• The Journal of Korean Orthopaedic Ultrasound Society
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• v.3 no.2
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• pp.54-58
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• 2010

Purpose: In patients with chronic cervical pain, the facet joint is the source of the majority. Due to the difficulty of identifying the exact location of the joint that causes these symptoms, the possibility of complications and the placebo effect brings clinical application into question. In this study, we assessed the prevalence of patients with chronic cervical pain and report the diagnostic and therapeutic usefulness of ultrasonography - guided facet joint block therapy. Materials and Methods: Patients with nonspecific chronic cervical pain for more than 6 months were selected. Patients with disc herniation, sciatica-related pain were excluded from the study and 160 patients who failed in conservative treatment (physical therapy, chiropractic therapy, medication) were included in the study. Diagnostic Ultrasonography-guided facet joint block was performed with 1% lidocaine, and after two weeks, Bupivacaine 0.25% was used in patients who tested positive for lidocaine. Patients with more than 75% pain reduction during movement after facet joint block were considered positive. Results: Among the 160 patients with chronic cervical pain, 96 patients(60%) had a positive reaction after facet block using lidocaine. Among the 64 patients with a negative reaction to lidocaine, 48 patients(75%) had a positive reaction to bupivacaine. There were 48 false positive patients(50%) who showed a positive reaction to lidocaine but a negative reaction to bupivacaine. The mean VAS of the total 160 patients before blocks was 8.5, after 2 weeks follow up it decreased to 2.7 (p = 0.001) and after 4weeks 3.6 (p = 0.001). The 8 patients as an initial improvement of symptoms are not satisfied with the procedure and the 3 patients had been worsened during observation, were showed pain relief after additional ultrasonography-guided facet joint block at 4th week. Conclusion: A single ultrasonography-guided block to chronic cervical pain patients has relatively low diagnostic value since high false positive rate. The twice facet joint blocks is thought to be a useful method for interventional pain management of patients with chronic cervical pain.

• PNF and Movement
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• v.13 no.4
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• pp.197-202
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• 2015

Purpose: This study aimed to examine the effects of a proprioceptive neuromuscular facilitation (PNF) program on neck pain, cervical range of motion, pressure pain, and the cervical flexion-relaxation ratio in a visual display terminal (VDT) worker. Methods: We recruited a 33-year-old VDT worker diagnosed with chronic VDT syndrome. The subject was treated using a PNF program for 20 minutes a day, three times a week for six weeks. All evaluations were performed every two weeks on the first test day. Results: The PNF program resulted in a significant improvement in the subject's neck pain, cervical range of motion, pressure pain, and the cervical flexion-relaxation ratio after six weeks, in comparison to the subject's condition before treatment. Conclusion: The PNF program can be used effectively to improve neck pain, cervical range of motion, pressure pain, and the cervical flexion-relaxation ratio in visual display terminal (VDT) workers.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.304-307
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• 1997

Continuous epidural infusion, a combination of local anesthetic and opioid, have been widely administered for treatment of chronic cancer pain. A serious complications of epidural block is paraplegia which can also be caused by : direct spinal cord injury, epidural hematoma, epidural abscess, ischemic change, neurotoxicity, preexisting disease. Continuous epidural block for pain control of patient with cervical cancer was performed at $T_{12}/L_1$ interspace. A 4 cm catheter was inserted cephalad into the epidural space. After four months, back pain and motor weariless of lower extremities progressively developed. Spine CT showed bony destruction and soft mass-like lesion at $T_9$ & $T_{12}$ spine. We propose paraplegia was caused by spinal cord compression which resulted from vertebral metastasis of cervical cancer.

