• Clinics in Shoulder and Elbow
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• v.1 no.1
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• pp.128-131
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• 1998

Fracture of the clavicle and dislocation of the acromioclavicular joint occur commonly as separate injuries. However, complete acromioclavicular dislocation with an ipsilateral clavicle fracture is quite rare. We experienced a case of acromioclavicular joint dislocation associated with fracture of clavicle and brachial plexus injury treated by open reduction and internal fixation.

• Journal of Korean Orthopaedic Sports Medicine
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• v.5 no.2
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• pp.117-122
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• 2006

Purpose: The purpose of this study is to investigate the relationship between rotator cuff tear and nerve injury, and prevalence of nerve injury using electromyographic study. Materials and Methods: From May 2004 to Feb. 2005, 19 cases, who underwent surgery for full-thickness rotator cuff tear, were evaluated for nerve injury using electomyogram instruments preoperatively. Rotator cuff tears caused by acute high energy trauma were excluded in this study. Mean age was 59 (range, 45-87) years and mean duration of symptoms was 45 (range, 1-360) month. Results: There were six nerve injuries (31.6%). All of them were incomplete brachial plexus injuries, and mainly postganglionic lesions. Four cases among them had minor trauma history. There were no significant differences in terms of cuff tear size, range of motion, pain score and functional score between groups with and without nerve injury. Conclusion: This study showed high prevalence (31.6%) of nerve injury in full-thickness rotator cuff tear. So careful physical examination and evaluation for nerve injury are needed in rotator cuff tear.

• Clinics in Shoulder and Elbow
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• v.10 no.2
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• pp.190-198
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• 2007

Purpose: The current study reports the clinical results of total elbow arthroplasties (TEA) which were Performed on patients with poor clinical and radiological results after initial surgeries for elbow fractures or dislocations. Materials and Methods: The clinical outcomes of twelve consecutive patients who underwent TEA after failed surgeries for elbow fractures or dislocations from january, 1995 to December, 2005 were evaluated. The initial diagnoses were distal humeral fractures in 8 cases and fracture-dislocations in 4 cases. The Mean period from the initial operations to the TEAs was 12 months. The mean folloow up period after TEA was 43 months. Results: The mean range of motion, in terms of active extension, activeflexion, supination, and pronation, improved from $14.2^{\circ}$, $96.7^{\circ}$, $50.8^{\circ}$ and $53.3^{\circ}$ to $5.4^{\circ}$, $122.1^{\circ}$, $63.3^{\circ}$ and $67.5^{\circ}$, respectively (p<0.05). RAdiolucent lines were found in 3 cases, which were 1 case of type 3, and 2 cases of type 4. All three loosening cases underwent revision TEAs. The mean postoperative Mayo elvow performance score was 79 point. There were 6 cases of excellent, 2 cases of good, and 4 cases in poor. Conclusion: Good clinical results were obtained after TEA performed in failed surgeries for elbow fractures of dislocations.

• Clinics in Shoulder and Elbow
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• v.1 no.1
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• pp.78-82
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• 1998

The following will describe a method of evaluating the SLAP lesion in the recurrent anterior dislocation of the shoulder. We have named it the biceps load test. The biceps load test is performed with the patient in the supine position and the arm to be examined is abducted 90/sup°/, and the forearm is in the supinated position. First, the anterior apprehension test is performed. When the patient become apprehensive, the patient is allowed active flexion of the elbow, while the examiner resists elbow flexion. If the apprehension is relieved or diminished, the test is negative. If aggravated or unchanged, the test is positive. A prospective study was performed, in which 75 patients who were diagnosed as having recurrent unilateral anterior instability of the shoulder underwent the biceps load test and arthroscopic examination. The biceps load test showed negative results in 64 of these patients, of which the superior labral-biceps complex was intact'in 63 cases and only I shoulder revealed a type n SLAP lesion. E]even patients with a positive test were confirmed to have type n SLAP lesions. A positive biceps load test represents an unstable SLAP lesion in a patient with recurrent anterior dislocation of the shoulder. The biceps load test is a reliable test for evaluating the SLAP lesion in the recurrent anterior dislocation of the shoulder(sensitivity: ,9] .7%, specificity: 100%, positive predictive value: 1.00 and negative predictive value: 0.98). Biceps contraction increases the torsional rigidity ?of the glenohumeral joint and long head of biceps tendan act as internal rotator of the shoulder in the abducted and externally rotated position. These stabilize the shoulder in abduction and external rotation position in the biceps load test.

• 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.

• Clinics in Shoulder and Elbow
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• v.9 no.1
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• pp.42-49
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• 2006

Purpose: This study evaluated clinical results, and recommended treatment protocol of traumatic anterior shoulder dislocation in the patients older than 60 years of age. Materials and Methods: Thirty-eight patients with first traumatic anterior shoulder dislocation aged over 60 years were included. The average age was 69.4 (range, 60 to 87 years). There were 8 men (average age of 71.6) and 30 women (average age of 69). Most common cause of injuries was a fall on the outstretched hand. The additional injuries were evaluated using MRI or CT arthrogram in the patients with significant pain and weakness while movements after 2 weeks sling immobilization. Results: Fifteen patients (39%) had rotator cuff tears and 5 patients (14%) had greater tuberosity fractures. The sizes of rotator cuff tears were diverse; 2 partial tears, 1 small tear, 4 medium tears, 3 large tears and 5 massive tears. Among 5 massive cuff tears, 3 patients revealed cuff arthropathy after reduction. 4 patients (11%) had recurrent dislocation more than one time during 1 month after the first dislocation. Bankart lesions revealed in 5 patients and three of them had associated rotator cuff tears. 3 out of 5 patients with Bankart lesions, 13 out of 15 patients with rotator cuff tears and 3 patients with displaced greater tuberosity fracture had operations. Conclusion: The injury mechanism of shoulder dislocation in patients older than 60 years of age seems to have either anterior or posterior mechanism. The diagnosis and treatment should be approached 2 weeks after dislocation.

