• Journal of the Korean Orthopaedic Association
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• v.56 no.6
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• pp.498-503
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• 2021

Purpose: The aim of this study were to find ideal entry point of straight antegrade humeral intramedullary nail (SAHN) for the treatment of proximal humerus fracture in Korean and to analyze anatomical conformity using computed tomography. Materials and Methods: From May 2014 to October 2016, the study was conducted retrospectively on 74 Korean patients who had taken computed tomography on both normal and affected shoulder joint as result of shoulder injury. The mean age of the patients was 64.5 years (range, 22-95 years). Radiologic evaluation was done using multiplanar reconstruction technique of the computer tomography on normal proximal humerus. We located ideal entry point of SAHN as the point where humerus intramedullary center axis and humeral head meet. Distance between the entry point and local anatomical landmark was measured. We defined the critical distance as the distance between entry point and the most medial point of the supraspinatus attachment site. For adequate fixation and avoidance of injury to rotator cuff, critical distance should be over 8 mm according to Euler, and we defined the critical type when it is less than 8 mm. Critical distance, sex, age, height, body weight, body mass index was evaluated for the statistical significance. Results: The ideal entry point was as follows: the mean anteroposterior distance, the sagittal distance to the lateral margin of bicipital groove, was 11.5 mm and the mean mediolateral distance, the coronal distance to the lateral margin of grater tuberosity, was 20.5 mm. The mean critical distance, distance from the entry point to the just medial to insertion of the supraspinatus tendon, was 8.0 mm. Critical type with critical distance less than 8 mm was found in 41 in 74 patients (55.4%). Conclusion: The ideal entry point of SAHN in Korean was located on 11.5 mm posteriorly from the lateral margin of bicipital groove and 20.5 mm medially from lateral margin of greater tuberosity. More than half of the cases were critical type. Since critical type can possibly cause rotate cuff injury during nail insertion on entry point, surgeon should consider anatomical variance before choosing surgical option.

• Clinics in Shoulder and Elbow
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• v.7 no.1
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• pp.10-13
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• 2004

Superior labrum anterior to posterior (SLAP) lesions of the shoulder has recently been a popular issue to shoulder surgeons. Now we are correlating many shoulder symptoms to this SLAP lesion. A 45 year-old female patient injured her shoulder when her arm sleeve was entrapped in moving automobile door. A forceful pull of the arm in external and abduction position was suspected. She complained continuous shoulder pain with limited range of motion for 2 months. Magnetic resonance image showed possible SLAP lesion but no definite diagnosis were made prior to the operation. Arthroscopic evaluation revealed SLAP type Ⅱ lesion with concomitant avulsion of the superior glenoid cartilage. In addition anterior labrocapsular tear was seen from 7 to 9 o'clock of anterior glenoid. The SLAP lesion and the anterior capsulolabral lesion were repaired properly to the glenoid. We report a case of glenoid-cartilage avulsion type of SLAP Ⅱwith anterior labrocapsular lesion.

• Archives of Reconstructive Microsurgery
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• v.7 no.2
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• pp.102-107
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• 1998

We have performed the operations for the restoration of shoulder abduction and elbow flexion in 17 patients(20 cases of neurotization) of brachial plexus injury at the Department of Orthopaedic Surgery, Korea University Hospital from October 1991 to May 1997. The mean follow-up period was 42 months. After neurotization for brachial plexus injury, functional recovery of shoulder abduction and elbow flexion were good and fair in 65%. In the functional evaluation, the clinical results of whole arm type were poorer than those of upper arm type, and the operations performed within 6 months since the injury were better than those of other cases.

• Clinics in Shoulder and Elbow
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• v.7 no.2
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• pp.98-102
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• 2004

The terrible triad of the shoulder, a combination of anterior shoulder dislocation, massive rotator cuff tear and neurologic injury, is rare. We experienced 4 patients with this condition who were treated with a rotator cuff repair. The mean age was 65 years. Follow-up averaged 27 months. All patients had a history of redislocation after initial traumatic shoulder dislocation and were evaluated with electromyography and magnetic resonance imaging. At the operation, massive rotator cuff tear and hypertrophy of the long head of the biceps were found in all patients. Clinically, 3 patients achieved recovery of their nerve injury by 3 months postoperatively and the final results were fair. In one patient, there was no recovery of deltoid function and this case was rated as a failure. For this injury pattern, the prognosis appears to be dependent on eventual nerve recovery when the rotator cuff has been repaired early.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.3 no.1
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• pp.21-25
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• 2010

