• Clinics in Shoulder and Elbow
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• 제19권3호
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• pp.149-154
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• 2016

Background: The purpose of this study is to compare clinical and radiological outcomes between trans-acromial fixation with Kirschner's wire (K-wire) and AO locking hook plate fixation for acute acromioclavicular (AC) joint dislocation. Methods: This study included 61 patients who underwent either closed reduction and trans-acromial fixation with K-wire (group A, 23 patients) or open reduction and internal fixation with AO locking hook plate (group B, 38 patients). Pain on a visual analogue scale (VAS) score, the University of California Los Angeles (UCLA) shoulder score, the American Shoulder and Elbow Surgeons (ASES) score, and active range of motion (ROM) were used in the functional evaluation. For radiological evaluation, coracoclavicular distance (CCD) was measured on both clavicular anteroposterior view and compared between groups. Results: At one-year follow-up, no significant differences in VAS pain score, UCLA shoulder score, ASES score, and active ROM were observed between groups, despite five cases (22.7%, 5/23) of complication in group A. The side-to-side difference between normal and affected CCD was $2.4{\pm}2.2mm$ in group A and $0.2{\pm}0.7mm$ in group B. This difference showed a statistical significance between groups (p<0.001). Conclusions: For the treatment of acute AC joint dislocation, the K-wire trans-acromial fixation group showed a significantly greater CCD than the AO locking hook plate group. In addition, during the follow-up period, much higher incidence of complication related to implant was observed in the trans-acromial fixation group. Although clinical outcomes between groups were not significantly different, these results should be interpreted carefully.

• Clinics in Shoulder and Elbow
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• 제20권3호
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• pp.153-161
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• 2017

Background: This study was conducted to compare the clinical and radiological outcomes of the locking hook plate fixation (HP) technique and the single tight rope (TR) technique applied for acute high-grade acromioclavicular (AC) joint separations. Methods: Between 2009 and 2014, 135 consecutive patients with acute AC joint separation Rockwood types III, IV, and V were subjected to surgical reconstruction. One hundred fourteen patients (84.4%) were available for retrospective evaluation. Of them, 62 and 52 were treated using the single TR group and clavicular HP group techniques, respectively. The visual analogue scale, Constant, American Shoulder and Elbow Surgeons (ASES), and Taft scores were used for clinical assessment. Postoperative shoulder range of motion was also assessed. An anteroposterior radiograph of the coracoclavicular distance (CCD) was obtained to evaluate the radiographic signs of recurrence. Results: The TR group patients had better Constant, ASES, and Taft scores than the HP group patients. The loss of reduction in terms of the CCD did not differ between groups. Subacromial osteolysis was observed in 34.6% of the cases in the HP group. However, there were no significant differences in the clinical outcomes between the patients with and without osteolysis in the HP group. Subcoracoid osteolysis, drill tunnel widening, and metal displacement were observed in 3.2%, 22.6%, and 4.8% of the cases in the TR group, respectively. Conclusions: The single TR technique was relatively more effective at treating acute high-grade AC joint injuries than the HP fixation technique (level of evidence: therapeutic; retrospective comparative study, Level III).

• Clinics in Shoulder and Elbow
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• 제21권1호
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• pp.48-55
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• 2018

While non-operative treatment with structured rehabilitation tends to be the strategy of choice in the management of Rockwood type III acromioclavicular joint injury, some advocate surgical treatment to prevent persistent pain, disability, and prominence of the distal clavicle. There is no clear consensus regarding when the surgical treatment should be indicated, and successful clinical outcomes have been reported for non-operative treatment in more than 80% of type III acromioclavicular joint injuries. Furthermore, there is no gold standard procedure for operative treatment of type III acromioclavicular joint injury, and more than 60 different procedures have been used for this purpose in clinical practice. Among these surgical techniques, recently introduced arthroscopic-assisted procedures involving a coracoclavicular suspension device are minimally invasive and have been shown to achieve successful coracoclavicular reconstruction in 80% of patients with failed conservative treatment. Taken together, currently available data indicate that successful treatment can be expected with initial conservative treatment in more than 96% of type III acromioclavicular injuries, whereas minimally invasive surgical treatments can be considered for unstable type IIIB injuries, especially in young and active patients. Further studies are needed to clarify the optimal treatment approach in patients with higher functional needs, especially in high-level athletes.

