• Clinics in Shoulder and Elbow
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• v.1 no.2
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• pp.242-249
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• 1998

Stiffness of the elbow joint is relatively common after trauma, ectopic ossification, bum, postoperative scar, and etc. Mild flexion deformity can be reduced by use of active or passive motion exercise, dynamic sling, hinged distractor device, or turnbuckle orthosis. But these methods have disadvantages of difficulty in gaining acceptable range of motion only with stretching exercise, re-contracture after conservative managements and poor results that flexion contracture remained. The common described operative exposures for treatment of the stiff elbow are anterior, lateral, posterior, and medial approach. Through Anterior, lateral and medial approach each has not access to all compartments of the elbow. But, posterior approach has benefits that access to posterior, medial and lateral aspects of the elbow and as needed, fenestration to the olecranon fossa that produces a communication between the anterior and posterior compartments of the elbow are possible. From June 1991 through April 1997, 11 patients who had posttraumatic stiff elbow, were treated with debridement arthroplasty through the posterior approach. The purpose of this study are to introduce technique of the debridement arthroplasty and to evaluate final outcomes. With regarding to preoperative pain degree, mild degree matches to 3 cases, moderate to 3 cases, and severe to 2 cases. In preoperative motion, flexion was average 85° and extension was 30°. Postoperatively nine patients had got the complete relief of pain and two patients continued to have mild pain intermittentely. Postoperative flexion improved to 127° and extension to 2°, so that elbow flexion had improved by an average of 42° and elbow extension by 28°. On the objective scale all patients had good or excellent results and they all felt that they were improved by operation. Debridement arthroplasty is one of excellent procedures for the intractable stiff elbow if it is not unstable or it has not incongrous. But it need a meticulous operative technique and a well-programmed rehabilitation.

• Safety and Health at Work
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• v.11 no.2
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• pp.207-214
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• 2020

Background: Prolonged sitting at work can lead to adverse health outcomes. The health risk of office workers is an increasing concern for the society and industry, with prolonged sitting work becoming more prevalent. Objective: This study aimed to explore the variation in muscle activities during prolonged sitting work and found out when and how to take a break to mitigate the risk of muscle symptoms. Methods: A preliminary survey was conducted to find out the prevalence of muscle discomfort in sedentary work. Firstly, a 2-h sedentary computer work was designed based on the preliminary study to investigate the variation in muscle activities. Twenty-four participants took part in the electromyography (EMG) measurement study. The EMG variations in the trapezius muscle and latissimus dorsi were investigated. Then the intervention time was determined based on the EMG measurement study. Secondly, 48 participants were divided into six groups to compare the effectiveness of every break type (passive break, active break of changing their posture, and stand and stretch their body with 5 or 10 mins). Finally, data consisting of EMG amplitudes and spectra and subjective assessment of discomfort were analyzed. Results: In the EMG experiment, results from the joint analysis of the spectral and amplitude method showed muscle fatigue after about 40 mins of sedentary work. In the intervention experiment, the results showed that standing and stretching for 5 mins was the most effective break type, and this type of break could keep the muscles' state at a recovery level for about 30-45 mins. Conclusions: This study offers the possibility of being applied to office workers and provides preliminary data support and theoretical exploration for a follow-up early muscle fatigue detection system.

• Smart Structures and Systems
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• v.17 no.5
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• pp.819-835
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• 2016

In this paper, the activities carried out within the EU funded Clean Sky Joint Technology Initiative (JTI GRA) Project and aimed at developing a morphing flap, are illustrated. The reference device is a regional aircraft single slotted flap, enhanced with deforming capabilities to obtain improved hyper-lift performance. The design started with the identification of the internal architecture, intended to allow camber variations. A concentrated-hinge architecture was selected, for its ability to fit different curvatures and for the possibility of easily realizing an "armadillo-like" configuration, then avoiding the use of a complicate deformable skin. The flap layout is made of segmented ribs, elastically hinged each other and span-wise connected by conventional spars. Relative rotations of the rib elements are forced by SMA structural actuators, i.e., cooperating in the external loads absorption. Super-elastic SMA are used to make up recovery elastic elements, necessary to regain the original shape after activation. These further elements in turn contribute to the overall flap rigidity. After assessing the hinge number and the size of the SMA active and passive elements, the advanced design phase was dealt with. It was aimed at solving manufacturing issues and producing the executive drawings. The realized demonstrator was finally tested in lab conditions to prove its functionality in terms of whether target shape actuation or attained shape preservation under loads. On the basis of the numerical results and the experimental outcomes, precious hints were obtained for further developments of the concept.

