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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 2, Issue 2 - Dec 1999
Volume 2, Issue 1 - Jun 1999
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Prognostic Factors for Arthroscopic Subacromial Decompression
Kim Sung-Jae ; Shin Sang-Jin ; Park Moon-Soo ;
Clinics in Shoulder and Elbow, volume 2, issue 2, 1999, Pages 93~98
Purpose: The purpose of this study was to analyze the prognostic factors for arthroscopic subacromial decompression and rotator cuff debridement in impingement syndrome. Materials and Methods : Arthroscopic subacromial decompression with or without rotator cuff debridement was performed in 46 cases of 44 consecutive patients with either stage n or stage ill impingement syndrome. The patients were classified by Neer's stage and size of tear according to the criteria of Cofield. The results were assessed with UCLA rating scale. We used repeated measures ANOVA and Chi-square test to assess correlation between the results and six variables including stage, rotator cuff tear size, age at the operation, duration of symptom, throwing sports activity, and trauma history. The follow-up period averaged 53 months(range, 27 to 92 months). Results: Lower stage by Neer's stage was correlated with higher postoperative scores and with significant difference between preoperative and postoperative scores of UCLA rating scale. However, other factors did not show significant influence upon the results. The patients with complete rotator cuff who showed satisfactory results after procedures were older and had shorter symptom duration, small cuff size. Conclusions : In patients with impingement syndrome treated by arthroscopic debridement and subacromial decompression, superior results were obtained when belonged to a lower Neer stage and when the rotator cuff was only partially tom. In cases with complete rotator cuff tear, higher success rates were obtained with smaller tear sizes. Age at operation, duration of symptoms, throwing athlete, traumatic tear did not affect the results.
Arthroscopic Decompression in Stage II Subacromial Impingement - Five to Twelve Years Follow up -
Choi Chong-Hyuk ; OJ Ogilvie-Harris ;
Clinics in Shoulder and Elbow, volume 2, issue 2, 1999, Pages 99~105
We investigated the effectiveness of arthroscopic decompression in stage Ⅱ subacromial impingement after long term follow up. Arthroscopic subacromial decompression was done in 104 consecutive patients who had stage Ⅱ subacromial impingement. After average of 8.4 years follow up, the final results were as following; 57 shoulders(55%) in excellent, 25(24%) in good, 16(15%) in fair and 6(6%) in poor. All parameters-pain, function, muscle strength and motion-were improved significantly(p<0.00l). Rotator cuff tear was developed in 10 shoulders after decompression. Among them, 8 shoulders had unfavorable results including two poor. In 6 failures, two had rotator cuff tear, three had recurrence of impingement with degenerative change and reflex sympathetic dystrophy was developed in one. Reoperations were done in 4 shoulders. Improvement of impingement symptoms was maintained in the most of patients(79%) after long term follow up. Arthroscopic decompression surgery was very effective means for stage Ⅱ impingement syndrome.
