• Journal of Korean Medicine Rehabilitation
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• v.28 no.1
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• pp.97-107
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• 2018

Objectives This is one of the manuals of East-West integrative medicine which was created by the committee on integrative medicine of Chung-Yeon Korean Medicine Hospital. The purpose of this manual is to support clinical decision-making and communication between Korean and western medical staff in a Korean medicine hospital during the rehabilitation of patients after knee surgery. Methods The draft was made by two rehabilitation specialists in Korean medicine. After a rehabilitation specialist in western medicine reviewed the draft and exchanged their ideas, a revised version that reflects the goal of consultation was made. Then the committee agreed to adopt the manuals through the process of review and feedback in addition to face-to-face discussions. Results This manual describes clinical decision-making for rehabilitation after arthroscopic partial meniscus resection, meniscus refixation, reconstruction of anterior and posterior cruciate ligaments. Therefore, it contains the schedule of rehabilitation treatment by the surgical technique, general goal of the rehabilitation by phase, guide for patients and postoperative infection management. Conclusions Despite some limitations, this manual has significance as the first example of a decision-making protocol suggestion for East-West integrative rehabilitation treatment after a knee surgery in one medical institution.

• Journal of Korean Medicine Rehabilitation
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• v.28 no.1
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• pp.109-120
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• 2018

Objectives This is one of the manuals of East-west integrative medicine which was created by the Committee on integrative medicine of Chung-Yeon Korean Medicine Hospital. The purpose of this manual is to support clinical decision making and communication during the rehabilitation of patients after shoulder surgery. Methods The drafting was done by two rehabilitation specialists in Korean medicine. After a rehabilitation specialist in western medicine reviewed the draft and exchanged their ideas, a revised version that reflects the goal of consultation was made. Then the Committee agreed to adopt the manuals through the process of review and feedback in addition to face-to-face discussions. Results This manual describes clinical decision making for rehabilitation after arthroscopic rotator cuff repair, SLAP repair, and arthrolysis. Therefore it contains the schedule of rehabilitation treatment through the surgical technique, general goal of the rehabilitation by phase, guide for patients and postoperative infection management. Conclusions The proposal of this manual has a significance for it provides information about decision making process and contents of treatment in one medical institution for East-west integrative rehabilitation treatment after shoulder surgery.

• Clinics in Shoulder and Elbow
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• v.21 no.1
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• pp.48-55
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• 2018

While non-operative treatment with structured rehabilitation tends to be the strategy of choice in the management of Rockwood type III acromioclavicular joint injury, some advocate surgical treatment to prevent persistent pain, disability, and prominence of the distal clavicle. There is no clear consensus regarding when the surgical treatment should be indicated, and successful clinical outcomes have been reported for non-operative treatment in more than 80% of type III acromioclavicular joint injuries. Furthermore, there is no gold standard procedure for operative treatment of type III acromioclavicular joint injury, and more than 60 different procedures have been used for this purpose in clinical practice. Among these surgical techniques, recently introduced arthroscopic-assisted procedures involving a coracoclavicular suspension device are minimally invasive and have been shown to achieve successful coracoclavicular reconstruction in 80% of patients with failed conservative treatment. Taken together, currently available data indicate that successful treatment can be expected with initial conservative treatment in more than 96% of type III acromioclavicular injuries, whereas minimally invasive surgical treatments can be considered for unstable type IIIB injuries, especially in young and active patients. Further studies are needed to clarify the optimal treatment approach in patients with higher functional needs, especially in high-level athletes.

