Yung-Tsan Wu

Ultrasound-guided pulsed radiofrequency stimulation of the suprascapular nerve for adhesive capsulitis: a prospective, randomized, controlled trial.

BACKGROUND:The treatment of adhesive capsulitis (AC) is a well-known, complicated, and long process. Recent studies have shown that pulsed radiofrequency (PRF) lesioning of the suprascapular nerve (SSN) using a fluoroscopy- or computed tomography-guided technique can alleviate shoulder pain. However, there are no studies of PRF lesioning of the SSN in patients with AC using ultrasound-guided (UG) techniques, except for 2 case reports. In this study, we compared the effect of physical therapy alone with physical therapy and PRF lesioning of the SSN using a UG technique. METHODS:Sixty patients with AC were included in the study. Patients were randomized into the following 2 groups: the intervention group containing patients who received 12 weeks of physical therapy after 1 treatment of PRF lesioning of the SSN, and the control group containing patients who received 12 weeks of physical therapy alone. All outcome measurements including visual analog scale (VAS), shoulder pain and disability index, and passive range of motion (PROM) were performed at 1, 4, 8, and 12 weeks after treatment. RESULTS:Forty-two patients (21 patients in each group) completed the study. The intervention group had a notably shorter time to onset of significant pain relief (6.1 ± 3.4 vs 28.1 ± 9.2 days; P < 0.001) and noticeable reduction of VAS score at week 1 (40% vs 4.7%) than the control group (P < 0.001). All measured variables in the intervention group and most variables in the control group showed significant improvement from the baseline (P < 0.05). A comparison of the 2 groups indicated significantly greater improvement in the intervention group at all times in VAS and shoulder pain and disability index scores (all P < 0.05), and for most gain of PROM (P < 0.05). There were no serious adverse effects or complications in either group. CONCLUSIONS:This study indicates that the application of PRF lesioning of the SSN using a UG technique combined with physical therapy provided better and faster relief from pain, reduced disability, and improved PROM when compared with physical therapy alone in patients with AC, an effect that persisted for at least 12 weeks.

Ultrasound-Guided Pulsed Radiofrequency for Carpal Tunnel Syndrome: A Single-Blinded Randomized Controlled Study

Objective We assessed the therapeutic efficiency of ultrasound-guided pulsed radiofrequency (PRF) treatment of the median nerve in patients with carpal tunnel syndrome (CTS). Methods We conducted a prospective, randomized, controlled, single-blinded study. Forty-four patients with CTS were randomized into intervention or control groups. Patients in the intervention group were treated with PRF and night splint, and the control group was prescribed night splint alone. Primary outcome was the onset time of significant pain relief assessed using the visual analog scale (VAS), and secondary outcomes included evaluation of the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) results, cross-sectional area (CSA) of the median nerve, sensory nerve conduction velocity (SNCV) of the median nerve, and finger pinch strength. All outcome measurements were performed at 1, 4, 8, and 12 weeks after treatment. Results Thirty-six patients completed the study. The onset time of pain relief in the intervention group was significantly shorter (median onset time of 2 days vs. 14 days; hazard ratio = 7.37; 95% CI, 3.04–17.87) compared to the control group (p < 0.001). Significant improvement in VAS and BCTQ scores (p < 0.05) was detected in the intervention group at all follow-up periods compared to the controls (except for the severity subscale of BCTQ at week 1). Ultrasound-guided PRF treatment resulted in a lower VAS score and stronger finger pinch compared to the control group over the entire study. Conclusions Our study shows that ultrasound-guided PRF serves as a better approach for pain relief in patients with CTS. Trial Registration ClinicalTrials.gov NCT02217293

Effect of radial shock wave therapy for carpal tunnel syndrome: A prospective randomized, double‐blind, placebo‐controlled trial

Three recent studies demonstrated the positive effect of extracorporeal shock wave therapy (ESWT) for treating carpal tunnel syndrome (CTS). However, none have entirely proved the effects of ESWT on CTS because all studies had a small sample size and lacked a placebo‐controlled design. Moreover, radial ESWT (rESWT) has not been used to treat CTS. We conducted a prospective randomized, controlled, double‐blinded study to assess the effect of rESWT for treating CTS. Thirty‐four enrolled patients (40 wrists) were randomized into intervention and control groups (20 wrists in each). Participants in the intervention group underwent three sessions of rESWT with nightly splinting, whereas those in the control group underwent sham rESWT with nightly splinting. The primary outcome was visual analog scale (VAS), whereas the secondary outcomes included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ), cross‐sectional area (CSA) of the median nerve, sensory nerve conduction velocity of the median nerve, and finger pinch strength. Evaluations were performed before treatment and at 1, 4, 8, and 12 weeks after the third rESWT session. A significantly greater improvement in the VAS, BCTQ scores, and CSA of the median nerve was noted in the intervention group throughout the study as compared to the control group (except for BCTQ severity at week 12 and CSA at weeks 1 and 4) (p < 0.05). This is the first study to assess rESWT in a randomized placebo‐controlled trial and demonstrate that rESWT is a safe and effective method for relieving pain and disability in patients with CTS.

