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Pulmonary embolism after elbow arthroscopy is extremely rare, and no cases have been reported in the literatures. We report the case of a 67-year-old woman who presented by pulmonary embolism after elbow arthroscopy for debridement of medial epicondylitis. Early detection and proper management with Heparin therapy were essential for saving this patient. Physicians must be alert to the possibility of pulmonary embolism after elective elbow arthroscopic procedures.

Background: This study aimed to compare the subscapularis muscle volume between the intact groups (group I) and supraspinatus tendon tear groups (group T) based on the sex and three different age groups.Methods: Subjects with a group I and subjects with group T without any other lesions were retrospectively evaluated from among patients who received a magnetic resonance imaging (MRI) scan between January 2011 and December 2013. The MRI scans were studied by a consultant radiologist. The subscapularis muscle volume was compared according to the age and sex; the age groups were categorized as patients in their 40s, 50s, and 60s. The volume of subscapularis muscle was measured by three-dimensional reconstructed images acquired through the axial section of 1.5T MRI.Results: No statistically significant differences were observed between subscapularis muscle volume of the group I and group T, except for male patients in their 50s (group I: 100,650 mm3 vs. group T: 106,488 mm3) and 60s (group I: 76,347 mm3 vs. group T: 99,549 mm3) (p

Medical images from hospitals consist of a 2D dataset and provide human body information as a slice. The human body has morphological structures in 3D space. To recognize real human organs, the body should be reconstructed using 2D slices to obtain its precise position and shape. In real clinical situations, doctors expend a great deal of time and effort to learn this reconstruction process. With medical 3D data, we will obtain more information about the human body, as well as more objective data from the simulation, which may contribute to more successful treatment and surgery plans. Especially, the purpose of imaging and modeling is to exact high-quality contents through various data processing from limited medical image information.

BACKGROUND: In a previous study undertaken to quantify capsular volume in rotator cuff interval or axillary pouch, significant differences were found between controls and patients with instability. However, the results obtained were derived from two-dimensional cross sectional areas. In our study, we sought correlation between three-dimensional (3D) capsular volumes, as measured by magnetic resonance arthrography (MRA), and multidirectional instability (MDI) of the shoulder.METHODS: The MRAs of 21 patients with MDI of the shoulder and 16 control cases with no instability were retrospectively reviewed. Capsular areas determined by MRA were translated into 3D volumes using 3D software Mimics ver. 16 (Materilise, Leuven, Belgium), and glenoid surface area was measured in axial and coronal MRA views. Then, the ratio between capsular volume and glenoid surface area was calculated, and evaluated with control group.RESULTS: The ratio between 3D capsular volume and glenoid surface area was significantly increased in the MDI group (3.59 ± 0.83 cm³/cm²) compared to the control group (2.53 ± 0.62 cm³/cm²) (p < 0.01).CONCLUSIONS: From these results, we could support that capsular volume enlargement play an important role in MDI of the shoulder using volume measurement.

// Wonbong Lim 1, 2, 3, * , HongMoon Sohn 1, 2, * , Youngjong Ko 1, 2 , Mineon Park 1, 2 , Bora Kim 1, 2 , Danbi Jo 4 , Jin Seok Jung 4 , Dae Hyeok Yang 5 , Jangho Kim 6 , Ok Joon Kim 7 , Donghwi Kim 1, 2 , Young Lae Moon 1, 2 , Jung-Joon Min 8 and Hoon Hyun 4 1 Department of Orthopedic Surgery, Chosun University Hospital, Gwangju 61453, South Korea 2 Laboratory of Orthopedic Research, Chosun University Hospital, Gwangju 61453, South Korea 3 Department of Premedical Program, School of Medicine, Chosun University, Gwangju 61452, South Korea 4 Department of Biomedical Sciences, Chonnam National University Medical School, Gwangju 61469, South Korea 5 Institute of Cell and Tissue Engineering, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea 6 Department of Rural and Biosystems Engineering, Chonnam National University, Gwangju 61186, South Korea 7 Department of Oral Pathology, School of Dentistry, Chonnam National University, Gwangju 61186, South Korea 8 Department of Nuclear Medicine, Chonnam National University Medical School, Gwangju 61469, South Korea * Authors contributed equally to this work Correspondence to: Hoon Hyun, email: hhyun@jnu.ac.kr Keywords: metastatic bone tumor, real-time in vivo imaging, near-infrared fluorescence, targeted fluorophore Received: July 07, 2017 Accepted: August 04, 2017 Published: August 11, 2017 ABSTRACT Tumors of the prostate or breast are particularly likely to metastasize to the bone, and early diagnosis of metastatic bone tumors is important for designing an effective treatment strategy. Imaging modalities for the detection of bone metastasis are limited, and radiation-based techniques are commonly used. Here, we investigated the efficacy of selective near-infrared (NIR) fluorescence detection of metastatic bone tumors and its role in the detection of bone metastasis in prostate and breast cancer cell lines and in a xenograft mouse model. A targeted NIR fluorophore was used to monitor metastatic bone tumors using a NIR fluorescence imaging system in real time, enabling the diagnosis of bone metastasis in vivo by providing the location of the metastatic bone tumor. The NIR fluorescence imaging technique using targeted NIR contrast agents is a potential tool for the early diagnosis of bone tumors.

