• Clinics in Shoulder and Elbow
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• v.18 no.3
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• pp.133-137
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• 2015

Background: The aim of this study was to investigate the demographic and clinical characteristics of patients with primary frozen shoulder in a Korean population. Methods: A total of 1,373 patients whose shoulders were diagnosed with primary frozen shoulder across 11 resident-training hospitals were reviewed retrospectively. Various demographic characteristics and clinical characteristics according to gender and presence of diabetes were evaluated. Results: The average age of patients was 55.4 years. Gender proportion was 58.3% females and 41.7% males. The frozen shoulder involved the non-dominant arm in 60.7% of patients and the bilateral arms in 17.6% of patients. The average duration of symptoms was 8.9 months, and 51.3% of patients had experienced nocturnal pain. Comorbidities associated with frozen shoulder in our sample of patients included diabetes (18.7%), cardiovascular diseases (17.7%), thyroid diseases (5.4%), and cerebrovascular diseases (3.6%). The diabetic group was correlated with the following demographic and clinical characteristics: old age, involvement of the dominant arm, nocturnal pain, long duration of symptoms, and no history of trauma. Further, we found that, in males, having a frozen shoulder was significantly correlated with a history of trauma; in females, having a frozen shoulder was significantly correlated with having thyroid diseases. Conclusions: These demographic data of primary frozen shoulder in the Korean population were consistent with those of previously reported epidemiologic studies. Primary frozen shoulder with diabetes was correlated with old age, bilateral involvement, long duration of symptoms, and nocturnal pain.

• Clinics in Shoulder and Elbow
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• v.18 no.3
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• pp.120-127
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• 2015

Background: We prospectively compared the response to blind and ultrasound-guided glenohumeral injection of corticosteroids for treatment of shoulder stiffness. Methods: A total of 77 patients with shoulder stiffness between April 2008 and March 2012 were recruited. Patients were randomized to receive either a blind (group 1, n=39) or ultrasound-guided (group 2, n=38) glenohumeral injection of 40 mg triamcinolone. The clinical outcomes and shoulder range of motion (ROM) before injection, at 3, 6, and 12 months after injection and at the last follow-up were assessed. The same rehabilitation program was applied in both groups during the follow-up period. Results: There was no significant difference in demographic data on age, sex, ROM, and symptom duration before injection between groups (p>0.05). There were no significant differences in ROM including forward flexion, external rotation at the side, external rotation at $90^{\circ}$ abduction, and internal rotation, visual analogue scale for pain and functional outcomes including American Shoulder and Elbow Surgeons score, Simple Shoulder test between the two groups at any time point (p>0.05). Conclusions: Based on the current data, the result of ultrasound-guided glenohumeral injection was not superior to that of blind injection in the treatment of shoulder stiffness. We suggest that ultrasound-guided glenohumeral injection could be performed according to the patient's compliance and the surgeon's preference. Once familiar with the non-imaging-guided glenohumeral injection, it is an efficient and reliable method for the experienced surgeon. Ultrasound could be performed according to the surgeon's preference.

• Clinics in Shoulder and Elbow
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• v.15 no.1
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• pp.32-36
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• 2012

Purpose: The purpose of this study was to evaluate the radiologic and clinical outcomes after intercalary tricortical iliac bone graft with plate fixation for the nonunion of midshaft clavicular fractures. Material and Methods: Between September 2007 and May 2011, 10 patients who were treated by the intercalary tricortical iliac bone graft, with plate fixation for clavicle nonunion, were studied. The mean follow-up period was 30.7 (12~57) months. After the sclerotic bone was excised to the bleeding cortical bone, we interposed the tricortical iliac bone to provide structural support and restore clavicle length, and then fixed the plate and screws. The radiologic outcomes on the serial plain radiographs and clinical outcomes, according to UCLA, ASES and Quick DASH scores, were analyzed. Results: Bony union was obtained in all cases (100%) and the average union time was 18.4 (14~24) weeks. The average respective UCLA and ASES scores improved from 16.7 and 52.1 preoperatively to 27.4 and 83.6 postoperatively (p<0.05). The average Quick DASH score was 40.5, at the final follow-up. Complications were 2 shoulder stiffness, and one case had removal of device and arthroscopic surgery at 11 months, postoperatively. There were no implant failure or infection. Conclusion: Intercalary tricortical iliac bone graft, with plate fixation for the nonunion of midshaft clavicular fractures, is a good option that can provide structural support and restore clavicle length, as well as high union rate.

• 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.

• Clinics in Shoulder and Elbow
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• v.11 no.1
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• pp.57-61
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• 2008

Tuberculous arthritis on the sternoclavicular joint is an uncommon disease and a delayed diagnosis can be due to the obscure clinical symptoms. We should suspect tuberculous arthritis in patients with slowly progressive pain, swelling, mild fever and a previous history of tuberculosis. Early diagnosis is important through conducting a thorough physical examination and performing laboratory tests and radiologic study. Tuberculous arthritis on the sternoclavicular joint should be treated with a combination of systemic antituberculous agents and thorough surgical debridement in marked damaged joints. When performing this operation, it is important not only to minimized the injury of the costoclavicular ligament, but also to avoid injury to the surrounding the vital structures such as the mediastinum and pleura after aggressive resection or radical debridement. We describe here 2 cases of the tuberculous arthritis on the sternoclavicular joint: one case had a good result after surgical debridement with using an anti-tuberculous agent, and the other had fatal complications such as mediastinal abscess and pleural effusion after the operation.

