• 대한정형외과학회지
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• 제55권2호
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• pp.103-116
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• 2020

회전근 개 파열은 인구의 고령화 및 영상 진단의 발전 등으로 인해 그 빈도가 빠르게 증가하고 있다. 최근에는 관절경적 봉합술이 일반화되어 있으며 수술 결과 역시 관혈적 봉합술과 대등한 유합률을 보이고 있다. 관절경적 수술 자체가 최소 침습적 방법이므로 수술 후 통증 감소와 조기 기능 향상이라는 부가적인 이점을 가질 수 있지만 최근에는 견관절의 관절경 수술 후 환자의 기능 회복을 더욱 향상시키기 위한 다양한 방법에 대한 관심이 높아지고 있다. 견관절 관절경 수술 후 기능 회복 치료 방법들은 수술 후 시기별로 나누어져 있으며 각 단계별로 활발히 연구되고 개선되고 있다. 그러나 각 시기별, 재활 단계별, 환자 개개인의 특성, 회전근개 파열의 정도 및 기저 질환에 따라 다양한 방법들이 많아 관절경적 회전근 개 봉합술 후 정상 견관절 상태로의 기능 회복을 위해 각 시기에 맞는 적합한 견관절의 기능 회복 방법에 대한 확립이 필요하다고 할 수 있다.

• Clinics in Shoulder and Elbow
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• 제25권4호
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• pp.296-303
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• 2022

Background: A previous study reported that hyperlipidemia increases the incidence of tears in the rotator cuff tendon and affects healing after repair. The aim of our study was to compare the gene and protein expression of torn rotator cuff tendons in patients both with and without hypercholesterolemia. Methods: Thirty patients who provided rotator cuff tendon samples were classified into either a non-hypercholesterolemia group (n=19, serum total cholesterol [TC] <200 mg/dL) and hypercholesterolemia group (n=11, serum TC ≥240 mg/dL) based on their concentrations of serum TC. The expression of various genes of interest, including COL1A1, IGF1, IL-6, MMP2, MMP3, MMP9, MMP13, TNMD, and TP53, was analyzed by real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR). In addition, Western blot analysis was performed on the proteins encoded by interleukin (IL)-6 and TP53 that showed significantly different expression levels in real-time qRT-PCR. Results: Except for IGF1, the gene expression levels of IL-6, MMP2, MMP9, and TP53 were significantly higher in the hypercholesterolemic group than in the non-hypercholesterolemia group. Western blot analysis confirmed significantly higher protein levels of IL-6 and TP53 in the hypercholesterolemic group (p<0.05). Conclusions: We observed an increase in inflammatory cytokine and matrix metalloproteinase (MMP) levels in hypercholesterolemic patients with rotator cuff tears. Increased levels of IL-6 and TP53 were observed at both the mRNA and protein levels. We suggest that the overexpression of IL-6 and TP53 may be a specific feature in rotator cuff disease patients with hypercholesterolemia.

• 대한관절경학회지
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• 제16권1호
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• pp.72-78
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• 2012

회전근 개는 비교적 좁은 견봉하 공간에 위치하며 신체의 다른 관절에서와 마찬가지로 노화에 따른 구조적인 변화를 겪게 된다. 일단 회전근 개 파열이 발생하면 파열된 건의 자연 치유는 기대하기 힘들며 다양한 요인들이 이 질환의 경과에 관여한다. 파열된 건 섬유는 지속적인 긴장 하에 놓여 파열의 크기는 시간이 흐를수록 증가하는 것이 보통이고 전형적으로 파열부의 퇴축이 진행된다. 영상 검사상의 소견과 증상의 발현과는 서로 상관 관계가 크지 않고, 견봉하 점액낭염 또는 관절와 상완 관절의 정상적인 역학에 변화가 초래되어 증상이 발생한다. 회전근 개 질환의 병인과 관련하여 많은 의견들이 있다. 회전근 개 질환이 실제 동일 경과를 밟는 일관된 양상을 보이기 보다는 각기 다른 경과를 보이는 이 질환의 다양성 때문에 그 병인과 관련된 다양한 관점이 있음을 부분적으로 설명하게 해 준다. 회전근 개 질환의 발병 원인은 노화에 따른 퇴행성 변성으로 대표되는 내인성 요인과 역학적 요인, 즉 외인성 요인으로 구분하여 설명하고 있으며, 이들은 서로 상호 작용을 하면서 질환을 진행시키는 것으로 보인다. 회전근 개 질환의 성공적인 치료를 위해서는 회전근 개의 구조, 기능, 병태 생리, 그리고 이 질환의 자연 경과에 대한 이해가 필수적이라 할 수 있다.