최근 의료 영상 기술의 발전은 진단, 수술계획, 또는 교육에 도움이 되는 수술 시뮬레이션을 만들어 왔다. 개선된 고화질 영상과 3차원 시각화는 의료 영상 가용성을 향상시키고 수술, 교육 분야에서 더 잘 이용할 수 있게 되었다. 실제 인간의 시각은 입체이다. 따라서, 외과의사의 판단을 통해 2차원 영상을 스테레오로 재구성하여 처리하는 것이 함께 필요하다. 이러한 과정을 줄이기 위해, 3차원 (3D) 이미지가 사용되어 왔다. 3D 영상은 복잡한 상황에서 외과 의사가 매우 짧은 시간에 판단할 수 있도록 3D 시각화를 강화하여 제공한다. 3D 화상 데이터 세트에 기초하여, 가상 내시경 수술 계획, 실시간 상호 작용 가상 의료시뮬레이션이 가능하게 되었다. 본 논문은 새로운 이미징 기술의 최근 응용 프로그램을 설명하고 이의 기본과 특별히 주목할 만한 의료 3D 복원 기술에 관한 것이다. 최근 CT, MR 및 기타 영상 양식의 기술발전은 흥미로운 새로운 솔루션과 어깨 영상의 활용 가능성을 넓혀왔다. 특히, 의료 기기에서 파생 된 3차원 (3D) 이미지는 고급 정보를 제공한다. 이 프레젠테이션은 어깨와 팔꿈치의 수술실습에서 원리, 3D 영상기술의 잠재적 응용가능성, 시뮬레이션, 3D프린팅을 설명한다.

Summary Recent advances in computed tomography and magnetic resonance imaging technology have resulted in exciting new solutions and possibilities for three-dimensional (3D) imaging. Especially, 3D images derived from medical devices provide advanced information. This article describes the principles and potential applications of 3D shoulder imaging techniques to sports medicine, including kinematic imaging and surgical simulation.

Great progress has been made in standardizing 2D medical images, but the standardization of 3D medical models is still lacking. The first Web extra at http://youtu.be/J_h3Pcono7A is a video in which a shoulder muscle is rendered based on a fresh cadaver and then laid out on a computer. The pattern is then applied to a 3D model of a shoulder, with corresponding muscle layers and connections to the bones. The second Web extra at http://youtu.be/u5eVGIuhPUA is a video in which flexion and extension range of motion and movement of the upper arm are applied to a 3D model. The third Web extra http://youtu.be/wS4NPn08NKI is a video rendering showing liquid simulation for realistic virtual surgery and medical communication. The fourth Web extra at http://youtu.be/YZ5PWZyS4E0 is a video rendering showing a colon cancer surgery simulation for realistic virtual surgery and medical communication. The fifth Web extra at http://youtu.be/QN5iJhX8PQ4 is a video rendering showing an arthroscopic surgery simulation for realistic virtual surgery and medical communication.

Macrophage-colony stimulating factor (M-CSF) has been reported to be required for the proliferation and differentiation of macrophages from hematopoietic progenitor cells. Recently, recombinant M-CSF (rM-CSF) became widely used as a biological research reagent in bone marrow stimulations, vaccine development, gene therapy approaches, and stem cell mobilization. rM-CSF is a glycoprotein that activates and enhances the differentiation and survival of macrophages, which play a key role in the osteoclastogenetic response. Here, we describe the construction of the gene encoding rM-CSF, its cloning, and expression in Escherichia coli, as well as the purification of rM-CSF protein, and its activity in a biological assay in mouse bone marrow cells. Our results show that the combination of experimental strategies employed to obtain recombinant rM-CSF can yield a biologically active protein, and may be useful when scaling-up production of other biologically similar proteins.

