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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
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Clinics in Shoulder and Elbow
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Korean Shoulder and Elbow Society
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Volume & Issues
Volume 12, Issue 2 - Dec 2009
Volume 12, Issue 1 - Jun 2009
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The Radiologic and Clinical Changes after Open Complete Repair of Massive Rotator Cuff Tears
Moon, Eun-Sun ; Choi, Min-Sun ; Kim, Myung-Sun ; Kong, Il-Kyu ; Kim, Byoung-Jin ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 109~114
DOI : 10.5397/CiSE.2009.12.2.109
Purpose: This study evaluated the preoperative and postoperative radiologic findings of patients with complete repairs after massive rotator cuff tears along with the incidence of re-tear and the clinical outcomes. Materials and methods: This study evaluated 33 cases who had open complete repairs for massive rotator cuff tears and these patients were followed up for more than 24 months. The clinical evaluation was performed according to the shoulder joint function test of the American Shoulder and Elbow Surgeons (ASES), and the degree of arthritis related to the massive rotator cuff tears was evaluated using the Hamada classification. Results: The ASES scores improved from 37.6 preoperatively to 85.6 postoperatively. The mean preoperative acromio-humeral interval (AHI) score was 6.5 mm, which increased to 9.3 mm immediately after surgery, and there was a decreased to 6.5 mm noted at the last follow up. The lower radiology stages of arthritis according to the classification showed better preoperative and postoperative results. Conclusion: An open complete repair as the surgical treatment for a massive rotator cuff tear showed satisfactory results for pain relief and an improvement in the shoulder joint function though re-tear after surgery.
The Usefulness of Multidetector CT Arthrography in the Diagnosis of Shoulder Pathology -Comparison with MR Arthrography and Arthroscopic Findings in the Same Patient-
Kim, Dong-Soo ; Park, Kyoung-Jin ; Kim, Yong-Min ; Choi, Eui-Sung ; Shon, Hyun-Chul ; Cho, Byung-Ki ; Park, Ji-Kang ; Kim, Seok-Won ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 115~125
DOI : 10.5397/CiSE.2009.12.2.115
Purpose: The purpose of the study is to evaluate the usefulness of CT arthrography (CTA) by conducting a comparative study of CTA and MR arthrography (MRA) with the arthroscopic findings in the same patients. Materials and methods: Forty nine patients who suffered from shoulder disease underwent MRA and CTA concurrently. The sensitivity and specificity of CTA was evaluated, as compared to MRA, in the case of four types of shoulder pathological lesions. The accuracy of CTA was evaluated by analyzing the arthroscopic findings of thirty four patients. Results: Compared to MRA, CTA showed a sensitivity of 90% and a specificity of 100% for diagnosing supraspinatus tendon (SST) full thickness tear, and CTA showed a sensitivity of 100% and a specificity of 97.5% for making the diagnosis of superior labrum anterior to posterior (SLAP) lesion. For diagnosing partial articular side supraspinatus avulsion (PASTA) lesion, some studies have shown the usefulness of CTA with a sensitivity of 71.4% and a specificity of 97.7%. However, for diagnosing SST bursal side partial tear, the sensitivity of CTA was as low as 10%. CTA has been shown to be relatively accurate when the diagnoses were verified with the arthroscopic findings; diagnosing SST full thickness tear and SLAP lesion with CTA has shown an accuracy of 100% and87.5% respectively, and CTA showed 71.4% diagnostic accuracy for PASTA lesion. Conclusion: CTA was a useful tool and it was equivalent to MRA for the assessment of SST full thickness tear, SLAP lesion and PASTA lesion, but not bursal side partial tear. Thus, it may be used preferably to diagnose shoulder pathology and for follow up as an inexpensive tool after operation.
