Analysis of Greater Tuberosity from the Center of the Humeral Head: Progression to Femoralization

BACKGROUND@#Progression of the tear size and erosion of the greater tuberosity (femoralization) in the supraspinatus tear makes it difficult to repair or increases the risk of a re-tear. This study examined the proximal articular surface and greater tuberosity of the humeral head in plain radiography.@*METHODS@#Two-hundred forty-seven cases, whose anteroposterior (AP) radiographs were taken correctly, were included from 288 cases, in whom the status of the supraspinatus had been confirmed by surgery. After downloading the plain AP radiograph as DICOM, the radius of the circle apposed at the superior half of the articular surface of the head, and the distance between the circle and the farthest point of the greater tuberosity (‘height’ of the greater tuberosity) were calculated using the software (TechHime, Korea). MRI checked the number of torn tendons and degree of muscular atrophy.@*RESULTS@#The following were encountered: 93 intact supraspinatus, 50 partial-thickness tears, and 104 full-thickness tears. In the analysis using the 93 intact cases, the average radius of the rotation center was 25.3 mm in male and 22.3 mm in female. The average height of the greater tuberosity from the circle with the same rotation center was 4.3 mm in male and 4.2 mm in female with no statistical significance. The correlation between the reparability of supraspinatus and height of the greater tuberosity, fatty infiltration, and muscular atrophy was confirmed.@*CONCLUSIONS@#The height of the greater tuberosity from the circle with the same rotation center was 4.3 mm in male and 4.2 mm in female. This height was strongly correlated with muscular atrophy and fatty infiltration of the supraspinatus tendon.

Surgical Treatment for the Shoulder Joint in Rheumatoid Patients

Rheumatoid arthritis (RA) is a systemic disease with medication as the treatment of choice. However, surgical treatment is recommended when no improvement is noted despite aggressive conservative treatment. Synovectomy provides desirable outcomes for RA patients in the early stage with a glenohumeral joint of Larsen grade II or less; conversely, arthroplasty is recommended for patients with a glenohumeral joint of grade III or higher. RA patients often have attenuation and dysfunction of the rotator cuff, and reverse shoulder arthroplasty has been proven to provide favorable outcomes in some patients. RA is often complicated with osteoporosis and bony deformity; therefore, close attention is necessary to prevent fractures during shoulder arthroplasty.

Surgical Treatment for the Shoulder Joint in Rheumatoid Patients

Rheumatoid arthritis (RA) is a systemic disease with medication as the treatment of choice. However, surgical treatment is recommended when no improvement is noted despite aggressive conservative treatment. Synovectomy provides desirable outcomes for RA patients in the early stage with a glenohumeral joint of Larsen grade II or less; conversely, arthroplasty is recommended for patients with a glenohumeral joint of grade III or higher. RA patients often have attenuation and dysfunction of the rotator cuff, and reverse shoulder arthroplasty has been proven to provide favorable outcomes in some patients. RA is often complicated with osteoporosis and bony deformity; therefore, close attention is necessary to prevent fractures during shoulder arthroplasty.

Ultrasonography in Sternoclavicular Joint Posterior Dislocation in an Adolescent: A Case Report

Sternoclavicular joint posterior dislocations are considered a very uncommon, and type of injury where if esophagus or airway injury occurs behind the clavicle, it poses a high risk to the patient. In addition, if epiphyseal fracture occurs as a result of the sternoclavicular joint posterior dislocation, surgical treatment is often required. However, in the absence of a complete ossification of the clavicle, it is difficult to differentiate between a simple dislocation and epiphyseal fracture-dislocation solely based on simple radiographs or computed tomography scans. In this case report, the authors present a case in which a sternoclavicular joint posterior dislocation was diagnosed in a 14-year-old male athlete. The case report discusses how the posterior dislocation without epiphyseal fracture was diagnosed using an ultrasound and subsequently treated with successful outcomes using manual reduction. The case report presents our findings along with discussion that includes a literature review of relevant research.