Background and Objective Bone homeostasis is maintained by a balance between osteoblastic bone formation and osteoclastic bone resorption, where intracellular reactive oxygen species (ROS) are crucial mediators of osteoclastogenesis. Recently, low-level light therapy (LLLT), a form of laser medicine used in various clinical fields, was shown to alleviate oxidative stress by scavenging intracellular ROS. The present study aimed to investigate the impact of 635 nm irradiation from a light-emitting diode (LED) on osteoclastogenesis from receptor activator of nuclear factor kappa-B (NF-κB) ligand (RANKL)-stimulated mouse bone marrow-derived macrophages (BMMs). Study Design/Materials and Methods The effects of LED irradiation on osteoclastogenesis were assessed in tartrate-resistant acid phosphatase (TRAP), 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), cell viability, and resorption pit formation, respectively. Quantitative real-time polymerase chain reaction (qPCR) and Western blot analyses were also performed to assess mRNA expression of osteoclastogenesis-related genes and phosphorylation of extracellular signal-regulated kinase 1/2 (ERK 1/2), p38, and c-Jun-N-terminal kinase (JNK). NF-κB activity was assayed by luciferase reporter assay and Intracellular ROS generation was investigated by the 2′,7′-dichlorodihydrofluorescein diacetate (H2DCF-DA) detection method. Results LED irradiation significantly inhibited RANKL-mediated osteoclast differentiation from BMMs and mRNA expression of TRAP, osteoclast-associated immunoglobulin-like receptor (OSCAR), and dendrocyte-expressed seven-transmembrane protein (DC-STAMP). Exposure to LED light likewise significantly decreased RANKL-facilitated NF-κB activity, p38 and ERK phosphorylation and intracellular ROS generation, and increased gene expression of nuclear factor E2-related factor 2 (Nrf2). Conclusions Taken together, the results presented herein show that LED irradiation downregulates osteoclastogenesis by reducing ROS production. Therefore, LED irradiation/LLLT might be useful as an alternative, conservative approach to osteoporosis management. Lasers Surg. Med. 47:745–755, 2015. © 2015 Wiley Periodicals, Inc.

The use of platelet-rich plasma (PRP) in sports medicine is a recently developed technique in which concentrated autologous blood is used to increase the healing rate of various tissues. PRP has been most extensively used in the treatment of different musculoskeletal disorders, particularly in athletic injuries. Owing to its apparent safety and ease of preparation and administration, there has been an increased interest in the efficacy of PRP in a large number of different clinical settings. PRP has been used to treat conditions such as lateral epicondylitis, ligamentous strains, muscular strains, and fracture nonunion in athletes. PRP can be injected to the site of the pathology, either during surgery or in the physician's office. The benefits of PRP in the clinical field appear to be promising, and many investigators are still exploring new ways to use this therapy effectively. However, the clinical evidence for the benefits of PRP in the field of sports medicine is unclear. The purpose of this article was to review the current evidence on PRP therapy in this field.

Background: Although there are several methods for evaluating bone quality, Hounsfield units (HU), a standardized computed tomography (CT) attenuation coefficient, provide a useful tool for estimating focal bone mineral density (BMD). The aim of this study is to investigate the HU for evaluating the degree of osteoporosis in greater tuberosity with regard to anchor positioning. Methods: Forty patients diagnosed as normal on shoulder CT were included and categorized according to age and gender. Axially sectioned CT images were processed to 3-dimensional models containing information about bone quality using Mimics (14.11 platform v14.1.1.1 Materialise). Three-dimensional anchors were simulated and positioned according to 6 regions of interest (ROI) in the greater tuberosity classified using Tingart’s system. Mean HU of intra-anchor volumes in the 6 regions was measured. Results: A significant decrease in HU was observed with increasing age (p=0.0001) and menopause (p Conclusions: Mean HU of ROIs provides a tool for preoperative assessment of focal BMD, which is a factor of suture anchor stability and can be used to aid decision-making regarding secure anchor positioning for rotator cuff repair. Our data support that the most secure point is the proximal regions of ROI.

Lateral epicondylitis (LE) is difficult to manage and can result in significant patient morbidity. Currently, the clinical use of platelet-rich plasma (PRP) for painful tendons has received attention, but its efficacy remains controversial. This study aimed to investigate the clinical effects of PRP and its biological components. A total of 156 patients with LE were randomly divided into group 1, treated with a single injection of 2-ml autologous PRP, and group 2, treated with a control received only physical therapy without injection. Both groups used a tennis elbow strap and performed stretching and strengthening exercises during 24 weeks' follow-up. Pain and functional improvements were assessed using the visual analog scale (VAS), Modified Mayo Clinic Performance Index for the elbow, and magnetic resonance imaging (MRI). White blood cell count, platelet count, and levels of platelet-derived growth factor-AB (PDGF-AB), PDGF-BB, transforming growth factor-β (TGF-β), vascular endothelial growth factor, epithelial growth factor, and interleukin-1 β in PRP were measured and investigated for statistical correlation with the clinical score. At 24 weeks, all pain and functional variables, including VAS score, Mayo Clinic performance scores, and MRI grade, improved significantly in group 1 (p

Tumors of the prostate or breast are particularly likely to metastasize to the bone, and early diagnosis of metastatic bone tumors is important for designing an effective treatment strategy. Imaging modalities for the detection of bone metastasis are limited, and radiation-based techniques are commonly used. Here, we investigated the efficacy of selective near-infrared (NIR) fluorescence detection of metastatic bone tumors and its role in the detection of bone metastasis in prostate and breast cancer cell lines and in a xenograft mouse model. A targeted NIR fluorophore was used to monitor metastatic bone tumors using a NIR fluorescence imaging system in real time, enabling the diagnosis of bone metastasis in vivo by providing the location of the metastatic bone tumor. The NIR fluorescence imaging technique using targeted NIR contrast agents is a potential tool for the early diagnosis of bone tumors.

