Assessment of the changes in cardiac sympathetic nervous activity using the pupil size changes measured in seated patients whose stellate ganglion is blocked by interscalene brachial plexus block / 대한마취과학회지

Background@#As a side effect of interscalene brachial plexus block (ISBPB), stellate ganglion block (SGB) causes reductions in pupil size (Horner’s syndrome) and cardiac sympathetic nervous activity (CSNA). Reduced CSNA is associated with hemodynamic instability when patients are seated. Therefore, instantaneous measurements of CSNA are important in seated patients presenting with Horner’s syndrome. However, there are no effective tools to measure real-time CSNA intraoperatively. To evaluate the usefulness of pupillometry in measuring CSNA, we investigated the relationship between pupil size and CSNA. @*Methods@#Forty-two patients undergoing right arthroscopic shoulder surgery under ISBPB were analyzed. Pupil diameters were measured at 30 Hz for 2 s using a portable pupillometer. Bilateral pupil diameters and CSNA (natural-log-transformed low-frequency power [0.04–0.15 Hz] of heart rate variability [lnLF]) were measured before ISBPB (pre-ISBPB) and 15 min after transition to the sitting position following ISBPB (post-sitting). Changes in the pupil diameter ([right pupil diameter for post-sitting – left pupil diameter for post-sitting] – [right pupil diameter for pre-ISBPB – left pupil diameter for pre-ISBPB]) and CSNA (lnLF for post-sitting – lnLF for pre-ISBPB) were calculated. @*Results@#Forty-one patients (97.6%) developed Horner’s syndrome. Right pupil diameter and lnLF significantly decreased upon transition to sitting after ISBPB. In the linear regression model (R2 =0.242, P=0.001), a one-unit decrease (1 mm) in the extent of changes in the pupil diameter reduced the extent of changes in lnLF by 0.659 ln(ms2/Hz) (95% CI [0.090, 1.228]). @*Conclusions@#Pupillometry is a useful tool to measure changes in CSNA after the transition to sitting following ISBPB.

Comparative study of glenoid version and inclination using two-dimensional images from computed tomographyand three-dimensional reconstructed bone models

Background@#This study was performed to compare glenoid version and inclination measured using two-dimensional (2D) images from computed tomography (CT) scans or three-dimensional (3D) reconstructed bone models. @*Methods@#Thirty patients who had undergone conventional CT scans were included. Two orthopedic surgeons measured glenoid version and inclination three times on 2D images from CT scans (2D measurement), and two other orthopedic surgeons performed the same measurements using 3D reconstructed bone models (3D measurement). The 3D-reconstructed bone models were acquired and measured with Mimics and 3-Matics (Materialise). @*Results@#Mean glenoid version and inclination in 2D measurements were –1.705º and 9.08º, respectively, while those in 3D measurements were 2.635º and 7.23º. The intra-observer reliability in 2D measurements was 0.605 and 0.698, respectively, while that in 3D measurements was 0.883 and 0.892. The inter-observer reliability in 2D measurements was 0.456 and 0.374, respectively, while those in 3D measurements was 0.853 and 0.845. @*Conclusions@#The difference between 2D and 3D measurements is not due to differences in image data but to the use of different tools. However, more consistent results were obtained in 3D measurement. Therefore, 3D measurement can be a good alternative for measuring glenoid version and inclination.

A Comparative Study on Internal Fixation Using Long Proximal Intramedullary Nail for the Treatment of Humeral Shaft Fracture according to Fracture Types

