• Clinics in Shoulder and Elbow
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• 제16권2호
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• pp.148-152
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• 2013

관절 관절경으로 수술적 치료를 시행한 후 전방 및 후방 골간 신경 증후군이 동시에 발생한 1예를 보고하고자 한다. 45세 남자 환자가 좌측 견관절의 불안정성으로 견관절 관절경 수술을 시행받았다. 전신 마취하 우측 측와위 자세에서 전완부를 신전한 상태에서 견인 장치를 부착한 상태로 2시간 동안 수술을 시행하였다. 1주일 후 환자는 좌측 전완부 동통, 수지의 신전력 및 무지와 인지의 심수지 굴근력의 저하로 외래를 방문하였다. 경과 관찰하였으나 증상이 지속되어 전방 골간 신경에 대해서는 신경 탐색술을 시행하였고 후방 골간 신경에서는 모래 시계 모양의 협착 소견이 발견되어 병변 절제 후 신경 외막 봉합술을 시행하였다. 수술 후 약 5개월간 외래에서 경과 관찰하였다. 신경 탐색술을 시행하고 3개월 후 총수지 신근의 기능이 회복하기 시작하였으며, 점차 회복하여 신경 탐색술 후 5개월째 증상이 완전히 회복되었다. 견관절 관절경 수술 후 전방 및 후방 골간 신경 증후군의 발생은 드물지만 견인 장치 및 수술 중 자세에 의해 유발될 수 있다. 따라서 견인 장치 부착 및 수술 자세에 대해 술자의 주의가 필요하다고 생각한다.

• Clinics in Shoulder and Elbow
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• 제26권4호
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• pp.455-461
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• 2023

Arthroscopic shoulder procedures are one of the most common procedures used to restore function through minimally invasive techniques. With the demand for shoulder arthroscopic procedures comes the need for safe, effective, and efficient surgery that maximizes patient outcomes while minimizing complications. Many variables contribute to visualization in shoulder arthroscopy including vascular anatomy, blood pressure control, arthroscopic pump systems, turbulence control, epinephrine, and tranexamic acid. Furthermore, patient positioning can have a dramatic effect on visualization with both the beach chair position and lateral decubitus positioning having various strengths and weaknesses depending on the intended procedure being performed. The purpose of this review is to examine the benefits and complications reported in the literature for improving visualization in shoulder arthroscopy.

• 대한통합의학회지
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• 제11권4호
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• pp.213-220
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• 2023

Purpose : The purpose of this study is to investigate the effect of each lower trapezius muscle exercise performed according to the abduction position (Y type - shoulder joint abduction 145 °, T type - shoulder joint abduction 90 °, and MPC type - shoulder joint 45 ° abduction) of the shoulder joint on the muscle activity of the round shoulder and lower trapezius muscle. Methods : This study was conducted on 31 adult men and women. Through random assignment, they were assigned to the Y group, T group, and MPC group. A 4-week intervention was performed for each group of 31 subjects who participated in the experiment, and shoulder height and lower trapezius muscle activity were measured before and after the intervention. Shoulder height measurement is a test to measure rounded shoulder posture. When the value is low, it means that rounded shoulder posture is improved. The muscle activity of the lower trapezius muscle was measured using the %MVIC method, and when the value is high, it means that the lower trapezius muscle is active. All measured data were verified using dependent t-tests for before and after comparisons and one-way analysis of variance for comparisons between groups. Results : The results of this study showed a significant decrease after intervention only in shoulder height. Muscle activity of the lower trapezius muscle decreased after intervention, but did not show a significant difference. Both variables showed no significant differences between groups. Conclusion : The results of this study show that three lower trapezius muscle exercises were performed on subjects in rounded shoulder posture. All three groups showed a significant decrease in the shoulder height value, a method of measuring rounded shoulder posture, and no significant differences between groups could be confirmed. Therefore, all three exercises can be considered effective in reducing shoulder posture.

• 국제물리치료학회지
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• 제2권1호
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• pp.229-236
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• 2011

The purpose of this study was to comparatively analyze the active stability of shoulder joints according to the frequency of overhead motions, such as serving and spiking, engaged in by female professional volleyball athletes who play different positions, and to provide the results as the basic data for developing exercise programs to prevent shoulder joint injuries. The subjects of this study were 50 Korean female professional volleyball players and positions were as follows: left and right attackers, centers, setters, and liberos. The external rotation and internal rotation muscle strength and muscle strength ratios of the dominant and non-dominant arms of all subjects were measured using Biodex. The results of this study are as follows: Frist, no significant differences were found in the internal and external rotation muscle strength of the dominant and non-dominant arms between positions. Second, for the shoulder joint muscle strength ratio of the dominant arm, by position, the setter showed significantly greater stability compared to the other positions. Third, for the shoulder joint muscle strength ratio of the non-dominant arm, by position, no significant difference in stability between positions was found. Fourth, it was found that the dominant arm had significantly greater instability of the shoulder joint than the non-dominant arm for attackers and centers, but no significant difference was found for setters and liberos. This study comparatively analyzed the muscle strength ratios of the external/internal rotations and dominant/non-dominant arms, which can determine the stability of the shoulder joints between female professional volleyball playing positions that engage in jumps and spikes using only the dominant hand and positions that do not.

