• 대한관절경학회지
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• 제16권2호
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• pp.175-179
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• 2012

활막 연골종증(synovial chondromatosis)은 관절 활막에 존재하는 활액막 세포가 연골모세포로의 화생에 의해 발생하는 것으로 슬관절, 고관절 등의 큰 관절에 주로 발생하며 견관절에 발생하는 경우는 드물다. 술전에 진단하기는 어려운 경우가 많으며, 수술적 활액막 절제술이 치료에 효과적이다. 저자들은 어깨 관절의 불편감과 통증을 호소하는 44세 여자환자에서 초자연골로 구성된 유리체를 동반한 견봉하 공간의 연골종증을 경험하여 이를 문헌 고찰과 함께 보고하고자 한다.

• Clinics in Shoulder and Elbow
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• 제26권4호
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• pp.390-396
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• 2023

Background: The subacromial (SA) space is a commonly used injection site for treatment of impingement syndrome. For shoulder stiffness, glenohumeral (GH) injections are commonly performed. However, in cases of impingement syndrome with mild shoulder stiffness, the optimal site of steroid injection has yet to be identified. Methods: This prospective, randomized study compared the short-term outcomes of ultrasound-guided GH and SA steroid injections in patients who were diagnosed with impingement syndrome and mild stiffness. Each group comprised 24 patients who received either a GH or SA injection of 40 mg of triamcinolone. Range of motion and clinical scores were assessed before and 3, 7, and 13 weeks after the injection. Results: GH and SA injections significantly improved the range of motion and clinical scores after 13 weeks of follow-up. Notably, targeting the GH joint resulted in an earlier gain of forward elevation, external rotation, and internal rotation in 3 weeks (P<0.001, P=0.012, and P=0.002, respectively) and of internal rotation and a Constant-Murley score in 7 weeks (P<0.001 and P=0.046). Subsequent measurements were similar between the groups and showed a steady improvement in all ranges of motion and clinical scores. Conclusions: GH injections may be more favorable than SA injections for treatment of impingement syndrome with mild stiffness, especially in improving the range of motion in the early period. However, the procedures showed similar outcomes after 3 months. Level of evidence: I.

• 대한견주관절학회:학술대회논문집
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• 대한견주관절학회 2008년도 제16차 학술대회
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• pp.164-164
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• 2008

The beach-chair traction position is designed to allow the use of traction while allowing the surgeon to orient the shoulder in an upright position and convert to an open procedure, if necessary. The patient is placed in the beach-chair position under general anesthesia. A three-point shoulder holder (Arthrex, Naples, Florida) is attached to the rail of the operating table on the same side as the surgeon, whereas it is placed on the side opposite the surgeon in the lateral decubitus position. A shoulder traction and rotation sleeve (Arthrex) are affixed to the arm following the manufacturer's instructions. Positioning the thumb toward the closed side of the sleeve ensures a field for the anterior portion of the rotator cuff and prevents the tendency of the suspension apparatus to place the arm in internal rotation. The arm is maintained in 30 to 40 degree abduction and 30 to 40 degree flexion by controlling the length and height of the bar and the location of the universal clamp. The universal clamp allows multiple planes of adjustment to control abduction and forward movement of the arm. The sleeve is attached to the longitudinal traction cable using a sterile hook, and a lateral strap is secured around the proximal portion of the sleeve to the overhead traction cable to ensure a field for glenohumeral reconstruction. The use of a lateral strap permits ideal shoulder positioning for improved access to the anterior and inferior glenohumeral joint. The lateral strap can be released or removed to widen the subacromial space during subacromial decompression or rotator cuff repair. A 10-lb weight is attached to the longitudinal traction cable for an average-sized person.

• Clinics in Shoulder and Elbow
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• 제21권3호
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• pp.127-133
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• 2018

