• Clinics in Shoulder and Elbow
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• v.21 no.4
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• pp.234-239
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• 2018

Background: In elbow fracture-dislocation, partial excision of the comminuted radial head fracture that is not amenable to fixation remains controversial considering the accompanying symptoms. This study was undertaken to evaluate the results of radial head partial excision when the comminuted radial head fracture involved <50% of the articular surface in all-arthroscopic repair of elbow fracture-dislocation. Methods: Patients were divided into two groups based on the condition of the radial head fracture. In Group A, the patients had a radial head comminuted fracture involving <50% of the articular surface, and underwent arthroscopic partial excision. Group B was the non-excision group comprising patients with stable and non-displacement fractures. Follow-up consultations were conducted at 6 weeks and at 3, 6, 12, and 24 months after surgery. Results: In all, 19 patients (Group A: 11; Group B: 8) met the inclusion criteria and were enrolled in the study. At the final follow-up, all 19 patients showed complete resolution of elbow instability. No significant differences were observed in the range of motion, visual analogue scale score, and Mayo elbow performance score between groups. Radiological findings did not show any complications of the radiocapitellar joint. However, nonunion of the coracoid fracture was observed in 3 patients (Group A: 1; Group B: 2), without any accompanying instability and clinical symptoms. Conclusions: Considering that the final outcome is coronoid fracture fixation and lateral collateral ligament complex repair for restoring elbow stability, arthroscopic partial excision for radial head comminuted fractures involving <50% of articular surface is an effective and acceptable treatment for elbow fracture-dislocation.

• The Korean Journal of Pain
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• v.23 no.4
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• pp.258-261
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• 2010

We report a 66-year-old woman with complex regional pain syndrome (CRPS) 1 treated with combined medical and active physical therapy. She was diagnosed with CRPS 1 following partial shoulder prosthesis due to proximal humerus fracture. Despite continuous medication and physical therapy, there was no improvement in her pain and functional outcome. Her overall pain was decreased by stellate ganglion block 3 times in two weeks conducted during the second month of the follow-up period. Following the ganglion blockades, pain and the other symptoms were decreased intermittently but range of motion (ROM) and functional status were not satisfied as much as expected. After the third month of follow-up, her passive and active ROM of the shoulder joint was increased after application of manipulation under general anesthesia. In conclusion, because CRPS 1 remains one of the most difficult pain syndromes, early diagnosis and treatment are important to have adequate functional results from physical therapy. Manipulation under general anesthesia may be an additional effective treatment tool to obtain functional improvement in some patients diagnosed with CRPS 1.

• Clinics in Shoulder and Elbow
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• v.24 no.3
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• pp.183-188
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• 2021

We report a case of a 69-year-old right-dominant man who had an open Monteggia-like lesion of the right elbow (Gustilo-Andersen IIIA) with severe proximal ulna bone loss associated with an ipsilateral ulnar shaft fracture due to a motorcycle accident. The patient underwent two-stage surgery. Wound debridement and bridging external fixation were performed at first. Three months later, a frozen massive osteochondral ulnar allograft was implanted and fixed with a locking compression plate. A superficial wound infection appeared 5 weeks after the second surgery. Superficial wound debridement, negative pressure therapy, and antibiotics were administered for 3 months, achieving infection healing. At 3 years post-surgery, the elbow range of motion was satisfactory with a Disabilities of the Arm, Shoulder and Hand (DASH) score of 16.7. Radiographs and computed tomography scans showed good allograft-bone integration without allograft reabsorption or hardware loosening. Although not complication-free, massive ulna osteochondral allograft implantation can be considered a valid option in cases of open Monteggia-like lesions associated with ulnar shaft fracture and severe bone loss in active patients, whenever osteosynthesis or joint replacement is not a proper solution. This type of bone stock restoration allows for future surgery, if needed.

• Physical Therapy Korea
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• v.25 no.3
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• pp.1-11
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• 2018

Background: Lumbopelvic stability is highly important for exercise therapy for patients with low back pain and shoulder dysfunction. It can be attained using a pelvic compression belt. Previous studies showed that external pelvic compression (EPC) enhances form closure by reducing sacroiliac joint laxity and selectively strengthens force closure and motor control by reducing the compensatory activity of the stabilizer. In addition, when the pelvic compression belt was placed directly on the anterior superior iliac spine, the laxity of the sacroiliac cephalic joint could be significantly reduced. Objects: This study aimed to compare the effects of EPC on lumbopelvic and shoulder muscle surface electromyography (EMG) activities during push-up plus (PUP) and deadlift (DL) exercise, trunk extensor strength during DL exercise. Methods: Thirty-eight subjects (21 men and 17 women) volunteered to participate in this study. The subjects were instructed to perform PUP and DL with and without the EPC. EMG data were collect from serratus anterior (SA), pectoralis major (PM), erector spinae (ES), and multifidus (MF). Trunk extensor strength were tested in DL exercise. The data were collected during 3 repetitions of all exercise and the mean of root mean square was used for analysis. Results: The EMG activities of the SA and PM were significantly increased in PUP with pelvic compression as compared with PUP without pelvic compression (p<.05). In DL exercise, a significant improvement in trunk extensor strength was observed during DL exercise with pelvic compression (p<.05). Conclusion: The results of this study indicate that lumbopelvic stabilization reinforced with external pelvic compression may be propitious to strengthen PUP in more-active SA and PM muscles. Applying EPC can improve the trunk extensor strength during DL exercise. Our study shows that EPC was beneficial to improve the PUP and DL exercise efficiency.

