• 제목/요약/키워드: Shoulder Instability

검색결과 289건 처리시간 0.026초

다방향성 불안정 견관절의 관절경을 이용한 치료 (Arthroscopic Treatment in Multidirectional Instability of the Shoulder Joint)

  • 이광진;변기용;권순태;김상범
    • Clinics in Shoulder and Elbow
    • /
    • 제1권1호
    • /
    • pp.40-45
    • /
    • 1998
  • Multidirectional instability of the shoulder joint is an unusual entity which is not yet well understood. Traditionally recommended treatment is non-operative, but recently arthroscopic treatment has been performed. This is a retrospective review of 20 patients who had multidirectional instability, who had been treated with arthroscopic capsular shift(7 cases), and arthroscopic treatment using Ho:YAG laser(l3 cases) at Department of Orthopaedic Surgery, Chungnam National University Hospital from July, 1988to February, 1997. Results of this study were as follows: 1. In five patients who were treated with arthroscopic anterior capsular shift only, all cases had redislocation of the shoulder joint. But there was no redislocation in two patients who were treated with arthroscopic anterior and posterior capsular shift. 2. ln three patients who were treated with laser-assisted capsular shift only, all cases had redislocation of the shoulder joint. But there was only one redislocation in ten patients treated with laser-assisted capsular shrinkage and capsular plication. Ho: Y AG laser has been found to be a safe and efficacious adjunct to many arthroscopic shoulder procedures. We had satisfactory results by combining a transglenoid capsular shift with laser-assisted capsular shrinkage. Arthroscopic laser-assisted capsular shrinkage and capsular plication is a one of recommendable treatment options in multidirectional instability of the shoulder joint.

  • PDF

견관절 불안정성에 대한 이학적 검사 (Physical Examination of Shoulder Instability)

  • 김재화
    • Clinics in Shoulder and Elbow
    • /
    • 제11권1호
    • /
    • pp.1-5
    • /
    • 2008
  • 견관절 불안정성에 대한 진단은 상세한 병력 청취, 이학적 검사, 이에 따른 각종 방사선학적 검사를 통해 이루어진다. 그러나 이학적 검사는 진단에 결정적인 역할을 하고 있음에도 불구하고 어려움을 느끼는 경우가 많다. 정확한 이학적 검사를 위해서는 충분한 해부학적 지식과 많은 경험을 필요로 하며, 또한 정상적인 전이와 병적인 이완의 정도는 매우 구별하기가 용이하지 않은 경우가 많기 때문이다. 견관절의 정상적인 안정성에 대한 해부학적, 생역학적 이해와 정확한 이학적 검사를 통해 불안정성의 방향과 정도뿐만 아니라 동반 병소까지 정확히 진단되어야 성공적인 수술의 전제 조건이 될 것이다.

견관절 외상성 전방 불안정성에 대한 Bio-knotless 봉합 나사못을 이용한 관절경적 Bankart 병변 봉합술 (예비 보고) (Arthroscopic Bankart Repair in Traumatic Anterior Shoulder Instability with Bio-knotless Anchor (Preliminary and Technical Report))

  • 염재광;성기혁;신용운
    • Clinics in Shoulder and Elbow
    • /
    • 제9권1호
    • /
    • pp.105-110
    • /
    • 2006
  • Purpose: This study reports the clinical results of the arthroscopic Bankart repair in traumatic anterior instability of the shoulder with bio-knotless anchor. Materials and Methods: 21 cases of 21 patients (20 male and 1 female) were included in this study. The average age was 24.8 years old and the period from the first injury to operation was average 37.2 months. All cases had Bankart lesion and 12 cases had Hill-Sachs' lesion. The SLAP lesion was associated in 6 cases. Preoperative Rowe score was average 29.1. Arthroscopic Bankart repair with bio-knotless anchor were performed in all cases; 3 anchors at 3, 4, 5 O'clock position of the glenoid were used in 11 cases and 2 anchors at 4, 5 O'clock position were used in 10 cases. All the associated SLAP lesions were repaired arthroscopically with bio-knotless anchor. Thermal capsular shrinkage at the anterior and inferior shoulder capsule after the Bankart repair was performed in 3 cases. The average follow up period was 20.2 months. Results: The Rowe score improved to 92.8, excellent in 17 cases and good in 4 cases, at last follow up period and 20 cases had full range of motion of the shoulder. 1 case had mild limited range of motion of the shoulder (150 degrees in flexion, 60 degrees in external rotation and T12 level in internal rotation) without any problem in normal activity. The arthroscopic revision surgery of the shoulder was performed in 1 case because of multiple traumatic injuries of the shoulder with pain postoperatively. Conclusion: Arthroscopic Bankart repair with bio-knotless anchor in traumatic anterior shoulder instability is one of the good methods because of the good clinical results.

