• Journal of Korean Foot and Ankle Society
• /
• v.14 no.2
• /
• pp.115-118
• /
• 2010

Purpose: To evaluate clinical features of ankle lesions, associated with anterior soft tissue impingement. Materials and Methods: We retrospectively reviewed 21 patients who had chronic anterior ankle pain as initial symptom and associated ankle lesions with anterior soft tissue impingement. Based on preoperative radiologic findings, physical examination intra-operative findings, appropriate procedures were done for lesions by either arthroscopic or minimal open procedure or combined. Clinical evaluation was done using American Orthopedic Foot and Ankle Society, ankle-hind foot score (AOFAS score) and visual analog scale (VAS) on last follow up. Results: Associated lesion(s) to anterior soft tissue impingement of the ankle were 16 cases of osteochondral lesion of talus, 14 cases of bony impingement, 6 cases of ankle lateral instability, 5 cases of loose body, 4 cases of os subfibulare. AOFAS score was $58.9\;{\pm}\;5.1$ preoperatively and $74\;{\pm}\;9.1$ on last follow up. Clinical satisfaction score using VAS showed excellent in 3 cases, good in 11, fair in 3, poor in 4. Conclusion: The patients who had anterior soft tissue impingement would have various associated lesions on their ankle. In such cases, preoperative counseling for variety of postoperative results would be needed.

• Journal of Korean Foot and Ankle Society
• /
• v.7 no.2
• /
• pp.208-217
• /
• 2003

Introduction: Soft-tissue impingement syndrome is now increasingly recognized as a significant cause of the chronic ankle pain. As a method to detect soft-tissue ankle impingement, a characteristic history and physical examination, routine MR imaging, and direct MR arthrography were used. The efficacy of routine MR imaging has been controversial for usefulness because of low sensitivity and specificity. Direct MR artrhography was recommaned for diagnosis because of the highest sensitivity, specificity and accuracy, but it requires an invasive procedure. The purpose of this study is to investigate the diagnostic accuracy of Fat suppressed, contrast enhanced, three-dimensional fast gradient recalled acquisition in the steady state with rediofrequency spoiling magnetic resonance imaging(CE 3D-FSPGR MRI) and to evaluate the clinical outcome of the arthroscopic treatment in assessing soft-tissue impingement associated with trauma of the ankle. Materials and Methods: We reviewed 38 patients who had arthroscopic evaluations and preoperative magnetic resonance imaging studies(3D-FSPGR MRI) for post-traumatic chronic ankle pain between January 2000 and August 2002. Among them, 24 patients had osteochondral lesion, lateral instability, loose body, malunion of lateral malleoli, and peroneal tendon dislocation. The patient group consisted of 23 men and 15 women with the average age of 34 years(16-81 years). The mean time interval from the initial trauma to the operation was 15.5 months(3 to 40 months), The mean follow-up duration of the assessment was 15.6months(12-48 months). MRI was simultaneously reviewed by two radiologists blinded to the clinical diagnosis. The sensitivity, specificity and accuracy of MRI was obtained from radiologic and arthroscopic finding. Arthroscopic debridement and additional operation for associated disease were performed. We used a standard protocol to evaluate patients before the operation and at follow-up which includes American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score. Results: For the assessment of the synovitis and soft tissue impingement, fat suppressed CE 3D-FSPGR MR imaging had the sensitivity of 91.9%, the specificity of 84.4 and the accuracy of 87.5%. AOFAS Ankle-Hindfoot Score of preoperative state was 69.2, and the mean score of the last follow-up was 89.1. These were assessed as having 50% excellent(90-100) and 50% good(75-89). The presence of other associated disease didn't show the statistically significant difference(>0.05). Conclusion: Fat suppressed CE 3D-FSPGR MR imaging is useful method comparable to MR arthrography for diagnosis of synovitis or soft-tissue impingement, and arthroscopic debridement results in good clinical outcome.

