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

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

No abstract available.

The introduction and adaptation of the methods of Ilizarov could be achieved correction of equines in patients with major problems such as posttraumatic equines associated with severe soft tissue injury that would not allow the use of conventional surgical methods. In order to evaluate the factors causing complications and affecting the results, we reviewed 12 cases in which the equines deformity of feet were corrected by the Ilizarov method from May 1991 to August 1995. Mean follow up periods were 18 months. The average age of patients was 28 years(ranged from 8 to 56 years). The causes of equines were posttraumatic 9, Charcot-Marie-Tooth disease 1, residual poliomyelitis 1, and deformity of unknown origin 1, and four cases were associated varus deformity. Correction periods was from 4 to 14 weeks(average 7 weeks), fixation period from 1 to 16 weeks(average 6.2 weeks). The additional immobilization with cast or brace was from 4 to 44 weeks, and then rehabilitation was done. Initial equines deformity was averaged 39.5 degrees (range 20-70 degrees). We obtained average 33 degrees of deformity correction which means the average 6.5 degrees of equines still was remained at the last follow up. Range of motion was improved from preoperative 11 to postoperative 20 degrees. One posttraumatic patient with calcaneal varus and loss of calf muscles, and one residual poliomyelitis patient recurred during follow up. We performed the triple arthrodesis and Achilles lengthening in one case of Charcot-Marie-Tooth disease and one case of equines deformity of unknown origin. Gait pattern and pain was improved in all but 2 cases with mild pain in walking. Complications during or after treatment were recurrence(2), anterior subluxation of talus(5), claw toe(10), partical rupture of Achilles tendon(1), valuges or varus deformity (4), posterior tibial nerve injury(1), rockerbottom deformity(2) and pin tract infection(5). The case of recurrence or second operation coourred in 4 of 12 cases(33%). To prevent the recurrence of equines deformity, we recommend that long period of maintainance, adequate cast immobilization or brace more than 3 months, and continuous rehabilitation. The key to prevent subluxation of talus was a precise hinge placement at the center of talar dome and, if subluxation of talus was occurred, it should be corrected by anterior or posterior translation using olive pin. It should be corrected by flexor tendon lengthening during correction period or after removal of Ilizarov, if claw toew deformity occurred.
Animals ; Arthrodesis ; Braces ; Charcot-Marie-Tooth Disease ; Congenital Abnormalities ; Equinus Deformity ; Follow-Up Studies ; Foot ; Gait ; Hoof and Claw ; Humans ; Ilizarov Technique ; Immobilization ; Muscles ; Olea ; Poliomyelitis ; Range of Motion, Articular ; Recurrence ; Rehabilitation ; Rupture ; Soft Tissue Injuries ; Talus ; Tenotomy ; Tibial Nerve ; Walking

Congenital radioulnar synostosis can be a disabling state, especially if it is bilateral or fixed hyperpronation. The purpose of this study is to introduce the surgical technique in proximal radioulnar synostosis who needs surgical intervention. Our procedures included excision of synostosis, interposition of muscle flap using brachioradialis, anconeus or extensor carpi ulnaris muscles with vascular pedicle for prevention of re-ankylosis and biceps transfer to improve supination. From July 1994 to July 1996, we evaluated 8 cases in 6 patients who underwent these procedures. The average age was 7 years and average duration of follow up was 24 months. The fixed forearms with hyperpronation have gained average 40 degrees of range of rotation. Improvement in holding and using small objects, sports activities and daily living activities was observed in all cases. There were no significant complications including re-ankylosis during the follow-up periods. In conclusion, surgical treatment of congenital radioulnar synostosis with these procedures is a reliable method that prevent re-ankylosis with providing forearm rotation.
Activities of Daily Living ; Follow-Up Studies ; Forearm ; Humans ; Muscles ; Sports ; Supination ; Synostosis* ; Tendon Transfer

No abstract available.
Arthroplasty, Replacement, Hip*

Purpose: The purpose of this paper is to clinically evaluate the usefulness of all arthroscopic repair with biceps incorporation in massive sized full thickness rotator cuff tears. Materials and Methods: This is a prospective comparative outcome study evaluating a series of all arthroscopic rotator cuff repairs with biceps incorporation on massive (range: 5~6 cm sized) from March 2003 to May 2006. Group I was twenty two cases of arthroscopically repaired with biceps incorporation, twenty cases of group II without biceps incorporation were analyzed. The average age of the patients was 58 years (range, 41~74 years), and mean follow-up was 24 months (range, 12~36 months). Results were statistically compared by Mann-Whitney test. Results: Average VAS for pain, ADL, UCLA score were not significantly different between group I and group II (P>0.05 for each). Forward elevation strength was 4.3 in group I, 3.5 in group II (P<0.05). On postoperative follow up ultrasound, retear was 10 cases in the middle of 19 cases at group I, 15 cases in the middle of 17 cases at group II (P<0.05). Conclusion: This study reveals that all arthroscopic repairs with biceps incorporation in massive sized full thickness rotator cuff tears is an effective surgical method and reduced retear and enhanced strength.
Activities of Daily Living ; Follow-Up Studies ; Humans ; Outcome Assessment (Health Care) ; Prospective Studies ; Rotator Cuff* ; Ultrasonography

