• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.115-125
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• 2009

Purpose: The purpose of the study is to evaluate the usefulness of CT arthrography (CTA) by conducting a comparative study of CTA and MR arthrography (MRA) with the arthroscopic findings in the same patients. Materials and methods: Forty nine patients who suffered from shoulder disease underwent MRA and CTA concurrently. The sensitivity and specificity of CTA was evaluated, as compared to MRA, in the case of four types of shoulder pathological lesions. The accuracy of CTA was evaluated by analyzing the arthroscopic findings of thirty four patients. Results: Compared to MRA, CTA showed a sensitivity of 90% and a specificity of 100% for diagnosing supraspinatus tendon (SST) full thickness tear, and CTA showed a sensitivity of 100% and a specificity of 97.5% for making the diagnosis of superior labrum anterior to posterior (SLAP) lesion. For diagnosing partial articular side supraspinatus avulsion (PASTA) lesion, some studies have shown the usefulness of CTA with a sensitivity of 71.4% and a specificity of 97.7%. However, for diagnosing SST bursal side partial tear, the sensitivity of CTA was as low as 10%. CTA has been shown to be relatively accurate when the diagnoses were verified with the arthroscopic findings; diagnosing SST full thickness tear and SLAP lesion with CTA has shown an accuracy of 100% and87.5% respectively, and CTA showed 71.4% diagnostic accuracy for PASTA lesion. Conclusion: CTA was a useful tool and it was equivalent to MRA for the assessment of SST full thickness tear, SLAP lesion and PASTA lesion, but not bursal side partial tear. Thus, it may be used preferably to diagnose shoulder pathology and for follow up as an inexpensive tool after operation.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.1 no.2
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• pp.78-85
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• 2008

Purpose: The findings of preoperative magnetic resonance imaging (MRI) and ultrasonography (US) examination in the diagnosis of rotator cuff tear were then compared with the findings of arthroscopic examination, and to evaluate the postoperative integrity of rotator cuff using serial US examination. Methods: Between February and May 2008, 29 patients with rotator cuff tear had undergone preoperative US and MRI examination and subsequent arthroscopic examination. And the results of MRI and US were compared with intra-operative results of the arthroscopic examination. We observed the postoperative integrity of rotator cuff using serial (postoperative 2 weeks, 6 weeks, 3 months) US examination. Results: The sensitivity of US and MRI for identifying rotator cuff tear were 100% and 100%. The sensitivity of US and MRI were 95% and 82% in full thickness tear, and 50%, 33% in partial thickness tear, respectively. Overall accuracy of US and MRI were 86%, 69%. Among 22 patients were operated for full thickness tear, intra-operative gap formation was identified in 11 patients (50%, small to medium 2 cases, large to massive 9 cases) which were identified at 2 weeks postoperative US. We could find 5 re-tears (23%, small to medium 1 case, large to massive 4 cases) on 6 weeks postoperative US after passive range of motion (ROM) exercise, and could also find 7 re-tears (32%, small to medium 2 cases, large to massive 5 cases)on 3 months postoperative US after active ROM exercise. Conclusion: Serial US after arthroscopic rotator cuff repair was useful to differentiate intra-operative gap formation from postoperative re-tear. We found 5 retears (23%) at 6 weeks and 7 retears (32%) at 3 months postoperative US, it was useful to make treatment plan during postoperative rehabilitation.

• 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.

• Journal of Acupuncture Research
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• v.31 no.4
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• pp.109-119
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• 2014

Objectives : The aim of this study is to observe clinical characteristics and treatment outcomes of inpatients admitted to a Korean medicine hospital for shoulder pain based on magnetic resonance imaging(MRI) findings. Methods : 28 patients with MRI data were included. Data on MRI findings, duration of pain, and treatment effects were collected. To measure treatment outcomes, verbal numerical rating scale(VNRS), range of motion(ROM), and a clinical condition grading system were used. Results : 1. The patient population was 75.0 % female and 39.3 %(n=11) belonged to the 51~60-year-old age group. In the under 40 population, 1 or less MRI findings were found. 2. As for the type of disorder, 82.1 % of the patients were diagnosed with 'Supraspinatus lesion', 39.3 % with 'subacromial-subdeltoid(SA-SA) bursitis', and 28.6 % with 'Adhesive capsulitis' 3. Numerous correlations could be made between duration of pain and MRI findings. 'rotator cuff full thickness tear' was more prevalent in acute shoulder pain patients, and 'Adhesive capsulitis' in chronic patients. 4. VNRS and ROM at the time of discharge had significantly improved as compared to VNRS and ROM at the time of admission. 5. As for correlation between MRI findings and clinical condition grade, patients diagnosed with 'rotator cuff partial tear' reported to be in 'good' condition or better whereas those with 'rotator cuff full thickness tear' reported to be in 'fair' condition or worse. Conclusions : Patients admitted to a Korean Medicine hospital for shoulder pain had varying degrees of severity as shown on MRI. Almost all lesions responded well to Korean medicine treatment.

