($\rho$ = 0.502, P < 0.001). The sum of TMD pain scores tends to increase as the sum of cervical muscle pain scores increases(Y = 0.395${\cdot}$X, $R^2$ = 0.659, P < 0.001). In the patients with masticatory muscle disorders, the sum of sternocleidomastoid and upper trapezius pain scores(mean = 8.67, SD = 4.95) and the sum of temporalis and masseter pain scores(mean = 3.37, SD = 3.56) showed moderate correlation($\rho$ = 0.375, P < 0.001). Those two variables were in a proportionate relationship(Y = 0.359${\cdot}$X, $R^2$ = 0.538, P < 0.001). In a partial correlation analysis of the sum of unilateral pain scores, the sum of right cervical muscle pain scores and the sum of left cervical muscle pain scores showed the highest correlation(r = 0.802, P < 0.001). The sum of right TMD pain scores and the sum of left TMD pain scores were moderately correlated(r = 0.481, P < 0.001). For the twenty patients with unilateral TMD pain, the partial correlation coefficient between the sum of ipsilateral cervical muscle pain scores and the sum of contralateral cervical muscle pain scores was the largest(r = 0.597, P = 0.009). A partial correlation between the sum of primary TMD side pain scores and the sum of ipsilateral cervical muscle pain scores was 0.564(P = 0.015). Conclusions: TMD is associated with cervical muscle pain on condition of pressure pain response to palpation. Of the cervical muscles, sternocleidomastoid and upper trapezius frequently exhibit moderate to severe pressure pain, and they are closely related to the masticatory muscle pain. The characteristic of symmetric involvement of pain is prominent in cervical muscles; however, TMD can affect the level of cervical muscle pain to modify its symmetric nature.

• The Korean Journal of Pain
• /
• v.1 no.2
• /
• pp.214-222
• /
• 1988

With the arm in hyperabduction, we have carried out 525 procedures of supraclavicular brachial plexus block from Aug. 1976 to June 1980, whereas block with the arm in adduction has been customarily performed by other authors. The anesthetic procedure is as follows: 1) The patient lies in the dorsal recumbent position without a pillow under his head or shoulder. His arm is hyperabducted more than a 90 degree angle from his side, and his head is turned to the side opposite from that to be blocked. 2) An "X" is marked at a point 1 cm above the mid clavicle, immediately lateral to the edge of the anterior scalene muscle, and on the palpable portion of the subclavian artery. The area is aseptically prepared and draped. 3) A 22 gauge 3.5cm needle attached to a syringe filled with 2% lidocaine (7~8mg/kg of body weight) and epineprine(1 : 200,000) is inserted caudally toward the second portion of the artery where it crosses the first rib and parallel with the lateral border of the muscle until a paresthesia is obtained. 4) Paresthesia is usually elicited while inserting the needle tip about 1~2 em in depth. If so, the local anesthetic solution is injected after careful aspiration. 5) If no paresthesia is elicited, the needle is withdrawn and redirected in an attempt to elicit paresthesia. 6) If, after several attempts, no paresthesia is obtained, the local anesthetic solution is injected into the perivascular sheath after confirming that the artery is not punctured. 7) Immediately after starting surgery, Valium is injected for sedation by the intravenous route in almost all cases. The age distribution of the cases was from 11 to 80 years. Sex distribution was 476 males and 49 females (Table 1). Operative procedures consisted of 103 open reductions, 114 skin grafts combined with spinal anesthesia in 14, 87 debridements, 75 repairs, i.e. tendon (41), nerve(32), and artery (2), 58 corrections of abnormalities, 27 amputations above the elbow (5), below the elbow (3) and fingers (17), 20 primary closures, 18 incisions and curettages, 2 replantations of cut fingers. respectively (Table 2). Paresthesia was obtained in all cases. Onset of analgesia occured within 5 minutes, starting in the deltoid region in almost all cases. Complete anesthesia of the entire arm appeared within 10 minutes but was delayed 15 to 20 minutes in 5 cases and failed in one case. Thus, our success rate was nearly 100%. The duration of anesthesia after a single injection ranged from $3\frac{1}{2}$ to $4\frac{1}{2}$, hours in 94% of the cases. The operative time ranged from 0.5 to 4 hours in 92.4% of the cases(Table 3). Repeat blocks were carried out in 33 cases when operative times which were more than 4 hours in 22 cases and the others were completed within 4 hours (Table 4). Two patients of the 33 cases, who received microvasular surgery were injected twice with 2% lidocaine 20 ml for a total of $13\frac{1}{2}$ hours. The 157 patients who received surgery on the forearms or hands had pneumatic tourniquets (250 torrs) applied without tourniquet pain. There was no pneumothorax, hematoma or phrenic nerve paralysis in any of the unilateral and 27 bilateral blocks, but there was hoarseness in two, Horner's syndrome in 11 and shivering in 7 cases. No general seizures or other side effects were observed. By 20ml of 60% urcgratin study, we confirm ed the position of the needle tip to be in a safer position when the arm is in hyperabduction than when it is in adduction. And also that the humoral head caused some obstraction of the distal flow of the dye, indicating that less local anesthetic solution would be needed for satisfactory anesthesia. (Fig. 3,4).

