• Clinics in Shoulder and Elbow
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• v.25 no.2
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• pp.112-120
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• 2022

Background: The prognostic factors for patients with full-thickness rotator cuff tears (RCTs) include tear size, muscle atrophy and fatty infiltration. However, the influence of early coexisting degenerative changes on RCT outcomes is unappreciated. The purpose of this study was to calculate the impact that pre-existing partial glenohumeral cartilaginous changes have on patients undergoing arthroscopic RCT repair. Methods: A study of 54 patients undergoing arthroscopic RCT repair was undertaken. The presence of co-existing patches of glenohumeral degenerative cartilaginous changes and RCT size was recorded at surgery. Pre- and postoperative outcomes were assessed using traditional (Oxford Shoulder Score [OSS], 5-level EuroQol-5D [EQ-5D-5L] questionnaire and EuroQol visual analog scale [EQ-VAS]) and patient-centric re-formatted prisms. Outcomes were assessed as an entire dataset, and sub-group analysis was performed according to the grade of co-existing arthritis and tear size. Results: Significant improvements (p<0.05) in clinical outcomes were recognized when assessed using either the traditional or reformatted prisms (average % improvements in OSS, EQ-5D-5L and EQ-VAS were 47%, 33% and 43%, respectively; average improvements in pain, function, and psychological well-being were 48%, 33% and, 29%, respectively). Positive gain was noted in all sub-groups of arthritic grading and tear size. Conclusions: Good clinical outcomes can be achieved following RCT repair even in the presence of local partial degenerative cartilage changes and advancing tear size. These benefits are patient-centered but require RCT repairability.

• Clinics in Shoulder and Elbow
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• v.16 no.1
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• pp.1-9
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• 2013

Purpose: The purpose of this study is to analyze the correlation between the degree of torn rotator cuff as recorded by MRI and degenerative change of acromion and greater tuberosity of humerus determined by simple radiographs. Materials and Methods: Of the 518 cases included in this study, a group of 234 cases had a chronic rotator cuff tear and a control group of 284 cases had an intact rotator cuff in shoulder MRI. The degree of degenerative changes was classified according to the length of spur and morphological change of acromion and greater tuberosity through the true anteroposterior simple radiograph in supraspinatus outlet view. The degree of tear (partial-thickness or full-thickness tear) and the size of complete rotator cuff tear were analyzed according to the MRI findings of shoulder. The authors also evaluated the correlation between the degree and size of torn rotator cuff and the degenerative change of acromion and greater tuberosity. Results: There were significant differences in the size and extent of torn rotator cuff according to the age, sex and degenerative change of acromion and greater tuberosity of humerus (p<0.001). More degenerative changes of acromion and greater tuberosity in simple shoulder radiographs showed the increased degree and size of torn rotator cuff (p<0.001). In addition, the higher degree and larger size of torn rotator cuff were noted in older age subjects (p<0.001) and in the female group (p<0.001). Conclusion: More degenerative changes of acromion and greater tuberosity in simple shoulder radiographs showed the increased degree and size of torn rotator cuff. Therefore, if a high degree of degenerative change of the acromion and greater tuberosity on simple radiograph is noted, the possibility of degenerative rotator cuff tear should be considered. In addition, the age and sex could be associative factors for larger size of torn rotator cuff.

• Journal of Korean Medicine Rehabilitation
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• v.24 no.1
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• pp.77-82
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• 2014

