Morphological changes of the posterosuperior glenoid on ultrasonography in adolescent baseball players

Ku Jung Hoei,Cho Hyung Lae,Kim Jong Min 대한정형외과 스포츠의학회 2020 Arthroscopy and Orthopedic Sports Medicine Vol.7 No.2

Background: This study aimed to evaluate the ultrasonographic changes of the posterosuperior glenoid (PSG) in adolescent baseball players. Methods: We analyzed 132 consecutive adolescent baseball players (mean age, 13.4 years; height, 162.6 cm; weight, 58.9 kg; playing career length, 3.2 years) who underwent bilateral sonographic comparison of the PSG. Fifty-four players complained about shoulder pain and 79 players displayed posterior tightness of the dominant shoulder. Using the nondominant shoulder as a control, the PSG of the dominant shoulder was scanned on horizontal axis view with a linear-array transducer, and demographic factors related to PSG abnormalities were evaluated. All players were divided into groups based on distinctive sonographic abnormalities of the PSG: normal, beak, slope, and round types. Results: Of the 132 players, 123 (93.2%) demonstrated abnormal PSG changes compared to the nondominant shoulder: beak type, 28.8% (38 players); slope type, 50.0% (66 players); and round type, 14.4% (19 players). Significant differences in mean age and length of playing career were identified among the different types: players with the beak type, slope type, and round type were a mean of 12.1, 13.8, and 15.6 years old (P = 0.002) and had a mean playing career length of 2.0, 3.5, and 5.4 years (P = 0.004), respectively. The mean slope angle of the slope type was 42.7°, and this angle was associated with the length of playing career (P = 0.035). Player position (P = 0.583), the presence of dominant shoulder pain (P = 0.739), and posterior shoulder tightness (P = 0.203) were not significantly associated with the type of PSG and slope angle. Conclusion: Morphological changes of the PSG in the dominant shoulder occur very frequently in adolescent baseball players. Age and length of playing career were significantly associated with this physiologic remodeling process of the premature PSG.

Intra-articular synovial lipoma in the posteromedial compartment of the knee

Jung Hoei Ku,Hyung Lae Cho,Jong Tae Park,Tae Hyun Wang,Hui Sun Yang 대한정형외과 스포츠의학회 2014 Arthroscopy and Orthopedic Sports Medicine Vol.1 No.1

Intra-articular synovial lipoma of the knee joint is exceedingly rare. Although there has been one documented case of an open excision in Korean literature, our report presents a first description treated entirely by arthroscopic methods. A 37-year-old female patient suffered from a catching or intermittent locking of the knee, like a loose body. The arthroscopy revealed a globular, yellowish tumor extending from the posteromedial capsule into the joint space. The mass was around the posterior horn of the medial meniscus and showed signal intensity similar to subcutaneous fat on T1- and T2-weighted magnetic resonance images. The tumor was totally excised under arthroscopic guidance and histological examination of the specimen revealed a tumor composed of mature adipose cells covered with a thin fibrous tissue. Thus, intra-articular synovial lipoma should be considered in the differential diagnoses when examining a patient with catching or locking of the knee.

주관절 내상과염과 동반된 척측 측부 인대 파열

구정회 ( Jung Hoei Ku ),조형래 ( Hyung Lae Cho ),진홍기 ( Hong Ki Jin ),김지언 ( Ji Un Kim ) 대한스포츠의학회 2017 대한스포츠의학회지 Vol.35 No.2

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.

청소년기 야구 선수의 박리성 골연골염에서 주관절 외측 구획 성장판의 조기 폐쇄

구정회 ( Jung Hoei Ku ),조형래 ( Hyung Lae Cho ),박기봉 ( Ki Bong Park ),이완석 ( Wan Seok Lee ) 대한스포츠의학회 2018 대한스포츠의학회지 Vol.36 No.4

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.

아마추어 야구 투수에서 발생한 견갑흉곽 점액낭염

구정회 ( Jung Hoei Ku ),조형래 ( Hyung Lae Cho ),황태혁 ( Tae Hyok Hwang ),이동현 ( Dong Hyun Lee ) 대한스포츠의학회 2015 대한스포츠의학회지 Vol.33 No.2

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.

