• Clinics in Shoulder and Elbow
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• v.26 no.3
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• pp.287-295
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• 2023

Background: Posterolateral rotatory instability (PLRI) is a common mechanism of recurrent elbow instability. While the essential lesion is a deficiency in the lateral ulnar collateral ligament (LUCL), there are often associated concomitant bony lesions, such as an Osborne-Cotterill lesions (posterior capitellar fractures) and marginal radial head fractures, that compromise stability. Currently, there is no standard treatment for posterior capitellar deficiency associated with recurrent PLRI. Methods: We conducted a retrospective review of five patients with recurrent PLRI of the elbow associated with a posterior capitellar impaction fracture engaging with the radial head during normal range of motion. The patients were treated surgically with LUCL reconstruction or repair and off-label reconstruction of the capitellar joint surface using a small metal prosthesis designed for metatarsal head resurfacing (HemiCAP toe classic). Results: Five patients (three adolescent males, two adult females) were treated between 2007 and 2018. At a median follow-up of 5 years, all patients had complete relief of their symptomatic instability. No patients had pain at rest, but two patients had mild pain (visual analog scale 1-3) during physical activity. Three patients rated their elbow as normal, one as almost normal, and one as greatly improved. On short-term radiographic follow-up there were no signs of implant loosening. None of the patients needed reoperation. Conclusions: Recurrent PLRI of the elbow associated with an engaging posterior capitellar lesion can be treated successfully by LUCL reconstruction and repair and filling of the capitellar defect with a metal prosthesis. This treatment option has excellent clinical results in the short-medium term. Level of evidence: IV.

• Clinics in Shoulder and Elbow
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• v.17 no.4
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• pp.166-174
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• 2014

Background: Our study was to determine the effect on shoulder isokinetic muscle strength and muscle endurance in isolated full-thickness supraspinatus tendon tear and combined other rotator cuff tear. Methods: Total of 81 male patients (mean age $57.8{\pm}7.4$ years) who were diagnosed as a full-thickness supraspinatus tendon tear were included. They were classified into isolated or combined tear. The isokinetic muscle strength and muscle endurance were measured using the Biodex multi-joint system $PRO^{(R)}$ (Biodex Medical Systems, Shirley, NY, USA) in following movements: shoulder abduction, adduction, flexion, extension, external rotation, and internal rotation. Then, the difference in muscle function according to the type of tears were assessed. Fifty-seven patients had isolated supraspinatus tendon (mean age $56.9{\pm}7.3$ years). They were classified into either anteroposterior tear or modified mediolateral tear. The size were measured using T2-weighted magnetic resonance imaging scans in sagittal plane. Results: Between subjects categorized into the type of tear, we found significant inter-categorical differences in isokinetic muscle strength during abduction, adduction, flexion, extension, and internal rotation, and in muscle endurance during flexion, extension, and internal rotation. Anteroposterior diameter tear, we did not show significant differences in either isokinetic muscle strength or muscle endurance during any movements. However, with modified mediolateral diameter, we found significant differences with isokinetic muscle strength during adduction, and in muscle endurance the external rotation and internal rotation. Conclusions: We found that a supraspinatus tendon tear associated with more numbers of rotator cuff tears has lower isokinetic muscle strength and muscle endurance than a tear found alone.

• Journal of The Korean Society of Integrative Medicine
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• v.12 no.2
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• pp.47-53
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• 2024

Purpose : This study investigated the effects of concentric and eccentric contractions on muscle strength using an isokinetic dynamometer (ID) in college students in their 20s. It aimed to understand the impact of differences between the dominant and non-dominant sides on strength asymmetry and to elucidate the clinical implications of these differences to establish an appropriate posture and environment for patients. Methods : The experiment was conducted with 30 healthy adult participants. Prior to the experiment, participants underwent a warm-up targeting the shoulders, and efforts were made to eliminate factors that could potentially influence the measurement results. Subsequently, the maximum safe range of motion of shoulder joint abduction, extension, and flexion was measured using an isokinetic muscle function testing device. Muscle strength was assessed using concentric and eccentric contractions alternating between the dominant and non-dominant sides, and paired sample t-tests were used for the analysis. Results : There was no significant difference between bilateral peak torques for eccentric contraction in shoulder joint abduction, extension, and flexion (p>0.05). There was also no significant difference between bilateral peak torques for concentric contraction in shoulder joint abduction, extension and flexion (p>0.05). Conclusion : This study found no statistically significant difference in muscle strength between the dominant and non-dominant sides during concentric and eccentric contractions. However, previous studies have shown significant differences between the dominant and non-dominant sides during eccentric and concentric contractions during internal shoulder rotation in the general population, as well as significant differences in the upper trapezius muscle. Therefore, further research is needed to support the application of different intensities for bilateral muscle strengthening exercises in clinical practice.

