• 대한정형외과 초음파학회지
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• 제8권1호
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• pp.1-5
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• 2015

목적: 본 연구는 수평 내전 검사로 인해 견관절 후방부 동통의 악화를 보이는 환자에 대해서 초음파 유도 하에 스테로이드를 이용한 극하근 주사 치료 후 그 유용성에 대하여 평가하고자 하였다. 대상 및 방법: 2013년 5월부터 2014년 5월까지 견관절 후방부 통증을 주소로 내원한 환자 중 수평 내전 검사 시 동통의 악화를 보이는 21명을 대상으로 하였다. 외래에서 초음파 유도하에 극하근에 스테로이드 주사 치료를 시행하였으며 시술 전, 시술 후 3개월, 6개월로 나누어 VAS 통증 점수, UCLA 점수를 평가하였다. 결과: 스테로이드를 이용한 극하근 주사 치료 3개월 경과 시 환자들의 VAS 점수, UCLA 점수에서 임상적으로 유의하게 향상되었다(p<0.05). 시술 후 3개월과 6개월을 비교하면 VAS 점수와 UCLA 점수는 유의한 차이는 없었다(p>0.05). 6개월 추시 후 증상의 호전이 있는 완쾌 및 호전은 14예(67%)이었고, 호전이 없는 비호전 및 악화는 7예(33%)이었다. 결론: 초음파 유도 하에 스테로이드를 이용한 극하근 주사요법은 견관절 후방 통증이 있으며 수평 내전 시 통증이 악화되는 증상이 있는 환자들에게 유용한 시술이라고 생각된다.

• Clinics in Shoulder and Elbow
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• 제20권1호
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• pp.30-36
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• 2017

Background: Isolated infraspinatus tear is very rare and clinical features are not as well known, therefore the purpose of this study was to evaluate clinical characteristics and outcomes of isolated infraspinatus tear that authors experienced. Methods: Authors reviewed 288 cases of full-thickness rotator cuff tear involving infraspinatus between 2010 and 2015, and retrospectively analyzed six cases of isolated infraspinatus tear. Perioperative clinical characteristics, postoperative functional outcomes of 6 months were investigated. Functional evaluation included visual analogue scale (VAS), range of motions, American Shoulder and Elbow Surgeons (ASES) score, and Constant score. Results: Calcific tendinitis was accompanied in 4 cases (66.7%). Three of them received steroid injection or aspiration or extracorporeal shockwave therapy. Mean preoperative pain VAS was 7.1 (range, 5-9), and mean postoperative pain VAS at 6 months later was 1.6 (range, 0-5). Preoperative muscle strength by isokinetic muscle performance test showed 52% deficit of abduction and 37.6% deficit of external rotation. All 6 patients had arthroscopic repair of the infraspinatus tendon. All the patients at the 6 months follow-up exhibited clinical improvement in the Constant score (67.8 [range, 45-77] to 89.3 [range, 81-100], p=0.029), and ASES score (52.3 [range, 30-77] to 90.0 [range, 80-100], p=0.002). There was no healing failure on imaging. Conclusions: Isolated infraspinatus tendon tear was frequently accompanied by calcific tendinitis, but pathophysiologic relationship should need more study. To rule out neurogenic etiology, magnetic resonance imaging and electromyography would be helpful. Arthroscopic infraspinatus tendon repair and supraspinatus debridement showed relatively good result in painful shoulder.

• 대한정형외과학회지
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• 제54권5호
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• pp.393-401
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• 2019

견관절 주위 통증은 정형외과 의사가 외래에서 접하는 가장 흔한 문제 중 하나이다. 견관절 주위 통증을 치료하기 위한 여러 치료 방법 중 상견갑신경 차단술뿐만 아니라 관절 및 관절 주위 주사 요법은 좋은 임상적 결과를 보이고 있다. 초음파 유도하 주사요법은 안전한 테크닉으로 합병증을 줄이고 시술의 안전성과 정확도를 높이고 있다. 초음파 유도하 견관절 주위 주사요법을 하기 위해서는 표면 해부학을 정확히 숙지하는 것이 중요하다. 이 논문은 표면해부학에 대한 설명 및 견관절과 주위 구조물의 초음파 해부학을 기술하는 데 그 목적이 있다. 또한 여러 주사방법 및 신경 차단술에 대해 설명하고자 한다.

• The Korean Journal of Pain
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• 제9권1호
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• pp.105-108
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• 1996

Localized or radiating pain in the arm and shoulder joint may result after faulty alignment causing compression or tension on nerves, blood vessels, or supporting soft tissues. The critical site of faulty alignment is the quadrangular space in the axilla bounded by the teres major, teres minor, long head of triceps, and humerus. The axillary nerve emerges through this space to supply the deltoid and teres minor. The activity of the trigger point on teres minor compressing the axillary nerve causes pain to develop through the area of sensory distribution of cutaneous branch of the axillary nerve. Relieving compression on the axillary nerve and suprascapular nerve is the key point to relieving the pain. Spasm of the supraspinatus and infraspinatus compressing the suprascapular nerve caused pain to develop in the shoulder joint and scapular area. We treated those patients experiencing such pain with local anesthetic infiltration or I-R laser stimulation on the identified trigger points.

