• Clinics in Shoulder and Elbow
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• v.25 no.4
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• pp.265-273
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• 2022

Background: Massive rotator cuff tears (MRCTs) with subscapularis (SSC) tears cause severe shoulder dysfunction. In the present study, the influence of SSC tears on three-dimensional (3D) shoulder kinematics during scapular plane abduction in patients with MRCTs was examined. Methods: This study included 15 patients who were divided into two groups: supraspinatus (SSP) and infraspinatus (ISP) tears with SSC tear (torn SSC group: 10 shoulders) or without SSC tear (intact SSC group: 5 shoulders). Single-plane fluoroscopic images during scapular plane elevation and computed tomography (CT)-derived 3D bone models were matched to the fluoroscopic images using two-dimensional (2D)/3D registration techniques. Changes in 3D kinematic results were compared. Results: The humeral head center at the beginning of arm elevation was significantly higher in the torn SSC group than in the intact SSC group (1.8±3.4 mm vs. -1.1±1.6 mm, p<0.05). In the torn SSC group, the center of the humeral head migrated superiorly, then significantly downward at 60° arm elevation (p<0.05). In the intact SSC group, significant difference was not observed in the superior-inferior translation of the humeral head between the elevation angles. Conclusions: In cases of MRCTs with a torn SSC, the center of the humeral head showed a superior translation at the initial phase of scapular plane abduction followed by inferior translation. These findings indicate the SSC muscle plays an important role in determining the dynamic stability of the glenohumeral joint in a superior-inferior direction in patients with MRCTs.

• Clinics in Shoulder and Elbow
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• v.26 no.1
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• pp.3-9
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• 2023

Background: Modifications of the medialized design of Grammont-type reverse shoulder arthroplasty (RSA) using a bony increased offset (BIO-RSA) has shown better clinical results and fewer complications. The aim of this study is to compare the clinical results, complications, and radiological outcomes between patients undergoing standard RSA and BIO-RSA. Methods: A retrospective review was performed of 42 RSA procedures (22 standard RSA and 20 BIO-RSA). With a minimum of 1 year of follow-up, range of motion (ROM), Constant shoulder score (CSS), visual analog scale (VAS), and subjective shoulder score (SSS) were compared. Radiographs and computed tomography (CT) scan were examined for scapular notching, glenoid and humeral fixation, and graft healing. Results: At a mean follow-up of 27.6 months (range, 12-48 months), a significant difference was found for active-internal rotation (P=0.038) and for passive-external rotation (P=0.013), with better results in BIO-RSA. No other differences were found in ROM, CSS (P=0.884), VAS score, and SSS. Graft healing and viability were verified in all patients with CT scan (n=34). The notching rate was 28% in the standard RSA group and 33% in the BIO-RSA group, but the standard RSA had more severe notching (grade 2) than BIO-RSA (P=0.039). No other significative differences were found in glenoid and humeral fixation. Conclusions: Bone-graft lateralization is associated with better internal and external rotation and with less severe scapular notching compared to the standard RSA. Integration of the bone graft occurs effectively, with no relevant changes observed on radiographic evaluation. Level of evidence: III.

• The Journal of Korean Physical Therapy
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• v.35 no.6
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• pp.167-176
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• 2023

Purpose: Due to the high incidence of shoulder injuries, including shoulder impingement syndrome (SIS), among CrossFit practitioners due to frequent overhead movements, serratus anterior exercises are considered crucial for scapular stabilization in both intervention and prevention. Objective: The objective of this study is to compare the muscle activity and ratios of scapular stabilizing and shoulder girdle muscles between individuals with and without SIS during serratus punch and wall slide exercises, both targeting the serratus anterior muscle, in CrossFit training practitioners. Methods: Surface electromyography was used to compare the muscle activity and activity ratio of scapular stabilizing muscles and shoulder muscles during serratus punch and wall slide exercises in two groups of 20 CrossFit practitioners: ten with SIS and ten without symptoms. Results: The group with SIS showed higher activation of the pectoralis major, upper trapezius, and a higher pectoralis major/serratus anterior and upper trapezius/serratus anterior muscle activation ratio during the serratus punch exercise compared to the group without SIS. Similarly, during the wall slide exercise, the group with SIS exhibited higher activation of the upper trapezius and a higher upper trapezius/serratus anterior muscle activation ratio compared to the group without SIS. However, no significant difference in serratus anterior muscle activation was observed between the two groups. Conclusions: This study highlights the higher activation of the pectoralis major and upper trapezius muscles in CrossFit practitioners with SIS during the serratus anterior exercise, suggesting the importance of minimizing the overactivation of these muscles to prevent impingement syndrome in this population.