Radiologic Assessment of Normal Acromial Arch
Hahn Sung Ho ; Yang Bo Kyu ; Yi Seung Rim ; Jung Sun Uk ; Yoo Sung Hwan ;
Clinics in Shoulder and Elbow, volume 2, issue 2, 1999, Pages 106~109
Purpose : The purpose of this study is to evaluate morphology of acromion in relation to age and symmetry in asymptomatic adults. Materials and Methods: Seventy five asymptomatic adults were divided into two groups by age(A group of age twenties and B group of age over forty) and both acromial outlet views were obtained. One hundred fifty radiographs were typed and assessed radiologically by methods of Getz and Liotard. Results: The relative percentages of acromial types I, Ⅱ, and Ⅲ were 3%, 90% and 7% in the A group and 6%, 82% and 12% in the B group respectively, Subacromial peak and spinoacromial angle were 4.3mm, 82 degrees in the A group and 4.6mm, 78 degrees in the B group. Conclusion: Incidence of type is not related to age in normal adult and type II is the most common type. Spinoacromial angle is decreased in older age group and type Ⅲ
The Results of Rotator Cuff Disease Treated by Arthroscopic Subacromial Decompression
Kim Jae-Hwa ; Han Seung-Kwan ; Cho Duck-Yun ;
Clinics in Shoulder and Elbow, volume 2, issue 2, 1999, Pages 110~114
We reviewed the results of arthroscopic surgery in patients with rotator cuff disease. Arthroscopic subacromial decompression(ASD) was performed on 22 patients with rotator cuff disease who had not responded to nonoperative measures. In the patients who had a complete tear of the rotator cuff(four of ten Neer's stage III patients), mini-open repair also was performed. Results were determined by questioning patients about their satisfaction with the outcome of surgery and by functional assessment of the shoulder with the parameters of pain, function, and range of motion according to the UCLA shoulder rating scale. The average follow-up was 21 months. The results were sixteen(72%) excellent, three(14%) good, two(9%) fair, and one(5%) poor. The following variables were analyzed to assess their influence on final outcome; duration of preoperative symptoms, Neer's stage(extent of damage to the cuff), type of acromion. Satisfactory results were achieved in thirteen of fourteen patients(93%) who had duration of preoperative symptoms below one year, and in four of six(67%) above 2 years. And satisfactory results were achieved in eleven of twelve patients(92%) who had Neer's stage II and in eight of ten(80%) stage III and achieved in six of seven patients(86%) who had Bigliani's acromion type I, in nine of eleven(82%) type II, and in four of four(100%) type III. There are multiple factors that may influence the recovery after ASD or the eventual outcome. However, although there is still a controversy about the pathogenesis of rotator cuff disease, We found that arthroscopic subacromial decompression and mini-open repair in patients with rotator cuff disease were well enough documented to be considered a standard treatment.
Type Ⅱ SLAP Lesion with the Rotator Cuff Tear
Kim Jin Sub ; Whang Pil Sung ; Yoo Jung Han ;
Clinics in Shoulder and Elbow, volume 2, issue 2, 1999, Pages 115~119
Purpose: We reviewed the SLAP lesions and associated injuries, also evaluated a hypothesis that the type II posterior SLAP lesion is related with posterior rotator cuff tear and gives rise to the postero-superior instability. Materials and Methods: The patient recording papers, MRI, video and operation sheets were reviewed with the 28 SLAP lesions confirmed by the arthroscopy among 242 cases. Among these SLAP lesions, type II was 22 cases and classified to the anterior, posterior(16 cases), combined subtype(6 cases) based on the main anatomic location. There were 14 cases of the type II accompanying rotator cuff tear. The average follow-up(13 months) results were evaluated with the ASES and Rowe rating score after repair or debridement of the SLAP lesions. Results: In the type II lesions accompanying the rotator cuff tears(14 cases), the posterior(l0 cases) and combined type(4 cases), cuff lesions were all existed posteriorly. Also We could confirm the drive-through sign in the eleven cases, though did not check the disappearance of this sign after repair because of retrospective study. We could followed up the 22 cases, 18 cases(77%) were excellent or good, fair 3 cases(14%) and poor 1 case(4%). Also, type II lesions with the rotator cuff tear(14 cases) were showed better results in the repair(8 cases) than the debridement(6 cases) of the unstable type II with the cuff repair. Conclusion: The type II lesions were frequently associated with the cuff tear in the specific location. We could presume the possibility of postero-superior instability in the SLAP lesion with the cuff injuries. Also, satisfactory results could be experienced when the unstable SLAP lesions with the cuff tear were repaired at the same time.
Arthroscopic Treatment for Articular Side Partial- Thickness Tears of the Rotator Cuff - Comparison Between Simple Debridement and Additional Acromioplasty -
Moon Young Lae ; Yoon Tae Hyun ; Park Joon Kwang ; Oh Seo Jin ;
Clinics in Shoulder and Elbow, volume 2, issue 2, 1999, Pages 120~125
Objectives : To evaluate the effects of arthroscopic acromioplasty and debridement for partial thickness articular side rotator cuff tears, Method: We divided 97 patients into 2 groups according to treatment protocol, with both groups having confirmed intra-articular partial tears of the rotator cuff. In group Ⅰ, we debrided the frayed and fibrotic cuff margin while in group II, we performed subacromial decompression in addition to debridement. After the surgery we checked all the patients with the modified UCLA shoulder rating scale. Results: The follow-up observation 12 months after surgery revealed that 44 patients in group I were rated as excellent in 32 cases, good in 10 cases, fair in 1 case, and poor in one case, while 53 patients in group II, were rated as excellent in 38 cases, good in 17 cases, and fair in 2 cases. Twenty-four month after surgery we observed that patients in group I were rated as excellent in 23 cases, good in 16 cases, fair in 4 cases, and poor in 1 case, while patients in group II were rated as excellent in 34 cases, good in 17 cases, and fair in 6 cases. Conclusion: The use of acromioplasty on partial thickness tears of rotator cuff, even in the cases of intra-articular nature, is preferable to the procedure performed without it.