• Korean Journal of Heritage: History & Science
• /
• v.43 no.1
• /
• pp.160-189
• /
• 2010

This study has been designed to grasp the present situation, shapes and meaning of the standing stones and rock pillars in the whole area of Noseong Mountain Fortress in Nonsan City which have never been academically reported yet. Accordingly, the research was carried out to grasp the spatial identity of Noseong Mt. and Noseong Mountain Fortress and the dispersion of standing stones scattered around inside and outside Noseong Mountain Fortress, while the shapes and structural characteristics of stones were investigated and analyzed focusing on Chongsuk Temple, which was considered to have the highest density of standing stones and greatest values for preservation as a cultural property. In consideration of the reference to the 'Top Sa' (tower temple) at the 'Bul Woo Jo' (Article about Buddhism Houses) of 'Shinjoong Dongguk Yeoji Seungram', theoretical existence of the temple according to surveying investigation, and the excavation records of roof tile pieces with the name of 'Gwan Eum Temple', it is presumed that there had been a Buddhist sanctum inside the fortress and it could be connected to the carved letters, 'Chongsuk Temple'. According the observation survey, the 6th place of standing stones among many other places inside the fortress shows that Chongsuk Temple appears to have the strong characteristics of artificially constructed space in consideration of the size of trees and stones, the composite trend of tree and stone composition, and trace of the adjacent well and strand and the construction of stairway leading to the stone gate. Along with the constellation of the Big Dipper carved on a rock at the same space, the stones, on which the letters of 'Shinseonam', 'Chilseongam' and 'Daejangam' were carved, including 'Chongsuksa', and the carved statue of Buddha, which was assumed to be Avalokitesvara Guan Yin, have offered clue which make it possible to infer that the space was a space for Chilseong and Mountain god(Folk Belief) that had originated from the combination of Buddhism, Taoism and folk religion. According to the actual measurement of standing stones at Chonsuk Temple, it was identified that there were big differences in height among 24 stones in total, ranging from 402~29cm and the averaged distance between each stone appeared to be 23.6cm. And the shape of stones appeared to be standing or flat, and various stones such as mountain-like stones and Buddha-like stones were placed in a special arrangement or assorted arrangement, but the direction of the stones had a consistency pointing to the west. And comparing to the trace of construction of ZEN Landscape Garden well known in the country, the three flat stones except for the standing and shaped stones appeared to have the shape of meditation statue, which is the typical formational factors of a ZEN Landscape Garden, on the basis of formational technique of stones. Among them, the flat stone facing the Buddhist saint statue, was formed by way of symbolization of three-mountain stone, which was assumed to be an offering stone for sacrificial food rather than carrying out ZEN Meditation. In consideration of the formation of standing stones at Chong-suk Temple, which was carried out in the composite stoning method based using the scalene triangle with ratio of 3:5:7 in order to seek the in-depth beauty based on the stone statues of three Buddhas where the three factors such as heaven, earth and humans are embodied in the elevated or flat formation, the stones at Chongsuk Temple and the space seemed to the trace of contracted garden construction that was formed with stones for a temple, so that could be used for ZEN meditation.