• Clinics in Shoulder and Elbow
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• v.25 no.1
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• pp.15-21
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• 2022

Background: This study was performed to identify the incidence of screw in-type lateral anchor pull-out in patients older than 60 years who underwent rotator cuff repair for large to massive rotator cuff tear (RCT). Methods: We reviewed 25 patients over 60 who were diagnosed with large to massive RCT and underwent arthroscopic rotator cuff repair in our hospital from March 2017 to February 2021. Preoperative tear size (anterior to posterior, medial to lateral) was measured via preoperative magnetic resonance imaging (MRI). All 25 patients underwent MRI scanning on postoperative day 1 and at 3 months after surgery. The change of anchor position was measured in axial views on MRI images postoperative day 1 and 3 months after surgery. And it was statistically compared according to bone mineral density (BMD), sex, and number of lateral anchors. Results: Two MRIs (postoperative day 1 and 3 months) in 25 patients were compared. Anchor pull-out occurred in six patients during 3 months (6.7%), and the mean pull-out length difference was 1.56 mm (range, 0.16-2.58 mm). There was no significant difference in the number of pull-out anchors, degree of pull-out difference by comparing BMD (A, BMD≤-2.5; B, BMD>-2.5), sex, or number of anchors used in each surgery (C, two anchors; D, three anchors) (p>0.05). Conclusions: Pull-out of screw in-type anchors was rarely observed and the mean pull-out length difference was negligibly small in our study. The screw in-type lateral anchor seems to be a decent option without concern of anchor pull-out even in elderly patients.

• Clinics in Shoulder and Elbow
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• v.24 no.3
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• pp.135-140
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• 2021

Background: We hypothesized in this study that the characteristics of retear cases vary according to surgeon volume and that surgical outcomes differ between primary and revision arthroscopic rotator cuff repair (revisional ARCR). Methods: Surgeons performing more than 12 rotator cuff repairs (RCRs) per year were defined as high-volume surgeons, and those performing fewer than 12 RCRs were considered low-volume surgeons. Of the 47 patients who underwent revisional ARCR at our clinic enrolled in this study, 21 cases were treated by high-volume surgeons and 26 cases by low-volume surgeons. In all cases, the interval between primary surgery and revisional ARCR, degree of "acromial scuffing," number of anchors, RCR technique, retear pattern, fatty infiltration, retear size, operating time, and clinical outcome were recorded. Results: During primary surgery, significantly more lateral anchors (p=0.004) were used, and the rate of use of the double-row repair technique was significantly higher (p<0.001) in the high- versus low-volume surgeon group. Moreover, the "cut-through pattern" was observed significantly more frequently among the cases treated by high- versus low-volume surgeons (p=0.008). The clinical outcomes after revisional ARCR were not different between the two groups. Conclusions: Double-row repair during primary surgery and the cut-through pattern during revisional ARCR were more frequent in the high- versus low-volume surgeon groups. However, no differences in retear site or size, fatty infiltration grade, or outcomes were observed between the groups.

• PNF and Movement
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• v.20 no.2
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• pp.223-233
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• 2022

Purpose: The study aimed to determine the effect of extra thoracic mobilization exercises on shoulder pain and function in patients who had undergone rotator cuff repair. Methods: Following the recording of baseline measurements, 20 subjects who had undergone rotator cuff repair were randomized into two groups: the experimental group (n = 10), which did thoracic mobilization exercises, and the control group (n = 10), which received traditional physical therapy. Each group participated in the intervention five times per week for two weeks. The pain (using the visual analogue scales [VAS]), the flexion and abduction range of motion (ROM), and the shoulder pain and disability index (SPADI) scores of both groups were recorded pre- and post-intervention. Paired t-tests were used to determine whether post-intervention scores were significantly different from pre-intervention scores, and independent t-tests were used to analyze differences in the dependent variables between the two groups. Results: After the two-week intervention, both groups experienced significantly decreased VAS and SPADI scores (p < 0.05) and significantly increased flexion and abduction ROM (p < 0.05). The experimental group that undertook the thoracic mobilization exercises showed greater improvements in pain, flexion and abduction ROM, and the SPADI than the control group (p < 0.05). Conclusion: These results suggest that thoracic mobilization exercises reduce shoulder pain and disability and enhance function in patients who have undergone rotator cuff repair.

• PNF and Movement
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• v.21 no.1
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• pp.75-86
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• 2023

Purpose: This study aims to determine the effect of proprioceptive neuromuscular facilitation (PNF) pectoralis minor stretching and lower trapezius strengthening exercise on posture change, shoulder range of motion (ROM), and pain in rotator cuff repair patients with a rounded shoulder posture (RSP). Methods: Following baseline measurements, the subjects (n = 25) with rotator cuff repair were randomized into two groups: the PNF group (n = 13), which engaged in PNF pectoralis minor stretching and lower trapezius strengthening exercise, and the control group (n = 12), which received traditional physical therapy. Each group participated in the intervention five times per week for two weeks. The RSP values for the postural changes, flexion and abduction ROM, and visual analogue scales (VASs) of both groups were recorded at both pre- and post-intervention. In addition, before and after the intervention, a paired t-test was conducted to compare the within-group changes and an independent t-test to compare the between-group differences. Results: After the two-week intervention, both groups experienced significantly decreased RSP and VAS values (p < 0.05) and a significantly increased ROM (p < 0.05). Meanwhile, the PNF group showed greater improvements in RSP, ROM, and VAS than the control group (p < 0.05). Conclusion: These results suggest that PNF pectoralis minor stretching and lower trapezius strengthening exercise reduce posture and shoulder pain and enhance ROM in rotator cuff repair patients with RSP.

