Study on Electromyographic Characteristics of Neck Muscles in College Students with Chronic Neck Pain

Objective:To provide new insights for the evaluation and diagnosis of chronic neck pain(CNP).Methods:22 patients with CNP and 22 healthy individuals were recruited from South China Normal University,who were all college students.The subjects'neck extensor muscle strength in the head neutral position,the natural anteversion position,and the maximum forward flexion position were measured by an isometric muscle strength tester respectively.The neck extensor strength of CNP patients and healthy subjects were compared.Results:In the neutral position,the maximum isometric muscle strength of neck extensor muscles was 12.31 kg for CNP patients and 15.16 kg for healthy individuals,resulting in a ratio of 81%strength in patients compared to healthy subjects.This difference was highly significant(P<0.000).In the natural anteversion position,the respective values were 12.6 kg for CNP patients and 15.05 kg for healthy individuals,with a ratio of 83%,and a significant difference between groups(P<0.001).In the maximum forward flexion position of the head,the values were 13.36 kg for CNP patients and 16.15 kg for healthy individuals,with a ratio of 82%,and a highly significant difference(P<0.000).Conclusion:The neck extensor muscle strength levels in college students with CNP were significantly lower compared to healthy college students across all measured positions.

The Relationship between Neck and Shoulder Pain and the Sagittal Alignment of the Spine in Standing in Younger Generation

Background: The relationship between chronic neck and shoulder pain and posture remains controversial. The purpose of this study was to investigate the relationship between chronic neck and shoulder pain and spinal sagittal alignment in standing posture in younger generation. Methods: Subjects included 57 females and 32 males (average age, 29.9 ± 5.7 years). All subjects were 20s or 30s. Spinal curvature was assessed using SpinalMouse. The subjects were also divided into a normal group (VAS zero group) and a pain group by VAS results. Statistical analysis was performed by Student’s t-test. Significance was defined as p < 0.05. Results: The normal group and pain group included 29 and 60 subjects, respectively. In terms of location of pain, thirty-one subjects felt neck pain, 50 felt pain above the scapula, and 17 felt pain between the thoracic spine and scapula. Thoracic kyphosis and lumbar lordosis in the pain group were significantly higher than those in the normal group (p = 0.013 and p = 0.020, respectively). Thoracic kyphosis in subjects with neck pain or pain above scapula was significantly higher than that in subjects without pain (p = 0.0075 and p = 0.025, respectively). Lumbar lordosis in subjects with pain above the scapula or interscapula was significantly higher than that in subjects without pain (p = 0.016).

Resolving Specific Psychological Stressors Can Instantly Reduce or Relieve Chronic Neck Pain and Upper Back Pain: Case Reports

Introduction: The goal of this study was to use a novel approach to pain relief which includes a participant using their mind to reduce or relieve their neck pain in a matter of minutes and taking continuous thermal medical imaging scans during the process to capture any concurrent temperature changes at the location of the self-reported pain. Previous studies using multidisciplinary approaches have shown that it is possible for a person to achieve a moderate reduction in pain over a period of time (typically two or more months). However, in this innovative study, the goal was to demonstrate rapid pain relief (in a matter of minutes) using only the mind. Case report: For this study, six subjects were selected, all of whom were experiencing long-term chronic neck pain. The subjects consisted of five adult females and one adult male. Several of the subjects also had pain that radiated into their upper back region. Each subject participated in one talk therapy session during which the subject’s neck was actively scanned by a thermal imaging (TI) camera that was programmed to take a new thermal image every thirty (30) seconds. The goal of the talk therapy session was to create a strong emotional shift by encouraging the subject to let go of negative emotions and replace buried painful feelings with feelings of positive expectation and optimism. Then, as the subject created this emotional shift, the goal was to observe if this change affected the subject’s self-reported physical pain, as well as noting any visible effects in thermal images. Results: All six subjects reported that they were able to relieve some or all of their pain by the end of the talk therapy session. As they did, there was simultaneously a significant decrease in temperature recorded on the TI images in the corresponding location in their neck and upper back region. This suggested that the pain relief the subjects reported was not merely “mind over matter”, since there were marked physiological changes taking place. Discussion and Conclusion: It’s worth noting that three of the subjects had moments during their talk therapy session where they thought about a specific painful memory that increased their negative emotions. At that moment, their self-reported pain also increased, and simultaneously, the infrared camera detected an increase in temperature in the corresponding location where the subjects reported increased pain. Subsequently, when the subjects were able to change the painful memory and once again move towards feelings of optimism, they reported pain relief, and simultaneously, the TI camera reported a decrease in temperature. Neither this potential outcome nor any other potential outcome was discussed with the subjects before or during the session. This research shows that talk therapy may be used as a new therapeutic option for people not only with neck pain, but possibly other types of pain, and that under certain circumstances, the results can be rapid.

