• Clinics in Shoulder and Elbow
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• 제20권4호
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• pp.217-221
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• 2017

Background: The purpose of this study was to evaluate the clinical and radiographic outcomes of internal fixation with locking T-plates for osteoporotic fractures of the proximal humerus in patients aged 65 years and older. Methods: From January 2007 through to December 2015, we recruited 47 patients aged 65 years and older with osteoporotic fractures of the proximal humerus. All fractures had been treated using open reduction and internal fixation with a locking T-plate. We classified the fractures in accordance to the Neer classification system; At the final follow-up, the indicators of clinical outcome-the range of motion of the shoulder (flexion, internal rotation, and external rotation) and the presence of postoperative complications-and the indicators of radiographic outcome-the time-to-union and the neck-shaft angle of the proximal humerus-were evaluated. The Paavolainen method was used to grade the level of radiological outcome in the patients. Results: The mean flexion was $155.0^{\circ}$ (range, $90^{\circ}-180^{\circ}$), the mean internal rotation was T8 (range, T6-L2), and the mean external rotation was $66.8^{\circ}$ (range, $30^{\circ}-80^{\circ}$). Postoperative complications, such as plate impingement, screw loosening, and varus malunion were observed in five patient. We found that all patients achieved bone union, and the mean time-to-union was 13.5 weeks of the treatment. The mean neck-shaft angle was $131.4^{\circ}$ at the 6-month follow-up. According to the Paavolainen method, "good" and "fair" radiographic results each accounted for 38 and 9 of the total patients, respectively. Conclusions: We concluded that locking T-plate fixation leads to satisfactory clinical and radiological outcomes in elderly patients with proximal humeral fractures by providing a larger surface area of contact with the fracture and a more rigid fixation.

• Clinics in Shoulder and Elbow
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• 제7권1호
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• pp.30-34
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• 2004

Purpose: To report our experience of treatment of rotator cuff tear and evaluate the mid-term outcome. Materials and Methods: We have performed 50 cases of mini-open rotator cuff repair from March 1996 to March 1999. Male to female ratio was 34：16, the average age 46.5(23∼57) years old, mean follow-up period was 78(62∼93) months. All-arthroscopic repair and open repair cases were excluded. Mean symptomatic period was 12.5(6∼38) months, operation was indicated in cases of no improvement by 6 months of conservative management. Preoperative simple radiographs and Magnetic resonance arthrography were obtained in all cases. We also observed the inflammation, synovitis, thickness of tear and associated pathology intraoperatively. We evaluated pain, function, and range of motion by UCLA score. Results: Overall UCLA score was mean 29.5 points. Excellent 25, good 18, poor 7 cases. Mean pain score was improved 2.6 to 7.5, 44 cases(88%) were improved and 6 cases(12%) were not improved. Mean functional score was improved 3.4 to 8.5, and activity at follow up, 25 cases(50%) were same, 8 cases(14%) were above, 17 cases(34%) were below compared with preoperative level. Mean active forward flexion was preoperative 112° to postoperative 160°, forward flexion strength was improved 3.8 to 4.7. 43 cases(86%) of patients were satisfied at the result, 7 cases(14%) were not satisfied or aggravated. Results: Mini-open rotator cuff repair was effective method in treating rotator cuff tear.

• 한국운동역학회지
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• 제16권4호
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• pp.61-71
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• 2006

The purpose of this study was to compare kinematic characteristics on the limbs at 3 different walking speed during the energy and the normal walking. Eight subjects performed energy walking and normal walking at the slow speed(65 beats/min), the normal speed(115beats/min), the fast speed(160 beats/min). The 3-d angle was calculated by vector projected with least squares solution with three-dimensional cinematography(Motion Analysis corporation). The range of motion was calculated on the trunk, shoulder, elbow, hip, knee joint. The results showed that stride length was no difference of the two walking pattern. The duration of support phase was also no difference of the two walking pattern. The range of motion of shoulder joint significantly increased in the sagittal and frontal planes, and the range of motion of elbow joint significantly increased as the energy walking. The range of motion of hip joint had no significant difference in the any planes in changing of walking speed. But the most remarkable difference of the two walking patterns revealed at the trunk. The range of flexion/extension angle had significant increasing $2.36^{\circ}$ at normal speed, and the range of the right/left flexion angle had significant increasing below $4^{\circ}$ at the 3 walking speed, and The range of rotation angle had significant increasing $7.35^{\circ}$, $9.22^{\circ}$, respectively at the normal and slow speed. But there was no significant difference of range of motion at the hip and knee joints between energy walking and normal walking.

