• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.126-136
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• 2009

Purpose: We evaluated the correlation of the anatomic parameters of the acromion those represent on the magnetic resonance image (MRI) of impingement syndrome. Materials and Methods: From June, 2004 to December, 2005, 71 cases were surgically proven to be impingement syndrome, and the anterior acromial hooking angle, the lateral acromial hooking angle (AAHA and LAHA) and the acromial hooking index (AHI: the sum of the AAHA and LAHA) were compared to 16 control cases. At the same period, 55 cases were surgically proven to be partial or full thickness rotator cuff tear, and age, gender and twelve anatomic parameters, including the acromial type, the acromial angle, the anterior covering, the acromial slope, the AAHA, the lateral acromial angle, the acromial torsional angle, the lateral acromial angulation, the LAHA, the lateral covering, the acromiohumeral distance and the AHI were assessed. Results: The AAHA and AHI were increased as impingement syndrome proceeded. The acromial type and acromial angle, and the AAHA, LAHA and AHI showed significant differences between the controls and the rotator cuff tear patients on univariant analysis. On multivariant analysis, gender was most strongly correlated with rotator cuff tear. Age, AAHA and the acromial angle showed similar correlation, respectively. Conclusion: The coronal acromial shape is correlated with rotator cuff tear, and it is important to correct the lateral acromial shape when performing acromioplasty.

• Clinics in Shoulder and Elbow
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• v.12 no.1
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• pp.7-13
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• 2009

Purpose: To evaluate the clinical and radiological results of arthroscopic tuberoplasty for irreparable massive rotator cuff tears. Materials and Methods: Eleven patients underwent arthroscopic tuberoplasty for irreparable massive rotator cuff tears between December 2004 and April 2007. The mean follow-up period was 17.3 months, and the average age at the time of surgery was 61.7-year-old. Five cases underwent arthroscopic tuberoplasty and 6 cases had arthroscopic subacromial decompression and tuberoplasty, simultaneously. Results: The average Constant score improved from 61.8 to 86.9 and the average UCLA score changed from 14.8 to 31.8 with 6 excellent, 3 good and 2 poor results (p=0.003). The active forward flexion improved from $111.8^{\circ}$ to $154.1^{\circ}$(p=0.011). The acromiohumeral interval increased from 3.94 mm preoperatively to 4.22 mm postoperatively (p=0.12). In the poor UCLA score group, the acromiohumeral interval changed from 1.67 mm preoperatively to 0.94 mm postoperatively. Conclusion: Arthroscopic tuberoplasty may be a second option to relieve the pain of irreparable massive rotator cuff tears and improve the range of motion. However, good results could not be expected if the acromiohumeral interval is < 2 mm preoperatively and decreased postoperatively.

• Clinics in Shoulder and Elbow
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• v.12 no.1
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• pp.1-6
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• 2009

Purpose: To evaluate and report the clinical and radiological outcomes of open reduction and internal fixation with a mini-T plate for unstable distal clavicle fractures. Materials and Methods: From December 2004 to July 2007, fifteen patients who had a fracture of the distal clavicle (Neer type II fracture) were treated with an open reduction and internal fixation using a mini-T plate. They were followed up for a minimum of one year and the clinical and radiological results were analyzed. Results: The average time to fracture union was 3.1(3~4) months. There were no complications, such as deep infection or fixation loss. The mean ASES score was 97 points (85~100points) at the last follow up period, and 14 patients had a full range of motion of the shoulder. Conclusion: Open reduction and internal fixation with a mini-T plate for unstable distal clavicle fracture is a good surgical method with good clinical and radiological results.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.109-114
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• 2009

Purpose: This study evaluated the preoperative and postoperative radiologic findings of patients with complete repairs after massive rotator cuff tears along with the incidence of re-tear and the clinical outcomes. Materials and methods: This study evaluated 33 cases who had open complete repairs for massive rotator cuff tears and these patients were followed up for more than 24 months. The clinical evaluation was performed according to the shoulder joint function test of the American Shoulder and Elbow Surgeons (ASES), and the degree of arthritis related to the massive rotator cuff tears was evaluated using the Hamada classification. Results: The ASES scores improved from 37.6 preoperatively to 85.6 postoperatively. The mean preoperative acromio-humeral interval (AHI) score was 6.5 mm, which increased to 9.3 mm immediately after surgery, and there was a decreased to 6.5 mm noted at the last follow up. The lower radiology stages of arthritis according to the classification showed better preoperative and postoperative results. Conclusion: An open complete repair as the surgical treatment for a massive rotator cuff tear showed satisfactory results for pain relief and an improvement in the shoulder joint function though re-tear after surgery.

