• Clinics in Shoulder and Elbow
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• 제3권2호
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• pp.79-86
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• 2000

Purpose: We analysed the clinical efficacy of inferior capsular shift operation in multidirectional instability of the shoulder joint in terms of functional aspects and patient's satisfaction Materials and Methods: From July, 1998 to March, 2000, we treated 23 cases of multidirectional instability of the shoulder joint with T-shaped inferior capsular shift and/or Bankart repair. All of them have complained of an experience about frank dislocations. Two of them has a voluntary component. We evaluated them according to complication, function, range of motion, stability and patient's satisfaction with an average follow-up of 15 months(the range of 9 to 27 months). Results: Eight cases were atraumatic multidirectional instability and coexisting Bankart lesion were present in 15. There was no redislocation, but one case of symptomatic subluxation, 3 cases of transient nerve palsy and 2 cases of feeling of laxity developed. Limitation of motion after surgery was an average of 3.4° in flexion, and 8.5° in external rotation. With Rowe scoring system, the clinical result was excellent or good in 22 cases and poor in one. According to American shoulder and elbow society, pain score improved to 1.4 from 6.1, and stability score also improved to 1.8 from 9.1. Conclusion: In multidirectional shoulder instability, one should pay attention to finding a coexisting Bankart lesion. In that case, adequate capsular volume reduction by using inferior capsular shift as well as repair of Bankart lesion is needed to get a good surgical outcome.

• Clinics in Shoulder and Elbow
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• 제14권1호
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• pp.125-133
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• 2011

목적: 정형외과 의사로 하여금 역행성 견관절 전치환술의 생역학적 기능과 그 작용을 더 잘 이해할 수 있게 함과 동시에, 최선의 수술적 치료를 시행할 수 있도록 돕는 데 있다. 대상 및 방법: 역행성 견관절 전치환술의 특정한 수술적 기법 및 주의점에 대해 심도있게 설명하고자 하였고, 견갑골 패임이나 능동적 외회전의 복원과 같이 역행성 견관절 전치환술과 관련된 최근의 주된 관심사에 대해서도 살펴보고자 하였다. 결과 및 결론: 수술 후 합병증을 증가시키지 않으면서 최선의 기능적 결과를 얻기 위해서는 역행성 견관절 전치환술의 개념, 그리고 그 수술 기법과 주의점에 대한 철저한 이해가 필수적이다.

• Biomaterials and Biomechanics in Bioengineering
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• 제3권2호
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• pp.115-127
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• 2016

Shoulder pain, injury and discomfort are public health and economic issues world-wide. The function of these joints and the stresses developed during their movement is a major concern to the orthopedic surgeon to study precisely the injury mechanisms and thereby analyze the post-operative progress of the injury. Shoulder is one of the most critical joints in the human anatomy with maximum degrees of freedom. It mainly consists of the clavicle, scapula and humerus; the articulations linking them; and the muscles that move them. In order to understand the behavior of individual muscle during abduction arm movement, an attempt has been made to analyze the stresses developed in the shoulder muscles during abduction arm movement during the full range of motion by using the 3D FEM model. 3D scanning (ATOS III scanner) is used for the 3D shoulder joint cad model generation in CATIA V5. Muscles are added and then exported to the ANSYS APDL solver for stress analysis. Sensitivity Analysis is done for stress and strain behavior amongst different shoulder muscles; deltoid, supraspinatus, teres minor, infraspinatus, and subscapularies during adduction arm movement. During the individual deltoid muscle analysis, the von Mises stresses induced in deltoid muscle was maximum (4.2175 MPa) and in group muscle analysis it was (2.4127MPa) compared to other individual four rotor cuff muscles. The study confirmed that deltoid muscle is more sensitive muscle for the abduction arm movement during individual and group muscle analysis. The present work provides in depth information to the researchers and orthopedicians for the better understanding about the shoulder mechanism and the most stressed muscle during the abduction arm movement at different ROM. So during rehabilitation, the orthopedicians should focus on strengthening the deltoid muscles at earliest.