골내 침범을 동반한 견관절 석회화 건염

구정회(Jung-Hoei Ku),조형래(Hyung-Lae Cho),박만준(Man-Jun Park),김정철(Jeong-Cheol Kim) 대한견주관절의학회 2011 대한견주관절의학회지 Vol.14 No.2

목적: 골내 침범이 동반된 비전형적인 견관절 석회화 건염 1예를 보고하고자 한다. 대상 및 방법: 만성적인 좌측 견관절 동통의 급성 악화와 운동 제한을 주소로 내원한 59세 여자 환자로 단순 방사선 상 견봉하 석회 침착과 자기 공명 영상 상 감염이나 종양과 유사하게 골 피질을 침범하고 석회 물질이 골 내부로 연장되어 있었다. 관절경하 석회 제거술과 골내 석회의 소파술, 건 결손부에 봉합 나사못을 이용한 회전근 개 봉합술을 시행하였다. 결과: 환자의 급성 견관절 통증은 술 후 즉각적인 호전을 보였고 순조로운 재활 경과와 관절 운동범위의 회복을 보였다. 술 후 5개월에 촬영한 단순 방사선 상 석회 침착의 재발은 관찰되지 않았다. 결론: 견관절 석회화 건염은 주위 골조직으로 연장된 다양한 영상 소견을 나타 낼 수 있으며, 질환을 정확히 판별함으로써 불필요한 검사나 치료를 피할 수 있을 것으로 생각된다. Purpose: We present an atypical case of calcific tendinitis of the shoulder with intraosseous loculation. Materials and Methods: A 59 year-old female complained of acute exacerbation of chronic left shoulder pain and restricted range of motion. Simple radiographs showed a subacromial calcific deposit and magnetic resonance imaging revealed cortical erosion with intraosseous extension of calcific material mimicking infection or tumor. She was managed with arthroscopic excision of the calcific deposit, curettage of the intraosseous lesion and subsequent rotator cuff repair with a suture anchor. Results: Her acute pain promptly subsided. Her rehabilitation was uneventful and she gained full range of motion. Radiographs five months after the operation showed no recurrence of calcific material. Conclusion: Calcific tendinitis of the shoulder can present with a variety of images involving the adjacent bone. The correct recognition of this disorder may avoid unnecessary investigation and treatment.

소아 야구 견의 견관절 초음파 소견

구정회 ( Jung Hoei Ku ),조형래 ( Hyung Lae Cho ),진홍기 ( Hong Ki Jin ),박기봉 ( Ki Bong Park ),신명지 ( Myung Ji Shin ) 대한스포츠의학회 2016 대한스포츠의학회지 Vol.34 No.2

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.

쇄골 원위단에 발생한 골용해증

구정회(Jung Hoei Ku),김진완(Jin Wan Kim),고영철(Young Chul Ko),조형래(Hyung Lae Cho),안수한(Su Han Ahn) 대한정형외과학회 2005 대한정형외과학회지 Vol.40 No.6

쇄골 원위단의 골용해증은 드문 질환이며 그 원인이나 발병 기전에 대해서도 잘 알려져 있지 않다. 저자들은 각각 급성 및 만성 외상 후에 발생한 쇄골 원위단의 골용해증 2예를 진단하고 보존적 치료에 호전을 보이지 않아 쇄골 원위단 절제술로 치료하여 만족할 만한 결과를 얻었기에 이를 문헌 고찰과 함께 보고하며 본 증례를 통해 쇄골 원위단의 골용해증의 발병 기전과 감별 진단, 치료에 대해 검토해보고자 한다. Osteolysis of the distal clavicle is a rare disease and its etiology and pathogenesis are poorly understood. We report two cases of the osteolysis that were resulted from acute blunt shoulder trauma and chronic repetitive one. After diagnosis, the two patients did not have shown the response to conservative management, so we performed distal clavicle resection on them and the results were satisfactory. Through these cases, we discuss the pathogenic mechanism, differential diagnosis and treatment options for the osteolysis of the distal clavicle.

K-강선을 이용한 소아 전완부 골절의 경피적 경골단판 골수강 내 고정술

구정회 ( Jung Hoei Ku ),고영철 ( Young Chul Go ),박만준 ( Man Jun Park ) 대한골절학회 2006 대한골절학회지 Vol.19 No.3

