Iatrogenic damage of the rotator cuff followed by postoperative shoulder function loss is a potential complication after antegrade intramedullary nailing (AIN) for a humeral fracture. The authors present a case of arthroscopic rotator cuff repair and subacromial decompression of a non-healed rotator cuff tendon (mainly supraspinatus) and secondary impingement syndrome caused either by the tear or a proud nail after AIN for a mid-shaft humeral fracture. At presentation, the patient complained of right shoulder pain and 'snapping', especially during forward elevation and abduction of the shoulder, of 4 years duration. Right shoulder pain started sometime after pain due to the humeral shaft fracture, operation had subsided, and persisted after nail removal. Arthroscopic findings showed a longitudinal rotator cuff tear at the nail entry point that had not healed and severe fibrous hypertrophy on the acromion underspace, which is a unique finding since most longitudinal splits of tendon fibers are more likely to heal than conventional rotator cuff tears detached from bone. The torn rotator cuff was repaired after debridement and placing side-to-side sutures. At his 34-month follow-up after rotator cuff repair, the patient showed complete recovery and had excellent clinical scores.
Acromion ; Arthroscopy ; Debridement ; Decompression ; Follow-Up Studies ; Fracture Fixation, Intramedullary* ; Humans ; Humeral Fractures ; Hypertrophy ; Rotator Cuff ; Shoulder ; Shoulder Pain ; Sutures ; Tendons

The elbow is the most frequent area of complaint in children and adolescent baseball players. The physical stresses associated with repetitive throwing create extra-ordinary forces, which may affect the normal osteochondral and soft tissue developmental process and are the important factors causing the decrease of competitive power and shortening of life as a baseball player in adolescents. We surveyed the 114 baseball players of middle & high school in Taegu in order to evaluate the prevalance of symptoms and radiologic findings of the elbow and correlation of these findings to career & position of the baseball game. The results were as follows. 1. Of 114 players, 83 were non-pitchers and 31 were pitchers. The mean career was 3.8 years (7 months to 6 years). 2. The 77 players (67.7%) had the pain on their elbow during or after daily exercise. Other clinical symptoms were locking (30.7%), limitation of motion (18.4%), swelling (16.6%) and clicks on motion (10.5%). 3. On the radiogram of the elbow, hypertrophy or separation of medial epicondyle were seen in 34% of players, loose bodies in 17%, hypertrophy of the humerus in 12% and cystic change of the capitellum in 11%. 4. The mean career of symptomatic players was 4.4 years but non-symptomatics was 2.7 years. The mean career of players who had abnormal radiologic findings was 5.1 years but 3.1 years in players who had no abnormal radiologic fingings. 5. Symptoms and pathologic changes were more common in the elbow of pitcher' s group due to throwing frequency & pitching style. 6. Among the 77 players who had any kinds of problem of the elbow, 49 players of them had no experience of visiting hospital. 7. To prevent these injuries of the elbow, the following recommendations were made. First, restrict the number of innings pitched per game. Second, avoid throwing the curve ball in this age group. Third, ensue an adequate warm up period before exercise or rest after games. Fourth, inform parents and coaches of possible harmful nature of excessive throwing.
Adolescent* ; Baseball* ; Child ; Daegu ; Elbow* ; Humans ; Humerus ; Hypertrophy ; Parents