• Anatomy and Cell Biology
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• v.56 no.4
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• pp.482-493
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• 2023

Understanding the anatomy of suprascapular area helps the clinicians and surgeons in management of any disability at the shoulder region. This work aimed to clear the different morphological and morphometrical types of suprascapular notch (SSN). Unknown 120 dry human scapulae of both sides and 60 formalin-embalmed cadaveric upper limbs (40 males and 20 females) were used in the present study. Three main morphological forms of SSN were reported: J, U, and V-shaped. J-shaped notch showed the highest incidence followed by U-shaped then V-shaped one. Morphometrically, type (III) notch was the most prevalent in both dry bones and cadavers, while the incidence of type (II) was the lowest form. Also, the measurements of superior transverse diameter, middle transverse diameter and vertical dimension of the different types of the notch showed no side or sex significant difference. The suprascapular foramen with ossified superior transverse scapular ligament (STSL) was seen in 5.8% of dry bones and 10% of cadaveric specimens. Fan and band-shaped ossified transverse scapular ligaments were reported. Absence of SSN was seen in 10.8% of dry bones, 7.5% of male and 10% of female specimens with left side predominance. V-shaped, absence, and ossified STSL were considered as predisposing factors of suprascapular nerve entrapment syndrome. Knowledge of the morphology and morphometric parameters of SSN is of great clinical significance for anatomists, radiologists, physiotherapists, orthopedics and neurosurgeons to perform good diagnosis and best planning for surgical or arthroscopic interventions within the shoulder region.

• Journal of the Korean Arthroscopy Society
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• v.1 no.1
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• pp.112-115
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• 1997

While the cruciate ligament has a profuse vascular response following injury, spontaneous repair does not occur. This may result from the fact that synovial fluid dilution of the hematoma following injury prevents the formation of a fibrin clot and thus the initiation of the healing mechanism. Another theory suggests that the dynamic nature of the fascicles of the anterior cruciate ligament(ACL) through even small ranges of motion prohibits spontaneous union to these fibers. But we experienced two cases of spontaneous healing of partially injured ACL. Initially they showed more than grade II anterior instability. 6 mm difference by stress roentgenographs(pull view) and difference of 8 mm by KT 1000TM arthrometer between the ACL injured knee and normal side knee. Lax, nearly complete tear of ACL and synovial bleeding were noted during arthroscopic examination but the continuity of synovial membrane was seemed to be intact. These cases were treated by conservative management rather than reconstructive procedure. Postoperatively they showed excellent clinical results, no anterior instability and unlimited athletic activity. Based on our clinical experience. we think that cruciate ligament has the spontaneous healing potential in acute stage and middle aged patient. We consider the microfracture technique and initial immobilization for accelleration of healing response of the ACL.

• Journal of Korean Foot and Ankle Society
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• v.15 no.4
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• pp.212-216
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• 2011

Purpose: This study was designed to analyze the usefulness of Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) in diagnosing symptomatic accessory tarsal bones. Materials and Methods: Twenty four feet (16 patients) with symptomatic accessory navicular and/or os trigonum, who agreed to take SPECT/CT, were included in this study. Fifteen feet had accessory navicular, five had os trigonum, and four had both. According to the uptake in the SPECT/CT, 11 feet were classified into high and 13 into low uptake groups. The low uptake group was treated non-operatively, while the high uptake group received operations when initial conservative management failed. A modified Kidner procedure was performed for accessory navicular and arthroscopic excision was done for os trigonum. After a mean follow-up of 6.8 (range, 3~13) months, the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Visual Analogue Scale (VAS) for pain were compared. Results: Patients in the high uptake group had a higher initial mean VAS score ($7.0{\pm}0.8$ vs $2.2{\pm}0.9$, p<0.05) and a lower initial mean AOFAS score ($45.9{\pm}9.2$ vs $83.9{\pm}4.2$, p<0.05) compared to the low uptake group. All patients in the low uptake group improved after non-operative treatment. Seven patients underwent operations and had a decreased VAS ($1.6{\pm}0.5$) and an increased AOFAS score ($88.3{\pm}1.8$) at the last follow-up. Four patients in the high uptake group demonstrated erratic symptoms. Conclusion: SPECT/CT can be a useful diagnostic tool and helpful in designing treatment plans for symptomatic accessory navicular and os trigonum.

