• Clinics in Shoulder and Elbow
• /
• v.25 no.3
• /
• pp.202-209
• /
• 2022

Background: The purpose of our study was to investigate short-term outcomes of two-stage reverse total shoulder arthroplasty (RTSA) with an antibiotic-loaded cement spacer for shoulder infection. Methods: Eleven patients with shoulder infection were treated by two-stage RTSA following temporary antibiotic-loaded cement spacer. Of the 11 shoulders, nine had pyogenic arthritis combined with complex conditions such as recurrent infection, extensive osteomyelitis, osteoarthritis, or massive rotator cuff tear and two had periprosthetic joint infection (PJI). The mean follow-up period was 29.9 months (range, 12-48 months) after RTSA. Clinical and radiographic outcomes were evaluated using the visual analog scale (VAS) score for pain, American Shoulder and Elbow Surgeons (ASES) score, subjective shoulder value (SSV), and serial plain radiographs. Results: The mean time from antibiotic-loaded cement spacer to RTSA was 9.2 months (range, 1-35 months). All patients had no clinical and radiographic signs of recurrent infection at final follow-up. The mean final VAS score, ASES score, and SSV were significantly improved from 4.5, 38.6, and 29.1% before RTSA to 1.7, 75.1, and 75.9% at final follow-up, respectively. The mean forward flexion, abduction, external rotation, and internal rotation were improved from 50.0°, 50.9°, 17.7°, and sacrum level before RTSA to 127.3°, 110.0°, 51.8°, and L2 level at final follow-up, respectively. Conclusions: Two-stage RTSA with antibiotic-loaded cement spacer yields satisfactory short-term clinical and radiographic outcomes. In patients with pyogenic arthritis combined with complex conditions or PJI, two-stage RTSA with an antibiotic-loaded cement spacer would be a successful approach to eradicate infection and to improve function with pain relief.

• Clinics in Shoulder and Elbow
• /
• v.25 no.1
• /
• pp.49-56
• /
• 2022

Background: The treatment approach for proximal humeral fractures is determined by various factors, including patient age, sex, dominant arm, fracture pattern, presence of osteoporosis, preexisting arthritis, rotator cuff status, and medical comorbidities. However, there is a lack of consensus in the literature regarding the optimal treatment for displaced proximal humeral fractures. This study aimed to assess and quantify the decision-making process for either conservative or surgical treatment and the choice of surgical method among shoulder surgeons when treating proximal humeral fractures. Methods: Forty sets of true anteroposterior view, scapular Y projection view, and three-dimensional computed tomography of proximal humeral fractures were provided to 12 shoulder surgeons along with clinical information. Surveys regarding Neer classification, decisions between conservative and surgical treatments, and chosen methods were conducted twice with an interval of 2 months. The factors affecting the treatment plans were also assessed. Results: The inter-rater agreement was fair for Neer classification (kappa=0.395), moderate for the decision between conservative and surgical treatments (kappa=0.528), and substantial for the chosen method of surgical treatment (kappa=0.740). The percentage of agreement was 71.1% for Neer classification, 84.6% for the decision between conservative and surgical treatment, and 96.4% for the chosen method of surgical treatment. The fracture pattern was the most crucial factor in deciding between conservative and surgical treatments, followed by age and physical activity. Conclusions: The decision between conservative and surgical treatment for proximal humeral fractures showed good agreement, while the chosen method between osteosynthesis and arthroplasty showed substantial agreement among shoulder surgeons.

• Clinical Pain
• /
• v.20 no.2
• /
• pp.99-104
• /
• 2021

Objective: To confirm the safety of Intra-articular (IA) injection on the ipsilateral adhesive capsulitis (AC) after breast cancer surgery. Methods: Between January 2017 and May 2020, we retrospectively studied 29 patients after breast cancer surgery who underwent IA injection in the glenohumeral joint for AC in aseptic procedure. Results: There were no side effects or complications such as lymphedema or cellulitis in the patients. There was a significant improvement in pain score and range of motion (ROM) at the 1st, 3rd, and 6th months visits compared to the baseline (p<0.05). The presence or absence of axillary lymph node dissection and radiation therapy had no significant difference in improvement of ROM. But, in rotator cuff syndrome (RCS) group, there was a significant difference in improvement of shoulder IR in patients without RCS. Conclusion: IA Injection on the ipsilateral AC after breast cancer surgery was safe and even effective to improve pain and shoulder ROM. Ipsilateral IA injection can be a good treatment for breast cancer surgery patients suffering from AC.

• Journal of the Korean Orthopaedic Association
• /
• v.54 no.6
• /
• pp.475-477
• /
• 2019

Stem cell research arose from the need to explore new therapeutic possibilities for intractable and lethal diseases. Although musculoskeletal disorders are basically nonlethal, their high prevalence and the relative ease of performing clinical trials have facilitated the clinical application of stem cells in this field. On the other hand, despite the plethora of in vitro and preclinical studies in stem cell research for regenerative medicine in the musculoskeletal system, few reliable clinical studies have been published. Stem cell therapy can be applied locally for bone, cartilage, and tendon regeneration. The candidate disease modalities in bone regeneration include large bone defects, nonunion of fractures, and osteonecrosis. Focal osteochondral defect and osteoarthritis are the current targets for cartilage regeneration. For tendon regeneration, bone-tendon junction problems, such as rotator cuff tears are hot topics in clinical research. To date, the literature supporting stem cell-based therapies comprises mostly case reports or case series.