Objectives Adhesive capsulitis (AC) is a restricted shoulder range of motion. Rotator cuff disease (RCD) has been believed to be a major etiologic factor of AC, however, how soon is the development time from RCD to AC (DTRA) has not been elucidated. The purpose of our study was to evaluate the correlation between the ultrasonographic characteristics of RCD and the DTRA. Methods Total 40 patients who were diagnosed as AC were recruited. The clinical characteristics of RCD were diagnosed by ultrasonography and classified with the Southern California Orthopedic Institute for Rotator Cuff Classification. The correlation was analyzed with Mann-Whitney U test and one-way analysis of variance. Results 60% of full thickness tear and 40% of partial thickness tear patients (10 male and 30 female, mean age of $54.0{\pm}8.4$ years) and 38% of bursitis and 21% of neovascularization were observed. The mean value of DTRA was $74.8{\pm}131.3$ days. There were no correlation between DTRA and gender (p=0.63), location of the partial tear (p=0.63), the severity of the partial thickness tear (p=0.63), full thickness tear (p=0.66) and completeness of the tear (p=0.16). The presence of bursitis or neovascularization was not associated with DTRA (p=0.60, p=0.61). Conclusions Although RCD is a major etiologic factor of AC, the severity, the type of RCD and the presence of bursitis and neovascularization were not statistically correlated with the DTRA in our study. Comprehensive consideration about etiologic factor analysis of AC will be needed with prospective study design for future study.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2005.03a
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• pp.1-1
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• 2005

• Clinics in Shoulder and Elbow
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• v.9 no.1
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• pp.42-49
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• 2006

Purpose: This study evaluated clinical results, and recommended treatment protocol of traumatic anterior shoulder dislocation in the patients older than 60 years of age. Materials and Methods: Thirty-eight patients with first traumatic anterior shoulder dislocation aged over 60 years were included. The average age was 69.4 (range, 60 to 87 years). There were 8 men (average age of 71.6) and 30 women (average age of 69). Most common cause of injuries was a fall on the outstretched hand. The additional injuries were evaluated using MRI or CT arthrogram in the patients with significant pain and weakness while movements after 2 weeks sling immobilization. Results: Fifteen patients (39%) had rotator cuff tears and 5 patients (14%) had greater tuberosity fractures. The sizes of rotator cuff tears were diverse; 2 partial tears, 1 small tear, 4 medium tears, 3 large tears and 5 massive tears. Among 5 massive cuff tears, 3 patients revealed cuff arthropathy after reduction. 4 patients (11%) had recurrent dislocation more than one time during 1 month after the first dislocation. Bankart lesions revealed in 5 patients and three of them had associated rotator cuff tears. 3 out of 5 patients with Bankart lesions, 13 out of 15 patients with rotator cuff tears and 3 patients with displaced greater tuberosity fracture had operations. Conclusion: The injury mechanism of shoulder dislocation in patients older than 60 years of age seems to have either anterior or posterior mechanism. The diagnosis and treatment should be approached 2 weeks after dislocation.

• Clinics in Shoulder and Elbow
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• v.8 no.1
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• pp.9-13
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• 2005

An isolated tear of the subscapularis is uncommon, and there are a few literatures regarding the treatment of this problem. But, the incidence has increased with development of the arthroscopic techniques. An all-arthroscopic rotator cuff repair is a challenging procedure that can be effectively performed for treatment of subscapularis tendon tears. Often, tears of the subscapularis tendon do not involve entire tendon, and retraction of the torn edge is within to 2 cm of its attachment site. Occasionally, the entire tendon is torn and retracted medially to the glenoid. This article outlines the examination, preoperative planning and details the steps necessary to perform this procedure on upper third of subscapularis tears.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.126-136
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• 2009

Purpose: We evaluated the correlation of the anatomic parameters of the acromion those represent on the magnetic resonance image (MRI) of impingement syndrome. Materials and Methods: From June, 2004 to December, 2005, 71 cases were surgically proven to be impingement syndrome, and the anterior acromial hooking angle, the lateral acromial hooking angle (AAHA and LAHA) and the acromial hooking index (AHI: the sum of the AAHA and LAHA) were compared to 16 control cases. At the same period, 55 cases were surgically proven to be partial or full thickness rotator cuff tear, and age, gender and twelve anatomic parameters, including the acromial type, the acromial angle, the anterior covering, the acromial slope, the AAHA, the lateral acromial angle, the acromial torsional angle, the lateral acromial angulation, the LAHA, the lateral covering, the acromiohumeral distance and the AHI were assessed. Results: The AAHA and AHI were increased as impingement syndrome proceeded. The acromial type and acromial angle, and the AAHA, LAHA and AHI showed significant differences between the controls and the rotator cuff tear patients on univariant analysis. On multivariant analysis, gender was most strongly correlated with rotator cuff tear. Age, AAHA and the acromial angle showed similar correlation, respectively. Conclusion: The coronal acromial shape is correlated with rotator cuff tear, and it is important to correct the lateral acromial shape when performing acromioplasty.

