• 대한약침학회지
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• 제27권1호
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• pp.14-20
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• 2024

Objectives: Frozen shoulder (FS) is one of the most challenging shoulder disorders for patients and clinicians. Its symptoms mainly include any combination of stiffness, nocturnal pain, and limitation of active and passive glenohumeral joint movement. Conventional treatment options for FS are physical therapy, nonsteroidal anti-inflammatory drugs, injection therapy, and arthroscopic capsular release, but adverse and limited effects continue to present problems. As a result, pharmacoacupuncture (PA) is getting attention as an alternative therapy for patients with FS. PA is a new form of acupuncture treatment in traditional Korean medicine (TKM) that is mainly used for musculoskeletal diseases. It has similarity and specificity compared to corticosteroid injection and hydrodilatation, making it a potential alternative injection therapy for FS. However, no systematic reviews investigating the utilization of PA for FS have been published. Therefore, this review aims to standardize the clinical use of PA for FS and validate its therapeutic effect. Methods: The protocol was registered in Prospero (CRD42023445708) on 18 July 2023. Until Aug. 31, 2023, seven electronic databases will be searched for randomized controlled trials of PA for FS. Authors will be contacted, and manual searches will also be performed. Two reviewers will independently screen and collect data from retrieved articles according to predefined criteria. The primary outcome will be pain intensity, and secondary outcomes will be effective rate, Constant-Murley Score, Shoulder Pain and Disability Index, range of motion, quality of life, and adverse events. Bias and quality of the included trials will be assessed using the Cochrane handbook's risk-of-bias tool for randomized trials. Meta analyses will be conducted using Review Manager V.5.3 software. GRADE will be used to evaluate the level of evidence for each outcome. Results: This systematic review and meta-analysis will be conducted following PRISMA statement. The results will be published in a peer-reviewed journal. Conclusion: This review will provide scientific evidence to support health insurance policy as well as the standardization of PA in clinical practice.

• 한국전문물리치료학회지
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• 제26권3호
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• pp.42-56
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• 2019

Background: Individuals with mechanical neck pain show biomechanical and neurophysiological changes, including cervical spine muscle weakness. As a result of deep muscle weakness, it causes stability disability and reduced upper thoracic spine mobility, which finally leads to functional movement restriction such as limited range of motion and dysfunction. Recent studies have shown that thoracic spine manipulation and mobilization could reduce symptoms of mechanical neck pain in patients. Objects: The purpose of this study was to investigate the effects of thoracic mobility exercise on cervicothoracic function, posture feature, and pain intensity in individuals with mechanical neck pain. Methods: The study subjects were 26 persons who were randomly assigned to the experimental (with thoracic mobility exercise) and control groups (without thoracic mobility exercise), with 13 subjects in each group. The cervicothoracic function (neck functional disability level and cervicothoracic range of motion), posture feature, and pain rating (using a quadrupled visual analogue scale [QVAS]) were measured before, after 3 weeks, and after 6 weeks. Results: Statistically significant group-by-time interactions were found with repeated analyses of variance for the Korean neck disability index (KNDI), all cervical range of motion (CROM), all thoracic range of motion (TROM), cranial rotation angle, sagittal shoulder posture (SSP), and QVAS (p<.05). All groups showed significant improvements from all times in all the evaluated methods. The KNDI, CROM, TROM of left rotation, and SSP in the experimental group showed significant improvements after 3 weeks, and the TROM of the right rotation and QVAS in the experimental group showed significant improvements after 6 weeks when compared with the control group. Conclusion: Thoracic mobility exercise during 6 weeks might be effective intervention to improve the functional level, posture feature, and QVAS pain rating for managing individuals with mechanical neck pain.

