• Clinics in Shoulder and Elbow
• /
• 제26권2호
• /
• pp.109-116
• /
• 2023

Background: Golf is a popular sport involving overhead activity and engagement of the rotator cuff (RC). This study aimed to determine to what level golfers were able to return to golf following RC repair, the barriers to them returning to golf and factors associated with their failure to return to golf. Methods: Patients preoperatively identifying as golfers undergoing RC repair at the study centre from 2012 to 2020 were retrospectively followed up with to assess their golf-playing status, performance and frequency of play and functional and quality of life (QoL) outcomes. Results: Forty-seven golfers (40 men [85.1%] and 7 women [14.9%]) with a mean age of 56.8 years met the inclusion criteria, and 80.1% were followed up with at a mean of 27.1 months postoperatively. Twenty-nine patients (76.3%) had returned to golf with a mean handicap change of +1.0 (P=0.291). Golf frequency decreased from a mean of 1.8 rounds per week preinjury to 1.5 rounds per week postoperatively (P=0.052). The EuroQol 5-dimension 5-level (EQ-5D-5L) index and visual analog scale (EQ-VAS) score were significantly greater in those returning to golf (P=0.024 and P=0.002), although functional outcome measures were not significantly different. The primary barriers to return were ipsilateral shoulder dysfunction (78%) and loss of the habit of play (22%). Conclusions: Golfers were likely (76%) to return to golf following RC repair, including mostly to their premorbid performance level with little residual symptomatology. Return to golf was associated with a greater QoL. Persistent subjective shoulder dysfunction (78%) was the most common barrier to returning to golf.

• Clinics in Shoulder and Elbow
• /
• 제17권2호
• /
• pp.68-76
• /
• 2014

Background: Recently, reverse total shoulder arthroplasty (RTSA) has been accepted as a main treatment option in irreparable massive rotator cuff tear with cuff arthropathy. The purpose of this study was to evaluate the early complication incidence and the preliminary clinical results of RTSAs performed in single institute. Methods: Fifty-seven RTSAs (56 patients) were performed between April 2011 and March 2013. The indications for RTSA were cuff tear arthropathy and irreparable massive rotator cuff tear with or without pseudoparalysis. Exclusion criteria were revision, preoperative infections and fractures. At final follow-up, 45 shoulders were enrolled. Mean follow-up duration was 12.5 months (range, 6-27 months). The mean age at the time of surgery was 73.6 years (range, 58-87 years). All the patients were functionally accessed via Constant score, American Shoulder and Elbow Surgeons (ASES) score, pain and functional visual analogue scale (VAS) scores and active range of motion. Complications were documented as major and minor. Major complications include fractures, infections, dislocations, nerve palsies, aseptic loosening of humeral or glenoid components, or glenoid screw problems. Minor complications include radiographic scapular notching, hematomas, heterotopic ossification, algodystrophy, intraoperative dislocations, intraoperative cement extravasation, or radiographic lucent lines of the glenoid. Results: The mean Constant score increased from 31.4 to 53.8 (p < 0.001). The pain and functional VAS scores improved (5.2 to 2.7, p < 0.001, 4.0 to 6.7, p < 0.001) and active forward flexion improved from $96.9^{\circ}$ to $125.6^{\circ}$ (p = 0.011). One or more complications occurred in 16 (35.6%) of 45 shoulders, with one failure (2.2%) resulting in the removal of implants by late infection. The single most common complication was scapular notching (9 [20%]). There were 4 (8.9%) axillary nerve palsies postoperatively (n=3: transient n. palsy, n=1: Symptom existed at 11 months postoperatively but improving). Conclusions: In a sort term follow-up, RTSA provided substantial gain in overall function. Most common early complications were scapular notching and postoperative neuropathy. Although overall early complication rate was as high as reported by several authors, most of the complications can be observable without compromise to patients' clinical outcome. Long term follow-up is required to clarify the clinical result and overall complication rate.

