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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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Journal DOI :
Korean Shoulder and Elbow Society
Editor in Chief :
Volume & Issues
Volume 15, Issue 2 - Dec 2012
Volume 15, Issue 1 - Jun 2012
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Differential Potential of Stem Cells Following Their Origin - Subacromial Bursa, Bone Marrow, Umbilical Cord Blood -
Sim, Sung Woo ; Moon, Young Lae ; Kang, Jung Hun ;
Clinics in Shoulder and Elbow, volume 15, issue 2, 2012, Pages 65~72
DOI : 10.5397/CiSE.2012.15.2.65
Purpose: To evaluate the differentiation potential of stem cells and their immunophenotype from 3 different sources. Methods: Our study involved three stem cell sources-subacromial bursal tissue, bone marrow, and umbilical cord blood. We obtained the subacromial bursal tissue and bone marrow from the patients undergoing shoulder surgery. After collecting the sample, we applied specific induction media for neurogenic, adipogenic and osteogenic differentiation. Also, flow-cytometry analysis was done to reveal the cell surface antigens. Results: We obtained 100% (8 cases) neural and adipogenic differentiation, but 62.5% (5 of 8 cases) osseous differentiation among the subacromial bursal tissue group. Bone marrow derived cells showed 100% neural (6 cases) and adipogenic (5 cases) differentiation, but 80% (4 of 5 cases) osseous differentiation. Umbilical cord blood derived cells revealed 97% (65 of 67 cases) neural, 53.7% (29 of 54 cases) adipogenic and 68.4% (39 of 57 cases) osseous differentiation. Immunophenotype analysis revealed that surface markers of bone marrow, subacromial bursal cell and umbilical cord blood derived mesenchymal stem cells are different from each other. Conclusions: Mesenchymal stem cells are potential agents in regenerative medicine and are characterized by expression of surface markers and by their differentiation potential. Our study with stem cells from subacromial bursal tissue, bone marrow and umbilical cord discovered that each stem cell has unique differentiation potential and function based on its origin. Various stem cells show multi-lineage differentiations in vitro which can be correlated to in vivo conditions.
Geometric Assessment of Scapular Thickness by Computed Tomography
Yoo, Jeong Hyun ; Chung, Soo Tai ; Park, Sang Jun ; Chang, Jun Hee ; Paik, Doo Jin ;
Clinics in Shoulder and Elbow, volume 15, issue 2, 2012, Pages 73~78
DOI : 10.5397/CiSE.2012.15.2.73
Purpose: Understanding exactly detailed anatomy and morphology of scapula is very important for further surgical procedures. This study was intended to provide accurate anatomic and morphologic information of scapula by exactly measuring scapular thickness using computed tomography and reconstructing its geometric model. Materials and Methods: Eight average lengths and two angles of 102 scapular structures obtained from 51 cadavers were generally measured by computed tomography. Also, to measure the scapular thickness, sagittal planes of each scapula were divided almost equally and the thicknesses of each sagittal plane was measured by computed tomography. After measuring every thickness, average results were calculated and the gender difference was compared by Student t-test. Results: Average results of the thickness of glenoid fossa, lateral border, medial border, and the middle 1/3 portion of the scapular body were 22.4 mm, 13.83 mm, 4.44 mm and 2.06 mm, respectively. Also, male scapulars were found to be significantly thicker than female. Based on these measured thicknesses, we reconstructed the 3-dimensional geometric model of scapula. Conclusion: From these results, glenoid fossa and lateral border were the thickest part of scapula, while the middle 1/3 portion of the scapular was the thinnest.
