Surgical repair has been widely accepted for full thickness tear of the rotator cuff. In traditional method, hony trough on the greater tuberosity of the humerus has heen used for tendon to hone suture. Recently, there have been some suggestions that hony trough would not he essential for repairing the rotator cuff. Purpose of this study was to investigate the clinical result of rotator cuff repair without bony trough. We evaIuated the clinical results of 23 operative repairs of the full-thickness tear of the rotator cuff, using modified ASES scoring system, at an average of l4 months postoperatively. For these cases, all the tendon to hone sutures were done without makin bony trough. There were 3 cases of small tear. 14 case of medium tear, 1 case of large tear and 5 cases of massive tear. Mini-open repairs with arthroscopic acromioplaslies were used for 9 cases with small or medium sized tear. Open acromioplasties and repairs were done for 14 cases. Nine cases were rated excellent (39%), and twelve cases showed good results (52%). Two cases showed fair results (9%). Averagc increase of score was 40 (ranee, 18 to 78). There were no complications or deteriorations of function. No patient needed additional surgery. Repair without hony trough is more simple and easier than the traditional method making bony trough. There would he possibility of less tension to the tendons and preserving more natural course of tendons. The authors believe that this method provides larger contact surface between the tendon and hone. The repairing method without hony trough is considered to he a safe and efficient method for the full thickness tear of the rotator cuff. This technique can he useful not only for ordinary open repair, but also for mini-open repair.
Humans ; Humerus ; Rotator Cuff* ; Shoulder ; Sutures ; Tendons

PURPOSE: To obtain basic anatomical data of proximal humerus of Korean adult skeleton. MATERIALS AND METHODS: Fifty-two dry humeri of Korean adults were measured with a caliper and goniometer. Measured parameters were retroversion, angle of the bicipital groove, bicipital groove-shaft angle, neck-shaft angle, diameters of the humeral head, dimension of the greater tuberosity, distance between humeral head and greater tuberosity, and length of the humerus. All of the eight parameters were measured twice. The correlations between retroversion and diameters of the humeral head, retroversion and length of the humerus, retroversion and angle of the bicipital groove, diameters of the humeral head and length of the humerus were analyzed by student t-test using SAS system. RESULTS: Retroversion was 34.2 degree with high individual variation, ranging from 17.0 degree to 50.0 degree. The angle of the bicipital groove was 36.2 (22.0-54.0) degree. The bicipital groove-shaft angle was 7.4 (1.0- 16.0) degree. The neck-shaft angle was 136.3 (120.0-150.0) degree. The superior-inferior diameter of the humeral head was 43.3 (35.5-52.0) mm, and anterior-posterior diameter was 39.9 (33.5-46.0) mm. The dimension of the greater tuberosity was 29.8 (19.0-46.0) mm, and the distance between humeral head and greater tuberosity was 7.9 (4.5-12.0) mm. The length of the humerus was 303.7 (265.0-388.0) mm. There was significant correlation between the head diameters, the retroversion, and the length, but no correlation between the retroversion and the angle of the bicipital groove. CONCLUSIONS: It is suggested that high individual variation of retroversion should be considered in case of arthroplasty. The humeral head was elliptical in shape. The mean narrow diameter of the humeral head was about 40 mm. The greater tuberosity was about 30 mm in dimension, and located 8 mm inferior to the humeral head. The bicipital groove was not a reliable reference in determining retroversion.
Adult* ; Arthroplasty ; Head ; Humans ; Humeral Head ; Humerus* ; Skeleton*

We treated 617 patients who were diagnosed as rotator cuff disease at the Department of Orthopaedic Surgery, Asan Medical Center in Korea between March, 1995 and December, 1996. We evaluated 175 cases who were followed up over five months and were treated according to our home treatment protocol. Average follow-up period was eleven months(range, five to eighteen months). We educated every patient who were not suspected of having full thickness tear of the rotator cuff based on clinical and MRI findings. According to patients condition, we treated them with both stretching and strengthening exercise or strengthening exercise only. This physician-directed home treatment was occasionally supported by the use of NSAID in case severe pain. Patients did stretching and strengthening exercise in 93(53%)cases, and strengthening exercise initially in 82(47%)cases. One hundred and forty five(83%) cases had satisfactory results. Home treatment of the rotator cuff disease is effective, convenient and not dangerous. We recommend this physiciandirected home treatment for primary management of almost all the patient with rotator cuff disease except full thickness tear of the rotator cuff tendon.
Chungcheongnam-do ; Clinical Protocols ; Follow-Up Studies ; Humans ; Korea ; Magnetic Resonance Imaging ; Rotator Cuff* ; Tendons

