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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
> Journal Vol & Issue
Clinics in Shoulder and Elbow
Journal Basic Information
Journal DOI :
Korean Shoulder and Elbow Society
Editor in Chief :
Volume & Issues
Volume 17, Issue 4 - Dec 2014
Volume 17, Issue 3 - Sep 2014
Volume 17, Issue 2 - Jun 2014
Volume 17, Issue 1 - Mar 2014
Selecting the target year
Short-term Low-dose Oral Corticosteroid Therapy of Impingement Syndrome of the Shoulder: A Comparison of the Clinical Outcomes to Intra-articular Corticosteroid Injection
Kim, Young Bok ; Kim, Young Chang ; Kim, Ji Wan ; Lee, Sang Jin ; Lee, Sang Won ; Choi, Hong Joon ; Lee, Dong Hyun ; Kim, Joo Young ;
Clinics in Shoulder and Elbow, volume 17, issue 2, 2014, Pages 50~56
DOI : 10.5397/cise.2014.17.2.50
Background: To assess the clinical outcomes of short-term oral corticosteroid therapy for impingement syndrome of the shoulder and determine whether it can be substituted as an alternative to the intra-articular injection. Methods: The clinical outcomes of the 173 patients, the oral steroid group (n=88) and the injection group (n=85), were measured at 3 weeks, 2, 4, and 6 months postoperatively. The clinical outcomes were assessed by measuring the the University of California at Los Angeles (UCLA) score, visual analog scale (VAS) and range of motion (ROM) at every follow-up. Any complications and recurrence rate were noted. A relationship between the treatment outcomes and factors such as demographic factors, clinical symptoms and radiographic findings were determined. Results: No difference was observed in VAS and UCLA scores between the two groups, but forward flexion and internal rotation of ROM were significantly improved in the injection group at the 2nd and 4th postoperative month (p < 0.05). At 6th postoperative month, recurrence rate of symptoms was 26% in the oral steroid group and 22% in the injection group. No major adverse effects were observed. When the clinical outcomes of the oral steroid group were compared to either demographic, clinical symptoms, or radiographic findings, UCLA score was found to be significantly low (p < 0.05) in patients with joint stiffness and UCLA score, whereas VAS score was significantly improved in patients with night pain (p < 0.05). Conclusions: Short-term low-dose oral corticosteroid therapy of impingement syndrome showed comparable clinical outcomes to intra-articular injection without any remarkable adverse effects. Low-dose oral steroids can be regarded as a partial alternative to intra-articular injection for the initial therapy of impingement syndrome of the shoulder.
The Effect of Different Starting Periods of Passive Exercise on the Clinical Outcome of Arthroscopic Rotator Cuff Repair
Back, Young-Woong ; Tae, Suk-Kee ; Kim, Min-Kyu ; Kwon, Oh-Jin ;
Clinics in Shoulder and Elbow, volume 17, issue 2, 2014, Pages 57~63
DOI : 10.5397/cise.2014.17.2.57
Background: To compare the effect of different starting periods of rehabilitative exercise (early or delayed passive exercise) on the rate of retear and other clinical outcomes after the arthroscopic repair of the rotator cuff. Methods: In total, 103 patients who underwent arthroscopic repair of the rotator cuff were included in the study. Determined at 2 weeks post-operation, patients who were incapable of passive forward elevation greater than
were allotted to the early exercise group (group I: 79 patients; 42 males, 37 females), whilst those capable were allotted to the delayed exercise group (group II: 24 patients; 14 males, 10 females). The group I started passive exercise, i.e. stretching, within 2 weeks of operation, whilst group II started within 6 weeks. The results were compared on average 15.8 months (11-49 months) post-operation using the passive range of motion, the Visual Analog Scale (VAS) pain score, and the University of California at Los Angeles (UCLA) and Constant scores. Stiffness was defined as passive forward elevation or external rotation of less than
compared to the contralateral side. Follow-up magnetic resonance imaging (MRI) was carried out on average 1 year post-operation and the rate of retear was compared with Sugaya's criteria. Results: There were no differences between the two groups in gender, age, smoking, presence of diabetes, arm dominance, period of tear unattended, pre-operative range of motion, shape and size of tear, degree of tendon retraction, and tendon quality. There were no significant differences in clinical outcomes. Whilst stiffness was more frequent in group II (p-value 0.03), retear was more frequent in group I (p-value 0.028) according to the MRI follow-up. Conclusions: During rehabilitation after the arthroscopic repair of the rotator cuff, the delay of passive exercise seems to decrease the rate of retear but increase the risk of stiffness.