Comparison of Rotational Strength in Shoulders with Anterior Instability and Normal Shoulders Using Isokinetic Testing
Lee, Dong-Ki ; Kim, Tae-Kwon ; Lee, Jin-Hyuck ; Lee, Dae-Hee ; Jung, Woong-Kyo ;
Clinics in Shoulder and Elbow, volume 15, issue 2, 2012, Pages 79~85
DOI : 10.5397/CiSE.2012.15.2.79
Objective: It has been expected that patient with posttraumatic recurrent anterior shoulder dislocation might have limited daily life activity because of pain and apprehension of dislocation. But there have been only a small number of investigations regarding the rotator strength in this patient. The aim of this study is to find the characteristics about rotator strength of patient with posttraumatic recurrent anterior shoulder dislocation using an isokinetic testing. Method: We enrolled thirteen patients with posttraumatic recurrent anterior shoulder dislocation and fifteen sex, age-matched healthy nonathletic subjects in this controlled study. All participants were male and there were no significant differences between the two groups in age, height, weight, BMI. Isokinetic internal rotator and external rotator strength was evaluated with a Biodex Isokinetic Testing machine (Biodex Medical Systems, Shirley, NY, USA), tests were performed at 60 deg/sec and 180 deg/sec for both sides. Peak torque normalized to body weight, external rotator to internal rotator ratio, total work and fatigue were calculated for each angular velocity. The association between internal rotator and external rotator strength and shoulder instability was analyzed by comparisons with a control group. Results: Any notable differences could not be found between the two groups given all data from no symptomatic left shoulder. There were no significant differences between the two groups statistically in internal rotation strength of right shoulder. However, there has been a tendency that at all angular velocities, external rotator peak torque to body weight, total work and external rotator to internal rotator ratio were significantly lower in the anterior instability group than the control group at all angular velocities. There was no substantial difference between those groups with respect to the fatigue of external rotator and internal rotator in our study. Conclusion: The prominent characteristics of posttraumatic recurrent anterior shoulder dislocation are external rotator weakness and loss of balance with external rotator and internal rotator. Therefore selective training using this information rotator might be helpful in conservative treatment and rehabilitation.
Clinical Results after Repair of Rotator Cuff Tear in Patients with Accompanying AC Joint Pathology: Clinical Comparison of Non-operative Treatment
Yoo, Moon-Jib ; Seo, Joong-Bae ; Lee, Dae-Hee ; Kim, Sung-Jin ;
Clinics in Shoulder and Elbow, volume 15, issue 2, 2012, Pages 86~90
DOI : 10.5397/CiSE.2012.15.2.86
Purpose: We studied the need for distal clavicle resection by comparing rotator cuff tear patients who underwent non-surgical treatment with and without acromioclavicular joint pathology. Materials and Methods: 45 cases that had been under follow up care for at least 9 months after receiving rotator cuff repair in our hospital between Jan. 2005 and Jun. 2011 had been studied. Acromioclavicular joint pathology group and control group were classified by physical examination and MRI findings. The temporal changes in shoulder joint abduction, internal and external rotation strength, ASES and KSS score of the two groups were measured and analyzed. Results: The acromioclavicular joint pathology complicated rotator cuff injury group's strength measurements for abduction, internal rotation, external rotation were each 8.05 (
), 11.33 (
), 10.24 (
) preoperatively and improved to 13.26 (
), 17.51 (
), 15.60 (
) post operatively while the KSS score and ASES score were each 49.07 (
) and 48.65 (
) preoperatively, improving to 84.48 (
) and 84.65. (
). The measurements for the group without complicating acromioclavicular pathology are as follows. The strength for abduction, internal rotation, external rotation was each 6.42 (
), 7.59 (
) and 7.93 (
) preoperatively, improving to 15.85 (
), 19.18 (
), 16.95 (
) post operatively, while the KSS score and ASES score each went from 42.12 (
) and 41.37 (
) to 83.44 (
) and 83.17 (
) respectively. The measurements for the two groups, however, did not show a statistically significant difference (p>0.05). Conclusion: Analysis of the rotator cuff injury groups with and without AC joint pathology showed that both groups had improved strength, ASES and KSS scores with no statistical difference difference among the groups. As such, it thought that conservative treatment is an acceptable alternative to distal clavicle resection.
Repair of Large to Massive Rotator Cuff Tears in the Elderly Patients
Jung, Hong Jun ; Chun, Jae Myeung ; Jeon, In-Ho ; Kwon, Jun ; Ha, Sang-Ho ; Yang, Sung Wook ; Lee, Ji-Ho ;
Clinics in Shoulder and Elbow, volume 15, issue 2, 2012, Pages 91~98
DOI : 10.5397/CiSE.2012.15.2.91
Purpose: The objective of this study is to evaluate the functional outcome and identify prognosis of retear patients in patients aged 65 years or over undergoing surgical repair for a large to massive full-thickness rotator cuff tear. Materials and Methods: From 1995 September to 2010 March, 147 patients aged 65years or over (40 male, 107 female, with an average age of 69.6) undergoing surgical repair for large to massive full thickness rotator cuff tear (large 67 cases, massive 80 cases). For functional evaluation, preoperative and postoperative 1 year range of motion and muscle power checked. For subjective evaluation, American shoulder and elbow surgeons score and Constant score were checked. For anatomical evaluation, 87 patients were checked shoulder MRI at the time of the postoperative 1 year. Results: ASES score improved from to 50.4 to 88.9, Constant score improved from 47.1 to 75.2. Supraspinatus power improved from 51.1% to 80.8%, external rotator muscle power improved from 64.5% to 83.1%. Forward elevation improved from 117.4 degrees to 153 degrees, external rotation improved from 23.6 degrees to 41.8 degrees. Follow up MRI showed re-tear in 23%, all re-tear patients were from massive tear except one patient. All re-tear patients showed improved clinical outcomes, but supraspinatus and external rotator muscle power were not improved. Conclusions: Patients aged 65 years or over undergoing surgical repair for a large to massive full-thickness rotator cuff tear showed successful outcomes over 90 percent. Re-tear patients also showed successful clinical outcomes. In elderly patients with large to massive full thickness rotator cuff tear, aggressive surgical repair leads good clinical outcomes.
