• The Korean Journal of Pain
• /
• v.22 no.3
• /
• pp.224-228
• /
• 2009

Background: Shoulder arthroscopic surgery is frequently associated with severe postoperative pain, which can be difficult to manage without the use of high-dose opioids. Although an interscalene brachial plexus block (ISBPB) can be used to provide anesthesia for shoulder arthroscopic surgery, its effect using low-dose mepivacaine on postoperative pain management has not been reported. We hypothesized that ISBPB using a low-dose mepivacaine can provide effective postoperative analgesia for shoulder arthroscopic surgery without the need for high-dose opioids and act as a significant motor or sensory block. Methods: This study examined a total of 40 patients, who underwent shoulder arthroscopic surgery, and received ISBPB with 10 ml of normal saline (group NS; n = 20) or 10 ml of 1% mepivacaine with epinephrine 1:200,000 (group MC; n = 20). The block was performed preoperatively. The postoperative pain score, opioid consumption, and side effect were recorded. Results: The visual analog scale scores were significantly lower in group MC than in group NS at 120 minutes after shoulder arthroscopic surgery ($1.9{\pm}1.0$ versus $4.0{\pm}1.4$). Group MC showed significantly lower fentanyl consumption after shoulder arthroscoic surgery than group NS ($27{\pm}32.6$ versus $79{\pm}18.9{\mu}g$). The degree of motor and sensory block after surgery was minimal. Conclusions: ISBPB using low-dose mepivacaine reduced the level of postoperative pain and fentanyl consumption without significant side effects. ISBPB using low-dose mepivacaine is a useful analgesic technique for shoulder arthroscopic surgery.

• Journal of Chest Surgery
• /
• v.50 no.1
• /
• pp.36-40
• /
• 2017

Background: Surgical treatment of thoracic outlet syndrome (TOS) is necessary when non-surgical treatments fail. Complications of surgical procedures vary from short-term post-surgical pain to permanent disability. The outcome of TOS surgery is affected by the visibility during the operation. In this study, we have compared the complications arising during the supraclavicular and the transaxillary approaches to determine the appropriate approach for TOS surgery. Methods: In this study, 448 patients with symptoms of TOS were assessed. The male-to-female ratio was approximately 1:4, and the mean age was 34.5 years. Overall, 102 operations were performed, including unilateral, bilateral, and reoperations, and the patients were retrospectively evaluated. Of the 102 patients, 63 underwent the supraclavicular approach, 32 underwent the transaxillary approach, and 7 underwent the transaxillary approach followed by the supraclavicular approach. Complications were evaluated over 24 months. Results: The prevalence of pneumothorax, hemothorax, and vessel injuries in the transaxillary and the supraclavicular approaches was equal. We found more permanent and transient brachial plexus injuries in the case of the transaxillary approach than in the case of the supraclavicular approach, but the difference was not statistically significant. Persistent pain and symptoms were significantly more common in patients who underwent the transaxillary approach (p<0.05). Conclusion: The supraclavicular approach seems to be the more effective technique of the two because it offers the surgeon better access to the brachial plexus and a direct view. This approach for a TOS operation offers a better surgical outcome and lower reoperation rates than the transaxillary method. Our results showed the supraclavicular approach to be the preferred method for TOS operations.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
• /
• v.9 no.2
• /
• pp.5-11
• /
• 2003

