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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
> Journal Vol & Issue
Clinics in Shoulder and Elbow
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Journal DOI :
Korean Shoulder and Elbow Society
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Volume & Issues
Volume 2, Issue 2 - Dec 1999
Volume 2, Issue 1 - Jun 1999
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Treatment of Type Ⅲ Acute Acromioclavicular Dislocation
Jeong Hwa Jae ; Koo Bon Seop ;
Clinics in Shoulder and Elbow, volume 2, issue 1, 1999, Pages 1~7
Purpose : There has been considerable controversy as to the method of the treatment of acute acromioclavicular joint dislocation classified to type III injury. The purpose of this study is to compare the conservative and operative treatment of the type III acute acromioclavicular joint dislocation in terms of clinical and radiological results. Materials and Methods: We treated 31 cases of acute, type III acromioclavicular joint dislocation, 17 cases were treated by operative methods and 14 patients by conservative treatment, and 1 year minimum follow-up was done from January 1990 to January 1996. We used UCLA Shoulder Rating Scale for clinical results. And for the radiological results coracoclaviclar distance were measured. We used Fisher's exact test for statistical analysis of results between the two treatment methods. Results: Fifteen(88.2%) of seventeen patients in operative treatment and eleven(78.6%) of fourteen patients in nonoperative treatment were rated excellent or good on the UCLA rating scale. In radiographic evaluation, the average coracoclavicular distances of preoperative state, immediate postoperation(or postreduction) and last follow-up were as follows. In operative cases, it was 1.75±0.21mm, 1.14±0.24mm and 1.33± 0.22mm respectively. In nonoperative cases, it was 1.65±0.14mm, 1.26±0.26mm, and 1.42±0.27mm respectively. Conclusion : This study demonstrated that there was no significant difference in clinical and radiological results between the operative and nonoperative treatment groups. So, nonoperative treatment is recommended for acute type III acromioclavicular dislocation as general rule.
Key-hole Technique in Treatment of A-C Dislocation - Preliminary Report -
Choi Chang-Hyuk ; Kwun Koing-Woo ; Kim Shin-Kun ; Lee Sang-Wook ; Yun Young-Jun ;
Clinics in Shoulder and Elbow, volume 2, issue 1, 1999, Pages 8~13
The results of the operative treatment of the Grade III acromioclavicular joint injury is defined by the durability of the reduced joint and free of exertional pain. Several surgical techniques have been applied to reduce and stabilize the joints effectively. Resection of clavicular lateral end and subacromial decompression also could be applied to prevent post-operative arthritic change. Biomechanical studies reveals the role of clavicular elevation and rotation to achieve more than 90 degrees of elevation. It also serves as a attachment site of deltoid and trapezius muscle. The stability and mobility of the both acromioclavicular and coracoclavicular joint are important to get full functional recovery. We modified the methods of coracoacromial ligament transfer described by Weaver-Dunn and by Shoji et a!. to prevent pullout of the transferred ligament and to get more improved functional results. Main technical point was harvesting full thickness bone block and fix it through the key-hole to reduce pull out angle
Operative Treatment of the Clavicular Midshaft Fractures in Adult - A Comparison between Intramedullary Multiple Steinmann Pins Fixation and Reconstruction Plate Fixation -
Lee Young Kuk ; Gu Hae Seo ;
Clinics in Shoulder and Elbow, volume 2, issue 1, 1999, Pages 14~20
Purpose: Despite of the popular use of the reconstruction plate for the fixation of clavicular shaft fractures, some disadventages have been raised such as long period of immobilization, long skin incision, loosening of plate and screws, and increased chance of nonunion due to severe periosteal injury. Thus, the authors have performed intramedullary multiple Steinmann pins fixation that could reduce the disadvantages of plate fixation in order to compare the treatment results between the two groups. Materials & Methods: From 1994. Jan. to 1997. Dec. the department of orthopaedic surgery of the Kwak's hospital treated operatively for 56 cases of the clavicular shaft fractures in adult. 