Ultrasound-Guided Dorsal Scapular Nerve Blockade in the Diagnosis and Management of Neck Pain

Neck pain is common and has multiple sources, but correct diagnosis and matched treatment provide the best outcomes. The first description of ultrasound-guided dorsal scapular nerve blockade using a single-shot local anesthetic technique for the diagnosis and treatment of neck pain is reported. A 38-year-old female patient presented with neck pain, and the history and clinical examination strongly suggested myofascial pain affecting the middle scalene muscle. The pain had been unresponsive to pharmacological therapy or physiotherapy. After identifying the dorsal scapular nerve (DSN) in the body of the middle scalene muscle, an ultrasound-guided nerve block was performed using a single injection of local anesthetic to alleviate the patient’s pain. It has been demonstrated that the dorsal scapular nerve can be identified in the neck and effectively blocked using ultrasound guidance. This technique has the potential to assist in the diagnosis and treatment of neck pain originating from the middle scalene muscle.

Spa therapy relieves knee and shoulder pain:a randomized controlled trial

Objective:To study the effect of spa therapy on relieving knee and shoulder pain.Methods:Participants were randomized to an intervention group(n=26)or a control group(n=23).The intervention group received the hot spring intervention program(1-2 times a day for two weeks),while the control group didn’t receive any intervention.Primary outcomes were assessed by the Western Ontario and McMaster University Osteoarthritis Index(WOMAC)and Shoulder Pain and Disability Index(SPADI).Secondary outcomes were assessed by general physical symptoms and Short Form-36(SF-36)health survey.Results:All parameters before intervention were homogenous between the groups.At baseline,there was no significant difference in WOMAC and SPADI index between the two groups,but there was a statistically significant difference in blurred vision,which was worse in the intervention group than in the control group(P<0.05).After intervention,general physical symptoms were relieved significantly in the intervention group compared with the control group(P<0.05).WOMAC index,SPADI index,social functioning,and general physical symptoms were relieved significantly after intervention in the intervention group(P<0.05).There is a significant difference in the blurred vision before and after the comparison of the control group(P<0.05).Conclusion:Spa therapy may relieve knee and shoulder pain and improve general physical symptoms and quality of life.

Pain management of hemiplegic shoulder pain post stroke in patients from Nanjing,China