Head and neck squamous cell carcinoma (HNSCC) is one of the most common cancers in the world. Resistance to cytotoxic chemotherapy is a major cause of mortality in patients with HNSCC. A small subset of cancer cells called cancer stem cells (CSCs) may be key contributors to drug resistance and tumor recurrence in HNSCC. The aim of this study was to determine whether CD133, which maintains properties of CSCs, promotes chemoresistance by arresting cell cycle transition and reducing apoptosis in HNSCC cells. CD133 overexpression was examined in KB cells, and colony forming and aldehyde dehydrogenase activity assays were performed. To investigate the role of CD133 in chemoresistance, cell death was analyzed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), Diff-Quick, flow cytometry, and western blot of apoptosis-related protein expression in fluorouracil (5-FU)- or cisplatin-treated cells. In addition, microarray and related protein expression assessments were performed to investigate the mechanism of chemoresistance against 5-FU and cisplatin in KB cells. Moreover, chemoresistance against 5-FU or cisplatin in a KB-inoculated mouse model was analyzed by hematoxylin and eosin staining, immunohistochemical study of CD133, and immunofluorescence of tumor tissue. In this study, we demonstrate that ectopic overexpression of CD133 significantly promotes properties of stemness in KB cell lines. Furthermore, CD133 promotes chemoresistance by arresting transition of the cell cycle and reducing apoptosis, which results in inhibition of tumor growth in 5-FU- or cisplatin-injected mouse tumor model. Taken together, our findings show that elevated levels of CD133 lead to HNSCC chemoresistance through increased stemness and cell cycle arrest.

One of the theories regarding oral carcinogenesis is that the tumor growth is initiated from cancer stem cells (CSCs) that self-renew and give rise to differentiated tumor cells, like stem cells do in normal tissues. The most common methods of CSC identification are based on CSC marker expression in carcinogenesis. This study examined the expression of CD133 and CD44, the most commonly used CSC biomarkers in oral squamous cell sarcoma (SCC), with the goal of identifying molecular biomarkers whose expression is associated with the multistep oral carcinogenesis. The expression of CD133, CD44, proliferating cell nuclear antigen (PCNA), and Cytokeratin (CK) was examined by Western blot analysis and confirmed by immunohistochemistry in a 4-nitroquinoline 1-oxide-induced rat tongue carcinogenesis model. Also, the expression of aldehyde dehydrogenase 1 (ALDH1), OCT-4 and Nanog were investigated for alteration of cancer cell stemness by Western blot. Along with the progress of multistep carcinogenesis, there were slight increases of CD133 and CD44 expression in the dysplasia group compared with normal rats. However, CD133 protein level was significantly overexpressed in SCC. The expression of PCNA and CK were low in normal group, but sequentially increased in SCC. ALDH1, Nanog and OCT-4 expression were significantly increased according to SCC grade during carcinogenesis. The findings indicate that CD133 is useful in identifying oral CSCs, which suggests that CD133 may serve as a predictor to identify CSCs with a high risk of oral cancer development.

Orthopaedic 3D is driving major innovations in many areas, such as manufacturing, engineering, art, education and medicine (1). Especially, the orthopaedic field is greatly becoming interested in this technology with the ability to create solutions specific tailored to the patient. From the creation of 3D models that help surgeons plan operations to the fabrication of patient-specific titanium implants, 3D printing is already changing traditional musculoskeletal industry (2).

In the Visible Korean project, serially sectioned images of the pelvis were made from a female cadaver. Outlines of significant structures in the sectioned images were drawn and stacked to build surface models. To improve the accessibility and informational content of these data, a five-step process was designed and implemented. First, 154 pelvic structures were outlined with additional surface reconstruction to prepare the image data. Second, the sectioned and outlined images (in a browsing software) as well as the surface models (in a PDF file) were placed on the Visible Korean homepage in a readily-accessible format. Third, all image data were visualized with interactive elements to stimulate creative learning. Fourth, two-dimensional (2D) images and three-dimensional (3D) models were superimposed on one another to provide context and spatial information for students viewing these data. Fifth, images were designed such that structure names would be shown when the mouse pointer hovered over the 2D images or the 3D models. The state-of-the-art sectioned images, outlined images, and surface models, arranged and systematized as described in this study, will aid students in understanding the anatomy of female pelvis. The graphic data accompanied by corresponding magnetic resonance images and computed tomographs are expected to promote the production of 3D simulators for clinical practice. Anat Sci Educ 6: 316–323. © 2013 American Association of Anatomists.

No anatomical study has been conducted over Asian population to design humeral head prosthesis for the population concerned. This study was done to evaluate the accuracy of commercially available humeral head prosthetic designs, in replicating the humeral head anatomy. CT scan data of 48 patients were taken and their 3D CAD models were generated. Then, humeral head prosthetic design of a BF shoulder system produced by a standardized, commercially available company (Zimmer) was used for templating shoulder arthroplasty and the humeral head size having the perfect fit was assessed. These data were compared with the available data in the literature. All the humeral heads were perfectly matched by one of the sizes available. The average head size was 48.5 mm and the average head thickness was 23.5 mm. The results matched reasonably well with the available data in the literature. The humeral head anatomy can be recreated reasonably well by the commercially available humeral head prosthetic designs and sizes. Their dimensions are similar to that of the published literature.