Changes in Matrix Metalloproteinase and Tissue Inhibitors of Metalloproteinase in Patients with Rotator Cuff Tears
Kwon, Oh-Soo ; Kim, Young-Yul ; Ha, Ji Yoon ; Kang, Han Bit ;
Clinics in Shoulder and Elbow, volume 17, issue 2, 2014, Pages 64~67
DOI : 10.5397/cise.2014.17.2.64
Background: The purpose of this study was to determine whether in patients with rotator cuff tears a correlation exists between molecular changes and clinical parameters such as age, duration of symptom, range of motion, and tear size. Molecular changes of matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) were assessed by measuring messenger RNA (mRNA) levels of the two proteins. Methods: The rotator cuff tissue from was obtained from the edge of a torn tendon revealed after debridement by a motorized shaver. Using the sample of rotator cuff tissue, the reverse transcription polymerase chain reaction was performed to quantify MMP-2 and TIMP-2 mRNA expression. To determine whether mRNA levels and the clinical variables, such as age, defect size, range of motion (ROM) of shoulder, and duration of symptoms, show any correlation, Spearman's correlation coefficients were used to test for significant differences. Results: There was an inverse correlation between the mRNA levels of MMP-2 and TIMP-2 from the torn rotator cuff tendons regardless of the clinical variables. However, comparison of mRNA levels versus clinical parameters such as age, defect size, range of motion and duration of symptoms revealed a number of findings. We found a significant correlation between age and mRNA levels of MMP-2 from torn cuffs (r = 0.513, p = 0.021). Further, we found a significant correlation between defect size in the full thickness tears and mRNA levels of MMP-2 (r = 0.454, p = 0.045). Conversely, no significant association between mRNA levels of MMP-2 and ROM or duration of symptom was found. Conclusions: Our results suggest that both MMP-2 and TIMP-2 may be involved in the disease process of rotator cuff tears. Although the level of mRNA expression of MMP-2 and TMP-2 remain constant in torn rotator cuffs irrespective of the clinical variables, their levels may be influenced by age and defect size, which could account to change in tendon degradation and the healing process.
Reverse Total Shoulder Arthroplasty: Early Outcome and Complication Report
Park, Yong-Bok ; Jung, Sung-Weon ; Ryu, Ho-Young ; Hong, Jin-Ho ; Chae, Sang-Hoon ; Min, Kyoung-Bin ; Yoo, Jae-Chul ;
Clinics in Shoulder and Elbow, volume 17, issue 2, 2014, Pages 68~76
DOI : 10.5397/cise.2014.17.2.68
Background: Recently, reverse total shoulder arthroplasty (RTSA) has been accepted as a main treatment option in irreparable massive rotator cuff tear with cuff arthropathy. The purpose of this study was to evaluate the early complication incidence and the preliminary clinical results of RTSAs performed in single institute. Methods: Fifty-seven RTSAs (56 patients) were performed between April 2011 and March 2013. The indications for RTSA were cuff tear arthropathy and irreparable massive rotator cuff tear with or without pseudoparalysis. Exclusion criteria were revision, preoperative infections and fractures. At final follow-up, 45 shoulders were enrolled. Mean follow-up duration was 12.5 months (range, 6-27 months). The mean age at the time of surgery was 73.6 years (range, 58-87 years). All the patients were functionally accessed via Constant score, American Shoulder and Elbow Surgeons (ASES) score, pain and functional visual analogue scale (VAS) scores and active range of motion. Complications were documented as major and minor. Major complications include fractures, infections, dislocations, nerve palsies, aseptic loosening of humeral or glenoid components, or glenoid screw problems. Minor complications include radiographic scapular notching, hematomas, heterotopic ossification, algodystrophy, intraoperative dislocations, intraoperative cement extravasation, or radiographic lucent lines of the glenoid. Results: The mean Constant score increased from 31.4 to 53.8 (p < 0.001). The pain and functional VAS scores improved (5.2 to 2.7, p < 0.001, 4.0 to 6.7, p < 0.001) and active forward flexion improved from
(p = 0.011). One or more complications occurred in 16 (35.6%) of 45 shoulders, with one failure (2.2%) resulting in the removal of implants by late infection. The single most common complication was scapular notching (9 [20%]). There were 4 (8.9%) axillary nerve palsies postoperatively (n=3: transient n. palsy, n=1: Symptom existed at 11 months postoperatively but improving). Conclusions: In a sort term follow-up, RTSA provided substantial gain in overall function. Most common early complications were scapular notching and postoperative neuropathy. Although overall early complication rate was as high as reported by several authors, most of the complications can be observable without compromise to patients' clinical outcome. Long term follow-up is required to clarify the clinical result and overall complication rate.
