Osseous Erosion by Spinoglenoid Ganglion Cyst in Adolescent Baseball Player: A Case Report / 대한스포츠의학회지

Spinoglenoid notch cysts, a certain expansion form of paralabral ganglion cyst, are often associated with superior labrum anterior to posterior (SLAP) lesions in overhead athletes. We report a unique case of spinoglenoid notch cyst that extended to posterosuperior bony glenoid in a 16-year-old high school male baseball fielder. Magnetic resonance imaging showed multilobulated spinoglenoid notch ganglion cyst associated with posterosuperior SLAP lesion, and computed tomography (CT) revealed distinct osseous erosion of posterosuperior glenoid. The cyst was enlarged on serial follow-up imaging, and his symptoms were continued, arthroscopic decompression was performed via posterosuperior capsulotomy. The concomitant SLAP lesion was not repaired, but only marginal debridement was performed. At 6 months after surgery, he returned to game without symptoms, and the bony glenoid lesion was almost remodeled on follow-up CT. In adolescent athletes, significant osseous erosion by spinoglenoid notch cyst may be accentuated due to the skeletal immaturity of posterosuperior glenoid.

Atypical Spondylolysis of the Fifth Lumbar Vertebra in Baseball Players:Two Cases Report / 대한스포츠의학회지

Lumbar spondylolysis is a frequent cause of low back pain especially in adolescents involved in sporting activities. It is considered as a fatigue-type defect in the pars interarticularis or isthmus resulted from repetitive hyperextension and rotation on the spine; however, there is still confusion in regard to imaging findings of the location and direction of the defect. We report two unique cases of fifth lumbar spondylolysis in professional baseball hitter and adolescent pitcher; early-stage unilateral incomplete isthmus fracture and bilateral fracture in a different configuration, respectively. Computed tomography demonstrated vertical and more coronally oriented fracture lines compared with typical spondylolytic defect, and repetitive rotation in the same direction of pitching might cause a different type of fracture on the contralateral isthmus with the preexisting unilateral defect. Intriguingly, early-stage unilateral fracture in hitter was united after only 6 weeks of rest and rehabilitation and able to return to the game.

First-Rib Fracture in a Baseball Pitcher / 대한스포츠의학회지

First-rib fractures may be caused due to high energy direct trauma, violent muscle contracture, or chronic fatigue. Isolated fractures are very rarely noted and may be a potential cause of nonspecific shoulder pain in overhead athletes. Although the exact mechanism underlying first-rib fractures caused by sudden muscular contracture is still not known, many repetitive activities have been associated with with these unique fractures. We present a case of an acute first-rib fracture in a rookie professional baseball pitcher. He returned to the same level of throwing in 5 months with rest and rehabilitation.

Progressive Brachial Plexus Palsy after Fixation of Clavicle Shaft Nonunion: A Case Report

The brachial plexus palsy is a rare complication of a clavicle fracture, occurring in 0.5% to 9.0% of cases. This condition is caused by excessive callus formation, which can be recovered by a spur resection and surgical fixation. In contrast, only seven cases have been reported after surgical reduction and fixation. A case of progressive brachial plexus palsy was observed after fixation of the displaced nonunion of a clavicle fracture. The symptom were improved after removing the implant.

Traumatic Posterior Rotator Cuff Tear in the Pre-existing Chronic Supraspinatus Tendon Tear / 대한스포츠의학회지

PURPOSE: This study aimed to evaluate the diagnostic characteristics and clinical results after surgical repair of traumatic superimposed posterior rotator cuff tear in the setting of preexisting retracted supraspinatus tendon tear.METHODS: A total of 20 patients (mean age, 62.1 years) were included and all patients had significant traumatic events mean 3.7 weeks prior to the surgery. Preoperative acromiohumeral distance (AHD, mean 3.2 mm) and arthritis change were analyzed on plain radiograph and magnetic resonance imaging was evaluated for the nature and extent of torn tendon, and fatty degeneration (FD) of all cuff muscles to validate if the tears were traumatic or chronic.RESULTS: Complete repairs were achieved in 15 patients and partial repair including posterior cuff in five. Functional and radiographic results were statistically evaluated and repair integrities were assessed with ultrasound at average 17.3 months. Overall functional outcome scores were significantly improved and 17 patients (85%) were satisfied with their symptoms. AHD was significantly recovered (mean, 6.7 mm), but two patients showed progression of arthritic change. Retears after the complete repair were three patients (20%), who showed poor outcome, with advanced preoperative FD of posterior cuff muscles. Five patients with partial repair of posterior cuff revealed improved functional score with no sign of retear of posterior cuff on ultrasound.CONCLUSION: Early recognition of traumatic superimposed posterior cuff tears and surgical repair can reliably restore shoulder function, and partial repair of posterior cuff also can be expected favorable outcomes in supraspinatus tear with advanced FD.