• Clinics in Shoulder and Elbow
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• v.11 no.1
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• pp.24-28
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• 2008

Purpose: We wanted to determine if preoperative three dimensional (3D) ultrasonographic evaluation for rotator cuff tear is useful to measure the real size of a torn rotator cuff for performing an operation Materials and Methods: This study included 15 cases (7 males and 8 female), and these patients were confirmed to have a full thickness tear of the rotator cuff by 3D ultrasonography and the operative findings, as well as on the magnetic resonance imaging (MRI). The average age of the patients was 55.4yrs. Results: The average difference between the 3D ultrasonographic and operative measurements of the full thickness tear of the rotator cuff was 0.7 mm in the transverse length and 2.0 mm in the longitudinal length. Conclusion: The low error between the 3D ultrasonographic and intraoperative measurements of rotator cuff tear shows the usefulness of preoperative 3D ultrasonographic evaluation for rotator cuff tear.

• Clinics in Shoulder and Elbow
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• v.11 no.1
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• pp.29-36
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• 2008

Purpose: We wanted to evaluate the relationship between the clinical outcomes and cuff integrity after open rotator cuff repair and we wanted to analyze the causes of rotator cuff retear. Materials and Methods: 78 patients who underwent open rotator cuff repair were enrolled from 2004 to 2006. All the patients were observed for a minimum follow-up of 12 months and they were evaluated by magnetic resonance imaging (MRI). The clinical outcomes were accessed by dividing the patients into the retear group and the intact group. The groups were also compared to analyze the cause of rotator cuff retear according to the preoperative tear size, the symptom duration, and so on. Results: The clinical outcome of the retear group (n=22) was improved significantly after operation (p<0.001, p<0.001), but the muscle power was not improved significantly (p=0.099, p=0.243). More retears were found in the patients who had a larger preoperative tear (p<0.001) and the symptom duration of the retear group was longer (p=0.027). Conclusion: Although there were retear after rotator cuff repair, the clinical outcomes were improved. Yet the muscle power of the supraspinatus and external rotator were not improved significantly. There were more retears for the cases that had a larger preoperative tear size and a longer duration of symptoms.

• Clinics in Shoulder and Elbow
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• v.11 no.1
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• pp.41-45
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• 2008

Purpose: To review the clinical and radiological results after an open reduction and internal fixation with a T-shaped LCP for unstable distal clavicle fractures. Materials and Methods: From February 2005 to June 2006, ten patients with distal clavicle Neer type II fractures were treated with an open reduction and internal fixation with a T-shaped LCP. Bony union was identified by plain radiography. The clinical results were analyzed according to the UCLA scoring system. Results: The mean time to fracture union was 9weeks and union was achieved in all cases. The mean UCLA score was 33.4 (30-35); excellent in 8 cases and good in 2 cases. In one case, loosening of one distal screw was occured and mild AC joint subluxation was observed in another case. Conclusion: 3.5 mm T-shaped LCP fixation is a useful technique for treating unstable distal clavicle fractures. This procedure provide stable fixation with no further AC joint injury.

• Clinics in Shoulder and Elbow
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• v.11 no.1
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• pp.46-52
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• 2008

Purpose: This study examined the outcomes of reconstruction of the coracoclavicular ligaments with using two suture anchors and performing coracoacromial ligament transfer in patients with acromioclavicular dislocation. Material and methods: Forty patients with complete acromioclavicular dislocation were included in this study. According to the preoperative radiographs, 5 patients with AC dislocations were diagnosed as type III, 4 patients as type IV and 31 patients as type V. Two 3.5mm suture anchors with four strands of nonabsorbable sutures were separately placed on the anterolateral and posteromedial portion of the base of the coracoid process to stabilize the distal clavicle. The coracoacromial ligament was then transferred to the undersurface of the distal end of the clavicle for augmentation. Results: At a mean follow-up of 28 months, the average Constant score improved to 97 points. All the patients returned to normal life at an average of 3.2 months postoperatively. At the last follow-up, 37 patients achieved anatomical reduction and three patients showed complete redislocation. However, the clinical results of the patients with redislocation were satisfactory. Conclusion: Anatomical coracoclavicular reconstruction using two suture anchors and coracoacromial ligament transfer for treating complete acromioclavicular dislocation is a safe, effective procedure for restoring a physiologically stable acromioclavicular joint.

• Clinics in Shoulder and Elbow
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• v.21 no.3
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• pp.151-157
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• 2018

Background: Nonunion of lateral humeral condyle fracture causes cubitus valgus deformity. Although corrective osteotomy or osteosynthesis can be considered, there are controversies regarding its treatment. To evaluate elbow joint biomechanics in non-united lateral humeral condyle fractures, we analyzed the motion of elbow joint and pseudo-joint via in vivo three-dimensional (3D) kinematics, using 3D images obtained by computed tomography (CT) scan. Methods: Eight non-united lateral humeral condyle fractures with cubitus valgus and 8 normal elbows were evaluated in this study. CT scan was performed at 3 different elbow positions (full flexion, $90^{\circ}$ flexion and full extension). With bone surface model, 3D elbow motion was reconstructed. We calculated the axis of rotation in both the normal and non-united joints, as well as the rotational movement of the ulno-humeral joint and pseudo-joint of non-united lateral condyle in 3D space from full extension to full flexion. Results: Ulno-humeral joint moved to the varus on the coronal plane during flexion, $25.45^{\circ}$ in the non-united cubitus valgus group and $-2.03^{\circ}$ in normal group, with statistically significant difference. Moreover, it moved to rotate externally on the axial plane $-26.75^{\circ}$ in the non-united cubitus valgus group and $-3.09^{\circ}$ in the normal group, with statistical significance. Movement of the pseudo-joint of fragment of lateral condyle showed irregular pattern. Conclusions: The non-united cubitus valgus group moved to the varus with external rotation during elbow flexion. The pseudo-joint showed a diverse and irregular motion. In vivo 3D motion analysis for the non-united cubitus valgus could be helpful to evaluate its kinematics.