• Clinics in Shoulder and Elbow
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• 제21권1호
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• pp.30-36
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• 2018

Background: The Korean Shoulder Scoring System (KSS) is a reliable and valid procedure for discriminative assessment of the clinical status of patients with rotator cuff tears. This study evaluates the correlation between the preoperative KSS and factors in patients with rotator cuff tears. Methods: From November 2009 to June 2016, 970 patients who underwent arthroscopic rotator cuff repair were retrospectively evaluated. A total of 490 patients met the study criteria. Preoperative factors included age, sex, symptom duration, mediolateral (ML) and anteroposterior (AP) tear size, acromiohumeral distance (AHD), tangent sign, tendon involvement (type I, supraspinatus; type II, supraspinatus and subscapularis; type III, supraspinatus and infraspinatus; type IV, all 3 tendons), fatty infiltration of rotator cuff muscles (group I, Goutallier stages 0 and 1; group II, Goutallier stages 2, 3, and 4), and KSS. Results: Old age, ML tear size, and AP tear size negatively correlated with the preoperative KSS (p<0.001). AHD showed a positive correlation with the preoperative KSS (p<0.001). A significantly inferior preoperative KSS was found in females and type III tendon involvement (p<0.001). For supraspinatus and infraspinatus, the preoperative KSS of group II fatty infiltration showed a significantly lower score than group I fatty infiltration (p<0.05). Conclusions: A relatively lower preoperative KSS was associated with old age, large tear size, narrow AHD, female, type III tendon involvement, and group II fatty infiltration of the supraspinatus and infraspinatus. Our study indicates that preoperative KSS can be a good measurement for the preoperative status of patients with rotator cuff tears.

• Clinics in Shoulder and Elbow
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• 제7권1호
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• pp.23-29
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• 2004

It has been reported that rotator cuff tear have good response to arthroscopic or open repair even if the range being so wide. However, the majority of this literature regarding the diagnosis and treatment of tear focused on lesion of the supraspinatus and infraspinatus tendons. But involvement of the subscapularis tendon with rotator cuff tear should be thought to be less common and poorer to open operative repair. Furthermore, some europian author have stated that the rotator cuff tear including the subscapularis tendon are sufficiently distinct in their clinical presentation and prognosis as to merit separate consideration of their diagnosis and treatment. The purpose of this study is to evaluate result of arthroscopic or open repair in patient with rotator cuff tear that include the subscapularis tendon. Of the 128 rotator cuff repairs performed from 1998 through 2003, 12 had a tear that include the subscapularis tendon in combination with the supraspinatus (8 cases) and infraspinatus (4 cases). Mean duration of symptoms before surgical treatment was 6 months (range 3 to 12 months). All 12 patient demonstrated a positive lift off sign. Shoulder function was assessed using the Constant- Murley score, which ranges from 30 to 58. Pain was assessed using a linear visual analogue scale range from 0 to 10. Postoperative Constant score range from 40 to 64 (average 47.8). Pain score improved from 5.5 to 8.5, but there are postoperative pain improvement on nothing in 5 patient. The overall result for 12 patient were satisfy in 2, fair in 5 and dissatisfy in 5: Therefore satisfactory result were noted only in 16 % of this overall group. In conclusion, we have failed to make good result in patient with rotator cuff tear that included the subscapularis tendon. At the result, outcome after surgical repair of this type of rotator tear is comparatively inferior to the result of operative repair of rotator cuff not involved the subscapularis tendon.

• 대한정형외과스포츠의학회지
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• 제5권1호
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• pp.50-57
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• 2006

