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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 3, Issue 2 - Dec 2000
Volume 3, Issue 1 - Jun 2000
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Hemiarthroplasty for the Comminuted Fracture of the Proximal Humerus
Seo Joong-Bae ; Won Choong-Hee ; Kim Yong-Min ; Choi Eui-Seong ; Lee Ho-Seung ; Hong Yoon-Chul ;
Clinics in Shoulder and Elbow, volume 3, issue 2, 2000, Pages 61~67
Purpose: Most proximal humeral fractures are minimally displaced and can be treated satisfactorily with a conservative method. But in many comminuted fractures, hemiarthroplasty is usually done as a primary treatment. The authors evaluated how much functional improvement was achieved after hemiarthroplasty and which factors influence on the final functional results. Materials and Methods: Eleven hemiarthroplasties were performed for three- and four-part fractures(including fracture-dislocation) between April 1992 and June 1999. There were eight women and three men, and the mean age was 65 years. According to Neer classification, six was three-part fracture and five was four-part fracture. Six patients were injured on their right shoulder and five on the left shoulder. Among the five four-part fractures, three had axillary nerve injury and among the six three-part fractures, only one patient had axillary nerve injury. The average follow-up period was 2.4 years(1 year-7 years) after operation. The functional results were evaluated with the UCLA scoring system(Modification for hemiarthroplasty). In addition to the overall results, we compared the results according to the classification of the fracture, the cause of injury, and whether the axillary nerve was injured. Results: At the last follow-up, average total UCLA score was 18.2. The mean score for pain was 7.0, mean muscle power and motion score was 5.5 and 5.7 respectively. The pain relief was more satisfactory than any other functional results. The average score for three-part fractures was 22, and the average for four-part fractures was 13.6. The average score for the patients fractured by vehicle accidents was 15.3, and 19.3 for the patients fractured by slip-down injury. In patients without axillary nerve injury, the average score was 20, and with axillary nerve injury, the score was 15. Conclusion: Shoulder hemiarthroplasty, for the treatment of proximal humeral fractures, cannot restore the shoulder function to normal, but can achieve the functional result to some degree, especially for the activity of daily living. And as for pain, we think that it is relatively effective measure. And we think that the severer the comminution, the more the chance of axillary nerve injury, and the poorer the functional results. In conclusion, the severity of initial injury seems to be the major prognostic factor.
Arthroscopic Treatment in Calcific Tendinitis of the Shoulder
Rhee Yong Girl ; Kim Young Hwan ; Park Moo Song ;
Clinics in Shoulder and Elbow, volume 3, issue 2, 2000, Pages 68~74
The purpose of this study is to evaluate the final outcome after arthroscopic calcific removal in the calcific tendinitis of the shoulder joint and to analyze the influencing factors to affect the surgical treatment on the final results. From September, 1993 to March, 2000, arthroscopic removal of the calcific deposit in the shoulder joint was performed in 34 consecutive patients who had had typical symptoms and failed with the conservative treatment and 21 cases of 20 patients could be followed up at least 2 years. Fourteen cases(67%) were located in the supraspinatus, 5 cases(24%) in the infraspinatus and 2 cases(9%) in the subscapularis. Preoperative severity of symptoms was correlated with higher postoperative score. Pain was relieved from 7.6 to 0.9(Visual Analogue Scale:VAS) and UCLA score improved from 13.9 preoperatively to 32.0 postoperatively, but there was no statiscally significant difference in according to the deposit size(P=0.386). Pain and UCLA score improved from 7.9 to 0.4 and from 12.7 to 33.0 respectively when a calcific deposit was located in the supraspinatus, from 7.6 to 1.0 and from 14.8 to 33.4 in the infraspinatus but pain relieved from 6.5 to 4.0 and UCLA score improved from 20.0 to 22.5 in the subscapularis and these outcomes were shown a statiscal significance(P=0.001). Completeness of removal did not affect the final results(P>0,05). Excellent was 23.8% in 5 cases, good 66.7% in 14 cases, fair 4.8% in 1 and poor 4.8% in 1, and patients were satisfied with their final results in 81 %.