The Predictor of Mortality within Six-Months in Patients with Spontaneous Cerebellar Hemorrhage: A Retrospective Study

Background and Purpose The mortality rate of cerebellar hemorrhage (CH) is generally higher than other types of intracranial hemorrhage. Recently, the increased survey rate of CH has come from improved clinical imaging and earlier surgical intervention. Hence, the predictors of intermittent- (1 to 6 months) and long-term (> 6months) mortality are clinically practical use for educational and therapeutic decisions. Unfortunately, the factors predictive mortality within six-month had not yet been systematically investigated. Methods Seventy-two patients with acute spontaneous CH were retrospectively analyzed. The patients were divided into the six-month mortality group (n = 21, died within 6 months after CH onset) and survival group (n = 51, survived beyond 6 months). The independent predictors of six-month mortality were investigated by multivariate Cox proportional hazards regression. Results The radiological brainstem compression (hazard ratios = 23.5; p < 0.001) was independent predictor of mortality within six-month after CH onset. The median onset time of six-month mortality was 5 days in patients with brainstem compression (p < 0.001) and the hazard ratios for the onset time was 13.1 compared with those without brainstem compression (95% CI, 4.7 to 36.3, p < 0.001). Conclusions We report the first study that radiological brainstem compression predicted the mortality within six-month after onset of CH. Patients with radiological brainstem compression were about 23 times more likely to die within 6 months after CH than those without radiological brainstem compression.

Brown-Sèquard syndrome caused by type III odontoid fracture: a case report and review of the literature.

Study Design. Case report. Objective. To present the second case of Brown-Sèquard syndrome (BSS) produced by type III odontoid fracture managed by conservative treatment. Summary of Background Data. The occurrence of BSS due to odontoid fracture is scarce. So far 6 cases have been reported, and only 1 is produced by type III odontoid fracture. The possible pathophysiology, clinical course and treatment outcome have been rarely discussed. Methods. A 39-year-old man presented with weakness of his left arm and leg, mild neck pain, and impaired proprioceptive and light touch sensations below the left C2 dermatome. There were decreased pain and temperature sensations below the right C4 dermatome too. Computerized tomography showed odontoid type III fracture with posterior displacement at that level. Magnetic resonance imaging presented focal hyperintensity around the C2 vertebral level. High dose of prednisolone, close reduction with Gardner-Wells tong skull traction, following external stabilization by Halo-Vest and rehabilitation therapy were applied. Results. Complete resolution of neck pain and significant improvement of motor and sensory functions, i.e., light touch and proprioception, were shown 2 months after spinal injury. Impaired temperature discrimination persisted, however. Conclusion. BSS is rarely caused by type III odontoid fracture and this is the second report. Conservative intervention is advantageous for both type III odontoid fracture and BSS which is consistent with previous results.

Six-month efficacy of platelet-rich plasma for carpal tunnel syndrome: A prospective randomized, single-blind controlled trial

Recently, a few small reports with short follow-up period have shown clinical benefits of platelet-rich plasma (PRP) for peripheral neuropathy including one pilot study and one small, non-randomized trial in patients with carpal tunnel syndrome (CTS). Therefore, we conducted a randomized, single-blind, controlled trial to assess the 6-month effect of PRP in patients with CTS. Sixty patients with unilateral mild-to-moderate CTS were randomized into two groups of 30, namely the PRP and control groups. In the PRP group, patients were injected with one dose of 3 mL of PRP using ultrasound guidance and the control group received a night splint through the study period. The primary outcome measure was the visual analog scale (VAS) and secondary outcome measures included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) score, the cross-sectional area (CSA) of the median nerve (MN), electrophysiological findings of the MN, and finger pinch strength. The evaluation was performed before treatment and at 1, 3, and 6 months post-injection. The PRP group exhibited a significant reduction in the VAS score, BCTQ score, and CSA of MN compared to the those of control group 6 months post-treatment (p < 0.05). Our study demonstrates that PRP is a safe modality that effectively relieves pain and improves disability in the patients with CTS.

