• 대한관절경학회지
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• 제13권1호
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• pp.72-76
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• 2009

당뇨환자로서 관절경적 회전근 개 봉합술을 시행 후 견관절의 화농성 관절염으로 진단된 2예에 대해 관절경적 치료 및 추가적인 개방성 치료를 시행하였다. 관절경적 회전근 개 봉합술 후 감염은 평균 18일 뒤에 발생하였으며, 증상 발현으로부터 수술까지의 평균 기간은 65일이었다. 또한 기능 평가는 KSS, ASES, UCLA, Constant 점수를 이용하였다. 관절경적 변연 절제술과 추가적인 시술 후 평균 22.5일의 항생제 치료로 4개월에 염증이 치료되었으며 최종 결과는 KSS점수가 82점, UCLA점수가 33점, ASES점수가 91점, Constant점수가 71점이었다. 관절경적 회전근 개 봉합술 후 발생한 화농성 견 관절염은 관절경적 치료 및 추가적인 시술로 치료되었고, 관절 운동 범위 및 기능적 결과와 통증 및 만족도는 많이 개선되었다.

• Clinics in Shoulder and Elbow
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• 제17권2호
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• pp.57-63
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• 2014

Background: To compare the effect of different starting periods of rehabilitative exercise (early or delayed passive exercise) on the rate of retear and other clinical outcomes after the arthroscopic repair of the rotator cuff. Methods: In total, 103 patients who underwent arthroscopic repair of the rotator cuff were included in the study. Determined at 2 weeks post-operation, patients who were incapable of passive forward elevation greater than $90^{\circ}$ were allotted to the early exercise group (group I: 79 patients; 42 males, 37 females), whilst those capable were allotted to the delayed exercise group (group II: 24 patients; 14 males, 10 females). The group I started passive exercise, i.e. stretching, within 2 weeks of operation, whilst group II started within 6 weeks. The results were compared on average 15.8 months (11-49 months) post-operation using the passive range of motion, the Visual Analog Scale (VAS) pain score, and the University of California at Los Angeles (UCLA) and Constant scores. Stiffness was defined as passive forward elevation or external rotation of less than $30^{\circ}C$ compared to the contralateral side. Follow-up magnetic resonance imaging (MRI) was carried out on average 1 year post-operation and the rate of retear was compared with Sugaya's criteria. Results: There were no differences between the two groups in gender, age, smoking, presence of diabetes, arm dominance, period of tear unattended, pre-operative range of motion, shape and size of tear, degree of tendon retraction, and tendon quality. There were no significant differences in clinical outcomes. Whilst stiffness was more frequent in group II (p-value 0.03), retear was more frequent in group I (p-value 0.028) according to the MRI follow-up. Conclusions: During rehabilitation after the arthroscopic repair of the rotator cuff, the delay of passive exercise seems to decrease the rate of retear but increase the risk of stiffness.

• 대한통합의학회지
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• 제2권1호
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• pp.63-76
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• 2014

Purpose : The purpose of this study was to ascertain the effects of scapular stabilization exercise before rotator cuff surgery on pain and range of motion of middle-aged women. Method : 20 subjects who agreed on this experiment and were diagnosed with rotator cuff rupture participated in this study. Experimental groups were treated while 40 minutes a day, 5 times per week, for 2 weeks before surgery. The effects of scapular stabilization exercise were evaluated on VAS and range of motion. Collected data were analyzed with SPSS for windows ver. 20.0 program. One-way repeated ANOVA was used to examine a significance of each variable by time. Two-way repeated ANOVA was applied to examine a significance of the experimental group against the control group. In all statistical tests, the significance level was set by ${\alpha}=.05$. Result : The results of this study are as follows: 1) In both control and experimental groups, VASs were decreased significantly according to intervention period. There was no significant difference between VASs of two groups. 2) In both control and experimental groups, ROMs of shoulder, flexion, abduction and external rotation were increased significantly according to intervention period. In these three flexibility measurement variables, there were significant differences between ROMs of two groups. Conclusion : In view of all the results in this study, scapular stabilization exercise on before rotator cuff surgery proved to be effective in improving their pain, range of motion after surgery. It will be sufficient data to perform with their own exercise program.