Arthroscopic UU-Tension Band Suture for Rotator Cuff Tear above 4 cm - Comparative Study with Simple Suture -
Ko, Sang-Hun ; Lee, Chae-Chil ; Shin, Seung-Myeong ; Kim, Sang Woo ; Cho, Bum-Keun ;
Clinics in Shoulder and Elbow, volume 15, issue 2, 2012, Pages 99~108
DOI : 10.5397/CiSE.2012.15.2.99
Purpose: To evaluate the clinical results of arthroscopic repair with UU-Tension Band suture for full thickness rotator cuff tear above 4 cm sized. Materials and Methods: From January 2006 to October 2011, in 71 full thickness tears above 4 cm sized which is possible to arthroscopic repair to medial margin of greater tuberosity. The group I is 71 patients which is arthroscopic repair with UU-Tension Band suture, and the group II is 20 cases which is arthroscopic repair with simple suture. Both groups were compared with a VAS score for pain, Activity of Daily Living, UCLA score, KSS score in pre operation, 7 months, 1 year and last follow-up. Statistical analysis was performed by student t test and paired t est. Mean age was 63.2 (52~80) year old, mean follow-up was 38.4 (13~62) months. Results: The VAS scores for pain decreased from 8.1 at preoperative period to 1.6 at postoperative last follow-up period in group I (p<0.05), the score decreased from 7.6 at preoperative period to 1.8 postoperative last follow-up period in group II (p<0.05). The significant difference was not noted between two groups (p<0.05). Mean ADL scores increased from 12.5 at preoperative period to 29.0 post operative last follow-up period in group I (p<0.05), the score increased from 11.3 in pre op to 27.5 post-operative last follow-up in group II (p<0.05). The significant difference was not noted between two groups (p<0.05). The UCLA score increased from 12.9 at preoperative period to 28.7 postoperative last follow-up period in group I (p<0.05), the score increased from 13.8 at preoperative period to 30.1 postoperative last follow-up period in group II (p<0.05). The significant difference was not noted between two groups (p<0.05). In comparing of retear which was checked by MRI and ultrasound evaluated at postoperative period 7 months (mean: 27.5 weeks), the retears were 28% in the group I, and 11 shoulders out of 20 shoulders in the group II. The significant differences were noted between two groups (p<0.05). Conclusion: Arthroscopic repair with UU-Tension Band suture and simple suture for full thickness rotator cuff tear above 4 cm sized were not different clinical result between both groups. However, the significant differences were noted in point of failure rate between both groups.
Ultrasonographic Findings and Usefulness in Ulnar Neuropathy at the Elbow
Kim, Dong-Hu ; Cho, Chul-Hyun ; Lee, Kyung-Rak ;
Clinics in Shoulder and Elbow, volume 15, issue 2, 2012, Pages 109~116
DOI : 10.5397/CiSE.2012.15.2.109
Purpose: The aim of this study was to evaluate preoperative ultrasonographic findings and usefulness in ulnar neuropathy around elbow. Materials and Methods: Twenty-two patients with ulnar neuropathy were performed preoperative ultrasonogram. The route, location, thickness of the ulnar nerve and space occupying lesion through longitudinal scan were evaluated. Cross-sectional areas of the ulnar nerve were measured at the level of medial epicondyle and 3 cm proximal and distal to the medial epicondyle through axial scan. Correlations between swelling ratio of ulnar nerve and eletrophysiologic study and preoperative Dellon's assessment were checked. Results: In 21 cases (95.6%) of total 22 cases, diffuse swelling of the ulnar nerve around elbow were identified. 4 cases had space occupying lesions including 3 ganglionic cysts and 1 heterotopic ossification. Cross sectional areas at the level of medial epicondyle were significantly larger than at the level of 3 cm proximal and distal to the medial epicondyle (p<0.05). There were no statistically significant correlations between swelling ratio of ulnar nerve and eletrophysiologic study and preoperative clinical assessment (p>0.05). Conclusion: This study showed that ultrasonography was helpful to detect etiology of ulnar neuropathy around elbow such as space occupying lesion, morphological change or dislocation of ulnar nerve. It could be useful tool for diagnosis and treatment in patients with ulnar neuropathy at elbow.
