• 대한정형도수물리치료학회지
• /
• 제13권1호
• /
• pp.67-72
• /
• 2007

Anatomy: The rotator cuff comprises four muscles-the subscapularis, the supraspinatus, the infraspinatus and the teres minor-and their musculotendinous attachments. The subscapularis muscle is innervated by the subscapular nerve and originates on the scapula. It inserts on the lesser tuberosity of the humerus. The supraspinatus and infraspinatus are both innervated by the suprascapular nerve, originate in the scapula and insert on the greater tuberosity. The teres minor is innervated by the axillary nerve, originates on the scapula and inserts on the greater tuberosity. The subacromial space lies underneath the acromion, the coracoid process, the acromioclavicular joint and the coracoacromial ligament. A bursa in the subacromial space provides lubrication for the rotator cuff. Etiology: The space between the undersurface of the acromion and the superior aspect of the humeral head is called the impingement interval. This space is normally narrow and is maximally narrow when the arm is abducted. Any condition that further narrows this space can cause impingement. Impingement can result from extrinsic compression or from loss of competency of the rotator cuff. Syndrome: Neer divided impingement syndrome into three stages. Stage I involves edema and/or hemorrhage. This stage generally occurs in patients less than 25 years of age and is frequently associated with an overuse injury. Generally, at this stage the syndrome is reversible. Stage II is more advanced and tends to occur in patients 25 to 40 years of age. The pathologic changes that are now evident show fibrosis as well as irreversible tendon changes. Stage III generally occurs in patients over 50 years of age and frequently involves a tendon rupture or tear. Stage III is largely a process of attrition and the culmination of fibrosis and tendinosis that have been present for many years. Treatment: In patients with stage I impingement, conservative treatment is often sufficient. Conservative treatment involves resting and stopping the offending activity. It may also involve prolonged physical therapy. Sport and job modifications may be beneficial. Nonsteroidal anti - inflammatory drugs(NSAIDS) and ice treatments can relieve pain. Ice packs applied for 20 minutes three times a day may help. A sling is never used, because adhesive capsulitis can result from immobilization.

• 척추신경추나의학회지
• /
• 제9권1호
• /
• pp.55-65
• /
• 2014

Objectives : The purpose of this review is to investigate the trends of traditional korean medicine treatments on frozen shoulder. Methods : We investigated the studies on traditional korean medicine treatments for frozen shoulder via searching 6 Korean web databases. As a result, 32 research papers were found to be analyzed according to their published year, the titles of journals, published institution, the types of study, the number of cases, the types of treatments, the instruments for assessment and ethical approvals. Results : 32 papers were published since 1989. The studies on traditional korean medicine treatments about frozen shoulder were mainly published in The journal of korean acupuncture & moxibustion medicine. 10 case series, 7 reviews, 6 non-randomized controlled trials, 5 randomized controlled trials and 4 case reports had been under research. In most of the research, the number of the cases were not enough. In 15 cases of the studies, various traditional korean medicine treatments were used to treat the symptoms. In 8 cases of the studies, one method was used to treat the symptoms. Range of motion(ROM) and visual analogue scale(VAS) were used as primary assessments. Among the 25 clinical studies, 5 of them were accepted by institutional review board(IRB). Conclusion : In this study, we analyzed the trends of traditional korean medicine treatments on frozen shoulder. Reviewing the domestic trends of studies on traditional korean medicine treatments for frozen shoulder and examining the strong and weak points of those treatments are essential for the future studies.