Photomodulation therapy (PBMT) using light-emitting diode (LED) has been proposed as an alternative to conventional osteoporosis therapies. Our aim was to determine the effect of irradiation with a light-emitting diode on receptor activator of NF-κB ligand (RANKL)-mediated differentiation of mouse bone marrow macrophages into osteoclasts and compare it to alendronate treatment. The cells were irradiated with LED at 635±10 nm, 9-cm spot size, 5 mW/cm2, and 18 J for 60 min/day in a CO2 incubator. The differentiation of irradiated and untreated RANKL-stimulated bone marrow macrophages into osteoclasts was evaluated by tartrate-resistant acid phosphatase (TRAP) staining and by molecular methods. These included assessing messenger RNA (mRNA) expression of osteoclastic markers such as TRAP, c-Fos, Atp6v0d2, DC-STAMP, NFATc1, cathepsin K, MMP9 and OSCAR; phosphorylation of various MAPKs, including extracellular signal-regulated kinase ERK1/2, P38, and JNK; NF-κB translocation; and resorption pit formation. Results were compared to those obtained with sodium alendronate. Production of reactive oxygen species was measured by a 2’,7’-dihydrodichlorofluorescein diacetate assay. LED irradiation and alendronate inhibited mRNA expression of osteoclast-related genes, such as TRAP, c-Fos, and NFATc1, and reduced the osteoclast activity of RANKL-stimulated bone marrow macrophages. LED irradiation, but not alendronate, also inhibited the production of reactive oxygen species (ROS); phosphorylation of ERK, P38, and IκB; and NF-κB translocation. These findings suggest that LED irradiation downregulates osteoclastogenesis by ROS production; this effect could lead to reduced bone loss and may offer a new therapeutic tool for managing osteoporosis.

Purpose: To evaluate the differentiation potential of stem cells and their immunophenotype from 3 different sources. Methods: Our study involved three stem cell sources-subacromial bursal tissue, bone marrow, and umbilical cord blood. We obtained the subacromial bursal tissue and bone marrow from the patients undergoing shoulder surgery. After collecting the sample, we applied specific induction media for neurogenic, adipogenic and osteogenic differentiation. Also, flow-cytometry analysis was done to reveal the cell surface antigens. Results: We obtained 100% (8 cases) neural and adipogenic differentiation, but 62.5% (5 of 8 cases) osseous differentiation among the subacromial bursal tissue group. Bone marrow derived cells showed 100% neural (6 cases) and adipogenic (5 cases) differentiation, but 80% (4 of 5 cases) osseous differentiation. Umbilical cord blood derived cells revealed 97% (65 of 67 cases) neural, 53.7% (29 of 54 cases) adipogenic and 68.4% (39 of 57 cases) osseous differentiation. Immunophenotype analysis revealed that surface markers of bone marrow, subacromial bursal cell and umbilical cord blood derived mesenchymal stem cells are different from each other. Conclusions: Mesenchymal stem cells are potential agents in regenerative medicine and are characterized by expression of surface markers and by their differentiation potential. Our study with stem cells from subacromial bursal tissue, bone marrow and umbilical cord discovered that each stem cell has unique differentiation potential and function based on its origin. Various stem cells show multi-lineage differentiations in vitro which can be correlated to in vivo conditions.

Three-dimensional (3D) printing technologies can now be applied to biocompatible materials, cells, and supporting components. This 3D bioprinting could allow printing of artificial organs. Although this potential is far from realized, and despite the constant technical changes, 3D bioprinting has already been valuable in orthopedic applications like bone and cartilage repair, with advances in 3D modeling of defective tissue, stem cell differentiation, bioprinting technology, and innovations in printing materials. In the present study, we reviewed the recent advances in 3D bioprinting, as well as a general procedure for 3D bioprinting for bone and cartilage transplantation. In addition, we review the applications that aim to replace damaged bone and cartilage tissues, and research of in vitro tissue culture models. Potential challenges are discussed based on the present limitations and technical perspective of 3D bioprinting for bone and cartilage transplantation.

Purpose: Management of the stiff elbow by arthroscopic procedure is an effective but technically demanding. Our purpose was to review the specific arthroscopic maneuver which can be useful for the stiff elbow. Materials and Methods: A stiff elbow that is refractory to conservative treatment can be treated surgi- cally to remove soft tissue or bony blocks to motion. The olecranon or coronoid osteophyte and loose bodies have been removed arthroscopically with good results and rare complications. Results and Conclusion: For the successful arthroscopic management of elbow stiffness, it need to knowledge and skills for debride contracted tissue and preserve vital anatomic structure.

