1.The Usefulness of Multidetector CT Arthrography in the Diagnosis of Shoulder Pathology: Comparison with MR Arthrography and Arthroscopic Findings in the Same Patient.
Dong Soo KIM ; Kyoung Jin PARK ; Yong Min KIM ; Eui Sung CHOI ; Hyun Chul SHON ; Byung Ki CHO ; Ji Kang PARK ; Seok Won KIM
Journal of the Korean Shoulder and Elbow Society 2009;12(2):115-125
PURPOSE: The purpose of the study is to evaluate the usefulness of CT arthrography (CTA) by conducting a comparative study of CTA and MR arthrography (MRA) with the arthroscopic findings in the same patients. MATERIALS AND METHODS: Forty nine patients who suffered from shoulder disease underwent MRA and CTA concurrently. The sensitivity and specificity of CTA was evaluated, as compared to MRA, in the case of four types of shoulder pathological lesions. The accuracy of CTA was evaluated by analyzing the arthroscopic findings of thirty four patients. RESULTS: Compared to MRA, CTA showed a sensitivity of 90% and a specificity of 100% for diagnosing supraspinatus tendon (SST) full thickness tear, and CTA showed a sensitivity of 100% and a specificity of 97.5% for making the diagnosis of superior labrum anterior to posterior (SLAP) lesion. For diagnosing partial articular side supraspinatus avulsion (PASTA) lesion, some studies have shown the usefulness of CTA with a sensitivity of 71.4% and a specificity of 97.7%. However, for diagnosing SST bursal side partial tear, the sensitivity of CTA was as low as 10%. CTA has been shown to be relatively accurate when the diagnoses were verified with the arthroscopic findings; diagnosing SST full thickness tear and SLAP lesion with CTA has shown an accuracy of 100% and87.5% respectively, and CTA showed 71.4% diagnostic accuracy for PASTA lesion. CONCLUSION: CTA was a useful tool and it was equivalent to MRA for the assessment of SST full thickness tear, SLAP lesion and PASTA lesion, but not bursal side partial tear. Thus, it may be used preferably to diagnose shoulder pathology and for follow up as an inexpensive tool after operation.
Arthrography
;
Arthroscopy
;
Humans
;
Sensitivity and Specificity
;
Shoulder
;
Tendons
2.The Radiologic and Clinical Changes after Open Complete Repair of Massive Rotator Cuff Tears.
Eun Sun MOON ; Min Sun CHOI ; Myung Sun KIM ; Il Kyu KONG ; Byoung Jin KIM
Journal of the Korean Shoulder and Elbow Society 2009;12(2):109-114
PURPOSE: This study evaluated the preoperative and postoperative radiologic findings of patients with complete repairs after massive rotator cuff tears along with the incidence of re-tear and the clinical outcomes. MATERIALS AND METHODS: This study evaluated 33 cases who had open complete repairs for massive rotator cuff tears and these patients were followed up for more than 24 months. The clinical evaluation was performed according to the shoulder joint function test of the American Shoulder and Elbow Surgeons (ASES), and the degree of arthritis related to the massive rotator cuff tears was evaluated using the Hamada classification. RESULTS: The ASES scores improved from 37.6 preoperatively to 85.6 postoperatively. The mean preoperative acromio-humeral interval (AHI) score was 6.5 mm, which increased to 9.3 mm immediately after surgery, and there was a decreased to 6.5 mm noted at the last follow up. The lower radiology stages of arthritis according to the classification showed better preoperative and postoperative results. CONCLUSION: An open complete repair as the surgical treatment for a massive rotator cuff tear showed satisfactory results for pain relief and an improvement in the shoulder joint function though re-tear after surgery.
Arthritis
;
Elbow
;
Follow-Up Studies
;
Humans
;
Incidence
;
Rotator Cuff
;
Shoulder
;
Shoulder Joint
3.The Short Term Clinical Follow-up Study for Hemiarthroplasty in Proximal Humeral Fracture.