• The Journal of Korean Physical Therapy
• /
• 제33권5호
• /
• pp.211-216
• /
• 2021

Purpose: The main purpose of this meta-analysis was to identify the degree of effect size and variables for the impact of manual physical therapy on the improvement in the range of motion of frozen shoulder patients. Methods: This study collected 8 studies published between 1st January 2010 and 31st December 2020. The analysis of the results verified 49 effect size data and the random effect model was chosen. Results: First, the full case showed the largest mean effect size of 2.485 (p<0.001). Second, the size of the effect based on manual therapy and modality therapy showed an effect size of 4.178 (p<0.001). Third, the outcome group included 6 variables. The external rotation (2.818) variable group showed the largest mean effect size, followed by internal rotation (2.748), flexion (2.643), abduction (2.356), and adduction (2.356). Six outcomes were significant and the mean effect sizes of all the varied groups were above large size. The number of participants showed a 20 or less effect size of 2.478 (p>0.737). The number of intervention periods showed 4 weeks 20 or more effect size of 2.782 (p>0.294). Finally, the 'Trim and Fill' result confirmed that the calibration effect size was 1.471 (p<0.001). Conclusion: This study verified that manual physical therapy had a substantial effect on the improvement of the range of motion of patients with frozen shoulders and that the effects were dependent on the methods of outcomes.

• Clinical Pain
• /
• 제20권1호
• /
• pp.25-29
• /
• 2021

Upper limb morbidity including shoulder pain, lymphedema, adhesive capsulitis, myofascial pain syndrome, and limited range of motions (LROMs) occurs frequently in breast cancer patients. Especially restricted upper limb motion aggravated by chronic lymphedema results in functional limitation and impaired activities of daily living (ADL). However, conventional rehabilitation therapy including complex decongestive therapy and stretching exercise is insufficient for managing advanced breast cancer patients with complex upper limb morbidity. Here, we report a case of breast cancer-related chronic lymphedema in a 62-years old female with severe LROM in all joints of the affected upper extremity that caused severe disability in ADL. Significant improvements in range of motion and upper extremity function were observed after serial extracorporeal shock wave therapy (ESWT), combined with conventional rehabilitation therapy. Therefore, ESWT might be recommended for managing the extensive limited joint motion which causes functional decline in a patient of chronic lymphedema with trophic skin change.

• Clinics in Shoulder and Elbow
• /
• 제26권1호
• /
• pp.64-70
• /
• 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.

• Clinics in Shoulder and Elbow
• /
• 제26권4호
• /
• pp.390-396
• /
• 2023

Background: The subacromial (SA) space is a commonly used injection site for treatment of impingement syndrome. For shoulder stiffness, glenohumeral (GH) injections are commonly performed. However, in cases of impingement syndrome with mild shoulder stiffness, the optimal site of steroid injection has yet to be identified. Methods: This prospective, randomized study compared the short-term outcomes of ultrasound-guided GH and SA steroid injections in patients who were diagnosed with impingement syndrome and mild stiffness. Each group comprised 24 patients who received either a GH or SA injection of 40 mg of triamcinolone. Range of motion and clinical scores were assessed before and 3, 7, and 13 weeks after the injection. Results: GH and SA injections significantly improved the range of motion and clinical scores after 13 weeks of follow-up. Notably, targeting the GH joint resulted in an earlier gain of forward elevation, external rotation, and internal rotation in 3 weeks (P<0.001, P=0.012, and P=0.002, respectively) and of internal rotation and a Constant-Murley score in 7 weeks (P<0.001 and P=0.046). Subsequent measurements were similar between the groups and showed a steady improvement in all ranges of motion and clinical scores. Conclusions: GH injections may be more favorable than SA injections for treatment of impingement syndrome with mild stiffness, especially in improving the range of motion in the early period. However, the procedures showed similar outcomes after 3 months. Level of evidence: I.

