• Clinics in Shoulder and Elbow
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• 제7권1호
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• pp.14-22
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• 2004

Purpose: To evaluate a usefulness of the simple radiograph in the patients with chronic shoulder pain 50 years and older. Material and method: 1152 patients with chronic shoulder pain and 100 asymptomatic individuals were involved in this study. All patients were 50 years and older. We excluded patients who had a history of fracture or dislocation. Radiographic interpretation was performed on a shoulder AP view, an axillary view and a supraspinatus outlet view. For statistical analysis, a chi-square test was performed. A p value of <0.05 was considered statistically significant. Results: Abnormal radiologic findings were identified in 369(32%) out of 1152 patients with a shoulder pain: greater tuberosity sclerosis, acromial sclerosis, subacromial osteophytes are common abnormal radiologic findings. A rotator cuff tear or impingement syndrome was identified on a final diagnosis in 61(85.2%) out of the 76 patients with radiologic abnormalities in both greater tuberosity and acromion (p<0.05). Abnormal radiologic findings were identified in 18% of the asymptomatic individuals. Conclusion: Simple radiographic analysis is an important primary diagnostic tool in patients (50 years and old) with chronic shoulder pain.

• Clinics in Shoulder and Elbow
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• 제5권1호
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• pp.42-46
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• 2002

Purpose : To analyze the outcome after barbotage and subacromial corticosteroid injection in acute pain attack with calcific tendinitis of the shoulder. Materials and Methods : Twenty-two patients with acute calcific tendinitis were analyzed with average follow-up of Twenty-two months. The shape and size of calcific deposits were classified. The outcome was assessed by UCLA shoulder score and pain in visual analogue scale(VAS). Results : Sixteen patients(73%) had permanent relief of pain. The results assessed by UCLA score were excellent in fourteen patients and good in two patients. Average VAS for pain was 0.6 ± 0.73 (range:0-2). No complication was enccpuntered, but six patients underwent surgical treatment due to lack of improvement or recurrence. Conclusion : Barbotage as a primary treatment in acute calcific tendinits of the shoulder is simple and effective, and therefore should be tried before surgical intervention.

• The Journal of Korean Physical Therapy
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• 제30권1호
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• pp.8-13
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• 2018

Purpose: The present study was to investigate effects of scapular position and pain on a trunk stabilization exercise with gym ball for patients with arthroscopic rotator cuff repair. Methods: Subjects were patients after 2 weeks of rotator cuff repairs. Subjects were randomly assigned to conservative treatment group (CTG, n=10) or trunk stabilization with gym ball group (SBG, n=10), and participated one of those groups for 2 weeks. Measurements about pain and scapular position were assessed in before and after treatment programs. Results: Pain reduced in both rest and night in SBG compared to CTG. In the case of scapular position, decreased scapular retraction (increased protraction) was found in CTG and vice versa in SBG. Reduced scapular anterior tilting was also found on SBG. Conclusion: The present study showed that early performed trunk stabilization with gym ball could bring a scapular alignment that increases subacromial space and reduces pain. This suggests early trunk stabilization with gym ball programs to restore shoulder functions for patients with rotator cuff repair.

• Clinics in Shoulder and Elbow
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• 제18권1호
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• pp.21-27
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• 2015

Background: To report the radiological and clinical outcomes of internal fixation using distal clavicle hook plates for distal clavicle fractures. Methods: From April 2008 to December 2012, 32 patients with distal clavicle fractures underwent surgery using an AO hook plate. The reduction was qualified and evaluated according to the radiological findings. The evaluation of the clinical outcomes was performed with the University of California at Los Angeles (UCLA) score, the Korean Shoulder score, and the visual analogue scale (VAS) pain score. Results: By radiological evaluation, we found that 31 of 32 patients showed anatomical reduction and solid bone union. Although we obtained satisfactory UCLA scores, Korean Shoulder Scale scores, and VAS pain scores, 12 cases of complications were present. We found 4 cases of osteolysis of the acromion, 1 case of nonunion, 3 cases of periprosthetic fractures, 3 cases of subacromial pain, and 1 case of skin irritation. We performed re-operations in 2 patients. Conclusions: To avoid complications associated with clavicle hook plates, choosing the appropriate hook size and bending of the hook according to the slope of the acromion undersurface is critical. Also, we believe that early removal of clavicle plates may help reduce complications.