목적: 견관절 회전근 개 전층 파열시 관절경적 복원술 후 대결절에 부착되어진 회전근 개의 건이 상완골에 어느 정도의 비율로 건-골(tendon to bone)에 치유되는지에 대하여 알아보고자 하였다. 또한 저자들은 극상건 전층 파열된 례에서 관절경적 복원술 후의 기능적 평가를 시행하였다. 대상 및 방법: 연속적 인 30례의 극상건 전층 파열을 19례에서 one row of anchor를, 11례에서는 two rows of anchor를 사용해 관절경적 복원술을 시행하였다. 환자들의 연령은 51세부터 79세로 평균 63세였으며, 평균 추시 기간은 술후 12개월부터 28개월로 평균 16개월이었다. 술전과 마지막 추시에 주관적 및 객관적인 기능적인 평가를 위해 Constant, ASES와 HCLA score를 측정하였다. 해부학적인 건 치유를 확인하기 위해 30례 전례에서 술후 6개월에서 20개월, 평균 10개월째 자기 공명 관절 조영술(25례)이나 자기 공명 술(5례)을 시행하였다. 결과: 관절경적 복원술후 회전근 개의 대결절에 대한 완전 치유는 30례중 21례(70.0%)였고, 부분적인 파열은 3례(10%)였으며, 극상건이 전혀 치유되지 않아 대결절에 부착되지 못한 경우는 6례 (20%)였으나, 그 중 5례에서는 술후 남아있는 결손의 크기가 처음 술전 보다는 작았다. 객관적인 평가로 Constant score는 술전에 평균 $55.7{\pm}7.1$점에서 술후 마지막 추시 관찰시에 $77.7{\pm}9.7$점으로 향상되었고(p<0.001), ASES xcore는 술전 $39.2{\pm}7.4$점에서 $72.4{\pm}12.6$점으로 향상되었고(p<0.001), UCLA score는 술전 $17.9{\pm}2.2$점에서 $26.5{\pm}5.0$점으로 향상되었다(p<0.001). 견관절의 전방 거상시 근력 이 대결절에 치유된 례 $(7.1kgs{\pm}2.4)$에서 전혀 치유되지 않아 완전히 재 파열되었거나, 부분 파열을 보인 례 $(4.5kgs{\pm}1.0)$에서 보다 통계학적으로 의미 있는 향상을 보였다(p<0.05). 건 치유에 결정적인 영향을 미치는 인자는 환자의 나이였다. 65세 이상의 환자에서는 단지 41.7%만이 대결절에 극상건의 완전한 치유율을 보였다(p<0.05). 결론: 회전근 개 중 극상건 전층 파열된 례에서 관절경적 복원술 후 약 70%에서 완전한 치 유를 보였다. 술후 극상건의 부분 파열 및 재파열은 근력 저하와 직접적인 연관을 가졌다. 특히, 노령 환자에서의 회전근 개 상태가 술후 재파열과 밀접한 관련이 있다.

• Clinics in Shoulder and Elbow
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• 제22권4호
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• pp.216-219
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• 2019

Background: Progression of the tear size and erosion of the greater tuberosity (femoralization) in the supraspinatus tear makes it difficult to repair or increases the risk of a re-tear. This study examined the proximal articular surface and greater tuberosity of the humeral head in plain radiography. Methods: Two-hundred forty-seven cases, whose anteroposterior (AP) radiographs were taken correctly, were included from 288 cases, in whom the status of the supraspinatus had been confirmed by surgery. After downloading the plain AP radiograph as DICOM, the radius of the circle apposed at the superior half of the articular surface of the head, and the distance between the circle and the farthest point of the greater tuberosity ('height' of the greater tuberosity) were calculated using the software (TechHime, Korea). MRI checked the number of torn tendons and degree of muscular atrophy. Results: The following were encountered: 93 intact supraspinatus, 50 partial-thickness tears, and 104 full-thickness tears. In the analysis using the 93 intact cases, the average radius of the rotation center was 25.3 mm in male and 22.3 mm in female. The average height of the greater tuberosity from the circle with the same rotation center was 4.3 mm in male and 4.2 mm in female with no statistical significance. The correlation between the reparability of supraspinatus and height of the greater tuberosity, fatty infiltration, and muscular atrophy was confirmed. Conclusions: The height of the greater tuberosity from the circle with the same rotation center was 4.3 mm in male and 4.2 mm in female. This height was strongly correlated with muscular atrophy and fatty infiltration of the supraspinatus tendon.

• Clinics in Shoulder and Elbow
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• 제18권1호
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• pp.47-51
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• 2015

Iatrogenic damage of the rotator cuff followed by postoperative shoulder function loss is a potential complication after antegrade intramedullary nailing (AIN) for a humeral fracture. The authors present a case of arthroscopic rotator cuff repair and subacromial decompression of a non-healed rotator cuff tendon (mainly supraspinatus) and secondary impingement syndrome caused either by the tear or a proud nail after AIN for a mid-shaft humeral fracture. At presentation, the patient complained of right shoulder pain and 'snapping', especially during forward elevation and abduction of the shoulder, of 4 years duration. Right shoulder pain started sometime after pain due to the humeral shaft fracture, operation had subsided, and persisted after nail removal. Arthroscopic findings showed a longitudinal rotator cuff tear at the nail entry point that had not healed and severe fibrous hypertrophy on the acromion underspace, which is a unique finding since most longitudinal splits of tendon fibers are more likely to heal than conventional rotator cuff tears detached from bone. The torn rotator cuff was repaired after debridement and placing side-to-side sutures. At his 34-month follow-up after rotator cuff repair, the patient showed complete recovery and had excellent clinical scores.