Acute Type V Acromioclavicular Injury Treated by the Modified Bosworth Technique
Kim Seung-Key ; Yi Sang-Hoon ; Park Jong Beom ; Bahk, Won-Jong ; Jang Il-Seok ; Chang Han ;
Clinics in Shoulder and Elbow, volume 2, issue 2, 1999, Pages 126~132
Purpose : To evaluate the functional and radiographic outcome of the modified Bosworth method in the surgical treatment of acute type V acromioclavicular joint dislocation. Materials and Methods: From June 1995 to May 1998, 20 patients were operated on for acute and complete acromioclavicular dislocation(Rockwood type V). The operative technique includes fixation of the coracoclavicular joint with Bosworth screw or 6.5mm cancellous screw and imbrication of trapezius and deltoid muscles. The average age was 34 years(range, 19 to 51 years). These 20 patients with an average follow-up of 18months, were evaluated clinically using the UCLA scoring system. Additional radiographical assessment was performed with stress radiographs. Results: Excellent or good clinical results were obtained in 95%(19 cases). And the average coracoclavicular interval ratio was decreased from 3.31(2.2-6.0) to 1.13(1-1.4) in stress radiographs. There were 4 cases of heterotopic calcification postoperatively but there was no correlation with clinical result. Posttraumatic A-C joint arthritis was developed in one case. In that case, the distal clavicular resection was done under the arthroscopic technique. Conclusion: The severe displacement observed with type V injuries is incompatible with normal shoulder function if the shoulder is left in its displaced position. In type V injuries, significant damage to the deltoid and trapezius musculature and overlying fascia occurs, therefore open reduction and good fixation must be obtained with imbrication of trapezius and deltoid muscles. In our type V acute complete acromioclavicular dislocation, the modified Bosworth technique provides excellent results with a low complication rate.
Coracoclavicular Screw Fixation for AC Dislocation and Unstable Distal Clavicle Fracture
Kim Jin Sub ; Jun Jin Ho ; Chung Yung Khee ;
Clinics in Shoulder and Elbow, volume 2, issue 2, 1999, Pages 133~137
Purpose: There are so many different methods with the their own advantages and disadvantages for acute AC dislocation and distal unstable clavicle fracture. We evaluated the usefulness of temporary Bosworth's coracoclavicular fixations using the cannulated screw and reviewed our clinical results. Materials and Methods: We evaluated 34 cases of temporary coracoclavicular fixations with cannulated screw and washer for acute AC dislocation(25cases in the Type V, Ⅲ) and distal unstable clavicle fracture(9cases in the Type ⅡB, Ⅱ+Ⅲ). All cases were fixed by the same techniques, guided cannulated screw under C-arm after the repair of the CC ligament within 1 week. Bases on the regular check, screws were removed at the 6-12 weeks under local anesthesia. The final clinical and radiological results(average 14 months follow-up) were rated with the UCLA scale. Results : All shoulders were gained nearly full ROM passively at the 3-4 weeks. The overall satisfactory resuIts(excellent or good) were achieved 88%(22/25) in the acute AC dislocation and all in the distal unstable clavicle fracture. There were no definite complications except three initial fixations loosening. Conclusion: Temporary Bosworth's coracoclavicular fixation using the cannulated screw with guided pin was simple precedure and provided enough initial stability for acute AC dislocation and distal unstable clavicle fracture.
