• Clinics in Shoulder and Elbow
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• 제26권4호
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• pp.366-372
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• 2023

Background: There is minimal literature on the morphology of partial distal biceps tendon (DBT) tears. We sought to investigate tear morphology by retrospectively reviewing 3-Tesla magnetic resonance imaging (3T MRI) scans of elbows with partial DBT tears and to propose a basic classification system. Methods: 3T MRI scans of elbows with partial DBT tears were retrospectively reviewed by two experienced observers. Basic demographic data were collected. Tear morphology was recorded including type, presence of retraction (>5 mm), and presence of discrete long-head and short-head tendons at the DBT insertion. Results: For analysis, 44 3T MRI scans of 44 elbows with partial DBT tears were included. There were 9 isolated long-head tears (20%), 13 isolated short-head tears (30%), 2 complete long-head tears with a partial short-head tear (5%), 5 complete short-head tears with a partial long-head tear (11%), and 15 peel-off tears (34%). Retraction was seen in 5 or 44 partial tears (11%), and 13 of the 44 DBTs were bifid tendons at the insertion (30%). Conclusions: Partial DBT tears can be classified into five sub-types: long-head isolated tears, short-head isolated tears, complete long-head tears with partial short-head involvement, complete short-head tears with partial long-head involvement, and peel-off tears. Classification of tears may have implications for operative and non-operative management. Level of evidence: III.

• Clinics in Shoulder and Elbow
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• 제19권2호
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• pp.84-89
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• 2016

Background: The purpose of this study was to assess the results of arthroscopic bridging repair using a human dermis allograft in the treatment of massive irreparable rotator cuff tears. Methods: From November 2009 to April 2011, 12 patients underwent arthroscopic bridging repair using a human dermis allograft in the treatment of massive irreparable rotator cuff tears. Patients were followed for an average of 33.9 months. Clinical outcome was evaluated preoperatively and postoperatively using the mean University of California, Los Angeles (UCLA) score and the Korean Shoulder Scoring System (KSS). Magnetic resonance imaging (MRI) was performed postoperatively at an average of 6.5 months. Results: At a mean follow-up of 33.9 months (range, 25 to 42 months), 11 out of 12 patients were satisfied with their procedure. Patients showed significant improvement in their mean modified UCLA score from 15.9 preoperatively to 29.4 postoperatively (p=0.001). The mean KSS score improved from 45.6 preoperatively to 80.5 postoperatively (p=0.002). In MRI studies, 9 out of 12 patients had full incorporation of the graft into the native rotator cuff remnant. To date, there has been no intraoperative or postoperative complication from the graft procedure, such as infection or allograft rejection, in any patient. Conclusions: Arthroscopic bridging repair using a human dermis allograft can be considered as an option in treatment of select cases of massive irreparable rotator cuff tears, resulting in high patient satisfaction.

• Investigative Magnetic Resonance Imaging
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• 제25권1호
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• pp.1-9
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• 2021

The aim of this study was to provide a new assessment of rotator cuff muscle activity. Eight male subjects (24.7 ± 3.2 years old,171.2 ± 9.8 cm tall, and weighing 63.8 ± 11.9 kg) performed the study exercises. The subjects performed 10 sets of the exercise while fixing the elbow at 90 degrees flexure and lying supine on a bed. One exercise set consisted of the subject performing external shoulder rotation 50 times using training equipment. Two imaging protocols were employed: (a) true fast imaging with steady precession (TrueFISP) at an acquisition time of 12 seconds and (b) multi-shot spin-echo echo-planar imaging (MSSE-EPI) at an acquisition time of 30 seconds for one echo. The main method of assessing rotator cuff muscle activity was functional T2 mapping using ultrafast imaging (fast-acquired muscle functional MRI [fast-mfMRI]). Fast-mfMRI enabled real-time imaging for the identification and evaluation of the degree of muscle activity induced by the exercise. Regions of interest were set at several places in the musculus subscapularis (sub), musculus supraspinatus (sup), musculus teres minor (ter), and deltoid muscle (del). We used the MR signal of the images and transverse relaxation time (T2) for comparison. Most of the TrueFISP signal was not changed by exercise and there was no significant difference from the resting values. Only the T2 in the musculus teres minor was increased after one set and the change were seen on the T2 images. Additionally, except for those after one and two sets, the changes in T2 were significant compared to those at rest (P < 0.01). We also demonstrated identify and visualize the extent to which muscles involved in muscle activity by exercise. In addition, we showed that muscle activity in a region such as a shoulder, which is susceptible to B0 inhomogeneity, could be easily detected using this technique.

