• Journal of Korean Neurosurgical Society
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• v.66 no.1
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• pp.90-94
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• 2023

Objective : Cubital tunnel syndrome, the most common ulnar nerve entrapment neuropathy, is usually managed by simple decompression or anterior transposition. One of the concerns in transposition is damage to the nerve branches around the elbow. In this study, the location of ulnar nerve branches to the flexor carpi ulnaris (FCU) was assessed during operations for cubital tunnel syndrome to provide information to reduce operation-related complications. Methods : A personal series (HJY) of cases operated for cubital tunnel syndrome was reviewed. Cases managed by transposition and location of branches to the FCU were selected for analysis. The function of the branches was confirmed by intraoperative nerve stimulation and the location of the branches was assessed by the distance from the center of medial epicondyle. Results : There was a total of 61 cases of cubital tunnel syndrome, among which 31 were treated by transposition. Twenty-one cases with information on the location of branches were analyzed. The average number of ulnar nerve branches around the elbow was 1.8 (0 to 3), only one case showed no branches. Most of the cases had one branch to the medial head, and one other to the lateral head of the FCU. There were two cases having branches without FCU responses (one branch in one case, three branches in another). The location of the branches to the medial head was 16.3±8.6 mm distal to the medial epicondyle (16 branches; range, 0 to 35 mm), to the lateral head was 19.5±9.5 mm distal to the medial epicondyle (19 branches; range, -5 to 30 mm). Branches without FCU responses were found from 20 mm proximal to the medial condyle to 15 mm distal to the medial epicondyle (five branches). Most of the branches to the medial head were 15 to 20 mm (50% of cases), and most to the lateral head were 15 to 25 mm (58% of cases). There were no cases of discernable weakness of the FCU after operation. Conclusion : In most cases of cubital tunnel syndrome, there are ulnar nerve branches around the elbow. Although there might be some cases with branches without FCU responses, most branches are to the FCU, and are to be saved. The operator should be watchful for branches about 15 to 25 mm distal to the medial epicondyle, where most branches come out.

• Clinics in Shoulder and Elbow
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• v.1 no.1
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• pp.93-99
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• 1998

We measured the glenohumeral and scapulothoracic movements during abduction of the arm in the coronal plane with radiologic analysis in the 30 shoulders of normal male adults who were without pain, limitation of motion, and history of trauma. In the resting position, the glenoid cavity of the scapula faced somewhat superiorly in over 80 percents of the individuals, the mean superior tilting was 5.7 degrees. The mean total scapulothoracic movement was 65.8 degrees and the mean total glenohumeral movement was 106.8 degrees during abduction of arm in the coronal plane. The mean ratio of the glenohumeral movement to the scapulothoracic movement was 1.6 and this GH/ST ratio was decreased toward the extreme abduction. When the arm was abducted, external rotation of the humeral head occurred and this external rotation was increased smoothly during 0 degree through 90 degrees, but steeply above 90 degrees. The acromiohumeral interval was 10.9 mm at the resting positon, and this interval decreased during the arm abduction. The superior migration of the humeral head was 3.1 mm while abducting the arm. Our measurement of the relationships of glenohumeral and scapulothoracic movements at the coronal plane would be useful in the understandings of the biomechanics of shoulder, but further study would be required for the analysis of the three dimensional relationship because of the limitation of our two dimensional analysis.

• Clinics in Shoulder and Elbow
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• v.11 no.2
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• pp.90-95
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• 2008

Purpose: We wanted to assess the accuracy of ultrasound for detecting abnormality of the long head of the biceps tendon in patients with rotator cuff disorders. Materials and Methods: Between January 2006 and March 2007, we reviewed the arthroscopic findings of biceps tendons in 67 patients with rotator cuff disorder and who underwent ultrasonography pre-operatively. The patients' average age was 58 years and there were 41 males and 26 females. The statuses of the biceps tendons were described as 'normal', 'dislocation', 'subluxation', 'partial or complete tears', and 'tendinopathy'. We investigated the correspondence between the arthroscopic and ultrasonographic findings. Results: On ultrasonography, the biceps tendons were 'normal' in 37 patients and 'abnormal' in 30 patients. On arthroscopy, 5 biceps tendons turned out to have partial tears, which were 'normal' on ultrasonography. On the other hand, 8 biceps tendons were 'normal' which were 'abnormal' on ultrasonography. Three dislocations and 4 complete tears of biceps tendons were identified on arthroscopy, and all of them were detected by ultrasonography. Of the 20 cases of 'tendinopathy' seen on ultrasonography, 15 patients had partial tears and the remaining 5 patients were normal on arthroscopy. Conclusion: Ultrasonography is accurate for detecting some biceps pathologies, such as dislocation or complete tear, but it is not accurate for the detection of partial tear.

