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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 9, Issue 2 - Dec 2006
Volume 9, Issue 1 - Jun 2006
Selecting the target year
Pathophysiology of the Rotator Cuff Tear
Jun, J.M. ;
Clinics in Shoulder and Elbow, volume 9, issue 1, 2006, Pages 1~6
DOI : 10.5397/CiSE.2006.9.1.001
Imaging of Rotator Cuff Tears
Park, J.S. ; Ryu, K.N. ;
Clinics in Shoulder and Elbow, volume 9, issue 1, 2006, Pages 7~13
DOI : 10.5397/CiSE.2006.9.1.007
Choi, Chang-Hyeok ;
Clinics in Shoulder and Elbow, volume 9, issue 1, 2006, Pages 14~19
DOI : 10.5397/CiSE.2006.9.1.014
The patient with a posttraumatic stiffness frequently has a history of prolonged immobilization after a traumatic event. Adhesions in the extraarticular humeroscapular motion interface may be present independently or in combination with intraarticular capsular contractures. A through history and physical examination usually reveal the cause and anatomic location of stiffness. Passive stretching exercise program is effective as a first line treatment, but manipulation under anesthesia is usually not effective because of potential complication such as fracture, tendon rupture and neurologic injury. The humeroscapular motion interface adhesion can be released either open or arthroscopically. The combined technique coupled with an aggressive rehabilitation program can provide more effective motion restoration and pain relief.
Open Repair of Massive Rotator Cuff Tears
Ahn, Byung-Woo ; Yoon, Jong-Ho ; Jo, Je-Il ; Kwag, Wan-Sub ; Wang, Kyung-Tae ; Jung, Sung-Weon ;
Clinics in Shoulder and Elbow, volume 9, issue 1, 2006, Pages 20~26
DOI : 10.5397/CiSE.2006.9.1.020
Purpose: To evaluate the usefulness and functional results of open repair of massive rotator cuff tears combined with or without the tenoplasty of biceps long head. Materials and Methods: From March 2003 to August 2004, we evaluated 18 cases of the patient treated with open repair of massive rotator cuff tears. The mean age was 56 years and mean follow-up period was 15 months. We performed open repair of massive rotator cuff tears by tendon to bone repair, but in irrepairable 4 cases for tendon to bone repair performed open repair combined with tenoplasty of biceps long head. The functional results were assessed using the Constant score, the parameters of which were pain, dialy activity, mobility, strength and satisfaction. Results: The functional results were excellent in 4 cases, good in 8 cases, fair in 3 cases and poor in 3 cases. And the results of open repair combined with tenoplasty of biceps long head were good in 2 cases and fair in 2 cases. Re-repair was done in 1 case for re-rupture. And the functional result of this case was fair. The 3 poor cases were suspected re-rupture, the factor of which old age and weakened rotator cuff. It was impossible to do re-repair. Conclusion: The open repair combined with or without tenoplasty of biceps long head is a useful and effective method for massive rotator cuff tear.
Early Complications after Repair of Massive Rotator Cuff Tear
Seo, Joong-Bae ; Bahng, Seung-Chul ;
Clinics in Shoulder and Elbow, volume 9, issue 1, 2006, Pages 27~33
DOI : 10.5397/CiSE.2006.9.1.027
Purpose: To investigate early complications after repair of massive rotator cuff tears and to find out factors that compromise the results. Materials and Methods: Fourteen patients who had two or more cuff tendons involved were included. All patients were operated by open acromioplasty and rotator cuff repair. At 3 months after operation, we investigated whether there were any early complications or not. We used ASES scoring system for preoperative and follow up evaluation. In addition, various preoperative factors, such as duration of symptom, degree of tendon retraction, degree of fatty degeneration, and acromio-humeral distance, were compared between the complicated patients and non-complicated patients. Results: At 3 months after operation, the ASES score and pain were improved in any degree in all patients. But 5 patients complained persisting pain, and three of them showed major complications such as re-rupture of rotator cuff or deltoid rupture. But no preoperative factors in complicated patients were significantly different from those in non-complicated patients. Conclusion: None of the preoperative factors were related to the complications. There was a tendency of overestimation of fatty degeneration in MRI. Some factors in surgical technique and rehabilitation were highly suspected to be related to the complications.