• Journal of Korean Physical Therapy Science
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• v.7 no.2
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• pp.615-628
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• 2000

This report is to study on the progress on which foot arch and planta has been changed according to body type based on 4 tilting of scapular & ilium. This study has been carried out to help contribute to some basic information like these. One was to find out how to assess and analysize the deformity of feet and ankle joint which may have the most impact on ideal alignment of anatomical posture. The other was to figure out how to diagnose and treat the deformity to get to the restoration. The results of this study is as followings; 1. The findings which had been made from 22 persons(50%) having left scapular and ilium forward tilt are as follows. 1) On the longitudinal length of the planta left parts of 18 persons(82%) are longer than the right one. On the transversel length of the planta right parts of 17 persons(77%) are longer than the left one. 2) On the size of medial longitudinal arch the left parts of 20 persons(91%) are more wider than the right one. 3) On the sign of supinated foot, the left parts of 18 persons(82%) are more common than the right one. 4) On the thickness of big toe, the left parts of 14 persons(64%) are thicker than the right one. 2. The findings which had been made from 15 persons(34%) having right scapular and ilium forward tilt are as follows. 1) On the longitudinal length of the planta right parts of 11 persons(73%) are longer than the left one. On the transversel length of the planta left parts of 13 persons(87%) are longer than the right one. 2) On the size of medial longitudinal arch the right parts of 13 persons(87%) are more wider than the left one. 3) On the sign of supinated foot, the right parts of 12 persons(80%) are more common than the left one. 4) On the thickness of big toe, the right parts of 7 persons(47%) are thicker than the left one. 3. The findings which had been made from 3 persons(7%) having left scapular and right ilium forward tilt are as follows. 1) On the longitudinal length of the planta right parts of 2 persons(67%) are longer than the left one. On the transversel length of the planta left parts of 2 persons(67%) are longer than the right one. 2) On the size of medial longitudinal arch the right parts of 3 persons(100%) are more wider than the left one. 3) On the sign of supinated foot, the right parts of 2 persons(67%) are more common than the left one. 4) On the thickness of big toe, the left parts of 2 persons(67%) are thicker than the right one. 4. The findings which had been made from 4 persons(9%) having right scapular and left ilium forward tilt are as follows. 1) On the longitudinal length of the planta left parts of 3 persons(75%) are longer than the right one. On the transversel length of the planta right parts of 2 persons(50%) are longer than the left one. 2) On the size of medial longitudinal arch the left parts of 3 persons(75%) are more wider than the right one. 3) On the sign of supinated foot, the left parts of 3 persons(75%) are more common than the right one. 4) On the thickness of big toe, the left parts of 3 persons(75%) are thicker than the right one.

• Journal of the Korean Orthopaedic Association
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• v.55 no.1
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• pp.46-53
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• 2020

Purpose: Scapular body fractures have generally been treated with non-surgical methods. This study reports the clinical and radiological outcomes after lateral-posterior internal fixation for treating displaced scapular body fractures. Materials and Methods: From March 2007 to May 2017, out of 40 patients who underwent internal fixation for scapular fractures, 13 cases of lateral plate fixation of a scapular body fracture were reviewed retrospectively. Preoperative and postoperative displacement, angulation and glenopolar angle (GPA) were measured. The range of shoulder motion, visual analogue scale (VAS), and disabilities of the arm, shoulder, and hand (DASH), and Constant score were assessed at the last follow-up. Results: The mean follow-up period was 17.7 months (range, 6-45 months). The mean preoperative GPA was 23.3°±3.96° (range, 17.8°-28.1°) and the postoperative GPA was 31.1°±4.75° (range, 22.5°-40.1°). Injury to the suprascapular nerve, nonunion, fracture redisplacement, metallic failure, or infection did not occur. At the last follow-up, the mean range of motion was 150.5°±19.3° in forward flexion, 146.6°±2.34° in lateral abduction, 66.6°±19.1° in external rotation, and 61.6°±18.9° in internal rotation. The VAS, DASH, and Constant scores were 1.7±1.3, 6.2±2.4, and 86±7.9 points, respectively. Conclusion: A scapular body fracture with severe displacement, angulation and marked decreased GPA can be stabilized by lateralposterior plate fixation using the appropriate surgical technique with good functional and radiological results.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.4
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• pp.301-307
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• 2004