• Clinics in Shoulder and Elbow
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• 제22권4호
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• pp.220-226
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• 2019

Background: This retrospective study was undertaken to evaluate mid-term clinical and radiological outcomes of lattisimus dorsi (LD) tendon transfer in patients with irreparable massive rotator cuff tears (MRCT). We hypothesize that LD tendon transfer would provide safe and satisfactory clinical outcomes at mid-term follow-up. Methods: From November 2008 to December 2016, 23 patients ($57.5{\pm}4.4years$; 20 male, 3 female) who underwent LD tendon transfer for massive tears, were enrolled. Inclusion criteria were irreparable MRCT. Exclusion criteria included full thickness subscapularis tear, rotator cuff arthropathy, anterosuperior rotator cuff tear, and osteoarthritis. Mean follow-up period was $4.7{\pm}4.0years$ (range, 2-12 years). Clinical assessment (American Shoulder and Elbow Surgeons [ASES], University of California, Los Angeles [UCLA], Simple Shoulder Test [SST]) and radiographic assessment (osteoarthritis [OA], acromiohumeral distance [AHI]) were evaluated. Results: ASES, UCLA and SST scores, and range of motion (ROM), except internal rotation, improved significantly at the last followup (p<0.05). Also, AHI was significantly improved at the last follow-up, from 6.6 mm to 8.2 mm (p=0.008). At the final follow-up, the radiologic stages of the glenohumeral osteoarthritis were determined as stage 1 in 9 patients, stage 2 in 10 patients, stage 3 in 2 patients, and stage 4 in 2 patients. Complications were observed in 21.7% cases: 3 re-tears and 2 infections were noted in our study. Conclusions: LD tendon transfer for irreparable MRCT provides satisfactory clinical outcomes at mid-term follow-up. Mild degenerative osteoarthritis (stage 1, 2) of the shoulder joint are common at the mid-term follow-up. Also, complications such as tear, infection should be considered.

• Clinics in Shoulder and Elbow
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• 제17권2호
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• pp.64-67
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• 2014

Background: The purpose of this study was to determine whether in patients with rotator cuff tears a correlation exists between molecular changes and clinical parameters such as age, duration of symptom, range of motion, and tear size. Molecular changes of matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) were assessed by measuring messenger RNA (mRNA) levels of the two proteins. Methods: The rotator cuff tissue from was obtained from the edge of a torn tendon revealed after debridement by a motorized shaver. Using the sample of rotator cuff tissue, the reverse transcription polymerase chain reaction was performed to quantify MMP-2 and TIMP-2 mRNA expression. To determine whether mRNA levels and the clinical variables, such as age, defect size, range of motion (ROM) of shoulder, and duration of symptoms, show any correlation, Spearman's correlation coefficients were used to test for significant differences. Results: There was an inverse correlation between the mRNA levels of MMP-2 and TIMP-2 from the torn rotator cuff tendons regardless of the clinical variables. However, comparison of mRNA levels versus clinical parameters such as age, defect size, range of motion and duration of symptoms revealed a number of findings. We found a significant correlation between age and mRNA levels of MMP-2 from torn cuffs (r = 0.513, p = 0.021). Further, we found a significant correlation between defect size in the full thickness tears and mRNA levels of MMP-2 (r = 0.454, p = 0.045). Conversely, no significant association between mRNA levels of MMP-2 and ROM or duration of symptom was found. Conclusions: Our results suggest that both MMP-2 and TIMP-2 may be involved in the disease process of rotator cuff tears. Although the level of mRNA expression of MMP-2 and TMP-2 remain constant in torn rotator cuffs irrespective of the clinical variables, their levels may be influenced by age and defect size, which could account to change in tendon degradation and the healing process.

• 대한정형외과스포츠의학회지
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• 제5권2호
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• pp.117-122
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• 2006

목적: 견관절 회전근 개 전층 파열로 진단된 환자를 대상으로 전기 진단 검사를 통하여 신경 손상 유무를 조사하여 유병율 및 상관관계를 알아보고자 하였다. 대상 및 방법: 2004년 5월 1일부터 2005년 2월 1일 까지 본원에서 회전근 개 전층 파열로 확진되어 수술적 가료를 받은 환자중 급성기 외상으로 인하여 발생한 골절 및 탈구가 없는 19례에서 술전에 전기 진단 검사를 시행하여, 신경 손상의 유병율 및 여러 가지 요인과의 상관관계를 조사하였다. 이들 대상 환자의 평균 연령은 $59.1{\pm}11.4(45\sim87)$세, 평균 이환 기간은 $48.4{\pm}100.2$(1개월$\sim$30년)개월, 성비는 13:5(남자:여자)이었고, 외상 후에 동통이 생긴 경우가 8례 있었다. 결과: 19례 중 6례(31.6%)에서 신경 손상이 동반되어 있었고, 신경 손상의 유형은 전례에서 상완 신경총 손상이었으며, 후각 신경절 후 병변이었다. 신경 손상이 있는 6례에서 외상과 더불어 증상이 시작된 경우가 4례(67%)이었고. 파열 크기, 관절 운동 범위, 동통 지수, 기능 지수는 신경 손상이 없는 경우와 큰 차이를 보이지 않았다. 결론: 회전근 개 파열이 있는 환자의 진단 및 치료에 있어 신경 손상이 동반될 수 있다는 것을 유념하고 필요하면, 근전도 검사를 통하여 신경 손상의 동반 여부를 확인한다면 적절한 치료계획에 도움이 되리라 사료된다.

