Physical Examinations of Rotator Cuff Tear

Successful treatment of any pathological condition of the shoulder requires an accurate diagnosis. Physical examination represents an integral part of the assessment of shoulder disorders. Pain, loss of strength, decreased range of motion, and instability are the most common symptoms caused by a great variety of different shoulder pathologies. Therefore, a sophisticated clinical approach to the patient with shoulder pathology is essential. A standardized evaluation including a variety of diagnostic tests and clinical assessments improves the diagnostic accuracy by specifically examining one component of the shoulder complex. In most cases a careful physical examination will establish or suggest a diagnosis and special investigative techniques such as imaging procedures can be applied more selectively for confirmation or further evaluation of the pathological entity.

Various Pathologic Lesions Associated with Anterior Shoulder Instability: Experience over 10-Years of Arthroscopic Treatment / 대한정형외과학회잡지

PURPOSE: We report upon the frequency and results of treatment for various pathologic lesions such as ALPSA lesions, capsular laxity, mid-capsular tear and HAGHL lesions in cases of anterior shoulder instability. MATERIALS AND METHODS: Two hundred and four consecutive patients with anterior shoulder instability underwent arthroscopic repair and the outcomes were evaluated according to various lesions and treatment modalities in a retrospective study afte a minimum of one year elapsed after surgery. RESULT: All 24 cases of ALPSA lesions were treated using the arthroscopic transglenoid suture technique. Clinical results were excellent in 18 cases. Of 67 cases of capsular laxity, type IV Bankart lesion was combined in 42. 47 cases were treated with the transglenoid technique and 20 with the transglenoid suture technique and capsular shrinkage. The clinical results were excellent in 45 cases. All 11 cases of mid-capsular tear were treated with its combined lesion, and the clinical results proved to be excellent in 8 cases. Of the 4 cases of HAGHL lesions, all cases were treated with the direct suture technique, and 2 had excellent clinical results. CONCLUSION: In the case of anterior shoulder instability, various pathologic lesions as well as Bankart lesion can be found. Therefore, the evaluation of the exact pathologic lesion causing instability and its appropriate treatment are important for satisfactory surgical outcomes. The arthroscopic transglenoid suture technique is one of the most useful methods of reconstruction in various pathologies of shoulder instability.

Classification and Treatment of SLAP Lesion / 대한정형외과학회잡지

PURPOSE: The Snyder's classification of SLAP lesion has many limitations in clinical use, His classification has no correlation with the mechanism of jnjury and treatment. Therefore, new rational classification oriented with injury mechanism and its treatment was needed. MATERIALS AND METHODS: This is a retrospective study of 74 patients with SLAP lesion which were found during arthroscopic treatment of 194 patients diagnosed with recurrent shoulder dislocation, impingement syndrome or SLAP lesion between March 1989 and January 1997. Mean follow-up time was 36 months (range, 18 to 72 months) and average age of patients was 26 years old (range, 17-47 yrs). All patients were arthroscopically examined and treated. We classified the SLAP lesion into 3 groups according to the stability of biceps anchor. Group I had superior labral tear (flap tear or bucket-handle tear or degenerative tear) with intact biceps stability, group II had disturbed biceps anchor (unstable shoulder), and group III is a mix of group I and II. By our classification, group I was 32 cases, group II was 31 cases, and group III was 11 cases. We treated the SLAP lesion according to our new classification. Group I was treated with arthroscopic debridement, group II with stabilization of biceps anchor, and group III with arthroscopic debridement and stabilization of biceps anchor. RESULTS: The result by the Rowe rating scale was excellent or good in 29 cases of 32 in group I, 25 cases of 29 in arthroscopic transglenoid suture technique group and 1 case of 2 in the group treated with biodegradable tack (Suretec) in group II, and 10 of 11 cases in group III. There was only one case of postoperative recurrence and no complication was found. Our transglenoid suture technique had a reasonable recurrence rate with few complications. CONCLUSIONS: Thus we propose our new classification and treatment of SLAP lesion, and arthroscopic transglenoid suture technique for the treatment of SLAP type II and III.