Chang Meen SUNG ; Se Hyun CHO ; Soon Taek JUNG ; Sun Chul HWANG ; Hyung Bin PARK
Journal of the Korean Shoulder and Elbow Society 2007;10(1):92-98
Introduction: The treatment of proximal humeral fracture is traditionally determined by Neer's classification system. The severely displaced three-part or four-part fracture is an indication for primary hemiarthroplasty. The current authors report the clinical results of 10 patients who received hemiarthroplasty for proximal comminuted fractures. The minimum follow-up period was 12 months. Materials and Methods: The current authors studied 10 patients who, between July 1999 and March 2005, each received hemiarthroplasty for a proximal humeral fracture of one shoulder. According to Neer's classification system, 5 of the patients had three-part fractures, and 5 of the patients had 4-part fractures. The mean interval between trauma and hemiarthroplasty was 6.1 days. The mean age of the 6 female and 4 male patients was 67.4 years (range: 56 to 76). Shoulder function was evaluated using the Constant score, the Simple Shoulder Test, and the modified UCLA score. Results: The mean Constant score was 51.4(range: 34 to 60). The mean modified SST score was 7.8 out of 12 tasks. Excluding the one patient who had also sustained an axillary artery rupture and a brachial plexus injury after the initial trauma, the mean Constant score for the remaining 9 patients was 53.5(range: 44 to 60), and the mean SST score was 7.2 tasks. The modified UCLA score averages for pain, function, and active forward flexion and strength were, respectively, 8.2(6~10), 6.6(2~8), and 6.9(4~8). The total UCLA score was an average of 21.7(12~26). Patients' the modified UCLA ratings were as follows: Excellent: 3, Good: 6, and Poor: 1. The patient with the poor outcome was the one who had also sustained the neurovascular injury. Patient's subjective satisfaction rating were as follows: Excellent: 2, Good: 7, and Poor: 1. Conclusion: Based on short term follow-up results, this study indicates that hemiarthroplasty is the treatment of choice for proximal humeral fractures on which it would be difficult to perform open reduction and internal fixation. Hemiarthroplasty is a useful treatment modality to prevent shoulder stiffness and to allow daily living tasks in elderly patients. However, restoration of muscle power and range of joint motion were not recovered satisfactorily.
Aged
;
Axillary Artery
;
Brachial Plexus
;
Classification
;
Female
;
Follow-Up Studies*
;
Fractures, Comminuted
;
Hemiarthroplasty*
;
Humans
;
Joints
;
Male
;
Rupture
;
Shoulder
;
Shoulder Fractures*
4.Metallic Radial Head Prosthesis in Korea.
Sang Hwan HAN ; Jun Gyu MOON ; Jong Wong PARK ; Ki Mo JANG
Journal of the Korean Shoulder and Elbow Society 2007;10(1):84-91
Purpose: The aim of this study was to report seven cases of metallic radial head prosthesis and present the limit of use in Korea. Materials and Methods: Metallic radial head arthroplasty was performed on 7 patients between April 2006 and December 2006, who had complex elbow injury including comminuted radial head fracture. Indication, operative findings and outcome were assessed. Availability and payment of implant were investigated. Results: All of the patients had more than one associated injury including coronoid fracture, olecranoan fracture, and ligament ruptures. According to Mason classification, there were three type III and four type IV fractures. All radial head fractures were too comminuted to reconstruct. There were two excellent results, four good, and one poor, as graded by Mayo score. There were no patient with instability and implant related complications. Insufficient supply of implant did not enable to do scheduled surgery in 2 cases. Current medical insurance did not cover charge for radial prosthesis, five patients could not help paying for that by themselves. Conclusion: Metallic radial head implants are useful when the radial head cannot be repaired reliably. Preoperative preparing and coverage by medical insurance based on appropriate indication are helpful for decision for a treatment option.
Arthroplasty
;
Classification
;
Elbow
;
Head*
;
Humans
;
Insurance
;
Korea*
;
Ligaments
;
Prostheses and Implants*
;
Radius
;
Rupture
5.Tenodesis of Long Head of the Biceps Brachii Tendon with Bioabsorbable Interference Screw.
Jae Kwang YUM ; Yong Woon SIN ; Sang Jin LEE
Journal of the Korean Shoulder and Elbow Society 2007;10(1):78-83
Purpose: This study reports the clinical results of the tenodesis of long head of the Biceps brachii tendon with bioabsorbable interference screw by minimal open procedure. Materials and Methods: Ten cases of 10 patients (7 male, 3 female) were included in this study. The average age was 45.8 years old and the average period from the symptom onset to operation was 13.7 months. Average preoperative ASES score was 38.5. The causes of injury was; sports activities in 4 patients, unknown in 4 patients, industrial accident in 1 patient and traffic accident in 1 patient. The average follow up period was 12.1 months. Tenodesis with bioabsorbable interference screw by minimal open precedure was performed in all cases. Results: The ASES score improved to 87.5 at last follow up period and 6 cases had full range of motion of the shoulder. 4 cases had mild limited range of motion of the shoulder without any problem in normal daily activity. Conclusion: It was assumed that tenodesis of long head of the biceps brachii tendon with bioabsorbable interference screw by minimal open precedure was one of the good methods with good clinical results.