The study investigated the current epidemiologic and etiologic trends of shoulder pain over the past 10 years in South Korea.Current Concepts: From 2011 to 2020, nationwide health statistics data of the following diseases and soft tissue damage codes related to shoulder pain were extracted from the Healthcare Bigdata Hub—M75, S43, and S46. The annual changes in total medical cost and the number of patients with the three codes were extracted. The crude and age-standardized prevalence rates, and the annual percentage change were analyzed to characterize trends in prevalence rates over time. Changes in the proportion of medical cost by age, hospital type, and outpatient/inpatient distribution were also analyzed. Among the three codes, a significant increase in total medical cost, crude and age-standardized prevalence was observed only for the code M75. Additionally, in the distribution of total medical cost for the code M75 by age, the increase in the number of patients of the age group of 60 to 69 years was remarkable. The total medical cost gradually decreased at the clinic level and showed a remarkably increasing trend at the hospital level. This pattern is consistent with those of rotator cuff disease (M751), a representative disease of shoulder lesions.Discussion and Conclusion: The age of patients with shoulder pain appears to be increasing. Considering this trend of change in health statistics on shoulder pain in Korea, socioeconomic support and improvement of health policy regarding the distribution of medical expenses and resources for shoulder pain will be more necessary in the future.

No abstract available in English.
Acetabulum ; Clinical Study

BACKGROUND: For Neer type IIB fracture of distal clavicle with coracoclavicular ligament injury, various surgical treatments have been used in literatures. However, there was no consensus on the optimal treatment. The aim of this study is to report the clinical and radiological results of open reduction and internal fixation of unstable distal clavicle fracture and suture augmentation of disrupted coracoclavicular ligament. METHODS: A prospective study was performed in 23 patients with Neer type IIB distal clavicle fracture in Seoul Medical Center, Eulji Hospital, and National Medical Center. Firstly, suture anchors are inserted in the base of coracoid process and preliminary reduction was achieved by tie-off of three suture limbs around the clavicle. Then, the final fixation was completed with anatomical locking plate. Bony union and the distance between coracoclavicular ligaments were evaluated. Clinical results and complications including stiffness and secondary procedures were evaluated. RESULTS: Bony union was achieved in all cases except one (22 of 23). At mean 14.9 months, no significant difference in the mean coracoclavicular distance was observed compared to uninjured shoulder (8.2 +/- 7.9 mm versus 7.3 +/- 3.4 mm, p=0.14). Pain visual analogue scale, American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were 0.5, 83.4, 78.5, and 6.2, respectively. Revision surgery was performed in one case of nonunion. Four patients who complained of skin irritation underwent implant removal. CONCLUSIONS: In cases of an unstable distal clavicle fracture with coracoclavicular ligament disruption, satisfactory clinical results were obtained by locking plate fixation and coracoclavicular ligament suture augmentation concurrently.
Arm ; Clavicle* ; Consensus ; Elbow ; Extremities ; Hand ; Humans ; Ligaments* ; Prospective Studies ; Seoul ; Shoulder ; Shoulder Fractures ; Skin ; Suture Anchors ; Sutures*

PURPOSE: The objective of this study was to assess myocardial function before and after IVIG treatment by tissue Doppler imaging in children with Kawasaki disease. METHODS: This study was conducted on 43 patients with Kawasaki disease from April 2005 to February 2006 at Dongsan Medical Center, Keimyung University. Myocardial function of all patients was examined using echocardiography before (time 1) and after intravenous gamma-globulin (IVGG, time 2) treatment. Deceleration time (DT), isovolumic relaxation time (IVRT), fractional shortening (FS), and peak early diastolic (E), peak late diastolic (A) velocity of transmitral flow were measured by M-mode and pulsed wave Doppler. Systolic (Sm), peak early diastolic (Em), peak late diastolic (Am) velocity in apical 4-chamber and 2-chamber views were measured by tissue Doppler imaging. The author calculated modified Tei index, E/A, E/Em ratio by using measured values. RESULTS: Forty three patients were 27 boys and 16 girls. The average age of patients was 3 years and 1 month. There was 5 patients treated IVGG more than twice and no patient with definite coronary dilatation. All conventional Doppler parameters showed no significant difference statistically between control and time 1, 2. Among tissue Doppler parameters measured at time 2 in comparison to control and time 1, modified Tei index in septum, E/Em and modified Tei index in inferior wall decreased significantly and Am in inferior wall increased significantly. CONCLUSION: Although the results did not show consistency throughout all measured areas, it showed significant difference between patients and control in some areas' myocardiac function in relative recovery phase. This results are thought that the change in myocardial function may be derived from the Kawasaki disease during acute phase and recovery phase. There should be more investigations both in number and in diversity of patients with Kawasaki disease and there also should be studies to find how the changes mentioned above are different from persistent febrile group without the Kawasaki disease and whether they are temporal changes in the acute phase due to IVIG volumic overload.
Child* ; Deceleration ; Dilatation ; Echocardiography ; Female ; gamma-Globulins ; Humans ; Immunoglobulins, Intravenous ; Mucocutaneous Lymph Node Syndrome* ; Relaxation