• Journal of Korean Medicine Rehabilitation
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• v.34 no.3
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• pp.43-51
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• 2024

Objectives The purpose of this study is to analyze trends of domestic research in Korean medicine treatment for rotator cuff tear. Methods Among the clinical papers published before March 2024, we used five databases for searching researches; Korean studies Information Service System, Oriental Medicine Advanced Searching Integrated System, Research Information Sharing Service, KMbase, ScienceON. Results 11 studies were finally selected. Acupuncture was used as a treatment in all 11 studies and pharmacopucture was used in 7 studies. Visual analogue scale and range of motion were frequently used as measurement tools. Most of the studies were case reports. Conclusions This study is a review about literatures on Korean medicine treatment for rotator cuff tear. In order to develop treatment and diagnosis of rotator cuff tear in the Korean medicine, more clinical studies with higher level of evidence should be conducted in the near future.

• Clinics in Shoulder and Elbow
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• v.27 no.2
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• pp.149-159
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• 2024

Background: In rotator cuff repair, the long head of the biceps tendon (LHB) is commonly used as graft material. However, factors influencing LHB tear severity are poorly understood, and predicting grade II LHB tears is challenging. This study aimed to identify these factors preoperatively. Methods: The demographics, medical parameters, and pain severity of 750 patients who underwent arthroscopic surgery from January 2010 to February 2021 were evaluated to determine the factors associated with LHB tear severity and grade II tears. Both overall and large-to-massive rotator cuff tear (RCT) cohorts underwent ordinal and binary logistic regression analyses. Predictive accuracy for grade II LHB tears was determined using the area under the receiver operating characteristic curve (AUC). Results: In the overall cohort, high-sensitivity C-reactive protein (hs-CRP) >1 mg/L (P<0.001), subscapularis tear (P<0.001), hypothyroidism (P=0.031), and the tangent sign (P=0.003) were significantly associated with LHB tear severity, and hs-CRP>1 mg/L, subscapularis tear, and Patte retraction degree were significantly associated with grade II LHB tears (P<0.001). In the large-to-massive RCT cohort, hs-CRP>1 mg/L, hypertension, and age ≥50 years (P<0.05) were significantly associated with LHB tear severity, and hs-CRP>1 mg/L (P<0.001) and hypertension (P=0.026) were significantly associated with grade II LHB tears. In both cohorts, hs-CRP >1 mg/L demonstrated good predictive accuracy for grade II LHB tears (AUCs: 0.72 and 0.70). Conclusions: Serum hs-CRP >1 mg/L is associated with LHB tear severity and serves as a reliable predictor of grade II LHB tears, facilitating preoperative assessment of the LHB as potential graft material in arthroscopic rotator cuff repair. serves as a reliable predictor of grade II LHB tears, facilitating preoperative assessment of the LHB as potential graft material in arthroscopic rotator cuff repair. Level of evidence: III.

• Clinics in Shoulder and Elbow
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• v.4 no.2
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• pp.173-180
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• 2001

Aim: To evaluate validity and responsiveness of four shoulder scoring systems. Material and Method: Twenty-five cases of shoulder instability(22 traumatic, 3 non-traumatic) and twenty-three cases of rotator cuff tear(12 small or medium, 10 large or massive) treated surgically were evaluated with the Shoulder Function Score of the University of Pennsylvania(Penn FS), Constant Score, UCLA Shoulder Rating Scale and Simple Shouler Test(SST), preoperatively and at final follow-up. The average follow-up was 16.0 months in instability group and 17.5 months in rotator cuff tear group. Using the SPSS program, Pearson linear correlation coefficiency(PLCC) between the scores were calculated. And to assess the construct validity, PLCC between patients' satisfaction and the scores were also calculated. Responsiveness was measured by the standardized response mean(SRM). Result: In instability group, correlation between the scoring systems was low preoperatively except between Constant and SST, but high after operation. Patients' satisfaction with the scores showed low PLCC preoperativley, but high PLCC postoperatively. SRM was high in PENN and UCLA, but when the satisfaction segment of the score was eliminated from UCLA, the SRM was the lowest. In rotator cuff tear group, there was high correlation between the scores not only preoperatively but postoperatively. And the patients' satisfaction matched well with the scores. SRM was particularly high in UCLA and SST. Even when satisfaction segment was eliminated from UCLA, the SRM was still the highest. Conclusion : Evaluation by the 4 scoring systems investigated in the study showed less consistency in instability than rotator cuff tear in terms of correlation and validity. Responsiveness was generally higher in rotator cuff tear group than in instability group except for Pennsylvania Shoulder Function Score. Therefore it is construed that use of any among the four scoring systems doesn't make difference in evaluation of rotator cuff lesions. However in instability group, care is needed because different result may be obtained according to the selection of a scoring system.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.1 no.1
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• pp.23-26
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• 2008

Ultrasonography (USG) is widely accepted diagnostic method for the rotator cuff tear. The availability, low cost, easy to access is main factors that favor USG as a primary diagnostic modality for various cuff disorders. We experienced a case of discrepancy between USG, MR arthrography (MRA) and arthroscopic examination. Seventy four year old female patient complained of right shoulder pain. USG depicted rotator cuff tear with the size of 1cm, and MRA demonstrated about 3cm sized tear. Complex massive tear with delamination of degenerated rotator cuff was identified in the arthroscopic examination. When we encounter a patient who has loss of rotator cuff power or severe symptom than findings of USG, MRA or repeat USG is warranted. We report a case of discrepancy between examination modalities with brief review of the literature.

• Journal of Korean Orthopaedic Sports Medicine
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• v.7 no.2
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• pp.59-66
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• 2008

• 대한정형외과스포츠의학회:학술대회논문집
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• 2007.04a
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• pp.33-43
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• 2007