• 대한정형외과 초음파학회지
• /
• 제1권2호
• /
• pp.112-116
• /
• 2008

최근 견관절 질환에 대한 이해가 높아짐에 따라서 견관절에서 초음파의 유용성 또한 급격히 증가하는 추세이다. 초음파 검사는 비 침습적이며 검사 비용이 저렴할 뿐만 아니라 견관절에서는 유일하게 회전근 개의 움직임을 실시간으로 관찰할 수 있다는 큰 장점이 있다. 견관절 초음파 검사는 일반적으로 환자가 앉은 자세에서 실시하며, 검사 순서는 전방에서부터 시작하여 후방 관절 구조물들을 확인하면서 검사를 마친다. 초음파 검사는 견관절 주위의 여러 근육과 인대, 관절와 순, 골 구조 등을 확인할 수 있으며, 특히 회전근 개 질환의 진단에 큰 도움을 준다. 회전근 개는 견갑하근, 극상근, 극하근, 그리고 소 원형근의 네 개의 근육으로 이루어진 하나의 운동 단위이며, 견관절의 능동 운동시 지렛점으로 작용하여 견관절 운동을 원활하게 조종하는 역동적 안정 요소의 기능을 담당한다.

• Journal of Acupuncture Research
• /
• 제18권5호
• /
• pp.1-10
• /
• 2001

Objective : This study was performed to confirm the effects of acupuncture on myofascial pain syndrome(MPS) through the change of visual analogue scale(VAS) and pain pressure threshold(PPT) and the usefulness of pressure algometer on the evaluation of pain. Methods : We perfomed this study with 20 outpatients complaining of upper back pain. Before acupuncture therapy(AT), immediately after AT and 2-3 days after AT, we respectively checked visual analogue scale(VAS) and pain pressure threshold(PPT) through pressure algometer, with patients seated and relaxed. The PPT was checked at major trigger point of upper trapezius, levator scapulae, supraspinatus, infraspinatus, rhomboideus minor. and the patients were needled at the same points and maintained for 15 minutes. Results : VAS of immediately after AT was mild higher than that of before AT, but not significantly different. and VAS of 2-3 days after AT was significantly lower than before AT and immediately after AT. PPT of immediately after AT was lower than before PT, but not significantly different. PPT of 2-3 days after AT was significantly higher than that of before AT and immediately after AT. Also PPT was significantly correlated with VAS. Conclusion : PPT of omen was signicantly lower than that of men. and there was no significant difference by age. PPT was increased according to pain duration. Effectiveness of acupuncture on myofascial pain syndrome through PPT and VAS is showed at 2-3 days after AT rather than immediatly after AT. and pressure algometer is useful for the evaluation of Acupuncture therapy on myofascial pain syndrome.

• 근관절건강학회지
• /
• 제4권1호
• /
• pp.74-86
• /
• 1997

This investigation has been conducted based on the medical chart of 344 patients who have been diagnosed of fibromyalgia syndrome during Oct. 9, 1996 through Nov. 20 at the Rheumatism Hospital of H. University located in Seoul. 280 which have been included in the analysis. 1. Only one patient was male in 280 patients, age distribution was from 28 to 76, in which the average age was 52.4. 2. Percentage of treatment duration was 6 months in 46.1%, 3 years in 22.1% and 2 years in 12.5%. Considering these results, it can be predicted that the number of patients might be increased and accumulated in the future. 3. Percentage of patients having primary fibromyalgia syndrome was 39.3%, having combination with osteoarthritis was 36.7% and the rest case have combination with rheumatoid arthritis at the same time. 4. The percentage of cases having patients 10-12 tender points was 37.1%, while the most of cases have pain at 12-19 tender points. The common locations of the tender point were at lateral epicondyle of elbow in 92.0%, at midpoint of upper border Trapezius in 84.8%, at upper part of scapula Supraspinatus in 82.9%, at medial fat pad proximal to the joint line knee in 81.85%, at intertransverse of $C_{5-7}$ Low cervical in 73.4% and at 2nd distal costochondral Junction 2nd rib in 72.0%. And most of the patients had joint functional disability at all in 47.1% with average 2.41 joint functional disability. 5. Age was not a variable influencing the number of tender points and the number of joint functional disability.

