• The Korean Journal of Pain
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• v.9 no.1
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• pp.105-108
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• 1996

Localized or radiating pain in the arm and shoulder joint may result after faulty alignment causing compression or tension on nerves, blood vessels, or supporting soft tissues. The critical site of faulty alignment is the quadrangular space in the axilla bounded by the teres major, teres minor, long head of triceps, and humerus. The axillary nerve emerges through this space to supply the deltoid and teres minor. The activity of the trigger point on teres minor compressing the axillary nerve causes pain to develop through the area of sensory distribution of cutaneous branch of the axillary nerve. Relieving compression on the axillary nerve and suprascapular nerve is the key point to relieving the pain. Spasm of the supraspinatus and infraspinatus compressing the suprascapular nerve caused pain to develop in the shoulder joint and scapular area. We treated those patients experiencing such pain with local anesthetic infiltration or I-R laser stimulation on the identified trigger points.

• Clinics in Shoulder and Elbow
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• v.25 no.4
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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.

• Clinics in Shoulder and Elbow
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• v.3 no.2
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• pp.61-67
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• 2000

Purpose: Most proximal humeral fractures are minimally displaced and can be treated satisfactorily with a conservative method. But in many comminuted fractures, hemiarthroplasty is usually done as a primary treatment. The authors evaluated how much functional improvement was achieved after hemiarthroplasty and which factors influence on the final functional results. Materials and Methods: Eleven hemiarthroplasties were performed for three- and four-part fractures(including fracture-dislocation) between April 1992 and June 1999. There were eight women and three men, and the mean age was 65 years. According to Neer classification, six was three-part fracture and five was four-part fracture. Six patients were injured on their right shoulder and five on the left shoulder. Among the five four-part fractures, three had axillary nerve injury and among the six three-part fractures, only one patient had axillary nerve injury. The average follow-up period was 2.4 years(1 year-7 years) after operation. The functional results were evaluated with the UCLA scoring system(Modification for hemiarthroplasty). In addition to the overall results, we compared the results according to the classification of the fracture, the cause of injury, and whether the axillary nerve was injured. Results: At the last follow-up, average total UCLA score was 18.2. The mean score for pain was 7.0, mean muscle power and motion score was 5.5 and 5.7 respectively. The pain relief was more satisfactory than any other functional results. The average score for three-part fractures was 22, and the average for four-part fractures was 13.6. The average score for the patients fractured by vehicle accidents was 15.3, and 19.3 for the patients fractured by slip-down injury. In patients without axillary nerve injury, the average score was 20, and with axillary nerve injury, the score was 15. Conclusion: Shoulder hemiarthroplasty, for the treatment of proximal humeral fractures, cannot restore the shoulder function to normal, but can achieve the functional result to some degree, especially for the activity of daily living. And as for pain, we think that it is relatively effective measure. And we think that the severer the comminution, the more the chance of axillary nerve injury, and the poorer the functional results. In conclusion, the severity of initial injury seems to be the major prognostic factor.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2007.03a
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• pp.63-64
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• 2007

• Journal of Korean Neurosurgical Society
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• v.42 no.1
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• pp.16-19
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• 2007

Objective : This report describes the clinical study of the surgical method of lateral third infraclavicular implantation of vagal nerve stimulation (VNS) generator through the axillary wrinkle incision. Methods : In a retrospective study, the data for 20 patients with medically intractable epilepsy treated by this approach were examined. The mean age was 31.4 years (range : 14-50), and the mean follow-up period was 12.15 months (range : 4-21 months). The male to female ratio was 2.3 : 1. The subcutaneous pocket for the generator was located in the lateral third infraclavicular area through the axillary wrinkle. Our method was a modification of the standard VNS generator implantation in the mid-infraclavicular pocket through anterior axillary incision. Results : There were the excellent or good cosmetic satisfaction in 95% of the cases and fair in 5%. The generator was located outside the lung field in 15%, periphery of the lung field in 45%, and crossed over the lung field in 40%. Discomfort from shoulder motion occurred transiently in 35% of cases. Other complications were minimal. Conclusion : These results demonstrate that the lateral third infraclavicular apporach will offers cosmetic benefits and reduction of obscuration of the lung field without serious complications. Thus, this technique provides an attractive alternative among the surgical techniques for the vagal nerve stimulation.

• Clinics in Shoulder and Elbow
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• v.25 no.3
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• pp.240-243
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• 2022

Isolated deltoid paralysis is a rare pathology that can occur after axillary nerve injury due to shoulder trauma or infection. This condition leads to loss of deltoid function that can cause glenohumeral instability and inferior subluxation, resulting in rotator cuff muscle fatigue and pain. To establish dynamic glenohumeral stability, a novel technique was invented. Humeral suspension is achieved using a double button implant with non-resorbable high strength cords between the acromion and humeral head. This novel technique was used in two patients with isolated deltoid paralysis due to axillary nerve injury. The results indicate that the humeral suspension technique is a method that supports centralizing the humeral head and simultaneously dynamically stabilizes the glenohumeral joint. This approach yielded high patient satisfaction and reduced pain. Glenohumeral alignment was improved and remained intact 5 years postoperative. The humeral suspension technique is a promising surgical method for subluxated glenohumeral joint instability due to isolated deltoid paralysis.