• 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.

• Clinics in Shoulder and Elbow
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• 제2권2호
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• pp.143-150
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• 1999

Purpose: The purpose of this study is to describe the characteristic clinical findings and treatment of suprascapular nerve entrapment by ganglion and to evaluate its results. Materials and Methods: Seven paitents with suprascapular nerve entrapment were evaluated on an average 13 months(range, six months to three years two months) after surgical excision and decompression. There were six males and one female. The mean age at operation was 31 years(range, 23 to 40 years), Suprascapular nerve entrapment were caused by compression of ganglion cyst in suprascapular notch or spinoglenoid notch in all cases. All patients complained of pain located over posterolateral area of the shoulder. Two patients had atrophy of both the supraspinatus and infraspinatus muscles, In four patients, only the infraspinatus muscle was involved. Muscle strength on both forward flexion and external rotation was decreased in two patients. In four patients, only external rotation was decreased. All patients underwent open excision of ganglion cyst and decompression. Results: The most dramatic effect of operation was prompt disappearance of pain in all patients. The average visual analog scale had improved from 7.2 to 0.6 point at the latest follow-up evaluation. An atrophy of the supraspinatus or infraspinatus muscle partially disappeared in four of six patients and muscle strength of forward flexion or abduction improved in all of six patients. The overall result was excellent for five patients and good for two. Conclusion: Surpascapular nerve entrapment by ganglionic cyst had clinically unique symptoms and signs on physical examination. Surgical excision is effective for symptomatic and functional outcomes. We believe that early intervention can be one of treatment modality before an irreversible damage occurs if the ganglion is large enough to compress suprascapular nerve, and to develop severe pain and muscular atrophy.

• Clinics in Shoulder and Elbow
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• 제21권1호
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• pp.15-21
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• 2018

Background: This study was undertaken to compare the outcome of supervised and home exercises with respect to range of motion (ROM), pain, and Single Assessment Numeric Evaluation (SANE). We further correlated the ROM recovery and pain reduction as well. Methods: The study included 49 patients who underwent arthroscopic rotator cuff repair. Rehabilitation was initiated after 4 weeks of immobilization. A total of 29 patients performed supervised exercise 3 times a week. Standardized education and brochures for review were provided to the remaining 20 patients who insisted on home rehabilitation. Statistical analysis was performed for comparing pain Numerical Rating Scale (NRS), SANE, and ROM. In addition, we also evaluated the correlation between pain and ROM. Results: Comparison of the two groups revealed no significant differences in forward flexion, internal rotation, abduction, and pain NRS. However, SANE at the 9th week (63.8 vs. 55.0, p=0.038) and improvement of external rotation from the 5th to the 9th week (17.6 vs. 9.3, p=0.018) were significantly higher in the supervised exercise group as compared to the home exercise group. Correlation of pain NRS with forward flexion, external rotation, internal rotation and abduction were statistically not significant (correlation coefficient=0.032 [p=0.828], -0.255 [p=0.077], 0.068 [p=0.642], and -0.188 [p=0.196], respectively). Conclusions: The supervised rehabilitation after arthroscopic rotator cuff repair showed better improvement in external rotation and higher SANE score after 4 weeks of rehabilitation exercise. However, no statistically significant correlation was observed between the recovery of ROM and short-term pain relief.

• 대한골대사학회지
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• 제25권4호
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• pp.243-249
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• 2018

Background: The aim of this study was to determine the accuracy and error range of hand grip strength measurement using various methods. Methods: Methods used for measurement of hand grip strength in 34 epidemiologic studies on sarcopenia were analyzed. Maximum grip strength was measured in a sitting position with the elbow flexed at 90 degrees, the shoulder in 0 degrees flexion, and the wrist in neutral position (0 degrees). Maximum grip strength in standing position was measured with the shoulder in 180 degrees flexion, the elbow fully extended, and the wrist in neutral position (0 degrees). Three measurements were taken on each side at 30 sec intervals. The uncertainty of measurement was calculated. Results: The combined uncertainty in sitting position on the right and left sides was 1.14% and 0.38%, respectively, and the combined uncertainty in standing position on the right and left sides was 0.35 and 1.20, respectively. The expanded uncertainty in sitting position on the right and left sides was 2.28 and 0.79, respectively, and the expanded uncertainty in standing position on the right and left sides was 0.71 and 2.41, respectively (k=2). Conclusions: Uncertainty of hand grip strength measurement was identified in this study, and a significant difference was observed between measurement. For more precise diagnosis of sarcopenia, dynamometers need to be corrected to overcome uncertainty.