• Archives of Plastic Surgery
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• v.43 no.2
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• pp.134-144
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• 2016

In adults, mallet finger is a traumatic zone I lesion of the extensor tendon with either tendon rupture or bony avulsion at the base of the distal phalanx. High-energy mechanisms of injury generally occur in young men, whereas lower energy mechanisms are observed in elderly women. The mechanism of injury is an axial load applied to a straight digit tip, which is then followed by passive extreme distal interphalangeal joint (DIPJ) hyperextension or hyperflexion. Mallet finger is diagnosed clinically, but an X-ray should always be performed. Tubiana's classification takes into account the size of the bony articular fragment and DIPJ subluxation. We propose to stage subluxated fractures as stage III if the subluxation is reducible with a splint and as stage IV if not. Left untreated, mallet finger becomes chronic and leads to a swan-neck deformity and DIPJ osteoarthritis. The goal of treatment is to restore active DIPJ extension. The results of a six- to eight-week conservative course of treatment with a DIPJ splint in slight hyperextension for tendon lesions or straight for bony avulsions depends on patient compliance. Surgical treatments vary in terms of the approach, the reduction technique, and the means of fixation. The risks involved are stiffness, septic arthritis, and osteoarthritis. Given the lack of consensus regarding indications for treatment, we propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which we treat with extra-articular pinning.

• Clinics in Shoulder and Elbow
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• v.14 no.1
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• pp.73-79
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• 2011

Purpose: To evaluate of the clinical usefulness of minimal invasive ulnohumeral arthroplasty in patients with mild to moderate elbow arthritis. Materials and Methods: From January 2000 to December 2008, twenty-nine patients with mild to moderate elbow arthritis underwent minimal invasive ulnohumeral arthroplasty. Among these patients, we reviewed the cases of 24 patients for whom we had follow-up data for at least 1 year. There were 20 males and 4 females with a mean age of 53 years (range: 31~69). We excluded patients with preoperative ulnar neuropathy symptoms and investigated the mean operation time, the joint range of motion, the time required until the start of joint exercise, and the Mayo elbow performance score (MEPS). Results: Passive and active joint exercises were started in an average of 1.8 days (range: 1~4) after surgery; the mean operation time was 38 minutes (range: 25~55). The elbow joint range of motion was 25-104 degrees (extension 0~70, flexion 80~130) preoperatively and was improved 40 degrees on average to 14-133 degrees (extension 0~45, flexion 90~150) after a year of follow up. The average time required until the start of joint exercise was 1.6 days (range: 1~5). MEPS were excellent in 9 cases and good in 5 cases after a year of follow up. Although there was 1 case of delayed wound healing and 7 cases of postoperative edema, they improved spontaneously. Conclusion: For patients with mild to moderate elbow arthritis, minimal invasive ulnohumeral arthroplasty is a clinically useful surgery since its operation time is short, early joint exercise is possible, and pain is mild.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.650-658
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• 2010

Purpose: In the case of repair for far distal parts of FDP (Flexor digitorum profundus) division, the method of either pull-out suture or fixation of tendon to the distal phalanx is preferred. In this paper, the results of a modified loop suture technique used for the complete division of FDP from both zone 1a and distal parts of zone 1b in Moiemen classification are presented. Methods: From July 2006 to July 2009, the modified loop suture technique was used for the 10 cases of FDP in complete division from zone 1a and distal parts of zone 1b, especially where insertion sites were less than 1 cm apart from a tendon of a stump. In a suture technique, a loop is applied to each distal and proximal parts of tendon respectively. Core suture of 2-strand and epitendinous suture are done with PDS 4-0. Out of 10 patients, the study was done on 6 patients who were available for the followup. The average age of the patients was 49.1 years (in the range from 26 to 67). 5 males and 1 female patients were involved in this study. There were 3 cases with zone 1a and distal parts of zone 1b. The average distance to the distal tendon end was 0.6 cm. There were 5 cases underwent microsurgical repair where both artery and nerve divided. One case of only tendon displacement was presented. The dorsal protective splint was kept for 5 weeks on average. The results of the following tests were measured: active & passive range of motion, grip strength test, key pinch and pulp pinch test. Results: The follow-up period on average was 11 months, in the range from 2 to 20 months. There was no case of re-rupture, but tenolysis was performed in 1 cases. In all 6 cases, the average active range of motion of distal interphalangeal joint was 50.8 degree. The grip strength (ipsilateral/contralateral) was measured as 88.7% and the pulp pinch test was 79.2% as those of contralateral side. Flexion contracture was presented in 2 cases (15 degree on average) and there was no quadrigia effect found. Conclusion: Despite short length of tendon from the insertion site in FDS rupture in zone 1a and distal parts of zone 1b, sufficient functional recovery could be expected with the tendon to tendon repair using the modified loop suture technique.

