No abstract available.
Shoulder Pain* ; Shoulder*

PURPOSE: We wanted to evaluate the results of arthroscopic management of an isolated rupture of the subscapularis tendon using suture anchors. MATERIALS AND METHODS: Twenty nine patients with unilateral ruptures of the subscapularis tendon and who underwent arthroscopic repair between February 2001 and October 2007 were reviewed prospectively. All the cases were isolated tears of the subscapularis without the involvement of any other rotator cuff tendon. In 19 patients the tear was localized to the superior one third, in 7 cases the tear was localized to the upper two thirds and the entire tendon was involved in 3 cases. The mean follow up period was 12.2 months (range: 6-26 months). The results of the treatment were assessed by evaluating the constant shoulder score and the pain score before surgery and after surgery. RESULTS: The constant shoulder score improved from 49.9+/-7.3 to 73.8+/-3.0 points compared to before surgery and the pain score improved from 4.3+/-3.2 to 11.2+/-3.0 points postoperatively. CONCLUSION: Arthroscopic repair of isolated ruptures of the subscapularis tendon using suture anchors is a good option for effectively managing these tears.
Follow-Up Studies ; Humans ; Prospective Studies ; Rotator Cuff ; Rupture ; Shoulder ; Suture Anchors ; Sutures ; Tendons

Spondylolisthesis is the slippage of all or part of one vertebra onto another. The term is derived from the Greek words spondylos and olisthesis. Wiltse, Macnab, and Newman combined their concepts in what remains the most widely accepted classification. Wiltse and Rothman in 1989 suggested a common congenital component in the etiology of dysplastic and isthmic types and added the postsurgical group to the original classification. The precise anatomy of the pars lesion is extremely important in understanding the pathogenesis. The pars interarticularis is the connecting link between pedicles, transverse processes, laminae, and the two articular facets acting as the pivot center. The L5-S1 articulation, being in the coronal plane, is more stable than the sagittal placement of the L4-5 facet joint. The fifth lumbar vertebra is stabilized by a large L5 transverse process, which supports strong muscular and ligamentous(iliolumbar) attachment. An increased lumbar lordosis increases the shear stress at the L4-5 level. Both congenital and isthmic types are often associated with spina bifida of the L5 or S1 segments. There seems to be a definite sex and racial difference, with black women (1.1%) having the lowest prevalence and white men(6.4%) the highest. The increased prevalence is in Alaskan natives and young sportsmen, ranging from 11% to 35%. Repetitive flexion, combined flexion-extension and both forcible hyperextension and rotation of the lumbar spine predispose to a pars stress fracture. Most of isthmic type develops during the first year of school, and by age 7 the prevalence is 4%. A further 1.4% of cases occur during adolescence, most between 11 and 15 years of age. In patients under 25 years of age with low back pain and isthmic spondylolisthesis, this lesion is most probably the cause of the symptoms(18.9%). In patients older than 40 years, it is seldom the only cause of low back pain (5.2%). The radicular pain is found in 14% of patients with isthmic spondylolisthesis. Degenerative spondylolisthesis results from long standing intersegmental instability. 10% of women over 60 years had a 1st or 2nd degree. It occurs 6 times more often at the L4-5 level and 5 times more often in women, mostly in those older than 40 years. The patient may have back pain (5.6%) with or without leg pain and/or may have intermittent claudication (80%). In traumatic spondylolisthesis, acute fractures of the pars interarticularis are rare and are always due to fracture of the other part of the posterior elements caused by severe trauma. In pathological spondylolisthesis, the bony strength is insuffient to resist forward motion of the proximal vertebra on the one below. In postsurgical spondylolisthesis, the most common etiology is extensive decompression with sacrifice of the facet joints.
Adolescent ; Animals ; Back Pain ; Classification* ; Decompression ; Female ; Fractures, Stress ; Humans ; Intermittent Claudication ; Leg ; Lordosis ; Low Back Pain ; Natural History* ; Population Groups ; Prevalence ; Spinal Dysraphism ; Spine ; Spondylolisthesis* ; Zygapophyseal Joint

No abstract available.
Writing*

There are many methods of making cement spacer in patients who require a two-staged operation for humeral head osteomyelitis. However, limitation of motion after the first surgery—due to inadequate size and insufficient intra-articular space for second surgery—remain to be an issue. To mitigate this issue, we made a cement spacer with the same size and shape of the patient humeral head. Four patients with humeral head osteomyelitis were enrolled in this study. To make the cement spacer, we used the Mimics program, and designed the molding box by a reverse engineering technique. We evaluated the range of motion and pain using a Constant score. The mean abduction was 50° (40°–60°), forward flexion was 50° (30°–70°), and average Constant score was 47.75 (44–52). Three-dimensional printed molding technique is one of the effective methods for humeral head osteomyelitis allowing for daily activities prior to the second surgery.
Fungi* ; Humans ; Humeral Head* ; Osteomyelitis* ; Range of Motion, Articular