Ultrasonography in Sternoclavicular Joint Posterior Dislocation in an Adolescent: A Case Report

Sternoclavicular joint posterior dislocations are considered a very uncommon, and type of injury where if esophagus or airway injury occurs behind the clavicle, it poses a high risk to the patient. In addition, if epiphyseal fracture occurs as a result of the sternoclavicular joint posterior dislocation, surgical treatment is often required. However, in the absence of a complete ossification of the clavicle, it is difficult to differentiate between a simple dislocation and epiphyseal fracture-dislocation solely based on simple radiographs or computed tomography scans. In this case report, the authors present a case in which a sternoclavicular joint posterior dislocation was diagnosed in a 14-year-old male athlete. The case report discusses how the posterior dislocation without epiphyseal fracture was diagnosed using an ultrasound and subsequently treated with successful outcomes using manual reduction. The case report presents our findings along with discussion that includes a literature review of relevant research.

Arthroscopic Olecranon Osteophyte Resection in the Baseball Players with Elbow Valgus Extension Overload Syndrome / 대한스포츠의학회지

We evaluated the clinical outcome after arthroscopic olecranon osteophyte resection without ligament operation in the elite baseball players who had valgus extension overload syndrome without moderate or severe medial collateral ligament injury. From January 2007 to December 2011, twelve patients underwent arthroscopic osteophyte resection without ligament operation and they were followed for more than 12 months. The mean age was 19.2 years and mean follow-up period was 26 months. The clinical results were evaluated using range of motion, visual analogue scale (VAS) and Mayo elbow performance score (MEPS). After checking osteophyte size and location through 3-dimensional computed tomography, arthroscopic osteophyte resection was performed. Average preoperative extension, flexion, pronation and supination were 2.3degrees, 138.2degrees, 76.4degrees, and 69.1degrees. Average postoperative extension, flexion, pronation and supination had been changed into 0.7degrees, 137.3degrees, 79.1degrees, and 77.3degrees. Average preoperative pain VAS and MEPS were 5.5 and 67.5. Average postoperative pain VAS and MEPS had been changed into 0.4 (p<0.001) and 97.5 (p<0.001). Eleven patients returned to play. Ten cases returned to their own position. No patients were performed other operation for elbow pain. The arthroscopic osteophyte resection in valgus extension overload syndrome with low grade medial ulnar collateral ligament (MUCL) injury or without MUCL injury was a one of the ideal treatment option for early return to pre-injury levels and relief of pain.

Stem Cell Therapy in Articular Cartilage Injury

The natural history after articular cartilage injury is unclear. However, it is generally accepted that once articular cartilage is injured, its ability to regenerate is limited and that injury progresses to arthritis with time. Over the years various treatments have been developed and are used, such as arthroscopic debridement, microfracture, multiple drilling, osteochondral transfer, and Autologous Chondrocyte Implantation (ACI). These can be divided into treatment methods which apply cells and those which apply tissue. The former include abrasion chondroplasty, microfracture, multiple drilling, and ACI. The latter include osteochondral transfer and allograft. Combination treatments using both cells and tissues are new-generation ACI and microfracture with biomaterials. The clinical applications of stem cell therapy is still at an early stage, but shows much promise, particularly in the management of cartilage defects.

