• Clinics in Shoulder and Elbow
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• 제7권2호
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• pp.76-82
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• 2004

Purpose: In the traumatic anterior shoulder instability, the laxity of joint capsule and ligament is frequently demonstrated. Although a arthroscopic procedure to address anterior instability with joint capsular redundancy have generally provided good results, its recurrence rate is higher than open procedure. By reducing the capsular redundancy, thermal shrinkage is likely to improve the outcome of arthroscopic anterior stabilization. The objective of this study was to evaluate additional thermal capsular shrinkage as a treatment of joint capsular redundancy in anterior shoulder instability. Materials and Methods: From March 1999 to June 2000, 25 shoulders of 23 patients of recurrent anterior shoulder dislocation underwent arthroscopic Bankart repair with shrinkage procedure. The mean follow up was 29 months and average age at the time of operation was 26 years. Of these patients, 20 were male and 3 were female who had been experienced the average 8 times of dislocation before operation. Thermal shrinkage alone without Bankart repair was performed in two cases who did not have Bankart lesion. The clinical result was evaluated in according to Modified Rowe Score. Results: The Modified Rowe Score was improved from preoperative 35 points to postoperative 88 points. None of cases showed recurrence of dislocation. But, in two cases, temporary sensory hypesthesia of the axillary nerve was developed and in two cases of postoperative stiffness, arthroscopic capsular release and brisement were performed. Conclusion: Additional capsular shrinkage in arthroscopic technique to address recurrent anterior shoulder instability could treat effectively the capsular redundancy.

• 한국정밀공학회지
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• 제22권11호
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• pp.38-44
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• 2005

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 1997년도 학술대회
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• pp.164-166
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• 1997

MR arthrography is a useful modality for evaluating the labrocapsular ligamentous complex(LOLC) of the shoulder. This study was performed to describe normal anatomic variations and pitfalis in image interpretation related to evaluation of the LOLC. MR Arthrogram of 56 shoulders in 41 asymptomatic young, active volunteers were prospectively reviewed to evaluate the labral shapes. capsular insertions and images which may mimic the lesions of glenohumoral instability. The anterior and posterior parts of the labra. respectively. varied in shape: triangular$(72\%,\; 36\%)$. round $(13\%,\; 35\%)$. cleaved$(8\%,\; 1\%)$. notched$(2\%,\; 0\%)$. flat$(5\%,\; 24\%)$ and absent$(0\%,\; 4\%)$. The anterior and posterior capsular insertions. respectively. varied in sites: Mosely and Oevergaard type I$(82\%,\;62\%)$, type II$(13\%,\; 3\%)$ and type III $(5\%,\; 2\%)$. A number of pitfalls in image interpretation were discovered. Articular cartilage undercutting the labrum$(29\%)$ and middle glenohumoral ligament in proximity to anterior labrum $(5\%)$ simulated a labral tear. Joint fluid interposed in the central. superior portion of the sublabral sulci$(25\%)$ simulated a SLAP lesion. Synovial fold$(38\%)$ in axillary pouch resembled a loose body. Knowledge of normal variations and pitfalls in MR arthrogram image interpretation of labral capsular - ligamentous complex will help the orthopedist to accurately detect debilitating derangements associated with the glenohumeral instability.

• Clinics in Shoulder and Elbow
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• 제4권2호
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• pp.181-185
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• 2001

Purpose: We reviewed the bilateral anterior shoulder instability to evaluate the final outcomes and influencing factors that had effect on the final outcomes. Materials and Methods: Sixteen patients of the bilateral shoulder instability underwent the operative treatment and 15 patients could be followed up average 29 months. There were Bankart lesions in 28 cases and 46% retracted markedly onto the medial side of the glenoid neck. Capsular redundancy could be seen in 50%, but the generalized ligamentous laxity in only two patients. We performed open Bankart repair in 21 cases and arthroscopic repair in 9 cases. Inferior capsular shift was performed in 12 cases of 15 cases in patients who was shown the capular redundancy. Results: The average increment of the forward flexion was 4° postoperatively but the average decrement of the external rotation was 6° postoperatively. After the inferior capsular shift surgery, there were significantly the decrement in external rotation by 13° even though the forward flexion was at the same level comparing with preoperative motion. There were 13 cases(43%) in excellent result, 14 cases(47%) in good and 3 case(l0%) in poor. Rowe score improved from 53 to 87.3 postoperatively. Conclusion : Re-establishing a proper capsular tensioning in a bilateral anterior shoulder instability is critical to ultimate success because there was a redundant laxity in a half and majority of them had marked retraction of an anteroinferior glenohumeral ligament complex. Especially, it should be considered that an unexpected limitation of external rotation could be occurred in the inferior capsular shift surgery.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2005년도 제3차 연수강좌
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• pp.78-93
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• 2005

