• Clinics in Shoulder and Elbow
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• v.22 no.2
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• pp.93-99
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• 2019

Background: Modified Phemister operation has been widely used for the treatment of acute acromioclavicular (AC) joint dislocation. Additionally, the use of suture anchor for coracoclavicular (CC) fixation has been reported to provide CC stability. This study was conducted to evaluate the clinical and radiological results of a modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation. Methods: Seventy-four patients underwent the modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation and were followed-up for an average of 12.3 months. The visual analogue scale (VAS), range of motion, Constant score, and Korean shoulder scoring system (KSS) were used for clinical assessment. Acromioclavicular interval (ACI), coracoclavicular distance (CCD), and acromioclavicular distance (ACD) were obtained to evaluate the radiological assessments. Results: At the last follow-up, the mean VAS Score was 1.7 points, the mean joint range of the forward flexion was $164.6^{\circ}$, external rotation at the side was $61.2^{\circ}$ and internal rotation to the posterior was a level of T12. The mean Constant score and the mean KSS was 82.7 points and 84.2 points, respectively. At the mean ACI, CCD, and ACD, significant differences were found preoperatively and at the last follow-up. When the ACI, CCD, and ACD were compared with the contralateral unaffected shoulder at the last follow-up, the affected shoulders had significantly higher values. Conclusions: The modified Phemister operation with CC ligament augmentation using suture anchor is clinically and radiologically effective at acute AC joint dislocation.

• Clinics in Shoulder and Elbow
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• v.22 no.4
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• pp.210-215
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• 2019

Background: This study was undertaken to evaluate early clinical outcomes of ultrasound-guided suprascapular nerve block (SSNB) using a proximal approach, as compared with subacromial steroid injection (SA). Methods: This retrospective study included a consecutive series of 40 patients of SSNB and 20 patients receiving SA, from August 2017 to August 2018. The visual analogue scale (VAS), American Shoulder Elbow Surgeon's score (ASES), University of California, Los Angeles score (UCLA), the 36 health survey questionnaire mental component summary (SF36-MCS), physical component summary (PCS), and range of motion (forward elevation, external rotation, and internal rotation) were assessed for clinical evaluations. Results: Compared with the baseline, VAS, and ranges of motion in the SSNB group significantly improved at the 4-week follow-up (VAS scores improved from $6.7{\pm}1.6$ to $4.3{\pm}2.4$, p<0.001; all ranges of motion p<0.05), while other variables showed no statistically significant differences. All clinical variables were significantly improved in the SA group (p<0.05). However, all clinical scores at the 4-week follow-up showed no significant difference between groups. Conclusions: Ultrasound-guided SSNB using proximal approach provides significant pain relief at 4-weeks after treatment, with statistically significant difference when compared with SA, suggesting that SSNB using proximal approach is a potentially useful option in managing shoulder pain. However, in the current study, it was less effective in improving shoulder function and health-related quality of life, compared with SA.

• PNF and Movement
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• v.20 no.2
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• pp.295-306
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• 2022

Purpose: This study aimed to investigate the effect of robot-assisted gait training on the active ranges of motion, gait abilities, and biomechanical characteristics of gait in patients who underwent lower extremity surgery, and to verify the effectiveness and clinical usefulness of robot-assisted gait training. Methods: This study was conducted on 14 subjects who underwent lower extremity surgery. The subjects participated in robot-assisted gait training for 2 weeks. The active ranges of motion of the lower extremities were evaluated, and gait abilities were assessed using 10-m and 2-min walk tests. An STT Systems Inertial Measurement Unit was used to collect data on biomechanical characteristics during gait. Spatiotemporal parameters were used to measure cadence, step length, and velocity, and kinematic parameters were used to measure hip and knee joint movement during gait. Results: Significant improvements in the active ranges of motion of the hip and knee joints (flexion, extension, abduction, and adduction) and in the 10-m and 2-min walk test results were observed after robot-assisted gait training (p < 0.05). In addition, biomechanical characteristics of gait, spatiotemporal factors (cadence, step length, and velocity), and kinematic factors (gait hip flexion-extension, internal rotation-external rotation angle, and knee joint flexion-extension) were also significantly improved (p < 0.05). Conclusion: The results of this study are of clinical importance as they demonstrate that robot-assisted gait training can be used as an effective intervention method for patients who have undergone lower extremity surgery. Furthermore, the findings of this study are clinically meaningful as they expand the scope of robot-assisted gait training, which is currently mainly applied to patients with central nervous system conditions.

