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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 18, Issue 4 - Dec 2015
Volume 18, Issue 3 - Sep 2015
Volume 18, Issue 2 - Jun 2015
Volume 18, Issue 1 - Mar 2015
Selecting the target year
Unsolved Legal Problems about Radiologic Characteristics of Traumatic Cuff Tears
Song, Hyun Seok ;
Clinics in Shoulder and Elbow, volume 18, issue 4, 2015, Pages 195~196
DOI : 10.5397/cise.2015.18.4.195
Minimal Medial-row Tie with Suture-bridge Technique for Medium to Large Rotator Cuff Tears
Lee, Hyun Il ; Ryu, Ho Young ; Shim, Sang-Jun ; Yoo, Jae Chul ;
Clinics in Shoulder and Elbow, volume 18, issue 4, 2015, Pages 197~205
DOI : 10.5397/cise.2015.18.4.197
Background: The purpose of this study was to evaluate the postoperative magnetic resonance imaging (MRI) results of minimal-tying (one medial-row tie among 4 medial-row sutures) on the medial-row in double-row suture-bridge configuration (
suture stands). Methods: From 2011 March to 2012 July, 79 patients underwent arthroscopic rotator cuff repair using
anchor double-row configuration. The mean age was 61.3 years (range, 31-81 years). Two double-loaded suture anchors were used for medial-row. Four medial-row stitches were made with only one medial-row knot-tying (the most anterior suture). Lateral-row was secured using the conventional suture-bridge anchor technique; all 4 strands were used for each anchor. Repair integrity was evaluated with MRI at mean 6.2 months postoperatively. Retear and the pattern of retear, change of fatty infiltration, and muscle atrophy of supraspinatus were evaluated using pre- and postoperative MRI. Results: Repaired tendon integrity was 38 for type I, 30 for type II, 6 for type III, 4 for type IV, and 1 for type V, according to Sugaya classification. Considering type IV/V as retear, the rate was 6.3% (5 out of 79 patients). Medial cuff failure was observed in 4 patients. Fatty atrophy of supraspinatus was significantly improved postoperatively according to Goutallier grading (p=0.01). The level of muscle atrophy of supraspinatus was not changed significantly after surgery. Conclusions: Minimal tying technique with suture configuration of four-by-four strand double-row suture-bridge yielded a lower retear rate (6.3%) in medium to large rotator cuff tears.
Evaluation of Rotator Cuff Repair Using Korean Shoulder Scoring System
Shin, Sang-Jin ; Lee, Juyeob ; Ko, Young-Won ; Park, Min-Gyue ;
Clinics in Shoulder and Elbow, volume 18, issue 4, 2015, Pages 206~210
DOI : 10.5397/cise.2015.18.4.206
Background: Assessment of the clinical outcomes after rotator cuff repair is essential for their effectiveness on treatment. The Korean Shoulder and Elbow Society devised the Korean Shoulder Scoring System (KSS) for patients with rotator cuff disorder. The purpose of this study was to evaluate the availability of the KSS for assessment of clinical outcomes in patients after arthroscopic rotator cuff repair, and for comparison with other appraisal scoring systems. Methods: A total of 130 patients with partial-thickness or full-thickness rotator cuff tear who underwent arthroscopic repair using a single row or double row suture bridge technique were enrolled. The average follow-up period was 25.9 months. All patients were classified according to various factors. Comparison within corresponding categories was performed, and the correlation between the KSS and other shoulder assessment methods including University of California Los Angeles (UCLA), Constant and American Shoulder and Elbow Surgeons (ASES) score was analyzed. Results: Total score of the KSS response had increased from 59.6 preoperatively to 88.96 at last follow-up. All KSS domains, including function, pain, satisfaction, range of motion, and muscle power had improved up to 24 months postoperatively. Statistical significance was observed mainly in preoperative measurements with number and size of torn tendons, and greater than or equal to grade 3 of fatty infiltration. The KSS was best correlated with the UCLA scoring system in both preoperative (r=0.785) and postoperative (r=0.951) measurements. Conclusions: The KSS was highly reliable and valid as a discriminative instrument, and it showed strong correlation with ASES and UCLA scoring systems.