• Clinics in Shoulder and Elbow
• /
• 제12권2호
• /
• pp.245-249
• /
• 2009

목적: 견관절의 관절와 순 병변과 정상적인 해부학적 변형에 대해서 많은 연구가 이루어졌다. 관절와 순 병변을 치료하는데 있어서 버포드 병변 및 관절하순 공 등의 해부학적 변형 등은 항상 감별을 요하게 된다. 대상 및 방법: 정상 변형을SLAP병변으로 오인한 19세 여자환자에 대해 관절경적 수술을 시행하였다. 결과: 관절경적 소견 상 상완 이두근 장두가 상부 관절낭 및 극상근건에 부착되어 있는 소견이 관찰되었고, 이것이 SLAP 병변으로 오인된 것으로 판단된다. 결론: 이에 저자들은 상부 관절와 순 전후 병변으로 진단되어 관절경 수술을 시행하던 중 경험한 상부 관절와 순과 이두박근 장건의 부착부위 간의 드문 해부학적 정상 변형을 문헌 고찰과 함께 보고하고자 한다.

• Clinics in Shoulder and Elbow
• /
• 제21권4호
• /
• pp.207-212
• /
• 2018

Background: Delaminated rotator cuff tear is known to be a degenerative tear having a negative prognostic effect. This study undertook to compare the anatomical and clinical outcomes of delaminated tears and single layer tears. Methods: Totally, 175 patients with medium to large rotator cuff tears enrolled for the study were divided into 2 groups, based on the tear pathology: single layer tear (group 1) and delaminated tear (group 2). Preoperatively, length of the remnant tendon, muscle atrophy of supraspinatus (SS), and fatty degeneration of SS and infraspinatus (IS) muscles were assessed on magnetic resonance imaging (MRI). For follow-up, the repair integrity of the rotator cuff was evaluated by ultrasonography. Clinical outcomes were assessed by evaluating the Constant score (CS) and Korean Shoulder Score (KSS). Results: Retears were detected in 6 cases of group 1 (6.5%) and 11 cases of group 2 (13.3%). Although higher in group 2, the retear rate was significantly not different (p=0.133). Preoperative MRI revealed length of remnant tendon to be $15.46{\pm}3.60mm$ and $14.17{\pm}3.16mm$ (p=0.013), and muscle atrophy of SS (occupation ratio) was $60.54{\pm}13.15$ and $56.55{\pm}12.88$ (p=0.045), in group 1 and group 2, respectively. Fatty degeneration of SS and IS in both groups had no significant differences. Postoperatively, no significant differences were observed for CS and KSS values between the groups. Conclusions: Delaminated rotator cuff tears showed shorter remnant tendon length and higher muscle atrophy that correlate to a negative prognosis. These prognostic effects should be considered during delaminated rotator cuff tear treatment.