Treatment of Two-Part Fracture of Humerus Neck Using T Plate Fixation
Nam, Il-Hyun ; Ahn, Gil-Yeong ; Yun, Ho-Hyun ; Kim, Jae-Cheol ; Moon, Gi-Hyuk ;
Clinics in Shoulder and Elbow, volume 9, issue 1, 2006, Pages 34~41
DOI : 10.5397/CiSE.2006.9.1.034
Purpose: This study is to analyze the result and complications of internal fixation with T-plate for two-part fracture of the neck of the humerus. Materials and Methods: The clinical results of fourteen patients who had been performed with this method mentioned above were reviewed. Their average age was 49.6. Postoperative mean follow up period was 24.1 months. Radiological evaluation was done by Kronberg's and shoulder function by Neer's. Results: By Kronberg evaluation, nine cases were good, two cases acceptable and three cases poor. By Neer's, mean score of shoulder function was 77.6 and 4 cases were excellent, one satisfactory, five unsatisfactory and four failure. The complications were the sfiff shoulder, loss of reduction and avascular necrosis of humeral head. Conclusion: In this study, there were differences according to the age. And we obtained an unsatisfactory result in patients over 50 years old. We consider that in patients over 50 years old, the differences were due to the muscle weakness through wide surgical approaches, postoperative implant loosening or the stiffness caused by poor rehabilitation.
Traumatic Anterior Shoulder Dislocation in Patients Older than 60 Years of Age
Ha, Jong-Kyoung ; Yoo, Jae-Doo ; Park, Sung-Pil ; Shin, Sang-Jin ;
Clinics in Shoulder and Elbow, volume 9, issue 1, 2006, Pages 42~49
DOI : 10.5397/CiSE.2006.9.1.042
Purpose: This study evaluated clinical results, and recommended treatment protocol of traumatic anterior shoulder dislocation in the patients older than 60 years of age. Materials and Methods: Thirty-eight patients with first traumatic anterior shoulder dislocation aged over 60 years were included. The average age was 69.4 (range, 60 to 87 years). There were 8 men (average age of 71.6) and 30 women (average age of 69). Most common cause of injuries was a fall on the outstretched hand. The additional injuries were evaluated using MRI or CT arthrogram in the patients with significant pain and weakness while movements after 2 weeks sling immobilization. Results: Fifteen patients (39%) had rotator cuff tears and 5 patients (14%) had greater tuberosity fractures. The sizes of rotator cuff tears were diverse; 2 partial tears, 1 small tear, 4 medium tears, 3 large tears and 5 massive tears. Among 5 massive cuff tears, 3 patients revealed cuff arthropathy after reduction. 4 patients (11%) had recurrent dislocation more than one time during 1 month after the first dislocation. Bankart lesions revealed in 5 patients and three of them had associated rotator cuff tears. 3 out of 5 patients with Bankart lesions, 13 out of 15 patients with rotator cuff tears and 3 patients with displaced greater tuberosity fracture had operations. Conclusion: The injury mechanism of shoulder dislocation in patients older than 60 years of age seems to have either anterior or posterior mechanism. The diagnosis and treatment should be approached 2 weeks after dislocation.