• Journal of Acupuncture Research
• /
• 제28권4호
• /
• pp.49-55
• /
• 2011

Objectives : The purpose of this study was 1) to investigate the possibility of taking blood stasis pattern as a clinical parameter of frozen shoulder, using blood stasis pattern questionnaire (BSPQ) to frozen shoulder group comparing with normal group, and 2) to find out the relationship of the severity of main frozen shoulder symptoms (pain and limited range of motion of shoulder) and the level of blood stasis pattern through BSPQ analysis. Methods : During the period of January 2010 to July 2010, fifty five frozen shoulder patients who visited outpatient clinic of department of acupuncture and moxibustion in East-West Neo Medical Center, Kyung Hee University and fifty five normal people without shoulder pain nor limited ROM in shoulder joint were evaluated through BSPQ, and to the frozen shoulder group, also evaluated three different visual analogue scales (VAS) of pain (pain on average, pain at night, and pain on motion) and active / passive range of motion (ROM) of shoulder joint. Results : Mean blood stasis pattern score of frozen shoulder patients group was significantly higher than the score of normal group (patients vs normal group : $4.85{\pm}1.68$ vs $3.49{\pm}1.54$). Three different types of pain VAS (on average, at night and on motion) showed low to very low positive correlation with BSPQ scores when analyzed with Pearson's correlation coefficient. ROM levels in shoulder joint were not significantly related to BSPQ scores, though active external rotation range showed low positive correlation with BSPQ scores. Conclusions : Patients with frozen shoulder showed higher blood stasis pattern score in BSPQ but the level of blood stasis pattern is not significantly related to the severity of pain or limitation of ROM in shoulder joint.

• Clinics in Shoulder and Elbow
• /
• 제13권1호
• /
• pp.1-6
• /
• 2010

목적: 상완골 간부 골절에서의 전향적 교합성 골수강내 금속정 고정술의 치료 결과 및 합병증에 대하여 알아 보고자 한다. 대상 및 방법: 2002년부터 2008년까지 상완골 간부 골절로 전향적 교합성 골수강내 금속정 고정술을 시행하고 골유합 기간까지 추시 관찰이 가능하였던 47예를 대상으로 임상적, 방사선학적 결과 및 술 후 합병증을 분석하였다. 술 후 추시 단순 방사선 검사로 골유합을 확인하였고, ASES 점수 평가법을 이용하여 임상적 평가를 시행하였다. 결과: 총 47예 중 41예 (87.2%)에서 골유합을 보였고, 평균 유합 시기는 14.5주였다. 주요 합병증으로 불유합이 6예, 지연 유합이 3예, 술 중 원위 상완골 후방 피질 골절이 2예, 견관절 유착성 관절막염이 1예를 포함한 영구적 견관절 동통이 2예 있었다. 임상적 결과는 우수가 29예, 양호가 11예, 보통이 4예, 불량이 3예로, 40예 (85.1%)에서 만족할 만한 결과를 보였다. 결론: 상완골 간부 골절에서의 전향적 교합성 골수강내 금속정 고정술은 만족할만한 골유합율 및 임상적 결과를 나타내었으며, 특히 다발성 골절 등의 동반 손상이 있는 경우 또는 분절 골절에서 유용한 하나의 치료 방법이라 사료된다.

• 대한약침학회지
• /
• 제27권1호
• /
• pp.14-20
• /
• 2024

Objectives: Frozen shoulder (FS) is one of the most challenging shoulder disorders for patients and clinicians. Its symptoms mainly include any combination of stiffness, nocturnal pain, and limitation of active and passive glenohumeral joint movement. Conventional treatment options for FS are physical therapy, nonsteroidal anti-inflammatory drugs, injection therapy, and arthroscopic capsular release, but adverse and limited effects continue to present problems. As a result, pharmacoacupuncture (PA) is getting attention as an alternative therapy for patients with FS. PA is a new form of acupuncture treatment in traditional Korean medicine (TKM) that is mainly used for musculoskeletal diseases. It has similarity and specificity compared to corticosteroid injection and hydrodilatation, making it a potential alternative injection therapy for FS. However, no systematic reviews investigating the utilization of PA for FS have been published. Therefore, this review aims to standardize the clinical use of PA for FS and validate its therapeutic effect. Methods: The protocol was registered in Prospero (CRD42023445708) on 18 July 2023. Until Aug. 31, 2023, seven electronic databases will be searched for randomized controlled trials of PA for FS. Authors will be contacted, and manual searches will also be performed. Two reviewers will independently screen and collect data from retrieved articles according to predefined criteria. The primary outcome will be pain intensity, and secondary outcomes will be effective rate, Constant-Murley Score, Shoulder Pain and Disability Index, range of motion, quality of life, and adverse events. Bias and quality of the included trials will be assessed using the Cochrane handbook's risk-of-bias tool for randomized trials. Meta analyses will be conducted using Review Manager V.5.3 software. GRADE will be used to evaluate the level of evidence for each outcome. Results: This systematic review and meta-analysis will be conducted following PRISMA statement. The results will be published in a peer-reviewed journal. Conclusion: This review will provide scientific evidence to support health insurance policy as well as the standardization of PA in clinical practice.