• Clinics in Shoulder and Elbow
• /
• 제22권1호
• /
• pp.9-15
• /
• 2019

Background: Latissimus dorsi (LD) tendon transfer is used as a treatment option for massive irreparable posterosuperior rotator cuff tears, and recently, an arthroscopic-assisted technique was introduced. This study was undertaken to evaluate the clinical and radiological outcomes of arthroscopic-assisted LD tendon transfer for the management of irreparable rotator cuff tears in active middle-aged patients. Methods: The records of five patients (two males) with irreparable tears involving the supraspinatus and infraspinatus tendons managed by arthroscopic-assisted LD tendon transfer were retrospectively reviewed. Clinical outcomes were assessed using the visual analogue scale (VAS) pain scale, American Shoulder and Elbow Surgeon's (ASES) scores, the University of California Los Angeles (UCLA) scale, and ranges of motion. Postoperative integrities of transferred tendon were evaluated by magnetic resonance imaging in 4 patients and by ultrasound in one. Results: Mean patient age was 55 years (range, 48-61 years), and mean follow-up period was 20 months (range, 12.0-27.2 months). Mean VAS score significantly improved from $6.6{\pm}2.6$ preoperatively to $1.8{\pm}2.5$ postoperatively (p=0.009), mean ASES score increased from $67.6{\pm}9.2$ to $84.6{\pm}15.1$, and mean UCLA score from $18.0{\pm}1.4$ to $28.8{\pm}8.5$ (all p<0.001). Postoperative imaging of the transferred LD tendon showed intact repair in 4 patients. The remaining patient experienced LD transfer rupture and a poor outcome. Conclusions: Arthroscopic-assisted LD tendon transfer improved shoulder pain and function in patients with massive, irreparable rotator cuff tears, and may be an option for this condition, especially in physically active patients.

• Investigative Magnetic Resonance Imaging
• /
• 제22권4호
• /
• pp.229-239
• /
• 2018

Purpose: To assess the diagnostic performance in detecting rotator cuff tears at 3T of non-arthrographic shoulder magnetic resonance imaging (MRI) using 3D isotropic turbo spin-echo (TSE-SPACE) sequence as compared with 2D sequences. Materials and Methods: Seventy-four patients who were arthroscopically confirmed to have underwent non-arthrographic shoulder MRI with 2D sequences and TSE-SPACE were included. Three independent readers retrospectively scored supraspinatus and infraspinatus tendon (SST-IST) and subscapularis tendon (SCT) tears on 2D sequences and TSE-SPACE. Results: The mean sensitivity, specificity, and accuracy of the three readers were 95%, 100%, and 95% on TSE-SPACE and 99%, 93%, and 98% on 2D sequences for detecting SST-IST tears, respectively, whereas those were 87%, 49%, and 68% on TSESPACE and 88%, 66%, and 77% on 2D sequences for detecting SCT tears, respectively. There was no statistical difference between the two sequences, except for in the specificity of one reader for detecting SCT tears. The mean AUCs of the three readers on TSE-SPACE and 2D sequences were 0.96 and 0.98 for detecting SST-IST tears, respectively, which were not significantly different, while those were 0.71 and 0.82 for detecting SCT tears, respectively, which were significantly different (P < 0.05). Conclusion: TSE-SPACE may have accuracy and reliability comparable to conventional 2D sequences for SST-IST tears at non-arthrographic 3T shoulder MRI, whereas TSE-SPACE was less reliable than conventional 2D sequences for detecting SCT tears.

• Clinics in Shoulder and Elbow
• /
• 제24권2호
• /
• pp.55-65
• /
• 2021

Background: Although ultrasound-guided needle decompression (US-GND) can treat calcific tendinitis of the shoulder effectively, repeat procedures might be required for unresolved symptoms. We evaluated the overall clinical outcomes of US-GND with subacromial steroid injection and the final results and factors predisposing toward repeat procedures. Methods: Ninety-eight patients who underwent US-GND for calcific tendinitis of the supraspinatus/infraspinatus were analyzed between March 2017 and December 2018. The clinical outcomes (pain visual analog scale, functional visual analog scale [FVAS], and American Shoulder and Elbow Surgeons [ASES] score) and final subjective satisfaction were compared between groups A (single US-GND) and B (repeat US-GND). The factors predisposing toward repeated US-GNDs were analyzed. Results: We found that 59.3% (58/98) of patient ASES scores were ≥80, and 73.5% of patients (72/98) were satisfied with the outcome. Group B (n=14) demonstrated a significantly higher rate of dominant-arm involvement compared to group A (78.6% vs. 48.8%, p=0.046). However, initial calcification size, shape, number, density, subscapularis involvement, lavage, and procedure time did not differ significantly between the groups. Group B showed poorer final FVAS (7 [interquartile range, 6-8] vs. 8 [interquartile range, 7-9], p=0.036) and subjective satisfaction compared to group A (satisfied: 5 [35.7%] vs. 67 [79.8%], p<0.001]. Conclusions: US-GND with subacromial steroid injection is a viable treatment option for calcific tendinitis of the shoulder. Dominant-arm involvement was the only independent factor for repeated US-GND. Final outcome of repeated US-GND for unimproved patients was promising; however, these outcomes were poor compared to those of the patients who improved after the first procedure.

