No abstract available.
Elbow* ; Shoulder*

No abstract available.
Elbow ; Shoulder

We experienced four patients that had gone unreduced for at least eight weeks and evaluated the results of the operative treatment in these paitents. All four cases were anterior dislocation, and among them three cases were dislocated by direct trauma and one was dislocated during seizure attack. Pain was moderate in one case and mild in three cases. In the preoperative range of motion, the average passive tlexion at the scapular plane was 143 degrees (90 degrees - l70 degrees) and average external rotation at the side was 33 degrees(5 degrees-60 degrees), but the average active flexion was 103 degrees, active external rotation was 16 degrees and the internal rotation at the back was the sacral level except one. All four patients complained of severe limitation of daily living activity due to limitation of motion and weakness and could not occupy their jobs. In all four cases, three dimensional CT scan was performed to evaluate glenoid and humeral bone defect and for preoperative planning. Operation was performed at 8 weeks after initial dislocation in two cases, 1 year later in one case and 2 years later in one case. Open reduction was done and the defect of humeral head was filled with osteochondral allograft in two cases. Fractured humeral head fragment was reduced and fixated with non-ahsorhahle suture in one case and prosthetic head replacement was performed in the other. As a result, three patients had a mild or moderate pain postoperatively and moderate functional restrictions in the activities of daily living, and they were considered to be unsatifactory. Two cases were subluxated during the follow-up. These results show that the overall prognosis for the surgical treatment of the chronic unreduced dislocated shoulder is unpredictable and unacceptable.
Activities of Daily Living ; Allografts ; Dislocations* ; Follow-Up Studies ; Head ; Humans ; Humeral Head ; Prognosis ; Range of Motion, Articular ; Seizures ; Shoulder* ; Sutures ; Tomography, X-Ray Computed

A SLAP lesion is a tear in the superior aspect of the glenoid labrum, in which the injury begins posteriorly and extends anteriorly, stopping at or above the mid glenoid notch. We reviewed retrospectively the clinical history, the positive physical findings, the associated diseases, and the final results of twenty four patients with SLAP lesion which were diagnosed and treated arthroscopically between October 1993 and February 1996. There were twenty three males and or.e female with an average age of 28 years. Follow-up time was averaged 18 months (range; 12 to 20) In according to Snyder's classification, seven cases were Type I, six cases were Type II, seven cases were Type III and four cases were Type IV. The common mechanisms of injury were compression force to the shoulder (ll cases),traction injury (7 cases) and the remainders were unknown. Among these, solitary SLAP lesion was eight cases. A high incidence of associated pathology was noted in these patients; multidirectional instability (1), unidirectional anterior instability (7), full thickness rotator cuff tear (3), partial thickness rotator cuff tear (5) and the frozen shoulder (1). Patients were treated for associated pathology and additional treatment of SLAP lesion was done by arthroscopic excision (9), repair (5), biceps tenodesis (1) and arthroscopic debridement (9). On evaluation, seventy nine percentages of patients obtained either good or excellent results post-operatively, and especially in the solitary SLAP lesions, eighty eight percentages achieved significant improvements, even though it was difficult to say whether the arthroscopic surgery itself contributed to resolve some of shoulder pain and instability when SLAP lesion was associated with other shoulder diseases.
Arthroscopy ; Bursitis ; Classification ; Debridement ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Pathology ; Retrospective Studies ; Rotator Cuff ; Shoulder Joint* ; Shoulder Pain ; Shoulder* ; Tenodesis

Acromioclavicular joint pain is a common cause of shoulder-related symptoms. Frequently, nonoperative treatment regimens resolve symptoms originating from acromioclavicular joint. However, patients refractory to conservative therapy require operative intervention and the resection of distal end of the clavicle has proven to be a reliable method in these patients. We performed fourteen cases of arthroscopic distal clavicle resection for acromioclavicular joint lesions between February 1995 and February 1997 and reviewed the efficacy of the arthroscopic distal clavicle resection, retrospectively. Causes of acromioclavicular joint pathology were 7 cases of degenerative osteoarthritis, 6 traumatic osteoarthritis and 1 partial instability. Average patient age was 50 years (range 19 to 70 years). Preoperatively all patients had pain, whereas 57% had acromioclavicular tenderness and 86% positive adduction test. The operations were performed with subacromial bursal approach. The average length of distal clavicle resection was 10mm (range 5 to 18mm). At an average follow-up of 18 months (range 8 to 30 months), the ASES score ranked 6 shoulders in excellent (43%), 6 good (43%), 1 fair (7%), and 1 poor (7%). Thus, the overall results suggest that arthroscopic acromioclavicular resection is one of the effective methods for the treatment of acromioclavicular joint pathology.
Acromioclavicular Joint* ; Clavicle ; Follow-Up Studies ; Humans ; Osteoarthritis ; Pathology ; Retrospective Studies ; Shoulder