• Clinics in Shoulder and Elbow
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• 제24권2호
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• pp.55-65
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• 2021

Background: Although ultrasound-guided needle decompression (US-GND) can treat calcific tendinitis of the shoulder effectively, repeat procedures might be required for unresolved symptoms. We evaluated the overall clinical outcomes of US-GND with subacromial steroid injection and the final results and factors predisposing toward repeat procedures. Methods: Ninety-eight patients who underwent US-GND for calcific tendinitis of the supraspinatus/infraspinatus were analyzed between March 2017 and December 2018. The clinical outcomes (pain visual analog scale, functional visual analog scale [FVAS], and American Shoulder and Elbow Surgeons [ASES] score) and final subjective satisfaction were compared between groups A (single US-GND) and B (repeat US-GND). The factors predisposing toward repeated US-GNDs were analyzed. Results: We found that 59.3% (58/98) of patient ASES scores were ≥80, and 73.5% of patients (72/98) were satisfied with the outcome. Group B (n=14) demonstrated a significantly higher rate of dominant-arm involvement compared to group A (78.6% vs. 48.8%, p=0.046). However, initial calcification size, shape, number, density, subscapularis involvement, lavage, and procedure time did not differ significantly between the groups. Group B showed poorer final FVAS (7 [interquartile range, 6-8] vs. 8 [interquartile range, 7-9], p=0.036) and subjective satisfaction compared to group A (satisfied: 5 [35.7%] vs. 67 [79.8%], p<0.001]. Conclusions: US-GND with subacromial steroid injection is a viable treatment option for calcific tendinitis of the shoulder. Dominant-arm involvement was the only independent factor for repeated US-GND. Final outcome of repeated US-GND for unimproved patients was promising; however, these outcomes were poor compared to those of the patients who improved after the first procedure.

• The Korean Journal of Pain
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• 제14권1호
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• pp.32-36
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• 2001

Background: There is no reliable objective test for the diagnosis of myofascial pain syndromes. The aim of this study was to evaluate the usefulness of a pressure algometer for the diagnosis of the trigger points and for the evaluation of the treatment in myofascial pain syndromes (MPS). Methods: Twenty female patients with clinical MPS of shoulder were included in this study. Pressure pain thresholds were measured by a pressure algometer at three different sites including the trapezius, supraspinatus and infraspinatus before, and then the 1st, 3rd and 7th days after TPI. Results: Mean pressure pain thresholds were lower in patients with MPS in than normal volunteers in all the examined skeletal muscles. Mean pressure pain thresholds in patients with MPS were increased significantly after TPI in all the examined skeletal muscles. Conclusions: Pressure algometer can be used as relatively objective diagnostic tool for locating trigger points and to quantify the effect of TPI in MPS. However, more investigation is necessary.

• 한국임상수의학회지
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• 제23권1호
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• pp.65-68
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• 2006

개 추간판 디스크의 2증례를 수침치료를 하였다. 증례 1은 경부 디스크(C3-C4)의 증례이었으며, 1-2차 치료에서는 덱사메타손(1 mg/ml), 3-5차 치료에서는 염산치아민(25mg/ml)을 각각 수침하였다. 사용혈위는 GV-16, GB-20, BL-10, LU-7, LI-4 및 SI-6이었다. 2-5차 치료에는 GV-6, GV-20 및 SP-6의 혈위를 추가하였다. 3-5차 치료에는 2% 염산리도카인(0.2ml)를 이용하여 견갑아래근 및 상완세갈래근의 압통점에 각각 수침하였다. 5차 치료 후 마비증상은 소실되어 치료를 중단하였으며, 5개월 후 증상의 재발은 인정되지 않았다. 증례 2는 요부디스크의 증례(L1-L2)로 1-2차 치료에는 덱사메타손 수침을 3-4차치료에는 염산치아민을 각각 수침하였다. 사용혈위는 GV-6를 주혈로, ST-36, ST-40, GB-34, ST-41 및 BL-40을 부혈로 각각 사용하였다. 또한 허리장골 늑골근 및 대퇴네갈래근의 압통점에 2% 염산리도카인(0.2ml)를 각각 수침하였다. 4차 치료 후 마비증상이 호전되어 치료를 중단하였고, 5개월 후 현재 까지 증상의 재발은 인정되지 않았다. 이상의 증례를 통하여, 덱사메타손과 염산치아민의 수침 및 리도카인을 이용한 압통점치료의 병용은 개의 경부 및 요부디스크의 증상을 효과적으로 콘트롤 할 수 있는 것으로 판단되었다.