American journal of physical medicine & rehabilitation
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Am J Phys Med Rehabil · Feb 2015
Case ReportsFully implantable peripheral nerve stimulation for the treatment of hemiplegic shoulder pain: a case report.
This case report describes the first participant treated with a fully implantable, single-lead peripheral nerve stimulation system for refractory hemiplegic shoulder pain. During the 6-wk trial stage, a temporary lead was placed percutaneously near the terminal branches of the axillary nerve to the deltoid. The primary outcome measure was the Brief Pain Inventory-Short Form Question 3, a 0-10 pain numeric rating scale. ⋯ After 11 wks of recovery, peripheral nerve stimulation was reinitiated and the participant became pain-free through the 9-mo follow-up. At 12 mos, Brief Pain Inventory-Short Form Question 3 score was 1. This case report demonstrates the feasibility of a single-lead, fully implantable peripheral nerve stimulation system for refractory hemiplegic shoulder pain.
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Am J Phys Med Rehabil · Feb 2015
Controlled Clinical TrialUltrasonographic cross-sectional area of spinal nerve roots in cervical radiculopathy: a pilot study.
Recently, sonographic assessment has been considered an alternative method for evaluating cervical root lesions. The aim of this pilot study was to measure cross-sectional areas (CSAs) of cervical spinal nerve roots using high-resolution ultrasonography in patients with cervical radiculopathy, to compare the CSA of nerve roots between the affected and unaffected sides. Patients with a clinical diagnosis of unilateral cervical radiculopathy, who were referred to the Department of Physical Medicine and Rehabilitation in the University General Hospital by general practitioners, were prospectively recruited. ⋯ Spearman rank-order correlation test showed a positive relationship between the CSA of the affected nerve root and the duration of symptoms (ρ22 = 0.467, P = 0.021). This is, to the authors' knowledge, the first comparative study to obtain the CSA of spinal nerve roots in cervical radiculopathy. Increased CSA of the affected nerve root relative to the unaffected side, as demonstrated by ultrasonography, may be useful as an additive clue for the diagnosis of cervical radiculopathy.
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Am J Phys Med Rehabil · Feb 2015
Differences in the course of daily activity level between persons with and without chronic pain.
The aim of this study was to determine differences in (the course of) daily activity level between persons with and persons without chronic pain. ⋯ Persons with and persons without chronic pain differed in daily activity level with regard to average movement intensity, peak movement intensity, and postures. No differences were found in the course of daily activity between the two groups.
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Am J Phys Med Rehabil · Jan 2015
Case ReportsPneumocephalus during cervical transforaminal epidural steroid injections: a case report.
A cervical transforaminal epidural injection of anesthetic and corticosteroids (CTFESI) is a frequently used procedure for cervical radiculopathy. Most cases of pneumocephalus after an epidural block occur when using an interlaminar approach with the loss-of-resistance technique. The authors present the first case of pneumocephalus after cervical transforaminal epidural injection of anesthetic and corticosteroids. ⋯ She subsequently complained of nausea and headache, and a computed tomography brain scan revealed pneumocephalus. After carefully assessing the fluoroscopic images, the authors believe that the needle may have punctured the dura mater of the nerve root sleeve, allowing air to enter the subdural space. Thus, fluoroscopic images should be carefully examined to reduce dural puncture when performing cervical transforaminal epidural injection of anesthetic and corticosteroids, and air should be completely removed from the needle, extension tube, and syringe.