• The Korean Journal of Pain
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• 제33권1호
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• pp.60-65
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• 2020

Background: Anatomic changes in the acromion have been considered a main cause of shoulder impingement syndrome (SIS). To evaluate the relationship between SIS and the acromion process, we devised a new morphological parameter called the acromion process cross-sectional area (APA). We hypothesized that the APA could be an important morphologic diagnostic parameter in SIS. Methods: We collected APA data from 95 patients with SIS and 126 control subjects who underwent shoulder magnetic resonance imaging (MRI). Then we measured the maximal cross-sectional area of the bone margin of the acromion process on MRI scans. Results: The mean of APAs were 136.50 ± 21.75 ㎟ in the male control group and 202.91 ± 31.78 ㎟ in the male SIS group; SIS patients had significantly greater APAs (P < 0.001). The average of APAs were 105.38 ± 19.07 ㎟ in the female control group and 147.62 ± 22.90 ㎟ in the female SIS group, and the SIS patients had significantly greater APAs (P < 0.001). The optimal APA cut-off in the male group was 165.14 ㎟ with 90.2% sensitivity, 91.4% specificity, and an area under the curve (AUC) of 0.968. In the female group, the optimal cut-off was 122.50 ㎟ with 85.2% sensitivity, 84.9% specificity, and an AUC of 0.928. Conclusions: The newly devised APA is a sensitive parameter for assessing SIS; greater APA is associated with a higher possibility of SIS. We think that this result will be helpful for the diagnosis of SIS.

• Clinics in Shoulder and Elbow
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• 제9권1호
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• pp.68-72
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• 2006

Purpose: To demonstrate arthroscopically the presence of bilateral shoulder "mirror lesions" due to overhead work. Materials and Methods: A cross-sectional study was performed in a historical cohort of 10 male tire plant workers who underwent MRI studies of both shoulders. Bilateral intraarticular shoulder pathology was diagnosed by magnetic resonance imaging and confirmed by arthroscopy. "Mirror lesions" were defined as similar pathology between an individual patient's two shoulders. Results: We report on ten patients who had bilateral "mirror lesions." The most common mirror lesions were tears of the rotator cuff. Most patients (7 of 10) had more than one mirror lesion in their shoulders. There were two bilateral full thickness tears involving the supraspinatus and infraspinatus, four bilateral partial thickness supraspinatus tears, six bilateral partial or upper corner lesion complete subscapularis tears, and one bilateral complete supraspinatus tear. Conclusion: Occupational overhead work with simultaneous use of both arms is associated with bilateral shoulder lesions verified by arthroscopy. By demonstrating the work-related bilateral shoulder involvement, this study suggests an etiopathogenesis for these lesions and provides rational for developing worksite prevention strategies.

• 척추신경추나의학회지
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• 제4권1호
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• pp.7-17
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• 2009

Objectives: The objective of this study is to report the effectiveness of Chuna treatment and burning acupuncture therapy on shoulder impingement syndrome. Methods: Among the patients with shoulder pain, We selected 3 patients diagnosed as shoulder impingement syndrome by physical examination and magnetic resonance imaging(MRI). After Chuna treatment and burning acupuncture therapy, we evaluated the effectiveness by measuring range of movement(ROM) and checking The Shoulder Pain And Disability Index(SPADI) every three times the patients called at the clinic for three weeks. Results: The symptoms of the patients got improved relatively in short period considering shoulder impingement syndrome belongs to chronic diseases and steps chronical procedure in recovering. Conclusions: These cases showed Chuna treatment and burning acupuncture therapy could be applied on shoulder impingement syndrome and were effective for improving the symptoms. We suggest that further studies and clinical trials will be needed afterwards.