• Clinics in Shoulder and Elbow
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• v.25 no.3
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• pp.202-209
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• 2022

Background: The purpose of our study was to investigate short-term outcomes of two-stage reverse total shoulder arthroplasty (RTSA) with an antibiotic-loaded cement spacer for shoulder infection. Methods: Eleven patients with shoulder infection were treated by two-stage RTSA following temporary antibiotic-loaded cement spacer. Of the 11 shoulders, nine had pyogenic arthritis combined with complex conditions such as recurrent infection, extensive osteomyelitis, osteoarthritis, or massive rotator cuff tear and two had periprosthetic joint infection (PJI). The mean follow-up period was 29.9 months (range, 12-48 months) after RTSA. Clinical and radiographic outcomes were evaluated using the visual analog scale (VAS) score for pain, American Shoulder and Elbow Surgeons (ASES) score, subjective shoulder value (SSV), and serial plain radiographs. Results: The mean time from antibiotic-loaded cement spacer to RTSA was 9.2 months (range, 1-35 months). All patients had no clinical and radiographic signs of recurrent infection at final follow-up. The mean final VAS score, ASES score, and SSV were significantly improved from 4.5, 38.6, and 29.1% before RTSA to 1.7, 75.1, and 75.9% at final follow-up, respectively. The mean forward flexion, abduction, external rotation, and internal rotation were improved from 50.0°, 50.9°, 17.7°, and sacrum level before RTSA to 127.3°, 110.0°, 51.8°, and L2 level at final follow-up, respectively. Conclusions: Two-stage RTSA with antibiotic-loaded cement spacer yields satisfactory short-term clinical and radiographic outcomes. In patients with pyogenic arthritis combined with complex conditions or PJI, two-stage RTSA with an antibiotic-loaded cement spacer would be a successful approach to eradicate infection and to improve function with pain relief.

• Clinics in Shoulder and Elbow
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• v.25 no.3
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• pp.230-235
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• 2022

Background: Unstable distal clavicles experience high non-union rates, prompting surgeons to recommend surgery for more predictable outcomes. There is a lack of consensus on the optimal method of surgical fixation, with an array of techniques described in the literature. We describe an alternative method of fixation involving the use of a distal clavicular anatomical locking plate with Fibertape cerclage augmentation in our series of patients. Methods: Nine patients (8 males and 1 female), with a mean age of 36 years, who sustained unstable fracture of the distal clavicle in our institution were treated with our described technique. Postoperative range of motion, functional and pain scores, and time to radiographic union were measured over a mean follow-up period of 10 months. Incidences of postoperative complications were also recorded. Results: At the last patient consult, the mean visual analog scale score was 0.88±0.35, with a mean Disabilities of the Arm, Shoulder, and Hand (DASH) score of 1.46±0.87 and American Shoulder and Elbow Surgeons (ASES) score of 94.1±3.57. The mean range of motion achieved was forward flexion at 173°±10.6°, abduction at 173°±10.6°, and external rotation at 74.4°±10.5°. All patients achieved internal rotation at a vertebral height of at least L2 with radiographical union at a mean of 10 weeks. No removal of implants was required. Conclusions: Our described technique of augmented fixation of the distal clavicle is effective, produces good clinical outcomes, and has minimal complications.

