The Effect of Arm Position on the Repaired Capsulolabrum after Arthroscopic Bankart Repair: Magnetic Resonance Imaging Study / 대한정형외과학회잡지

PURPOSE: To evaluate and describe the findings of immediate postoperative, magnetic resonance (MR) arthrography of repaired capsulolabrum using two different arm positions (internal rotation and external rotation) for patients who had undergone arthroscopic Bankart repair. MATERIALS AND METHODS: Arthroscopically-repaired Bankart lesions were examined in the axial T2-weighted images of MR-arthrogram in twenty-two shoulders on the immediate postoperative day. We measured three parameters (height, slope, and medial overhang) on the axial images at the anteroinferior portion of the glenoid in internal and external rotation of the adducted arm. The mean internal rotation of the arm was 30degrees (range, 14degrees to 45degrees) and the mean external rotation was 19degrees (range, 2degrees to 44degrees). The two heights and slopes were compared using the paired t-test. For medial overhang, crosstable McNemar test was used. Statistical analyses were performed with the SPSS software package. RESULTS: There were 21 male and 1 female patients with a mean age of 24 years (range, 17 to 36 years). The arms in internal rotation position showed a loss of capsulolabral buttress in all patients. When the arm was in external rotation, the height and slope of the labrum were both greater, being on average 1.47 mm and 7degrees, respectively (p<0.001 for both measures), than those in the internal rotation position. Medial overhang on the glenoid rim was 81% positive when the arm was in the internal rotation position but 86% negative with the arm externally rotated (p<0.001). CONCLUSION: Loss of repaired capsulolabral buttress seems to be inevitable when the arm is immobilized in the internal rotation position after arthroscopic Bankart repair. To prevent this, we recommend immobilization of the arm in external rotation after the surgery.

Causes of the Painful Hemiplegic Shoulder and Comparison of the Results of Radiologic Evaluation

OBJECTIVE: The purposes of this study were to investigate the findings of various diagnostic tools for shoulder pain in hemiplegic patients and to compare the results of each diagnostic tool. METHOD: Sixty shoulders in hemiplegic patients with shoulder pain were evaluated by physical examination, visual analogue scale, plain X-ray, arthrogram, ultrasonography and 3-phasic bone scan. RESULTS: The subluxation of shoulder on X-ray was found in 45 patients. The abnormal findings of arthrogram were 39 patients and the most common finding was adhesive capsulitis. The abnormal findings of ultrasonography were 45 patients and the most common finding was supraspinatus tendinitis. In cases of shoulder subluxation on X-ray, manycases were associated with supraspinatus tendinitis on ultrasonography and with adhesive capsulitis on arthrogram. In comparison with the arthrogram and ultrasonography, partial and complete rotator cuff tear findings show consistency. And patients with adhesive capsulitis on arthrogram show significantly high incidence of biceps tendinitis finding on ultrasonography. CONCLUSION: In hemiplegic patients with shoulder pain, the ultrasonography is more valuable and useful as an invasive diagnositc method for the evaluation of rotator cuff tendinitis especially when there is subluxation in X-ray and adhesive capsulitis in physical examination.

Arthrographic Evaluation in Developmental Dislocation of the Hip: Comparison Between Hip Arthrogram and Operative Findings / 영남의대학술지

One of the main purposes in the treatment of developmental dislocation of the hip is to achieve and maintain concentric, congruent, and stable reduction. The arthrogram perform an important role in the diagnosis and treatment of developmental dislocation of the hip. The arthrogram provides much information about the soft tissue status of the hip joint. Limbus and ligamentum teres is exactly evaluated so we can plan the reduction and treatment before operation. 18 preoperative hip arthrograms of 17 children treated for developmental dislocation of the hip from 1992 to 1998 were reviewed. The limbus, ligamentum teres and transverse acetabular ligament were compared with the pathoanatomy seen at the time of open reduction. Arthrography proved reliable in identifying the limbus and ligamentum teres. So we recommend that arthrography must be performed before closed or open reduction. Also, we recorded the radiographic parameters: acetabular index, acetabular floor thickness, center edge(CE) angle of Wiberg, and Y-coordinate. The center edge(CE) angle of Wiberg obtained from arthrography was measured more accurately than from simple roentgenograms because the ossification of the femoral head was frequently located eccentrically in the developmental dislocation of the hip.

CT Arthrographic Finding in Shoulder Instability / 대한정형외과학회잡지

The purpose of this study is to evaluate the morphologic findings of the labrum and capsuloligamentous structures in the normal and unstable shoulders and to compare the effectiveness of double contrast arthrographic findings which were taken with supine and prone position. We reviewed the computerized tomographic arthrogram in 9 cases of normal shoulder and l3 cases of shoulder instability. We evaluated the shape of the labrum, the attachment of anterior capsule and the amount of capsular laxity. Capsular laxity was compared each others in normal, the unidirectional instability and the multidirectional instability. Among these materials, we simultaneously performed CT arthrogram with supine and prone position and evaluated which is more reliable and accurate. Scapular inclination was ahout 25 degrees in the supine position and ahout 60 degrees in the prone position. Normal glenoid labrum varied in size and shape, so its lack of a classic appearance might not indicate a labral tear. Variations existed in the anterior capsular attachment onto the glenoid. The anterior capsule was used to attach far away from the glenoid rim. but it might not indicate an anterior instability. With the prone position, the labral lesion took more excellent visualization due to the contrast coating on the glenoid labrum in both anterior and posterior. Anterior capsular expansion was seen well with prone position in anterior instability. In summary, for proper interpretation of the instability, awareness of the morphologic variations of the labrum and capsuloligamentous structure is important. CT double contrast arthrography with prone position has made a significant contribution to improving and easing the documentation of variety of anatomic abnormalities. Now we recommend the prone position in CT arthrogram for imaging glenoid labrum pathology in shoulder instability.

Arthrography in Congenital Dislocation of the Hip / 대한정형외과학회잡지

Arthrography is an invaluable procedure in critically verifyging the concentricity of closed reduction and the optimum position of stability. And it is known to be the most accurate and certain way of demonstrating lesser degrees of incongruity. It can visualize the intrinsic obstructive fractors, such as capsular attachment, the labrum, the psoas tendon and its relationship to the joint, the pulvinar, ligamentum teres, the inferior transverse ligament, and the shape of the femoral head and acetabulum. We analyzed 20 cases of congenital dislocation of the hip in 17 patients, which had been evaluated by arthrography. The results are as follows: 1. We found the inferior approach very efficient among many kinds of arthrographic techniques. 2. Among 20 cases, 12 cases could be treated with closed reduction and 8 cases were treated by open reduction such as capsuloplasty, partial limbusectomy, and removal of space occupying lesion in acetabulum, including 2 cases of Salter's innominate osteotomy and 1 case of derotational osteotomy. 3. Among the intracapsular obstructive factors which played major role in hindering closed reduction, capsular constriction was shown in 8 case, inverted or hypertrophic limbus in 5 cases, and other space occupying lesions in 2 cases. 4. We performed combined operation including bone and soft tissue for severe extra- and intracapsular lesions and closed reduction for mild to moderate extra- and intracapsular lesions. 5. Arthrography of the hip joint was indispensable in evaluating the intracapsular osstructive lesions as well as detecting the subtle incongruent reduction.