• Clinics in Shoulder and Elbow
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• 제11권2호
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• pp.185-188
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• 2008

견봉-쇄골 관절 손상은 흔히 견관절 상외측에서의 직접적인 외상으로 발생한다. Rockwood 제4형 손상은 상대적으로 드물게 생기며, 다발성 외상 환자의 경우 타 손상으로 쉽게 잘못 진단되어지거나 간과되어지는 경우가 있다. 제 4형 손상 환자의 잘못된 치료를 피하기 위해서는 견봉-쇄골 관절의 세심한 이학적 검사와 적절한 방사선학적 검사가 필요하다. 이에 저자들은 다발성 늑골 골절이 동반된 제 4형 견봉-쇄골 관절 손상을 초기에 진단하지 못하고 간과한 2예를 변형 Weaver-Dunn 재건술로 치료하였기에 문헌 고찰과 함께 보고하고자 한다.

• Clinics in Shoulder and Elbow
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• 제2권1호
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• pp.35-40
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• 1999

Impingement syndrome is caused by a conflictual status between rotator cuff, subacromial bursa and anatomic and functional coracoacromial arch. The purpose of this study was to assessment the coracoacromial arch by MRI and to determine major factors among five components of coracoacromial arch. We analyzed forty-two cases of clinical impingement sign and test positive and postoperative confirmed diagnosed from March, 1991 to January, 1999. We evaluated acromial end abnormality according to the Bigliani acromial type and formation of osteophyte. Clavicular end abnormality classified flat, outward protrusion, inward protrusion to coracoacromial arch. Acromioclavicular joint abnormalities were advanced osteoarthritis and positive signal change. Coracoacromial ligament thickening was above 2 mm in oblique sagittal image. Coracoid process abnormality was inward protrusion to coracoacromial arch. All consecutive patients abnormalities were as follows: clavicular end osteophyte formation and inward protrusion to coracoacrmial arch were 30%, acromial end osteophyte formation was 28%, advanced acromioclavicular joint arthritis and osteophyte formation were 56%, coracoacromial ligament thickening was 24% and no coracoid process inward protrusion to coracoacromial arch. Impingement syndrome combined with rotator cuff tear group abnormalities were clavicular end(40%), acromial end(40%), acromioclavicular joint(20%), coracoacromialligament(20%) and coracoid process abnormality(0%) respectively. Only impingement syndrome group abnormalities were clavicular end(25%), acromial end(31%), acromioclavicular joint(62%), coracoacromial ligament(25%) and coracoid process(0%) respectively. Acromial type I(flat) were 6 cases, type II(curved) were 26 cases and type III(hooked) were 10 cases. We concluded that the most important contributing factors for impingement syndrome was acromial type and second was acromioclavicular joint arthritis and bony spur formation.

• Clinics in Shoulder and Elbow
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• 제27권1호
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• pp.11-17
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• 2024

Background: Rotator cuff tears are often associated with synovitis, but the ability of noninvasive ultrasonography to predict the severity of synovitis remains unclear. We investigated whether ultrasound parameters, namely peak systolic velocity in the anterior humeral circumflex artery and Doppler activity in the glenohumeral joint and subacromial space, reflect synovitis severity. Methods: A total of 54 patients undergoing arthroscopic rotator cuff repair were selected. Doppler ultrasound was used to measure peak systolic velocity in the anterior humeral circumflex artery and Doppler activity in the glenohumeral joint and subacromial space, and these values were compared with the intraoperative synovitis score in univariate and multivariate analyses. Results: Univariate analyses revealed that tear size, peak systolic velocity in the anterior humeral circumflex artery, and Doppler activity in the glenohumeral joint were associated with synovitis in the glenohumeral joint (P=0.02, P<0.001, P=0.02, respectively). In the subacromial space, tear size, peak systolic velocity in the anterior humeral circumflex artery, and Doppler activity in the subacromial space were associated with synovitis severity (P=0.02, P<0.001, P=0.02, respectively). Multivariate analyses indicated that tear size and peak systolic velocity in the anterior humeral circumflex artery were independently associated with synovitis scores in both the glenohumeral joint and the subacromial space (all P<0.05). Conclusions: These findings demonstrate that tear size and peak systolic velocity in the anterior humeral circumflex artery, which can both be measured noninvasively, are useful indicators of synovitis severity.