• Journal of Acupuncture Research
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• 제33권4호
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• pp.165-180
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• 2016

Objectives : This study is aimed to report the effectiveness of ultrasound-guided bee venom pharmacopuncture in rotator cuff disease patients. Methods : We treated 4 rotator cuff disease patients with ultrasound-guided bee venom pharmacopuncture and integrative Korean Medical Treatment. The Numeric Rating Scale(NRS), Shoulder Pain And Disability Index(SPADI), and Range Of Motion(ROM) were applied as outcome measures. Results : Comparing before and after treatment, both NRS and SPADI scores were decreased, and ROM was increased in all cases. And adverse events about bee venom pharmacopuncture have not been observed. Conclusion : This study shows ultrasound-guided bee venom pharmacopuncture has a meaningful clinical effect on the improving shoulder pain, disability and ROM.

• 대한관절경학회지
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• 제12권2호
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• pp.82-86
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• 2008

최근 회전근개 질환을 수술적으로 치료하는 경우가 점점 많아지고 있다. 회전근개 파열의 술후 재활 치료는 진단, 수술만큼이나 중요하며 성공적인 치료 결과에 결정적 영향을 미친다. 또한 적절한 재활 치료를 위해서는 견관절의 해부학적, 생역학적 이해를 필요로 한다. 술후 재활은 추가 손상을 방지하고, 염증을 줄이며, 교원질의 회복을 도모하고 약해진 근육을 강화시키며 유착, 구축 등에 의해 감소된 관절 운동을 회복하고, 쉽게 피로한 근육의 지구력을 기르면서 봉합 부위와 삼각근을 보호해야 한다. 이러한 치료 지침은 환자의 조건에 따라서 개별화 되어야만 할 것이다.

• Clinics in Shoulder and Elbow
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• 제17권2호
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• pp.91-100
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• 2014

Partial-thickness rotator cuff tear (PTRCT) is not single disease entity but one phase of disease spectrum. Symptoms of PTRCT vary from being asymptomatic to severe pain leading to deterioration in quality of life. Pathogenesis of degenerative PTRCT is multifactorial. Whereas articular sided PTRCT is usually caused by internal causes, both internal and external causes have important role in bursal sided PTRCT. A detailed history, clinical examination and magnetic resonance angiography are used in the diagnosis of PTRCT. Treatment of PTRCT is chosen based on age, demands of patients, causes and depth of tear. In most patients, non-operative treatment should be initiated. Whereas debridement can be done for less than 6 mm of articular sided PTRCT and in less than 3 mm of bursal sided PTRCT, repair techniques should be considered for higher grade PTRCT than that. Although the effect of acromioplasty is not clear, acromioplasty may be performed when the extrinsic causes appear to be the cause of tear. Either transtendon repair technique or repair after tear completion provided satisfactory clinical outcomes in treatment of articular sided PTRCT.

• 대한정형외과 초음파학회지
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• 제6권2호
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• pp.53-59
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• 2013

목적: 회전근 개 환자의 진단에 사용되는 관절 조영술 후 컴퓨터 단층 촬영 (CT arthrography, CTA)과 초음파 검사의 소견을 관절경에서 확인된 결과와 비교하여 두 검사의 진단적 가치를 평가하고자 하였다. 대상 및 방법: 회전근 개 질환으로 의심된 57명에서 CTA를 시행하였고, 이 중 28명에서는 초음파 검사를 동시에 시행하였다. 관절경 소견을 기준으로 하여, 회전근 개의 전 층 및 부분 층 파열에 대한 두 검사의 진단적 가치와 파열 크기에 대한 예측도를 평가하였다. 결과: CTA는 전 층 파열에 대한 민감도가 86.2%, 특이도가 100%, 부분 층 파열에 있어서 민감도는 58.3%, 특이도 87.8%의 결과를 보였다. 초음파 검사는 전 층 파열에 있어서는 민감도 84.6%, 특이도 86.7% 부분 층 파열에 대해서는 민감도 84.6%, 특이도 73.3%의 고른 결과를 보였지만, 파열의 크기를 예측하는 데는 CTA보다 낮은 정확성을 보였다. 결론: 두 검사 모두 회전근 개 질환에서 우수한 진단적 가치를 보였으며, CTA는 동일 환자에서 시행한 초음파 검사와 비교할 때, 부분 층 파열에 대한 정확성은 떨어지나, 파열의 크기를 예측하는 데는 더 높은 효용성을 보였다.