Acromion Morphology in Coronal and Sagittal Plane; Correlation with Rotator Cuff Syndrome
Jo, Chris H. ; Kim, Jung-Taek ; Yoon, Kang-Sup ; Lee, Ji-Ho ; Kang, Seung-Baek ; Lee, Jae-Hyup ; Han, Hyuk-Soo ; Rhee, Seung-Whan ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 126~136
DOI : 10.5397/CiSE.2009.12.2.126
Purpose: We evaluated the correlation of the anatomic parameters of the acromion those represent on the magnetic resonance image (MRI) of impingement syndrome. Materials and Methods: From June, 2004 to December, 2005, 71 cases were surgically proven to be impingement syndrome, and the anterior acromial hooking angle, the lateral acromial hooking angle (AAHA and LAHA) and the acromial hooking index (AHI: the sum of the AAHA and LAHA) were compared to 16 control cases. At the same period, 55 cases were surgically proven to be partial or full thickness rotator cuff tear, and age, gender and twelve anatomic parameters, including the acromial type, the acromial angle, the anterior covering, the acromial slope, the AAHA, the lateral acromial angle, the acromial torsional angle, the lateral acromial angulation, the LAHA, the lateral covering, the acromiohumeral distance and the AHI were assessed. Results: The AAHA and AHI were increased as impingement syndrome proceeded. The acromial type and acromial angle, and the AAHA, LAHA and AHI showed significant differences between the controls and the rotator cuff tear patients on univariant analysis. On multivariant analysis, gender was most strongly correlated with rotator cuff tear. Age, AAHA and the acromial angle showed similar correlation, respectively. Conclusion: The coronal acromial shape is correlated with rotator cuff tear, and it is important to correct the lateral acromial shape when performing acromioplasty.
Arthroscopic Treatment with Suture Anchor for the Isolated Subscapularis Tear
Moon, Young-Lae ; An, Ki-Yong ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 137~141
DOI : 10.5397/CiSE.2009.12.2.137
Purpose: We wanted to evaluate the results of arthroscopic management of an isolated rupture of the subscapularis tendon using suture anchors. Materials and Methods: Twenty nine patients with unilateral ruptures of the subscapularis tendon and who underwent arthroscopic repair between February 2001 and October 2007 were reviewed prospectively. All the cases were isolated tears of the subscapularis without the involvement of any other rotator cuff tendon. In 19 patients the tear was localized to the superior one third, in 7 cases the tear was localized to the upper two thirds and the entire tendon was involved in 3 cases. The mean follow up period was 12.2 months (range: 6-26 months). The results of the treatment were assessed by evaluating the constant shoulder score and the pain score before surgery and after surgery. Results: The constant shoulder score improved from
points compared to before surgery and the pain score improved from
points postoperatively. Conclusion: Arthroscopic repair of isolated ruptures of the subscapularis tendon using suture anchors is a good option for effectively managing these tears.
Operative Treatment of Capitellar Fractures Associated with/without Other Injury Around the Elbow
Kang, Ho-Jung ; Park, Kwang-Hwan ; Lee, Jung-Kil ; Choi, Yun-Rak ; Hahn, Soo-Bong ; Kim, Sung-Jae ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 142~149
DOI : 10.5397/CiSE.2009.12.2.142
Purpose: We wanted to assess the radiological and clinical results and the prognostic factors after an operation for capitellar fractures associated with/without other injury around the elbow. Materials and Methods: Among the 25 patients (mean age: 49 years-old) who underwent open reduction and internal fixation for capitellar fractures, there were nineteen type 1 fractures and six type 3 fractures. The mean follow up period was 14.8 months. We assessed the factors affecting the radiological and functional results, such as the fracture pattern, the patient age and the surgical approaches. Results: In 24 of 25 patients, bony union was achieved at postoperative 1 year. There were eighteen excellent, four good, two fair and one poor functional results according to the Broberg and Morrey elbow score. The most common type was type 1 and the most common associated injury was lateral condylar fracture. The patients with type 1 fracture rather than the patients with type 3 fracture and the patients who had an extraarticular associated fracture rather than an intraarticular associated fracture had better clinical outcomes. Conclusion: 22 (88%) of the patients were satisfied at the result. The type of capitellar fracture and an associated intraarticular elbow fracture were shown to be important prognostic factors in this study.