• Clinics in Shoulder and Elbow
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• v.13 no.1
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• pp.7-13
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• 2010

Purpose: Our purpose was to retrospectively analyze clinical results of subpectoral tenodesis of the proximal biceps tendon using an interference screw. Materials and Methods: We reviewed 23 cases of patients receiving tenodesis of the proximal biceps tendon between January 2008 and January 2009 for whom we had follow-up data for at least 1 year. Twenty-three cases were operated on using subpectoral tenodesis; 16 of these cases had a rotator cuff tear. The results were judged using a visual analog scale (VAS), ASES, tenderness on the biceps groove, fixation failure and the degree of deformity (BAD). Results: VAS and ASES scores were significantly improved in all patients by the time of the final observation. There were no significant complications or fixation failures. The patients without a tear of the rotator cuff had a better result than patients with a tear of the rotator cuff, but the difference between the two groups was not significant (p>0.05). Conclusion: In patients with pathology of the long head of the biceps brachii, benefits of subpectoral interference screw tenodesis include pain relief, maintenance of functional biceps, muscle strength, and cosmesis. Subpectoral biceps tenodesis using interference screw fixation appears to be a promising, reproducible, reliable technique for addressing anterior shoulder pain related to pathology of the long head of the biceps brachii.

• Journal of the Korean Arthroscopy Society
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• v.16 no.1
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• pp.72-78
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• 2012

The rotator cuff is situated in a potential tight subacromial space and undergoes senescent structural changes commonly observed in other joints of the body. When the cuff fails, spontaneous healing of the torn tendon is not expected to occur, and multiple factors may be responsible. Its fibers are under tension and typically retract on tearing. The subacromial bursal inflammation and alterations in normal glenohumeral kinematics have been considered in the development of symptoms. Controversy continues to exist concerning the pathogenesis of rotator cuff disease. The heterogeneity of the disorder, as well as the notion that rotator cuff disease may not actually represent a continuum of the same process, but rather, is a compilation of independent disorders, may partly explain the differing viewpoints on its origin. Two contrasting pathogenetic mechanisms have been extensively described and include vascular, or intrinsic, causes and impingement, or extrinsic, factors. Other etiologies have also been reported that include trauma, congenital or developmental factors, and instability. For successful treatment of the rotator cuff diseases, it is essential to understand the structure and function of rotator cuff and to clarify the pathogenesis and natural history of its disorder.

• Clinics in Shoulder and Elbow
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• v.1 no.2
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• pp.221-229
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• 1998

We measured, with manual goniometer, the active and passive arc of motion of the shoulder in 31 healthy male subjects who were right-hand dominant and who ranged in age from twenty to thirty-one years. Among ten directions through the four motion plane, the range of motion on the dominant side were significantly smaller than those on the non-dominant side in the motion of six directions. We also measured the motion fraction of the glenohumeral and scapulothoracic movement using fluoroscope in 30-degree intervals of arm elevation in the scapular plane. The ratio of glenohumeral to scapulothoracic movement(θGH/θST) was 1.6 for the full range of motion in scapular plane. At the lower angles of abduction, scapulothoracic movement was slight compared with glenohumeral movement. The motion fraction of scapulothoracic joint was increased from 60-degree to 150 degree of arm angle especially between 120 to 150 degree. During arm elevation, scapula was also extended from 42 degrees to 20 degrees tilting as well as internal rotation. The measuring technique of glenohumeral to scapulothoracic movement(θGH/θST) with fluoroscopy could be applied to the simple radiographic measurement at the out-patient clinic in order to identify the pathology and recovery of shoulder motion after treatment.