• Journal of the Korean Society of Physical Medicine
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• v.17 no.1
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• pp.49-61
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• 2022

PURPOSE: This study compared the effects of proprioceptive sensation, subacromial space, and dynamic function according to proprioceptive neuromuscular facilitation (PNF), static stretching (SS), and complex rotational stretching (CRS). METHODS: Thirty students without any musculoskeletal disease who volunteered to participate were included in this study. The following metrics were measured to evaluate the function and stability under the normal conditions, with the PNF, SS, and CRS: special test and flexion, extension, abduction, adduction, internal rotation, external rotation (shoulder range of motion) and reaching distance on the medial (ME), superolateral (SL), inferolateral (IL), and subacromial space and proprioceptive sensation were evaluated. All measures were analyzed using one-way ANOVA and repeated measures of ANOVA. RESULTS: A clear difference in adduction in the range of motion was observed in all groups (p < .05). Significant differences could not be identified in all values in the error test, except for Ab (p < .05). Significant differences in reach were noted in all directions of the SS and PNF in the Me, SL, and IL (p < .05). After the intervention, significant differences in the average values could be identified in all groups except for the SS group after rest (p < .05). After the intervention, there was a significant difference between the CRS and SS and PNF groups (p < .05). CONCLUSION: The application of CRS is as helpful as the existing SS and PNF for improving the joint range of motion improvement, shoulder balance, and subacromial space.

• Clinics in Shoulder and Elbow
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• v.25 no.4
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• pp.311-320
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• 2022

Background: The outcomes of patients 50-55 years old or younger undergoing prosthetic shoulder arthroplasty (PSA) may not generalize to younger patients. We report outcomes following PSA in a consecutive series of patients 40 years or younger. We hypothesize that total shoulder arthroplasty (TSA) provides better outcome and durability than resurfacing hemiarthroplasty (RHA). Methods: Patients were stratified by diagnosis and surgical procedure performed, RHA or TSA. Active range of motion and self-assessed outcome were evaluated preoperatively and at final follow-up. Results: Twenty-nine consecutive PSAs were identified in 26 patients, comprising 9 TSAs and 20 RHAs, with a minimum of 2-year follow-up. Twelve PSAs were performed for chondrolysis. Mean active forward elevation, abduction, external rotation, and internal rotation improved significantly (p<0.001 for all). Mean pain score improved from 6.3 to 2.1, Simple Shoulder Test from 4.0 to 9.0, and American Shoulder and Elbow Surgeons score from 38 to 75 (p<0.001 for all). Patients undergoing RHA and TSA had similar outcomes; but three RHAs required revision, two of these within 4 years of implantation. Four of five patients undergoing revision during the study period had an original diagnosis of chondrolysis. Conclusions: PSA in young patients provides substantial improvement in active range of motion and patient reported outcomes irrespective of diagnosis and glenoid management. However, patients undergoing RHA, especially for chondrolysis, frequently require subsequent revision surgery, so that RHA should be considered with caution in young patients and only after shared decision-making and counsel on the risk of early revision to TSA.

• Physical Therapy Korea
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• v.30 no.2
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• pp.144-151
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• 2023

Background: The gluteus maximus (GM) muscle comprise the lumbo-pelvic complex and is an important stabilizing muscle during leg extension. In patients with low back pain (LBP) with weakness of the GM, spine leads to compensatory muscle activities such as instantaneous increase of the erector spinae (ES) muscle activity. Four-point kneeling arm and leg lift (FKALL) is most common types of lumbopelvic and GM muscles strengthening exercise. We assumed that altered hip position during FKALL may increase thoraco-lumbar stabilizer like GM activity more effectively method. Objects: The purpose of this study was investigated that effects of the three exercise postures on the right-sided GM, internal oblique (IO), external oblique (EO), and multifidus (MF) muscle activities and pelvic kinematic during FKALL. Methods: Twenty eight healthy individuals participated in this study. The exercises were performed three conditions of FKALL (pure FKALL, FKALL with 120° hip flexion of the supporting leg, FKALL with 30° hip abduction of the lifted leg). Participants performed FKALL exercises three times each condition, and motion sensor used to measure pelvic tilt and rotation angle. Results: This study demonstrated that no significant change in pelvic angle during hip movement in the FKALL (p > 0.05). However, the MF and GM muscle activities in FKALL with hip flexion and hip abduction is greater than pure FKALL position (p < 0.001). Conclusion: Our finding suggests that change the posture of the hip joint to facilitate GM muscle activation during trunk stabilization exercises such as the FKALL.