• Clinics in Shoulder and Elbow
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• v.17 no.2
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• pp.50-56
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• 2014

Background: To assess the clinical outcomes of short-term oral corticosteroid therapy for impingement syndrome of the shoulder and determine whether it can be substituted as an alternative to the intra-articular injection. Methods: The clinical outcomes of the 173 patients, the oral steroid group (n=88) and the injection group (n=85), were measured at 3 weeks, 2, 4, and 6 months postoperatively. The clinical outcomes were assessed by measuring the the University of California at Los Angeles (UCLA) score, visual analog scale (VAS) and range of motion (ROM) at every follow-up. Any complications and recurrence rate were noted. A relationship between the treatment outcomes and factors such as demographic factors, clinical symptoms and radiographic findings were determined. Results: No difference was observed in VAS and UCLA scores between the two groups, but forward flexion and internal rotation of ROM were significantly improved in the injection group at the 2nd and 4th postoperative month (p < 0.05). At 6th postoperative month, recurrence rate of symptoms was 26% in the oral steroid group and 22% in the injection group. No major adverse effects were observed. When the clinical outcomes of the oral steroid group were compared to either demographic, clinical symptoms, or radiographic findings, UCLA score was found to be significantly low (p < 0.05) in patients with joint stiffness and UCLA score, whereas VAS score was significantly improved in patients with night pain (p < 0.05). Conclusions: Short-term low-dose oral corticosteroid therapy of impingement syndrome showed comparable clinical outcomes to intra-articular injection without any remarkable adverse effects. Low-dose oral steroids can be regarded as a partial alternative to intra-articular injection for the initial therapy of impingement syndrome of the shoulder.

• Clinics in Shoulder and Elbow
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• v.17 no.2
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• pp.64-67
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• 2014

Background: The purpose of this study was to determine whether in patients with rotator cuff tears a correlation exists between molecular changes and clinical parameters such as age, duration of symptom, range of motion, and tear size. Molecular changes of matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) were assessed by measuring messenger RNA (mRNA) levels of the two proteins. Methods: The rotator cuff tissue from was obtained from the edge of a torn tendon revealed after debridement by a motorized shaver. Using the sample of rotator cuff tissue, the reverse transcription polymerase chain reaction was performed to quantify MMP-2 and TIMP-2 mRNA expression. To determine whether mRNA levels and the clinical variables, such as age, defect size, range of motion (ROM) of shoulder, and duration of symptoms, show any correlation, Spearman's correlation coefficients were used to test for significant differences. Results: There was an inverse correlation between the mRNA levels of MMP-2 and TIMP-2 from the torn rotator cuff tendons regardless of the clinical variables. However, comparison of mRNA levels versus clinical parameters such as age, defect size, range of motion and duration of symptoms revealed a number of findings. We found a significant correlation between age and mRNA levels of MMP-2 from torn cuffs (r = 0.513, p = 0.021). Further, we found a significant correlation between defect size in the full thickness tears and mRNA levels of MMP-2 (r = 0.454, p = 0.045). Conversely, no significant association between mRNA levels of MMP-2 and ROM or duration of symptom was found. Conclusions: Our results suggest that both MMP-2 and TIMP-2 may be involved in the disease process of rotator cuff tears. Although the level of mRNA expression of MMP-2 and TMP-2 remain constant in torn rotator cuffs irrespective of the clinical variables, their levels may be influenced by age and defect size, which could account to change in tendon degradation and the healing process.

• Clinics in Shoulder and Elbow
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• v.17 no.2
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• pp.68-76
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• 2014

