• Clinics in Shoulder and Elbow
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• v.24 no.3
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• pp.125-134
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• 2021

Background: To evaluate clinical and radiological outcomes of bony increased offset-reverse total shoulder arthroplasty (BIO-RSA) in the Asian population at mid-term follow-up. Methods: From June 2012 to August 2017 at a single center, 43 patients underwent BIO-RSA, and 38 patients with minimum 2 years follow-up were enrolled. We evaluated the clinical and radiological outcomes, and complications at the last follow-up. In addition, we divided these patients into notching and no-notching groups and compared the demographics, preoperative, and postoperative characteristics of patients. Results: Visual analogue scale, American Shoulder and Elbow Surgeons, University of California-Los Angeles Shoulder Scale, and Simple Shoulder Test scores improved significantly from preoperative (5.00, 3.93, 1.72, 3.94) to postoperative (1.72, 78.91, 28.34, 7.66) (p<0.05) outcomes. All range of motion except internal rotation improved significantly at the final follow-up (p<0.05), and the bone graft was well-incorporated with the native glenoid in all patients (100%). However, scapular notching was observed in 20 of 38 patients (53%). In the comparison between notching and no-notching groups (18 vs. 20 patients), there were no significant differences in demographics, radiological parameters, and clinical outcomes except acromion-greater tuberosity (AT) distance (p=0.003). Intraoperative complications included three metaphyseal fractures and one inferior screw malposition. Postoperative complications included ectopic ossification, scapular neck stress fracture, humeral stem relaxation, and late infection in one case each. Conclusions: BIO-RSA showed improved clinical outcomes at mid-term follow-up in Asian population. However, we observed higher scapular notching compared to the previous studies. In addition, adequate glenoid lateralization with appropriate humeral lengthening (AT distance) might reduce scapular notching.

• Journal of Korean Neurosurgical Society
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• v.60 no.6
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• pp.676-683
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• 2017

Objective : The purpose of this study is to evaluate the efficacy and safety of 3-level hybrid surgery (HS), which combines fusion and cervical disc replacement (CDR), compared to 3-level fusionin patient with cervical spondylosis involving 3 levels. Methods : Patients in the anterior cervical discectomy and fusion (ACDF) group (n=30) underwent 3-level fusion and the HS group (n=19) underwent combined surgery with fusion and CDR. Clinical outcomes were evaluated using the visual analogue scale for the arm, the neck disability index (NDI), Odom criteria and postoperative complications. The cervical range of motion (ROM), fusion rate and adjacent segments degeneration were assessed with radiographs. Results : Significant improvements in arm pain relief and functional outcome were observed in ACDF and HS group. The NDI in the HS group showed better improvement 6 months after surgery than that of the ACDF group. The ACDF group had a lower fusion rate, higher incidence of device related complications and radiological changes in adjacent segments compared with the HS group. The better recovery of cervical ROM was observed in HS group. However, that of the ACDF group was significantly decreased and did not recover. Conclusion : The HS group was better than the ACDF group in terms of NDI, cervical ROM, fusion rate, incidence of postoperative complications and adjacent segment degeneration.

• The Korean Journal of Pain
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• v.20 no.1
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• pp.31-39
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• 2007

Background: Cervical radicular pain can arise fromvarious structures, including spinal nerves, discs, zygapophyseal joints, ligaments, and myofascial connective tissue. However, no adequate experiments have been found regarding methods for the microadhesiolysis of adhesional connective tissue around the zygapophyseal joints and nerves. The first objective of this study was to ascertain the effect of fluoroscopy guided interventional microadhesiolysis and nerve stimulation (FIMS) on chronic cervical radicular pain caused by zygapophyseal joint dysfunction. The second objective was to identify the duration of pain alleviation, as well as commonly occurring regions for zygapophyseal joint dysfunction. Methods: Twenty-eight patients were diagnosed with cervical radicular pain. The cervical zygapophyseal joints and adhesional structures around the cervical zygapophyseal joints were stimulated by adhesiolysis with a rounded needle; the procedure was performed once every second week. A visual analogue scale (VAS) for pain and neck range of motion (ROM) were used as indices for evaluating the degree of pain 1 and 3 months after completion of the procedures. A relief effect of FIMS was accepted when the VAS index decreased 50% compared with a previous VAS, and when there was absence of limitation of ROM. Results: Among the patients, 52% showed zygapophyseal joint dysfunction in C5-6, 38% in C4-5, 7% in C2-3, and 3% in C6-7. After performing FIMS, the VAS index decreased in most of the patients after 1 and 3 months (92.8% and 75%, respectively), and treatment frequency was $2.7{\pm}1.2$. There was no correlation between the number of FIMS procedures and the degree of VAS. Conclusions: FIMS is considered an effective modality in patients suffering from cervical radicular pain.