No abstract available.
Follow-Up Studies* ; Knee*

Posterior instability of the shoulder is far less common than anterior or multidirectional instability. There is still controversy in the diagnosis and treatment of recurrent posterior instability, and many treatment protocols have been advocated. However the failure rate as high as 50% was reported. The purpose of this study is to introduce characteristic physical findings of posterior instability, to present our operative techniques, and to report the efficacy of a superior shift of the postero-inferior capsule in the treatment of recurrent posterior instability. From June 1995 to September 1996, five patients, six shoulders underwent postero-inferior capsular shift for posterior instahility and were evaluated at an average of 17 months(ranged from 9 to 26 months) after operation. The average age was 22.4 years. Preoperatively, mean scores of pain, stability and function according to American Shoulder and Elbow Society (ASES) scoring system were 21, 9, and 16 points respectively and mean overall ASES score was 46 points. After surgery, the average range of motion was 175 of forward elevation and 74 of external rotation and internai rotation in back was up to the sixth thoracic level. Postoperative mean scores of pain, stability and function were 29, 34 and 25 points respectively and mean overall ASES score was 88.5 points. No patient had a recurrence of posterior instability. All patients had satisfactory results with significant improvement in stability and function except one case who had multidirectional instability that mainly involved the posterior component
Clinical Protocols ; Diagnosis ; Elbow ; Humans ; Range of Motion, Articular ; Recurrence ; Shoulder*

Twenty six consecutive patients with superior labrum anterior to posterior (SLAP) lesions of the shoulder involving the hiceps attachment to the labrum were fixed with biodegradable tack through a new lateral portal arthroscopically and reviewed to evaluate the efficacy of the biodegradable tack tixation in the unstable SLAP lesion. The tack was placed at the posterosuperior aspect of biceps attachment and directed toward anteroinferior via lateral portal just lateral to the acromial margin. Mean follow up duration was 18 months (range, 8 to 27). According to Snyder s classification, 24 cases were type ll, 1 case was type III and 1 case was type IV. lsolated SLAP lesion was nine cases (35%,) in our series. Thirteen cases were associated with the unidirectional anterior instability, one case with the multidirectional instability, 2 cases with the full thickness tear of the rotator cuff and 1 case with the acromioclavicular injury. Preoperative scores increased postoperatively by using the American Shoulder and Elbow Society (ASES) evalualion system in all cases. ln isolated SLAP lesions, pain scores improved from 3.0 to 4.2, stability scores from 3.7 to 5.0, and function scores from 2.7 to 3.4. In associated SLAP lesions, pain scores improved from 3.2 to 4.2, stability scores from 3.5 to 4.8 and function scores from 3.1 to 3.9, Overall scores improved from 71 to 93 in associated SLAP lesions and improved from 67 to 90 in isolated lesions. Eiehteen patients(69%) achieved excellent results and 6 patients(23% ) ohtained good results. And there were no complications related to the use of biodegradable implant. Thus, arthroscopic fixation is recommendable in the management of the unstable SLAP lesions.
Absorbable Implants ; Classification ; Elbow ; Follow-Up Studies ; Humans ; Rotator Cuff ; Shoulder

To identify whether acromial shape, osteophyte, and acromio-humeral interval have effects on impingement syndrome or rotator cuff tear, we reviewed 40 cases of normal group (F:M=22:18), and 30 cases of impingement syndrome(F:M=16:14). Forty cases of normal group aged from 40 to 69 who had no pain, no abrasion sign, no limitation of motion, and normal function of shoulder joint were selected. Thirty cases of impingement syndrome were managed by acromioplasty of direct repair from October, 1993 to May, 1994. Twenty-five cases of 30 were identified rotator cuff tear(RCT), and the others were turned out subacromial abrasion. We reviewed the acromial thickness, the acromial shape, the anterior protuberance, the presence of osteophyte, and the acromio-humeral interval to compare the difference between two groups. Forty-seven point five per cent of normal group had a flat, type I acromion, 47.5% had a curved, type II acromion and 5% were identified by a hooked, type III acromion. However, in subjects with impingement syndrome and RCT, 37% had type I, 20% had type II, and 43% displayed type III. Type III was considerably noticed in the massive tear. In regarding to acromial thickness, normal group had type A(less than 8mm)-37.5%, type B(8-12mm)-62.5%, and the impingement syndrome or RCT group had type A-53%, type B-47%. We couldn’t find any significant difference with each group in type III(more than 8mm)-15% in normal, and type I-17%, type II-33%, type III-50% in the impingement syndrome or RCT. It was suggested that the anterior protuberance was related with the evidence of RCT. A-H interval was 10.25mm±1.46mm in normal, and 9.44mm±1.70mm in the impingement syndrome or RCT. There was on significance in A-H interval except rotator cuff arthropathy. Thirty three percent of normal group had osteophytes and 40% of impingement syndrome or RCT had osteophytes on the undersurface of acromion.
Acromion ; Osteophyte ; Rotator Cuff ; Shoulder ; Shoulder Joint ; Tears

No abstract available.