Characteristics of Magnetic Resonance Arthrography Findings in Traumatic Posterosuperior Rotator Cuff Tears
Cho, Yung-Min ; Kim, Sung-Jae ; Oh, Jin-Cheol ; Chun, Yong-Min ;
Clinics in Shoulder and Elbow, volume 18, issue 4, 2015, Pages 211~216
DOI : 10.5397/cise.2015.18.4.211
Background: Few studies have investigated magnetic resonance (MR) characteristics of traumatic posterosuperior rotator cuff tears involving the supraspinatus and infraspinatus. We hypothesized that traumatic rotator cuff tears may have MR characteristics distinguishable from those of non-traumatic tears. Methods: Preoperative MR arthrography and intraoperative tear size measurements were compared in 302 patients who underwent MR arthrography and subsequent arthroscopic rotator cuff repairs for traumatic (group T, 61 patients) or non-traumatic (group NT, 241 patients) tears. The inclusion criteria for both groups were posterosuperior full-thickness rotator cuff tear and age between 40 and 60 years. For group T, traumas were limited to accidental falls or slips, or sports injuries, motor vehicle accidents; injuries were associated with acute onset of pain followed by functional shoulder impairment; and time between injury and magnetic resonance imaging (MRI) was 6 weeks or less. Results: In group T, 72.1% of shoulders (44 patients) had tendon tears with blunt edges while 27.9% of shoulders (17 patients) had tears with tapering edges. In contrast, 21.2% of patients in group NT (51 patients) had blunt-edge tears, while 78.8% (190 patients) of tears had tapering edges. These results were statistically significant (p<0.001) and estimated odds ratio was 9.6. The size of tear did not vary significantly between groups. Conclusions: We found no exclusive MR characteristic to define traumatic tears. However, oblique coronal MRI of traumatic tears showed a significant tendency for abrupt and rough torn tendon edges and relatively consistent tendon thicknesses (without lateral tapering) compared to non-traumatic cuff tears.
The Clinical Results of Conservative Treatment of Frozen Shoulder Using Continuous Passive Motion
Chung, Hoe-Jeong ; Kim, Doo-Sup ; Yoon, Yeo-Seung ; Lee, Dong-Woo ; Hong, Kyung-Jin ;
Clinics in Shoulder and Elbow, volume 18, issue 4, 2015, Pages 217~220
DOI : 10.5397/cise.2015.18.4.217
Background: The purpose of this study is to administer conservative treatment in 30 patients diagnosed with idiopathic frozen shoulder, following the suggested frozen shoulder rehabilitation program and to assess the clinical outcome using a prospective study. Methods: Thirty patients diagnosed with idiopathic frozen shoulder, treated with steroid hormone injection on the articular joint with an intra-articular steroid (triamcinolone 40 mg+lidocaine 4 ml) injection and started on stepwise shoulder extension exercise were chosen. The subjects were divided into two groups of 15 people each with one group undergoing rehabilitation with continuous passive motion (CPM) and the other group without it. Follow-ups were done before rehabilitation and at 4-week intervals with the 24th being the final week. At every follow-up, passive range of motion (ROM) was measured and surveys on pain and clinical score were administered. Results: In the last follow-up, both groups showed statistically significant improvements in all evaluation criteria. However, no statistical difference in all values of the ROM and Constant score evaluation criteria was observed between the groups. Only in the last follow-up, group 1 had a visual analog scale (VAS) score of
points, which was lower, with statistical significance, than the VAS score of group 2, which was
points (p<0.001). Conclusions: Study using CPM in treatment of frozen shoulder has been inadequate, meaning that there is still room for improvement and need for more study on setting a more specific protocol and guidelines for this procedure.
