Clinical Results after a Rehabilitation Program for Lateral Epicondylitis of the Elbow / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the clinical effectiveness of a rehabilitation program for the patients with lateral epicondylitis. MATERIALS AND METHODS: Twenty-three patients with lateral epicondylitis were included from April 2009 to October 2009 and all the patients were treated with a rehabilitation program for 6 weeks. The evaluation at baseline and at 12 weeks after rehabilitation included the subjective assessment of symptoms and the objective assessment with measuring the grip strength and muscle power of the wrist extensors and flexors and the forearm supinators and pronators. After 6 months, subjective satisfaction was evaluated via telephone calls. The data was analyzed using the Wilcoxon signed rank test (SPSS ver. 16.0). RESULTS: At 12 weeks, the subjective satisfaction was improved in on the three questionnaires. The grip strength increased from 25.1 kg to 37.8 kg (p<0.05). On the Biodex analysis, there was significant difference at the wrist extensors. At 6 months, 21 cases had excellent or good results according to the score and 2 cases complained of remaining pain. CONCLUSION: Our rehabilitation program is thought to be good treatment for the patients with lateral epicondylitis, and it is a practical and precautionary step for the cases of lateral epicondylitis if the patients themselves are educated to volutarily participate in the program.

Comparison of Isokinetic Strength between Stage 1,2 Impingement Syndrome and Rotator Cuff Tear

PURPOSE: The goal of this study was to evaluate differences in strength deficits between (i) patients with stage 1 or 2 impingement syndrome and (ii) patients with rotator cuff tears. MATERIALS AND METHODS: We enrolled 43 patients with stage 1 or 2 impingement syndrome (group 1) and 21 patients with rotator cuff tears (group 2). The isokinetic strength of both groups was evaluated at 60degrees/sec for external rotation, internal rotation, adduction and abduction. We measured the peak torque, total work, average power of bilateral sides, peak torque relationship to body weight, and the ratio between unilateral agonist and antagonist. RESULTS: The isokinetic strength deficits assessed in ratio of peak torque to body weight for group 1 and group 2 respectively were; 28.48+/-23.76% and 29.12+/-32.81% for abduction (p=0.929), 7.20+/-13.98% and 18.94+/-19.52%; for adduction (p=0.021), 16.88+/-13.76% and 25.80+/-24.07%; for external rotation (p=0.221), and 14.1+/-25.67% and 29.02+/-35.06% for internal rotation (p=0.059). For average power and total work, group 2 showed a significantly greater deficit for adduction and internal rotation than group 1. CONCLUSION: Those with rotator cuff tears have more isokinetic muscle strength deficits than those with stage 1 or 2 impingement syndrome. Progression from stage 1 and 2 impingement syndrome to stage 3 may result in greatest changes in strength deficits for internal rotation and adduction.

A Case of Tumoral Calcinosis in a Hemodialysis Patient with Secondary Hyperparathyroidism / 대한신장학회지

Tumoral calcinosis is a periarticular calcific lesion and rare complication in patients with maintenance hemodialysis. The pathogenesis of tumoral calcinosis is poorly understood but may be due to elevated serum phosphorus, a high calcium phosphorus (Ca x P) product or secondary hyperparathyroidism in hemodialysis patients. A 30-year-old man presented with pain and palpable mass of left shoulder. He had been on maintenance hemodialysis with high flux dialyzer for 10 years. Laboratory finding showed hyperphosphatemia and elevated intact PTH concentration. A shoulder X-ray and CT scan demonstrated a massive calcification. Following partial resection, pain was relieved. Here we report a case of tumoral calcinosis of shoulder in a hemodialysis patient with untreated hyperphosphatemia and secondary hyperparathyroidism.

The Treatment of Infected Non-union of Long Bones with Plate and Screws

PURPOSE: To evaluate the usefulness of internal fixation with plate in treating infected nonunion of long bone. MATERIALS AND METHODS: From March 1993 to February 2004, ten patients who underwent internal fixation with plate and cancellous bone graft on account of infected nonunion of long bone were retrospectively examined. The medical treatment were composed of thorough and adequate debridement of necrotic tissue, irrigation and plate fixation. Two patients were operated on with bridging plate method. Autologous cancellous bone graft was performed in 6 patients. In 2 cases, it was performed 4 weeks after internal fixation. RESULTS: In 9 patients, radiographic union appeared on the average of 6.8months and infections were cured before union occurred. CONCLUSION: Internal fixation with plate is a useful method for the solid fixation in the treatment of infected nonunion. The general concern was that the inserted hardware worsened the infection, which was overcomed with the operative techniques as bridging plate, debridement and cancellous bone graft.

