• 한국방사선학회논문지
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• 제6권5호
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• pp.427-433
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• 2012

본 연구는 오른쪽 어깨관절에 칼텐본-에비엔즈컨셉 미끄러뜨림 등급II와 III으로 아래쪽미끄러뜨림 적용시 위팔뼈머리의 이동거리 및 벌림각도(abduction angle)의 변화를 알아보고자 하였다. 미끄러뜨림 등급II(Grade II) 적용시 위팔뼈머리는 초기보다 아래쪽으로 5mm 가량 이동하였고 등급III 적용시 8mm 가량 이동하였다. 이동거리에 대한 성별 비교에서는 남자가 여자에 비해 등급별로 이동거리가 높게 나타났으나 통계적으로 유의한 차이는 나타나지 않았다. 등급 II(Grade II) 적용시 벌림각도는 초기보다 $10^{\circ}$ 가량, 등급III(Grade III) 적용시 $12^{\circ}$ 가량 증가하였다. 벌림각도에 대한 성별 비교에서는 모든 등급별로 여자가 남자보다 벌림각도가 크게 나타났으나 통계적으로 유의한 차이는 나타나지 않았다. 본 연구를 통해 미끄러뜨림 등급 적용시 위팔뼈머리의 운동형상학적 변화를 알아보았으며 향후 추가 연구를 통해 이들 변화가 주변 구조물에 미치는 영향에 대해 알아본다면 보다 과학적인 근거중심의 치료를 기대할 수 있을 것으로 사료된다.

• 한국전문물리치료학회지
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• 제19권4호
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• pp.8-15
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• 2012

Posterior shoulder muscle tightness is frequently observed in shoulder impingement syndrome because tightness in the posterior portion of the shoulder muscles can cause anterior and superior translation of the humeral head in relation to the glenoid fossa. The purpose of this study was to determine the immediate effects of soft tissue massage on acromiohumeral distance (AHD), anterior translation of the humeral head, and glenohumeral (GH) range of motion (ROM) in subjects with posterior shoulder muscle tightness. Twenty-seven subjects with greater than $10^{\circ}$ difference in the range of GH horizontal adduction between right and left sides were recruited. The range of GH horizontal adduction and internal rotation were measured by a digital inclinometer. The AHD and anterior translation of the humeral head were measured using ultrasonography. A paired t-test was used to compare AHD, anterior translation of the humeral head, and the range of GH horizontal adduction and internal rotation before and after soft tissue massage. The results showed that AHD increased significantly (p<.05) and the anterior translation of humeral head decreased slightly, but not significantly (p=.40) after the soft tissue massage. Furthermore, the ROM of horizontal adduction and internal rotation in the GH joint increased significantly after the soft tissue massage (p<.05). These findings indicate that soft tissue massage on posterior shoulder muscle tightness is an effective method to increase AHD and ROM in the horizontal adduction and internal rotation of the GH joint.

• Investigative Magnetic Resonance Imaging
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• 제23권3호
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• pp.228-240
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• 2019

Purpose: The aim of this study is to evaluate the T2 value of the articular cartilage of the glenohumeral joint in rotator cuff disease displayed on 3.0T MRI and to apply it in clinical practice. Materials and Methods: This study involved sixty-two patients who underwent shoulder MRI containing T2 mapping. The mean T2 value was measured by placing a free hand ROI over the glenoid or humeral cartilage from the bone-cartilage interface to the articular surface on three consecutive, oblique coronal images. The drawn ROI was subsequently divided into superior and inferior segments. The assessed mean T2 values of the articular cartilage of the glenohumeral joint were compared and evaluated based on the degree of rotator cuff tear, the degree of fatty atrophy of the rotator cuff, and the acromiohumeral distance. Results: ICC values between two readers indicated moderate or good reproducibility. The mean T2 value for the articular cartilage of the glenoid and humeral head cartilage failed to show any significant difference based on the degree of rotator cuff tear. However, the mean T2 values of articular cartilage, based on fatty atrophy, tended to be higher in fatty atrophy 3 or fatty atrophy 4 groups while some subregions displayed significantly higher mean T2 values. There was no correlation between the acromiohumeral distance and the mean T2 values of the articular cartilage of the glenoid and humeral head. Conclusion: T2 mapping of the glenohumeral joint failed to show any significant difference in quantitative analysis of the degenerative change of the articular cartilage based on the degree of rotator cuff tear. However, it also offers quantitative information on the degenerative change of cartilage of the glenohumeral joint in patients with rotator cuff tear and severe fatty atrophy of the rotator cuff.

