• Clinics in Shoulder and Elbow
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• 제25권4호
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• pp.339-346
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• 2022

Rotator cuff tear is the most common cause of shoulder pain in middle-age and older people. Arthroscopic rotator cuff repair (ARCR) is the most common treatment method for rotator cuff tear. Early postoperative pain after ARCR is the primary concern for surgeons and patients and can affect postoperative rehabilitation, satisfaction, recovery, and hospital day. There are numerous methods for controlling postoperative pain including patient-controlled analgesia, opioid, interscalene block, and local anesthesia. Regional blocks including interscalene nerve block, suprascapular nerve block, and axillary nerve block have been successfully and commonly used. There is no difference between interscalene brachial plexus block (ISB) and suprascapular nerve block (SSNB) in pain control and opioid consumption. However, SSNB has fewer complications and can be more easily applied than ISB. Combination of axillary nerve block with SSNB has a stronger analgesic effect than SSNB alone. These regional blocks can be helpful for postoperative pain control within 48 hours after ARCR surgery.

• The Journal of Korean Physical Therapy
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• 제33권2호
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• pp.114-121
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• 2021

Purpose: This study examined the effects of therapeutic massage (TMP) and home exercise program (HEP) on pain, range of motion (ROM), depression, and quality of life (QOL) after arthroscopic rotator cuff repair in middle-aged women. Methods: Nineteen middle-aged women who underwent arthroscopic rotator cuff repair were enrolled in the study. All subjects were assigned randomly to the experimental group (n=9) or the control group (n=10). The subjects in both groups performed HEP for 30 minutes, three times per day, for eight weeks. The subjects in the experimental group also performed HEP, with TMP being performed for 30 minutes, 16 sessions for eight weeks. All subjects were evaluated with a visual analogue scale (VAS), shoulder ROM, self-rating depression scale (SDS), and Korean brief version of WHO quality of life scale (WHOQOL-BREF). A paired t-test was performed to test the significant differences between before and after the intervention. An independent t-test was conducted to test the significant differences between the groups. Results: Following the intervention, both groups showed significant differences than before the intervention in the VAS, shoulder ROM, SDS, and WHOQOL-BREF (p<0.05). There were significant differences in the ROM of shoulder flexion, SDS, and WHOQOL-BREF between the groups (p<0.05). Conclusion: These findings suggest that intensive TMP is an effective method for improving shoulder flexion mobility, depressive symptom, and QOL in middle-aged women after arthroscopic rotator cuff repair.

• 대한관절경학회지
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• 제16권1호
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• pp.98-103
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• 2012

회전근 개 파열의 봉합술은 최근 들어 괄목할만한 발전을 보여주고 있다. 회전근 개 파열의 자연사를 관찰하면 대부분의 경우에서 시간이 지남에 따라 크기가 증가하는 양상이 관찰되었다. 회전근 개 파열의 후기에 오는 지방 침윤 및 광범위 회전근 개 파열 후 발생하는 회전근 개 파열 관절증은 회전근 개 파열의 봉합술에서 예후를 예측하거나 수술 시기를 결정하는데 중요한 요소라 할 수 있다. 회전근 개 파열시 증상 발생 후 3년 뒤에 중등도의 지방 침윤이 발생하는 것으로 관찰되어 그 이전에 회전근 개 파열의 봉합술을 시행하는 것이 추천되고 있으며, 또한 회전근 개 파열 관절증에서도 견봉상완골 간격이 감소하기 전에 봉합술을 하는 것이 권장되고 있다. 회전근 개 파열의 관절경하 봉합술은 크게 일열 봉합술 및 이열 봉합술로 나눌 수 있으며, 시간과 비용 면에서는 전자가 장점이 있으나, 생역학적이 관점에서는 후자가 더 우수하다. 이열 봉합술의 생역학적인 장점을 유지하면서 보다 적은 시간에 회전근 개의 봉합을 가능하게 한 교량형 봉합술이 개발되어 최근 널리 사용되고 있으며, 교량형 봉합술 내에서도 파열의 특성에 따라 몇 가지 다른 술식이 개발되어 사용되고 있다.