• Clinics in Shoulder and Elbow
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• v.14 no.1
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• pp.117-124
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• 2011

Purpose: We reviewed arthroscopic reconstruction among the several treatment options for anterior shoulder instability with a bony Bankart lesion. Materials and Methods: Although open Bankart repair has long been considered the optimal surgical management of anterior shoulder instability, advancements in arthroscopic techniques have led to a recent shift to arthroscopic Bankart repair. However, for cases of a glenoid bony defect, several authors have reported various methods to accurately measure the amount of bony defect. Results: The arthroscopic technique of bony Bankart reconstruction continues to evolve and various methods have followed. To overcome the limitations of single fixation of a Bankart lesion, arthroscopic dual fixation (2 point fixation) has recently been tried to anatomically repair and restore the rigid fixation of a bony fragment. The concept of performing the Bristow-Latarjet transfer procedure under arthroscopy has also recently emerged. However, a large series of cases and long term follow up are required to prove the better results. Conclusion: To obtain a successful outcome for patients with anterior instability with a glenoid bony defect, it is imperative that the surgeon be aware of the accurate status of the bony defect and the intraoperative, postoperative factors associated with the proper treatment of this unstable pathology.

• Clinics in Shoulder and Elbow
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• v.13 no.2
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• pp.181-187
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• 2010

Purpose: To determine clinical results for arthroscopic repair of a full-thickness rotator cuff tear using a suture bridge technique. Materials and Methods: Between November, 2007 and October, 2008, we evaluated 90 cases of arthroscopic middle, large rotator tear cuff repair. The mean follow-up period was 15 months (range, 12-23 months). Forty-three cases had medium-sized tears; 47 cases had large-sized tears. At the preoperative stage and again at last follow-up, functional results were assessed by the KSS, ASES, UCLA and the PVAS (Pain visual analogue score). Results: Pain score improved from 2.56 preoperatively to 0.96 at final follow-up; movement scores improved from 6.94 to 1.70. At. final follow-up, the average UCLA score improved from 17.08 to 31.17 with 31 excellent (34%), 49 good (54%) and 10 poor results (12%). The final UCLA score was 31.47 in the group less than 60 years of age and 30.69 in the group over 61 years of age (p=0.344). The UCLA score was 31.23 in those with medium-sized tears and 31.11 in those with large-sized tears (p=0.924). The UCLA score was 31.10 in non-trauma patients and 31.23 in trauma patients (p=0.929). Conclusion: Arthroscopic repair of a full-thickness rotator cuff tear using a suture bridge technique can produce excellent clinical results. These outcomes are not affected by age or trauma history.

• Clinics in Shoulder and Elbow
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• v.2 no.2
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• pp.178-186
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• 1999

Twenty-three patients with chronic shoulder pain beyond 6 months after the fracture of the greater tuberosity underwent arthroscopic treatment and were retrospectively assessed after an average of 29 months(range, 22 to 40 months). There were 18 men and 5 women with the average age of 39 years(range, 24 to 61 years). Fourteen were isolated fractures and nine were related to acute anterior instability episode. The average displacement of the fracture was 2.3mm(range, 0 to 4mm) on the anteroposterior view of the plane radiographs. At the time of arthroscopy, all patients had partial thickness rotator cuff tears in the articular surface. The cuff tears were located on the tuberosity fracture area and were an Ellman's grade I to n in depth. With the arthroscopic debridement or repair of the tear depending on the condition of the tear itself, as well as the subacromial decompression, the UCLA score revealed good to excellent results in 20 and fair in 3 patients. Nineteen of the patients had returned to the previous level of activities. The patient with a higher activity demand revealed a lower level of activity return(p=0.034). The partial thickness rotator cuff tear should be considered in patients with chronic shoulder pain after the minimally displaced fracture of the greater tuberosity, and arthroscopic debridement or repair is an appropriate procedure.

• Journal of Korean Medicine Rehabilitation
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• v.31 no.2
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• pp.69-79
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• 2021

Objectives The purpose of this study was to verify the effect of integrative Korean medicine on acute postoperative pain after arthroscopic shoulder surgery. Methods This study was conducted in a retrospective observational way. Patients who met the inclusion criteria were divided into integrative Korean medicine-treated group (IKM group) and no integrative Korean medicine treated-group (No IKM group). The primary outcome was the difference in the amount of change in pain intensity. The secondary outcome was the difference in pain intensity, opioid consumption over time, and the number of adverse events after surgery. Results The change of numerical rating scale for pain intensity from baseline to IKM group was 3.09±2.12, while 2.64±1.80 in no IKM group, and the difference of change between two groups was statistically significant (p<0.05). Difference in the use of opioid between two groups over time after surgery was also statistically significant (p=0.000). Conclusions The results of this study suggest that integrative Korean medicine can be effective for acute postoperative pain after arthroscopic shoulder surgery.