• Clinics in Shoulder and Elbow
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• 제17권2호
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• pp.64-67
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• 2014

Background: The purpose of this study was to determine whether in patients with rotator cuff tears a correlation exists between molecular changes and clinical parameters such as age, duration of symptom, range of motion, and tear size. Molecular changes of matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) were assessed by measuring messenger RNA (mRNA) levels of the two proteins. Methods: The rotator cuff tissue from was obtained from the edge of a torn tendon revealed after debridement by a motorized shaver. Using the sample of rotator cuff tissue, the reverse transcription polymerase chain reaction was performed to quantify MMP-2 and TIMP-2 mRNA expression. To determine whether mRNA levels and the clinical variables, such as age, defect size, range of motion (ROM) of shoulder, and duration of symptoms, show any correlation, Spearman's correlation coefficients were used to test for significant differences. Results: There was an inverse correlation between the mRNA levels of MMP-2 and TIMP-2 from the torn rotator cuff tendons regardless of the clinical variables. However, comparison of mRNA levels versus clinical parameters such as age, defect size, range of motion and duration of symptoms revealed a number of findings. We found a significant correlation between age and mRNA levels of MMP-2 from torn cuffs (r = 0.513, p = 0.021). Further, we found a significant correlation between defect size in the full thickness tears and mRNA levels of MMP-2 (r = 0.454, p = 0.045). Conversely, no significant association between mRNA levels of MMP-2 and ROM or duration of symptom was found. Conclusions: Our results suggest that both MMP-2 and TIMP-2 may be involved in the disease process of rotator cuff tears. Although the level of mRNA expression of MMP-2 and TMP-2 remain constant in torn rotator cuffs irrespective of the clinical variables, their levels may be influenced by age and defect size, which could account to change in tendon degradation and the healing process.

• Journal of Acupuncture Research
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• 제38권1호
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• pp.20-31
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• 2021

The objective was to evaluate the effectiveness and safety of acupuncture for patients with rotator cuff diseases. There were 12 electronic databases and 3 trial registries searched up to November 30th, 2019. All randomized trials were eligible, regardless of language, date of publication, or settings. The primary outcomes were pain, shoulder function, and proportion of improved participants assessed within 12 weeks of randomization of the trial. The Cochrane risk of bias for the studies was assessed. Effects sizes were presented as a risk ratio, mean difference, or standardized mean difference with a 95% confidence intervals. Grading of Recommendations Assessment, Development and Evaluation approach was adopted to rate certainty of evidence. Of the 3,686 records screened, 28 randomized trials (2,216 participants) were included in this review. The types of acupuncture included manual acupuncture, dry needling, electroacupuncture, acupotomy, warm needle acupuncture, and fire needle acupuncture. All of the studies had an unclear or high risk of bias related to more than 1 domain. Significant benefits of acupuncture in terms of pain and shoulder function were observed in all comparisons, however, the proportion of improved participants was not described in 2 comparisons. There was substantial heterogeneity among meta-analyzed trials. No serious harm was observed. For primary outcomes, the overall certainty of evidence was very low. There was very low certainty of evidence for the benefits of acupuncture for patients with rotator cuff diseases. The safety of acupuncture remains unclear due to the incompleteness of reporting. Future well-designed randomized trials with transparent reporting are required.

• Clinics in Shoulder and Elbow
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• 제25권1호
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• pp.22-27
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• 2022

Background: In some patients with rotator cuff tear (RCT), the axial view of magnetic resonance imaging (MRI) shows subtle posterior decentering (PD) of the humeral head from the glenoid fossa. This is considered to result from a loss of centralization that is typically produced by rotator cuff function. There are few reports on PD in RCT despite the common occurrence of posterior subluxation in degenerative joint disease. In this study, we investigated the effect of PD in arthroscopic rotator cuff repair (ARCR). Methods: We conducted a retrospective study of consecutive patients who underwent ARCR at our institute and were followed-up for at least 1 year. PD was identified as a 2-mm posterior shift of the humeral head relative to the glenoid fossa in the axial MRI view preoperatively. The tear size and fatty degeneration (FD, Goutallier classification) were also evaluated using preoperative MRI. Retears were evaluated through MRI at 1 year postoperatively. Results: We included 135 shoulders in this study. Ten instances of PD (including seven retears) were observed preoperatively. Fifteen retears (three and 12 retears in the small/medium and large/massive tear groups, respectively) were observed postoperatively. PD was significantly correlated with tear size, FD, and retear occurrence (p<0.01 each). The odds ratio for PD in retears was 34.1, which was greater than that for tear size ≥3 cm and FD grade ≥3. Conclusions: We concluded that large tear size and FD contribute to the occurrence of PD. Furthermore, PD could be a predictor of retear after ARCR.