목적: 소아 전완부 골절의 표준적인 치료는 비관혈적 정복 후 석고 고정이나, 때로 불만족스런 고정이나 불안정한 경우 수술적 방법이 필요하며, 수술이 필요한 동시 골절의 치료로 본원에서 시행한 K-강선을 이용한 경피적 경골단판 골수강 내 고정술에 대해 임상적, 방사선학적 결과를 보고하고자 한다. 대상 및 방법: 2001년 1월부터 2004년 12월까지 소아 전완부 골절 중에서 동시 골절 환아 18예를 대상으로 K-강선을 이용한 경피적 경골단판 골수강 내 고정술을 시행하였으며 골 유합의 시기와 최종 추시까지의 합병증 발생 유무를 분석하였다. 결과: K-강선을 이용한 골수강 내 고정술을 시행한 18예에서 평균 추시 기간은 15개월이었으며 평균 나이는 7.8세였다. 평균 골유합 시기는 6.2주 (5-7주)였으며, 불유합, 부정유합, 요척골간 골유합증 및 재골절의 소견은 보이지 않았으며, 2예에서 국소 핀 감염이 관찰되었으나 보존적 요법으로 치료되었고, 술 후 반흔이 작고 최종 추시까지 합병증은 관찰되지 않았다. 결론: K-강선을 이용한 경피적 경골단판 골수강 내 고정술은 수술이 필요한 소아의 전완부 동시 골절에서 최소 침습적인 방법으로 술후 반흔이 작고 술식이 간단하며 삽입물의 제거가 용이하다는 장점이 있어 좋은 치료 방법의 하나로 생각된다. Purpose: Although the standard treatment of diaphyseal forearm fractures in children is conservative treatment with closed reduction and cast immobilization, unstable or irreducible fractures are usually needed by surgical intervention. The aim of this article is to determine the efficacy of the percutaneous transphyseal intramedullary K-wires fixation for the forearm diaphyseal fractures in children. Materials and Methods: In this retrospective study, we reviewed 18 cases of forearm diaphyseal fractures in children, which were treated with percutaneous transphyseal intramedullary nailing using K-wires from January 2001 to December 2004. We analyzed the period for radiologic bone union and the complications until the last follow-up. Results: The average period of follow-up was 15 months with mean age of 7.8 years. The average time to bone union was 6.2 weeks and nonunion, malunion, radio-ulnar synostosis and refracture were not found, just 2 local pin site infections were seen but healed by conservative treatment. Postoperative scar was small and the complications until the last follow-up were not found. Conclusion: In the operative treatment of the forearm diaphyseal fractures in children, we think percutaneous transphyseal intramedullary K-wire fixation is one of the effective methods because of the minimal invasiveness, simplicity and easiness in removal.

경골 근위부에 발생한 Brodie 농양에서 내시경을 이용한 소파술 - 증례 보고 -

구정회,조형래,박만준,최승현,Ku, Jung-Hoei,Cho, Hyung-Lae,Park, Man-Jun,Choi, Seung-Hyun 대한관절경학회 2007 대한관절경학회지 Vol.11 No.2

Brodie 농양은 빈도가 흔하지 않고, 독성이 적은 원인균에 의해 발생하는 아급성 혹은 만성 골수염의 국소형으로 소아나 청소년의 하지 장골 특히 경골의 골간단과 골단 부위에 호발하나 성인에서도 발생할 수 있다. 수술적 치료시 병변의 위치가 근위 경골 골간단 후방에 위치한 경우 개방적 소파술로는 병소 접근이 어렵고 신경 혈관 손상 및 주위 조직 오염의 위험성이 있다. 본원 정형외과에서 48세 남자에서 발생한 경골 근위부 골간단 후방부의 Brodie 농양을 전방 십자 인대 재건술시 사용하는 표적 기구(Rigid fix system, Mitek, Johnson & Johnson, Norwood, MA)를 이용하여 병소에 손쉽고 정확하게 삽입구를 만들어 내시경 시야 하에서 염증 및 육아 조직을 제거하여 치료한 경험이 있어 이를 문헌 고찰과 함께 보고하고자 한다. Brodie abscess is a localized form of subacute or chronic osteomyelitis which is common in children but may also occur in adulthood. When Brodie abscess is located in the posterior metaphysis of the proximal tibia, open biopsy and curettage have a difficulty in approach to the lesion and can cause neurovascular injury or soft tissue contamination. We report a case wherein a novel surgical technique was used to treat a Brodie abscess in the posterior proximal tibial metaphysis in 48 year-old-male with endoscopic-assisted curettage by commercial anterior cruciate ligament targeting device(Rigid Fix; Mitek, Johnson & Johnson, Norwood, MA). Two portals were created toward the abscess site and, through each portal interchangeably, the granulation tissue and sclerotic bone could be excised. We believe that endoscopic-assisted curettage presents safe technique, decreased morbidity, accurate assessment of the extent of the abscess and possible improvement in long-term outcomes.