Clinical Result of Arthroscopic Partial Repairs in Massive Rotator Cuff Tears
Yoo, Jae-Chul ; Ko, Kyung-Hwan ; Woo, Kyung-Jea ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 150~158
DOI : 10.5397/CiSE.2009.12.2.150
Purpose: With the better understanding of cuff function, partial repair or "force couple repair" for treating massive irreparable rotator cuff tear has gained some popularity. However, there were few reports on the results of partial repair. The purpose of this study was to report the clinical outcome of massive irreparable rotator cuff tears who received arthroscopic force-couple repair or partial repair. Materials and Methods: From June 2005 to Feb 2008, arthroscopic partial repairs were performed for 16 irreparable rotator cuff tears among the 101 large to massive rotator cuff tears that were operated on. Clinical and radiographic evaluation were done at the final follow-up. Results: There were 7 men and 9 women with a mean age of 66.6 years. The mean follow-up period was 27.3 month (range: 15-46). The pain VAS improved from 4.4 (
) to 2.1 (
) and the functional VAS improved from 46.9 (
) to 70.0 (
). The ASES score improved from 39.0 (
) to 80.3 (
) and the KSS score was 81.9 (
) at the final follow-up. The acromio-humeral distance was 6.6 cm (
) preoperatively and 6.2 cm (
) postoperatively without significant change (p
Improvement of the Elbow Function with Early Mobilization and Rigid Fixation of Coronoid Fracture by Tension Band Technique
Rhyou, In-Hyeok ; Suh, Bo-Gun ; Kim, Hyung-Jin ; Chung, Chae-Ik ; Kim, Kyung-Chul ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 159~166
DOI : 10.5397/CiSE.2009.12.2.159
Purpose: We wanted to evaluate the surgical results of early mobilization after rigid fixation of small coronoid fracture using the tension band technique Materials and Methods: Eight cases of coronoid fracture were fixed with the tension band technique and using K-wire and wire through the medial approach. All the cases were Regan-Morrey type 2. According to O`Driscoll, they were classified as 5 cases of the tip type (subtype 2) and 3 cases of the anteromedial type (1 case of subtype 2, and 2 case of subtype 3). The associated collateral ligament injuries (6 cases) and radial head/neck fractures (4 cases) were managed simultaneously. After immobilization for 5~7 days, active ROM exercise with a fitted hinge brace started and continued till postoperative 6 weeks. The patients were assessed for pain, ROM and functional disability using the Mayo elbow performance score (MEPS) at an average of 11 months (range: 6~28 months). The ulnar nerve symptoms were also investigated. Results: We observed solid union in all the coronoid fractures without hardware failure. An average of 2.2 wires (range: 2~4) were used. The mean extension was
), the mean flexion was
), the mean pronation was
) and the mean supination was
). The mean MEPS was 96 (range: 65~100). Ulnar nerve symptoms occurred at postoperative one day and persisted in one patient with the terrible triad of taking radial head excision and residual medial instability. Conclusion: The tension band technique uses easily obtained, economic K-wires and the wire was strong enough to permit early elbow ROM exercise and the technique might improve the elbow function. It was especially useful for fixation of multiple small fragments.
Treatment of the Acromioclavicular Joint Dislocation Using a AO Hook Plate
Lee, Ki-Won ; Choi, Young-Joon ; Ahn, Hyung-Sun ; Kim, Chung-Hwan ; Hwang, Jae-Kwang ; Han, Hee-Don ; Kim, Jae-Hyoun ; Joo, Youn-Suk ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 167~172
DOI : 10.5397/CiSE.2009.12.2.167
Purpose: We wanted to evaluate the results of treating acromioclavicular joint dislocation using an AO hook plate. Materials and Methods: Between February 2008 and September 2009, 10 patients underwent implant removal after surgical treatment of acromioclavicular joint dislocation using a AO hook plate. The Constant-Murley scoring system was administered postoperatively for evaluating the clinical results, and simple X-ray was taken for evaluating the state of reduction. Results: All cases showed satisfactory results on the clinical and radiological study. The mean Constant-Murley score at follow-up was 90.5 (range: 84~95). Three patients had some degree of discomfort with the hook plate, but these symptoms were relieved on removal of the plate. The radiological evaluation showed restoration of the vertical displacement of the clavicle in all the patients. No complications occurred such as infection, plate failure or redislocation after removal of the plate. Conclusion: The short term follow-up results of treating acromioclvicular joint dislocation using an AO hook plate were satisfactory both clinically and radiologically.