• Journal of the Korean Society of Physical Medicine
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• v.14 no.2
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• pp.29-40
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• 2019

PURPOSE: Despite the widespread occurrence in the general population, few studies have directly evaluated the effects of shingles on non-specific neck pain (NSNP). This study investigated whether sensory training or therapeutic stretching exercises are more effective in increasing neck mobility and reducing neck pain in chronic NSNP patients. METHODS: Eighty-one subjects aged between 20 and 32 years with chronic neck pain (> six months), were allocated randomly to three groups: sensorimotor training group (STG), therapeutic stretching group (TSG), and home exercise group (HEG). All participants received a half-hour training session, three times weekly for six weeks. The outcomes were evaluated using the neck disability index for measuring neck pain, and a universal goniometer to measure the cervical passive range of motion before and after the six-week intervention. RESULTS: The post-test neck disability index scores in the STG (t = 4.86) and TSG (t = 3.24) were decreased significantly (p < .05). The passive range of motion changes in all cervical movements in the STG was increased significantly (p < .05) after intervention compared to those in the other two groups. CONCLUSION: Sensorimotor training using chin tuck exercises may improve neck pain and mobility in subjects with chronic NSNP.

• Journal of Korean Medicine Rehabilitation
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• v.27 no.1
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• pp.37-51
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• 2017

Objectives This study was designed to identify the effect of acupuncture combined with wooden neck pillow self-exercise program (WSP). Methods 25 eligible subjects with chronic neck pain were recruited from September 2015 to August 2016. Subjects were treated by acupuncture twice a week for 4 weeks, also were educated WSP and exercised every day for 4 weeks. They were assessed using PI-NRS, NDI and the maximum muscle strength of deep cervical flexor muscles (DCF) before and after treatment. Also the Cobb's angle (C1-C7), Ishihara index, Park method were assessed for evaluating the radiographical changes. Variables were compared using paired t-test. And correlates analysis was used for analyzing relationship between differentials in the maximum muscle strength of DCF and differentials in cervical spine curvature measurement methods. Results Among the 25 subjects, 4 subjects were lost to follow-up or excluded in accordance with the criteria. Significant differences on NRS, NDI and the maximum muscle strength of DCF were seen after treatment (p<0.001). In radiological finding, cervical spine curvature measurement methods were significantly increased (p<0.001, p<0.05, p<0.05). Differentials in the maximum muscle strength of DCF significantly correlates to differentials in Ishihara index (R=0.479, p<0.05). Conclusions Acupuncture combined with WSP may decrease neck pain intensity and associated disability, and also increase the muscle strength of DCF and cervical lordosis, in patients with chronic neck pain. Especially, Improving the muscle strength of DCF has a relationship with improving Ishihara index. However, due to the design of this study, this treatment can not be compared with other treatments. Future randomized project should be needed.

• Physical Therapy Korea
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• v.27 no.1
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• pp.1-10
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• 2020

Background: Thoracic spine self-mobilization exercise is commonly used to manage patients with neck pain. However, no previous studies have investigated the effects of thoracic spine self-mobilization exercise alone in patients with chronic neck pain. Objects: The purpose of this study was to investigate the effects of thoracic self-mobilization using a tool on cervical range of motion (ROM), disability level, upper body posture, pain and fear-avoidance beliefs questionnaire (FABQ) in patients with chronic neck pain. Methods: The subjects were 49 patients (21 males, 28 females) with chronic neck pain. The subjects were randomly divided into an experimental group (EG, n = 23) and control group (CG, n = 26). For the EG, thoracic self-mobilization was applied. We placed a tool (made with 2 tennis balls) under 3 different vertebral levels (T1-4, T5-8, T9-12) of the thoracic spine and the subjects performed crunches, which included thoracic flexion and extension in supine position. Five times × 3 sets for each levels, twice a week, for 4 weeks. Cervical pain, disability, upper body posture, FABQ results, and ROM were evaluated at baseline, after 4 weeks of intervention, and at 8 weeks of follow-up. Assessments included the quadruple visual analogue scale (QVAS); Northwick Park neck pain questionnaire (NPQ); craniovertebral angles (CVA), forward shoulder angle (FSA) and kyphosis angle (KA) measurements for upper body posture; FABQ and cervical ROM testing. Results: The EG showed a statistically significant improvement after intervention in the QVAS (-51.16%); NPQ (-53.46%); flexion (20.95%), extension (25.32%), left rotation (14.04%), and right rotation (25.32%) in the ROM of the cervical joint; KA (-7.14%); CVA (9.82%); and FSA (-4.12%). Conclusion: These results suggest that, for patients with chronic neck pain, thoracic self-mobilization exercise using a tool (tennis balls) is effective to improve neck pain, disability level, the ROM, and upper body posture.

