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The Usefulness of Multidetector CT Arthrography in the Diagnosis of Shoulder Pathology: Comparison with MR Arthrography and Arthroscopic Findings in the Same Patient.

Dong Soo KIM ; Kyoung Jin PARK ; Yong Min KIM ; Eui Sung CHOI ; Hyun Chul SHON ; Byung Ki CHO ; Ji Kang PARK ; Seok Won KIM

Journal of the Korean Shoulder and Elbow Society.2009;12(2):115-125.

PURPOSE: The purpose of the study is to evaluate the usefulness of CT arthrography (CTA) by conducting a comparative study of CTA and MR arthrography (MRA) with the arthroscopic findings in the same patients. MATERIALS AND METHODS: Forty nine patients who suffered from shoulder disease underwent MRA and CTA concurrently. The sensitivity and specificity of CTA was evaluated, as compared to MRA, in the case of four types of shoulder pathological lesions. The accuracy of CTA was evaluated by analyzing the arthroscopic findings of thirty four patients. RESULTS: Compared to MRA, CTA showed a sensitivity of 90% and a specificity of 100% for diagnosing supraspinatus tendon (SST) full thickness tear, and CTA showed a sensitivity of 100% and a specificity of 97.5% for making the diagnosis of superior labrum anterior to posterior (SLAP) lesion. For diagnosing partial articular side supraspinatus avulsion (PASTA) lesion, some studies have shown the usefulness of CTA with a sensitivity of 71.4% and a specificity of 97.7%. However, for diagnosing SST bursal side partial tear, the sensitivity of CTA was as low as 10%. CTA has been shown to be relatively accurate when the diagnoses were verified with the arthroscopic findings; diagnosing SST full thickness tear and SLAP lesion with CTA has shown an accuracy of 100% and87.5% respectively, and CTA showed 71.4% diagnostic accuracy for PASTA lesion. CONCLUSION: CTA was a useful tool and it was equivalent to MRA for the assessment of SST full thickness tear, SLAP lesion and PASTA lesion, but not bursal side partial tear. Thus, it may be used preferably to diagnose shoulder pathology and for follow up as an inexpensive tool after operation.
Arthrography ; Arthroscopy ; Humans ; Sensitivity and Specificity ; Shoulder ; Tendons

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The Radiologic and Clinical Changes after Open Complete Repair of Massive Rotator Cuff Tears.

Eun Sun MOON ; Min Sun CHOI ; Myung Sun KIM ; Il Kyu KONG ; Byoung Jin KIM

Journal of the Korean Shoulder and Elbow Society.2009;12(2):109-114.

PURPOSE: This study evaluated the preoperative and postoperative radiologic findings of patients with complete repairs after massive rotator cuff tears along with the incidence of re-tear and the clinical outcomes. MATERIALS AND METHODS: This study evaluated 33 cases who had open complete repairs for massive rotator cuff tears and these patients were followed up for more than 24 months. The clinical evaluation was performed according to the shoulder joint function test of the American Shoulder and Elbow Surgeons (ASES), and the degree of arthritis related to the massive rotator cuff tears was evaluated using the Hamada classification. RESULTS: The ASES scores improved from 37.6 preoperatively to 85.6 postoperatively. The mean preoperative acromio-humeral interval (AHI) score was 6.5 mm, which increased to 9.3 mm immediately after surgery, and there was a decreased to 6.5 mm noted at the last follow up. The lower radiology stages of arthritis according to the classification showed better preoperative and postoperative results. CONCLUSION: An open complete repair as the surgical treatment for a massive rotator cuff tear showed satisfactory results for pain relief and an improvement in the shoulder joint function though re-tear after surgery.
Arthritis ; Elbow ; Follow-Up Studies ; Humans ; Incidence ; Rotator Cuff ; Shoulder ; Shoulder Joint

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Open Techniques for Bone Defect in Anterior Shoulder Instability.

Bong Gun LEE ; Yong Girl RHEE

Journal of the Korean Shoulder and Elbow Society.2009;12(2):255-263.