Backgrounds: Three-dimensional (3D) measurement in computer software has become increasingly popular, which uses 3D visualization instead of traditional two-dimensional (2D) viewing angle by plain X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI). The goal of this study is to introduce the 3D modeling of glenohumeral joint and a method of 3D measurement technique by using computer tool. We hope it can achieve accurate parameters by computer tool and help surgeons to choose the treatment of shoulder instability. Also, the parameters of normal shoulder can help us choose the prosthesis of both total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA). Methods: Three dimensional measurement and relative parameters of glenoid and humeral head in normal cadaver and one patient’s shoulder were evaluated with software of Mimics and Imageware, in order to choose the treatment of shoulder instability. We used the Chinese Digital Man No. 1 and Woman No. 1 as the normal cadaver and patient’s shoulder as instability modeling, which were collected and made by Southern Medical University in Guangzhou, China. Four shoulders (both shoulders of the Chinese Digital Man No. 1 and Woman No. 1) were collected from DICOM format by CT scans and three dimensional reconstructions were performed in Mimics software. Results: The parameters of normal glenoid and humeral head were the anteroposterior diameter, supra-inferior diameter, depth and curvature radius of glenoid labrum, and radius of humeral head. The Man No. 1: The left and right shoulder showed 24.66 and 23.70 mm of anteroposterior diameter, 34.70 and 33.43 mm of supra-inferior diameter, 4.05 and 4.01 mm of depth of glenoid labrum, 25.62 and 25.02 mm of curvature radius of glenoid labrum, 22.16 and 22.22 mm of radius of humeral head, respectively. The Woman No. 1: The left and right shoulder showed 20.40 and 19.96 mm of anteroposterior diameter, 29.68 and 29.35 mm of supra-inferior diameter, 2.48 and 2.34 mm of depth of glenoid labrum, 27.92 and 26.47 mm of curvature radius of glenoid labrum, 20.48 and 19.80 mm of radius of humeral head, respectively. In another case we considered a 27-year-old male with a history of shoulder recurrent dislocation in May, 2018. His CT showed he suffered from a bony bankart injury and Hill-sachs lesion. We calculated and measured the parameters of his shoulder by computer software. The length of the lesion is 31.67 mm. The radius of the circle is 11.64 mm given in the software. According to the distance between border-top and border-bottom of bankart lesion that is 21.74 mm, the area of the circle equals 425.2028 mm 2 and the area of bone loss equals 118.2855 mm 2 , for a calculated bone loss of 27.82%. The depth of the lesion is 11.13 mm. Conclusions: A 3D model can provide a more vivid vision of the glenohumeral joint. We hope that measuring parameters can be performed by using computer software tool, without manual measurement and calculated in minimum error range.

The development of three-dimensional (3D) images is causing many effects across the medical system. Other surgery departments are also working on 3D printing and simulation, but the majority of the field is the orthopedic field. Most of the medical training was done through cadaver, but with the development of 3D images, training and simulation can be conducted through virtual reality (VR). In surgery where complex and dangerous neurovascular structures are close, such as pelvic fractures, augmented reality (AR) technology may be used to minimize the risk of surgery. 3D printers allow special implants that are tailored to the individual’s characteristics rather than mass-produced implants during fracture or arthroplasty surgery. Using VR can also help the patient's rehabilitation. While there are still disadvantages of increased overall costs and verification of stability, some of the aforementioned techniques will help both patients and physicians. This document provides an overview of the 3D printing and simulation used in the orthopedics.

This study analyzed the effectiveness of suprascapular nerve block under ultrasonographic guidance in patients with perishoulder pain. Patients with perishoulder pain were enrolled in the study and were randomly divided into 2 groups. In the first group of 25 patients (12 men and 13 women), nerve block was applied under ultrasonographic guidance. Mean patient age in this group was 55.1 years. In the control group, 25 patients (11 men and 14 women) underwent nerve block without ultrasonographic guidance; mean patient age was 51.6 years. Degree of pain was assessed using a visual analog scale (VAS) and shoulder function was evaluated using the Constant shoulder score (CSS) before the nerve block, immediately following the procedure, and 1 month after the procedure. There was no statistically significant difference between the 2 groups in VAS score and CSS before the procedure ( P >.05). Immediately after the procedure, both the study and control groups revealed significantly improved VAS and CSS patterns ( P P

The purpose of this study is to evaluate the hypothesis that ultrasonographic probe-induced tenderness is a useful adjunct to the simple sonography in confirming the location of the pathology within the extensor carpi radialis brevis tendon in patients with lateral epicondylitis of the elbow. We conducted a case controlled study by evaluating 27 consecutive patients in the age group of 37-59 years (median 44) who had typical symptoms of lateral epicondylitis and a visual analogue score of more than 4 and evaluating a same number of asymptomatic healthy volunteers in the age group of 37-59 years (median 43) by means of ultrasound examination of the lateral elbow in a period of 5 months from 2007 to 2008. When we identified sonographic anechoic or hypoechoic lesions within the common extensor tendon we compressed it with the ultrasound probe to elicit tenderness so as to confirm the site of lesion within the affected tendon. We observed that the abnormal lesion detected by ultrasonography corresponded to the point of maximal tenderness when compressed by the probe in all the symptomatic patients. We therefore conclude that as it is essential to accurately detect the lesion within the extensor carpi radialis brevis for the purpose of diagnosis and treatment of lateral epicondylitis of elbow the technique of inducing tenderness at site of abnormal shadow on ultrasound within the extensor carpi radialis brevis tendon improves the accuracy of identifying the site of lesion, prevents the misinterpretation of anisotropy as pathological lesion and also can be useful to maximize the efficacy of interventions aimed in treating the lateral epicondylitis.