Accidents, Occupational
;
Accidents, Traffic
;
Follow-Up Studies
;
Head*
;
Humans
;
Male
;
Range of Motion, Articular
;
Shoulder
;
Sports
;
Tendons*
;
Tenodesis*
6.Arthroscopic Repair of Type II SLAP lesion with Bio-knotless Anchor.
Jae Kwang YUM ; Hyung Jin CHUNG ; Ho Jong RA
Journal of the Korean Shoulder and Elbow Society 2007;10(1):73-77
Purpose: This study reports the clinical results of the arthroscopic repair of type II SLAP lesion with bio-knotless anchor. Materials and Methods: 25 cases of 25 patients (20 male, 5 female) were included in this study. The average age was 44.5 years old. Preoperative ASES score was average 44. Arthroscopic SLAP repair with 1 or 2 bio-knotless anchors were performed in all cases. The average follow up period was 15 months. Results: The ASES score improved to average 92.7 at last follow up period and 23 cases had full range of motion of the shoulder. 2 case had mild limited range of motion of the shoulder without any problem in normal activity. Conclusion: Arthroscopic repair with bio-knotless anchor in type II SLAP lesion is one of the good methods because of the good clinical results.
Follow-Up Studies
;
Humans
;
Male
;
Range of Motion, Articular
;
Shoulder
7.Correlation of Clinical Outcome and Cuff Integrity after Open Repair in Large and Massive Rotator Cuff Tears.
Haeng Kee NOH ; Joon Ho WANG ; Dong Hwee KIM ; Jong Woong PARK ; Jae Gyoon KIM ; Jung Ho PARK
Journal of the Korean Shoulder and Elbow Society 2007;10(1):65-72
Purpose: To evaluate the relationship between the clinical outcome and the cuff integrity following open repair in large and massive rotator cuff tears using ultrasonography as an imaging modality. Material and Methods: From November 2001 to April 2005, 17 cases(16 patients) who had open repair of tear measuring more than 3cm were assessed with minimal follow-up of 12 months in this study. 6 cases had a large tear and 11 cases a massive tear. There were 6 men and 11 women with a mean age of 52 years at surgery (range, 33 to 72 years). The evaluation consisted of the preoperative and postoperative shoulder scores according to UCLA shoulder scoring system and Visual analogue scale (VAS). Ultrasonography was performed by a experienced musculoskeletal physician at a minimum of 12 months postoperatively to evaluate the postoperative cuff integrity. Results: Retear were detected in four of seventeen cases. Regardless of the presence of recurrent tear, 14 cases had UCLA score of more than 29 points (good grade). All 17 had an improvement in the functional score, which increased from an average of 15.1 to 31.2 points. All cases showed pain relief and five cases had no pain. Sixteen cases except one had the range of motion of forward elevation above 90degrees. Conclusion: Open rotator cuff repair in large and massive tears showed low retear rate. At a minimum of twelve months follow-up, all cases had improvement on UCLA score, pain relief, increased range of motion of the shoulder regardless of retear. And the correlation between recurrent tear and function score was not statistically significant.
Female
;
Follow-Up Studies
;
Humans
;
Male
;
Range of Motion, Articular
;
Rotator Cuff*
;
Shoulder
;
Ultrasonography
8.Arthroscopic Repair of Type II SLAP Lesion with Bioabsorbable Knotless Suture Anchor: Surgical Technique and Clinical Results.
