• 한방재활의학과학회지
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• 제29권4호
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• pp.127-134
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• 2019

The Objective of this study is to report the results of greater trochanteric pain syndrome (GTPS) patient with Korean medicine therapy. There were insufficient clinical trials and case reports of GTPS treated with Korean medicine, we report the GTPS case remarkably improved treatment results. We treated the patient with acupuncture, acupotomy, pharmacopuncture, Chuna manual therapy and herbal medication. To evaluate the treatment effects, we used the measures including Verbal numerical rating scale, Oswestry disability index and Victorian Institute of Sport Assessment-gluteal tendinopathy scale. After total of 26 days of treatment, the patient's hip pain and disability were greatly reduced, and the outcome measures showed this great improvement. Korean medicine therapy might be effective in GTPS, although further study is needed to determine the role for Korean medicine.

• Clinics in Shoulder and Elbow
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• 제11권2호
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• pp.90-95
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• 2008

목적: 회전근 개 질환 환자에서 상완 이두건의 병소에 대한 수술 전 초음파 검사의 정확성을 알아보기 위하여 본 연구를 시행하였다. 대상 및 방법: 2006년 1월부터 2007년 3월까지 회전근 개 질환으로 수술적 치료를 받은 환자 중 수술 전 초음파 검사를 시행 한 67명의 환자를 대상으로 후향적 조사를 하였다. 환자들의 연령은 평균 58세였으며, 남자 41예, 여자 26예였다. 상완 이두건의 관절경 및 초음파 소견은 '정상', '탈구', '아탈구', '건증', '부분 또는 완전 파열'등으로 기술하였으며, 관절경과 초음파 소견 간의 일치 여부를 조사하였다. 결과: 초음파 검사 67예 중 37예가 '정상'이었으며, 30예가 '비정상'이었다. '정상' 37예 중 5예는 관절경 검사상 '부분 파열'이 있었으며, '비정상' 30예 중 8예는 관절경 검사상 '정상'이었다. 초음파 검사상 3예의 '탈구' 및 4예의 '완전 파열'은 관절경 검사 결과와 일치하였다. 초음파 검사에서 '건증'이 기술된 20예는 관절경 검사에서 '부분 파열' 15예, '정상' 5예로 관찰되었다. 결론: 상완 이두건의 병소에 대한 초음파 검사는 상완 이두건의 탈구 또는 완전 파열 시에는 진단이 일치하였으나, 부분 파열에 대해서는 정확한 진단이 어려웠다.

• Clinics in Shoulder and Elbow
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• 제17권3호
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• pp.107-113
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• 2014

Background: Sonoelastography (SE) is a new technique that can assess differences in tissue stiffness, the purpose of this study was to evaluate the ability of SE to assess the long head of biceps tendon alteration. Methods: Forty shoulders of 36 consecutively registered patients with clinical symptoms and conventional ultrasonography findings of biceps tendinitis or tendinosis, and 40 asymptomatic shoulders of 20 healthy volunteers were assessed with SE. Transverse and longitudinal images of long head of biceps tendon were obtained using SE. SE images were performed by one orthopedic surgeon and evaluated by two orthopedic surgeons using an experimentally proven color grading system. Results: The transverse images of SE showed a sensitivity of 87.5%, a specificity of 95.0% and a accuracy of 91.3%, the longitudinal images of SE showed a sensitivity of 92.5%, a specificity of 90.0% and a accuracy of 91.3%. Inter-observer reliability of SE was in 'almost perfect agreement' with a weighted kappa coefficient of 0.83. Conclusions: SE is valuable in the detection of the intratendinous and peritendinous alterations of biceps tendon, and has excellent accuracy and excellent correlation with conventional ultrasound findings.

