• Clinics in Shoulder and Elbow
• /
• v.17 no.3
• /
• pp.134-137
• /
• 2014

To report the fracture of proximal humerus in the lateral anchor site after suture bridge repair. A 57-year-old female patient with shoulder pain on the right-side was admitted through the emergency room following a car accident. Seven weeks before the accident, the patient had undergone surgery at a different hospital for the repair of supraspinatus tendon rupture on the right-side via suture bridge technique. Humerus surgical neck fracture was confirmed by X-ray, and proximal humerus fracture at the anchor site was confirmed by magnetic resonance imaging. Following 7 months of conservative treatment resulted in satisfactory bone union and motion of the shoulder joint. We report the need of close observation during and after the arthroscopic repair of the rotator cuff in patients with osteoporosis.

• Journal of Korean Orthopaedic Sports Medicine
• /
• v.12 no.1
• /
• pp.29-36
• /
• 2013

Purpose: Proprioceptive function has been known to be important to shoulder stability. However, the function in rotator cuff tear patients is rarely investigated. The purpose of current study is to report the proprioceptive function in rotator cuff tear patients and to analyze the proprioceptive function regarding the tear size and the presence of subscapularis tear. Materials and Methods: Between 2011 and 2012, total 76 patients (male 28 and female 48) were recruited and average age was 61.7 years old (range, 38~76). Preoperatively, joint position senses in internal and external rotation were measured for proprioceptive function testing by method of active re-positioning technique. The absolute difference from set point was measured. Proprioceptive function was further analyzed according to tear size of rotator cuff, the presence of subscapularis tear, visual analogue scale of pain, shoulder functional score (American society of elbow and shoulder score), and ranges of motion in shoulder. Results: The absolute difference for external rotation was $4.9^{\circ}{\pm}2.9^{\circ}$, in normal joint and $4.9^{\circ}{\pm}3.0^{\circ}$for involved joint in rotator cuff tear patients. This difference was not significant statistically (p=0.87). The absolute difference for internal rotation was $4.0^{\circ}{\pm}2.7^{\circ}$in normal joint whereas $4.8^{\circ}{\pm}3.7^{\circ}$ for involved joint showing statistically significant difference (p=0.043). There was some trend that the proprioceptive function of internal rotation was more impaired in the bigger tear size group (more than medium tear) compared to the smaller tear size group (partial thickness and small tear, 5.0 vs. 4.0, p=0.061). The impairment of internal rotation proprioception was also accentuated in patients with subscapularis tear (4.8 vs. 4.0, p=0.065). The proprioceptive function of internal rotation was decreased when the pain visual analogue scale was increased (5.2 vs. 4.0 p=0.04), shoulder functional score was decreased (6.1 vs. 4.2, p=0.005), or range of motion in shoulder joint was restricted (5.3 vs. 3.7, p=0.041). Conclusion: The deficit of proprioceptive function was observed in rotator cuff tear patients. Proprioception for internal rotation was impaired in patients with the bigger tear size and subscapularis tear. Pain, shoulder function score, and range of motion were also shown to be related with the deficit in proprioceptive function.

• Archives of Reconstructive Microsurgery
• /
• v.8 no.1
• /
• pp.92-96
• /
• 1999

Neuroma is formed by abnormal, incomplete nerve regeneration after nerve injury. A painful neuroma in the hand can be psychologically and physically disabling. The goal of treating painful neuroma is to relieve pain and to restore nerve function. A numerous treatment modality was reported for alleviating the problem. These treatments include crushing the neuroma, ligating it, burying in soft tissue, bone, and muscle, injecting it with alcohol, phenol, and steroid, capping it with silicone cuff. But, none of these methods has been uniformly successful, although each has its advocates. No one technique reliably prevents formation of a painful neuroma. However, the principles of treatment is resection of neuroma and proximal stump of the nerve is transposed to appropriate adjacent tissue. Our current technique was resection of neuroma with partial normal neural tissue, and then the nerve ending was transposed and sutured to the side of the proximal stump with 10-0 nylon, so end-to-side neurorrhaphy was made. The nerve ending had to be placed and fixed into the proximal nerve epineurium like as a figure of a loop. We believe this technique is another useful method for the treatment of painful neuroma.