• Clinics in Shoulder and Elbow
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• 제22권4호
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• pp.220-226
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• 2019

Background: This retrospective study was undertaken to evaluate mid-term clinical and radiological outcomes of lattisimus dorsi (LD) tendon transfer in patients with irreparable massive rotator cuff tears (MRCT). We hypothesize that LD tendon transfer would provide safe and satisfactory clinical outcomes at mid-term follow-up. Methods: From November 2008 to December 2016, 23 patients ($57.5{\pm}4.4years$; 20 male, 3 female) who underwent LD tendon transfer for massive tears, were enrolled. Inclusion criteria were irreparable MRCT. Exclusion criteria included full thickness subscapularis tear, rotator cuff arthropathy, anterosuperior rotator cuff tear, and osteoarthritis. Mean follow-up period was $4.7{\pm}4.0years$ (range, 2-12 years). Clinical assessment (American Shoulder and Elbow Surgeons [ASES], University of California, Los Angeles [UCLA], Simple Shoulder Test [SST]) and radiographic assessment (osteoarthritis [OA], acromiohumeral distance [AHI]) were evaluated. Results: ASES, UCLA and SST scores, and range of motion (ROM), except internal rotation, improved significantly at the last followup (p<0.05). Also, AHI was significantly improved at the last follow-up, from 6.6 mm to 8.2 mm (p=0.008). At the final follow-up, the radiologic stages of the glenohumeral osteoarthritis were determined as stage 1 in 9 patients, stage 2 in 10 patients, stage 3 in 2 patients, and stage 4 in 2 patients. Complications were observed in 21.7% cases: 3 re-tears and 2 infections were noted in our study. Conclusions: LD tendon transfer for irreparable MRCT provides satisfactory clinical outcomes at mid-term follow-up. Mild degenerative osteoarthritis (stage 1, 2) of the shoulder joint are common at the mid-term follow-up. Also, complications such as tear, infection should be considered.

• 대한통합의학회지
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• 제11권1호
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• pp.87-98
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• 2023

Purpose : This study was to verify the effectiveness of eccentric training and to make clinical recommendations on detailed application methods by comparing the effects of changes in acromiohumeral distance (AHD), pain intensity, muscle strength, and functional performance after applying a 12-week eccentric training program (ET group) or concentric training program (CT group) for patients with partial rotator cuff (supraspinatus) tears with moderate to severe shoulder pain. Methods : A total of 29 subjects were assigned to either the "ET group (n=15)" or the "CT group (n=14)" through simple randomization and were measured in the same way at baseline before intervention, 4 weeks and 12 weeks after intervention. All subjects received a physical therapy program 12 sessions 3 times a week for the first 4 weeks, and physical therapy program, 12 sessions a week, from 4 weeks to 12 weeks, for a total 20 sessions. Ultrasound machine was used for AHD, visual analog scale (VAS) was used for pain intensity, electronic hand held dynamometer was used for muscle strength, Korean Constant shoulder score (K-CSS) used for functional performance. Results : AHD, pain intensity, and muscle strength did not show significant differences at 4 weeks, but improved numerically, and showed significant differences at 12 weeks (p<.05), showing superior results in the eccentric training group compared to the concentric training group. Functional performance showed significant changes at both 4 and 12 weeks (p<.05), and excellent results were also found in the eccentric training group. Conclusion : In patients with partial rotator cuff tears with moderate to severe shoulder pain, an eccentric training program increased acromiohumeral distance (AHD), reduced pain, and increased muscle strength. Therefore, it can be clinically presented as an intervention method that can quickly and effectively improve functional performance, which is the ultimate goal of physical therapy.