Reconstruction of Coracoclavicular Ligament with Semitendinosus Tendon Graft - Technical Note -
Choi Nam-Hong ; Bae Sang-Wook ; You Soo-Geun ;
Clinics in Shoulder and Elbow, volume 2, issue 2, 1999, Pages 138~142
Coracoclavicular ligament is main restraint to superior instability of the distal clavicle. Coracoacromial ligament, extensor tendon of toe, palmaris longus tendon, and Dacron tape have been used to reconstruct coracoclavicular ligament. We used semitedinosus tendon to reconstruct coracoclavicular ligament. The semitendinosus tendon was harvested as a usual fashion. After the distal clavicle and coracoid process were exposed, a hole of six millimeter diameter was made on the center of whole thickness of the distal clavicle. A malleolar screw was fixed from distal clavicle to coracoid process to maintain the reduced position of the acromioclavicular joint. The leading suture of tendon graft was passed through the hole of the distal clavicle and looped under the coracoid process. After leading portion of tendon graft was looped over the clavicle, sutures were made between each end of the tendon graft with nonabsorbable suture materials.
Suprascapular Nerve Entrapment Neuropathy by Ganglion Cyst
Rhee Yong Girl ; Kim Kang II ; Yang Hyoung Seop ;
Clinics in Shoulder and Elbow, volume 2, issue 2, 1999, Pages 143~150
Purpose: The purpose of this study is to describe the characteristic clinical findings and treatment of suprascapular nerve entrapment by ganglion and to evaluate its results. Materials and Methods: Seven paitents with suprascapular nerve entrapment were evaluated on an average 13 months(range, six months to three years two months) after surgical excision and decompression. There were six males and one female. The mean age at operation was 31 years(range, 23 to 40 years), Suprascapular nerve entrapment were caused by compression of ganglion cyst in suprascapular notch or spinoglenoid notch in all cases. All patients complained of pain located over posterolateral area of the shoulder. Two patients had atrophy of both the supraspinatus and infraspinatus muscles, In four patients, only the infraspinatus muscle was involved. Muscle strength on both forward flexion and external rotation was decreased in two patients. In four patients, only external rotation was decreased. All patients underwent open excision of ganglion cyst and decompression. Results: The most dramatic effect of operation was prompt disappearance of pain in all patients. The average visual analog scale had improved from 7.2 to 0.6 point at the latest follow-up evaluation. An atrophy of the supraspinatus or infraspinatus muscle partially disappeared in four of six patients and muscle strength of forward flexion or abduction improved in all of six patients. The overall result was excellent for five patients and good for two. Conclusion: Surpascapular nerve entrapment by ganglionic cyst had clinically unique symptoms and signs on physical examination. Surgical excision is effective for symptomatic and functional outcomes. We believe that early intervention can be one of treatment modality before an irreversible damage occurs if the ganglion is large enough to compress suprascapular nerve, and to develop severe pain and muscular atrophy.
Humeral, Glenoid Retroversion and Bicipital Groove Distance of the Normal Korean Adults
Kim Jin Sub ; Yoo, Jung Han ; Park Joo Hyuk ;
Clinics in Shoulder and Elbow, volume 2, issue 2, 1999, Pages 151~156
Purpose : Average humeral head retroversion was showed significant wide range from literatures based on variable measuring technique, We performed computed tomography(CT) study in an effort to define the specific anatomy relationships and evaluate their use. Materials and Methods : Two hundreds shoulders and distal humeri CT scan with no known pathology were examined. The study population was divided to 10 groups by gender and age (from third to seventh decade). The number of each group was twenty. Retroversion of proximal humerus and glenoid were measured using the lines that were connected the central axis of humeral head, central points of the humeral epicondyles paralleling to the trochlea, paralled to the glenoid surface, midpoint between the transverse glenoid diameter and medial edge of the scapular. We also measured the bicipital groove distance from the humeral central axis and scapulothoracic angle. Results: Retroversion of proximal humerus was highly variable, ranging in this study from 13 to 58 degrees(mean 28.73) These values correlated with sex, not age, height or hand dominance. Glenoid retroversion at the inferior sections showed average 1.3 degree, did not signigicant differences. The central axis was an average of l0mm(5-15mm) posterior to the posterior margin of the bicipital groove. Scapulothoracic angle was average 43 degrees(25-53 degrees) Conclusion: Anatomical reconstruction of retroversion angle should be individualized and bicipital groove could be useful as landmark for the lateral fin of the prosthesis to be positioned an average of 10mm posteriorly.