The flap considered at first for the reconstruction of large maxillary defect, especially mid-face defect, is scapular free flap, because it provides ample composite tissue which can be designed 3-dimensionally for orbital, facial and oral reconstruction. In case of maxillary defect involving hard palate, however, this flap has some limitations. First, its bulk prevents oral function and physio-anatomic reconstruction of nasal and oral cavity. Second, mobility and thickness of cutaneous paddle covering the alveolar area reduce retention of tissue-supported denture and give rise to peri-implantitis when implant is installed. Third, lateral border of scapula that is to reconstruct maxillary arch and hold implants is straight, not U-shaped maxillary arch form. To overcome these problems, new concept of step prefabrication technique was provided to a 27-year-old male patient who had been suffering from a complete hard palate and maxillary alveolar ridge defect. In the first stage, scapular osteomuscular flap was elevated, tailored to fit the maxillary defect, particulated autologous bone was placed subperiosteally to simulate U-shaped alveolar process, and then wrapped up with split thickness skin graft(STSG, 0.3mm thickness). Two months later, thus prefabricated new flap was elevated and microtransferred to the palato-maxillary defect. After 6 months, 10 implant fixtures were installed along the reconstructed maxillary alveolus, with following final prosthetic rehabilitation. The procedure was very successful and patient is enjoying normal rigid diet and speech.

• The Journal of Pediatrics of Korean Medicine
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• v.17 no.2
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• pp.55-74
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• 2003

Objective : The purpose of this study was to investigate the back shape and self-conscious symptoms of the students in S High school using the phase-shifting scanning grating projection Moire interferometer and Questionnaire investigations. Methods : In this study the subjects consisted of 317 pupils[168 boys(53%), 149girls(47%)] attending S high school in Sungnamsi, Kyoungkido in 2002. Their ages ranged from sixteen to eighteen. With the phase-shifting scanning grating projection moire interferometer, the posterior views of the body were taken to see if there are correlation of remainder value of the height spot of left & right shoulder blade and gluteal region in Moire topography. And using questionnaire investigation, we investigated the self-conscious symptoms. Results : 1. In questionnaire investigation, we observed that the ratios of self-conscious symptoms of girls are more than that of boys. The ratios of headache, neck pain, lower back pain, digestive symptom were more than 70% in boys and girls. 2. In Moire topography, more frequent findings of scapular region were observed that left scapular area were higher than right(in boys 69.3%, 60%, 100%, aged 16,17,18, in girls 66.8%, 40.5%, 58.8% aged 16,17,18). 3. More frequent findings of gluteal region were observed that left scapular area were higher than right(in boys 75.2%, 60%, 36.4% aged 16,17,18, in girls 61.1%, 46.8%, 64.7% aged 16,17,18) 4. More frequent findings of reminder value of the vertical lines of cervical and buttock region in Moire topography were observed that the vertical lines of cervical region were inclined to left than the vertical lines of buttock(in boys 73.3%, 92.2%, 100% aged 16,17,18, in girls 72.2%, 77.2%, 73.5% aged 16,17,18) Conclusion : From these results, we found that the self-conscious symptoms were more than in girls than boys; the ratio of headache, neck pain, Lower back pain, digestive symptom was more than the others; the back shape of high school students were not balanced in scapular and buttock region; necks were inclined to left than buttock.