• The Journal of Korean Physical Therapy
• /
• 제28권2호
• /
• pp.101-105
• /
• 2016

Purpose: The purpose of this study was to determine the effects of group exercise, manual therapy, and a home exercise program on VAS (visual analogue scale), ROM (range of motion) of shoulder, and functional outcome in adhesive capsulitis. Methods: The study was conducted with 45 patients. All subjects were randomly assigned to 3 groups: group exercise (n=15), manual therapy (n=15), home exercise (n=15). The subjects performed an intervention program 3 times a week for 4 weeks a total of 12 times. Outcome measurements were VAS, ROM, and Constant-Murley score outcome measures. Measurements were taken four times, at baseline, 4 weeks later, 8 weeks later, and 12 weeks later. Results: VAS, ROM of the shoulder, and functional outcomes showed improvement in all groups at the final follow-up (p<0.05). VAS and ROM showed greater improvement with group exercise and manual therapy than home exercise, however, there were no significant differences between the two groups (p>0.05). Functional outcomes showed the greatest improvement in group exercise at the final follow-up. This improvement was greater than with manual therapy or home exercise (p<0.05). Conclusion: Group exercise and manual therapy were more effective for improving pain, ROM, and function than home exercise in adhesive capsulitis. In particular, group exercise is more effective in functional recovery than other physiotherapy interventions.

• Clinics in Shoulder and Elbow
• /
• 제4권2호
• /
• pp.161-165
• /
• 2001

Purpose: The purpose of this study was to analyze the possible contributing factors and surgical results of rotator cuff tears in patients younger than 40 years of age. Materials and Methods: From July, 1996 to February, 2000, twelve patients were available to participate in the study. The average age was 35 years (range, 17 to 40 years) old. Follow-up averaged eighteen months (range, 12 to 55 months). There were eleven men and one women. Each shoulder was evaluated with UCLA shoulder functional assessment, return-to-work status, return-to-sport status, and overall postoperative satisfaction. Results: After operation, eleven patients (92%) reported diminished pain relative to their preoperative level, and ten patients (83%) were improved in shoulder function. eleven patients (92%) exhibited improved strength after operation. nine patients (75%) returned to employment, and six patients (50%) returned to sports activities. Preoperative UCLA score averaged 12 and postoperative score averaged 31. Ten patients (83%) were satisfied with the outcome of their treatment. Conclusion: A traumatic event was the etiology of the rotator cuff tears in patients younger than 40 years. Results of surgical treatment in this younger group were satisfactory.

• Clinics in Shoulder and Elbow
• /
• 제27권2호
• /
• pp.219-228
• /
• 2024

Background: Standard open acromioclavicular (AC) stabilization is associated with increased postoperative complications including deltoid injury, infection, tunnel complications, loss of reduction, and wound/cosmetic concerns. Arthroscopy may offer superior visualization and advantages that limit these risks. The aim of this prospective non-randomized study is to evaluate advantages and long-term reliability of arthroscopic AC stabilization. Methods: Thirty-two patients with acute grade III, IV and V AC dislocations underwent arthroscopic AC reconstruction with long-term assessment by clinical AC examination, Simple Shoulder Test, American Shoulder and Elbow Surgeons scores, visual analog scale, Specific AC Score and Quick Disabilities of the Arm, Shoulder and Hand scores. Radiographs verified conservation of initial reduction and presence of coracoclavicular (CC) ossifications. Complications, revision rate, and satisfaction were assessed and compared to the literature. Results: Mean follow-up time was 67.6 months. All clinical outcome scores improved and differences were statistically significant (P<0.001). Initial postoperative radiographs consistently showed complete reduction. Two patients experienced relapse to grade II AC dislocation without clinical implications. In total, 71.8% showed CC ossifications without functional impairment, and in 31.3% concomitant injuries were observed. Reintervention rate was 9.4%, and 96.9% of patients were satisfied with procedure outcomes. Conclusions: Arthroscopic stabilization for acute AC joint dislocations offers satisfactory clinical and radiographic outcomes, and our results show that the arthroscopic technique is reliable in the long run. We report better reduction in maintenance, fewer complications, and similar reoperation rates compared to other techniques.

