• Progress in Medical Physics
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• v.19 no.4
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• pp.269-275
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• 2008

Although MR imaging is generally applicable to depict knee joint deterioration it, is sometimes occurred to mis-read and mis-diagnose the common knee joint diseases. In this study, we employed magnetization transfer ratio (MTR) method to improve the diagnosis of the various knee joint diseases. Spin-echo (SE) T2-weighted images (TR/TE 3,400-3,500/90-100 ms) were obtained in seven cases of knee joint deterioration, FSE T2-weighted images (TR/TE 4,500-5,000/100-108 ms) were obtained in seven cases of knee joint deterioration, gradient-echo (GRE) T2-weighted images (TR/TE 9/4.56/$50^{\circ}$ flip angle, NEX 1) were obtained in 3 cases of knee joint deterioration, In six cases of knee joint deterioration, fat suppression was performed using a T2-weighted short T1/tau inverse recovery (STIR) sequence (TR/TE =2,894-3,215 ms/70 ms, NEX 3, ETL 9). Calculation of MTR for individual pixels was performed on registration of unsaturated and saturated images. After processing to make MTR images, the images were displayed in gray color. For improving diagnosis, three-dimensional isotropic volume images, the MR tristimulus color mapping and the MTR map was employed. MTR images showed diagnostic images quality to assess the patients' pathologies. The intensity difference between MTR images and conventional MRI was seen on the color bar. The profile graph on MTR imaging effect showed a quantitative measure of the relative decrease in signal intensity due to the MT pulse. To diagnose the pathologies of the knee joint, the profile graph data was shown on the image as a small cross. The present study indicated that MTR images in the knee joint were feasible. Investigation of physical change on MTR imaging enables to provide us more insight in the physical and technical basis of MTR imaging. MTR images could be useful for rapid assessment of diseases that we examine unambiguous contrast in MT images of knee disorder patients.

• Journal of Korean Foot and Ankle Society
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• v.22 no.2
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• pp.55-61
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• 2018

Chronic lateral ankle instability is a major complication of acute ankle sprains, which can cause discomfort in both daily and sports activity. In addition, it may result in degenerative changes to the ankle joint in the long term. An accurate diagnostic approach and successful treatment plan can be established based on a comprehensive understanding of the concept of functional and mechanical instability. The patients' history and correct physical examination would be the first and most important step. The hindfoot alignment, competence of the lateral ligaments, and proprioceptive function should be evaluated. Additional information can be gathered using standard and stress radiographs. In addition, concomitant pathologic conditions can be investigated by magnetic resonance imaging. Conservative rehabilitation composed of the range of motion, muscle strengthening, and proprioceptive exercise is the main treatment for functional instability and mechanical instability. Regarding the mechanical instability, surgical treatment can be considered for irresponsible patients after a sufficient period of rehabilitation. Anatomic repair (modified $Brostr{\ddot{o}}m$ operation) is regarded as the gold standard procedure. In cases with poor prognostic factors, an anatomical reconstruction or additional procedures can be chosen. For combined intra-articular pathologies, arthroscopic procedures should be conducted, and arthroscopic lateral ligament repair has recently been introduced. Regarding the postoperative management, early functional rehabilitation with short term immobilization is recommended.

• Physical Therapy Korea
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• v.27 no.2
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• pp.133-139
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• 2020

Background: The gastrocnemius (GCM) is one of the lower extremity muscles that tend to tighten easily. GCM tightness results in limited ankle dorsi-flexion (DF), especially when the knee joint is fully extended. Joint flexibility is determined by the morphological and physiological characteristics of joints, muscles, tendons, and ligaments. Impaired joint flexibility can be attributed to increased susceptibility to muscle injury. High-frequency diathermy is clinically used to reduce pain and muscle tightness and to improve limited range of motion. Objects: This study aimed to investigate the immediate effects of high-frequency therapy in subjects with GCM tightness. Methods: The study was designed as a one-group before-after trial. The subjects included 28 volunteers with GCM tightness (an active ankle DF angle of less than 12°) without any known neurological and musculoskeletal pathologies in the ankle and calf areas. WINBACK Transfer Electrode Capacitive and Resistive Therapy equipment was used to apply high-frequency therapy to the subjects' GCMs for 10-15 minutes. The pennation angle and the fascicle length of the GCM were measured using ultrasonography. The flexibility of the ankle joint, peak torque to the passive ankle DF (Biodex), and soft tissue stiffness (MyotonPRO) were also measured. Results: The pennation angle was significantly decreased following the treatment; however, no significant difference in the fascicle length was found (p < 0.05). The flexibility was significantly increased and both the passive peak torque to passive ankle DF and the soft tissue stiffness significantly decreased (p < 0.05). Conclusion: High-frequency therapy is immediately effective for improving the muscle's architectural properties and functional factors in subjects with GCM tightness. Further longitudinal clinical studies are required to investigate the long-term effects of high-frequency therapy on subjects with GCM tightness from various causes.