• Clinics in Shoulder and Elbow
• /
• v.18 no.4
• /
• pp.248-253
• /
• 2015

Background: Scapular notching can happen at diverse location depending on implant design or operative technique, therefore, it is easily misdiagnosed. Thus, this study purposed to suggest a method helpful to assess scapular notching. Methods: The subjects were 73 cases of reverse shoulder arthroplasty (RSA) for cuff tear arthropathy during the period from May 2009 to April 2014 and followed-up for over a year. There was medialized RSA in 22 cases, bone increased offset RSA (BIO-RSA) in 36 cases, and metal increased offset RSA (metal-RSA) in 15 cases. Scapular notching was not determined by bone defect at the inferior of glenosphere as Sirveaux's classification, but scapular notching at the site where the rotational route of the polyethylene of humeral implant met the scapular neck were examined. The results were compared with conventional method. Results: By conventional method, scapular notching was observed in 10 cases (45.5%) in medialized RSA, 12 cases (33.3%) in BIO-RSA, and none in metal-RSA. By new method, it was observed in 9 cases (40.9%) in medialized RSA, 10 cases (27.8%) in BIO-RSA, and none of metal-RSA. The site of scapular notching was apart from glenoshpere in 18 cases, and at inferior of glenosphere in 1 case. Absorption of bone graft was observed in 4 (11.1%) out of 36 cases of BIO-RSA. Conclusions: It is hard to distinguish scapular notching from absorption of bone graft in BIO-RSA, and bone absorption at the lateral lower end of glenoid in medialized RSA. Thus, it is considered useful to assess scapular notching at the site where the rotational route of the polyethylene insert meets scapular neck.

• The Journal of the Korea institute of electronic communication sciences
• /
• v.14 no.6
• /
• pp.1257-1264
• /
• 2019

The traditional cuff-based method for BP(Blood Pressure) measurement is not suitable for continuous real-time BP measurement techniques. For this reason, the previous studies estimated various blood pressures by fusion with the electrocardiography (ECG) and photoplethysmogram (PPG) sensor signals. However, conventional techniques based on PPG bio-sensing measurement face many challenging issues such as noisy supply fluctuation, small pulsation, and drifting non-pulsatile. This paper proposed a novel BP estimation methods using PPG and ECG sensors, which can be derived from the relationship between PPG and ECG using PTT(Pulse Transit Time) and PWV(Pulse Wave Velocity). Unlike conventional height ratio features, which are extracted on the basis of the peaks in the PPG and ECG waveform. The proposed method can be reliably obtained even if there are missing peaks among the sensed PPG signal. The increased reliability comes from periodical estimation of the peak-to-peak interval time using ECG and PPG. After 250,000 times trials of the blood pressure measurement, the proposed estimation technique was verified with the accuracy of ±28.5% error, compared to a commercialized BP device.

• Clinics in Shoulder and Elbow
• /
• v.10 no.1
• /
• pp.136-139
• /
• 2007

Shoulder arthroscopic surgeries are an accepted technique for many shoulder disease and have many advantages over open surgeries. To date, shoulder arthroscopic surgery have been rare complications that compromise patient airway, caused by the leakage of irrigation fluid out of the shoulder joint space into the surrounding soft tissues and then the neck and the pharynx. This report presents a case of life-threatening airway obstruction due to extra-articular saline collection during arthroscopic rotator cuff repair. In concluding we should hourly check the patient's neck swelling undergoing shoulder arthroscopic surgery, because anesthetized patients cannot complain of the airway problem may progress until it becomes life-threatening.

• Clinics in Shoulder and Elbow
• /
• v.1 no.2
• /
• pp.160-166
• /
• 1998

The purpose of this study was to assess the results of arthroscopic subacromial decompression in patients with chronic impingement and to evaluate the results according to the rotator cuff pathology. We evaluated the clinical results of treatment for chronic impingement syndrome in 28 patients from Feb 1996 to Feb 1997. There were twenty men and eight women in age from 24 to 72 years (mean age 51) with dominant arm involvement in sixteen patients. Follow up evaluations averaged 15(range 12-24)months. The average duration of symptoms were 15(range 6­60)months. The final diagnoses which were based on the physical examination, plain radiographs and arthroscopic findings, were stage II impingement in 16 patients and stage ill impingement in 12 patients. We excluded the patients with acromioclavicular arthritis or glenohumeral instability in this study. All patients were managed non-operatively a minimum of six months. During the operation we performed contouring and smoothing the acromial undersurface and only resecting of the anterolateral band of the coracoacromial ligament. The clinical results were quantitated using UCLA shoulder rating score. Satisfactory results were obtained in 23(80%) patients. Unsatisfactory results were obtained in 5(18%) patients with posterior cuff tear. The average UCLA pain score showed significant improvement from 2.8(constant pain) to 7.2(present during heavy activities) at final follow up. The function and active forward flexion scores also increased from their preoperative value. There was no significant differences according to the surface and severity of tear and NeeI' stage (P>0.05). These results compared favorably with those reported following open acromioplasty. While arthroscopic subacromial decompression is a demanding technique with a learning curve, it is a reliable treatment for chronic impingement syndrome. A less aggressive approach to subacromial decompression and preserving the posteromedial band of the coracoacromialligament does not appear to compromise results.