The posterior and multidirectional instability of the shoulder is a complex problem in terms of diagnosis and treatment. Increased joint volume by redundant capsular ligament has been regarded as a major pathogenesis of the posterior and multidirectional instability. Distinct from multidirectional hyperlaxity, multidirectional instability has symptoms related with increased translations in more than one direction. Recent report that shoulder symptom originates from labral lesion which was created by excessive rim-loading of the humeral head on the posteroinferior glenoid labrum during repetitive subluxation helps us to understand the pathogenesis of such instability. Painful jerk and Kim tests indicate labral lesion in the multidirectionally loose shoulder, suggesting multidirectional instability. Also, painful jerk test is a prognostic sign of failure of nonoperative treatment. The labral lesion can be an incomplete tear or a concealed lesion which often has been underestimated. Operative treatment is indicated when nonoperative treatment has failed. Arthroscopic capsulolabroplasty is a reliable procedure, which not only provides capsular balance, but also restores the labral height.

• Clinics in Shoulder and Elbow
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• 제12권1호
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• pp.27-32
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• 2009

목적: 견관절 전방 불안정성에서 관절경 술식을 이용한 전하방 관절낭 상방전위 및 중첩술과 부가적인 하방 관절낭 중첩술과의 추시 결과를 비교하고자 한다. 재료 및 방법: 2005년 3월부터 2007년 8월까지 견관절의 전방 불안정성을 보인 환자중에서 전하방 관절낭 중첩술을 시행하고 하방 관절낭 중첩술을 추가로 시행하지 않은 42예(1군)와 부가적인 하방 관절낭 중첩술을 시행한 33예(2군)를 대상으로 하였다. 평균 나이는 1군이 22.5(17~31)세, 2군이 21.8(16~30)세였으며, 평균 추시 기간은 1군이 23.5(12~45)개월, 2군이 20.1 (12-49)개월이었다. 술 전과 술 후 6개월, 1년, 최종 추시에서 운동 범위와 Rowe점수를 측정하였고 합병증의 빈도를 비교하였다. 결과: Rowe score는 1군에서는 술 전 평균 20.6 에서 술 후 최종 추시에서 86.8 로, 2군에서는 술 전 평균 20.5 에서 술 후 최종 추시에서 94.1 로 개선되었다. 견관절 전방 불안정성에서 관절경 하 재건술은 모든 군에서 좋은 결과를 보였지만 1군에서보다 2군에서 더 좋은 결과를 보였고(p<0.05), 합병증의 비교에서 2군이 합병증이 더 적었다(p<0.05). 결론: 전하방 관절낭 중첩술과 부가적으로 시행된 하방 관절낭 중첩술은 재발성 견관절 전방 탈구의 합병증의 빈도를 낮추고 결과를 호전시킬 수 있는 술식으로 생각된다.

• Clinics in Shoulder and Elbow
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• 제11권1호
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• pp.19-23
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• 2008

목적: 비수술적 치료에 반응하지 않는 일차성 유착성 관절낭염 환자에서 견봉하 점액낭의 병변을 발견하고 임상적 의의를 파악하고자 하였다. 대상 및 방법: 유착성 관절낭염 환자 21예를 대상으로 하였으며 견봉하 점액낭 유리술을 시행하고 환자의 견관절 운동 범위의 호전 정도를 측정하였고, VAS 점수 및 UCLA 평가를 시행하였다. 결과: 발견된 병변은 점액낭염, 경도의 오구 견봉 인대의 마찰 소견, 충돌 소견 및 유착의 소견이 관찰되었으며 단순 견봉 상완 관절 유리술에 비하여 기능적, 통증의 호전 효과를 조기에 얻을 수 있음을 관찰할 수 있었다. 결론: 일차성 유착성 관절낭염 환자에서 견봉하 관절경을 시행하는 것은 숨겨진 이차성 동결견의 가능성과 이차변화를 평가하여 치료와 예후 판정에 도움이 될 것으로 보인다.