The dose-dependent efficiency of radial shock wave therapy for patients with carpal tunnel syndrome: a prospective, randomized, single-blind, placebo-controlled trial

Recently, extracorporeal shock wave therapy (ESWT) has been shown to be a novel therapy for carpal tunnel syndrome (CTS). However, previous studies did not examine the diverse effects of different-session ESWT for different-grades CTS. Thus, we conducted a randomized, single-blind, placebo-controlled study. Sixty-nine patients (90 wrists) with mild to moderate CTS were randomized into 3 groups. Group A and C patients received one session of radial ESWT (rESWT) and sham eESWT per week for 3 consecutive weeks, respectively; Group B patients received a single session of rESWT. The night splint was also used in all patients. The primary outcome was Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) points, whereas secondary outcomes included the sensory nerve conduction velocity and cross-sectional area of the median nerve. Evaluations were performed at 4, 10, and 14 weeks after the first session of rESWT. Compared to the control group, the three-session rESWT group demonstrated significant BCTQ point reductions at least 14 weeks, and the effect was much longer lasting in patients with moderate CTS than mild CTS. In contrast, the effect of single-session rESWT showed insignificant comparison. rESWT is a valuable strategy for treating CTS and multiple-session rESWT has a clinically cumulative effect.

Effect of Radial Shock Wave Therapy on Spasticity of the Upper Limb in Patients With Chronic Stroke: A Prospective, Randomized, Single Blind, Controlled Trial

AbstractRecently, studies have reported that extracorporeal shock wave therapy (ESWT) is a safe, noninvasive, alternative treatment for spasticity. However, the effect of ESWT on spasticity cannot be determined, because most studies to date have enrolled small patient numbers and have lacked placebo-controlled groups and/or long-term follow-up. In addition, whether varying the number of ESWT sessions would affect the duration of the therapeutic effect has not been investigated in a single study. Hence, we performed a prospective, randomized, single blind, placebo-controlled study to investigate the long-term effect of radial ESWT (rESWT) in patients with poststroke spasticity and surveyed the outcome of functional activity.Sixty patients were randomized into 3 groups. Group A patients received 1 session of rESWT per week for 3 consecutive weeks; group B patients received a single session of rESWT; group C patients received one session of sham rESWT per week for 3 consecutive weeks. The primary outcome was Modified Ashworth Scale of hand and wrist, whereas the secondary outcomes were Fugl-Meyer Assessment of hand function and wrist control. Evaluations were performed before the first rESWT treatment and immediately 1, 4, 8, 12, and 16 weeks after the last session of rESWT.Compared to the control group, the significant reduction in spasticity of hand and wrist lasted at least 16 and 8 weeks in group A and B, respectively. Three sessions of rESWT had a longer-lasting effect than one session. Furthermore, the reduction in spasticity after 3 sessions of rESWT may be beneficial for hand function and wrist control and the effect was maintained for 16 and 12 weeks, respectively.rESWT may be valuable in decreasing spasticity of the hand and wrist with accompanying enhancement of wrist control and hand function in chronic stroke patients.

Conus medullaris metastasis in breast cancer: report of a case and a review of the literature

Intramedullary spinal cord metastasis is quite rare. This report presents the case of a female patient with metastasis of the conus medullaris from breast cancer, presenting with paraplegia and sphincter dysfunction. Bladder dysfunction improved after removal of the conus mass. This report is the seventh case of conus medullaris metastasis from breast cancer and the first review of clinical outcome, survival time and other data of all these 7 cases. This study also reviewed cases of intramedullary spinal cord metastasis arising from breast cancer in regions other than the conus medullaris in the literature. Longer survival time resulted from surgery in contrast to those without surgery in the latter group.

Massage-Induced Brachial Plexus Injury

Background and Purpose There are few reports in the literature of adverse effects resulting from massage therapy (MT) and no reports of brachial plexus injury (BPI) associated with MT. This case report describes an uncommon case of BPI that developed after a session of MT and reviews previously published reports of peripheral nerve injury following MT. Case Description A 58-year-old Asian woman developed sudden unilateral paralysis of her left shoulder girdle after a session of MT. A diagnosis of acute BPI was suspected due to her recent history and the results of several examinations. The results of electrodiagnostic studies indicated a possible location for the lesion and ultimately led to a different diagnosis. Outcomes The patient regularly participated in a twice-weekly rehabilitation program targeting the left shoulder. The rehabilitation program included supervised passive range of motion, strengthening, and stretching exercises as well as a home exercise program. A 12-month follow-up showed the patient had achieved gradual recovery of shoulder strength, resolution of limitations of range of motion, and relief of shoulder pain. Discussion This is believed to be the first report of BPI associated with MT. This case report serves as a reminder to massage therapists and physical therapists that MT of the neck should be carefully performed to avoid injury. Further studies will help design safer and more effective MT for the future.