Operative Treatment of Medial Epicondylitis: A Comparative Analysis of the Clinical Outcomes between the Suture Anchor Group and the Non-suture Anchor Group
Cheon, Sang Jin ; Jeon, Woong Ki ;
Clinics in Shoulder and Elbow, volume 18, issue 4, 2015, Pages 221~228
DOI : 10.5397/cise.2015.18.4.221
Background: The The purpose of this study was to make a comparative analysis of the clinical outcomes after the operative treatment of refractory medial epicondylitis between the suture anchor group and the non-suture anchor group. Methods: We enrolled 20 patients (7 men and 13 women) with recalcitrant medial epicondylitis who were able to receive operative treatment in a minimum of an 18-month follow-up. The mean age was 48.6 years (range, 36-59 years). The patients were allocated into either the suture anchor group (7 patients) or the non-suture anchor group (13 patients). We evaluated clinical outcomes using the visual analog scale (VAS), the pain grading system of Nirschl and Pettrone, and postoperative grip strength. Results: The VAS score decreased from 8.8 to 2.0 for the suture anchor group and from 8.6 to 1.3 for the non-suture anchor group (p=0.16). The postoperative grip strength was 95%, 93% of the non-treated arm in both groups (p=0.32). The postoperative satisfaction level was good in 5 patients and fair in 2 for the suture anchor group and excellent in 5 patients, good, in 4, and fair, in 4 for the non-suture anchor group (p=0.43). The clinical outcomes did not show a statistically significant difference between the two groups. Conclusions: We found that patients with recalcitrant medial epicondylitis were treated reliably with satisfactory clinical outcomes whether or not suture anchors were used. We believe the use of suture anchors when more than 50% of the tendon origin is affected provides an effective and favorable treatment modality.
Dynamic Stabilization of the Scapula for Serratus Anterior Dysfunction: A Retrospective Study of Functional Outcome and Results
Chung, Soo Tai ; Warner, Jon J.P. ;
Clinics in Shoulder and Elbow, volume 18, issue 4, 2015, Pages 229~236
DOI : 10.5397/cise.2015.18.4.229
Background: Twenty-six patients (12 male and 14 female) with symptomatic scapular winging caused by serratus anterior dysfunction were managed by split pectoralis major tendon transfer (sternal head) with autogenous hamstring tendon augmentation from 1998 to 2006. Methods: Twenty-five patients showed positive results upon long thoracic nerve palsy on electromyography. The mean duration of symptoms until surgery was 48 months (range, 12-120 months). Four patients had non-traumatic etiologies and 22 patients had traumatic etiologies. On follow-up assessment for functional improvement, a Constant-Murley score was used. Twenty-one patients were completely evaluated, while five patients who had less than 12 months of follow-up were excluded. Results: Pain relief was achieved in 19 of the 21 patients, with 20 patients showing functional improvement. The pain scores improved from 6.0 preoperatively to 1.8 postoperatively. The mean active forward elevation improved from
) preoperatively to
) postoperatively. The mean Constant-Murley score improved from 57.7 (range, 21-86) preoperatively to 86.9 (range, 42-98) postoperatively. A recurrence developed in one patient. Of the 21 patients, ten had excellent results, six had good results, four had fair results, and one had poor results. Conclusions: Most patients with severe symptomatic scapular winging showed functional improvement and pain relief with resolution of scapular winging.
An Analysis on the Effect of Patient-controlled Analgesia Performed by Orthopaedic Department or Postoperative Pain Control after Shoulder and Elbow Surgery
Yum, Jae-Kwang ; Kim, Jin-Hyok ; Boo, Kyung-Hwan ; Ahn, Soo-Hyung ;
Clinics in Shoulder and Elbow, volume 18, issue 4, 2015, Pages 237~241
DOI : 10.5397/cise.2015.18.4.237
Background: We investigated the effectiveness of pain management and the adverse events of intravenous (IV) patient-controlled analgesia (PCA) after orthopedic surgery. Methods: From September 2014 and August 2015, we performed a retrospective analysis of 77 patients who underwent orthopedic surgery of the shoulder or the elbow in our hospital. The composition of the intravenous PCA administered to the patients was as follows: 250 mg of dexketoprofen trametamol, 70 mg of oxycodone, and 0.6 mg of ramosetron, which were made up to 79 ml of normal saline. We evaluated and statistically analyzed the difference in the visual analogue scale (VAS) scores for pain at immediate postoperation, at 24 hours of PCA, at 72 hours of PCA, and after discontinuation of PCA and in the incidence of adverse events. Results: We found that VAS score decreased for 3 postoperative days and that with discontinuation of IV PCA a meaningful change in VAS score was no longer seen. Of the 77 patients, 22 presented with adverse events (28.6%). We terminated IV PCA temporarily in the 21 patients who presented with adverse events; we terminated analgesia permanently in one patient (1.2%). Consequently, 76 of 77 patients carried out IV PCA till the designated period. Conclusions: Intravenous PCA after orthopedic surgery of the shoulder or the elbow may be accompanied with adverse events. Careful assessment of the patient and treatment of the adverse outcomes are key to a successful maintenance of PCA and to a successful management of postoperative pain.
