• Clinics in Shoulder and Elbow
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• v.16 no.1
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• pp.47-52
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• 2013

Lesions of the long head biceps tendon pulley are frequent causes of shoulder dysfunction and pain. These lesions cause instability of the long head of the biceps tendon (LHB), and intra-articular tear of the subscapularis and the supraspinatus tendon might result from them. The arthroscopic repair of these lesions has not gained widespread acceptance as an effective procedure. Predictable results can be obtained by treating these lesions more definitively with tenotomy or tenodesis. The purpose of this article is to review the anatomy and properties of the LHB pulley and to provide treatment strategies for alleviating pulley lesions.

• The Journal of Korean Medicine
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• v.39 no.4
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• pp.121-125
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• 2018

Objectives: This study was carried out to analyse Hand Greater Yang Skin in human. Methods: Hand Greater Yang meridian was labeled with latex in the body surface of the cadaver. And subsequently body among superficial fascia and muscular layer were dissected in order to observe internal structures. Results : A depth of Skin encompasses a common integument and a immediately below superficial fascia, this study established Skin boundary with adjacent structures such as relative muscle, tendon as compass. The Skin area of the Hand Greater Yang in human are as follows: The skin close to 0.1chon ulnad of $5^{th}$ nail angle, ulnad base of $5^{th}$ phalanx, ulnad head of $5^{th}$ metacapus(relevant muscle: abductor digiti minimi muscle), ulnad of hamate, tip of ulnar styloid process(extensor carpi ulnaris tendon), radiad of ulnar styloid process, 2cm below midpoint between Sohae and Yanggok(extensor carpi ulnaris), between medial epicondyle of humerus and olecranon of ulnar(ulnar nerve), The skin close to deltoid muscle, trapezius muscle, platysma muscle, inner muscles such as teres major muscle, infraspinatus muscle, supraspinatus muscle, levator scapulae muscle, splenius cervicis muscle, splenius capitis muscle, sternocleidomastoid muscle, digastric muscle, stylohyoid muscle, zygomaticus major muscle, auricularis anterior muscle. Conclusions: The Skin area of the Hand Greater Yang from the anatomical viewpoint seems to be the skin area outside the superficial fascia or muscles involved in the pathway of Hand Greater Yang meridian, collateral meridian, meridian muscle, with the condition that we consider adjacent skins.

• Journal of the Korean Orthopaedic Association
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• v.54 no.5
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• pp.393-401
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• 2019

The shoulder pain is one of the most common problems to orthopaedic surgeons in clinic. Among therapeutic modality used to manage this pain, joint and periarticular injection, as well as suprascapular nerve block, show good clinical outcome. Ultrasound guidance is a safe technique, increasing the safety and accuracy of the procedure and reducing complications. An accurate understanding of the surface anatomy is important in performing the ultrasound-guided shoulder injections. This article aims to describe the surface anatomy and sono anatomy of both the shoulder and the surrounding structures and also summarize different infiltration techniques and peripheral nerve blocks.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.13 no.1
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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.

• Journal of Korean Medicine Rehabilitation
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• v.33 no.4
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• pp.45-59
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• 2023

Objectives The aim of this study was to analyze the trends of researches on oriental medicine treatments for supraspinatus tendinopathy. Methods We used five databases for searching researches; Korean studies Information Service System, Oriental Medicine Advanced Searching Integrated System, Research Information Sharing Service, PubMed, and China National Knowledge Infrastructure. Only randomized controlled trials suitable for the subject were selected. The methodological quality of included randomized controlled trials (RCTs) was assessed by the Cochrane risk of bias tool. Results Twenty randomized controlled trials were analyzed. There were 9 types of treatment interventions; acupuncture, acupotomy, pharmacopuncture, electroacupuncture, fire needling, warming needle, catgut-embedding therapy, herbal medicine, cupping. The most frequently used treatment intervention was acupuncture and acupotomy. There were 9 outcome measurements including visual analog scale (VAS), Constant-Murley Score (CMS), and range of motion. The most used measurement was VAS. As a result of meta-analysis, acupuncture was more effective than control group in VAS. Additionally, acupotomy was clinically significant compared to control groups in VAS and CMS. Conclusions In this review, we analyzed researches on effectiveness of oriental medicine for supraspinatus tendinopathy. A provisional conclusion can be produced that acupuncture and acupotomy showed beneficial effect to supraspinatus tendinopathy. Although there were some RCT studies, many of them had a high risk of bias, so it is hard to conclude that our study can include overall clinical status. Further well-designed trials are needed.

• Clinics in Shoulder and Elbow
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• v.26 no.1
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• pp.10-19
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• 2023

Background: Tendon degeneration contributes to rotator cuff tears; however, its role in postoperative structural integrity is poorly understood. The purpose of this study was to investigate the factors associated with postoperative structural integrity after rotator cuff repair, particularly focusing on the histology of tendons harvested intraoperatively. Methods: A total of 56 patients who underwent primary arthroscopic rotator cuff repair between 2009 and 2011 were analyzed. A 3-mm-diameter sample of supraspinatus tendons was harvested en bloc from each patient after minimal debridement of the torn ends. Tendon degeneration was assessed using seven histological parameters on a semi-quantitative grading scale, and the total degeneration score was calculated. One-year postoperative magnetic resonance imaging was used to classify the patients based on retear. Results: The total degeneration scores in the healed and retear groups were 13.93±2.03 and 14.08±2.23 (P=0.960), respectively. Arthroscopically measured anteroposterior (AP) tear sizes in the healed and retear groups were 24.30±12.35 mm and 36.42±25.23 mm (P=0.026), respectively. Preoperative visual analog scale pain scores at rest in the healed and retear groups were 3.54±2.37 and 5.16±2.16 (P=0.046), respectively. Retraction sizes in the healed and retear groups were 16.02±7.587 mm and 22.33±13.364 mm (P=0.037), respectively. The odds of retear rose by 4.2% for every 1-mm increase in AP tear size (P=0.032). Conclusions: The postoperative structural integrity of the rotator cuff tendon was not affected by tendon degeneration, whereas the arthroscopically measured AP tear size of the rotator cuff tendon was an independent predictor of retear. Level of evidence: III.