• 대한정형외과 초음파학회지
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• 제1권1호
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• pp.58-63
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• 2008

비골 건 탈구 손상의 발생 기전은 전형적으로 대부분이 발목 외상 후에 발생하며, 발목이 심하게 배부 굴곡된 상태에서 비골 건이 갑작스럽고 심하게 구축하는 경우에 흔히 발생한다. 본 손상이 재발하는 경우에는 단 비골 건 파열이 자주 동반되며, 초음파 검사로 비골 구에서 탈구 되는 소견을 확인 할 수 있다. 만성 재발성 탈구는 수술적 치료가 필요하며 비골 구를 깊게 하는 술식을 시행하여 좋은 결과를 얻을 수 있다. 전 경골건의 비외상성 파열은 고령 층 중 활동성 높은 부류에서 만성 자극에 의한 마멸, 국소적 스테로이드 주사, 당뇨병성 건염이나 염증성 관절증과 같은 전신질환에 의해 건의 연속성이 약화된 상태에서 호발한다.

• Clinical and Experimental Pediatrics
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• 제62권6호
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• pp.199-205
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• 2019

Although Mycoplasma pneumoniae pneumonia (MPP) has been generally susceptible to macrolides, the emergence of macrolide-resistant MPP (MRMP) has made its treatment challenging. MRMP rapidly spread after the 2000s, especially in East Asia. MRMP is more common in children and adolescents than in adults, which is likely related to the frequent use of macrolides for treating M. pneumoniae infections in children. MRMP is unlikely to be related to clinical, laboratory, or radiological severity, although it likely prolongs the persistence of symptoms and the length of hospital stay. Thereby, it causes an increased burden of the disease and poor quality of life for the patient as well as a societal socioeconomic burden. To date, the only alternative treatments for MRMP are secondary antimicrobials such as tetracyclines (TCs) or fluoroquinolones (FQs) or systemic corticosteroids; however, the former are contraindicated in children because of concerns about potential adverse events (i.e., tooth discoloration or tendinopathy). A few guidelines recommended TCs or FQs as the second-line drug of choice for treating MRMP. However, there have been no evidence-based guidelines. Furthermore, safety issues have not yet been resolved. Therefore, this article aimed to review the benefits and risks of therapeutic alternatives for treating MRMP in children and review the recommendations of international or regional guidelines and specific considerations for their practical application.

• Clinics in Shoulder and Elbow
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• 제22권4호
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• pp.227-234
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• 2019

Lateral epicondylitis, also known as 'tennis elbow', is a degenerative rather than inflammatory tendinopathy, causing chronic recalcitrant pain in elbow joints. Although most patients with lateral epicondylitis resolve spontaneously or with standard conservative management, few refractory lateral epicondylitis are candidates for alternative non-operative and operative modalities. Other than standard conservative treatments including rest, analgesics, non-steroidal anti-inflammatory medications, orthosis and physical therapies, nonoperative treatments encompass interventional therapies include different types of injections, such as corticosteroid, lidocaine, autologous blood, platelet-rich plasma, and botulinum toxin, which are available for both short-term and long-term outcomes in pain resolution and functional improvement. In addition, newly emerging biologic enhancement products such as bone marrow aspirate concentrate and autologous tenocyte injectates are also under clinical use and investigations. Despite all non-operative therapeutic trials, persistent debilitating pain in patients with lateral epicondylitis for more than 6 months are candidates for surgical treatment, which include open, percutaneous, and arthroscopic approaches. This review addresses the current updates on emerging non-operative injection therapies as well as arthroscopic intervention in lateral epicondylitis.

• Clinical Pain
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• 제18권2호
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• pp.138-141
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• 2019

Lateral epicondylopathy represents pain in the lateral (radial aspect) of the elbow caused by degeneration in the common extensor tendon. Calcium deposit frequently developes in lateral epicondylopathy, with the prevalence up to 46%. There are considerable debates on its treatment protocols for lateral epicondylopathy so far, likewise, the effective treatment method for calcific lateral epicondylopathy has not been established. We report here a case of chronic intractable calcific lateral epicondylopathy treated with ultrasound-guided barbotage and focused type extracorporeal shock wave therapy (ESWT). To our knowledge, this is the first report of calcific lateral epicondylopathy treated by ultrasound-guided barbotage combined with ESWT.