Acromial Morphology in Different MR Oblique Sagittal Slices: Correlation with Rotator Cuff Disorder
Jo, Chris H. ; Kim, Ji-Beom ; Choi, Hye-Yeon ; Ko, Young-Whan ; Yoon, Kang-Sup ; Lee, Ji-Ho ; Kang, Seung-Baik ; Lee, Jae-Hyup ; Han, Hyuk-Soo ; Rhee, Seung-Whan ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 173~179
DOI : 10.5397/CiSE.2009.12.2.173
Purpose: On the hypothesis that the acromion morphology is changed according to the its site, we identified the morphology of the acromion on the oblique slices of MRI and we investigated the association of the acromial shape with the clinical stages of rotator cuff disorder on the magnetic resonance (MR) images. In addition, we compared the acromion morphology on MRI and simple X-rays. Material and Methods: The MR images of seventy one patients with rotator cuff disorder and who underwent arthroscopic surgery were compared with that of a control group of sixteen patients who didn`t have rotator cuff disorder on MRI. On three subsequent oblique sagittal slices from the lateral edge of the acromion (S1, S2 and S3), each acromion morphology on the MRI slices was classified according to Epstein et al: flat, curved or hooked. We investigated the changing parttern of the acromion shape and we compared the acromion shape on MRI and that on simple X-rays. We classified the rotator cuff tear by the severity: bursitis, partial thickness tear or full thickness tear. We investigated which acromial type on the MRI oblique slice was associated with the severity of rotator cuff disease. Results: Changes of the acromial shape occurred in 54 patients (76.1%). The most frequent pattern was that the types are same on S1 and S2 and different on S3 (22 cases, 31.0%). The acromial type on S1 and S2 was significantly associated with the severity of rotator cuff disorder (p
Outcome of Arthroscopic Suture Bridge Technique for Rotator Cuff Tear: Short Term Clinical Outcome In Full-thickness Tear With Fatty Degeneration Less Than Moderate Degree
Cheon, Sang-Jin ; Hur, Joon-Oh ; Suh, Jeung-Tak ; Yoo, Chong-Il ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 180~188
DOI : 10.5397/CiSE.2009.12.2.180
Purpose: We evaluate the short-term clinical outcome of arthroscopic rotator cuff tendon repair with suture-bridge technique in patients with full thickness rotator cuff tear. Materials and Methods: 29 (male:17, female:12) consecutive shoulders treated with this index procedure and early rehabilitation were enrolled. Mean age was 56.4 years (range, 34~73 years) and mean follow-up period was 13 months (range, 12-15 months). Clinical outcomes were evaluated by using the University of California Los Angeles (UCLA) score, the Korean Shoulder Scoring System (KSS) and Visual Analogue Scale (VAS). Postoperative cuff integrity was evaluated through magnetic resonance imaging (MRI) and categorized by Sugaya classification. Results: Postoperative UCLA scores improved from 16.4 to 31.6 (p< 0.05) and KSS scores showed 88 at 6 months and 92 at last follow up. Preoperative VAS score was 8.6, which was decreased to 2.1 at 3 months and 1.4 at 6 months postoperatively. 28 patients (96.5%) had increase in range of motion. The follow up MRI was taken in 15 shoulders and the cuff integrity was type I in 6 cases, type II in 7, type III in 1 and type V in 1 by Sugaya classification. Conclusion: Arthroscopic suture-bridge technique resulted in good or excellent clinical outcome in 96.5% of the cases, so we think this technique is one of the reliable procedure for full-thicknes rotator cuff tear.