Operative Treatment of the Displaced Midshaft Clavicle Fracture Using Precontoured Locking Compression Plate
Kim, Jeong Woo ; Kang, Hong Je ; No, Sung Hyun ;
Clinics in Shoulder and Elbow, volume 15, issue 2, 2012, Pages 117~122
DOI : 10.5397/CiSE.2012.15.2.117
Purpose: To assess the effectiveness of internal fixation using a precontoured locking compression plate for the treatment of the displaced clavicle fracture by analyzing both radiological and clinical outcomes. Materials and Methods: We reviewed 34 cases of displaced clavicle shaft fracture treated by internal fixation using precontoured locking compression plates between May 2009 and February 2010. Radiological outcomes were analized on the basis of bone union and the differences between the time for bone union depending on sex and age. Clinical outcomes were analyzed on the basis of quick DASH Scores and the differences in the range of motion of the affected shoulder compared to the contralateral shoulder. Results: In the radiological evaluation, all fractures showed bone union, and the average time for bone union was 12.3 weeks, without delayed unions. Time for bone union did not differ significantly with respect to sex and age (p=0.87). In the clinical evaluation, the average final quick DASH Score was 23.5 (range, 12~42). At final follow up, the range of motion after bone union in the affected shoulder was not significantly different from that of the contralateral shoulder (p=0.69). Conclusion: The internal fixation achieved using precontoured locking compression plate in displaced clavicle shaft fracture showed effective bone union and can be considered as a reliable method with fine clinical results showing early range of motion at the shoulder joint.
Clinical Comparison of Two Types of Hook Plate in Surgical Treatment of Acromioclavicular Dislocation - AO Hook Plate and Wolter Plate -
Choi, Jea-Yeol ; Kim, Eugene ; Jeong, Haw-Jae ; Ahn, Jin Whan ; Shin, Hun-Kyu ; Park, Se-Jin ; Lee, Seung-Hee ; Lee, Jae-Wook ; Choi, Kyu-Bo ;
Clinics in Shoulder and Elbow, volume 15, issue 2, 2012, Pages 123~129
DOI : 10.5397/CiSE.2012.15.2.123
Objective: To evaluate if acromial locking in hook plate is necessary for surgical treatment of acromioclavicular dislocation by compare Wolter plate and AO hook plate. Methods: Seventy one patients who have Rockwood type III to V acromioclavicular joint dislocation treated with AO hook plate and Wolter plate were involved. Among them, 39 patients were treated with Wolter hook plate and 32 patients with AO hook plate. The Constant-Murley score and the range of motion of shoulder joint were measured on postoperative 1st ,
months, and the radiological complications involving plate and bone were investigated. Results: Constant-Murley score of postoperative one year were
in AO hook plate group and
in Wolter plate group without statistical difference (p<0.05). Faster recover of forward elevation and external rotation were examined in Wolter plate group at first and third months after surgery than those of AO hook plate group, but there were no significant difference between after six months or later after surgery. Four cases of loosen or broken screws and one case of pull-out of plate were found in Wolter plate group. Seven cases of subacromial bony erosion and one periprosthetic fracture were found in AO hook plate group. Conclusion: Although clinical outcomes of both two methods were same, no matter if acromial locking system was or not. More radiological complication of plate and bone were found in AO hook plate than that of Wolter plate. However also had disadvantage like larger incision during surgery.