• Journal of muscle and joint health
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• v.13 no.1
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• pp.31-42
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• 2006

Purpose: The purpose of this study was to identify the effects of aquatic exercise program on physical fitness, pain and physiological function in patients with osteoarthritis. Method: The subjects of the study were thirty women(age: forty-seventy five) who have an osteoarthritis. Aquatic exercise program consist of approximately two hours of exercise in water, two days per week, for six weeks. Data were gathered from April 19 2005 to May 27 using a questionnaire and measuring physical fitness and physiological index. Data were analyzed with the SPSS Win 12.0 using frequency and paired t-test for difference between pre-exercise and post-exercise. Results: The results of this study were as follows: There were significantly increased on left shoulder (t=3.848, p=.001) and waist flexibility(t=-5.622, p=.001) scores. There were significantly decreased on pain score(t=5.288. p=.000), body weight(t=5.072, p=.001), systolic B.P(t=18.362, p=.001), diastolic B.P(t=32.558, p=.001), blood sugar(t=1.805, p=.041), total cholesterol(t=2.032, p=.026) scores. Conclusion: From these results, it is concluded that the aquatic exercise program can be effective in increasing physical fitness, physiological function and decreasing pain in patients with osteoarthritis.

• Radiation Oncology Journal
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• v.23 no.1
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• pp.32-42
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• 2005

Purpose : To evaluate the incidence of arm morbidity following breast cancer surgery including axillary dissection and to identify related factors. Materials and Methods : One hundred and fifty nine patients were studied using a self-report questionnaire and a clinical examination. Lymphedema, reduction of range of motion in shoulder joint and subjective symptoms (pain, impaired arm movement, numbness, stiffness) were evaluated. As related factors, demographic, oncologic characteristics and types of treatment were analysed. Results : The incidence of lymphedema ($\geqq$2 cm difference comparing to unaffected arm) was $6.3\%$, $10.7\%$, $22.5\%$ and $23.3\%$ at each 10 cm, 20 cm, 30 cm, and 40 cm from wrist. Reduction of range of motion in shoulder joint ($\geqq$ 20 degree difference comparing to unaffected arm) was noted In more than 1/3 patients for flexion, abduction and internal rotation. Especially the reduction of range of motion in internal rotation was severe ($>50\%$ reduction) in 1/3 patients. Approximately 50 to $60\%$ of patients complained impaired arm movement, numbness, stiffness and pain. Body mass index (BMI) was the significant risk factor for lymphedema. Conclusion : Lymphedema was present in 1/3 of patients and the common sites of edema were 30 cm 40 cm proximal from the wrist. Also most severe reduction of range of motion in shoulder joint was with internal rotation. There needs weight control for lymphedema because BMI was the significant risk factor for lymphedema. Also rehabilitation program for range of motion especially internal rotation In shoulder joint should be developed.

• Clinics in Shoulder and Elbow
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• v.25 no.1
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• pp.22-27
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• 2022

Background: In some patients with rotator cuff tear (RCT), the axial view of magnetic resonance imaging (MRI) shows subtle posterior decentering (PD) of the humeral head from the glenoid fossa. This is considered to result from a loss of centralization that is typically produced by rotator cuff function. There are few reports on PD in RCT despite the common occurrence of posterior subluxation in degenerative joint disease. In this study, we investigated the effect of PD in arthroscopic rotator cuff repair (ARCR). Methods: We conducted a retrospective study of consecutive patients who underwent ARCR at our institute and were followed-up for at least 1 year. PD was identified as a 2-mm posterior shift of the humeral head relative to the glenoid fossa in the axial MRI view preoperatively. The tear size and fatty degeneration (FD, Goutallier classification) were also evaluated using preoperative MRI. Retears were evaluated through MRI at 1 year postoperatively. Results: We included 135 shoulders in this study. Ten instances of PD (including seven retears) were observed preoperatively. Fifteen retears (three and 12 retears in the small/medium and large/massive tear groups, respectively) were observed postoperatively. PD was significantly correlated with tear size, FD, and retear occurrence (p<0.01 each). The odds ratio for PD in retears was 34.1, which was greater than that for tear size ≥3 cm and FD grade ≥3. Conclusions: We concluded that large tear size and FD contribute to the occurrence of PD. Furthermore, PD could be a predictor of retear after ARCR.