• 대한관절경학회:학술대회논문집
• /
• 2009.10a
• /
• pp.104-107
• /
• 2009

• Journal of Korean Foot and Ankle Society
• /
• v.15 no.4
• /
• pp.195-200
• /
• 2011

Impingement syndrome of the ankle is defined as painful mechanical limitation of full ankle movement secondary to osseous and/or soft tissue abnormality. These conditions occur more commonly in active people and athletes probably because recurrent subclinical injury is an important factor in development of the syndrome. Impingement syndromes of the ankle are categorized according to their anatomical site around the ankle joint. Anterolateral, anterior and posterior impingement has been extensively described in the orthopaedic literature. The purpose of this article is to review the clinical feature and management of anterior impingement syndrome of the ankle.

• Physical Therapy Korea
• /
• v.17 no.4
• /
• pp.35-40
• /
• 2010

Stiffness of the posterior deltoid is as a causative factor in the limited range of glenohumeral horizontal adduction and various other shoulder pathologies including shoulder impingement syndrome, frozen shoulder, and humerus anterior glide syndrome. The purpose of this study was to compare the effects of two techniques (soft tissue massage and cross-body stretch) on increasing the range of horizontal adduction. Thirty-two subjects with a $10^{\circ}$ or greater difference between the right and left sides in horizontal adduction were selected. Sixteen subjects from each group were allocated randomly. Interventions were applied on six occasions for 2 weeks, and the range of horizontal adduction was measured using an inclinometer at pre-and post-intervention. A $2{\times}2$ analysis of variance (intervention${\times}$time) was used to compare the effects of the two techniques. In the soft tissue massage group, the angle of horizontal adduction significantly increased compared with the cross-body stretch group. These findings indicate that the soft tissue massage of the posterior deltoid muscle is a more effective method to increase the flexibility of the glenohumeral horizontal adduction.

• Journal of Korean Foot and Ankle Society
• /
• v.28 no.2
• /
• pp.60-67
• /
• 2024

Purpose: Sinus tarsi syndrome (STS) is caused by various pathologies. However, the exact etiology of STS remains controversial. This study evaluated the imaging and arthroscopic findings of patients who underwent surgical treatment after conservative treatment for STS failed. Materials and Methods: Between December 2014 and August 2018, 20 patients (21 cases) who underwent surgical treatment for STS were included in the study. The clinical results were analyzed using the visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional scale. The radiographic results were analyzed using Meary's angle, calcaneal pitch angle, and hindfoot alignment angle. The pathologic conditions of sinus tarsi were confirmed by magnetic resonance imaging (MRI) and subtalar arthroscopy. Synovitis, bone edema, and accessory anterolateral talar facet (AALTF) were evaluated on MRI. Synovial thickening, cartilage damage, interosseous talocalcaneal ligament (ITCL) and cervical ligament rupture, soft tissue impingement, AALTF, and accessory talar facet impingement (ATFI) were evaluated by subtalar arthroscopy. Results: The mean duration of symptoms was 28.7 months (4~120). All patients showed significant improvement in the VAS and AOFAS ankle-hindfoot scale. Significant improvements in hindfoot alignment angle and Meary's angle postoperatively were noted in patients who underwent medial displacement calcaneal osteotomy. MRI confirmed synovitis in all patients, AALTF in 19 cases (90.5%), and ATFI with bone edema in seven cases (33.3%). In subtalar arthroscopy, pathologic conditions were observed in the following order: synovitis in 21 cases (100%), AALTF in 20 cases (95.2%), ITCL partial rupture in nine cases (42.9%), and soft tissue impingement in seven cases (33.3%). All cases had two or more pathological conditions, and 15 (71.4%) had three or more. Conclusion: In cases of STS that do not respond to conservative treatment, a comprehensive examination of the lesions of the tarsal sinus and lesions around the subtalar joint is essential.