Background: Recently, reverse total shoulder arthroplasty (RTSA) has been accepted as a main treatment option in irreparable massive rotator cuff tear with cuff arthropathy. The purpose of this study was to evaluate the early complication incidence and the preliminary clinical results of RTSAs performed in single institute. Methods: Fifty-seven RTSAs (56 patients) were performed between April 2011 and March 2013. The indications for RTSA were cuff tear arthropathy and irreparable massive rotator cuff tear with or without pseudoparalysis. Exclusion criteria were revision, preoperative infections and fractures. At final follow-up, 45 shoulders were enrolled. Mean follow-up duration was 12.5 months (range, 6-27 months). The mean age at the time of surgery was 73.6 years (range, 58-87 years). All the patients were functionally accessed via Constant score, American Shoulder and Elbow Surgeons (ASES) score, pain and functional visual analogue scale (VAS) scores and active range of motion. Complications were documented as major and minor. Major complications include fractures, infections, dislocations, nerve palsies, aseptic loosening of humeral or glenoid components, or glenoid screw problems. Minor complications include radiographic scapular notching, hematomas, heterotopic ossification, algodystrophy, intraoperative dislocations, intraoperative cement extravasation, or radiographic lucent lines of the glenoid. Results: The mean Constant score increased from 31.4 to 53.8 (p < 0.001). The pain and functional VAS scores improved (5.2 to 2.7, p < 0.001, 4.0 to 6.7, p < 0.001) and active forward flexion improved from $96.9^{\circ}$ to $125.6^{\circ}$ (p = 0.011). One or more complications occurred in 16 (35.6%) of 45 shoulders, with one failure (2.2%) resulting in the removal of implants by late infection. The single most common complication was scapular notching (9 [20%]). There were 4 (8.9%) axillary nerve palsies postoperatively (n=3: transient n. palsy, n=1: Symptom existed at 11 months postoperatively but improving). Conclusions: In a sort term follow-up, RTSA provided substantial gain in overall function. Most common early complications were scapular notching and postoperative neuropathy. Although overall early complication rate was as high as reported by several authors, most of the complications can be observable without compromise to patients' clinical outcome. Long term follow-up is required to clarify the clinical result and overall complication rate.

• Clinics in Shoulder and Elbow
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• v.10 no.2
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• pp.199-203
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• 2007

Purpose: It is very important to evaluate and fix coronoid process fractures because they are a critical element for a stable, effective elbow function. The lateral view of the elbow joint is used for a radiographic evaluation of the coronoid but an understanding of the fracture pattern is often difficult because of overlap of the radial head and obliquity of the fracture line. We developed the coronoid view, which is a new radiograph for an evaluation of the coronoid process fracture, and discuss its advantages for a postoperative follow-up. Materials and Methods: The coronoid view was designed for an evaluation of the anteromedial fragment of the coronoid process. After the patient sat on his side, the shoulder was abducted $45^{\circ}$ and the elbow was flexed $90^{\circ}$. The X-ray beam was shot perpendicular to the table. Since shoulder was abducted $45^{\circ}$ the fracture line of the coronoid process can be parallel to the X-ray beam, and the radial head can be cleared. Conclusion: The coronoid view can be a good alternative radiograph for an evaluation of a coronoid process fracture because the beam is parallel to the fracture line. The coronoid view can be particularly useful in postoperative patient follow-up where computed tomography is impractical due to metal implants and cost.

• Clinics in Shoulder and Elbow
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• v.10 no.2
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• pp.204-211
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• 2007

Purpose: To evaluate the result and complication of treatment using Locking Compression Plate (LCP) for fracture of proximal humerus. Materials and Methods: Between 2004 and 2006, 21 patients with two-part and three-part fractures of the proximal humerus were treated by LCP fixation. Their average age was 54.9 years. Postoperative mean follow-up period was 22.9 months. The reduction was qualified and complication were assessed with final radiographs. The functional outcome was evaluated by Neer's rating system. Results: By Neer's functional evaluation, mean score of shoulder function was 86.3 and 18 case (86%) had excellent or satisfactory results. There was one case of nonunion but no infection or avascular necrosis of the humeral head. No correlation was found between the final result and the type of fracture, age, gender or quality of reduction. Conclusion: We obtained satisfactory result of LCP fixation for fracture of proximal humerus in this study. LCP fixation for proximal humerus fracture is a reliable method to obtain satisfactory reduction, rigid fixation and early exercise.

• Clinics in Shoulder and Elbow
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• v.10 no.2
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• pp.212-219
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• 2007

Purpose: To determine the causes of the surgical treatment results in glenoid fracture by a retrospective analysis. Materials and methods: From March 1999 to February 2004, 9 patients who underwent an open reduction due to a glenoid fracture were reviewed. The modified Ideberg classification was used. There were 1, 3, 2, 1 and 2 cases of modified Ideberg type I, II, III, V, and VI, respectively. The internal fixators were a reconstruction plate, a small plate, a one-third tubular plate, a small screw, and a cannulated screw in 6, 1, 3, 3 and 1 case, respectively. The constant score and Adam's functional assessment method were used to evaluate the postoperative shoulder function. Results: The average time for fracture union was 7 weeks. The functional assessment was excellent in 4 cases, good in 3 cases, and fair in 2 cases. There were two complications related to surgery; articular screw encroachment, and inferior glenoid bone resorption without instability. Conclusion: A glenoid fracture with glenohumeral instability or displaced that was treated by open surgery showed good clinical results. Moreover, the more comminuted fracture had a lower functional score.