• Clinics in Shoulder and Elbow
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• v.26 no.1
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• pp.64-70
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• 2023

Background: This study aimed to analyze the efficacy of single-dose corticosteroid injection (CSI) administered at 6 weeks postoperative to treat stiffness following arthroscopic rotator cuff repair (ARCR). Methods: In this prospective, multicentric, case-control study, post-ARCR stiffness at 6 weeks was treated with either a single dose of intra-articular CSI (CSI group) or physical therapy with oral analgesics (non-CSI group). Pain intensity according to visual analog scale (VAS), functional outcome using the Constant Murley Shoulder Score, time to return to activities of daily living (ADLs), and retear rate were recorded at 6 weeks, 9 weeks, 12 weeks, 6 months, 12 months, and 18 months postoperatively in both groups. Results: A total of 149 patients (54.5%) in the CSI group and 124 patients (45.5%) in the non-CSI group were included in this study. Pain and function were significantly better in the CSI group at 9-week, 12-week, and 6-month (P<0.001) follow-up, whereas they were not significantly different when the groups were compared at 12- and 18-month follow-up. The mean duration to return to ADLs was significantly shorter (P<0.001) in the CSI group. The incidence of retears was not significantly different (P=0.36) between groups at the end of 18 months of follow-up. Conclusions: Single-dose intra-articular CSI administered at 6 weeks postoperative to treat post-ARCR stiffness significantly improved pain, function, and duration of return to ADLs without increasing the risk of retears compared to patients who did not receive intra-articular CSI. Level of evidence: III.

• Journal of the Korean Society of Physical Medicine
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• v.11 no.3
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• pp.49-54
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• 2016

PURPOSE: This study was implemented to measure the muscle activity of muscles surrounding shoulder during push-up exercise according to the slope angle. METHODS: This study has research subject consisting of 25 normal male adults without neurologic or musculoskeletal injury in shoulder part. EMG was used as a tool for measuring muscle activity and four muscles including upper trapezius (UT), middle trapezius (MT), Lower Trapezius (LT), and Serratus Anterior (SA) were chosen for measuring the muscle activity of muscles surrounding shoulder. Tilting table slope was set at $0^{\circ}$, $30^{\circ}$, $45^{\circ}$, and $60^{\circ}$ and push-up motion was performed three time for each case to use the average value. The measured value was used after generalization process to create %RVC value where the measured value was standardized by using $0^{\circ}$ as a standard. RESULTS: There was a difference of muscle activity according to the tilting table slope during push-up exercise. In UT, MT, and SA, there was no significant $0^{\circ}$ and $30^{\circ}$, $45^{\circ}$ and $60^{\circ}$. But there was significant $30^{\circ}$ and $45^{\circ}$. LT was significant difference between $45^{\circ}$ and $60^{\circ}$ (p<.05). CONCLUSION: There are cases where push-up exercise should be selectively implemented due to shoulder problems. According to this results between $0^{\circ}$ and $30^{\circ}$, push up will be able to more effectively exercise. Applying proper angle of tilting table for push-up to patients who have difficulties in performing motions along with physical consumption can deliver effective and easy exercise program.

• Clinics in Shoulder and Elbow
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• v.11 no.1
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• pp.19-23
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• 2008

Purpose: To evaluate the bursoscopic findings of refractory primary adhesive capsulitis of the shoulder and to determine the clinical correlation. Materials and Methods: Arthroscopic capsular release was performed in 21 refractory adhesive capsulitis patients who had not responded to conservative treatment. The VAS for pain, range of motion, UCLA score was checked before and after surgery, and at the last follow up. Results: Bursitis, mild friction and impingement on coracoacromial ligament, as well as adhesion were observed. The function and pain improved earlier than after simple acromiohumeral joint capsular release. Conclusion: Subacromial bursoscopy helps rule out a hidden secondary frozen shoulder or secondary changes with primary adhesion. In addition, it has the advantage of being both a treatment and procedure for making a prognosis.

• Clinics in Shoulder and Elbow
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• v.17 no.2
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• pp.50-56
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• 2014

Background: To assess the clinical outcomes of short-term oral corticosteroid therapy for impingement syndrome of the shoulder and determine whether it can be substituted as an alternative to the intra-articular injection. Methods: The clinical outcomes of the 173 patients, the oral steroid group (n=88) and the injection group (n=85), were measured at 3 weeks, 2, 4, and 6 months postoperatively. The clinical outcomes were assessed by measuring the the University of California at Los Angeles (UCLA) score, visual analog scale (VAS) and range of motion (ROM) at every follow-up. Any complications and recurrence rate were noted. A relationship between the treatment outcomes and factors such as demographic factors, clinical symptoms and radiographic findings were determined. Results: No difference was observed in VAS and UCLA scores between the two groups, but forward flexion and internal rotation of ROM were significantly improved in the injection group at the 2nd and 4th postoperative month (p < 0.05). At 6th postoperative month, recurrence rate of symptoms was 26% in the oral steroid group and 22% in the injection group. No major adverse effects were observed. When the clinical outcomes of the oral steroid group were compared to either demographic, clinical symptoms, or radiographic findings, UCLA score was found to be significantly low (p < 0.05) in patients with joint stiffness and UCLA score, whereas VAS score was significantly improved in patients with night pain (p < 0.05). Conclusions: Short-term low-dose oral corticosteroid therapy of impingement syndrome showed comparable clinical outcomes to intra-articular injection without any remarkable adverse effects. Low-dose oral steroids can be regarded as a partial alternative to intra-articular injection for the initial therapy of impingement syndrome of the shoulder.