Operative Treatment of Terrible Triad in Elbow of Adults
Kim, Byung-Heum ; Park, Jong-Seok ; Choi, Ho-Rim ; Lee, Sang-Sun ; Rah, Soo-Kyun ; Lee, Hyun-Wook ;
Clinics in Shoulder and Elbow, volume 9, issue 1, 2006, Pages 50~59
DOI : 10.5397/CiSE.2006.9.1.050
Purpose: The nonoperative outcome of elbow dislocations with associated radial head and coronoid fractures are often unsatisfactory because of chronic instability and stiffness from proloned immobilization, Therefore we managed these injuries with well programed surgical appproaches. Method: Ten patients with this injury were evaluated retrospectively from May 1998 to June 2004 after a minimum of 12 months. These injuries include elbow dislocation and associated fractures of both the radial head and the coronoid process. All ten patients were treated by one clinic operatively with similar scheduled surgical methods which started on the lateral side and terminated on the medial side of the elbow. Radial head and neck fractures were classified Mason types, as two and three types respectively with six and four cases and six cases were fixated. Coronoid process were fixated with screws anteroposterior directly or anchor suture in all cases, each type was classified one, two and three. where were three type one, four type two, and three type three were according to Regan and Morrey classification. Results: The outcome was three resulting in excellent, four good, two normaland and the remaining case was one poor according to the Mayo Elbow Performance score. At a terminal follow up, the range of motion of the elbow averaged flection contracture,
and further flection,
. Two patients had complications requiring additional care. One, displaced coronoid process which was repaired with capsule and the other patient experienced, palsy of ulnar nerve and contracted elbow joint. Conclusions: Usage of early operation as the minimum injury of medial ligaments complex and the rigid fixation of fractures to prompt motion with our scheduled management for elbow dislocations with associated radial head and coracoid fractures provided excellent results.
The Surgical Treatment of Acute Acromioclavicular Joint Dislocation Using C-C Sling Method and Modified Phemister Operation
Chun, Churl-Hong ; Shim, Dae-Moo ; Jeung, Ul-Oh ; Lee, Jong-Myoung ; Lee, Byung-Chang ; Kim, Joung-Woo ;
Clinics in Shoulder and Elbow, volume 9, issue 1, 2006, Pages 60~67
DOI : 10.5397/CiSE.2006.9.1.060
Purpose: The purpose of this study was to compare the method of using coraco-clavicular (C-C) sling with modified Phemister operation by postoperative clinical results, radiologic analysis and complications. Materials and Methods: 33 patients of acromioclavicular joint dislocation were included in this study. Thirteen patients were treated with simple C-C sling method and twenty patients were treated with modified Phemister operation. The assesment of clinical and radiological evaluation were performed and the final results were examined by using the Weitzman's classification. Results: In the final result of C-C sling method group, forward elevation
, external rotation
, internal rotation T8 level, Visual Analogue Scale (VAS) 83.3 points were checked. In modified Phemister operation group, forward elevation
, external rotation
, internal rotation T6 level, VAS 83.8 points were checked. In coracoclavicular distance of C-C sling method group, pre-operation 12.82 mm and last follow up 8.37 mm were checked. In modified Phemister operation group, pre-operation 12.8 mm and last follow up 7.7 mm were checked. In functional evaluation by the Weitzman criteria, C-C sling group had excellent 8, good 1, fair 1 and modified Phemister group had excellent 13, good 4, fair 3. Conclusion: C-C sling method would be the better than the Modified Phemister operation because of short operation time and smaller skin incision.
Bilateral Shoulder Involvement with Mirror Image Lesion -An Arthroscopic Study in Overhead Workers
Moon, Young-Lae ; Lee, Chul-Gab ; Kim, Jong-Sik ;
Clinics in Shoulder and Elbow, volume 9, issue 1, 2006, Pages 68~72
DOI : 10.5397/CiSE.2006.9.1.068
Purpose: To demonstrate arthroscopically the presence of bilateral shoulder "mirror lesions" due to overhead work. Materials and Methods: A cross-sectional study was performed in a historical cohort of 10 male tire plant workers who underwent MRI studies of both shoulders. Bilateral intraarticular shoulder pathology was diagnosed by magnetic resonance imaging and confirmed by arthroscopy. "Mirror lesions" were defined as similar pathology between an individual patient's two shoulders. Results: We report on ten patients who had bilateral "mirror lesions." The most common mirror lesions were tears of the rotator cuff. Most patients (7 of 10) had more than one mirror lesion in their shoulders. There were two bilateral full thickness tears involving the supraspinatus and infraspinatus, four bilateral partial thickness supraspinatus tears, six bilateral partial or upper corner lesion complete subscapularis tears, and one bilateral complete supraspinatus tear. Conclusion: Occupational overhead work with simultaneous use of both arms is associated with bilateral shoulder lesions verified by arthroscopy. By demonstrating the work-related bilateral shoulder involvement, this study suggests an etiopathogenesis for these lesions and provides rational for developing worksite prevention strategies.
