Ultrasonography is a powerful and useful method for the examination of the various shoulder diseases. The use of high-resolution transducer and technical evolution allowed the improvement of the accuracy of detection of the rotator cuff disease. In addition to diagnostic tool, ultrasonography can be applied as an optimal guidance in many intervention therapy around shoulder. However, its limitation is that there is marked disparity between the operators' experience levels. This article describes stepwise methods for evaluating shoulder conditions, ultrasonographic findings of various shoulder pathology, and guidance techniques for intervention therapy.
Pathology ; Rotator Cuff ; Shoulder Pain* ; Shoulder* ; Transducers ; Ultrasonography*

Clavicle fractures are very common injuries in adults and children and the majority of these fractures occur in the midshaft. Traditionally, mid-clavicle fractures have been treated with conservative methods and the clinical outcomes of this method are believed to be excellent. On the other hand, recent studies have shown that the clinical results of severe comminuted or markedly displaced fractures after conservative management were not as favorable as previously described. Despite these concerns, the conservative treatment of mid-clavicle fractures is still an efficient method, which can be applied to all patients as a primary care. This review focuses on the proper indication, technique, and limitations of conservative treatment of mid-clavicle fractures.
Adult ; Child ; Clavicle ; Hand ; Humans ; Methods ; Primary Health Care ; Shoulder

Forty five cases of adult tibial shaft fractures were treated with flexible intramedullary nails under image intensifier at the department of orthopaedic surgery, Capital Armed Forces General Hospital during between April 1986 to July 1988. The results were summarized as follows: 1. 45 cases were all male, the average age was 24.3 years and the most common cause of fractures was sports injury(20 cases) and the second most common cause was traffic accident(18 cases). 2. 11 cases out of 45 cases were open fracture and 34 cases were closed fracture. Eight cases of open fraeture were grade I and three cases were grade II. Twenty eight cases were comminuted fracture. The most common level of the fracture was middle third of the tibial shaft. 3. Average interval from injury to Ender nailing was 13.5 days and the mean duration of permission to full weight bearing was 9.2 weeks. 4. Out of 2 cases of delayed union, the average time of clinical bone union was 9.7 weeks and that of roentgenological bone union was 14 weeks. 5. 11 cases of complication were noted among the 45 cases of tibial shaft fracture which were treated by PGP nailing such as angulation, rotation, ankle joint stiffness, delayed union, shortening, and soft tissue infection. 6. PGP nailing is considered to be a valuable method in treating tibial shaft fracture because of their relative ease of nailing, allowing early weight bearing and decreased complication.
Adult ; Ankle Joint ; Arm ; Fractures, Closed ; Fractures, Comminuted ; Fractures, Open ; Hospitals, General ; Humans ; Male ; Methods ; Soft Tissue Infections ; Sports ; Tibial Fractures ; Weight-Bearing

Since the development of the first anatomic shoulder replacement in 1950, the technology has undergone substantial evolution, making it a viable option to manage variable shoulder problems, including severe osteoarthritis, rheumatoid arthritis, and fracture of the proximal humerus. However, the design of conventional total shoulder arthroplasty prostheses does not account for concomitant musculotendinous pathologies, including larger rotator cuff tears, which are associated with fatty infiltration of the infraspinatus muscle and substantially compromise the outcome of total shoulder arthroplasty. For patients without a rotator cuff or with rotator cuff tear arthropathy, hemiarthroplasty was the conventional treatment. Unfortunately, for these indications, hemiarthroplasty may provide little improvement in range of motion or function. Recently, radical changes in prosthetic design were made that transformed poorly performing reverse ball-and-socket total shoulder prosthesis into a highly successful salvage implant for pseudoparalytic and severe rotator cuff–deficient shoulders. The annual number of reverse total shoulder arthroplasties is increasing dramatically, and the indications also have expanded to include several conditions. In this review, the current concept of variable shoulder arthroplasty is discussed for clinical physicians