• Clinics in Shoulder and Elbow
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• 제21권2호
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• pp.75-81
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• 2018

Background: We investigated the resolution of pain and functional recovery of shoulder after arthroscopic removal of calcific deposits in patients with chronic calcific tendinitis. Methods: We enrolled 39 patients who were treated arthroscopically for chronic calcific tendinitis that had been non-responsive to at least 6 months of conservative treatment. We evaluated clinical outcome in terms of the American Shoulder Elbow Surgeons (ASES), the Constant score, the visual analogue score (VAS) for pain. We used plain radiography to measure the size of the calcific deposits. We also analyzed the clinical outcomes in terms of whether or not a cuff repair was performed or the degree of removal of calcific deposits. Results: We found that complete resolution of pain took on average 5.7 months after the arthroscopic treatment. The ASES and the Constant score significantly improved from the 3-month follow-up, however it took 6 months until the scores reached on average 80 points or above. We found that these clinical outcomes at the final follow-up did not significantly differ by whether or not cuff repair was performed. Similarly, we found that the clinical outcomes did not significantly differ by the degree of calcium removal. Conclusions: We found that arthroscopic removal of calcification leads to improved clinical outcomes in patients with chronic calcific tendinitis. However, our findings show it takes at least 6 months for the clinical improvement to become statistically significant. We also found that concomitant cuff repairs or the degree of removal of calcification does not affect the clinical outcome of the arthroscopic treatment.

• Clinics in Shoulder and Elbow
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• 제25권2호
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• pp.101-105
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• 2022

Background: Rotator cuff tears cause pathologies of the long head of the biceps tendon (LHBT). One of the surgical treatments for such a tear is LHBT tenodesis to the humerus. This study aims to compare simultaneous rotator cuff repair and LHBT tenodesis with or without detachment of the proximal end of the LHBT (PELHBT) from its site of adhesion to the glenoid. Methods: This retrospective study involved patients affected by LHBT pathology with rotator cuff tear. The patients were divided into two groups, with or without PELHBT detachment from the glenoid. Therapeutic outcomes were investigated by evaluation of patient satisfaction, pain based on visual analog scale, shoulder function based on Constant score and simple shoulder test, and biceps muscle strength based on the manual muscle testing grading system before surgery, at 6 months, and at the final visit after surgery. Results: Groups 1 and 2 comprised 23 and 26 patients, respectively, who showed no significant differences in demographic characteristics (p>0.05). Shoulder function, biceps muscle strength, pain, and satisfaction rate improved over time (p<0.05) but were not significantly different between the two groups (p>0.05). No post-surgical complication was found in either group. Conclusions: There was no difference in final outcomes of tenodesis with or without detachment of the PELHBT from the supraglenoid tubercle. Such tendon detachment is not necessary.

• International Journal of Contents
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• 제10권3호
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• pp.90-95
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• 2014

The purpose of this study was to analyze the changes in muscle fatigue by using electromyography (EMG) measurements of the median frequency of shoulder muscles of patients who underwent rotator cuff repair, and to provide basic data for efficient exercise methods during rehabilitation after the repair. In the study, 24 male and 8 female patients who underwent rotator cuff repair performed continuous passive shoulder joint motion for 3 weeks and the median frequency of their shoulder muscles before and after the repair were compared using measurements by EMG. The infraspinatus, supraspinatus, and serratus anterior muscles showed significant differences in the changes in the median frequency before and after the repair. Significant differences were also found in the median frequency of the three muscles both before and after the repair. Additionally, the middle deltoid muscle had a lower median frequency than the supraspinatus muscle before the repair and the infraspinatus muscle had a lower median frequency than the middle deltoid muscle after the repair. It is expected that these results will serve as important data in developing rehabilitation exercise programs for the infraspinatus, supraspinatus, and serratus anterior muscles by compensating the middle deltoid muscle with the lowest muscle fatigue after the rotator cuff repair erase.