• Clinics in Shoulder and Elbow
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• v.19 no.3
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• pp.155-162
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• 2016

Background: The study aimed to determine the type of capsular insertion and the extent of capsular elongation in anterior shoulder instability by quantitatively evaluating their computed tomography arthrographic (CTA) findings, and to investigate the correlation of these parameters with surgical outcomes. Methods: We retrospectively reviewed 71 patients who underwent CTA and arthroscopic capsulolabral reconstruction for anterior shoulder instability between April 2004 and August 2008. The control group comprised 72 patients diagnosed as isolated type II superior labrum anterior to posterior (SLAP) lesion during the period. Among the 143 patients, 71 were examined with follow-up CTA at an average 13.8 months after surgery. It was measured the capsular length and cross-sectional area at two distinct capsular regions: the 4 and 5 o'clock position of the capsule. Results: With regards to the incidence of the type of anterior capsular insertion, type I was more common in the control group, whereas type III more common than in the instability group. Anterior capsular length and cross-sectional area were significantly greater in the instability group than in the control group. Among patients of the instability group, the number of dislocations and the presence of anterior labroligamentous periosteal sleeve avulsion lesion were significantly associated with anterior capsular redundancy. Postoperatively, recurrence was found in 3 patients (4.2%) and their postoperative capsular length and cross-sectional area were greater than those of patients without recurrence. Conclusions: Capsular insertion type and capsular redundancy derived through CTA may serve as important parameters for the management of anterior shoulder instability.

• Journal of Oral Medicine and Pain
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• v.38 no.1
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• pp.87-95
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• 2013

Osteoarthritis (OA) of the temporomandibular joint (TMJ) is a severe form of temporomandibular disorders (TMDs), presenting gradual breakdown of articular cartilage and subchondral bone by the functional load sustained to exceed the physiologic tolerance of the joint. In such a joint loaded, offensive bioactive materials such as matrix degrading proteins, cytokines, and free radicals increase in concentration to shift the tissue response in the joint to degeneration from regeneration or remodeling. Recently, it has been issued that obesity can play an offensive role in pathogenesis of OA in a metabolic way. Adipokines released by adipose cells are present at higher concentration in the arthritic joint and joints of obese individuals. However, because of conflicting data reported, further scientific study should be performed to elucidate the practical role of adipokines in pathogenesis of TMJ OA. As far as the clinical signs and symptoms of TMJ OA are not much different from those of other forms of TMD and any definitive treatment modality to control directly the bone resorptive activity is not available yet, the treatment of TMJ OA should be directed to reduce the physical load and enhance the physiologic tolerance of the joint by means of conservative treatment such as physical therapy, medication, and occlusal splint therapy for sufficient period and, if needed after that, supplementary surgical procedure such as intra-articular injection, arthrocenthesis, and arthroscopic surgery that have turned out to be effective to control OA signs and symtpoms. Enthusiastic reassurance and motivation for patients to control behaviors for themselves to reduce unnecessary functional load in daily life is very important for the joint to reach to more favorable orthopedic stability of the TMJ more quickly, guaranteeing more successful management TMJ OA.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.10
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• pp.303-308
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• 2019

Non-traumatic acute myelopathy caused by cervical disc herniation is rare. To date, no case has been reported to be caused by extrusion cervical disc herniation, unrelated to patient posture during surgery. Here, we report the case of a 65-year-old male patient with cervical myelopathy who underwent subsequent arthroscopic rotator cuff surgery under general anesthesia; non-cervical spine surgery. Ed. Notes: I am unable to understand the insertion of the highlighted phrase. Please delete if not required, or revise the sentence appropriately. Patient showed acute postoperative tetraplegia in spite of optimal anesthetic management. He showed no limitation of neck movement at pre-operative airway evaluation, and had no history of trauma to the cervical spine. During surgery, there had been no overextension or twisting of the neck, including at the time of anesthetic induction by tracheal intubation. However, cervical disc herniation causing spinal canal cord compression was detected in the postoperative magnetic resonance imaging, which probably resulted in tetraplegia of the patient. Motor and sensory functions were recovered after 21 days of conservative treatment, including steroid pulse intravenous therapy without any surgical intervention. In this report, the disease is described after reviewing other reported cases; furthermore, we also discuss the pathophysiology of the disease. Based on our report, we propose that under general anesthesia, clinicians should pay attention to the possibility of pre-existing cervical disease, even in non-cervical spine surgeries of geriatric patients.