• Clinics in Shoulder and Elbow
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• 제22권3호
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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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• 제25권4호
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• pp.257-264
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• 2022

Background: Chronic subscapularis tendon tear (SBT) is a degenerative disease and a common pathologic cause of shoulder pain. Several potential risk factors for chronic SBT have been reported. Although metabolic abnormalities are common risk factors for degenerative disease, their potential etiological roles in chronic SBT remains unclear. The purpose of this study was to investigate potential risk factors for chronic SBT, with particular attention to metabolic factors. Methods: This study evaluated single shoulders of 939 rural residents. Each subject undertook a questionnaire, physical examinations, blood tests, and simple radiographs and magnetic resonance imaging (MRI) evaluations of bilateral shoulders. Subscapularis tendon integrity was determined by MRI findings based on the thickness of the involved tendons. The association strengths of demographic, physical, social, and radiologic factors, comorbidities, severity of rotator cuff tear (RCT), and serologic parameters for SBT were evaluated using logistic regression analyses. The significance of those analyses was set at p<0.05. Results: The prevalence of SBT was 32.2% (302/939). The prevalence of partial- and full-thickness tears was 23.5% (221/939) and 8.6% (81/939), respectively. The prevalence of isolated SBT was 20.2% (190/939), SBT combined with supraspinatus or infraspinatus tendon tear was 11.9% (112/939). In multivariable logistic regression analysis, dominant side involvement (p<0.001), manual labor (p=0.002), diabetes (p<0.001), metabolic syndrome (p<0.001), retraction degree of Patte tendon (p<0.001), posterosuperior RCT (p=0.010), and biceps tendon injury (p<0.001) were significantly associated with SBT. Conclusions: Metabolic syndrome is a potential risk factor for SBT, as are these factors: overuse activity, diabetes, posterosuperior RCT, increased retraction of posterosuperior rotator cuff tendon, and biceps tendon injury.

• Clinics in Shoulder and Elbow
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• 제22권1호
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• pp.3-8
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• 2019

Background: This study aimed to compare the subscapularis muscle volume between the intact groups (group I) and supraspinatus tendon tear groups (group T) based on the sex and three different age groups. Methods: Subjects with a group I and subjects with group T without any other lesions were retrospectively evaluated from among patients who received a magnetic resonance imaging (MRI) scan between January 2011 and December 2013. The MRI scans were studied by a consultant radiologist. The subscapularis muscle volume was compared according to the age and sex; the age groups were categorized as patients in their 40s, 50s, and 60s. The volume of subscapularis muscle was measured by three-dimensional reconstructed images acquired through the axial section of 1.5T MRI. Results: No statistically significant differences were observed between subscapularis muscle volume of the group I and group T, except for male patients in their 50s (group I: $100,650mm^3$ vs. group T: $106,488mm^3$) and 60s (group I: $76,347mm^3$ vs. group T: $99,549mm^3$) (p<0.05). Males had a larger mean volume of subscapularis muscle than females, and the subscapularis muscle volume decreased in a linear manner with increasing age. Conclusions: Decrease in subscapularis muscle volume was observed with increasing age, and the impact of supraspinatus tear on subscapularis muscle volume is age and sex dependent.

• 대한영상의학회지
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• 제83권1호
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• pp.252-252
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• 2022

• Clinics in Shoulder and Elbow
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• 제18권2호
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• pp.61-67
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• 2015

Background: The purposes of the study were to examine rotator cuff tendon degeneration with respect to harvesting location, to determine a rationale for debridement of the torn end, and thus, to determine adequate debridement extent. Methods: Twenty-four patients with a full-thickness rotator cuff tear were included in the study. Tendon specimens were harvested during arthroscopic rotator cuff repair from three locations; from torn ends after minimal regularization of fraying (native end group, NE group), from torn ends after complete freshening of the frayed end (freshened end group, FE group), and from the macroscopically intact portion just distal to the musculotendinous junction (musculotendinous junction group, MTJ group). Control samples were harvested from patients admitted for surgery for proximal humerus fracture. Harvested samples were evaluated using a semi-quantitative grading scale. Results: Mean total degeneration scores in the NE group ($13.3{\pm}3.21$), the FE group ($12.5{\pm}2.30$), and in the MTJ group ($10.8{\pm}3.10$) were significantly higher than those in the normal control group ($5.0{\pm}2.87$; all p<0.001). Mean total degeneration score in the NE group was significantly higher than that in the MTJ group (p=0.012), but was not from that of the FE group. Mean total degeneration score in the FE group was not significantly different from that of the MTJ group. Conclusions: Tendon degeneration exists throughout the entire tendon to the macroscopically intact portion of full-thickness rotator cuff tear. Therefore, aggressive debridement to grossly normal appearing, bleeding tendon is unnecessary for enhancing healing after repair.