Purpose: To evaluate efficacy of ultrasound guided prolotherapy in patients with persistant symptoms after rotator cuff repair. Materials and Methods: Between January and December of 2008, 90 patients who had persistant pain and shoulder adhesion 4 weeks after rotator cuff repair were treated with ultrasound guided prolotherapy. The mean age was 55.2 years. Visual analogue scale (VAS) and range of motion (ROM) before and after the procedure, complications related to the procedure were analyzed. Results: The average VAS score at 4 weeks follow up decreased to $2.5{\pm}2.304$ from $6.3{\pm}1.25$ before prolotherapy and forward flexion range at 4 weeks follow up increased to $143{\pm}26.63$ from $106{\pm}21.64.$ Four weeks after the ultrasound guided prolotherapy, 74 cases(82%) reported of improved pain and ROM, 13 cases(14%) reported of improvement after 2~5 days of the procedure and 3 cases(4%) had no improved in pain and ROM. No complications were encountered. Conclusion: The authors believe that ultrasound guided prolotherapy in repaired rotator cuff tear patients theoretically increased possibilities of healing and with relieving the pain of the patients results in increased possibility of rehabilitation effect.

• Clinics in Shoulder and Elbow
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• v.12 no.1
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• pp.67-75
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• 2009

Purpose: This study evaluated the clinical outcomes of debridement arthroplasty using the posteromedial approach in elbow joints with pain and bony limitation of motion. Materials and Methods: This study involved 16 elbows in 16 patients with pain and bony limitation of motion, which were treated by debridement arthroplasty using the posteromedial approach from March 2005 to March 2008. The mean follow up period was 27.6 (13~52) months. The clinical outcomes were analyzed using the Visual Analogue Scale(VAS) for pain scale, the preoperative and postoperative range of motion and the Mayo Elbow Performance Scores(MEPS). Results: The VAS was decreased significantly from a preoperative mean of 4.5 to a postoperative mean 1.1 (p<0.001). The average arc of motion improved significantly from $61.6 (0~90)^{\circ}$ preoperatively to $109.4 (80-120)^{\circ}$ postoperatively (p<0.001). The MEPS also improved significantly from 59.4 to 85.6 postoperatively (p<0.001). There were no complications, such as hematoma and elbow instability. Conclusion: Debridement arthroplasty using the posteromedial approach is a useful surgical procedure in the elbow joint with pain and bony limitation of motion, where all compartments can be debrided, the ulnar nerve can be manipulated easily and damage to the medial collateral ligament can be minimized.

• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.78-83
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• 2007

Purpose: This study reports the clinical results of the tenodesis of long head of the Biceps brachii tendon with bioabsorbable interference screw by minimal open procedure. Materials and Methods: Ten cases of 10 patients (7 male, 3 female) were included in this study. The average age was 45.8 years old and the average period from the symptom onset to operation was 13.7 months. Average preoperative ASES score was 38.5. The causes of injury was; sports activities in 4 patients, unknown in 4 patients, industrial accident in 1 patient and traffic accident in 1 patient. The average follow up period was 12.1 months. Tenodesis with bioabsorbable interference screw by minimal open precedure was performed in all cases. Results: The ASES score improved to 87.5 at last follow up period and 6 cases had full range of motion of the shoulder. 4 cases had mild limited range of motion of the shoulder without any problem in normal daily activity. Conclusion: It was assumed that tenodesis of long head of the biceps brachii tendon with bioabsorbable interference screw by minimal open precedure was one of the good methods with good clinical results.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.142-149
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• 2009

Purpose: We wanted to assess the radiological and clinical results and the prognostic factors after an operation for capitellar fractures associated with/without other injury around the elbow. Materials and Methods: Among the 25 patients (mean age: 49 years-old) who underwent open reduction and internal fixation for capitellar fractures, there were nineteen type 1 fractures and six type 3 fractures. The mean follow up period was 14.8 months. We assessed the factors affecting the radiological and functional results, such as the fracture pattern, the patient age and the surgical approaches. Results: In 24 of 25 patients, bony union was achieved at postoperative 1 year. There were eighteen excellent, four good, two fair and one poor functional results according to the Broberg and Morrey elbow score. The most common type was type 1 and the most common associated injury was lateral condylar fracture. The patients with type 1 fracture rather than the patients with type 3 fracture and the patients who had an extraarticular associated fracture rather than an intraarticular associated fracture had better clinical outcomes. Conclusion: 22 (88%) of the patients were satisfied at the result. The type of capitellar fracture and an associated intraarticular elbow fracture were shown to be important prognostic factors in this study.