• Clinics in Shoulder and Elbow
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• 제18권4호
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• pp.197-205
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• 2015

Background: The purpose of this study was to evaluate the postoperative magnetic resonance imaging (MRI) results of minimal-tying (one medial-row tie among 4 medial-row sutures) on the medial-row in double-row suture-bridge configuration ($2{\times}2$ anchor with $4{\times}4$ suture stands). Methods: From 2011 March to 2012 July, 79 patients underwent arthroscopic rotator cuff repair using $2{\times}2$ anchor double-row configuration. The mean age was 61.3 years (range, 31-81 years). Two double-loaded suture anchors were used for medial-row. Four medial-row stitches were made with only one medial-row knot-tying (the most anterior suture). Lateral-row was secured using the conventional suture-bridge anchor technique; all 4 strands were used for each anchor. Repair integrity was evaluated with MRI at mean 6.2 months postoperatively. Retear and the pattern of retear, change of fatty infiltration, and muscle atrophy of supraspinatus were evaluated using pre- and postoperative MRI. Results: Repaired tendon integrity was 38 for type I, 30 for type II, 6 for type III, 4 for type IV, and 1 for type V, according to Sugaya classification. Considering type IV/V as retear, the rate was 6.3% (5 out of 79 patients). Medial cuff failure was observed in 4 patients. Fatty atrophy of supraspinatus was significantly improved postoperatively according to Goutallier grading (p=0.01). The level of muscle atrophy of supraspinatus was not changed significantly after surgery. Conclusions: Minimal tying technique with suture configuration of four-by-four strand double-row suture-bridge yielded a lower retear rate (6.3%) in medium to large rotator cuff tears.

• Investigative Magnetic Resonance Imaging
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• 제22권4호
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• pp.229-239
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• 2018

Purpose: To assess the diagnostic performance in detecting rotator cuff tears at 3T of non-arthrographic shoulder magnetic resonance imaging (MRI) using 3D isotropic turbo spin-echo (TSE-SPACE) sequence as compared with 2D sequences. Materials and Methods: Seventy-four patients who were arthroscopically confirmed to have underwent non-arthrographic shoulder MRI with 2D sequences and TSE-SPACE were included. Three independent readers retrospectively scored supraspinatus and infraspinatus tendon (SST-IST) and subscapularis tendon (SCT) tears on 2D sequences and TSE-SPACE. Results: The mean sensitivity, specificity, and accuracy of the three readers were 95%, 100%, and 95% on TSE-SPACE and 99%, 93%, and 98% on 2D sequences for detecting SST-IST tears, respectively, whereas those were 87%, 49%, and 68% on TSESPACE and 88%, 66%, and 77% on 2D sequences for detecting SCT tears, respectively. There was no statistical difference between the two sequences, except for in the specificity of one reader for detecting SCT tears. The mean AUCs of the three readers on TSE-SPACE and 2D sequences were 0.96 and 0.98 for detecting SST-IST tears, respectively, which were not significantly different, while those were 0.71 and 0.82 for detecting SCT tears, respectively, which were significantly different (P < 0.05). Conclusion: TSE-SPACE may have accuracy and reliability comparable to conventional 2D sequences for SST-IST tears at non-arthrographic 3T shoulder MRI, whereas TSE-SPACE was less reliable than conventional 2D sequences for detecting SCT tears.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2005년도 제13차 춘계학술대회
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• pp.14-15
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• 2005

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2006년도 제4차 연수강좌
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• pp.122-127
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• 2006

관절와 상완 관절의 후상방의 병적 변화로 통증이 유발되는 internal impingement는 overhead athlete뿐만아니라 nonathlete에서도 비교적 흔한 질환이다. 특징적인 동통, 특정 동작에 악화되는 증상 및 선택적인 검사 및 MRI검사 등을 통해 진단할 수 있으며, 확진은 관절경적 검사에 의한다. 보존적인 치료가 질병초기에는 효과적이다. 만약 증상이 지속 또는 악화된다면 수술적인 치료가 필요하며 다양한 수술적 방법들이 있다. 주 병변에 대한 적극적인 치료가 이루어져야 하며, 전방관절의 microinstability or laxity에 대한 치료, tight posteroinferior capsule에 대한 capsular release 및 동반된 rotator cuff 및 labrum의 병변에 대한 치료가 이루어 져야 한다.