BACKGROUND: This study was conducted to compare the radiological and clinical outcomes of internal fixation using a Polarus humeral nail for treatment of a humeral shaft fracture according to fracture types. METHODS: From 43 patients, 13 were excluded and 30 patients were included. The 30 patients were divided into 2 groups: 15 in group I (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen classification type A and B) and 15 in group II (type C). The mean age was 63.1 years (range, 20–87 years), and mean follow-up period was 2.3 years (range, 1.0–6.1 years). The causes of injuries were as follows: 12, traffic accidents; 14, simple slips; 2, simple falls; 2, contusions after lower energy trauma. Radiological and clinical evaluations were performed. RESULTS: Radiological union was confirmed by plain anteroposterior and lateral radiographs on average of 5.0 months in group I, and 8.4 months in group II, respectively. Differences between the two groups were statistically significant (p<0.01). The clinical union value was 1.6 in group I, and 2.0 months in group II, but these values did not differ significantly (p=0.441). The mean Korean shoulder scoring system scores were 89.7 and 90.6, which did not differ significantly (p=0.352). CONCLUSIONS: Intramedullary nailing using the Polarus humeral nail is considered to be a good treatment modality for all types of humeral shaft fractures. Additionally, the Polarus humeral nail can be an optimal choice for the treatment of complex type fractures such as segmental or comminuted humeral shaft fractures.

A Comparative Study on Internal Fixation Using Long Proximal Intramedullary Nail for the Treatment of Humeral Shaft Fracture according to Fracture Types

BACKGROUND@#This study was conducted to compare the radiological and clinical outcomes of internal fixation using a Polarus humeral nail for treatment of a humeral shaft fracture according to fracture types.@*METHODS@#From 43 patients, 13 were excluded and 30 patients were included. The 30 patients were divided into 2 groups: 15 in group I (Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen classification type A and B) and 15 in group II (type C). The mean age was 63.1 years (range, 20–87 years), and mean follow-up period was 2.3 years (range, 1.0–6.1 years). The causes of injuries were as follows: 12, traffic accidents; 14, simple slips; 2, simple falls; 2, contusions after lower energy trauma. Radiological and clinical evaluations were performed.@*RESULTS@#Radiological union was confirmed by plain anteroposterior and lateral radiographs on average of 5.0 months in group I, and 8.4 months in group II, respectively. Differences between the two groups were statistically significant (p<0.01). The clinical union value was 1.6 in group I, and 2.0 months in group II, but these values did not differ significantly (p=0.441). The mean Korean shoulder scoring system scores were 89.7 and 90.6, which did not differ significantly (p=0.352).@*CONCLUSIONS@#Intramedullary nailing using the Polarus humeral nail is considered to be a good treatment modality for all types of humeral shaft fractures. Additionally, the Polarus humeral nail can be an optimal choice for the treatment of complex type fractures such as segmental or comminuted humeral shaft fractures.

Difference in the Surgical Approach in Reverse Total Shoulder Arthroplasty for Cuff Tear Arthroplasty: Comparison of the Radiological and Clinical Result according to the Deltopectoral and Anterosuperior Approach / 대한정형외과학회잡지

PURPOSE: This study compared the clinical and radiological results of reverse total shoulder arthroplasty (RSA) using an anterosuperior approach with those using a deltopectoral approach to determine the difference in cuff tear arthroplasty between both approaches. MATERIALS AND METHODS: A retrospective review of 24 consecutive patients who underwent RSA due to cuff tear arthroplasty from February 2014 to November 2015 was performed. The anterosuperior and deltopectoral approaches were 12 cases each. The mean age was 72 years and the mean follow-up period was 13.2 months. The clinical results were assessed using the visual analogue pain scale, American Shoulder and Elbow Surgeon score, Korean shoulder scoring system, and the Constant score. The prosthesis-scapular neck angle (PSNA), peg-glenoid rim distance (PGRD), scapular neck-inferior glenosphere rim distance (inferior glenosphere overhang), acromion-greater tuberosity (AT) distance, glenoid-greater tuberosity (GT) distance were assessed, and severity of notching according to the Nerot-Sirveaux classification, were measured from the radiology evaluation. RESULTS: Compared to the anterosuperior approach, the PSNA (9.6°, p=0.018) and inferior glenosphere overhang (2.0 mm, p=0.024) were significantly greater in the deltopectoral approach and the PGRD (2.2 mm, p=0.043) was shorter. The AT and GT distance was similar in the two groups. Two and three cases of implant notching occurred on deltopectoral approach and anterosuperior approach, respectively. No metal loosening, acromion fracture, or nerve injury was noted. The clinical results improved significantly in both groups, but there was no statistically significant difference between the two groups. CONCLUSION: The anterosuperior approach could cause the superior position of the glenoid baseplate and a decrease in the inferior tilt compared to the deltopectoral approach, but the clinical results had improved in both groups and there was no difference between the two groups.