Suture Anchor Capsulorraphy in the Traumatic Anterior Shoulder Instability: Open Versus Arthroscopic Technique
Kim Seung-Ho ; Ha Kwon-Ick ; Kim Sang-Hyun ;
Clinics in Shoulder and Elbow, volume 2, issue 2, 1999, Pages 157~169
Eighty-nine shoulders in eighty-eight patients with traumatic unilateral anterior shoulder instability were evaluated for Rowe and UCLA scores, recurrence, return to activity, and range of motion by an independent examiner at an average of 39 months after either arthroscopic or open Bankart repair using suture anchors. The arthroscopic technique included a minimum of 3 anchors, and a routine incorporation of capsular plication and proximal shift. Twentysix shoulders(86.6%) out of thirty in the open Bankart repair group had excellent or good results while fiftyfour(91.5%) of the fifty-nine shoulders with arthroscopic Bankart repair had excellent or good results. The arthroscopic group revealed significantly better results in the Rowe(p=.041) and UCLA scores(p=.026). Two shoulders in each group developed redislocation. There were no significant differences in the loss of external rotation and return to prior activity between the two groups(p>.05). The residual instability occurred more frequently in the group of patients with lesser anchors. Arthroscopic suture anchor capsulorraphy has results equal to or better than the open Bankart procedure.
Electromyographic Analysis of the Biceps Brachii during Provocative Tests
Lee Young-Soo ; Shin Dong-Rae ; Cho Sang-Hyun ; Nam Ki-Sun ; Kim Sung-Jae ;
Clinics in Shoulder and Elbow, volume 2, issue 2, 1999, Pages 170~177
The electromyographic activity of four muscles(biceps, supraspinatus, infraspinatus and subscapularis) was measured from non-dominant shoulders of 12 volunteers by six different provocative test for the biceps pathology. The provocative tests were Speed, Yergason, Ludington, Heuter, O'Brien and the abduction-extension test. Each test was performed in a force of 30% of maximal voluntary contraction. The levels of activity of the biceps were higher than those of the other rotator cuff muscles only in Speed's test: 28% in the biceps, 26% in the infraspinatus, 25% in the supraspinatus and 21 % in the subscapularis. The levels of activity of the biceps as a percent of MMT(maximal manual test) were higher in Speed's(42%) and O'Brien's test with the arm supinatecl(42%). Speed's test can isolate the activity of biceps better than the other tests but it is a nonspecific test by which the biceps tendon was also activated within other rotator cuff muscles.
Arthroscopic Treatment of Symptomatic Shoulders with Minimally Displaced Greater Thberosity Fracture
Kim Seung-Ho ; Ha Kwon-Ick ;
Clinics in Shoulder and Elbow, volume 2, issue 2, 1999, Pages 178~186
Twenty-three patients with chronic shoulder pain beyond 6 months after the fracture of the greater tuberosity underwent arthroscopic treatment and were retrospectively assessed after an average of 29 months(range, 22 to 40 months). There were 18 men and 5 women with the average age of 39 years(range, 24 to 61 years). Fourteen were isolated fractures and nine were related to acute anterior instability episode. The average displacement of the fracture was 2.3mm(range, 0 to 4mm) on the anteroposterior view of the plane radiographs. At the time of arthroscopy, all patients had partial thickness rotator cuff tears in the articular surface. The cuff tears were located on the tuberosity fracture area and were an Ellman's grade I to n in depth. With the arthroscopic debridement or repair of the tear depending on the condition of the tear itself, as well as the subacromial decompression, the UCLA score revealed good to excellent results in 20 and fair in 3 patients. Nineteen of the patients had returned to the previous level of activities. The patient with a higher activity demand revealed a lower level of activity return(p=0.034). The partial thickness rotator cuff tear should be considered in patients with chronic shoulder pain after the minimally displaced fracture of the greater tuberosity, and arthroscopic debridement or repair is an appropriate procedure.