• Journal of the Society of Naval Architects of Korea
• /
• v.60 no.6
• /
• pp.441-449
• /
• 2023

With the enforcement of environmental regulations by the International Maritime Organization, the market for eco-friendly ships is expanding, and ships using electric propulsion devices are emerging as a promising solution. Many studies have been conducted to predict the failure of ships, but most of them are mainly research on the main diesel engine of ships. As the ship's propulsion method changes, new data is needed to predict the failure of electric propulsion ships. In this paper aims to analyze the failure characteristics of the electric propulsion system in consideration of the difference in the type of failure between the internal diesel engine and the electric propulsion system. The ship's propulsion unit assumed a DC motor and a signal pattern for normal conditions and general failure modes, but the failure record of the electric propulsion device operated on the actual ship was not available, so it generated a failure signal for small electric motor equipment to identify the failure signal. Assuming unbalance, misalignment, and bearing failure, which are the primary failure modes of the ship's electric motor, a failure signal was generated using a "rotator vibration data generator," and the frequency band, size, and phase difference of the measured vibration signal were analyzed to analyze the characteristics of each failure condition. Finally, the characteristics of each failure condition were identified so that the signals according to the failure type could be classified.

• Physical Therapy Korea
• /
• v.31 no.1
• /
• pp.72-78
• /
• 2024

Background: Limitations of shoulder range of motion (ROM), particularly shoulder internal rotation (SIR), are commonly associated with musculoskeletal disorders in both the general population and athletes. The limitation can result in connective tissue lesions such as superior labrum tears and symptoms such as rotator cuff tears and shoulder impingement syndrome. Maintaining the center of rotation of the glenohumeral joint during SIR can be challenging due to the compensatory scapulothoracic movement and anterior displacement of the humeral head. Therefore, observing the path of the instantaneous center of rotation (PICR) using the olecranon as a marker during SIR may provide valuable insights into understanding the dynamics of the shoulder joint. Objects: The aim of the study was to compare the displacement of the olecranon to measure the rotation control of the humeral head during SIR in individuals with and without restricted SIR ROM. Methods: Twenty-four participants with and without restricted SIR ROM participated in this study. The displacement of olecranon was measured during the shoulder internal rotation control test (SIRCT) using a Kinovea (ver. 0.8.15, Kinovea), the 2-dimensional marker tracking analysis system. An independent t-test was used to compare the horizontal and vertical displacement of the olecranon marker between individuals with and without restricted SIR ROM. The statistical significance was set at p < 0.05. Results: Vertical displacement of the olecranon was significantly greater in the restricted SIR group than in the control group (p < 0.05). However, no significant difference was observed in the horizontal displacement of the olecranon (p > 0.05). Conclusion: The findings of this study indicated that individuals with restricted SIR ROM had significantly greater vertical displacement of the olecranon. The results suggest that the limitation of SIR ROM may lead to difficulty in rotation control of the humeral head.

• Journal of Life Science
• /
• v.20 no.4
• /
• pp.549-554
• /
• 2010

Increased external rotation and decreased internal rotation have been noted to occur progressively in the throwing shoulders of baseball pitchers. The purpose of this study was to provide descriptive data for terminal range eccentric antagonist/concentric agonist shoulder muscle strength in collegiate baseball pitchers with humeral head retroversion diagnosed through MRI. The dominant and non-dominant shoulders of 9 asymptomatic baseball pitchers were tested through a range of 20 degrees of external rotation to 90 degrees of internal rotation using the Biodex system 3 isokinetic dynamometer at speeds of $90^{\circ}/s$ and $180^{\circ}/s$. Differences between the dominant and non-dominant shoulders were assessed using the paired samples t-test. Total range of motion, measured at $90^{\circ}$ of glenohumeral abduction, was $180.1^{\circ}$ for dominant shoulders and $183.7^{\circ}$ for non-dominant shoulders. Humeral head retroversion measured $47.6{\pm}6.1^{\circ}$ in dominant and $37.8{\pm}5.3^{\circ}$ in non-dominant extremities. The mean internal rotator concentric contraction (IR-Con) showed a significant difference compared to $31.5{\pm}5.1$ (Nm) in dominant and $38.7{\pm}5.2$ (Nm) in non-dominant shoulders at $180^{\circ}/s$ (p<0.05). The mean external rotator eccentric contraction (ER-Ecc) showed a significant difference compared to $20.3{\pm}4.7$ (Nm) in dominant and $25.1{\pm}3.7$ (Nm) in non-dominant shoulders at $90^{\circ}/s$ (p<0.05). There is a pattern of increased external rotation and decreased internal rotation in the dominant extremity that significantly correlates with an increase in humeral retroversion.