Multidetector CT (MDCT) Arthrography in the Evaluation of Shoulder Pathology: Comparison with MR Arthrography and MR Imaging with Arthroscopic Correlation
Kim, Jae-Yoon ; Gong, Hyun-Sik ; Kim, Woo-Sung ; Choi, Jung-Ah ; Kim, Byung-Ho ; Oh, Joo-Han ;
Clinics in Shoulder and Elbow, volume 9, issue 1, 2006, Pages 73~82
DOI : 10.5397/CiSE.2006.9.1.073
Purpose: The purpose of the present study was to evaluate the diagnostic efficacy of CT arthrography (CTA) in the assessment of various shoulder pathologies, compared with MR arthrography (MRA) and MRI with arthroscopic correlation. Materials and Methods: CTA in 84 patients, MRA in 70 patients, and MRI in 27 patients were obtained. A radiologist interpreted each image for 5 pathologies: Bankart, SLAP, Hill-Sachs lesion, full-thickness, and partial-thickness rotator cuff tear. Detailed arthroscopic reports were compared with CTA, MRA, and MRI. The sensitivity, specificity, predictive values, and accuracy were calculated. The agreement between each diagnostic modality and arthroscopy was calculated. Diagnostic efficacy was assessed by the areas under the receiver operating characteristic (ROC) curves. Results: The diagnostic values of all three imaging groups were comparable to each other for Bankart, SLAP, Hills-Sachs, and full-thickness cuff tear lesions, but those of CTA were lower than MRI and MRA for partial-thickness cuff tears. The areas under the ROC curves for CTA, MRA, and MRI were not significantly different for all pathologies, except for partial-thickness cuff tears. Conclusion: CTA was equally competent to MRA or MRI in demonstrating Bankart, Hill-Sachs lesions, SLAP, and full thickness rotator cuff tears but not as efficient in diagnosing partial thickness rotator cuff tears.
The Evaluation for the Usefulness of Arthroscopic Miniopen Repair which Related with Large and Massive Sized Full Thickness Rotator Cuff Tear and Clinical Results
Ko, Sang-Hun ; Cho, Sung-Do ; Choe, Seung-Wan ; Park, Mun-Soo ; Gwak, Chang-Youl ; Kim, Sang-Woo ; Jung, Kwang-Hwan ; Cha, Jae-Ryong ;
Clinics in Shoulder and Elbow, volume 9, issue 1, 2006, Pages 83~88
DOI : 10.5397/CiSE.2006.9.1.083
Purpose: To evaluate the usefulness of arthroscopic decompression and miniopen repair that was related with large and massive sized full thickness rotator cuff tear and assess clinical result. Materials and Methods: Twenthy-nine cases of miniopen repaired full thickness tear of rotator cuffs that arthroscopically decompressed were studied. From October 1998 to December 2004 we have analysed 29 repairs of large and massive sized FTRCT, the average age 44 (
) years old, mean follow-up was 34 (
) months. We analyzed the results statistically by paired t-test. Results: Postoperative VAS of pain improved average 7.0 to 1.7, UCLA score improved 13.7 to 31.9, ADL improved 11.3 to 25.3 respectively (all, P=0.000). Twenty five cases(82.8%) of the patients showed excellent & good results at the final follow-up. The satisfied rate was 26 cases(89.7%). Conclusions: Arthroscopic decompression and miniopen repair in large and massive sized full thickness rotator cuff tears are effective surgical methods.
