• Clinics in Shoulder and Elbow
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• v.24 no.2
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• pp.93-97
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• 2021

Background: Injection therapy around the distal biceps tendon insertion is challenging. This therapy may be indicated in patients with a partial distal biceps tendon tear, bicipitoradial bursitis and tendinopathy. The primary goal of this study was to determine the accuracy of manually performed injections without ultrasound guidance around the biceps tendon. Methods: Seven upper limb specialists, two general orthopedic specialists, and three orthopedic surgical residents manually injected a cadaver elbow with acrylic dye using an anterior and a lateral infiltration approach. After infiltration the cadaveric elbows were dissected to determine the location of the acrylic dye. Results: In total, 79% of the injections were localized near the biceps tendon. Of these injections, 20% were localized on the radius near the bicipitoradial bursa. In total, 53% of the performed infiltrations were injected by anterior and 47% by lateral approaches. Of the injections near the distal biceps (79%), 47% were injected by an anterior and 53% by a lateral approach. Of the injections on the radius (20%), 33% were injected by anterior and 67% by lateral approach. Of the inaccurate injections (21%), 75% were injected anterior and 25% lateral. Conclusions: Manual infiltration without ultrasound guidance for distal biceps pathology lacks accuracy. We therefore recommend ultrasound guidance for more accurate infiltration.

• Journal of Korean Foot and Ankle Society
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• v.20 no.3
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• pp.112-115
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• 2016

Purpose: We aimed to investigate the safety zone for Achilles tendon insertion in the posterior aspect of the calcaneus via the use of magnetic resonance imaging (MRI) when planning for insertional Achilles tendinopathy. Materials and Methods: This study included 95 patients. The MRI of midsagittal plane of the ankle joint was used to measure the proximal and distal insertion point for the Achilles tendon in the posterior aspect of the calcaneus. Patients were divided into three groups according to the proportion of the distal insertion point out of the entire calcaneal length: the proximal, middle, and distal insertion groups. Results: The mean proximal and distal insertion points for the Achilles tendon were measured as 1.05 cm (0~2.11 cm) and 2.36 cm (1.60~2.93 cm), respectively. When the posterior aspect of the calcaneus was used as the reference plane, none of the patients was in the proximal insertion group, while 75 and 20 patients were in the middle and distal insertion groups, respectively. The insertion portion was longer in the distal insertion group ($1.47{\pm}0.25cm$) than in the middle insertion group ($1.27{\pm}0.35cm$). Statistically significant differences with respect to the length of the insertion portion were observed between the two groups (p=0.008). Conclusion: Removal of more than 1 cm below the superior margin of the posterior calcaneus may be dangerous. An MRI study on the Achilles tendon of patients without hindfoot deformity or tendinopathy revealed various insertional characteristics. Preoperative MRI evaluation is safer than relying solely on the simple radiological assessment when planning for insertional Achilles tendinopathy.

• Clinics in Shoulder and Elbow
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• v.27 no.1
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• pp.79-87
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• 2024

Rotator cuff disease is a common cause of shoulder pain for which partial-thickness rotator cuff tears occupy a significant proportion. Such tears are often difficult to diagnose and manage in the general clinic setting. A review of the available literature from well-known databases was performed in this study to provide a concise overview of partial-thickness rotator cuff tears to aid physicians in their understanding and management.

• Journal of Korean Foot and Ankle Society
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• v.11 no.1
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• pp.67-71
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• 2007

Purpose: To evaluate clinical results of the 5th proximal metatarsal intraarticular fracture (Zone I) with displacement treated operatively and to evaluate predisposing factors of the 5th proximal metatarsal fracture (Zone I). Materials and Methods: 11 patients treated for the 5th proximal metatarsal fracture (Zone I) operatively and 10 patients treated conservatively between Jan 2003 and Dec 2005, were followed for more than one year. Functions were graded by AOFAS foot scoring system and union time and postoperative complications were also evaluated. Calcaneal pitch angle was also evaluated. Results: Clinically there were no much difference in results. Clinical points were 94.5 in the operative group and 92.3 in the conservative group. At the last follow-up, the radiographic results showed union in all cases. During the follow-up period, there were no significant complications. But in the conservative group, displaced fracture with calcaneal pitch angle over 30 degree tends to show delayed union and time to loss of pain tends to be prolonged. Conclusion: Calcaneal pitch angle is thought to predisposing factor for 5th metatarsal base fracture. Operative treatment is viable option for the 5th proximal metatarsal intraarticular fracture with displacement and with calcaneal pitch angle over 30 degree. In cases of cavovarus foot deformity, we think operative treatment should be considered with deliberation and long term follow-up study for peroneal tendinopathy should be needed.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.5 no.2
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• pp.94-98
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• 2012