Anatomical Reduction with Brick-Work Technique in Comminuted Intraarticular Distal Radius Fractures

PURPOSE: This study examined the clinical outcomes of comminuted intraarticular distal radius fractures treated by an anatomical reduction using a brick-work technique. MATERIALS AND METHODS: Seventeen patients with AO/OTA type 23-C3 distal radius fractures were enrolled in this study. An anatomical reduction of the articular surface was achieved using a brick-work technique through the dorsal approach and dorsal plates were used for fixation. The postoperative functional results were assessed with the range of motion of the wrist and the modified Mayo wrist score (MMWS). In addition, the radial length, radial inclination, volar tilt, and Lidstrom score were evaluated from the radiology results. The mean postoperative follow-up period was 13.6 months. RESULTS: All patients showed bony union and the mean range of motion of the injured wrists was 94% (92% to 95%) of the uninjured side. The mean MMWS was 85.3, and the functional results were excellent in 12 patients, good in 4, and fair in one at the final follow-up. Based on the final radiographic measurements, the radial length, volar tilt, and radial inclination were 11.4 mm (10.0 to 13.5 mm), 6.6° (−1.8° to 9.2°), and 21.3° (20.1° to 25.7°), respectively. The radiologic results according to the Lidstrom score were excellent in 14 patients and good in three. CONCLUSION: An anatomical reduction with the brick-work technique is relatively easy, results in a reproducible clinical outcome, and could be a safe and effective treatment option for severe comminuted intraarticular distal radius fractures that are not amenable to volar plate fixation.

Free Vascularized Fibular Graft for Femoral Head Collapse Combined with Ununited Pathologic Intertrochanteric Fracture / 대한정형외과학회잡지

Surgery for pathologic hip fracture poses significant challenges regarding the fixation of fracture and management of the original tumor lesion. An extensive destruction of the femoral neck and intertrochanteric region by benign or malignant lesions complicated by a pathological fracture generally necessitates total hip arthroplasty; however, in adolescents and young adults, preservation of the hip is preferable. We present a 14-year-old female patient, who sustained a pathological intertrochanteric fracture through a pre-existing aneurysmal bone cyst. Several operative interventions with internal fixation and bone graft were unsuccessful, and combined nonunion and progression of osteolysis around the compression hip screw eventually caused femoral head collapse, mimicking osteonecrosis. Hip preservation and resolution of the original tumor were achieved by free vascularized fibular graft.

Early Lateral Compartment Physeal Closure of the Elbow in Osteochondritis Dissecans of the Adolescent Baseball Players / 대한스포츠의학회지

PURPOSE: The purpose of this study is to identify bilateral differences of physeal closure of the lateral compartment of the elbow in osteochondritis dissecans (OCD) and related factors with premature physeal closure. METHODS: Initial radiographs of the bilateral elbows in 40 baseball players with OCD (group I) were reviewed for the status of physeal closure of the lateral compartment; capitellum, radial head, lateral epicondyle. Forty baseball players with medial epicondylar apophysitis (group II) were enrolled as a control. Relative status of physeal closure of dominant elbow was defined as early, same, and delayed. Bilateral differences of the status of physeal closure were analyzed between groups, and according to the radiographic stages, extent of the lesions and demographic factors in group I. RESULTS: Significant early physeal closures of dominant elbows were identified in group I in capitellum (group I, 55%; group II, 3%), radial head (group I, 53%; group II, 3%), and lateral epicondyle (group I 37%; group II, 5%). In group I, advanced stage and extended lesion showed early lateral compartment physeal closure especially in capitellum and radial head, and players with longer career length and limitation of motion showed early closure. CONCLUSION: Over the half of the adolescent baseball players with OCD demonstrated early radiocapitellar physeal closures of dominant elbow in initial presentation. Because premature physeal closure contributes to the development of arthritis without appropriate radiocapitellar remodeling, early detection of OCD is essential for prevention of arthritis and successful conservative management.