• Journal of Oral Medicine and Pain
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• v.23 no.1
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• pp.21-36
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• 1998

The purpose of this study was analyse the mandibular movements in patients with internal derangement of the temporomandibular joint according to diagnostic subgroups. The author classified patients with internal derangement of the temporomandibular joint into 4 diagnostic subgroups by means of the magnet resonance imagings, and evaluated the clinical signs and the mandibular movements with Mandibular Kinesiograph(MKG) in each subgroups. The mandibular movements, measured in this study, were the types of movement in frontal and sagittal plane, velocities in opening and closing movement, and the opening and closing movement, and the opening and closing velocity pattern. The data were compared between the 5 groups including the normal group. The results were as follows : 1. Pain was more frequently observed in the anterior disc displacement without reduction group than in the anterior disc displacement with reduction group. Sound of joint was more frequently observed in the anterior disc displacement with reduction group, and limitation of mandibular opening movement was more frequently observed in the anterior disc displacement without reduction group. Duration of the anterior disc displacement without reduction group was significantly short compared to that of the anterior disc displacement with reduction group, and duration of the unilateral anterior disc displacement without reduction group was shortest in the experimental group. The frequency of Angle's classifications had not significant correlations between the experimental groups. 2. Active and passive range of the opening movement, maximum protrusive movement, maximum lateral movement toward left side were significantly decreased in the experimental groups compared to the control group, but there was no significant difference in the range of the maximum lateral movement toward right side between the control and experiment groups. In unilateral anterior disc displacement without reduction group, the range of maximum lateral movement toward unaffected side was no significant difference in the range of the maximum lateral movement between toward affected side and toward unaffected side. 3. Maximum opening velocity, maximum closing velocity, average opening velocity, average closing velocity and maximum velocity of terminal tooth contact were significantly decreased in the experimental groups compared to control group. There was no significant difference in maximum opening velocity and maximum velocity of Terminal tooth contact between the subgroups of the experimental group each other, but there was significant difference in maximum closing velocity, average opening velocity and average closing velocity between the subgroups each other. 4. In the frontal plane of the MKG, the frequency of complex deviation type(F-2)pattern was significantly increased in the anterior disc displacement with out reduction group compared to the anterior disc displacement with reduction group and the control group. In the sagittal plane, the frequency of coincident type(S-1)was decreased in the same group. 5. In the maximum opening velocity pattern, the frequency of no-peak type (OV-3)in the unilateral anterior disc displacement with reduction group was significantly increased compared to the control group. The frequency of 1-peak type (OV-1) and 2-peak type (OV-2) was decreased in the anterior disc displacement with out reduction group, but the frequency of no-peak type (OV-3)was increased in the same group. In the maximum closing velocity pattern, the frequency of no-peak type (CV-3) was significantly increased in the anterior disc displacement without reduction group. Compared to the anterior disc displacement with reduction group and the control group. The frequency of 1-peak type (CV-1) and 2-peak type (CV-2) in the anterior disc displacement with reduction group was decreased than that in the control group.

• Journal of Pharmacopuncture
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• v.27 no.1
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• pp.14-20
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• 2024