Pain and Power Doppler Ultrasonographic Evaluation according to Bursal Preservation after Arthroscopic Rotator Cuff Repair: Comparison between Complete and Minimal Bursectomy in Early 3 Months / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to compare the clinical and power Doppler ultrasonographic results of arthroscopic rotator cuff repair (ARCR) between using a complete and a minimal bursectomy. Moreover, we aimed to evaluate the pain-relief and neoangiogenesis according to bursal preservation. MATERIALS AND METHODS: Between December 2015 and August 2016, we performed a retrospective review of 78 consecutive patients who underwent ARCR due to full thickness rotator cuff tear (small-large sized tear). Thirty-six patients received ARCR using minimal bursectomy (Group A), while 42 patients received ARCR via complete bursectomy (Group B). The mean age was 57.8 years and the average symptom duration period was 20.3 months. Clinical result was assessed using a visual analogue scale (VAS) pain score due to evaluate the pain-relief and power Doppler ultrasonographic result was classified according to the modified Newman classification due to evaluate the neoangiogenesis. RESULTS: There was no statistically significant difference in operation time, pain-relief, and neoangiogenesis in accordance with bursal preservation between the two groups. Compared to the preoperative values, pain was significantly increased two weeks postoperatively in both groups (Group A: −1.8±1.4, p=0.000; Group B: −1.4±1.7, p=0.000). Compared to the preoperative values using the power Doppler ultrasound, neoangiogenesis was significantly improved at the postoperative 6 weeks (Group A: 0.7±0.9, p=0.000; Group B: 0.9±1.1, p=0.000) and 3 months (Group A: 0.9±1.0, p=0.000; Group B: 1.0±1.1, p=0.000) in both groups. CONCLUSION: Serial follow-up by power Doppler ultrasound before and after ARCR showed a neoangiogenesis of up to 3 months in both groups, but there was no difference in pain-relief and neoangiogenesis between the two groups.

Serial Magnetic Resonance Imaging to Determine the Progression of Neglected Recalcitrant Rotator Cuff Tears: A Retrospective Multicenter Study

BACKGROUND: To determine the natural progression of conservatively treated rotator cuff tears, we evaluated changes in radiologic and clinical parameters in patients whose recalcitrant tears were neglected after conservative treatment. METHODS: A total of 73 patients with recalcitrant rotator cuff tears in spite of conservative treatment were included in this study. We measured changes in tear size and in the extent of fatty infiltration of the rotator cuff by comparing the initial and final follow-up magnetic resonance imagings (MRIs). To determine factors influencing the change in tear size, we collected the medical history of patients taken at the time of initial admission. RESULTS: The average follow-up period was 20.1 months, and the average increase in tear size across this period was 6.2 mm. In terms of steroid injection, we found that the increases in tear size of the steroid injection group (p=0.049) and of the sub-group that had received more than three steroid injections (p=0.010) were significantly greater than that of the non-steroid injection group. CONCLUSIONS: We found that the increase in cuff tear size was on average 6.2 mm across the follow-up period, indicating that neglecting cuff tears may cause them to progress into more severe tears. We also observed that a history of steroid injection might be a possible risk factor for a worse prognosis of cuff tears. Therefore, we suggest that patients with rotator cuff tears and a history of steroid injection are recommended aggressive modes of treatment such as surgery.