Background: This study was undertaken to evaluate the outcome of the arthroscopic capsular release for adhesive capsulitis of the shoulder. Methods: This study retrospectively investigated thirty shoulders in 29 patients who presented with recalcitrant adhesive capsulitis and underwent arthroscopic treatments. Other than typical findings of adhesive capsulitis, combined pathologies in the glenohumeral joint and subacromial space were evaluated by arthroscopy. Clinical evaluations were performed using the Constant's score and ranges of motion (ROM) at preoperative, 6 months postoperatively and at the final follow-up. Results: Our study included 17 women and 12 men with a mean age of 53.8 years (range, 34-74). Mean follow-up duration was 24 months (range, 12-40 months). Assessment of combined pathologies revealed that partial rotator cuff tear of less than 25% thickness, was most common (overall 83.3%; with bursal 57% and articular 23%). Subacromial synovitis and adhesion were also frequent (53.3%). The Constant score and ranges of motion significantly improved at the final follow-up, compared with preoperative levels. However, clinical results at 6 months postoperatively were found to be significantly inferior to those observed at the final follow-up ($p{\leq}0.001$ for all factors). Functional impairment was the major complaint in 59.3% patients at the 6 months follow-up. Conclusions: Although arthroscopic capsular release yielded favorable outcome at the mean 24 months follow-up, pain and motion limitations at 6-month postoperatively persisted in more than 50% of our patients. While combined pathologies were commonly encountered during arthroscopy, although their effects on surgical outcome in adhesive capsulitis remains unclear in this study.

• The Journal of Korean Physical Therapy
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• 제30권1호
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• pp.8-13
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• 2018

Purpose: The present study was to investigate effects of scapular position and pain on a trunk stabilization exercise with gym ball for patients with arthroscopic rotator cuff repair. Methods: Subjects were patients after 2 weeks of rotator cuff repairs. Subjects were randomly assigned to conservative treatment group (CTG, n=10) or trunk stabilization with gym ball group (SBG, n=10), and participated one of those groups for 2 weeks. Measurements about pain and scapular position were assessed in before and after treatment programs. Results: Pain reduced in both rest and night in SBG compared to CTG. In the case of scapular position, decreased scapular retraction (increased protraction) was found in CTG and vice versa in SBG. Reduced scapular anterior tilting was also found on SBG. Conclusion: The present study showed that early performed trunk stabilization with gym ball could bring a scapular alignment that increases subacromial space and reduces pain. This suggests early trunk stabilization with gym ball programs to restore shoulder functions for patients with rotator cuff repair.

• 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.

• Clinics in Shoulder and Elbow
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• 제23권1호
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• pp.3-10
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• 2020

Background: The aim of this study was to evaluate clinical experience with arthroscopic debridement for septic arthritis of the shoulder joint and to report on our patient outcomes. Methods: The retrospective analysis included 36 shoulders (male:female, 15:21), contributed by 35 patients (mean age, 63.8 years) treated by arthroscopy for septic arthritis of the shoulder between November 2003 and February 2016. The mean follow-up period was 14.3 months (range, 12-33 months). An additional posterolateral portal and a 70° arthroscope was used to access the posteroinferior glenohumeral (GH) joint and posteroinferior subacromial (SA) space, respectively. Irrigation was performed with a large volume of fluid (25.1±8.1 L). Multiple suction drains (average, 3.3 drains) were inserted into the GH joint and SA space and removed 8.9±4.3 days after surgery. Intravenous antibiotics were administered for 3.9±1.8 weeks after surgery, followed by oral antibiotic treatment for another 3.6±1.9 weeks. Results: Among the 36 shoulders, reoperation was required in two cases (5.6%). The average range of motion achieved was 150.0° for forward flexion and T9 for internal rotation. The mean simple shoulder test score was 7.9±3.6 points. Nineteen shoulders (52.8%) had acupuncture or injection history prior to the infection. Pathogens were identified in 15 shoulders, with Staphylococcus aureus being the most commonly identified pathogen (10/15). Both the GH joint and the SA space were involved in 21 shoulders, while 14 cases involved only the GH joint and one case involved only the SA space. Conclusions: Complete debridement using an additional posterolateral portal and 70° arthroscope, a large volume of irrigation with >20 L of saline, and multiple suction drains may reduce the reoperation rate.

• Clinics in Shoulder and Elbow
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• 제17권1호
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• pp.18-24
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• 2014