Objectives: Frozen shoulder (FS) is one of the most challenging shoulder disorders for patients and clinicians. Its symptoms mainly include any combination of stiffness, nocturnal pain, and limitation of active and passive glenohumeral joint movement. Conventional treatment options for FS are physical therapy, nonsteroidal anti-inflammatory drugs, injection therapy, and arthroscopic capsular release, but adverse and limited effects continue to present problems. As a result, pharmacoacupuncture (PA) is getting attention as an alternative therapy for patients with FS. PA is a new form of acupuncture treatment in traditional Korean medicine (TKM) that is mainly used for musculoskeletal diseases. It has similarity and specificity compared to corticosteroid injection and hydrodilatation, making it a potential alternative injection therapy for FS. However, no systematic reviews investigating the utilization of PA for FS have been published. Therefore, this review aims to standardize the clinical use of PA for FS and validate its therapeutic effect. Methods: The protocol was registered in Prospero (CRD42023445708) on 18 July 2023. Until Aug. 31, 2023, seven electronic databases will be searched for randomized controlled trials of PA for FS. Authors will be contacted, and manual searches will also be performed. Two reviewers will independently screen and collect data from retrieved articles according to predefined criteria. The primary outcome will be pain intensity, and secondary outcomes will be effective rate, Constant-Murley Score, Shoulder Pain and Disability Index, range of motion, quality of life, and adverse events. Bias and quality of the included trials will be assessed using the Cochrane handbook's risk-of-bias tool for randomized trials. Meta analyses will be conducted using Review Manager V.5.3 software. GRADE will be used to evaluate the level of evidence for each outcome. Results: This systematic review and meta-analysis will be conducted following PRISMA statement. The results will be published in a peer-reviewed journal. Conclusion: This review will provide scientific evidence to support health insurance policy as well as the standardization of PA in clinical practice.

• Clinics in Shoulder and Elbow
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• v.1 no.2
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• pp.221-229
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• 1998

We measured, with manual goniometer, the active and passive arc of motion of the shoulder in 31 healthy male subjects who were right-hand dominant and who ranged in age from twenty to thirty-one years. Among ten directions through the four motion plane, the range of motion on the dominant side were significantly smaller than those on the non-dominant side in the motion of six directions. We also measured the motion fraction of the glenohumeral and scapulothoracic movement using fluoroscope in 30-degree intervals of arm elevation in the scapular plane. The ratio of glenohumeral to scapulothoracic movement(θGH/θST) was 1.6 for the full range of motion in scapular plane. At the lower angles of abduction, scapulothoracic movement was slight compared with glenohumeral movement. The motion fraction of scapulothoracic joint was increased from 60-degree to 150 degree of arm angle especially between 120 to 150 degree. During arm elevation, scapula was also extended from 42 degrees to 20 degrees tilting as well as internal rotation. The measuring technique of glenohumeral to scapulothoracic movement(θGH/θST) with fluoroscopy could be applied to the simple radiographic measurement at the out-patient clinic in order to identify the pathology and recovery of shoulder motion after treatment.

• Sim-seong Yeon-gu
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• v.37 no.2
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• pp.149-183
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• 2022

The oracle of the I Ching, divination can be understood as 'synchronicity phenomenon' in analytic psychology. In order to experience divination actually, it requires a religious attitude that asks questions with a serious mind when a person is in trouble that consciousness reaches its limit. It is not just a passive attitude, but a modest, active attitude to ask what I can do now. The experience of the oracle of the I Ching connected to supra-consciousness is similar to 'active imagination'-talking with the archetype of collective unconsciousness-and is 'the process of finding the rhythm of Self-archetype, the absolute wisdom of unconsciousness.' One month before my father's death, I took care of him who couldn't communicate verbally and I divination with a question 'What can I do for my father and me now?' The I Ching's answer was hexagram 19 Lin 臨, nine at the beginning. It's message was '咸臨貞吉 joint approach. perseverance brings good fortune.' 志行正也 we must adhere perseveringly to what is right.' Through this phrase, I learned the attitude of waiting for life after death as if 'joyful obedient' to the providence of nature that spring comes after winter. And I found that keeping the touching emotion of meeting infinity (in analytical psychological terms, 'Self') with perseveration is to do the true meaning of life beyond popular money-mindedness. And six months before my father's death, I had a dream about the afterlife. In the process of interpreting that dream, I learned not only from the shock of the direct message that 'it is a truth that there is something after death,' but also the regeneration of the mind through introversion from the similarity between the closed ward and '黃泉'-chinese underworld through amplification. And I learned the importance of an open attitude to accept new things through the 'window to eternity' symbolized by the white iron gate. In my father's catholic funeral ritual, I had hope that the catholic doctrine 'Communio Sanctorum'-A spiral cycle in which the living and the dead help each other may be real as well as a symbol of the individuation process in which consciousness and unconsciousness interact in our minds. Through the consolation received through the funeral visit of many people I met in my life, I found the answer that the path to contact with infinity begins with loving the beings in front of me. I tried to understand this continuous experience by the perspective of analytical psychology.