Synovial Osteochondromatosis of the Subtalar Joint in an Adolescent Baseball Player / 대한스포츠의학회지

Synovial chondromatosis is an uncommon disorder characterized by cartilaginous proliferation within the synovial membrane of the articular joint. Smaller joints are rarely affected and it may be progressed to osteochondromatosis after ossification or calcification of metaplastic cartilage. It is commonly presented in the third to fourth decade of life, but rarely presented in adolescence. We report a unique case of synovial osteochondromatosis of the subtalar joint in 14-year-old baseball player. Arthroscopic removal of loose body and complete excision of the osteochondral mass with concomitant synovectomy resulted in satisfactory outcome without recurrence at final follow-up.

Ulnar Collateral Ligament Tear Combined with Medial Epicondylitis of the Elbow / 대한스포츠의학회지

Medial epicondylitis, also known as “golfer's elbow,” is a common overuse syndrome of the elbow and predominantly affects the origin of the common flexor tendon. We report two unique cases of medial epicondylitis complicated by chronic complete tear of the ulnar collateral ligament and common flexor tendon origin. Physical examination showed a focal huge swelling of medial epicondylar region of the dominant elbow and magnetic resonance imaging revealed complete tear of the ulnar collateral ligament and common flexor tendon and extravasation of intra-articular effusion. Satisfactory results were achieved with ulnar collateral ligament reconstruction and simultaneous repair of the common flexor tendon origin.

Posterior Glenoid Lesions on Magnetic Resonance Imaging in Adolescent Baseball Players / 대한스포츠의학회지

The purpose of this study is to evaluate the characteristics of posterior glenoid lesion (PGL) on magnetic resonance imaging (MRI) in adolescent baseball players. Seventy-two adolescent baseball players (mean age, 15.1 years) who underwent MRI scan for dominant shoulder pain were enrolled and the location and morphologic features of PGLs were assessed on MRI. All players were divided into three groups based on the physeal status of proximal humerus: group I, open; group II, partial closure; and group III, complete closure. Of the 72 players, posterior glenoid rim rounding (69%) and periosteal thickening (88%) were the main PGL on axial imaging. Osteochondritis dissecans (OCD) of glenoid (10%), Bennett lesion (6%), and posterior labral tear (21%) were also identified. On oblique sagittal imaging, bony PGL including OCD involves mid-portion of posterior glenoid consistent with the level of the infraspinatus muscle, but Bennett lesion was located relatively lower than PGL. Posterior glenoid rim rounding was more prevalent in younger players (group I, 86%; group II, 78%; group III, 43%; p=0.015), and posterior labral tears were in older players (group I, 0%; group II, 19%; group III, 38%, p=0.027). Factors related with prevalence of posterior glenoid rim rounding were increased body mass index (p=0.016), pitchers (p=0.024), and players with posterior shoulder tightness (p=0.023), but career length was not statistically significant (p=0.089). Decreasing the rate of posterior glenoid rim rounding with skeletal growth implies that it may be recovered through the remodeling process, and labral tears are increasing internal impingement lesion after physeal closure.

Treatment for the Recalcitrant Anterior Shin Skin Lesion after Chronic Osteomyelitis of the Tibia: Diaphyseal Osteoplasty and Soft Tissue Primary Closure / 대한정형외과학회잡지

PURPOSE: We aimed to report the clinical results of diaphyseal osteoplasty and primary soft tissue closure in recalcitrant poor skin lesion with superficial or localized bone infection on the anterior shin after chronic osteomyelitis. MATERIALS AND METHODS: We retrospectively reviewed 7 patients with poor shin skin lesion complicated by superficial and localized bone infection after chronic osteomyelitis. The average duration of chronic osteomyelitis was 39 years. After excision of the poor skin lesion, diaphyseal osteoplasty of the tibia was performed for the resection of infected bone and primary closure of the soft tissue defect. Postoperative results were evaluated with recovery of skin lesion, the amount of bone resection by osteoplasty and complications including recurrence of osteomyelitis. RESULTS: Mean size of excised skin lesion during surgery was 3.0×14.1 cm and successful primary closures of the defect were possible in all cases. All shin skin lesions were recovered and the amount of resected bone was mean of 18.7% of the anteroposterior diameter of the tibia. There was no recurrence of skin lesion, osteomyelitis or stress fracture. CONCLUSION: After treatment of a previous intramedullary infection in chronic osteomyelitis of the tibia, recalcitrant poor shin skin lesion complicated with superficial or localized bone infection was effectively recovered by diaphyseal osteoplasty and primary soft tissue closure. This procedure is relatively simple compared to other surgeries and effective in recovery of healthy shin skin without recurrence of osteomyelitis.