Iatrogenic damage of the rotator cuff followed by postoperative shoulder function loss is a potential complication after antegrade intramedullary nailing (AIN) for a humeral fracture. The authors present a case of arthroscopic rotator cuff repair and subacromial decompression of a non-healed rotator cuff tendon (mainly supraspinatus) and secondary impingement syndrome caused either by the tear or a proud nail after AIN for a mid-shaft humeral fracture. At presentation, the patient complained of right shoulder pain and 'snapping', especially during forward elevation and abduction of the shoulder, of 4 years duration. Right shoulder pain started sometime after pain due to the humeral shaft fracture, operation had subsided, and persisted after nail removal. Arthroscopic findings showed a longitudinal rotator cuff tear at the nail entry point that had not healed and severe fibrous hypertrophy on the acromion underspace, which is a unique finding since most longitudinal splits of tendon fibers are more likely to heal than conventional rotator cuff tears detached from bone. The torn rotator cuff was repaired after debridement and placing side-to-side sutures. At his 34-month follow-up after rotator cuff repair, the patient showed complete recovery and had excellent clinical scores.
Acromion ; Arthroscopy ; Debridement ; Decompression ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Humans ; Humeral Fractures ; Hypertrophy ; Rotator Cuff ; Shoulder ; Shoulder Pain ; Sutures ; Tendons

Purpose: This study examined the characteristics based on the ultrasound findings of non-contact, gradual-onset shoulder pain in recreational-level surf beginners with a surf experience of one year or less and the treatment outcomes. Materials and Methods: From January 2019 to May 2020, 34 patients with gradual-onset shoulder pain from recreational-level surfing activity who visited outpatient clinics were analyzed retrospectively with prospective data collection. All patients had a surf experience of one year or less as surf club members. The demographic data, including the surf-specific data and physical test, were reviewed. Simple radiographs and ultrasound of both shoulders were performed for an initial evaluation in all patients. If needed, magnetic resonance images were taken for an additional evaluation. Conservative treatments, including medication or injection, combined with trunk extension, periscapular, and core muscle training were performed in all cases. The clinical outcomes were evaluated using the visual analog scale for pain (PVAS), the Simple Shoulder Test (SST) score at the initial and final follow-up, and the patient’s level of satisfaction with treatment. Results: Thirty-two patients (94.1%) showed minor symptoms. The clinical findings were predominantly divided into periscapular or pectoralis muscle strain (14.7%), proximal biceps tendinopathy (38.2%), subacromial impingement (44.1%), and shoulder instability (2.9%). The common findings in ultrasound were effusion around the biceps tendon, cuff tendinosis, and subacromial bursitis. The mean PVAS and SST score improved significantly at the last follow-up (p<0.001, p<0.001). The patient’s satisfaction with treatment ranged from ‘satisfied’ to ‘very satisfied’ in 31, ‘so so’ in two, and ‘dissatisfied’ in one patient. Conclusion This study showed that the common pathologic conditions of shoulder pain in recreational-level beginners with a surf experience of one year or less are tendinopathy around the long head of the biceps tendon and rotator cuff. Ultrasound was helpful in rapidly diagnosing and determining the treatment plans during the primary diagnostic approach at the outpatient visit. Most cases were associated with minor symptoms that did not interfere with work or surfing and showed relatively satisfactory results for conservative treatments combined with functional muscle training.