PURPOSE: An osseous defect in the glenoid and humeral head is closely associated with recurrence of anterior shoulder instability. The purpose of this article is to describe the open surgical techniques and introduce our experiences with anterior instability with a significant osseous defect. MATERIALS AND METHODS: We reviewed the articles that have focused on and/or mentioned the affect of osseous defects on anterior shoulder instability. The open surgical techniques and its related pearls are summarized in this review. RESULTS: Accurate evaluation for the size and location of the osseous defect is critical for preventing recurrence after restoration of the anterior capsulolabral structure. The glenoid bone restoration techniques include the coracoids transfer (the Bristow procedure and the Latarjet procedure) and a structural iliac bone graft. Rotational humeral osteotomy and an osteoarticular allograft could be used for repairing a significant posterosuperior humeral defect (Hill-Sachs lesion). Shoulder arthroplasty may be tried for treating a humeral bone defect, but more study on this is needed. CONCLUSION: Open surgical restoration decreases the risk of recurrence anterior shoulder instability that is combined with a significant osseous defect. Arthroscopic surgery currently has limitations for treating an osseous defect, but it will become useful in proportion to the development of arthroscopic instruments and techniques in the future.
Arthroplasty ; Arthroscopy ; Humeral Head ; Osteotomy ; Recurrence ; Shoulder ; Transplantation, Homologous ; Transplants

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Operative Treatement of Snapping Triceps Syndrome and Ulnar Nerve Dislocation.

Ho Jung KANG ; Hee Young LEE ; Jeong Gil LEE ; Sung Jae KIM ; Soo Bong HAHN

Journal of the Korean Shoulder and Elbow Society.2009;12(2):250-254.

PURPOSE: Snapping triceps syndrome is dynamic condition in which medial head of triceps snaps (dislocates) over the medial epicondyle as the elbow is flexed. MATERIALS AND METHODS: The symptoms are pain or snapping at the medial aspect of the elbow and/or symptoms from coexisting ulnar nerve irritation. The diagnosis can be made by dynamic ultrasonography. RESULTS AND CONCLUSION: And successful outcome can be archived by operative treatment, which are ulnar nerve anterior transposition and tenotomy of medial head of triceps.
Dislocations ; Elbow ; Head ; Tenotomy ; Ulnar Nerve

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Rare Normal Variation Between Biceps Anchor and Superior Labrum: A Case Report.

Yong Ju KIM ; Hoon JEONG ; Jong Kyoung HA ; Kwan Hee LEE ; Woo Jin LEE

Journal of the Korean Shoulder and Elbow Society.2009;12(2):245-249.

PURPOSE: Labral lesions and its anatomic variants have been studied by several authors in the last decade. Buford complex and sublabral recess are most common variants. Their recognition is important in order to distinguish them from superior and anterior labral tear. MATERIALS AND METHODS: We report one case of a 19-year-old female who was mistaken SLAP lesion for normal variant and was treated with arthroscopic surgery. RESULTS: The arthroscopic finding shows rare normal variant of biceps anchor and superior labrum. The biceps long head tendon was inserted at superior labrum and supraspinatus tendon area. This finding was mistaken to SLAP lesion. CONCLUSION: We report rare normal variant of biceps anchor and superior labrum that was observed during arthroscopic surgery for SLAP lesion.
Arthroscopy ; Female ; Head ; Humans ; Shoulder Joint ; Tendons ; Young Adult

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Surgical Treatment Using Anchor Suture of Coracoid Process Fracture with Acromioclavicular Joint Dislocation: A Case Report.

Woon Seob JEONG ; Sang Soo LEE ; Yon Sik YOO ; Do Young KIM ; Keun Min PARK

Journal of the Korean Shoulder and Elbow Society.2009;12(2):240-244.