The Results of Ender Nailing for the Proximal Humerus Fractures - Radiological Evaluation -
Park Jin Soo ; Chung Moon Sang ; Yoon Kang Sub ; Baek Goo Hyun ; Lee Ji Ho ; Kang Seung Baek ; Kim Dong Wook ;
Clinics in Shoulder and Elbow, volume 2, issue 2, 1999, Pages 187~198
Purpose: The authors compared the results of Ender nailing for the proximal humerus fractures with those of the conservative methods radiographically. Materials and Method: Nine patients(mean age: 69 years.) received Ender nailing, and the other nine patients, conservative treatments(mean age: 73 years). All fractures were 2 part fractures. The Ender nails were inserted either through posterior elbow approach or transepicondylar approach. A simple Velpeau bandage was applied to the conservative treatment group. The average follow-up was 15 months. Results: The initial status of the anatomical reduction, i.e., the values of the medial shift, overlapping and the varus agulation, were little changed at follow-up radiographs in both the Ender nailing group and the conservative treatment group. There was no significant difference for the status of anatomical reduction between the Ender nailing group and the conservative treatment group. The stability of fixation by Ender nails, i.e., the degree of fanning out of the nails was poor in most cases. Not a few problems/complications happened in cases of Ender nailing group; backing out of the nail in three cases, penetration of the nails into the humeral heads in 3, fractures or cracking of the humerus around the nail insertion area in 4 and reduction loss in one. Conclusion: We could not get better results with the use of Ender nail. We use no longer Ender nails for the proximal humerus fractures. Further studies are needed for the better option for the proximal humerus fractures.
Humeral Avulsion of the Glenohumeral Joint Capsule - Case Report -
Lee Young-Soo ; Baek Joon-Sik ; Shin Dong-Rae ;
Clinics in Shoulder and Elbow, volume 2, issue 2, 1999, Pages 199~203
It is well known that the essential pathology in traumatic anterior dislocation of the shoulder is the avulsion of the glenohumeral ligament complex from the glenoid rim, However, there were some reports that the avulsion can occur from the humeral attachment site. We have experienced a 42-year-old man who had complained of persistent shoulder pain after traffic accident and showed the instability on physical examination. The MR arthrogram and arthroscopic surgery revealed the avulsion of glenohumeral ligament from the humeral attachment site. We repaired the lesion using the suture anchor through the anterior axillary approach and had a good result after 1 year
Thberculosis Abscess of the Brachio-Radialis Muscle without Osseous Involvement - A Case Report -
Han Chang-Whan ; Kim Weon-Yoo ; Ko Lak-Hyun ; Cheon Jin-Sung ; Kim Jin-Young ;
Clinics in Shoulder and Elbow, volume 2, issue 2, 1999, Pages 204~208
The diagnosis of isolated tuberculosis of the brachioradialis muscle without osseous involvement was made by excision of the lesion and histologic examination in a 72-year-old woman who was in a poor general state. The patient was free of other systemic symptoms or other foci of infection. The wound healed without complication with the aid of antituberculous chemotherapy. Two years later, the patient remains symptom-free with no signs of recurrence.
Tardy Ulnar Nerve Palsy Caused by Bilateral Cubitus Varus Deformities - A Case Report -
Lee Sang Yup ; Kim Jeong Hwan ; Lee Sang Gug ; Chung Chae Ik ; Kim Young Hwan ; Hwang Sik ;
Clinics in Shoulder and Elbow, volume 2, issue 2, 1999, Pages 209~213
It is well known that tardy ulnar nerve palsy occurs with cubitus valgus deformity as a late complication after a nonunion of lateral condyle fracture of the humerus in childhood. On the other hand, cubitus varus deformity often results from malunion of supracondylar fractures of the humerus. However, reports of tardy ulnar nerve palsy in cubitus varus deformity are few. We report a patient with bilateral cubitus varus deformities with bilateral tardy ulnar nerve palsy which was confirmed with EMG. She was treated by step cut osteotomy(DeRosa and Graziano) with subcutaneous anterior transposition of ulnar nerve