BACKGROUND: For early detection of developmental dysplasia of the hip (DDH), neonatal hip screening using clinical examination and/or ultrasound has been recommended. Although there have been many studies on the reliability of both screening techniques, there is still controversy in the screening strategies; clinical vs. selective or universal ultrasound screening. To determine the screening strategy, we assessed the agreement among the methods; clinical examination by an experienced pediatric orthopedic surgeon, sonographic morphology, and sonographic stability. METHODS: From January 2004 to June 2009, a single experienced pediatric orthopedic surgeon performed clinical hip screenings for 2,686 infants in the neonatal unit and 43 infants who were referred due to impressions of hip dysplasia before 3 months of age. Among them, 156 clinically unstable or high-risk babies selectively received bilateral hip ultrasound examinations performed by the same surgeon using the modified Graf method. The results were analyzed statistically to detect any correlations between the clinical and sonographic findings. RESULTS: Although a single experienced orthopedic surgeon conducted all examinations, we detected only a limited relationship between the results of clinical and ultrasound examinations. Ninety-three percent of the clinically subluxatable hips were normal or immature based on static ultrasound examination, and 74% of dislocating hips and 67% of limited abduction hips presented with the morphology below Graf IIa. A total of 80% of clinically subluxatable, 42% of dislocating and 67% of limited abduction hips appeared stable or exhibited minor instability on dynamic ultrasound examination. About 7% of clinically normal hips were abnormal upon ultrasound examination; 5% showed major instability and 3% showed dysplasia above Graf IIc. Clinical stability had small coefficients between ultrasound examinations; 0.39 for sonographic stability and 0.37 for sonographic morphology. Between sonographic stability and morphology, although 71% of hips with major instability showed normal or immature morphology according to static ultrasound examination, the coefficient was as high as 0.64. CONCLUSIONS: Discrepancies between clinical and ultrasound examinations were present even if almost all of the exams were performed by a single experienced pediatric orthopedic surgeon. In relation to screening for DDH, it is recommended that both sonographic morphology and stability be checked in addition to clinical examination.
Hip Dislocation ; Hip* ; Humans ; Infant ; Mass Screening* ; Orthopedics ; Ultrasonography*

BACKGROUND: For early detection of developmental dysplasia of the hip (DDH), neonatal hip screening using clinical examination and/or ultrasound has been recommended. Although there have been many studies on the reliability of both screening techniques, there is still controversy in the screening strategies; clinical vs. selective or universal ultrasound screening. To determine the screening strategy, we assessed the agreement among the methods; clinical examination by an experienced pediatric orthopedic surgeon, sonographic morphology, and sonographic stability. METHODS: From January 2004 to June 2009, a single experienced pediatric orthopedic surgeon performed clinical hip screenings for 2,686 infants in the neonatal unit and 43 infants who were referred due to impressions of hip dysplasia before 3 months of age. Among them, 156 clinically unstable or high-risk babies selectively received bilateral hip ultrasound examinations performed by the same surgeon using the modified Graf method. The results were analyzed statistically to detect any correlations between the clinical and sonographic findings. RESULTS: Although a single experienced orthopedic surgeon conducted all examinations, we detected only a limited relationship between the results of clinical and ultrasound examinations. Ninety-three percent of the clinically subluxatable hips were normal or immature based on static ultrasound examination, and 74% of dislocating hips and 67% of limited abduction hips presented with the morphology below Graf IIa. A total of 80% of clinically subluxatable, 42% of dislocating and 67% of limited abduction hips appeared stable or exhibited minor instability on dynamic ultrasound examination. About 7% of clinically normal hips were abnormal upon ultrasound examination; 5% showed major instability and 3% showed dysplasia above Graf IIc. Clinical stability had small coefficients between ultrasound examinations; 0.39 for sonographic stability and 0.37 for sonographic morphology. Between sonographic stability and morphology, although 71% of hips with major instability showed normal or immature morphology according to static ultrasound examination, the coefficient was as high as 0.64. CONCLUSIONS: Discrepancies between clinical and ultrasound examinations were present even if almost all of the exams were performed by a single experienced pediatric orthopedic surgeon. In relation to screening for DDH, it is recommended that both sonographic morphology and stability be checked in addition to clinical examination.
Hip Dislocation ; Hip* ; Humans ; Infant ; Mass Screening* ; Orthopedics ; Ultrasonography*