• The Journal of the Korea Contents Association
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• v.10 no.6
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• pp.323-328
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• 2010

If a patient wearing arm sliding due to shoulder dislocation or fracture is impossible with abduction, the velpeau view is performed instead of superior-inferior axial projection view. However, it aggravates the patient's pain because it is difficult for the patient with dislocation or fracture to pull back the shoulders. Therefore, I suggest a new method of the 'modified velpeau view' that allows patients to lower their heads at examination. In order to investigate the easiness of fixing posture at examination and clinical utility, I conducted a study comparing the bone structures at the velpeau view and those at the modified velpeau view depending on wall-bucky and the patients' leaning forward angle ($30^{\circ},\;45^{\circ},\;60^{\circ}\;and\;75^{\circ}$), with the subjects of 20 velpeau view-prescribed patients amongst who had come to my hospital suspected of dislocation of shoulder or fracture and 30 healthy people from October of 2009 to January of 2010. Department of radiologists and orthopedics specialists evaluated the pictures for scales 0 to 5(best grade) under the given criteria. As a result of comparison in bone structures depending on wall-bucky and the leaning-forward angle in the group of healthy people, the velpeau view and the modified velpeau showed a similar diagnostic utility at $45^{\circ}$ and $60^{\circ}$. The picture evaluation result for proving diagnostic value showed that the anterior and posterior of shoulder heads and the anterior and posterior of glenoid fossa could be observed in the velpeau view; on the other hand, besides these areas acromioclavicular joint and coracoid process could be viewed in the modified velpeau view. This result verified that the modified velpeau view could replace the velpeau view for its diagnostic value as an examination method. This result, moreover, suggests that the modified velpeau view needs to be studied and improved from a variety of perspectives not only for an alternative for patients having troubles with the velpeau view position but also for clinical application of new test method for diagnosis of shoulder disorders other than dislocation of shoulder or fracture.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.1 no.1
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• pp.85-97
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• 1995

Orthopaedic medicine was developed and published by James Cyriax, a British Orthopaedic Physician on 1929. Orthopaedic medicine is concerned with the diagnosis and treatment of soft tissue lesions. These disorders affect a substantial proportion of all patients in general and in particular, physiotherapy and sports clinics. In broad terms these disorders em trace conditions. such as arthritis. rheumatism. fibrositis. backache. lumbago, sciatica, frozen shoulder, tennis elbow, strained wrist, sprains, aches, inflanmation and sports injuries generally. The soft Moving tissues share one thing in common - they are all radiotranslucent and the tissues in question are the joint capsule, the ligaments, the fasciae, dural sheath. These structures can cause pain but none of them is visible on the radiograph. Dr. Cyriax divided all soft tissues into two basic types : 1) Contractile tissue, 2) Inert or noncontractile tissue. The mechanism of diagnosis is tension applied manually. The physician subjects each tissue about the incriminated joint to tension in turn which they call 'Selective tension' with Cyriax's assessment, a more definitive diagnosis can be obtained and proper treatment can be implemented.

• Journal of Korean Physical Therapy Science
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• v.13 no.2
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• pp.47-55
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• 2006

This study was executed in order utilized five typical taping therapy spending on upper limb end part, and to grasp an influence on shoulder pain of upper limb part among spiral balance taping therapy of Danaca. This study was performed at Physical therapy Dept. of Gyeongbuk H orthopedics until 2005 November 4 from 2005 October 4th. This study appealed for a shoulder pain, and visited all 25(15 Non capsular lesions, 10 capsular lesions) patients to the objects. We executed study to the objects to a patient to agree with us after explaining a purpose and object of this study. Urged warning, and all executed eight times over about the patient who executed taping therapy for five weeks so as not to be able to get other therapy treatment. Application way of taping therapy applied all once at random generally five taping therapy to apply to limbs end of upper at clinical so far. Operated on the results about pain decrease, and we calculated as compared before and after five taping therapy. Also, operated again on them in a taping therapy judged that there was pain decrease, and we returned them to home. We make a comparative analysis for a pain after and before a treatment as we use the VAS which is evaluation of a pain in this study. The results of this study are as follows. Appeared so as operated, and a pain decrease change of Non capsular lesions became lower with a the average of 2.3 after a taping therapy in the average of 6.4s former a treatment, and to note statistically later Taping therapy of upper limb end part.(P<0.01). The pain decrease change of capsular lesions of a shoulder joint pain index decreased with the average of 4.0 after a taping therapy treatment in the average of 6.0 former a treatment after Taping therapy of upper limb end part, but were not able to note statistically.(P>0.05) Taping therapy of upper limb end part is positive to pain decrease of shoulder joint in the above-mentioned study can affect, and can especially get the effective conclusion that was able to affect from pain decrease of Non capsular lesions.

