• Clinics in Shoulder and Elbow
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• v.24 no.3
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• pp.172-177
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• 2021

Background: This study aimed to evaluate the response rate to arthroscopic release treatment in adhesive capsulitis of the shoulder (ACS) for patients with refractory to conservative treatment. Methods: In this retrospective study, 51 patients (age mean, 49.1±5.6 years) with unilateral adherent capsule underwent arthroscopic releasing surgery for the shoulder capsule. Etiologies of the ACS in 30 patients were idiopathic: 10 patients were affected after surgery and 11 patients following trauma. The patients were evaluated in terms of shoulder function, satisfaction rate, pain intensity, and joint range of motion (ROM) based on a Constant score, a Simple Shoulder Test, the visual analog scale, and four movements, respectively. Results: The mean Constant score before surgery was 48.2±3.5 and reached 74.4±6 and 77.0±6.3 at 6 months and the final follow-up, respectively (p<0.001). The mean scores of pain intensity, a Simple Shoulder Test, and ROM showed significant improvement at all follow-ups (p<0.001). Sex, age, and diabetes did not have any significant effect on patient recovery. However, patients who experienced ACS after surgery had poorer results than others at all follow-up points. Conclusions: Arthroscopic releasing surgery of the shoulder in patients with ACS refractory to conservative treatment produces rare complications and an effective injury response. It seems that patients suffering ACS following surgery have a weaker response to the treatment.

• Clinics in Shoulder and Elbow
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• v.6 no.2
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• pp.143-148
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• 2003

Objectives: To analyze the postoperative functional outcome of shoulder in patients with arthroscopically assisted repair of large to massive rotator cuff tears with or without acromioplasty and role of acromioplasty. Materials and Methods: From June 1996 to June 2002, twenty six patients with large to massive rotator cuff tears were undergone arthroscopically assisted repair. Mean follow up was over one year. Fourteen were male and twelve were female. Mean age was 51 years old(39-66). Mean duration was 9 months. Acromioplasty was done in 14 cases concomitantly. They were divided into two groups. Group I: arthroscopic cuff repair with acromioplasty(14 cases). Group II: arthroscopic cuff repair without acromioplasty(12 cases). Each shoulder was evaluated at preoperative and final follow-up with Visual Analogue Scale(VAS), University of Pennsylvania Patient self-assessment of pain, University of Pennsylvania Patient self-assessment of function, ASES standardized shoulder assessment form, Simple Shoulder Test, UCLA score and range of motion(ROM). We analyzed the differences between the two groups. Shoulder ROM and acromioplasty were determining factors. Statistics was tested by correlation analysis and repeated measure ANOVA test. Results: At the final follow up, functional outcome and pain were improved but they had no statistical significance between the two groups(p>0.05). Combined procedure, acromioplasty, didn't affect on VAS. UCLA score, University of Pennsylvania Patient self-assessment of pain, University of Pennsylvania Patient self-assessment of function, ASf:S standardized shoulder assessment form and Simple Shoulder Test(p>0.05). In group II, forward flexion and abduction were statistically improved at the final follow up than in group I(p<0.05). Conclusions: It appears that arthroscopic repair is satisfactory procedure in patients with large to massive cuff tears. Combined procedure, acromioplasty, doesn't affect on postoperative functional outcome of shoulder.

• Clinics in Shoulder and Elbow
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• v.4 no.2
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• pp.173-180
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• 2001

Aim: To evaluate validity and responsiveness of four shoulder scoring systems. Material and Method: Twenty-five cases of shoulder instability(22 traumatic, 3 non-traumatic) and twenty-three cases of rotator cuff tear(12 small or medium, 10 large or massive) treated surgically were evaluated with the Shoulder Function Score of the University of Pennsylvania(Penn FS), Constant Score, UCLA Shoulder Rating Scale and Simple Shouler Test(SST), preoperatively and at final follow-up. The average follow-up was 16.0 months in instability group and 17.5 months in rotator cuff tear group. Using the SPSS program, Pearson linear correlation coefficiency(PLCC) between the scores were calculated. And to assess the construct validity, PLCC between patients' satisfaction and the scores were also calculated. Responsiveness was measured by the standardized response mean(SRM). Result: In instability group, correlation between the scoring systems was low preoperatively except between Constant and SST, but high after operation. Patients' satisfaction with the scores showed low PLCC preoperativley, but high PLCC postoperatively. SRM was high in PENN and UCLA, but when the satisfaction segment of the score was eliminated from UCLA, the SRM was the lowest. In rotator cuff tear group, there was high correlation between the scores not only preoperatively but postoperatively. And the patients' satisfaction matched well with the scores. SRM was particularly high in UCLA and SST. Even when satisfaction segment was eliminated from UCLA, the SRM was still the highest. Conclusion : Evaluation by the 4 scoring systems investigated in the study showed less consistency in instability than rotator cuff tear in terms of correlation and validity. Responsiveness was generally higher in rotator cuff tear group than in instability group except for Pennsylvania Shoulder Function Score. Therefore it is construed that use of any among the four scoring systems doesn't make difference in evaluation of rotator cuff lesions. However in instability group, care is needed because different result may be obtained according to the selection of a scoring system.