• Korean Journal of Computational Design and Engineering
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• v.17 no.3
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• pp.149-155
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• 2012

The ankle over-pronation causes the mechanical overloading transferred to proximal areas (i.e. knees or hips) over time. Thus, the over-pronation is recognized as a contributory factor in a wide variety of musculo-skeletal pathologies in lower extremities. Commonly, over-pronated ankles are treated using specially designed insoles that support medial heels and correct the posture of lower limbs. However, the biomechanical effects of the insoles are not yet fully understood, so there still are controversies whether such insoles really have clinical significance. In this study, in order to verify the effects of insoles and determine the best shape of the insoles, we examined how the medio-lateral knee joint reaction force changes due to insole conditions through a case study about a subject. As a result, it is revealed that the medial heel post, which drastically reduced the peak medio-lateral knee joint reaction force, has significant effects on the gait of the over-pronated patients. However, in case that the arch support is combined together, the positive effect of the medial heel post may rather decrease.

• International Journal of Contents
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• v.6 no.1
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• pp.41-46
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• 2010

The aim of this study was to investigate the effect of different shoe-heel heights on the surface electromyographic (EMG) activity of vastus medialis (VM) and vastus lateralis (VL) during treadmill walking in female patients with patellofemoral pain (PFP). Nineteen women with PFP participated in this research. EMG signals were recorded from the VM and VL of both sides and were compared during the treadmill walking. The subjects walked on a treadmill wearing shoes of three different heel heights: 1 cm, 3 cm and 7 cm. Each subject walked on a treadmill for five minutes at a speed of 2 km/hour with three minutes resting intervals between consecutive trials. The data were analyzed by one-way repeated-measures analysis of variance. The results of the present study indicate that EMG data of the VM and VL of female patients with PFP did improve with an increase in the height of the shoe heel, which were statistically significant. Additionally, the EMG activity of VM increased more dramatically than that of VL associated with the task of walking with high-heeled shoes on the treadmill. This study suggests that the type of high-heeled shoes is related to the VM and VL muscle activation patterns contributing to knee joint pathologies in female patients with PFP.

• Clinics in Shoulder and Elbow
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• v.25 no.1
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• pp.42-48
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• 2022

Background: Total shoulder arthroplasty (TSA) has been demonstrated to be an effective treatment for multiple shoulder pathologies. The purpose of our study was to compare the relative value units (RVUs) per minute of surgical time for primary and revision TSA. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients that underwent primary TSA, one-component revision TSA, and two-component revision TSA between January 1, 2015 and December 31, 2017 using current procedure terminology codes. RVUs were divided by mean operative time for each procedure to determine the amount of revenue generated per minute. Rates were compared between the groups using a one-way analysis of variance with post-hoc Tukey test. Statistical significance was set at p<0.05. Results: When dividing compensation by surgical time, we found that two-component revision generated more compensation per minute compared to primary TSA (0.284±0.114 vs. 0.239±0.278 RVU per minute or $10.25±$4.11 vs. $8.64±$10.05 per minute, respectively; p=0.001). Conclusions: The relative value of revision TSA procedures is weighted to account for the increased technical challenges and time associated with these procedures. This study confirms that reimbursement is higher for revision TSA compared to primary TSA.

• The Korean Journal of Pain
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• v.21 no.2
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• pp.164-167
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• 2008

Frozen shoulder is known to be a self-limited disease, and it is associated with chronic pain and limitation of joint movement. Although its etiology is still unknown, frozen shoulder is associated with several diseases. The diagnosis is made based on the medical history, the clinical and radiological examinations and exclusion of other shoulder pathologies. The skeleton is one of the most common sites of metastasis in patients with lung cancer. It has been reported that the incidence of bone metastases in lung cancer patients is approximately 30-40%, and the median survival time of patients with such metastases is 6-7 months. We experienced a case of a 77-year-old female patient who complained of right shoulder pain and limited joint mobility, and these symptoms were due to metastatic lung cancer in the shoulder.