39 cases of them were treated with the plate fixation and 17 cases with the intramedullary multiple Steinmann pins fixation(SP group). Reconstruction plates(Plate group) were used for 26 out of 39 patients treated with plate fixation. Among the Plate group and SP group, each 15 cases were selected by age and sex and compared each other according to the bone union time, union rate, complication, and functional results. The follow-up period was 12 months at the shortest and 48 months at the longest and the average was 16 months. Results: The Plate group showed that the bone union time was 7 weeks and the bone union rate was 93%. The SP group showed 6.5 weeks and 100% respectively. In complication, the Plate group had 1 case of loosening of plate and screws and delayed union; SP group had 1 case of pin migration. The functional results according to Kang's criteria, 87% of the Plate group and 93% of the SP group showed good or excellent. Conclusion : The SP group showed very comparable results in terms of the bone union time, bone union rate, complication, and functional results comparing to the Plate group. The intramedullary multiple Steinmann pins fixation showed several advantages over the reconstruction plate fixation, which were simple operative technique, easy removal of pins, being able to perform immediate postoperative full range of motion exercise. Therefore, the intramedullary multiple Steinmann pins fixation is thought to be one of the useful operative techniques in treatment of the clavicular shaft fractures in adult.
The Treatment of One-Part Fractures of the Greater Thberosity of the Proximal Humerus
Park Tae-Soo ; Kim Tae-Seung ; Park Ye-Soo ; Kim Do-Hyeung ; Kang Chang-Nam ; Whang Kuhn-Sung ;
Clinics in Shoulder and Elbow, volume 2, issue 1, 1999, Pages 21~27
Purpose : The purpose of this study was to evaluate the functional outcomes of one-part fracture of the greater tuberosity that had been treated either by a conservative treatment or an operative approach. Materials and Method: Eighteen shoulders in 18 patients who had an one-part fracture of the greater tuberosity of the proximal humerus were managed, and the average follow-up period was 4 years and 10 months (range, 1 year to 8 years 6 months). Results: According to Neer's criteria for evaluation of results, in the group of 13 patients managed nonoperatively, the results were good or excellent in ten patients, fair in one, and poor in two. In the group managed operatively, the results were excellent in all five patients. Conclusion: If the displacement of the fragment is more than 5mm in young active patients, and more than 3mm especially in athletes and heavy laborers involved in overhead activity, the fragment should be mobilized, repaired and fixed into its original bed or a little bit inferolaterally with multiple heavy non-absorbable sutures, tension band technique, or cancellous screws and washers. We would suggest that the patients showing one-part fracture of the greater tuberosity of the proximal humerus should be evaluated individually.
Magnetic Resonance Imaging Assessment of Acromion Morphology and Superior Displacement of the Humeral Head in the Impingement Syndrome
Koo Bon Seop ; Kim Kyung Chul ; Oh Jung Hee ;
Clinics in Shoulder and Elbow, volume 2, issue 1, 1999, Pages 28~34
Purpose: We studied magnetic resonance imaging of acromion morphology and superior displacement of the humeral head in the patients with diagnosis of rotator cuff impingement syndrome, and also documented the relationship of type Ⅲ acromion to the rotator cuff tear. Materials and Methods: We reviewed retrospectively 40 patients(40 shoulders) who had arthroscopic treatment for the diagnosis of stage II impingement or rotator cuff partial tear and did not have other risk lesions except acromion factor. The mean age was 48.7 years at operation. 21 men(2l shoulders), mean age of 26 years, were used as controls. Acromial type, tilt, and superior displacement of humeral head in sagittal plane, and acromial lateral angulation in coronal plane were measured. Four parameters of the patients were compared with those of control group. And then, the data were subdivided and analyzed with respect to acromial type and patient age in the impingement group. Student t test and multi-way ANOVA were used. Results: In impingement group, Farley's type I acromion, 33%, type Ⅱ, 38%, type Ⅲ, 27% and type Ⅳ, 2%. Superior displacement of humeral head( 4.8mm) were characteristic in the impingement group compared with the control group(1.3mm)(p<0.05). But acromial tilt and lateral angulation were not statistically different. In the analysis of the impingement group, the change of 4 parameters was not significant with respect to age(p>0.05), but lateral angulation in type I acromion(18 degree) and superior displacement of humeral head in type Ⅲ acromion(6.3mm) were significantly increased(p<0.05). All 4 parameters were not different between two subdivided types of type Ⅲ acromion. Conclusion: All types of acromian and large lateral angulatian cauld develop impingement syndrame, but acromial tilt was nat risk factar. Appearance of type Ⅲ acromian and increased superiar displacement of humeral head were characteristic findings in the impingement syndrame. Superiar displacement of humeral head as a result of degenerative change of rotatar cuff was probably primary cause far impingement. The type Ⅲ acromian might be an acquired farm, which cauld be expected to accelerate the tear of rotatar cuff as a cansequence.