Single and Double-row Repair in Rotator Cuff Tears
Park, Jin-Young ; Choi, Jin-Hyung ; Park, Hong-Keun ; Yu, Je-Wook ; Seo, Joong-Bae ;
Clinics in Shoulder and Elbow, volume 9, issue 1, 2006, Pages 89~95
DOI : 10.5397/CiSE.2006.9.1.089
Purpose: Arthroscopic repair of rotator cuff tears are many techniques that have been developed to improve the initial postoperative strength of the repair. There was a doubt that current arthroscopic cuff repairs using a single row of suture anchors reproduce insufficient area of the anatomic cuff insertion, and concerns about failure of fixation often lead surgeons to limit early motion. Newer technique of double-row repair in arthroscopic treatment may provide initial stronger fixation and more contact with bone at the repair site than single-row repair did. We studied the comparison between clinical outcomes of arthroscopic single- and double-row repair in cuff tears at 1year postoperatively. Materials and methods: We retrospectively analyzed 40 shoulders with single-row repair and 38 shoulders with double-row repair of full-thickness rotator cuff tears between May 2002 and October 2004. Out of total 78 shoulders, 42 (54%) were male patients and 36 (46%) were female patients and the mean age at surgery was 56 years. All patients were diagnosed by physical examination and MRI. At 1year' follow-up after operation, we evaluated with the ASES and the Constant scoring system, and measured muscle power of abduction, internal and external rotation of the affected shoulder then compared with each other. Results: Mean ASES scores and Constant scores in double-row repair group improved more than single-row repair group significantly at 1year postoperatively. Muscle power of abduction and internal rotation, especially abduction power, improved more significantly in double-row repair group than in single-row repair. Conclusion: Arthroscopic double-row repair for the full thickness rotator cuff tear may be a superior technique, which showed better clinical outcomes and restoration of muscle power compared with single-row repair at relatively short period of postoperative follow-up. Restoration of footprint close to normal anatomy by double-row repair seems to play an important role in the recovery of muscle strength.
Comparison of Treatment Methods in Completely Displaced Supracondylar Fractures of Humerus in Children - Open reduction and pinning versus Closed reduction and pinning-
Lee, Sang-Ho ; Choi, Joon-Cheol ; Na, Hwa-Yeop ; Lee, Young-Sang ; Choi, Jun-Won ; Lee, Sang-Yoon ; Won, Jong-Won ; Sin, Min-Ho ; Kim, Woo-Sung ;
Clinics in Shoulder and Elbow, volume 9, issue 1, 2006, Pages 96~104
DOI : 10.5397/CiSE.2006.9.1.096
Purpose: To evaluate and compare the results of children with displaced supracondylar fractures of humerus treated with open reduction and pinning with closed reduction and pinning. Materials and Methods: From March 2002, we treated 17 patients with completely displaced supracondylar fractures under the age of 7 with a minimal follow up period of 6 months. 9 patients were treated with closed reduction and pinning and 8 patients were treated with open reduction and pinning. The clinical results were evaluated with Flynn's criteria. Time to bone union was also analyzed for these two set of patients. Results: The group treated with open reduction had 6 excellent and 2 good results for change in carrying angles, 5 excellent, 2 good and 1 fair results for motion loss evaluated by Flynn's criteria. The average time to bony union for this group was 5.8 weeks. The group treated with closed reduction had 6 excellent, 2 good, and 1 fair results for change in carrying angles and 7 excellent, 1 good and 1 fair results for motion loss. The average time to bony uinon for this group was 3.7 weeks. Conclusion: In treating completely displaced supracondylar fractures of humerus in children, the closed reduction method and open reduction method all showed good results. But the operation time, duration of hospital stay and time to union was somewhat shorter for the patients treated with closed redution and pinning.