• Clinics in Shoulder and Elbow
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• 제20권4호
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• pp.183-188
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• 2017

Background: To evaluate the clinical outcomes and associated repair integrity in patients treated with arthroscopic repair for a transtendinous rotator cuff tear followed by resection of the remnant rotator cuff tendon. Methods: Between July 2007 and July 2011, we retrospectively reviewed patients who were treated for transtendinous full-thickness tears in the tendinous portion of the rotator cuff by arthroscopic repair. Clinical outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Rating Scale of the University of California at Los Angeles (UCLA), the Constant-Murley score, a visual analogue scale (VAS) pain score, and range of motion (ROM). The repair integrity was determined by magnetic resonance imaging or ultrasonography. Results: There were 19 shoulders with transtendinous full-thickness tears in the tendinous portion of the rotator cuff. The ASES, UCLA, Constant-Murley, and VAS pain scores showed significant improvements in function and symptoms (all p<0.001). The active ROM for forward flexion and abduction was also significantly improved (p=0.002 and p<0.001, respectively). The postoperative radiological examination showed cuff integrity without a re-tear in 68.4% of patients. However, the UCLA, ASES, and Constant-Murley scores were not significantly different between healed and re-torn group (p=0.530, p=0.885, and p=0.262, respectively). Conclusions: Although repair of transtendinous rotator cuff tears followed by resection of the remnant rotator cuff tendon in the footprint has a relatively high re-tear rate, no significant difference was observed in the short-term clinical results between the re-tear and healed groups.

• Clinics in Shoulder and Elbow
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• 제22권3호
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• pp.159-170
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• 2019

Delaminated rotator cuff tear pertains to the horizontal split of the tendon substance. As reported previously, the presence of a delaminated tear and incidence of delaminated rotator cuff tear ranges from 38% to 92%. The different strain intensities applied across the rotator cuff tendon, and the shear stress between the bursal and articular layers seem to play a role in its pathogenesis. In a delaminated rotator cuff tear, the degree and direction of retraction between two layers differ, with accompanying intrasubstance cleavage. A surgeon therefore needs to consider and carefully evaluate the tear characteristics when repairing delaminated rotator cuff tear. Delaminated rotator cuff tear is considered to be a poor prognostic factor after rotator cuff repair, but numerous surgical repair techniques have been introduced and applied to resolve this problem. Recent literature has reported good clinical outcomes after delaminated rotator cuff repair.

• Clinics in Shoulder and Elbow
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• 제22권4호
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• pp.190-194
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• 2019

Background: The duration of immobilization after arthroscopic rotator cuff repair and the optimal time to commence rehabilitation are still the subject of ongoing debates. This study was undertaken to evaluate the functional outcome and rotator cuff healing status after arthroscopic rotator cuff repair by comparing early and delayed rehabilitation. Methods: Totally, 76 patients with small, medium, and large sized rotator cuff tears underwent arthroscopic repair using the suturebridge technique. In early rehabilitation group, 38 patients commenced passive range of motion at postoperative day 2 whereas 38 patients assigned to the delayed rehabilitation group commenced passive range of motion at postoperative week 3. At the end of the study period, clinical and functional evaluations (Constant score, the University of California, Los Angeles [UCLA] shoulder score) were carried out, subsequent to measuring the range of motion, visual analogue scale for pain, and isokinetic dynamometer test. Rotator cuff healing was confirmed by magnetic resonance imaging at least 6 months after surgery. Results: No significant difference was obtained in range of motion and visual analogue scale between both groups. Functional outcomes showed similar improvements in the Constant score (early: 67.0-88.0; delayed: 66.9-91.0; p<0.001) and the UCLA shoulder score (early: 20.3-32.3; delayed: 20.4-32.4; p<0.001). Furthermore, rotator cuff healing showed no significant differences between the groups (range, 6-15 months; average, 10.4 months). Conclusions: Delayed passive rehabilitation does not bring about superior outcomes. Therefore, early rehabilitation would be useful to help patients resume their daily lives.

• The Korean Journal of Pain
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• 제33권4호
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• pp.344-351
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• 2020

Background: The effects of far-infrared radiation (FIR) on the treatment of rotator cuff diseases remains unknown. We evaluated the safety and efficacy of FIR after arthroscopic rotator cuff repair with regard to postoperative pain and healing. Methods: This prospective randomized comparative study included 38 patients who underwent arthroscopic rotator cuff repair due to a medium-sized tear. Patients were randomly divided into the FIR or control group (n = 19 per group). In the FIR group, FIR with an FIR radiator started 1 week postoperatively for 30 minutes per session twice daily. It lasted until abduction brace weaning at 5 weeks postoperatively. We assessed pain using a pain visual analogue scale (pVAS) and measured the range of motion (ROM) of the shoulder at 5 weeks, and 3 and 6 months, postoperatively. The anatomical outcome was evaluated using magnetic resonance imaging at 6 months postoperatively. Results: At 5 weeks postoperatively, the average pVAS score was lower in the FIR group than in the control group (1.5 ± 0.8 vs. 2.7 ± 1.7; P = 0.019). At 3 months postoperatively, the average forward flexion was higher in the FIR group (151.6° ± 15.3° vs. 132.9° ± 27.8°; P = 0.045), but there was no significant difference at 6 months postoperatively. There was no significant difference in healing failure between the groups (P = 0.999). Conclusions: FIR after arthroscopic rotator cuff repair could be an effective and safe procedure to reduce postoperative pain, thereby facilitating rehabilitation and better ROM in the early postoperative period.