• Clinics in Shoulder and Elbow
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• v.6 no.1
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• pp.55-66
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• 2003

Background: The purpose of this study was to evaluated results of arthroscopic treatment of the traumatic recurrent unidirectional posterior subluxation. Materials and Methods: We treated twenty-seven patients who had traumatic recurrent unidirectional posterior subluxation of the shoulder by arthroscopic labral repair and posterior capsular shift and prospectively evaluated for a mean of thirty-nine months (range,24 to 85 months). Patients who had posteroinferior instability, multidirectional instability, atraumatic onset, or revision cases were excluded. There were twenty-five male and two female patients with the mean age of twenty-one years (range, 14 to 33 years). All patients were involved in sports activity. All had a significant traumatic event prior to the onset of the instability. Stability, motion, three objective measurement (UCLA, ASES, and Rowe scores) and two subjective measurements (pain and function visual analogue scale) were evaluated. Results: The most common finding in magnetic resonance image-arthrogram was separation of the posteroinferior labrum without displacement in 9 patients, In arthroscopic examination, all patients had one or more lesions in the posterior inferior labrum and capsule. The most common finding was incomplete stripping of the posterior inferior labrum (18 patients). The posteroinferior capsule subjectively appeared to be stretched in twenty-two patients. At follow-up, all patients had improved shoulder function and scores(p < 0.01). All patients had stable shoulder by subjectivel and objectivel measurements, except one patient who had recurrent subluxation. All but one patient with postoperative recurrence were able to return to their prior sports activity with little or no limitation. Twenty-four patients were graded as having more than 90％ of shoulder function. Their were twenty-one excellent, five good, and one fair UCLA. scores. Pain sore improved from 4.5 to 0.2 point(p : 0.0001). Mean loss internal rotation was one vertebral level. None had operative complications. Conclusion: In conclusion, treatment outcomes of the traumatic unidirectional recurrent posterior subluxation are consistently reliable with respect to the stability, pain relief, and functional restoration by the arthroscopic posterior capsular shift procedure.

• The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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• v.22 no.1
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• pp.17-25
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• 2016

Purpose: This study was aimed to determine the effects of thoracic spine thrust manipulation on muscle activities of the scapular upward rotators and middle deltoid, active range of motion (AROM), shoulder pain, and rounded shoulder posture in young adults with rounded shoulder. Methods: The subjects were 30 young adults (14 males, 16 females) with rounded shoulder. Thirty subjects were randomly assigned to an experimental (manipulation) and control (placebo) groups of fifteen subjects respectively. The manipulation group received the manipulation (high velocity, low amplitude), which was performed by a physical therapist with the subject in the supine position and with the arms crossed over the chest and hands passed over the shoulders. For the sham group, the same procedure was performed, with the exception that the high-velocity thrust was not applied. Measurements were taken before and after the intervention. Muscle activity of upper and lower trapezius, serratus anterior, middle deltoid was measured using surface electromyography. Visual analog scale (VAS) was used for shoulder pain. Goniometry was used for shoulder abduction active range of motion (AROM). Straight edge was used for supine rounded shoulder posture (RSP) distance. Results: The muscle activity of the upper trapezius, lower trapezius and middle deltoid muscle increased significantly after the intervention (p<.05). However, no significant difference was observed in serratus anterior muscle (p>.05). The VAS was significantly decreased and AROM significantly increased after the intervention (p<.05). The distance of RSP were not significant (p>.05). The control group showed no differences before and after the intervention (p>.05). Conclusion: The results of this study suggest that thoracic spine thrust manipulation can be an effective component of treatment plan to improve pain and function.