Arthroscopic Bankart Repair in Traumatic Anterior Shoulder Instability with Bio-knotless Anchor (Preliminary and Technical Report)
Yum, Jae-Kwang ; Sung, Ki-Hyuk ; Shin, Yong-Woon ;
Clinics in Shoulder and Elbow, volume 9, issue 1, 2006, Pages 105~110
DOI : 10.5397/CiSE.2006.9.1.105
Purpose: This study reports the clinical results of the arthroscopic Bankart repair in traumatic anterior instability of the shoulder with bio-knotless anchor. Materials and Methods: 21 cases of 21 patients (20 male and 1 female) were included in this study. The average age was 24.8 years old and the period from the first injury to operation was average 37.2 months. All cases had Bankart lesion and 12 cases had Hill-Sachs' lesion. The SLAP lesion was associated in 6 cases. Preoperative Rowe score was average 29.1. Arthroscopic Bankart repair with bio-knotless anchor were performed in all cases; 3 anchors at 3, 4, 5 O'clock position of the glenoid were used in 11 cases and 2 anchors at 4, 5 O'clock position were used in 10 cases. All the associated SLAP lesions were repaired arthroscopically with bio-knotless anchor. Thermal capsular shrinkage at the anterior and inferior shoulder capsule after the Bankart repair was performed in 3 cases. The average follow up period was 20.2 months. Results: The Rowe score improved to 92.8, excellent in 17 cases and good in 4 cases, at last follow up period and 20 cases had full range of motion of the shoulder. 1 case had mild limited range of motion of the shoulder (150 degrees in flexion, 60 degrees in external rotation and T12 level in internal rotation) without any problem in normal activity. The arthroscopic revision surgery of the shoulder was performed in 1 case because of multiple traumatic injuries of the shoulder with pain postoperatively. Conclusion: Arthroscopic Bankart repair with bio-knotless anchor in traumatic anterior shoulder instability is one of the good methods because of the good clinical results.
Arthroscopic treatment of Pigmented Villonodular Synovitis with combined Rotator Cuff Tear - 3 Case Reports -
Ji, Jong-Hun ; Kim, Weon-Yoo ; Han, Chang-Hwan ; Kim, Young-Yel ; Kim, Seung-Jun ; Kim, Ji-Chang ;
Clinics in Shoulder and Elbow, volume 9, issue 1, 2006, Pages 111~118
DOI : 10.5397/CiSE.2006.9.1.111
Most pigmented villonodular synovitis (PVNS) is occurred in knee joint and finger of hand. PVNS is rarely occurred in shoulder joint. In English and French literatures, less than 30 cases were reported. We report 3 PVNS cases with rotator cuff tears, which was treated by arthroscoic extensive synovectomy, debridement and rotator cuff repair. The PVNS with rotator cuff tear in shoulder joint was rarely reported in the Korean literature.
Isolated Avulsion of the Lesser Tuberosity of the Humerus in an Adolescent Judo Player - A Case Report -
Yum, Jae-Kwang ; Chung, Hyung-Jin ; Choi, Eul-O ; Lee, Sang-Lim ;
Clinics in Shoulder and Elbow, volume 9, issue 1, 2006, Pages 119~123
DOI : 10.5397/CiSE.2006.9.1.119
Isolated avulsion of the lesser tuberosity of the humerus in adolescent is rare injury. The mechanism of injury is acute forced external rotation and with the arm in abduction which has been reported in children participating in sports such as football, hockey, volleyball, wrestling and skateboarding. The diagnosis is often delayed despite chronic pain and disability. Authors report the unique case of a skeletally immature adolescent Judo player who had an isolated avulsion of the lesser tuberosity of the humerus with the references.
Percutaneus Cerclage Wiring in Distal Clavicle Fracture Type 2a - One Case Report -
Kim, Jae-Hwa ; Lee, Soon-Chul ; Cho, Duck-Yun ; Yoon, Hyung-Ku ; Lee, Yoon-Seok ;
Clinics in Shoulder and Elbow, volume 9, issue 1, 2006, Pages 124~129
DOI : 10.5397/CiSE.2006.9.1.124
Distal clavicular fracture frequently requires operative treatment due to high rate of non-union. The operative technique includes the tension band wiring, K- wire fixation, and cerclage wiring etc. Each method has disadvantages somewhat like pin migration or acromioclavicular joint injury and so on. For the distal clavicular fracture type 2a, because of its oblique fracture line, the cerclage wiring is suitable. We performed the cerclage wiring percutaneously under minimal incision without injury to periosteum for the patient who had the distal clavicular fracture type 2a, and the result was favorable.