• 한국전문물리치료학회지
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• 제29권2호
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• pp.106-116
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• 2022

Background: Shoulder external rotation exercises are commonly used to improve the stabilizing ability of the infraspinatus. However, during exercise, excessive activation of the posterior deltoid compared to the infraspinatus causes the humeral head to move anteriorly in an abnormal position. Many researchers have emphasized selective activation of the infraspinatus during shoulder external rotation exercise. Objects: This study aims to delineate the optimal exercise method for selective activation of infraspinatus by investigating the muscle activities of the infraspinatus and posterior deltoid according to the four shoulder exercise methods and two forearm positions. Methods: Thirty healthy individuals participated in this study. The participants were instructed to perform shoulder external rotation exercises following four exercise methods: sitting external rotation (SIER); standing external rotation at 90° abduction (STER); prone external rotation at 90° abduction (PRER); side-lying external rotation (SLER), and two forearm positions (neutral, supinated). The electromyography (EMG) signal amplitude was measured during each exercise. Surface EMG signals were recorded from the posterior deltoid, infraspinatus, and biceps brachii. Results: EMG results of the infraspinatus and posterior deltoid in PRER, were significantly higher than that of the other exercises (p < 0.01). The EMG ratio (infraspinatus/posterior deltoid) in SIER was significantly higher than that of the other exercises. EMG activation of the posterior deltoid in SIER, PRER, and SLER was significantly higher in neutral than in supinated (p < 0.01). Furthermore, the EMG of the infraspinatus in SIER was significantly higher in neutral than in supinated (p < 0.01). The EMG ratio (infraspinatus/ posterior deltoid) in SIER was significantly higher in neutral than in supinated (p < 0.05.) Contrarily EMG ratios in PRER and SLER were significantly higher in supinated than in neutral (p < 0.05). Conclusion: The results show that clinicians should consider these exercise methods and forearm positions when planning shoulder external rotation exercises for optimal shoulder rehabilitation.

• Clinics in Shoulder and Elbow
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• 제3권2호
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• pp.95-101
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• 2000

Purpose : The purpose of this study was to evaluate the efficacy of oblique coronal MR images, oblique axial images of neutral, internal rotation and external rotation positions in the diagnosis of SLAP Ⅱ lesion. Materials and Methods: MR arthrography of the glenohumeral joint was evaluated retrospectively in 16 patients(16 shoulders) who underwent arthroscopic surgery(mean age; 38 years old, Male; 13, Female; 3). Oblique coronal fat-suppressed Tl-weighted spin echo images were performed with each shoulder in the neutral position of the arm and oblique axial images were performed in neutral, internal and external rotations of the arm respectively. The preoperative findings of MR were classified as definite tear, possible tear and no tear. Arthroscopic findings were correlated with MR findings of several different position of the arm. Results: Arthroscopic surgery revealed 8 SLAP Ⅱ lesion, 2 SLAP I lesion, and 6 normal superior labrum respectively. The accuracy of diagnosis in the 8 SLAP Ⅱ lesion were high on oblique axial image in external rotation which were interpreted as 8 definite tear, to compare with oblique axial images in neutral position which were interpreted as 4 definite tear, 3 possible tear, 1 no tear. The 6 normal superior labrum lesion were interpreted as no tear in all three position. The 2 SLAP I lesion were interpreted as 1 definite tear, 1 no tear on oblique axial image in neutral position and 1 definite tear, 1 possible tear on oblique axial image in external rotation. Conclusion: This study showed that axial MR images in external rotation of the arm combined with oblique coronal images have proved to be effective to detect SLAP Ⅱ lesion, and should be considered in imaging protocol for MR arthrography of the SLAP Ⅱ lesion.

• 대한방사선기술학회지:방사선기술과학
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• 제32권3호
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• pp.253-259
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• 2009