MR Findings of Chondromalacia Patella: Correlation of the Grade and Associated Lesions with ArthroscopicFindings

PURPOSE: To assess the MR findings of chondromalacia patella and correlate the grade and associated lesionswith the arthroscopic findings. MATERIALS AND METHODS: Twenty-five patients with pain in the anterior part of theknee underwent fat-suppressed axial and coronal T2-weighted, dual echo sagittal proton density-weighted andT2-weighted, and in some cases, T1-weighted and T2*-weighted imaging, using a 10-cm field of view, and a 5-inchgeneral purpose coil. We retrospectively assessed these find dings, and the locations, grades and associatedlesions, and correlated these with the arthroscopic findings. RESULTS: Fourteen cases(56%) of chondromalaciapatellae were arthroscopic grade I / II, nine(36%) were grade III, and two(8%) were grade IV; associated lesionswere medial synovial plicae (16 cases, 64%), meniscus tear (10 ; 40%), cruciate ligament injury (two ; 8%),complete or incomplete discoid meniscus (four ; 16%), bipartite patella (one ; 4%) and Osgood-Schlatter disease(one ; 4%). In 24 cases, MR imaging indicated chondromalacia patella ; 17 cases were grade I / II, five were gradeIII, and two were grade IV. the location of chondromalacia patella was the medial facet (five cases ; 20%), lateralfacet (three ; 12%), junction of the medial and odd facet (13 ; 52%), and diffuse involvement (four ; 16%). Thesensivity and specificity of MR imaging were 72% and 96% respectively. CONCLUSION: We evaluated the exact locationand grade of chondromalacia patella and associated lesions, as seen on MR images. These and the arthroscopicfindings showed close correlation, and in cases involving this condition, MRI is thus a useful indicator of anappropriate surgical method and plan.

Arthroscopic Transglenoid Suture Technique ( Rhee's method ): Cadaveric Studies on Relationship between Pinning site and Neurovascular Structures / 대한정형외과학회잡지

Arthroscopic treatment of shoulder instability involves two techniques mainly, transglenoid suture technique and anterior anchoring system. However, anterior anchoring system has some disadvantages such as limited indication, high cost, technical difficulty and incapability to suture or reconstruct for all types of Bankart lesion. Disadvantages of transglenoid suture techniques are indirect suture tie, bump effect and possibility of the suprascapular nerve injury. The authors use modified transglenoid suture technique (Rhees method) for shoulder instability involving Bankart lesion, type II SLAP lesion and capsular laxity. The purpose of this study is to accurately describe the relationship between the major neurovascular structures and the pinning sites used in transglenoid suture technique (Rhees method). Placement of two or three arthroscopic Beath pinning sites was simulated in four fresh cadaveric shoulder specimens by placing Steinman pins into the glenoid rim under open field. The specimens were then dissected and the relationship of the pinning sites to the suprascapular nerve and suprascapular artery were recorded. In Bankart lesion repair, safe zone of pinning sites were 2 and 5 oclock in two portals in right shoulder, safe zone of pinning sites were 7 and 10 oclock in two portals in left shoulder. Safe direction of pinning was as possible as inferomedial side in scapula. In type II SLAP repair, safe zone of pinning sites were 2 oclock and just above 2 oclock of glenoid in right shoulder and 10 oclock and just above 10 oclock of glenoid in left shoulder. Safe direction of pinning was pararell to glenoid cavity and slightly superior in horizontal plane. From this study, these sites and directions appeared to be safe. Proper pinning depends on careful attention to the topographical anatomy about the shoulder.