• Journal of Korean Physical Therapy Science
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• v.12 no.4
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• pp.11-24
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• 2005

대전에 소재하는 C 대학교 병원의 물리치료실에 2003년 5월 9일부터 2004년 10월 20일까지 내원한 환자들 중 견부 통증의 진단으로 치료를 받은 환자 가운데 중추신경계에 손상 병력이 없고, 치료사와 의사소통이 가능한 인지 능력을 가졌으며, 실험에 참가하기로 동의한 환자를 대상으로 내원한 순서에 따라 아로마 초음파군, 아로마군, 초음파군에 각각 30명씩을 배정하여 실험한 결과, 치료의 횟수가 증가함에 따라 통증의 정도를 알아보는 시각적 통증 점수가 감소하였으며(p<0.001), 군 간에 통증 감소의 정도도 차이가 있었다. 사후 검정을 보면 아로마 초음파군과 아로마군의 통증 감소의 정도가 초음파군에 비해 높았다(p<0.001). 또한 치료의 횟수가 증가함에 따라 McGill-Melzac 통증 점수 역시 감소하였으며(p<0.001), 군 간에 차이는 없었지만, 교호작용을 고려하면 아로마를 사용한 군에서 감소 폭이 더 큰 것으로 해석할 수 있다. 압통계의 역치 역시 치료의 횟수가 증가함에 따라 모든 군에서 상승하였으며(p<0.001), 군 간에 역치 증가의 정도에도 차이가 있었는데(p<0.05), 사후 검정을 보면 아로마 초음파군이 아로마군에 비해 역치 증가의 폭이 더 컸다. 따라서 압통계의 역치 증가는 아로마 보다는 초음파에 더 영향을 받는 것으로 생각할 수 있다. 이상의 결과로 볼 때 아로마 오일은 주관적이고, 정서적인 통증을 검사하는 시각적 통증 점수와 McGill-Melzac 점수에 많은 영향을 미치는 반면 조직의 회복에 의해 상승하는 압력 역치를 검사하는 압통계의 수치에는 영향을 적게 미침을 확인할 수 있었으며, 반면 초음파는 주관적, 정서적인 통증의 감소보다는 실제 조직이 회복되면서 감소하는 통증에 더 많은 영향을 미치는 것을 알 수 있었다.

• Journal of Acupuncture Research
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• v.22 no.6
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• pp.165-171
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• 2005

목적 : 견관절 질환의 대부분의 원인을 차지하는 극상근건과 견봉하 점액낭 질환 침치료에 있어서 근위취혈의 관점으로 접근했을 때 손상된 조직인 극상근건과 견봉하 점액낭에 자입하는 것이 중요하다. 어떻게 이 조직에 접근할 것인가에 대해 X선 촬영을 통해 확인해 보고자 한다. 방법 : 4명의 지원자를 받아서 견우혈(LI 15), 거골혈(巨骨穴)(LI 16), 노상혈(UE 57)의 혈자리에 투시촬영을 이용해 자침을 하였다. 투시촬영으로 원하는 조직에 침이 자입되었음을 확인한 후 X선 촬영을 하여 확인하는 방법으로 진행하였다. 결과 : 견우혈(LI 15) 자침시(刺針時) 5cm의 깊이로 직자(直刺)할 때 원하는 조직인 근상근건과 견봉하 점액낭에 도달하는 것을 확인할 수 있었다. 거골혈(巨骨穴)(LI 16) 자침시(刺針時) 5cm의 깊이로 노상혈 부위로 하사자(下斜刺) 했을 때, 노상혈(UE 57) 자침시(刺針時) 5cm의 깊이로 거골혈(巨骨穴) 부위로 상사자(上斜刺) 했을 때 극상근건과 견봉하 점액낭에 도달함을 확인할 수 있었다. 결론 : 극상근건과 견봉하 점액낭 질환을 근위취혈의 관점으로 치료하고자 할 때 견우혈, 거골혈(巨骨穴), 노상혈에 정확한 깊이와 방향으로 자입을 해야 원하는 조직인 극상근건과 견봉하 점액낭에 자입할 수 있음을 확인할 수 있었다.