• Clinics in Shoulder and Elbow
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• 제24권2호
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• pp.88-92
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• 2021

Background: Patients who have rotator cuff arthropathy experience a limited range of motion (ROM) of the shoulder joint and experience problems in performing their daily activities; however, no evidence is available to suggest the exact ROM of the shoulder joint in this population. Therefore, this study sought to determine the degree of motion of the shoulder joint in three planes during different activities. Methods: Five subjects with rotator cuff injuries participated in this study. The motion of the shoulder joints on both the involved and normal sides was assessed by a motion analysis system while performing forward abduction (task 1), flexion (task 2), and forward flexion (task 3). The OpenSIM software program was used to determine the ROM of the shoulder joints on both sides. The difference between the ranges of motion was determined using a two-sample t-test. Results: The ROMs of the shoulder joint in task 1 were 93.5°±16.5°, 72.1°±2.6°, and 103.9°±25.7° for flexion, abduction, and rotation, respectively, on the normal side and 28°±19.8°, 31°±31.56°, and 48°±33.5° on the involved side (p<0.05). There was no significant difference between the flexion/extension and rotation movements of the shoulder joint when performing task 1. However, the difference between flexion and rotation movements of the shoulder joints for the second task was significant (p>0.05). Conclusions: Those with rotator cuff arthropathy have functional limitations due to muscle weakness and paralysis, especially during the vertical reaching task. However, although these individuals have decreased ROM for transverse reaching tasks, the reduction was not significant.

• Clinics in Shoulder and Elbow
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• 제21권3호
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• pp.169-175
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• 2018

Traumatic anterior dislocation of the shoulder is one of the most common directions of instability following a traumatic event. Although the incidence of shoulder dislocation is similar between young and elderly patients, most studies have traditionally focused on young patients due to relatively high rates of recurrent dislocations in this population. However, shoulder dislocations in older patients also require careful evaluation and treatment selection because they can lead to persistent pain and disability due to rotator cuff tears and nerve injuries. This article provides an overview of the nature and pathology of acute primary anterior shoulder dislocation, widely accepted management modalities, and differences in treatment for young and elderly patients.

• 한국전문물리치료학회지
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• 제24권1호
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• pp.19-29
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• 2017

Background: Patients after rotator cuff (RC) surgery experienced pain, weakness and limited of motion of the shoulder. Physical therapists have used heat therapy, electrotherapy, range of motion (ROM) exercise and other methods to treat patients after RC surgery. In addition, functional taping is also used to support joint movement and to increase shoulder joint stability. Objects: The purpose of this study was to determine the initial effects of functional taping using non-elastic tape on pain, strength and ROM of the shoulder following RC surgery. Methods: Forty-eight patients with who underwent RC surgery volunteered for this study. The subjects were randomly divided into an experimental group (EG, $n_1=25$) and a control group (CG, $n_2=23$). First, non-allergic tape was applied to the shoulder to prevent skin irritation. The EG applied functional taping using non-elastic tape and the CG applied sham taping using elastic tape. Assessment tools included the shoulder pain and disability index for functional activity score, visual analog scale for level of pain, shoulder muscle strength, hand grip strength and ROM testing. Results: Pain score in the both group significantly decreased (p<.05), and change in pain score of in the EG increased significantly than in the CG (p<.05). Shoulder strength and ROM in the both group significantly increased (p<.05). Especially external rotation and extension of the shoulder ROM in the EG increased significantly more than in the CG (p<.05), but the rate of change in the two groups showed no significant difference. Conclusion: These results suggest that functional taping using non-elastic tape was initially effective in decreasing pain score level in patients with RC surgery.

• Clinics in Shoulder and Elbow
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• 제25권2호
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• pp.129-139
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• 2022

Background: Several therapeutic methods have been proposed for frozen shoulder syndrome. These include suprascapular nerve block, a simple and cost-effective technique that eliminates the need for nonsteroidal anti-inflammatory drug therapy. Methods: This was a clinical trial that included patients with unilateral shoulder joint stiffness. Patients were divided into three groups: those treated with isolated physiotherapy for 12 weeks (PT group), those treated with a single dose intra-articular injection of corticosteroid together with physiotherapy (IACI group), and those treated with a suprascapular nerve block performed with a single indirect injection of 8-mL lidocaine HCL 1% and 2 mL (80 mg) methylprednisolone acetate together with physiotherapy (SSNB group). The variables assessed were age, sex, side of involvement, dominant limb, presence of diabetes, physical examination findings including erythema, swelling, and muscle wasting; palpation and movement findings; shoulder pain and disability index (SPADI) score; and the visual analog scale (VAS) score pre-intervention and at 2-, 4-, 6-, and 12-week post-intervention. Results: Ninety-seven patients were included in this survey (34 cases in the PT group, 32 cases in the IACI group, and 31 cases in the SSNB group). Mean age was 48.55±11.06 years. Fifty-seven cases were female (58.8%) and 40 were male (41.2%). Sixty-eight patients had a history of diabetes (70.1%). VAS and SPADI scores and range of mototion degrees dramatically improved in all cases (p<0.001). Results were best in the SSNB group (p<0.001), and the IACI group showed better results than the PT group (p<0.001). Conclusions: Suprascapular nerve block is an effective therapy with long-term pain relief and increased mobility of the shoulder joint in patients with adhesive capsulitis.