• Journal of the Korean Arthroscopy Society
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• v.12 no.3
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• pp.185-190
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• 2008

Purpose: The purpose of this study is to provide the clinical outcomes of arthroscopic type II SLAP repair in non-athletes, and to compare the clinical outcomes between those who had isolated type II SLAP lesion and those who had combined partial thickness supraspinatus tear that did not required a combined repair. Materials and Methods: From July 2005 to January 2007, 142 consecutive type II SLAP lesions were treated with arthroscopic surgery. The inclusion criteria for the study were; (1) younger than 50 years old; and (2) non-athletes. Exclusion criteria were; (1) prior surgery, fracture or combined recurrent dislocation history on the affected shoulder; (2) combined full thickness rotator cuff tear or PTST (>50% thickness) patient that needed repair; and (3) combined infection, arthritis or inflammatory disease. Remaining 19 patients meet the criteria. Among them, 13 had combined PTRCT that did not require repair (Group I), and 6 had isolated type II SLAP lesion without combined supraspinatus tear (Group II). The mean age was 36.7 years (29~49 years), mean symptom duration was 39.1 months (3~216 months) and mean follow-up was 19.0 months (12~27 months). In all patients, the range of motion of affected shoulder, pain and function visual analogue scale (PVAS, FVAS), the Constant score and UCLA score were evaluated preoperatively and postoperatively. Results: In group I, external rotation at side was decreased significantly (p=0.003),but there were no statistical significant change at the remains(p>0.05). And there were no differences between groups (p>0.05). At the final follow-up, all clinical outcome measurements improved after surgery with statistical significance (p<0.05): UCLA score, $22.8{\pm}5.2$ to $32.8{\pm}2.1$; Constant score, $79.4{\pm}8.6$ to $94.9{\pm}4.3$; PVAS $5.4{\pm}2.7$ to $1.1{\pm}1.4$; FVAS $63.2{\pm}15.3$ to $93.4{\pm}7.3$. But, in group comparison of the mean UCLA score and Constant score, there were no statistical significant differences between two groups. Conclusion: Arthroscopic repair of type II SLAP lesion provided good clinical outcomes in nonathletic population. Combined partial thickness supraspinatus tear does not seem to hamper the final outcome at minimal 1 year follow-up.

• Clinics in Shoulder and Elbow
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• v.13 no.2
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• pp.286-292
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• 2010

Purpose: Stability of joints and maintenance of range of motion are needed for optimum function. The most common complaint about the elbow joint is joint stiffness. Recent articles have reported good outcomes in the treatment of stiff elbow joints. However, deciding which procedure to use is always difficult. Materials and Methods: Morrey et al. reported that the functional range of motion of the elbow joint is $30-130^{\circ}$ of flexion-extension and $50^{\circ}C$ of supination and pronation. About 90% of daily activities are done using this range of motion. Stiff elbow joints can be classified according to the traumatic events that caused the problem or the location of the main pathology. Intraarticular pathology includes severe articular mismatch, intraarticular adhesions, loss of articular cartilage, mechanical blockade by osteophytes, loose bodies, and hypertrophied synovium. Extraarticular pathology includes severe capsular adhesion due to the trauma or to dislocation, contracture of the collateral ligaments or muscles, bony bridge. Results and Conclusions: The main pathology underlying the loss of extension is the fibrous contracture of the anterior capsule. In this pathology, an anterior capsulectomy would be helpful. The main pathology underlying the loss of flexion is the contracture of the posterior band of medial collateral ligament.

• Clinics in Shoulder and Elbow
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• v.9 no.2
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• pp.196-201
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• 2006

We report two cases of migration of K-wires from the acromioclavicular joint to the neck. A 73-year-old man complained of right shoulder pain for one month and had undergone orthopedic surgery because of acromioclavicular joint dislocation about 27 years earlier. Another 56-year-old man complained of left shoulder pain and neck pain for 5 years and had undergone orthopedic surgery because of acromioclavicular joint dislocation about 25 years earlier. In both cases, we took X-rays to look for the cause of shoulder pain and discovered broken and migrated K-wires in the neck. We removed the K-wires from the trapezius muscle and the paraspinal muscle respectively. K-wire fixation technique is simple and effective but should be followed up with X-rays periodically. In addition, we should warn patients of the possibility of migration of K-wire. And it is desirable for us to avoid using K-wire near major neurovascular structures like the sternoclavicular joint and the clavicle.

• Journal of Korean Physical Therapy Science
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• v.8 no.1
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• pp.859-867
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• 2001

The purpose of this single subject care study was to evaluate the effectiveness of a functional electrical stimulation(FES) treatment program designed to prevent glenohumeral pint stretching and subsequent subluxation and shoulder pain in hemiplegic patients. The subject was a 43-year-old male who had left side hemiparesis with shoulder pain and subluxation on affected side. He received conventional physical therapy and additional FES therapy where two flaccid shoulder muscles, supraspinatus and posterior deltoid. were induced to contract repetitively up to 20 minutes for 2 weeks. As a result. the patient showed improvements in hemiplegic arm function, reduction in subluxation(as indicated by Jig test) and range of motion(SLROM). But it was difficult to generalize. We concluded that the FES program was effective in reducing the severity of shoulder subluxation and pain. Further study must be evaluated its statistical significance.