• Physical Therapy Korea
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• v.29 no.1
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• pp.54-63
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• 2022

Background: Low back and neck pain are two of the most common medical problems in the adult population. It is estimated that between 70% and 80% adults experience an episode of low back pain at least once during their lifetime. Objects: This study aimed to compare the effects of various stretching exercises and muscle energy techniques used for treatment of iliopsoas, quadratus lumborum, and hamstrings of patients with low back pain. Methods: A total of 52 subjects were randomly assigned to the control group (n = 17), the muscle energy technology group (METG, n = 19), and the stretching exercise group (SEG, n = 16). Interventions were performed twice a week for 4 weeks. Outcomes were measured before and after 4 weeks of treatment in the three groups, using the Korean version of the Oswestry Disability Index, the Visual Analogue Scale (VAS), the Fear Avoidance Belief Questionnaire (FABQ), the Finger to Floor test (FTF), the Modified-Modified Schober Test (MMS), and the Trunk Flexion Range of Motion test. Results: This study showed significant reduction in the pre-test and post-test KODI, VAS, and FABQ scores in all the three groups (p < 0.05). The KODI, VAS, FABQ and FTF assessed in this study showed interactions between the groups and the measurement time point (p < 0.01). After intervention, the KODI, VAS, FABQ and FTF in the SEG and METG were significantly higher (p < 0.05), and there was no difference between the METG and SEG. MMS and HFROM test showed no difference between the three groups (p > 0.05). Conclusion: KODI, VAS, FABQ and FTF showed significant improvement after basic physical therapy, muscle energy technique, and stretching exercise intervention. And there was no significant difference in the intervention effect between the muscle energy group and the stretching exercise group.

• Journal of Korean Medicine Rehabilitation
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• v.21 no.4
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• pp.241-256
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• 2011

Objectives: This study is to observe the effect of oriental medicine treatment combined with Soyeom pharmacopuncture therapy on traumatic rupture of intervertebral disc patients caused by traffic accidents. Methods: The patients who have traumatic rupture in lumbar(L)-spine(case 1) and cervical(C)-spine(case 2) were treated by oriental medicine treatment in combination with Soyeom pharmacopunture therapy. VAS(visual analog scale), ROM(range of motion), and physical exam were checked on a daily basis while NDI(neck disability index) and ODI(Oswestry disability index) were examined for 3 times at 7 day interval. Results: 1. Fer 8-9 days from the admission day, the sole use of oriental medicine treatment did not make many improvements in the case of two patients' symptoms. After combining with Soyeom pharmacopuncture therapy, chief complaints were improved significantly. 2. In case 1, lumbago decreased from VAS 10 to VAS 5 and lumbar ROM got better than before. ODl score cropped from 42 to 27. 3. In case 2, left shoulder pain and nuchal pain lowered from VAS 10 to VAS 4, left upper limb numbness and weakness were improved, The patient showed nearly fun ROM. NDI score decreased from 26 to 19. Conclusions: Oriental medicine treatment in combination with Soyeom pharmacopuncture therapy is proved to be helpful to improve the symptoms of the traumatic rupture of intervertebral else patients caused by traffic accident.

• Physical Therapy Rehabilitation Science
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• v.11 no.4
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• pp.454-463
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• 2022

Objective: The purpose of this study was to compare concurrent validity and test-retest reliability based on Craniovertebral angle of 'Angles video goniometer', a smart phone application for convenient range of motion measurement, and 'Image J', an analysis software with high reliability and validity. This was conducted to find out whether 'Angle video goniometer' can be used clinically. Design: Cross-sectional study Methods: Fifty subjects were imaged laterally, and the angle of the head and spine was measured using Image J and the Angles video goniometer, respectively, in a resting posture and a chin in posture. The level of concurrent validity between the two measurement methods and the level of inter-rater reliability and intra-rater reliability were analyzed. Results: For forty participants, the concurrent validity between Image J and Angles video goniometer showed very high validity with ICC of 0.997(0.995~0.999) and 0.994(0.994~0.998), CVME% 0.71~0.72%, SEM% 0.31~0.34, MDC% 0.86~0.94. The test-retest intra-rater reliability showed very high reliability ICC 0.994(0.991~0.996), CVME% 0.71%, SEM% 0.31~0.43, MDC% 0.86~1.19%. The test-retest inter-rater showed very high reliability ICC 0.995(0.992~0.997), CVME% 0.71%, SEM% 0.43~0.59%, MDC% 1.20~1.62% Conclusions: Angles video goniometer', a smartphone application, is a device with very high reliability and validity for craniovertebral angle measurement in healthy adults, and it is a device that can be easily used in clinical practice.