Calcific tendinitis is characterized by inflammation around calcium hydroxyapatite crystal deposits. Minimally invasive extracorporeal shock wave therapy (ESWT) has been postulated to be an effective treatment option for treating calcific tendinitis. In clinical practice, shock waves usually are aimed at the painful area after palpation and not focused. It has been known that exact fluoroscopic focusing of ESWT at the calcific deposit for treatment of calcifying tendinopathy is highly effective. Ultrasound is a simple, inexpensive and radiation-free diagnostic tool that has been used to demonstrate tendinopathy including calcific tendinitis. However, focusing of shock wave under ultrasound is less well established. We present a patient in whom large calcific tendinitis of gluteus medius was completely resolved by exact focusing of ESWT by ultrasound with literature review.

• Physical Therapy Korea
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• v.12 no.3
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• pp.94-100
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• 2005

Eccentric muscle contraction is more effective than concentric and iosmetric muscle contraction in increasing muscle strength. Also, eccentric or concentric-eccentric training has greater effective in neural activation and muscle hypertrophy than concentric training. In some study, eccentric exercises have been shown to reduce pain and improve function on Achilles tendinopathy. The purpose of this study was to evaluate the effect of eccentric isokinetic exercise in a patient with dislocation of the tarsometatarsal joint by traffic accident. After eccentric isokinetic training, peak torque, average work, and average power were increased. Also, the patient was fully weightbearing with a pain free normal gait thus making good recovery.

• Journal of Korean Foot and Ankle Society
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• v.22 no.2
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• pp.49-54
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• 2018

Ankle sprains are among the most common injuries sustained during athletic activities and daily life. Acute ankle sprain is usually managed conservatively with functional rehabilitation but the failure of conservative treatment leads to the development of chronic ankle instability. The development of repetitive ankle sprains and persistent symptoms after injury has been termed chronic ankle instability. Acute ankle sprains and chronic ankle instability require a careful evaluation to detect other comorbidities, such as subtalar instability, osteochondral defect, peroneal tendinopathy, tarsal coalition, os trigonum, flexor hallucis longus tendinitis, calcaneus anterior process fracture, and neural injuries. For the successful treatment of acute ankle sprains and chronic ankle instability, the treatment of comorbidity lesions should be performed first.

• Clinics in Shoulder and Elbow
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• v.19 no.4
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• pp.245-248
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• 2016

A 55-year-old female experienced acute left shoulder pain without specific trauma. Radiography showed calcific deposits in the inferior part of the glenoid fossa. Magnetic resonance arthrography showed calcific deposits in the origin of the long head of triceps brachii muscle. Conservative treatment failed to resolve the symptoms; therefore, arthroscopic surgery was performed. The patient experienced immediate and dramatic pain relief, and normal shoulder motion was demonstrated 1 year after surgery. In conclusion, although rare, calcific tendinitis of the triceps brachii muscle, which causes shoulder pain, should be included in the differential diagnosis of acute shoulder pain. Arthroscopic surgery is a treatment option for chronic cases and those resistant to conservative treatment.

• Journal of Korean Foot and Ankle Society
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• v.16 no.1
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• pp.26-30
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• 2012

The subtalar joint is a complex joint that is functionally responsible for inversion and eversion of the hindfoot. Advances in optical technology and surgical instrumentation have allowed the arthorscocpic surgeon to investiagate the small joints including the subtalar joint. Indications for subtalar arthroscopy include pain, swelling, stiffness and locking. Therapeutic indications include treatment of chondromalacia, osteophytes, arthrofibrosis, synovitis, loose bodies, osteochondral lesions, excision of a painful os trigonum, arthrodesis, and FHL tendinopathy. Contraindications to subtalar arthroscopy include infection, advanced osteoarthritis with deformity, severe edema, poor vascularity and poor skin quality. Subtalar arthroscopy is a technically demanding and difficult procedure that should only be performed by experienced surgeons. With proper instrumentation and careful operative techniques, satisfactory results may be obtained with minimal morbidity.

• Journal of Korean Foot and Ankle Society
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• v.25 no.1
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• pp.10-16
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• 2021

Evidence-based papers on the treatment of some chronic tendinopathy or ligament lesions using an injection in foot and ankle disorders have been reported, but there are few reports on the treatment of acute ankle ligament injury. On the other hand, some papers have reported a faster return to play for injection therapy that combines RICE (Rest, Icing, Compression, and Elevation) treatment and rehabilitation. Injection therapy can be used as an additional treatment for ankle ligament injury. Rather than having narrow-minded thinking about these treatments, it is important to make efforts to verify the safety and precautions of treatment and recognize them as a category of normal treatment. Continuous analysis and monitoring of these treatments can satisfy patients whose needs are changing rapidly.