• Journal of Korean Physical Therapy Science
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• v.28 no.1
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• pp.46-53
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• 2021

Background: The purpose of this study was to investigate the effect of taping applied to the lower trapezius on the upper trapezius muscle tone, pain intensity, cervical rotation range of motion in chronic upper trapezius pain patients. Design: Case-control study. Methods: Twenty subjects with chronic upper trapezius pain were classified into an experimental group and a control group. The experimental group applied lower trapezius facilitation taping and the control group applied sham taping. Taping Before and after the application of taping, muscle tone, pain intensity, and cervical rotation range of motion of the upper trapezius were measured. Results: In the experimental group, there were significant differences in the pressure pain threshold and muscle tone before and after taping. In the comparison between groups, there was a significant difference in muscle tone between the experimental group and the control group. Conclusion: The application of the lower trapezius facilitation taping was found to be effective in reducing the pressure threshold and muscle tone of the upper trapezius. Therefore, it is expected that more effective treatment can be provided by adding lower trapezius facilitation taping to the treatment protocol for patients with chronic shoulder pain.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.264-267
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• 1996

Cervical epidural block can be useful in the management of acute and chronic pain of the head, neck, shoulder, and arm, for selected patients. In spite of the widespread use of cervical epidural blocks for pain, there is limited published data on the specific technique and complications regarding the procedure. High levels of epidural block do not appear to be associated with clinically significant circulatory or ventilatory changes unless the concentrations of local anesthetics used are great enough to produce paralysis of intercostal and phrenic nerves. However, high level of epidural block is associated with sympathetic block which may affect responses of circulatory and ventilatory systems. Accordingly, the possibility of major complications of cervical epidural block must be borne in mind. We experienced two cases of respiratory arrest during cervical epidural block with bupivacaine. This is a report regarding complications of cervical epidural block.

• The Korean Journal of Pain
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• v.4 no.2
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• pp.147-151
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• 1991

Cervical epidural steroid injection, although not as familiar to many anesthesiologists, can be useful in the management of patients with acute and chronic neck, shoulder and arm pain. My clinic personally contacted and interviewed thirty patients with cervical radiculopathy who received cervical epidural steroid injection. Twenty seven percent of the patients had a excellent response(greater than 75% improvement) and fifty percent of the patients had a good response (greater than 50% improvement) to an injection of steroid into the cervical epidural space. We have concluded that cervical epidural steroid injection was very effective in the management of cervical radiculopathy and represented a possible alternative to surgery. Many anesthesiologists should add to their armamentarium the use of such techniques in the management of cervical radiculopathy.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.105-108
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• 1998

Backgrounds: Cervical epidural nerve block is useful in the management of a variety of acute, chronic and cancer related pain syndromes involving the head, face, neck and upper extrimity. To safely perfom the cervical epidural block, an appreciation of the expected distance from skin to epidural space is important. We studied the distance from skin to cervical epidural space of adults to determine if any relationship exists between patient height, weight and neck circumference and the distance from skin to epidural space. Methods: Patients 170, suffering from neck and upper extremity pain with cervical HIVD(herniated intervertebral dics) were selected. Cervical epidural block was performed at $C_{6\sim7}$ or $C_{7-}T_1$ intervertebral space. Then measured the distance from skin to epidural space and analysed the relationship between age, height, weight and neck circumference and the distance from skin to epidural space. Results: The cervical epidural depth of male $C_{6\sim7}$, male $C_{7-}T_1$, female $C_{6\sim7}$ and female $C_{7-}T_1$ groups were $5.17{\pm}0.63$, $5.47{\pm}0.59$, $4.84{\pm}0.56$ and $5.01{\pm}0.60$ cm respectively. Cervical epidural depth significantly correlated with body weight, ponderal index and neck circumference. Conclusions: The distance from skin to cervical epidural space has significant relationships with weight, ponderal index and neck circumference. Although experience is important, patient's weight and neck circumference are indicating factor, of the cervical epidural depth.