We selected 106 hemiplegic patients with shoulder pain hospitalized after stroke from three hospi- tals in Nanjing, China between February 2007 and January 2012. All patients had complete clinical data sets and accounted for 45.5% of the inpatients because of stroke. Results showed that the number of patients with hemiplegic shoulder pain post stroke increased yearly, attacking mainly males 50-69 years of age. Of 106 patients, there were 60 cases （56.6%） of adhesive capsulitis, 19 （17.9%） of shoulder subluxation, 14 （13.2%） of complex regional pain syndrome, and 13 （12.6%） of central pain. The main symptoms were shoulder pain （100%）, limit of shoulder mobility （98.1%）, and adhesion of the scapula （56.6%）. MRI of the shoulder showed tendon and ligament lesions （57.1%） and rotator cuff tear （38.1%）. 53.8% of central pain was related to the thalamus, in addition to the basal ganglia, brain stem, and cerebellopontine angle. Shoulder pain, upper limb motor function, and function independence were significantly improved after comprehensive rehabilitation. In par- ticular, electroacupuncture based on basic physical therapy exhibited efficacy on shoulder subluxa- tion and complex regional pain syndrome. Multiple linear regression results showed a negative re- lationship of efficacy of pain management with the attack period of shoulder pain, involvement of the posterior limb of the internal capsule, and duration between onset and rehabilitation treatment, but a positive correlation with pain-related education, pain regression period, and pain diagnosis.

Therapeutic efficacy of acupuncture combined with neuromuscular joint facilitation in treatment of hemiplegic shoulder pain

BACKGROUND Stroke is a type of cerebrovascular disease with high prevalence,mortality,and onset of disability.As a neurodevelopmental therapy,neuromuscular joint facilitation(NJF)is widely used in the treatment of orthopedic and neurological disorders in the clinical practice.It is mainly used for central nervous system diseases or orthopedic diseases,movement disorders,and pain rehabilitation.According to related studies,NJF can also be used as a rehabilitation treatment in patients with hemiplegic shoulder pain(HSP).AIM To investigate the clinical efficacy of acupuncture combined with NJF in patients with HSP.METHODS Forty patients with HSP were randomly divided into a treatment group and a control group.The treatment group was treated with acupuncture combined with NJF and the control group was treated with acupuncture alone.All patients were assessed by using the visual analogue scale(VAS),Fugl-Meyer assessment(FMA),Barthel index(BI),and passive range of motion(PROM)before and after the training.All the clinical data were analyzed using SPSS 20.0 statistical software.RESULTS There was no statistical difference in the general characteristics between the two groups.In the terms of duration of treatment,age,and pre-treatment indicators,the two groups were comparable(P>0.05).After the treatment,VAS,PROM,BI,and FMA scores were significantly improved in the two groups of patients(P<0.05).The VAS,PROM and FMA scores were significantly higher in the treatment group than in the control group(P<0.05).However,there was no significant difference in BI scores between the two groups(P>0.05).CONCLUSION Both acupuncture alone and acupuncture combined with NJF in the treatment of HSP are effective,and can improve the clinical symptoms of patients.Acupuncture combined with NJF can improve the upper limb motor function,relieve pain,and increase joint mobility in patients with HSP.The combination therapy is better than acupuncture alone.However,there is no significant difference in improving the score of patients’self-care ability.

Effectiveness of a 12-Week Program of Active and Passive Stretching in Improving Low Back and Neck Pain in Japanese Sedentary Men

Purpose: Muscle stretching is frequently prescribed in physical therapy to manage lower back and neck pain. However, there is no clear evidence regarding the differences in effectiveness of active and passive stretching. Therefore, we aimed to evaluate the relative effectiveness of a 12-week program of active and passive stretching on selected physical and mental stress variables of sedentary men with lower back and neck pain. Methods: A cohort of 28 sedentary men, 30 - 49 years old, were divided into two intervention groups: the passive stretching group (PSG, n = 15) and the active stretching group (ASG, n = 13). A trainer assisted with static passive stretching, while participants in the ASG were provided with an instructional video. The following outcomes were measured at the start and end of the first and twelfth week of the stretching program: physical measures (visual analogue scale score of lower back and neck pain;finger-to-floor distance, gravimetric assessment of pelvic tilt, muscle hardness of the biceps femoris, and straight-leg raising) and mental stress measures (α-amylase and cortisol levels in saliva samples). Results: Although both active and passive stretching produced acute changes in lower back and neck pain, only passive stretching yielded long-term improvement in pain, finger-to-floor distance, pelvic tilt, hardness of biceps femoris muscle and cortisol levels (p Conclusion: Passive stretching is superior to active stretching in reducing pain, increasing muscle extensibility and correcting posture among a group of sedentary men with lower back and neck pain.