견관절 Scoring System의 비교연구 (A Comparative Study of the Shoulder Scoring Systems)

  • 태석기;조성구;정영복;진휘재;김종원
    • Clinics in Shoulder and Elbow
    • /
    • 제4권2호
    • /
    • pp.173-180
    • /
    • 2001
  • Aim: To evaluate validity and responsiveness of four shoulder scoring systems. Material and Method: Twenty-five cases of shoulder instability(22 traumatic, 3 non-traumatic) and twenty-three cases of rotator cuff tear(12 small or medium, 10 large or massive) treated surgically were evaluated with the Shoulder Function Score of the University of Pennsylvania(Penn FS), Constant Score, UCLA Shoulder Rating Scale and Simple Shouler Test(SST), preoperatively and at final follow-up. The average follow-up was 16.0 months in instability group and 17.5 months in rotator cuff tear group. Using the SPSS program, Pearson linear correlation coefficiency(PLCC) between the scores were calculated. And to assess the construct validity, PLCC between patients' satisfaction and the scores were also calculated. Responsiveness was measured by the standardized response mean(SRM). Result: In instability group, correlation between the scoring systems was low preoperatively except between Constant and SST, but high after operation. Patients' satisfaction with the scores showed low PLCC preoperativley, but high PLCC postoperatively. SRM was high in PENN and UCLA, but when the satisfaction segment of the score was eliminated from UCLA, the SRM was the lowest. In rotator cuff tear group, there was high correlation between the scores not only preoperatively but postoperatively. And the patients' satisfaction matched well with the scores. SRM was particularly high in UCLA and SST. Even when satisfaction segment was eliminated from UCLA, the SRM was still the highest. Conclusion : Evaluation by the 4 scoring systems investigated in the study showed less consistency in instability than rotator cuff tear in terms of correlation and validity. Responsiveness was generally higher in rotator cuff tear group than in instability group except for Pennsylvania Shoulder Function Score. Therefore it is construed that use of any among the four scoring systems doesn't make difference in evaluation of rotator cuff lesions. However in instability group, care is needed because different result may be obtained according to the selection of a scoring system.

  • PDF

다방향 견관절 불안정성에 대한 관절경적 치료 - 경 관절와 봉합술과 관절낭 축화술을 동시에 사용한 군과 관절낭 축화술을 사용한 군의 비교 - (Arthroscopic Treatment for Multidirectional Shoulder Instability - Comparison between Thermal Capsulorrhaphy and Transglenoid Suture with Thermal Capsulorrhaphy -)

  • 이광진;김경천;신현대;김영모;우세민;송호섭;강태환;변기용
    • Clinics in Shoulder and Elbow
    • /
    • 제9권2호
    • /
    • pp.162-168
    • /
    • 2006
  • Purpose: To compare the clinical results of arthroscopic transglenoid suture with thermal capsulorrhaphy and thermal capsulorrhaphy on multidirectional shoulder instability. Materials and Methods: From January 1993 to September 2001, 23 patients who received the artrhoscopic treatment were the subjects and follow up period were at least 2 years. Each were subdivided as Group A(7 cases), which took transglenoid suture with thermal capulorrhaphy and Group B(16 cases), who took only thermal capsulorrhaphy. Clinical results were evaluated by Rowe score before and after surgery. Results: After operation according to Rowe score 4(57.1%) were excellent, 1(14.3%) were good and 2(28.6%) were fair in the Group A. for Group B 6(37.5%) were excellent, 2(12.5%) were good, 5(31.3%) were fair and 3(18.8%) were poor. Shoulder instability was recurred in 1(14.2%) case of Group A and 8(50%) cases of Group B during follow up period. Conclusion: Thermal capsulorrhaphy is thought to be a good adjuvent method, if it done with anterior capsular shift by transglenoid suture in multidirectional shoulder instability.

