• The Korean Journal of Pain
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• 제10권2호
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• pp.225-230
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• 1997

Background: Authors modified the traditional continuous axillary brachial plexus block technique of Selander for purpose of increasing success rate and decreasing complications by use of commercial epidural anesthesia set. Method: Thirty-nine patients scheduled for upper extremity operations were injected with 40 ml of anesthetic solution by axillary perivascular technique, using 23~25G immobile needle at 2 cm from the pectoralis major. Tuohy needle was immediately introduced at 4 cm from the pectoralis major and pierced the expanded neurovascular sheath at an angle of 30 degree to the skin. The "pop" was well noted well. Needle was advanced 0.5 to 3.0 cm and epidural catheter introduced through the needle. After removal of needle, occlusive dressing was done. Tip of catheter and spread of solution were demonstrated by fluoroscopy with contrast dye after completion of procedure. Result: Catheter insertion was successful at first attempt for all case. Total length of insertion was from 6 to 13($10.0{\pm}1.7$) cm. Tip of catheter was placed in infraclavicular space(66.7%), about the humeral head(17.9%) and in upper arm in 3 cases as U-shape(7.9%). Catheters were maintained for $6.7{\pm}2.6$(3-12) days. There were no complications such as: perforation of major vessels, needle trauma to nerve, infection, bleeding or hematoma. Conclusion: This study demonstrated continuous axillary brachial plexus block with epidural anesthesia set is safe, easy and convenient modification of technique of Selander.

• Clinics in Shoulder and Elbow
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• 제9권1호
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• pp.34-41
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• 2006

Purpose: This study is to analyze the result and complications of internal fixation with T-plate for two-part fracture of the neck of the humerus. Materials and Methods: The clinical results of fourteen patients who had been performed with this method mentioned above were reviewed. Their average age was 49.6. Postoperative mean follow up period was 24.1 months. Radiological evaluation was done by Kronberg's and shoulder function by Neer's. Results: By Kronberg evaluation, nine cases were good, two cases acceptable and three cases poor. By Neer's, mean score of shoulder function was 77.6 and 4 cases were excellent, one satisfactory, five unsatisfactory and four failure. The complications were the sfiff shoulder, loss of reduction and avascular necrosis of humeral head. Conclusion: In this study, there were differences according to the age. And we obtained an unsatisfactory result in patients over 50 years old. We consider that in patients over 50 years old, the differences were due to the muscle weakness through wide surgical approaches, postoperative implant loosening or the stiffness caused by poor rehabilitation.

• 대한정형외과스포츠의학회지
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• 제1권2호
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• pp.149-153
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• 2002

목적: Bankart병변이있는 외상성재발성견관절탈구환자에서봉합나사를이용한관절경적봉합술의유용성을알아보았다. 대상및방법: 견관절의외상성전방불안정성환자에대해봉합나사를이용한관절경적Bankart병변봉합술을시행한환자중12개월이상추시가가능하였던54례를대상으로Rowe와Zarins의평가방법을이용하여결과를판정하였다.결과: 관절경하에서확인된동반병변으로Hill-S achs병변이28례에서, SLAP병변과상완골골두의연골연화증은각각6례에서관찰되었다. Rowe와Zains의평가방법에따라평가하여50례( 92.6$\%$ )에서양호이상의결과를얻었으며, 재탈구는2례에서발생하였다.결론: 외상성재발성견관절탈구로인한전방불안정성환자에서Bankar병변에대해봉합나사를이용한관절경적봉합술은우수한임상결과와낮은재발율을보이고, 합병증이낮은효과적인술식중의하나라고사료된다.