• 대한정형도수물리치료학회지
• /
• 제26권2호
• /
• pp.45-53
• /
• 2020

Purpose: The purpose of this study was conducted to investigate the effects of kinesio taping and coordination exercise on the myofascial pain syndrome and shoulder function. Methods: The patients with myofascial pain syndrome were participated in this study and divided randomly 2 groups. Control group (n=22) was taken only physical therapy program. Experimental group (n=22) was taken physical therapy with Kinesio taping and coordination exercise. The Kinesio taping in experimental group applied on levator scapulae and supraspinatus. The coordination exercise performed in supine position and sitting position on 15 times during 10 seconds each positions. We measured the pain degree using visual analog scale (VAS), pain rating score (PRS), pressure pain threshold (PPT), myofascial pain subjects symptoms index and shoulder motor function using constant shoulder assessment scale; CSA before and after experiment. Results: The significant test of CSA, myofascial pain subjects symptoms index, VAS, PRS according to applying the Kinesio taping and coordination exercise between groups used ANCOVA. In the result following analysis, there was significance on VAS (F=13.071, p=.031), PRS (F=12.130, p=.014), PPT (F=7.378, p=.016), CSA (F=5.302, p=.026) between control group and experimental group. Conclusion: Then, Kinesio taping and coordination exercise has benefit on the VAS, PRS, PPT, CSA in patients with myofascial pain syndrome. So, it may suggest that Kinesio taping combined with coordination exercise will be helpful of the pain and shoulder function improvement the patients with myofascial pain syndrome.

• Investigative Magnetic Resonance Imaging
• /
• 제25권1호
• /
• pp.1-9
• /
• 2021

The aim of this study was to provide a new assessment of rotator cuff muscle activity. Eight male subjects (24.7 ± 3.2 years old,171.2 ± 9.8 cm tall, and weighing 63.8 ± 11.9 kg) performed the study exercises. The subjects performed 10 sets of the exercise while fixing the elbow at 90 degrees flexure and lying supine on a bed. One exercise set consisted of the subject performing external shoulder rotation 50 times using training equipment. Two imaging protocols were employed: (a) true fast imaging with steady precession (TrueFISP) at an acquisition time of 12 seconds and (b) multi-shot spin-echo echo-planar imaging (MSSE-EPI) at an acquisition time of 30 seconds for one echo. The main method of assessing rotator cuff muscle activity was functional T2 mapping using ultrafast imaging (fast-acquired muscle functional MRI [fast-mfMRI]). Fast-mfMRI enabled real-time imaging for the identification and evaluation of the degree of muscle activity induced by the exercise. Regions of interest were set at several places in the musculus subscapularis (sub), musculus supraspinatus (sup), musculus teres minor (ter), and deltoid muscle (del). We used the MR signal of the images and transverse relaxation time (T2) for comparison. Most of the TrueFISP signal was not changed by exercise and there was no significant difference from the resting values. Only the T2 in the musculus teres minor was increased after one set and the change were seen on the T2 images. Additionally, except for those after one and two sets, the changes in T2 were significant compared to those at rest (P < 0.01). We also demonstrated identify and visualize the extent to which muscles involved in muscle activity by exercise. In addition, we showed that muscle activity in a region such as a shoulder, which is susceptible to B0 inhomogeneity, could be easily detected using this technique.