양측 견관절에 발생한 전방 불안정성 (Bilateral Anterior Shoulder Instability)

  • 이용걸;조남수
    • Clinics in Shoulder and Elbow
    • /
    • 제4권2호
    • /
    • pp.181-185
    • /
    • 2001
  • Purpose: We reviewed the bilateral anterior shoulder instability to evaluate the final outcomes and influencing factors that had effect on the final outcomes. Materials and Methods: Sixteen patients of the bilateral shoulder instability underwent the operative treatment and 15 patients could be followed up average 29 months. There were Bankart lesions in 28 cases and 46% retracted markedly onto the medial side of the glenoid neck. Capsular redundancy could be seen in 50%, but the generalized ligamentous laxity in only two patients. We performed open Bankart repair in 21 cases and arthroscopic repair in 9 cases. Inferior capsular shift was performed in 12 cases of 15 cases in patients who was shown the capular redundancy. Results: The average increment of the forward flexion was 4° postoperatively but the average decrement of the external rotation was 6° postoperatively. After the inferior capsular shift surgery, there were significantly the decrement in external rotation by 13° even though the forward flexion was at the same level comparing with preoperative motion. There were 13 cases(43%) in excellent result, 14 cases(47%) in good and 3 case(l0%) in poor. Rowe score improved from 53 to 87.3 postoperatively. Conclusion : Re-establishing a proper capsular tensioning in a bilateral anterior shoulder instability is critical to ultimate success because there was a redundant laxity in a half and majority of them had marked retraction of an anteroinferior glenohumeral ligament complex. Especially, it should be considered that an unexpected limitation of external rotation could be occurred in the inferior capsular shift surgery.

  • PDF

전방 불안정성 견관절에서 이두박근의 근전도 활동성 (Electromyographic Activity of the Biceps Brachii Muscle in Shoulders With Anterior Instability)

  • 김승호;하권익;김현숙;김선우;박종혁;김영민
    • Clinics in Shoulder and Elbow
    • /
    • 제3권2호
    • /
    • pp.87-94
    • /
    • 2000
  • Purpose : The purpose of this study was to evaluate the activity of the biceps brachii muscle in the vulnerable abduction and external rotation position of the shoulder in patients with anterior instability. Materials and Methods: This experimental study include a prospective analysis of the electromyographic(EMG) data on a group of patients with traumatic unilateral anterior instability of the shoulder. The EMG data of unstable shoulders was compared with those of opposite shoulders as control. The optimal sample size for the case-control study was calculated using an nQuery Advisor program(nQuery Adviser 3.0, Statisticl solutions Ltd., Ireland). The EMG analyses were conducted in 76 shoulders in 38 patients who had a traumatic anterior instability in one shoulder. The EMG records were obtained at different position of shoulder, which included 0° , 45° , 90° and 120° of shoulder abduction. In each angle of shoulder abduction, the arms were placed in an external rotation as tolerated by the anterior apprehension. The paired-sample T test was used to compare the difference of the root mean square(RMS) voltages between the stable and unstable shoulders in each degree of arm position. Results : The RMS voltage of the biceps muscle was significantly greater in the unstable shoulder than opposite stable shoulder in all position of the arm(p<0.001). The RMS voltage of the biceps was maximal at 90° and 120° of external rotation in the unstable shoulder(p<0.05). The RMS voltage of the supraspinatus muscle revealed no differences in any of the test conditions(p=0.904, 0.506, 0.119 and 0.781 in 0° , 45° , 90° and 120° , respectively) Conclusion: In the vulnerable abduction and external rotation position, the biceps muscle plays an active compensatory role in the unstable shoulder while not in the stable shoulder.

  • PDF

회전근 간 병변: 불안정증과 강직 (Rotator Interval Lesion: Instability & Stiffness)

  • 오정환;박진영
    • Clinics in Shoulder and Elbow
    • /
    • 제8권1호
    • /
    • pp.5-8
    • /
    • 2005
  • 회전근 간의 질환은 과거 강직과 불안정성에 대한 연구가 주종을 이루었다. 동결견에 대한 치료로 회전근 간을 절제하는 것도 치료의 한 방법으로 사용되어 왔다. 불안정성에 대한 치료 중 회전근 간의 봉합술은 아직은 다른 치료 방법을 시행하고 추가적인 관절 운동 범위의 감소가 필요할 때 사용할 수 있는 보조적인 방법으로 사용하는 것이 좋을 것으로 보인다. 그 외의 회전근 간 자체 파열 등의 병변이 발생할 수 있으므로 수술시 반드시 확인해야 하는 구조물로 사료된다.