Spinal accessory neuropathy in patients with chronic neck pain

AIM: To assess the presence of spinal accessory neuropathy in patients with chronic neck pain.METHODS: Patients with pain either regional or focal in the neck or shoulders for at least 6 mo(chronic neck pain) were recruited randomly from the Rheumatology and Rehabilitation Outpatient Clinic at the Faculty of Medicine-Suez Canal University. Two groups were compared: 30 patients with chronic neck pain with mean age(36.97 ± 12.45 years) and 10 apparently healthy controls. Trapezius muscle examination including inspection and range of motion both active and passive was performed. A full clinical neurological examination was carried out to exclude peripheral neuropathy and motor neuron disease. According to the subject's type of work, cases were categorized into labor-intensive and non-labor intensive tasks. A nerve conduction study(NCS) was performed on spinal accessory nerves at both sides for all patients and controls. Parameters including latencies and amplitudes of compound motor action potential(CMAP) were compared with the chronicity of neck pain using the neck disability score. This cross sectional study was carried in the Rheumatology and Rehabilitation Department, at Suez Canal University Hospital, Ismailia, Egypt.RESULTS: Physical examination revealed that 80% of cases had spinal trapezius muscle spasm. Restricted neck motion was present in 16.6% of cases. No one suffered from muscle wasting or weakness. Pain was bilateral in 18 patients(60%), localized to the right side in six patients(20%) and localized to the left side in six patients(20%). The causes of neck pain in the patients studied were nonspecific, due to physical stresses, cervical spondylosis and mild cervical disc herniation. Mean disease duration in patients with labor-intensive tasks was(3.9 ± 2.1 years), which was longer than that in patients with non-labor intensive tasks(3.1 ± 1.9 years); however, this difference was statistically insignificant. Spinal accessory NCSs were performed while subjects were in sitting positions and relaxed with naturally suspended arms to minimize muscular movement. The results of electrophysiological studies revealed that mean right and left latencies of the spinal accessory nerve were 2.96 ± 0.69 ms, 2.98 ± 0.61 ms in the patient group and 2.44 ± 0.38 ms, 2.33 ± 0.36 ms in control group respectively. These differences were statistically significant with P = 0.028 and 0.006 respectively. Spinal accessory NCS showed normal CMAP amplitude in both patients and controls. Comparing the results of the neck disability index(NDI) to different characteristics in patients with chronic neck pain, showed that patients with labor-intensive work had a higher NDI score mean(34.7 ± 9.5) compared to those with non-labor-intensive work, with significant statistical difference(P = 0.011). In addition, mean NDI scores were higher in males, and patients aged over 40 years and this difference was statistically significant(P = 0.007 and P = 0.009 respectively). Correlation studies between right and left spinal accessory nerve latencies and disability percent calculated using the NDI revealed a positive correlation. Moreover, there was a positive correlation between age and disability percent.CONCLUSION: This study demonstrates electrophysiological evidence of demyelination in a significant proportion of patients with chronic cervical pain.

Treatment for Depression with Chronic Neck Pain Completely Cured in 94.2% of Patients Following Neck Muscle Treatment