Evaluation of Coraco-Acromial Arch in Patients with Impingement Syndrome
Rhee Kwang-Jin ; Byun Ki-Yong ; Kwon Soon-Tae ; Byun Kyu-Hwan ;
Clinics in Shoulder and Elbow, volume 2, issue 1, 1999, Pages 35~40
Impingement syndrome is caused by a conflictual status between rotator cuff, subacromial bursa and anatomic and functional coracoacromial arch. The purpose of this study was to assessment the coracoacromial arch by MRI and to determine major factors among five components of coracoacromial arch. We analyzed forty-two cases of clinical impingement sign and test positive and postoperative confirmed diagnosed from March, 1991 to January, 1999. We evaluated acromial end abnormality according to the Bigliani acromial type and formation of osteophyte. Clavicular end abnormality classified flat, outward protrusion, inward protrusion to coracoacromial arch. Acromioclavicular joint abnormalities were advanced osteoarthritis and positive signal change. Coracoacromial ligament thickening was above 2 mm in oblique sagittal image. Coracoid process abnormality was inward protrusion to coracoacromial arch. All consecutive patients abnormalities were as follows: clavicular end osteophyte formation and inward protrusion to coracoacrmial arch were 30%, acromial end osteophyte formation was 28%, advanced acromioclavicular joint arthritis and osteophyte formation were 56%, coracoacromial ligament thickening was 24% and no coracoid process inward protrusion to coracoacromial arch. Impingement syndrome combined with rotator cuff tear group abnormalities were clavicular end(40%), acromial end(40%), acromioclavicular joint(20%), coracoacromialligament(20%) and coracoid process abnormality(0%) respectively. Only impingement syndrome group abnormalities were clavicular end(25%), acromial end(31%), acromioclavicular joint(62%), coracoacromial ligament(25%) and coracoid process(0%) respectively. Acromial type I(flat) were 6 cases, type II(curved) were 26 cases and type III(hooked) were 10 cases. We concluded that the most important contributing factors for impingement syndrome was acromial type and second was acromioclavicular joint arthritis and bony spur formation.
Meniscoid-type SuperrJior Labrum Associated with Internal Derangement of Shoulder Joint
Choi Chang-Hyuk ; Kwun Koing-Woo ; Kim Shin-Kun ; Lee Sang-Wook ; Park Bum-Jin ;
Clinics in Shoulder and Elbow, volume 2, issue 1, 1999, Pages 41~46
Glenoid labrum acts as one of static stabilizer of the glenohumeral joint. It deepens the glenoid socket and may also serve as a chock, acting as a wedge in preventing glenohumeral translation. Two types of variations in labral anatomy were noted by Detrisac and Johnson. Type A has a superior labrum that is detached centrally but well attached peripherally. The type B labrum is well attached centrally and peripherally at all sites. A meniscoid-type labrum is thought to be normal unless there are splits or fragmentation of the overlying labral tissue. Meniscoid type labrum is different from SLAP II lesion in that it has a firm anchoring on the superior labrum. We observed four cases that had a meniscoid variant superior labrum, which covered the superior glenoid unusually larger than normal in the arthroscopic treatment of shoulder pathology including instability and rotator cuff diseases. We did arthroscopic reshaping and debridement of meniscoid variant superior labrum combined with pathologic change of the glenohumeral joint. Further study would be required for understanding the mechanism of the development of meniscoid variant labrum and its clinical significance.