Primary Traumatic Anterior Shoulder Dislocation in the Middle-aged And Elderly Patients
Lee Kwang-Won ; Ryu Chang-Soo ; Kim Ha-Yong ; An Jae-Hun ; Yum Jin-Sub ; Kim Whoan-Jeang ; Choy Won-Sik ;
Clinics in Shoulder and Elbow, volume 3, issue 2, 2000, Pages 75~78
Purpose: The purpose of this study was to review primary traumatic anterior shoulder dislocation in the 40 years and older to determine the incidence of recurrence, rotator cuff injury and associated fractures. Materials and Methods: From May, 1991 to October, 1998, seventeen patients were available to participate in the study. The average age was 55 years(range, 40 to 75 years). Follow-up averaged 27 months(range, 12 to 48 months). There were 12 men and 5 women. 10 right and 7 left shoulders were involved. Any participant with a history of shoulder pain and limitation of motion was excluded from the study. Each shoulder was evaluated with UCLA shoulder functional assessment. Results: The overall results were excellent in 9 patients(52.9%), good in 3 patients(17 .6%), fair in 3 patients(17.6%), and poor in 2 patients(11.7%). Surgical treatment of the associated rotator cuff and greater tuberosity fracture injuries resulted in 5 patients with excellent(55.6%), 3 patients with good(33.3%) and I patient with poor(11.1 %) and Nonsurgical treatment of the associated injuries resulted in 2 patients with excellent(33.3%), 3 patients with fair(50%), 1 patient with poor(16.7%)(P=0.025). Conclusion : Our findings on small number of patients suggest that the diagnosis of a rotator cuff and other pathologies should be approached aggressively by an MRI, CT arthrogram if significant pain and weakness are still present and early surgical repair of rotator cuff and greater tuberosity can lead to restoration of shoulder function and better outcomes in selected patients.
Treatment of Multidirectional Instability of the Shoulder with Inferior Capsular Shift
Lee Byoung Chang ; Chun Churl Hong ; Park Seong Kyu ;
Clinics in Shoulder and Elbow, volume 3, issue 2, 2000, Pages 79~86
Purpose: We analysed the clinical efficacy of inferior capsular shift operation in multidirectional instability of the shoulder joint in terms of functional aspects and patient's satisfaction Materials and Methods: From July, 1998 to March, 2000, we treated 23 cases of multidirectional instability of the shoulder joint with T-shaped inferior capsular shift and/or Bankart repair. All of them have complained of an experience about frank dislocations. Two of them has a voluntary component. We evaluated them according to complication, function, range of motion, stability and patient's satisfaction with an average follow-up of 15 months(the range of 9 to 27 months). Results: Eight cases were atraumatic multidirectional instability and coexisting Bankart lesion were present in 15. There was no redislocation, but one case of symptomatic subluxation, 3 cases of transient nerve palsy and 2 cases of feeling of laxity developed. Limitation of motion after surgery was an average of 3.4° in flexion, and 8.5° in external rotation. With Rowe scoring system, the clinical result was excellent or good in 22 cases and poor in one. According to American shoulder and elbow society, pain score improved to 1.4 from 6.1, and stability score also improved to 1.8 from 9.1. Conclusion: In multidirectional shoulder instability, one should pay attention to finding a coexisting Bankart lesion. In that case, adequate capsular volume reduction by using inferior capsular shift as well as repair of Bankart lesion is needed to get a good surgical outcome.
Electromyographic Activity of the Biceps Brachii Muscle in Shoulders With Anterior Instability
Kim Seung-Ho ; Ha Kwon-Ick ; Kim Hyeon-Sook ; Kim Seon-Woo ; Park Jong Hyuk ; Kim Young-Min ;
Clinics in Shoulder and Elbow, volume 3, issue 2, 2000, Pages 87~94
Purpose : The purpose of this study was to evaluate the activity of the biceps brachii muscle in the vulnerable abduction and external rotation position of the shoulder in patients with anterior instability. Materials and Methods: This experimental study include a prospective analysis of the electromyographic(EMG) data on a group of patients with traumatic unilateral anterior instability of the shoulder. The EMG data of unstable shoulders was compared with those of opposite shoulders as control. The optimal sample size for the case-control study was calculated using an nQuery Advisor program(nQuery Adviser 3.0, Statisticl solutions Ltd., Ireland). The EMG analyses were conducted in 76 shoulders in 38 patients who had a traumatic anterior instability in one shoulder. The EMG records were obtained at different position of shoulder, which included 0° , 45° , 90° and 120° of shoulder abduction. In each angle of shoulder abduction, the arms were placed in an external rotation as tolerated by the anterior apprehension. The paired-sample T test was used to compare the difference of the root mean square(RMS) voltages between the stable and unstable shoulders in each degree of arm position. Results : The RMS voltage of the biceps muscle was significantly greater in the unstable shoulder than opposite stable shoulder in all position of the arm(p<0.001). The RMS voltage of the biceps was maximal at 90° and 120° of external rotation in the unstable shoulder(p<0.05). The RMS voltage of the supraspinatus muscle revealed no differences in any of the test conditions(p=0.904, 0.506, 0.119 and 0.781 in 0° , 45° , 90° and 120° , respectively) Conclusion: In the vulnerable abduction and external rotation position, the biceps muscle plays an active compensatory role in the unstable shoulder while not in the stable shoulder.
