• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.180-188
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• 2009

Purpose: We evaluate the short-term clinical outcome of arthroscopic rotator cuff tendon repair with suture-bridge technique in patients with full thickness rotator cuff tear. Materials and Methods: 29 (male:17, female:12) consecutive shoulders treated with this index procedure and early rehabilitation were enrolled. Mean age was 56.4 years (range, 34~73 years) and mean follow-up period was 13 months (range, 12-15 months). Clinical outcomes were evaluated by using the University of California Los Angeles (UCLA) score, the Korean Shoulder Scoring System (KSS) and Visual Analogue Scale (VAS). Postoperative cuff integrity was evaluated through magnetic resonance imaging (MRI) and categorized by Sugaya classification. Results: Postoperative UCLA scores improved from 16.4 to 31.6 (p< 0.05) and KSS scores showed 88 at 6 months and 92 at last follow up. Preoperative VAS score was 8.6, which was decreased to 2.1 at 3 months and 1.4 at 6 months postoperatively. 28 patients (96.5%) had increase in range of motion. The follow up MRI was taken in 15 shoulders and the cuff integrity was type I in 6 cases, type II in 7, type III in 1 and type V in 1 by Sugaya classification. Conclusion: Arthroscopic suture-bridge technique resulted in good or excellent clinical outcome in 96.5% of the cases, so we think this technique is one of the reliable procedure for full-thicknes rotator cuff tear.

• Economic and Environmental Geology
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• v.2 no.4
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• pp.23-71
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• 1969

Sediment samples were taken at about half-mile intervals from all the inajor rivers draining the St. Austell granite mass. The minus 80 mesh(B.S.S.) fraction of each sample was analysed, using semiquantitative methods, for sodium, potassium, lithium, phosphorus, nickel, chromium, tin, tungsten, arsenic copper, zinc and lead. The work was carried out with the view to gaining further information as to the geographical distribution of such different granite facies as might axist, and to investigate the geochemical dispersion of these elements with relation to mineralisation in this area. The sesults confirm Exley's suggestion that the mass consists of two major granite intrusions, the earlier undifferentiated one is joined on the west by a later differentiated intrutive. During the work grid deviation maps proved particularly useful in obtaining data concerning the nature of the granite but frequency diagrams were not particularly helpful. All the known lode areas were associated with stream sediments containing anomalously high concentrations of lode metals and it is concluded that these high concentrations are due premarily to lode material transferred to the streams in the form of tailings lost during milling operations.

• Clinics in Shoulder and Elbow
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• v.11 no.2
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• pp.90-95
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• 2008

Purpose: We wanted to assess the accuracy of ultrasound for detecting abnormality of the long head of the biceps tendon in patients with rotator cuff disorders. Materials and Methods: Between January 2006 and March 2007, we reviewed the arthroscopic findings of biceps tendons in 67 patients with rotator cuff disorder and who underwent ultrasonography pre-operatively. The patients' average age was 58 years and there were 41 males and 26 females. The statuses of the biceps tendons were described as 'normal', 'dislocation', 'subluxation', 'partial or complete tears', and 'tendinopathy'. We investigated the correspondence between the arthroscopic and ultrasonographic findings. Results: On ultrasonography, the biceps tendons were 'normal' in 37 patients and 'abnormal' in 30 patients. On arthroscopy, 5 biceps tendons turned out to have partial tears, which were 'normal' on ultrasonography. On the other hand, 8 biceps tendons were 'normal' which were 'abnormal' on ultrasonography. Three dislocations and 4 complete tears of biceps tendons were identified on arthroscopy, and all of them were detected by ultrasonography. Of the 20 cases of 'tendinopathy' seen on ultrasonography, 15 patients had partial tears and the remaining 5 patients were normal on arthroscopy. Conclusion: Ultrasonography is accurate for detecting some biceps pathologies, such as dislocation or complete tear, but it is not accurate for the detection of partial tear.