Background: Most previous studies have evaluated flexion strength to assess recovery after arthroscopic rotator cuff (RC) repair.However, limited data are available regarding peak torque at the initial angle (iPT) because most studies have measured flexion strength for peak torque (PT), particularly in small- and medium-sized supraspinatus tears. The purpose of this study was to compare conventional PT and iPT to evaluate supraspinatus muscle strength after arthroscopic RC repair in patients with small- and medium-sized supraspinatus tears. Methods: Isokinetic muscle performance testing was performed in 42 patients with small tears and in 47 patients with medium-sized tears. PT and iPT were evaluated before and 1 year after surgery and were recorded at an angular velocity of 60°/sec and 180°/sec with an isokinetic test. Results: PT and iPT were significantly lower in the involved-side shoulders than in the uninvolved-side shoulders (PT: small tear, p < 0.001; medium tear, p < 0.001; iPT: small tear, p < 0.001; medium tear, p < 0.001) in both groups, preoperatively. However, postoperatively, in the involved-side shoulders, PTs were not different in both small- and medium-sized tears (all p > 0.05), but iPTs were significantly lower in the involved-side shoulders (small tear, p < 0.001; medium tear, p < 0.001). iPT was significantly lower in the involved side shoulders in the medium-sized tear group than in the small-sized tear group before and after surgery (p < 0.05). In the smalland medium-sized tear groups, tear size was significantly correlated with preoperative iPT in the involved-side shoulders (small tear: r = –0.304, p = 0.046; medium tear: r = –0.323, p= 0.027). However, pain visual analog scale was significantly correlated with preoperative (small tear: r = –0.455,p = 0.002; medium tear: r = –0.286, p = 0.044) and postoperative (small tear: r = –0.430, p = 0.005; medium tear: r = –0.354, p = 0.021) iPT in the involved-side shoulders. Furthermore, fatty infiltration grade of the supraspinatus muscle and global fatty degeneration index were not associated with preoperative and postoperative PT and iPT in each group (all p > 0.05). Conclusions iPT is as important as conventional PT in isokinetic testing to assess supraspinatus muscle strength before and after RC repair.

In order to accurately diagnose lesions of musculoskeletal tissue, evaluation not only of the abnormality of the bone, but the condition of soft tissue is important. Magnetic resonance imaging has been widely used in evaluation of the state of soft tissue, however, it has the disadvantage that testing is expensive and real-time scanning is not possible. In recent years, ultrasonography has been used for evaluation of musculoskeletal tissue and its usefulness has shown a gradual increase. The ultrasound image is determined by the tissue specific acoustic impedance and other factors. Highly reflective tissues such as bone, calcification, ligament, and tendon are expressed as hyperechoic images, and less reflective tissues such as muscle and nerve are expressed as hypoechoic images.
Acoustics ; Electric Impedance ; Ligaments ; Magnetic Resonance Imaging ; Muscles ; Musculoskeletal System ; Tendons ; Ultrasonography

Purpose: Epidemiological data on injuries resulting from ice hockey and their management are lacking in Korea. A comprehensive analysis of such data is crucial for the effective prevention and management of ice hockey injuries. This study aimed to determine the epidemiological profile of ice hockey injuries and their management among elite Korean players. Methods: The descriptive epidemiological study involved three semiprofessional male ice hockey teams and used a retrospective self-reported questionnaire for assessment. The data collected included demographic characteristics such as player positions and stick-side preferences, injured body parts, injury types, treatment methods, and the decision-maker for returning to sports. Results: A total of 68 players were included in the study, of whom 58 (85.3%) experienced moderate-to-severe orthopedic injuries. Among the reported injuries, 93 (77.5%) occurred during the games, with player-to-player contact being the most frequent cause of such injuries. The decision to return to sports in 53 cases (44.2%) was made by the medical staff, whereas players and nonmedical staff made that decision in 67 cases (55.8%). The decision-making process of the medical staff for allowing players to return to sports was significantly associated with the player’s position and whether the injury required surgery. Conclusion The study emphasizes the high prevalence of orthopedic injuries among elite ice hockey players in Korea and the importance of injury prevention strategies. It also highlights the need for increased involvement of medical staff in return-to-play decisions to ensure successful recovery of players and their reintegration into the competition.

BACKGROUND: This study aimed to verify the diagnostic performance of Ultrasonography (US) in the evaluation of fatty infiltration (FI) in rotator cuff muscles and to analyze the diagnostic values of each measurement component. METHODS: The degree of FI in 108 shoulders was assessed by magnetic resonance imaging (MRI) and US. MRI findings were graded by the Goutallier classification. US findings were graded by the Strobel method. Agreement between MRI and US findings was evaluated. The sensitivity and specificity for detecting FI and intraobserver reliabilities were also assessed. RESULTS: US grading of the infraspinatus based on short-axis architecture showed good agreement (κ = 0.62). US grading-based on architecture showed good agreement for both supraspinatus and infraspinatus in long- and short-axis scans (supraspinatus, κ = 0.63; infraspinatus, κ = 0.68), while that based on echogenicity showed moderate agreement (supraspinatus, κ = 0.51; infraspinatus, κ = 0.50). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of detecting advanced FI were significant in both axes. CONCLUSIONS US is effective for detecting advanced FI in the rotator cuff muscles. US can assess the infraspinatus more accurately than the supraspinatus, and architecture is a more decisive component of FI status than echogenicity.