PURPOSE: These case reports have been prepared to highlight the uncommon occurrence of anterior shoulder dislocation after an epileptic seizure, the recognition of which is important as this type of injury is associated with bony lesions and a high incidence of recurrence. MATERIALS AND METHODS: We report two cases of recurrent anterior dislocation of the shoulder due to grand mal epilepsy. These cases were treated as usual anterior dislocations of the shoulder, and were regularly followed to detect any recurrence of shoulder instability. RESULTS: Outcome of the surgery in the two cases was different because of the differences in seizure control. In the patient in whom seizures were well-controlled, there was no recurrence of instability, while the patient with poorly controlled seizures developed a recurrence of the dislocation following shoulder repair. CONCLUSION: The authors emphasize the need to control seizures in order to prevent injury recurrence in this subset of patients.
Dislocations ; Epilepsy ; Epilepsy, Tonic-Clonic ; Humans ; Incidence ; Recurrence ; Seizures ; Shoulder ; Shoulder Dislocation

BACKGROUND: Although there are several methods for evaluating bone quality, Hounsfield units (HU), a standardized computed tomography (CT) attenuation coefficient, provide a useful tool for estimating focal bone mineral density (BMD). The aim of this study is to investigate the HU for evaluating the degree of osteoporosis in greater tuberosity with regard to anchor positioning. METHODS: Forty patients diagnosed as normal on shoulder CT were included and categorized according to age and gender. Axially sectioned CT images were processed to 3-dimensional models containing information about bone quality using Mimics (14.11 platform v14.1.1.1 Materialise). Three-dimensional anchors were simulated and positioned according to 6 regions of interest (ROI) in the greater tuberosity classified using Tingart's system. Mean HU of intra-anchor volumes in the 6 regions was measured. RESULTS: A significant decrease in HU was observed with increasing age (p=0.0001) and menopause (p<0.001). A significant difference in HU was found between male and female groups with males showing the higher values (p=0.0001). HU of proximal areas of ROI was higher than those of distal areas (p<0.005). However, although mean HU of distal posterior ROI showed the lowest values, no statistically significant difference was found between anterior, middle, and posterior regions (p=0.087). CONCLUSION: Mean HU of ROIs provides a tool for preoperative assessment of focal BMD, which is a factor of suture anchor stability and can be used to aid decision-making regarding secure anchor positioning for rotator cuff repair. Our data support that the most secure point is the proximal regions of ROI.
Bone Density* ; Female ; Humans ; Humerus* ; Male ; Menopause ; Osteoporosis ; Rotator Cuff ; Shoulder ; Suture Anchors

PURPOSE: We report here on a solution for the case of a 71 year old lady with cartilage destruction in the left shoulder and the loss of the rotator cuff secondary to post-septic arthritic sequelae. MATERIALS AND METHODS: After thorough laboratory, clinical and radiological investigation of the patient to rule out any foci of active infection, we contemplated performing reverse total shoulder arthroplasty as a primary procedure. RESULTS: At 22 months follow up, the patient had an excellent result according to the UCLA and ASES scales. CONCLUSION: Reverse total shoulder arthroplasty seems to be an efficient procedure to improve pain and function in the post-septic shoulder accompanying severe rotator cuff injury.
Arthritis, Infectious ; Arthroplasty ; Cartilage ; Follow-Up Studies ; Humans ; Rotator Cuff ; Shoulder

PURPOSE: To evaluate the bursoscopic findings of refractory primary adhesive capsulitis of the shoulder and to determine the clinical correlation. MATERIALS AND METHODS: Arthroscopic capsular release was performed in 21 refractory adhesive capsulitis patients who had not responded to conservative treatment. The VAS for pain, range of motion, UCLA score was checked before and after surgery, and at the last follow up. RESULTS: Bursitis, mild friction and impingement on coracoacromial ligament, as well as adhesion were observed. The function and pain improved earlier than after simple acromiohumeral joint capsular release. CONCLUSION: Subacromial bursoscopy helps rule out a hidden secondary frozen shoulder or secondary changes with primary adhesion. In addition, it has the advantage of being both a treatment and procedure for making a prognosis.
Adhesives ; Bursitis ; Friction ; Humans ; Imidazoles ; Joint Capsule Release ; Joints ; Ligaments ; Nitro Compounds ; Range of Motion, Articular ; Shoulder

PURPOSE: We wanted to evaluate the normal glenoid size of Koreans in their 7th and 8th decades by conducting Computed tomographic (CT) studies. MATERIALS AND METHODS: The CT images were obtained from the normal scapulae of the patients (mean age: 68.8) who had humeral fracture. A display workstation version 2.0.73.315 was used to measure the scans to determine the maximal superoinferior (SI) and anteroposterior (AP) diameters of the glenoid vault. RESULTS: The average diameters of curvature of the glenoid were 31.2 mm (range: 27 to 34 mm) in the superior-inferior direction and 26.1mm (range: 22 to 31mm) in the anterior-posterior direction. CONCLUSION: This study showed the normal glenoid size of Koreans and it is different from the size that the international literature reported. It should be an important factor for the treatment of fracture or in designing arthroplasty implants.
Arthroplasty ; Humans ; Humeral Fractures ; Scapula ; Shoulder