Open Capsular Shift versus Arthroscopic Bankart Repair for Recurrent Dislocation of Shoulder
Kim Jung-Man ; Seo Jeong-Tae ; Chang Cheong-Ho ; Kim Tac-Soo ;
Clinics in Shoulder and Elbow, volume 2, issue 1, 1999, Pages 47~52
The results of open capsular shift(Group 1) and arthroscopic trans glenoid Bankart repair(Group 2) for the recurrent anterior dislocation of the shoulder were compared. During a 4-year period, 25 patients were surgically treated. Fourteen shoulders had open Bankart procedure and capsular shift, and II shoulders were treated arthroscopically. A Bankart lesion was found in 12 out of 14 patients in Group I and all 11 patients in Group 2. Average follow-up period was 46 months for Group 1 and 23.4 months for Group 2. Group 1 showed 71.4% good to excellent results with 1 recurrent dislocation. Group 2 showed 90.9% good to excellent results with no recurrent dislocation. The cause of less favorable results of Group I compared with Group 2 was loss of external rotation postoperatively. The study showed that the results of arthroscopic Bankart repair was comparable to the open capsular shift in terms of stability, and the postoperative function was better than open capsular shift.
Inferior Capsular Shift Procedure for Multidirectional Instability of the Shoulder in Contact Athletes
Kim Young Kyu ; Baek Seung Jeong ;
Clinics in Shoulder and Elbow, volume 2, issue 1, 1999, Pages 53~59
Initial treatment of multidirectional instability of the shoulder would be a thorough rehabilitation program. If rehabilitation fails to resolve a patient's symptoms, the most commonly performed surgical procedure remains the inferior capsular shift. Eleven patients who had disabling multidirectional instability of the shoulder were managed with the inferior capsular shift. All of the procedure were performed by means of an anterior approach and a laterally based capsular shift. All of the patients were the contact athletes. The purpose of our study was to evaluate the efficacy of the inferior capsular shift procedure in the contact athletic patients, to review the loss of external rotation postoperatively and to discuss their return to sports. Mean follow up duration was 14.5 months(range, 12 to 24). Pain was relieved postoperatively in all cases and most patients could get stability except one case of recurrent subluxation. The average loss of external rotation and forward flexion after the operation were Y and 30 at last follow up. By the rating scale from American Shoulder and Elbow Society, overall scores improved from 49 points to 85 points. The results were excellent or good in 9 patients(82%) out of 11 patients. In reference to return to sports, 10 patients(91 %) of 11 patients returned to their sports with 7 patients (64%) returning at the same levels of competitiveness. The inferior capsular shift procedure was considered to be a recommendable method for the management of the multidirectional instability of the shoulder.