• 대한정형외과 초음파학회지
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• 제1권2호
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• pp.112-116
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• 2008

최근 견관절 질환에 대한 이해가 높아짐에 따라서 견관절에서 초음파의 유용성 또한 급격히 증가하는 추세이다. 초음파 검사는 비 침습적이며 검사 비용이 저렴할 뿐만 아니라 견관절에서는 유일하게 회전근 개의 움직임을 실시간으로 관찰할 수 있다는 큰 장점이 있다. 견관절 초음파 검사는 일반적으로 환자가 앉은 자세에서 실시하며, 검사 순서는 전방에서부터 시작하여 후방 관절 구조물들을 확인하면서 검사를 마친다. 초음파 검사는 견관절 주위의 여러 근육과 인대, 관절와 순, 골 구조 등을 확인할 수 있으며, 특히 회전근 개 질환의 진단에 큰 도움을 준다. 회전근 개는 견갑하근, 극상근, 극하근, 그리고 소 원형근의 네 개의 근육으로 이루어진 하나의 운동 단위이며, 견관절의 능동 운동시 지렛점으로 작용하여 견관절 운동을 원활하게 조종하는 역동적 안정 요소의 기능을 담당한다.

• 한국전문물리치료학회지
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• 제22권4호
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• pp.62-70
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• 2015

The aims of the current study were to assess reliability of range of motion (ROM) measurement of glenohumeral internal rotation (GIR) with a pressure biofeedback stabilization (PBS) method and to compare the reliability between manual stabilization (MS) and the PBS method. In measurement of pure glenohumeral joint motion, scapular stabilization is necessary. The MS method in GIR ROM measurement was used to restrict scapular motion by pressing the palm of the tester's hand over the subject's clavicle, coracoid process, and humeral head. The PBS method was devised to maintain consistent pressure for scapular stabilization during GIR ROM measurement by using a pressure biofeedback unit. GIR ROM was measured by 2 different stabilization methods in 32 subjects with GIR deficit using a smartphone clinometer application. Repeated measurements were performed in two test sessions by two testers to confirm inter- and intra-rater reliability. After tester A performed measurements in test session 1, tester B's measurements were conducted one hour later on the same day to assess the inter-rater reliability and then tester A performed again measurements in test session 2 for confirming the intra-rater reliability. Intra-class correlation coefficient (ICC) (2,1) was applied to assess the inter-rater reliability and ICC (3,1) was applied to determine the intra-rater reliability of the two methods. In the PBS method, the intra-rater reliability was excellent (ICC=.91) and the inter-rater reliability was good (ICC=.84). The inter-rater and intra-rater reliability of the PBS method was higher than in the MS method. The PBS method could regulate manual scapular stabilization pressure in inter- and intra-rater measuring GIR ROM. Results of the current study recommend that the PBS method can provide reliable measurement data on GIR ROM.

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

• Clinics in Shoulder and Elbow
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• 제10권2호
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• pp.227-231
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• 2007

골절이 동반된 견관절 후방 탈구는 견관절 탈구의 1% 미만을 차지하며 동반되는 골절은 상완골 두 감입 골절이나 소결절 골절이 대부분이다. 그러나 회전근 개 전 파열이 동반된 후방 탈구는 아직까지 보고된 적이 없다. 저자들은 견관절 후방 탈구와 함께 극상근건이 부착된 대결절 견열 골절, 극하근건, 소원형근건 및 견갑하근건의 완전 파열이 동반되어 수술 치료한 1예를 경험하였기에 문헌 고찰과 함께 보고하고자 한다.

• 대한정형외과학회지
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• 제55권5호
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• pp.374-382
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• 2020

견관절 불안정증 수술의 가장 흔한 합병증은 불안정성의 재발이다. 견관절 불안정증 수술 후 불안정증 재발의 원인은 주로 외상, 부정확한 진단 및 술기상의 문제 등이 있으며 재발률을 높이는 위험인자로는 환자 요인과 해부학적 원인, 기술적 요인이 있다. 수술 실패의 원인을 세심한 병력 청취와 이학적 검사, 영상학적 검사 등으로 파악하여 원인 병변에 적절한 치료를 시행해야 한다. 수술 후 재발한 불안정증은 우선적으로 비수술적 치료를 고려해야 한다. 하지만 비수술적 치료가 실패한 경우 Bankart 병변의 파열, 관절막의 이완, 관절와 및 상완골 두의 결손에 따른 올바른 적응증을 가지고 적절한 치료 방법을 선택하여 가능한 해부학적 복원을 시행하여야 재발이 반복되는 것을 방지할 수 있을 것이다.