Comparison of Clinical and Radiological Results according to Glenosphere Position in Reverse Total Shoulder Arthroplasty: A Short-term Follow-up Study

BACKGROUND: In a previous biomechanical study, eccentric glenospheres with more inferior position of the center of rotation were shown to improve range of motion and reduce the incidence of scapular notching after reverse total shoulder arthroplasty (RSA). The purpose of this study was to compare the clinical and radiological results of RSA using an eccentric glenosphere to those using a concentric glenosphere and to determine the usefulness of the eccentric glenosphere. METHODS: From 2009 to 2015, we performed a retrospective review of 20 consecutive patients who underwent RSA using a deltopectoral approach. Nine patients underwent RSA using a concentric glenosphere (group A) while 11 had an eccentric glenosphere (group B). The average follow-up period was 13.9 months (range, 12 to 18 months). All glenoid components were placed with 15° of inferior tilt. Clinical results were assessed using the visual analog pain scale score (VAS), the American Shoulder and Elbow Surgeon (ASES) score, the Korean shoulder scoring system (KSS), and the Constant score. On radiological evaluation, prosthesisscapular neck angle (PSNA), peg-glenoid rim distance (PGRD), scapular neck-inferior glenoshere rim distance (inferior glenoshpere overhang), acromion-greater tuberosity (AT) distance, glenoid-greater tuberosity (GT) distance, and severity of notching according to the Nerot-Sirveaux classification were assessed. RESULTS: The clinical results improved significantly in both groups, but there was no statistically significant difference between the two groups. A significant intergroup difference was observed with regard to PGRD (24.8 ± 1.6 mm for group A vs. 22.2 ± 1.9 mm for group B; p = 0.002) and inferior glenosphere overhang (2.0 ± 1.7 mm for group A vs. 5.8 ± 1.6 mm for group B; p = 0.000). Seven of 9 patients in group A developed notching compared with 2 of 11 patients in group B (p = 0.022). The other radiological parameters such as inferior tilt and AT and GT distances were not significantly different between two groups. Complications such as loosening and scapular fractures did not occur. CONCLUSIONS: The eccentric glenosphere in RSA was more effective in reducing the rate of notching than the concentric glenosphere although clinical outcomes were not significantly different in the short-term follow-up.

Serial Magnetic Resonance Imaging to Determine the Progression of Neglected Recalcitrant Rotator Cuff Tears: A Retrospective Multicenter Study

BACKGROUND: To determine the natural progression of conservatively treated rotator cuff tears, we evaluated changes in radiologic and clinical parameters in patients whose recalcitrant tears were neglected after conservative treatment. METHODS: A total of 73 patients with recalcitrant rotator cuff tears in spite of conservative treatment were included in this study. We measured changes in tear size and in the extent of fatty infiltration of the rotator cuff by comparing the initial and final follow-up magnetic resonance imagings (MRIs). To determine factors influencing the change in tear size, we collected the medical history of patients taken at the time of initial admission. RESULTS: The average follow-up period was 20.1 months, and the average increase in tear size across this period was 6.2 mm. In terms of steroid injection, we found that the increases in tear size of the steroid injection group (p=0.049) and of the sub-group that had received more than three steroid injections (p=0.010) were significantly greater than that of the non-steroid injection group. CONCLUSIONS: We found that the increase in cuff tear size was on average 6.2 mm across the follow-up period, indicating that neglecting cuff tears may cause them to progress into more severe tears. We also observed that a history of steroid injection might be a possible risk factor for a worse prognosis of cuff tears. Therefore, we suggest that patients with rotator cuff tears and a history of steroid injection are recommended aggressive modes of treatment such as surgery.

Corrigendum: Risk Factors for Recurrence of Anterior Shoulder Instability after Arthroscopic Surgery with Suture Anchors

In the published article by Choi et al., a part of expression of the Abstract and the Conclusion section in the main body text have been corrected. Underlined text should be read carefully.