PURPOSE: This study evaluated the clinical and radiological outcomes of semiconstrained total elbow arthroplasty. MATERIALS AND METHODS: Thirty-nine elbows with semiconstrained total elbow arthroplasty and who were followed up for at least 3 years were enrolled in this study. There were 29 and 10 cases in the non-traumatic arthritis and traumatic arthritis groups, respectively. The mean age at the time of surgery was 53.9 years, and the mean follow-up period was 54 months. RESULTS: At the last follow-up, the pain score during motion decreased from 7.37 to 1.23. The Mayo elbow performance score was 86. The mean loss of terminal extension improved from 32degrees to 11degrees and the mean maximum flexion improved from 90.3degrees to 125.2degrees. Radiology analysis, 15 elbows showed radiolucency and 8 elbows showed loosening. There were 13 cases of radiolucency and 7 cases of loosening in the non-traumatic arthritis group. In the traumatic arthritis group, there were 2 cases of radiolucency and 1 case of loosening. CONCLUSION: Semiconstrained total elbow arthroplasty for non-traumatic and traumatic arthritis of the elbow produced satisfactory functional results. The non-traumatic arthritis group had a higher incidence of radiolucency and loosening than the traumatic group.
Arthritis* ; Arthroplasty* ; Elbow* ; Follow-Up Studies ; Incidence

OBJECTIVE: The goal of this study is to investigate the effect of subacromial bursa injection of hyaluronate in patients with adhesive capsulitis of shoulder. METHOD: Fifty nine patients with adhesive capsulitis of shoulder were injected with hyaluronate (Hyruan , LG chemical) 2.5 ml to subacromial bursa once a week for 5 weeks and randomly selected twenty eight patients among them were injected with Depomedrol 20 mg only at first week. The effect of hyaluronate injection was evaluated by pain (Visaul analogue scale), night pain, range of motion of shoulder, functional activities of daily living and patient's self satisfaction at preinjection, every week after first injection until 5th week, 8th and 12th week. RESULTS: Visual analogue scale and night pain were significantly decreased at 5th and 12th week compared with preinjection status. The range of motion of shoulder and functional activities of daily living significantly improved at 5th week and 12th week. Eighty eight percent (N=52) of patients reported as a little improved, improved or much improved at 5th week. No significant serious side effect of injection was found until 12th week. CONCLUSION: Hyaluronate injection into subacromial bursa decreased pain and improved shoulder range of motion. It also improved functional activities of daily living of patients with adhesive capsulitis. So it is effective and safe for those patients, especially who cannot receive corticosteroid intra articular injection.
Activities of Daily Living ; Adhesives* ; Bursitis* ; Humans ; Prospective Studies* ; Range of Motion, Articular ; Shoulder Joint* ; Shoulder*

Background: Synovial osteochondromatosis (SOC) of the shoulder is a rare condition with unclear characteristics. This study evaluated the clinical features and postoperative functional outcomes of SOC of the shoulder that are distinct from SOC of other joints. Methods: The characteristics of 28 shoulders with SOC that underwent arthroscopy were retrospectively assessed. Ten shoulders (35.7%) had rotator cuff tears (RCTs) and underwent concomitant arthroscopic rotator cuff repair. The mean follow-up period was 83.6 months (range, 24–154 months). Demographic characteristics and loose bodies localized under arthroscopy were compared between cases with and without concomitant RCTs. Radiography, ultrasonography, or magnetic resonance imaging were performed preoperatively and postoperatively. Visual analog scale (VAS) scores for pain and satisfaction were evaluated for all cases, and functional scores were assessed in shoulders with concomitant RCTs. Results: The average age was 36.2 ± 15.6 years among patients without RCTs and 58.3 ± 7.2 years among patients with RCTs.Seven shoulders (7%) had osteoarthritis. Arthroscopy revealed loose bodies in multiple spaces, including the glenohumeral joint, subacromial (SA) space, and biceps tendon sheath. Overall, loose bodies were found in multiple spaces in 12 shoulders (42.9%). Loose bodies were found in the SA space only in 4 shoulders (22.2%) without RCTs and in 7 shoulders (70.0%) with RCTs. VAS for pain decreased significantly from 3.9 ± 2.3 to 1.1 ± 1.3 (p < 0.001). The functional scores increased significantly after arthroscopic management for patients with concurrent RCTs (all p < 0.05). Recurrence of SOC occurred in 3 of the 22 shoulders (13.6%) who underwent postoperative imaging, but no patient had a recurrent RCT. Conclusions Pain relief and patient satisfaction were achieved via arthroscopic management. Unlike in other joints, loose bodies can occur simultaneously in several spaces in the shoulder, including the glenohumeral joint, SA space, and biceps tendon sheath. Early diagnosis of SOC of the SA space can help prevent osteoarthritis and RCT progression.