Latarjet Operation for Anterior Shoulder Instability with Glenoid Bone Defect
Cho, Seung-Hyun ; Cho, Nam-Su ; Yi, Jin-Woong ; Choi, Il-Hun ; Kwack, Yoon-Ho ; Rhee, Yong-Girl ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 189~198
DOI : 10.5397/CiSE.2009.12.2.189
Purpose: We wanted to evaluate the clinical results of the Latarjet procedure for treating anterior shoulder instability combined with a glenoid bone defect. Materials and Methods: Between Oct. 2006 and May. 2007, fourteen patients underwent a Latarjet operation to treat their anterior shoulder instability combined with a glenoid bone defect. The mean follow-up period was 15 months (range: 12 to 19 months), and the average age at the time of surgery was 29.9-years-old (range: 19 to 44 years). There were 13 males and 1 female. Eight patients exhibited involvement of the right shoulder. The dominant arm was involved in 8 patients. Six patients had undergone a previous arthroscopic Bankart repair before their Latarjet operation and 2 patients had a history of seizure. Results: The average Rowe score improved from 51.8 to 80.2 with 9 excellent, 4 good, and 1 fair results. The average Korean shoulder score for instability improved from 61.6 to 82.1 postoperatively. The active forward flexion and external rotation at the side of the involved shoulder was an average of
less than that of the uninvolved shoulder. The muscle strength of the involved shoulder measured 78.7% in forward flexion and 82.5% in external rotation, as compared with that of the uninvolved shoulder. There was 1 case of dislocation, 1 transient subluxation, 2 fibrotic unions, 1 resorption of the transferred coracoid process, 1 intraoperative broken bone, 1 transient musculocutaneous nerve injury and 1 case of stiffness. Conclusion: The Latarjet procedure for treating anterior shoulder instability combined with a significant glenoid defect effectively restores function and stability through extending the articular arc at the expense of external rotation. We should be cautious to avoid or detect complications when performing coracoid transfer.
Clinical Outcomes After Arthroscopic Double-Row Rotator Cuff Repair and Evaluation of Cuff Integrity by CT Arthrography
Jo, Chris H. ; Kim, Je-Kyoon ; Yoon, Kang-Sup ; Lee, Ji-Ho ; Kang, Seung-Baek ; Lee, Jae-Hyup ; Han, Hyuk-Soo ; Rhee, Seung-Whan ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 199~206
DOI : 10.5397/CiSE.2009.12.2.199
Purpose: Our goal for this study was to prospectively evaluate the functional & structural outcomes, by means of CT arthroscopy, of arthroscopic double-row fixation for treating rotator cuff tear. We also attempted to determine the variants that affect the functional & structural outcomes. Materials and Methods: Twenty seven consecutive patients underwent arthroscopic rotator cuff repair with double-row fixation. The average age at the time of the operation was fifty six years. The preoperative and postoperative examinations consisted of determining the Constant score, the score for the visual analogue scale for pain, the UCLA score, the American Shoulder and Elbow Surgeons (ASES) score, as well as a full physical examination of the shoulder. Preoperative MR arthrography was used to evaluate the integrity and atrophy of the rotator cuff. We measured the intraoperative tear size in the sagittal and coronal planes. Postoperative CT arthrography was used at one year postoperatively to evaluate the integrity and atrophy of the repaired tendons and muscles. Results: Preoperative MR arthrography revealed an average 29.22 mm tear size in the sagittal plane and an average 22.72 mm tear size in the coronal plane. Twelve cases of supraspinatus muscle atrophy and two cases of infraspinatus atrophy were observed on the preoperative MR arthrography. The average clinical outcome scores all significantly improved at the time of follow-up. At a mean of one year postoperatively, CT arthrography revealed 48.1% of the shoulders had healed, 11.1% showed incomplete healing and 40.7% showed retear of the repaired tendon. Conclusion: Arthroscopic double-row repair can result in improved clinical outcomes and good patient satisfaction. However, the problems about how to enhance healing of the repaired tendon still remain.