We report three patients with cervical neuromuscular syndrome (CNMS) who followed similar courses. Autonomic imbalance may occur following neck muscle pain, and a wide variety of somatic symptoms including headache and vertigo appear and a generalized poor condition may continue for long periods. If many such somatic symptoms persist for months to years, symptoms of depression are exacerbated. The patients end up in psychiatric clinics, where they are diagnosed with depression, but they do not respond to antidepressants. Thus, they continue to suffer for many years. These patients eventually were completely cured with the resolution of neck pain by neck muscle treatment, using two types of special low-frequency therapy equipment, far-infrared radiation and acupuncture. When treatment for the neck muscles is initiated, symptoms of depression are quickly relieved, and diverse somatic symptoms disappear one after another as neck muscle tension is gradually alleviated (the number of abnormal neck muscle checkpoints decreases). Such a course suggests that neck muscle tension and chronic pain are closely related to depression. Neck muscle-related depression due to CNMS clearly differs from psychiatric conditions such as major and bipolar depression. In patients with neck muscle-related depression, symptoms of depression are not accompanied by ungrounded anxiety, a sense of emptiness, apathy, or self-rejection. Neck muscle abnormalities leading to CNMS are caused by head injury, whiplash injury, and a prolonged forward-bent-posture due to using a personal computer, playing computer games, texting, and engaging in machine-paced work such as assembly-line operation.

The Effects of Interferential Stimulation on Pain and Motion after Shoulder Surgery: A Prospective Randomized Study

Purpose: The purpose of this study is to determine the effects of interferential stimulation on pain and motion after shoulder surgery. Study Design: Randomized Controlled Trial. Methods: 102 patients undergoing arthroscopic rotator cuff repair or labral repair were prospectively randomized to receive either an interferential stimulation unit immediately after surgery (STIM) or not to receive the unit (NO-STIM). Each patient was measured for the range of motion (ROM) in forward flexion (FF), abduction (ABD), internal rotation (IR) and external rotation (ER). These measurements were taken prior to surgery and at the 6 weeks post-operative time point. Visual Analogue Scale (VAS) scores (0 - 10) and the amount of narcotic taken (standardized to 10 mg equivalents of hydrocodone) were measured and compared between the two groups at 2 days and 4 weeks post-operatively. 51 patients were excluded due to failure to document VAS scores and medication usage, lack of follow-up at the 6 weeks post-operative time point or hospitalization after surgery. This left 27 patients in the STIM group and 24 patients in the NO-STIM group. Results: No difference was found in the amount of narcotic taken after 2 days (STIM 14.37 ± 1.02, NO-STIM 15.88 ± 1.22, p = 0.34) or after 4 weeks (STIM 45.32 ± 4.36, NO-STIM 48.96 ± 5.50, p = 0.60). No difference in mean VAS scores were found at 2 days (STIM 5.56 ± 0.53, NO-STIM 4.63 ± 0.57, p = 0.24) or 4 weeks (STIM 1.68 ± 0.39, NO-STIM 1.38 ± 0.34, p = 0.57). At 6 weeks post-operatively, a difference was found in ER (STIM 62.5 ± 4.09, NO-STIM 50.4 ± 4.09, p = 0.04), and no differences found in FF (STIM 134.2 ± 5.29, NO-STIM 133.3 ± 4.85, p = 0.60), ABD (STIM 124.8 ± 6.22, NO-STIM 119.6 ± 5.42, p = 0.53) or IR (STIM 60.0 ± 3.69, NO-STIM 55.9 ± 3.03, p = 0.39). A post-hoc power analysis performed using an á = 0.05 revealed the study to be 90% powered to identify a difference of one narcotic equivalent between groups and 90% powered to identify a 0.3 difference in VAS scores. Conclusions: The use of an interferential stimulator in the immediate post-operative period had no effect on pain or narcotic usage following arthroscopic rotator cuff repair or labral repair. External rotation was significantly greater in the interferential stimulator group while no differences were found in other motion parameters.

Case-control study on regular Ba Duan Jin practice for patients with chronic neck pain

Purpose:To observe the long-term effects of regular Ba Duan Jin exercises for patients with chronic neck pain.Methods:Participants with chronic neck pain were instructed to perform
30 min/d of Ba Duan Jin exercises(n?36)or assigned to a control group(n?36)for six months.Data from a visual analogue scale,Northwick Park Neck Pain Questionnaire,and the 36-item Shortform Health Survey(SF-36)were collected before,and three and six months after intervention began.Results:Participants undergoing Ba Duan Jin exercises achieved significantly greater improvement than the controls in visual analogue scale,Northwick Park Neck Pain Questionnaire and SF-36 health transition scores(all p<0.05).However,no significant differences were observed in SF-36 physical or mental component summaries.Conclusion:Regular Ba Duan Jin practice reduces suffering and pain,and increases health satisfaction in individuals with chronic neck pain.