• Physical Therapy Korea
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• v.25 no.3
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• pp.39-50
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• 2018

Background: High string instrument (violin, viola) players are at high risk for developing musculoskeletal problems. In particular, a higher prevalence of shoulder problems has been reported. However, evidence of the effectiveness of therapeutic exercise for musicians with this condition is lacking until now. Objects: This case series study investigated the effect of a specific exercise program on shoulder pain, dysfunction, and posture of professional orchestral high string musicians. Methods: Five professional orchestral high string players with shoulder pain participated in this study. A six-week specific exercise program focus on scapular stability for shoulder pain consisted of scapular muscle exercise. Physical examinations for pain and dysfunction, posture were performed, were identified among all subjects before starting the exercise program. Results: The results revealed that shoulder pain decreased by 67.86% and the effect of pain on instrument play decreased by 63.33%. The shoulder pain and disability Index and the performing arts module-quick disability of the arm, shoulder and hand scale decreased by 71.72% and 51.61% respectively. The exercise program improved function and posture. Conclusion: A specific exercise program for high string players was effective in managing shoulder pain. This case series is intended to provide empirical data on the effectiveness of an exercise program aimed at assessing the effect of exercise on pain, dysfunction, and posture of professional orchestra musicians associated with specific instrument groups.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.232-235
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• 2009

Purpose: We report here on a solution for the case of a 71 year old lady with cartilage destruction in the left shoulder and the loss of the rotator cuff secondary to post-septic arthritic sequelae. Materials and methods: After thorough laboratory, clinical and radiological investigation of the patient to rule out any foci of active infection, we contemplated performing reverse total shoulder arthroplasty as a primary procedure. Results: At 22 months follow up, the patient had an excellent result according to the UCLA and ASES scales. Conclusion: Reverse total shoulder arthroplasty seems to be an efficient procedure to improve pain and function in the post-septic shoulder accompanying severe rotator cuff injury.

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

• Journal of Korean Physical Therapy Science
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• v.31 no.2
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• pp.63-74
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• 2024

Background: This study aimed to determine the effects of static stretching on the pain and range of motion (ROM) of shoulder joints in middle aged women patients with frozen shoulders. Design: One group pretest-posttest design Methods: The participants were 15 middle aged women patients with frozen shoulders in their 40s to 60s. Subjective and objective pain and joint ROM(range of motion) were measured, and the static stretching intervention consisted of 15 minutes of flexion, abduction and external rotation stretching. Results: The results of this study indicated that the daily pain of shoulder joints and pressure pain thresholds of the muscles surrounding the shoulder joints were generally improved after the intervention with the static stretching, for which significant differences were observed (p<0.05). The ROM of shoulder joint flexion, abduction, and external rotation was significantly increased (p<0.05) after the intervention with the static stretching. Conclusion: Static stretching intervention in patients with frozen shoulders relieved shoulder joint pain and had positive effects on the ROM of shoulder joints. Thus, the application of static stretching in middle aged womenpatients who experience severe pain could be effective at enhancing the function of shoulder joints without pain.

• Journal of Pharmacopuncture
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• v.9 no.1
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• pp.139-154
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• 2006

Objective : This experiment was conducted to evaluate the effectiveness of Acupuncture, Bee Venom Acupuncture (BVA) and Bee Venom Herbal Acupuncture (BVHA) on post-stroke hemiplegic shoulder pain. Methods : 30 patients were randomly allocated into Acupuncture group, BVA group and BVHA group and was monitored weekly for 4 weeks; initial($T_0$), 1 week($T_1$), 2 weeks($T_2$), 3 weeks($T_3$) and 4 weeks($T_4$). Results : Visual analogue scale of shoulder pain showed significant decrease in BVA and BVHA groups compared to the Acupuncture group at T4 evaluation. Painless passive ROM of shoulder external rotation and Fugl-Meyer Motor Assessment of Upper Limb motor function showed significant increase in all groups. Modified Ashworth scale of the spasticity of upper limb showed no differences between the three groups. Conclusion : BVA & BVHA appears to be an effective in treating post-stroke hemiplegic shoulder pain. Further clinical studies must be done to obtain more concrete findings.