• 대한정형외과 초음파학회지
• /
• 제7권1호
• /
• pp.7-12
• /
• 2014

목적: 경피 Buprenorphine 제제는 보존적 치료의 한 방법으로 이용 범위를 넓히고 있으나 정형외과의 세분화된 영역에서의 통증 조절 효과에 대한 연구는 많지 않다. 이에 본 연구에서는 견관절 통증을 호소하는 동결기의 동결견 환자에게 투여한 경피 Buprenorphine 제제의 통증 조절 효과에 대해 알아보고자 하였다. 대상 및 방법: 2013년 3월에서 9월 사이의 기간 동안 5~6개월 이상 견관절 통증이 지속되고 운동범위의 제한이 확인되었으나 자기공명 영상 검사나 초음파 진단 검사상 가능한 다른 병리적 소견이 발견되지 않아 최종적으로 동결기 상태의 동결견으로 진단 받은 총 127명의 환자들을 대상으로 하였다. 모든 환자들은 관절와-상완 관절 내 스테로이드 주사요법을 1회 시행 받았다. 첫 외래 방문 이후 2~4주 후 전화를 통한 설문을 시행하였으며 전체 127명의 대상 환자 중 22명의 환자가 전화 설문을 거부하여 최종 105명의 환자가 대상이 되었으며 이중 경구 NSAID 제제와 함께 경피 Buprenorphine 제제를 처방 받은 실험군(BP group)은 51명, 경구 NSAID 제제 만을 처방 받은 대조군(NP group)은 54명이었다. 치료 효과의 평가를 위하여 첫 외래 방문 시 및 전화 설문 시 시각적 통증 점수(PVAS), 시각적 기능 점수(FVAS), 미국 정형외과 견주관절 점수(ASES score)를 측정하였다. 결과: 전반적인 통증 및 기능 임상 점수에서 양 군 동일하게 투여 전 보다 투여 후에 호전되는 추세를 보였다. 각군의 평가 점수들의 투여 후 결과는 투여 전과 비교하여 통계적으로 의미 있게 호전되었다(p<0.001). PVAS 점수는 BP group에서 3.55, NP group 에서 2.87로 BP group에서 오히려 0.68 높은 것으로 관찰되었으나 통계적으로 유의하지는 않았다(p=0.088). 투여 전 ASES 점수는 두 군간 차이를 보이지 않았던 반면 투여 후 점수는 BP group에서 57.31, NP group에서 64.24로 NP group에서 유의하게 높았다(p<0.05). 반면 FVAS 는 두군 모두 호전되는 추세는 보였으며 역시 NP group에서 높았으며 투여 후 점수에서 통계적으로 유의한 차이를 보였다(p<0.05). 결론: 동결기의 동결견 환자에게 1회 관절 내 스테로이드 주사치료 및 경구 NSAID 제제에 추가로 투여한 경피 Buprenorphine 제제는 단기 추시에서 투여하지 않은 경우보다 우월한 통증 및 기능적 임상 결과를 보이지 않았다.