Is the UU Stitch Really Alternative to Modified MA (Mason-Allen) Stitch for Rotator Cuff Repair? - Biomechanical Comparative Study of UU to Modified MA Stitch -
Friedman, Darren J ; Ko, Sang-Hun ; Park, Ki-Bong ; Jun, Hyung-Min ; Kim, Tae-Won ; Lim, Hyun-Woo ; Yum, Young-Jin ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 207~214
DOI : 10.5397/CiSE.2009.12.2.207
Purpose: In arthroscopic rotator cuff repairs there are generally weak link in tendon suture interface, arthroscopic rotator cuff repairs can have higher retear rates than open repairs. The purpose of this study was to compare the strength of UU (Ulsan University) suture than open modified MA (Mason-Allen) suture when suture anchored into bone. Materials and Methods: The human supraspinatus tendons were harvested from the shoulder of the cadaver and split in 2 times, producing four tendons per one shoulder, for a total of 24 specimens. Two suture configurations (UU, MA) were randomized and checked on each set of tendons. Specimens were cyclically loaded under force control between 5 and 30 N at 0.25 Hz for fifty cycles. Each specimen was loaded to failure under displacement control at 1 mm/sec. Cyclic elongation, peak to peak displacement, stiffness, ultimate tensile load, mode of failure were checked. Results: No significant difference was found between two suture configuration with respect to peak to peak displacement, cyclic elongation, and stiffness. With regard to ultimate failure load, there were no significant difference statistically between the UU suture and modified MA suture (109.4 N, 110.6 N). The most common mode of failure between both sutures was suture pull-out through the tendon. Conclusion: The UU suture and modified MA suture produced similar biomechanical properties.
Arthroscopic Evaluation on Intra-Articular Pathology in Recurrent Shoulder Dislocation Aged Over 40 Years
Min, Woo-Kie ; Kim, Ju-Eun ; Cho, Hwan-Seong ; Kim, Poong-Taek ; Jeon, In-Ho ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 215~220
DOI : 10.5397/CiSE.2009.12.2.215
Purpose: This study is to analyze the prevalence of various intra-articular lesions in patients with traumatic recurrent anterior dislocation of shoulder over 40 years and suggest clinical implications for treatment. Materials and Methods: We retrospectively studied 16 cases that underwent surgical treatment for recurrent anterior dislocation of shoulder from January 2001 to May 2009. There were 9 males and 7 females, and the mean age was 52.7years. We carried out arthroscopic exam for all patients based on standard protocol, which included labrum, capular lesion, cuff, bony lesions. Results: All 16 cases showed Hill-Sachs lesion, 3 patients (19%) had bony Bankart lesion, 6 patients (38%) had labral tear. Capsular tear were found 15 patients (94%). Twelve (75%) had ruptured supraspinatus and 5 (31%) had subscapularis tear. Only one (6%) had SLAP lesion. Conclusion: There was relatively higher incidence of capsular and rotator cuff tears in patients over age 40 years. Preoperative planning to address these lesions is highly recommended.
Subclavian Portal Approach for Isolated Subscapularis Tendon Tear - Technical Note -
Choi, Chang-Hyuk ; Kim, Shin-Kun ; Chang, Il-Woong ; Kim, Se-Sik ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 221~225
DOI : 10.5397/CiSE.2009.12.2.221
Purpose: For an isolated tear of the subscapularis tendon, the presented technique using a subclavian portal provides both a good angle for anchor placement and sufficient space for managing the upper portion of a subscapularis tendon tear. Materials and Methods: The conventional method needs 2 additional portals for traction, debriding the footprint and anchor fixation for repair. The presented technique requires only an anterior portal for suture management and a subclavian portal without cannula for suture anchoring and placement of suture hooks. Results: The two suture limbs of the anchor can be placed on the subscapularis tendon by the switching technique and these limbs are repaired sequentially. Conclusion: This technique is simple and reproducible and it can be applied to partial tears and minimally retracted subscapularis tears.
Bilateral Traumatic Locked Posterior Dislocation of the Shoulder - A Case Report -
Lim, Jong-Min ; Suh, Jeung-Tak ; Ahn, Jae-Min ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 226~231
DOI : 10.5397/CiSE.2009.12.2.226
Purpose: Bilateral traumatic locked posterior dislocations of the shoulder are very rare and there has been no report on the operative treatment for this injury in the Korean medical literature. Materials and Methods: We present here a case of bilateral locked posterior dislocations of the shoulders after trauma and this was successfully treated with open reduction and lesser tuberosity transfer on the right shoulder and subscapularis tendon transfer on the left shoulder. Results and Conclusion: Twenty-four months later, the clinical and radiologic results were excellent.