• Clinics in Shoulder and Elbow
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• 제13권2호
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• pp.293-298
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• 2010

목적: 주관절은 굴곡 구축 40도 이상 굴곡 제한 105도 이하일 경우 일상 생활에 상당한 장애를 일으킬 수 있는 관절로 그 치료의 정도 및 시기를 결정하기가 상당히 어려운 것으로 알려져 있다. 이에 이 종설에서는 현재까지 인정된 주관절 구축의 수술적 접근법에 대하여 고찰하여 보도록 하겠다. 대상 및 방법: 환자의 병력을 포함하여 충분한 임상적 조사를 하는 것이 중요하다. 그리고 방사선학적 방법을 이용하여 환자의 주관절 구축에 대한 원인 및 상태를 정확히 파악하고 그에 적합한 수술법을 선택한다. 수술법으로는 관절경적 유리술 (arthroscopic release) 및 관혈적 유리술 (Open release), 견인 관절 성형술 (Distraction Arthroplasty), 인공관절 치환술 (Total elbow replacement)이 있으며 관혈적 유리술은 4가지 기본 도달법 -전방 도달법 (anterior approach), 내측 도달법 (medial "over the top" approach), 제한된 외측 도달법 (limited lateral approach: column procedure) 광범위 후방 도달법 (posterior extensile approach)-으로 분류될 수 있다. 결과 및 결론: 현재 주관절 구축의 수술은 관절경의 발달로 인한 최소 침습적인 방법이 대두되고 있으나 그 경과의 판정은 아직 미미하며 그에 대한 문헌 보고가 많지 않은 상태로 고식적인 개방성 접근법을 이용하는 것을 원칙으로 하고 있으며 접근법에 따른 분류를 사용하고 있다.

• 척추신경추나의학회지
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• 제9권1호
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• pp.89-101
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• 2014

상기 증례에서 저자는 극상근건 부분 파열 환자에게 한방치료 및 ART 치료를 적용하여 견관절 ROM, VAS 평가를 통해 다음과 같은 결론을 얻었다. 1. 극상근건 부분 파열로 견통 및 견관절 ROM 제한 발생한 환자에게 한방치료 및 ART 치료를 적용하여 견관절 ROM, VAS에서 현저한 개선 보인 것을 확인할 수 있었다. 2. 비교적 증례가 많지 않고 한방적 치료 과정이 정립되어 있지 않은 극상근건 부분 파열에 한방 치료와 ART 치료를 병행하는 것이 효과가 있음 을 알 수 있었다.

• Archives of Plastic Surgery
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• 제37권3호
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• pp.301-303
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• 2010

Purpose: The axillary web syndrome (AWS) is a selflimiting cause of morbidity in the early postoperative period after axillary surgery. This article presents a rare complication developed after surgical treatment for axillary osmidrosis. Methods: A 55-year-old male patient underwent surgical excision of skin and glandular tissue for axillary osmidrosis. Three weeks after the surgery, he visited our department due to a visible web of left axillary skin overlying palpable cord extends into the medial ipsilateral arm. There was a taut and tender cord of tissue under the skin and shoulder abduction was limited to less than 90 degrees. He was diagnosed with AWS and treated with conservative management. Results: Four months later, AWS resolved completely without any treatment and patient was free of pain or motion restriction. Conculsion: Axillary web syndrome has been described as frequent complication after axillary lymph node dissection or sentinel node biopsy, but not after surgical treatment of axillary osmidrosis. Surgeons must be aware of the risk of axillary web syndrome after treatment of axillary osmidrosis.

• Archives of Reconstructive Microsurgery
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• 제21권1호
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• pp.1-7
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• 2012

Purpose: This retrospective study was to determine the functional results of patients who were amputated of their fingertip between patients who were treated with replantation and patients who were treated with thenar flap. Materials and Methods: From 2004 to 2007, we identified and operated 159 patients who were diagnosed with fingertip amputations. Of 159 patients, Eighty-two patients were treated by replantation (67 in men and 14 in women) and the mean age at the operation was 41 years (range, 15-68 years). Seventy-nine patients was treated with thenar flap(54 in men and 25 in women) and the mean age at the operation was 43 years(range, 21-70 years). We compared variables between two groups including, age, gender, diagnosis, duration of hospital admission, grip strength, two-point discrimination, Semmes Weinstein monofilament test, active range of motion (ROM) of the proximal and distal interphalangeal (PIP and DIP) joint, pain (or tenderness), paresthesia, cold intolerance, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and finger for activities of daily living (ADLs). Results: The duration of admission was longer in Replantation group than in Thenar flap group(p=0.001). However, the grip strength (p=0.003) and Semmes Weinstein monofilament test (p=0.029) in the Replanation group were statistically superior to the Thenar flap group. The average DASH disability (p=0.003)/symptom score (p=0.007) and ADLs (p<0.001) in the Replantation group was statistically better. In addition, cold intoleranace test of Thenar flap group is worse than the Replantation group. Conclusion: This study demonstrate that fingertip replantation have demonstrated not only to obtain the best appearance but also to gain better functional outcome. However, it is impossible to perform replatation, the thenar flap can be limited alternative method for fingertip amputation in aspect of preservation of range of motion and hospitalization time.