The Correlation between Outcome Evaluation Systems after Anterior Cruciate Ligament Reconstruction

PURPOSE: The purpose of this study was to evaluate the correlation between various subjective, objective tests and real functional performances of the patients after ACL reconstruction. METHOD: Twenty-four patients after ACL reconstruction using 12 hamstring autograft and 12 Achilles allograft were evaluated. Lysholm knee score, IKDC subjective score, Knee Outcome Survey score and Tegner activity score were evaluated for the subjective outcome value. Static instability tests, Biodex dynamometer and hop tests were done for the objective outcome value. Three functional performance tests(FPTs) such as carioca test, shuttle run test and co-contraction test were done for deciding the real performance ability of the patients. Each score system was compared with FPT results. RESULTS: The results of Hamstring group were better than those of Achilles group, but there was no statistical significance. IKDC subjective score, single leg hopping test, and quadriceps power in low velocity of biodex dynamometer tests had a positive correlation with the total FPT results. CONCLUSION: IKDC subjective score, one leg hopping test showed significant correlation with functional performance test and they can be used as effective methods to decide whether the subjects after ACL reconstruction can return to sports activity.

A Study on the Proteins that Interact with Human Nebulin SH3 Domain / 대한정형외과연구학회지

OBJECTIVE: bjective: By identifying the unknown substance responsible for binding with nebulin SH3 domain within the sarcomeric Z-line, we tried to find out Z-line structure which plays an important role on muscle contraction and maintenance of muscle funtion. METHOD: First, the bait plasmid was made by binding the DNA binding domain of Gal4 protein of yeast and the SH3 domain. Second, library plasmid was made by binding activation domain and human skeletal cDNA library. Then, the base sequence of the clone, produced by combining the two proteins expressed by transgenically converted plasmid in yeast, was analyzed. RESULT: We screened out six true positive clones and analyzed the base sequence of the two of six clones. We identified them to be alpha-actinin2. CONCLUSION: We can theorize that Neublin SH3 domain and alpha-actinin2 plays a vital role for the integration of Z-line. Thus, this is an important data in further studying muscle functions, mechanisms, and muscular disease as well.

Correlation between ACL Injury and Bone Signal Abnormality in MRI / 대한정형외과학회잡지

Specific bone signal abnormalities of MRI of patient with knee injury, although plain radiographs are normal, suggest that ACL injury may be present. Twenty eight MRI examinations in which ACL injury were present, were retrospectively reviewed and were correlated with bone signal changes. The results obtained were as follows; 1. Of twenty eight ACL injuries seen with MR imaging, bone signal abnormality was present at the lateral femoral condyle (LFC) in 8 patients (29%), at the posterolateral tibial plateau in 10patients (36%) and at both sites in 5 patients (18%). 2. In acute knee injury, all seven patients with complete ACL tear had bone signal abnormalities at MRI and of all seven patients, six patients showed bone signal abnormalities at lateral femoral condylar or posterolateral tibial plateau. 3. In conclusion, bone signal abnormalities at posterolateral tibia or lateral femoral condyle are present in almost cases of acute complete ACL tear. Therefore the bone signal abnormalities suggest that there may be ACL injury.

Effects of Steroids and vitamin D Derivatives on Differentiation and Proliferation of Cultrured Osteoblast Cells / 대한정형외과학회잡지

This study was designed to evaluate of the effects ofB-estradiol, progesterone, dexamethasone, hydrocortisone, calcitriol and alfacalcidol on the cell proliferation and differentiation in the rat osteoblast-like osteosarcoma cells ROS 17/2.8. The proliferation of ROS 17/2.8 cell treated with 1 M B-estradiol, 1 M progesterone, 1 M hydrocortisone, 1 M dexamethasone, 10 (-8) M calcitriol and 10 (-8) M alfacalcidol was decreased by 19%, 56%, 60%, 64%, 28% and 38% of control, respetively. Production of TGF-Bl by ROS 17/2.8 cells treated with B-estradiol, progesterone, hydrocortisone, dexamethasone, calcitriol and alfacalcidol was elevated by 30%, 18%, 60%, 48%, 405% and 452% of control, respectively. Alkaline phosphatase activity of ROS 17/2.8 cell treated with hydrocortisone, dexamethasone, calcitriol and alfacalcidol was increased by 3.4 times, 12.9 times, 10.0 times and 5.1 times of control, respectively, but with B-estradiol and progesterone decreased by 39% and 10% of control respectively. Northern blot experiments demonstrated that calcitriol and alfacalcidol increased mRNA levels of both osteocalcin and osteopontin.