Optimal Shoulder Position for Visualization of SLAP Ⅱ lesion on MR-Arthrography
Lee Young-Soo ; Shin Dong-Bae ; Park Soo-Jin ; Kim Jin-Yong ; Kim Hee-Sang ; Ha Du-Hae ;
Clinics in Shoulder and Elbow, volume 3, issue 2, 2000, Pages 95~101
Purpose : The purpose of this study was to evaluate the efficacy of oblique coronal MR images, oblique axial images of neutral, internal rotation and external rotation positions in the diagnosis of SLAP Ⅱ lesion. Materials and Methods: MR arthrography of the glenohumeral joint was evaluated retrospectively in 16 patients(16 shoulders) who underwent arthroscopic surgery(mean age; 38 years old, Male; 13, Female; 3). Oblique coronal fat-suppressed Tl-weighted spin echo images were performed with each shoulder in the neutral position of the arm and oblique axial images were performed in neutral, internal and external rotations of the arm respectively. The preoperative findings of MR were classified as definite tear, possible tear and no tear. Arthroscopic findings were correlated with MR findings of several different position of the arm. Results: Arthroscopic surgery revealed 8 SLAP Ⅱ lesion, 2 SLAP I lesion, and 6 normal superior labrum respectively. The accuracy of diagnosis in the 8 SLAP Ⅱ lesion were high on oblique axial image in external rotation which were interpreted as 8 definite tear, to compare with oblique axial images in neutral position which were interpreted as 4 definite tear, 3 possible tear, 1 no tear. The 6 normal superior labrum lesion were interpreted as no tear in all three position. The 2 SLAP I lesion were interpreted as 1 definite tear, 1 no tear on oblique axial image in neutral position and 1 definite tear, 1 possible tear on oblique axial image in external rotation. Conclusion: This study showed that axial MR images in external rotation of the arm combined with oblique coronal images have proved to be effective to detect SLAP Ⅱ lesion, and should be considered in imaging protocol for MR arthrography of the SLAP Ⅱ lesion.
Analgesia After Subacromial Arthroscopy: Prospective Double-blind Study of Continuous Mixed Intra-bursal Infusion with Morphine and Bupivacaine and placebo
Park Jin-Young ; Lee Kwan-Woo ; Kim Yun ; Yoo Moon-Jib ;
Clinics in Shoulder and Elbow, volume 3, issue 2, 2000, Pages 102~108
The aim of this study is to determine if intra-bursal morphine and Bupivacaine mixed infusion provided useful analgesia after subacromial arthroscopic operation. At the end of the subacromial arthroscopy, continuous intra-bursal infusion catheter was inserted. In a double-blind randomized trial, Sixty patients were allocated to one of two groups: placebo group(n=30) received continuous saline infusion. Study group received mixed 5㎖ of 0.5% Bupivacaine, 2㎎ of morphine and 0.05㎖ of 1/1000 epinephrine as bolus and mixed solution of 40㎖ of 0.5% Bupivacaine and 8㎎ of morphine as maintenance dose with continuous infusion pump(0.5㎖ hourly). In the placebo group, two patients were discontinued due to leakage and catheter coming out each. Intensity of pain was evaluated preoperatively and postoperatively for 3 days by 10 graded visual analogue scale. Night pain, pain on motion, sleep disturbance, lying on painful shoulder and amounts of intramuscular pain killer were recorded. Analgesic effect for pain was cleared at 1st and 2nd postoperative day and there was less sleep disturbance for 3 days postoperatively in study group. There was no difference in pain on motion postoperatively. In study group, less pain killers were used in the first 48 hours postoperatively. The continuous intra-bursal infusion decreased perception of pain at resting stage and reduced supplemental analgesic requirement for 2 days postoperatively.
Suprascapular Nerve Entrapment by Ganglion Cyst - 2 Cases Report -
Kyung Hee-Soo ; Kim Sung-Jung ; Kim Poong-Taek ; Kim Young-Woo ;
Clinics in Shoulder and Elbow, volume 3, issue 2, 2000, Pages 109~114
Ganglion cysts causing suprascapular nerve compression are uncommon cause of suprascapular nerve entrapment. The advent of magnetic resonance imaging and its application in patients with shoulder pain has improved the ability to diagnose cystic lesions causing extrinsic compression of the suprascapular nerve. We present two cases of suprascapular nerve compression by ganglion cyst which was decompressed by surgical excision. Suprascapular nerve compression was also revealed by magnetic resonance imaging(MRI), electromyogram(EMG) and clinical present of muscle atrophy and motor weakness. In each case, the symptom was resolved after sugical excision of the cystic lesion. We experienced two cases of suprascapular nerve entrapment by ganglion cyst and report the clinical, radiological and pathological findings in detail.
The Osteochondritis Dissecans of The Adult Elbow - A Case Report -
Moon Young Lae ; You Jae Won ; Cho Sam Ho ;
Clinics in Shoulder and Elbow, volume 3, issue 2, 2000, Pages 115~117
Adult type of osteochondritis dissecans of elbow is very rare condition. We describe a case of a osteochondritis dissecans of capitellum in 51-year-old male patient. We performed arthroscopy procedure for removal of loose osteochondral fragments. After I year follow-up, the patient gained good result.