연구목적 : 편마비 환자에 있어 견부 아탈구 진단에 유용한 촬영법을 알아보고, 편마비 상태를 고려한 촬영방법을 알아보고자 하였다. 연구방법 : 뇌졸중으로 인한 편마비 환자 중 마비측 견관절 부위의 견봉 끝과 상완골두 사이가 1 수지폭 이상인 33명의 환자를 대상으로 견관절 전후방향촬영은 누운 자세와 앉은 자세의 영상을 비교하였고, 흉곽을 통한 상완골 측방향 촬영은 앉은 자세에서 건측과 환측의 영상을 비교하였다. 축방향 촬영은 누운 자세에서 건측과 환측을 비교하였고, 상완골두의 중심, 관절와의 중심, 견봉의 최하외측단의 3가지 기준점으로 거리를 측정하여 평균비교 분석(t-test)을 시행하였다. 연구결과 : 대상자를 누운 자세에서 앉히고 견관절 자연지위를 취한 후 견관절 아탈구가 되기까지의 시간은 평균 123초였다. 견관절 전후 방향 촬영에서 상완골두의 중앙점과 견봉의 최하외점과의 거리가 누운 자세에서는 평균 $49.90{\pm}13.6\;mm$이었고, 앉은 자세에서는 $60.72{\pm}16.3\;mm$이로 유의한 차이가 있었다. 흉곽을 통한 측방향 촬영에서는 환측 $35.92{\pm}6.2\;mm$, 건측 $28.76{\pm}5.4\;mm$으로 유의한 차이가 있었다. 누운 자세의 견관절 축방향 촬영에서는 건측과 환측 각각 $23.01{\pm}9.0\;mm$, $22.45{\pm}8.2\;mm$로 유의한 차이가 없었다. 결론 : 견관절 아탈구 진단을 위한 견관절 촬영은 촬영 전 수지폭 검사를 통해 아탈구가 진행됨을 확인한 후 촬영을 하여야 진단적 가치가 있다. 이를 위해 앉은 자세에서 견관절 자연지위로 120초 지난 후 촬영을 하여야 한다. 또한 견관절 전후방향 영상과 흉곽을 통한 측방향 촬영은 아탈구를 평가하는데 유효하였고, 견관절 축방향에서는 아탈구의 차이가 없으므로 진단적 가치가 떨어진다고 볼 수 있다.

• The Journal of Korean Physical Therapy
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• 제34권1호
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• pp.6-11
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• 2022

Purpose: This study investigated the muscle activity of the lower trapezius (LT) during three different shoulder flexion exercises. Methods: Twenty-three subjects between 20 and 25 years of age were enrolled. The subjects were asked to perform three different shoulder flexion exercises: 1) shoulder flexion in prone (SFP), 2) shoulder flexion in push-up with a swiss ball (SFPUS) and 3) shoulder flexion in a quadruped position with a swiss ball (SFQPS) in random order. The muscle activity of LT during each shoulder flexion exercise was measured by using surface electromyography. The muscle activity of LT was compared using one-way analysis of variance (ANOVA) and Bonferroni post hoc test among three different shoulder flexion exercises. The statistical significance level was set at α=0.01. Results: The muscle activity of LT was significantly different among three different shoulder flexion exercises (SFP, SFPUS, and SFQPS). The LT muscle activity with SFQPS exercise was greater than SFP and SFPUS exercises (p<0.01). There was no significant difference in LT muscle activity between SFP and SFPUS exercises (p>0.01). Conclusion: The LT muscle activity was greater during SFQPS than SFP and SFPUS. Therefore, SFQPS exercise can be recommended for selectively activation of LT muscle.

• 대한통합의학회지
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• 제7권3호
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• pp.109-115
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• 2019

Purpose : The purpose of this study was to investigate the activity of muscles around the scapulothoracic muscles according to the angle of shoulder joint abduction in the prone position. Methods : The participants included 15 adult males who had not undergone orthopedic surgery and did not have shoulder joint impairments. We measured the muscle activity of the upper trapezius, middle trapezius, lower trapezius, and serratus anterior at $120^{\circ}$, $90^{\circ}$, and $60^{\circ}$ shoulder joint abduction angles. Results : There was a significant difference in the comparison of muscle activity in the upper trapezius, middle trapezius, and serratus anterior muscles according to the shoulder joint abduction angle (p<.05). The results of the post test showed that the upper trapezius was significantly different between $120^{\circ}$ and $60^{\circ}$ (p<.01), and the middle trapezius was significantly different between $90^{\circ}$ and $120^{\circ}$, and between $90^{\circ}$ and $60^{\circ}$ (p<.05). There was a significant difference in the serratus anterior between $120^{\circ}$ and $90^{\circ}$ (p<.01), and $120^{\circ}$ and $60^{\circ}$ (p<.01). Conclusion : The results of this study could be used to determine an effective shoulder joint abduction angle to reduce muscle activity of the upper trapezius and increase muscle activity of the middle trapezius, lower trapezius, and serratus anterior.

• 대한물리치료과학회지
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• 제31권1호
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• pp.33-45
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• 2024

Background: This study aimed to investigate the effect of elastic band-resistive exercise using audio-visual medium on pain, proprioception, and motor function in adults with chronic neck and shoulder pain. Design: One group pretest-posttest follow-up experimental design. Method: Twenty adult women with neck and shoulder pain voluntarily participated in this study. Elastic band-resistive exercise using audio-visual medium including cervical flexion and extension, shoulder external rotation, and scapular retraction-protraction motions was conducted 5 times a week for 3 weeks. The Numerical Rating Scale, pressure threshold tool, CROM goniometer, and Image J software were used to assess subjective pain level, tenderness threshold (pain), joint position sense error (proprioception), joint range of motion, and postural alignment (motor function), respectively. Result:: The pain intensity and threshold and joint position sense error showed significant decreases after the intervention, whereas the joint range of motion angle revealed significant increases. The postural alignment including forward head posture and rounded shoulder revealed significant improvements after the intervention. Conclusions: Therefore, we suggest that elastic band-resistive exercise through audio-visual medium would be helpful in preventing and managing pain and physical dysfunction in individuals with chronic neck and shoulder pain, and then it would support the development of health management-related online education content.