Chae Chil LEE ; Sung Jae KIM ; Chang Ho HWANG ; Dong Kyo SEO ; Sang Hun KO
Journal of the Korean Shoulder and Elbow Society 2007;10(1):59-64
Purpose: The purpose of this study was to evaluate the results of bioabsorbable knotless suture anchoring for isolated type II SLAP. Materials and Methods: Fourteen patients with isolated type II SLAP underwent a surgical repair with bioabsorbable knotless anchor arthroscopically. Instability, rotator cuff tears or simple subacromial decompression were excluded. The UCLA and pain of VAS (Visual Analogue Scale), ADL (Activity of Daily Living, from the American Shoulder and Elbow Society) were evaluated and patients underwent a thorough shoulder examination at a minimum follow-up period of 2 years postoperatively. Results: At a mean of 27.1 months follow-up. The mean UCLA score improved from 14.4 pre-operatively to 31.2 on last follow-up. The mean VAS for pain was 4.9 and on last follow-up 1.0. The mean VAS for instability was 2.6 and on last follow-up 0.5. The mean ADL was 10.4 and on last follow-up 25.0. 12 patients reported their satisfaction as good to excellent and 10 of the 14 patients returned to their pre-injury level of activity (athletics) (P<0.05). Conclusion: Arthroscopic repair with bioabsorbable knotless suture anchors is an effective surgical technique for the treatment of an isolated unstable type II SLAP lesion. Overall satisfaction was only 85.7%. 1 patient had severe stiffness and 1 patient had shoulder pain.
Activities of Daily Living
;
Decompression
;
Elbow
;
Follow-Up Studies
;
Humans
;
Rotator Cuff
;
Shoulder
;
Shoulder Pain
;
Suture Anchors*
;
Sutures*
9.Arthroscopic Resection of Synovial Plica in Elbow.
Journal of the Korean Shoulder and Elbow Society 2007;10(1):50-58
Purpose: To report our experience with nine cases of pathologic synovial plica on radiohumeral joint which symptom of painful snapping elbow was improved by arthroscopic resection. Materials and Methods: Between 1999 and 2004, 43 cases of elbow arthroscopy were performed by one surgeon. Eight patients with nine cases showed pathologic synovial plica in conjunction with snapping or posterolateral elbow pain. The mean age of eight patients (man: 7, woman: 1) was 29 years (range 16~56 years). All patients had a trial of conservative treatment at least six months (range 6~16 months). The diagnosis was confirmed before surgery in six cases and at the time of surgery in three cases. Pain, snapping, and subjective results were evaluated at least 12 months in the average (range 12~24). Results: All patients showed a hypertropic lateral synovial plica with local synovitis. Seven of them had an associated lesion of chondromalacia on radial head. One of them was associated with radiocapitellar arthritis and had a wrapping over the radial head. Six patients experienced improved posterolateral pain at the end of study (VAS<1). However, the other two patients had occasional pain with activity. One of them persisted with mechanical symptoms, which was treated with additional arthroscopic procedure. Conclusion: Synovial plica in elbow should be considered as an important entity of common elbow disease, especially when pain in the lateral aspect of the elbow with a snapping sensation during motion is featured in patients. The arthroscopic resection seems to be safe and efficient in the short and long term treatment of plica in the elbow joint.
Arthritis
;
Arthroscopy
;
Cartilage Diseases
;
Diagnosis
;
Elbow Joint
;
Elbow*
;
Female
;
Head
;
Humans
;
Joints
;
Sensation
;
Synovitis
10.The Thickness of Normal and Repaired Rotator-cuff Measured in MRI.
Jung Man KIM ; Yang Soo KIM ; Yong Jin KWON ; Ju Seok YOO ; Hyun Woo JUNG
Journal of the Korean Shoulder and Elbow Society 2007;10(1):42-49
Purpose: To compare the thickness of the repaired full-thickness rotator-cuff tear to that of normal rotator-cuff in young and old persons and evaluate the relationship between the tear size and the repaired thickness in the full-thickness tear using MRI. Materials and Methods: The thickness of the rotator-cuff of the repaired full thickness tear(age: 45~77, mean 63.3 years, 19 patients: group 1) were compared with those of old intact patients (age: 46~69, mean 57.9 years, 23 patients: group 2) and young intact patients (age: 18~30, mean 23.3 years, 22 patients: group 3). The tear length and width was measured in oblique coronal and oblique sagittal view of MRA, respectively, and the thickness was measured in coronal oblique view 15mm anterior to the posterolateral margin of the glenoid. Correlation between the preoperative tear size (the bigger one between the length and the width) and the postoperative thickness in group 1 was also evaluated statistically. Results: The postoperative rotator-cuff thickness in group 1 was 3.0 mm in average, which was inversely proportional to the preoperative tear size (P<0.001). The rotator-cuff thickness was 3.9mm in group 2 and 5.0mm in group 3, and there was statistically significant difference among the three groups(P<0.05). Conclusion: The rotator-cuff thickness decreases with age and the postoperative thickness in the full-thickness tear was inversely proportional to the tear size, smaller than that of the intact rotator-cuff.
Humans
;
Magnetic Resonance Imaging*