The Primary Reverse Total Shoulder Arthroplasty for Post-septic Destroyed Shoulder - A Case Report -
Moon, Young-Lae ; Nam, Ki-Young ; Jo, Sueng-Hwan ; Venkat, Gorthi ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 232~235
DOI : 10.5397/CiSE.2009.12.2.232
Purpose: We report here on a solution for the case of a 71 year old lady with cartilage destruction in the left shoulder and the loss of the rotator cuff secondary to post-septic arthritic sequelae. Materials and methods: After thorough laboratory, clinical and radiological investigation of the patient to rule out any foci of active infection, we contemplated performing reverse total shoulder arthroplasty as a primary procedure. Results: At 22 months follow up, the patient had an excellent result according to the UCLA and ASES scales. Conclusion: Reverse total shoulder arthroplasty seems to be an efficient procedure to improve pain and function in the post-septic shoulder accompanying severe rotator cuff injury.
Pectoralis Major Tendon Transfer for Refractory Winged Scapula - A Case Report -
Ko, Sang-Hun ; Cho, Sung-Do ; Lee, Ki-Jae ; Lee, Chae-Chil ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 236~239
DOI : 10.5397/CiSE.2009.12.2.236
Purpose: We wanted to evalulate the clinical results of pectoris major tendon transfer for a neglected winged scapula that was caused by paralysis of the serratus anterior due to injury to the long thoracic nerve. Materials and Methods: A patient had neglected winged scapula that followed an arthroscopic operation for multi-directional instability of the shoulder joint, which was caused by traumatic dislocation. The patient was treated with pectoralis major tendon transfer using the modified Eden-Lange procedure. The range of a motion was improved from forward flexion
and external rotation
respectively. Results and Conclusion: There were no complications or recurrence and the patient`s psychological satisfaction was also high. If the shoulder girdle muscles are intact, except for the serratus anterior, then pectoralis tendon transfer is a satisfactory method that can provide normal scapulo-thoracic motion.
Surgical Treatment Using Anchor Suture of Coracoid Process Fracture with Acromioclavicular Joint Dislocation - A Case Report -
Jeong, Woon-Seob ; Lee, Sang-Soo ; Yoo, Yon-Sik ; Kim, Do-Young ; Park, Keun-Min ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 240~244
DOI : 10.5397/CiSE.2009.12.2.240
Purpose: This study examined the outcomes of closed reduction and fixation of the coracoid process fracture using a suture anchor in a patient with combined acromioclavicular dislocation for which the coraco-clavicular ligament was intact. Materials and Methods: A 26 year-old male patient with a coracoid process fracture that was associated with a type III acromioclavicular joint dislocation was operated on with anchor suture fixation. This is the first trial of this operative procedure. Results: At the postoperative follow-up at 3 months, complete union of the coracoid process fracture was seen. The shoulder had a full range of motion and the shoulder function was normal. Conclusion: Closed reduction and fixation using one suture anchor for treating coracoid process fracture is a safe, effective procedure.
Rare Normal Variation Between Biceps Anchor and Superior Labrum - A Case Report -
Kim, Yong-Ju ; Jeong, Hoon ; Ha, Jong-Kyoung ; Lee, Kwan-Hee ; Lee, Woo-Jin ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 245~249
DOI : 10.5397/CiSE.2009.12.2.245
Purpose: Labral lesions and its anatomic variants have been studied by several authors in the last decade. Buford complex and sublabral recess are most common variants. Their recognition is important in order to distinguish them from superior and anterior labral tear. Materials and Methods: We report one case of a 19-year-old female who was mistaken SLAP lesion for normal variant and was treated with arthroscopic surgery. Results: The arthroscopic finding shows rare normal variant of biceps anchor and superior labrum. The biceps long head tendon was inserted at superior labrum and supraspinatus tendon area. This finding was mistaken to SLAP lesion. Conclusion: We report rare normal variant of biceps anchor and superior labrum that was observed during arthroscopic surgery for SLAP lesion.