Thoracic outlet syndrome is actually a collection of syndromes brought about by abnormal compression of the neurovascular bundle by bony, ligamentous or muscular obstacles between the cervical spine and the lower border of the axilla. First of all a syndrome is defined as a group of signs and symptoms that collectively characterize or indicate a particular disease or abnormal condition. The neurovascular bundle which can suffer compression consists of the brachial plexus plus the C8 and T1 nerve roots and the subclavian artery and vein. The brachial plexus is the network of motor and sensory nerves which innervate the arm, the hand, and the region of the shoulder girdle. The vascular component of the bundle, the subclavian artery and vein transport blood to and from the arm. the hand. the shoulder girdle and the regions of the neck and head. The bony, ligamentous, and muscular obstacles all define the cervicoaxillary canal or the thoracic outlet and its course from the base of the neck to the axilla or arm pit. Look at the scheme of this region and it all becomes more easily understood. Compression occurs when the size and shape of the thoracic outlet is altered. The outlet can be altered by exercise, trauma, pregnancy, a congenital anomaly, an exostosis, postural weakness or changes. Thoracic outlet syndrome has been described as occurring in a diverse population. It is most often the result of poor or strenuous posture but can also result from trauma or constant muscle tension in the shoulder girdle. The first step to beginning any treatment begins with a trip to the doctor. Make a list of all of the symptoms which seem to be present even if the sensations are vague. Make a note of what activities and positions produce or alleviate the symptoms and the time of day when symptoms are worst. Also, note when the symptoms first appeared. This list is important and should also include any questions one may have.

• The Journal of Korean Orthopaedic Ultrasound Society
• /
• v.7 no.1
• /
• pp.67-75
• /
• 2014

There are several kinds of regional nerve blockades, such as interscalene brachial plexus block, C5 root block, suprascapular nerve block, and axillary nerve block, which can be applied for anesthesia and postoperative pain control after shoulder surgeries. These regional nerve blockades have shown good results, but high failure rate and serious complications, such as phrenic nerve palsy, pneumothorax, and nerve injury, still remain. Ultrasound-guided intervention can increase the success rate of nerve blockades and reduce complications. We described the method of ultrasound-guided intervention for the regional nerve blockades around shoulder.

• Physical Therapy Korea
• /
• v.13 no.2
• /
• pp.43-51
• /
• 2006

The term thoracic outlet syndrome (TOS) is used to describe patients with compressed subclavian arteries, veins, and brachial plexuses in the region of the thoracic outlet. The objective of this study was to evaluate a scalenus stretching exercise that aims to restore normal function to patients with TOS. This study consisted of 60 patients with symptoms of TOS, and divided the patients into 3 groups: one that received manual therapy, one that practiced self stretching, and a control group. Each group consisted of 20 patients. This study assessed the efficacy of scalenus stretching exercise by examining the resting pain, tenderness, spherical grip power, and pinch grip power of patients. The data were analyzed using one-way ANOVA, Scheffe post hoc test, and independent t-test. The results showed that resting pain was statistically significant within the manual therapy and self stretching groups (p<.05), and that the resting pain of the manual therapy group was more statistically significant than that of the self stretching group (p<.05). Tenderness, spherical grip power, and pinch grip were statistically significant within the manual therapy and self stretching groups (p<.05), but there was no statistically significant difference between the two groups (p>.05). Finally I could see that there were no statistical differences between manual therapy and self stretching to improve the symptoms of the patients with TOS. These results imply that self stretching by patients is as important as manual therapy by a physical therapist.

• Annals of Clinical Neurophysiology
• /
• v.7 no.2
• /
• pp.83-87
• /
• 2005

Background: The study of the medial antebrachial cutaneous nerve (MABCN) is an underused electrodiagnostic tool. But its use is often crucial for assessing mild lower brachial plexus or MABCN lesions, and sometimes for differentiating an ulnar mononeuropathy from a lower brachial plexopathy. This study was designed to know the difference of amplitude and velocity in a stimulation method (orthodromic vs antidromic), side of an arm and sex according by age. Method: MABCN conduction studies were performed orthodromically and antidromically in 90 subjects (42 women and 48 men, ranging from 22 to 79 years of age). We divided subjects into three groups by age (group 1: 20-39 years, group 2: 40-59 years, group 3: 60-79 years). The mean sensory nerve action potential amplitudes and sensory nerve conduction velocities in each group was compared by stimulation method, side of an arm and sex. Result: The amplitudes and velocities made a significant difference between orthodromic and antidromic method in all age groups. At comparison in amplitude and velocity by side of an arm, only amplitude was significantly higher in right arm than left by any stimulation method. The amplitudes and velocities were of no statistically differences in sex except amplitude checked orthodromically in right arm. Conclusion: This study suggests that there is the differences in conduction study of MABCN by stimulation method and side of an arm.