• Clinics in Shoulder and Elbow
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• v.26 no.3
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• pp.267-275
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• 2023

Background: Physical therapy (PT) plays an important role in the recovery of function following anatomic total shoulder arthroplasty (aTSA). While several PT protocols have been published for these patients, there is no standardized protocol for aTSA rehabilitation. This lack of standardization may lead to confusion between patients and physicians, possibly resulting in suboptimal outcomes. This study examines how PT protocols provided by academic orthopedic surgery programs vary regarding therapeutic goals and activities following aTSA. Methods: PT protocols for aTSA available online from the Accreditation Council for Graduate Medical Education accredited orthopedic surgery programs were included for review. Each protocol was analyzed to evaluate it for differences in recommendation of length of immobilization, range of motion (ROM) goals, start time for and progression of therapeutic exercises, and timing for return to functional activity. Results: Of 175 accredited programs, 25 (14.2%) had protocols publicly available, programs (92%) recommended sling immobilization outside of therapy for an average of 4.4±2.0 weeks. Most protocols gave recommendations on starting active forward flexion (24 protocols, range 1-7 weeks), external rotation (22 protocols, range 1-7 weeks), and internal rotation (18 protocols, range 4-7 weeks). Full passive ROM was recommended at 10.8±5.7 weeks, and active ROM was 13.3±3.9 weeks, on average. ROM goals were inconsistent among protocols, with significant variations in recommended ROM and resistance exercise start times. Only 13 protocols (52%) gave recommendations on resuming recreational activities (mean, 17.4±4.4 weeks). Conclusions: Publicly available PT protocols for aTSA rehabilitation are highly variable. Level of evidence: IV.

• Hip & pelvis
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• v.34 no.4
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• pp.245-254
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• 2022

Purpose: Management of pediatric subtrochanteric femur fractures (SFFs) is difficult. The aim of this study was to evaluate the outcomes of adolescent SFFs treated with adult proximal humeral locking plates (PHLPs). Materials and Methods: A retrospective analysis of 18 adolescents (11 male, 7 female) with a diagnosis of SFF who underwent internal fixation with a PHLP was conducted. Data regarding injury mechanism, fracture pattern, and time to union were recorded for all patients. In addition, a clinical and functional evaluation of patients was performed using the Harris hip score (HHS), Iowa hip score (IHS), modified Merle d'Aubigne-Postel score (MMAPS), Flynn criteria, and hip range of motion (ROM). Results: The mean age of the patients was 12.72±2.05 years (range, 10-16 years). Radiological observation was performed for evaluation of five different injury mechanisms and different fracture patterns in patients. The mean postoperative HHS was 92.27±5.61, the mean IHS was 90.88±6.46, and the mean MMAPS was 17.22±0.94. According to the Flynn criteria, excellent results were achieved in 14 cases and satisfactory results were obtained in four cases. Measurements of the patients' mean hip ROM values were as follows: 17.77±3.52° in extension, 115.27±6.74° in flexion, 43.05±3.48° in abduction, 27.50±4.28° in adduction, 42.22±4.60° in internal rotation, and 42.22±3.91° in external rotation. Conclusion: Surgery performed on adolescent patients using an adult PHLP showed good, safe results. Therefore, it should be considered as an alternative option.