• The Journal of the Korean bone and joint tumor society
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• v.2 no.1
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• pp.1-7
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• 1996

PURPOSE : The purpose of this study is to know the ability of detecting malignant tumor tissue by Tl-201 scan, and to compare with that of Tc-99m-MIBI and Tc-99m-MDP scan. MATERIAL AND METHODS : Between February 1994 and December 1995,38 unselected patients with various bone pathologies were studied prospectively. Eighteen had malignant bone and soft tissue pathologies, while twenty had benign. All patients were studied with Tl-201, Tc-99mMIBI and Tc-99m-MDP scan prior to surgical biopsy. PICKER Prism 2000 gamma camera with high resolution parallel hole collimator was used for scanning. To avoid the interaction of isotope, the early(30min.) and delayed phase(3hrs.) of Tl-20l scan was performed first and Tc-99m-MIBI scan was performed after 30 minutes, and then Tc-99m-MDP scan 48 hours later. The scan images were visually evaluated by a blinded nuclear medicine physician. We could find true positive, true negative, false positive and false negative by the comparison of results with those of biopsy. We calculated positive and negative predictive value(%), sensitivity(%), specificity(%) and diagnostic accuracy(%) of each scan. RESULT : The results of each scan were 85.7, 100, 100, 85, 92.1% in Tl-201, 81, 94.1, 94.4, 80, 86.8% in Tc-99m-MIBI and 50, 66.7, 88.9, 20, 52.6% in Tc-99m-MDP scan. As a conclusion, Tl-201 scan was the most specific and accurate method for detecting malignant tumor tissue. Tc-99m-MIBI scan was also good for malignant tumor searching. CONCLUSION : With our results, we can use Tl-201 scan to differentiate benign from malignant tumor, and to evaluate the response of preoperative chemotherapy or radiotherapy, and to determine the residual tumor or local recurrence. For the better result, we need to have a more detail information about false positive cases and a more objective and quantitative reading technique.

• Journal of the Korean Arthroscopy Society
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• v.12 no.3
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• pp.211-216
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• 2008

Purpose: The frequency of foreign body in the knee joint is not as high, but it sometimes required wide or multiple arthrotomy in order to remove, which can baffle the surgeon in some ways. Our study is to evaluate for effectiveness of arthroscopic retrieval for intra-articular foreign body in the knee joint. Materials and Methods: The 22 patients(16 males, 6 females) had received arthroscopic foreign body retrieval in the knee joint from March 1983 to September 2006. The causes of foreign bodies of the knee joint were 7 of trauma (31.9%) related cases, 13 of surgery related cases (59.0%), 2 found during follow up after operation (8.1%) in pathologies of foreign body. Results: There were 15 of metal showed the most percentage (68.1%), 7 of non-metal (31.9%) in types of foreign bodies, and others included bullet, suture material, pencil lead, broken wire etc. All cases were used by arthroscopic techniques. All foreign bodies were removed easily and were showed no complication such as postoperative joint stiffness. Conclusion: Arthroscopic foreign body retrieval in the knee joint is effective surgery in terms of easy access to foreign body and less postoperative complication.

• Clinics in Shoulder and Elbow
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• v.21 no.2
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• pp.82-86
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• 2018

Background: Although a common shoulder disease, there are no accepted classification criteria for frozen shoulder (FS). This study therefore aimed to evaluate the accuracy of the conventionally used FS classification system. Methods: Primary FS patients (n=168) who visited our clinic from January 2010 to July 2015 were included in the study. After confirming restrictions of the glenohumeral joint motion and absence of history of systemic disease, trauma, shoulder surgery, shoulder muscle weakness, or specific x-ray abnormalities, the Zuckerman and Rokito's classification was employed for diagnosing primary FS. Following clinical diagnosis, each patient underwent a shoulder magnetic resonance imaging (MRI) and blood tests (lipid profile, glucose, hemoglobin A1c, and thyroid function). Based on the results of the blood tests and MRIs, the patients were reclassified, using the criteria proposed by Zuckerman and Rokito. Results: New diagnoses were ascertained including blood test results (16 patients with diabetes, 43 with thyroid abnormalities, and 149 with dyslipidemia), and MRI revealed intra-articular lesions in 81 patients (48.2%). After re-categorization based on the above findings, only 5 patients (3.0%) were classified having primary FS. The remaining 163 patients (97.0%) had either undiagnosed systemic or intrinsic abnormalities (89 patients), whereas 74 patients had both. Conclusions: These findings demonstrate that most patients clinically diagnosed with primary FS had undiagnosed systemic abnormalities and/or intra-articular pathologies. Therefore, a modification of the Zuckerman and Rokito's classification system for FS may be required to include the frequent combinations, rather than having a separate representation of systemic abnormalities and intrinsic causes.