Clinical and Radiological Results of Reverse Total Shoulder Arthroplasty Using a 25-mm Glenoid Baseplate
Lee, Ji Min ; Kim, In Bo ; Jung, Dong Wook ;
Clinics in Shoulder and Elbow, volume 18, issue 4, 2015, Pages 242~247
DOI : 10.5397/cise.2015.18.4.242
Background: The size of the baseplate used in reverse total shoulder arthroplasty (RTSA) tends to be larger than the average size of the glenoid in the Korean population. The mismatch between the sizes of the baseplate and the patient's glenoid may result in improper fixation of the glenoid baseplate. This in turn may lead to the premature loosening of the glenoid component. Thus, we evaluated the short-term results of using a 25-mm baseplate in RTSA. Methods: Seventeen patients with cuff tear arthropathy underwent RTSA with a 25-mm baseplate. The mean age of the patients was 70.1 years, and the mean follow-up period was 14.0 months. We evaluated clinical outcomes preoperatively and postoperatively: the range of shoulder motion, the American Shoulder and Elbow Surgeons (ASES) score, and the Korean Shoulder Society (KSS) score. Results: We found that the mean ASES score and KSS improved from 35.0 to 74.4 (p<0.001) and from 46.9 to 71.8 (p<0.001) with RTSA. The mean forward elevation and abduction, external rotation also improved from
(p<0.05) and from
(p=0.43). Postoperative complications were seen in 12% of patients, but neither the loosening of the glenoid baseplate nor inferior scapular notching were observed. Conclusions: In sum, the results of using a 25-mm baseplate in RTSA were similar to those of previous reports. Even though the outcomes are those of a short-term follow-up, neither the loosening of the glenoid baseplate nor the scapular notching were observed.
Evaluating Scapular Notching after Reverse Total Shoulder Arthroplasty
Kim, Young-Kyu ; Won, Jun-Sung ; Park, Chang-Kyu ; Kim, Jong-Geun ;
Clinics in Shoulder and Elbow, volume 18, issue 4, 2015, Pages 248~253
DOI : 10.5397/cise.2015.18.4.248
Background: Scapular notching can happen at diverse location depending on implant design or operative technique, therefore, it is easily misdiagnosed. Thus, this study purposed to suggest a method helpful to assess scapular notching. Methods: The subjects were 73 cases of reverse shoulder arthroplasty (RSA) for cuff tear arthropathy during the period from May 2009 to April 2014 and followed-up for over a year. There was medialized RSA in 22 cases, bone increased offset RSA (BIO-RSA) in 36 cases, and metal increased offset RSA (metal-RSA) in 15 cases. Scapular notching was not determined by bone defect at the inferior of glenosphere as Sirveaux's classification, but scapular notching at the site where the rotational route of the polyethylene of humeral implant met the scapular neck were examined. The results were compared with conventional method. Results: By conventional method, scapular notching was observed in 10 cases (45.5%) in medialized RSA, 12 cases (33.3%) in BIO-RSA, and none in metal-RSA. By new method, it was observed in 9 cases (40.9%) in medialized RSA, 10 cases (27.8%) in BIO-RSA, and none of metal-RSA. The site of scapular notching was apart from glenoshpere in 18 cases, and at inferior of glenosphere in 1 case. Absorption of bone graft was observed in 4 (11.1%) out of 36 cases of BIO-RSA. Conclusions: It is hard to distinguish scapular notching from absorption of bone graft in BIO-RSA, and bone absorption at the lateral lower end of glenoid in medialized RSA. Thus, it is considered useful to assess scapular notching at the site where the rotational route of the polyethylene insert meets scapular neck.