• Clinics in Shoulder and Elbow
• /
• 제25권3호
• /
• pp.230-235
• /
• 2022

Background: Unstable distal clavicles experience high non-union rates, prompting surgeons to recommend surgery for more predictable outcomes. There is a lack of consensus on the optimal method of surgical fixation, with an array of techniques described in the literature. We describe an alternative method of fixation involving the use of a distal clavicular anatomical locking plate with Fibertape cerclage augmentation in our series of patients. Methods: Nine patients (8 males and 1 female), with a mean age of 36 years, who sustained unstable fracture of the distal clavicle in our institution were treated with our described technique. Postoperative range of motion, functional and pain scores, and time to radiographic union were measured over a mean follow-up period of 10 months. Incidences of postoperative complications were also recorded. Results: At the last patient consult, the mean visual analog scale score was 0.88±0.35, with a mean Disabilities of the Arm, Shoulder, and Hand (DASH) score of 1.46±0.87 and American Shoulder and Elbow Surgeons (ASES) score of 94.1±3.57. The mean range of motion achieved was forward flexion at 173°±10.6°, abduction at 173°±10.6°, and external rotation at 74.4°±10.5°. All patients achieved internal rotation at a vertebral height of at least L2 with radiographical union at a mean of 10 weeks. No removal of implants was required. Conclusions: Our described technique of augmented fixation of the distal clavicle is effective, produces good clinical outcomes, and has minimal complications.

• Clinics in Shoulder and Elbow
• /
• 제24권3호
• /
• pp.147-155
• /
• 2021

Background: This study aimed to evaluate the co-administration effect of atelocollagen combined with hyaluronic acid (HA) injections for treatment of full-thickness rotator cuff tear (RCT). Methods: Eighty patients who underwent arthroscopic rotator cuff repair for full-thickness RCT from March 2018 to November 2019 were enrolled. The patients were randomly allocated to the following groups: combined atelocollagen and HA injection (group I, n=28), only HA injection (group II, n=26), and no injection (group III, n=26). Clinical outcomes were assessed at 3, 6, and 12 months after surgery using the American Shoulder and Elbow Surgeons score, visual analog scale pain score, functional scores (pain visual analog scale, function visual analog score), and range of motion. Magnetic resonance imaging was performed 12 months after surgery to evaluate rotator cuff integrity. Results: Preoperative demographic data and postoperative clinical outcomes did not differ significantly among the three groups (p>0.05). However, in group I, the number of steroid injections after surgery was significantly lower than that in the other groups (p=0.011). The retear rate on follow-up magnetic resonance imaging was significantly higher in group II (9.5%, n=2) and group III (13.6%, n=3) than in group I (0%) (p=0.021). Conclusions: Co-administration of atelocollagen and HA improves healing of the rotator cuff and increases the integrity of the rotator cuff repair site. This study provides encouraging evidence for use of combined atelocollagen-HA injections to treat patients with full-thickness RCT.

• PNF and Movement
• /
• 제14권1호
• /
• pp.23-32
• /
• 2016

Purpose: The purpose of this study was to determine the effects of a coordinative locomotor training program on the functional movement screen (FMS) scores of badminton players. Methods: The participants consisted of 31 badminton players who were randomly assigned to either an experimental group (n=15) or a control group (n=16), and engaged in exercise five times per week for six weeks. The experimental group engaged in coordinative locomotor training and the control group engaged in general exercise. An FMS kit (USA) was used to measure the following: FMS score, deep squat, hurdle step, in-line lunge, shoulder mobility, active straight leg raise, trunk stability push up, and rotary stability. Results: The FMS score, deep squat, hurdle step, in-line lunge, active straight leg raise, and trunk stability push up showed significant improvement in the experimental group (p<0.05). Conclusion: The coordinative locomotor training program was able to produce confirmation that functional movement screen scores change in the case of effective exercise interventions in badminton players.