• Clinics in Shoulder and Elbow
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• v.11 no.2
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• pp.77-81
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• 2008

The goal of rotator cuff repairs is to achieve high initial fixation strength, minimize gap formation, maintain mechanical stability under cyclic loading and optimize the biology of the tendon-bone interface until the cuff heals biologically to the bone. Single row repairs are least successful in restoring the footprint of the rotator cuff and are most susceptible to gap formation. Double row repairs have an improved load to failure and minimal gap formation. Transosseous equivalent repairs (suture bridge technique) have the highest ultimate load and resistance to shear and rotational forces and the lowest gap formation. Even though the superior advantages of double row and transosseous equivalent repairs, those techniques take longer surgical time and are more expensive than single row repairs. Therefore single row repairs can be useful in bursal side partial thickness or small size full thickess rotator cuff tear.

• Journal of Korean Orthopaedic Sports Medicine
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• v.12 no.1
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• pp.29-36
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• 2013

Purpose: Proprioceptive function has been known to be important to shoulder stability. However, the function in rotator cuff tear patients is rarely investigated. The purpose of current study is to report the proprioceptive function in rotator cuff tear patients and to analyze the proprioceptive function regarding the tear size and the presence of subscapularis tear. Materials and Methods: Between 2011 and 2012, total 76 patients (male 28 and female 48) were recruited and average age was 61.7 years old (range, 38~76). Preoperatively, joint position senses in internal and external rotation were measured for proprioceptive function testing by method of active re-positioning technique. The absolute difference from set point was measured. Proprioceptive function was further analyzed according to tear size of rotator cuff, the presence of subscapularis tear, visual analogue scale of pain, shoulder functional score (American society of elbow and shoulder score), and ranges of motion in shoulder. Results: The absolute difference for external rotation was $4.9^{\circ}{\pm}2.9^{\circ}$, in normal joint and $4.9^{\circ}{\pm}3.0^{\circ}$for involved joint in rotator cuff tear patients. This difference was not significant statistically (p=0.87). The absolute difference for internal rotation was $4.0^{\circ}{\pm}2.7^{\circ}$in normal joint whereas $4.8^{\circ}{\pm}3.7^{\circ}$ for involved joint showing statistically significant difference (p=0.043). There was some trend that the proprioceptive function of internal rotation was more impaired in the bigger tear size group (more than medium tear) compared to the smaller tear size group (partial thickness and small tear, 5.0 vs. 4.0, p=0.061). The impairment of internal rotation proprioception was also accentuated in patients with subscapularis tear (4.8 vs. 4.0, p=0.065). The proprioceptive function of internal rotation was decreased when the pain visual analogue scale was increased (5.2 vs. 4.0 p=0.04), shoulder functional score was decreased (6.1 vs. 4.2, p=0.005), or range of motion in shoulder joint was restricted (5.3 vs. 3.7, p=0.041). Conclusion: The deficit of proprioceptive function was observed in rotator cuff tear patients. Proprioception for internal rotation was impaired in patients with the bigger tear size and subscapularis tear. Pain, shoulder function score, and range of motion were also shown to be related with the deficit in proprioceptive function.

• Clinics in Shoulder and Elbow
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• v.13 no.1
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• pp.161-166
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• 2010

Purpose: Irreparable massive rotator cuff tears pose a distinct clinical challenge for the orthopaedist and non-surgical treatment has had inconsistent results and proven unsuccessful for chronic symptoms, while surgery, including debridement and partial and complete repairs have had varying degrees of success. Materials and Methods: For rotator cuff tears that are deemed irreparable, treatment options are limited. Results and Conclusion: The use of tendon transfers (latissimus dorsi for posterosuperior type cuff defects and pectoralis major for subscapularis defects) in younger patients to reconstruct rotator cuffs and re-establish function and restore shoulder kinematics can be useful in solving this difficult problem.