• 대한정형도수물리치료학회지
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• 제22권2호
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• pp.15-20
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• 2016

Background: The purpose of this study was to compared of scapular position between operation side and non-operation side to the rotator cuff surgery. Methods: This study was carried out with a total 34 patients: male (n=14), female (n=20). Shoulder range of motion (ROM), the quadruple visual analogue scale (QVAS), the shoulder pain and disability index (SPADI), and the scapular index (SI) were used to assess shoulder posture and function. SI was the resting position of the scapular was determined by measuring the distance from the mid-point of the sternal notch (SN) to the medial aspect of the coracoid process (CP) and the horizontal distance from the posterolateral angle of the acromion (PLA) to the thoracic spine (TS) with a soft tape measure. The SI was calculated using the equation: [(SN to CP/PLA to TS) ${\times}$ 100]. Results: There were no significant difference in ROM, QVAS to rotator repair patients according to SI (p>.05). There were significant differences in SI between the operation side and the non-operation side (p<.01). Conclusions: Scapular position was operation side more internal rotation, protraction, abduction than non-operation side. Therefore, health professionals managing for rotator cuff tear repair patients should consider scapular position.

• Clinics in Shoulder and Elbow
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• 제18권4호
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• pp.269-271
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• 2015

Latissimus dorsi tendon transfer is a well-established method for treatment of irreparable posterosuperior rotator cuff tears. We report on an anterolateral mini-open technique with a porcine dermal patch augmentation for latissimus dorsi tendon transfer. Use of this technique would result in avoidance of deltoid damage by anterolateral mini-open approach and reduction of failure rate by patch augmentation.

• Clinics in Shoulder and Elbow
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• 제24권4호
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• pp.272-278
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• 2021

Anatomical total shoulder arthroplasty (TSA) has been used widely in treatment of glenohumeral osteoarthritis and provides excellent pain relief and functional results. Reverse total shoulder arthroplasty (RSA) was created to treat the complex problem of rotator cuff tear arthropathy. RSA also has been performed for glenohumeral osteoarthritis even in cases where the rotator cuff is preserved and has shown good results comparable with TSA. The indications for RSA are expanding to include tumors of the proximal humerus, revision of hemiarthroplasty to RSA, and revision of failed TSA to RSA. The purposes of this article were to describe comprehensively the conditions under which RSA should be considered in glenohumeral osteoarthritis, to explain its theoretical background, and to review the literature.

• 대한정형외과 초음파학회지
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• 제1권1호
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• pp.23-26
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• 2008

회전근 개 파열의 진단에서 초음파 검사는 간편성, 저비용, 손쉬운 접근성 등의 이유로 최근 널리 이용되고 있다. 저자들은 관절경적 회전근 개 복원술을 시행한 환자에서 초음파와 자기공명 조영술 검사상 파열의 크기 등이 각각에 따라 차이를 보여 이를 보고하고자 하며, 관련된 문헌을 고찰하고자 하였다. 74세 여자가 우측 어깨의 통증을 호소하였고, 신체 검진 상 충돌 증후군의 소견과 극상건의 근력 저하를 보여주었다. 초음파 상 1 cm 가량의 회전근 개 전층 파열이 관찰되었으나, 자기공명 조영술에서는 3 cm 정도 크기의 파열이 관찰되었다. 관절경 소견상 회전근 개의 광범위 층상 파열과 함께 결손 부위에 얇은 막으로 덮여 있는 부분이 있어, 이러한 복합적인 파열 형태가 초음파 검사에서 크기를 작게 측정하게 된 원인이 될 수 있었을 것으로 판단하였다. 초음파 검사의 장점과 한계점을 충분히 고려하여, 검사 결과에 비하여 근력의 저하나 오랜 기간의 증상을 보여준다면 추가적 자기공명 조영술이나 반복적인 초음파 검사를 고려하여야 할 것으로 생각된다.