Till date a primary reverse total shoulderarthroplasty for the post septic sequelae of theshoulder was not reported in the literatureeven though there were a few reports aboutthe revision arthroplasty with reverse shoulderprosthesis. The authors report their experiencewith the use of the reverse shoulder prosthesisas a primary modality of treatment in a postseptic sequelae shoulder.

Twenty nine patients with unilateral ruptures of the subscapularis tendon andwho underwent arthroscopic repair between February 2001 and October 2007 were reviewed prospective-ly. All the cases were isolated tears of the subscapularis without the involvement of any other rotator cufftendon. In 19 patients the tear was localized to the superior one third, in 7 cases the tear was localized tothe upper two thirds and the entire tendon was involved in 3 cases. The mean follow up period was 12.2months (range: 6-26 months). The results of the treatment were assessed by evaluating the constant shoul-der score and the pain score before surgery and after surgery.

Purpose: These case reports have been prepared to highlight the uncommon occurrence of anterior shoulder dislocation after an epileptic seizure, the recognition of which is important as this type of injury is associated with bony lesions and a high incidence of recurrence. Materials and Methods: We report two cases of recurrent anterior dislocation of the shoulder due to grand mal epilepsy. These cases were treated as usual anterior dislocations of the shoulder, and were regularly followed to detect any recurrence of shoulder instability. Results: Outcome of the surgery in the two cases was different because of the differences in seizure control. In the patient in whom seizures were well-controlled, there was no recurrence of instability, while the patient with poorly controlled seizures developed a recurrence of the dislocation following shoulder repair. Conclusion: The authors emphasize the need to control seizures in order to prevent injury recurrence in this subset of patients.

Purpose: To evaluate the bursoscopic findings of refractory primary adhesive capsulitis of the shoulder and to determine the clinical correlation. Materials and Methods: Arthroscopic capsular release was performed in 21 refractory adhesive capsulitis patients who had not responded to conservative treatment. The VAS for pain, range of motion, UCLA score was checked before and after surgery, and at the last follow up. Results: Bursitis, mild friction and impingement on coracoacromial ligament, as well as adhesion were observed. The function and pain improved earlier than after simple acromiohumeral joint capsular release. Conclusion: Subacromial bursoscopy helps rule out a hidden secondary frozen shoulder or secondary changes with primary adhesion. In addition, it has the advantage of being both a treatment and procedure for making a prognosis.

Purpose: We wanted to evaluate the normal glenoid size of Koreans in their 7th and 8th decades by conducting Computed tomographic (CT) studies. Materials and Methods: The CT images were obtained from the normal scapulae of the patients (mean age: 68.8) who had humeral fracture. A display workstation version 2.0.73.315 was used to measure the scans to determine the maximal superoinferior (SI) and anteroposterior (AP) diameters of the glenoid vault. Results: The average diameters of curvature of the glenoid were 31.2 mm (range: 27 to 34 mm) in the superior-inferior direction and 26.1mm (range: 22 to 31mm) in the anterior-posterior direction. Conclusion: This study showed the normal glenoid size of Koreans and it is different from the size that the international literature reported. It should be an important factor for the treatment of fracture or in designing arthroplasty implants.

We developed the 4channel Light Medical Therapy Apparatus for External Injury Cure using a high brightness LED. This equipment was fabricated using a micro-controller and a high brightness LED, and designed to enable us to control light irradiation time, intensity, frequency and so on, Especially, to control the light irradiation frequency, FPGA was used, and to control the change of output value, TLC5941 was used. Control stage is divided into 4 levels by program. Consequently, the current value could be controlled by the change of level in Continue Wave(CW) and the output of a high brightness LED could be controlled stage by stage. Compared with one LED irradiation, several LEDs irradiation could increase optical power.

Shoulder arthroscopic surgeries are an accepted technique for many shoulder disease and have many advantages over open surgeries. To date, shoulder arthroscopic surgery have been rare complications that compromise patient airway, caused by the leakage of irrigation fluid out of the shoulder joint space into the surrounding soft tissues and then the neck and the pharynx. This report presents a case of life-threatening airway obstruction due to extra-articular saline collection during arthroscopic rotator cuff repair. In concluding we should hourly check the patient's neck swelling undergoing shoulder arthroscopic surgery, because anesthetized patients cannot complain of the airway problem may progress until it becomes life-threatening.