• 대한물리의학회지
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• 제6권4호
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• pp.397-406
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• 2011

Purpose : Recently ultrasound images has been used to measure the subacromial space with a linear measurement of the acromiohumeral distance. The purpose of this study was to comparison of distance of subacromial space using ultrasonographic measurement on arm positions of shoulder injured patients. Methods : The subjects were 30 shoulder injured patients (19 males and 11 females). Ultrasonography was performed to measure subacromial space during each shoulder resting position, $45^{\circ}$ abduction, internal rotation with $45^{\circ}$ abduction and external rotation with $45^{\circ}$ abduction. Results : Subacromial space was a significantly difference between injured arm and normal arm at shoulder resting position. At $45^{\circ}$ abduction, subacromial space was narrowing significantly between injured arm and normal arm. At external rotation with $45^{\circ}$ abduction, subacromial space were wider in normal arm than in injured arm but it was not significantly. Intra-observer reliability for ultrasonography measurement of subacromial distance was excellent (.96~.99). Conclusion : These results identified that positions of injured shoulder was related to subacromion space.

• Clinics in Shoulder and Elbow
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• 제19권3호
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• pp.125-129
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• 2016

Background: Superior migration of humeral head has been conventionally determined by measuring the acromiohumeral distance (AHD), We sought to devise a novel measurement system more reliably and accurately than AHD. We described a structural landmark called 'C-line'. In this study, we investigated the clinical usefulness of 'step-off of the C-line (SOC)' compared to that of AHD. Methods: The C-line formed from the medial margin of the proximal humeral head continuing up to the inferior margin of the articular glenoid and then to the lateral border of the scapula. The superior migration of the humeral head triggered by a rotator cuff tear introduces a discontinuity in this C-line. We measured the distance of this discontinuity. We enrolled 144 patients who underwent a rotator cuff repair. We selected 58 controls who didn't have any cuff lesions apparent on magnetic resonance imaging. Using radiographs derived from standardized true anteroposterior views of the shoulder, we measured the SOC and the AHD. We used t-tests for statistical analyses. Results: A rotator cuff tear was associated with an increase in SOC and a decrease in AHD. In control group, the mean SOC was $1.29{\pm}1.71mm$ and AHD was $9.71{\pm}2.65mm$. In cuff tear group, the mean SOC was $3.15{\pm}3.41mm$ and AHD was $8.28{\pm}1.76mm$. The mean SOCs of the patient group in relation to the mean SOC of the control group according to tear size, the SOCs of medium tear and lager groups showed statistically significant increase (p<0.05). Conclusions: The SOC may be a similarly effective to diagnose cuff tears of medium size and larger compared with AHD.

• Clinics in Shoulder and Elbow
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• 제13권1호
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• pp.146-152
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• 2010

목적: 광범위 회전근 개 파열에 대한 여러 가지 수술 방법 중 고령의 봉합이 불가능한 파열에 대해 시행하는 단순 변연절제술 및 결절성형술에 대해 알아보고자 하였다. 대상 및 방법: 봉합 불가능한 광범위 회전근 개 파열에 대한 여러 수술 방법 및 치료 방법의 선택에 대하여 문헌을 검토하고 정리하였다. 특히 고령의 봉합이 불가능한 광범위 회전근 개 파열에 시행할 수 있는 단순 변연절제술 및 결절성형술에 대해 연구 발표된 논문을 조사하여 요약하고 정리하였다. 또한 본 저자들의 교실에서 회전근 개의 심한 퇴축으로 도저히 봉합이 불가능하였던 32예를 대상으로 시행된 관절경적 결절성형술의 수술 방법을 소개하고 임상적 및 방사선학적 결과를 분석하였으며 그 결과에 미치는 요인들을 조사하였다. 결과: 평균 29개월 (13~52개월) 추시한 결과 통계적으로 의미있는 통증의 감소와 능동적 거상 운동 범위의 증가를 확인할 수 있었으며 기능적 향상을 얻을 수 있었다. 하지만 수술 전 견봉-상완 간격이 2 mm 미만으로 좁았던 경우에는 수술 후 불량한 결과를 보였다. 결론: 광범위 파열의 관절경적 치료에 있어, 일단 회전근 개 유리술 후 봉합이 가능한 경우는 최대한 봉합술을 시도해 볼 수 있으며, 봉합이 불가능한 광범위 파열의 경우에는 무리하게 일차 복원술을 시도하기 보다는 수술 전 통증은 있으나 90도 이상 능동적 전방 거상이 가능하고 방사선 사진상 견봉과 상완골 두 사이 간격이 2 mm 미만으로 좁아지지 않은 경우에는 견봉성형술을 포함한 관절경적 결절성형술을 고려해 보아야 할 것이다.