• 대한관절경학회지
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• 제16권1호
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• pp.40-46
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• 2012

목적: 주관절의 원발성 골성 관절염의 치료로 관절경적 전방 변연 절제술 및 최소 절개를 이용한 후방 골극 절제술을 시행하여 이 술식의 유용성을 알아보고자 하였다. 대상 및 방법: 2003년 3월부터 2010년 2월까지 불응성 주관절 골성 관절염의 치료로 관절경적 전방 변연 절제술 및 최소 절개 하 후방 골극 절제술을 시행한 19예를 대상으로 하였다. 추시 기간은 평균 19개월이었으며, 평균 연령은 49세였다. 결과는 Andrew-Carson Rating Scale (ACRS)과 Mayo Elbow Performance Score (MEPS)를 이용하여 평가하였다. 결과: 운동 범위는 굴곡 구축이 수술 전 $28.7^{\circ}$에서 수술 후 $17.9^{\circ}$, 후속 굴곡은 $105.1^{\circ}$에서 $121.8^{\circ}$로 증가하였다. MEPS는 51.1점에서 수술 후 87.9점으로 호전되어 우수 3예, 양호 13 예, 보통 3예를 보였다. ACRS는 92.9점에서 수술 후 168.2점으로 호전되어 우수 3예, 양호 14예, 보통 2예를 보였다. 1예를 제외한 전 예에서 일상생활에 지장이 없이 이전 직업으로 복귀하였다. 결론: 불응성 주관절 골성 관절염의 치료로 관절경적 전방 변연 절제술 및 최소 절개 하 후방 골극 절제술은 동통 완화 및 기능 회복에 도움이 되는 술식이라 생각된다. 그러나 골극의 재발이나 관절염의 진행 여부는 장기적 추시가 필요할 것으로 사료된다.

• 한국운동역학회지
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• 제17권4호
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• pp.169-179
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• 2007

The purpose of this study was to investigate the relations between the segments of the body and to qualitatively analyze coordination pattern of joints and segments during Sweep Shot movement in Ice Hockey, by utilizing coordination variables was angle vs. angle plots. By the utilization the three dimensional anatomical angle cinematography, the angles of individual joint and segment according to sweep shot in ice hockey. The subjects of this study were five professional ice hockey players. The reflective makers were attached on anatomical boundary line of body. For the movement analysis three dimensional cinematographical method(APAS) was used and for the calculation of the kinematic variables a self developed program was used with the LabVIEW 6.1 graphical programming(Johnson, 1999) program. By using Eular's equations the three dimensional anatomical Cardan angles of the joint and ice hockey stick were defined. The three dimensional anatomical angular displacement and coordination pattern of trunk and Upper limb(shoulder-elbow, elbow-wrist linked system) showed important role of sweep shot in ice hockey. As the result of this paper, for the successful movement of sweep shot in ice hockey, it is most important role of coordination pattern of trunk-shoulder, shoulder-elbow and elbow-wrist. specially turnk movememt as a proximal segment. Coordination pattern of Upper Limb(upperarm-forearm-hand) of Sweep Shot movement in Ice Hockey that utilizes coordination variables seems to be one of useful research direction to understand basic control mechanisms of Ice hockey sweep shooting linked system skill. this study result showed flexion-extension, adduction-abduction and internal-external rotation of trunk are important role of power and shooting direction coordination pattern of upper Limb of Sweep Shot movement in Ice Hockey.

• Clinics in Shoulder and Elbow
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• 제21권1호
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• pp.42-47
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• 2018

A 25-year-old woman presented to the emergency room with a painful and swollen right forearm. She had just sustained an injury from an accident during which her arm was tightly wound by a rope as she was lowering a net from a fishing boat. Before being released, her arm was rigidly trapped in the rope for approximately ten minutes. Radiographs revealed anterior dislocation of the radial head that was accompanied by plastic deformation of the proximal ulna, manifested as a reversal of the proximal dorsal angulation of the ulna (PUDA); suggested a Monteggia equivalent fracture. With the patient under general anesthesia, we reduced the radial head by posterior compression at $90^{\circ}$ of elbow flexion and at neutral rotation of the forearm. However, the reduction was easily lost and the elbow re-dislocated with even slight supination or extension of the arm. After the osteotomy of the ulnar deformity to restore the PUDA to normal, the reduction remained stable even with manipulation of the arm. We found that the patient could exercise a full range of motion without pain at the 3-month follow-up, and neither residual instability nor degenerative changes were observed at the final 3-year follow-up.