• Clinics in Shoulder and Elbow
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• v.11 no.2
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• pp.131-136
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• 2008

Purpose: Parsonage-Turner syndrome is a rare disorder with sudden onset of severe pain around the shoulder girdle, followed by weakness of the shoulder muscles. The purpose of the current study was to describe the clinical features associated with this condition and to review the literature. Materials and methods: A retrospective study of the Parsonage-Turner syndrome was carried out for 6 patients seen from December 2005 to July 2008. The clinical and radiographic data was collected by medical records and telephone interviews. Five patients were males and one was female with ages ranging between 20-68 years (mean, 43.5). The mean follow-up period was 19.1 months (range, 14-27 months). Results: The intense pain around shoulder continued for 1 day to 3 weeks and decreased spontaneously at a mean of 3.3 weeks (range, 2-5 weeks) after onset of pain. Weakness in the involved muscles had developed at a mean of four weeks (range, 2-7 weeks). At the end of follow-up, five patients had an improvement of their strength and one patient had regained full strength. Electromyography was the most helpful in diagnosis. Conclusion: Parsonage-Turner syndrome is a self-limited disorder with a good outcome. Understanding of the course will assist in the diagnosis and treatment.

• Clinics in Shoulder and Elbow
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• v.13 no.1
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• pp.64-71
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• 2010

Purpose: To evaluate pathologic patterns and outcomes of treatment of a biceps tendon lesion associated with a rotator cuff tear. Materials and Methods: We reviewed 92 patients (i) who underwent surgery for a cuff tear, (ii) for whom the biceps lesion could be observed retrospectively, and (iii) had a minimum follow-up of 2 years. The pathology of biceps tendon was classified into 4 types: tenosynovitis, fraying or hypertrophy, tear, and instability. All but the 4 with massive cuff tears were repaired. The biceps lesions were treated with debridement in 30, tenotomy in 10, tenodesis in 8, and recentering in 4. UCLA scoring was used for clinical results. Results: Seventy patients had a biceps lesion, 19 tenosynovitis, 22 fraying or hypertrophy, 21 a tear, and 8 instability. A biceps lesion was observed in 63% of cases of cuff tears below the medium size, and in 88% of cases with cuff tears above the large size. UCLA scores according to the pathology of the biceps lesion were 29.6 in the absence of a biceps lesion, and 28.3 in its presence. UCLA scores in patients with tenotomy or tenodesis for associated biceps tendon lesions were 28.2. Conclusion: There is a greater incidence and severity of a biceps lesion with a larger cuff tear. Therefore, the cause of a biceps lesion might be related to the cause of the cuff tear. Among the several options of treatment for biceps lesion, tenotomy or tenodesis may be particularly effective in providing pain relief.

• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.33-41
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• 2007

Purpose: The purpose of this study was to prove the effectiveness of the open medial (glenoid-based) anterior-inferior capsular shift in patients with multidirectional shoulder instability. Materials and Methods: We reviewed 19 patients treated by medial anterior-inferior capsular shift for multidirectional shoulder instability from March, 1998 to December, 2003. 15 patients of them have experienced recurrent dislocation. 8 patients(42%) showed bilateral laxity and 11 patients(58%) generalized ligamentous laxity, and 2 patients(10.5%) voluntary subluxation. An average follow-up was 24 months (range : $9{\sim}32$ months). Results: Pain improved in 18 patients of all. There was an average loss of 10 degree of external rotation, but no limitation of activity of daily living. There was no redislocation and subluxation, but two patients had some apprehension in sports activity. With Rowe score, the result was excellent or good in all patients. There were hematoma and local skin problem in 1 patient, but all had healed up. Conclusion: Medial anterior-inferior capsular shift in multidirectional shoulder instability provided satisfactory results in pain relief, patient's satisfactions and stability of glenohumeral joint. Though some of them have anterior gleniod deformities and large Hill-Sachs lesions, we could get good stabilities.

• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.27-32
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• 2007

Purpose: To investigate the validity of positive signs of supraspinatus test. Materials and Methods: The empty can test and full can test were performed on 200 shoulders which were diagnosed with magnetic resonance imaging or surgical findings as full thickness tear, partial thickness tear and no tear. Presence of pain, weakness, pain or weakness, and both pain and weakness were recorded as positive signs separately. The two tests with positive signs were compared and analyzed. Results: Pain and weakness were severity-dependent, and the empty-can test had a higher incidence of pain. The sensitivities of the two supraspinatus tests in all positive signs were higher when including partial-thickness tears in the tear group; however, their specificities were higher when excluding partial-thickness tears. The sensitivities of an empty-can test in 'pain', 'pain or weakness', 'both pain and weakness' were higher than those of the full-can test, otherwise, the specificity of the full-can test for 'pain' and 'pain or weakness' were higher. Concordance rate between 'pain or weakness' and 'pain' was the highest in all categorization. Conclusion: Both empty can and full can test were valuable for detecting torn rotator cuff.

• Clinics in Shoulder and Elbow
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• v.15 no.1
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• pp.37-42
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• 2012

Purpose: To consider the proper management of proximal humerus fracture on gunshot wounds. Materials and Methods: A 28-year-old male patient, who sustained a gunshot injury on the left arm 5 days ago, was admitted through the emergency department. Although he underwent an emergency surgery (bullet fragment removal and debridement), there remained bullet fragments around the proximal humerus fracture site. The wound seemed to be infected and a partial dehiscence occurred. No neurologic deficit was noted. Immediate exploration and debridement were performed, and an external fixator was applied to restore the anatomical alignment and manage the wounds. Intravenous antibiotics were administered. On the 9th postoperative day, wound debridement was done again, and cement beads mixed with antibiotics were inserted. After two weeks, the external fixator was removed, and the pin sites were closed after debridement. One week later, the open reduction and internal fixation with locking compression plate and screws were done. Result: At 3 months after the internal fixation, the bone union was obtained with satisfactory alignment of the humerus. Conclusion: The severity of the soft tissue injury influences the fracture management plan. Further, the risk on lead toxicity should be considered.

• Investigative Magnetic Resonance Imaging
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• v.14 no.1
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• pp.10-20
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• 2010

Purpose : Recently, the Recon Challenge at the 2009 ISMRM workshop on Data Sampling and Image Reconstruction at Sedona, Arizona was held to evaluate feasibility of highly accelerated acquisition of time resolved contrast enhanced MR angiography. This paper provides the step-by-step description of the winning results of k-t FOCUSS in this competition. Materials and Methods : In previous works, we proved that k-t FOCUSS algorithm successfully solves the compressed sensing problem even for less sparse cardiac cine applications. Therefore, using k-t FOCUSS, very accurate time resolved contrast enhanced MR angiography can be reconstructed. Accelerated radial trajectory data were synthetized from X-ray cerebral angiography images and provided by the organizing committee, and radiologists double blindly evaluated each reconstruction result with respect to the ground-truth data. Results : The reconstructed results at various acceleration factors demonstrate that each components of compressed sensing, such as sparsifying transform and incoherent sampling patterns, etc can have profound effects on the final reconstruction results. Conclusion : From reconstructed results, we see that the compressed sensing dynamic MR imaging algorithm, k-t FOCUSS enables high resolution time resolved contrast enhanced MR angiography.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.215-220
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• 2009

Purpose: This study is to analyze the prevalence of various intra-articular lesions in patients with traumatic recurrent anterior dislocation of shoulder over 40 years and suggest clinical implications for treatment. Materials and Methods: We retrospectively studied 16 cases that underwent surgical treatment for recurrent anterior dislocation of shoulder from January 2001 to May 2009. There were 9 males and 7 females, and the mean age was 52.7years. We carried out arthroscopic exam for all patients based on standard protocol, which included labrum, capular lesion, cuff, bony lesions. Results: All 16 cases showed Hill-Sachs lesion, 3 patients (19%) had bony Bankart lesion, 6 patients (38%) had labral tear. Capsular tear were found 15 patients (94%). Twelve (75%) had ruptured supraspinatus and 5 (31%) had subscapularis tear. Only one (6%) had SLAP lesion. Conclusion: There was relatively higher incidence of capsular and rotator cuff tears in patients over age 40 years. Preoperative planning to address these lesions is highly recommended.