• Clinics in Shoulder and Elbow
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• 제2권2호
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• pp.110-114
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• 1999

We reviewed the results of arthroscopic surgery in patients with rotator cuff disease. Arthroscopic subacromial decompression(ASD) was performed on 22 patients with rotator cuff disease who had not responded to nonoperative measures. In the patients who had a complete tear of the rotator cuff(four of ten Neer's stage III patients), mini-open repair also was performed. Results were determined by questioning patients about their satisfaction with the outcome of surgery and by functional assessment of the shoulder with the parameters of pain, function, and range of motion according to the UCLA shoulder rating scale. The average follow-up was 21 months. The results were sixteen(72%) excellent, three(14%) good, two(9%) fair, and one(5%) poor. The following variables were analyzed to assess their influence on final outcome; duration of preoperative symptoms, Neer's stage(extent of damage to the cuff), type of acromion. Satisfactory results were achieved in thirteen of fourteen patients(93%) who had duration of preoperative symptoms below one year, and in four of six(67%) above 2 years. And satisfactory results were achieved in eleven of twelve patients(92%) who had Neer's stage II and in eight of ten(80%) stage III and achieved in six of seven patients(86%) who had Bigliani's acromion type I, in nine of eleven(82%) type II, and in four of four(100%) type III. There are multiple factors that may influence the recovery after ASD or the eventual outcome. However, although there is still a controversy about the pathogenesis of rotator cuff disease, We found that arthroscopic subacromial decompression and mini-open repair in patients with rotator cuff disease were well enough documented to be considered a standard treatment.

• Clinics in Shoulder and Elbow
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• 제6권2호
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• pp.161-166
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• 2003

Purpose: To evaluate the usefulness of arthroscopic repair that was related with full thickness rotator cuff tear and assess clinical result. Materials and Methods: Twenty-one cases of arthroscopically repaired full thickness tear of rotator cuffs were studied. Between October 1998 to July 2002 we have analysed 21 repairs of FTRCT the average age 54(42∼74) years old, mean follow-up was 24(12∼41) months We analyzed the results statistically by paired t-test. Results: Postoperative VAS of pain improved average 7.2 to 1.9, UCLA score improved 13.9 to 31.9, ADL improved 11.5 to 25.5 respectively(all, p<0.001). Eighty-seventh ％ of the patients showed excellent St good results at the final follow-up. The satisfied rate was 90.5%(19cases). Conclusions: Arthroscopic repair in full thickness rotator cuff tear is effective surgical methods.

• Clinics in Shoulder and Elbow
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• 제6권1호
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• pp.72-79
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• 2003

Purpose: To compare the results of arthroscopic rotator cuff repair and subacromial decompression in partial thickness rotator cuff tear (PTRCT) with those in full thickness rotator cuff tear (FTRCT). Subjects and method: Of the 46 patients who were rested of the rotator cuff tear based on the operational findings, 42 patients who were able to receive a serial follow-up for 2 years were selected as the study subjects. The average age of the patients at the time of the operation was 55 years, and the mean duration of the follow-up was 34 months. The subjects included 22 cases of PTRCT and 20 cases of FTRCT. In terms of rotator cuff repair, the average number of tendon to tendon repair (TTR) was 1 in both PTRCT and FTRCT, and that of tendon to bone repair (TBR) was 1 and 3 in PTRCT and FTRCT, respectively. The average number of use of suture anchor was 1 and 2 in PTRCT and FTRCT, respectively. The level of shoulder pain and function of the subjects were measured using shoulder functional evaluation score of American shoulder and elbow society (ASES score) at before and 2 years following the operation. Results: At the final follow-up following the operation, PTRCT group showed changes in scores from 7.2 to 0.9 on average pain score and 34 to 91 on ASES score, whereas FTRCT group showed changes in scores from 7.6 to 1.2 on pain score and 29 to 88 on ASES score. There were no significant differences between the two groups (P > 0.05). The average range of motion of shoulder significantly increased in both groups at the final follow-up in comparison with the pre-operative time point. The evaluation at the final follow-up showed that 93% of the total subjects showed good or excellent results, and 95％ showed satisfactory results from the procedure with regard to pain reduction and functional outcomes. Two cases of the 3 fair results were caused by acromioclavicular arthritis. Conclusion: It may be anticipated that arthroscopic rotator cuff repair and subacromial decompression may bring satisfactory post-operative outcomes in both PTRCT and FTRCT on pain relief and functional recovery. However, careful preoperative examination of the acromioclavicular joint is critical to avoid failures of these procedures.