• The Journal of Korean Medicine
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• v.26 no.1 s.61
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• pp.11-17
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• 2005

This study was carried out to identify the components of the human heart meridian muscle, the regional muscle group being divided into outer, middle, and inner layers. The inner parts of the body surface were opened widely to demonstrate muscles, nerves, blood vessels and to expose the inner structure of the heart meridian muscle in the order of layers. We obtained the following results; $\cdot$ The heart meridian muscle is composed of muscles, nerves and blood vessels. $\cdot$ In human anatomy, the difference between terms is present (that is, between nerves or blood vessels which control the meridian muscle and those which pass near by). $\cdot$ The inner composition of the heart meridian muscle in the human arm is as follows: 1) Muscle H-l: latissimus dorsi muscle tendon, teres major muscle, coracobrachialis muscle H-2: biceps brachialis muscle, triceps brachialis muscle, brachialis muscle H-3: pronator teres muscle and brachialis muscle H-4: palmar carpal ligament and flexor ulnaris tendon H-5: palmar carpal ligament & flexor retinaculum, tissue between flexor carpi ulnaris tendon and flexor digitorum superficialis tendon, flexor digitorum profundus tendon H-6: palmar carpal ligament & flexor retinaculum, flexor carpi ulnaris tendon H-7: palmar carpal ligament & flexor retinaculum, tissue between flexor carpi ulnaris tendon and flexor digitorum superficial is tendon, flexor digitorum profundus tendon H-8: palmar aponeurosis, 4th lumbrical muscle, dorsal & palmar interrosseous muscle H-9: dorsal fascia, radiad of extensor digiti minimi tendon & extensor digitorum tendon 2) Blood vessel H-1: axillary artery, posterior circumflex humeral artery H-2: basilic vein, brachial artery H-3: basilic vein, inferior ulnar collateral artery, brachial artery H-4: ulnar artery H-5: ulnar artery H-6: ulnar artery H-7: ulnar artery H-8: palmar digital artery H-9: dorsal digital vein, the dorsal branch of palmar digital artery 3) Nerve H-1: medial antebrachial cutaneous nerve, median n., ulnar n., radial n., musculocutaneous n., axillary nerve H-2: median nerve, ulnar n., medial antebrachial cutaneous n., the branch of muscular cutaneous nerve H-3: median nerve, medial antebrachial cutaneous nerve H-4: medial antebrachial cutaneous nerve, ulnar nerve H-5: ulnar nerve H-6: ulnar nerve H-7: ulnar nerve H-8: superficial branch of ulnar nerve H-9: dorsal digital branch of ulnar nerve.

• The Korean Journal of Pain
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• v.25 no.1
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• pp.60-64
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• 2012

The patient was a 45-year-female who presented with pain at right shoulder and right upper arm. The patient suffered from right shoulder and arm pain for 3 years and had pain management which was performed using medication and conservative management after she had been diagnosed with calcific tendinitis. However, substantial pain relief was not consistently achieved, and recurrence of pain was reported. Therefore, we performed right axillary nerve and suprascapular nerve block through pulsed radiofrequency. Two months after the procedure, the shoulder pain gradually subsided with the size reduction of the calcified nodule and she needed no more pain management.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.7 no.1
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• pp.67-75
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• 2014

There are several kinds of regional nerve blockades, such as interscalene brachial plexus block, C5 root block, suprascapular nerve block, and axillary nerve block, which can be applied for anesthesia and postoperative pain control after shoulder surgeries. These regional nerve blockades have shown good results, but high failure rate and serious complications, such as phrenic nerve palsy, pneumothorax, and nerve injury, still remain. Ultrasound-guided intervention can increase the success rate of nerve blockades and reduce complications. We described the method of ultrasound-guided intervention for the regional nerve blockades around shoulder.

• The Korean Journal of Pain
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• v.29 no.1
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• pp.29-33
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• 2016

Background: The purpose of this study was to evaluate the effect of dexamethasone or dexmedetomidine added to ropivacaine on the onset and duration of ultrasound-guided axillary brachial plexus blocks (BPB). Methods: Fifty-one ASA physical status I-II patients with elective forearm and hand surgery under axillary brachial plexus blocks were randomly allocated to receive 20 ml of 0.5% ropivacaine with 2 ml of isotonic saline (C group, n = 17), 20 ml of 0.5% ropivacaine with 2 ml (10 mg) of dexamethasone (D group, n = 17) or 20 ml of 0.5% ropivacaine with 2 ml ($100{\mu}g$) of dexmedetomidine (DM group, n = 17). A nerve stimulation technique with ultrasound was used in all patients. The onset time and duration of sensory blocks were assessed. Results: The duration of the sensory block was extended in group D and group DX compared with group C (P < 0.05), but there was no significant difference between group D and group DX. However, there were no significant differences in onset time in all three groups. Conclusions: Dexamethasone 10 mg and dexmedetomidine $100{\mu}g$ were equally effective in extending the duration of ropivacaine in ultrasound-guided axillary BPB with nerve stimulation. However, neither drug has significantly effects the onset time.