Background: To evaluate the efficacy of the subclavian portal approach for the arthroscopic repair of isolated subscapularis tendon tear. Methods: We used the subclavian portal to carry out arthroscopic repair of the isolated subscapularis tendon tear. The surgery was carried out in 18 cases (average age of 53) from May 2006 to December 2009 with a mean follow-up period of 35 months. Of these cases, 13 patients had the tear in their dominant arms, 16 were male, and 12 were from traumatic ruptures with on average 7.6 months of symptom period to operation. Additional surgery, acromioplasty and subacromial debridement, were carried out on 4 cases each during the subscapularis repair. The integrity of cuff status was assessed by ultrasonographic examination at 6 months and at 1 year after operation. Results: The initial average range of motion in forward flexion, external rotation, and internal rotation were $160^{\circ}$, $50^{\circ}$ and L4, respectively. At the 1 year follow-up period, these improved to $160^{\circ}$, $52^{\circ}$ and T12, respectively. The initial average functional scores were assessed by KSS, ASES, UCLA, and Constant scoring systems, which were 67, 60, 26, and 65, respectively. These scores improved progressively with time. At 3 months after operation, the scores were 74, 67, 27, and 74; at 6 months, 83, 77, 31, and 75; at 1 year, 88, 86, 32, and 79; and at the final follow-up of 35 months, 84, 92, 34, and 84. Conclusions: In the repair of isolated subscapularis tendon tear, the subclavian portal approach provided a good angle for anchor insertion and sufficient space to manage the upper portion of the tendon tear. In turn, these provisions resulted in satisfactory clinical results.

• Clinics in Shoulder and Elbow
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• 제20권3호
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• pp.126-132
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• 2017

Background: The aim of the present study was to determine the correlation between the amount of pain reduction after local anesthetic injection into the subacromial space preoperatively and clinical outcome after arthroscopic rotator cuff repair. Methods: A total of 127 patients who underwent arthroscopic rotator cuff repair and followed up at least 1 year were analyzed retrospectively. Preoperatively, a visual analogue scale (VAS) for pain was measured in all patients before and after the ultrasound guided impingement test. The participants were divied into four groups according to pain reduntion ater impingement test (Group A: >75%, Group B: 50%-75%, Group C: 25%-50%, Group D: <25%). VAS for pain, shoulder range of motion, shoulder isometric strength, ASES score were evaluated preoperatively and at 3, 6, 9, and 12 months postoperatively. Results: After surgery, the amount of pain reduction shows significantly at 3, 6 months in Groups A, B as compared to Groups C, D (p<0.05). Among the range of motion of shoulder joint, forward flexion was significantly improved in Group A at 3 months (p<0.05). The ASES score significantly improved at 3, 6 months in Groups A, B as compared to Group C, D (p<0.05). Conclusions: Preoperative degree of pain reduction after impingement test correlates with the improvement of pain after arthroscopic rotator cuff repair, especially in the early phase. Therefore, the impingement test could be effectively used.

• Clinics in Shoulder and Elbow
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• 제15권1호
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• pp.1-7
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• 2012

목적: 사각근간 상완 신경총 차단 하 회전근 개 복원술 후 다중 통증 조절법을 통한 초기통증 조절의 유용성을 확인해 보고자 하였다. 대상 및 방법: 회전근 개 전층 파열로 관절경 하 회전근 개 복원술을 시행한 80명의 환자들을 대상으로 하였다. 전례에서 술 전 마취로 사각근간 상완 신경총 차단을 시행하였고 수술 후 견봉하 공간에 Bupivacaine 유치 도관을 통한 일회성 통증 조절만 시행한 A군 (Group A : Local analgesia group)과 유치 도관 주사에 추가하여 경구 약물로 아편양 제재, 아세트아미노펜-트라마돌 복합제, 선택적 COX2 억제제를 사용하는 다중 통증 조절법을 시행한 B군 (Group B : Multimodal control group)으로 나누어 비교하였다. 수술 당일 야간, 술 후 1, 2, 3일 및 술 후 2주의 주간과 야간의 통증 점수 (visual analogue scale, VAS), 입원 중 추가 투여한 ketolorac 주사의 횟수와 약물과 관련된 부작용에 대해 비교, 분석을 하였다. 결과: 수술 당일 야간, 술 후 1, 2, 3일, 술 후 2주의 주간 및 야간의 평균 VAS는 A군에서 각각 7.4점, 7점/6.8점 (주/야), 4.5점/5.2점, 4.8점/5.0점, 2.2점/2.7점 이었으며 B군에서 각각 6.5점, 4.3점/5.4점, 3.2점/4.3점, 3.0점/4.1점, 2.4점/2.5점으로 수술 당일 야간과 수술 후 1,2,3일의 주간통 및 술 후1일의 야간통에서 각각 유의한 감소를 보였다 (p<0.05). A군과 B군의 하루 당 평균 ketolorac 투여 횟수는 각각1.1회, 0.5회였고 부작용의 차이는 없었다. 결론: 관절경적 회전근 개 복원술 후 다중 통증 조절법을 통한 초기 통증 조절은 효과적인 진통조절을 보여 환자의 만족도를 높일 수 있는 방법으로 생각되었다.