• Clinics in Shoulder and Elbow
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• 제10권2호
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• pp.160-166
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• 2007

목적: 다발성 회전근 개 파열에서 일차 복원술의 결과와 결과에 영향을 주는 인자를 분석하고자 하였다. 대상 및 방법: 1997년에서 2003년 사이에 두 개 이상 건이 이환된 회전근 개 파열에 대하여 일차 복원술을 시행한 후 2년 이상 추시된 19예(평균 연령 64.8세)를 대상으로 UCLA score의 변화를 조사하고, 외상, 능동적 운동, 견봉-상완골간 간격, 파열의 크기, 면적 등과 UCLA score사이의 상관 관계를 Pearson 선형 상관계수(PLCC)를 이용하여 검증하였다. 결과: UCLA score는 평균 9.4에서 26.1로 전 예에서 뚜렷이 증가하였으나 Ellman 기준상 53%에서 우수, 47%는 불량의 결과를 보였다. 외상, 능동적 거상, 견봉-상완골 간격 및 파열의 크기는 UCLA score와 상관관계가 없었으나 파열 면적은 UCLA score와 역 상관관계가 있었으며(PLCC=-0.696) MRI상 극하근의 Goutallier등급 III단계 이상 변성이 있는 경우는 불량한 결과를 보였다. 결론: 다발성 회전근 개 파열에서 일차 복원술의 결과는 53%에서 만족스러웠다. 큰 파열 면적, 극하근의 심한 변성은 불량 예후인자로 사료된다.

• Clinics in Shoulder and Elbow
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• 제25권3호
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• pp.173-181
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• 2022

Background: Healing of the tendon itself is not always related to successful clinical outcomes after rotator cuff repair. It was hypothesized that certain radiologic factors affecting clinical outcomes could exist in case of the retear after arthroscopic rotator cuff repair (ARCR) and the radiologic factors could help predict clinical process. The purpose of this study was to identify the radiologic factors associated with clinical outcomes of the retear after ARCR. Methods: Between January 2012 and December 2019, among patients with sufficient footprint coverage for ARCR, 96 patients with Sugaya classification 4 or higher retear on follow-up magnetic resonance imaging were included. The association between clinical outcomes such as American Shoulder and Elbow Surgeons (ASES) score, Constant score and range of motion and radiologic variables such as initial tear dimension, retear dimension, variance of tear dimension, critical shoulder angle, acromial index, and acromiohumeral distance was analyzed. Results: Preoperatively, the ASES and Constant scores were 59.81±17.02 and 64.30±15.27, respectively. And at the last follow-up, they improved to 81.56±16.29 and 78.62±14.16, respectively (p<0.01 and p<0.01). In multiple linear regression analysis, the variance of the mediolateral dimension of tear had statistically significant association with the ASES and Constant scores (p<0.01 and p=0.01). Conclusions: In patients with the retear after ARCR, the variance in the mediolateral dimension of tear had significantly negative association with the clinical outcomes. This could be considered to be reference as relative criteria and needed more sample and mechanical study.