Ultrasonographic Findings of Little Leaguer's Shoulder / 대한스포츠의학회지

The purpose of this study is to evaluate the ultrasonographic findings of little leaguer's shoulder among adolescent baseball players. Forty-two little leaguer's shoulder patients (age, 11–16 years; mean, 13.8 years; right, 39; left, 3), based on plain X-ray, were examined by bilateral shoulder ultrasonography. All patients were divided into groups on the basis of sonographic abnormalities and bilateral differences of physeal gap were measured in the cases of significant physeal widening. Sonographic abnormalities of dominant shoulder were physeal irregularity (45%), physeal fragmentation (21%), periosteal thickening (36%) and physeal widening (83%) that was the most common abnormalities. Seven of 42 patients (group A) had only physeal irregularity with minimal physeal widening, 26 patients (group B) had more than 1-mm physeal widening compared with nondominant shoulder. Nine patients (group C) had both physeal widening and fragmentation. Mean physeal gaps of the dominant and nondominant shoulders in 35 patients (group B and C) were 3.4±0.8 mm and 1.4±0.1 mm, respectively (p=0.013) and increased average physeal gap of dominant shoulder was 2.0±0.8 mm. Among three groups of patients, the duration of symptom was significant longer in group C (p=0.011). Physeal widening and fragmentation were associated with progression of the disease, but physeal irregularity was relatively early sonographic finding. Ultrasonography is a useful tool to evaluate the status of proximal humeral epiphysis and can aid early diagnosis of little leaguer's shoulder in the field.

Iatrogenic Humeral Fracture during Reduction of Shoulder Dislocation: Two Cases Report

Shoulder dislocation is the most common dislocation presenting to the emergency department. In old age, the attempt of closed reduction is made with caution in order to prevent iatrogenic fracture around the shoulder. We report two cases of iatrogenic fractures of humeral shaft and anatomical neck in female patients older than 70 years old, which occurred during the manual closed reduction. One patient was proved as first-time and the other was recurrent. In addition, the second case had a massive irreparable rotator cuff tear. Those patients were treated successfully with humeral nailing and reverse total shoulder arthroplasty, respectively.

Coil Embolization of a Pseudoaneurysm of the Anterior Tibial Artery: A Case Report / 대한족부족관절학회지

Development of a pseudoaneurysm around the ankle is an uncommon complication after surgery. We experienced a case of a pseudoaneurysm, which developed from the anterior tibial artery. A 44-year-old woman had sustained painful swelling of her right ankle after the removal of implants for a distal fibular fracture. The pseudoaneurysm was confirmed by ultrasonography and angiography. The patient was treated with an intervention using a coil and recovered without further complaints. This case report aims to increase the awareness of this complication with review of literature.

Rapidly Progressive Osteonecrosis of the Humeral Head after Arthroscopic Bankart and Rotator Cuff Repair in a 66-Year Old Woman: A Case Report

Humeral head chondrolysis has been widely reported as a devastating complication after arthroscopic shoulder surgery; however little is known about post-arthroscopic humeral head osteonecrosis. We experienced a 66-year-old female patient with rapidly progressive osteonecrosis of the humeral head only seven months after arthroscopic Bankart and rotator cuff repair. The patient had no systemic risk factors for osteonecrosis. A satisfactory result was achieved with reverse total shoulder arthroplasty for severe humeral head destruction and an irreparable massive rotator cuff tear. Shoulder surgeons should be aware of such severe complication, perform routine radiographs, and pay close attention to the presence of constant pain or loss of motion after arthroscopic shoulder surgery.