Two Cases of Biodegradable Suture Anchor Displacement Diagnosed with Ultrasonography following Arthroscopic Rotator Cuff Repair
Oh, Joo Han ; Song, Byung Wook ; Rhie, Tae-Yon ;
Clinics in Shoulder and Elbow, volume 18, issue 4, 2015, Pages 254~260
DOI : 10.5397/cise.2015.18.4.254
With the advancement of shoulder arthroscopy, use of biodegradable suture anchors in the surgical repair of rotator cuff tears has increased. Because of the radiolucency of these anchors, radiography is not appropriate for early detection of anchor failure. Ultrasonography is an advantageous modality in visualizing biodegradable, radiolucent anchors on a real-time basis without risk of radiation exposure. We report on two cases of displacement of a biodegradable suture anchor diagnosed on ultrasonography during the postoperative follow- up, which has not been previously reported. Because this displacement could be missed in the postoperative follow up ultrasonography, we describe the ultrasonographic features of the displaced biodegradable anchors. Surgeons and radiologists should pay special attention to the possibility of displacement of the suture anchor in patients who underwent rotator cuff repairs using suture anchors.
Neuropathic Arthropathy of the Shoulder Associated with Cervical Syringomyelia: A Case Report
Park, Jaehyun ; Im, Taekang ; Moon, Jinsun ; Lee, Yongbeom ;
Clinics in Shoulder and Elbow, volume 18, issue 4, 2015, Pages 261~265
DOI : 10.5397/cise.2015.18.4.261
Neuropathic shoulder arthropathy or Charcot's shoulder is an extremely rare disease, and sometimes it is associated with cervical syringomyelia. Clinical symptoms of the disease include edema of the shoulder and restriction in range of motion. Radiological diagnosis can be made through plain radiography through a characteristic, atrophic destruction of the joint. We experienced a Charcot's joint of the shoulder wherein destruction of the joint progressed extremely quickly and reviewed the literature concerning this condition.
Arthroscopic Decompression of an Inferior Paralabral Cyst of the Shoulder in an Elderly Patient: A Case Report
Kim, Ju-Oh ; An, Ki-Yong ; Bong, Hwang-Se ; Lee, Kyu-Jung ; Min, Woong-Bae ;
Clinics in Shoulder and Elbow, volume 18, issue 4, 2015, Pages 266~268
DOI : 10.5397/cise.2015.18.4.266
The widespread use of diagnostic radiography, especially using magnetic resonance imaging, has helped to increase the diagnosis of paralabral cysts in patients with chronic shoulder pain. These paralabral cysts are frequent in the anterior, the superior, and the posterior compartment of the shoulder joint but are rare in the inferior compartment. Paralabral cysts in the shoulder appear particularly in men in their third and fourth decades but rarely in elderly patients. We report a case of an inferior paralabral cyst in an elderly patient whom we treated through arthroscopic decompression.
Anterolateral Mini-open Fixation with a Patch Augmentation for Latissimus Dorsi Tendon Transfer in Irreparable Rotator Cuff Tears: Technical Note
Kim, Du-Han ; Kim, Dong-Hu ; Cho, Chul-Hyun ;
Clinics in Shoulder and Elbow, volume 18, issue 4, 2015, Pages 269~271
DOI : 10.5397/cise.2015.18.4.269
Latissimus dorsi tendon transfer is a well-established method for treatment of irreparable posterosuperior rotator cuff tears. We report on an anterolateral mini-open technique with a porcine dermal patch augmentation for latissimus dorsi tendon transfer. Use of this technique would result in avoidance of deltoid damage by anterolateral mini-open approach and reduction of failure rate by patch augmentation.