• Clinics in Shoulder and Elbow
• /
• 제7권1호
• /
• pp.30-34
• /
• 2004

Purpose: To report our experience of treatment of rotator cuff tear and evaluate the mid-term outcome. Materials and Methods: We have performed 50 cases of mini-open rotator cuff repair from March 1996 to March 1999. Male to female ratio was 34：16, the average age 46.5(23∼57) years old, mean follow-up period was 78(62∼93) months. All-arthroscopic repair and open repair cases were excluded. Mean symptomatic period was 12.5(6∼38) months, operation was indicated in cases of no improvement by 6 months of conservative management. Preoperative simple radiographs and Magnetic resonance arthrography were obtained in all cases. We also observed the inflammation, synovitis, thickness of tear and associated pathology intraoperatively. We evaluated pain, function, and range of motion by UCLA score. Results: Overall UCLA score was mean 29.5 points. Excellent 25, good 18, poor 7 cases. Mean pain score was improved 2.6 to 7.5, 44 cases(88%) were improved and 6 cases(12%) were not improved. Mean functional score was improved 3.4 to 8.5, and activity at follow up, 25 cases(50%) were same, 8 cases(14%) were above, 17 cases(34%) were below compared with preoperative level. Mean active forward flexion was preoperative 112° to postoperative 160°, forward flexion strength was improved 3.8 to 4.7. 43 cases(86%) of patients were satisfied at the result, 7 cases(14%) were not satisfied or aggravated. Results: Mini-open rotator cuff repair was effective method in treating rotator cuff tear.

• 대한정형외과스포츠의학회지
• /
• 제12권1호
• /
• pp.29-36
• /
• 2013

목적: 고유 수용성 감각 기능은 견관절의 안정성에 중요한 역할을 하는 것으로 알려졌으나 회전근개 파열 환자에 대하여는 크게 알려진 바가 없다. 본 연구의 목적은 회전근개 파열 환자의 고유 수용성 감각 기능에 대하여 조사하고자 하였고 특히 파열크기, 견갑하근의 파열 유무 등에 따라 조사하고자 하였다. 대상 및 방법: 2011년 7월부터 2012년 2월까지 회전근개의 파열로 본원에서 수술적 치료가 시행된 76예(남자 28명, 여자 48명)를 대상으로 하였고 평균 나이는 61.7세(범위, 38세~76세)였다. 수술전 고유 수용성 감각 기능 평가를 위하여 외회전 및 내회전에 대한 위치 감각(joint position sense)를 측정하였고 방식은 능동적 재위치법(active re-positioning)을 사용하였다. 정해진 회전 각도와의 편차의 절대값을 측정하였다. 회전근개의 파열 크기, 견갑하근의 파열 유무, 통증(pain visual analogue scale), 견관절 기능 점수(American society of elbow and shoulder score), 견관절 운동 범위를 조사하였으며 이들 변수에 따른 차이를 비교하였다. 결과: 외회전의 경우 정상 관절은 $4.9^{\circ}{\pm}2.9^{\circ}$, 이환된 관절은 $4.9^{\circ}{\pm}3.0^{\circ}$의 절대 편차를 보였고 이는 통계적으로 유의하지 않은 차이를 보였다(p=0.87). 내회전의 경우 정상관절은 $4.0^{\circ}{\pm}2.7^{\circ}$인데 비하여 이환된 관절은 $4.8^{\circ}{\pm}3.7^{\circ}$로 편차가 증가하였으며 이는 통계적으로 유의하였다(p=0.043). 회전근개의 파열 크기에 따라 파열이 더 큰 경우(중파열 이상)가 파열이 더 작은 경우(부분파열 및 소파열)에 비하여 내회전의 고유감각기능 감소가 더 뚜렷한 경향을 보였으며(5.0 vs. 4.0, p=0.061), 견갑하근의 파열이 있는 환자군에서 내회전의 고유감각 기능 감소가 더 뚜렷한 경향을 보였다(4.8 vs. 4.0, p=0.065). 통증이 클수록, 견관절 기능 검사 점수가 낮을수록 내회전에 대한 고유감각기능이 감소하였으며(각각 p=0.04 및 p=0.005) 견관절 운동 범위의 제한이 있는 환자군에서 내회전 고유감각기능이 더욱 감소되는 것이 관찰되었다(5.3 vs. 3.7, p=0.041). 결론: 회전근개 파열 환자에서 내회전에 대한 고유감각기능 감소가 관찰되었으며 특히 이는 회전근개의 파열 정도가 심하고 견갑하근의 파열이 동반된 경우 뚜렷한 경향을 보였다. 또한 통증이 심하거나 견관절 기능 점수가 낮으며 운동 범위의 제한이 있는 경우 내회전에 대한 고유감각기능이 감소하는 것으로 관찰되었다.