• Clinics in Shoulder and Elbow
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• 제25권1호
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• pp.73-89
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• 2022

Background: To evaluate the efficacy of autologous platelet-rich plasma (PRP) injections in the treatment of common shoulder diseases. Methods: The PubMed, Medline, and Central databases and trial registries were searched from their inception to October 2020 for randomized controlled trials of autologous PRP injections for shoulder diseases versus placebo or any control intervention. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed in the selection, analysis, and reporting of findings. The primary outcome was pain intensity (visual analog scale), and secondary outcomes were changes in function and quality of life (QoL). Results: A total of 17 randomized controlled trials of PRP versus control were analyzed. From 8-12 weeks to ≥1 year, PRP injections were associated with better pain relief and functional outcomes than control interventions. PRP injections were also associated with greater QoL, with an effect size of 2.61 (95% confidence interval, 2.01-14.17) at medium-term follow-up. Compared with placebo and corticosteroid injections, PRP injections provided better pain relief and functional improvement. In subgroup analyses, trials in which PRP was prepared by the double centrifugation technique, the platelet concentration in the PRP was enriched ≥5 times, leucocyte-rich PRP was used, or an activating agent was used before application reported the most effective pain relief at 6-7 months. Conclusions: PRP injections could provide better pain relief and functional outcomes than other treatments for persons presenting with common shoulder diseases. PRP injections have a greater capacity to improve shoulder-related QoL than other interventions.

• Clinics in Shoulder and Elbow
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• 제25권4호
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• pp.274-281
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• 2022

Background: In the present study, the age- and sex-adjusted Constant score (CS) in a normal Indian population was calculated and any differences with other population cohorts assessed. Methods: The study participants were patients who visited the outpatient department for problems other than shoulder and healthy volunteers from the local population. Patients without shoulder pain/discomfort during activity were included in the study. Subjects with any problem that might affect shoulder function (e.g., cervical, thoracic spine, rib cage deformity, inflammatory arthritis) were excluded. Constant scoring of all participants was performed by trained senior residents under the supervision of the senior faculty. Shoulder range of movement and strength were measured following recommendations given by the research and Development Committee of the European Society for Shoulder and Elbow Surgery (2008). A fixed spring balance was used for strength measurement; one end was fixed on the floor and the other end tied with a strap to the wrist of the participant, arm in 90° abduction in scapular plane with palm facing down. Results: Among the 248 subjects (496 shoulders), the average age was 37 years (range, 18-78 years), 65.7% were males (326 shoulders) and 34.3% females (170 shoulders). The mean CS was 84.6±2.9 (males, 86.1±3.0; females, 81.8±2.9). CS decreased significantly after 50 years of age in males and 40 years of age in females (p<0.05). The mean CS was lower than in previous studies for both males and females. Heavy occupation workers had higher mean CS (p<0.05). A linear standardized equation was estimated for calculating the adjusted CS for any age. Conclusions: Mean CS and its change with age differed from previous studies among various population cohorts.

• 혜화의학회지
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• 제21권1호
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• pp.135-141
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• 2012

Objectives : This study was conducted to understand 4 groups in tentatively named "muscle coordinative manipulation" by Korean medicine. Methods : We researched some articles on meridian-muscle theory and muscle's action that are classified into 4 groups in muscle coordinative manipulation. Results : The outcome of examining the hypothesis is as follows: 1. The 1st hypothesis : 'Elevated shoulder' group mainly consists of muscles that are involved with shoulder elevation, abduction and external rotation. 'Lowered shoulder' group is mainly composed of muscles that acts of shoulder depression, adduction and internal rotation. 'Elevated pelvis' & 'Lowered pelvis' groups didn't show significant features by the movement of the hips. 2. The 2nd hypothesis : Most of muscles in 'elevated & lowered shoulder' groups are classified into 'hand taiyang' meridian-muscle. Most of muscles in 'elevated pelvis' group are included in 'foot jueyin' meridian-muscle. Most of muscles in 'lowered pelvis' group are classified into 'foot taiyang & foot yangming' meridian-muscle. Conclusions : There is no significant classification in muscles that comprise 4 groups in muscle coordinative manipulation when it comes to meridian-muscle theory and muscle function. More studies on chain reaction of muscle and subsequent analysis in Korean medicine are needed.