Gravity Valgus Stress Ultrasonographic Assessment of Ulnar Collateral Ligament Injury among Baseball Players / 대한스포츠의학회지

The purpose of this study is to evaluate the gravity valgus stress ultrasonographic findings of ulnar collateral ligament (UCL) injury among baseball players. Twenty-eight (age, 16-30; mean, 19.5 years) UCL injured players, diagnosed by magnetic resonance imaging (MRI), were examined by bilateral elbow ultrasonography. On MRI findings, partial and complete tears were 17 and 11 players, respectively. Ultrasonographic examinations were performed in 90 degree elbow flexion with gravity valgus stress, and abnormalities around UCL and ulnohumeral distance were compared with contralateral uninjured elbow. 22 of 28 (79%) players had sonographic abnormalities in injured elbow such as thickening, wavy contour of the UCL (32%), hypoechoic foci in the ligament (43%), osteophyte on trochlear or ulnar articular margin (36%), joint effusion (29%) and ossicles in or around the UCL (68%) that were the most common finding in both partial and complete tears. In all players, the ulnohumeral distance was significantly wider on the injured side than it was on the uninjured side (4.0+/-1.5 mm and 2.5+/-0.43 mm, respectively; p=0.015). Significant increased average ulnohumeral distance in injured elbow was observed with complete UCL tears compared with partial tears (5.4+/-0.9 mm and 3.1+/-0.8 mm, respectively; p=0.021) and the mean difference between injured and uninjured elbow was more significant in complete tears than partial tears (2.8+/-1.2 mm and 0.7+/-0.6 mm, respectively; p=0.012). Gravity valgus stress ultrasonography is rapid noninvasive diagnostic tool and can provide clinicians valuable information regarding the condition of the UCL and medial elbow laxity in partial and complete UCL tear players.

Scapulothoracic Bursitis in a Amateur Baseball Pitcher / 대한스포츠의학회지

Scapulothoracic bursitis refers to inflammation of the bursae secondary to trauma or overuse owing to sports activities or work. It usually causes persistent pain and scapulothoracic crepitus by irritation of bursa but can be presented as painless mass around chest wall. We report a case of scapulothoracic bursitis in a baseball pitcher presenting as rapidly growing chest wall mass confused with a soft tissue tumor. Computed tomography and magnetic resonance imaging revealed as a well-demarcated cystic mass situated between the scapula and chest wall. Incisional drainage resulted in complete resolution of the mass within a couple of weeks. Scapulothoracic bursitis may be presented as painless huge mass in overhead sports athlete and one of the differential diagnoses of soft tissue tumor of the chest wall.

Rapidly Progressive Osteonecrosis of the Humeral Head after Arthroscopic Bankart and Rotator Cuff Repair in a 66-Year Old Woman: A Case Report

Humeral head chondrolysis has been widely reported as a devastating complication after arthroscopic shoulder surgery; however little is known about post-arthroscopic humeral head osteonecrosis. We experienced a 66-year-old female patient with rapidly progressive osteonecrosis of the humeral head only seven months after arthroscopic Bankart and rotator cuff repair. The patient had no systemic risk factors for osteonecrosis. A satisfactory result was achieved with reverse total shoulder arthroplasty for severe humeral head destruction and an irreparable massive rotator cuff tear. Shoulder surgeons should be aware of such severe complication, perform routine radiographs, and pay close attention to the presence of constant pain or loss of motion after arthroscopic shoulder surgery.

Evaluation of the Kinetic Chain in Little League Elbow / 대한스포츠의학회지

This study is to evaluate the abnormalities in the kinetic chain in the players with little league elbow during the medical screening of middle school baseball teams. Ninety-three players were examined with elbow ultrasonography in the field. Using kinetic chain evaluation test, 27 players sonogrphically diagnosed of little league elbow in dominant arm were compared with 25 players who were normal as control. Scapular-spine distance, horizontal flexion test, combined abduction test, and glenohumeral internal rotation deficit were used for evaluating kinetic chain in the upper extremities, while tightness of quadriceps and hamstring muscles, internal rotation of stance leg, and external rotation of stride leg were used for lower extremities. Also, the single leg stance test and finger-floor distance were used for core stability and flexibility. Twenty-five of 27 players (93%) having little league elbow showed kinetic chain abnormalities of either upper or lower extremities or trunk. This rate was significantly higher for the players having the little leaguer's elbow than control (28%) (p=0.017). Each specific tests for evaluating kinetic chain were also more prevalent in little league elbow group than control, and the abnormalities in the upper extremity were more common than those in lower extremity (p=0.026). Combined abduction test (23/27) and limitation of internal rotation of stance leg (16/27) were the most prevalent abnormalities in upper and lower extremity test, respectively. Our findings showed that there are many abnormalities in kinetic chain in players having the little league elbow and it may be associated with pathogenesis of little league elbow.