• Clinics in Shoulder and Elbow
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• v.25 no.4
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• pp.257-264
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• 2022

Background: Chronic subscapularis tendon tear (SBT) is a degenerative disease and a common pathologic cause of shoulder pain. Several potential risk factors for chronic SBT have been reported. Although metabolic abnormalities are common risk factors for degenerative disease, their potential etiological roles in chronic SBT remains unclear. The purpose of this study was to investigate potential risk factors for chronic SBT, with particular attention to metabolic factors. Methods: This study evaluated single shoulders of 939 rural residents. Each subject undertook a questionnaire, physical examinations, blood tests, and simple radiographs and magnetic resonance imaging (MRI) evaluations of bilateral shoulders. Subscapularis tendon integrity was determined by MRI findings based on the thickness of the involved tendons. The association strengths of demographic, physical, social, and radiologic factors, comorbidities, severity of rotator cuff tear (RCT), and serologic parameters for SBT were evaluated using logistic regression analyses. The significance of those analyses was set at p<0.05. Results: The prevalence of SBT was 32.2% (302/939). The prevalence of partial- and full-thickness tears was 23.5% (221/939) and 8.6% (81/939), respectively. The prevalence of isolated SBT was 20.2% (190/939), SBT combined with supraspinatus or infraspinatus tendon tear was 11.9% (112/939). In multivariable logistic regression analysis, dominant side involvement (p<0.001), manual labor (p=0.002), diabetes (p<0.001), metabolic syndrome (p<0.001), retraction degree of Patte tendon (p<0.001), posterosuperior RCT (p=0.010), and biceps tendon injury (p<0.001) were significantly associated with SBT. Conclusions: Metabolic syndrome is a potential risk factor for SBT, as are these factors: overuse activity, diabetes, posterosuperior RCT, increased retraction of posterosuperior rotator cuff tendon, and biceps tendon injury.

• Clinics in Shoulder and Elbow
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• v.22 no.1
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• pp.9-15
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• 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.

• Journal of the Korean Arthroscopy Society
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• v.5 no.1
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• pp.27-31
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• 2001

Purpose : The purpose of this study was to evaluate results of the arthroscopic treatment of calcific tendinitis of the shoulder resistant to conservative treatment. Materials and Methods : From March, 1996 to June, 1998, fourteen patients underwent shoulder arthroscopy to treat resistant calcific tendinitis of the rotator cuff despite conservative treatment for more than 6 months. Calcium deposits were localized to the supraspinatus tendon only in eleven patients, the supraspinatus and infraspinatus tendon in two patients, and to the supraspinatus and subscapularis tendon in one patient. Each shoulder was evaluated with UCLA shoulder rating scale and Constant-Murley score Results : The Constant-Murley pain score improved from average score 3.2 before surgery to average score 8.3 after surgery, and the UCLA functional average score improved from 4.5 preoperatively to 8.3 postoperatively. Preoperative ROM averaged $110^{\circ}$ of flexion, $45^{\circ}$ of external rotation, $90^{\circ}$ of abduction, and internal rotation with the thumb reaching to the spinous process of the third lumbar vertebra, but postoperative range of motion averages improved as follows: $170^{\circ}$ or flexion, $50^{\circ}$ of external rotation, $140^{\circ}$ abduction, and internal rotation with the spinous process of the twelveth thoracic vertebra. Overall 3 patients were rated excellentm 9 were good, 2 were fair. Conclusion : Shoulder arthroscopy is an effective treatment in patients with refractory calcific tendinitis.

• Journal of Korean Orthopaedic Sports Medicine
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• v.11 no.2
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• pp.75-81
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• 2012

Purpose: To evaluate the ultrasonographic (US) findings in both shoulders of asymptomatic high school baseball players and compare with healthy control. Materials and Methods: 42 individuals (age: $7.6{\pm}1.2$ years) participated in this study. We recruited two groups of high school male baseball players, 14 pitchers and 18 fielders without shoulder pain for recent 6 months as well as one control group of 10 untrained healthy high school students who were age-matched. Ultrasound measurements of thickness of the biceps and supraspinatus tendon and acromio-humral distance (AHD) at $0^{\circ}$ abduction were taken in dominant and nondominant shoulders. Results: On US examination, subacromial bursa effusion was observed in 7 of the dominant shoulders and in 2 of the nondominant shoulder of 32 baseball players and in none of the asymptomatic controls. The thickness of the biceps and supraspinatus tendons and AHD in both shoulders were significantly greater in the baseball players than in the controls (p<0.05). We also found that the biceps and supraspinatus tendon thickness and AHD of the dominant shoulder were significantly greater than the non-dominant shoulder in baseball players (p<0.05), but there were no differences between pitchers and fielders and between healthy controls. Conclusion: Subacromial effusion could be found even in the asymptomatic stage and the thickness of the biceps and supraspinatus tendons and AHD were significantly greater in the baseball players than in the healthy controls. Our data is useful reference guide for the ultrasonographic diagnosis of shoulder pathologies occurring in high school baseball players.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.5 no.2
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• pp.81-88
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• 2012

