• Clinics in Shoulder and Elbow
• /
• 제18권2호
• /
• pp.113-118
• /
• 2015

Rotator cuff tear is a common reason for shoulder pain. Although the surgical technique of rotator cuff repair is developing, high retear rate requires additional supplementary methods. Among these supplementary methods, as a kind of biologic augmentation, platelet-rich plasma (PRP) has been spotlighted and has recently been studied by many researchers. PRP, a concentrate of platelet extract obtained from whole blood, contains numerous growth factors. As this is known to play an important role in the tissue recovery process, it had been used for research in a variety of fields including orthopedics. Use of PRP has been attempted in surgical treatments of rotator cuff tear for better results; however, only a few large-scale research studies on the effect of PRP have been reported. Clinical results of each study are also variable. Therefore research using large-scale randomized, double-blind trials should be conducted in order to prove the application range, safety, and clinical effects of PRP.

• Clinics in Shoulder and Elbow
• /
• 제20권1호
• /
• pp.42-45
• /
• 2017

One of the most important factors leading to a successful healing of rotator cuff tear is good bone quality to secure the suture anchor in the bone for a stable fixation. However, rotator cuff tear are commonly found in elderly patients, and their proximal humerus often shows osteoporosis or cystic lesions. Especially when the transosseous repair prevails for a torn rotator cuff, a weak metaphyseal cancellous bone is often the case, which associated with difficulty in stable fixation of the lateral row suture anchor. In this situation, we were able to augment the lateral row fixation with polymethylmethacrylate bone cement. Although there is a concern of disturbance in the blood flow and healing potential, our case showed good clinical results with respect to healing. If we suspect a weak fixation of the lateral row suture anchor, bone cement seems to be a good option for augmentation.

• Clinics in Shoulder and Elbow
• /
• 제23권2호
• /
• pp.105-108
• /
• 2020

Stress fractures of the acromion and scapular spine are well-known complications following reverse total shoulder arthroplasty. However, these fractures in patients with massive rotator cuff tear or cuff tear arthropathy are extremely rare, and the pathogenesis, clinical features, diagnosis, and treatment of these fractures are poorly understood. We report a case of bilateral stress fracture of the posterior angle of the acromion in a patient with massive rotator cuff tear and discuss the pathogenesis, clinical manifestation, and treatment with a review of the literature.

• Clinics in Shoulder and Elbow
• /
• 제23권2호
• /
• pp.109-117
• /
• 2020

Repair of the rotator cuff tear is a joint-tightening procedure that can worsen joint stiffness. This paradoxical phenomenon complicates treatment of rotator cuff tear with joint stiffness. As a result, there is controversy about how and when to treat joint stiffness. As many treatments have been published, this review discusses the latest findings on treatment of rotator cuff tear with joint stiffness.

• Clinics in Shoulder and Elbow
• /
• 제21권4호
• /
• pp.246-251
• /
• 2018

Compared to single row repair, use of lateral row anchors in suture bridge rotator cuff repair enhances repair strength and increases footprint contact area. If a lateral knotless anchor (push-in design) is inserted into osteoporotic bone, pull-out of the lateral row anchor can developed. However, failures of lateral row anchors have been reported at several months after surgery. In our cases, even though complete cuff healing occurred, delayed pull-out of the lateral row anchor in the suture bridge repair occurred. In comparison to a conventional medial anchor, further biomechanical evaluation of the pull-out force, design, and insertion angle of the lateral anchor is needed in future studies. We report three cases with delayed pull-out of lateral row anchor in suture bridge rotator cuff repair with a literature review.

• Clinical Pain
• /
• 제19권2호
• /
• pp.64-69
• /
• 2020

Ultrasound (US) imaging is an efficient, easy to use, rapid, dynamic, noninvasive, with rare side-effects and inexpensive tool allowing for facilitated diagnosis and management of the painful shoulder. It also has advantages over other imaging modalities in the evaluation of the postoperative shoulder for rotator cuff integrity and correct anchor and suture placement, as well as rotator cuff analysis following repair surgery. Early postoperative tendons frequently had a hypo- echoic echo texture and the absence of a fibrillar pattern, which might be misinterpreted as recurrent tears. however, these features often normalized into tendons with an increased echo texture and the reappearance of a fibrillar pattern at 6 months. Based on these sequential findings, the US findings within 3 months after surgery should be interpreted with caution to accurately understand and monitor the repaired tendon status.

• Clinics in Shoulder and Elbow
• /
• 제25권4호
• /
• pp.339-346
• /
• 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
• /
• 제25권4호
• /
• pp.328-333
• /
• 2022

Irreparable rotator cuffs with retracted torn ends remain a significant challenge for most shoulder surgeons. Since repairs are preferable to reconstruction or replacement whenever possible, studies for anatomical reductions with minimal tension and secure fixation are important. In this study, the authors introduce an arthroscopic supraspinatus advancement (ASSA) procedure for retracted rotator cuff tears that could not be adequately reduced to the original footprint. Using modified long, narrow, curved Cobb elevators, procedures can be performed through lateral portals without any additional skin incision. Following meticulous stepwise three-compartment elevation procedures based on the supraspinatus insertion anatomy, the supraspinatus muscle could be safely elevated from the fossa and sufficiently advanced laterally. The authors suggest that ASSA could be a useful procedure for management of challenging retracted rotator cuff tears by maximizing lateral excursions that could convert irreparable tears to reparable tears in select patients.

• Clinics in Shoulder and Elbow
• /
• 제26권3호
• /
• pp.323-329
• /
• 2023

Rotator cuff tear is a common shoulder injury that compromises both function and quality of life. Despite the prevalence of the injury and advancements in repair techniques, a significant percentage of these repairs fail. This review aims to explore the multifactorial reasons behind this failure, including the degenerative nature of the rotator cuff tendon, inherent and extrinsic factors, and the role of hypoxia in tissue degeneration. Additionally, it elucidates potential strategies for improving healing outcomes.

• 성인간호학회지
• /
• 제21권5호
• /
• pp.538-546
• /
• 2009

Purpose: The purpose of this study was to identify the effects of cuff pressure on postoperative sore throat. Methods: Data were collected from January 4 through May 15, 2008. Among the 60 patients, 30 patients were randomly assigned to the control group and the rest to the experimental group. Initial cuff pressure of both groups was set at 20 $cmH_2O$. The experimental group was maintained at 20 $cmH_2O$ throughout the anesthesia, while the control group was not regulated further. Sore throat was assessed at postoperative 1, 24 and 72 hours. Data were analyzed using Mann-Whitney test and Spearman's rho coefficients. Results: Cuff pressure in control group increased from 20 to 43 $cmH_2O$ within 3 hours after induction. However, the experimental group showed that there was apparently a reduced rate of sore throat at postoperative 24 hours (p = .048), and 72 hours (p = .002) than in the control group. However, no outstanding differences between both groups at postoperative 1 hour (p = .081) were detected. The correlation between cuff pressure and sore throat was statistically significant ($r_s$ = .590, p < .001). Conclusion: We conclude that maintaining cuff pressure at 20 $cmH_2O$ could be an effective means to reduce sore throat in surgical patients with inhalation anesthesia.