• 대한관절경학회지
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• 제10권1호
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• pp.118-122
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• 2006

목적: 슬개대퇴관절 불안정성에 대한 치료 방법 중 하나인 관절경적 all inside 관절막 중첩술 및 외측 지대 유리술을 소개하고자 한다. 방법: 슬관절의 관절경적 기본 검사 후, 관절경을 전내측 도달법을 개설하여 위치한 후, 외측 지대의 근위부에서 원위부까지 유리술을 시행하기 위하여 상외측 도달법을 개설하여 관절경 scissor를 위치한다. 슬개골의 가장자리부터 5 mm에서 1 cm정도에서 외측 지대 유리술을 시행한다. 외측 지대 유리술 후, 관절경을 전외측 도달법을 개설하여 위치한 후, 상외측 도달법을 개설하여 5 mm 배관을 삽입하고, 조작용 상내측 삽입구를 개설한다. 경피적으로 만곡 침을 상내측 삽입구를 통해 통과시킨 후 봉합사를 상외측 삽입구를 통해 회수하는, all inside 수기로 시행된다. 결론: 근위부 재정렬을 위한 여러 가지 관절경적 방법이 제시되었지만, 대부분이 내측 절개를 이용한 관절경 보조수기 방법들이었다. 관절경적 all inside 관절막 중첩술 및 외측 지대 유리술은 기존의 관절경 보조 수기 방법들에 비해 내측 절개를 피함으로써 내측 광사근에 손상을 주지 않는 점에서 장점을 가진다. 이 수기는 최소 침습적이면서 직접 관찰하면서 내측 슬개대퇴 인대의 긴장의 정도를 조절하기가 쉬운 수술 수기로 사료된다.

• Clinics in Shoulder and Elbow
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• 제20권4호
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• pp.195-200
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• 2017

Background: This study investigated and evaluated the clinical outcomes of intra-articular lesions of traumatic anterior shoulder dislocation (TASD) associated with greater tuberosity (GT) fracture of the humerus. Methods: Subjects included 20 patients who were surgically or non-surgically treated for GT fracture of the humeurs with TASD, and followed-up for at least 2 years. The mean follow-up period was 54.1 months (range, 24-105 months). Of the 20 patients, 12 were treated surgically. Intra-articular lesions were identified randomly on magnetic resonance imaging scans (repeated thrice) by experienced radiologists and orthopedic surgeons. The accompanying intra-articular lesions were left untreated. Clinical outcomes were evaluated by Simple Shoulder Test (SST) and Western Ontario Shoulder Instability index (WOSI) at the last follow-up. Results: Intra-articular lesions were identified in 19 patients: 7 Bankart lesions, 15 humeral avulsion of the glenohumeral ligament lesions, 3 glenoid avulsion of the glenohumeral ligament lesion, and 6 inferior capsular tears. Two or more intra-articular lesions were identified in 6 patients. The mean SST score was 10.9 and the mean WOSI score was 449.3 at the last follow-up. Conclusions: For GT fracture of the humerus with TASD, a high frequency of diverse intra-articular lesions was identified. There were no incidence of recurrent shoulder dislocations, and good clinical outcomes were obtained without treatment of the intra-articular lesions. We thereby comprehend that although intra-articular lesions may occur in TASD associated with GT fracture of the humeurs, merely treating the GT fracture of the humerus is sufficient.

• Clinics in Shoulder and Elbow
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• 제5권2호
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• pp.73-80
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• 2002

Purpose: Weight lifting is a good training to control body weight, to correct body shape and to relieve stress. How-ever if the training is continued by inadequate training method and technique, the risks of the shoulder injuries are relatively high. Main Subject: The rotator cuff injury is the most common disorder to wright lifters and often results from the train- ing program of upright row, military press and pectoral deck. The chances of subacromial impingement in these postures are high because the shoulder rotates under the acromion at 90 abduction state. Shoulder instability in weight lifters can develop due to various causes. aepeated microtrauma and excessive abduction and external rotation may result in laxity of the anterior capsular structure, ligament and muscles. Behind the neck and bench press are high risk training postures. Other than those injuries, idiopathic osteolysis of distal clavicle, acromioclavicular separation, pectoralis major muscle rupture, and triceps muscle rupture nay develop. Conclusion: The best treatment option of the shoulder injury to weight lifters is to eliminate the possible risk elements for the weight lifters in training program and to provide proper and prompt treatment as soon as possible.