• 복식문화연구
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• 제25권3호
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• pp.301-314
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• 2017

This study focused on the movement adaptability of $19^{th}$ century classical opera stage costumes. Researchers focused on a basic $19^{th}$ century women's jacket. The study analyzed movement adaptability using ROM (range-of-motion) tests of the upper limb flexion and abduction postures. It developed two research garments to mimic basic $19^{th}$ century style jackets with or without gussets at the axilla. The ROM experiment identified the gusset size as 11cm in length. Experimental postures included upper limb flexion and abduction. The study measured subjective comfort at 8 postures. These postures included the flexion and abduction of the arms and torso. Subjects also evaluated the subjective comfort of the rotation posture of the torso. Researchers evaluated the similarities between research garments' silhouettes and the $19^{th}$ century women's jacket. The study used a 3D virtual fitting system to evaluate fit, and specialists further analyzed fit with photographs and 3D virtual graphics. The results are as follows. The silhouettes of both research garments were similar to the silhouettes of the $19^{th}$ century western women's jacket. The jacket with axilla gusset had a better fit than the basic style jacket. The basic style jacket without the axilla gusset showed limited movement adaptability at the shoulder joint and it caused discomfort at the axilla and elbow. The 3D virtual fit test was not a suitable method for analyzing silhouette similarity.

• 대한정형외과 초음파학회지
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• 제7권1호
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• pp.7-12
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• 2014

목적: 경피 Buprenorphine 제제는 보존적 치료의 한 방법으로 이용 범위를 넓히고 있으나 정형외과의 세분화된 영역에서의 통증 조절 효과에 대한 연구는 많지 않다. 이에 본 연구에서는 견관절 통증을 호소하는 동결기의 동결견 환자에게 투여한 경피 Buprenorphine 제제의 통증 조절 효과에 대해 알아보고자 하였다. 대상 및 방법: 2013년 3월에서 9월 사이의 기간 동안 5~6개월 이상 견관절 통증이 지속되고 운동범위의 제한이 확인되었으나 자기공명 영상 검사나 초음파 진단 검사상 가능한 다른 병리적 소견이 발견되지 않아 최종적으로 동결기 상태의 동결견으로 진단 받은 총 127명의 환자들을 대상으로 하였다. 모든 환자들은 관절와-상완 관절 내 스테로이드 주사요법을 1회 시행 받았다. 첫 외래 방문 이후 2~4주 후 전화를 통한 설문을 시행하였으며 전체 127명의 대상 환자 중 22명의 환자가 전화 설문을 거부하여 최종 105명의 환자가 대상이 되었으며 이중 경구 NSAID 제제와 함께 경피 Buprenorphine 제제를 처방 받은 실험군(BP group)은 51명, 경구 NSAID 제제 만을 처방 받은 대조군(NP group)은 54명이었다. 치료 효과의 평가를 위하여 첫 외래 방문 시 및 전화 설문 시 시각적 통증 점수(PVAS), 시각적 기능 점수(FVAS), 미국 정형외과 견주관절 점수(ASES score)를 측정하였다. 결과: 전반적인 통증 및 기능 임상 점수에서 양 군 동일하게 투여 전 보다 투여 후에 호전되는 추세를 보였다. 각군의 평가 점수들의 투여 후 결과는 투여 전과 비교하여 통계적으로 의미 있게 호전되었다(p<0.001). PVAS 점수는 BP group에서 3.55, NP group 에서 2.87로 BP group에서 오히려 0.68 높은 것으로 관찰되었으나 통계적으로 유의하지는 않았다(p=0.088). 투여 전 ASES 점수는 두 군간 차이를 보이지 않았던 반면 투여 후 점수는 BP group에서 57.31, NP group에서 64.24로 NP group에서 유의하게 높았다(p<0.05). 반면 FVAS 는 두군 모두 호전되는 추세는 보였으며 역시 NP group에서 높았으며 투여 후 점수에서 통계적으로 유의한 차이를 보였다(p<0.05). 결론: 동결기의 동결견 환자에게 1회 관절 내 스테로이드 주사치료 및 경구 NSAID 제제에 추가로 투여한 경피 Buprenorphine 제제는 단기 추시에서 투여하지 않은 경우보다 우월한 통증 및 기능적 임상 결과를 보이지 않았다.