• 한국전문물리치료학회지
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• 제23권2호
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• pp.84-92
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• 2016

Background: Strengthening the supraspinatus is an important aspect of a rehabilitation program for subacromial impingement and tendinopathy. Many authors recommended empty-can (EC), full-can (FC), and prone full-can (PFC) exercises to strengthen the supraspinatus. However, no ultrasonography study has yet investigated supraspinatus muscle architecture (muscle thickness; MT, pennation angle; PA, fiber bundle length; FBL) in relation to supraspinatus strengthening exercises. Objects: The purpose of this study was to compare the architecture (MT, PA, and FBL) of the supraspinatus muscle during three different types of exercises (EC, FC, and PFC) using diagnostic ultrasound. Methods: Participants performed three different exercises: (A) EC; the arm was maintained at $60^{\circ}$ abduction with full internal rotation in the sitting position, (B) FC; the arm was maintained at $60^{\circ}$ abduction with full external rotation in the sitting position, and (C) PFC; the arm was maintained at $60^{\circ}$ abduction with full external rotation in the prone position. Ultrasonography was used to measure the MT, PA and FBL of the supraspinatus. One-way repeated analysis of variance with Bonferroni's post-hoc test was used to compare between the three exercises and the initial position of each exercise. Results: Compared with each initial position, the FC exercise showed the greatest mean difference in muscle architecture properties and the PFC exercise showed the least mean difference. Conclusion: The findings suggest that the FC exercise position may have an advantage in increasing the amount of contractile tissue or producing muscle power and the PFC exercise position may be useful in a rehabilitation program because it offers the advantage of maintaining the muscle architecture properties.

• Clinics in Shoulder and Elbow
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• 제19권4호
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• pp.202-208
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• 2016

Background: Our study aimed to make a comparative analysis of clinical outcomes of arthroscopic decompression for rotator cuff calcific tendinitis by location of calcific deposits and by its size. Methods: We enrolled a total of 38 patients, comprising 39 affected shoulders, who underwent arthroscopic decompression for calcific tendinitis. As our clinical scores, we evaluated the UCLA, the ASES, and the VAS scores and analyzed them by calcific location, by calcific deposit size, by the presence or absence of calcific remnants, and by whether concomitant cuff repair was performed. Results: The clinical scores of those whose calcific deposit had an area greater than $77.0mm^2$ and of those whose calcific deposit had an area smaller than $77.0mm^2$ did not significantly differ (p=0.21 in ASES; p=0.19 in UCLA; p=0.17 in VAS). Nor did the clinical scores significantly differ with respect to the location of calcification (p=0.23). Further, the clinical scores did not significantly differ between those who had calcific remnants and those who did not and between those who received additional cuff repair and those who did not. Conclusions: We found that the clinical outcomes after arthroscopic decompression of calcific tendinitis were not significantly associated with the cuff tendon in which the calcium deposits are found; the location of the calcium deposits in the supraspinatus tendon (if found in this tendon); the size of calcific deposits; the presence of calcific remnants; and concomitant cuff repairs.

• Clinics in Shoulder and Elbow
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• 제20권2호
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• pp.84-89
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• 2017

Background: Common and effective treatments for calcific tendinitis involve needling procedures. However, it has been widespread practice to refer patients with calcific tendinitis, which is a predominantly orthopedic condition, to radiology department. The purpose of this study was to compare clinical and radiological outcomes after ultrasound-guided needling for calcific tendinitis between the orthopedics and radiology department. Methods: Seventy-seven shoulders (Group 1) and 38 shoulders (Group 2) treated in the radiology and orthopedic department, respectively. A fellowship-trained orthopedic surgeon and a musculoskeletal radiologist each performed the procedure of ultrasound-guided needle decompression with subacromial steroid injection. Clinical outcomes was evaluated using the visual analogue scale for pain (pVAS) and the American Shoulder and Elbow Surgeons (ASES) shoulder score before treatment and at each follow-up. The pre- and postneedling size and shape of the calcific deposits were compared between the two groups. Results: We analyzed a total of 56 shoulders for Group 1 and 32 shoulders for Group 2. The mean age and sex ratio of the patients no significantly different. We found that the mean decrease in the diameter of calcification between pre- and post-needling was 9.0 mm for Group 1 and 13.1 mm for Group 2; the difference was significantly larger in Group 2 than in Group 1. Both groups showed improved pVAS and ASES scores after needling but the extent of these improvements did not differ with the type of operator. Conclusions: Needling decompression performed by orthopedic surgeons could a viable option for the treatment of calcific tendinitis.