Rhee's method / 대한정형외과학회잡지

This is a retrospective review of 11patients of type II SLAP lesion which were found during arthroscopic treatment of 26 patients diagnosed SLAP lesion, clinically and radiologically, hetween March l989 and June 1996. Follow-up time was averaged 26 months (range, l2 months to 72 months) and average age was 30 years old. All patients were treated arthroscopically for SLAP lesion. In type II 2 cases were repaired hy biodegradable tacks (Suretac(R)), 9 cases were repaired by transglenoid and transscapular tcchnique that included dehridement of the frayed lahrum and ahrasion of the superior glenoid neck, followed hy the placement of multiple suture on the torn capsular-labrum complex and lahrum-biccps tendon complex using suture hook, heath pin and # 0 PDS (Rhee's method). Among 9 cases with transglenoid and transscapular suture technique in type II SLAP lesion, the result were quantitated with Rowe ratin scale, 4 cases were exellent, 3 cases were good and 2 cases were fair. Our modification technique, using transglenoidal two bone hole technique and tying on scapular spine can ohtain as compatible fixation as other techniques which include metal staple, bioderadahle tacks (Suretac(R)) and anterior anchoring system such as mini-Revo. Our technique also has reasonable recurrence rate with few complication. The advantage of our modified technique is able to do superior capsular advancement, capsular plication and capsular shift which procedures are very difficult in other techniques. We propose arthroscopic transglenoid and transscapular suture technique (Rhee's method) for type II SLAP lesion as one of new method of suture for type II SLAP lesion.

Arthroscopic Classification of Bankart Lesion and Modification of Arthroscopic Capsular Suture / 대한정형외과학회잡지

Forty-five modified arthroscopic transglenoid suture capsulorrhaphy were performed between January 1989 and May 1995 with minimum follow-up of one year among sixty-four recurrent anterior shoulder instability in Chungnam National University Hostital. The average age at operation were 25 year and average time interval from injury to surgery were 12 month. we classify the Bankart lesion into 4 type according to the extent of capsulolabral complex detatchment, associated glenoid rim fracture, type II SLAP lesion and absence of glenoid labrum. Type Ia have a separation of labrum and inferior glenohumeral ligament from the glenoid rim and scapular neck (classic Bankart lesion) and type IIa have a capsular separation and glenoid rim fracture. Type IIIa have above mentioned type Ia or type IIa with type II SLAP lesion and type IVa have capsular separation without identifiable labral structure. We also subdivided the each type into subgroup b according to coexistence of capsular laxity. We modify the capsular suture technique according to classification. Type Ia, and type IIa were treated with in situ Bankart repair. Type Ib and type IIb were treated with capsular advancement. Type IIIa and 1IIb were treated with Bankart repair and additional fixation of SLAP lesion. Type IVa and IVb were treated with purse string type suture (capsular shift superiorly) with multiple stitches. All patients had various shape of Bankart lesion, so author s proposed classification of the Bankart lesion can be applied to each type. Arthroscopic finding were as follows. Twelve shoulders (27%) have type Ia Bankart lesion and six patient (13%) have type lIa lesion. Type lIIa were observed in eight shoulders (18%) and four patient (9%) were type IVa. The capsular laxity (subgroup b) were found in 15 patient (33%). None of the 45 patients experienced intraoperative complications or infec tion. All patients had full, painless range of motion and had no recurrence except four patient. One is type IIIa Bankart lesion in which associated type II SLAP was not repaired and the other two patients had sport injury and one patient had severe retrauma on 2 years after operation. We conclude that Bankart lesion is the essential lesion of recurrent anterior shoulder instability and were founded in all cases of recurrent anterior shoulder instability, and modified athroscopic transglenoid suture capsulorrhaphy according to arthroscopic classification is safe and effective method with acceptable recurrence rate.

Cosed, semiclosed, open intramedullary nailing in segmental fractures of fmoral shaft / 대한정형외과학회잡지

No abstract available.

Sonographic evaluation of new bone formation at the distraction site in ilizarov limb lengthening procedure / 대한정형외과학회잡지

No abstract available.