• Korean Journal of Applied Biomechanics
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• v.17 no.3
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• pp.197-207
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• 2007

It has been reported that Back-Tension played a significant role in archery (Lee & Bondit, 2005; Kim, 2007) but there are a few researches related Back-Tension in Korea recently. Therefore, the purpose of this study was to investigate archery back tension technique for the second ranked archer in the World and to find ways to improve performance. A subject(height: 185cm, mass: 82kg, years: 21yrs, careers: 12yrs) who is a number of national team and the second ranked archer in the World authorized by FITA (Federation Internationale de Trial Arc) was perticipated in this experiment. When shooting 60 shots($12{\times}5$), shooting motions were recorded with 7 infrared cameras and 2 ultrahigh-speed cameras. A QTM and an Auto Track were used to acquire raw data. The sampling rates of both cameras were 200 Hz. and 1000 Hz. respectively and data were filtered using a fourth order Butterworth low pass filtering with a cutoff-frequency of 30Hz. The parameters were calculated with Matlab6.5 and analyzed with SPSS11.0. After Pearson's correlations between 8 parameters were analyzed, 5 parameters from 13parameters that affected records were analyzed with multiple regression analysis (Enter order: x1, x2, x3, x4, x5). The results were as follows: 1. Comparing between parameters according to scores, the patterns of horizontal and vertical angular velocity(av.) of scapular relative angle was different between 8 score and 9 or 10 scores. 2. The correlations of parameters that affected records were a horizontal av.(x1, p=.032<.05) and a vertical av.(x3, p=.033<.05) of scapular from release to delivery in KB back-tension (anchoring-delivery). 3. The decision coefficients(R2) of above two parameters and three parameters selected by experts that may affect record, that is, an absolute trunk angle(x4) from in KKC back-tension (anchoring-release) and a horizontal relative scapular angle(x2) and an absolute trunk angle(x5) from release to delivery in KB back-tension were 7.7%(x1), 0.1%(x2), 8.5%(x3), 0.7%(x4) and 0.9%(x5) in sequence. 4. The multiple regression equation was a y= -1.16E-2 x1 + 0.109 x2 + 3.437E-2 x3 + 6.139E-2 x4 + 0.117 x5 + 3.420 In conclusion, a total contribution was low, that is, R2(17.9%) suggested that on the one hand, Lim's motion may not depend on a certain factor because his postural factors affected shooting motion are some stable on the other hand, unknown factors may exist(e.g. psychological, physiological factors etc.). Further study of EMG patterns of muscles and anatomic consideration related to shoulder girdle and scapular bones may help to identify mechanism of Back-Tension.

• Physical Therapy Korea
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• v.26 no.3
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• pp.1-10
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• 2019

Background: Winged scapular (WS) causes muscle imbalance with abnormal patterns when moving the arm. In particular, the over-activation of the upper trapezius (UT) and decrease in activity of the lower trapezius (LT) and serratus anterior (SA) produce abnormal scapulohumeral rhythm. Therefore, the SA requires special attention in all shoulder rehabilitation programs. In fact, many previous studies have been devoted to the SA muscle strength training needed for WS correction. Objects: The purpose of this study was to investigate the effect of shoulder girdle muscle and ratio according to the angle of shoulder abduction and external weight in supine position. Methods: Twenty three WS patients participated in this experiment. They performed scapular protraction exercise in supine position with the weights of 0 kg, 1 kg, 1.5 kg, and 2 kg at shoulder abduction angles of $0^{\circ}$, $30^{\circ}$, $60^{\circ}$, and $90^{\circ}$. The angle and weight applications were randomized. Surface electromyography (EMG) was used to collect the EMG data of the SA, pectoralis major (PM), and UT during the exercise. The ratio of PM/SA and UT/SA was confirmed. Two-way repeated analyses of variance were used to determine the statistical significance of SA, PM, and UT and the ratios of PM/SA and UT/SA. Results: There was a significant difference in SA according to angle (p<.05). Significant differences were also identified depending on the angle and weight (p<.05). The angle of abduction at $0^{\circ}$, $30^{\circ}$ and weight of 2 kg showed the highest SA activity. However, there was no significant difference between PM and UT (p>.05). There was a significant difference between PM/SA and UT/SA in ratio of muscle activity according to angle (p<.05). Significant differences were found at PM/SA angles of $30^{\circ}$, $60^{\circ}$ and $90^{\circ}$ (p<.05). For UT/SA, significant difference was only observed at $90^{\circ}$ (p<.05). Conclusion: Based on the results of this study, in order to strengthen the SA, it was found to be most effective to use 1 and 1.5 kg weights with abduction angles of $0^{\circ}$ and $30^{\circ}$ at shoulder protraction in supine position.

• 대한미세수술학회:학술대회논문집
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• 1996.10a
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• pp.165-166
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• 1996