• Journal of the Korean Arthroscopy Society
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• v.12 no.3
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• pp.185-190
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• 2008

Purpose: The purpose of this study is to provide the clinical outcomes of arthroscopic type II SLAP repair in non-athletes, and to compare the clinical outcomes between those who had isolated type II SLAP lesion and those who had combined partial thickness supraspinatus tear that did not required a combined repair. Materials and Methods: From July 2005 to January 2007, 142 consecutive type II SLAP lesions were treated with arthroscopic surgery. The inclusion criteria for the study were; (1) younger than 50 years old; and (2) non-athletes. Exclusion criteria were; (1) prior surgery, fracture or combined recurrent dislocation history on the affected shoulder; (2) combined full thickness rotator cuff tear or PTST (>50% thickness) patient that needed repair; and (3) combined infection, arthritis or inflammatory disease. Remaining 19 patients meet the criteria. Among them, 13 had combined PTRCT that did not require repair (Group I), and 6 had isolated type II SLAP lesion without combined supraspinatus tear (Group II). The mean age was 36.7 years (29~49 years), mean symptom duration was 39.1 months (3~216 months) and mean follow-up was 19.0 months (12~27 months). In all patients, the range of motion of affected shoulder, pain and function visual analogue scale (PVAS, FVAS), the Constant score and UCLA score were evaluated preoperatively and postoperatively. Results: In group I, external rotation at side was decreased significantly (p=0.003),but there were no statistical significant change at the remains(p>0.05). And there were no differences between groups (p>0.05). At the final follow-up, all clinical outcome measurements improved after surgery with statistical significance (p<0.05): UCLA score, $22.8{\pm}5.2$ to $32.8{\pm}2.1$; Constant score, $79.4{\pm}8.6$ to $94.9{\pm}4.3$; PVAS $5.4{\pm}2.7$ to $1.1{\pm}1.4$; FVAS $63.2{\pm}15.3$ to $93.4{\pm}7.3$. But, in group comparison of the mean UCLA score and Constant score, there were no statistical significant differences between two groups. Conclusion: Arthroscopic repair of type II SLAP lesion provided good clinical outcomes in nonathletic population. Combined partial thickness supraspinatus tear does not seem to hamper the final outcome at minimal 1 year follow-up.

• Journal of Korean Orthopaedic Sports Medicine
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• v.5 no.1
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• pp.85-87
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• 2006

견갑하근 건의 파열의 흔한 원 인은 대개 외상이다. 극상근 건의 파열에 비해 드문 것으로 알려져 왔으나 최근 견관절의 관절내시경 시술이 증가함에 따라 관절면의 부분 파열이 많이 보고되고 있다. 본 증례는 40세 남자 환자로 상완골 소결절에 발생한 골극에 의한 견갑하근 건의 관절면의 부분층 파열에 대해 관절경하 골극의 제거 및 견갑하근 건의 변연절제술 후 양호한 결과를 보였다

• 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.

• Journal of the Korean Arthroscopy Society
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• v.13 no.2
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• pp.155-160
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• 2009

Purpose: The purpose of this study was to evaluate the pain recovery pattern according to the integrity and to analyze the factors affecting the progress and level of pain postoperatively. Materials and Methods: We examined 153 patients, who were treated with arthroscopic rotator cuff repair. 101 rotator cuff tears were full-thickness tear and 52 were partial tear. The mean follow up duration was 20 months (12~30 months). We evaluated the visual analogue scale, range of motion, ASES (American Shoulder and Elbow Surgeons), and UCLA (University of California at Los Angeles) scores preoperatively and postoperatively. We analyzed the pain recovery pattern between partial and full thickness tear using Student T-test and the factors affecting the progress and level of postoperative pain using multiple regression analysis. Results: The change patterns of visual analogue scale after arthroscpoic repair were similar regardless of the tear integrity. The VAS showed a continuous decreasing pattern, but increased at first 3 weeks postoperatively and at 7 weeks postoperatively, and then, decreased thereafter. The average VAS was ${\leqq}2$ points by postoperative 3 months. The factor affecting the pain score at 3 months was related to the preoperative limitation in forward flexion ($r^2=0.377$, p=0.021). Conclusion: There was no differences of the pain recovery pattern according to the integrity, and the factor affecting the progress of postoperative pain was preoperative angle of forward elevation. So, the appropriate preoperative rehabilitation protocol that can improve motions of the shoulder joint would help to improve the level of postoperative pain and functional recovery.

• Journal of the Korean Society of Radiology
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• v.16 no.7
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• pp.961-968
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• 2022

Rotator cuff tears are a leading cause of shoulder pain in adults. Due to the increase in social activities, the number of patients complaining of shoulder pain is increasing, and interest in shoulder diseases is also increasing. With the development of ultrasound equipment, the sensitivity and specificity of diagnosis are high, and it is used to diagnose rotator cuff tears in musculoskeletal disease. Ultrasound is recognized as a complementary method to MRI examination in rotator cuff tears. Therefore, this study aimed to find out the diagnostic usefulness of ultrasound and MRI examinations in the diagnosis of shoulder rotator cuff tears.A retrospective analysis was performed on 262 patients who were diagnosed with final rotator cuff damage by arthroscopy after completing ultrasound and MRI examinations. Sensitivity, feature, positive predictive value, image predictive value, and touch were disassembled for the test results. In addition, the degree of clavicular tear was scored and recorded in 5 stages. Ultrasound examination was similar to MRI examination results for both full-thickness and partial tears, and there was no statistically significant difference. Partial tear test results showed higher positive predictive value and accuracy than MRI test. In conclusion, ultrasound can be fully utilized as a screening test for rotator cuff disease, and it is thought that it will be selected and used clinically according to the patient's constitution and situation.

• 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.