• Journal of The Korean Society of Integrative Medicine
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• v.9 no.2
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• pp.141-152
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• 2021

Purpose: This study aimed to compare the effects of ischemic compression (IC) therapy and extracorporeal shock wave therapy (ESWT) in patients with upper trapezius myofascial pain syndrome and to present an effective treatment method for these patients. Methods: A total of 42 patients with upper trapezius myofascial pain syndrome were randomly assigned to the IC group (n = 21) and ESWT group (n = 21). IC therapy and ESWT were performed in the IC and ESWT groups, respectively. Treatment was applied to the trigger point of the upper trapezius muscle. Visual analog scales (VAS), pain pressure threshold (PPT), range of motion, neck disability index (NDI), and fear-avoidance belief questionnaire (FABQ) were evaluated before and after the intervention to compare its effectiveness. Results: Both groups showed significant differences before and after the intervention in VAS, PPT, NDI, FABQ, flexion, extension, right side bending, and left side bending (p <.05). In addition, there were significant differences in the IC group compared to the ESWT group in VAS, PPT, and NDI (p <.05). Conclusion: IC therapy and ESWT applied to patients with upper trapezius myofascial pain syndrome are mediating methods of pain, function, and psychosocial effects. In addition, IC therapy may be a more effective mediating method for pain and dysfunction than ESWT.

• Clinics in Shoulder and Elbow
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• v.22 no.1
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• pp.29-36
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• 2019

Background: The execution of fibular allograft augmentation in unstable proximal humerus fractures (PHFs) was technically demanding. In this study, the authors evaluated the clinical and radiographic outcomes after tricortical iliac allograft (TIA) augmentation in PHFs. Methods: We retrospectively assessed 38 PHF patients treated with locking-plate fixation and TIA augmentation. Insertion of a TIA was indicated when an unstable PHF showed a large cavitary defect and poor medial column support after open reduction, regardless of the presence of medial cortical comminution in preoperative images. Radiographic imaging parameters (humeral head height, HHH; humeral neck-shaft angle, HNSA; head mediolateral offset, HMLO; and status of the union), Constant score, and range of motion were evaluated. Patients were grouped according to whether the medial column support after open reduction was poor or not (groups A and B, respectively); clinical outcomes were compared for all parameters. Results: All fractures healed radiologically (average duration to complete union, 5.8 months). At final evaluation, the average Constant score was 73 points and the mean active forward flexion was $148^{\circ}$. Based on the Paavolainen assessment method, 33 patients had good results and 5 patients showed fair results. The mean loss of reduction was 1.32 mm in HHH and 5.02% in HMLO. None of the parameters evaluated showed a statistically significant difference between the two groups (poor and not poor medial column support). Conclusions: In unstable PHFs, TIA augmentation can provide good clinical and radiological results when there are poor medial column support and a large cavitary defect after open reduction.

• Journal of Korean Neurosurgical Society
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• v.46 no.6
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• pp.532-537
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• 2009

Objective : Recently, motion preservation has come to the forefront of emerging technologies in spine surgery. This is the important background information of the emergence of cervical arthroplasty as an alternative to arthrodesis that offers the promise of restoring normal spinal movement and reduces a kinematic strain on adjacent segments. The study was designed to evaluate early surgical outcome and radiological effects of $Bryan^{(R)}$ cervical disc prosthesis. Methods : The authors retrospectively reviewed radiographic and clinical outcomes in 52 patients who received the $Bryan^{(R)}$ Cervical Disc prosthesis, for whom follow-up data were available. Static and dynamic radiographs were measured by computer to determine the angles formed by the endplates of the natural disc preoperatively, those formed by the shells of the implanted prosthesis, the angle of functional spine unit (FSU), and the C2-7 Cobb angle. The range of motion (ROM) was also determined radiographically, whereas clinical outcomes were assessed using Odom's criteria, visual analogue pain scale (VAS) and neck disability index (NDI). Results : A total of 71 $Bryan^{(R)}$ disc were placed in 52 patients. A single-level procedure was performed in 36 patients, a two-level procedure in 13 patients, and a three-level procedure in 3. Radiographic and clinical assessments were made preoperatively. Mean follow-up duration was 29.2 months, ranging from 6 to 36 months. All of the patients were satisfied with the surgical results by Odom's criteria, and showed significant improvement by VAS and NDI score (p < 0.05). The postoperative ROM of the implanted level was preserved without significant difference from preoperative ROM of the operated level (p < 0.05). 97% of patients with a preoperative lordotic sagittal orientation of the FSU were able to maintain lordosis. The overall sagittal alignment of the cervical spine was preserved in 88.5% of cases at the final follow up. Interestingly, preoperatively kyphotic FSU resulted in lordotic FSU in 70% of patients during the late follow up, and preoperatively kyphotic overall cervical alignment resulted in lordosis in 66.6% of the patients postoperatively. Conclusion : Arthroplasty using the $Bryan^{(R)}$ disc seemed to be safe and provided encouraging clinical and radiologic outcome in our study. Although the early results are promising, this is a relatively new approach, therefore long-term follow up studies are required to prove its efficacy and its ability to prevent adjacent segment disease.

• Clinics in Shoulder and Elbow
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• v.9 no.1
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• pp.50-59
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• 2006

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, $6^{\circ}(0{\sim}20^{\circ})$ and further flection, $129^{\circ}(115{\sim}140^{\circ})$. 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.