PURPOSE: To report the treatment results of anatomical reduction of all fracture fragments and internal fixation using an inter-fragmentary screw and plate in displaced mid-shaft clavicle fracture with comminution. MATERIALS AND METHODS: Between June 2005 and August 2011, 13 consecutive displaced clavicle fractures with comminution (Edinburgh classification IIB2) treated by anatomic reduction and internal fixation using inter-fragmentary screw and plate were retrospectively evaluated. There were 11 male and 2 female patients with a mean age of 37.4 years (15~55 years). The right clavicle was injured in 4 patients and the dominant arm was involved in 46%. The mean duration from trauma to surgery was 7.0 days. The cause of injury was a traffic accident in three, a fall in two, and sports activity or direct injury in eight patients. All of the fracture pieces were anatomically reduced and fixed with inter-fragmentary screws. An additional plate was applied to maintain and reinforce the reduction of the fracture. Radiographic assessments for the numbers of fragments and the amount of shortening and displacement were performed. To verify the fracture healing and determine the time from fracture surgery to union and complications, all of the radiographs taken after surgery were evaluated. RESULTS: The number of fragments was 2 in 7 cases, 3 in 5 cases, and 6 in one case. The mean shortening of the clavicle was 1.1 cm (0.3~2.1 cm) and mean displacement between the main fragments was 2.6 cm (1.3~4.5 cm). The mean duration of follow-up was 16.5 months (8~26 months). Radiographic union was achieved in all patients with a mean time to union of 10.8 weeks (8~14 weeks). There were no complications including metal failure, nonunion, or infection. CONCLUSION: Anatomical reduction of all the fracture fragments and fixation using inter-fragmentary screws in addition to the usual plate fixation showed good fracture healing in displaced clavicle fracture with comminution.
Accidents, Traffic ; Arm ; Clavicle ; Displacement (Psychology) ; Female ; Follow-Up Studies ; Fracture Healing ; Fractures, Comminuted ; Humans ; Male ; Retrospective Studies ; Sports

OBJECTIVES: Deep brain stimulation (DBS) of subthalamic nuclei (STN) is one of the current modalities of refractory epilepsy, but its exact mechanism and route of action have not been elucidated yet. We investigated the effect of STN stimulation on the development and propagation of seizures in the rats with lithium-pilocarpine induced status epilepticus in its functional anatomy. METHODS: Both pilocarpine injection and high frequency stimulation on STN (HFSSTN) were provided to rats (STN group, n=12), but pilocarpine injection with no stimulation was done on the sham group (n=8). The latency to first discrete ictal discharges and the latency to status epilepticus (SE) were analyzed and the electrical stimulation lasted for 30, 60, 90, 120 minutes after its first discrete spikes. After stimulation, the rats were immediately decapitated for immunohistochemistry and histologic examination. RESULTS: Both the latency to first discrete ictal discharges and the latency to the onset of SE were delayed in the STN group than in the sham group. The latency to the first SE was also more delayed in the STN group (42.7+/-7.9 min) than in the sham group (p<0.05). Remarkably, there was marked Fos immunoreactivity (FIR) on the reticular thalamic nuclei in the STN group, but not in the sham group. CONCLUSIONS: Increased FIR in the reticular thalamic nuclei during HFSSTN suggested that the facilitation of the inhibitory thalamic output prevented generalized motor seizure behavior. We assume that HFSSTN has a pivotal role in the suppression or progression to SE, but cannot prevent seizure onset.
Animals ; Deep Brain Stimulation ; Electric Stimulation* ; Epilepsy ; Immunohistochemistry ; Pilocarpine ; Rats* ; Seizures ; Status Epilepticus* ; Subthalamic Nucleus* ; Thalamic Nuclei