Painful stiff shoulder after trauma may be one of the difficult situation. Incomplete brachial plexus palsy may cause painful stiff shoulder. Symptoms and signs of this entity are vague. It is not rare to miss detecting subtle damage of the brachial plexus. We analysed these cases to identify specific clues on history and physical examination that help making the diagnosis of this entity. We have experienced 14 cases of incomplete brachial plexus palsy that showed painful stiff shoulder in Asan Medical Center from March 1995 to February 1996. All the charts and letters from primary care hospitals were reviewed. Initial diagnosis of the primary hospital, duration of delay of diagnosis after initial trauma, clues for the diagnosis in history and physical findings, patterns of the nerve injuries were analyzed. Average age was 48 years (from 25 to 84). Nine cases were male, and five cases were female. The most common primary diagnosis was proximal humerus fracture. Delayed diagnosis was the most remarkable feature. Average duration of delayed diagnosis was about three months (from one to thirteen months). Tentative diagnosis was made on the base of history and physical examination. The most frequent clue on the history was long standing painful stiff shoulder inappropriate to the initial diagnosis. The most common physical finding was tenderness at the brachial plexus area. Definite diagnosis was confirmed with electromyography. Careful history taking and thorough physical examination are essential for every shoulder injury. Incomplete brachial plexus palsy is one of the cause of painful stiff shoulder. It is important to keep in mind this entity to arrive correct diagnosis. Eletromyography should be done for the suspected cases.
Brachial Plexus ; Chungcheongnam-do ; Delayed Diagnosis ; Diagnosis ; Electromyography ; Female ; Humans ; Humerus ; Male ; Paralysis* ; Physical Examination ; Primary Health Care ; Shoulder*

Restoration of the M-P joint of a damaged or lost joint by trauma, tumor and others is necessary for adequate function of the hand. Several procedure have been described for restoration of the M-P joint. We experienced a case of vascularized joint transter for a lost joint by trauma. After 1 year and 2 months follow-up, there have been no degenerative change and no pain.
Follow-Up Studies ; Hand ; Joints

The relative rarity and anatomical position of presacral tumors may lead to difficulty in diagnosis and surgical treatment. The clinical features and surgical approach of 4such tumors(teratocarcinoma 1, endodermal sinus tumor 1, chordoma 1, neurilemmoma 1) have therefore reviewed. Low back pain or sacral pain was present in 3patients although all tumors were palpable on rectal examination. Surgical resection was carried out using the posterior transverse approach in Kraske's prone position. Complete surgical excision was performed in 3cases(chordoma, teratocarcinoma, neurilemmoma) and incomplete excision in 1 case(endodermal sinus tumor). A review of literature concerning these tumors and the surgical approach are presented.
Chordoma ; Diagnosis ; Endodermal Sinus Tumor ; Low Back Pain ; Neurilemmoma ; Prone Position ; Teratocarcinoma

The compartment syndrome was first described by Von Volkmann in 1872 and then many reports have been published. The anterior tibial compartment syndrome and the volar compartment syndrome of the forearm are well known, but the thenar compartment syndrome is very rare. A case of the thenar compartment syndrome developed with the CO poisoning was experienced and treated satisfactorily by the fasciotomy and secondary repair.
Compartment Syndromes ; Forearm ; Poisoning

Pain, traumatic arthritis, joint stiffness and joint subluxation are common sequelae of fracture dislocations of the proximal interphalangeal joints of the finger. Many kinds of methods were used to treat fracture dislocation of the proximal interphalangeal joint. The prognosis is greatly influenced by the method and the time of treatment. Authors treated 4 cases of fracture dislocations of the proximal interphalangeal joint with 3 different method. For a case with small bony fragment, we used the extension block splint of McElfresh. For a old case, we used the volar plate arthroplasty mothod of Eaton. And for two cases with large bony fragment, we used the force couple splint method of Agee after open reduction and internal fixation. The results were satisfactory.
Arthritis ; Arthroplasty ; Dislocations ; Fingers ; Joints ; Methods ; Prognosis ; Splints

A forty-seven-year-old male miner complained of paresthesia over right hypothenar area and ring and little fiugers for 3 months. On physical examination and electromyography, ulnar nerve dysfunction below elbow was noted. Intraoperatively, an anomalous muscle, the epitrochleoanconeus muscle, was found between the triceps muscle and flexor carpi ulnaris muscle, but it was clearly distinguished from them. Resection of the muscle and medial epicondylectomy were performed. The epitrochleoanconeus muscle is an anomalous muscle which arises from the medial epicondyle of the humerus and inserts into the medial border of the olecranon. The reports on ulnar nerve entrapment syndrome by this muscle were rare. On 14 months follow up, the symptoms and signs were improved.
Elbow ; Electromyography ; Follow-Up Studies ; Humans ; Humerus ; Male ; Miners ; Olecranon Process ; Paresthesia ; Physical Examination ; Ulnar Nerve Compression Syndromes ; Ulnar Nerve

Purpose of this study was to investigate the biomechanical fates of the partial thickness tear of the rotator cuff in rabbit, and try to provide guideline of treatment for the partial thickness tear of the rotator cuff tendon. Infraspinatus tendons of fifty rabbits were used for study. The rabbits were divided into three groups, twenty for one-third resection(superficial partial resection group), twenty for two-thirds resection(deep partial resection group) and ten for control group. Extraarticular portion of the infraspinatus tendons of the rabbits were resected partially with one-third or two-thirds thickness for each experimental group. We sacrificed five rabbits of each experimental group at 3, 6, 9, and 12 weeks after the resections, and five rabbits for the control group at 6 and 12 weeks. Average maximal load per area of the infraspinatus tendons was measured by tension test. There was significant difference between the deep partial resection group, 5.3 and 6.3 N/emat 6 and 12 weeks respectively, and the control group, 13.2 N/mm(P<0.05). There was no difference between the control and superficial partial resection group, 12.8 and 14.1 N/mm at 6 and 12 weeks, respectively. Shallow partial tears might be healed spontaneously. Deep partial tears would not be healed naturally. When surgical treatment is indicated for deep partial tears of the rotator cuff, tendon repair, rather than debridement, would provide more predictable results.
Debridement ; Rabbits* ; Rotator Cuff* ; Shoulder ; Tendons