• 대한관절경학회:학술대회논문집
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• 대한관절경학회 2006년도 제15차 추계학술대회 심포지움
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• pp.35-39
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• 2006

Posterior capsular tightness with glenohumeral internal rotation deficit is usually considered to be an acquired condition of the throwing shoulder and is usually treated conservatively. However, because posterior capsular tightness is sometimes irreversible, we have performed arthroscopic capsular release for painful throwing shoulder with posterior capsular tightness. The true loss of internal rotation and posterior stiffness was confirmed by examination with the patient under anesthesia, and contracture of the posterior capsule and the posterior band of the inferior glenohumeral ligamant was observed arthroscopically. Because an extensive adhesion between the capsule and the fascia of the external rotators was noted, a capsular release was performed from 6 o'clock to 11 o'clock (in the right shoulder) to completely expose the muscle belly of the external rotators. Of the first 16 consecutive patients, 4 had no concomitant lesions and underwent posterior capsular release alone. With a minimum of 2 years' follow-up, it was ascertained that the throwing pain completely disappeared in 14 patients and improved in 2. In all, 11 patients returned to their preinjury performance level, and 5 returned to a lower level of function. In the 4 patients who had no concomitant lesions, throwing pain completely disappeared, and all were able to return to their preinjury performance level.

• Clinics in Shoulder and Elbow
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• 제23권2호
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• pp.100-104
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• 2020

Function and strength of the deltoid muscle are important in reverse shoulder arthroplasty (RSA). Moreover, location and shape of the acromion, clavicle, and scapular spine, which are origins of the deltoid muscle, are also important. The frequency of os acromiale is 5% to 15%; however, it is rare in the Asian population, affecting approximately 0.7% of Koreans. RSA has rarely been reported in patients with os acromiale. We present a case series of two patients with cuff tear and arthropathy combined with os acromiale who underwent RSA. From 2016 to 2018, two patients with os acromiale who presented with pain and limited range of motion (ROM) underwent RSA with cuff tear arthropathy using the subscapularis-sparing deltopectoral approach. Their ROM, visual analog scale (VAS), and satisfaction were evaluated before and after surgery. In both patients, VAS decreased, ROM increased, and postoperative satisfaction increased. There were no specific complications due to os acromiale. The VAS, ROM, and satisfaction of patients improved after surgery compared with values before surgery. However, careful attention must be given during surgery to ensure optimal repair and recovery.

• 대한산업공학회지
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• 제25권2호
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• pp.266-273
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• 1999

The maximum work capacity at various shoulder angles was estimated in terms of joint moment through maximum voluntary contraction (MVC) measurement, and the result was compared to workload computed from 3-D static lifting model (3DSSPP) based upon national institute of safety and health (NIOSH) lifting guideline (1991). The electromyography (EMG) of anterior/posterior deltoid and trapezius muscle was also recorded to study the function of individual muscle during asymmetric shoulder lifting. Psychophysical workload was measured to observe the difference from MVC or biomechanical estimation. An apparatus was constructed for the study and twenty five trials including five flexion angles and five add/abduction angles were performed isometrically. Results indicated that MVC at 30 degree of flexion was the strongest whereas MVC at 120 degree was the weakest. In case of add/abduction, MVC decreased to 77 to 89 % during add/abduction compared to the MVC at neutral position. Regarding the normalized EMG value, a substantial increase was observed at 30 and 60 degree abduction. More importantly, the shoulder moment computed from maximum permissible limit (MPL) was greater than the moment at MVC condition during 30 degree adduction. Current result can be used as a reference information for a safe workplace design to prevent the shoulder from an excessive work load in industry.

• 한국전문물리치료학회지
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• 제26권4호
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• pp.53-62
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• 2019

Background: Shoulder function is achieved by the coordinated movements of the scapula, humerus, and thoracic spine, and shoulder disorders can be associated with altered scapular kinematics. The trunk plays an important role as the kinematic chain during arm elevation. Objects: The purpose of this study was to determine the effects of thoracic hyperkyphosis on scapular orientation and trunk motion. Methods: Thirty-one subjects (15 in the ideal thorax group and 16 in the thoracic hyperkyphosis group) performed right-arm abduction and adduction movements in an unconstrained plane. The scapular orientation and trunk motion were recorded using a motion analysis system. Results: Those subjects with thoracic hyperkyphosis displayed greater scapular posterior tilting at a $120^{\circ}$ shoulder elevation, greater scapular internal rotation throughout the arm raising phase, and greater trunk axial rotation at the upper ranges of the shoulder elevation, compared to those subjects with an ideal thorax (p<.05). Conclusion: Thoracic hyperkyphosis can cause scapular instability, greater trunk rotation and greater scapular posterior tilting, and may contribute to preventing the achievement of a full range of humeral abductions in an unconstrained plane.