The Effect of Preparatory Education Program on Discomfort and Retching of Examinees during Upper Gastrointestinal Endoscopy / 가정의학회지

BACKGROUND: Although upper gastrointestinal (UGI) endoscopy is highly sensitive for the detection of esophago-gastroduodenal lesions, pain and discomfort during the procedure cause examinees to experience stress and anxiety. Moreover, there have been only a few studies on relief of pain and discomfort during UGI endoscopy through preparatory interventions. Therefore, the aim of this study was to investigate the relationship between a preparatory education program and the discomfort and retching experienced by examinees during endoscopy. METHODS: A total of 306 examinees who visited a health promotion center and underwent non-sedated endoscopy from May 13 to July 3, 2009 were included in this study. After they were assigned to experimental (n = 154) and control groups (n = 152), their discomfort and retching were measured with a visual analogue scale. The preparatory education program consisted of cognitive intervention, behavioral intervention and information. RESULTS: The preparatory education program relieved discomfort during endoscopy in male subjects, in subjects aged 60 and over, or in subjects with previous endoscopic experience with statistical significance (P < 0.05). It also relieved retching during endoscopy in subjects aged 60 and over with statistical significance (P = 0.023). Multiple logistic regression analysis showed that the preparatory education program significantly relieved the discomfort of examinees during endoscopy (P = 0.028). CONCLUSION: We found that the preparatory education program used in this study could significantly relieve the discomfort caused by endoscopy, particularly in subjects aged 60 and over, or in male subjects with a high incidence of stomach cancer in Korea.

Bone Formation of Cultured Osteoblasts in Bone Defect of Radial Shaft of Rabbit / 대한정형외과학회잡지

PURPOSE: To evaluate the osteogenic potential of an autologous cultured osteoblast transplant to the bone defects. MATERIALS AND METHODS: Radial bone defects over 15 mm were made in 20 New Zealand white rabbits using the anterior approach. There were 10 rabbits in the control group, which underwent an iliac bone graft to the preformed bone defect 3 weeks from the initial operation. There were 10 rabbits in the experimental group that underwent an autologous cultured osteoblasts injection. After 9 weeks, both groups were compared radiologically and histologically. RESULTS: The osteogenesis in both groups were progressed similarly and there was no difference in terms of the amount of bone formation and the duration of the bone union. CONCLUSION: An autologous cultured osteoblast transplant to the bone defect produces bone efficiently.In addition, it can be applied to a wide field, which requires a bone grafting operation.

Anterior Decompression and Fusion with Instrumentation in Osteoporotic Vertebral Fracture / 대한척추외과학회지

STUDY DESIGN: A Retrospective study OBJECTIVE: To evaluate the results after an anterior decompression and fusion, with anterior instrumentation, using a Z-plate in osteoporotic vertebral fractures. SUMMARY OF LITERATURE REVIEW: Despite conservative treatment, continuous severe pain, progressive neurological impairments and deformity may need surgical treatment in osteoporotic vertebral fractures accompanied with neurological deficit. MATERIALS AND METHODS: Fourteen patients that had undergone anterior decompression and an autogenous iliac bone graft, with anterior internal fixation, between 1997 and 2001, under the diagnosis of an osteoporotic vertebral fracture, were reviewed. The chief complaints, severity of pain measured, using the Denis pain scale, fracture patterns, fracture level, changes of kyphotic angle (revised with sagittal index) and complications were analyzed. RESULTS: Symptoms subsided completely in 5 patients, one case showed no definite improvement and 8 showed improved symptoms. The fracture levels included: 1 and 2 cases at the 11th and 12th thoracic spine, and 8, 1 and 2 in the 1st, 2nd and 3rd lumbar spine, respectively. 10 patients showed wedge type fractures, three a compression type and one a biconcave type. The average kyphotic deformity decreased 49.0% (50.9% when revised with sagittal index) after surgery, but the average loss of correction angle was 28.8% (26.0% when revised with sagittal index), compared with the immediate postoperative correction angle. THE COMPLICATIONS INCLUDED: screw loosening and adjacent vertebral fractures in 3 and 4 patients, respectively. Two patients had the combined problem of screw loosening and an adjacent vertebral fracture. CONCLUSION: In anterior decompression and fusion, with instrumentation, for osteoporotic vertebral fracture treatment, the complications were primarily related, directly or indirectly, to the underlying osteoporosis. Complete neurological recovery occurred 9 of the 11 patients, but residual pain was common.