• Journal of the Korean Orthopaedic Association
• /
• v.56 no.1
• /
• pp.68-75
• /
• 2021

Purpose: The purpose of this study was to analyze the motion of the shoulder joint dynamically through a depth sensor-based motion analysis system for the normal group and patients group with shoulder disease and to report the results along with a review of the relevant literature. Materials and Methods: Seventy subjects participated in the study and were categorized as follows: 30 subjects in the normal group and 40 subjects in the group of patients with shoulder disease. The patients with shoulder disease were subdivided into the following four disease groups: adhesive capsulitis, impingement syndrome, rotator cuff tear, and cuff tear arthropathy. Repeating abduction and adduction three times, the angle over time was measured using a depth sensor-based motion analysis system. The maximum abduction angle (θ_max), the maximum abduction angular velocity (ω_max), the maximum adduction angular velocity (ω_min), and the abduction/adduction time ratio (t_abd/t_add) were calculated. The above parameters in the 30 subjects in the normal group and 40 subjects in the patients group were compared. In addition, the 30 subjects in the normal group and each subgroup (10 patients each) according to the four disease groups, giving a total of five groups, were compared. Results: Compared to the normal group, the maximum abduction angle (θ_max), the maximum abduction angular velocity (ω_max), and the maximum adduction angular velocity (ω_min) were lower, and abduction/adduction time ratio (t_abd/t_add) was higher in the patients with shoulder disease. A comparison of the subdivided disease groups revealed a lower maximum abduction angle (θ_max) and the maximum abduction angular velocity (ω_max) in the adhesive capsulitis and cuff tear arthropathy groups than the normal group. In addition, the abduction/adduction time ratio (t_abd/t_add) was higher in the adhesive capsulitis group, rotator cuff tear group, and cuff tear arthropathy group than in the normal group. Conclusion: Through an evaluation of the shoulder joint using the depth sensor-based motion analysis system, it was possible to measure the range of motion, and the dynamic motion parameter, such as angular velocity. These results show that accurate evaluations of the function of the shoulder joint and an in-depth understanding of shoulder diseases are possible.

• Journal of the Korean Orthopaedic Association
• /
• v.54 no.2
• /
• pp.110-119
• /
• 2019

Proximal humerus fracture can be defined as a fracture that occurs in the surgical neck or proximal part of the humerus. Despite the appropriate treatment, however, various complications and sequelae can occur, and the treatment is quite difficult often requiring surgical treatment, such as a shoulder replacement. The classification of sequelae after a proximal humerus fracture is most commonly used by Boileau and can be divided into two categories and four types. Category I is an intracapsular impacted fracture that is not accompanied by important distortions between the tuberosities and humeral head. An anatomic prosthesis can be used without greater tuberosity osteotomy. In category I, there are type 1 with cephalic collapse or necrosis with minimal tuberosity malunion and type 2 related to locked dislocation or fracture-dislocation. Category II is an extracapsular dis-impacted fracture with gross distortion between the tuberosities and the humeral head. To perform an anatomic prosthesis, a tuberosity osteotomy should be performed. In category II, there are type 3 with nonunion of the surgical neck and type 4 with severe tuberosity malunion. In type 1, non-constrained arthroplasty (NCA) without a tuberosity osteotomy should be considered as a treatment. On the other hand, reverse shoulder arthroplasty (RSA) should be considered if types 1C or 1D accompanied by valgus or varus deformity or severe fatty degeneration of the rotator cuff. In general, the results are satisfactory when NCA is performed in type 2 sequelae. On the other hand, RSA can be considered as an option when there is no bony defect of the glenoid and a defect of the rotator cuff is accompanied. In type 3, it would be effective to perform internal fixation with a bone wedge graft rather than shoulder replacement arthroplasty. Recent reports on the results of RSA are also increasing. On the other hand, recent reports suggest that good results are obtained with RSA in type 3. In type 4, RSA should be considered as a first option.

• Clinics in Shoulder and Elbow
• /
• v.2 no.1
• /
• pp.41-46
• /
• 1999

Glenoid labrum acts as one of static stabilizer of the glenohumeral joint. It deepens the glenoid socket and may also serve as a chock, acting as a wedge in preventing glenohumeral translation. Two types of variations in labral anatomy were noted by Detrisac and Johnson. Type A has a superior labrum that is detached centrally but well attached peripherally. The type B labrum is well attached centrally and peripherally at all sites. A meniscoid-type labrum is thought to be normal unless there are splits or fragmentation of the overlying labral tissue. Meniscoid type labrum is different from SLAP II lesion in that it has a firm anchoring on the superior labrum. We observed four cases that had a meniscoid variant superior labrum, which covered the superior glenoid unusually larger than normal in the arthroscopic treatment of shoulder pathology including instability and rotator cuff diseases. We did arthroscopic reshaping and debridement of meniscoid variant superior labrum combined with pathologic change of the glenohumeral joint. Further study would be required for understanding the mechanism of the development of meniscoid variant labrum and its clinical significance.