• Clinics in Shoulder and Elbow
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• 제18권1호
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• pp.47-51
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• 2015

Iatrogenic damage of the rotator cuff followed by postoperative shoulder function loss is a potential complication after antegrade intramedullary nailing (AIN) for a humeral fracture. The authors present a case of arthroscopic rotator cuff repair and subacromial decompression of a non-healed rotator cuff tendon (mainly supraspinatus) and secondary impingement syndrome caused either by the tear or a proud nail after AIN for a mid-shaft humeral fracture. At presentation, the patient complained of right shoulder pain and 'snapping', especially during forward elevation and abduction of the shoulder, of 4 years duration. Right shoulder pain started sometime after pain due to the humeral shaft fracture, operation had subsided, and persisted after nail removal. Arthroscopic findings showed a longitudinal rotator cuff tear at the nail entry point that had not healed and severe fibrous hypertrophy on the acromion underspace, which is a unique finding since most longitudinal splits of tendon fibers are more likely to heal than conventional rotator cuff tears detached from bone. The torn rotator cuff was repaired after debridement and placing side-to-side sutures. At his 34-month follow-up after rotator cuff repair, the patient showed complete recovery and had excellent clinical scores.

• Clinics in Shoulder and Elbow
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• 제2권2호
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• pp.106-109
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• 1999

Purpose : The purpose of this study is to evaluate morphology of acromion in relation to age and symmetry in asymptomatic adults. Materials and Methods: Seventy five asymptomatic adults were divided into two groups by age(A group of age twenties and B group of age over forty) and both acromial outlet views were obtained. One hundred fifty radiographs were typed and assessed radiologically by methods of Getz and Liotard. Results: The relative percentages of acromial types I, Ⅱ, and Ⅲ were 3%, 90% and 7% in the A group and 6%, 82% and 12% in the B group respectively, Subacromial peak and spinoacromial angle were 4.3mm, 82 degrees in the A group and 4.6mm, 78 degrees in the B group. Conclusion: Incidence of type is not related to age in normal adult and type II is the most common type. Spinoacromial angle is decreased in older age group and type Ⅲ.

• Clinics in Shoulder and Elbow
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• 제19권3호
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• pp.143-148
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• 2016

Background: The purpose of our study was to evaluate the accuracy of reduction based on postoperative computed tomography (CT) images after arthroscopic stabilization using tightrope system for unstable distal clavicle fracture. Methods: Twelve patients with distal clavicle fracture combined with coracoclavicular (CC) ligament injury (type II, V) who received arthroscopically assisted fixation using a flip button device were evaluated for accuracy of reduction using 3-dimensional postoperative CT scan by measuring the degree of distal clavicular angulation and clavicular shortening. Results: Immediate postoperative plain radiograph confirmed restoration of the CC distance (CCD) in 10 patients. At final follow-up, the CCD remained reduced anatomically on plain radiographs in these patients. All patients showed excessive posterior angulation and shortening compared to the opposite side. The average Constant score recovered to 94.8 at final follow-up. Conclusions: Indirect reduction and arthroscopic subacromial approach with flip button fixation of unstable distal clavicle fractures demonstrated favorable clinical results despite unavoidable posterior angulation of distal clavicle and shortening the total length of clavicle.

• 한국전문물리치료학회지
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• 제23권2호
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• pp.84-92
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• 2016

Background: Strengthening the supraspinatus is an important aspect of a rehabilitation program for subacromial impingement and tendinopathy. Many authors recommended empty-can (EC), full-can (FC), and prone full-can (PFC) exercises to strengthen the supraspinatus. However, no ultrasonography study has yet investigated supraspinatus muscle architecture (muscle thickness; MT, pennation angle; PA, fiber bundle length; FBL) in relation to supraspinatus strengthening exercises. Objects: The purpose of this study was to compare the architecture (MT, PA, and FBL) of the supraspinatus muscle during three different types of exercises (EC, FC, and PFC) using diagnostic ultrasound. Methods: Participants performed three different exercises: (A) EC; the arm was maintained at $60^{\circ}$ abduction with full internal rotation in the sitting position, (B) FC; the arm was maintained at $60^{\circ}$ abduction with full external rotation in the sitting position, and (C) PFC; the arm was maintained at $60^{\circ}$ abduction with full external rotation in the prone position. Ultrasonography was used to measure the MT, PA and FBL of the supraspinatus. One-way repeated analysis of variance with Bonferroni's post-hoc test was used to compare between the three exercises and the initial position of each exercise. Results: Compared with each initial position, the FC exercise showed the greatest mean difference in muscle architecture properties and the PFC exercise showed the least mean difference. Conclusion: The findings suggest that the FC exercise position may have an advantage in increasing the amount of contractile tissue or producing muscle power and the PFC exercise position may be useful in a rehabilitation program because it offers the advantage of maintaining the muscle architecture properties.