The Results of Bankart Repair for Anterior Instability of the Shoulder - Arthroscopic versus Open Bankart Procedure -
Rhee Yong Girl ; Park Jae Young ;
Clinics in Shoulder and Elbow, volume 2, issue 1, 1999, Pages 60~73
Purpose : The purpose of this study was to compare patients with anterior shoulder instability who were treated with an open Bankart procedure with those treated with an arthroscopic procedure, and to evaluate factors influencing the final outcomes and recurrence. Materials & Methods : One hundred seven shoulders underwent open Bankart repair, and fifty-one shoulders were treated arthroscopically. Average followup for open group was 34 months, and for arthroscopy group was 25 months. The Bankart Rating System by Rowe was used to evaluate the clinical outcome of the procedure. And, the patients were asked about any changes concerning their sports and professional activities. Results: According to Bankart Rating system by Rowe, open group had 97% fair to excellent results with 2 recurrent dislocation(1.8%) and 4 recurrent subluxation(3.6%), and arthroscopy group had 94% fair to excellent results with 3 recurrent dislocation(5.8%) and 4 recurrent subluxation(8%). In open group, 9 shoulders(8.4%) had the mild limitation of range of motion at the time of followup, and 2 shoulders(3.9%) in arthroscopy group. Age and gender do not seem to be a significant factor contributing to an increased re-recurrence rate. The incidence of re-recurrence seems to be affected by dominance, frequency, and patient's activity. The size of Bank art lesion might be also considered as a contributing factor. Conclusion: Either open or arthroscopic Bankart procedures are safe and effective methods with acceptable results if an adequate patient's selection, precise surgical technique and proper postoperative care are done. And arthroscopic surgery could be considered if the anterior instability is non-dominant, non-athlete, traumatic unidirectional and Bankart lesion has minimal erosion of the glenoid and it has thick and mobile labrum.
The Diabetic Frozen Shoulder: Arthroscopic Release
Han Chang-Whan ; Kim Jin-Young ; Kim Weon-Yoo ; Sung Jin-Hyung ; Yoo Jae-Duk ; Rho Sang-Hyun ;
Clinics in Shoulder and Elbow, volume 2, issue 1, 1999, Pages 74~83
In diabetics, the frozen shoulder has been difficult to treat. They tend to respond poorly to manipulation. In this report we present the rationale and results of arthroscopic selective capsular release for those patients. Nine patients, who were diabetics, developed frozen shoulders which failed to respond to conservative management. They had persistent pain, stiffness, and limited function. An arthroscopic release was performed by progressively releasing the anterior structures from superior to inferior. Postoperatively physiotherapy was carried out daily to maintain the range of movement. At a follow up of 12 to 37 months the patients were assessed using the American Shoulder Society scheme. In addition, the patients were assessed preoperatively and postoperatively on four criteria: pain, external rotation, abduction and function. We found that the patients were statistically significantly improved in all four categories. Three of the nine patients had no pain, full range of motion compared with the opposite side and full function. There was one poor result of no improvement. The remaining five patients had improved but still had residual abnormalities. We consider arthroscopic release to be an effective treatment for the resistant diabetic frozen shoulder.
Buford Complex - A Case Report
Park Jin- Young ; Seo Hyun-Seog ; Yoo Moon-Jib ;
Clinics in Shoulder and Elbow, volume 2, issue 1, 1999, Pages 84~87
The Buford complex is unusual variant of the glenohumeral joint. This complex is distinguished by a cord-like middle glenohumeral ligament that oriented directly form the superior labrum at the base of the biceps tendon and crosses the subscapularis tendon to insert on the humerus. There is no anterior-superior labral tissue present between this attachment and the mid-glenoid notch. This anatomical variation may lead the surgeon to confuse this complex with a sublabral hole, pathologic labral detachment, Bankart lesion or SLAP lesion. We report a case of Buford complex which was found incidentally during the operation of impingement syndrome with stiffness and treated with subacromial decompression only.
Sternocostoclavicular Hyperostosis - One Case Report -
Yoo Jae-Doo ; Lee Dong-Wook ; Han*, Woon-Seop ; Lee Sun-Hwa ;
Clinics in Shoulder and Elbow, volume 2, issue 1, 1999, Pages 88~92
Sternocostoclavicular hyperostosis is a relatively uncommon disease characterized by hyperostosis and soft tissue ossification in the clavicle, sternum and the anterior part of the upper ribs. Although the cause of this disease is unknown, radiologic feature is diagnostic. We report one case of sternocostoclavicular hyperostosis with pain and limitation of motion on shoulder.