Purpose: To evaluate the ultrasonographic (US) findings in both shoulders of asymptomatic high school overhead athletes and compare with healthy control. Materials and Methods: 33 individuals (age: $17.5{\pm}1.4$ years) participated in this study. We recruited two groups of high school male athletes, 13 baseball and 10 volleyball players without shoulder pain for recent 6 months as well as one control group of 10 untrained healthy high school students who were age-matched. Ultrasound measurements of thickness of biceps and supraspinatus tendon and acromio-humral distance (AHD) at 0o abduction were taken in dominant and nondominant shoulders. Results: On US examination, subacromial bursa effusion was observed in 5 of the dominant shoulders and in 1 of the nondominant shoulder of 23 overhead athletes and in none of the asymptomatic controls. The thickness of the biceps and supraspinatus tendons and AHD in both shoulders were significantly greater in the athletes than in the controls (P<0.05). We also found that the thickness of the biceps and supraspinatus tendon and AHD of the dominant shoulder were significantly greater than the non-dominant shoulder in overhead athletes (P<0.05), but there were no differences between baseball and volleyball players. Conclusion: Subacromial effusion could be found even in the asymptomatic stage overhead athlete and the thickness of the biceps and supraspinatus tendons and AHD were significantly greater in the overhead athletes than in the healthy controls. Our data is useful reference guide for the ultrasonographic diagnosis of shoulder pathologies occurring in overhead athletes.

• Clinics in Shoulder and Elbow
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• v.18 no.2
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• pp.61-67
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• 2015

Background: The purposes of the study were to examine rotator cuff tendon degeneration with respect to harvesting location, to determine a rationale for debridement of the torn end, and thus, to determine adequate debridement extent. Methods: Twenty-four patients with a full-thickness rotator cuff tear were included in the study. Tendon specimens were harvested during arthroscopic rotator cuff repair from three locations; from torn ends after minimal regularization of fraying (native end group, NE group), from torn ends after complete freshening of the frayed end (freshened end group, FE group), and from the macroscopically intact portion just distal to the musculotendinous junction (musculotendinous junction group, MTJ group). Control samples were harvested from patients admitted for surgery for proximal humerus fracture. Harvested samples were evaluated using a semi-quantitative grading scale. Results: Mean total degeneration scores in the NE group ($13.3{\pm}3.21$), the FE group ($12.5{\pm}2.30$), and in the MTJ group ($10.8{\pm}3.10$) were significantly higher than those in the normal control group ($5.0{\pm}2.87$; all p<0.001). Mean total degeneration score in the NE group was significantly higher than that in the MTJ group (p=0.012), but was not from that of the FE group. Mean total degeneration score in the FE group was not significantly different from that of the MTJ group. Conclusions: Tendon degeneration exists throughout the entire tendon to the macroscopically intact portion of full-thickness rotator cuff tear. Therefore, aggressive debridement to grossly normal appearing, bleeding tendon is unnecessary for enhancing healing after repair.

• Clinics in Shoulder and Elbow
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• v.26 no.2
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• pp.131-139
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• 2023

Background: Massive rotator cuff tears (RCTs) are complicated by muscle atrophy, fibrosis, and intramuscular fatty degeneration, which are associated with postoperative tendon-to-bone healing failure and poor clinical outcomes. We evaluated muscle and enthesis changes in large tears with or without suprascapular nerve (SN) injury in a rat model. Methods: Sixty-two adult Sprague-Dawley rats were divided into SN injury (+) and SN injury (-) groups (n=31 each), comprising tendon (supraspinatus [SSP]/infraspinatus [ISP]) and nerve resection and tendon resection only cases, respectively. Muscle weight measurement, histological evaluation, and biomechanical testing were performed 4, 8, and 12 weeks postoperatively. Ultrastructural analysis with block face imaging was performed 8 weeks postoperatively. Results: SSP/ISP muscles in the SN injury (+) group appeared atrophic, with increased fatty tissue and decreased muscle weight, compared to those in the control and SN injury (-) groups. Immunoreactivity was only positive in the SN injury (+) group. Myofibril arrangement irregularity and mitochondrial swelling severity, along with number of fatty cells, were higher in the SN injury (+) group than in the SN injury (-) group. The bone-tendon junction enthesis was firm in the SN injury (-) group; this was atrophic and thinner in the SN injury (+) group, with decreased cell density and immature fibrocartilage. Mechanically, the tendon-bone insertion was significantly weaker in the SN injury (+) group than in the control and SN injury (+) groups. Conclusions: In clinical settings, SN injury may cause severe fatty changes and inhibition of postoperative tendon healing in large RCTs. Level of evidence: Level Basic research, controlled laboratory study.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2008.03a
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• pp.91-93
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• 2008

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2008.03a
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• pp.167-167
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• 2008

연부조직에서의 연골종은 주로 수부에서 드물게 보고되고 있으나, 견관절의 회전근 개 내에 발생한 경우는 보고된 바 없다. 저자들은 견관절의 상관절와순 파열로 내원한 30세 남자에서 발견된 극상건 내 연골종을 관절경적으로 치료하여 좋은 결과를 얻었기에 문헌 고찰과 함께 보고하고자 한다.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2009.03a
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• pp.80-80
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• 2009