• Journal of Yeungnam Medical Science
• /
• v.41 no.2
• /
• pp.120-127
• /
• 2024

Background: Physiatrists are facing with survivors from disasters in both the acute and chronic phases of muscle and nerve injuries. Similar to many other clinical conditions, neuromusculoskeletal ultrasound can play a key role in the management of such cases (with various muscle/nerve injuries) as well. Accordingly, in this article, a recent single-center experience after the Turkey-Syria earthquake will be rendered. Methods: Ultrasound examinations were performed for various nerve/muscle lesions in 52 earthquake victims referred from different cities. Demographic features, type of injuries, and applied treatment procedures as well as detailed ultrasonographic findings are illustrated. Results: Of the 52 patients, 19 had incomplete peripheral nerve lesions of the brachial plexus (n=4), lumbosacral plexus (n=1), and upper and lower limbs (n=14). Conclusion: The ultrasonographic approach during disaster relief is paramount as regards subacute and chronic phases of rehabilitation. Considering technological advances (e.g., portable machines), the use of on-site ultrasound examination in the (very) early phases of disaster response also needs to be on the agenda of medical personnel.

• Journal of Trauma and Injury
• /
• v.32 no.4
• /
• pp.243-247
• /
• 2019

Subclavian vein injuries occasionally occur as a sequela of penetrating trauma or vascular access, but have rarely been reported to occur after clavicle fracture. The subclavian vessels are mainly enclosed by the subclavius muscle, the first rib, and the costocoracoid ligament. Therefore, in such cases, subclavian vein injury is rare because of the strcutures surrounding the subclavian vessels. Nevertheless, subclavian vein injuries occasionally show thrombotic manifestations, and thrombosis of the upper limbs constitutes 1-4% of cases of total deep vein thrombosis. Furthermore, to the best of the authors' knowledge, although vessel injuries have been reported after clavicle or rib fractures and nerve injuries to regions such as the brachial plexus, no case involving delayed presentation of isolated subclavian vein stenosis after clavicle fracture due to blunt trauma has yet been reported.

• Journal of Chest Surgery
• /
• v.21 no.3
• /
• pp.563-566
• /
• 1988

Thoracic outlet syndrome refers to compression of the subclavian vessels and brachial plexus at the superior aperture of the thorax. it was previously designated according to presumable etiologies such as scalenus anticus, costoclavicular, hyperabduction, cervical rib and first thoracic rib syndromes. We experienced a case of thoracic outlet syndrome[costoclavicular syndrome] which was caused by posttraumatic left clavicular fracture. Patient had suffered from swelling and cyanosis of left forearm and hand. preoperative vascular doppler test, angiography and venography were performed. First rib resection was done with transaxillary approach. After operation preoperative cyanosis and swelling of left forearm and hand were disappeared. Postoperative course was uneventful.

• Annals of Clinical Neurophysiology
• /
• v.3 no.1
• /
• pp.47-49
• /
• 2001

Lateral antabrachial cutaneous neuropathy(LACN) was diagnosed in a 42-year-old woman who developed pain and paresthesia in the left forearm after several days of heavy labor. The symptoms were resolved with conservative treatment, including cessation of heavy labor and a brief course of oral corticosteroids. But the symptoms recurred after 9 months. Those were also resolved with same treatment as the first attack. LACN is important to recognize because the symptoms may mimic the pathology of a cervical root, the brachial plexus, the radial and median nerves at the level of the elbow, and a focal idiopathic inflammatory neuritis.