Summary There are many injuries associated with the practice of martial arts. There is a growing population of people who practice various forms of martial arts on a daily basis with improper or insufficient supervision making them prone to execute the techniques in an erroneous manner subsequently leading to injury. Fracture of the clavicle during Hapkido training has been associated directly to incorrect execution of basic techniques. During 1998-2000 twelve black belt level Hapkido athletes were reported to present mid clavicle fractures of the right limb directly associated to the erroneous execution of specific basic Hapkido maneuvers. The erroneous techniques where reproduced with healthy trained athletes under a controlled environment to analyze the error in their execution and the biomechanics correlating to the fracture of the clavicle. All the patients were diagnosed with Allman group Ib/ Robinson type 2 fracture of the dominant limb clavicle, directly associated with incorrect execution of the break falling and roll techniques. These when analyzed reproduced very accurately two distinct models of the biomechanics in the pathology of mid clavicle fractures. The two techniques described are practiced in various other styles of martial arts including Judo. These techniques serve as a precise illustration of two biomechanical models used when describing the forces that produce mid clavicle fractures. The analysis of the various techniques incorrectly done, leading to the fracture of the clavicle, represents in vivo mathematical models explaining the mechanisms of lesion. The major risk factors for injury are improper supervision and/or coaching as well as incorrect level of training of the techniques executed.

Bone homeostasis is maintained by a balance between osteoblastic bone formation and osteoclastic bone resorption, where intracellular reactive oxygen species (ROS) are crucial mediators of osteoclastogenesis. Recently, low-level light therapy (LLLT), a form of laser medicine used in various clinical fields, was shown to alleviate oxidative stress by scavenging intracellular ROS. The present study aimed to investigate the impact of 635 nm irradiation from a light-emitting diode (LED) on osteoclastogenesis from receptor activator of nuclear factor kappa-B (NF-κB) ligand (RANKL)-stimulated mouse bone marrow-derived macrophages (BMMs).The effects of LED irradiation on osteoclastogenesis were assessed in tartrate-resistant acid phosphatase (TRAP), 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), cell viability, and resorption pit formation, respectively. Quantitative real-time polymerase chain reaction (qPCR) and Western blot analyses were also performed to assess mRNA expression of osteoclastogenesis-related genes and phosphorylation of extracellular signal-regulated kinase 1/2 (ERK 1/2), p38, and c-Jun-N-terminal kinase (JNK). NF-κB activity was assayed by luciferase reporter assay and Intracellular ROS generation was investigated by the 2',7'-dichlorodihydrofluorescein diacetate (H2 DCF-DA) detection method.LED irradiation significantly inhibited RANKL-mediated osteoclast differentiation from BMMs and mRNA expression of TRAP, osteoclast-associated immunoglobulin-like receptor (OSCAR), and dendrocyte-expressed seven-transmembrane protein (DC-STAMP). Exposure to LED light likewise significantly decreased RANKL-facilitated NF-κB activity, p38 and ERK phosphorylation and intracellular ROS generation, and increased gene expression of nuclear factor E2-related factor 2 (Nrf2).Taken together, the results presented herein show that LED irradiation downregulates osteoclastogenesis by reducing ROS production. Therefore, LED irradiation/LLLT might be useful as an alternative, conservative approach to osteoporosis management.

Purpose: To demonstrate arthroscopically the presence of bilateral shoulder "mirror lesions" due to overhead work. Materials and Methods: A cross-sectional study was performed in a historical cohort of 10 male tire plant workers who underwent MRI studies of both shoulders. Bilateral intraarticular shoulder pathology was diagnosed by magnetic resonance imaging and confirmed by arthroscopy. "Mirror lesions" were defined as similar pathology between an individual patient`s two shoulders. Results: We report on ten patients who had bilateral "mirror lesions." The most common mirror lesions were tears of the rotator cuff. Most patients (7 of 10) had more than one mirror lesion in their shoulders. There were two bilateral full thickness tears involving the supraspinatus and infraspinatus, four bilateral partial thickness supraspinatus tears, six bilateral partial or upper corner lesion complete subscapularis tears, and one bilateral complete supraspinatus tear. Conclusion: Occupational overhead work with simultaneous use of both arms is associated with bilateral shoulder lesions verified by arthroscopy. By demonstrating the work-related bilateral shoulder involvement, this study suggests an etiopathogenesis for these lesions and provides rational for developing worksite prevention strategies.

An isolated tear of the subscapularis is uncommon, and there are a few literatures regarding the treatment of this problem. But, the incidence has increased with development of the arthroscopic techniques. An all-arthroscopic rotator cuff repair is a challenging procedure that can be effectively performed for treatment of subscapularis tendon tears. Often, tears of the subscapularis tendon do not involve entire tendon, and retraction of the torn edge is within to 2 cm of its attachment site. Occasionally, the entire tendon is torn and retracted medially to the glenoid. This article outlines the examination, preoperative planning and details the steps necessary to perform this procedure on upper third of subscapularis tears.