Unusual Migration of Kirschner's Wire into Intervertebral Foramen after Lateral Clavicle Fracture Fixation - A Case Report
Lee, Jin-Ho ; Chung, Jae-Yoon ; Kim, Myung-Sun ;
Clinics in Shoulder and Elbow, volume 17, issue 2, 2014, Pages 77~79
DOI : 10.5397/cise.2014.17.2.77
The migration of metallic devices such as Kirschner's wire (K-wire) from the shoulder is a well-recognized and significant complication of operation, the wire ending up in the lungs, the heart, the esophagus, the aorta or the subclavian artery. However, spinal migration is very rare. We report the case of a 72-year-old female patient with K-wire migration into the C7-T1 intervertebral foramen, 2 months after surgery for a lateral end fracture of left clavicle.
Tuberculous Tenosynovitis of the Elbow - A Case Report
Oh, Chi-Hun ; Park, Jung-Ho ; Kim, Jung-Wook ;
Clinics in Shoulder and Elbow, volume 17, issue 2, 2014, Pages 80~83
DOI : 10.5397/cise.2014.17.2.80
A 29-year-old man visited our clinic owing to a persistent swelling in the anterior part of the left elbow joint that began one year ago. Through magnetic resonance imaging (MRI), we observed tenosynovitis with multiple rice bodies, and so we performed an excisional biopsy and tenosynovectomy. Through pathology and culture tests, we identified tuberculosis in the tissue biopsy that we harvested intraoperatively. Following the anti-tuberculosis medication relieved the patient's symptoms without recurrence. Since tuberculosis of the elbow occurs only rarely, and the symptoms mimic those of rheumatoid synovitis or of non-specific chronic synovitis, early diagnosis and appropriate treatment are often delayed. The authors report this rare case of tuberculous tenosynovitis of the elbow with a review of the relevant literature.
Animal Experiments Using Rotator Cuff
Chung, Seok Won ; Kim, Sae Hoon ; Oh, Joo Han ;
Clinics in Shoulder and Elbow, volume 17, issue 2, 2014, Pages 84~90
DOI : 10.5397/cise.2014.17.2.84
In conducting animal studies using rotator cuff, researchers should select the appropriate types of animals and experimental models. This should also be followed by complete understanding of the selected experimental animals as well as the methods for evaluating the results. Thus, researchers could minimize errors and failure in conducting animal experimental studies. Further, this will provide a basis of establishing new idea and theory about rotator cuff diseases.
Partial Thickness Rotator Cuff Tears
Shin, Sang-Jin ; Seo, Myeong-Jae ;
Clinics in Shoulder and Elbow, volume 17, issue 2, 2014, Pages 91~100
DOI : 10.5397/cise.2014.17.2.91
Partial-thickness rotator cuff tear (PTRCT) is not single disease entity but one phase of disease spectrum. Symptoms of PTRCT vary from being asymptomatic to severe pain leading to deterioration in quality of life. Pathogenesis of degenerative PTRCT is multifactorial. Whereas articular sided PTRCT is usually caused by internal causes, both internal and external causes have important role in bursal sided PTRCT. A detailed history, clinical examination and magnetic resonance angiography are used in the diagnosis of PTRCT. Treatment of PTRCT is chosen based on age, demands of patients, causes and depth of tear. In most patients, non-operative treatment should be initiated. Whereas debridement can be done for less than 6 mm of articular sided PTRCT and in less than 3 mm of bursal sided PTRCT, repair techniques should be considered for higher grade PTRCT than that. Although the effect of acromioplasty is not clear, acromioplasty may be performed when the extrinsic causes appear to be the cause of tear. Either transtendon repair technique or repair after tear completion provided satisfactory clinical outcomes in treatment of articular sided PTRCT.