DEVELOPMENT OF CLINICAL STUDIES ON ACUPUNCTURE TREATMENT OF SHOULDER PAIN IN PATIENTS WITH WIND STROKE

In the present paper, the authors review some new results of acupuncture treatment of shoulder pain in stroke patients from ① application of filiform needle with different needling manipulations, ② selection and combination of acupoints, and ③ some special needling methods including point-injection. Generally, if acupuncture therapy is used in combination with other rehabilitation methods, the therapeutic effect of shoulder-pain-relief will be much better. Regarding the acupoint selection, both local acupoints and those of the yang meridians are primarily used in clinical practice. Further studies on treating shoulder pain of hemiplegia based upon the basic theory of TCM are necessary.

The characteristics and correlative research of“Jin Shang”associated with chronic neck pain in young adults based on ultrasound imaging

Objective:To investigate the characteristics of'Jin Shang',a specialized term in traditional Chinese medicine(TCM)theory,in young adults with chronic neck pain(CNP)and investigated the correlation of'Jin Shang'with pain intensity and living disabilities using cross-section study.Methods:The thickness of the bilateral splenius capitis and semispinalis capitis were measured by ultrasound imaging(USI)as the objective performance of'Jin Shang'.The visual analogue scale(VAS)and Northwick Park Questionnaire(NPQ)were used to assess pain intensity and living disability.The Student's t test was used to investigate the difference in neck extensor muscle(NEM)thickness between CNP patients and healthy controls.Pearson's correlation and multiple linear regression were applied to investigate the relationship between NEM thickness,pain intensity and disability.Results:Fifty-nine young adult CNP patients and 16 healthy controls were recruited in this study,in accordance with specific inclusion and exclusion criteria.The student's t test showed that in CNP patients,the thickness of the semispinalis capitis during isometric contraction was significantly thinner than that of healthy controls(P=.04).Pearson's correlation analysis also revealed significant relationships between NEM thickness,VAS,and NPQ,while multiple linear regression showed that the thickness of the NEM in CNP patients was a significant predictor of pain intensity and disability.Conclusion:There was a significant difference in the thickness of the NEM in young adults with CNP when compared to healthy controls.Alterations in the NEM thickness in both rest and contraction are moderately related to neck pain and living disabilities.Our results investigated the characteristics of'Jin Shang'using USI and revealed a correlation between'Jin Shang'and CNP symptoms,which demonstrates that NEM plays an important role in CNP.

Comparative pilot study on the effects of pulsating and static cupping on non-specific neck pain and local skin blood perfusion

Objective:To compare the effects of pulsating and static cupping on non-specific neck pain and local skin microcirculation blood perfusion,which is a pilot study.Methods:Seventy participants with non-specific neck pain were randomized to the following groups:low-frequency pulsating cupping(LF,n=20);high-frequency pulsating cupping(HF,n=20);static cupping(SC,n=20),or waiting list(WL,n=10).The LF,HF,and SC received a bilateral 10-minute cupping treatment at Jianzhongshu(SI 15).Outcomes were pain intensity(visual analog scale,VAS),functional status(Neck Disability Index,NDI),and skin blood perfusion at the SI 15,Dazhui(GV 14),and Shenzhu(GV 12)acupoint areas,measured using Laser Speckle Contrast Analysis technology.Results:Both LF and HF groups showed a significant reduction in VAS scores compared with the SC group(9.00,95%Cl 1.05-16.95,P=.027;8.75,95%CI 0.80-16.70,P=.031).There was no significant difference in VAS scores between the LF and HF groups(P>.05)and between NDI scores measured 3 days after intervention among the four groups(P>.05).In the SI 15 area,blood perfusion in the three treatment groups was higher than that in WL group(P<.01),and the perfusion unit(PU)of the HF pulsating group at 5 minutes after intervention was significantly higher compared with the SC group(P<.05).In the GV 14 area,blood perfusion in the two pulsating cupping groups was higher compared with the WL and SC groups after cupping(P<.05).In the GV 12 area,the PU of the LF group was higher compared with the other three groups only at the time of cup removal(P<.05).Conclusion:This study showed that pulsating cupping may have more favorable analgesic effects on non-specific neck pain compared with static cupping,which may be related to its better effect on improving the local skin blood perfusion.