• Clinics in Shoulder and Elbow
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• 제2권1호
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• pp.35-40
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• 1999

Impingement syndrome is caused by a conflictual status between rotator cuff, subacromial bursa and anatomic and functional coracoacromial arch. The purpose of this study was to assessment the coracoacromial arch by MRI and to determine major factors among five components of coracoacromial arch. We analyzed forty-two cases of clinical impingement sign and test positive and postoperative confirmed diagnosed from March, 1991 to January, 1999. We evaluated acromial end abnormality according to the Bigliani acromial type and formation of osteophyte. Clavicular end abnormality classified flat, outward protrusion, inward protrusion to coracoacromial arch. Acromioclavicular joint abnormalities were advanced osteoarthritis and positive signal change. Coracoacromial ligament thickening was above 2 mm in oblique sagittal image. Coracoid process abnormality was inward protrusion to coracoacromial arch. All consecutive patients abnormalities were as follows: clavicular end osteophyte formation and inward protrusion to coracoacrmial arch were 30%, acromial end osteophyte formation was 28%, advanced acromioclavicular joint arthritis and osteophyte formation were 56%, coracoacromial ligament thickening was 24% and no coracoid process inward protrusion to coracoacromial arch. Impingement syndrome combined with rotator cuff tear group abnormalities were clavicular end(40%), acromial end(40%), acromioclavicular joint(20%), coracoacromialligament(20%) and coracoid process abnormality(0%) respectively. Only impingement syndrome group abnormalities were clavicular end(25%), acromial end(31%), acromioclavicular joint(62%), coracoacromial ligament(25%) and coracoid process(0%) respectively. Acromial type I(flat) were 6 cases, type II(curved) were 26 cases and type III(hooked) were 10 cases. We concluded that the most important contributing factors for impingement syndrome was acromial type and second was acromioclavicular joint arthritis and bony spur formation.

• Clinics in Shoulder and Elbow
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• 제17권4호
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• pp.159-165
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• 2014

Background: Kirschner's wire (K-wire) transfixation and locking hook plate fixation techniques are widely used in the treatment of acute acromioclavicular joint (ACJ) dislocation. The purpose of this study was to compare the clinical and radiologic outcomes between K-wires transfixation and a locking hook plate fixation technique. Methods: Seventy-seven patients with acute ACJ dislocation managed with K-wire (56 shoulders) and locking hook plate (21 shoulders) were enrolled for this study. The mean follow-up period was 61 months. Results: At the last follow-up, the shoulder rating scale of the University of California at Los Angeles (UCLA) was higher in patients treated with locking hook plate than with K-wires ($33.2{\pm}2.7$ vs. $31.3{\pm}3.4$, p=0.009). In radiologic assessments, coracoclavicular distance (CCD) (7.9 mm vs. 7.7 mm, p=0.269) and acromioclavicular distance (ACD) (3.0 mm vs. 1.9 mm, p=0.082) were not statistically different from contralateral unaffected shoulder in locking hook plate fixation group, but acromioclavicular interval (ACI) was significant difference. However, there were significant differences in ACI, CCD, and ACD in K-wire fixation group (p<0.001). Eleven complications (20%) occurred in K-wire transfixation group and 2 subacromial erosions on computed tomography scan occurred in locking hook plate fixation group. Conclusions: ACJ stabilization was achieved in acute ACJ dislocations treated with K-wires or locking hook plates. Locking hook plate can provide higher UCLA shoulder score than K-wire and maintain CCD, and ACD without ligament reconstruction. K-wire transfixation technique resulted in a higher complication rate than locking hook plate.