• Clinics in Shoulder and Elbow
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• 제17권3호
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• pp.120-126
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• 2014

Background: To compare the treatment of the proximal humerus fracture using a Polarus nail or Philos plate, we aimed to analyze the functional recovery and the factors affecting the selection between the two types of surgery. Methods: The study included 107 patients with proximal humerus fracture who underwent surgery at our institution. Of these patients, 67 underwent surgery with Polarus nails (G1) and 40 with Philos plates (G2). In G1, the cases of two- and three-part fractures were 60 and 7 cases, in G2, the cases of two-, three-, and four-part fractures were 28, 10, and 2 cases, respectively. The average age was 61 years old, and the average follow-up period was 32.5 months. We compared radiological results, the functional recovery retrospectively. Results: The radiological union time was 6.8 weeks and 8.7 weeks on average in G1 and G2 (p < 0.05). At the one-year follow-up period, these were visual analogue scale (VAS) 1.355, forward flexion (FF) 130.968, external rotation (ER) 50.161, internal rotation (IR) L2 in G1, and VAS 0.781, FF 135.806 ER 51.25, IR L1 in G2, respectively, showing no significant differences between the two groups (p > 0.05). Similar observations were made at the final follow-up. In terms of functional recovery, no significant differences were seen at the one-year or at the final follow-up period (p > 0.05). Conclusions: For the surgical treatment of proximal humeral fracture, the selection of the type of surgery is affected by the fracture pattern. However, both methods give satisfactory outcomes and do not show significant differences in the functional outcome after the surgery.

• Clinics in Shoulder and Elbow
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• 제22권2호
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• pp.93-99
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• 2019

Background: Modified Phemister operation has been widely used for the treatment of acute acromioclavicular (AC) joint dislocation. Additionally, the use of suture anchor for coracoclavicular (CC) fixation has been reported to provide CC stability. This study was conducted to evaluate the clinical and radiological results of a modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation. Methods: Seventy-four patients underwent the modified Phemister operation with CC ligament augmentation using suture anchor for acute AC joint dislocation and were followed-up for an average of 12.3 months. The visual analogue scale (VAS), range of motion, Constant score, and Korean shoulder scoring system (KSS) were used for clinical assessment. Acromioclavicular interval (ACI), coracoclavicular distance (CCD), and acromioclavicular distance (ACD) were obtained to evaluate the radiological assessments. Results: At the last follow-up, the mean VAS Score was 1.7 points, the mean joint range of the forward flexion was $164.6^{\circ}$, external rotation at the side was $61.2^{\circ}$ and internal rotation to the posterior was a level of T12. The mean Constant score and the mean KSS was 82.7 points and 84.2 points, respectively. At the mean ACI, CCD, and ACD, significant differences were found preoperatively and at the last follow-up. When the ACI, CCD, and ACD were compared with the contralateral unaffected shoulder at the last follow-up, the affected shoulders had significantly higher values. Conclusions: The modified Phemister operation with CC ligament augmentation using suture anchor is clinically and radiologically effective at acute AC joint dislocation.

• Clinics in Shoulder and Elbow
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• 제26권2호
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• pp.140-147
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• 2023

Background: The management of acromioclavicular (AC) joint dislocation remains controversial. Recently, anatomic coracoclavicular (CC) fixation with a double clavicular tunnel and three flip-buttons has shown promising results. This study aimed to evaluate functional and radiological outcomes in patients with high-grade AC joint dislocation treated with anatomic CC fixation using double clavicular tunnels and three flip-buttons. Methods: A retrospective, unicentric study was performed. The study included patients with high-grade AC joint dislocation who underwent surgery with anatomic CC fixation using double clavicular tunnels and three flip-buttons. Demographic data were obtained from medical records. A functional evaluation using subjective shoulder value (SSV), visual analog scale (VAS), and disabilities of the arm, shoulder, and hand (DASH) questionnaires was performed, and an evaluation of preoperative and postoperative comparative Zanca view images was performed. Factors associated with functional outcomes and radiological AC reduction were analyzed. Results: A total of 83 patients completed follow-up and were included in the analysis. The mean SSV, VAS, and DASH scores were 92.8, 0.8, and 6.4, respectively. Patients who had complications experienced significantly worse functional outcomes (DASH: P=0.037). Suboptimal final AC reduction was observed in nine patients (11.1%), and significantly more frequently in patients older than 40 years (P=0.031) and in surgeries performed more than 7 days after injury (P=0.034). There were two reoperations (2.4%). Conclusions: Anatomic CC fixation with a double clavicular tunnel and three flip-buttons leads to good functional outcomes, low complication rates, and high rates of optimal AC reduction.