Usefulness of the Additional K-Wire Fixation and Suture for Reinforce the Treatment of Distal Clavicle Fracture Using Modified Tension Band Wiring

PURPOSE: We attempted to evaluate the clinical results of modified tension band wiring (MTBW) with additional K-wire fixation and suture for distal clavicle fracture. MATERIALS AND METHODS: Fifty-nine patients with a distal clavicle fracture from May 2009 to December 2013 treated with MTBW were enrolled in this study. Their fracture types were type 2, 12; and type 3, 33; type 4, 8; and type 5, 6 according to Craig classification group II; average age was 47.2 years with a mean follow-up period of 27.9 months. The operations were performed within a mean of 3.1 days a fter t rauma. The c linical results were evaluated u sing University of California at Los Angeles scores (UCLA), American Shoulder and Elbow Surgeons scores (ASES) and Korean Shoulder Society scores (KSS) at 1 year after surgery. RESULTS: Radiographic bone union was achieved at a mean of 3.7 months after the operation. In the last observation, their range of motion was forward flexion 159.0°, external rotation 59.8°, and internal rotation 4.3 points, and there were 2 cases of nonunion. Each average functional score was UCLA 31.3 points, KSS 91.6 points, and ASES 93.0 points. CONCLUSION: For the surgical treatment of distal clavicle fractures, MTBW with additional K-wire fixation and suture is a useful technique allowing early range of motion exercises, minimizing soft tissue damage, and preserving the acromio-clavicular joint.

Risk Factors for Recurrence of Anterior Shoulder Instability after Arthroscopic Surgery with Suture Anchors

BACKGROUND: We investigated the risk factors for the recurrence of anterior shoulder instability after arthroscopic surgery with suture anchors and the clinical outcomes after reoperation. METHODS: A total of 281 patients (February 2001 to December 2012) were enrolled into our study, and postoperative subluxation and dislocation were considered as recurrence of the condition. We analyzed radiologic results and functional outcome including the American Shoulder and Elbow Surgeons Evaluation Form, the Korean Shoulder Society Score, and the Rowe scores. RESULTS: Of the 281 patients, instability recurred in 51 patients (18.1%). Sixteen out of 51 patients (31.4%) received a reoperation. In terms of the functional outcome, we found that the intact group, comprising patients without recurrence, had a significantly better functional outcome than those in the recurrent group. The size of glenoid defect at the time of initial surgery significantly differed between intact and recurrent group (p<0.05). We found that the number of dislocations, the time from the initial presentation of symptoms to surgery, and the number of anchor points significantly differed between initial operation and revision group (p<0.05). The functional outcome after revision surgery was comparable to intact group after initial operation. CONCLUSIONS: Eighteen percent of recurrence occurred after arthroscopic instability surgery, and 5.6% received reoperation surgery. Risk factors for recurrence was the initial size of glenoid defect. In cases of revision surgery, good clinical outcomes could be achieved using additional suture anchor.

Isolated Musculocutaneous Nerve Palsy after the Reverse Total Shoulder Arthroplasty

Reverse total shoulder arthroplasty has been performed with promising results in rotator cuff tear arthropathy. However, the global complication of the reverse total shoulder arthroplasty is relatively higher than that of the conventional total shoulder arthroplasty. Neurologic complications after reverse total shoulder arthroplasty are rare but there are sometimes remaining sequelae. The cause of the neurologic complication is multifactorial, including arm traction, position and the design of the implant. Most cases of neurologic palsy following reverse total shoulder arthroplasty occur in the axillary nerve and the radial nerve. The authors report on a case of a 71-year-old man with isolated musculocutaneous nerve palsy after reveres total shoulder arthroplasty with related literature.

Corrigendum: Risk Factors for Recurrence of Anterior Shoulder Instability after Arthroscopic Surgery with Suture Anchors

In the published article by Choi et al., a part of expression of the Abstract and the Conclusion section in the main body text have been corrected. Underlined text should be read carefully.