Operative Treatement of Snapping Triceps Syndrome and Ulnar Nerve Dislocation
Kang, Ho-Jung ; Lee, Hee-Young ; Lee, Jeong-Gil ; Kim, Sung-Jae ; Hahn, Soo-Bong ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 250~254
DOI : 10.5397/CiSE.2009.12.2.250
Purpose: Snapping triceps syndrome is dynamic condition in which medial head of triceps snaps (dislocates) over the medial epicondyle as the elbow is flexed. Materials and Methods: The symptoms are pain or snapping at the medial aspect of the elbow and/or symptoms from coexisting ulnar nerve irritation. The diagnosis can be made by dynamic ultrasonography. Results and Conclusion: And successful outcome can be archived by operative treatment, which are ulnar nerve anterior transposition and tenotomy of medial head of triceps.
Open Techniques for Bone Defect in Anterior Shoulder Instability
Lee, Bong-Gun ; Rhee, Yong-Girl ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 255~263
DOI : 10.5397/CiSE.2009.12.2.255
Purpose: An osseous defect in the glenoid and humeral head is closely associated with recurrence of anterior shoulder instability. The purpose of this article is to describe the open surgical techniques and introduce our experiences with anterior instability with a significant osseous defect. Materials and Methods: We reviewed the articles that have focused on and/or mentioned the affect of osseous defects on anterior shoulder instability. The open surgical techniques and its related pearls are summarized in this review. Results: Accurate evaluation for the size and location of the osseous defect is critical for preventing recurrence after restoration of the anterior capsulolabral structure. The glenoid bone restoration techniques include the coracoids transfer (the Bristow procedure and the Latarjet procedure) and a structural iliac bone graft. Rotational humeral osteotomy and an osteoarticular allograft could be used for repairing a significant posterosuperior humeral defect (Hill-Sachs lesion). Shoulder arthroplasty may be tried for treating a humeral bone defect, but more study on this is needed. Conclusion: Open surgical restoration decreases the risk of recurrence anterior shoulder instability that is combined with a significant osseous defect. Arthroscopic surgery currently has limitations for treating an osseous defect, but it will become useful in proportion to the development of arthroscopic instruments and techniques in the future.
Complications after Trauma Around the Elbow Joint
Jeon, In-Ho ; Kim, Ju-Eun ; Kim, Poong-Taek ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 264~270
DOI : 10.5397/CiSE.2009.12.2.264
Purpose: The elbow joint is one of the most stable joints. Dislocation and fracture can occur in elbow joint most commonly next to shoulder joint. Various injuries can occur according to generated mechanism, age of patient and impact. Despite proper treatment, various complications can occur. Materials and Methods: We describe etiology and treatment of these complications after elbow trauma such as stiffness, instability and heterotopic ossification. Results and Conclusion: Malunion, nonunion and traumatic arthritis are addressed as a possible complication after fracture around elbow joint.
Park, Jin-Young ; Lhee, Sang-Hoon ; Oh, Jeong-Hwan ; Kim, Hong-Kyum ;
Clinics in Shoulder and Elbow, volume 12, issue 2, 2009, Pages 271~277
DOI : 10.5397/CiSE.2009.12.2.271
Purpose: Scapular dyskinesis is an alteration in the normal position or motion of the scapula during coupled scapulohumeral movements. Vast majority of shoulder pathologies are known to be related with scapular motion abnormalities. Because there being enthusiasm about scapular pathology in recent literatures, understanding scapular dyskinesis seems to be an important subject. The authors describe the importance of scapular abnormality in terms of shoulder pathology. Materials and Methods: Usually the inhibition or disorganization of activation patterns in scapular stabilizing muscles lead to scapular dyskinesis. This motion abnormality has more important values in Elite Athletes because it might be the sign of future shoulder pathology; for example, SLAP and internal impingement. Treatment of scapular dyskinesis is directed at managing underlying causes and restoring normal scapular muscle activation patterns by kinetic chain-based rehabilitation protocols. Treatment is also important to prevent secondary shoulder injuries. Results and Conclusion: Understanding scapular pathology may be the main key to approach to the shoulder pathology. Also treating scapular pathology might be important in preventing secondary shoulder injuries.