• Journal of the Korean Arthroscopy Society
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• v.11 no.1
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• pp.24-31
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• 2007

Purpose: To evaluate any combined rotator cuff pathologies in adhesive capsulitis patients with magnetic resonance arthrography (MRA) or ultrasonography (USG), and to see any differences in findings between MRA and USG. Materials and Methods: From June to December 2005, 80 consecutive patients with adhesive capsulitis were prospectively evaluated with either MRA or USG. Two groups were randomly assigned for examination. Evaluation were focused on any combined rotator cuff pathologies especially supraspinatus tendon. Results: Small (less than 1 cm) full-thickness SSP tendon tear were seen in 6 patients (MRA 4, USG 2, 8%) and partial-thickness SSP tendon tears in 21 (MRA 12, USG 9, 26%). In addition, supraspinatus tendinopathy were seen in 15 patients (MRA 7, USG 8, 19%). Overall, various SSP pathologies were reported in 42 patients (53%) of the study objects (MRA 23, 68% and USG 19, 41%). Subscapularis tendon partial tears were reported in 9 patients (MRA 6, USG 3, 11%). There were no statistical differences of the findings between MRA and USG in detecting rotator cuff pathologies (p>0.5). Conclusion: Nearly one half of the adhesive capsulitis patients showed various supraspinatus tendon pathology in MRA or USG. Although MRA group showed slight higher percentage of associated rotator cuff pathology than USG group (without statistical significance), this could be attributed to better resolution capacity of MRA than USG.

• Clinics in Shoulder and Elbow
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• v.16 no.2
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• pp.130-134
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• 2013

A painful pseudoarthrosis will develop due to a delay in diagnosis and treatment, and surgical care is required. Treatment of pseudoarthrosis is really difficult because the acromion is a thin flat bone that is difficult to be fixed firmly. A 52-year-old woman with multiple trauma had an acromial fracture that was not detected until it had caused pain after ambulation. Open reduction and internal fixation with a variable angle locking compression plate for distal radius and autogenous iliac bone graft were performed. At nine months after the operation, there was partial tear in the supraspinatus tendon, and arthroscopic repair of the supraspinatus tendon was performed. At nine months after the operation, radiographs showed a complete union. At three months after tendon repair, the patient had excellent function of the shoulder. We have reported a case of a successful treatment of nonunion and pseudoarthrosis of acromial fracture that is difficult to be fixed.

• Clinics in Shoulder and Elbow
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• v.22 no.3
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• pp.121-127
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• 2019

Background: Posterior decentering is not an uncommon finding on rotator cuff tear patients' shoulder magnetic resonance imaging. No previous study has reported on the relationship between posterior decentering and rotator cuff tear. Methods: We assessed patients' rotator cuff tear humeral head positions based on humeral-scapular alignment (HSA). Subjects were classified into centering and decentering groups based on a <2 mm or >2 mm HSA value, respectively. Differences in rotator cuff tear size, degree of tear, and fatty degeneration between the two groups were evaluated. Results: One hundred seventy-five patients (80 males, 95 females; mean age: $59.7{\pm}6.5$ years old) were selected as subjects (casecontrol study; level of evidence: 3). Tear size, degree of subscapularis tendon tear, and fatty degeneration of the supraspinatus, infraspinatus, and subscapularis muscles were significantly different between the two groups (p<0.001, p<0.001, p<0.001). Conclusions: The occurrence of decentering was related to rotator cuff tear size, degree of subscapularis tendon tear, and fatty degeneration of the rotator cuff muscles.

• Clinics in Shoulder and Elbow
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• v.18 no.4
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• pp.211-216
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• 2015

Background: Few studies have investigated magnetic resonance (MR) characteristics of traumatic posterosuperior rotator cuff tears involving the supraspinatus and infraspinatus. We hypothesized that traumatic rotator cuff tears may have MR characteristics distinguishable from those of non-traumatic tears. Methods: Preoperative MR arthrography and intraoperative tear size measurements were compared in 302 patients who underwent MR arthrography and subsequent arthroscopic rotator cuff repairs for traumatic (group T, 61 patients) or non-traumatic (group NT, 241 patients) tears. The inclusion criteria for both groups were posterosuperior full-thickness rotator cuff tear and age between 40 and 60 years. For group T, traumas were limited to accidental falls or slips, or sports injuries, motor vehicle accidents; injuries were associated with acute onset of pain followed by functional shoulder impairment; and time between injury and magnetic resonance imaging (MRI) was 6 weeks or less. Results: In group T, 72.1% of shoulders (44 patients) had tendon tears with blunt edges while 27.9% of shoulders (17 patients) had tears with tapering edges. In contrast, 21.2% of patients in group NT (51 patients) had blunt-edge tears, while 78.8% (190 patients) of tears had tapering edges. These results were statistically significant (p<0.001) and estimated odds ratio was 9.6. The size of tear did not vary significantly between groups. Conclusions: We found no exclusive MR characteristic to define traumatic tears. However, oblique coronal MRI of traumatic tears showed a significant tendency for abrupt and rough torn tendon edges and relatively consistent tendon thicknesses (without lateral tapering) compared to non-traumatic cuff tears.