Risk Factors for Recurrence of Anterior Shoulder Instability after Arthroscopic Surgery with Suture Anchors

BACKGROUND: We investigated the risk factors for the recurrence of anterior shoulder instability after arthroscopic surgery with suture anchors and the clinical outcomes after reoperation. METHODS: A total of 281 patients (February 2001 to December 2012) were enrolled into our study, and postoperative subluxation and dislocation were considered as recurrence of the condition. We analyzed radiologic results and functional outcome including the American Shoulder and Elbow Surgeons Evaluation Form, the Korean Shoulder Society Score, and the Rowe scores. RESULTS: Of the 281 patients, instability recurred in 51 patients (18.1%). Sixteen out of 51 patients (31.4%) received a reoperation. In terms of the functional outcome, we found that the intact group, comprising patients without recurrence, had a significantly better functional outcome than those in the recurrent group. The size of glenoid defect at the time of initial surgery significantly differed between intact and recurrent group (p<0.05). We found that the number of dislocations, the time from the initial presentation of symptoms to surgery, and the number of anchor points significantly differed between initial operation and revision group (p<0.05). The functional outcome after revision surgery was comparable to intact group after initial operation. CONCLUSIONS: Eighteen percent of recurrence occurred after arthroscopic instability surgery, and 5.6% received reoperation surgery. Risk factors for recurrence was the initial size of glenoid defect. In cases of revision surgery, good clinical outcomes could be achieved using additional suture anchor.

Isolated Musculocutaneous Nerve Palsy after the Reverse Total Shoulder Arthroplasty

Reverse total shoulder arthroplasty has been performed with promising results in rotator cuff tear arthropathy. However, the global complication of the reverse total shoulder arthroplasty is relatively higher than that of the conventional total shoulder arthroplasty. Neurologic complications after reverse total shoulder arthroplasty are rare but there are sometimes remaining sequelae. The cause of the neurologic complication is multifactorial, including arm traction, position and the design of the implant. Most cases of neurologic palsy following reverse total shoulder arthroplasty occur in the axillary nerve and the radial nerve. The authors report on a case of a 71-year-old man with isolated musculocutaneous nerve palsy after reveres total shoulder arthroplasty with related literature.

Arthroscopic Changes of the Biceps Pulley in Rotator Cuff Tear and Its Clinical Significance in Relation to Treatment

BACKGROUND: In the case of rotator cuff tears, the biceps pulley can be stressed by the unstable biceps tendon, and this can subsequently affect the stability of the subscapularis tendon. Therefore, it is important to distinguish between normal variations and lesions of the biceps pulley that affect anterosuperior lesions in cases of rotator cuff tears. METHODS: From January 2002 through November 2010, we observed biceps pulley and associated anterosuperior lesions in 589 of 634 cases (93%) of arthroscopic rotator cuff repair, including 72 cases (12.2%) of small tears, 219 cases (37.2%) of medium tears, 134 cases (22.8%) of large tears, and 164 cases (27.8%) of massive tears. We classified normal stretched biceps pulleys as type I, stretched biceps pulleys with mild changes as type II, those with a partial tear as type III, and torn pulleys as type IV. RESULTS: We were able to classify 589 cases of biceps pulleys as type I, II, III, or IV associated lesions in rotator cuff tears. Type I was seen in 91 cases (15.4%), type II in 216 cases (36.7%), type III in 157 cases (26.7%), and type IV in 101 cases (17.1%); unidentified cases numbered 24 (4.1%). Nearly three-quarters, 73.3%, of the cases (432/589) had associated anterosuperior lesions, and combined treatment for the associated lesions was administered in 29.2% (172/589) of cases. CONCLUSIONS: Biceps pulley lesions with more than partial tears were identified in 48% of rotator cuff tear cases. The incidence and severity of pulley lesions were related to the rotator cuff tear size, the status of the long head of the biceps tendon and subscapularis tendon lesion, and the treatment methods.