• Physical Therapy Korea
• /
• v.19 no.4
• /
• pp.8-15
• /
• 2012

Posterior shoulder muscle tightness is frequently observed in shoulder impingement syndrome because tightness in the posterior portion of the shoulder muscles can cause anterior and superior translation of the humeral head in relation to the glenoid fossa. The purpose of this study was to determine the immediate effects of soft tissue massage on acromiohumeral distance (AHD), anterior translation of the humeral head, and glenohumeral (GH) range of motion (ROM) in subjects with posterior shoulder muscle tightness. Twenty-seven subjects with greater than $10^{\circ}$ difference in the range of GH horizontal adduction between right and left sides were recruited. The range of GH horizontal adduction and internal rotation were measured by a digital inclinometer. The AHD and anterior translation of the humeral head were measured using ultrasonography. A paired t-test was used to compare AHD, anterior translation of the humeral head, and the range of GH horizontal adduction and internal rotation before and after soft tissue massage. The results showed that AHD increased significantly (p<.05) and the anterior translation of humeral head decreased slightly, but not significantly (p=.40) after the soft tissue massage. Furthermore, the ROM of horizontal adduction and internal rotation in the GH joint increased significantly after the soft tissue massage (p<.05). These findings indicate that soft tissue massage on posterior shoulder muscle tightness is an effective method to increase AHD and ROM in the horizontal adduction and internal rotation of the GH joint.

• Journal of the Korean Arthroscopy Society
• /
• v.13 no.3
• /
• pp.229-234
• /
• 2009

• Clinics in Shoulder and Elbow
• /
• v.1 no.1
• /
• pp.19-25
• /
• 1998

Appropriate clinical examination and imaging may lead to early diagnosis and treatment of the shoulder impingement syndrome, thus preventing progressing to a complete tear of rotator cuff. The impingement syndrome was caused by repeated entrapment and compression of supraspinatus tendon between the proximal end of humerus inferiorly, particullary its greater tuberosity. and one or m <)re component of coracoacromial arch superiorly. The purpose of this study is to critically, evaluate the result of twenty-five consecutive subacromial decompression with impingement syndrome and to assess the diagnostic accuracy of MR imaging by using oblique coronal and oblique sagittal plan. These patients were treated by arthroscopic subacromial decompression after their pains failed to improve with conservative therapy over three month. The average follow up was 25 month(range, 12 to 50). The mean age was 43 year old. The results were rated based on subjective response and the UCLA shoulder rating scale of the result. Ten patients(40%) were rated as excellent, 11patients(44%) were good. while four patients(16%) were fair. Radiologic evaluation suggested that the oblique sagittal plan of MRI can be helpful in evaluation of bony and soft-tissue structure of the coracoacromial arch and determining depth of bony resection. There were no infection or neurovascular injury. In reviewing our result, it appears that the arthroscopic subacromial decompression can be successful sugery for shoulder impingement syndrome and diagnostic accuracy of supplimentary oblique sagittal view of MRI was relatively higher than oblique coronal view alone for apprqpriate surgical plan.

• Journal of the Korean Arthroscopy Society
• /
• v.14 no.3
• /
• pp.192-195
• /
• 2010

Subcoracoid impingement resulting from abnormal contact between the anterosuperior humerus and the anterior coracoacromial arch represents an uncommon source of anterior shoulder pain. Certain operative procedures can also alter the relationship between the coracoid and the lesser tuberosity, leading to impingement of the interventing soft tissue, including the subscapularis and the bursa. We describe an unique case of subcoracoid impingement with the tear of subscapularis tendon after the internal fixation of the fractured coracoid process with cannulated screw due to crowding of the coracohumeral space. Arthroscopic removal of the screw and repair of the subscapularis in our patient resulted in successful resolution of his symptoms. Although subcoracoid impingement is a rare cause of shoulder pain, failure to diagnose and treat this condition may represent a significant cause of failed shoulder surgery.