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턱관절 증후군 환자에서 초음파 유도 하에 시행한 신경 수용체 자극술 -증례 보고-
안강,강임홍,김재헌,박수영,이상철 대한마취통증의학회 2010 Anesthesia and pain medicine Vol.5 No.3
Pains derived from the temporomandibular joint are not treated easily. Recently, an arthroscopic surgical management has been reported, but its efficacy has not been proven yet. In this case report, we introduce an effective non-surgical treatment technique for the temporomandibular joint using a specially designed dry needle under ultrasonography guidance. Since the patient has pain related to mouth movement, accompanying decreased mouth opening, clicking sound or crepitus on physical examination, this approach will be helpful for pain relief and for functional recovery of the temporomandibular joint.
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안강,이상철 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.5
The term peripheral neuropathic pain has recently been suggested to embrace the combination of positive and negative symptoms in patients whose pain is due to pathological changes or dysfunction in peripheral nerves or nerve roots (including nerve trunk). Nerve root pain characteristically shows the tenderness following the course of the involved innervation area, whereas dysesthesia on locus is the pain felt in its peripheral sensory distribution. However, when pain of nerve origin is severs, it can be felt in regions outside the sensory distribution of the particular nerve. Careful examination of chronic musculoskeletal pain often reveals them to be the effects of nerve trunk dysfunction appearing in the musculoskeletal system. The underlying problem is malfunction of the peripheral nervous system due to chronic nerve root irritative injury, and pain is one possible result of downstream product of the neuropathy which is not inevitable. Some findings of neuropathic changes, which is not usually detected through conventional radiologic and laboratory methods, are present primarily in soft tissue (ie., tenderness over muscle motor point, tendon and ligament; palpable soft tissue contracture bands and restricted joint range). Therefore, careful evaluation must be performed and those soft tissue changes should be described. Neuropathy degrades the quality of collagen, causing it to have fewer cross-links; it is, therefore, become frailer than normal collagen. Careful palpation and physical examination is the important tool can detect all of these phenomena. (Korean J Anesthesiol 2002; 43: 535~541)
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안강 대한마취통증의학회 2009 Anesthesia and pain medicine Vol.4 No.1
IMS is more than a needling technique. It has a background based on physiology, and needling depends upon a detailed knowledge of anatomy. The rationale conforms to Canon’s law of denervation supersensitivity. Thus, IMS is a theoretical model that has the support of western physiologists. IMS worked by desensitizing supersensitive body segments. Therefore the technique needs detailed physical examination on segmental innervation area and needling skill to find accurate needling point. IMNS (Interventional Microadhesiolysis and Nerve Stimulation) works for hypersensitive joint soft tissue and FIMS (Fluoroscopy guided Interventional Microadhesiolysis and nerve Stimulation) works for hypersensitive nerve root, whereas classical IMS works for nerve stimulation due to muscle needling. In the future, we can adopt these techniques for brain disease according by Canon’s law.
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Interventional muscle and nerve stimulation for spasmodic torticollis -A case report-
안강,전형준,이상철 대한마취통증의학회 2010 Anesthesia and pain medicine Vol.5 No.3
A 49-year-old woman with spasmodic torticollis was treated with interventional muscle and nerve stimulation (IMNS). Her neck was tilted to the left, and her chin was rotated and tilted to the right. Based on patient history, physical examination, and X-ray findings, the right C2-3, C3-4, C4-5 and C5-6 facet joints were selected for IMNS treatment. Under ultrasound guidance, an Ahn’s Needle (a specially designed needle for IMNS) was inserted from the midline of the posterior neck and advanced toward a point over the capsule of the facet joints. The needle was moved gently forward and backward within a 1−2 mm range until no resistance was felt at the tip. After undergoing three rounds of IMNS treatment, the dystonic features were grossly normal but spontaneous activities of the muscles innervated by C6 remained. Although we did not demonstrate complete improvement of spasmodic torticollis, our report suggests that IMNS has therapeutic value for spasmodic torticollis.
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IMS를 이용한 내전형 경련성 부전실성증 치료 -증례 보고-
안강,전형준,이상철 대한마취통증의학회 2009 Anesthesia and pain medicine Vol.4 No.3
Spasmodic dysphonia is a voice disorder that’s characterized by intermittent, involuntary tightening or constriction of the larynx during phonation. This paper describes the case of a 45-yr-old female who suffered from phonation difficulties along with posterior and anterior neck pain. She was diagnosed with adductor type spasmodic dysphonia, which is a chronic disorder involving hyperadduction of the vocal mechanism and a resultant vocal arrest. The neural innervation of the intrinsic laryngeal musculature and the cervical nerves too may well be amenable to intramuscular stimulation therapy.
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안강,문지석,이상철 대한마취통증의학회 2009 Anesthesia and pain medicine Vol.4 No.3
Background: Cervical facet joint stimulation is a good therapeutic option for treating chronic neck pain. Fluoroscopy is the gold standard, as an imaging tool, for performing cervical facet joint stimulation. Ultrasound guided stimulation is safe and accurate, but there have been no reports on using ultrasound guided cervical facet joint stimulation to treat chronic neck pain. We wanted to describe successful ultrasound guided cervical facet joint IMS for treating patients with chronic neck pain. Methods: Twenty six adult patients were treated with IMS on a cervical facet joint. A low frequency ultrasound system was used (Qsonix by Ultrasonix, Canada with a 6−12 Hz linear probe). The patients were positioned in the prone position with a slight extended neck. A parasagittal posterior view of the cervical spine was obtained with using a sterile technique. This allowed visualization, in a single view, of all the cervical facet joints on the one side. We performed this procedure with a transverse approach after manually palpating the facet joint. This allowed real-time monitoring of the needle along its entire length. Results: The posterior neck pain and the dorsal back pain were both decreased after needle stimulation. Ultrasound guided dry needling could be performed accurately for all the patients. Conclusions: This is the first description of cervical facet dry needle stimulation under ultrasound guidance for treating chronic neck pain. The advantages of ultrasound guidance include accurate targeting, reducing the unwanted injury and improved patient discomfort.
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