Type A aortic dissection developed after type B dissection with the presentation of shoulder pain: A case report

BACKGROUND Aortic dissection(AD)is a life-threatening condition with a high mortality rate without immediate medical attention.Early diagnosis and appropriate treatment are critical in treating patients with AD.In the emergency department,patients with AD commonly present with classic symptoms of unanticipated severe chest or back pain.However,it is worth noting that atypical symptoms of AD are easily misdiagnosed.CASE SUMMARY A 51-year-old woman was first diagnosed with scapulohumeral periarthritis due to left shoulder pain.After careful examination of her previous medical history and contrast-enhanced computed tomography angiography,the patient was diagnosed with a new type A AD after chronic type B dissection in the ascending aorta.The patient was successfully treated with surgical replacement of the dissected aortic arch and remains in good health.CONCLUSION New retrograde type A AD after chronic type B dissection is relatively rare.It is worth noting that a physician who has a patient with suspected AD should be vigilant.Both patient medical history and imaging tests are crucial for a more precise diagnosis.

Fever and neck pain after pacemaker lead extraction: A case report

BACKGROUND Venous thrombosis(VT) is one of the minor complications of pacemaker lead extraction. It is often found due to the swelling of the limbs after the extraction. It is easy to be neglected or even misdiagnosed in the absence of typical clinical symptoms. The incidence, risk factors, and long-term impact of this complication are still unclear. Herein, we report a case of deep VT caused by transvenous lead extraction, which is easily misdiagnosed.CASE SUMMARY A 66-year-old woman underwent a pacemaker lead extraction at our hospital because of a pacemaker pocket infection. After the extraction, she began to experience intermittent fever accompanied by sweating. The highest body temperature recorded was 37.9℃. Additionally, she reported migratory pain that made her uncomfortable. The pain was mistakenly thought to be caused by operation trauma. At first, the pain radiated from the left chest to the mandible.Then, the pain in the left chest was alleviated, but pain in the left neck and throat appeared. Finally, the pain was confined to the mandible and a submandibular mass was palpated with no other abnormalities upon physical examination.Computed tomography venography and angiography finally indicated that the fever and pain were the symptoms of thrombophlebitis caused by lead extraction.The patient was then treated with rivaroxaban for more than three months and has shown no symptoms since she left the hospital.CONCLUSION The possibility of thrombosis should be considered when pain and recurrent fever occur after pacemaker lead extraction.

Validation of the functional rating index for the assessment of athletes with neck pain

AIM: To validate the culturally-adapted Persian Functional Rating Index(PFRI) for assessing neck pain(NP) in athletes. METHODS: In this cross-sectional study, 100 athletes with NP and 50 healthy athletes participated and responded to the PFRI. Fifty athletes with NP completed the PFRI for at least 7 d later to establish test-retest reliability. RESULTS: The athletes with NP responded to all items, indicating excellent clinical utility. No floor and ceiling effects were found, indicating content validity and responsiveness. The PFRI revealed capability to discriminate between the athletes with NP and healthy athletes. The PFRI demonstrated strong correlation with the Numerical Rating Scale(Spearman's rho = 0.94), and the Persian Neck Disability Index(Pearson r = 0.995), supporting criterion and construct validity. Internal consistency reliability was high(Cronbach's α coefficient: 0.97). The test-retest reliability was excellent(ICCagreement = 0.96). The absolute reliability values of standard error of measurement and smallest detectable change were 3.2 and 8.84, respectively. An exploratory factor analysis yielded one factor explaining 78.03% of the total variance. CONCLUSION: The PFRI is a valid and reliable measure of functional status in athletes with NP.