• Clinics in Shoulder and Elbow
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• v.23 no.2
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• pp.71-79
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• 2020

Background: The glenoid version of the shoulder joint correlates with the stability of the glenohumeral joint and the clinical results of total shoulder arthroplasty. We sought to analyze and compare the glenoid version measured by traditional axial two-dimensional (2D) computed tomography (CT) and three-dimensional (3D) reconstructed images at different levels. Methods: A total of 30 cases, including 15 male and 15 female patients, who underwent 3D shoulder CT imaging was randomly selected and matched by sex consecutively at one hospital. The angular difference between the scapular body axis and 2D CT slice axis was measured. The glenoid version was assessed at three levels (midpoint, upper one-third, and center of the lower circle of the glenoid) using Friedman's method in the axial plane with 2D CT images and at the same level of three different transverse planes using a 3D reconstructed image. Results: The mean difference between the scapular body axis on the 3D reconstructed image and the 2D CT slice axis was 38.4°. At the level of the midpoint of the glenoid, the measurements were 1.7°±4.9° on the 2D CT images and -1.8°±4.1° in the 3D reconstructed image. At the level of the center of the lower circle, the measurements were 2.7°±5.2° on the 2D CT images and -0.5°±4.8° in the 3D reconstructed image. A statistically significant difference was found between the 2D CT and 3D reconstructed images at all three levels. Conclusions: The glenoid version is measured differently between axial 2D CT and 3D reconstructed images at three levels. Use of 3D reconstructed imaging can provide a more accurate glenoid version profile relative to 2D CT. The glenoid version is measured differently at different levels.

• Clinics in Shoulder and Elbow
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• v.10 no.1
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• pp.50-58
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• 2007

Purpose: To report our experience with nine cases of pathologic synovial plica on radiohumeral joint which symptom of painful snapping elbow was improved by arthroscopic resection. Materials and Methods: Between 1999 and 2004, 43 cases of elbow arthroscopy were performed by one surgeon. Eight patients with nine cases showed pathologic synovial plica in conjunction with snapping or posterolateral elbow pain. The mean age of eight patients (man: 7, woman: 1) was 29 years (range $16{\sim}56$ years). All patients had a trial of conservative treatment at least six months (range $6{\sim}16$ months). The diagnosis was confirmed before surgery in six cases and at the time of surgery in three cases. Pain, snapping, and subjective results were evaluated at least 12 months in the average(range $12{\sim}24$). Results: All patients showed a hypertropic lateral synovial plica with local synovitis. Seven of them had an associated lesion of chondromalacia on radial head. One of them was associated with radiocapitellar arthritis and had a wrapping over the radial head. Six patients experienced improved posterolateral pain at the end of study (VAS<1). However, the other two patients had occasional pain with activity. One of them persisted with mechanical symptoms, which was treated with additional arthroscopic procedure. Conclusion: Synovial plica in elbow should be considered as an important entity of common elbow disease, especially when pain in the lateral aspect of the elbow with a snapping sensation during motion is featured in patients. The arthroscopic resection seems to be safe and efficient in the short and long term treatment of plica in the elbow joint.

• Clinics in Shoulder and Elbow
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• v.24 no.2
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• pp.66-71
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• 2021

Background: Extra-articular distal humerus locking plates (EADHPs) are precontoured anatomical plates widely used to repair distal humeral extra-articular diaphyseal fractures. However, EADHPs frequently cause distal protrusion and resulting skin discomfort. The purpose of this study was to predict the occurrence of anatomic fit mismatch. We hypothesized that the smaller the humerus size, the greater the anatomic fit mismatch with EADHP. Methods: Twenty humeri were analyzed in this study. Humeral length and distal humeral width were used as parameters of humeral size. Plate protrusion was measured between the EADHP distal tip and the distal humerus. We set the level of unacceptable EADHP anatomic fit mismatch as ≥10 mm plate protrusion. Results: A significant negative linear correlation was also confirmed between humeral size and plate protrusion, with a coefficient of determination of 0.477 for humeral length and 0.814 for distal humeral width. The cutoff value of humeral length to avoid ≥10 mm plate protrusion was 293.6 mm (sensitivity, 88.9%; specificity, 81.8%) and for distal humeral width was 60.5 mm (sensitivity, 100%; specificity, 81.8%). Conclusions: Anatomic fit mismatch in distal humeral fractures after EADHP fixation has a negative linear correlation with humeral length and distal humeral width. For patients with a distal humeral width <60.5 mm, ≥10 mm plate protrusion will occur when an EADHP is used, and an alternative implant or approach should be considered.