• 한국전문물리치료학회지
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• 제29권2호
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• pp.106-116
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• 2022

Background: Shoulder external rotation exercises are commonly used to improve the stabilizing ability of the infraspinatus. However, during exercise, excessive activation of the posterior deltoid compared to the infraspinatus causes the humeral head to move anteriorly in an abnormal position. Many researchers have emphasized selective activation of the infraspinatus during shoulder external rotation exercise. Objects: This study aims to delineate the optimal exercise method for selective activation of infraspinatus by investigating the muscle activities of the infraspinatus and posterior deltoid according to the four shoulder exercise methods and two forearm positions. Methods: Thirty healthy individuals participated in this study. The participants were instructed to perform shoulder external rotation exercises following four exercise methods: sitting external rotation (SIER); standing external rotation at 90° abduction (STER); prone external rotation at 90° abduction (PRER); side-lying external rotation (SLER), and two forearm positions (neutral, supinated). The electromyography (EMG) signal amplitude was measured during each exercise. Surface EMG signals were recorded from the posterior deltoid, infraspinatus, and biceps brachii. Results: EMG results of the infraspinatus and posterior deltoid in PRER, were significantly higher than that of the other exercises (p < 0.01). The EMG ratio (infraspinatus/posterior deltoid) in SIER was significantly higher than that of the other exercises. EMG activation of the posterior deltoid in SIER, PRER, and SLER was significantly higher in neutral than in supinated (p < 0.01). Furthermore, the EMG of the infraspinatus in SIER was significantly higher in neutral than in supinated (p < 0.01). The EMG ratio (infraspinatus/ posterior deltoid) in SIER was significantly higher in neutral than in supinated (p < 0.05.) Contrarily EMG ratios in PRER and SLER were significantly higher in supinated than in neutral (p < 0.05). Conclusion: The results show that clinicians should consider these exercise methods and forearm positions when planning shoulder external rotation exercises for optimal shoulder rehabilitation.

• Anatomy and Cell Biology
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• 제56권4호
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• pp.552-561
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• 2023

The endocrinology of type 2 diabetes (T2D) and its predisposing factors have been studied extensively while its skeletal effects have received negligible research despite this being a global disease. The cellular and molecular association between proximal humeral fractures and T2D has not been fully elucidated. We aimed to study bone cell quantities and immunolabel osteogenic and antiosteogenic cytokines. The study used 12-week-old rats (23 males) consisting of 8 Sprague Dawley (SD) and 15 Zucker Diabetic Sprague Dawley (ZDSD). Weekly mass measurements were taken while fasting blood glucose levels were recorded every 2 weeks with oral glucose tolerance tests conducted once every 4 weeks. Upon termination at the age of 28 weeks, humeri were fixed in 10% buffered formalin, prior to decalcification in ethylenediaminetetraacetic acid. The bone samples were then processed in ascending grades of alcohol using an automatic processor before embedding in paraffin wax. Sections were cut at 5 ㎛ thickness in a series for Haematoxylin and Eosin stain, and immunohistochemistry was performed with the anti-tartrate-resistant acid phosphatase (TRAP), anti-alkaline phosphatase (ALP), anti-bone morphogenetic protein 3 (BMP3), anti-transforming growth factor beta 1 (TGFβ1), anti-aged glycation end product (AGE) antibodies in the sequence. ZDSD rats had more adipocytes, BMP3 and AGEs expression with higher numbers of TRAP positive osteocytes and fewer ALP cells although no differences were found in TGFβ1 immunopositivity. We also found that T2D increases the number of AGEs immuno-positive cells, as well as its extracellular expression, thus providing a conducive environment for the interaction of the osteogenic cytokine and its antagonist to suppress osteoblastogenesis. ZDSD groups had higher adipocyte numbers therefore increased marrow adiposity in T2D.