Comparison of femoral neck fracture healing and affected limb pain after anterolateral-approach minimally invasive total hip replacement and hemiarthroplasty

Objective:To study the differences in femoral neck fracture healing and affected limb pain after anterolateral-approach minimally invasive total hip replacement and hemiarthroplasty. Methods:A total of 92 patients with femoral neck fracture who received hip replacement in our hospital between May 2013 and December 2015 were selected and randomly divided into total hip and half hip group, total hip group received anterolateral-approach minimally invasive total hip replacement, half hip group received anterolateral-approach minimally invasive hemiarthroplasty, and 1 month after operation, serum was collected to detect the levels of bone metabolism markers, osteocyte cytokines, SP and CGRP.Results:1 month after operation, serum PINP, PICP, BMP, TGF-β, FGF, IGF-I and IGF-II levels of total hip group were significantly higher than those of half hip group while TRAP5b and CatK levels were significantly lower than those of half hip group;the day after operation, serum pain media SP and CGRP levels were not significantly different between the two groups of patients;36 h after operation, serum SP and CGRP levels of total hip group were significantly lower than those of half hip group.Conclusion:The bone metabolism after anterolateral-approach minimally invasive total hip replacement is better than that after hemiarthroplasty, and the degree of pain is less than that after hemiarthroplasty.

Neural Modulation of Hemiparetic Shoulder Pain by Repetitive Ultrasound-Guided Suprascapularis Nerve Block

Background: Neural blockade is widely used in clinical practice to alleviate acute or chronic pain, including pain during rehabilitation. To date there is little controlled evidence to confirm the efficacy of nerve blocks in hemiparetic shoulder pain after stroke. Design: This study is a prospective, open label, cohort trial reporting result from a cohort of stroke patients affected by shoulder pain. Aim: As a cohort study report, in which it is often firstly reported the possibility of an association between an observed effect and a specific environmental based on detailed clinical evaluations and histories, we aim to firstly provide clues in identifying Suprascapularis Nerve blockade as further valuable approach for shoulder pain after stroke. Population: We studied a cohort of patients affected by hemiparetic shoulder pain after Stroke. Methods: Our protocol foresees nerve blocks to be performed each 3 out of 4 days (treatment lasting 30 days) in conjunction with a rehabilitation program with the first aim to provide the window of opportunity to proceed with effective rehabilitation. 47 potential study subjects fulfilled the study criteria and were enrolled. Twenty-four subjects were randomised to the study Group to receive SSNB for the pain of their hemiparetic shoulder while 23 subjects randomized to the control Group whose member did not receive SSNB. They received serial blocks each 3 out of 4 days during rehabilitation.Results: Both treatment reported a reduction in the intensity of their shoulder pain, according to data collected from day 1 through day 42 (6 weeks). Study Group patients, receiving SSNBs, reported significant improvement from entry through the whole follow-up period. The efficiency data were higher for SSNB Group after 2 weeks and again for SSNb group at the end of treatment. Conclusion: Excellent pain relief was achieved in SSNB without clinically relevant complications, these patients having a better improvement on pain during rehabilitation, than the control subjects. Great efficacy has been achieved by combining a nerve block and rehabilitation. About Clinical Rehabilitation Impact, we believe that Suprascapularis nerve blocks can help the stroke survivors maintain an ambulatory or outpatient treatment status, maintain participation in a physical therapy or rehabilitation program, decrease the need for analgesics and in some cases lead to a complete pain relief.