• PNF and Movement
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• 제17권1호
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• pp.41-46
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• 2019

Purpose: Continuous use of a smartphone increases the angle of forward bending of the user's cervical vertebrae, causing pain in the shoulders and back, including the thorax, lumbar region, and vertebrae. Although there are many studies on changes in the cervical spine due to smartphone usage, the changes in the shoulders, thoracolumbar spine, and pelvic have rarely been compared. The purpose of this study is to investigate the change in the spinal segments, shoulders, and pelvic when using a smartphone with both hands while in the standing position. Methods: This study was conducted on 35 adults in their twenties. The selection criteria for the subjects were limited to those in a similar age group, thus excluding posture differences according to age, and to those who did not have specific diseases or pain in the spinal and musculoskeletal system for 12 months prior to the study. In this study, we used a 3D spinal diagnostic imaging system (Back Mapper, Frickenhausen) to compare the changing conditions in each vertebral segment before and during smartphone usage with both hands while in the standing position. Posture differences according to smartphone usage were compared using the paired t-test for the motion of each spinal segment. Results: This study showed that the thoracic and lumbar angle increased posteriorly during smartphone usage (p<0.05). In addition, the anterior rotation angle of the shoulder bone significantly increased, but no significant difference occurred in the pelvic region. Conclusion: Based on the results of this study, smartphone usage with both hands while in the standing position showed that the spine, as a whole, forms a kyphotic curve. Therefore, we propose to present a postural guideline for correct smartphone usage, considering the change in each vertebral segment.

• 대한관절경학회지
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• 제11권1호
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• pp.32-38
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• 2007

목적: 견관절의 제 5형 SLAP 병변에 대하여 bio-knotless 봉합 나사못을 이용하여 관절경적 봉합을 시행한 후 추시한 결과 만족할 만한 임상적 결과를 얻었기에 이를 보고하고자 한다. 대상 및 방법: 지속적인 추시가 가능하였던 10례에 대하여 임상적 결과를 분석하였으며 평균 연령은 32.7세($20{\sim}49$)였고 모두 남자였다. 손상의 원인은 7례에서 스포츠 손상이었으며 1례가 산업 재해, 2례가 교통 사고였다. 처음 수상한 날로부터 수술까지의 기간은 평균 47.2개월이었으며 수술 전 Rowe 점수는 평균 37.5점($30{\sim}55$)이었다. 모든 예에서 SLAP 병변을 먼저 관절경적으로 1개 또는 2개의 bio-knotless 나사못을 사용하여 봉합한 다음 Bankart 병변을 봉합하였는데 3개의 bio-knotless 나사못을 삽입한 경우가 7례, 2개를 삽입한 경우가 3례였다. 수술 후 3주간 상지 외전 보조기를 착용시키고 매일 간헐적인 수동적 견관절 굴곡-외회전-내회전 운동을 시행하였고, 관절의 운동 범위가 정상이 되면 회전근 개의 근력 회복을 위한 운동 치료를 시행하였고, 마지막 단계에서는 삼각근 및 견갑골 주위 근육 강화를 위한 근력 강화 운동을 시행하였다. 결과: 평균 추시 기간은 15.7개월($6{\sim}27$)이었으며 최종 추시시 견관절의 운동 범위는 8례에서 완전한 회복을 보였으나 산업 재해에 의한 손상의 환자에서는 굴곡 170도, 상지 내전 상태에서의 외회전 60도, 내회전은 제 12 흉추 범위를 보였으며 교통사고로 수상한 1례에서 견관절의 능동적 운동 범위가 굴곡 160도, 상지 내전 상태에서의 외회전 45도, 내회전은 제 12 흉추 범위를 보였으나 일상 생활에는 문제가 없었다. 최종 추시시 Rowe 점수는 평균 93점($75{\sim}100$)으로 모두 우수한 결과의 소견을 보였다. 결론: 제 5형 SLAP 병변에 대하여 bio-knotless를 이용한 관절경적 봉합 수술이 만족할 만한 임상적 결과의 소견을 보여 매우 좋은 수술 방법으로 사료된다.