Clinical Outcome after Surgical Treatment of Intra-articular Comminuted Fracture of the Distal Humerus in the Elderly: Open Reduction and Internal Fixation Versus Total Elbow Arthroplasty
Kim, Doo-Sup ; Yoon, Yeu-Seung ; Yi, Chang-Ho ; Woo, Ju-Hyung ; Rah, Jung-Ho ;
Clinics in Shoulder and Elbow, volume 15, issue 2, 2012, Pages 130~137
DOI : 10.5397/CiSE.2012.15.2.130
Purpose: To evaluate and report the clinical outcome after surgical treatment of intra-articular comminuted fracture of distal humerus in the elderly with osteoporosis. Materials and Methods: From January 2007 to October 2009, 24 patients aged older than 65 years with intra-articular comminuted fracture of distal humerus underwent surgical treatment. 18 patients (Group I) were managed using primary open reduction and internal fixation (OR IF) through the modified posterior approach and 6 patients (Group II) were taken primary total elbow arthroplasty. The average follow up period was 17.2 months. According to the AO classification, there were 8 C2, 16 C3 type fractures. All enrolled patients were evaluated radiographically and clinically. Clinical outcomes were assessed with the Mayo Elbow Performance, Disabilities of Arm and Shoulder and Hand, and Musculoskeletal Functional Assessment functional questionnaires. Results: The bony union was observed in 18 patients in group I at average 14 weeks. There were 2 patients with neurapraxia of whom the ulnar nerve symptom did not improve despite of anterior transposition. And non-union at osteotomy sites was seen in 2 patients. The mean Mayo Elbow Performance score was 87.0. The mean DASH score was 32.4. The average arc of elbow flexion was
) with mean flexion-contracture of
(range, 0 to 35). 6 patients in Group II showed no complication during follow up periods. The mean Mayo Elbow Performance score was 89.1. The mean DASH score was 44.3. The average arc of elbow flexion was
) with mean flexion-contracture of
(range, 0 to 30). Conclusions: With careful patient selection, Total elbow arthroplasty as well as OR IF could achieve good outcomes in elderly of comminuted intra-articular distal humerus fracture with osteoporosis.
Pigmented Villonodular Synovitis Mimiking the Bone Tumor of the Fossa Olecrani of Elbow in a 8-year-old Boy - A Case Report -
Kim, Sung-Soo ; Lee, Sang-Yup ; Yoon, Min Geun ; Seo, Young Hoon ; Moon, Myung-Sang ;
Clinics in Shoulder and Elbow, volume 15, issue 2, 2012, Pages 138~142
DOI : 10.5397/CiSE.2012.15.2.138
Pigmented villonodular synovitis (PVNS) is a rare benign proliferative disorder that results in villous hyperplasia and nodule formation in the synovium, tendon sheath and bursa. That most commonly affects the knee and the hip joint in adult. PVNS of the hand, the wrist, the shoulder and the elbow is rare and that of the elbow in children is particularly rarer. An eight-year-old boy had his left elbow pain and a lesion like benign bone tumor in the left fossa olecrani on plain x-ray. During the operation, abnormal synovial hyperplasia in his left elbow joint led us to diagnose PVNS. Therefore, open curettage of the lesion and radical synovectomy was performed. The specimen of the synovectomized tissue revealed PVNS. The left elbow pain subsided after the operation and the child restored a full range of motion of his left elbow. We reported this rare case of PVNS in a child's elbow joint mimicking the bone tumor together with a review of the literature.
Triple Disruption of the Superior Shoulder Suspensory Complex - Case Report at 5-year-follow up -
Sung, Chang-Meen ; Park, Hyung Bin ;
Clinics in Shoulder and Elbow, volume 15, issue 2, 2012, Pages 143~147
DOI : 10.5397/CiSE.2012.15.2.143
A triple disruption of the SSSC, an extremely rare injury, has been reported by only a few authors. We present a patient who had sustained a triple disruption of the SSSC: coracoid and scapular spine fractures, and an acromioclavicular joint separation. Treatment consisted of an anatomical restoration of the SSSC, with maintenance of the acromiohumeral and coracohumeral distances; this was achieved by open reduction and internal fixation of the fractures and of the separation. Six months after surgery, the injured shoulder was asymptomatic, with full range of motion. Five years after surgery, at the final follow-up, the function of the SSSC had been restored to the patient's complete satisfaction.
Is the Strong Fixation Necessary in Performing Biceps Tenodesis?
Song, Hyun Seok ; Choi, Woo Hyuk ;
Clinics in Shoulder and Elbow, volume 15, issue 2, 2012, Pages 148~153
DOI : 10.5397/CiSE.2012.15.2.148
Various biceps tenodesis techniques being used, make it difficult to compare the result of reports. First, the biceps tenodesis could be classified according to being performed by open incision or by the arthroscopic procedure. Second, it could be classified as a soft tissue and bony tenodesis according to the tissue which the long head of biceps is fixed with. Third, it could be classified as a proximal and distal tenodesis according to the location which the long head of biceps is fixed with. Fourth, it could be classified according to the implant (interference screw, suture anchor, knotless suture anchor). A decision should be suspended until an appropriate strength of tenodesis is revealed.