• Journal of Chest Surgery
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• 제48권2호
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• pp.151-154
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• 2015

Extensive tumoral calcinosis affecting a large joint is uncommon in patients with systemic sclerosis. We report the case of a 52-year-old female patient referred for a growing calcified mass in the shoulder. She was diagnosed with interstitial lung disease and progressive systemic sclerosis. Although the pain and disability associated with the affected joint was not severe, the patient underwent surgical excision because the mass continued to grow and was likely to produce shoulder dysfunction and skin ulceration. The patient appeared well 10 months after surgery with no signs of recurrence. This report highlights the timing and indication of surgical excision in similar cases.

• Clinics in Shoulder and Elbow
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• 제6권2호
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• pp.115-126
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• 2003

Although painful conditions of varying degrees of severity involving the soft tissues (i .e., muscles, tendons, ligaments, periosteum and peripheral nerves) occur frequently, their underlying pathogenesis is poorly understood. The term peripheral neuropathic pain has recently been suggested to embrace the combination of positive and negative symptoms in patients whose pain is due to pathological changes or dysfunction in peripheral nerves or nerve root. The spinal nerve root, because of its vulnerable position, is very easily prone to injury from pressure, stretch, angulation, and friction. Therefore, not a few of musculoskeletal chronic pains are result of nerve root dysfunction. Neuropathic changes due to nerve root dysfunction are primarily in soft tissue especially muscle, tendon and joint. It shows tenderness over muscle motor points and palpable muscle contracture bands and restricted Joint range. Careful palpation and physical examination is the important tool that, be abne to detect all of these phenomena.

• Clinics in Shoulder and Elbow
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• 제13권1호
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• pp.92-98
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• 2010

목적: 견봉 쇄골 관절 손상의 치료 방법으로서 Clavicle hook plate를 이용한 고정술의 결과를 분석하였다. 대상 및 방법: 2008년 2월부터 2010년 4월까지 본원에서 견봉 쇄골 관절 탈구로 Clavicle hook plate를 이용한 고정술을 시행하였던 18예를 대상으로 하였다. 제 3형의 견봉 쇄골 관절 손상이 7예, 제 5형이 11예였으며, Clavicle hook plate는 수술 후 3개월 이후에 제거하였다. 치료 결과의 판정은 스트레스 부하 방사선 촬영을 하여 건측과 비교하였고 Korean shoulder scoring system 및 American shoulder elbow society score를 이용하여 견관절의 기능과 환자의 만족도를 평가하였다. 평균 추시 기간은 9개월이었다. 결과: 스트레스 부하 방사선 사진에서 오구 쇄골 간격이 건측에 비해 수술 전 평균 114% 증가되어 있었으나 수술 후 최종 추시 시 23%로 감소하였으며, Korean shoulder scoring system은 평균 80점이었고 American shoulder elbow society score는 평균 74점이었다. 결론: 견봉 쇄골 관절 손상의 Clavicle hook plate를 이용한 고정 시 충분한 관절 안정성으로 조기 재활이 가능하며, 방사선학적 및 기능적으로도 비교적 만족할만한 결과를 얻을 수 있어 수술적 치료에 있어 유용한 방법 중 하나라고 사료된다.

• Journal of Oral Medicine and Pain
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• 제20권2호
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• pp.257-267
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• 1995

An Epidemiologic study was carried out on 77 TMD patients with degenerative joint disease who had visited the Orofacial Pain Clinic in Pusan National University Hospital. Al subjects were interviewed and examined clinically and radiologically using a standardized examination form. As related to gender and duration, subjective and objective sysmptoms in DJD patients were studied. The obtained results were as follows : 1. There were much more patients in the twenties or thirties, women and histories such as chronic duration and microtrauma. 2. Most patients responded positively more often to the questions of jaw function, unilateral chewing in habits, poot appetite and depression in behavioral response and shoulder pain in worsening prognosis 3. While the most common reasons for treatment were pain, noise, and limitation of opening, the associated symptoms such as headache, neckache, earache, jaw dysfunction, neck dysfunction, acute bite change and dizziness, ringing or fullness in the ears as secondary CNS excitatory effects were complained. 4. Opening the mouth in 25 to 40mm, soft end feel and deflective incisal pathway were seen and more tenderness to lateral or dorsal capsule of joint than intra or extra oral muscles were complained. 5. While there appeared no click, crepitus and single click in acute group, in chronic group, crepitus, single click and no click appeared in order of sequence. 6. Tomogram or bone scan revealed more bony changes than panorama and transcranial view.