• Quality Improvement in Health Care
• /
• v.3 no.1
• /
• pp.94-103
• /
• 1996

Background : Blood pressure is an important indicator in diagnosis and assessing treatment of a patient. Clinical staffs use blood pressure on the assumption that measured value is accurate and reliable. However, whether measured blood pressure is accurate has been rarely investigated in Korea. Objectives : The aims of this study are to evaluate clinical staffs' knowledge and technique as well as accuracy of sphygmomanometer. Also the program to improve the measurement is developed. Methods : Seventy-three registered nurses were asked nine multiple choice questions including Korotkoff sound, cuff size, and deflation rate. Simultaneously characteristics of nurses were examined, age, working place, duration of employment and academic degree. A testing videotape(Standardizing Measurement Video-Tutored Course) was used for evaluating the accuracy of measurement. Testees were to read and record the 12 cases of blood pressure measurement, watching a falling mercury column and hearing Korotkoff sounds. After 10 minutes' education, they were again tested with the same cases. Additionally, 83 mercury sphygmomanometers were checked to find defects such as inaccurate calibration and zero setting, leaky bladder, etc. Results: For the knowledge testing correct response rate was 41.1%. They were the lowest in selecting the proper cuff size and Korotkoff sound. In examining accuracy of blood pressure with videotape, nurses had 67.7% correct response rate. The correct response rate was significantly improved by a session of education. About 23% of sphygmomanometers was without discernable defects. Conclusion : The knowledge and skill of clinical staffs along with the accuracy of equipment have to be improved. A properly designed education program would contribute to the accuracy improvement of blood pressure measurement. Also, more concerns should be given to the precision and maintenance of equipment.

• Clinics in Shoulder and Elbow
• /
• v.13 no.1
• /
• pp.7-13
• /
• 2010

Purpose: Our purpose was to retrospectively analyze clinical results of subpectoral tenodesis of the proximal biceps tendon using an interference screw. Materials and Methods: We reviewed 23 cases of patients receiving tenodesis of the proximal biceps tendon between January 2008 and January 2009 for whom we had follow-up data for at least 1 year. Twenty-three cases were operated on using subpectoral tenodesis; 16 of these cases had a rotator cuff tear. The results were judged using a visual analog scale (VAS), ASES, tenderness on the biceps groove, fixation failure and the degree of deformity (BAD). Results: VAS and ASES scores were significantly improved in all patients by the time of the final observation. There were no significant complications or fixation failures. The patients without a tear of the rotator cuff had a better result than patients with a tear of the rotator cuff, but the difference between the two groups was not significant (p>0.05). Conclusion: In patients with pathology of the long head of the biceps brachii, benefits of subpectoral interference screw tenodesis include pain relief, maintenance of functional biceps, muscle strength, and cosmesis. Subpectoral biceps tenodesis using interference screw fixation appears to be a promising, reproducible, reliable technique for addressing anterior shoulder pain related to pathology of the long head of the biceps brachii.

• Journal of Korean Academy of Fundamentals of Nursing
• /
• v.7 no.1
• /
• pp.7-15
• /
• 2000

To assess the accuracy of blood pressure measurement in general hospital nurses, 276 nurses at four hospital in Kyungju city and Pohang city were observed during the study period 20 December 1998 to 29 December 1998. The nurses measuring the blood pressure of simulated patient's were checked by the researcher or 20 items, that are recommended for consideration when doing a blood pressure measurement. Of the six items in the preparation step for measuring blood pressure, the accuracy of 'patients shouldn't talk during the procedure' had the lowest frequency(27.1%) and the other five items were above 80%. Of the ten items on blood pressure measuring technique, the accuracy of the frequency for 'inflating the cuff until the radial or brachial artery pulse is no longer palpable and then adding 30mmHg' was 0%, 'waiting $30{\sim}60$ seconds before reinflating the cuff' was alse 0%, 'rapidly deflating the cuff', 0.3%, 'rapidly and steadily inflating the cuff to the maximal level as per above-mentioned initial systolic pressure assessment step', 0.7%, 'reading the pressure to the nearest 2mmHg mark on the manometer', 10.8%, the remaining items were above 70%. Of the four items on blood pressure recording, the accuracy of 'recording the cuff size' had a frequency of 0.3%, 'recording the patient's position such as sitting, standing or lying position', 10.8%, 'recording the arm or leg which was used for measuring the blood pressure', 53.6%, and 'recording systolic/diastolic pressure', 100%. The variables significantly related to the accuracy of the blood pressure measurement were age, career position at hospital, and qualification education for blood pressure measurement(p<0.01). In the multiple regression analysis, position and qualification education were significant variables(p<0.01). In conclusion, the accuracy of blood pressure measurement was very low, thus, qualification education for blood pressure measurement should be done immediately to improve the accuracy of measurement by nurses in general hospitals.