Ultrasonographic Serial Evaluation after Reconstruction of the Ulnar Collateral Ligament and the Common Flexor Tendon of the Elbow in a High School Female Weight Lifter / 대한정형외과학회잡지

A 16-year-old female weight-lifter with average records of 70 kg for the snatch event and 90 kg for the clean and jerk event suffered chronic ulnar collateral ligament injury, and underwent ulnar collateral ligament reconstruction. An ultrasonographic evaluation was performed at six weeks, three months, six months, nine months, and one year after the operation. The horizontal and vertical distances measured during the initial ultrasonographic examination as well as at six weeks, three months, six months, nine months, and one year after the operation were 8.4 mm, 2.0 mm, 2.6 mm, 2.8 mm, 2.7 mm, 2.7 mm, and -1.2 mm, 2.4 mm, 1.0 mm, 0.0 mm, 0.0 mm, 0.0 mm, respectively. The lifting records at one year after the operation were 65 kg for the snatch event and 90 kg for the clean and jerk event. The ultrasonographic method of serial examination was useful for evaluation of the rehabilitation program and for deciding on the time to return to competition.

Valgus Laxity of Elbow Joint in High School Weight Lifters: Ultrasonographic Assessment / 대한스포츠의학회지

We evaluated abnormalities in medial portion of elbow in high-school weightlifter compared with the non weightlifter using a stress radiography and ultrsonography. The experimental group(G1) was 26 high school weightlifters with an average age of 17 years old (range, 16.18 years). The control group (G2) were comprised of 25 age matched general students. Both groups received physical examination, simple and valgus stress radiography and ultrasonography on both side of elbow. Physical examination showed 26.9% (14/52 elbows) tenderness and 19.2% (10/52 elbows) valgus laxity in G1, no tenderness and laxity in G2. There were no differences in medial joint gaps on simple radiography (G1, 3.3 mm, G2, 2.7 mm; p>0.05), but the valgus stress view showed 5.6+/-0.8 mm medial joint gap in G1 and 3.8+/-0.8 mm in G2 (p<0.001). Ultrasonography in G1, angular deformity was found in 67.3% (36/52) and G2 all in normal (p<0.01). The horizontal distance was an average 4.9+/-1.23 mm for the G1 and 3.1+/-0.78 mm for the G2 (p<0.001). Vertical distance of the proximal portion of the ulna was average 0.58+/-0.94 mm for the G1 and 1.59+/-0.49 mm for the G2 (p<0.001). In G1, angular deformity of male was 50% (15/30 elbows) and female was 95% (21/22 elbows) (p<0.001). Change of horizontal and vertical distance were larger in female (p<0.05). In conclusion, there were increased incidence of medial elbow joint laxity in high school weightlifter, especially in female, regardless of career. Sustained valgus laxity could be prone to ulnar collateral ligament injury and should be evaluated with ultrasonography-assisted dynamic study.

Choice of Initial Operation and Functional Outcome in Rotator Cuff Repair on Both Shoulder / 대한정형외과학회잡지

PURPOSE: We evaluated the influencing factors in selection of initial operation and outcomes after operative treatment of symptomatic rotator cuff tear including both sides. MATERIALS AND METHODS: From December 2000 to March 2011, 60 shoulders of 30 patients underwent arthroscopic rotator cuff repair by a single experienced shoulder surgeon in our clinic. We retrospectively compared outcome by operation order according to hand dominance, tear size and by operation timing, operation method, and tear size. Symptom period was 10 months until the first operation and 19 months until the second operation. Interval between first and second operation was nine months. RESULTS: In comparison by operation order according to hand dominance and tear size, the functional scores did not differ significantly between the initial repair and delayed repair group (p>0.05). In comparison in a total of 60 cases, the functional outcome according to the operation timing and method of operation was not significantly different (p>0.05). The smaller sized tear group showed significantly better functional outcome, compared to the larger sized tear group (p<0.05). CONCLUSION: In cases of both-side symptomatic rotator cuff tear, most operations were performed on the more symptomatic side and the dominant arm first. The functional outcome showed improvement, regardless of operation order according to hand dominance and tear size, and regardless of operation timing and operation method as well. Tear size was the only significant factor influencing functional outcome.