PURPOSE: This study examined the outcomes of closed reduction and fixation of the coracoid process fracture using a suture anchor in a patient with combined acromioclavicular dislocation for which the coraco-clavicular ligament was intact. MATERIALS AND METHODS: A 26 year-old male patient with a coracoid process fracture that was associated with a type III acromioclavicular joint dislocation was operated on with anchor suture fixation. This is the first trial of this operative procedure. RESULTS: At the postoperative follow-up at 3 months, complete union of the coracoid process fracture was seen. The shoulder had a full range of motion and the shoulder function was normal. CONCLUSION: Closed reduction and fixation using one suture anchor for treating coracoid process fracture is a safe, effective procedure.
Acromioclavicular Joint ; Dislocations ; Follow-Up Studies ; Humans ; Ligaments ; Male ; Range of Motion, Articular ; Shoulder ; Suture Anchors ; Sutures

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Pectoralis Major Tendon Transfer for Refractory Winged Scapula: A Case Report.

Sang Hun KO ; Sung Do CHO ; Ki Jae LEE ; Chae Chil LEE

Journal of the Korean Shoulder and Elbow Society.2009;12(2):236-239.

PURPOSE: We wanted to evalulate the clinical results of pectoris major tendon transfer for a neglected winged scapula that was caused by paralysis of the serratus anterior due to injury to the long thoracic nerve. MATERIALS AND METHODS: A patient had neglected winged scapula that followed an arthroscopic operation for multi-directional instability of the shoulder joint, which was caused by traumatic dislocation. The patient was treated with pectoralis major tendon transfer using the modified Eden-Lange procedure. The range of a motion was improved from forward flexion 90degrees and external rotation 70degrees to 170degrees and 150degrees respectively. RESULTS AND CONCLUSION: There were no complications or recurrence and the patient's psychological satisfaction was also high. If the shoulder girdle muscles are intact, except for the serratus anterior, then pectoralis tendon transfer is a satisfactory method that can provide normal scapulo-thoracic motion.
Dislocations ; Humans ; Muscles ; Paralysis ; Recurrence ; Scapula ; Shoulder ; Shoulder Joint ; Tendon Transfer ; Tendons

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The Primary Reverse Total Shoulder Arthroplasty for Post-septic Destroyed Shoulder: A Case Report.

Young Lae MOON ; Ki Young NAM ; Sueng Hwan JO ; Gorthi VENKAT

Journal of the Korean Shoulder and Elbow Society.2009;12(2):232-235.

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

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Bilateral Traumatic Locked Posterior Dislocation of the Shoulder: A Case Report.

Jong Min LIM ; Jeung Tak SUH ; Jae Min AHN

Journal of the Korean Shoulder and Elbow Society.2009;12(2):226-231.

PURPOSE: Bilateral traumatic locked posterior dislocations of the shoulder are very rare and there has been no report on the operative treatment for this injury in the Korean medical literature. MATERIALS AND METHODS: We present here a case of bilateral locked posterior dislocations of the shoulders after trauma and this was successfully treated with open reduction and lesser tuberosity transfer on the right shoulder and subscapularis tendon transfer on the left shoulder. RESULTS AND CONCLUSION: Twenty-four months later, the clinical and radiologic results were excellent.
Dislocations ; Shoulder ; Shoulder Dislocation ; Tendon Transfer

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Subclavian Portal Approach for Isolated Subscapularis Tendon Tear: Technical Note.

Chang Hyuk CHOI ; Shin Kun KIM ; Il Woong CHANG ; Se Sik KIM

Journal of the Korean Shoulder and Elbow Society.2009;12(2):221-225.

PURPOSE: For an isolated tear of the subscapularis tendon, the presented technique using a subclavian portal provides both a good angle for anchor placement and sufficient space for managing the upper portion of a subscapularis tendon tear. MATERIALS AND METHODS: The conventional method needs 2 additional portals for traction, debriding the footprint and anchor fixation for repair. The presented technique requires only an anterior portal for suture management and a subclavian portal without cannula for suture anchoring and placement of suture hooks. RESULTS: The two suture limbs of the anchor can be placed on the subscapularis tendon by the switching technique and these limbs are repaired sequentially. CONCLUSION: This technique is simple and reproducible and it can be applied to partial tears and minimally retracted subscapularis tears.
Catheters ; Extremities ; Suture Anchors ; Sutures ; Tendons ; Traction

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